Chapter 20: Labour & Birth Complications

Labour & Birth Complications begins by distinguishing preterm birth, defined by gestational length (less than 37 weeks), from low birth weight, which describes an infant's mass at delivery. The text explores the multifactorial causes of spontaneous preterm labour, including social determinants, maternal infections, and genetic predispositions. Predictive tools such as fetal fibronectin testing and ultrasound-measured cervical length are discussed as methods to identify at-risk patients. Clinical interventions emphasize prolonging pregnancy long enough to administer antenatal glucocorticoids for fetal lung maturity and using magnesium sulphate for neonatal neuroprotection against cerebral palsy. The discussion extends to premature rupture of membranes (PROM) and the associated risks of chorioamnionitis. Furthermore, the chapter addresses post-term pregnancies and the resulting risks of macrosomia and oligohydramnios, which often necessitate labour induction. Dystocia, or abnormally slow labour progress, is analyzed through the lens of the "five P’s": passenger, passageway, powers, position, and psychological response. Nursing care for specific populations, such as patients with obesity or multifetal gestations, is detailed to address their unique physiological challenges. The text also provides a comprehensive overview of obstetrical procedures, including the use of the Bishop score to evaluate the favourability of the cervix, labour induction via oxytocin or prostaglandins, and operative techniques like forceps- and vacuum-assisted births. Special consideration is given to the criteria for a trial of labour after Caesarean (TOLAC) and the pursuit of a vaginal birth after Caesarean (VBAC). Finally, the chapter outlines life-saving protocols for critical emergencies, such as meconium-stained amniotic fluid, shoulder dystocia (managed via the McRoberts manoeuvre and suprapubic pressure), prolapsed umbilical cords, uterine rupture, and the rare, devastating anaphylactoid syndrome of pregnancy, also known as amniotic fluid embolism (AFE).