NCM 109

PROBLEMS WITH
PASSENGER
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 NCM 109

PROBLEMS WITH
PASSENGER
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 1. PROLAPSE OF THE UMBILICAL CORD
Loop of the umbilical cord slips down in front of the
presenting part.

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 1. PROLAPSE OF THE UMBILICAL CORD
Risk factors:
Premature Rupture of Membranes
Fetal Presentation other than cephalic
Placenta previa
Intrauterine tumors preventing the presenting part from
engaging
A small fetus
Cephalopelvic disproportion (CPD)
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Multiple gestation
Polyhydramnios
 1. PROLAPSE OF THE UMBILICAL CORD
Signs and Symptoms:
Abnormal fetal heart tone pattern
Bradycardia
Exposed cord
Variable deceleration -
Deceleration - decrease in fetal heart rate
 1. PROLAPSE OF THE UMBILICAL CORD
Management
A prolapse cord is always an emergency
Fetal head against the cord at the pelvic can lead to
cord compression and decreased oxygenation to the
fetus.
Management: Relieving compression and preventing
fetal anoxia
Placing a gloved hand in the vagina to manually
elevate the head
Placing in trendelenburg position
 1. PROLAPSE OF THE UMBILICAL CORD
Management
Administer oxygen via face mask at 10 lpm
Tocolytic agent may also be administered to reduce uterine
activity and decrease pressure on the fetus
If prolapsed an exposed to room air:
Drying will begin => constriction and atrophy of the
umbilical vessels
Do not attempt to push the cord back
R: can add to compression by causing knot and
kinking
Mgt: Cover exposed part with sterile saline compress
to prevent drying
 2. MULTIPLE GESTATION
Pregnancies with two or more fetuses
PROBLEMS WITH FETAL POSITION, PRESENTATION,
SIZE, AND PASSAGE
 REVIEW
Lie: The relationship between the long axis of the
fetus and the mother
Longitudinal, Transverse, Oblique
 REVIEW
Presentation: : The fetal part that first enters the
maternal pelvis
Cephalic vertex is the most common and is the safest.
Presentations: Cephalic, Breech, Shoulder, Face and Brow
 REVIEW
Position:The orientation of the fetus in the womb,
identified by the location of the presenting part of the
fetus relative to the pelvis of the mother.
 REVIEW
Malpositon:abnormal positon of the vertex of the fetal
head (Occiput as the reference point) relative to the
maternal pelvis.
Vertex: the fetus head is down, headfirst and facing
the spine with its chin tucked to its chest.
1. Occipitoposterior Presentation
An abnormal position of the vertex rather than an
abnormal presentation.
1. Occipitoposterior Presentation
more common: ROA
R:diameter is reduced by the presence of sigmoid colon.
Labor is prolonged because the arc of rotation is greater
Pressure and pain would be experience by the woman in
her lower back owing to sacral nerve compression when the
fetal head rotates against the sacrum.
Management:
Apply counterpressure on the sacrum by back rub
Heat and cold compress
1. Occipitoposterior Presentation
To help fetus rotate:
Position the mother on side lying position (opposite the
fetal back) or hand and knees position
Instruct the mother to void every 2 hours to empty
bladder:
R: Avoid impending the descent of the fetus
If no rotation, CS is done.
2.Breech Presentation
Frank, complete, footing
Breech presentation increases fetal risk for anoxia,
traumatic injury to the head, fracture of the spine or arm,
dysfunctional labor, meconium aspiration
2.Breech Presentation
Assessment:
Fetal heart sound are usually heard high in the
abdomen.
Management:
Always monitor FHR and uterine contractions = can
indicate fetal distress
3. Face Presentation
Face (chin or mentum)
presentation is rare.
Confirmed by vaginal
examination when the nose,
mouth or can can be felt as a
presenting part.
3. Face Presentation
Usually happens in women with
contracted pelvis, placenta
previa or relaxed uterus.
Infants can have facial edema
and ecchymosis.
Will disappear after a few
days.
4. Oversized Fetus
Macrosomia or an oversized fetus weighs more than
4000 to 4500g
Usually born to women with diabetes or develop
gestational diabetes
Wide Shoulders pose a problem because of fetal-
pelvic disproportion or uterine rupture from
obstruction
4. Oversized Fetus
If born vaginally
Cervical nerve palsy
Diaphragmatic injury
Fractured clavicle due to
shoulder dystocia
Woman is at risk for uterine
atony and overdistended
uterus, uterine rupture.
5. Brow Presentation
Rarest presentation.
Cesarean is necessary unless
the presentation
spontaneously corrects itself.
7. Shoulder Dystocia
Birth problem because the weight, size, of newborns
are increasing.
Occurs at the second stage of labor when the fetal
head is born but the shoulders are too broad to enter
and be born through the pelvic outlet.
Can result in vaginal or cervical tear.
Usually occurs in patients with diabetes, multiparas,
and LGA, and postdate fetuses.
7. Shoulder Dystocia
McRoberts Maneuver
Flex her thighs sharply on her abdomen to allow
widening the pelvic outlet and allow the anterior
shoulder to be born.
Suprapubic Pressure
Applying pressure can help the shoulder out from
beneath the symphysis pubis.