COMPLICATIONS OF LABOR AND DEVERY

PRETERM RUPTURE OF THE MEMBRANE-(PROM) Rupture of fetal membranes or amniotic

sac with loss of amniotic fluid before onset of labor

Maternal Causes

1. Maternal infection (chorioamnionitis, Renal, DM, heart disease)

2. Uterine abnormalities (over distention, incompetent cervix)

3. Trauma-poor nutrition, low socio economic status, lack of prenatal care, lack of rest and
Excessive fatigue/recent intercourse
4. Extremes of age, weight below 100 lbs, height below 5 feet
5. Smoking- extreme emotional stress

Major threat to fetus

1. Fetal infection/ malformation

2 Pressure on umbilical cord due to loss of amniotic fluid inhibiting fetal nutrient supply & motor
Development.
3. Cord prolapse-extension of the cord out of the uterus into the vagina causing interference
with Fetal circulation.
4. Potter like syndrome remaining in a non-fluid environment resulting to distorted facial features
And pulmonary hypoplasia from uterine pressure-olygohydramnios
5. Prematurity/ premature delivery

● The greater the amount of amniotic fluid that remains, the better will be the pregnancy
outcome

ASSESSMENT

1. History that describe sudden gush of clear fluid from the vagina with continued leakage
Minimally as reported by the mother I

2. Sterile vaginal speculum exam is done to observe for vaginal pooling of fluid - the most
reliable Confirmation of PROM

DIAGNOSTIC TESTS

1. Nitrazine test Amniotic fluid-alkaline reaction-blue in color Urine-acidic reactions remains

yellow

2. Ferning test- A test for increase estrogen fluid on microscopic study. Amniotic fluid increase in
Sodium- It will assume a ferning pattern when dried on slide Urine will not show this pattern
3. Ultrasound-to assess Amniotic fluid index

4. Monitor for vaginal infection-culture for Neisseria gonorrhea, streptococcus and chlamydia is
Obtained.

5. WBC count- increase with membrane rupture

6. Avoid IE if rupture is confirmed as it increases chances for infection

7 Sterile speculum exam- direct visualization of fluid from cervical os

Therapeutic Management of PROM

1. Stem cell repair of ruptured membrane through genetic engineering

2. If labor is (-) & baby is matured & can live extra uterine life, labor is begun 24 hours after and
can be induced oxytocin so infant can be born before onset of infection

3. If preterm woman is kept on bedrest at home or in the hospital, she is given corticosteroid ,To
hasten fetal lung maturity

4. If with infection-broad spectrum antibiotic be given to delay onset of labor & reduce risk of
infection

5. If with no sign of infection, tocolytic agent may be given to halt UC if fetus is healthy
(Duphaston)

6. NO IE as much as possible due to PROM to prevent infection

7. Take body temperature every 2 hours to monitor when infection sets in.

Home Health Care

1. Maintain bed rest with bathroom privileges Don't allow ambulation to prevent prolapse of the
cord

2. Calculate gestational age

3. Count fetal movements daily & report if less than 4 in an hour or abnormal increase(Fetal
thrashing)

4. Observe and record character, amount, color & odor of amniotic fluid
5. Be alert for early sign of infection, fever chills body malaise & signs of labor onset.

● Body temp taking every 2 hours- to monitor when infection set in

● Good perineal hygiene

6. Avoid tub baths, breast stimulation, sexual stimulation & intercourse

7. Monitor signs of cord prolapse

8. Provide psychological support

● a) Support client & family

● b) Inform client of progress

● c) Prepare client and family for early interruption of pregnancy as indicated

PRETERM LABOR OR PREMATURE LABOR-is a uterine contractions occurring after 20th

week and before 37th week gestation Contractions are less than 10 minutes apart resulting to
progressive cervical changes.

