Assignment

In
MHCN

Submitted by: Noah Kent Mojica

BSN 2-D

Submitted to: Mrs. Teresita D. Ong RN, MN

ABO Incompatibility

ABO incompatibility is one of the diseases which can cause jaundice. ABO
incompatibility happens when a mother's blood type is O, and her baby's blood type is A
or B. The mother's immune system may react and make antibodies against her baby's
red blood cells.
Treatment, the antibodies in ABO HDN cause anemia due to destruction of fetal
red blood cells and jaundice due to the rise in blood levels of bilirubin a by-product of
hemoglobin break down. If the anemia is severe, it can be treated with a blood
transfusion, however this is rarely needed.

Malpositions and Malpresentation

Malpositions are abnormal positions of the vertex of the fetal head (with the
occiput as the reference point) relative to the maternal pelvis. Malpresentations are all
presentations of the fetus other than vertex.

-Types of Malpresentation

1.) Breech Presentation

a. Breech presentation is the most common malpresentation, with
the majority discovered before labour. Breech presentation is
much more common in premature labour.
b. Approximately one third are diagnosed during labour when the
fetus can be directly palpated through the cervix.
c. After 37 weeks, external cephalic version can be attempted
whereby an attempt is made to turn the baby manually by
manipulating the pregnant mother's abdomen. This reduces the
risk of non-cephalic delivery and is quite low in risk. Maternal
postural techniques have also been tried, but there is insufficient
evidence to support these.
d. Many women who have a breech presentation can deliver
vaginally. Factors which make this more likely to be successful
include a baby weighing between 2.0 and 3.8 kg, in a simple
breech position, ie not footling or kneeling, no previous
caesarean section, and an average-sized pelvis.
e. In one study undertaken, women who had an elective
caesarean section for a breech presentation in their first
pregnancy had approximately a 1 in 10 chance of having an
elective caesarean section for a breech presentation in their
second pregnancy. Overall, the incidence of repeat caesarean
 section for their second baby was 43.8%, and of those allowed
to labour, 84% achieved a vaginal delivery. These results
compared favorably with women who had an elective caesarean
section with a cephalic presentation in their first pregnancy.
2.) Transverse lie
a. When the fetus is positioned with the head on one side of the
pelvis and the buttocks in the other (transverse lie), vaginal
delivery is impossible.
b. This requires caesarean section unless it converts or is
converted late in pregnancy. The surgeon may be able to rotate
the fetus through the wall of the uterus once the abdominal wall
has been opened. Otherwise, a transverse uterine incision is
needed to gain access to a fetal pole.
c. Internal podalic version is no longer attempted.
d. Transverse lie is associated with a risk of cord prolapse of up to
20%.
-Types of Malposition

1. Occipito-posterior position

a. This is the most common malposition where the head initially

engages normally but then the occiput rotates posteriorly
rather than anteriorly. 5.2% of deliveries are persistent
occipito-posterior.

b. The occipito-posterior position results from a poorly flexed

vertex. The anterior fontanelle (four radiating sutures) is felt
anteriorly. The posterior fontanelle (three radiating sutures)
may also be palpable posteriorly.

c. It may occur because of a flat sacrum, poorly flexed head or

weak uterine contractions which may not push the head
down into the pelvis with sufficient strength to produce
correct rotation.
2. Occipito-Transverse position

a. The head initially engages correctly but fails to rotate and

remains in a transverse position.

3. Face Presentation

a. Face presents for delivery if there is complete extension of

the fetal head.

b. Face presentation occurs in 1 in 1,000 deliveries.

c. With adequate pelvic size, and rotation of the head to the

mento-anterior position, vaginal delivery should be achieved
after a long labour.

d. Backwards rotation of the head to a mento-posterior position

requires a caesarean section.
 4. Brow Position

a. The fetal head stays between full extension and full flexion
so that the biggest diameter (the mento-vertex) presents.

b. Brow presentation occurs in 0.14% of deliveries.

c. Brow presentation is usually only diagnosed once labour is

well established.

d. The anterior fontanelle and super orbital ridges are palpable

on vaginal examination.

e. Unless the head flexes, a vaginal delivery is not possible,

and a caesarean section is required.

Management
 Make a rapid evaluation of the general condition of the woman including vital
signs (pulse, blood pressure, respiration, temperature).
 Assess fetal condition:
- Listen to the fetal heart rate immediately after a contraction:
- Count the fetal heart rate for a full minute at least once every 30 minutes during the
active phase and every 5 minutes during the second stage;
- If there are fetal heart rate abnormalities (less than 100 or more than 180 beats per
minute), suspect fetal distress.
- If the membranes have ruptured, note the colour of the draining amniotic fluid:
- Presence of thick meconium indicates the need for close monitoring and possible
intervention for management of fetal distress;
- Absence of fluid draining after rupture of the membranes is an indication of reduced
volume of amniotic fluid, which may be associated with fetal distress.

-Complications
Fetal complications of breech presentation include:
 cord prolapse;
 birth trauma as a result of extended arm or head, incomplete dilatation of the
cervix or cephalopelvic disproportion;
 asphyxia from cord prolapse, cord compression, placental detachment or
arrested head;
 damage to abdominal organs;
 Broken neck.

Signs and Symptoms

 Intense back pain in labor

 Dysfunctional labor pattern
 Prolonged active phase
 Secondary arrest of dilatation
 Arrest of Descent
Conditions associated with fetal malpresentation are:

Maternal

 Polyhydramnios
 Oligohydramnios
 Uterine abnormalities (bicornuate, uterus)
 Pelvic tumour
 Uterine surgery
Fetal

 Prematurity
 Multipara
 Fetal anomalies (hydrocephalus, anencephaly)
Placental

 Placenta previa
Citations

Lissienko, K. (2016, February 16). ABO Incompatibility. Retrieved from

https://www.kidshealth.org.nz/abo-incompatibility

Sambrook, J. (2014, August 29). Malpresentations and Malpositions Information. Retrieved

from https://patient.info/doctor/malpresentations-and-malpositions

(n.d.). Retrieved from https://hetv.org/resources/reproductive-

health/impac/Symptoms/Malpositions__malpresetations_S69_S81.html