PROBLEMS OF THE PASSENGER PART 1 Flashcards
refers to a position other than an
occipitoanterior position
fetal malposition
3 types of fetal malposition
- occipitoposterior
- occipitotransverse
- oblique or asynclyptic
s/sx of fetal malposition
- intense back pain
- dysfunctional labor pattern
- prolonged active phase
- secondary arrest
physical manifestations of fetal malposition
- depression above the symphysis
- FHT heard far laterally on abd
- wide diamond shaped fontanelle can be felt on the anterior pelvis
maternal positions to facilitate fetal position change
- side lying
- knee chest
- hand and knees
- pelvic rocking
- support person may perform firm stroking motions on abd
other things one could do to facilitate fetal position change
- sit on the toilet
- walk around the room
- pelvis rock beside bed
- rest in jacuzzi / lie on her side on the bed
maternal risks for fetal malposition:
Mother may suffer a ___-degree ___ or extension of ___ during the second stage of labor
third-fourth degree perineal laceration;
midline episiotomy
if CPD is assessed, ___ is done
cesarean section
rotation of an abnormally positioned fetus by means of forceps with subsequent reapplication of forceps for delivery
scanzoni’s maneuver
- Seen in women with
hypotonic labor - Diminished
anteroposterior pelvic
diameter (as seen in
platypelloid pelvis) or - Diminished transverse
diameter (in the android
pelvis)
occipitotransverse
maternal risks for occipitotransverse
- soft tissue damage
- fistulas (from tissue anoxia)
- postpartal hemorrhage
fetal risks of occipitotransverse
cerebral damage (undetected CPD)
- In the presence of hypotonic labor pattern & (-) CPD, Diluted ___ may be administered
oxytocin
When rotation, uterine cavity, & CPD are absent, Birth is often accomplished by ___, ____, or ____
midforceps, manual rotation, vacuum extraction
- If deep transverse arrest exists, ___ may be applied as long as excessive force is avoided.
forceps
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
3 abnormal presentations
sinciput (military)
brow
face
- Rarest of the presentations
- Occurs when the area between the anterior fontanelle & the fetal eyes descend first
brow presentation
true or false: brow presentation occurs more in nullipara than multipara
false - occurs more in multipara than nullipara
brow presentation is due to?
lax abdominal and pelvic musculature
- A fetal head presentation at a different angle than expected is termed ____
asynclytism
___ 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 (chin / mentum)
maternal risks for fetal malpresentation
- perineal lacerations
- CPD
- prolonged labor
fetal risks for fetal malpresentation
- fetal mortality
- trauma (tentorial tears, cerebral and neck compression, trachea and larynx damage)
nursing assessment of fetal malpresentation using leopold’s maneuver
- head feels more prominent than normal
- head and back on the same side
- back is difficult to outline (concave)
- FHT heard where arms and feet are palpated
(+)labor problems but (-) CPD, a ___ may be attempted
manual conversion
Some medical experts advocate, midforceps-assisted birth (+) of ___ & ___
complete dilatation;
fetal position at +2
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
breech presentation
types of breech presentation
complete
frank
footling
in breech presentation, FHR can be heard where?
lower quadrant or umbilicus
criteria for vaginal birth in breech presentation
- adequate pelvis
- frank breech (weight <3500)
- spontaneous labor
- clinician skilled in breech birth
A breech presentation, therefore, may be caused by anything that
interferes with this mechanism of adaptation:
- ges age < 40 weeks
- abnormal fetus
- hydramnios
- midseptum uterus
- mass in uterus
- pendulous abd
- multiple gestation
breech complications
- morbitdity
- LBW
- anoxia
- head injury
- spine/arm fracture
- PROM
- dysfunctional labor
- p. previa
- multiple fetus
maternal risks of breech presentation
- prolonged labor
- prolapsed cord
- head entrapment
- perinatal mortality
types of version to perform
external
internal
when a baby is delivered vaginally without any manipulation, other than supporting the baby
Spontaneous breech delivery
a vaginal delivery where the fetus descends spontaneously to the umbilicus, and then the lower part of the body is extracted with assistance
Partial breech delivery
The fetal feet are grasped, and the entire fetus is extracted
Total breech delivery
presentation that is also called as transverse lie
shoulder
shoulder presentation occurs in ___ in 300 term births
1
landmark of shoulder presentation
acromion process of scapula
conditions associated with shoulder presentation
- grand multiparity w relaxed uterine muscles
- preterm fetus
- abnormal uterus
- polyhydramnios
- placenta previa
- contracted pelvis
One in which there are
two presenting parts,
such as the occiput &
fetal hand
compound presentation
___ is often successful if attempted in early labor
intrapartum ECV (external cephalic version)
true or false - Most compound presentation resolve themselves spontaneously, but
others require additional manipulation at birth
true
If prolapsed part is the ___, the birth is generally not difficult.
hand
