Nursing 209

N209: Reproductive Health Study Guide

4.4 Fetal Labor Concerns • Presentation: The part of the fetus that is overlying the maternal pelvic inlet o Occiput posterior: The fetal neck is flexed; most common abnormal presentation o Face or brow: The head is hyperextended o Normal presentation: Vertex with occiput anterior o Breech presentation: The second most common abnormal presentation  Frank: Buttocks before the head (pike position)  Complete: Fetus sitting with hips and knees flexed  • Fetal lie: The relationship between the long axis of the fetus to the long axis of the mother o Normal: Longitudinal lie; cephalic presentation o Transverse: The long axis of the fetus is horizontal to the long axis of the mother o Oblique: No presenting part 4.5 Delivery Interventions Shoulder Dystocia • Presenting part is vertex, but fetal shoulder becomes lodged behind symphasis pubis after delivery of the head • Turtle sign: Fetal head is delivered but pulls back tightly against the perineum • Maneuvers for shoulder dystocia delivery: o McRoberts maneuver: The mother’s thighs are hyperflexed and suprapubic pressure is applied o Wood screwmaneuver: The physician or midwife inserts a hand into the vagina posteriorly and presses on the posterior shoulder to rotate the fetus o Zavanelli maneuver: If all attempts are unsuccessful, the infant’s head is flexed and replaced back and rotated into the vagina followed by cesarean section delivery Operative Vaginal Delivery • Application of forceps or vacuum extractor to the baby’s head during the second stage of labor to facilitate delivery • Must be completely dilated with presenting part at +2 station or lower • Must have empty maternal bladder • Rupture of membranes confirmed • Pelvic adequacy ensured Footling: One or both legs are completely extended and present before buttocks (single footling or double footling)

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