CPD & UCP

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Cephalopelvic Disproportion (CPD) & umbilical cord prolapse

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MCN Abnormalities : 

MCN Abnormalities June Frederick Tiu Andrew Ross Reintar Princess May Mariquit Mohammad Ammar Solaiman

UMBILICAL CORD PROLAPSE : 

UMBILICAL CORD PROLAPSE A loop of the umbilical cord clips down in front of the presenting fetal. Prolapse may occur at any time after the membranes rupture if the presenting part is not fitted firmly into the cervix.

Slide 3: 

Prolapsed Cord Fetus moves downward into the pelvis Cord compressed Diminished oxygen and Blood supply to fetus Fetal distress

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ASSESSMENT: On initial vaginal examination, cord may be felt as the presenting part during labor and also be identified on a sonogram. Assess fetal viability by checking for a palpable pulse in the cord. Assess for fetal heart sounds. SIGNS AND SYMPTOMS: Exposed umbilical cord Rapid deceleration of FHR (Normal: 120-160bpm)

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THEAPEUTIC AND MEDICAL MANAGEMENT: Relieve pressure on the cord by placing a glove hand in the vagina and manually elevate fetal head of the cord. Place woman in a knee chest or trendelenburg position Administer oxygen at 10 liters per minute via face mask to mother Administer tocolytic agent (Magnesium sulfate) to reduce uterine activity and pressure on the fetus When prolapsed cord is exposed to room air do not attempt to push any exposed cord back in to the vagina instead cover any exposed portion with a sterile saline compress to prevent drying When cervix is fully dilated at the time of prolapse physician may choose to deliver infant quickly possibly by forceps SUGICAL MANAGEMENT: Cesarian Section

NURSING DIAGNOSES:(prioritized) : 

NURSING DIAGNOSES:(prioritized) Impaired gas exchange Ineffective tissue perfusion Risk for infection Anxiety Fatigue

Nursing Interventions : 

Nursing Interventions Position pt. in Trendelenburg or knee-chest posn. Manually raise the presenting part aseptically Administer Oxygen 10L/min via face mask Strictly follow proper handwashing and aseptic techniques for all healthcare providers Monitor pt’s. temp. Maintain sterility of equipments Identify client’s perception of the threat presented by the situation.

Nursing Interventions : 

Nursing Interventions Monitor physical response for example, palpitations/rapid pulse Show openness and availability as a healthcare provider Note nutritional status and fluid balance Assess psychological and physical factors that may affect reports of fatigue level Evaluated aspect of “learned helplessness” that may be manifested by giving up

Cephalopelvic Disproportion (CPD) : 

Cephalopelvic Disproportion (CPD) RISK FACTORS: Increased Fetal Weight: Large babies, hereditary (>5kgs or >10lbs.) Postmature babies (>42 weeks) Macrosomic babies, diabetic mothers Fetal Position face, brow, mentoposterior, occipitoposterior positions, vertex presentations (normal: cephalic) Problems with the Pelvis: Anterior sacrococcygeal tumors Small pelvis. Rickets, osteomalacia, tuberculosis, poliomyelitis Previous accident

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Fetal Distress No engagement, Fetus remain floating Malposition Trial labor Prolonged Labor Delayed 2nd Stage PROM Uterine Cord Prolapse Pelvic and/or Fetal Abnormalities

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Assessments: Pelvic inlet and/or outlet <11cm Diabetic Mother No engagement between 36-38 weeks of pregnancy Primigravida Signs and Symptoms: Prolonged labor Diagnostic tests: clinical pelvimetry, radiological pelvimetry, and ultrasound Surgical Management: Cesarian Section Medical Management: External cephalic version Tocolytics, Magnesium Sulfate

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Nursing Management: Trial Labor Monitor fetal heart sounds and uterine contractions continuously. Urge the patient to void every 2 hours. After Rupture of membranes, assess FHR carefullly. Emphasize, but do not overstress that it is best for their baby to be born vaginally Cesarian Section Provide explanation about why cesarean birth is necessary and now is the best route for the birth of the baby. Reassure the patient and Sos that cesarean birth is an alternative, not an inferior, method of birth.

Nursing Diagnoses: : 

Nursing Diagnoses: Anxiety Fatigue Impaired Skin Integrity Risk for infection Situational Low Self-Esteem

Nursing Interventions : 

Nursing Interventions Manually raise the presenting part aseptically Strictly follow proper handwashing and aseptic techniques for all healthcare providers Monitor pt’s. temp. Maintain sterility of equipments Identify client’s perception of the threat presented by the situation.

Nursing Interventions : 

Nursing Interventions Monitor physical response for example, palpitations/rapid pulse Show openness and availability as a healthcare provider Note nutritional status and fluid balance Assess psychological and physical factors that may affect reports of fatigue level Evaluated aspect of “learned helplessness” that may be manifested by giving up

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