COMPLICATIONS OF

LABOR

Prepared By:

Anna Grace A. Zacal

 PRETERM LABOR
Labor that occurs after the 20th week and
before 37th week of gestation
RISK FACTORS
Maternal Factors
Fetal Factors
Placental Factors
Unknown Causes
 COMPLICATION
Prematurity
Fetal death
Small for gestational age/IUGR
Increase perinatal morbidity
and mortality
 TREATMENT
HOSPITALIZATION prevent premature delivery
Bed rest
Adequate hydration: oral & parenteral
Monitoring: uterine contraction, VS, I & O, Signs of
Infxn, Cardiac & respiratory status, and distress
effacement
Fetal well being
Early signs of edema: pulmonary edema is a
possible complication of progress
 TREATMENT
Promotion of physical and emotional comfort:
keep client informed of progress
Administer Tocolytics to arrest labor by causing
relaxation of the uterus,examples: MgSO4,
Terbutaline and Ritodrine
Administer corticosteroids like Betamethasone
(Celestone) for surfactant production when
arrest of preterm labor is contraindicated
 PRECIPITATE LABOR
Short labor that lasts for 2 to 3 hour or less

RISK FACTORS:
Multiparity
Trauma
Large pelvis and lax soft tissues
Small fetus
Labor induction by oxytocin and ROM
Severe emotional stress
COMPLICATIONS:
Maternal
Fetal INTERVENTIONS:
NEVER LEAVE PATIENT

TREATMENT
Episiotomy
Delivery

ASSESSMENT FINDINGS
 DYSTOCIA
Prolonged difficult labor and/or delivery because of
problems with the factors in labor (4 Ps)

RISK FACTORS:
Faults of the Passengers
Faults of the Passages
Faults of the Primary Power
Faults of the Person/Client
 COMPLICATIONS
Maternal exhaustion and dehydration
Infection
Traumatic operative births
Fetal distress
Birth injuries
Perinatal mortality
 TREATMENT
Bed rest
Sedation of hypertonicity
Stimulation with oxytocin for
hypotonicity
Cesarean section
Forceps as indicated
 DIAGNOSIS
Vaginal examination
Leopolds maneuver
Pelvimetry
UTZ
Diagnosis of type of dystocia
 INTERVENTION
Hypotonic Uterine Inertia Hypertonic Uterine Inertia
Onset: Late onset; usually in the Onset: Early onset; usually as early
active phase as the latent phase

Contractions: Weak, painless Contractions: Strong, painful

Causes: Overdistention, advanced Causes: Primigravidity, young age,
age, increased parity, contractures, injudicious use of oxytocin
fetal malposition, analgesia/anesthesia

Treatment: Enema, walking if not Treatment: Sedation

contraindicated; amniotomy, oxytocin
 PREMATURE RUPTURE OF
MEMBRANES
Rupture of the membrane before term/labor;
unconnected with labor

ASSESSMENT FINDINGS
Maternal report of passage of fluid per vagina
Determination of alkaline amniotic fluid and not
acidic urine or vaginal discharge
 DIAGNOSIS
Nitrazine Test

Ferning Test

Sterile Speculum examination

COMPLICATIONS

INTERVENTIONS
 UTERINE RUPTURE
Rupture of the uterus because of the stress of labor with
extrusion of uterine contents into the abdominal cavity

RISK FACTORS:
Previous CS scar Improper use of oxytocin
Overdistention of the uterus Abnormal presentation
Strong contractions with non-progressive labor
Injudicious obstetrics Trauma
Ill-advised podalic version
ASSESSMENT FINDINGS

COMPLICATIONS
Hemorrhage or shock
Maternal and fetal mortality
Infection form traumatized diseases
 TREATMENT
Laparotomy to deliver the fetus
Hysterectomy for complete rupture (although in
most cases, the uterus may be sutured and left in)
Blood, plasma, and IV fluids replacement
Antibiotics

INTERVENTIONS
 FETAL DISTRESS
Fetal condition resulting from fetal hypoxia

RISK FACTORS:
Dystocia Cord coil, cord compression
Improper use of oxytocin, analgesia/anesthesia
DM, cardiac disease, and other co-existing conditions in the mother
Bleeding complications in the third trimester like
placenta previa and abruptio placenta
PIH Supine hypotensive syndrome
ASSESSMENT FINDINGS TRIAD
SYMPTOMS
FHT above 160 or below 120 per minute
Meconium-stained amniotic fluid in a
non-breech presentation
Fetal hypermobility/hyperactivity

INTERVENTIONS
 VENA CAVAL SYNDROME/SUPINE
HYPOTENSION SYNDROME
Partial occlusion of the vena cava from the pressure of
the pregnant uterus causing shock-like symptoms

