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Clinical aspects of Maternal and Child nursingNUR 363Lecture 4

Intrapartum complications

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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.

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2-Preterm labor.

It is labor that begins after 24th week's gestation and before 37 weeks gestation.

Causes- PROM.-preeclampsia.-placenta previa.-abruptio placenta.- trauma.-multiple gestation.

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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.

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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.

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4- Prolonged pregnancy

-It is a pregnancy that extends past 42 weeks gestation

- Actual cause is unknown.

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5- Dysfunctional labor

-It is difficult, prolonged labor due to mechanical factors.

- Etiology.Fetal factors (passenger).Uterine factors (power).Pelvic factors (passageway).Psyche factors

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6- Uterine rupture

-It is the tearing of the uterus either complete or incomplete.

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7- Uterine inversion

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

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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.

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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.

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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.