Precipitate Labor – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Precipitate Labor
A labor is called precipitate when combined duration of the first and second stage is less than two hours. It is common in multipara. Rapid expulsion is due to hyperactive uterine contraction associated with diminished soft tissue resistance. Delivery often occurs without the benefit of asepsis.
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Precipitate delivery refers to a delivery which results after an unusually rapid labor (combined 1st stage and second stage duration is <2hrs and culminates in the rapid, spontaneous expulsion of the infant. Delivery often occurs without the benefit of asepsis.
Causes of precipitate labor:
➤ An above-average “pelvic outlet”.
➤ A well-aligned pelvis, pubic bone and birth canal.
➤ An unusually small baby.
➤ A baby positioned extremely well to come out.
➤ Having a female relative who also experienced fast labors.
➤ Previously experienced fast labor.
➤ Over-stimulation of contractions.
Risk factors of precipitate labor:
➤ Maternal multiparous status.
➤ Small foetus.
➤ Relaxed pelvic and vaginal musculature.
➤ History of rapid labours with previous deliveries.
➤ History of previous precipitate labor.
➤ Delivery out of asepsis.
➤ Maternal soft tissue injuries.
➤ Foetal injuries from rapid explusion at delivery.
Management of precipitate labor:
Important nursing interventions include:
➤ Continuous assessment of maternal and foetal status.
➤ Communicating to physician any change in status, maternal or foetal intolerance or signs of impending problems.
➤ Teaching and reinforcing relaxation techniques.
➤ Administering tocolytic medications as ordered.
➤ Side-lying position to enhance placental blood flow and to reduce the effects of aortocaval compression.
➤ Oxygen to the mother and adequate blood volume with non-additive intravenous fluids.
Care for the Infant:
➤ The nurse should cradle the infant against his (the nurse’s) body with the infant’s head supported by the palm of his hand and the body supported by the forearm. This method allows the nurse a free hand.
➤ The infant should be held with his head tilted downward to facilitate the drainage of mucus and fluid from the upper airway.
➤ The infant should be held at or below the level of the uterus until the umbilical cord stops pulsating to prevent loss of neonatal blood to the placenta.
After delivery:
➤ Assessing uterine fundus for atony.
➤ Checking perineum for haematoma or laceration.
➤ Assessing neonate for soft tissue injuries.
➤ Monitoring vital signs to ensure stability.
Complications of precipitate delivery:
A. Maternal complications:
➤Excessive laceration cervical, vagina and perineal.
➤ Usually rapid and strong labor.
➤ Uterine inversion due to forceful uterine contraction.
➤ Pain, anxiety.
➤ PPH.
➤ Abruptio placenta.
➤ Puerperal sepsis.
B. Fetal complications:
➤ Birth trauma (IVH, Brachial palsy).
➤ Intrauterine haemorrhage.
➤ May cause aspiration of amniotic fluid.
➤ Meconium stained fluid.
➤ Fetal distress.
➤ There may be infection as a result of unsterile delivery.
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