Chapter 23
Chapter 23 high risk pregnant client during labor and delivery
Four main components of the labor process
1. passenger or fetus
2. passage way or pelvic bones and other pelvic structure
3. powers or uterine contractions
4. clients psyche or psychological state
Problems with the passenger
-Problem may arise if preterm, also during multiple gestation.
Fetal malposition
1. Occipitoposterior position
ROP or LOP
Second stage of labor
Complains of severe back pain from the pressure of the fetal head pressing against other sacrum
Fetal malpresentation
1. Asynctilism vertex malpresentation
Fetal head presenting at a different angle than expected
2. Brow presentation
Rare
Occurs in multiparty
Woman with relaxed abdominal muscles
Results in obstructed labor
CS is necessary
Infant can have extreme ecchymotic bruising in the face
Reassure parents that child is well after birth.
3. Face presentation
Rare
Occurs, the head diameter the fetus presents to the pelvis is often too large for birth to proceed
Head that feels more apparent than normal
Confirmed for vaginal examination when the nose, mouth or chin can be felt as the presenting part.
Sonogram - pelvic diameters are measured
Babies born: facial edema and purple ecchymotic bruising, observe for patent airway, severe lip edema - unable to suck for a day or two,necessary for gavage feeding, edema will disappear in a few days
4. Shoulder presentation
Fetus lies horizontally
Presenting part is usually:
-one of the shoulders (acromiom process)
-An iliac crest
-A hand
-Or an elbow
May be caused by:
-Relapsed abdominal walls from grand multiparity - which allows for the unsupported uterus to fall forward
-Placenta previa Most infants are born by CS why?
-Membranes have ruptured at the beginning of labor
-No firm presenting part
Occurs in women with:
-pendulous abdomen
-Uterine masses that obstruct the lower uterine segment
-Contraction of the pelvic brim
Four main components of the labor process
1. passenger or fetus
2. passage way or pelvic bones and other pelvic structure
3. powers or uterine contractions
4. clients psyche or psychological state
Problems with the passenger
-Problem may arise if preterm, also during multiple gestation.
Fetal malposition
1. Occipitoposterior position
ROP or LOP
Second stage of labor
Complains of severe back pain from the pressure of the fetal head pressing against other sacrum
Fetal malpresentation
1. Asynctilism vertex malpresentation
Fetal head presenting at a different angle than expected
2. Brow presentation
Rare
Occurs in multiparty
Woman with relaxed abdominal muscles
Results in obstructed labor
CS is necessary
Infant can have extreme ecchymotic bruising in the face
Reassure parents that child is well after birth.
3. Face presentation
Rare
Occurs, the head diameter the fetus presents to the pelvis is often too large for birth to proceed
Head that feels more apparent than normal
Confirmed for vaginal examination when the nose, mouth or chin can be felt as the presenting part.
Sonogram - pelvic diameters are measured
Babies born: facial edema and purple ecchymotic bruising, observe for patent airway, severe lip edema - unable to suck for a day or two,necessary for gavage feeding, edema will disappear in a few days
4. Shoulder presentation
Fetus lies horizontally
Presenting part is usually:
-one of the shoulders (acromiom process)
-An iliac crest
-A hand
-Or an elbow
May be caused by:
-Relapsed abdominal walls from grand multiparity - which allows for the unsupported uterus to fall forward
-Placenta previa Most infants are born by CS why?
-Membranes have ruptured at the beginning of labor
-No firm presenting part
Occurs in women with:
-pendulous abdomen
-Uterine masses that obstruct the lower uterine segment
-Contraction of the pelvic brim