MAGA, JAMAICA Q.

NURSING CARE OF A PREGNANT FAMILY WITH SPECIAL 2. Be aware of the risk

NEEDS
Pregnancy Education
The Pregnant Adolescent
1. Nutrition
- 11 to 17 years old 2. Activity and rest
- Erik Erikson: IDENTITY vs ROLE CONFUSION 3. Childbirth preparation
4. Birth decisions
Facts Regarding Teenage
5. Plans for the baby
1. Beginning and completing puberty
Complications
2. Girls maturing earlier than boys
3. Very conscious of changes in body 1. Pregnancy Induced Hypertension
4. Rapid growth 2. Iron-deficiency anemia
5. Move from concrete to abstract thinking 3. Preterm labor (failed remodeling, O2 decreases
6. Increased independence and causes contraction)
7. Strong peer group association 4. Cephalopelvic disproportion (immature pelvic,
8. Increased interest in opposite sex small. Baby cannot fit in the pelvic since the
pelvic is not mature enough)
*Oedipus Complex- a boy is fixated on his mother and
5. Postpartum Hemorrhage
competes with his father for maternal attention
6. Inability to adapt post partally (cannot take care
* Electra Complex- the attraction of a girl to her father of the baby)
and rivalry with her mother
* TRUST vs DISTRUST happens if the parents are not the
Anticipatory Guidance for Adolescent one who is taking care of their child

1. Learns technique to protect self from physical, Risk

emotional, and sexual abuse, including rape
1. Conflicting development crisis
2. Seek help if physically/ sexually abused.
2. High risk for hypertension
3. If sexually active, safe sex information,
3. High risk for premature labor
pregnancy, and prevention
4. High risk for cephalopelvic disproportion
4. Avoid smoking, drugs, and alcohol
5. High risk hemorrhoids
Predisposing Factors 6. High risk for iron-deficiency anemia (cause is
PICA and eating non nutritious foods)
1. Earlier age of menarche in girls.
2. Rates of sexual activity among teenagers OVER AGE: 40 PREGNANCY
3. Lack of knowledge about contraception or
- Advanced maternal age
abstinence
- Generativity vs Stagnation (Erik Erikson)
4. Desire of young girls to have a baby
- Generativity- (+) stable job
Prenatal Assessment & Health History - Stagnation- no progress, no improvement

1. Denial she is pregnant Facts

2. Lack of knowledge of the importance of prenatal
1. Physiological processes begin slowly decline
care
2. Cognitive skills peak
3. Dependence or others for transportation
3. Creativity at maximum
4. Feeling awkward in a prenatal setting
4. Increase in community involvement
5. Fear of first pelvic examination (transvaginal/ IE)
5. Increase in concern for future of society
6. Difficulty relating to authority figures
6. Family task
Physical Examination 7. Assist children to responsible adulthood
8. Role reversal to aging parents
1. Be informative 9. Defines role of grand parenting
MAGA, JAMAICA Q.

