UNIVERSITY OF THE CORDILLERAS BSN 2 – 2 ND SEMESTER

NCM 109: Care of Mother, Newborn & Child at risk or with problems (Acute & Chronic)
CLINICAL INSTRUCTOR: Ma’am Grace Espino

PROBLEMS WITH THE POWER

 Refers to the ability of the uterine muscle CLASSIFICATION
to contract A. HYPERTONIC UTERINE DYSFUNCTION
 The uterus is an involuntary muscle. It  Resting tone: more than 15 mm Hg.
must not only start contracting but it  Contractions: Frequent prolonged
must establish a pattern of contractions. contractions that are not productive.
 It includes:  Phase of Labor: Latent
o Dystocia  Symptom: Painful
o Premature labor  Cause: This type of contraction occurs
because the muscle fibers of the
o Precipitate labor and birth
myometrium do not repolarize or relax
o Uterine prolapse
after a contraction, thereby "wiping it
o Uterine rupture clean" to accept a new pacemaker
stimulus.
INEFFECTIVE UTERINE FORCE  COLICKY UTERUS
 Occurs when uterine contractions o Incoordination of the different
become abnormal or ineffective, as parts of the uterus in
uterine contractions are the basic force contractions.
behind moving the fetus through the birth  HYPERACTIVE LOWER UTERINE SEGMENT
canal o The dominance of the upper
segment is lost.
DYSTOCIA  The condition is more common in
 Difficult labor or birth primigravidae and characterised by:
 Refers to any labor which does not o Labour is prolonged
advance normally o Uterine contractions are
 A dysfunctional labor may result from irregular and more painful. The
problems with powers of labor, the pain is felt before and
passenger, the passage, the psyche; or a throughout the contractions with
combination of these marked low backache often in
occipito-posterior position.
FACTORS o High resting intrauterine
 Forces are inadequate (Faulty power). pressure in between uterine
Example: Inertia – sluggishness of uterine contractions detected by
contractions tocography (normal value is 5-10
 Abnormal position of the passenger mmHg).
(infant) o Slow cervical dilatation
 Abnormal passageway (birth canal) o Premature rupture of
membranes.
COMMON CAUSES o Fetal and maternal distress.
 Maternal fatigue B. HYPOTONIC UTERINE DYSFUNCTION
 Maternal inactivity  The slowing or complete arrest of the
 Inappropriate use of analgesia (excessive progress of labor, caused by weak or
or too early administration) infrequent contractions of the uterus.
 Disproportion between the maternal  Secondary power dysfunction
pelvis and fetal presenting part  AETIOLOGY:
 Poor fetal position (Posterior rather than o Unknown but the following
anterior) factors may be incriminated:
 Overdistension of the uterine – as with GENERAL FACTORS:
multiple gestation, hydramnios, or  Primigravida porticularly
oversized fetus elderly.
 Presence of a full rectum or urinary  Angemia and asthenia.
bladder that impedes fetal descent  Nervous and emotional
as onxiety and fear.
UNIVERSITY OF THE CORDILLERAS BSN 2 – 2 ND SEMESTER
NCM 109: Care of Mother, Newborn & Child at risk or with problems (Acute & Chronic)
CLINICAL INSTRUCTOR: Ma’am Grace Espino

