PRECIPITATE

LABOR
• Precipitate dilation is cervical that occurs at a
rateof 5 cm or more per hour in a primipara or 10 cm
or more per hour in a multuipara.

• Precipitate birth occurs when uterine contarctions

are so strong a woman gives birh with only a few,
rapidly occuring contractions, often defined as a
labor that is completed in fewer than 3 hours.

• Precipitate labor can be predicted from a labor

graph if during the active phase of dilation, the rate
is greater than 5 cm/hr (1 cm every 12 mins.) in a
nullipara or 10 cm/hr (1 cm every 6 mins.) in a
multipara
 INDUCTION AND
AUGMENTATION
OF LABOR
• When labor contractions are
ineffective, severeal interventions, such
as induction and augmentation of labor
with oxytocin of amniotomy (artificial
rupture of the membranes), may be
initiated to strengthen them.

• Induction of labor means labor is

started artificially. Augmentation of
labor refers to assissting labor that has
started spontaneously but not effective.
 Cervical
Ripening
• A change in the cervical consistency from firm to soft, is the first change of the
uterus in early labor because, until this has happened, dilation and
coordination of uterine contractions will not occur.

• To determine whether a cervix is “ripe” or ready for dilation, Bishop (19640

established criteria for scoring the cervix

• To help a cervix “ripen” a number of methods can be instituted. The simplest

method known as “stripping the membrane” or separating the membranes
from lower uterine segment manually, using a gloved finger in the cervix
Stripping Membrane
 Induction of Labor by
Oxytocin
• After a cervix is “ripe” administration of oxytocin (a synthetic form of
naturally occuring pituitary hormones) can be used to initiate labor
contractions if a pregnancy is a term.

• Oxytocin is always administered intravenously, so that, if uterine

hyperstimulation should occur, it can be quickly discontinued. Because the
half-life of oxytocin is approximately 3 minutes, the falling serum level and
effects are apparent almost immediately after discontinuation of IV
administration.

• The danger of hyperstimulation is that a fetus needs 60-90 seconds between

contractions in order to receive adequate oxygenation from placenta blood
 Augmentation by
Oxytocin

• Augmentation of labor may be used if labor contractions begin

spontaneously but then become weak, irregular, or ineffective (i.e hypotonic)

• Precautions regarding oxytocin augmentation are the same as for primary

oxytocin induction of labor.

• Be certain the drug is increased in small increments only and that fetal heart
sounds are well monitored during the procedure.
 UTERINE
RUPTURE
• Rupture of the uterus during labor, although
rare, is always a possiblity. It occurs most often in
women who have a previous cesarean scar.
Contribution factors may include prolonged
include prolonged labor, abnormal presentation,
multiple gestation, unwise use of oxytocin,
obstructed labor, and traumatic maneuvers of
forceps or traction.

• If a uterus should rupture, the women

experience a sudden, severe pain during a strong
labor contraction, which she may report as a
“tearing” sensation.
 INVERSION
OF THE
•UTERUS
Refers to the uterus turning inside out with
either birth of the fetus or delivery of the
placenta.

• It may occur if traction is applied to the

umbilical cord to remove the placenta or if
pressure is applied to theuterine fundus
when the uterus is not connected.

• It may also occur if the placenta is attached

at the fundus so that, during birth, the
passage of the fetus pulls the fundus
downward.
AMNIOTIC FLUID
EMBOLISM
• Occurs when amniotic fluid is forced into
an open maternal uterine blood sinus after a
membrane rupture or partial premature
seperation of the placenta.

• A more likely cause of symptoms is a

humoral or anaphylactoid response to
amniotic fluid in the maternal circulation.

• A woman’s prognosis depends on the size

of the embolism, the speed with which the
emergency condition was detected.
 Problems
With the
Passenger
• The fetus is basically passive during birth,
complications may arise if an infant is
immature or preterm or if the maternal pelvis
is so undersized, that iss diameterd are smaller
than the fetal skull.

• It also can occur if the umbilical cord

prolapses, if more than one fetus is present, or
if a fetus is malpositioned or too large for birth
canal.
 PROLAPSE OF THE
UMBILICAL CORD

In umbilical cord prolapse, a loop of the umbilical cord slips down in front
of the presenting fetal part. If presenting fetal part is not fitted firmly into the
cervix. It tends to occur most often with:

• Premature rupture of membrane

• Fetal presentation other than cephalic
• Placenta previa
• Intrauterine tumors preventing the presenting part from engaging
• Small fetus
• CPD preventing firm engagement
• Polyhydramnios
• Multiple gestation

Assessment
• The cord may be felt as the presenting part
on an initial vaginal examination during labor
or can be visualized on ultrasound if one of
these is taken during labor.
• Cord prolapse is first discovered only after
the membranes have ruptured, when the FHR
is discovered to be unusually slow or variable
on fetal monitor, the may be visible at the
vulva
Therapeutic
Management
• Prolapse cord is always an emergency situation
because the pressure of fetal head against the
cord at the pelvic brim leads to cord
compression and decreased oxygenation to the
fetus.
• Management is aimed, therefore, at relieving
pressure on the cord, thereby relieving the
compression and resulting fetal anoxia.
• This may be done by placing a gloved hand in
the vagina and manually elavating the fetal head
off the cord, or by placing the woman in a knee-
chest or Trendelenburg position, to cause the
fetal head to fall back from the cord.
 Amnioinfusion
• Is the addition of a sterile fluid into the
uterus to supplement the amniotic fluid and
reduce compression on the cord.
• Although amnioinfusion is used for only a
short time until the cervix is fully dilated or a
cesarean birth can be arranged, the procedure
can also be performed daily for woman with
oligohydramnios.
Fetal Blood Sampling
• Obtaining the fetal oxygen saturation level by
inserting a fetal oximeter into the uterus to rest
next to the level fetal cheek or obtaining a
positive response response to scalp
stimulation.
• Fetal blood sampling obtaing a sample of
blood from the fetal scalp during a vaginal
exam.
 MULTIPLE GESTATION

• Multiple gestation may be born by cesarean birth to decrease the risk the
second fetus will be experience anoxia; often, this is also the situation in
multiple gestation of three or more because of the increased incidence of
cord entanglement and premature separation of the placenta.

• Anemia and gestational hypertension occur at higher than usual incidences

during multiple gestation.

• Because of multiple fetuses, abnormal presentation may occur.

 One Infant Vertex and One
Both Infant Vertex Breech
 One Infant Vertex and One in a
Both Infant Breech Transverse lie