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CEPHALOPELVIC DISPROPORTION
- A narrowing, or contractions, of the birth canal, which
can occur at the inlets, midpelvis, or outlet, causes a
disproportion between the size of the fetal head and
the pelvic diameters, or cephalopelvic disproportion
(CPD). CPD results in failure of labor to progress
PRIMARY PROBLEMS
Malpositioning can occur because the fetuss
head isnt engaged in the pelvis.
Malpositioning can lead to further
complications. For example, if membranes
rupture, the risk for cord prolapse increases
significantly.
CAUSES
Small pelvis is major contributing factor in CPD. It may
result in rickets in the early life of the mother, or a
pelvis that isnt fully matured in a young adolescent.
The fetal head may be too large to fit or the overall fetal
size may be prohibitively large (known as macrosomia).
DETECTION
A previous vaginal birth without any problem
is substantial proof that the birth canal is
considered adequate.
MANAGEMENT
A trial labor may be allowed to continue of descent of the
presenting part and dilatationof the cervix are occurring.
The following nursing measures areimportant in trial labor:
Monitor fetal heart sounds anduterine contractions continuously.
Make sure that the womans urinarybladder is kept empty to allow
thefetal head to use all space, makingdelivery possible.
CEPHALOPELVIC DISPROPORTION
2. Mechanical means:
- amniotomy
-laminaria insertion
-nipple stimulation
Augmentation of Labor:
-assisting client when labor process is not
progressing normally ( prolonged labor) by
pharmacologic or mechanical means
Nursing Diagnoses:
Planning/Implementation
1. Prepare mother and labor coach for induction
- explain all procedures
- obtain informed consent
2. Remain with the patient at all times
3. Obtain and record baseline v/s, FHR, contractions
4. Monitor pitocin administration
- gradual increase drip rate till contractions occur every 23mins
- slow rate if (+) hypotension or tachycardia
7. Maintain hydration
Prepare for E CS if necessary
Evaluation/Outcome
1. Labor begins or increases and progresses to birth
2. Pitocin causes no adverse effects
3. Anxiety is decreased
4. Client shows no signs of infection
Multipara
PHASE
PHASE
AVERAGE
UPPER
NORMAL
AVERAGE
UPPER
NORMAL
LATENT
8.6
20
5.3
14
ACTIVE
5.8
12
2.5
2ND STAGE
1.5
0.25
Labor Curves
CESAREAN DELIVERY
CS delivery Indications:
1.CPD
2.malposition
3.Malpresentation
4previous CS
5.complete or partial placenta previa
6.abruptio placenta
7.prolapsed umbilical cord
8.fetal distress
Obstetric Intervention
Types:
1. Low Segment
incision done on lower uterine segment
blood loss is minimal
possibility of later uterine rupture is lessened
2.Classic
incision is made on the wall of the body of the uterus
done for anterior placenta previa
done for transverse lie
PFANNENSTIEL
Obstetric Interventions:
Nursing Care:
a. monitor vital signs closely
b. check dressing site
c. inspect perineal pad
d. check uterine fundus for firmness
e. breathing exercises
f. out of bed 1st post-op day
g. have the woman hold the baby ASAP
Other Complications:
A. PREMATURE LABOR & BIRTH Contributing
Factors:
a. multiple gestation
b. Polyhydramnios
c. PROM
d. incompetent cervix
E .placenta previa / abruptio placenta
f. previous preterm labor
g. infection
Management :
1. Prevention of Premature Delivery
- if woman is currently in preterm labor, she is admitted to the hospital
Bedrest
monitoring of contractions
IE
Tocolytic drugs ( Ritodrine, Terbutaline SO4)
Patient Teaching:
- teach woman symptoms of preterm labor
uterine contractions irregular pattern for more than 1 hour while at rest
intermittent or constant uterine cramps
low, dull backache & abdominal cramping
rupture of membrane
Analysis/Nursing Diagnoses:
1.
2.
3.
4.
5.
6.
7.
