2M Intrapartal Complications Written Report 109

Cebu Doctors’ University
College of Nursing
Mandaue City, Cebu, Philippines
NCM 109: Care for the Mother and Child at-Risk

or with Problems (Acute and Chronic)
ANTEPARTUM COMPLICATIONS
Group A – 3:
Balbuena, Katya
Gabun, Johncen Brian L.
Hamoy, Heaven Khrys
Igot, Marvie Raymon
Jayson, Ellen Rose
Joe, Rinoah Airish
Lear, Niekkah Mae P.
Limboy, Roanna Therese G.
Locsin, Aaliyah Bjorn B.
Locsin, Ninna Cherizze M.
Magan, April Pai A.
Oliver, Diamae S.
Osnan, Jasper G.
Pangilinan, Carlin Gyandev P.
Rosal, Cromwell Ernest
Facilitator: Mrs. Dee Jane A. Dumagan, MAN, RN

Date Submitted: February 16, 2022
Prolapse of the Umbilical Cord
I. Definition/Description of the Disease or Complication
Umbilical cord prolapse happens when the cord falls through the open cervix into the
vagina before the baby enters the birth canal. The cord is pinched between the baby's body and
the pelvic bones when this occurs. This lowers the baby's blood flow, resulting in oxygen
deficiency.
II. Etiology/Cause
Premature rupture of the membranes, which occurs when a mother's water breaks prior
to labor and her baby's head has started to "engage," (settle into the delivery canal), is the most
prevalent cause of cord prolapse. Aside from the rupture of the membranes, it also includes:
● Fetal presentation other than cephalic
● Placenta previa
● Intrauterine tumors prevent the presenting part from engaging
● Small fetus
● CPD (Cephalopelvic disproportion) preventing firm engagement
● Polyhydramnios
● Multiple gestations
III. Types if Applicable

Umbilical cord prolapse is classified into three (3) types:
1. Overt cord prolapse - After the membranes are ruptured, the cord passes
through the cervix into the vaginal opening.
2. Funic presentation - A coil of umbilical cord connects the fetal presenting
section to the still-intact fetal membranes enclosing the cervical os.
3. Occult prolapse - It happens when the cord is found alongside the presenting
part, despite being undetectable by the examiner.
IV. Signs and Symptoms

Signs Symptoms
● a non-engaged or ill-fitting presenting ● Severe abdominal pain

part ● Decreased movement of the fetus
● Decrease in fetal heart rate inside the womb
● Variable deceleration FHR pattern
suddenly becomes apparent on the
fetal monitor
V. Management
● Nursing, Medical, Pharmacologic, Surgical
Nursing Management Medical Management Pharmacologic Surgical Management
Management
● To avoid ● Seeing or ● Tocolytic drug - ● Amnioinfusion - It

vasospasm, avoid palpating the To minimize has been reported
handling the cord. prolapsed cord on uterine activity as a strategy of
pelvic exam and fetal avoiding or
● Encourage into left pressure alleviating umbilical
lateral position ● Funic cord compression
decompression- during labor. It is a
● Monitor and most common treatment that
evaluate fetal heart method of replaces amniotic
tone alleviating cord fluid by infusing
compression. The regular saline or
● Assess a laboring examiner's hand lactated Ringer's
client frequently If is placed in the solution into the
the fetus is preterm vaginal canal and uterine cavity.
or small for used to lift the
gestational age, fetal head off the ● Cesarean Section -
the fetal presenting cord while Umbilical cord
part is not emergency prolapse is a life-
engaged, or the cesarean delivery threatening
membranes are preparations are maternal
ruptured made. complication that
necessitates the
baby's urgent
delivery. Thus,
cesarean section is
the most common
method of delivery.
VI. Relevant Pictures/Videos

https://youtu.be/foSCUlDlgwA
Overt Cord Prolapse Funic Presentation Occult Cord Prolapse

VII. One (1) priority Nursing Care Plan for each complication
Nursing Nursing Objectives of

Scientific Basis Nursing Actions Rationale
Assessment Diagnosis Care
Risk Problem: Risk fo The umbilical General Measures to maintain

