COMPLICATIONS OF LABOR AND BIRTH
PRETERM LABOR
Between 20-37 week’s gestation, preterm labor and premature ruptures of membranes leads to preterm labor, early prenatal care reduce or eliminate some risk factors criteria for diagnosing preterm labor include: gestation less than 36 wks documented uterine contractions every 5-10 mins lasting for atleast 30 seconds and persisting for more than 1 hr cervical dilation more than 2.5cm and 75% effaced
ASSOCIATED FACTORS exact cause is unclear, risk factors: poor prenatal care, infections, including periodontal infections; nutritional status, socioeconomic status, race and lifestyle; maternal anemia, UTI, smoking, alcohol, cocaine, other harmful substances, STDs risk of spontaneous preterm increase as length of cervix decrease
SIGNS AND SYMPTOMS
Uterine cramping, abdominal cramping, vaginal bleeding, change in vaginal discharge, vaginal or pelvic pressure, low back pain, thigh pain
DRUGS USED TO STOP PRETERM LABOR (TOCOLYTICS)
Tocolytic Drug
Adverse Effect
Comments
Ritodrine (Yutopar) (B-adrenergic agonist)
Cardiovascular: maternal and fetal tachycardia
Pulmonary: SOB, chest pain, pulmonary edema, tachypnea
Gastrointestinal: nausea, vomiting, diarrhea, ileus
Central nervous system: tremors. jitteriness, restless-ness, apprehension
Metabolic alterations: hyperglycemia, hypokalemia, hypocalcemia
Side effects dose related and more prominent during increases in the infusion rate than during maintenance therapy
ECG clearance suggested, HTN and uncontrolled DM are contraindication
Magnesium Sulfate
Depression of deep tendon reflexes, respiratory depression, cardiac arrest (usually at serum magnesium levels >12 mg/dl)
Less serious side effects: lethargy, weakness, visual blurring, headache, sensation of heat, nausea, vomiting, constipation, oliguria
Fetal-neonatal effects: reduced heart rate variability, hypotonia
Adverse effects dose related, occurring at higher serum levels
Indomethacin (postagalndlin synthesis inhibitor)
Epigastric pain, gastrointestinal bleeding; increased risk for bleeding: dizziness.
Fetal effects: may have constriction of ductus arteriosus and decreased urinary output; decreased urinary output is associated with oligohydramnios, which may result in cord compression Respiratory distress syndrome

Nifedipine (Procardia)
(calcium channel blocker)
Maternal flushing, transient tachycardia. hypotension; use with magnesium sulfate can cause serious hypotension and low calcium levels

Corticosteroids
Increased blood sugar
Given to accelerate production of surfactant, increase fetal lung maturity, and prevent neonatal intracranial hemorrhage
Betamethasone, dexamethasone

Monitor mother and newborn closely: mother for pulmonary edema and hyperglycemia, and newborn for heart rate changes
Given to mother 24-48 hr before birth of premature newborn (<34 wk gestation) because it can hasten lung maturity
Terbutaline (Brethine) (B-adrenergic agonist)
Tachycardia; monitor vital signs
Shortness of breath; monitor insertion site for infection

PREMATURE RUPTURE OF MEMBRANES
PROM- 1hr before true labor, PPROM- before 37 wk gestation
Nitrazine paper test will turn blue-green on contact with amniotic fluid
MANAGEMENT
Bed rest with bathroom privileges and observation for infection, NST, and daily assessment of fetal compromise
DYSTOCHIA
Difficult labor results of power, passageway, passenger, psyche.
Nursing assessment of intensity, frequency, and duration of contractions is important
POWERS
ABNORMAL UTERINE CONTRACTIONS
Dysfunctional labor results from abnormal uterine contractions that prevent normal progress of cervical dilation, effacement, and descent of presenting part
HYPOTONIC DYSFUNCTION AND HYPERTONIC UTERINEDYSFUNCTIONS
When occurs
Contraction
Implications
Management
Hyoptonic Labor
Active phase, may occur in latent phase
Infrequent, poor intensity, low resulting tone between contractions
Maternal: seldom, painful, prolonged labor, PROM, risk of infection, anxiety
Fetal: