MCN 3 Nursing Care of the client with high-risk labor & delivery & her family Flashcards
Abnormal positions of the vertex of the fetal head(with the occiputas the reference point) relative to the maternal pelvis
Fetal malposition
This is also called as Vertex presentation
Cephalic presentation
If the posterior aspect of the head of the fetus is called occiput or occiputo what about the anterior aspect
Sinciput
This fetal position is posterior rather than anterior. Tend to occur in women with android, anthropoid, or contracted pelvises.
Occipitoposterior Position
The four types of female pelvis
Differentiate
Gynecoid o
Android ♡
Platypelloid ◇
Android 0
What are the
two normal cephalic presentation.
ROA
LOA
One of the complications of occiputoposterior position is it increases the risk of umbilical
cord prolapse. What would be your management?
Confirm position by vaginal
examination or ultrasound.
Because the fetal head rotates against the sacrum, a woman may experience pressure and pain in her lower back because of sacral nerve compression. What would be your nursing management?
Applying counter pressure on the sacrum by a backrub.
For the nursing consideration of occiputoposterior, why do we advice the mother to void every 2 hours to keep her bladder empty?
Full bladder could further impede descent of the fetus.
What is effacement?
Thinning or shortening of the cervix
Occurs when the part of the fetus which is closest to the pelvic inlet is not the fetal head.
Fetal malpresentation
or Breech presentation
Space in the hip bone that occupies the organs of the reproductive system.
Pelvic cavity
TRUE or FALSE
Most fetuses are in a breech presentation early in pregnancy. By week 38, however approximately 97% of all pregnancies, a fetus turns to a cephalic presentation.
TRUE
A type of breech presentation: Knees and thighs are flexed on the abdomen.
Complete
A type of breech presentation: Knees are extended, hips are flexed.
Frank
What is a Pendulous abdomen?
Uterus may fall so far forward that the fetal head comes to lie outside the pelvic brim, causing a breech presentation.
These are factors for breech presentation except which?
a. Gestational age less than 40 weeks
b. Abnormalities such as anencephaly,hydrocephalus,or meningocele
c. Polyhydramnios
d. Congenital anomaly of the uterus, such as a mid septum
None
All are factors that might affect breech presentation
This is Assessment is for what presentation.
Contour of the mother’s abdomen at term may appear fuller side to side rather than top to bottom.
Shoulder Presentation
Which of these are factors for breech presentation.
a. Gestational age less than 40 weeks
b. Abnormalities such as anencephaly, hydrocephalus, or meningocele
c. Polyhydramnios
d. Congenital anomaly of the uterus, such as a mid septum, that trapsthefetusinabreech position
e. Prolapse of the umbilical cord
f. Any space-occupying mass in the pelvis (fibroid tumor of uterusorap.previa)
g. Pendulous abdomen (the uterus may fall so far forward that thefetal headcomes to lie outside the pelvic brim, causing a breech presentation)
h. Multiple gestation (the presenting infant cannot turn to a vertexposition)
i. Chorioamnionitis
A B C D F G H
Prolapse of the umbilical cord and chorioamnionitis doesn’t directly affect breech presentation
A congenital condition where the uterus has a septum or wall of tissue dividing it partially or completely into two separate cavities.
Uterine septate/septum
All are assessments for breech presentation except?
a. Fetal heart sounds heard low in the abdomen.
b. Leopold maneuvers and a vaginal examination.
c. Ultrasound
d. FHR monitoring and uterine contractions
a. Fetal heart sounds are heard high in the abdomen
In Breech Presentation
The Birth Technique can be
Vaginally: The mother is allowed to push if dilatation of at least 4-7 is achieved, and the bottom, trunk, and shoulders are born. True or false.
False. She is allowed to push if FULL dilatation is achieved, uterine rupture might occur if the uterine is not fully dilated.
