PROBLEMS WITH THE POWER Flashcards
- occur when labor lasts less
than 3 hours & results in
rapid birth - uterine contractions are so
strong
PRECIPITATE LABOR & BIRTH
Causes of Precipitate labor
- abnormally low
resistance in
maternal soft tissues - abnormally strong
uterine contraction
Contributing Factors of precipitate labor
- Multiparity
- large pelvis
- previous precipitate labor
- small baby in a favorable position
Signs & Symptoms of precipitate labor
- Intense pain
- Increase HR, temp., & BP
- Diaphoresis
- Restlessness
- Hypertonic contractions
Risks of Precipitous Labor
A. Maternal
* Uterine rupture
* Lacerations of the cervix, vagina, & perineum
* Postpartum hemorrhage
B. Fetal-neonatal
* Hypoxia
* Cerebral trauma
* Pneumothorax
Clinical Therapy of precipitate labor
- Close monitoring in the last few weeks
of pregnancy. - If cervix softens & begins to dilate, the
woman may be scheduled for immediate
induction of labor.
Assessment of precipitate labor
- Identify clients at increased risk
- During labor, presence of one or both of the following factors may indicate potential problems:
❖ accelerated cervical dilatation(more than 2 cm/hr in multigravida & more than 1.2 cm/hr in primigravida) & fetal descent
- During labor, presence of one or both of the following factors may indicate potential problems:
❖ intense uterine contractions w/ little uterine relaxation between contractions
- uterus has descended
from its normal position
in the pelvis farther down
into the vagina - extent of the prolapse is
determined by the location
of the cervix in the vagina
UTERINE PROLAPSE
Causes of uterine prolapse
- Pregnancy & trauma incurred during childbirth
- Loss of muscle tone
- Tumor in the pelvic cavity
- Genetics
Risk Factors of uterine prolapse
- One or more pregnancies & vaginal births
- Giving birth to a large baby
- Increasing age
- Frequent heavy lifting
- Chronic coughing
Types of uterine prolapse
- First degree (mild)
- Second degree (moderate)
- Third degree (severe)
Signs & Symptoms of uterine prolapse
- Mild uterine prolapse - no s/sx
- Moderate to severe uterine prolapse may experience the following:
❖ Sensation of heaviness or pulling in the pelvis
❖ Tissue protruding from the vagina
❖ Urinary difficulties, such as urine leakage or urge incontinence
Diagnostic Tests of uterine prolapse
- pelvic exam
- ultrasound or MRI
Therapeutic Management of uterine prolapse
Lifestyle changes
* Vaginal pessary
* Surgical repair
- A tear in the wall
of the uterus - Rupture of the uterus
during labor is rare
UTERINE RUPTURE
Causes of uterine rupture
- uterine overdistention
- external or internal version
- iatrogenic perforation
- excessive use of uterotonics
- failure to recognize labor dystocia with excessive uterine contractions against a lower uterine restriction ring
Risk Factors of uterine rupture
- prior uterine surgery including CS
- fetal malpresentation
- Grandmultiparity
- operative vaginal birth
- oxytocic induction of labor
Classifications of uterine rupture
- Complete rupture
- Incomplete rupture
Signs & Symptoms of uterine rupture
- Sudden , severe abdominal pain during a strong labor contraction, which may be reported as a “tearing’’ sensation
- Minimal to diffuse vaginal bleeding
- Concealed hemorrhage may occur in the abdominal cavity or broad ligaments, undetected until woman becomes symptomatic from hypovolemic shock
Assessment of uterine rupture
- Maternal uterine activity – contraction frequency, intensity, duration, & resting phases
- Abdomen should be assessed for signs of abdominal trauma, bruising, tenderness, pain, & rigidity
Therapeutic Management of uterine rupture
- Fluid replacement therapy
- Oxytocin
- Emergency exploratory laparotomy with cesarean
delivery - Blood transfusion
- Uterus may be either repaired or needs to be removed
▪ uterus turns inside out
with either birth of the
fetus or delivery of the
placenta
UTERINE INVERSION
Risk Factors of Uterine inversion
- Short umbilical cord
- Excessive traction on the umbilical cord
- Excessive fundal pressure
- Fundal implantation of the placenta
- Retained placenta & abnormal adherence of the placenta
- Vaginal births after previous CS
Classifications of Uterine inversion
- Incomplete inversion
- Complete inversion
- Prolapsed inversion
- Total inversion
Signs & Symptoms of Uterine inversion
- Hemorrhage
- Sudden appearance of a vaginal mass
- Fundus is not palpable in the abdomen
- show signs of blood loss – hypotension, dizziness, pallor or diaphoresis
Diagnostic Test/Procedure of Uterine inversion
- usually based on clinical s/sx
- UTZ
Therapeutic Management of Uterine inversion
- Administration of drugs to soften
uterus during reinsertion - Manual reinsertion of the uterus
- Abdominal surgery
- Antibiotics
