Intrapartum complications: Nursing

The intrapartum period begins with the onset of labor and lasts until the delivery of the newborn and placenta. Complications during the intrapartum period can be related to premature rupture of membranes, or PROM, and preterm labor.

PROM is when the amniotic membranes spontaneously rupture before the beginning of true labor. PROM can lead to complications such as oligohydramnios, meaning there isn’t enough amniotic fluid left to surround the fetus; and umbilical cord prolapse, which is when the umbilical cord moves ahead of the fetus and becomes compressed, which cuts off circulation to the fetus.

PROM also makes it easy for microorganisms in the vagina to travel into the uterus, causing chorioamnionitis, which is an infection of the remaining amniotic tissue and fluid.

PROM can present as either a gush of vaginal fluid or a slow leaking of fluid from the vagina. Diagnosis of PROM is made by sterile speculum exam to look for a pool of fluid near the cervix.

If fluid is present, PROM can be confirmed if pH testing shows alkalinity of the fluid. Other information can be gathered during the speculum exam, including an estimation of cervical dilation and effacement, as well as testing the fluid for the presence of phosphatidylglycerol, or PG, which is an indication of fetal pulmonary maturity.

Nursing management of PROM primarily depends on the gestational age and involves weighing the risks of preterm birth versus expectant management, which consists of observation for infection, labor onset, and testing for fetal well-being.

In all cases, you’ll administer antibiotics prophylactically, as ordered, even if infection isn’t suspected. If your patient is at 37 weeks of gestation and labor doesn't start soon, labor will typically be induced with oxytocin after cervical softening agents like prostaglandin E2 have been administered, as needed.

If gestation is between 34 to 36 weeks and there’s evidence of chorioamnionitis and fetal compromise, labor should be induced promptly.

Otherwise, you’ll manage your patient expectantly with close monitoring for infection, fetal lung maturity, and fetal activity; and you’ll administer corticosteroids to promote fetal lung maturity in addition to antibiotics.

If expectant management can be safely done at home, be sure to teach your patient to take steps to decrease the risk of infection by not inserting anything vaginally and avoiding sexual intercourse.

In cases of preterm gestation, teach them to avoid breast stimulation, which can stimulate uterine contractions. Finally, teach them to contact their health care provider right away for signs or symptoms of infection such as an elevated temperature, foul-smelling vaginal discharge, abdominal tenderness; if there’s a decrease in fetal movement; or if uterine contractions begin.

Preterm labor is when labor occurs after the 20th week of pregnancy but before the 37th week. Complications are mostly related to preterm birth, since the fetus is not yet ready for extrauterine life.

These complications can include neonatal respiratory distress and neurologic disabilities. The presentation of preterm labor can be subtle and can manifest as menstrual-like cramps; pelvic pressure; a sensation that the fetus is pushing downward on the pelvic floor; low back pain; and watery or bloody vaginal discharge.

Cervical changes like effacement, dilation, and shortening of cervical length will also be present. Testing can be done to look for the presence of biomarkers in the amniotic membranes that are associated with preterm labor like the fibronectin and placental alpha macroglobulin‑1, or PAMG-1.

Nursing management of preterm labor is focused on delaying birth and preventing complications. To help promote blood flow to the fetus and decrease fetal pressure on the cervix, assist your patient into a side-lying position.

You’ll also keep them hydrated by administering the prescribed IV fluids. To help reduce uterine contractions, administer the prescribed tocolytics, like magnesium sulfate; nifedipine, which is a calcium channel blocker; indomethacin, a prostaglandin synthesis inhibitor, or terbutaline, which is beta-adrenergic medication.

Corticosteroids can be administered to promote fetal lung maturity; and if bacterial infections are present or suspected, antibiotics are administered.

During care, you’ll keep a close eye on your patient and their fetus by monitoring vital signs, evaluating uterine contractions and monitoring fetal heart rate patterns.

Also, be sure to provide psychosocial support by encouraging them to express their concerns, providing reassurance, and keeping them informed about their labor progression and the well-being of their fetus.

Alright, as a quick recap...The intrapartum period begins with the onset of labor and lasts until the delivery of the newborn and placenta.

Complications during the intrapartum period can be related to premature