This document discusses complications that can arise during labor and delivery. It defines dystocia, or difficult labor, as being caused by abnormalities in uterine contractions (power), the pelvis or birth canal (passageway), fetal position or size (passenger), maternal psychology, or maternal position. Specific issues that can contribute to dystocia are then outlined such as ineffective contractions, pelvic abnormalities, breech or shoulder presentations of the baby, maternal fear or anxiety, and supine positions of the mother. Diagnosis, management, complications, and nursing care are also reviewed.
The document discusses preeclampsia, including its signs, symptoms, risk factors, diagnostic tests, pathophysiology, and treatment. Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to other organ systems. It is caused by abnormal development of the placenta leading to reduced blood flow and endothelial cell dysfunction systemically. Proper management involves monitoring blood pressure, delivering the baby to resolve symptoms, and potentially using antihypertensive medications.
This document discusses complications that can arise from ineffective uterine force during labor and delivery. It describes three types of dysfunctional contractions - hypotonic, hypertonic, and uncoordinated - that can lead to ineffective labor. It also discusses how dysfunctional labor can impact the different stages of labor and delivery, potentially resulting in prolonged phases, arrest of dilation or descent, or precipitate labor. Management strategies aim to improve uterine contractions and fetal positioning or may require interventions like oxytocin administration, cesarean delivery, or removal of contraction rings.
This document discusses various fetal malpresentations and malpositions that can occur during labor and delivery. It defines malpresentation as a non-vertex presentation such as breech, brow, or transverse lie, and malposition as positions other than occiput anterior. Common presentations and positions are described along with their diagnosis, management, and potential complications. Breech presentation management includes external cephalic version, spontaneous version, or caesarean section depending on gestational age and other risk factors. Vaginal breech delivery techniques like Pinard's maneuver and Burns Marshall method are outlined. Face presentations are also summarized.
This document discusses various complications that can occur with the passage of the baby during birth due to issues with the mother's pelvis or birth canal. It describes how narrowing or contractions of the inlet, midpelvis, or outlet can cause cephalopelvic disproportion. It also discusses other potential issues like anomalies of the placenta such as placenta succenturiata which could lead to hemorrhage if lobes are retained, and vasa previa which involves blood vessels crossing the cervix and can cause bleeding with dilation. External cephalic version and trial of labor are mentioned as potential approaches to addressing some of these complications.
A 27-year-old woman was admitted to the hospital with severe pre-eclampsia at 35 weeks and 3 days of gestation. She had a blood pressure of 180/110 mmHg, proteinuria, edema, headache, and blurred vision. She received magnesium sulfate and antihypertensive medications. She later had a cesarean section under general anesthesia and delivered twins weighing 1.8 kg and 1.6 kg. The nursing care focused on monitoring her vital signs and symptoms, managing her blood pressure and fluids, providing rest and medications, and health education. Recommendations included improving equipment, guidelines, and staff training for managing severe pre-eclampsia.
The EINC initiative of the Philippine Department of Health- Non Communicable Diseases Prevention and Control-Family Health Office (DOH-NCDPC-FHO) and DOH Center for Health Promotions (NCHP), supported by the Joint Programme on Maternal and Neonatal Health (JPMNH), and being funded by AusAID, was piloted in 11 hospitals in the Philippines, and has yielded favorable results.
The recommended EINC practices during the intrapartum period include continuous maternal support by having a companion of choice during labor and delivery, freedom of movement during labor, monitoring progress of labor using the partograph, non-drug pain relief before offering labor anesthesia, position of choice during labor and delivery, spontaneous pushing in a semi-upright position, non-routine episiotomy, and active management of the third stage of labor (AMTSL).
For newborns, four core steps were recommended in a time bound sequence. A social marketing handle, “The First Embrace,” accompanied the initiative for practice change among health workers.
1. Cesarean delivery is a surgical procedure to deliver babies through incisions in the mother's abdomen and uterus.
2. The most common type of cesarean incision is a low transverse incision in the lower uterine segment.
3. Indications for cesarean delivery include cephalopelvic disproportion, fetal distress, breech presentation, and previous uterine surgeries.
The document discusses preeclampsia, including its signs, symptoms, risk factors, diagnostic tests, pathophysiology, and treatment. Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to other organ systems. It is caused by abnormal development of the placenta leading to reduced blood flow and endothelial cell dysfunction systemically. Proper management involves monitoring blood pressure, delivering the baby to resolve symptoms, and potentially using antihypertensive medications.
This document discusses complications that can arise from ineffective uterine force during labor and delivery. It describes three types of dysfunctional contractions - hypotonic, hypertonic, and uncoordinated - that can lead to ineffective labor. It also discusses how dysfunctional labor can impact the different stages of labor and delivery, potentially resulting in prolonged phases, arrest of dilation or descent, or precipitate labor. Management strategies aim to improve uterine contractions and fetal positioning or may require interventions like oxytocin administration, cesarean delivery, or removal of contraction rings.
This document discusses various fetal malpresentations and malpositions that can occur during labor and delivery. It defines malpresentation as a non-vertex presentation such as breech, brow, or transverse lie, and malposition as positions other than occiput anterior. Common presentations and positions are described along with their diagnosis, management, and potential complications. Breech presentation management includes external cephalic version, spontaneous version, or caesarean section depending on gestational age and other risk factors. Vaginal breech delivery techniques like Pinard's maneuver and Burns Marshall method are outlined. Face presentations are also summarized.
This document discusses various complications that can occur with the passage of the baby during birth due to issues with the mother's pelvis or birth canal. It describes how narrowing or contractions of the inlet, midpelvis, or outlet can cause cephalopelvic disproportion. It also discusses other potential issues like anomalies of the placenta such as placenta succenturiata which could lead to hemorrhage if lobes are retained, and vasa previa which involves blood vessels crossing the cervix and can cause bleeding with dilation. External cephalic version and trial of labor are mentioned as potential approaches to addressing some of these complications.
A 27-year-old woman was admitted to the hospital with severe pre-eclampsia at 35 weeks and 3 days of gestation. She had a blood pressure of 180/110 mmHg, proteinuria, edema, headache, and blurred vision. She received magnesium sulfate and antihypertensive medications. She later had a cesarean section under general anesthesia and delivered twins weighing 1.8 kg and 1.6 kg. The nursing care focused on monitoring her vital signs and symptoms, managing her blood pressure and fluids, providing rest and medications, and health education. Recommendations included improving equipment, guidelines, and staff training for managing severe pre-eclampsia.
The EINC initiative of the Philippine Department of Health- Non Communicable Diseases Prevention and Control-Family Health Office (DOH-NCDPC-FHO) and DOH Center for Health Promotions (NCHP), supported by the Joint Programme on Maternal and Neonatal Health (JPMNH), and being funded by AusAID, was piloted in 11 hospitals in the Philippines, and has yielded favorable results.
The recommended EINC practices during the intrapartum period include continuous maternal support by having a companion of choice during labor and delivery, freedom of movement during labor, monitoring progress of labor using the partograph, non-drug pain relief before offering labor anesthesia, position of choice during labor and delivery, spontaneous pushing in a semi-upright position, non-routine episiotomy, and active management of the third stage of labor (AMTSL).
For newborns, four core steps were recommended in a time bound sequence. A social marketing handle, “The First Embrace,” accompanied the initiative for practice change among health workers.
1. Cesarean delivery is a surgical procedure to deliver babies through incisions in the mother's abdomen and uterus.
2. The most common type of cesarean incision is a low transverse incision in the lower uterine segment.
3. Indications for cesarean delivery include cephalopelvic disproportion, fetal distress, breech presentation, and previous uterine surgeries.
