pROBLEM WITH POWER

Latent phase

onset of labor to 4cm dilatation

Active phase

4cm to complete

dilatation

Second stage:

From full dilatation

to birth of baby

First stage

Time span from beginning of regular contractions to complete cervical dilatation

Latent phase: NULLIPARA

ave

upper Normal

8.6 hours

20 hours

Latent phase: MULTIPARA

Ave

upper Normal

5.3

14

Active phase: Nullipara

Ave

Upper Normal

4.9 — 1.2 cm/hr

12

Active phase: multipara

Ave

Upper Normal

2.5 — 1.5 cm/hr

6 h

second stage

Full dilation to birth of baby

second stage: NULLIPARA

ave

upper normal

1

2 h without epidural, 3h with epidural

second stage: MULTIPARA

ave

upper normal

0.5

under 2 h without epidural, under 2h with epidural

placenta stage

Nullipara

Multipara

30 min

30 min

inertia

DYSFUNCTIONAL LABOR

DYSFUNCTIONAL LABOR (inertia)

Force of labor is less then usual

DYSFUNCTIONAL LABOR (inertia)

Sluggish contractions

DYSFUNCTIONAL LABOR (inertia)

Can occur at any point in labor but

classified as primary (occurring at the

onset of labor)

primary

occurring at the onset of labor

DYSFUNCTIONAL LABOR (inertia)

Causes (7)

o Primagavida

o CPD

o ROP or extension of fetal head than flexion

o Failure of uterine muscle to contract properly

o Overdistension of uterus (multiple pregnancy,

polyhydramnios, excessively oversized fetus)

o A mother exhausted from labor

o Inappropriate use of analgesia

DYSFUNCTIONAL LABOR

(Inertia)

Cause: Primagavida

DYSFUNCTIONAL LABOR

(Inertia)

Cause: CPD

DYSFUNCTIONAL LABOR

(Inertia)

Cause: ROP or extension of fetal head than flexion

DYSFUNCTIONAL LABOR

(Inertia)

cause: Failure of uterine muscle to contract properly

DYSFUNCTIONAL LABOR

(Inertia)

Cause:Overdistension of uterus (multiple pregnancy,

polyhydramnios, excessively oversized fetus)

DYSFUNCTIONAL LABOR

(Inertia)

Cause: A mother exhausted from labor

DYSFUNCTIONAL LABOR

(Inertia)

Cause: Inappropriate use of analgesia

Uterine contractions

basic force that moves the fetus through

the birth canal

1. adenosine triphosphate

2. major electrolytes

3. protein

4. epinephrine

5. norepinephrine

6. progesterone

7. prostaglandin

INEFFECTIVE UTERINE FORCE interplay of ____ and the influence of ____ and (5)

(calcium, sodium and potassium);

major

electrolytes 3

INEFFECTIVE UTERINE FORCE

▪ Interplay of adenosine triphosphate and the influence of major

electrolytes (calcium, sodium and potassium); and proteins

(action and myosin), epinephrine and norepinephrine,

progesterone and prostaglandin

1. action

2. myosin

INEFFECTIVE UTERINE FORCE proteins (2)

Dysfunctional labor occurs

▪ When they have less strength than usual or are rapid but

ineffective __ occurs

INEFFECTIVE UTERINE FORCE

When they have less strength than usual or are rapid but

ineffective====Dysfunctional labor occurs

Hypertonic Uterine Contractions

Occurs most often in Primigravidas

Hypertonic Uterine Contractions

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

Hypertonic Uterine Contractions

Contractions are ineffectual, erratic, uncoordinated, and

involve only a portion of the uterus

Hypertonic Uterine Contractions

Increase in frequency of contractions, but intensity is decreased

Hypertonic Uterine Contractions

do not bring about dilation and effacement of the cervix

Hypertonic Uterine Contractions

Most commonly seen in latent phase of labor

primigravidas

Hypertonic Uterine Contractions

occurs often in:

15mmhg

Hypertonic Uterine Contractions

resting tone increases in

Frequency in contractions

intensity

Hypertonic Uterine Contractions

increase in___

decrease in ___

latent phase of labor

Hypertonic Uterine Contractions

most commonly seen in

dilation and effacement of the cervix

Hypertonic Uterine Contractions

do not bring about (2)

Muscle fibers of the myometrium do not repolarize

(relax after contraction)

▪ More painful than usual

▪ Myometrium becomes tender from constant lack of

relaxation

▪ Results to anoxia of uterine cells

Hypertonic Uterine Contractions CAUSES (4)

Hypertonic Uterine Contractions

cause

Muscle fibers of the myometrium do not repolarize

(relax after contraction)

Hypertonic Uterine Contractions

More painful than usual

Hypertonic Uterine Contractions

Myometrium becomes tender from constant lack of

relaxation

Hypertonic Uterine Contractions

Results to anoxia of uterine cells

anoxia of uterine cells

hypertonic uterine contractions results to

repolarize

(relax after contraction)

1. PAINFUL contractions in resting tone uterine muscle

anoxia

2. Dilatation and effacement of the cervix does not

occur

3. Prolonged latent phase

4. fetal distress occur early

5. anxious and discouraged

hypertonic uterine contractions

SIGNS AND SYMPTOMS(2)

