Complications related to the labor process

Prolapsed Umbilical Cord

• Occurs when umbilical cord moves through cervix/birth canal before fetus, disrupting circulation.
• Do not leave the client.
• Notify provider and get immediate assistance.
• Try inserting fingers into vagina to relieve pressure on cord and reposition (e.g., knee-chest, Trendelenburg, side-lying).
• Maintain warmth and moisture if cord is protruding.
• Continuous fetal heart rate (FHR) monitoring.
• Administer oxygen, stop Pitocin, and give intravenous fluids (IV bolus).
• Prepare for immediate birth.

Meconium-Stained Fluid

• Occurs when the newborn passes meconium (first stool) in utero.
• Document color and consistency of fluid.
• Consider possible reasons for meconium passage.
• Notify neonatal resuscitation team to be present at delivery.
• Gather necessary equipment.
• Perform suctioning protocol (assess newborn, suction mouth/nose with bulb syringe, or ET tube) as needed.
• Meconium is sterile; it is not an automatic infection concern.

Fetal Distress

• Occurs when FHR is below 110 or above 160, minimal fetal activity, or presence of decelerations.
• Notify the provider and get immediate assistance.
• Continuous FHR monitoring and maternal vital signs.
• Reposition client (e.g., left lateral).
• Administer oxygen, stop Pitocin, give intravenous fluids (IV bolus).
• Prepare for immediate birth if unable to stop fetal distress.
• Notify neonatal team for birth.

Dystocia

• Occurs during labor when difficult or abnormal labor occurs due to 5 P's (power, passage, passenger, position, psyche).
• Continuous FHR and contraction monitoring (potentially internal for accuracy).
• Consider Pitocin (oxytocin) use and other interventions for strength of contractions.
• Amniotomy (rupture of membranes).
• Positioning to aid progression, counter pressure on sacrum.
• Consider C-section if baby's size or position is a concern.
• Possible forceps or vacuum-assisted delivery.

Precipitous Labor

• Labor that takes 3 hours or less.
• Do not leave the client.
• Prepare for emergency delivery, collect equipment.
• Notify provider.
• Control urge to push to allow for slow progression.
• Do not try to stop delivery.
• Massage perineum and vaginal opening to prevent tearing.
• Assess mom and baby for trauma.
• Notify postpartum staff of precipitous labor for close monitoring.

Uterine Rupture

• Occurs when uterine wall bursts, leading to internal bleeding.
• Client reports ripping or tearing pain with extreme tenderness.
• Administer intravenous fluids (IVF) and oxygen.
• Prepare for blood product transfusions.
• Prepare for immediate cesarean section (baby may be in abdominal cavity).
• Possible hysterectomy or laparotomy to stop bleeding depending on severity.
• Treat for shock (monitor vital signs, oxygen, IVF, temperature).

Anaphylactoid Syndrome

• Also known as amniotic fluid embolism.
• Amniotic fluid enters maternal bloodstream, causing the body to react as a foreign body.
• Reports sudden chest pain or shortness of breath.
• Can progress to disseminated intravascular coagulation (DIC) with bleeding.
• Administer oxygen, intravenous fluids (IVF), blood products.
• Prepare for emergency cesarean section if necessary.
• Intubation, CPR, and resuscitation if cardiac or respiratory arrest occurs.
• High maternal morbidity rate (approximately 90%).