Distress In Pregnancy

1. Distress In Pregnancy Emily, Laura, Rachel, and Vicki

2. Fetal Distress • Refers to the presence of signs in a pregnant woman before or after birth that suggest that the fetus might not be well. • Usually indicates that a child is suffering from ischemia (low blood supply) or hypoxia (low blood oxygen) • Can cause brain damage or death if not properly treated • More likely to happen during prolonged labor

3. Signs and symptoms of distress Decreased fetal movement felt by mother Increased or decreased fetal heart rate Vaginal bleeding Abdominal and back pain experienced by the mother Mothers blood pressure drastically increasing Meconium -first excrement passed by the baby: if this happens before birth, the baby can breathe it in, risking infection. -shown when the mother’s water has a yellow-green tinge instead of being clear. Asphyxias- (inadequate intake of oxygen; suffocation)

4. Common Causes/Types

5. Pre-Eclampsia: Is a medical condition that reduces the flow of blood to the placenta • Usually occurs after the first 20 weeks of pregnancy and is characterized by high blood pressure, rapid swelling or weight gain, and protein in the mother’s urine. • If left untreated it can develop into eclampsia, which is the life-threatening occurrence of seizures during pregnancy. • The only true cure for pre-eclampsia is delivery, but can be treated using: • Bed rest: used to help lower blood pressure and increase blood flow to the placenta, giving the baby a chance to fully develop before it is delivered. • Medication: doctors often prescribe blood pressure medication( to lower blood pressure and increase blood flow to palcenta to nourish the baby), corticosteroids (temporarily improve liver and platelet function and help the baby’s lungs develop more quickly, so that it can be delivered), or anticonvulsive medications (prevents seizures)

7. Abnormal Position: -Breech: when the baby’s buttocks and or feet are positioned to be delivered first. Breach babies can be vaginal, but are often delivered by caesarian section. -Frank breech: the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of their body, with the feet near the head -Complete breech: the buttocks are pointing downward with the legs folded at the knees and feet near the buttocks -Footling breech: one or both of the baby’s feet point downward and will deliver before the rest of the body -Transverse Presentation: when the baby is lying sideways with the head on one of the mother’s sides and the buttocks are on the other. This often results in the shoulder or arm entering the birth canal first. Transverse babies cannot be delivered vaginally unless they are turned while in the uterus, most often they are delivered by caesarian section.

9. Nuchal Cord • A nuchal cord is when the umbilical cord is wrapped 360 degrees around the baby’s neck. This is usually not a big deal, even if it is a “tight” nuchal cord, which means it cannot be slipped off the baby’s head before birth. However, this can lead to a decreased heart rate in some instancesor asphyxias. If this happens, the doctor may attempt to maneuver the cord so that it is freed from the baby, or clamp the umbilical cord partway through birth. However, if a nuchal cord leads to decreased heart rate or asphyxia, there may be need for an emergency caesarian section.

11. Umbilical Cord Prolapse • This is where the umbilical cord passes through the cervix before or at the same time as the baby’s head. • When this happens, the umbilical cord can become compressed between the baby and the tissue of the mother, cutting off the baby’s oxygen and blood supply. • In most cases, the baby will then be taken out through a C-section. • If a C-section cannot be performed, the doctors will try to relieve the pressure by gently lifting the baby up off of the umbilical cord.

12. Umbilical Cord Prolapse Cont. • There is a greater chance of having an umbilical cord prolapse if: • There is too much amniotic fluid around the baby • The baby is in the breech position • The mother is having twins • The umbilical cord is unusually long

13. Uterus Prolapse • This is when the uterus slips down into or protrudes from the vagina due to weakened and stretched ligaments and pelvic floor muscles. • Most uterine prolapses happen to females who are postmenopausal or who have had multiple vaginal births.

14. Uterus Prolapse Cont. • There are various degrees that categorize how severe the prolapse is. • First degree: The cervix droops into the vagina. • Second degree: The cervix drops to the level just inside the opening of the vagina. • Third degree: The cervix is outside the vagina. • Fourth degree: The entire uterus is outside the vagina. This condition is also called procidentia. This is caused by weakness in all of the supporting muscles.

15. Premature Births • A premature baby is one who is born before 37 weeks. • Most babies born at this time have medical issues, some of which are more severe than others.

16. Multiple births: • Have 2 or more infants in one pregnancy Concerns • born before organs or body has matured • Need help to breathe, eat, fight infections and staying warm • put into the NICU • preterm labour and birth • rick of miscarriage • twin­to­twintranfusionsyndrom­ placenta is shared • postpartum hemorage­ large placenta area over distended uterus can put the mother at risk of bleeding after the delivery • higher chance of a C­sectionabnormal amouints of amniotic fluid.

