High-Risk Pregnancy Intrapartum Notes

High-Risk Pregnancy Intrapartum Powerpoint Notes

• Dysfunctional Labor: Also known as "inertia," it denotes sluggish uterine contractions.

• Classification: Primary (occurring at the onset of labor) or secondary (occurring later in labor).

• Uterine Contractions:

  • Normal: Interval 2-2 1/2, Duration 30-90 seconds, Intensity 40-50 mmHg.
  • Hypertonic: Interval <2, Duration asynchronous, Intensity >50 mmHg.
  • Hypotonic: Interval >5, Duration synchronous, Intensity <30 mmHg.

• Hypotonic Uterine Contractions (Etiology):

  • Contractions: Not more than 2 or 3 in a 10-minute period.
  • Resting Tone: Less than 10 mmHg.
  • Strength of contractions: does not rise above 25 mmHg.
  • Labor Phase: Active.
  • Symptom: Painless.

• Hypotonic Contraction Management:

  • Oxytocin: Given as a piggyback.
  • Monitor uterine contractions and FHR every 15 minutes.
  • Keep Magnesium sulfate at bedside if uterine tetany occurs.
  • Side Effects: Hypotension, dizziness, nausea/vomiting, tachycardia, fetal tachycardia or bradycardia, hypertonic contractions, decreased urine output.

• Hypertonic Contractions:

  • Resting Tone: More than 15 mmHg.
  • Frequent, prolonged contractions that are not productive.
  • Labor Phase: Latent.
  • Symptom: Painful.
  • Cause: Muscle fibers of the myometrium do not repolarize or relax after a contraction, preventing the acceptance of a new pacemaker stimulus.

• Hypertonic Contraction Management:

  • Treatment with intact membranes.
  • Rest., Hydration, Sedatives.
  • Tocolytics.

• Comparison of Hypertonic and Hypotonic Contractions:

  • Hypertonic: Latent phase, painful, unfavorable to oxytocin, helpful to sedation.
  • Hypotonic: Active phase, limited pain, favorable to oxytocin, little value to sedation.

• Uterine Dyssynchrony: Uncoordinated contractions, acting independently of the pacemaker, can interfere with blood supply to the placenta.

• Dysfunctional Labor (1st Stage):

  • Prolonged latent phase.
  • Protracted active phase.
  • Prolonged deceleration phase.
  • Secondary arrest of dilation.

• Lengths of Labor Phases (Table): Provides average time frames for nulliparous and multiparous women for latent phase, active phase, second stage, and placenta stage.

• Prolonged Latent Phase: Latent phase lasting >20 hours (nulliparous) or >14 hours (multiparous).

  • Causes: Unripe cervix, excessive analgesia, excessive tocolytics, pain relief.
  • Management: Supportive care, decrease stimulation, amniotomy, oxytocin, C-section.

• Protracted Active Phase: Cervical dilation <1.2 cm/hr (nulliparous) or <1.5 cm/hr (multiparous) in duration >12 hours (primi) or 6 hrs(multi).

  • Causes: Fetal malposition, CPD, ineffective myometrial activity.
  • Management: C-section, oxytocin.

• Prolonged Deceleration Phase: Descent exceeding 3 hrs (nulliparous) or 1 hr (multiparous).

  • Causes: Fetal head malposition.
  • Management: C-section.

• Secondary Arrest of Dilation: No progress in cervical dilation >2 hours.

  • Management: C-section.

• Complications with Power (graphs): Illustrates normal and abnormal patterns of labor progression showing cervical dilation and station over the time.

• 2nd Stage Dysfunctional Labor (Prolonged Descent & Arrest of Descent):

  • Prolonged Descent: Descent <1 cm/hr (nullipara), <2 cm/hr (multipara).
  • Arrest of Descent: No descent for 2 hrs (nullipara); 1 hr (multipara).

• Management: Oxytocin, amniotomy, positioning, C-section (trial labor).

• Precipitate Labor: Strong, few, rapidly occurring uterine contractions, delivery completed in <3 hours, Cervical dilation 5 cm/hr (primi) or 10 cm/hr (multi).

  • Risks: Premature placental separation, cervical/perineal lacerations, fetal head injury.
  • Management: Tocolytics, sedatives, pain relief.

• Induction and Augmentation: Procedures to initiate or accelerate labor.

• Cervical Ripening: The process of preparing the cervix for dilation before labor. Includes information on dilation, effacement percentages, station, consistency, and position.

• Oxytocin: A hormone used to induce or augment labor.

• Uterine Rupture: Rare complication (5% maternal deaths), caused by contributing factors.

  • Contributing Factors: Pathologic retraction ring, S/Sx of shock, FHT absent.
  • Clinical Findings: Classic C-section, prolonged labor, multiple pregnancy, traumatic labor.
  • Management: Emergency laparotomy/Hysterectomy, fluid, blood transfusion.

• Inversion of the Uterus: Uterus turning inside out.

  • Clinical Findings: Fundus may protrude from vagina, fundus not palpable, S/Sx of shock.
  • Management: Do not replace the uterus/placenta. If necessary, hysterectomy, oxytocin.

• Amniotic Fluid Embolism: Amniotic fluid entering the maternal circulation, potentially fatal if not treated.

  • Causes: Meconium, fetal sheds, oxytocin administration, PROM, hydramnios, abruptio placentae.
  • Clinical Findings: Chest pain, dyspnea, cyanosis, pulmonary artery HTN, DIC.
  • Management: Intubation/MV, CPR, ICU admission.