TRUE or FALSE
These are normal findings of breech presentation
a. Frank breech position tends to keep his or her legs extended and at the level of the face for the first month of life.
b. Footling breech may tend to keep the legs extended
in a footling position for the first 2 weeks
False. Persistent positioning consistent with a breech presentation beyond the first few days of life, (at least 2-3 days) it’s essential to consult with a pediatrician or healthcare provider.
An abnormal form of cephalic presentation where the presenting part is the mentum/chin.
Face presentation
True or False
Face Presentation
Birth Technique:
If the chin is in the posterior aspect of the mother and the pelvic diameters are
within normal limits, it may be possible for the infant
to be born without difficulty.
False. The Chin or mentum of the baby must be on the anterior aspect of the pelvic not on the posterior aspect.
All are factors of Face Presentation except, which?
a. Contracted pelvis
b. Relaxed uterus of a multipara
c. Prematurity
d. Transverse lie
e. Polyhydramnios
f. Placenta previa
e. Fetal malformation
D. Transverse lie is a different fetal presentation
The following are nursing considerations for face presentation except which?
a. Assess for facial edema and ecchymotic bruising
b. Observe the infant closely for a patent airway.
c. Gavage( way to provide breastmilk or formula directly to your baby’s stomach) feedings may be necessary to allow them to obtain enough fluid until they can suck effectively.
d. May be transferred to a neonatal intensive care unit for 24 hrs
e. Reassure the parents that the edema is transient and will disappear in a few days with no aftermath.
None. All optoins are nursing considerations
A cephalic presentation in which the head is midway between flexion and extension. Rarest of the presentations.
Brow presentation
In a Face Presentation, if the mentum is in the posterior aspect of the mother, what would be the birth technique. NSD or CS
Cesarean Section
In the management of brow presentation, if the presentation spontaneously corrects itself. What would be the birth technique, NSD or CS?
Normal Spontaneous Delivery
In the management of brow presentation, Unless the presentation spontaneously corrects, what would be the birth technique, NSD or CS?
Cesarean Section
A fetal presentation in which the fetal longitudinal axis lies perpendicular to the long axis of the uterus.
Transverse Lie
All of these are factors for Tranverse Lie except which?
a.Pendulousabdomens
b. Uterinefibroidtumors
c. Congenital abnormalities of the uterus
d. Polyhydramnios
e. Maternal weight or body mass index (BMI)
f. It may occur in infants with hydrocephalus or another abnormality that prevents the head from engaging
g. Prematurity
h. Strenuous Exercise
i. Multiplegestations
j. Shortumbilicalcord
E. Maternal weight can influence factors such as the risk of gestational diabetes, hypertension, or cesarean delivery, but it does not directly impact the baby’s position in the womb.
H. Strenuous physical activity is not typically considered a direct factor in influencing fetal presentation, however, strenuous activity during pregnancy may increase the risk of other complications, such as preterm labor or placental abruption
Fetal malpresentation:
The presenting part is usually one of the shoulders
(acromionprocess), an iliac crest, a hand, or an elbow. Associated with a transverse lie
Shoulder presentation
A loop of the umbilical cord slips down infront of
the presenting fetal part.
An emergency situation: leads to cord compression and decreased oxygenation to the fetus.
Prolapse of the umbilical cord
Which of these should be your assessments in an umbilical cord prolapse:
a. Vaginal exam: cord may be felt as the presenting part
b. Transvaginal UTZ
c. FHR: unusually slow or a variable deceleration
d. Can be confirmed by Leopold maneuvers.
A
B
C
Leopold maneuvers are unnecessary in assessing Prolapse of the umbilical cord
What would be the birth technique for Shoulder presentation. NSD or CS
Cesarean Section
All of these are factors for Prolapse of the umbilical except which?
A. Premature rupture of membranes
b. Fetal presentation other than cephalic
c. Placenta previa
d. Intrauterine tumors preventingthe presenting part from engaging
e. A small fetus
f. CPD preventing firm engagement
g. Polyhydramnios
h. Multiple gestation
None. All are factors of Umbilical cord prolapse