impaired cord is a baby’s Objective: and manage the gas
Impaired gas fetal gas lifeline. This tube- After 5 days of exchange of the fetus
exchange exchange like structure holistic student in having mechanical
related to attaches the fetus nurse-client compressions.
Objective risk factors to the placenta. It interaction the
Cues: of includes blood fetus of the Independent:
mechanical arteries that client will show
● Vital compression transport oxygen, no signs of 1. Assess the 1. Fetal
Signs: of cord nutrients and also respiratory fetal heart distress
eliminates waste distress when tone during can be
T: 37.3 from the fetus. doing the and after each determine
PR: 108 bpm However, a mechanical contraction. d through
RR: 15 bpm prolapsed compression the
BP: 100/70 umbilical cord is a of the umbilical abnormal
FHR: 100 and condition in which cord heart rate
prolonged the supply of of the
deceleration oxygenated blood Specific baby.
continues from the placenta Objectives: Monitoring
to the baby After 8 hours the fetal
● Fetal through the of nursing heart tone
distress umbilical cord is interventions, during
due to suddenly and the fetus will contractio
altered severely reduced. be able to: n is a vital
fetal According to means to
heart NANDA, impaired 1. Have a settle if
rate gas exchange is stable there is
● Change any excess or fetal any
s in deficit in heart presence
fetal oxygenation tone of cord
heart and/or carbon within prolapse.
tone dioxide normal
● Increas elimination at the limit Source:
es in alveolar-capillary and will Brennan, D.
amnioti membranes thus be free (2021, March 9).
c fluid this might be a from What Is Umbilical
● Decrea risk for the fetus. prolon Cord Prolapse?
sed or The umbilical ged Retrieved
increas cord transports deceler February 11,
ed fetal oxygenated blood ation 2022, from
movem and nutrients WebMD website:
ent from the placenta 2. Achiev https://www.web
to the baby that is e the md.com/parenting
Subject Cues: why any absenc /what-is-umbilical-
● The disruption in the e of cord-
mother umbilical cord's fetal prolapse#:~:text=
verbaliz normal blood flow distres Umbilical%20cord
es that and gas s %20prolapse%20
her exchange can occurs%20when,
baby result in 3. Have of%20oxygen%20
has potentially fatal no any to%20your%20ba
lesser injuries to the signs by.
movem baby. When the of
ents as umbilical cord restricti 2. Take note of 2. Taking
compar that connects the on of the short-term note of
ed to placenta and the gas and long-term both short-
her last fetus becomes exchan variations in term and
pregna compressed or ge Fetal Heart long-term
ncy. flattened, the flow when Rate. FHR
of blood, oxygen, perfor variations
and nutrients to ming determine
the baby is mecha s the fetus
restricted. nical state,
compr considerin
Sources: ession g the
Boushra, M. to the normal
Stone, A., & fetus beat-to-
Rathbun., K. M. beat
(2021, May 20). 4. Achiev changes
Umbilical Cord e an should be
Prolapse. increas between 6
Retrieved from ed or and 10
ncbi: normal bpm,
https://www.ncbi. movem demonstra
nlm.nih.gov/book ent in ting fetal
s/NBK542241/ the CNS
mother stability.
Doenges, M.E., ’s Source:
Moorhouse, M.F., womb. Brennan, D.
& Murr, A.C. (2021, March 9).
(2019). Nurse’s What Is Umbilical
Pocket Guide: Cord Prolapse?
Diagnoses, Retrieved
Prioritized February 11,
Interventions, and 2022, from
Rationales. 15th WebMD website:
Edition. F.A. https://www.web
Davis, md.com/parenting
Philadelphia, /what-is-umbilical-
Pennsylvania cord-
prolapse#:~:text=
Mutchler, C. Umbilical%20cord
(2021, July 4). %20prolapse%20
What Is Umbilical occurs%20when,
Cord of%20oxygen%20
Compression? to%20your%20ba
Retrieved from by.
verywellhealth:
https://www.very 3. Monitor Fetal 3. Monitoring
wellhealth.com/u heart rate FHR
mbilical-cord- variations on a determine
compression- regular basis any
signs-and- for severe, presence
complications- moderate, or of Hypoxia
5187744#:~:text= extended or low
Umbilical%20cor decelerations oxygen
d%20compressio levels of
n%20happens%2 the fetus.
0when,and%20n Variable
utrients%20to%2 decelerati
0the%20baby. ons
suggest
hypoxia,
which
might
caused by
cord
entrapmen
t or
shortened
cord.
Source:
Doenges, M. D.
E., Moorhouse, M.
M. R. M. F., &
Murr, A. M. C.
(2019). Nursing
Care Plans:
Guidelines for
Individualizing
Client Care
Across the Life
Span (Tenth ed.)
[E-book]. F.A.
Davis Company.
4. Teach the 4. Obtaining