Anticipatory Guidance for Adults and Other Adults - Thrombophlebitis (Inflammation in veins caused
by thrombus)
1. Assist to identify health care resources within
their community A woman who is SUBSTANCE-DEPENDENT
2. Encourage health screening and regular physical
- A substance that makes the girl addict before
examination
pregnancy
*PAPSMEAR- test for early detection of cervical cancer - Cocaine
- Amphetamine
3. Encourage healthy living style
- Marijuana
Predisposing Factors - Narcotic Agonists
- Inhalants (gas, thinner, solvent, etc.)
- Community involvement - Methamphetamine
- “Sandwich Generation” in the middle of two
generation (old and new) Gateway Drugs
- Problems related to arranging for child care
• Narcotic
- Financial and space restraints
1. “Opioids” and originally derived from substance
Prenatal Assessment and Health History
‘opiates’ and its common form include morphine
- Mistakenly believe menopause (analgesic) and heroin (a highly addictive
- “Socially-Inclined Pregnancy” (day pregnancy) analgesic drug derived from morphine)
- Physical examination 2. Cocaine (1st class shabu)- Cocaine is a strong
a. Varicosities stimulant mostly used as recreational drug, it is
b. Diabetes commonly snorted, inhaled or injected into the
c. Breast cancer veins.
- Should be in supine position. Standing and 3. Hallucinogens
sitting is acceptable - Common types: LCD, PCP & Peyote
- After menstruation - Produces sensory hallucinations, involving any of
- After birth the 5 body senses (seeing, hearing, smelling,
d. Hydatidiform mole tasting, and touching)
- Chromosomal Assessment 4. Amphetamines
a. Down syndrome - Boost alertness and increases activity of the
- Low set syndrome central nervous system, the most sued form of
- Sun downy eyes stimulant are amphetamine
- Mental retardation
• Inhalants
- Problem in speech and cognitive function
- Drugs that are to be inhaled and are available as
Pregnancy Education
either a Gas or Solvent.
- Nutrition - Most common inhalant products like nail polish.
- Activity and rest
•Cannabis
- Childbirth Preparation
- Birth decisions - Marijuana used has been legalized in certain
- Plans for the baby states by prescription because of its
psychoactive effects.
Complication
General Aspects
- Pregnancy- Induced Hypertension
- Failure to progress in labor - Natural drug addiction has been associated with:
- Difficulty accepting the event a. Prenatal malnutrition and vitamin deficiency
- Hemorrhoids b. Increased risk of antepartal infections
- Varicosities
MAGA, JAMAICA Q.
c. Higher incidence of antepartal and
intrapartal complications
- Infant at risk for:
a. Intrauterine Growth Retardation (IUGR)
b. Prematurity
 20-25inch normal length
 22-23 inch recommended length
c. Fetal distress (↓O2= Hyperactivity)
d. Perinatal death (death inside the womb)
e. Child abuse
f. Sudden Infant Death Syndrome (no specific
reason but maybe related to prematurity,
aspiration, etc.)
g. Learning and Behavior Disorders
 Withdrawal syndrome- what the mother
feels will be different for the fetus
 If the mother is hyperactive then the
baby is not
h. Poor social judgements
WITHDRAWAL OF ACCUSTOMED DRUG LEVELS
↓  Increased mucus production
PHYSIOLOGIC DEPRIVATION RESPONSE
Etiology
REPEATED INTRAUTERINE ABSORPTIION OF
ILLEGAL DRUGS FROM MATERNAL BLOOD
STREAM
↓  Too much O2 can cause neonatal
FETAL DEPENDENCY
Assessment
Degree of withdrawal depends on type and duration of
addiction and maternal drug levels at birth
- Irritability, Hyperactivity, Hypertonicity,
Exaggerated Reflexes, Tremors, High-Pitched
Cry, Difficult to comfort
 Assess Moro Reflex-exaggerated startle
reflex, with tremors, hyperactivity, etc.
 Mgmt: Away from the nurses station,
isolated from others, limit of visitors
- “Step Reflex”
 A baby appears to take steps when held
upright with his or her feet touching a
solid surface. (normal)
 Substance user: Exaggerated, baby
assumes to run
- “Head- Righting” Reflex
 Responsible for correcting the position of
the body in relation to the position of the
head
 Substance user: the head follows the
position of the body instead of remaining
straight
- Nasal stiffness and sneezing, Respiratory
Distress, Tachypnea, Cyanosis, or Apnea
 If nonsubstance user, it is possible that
there is a problem in Central Nervous
System (CNS)
- Exaggerated acrocyanosis or mottling (rashes) in
the infant who is warm
- Sweating
- Hunger
 Sucks on fists
 Regurgitation (lungad)
 Vomiting
 Poor feeding
 Diarrhea
- Convulsions with abnormal eye rolling and
chewing motions
- Developmental (age/mental) retardation
Nursing Care Plan/ Implementation
- Prevent/ Minimize Respiratory distress
blindness
 O2 must be 2-3L
- Minimize possibility of convulsion (↑Temp, (+)
eye rolling, (+) chewing motion, (+) chills
 Maintain quiet environment
 Monitor RR first, PR second, and
Temperature last
- Maintain nutrition and Hydration
 Breast feeding and IVF
- Maintain and promote skin integrity
- Minimize withdrawal symptoms
 Administer medication as ordered
1. Paregoric Elixir- anti-emetic (vomit)
2. Phenobarbital- anti-convulsion
3. Chlorpromazine- for hallucination
4. Methadone- anxiolytics
- Emotional support to mother
 Encourage verbalization of feeling of
guilt, anxiety, fear, concerns.
MAGA, JAMAICA Q.

