07.07 Dystocia

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Overview

  1. Difficult labor that may be prolonged or extraordinarily painful

Nursing Points

General

  1. Various reasons
    1. Hypotonic contractions: too weak, ineffective
    2. Hypertonic contractions: too strong, uncoordinated
    3. Extremely large fetus
    4. Fetus is awkward/bad position
    5. Less than ideal maternal pelvic structure

Assessment

  1. Excessive pain
  2. Fetal distress
  3. Uncoordinated/disorganized contractions
  4. Labor not progressing

Therapeutic Management

  1. Assess for fetal distress
    1. Notify MD as appropriate
  2. Administer medications as ordered
    1. Pain meds
    2. IVF
    3. Tocolytics
  3. Promote rest
  4. If hypotonic contractions are occurring, oxytocin (Pitocin) may be indicated.  Begin appropriate monitoring of mother and baby and titrate appropriately.

Nursing Concepts

  1. Reproduction
  2. Safety

Patient Education

  1. Turn and reposition
  2. Medication options

Reference Links

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Video Transcript

In this lesson I will explain dystocia and your role in providing care.

Dystocia means prolonged labor or painful labor. The labor doesn’t go as smoothly as it should. This occurs for various reasons. Labor could be hypotonic which means that contractions are too weak and ineffective. We need contractions to happen at a certain increment and strength to cause dilation and effacement. With hypotonic labor this doesn’t happen. Hypertonic contractions will be the opposite. These are too strong and uncoordinated. This causes a lot of pain and because they are not coordinated proper dilation and effacement don’t occur. An extremely large fetus can prolong labor because it takes longer for the fetus to get itself delivered. If the fetus is in a bad position or the pelvic structure is not ideal it will prolong labor. If the fetus isn’t lined up in the pelvis correctly then its going to take longer. Think about those awkward times you have tried to move a couch through a doorway. You have to get lined up just right to get in or out, right?! So if the fetus is a little too much to the left or right in the pelvis and not centered then it will take longer to get out

What do we find on assessment? The patient might have excessive pain. In a uterus that is hypertonic it is contracting constantly. It’s like a charlie horse that you get but in your abdomen. So the muscle cannot relax so this means pain! This also means fetal distress. If the uterus is contracting too much it is not resting in between. When the uterus rests it refills with blood and healthy nutrients for the fetus. So this means if the uterus can’t rest, it can’t refill with oxygen so this means the fetus gets distressed. Another assessment piece is that on the monitor strip you will see uncoordinated contractions. So the contractions aren’t consistent. This will cause labor to not progress and prolong the process. Good strong regular contractions will push the fetus down to the cervix and the head on the cervix will help dilate the cervix. If contractions are not in a good strong regular pattern then it will take longer for this process.
For our management of this patient we will be constantly assessing for fetal distress. If the fetus shows any distress then we need to notify the doctor immediately. We will give medications as ordered. So some of these medications will be for pain of contractions, IV fluids if the patient is having painful contractions from dehydration or if she needs IV fluids prior to getting her epidural. Tocolytics might be given if there is hypertonic labor and we need to stop all the contractions and relax the uterus. If labor is hypotonic so we don’t have good contractions then we might be giving oxytocin or pitocin to get contractions going and stronger. For some we will be promoting rest for this patient. She needs to rest in between contractions. For other patients like those in hypotonic labor we might get them to walk. Walking can help strengthen contractions or bring them closer together so that’s why it will help hypotonic labor.
Education will involve educating on different positions and helping her turn and reposition to these positions. Sometimes turning the patient and different positions can help get the baby into a better place. Also education on her medication options. If she wants something temporary to take the edge off before getting an epidural or if she wants to go straight for the epidural. Just helping the patient know her options so she can have a say in her care.

Reproduction and safety are our nursing concepts for someone having labor dystocia. We always want to promote safety of mom and baby and dystocia can cause some unsafe situation.
Let’s review. Dystocia is a labor that is either prolonged and does not progress the way it should or a labor that is extremely painful. Things that cause labor to be prolonged are a hypotonic labor. So a labor where we don’t have good contraction patterns. We need contractions because this helps to push the baby down in the pelvis and out. Macrosomic babies, so big babies will take longer to deliver. A small pelvis or poorly positioned fetus. Remember we need the fetus to be lined up just right to get it’s way out. Painful labor is caused by hypertonic labor. So strong, too frequent contractions. Think of a charlie horse in your calf that is continuous. That hurts! So that is similar to what is happening with the uterus. When this is occurring in the uterus the muscle stays contracted and cannot fully relax, which causes pain!

Make sure you check out the resources attached to this lesson and review the different management for different dystocia. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 5

A nurse believes her laboring client may be experiencing hypotonic labor. Which finding would be consistent with this?

  • Question 2 of 5

A nurse believes her laboring client may be experiencing hypertonic labor. Which finding would be consistent with this?

  • Question 3 of 5

A nurse is assessing multiple laboring clients. The nurse knows which client is more at risk for dystocia?

  • Question 4 of 5

A nurse is caring for a laboring client an notes signs of hypertonic labor. What nursing action(s) should the nurse take at this time. Select all that apply.

  • Question 5 of 5

A nurse is caring for a laboring client. Contractions are 6-7 minutes apart and the client is 4 cm dilated with intact membranes. This is unchanged from the last exam several hours ago. What is the expected management for this patient? Select all that apply.

Module 0 – OB Course Introduction

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