Labor and Delivery Complications

• Study notes on complications during labor and delivery

Premature Rupture of Membranes (PROM)

• PROM is the rupture of the amniotic sac before labor begins
• Leads to loss of amniotic fluid
• Recent sexual intercourse, incompetent cervix, and infections like gonorrhea or Chlamydia can cause PROM
• Hormonal changes may also lead to PROM
• Assessment involves checking for vaginal fluid leakage and decreased contraction intensity
• Perform a Nitrazine Paper Test for diagnosis
• Monitor fetal heart rate (FHR) for hypoxia
• Check maternal vital signs, especially temperature
• To prevent infection, avoid internal examinations
• Prepare for Cesarean Section (CS) delivery if fetal distress is present

Preterm Labor

• Labor occurring after 20 weeks but before 36-37 weeks of gestation is preterm labor
• Symptoms include regular or frequent contractions, which may or may not be painful
• Constant low or dull backache
• Belly cramps with or without diarrhea
• Feeling that the baby is pushing down
• Changes in vaginal discharge or more vaginal discharge
• Possible breaking of the bag of waters (BOW)
• Signs include premature contractions, effacement (60-80%), and dilation (2-3 cm)
• Administer tocolytics such as Ritodrine or Terbutaline
• Tocolysis is contraindicated in cases of intrauterine fetal demise, fetal anomalies, maternal hemorrhage, or severe preeclampsia/eclampsia
• Ritodrine relaxes smooth muscles but can cause tachycardia and chest pain
• Terbutaline is a Beta-2 agonist that may cause palpitations and tremors

Prolonged Labor

• Prolonged labor is labour lasting greater than 20 hours in primigravida and greater than 14 hours in multigravida
• Ineffective uterine contractions are a common cause in primigravidas
• Malpresentation, such as face or brow presentation, can lead to prolonged labor
• Cephalopelvic disproportion (CPD) is another possible cause
• Uterine atony, maternal exhaustion, or a tight nuchal/short cord may result in prolonged labor
• Monitor maternal and fetal vital signs
• Monitor for maternal exhaustion
• Provide maternal rest and hydration

Dystocia (Difficult Labor)

• Dystocia is difficult labor that arises from issues related to power, passenger, or passageway
• Power issues include hypertonic or hypotonic uterine contractions
• Passenger issues include malpresentation like breech, face, or brow, as well as macrosomia
• Passageway issues include CPD or a contracted pelvis
• Hypertonic uterine contractions are painful but ineffective
• Manage hypertonic contractions with rest, pain relief using morphine sulfate, and Cesarean section if necessary
• Hypotonic uterine contractions are weak
• Manage hypotonic contractions with oxytocin, amniotomy, and maternal repositioning

Prolapsed Umbilical Cord

• The umbilical cord slips through the cervix before the presenting part in a prolapsed umbilical cord, causing cord compression
• Risk factors include PROM, breech presentation, placenta previa, and hydramnios
• Signs include visible or felt cord in vaginal exam and fetal distress
• Relieve pressure by placing the mother in knee-chest or Trendelenburg position
• Do not push the cord back inside
• Cover the cord with sterile gauze soaked in normal saline solution (NSS)
• Perform immediate Cesarean section if the cervix is not fully dilated

Occipito-Posterior Position

• The fetal head faces the maternal spine, leading to prolonged labor
• Intense back pain and slow labor progression are signs
• Encourage position changes like squatting
• Provide back rubs and warm compresses
• Cesarean section if needed

Precipitate Labor

• Labor lasts less than 3 hours from start to finish

Placental and Cord Anomalies

• Placenta Accreta is an abnormally deep placental attachment
• Velamentous Insertion involves cord vessels spreading before reaching the placenta
• Vasa Previa involves vessels crossing the cervix, which risks fetal hemorrhage
• Management includes C-section for severe cases and hysterectomy if excessive bleeding occurs