Abnormal Progress in Labor (Precipitous Labor and Birth & Retraction Rings)
Transcript of Abnormal Progress in Labor (Precipitous Labor and Birth & Retraction Rings)
Abnormal Progress in Labor
Precipitous Labor and Birth
Retraction Rings
Busa, Ana Marie
Nodalo, Evelyn Tan, Louie
Ymas, Christine
Precipitous Labor
and Birth
Precipitate Labor – occur when uterine contractions are so strong that the woman gives birth with only so strong that the woman gives birth with only a few, rapidly occurring contractions. It is also defined as an extremely rapid labor that last less than 3 hours from start to finish
Precipitate Birth - is a sudden and often unattended birth.
Contributing Factors:
•Multiparity•Large pelvis•Previous precipitous labor•Small fetus in a favorable position•Strong contractions
Signs & Symptoms• Increased pain more than normal• Increased maternal heart rate, pulse
and body temp• Increased BP • Nasal Flaring• Anxiety• Restlessness• Hypertonic Contractions
Maternal risk:• Lacerations of the cervix, vagina, and or
perineum• Uterine rupture• Amniotic fluid embolism• Postpartal hemorrhage• Abruptio placentae
Fetal/neonatal risk:• Fetal hypoxia• Cerebral trauma• Meconium stained fluid• Low apgar score
A D P I E
Assessment:• Assess previous labor history if the woman is a
multipara• Assess contraction status. Be alert for
contractions that are more frequent than every 2 minutes and dilatation that progresses faster than normal (more than 1.5cm/hr)
• Assess fetal status• Assess mothers comfort level• Assess mother’s coping abilities
Nursing Diagnoses:• Acute pain related to accelerated labor pattern• Risk for ineffective coping related to
ineffectiveness of breathing techniques to relieve discomfort
Planning:During the entire process of labor and birth:
• The nurse should closely monitor the woman’s contractions and cervical dilatation, and an emergency birth pack is kept near the bedside.
• The nurse should stay in constant attendance, assist the woman to a comfortable position and provides a quiet environment.
Nursing Interventions:Non- Pharmacologic:• Continue electric monitoring• Remain in room to provide support and
comfort measures for the woman
• Instruct the woman not to bear down until she is instructed to do so.
• Instruct woman to pant with contractions if fetal head is crowning
• Apply gentle pressure anteriorly against the fetal head to maintain flexion and prevent it from delivering too quickly.
• Support the perineum by making U shape with the other hand and supporting the descending head between contractions to prevent excess tearing and perineal lacerations.
Pharmacologic:• In such cases, a tocolytic agent such as
terbutaline may be administered to reduce the force and frequency of contractions
• Notify physician for rapid cervical changes
Evaluation:
• The woman and her baby are closely monitored during labor and a safe birth occurs
• The woman states that she feels supported and enhanced comfort during labor and birth
Retraction Ring
Retraction Ring - also called Bandl’s Ring
- occurs at the junction of the upper and lower uterine segments. The Ring usually appears at the 2nd stage of labor as a horizontal indentation across the abdomen and is a warning sign that a dysfunctional labor is occurring; it is formed by excessive retraction of the upper uterine segment.
-A constriction of the junction between the thinned lower uterine segment and the thick retracted upper uterine segment caused by obstructed labor; a sign of impending rupture of the uterus.