The document provides information on nursing care of the mother during the postpartum period. Key points include:
- The postpartum period lasts approximately 6 weeks as the body returns to its pre-pregnant state.
- Physiologic changes include uterine involution over 10 days and lochia discharge over 3 weeks. Engorgement may occur between days 3-5.
- Nursing assessments include monitoring vital signs, bleeding, breast engorgement, and bonding with the infant. Interventions focus on preventing infection, reducing pain and fatigue, and promoting breastfeeding and self-care.
1) Prolapsed umbilical cord occurs when the umbilical cord is displaced into or through the cervix during labor, putting pressure on the cord and restricting blood flow to the fetus.
2) Risk factors include non-cephalic fetal position, prematurity, polyhydramnios, multiple gestation, and disproportion between the fetus and pelvis.
3) Signs include variable fetal heart decelerations, palpation of the cord in the vagina or cervix, and fetal distress. Immediate management involves positioning the mother to relieve pressure on the cord and expedited delivery by cesarean section if the cervix is not fully dilated.
This document provides an introduction to the EBW Healthcare series of distance learning books for healthcare professionals. It was developed by the Perinatal Education Trust to provide appropriate, up-to-date learning materials for healthcare workers in under-resourced areas. The books use a self-help, decentralised learning method with question-and-answer formats, skills workshops, and pre- and post-tests to enable continuing education.
- Provide emotional support and
encourage expression of feelings
- Explain options for management
- Discuss autopsy and genetic
counseling
- Refer to bereavement counselor
- Follow up after delivery
Preterm Labor, Hyperemesis Gravidarum PathophysiologyReynel Dan
This document lists various risk factors that can precipitate or predispose a person to preterm labor and birth. Precipitating factors include dehydration, habitual abortion, and heavy work. Predisposing factors include a history of cervical procedures or congenital abnormalities, infections, induced abortions, preterm deliveries, or perinatal deaths. Additional risk factors include low socioeconomic status, inadequate weight gain or prenatal care, multiple gestations, smoking, substance abuse, and chorioamnionitis.
This document discusses the psychological adaptations that occur during pregnancy. It covers three trimesters of pregnancy and the common experiences women face, including ambivalence, introversion, acceptance of pregnancy, role assumption, self-image changes, establishing a relationship with the fetus, and preparation for birth. It also discusses cultural influences on pregnancy experiences, such as dietary practices, activity levels, and birth preparations that are specific to different cultures. Understanding these psychological and cultural aspects can help both mothers and their partners during this transition to parenthood.
This document summarizes several high risk conditions that can occur during labor and delivery as well as in the postpartum period. It outlines malpositions and malpresentations that can complicate labor, including occiput posterior, breech, shoulder dystocia, and dysfunctional or hypotonic/hypertonic contractions. It also discusses preterm labor risks and management, cord prolapse, post-term pregnancy risks, reasons for cesarean section, and postpartum complications such as hemorrhage, infection, and affective disorders.
This document discusses various complications that can arise regarding the mother and passenger (baby) during pregnancy and childbirth. It covers complications such as prolapse of the umbilical cord, multiple gestation, fetal positioning issues like face presentation and brow presentation, fetal size issues like macrosomia and shoulder dystocia, and breech presentation. It also discusses managing the mother's psyche and emotional state during birth as that can impact the birthing process if she is feeling afraid, tense or unsupported. Effective management strategies are provided for each complication depending on whether a normal spontaneous delivery is possible or if cesarean section is required.
Anticipatory grieving related to pregnancy loss ncpIda Hui-Ming
This document outlines nursing interventions for clients experiencing grief and loss from abortion, pregnancy loss, or perinatal death. It includes assessing the client's emotional state and coping skills, encouraging expression of feelings, identifying support systems, monitoring for suicidal ideation, ensuring comfort, and recognizing individual differences in grieving processes. Nursing goals are to facilitate healthy grieving and coping. Risks like complicated grieving, hemorrhage, disseminated intravascular coagulation, and infection require monitoring and evidence-based interventions.
The document provides information on the BUBBLE-HE method for assessing postpartum patients. It describes each component of the acronym: Breast, Uterus, Bladder, Bowels, Lochia, Homan's sign, and Episiotomy/perineum. For each component, it outlines what to assess, normal findings, and nursing considerations. It also discusses breastfeeding and bottle feeding, including benefits and teaching points for each.
Pregnancy- Gordon's Functional Health PatternsJacey Mitchell
The document discusses various patterns related to pregnancy from both the perspective of the fetus and pregnant woman. It covers nutritional, elimination, activity, sleep, cognitive, self-perception, roles-relationships, coping-stress tolerance, and values-belief patterns. Key aspects addressed include the importance of proper nutrition for growth and development, common discomforts experienced during pregnancy, the development of fetal senses and sleep cycles, and psychological and emotional changes experienced by the pregnant woman.
The document outlines 16 hallmarks that characterize the art and science of midwifery. Key hallmarks include recognizing important female life stages as normal physiological processes, advocating for non-intervention during normal processes absent complications, and promoting woman-centered care, empowerment, and continuity of care. Midwifery also focuses on health promotion, education, advocacy for informed choice, and collaboration with other healthcare professionals.
The document provides information on various topics related to maternal and child health nursing for the upcoming December 2012 PNLE exam, including:
1. Stages of pregnancy, signs of pregnancy, diagnostic tests during pregnancy such as ultrasound and amniocentesis.
2. Discomforts of pregnancy like nausea and vomiting, and ways to manage them.
3. Details of the stages of labor, nursing care during labor, and complications like abortion and ectopic pregnancy.
4. Postpartum topics like lochia, perineal lacerations, micronutrient supplementation during pregnancy.
Magnesium sulfate is used to treat acute nephritis, control hypertension in preeclampsia/eclampsia, correct or prevent hypomagnesemia, and as an adjunct treatment for acute MI and asthma exacerbations. It has contraindications for those with heart block, renal insufficiency, or abdominal symptoms. Potential side effects include weakness, dizziness, bowel issues, and hypermagnesemia. Nurses should monitor magnesium levels during IV therapy and watch for signs of toxicity.
Community health nursing involves promoting health, preventing disease, and managing factors affecting health at the community level. It aims to raise the overall health status of populations. A community is defined as a group of people living in a specific geographical area with common characteristics or interests. Community health nursing utilizes the nursing process to provide care to individuals, families, population groups, and communities. It combines public health science with nursing skills and social assistance. The community is considered the patient, with the family as the unit of care.
The document provides an overview of the history and evolution of midwifery as a profession. It discusses how midwifery was traditionally practiced by women for centuries until the 17th century when male midwives began to emerge. It also outlines key terminology used in midwifery and describes the roles and responsibilities of midwives, which include providing care during pregnancy, labor, delivery and the postpartum period. Additionally, it notes several trends in modern midwifery, such as an emphasis on family-centered care, cost containment measures, expanded nursing roles, and increased use of technology.
This document discusses multiple pregnancy (twins, triplets etc.). It begins by defining multiple pregnancy as the simultaneous development of more than one fetus in the uterus. The most common type is twins (two fetuses), although three, four, five or six fetuses may also occasionally develop. It notes that twins resulting from two separate eggs (dizygotic) are more common than those from a single egg splitting (monozygotic). Risk factors, diagnostic evaluations, complications and management of multiple pregnancies are discussed in detail.
