Lecture Notes: Labor Dystocia, Prolapsed Umbilical Cords, and C-Section Births

Labor Dystocia

• Definition: Prolonged or difficult birth.
• Causes:
  • Fetal macrosomia (large baby)
  • Maternal fatigue
  • Uterine abnormalities
  • Cephalopelvic disproportion (baby's head too large for pelvis)
  • Fetal malpresentation (baby not in a favorable position)
  • Anesthetic or analgesic use (e.g., strong epidurals affecting pushing effectiveness)
• Signs and Symptoms:
  • Lack of progress in labor (no dilation, effacement, or fetal descent)
• Management:
  • Encourage ambulation or position change
  • Position patient on hands and knees to aid fetal rotation
  • Shoulder dystocia: Emergency where fetal shoulder is stuck
    • Interventions:
      • Apply suprapubic pressure
      • Perform McRoberts maneuver
  • Assist with amniotomy
  • Administer oxytocin as ordered
  • Prepare for possible assisted delivery or C-section

Prolapsed Umbilical Cord

• Definition: The umbilical cord protrudes through the cervix before the baby.
• Consequences:
  • Cord compression can cause fetal hypoxia, fetal distress, compromised circulation
• Detection:
  • Visible or palpable during a cervical check
  • Variable decelerations on fetal heart rate monitor
• Nursing Care:
  • Call for assistance without leaving the patient
  • Insert sterile-gloved fingers to relieve cord compression
  • Position patient in knee-chest or Trendelenburg position
  • Cover exposed cord with warm, sterile, saline-soaked towel
  • Administer oxygen
  • Prepare for emergency C-section

C-Section Births

• Definition: Delivery of an infant via surgical incision in the abdomen and uterine wall.
• Types: Classic, transverse, emergency
• Anesthesia Options:
  • Spinal anesthesia (planned C-section)
  • Epidural anesthesia
  • General anesthesia (emergencies)
• Risk Factors for C-Section:
  • Labor dystocia
  • Fetal malpresentation
  • Failure to progress
  • Fetal distress
  • Previous C-section (some opt for VBAC)
• Complications:
  • Hemorrhage
  • Infection
• Nursing Care:
  • Ensure patent IV
  • Insert Foley catheter
  • Administer IV fluids and preoperative medications
  • Provide postoperative analgesia (e.g., Duramorph)
  • Monitor incision for infection, drainage, dehiscence

Quick Quiz

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

• Recommendation: Subscribe for more educational content.