mother all prolapsed
about umbilical
umbilical cord cord is
prolapse and rare but
its warning inevitable.
signs of the So, only a
fetus such as few are
irregular heart informed
rate and due to
passing pregnancy
meconium on history.
labor Educating
mothers
about this
complicati
on assist
them in
preparatio
n and what
to expect
when
labor
occurs.
Source:
Australasian birth
Trauma
Association.
(2020, March 2).
Fetal distress.
Retrieved
February 11,
2022, from
Pregnancybirthba
by.org.au website:
https://www.pregn
ancybirthbaby.org
.au/fetal-
distress#:~:text=F
etal%20distress%
20is%20diagnose
d%20by,the%20b
aby’s%20heart%2
0during%20pregn
ancy.
5. Demonstrate 5. Showing
knee-to-chest the mother
position how to
(Trendelenbur properly
g position) to position
the mother in can
relieving decrease
pressure on further
the umbilical compressi
cord. on on the
umbilical
cord and
helps
reduce the
possibility
of a
prolapsed
cord while
waiting for
the
delivery.
Source:
TeachMe ObGyn.
(2017). Umbilical
Cord Prolapse -
Risk Factors -
Management -
TeachMeObGyn.
Retrieved
February 12,
2022, from
TeachMeObGyn
website:
https://teachmeob
gyn.com/labour/e
mergencies/cord-
prolapse/
6. Instruct 6. Breathing
mother about exercises
breathing promote
exercises as a more
regime and effective
preparation breathing
for childbirth and airway
managem
ent to the
mother
and for the
benefit of
the baby
especially
when
contractio
ns are
occurring
as an
indication
of labor.
Source:
Doenges, M. D.
E., Moorhouse, M.
M. R. M. F., &
Murr, A. M. C.
(2019). Nursing
Care Plans:
Guidelines for
Individualizing
Client Care
Across the Life
Span (Tenth ed.)
[E-book]. F.A.
Davis Company.
Dependent: 7. Funic
7. Assist the decompre
mother in ssion is
preparing for a the most
vaginal frequent
examination means of
or funic relieving
decompressio cord
n to alleviate compressi
the pressure on, and it
of the is also the
presenting maneuver
part on the doctors
cord as favor. The
ordered by the examiner's
physician. hand is put
in the
vagina
and used
to lift the
fetal head
off the
cord while
preparing
for an
emergenc
y
cesarean
birth.
Source:
StatPearls. (2021,
May 20). Umbilical
Cord Prolapse.
Retrieved
February 12,
2022, from
StatPearls
website:
https://www.statp
earls.com/ArticleL
ibrary/viewarticle/
30751
8. Ensure that all 8. Umbilical

necessary cord
materials prolapse is
needed during a life-
a Cesarean threatenin
section g obstetric
delivery are emergenc
readied as y that
instructed by demands
the attending the baby's
physician urgent
delivery.
Cesarean
section is
the most
common
method of
delivery. In
this case,
doctor’s
order of
performing
ceserean
delivery
can help in
decreasin
g the
danger of
prenatal
hypoxia.
Source:
Cleveland Clinic
medical
professional.
(2020). Umbilical
Cord Prolapse:
Causes,
Diagnosis &
Management.
Retrieved
February 12,
2022, from
Cleveland Clinic
website:
https://my.clevela
ndclinic.org/health
/diseases/12345-
umbilical-cord-
prolapse#manage
ment-and-
treatment
Interdependent:
9. Collaborate 9. Dieticians
with a provide
dietician for informatio
the mother's n and
diet meal plan guidance
and lifestyle in
modifications determinin
g
individual
nutritional
needs
incorporati
ng one's
pregnancy
. Also, it
aids in
discussion
s about
necessary
lifestyle
changes
that aim at
realistic
goals for
the
patient,
especially
for a case
of
prolapsed
cord.
Source:
Doenges, M. D.
E., Moorhouse, M.
M. R. M. F., &
Murr, A. M. C.
(2019). Nursing
Care Plans:
Guidelines for
Individualizing
Client Care
Across the Life
Span (Tenth ed.)
[E-book]. F.A.
Davis Company.
10. Collaborate 10. Counselin

with a g is crucial
psychologist for a
about the pregnant
mother's fears woman
when labor who is
happens. concerned
about both
herself
and her
baby's
health.
Additional
assistance
,
particularl
y from
another
healthcare
expert,
helps her
to view the
situation
more
positively.
Source:
Doenges, M. D.
E., Moorhouse, M.
M. R. M. F., &
Murr, A. M. C.
(2019). Nursing
Care Plans:
Guidelines for
Individualizing
Client Care
Across the Life
Span (Tenth ed.)
[E-book]. F.A.
Davis Company.
REFERENCES:
Boyd, T. K., Parast, M. M., Horii, M., & Tantbírójn, P. (2018). Placental Correlates of Unanticipated
Fetal Death. Diagnostic Gynecologic and Obstetric Pathology, 1182–1218.
https://doi.org/10.1016/b978-0-323-44732-4.00032-7
Brennan, D. (2021, March 9). What Is Umbilical Cord Prolapse? Retrieved February 10, 2022,
from WebMD website: https://www.webmd.com/parenting/what-is-umbilical-cord-
prolapse
Cord Prolapse Nursing Management. (2018, August). Retrieved from rnpedia:

https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-notes/cord-prolapse/
De Bellefonds, C. (2020, November 16). Cord Prolapse During Pregnancy. Retrieved February
10, 2022, from What to Expect website:
https://www.whattoexpect.com/pregnancy/pregnancy-health/complications/cord-
prolapse.aspx
Prolapse, U. C. (2017, December 22). Teachme ObGyn. Retrieved from

