Chapter 16 – Complications Related to Labor PDF

- **PROLAPSED UMBILICAL CORD** - Occurs when the umbilical cord is moving through cervix/birth canal before the fetus or is displaced preventing circulation - DO NOT leave the client! - Notify the provider and call for immediate assistance - Insert fingers into...

- **PROLAPSED UMBILICAL CORD** - Occurs when the umbilical cord is moving through cervix/birth canal before the fetus or is displaced preventing circulation - DO NOT leave the client! - Notify the provider and call for immediate assistance - Insert fingers into vagina and try to alleviate pressure on the cord - Reposition (knee-chest, Trendelenburg, side lying) - If cord protruding, keep warm, moist - Continuous FHR monitoring - Oxygen, stop Pitocin, IVF bolus - Prepare for IMMEDIATE birth - **MECONIUM-STAINED FLUID** - Occurs when the newborn passes the first stool (meconium) while still in utero; may be thin (slightly greenish tinged fluid) or thick (thick jellylike chunks) - Document color and consistency and possible reason why - Notify neonatal resuscitation team to be present at delivery; gather all equipment - Suction Protocol: - Assess newborn but avoid stimulating/drying - If doing well: suction mouth and nose using bulb syringe - If not doing so well: use ET tube to suction below vocal cords (preferably before spontaneous breathing occurs - Meconium is sterile so this is NOT automatic concern for infection! - **FETAL DISTRESS** - Occurs when FHR remains below 110 or above 160; there is little to no fetal activity; or presence of/combo of late decelerations, absent or minimal variability, recurrent variable decelerations, or prolonged decelerations - Notify the provider and call for immediate assistance - Notify the provider and call for immediate assistance - Continuous FHR monitoring and maternal vital signs - Reposition client in left side-lying position (can also try other positions is no success - Administer oxygen, discontinue Pitocin, IVF bolus - Prepare client for immediate birth if unable to stop! - Notify neonatal resuscitation team to be present at birth! - **DYSTOCIA** - Occurs when labor is difficult or abnormal (5 P's) - Management will depend on cause: - Continuous FHR and contraction monitoring (may need internal for accuracy - Pitocin may be utilized to reset or strengthen contractions - Amniotomy (rupture of membranes- AROM versus SROM) - Positioning to aid in progressing and pushing; counter pressure on sacral area - Cesarean section if baby's position or size is the concern - Forceps or vacuum-assisted delivery - Pain medications or relaxation techniques - Empty the bladder - Notify the provider and provide continual updates - **PRECIPITOUS LABOR** - Occurs when labor happens in 3 hours or less - DO NOT LEAVE the client!!! EVER!!! - Prepare for emergency delivery- call for assistance, gather equipment - Notify the provider - Control the urge to push to allow slow progression - Do NOT attempt to stop the delivery! - Massage (stretch) the perineum/vaginal opening to prevent tearing - Assess mom and baby for trauma from speedy delivery - Notify postpartal nurse and baby nurse of precipitous labor for close monitoring of signs of trauma, bleeding, injury, etc - **UTERINE RUPTURE** - Occurs when the uterus ruptures (uterine wall bursts). Internal bleeding is present when this occurs. - Client reports ripping or tearing pain with extreme tenderness - Administer IVF and oxygen - Prepare to administer blood product transfusions - Prepare for IMMEDIATE cesarean section! (Baby is floating in abdominal cavity and cannot survive) - A hysterectomy or laparotomy may be needed to stop bleeding - depending on severity of rupture - Treat signs/symptoms of shock- vital signs, oxygen, IVF, temperature - **ANAPHYLACTOID SYNDROME** - AKA: amniotic fluid embolism. Occurs when there is rupture and amniotic fluid enters maternal blood stream. Mom's body recognizes this as a foreign body and treats it like a clot! - Reports sudden chest pain and/or sudden shortness of breath - Will progress to DIC with bleeding from venipuncture sites and incisions or wounds - Circulatory collapse will occur (tachycardia, hypotension, shock, cardiac arrest) - Administer oxygen, IVF bolus, blood products - Prepare for emergency cesarean section if baby not already out - Intubation, CPR, resuscitation when cardiac and respiratory arrest occur - Maternal morbidity rate approximately 90% in these cases