 Refer for social service Hypotonic Contractions vs. Hypertonic Contractions

PHYSICALLY or COGNITIVELY CHALLENGED WOMAN - CTG reading (Cardiotocogram- used to monitor

the fetal heartbeat and the uterine contractions
General Aspects
during pregnancy and labor)
- Rights (same rights as others applied) - Hypotonic: mas mababa ang uterine contraction
- Modifications of pregnancy tone
- Pregnancy education
CRITERIA HYPERTONIC HYPOTONIC
- Safety
Most common
- Emergency contacts Active
phase of Latent (↑↑UC)
- Transportation (↓UC)
occurence
- Mobility Limited pain
- Elimination Symptoms Painful (should be
- Autonomic Responses painful)
No meds (meds can
Modifications Medications cause hypotonic No meds
contraction
- Prenatal Care Modification Unfavorable
Favorable
- Labor & Birth Modifications Oxytocin reaction (can cause
reaction
- Postpartum Modifications abruption placenta)
- Planning Child Care Sedation muscle
relaxant (uterus) Helpful Little Value
LESSON: NURSING CARE OF A FAMILY EXPERIENCING A (3-4h effect)
COMPLICATION OF LABOR OR BIRTH
Normal: Latent (mild) → Active (moderate to strong) →
COMPONENTS OF LABOR Transition (Strong)
1. Power Lengths of Phases & Stages of Normal Labor in Hours
2. Passenger
3. Passageway NULLIPARA- PRIMI MULTIPARA
PHASE Upper Upper
4. Psyche- mother’s attitude towards labor Average Average
Normal Normal
COMPLICATIONS WITH THE POWER First Stage: Time span from beginning of regular contrac-
tions to complete cervical dilatation
DYSFUNCTIONAL LABOR Latent
8.6hr 20.0hr 5.3hr 14.0hr
Phase
- Sluggishness of contractions, or that force of 4.9hr/1.2
2.5hr/
labor is less than usual Active cm/hr
12.0hr 1.5cm/hr 6.0hr
Phase cervical
cervical d.
Common Causes of Dysfunctional Labor d.
<1hr <1hr
1. Primigravida Second (s̅ epidural) (s̅ epidural)
1hr 0.5hr
Stage <2hr <2hr
2. Narrowed Pelvic Bone Contraction (c̅ epidural (c̅ epidural)
3. Posterior fetal position & Extension of the fetal Placenta
30mins 30mins
head Stage
4. Failure of the uterine muscle to contract
properly
Placenta Stage: Shultz and Duncan
5. Presence of full rectum or urinary bladder
6. Exhaustion • 7-8cm/ 6-7cm: prepare the instruments and other
7. Inappropriate use of analgesia things

*Left side lying for Uterine Contraction and Opening of • 10cm: vaginal prep
Cervix
MAGA, JAMAICA Q.