https://teachmeobgyn.com/labour/emergencies/cord-prolapse/
Rashid, H. (2019). Umbilical Cord Prolapse, Presented By Mohammed Haroon Rashid. Retrieved
February 11, 2022, from Slideshare.net website:
https://www.slideshare.net/HaroonRashid110/umbilical-cord-prolapse-presented-by-
mohammed-haroon-rashid
Multiple Gestation
Multiple Gestation or what we called multiple pregnancies is when a woman is

having two or more fetuses. The mother may be expecting twins, triplets, or more. During
the first trimester, most women find out they're pregnant with multiples. This type of
pregnancy happens in approximately three percent of pregnancies and is considered as
a type of high-risk pregnancy.
II. Etiology/Cause
Multiple Gestation can happen randomly. During a cycle, if a woman ovulates two
eggs, then each egg will have the capability to be fertilized by the sperm. In the event that
two different sperm fertilize two different eggs, the woman will then be pregnant with non-
identical (fraternal) twins. A fertilized egg will also randomly divide itself into multiple,
genetically identical embryos. Identical twins will likely develop if the egg divides into two.
Fraternal twins
- In the uterus, two separate eggs will be fertilized and implanted. The fetuses are
siblings who share the same uterus – might look alike or different, and could be of
the same gender (two girls or two boys) or of two different genders.
- This type of twins has its own placenta and amniotic sac, making this pregnancy
the lowest risk of all multiple pregnancies.
- Fraternal twins are frequently referred to as 'dizygotic' twins since they have two
zygotes (fertilized eggs).
Identical twins
- When a single fertilized egg is split in half, identical twins are produced. The
fetuses will share the same DNA because each half (embryo) is genetically
identical, meaning they will share many characteristics.
- Identical twins can look quite different from each other since their appearance is
influenced by both their environment and their DNA.
- This type of twins can share the same placenta and amniotic sac, or have their
own placenta and amniotic sac.
- Identical twins are frequently referred to as 'monozygotic' since they have one
zygote (fertilized egg).
Triplets and 'higher order multiples' (HOMs)
- A combination of identical and fraternal multiples can result in triplets, quadruplets,

quintuplets, sextuplets, or more. Triplets, for example, can be fraternal (trizygotic),
resulting from the fertilization and implantation of three individual eggs in the
uterus; identical, resulting from the division of one egg into three embryos; or a
combination of the two.
Signs Symptoms
● Multiple embryos on ultrasound ● Intense morning sickness

● Multiple fetal heartbeats ● Severe breast tenderness
● High levels of human chorionic ● Strong back pain and fatigue
gonadotropin (hCG)
● High levels of alpha-fetoprotein (AFP)
● Large fundal height
● Rapid weight gain in the first trimester
V. Management

Management
● Assess the patient’s ● A Maternal-Fetal ● Analgesia is mainly ● Cesarean section is

hematocrit level specialist or an OB- used during early more preferable than
and blood pressure GYNE is needed for labor to help you rest normal delivery since
closely during labor this complication. and conserve your multiple gestations can
or while waiting for energy. result in fetal anoxia on
cesarean ● A Perinatologist is the part of the second
arrangements to also called for ● Anesthesia fetus.
detect anemia and special testing or specifically regional
gestational ultrasound anesthesia for
hypertension. evaluations. cesarean delivery.
This reduces pain
● Urge the patient to ● Maternal and fetal throughout the
spend the early testing is also birthing process and
hours of labor needed allows surgical
engaged in procedures to be
activities such as done.
playing cards or
reading to make the ● To relax the uterus,
time pass more nitroglycerin may be
quickly. administered.
● Support the ● If preterm labor

patient’s breathing occurs, Tocolytic
exercises to medications may be
minimize the need given to aid in the
for analgesia or slowing or stopping of
anesthesia. uterine contractions.
This medication often
● After birth, assess used includes
the patient magnesium sulfate.
thoroughly and
immediately ● Do not administer
because there oxytocin to avoid
might be difficulty in compromising the
contracting an circulation of unborn
overly distended twins but can be given
uterus which will after the birth of the
then result in last fetus.
uterine atony,
placing the patient ● Since lung immaturity
at risk for is a major problem of
hemorrhage. premature babies,
Corticosteroid
medications may be
administered to help
the fetuses’ lungs
mature.
https://youtu.be/nVhEkRG8-ws
Nursing Nursing Scientific Basis Objectives of Nursing Actions Rationale

