RATIONALE

1. The occiput posterior position (OP) is often pinpointed as the most likely culprit. In the
OP position, the baby is facing up toward the mother's pubic bone, causing the harder
part of the baby's skull to rest on the bony part of the spine, pressing on the nerves and
causing pain. The mother may complain of backache and she may feel that her baby’s
bottom is very high up against her ribs. She may report feeling movements across both
sides of her abdomen.

2. Possible maternal complications of fetal macrosomia might include: Labor problems.

Fetal macrosomia can cause a baby to become wedged in the birth canal (shoulder
dystocia), sustain birth injuries, or require the use of forceps or a vacuum device during
delivery (operative vaginal delivery). Prolonged labor may happen if: The baby is very
big and cannot move through the birth canal.

3. Shoulder dystocia occurs at the second stage of labor, when the fetal head is born
but the shoulders are too broad to enter and be born through the pelvic outlet. It is a
birth problem and is most apt to occur in women with diabetes, in multiparas, and in
postdate pregnancies. The condition may be suspected earlier if the second stage of
labor is pro- longed, if there is arrest of descent, or if, when the head appears on the
perineum (crowning), it retracts instead of protruding with each contraction (a turtle
sign).

4. The nurse should instruct the woman to assume a hands and knees position to help
the fetus rotate. Trendelenburg’s position could not aid in the rotation of the fetus and
would slow down descent. While a fetal position would be difficult to assume for a
pregnant woman. The woman should also lie on her side opposite the fetal back to aid
the fetus in rotating.

5. Gestational diabetes is one of the predisposing factors to macrosomia.

Occipitoposterior position does not predispose the fetus to macrosomia. Multiparity
instead of primiparity can lead to an oversized fetus. CPD is one of the complications of
an oversized fetus.

6. The largest part of the uterus is the fundus, so the fetus turns into cephalic position
because the buttocks and the lower extremities can be accommodated more properly in
the fundus.

7. As long as the chin is anterior and the pelvic diameters are normal, the woman can
give birth naturally. It is possible to deliver a fetus in face presentation vaginally as long
as the head diameter and pelvic diameter are normal. Face presentation and cephalic
presentation are different from each other. It is still possible to deliver vaginally for face
presentation.

8. Obstructed labor results from the jamming of the head in the brim of the pelvis. Brow
presentation cannot have a precipitate labor because the mother would have difficulty in
the descent of the fetus. While normal labor may or may not happen, but most of the
time obstructed labor occurs because the head is jammed and cannot go past the
pelvis.

9. Extreme ecchymosis or bruising due to brow presentation is normal and would

dissipate after several days.

10. If the chin is posterior, cesarean birth is necessary. If the chin is anterior, the fetus
can be born vaginally. Normal pelvic diameters allow vaginal birth. A pelvic diameter
higher than normal can undergo vaginal birth.