CEPHALOPELVIC DISPROPORTION

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CEPHALOPELVIC DISPROPORTION
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• Implies disproportion between the head of the
  baby (cephalus) and the mothers pelvis
• Complications can occur if the fetal head is too
  large to pass through the mothers 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

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CAUSES

• increased fetal weight
• fetal position
• problems with the pelvis
• problems with the genital tract

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SIGNS AND SYMPTOMS

• the delivery of the baby is obstructed
• The labor is prolonged

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pathophysiology
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Disproportion between head of the baby and the
mothers pelvis
Fetus does not engage but remains floating
malposition
Premature rupture of membranes
Trial labor
Prolonged labor
Uterine cord prolapse
Delayed second stage
Fetal distress!!
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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.

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DIAGNOSIS

• Ultrasound estimation of the babys size can be
  made by ultrasonogram

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MANAGEMENT

• Cesarian section

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NURSING DIAGNOSIS

• Anxiety
• Fatigue
• Risk for fetal injury
• Risk for impaired skin integrity
• Situational low self- esteem

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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 clients ability to cope
  with current situation

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PREGNANCY INDUCED HYPERTENSION
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Pregnancy- induced hypertension

• A condition in which vasospasm occurs during
  pregnancy in both small and large arteries
• Originally was called toxemia
• Cause unknown

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Risk Factors

• Women of color, or with a multiple p regnancy,
  primiparas lt20 years of age or gt40 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)

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Signs and symptoms

• HPN
• Proteinuria
• Extensive edema
• Vision changes

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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 gt30 mmHg and diastolic pressure gt15
  mmHg above pre pregnancy values
• proteinuria (1 or 2 on a reagent test strip on
  a random sample)
• edema

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• 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

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pathophysiology
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Increased cardiac output
Injury of endothelial cells of the arteries
leading to vasospasm
Change in the action of prostaglandins resulting
to Vasoconstriction
Dec blood supply and O2 perfusion To vital organs
hypertension
Liver/ pancreas
Kidneys
placenta
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kidneys
Dec glomerular filtration
Glomerular degeneration
Inc tubular reabsorption of sodium
Inc glomerular permeabilty
water retention
Escape of serum proteins, albumin And globulin,
into the urine (proteinuria)
edema
oliguria
Fluid diffuses from circ system to extracellular
spaces
Gen H2O retention
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LIVER
Tissue ischemia
Vascular stasis
Epigastric pain
Convulsion!!
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PLACENTA
Tissue ischemia
Release thromboplastin-like substances
Premature placental deterioration
Dec fetal nutrient
Abruptio placenta
Fetal distress
Premature labor and delivery
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Nursing diagnoses

• Decreased cardiac output
• Ineffective tissue perfusion
• Fluid volume excess
• Urinary retention
• Risk for fetal injury
• Social isolation

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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

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• 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

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• 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

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• Administration medications to prevent eclampsia
• hydralazine/ Apresoline
• labetalol/ Normodyme
• DOC magnesium sulfate antidote calcium
  gluconate
• Eclampsia
• - seizure precautions

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Prepared by
miko
camay
ricah