I. Physio Risk for Fetal Multiple Gestation General Independent:

logic Injury related can lead to Objectives:
Risk for Fetal to Multiple different 1. Assess Fetal This is to detect
Injury Gestation complications. In After ____ of Heart rate abnormal heart
this type ofnursing response such as
Objective Risk for Fetal pregnancy, intervention, the bradycardia or
Cues: Injury related common patient will deliver tachycardia.
to Abnormal complications the fetuses with no
● BP: Fetal such as abnormal complications. Martin, P. B.
130/8 Presentation fetal presentation (2019, June 1). 4
5 can lead to the Specific Dysfunctional
mmHg injury of theObjectives: Labor (Dystocia)
● He fetuses. After _ hours of Nursing Care
● Fetal Furthermore, a
holistic nursing Plans.
Ultras firm head care, the client will Nurseslabs.
ound engagement is
be able to: https://nurseslabs
showe not present in a .com/4-
d multifetal 1. Cooperate in dysfunctional-
prese pregnant mother the medical and labor-dystocia-
nce of due to the fact nonpharmacologic nursing-care-
Multipl that the babies al treatment plans/#risk_for_fe
e are small, with regiment given by tal_injury
Gestat this, the babies the medical
ion are prone topractitioners. 2. Monitor the 2. This is to know
● Doppl injuries in patient’s Blood if the mother’s
er delivery. 2. Display a Pressure blood pressure is
detect Normal Fetal high, since
ed two Heart rate for the Multifetal
separ Source: babies. pregnant mothers
ated Belleza, R. M. N. are more prone to
fetal (2021b, April 22). 3. Demonstrate a Pregnancy
heart Labor behavior and a Induced
beat. Complications. manner that Hypertension
Nurseslabs. lessen the risks of
Subjective https://nurseslabs fetal injury Belleza, R. M. N.
cues: .com/labor- especially when (2021, April 22).
● “Naka complications/#m there are two Labor
sinati ultiple_gestation fetuses living Complications.
kog inside the mother. Nurseslabs.
lihok https://nurseslabs
sa .com/labor-
bata complications/#m
pero ultiple_gestation
nahibo
ng ko 3. Support patient 3. This is to
ngano through breathing diminish or
ng exercises and minimize the need
murag maternal for analgesia or an
kadag positioning anesthesia
han
mu Breathing
lihok” Techniques for
Childbirth |
HealthLink BC.
(2020).
HealthLink.
https://www.healt
hlinkbc.ca/pregna
ncy-
parenting/labour-
and-birth/during-
labour/breathing-
techniques-
childbirth
4. Assess for 4. This allows the

Malpositioning medical
using Leopold’s practitioners to
Maneuvers determine fetal lie,
position and
presentation
which may be a
risk factor for fetal
injury.
Martin, P. B.
(2019b, June 1). 4
Dysfunctional
Labor (Dystocia)
Nursing Care
Plans.
Nurseslabs.
https://nurseslabs
.com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/#risk_for_fe
tal_injury
5. Note the 5. Contractions

frequency of under 2 mins or
uterine less do not allow
contractions sufficient
especially if the oxygenation of the
frequency is 2 min intervillous
or less. Notify the spaces.
physician
immediately. Martin, P. B.
(2019b, June 1). 4
Dysfunctional
Labor (Dystocia)
Nursing Care
Plans.
Nurseslabs.
.com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/#risk_for_fe
tal_injury
6. If preterm labor 6. Tocolytic

occurs, agents are used to
administer slow down labor to
tocolytic prevent preterm
medications to labor which would
slow down or be detrimental to
delay labor. both mother and
the fetus
especially when
the mother is a
Multifetal
pregnant woman.
Miyazaki, C.
(2016, January
14). Tocolysis for
inhibiting preterm
birth in extremely
preterm birth,
multiple
gestations and in
growth-restricted
fetuses: a
systematic review
and meta-analysis
- Reproductive
Health. BioMed
Central.
https://reproductiv
e-health-
journal.biomedce
ntral.com/articles/
10.1186/s12978-
015-0115-7
Dependent
7. Make sure that 7. Cesarean

all necessary section is possible
materials are especially when a
prepared during a mother fails to do
Cesarean section labor or the labor
delivery as is already
instructed by the prolonged which
attending could result to
physician fetal injury.
Tanigaki, S.,
Takemori, S.,
Osaka, M., &
Watanabe, M.
(2020). Cesarean
Section of
Multifetal
Pregnancy. US
National Library of
Medicine.
https://www.ncbi.
nlm.nih.gov/pmc/
articles/PMC7396
478/
8. Assist the 8. This different

Physician with the positioning may
elevation of vertex reduce pressure
if instructed or on cord.
required
Wayne, G.,
BSN, & R.N.
(2016,
September 25).
10 Cesarean
Birth Nursing
Care Plans.
Nurseslabs.
https://nursesla
bs.com/cesarea
n-birth-
nursingcare-
plans/
Interdependent
9. Collaborate 9. Mothers
with a nutritionist carrying two or
and/or a dietician more fetuses
to create a proper need more
and suitable meal calories, protein,
plan for the and other
Multifetal nutrients,
pregnant mother. including iron.
Heard, A. J., MD.