Intrapartum Care: Monitoring and management of the first stage of labourSaide OER Africa
Intrapartum Care was developed for doctors and advanced midwives who care for women who deliver in district hospitals. It contains theory chapters and skills workshops adapted from the labour chapters of Maternal Care. monitoring the mother, fetus, and progress of labour, the second and third stages of labour, managing pain, the puerperium and family planning
The document provides information on nursing care of the mother during the postpartum period. Key points include:
- The postpartum period lasts approximately 6 weeks as the body returns to its pre-pregnant state.
- Physiologic changes include uterine involution over 10 days and lochia discharge over 3 weeks. Engorgement may occur between days 3-5.
- Nursing assessments include monitoring vital signs, bleeding, breast engorgement, and bonding with the infant. Interventions focus on preventing infection, reducing pain and fatigue, and promoting breastfeeding and self-care.
1) Prolapsed umbilical cord occurs when the umbilical cord is displaced into or through the cervix during labor, putting pressure on the cord and restricting blood flow to the fetus.
2) Risk factors include non-cephalic fetal position, prematurity, polyhydramnios, multiple gestation, and disproportion between the fetus and pelvis.
3) Signs include variable fetal heart decelerations, palpation of the cord in the vagina or cervix, and fetal distress. Immediate management involves positioning the mother to relieve pressure on the cord and expedited delivery by cesarean section if the cervix is not fully dilated.
This document provides an introduction to the EBW Healthcare series of distance learning books for healthcare professionals. It was developed by the Perinatal Education Trust to provide appropriate, up-to-date learning materials for healthcare workers in under-resourced areas. The books use a self-help, decentralised learning method with question-and-answer formats, skills workshops, and pre- and post-tests to enable continuing education.
- Provide emotional support and
encourage expression of feelings
- Explain options for management
- Discuss autopsy and genetic
counseling
- Refer to bereavement counselor
- Follow up after delivery
Preterm Labor, Hyperemesis Gravidarum PathophysiologyReynel Dan
This document lists various risk factors that can precipitate or predispose a person to preterm labor and birth. Precipitating factors include dehydration, habitual abortion, and heavy work. Predisposing factors include a history of cervical procedures or congenital abnormalities, infections, induced abortions, preterm deliveries, or perinatal deaths. Additional risk factors include low socioeconomic status, inadequate weight gain or prenatal care, multiple gestations, smoking, substance abuse, and chorioamnionitis.
This document discusses the psychological adaptations that occur during pregnancy. It covers three trimesters of pregnancy and the common experiences women face, including ambivalence, introversion, acceptance of pregnancy, role assumption, self-image changes, establishing a relationship with the fetus, and preparation for birth. It also discusses cultural influences on pregnancy experiences, such as dietary practices, activity levels, and birth preparations that are specific to different cultures. Understanding these psychological and cultural aspects can help both mothers and their partners during this transition to parenthood.
This document summarizes several high risk conditions that can occur during labor and delivery as well as in the postpartum period. It outlines malpositions and malpresentations that can complicate labor, including occiput posterior, breech, shoulder dystocia, and dysfunctional or hypotonic/hypertonic contractions. It also discusses preterm labor risks and management, cord prolapse, post-term pregnancy risks, reasons for cesarean section, and postpartum complications such as hemorrhage, infection, and affective disorders.
This document discusses various complications that can arise regarding the mother and passenger (baby) during pregnancy and childbirth. It covers complications such as prolapse of the umbilical cord, multiple gestation, fetal positioning issues like face presentation and brow presentation, fetal size issues like macrosomia and shoulder dystocia, and breech presentation. It also discusses managing the mother's psyche and emotional state during birth as that can impact the birthing process if she is feeling afraid, tense or unsupported. Effective management strategies are provided for each complication depending on whether a normal spontaneous delivery is possible or if cesarean section is required.
Anticipatory grieving related to pregnancy loss ncpIda Hui-Ming
This document outlines nursing interventions for clients experiencing grief and loss from abortion, pregnancy loss, or perinatal death. It includes assessing the client's emotional state and coping skills, encouraging expression of feelings, identifying support systems, monitoring for suicidal ideation, ensuring comfort, and recognizing individual differences in grieving processes. Nursing goals are to facilitate healthy grieving and coping. Risks like complicated grieving, hemorrhage, disseminated intravascular coagulation, and infection require monitoring and evidence-based interventions.
The document provides information on the BUBBLE-HE method for assessing postpartum patients. It describes each component of the acronym: Breast, Uterus, Bladder, Bowels, Lochia, Homan's sign, and Episiotomy/perineum. For each component, it outlines what to assess, normal findings, and nursing considerations. It also discusses breastfeeding and bottle feeding, including benefits and teaching points for each.
Pregnancy- Gordon's Functional Health PatternsJacey Mitchell
The document discusses various patterns related to pregnancy from both the perspective of the fetus and pregnant woman. It covers nutritional, elimination, activity, sleep, cognitive, self-perception, roles-relationships, coping-stress tolerance, and values-belief patterns. Key aspects addressed include the importance of proper nutrition for growth and development, common discomforts experienced during pregnancy, the development of fetal senses and sleep cycles, and psychological and emotional changes experienced by the pregnant woman.
The document outlines 16 hallmarks that characterize the art and science of midwifery. Key hallmarks include recognizing important female life stages as normal physiological processes, advocating for non-intervention during normal processes absent complications, and promoting woman-centered care, empowerment, and continuity of care. Midwifery also focuses on health promotion, education, advocacy for informed choice, and collaboration with other healthcare professionals.
The document provides information on various topics related to maternal and child health nursing for the upcoming December 2012 PNLE exam, including:
1. Stages of pregnancy, signs of pregnancy, diagnostic tests during pregnancy such as ultrasound and amniocentesis.
2. Discomforts of pregnancy like nausea and vomiting, and ways to manage them.
3. Details of the stages of labor, nursing care during labor, and complications like abortion and ectopic pregnancy.
4. Postpartum topics like lochia, perineal lacerations, micronutrient supplementation during pregnancy.
Magnesium sulfate is used to treat acute nephritis, control hypertension in preeclampsia/eclampsia, correct or prevent hypomagnesemia, and as an adjunct treatment for acute MI and asthma exacerbations. It has contraindications for those with heart block, renal insufficiency, or abdominal symptoms. Potential side effects include weakness, dizziness, bowel issues, and hypermagnesemia. Nurses should monitor magnesium levels during IV therapy and watch for signs of toxicity.
Community health nursing involves promoting health, preventing disease, and managing factors affecting health at the community level. It aims to raise the overall health status of populations. A community is defined as a group of people living in a specific geographical area with common characteristics or interests. Community health nursing utilizes the nursing process to provide care to individuals, families, population groups, and communities. It combines public health science with nursing skills and social assistance. The community is considered the patient, with the family as the unit of care.
The document provides an overview of the history and evolution of midwifery as a profession. It discusses how midwifery was traditionally practiced by women for centuries until the 17th century when male midwives began to emerge. It also outlines key terminology used in midwifery and describes the roles and responsibilities of midwives, which include providing care during pregnancy, labor, delivery and the postpartum period. Additionally, it notes several trends in modern midwifery, such as an emphasis on family-centered care, cost containment measures, expanded nursing roles, and increased use of technology.
This document discusses multiple pregnancy (twins, triplets etc.). It begins by defining multiple pregnancy as the simultaneous development of more than one fetus in the uterus. The most common type is twins (two fetuses), although three, four, five or six fetuses may also occasionally develop. It notes that twins resulting from two separate eggs (dizygotic) are more common than those from a single egg splitting (monozygotic). Risk factors, diagnostic evaluations, complications and management of multiple pregnancies are discussed in detail.
