precipitating labor


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precipitating labor


Presentation Transcript

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Precipitate Labor

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General information: Labor of less than 3 hours, rate of cervical dilatation 5cm/hr or faster –nulliparas 10 cm/hr - multipara Emergency delivery without client’s physician/ midwife Extreme rapid labor and delivery – result from low resistance of soft part of the birth canal. Assessment findings: As labor is progressing quickly, assessment may need to be done rapidly Client may have history of previous precipitous labor and delivery Desire to push Observe status of membranes, perineal area for bulging and for signs of bleeding

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Results to hypertonic uterine contraction that are tetanic in intensity Hypertonic contraction pushing the fetus faster than normal (less than 3 hours) Complications: Maternal complication: Uterine rupture Laceration of the birth canal Amniotic fluid embolism Excessive Post partum hemorrhage Fetal complications: Hypoxia Intracranial hemorrhage Unattended birth Sudden birth of infant Low resistance of soft part of birth canal Cervical dilatation is faster than normal

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Signs/ symptoms: Intense Pain more than normal Increase heart rate, pulse, body temp. Increased BP Diaphoresis SOB Nasal flaring Anxiety Restlessness Hypertonic contractions

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Medical Management: Emergency delivery of an infant: Assess the client’s affect and the ability to understand directions, as well as other resources available (other physicians, nurses, auxiliary personnel). Stay with client at all times Pant and blow to decrease urge to push Do not prevent birth of baby Maintain sterile environment if possible Rupture membranes if necessary Check for nuchal cord, slip over head if possible Check around the infant’s neck for a possible tight umbilical cord: if present, cord must be clamped and cut before delivery Support the perineum with a sterile towel as crowning occurs Use gentle aspiration with bulb syringe to remove blood and mucus from nose and mouth Deliver shoulder after external rotation, asking mother to push gently if needed Hold baby in a head down position to facilitate drainage of secretions Check mother for excess bleeding, massage uterus prn Cut cord when pulsation cease, if cord clamp is available, if no clamp, leave intact

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Give medication: Tocolytics – inhibits uterine contractions Surgical Management: episiotomy as necessary

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Nursing Diagnosis: Pain r/t force of hypertonic contractions. Provide reassurance and instruct the woman in a calm, controlled manner. Provide nonpharmacologic pain relief such as massages. Instruct the pt. to assume Sim’s lateral position; this would help to slow her labor down and help prevent lacerations. Encourage pt. to pant at this time to prevent bearing down. Anxiety r/t process and stress of labor and birth. Explain to pt. the process of labor and delivery Provide support as patient undergo labor. Approach patient in a calm and controlled manner. Risk for injury (maternal and fetal) r/t hypertonic contractions. Stay with client at all times Look out for crowning of fetus Position pt. in Sim’s lateral position as indicated to try to slow down contractions Assist in delivery of baby and placenta Assist in performance of episiotomy

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Risk of deficient fluid volume r/t hemorrhage 2 ° abrupt detachment of placenta 3 ° precipitous delivery. Observe pt. for signs of hemorrhage after delivery, and monitor for changes in vital signs Assist in giving medications that prevent hemorrhage as indicated, and start IV line as ordered. Massage uterus prn. Risk for infection. Use aseptic technique in assisting with delivery and episiorrhapy. Maintain sterile environment if possible. Teach pt. proper cleaning of area and wound site, if present.

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Mendoza Alferez Macadato Capangpangan DeLa Cruz

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