NLE High-Risk Pregnancy & Obstetric Complications — Complications of Labor & DeliveryConcept Map

Concept

Dystocia (Dysfunctional Labor)

Sub Concepts

• Powers: Hypotonic dysfunction (weak, infrequent contractions)
• Powers: Hypertonic dysfunction (frequent, uncoordinated contractions)
• Passageway: Cephalopelvic disproportion
• Passenger: Malposition, malpresentation, macrosomia
• Psyche: Maternal fear and anxiety
• Management: Oxytocin augmentation vs. rest and sedation

Relationship To Central

Most common complication affecting labor progression; rooted in the 4 Ps framework

Concept

Preterm Labor

Sub Concepts

• Definition: Regular contractions with cervical change 20-37 weeks
• Risk factors: Infection, multiple gestation, polyhydramnios
• Tocolytics: Magnesium sulfate, nifedipine, terbutaline, indomethacin
• Antenatal corticosteroids: Betamethasone and dexamethasone for fetal lung maturity
• Neuroprotection: Magnesium sulfate benefits to preterm fetal brain
• Nursing focus: Buy 48 hours for steroids and transfer

Relationship To Central

Time-sensitive complication requiring intervention to delay delivery

Concept

Post-Term Labor & Pregnancy

Sub Concepts

• Definition: Pregnancy beyond 42 weeks gestation
• Complications: Oligohydramnios, meconium aspiration, macrosomia
• Fetal monitoring: Non-stress test, biophysical profile, amniotic fluid index
• Management: Induction of labor
• Neonatal preparation: Meconium aspiration precautions

Relationship To Central

Prolonged gestation increasing placental insufficiency and fetal compromise risk

Concept

Prolapsed Umbilical Cord

Sub Concepts

• Pathophysiology: Cord ahead of presenting part causes compression
• Risk factors: High unengaged presenting part, malpresentation, polyhydramnios
• Recognition: Visible cord or sudden fetal bradycardia/variable decelerations
• Emergency actions: Reposition mother, lift presenting part, cover protruding cord
• Positions: Knee-chest, Trendelenburg, steep left-lateral with elevated hips
• Do NOT push cord back in
• Definitive treatment: Emergency cesarean delivery

Relationship To Central

True obstetric emergency requiring immediate fetal-oxygen restoration

Concept

Uterine Rupture

Sub Concepts

• Risk factors: Previous cesarean scar, excessive oxytocin, trauma, obstructed labor
• Manifestations: Sudden sharp pain, cessation of contractions, fetal distress, shock
• Pathophysiology: Tear in uterine wall with possible fetal expulsion
• Management: Emergency laparotomy, delivery, repair or hysterectomy
• Shock management: Large-bore IV, fluids, blood products, oxygen
• Prevention: Cautious oxytocin use, monitoring for tachysystole

Relationship To Central

Catastrophic maternal-fetal emergency threatening life of both

Concept

Cesarean Birth

Sub Concepts

• Indications: CPD, fetal distress, malpresentation, placenta previa, active herpes
• Uterine incisions: Low transverse (Pfannenstiel) vs. classical (vertical)
• Transverse advantage: Permits future VBAC
• Classical contraindication: No future vaginal delivery allowed
• Preoperative nursing: Consent, NPO, IV access, catheter, antacid
• Postoperative nursing: Fundus/lochia monitoring, incision care, thromboembolism prevention
• Complications: Hemorrhage, infection, paralytic ileus

Relationship To Central

Surgical alternative to vaginal delivery for high-risk or complicated labor

Concept

Shoulder Dystocia

Sub Concepts

• Presentation: Turtle sign—head retracts against perineum
• Risk factors: Macrosomia, maternal diabetes
• Priority maneuver: McRoberts maneuver (thigh hyperflexion)
• Additional maneuver: Suprapubic pressure
• Contraindication: Never use fundal pressure
• Complications: Brachial plexus injury (Erb palsy), clavicle fracture