Intrapartum Care: Monitoring and management of the first stage of labourSaide OER Africa
Intrapartum Care was developed for doctors and advanced midwives who care for women who deliver in district hospitals. It contains theory chapters and skills workshops adapted from the labour chapters of Maternal Care. monitoring the mother, fetus, and progress of labour, the second and third stages of labour, managing pain, the puerperium and family planning
The document discusses various psychological changes and disorders that can occur during the postpartum period. It describes common changes like adjustment to new roles, postpartum blues, cultural influences on attachment. It also discusses postpartum disorders like depression, anxiety, stress reactions and trauma from delivery, postpartum OCD, PTSD and psychosis. Nursing interventions are focused on early detection and referral for treatment of any psychological issues and supporting positive parenting behaviors.
Postpartum hemorrhage and other complications are described. Uterine atony is a common cause of early postpartum hemorrhage. Retained placental fragments can also cause hemorrhage. Clinical manifestations of hemorrhage include hypotension and vaginal bleeding. Management involves oxytocics, IV fluids, blood transfusion, and curettage if needed. Nursing focuses on monitoring for shock, administering treatments, and educating on postpartum care and warning signs. Puerperal infections and hematomas are also risks and are managed with antibiotics, analgesics, and hygiene education. Amniotic fluid embolism is a rare but often fatal complication from amniotic debris entering the mother's
Chapter 8 nursing care during labor and pain managementLeonila Limpio
This chapter discusses nursing care during labor and pain management. It covers cultural considerations during labor, different birth settings including hospital, birthing centers, and home births. It describes the stages of labor and nursing assessments and interventions during each stage. Nonpharmacological and pharmacological pain management strategies are discussed. The chapter objectives are to describe nursing care during labor including assessments, interventions, pain management and immediate newborn care.
The document provides information on managing the normal postpartum period, or puerperium. It defines the puerperium as lasting 6 weeks after delivery of the placenta. During this time, the mother's body returns to its non-pregnant state through physical changes in organs like the uterus, breasts, cardiovascular and gastrointestinal systems. Proper management of the first hour after delivery and routine observations are important to prevent postpartum hemorrhage. With no complications, patients can typically be discharged 6 hours after a normal vaginal delivery or after 3 days for a Cesarean section. Follow-up postnatal care is also required during the 6-week period.
Intrapartum Care was developed for doctors and advanced midwives who care for women who deliver in district hospitals. It contains theory chapters and skills workshops adapted from the labour chapters of Maternal Care. Monitoring the mother, fetus, and progress of labour, the second and third stages of labour, managing pain, the puerperium and family planning
This document provides a user's manual for monitoring labor using a partograph. It describes the observations that should be charted on the partograph, including cervical dilation, fetal descent, uterine contractions, and fetal and maternal conditions. It explains how to identify abnormal labor progress and provides guidance on management for different scenarios, such as when labor is between the alert and action lines or beyond the action line. The goal is to use the partograph as a tool to help safely manage labor.
The document provides an overview of the partograph, which is a graphical record used to monitor the progress of labor and the condition of the mother and fetus. It describes the history and development of the partograph, including Friedman's original partogram from 1954 and later modifications by Philpott and Castle that introduced alert and action lines. The WHO partograph is explained in detail, outlining its components for monitoring fetal condition, labor progress, and maternal condition. Guidelines are provided for normal labor progression and management based on the partograph, as well as how to identify and respond to abnormal labor progress. Key considerations for using oxytocin augmentation are also reviewed.
The document provides an outline and overview of a presentation on the management of abnormal labor and the partograph. It discusses the definition of normal and abnormal labor and various etiologies of abnormal labor including abnormal patterns of labor, abnormalities of the birth canal or passenger, and abnormalities of uterine power. It describes specific abnormal patterns like prolonged latent phase, protraction disorders, arrest disorders, and precipitate labor. It also discusses evaluating and managing different abnormalities of the birth canal, passenger (fetus), and uterine contractions. The last section introduces the topic of the partograph for monitoring labor.
The document provides an overview of contraceptive methods in India. It discusses the history of contraception from ancient times to modern advances. Key facts about the contraceptive scenario in India are presented from surveys conducted in 2005-2006. The document then classifies and describes various contraceptive methods including barrier methods like male and female condoms, as well as intrauterine devices, hormonal methods, and permanent sterilization methods. Advanced methods still in development are also briefly mentioned.
The document discusses care for pregnant women with HIV/AIDS, including prevention of parent-to-child transmission (PPTCT). Key points include: HIV can be transmitted from mother to child during pregnancy, delivery, or breastfeeding; antiretroviral therapy and safer delivery practices can reduce transmission risk; and PPTCT programs aim to prevent transmission through counseling, testing, treatment and supporting safer infant feeding options.
This document discusses emotional labor, which refers to displaying required emotions as part of one's job. It covers Arlie Hochschild's perspective on emotional labor as managing feelings to achieve outward displays. Hochschild identified two strategies for emotional labor - surface acting, where one regulates expressions, and deep acting, where one modifies feelings. The document also examines research on the relationships between emotional labor, job satisfaction, emotional exhaustion, and organizational commitment. Professors who expressed genuine positive emotions experienced less burnout and more job satisfaction and commitment.
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
Ultrasound is the primary imaging technique used in gynecology. It can be performed transabdominally or transvaginally. Transvaginal ultrasound (TVUS) allows for a narrower field of view and shallower imaging compared to transabdominal ultrasound (TAUS), but does not require a full bladder. TVUS is useful for evaluating early pregnancies, uterine texture, and measuring ovarian cysts. Ultrasound is used extensively to image the pelvic organs, assess gynecologic problems, and evaluate adnexal masses and cancers.
Newborn infants undergo several physiological adaptations after birth. The foramen ovale and ductus arteriosus close as pulmonary vascular resistance decreases and oxygen levels in the lungs increase. Temperature regulation is important as newborns have a narrow temperature range and lack body fat. They rely on caregivers to prevent heat loss through proper drying, skin-to-skin contact, and room temperature. Liver function also adapts as the immature liver transitions to breaking down bilirubin from red blood cells.
This document summarizes pharmacology of drugs relevant to obstetrics. It discusses changes in pregnancy that impact drug absorption, distribution and elimination. It covers teratogenic drugs and their effects in different trimesters. It then summarizes various drug classes used for gastric aspiration prevention, analgesia, local anesthesia, contracting the uterus, and relaxing the uterus. It provides details on specific drugs in each class including dosages, mechanisms of action, side effects and considerations in pregnancy. It concludes with a brief section on laparoscopic surgeries in pregnancy.
The document provides guidelines for taking a thorough gynecology history. It emphasizes maintaining patient comfort and privacy, using sensitive communication, and exploring all relevant medical, surgical, obstetric, menstrual, sexual and family histories. The key components of history taking are outlined, including chief complaints, menstrual, obstetric and medical histories. Factors to assess for various presenting issues like abnormal bleeding, discharge, masses and infertility are described.
hemorrhagic complication in first trimester Muni Venkatesh
The document discusses hemorrhagic complications that can occur in the first trimester of pregnancy, including abortion, gestational trophoblastic disease, and molar pregnancies. It provides details on the types, symptoms, diagnosis, and treatment of conditions like threatened abortion, inevitable abortion, missed abortion, recurrent abortion, septic abortion, hydatidiform mole (complete and partial), and malignant gestational trophoblastic disease. Molar pregnancies are characterized by abnormal proliferation of chorionic villi and classified as complete or partial depending on the presence of fetal tissue. Follow-up of molar pregnancies is important to monitor hCG levels and detect malignant transformation.
