Complications on Labor and Delivery Flashcards
high risk factors/ ppppp
a. Passenger or fetus
b. Passage
c. Power or uterine contraction
d. Placenta
e. Psyche or psychologic state
Problems of Passenger
A. fetal malposition
1. occipito- posterior (OP)
2. occipito- transverse
B. fetal malpresentation
1. Vertex malpresentation
2. Breech presentation
3. Shoulder presentation
results from a poorly flexed vertex caused by a flat sacrum resulting to poorly flexed head and weak uterine contractions
occipito-posterior position
nursing care position of occipito posterior position
- side-lying
- knee-chest
- hands-and-knees
- pelvic rocking
head initially engages correctly but fails to rotate and remains in transverse position
occipito transverse position
alternatives for delivery
- if the 2nd stage is reached, the head must be manually rotated with Kielland’s forceps or delivered using vaccuum extraction
- cesarean section if there is failure of forceps delivery
3 vertex malpresentation
brow/sinciput - forehead
mentum - chin
face – face; asynclitism
buttocks or feet
* occurs in 3% of births
breech presentation
types of breech presentation
Complete
Frank
Footling
buttocks and
tightly flexed feet
complete
buttocks alone
incomplete
one foot presents – single footling
* both feet – double footling
footling
a procedure used to change the
fetal presentation by abdominal or
intrauterine manipulation
version
types of version
- external cephalic version (ECV)
- podalic version
used when the second fetus during a vaginal twin birth and only if the
twin does not descend readily or if the heart rate is non-reassuring
podalic version
breech to cephalic
presentation by external manipulation
of the maternal abdomen
external cephalic version
refers to fetal compromise that
results in a stressful and potentially
lethal condition
fetal distress
- a loop of the umbilical cord
slips down in front of the
presenting fetal part - occur at any time after the
membranes rupture if the
presenting part is not fitted firmly
into the cervix
prolapse of the umbilical cord
- refers to the feelings that
the woman brings to labor - feelings may include
apprehension and fear;
common are excitement and
wonderment - major component is the
woman’s psychological
readiness for labor
problems with the psyche
any blood loss from the
uterus greater than 500 ml
within a 24-hour period
postpartum hemorrhage
Postpartal hemorrhage within the 24 hrs
early
postpartal hemorrhage anytime after the first
24 hours during the remaining
days of the 6 week peurperium
late
uterus must remain in a contracted state after
birth to allow the open vessel at the placental
site to remain in a contracted state after birth
uterine atony
a placenta does not deliver in its entirety; fragments of
it separate and are left behind
retained placental fragments
infection of the endometrium, the lining of the
uterus
endometritis
suture line on the perineum from an
episiotomy or laceration repair
Assessment:
pain, heat, and a feeling of pressure
inflammation of suture line
wound infection
bacteria may be introduced into the bladder at
the time of catheterization
UTI
3 Postpartal Puerperal Infection
endometritis
wound infection
uti
deficiency in clotting ability caused by vascular
injury
Disseminated Intravascular Coagulation
Thromboembolic Disorders
Deep Vein thrombosis
Pulmonary embolism
formation of a clot in a deep vein
* femoral vein, popliteal vein, deep vein of the pelvis
deep vein thrombosis
a blockage of the main artery of the lung or one of its
branches
Pulmonary embolism
small lacerations or tears of the birth canal
laceration
laceration sites
- cervical
- vaginal
- perineal
vaginal mucous membrane and skin of the
perineum to the fourchette
first degree
- vagina, perineal skin, fascia,
levator ani muscle, and perineal
body
second degree
entire perineum, and
reaches the external sphincter of
the rectum
third degree
entire perineum, rectal
sphincter, and some of the mucous
membrane of the rectum
4th degree