A woman is documented as being in actual labor than being false labor if contractions have
caused cervical effacement over 80% or dilatation over 1 cm

It is associated with:

1. Dehydration
2 UTI
3. Chorioamnionitis- infection of fetal membranes and fluid
4. Large fetal size
5. Intimate partner violence

Therapeutic management of preterm can be done to halt preterm labor in the following
conditions:

1. Fetal membrane have not ruptured

2. Absence of fetal distress 3. No evidence of bleeding

4. Cervix not dilated more than 4-5 cm & effacement not more than 50%

IF ADMITTED
1.Patient is kept on bedrest to relieve pressure of fetus on the cervix

2 External fetal & uterine monitor are attached to monitor FHT & UC

3. IV therapy to keep her hydrated-if client is dehydrated-pituitary gland will be activated to

secrete ADH which may cause the pituitary gland to release oxytocin strengthening UC more

5. Vaginal & cervical culture & a clean catched urine is prescribed to rule out infection &
antibioticis given PRN

6. Drug administration

● a) Terbutaline (Aminophylline) tocolytic agent-not use over 48-72 hours of therapy

because it can lead to maternal heart problem and death Not use on OPD basis for it
requires professional assessment (15Oxsuprine)

● b) Magnesium Sulfate-drug that halts calcium uptake by the muscles. It has the potential
to reduce UC administered per IV until UC stops

● c)Bethamethasone-helps in formation of surfactants thus reducing possibility of RDS in

infants

● If pregnancy is less than 34 weeks, 2 doses of 12 mg Bethamethasone, IM 24 hours

apart

● may be given or 4 doses of 6 mg Dexamethasone IM 12 hours apart

7. If successful maybe discharged & pregnancy continued with limited strenuous activity,
adequate
nutrition & hydration

Risk factors

1.Low socio economic status/ No prenatal care / poor nutrition

2. More than 2 children at home with no house help

3. Maternal age less than 18 years old or over 35

Signs and symptoms/Assessment

1. Persistent, dull and low back pain

2 Vaginal spotting
3. A feeling of pelvic pressure & abdominal tightening

4. Menstrual like cramping with increasing vaginal discharges

Nursing diagnosis

1 Knowledge deficit about preterm labor

2. Fear for the uncertain outcome of pregnancy

3. Risk for fetal injury R/T preterm birth

4. Fetal risk for a variety of health problems

5. Situational low self-esteem R/T feelings of responsibility for preterm labor

6. Lac of support system and care of infant in the postpartum period

Diagnostic tests

1 Ultrasound- intact gestational sac

2. Analysis of vaginal mucus for presence of fetal fibronectin- a protein that is produced by the

● Thropoblast if present in vaginal mucus it predicts preterm contraction If absent-labor will

not occur in 14 to28 hours.

Home health care

1.Discharge instructions- it is given once contraction have stopped & maternal & fetal well being
Are stabilized with health teachings

● a) Bed rest (left lateral recumbent position) b) Medication to be continued at home

● c) Signs of recurrent preterm labor

● d) Nutrition

● e) Activity and life style changes

● f )Avoid sex because prostaglandin in the sperm promotes uterine contraction

● g Empty bladder as often as possible

 ● h. Drink plenty of water (8-9 glasses daily)

● I. If symptoms persists, call the physician or rush to the hospital

Preterm labor can be halted in the following conditions:

1. There is no bleeding and cervical dilatation

2. FHT are good & uterine contraction is (-)

3. Fetal membranes have not ruptured

Contraindication to Arresting premature labor

1. Advance pregnancy

2 Ruptured BOW

3. Maternal diseases like bleeding. PIH, heart disease

4. Fetal distress

5. Presence of fetal problem like isoimmunization

1. Tocolytics used in the treatment of premature labor A there

a) Magnesium Sulfate- Calcium antagonist and CNS depressant. It stops & relaxes the smooth
muscles of the uterus through calcium displacement

b) interferes with muscle contractility Few serious side effects are patient feels hot, flushed,
headache, nausea, diarrhea
Dizziness, nystagmus and lethargy Fetal side effect- Hypotonia-reduced muscle tension

2. Terbuline- Decreases effect of calcium on muscle activation to slow or stop uterine

contraction 8mg 1 tablet every 8 hours S/E increase heart rate, nervousness, tremors, N/V

3. Nifedifine-calcium channel blocker. It delays delivery for at least 48 hours

4. Ritodrine Hydrochloride (YUtopar) It is a beta sympathomimetic drug that act by stimulating

the beta 2 receptors in smooth muscles. The frequency and intensity of uterine contractions
decrease as the muscle relaxes

5. Indomethacin- prostaglandin synthesis inhibitor

6. Betamethasone (Celestone) given to improve fetal lung maturity

PROLAPSE UMBILICAL CORD-Displacement of cord in a downward direction, near or ahead

of the

presenting part or in the vagina. Loop of umbilical cord slips down infront of the presenting part.
It is always emergency due to pressure of fetal head against the cord leading to