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Inertia

other term for Dysfunctional Labor

• sluggish contraction

• force of labor is less than usual

• can occur at any point in labor but classified as PRIMARY (occuring at the onset of labor)

Discuss Dysfunctional Labor

Dysfunctional labor

• can occur at any point in labor but classified as PRIMARY (occuring at the onset of labor)

Primigravida
CPD

ROP or extension of fetal head other than flexion

failure of uterine muscle to contract properly

overdistention of uterus

maternal exhaustion

analgesia

what are the causes of Dysfunctional Labor

multiple pregnancy

polyhydramnios

excessively oversized fetus

What causes Overdistention of uterus in Dysfunctional Labor

Interplay of adenosine triphosphate, and influence of major electrolytes (calcium , sodium , potassium ) and proteins (actin and myosin) , epinephrine, and norepinephrine, progesterone and prostaglandin

Discuss Ineffective uterine Contraction

less strength than usual or

rapid but ineffective

When they (contractions) have ______ or are ________ ====Dysfunctional labor occurs

Uterine Contractions

basic force that moves the fetus through the birth canal

Primigravidas

Hypertonic uterine contraction occurs more often in

• marked by increase resting tone to more than 15 mmHg

• contractions are ineffectual, erratic, uncoordinated and involve only a portion of uterus

• increase in frequency of contraction, but intensity is decreased

• do not bring dilatation and effacement

• seen in Latent phase of labor

Discuss Hypertonic Uterine Contraction

Latent Phase of labor

what phase i Hypertonic Uterine contraction seen in

Hypertonic Uterine contractions

Increase in frequency of contractions, but intensity is decreased

Hypertonic uterine Contractions

Contractions are ineffectual, erratic, uncoordinated, and

involve only a portion of the uterus

Hypertonic uterine Contractions

Marked by an increase in resting tone to more than 15mmHg

muscle fibers of the myometrium do not Repolarize (relax after contraction)

Myometrium becomes tender from constant lack of relaxation

results to Anoxia of uterine cells

what are the causes of Hypertonic uterine contraction

Hypertonic Uterine Contraction

▪ Results to anoxia of uterine cells

• Painful contraction in resting tone uterine muscle

  • Anoxia causing constant cramping pain

• Dilatation and effacement does not occur ‘

• prolonged Latent Phase

  • Stay at 2-3 cm do not dilate

• Fetal Distress occur early

• Anxious and Discouraged

What are the Signs and Symptoms of Hypertonic Uteirne contraction

Hypertonic uterine contraction

• uterine resting tone is high, decreasing Placental Perfusion

Fetal distress occur early

• what condition ?

• Why?

Hypertonic uterine Contraction

Prolonged latent phase

• Stay at 2 - 3 cm

• don’t dilate as should

lack of relaxation between contraction do not allow Optimal Artery Filling can lead to Anoxia

What is the danger of Hypertonic uterine contraction

tocolytics to reduce uterine tone

Provide with Comfort Measure

• warm shower, mouth care, imagery, music, back rub

mild sedation

bedrest

hydration

cesarean delivery

What are the treatment for Hypertonic Uterine Contraction

Deceleration in FHR

Abnormally long first stage labor

Lack of progress with pushing (second-stage arrest)

Hypertonic Uterine Contraction Should be Delivered Cesarean Section if ?

Second Stage arrest

Term for : Lack of progress with pushing

number of contraction is Unusually INFREQUENT not more than 2-3 in 10 minute period

• resting tone remains less than 10 mmHg

• strength of contraction does not rise above 25 mmHg

Discuss Hypotonic Uterine Contraction

Active phase of labor

after administration of anesthesia

bladder / bowel distention

Hypotonic Uterine Contraction Apt to occur during?

increases length of labor

Why does Bladder / bowel distention causes Hypotonic UC

Overstretching of the uterus

• large baby , multiple babies, polyhydramnios, multiple parity

bowel / bladder distention preventing descent

excessive use of analgesia

Discuss the etiology and Pathophysiology of Hypotonic UC

weak contractions - becomes mild

Infrequent every 10-15 minutes and brief

easily indented with fingertip pressure at peak of contraction

prolonged Active phase

Psychological trauma - frustrated

What are the Signs and Symptoms of Hypotonic uterine Contraction?

maternal exhaustion

risk for postpartal hemorrhage

Prolonged Active Phase in Hypotonic UC can cause?

• Ambulation : increases contraction

• Nipple stimulation, release endogenous Pitocin to stimulate contractions

• Enema: stimulate contraction

• Amniotomy

Treatment for Hypotonic Uterine Contraction

amniotomy

hypotonic Uterine Contraction

artificial rupture of the membranes is called?
what condition can it be done?

