Precipitate labor and delivery Nursing diagnosis:

-occurs within 3 hours from onset of

contraction to the delivery of the baby. Uterine rupture:
Causes:
Signs and symptoms:
 Rate of cervical dilatation 5cm.hr or - Tearing of scar from previous C/S
faster in nullipara - Prolonged laor, malpresentation
 10cm per hour in multipara - Overdistention
 Desire to push - Unwise use of oxytocin. Forceps and
 Hypertonic contractions vacuum extraction.
 Intense pain more than normal
 Restlessness. S and S:
Impending uterine rupture
Predisposing factors: - Pathologic retraction ring
1. Multiparity - Strong uterine contractions without
2. Maternal fatigue previous brief labor cervical dilatation
3. Age >35: younger than 20 #prepare fo CS

Precipitating: If uterus should rupture;

1. Induction of labor 1. Sudden severe pain during a strong
2. Hypertonic contraction labor contraction
3. Multiple gestation 2. Tearing or popping sensation in the
4. Adequate pelvis and small fetus abdomen.
5. Anxiety and stress
Types of rupture:
Complication: Complete
Maternal: - Goes through endometrium,
1. Uterine rupture myometrium and perimetrium.
2. Laeration of birth canal - Uterine contractions stop
3. Pp haemorrhage - Signs of shock
4. AFE - Change in abdominal contour
Fetal: - Fetal parts are palpable thru the
5. hypoxia abdominal wall.
6. Infection intracranial bleeding Incomplete:
- Leaves the perimetrium intact
Management: - Persistent tenderness over the lower
 Tocolytics – medical segment.
 Episiotomy as necessary – surgical - Disorganized uterine patter
- Fetal bradycardia.
 EMERGENCY DELIVERY OF AN INFANT
1. Pant and blow Management:
2. Do not prevent birth of the baby 1. Blood transfusion and IVF. Admin
3. Maintain sterile environment 2. )2 inhalation
4. Handle the delivery 3. E laparotomy
Important consideration: come to the hospital 4. Emotional support
at first sign of labor
INVERSION OF THE RUPTURE
Cause:
 1. Application of traction to the Causes:
umbilical cord. Retain placental fragments
2. Application of rupture to the fundus Infection
when the uterus is not contracted Sub involution of uterus
3. If placenta Is attached to the fundus.

Signs and symptoms:

- Sudden gush of blood from the vagina
- Fundus is not palapable in the
abdomen
- Signs of shock

Interventions:
1. Do not attempt to replace an
inversion
2. Never attempt to remove the
placenta if it is still attached
3. Do not give oxytocin
4. O2 inhalation and assess vital sings
5. General anesthesia or tocolytic IV
6. Make an attempt to reposition the
uterus
7. Oxytocic after manual replacement
8. Antibiotic
9. C/S during future pregnancies.

POST PARTUM COMPLICATIONS:

1. Hemorrhage
2. Infection
3. Thromboembolic disorder
4. Psychiatric disorders.

POST PARTUM HEMORHAGE:

- Decreased in the haematocrit of 10
percent or greater after delivery.
-
Types:
a. Early PP hemorhage: first 24
hours
Causes:
Uterine atony
Laceration and hematoma of birth canal
Inversion o uterus

b. Late PP haemorrhage: after 24 hrs

– 4 wsks