Relationship To Central

Perinatal emergency after head delivers but shoulder obstructs

Concept

Amniotic Fluid Embolism

Sub Concepts

• Pathophysiology: Amniotic fluid enters maternal circulation
• Manifestations: Respiratory distress, cyanosis, cardiovascular collapse, DIC
• Timing: Can occur during labor, delivery, or immediate postpartum
• Management: CPR, oxygen/intubation, fluids and blood products
• Coagulopathy correction: Essential component of treatment

Relationship To Central

Rare but catastrophic complication with high mortality rate

Concept

Precipitous Labor

Sub Concepts

• Definition: Labor from onset to birth in less than 3 hours
• Maternal risks: Lacerations, hemorrhage
• Fetal risks: Hypoxia and trauma
• Nursing priority: Constant attendance, support emerging fetus
• Intervention: Do not restrain fetus, support descent

Relationship To Central

Rapid labor completion (under 3 hours) with distinct maternal-fetal risks

Concept

Oxytocin in Complicated Labor

Sub Concepts

• Use: Induction/augmentation of uterine contractions
• Administration: IV infusion pump with titration to effective contraction pattern
• Monitoring: Continuous assessment for uterine tachysystole
• Tachysystole definition: More than 5 contractions/10 min, duration over 90 seconds
• Action for tachysystole: Discontinue immediately
• Complications: Uterine rupture, fetal hypoxia, water intoxication
• Antidiuretic effect: Risk of hyponatremia with prolonged use

Relationship To Central

High-alert medication requiring vigilant monitoring to prevent iatrogenic complications

Concept

Fetal Heart Rate Interpretation in Complicated Labor

Sub Concepts

• Normal baseline: 110-160 beats/minute
• Reassuring features: Moderate variability and accelerations
• Early decelerations: Mirror contraction, benign, head compression
• Variable decelerations: Abrupt V or U-shaped, cord compression signal
• Late decelerations: Begin after contraction peak, uteroplacental insufficiency
• Severe bradycardia: Non-recovery indicates urgent delivery need
• Intrauterine resuscitation: Stop oxytocin, reposition, IV fluids, oxygen

Relationship To Central

Essential skill for detecting fetal compromise and guiding intervention timing

Concept

Nursing Process Application in Labor Complications

Sub Concepts

• Assessment: Continuous fetal monitoring, vital signs, contraction pattern evaluation
• Diagnosis: NANDA nursing diagnoses based on complication type
• Planning: Prioritize using Maslow (safety/emergency first, then physiologic)
• Implementation: Recognize patterns, relieve fetal pressure, support airway-circulation-perfusion
• Evaluation: Maternal-fetal response to interventions, readiness for delivery
• Documentation: Per RA 9173 standards and institutional protocols

Relationship To Central

Systematic framework for prioritizing interventions using NCM levels and Maslow hierarchy

Concept

Philippine Healthcare Context in Obstetric Emergencies

Sub Concepts

• RA 9173 Nursing Practice Act: Scope of independent and collaborative nursing actions
• Level of responsibility: NCM Level III or IV (independent practitioners/managers)
• Rural vs. urban settings: Recognition and stabilization vs. immediate specialist care
• Referral protocols: When and how to transfer high-risk complications
• Communication: Effective handoff and documentation for continuity
• Resource management: Adapting care with available equipment and supplies

Relationship To Central

Practice framework for nurses working in resource-varied settings across the Philippines

To

Oxytocin Management

From

Dystocia

Strength

strong

Relationship

Hypotonic dystocia is managed with oxytocin augmentation, requiring careful monitoring for tachysystole and complications

To

Cesarean Birth

From

Dystocia

Strength

strong

Relationship

Unresolved dystocia from CPD or failed augmentation leads to cesarean delivery

To

Antenatal Corticosteroids

From

Preterm Labor

Strength

strong

Relationship

Corticosteroids administered in preterm labor to accelerate fetal lung maturity and reduce neonatal morbidity

