Labor Dystocia, Prolapsed Umbilical Cord, and C-Section Births

Introduction

• Overview provided by Meris from Level Up RN.
• Discussion on labor dystocia, prolapsed umbilical cords, and C-sections.
• Reference to maternity flashcards available on leveluprn.com.

Labor Dystocia

Definition

• Dystocia: Prolonged or difficult birth.

Causes

• Fetal Macrosomia: Large baby difficult to pass through the pelvis.
• Maternal Fatigue: Prolonged labor can exhaust the mother.
• Uterine Abnormalities: Structural differences or weaknesses.
• Cephalopelvic Disproportion: Baby's head too big for pelvis.
• Fetal Malpresentation: Baby not positioned correctly.
• Anesthetic/Analgesic Use: Strong epidurals can hinder effective pushing.

Signs and Symptoms

• Lack of labor progression (e.g., dilation, effacement, fetal descent).

Interventions

• Encourage ambulation or position changes to aid baby’s rotation.
• For posterior to anterior baby positioning: Position mother on hands and knees.

Shoulder Dystocia

• Emergency: Fetal shoulder stuck on maternal pelvis.
• Possible damages: Nerve, muscle, bone injuries.
• Interventions:
  • Suprapubic pressure.
  • McRoberts maneuver.

General Management Options

• Amniotomy, Oxytocin administration.
• Prepare for assisted delivery or C-section.

Prolapsed Umbilical Cord

Definition

• Cord protrudes through cervix ahead of baby.

Risks

• Cord compression leading to fetal hypoxia, distress, compromised circulation.

Detection

• Visual inspection or manual palpation during cervical check.
• Variable decelerations on fetal heart monitoring.

Nursing Care

• Call for assistance without leaving the patient.
• Use sterile gloves, insert fingers to lift fetal presenting part off the cord.
• Positioning: Knee-chest or Trendelenburg.
• Cover exposed cord with warm, sterile saline-soaked towel.
• Administer oxygen and prepare for C-section.

C-Section (Cesarean Section)

Definition

• Surgical delivery of infant via abdominal and uterine incision.

Types of Anesthesia

• Spinal Anesthesia: For planned C-sections.
• Epidural Anesthesia: Transition from vaginal to C-section.
• General Anesthesia: Used in emergencies ("splash-and-dash")

Indications for C-Section

• Labor dystocia, fetal malpresentation, failure to progress.
• Fetal distress and prior C-section.

Complications

• Hemorrhage and infection.

Nursing Care

• Ensure IV access, insert Foley catheter, run IV fluids.
• Administer preoperative medications (e.g., antibiotics).
• Provide postoperative analgesia (e.g., Duramorph).
• Monitor incision site for infection or complications.

Review Quiz

• Shoulder Dystocia Pressure: Suprapubic region.
• Positions for Prolapsed Cord: Trendelenburg or knee-chest.
• Care for Exposed Cord: Cover with warm, sterile, saline-soaked towel.

Conclusion

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