Dystocia, Labor Complications, and Management in Obstetrics

Define Dystocia

abnormal or difficult labor that is too fast or too slow, causing fetal distress

How do you resolve dystocia? WHat is it the leading cause of?

Required medical or surgical intervention, is the leading cause of cesarean deliveries

What can cause dystocia?

Problems with the 5 P's of Labor

Problems with powers ( expulsive forces), passageway( pelvis, birth canal), psych ( maternal stress), and passenger( position, fetus)

Why is an Epidural is risk factor for dystocia?

Why is an Epidural is risk factor for dystocia?

sometimes it can relax pt. enough that they can relax mentally as well, but then it's also seen that if they get one too early, it numbs too much and can slow labor progress down. This is why we don't wanna give it too early.

Why is Multiple gestation is risk factor for dystocia?

a tired uterus can't contract as well

Why is an prolong 1st stage og Labor and Maternal Exhaustion is risk factor for dystocia?

too tired too much cause it's a long time to be pushing

Why is an Nulliparty is risk factor for dystocia?

first pregnancy is harder

Why is an Short maternal stature is risk factor for dystocia?

gonna have to work harder, cause statistically it just takes longer

Why is an LGA/ post term is risk factor for dystocia?

these are big babies and so they take longer to deliver

Why is an Shoulder dystocia is risk factor for dystocia?

this kinda goes hand-in-hand w/ LGA babies cause, since the baby is so big that means the shoulders are bigger too and so it's more likely for shoulders to get stuck

Why is an Induction is risk factor for dystocia?

because you're forcing nature, pretty much, it's going to cause difficulty but also it still just leads to body exhaustion, because it still is labor that's happening AND you're just speeding it up

Why is Chorioamniotis a risk factor for dystocia?

an infection of the placenta and amniotic membranes that surround the growing baby in the uterus

Why is caffeine a risk factor for dystocia?

Caffeine can increase the frequency and intensity of uterine contractions, which could contribute to a difficult or prolonged labor

The 5 P's: Define Power

How can power be a problems associated with dysfunctional labor?

Power: The forceful pushing (involuntary and voluntary)

So if powers too slow, too little, or too much it can cause problems with labor

Power

Define Hypertonic uterine dysfunction, what causes it?

How does it affect contractions and placental perfusion?

What is the range for tachysystole?

What is the priority intervention for this?

Hypertonic uterine dysfunction

Causes: Oxytocin, fetal malpresentation

Never relaxes between contractions

Ineffective contractions, low placental perfusion

Longer latent phase, exhausted mother, and tachysystole (6 or more contractions in a 10 min period)

STOP THE PITOCIN

Power

Define Hypotonic uterine dysfunction, what causes it?

How does it affect contractions and the fundus?

What are the risk factors?

What is the highest risk after delivery?

Hypotonic uterine dysfunction

During active labor→ the uterus is tiring out from something, and its going to weakened the contractions

Weak contractions, softer fundus with contraction

Risk Factors:

Overstretching of the uterus –mutiple birhts, postdates, LGA, too much fluid

Bowel/blader→ mu distention

Excessive analgesia

Risk of hemorrhage after delivery

Explain The problems with dysfunctional Power.

Define precipitate Labor and its signs and symptoms and complications.

Problems

Precipitate Labor

Abnormally rapid

Less than 3 hours

Signs/Symptoms

Soft/stretchy tissues

Abnormally strong contractions

Complications:

Maternal anxiety

Injury

Bleeding

Fetal hypoxic injury

Trauma

The 5 P's: Define Passenger

How can Passenger be a problems associated with dysfunctional labor?

Passenger→ This describes issues with baby such as being in the wrong position

What components are included in the Passenger factor of labor?

How can vertex be unfavorable at times?

When is breeching usually stuck?

What are the risks?

How are positions corrected, What is this called? and what is monitored after?

Presentation or Position

Vertex but not flexed (face), OP

Breech

Usually stuck by 35-36 weeks→ babies are going to move around at some point but by 35-36 wks” baby is officially stuck”

Risks: Can make vaginal delivery risky due to potential for cord prolapse or head getting stuck.

External Cephalic Version (ECV)

Purpose: Turn a breech baby to head-down before labor.

Timing: 36–38 weeks (after 36 weeks to avoid preterm labor; before labor starts)

How: Done manually by the provider, often in hospital with ultrasound and fetal heart rate monitoring.

What does multiple gestations refer to?

What is the risk for babies?

Implications for a vaginal delivery? What is usually done?

WHat are the maternal risks?

Multiple Gestations (Twins or More)

More common with IVF and fertility treatments.

Risks for babies: prematurity, growth restrictions (IUGR), higher chance of needing cesarean

Vaginal delivery:

Only safe if both twins are head-down (vertex/vertex).

Usually done in OR due to potential complications.

Must monitor both fetuses closely during labor.

