PowerPoint Presentation

FETAL MALPOSITIONSRelationship of assigned area of the presenting part or landmark to the maternal pelvis or the relationship of the fetus presenting part to the mother's pelvis.

Maternal Pelvis is divided into four quadrants according to mothers right and left:

Right AnteriorLeft AnteriorRight PosteriorLeft PosteriorPOSITIONMalpositions are abnormal position of the vertex of the fetal head (with the occiput as the reference point) relative to the maternal pelvis.PROBLEM:The fetus is in an abnormal position that may result in prolonged or obstructed labour.MALPOSITIONSVERTEX PRESENTATION (OCCIPUT)LOA Left OccipitoanteriorLOP Left OccipitoposteriorLOT Left OccipitotransverseROA Right OccipitoanteriorROP Right OccipitoposteriorROT Right Occipito Transverse

BREECH PRESENTATION (SACRUM)LSaA Left SacroanteriorLSaP Left SacroposteriorLSaT Left SacrotransverseRSaA Right SacroanteriorRSaP Right SacropsteriorRSaT Right SacrotransverseFACE PRESENTATION (MENTUM)LMA Left MentoanteriorLMP Left MentoposteriorLMT Left MentotransverseRMA Right MentoanteriorRMP Right MentoposteriorRMT Right Mentotransverse

SHOULDER PRESENTATION(ACROMION PROCESS)LAA Left ScapuloanteriorLAP Left ScapuloposteriorRAA Right ScapuloanteriorRAP Right ScapuloposteriorTYPES OF FETAL MALPOSITIONVERTEX PRESENTATION (OCCIPUT)

BREECH PRESENTATION (SACRUM)

FACE PRESENTATION (MENTUM)SHOULDER PRESENTATION(ACROMION PROCESS)

GENERAL MANAGEMENT:Make a rapid evaluation of the general condition of the woman including vital signs ( pulse, blood pressure, respiration, temperature).Assess fetal condition.Listen to the fetal heart rate immediately after a contractionIf the membranes have ruptured, note the colour of the draining amniotic fluid.

Provide encouragement and supportive care.Review progress of labour using a partograph.ASSESSMENTDETERMINE THE PRESENTING PARTThe most common presentation is the vertex of the fetal head.If the vertex is the presenting part, use landmarks of the fetal skull to determine the position of the fetal head.DETERMINE THE POSITION OF THE FETAL HEADThe fetal head is normally engages in the maternal pelvis in an occiput transverse position, with the fetal occiput transverse in the maternal pelvis.With descent, the fetal head rotates so that the fetal occiput is anterior in the maternal pelvis.An additional feature of a normal presentation is a well-flexed vertex, with the fetal occiput lower I the vagina than the sinciput.If the fetal head is well-flexed with occiput anterior or occiput transverse (in early labor) proceed with delivery.If the fetal head is not occiput anterior, identify and manage the malpositions.If the fetal head is not the presenting part or the fetal head is not well-flexed, identify and manage the malpresentation.NURSING DIAGNOSISParacervical blockPudental blockLocal anesthesia for cesarean sectionSpinal (subarachnoid) anesthesiaKetamineExternal versionInduction and augmentation of labourVacuum extractionForceps deliveryManual removal of placentaRepair of cervical tearsRepair of vaginal and perinatal tearsCorrecting uterine inversionRepair of ruptured uterusUterine and utero-ovarian artery ligationPostpartum hysterectomySalpingectomy for ectopic pregnancyCesarean sectionSymphysontomyCraniotomy and craniocentesisDilatation and curettageManual vacuum aspirationCesarean sectionSymphysontomyCraniotomy and craniocentesisDilatation and curettagePROCEDURESIMPLEMENTATIONAdmit to the birthing home.Determine if the clients membranes have ruptured.Encourage family participation.Perform leopold maneuver and vaginal exams as appropriate.Monitoring maternal VS and fetal heart rate and pattern.Apply electronic fetal monitor as appropriate.Provide ice chips.Encouraging voiding at least every 2 hours.Assisting with anesthetic administration.Assisting with amniotomy with assessment of fetal heart rate, fetal positioning, and fetal cord after amniotomy.Cleansing perineum and assisting with pad changes regularly.Monitoring progress including vaginal discharge, cervical dilation, and effacement, position, and fetal descent.Performing vaginal examination as necessary.Encouraging spontaneous bearing-down efforts for second stage.Assisting coach and supporting client and partner.Preparing supplies and equipment for delivery.Notifying primary health care provider at appropriate time to scrub for attending delivery.Assessing pain level, instituting positioning, breathing, relaxation.OUTCOMECoping mechanisms.

Techniques to facilitate labour.

Uterine contraction frequency, duration and intensity within expected range.

Physiologic parameters such as VS, neurologic reflexes, urine output,and blood glucose levels within expected range.

Progressive cervical dilation.END