1 Clinical aspects of Maternal and Child nursing NUR 363 Lecture 4 Intrapartum complications

2 1-Premature rupture of membrane (PROM) -It is the rupture of the chorion and amnion one hour or more before the onset of labor. -It is associated with malpresentation, sub clinical infection and incompetent cervix. -The leading cause of death associated with PROM is infection. -PROM is marked by amniotic fluid gushing from vagina. -Maternal fever and fetal tachycardia may indicate infection.

3 2-Preterm labor. It is labor that begins after 24 th week's gestation and before 37 weeks gestation. Causes - PROM. -preeclampsia. -placenta previa. -abruptio placenta. - trauma. -multiple gestation.

4 3- Cord prolapse - It is descent of the umbilical cord into the vagina ahead of the fetal presenting part with resulting compression of the cord between the presenting part and the maternal pelvis.

5 3- Cord prolapse Clinical manifestations include fetal tachycardia with deceleration during contraction. Also the umbilical cord can be seen or felt during vaginal examination. Nursing interventions include -lowering the head of the bed and elevate the clients hips on a pillow, or placing the client in the knee- chest position to minimize pressure on the cord. -apply oxygen.

6 4- Prolonged pregnancy -It is a pregnancy that extends past 42 weeks gestation - Actual cause is unknown.

7 5- Dysfunctional labor - It is difficult, prolonged labor due to mechanical factors. - Etiology.Fetal factors (passenger).Uterine factors (power).Pelvic factors (passageway).Psyche factors

8 6- Uterine rupture -It is the tearing of the uterus either complete or incomplete.

9 7- Uterine inversion - The uterus turns completely or partially inside out, it occurs immediately following delivery of the placenta or immediate post partum period.

10 8- Cesarean delivery In this surgical procedure, the newborn is delivered through the abdomen from an incision made through the maternal abdomen and the uterus.

11 8- Cesarean delivery -Typed of cesarean delivery 1- Classic or vertical-this is indicated in emergency situations, when there are abdominal adhesions from previous surgeries, or when the fetus is in a transverse lie. Blood loss is increased because large blood vessels of the myometrium are involved.

12 8- Cesarean delivery 2- Transverse low segment-the most common type, the incision is low, and the uterine incision is horizontal in the lower uterine segment, blood loss is minimum, the incision is easy to repair. -Reasons for C/S a- Maternal factors. b- Fetal reasons.