PROBLEMS WITH THE POWER

 Hormonal due to
deficient prostaglandins
or oxytocin as in RISK FACTORS
induced labour.  Infection
 Improper use of  Uterine atony
anolgesics.  Bleeding
LOCAL FACTORS  Laceration
 Overdistension of the
uterus.
CAUSES
 Developmental
POWER Uterine contractions are not
anomalies of the uterus
in line with the goals of the
 Myomas
stages of labor.
 Malpresentations,
PASSENGER Fetal may be too big or there
malpositions and
is a malpresentation.
cephalopelvic
PASSAGEWAY Pelvic size is small
disproportion
 Full bladder and rectum.
 TYPES: NURSING MANAGEMENT
PRIMARY Weak uterine  Ruling out CPD assessing FHR pattern
INERTIA contractions from the  Assessing characteristics of amniotic fluid
start  Assessing maternal wellbeing
SECONDARY Inertia developed after  Asses bearing down efforts
INERTIA a period of good  General measures:
uterine contractions o Examination to detect
when it failed to disproportion, malpresentation
overcome an or malposition and manage
obstruction so the according to the case.
uterus is exhausted. o Proper management of the first
 Labour is prolonged. stage (see normal labour).
 Uterine contractions are infrequent, weak o Prophylactic antibiotics in
and of short duration. prolonged labour particularly if
 Slow cervical dilatation. membranes are ruptured.
 Membranes are usually intact  Amniotomy:
 The foetus and mother are usually not o Providing that vaginal delivery is
affected apart from maternal anxiety due amenable, the cervix is more
to prolonged labour. than 3 cm dilatation and the
 More susceptibility for retained placenta presenting part occupying well
and postpartum haemorrhage due to the lower uterine segment
persistent inertia. o Artificial rupture of membranes
 Tocography: shows infrequent waves of augments the uterine
contractions with low amplitude. contractions by:
C. UNCOORDINATED CONTRACTIONS  Release of
prostaglandins.
PROLONGED LABOR  Reflex stimulation of
uterine contractions
SIGNS AND SYMPTOMS
when the presenting
 Signs of false labor
part is brought closer to
 Ineffective dilatation of the cervix
the lower uterine
 Ineffective effacement of the cervux
segment.
 Easily exhausted
 ORGANIC DYSTOCIA
 No progress in labor
o Caesarean section is the
 S/S observed through IE:
management of choice.
o Arrest of dilatation
 FUNCTIONAL DYSTOCIA
o Arrest of descent
UNIVERSITY OF THE CORDILLERAS BSN 2 – 2 ND SEMESTER
NCM 109: Care of Mother, Newborn & Child at risk or with problems (Acute & Chronic)
CLINICAL INSTRUCTOR: Ma’am Grace Espino

PROBLEMS WITH THE POWER

o Pethidine and antispasmodics: extends upwards tearing the
may be effective. main uterine vessels.
o Caesarean section: if medical
treatment fails or foetal distress PHYSIOLOGICAL RETRACTION RING
developed.  It is a line of demarcation between the
upper and lower uterine segment present
MEDICAL MANAGEMENT during normal labour and cannot usually
 OXYTOCIN be felt abdominally.
o Providing that there is no  It is the rising up retraction ring during
contraindication for it, 5 units of obstructed labour due to marked
oxytocin (syntocinon) in 500 c.c retraction and thickening of the upper
glucose 5% is given by IV infusion uterine segment while the relatively
starting with 10 drops per possive lower segment is markedly
minute and increasing gradually stretched and thinned to accommodate
to get a uterine contraction rate the foetus.
of 3 per 10 minutes.  The Bandl's ring is seen and felt
abdominally as a transverse groove that
SURGICAL MANAGEMENT may rise to or above the umbilicus.
 OPERATIVE DELIVERY
o Vaginal delivery: by forceps,
vacuum or breech extraction
according to the presenting part
and its level providing that:
 Cervix is fully dilated.
vaginal delivery is
amenable.
o Caesarean section is indicated
in:
 Failure of the previous
methods
 Contraindications to
oxytocin infusion
including disproportion.
 Fetal distress before full
cervical dilatation.

ABNORMAL PROGRESS
CAUSED BY:
 Functional (primary):
o In spite of the absence of any
organic lesion and the well
effacement of the cervix, the
external os fails to dilate.
o This may be due to lack of
softening of the cervix during
pregnancy or cervical spasm
resulted from overactive
sympathetic tone.
 Annular detachment of the cervix:
o Rupture uterus.
o Postpartum haemorrhage:
particularly if cervical laceration