Problems with the Passenger Flashcards
Problems with the Passenger
- Immature
- Preterm birth
- The fetus does not tolerate the stress of labor
- Umbilical cord prolapse
- If more than one fetus is present
- Fetus is malpositioned
- Fetus is too large for the birth canal
Umbilical cord prolapse can be detected by
Fetal monitoring
Umbilical cord prolapse may occur with what conditions?
- Premature rupture of the membranes
- Fetal presentation other than cephalic
- Placenta previa
- Intrauterine tumors preventing the presenting part from engaging
- A small fetus
- CPD preventing firm engagement
- Polyhydramnios
- Multiple gestation
This may occur at any time after the membranes rupture if the presenting fetal part is not fitted firmly into the cervix
Cord prolapse
Cord prolapse may occur at any time after the membranes rupture if the presenting fetal part
It is not fitted into the cervix
The time allowed for parents to inspect multiple gestation infants depends on two important variables
- Weight of infant
- Condition of infant
If the infant is preterm, it is usually at risk of what condition?
Hypothermia
If the parents worry about the healthcare team to be confused by their infants, review with them the measures used such as
Armbands
The infants need careful assessment to determine their
True gestational age and whether a phenomenon such as twin-to-twin transfusion could have occured
If parents are unable to inspect their infant immediately after birth, what would be the next course of action?
Be certain and inform them that they have the opportunity to do so as soon as possible
Assessment for cord prolapse
- Always assess fetal heart sounds immediately after rupture of the membranes
- Cord prolapse be discovered only after the rupture of membranes
- During a vaginal examination, the cord may be felt as the presenting part or visualized on ultrasound
Therapeutic management for Cord prolapse
- Placing a gloved hand in the vagina and manually elevating the fetal head of the cord
- Placing the patient in a knee-chest or Trendelenburg position
- Administer oxygen by face mask (10L)
- Prescription/administration of tocolytic agents
Cord prolapse is always an emergency situation because it leads to
- Cord compression
- Decreased oxygenation of the fetus or fetal anoxia
Rationale
Placing the patient in a knee-chest or Trendelendburg position
To cause the fetal head to fall back from the cord
Rationale
Administration of tocolytic agents as part of the therapeutic management of a cord prolapse
To reduce uterine activity and pressure on the fetus
If the cord is exposed fully, what will happen afterwards?
Drying of the cord begins
Drying of the cord leads to what condition
Constriction and atrophy of the umbilical vessels
True or False: Do not attempt to push any exposed cord back to the vagina because this could add to the compression by causing knotting or kinking
True
Rationale
Do not attempt to push any exposed cord back to the vagina
This could add to the compression by causing knotting or kinking
Therapeutic management for an exposed umbilical cord
Cover any exposed portion with a sterile saline compress to prevent drying
If the cervix is fully dilated at the time of the prolapse, what would be the next course of action?
Deliver the infant quickly - possibly with forceps - to prevent fetal anoxia
If dilatation is incomplete, what would be the next course of action?
The birth method of choice is upward pressure on the presenting part
Addition of a sterile fluid into the uterus to supplement the amniotic fluid and reduce compression of the cord
Amnioinfusion
Rationale of amnioinfusion or addition of a sterile fluid into the uterus
- Supplement the amniotic fluid
- Reduce compression of the cord
