PROBLEMS WITH THE POWER

a. Dystocia (Difficult Labor)

1. Hypertonic Uterine Dysfunction
- frequent contractions at midsegment of the uterus with decreased intensity and increased
uterine tone occurring during the latent phase of labor.
 Ineffective in causing cervical dilatation or effacement to progress
 Uterus does not relax complete between contractions
 Occurs before 4cm dilation
Maternal risk
 Loss of control related to the intensity of pain and lack of progress
 Exhaustion
Nursing management
 Decrease noise and stimulation
 Monitor FHT and labor progress
Medical management
 Monitor uterine contractions
 Initiate therapeutic rest measures (bed rest)
 Administer analgesic (morphine sulfate)
 CS birth indications – the presence of late deceleration, abnormally long first stage of
labor and lack of progress with pushing
Hypotonic Uterine dysfunction
 Low or infrequent contractions
 Contractions that is not increasing beyond 2 to 3 in a 10minute period
 Resting tone of the uterus remains less than 10mmHg
 Strength contractions does not rise above 25mmHg
 Most occur on the active phase of labor
Cause
 Administration of analgesia
 Bowel or bladder distention
 Overstretched uterus due to multiple gestation
 Macrosmia
Maternal risk
 Ineffective cervical dilatation
 Prolonged labor
  Ineffective uterine contraction during the post-partal period
 Possible post-partal hemorrhage
 Risk for infection
Nursing management
 Palpate uterine fundus
 Monitor BP
 Monitor lochia every 15 minutes
Medical management
 Administration of oxytocin – strengthen contractions and increase their effectiveness
 Amniotomy (artificial rupture of membranes) - to improve labor and further speed labor

ABNORMAL PROGRESS IN LABOR

DYSFUNCTION ATHE FIRST STAGE OF LABOR
Prolonged Latent Phase
 Ineffective contractions during the first stage of labor
 >20 hours in a nulliparous patient
 > 14 hours in a multiparous patient
Causes
 Cervix is not “ripe”
 Excessive use of analgesic early in labor
Signs and symptoms
 Hypertonic uterus
 Inadequate relaxation
 Mild & ineffective contractions – less than 15mmHg
Nursing management
 Changing linen and woman’s gown
 Darkening room
Medical Management
 Help uterus to relax
 Adequate fluid for rehydration
 Pain relief (morphine sulfate)
 Oxytocin infusion to assist labor may be necessary
  Cesarean birth
Prolonged Active Phase
 Dilatation <1.2 cm in nulliparous
 Dilatation <1.5 cm in multiparous
 Active phase lasts > 12 hours in primigravida
 Active phase lasts >6 hours in multigravida
Cause
 Fetal malposition and malpresentation
Signs and symptoms
 Hypotonic uterus
 Ineffective cervical dilation
Management
 Ultrasound to show that CPD is not present
 Oxytocin to enhance labor
 If the cause is fetal malposition or CPD, CS birth is done
Prolonged Deceleration Phase
 Deceleration phase extends beyond 3 hours in a nullipara or 1 hour in multipara
Cause
 Abnormal fetal head position
Signs and symptoms
 >3 hours in nullipara, >1 hour in multipara
Management
 Cesarean delivery
DYSFUNCTION WITH THE SECOND STAGE OF LABOR (EXPULSION STAGE)
Prolonged Descent
 Descent is <1cm/hr in a nullipara, <2cm/hr in a multipara
 Infrequent contractions and of poor quality and dilatation stop
Management
 Rest
 IV fluid therapy
 Amniotomy
  If membranes have not ruptured, rupturing them may be applicable
 IV oxytocin
 Semi- fowler's position, squatting, kneeling, or more effective pushing may speed descent
Arrest of Descent
 no descent has occurred for 1 hour in a multipara or 2 hours in a nullipara
 Movement beyond 0 a station has not occurred
Cause
 CPD
Management
 Oxytocin to assist labor if vaginal birth

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