Obstetrics: Malpresentation and Fetal Distress

Questions and Answers

What degree of rotation does the fetal head require during internal rotation from a posterior position?

180 degrees

90 degrees

135 degrees (correct)

45 degrees

Which position is NOT recommended to aid rotation from a posterior fetal position?

Standing upright (correct)

Squatting

Lying on the right side

Assuming a hands and knees position

What labor pattern suggests the fetus is in a posterior presentation?

Decreased fetal heart rate

Frequent contractions

Prolonged active phase (correct)

Rapid descent

How does a posteriorly presenting fetal head affect the fit within the cervix?

Fits loosely, increasing risk of complications Signup and view all the answers

What symptom may a woman experience due to sacral nerve compression during labor?

Intense back pressure and pain Signup and view all the answers

What is a recommended method to relieve back pain caused by fetal head rotation against the sacrum?

Applying counterpressure with a back rub Signup and view all the answers

What factor could hinder fetal rotation through the pelvis?

Contracted pelvis shapes Signup and view all the answers

Why is it essential to confirm the position of a fetus presenting in a posterior position?

To manage risk of umbilical cord prolapse Signup and view all the answers

What is the primary aim of therapeutic management during a cord prolapse?

To relieve pressure on the umbilical cord. Signup and view all the answers

Which position can be used to aid in relieving pressure from the cord?

Knee-chest position Signup and view all the answers

What should be done if the cord is exposed to room air?

Cover the exposed portion with a sterile saline compress. Signup and view all the answers

When is it appropriate to use forceps during the delivery process with cord prolapse?

When the cervix is fully dilated. Signup and view all the answers

What intervention may be prescribed to reduce uterine activity in a cord prolapse scenario?

Tocolytic agents Signup and view all the answers

Why are twins more often delivered by cesarean birth?

To reduce the risk of anoxia in the second fetus. Signup and view all the answers

What complication is more likely to occur in multiple gestations?

Increased cord prolapse risk. Signup and view all the answers

What factor increases the risk of cord prolapse during multiple pregnancies?

Premature placenta separation. Signup and view all the answers

What is a common complication associated with large babies at birth?

Uterine dysfunction Signup and view all the answers

What maternal condition is most frequently associated with the birth of large babies?

Diabetes Signup and view all the answers

What is a potential consequence of fetal pelvic disproportion?

Uterine rupture Signup and view all the answers

Which condition may lead to umbilical cord prolapse during labor?

Premature rupture of membranes Signup and view all the answers

During assessment, what indicates a possible cord prolapse?

Visible cord at the vulva Signup and view all the answers

What fetal presentation is likely to increase the risk of umbilical cord prolapse?

Breech presentation Signup and view all the answers

What is the preferred birth method if an oversized infant cannot be delivered vaginally?

Cesarean birth Signup and view all the answers

What is a common finding during an examination that may indicate cord prolapse?

Variable deceleration in fetal heart rate Signup and view all the answers

What is a common risk associated with breech presentation?

Increased likelihood of umbilical cord prolapse Signup and view all the answers

Which of the following is NOT a type of vertex malpresentation?

Breech presentation Signup and view all the answers

What can occur if the fetal position is occipitoposterior?

Prolonged labor duration Signup and view all the answers

Which nursing intervention is critical in addressing fetal distress?

Prepare for immediate delivery Signup and view all the answers

Which condition is classified as a problem with the powers during labor?

Hypotonic uterine dysfunction Signup and view all the answers

What is a consequence of an immature fetus during labor?

Higher risk of maternal complications Signup and view all the answers

Which nursing assessment is crucial for managing umbilical cord prolapse?

Monitor fetal heart rate continuously Signup and view all the answers

What factor can contribute to cephalopelvic disproportion during labor?

Large fetal head size Signup and view all the answers

What condition is characterized by difficulty in uterine contractions due to overstretching from multiple gestations?

Uterine atony Signup and view all the answers

What can be determined by external abdominal palpation or ultrasound after the birth of the first infant?

Lie of the second fetus Signup and view all the answers

Which statement accurately describes the most common presentation of twins during birth?

Both twins in vertex position Signup and view all the answers

What is a potential risk associated with prolonged labor or birth in multiple gestations?

Hemorrhage from uterine atony Signup and view all the answers

Which intervention may be initiated to assist uterine contractions if vaginal birth is planned after the first infant?

Oxytocin infusion Signup and view all the answers

What occurs as a result of a disproportion between the size of the fetal head and the pelvic diameters?

Cephalopelvic disproportion (CPD) Signup and view all the answers

What can be used to relax the uterus if uterine relaxation is necessary?

Nitroglycerin Signup and view all the answers

After the birth of the first child in a multiple gestation, what should be done with the baby’s cord?

Tie or clamp both ends permanently Signup and view all the answers

Study Notes

Vertex Malpresentation

Brow Presentation: Occurs when the fetal forehead is the presenting part.
Face Presentation: Fetal face is the presenting part; can complicate delivery.
Sincipital Presentation: The fetal vertex presents with the brow, between brow and forehead.

Breech Presentation

Types: Include complete, incomplete, and frank breech.
Maternal Risks: Higher risk for perineal tearing and c-section requirement.
Vaginal Delivery of Breech: Can be complex, requiring skilled assistance.
External/Podalic Version: A maneuver to turn the fetus into a cephalic position before delivery.

Nursing/Medical Care of Clients with Malpresentation

Care involves monitoring fetal heart rate and positioning strategies to encourage optimal fetal positioning.

Fetal Distress

Causes: Include umbilical cord compression, placental insufficiency, and fetal hypoxia.
Signs/Symptoms: Changes in fetal heart rate patterns, decreased fetal movement.
Nursing Interventions: Position changes, oxygen supplementation, and continuous fetal monitoring.

Prolapse Umbilical Cord

Cause: Happens when the umbilical cord slips ahead of the presenting fetal part.
Contributing Factors: Include premature rupture of membranes and abnormal fetal presentations.
Assessment & Nursing Diagnoses: Detectable during vaginal examination; assess fetal heart rate.
Nursing Interventions: Elevate fetal head, change maternal position, cover exposed cord with sterile compress.

Problems with the Passageway

Abnormal Pelvic Size/Shape: Can result in cephalopelvic disproportion and shoulder dystocia.

Problems with the Powers

Dystocia: Refers to ineffective labor progression.
Hypertonic Uterine Dysfunction: Characterized by frequent, ineffective contractions.
Hypotonic Uterine Dysfunction: Occurs when the contractions are inadequate.
Uterine Rupture: A severe complication involving tearing of the uterine wall.

Placental Problems

Lower Uterine Segment Implantation: Can lead to complications such as placenta previa.
Premature Detachment of Placenta: Risk of fetal distress and maternal bleeding.

Additional Notes on Fetal Positions

Occipitoposterior Position: Fetal occiput is directed posteriorly; can complicate labor.
Signs of Dysfunctional Labor: May include prolonged phases of labor and abnormal fetal heart patterns.
Management Strategies: Include maternal positioning to encourage rotation of the fetus.

Multiple Gestations

Delivery Risks: Increased likelihood of cesarean delivery due to fetal distress.
Post-delivery Assessment: Careful monitoring for uterine atony and hemorrhage risk, especially after multiple births.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers various types of fetal malpresentation, including vertex, breech, and shoulder presentations, along with their implications. Additionally, it explores fetal distress causes, symptoms, and nursing interventions required for proper care. A must for nursing and medical students focusing on obstetric care.