Abnormal Progress in Labor (Precipitous Labor and Birth & Retraction Rings)

Abnormal Progress
in Labor
Precipitous Labor and
Birth
Retraction Rings
Busa, Ana
Marie
Nodalo, Evelyn
Tan, Louie
Ymas, Christine
Precipito
us Labor
and
Precipitate Labor – occur when
uterine contractions are so strong that
the woman gives birth with only so
strong that the woman gives birth
with only a few, rapidly occurring
contractions. It is also defined as an
extremely rapid labor that last less
than 3 hours from start to finish
Precipitate Birth - is a sudden and
often unattended birth.
Contributing
Factors:
•Multiparity
•Large pelvis
•Previous
precipitous labor
•Small fetus in a
favorable position
Signs & Symptoms
• Increased pain more than normal
• Increased maternal heart rate, pulse
and body temp
• Increased BP
• Nasal Flaring
• Anxiety
• Restlessness
• Hypertonic Contractions
Maternal risk:
• Lacerations of the cervix, vagina, and or
perineum
• Uterine rupture
• Amniotic fluid embolism
• Postpartal hemorrhage
• Abruptio placentae
Fetal/neonatal risk:
• Fetal hypoxia
• Cerebral trauma
• Meconium stained fluid
• Low apgar score
ADPI
E
Assessment:
• Assess previous labor history if the woman is a
multipara
• Assess contraction status. Be alert for contractions
that are more frequent than every 2 minutes and
dilatation that progresses faster than normal
(more than 1.5cm/hr)
• Assess fetal status
• Assess mothers comfort level
• Assess mother’s coping abilities
Nursing Diagnoses:
• Acute pain related to accelerated labor pattern
• Risk for ineffective coping related to
ineffectiveness of breathing techniques to relieve
discomfort
Planning:
During the entire process of labor and birth:
• The nurse should closely monitor the woman’s

contractions and cervical dilatation, and an
emergency birth pack is kept near the bedside.
• The nurse should stay in constant attendance,

assist the woman to a comfortable position and
provides a quiet environment.
Nursing Interventions:
Non- Pharmacologic:
• Continue electric monitoring
• Remain in room to provide support and comfort
measures for the woman
• Instruct the woman not to bear down until
she is instructed to do so.
• Instruct woman to pant with contractions if
fetal head is crowning
• Apply gentle pressure anteriorly against the
fetal head to maintain flexion and prevent it
from delivering too quickly.
• Support the perineum by making U shape
with the other hand and supporting the
descending head between contractions to
prevent excess tearing and perineal
lacerations.
Pharmacologic:
• In such cases, a tocolytic agent such as
terbutaline may be administered to reduce
the force and frequency of contractions
• Notify physician for rapid cervical changes
Evaluation:
• The woman and her baby are closely
monitored during labor and a safe birth
occurs
• The woman states that she feels supported
and enhanced comfort during labor and birth
Retractio
n Ring
Retraction Ring - also called Bandl’s Ring
- occurs at the junction of the upper and lower uterine
segments. The Ring usually appears at the 2nd stage of
labor as a horizontal indentation across the abdomen
and is a warning sign that a dysfunctional labor is
occurring; it is formed by excessive retraction of the
upper uterine segment.
-A constriction of the junction between the thinned
lower uterine segment and the thick retracted upper
uterine segment caused by obstructed labor; a sign of
impending rupture of the uterus.
Retraction Ring
Retraction Ring
Ruptured Uterus
Contributing Factors
• An abnormality in a mother’s pelvis (a
contracted pelvis).
• Fetal causes (hydrocephalus, fetal ascitis,
sacrococcygeal tumours, conjoined twins
• Cephalopelvic disproportion
• Previous caesarean section, still births and
previous prolonged labor.
• Delay in referral to higher level of care for
caesarean sections
• Abnormal presentations and position
Signs & Symptoms
• Hypertonic contractions
• Presenting part driven/jammed
• Mother experiences severe pain and excited or restless emotions
• Maternal pulse, temperature rise
• Palpable, taut round ligaments; may also be visible
• Baby entirely or almost entirely in lower uterine segment.
• Ring felt as transverse ridge, as high up as umbilicus or
potentially even higher
• Mother maybe cold and clammy Anxious and restless
• Uterus is painful and sore to touch
• Fundus is thickened and tense
• The mother complains of severe abdominal pains
Maternal Risk:
• Puerperal sepsis
• rupture of the lower segment,
• maternal hemorrhage
• maternal exhaustion, inertia, and arrest of
contractions
• maternal fistula, lacerations
• Neonatal Risk:
• Asphyxia
• Intracranial hemorrhage
• Delayed complications—delayed milestones,
convulsive disorders, mental retardation etc.
• placental abruption
• uteroplacental insufficiency with resultant fetal
hypoxia and distress.
• still births and neonatal death
Pathologic retraction ring occurs,
strong uterine contractions w/o
cervical dilatation
“tearing sensation”
Complete Uterine Incomplete Uterine
rupture rupture
Rupturing of endometrium, Rupturing of endometrium and