17. Delivery • Sometimes normal (vaginally) • Most of the time C­section Most ever born at once that survived was 8 Most ever born was 15 but none of them survived

18. Shoulder dystocia What? • Is when the head is out but the shoulders get stuck Causes • either a big baby, small pelvis, or the mother is just not in a good position • Why is it bad? • While the child is stuck the umbilical cord is squished and lungs are compressed so no oxygen can reach child

19. How the doctor fixes it 1. change position­ nurses hold legs up, doctor/midwife press on tummy above the pelvic bone 1. http://www.youtube.com/watch?v=KPRgA7BuREM 2. Doctor/midwife eases hand into vagina to try and help baby out, sometimes a episiotomy needs to be performed 3. Doctor/midwife may need to break the infants collar bone­ http://www.youtube.com/watch?v=JMaAptMOSmg&list=PLrQjrSx3XGKMCtV3UZhMhQCyB9d9qaxy_ 2. Doctor/midwife may need to perform a C­section­ So they push the baby back up the vagina

20. These issues can include: • Respiratory distress syndrome (RDS)- This is a breathing problem most common in babies born before 34 weeks of pregnancy. Babies with RDS don’t have a protein called surfactant that keeps small air sacs in the lungs from collapsing. • Intraventricular hemorrhage (IVH)- This is bleeding in the brain. It usually happens near the ventricles in the center of the brain. A ventricles is a space in the brain that’s filled with fluid. • Patent ductusarteriosis (PDA)- This is a heart problem that happens in the connection (called the ductusateriosus) between two major blood vessels near the heart. If the ductus doesn’t close properly after birth, a baby can have breathing problems or heart failure. Heart failure is when the heart can’t pump enough blood.

21. Necrotizing enterocolitis (NEC) - This is a problem with a baby’s intestines. It can cause feeding problems, a swollen belly and diarrhea. It sometimes happens 2 to 3 weeks after a premature birth. • Retinopathy of prematurity (ROP)- This is an abnormal growth of blood vessels in the eye. ROP can lead to vision loss. • Jaundice- This is when a baby's eyes and skin look yellow. A baby has jaundice when his liver isn't fully developed or isn't working well. • Anemia - This is when a baby doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body. • Bronchopulmonary dysplasia (BPD)- This is a lung condition that can develop in premature babies as well as babies who have treatment with a breathing machine. Babies with BPD sometimes develop fluid in the lungs, scarring and lung damage.

22. Different ways doctors respond to fetal distress:

23. Caesarian Section • Baby is delivered through an incision made through your abdomen and into the uterus. • In the case of fetal distress, the caesarean section will most likely be an emergency caesarean section. • This may take place if the cervix doesn’t dilate fully, birth is not progressing as normal, or if there is bleeding during labor.

25. Forceps Delivery • Forceps delivery is used during vaginal delivery • Typically done when the second stage of labor is not progressing or the baby’s safety is in question • Forceps are an instrument shaped like spoons or salad tongs • Applied to baby’s head to guide it out of the birth canal

27. Ventouse Delivery • Instrument attached to baby’s head by a suction cup • During a contraction, the doctor pulls gently on the device to deliver the baby • Reduced risk of tearing with this instrument as opposed to the forceps

29. Episiotomy • A cut made to make the vaginal opening bigger • This will be repaired with stiches later

30. Sources • http://www.babylaw.com/fetal-distress/ • http://www.mayoclinic.org/tests-procedures/forceps-delivery/basics/definition/prc-20014741http://www.nhs.uk/conditions/pregnancy-and-baby • http://www.bottarleone.com/lawyer-attorney-1423044.html • http://www.medscape.com/viewarticle/780171 • www.wikipedia.com

31. http://en.wikipedia.org/wiki/Fetal_distress • http://motherhood.modernmom.com/signs-stressed-baby-womb-12048.html • http://voices.yahoo.com/10-common-signs-fetal-distress-2020368.html • http://www.birthingnaturally.net/birth/challenges/transverse.html • http://www.babycenter.ca/a257/pre-eclampsia • http://en.wikipedia.org/wiki/Pre-eclampsia • http://www.mayoclinic.org/diseases-conditions/preeclampsia/basics/treatment/con-20031644

32. http://www.webmd.com/women/guide/prolapsed-uterus • http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/umbilical-cord-prolapse?page=full • http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/umbilical-cord-prolapse • http://www.thirdage.com/hc/c/umbilical-cord-prolapse-treatment • http://www.marchofdimes.com/baby/premature-babies.aspx