PROBLEMS WITH FETUS

Shemaia R. Zephyrin

Fetal Size
Macrosomia large fetus that ways more than 400 g (8.8 lbs.) at birth.
Large fetus may not fit through womans pelvis and distends the
uterus and contribute to hypotonic labor dysfunction.
Sometimes a single part of fetus can be too large (ex. Hydrocephalus
abnormal amount of fluid in brain which causes fetal head to be too
large to fit in pelvis while the weight and body size is normal.)
Shoulder dystocia (EMERGENCY!) Fetal head is too large = fetal
head is born but shoulders become impacted above mothers symphysis
pubis.

Cont.
The head is out, chest cannot expand. Cord compresses between fetus
and mother's pelvis. HCP may request nurse to apply firm downward
pressure just above symphysis pubis to push shoulders toward pelvic
canal
Loosen shoulders = 1) Squat 2) Sharp flexion of thighs against abd.

Nursing Care
Mother successfully delivers large infant? Both mother and child
should be observed for injuries after birth.
Woman may have large episiotomy/laceration. Large infant is
more likely to have fractured clavicle(s).
Childs clavicles felt for crepitus or deformity of bones and arms
observed for equal movement (Moro reflex)
Woman more at risk for uterine atony and postpartum
hemorrhage, b/c after birth womans uterus does not contract well
to control placental site.

ABNORMAL FETAL
PRESENTATION OR POSITION

Abnormal Presentation
(Breech or face presentation)
In US, most fetuses in breech are born by C-section.
During vaginal birth for this condition, the trunk and extremities
are born before the head.
After fetal body delivered, umbilical cord can be compressed
between fetal head and mother pelvis.
To avoid fetal hypoxia, the head should be delivered quickly.
Intrapartum nurses = be prepared
To avoid need for C-section , external version is used (mot always
successful.)

Abnormal Positions
Common cause: fetus remains in persistent occiput posterior
position. Occiput position either occupies left or right
posterior quadrant of pelvis.
Labor longer when rotation does not occur.
Occiput posterior position = intense and poorly relieved back
and leg pain characterize labor.
Women with small or average size remain in an occiput
posterior position. Physician may use forceps to rotate fetal
head into occiput anterior position.

Nursing Care
Encourage women to assume positions that favor fetal rotation and
descent. They reduce back pain:
Sitting, kneeling or standing while leaning forward
Rock on pelvis back and forth while on hands and knees (to encourage
rotation)
Side lying (on left side for ROP + right side lying for LOP)
Squatting (for 2nd stage labor)
Lunging by placing 1 foot in a chair w/foot and knee pointed to that
side. Lunge sideways during a contraction for 5 seconds/time.

MULTIFETAL PREGNANCY

Multifetal Pregnancy
More than 1 fetus? Several factors can make dysfunctional labor
likely:
Uterine over distention = poor contraction quality
Abnormal presentation/position 1+ fetuses interferes w/labor
mechanisms.
Often 1 fetus delivered as cephalic and as 2nd breech (unless
version done.)

Nursing Care
Each fetus monitored separately during labor
Upright/ side-lying position w/ head slightly elevated aids
breathing and usually most comfortable.
Nursery and intrapartum staff = prepare equipment and meds for
every infant expected.
Anesthesiologist and pediatrician often present at birth because
potential maternal or neonatal problems.
1 nurse for each infant. Another nurse occupies mothers needs.

The End!