March 7, 2012
Labor, from beginning of true contractions to the delivery of the infant and placenta, typically lasts 9-19 hours. Precipitous labor is labor that lasts less than 3 hours, resulting in a precipitous birth, an emergency situation that could cause trauma to the mother and infant. There are many reasons for this anomaly, a large pelvis, small fetus in the optimal position or a previous precipitous birth. Any of these factors in conjunction with intense contractions results in a rapid decent of the fetus through the birth canal. This rapid expulsion could lead to head trauma in the fetus. The mother, enduring the tumultuous contractions, could receive lacerations to the vagina, cervix, urethra, perineal area or uterine rupture. The mother is also at a higher risk for amniotic fluid embolus and postpartum hemorrhage. Precipitous labor accounts for roughly 2% of births in the United States.
A history of precipitous labor is the greatest significant risk factor for subsequent rapid deliveries. According to Ladewig, London and Davidson, women with a history of precipitous labor should be monitored closely and generally are suggested to induce labor around 38 weeks gestation to ensure the safety of the mother and fetus. Considering the nature of labor, however, there are no guarantees as to when labor may begin. If a pregnant client presents with intense contractions with little uterine relaxation in between and the client states contractions started within the hour, precipitous labor should be suspected. A thorough history should be obtained as quickly as possible, including any previous precipitous births, any childbirth preparations and a family history of precipitous labor. Leopold’s Maneuvers should be performed to determine the fetal position, if abnormal position is definite, the OR may need to be notified. During the cervical examination, any bulging of the perineal area,...