This document discusses problems that can occur with fetal position, presentation, or size during labor and delivery. It describes issues like occipitoposterior position where the baby's head is facing the wrong way, breech presentation where the baby is feet or butt first, face or brow presentations which are types of abnormal head position, and transverse lie where the baby is laying horizontally across the womb. It provides information on assessment of these problems, contributing risk factors, potential complications, and therapeutic management approaches including manual maneuvers, positions, and when cesarean delivery may be recommended.
This document discusses placental abnormalities including placenta previa and abruption placentae. It provides information on pathophysiology, clinical manifestations, diagnostic evaluation, management, nursing assessment, nursing diagnoses, interventions, patient education, and evaluation for each condition. Placenta previa is when the placenta covers all or part of the cervical os, which can cause painless bleeding late in pregnancy. Abruptio placentae is premature separation of the placenta from the uterus, which causes bleeding and can lead to shock. Ultrasound is used for diagnosis and treatment involves bed rest, monitoring, and delivery by c-section if needed to stabilize the mother and baby.
This document discusses breech delivery, including definitions, types, incidence, diagnosis, management, and risks. It defines breech delivery as presentation where the fetus is in a longitudinal lie with the buttocks presenting at the pelvis. The main types are complete and frank breech. Incidence is low where high parity births are minimal and cephalic version is routinely performed. Management includes attempting external cephalic version after 37 weeks or planning for cesarean section. Vaginal breech delivery carries risks to the fetus like intracranial damage so careful maneuvers are needed during the second stage of labor to prevent complications.
The document discusses prolonged and obstructed labor. Prolonged labor is defined as the first and second stages of labor taking more than 18 hours total. Obstructed labor occurs when descent is arrested due to a mechanical obstruction, despite adequate contractions. Causes include cephalopelvic disproportion, malpositions, or large babies. Risks include maternal exhaustion, infection, and fetal distress or death. Treatment involves identifying the obstruction's cause, resuscitating the mother, relieving the obstruction via vaginal operative delivery or C-section, and preventing or treating complications like infection.
1. The document discusses various operative obstetric procedures including vaginal operations like forceps delivery, breech extraction, and vacuum extraction as well as abdominal operations like cesarean section and postpartum hysterectomy.
2. Forceps delivery classifications include outlet, low, mid, and high forceps. Indications, techniques, and complications are described.
3. Breech delivery techniques include the Pinard maneuver and total breech extraction. Risks to the mother and fetus are outlined.
4. Vacuum extraction provides an alternative to forceps delivery using suction to assist delivery. Placement of the suction cup is critical for success.
The document outlines the stages of prenatal development from conception through birth. It discusses the following stages: conception, the germinal stage (first two weeks), the embryonic stage (third through eighth weeks), and the fetal stage (ninth month to birth). Key events in each stage include fertilization, implantation, development of vital organs, bone formation, and growth to an average weight of 7.5 pounds. The document also addresses potential influences on prenatal development like maternal health, nutrition, environmental factors, and drug/alcohol exposure that can negatively impact the fetus.
1. Prenatal development occurs in three main stages - conception, germinal (first two weeks), and embryonic (third through eighth weeks) where major organs begin to develop.
2. The fetal stage from the ninth week to birth sees continued growth and development until birth, including bone formation and ability to move.
3. Many factors can negatively influence prenatal development, including maternal health issues, nutrition, environmental toxins, drugs/alcohol, and home stressors. Proper prenatal care is important for healthy outcomes.
This document discusses prolonged labor, obstructed labor, and dystocia caused by fetal anomalies. Prolonged labor is defined as the combined first and second stage of labor exceeding 18 hours. It can be caused by issues with cervical dilation, fetal descent, uterine contractions, or pelvic and fetal factors. Obstructed labor occurs when descent is arrested due to a mechanical obstruction in the birth canal or fetus. This can lead to exhaustion, dehydration, acidosis, and infection for the mother. Fetal risks include hypoxia, infection, head molding issues, and increased need for operative delivery. Prevention focuses on identifying risk factors. Treatment involves evaluating the cause and deciding between augmentation, assisted delivery, or C-
1) Prolonged labor is defined as labor lasting over 20 hours for first time mothers and over 14 hours for mothers who have previously given birth. It can be caused by issues like malpresentation, cephalopelvic disproportion, or problems with uterine contractions.
2) Signs of prolonged labor include exhaustion, dehydration, high pulse rate, and potential fetal distress. It increases risks for both mother and baby.
3) Management of prolonged labor involves identifying the cause, giving the mother fluids and pain relief, monitoring progress and fetal wellbeing, and potentially assisting delivery or performing a C-section if vaginal delivery is not possible or safe.
This document discusses several conditions that can cause difficulties during childbirth due to the size relationship between the baby's head and the mother's pelvis, including inlet contraction, outlet contraction, and cephalopelvic disproportion. It describes the normal measurements of the pelvic inlet and outlet, potential causes of each condition, assessment findings, management strategies, and complications. It also covers shoulder dystocia, defining it as when the baby's anterior shoulder gets stuck under the pubic bone after the head is delivered. Risk factors, pathophysiology, assessment findings, and management techniques like McRoberts position and suprapubic pressure are outlined.
Obstructed labor occurs when the baby's descent through the birth canal is arrested despite adequate contractions, due to mechanical obstruction. It can be caused by issues with the mother's pelvis or soft tissues (fault in the passage) or fetal abnormalities (fault in the passenger). Effects on the mother include exhaustion, dehydration, infection, and injury to the genital tract. The fetus may experience asphyxia, acidosis, and intracranial hemorrhage. Management involves rehydration, antibiotics if infection is present, and expedited delivery by c-section, vacuum extraction, or symphysiotomy and c-section if needed. Complications can be severe if not properly managed.
The document provides information about homework help resources and a case study on abruptio placentae (placental abruption). It includes an introduction to abruptio placentae, objectives of studying the case, patient profile, assessments of the patient's health history and tests, anatomy and pathophysiology of the condition, and a nursing care plan. The case study aims to increase understanding of abruptio placentae, including diagnosing and treating the condition, administering appropriate drugs and transfusions, and formulating a nursing care plan.
BREECH PRESENTATION obstetrics and gynacology mbbs final yearsarath267362
BREECH PRESENTATION obstetrics and gynacology mbbs final year
presentation , pregnancy
final year mbbs
normal labor
breech labor complications
management
BREECH
tdmc kerala
The document discusses promoting fetal and maternal health through the nursing process of assessment, diagnosis, planning, and evaluation. It covers topics like health promotion during pregnancy, common discomforts at different stages, preventing exposure to teratogens, and addressing maternal stress. The overall goal is to describe strategies nurses can use to promote healthy behaviors and outcomes for both mother and baby.
Labour is considered prolonged if it lasts more than 12 hours. It can be caused by issues with the passageway (pelvis), passenger (baby), powers (contractions), or psyche (mental state). Prolonged labour risks maternal and fetal complications if neglected. Close monitoring is needed to detect obstruction early. Treatment depends on fetal viability but may include resuscitating the mother, controlling infection, relieving obstruction via c-section, and post-delivery care like antibiotics and bladder drainage. Abnormal uterine contractions can also prolong labour and are treated with oxytocin.
This document provides an overview of abnormal labour, including definitions, causes, signs and symptoms, diagnosis, management, and specific types such as prolonged labour and maternal injuries. Abnormal labour is defined as labour that does not meet normal time limits and milestones. It can be caused by issues with uterine contractions, pelvic abnormalities, large babies, or psychological factors. Prolonged labour increases risks for both mother and baby. Management may include accelerating labour through drugs or proceeding with c-section if needed. Maternal injuries from labour include perineal tears, vaginal tears, cervical tears, and vulval hematoma, which require repair or drainage. The document also describes different types of abnormal uterine action.
