3354539 cephalopelvic disproportion
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CEPHALOPELVIC DISPROPORTION
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Implies disproportion between the head of the baby (cephalus) and the mother’s pelvis
Complications can occur if the fetal head is too large to pass through the mother’s pelvis or birth canal
One of the commonest cause of different complications in labor
Very frequently diagnosed and is a very common indication of cesarian sections
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CAUSES
increased fetal weight fetal position problems with the pelvis problems with the genital tract
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SIGNS AND SYMPTOMS
• the delivery of the baby is obstructed
• The labor is prolonged
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Disproportion between head of the baby and the mother’s pelvis
Fetus does not engage but remains floating
malposition Premature rupture of membranes
Uterine cord prolapse
Fetal distress!!
Trial labor
Prolonged labor
Delayed second stage
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DIAGNOSIS
Estimation of the size of the pelvis:Clinical pelvimetry – assessment of
the size of the pelvis is made manually by examining the pelvis and palpating the pelvic bones by vaginal examination
Radiologic pelvimetry – xrays or CT scans are taken of the pelvis in different angles and views and the pelvic diameter measured.
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DIAGNOSIS
Ultrasound – estimation of the baby’s size can be made by ultrasonogram
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MANAGEMENT
Cesarian section
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NURSING DIAGNOSIS
• Anxiety
• Fatigue
• Risk for fetal injury
• Risk for impaired skin integrity
• Situational low self- esteem
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interventions
• Monitor heart sounds and uterine contractions continuously, if possible, during trial labor.
• Urge the woman to void every 2 hours s• Assess FHR carefully• Establish a therapeutic relationship, conveying
empathy and unconditional positive regard• Instruct in methods to conserve energy• Massage bony prominences gently and change
position on bed in a regular schedule• Convey confidence in client’s ability to cope with
current situation
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PREGNANCY – INDUCED HYPERTENSION
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Pregnancy- induced hypertension
• A condition in which vasospasm occurs during pregnancy in both small and large arteries
• Originally was called toxemia
• Cause: unknown
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Risk Factors
• Women of color, or with a multiple p regnancy, primiparas <20 years of age or >40 years
• Women from low socioeconomic backgrounds, whose who have had 5 or more pregnancies, those who have hydramnios, or those who have underlying disease (e.g. heart disease, DM with vessel or renal involvement, essential HPN)
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Signs and symptoms
• HPN
• Proteinuria
• Extensive edema
• Vision changes
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Classifications of PIH• Gestational HPN
↑ BP but has no proteinuria or edema no drug therapies necessary
• Mild Preeclampsia BP rises to 140/90 mmHhg, taken on 2 ocassions at
least 6H apart systolic BP >30 mmHg and diastolic pressure >15
mmHg above pre pregnancy values proteinuria (1+ or 2+ on a reagent test strip on a
random sample)edema
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• Severe preeclampsia BP of 160 mmHg (systolic) and 110 mmHg
(diastolic) proteinuria (3+ or 4+ on a random urine sample or
more than 5 g on a 24H sample) extensive edema
• Eclampsia seizure or coma accompanied by s/sx of
preeclampsia
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Increased cardiac output
Injury of endothelial cells of the arteries leading to vasospasm
Change in the action of prostaglandins resulting toVasoconstriction
Dec blood supply and O2 perfusion To vital organs
hypertension
Kidneys Liver/ pancreas placenta
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kidneys
Glomerular degeneration Dec glomerular filtration
Inc glomerular permeabiltyInc tubular reabsorption
of sodium
Escape of serum proteins, albuminAnd globulin, into the urine (proteinuria)
water retention
Fluid diffuses from circ system to extracellular spaces
edema oliguria
Gen H2O retention
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LIVER
Tissue ischemia
Vascular stasis
Epigastric pain
Convulsion!!
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PLACENTA
Tissue ischemia
Release thromboplastin-like
substances
Premature placental deterioration
Dec fetal nutrient Abruptio placenta
Fetal distress
Premature labor and delivery
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Nursing diagnoses
• Decreased cardiac output
• Ineffective tissue perfusion
• Fluid volume excess
• Urinary retention
• Risk for fetal injury
• Social isolation
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Nursing interventions
Mild PIH• Promote bed rest – lateral recumbent
position
• Promote good nutrition – usual pregnancy diet
• Provide emotional support – instruct woman to report if symptoms worsen, bring concerns out into the open
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Severe PIH• Support bed rest – visitors restricted to
support people, darken room, if possible, provide clear explanations of what is happening and what is planned, allow opportunity to express feelings
• Monitor maternal well-being – monitor BP q4H, obtain blood studies, daily hematocrit levels as ordered, anticipate need for freq plasma estriol levels and electrolyte levels, obtain daily wts and MIO
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• Monitor fetal well being – single doppler auscultation approx 4H interval, FHR maybe assessed with an external fetal monitor, NST or BPP daily, O2 admin to mother
• Support a nutritious diet – moderate to high in protein and moderate in sodium, IVF line
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• Administration medications to prevent eclampsia – hydralazine/ Apresoline– labetalol/ Normodyme– DOC: magnesium sulfate antidote:
calcium gluconate
Eclampsia- seizure precautions
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Prepared by
miko camay
ricah