Locations which problems with the passageway can occur
- Inlet
- Midpelvis
- Outlet
Causes of the narrowing of the passageway
- CPD
- Disproportion between the size of the fetal head
- Pelvic diameters
It is the narrowing of the anteroposterior diameter of the pelvis to less than 11cm or the transverse diameter to 12cm or less
Inlet contraction
Caused by rickets in early life or an inherited small pelvis
Inlet contraction
Caused by the lack of Vitamin D or Calcium
Rickets
If engagement does not happen in a primigravida, what conditions should be suspected?
- Fetal abnormality (larger than usual)
- Pelvic abnormality (smaller than usual)
If CPD exists because the fetus may not engage but instead remains “floating”, the possibility of what condition might occur?
Possibility of cord prolapse might occur
Narrowing of the transverse diameter, the distance between the ischial tuberosities at the outlet, to less than 11cm
Outlet contraction
To determine whether labor will progress normally
Trial labor
Trial labor continues as long as what two conditions continues to occur?
- Decent of the presenting part
- Dilatation of the cervix
What should be monitored during the trial labor?
- Fetal heart sounds
- Uterine contractions
How frequent to urge the patient to void?
Every 2 hours
What is the rationale to urge the patient to void every 2 hours?
To make the urinary bladder empty - allowing the fetal head to use all the space available
What conditions to discontinue trial labor?
- A definite period (6-12hrs), adequate progress in labor cannot be documented
- Fetal distress occurs anytime
Turning of a fetus from a breech position to a cephalic position before birth
External Cephalic Version
Contraindications of External Cephalic Version
- Multiple gestation
- Severe oligohydramnios
- Small pelvic diameters
- Cord that wraps around the fetal neck
- Unexplained third trimester bleeding - possible placenta previa
Rationale of the indication of epidurals
To help discomfort and provide additional muscle relaxation
Patients who are Rh negative should receive ______________ after the procedure in case undetected bleeding occurs
Rh immunoglobulin
Forceps may be necessary with any of the following conditions
- A patient is unable to push with contractions in cases where someone has received regional anesthesia or has a spinal cord injury
- Cessation of decent in the second stage of labor occurs
- A fetus is in an abnormal position
- A fetus is in distress but very low in the pelvis
What to be mindful of before forceps are applied?
- Membranes must be ruptured
- CPD must not be present
- The cervix must be fully dilated
- The patient’s bladder must be empty
A kind of procedure will be performed if a fetus, positioned far enough down the birth canal
Vacuum Extraction
One disadvantage of Vacuum Extraction
More perineal lacerations may occur (over natural birth)
Major disadvantage of Vacuum Extraction
- It will cause a marked caput on the newborn head
- Tentorial tears from extreme pressure will occur
Contraindication of Vacuum Extraction
Preterm infants because of the softness of the preterm skull
