Complications in Labor - POWER

• Inertia


  Term to denote sluggishness of contractions; force of labor that is less than usual
• Dysfunctional labor - more current term for INERTIA
• Dysfunctional labor can occur at any point of pregancy
• Types of Dysfunctional Labor;

  Primary - occurring at the onset of labor

  Secondary - occurring later in labor
• Factors that prolonged labor;

  1. Large Fetus
  2. Hypertonic contractions
  3. Hypotonic contractions
  4. Uncoordinated contractions
• Prolonged labor can result to;

  1. Postpartum Infection
  2. Hemorrhage
  3. Increase fetal mortality
• Uterine contractions - the basic force that moves the fetus from birth canal
• Uterine contractions occur because of these enzymes;

  1. ATP
  2. Electrolytes (Calcium, Sodium, Potassium)
  3. Contractile Protein (Actin, Myosin)
  4. Epinephrine and Norepinephrine
  5. Oxytocin (Posterior Pituitary Gland)
  6. Estrogen, Progesterone, Prostaglandin
• Hypotonic contractions - numbers of uterine contractions are infrequent
• Hypotonic Contractions;

  Resting - less than 10 mmHg

  Strength - less than 25 mmHg
• Hypotonic contractions occurs;

  1. Overstretched uterus
  2. large fetus
  3. polyhydramnios
  4. Uterus that is lax from multiparity
• Hypertonic contractions - more frequent uterine contractions
• Hypertonic contractions;

  Resting - greater than 15 mmHg

  Strength - similar to HYPOTONIC but occurs more frequent
• Dangers of Hypertonic;

  Lack of uterine relaxation could result to fetal anoxia due to failed artery filling
• Cesarean birth in Hypertonic contractions occurs if;

  1. Abnormally long first stage of labor
  2. Deceleration of FHR
  3. Lack of progress in pushing
• Hypotonic Contractions;

  1. Occurs in Active Phase
  2. After administration of Analgesia
• Hypertonic contractions occur in;

  1. Latent phase
  2. occurs because more than ONE uterine pacemaker is stimulating contractions
• Hypertonic contractions

  Symptoms - Painful

  Medicine Ad. - Analgesia
• Hypotonic Contractions

  Symptoms - Painless

  Medicine Ad. - Oxytocin
• Uncoordinated contractions - all contractions has no rhythm
• Steps of Contractions;

  1. Contractions sweep down the organ
  2. Encircling it
  3. Repolarization
  4. Relaxation
• Uncoordinated contractions - Oxytocin is helpful to maintain the rhythm of uterine contractions
• Dysfunctional labor at First Stage of labor

  1. Prolonged Latent stage
  2. Protracted Active Stage
  3. Prolonged deceleration stage
  4. Secondary arrest of dilation
• Pronlonged Latent Stage - when contractions are ineffective; greater than 20 hours (nullipara); 14 hours (multipart)
• Prolonged Latent Phase occurs if;

  1. cervix not ripe
  2. hypertonic contractions
• Prolonged Latent stage;

  Nursing Management;

  1. Help uterus rest
  2. Hydration
  3. Analgesia (Morphine Sulfate)
  4. Dark, quiet room
• Prolonged Latent Stage;

  If not managed, cesarean birth or amniotomy and oxytocin administration to assist labor
• Protracted Active phase - associated with fetal malposition/cephalopelvic disproportion (CPD)
• This phase (protracted active phase) is prolonged if cervical dilation is not at least;

  1.2 cm/hr - nullipara

  1.5 cm/hr - multipara
• Protracted Active phase;

  active phase last for;

  greater than 12 hrs. - nullipara

  6 hrs - multipara
• If cephalopelvic disproportion, cesarean birth is necessary
• Hypotonic labor occurs in Protracted active phase
• If no Cephalopelvic disproportion, oxytocin administration to augment labor
• Prolonged deceleration phase -becomes prolonged if it extends;

  3 hrs. - nullipara

  1 hr - multipara
• Prolonged Deceleration phase is caused by fetal head position
• Secondary arrest of dilation - if no progress of cervical dilation for longer than 2 hrs.
• Dysfunction in second stage of labor;

  1. Prolonged descent
  2. arrest of descent
• Prolonged Descent;

  less than 1 cm/hr nullipara

  2 cm/hr - multipara

  second stage last for 2 hours
• Prolonged descent - with prolonged active phase of dilation and prolonged descent; contraction are good quality and duration but then contractions become infrequent and poor quality and dilation stops.
• Prolonged descent;

  Management

  1. Amniotomy
  2. IV infusion of Oxytocin
  3. Positions (semi-fowler, kneeling, squatting) - to promote pushing