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NURS783 Exam 4 > Malpresentation > Flashcards

Malpresentation Flashcards

1
Q

lie

A

fetal spine relative to maternal spine

  • longitudinal
  • transverse
  • oblique
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2
Q

presentation

A

fetal part that overlies pelvic inlet

  • occiput (vertex)
  • chin (mentum)
  • brow
  • compound = >1 part
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3
Q

position

A

relationship of fetal presenting part to maternal pelvis

  • occiput in cephalic
  • sacrum in breech
  • R/L
  • anterior/posterior
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4
Q

attitude

A

position of fetal head w/ regard to fetal spine

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5
Q

station

A

descent of bony presenting part through birth canal (-5 to +5); 0 = plane of ischial spines

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6
Q

denominator

A

part that is lowest

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7
Q

complete breech

A

flexed at hips and knees

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8
Q

incomplete breech

A

incomplete deflexion of one or both knees or hips

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9
Q

frank breech

A

flexed at hips and extended at knees

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10
Q

When should external cephalic version be attempted in transverse and oblique lies?

A

36-37wks

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11
Q

funic presentation

A

umbilical cord presentation - rare at term

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12
Q

malposition

A

any position that is not:

1) occiput anterior
2) left occiput anterior OR
3) right occiput anterior

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13
Q

What are risks associated w/ malpresentation?

A

1) diminished vertical polarity of uterine cavity
2) increased/decreased fetal movement
3) obstructed pelvic inlet
4) fetal malformation
5) prematurity
6) abnormal placentation

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14
Q

What are risk factors for malpresentation?

A

1) uterine anomaly
2) conditions that result in decreased fetal muscle tone, strength, or activity (e.g. oligo, aneuploidies, neuro dysfunctino)
3) cephalopelvic disproportion
4) sedentary lifestyle

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15
Q

What are risks associated w/ footling breech?

A

1) cord prolapse

2) head entrapment

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16
Q

What are risks associated w/ compound presentation?

A

1) cord prolapse = most common

2) birth trauma

17
Q

What are risks associated w/ face presentation?

A

1) prolonged labor –> intrapartum death
2) abnormal FHR
3) fetal laryngeal and tracheal edema

18
Q

What are risks associated w/ external cephalic version?

A

serious complications rare

1) abnormal FHR patterns
2) persistent pathologic FHR patterns
3) placental abruption
4) vaginal bleeding
5) emergency c/s

19
Q

When and why should external cephalic version be attempted?

A

@36-37wks

preterm ECV associated w/ perinatal mortality

20
Q

What are contraindications to external cephalic version?

A

1) oligo
2) fetal growth restriction
3) abnormal FHR tracing
4) uterine anomaly
5) ruptured membranes
6) HTN of pregnancy
7) antepartum bleeding

21
Q

What are risk factors for transverse lie and shoulder presentation?

A

1) multiparity
2) preterm fetus
3) uterine anomaly
4) poly
5) placenta previa

22
Q

What are risk factors for face presentation?

A

1) prematurity
2) fetal weight < 2500g
3) fetal macrosomia
4) anencephaly
5) high parity

23
Q

How should funic presentation be managed?

A

1) GET HELP!
2) put pt in Trendelenberg
3) get FHTs
4) emergency c/s

24
Q

Describe moxibustion

A

traditional Chinese method

  • burn cigar-shaped roll of Artemisia vulgaris or “mugwort”
  • hold over acupoint bladder 67 (lateral side of little toes)
  • used to induce labor or vert fetus
25
Q

Which face presentation has better vaginal delivery outcomes?

A

mentum anterior - diameter can fit through canal; mentum posterior less likely to pass successfully

26
Q

What are contraindications to TOL in breech presentation?

A

1) cord presentation
2) fetal growth restriction OR macrosomia
3) any presentation other than complete or frank breech
4) clinically inadequate pelvis
5) fetal anomaly incompatible w/ vaginal delivery
6) estimated fetal weight <2500g or >4000g

27
Q

Describe labor management for breech presentation

A

1) perform clinical pelvic exam
2) ensure adequate labor progress; if not progressing –> C/S
3) continuous fetal monitoring mandatory
4) IOL NOT recommended; augmentation w/ oxytocin = okay
5) passive second stage w/out pushing may last up to 90min; active pushing should not last >60min
6) second stage should take place in/near OR
7) providers skilled in neonatal resuscitation close by

NURS783 Exam 4 (11 decks)

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