ELECTIVE INDUCTION 6. Maintain hydration

7. Provide for blood typing, Rh incompatibility,
- Stimulation of uterine contractions during
Cross matching
pregnancy before labor begins on its own to
8. Have O2, suction, and resuscitation equipment
achieve a vaginal birth
available (if APGAR is ↓ <3)
Pharmacological 9. Prepare for emergency caesarean birth if
necessary
- Vaginal insertion of prostaglandin E2
• To change hypotonic to hypertonic if during * Long hypotonic can cause respiratory distress
transition is hypotonic
Complications
- Vaginal insertion of misoprostol tablet
1. PREMATURE RUPTURE OF MEMBRANES
Mechanical
IMPLICATIONS
- Artificial rupture of membrane
MATERNAL FETAL
• To promote ↑UC
• Ascending infection • Prolapsed cord (not
• Facilitate labor and delivery of baby (After 24-48 hours of totally engage so there is
• Amniotomy (procedure) using amniotome PROM infection can occur still a space for cord to
(sinasabay sa IE) at uterus) come out)
- Insertion of Lamenaria tent • FHR decelerations
• Looks like IUD to block the baby • Sepsis (infection in
- Nipple massage to promote release of oxytocin blood)
Medical or Obstetric Reason
Nursing Assessment
1. Diabetes
2. Hypertensive disorders 1. Time of rupture of membranes (infection)
3. Rh incompatibility 2. Fetal heart rate and maternal VS
4. Placental insufficiency 3. Perineum for prolapsed cord
5. Premature rupture of labor at term s̅ onset of 4. Confirmation of rupture of membranes by Fern
labor Test
6. Post-term gestation (beyond 9 months) 5. Confirmation of presence of amniotic fluid by
7. History of precipitate birth Nitrazine paper
8. Fetal jeopardy (fetus experiences fetal distress 6. Characteristics of leaking amniotic fluid: Odor
due to poor placental perfusion) (Odorless), Color (Clear)
: Gray/ Cloudy (Infection) and Green (Meconium)
Not Done When…
Therapeutic Intervention
1. Cephalopelvic disproportion
2. Malpresentation of fetus 1. Hospitalization with bedrest after 37 weeks
3. Fetal distress gestation
4. Placenta previa- total 100% 2. Amnio-infusion of isotonic saline
5. Active Genital herpes 3. Prophylactic antibiotics for ascending infection

Nursing Interventions Nursing Intervention

1. Prepare mother for induction 1. Monitor FHR and maternal VS

2. Obtain and record baseline information 2. Monitor uterine activity
3. Monitor oxytocin (NSD if maganda, CS if (+) 3. Avoid unnecessary vaginal examination
malpresentation of fetus) 4. Ensure adequate hydration
4. Monitor effect of prostaglandin 5. Educate parents
5. Assist with artificial rupture of membrane 6. Provide perineal hygiene
(amniotomy) *Dorsal Recumbent position 7. Administer antibiotics as ordered
MAGA, JAMAICA Q.

2. PRECIPITATE LABOR 4. Presenting part- not palpable on vaginal

examination
- Rapid labor and birth of less than 3-hour
5. FHT- tachycardia (compensatory mechanism)
duration
• Incomplete Rupture
Nursing Assessment
1. CONTRACTIONS: Continue, accompanied by
1. Rapid Cervical dilatation
abdominal pain and failure to dilate, may
2. Accelerated fetal descent
become dystonic
3. History of rapid labor
2. Sign of shock
4. Rapid uterine contractions with decreased
3. May demonstrate vaginal bleeding
periods of relaxation between contractions
4. Fetal heart tones- absent/ bradycardia
Nursing Intervention
Medical Intervention
1. Remain with mother and Monitor closely
1. SURGERY: Laparotomy (to determine the
2. Keep emergency birth pack available
location of rupture), Hysterectomy
3. Support and guide fetal head through birth canal
2. Replace blood loss
when birth occurs
3. Reduce possibility of infection
3. ARREST IN CERVICAL DILATATION
Nursing Intervention
- Not progressing cervical dilation
• Safeguard Status
- Many hours have passed pero slow pa rin and
hindi nagpaprogress 1. Prepare for immediate laparotomy
2. Oxygen per mask (4-5L) face mask
4. UTERINE RUPTURE
3. Order STAT type and cross-matches for blood
- Stress on uterine muscle exceeds its ability to 4. Establish IV line
stretch 5. Insert IFC (French 16- any sex)
- ↓ BP (mother), (+) fetal distress, ↑FHT 6. Abdominal Prep
7. Surgical Permit
Etiology (Causes)
• Emotional Support
1. Over distention
2. Old scars 1. Encourage verbalization of feelings
3. Contractions against CPD (Cephalopelvic 2. Explain all procedures
Disproportion) Malpresentation, Pathological 3. Keep family informed of progress
Retraction ring.
4. Injudicious obstetrics- malapplication of forceps
(NSD, assisted delivery; should be open cervix
and crowning)
5. Tetanic Contractions due to over use of oxytocin

Nursing Assessment

Identifying predisposing factors

• Complete Rupture

1. PAIN: Sudden, sharp, abdominal; followed by

cessation of contractions; tender abdomen
(board-like) due to presence of blood
2. Signs of shock (hypovolemic shock); vaginal
bleeding
3. Absent fetal heart tones
MAGA, JAMAICA Q.

