High Risk Pregnancy

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 High Risk Pregnancy- is one in which a concurrent disorder, pregnancy related complications or external factor jeopardizes the health of the woman, the fetus or both. Complications with POWER

Dystocia- can arise from any of the four main component of the labor process: Power, Passenger, Passageway and Pysche. -defined as a long, difficult, abnormal labor.
-Power: dysfunctional labor
-Passageway: alterations in pelvic structure
- Passenger: fetal malpresentation or anomalies
- Pysche: psychologic response of the mother to birth
Risk factors:
-overstimulation of oxytocin
-body build
-congenital malformations
-Asess maternal and fetal well being
- Cervical ripening
-Induction or Augmentation w/ oxytocin

Inertia- a time honoured term to denote that sluggishness of contractions or the force of labor has occurred. Also called as Dysfunctional Labor. Ineffective Uterine Force
-abnormal or ineffective labor
- Number of contraction is unusually low or infrequent (not more than 2 0r 3 occurring in a 10min. Period) -Resting tone of the uterus remains less than 10mmHg and the strength of contractions does not rise above 25mmHg -Contractions are not exceedingly painful, because of their lack of intensity -Increase length of labor because it requires more uterine contractions - Can cause the uterus not to contract effectively during postpartum because of exhaustion, increasing chance of postpartum haemorrhage. Risk factors:

-Bladder distention prevent descent
-A uterus that is overstretched because of multiple gestation -Administration of analgesia
-Marked by an increase in resting tone more than 15mmHg
-Contractions then to occur frequently
-Occur because muscle fibers of myometrium do not repolarize or relax after a contraction -They tend to be more painful than usual because the myometrium becomes tender from constant lack of relaxation -Breathing exercises are not effective with this type of contraction -Can cause fetal anoxia because of lack of relaxation between contractions -Uterine and fetal external monitoring should be applied atleast 15mins. To ensure resting phase if contractions is adequate and there is no late deceleration. -CS birth may be necessary if deceleration occurs

-More than one pacemaker may be initiating contractions
-May occur so closely together that they do not allow good cotyledon filling -Fetal external monitor reveals abnormal pattern
-Oytocin administration may be helpful to stimulate more effective contractions Abnormal Progress on Labor
Dysfunction of the 1st Stage of Labor
(True labor to Cervical Dilatation)
A. Prolonged Latent Phase
-Longer than 20hrs. in nullipara and 14hrs. in multipara
-Uterus tend to be in hypertonic state
-Relaxation between contractions are only mild and therefore ineffective Causes:
-Unripe cervix
-excessive use of analgesics
-One segment of the uterus contract with more force than other segment

-Provide adequate fluid for hydration
-Pain relief w/ a drug (morphine sulphate)
-Changing then lines and the woman’s gown, Darkening room lights -Decrease noise and stimulation
If this Interventions are not EFFECTIVE:
-CS birth
-Oxytocin infusion

B. Protracted Active Phase
-Phase is prolonged if dilatation does not occur at rate of atleast 1.2cm/hr in nullipara and 1.5cm/hr in multipara. -Active phase last longer than 12hrs in nullipara and 6hrs in multipara Causes:

-Fetal Malposition
- Ineffective myometrical activity
-CS birth
-If CPD is not present oxytocin administratio to augment labor C. PROLONGED DECELERATION PHASE
-Extend beyond 3hrs. in nullipara or 1hr in multipara
-results from abnormal fetal position
-CS birth is required
- No progress in cervical dilatation...
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