Labor and Delivery Emergencies and
Complications
Review and Preparation
● Practice dosage calculations.
● Understand the GTAL (Gravida, Term, Preterm, Abortions, Living) system for obstetric
history.
● Know how to estimate the date of delivery.
● Be prepared for therapeutic communication, especially when patients want to
incorporate cultural practices into their labor.
Shoulder Dystocia
Definition:
Shoulder dystocia occurs when the baby's shoulder becomes impacted behind the pubic bone
after the head has delivered. This is a serious and emergent situation.
Intervention:
● Perform McRoberts' Maneuver: Hyperflex the mother's legs and knees towards her
chest, pressing her thighs against her abdomen.
● Apply suprapubic pressure (above the pubic bone).
● DO NOT apply fundal pressure.
Umbilical Cord Prolapse
Definition:
Umbilical cord prolapse is a rare but emergent medical emergency where the umbilical cord
slips ahead of the fetus and protrudes through the cervix into the vagina before the baby
delivers. Instead of the baby's head presenting, the cord presents.
Signs:
A sudden drop in fetal heart rate immediately after the mother's water breaks can indicate cord
prolapse.
,Intervention:
● Immediate Pressure Relief: The labor nurse must place a hand inside the vagina to lift
the presenting part of the fetus off the cord, relieving pressure.
● Maintain Position: Hold the cord until the baby is delivered to prevent cord
compression, which decreases fetal oxygen levels.
● Goal: Allow oxygen and blood flow through the placenta, umbilical cord, and to the fetus.
Placenta Previa
Definition:
A painless, bright red bleeding that occurs when the placenta covers the cervix, partially or
completely. It acts like a curtain over the cervix.
Intervention and Management:
● Pelvic Rest: No vaginal exams are permitted.
● Patient Education:Tell patient bedrest.
● Preparation: Prepare for IV access, fluids, and possibly an ultrasound to confirm
placental position, as the placenta can shift.
● Delivery: Usually requires a Cesarean section.
Placental Abruption
Definition:
The premature detachment of the placenta from the uterine wall. This is an emergent situation.
Signs and Symptoms:
● Painful, dark red bleeding.
● Firm, tender, or rigid uterine tone.
Intervention and Management:
● Monitoring: Closely monitor fetal heart rate (FHR).
● Management: Administer IV fluids, and prepare for possible blood products and
emergency delivery.
Terminology Clarification:
● Abruption: Abrupt detachment.
, ● Previa: "Pre" means before, "via" relates to passage (like through the cervix); hence,
covering the cervical opening.
Premature Rupture of Membranes (PROM)
Definition:
PROM means pre-rupture of membranes. This is when the amniotic sac ruptures (water breaks)
before the onset of labor.
Risks:
● Increased risk for infection for both mother and fetus.
● Risk for infection.
Intervention and Management:
● Monitoring: Close monitoring is required.
● Key Sign of Infection: A fever or elevated temperature is a critical indicator of infection.
● Patient Education:No intercourse when PROM.
● Assessment: Monitor temperature.
Fetal Heart Rate Monitoring and Decelerations
Decelerations are observed on the fetal monitor during labor and indicate changes in the fetal
heart rate. Different types require specific nursing interventions.
Variable Decelerations
● Cause: Often caused by compression on the umbilical cord.
● First Nursing Intervention:Change position of patient.
● Additional Interventions: Apply oxygen, administer IV fluids.
● Goal of Repositioning: To relieve pressure on the umbilical cord.
Late Decelerations
● Concern: These are concerning and can indicate placental insufficiency or inadequate
perfusion of the placenta, meaning oxygen lacking.
● First Nursing Intervention: Place the patient in the left lateral position.
● Additional Intervention:Stop oxytocin if it is being administered.
● Rationale for Left Lateral Position: Optimizes blood flow to the placenta.
Early Decelerations
Complications
Review and Preparation
● Practice dosage calculations.
● Understand the GTAL (Gravida, Term, Preterm, Abortions, Living) system for obstetric
history.
● Know how to estimate the date of delivery.
● Be prepared for therapeutic communication, especially when patients want to
incorporate cultural practices into their labor.
Shoulder Dystocia
Definition:
Shoulder dystocia occurs when the baby's shoulder becomes impacted behind the pubic bone
after the head has delivered. This is a serious and emergent situation.
Intervention:
● Perform McRoberts' Maneuver: Hyperflex the mother's legs and knees towards her
chest, pressing her thighs against her abdomen.
● Apply suprapubic pressure (above the pubic bone).
● DO NOT apply fundal pressure.
Umbilical Cord Prolapse
Definition:
Umbilical cord prolapse is a rare but emergent medical emergency where the umbilical cord
slips ahead of the fetus and protrudes through the cervix into the vagina before the baby
delivers. Instead of the baby's head presenting, the cord presents.
Signs:
A sudden drop in fetal heart rate immediately after the mother's water breaks can indicate cord
prolapse.
,Intervention:
● Immediate Pressure Relief: The labor nurse must place a hand inside the vagina to lift
the presenting part of the fetus off the cord, relieving pressure.
● Maintain Position: Hold the cord until the baby is delivered to prevent cord
compression, which decreases fetal oxygen levels.
● Goal: Allow oxygen and blood flow through the placenta, umbilical cord, and to the fetus.
Placenta Previa
Definition:
A painless, bright red bleeding that occurs when the placenta covers the cervix, partially or
completely. It acts like a curtain over the cervix.
Intervention and Management:
● Pelvic Rest: No vaginal exams are permitted.
● Patient Education:Tell patient bedrest.
● Preparation: Prepare for IV access, fluids, and possibly an ultrasound to confirm
placental position, as the placenta can shift.
● Delivery: Usually requires a Cesarean section.
Placental Abruption
Definition:
The premature detachment of the placenta from the uterine wall. This is an emergent situation.
Signs and Symptoms:
● Painful, dark red bleeding.
● Firm, tender, or rigid uterine tone.
Intervention and Management:
● Monitoring: Closely monitor fetal heart rate (FHR).
● Management: Administer IV fluids, and prepare for possible blood products and
emergency delivery.
Terminology Clarification:
● Abruption: Abrupt detachment.
, ● Previa: "Pre" means before, "via" relates to passage (like through the cervix); hence,
covering the cervical opening.
Premature Rupture of Membranes (PROM)
Definition:
PROM means pre-rupture of membranes. This is when the amniotic sac ruptures (water breaks)
before the onset of labor.
Risks:
● Increased risk for infection for both mother and fetus.
● Risk for infection.
Intervention and Management:
● Monitoring: Close monitoring is required.
● Key Sign of Infection: A fever or elevated temperature is a critical indicator of infection.
● Patient Education:No intercourse when PROM.
● Assessment: Monitor temperature.
Fetal Heart Rate Monitoring and Decelerations
Decelerations are observed on the fetal monitor during labor and indicate changes in the fetal
heart rate. Different types require specific nursing interventions.
Variable Decelerations
● Cause: Often caused by compression on the umbilical cord.
● First Nursing Intervention:Change position of patient.
● Additional Interventions: Apply oxygen, administer IV fluids.
● Goal of Repositioning: To relieve pressure on the umbilical cord.
Late Decelerations
● Concern: These are concerning and can indicate placental insufficiency or inadequate
perfusion of the placenta, meaning oxygen lacking.
● First Nursing Intervention: Place the patient in the left lateral position.
● Additional Intervention:Stop oxytocin if it is being administered.
● Rationale for Left Lateral Position: Optimizes blood flow to the placenta.
Early Decelerations
