OB Procedures

• Hypertonic Labor

  • Often occurs in the latent phase
  • Resting tone of the myometrium increases-often with constant pain
  • Contractions are erratic with higher intensity, cx length may decrease
  • Maternal exhaustion
  • Fetal risks: fetal intolerance of labor due to decreased placental perfusion & lead to hypoxia/asphyxia
  • Nursing care: promote sleep/rest, promote relaxation, PO or IV hydration, assess FHR/UCs/vaginal exam, & administer tocolytic or pain medications as ordered
• Hypotonic Labor

  • Typically occurs in the active phase of labor
  • Less than 2-3 cxs in 10 minutes
  • Contractions may weaken in intensity/duration
  • Contractions not strong enough to result in dilation or effacement
  • Maternal risks: exhaustion and infection (if membranes ruptured)
  • Fetal risks: fetal intolerance of labor, decrease in variability or late decels
  • Nursing care: administer Pitocin, amniotomy, encourage voiding, treat dehydration, encourage position changes, evaluate FHR, limit vaginal exams
• Arrest Disorders

  • Can occur in stage 1 and in stage 2
  • Stage 1 arrest: More than 6 cm in active phase AND more than 4 hours of adequate cxs/6 hrs inadequate cxs
  • Stage 2 arrest: after 2-3 or 4 hours of pushing
• Precipitous Labor and Birth

  • Lasting less than 3 hours
  • UCs occur more frequently, longer duration, and more intense
  • Risk factors: grand multip, history of precip delivery
  • Delivery is sudden, unexpected and often unattended
  • Maternal risks: PPH, lacerations, placental abruption
  • Fetal risks: Hypoxia, CNS depression
  • Nursing care: Monitor closely STAY with pt, SVE, breathing techniques, FHR for distress, O2, IV fluids, terbutaline & GET HELP! (perform gentle counter pressure on head to control the delivery)
• Fetal (passenger) dystocia

  • OA presentation is considered favorable
  • Persistent OP or OT
  • Due to excessive size (macrosomia), multiples, and fetal anomaly
• Cephalopelvic disproportion (CPD)

  • Fetal head is larger than the pelvic diameter
  • Nursing care: position changes (squatting, turning, hands-and-knees), comfort care, monitor FHR, and prepare for instrument-assisted or C-section
• Shoulder dystocia

  • EMERGENCY!
  • Shoulders become impacted under the symphysis after the delivery of the fetal head
  • Turtle sign: retraction of the fetal head against the perineum
  • Asphyxia starts after 5 minutes
  • Nursing care: SUPRAPUBIC PRESSURE, MCROBERTS MANEUVER, midline episiotomy, empty bladder neonatal resuscitation
  • Neonatal complications: brachial plexus injury, broken clavicle, neurological injury, asphyxia and death
• Most favorable pelvic shape

  Gynecoid
• Post-term pregnancy

  • Pregnancy 42 weeks and beyond
  • NST 2-3 a week
  • AFI-oligohydramnios
  • Induction at 41 weeks or greater
  • Assess for signs of fetal distress-> deteriorating placenta
  • Post maturity syndrome
• Umbilical cord prolapse

  • Umbilical cord precedes the presenting part
  • Pressure on cord from presenting part and maternal pelvis compress the cord- FHR drops and does not recover (prolonged variable decel -> bradycardia)
  • Risk factors: breech or shoulder, not engaged in pelvis, preterm/small, multiple gestation and polyhydramnios
  • Nursing care: relieve pressure on cord ASAP (lift presenting part off cord with gloved hand), position changes (knee-chest position or elevating hips & trendelenburg position), DC oxytocin, O2, tocolytic
• Anaphylactoid syndrome (amniotic fluid embolism)

  Amniotic fluid enters into maternal circulation and causes a massive anaphylactic-like, inflammatory response to the fetal fluid/particulate
• Risk factors

  • Precipitous delivery
  • AMA
  • Placenta previa/abruption
  • Preeclampsia
  • Instrumental or C section
  • Cervical lacerations
  • Grand multipls
• Anaphylactoid syndrome is an EMERGENCY
• Causes of anaphylactoid syndrome

  1. Respiratory failure

  2. Cardiogenic shock

  3. Respiratory/cardiac arrest

  4. Uterine atony

  5. Massive hemorrhage

  6. Disseminated intravascular coagulation
• Nursing care PPH

  • Code
  • CPR
  • O2
  • IV access
  • RBCs/platelets
  • ICU
  • High mortality rate
  • Survivors typically have permanent neurological injury
• Disseminated intravascular coagulation

  • Risk factors: anaphylactoid syndrome, abruptio placenta, preeclampsia, HELLP syndrome, sepsis, PPH
  • Patho: blood clotting mechanisms inappropriately activate due to severe inflammatory response to initial event, leads to fibrin blood clot formation in small vessels and depletion of clotting factors leading to massive hemorrhage
  • Signs/symptoms: severe uterine bleeding, bleeding from IV site/incision/gums and signs of shock
• Placenta accreta

  • Chorionic villi attach directly to the myometrium
• Placenta increta

  • Myometrium is invaded by chorionic villi
• Placenta percreta

  • myometrium penetrated by chorionic villi
• Greatest risk factor for abnormal placentation 


  previous c sections
• Uterine rupture

  • Tearing of uterine muscles either complete, incomplete or dehiscence
  • Weakened uterine scar: vertical incision worst
  • VBACs
  • Mismanagement of Pitocin
  • Obstetric trauma
  • Signs: tearing sensation, vaginal bleeding, fetal compromise/loss of fetal heart tones, maternal hemorrhage, hypovolemia, and shock
• Uterine rupture nursing care

  • Notify provider
  • Monitor vitals, assess bleeding, pain
  • Administer oxygen
  • Administer IV fluids
  • Prepare for surgical repair and/or C-section
  • Administer blood
• Uterine inversion (prolapse)

  • Uterus is placed manually or surgically
  • Assess for bleeding, shock