The pressure of the enlarged uterus on the inferior

vena cava and aorta especially during contractions
causes a reduction in the blood flow to the heart
reduced cardiac output supine hypotensive
syndrome decreased blood flow to fetoplacental unit
fetal distress
RISK FACTORS
Conditions where the uterus is extra large
- multiple pregnancy
- polyhydramnios
- DM
Obesity
Prolonged supine position

INTERVENTIONS
AMNIOTIC FLUID EMBOLISM
The escape of amniotic fluid into maternal
circulations through the placental site and into the
pulmonary arterioles

RISK FACTORS
PROM or Normal ROM
Abruptio placenta
Difficult labor
 INCIDENCE: Rare but usually fatal; mortality in the first
hour in 25% of pregnant women with amniotic fluid
embolism

PROGNOSIS: usually fatal for both mother and baby

ASSESSMENT FINDINGS
Maternal Respiratory Distress
Circulatory Collapse
Secondary
TREATMENT: Cardiorespiratory
support

INTERVENTIONS
 PROBLEMS WITH POSITION,
PRESENTATION OR SIZE
Oftentimes, fetal position is posterior rather than anterior.
The occiput is directed diagonally and posteriorly, right
occipitoposterior (ROP) or Left occipitoposterior (LOP)

Posteriorly presenting head does not fit the cervix as snugly

as one in an anterior position. Because this increases the
risk of umbilical cord prolapse, the position of the fetus is
confirmed on vaginal examination or by UTZ.

Infuse IV glucose solution for mothers to replace glucose

used for energy
 BREECH PRESENTATION

Birth of the head is the most hazardous

part of a breech birth. Because the
umbilicus precedes the head, a loop of cord
passes down alongside the head against
the pelvic brim will automatically compress
this loop of cord
 FACE PRESENTATION
Asynclitism a fetal head presenting at a different angle
than expected like Face and Brow presentations. Face (chin
or mentum) is rare, but when occurs, the diameter that the
fetus presents is too large for birth to proceed.

A head that feels more prominent than normal with no

engagement apparent in Leopolds maneuver suggests a
face presentation. Also suggested when the head and back
are both felt on the same side of the uterus with Leopolds
maneuver.
BOW PRESENTATION
The rarest of the presentation
 TRANSVERSE LIE
Occurs in women with pendulous abdomens, with uterine
masses such as fibroid tumors that obstruct the lower
uterine segment, with contraction of the pelvic brim, with
congenital abnormalities of the uterus, or with hydramnios.

A mature fetus cannot be delivered vaginally from this

presentation. Often, membranes rupture at the beginning of
labor. Because there is no firm presenting part, the cord or
an arm may prolapse, or the shoulder obstructs the cervix.
CS is necessary.
 OVERSIZED FETUS
Macrosomia weight more than 4000 g to
4500 g (approximately 9 to 10 lb)

May cause uterine dysfunction during labor

or at birth owing to the overstretching of the
fibers of the myometrium.

Mother has increased risk of hemorrhage

 FETAL DYSTOCIA
Occurs at the second stage of labor when the
fetal head is born but the shoulders are too
broad to enter and be delivered through the
pelvic outlet

Asking the woman to flex her thighs sharply on

her abdomen (McRobertss maneuver) widens
the pelvic outlet and may let the anterior
shoulder deliver
 ANOMALIES OF THE PLACENTA
Placenta succenturiata has one or more accessory lobes
connected to the main placenta by blood vessels. No fetal
abnormality is associated.

Placenta circumvallata the fetal side of the placenta is

covered to some extent with chorion. The umbilical cord
enters the placenta at the usual midpoint, and large vessels
spread out from there. They end abruptly at the point where
the chorion folds back onto the surface, however.

Placenta marginata the fold of chorion reaches just to the

edge of the placenta
 ANOMALIES OF THE PLACENTA
Battledore Placenta the cord is inserted marginally rather than centrally
(rare and has no known clinical significance)

Velamentous Insertion of the cord the cord, instead of entering the

placenta directly, separates into small vessels that reach the placenta by
spreading across the fold of amnion. (associated with multiple pregnancy
and fetal anomalies)

Vasa Pevia umbilical vessels of a velamentous cord insertion cross the

cervical os, so they would deliver before the fetus. The vessels may tear
with cervical dilatation, the same as a placenta previa may tear.
PLACENTA ACCRETA attachment to the myometrium
 ANOMALIES OF THE CORD
TWO-VESSEL CORD one vein and one artery ONLY;
associated with congenital heart and kidney anomalies,
because the insult that cause the loss of the vessel probably
led to other mesoderm germ layer structures as well.

UNUSUAL CORD LENGTH unusually short = premature

separation of the placenta or abnormal fetal lie; unusually
long = compromised more easily because of its tendency to
twist or knot more. (nucchal cord)