(2021, July 19).
Multifetal
Pregnancy
Treatment &
Management:
Approach
Considerations,
Multifetal
Reduction,
Nutrition.
Medscape.
https://emedicine.
medscape.com/ar
ticle/1618038-
treatment
10. Collaborate 10. Allowing good

with the partner or communication
a household loved and interaction
one and regularly between the nurse
check the and the loved one
behavior of the would allow
mother. proper
surveillance
throughout the
multifetal
pregnant mother.
Support allows the
mother to be less
stressed and
more eased.
Partner Support
During
Pregnancy.
(2020).
MyHealthAlberta.
https://myhealth.a
lberta.ca/Health/p
ages/conditions.a
spx?hwid=abp735
2#:~:text=When%
20both%20partne
rs%20support%2
0each,feel%20ha
ppier%20and%20
less%20stressed.
REFERENCES:
Belleza, R. M. N. (2021, April 22). Labor Complications. Nurseslabs.

https://nurseslabs.com/labor-
complications/?fbclid=IwAR01v4l7_VsNNXbtSqeoMl3qL8puckunWuoOdgB6yOQKHf9lxt
vwq_uPYtQ#multiple_gestation
SheCares Editorial Team. (2021, December 26). Multiple Gestation: Twin Pregnancy and More.
SheCares. https://www.shecares.com/pregnancy/multiple-gestation-twin-pregnancy-and-
more
Types of multiple pregnancy. (2019, December). Pregnancy Birth and Baby.

https://www.pregnancybirthbaby.org.au/types-of-multiple-pregnancy
Hydramnios
Hydramnios is a condition that occurs when too much amniotic fluid builds up during
pregnancy. It is also called amniotic fluid disorder or polyhydramnios.
II. Etiology/Cause
Amniotic fluid is a clear, slightly yellowish liquid that surrounds the unborn baby (fetus)
during pregnancy. It is contained in the amniotic sac. The amount of fluid increases until the
36th week of pregnancy. After that, it slowly decreases. If the fetus makes too much urine or
does not swallow enough, amniotic fluid builds up. This causes hydramnios. It may be caused
by diabetes in the mother.

● Mild Hydramnios - may not cause any problems. Often, extra fluid that appears
during the second trimester returns to normal on its own. Mild polyhydramnios is
more common than severe polyhydramnios. Has a vertical pocket diameter of 8-11 cm
● Moderate Polyhydramnios - Has a vertical pocket diameter of 12-15 cm
● Severe Polyhydramnios - Has a vertical pocket diameter of 16 cm or more

The following are the most common symptoms of hydramnios. However, each woman
may experience symptoms differently.
Signs Symptoms
● Shortness of breath or inability to ● Uterine discomfort or contractions

breathe ● Swelling in the abdominal walls and
● Increased weight gain lower extremities
● ● Rapid growth of uterus
● Fetal malposition such as breech
presentation
V. Management
Management
- Maintain bed rest. This - Schedule additional - Tocolytics may be - Amniocentesis is a

helps to increase appointments to necessary to prevent or procedure in which
uteroplacental check on the size of halt preterm labor. amniotic fluid is
circulation and reduces the growing uterus. removed from the
pressure on the cervix, To show that the - Indomethacin The uterus for testing or
which may help preterm baby can be born health care provider treatment.
labor, healthy and may prescribe the oral
- Assess vital signs as without medication
well as lower complications. indomethacin (Indocin)
extremity edema to help reduce fetal
frequently. The urine production and
extremely tense amniotic fluid volume.
uterus puts unusual
pressure on both the
diaphragm and the
vessels of the pelvis
- Encourage the
mother to eat a high
fiber diet, this is to
avoid constipation,
suggest a stool
softener if diet alone
is ineffective.
https://youtu.be/AH9d89iRGFw
I. Physio
Nursing Polyhydramnios General Independent:
logic
Diagnosis: is a disorder that Objectives:
Risk for affects a pregnant 1.) Place the 1.) Mild
Risk for Fetal After ____ of mother on close polyhydramniosis
Maternal and woman's uterus.
Injury nursing monitoring. in pregnant
Fetal Injury In this disease, intervention, the women
Objective related to the uterus fills patient will deliver They might not
Cues: polyhydramni with too much the fetuses with no necessitate
os amniotic fluid (the complications. active
liquid that management.
● Shortn surrounds the Specific
The majority of
Objectives:
ess of baby in the
After _ hours of
the time, they will
breath womb). When this holistic nursing resolve
or the happens, the care, the client will themselves.
inabilit uterus expands be able to: They will, instead
y to beyond its typical Any indicators of
1. deterioration
breath size.
To willingly should be
e continuously
The amniotic fluid Participate in the
● Swelli medical and watched.
plays an
ng in nonpharmacologic and their
important function
the al therapy manifestations
in the
lower regimens
development of prescribed by the
extrem
the fetus. doctors. 2.) Prepare the 2.) An ultrasound
ities
Amniotic fluid is patient for examination
and
normally ingested 2. Ensure that the biophysical called a
abdom fetal heart rate is profile and
by the infant in the biophysical
inal normal. non-stress test.
womb and profile is used to
wall 3. Demonstrate determine the
subsequently
● Uterin behavior and health of a
urinated out. The mannerisms that
e person.
amount of fluid in reduce the danger
disco to determine the
the uterus is
of fetal damage,
mfort
especially when
amount of
stabilized as a
or the mother is amniotic fluid in
result of this. the uterus
contra carrying two
ctions This problem fetuses. as well as the
● Fetal tone, movement,
might appear as
and breathing
malpo early as 16 weeks
Non-stress exam
sition, into the on the baby - to
such pregnancy. see if the
as However, as the the baby's heart
breech pregnancy rate when he or
presen advances into the she is
tation latter weeks, it is Moves.
more likely to
manifest.
3.) Prepare the 3.) To allow the
Subjective patient for healthcare team
Cues: admission if to monitor the
there is pregnant mother
any evidence of and her baby,
● “Magli worsening and to provide
sud maternal and/or prescribed
man fetal health due treatments as
kug to deemed
Cr” polyhydramnios. necessary.
● “Lisud
man
kug 4.) Treat the 4.) Efficient
ginha underlying maternal or
wa” conditions paternal care
● “Mura related to It's possible that
man polyhydramnios, gestational
such as diabetes will aid
kug
gestational/ in the resolution
nangh
maternal of the problem.
upong diabetes and polyhydramnios.
” rhesus disease. Anti-D
● “Nang medication is
hagi given.
man infusion of
akua immunoglobulin
pus.on into a pregnant
” woman
Rh D negative
women can avoid
getting pregnant.
Rhesus disease
is a contagious
disease that can
lead to death.
polyhydramnios.
Dependent:
1.) Obtain 1.) Severe cases

