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CEPHALOPELVIC DISPROPORTION

CEPHALOPELVIC DISPROPORTION. 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

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CEPHALOPELVIC DISPROPORTION

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  1. CEPHALOPELVIC DISPROPORTION

  2. 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

  3. CAUSES • increased fetal weight • fetal position • problems with the pelvis • problems with the genital tract

  4. SIGNS AND SYMPTOMS • the delivery of the baby is obstructed • The labor is prolonged

  5. pathophysiology

  6. Disproportion between head of the baby and the mother’s pelvis Fetus does not engage but remains floating Premature rupture of membranes malposition Trial labor Prolonged labor Uterine cord prolapse Delayed second stage Fetal distress!!

  7. 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.

  8. DIAGNOSIS • Ultrasound – estimation of the baby’s size can be made by ultrasonogram

  9. MANAGEMENT • Cesarian section

  10. NURSING DIAGNOSIS • Anxiety • Fatigue • Risk for fetal injury • Risk for impaired skin integrity • Situational low self- esteem

  11. 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

  12. PREGNANCY – INDUCED HYPERTENSION

  13. Pregnancy- induced hypertension • A condition in which vasospasm occurs during pregnancy in both small and large arteries • Originally was called toxemia • Cause: unknown

  14. 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)

  15. Signs and symptoms • HPN • Proteinuria • Extensive edema • Vision changes

  16. 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

  17. 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

  18. pathophysiology

  19. Increased cardiac output Injury of endothelial cells of the arteries leading to vasospasm Change in the action of prostaglandins resulting to Vasoconstriction Dec blood supply and O2 perfusion To vital organs hypertension Liver/ pancreas Kidneys placenta

  20. kidneys Dec glomerular filtration Glomerular degeneration Inc tubular reabsorption of sodium Inc glomerular permeabilty water retention Escape of serum proteins, albumin And globulin, into the urine (proteinuria) edema oliguria Fluid diffuses from circ system to extracellular spaces Gen H2O retention

  21. LIVER Tissue ischemia Vascular stasis Epigastric pain Convulsion!!

  22. PLACENTA Tissue ischemia Release thromboplastin-like substances Premature placental deterioration Dec fetal nutrient Abruptio placenta Fetal distress Premature labor and delivery

  23. Nursing diagnoses • Decreased cardiac output • Ineffective tissue perfusion • Fluid volume excess • Urinary retention • Risk for fetal injury • Social isolation

  24. 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

  25. 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

  26. 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

  27. Administration medications to prevent eclampsia • hydralazine/ Apresoline • labetalol/ Normodyme • DOC: magnesium sulfate antidote: calcium gluconate Eclampsia - seizure precautions

  28. Prepared by miko camay ricah

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