Fetal Distress Flashcards
13 Causes of Fetal Distress
- breathing problems
- low bp
- uterine rupture
- uterine infection
- nuchal cord
- post maturity
- abruptio placenta
- low amniotic fluid
- shoulder dystocia
- multiple birth
- abnormal fetal position and presentation
- premature closure of FDA
- umbilical cord prolapse
(4) Signs & Symptoms of Fetal Distress
- decreased fetal movement
- meconium stain
- biochemical signs
- non-reassuring patterns
(4) Management in fetal distress
- IV FLUID
- Tocolytics
- Sidelying Position
- Tocolytic Therapy
What position should be given? For Fetal Distress
Side Lying Position
the cord dropping alongside the baby, but may not be seen in advance
occult cord prolapse
the cord coming before the baby’s head can come out
overt cord prolapse
(7) risk factors of prolapse umbilical cord
- malpresentation
- LBW
- multipara
- multiple gestation
- presence of long cord
- cpd, hydramnios
- PROM, placenta previa
Fetal Risk for Prolapsed Umbilical Cord (3)
- bradycardia
- umbillical cord compression
- persistent variable deceleration may develop and fetus may die
(4) Implementation Prolapsed Umbilical Cord
- bed rest
- if bradycardia is present, do a vaginal exam
- woman is kept horizontal
- FHR auscultated for a full minute
(4) Medical Management of Umbilical Cord
- give oxygen mask
- if loop of cord is present, put finger in vaginal to not distend the fetal head
- check FHR
- position the mother trendelenburg, sims, knee chest
- rolled towel under the woman’s right or left hip
What would you do if the umbilical cord is portruding from vagina?
- wrap towel in sterile normal saline solution
- do not attempt to put back umbilical cord in the cervix
- tocolytic therapy
weigh of the baby to signal shoulder dystocia
- 4500 grams
termed as difficulty in the birth of the shoulder?
shoulder dystocia
risk factors for shoulder dystocia?
- excessive weight
- DM
- obesity
- previous hx shoulder dystocia
- post date pregnancies
intrapartum risk factors of shoulder dystocia?
- prolonged 2nd stage
- slow descent
two main signs that shoulder dystocia is present
- turtle sign
- does not emerge in moderate traction/pushing after fetal head
neonatal risks for shoulder dystocia
- asphyxia
- brachial plexus injury
- apgar score of 5 or < at one minute
- fractured clavicles or humerus
- death
maternal risk of shoulder dystocia
- postpartum hemorrhage
- rectal injuries
if difficulty extacting the shoulder occurs during birth, what would the OB/CNM do? (the main medication management)
- McRoberts maneuver: direct the woman to sharply flex her thigh up against her abdomen.
other interventions for shoulder dystocia beside the McRoberts Maneuver
- apply suprapubic pressure and using the wood screw maneuver
- enlarging the episiotomy
- checking the placement of the shoulder
results when the umbilical cord precedes the fetal presenting part
prolapsed umbilical cord
misconceptions in shoulder dystocia
- problem is not identified, if head has already ascendedm and shoulder has been locked in symphysis pubius
what happens in shoulder dystocia, the position it moves in the vagina of the mother
- the head appears in the perineum, it does not portrude, but retracts (turtle sign)
other medical management for shoulder dystocia
- maternal pelvis is evaluated carefully
- palpating the crown-rump length of the fetus in utero to estimate fetal size
- fundal height measurement
- there may be a slowing of fetal descent (change of station) and a prolonged second stage.