consent from the of
patient to polyhydramnios
perform may necessitate
amniocentesis hospitalization.
after explaining extra amniotic
the fluid is drained
procedure's through
purpose, amniocentesis.
benefits, and This is likewise
risks. the case with the
treatment.
when premature
labor develops as
a result of
polyhydramnios.
The medical staff
will assist you.
Every 1 to 3
weeks, the
patient must be
monitored.
after undergoing
treatment.
Interdependent:
1.) Administer 1.) The doctor

prescribed may write a
medications for prescription for
the you.
management of assisting in the
AFV and fetal decrease of
urine amniotic fluid
Production. fetal urine output
(AFV) and
volume (AFV).
This
The majority of
the time,
medicine isn't
prescribed for
Women who are
over 31 weeks
pregnant.
SOURCE:
Polyhydram
nios
nursing
care plans
diagnosis
and
intervention
s.
NurseStudy
.Net. (2021,
September
2).
Retrieved
February
13, 2022,
from
https://nurs
estudy.net/
polyhydram
nios-nclex-
nursing-
review/
.
REFERENCES:
Hydramnios - Health Encyclopedia - University of Rochester Medical Center. (n.d.).

Urmc.Rochester.Edu. Retrieved February 10, 2022, from
https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&Content
ID=P02430
Hydramnios. (n.d.). Medlineplus.Gov. Retrieved February 10, 2022, from

https://medlineplus.gov/ency/patientinstructions/000599.htm#:%7E:text=Mild%20hydram
nios%20is%20more%20common,a%20problem%20with%20the%20fetus.
Occipito-posterior Position
- In the occiput-posterior position, the baby is facing the mother’s front with its head
down, meaning the occiput (assuming the presentation is vertex) is directed
diagonally and posteriorly, either to the right (right occipito-posterior [ROP]) or to
the left (occipito-posterior [LOP]). But, ROP is more common than LOP.
- The occipito-posterior position is known to be the most common abnormality
regarding fetal positioning. It tends to occur in women with android, anthropoid, or
contracted pelvises.
- Studies suggest that this is associated and may lead to many complications in
labor that consequently lead to adverse maternal and natal conditions such as
operative vaginal delivery (forceps or vacuum delivery), cesarean delivery, and
postpartum hemorrhage.
- The fetal head rotates against the sacrum, a woman may experience pressure and
pain in her lower back because of sacral nerve compressions.
I. Etiology / Cause
● Shape of the pelvic inlet: associated with either an anthropoid (oval-shaped) or
android (heart shaped) pelvis
● Maternal Kyphosis: or hunchback (excessive curvature of the spinal cord) can
make the fetal back fit into the curve.
● Other causes:
○ Multiple pregnancies
○ Placenta Previa
○ Pelvic tumors
○ Polyhydramnios
II. Types if Applicable

A. Left Occiput Posterior Position- this position has the baby’s back facing
towards the left side of the mother with the back of its food facing the mother’s
back as well.
B. Right Occipitoposterior Position - the right occipitoposterior position has the

baby’s back facing towards the right side of the mother while having the back of
its head facing the back of the mother.
C. Direct/ Straight Occipitoposterior Position- as the name suggests, the straight

occipitoposterior position has the baby’s head facing directly toward the front of
the mother with the back of its head facing the back.
III. Signs and Symptoms
Signs Symptoms
During abdominal examination: ● Backache