Maternal risks:

Uterine rupture and hemorrhage due to uterine overdistention (too stretched from multiple babies).

Describe Excessive Fetal Size. What is the name for this, and how large?

Biggest risk?

How are they delivered?

Maternal Risks?

Fetal Risks?

Defined as >4000 g (approx. 8 lb 13 oz)

Risks:

Dystocia (difficult labor, baby stuck in birth canal)

Instrument-assisted delivery may be needed (forceps, vacuum)

Scheduled C-section may be considered to prevent complications

Maternal risks:

Hemorrhage

Perineal or vaginal lacerations

Fetal risks:

Birth injuries (shoulder dystocia, fractures)

Explain Shoulder Dystocia and its causes.

Fetal Injuries?

Maternal Injuries?

Nursing Interventions?

Shoulder Dystocia

Obstruction of fetal decent of shoulders after head is delivered

Obstetric Emergency!

Why does it happen?

Large fetus, having a pelvic abmormality, or malpresentation of the bay

Fetal injury: asphyxia, brachial plexis injury, fractures

Maternal injury: hemorrhage d/t uterine atony, rupture, lacerations

Nursing care:

Call for help!

Assist with McRoberts maneuver or suprapubic pressure

No fundal pressure! Call NICU team!

The 5 P's: Define Passageway

What are the components?

Explain Cephalopelvic Disproportion (CPD)

What can be caused by these? What are these results?

Passageway

Pelvis

Pelvic inlet

Pelvic outlet

Pelvic shape

Cephalopelvic Disproportion (CPD)

Occurs when baby’s head is too large (or in a difficult position) to fit through the mother’s pelvis.

Can be caused by:

Baby’s size (LGA/macrosomia)

Pelvic shape or small pelvis

Malposition (OP, face, breech)

Result: Labor is prolonged or obstructed → leads to dystocia.

The 5 P's: Define Psyche

What are the components?

What are its impact on dystocia?

Psyche

Negative emotions

Anxiety

Fear

Helplessness

Impact on dystocia:

Uterine dysfunction

uncoordinated contractions

Pain

Surgical birth risk

What is the range for preterm labor?

20-37 weeks gestation, because if you recall anything 20-37 is considered preterm. (before 20 is considered SAB)

risk factors for preterm labor?

infection(dental and UTI usually);

Uterine anomalies(some ppl are born with heart-shaped uteruses and so the uteruses dont' work that well or some people are born with more than 1 uterus); multiple gestations; polyhydramnios (too much fluid); genetics; low socioeconomic status; ETOH/Drug usage(has to do w/ nutrition and nutrition is huge when coming to preterm labor); extreme age (very young <19 yrs or older >35);

Race;

Obesity

What is the first intervetion for someone goiong through preterm labor?

What is additionally given? Why? And When?

If someone is going through preterm labor, or having preterm labor, even if we try to delay it,

we are still gonna prophylactically give them a corticosteroid called Betamethasone, because it will help with inc. the surfactant production. Typically this steroid is given to the mom between 24-34 wks

What subjective risks factors are present in preterm labor?

What is the range for tachysystole?

Risk factors

Subjective:

Change in Discharge or spotting

ROM

Pelvic pressure→ a real quick heaviness

Backache, cramps, GI

Heaviness or aching in the thighs

Uterine contractions with or without pain

tachysystole: 6+ contractions per hour

*contractions may nt be obvious

diagnostic tests used to assess preterm labor risk?

Explain FFN, how is it detected?

Explain the timing significance (when is it ok to be detected and when is it not)

1. CBC: To detect infection or anemia

2. Urinalysis (UA): check for UTI.

3. Amniotic Fluid Analysis: assess for infection, rupture of membranes, or fetal lung maturity.

Amniotic fluid culture: Detects infection (chorioamnionitis).

4. Fetal Fibronectin (FFN) Test: A screening test to predict risk of preterm delivery.

What it is:

FFN is a glycoprotein produced by the chorion (outer fetal membrane).

It acts as a “biological glue” that helps the membranes stick to the uterine lining.

Mechanism:

When the connection between the uterus and membranes begins to break down (like with contractions or inflammation), FFN leaks into vaginal secretions.

Timing significance:

Normally present early in pregnancy (up to ~23 weeks) and again near term (~37+ weeks).

Should not be detected between 24–34 weeks.

What is a Diagnostic Test fpr preterm labor?

Cervical length measurement (U/S)

Good predictor after 16 weeks

If cervical length >30mm = no delivery in 2 weeks

contraindications for Tocolytic

contraindications for Tocolytic medications are: if there is placental abruption(when placenta separates from uterine wall); fetal distress(if the fetus is having respiratory distress, we don't wanna get the baby out and instead we'd wanna keep the baby in);

Preeclampsia/Eclampsia;

any dilation >6cm(because there's no point in stopping it if they're already in the active phase of labor); maternal instability (if the mom isn't stable you wouldn't wanna let them deliver the baby just yet.)

