1. Developed by D. Ann Currie RN, MSN

2.  Preterm Labor  Premature Rupture of Membranes  Dystocia  Labor Dysfunctions  Precipitous Labor and Birth  Fetal MalPositions  Fetal Malpresentations  Shoulder Dystocia  Prolapsed Umbilical Cord  Cephalopelvic Disproportion  Placenta Problems  Lacerations

3.  Define as a labor that occurs between 20-37 weeks of pregnancy  Prematurity is the number one cause of neonatal mortality in USA.  Preterm births occurs in 11-12% of births

4.  Many factors may place a woman at risk for preterm labor: such as  antepartum hemorrhage  trauma  infections  lower socioeconomic status  Multiple gestation  See text for other causes

5.  Clinical Manifestations of PTL:  Abdominal Pain  Back Pain  Pelvic Pain  Menstrual –like Cramps  Increased Vaginal Discharge  Pelvic Pressure  Urinary Frequency  Diarrhea

6.  Bedrest  Pelvic Rest  Hydration  Medications:  Tocolytics:  Beta agonists- terbutaline  Magnesium Sulfate  Calcium Channel Blockers-  Nifedipine (Procardia EL)  Indomethacin (Indocin)  Others: Antibiotics

7.  Fetal Demise  Lethal Fetal Anomaly  Severe Preeclampsia/ eclampsia  Hemorrhage/Abruptio placenta  Chorioamnionitis  Severe Fetal Growth Restriction  Fetal Maturity  Acute Nonreassuring Fetal Heart Pattern

8.  Teach all pregnancy clients the clinical manifestations of PTL and to report to their health care provider if they occur.  Teach self care measures to prevent PTL  Teach and assist in treatment of PTL  Prevent complications of Treatment-  Prolong bedrest  Tocolytic medications

9.  PROM is defined as rupture of membranes one hour prior to labor starting.  Premature Premature Rupture of Membrane is rupture of membranes prior to 37 weeks. (PPROM)  Complications associated with PPROM:  Preterm labor  Infections  Oliohydramnios  Abruptio Placenta  Fetal Problems-IUGR, Pulmonary Hypoplasia, and other

10.  Defined as an abnormal labor pattern that may occur because of abnormalities in the power, the passenger, or the passage.  It may encompass many things in labor.

11.  Primary Labor dysfunction:  Hypertonic Labor Pattern is ineffectual uterine contractions of poor quality occurring in the latent phase of labor. UC are painful but do not dilate or efface the cervix.  It may cause:  Increased discomfort  Fatigue  Stress  Dehydration  Infection  Nonreassuring Fetal Heart Pattern

13.  Management:  Rest  Hydration  Sedation - Sedatives such as :  Seconal  Dalmane  Morphine Sulfate 

14.  This is poor uterine contractions- irregular or low amplitude.  If not caused by CPD  Management:  Oxytocin (Pitocin)  Augmentation

15.  It is when the entire process of labor and birth occurs within 3 hours.  Precipitous Labor is when cervical dilation is 5cm or more per hour for a primigravida and 10 cm per hour for a multipara.  Precipitous birth is a sudden birth  It may be unattended or nurse attended birth. 

16.  Complications: Abruptio placenta  Lacerations  Fetal Risks:  MAS,  Brachial Palsy,  Intracranial  Trauma  Management: Closely monitor  Scheduled induction in  control environment with  physician available

17.  Occiput posterior position (OP) is the most common mal position.  The client experiences intense BACK PAIN while in labor.  Complications:  Pain  3 rd or 4 th degree lacerations  or extension of episiotomy  Arrest of decent  C/S

18.  Position- Side –lying  Hand-and-knee position  Pelvic Rocking  Counter Pressure in small of back  Physician may have to assist in turn baby with forceps or vacuum extraction

19.  Breech  Brow  Face  Shoulder  Complex

21.  Breech Presentation is the most common malpresentation  About 4% of all Births  Frank Breech is the most common type of Breech. It is characterized by flexed hips and extended knees.  Footling Breech is characterized by one or both feet presenting.  Complete Breech

22.  Head Entrapment  Prolapsed Cord  MAS  Fetal Asphyxia and Hypoxia  Increased Risk for perinatal morbidity and morality.

25.  Brow Presentations are the least common of all presentations.  In a Brow presentation the forehead is the presenting part.  Results in a prolonged labor or secondary arrest of labor.  C/S is best for delivery  Complications:  Extension of episiotomy or lacerations  Birth injuries to fetus: cerebral or neck  compression  Damage to the trachea and larynx.  Infant Mortality

28.  A Mentoanterior position can be delivered vaginally.  A Mentoposerior position can not be delivered vaginally.  Complications of a face presentation:  Prolonged labor  Infection  C/S  Facial Trauma

30.  Transverse Lie  Vaginal Birth is impossible  Cesarean Birth  Possibility of Prolapsed Cord if Membranes Rupture

31.  An Obstetric Emergency  Occurs with :  Macrosomic fetuses.  Obese woman or excessive weight  gain during pregnancy.  Woman of short statue.  Management:  McRoberts maneuver  Client should bring back legs/  thighs against abdomen  The nurse will apply suprapubic  anterior pressure to release anterior  shoulder.

33.  When the umbilical cord precedes the fetal presenting part.  The cord may fall or be washed down through the cervix into the vagina or Trapped between the presenting part and the maternal pelvis  Occult cord prolapse may lay beside or just ahead of the fetal head

34.  Ant time the presenting part is not well engaged or firmly against the cervix, a prolapsed cord can occur.  This is an emergency because the cord can be compressed causing hypoxia and possible fetal death.  Prevent cord compression by manually preventing presenting part compressing the cord  Position- Knee-Chest position  ( gynopectorus position) or Tendelburg

35.  Immediate Cesarean Section is needed  Remember to cover client when going through hall.

36.  Abruptio Placenta  Placenta Previa  Placenta and Umbilical Cord Variations  Placenta Adherence :  Placenta Accreta  Placenta Increta  Placenta Percreta

38.  Placenta Accreta: is when the chorionic villi attaches directly to the myometrium. This is the most common form of placenta adherence.  Placenta Increta is when the placenta invades the myometrium.  Placenta Percreta is when the placenta penetrates the myometrium.  Complication is maternal hemorrhage.  Depending on the amount and depth of involvement will determine treatment

39.  First Degree Laceration is limited to the fourchette, perineal skin, and vaginal mucous membrane.  Second Degree Laceration involves the perineal skin, vaginal mucous membrane, underlying fascia, and the muscles of the perineal body.

40.  Third Degree Laceration extends through the perineal skin, vagina mucous membranes, and perineal body and involves the anal sphincter and may extend up the anterior wall of the rectum.  Fourth Degree Laceration extends through the rectal mucosa to the lumen of the rectum.

41.  Care:  Get order for ice pack  Pain medications  Stool Softener  Pericare  Sitzbath  Remember nothing in rectum-  No Suppostories  No Enemas  No Rectal Exams 