This document discusses breech presentation, which occurs when a baby is positioned bottom or feet first in the uterus instead of head first. It defines the different types of breech positions and discusses risk factors, diagnosis, management options, and complications associated with vaginal breech delivery and cesarean section for breech babies. Management options include external cephalic version, vaginal delivery, or cesarean section depending on the specific situation. Risks and procedures for both vaginal delivery and cesarean section are outlined.
Cesarean section is a surgical procedure to deliver a baby through incisions in the mother's abdomen and uterus. The most common type of uterine incision is low transverse. Indications for cesarean include cephalo-pelvic disproportion, fetal distress, breech presentation, and previous uterine surgery. Potential complications include hemorrhage, infection, and increased risk of prematurity. Nursing care focuses on preventing infection, managing pain, and promoting bonding between mother and infant.
This document discusses hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia. It defines the conditions and describes their typical symptoms of hypertension, edema, and protein in the urine. The pathophysiology involves vasoconstriction, endothelial damage, and increased capillary permeability. Management involves medications to lower blood pressure like magnesium sulfate and antihypertensives. Close monitoring of the mother and fetus is needed to watch for complications that could require early delivery.
This document discusses various menstrual disorders including amenorrhea, dysmenorrhea, dysfunctional bleeding, premenstrual syndrome, pelvic inflammatory disease, endometriosis, pelvic relaxation disorders, cystitis, urinary incontinence, and perimenopause. It defines each condition, discusses etiology and pathophysiology, assessment findings, diagnosis, and treatment. Nursing considerations are provided for educating women on prevention and management of these common gynecological issues.
11.infectious disease of genitalia & sexual transmitted infectionsHishgeeubuns
This document discusses several common sexually transmitted infections (STIs), including bacterial vaginosis, trichomoniasis, yeast infections, chlamydia, gonorrhea, syphilis, genital herpes, human papillomavirus, and HIV/AIDS. For each STI, the causative agent, signs and symptoms, diagnosis, and treatment are described. Prevention strategies are also covered, such as perineal hygiene, safe sex practices, and STI screening during pregnancy.
This document discusses women's health topics including screening tests for early detection of diseases of the reproductive system. It covers Pap smear tests, which are recommended annually or every 3 years for women ages 21 to 65 as the best way to detect cervical cancer early. Breast self-exams are also discussed as a way for women to check their own breasts for lumps or other changes on a monthly basis. The importance of early detection of breast cancer through clinical exams and mammography is emphasized, as treatment is most successful when cancer is found early.
1. Hemorrhagic disorders in pregnancy can occur early or late term and include conditions like spontaneous or induced abortion, ectopic pregnancy, molar pregnancy, and placental abnormalities.
2. Spontaneous abortion, also called miscarriage, is the unintentional termination of pregnancy before 20 weeks gestation. Risk factors include chromosomal abnormalities, infections, or lifestyle factors. Ectopic pregnancy occurs when the fertilized egg implants outside the uterus, usually in the fallopian tubes.
3. Molar pregnancy results from abnormal placenta formation causing a cluster of cysts instead of a normal placenta and baby. It carries risks for hemorrhage and later development of gestational troph
This document discusses hyperemesis gravidarum and diabetes in pregnancy. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy persisting past the first trimester, affecting 0.3-1% of pregnancies. It can cause dehydration, weight loss, and electrolyte imbalances. Treatment involves IV fluids, antiemetics, and nutritional support. Diabetes in pregnancy occurs in 7% of pregnancies and increases risks for mothers and babies. Good management through glucose monitoring, identifying complications, and maintaining normal levels can help mitigate these risks. The goals are healthy glucose levels and identifying/managing any issues that arise.
The document discusses hypertensive disorders of pregnancy including gestational hypertension, preeclampsia, and eclampsia. It describes the pathophysiology as involving vasoconstriction, endothelial damage, and increased capillary permeability. Symptoms include hypertension, proteinuria, edema, headaches and visual changes. Management involves medications to lower blood pressure like magnesium sulfate and delivery if symptoms cannot be controlled. Complications for mother and baby include abruption, HELLP syndrome, prematurity and growth restriction.
2. mongolia(high risk maternity care overview)Hishgeeubuns
This document discusses high risk pregnancies and maternal mortality. It defines high risk pregnancy as any pregnancy with complications that could threaten the health of the mother or baby. The document then shows maps and charts detailing the leading causes of maternal mortality worldwide, including hemorrhage, infections, unsafe abortions, eclampsia, and obstructed labor. It also discusses reasons for delays in women seeking and receiving adequate medical care during pregnancy and childbirth. The rest of the document outlines various medical and obstetric risk factors that can contribute to a high risk pregnancy, and describes a prenatal risk indicator form used to assess risk levels throughout a woman's pregnancy.
This document discusses several types of benign and malignant tumors of the female reproductive system. It provides information on uterine fibroids, endometrial hyperplasia, benign cervical polyps, benign ovarian cysts, and various cancers of the uterus, cervix, ovaries, and vulva. For each condition, it outlines etiology, risk factors, signs and symptoms, diagnosis, treatment options, and survival rates. Nursing care focuses on pre/post-operative support, education, counseling and symptom management.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
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Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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2. Labor is a natural process,
but one faced with many
uncontrollable variables.
3. DYSTOCIA
• Definition:Dystocia, or difficult
labor, abnormal 5P in labor.
1. Power; uterine contraction
2. Pathway; pelvis, cervix, birth canal
3. Passenger; fetus, placenta
4. Psychology; maternal fear and anxiety
5. Position; maternal birthing position
4. 1. Power ; Contraction
abnormalities
1. Contractions that are not strong enough or frequent enough to
produce a normal labor pattern will not result in dilatation and
effacement within a normal time frame.
2. Problems with the force of labor will result in ineffective
contractions or ineffective bearing down (pushing) during the
second stage of labor.
3. Etiology of abnormalities in the force of labor include:
a. Early or excessive use of analgesia
b. Overdistention of the uterus
c. Excessive cervical rigidity
d. Grand multiparity
e. Mild pelvic contraction
f. Postmature and large infants
5. 2. Passageway abnormalities
1. Problems in the pelvis or soft tissues of the reproductive tract.
2. Most often problems with the passageway are a result of pelvic abnormalities
that interfere with the engagement, descent, and expulsion of the fetus.
a. The size and shape of the pelvis is important.
b. Obstruction may result from problems of the soft tissue such as a uterine or
ovarian fibromyoma.
3. Contractions of the inlet are noted when the anteroposterior diameter is less
than 10 cm
4. Midpelvic contractions occur when the distance between the ischial spines is
less than 9 cm.
5. A contracted pelvic outlet is diagnosed when the distance between the ischial
spines is less then 8 cm.
When the pelvis is contracted and the fetus cannot fit through the
pelvis, CPD(cephalo-pelvic disproportion) exists.
6. 3. Passenger; Fetal abnormalities
1. Normal fetal passage
a. Normally the fetus enters the pelvic inlet transversely and
then rotates to an occiput anterior position, allowing for the
smallest diameter of the fetal head to pass through the pelvis.
b. When the fetal head enters the pelvis posteriorly, it must
rotate to the anterior position.
3. If the fetus does not turn, then it remains in the posterior
position and may slow down the progress of descent.
a. If the pelvis is large enough, the baby can be born in the
posterior position.
b. If the pelvis is borderline and the contractions ineffective, a
Cesarean section may be necessary.