myometrium and perimetrium myometrium
Localized tenderness and

Uterine contraction stops persisting aching pain over the
area of the uterine segment
Bleeding into the peritoneal

Swelling of the abdomen:
•Retracted uterus cavity
•Extrauterine fetus
Hemorrhage from torn uterine

arteries
Bleeding to the vagina
Decreased blood volume Decreased cardiac output
Heart attempts to circulate

Decreased venous return
remaining blood volume
Decreased BP
Vasoconstriction of
peripheral vessels,
increased heart rate
Increases gas exchange to
oxygenate better the
Cold, clammy skin
decreased blood volume
Increased respiratory rate
Uterine perfusion is Continued blood loss will

decreased continue to fall BP
Fetal distress
Decreased brain perfusion

Decreased kidney perfusion
Decreased LOC (lethargy,

coma) Decreased urine output
Renal failure
Death of Mother and fetus

ADPI
E
Assessment
• Assess maternal vital signs; especially note an increase in rate
and depth of respirations, an increase in pulse , or a drop in BP
indicating status change.
• Observe for signs and symptoms of impending rupture (ie, lack
of cervical dilatation, tetanic uterine contractions, restlessness,
anxiety, severe abdominal pain, fetal bradycardia, or late or
variable decelerations of the FHR).
• Assess fetal status by continuous monitoring.
• Assess fetal position, presentation and descent.
• Assess laboring woman for hydration status.
• Assess woman’s comfort and coping level.
Diagnosis
•Acute Pain related to inability to
relax secondary to labor pattern
•Fatigue and Anxiety related to
prolonged labor
•Risk for deficient fluid volume
related to length and work of
labor.
Planning
During the entire process of labor and birth:
• The nurse should closely monitor the
woman’s contractions and cervical
dilatation, and an emergency birth pack is
kept near the bedside.
• The nurse should stay in constant
attendance, assist the woman to a
comfortable position and provides a quiet
environment.
Intervention
Non-Pharmacologic Intervention
• Monitor labor status and fetal status
through continuous electronic monitoring
and then compare to expected norms.
• Assist in relaxation and breathing
techniques, Back-rubs, change sheets
• Maintain a quiet and calm atmosphere to
enhance relaxation.
• Try alternative maternal positions or
activity that might facilitate rotation of
fetal head or assist with fetal descent.
• Ask patient to lie on the left side to
prevent impeding the vena cava.
Pharmacologic Interventions
• Start IV Fluid as prescribed to provide
glucose for energy.
• Prepare for Cesarean Section as
indicated.
• Administer IV morphine sulfate or the
inhalation of amyl nitrate as
prescribed to relieve retraction ring.
• Administer tocolytic as prescribed to
halt contractions.
Evaluation
• Client states that she is able to
continue active participation in labor
and maintains effective breathing.
• The woman and her baby are closely
monitored during labor and a safe
birth occurs
• The woman states that she feels
supported and enhanced comfort
during labor and birth
Thank you
for
Listening!!!!

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Abnormal Progress in Labor (Precipitous Labor and Birth & Retraction Rings)

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Abnormal Progress

• The nurse should closely monitor the woman’s

• The nurse should stay in constant attendance,

Rupturing of endometrium, Rupturing of endometrium and

Localized tenderness and

Bleeding into the peritoneal

Hemorrhage from torn uterine

Decreased blood volume Decreased cardiac output

Heart attempts to circulate

Increased respiratory rate

Uterine perfusion is Continued blood loss will

Decreased brain perfusion

Decreased LOC (lethargy,

Death of Mother and fetus

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