Interventions:
1. Monitor VS, FHR, contractions and progression of labor
2. Maintain bed rest
3. Inform client about the medication; obtain consent
4. Provide emotional support; reduce anxiety and prepare for possible
loss of baby
5. Provide special care related to the administration of tocolytic drugs
6. Prepare for use of glucocorticoid therapy for the fetus
7. Prepare for premature birth if labor continues
8. Provide home instructions for halting preterm labor
Evaluation/Outcome:
1. Labor ceases
2. FHT satisfactory
3. No adverse effects from tocolytic drugs
4. Anxiety decreases
5.Client and partner able to state recurring signs
of preterm labor
Other Complications:
PRECIPITATE DELIVERY - characterized by very strong contractions &
delivery that occurs less than 3 hours of labor
Predisposing Factors:
multiparity
history of rapid labor
premature or small fetus
large bony pelvis Risks:
perineal lacerations
hemorrhage
cerebral trauma
Management:
Planning/Implementation:
1. Remain with mother and monitor closely
2. Keep emergency birth pack at bedside
3. Keep mother and partner informed throughout process of
labor and birth
Evaluation/Outcomes:
1. Mother is safe throughout labor and birth
*babys are nose breathers
2.Neonate remains injury free during birth
UTERINE INVERSION
*baby out. Placenta next.. Delivered w/in 30mins.
Check for placental separation
*gushing of blood
*involution of uterus
*rising of fundus
*lenghtening of the cord
*BRANT ANDREWS MANUEVER-movement: updown, right-left placenta
UTERINE PROLAPSE/inversion
- can happen to old women; multigravida.. ; who didnt give birth
& h-mole
UTERINE RUPTURE
*prolonged labor due to cephalopelvic
disproportion
*previous CS
*primigravida with prolonged cpd
PLACENTAL PROBLEMS
PLACENTA PREVIA
ABRUPTIO PLACENTA
PLACENTA ACCRETA
1.First Trimester
- ambivalence; focuses more on self
- fear
-possible decrease in sex drive
TASK:
Accepting the pregnancy, I am pregnant
2.Second Trimester
- increased awareness and interest in fetus
-acceptance of reality of pregnancy
- feeling of well-being
-preoccupation with self
TASK:
Accepting the baby, A baby is growing inside
me
3. Third Trimester
- anticipation of labor and delivery
- fears ( impending labor ) and fantasies
( motherhood) about pregnancy
- heightened introversion
- view infant as reality vs fantasy
- spurt of energy during the last month
TASK:
Preparing for parenthood, I am a mother
COUVADE SYNDROME - group of physiological & behavioral
manifestation experienced by the husban- are often the results of stress, anxiety & empathy for the pregnant
women
Therapy : counseling
Nursing Role: refer for counseling
BLEEDING
INFECTION
THROMBOEMBOLISM
PSYCHIATRIC DISORDERS
Postpartum
Complications:Hemorrhage
Description - Blood loss exceeding 500 ml. after vaginal childbirth or
1000 ml. after cesarean birth
Assessment :
Early
Occurs during 24 hours after delivery
Caused by uterine atony or laceration or inversion of uterus
Late
Occurs after the 24 hours following delivery
Caused by retained fragments of placenta
Interventions:
Interventions:
Check client's vital signs and temperature every 2 to 4
hours
Make mother as comfortable as possible; position her for
comfort and to promote vaginal drainage
Keep mother warmed if chilled
Isolate newborn from the mother only if mother is
infectious
Provide a high-calorie, high-protein diet and encourage
fluids to 3000 to4000 ml/day if not contraindicated
Encourage frequent voiding and monitor client's intake and
output
Monitor results of cultures if they were prescribed
Administer antibiotics according to organism, as prescribed
Postpartum
Complications:Endometritis
Description :
Infection of uterine lining after delivery; caused by bacteria
that invade uterus at site of attachment of placenta
Infection may spread, involving entire endometrium and
causing peritonitis, paralytic ileus, or pelvic abscess
Assessment :
Chills and fever
Uterine tenderness and enlargement
Foul odor or purulent lochia; may increase or decrease in
volume
Malaise, fatigue, tachycardia
I nterventions:
Monitor client's vital signs
Obtain cultures of blood and lochia
Assist client into Fowler's position to facilitate
drainage of lochia
Administer antibiotics and pain medication as
prescribed
Instruct client in proper handwashing techniques
Initiate wound(contact) precautions as necessary
Breastfeeding may be restricted during infectious
period; if woman is breastfeeding, she may need
to pump her breasts to establish and maintain
lactation
Postpartum Complications:
Thrombophlebitis
Description:
A condition in which a clot forms in a vessel wall as a
result of inflammation of the wall
Partial obstruction of vessel may occur
Increased levels of clotting factors in postpartum
period place client at risk
Assessment :
Heat, tenderness, and pain in affected leg
Swelling of affected leg
Homans' sign
Chills and fever
Swelling/Homans sign
- pain is felt when the foot is dorsiflexed on the affected area.
Do not massage