7. 3.Passenger; Fetal Abnormalities
4. Breech presentations occur in approximately 3% of all
deliveries.
a. This presentation is more common in multiple
gestations, increased parity, hydramnios, placenta
previa, and preterm infants.
b. Usually the method of choice for delivery is a
cesarean section.
5. Shoulder presentation occurs when the infant lies
crosswise in the uterus. The infant is delivered by
cesarean section.
6. A large infant may not fit through the pelvis and CPD
may result.
8. 4. Maternal psychology
• Maternal fear, anxiety influenced cervical
dilatation and adequate tissue perfusion.
• Fear anxiety catecholamine hormone
release vasocontraction ineffective
perfusion to fetus fetal distress
• Fear anxiety catecholamine hormone
release ineffective cervical dilatation and
maternal exhausted prolonged labor
9.
10. 5. Maternal Position
• Up right position; using gravity
• Lie down position; supine hypotensive
syndrome
11. Diagnostic Evaluation
1. Inadequate progress of cervical effacement, dilatation, or
descent of the presenting part as determined by vaginal
examination
2. Evaluation of labor progress by recording and assessing serial
vaginal examinations using Freidman's curve
a. Using Freidman's curve, a prolonged latent phase in the
primigravida is greater than 20 hours and in the multigravida it
is greater than 14 hours.
b. During the active phase, the cervix of a primigravida will
normally dilate at least 1.2 cm/h, and the multigravida 1.5 cm.
In addition,
c. The fetus should be descending through the birth canal. In
the primigravida the rate of descent is 1 cm/h and 2 cm/h for
the multigravida.
15. Management
1. Treatment for contraction abnormalities involves
stimulation of labor through the use of oxytocin. An
intrauterine pressure catheter may be used.
2. Management for maternal passageway or fetal
passage problems(CPD) involves delivery in the
safest manner for the mother and fetus.
a. If the problem is related to the inlet or
midpelvis, a cesarean delivery is indicated.
• b. If the size of the outlet is the problem, a
forceps/vacuum/C-section delivery is usually
performed.
17. Nursing Assessment
1. Evaluate fetal presentation, position, and
size.
2. Evaluate progress of labor, noting dilations
and effacement in relation to time of labor
along with descent of the fetal head.
3. Monitor fetal heart rate and contraction
status at least every 30 minutes.
4. Monitor maternal vital signs at least every
hour.
5. Assess bladder fullness.
22. Nursing Diagnoses
A. Pain related to physical and psychological
factors of difficult labor
B. Anxiety related to threat of change in the
health status of self and fetus
23. Nursing Interventions
A.
Promoting Comfort
1. Review relaxation techniques.
2. Encourage use of breathing techniques learned in Childbirth
education classes.
3. Encourage frequent change of position.
4. Encourage voiding every hour.
5. Provide back rubs and sacral pressure as needed.
6. Offer ice chips as needed to combat a dry mouth, if permitted.
7. Provide a quiet, darkened room.
8. Provide frequent encouragement to the woman and her support
person.
9. Administer pain medication for analgesia, as ordered.
10. Assist with the administration of anesthesia, as indicated.
24. B. Decreasing Anxiety
1. Provide anticipatory guidance regarding the use
of medication, equipment, and procedures.
2. Educate the woman about the administration of
oxytocin (Pitocin).
3. Discuss with the woman the nature of the
contractions associated with an induced labor
(ie, short acceleration, intense plateau, short
deceleration).
4. Prepare the family for cesarean delivery, if
necessary.
26. HYDRAMNIOS
(POLYHYDRAMNIOS)
Definition
• Hydramnios (polyhydramnios) is caused by
an excessive amount of amniotic fluid.
• Normal amnionic fluid; 500-1200cc
• Hydramnios (polyhydramnios) 2000cc over
• Oligohydroamnios less then 300cc
• The amount of amniotic fluid present is
controlled in part by fetal
urination, swallowing, and breathing.
27. Pathophysiology/Etiology
1. The etiology is often unclear.
2. Anomalies causing impaired fetal swallowing
or excessive micturition may contribute to the
condition.
3. It is associated with maternal diabetes,
multiple gestation and Rh isoimmunization.
4. Other associated factors are anomalies of
the central nervous system including spina
bifida and anencephaly or anomalies of the
gastrointestinal tract including
tracheoesophageal fistula.
28. Clinical Manifestations
1. Excessive weight gain, dyspnea
2. Abdomen may be tense and shiny.
3. Edema of the vulva, legs, and lower
extremities.
4. Increased uterine size for gestational age
usually accompanied by difficulty in palpating
fetal parts and in auscultation of fetal heart
29. Management
1. Depends on the severity of the condition and the
cause; hospitalization is indicated for maternal distress
or for intervention regarding fetal prognosis.
2. If impairment of maternal respiratory status
occurs, amniocentesis for removal of fluid may be
performed.
a. The amniocentesis is performed under ultrasound for
location of the placenta and fetal parts.
b. The fluid is then slowly removed.
c. Rapid removal of the fluid can result in a premature
separation of the placenta.
d. Usually 500 to 1,000 mL of fluid is removed.
30. Complications
1. Preterm labor
2. Cord prolapsed
3. Dysfunctional labor with increased risk for
cesarean section
4. Postpartum hemorrhage due to uterine
atony from gross distention of the uterus
32. Nursing Assessment
1. Evaluate maternal respiratory status.
2. Inspect abdomen and evaluate uterine
height and compare with previous findings.
33. Nursing Diagnoses
A. Ineffective Breathing Pattern related to
pressure on the diaphragm
B. Altered Tissue
Perfusion, Placental, related to pressure
from excess fluid
C. Impaired Physical Mobility related to
edema and discomfort from the enlarged
uterus
D. Anxiety related to fetal outcome
34. Nursing Interventions
A. Promoting Effective Breathing
1. Position to promote chest expansion with
head elevated.
2. Provide oxygen by face mask, if
indicated.
3. Limit activities and plan for frequent rest
periods.
4. Maintain adequate intake and output.
35. B. Promoting Placental Tissue
Perfusion
1. Position on left side if possible, with head
elevated. If unable to position on side, use
a wedge to displace the uterus to the left.
2. Encourage passive or active assisted
range of motion to the lower extremities.
3. Monitor fetal heart rate as directed.
4. Provide a diet adequate in
protein, iron, and fluids.
36. C. Promoting Mobility
1. Assist the woman with position changes
and ambulation as needed.
2. Advise on alternating activity with rest
periods for legs.
3. Instruct the woman to wear loose fitting
clothing and low-heeled shoes with good
support.
37. D. Decreasing Anxiety
1. Explain the cause of hydramnios, if known.
2. Encourage the patient and family to ask
questions regarding any treatment or
procedures.
3. Encourage expression of feelings.
4. Prepare patient for the type of delivery that is
anticipated and for the expected finding at the
time of delivery.
5. Encourage presence of support person.
38. Patient Education/Health
Maintenance
1. Instruct the woman to notify her health
care provider if she experiences
respiratory distress.
2. Teach the woman signs of preterm labor
and the need to report them to health care
provider.
39. Evaluation
A. Respirations 20 and unlabored
B. Fetal heart rate within normal limits
C. Verbalizes improved comfort; moves
freely
D. Discusses realistically the pregnancy
outcome; questions regarding treatment
for self and fetus
41. Definition
• Preterm(premature) rupture of membranes
(PROM) is defined as rupture of the
membranes before the onset of
spontaneous labor.
• Normally spontaneous membranes
rupture(break) end of 1st stage or
beginning of second stage.
