High-Risk Pregnancy Intrapartum Problems PDF

HIGH-RISK PREGNANCY INTRAPARTUM PROBLEM WITH PASSENGER PROLAPSE OF UMBILICAL CORD Cord protrudes from cervix to vagina Prolapse of seen in breech with unengaged presenting part umbilical cord PROM Risk Cord compression Release the...

HIGH-RISK PREGNANCY INTRAPARTUM PROBLEM WITH PASSENGER PROLAPSE OF UMBILICAL CORD Cord protrudes from cervix to vagina Prolapse of seen in breech with unengaged presenting part umbilical cord PROM Risk Cord compression Release the cord Management Position: knee-chest. trendelenburg E C-section MULTIPLE PREGNANCY Family history Increased maternal age Risk factors Increase parity Conceiving w/in 1 month of stopping OC Increased coitus frequency Post-partal hemorrhage Maternal PTL Anemia PIH Risks/Danger Polyhydramnios Placenta previa Dysfunctional Labor Abnormal Presentation Congenital anomalies Monozygotic twin: Twin- Fetal danger twin transfusion Umbilical cord intertwined  MULTIPLE PREGNANCY MANAGEMENT Intrapartu Postpartu Antepartum m m Assess Early US Monitor to confirm twins closely for twins Maternal VS uterine atony Increased Vaginal Emotional caloric need delivery with support > prenatal CS backup Referral to checkups Social worker Rest Assess for infection Monitor fetal well- being Problem with presentation, position and size Occiput posterior position MALPRESENTATION OCCIPITOPOSTERIOR POSITION BREECH PRESENTATION FACE PRESENTATION BROW PRESENTATION TRANSVERSE LIE OVERSIZED FETUS (MACROSOMIA)  Occiput posterior position occurs in women with anthropoid, Malpresentation android, contracted pelvis Risk Fetal sacral nerve compression Back rub Void Q 2 hrs. Management Assisted delivery Watch for post-partal bleeding  breech Developing hip dysplasia Cord prolapse – anoxia Traumatic injury to the head – IC hemorrhage, anoxia Risk Fracture of arm and spine Dysfunctional labor PROM Meconium staining  asynclitism Face Risk: too large presenting part Brow Rarest Cause: multipara with relaxed abdominal muscles Risk: fetal facial bruising  Transverse lie Maternal women with pendulous abdomen Risk uterine fibroids/tumors contracted pelvis Factors polyhydramnios Hydrocephalus Fetal Risk congenital anomalies Prematurity Factors Multiple gestations Short umbilical cord  macrosomia fetus weighing > 4000-4500 grams (9-10lbs) Macrosomia Associated with gestational DM, multiparity Risk Post partal hemorrhage  SHOULDER DYSTOCIA Shoulder dystocia shoulder remain wedged against pubic bone after head delivery Risk factors macrosomia GDM, obesity LGA, previous shoulder dystocia Complications Permanent injury to newborn (brachial plexus injury, fractured clavicle) Post-partum hemorrhage Bladder injury Management McRobert’s position Fetal anomaly Hydrocephalus Anecephaly  Thank you THE LORD IS MY SHEPHERD