Chapter 16: Complications Related to the Labor Process

What is a prolapsed umbilical cord?

The umbilical cord slips below or beside the presenting fetal part, causing cord compression.

What is the greatest danger of a prolapsed umbilical cord?

Fetal hypoxia due to cord compression.

What are risk factors for a prolapsed umbilical cord?

Breech presentation, unengaged presenting part, ROM, polyhydramnios, multifetal pregnancy, and amniotomy before engagement.

What are signs of a prolapsed umbilical cord?

Visible or palpable cord, variable or prolonged decelerations, fetal bradycardia, and client reporting something protruding from the vagina.

What is the FIRST nursing action for a prolapsed umbilical cord?

Insert a sterile-gloved hand and lift the presenting part off the cord.

What positions help relieve pressure on a prolapsed umbilical cord?

Knee-chest, Trendelenburg, or modified Sims position.

Why is a warm sterile saline-soaked towel placed over a prolapsed cord?

To prevent vasospasm and maintain cord moisture.

What oxygen should be given with a prolapsed cord?

Face mask oxygen as prescribed or per protocol.

What delivery is usually required for a prolapsed cord?

Emergency cesarean birth unless vaginal birth is imminent.

What causes meconium-stained amniotic fluid?

Fetal maturity or fetal hypoxia causing relaxation of the anal sphincter.

What color is meconium-stained amniotic fluid?

Green, brown, or yellow.

What is the major newborn complication of meconium-stained fluid?

Meconium aspiration syndrome.

Which pregnancies have an increased risk of meconium-stained fluid?

Post-term pregnancies (>38 weeks), breech presentation, preeclampsia, and chorioamnionitis.

What nursing actions are required with meconium-stained fluid?

Document color, notify neonatal team, prepare resuscitation equipment, and follow NRP guidelines.

When should skin-to-skin occur with meconium-stained fluid?

Only if the newborn is vigorous and crying.

What fetal heart rate is considered nonreassuring?

Less than 110 bpm or greater than 160 bpm.

What fetal heart rate variability is concerning?

Minimal or absent variability.

Which fetal heart rate decelerations indicate fetal distress?

Late, prolonged, and recurrent variable decelerations.

What are nursing interventions for nonreassuring fetal status?

Left lateral position, stop oxytocin, increase IV fluids, administer oxygen if indicated, notify provider, and prepare for cesarean birth if needed.

What is dystocia?

Difficult or abnormal labor caused by problems with the five Ps.

What are the five Ps of labor?

Passenger, Passageway, Powers, Position, and Psychologic response.

What are common causes of dystocia?

Cephalopelvic disproportion, macrosomia, malpresentation, uterine abnormalities, maternal fatigue, dehydration, fear, and obesity.

What are findings of dystocia?

Poor cervical dilation, poor fetal descent, ineffective contractions, and ineffective pushing.

How is dystocia treated?

Position changes, ambulation, hydrotherapy, oxytocin, amniotomy, operative vaginal birth, or cesarean birth.

Which maternal position helps rotate an occiput posterior fetus?

Hands-and-knees position.

Why should laboring clients with dystocia void frequently?

To prevent bladder distention and improve fetal descent.

What is the purpose of oxytocin during dystocia?

To augment labor by strengthening contractions.

When should oxytocin NOT be used?

With hypertonic contractions.

What is precipitous labor?

Labor lasting 3 hours or less from contractions to birth.

Who is at increased risk for precipitous labor?

Multiparous clients, clients with hypertension, previous precipitous birth, cocaine use, prostaglandin induction, or oxytocin use.

What are findings of precipitous labor?

Very frequent, strong contractions with little or no uterine relaxation.

What fetal complication results from hypertonic contractions?

Reduced fetal oxygen supply.

What maternal complications can occur with precipitous labor?

Lacerations, uterine rupture, postpartum hemorrhage, and tissue trauma.

What fetal complications can occur with precipitous labor?

Intracranial hemorrhage, hypoxia, and respiratory distress.

What nursing care is provided during precipitous labor?

Do not leave the client, provide reassurance, side-lying position, prepare for rapid birth, and assess mother and newborn for trauma.

What is uterine rupture?

A complete separation of all layers of the uterine wall.

What is uterine dehiscence?

An incomplete separation of the uterine wall.

Who is at greatest risk for uterine rupture?

Clients with previous cesarean births, uterine surgery, overdistended uterus, polyhydramnios, oxytocin-induced tachysystole, or multiple gestation.

What are signs of uterine rupture?

Sudden tearing pain, fetal bradycardia, loss of fetal station, cessation of contractions, palpable fetal parts, hypotension, and shock.

What is the priority treatment for uterine rupture?

Emergency cesarean birth.

What nursing care is provided for uterine rupture?

Oxygen, IV fluids, blood products if ordered, and prepare for emergency surgery.

What is an amniotic fluid embolism?

Amniotic fluid enters the maternal circulation causing respiratory distress, cardiovascular collapse, and DIC.

When can an amniotic fluid embolism occur?

During labor, delivery, or within 30 minutes after birth.

What are risk factors for amniotic fluid embolism?

Placenta previa, placental abruption, oxytocin use, cesarean birth, forceps birth, multifetal pregnancy, polyhydramnios, and hypertensive disorders.

What are respiratory findings of an amniotic fluid embolism?

Dyspnea, cyanosis, pulmonary edema, respiratory arrest, and restlessness.

What are circulatory findings of an amniotic fluid embolism?

Hypotension, tachycardia, cardiac arrest, and shock.

What coagulation disorder commonly occurs with amniotic fluid embolism?

Disseminated intravascular coagulation (DIC).

What are signs of DIC during an amniotic fluid embolism?

Bleeding from IV sites, incisions, and uterine atony.

What nursing care is provided for an amniotic fluid embolism?

Administer oxygen, prepare for intubation, provide CPR if needed, administer IV fluids and blood products, monitor mother and fetus, and prepare for emergency cesarean birth if the fetus has not been delivered.

Which labor complication is associated with variable decelerations and a visible umbilical cord?

Prolapsed umbilical cord.

Which labor complication is associated with green amniotic fluid?

Meconium-stained amniotic fluid.

Which labor complication is associated with tearing abdominal pain and loss of fetal station?

Uterine rupture.

Which labor complication is associated with sudden dyspnea, hypotension, and DIC?

Amniotic fluid embolism.

Which labor complication is associated with labor lasting less than 3 hours?

Precipitous labor.