PROBLEMS

WITH THE
POWER 2
 Hypertonic uterine Contraction
Frequent contractions with decreased intensity
and increased uterine tone occurring during the
latent phase of labor
ineffective in causing cervical dilation or
effacement to progress
uterus does not relax completely between
contractions
Occurs before 4 cm dilation
MATERNAL EFFECTS
Loss of control related to intensity of
pain and lack of progress
Exhaustion

FETAL EFFECTS
Fetal asphyxia with meconium aspiration
Management:
Monitor uterine contraction
Initiate therapeutic rest measures
Administer analgesic
Monitor fetus though fetal external monitor
Cesarean birth indications:
Presence of late deceleration
abnormally long first stage oflabor
lack of progress with pushing.
Nursing diagnoses on women
experiencing
1. Dystocia or fetal injury related to
Risk for maternal
interventions implemented for dystocia
2. Powerlessness related to loss of control
3. Risk for infection related to rupture of
membranes
4. Ineffective coping related to lack of support
system
5. pain
Hypotonic Uterine Contraction
Onset: late onset;usually in the
active phase
Contractions: weak;painless
Tension not synchronous
Causes: overdistention,
advanced age, increased parity,
contractures, fetal malposition,
analgesia/ anesthesia
Treatment: enema, walking if
Hypertonic Uterine Contraction
Onset: early onset; as early as
latent phase
Contractions: strong, painful
Uncoordinated, increased
contractions but ineffective
dilatation
Causes: primigravidity, young
age, improper use of oxytocin
Treatment: sedation, rest,
ABNORMAL PROGRESS IN LABOR
 Dysfunction at the
First Stage of Labor
 PROLONGED LATENT PHASE
Ineffective contractions during the rst stage
of labor
> 20 hours in a nulliparous patient
> 14 hours in a multiparous client
May indicate CPD

Causes:
cervix is not ripe
excessive use of an analgesic early in labor
Management:
Help uterus to rest
adequate uid for hydration
pain relief (morphine sulfate)
Changing the linen and the womans gown
darkening room lights
decrease noise and stimulation
amniotomy (articial rupture of membranes)
oxytocin infusion to assist labor may be necessary

PROTRACTED ACTIVE PHASE DILATION
Dilatation < 1.2 cm in nulliparous
Dilatation < 1.5 cm in multiparous
active phase lasts >12 hours in
primigravida
active phase lasts >6 hours in a
multigravida
Causes :

Management:
ultrasound to show that CPD is not
present
oxytocin to augment labor
Ifthe cause is fetal malposition or
CPD, cesarean birth is done
 Dysfunction at the
Second Stage of Labor
PROLONGED/PROTRACTED DESCENT

descent is :
< 1cm/hr in a nullipara
2cm/hr in a multipara

second stage lasts over 3 hours

in a multipara
Management:
rest
IV fluid therapy
Amniotomy (artificial rupture of
membrane)may be helpful
Intravenous (IV) oxytocin
Semi-Fowlers position, squatting, kneeling,
or more effective pushing may speed