problem with power

• Hypotonic Uterine Contractions


  Weak and infrequent contractions which are insufficient to dilate the cervix
• Hypotonic Uterine Contractions


  • Usually occur during active phase
• Causes of Hypotonic Uterine Contractions


  • overdistention of the uterus
  • malpresentation and malposition
  • pelvic bone contraction
  • unripe or rigid cervix
  • congenital abnormalities of the uterus
  • unknown causes

  
• Complications of Hypotonic Uterine Contractions

  • postpartum hemorrhage
  • fetal distress and death
  • maternal exhaustion
  • maternal and fetal infection
• Management of Hypotonic Uterine Contractions

  1. Rule out fetopelvic disproportion

  2. Amniotomy

  3. Augmentation

  4. Ceasrean section if with CPD
• Hypertonic Uterine Contractions


  • Usually encountered in the latent phase
  • Too frequent but uncoordinated
  • No complete relaxation in between contractions
  • Too painful contractions but ineffective and out of proportion to their intensity
• Management of Hypertonic Uterine Contractions

  1. Evaluate pelvic size

  2. Maintain fluid and electrolyte balance

  3. Therapeutic rest

  4. Empty bladder

  5. Side lying position

  6. Watch out for danger signals

  
• Precipitate Labor

  Labor that occurs within 3 hours from onset of contraction to delivery of baby
• Predisposing Factors for Precipitate Labor

  • Multiparity
  • Large pelvis
  • lax unresistant maternal tissue
  • Small baby in good position
  • Induction of labor: amniotomy, oxytocin
  • Absence of painful sensation
• Complications of Precipitate Labor

  • Maternal: laceration of birth canal, uterine rupture, postpartum hemorrhage, amniotic fluid embolism
  • Fetal: hypoxia, intracranial hemorrhage, Erb-Ducheanne Palsy, Premature separation of placenta, Injuries
• Management of Precipitate Labor

  1. Proper appraisal of multiparous women

  2. Warn women with previous history

  3. Stop oxytocin infusion

  4. Never hold baby back

  5. Pant then push

  6. If with unavailable supply, do not cut cord

  7. Rub soles if baby does not cry spontaneously

  8. Check mother and baby for injuries
• Types of Arrest Disorders

  • prolonged deceleration phase
  • arrest of dilatation
  • arrest of descent
  • failure of descent
• Causes of Arrest Disorders

  • excessive sedation
  • conduction analgesia
  • fetal malposition
• Management of Arrest Disorders

  1. reassess pelvic size, presentation, position

  2. Oxytocin stimulation

  3. CS if with CPD
• Uterine Rupture


  • Tearing of muscles of the uterus
  • Occurs when uterus can no longer withstand the strain placed upon it

  
• Causes of Uterine Rupture

  • rupture of scar from previous CS
  • prolonged or obstructed labor
  • malposition and mal presentation
  • multiple gestation
  • injudicious use of oxytocin
  • forceps and vaccum extraction
  • internal version
  • precipitate labor and delivery
  • overdistention of the uterus
  • external trauma
  • placenta accreta
  • adenomyosis
  • gestational trophobalastic neoplasia

  
• Signs and Symptoms of Uterine Rupture


  • Often manifested by a pathologic retraction ring
  • Sharp tearing pain at the peak of contraction

  
• Types of Uterine Rupture

  • complete
  • incomplete

  
• Management of Uterine Rupture

  1. Blood transfusion, IVF

  2. Oxygenation

  3. Emergency laparotomy

  4. emotional support

  5. Post op care

  
• Uterine Inversion


  Uterus partly or completely turned inside out
• Causes of Uterine Inversion

  • Pulling of an umbilical cord
  • Applying pressure on uncontracted uterus
  • Placenta accreta
  • Sudden increase in intra-abdominal pressure
• Signs and Symptoms of Uterine Inversion

  • Fundus no longer palpable
  • Sudden gush of blood
  • Uterus appear in the vulva

  
• Management of Uterine Inversion

  1. Prevention

  2. Woman under general anesthesia

  3. BT, IVF

  4. Do not attempt to remove placenta if still un attached

  5. Give oxytocin only after the uterus is properly replaced

  6. Monitor VS
• Pelvic Dystocia


  • Narrowing in one or more of the pelvis of the important diameters
  • Cephalopelvic disproportion
  • Inlet contraction
  • Midpelvis contraction- most common
  • Outlet contraction
• Complications of Pelvic Dystocia


  • Prolonged labor
  • Face and shoulder presentation
  • Absence of cervical dilatation
  • Uterine rupture
  • Fistula formation
  • Intrapartum infection
  • Cord prolapse
  • Caput succedaneum

  
• Breech Presentation


  most common fetal malpresentation
• Causes of Breech Presentation

  • Uterine relaxation
  • fetal abnormalities
  • hydramnios
  • congenital abnormalities of uterus
  • contracted pelvis
  • previous breech delivery
  • space occupying mass in the uterus
  • prematurity
  • multiple pregnancy
  • unknown causes

  
• Complications of Breech Presentation


  • Birth trauma
  • Prolonged labor
  • Uterine anoxia
  • cord prolapse
  • Fetal death

  
• Shoulder Dystocia


  Shoulder is trapped after delivery of the head

  
• Contributing Factors for Shoulder Dystocia

  • Antepartum condition- maternal obesity, DM, post term
  • Intrapartum condition- forceps, prolonged second stage

  
• Fetal Complications of Shoulder Dystocia

  • Erbs palsy
  • Fracture of humerus and clavicle
  • Abnormal neurologic examination

  
• Forceps Delivery


  • Indications: Inability of the mother to push, Maternal conditions, Fetal conditions, Abnormal position/presentation, Prolonged second stage
  • Prerequisites: Head must be engaged, Presentation and position known, Membranes ruptured, No CPD, Cervix fully dilated, Bladder empty
• Complications of Forceps Delivery

  • Mother- lacerations, uterine prolapse
  • Fetus- cephalhematoma, facial palsy
• Nursing Responsibility for Forceps Delivery

  explain procedure, Position and drape, Do not push during application of forcep