COMPLICATIONS WITH THE PASSENGER Analysis

PROLAPSED UMBILICAL CORD 1. Impaired Gas Exchange, Fetal, related to

interruption of blood flow from placenta/fetus
Pathophysiology
• Nursing Intervention
- Administer Oxygen, for fetus, 2-3L
Cord descent in advance of presenting part
2. Anxiety/ Maternal related knowledge of fetal
jeopardy
• Nursing Intervention
Compression (in cervix) interrupts blood flow - Modified T-burg position
3. Reduce pressure on Cord
- POSITION: Lateral modified Sim’s with hips
elevated (can consider but T-burg is the best
Exchange of fetal/maternal gases position
- : Modified Trendelenburg (Increase UC, FHT, and
O2)
Fetal Hypoxia (↓O2 level of fetus) - With gloved hand (Sterile), support fetal
presentation

Nursing Intervention
Fetal anoxia (absent O2) 1. Increased Maternal/ Fetal Oxygenation
- O2/ mask start 2-3LPM via nasal cannula (if 8-
10lpm use face mask)
2. Protect exposed cord
Fetal death if unrelieved
- Continuous pressure on the presenting part to
keep pressure of cord
Etiology/Reasons - Push onti yung presenting part para di maipit
(mabawasan yung malakas na pressure sa
- Spontaneous or artificial rupture of membranes umbilical cord)
before presenting part is engaged 3. Identify fetal response
- Excessive force of escaping fluid, as in - Reduce threat to fetal survival: Monitor FHR
polyhydramnios continuously
- Malposition- breech, compound presentation, 4. Expedite (hurry) termination of threat to fetus
transverse lie - Prepare for immediate caesarean birth
- Preterm of fetus who is SGA-allows space of cord 5. Support mother and significant other:
descent - Staying with them and explaining
Assessment Mode of Delivery: CS
- Visualization of cord outside (or inside) vagina BREECH PRESENTATION
- Palpation or pulsation mass on vagina
examination - Position of the fetus in which buttock alone,
- Fetal distress- variable deceleration (due to cord buttocks and feet, or one or both feet descend
compression) and persistent bradycardia through the birth canal first
- NORMAL: (+) UC= ↑ FHT (-)UC= Normal FHT Etiology
- ABNORMAL: (-) UC= ↓FHT
1. Gestational age less than 40 weeks
2. Abnormality in a fetus, such as hydrocephalus
that hinder engagement of fetus(obstruction sa
daanan ng CSF)
MAGA, JAMAICA Q.