• contractions are more similar to spontaneous labor

• usually no risk of rupture of uterus

• do not require close surveillance

Advantages of doing Amniotomy before Pitocin

AROM-cot

amniotomy finger cot for the artificial rupture of membranes

• delivery must occur

• increase danger for prolapse

• caput Compression and molding of the fetal head (caput)

Disadvantage of Amniotomy

caput

Compression and molding of the fetal head is known as?

check fetal heart tones

assess color odor amount

provide perineal care

monitor contraction

check temperature every 2 hours

what are the Nursing Care for Amniotomy

Pitocin

used for augmentation of labor

CPD not present

Pitocin is only used if?

20 units / 1000cc Fluid

hang as secondary infusion, never as primary

Administration of Pitocin

Pitocin

hang as secondary infusion, never as primary

Achieve contraction every 2-3 minutes with good intensity with relaxation in between

What is the goal in administering pitocin

• Assess contractions: are they increasing but not tetanic

• Assess dilation and effacement

• Monitor VS and FHTs

Nursing Care in Pitocin

Labor lasting more than 18-24 hours

Cervical Dilatation

• Primi 1.2 cm / hr

• Multi 1.5 cm / hr

Descent

Primi 1 cm / hr

Multi 2 cm / hr

Prolonged labor define

• what are the normal value for Cervical Dilatataion and Descent

delivery outside normal setting

everything is Out of Control

mom is frightened, angry, and feels cheated

Discuss Rapid Delivery

Rapid Delivery

▪ mom is frightened, angry, feels cheated

Do not leave the woman alone

try to make the place clean

try to get the mother in control (panting)

apply gentle pressure on the fetal head

Nursing for Rapid Delivery

Panting : Rapid delivery

give example for “ try to get the mother in control “ and what condition is it used

Pathologic Retraction Rings

Bandl’s ring is also termed as?

hard band that forms across the uterus at the junction of upper and lower uterine segments and interferes with fetal descent

• appears during 2nd stage of labor

• palpated as horizontal indentation across abdomen

• a Warning sign that Severe Dysfunctional labor is occurring

Discuss Bandl’s ring | pathologic Retraction tings

Bandl’s ring

A warning sign that severe dysfunctional labor is occurring

Retracted upper uterine segment

Distended lower uterine segment

Characteristic of the uterine segment in Bandl’s ring

formed by excessive retraction of upper uterine segment

if not relieved

• uterine rupture

• neurologic damage to fetus (placental stage)

• Maternal hemorrhage

Discuss the Pathophysiology of bandl’s Ring

bandl’s ring

if not relieved

• uterine rupture

• neurologic damage to fetus (placental stage)

• Maternal hemorrhage

Uncoordinated contractions (early labor)

obstetric manipulation / administration of oxytocin (pelvic division)

fetus and placenta are gripped by the retraction ring and cannot advance

what are the causes of bandl’s ring

Ultrasound

diagnostic for Bandl’s ring

IV morphine sulfate

Inhalation of Amyl nitrite

Tocolytic meds (terbutaline)

caesarean section

Manual removal of placenta (under general anesthesia)

Treatment for Bandl’s Ring

Bandl’s Ring

IV morphine sulfate

Inhalation of Amyl nitrite

Tocolytic meds (terbutaline)

caesarean section

Manual removal of placenta (under general anesthesia)

A cervical dilatation that occurs at a rate of

• 5 cm or more per hour (Primi)

• 10 cm or more (Multi)

Define Precipitate Dilatation

Uterine contractions are so strong a woman gives birth with

only a few, rapidly occurring contractions (labor completed

in fewer than 3 hours)

Define Precipitate birth

• lack of resistance from maternal tissue to passage of fetus

• Intense uterine contraction

• Small baby in a favorable position

Causes

• Multiparity

• induction of Labor by oxytocin

• Amniotomy

What are the Etiology of PRECIPITATE LABOR

What are the causes?

• If the baby delivers too fast, does not allow the cervix to dilate and efface which leads to cervical lacerations

• Uterine rupture

• Hemorrhage

• Lacerations of the birth canal

• Fetal hypoxia and fetal intracranial hemorrhage

what are the complications of Precipitate labor

Monitor progress of labor

• Active phase dilation is

  • Nullipara: 5cm | hr (1 cm / 12 minutes)

  • Multipara 10 cm / hr (1 cm / 6 minutes)

  • Tocolytics may be administered

• prepare woman with history of precipitate labor to plan

  • transportation to hospitals

  • alternative birthing center

Prevention for Precipitate labor

Induction and augmentation of labor

means Labor is started artificially

ineffective

Strengthen

When labor is __________ induction and augmentation is used to ______- them

Augmentation

Refers to assisting labor that started spontaneously but is not effective

Preeclampsia

eclampsia

Severe HTN

Diabetes

Rh Sensitization

IUGR

Prolonged Rupture of membranes

Post maturity

What are the Conditions that requires Induction ? Augmentation of labor?

Uterine rupture

premature separation of placenta

What are the Dangers of Induction / augmentation of labor?