To

Tocolytics

From

Preterm Labor

Strength

strong

Relationship

Tocolytic agents suppress contractions to allow time for steroid effect and fetal maturation

To

Emergency Cesarean Delivery

From

Prolapsed Umbilical Cord

Strength

strong

Relationship

Prolapsed cord requires emergency cesarean after immediate pressure relief maneuvers

To

Labor Complications Recognition

From

Fetal Heart Rate Interpretation

Strength

strong

Relationship

FHR patterns (late decelerations, bradycardia) are early warning signs of cord compression, placental insufficiency, and uterine rupture

To

Oxytocin Management

From

Uterine Rupture

Strength

strong

Relationship

Excessive oxytocin causing tachysystole is a major risk factor for uterine rupture

To

Intrauterine Resuscitation

From

Oxytocin Management

Strength

strong

Relationship

Non-reassuring FHR from oxytocin overstimulation requires immediate oxytocin discontinuation and resuscitation measures

To

Obstetric Emergencies

From

Shoulder Dystocia

Strength

strong

Relationship

Shoulder dystocia is a perinatal emergency requiring specific McRoberts maneuver and suprapubic pressure techniques

To

Meconium Aspiration Risk

From

Post-Term Pregnancy

Strength

moderate

Relationship

Post-term placental insufficiency increases oligohydramnios and meconium staining, requiring neonatal resuscitation preparation

To

Postoperative Complications

From

Cesarean Birth

Strength

strong

Relationship

Cesarean delivery carries risks of hemorrhage, infection, thromboembolism, and ileus requiring vigilant postoperative monitoring

To

Emergency Resuscitation

From

Amniotic Fluid Embolism

Strength

strong

Relationship

AFE presents as sudden cardiovascular collapse requiring immediate CPR, supportive care, and DIC management

To

Maternal Trauma

From

Precipitous Labor

Strength

moderate

Relationship

Rapid labor progression increases risk of maternal lacerations and hemorrhage due to limited tissue distension time

To

Intrauterine Resuscitation Bundle

From

Fetal Heart Rate Interpretation

Strength

strong

Relationship

Late decelerations or severe bradycardia trigger the systematic resuscitation sequence: stop oxytocin, reposition, IV fluids, oxygen

To

Nursing Priority Actions

From

Early Recognition

Strength

strong

Relationship

Early identification of labor complications enables rapid implementation of priority interventions following airway-circulation-perfusion hierarchy

To

Fetal Heart Rate Changes

From

Prolapsed Cord

Strength

strong

Relationship

Cord compression from prolapse produces characteristic variable decelerations and sudden bradycardia as the cord is compressed

To

Active Phase Labor

From

Hypotonic Dystocia

Strength

moderate

Relationship

Hypotonic dysfunction typically occurs in active phase from overdistension or full bladder, responsive to augmentation

To

Latent Phase Labor

From

Hypertonic Dystocia

Strength

moderate

Relationship

Hypertonic dysfunction occurs in latent phase with uncoordinated contractions; oxytocin is contraindicated

To

VBAC Eligibility

From

Low Transverse Uterine Incision

Strength

strong

Relationship

Low transverse incision permits trial of labor after cesarean (VBAC); classical incision does not

To

Preterm Neuroprotection

From

Magnesium Sulfate

Strength

moderate

Relationship

Magnesium sulfate in preterm labor provides neuroprotection for the preterm fetal brain beyond tocolytic effects

To

Complication Prevention

From

Nursing Assessment

Strength

strong

Relationship

Continuous assessment using NCM frameworks enables early detection of warning signs and prevention of catastrophic complications

To

Nursing Practice Scope

From

Philippine Healthcare Context

Strength

strong

Relationship

RA 9173 defines the scope of nursing practice in obstetric complications; NCM levels guide independent vs. collaborative actions

To

Referral and Transfer Protocols

From

Rural vs Urban Settings

Strength

moderate

Relationship

Philippine healthcare delivery requires nurses in resource-limited settings to stabilize and refer high-risk complications appropriately