Chapter 16 – Intrapartum Complications

What is another medical term for dysfunctional labor?

Dystocia

Which four traditional "P's" can contribute to dysfunctional labor?

Powers, Passenger, Passage, Psyche (or any combination of these)

Name two major problems of the power that can slow labor.

Ineffective uterine contractions and ineffective maternal pushing

List three maternal conditions that can lead to ineffective contractions.

Maternal fatigue, hypoglycemia, fluid-electrolyte imbalance (others: inactivity, excessive analgesia, catecholamine surge, etc.)

How does ambulation generally affect labor progress?

Ambulation helps labor progress by enhancing the effectiveness of contractions.

Define labor dystocia in one sentence.

Labor dystocia is difficult labor characterized by failure to progress because contractions are too weak or uncoordinated.

In which phase of labor does secondary arrest (halt in cervical dilation) most often occur?

Active phase

What is the first nursing priority when managing labor dystocia?

Identify the cause and promote adequate hydration, position change, and comfort.

Why is oxytocin used in labor dystocia, and what is its main fetal risk?

Oxytocin augments weak contractions; main fetal risk is reduced placental perfusion from excessive contractions.

Define uterine tachysystole.

More than 5 contractions in 10 minutes (averaged over 30 minutes) or contractions lasting ≥2 minutes, with insufficient resting tone.

What is the initial action if tachysystole occurs during an oxytocin infusion?

Decrease or discontinue the oxytocin infusion.

Which fetal condition is most threatened by uterine tachysystole?

Compromised placental perfusion leading to fetal hypoxia.

What fetal weight defines macrosomia?

Approximately > 4000 g (8 lb 8 oz).

What urgent obstetric situation is suggested by the "turtle sign"?

Shoulder dystocia

Describe McRoberts maneuver.

Maternal thighs are sharply flexed onto her abdomen to straighten the pelvic curve and free impacted shoulders.

Which maternal position change often helps an occiput-posterior fetus rotate anteriorly?

Hands-and-knees (or all-fours) position, pelvic rocking, or side-lying opposite the fetal occiput.

Why should the bladder be kept empty during labor?

A full bladder obstructs fetal descent, reduces pelvic space, and increases maternal discomfort.

At what duration is labor considered prolonged?

12 hours (active labor) or when progress falls below expected dilation/descent rates.

List two complications of prolonged labor.

Maternal or neonatal infection, maternal exhaustion (others: anxiety, fetal malposition).

Define precipitous labor.

Birth that occurs within 3 hours of labor onset.

Name two fetal complications associated with precipitous labor.

Hypoxia (due to intense contractions) and birth trauma.

During precipitous labor, what maternal position promotes fetal oxygenation?

Side-lying (left lateral)

State the temperature thresholds that satisfy the fever criterion for Triple I.

≥ 39 °C (102.2 °F) once, or 38.0–38.9 °C (100.4–102.1 °F) on two readings 30 minutes apart.

Triple I must include fever plus at least one of four additional findings. Name two.

Fetal tachycardia, maternal WBC > 15 000 (without steroids), purulent cervical discharge, cloudy/amniotic fluid with odor.

What is PROM?

Premature rupture of membranes – rupture of the amniotic sac before labor onset at any gestational age.

Differentiate PROM from PPROM.

PPROM is PROM that occurs before 37 weeks’ gestation.

Why are digital vaginal exams avoided after PROM?

To minimize introduction of infection into the uterus.

Which bedside test shows ferning to confirm membrane rupture?

Nitrazine pH or fern test on pooled vaginal fluid.

List two maternal teaching points for home care after PPROM.

No vaginal intercourse, check temperature four times daily and report ≥ 100 °F (others: avoid breast stimulation, report contractions or foul discharge).

Define preterm labor.

Labor between 20 weeks and before 37 completed weeks’ gestation.

Name two maternal medical conditions that predispose to preterm labor.

Urinary tract infection, hypertension (others: diabetes, drug use, connective-tissue disease).

What two screening tools best predict preterm birth risk?

Short cervical length on transvaginal ultrasound and positive fetal fibronectin in vaginal secretions.

What is the primary goal when tocolytics are given for preterm labor?

Delay birth long enough to administer corticosteroids for fetal lung maturity (usually 24–48 hours).

List the three physiologic criteria that must be met to continue a magnesium sulfate infusion.

Urine output ≥ 30 mL/hr, respiratory rate ≥ 12/min, deep tendon reflexes present (+1 or +2).

Which medication reverses magnesium sulfate toxicity?

Calcium gluconate IV

Give one contraindication to magnesium sulfate as a tocolytic.

Gestational age > 34 weeks, myasthenia gravis, pulmonary edema, significant vaginal bleeding, or fetal distress.

Which calcium-channel blocker is used as a tocolytic and what is a key maternal side effect?

Nifedipine; can cause postural hypotension/flushing/headache.

Why are indomethacin and ibuprofen usually limited to pregnancies <32 weeks for tocolysis?

They may cause fetal ductus arteriosus constriction, oligohydramnios, and pulmonary hypertension in later gestation.

What bronchodilator is administered subcutaneously as a beta-adrenergic tocolytic?

Terbutaline (Brethine)

Which vital sign changes warrant stopping terbutaline?

Maternal heart rate > 130 bpm, BP < 90/60, or significant arrhythmia.

What corticosteroid regimen promotes fetal lung maturity between 24–34 weeks?

Betamethasone 12 mg IM, two doses 24 hours apart (or dexamethasone 6 mg IM every 12 hrs × 4).

For what neurologic purpose is magnesium sulfate given to mothers <32 weeks in threatened preterm birth?

Neuroprotection to reduce risk of cerebral palsy.

How is post-term pregnancy defined?

Pregnancy continuing beyond 42 completed weeks.

Name two maternal risks of post-term pregnancy.

Labor dystocia, postpartum hemorrhage (others: lacerations, infection).

What is the most serious fetal risk of post-term pregnancy related to amniotic fluid volume?

Oligohydramnios leading to umbilical cord compression and hypoxia.

What antenatal test is commonly used for post-term pregnancies to assess fetal well-being?

Biophysical profile (with or without non-stress test).

Define placenta accreta.

Placental villi attach too deeply into the uterine wall without penetrating muscle.

Differentiate placenta increta from percreta.

Increta invades myometrium; percreta penetrates through uterine muscle to nearby organs (e.g., bladder).

Why is a prolapsed umbilical cord an obstetric emergency?

Cord compression rapidly cuts off fetal oxygenation.

What is the immediate nursing action when a prolapsed cord is palpated?

Relieve pressure on the cord with a gloved hand and position mother in knee-chest or Trendelenburg while calling for help.

List two classic signs of uterine rupture during labor.

Sudden abdominal pain with cessation of contractions and fetal distress or absent FHR (others: vaginal bleeding, palpable fetal parts outside uterus).

Which previous surgical history most increases risk for uterine rupture?

Previous cesarean section or other full-thickness uterine surgery.

Describe uterine inversion.

Uterus turns inside out and may protrude through the cervix or vagina, causing massive hemorrhage.

Name one common cause of uterine inversion.

Excessive traction on the umbilical cord before placental separation or vigorous fundal pressure.

Following uterine inversion, what is the immediate medical management?

Manual reposition of the uterus, often under anesthesia, and treatment of hemorrhagic shock.

After any severe intrapartum complication (e.g., inversion, rupture), how often should vital signs be taken initially?

Every 15 minutes (or per facility protocol) until stable.

For a woman who experiences uterine inversion, what delivery route is recommended in future pregnancies?

Cesarean birth