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IF LABOR CONTINUES:
• Assessment:
• Onset (latent phase & most common in active phase).
• Contractions - normal previously, will demonstrate:
• Decreased frequency.
• Shorter duration.
• Diminished intensity (mild to moderate).
• Less uncomfortable.
• Cervical changes – slow or cease.
• Signs of fetal distress – rare.
• Usually late in labor d/t infection secondary to prolonged
ROM.
• Tachycardia.
• Grade III: The bleeding may be severe & may be concealed in some
instances. Uterine ctx are tetanic and painful. Maternal hypotension may be
present. The fibrinogen level is greatly decreased & there are coagulation
problems.
Diagnosis: may be made by ultrasound, but frequently the diagnosis is made and
confirmed at delivery, by inspection of the placenta.
• Umbilical Cord Abnormalities
• Velamentous insertion of the cord
• Umbilical cord compression
• Umbilical cord prolapse
• Velamentous Insertion of the Cord
• Condition where the umbilical cord joins the placenta at the edge, rather than
the typical insertion in the center.
• Can result in chronic altered fetal perfusion. Can lead to trauma and
compression during L&D, resulting in rupture and hemorrhage.
• Assessment:
• Visualization of cord outside (or inside) vagina.
• Palpation of pulsating mass on vaginal exam.
• Fetal distress – variable deceleration and persistent bradycardia.
• Nursing interventions:
• Reduce pressure on cord.
• Increase maternal / fetal oxygenation (O2 per mask @ 8-10 liters).
• Protect exposed cord (continuous pressure on presenting part to keep
pressure off cord).
Causes:
• Partial separation of normal placenta
• Entrapment of the partially or completely separated placenta by uterine
constriction ring
• Mismanagement of the 3rd stage of labor
• Abnormal adherence of the entire placenta or a portion of placenta to
the uterine wall
Types:
• Nonadherent retained placenta
• Adherent retained placenta