Procedural Manual For Delivery Cases

Difficult Labor

Difficult labor is one that cannot proceed naturally and requires external intervention. If neglected, it can lead to complications like uterine rupture or fetal death.

Symptoms and Signs of Difficult Labor:

Symptoms in the mother:

• Severe pain.
• Fever (above 38°C).
• Increased heart rate (over 120 beats per minute).
• Presence of acetone in urine.
• Signs of exhaustion (such as facial congestion, color changes, and severe dry lips).
• Swelling of the genital area and vaginal dryness.

Symptoms in the fetus:

• Increased heart rate above 160 beats per minute or decreased below 120.
• Cessation of fetal movement.
• Presence of meconium in the amniotic fluid in the case of vertex presentation.
• Slippage of the skull bones.

Causes of Difficult Labor:

1. Abnormal fetal position and presentation: Such as breech or transverse presentation.
2. Narrow or deformed pelvis: Can hinder the passage of the baby through the birth canal.
3. Abnormal uterine contractions: Can be excessively strong or weak, hindering labor progress.

Early Rupture of Membranes

Early rupture of membranes (amniotic sac tear) can occur before labor begins. This may lead to serious complications like preterm birth or fetal injury.

Symptoms of Early Membrane Rupture:

• Unusual flow of amniotic fluid.
• Continuous leakage of fluid when walking, standing, or straining.
• Presence of meconium in the amniotic fluid.
• Fever in the mother if there is an infection.

Nursing Care:

• Monitor the mother's temperature and fetal heart rate.
• Maintain cleanliness and avoid frequent vaginal examinations.
• Administer medication as per the doctor’s instructions.

Twin Pregnancy

Twin pregnancy occurs when the mother carries more than one fetus. It can be either a monozygotic (identical) or dizygotic (fraternal) pregnancy. Twin pregnancies are associated with complications such as hypertension or preterm birth.

Nursing Care for Twin Pregnancy:

• Delivery should take place in a hospital.
• Support the mother in increasing iron and calcium intake.
• Encourage a healthy diet and continuous monitoring.

Perineal Tears

Perineal tears may occur during delivery, where the skin or muscles of the perineum are damaged as the baby's head passes through.

Types of Perineal Tears:

• First-degree tears: Involve the skin only.
• Second-degree tears: Involve the skin and muscles of the perineum.
• Third-degree tears: Involve the skin, muscles, and the anal sphincter.
• Fourth-degree tears: Involve the skin, muscles, anal sphincter, and rectal wall, creating a single cavity between the vagina and rectum.

Causes of Perineal Tears:

• Lack of perineal flexibility.
• Large fetal head.
• Allowing the head to stretch before crowning.
• Narrow pelvic arch.
• Rapid delivery during uterine contractions.
• Use of forceps during delivery.