3. Hydramnios- excessive amount of amniotic fluid Analysis/ Nursing Diagnosis

4. Congenital anomaly such as midseptum (may
1. Acute pain, related to prolonged posterior
pagitan/harang sa uterus kaya di maka engage
pressure of fetal buttock
si baby)
2. Risk form maternal or neonatal injury r/t difficult
5. Any space-occupying mass in the pelvis (Placenta
birth
Previa- total/subtotal, cyst, tumor)
3. Risk for suffocation (↓Oxygen due to
6. Multiple Gestation- # of baby inside the womb
compression) of fetus r/t interruption in
Implications umbilical blood flow secondary to umbilical cord
compression
Maternal Fetal
• Hypoxia- low/decrease O2
Caesarean Birth • Increased mortality
• Anoxia- (-) O2 / absence of O2/ Prolong (-) O2
• Occurrence of prolapsed cord
leading asphyxia supply
• Birth trauma such as brachial • Asphyxia- Super low O2, prolonged low O2 can
palsy and fracture of the upper affect organs and cause tissue or organ death
extremities
Nursing Intervention
Brachial palsy- pwede ma-hit
and clavicle and hindi na 1. Use measures to promote comfort (Deep
magalaw ang brachial/arm breathing, Left side lying, elevate head to
promote O2)
Assessment 2. Monitor FHR in upper quadrants
- Recognition of breech presentation when 3. Watch for prolapsed cord; if it occurs:
performing Leopold’s maneuver and vaginal • With a sterile gloved hand, gently push the
examination presenting part away from the cord
- Auscultation of fetal heart tones above umbilicus • Place the client in the moderate Tburg position
- Presence of meconium without signs of fetal to keep presenting part away from the cord
distress • Keep prolapsed cord moist with sterile water
4. Prepare the client for CS birth
Classification BEFORE
1. Frank- halos nakadikit sa mukha or nakaangat sa • Consent
clavicle • Explain the procedure to the patient
2. Complete (footling)- naka indian sit pero • NPO (8-10 hours)
nakadikit paa sa abdomen • Shave the abdomen
3. Incomplete (footling)- parehong nakababa • Make sure that navel and pubic area are clean
AT OR
• Obtain baseline data
• Patient IV line
• Flat on bed
• FHT
DURING
• Side lying for spinal anesthesia
• Supine position
• Insert IFC
• Perineal prep→ abdominal prep
5. Teach mother and partner about the process of
breech birth
6. Observe for frank meconium (results from
contraction of the uterus on lower colon of the
fetus)
MAGA, JAMAICA Q.
Problems with Position and Presentation
1. POSITION- relationship of presenting part to the
pelvis of mother
2. PRESENTATION- cephalic/ breech/ transverse
(kung ano nakikitang part sa cervix)
Left Occiput Anterior (LOA)- most common and best
• OCCIPITOPOSTERIOR POSITION
Nursing Intervention
1. To relieve a portion of the pain, applying counter
pressure on the sacrum
2. To help the fetus rotate, the woman may lie on
the side opposite the fetal back or assume a
hands and knees position
3. The woman should void every 2 hours to keep
her bladder empty and avoid impeding the
descent of the fetus
4. The fetal head might arrest (because of not
voiding) in the transverse position or there might
be no rotation at all, so cesarean would be
necessary
• FACE PRESENTATION (Cephalic Presentation)
- Not a candidate for CS
Nursing Intervention
1. If the chin is anterior and the pelvic diameters
are within normal limits, the infant can be born
vaginally
2. If the chin is posterior, cesarean birth is the birth
method of choice.
3. Assess the patency of the infant’s airway closely
(NSD: wipe the mouth and nose; CS: Suction
mouth to nose)
4. Reassure the parents that the edema (Caput
succedaneum is caused by prolonged labor and
will last up to 24 hours) is transient and will
disappear after a few days
• BROW PRESANTATION
Nursing Intervention
1. CS birth should be necessary unless the
presentation spontaneously corrects itself
2. Extreme ecchymosis (pasa/bruise) on the face is
also present in infants born after a brow
presentation
3. Reassure the parent that the bruising over the
same area as the anterior fontanelle is normal
• TRANSVERSE LIE
- Shoulder and nakaharap
Nursing Intervention
1. Leopold’s Maneuver and Sonogram (UTZ)
2. Anticipate cesarean delivery
3. Reassure the parents regarding the prognosis of
the situation is NSD prognosis is low
AMNIOTIC FLUID EMBOLISM
- This problem occurs when amniotic fluid enters
the maternal circulation through open venous
sinuses in the placenta, at an area of placental
separation, or through cervical tears under
pressure from the contracting uterus.
Reasons
1. Tears- uterine rupture
2. Abruptio Placenta- can result to stroke
3. PIH
Process
a. Amniotic fluid and fetal tissue gain access to the
maternal circulation via a defect in the placenta
b. The uterine veins and Inferior Vena Cava carry
the material up to the mother’s heart and out to
the lungs bilaterally
c. The fetal material makes its way through the
lungs and returns to the heart where it is
pumped out to the entire body.
* Same management sa pulmonary embolism and
pagpunta sa vein.
Risk Factors
- Hyper stimulation of the uterus during labor
(oxytocin)
- Abortion (D&C) due to amniotic fluid
- Amniocentesis- aspiration of amniotic fluid
- Multiparas
- Scarring of the uterus
Associated Risk Factors
1. Pre-eclampsia
2. Abruptio placenta
3. Placenta previa
MAGA, JAMAICA Q.