Fetus is Longitudinal lie

Cervix is ripe / ready for birth

presenting part is the fetal head (vertex) and is engaged

no CPD

Fetus is estimated to be mature by date (over 39 weeks)

Conditions Needed Before Induction of Labor

Change in cervical Consistency from Firm to soft

What is Cervical Ripening

1. stripping / separating the membranes from the lower uterine segment manually ysing gloved finger in the cervix

2. Hygroscopic suppositories

3. insertion of prostaglandin (Dinoprostone)

what are the way to Help Ripen the cervix

• Cervical ripening

  • stripping/ separating membranes from lower uterine segment using glvoed finger

  • Hygroscopic suppositories
    Insertion of prostaglandin

• Induction of labor by Oxytocin

What are the methods of iduction / augmentation of labor

• Cervical ripening

Complications

• bleeding from undetected low lying placenta

• inadvertent rupture of membranes

• Infections if membranes rupture

Stripping the membranes or separating the membranes from

the lower uterine segment manually using gloved finger in the

cervix

• what is the goal?

• what are the possible complications

Hygroscopic Suppositories

• cervical contractions

Suppositories of seaweed that swell on contact with _____

Laminaria technique

It gradually and gently urge dilatation

Hygroscopic Suppositories

Held in place by a gauze sponges saturated with povidone-iodine or anti-fungal cream

gauze sponge ‘

providone iodine

anti-fungal cream

Hygroscopic suppositories are held in place by a _______ saturated with _________ or ___________

dinoprostone

a medication used to ripen the cervix by insertion of prostaglandin

posterior fornix of vagina, by the cervix

• if placed in the evening, ripening will occur in the mornign

where is prostaglandin / dinoprostone inserted

remain in side-lying position to prevent leak or loss of medication

what should be the position of the woman in Insertion of Prostaglandin ( dinoprostone)

Insertion of prostaglanding / dinoprostone

Woman should remain in side-lying position (prevent leak or loss of

medication)

monitor FHR

What to monitor when you inserted prostaglandin / dinoprostone to ripen the cervix?

Vomiting, fever, diarrhea, Hypertension

Side effects of Insertion of prostaglandin

Oxytocin Induction

Should be started 12 hours after prostaglandin administration

a synthetic form of naturally occurring pituitary hormone

always administered Intravenously

if hyperstimulation occurs it can be discontinued quickly

Discuss Induction of labor by Oxytocin

if hyperstimulation occurs

when is Induction of labor by oxytocin discontinued>

pituitary hormone

Synthethic oxytocin is a synthetic form of naturally occurring?

5 or more contraction in a 10 minute period

contraction lasting more than 2 minutes in duration

occurring within 60 seconds or each other

Discuss Hyperstimulation

Hyperstimulation

5 or more contractions in a 10-minute period

✓ Contractions lasting more than 2 minutes in duration

✓ Occurring within 60 seconds or each other

• left side-lying position (improve blood flow to fetus)

• IV fluid bolus ( dilute oxytocin)

• Oxygen by mask ay 8-10 liters

What is the Nursing Care for Hyperstimulation

Nursing care for hyperstimulation

• left side-lying position (improve blood flow to fetus)

• IV fluid bolus ( dilute oxytocin)

• Oxygen by mask ay 8-10 liters

10 international units in 1000 mL Lactated ringer’s solution

Oxytocin (Pitocin) commonly mixed in proportion of ?

• N/V

• Cardiac Arrythmias

• Uterine hypertonicity

• tetanic contractions

• Uterine rupture (excessive dosage)

• severe water intoxication

• Fetal Bradycardia

Possible Side Effects of Induction of Labor by Oxytocin

• prepare Iv solution by addin 1 ml (10 IU) to 1000mL of IV fluid

• use infusion pump for accurate control of infusion rate

• regulate rate

• Monitor Frequency, duration, strength of contractions

• Assess maternal pulse and blood pressure (hypotension), FHR (fetal distress)

• monitor Intake and Output

• watch out for possible water intoxication (headache and vomiting)

• Limit IV fluid to 150 ml/hr

• Prepare woman for birth

Nursing Implication for Induction of Labor by Oxytocin

• prepare

• use

• ____

• monitor
  assess

• Monitor
  watch out

• Limit

• Prepare

headache and Vomiting

• induction of labor by oxytocin

what are the signs of water intoxication

• where does it occur

8 or higher

A total score of _____ indicates that the cervix is considered ready for birth and should respond to induction

labor that occurs ater 20 weeks but before 37 weeks

etiology

• UTI

• PROM

Define premature / preterm labor

• inlcude the etiology

Stop the labor

suppress uterine activity

what is the goal in premature/ preterm labor

Drug therapy / tocolytics

• stop or arrest labor

What is the Intervention for Premature / preterm labvor

• patient in active labor (4 cm or more)

• secere pre-eclampsia

• fetal complications / fetal demise

• hemorrhage is present

• ruptured membranes

Criteria of use for Tocolytics (don’t give if?)

• Yutopar ( ritodrine )

• brethine (Terbutaline sulfate)

Examples of Tocolytics used for preterm ;labor