Bad obstetric history simply implies previous unfavourable fetal outcome in terms of two or more consecutive spontaneous abortions, history of intrauterine fetal death, intrauterine growth retardation, still birth, early neonatal death and congenital anomalies.
Possible Causes of Bad Obstetric History
Bad obstetric history may be caused by some of the following;
- Genetic
- Hormonal
- Abnormal maternal immune response
- Maternal infection.
- Primary infections caused by toxoplasma gondii, rubella virus, cytomegalovirus, and herpes simplex virus is one of the major causes of bad obstetric history.
Obstetric Emergencies Related to Mother That May Lead to Bad Obstetric History
- Vasa previa; when the fetal blood vessels lay over the OS in front of the presenting part.
- Cord prolapse; the cord lies in front of the presenting part when the membranes are ruptured.
- Shoulder dystocia; inability of the shoulder to transverse the pelvis spontaneously after delivery of the head.
- Obstetric shock.
- Postpartum haemorrhage.
- Ante partum haemorrhage.
- Severe eclampsia.
- Severe Pre-eclampsia.
- Maternal exhaustion.
Read Also: How To Diagnose Obstetric Shock
Possible Nursing Diagnosis of a Patient Who Underwent Surgery During Labour Due to Bad Obstetric History
Mother Related;
- Ineffective breathing pattern related to effect of anaesthesia, evidenced by respiratory rate of 36 cycle per minutes.
- Acute pain related to surgical incision evidenced by abnormal guarding.
- Impaired tissue integrity related to surgical incision evidenced by open wound.
- Anxiety related to unknown outcome of her condition evidenced by her numerous questions.
- Bathing selfcare deficit, related to pain associated with surgical incision evidenced by her complaint of pain.
- Disturbed sleep pattern related to anxiety evidenced by being awake through the day.
- Hopelessness related to her inability to deliver a live baby herself evidenced by her complaint of being worthless.
- Situational low self esteem related to her inability to deliver a live baby evidenced by her consistent shaking of her head.
- Powerlessness related to pain evidenced by not being able to lift herself from bed with help.
- Risk for infection related to her open wound.
- Risk for constipation related to her immobility.
- Risk for suicide related to her hopelessness.
- Risk for chronic sorrow related to her previous losses.
- Risk for impaired attachment related to her inability to breast feed within 30 minutes of birth.
- Risk for compromised human dignity related to her feeling of worthlessness.
Baby Related;
- Ineffective airway clearance related to excess mucous evidenced by inability to cry.
- Ineffective breathing pattern related to the effect of general anaesthesia evidenced with paleness with Apgar score of 6.
- Hypothermia related to exposure to air evidenced by inability to cry.
- Risk for delayed development related to inability to thrive associated with neonatal asphyxia.
Methods of Pain Relieving During Labour
Homeopathy;
This aims to reinforce the body’s physiological response. Homeopathy remedies are prepared from plant extract and minerals. It aims at relieving anxiety and alleviate back pain during labour.
Hydrotherapy;
This involves the immersion in water as means of analgesia. It has the following benefits;
- Relieves discomfort and strain on the pelvis.
- There is less risk for augmentation with oxytocics
- Reduction in the use of analgesia.
- Reduction in the length of labour.
- Lower incidence of genital tract trauma.
Transcutaneous Electrical Nerve Stimulation(TENS);
This is an effective method of relieving pain in labour. TENS stimulates the production of natural endormorphins and enkephalins and thereby impeded incoming pain stimuli. TENS apparatus consist of four electrodes which are positioned at the level of T10 and L1 on the mother’s back and are effective for the control of pain during the first stage of labour. The other two electrodes are situated between S2 and S4 and control pain at the second stage of labour.
Music Therapy;
Research is still on as to its benefit in labour
Opiate Drugs;
These drugs work by binding to the reception sites of the central nervous system.
Inhalational analgesia ;
This is an anaesthetic in the form of gases and volatile liquid, used in labour for relieving pain. When given in large doses it produces analgesic effect and loss of consciousness, but when given in smaller doses or more dilute form they produce only analgesic effect.
Regional(epidural) Analgesia;
This works by blocking the conduction of impulses along the sensory nerves as they enter the spinal cord thus relieving pain in the patient.
- It tends to lower the blood pressure, hence it is important in pregnancy induced hypertension.
- It does not depress the respiratory centre of the fetus.
- It gives effective pain relieve in prolonged labour thus allowing the mother to rest.
- It enquires more frequent monitoring of vital signs.
- It lengthens the first stage of labour.
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