Clinical Manifestations

1. Sudden Respiratory Distress

2. Pink, frothy sputum
3. Drop in blood pressure
4. Depressed cardiac function
5. Hypoxia

Medical Management

- Similar to pulmonary embolism

Medications

1. Fibrinogen replacements and IV heparin

2. Insertion of CVP line (jugular vein, sterile Cause of CPD
technique)
Large baby due to:
3. Blood transfusion (in case na madaming blood
ang mawala) 1. Hereditary factors
4. Cardiopulmonary resuscitation 2. Diabetes
3. Post maturity
Nursing Intervention
4. Abnormal fetal position
1. Assist in emergency resuscitation and provide 5. Small pelvis
critical care 6. Abnormally shaped pelvis
- Assist with ventilation- ambo bag
Degree of Disproportion
- Prepare for CVP insertion
- Administer medication and blood to treat DIC •Minor Disproportion
and shock
- the anterior surface of the head is in line with the
- Provide emotional support to father and
posterior surface of the symphysis. During labor,
significant others
the head is engaged due to molding and vaginal
CEPHALOPELVIC DISPROPORTION (CPD) delivery.
- L/R Occipito Posterior
- occurs when a baby’s head or body is too large
- NSD
to fit through
• Moderate Disproportion: 1st degree disproportion
Pelvis
- The anterior surface of the head is in line with
- ANATOMICAL DEF: it is a pelvis in which one or
the anterior surface of the symphysis
more of its diameter is reduced below the
- L/R Occipito Posterior
normal by 1 or more cm
- NSD
- OBSTETRIC DEF: pelvis in which its size and shape
is sufficiently abnormal that intervene with • Marked Disproportion: 2nd degree disproportion
vaginal delivery of normal size fetus
- The head overrides the anterior surface of the
Types of Pelvic symphysis
- L/R Occipito posterior but di makasiksik
- Gynecoid “Round”- 50%
- Anthropoid “Oval-long”- 25% Degree of True Conjugate Disproportion
- Android “Wedge”- 20%
• Minor degree
- Platypelloid “Oval”- 5%
- The TRUE CONJUGATE is 9-10cm. It corresponds
to minor disproportion
- Should be occipitobregmatic
MAGA, JAMAICA Q.

• Moderate Degree 3. Nonengagement

4. Pyelonephritis- inflammation on specific part of
- The TRUE CONJUGATE is 8-9cm. It corresponds
kidney
to moderate
- Pwede pa itry Complications during Labor

• Severe Degree 1. Slow cervical dilatation and prolonged labor

2. PROM and Cord prolapsed
- The TRUE CONJUGATE is 6-8cm. It corresponds
3. Obstructed labor and ruptured uterus
to marked disproportion
4. Injury to pelvic joints or nerves from difficult
- CS na
forceps delivery
• Extreme 5. Postpartum hemorrhage

- The TRUE CONJUGATE is 5cm Complications: Fetal

* Normal Conjugate: 11.5cm 1. Intracranial hemorrhage

2. Asphyxia
* Suboccipitobregmatic- 9.5cm 3. Fracture skull
* Occipitofrontal- 12cm 4. Nerve injuries such as brachial palsy
5. Intra-amniotic infection
* Occipitomentum- 13.5cm

Contracted Pelvis: MANAGEMENT

- Depends mainly on the degree of disproportion

- MINOR: Vaginal delivery
- MODERATE: Trial labor, if failed CS
- SEVERE: CS

Indication of Trial of Labor

- Young primigravida of good health

- Moderate disproportion
- Cephalic/Vertex Presentation
- No contracted outlet
- Average size baby

• Procedure Trial of Labor (Moderate: Double Set-up)

- Trial is carried out in a hospital where facilities

for CS is available
- Adequate analgesia
- Nothing by mouth

• Termination of Labor

- VAGINAL DELIVERY: either spontaneously or by

forceps if the head is engaged
- CS if: failed trial of labor or complications occur
during trial

Complications during Pregnancy: Maternal

1. Malpresentations
2. Pendulous abdomen