1. stay at 2 - 3 cm

2. do not dilate as should

HUC

prolonged latent phase (2)

uterine resting tone

placental perfusion

HUC

Fetal distress occurs early= high, decrease in -

Lack of relaxation between contractions

may not allow optimal uterine artery

filling

HUC

Danger

fetal anoxia

Lack of relaxation between contractions

may not allow optimal uterine artery

filling can lead to

1. comfort measure (warm shower, mouth care, imagery, music, back rub)

2. mild sedation

3. bedrest

4. hydration

5. tocolytics to reduce high uterine tone

6. cs (as needed)

HUC

treatment (6)

tocolytics

___ to reduce high uterine tone

o Decelerations in the FHR

o Abnormally long first stage of labor

o Lack of progress with pushing (second-stage arrest)

HUC

TREATMENT

▪ Cesarean Section Delivery if:(3)

(second-stage arrest

Lack of progress with pushing

HYPOTONIC UTERINE CONTRACTIONS

Number of contractions is unusually infrequent

HYPOTONIC UTERINE CONTRACTIONS

Resting tone remains less than 10 mmHg

HYPOTONIC UTERINE CONTRACTIONS

Strength of contractions does not rise above

25mmHg

1. not more than 2-3 in 10 min

2. less than 10mmHg

3. does not rise above 22mmHg

HYPOTONIC UTERINE CONTRACTIONS

1. num of contraction

2. resting tone

3. strength

the active phase of labor

o After administration of anesthesia

o Bladder or bowel distention

hypo UC

▪ Apt to occur during: (3)

length of labor

bladder or bowel distention increases

1. overstretching of the uterus

2. bowel or bladder distention preventing descent

Etiology and Pathophysiology (2)

o large baby

o multiple babies

o Polyhydramnios

o multiple parity

hypo UC

Etiology and Pathophysiology

▪ Overstretching of the uterus (4)

analgesia

Etiology and Pathophysiology

Bowel or bladder distention preventing descent excessive use of

▪ Weak contractions – become mild

▪ Infrequent (every 10 – 15 minutes +) and brief

▪ Can be easily indented with fingertip pressure at peak of

contraction

▪ Prolonged ACTIVE Phase

▪ Psychological trauma - frustrated

hypo Signs and Symptoms (5)

o Exhaustion of the mother

o Risk for postpartal hemorrhage

hypo UC

s and sx prolonged active phase (2)

1. ambulation

2. nipple stimulation

3. enema

4. amniotomy

Hypo UC

Treatment (4)

Ambulation

getting up and walking will increase contractions

Nipple Stimulation

causes release of endogenous Pitocin which can

stimulate contractions

enema

warmth of ___ may stimulate contractions

endogenous Pitocin

Nipple Stimulation

o causes release of _______ which can

stimulate contractions

Amniotomy

o artificial rupture of the membranes

✓Contractions are more similar to those of

spontaneous labor

✓Usually no risk of rupture of the uterus

✓Does not require as close surveillance

Amniotomy

o Advantages of doing this before Pitocin (3)

AROM-Cot

amniotomy finger cot for the artificial rupture of membranes

o Delivery must occur

o Increase danger of prolapse of umbilical cord

o Compression and molding of the fetal head

(caput)

Amniotomy

▪ Disadvantages (3)

caput

molding of the fetal head

▪ # 1-Check the fetal heart tones

▪ Assess color, odor, amount

▪ Provide with perineal care

▪ Monitor contractions

▪ Check temperature every 2 hours

Amniotomy - Nursing Care (5)

Pitocin

for augmentation of labor

Pitocin

Use only if CPD is not present

CPD

PITOCIN is used only when ___ is not present

Pitocin

hang as a secondary infusion, never as

primary

20 units /1000 cc fluid

Pitocin give

▪ Use only if CPD is not present

▪ Give 20 units /1000 cc fluid

▪ hang as a secondary infusion, never as

primary

Pitocin – for augmentation of labor (3)

Achieve contractions every 2 - 3 minutes of good

intensity with relaxation between

Pitocin - GOAL:

pitocin

Achieve contractions every 2 - 3 minutes of good

intensity with relaxation between

o Assess contractions--are they increasing but not

tetanic

o Assess dilation and effacement

o Monitor vital signs and FHT’s

Pitocin Nursing care (3)

Prolonged Labor

A labor lasting more than 18-24 hours

o Cervical dilation

✓Primigravida 1.2 cm / hr

✓Multigravida 1.5 cm / hr

▪ Descent

o 1 cm. / hr in primigravida

o 2 cm./ hr. in multigravida

labor NORMAL

cx and descend (Primi and Multi)

Rapid delivery

Delivery/delivery outside normal setting

Rapid delivery

Everything is OUT OF CONTROL

▪ Do NOT leave the mother alone

▪ Try to make the place clean

▪ Try to get the mother in control (Panting)

▪ Apply gentle pressure to the fetal head

nursing care for rapid delivery (4)

BANDL’S RING

PATHOLOGIC RETRACTION RINGS

BANDL’S RING

Hard band that forms across the uterus at the junction of the

upper and lower uterine segments and interferes with fetal

descent

BANDL’S RING

Usually appears during the 2nd stage of labor

BANDL’S RING

Palpated as horizontal indentation across the abdomen