Prolonged labour happens to be a situation where by labour process last for more than the usual time length of labour.
Causes of Prolonged Labour
Below are some major causes of prolonged labour;
- Mal-presentation.
- Nulliparity
- Short stature.
- Tight perineum.
- Cervical dystocia.
- Bandl’s ring
- Teenage pregnancy.
- Mal-positioning.
- Cephalon-pelvic disproportion.
- Full bladder.
- Loaded rectum.
- Uterine atony
- Maternal exhaustion.
- Congenital abnormalities of the uterus.
- Contracted pelvis
- Macrosomia (big baby).
- Contracted pelvis.
- Low lying mass in the pelvis e.g
Possible Nursing and Medical Management of a Patient Undergoing Prolonged Labour
Admission;
- Welcome her warmly into an already made bed.
- Obtain an intelligent history of onset of labour, rupture of membrane, frequency and strength of uterine contraction.
- Access patient’s general condition that is temperature, pulse, respiration, blood pressure and fetal heart rate half hourly and uterine testing four hourly.
- Conduct general examination to exclude anaemia e.t.c.
- Perform abdominal examination to determine lie, presentation, position and engagement.
- Note the type of contraction and fetal heart rate.
- Perform vaginal examination to ascertain degree of dilatation, state of membranes and position of presentation.
Psychological Care;
- Reassure woman and husband to allay their anxiety or fear.
- Give them necessary explanation to enable them understand the situation.
- Obtain consent to all aspects of management.
Comfort and Analgesia;
- Encourage her to adopt the most comfortable position.
- Give adequate analgesics.
Hygiene;
- Maintain adequate hygiene especially if the membranes have ruptured to prevent infection.
- Soiled pads and linens should be changed as necessary.
Observation;
- Closely observe the condition of the woman including her behavior.
- Record all observations on the pathography or client’s record.
- Monitor vital signs closely.
- Take vaginal swab if membranes have longed been ruptured.
- Commence patient on antibiotics when infection is suspected.
Nutrition/Fluid Balance;
- Oral fluids should be restricted to sips.
- Intravenous infusion can be given to prevent dehydration.
- Keep fluid balance chart.
Care of the Bladder;
- Encourage her to empty her bladder every two hours as full bladder may affect uterine action.
- Catheterize her to empty her bladder if she is not able .
- Every urine drained should be tested for sugar, protein and acetone.
- Record the amount of each urine on the fluid chart.
Assessment of Progress
- Perform periodic palpation to assess the descent of the presenting part.
- Carry out vaginal examination four hourly and must be done by the same person each time to avoid variability between examiners.
- Note the cervical dilatation, the consistency of the cervix whether thick or thin and its application to the presenting part .
- Note also the position of the presentation, the degree of moulding and the presence of a caput.
- Note the colour of the amniotic fluid if membranes have ruptured to ascertain if it is meconium stain(should be reported urgently)
Fetal Wellbeing;
- Monitor fetal heart rate continuously as intermittent auscultation cannot assess the baseline variability.
Medical Intervention
Depending on the doctor’s findings, any of the following intervention can be administered:
- Forceps delivery.
- Augmentation of labour with prescribed medication.
- Ventous delivery.
- Cesarean section.
Complications That May Occur Due To Prolonged Labour
To Mother:
- Maternal exhaustion.
- Infection due to repeated vaginal examination.
- Postpartum haemorrhage due to uterine atony.
- Uterine rupture.
- Neurogenic shock.
- Fresh still birth
- Neonatal death
To Baby:
- Fetal distress.
- Asphyxia neonatorum.
- Aspiration pneumonia.
- Caput succedenum.
- Intracranial haemorrhge.
- Neonatal infection.
- Fresh still birth.
- Neonatal death.
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