Retraction Ring
Retraction Ring
Ruptured Uterus
Contributing Factors• An abnormality in a mother’s pelvis (a
contracted pelvis).• Fetal causes (hydrocephalus, fetal ascitis,
sacrococcygeal tumours, conjoined twins• Cephalopelvic disproportion• Previous caesarean section, still births and
previous prolonged labor.• Delay in referral to higher level of care for
caesarean sections• Abnormal presentations and position
Signs & Symptoms• Hypertonic contractions• Presenting part driven/jammed• Mother experiences severe pain and excited or restless
emotions• Maternal pulse, temperature rise• Palpable, taut round ligaments; may also be visible• Baby entirely or almost entirely in lower uterine segment.• Ring felt as transverse ridge, as high up as umbilicus or
potentially even higher• Mother maybe cold and clammy Anxious and restless• Uterus is painful and sore to touch• Fundus is thickened and tense• The mother complains of severe abdominal pains
Maternal Risk:• Puerperal sepsis• rupture of the lower segment, • maternal hemorrhage• maternal exhaustion, inertia, and arrest of
contractions• maternal fistula, lacerations
• Neonatal Risk:• Asphyxia• Intracranial hemorrhage• Delayed complications—delayed milestones,
convulsive disorders, mental retardation etc.• placental abruption • uteroplacental insufficiency with resultant fetal
hypoxia and distress. • still births and neonatal death
Pathologic retraction ring occurs, strong uterine contractions w/o
cervical dilatation
“tearing sensation”
Complete Uterine rupture
Incomplete Uterine rupture
Rupturing of endometrium, myometrium and perimetrium
Rupturing of endometrium and myometrium
Uterine contraction stopsLocalized tenderness and
persisting aching pain over the area of the uterine segment
Swelling of the abdomen:•Retracted uterus
•Extrauterine fetus
Hemorrhage from torn uterine arteries
Bleeding into the peritoneal cavity
Bleeding to the vagina
Decreased blood volume
Decreased venous return
Decreased cardiac output
Decreased BP
Heart attempts to circulate remaining blood volume
Vasoconstriction of peripheral vessels, increased heart rate
Cold, clammy skin
Increases gas exchange to oxygenate better the decreased
blood volume
Increased respiratory rate
Continued blood loss will continue to fall BP
Uterine perfusion is decreased
Fetal distress
Decreased brain perfusion
Decreased kidney perfusion
Decreased LOC (lethargy, coma)Decreased urine output
Renal failure
Death of Mother and fetus
A D P I E
Assessment• Assess maternal vital signs; especially note an
increase in rate and depth of respirations, an increase in pulse , or a drop in BP indicating status change.
• Observe for signs and symptoms of impending rupture (ie, lack of cervical dilatation, tetanic uterine contractions, restlessness, anxiety, severe abdominal pain, fetal bradycardia, or late or variable decelerations of the FHR).
• Assess fetal status by continuous monitoring.• Assess fetal position, presentation and
descent.• Assess laboring woman for hydration status.• Assess woman’s comfort and coping level.
Diagnosis•Acute Pain related to inability
to relax secondary to labor pattern
•Fatigue and Anxiety related to prolonged labor
•Risk for deficient fluid volume related to length and work of labor.
PlanningDuring the entire process of labor and birth:
• The nurse should closely monitor the woman’s contractions and cervical dilatation, and an emergency birth pack is kept near the bedside.
• The nurse should stay in constant attendance, assist the woman to a comfortable position and provides a quiet environment.
InterventionNon-Pharmacologic Intervention• Monitor labor status and fetal status
through continuous electronic monitoring and then compare to expected norms.
• Assist in relaxation and breathing techniques, Back-rubs, change sheets
• Maintain a quiet and calm atmosphere to enhance relaxation.
• Try alternative maternal positions or activity that might facilitate rotation of fetal head or assist with fetal descent.
• Ask patient to lie on the left side to prevent impeding the vena cava.
Pharmacologic Interventions• Start IV Fluid as prescribed to
provide glucose for energy.• Prepare for Cesarean Section as
indicated.• Administer IV morphine sulfate or the
inhalation of amyl nitrate as prescribed to relieve retraction ring.
• Administer tocolytic as prescribed to halt contractions.
Evaluation• Client states that she is able to
continue active participation in labor and maintains effective breathing.
• The woman and her baby are closely monitored during labor and a safe birth occurs
• The woman states that she feels supported and enhanced comfort during labor and birth
Thank you for
Listening!!!!