12 Questions
What is the most ideal fetal position for vaginal birth?
Left occipito-anterior
In fetal malpositions, which position may lead to arrested labor and complications during delivery?
Occipito-posterior
What is a common maternal risk associated with fetal malposition in the occipito-posterior position?
Prolonged active phase
How many degrees does the fetus rotate from the LOP (Left Occipito-posterior) position for birth?
135 degrees
What is a common maternal symptom associated with fetal malposition during labor?
Intense back pain
In which position does the head rotate in a longer arc due to the posterior presentation?
Occipito-posterior
What is the main cause of a persistent occiput transverse position?
Ineffective uterine contractions
Which of the following nursing interventions may facilitate rotation of the fetus in an occiput transverse position?
Recommend the knee-chest position
What is the primary diagnostic method for identifying an occiput transverse position?
Abdominal palpation
Which of the following is NOT a potential nursing diagnosis associated with an occiput transverse position?
Preterm Labor
What is the recommended medical management if the fetal heart rate is abnormal during an occiput transverse position?
Deliver by cesarean section
Which of the following nursing interventions is recommended to address anxiety in a client with an occiput transverse position?
Keep the client and family informed of progress
Study Notes
Fetal Malposition
- Fetal malposition refers to positions other than occipito-anterior position during labor
- Malpositions include occipito-posterior and occipito-transverse positions of the fetal head in relation to the maternal pelvis
- Fetal malpositions are more common in multipara or those with lax abdominal wall
- Fetal malpositions are assessed during labor
Occipito-Anterior Position
- The most ideal position for vaginal birth
- The fetus rotates 90 degrees from this position during labor
Occipito-Posterior Position
- Can cause arrested labor, perineal tears, or extension of an episiotomy
- Maternal risks include prolonged labor, potential for operative delivery, extension of episiotomy, and 3rd or 4th degree laceration of the perineum
- Maternal symptoms include intense back pain in labor, dysfunctional labor pattern, prolonged active phase, secondary arrest of dilation, and arrest of descent
- The fetus rotates 135 degrees from this position during labor
Occipito-Transverse Position
- Incomplete rotation of OP to OA results in the fetal head being in a horizontal or transverse position
- Persistent occiput transverse position occurs as a result of ineffective contractions or a flattened bony pelvis
- Diagnosis involves abdominal examination and vaginal examination
- Ultrasound can be used to confirm diagnosis
Nursing Management
- Impaired gas exchange: encourage the mother to lie on her side, use knee-chest position, and pelvic-rocking to facilitate rotation
- Pain: encourage relaxation with contractions, apply sacral counter-pressure, and provide comfortable environment
- Fatigue: assess psychological and physical factors, monitor physical response, and monitor fetal heart beat and contractions
- Anxiety: keep client and family informed, provide support, and identify client's perception of threat
Medical Management
- If there are signs of obstruction or abnormal fetal heart rate, deliver by cesarean section
- If membranes are intact, rupture them with an amniotic hook or a Kocher clamp
- If cervix is not fully dilated and there are no signs of obstruction, augment labor with oxytocin
- If cervix is fully dilated but there is no descent in the expulsive phase, assess for signs of obstruction
Learn about fetal malpositions such as occipito-posterior and occipito-transverse, and the ideal left occipito-anterior position for vaginal birth. This lesson covers assessments during labor and the significance of LOA position in cephalic presentation.
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