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Problems With The Passenger
Problems With The Passenger
Passenger
PROLAPSE OF THE UMBILICAL
CORD/UMBILICAL CORD PROLAPSED
Main Problem:
* A loop of the umbilical cord slips down
in front of the presenting fetal part.
* Occurs at any time after the
membranes rupture if the presenting
part is not fitted firmly into the cervix.
* Incidence is 0.4% 0f births
PROLAPSE OF THE UMBILICAL
CORD
A. The cord is prolapsed
B. The cord is visible at the
but still within the
vulva.
uterus.
PROLAPSE OF THE UMBILICAL
CORD/UMBILICAL CORD
PROLAPSED
CONTRIBUTING FACTORS:
Situation: A woman in labor room tells the nurse, “My water just
broke, and it felt like something fell out.”
2. ______________________________________________
3. ______________________________________________
4. ______________________________________________
5. ______________________________________________
6. ______________________________________________
7. ______________________________________________
PROBLEMS WITH
POSITION,PRESENTAT
ION,
OR SIZE
OCCIPITOPOSTERIOR POSITION
(ROP/LOP)
The fetal position is posterior rather than anterior, the
occiput is directed diagonally and posteriorly, either to
the right (ROP) or to the left (LOP).
Occiput
(LOP)
1
• Attitude is moderate because the hips are flexed but the knees are
extended to rest on the chest. The buttocks alone present to the cervix.
BREECH PRESENTATION
2. Complete breech presentation
Lie: Longitudinal
Attitude: Good (fulLflexion)
• The fetus has thighs tightly flexed on the abdomen; both the buttocks and
the tightly flexed feet present to the cervix.
BREECH PRESENTATION
3. Footling breech presentation
Lie: Longitudinal
Attitude: Poor
• Neither the thighs nor lower legs are flexed. If one foot presents, it is a
single-footling breech; if both present, it is a double-footling breech.
BREECH PRESENTATION
Complications:
1. Anoxia from prolapsed cord
2. Traumatic injury to the after-coming head
(possibility of intracranial haemorrhage or anoxia)
3. Fracture of the spine or arm
4. Dysfunctional labor
5. Early rupture of the membranes because of the poor
fit of the presenting part.
6. Meconium aspiration
BREECH PRESENTATION
Assessment:
1. FHT heard high in the abdomen
2. Leopold’s, vaginal exam, or ultrasound exam reveals
the presentation.
Ultrasound clearly confirms the presentation including
additional information on pelvic diameters, fetal skull diameter, and
evidence of possible placenta previa causing the breech
presentation.
3. Monitor FHR and uterine contractions continuously
- to detect early signs of fetal distress from a complication like
prolapsed cord.
BREECH PRESENTATION
- Birth technique:
1. Vaginal delivery
Birth of head is the most hazardous because
umbilicus precedes the head.
Head compresses the cord
2nd danger is intracranial hemorrhage
2. Planned C/S – usual method
BREECH PRESENTATION
BIRTH TECHNIQUE: VAGINAL DELIVERY
As the breech spontaneously To aid in delivery of the head, the
emerges from the birth canal, it is trunk of the infant is usually straddled
steadied and supported by a sterile over the physician’s right forearm .
towel against the infant’s inferior Two fingers of the physician’s left
surface. hand are placed in the infant’s mouth
Vertex Malpresentation
Asynclitism
- Fetal head presenting at different angle.
- Examples: Face and brow presentations
FACE BROW
FACE BROW
Vertex Malpresentation
FACE
VERTEX MALPRESENTATION:
FACE PRESENTATION
ASSESSMENT
CONTRIBUTING FACTORS:
CONTRIBUTING FACTOR:
1. Multipara or a woman with relaxed abdominal muscles.
ASSESSMENT:
1. Obstructed labor
BIRTH TECHNIQUE:
1. Cesarean birth
VERTEX MALPRESENTATION:
BROW PRESENTATION
Therapeutic management:
1. Observe infant for patent airway
- May have extreme ecchymotic bruising on the face, over the same
area as the anterior fontanelle or “soft spot”.
Complications:
1. Early rupture of membranes usually at the beginning of
labor.
2. Cord or arm prolapse or shoulder may obstruct the cervix
Therapeutic management:
4. C/S is the birth method of choice
OVERSIZED FETUS
(MACROSOMIA)
Fetus who weighs more than 4,000 – 4,500 g
(9 – 10 lbs.)
Risk factors:
1. Diabetic or develop gestational diabetes
2. Multiparity
OVERSIZED FETUS
(MACROSOMIA)
Complications:
RISK FACTORS:
1. Shoulder dystocia
2. Cord coil, cord compression
3. Improper use of oxytocin, analgesia/anesthesia
4. Diabetes mellitus, cardiac disease, and other co
existing conditions in the mother
5. Bleeding complications in the third trimester like
placenta previa and abruptio placenta
6. Pregnancy induced hypertension (PIH)
7. Supine hypotensive syndrome
FETAL DISTRESS
ASSESSMENT FINDINGS TRIAD SYMPTOMS