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

malposition Premature rupture of membranes

Uterine cord prolapse

Fetal distress!!

Trial labor

Prolonged labor

Delayed second stage

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

• 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 toVasoconstriction

Dec blood supply and O2 perfusion To vital organs

hypertension

Kidneys Liver/ pancreas placenta

kidneys

Glomerular degeneration Dec glomerular filtration

Inc glomerular permeabiltyInc tubular reabsorption

of sodium

Escape of serum proteins, albuminAnd globulin, into the urine (proteinuria)

water retention

Fluid diffuses from circ system to extracellular spaces

edema oliguria

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

• 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 antidote:

calcium gluconate

Eclampsia- seizure precautions

Prepared by

miko camay

ricah