42. Preterm Premature Rupture of Membranes:
When the water bag breaks before 37
weeks of pregnancy AND labor has not
started.
Premature Rupture of Membranes:
When the water bag breaks before the
start of labor.
43. Pathophysiology/Etiology
1. The exact etiology of PROM is not clearly understood.
2. In preterm PROM, risk factors include:
a. Infection
b. Previous history of PROM
c. Hydramnios
d. Incompetent cervix
e. Multiple gestation
f. Abruptio placentae
3. PROM is manifested by a large gush of amniotic fluid or
leaking of fluid per vagina, which usually persists.
44. Diagnostic Evaluation
Nitrazine test—positive test will change pH
paper strip from yellow-green to blue in the
presence of amniotic fluid taken from the
vaginal canal.
Amniotic fluid; alkali
Urine; acid
45. Management
1. Once PROM is confirmed, the woman is admitted to the
hospital and usually remains there until delivery.
2. The woman is evaluated to rule out labor, fetal
distress, and infection and to establish gestational age. If
all factors are ruled out, the woman is managed
expectantly.
3. For PROM, tocolytics, corticosteroids (to decrease the
severity of respiratory distress syndrome in the
premature neonate) and prophylactic antibiotics are
used, but remain controversial.
4. Management of PROM at 36 weeks' gestation or greater
focuses on delivery.
5. Vaginal examinations are kept to a minimum to prevent
infection.
47. Nursing Assessment
1. TPRBP check every 4 hours.
If temperature or pulse are elevated take
them every 1 to 2 hours as indicated.
2. Monitor the amount and type of amniotic fluid
that is leaking and observe for purulent, foulsmelling discharge.
3. Evaluate daily CBC
4. Evaluate fetal status every 4 hours or as
indicated, noting fetal activity and heart rate.
5. Determine if uterine tenderness occurs on
abdominal palpation.
48. Nursing Diagnoses
• A. Risk for Infection related to ascending
bacteria
• Also see Preterm Labor,
49. Nursing Interventions
A. Preventing Infection
1. Evaluate amount and odor of amniotic fluid leakage.
2. Do not perform vaginal examinations without consulting the
primary health care provider.
3. Place patient on disposable pads to collect leaking fluid and
change pads every 2 hours or more frequently as needed.
4. Review the need for good hand washing technique and hygiene
after urination and defecation.
5. Monitor fetal heart rate and fetal activity every 4 hours or as
indicated.
6. Monitor maternal temperature, pulse respiration, blood pressure,
and uterine tenderness every 4 hours or as indicated.
51. PROLAPSED UMBILICAL CORD
A prolapsed umbilical cord slips in front of or
alongside the fetal presenting part.
Types of cord prolapse include:
▪ Complete—the cord can be felt on vaginal
examination and be seen in the vaginal canal.
▪ Occult—the cord cannot be felt on vaginal
examination or be seen. The cord lies between the
presenting part and the maternal pelvis. Changes
in the fetal heart rate are evident.
▪ Forelying—the cord can be felt on vaginal
examination, but cannot be seen. The cord lies in
front of the presenting part.
52.
53. Pathophysiology/Etiology
A fetal cord prolapse may occur when there is
adequate room between the fetal parts and the
maternal pelvis. Predisposing factors include:
1. Rupture of membranes, when the presenting part
is not engaged in the pelvis
2. More common in shoulder and foot presentations
3. Prematurity—small fetus allows more space
around presenting part
4. Hydramnios—causes greater amount of fluid to be
released with greater force when membranes
rupture
54. Prolapsed of cord
• Pathophysiology/Etiology:
PROM, Preterm, Hydroamnious, CPD
Breach presentation, Placenta previa,
• Clinical Manifestations : alteration FHS,
Palpitation cord with vaginal examination
• Management
- Knee-chest position or Sim’s positon, elevate buttocks
- Check FHS and O₂ supply 8 to 10 L/min.
- No vaginal examination
- Coved wet gauze on the prolapsed cord
-Prepared C-section delivery/vaginal delivery depending to
fetal condition
55. • NURSING ALERT:
Prolapse should be suspected with fetal
heart rate deceleration after rupture of the
membranes.
56. Management
1. Delivery of the fetus as soon as possible
2. Relief of pressure from the umbilical cord
57. Complications
A. Maternal
1. Infection
2. Risk for increased blood loss from
emergency delivery
3. Fear and anxiety
B. Fetal
1. Prematurity
2. Complications resulting from hypoxia
3. Fetal death
58.
59. Nursing
Assessment/Interventions
1. Observe fetal heart rate deceleration.
2. Identify complete or forelying cord prolapse with a vaginal
examination by a qualified nurse or health care provider.
3. Explain procedures as much as possible to the woman during
this emergent situation.
4. Administer oxygen by face mask at 8 to 10 L/min.
5. Relieve pressure from the presenting part of the fetus off the
umbilical cord by manually pushing the presenting part
upward with a gloved hand. Pressure must be relieved until
the fetus is delivered via cesarean or vaginally.
6. Provide constant support to the woman and her support
persons.
7. Encourage the woman to talk about her feelings regarding
herself and the baby after delivery.
60. Preterm Labor
Definition:
1. 20 to 36 weeks of pregnancy
AND
2. Uterine contractions
AND
3. 80% thinning of the cervix
OR
4. Cervical dilation > 1cm
66. Management
• The focus of treatment is prevention of
delivery of a preterm infant.
• The method depends on the cervical
dilatation and contraction pattern.
• If contractions are detected early and
treatment is begun early, there is a higher
rate of stopping labor.
67. Preterm Labor
• Treatment Approaches
If preterm birth is
suspected, giving
mother steroids( at
least 48 hours before
birth can significantly
help the baby breathe
69. B. Tocolytic Therapy
• If conservative therapy is not
successful, tocolytic therapy is instituted.
These drugs should be used only when the
potential benefit to the fetus outweighs the
potential risk
- Yutopar
- Bricanyl
- MgSO4
- Indocin
- Procardia
71. Nursing Diagnoses
A. Anxiety related to medication and fear of
outcome of pregnancy
B. Diversional Activity Deficit related to
prolonged bed rest
72. Nursing Interventions
A. Decreasing Anxiety
1. Provide accurate information on the status of
the fetus and labor (contraction pattern).
2. Allow the woman and her support person to
verbalize their feelings regarding the episode
of preterm labor and the treatment.
3. If a private room is not used, do not place the
woman in a room with a woman who is in
labor or who has lost an infant.
4. Encourage relationship with other patients
73. B. Promoting Diversional Activities
1. Determine quiet craft activities that can be
done in bed.
2. Provide radio, books, and television.
3. Encourage visits from family, especially other
children and friends. If possible encourage
them to bring in favorite foods for the woman
and to dine as a family.
4. Encourage other family activities, such as
helping with homework. This will assist on
maintaining the family unit.
74. Patient Education/Health
Maintenance
1. Educate the woman about the importance of
continuing the pregnancy until term or until there is
evidence of fetal lung maturity.
2. Encourage the need for compliance with a
decreased activity level or bed rest, as indicated.
3. Teach the woman the importance of proper
nutrition and the need for adequate hydration, at
least 8 glasses of fluids a day.
4. Instruct the woman not to engage in sexual
activity.
5. Teach the woman the signs and symptoms of
infection and to report them
Editor's Notes
Treatment is begun early with the use of bed rest in a left lateral position.2. Hydration with IV fluids and continuous monitoring of fetal status and uterine contraction pattern are instituted.3. If this stops the contractions, tocolytic therapy is not needed.