PROBLEMS OF THE PASSENGER 2 Flashcards
refers to a position other than an
occipitoanterior position
FETAL MALPOSITION
FETAL MALPOSITION NURSING ASSESSMENT
- Intense back pain (first stage of labor)
- Dysfunctional labor pattern
- Prolonged active phase
- Secondary arrest of dilatation, or arrest of descent
- May reveal a depression in the maternal abdomen
above the symphysis - FHT may be heard far laterally on the maternal
abdomen
FETAL MALPOSITION TYPES
- Occipitoposterior
- Occipitotransverse
- Oblique or Asynclyptic (positions of the
fetal head in relation to the
maternal pelvis)
FETAL MALPOSITION MATERNAL-FETAL RISK
- Mother may suffer a third or fourthdegree perineal laceration or extension
of midline episiotomy during the second
stage of labor. - There is no increased risk of fetal
mortality due to OP position unless labor
is protracted or an operative process is
performed.
FETAL MALPOSITION NURSING PLAN
- Side lying position
- Knee-chest position
- Hands-&-knees position
- Pelvic rocking
- Support person may perform firm
stroking motions on the abdomen
FETAL MALPOSITION MEDICAL MANAGEMENT
- Close monitoring of the maternal & fetal
status & labor progress - If CPD- C/S is done
Vaginal birth is possible as follows
* Await spontaneous birth
* Forceps assisted birth with the occiput directly
posterior.
* Forceps rotation of the occiput to the anterior
position and birth (Scanzoni’s maneuver).
* Manual rotation to the anterior position followed
by forceps assisted birth.
When rotation, uterine cavity, & CPD are absent Birth is often accomplished by
midforceps, manual rotation, or vacuum extraction
Three vertex attitudes classified as abnormal
presentations
- Sinciput (Military)
- Brow
- Face
- Seen in women with hypotonic labor
- Diminished anteroposterior pelvic diameter (as seen in platypelloid pelvis) or
- Diminished transverse diameter (in the android pelvis)
OCCIPITOTRANSVERSE
In the presence of hypotonic labor pattern & (-) CPD _____________ may be administered while closely monitoring the maternal-fetal responses
Diluted ocytocin
Refers to a fetal presenting part which
includes the vertex as in brow, face &
sinciput, the breech, like frank, complete,
footling, transverse, & compound
presentation
FETAL MALPRESENTATION
- Rarest of the presentations
- Occurs when the area between the anterior fontanelle & the fetal eyes descend first
- Occurs more often in the multipara than in nullipara
- Due to lax abdominal & pelvic musculature
BROW PRESENTATION
1.) With a vaginal birth, ___________ are
inevitable & may extend into the rectum or
vaginal fornices
2.) Trauma during the birth process leads to
tentorial tears, cerebral & neck compression, &
damage to the trachea & larynx
perineal lacerations
- A fetal head presentation at a different angle
than expected is termed asynclytism - (chin, or mentum) presentation is rare,
but when it does occur, the head diameter the
fetus presents to the pelvis is often too large
for birth to proceed
FACE PRESENTATION
TESTS
1.) Vaginal Examination
2.) Sonogram
3.) Pelvic Measurement
LEOPOLD’S MANEUVER FACE PRESENTATION
1.) Head that feels more _______ than normal (-) engagement
2.) __________ are both felt on same side of the uterus
3.) Back is difficult to outline in this presentation because it is ________
4.) If back is extremely concave, ___may be transmitted to the forward thrust chest & heard on the side of
the fetus where feet & arms can be palpated
1.) Prominent
2.) Head & back
3.) Concave
4.) FHT
1.) The fetus should be observed closely during labor
for signs of hypoxia as evidenced by__________
2.) Some medical experts advocate, midforceps-assisted
birth (+) of complete dilatation & fetal station at ____
1.) late decelerations & bradycardia
2.) +2
Assure couple that the facial edema & excessive
molding are only temporary & will ________
subside in three or four days
(+)labor problems but (-) CPD, a __________may be attempted
manual conversion
If (-)CPD, the chin (mentum) is anterior, & labor
pattern is effective
vaginal birth
occurs when the fetal buttocks, legs or feet or combinations of these parts present first into the maternal pelvis FHB is in the lower quadrant
&/or in the umbilicus
- Types:
1. Complete
2. Frank
3. Footling (double or single)
BREECH PRESENTATION
1.) – hard, round, readily ballotable fetal head is found to
occupy fundus
2.) indicates back to be on one side of the abdomen & the small parts on the other side
3.) breech is movable above the pelvic inlet
4.) firm breech to be beneath the symphysis
1.) LM1
2.) LM2
3.) LM3
4.) LM4
List of the following criteria for vaginal birth in Breech
Presentation:
- Adequate pelvis (x-ray pelvimetry)
- The fetus presents as a frank breech (weight < 3500 gm); as estimated by sonogram or two or more experienced clinicians.
- The woman is in spontaneous labor as demonstrated by
progressive dilatation & effacement of the cervix & fetal
descent.
BREECH PRESENTATION Complications to be anticipated:
A. Perinatal morbidity & mortality from difficult
delivery
B. LBW from prematurity, growth retardation
C. Anoxia from prolapsed cord
D. Traumatic injury to the head
E. Fracture of the spine or arm
F. Early rupture of the membranes
G. Dysfunctional labor
H. Placenta previa
I. Multiple fetuses
BREECH MATERNAL-FETAL RISKS
- Prolonged labor
- Prolapsed cord once the membranes rupture
- In the presence of unrecognized CPD, the fetal
head may not fit through into the maternal
pelvis (head entrapment) - Increased incidence of perinatal mortality
Types of Version:
- External version
- Internal version
GENERAL METHODS OF BREECH DELIVERY/EXTRACTION
a. Spontaneous breech delivery
b. Partial breech delivery
c. Total breech delivery
also called as transverse lie
- Most frequently, shoulder is the presenting part & acromion process of the scapula is the landmark
- However, fetal arm, back & abdomen, or side may present in the transverse lie
- Occurs in 1 in 300 term births
SHOULDER PRESENTATION
Conditions associated with Shoulder presentation:
- Grand multiparity with relaxed uterine muscles
- Preterm fetus
- Abnormal uterus
- Excessive amniotic fluid
- Placenta previa
- Contracted pelvis
SHOULDER PRESENTATION LEOPOLDS:
1.) – No fetal pole is detected in fundus
2.) – Ballotable head is found in one iliac
fossa & the breech on the other side
3.) NEGATIVE
4.) NEGATIVE
1.) LM1
2.) LM2
3.) LM3
4.) LM4
One in which there are two presenting parts,
such as the occiput & fetal hand
- Most resolve themselves spontaneously, but
others require additional manipulation at birth - If prolapsed part is the hand, the birth is generally
not difficult.
COMPOUND PRESENTATION
COMPOUND PRESENTATION:
If there is uterine dysfunction or fetal distress
CS is indicated