How can you Prevent pretem labor?

avoid long distance traveling, strain, infections and have good nutrition/weight management

What are signs of preterm labor?

Contraction pattern frequency

Leaking Backache

GI issues

Pelvic pressure

placenta previa

attached to lower uterine segment

all pts need c section,

if a patient has painless bleeding, what is the most likely diagnosis?

placenta previa

If a patient has painful bleeding, it is most likely

placental abruption

Risk factors for placental abruption?

Risk factors

Illicit drugs (cocaine) --> is a big ole stimulant

Trauma → car accidents, intimate partner violence

HTN

Smoking

Intervention for placental abruption?

Depends of gestation and severity

monitor moms cvs

Prompt delivery of fetus needs to be done

C-sections will be done if the baby is still alive and vaginal births will be done if the fetus has passed in the womb

symptoms: board like abdomen and pain

Explain Uterine Rupture

what main fetal symtom?

risk factors?

emergency, needs c-section

bradycardia

Interventions for PROM?

For PPROM?

infection risk, induce labor

PPROM: no vag exams, antibiotics/steroids, monitor

cannot use labetalol if pt has what respiratory condition?

asthma

physiologic jaundice occurs when?

What is it from?

Immature liver enzymes, occurs After 24 hours. Formula feeding can worsen this

ABO incompatibility shows up in first 24 hours

increasing pain with low bp and bleeding is indicative of what?

hematoma

explain frequency of assessment for pph

q 15 min for the first hour

q 30 mins for the second hour

q 4 hours after for first 24 hours

explain medications for pph

Oxytocin first

TXA (antifibrilytic) , a upportive medication given in the first 3 hourss; prevents breakdown of clots, then methergine - uterotonic, but watch BP, the carbo (hemabate) - another utero, then misoprostol - expulsion of everything

last resort = carbo (hemabate) strongest

Why is carbo (hemabate), the uterotonic, not used for asthma patients?

contraindicated, can cause bronchspams

In PPH, when we transfuse fluids, we should also get a lab test for what??

Why should be not give fluids until that lab test is done?

Type screen for blood compatibility. Check CBC the morning og

Fluids can dilute blood, messing up results

explain diff severities of blood loss

mild: body will attempt to prioritize, will cause diaphorsis, sweating, fast HR, and small droop in BP

moderate, prioritize center and not limbs, will cause skin changes, olliguria,

severe: hypotension <90, 50% blood loss, instable

Why do we not check homans sign during a DVT check

can dislodge clot, test itself is unreliable

when does pp blues resolve?

when does negative emotions and sysmptoms have to persist for until itsconsidered ppd?

By 2 weeks

After 2 week, with symptoms persistant and worsening

How do we assess post partum depressum

what number indicates depression?

What happens if the score is Greater than 13?

Edinburgh Postnatal Depression Scale (EPDS)

~7

call social services

TTN happens to preterm or term babies. Whats the range for respirations? interventions?

What about respiratory distress syndrome?

Term, >60 RR, withold feedings to avoid respirations

Cyanotic and tachypnea, only in PRETERM babies,

What test is given for ABO incompatibility?

What 3 things do you look at when assessing for bilirubin

COOMBS test

CBC, reticulocyte

5. Which factors increase newborn's risk for hyperbilirubinemia?

LGA, immature liver, rh incompatibility

Most significant assessment and findings for mild preeclampisa

140/90 BP, facial swelling, edemia, 2+ reflexes, check weight (for edema) and hyperflexion (toes flexing) clonus,

What labs will the nurse anticpate for preeclampsia

CBC, BUN, AST, ALS, UA

What is the only treatment for preeclampsia?

Delivery

Why is magnesium sulfate given for preeclmapsia?

For seizure control

Explain Mag sul toxicity, and sude effects

no deep tendon reflexes, RR <12, Lethargic, low urine output

flushing, nausea

Management for MILD preeclampsia?

bed rest, BP, and fetal kick counts

Management for SEVERE preeclampsia?

Hospitalization

Mag sulf, antihypertensives, oxytocin for induction of labor

What is HELLP

Pre-eclampsia complication

Hemolysis, elevated liver enzymes, low platelets

Hemolysis (H):

Red blood cells are destroyed as they pass through constricted and damaged blood vessels caused by vasospasms.

This leads to anemia, increased bilirubin, and decreased hemoglobin.

Elevated Liver Enzymes (EL):

Vasospasm decreases blood flow to the liver, causing ischemia and tissue damage.

Liver cells break down, releasing AST and ALT, which become elevated.

The liver may become swollen or tender (RUQ pain).

Low Platelets (LP):

Platelets are used up trying to repair damaged endothelium.

This leads to thrombocytopenia and can trigger DIC (Disseminated Intravascular Coagulation).