MCN Finals // topic 2
Problems with the Passageway Assessment Findings: Cephalopelvic Disproportion
Inlet Contraction 1. prolonged labor ➢ A condition in which the fetal head size is too
2. arrest of descent large to fit through the maternal pelvis.
➢ Narrowing of the anteroposterior diameter to
< 11 cm, or of the transverse diameter to <12 Complications: Risk Factors:
cm.
1. Fetal malposition (with CPD) 1. Gestational diabetes
The Pelvic Inlet 2. Premature rupture of membranes 2. Multiparity
3. Cord prolapse 3. Fetal malformation
4. Shape or size of maternal pelvis
Therapeutic management:
5. Shape or position of the fetus’ head
1. Pelvic measurements should be taken Signs and Symptoms
and recorded in every primigravida
1. General lack of cervical change or fetal
before week 24 of pregnancy so as a birth
descent during the
decision can be made.
1. active phase of first stage of labor
2. CS for inadequate inlet measurements
2. Dystocia – abnormal labor or failure of
➢ At the pelvic inlet, the anteroposterior and the fetal lie and position are poor.
labor to progress
diameter is the narrowest diameter Outlet Contraction 3. Uncontrollable pushing before complete
➢ Normal anteroposterior diameter size is 11 ➢ Narrowing of the transverse diameter at the dilation of cervix
cm outlet to less than 11 cm. Diagnostic Tests
➢ Normal transverse diameter size is 12.4 cm to > The distance between the ischial
13.5 cm 1. Trial labor – attempt at vaginal delivery
tuberosities
(when measurements indicate borderline
Causes: CPD)
1. Rickets 2. Utrasound estimation of fetal size
2. Inherited small pelvis compared to manual pelvic
✓ In primigravidas, the fetal head normally measurements (prior to labor) and
engages between week 36-38 of pregnancy. computed tomography
o If this not occur at expected 3. X-ray pelvimetry – to visualize pelvic
gestational age, either a fetal measures
abnormality or a pelvic abnormality THERAPEUTIC MANAGEMENT
should be suspected. 1. Assist client to cope emotionally with
✓ In multigravidas, engagement does not occur cesarean delivery.
until labor begins. (normal)
MCN Finals // topic 2
2. Stress the importance of the safety of the SHOULDER DYSTOCIA COMPLICATIONS to the Baby
baby. the anterior shoulder of the baby is unable to
1. Cord compression
3. Monitor FHR, uterine contractions, and pass under the maternal pubic arch after the
2. Brachial plexus injury or fractured clavicle
cervical dilatation. head is born.
4. Nursing care during “trial of labor” is ETIOLOGY THERAPEUTIC MANAGEMENT
similar to that of any labor, except that
1. advanced maternal age 1. Place the client in the McRobert’s position
assessments of cervical dilation and fetal
2. diabetes (Thighs are pulled up against the abdomen
descent are done more often.
3. multiparity with hips abducted).
- If progress ceases, a cesarean birth
4. post-date pregnancy o to widen the pelvic outlet thus
is necessary.
5. Report any signs of fetal distress to the facilitates the delivery of the anterior
PATHOPHYSIOLOGY
caregiver immediately. shoulder.
6. Provide emotional support by keeping the ➢ The wide anterior shoulder locks beneath the 2. Apply suprapubic pressure.
woman/couple informed and explaining symphysis pubis. o to help the shoulder escape from
procedures ➢ The problem occurs at the second stage of beneath the symphysis pubis and be
7. Help the woman assume different labor and often is not identified until the head delivered.
positions to increase the pelvic diameters has already been born.
(e.g., sitting or squatting, changing from ASSESSMENT FINDINGS
one side to the other, hands-and-knees
position) 1. Associated findings
1.1 birth process in the second stage is prolonged
COMPLICTIONS to the Mother 1.2 arrest of descent
2. Clinical manifestations
1. Exhaustion 2.1 The fetal head retracts against the mother’s
2. Postpartum hemorrhage perineum instead of protruding with each
3. Infection contraction as soon as the head appears on
the perineum/is delivered. (a turtle sign)
COMPLICATIONS to the Baby 2.2 External rotation does not occur.
1. Cord prolapse COMPLICATIONS to the Mother
2. Birth trauma
3. Fractured clavicle 1. Vaginal or cervical tears
4. Erb’s palsy 2. Bleeding
5. Anoxia
