Transcript 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
Very frequently diagnosed and is a very
common indication of cesarian sections
CAUSES

increased fetal weight
 fetal position
 problems with the pelvis
 problems with the genital tract
SIGNS AND SYMPTOMS
• the delivery of the baby is obstructed
• The labor is prolonged
Disproportion between head of the baby and the mother’s pelvis
Fetus does not engage but remains floating
Trial labor
Premature rupture
of membranes
malposition
Prolonged labor
Uterine cord prolapse
Delayed second stage
Fetal distress!!
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.
DIAGNOSIS
Ultrasound – estimation of the baby’s size
can be made by ultrasonogram
MANAGEMENT
Cesarian section
NURSING DIAGNOSIS
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Anxiety
Fatigue
Risk for fetal injury
Risk for impaired skin integrity
Situational low self- esteem
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
PREGNANCY – INDUCED
HYPERTENSION
Pregnancy- induced
hypertension
• A condition in which vasospasm occurs
during pregnancy in both small and large
arteries
• Originally was called toxemia
• Cause: unknown
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)
Signs and symptoms
• HPN
• Proteinuria
• Extensive edema
• Vision changes
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
• 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
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
Kidneys
Liver/ pancreas
placenta
hypertension
kidneys
Glomerular degeneration
Inc glomerular permeabilty
Dec glomerular filtration
Inc tubular reabsorption
of sodium
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
LIVER
Tissue ischemia
Vascular stasis
Epigastric pain
Convulsion!!
PLACENTA
Tissue ischemia
Release
thromboplastin-like
substances
Premature placental deterioration
Dec fetal nutrient
Abruptio placenta
Fetal distress
Premature labor and delivery
Nursing diagnoses
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Decreased cardiac output
Ineffective tissue perfusion
Fluid volume excess
Urinary retention
Risk for fetal injury
Social isolation
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
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
• 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
• Administration medications to prevent
eclampsia
– hydralazine/ Apresoline
– labetalol/ Normodyme
– DOC: magnesium sulfate
calcium gluconate
Eclampsia
- seizure precautions
antidote:
Prepared by
miko
camay
ricah