Comprehensive Obstetric Labor and Delivery Complications Guide

Dystocia

Abnormal labor progress due to problems with powers (contractions), passenger (fetal size/presentation), or pelvis.

Complications of Dystocia

Maternal exhaustion, infection, hemorrhage; fetal intolerance, hypoxia.

Labor Induction

Stimulation of contractions before spontaneous onset.

Indications for Labor Induction

GHTN, preeclampsia, PROM, fetal compromise.

Contraindications for Labor Induction

Previa, transverse lie, prior classical C/S, herpes.

Methods of Induction

Membrane stripping, amniotomy, cervical ripening (mechanical: balloon, laminaria; pharmacologic: Cervidil, Cytotec), oxytocin infusion.

Oxytocin Risks

Tachysystole, uterine rupture, water intoxication, failed induction.

Tachysystole

>5 contractions in 10 min; risks: fetal hypoxia, acidosis, uterine rupture.

Nursing for Tachysystole

Stop oxytocin, reposition, O₂, IVF, tocolytics if needed.

Precipitous Labor

Labor <3 hrs; risks: maternal hemorrhage, lacerations; neonatal hypoxia, CNS depression.

Operative Vaginal Birth

Assisted delivery with vacuum or forceps.

Risks of Operative Vaginal Birth

Maternal lacerations, neonatal scalp/facial trauma.

Shoulder Dystocia

Obstructed shoulder after head delivered; turtle sign.

Management of Shoulder Dystocia

McRoberts, suprapubic pressure, maneuvers. No fundal pressure.

Prolapsed Cord

Cord slips past presenting part; emergency C/S.

Nursing for Prolapsed Cord

Elevate presenting part, Trendelenburg/knee-chest, O₂, IV fluids, prep OR.

Uterine Rupture

Sudden tearing pain, bleeding, abnormal FHR, maternal shock.

Nursing for Uterine Rupture

Stabilize hemodynamics, prep for emergency C/S.

Amniotic Fluid Embolism

Sudden collapse with respiratory distress, hypotension, DIC.

Nursing for Amniotic Fluid Embolism

Activate code, O₂, IV fluids, blood products, emergent delivery.

IUFD

Stillbirth after 20 wks.

Risks for IUFD

AMA, obesity, HTN, diabetes.

Care for IUFD

Induction, emotional support, memory-making.

Chorioamnionitis

Infection of membranes.

S/S of Chorioamnionitis

Fever, tachycardia, foul fluid.

Nursing for Chorioamnionitis

Antibiotics, monitor vitals, FHR.

Meconium-Stained Fluid

Fetal stool in amniotic fluid.

Risks of Meconium-Stained Fluid

Aspiration.

Nursing for Meconium-Stained Fluid

Alert neonatal team, prepare resuscitation.

Vasa Previa

Fetal vessels implant in membranes → bleeding with ROM.

Cesarean Birth

Surgical delivery of fetus through abdomen & uterus.

Indications for Cesarean Birth

Previa, malpresentation, prior C/S, fetal distress, CPD, macrosomia, maternal request.

Pre-Op C/S Care

Labs, anesthesia consult, NPO, prophylactic antibiotics, consent, IV fluids, FHTs, SCDs, aspiration meds.

Intra-Op C/S Care

Time-out, anesthesia, catheter, antiseptic prep, support person, monitor blood loss, administer oxytocin.

Post-Op C/S Care

Pain management, wound checks, diet progression, ambulation, TCDB, infection prevention, breastfeeding support.

C/S Complications

Hemorrhage, infection, thromboembolism, bladder injury, anesthesia issues.

Prevention of C/S Complications

Antibiotics, ambulation, wound care, SCDs.

Discharge Education after C/S

Wound care, infection/hemorrhage warning signs, pain management, activity limits, emotional support, contraception, follow-up.