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Dysfunctional Labor


Description

  • Dysfunctional labor is difficult, painful, prolonged labor due to mechanical factors.

Etiology
  1. Fetal factors (passenger) include unusually large fetus, fetal anomaly, malpresentation, and malposition
  2. Uterine factors (powers) include hypotonic labor, hypertonic labor, precipitous labor, and prolonged labor.
  3. Pelvic factors (passage) include inlet contracture, midpelvis contracture, and outlet contracture.
  4. “Psyche” factors include maternal anxiety and fear and lack of preparation.

Pathophysiology
  • Uterine contractions are ineffective secondary to muscle fatigue or overstretching.

Assessment Findings
  • Clinical manifestations include irregular uterine contractions and ineffective uterine contractions in terms of contractile strength and duration.

Nursing Management
  1. Optimize uterine activity. Monitor uterine contractions for dysfunctional patterns; use palpation and an electronic monitor.
  2. Prevent unnecessary fatigue. Check the client’s level of fatigue and ability to cope with pain.
  3. Prevent complications of labor for the client and infant.
    • Assess urinary bladder; catheterize as needed.
    • Assess maternal vital signs, including temperature, pulse, respiratory rates, and blood pressure.
    • Check maternal urine for acetone (an indication of dehydration and exhaustion).
    • Assess condition of fetus by monitoring FHR, fetal activity, and color of amniotic fluid.
  4. Provide physical and emotional support.
    • Promote relaxation through bathing and keeping the client and bed clean, back rubs, frequent position changes (sidelying), walking (if indicated), and by keeping the environment quiet.
    • Coach the client in breathing and relaxation techniques.
  5. Provide client and family education.






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