● Can be felt when the baby kicks right
● Inspection at the front of the tummy, generally
○ Flattened abdomen, rather around the middle
than rounded shape.
○ Presence of saucer shaped
depression
○ Fetal movement may be
detected near the middle line
● Palpation
○ Fetal limbs are felt more easily
near midline on either side
○ Fetal back is felt far away from
midline on flank
○ Head is not engaged
● Auscultation
○ FHS can be heard on the
lower part of the belly.
● Vaginal examination
○ Sagittal suture occupies any of
the oblique diameter of pelvis
○ Posterior fontanelle is felt near
the sacro-iliac joint
○ Anterior fontanelle is felt more
easily.
● Ultrasonography or lateral view x-ray
IV. Management
Management
● Apply ● Manual Rotation ● Oxytocin infusion ● Operative vaginal

counterpressure to manage to induce labor and delivery from the
by a back rub to persistent occiput for OP Position
relieve mother’s posterior position forceps/vacuum - Done if
back pain delivery. there is
- All women with a sufficient
● Promote singleton room
emotional pregnancy after ● Administration of between the
support and 37 weeks of ergometrine for occiput and
provide gestation with prevention of the sacrum
assurance to persistent occiput Postpartum that can
prevent patient posterior position hemorrhage allow the
from worrying reduces chances (PPH). baby to turn.
of occiput - Forceps or a
● REBOZO posterior position ● Terbutaline as vacuum
method of at delivery, tocolytic medicine extractor is
jiggling and operative delivery relaxes the uterus used to
massaging a and anal and prevents bring out the
uterus - helpful sphincter injuries. uterine contraction baby.
when assisting to attempt manual
the fetus to Source:Management of persistent rotation. Source: Symptoms of Baby Turning
occiput posterior position: The Head Down (healthline.com)
rotate into a added value of manual rotation -
better position. Bertholdt - - International Journal of
Gynecology & Obstetrics -
Wiley Online Library ● C-section
● Be certain to let
- This is done
the woman void ● Epidural when the
approx. 2 hrs, anesthesia will be above
because a full ordered to method
bladder impedes prevent possible does not
the descent of a prolonged labor. help to
fetus.
deliver the
Source: Epidural Timing: The baby
● Provide oral Earlier the Better? - The ObG
Project through the
sports drink or IV
vagina.
glucose solution
● Obstetricians will
to replace Source: Symptoms of Baby Turning
do an ultrasound Head Down (healthline.com)
glucose stores
scan to diagnose
she is using to
the position and to
keep active in
compare the
labor.
baseline data.
● If forceps are Source: Occiput Posterior: Does It
used to help the Affect Labor And How To Manage
fetus rotate: It? (momjunction.com)
Observe a
woman closely
for hemorrhage
for cervical
lacerations or
infections in the
postpartum
period.
V. Relevant Pictures/Videos
ROP LOP STRAIGHT OP
https://www.youtube.com/watch?v=YLSZJxdkKik
VI. One (1) priority Nursing Care Plan for each complication
Physiologica Studies have General Independent

l factor: Risk for shown that the Objective:
infection occipitoposterior
Risk for position can lead After 2-3 days of 1. Instruct the 1. Taking a hot
infection related to to an increased therapeutic patient to use a sitz bath for 20
compromised risk of a mother nursing action, the hot sitz bath. mins thrice a day
necessitating an patient will remain promotes healing
Objective immune assisted delivery. afebrile and comfort.
cues: systems Moreover, the throughout
● Primip said assisted hospital stay, SOURCE:
arous secondary to deliveries do exhibit evidence of 9 Practices To
mothe perineal have certain progressiv healing Heal From A
r tendencies of as demonstrated Perineal Tear –
● BP- laceration. causing by clean, dry, Physical And
118/7 complications absent edema and Emotionally. Built
6 such as perineal intact episiotomy To Birth. (2021).
● T- laceration, site. Also, will also Retrieved from
36.9 C specifically in verbalize Perineal Tear
● P- 84 cases where understanding of Healing |
● RR- vacuum risk factors, Emotional +
21 extraction is achieve timely Physical — Built
imperative. . wound healing To Birth Online
● 2nd Infections are not and continue to be Class | Bridget
degre rare in these free of any Teyler
e circumstances symptoms of
lacerat and can infection during
ion potentially be the postpartum 2. Educate the 2. This will not
● Skin is detrimental for period. mother on the risk only help the
torn the patient. of infection patient
due to Lacerations related to perineal understand what
birthin during laceration as well the condition is,
g labor/delivery can as how to prevent but also enable
proces make the immune Specific it. In addition, her to make
s system of the Objectives: instructing the choices that
● 6 patient vulnerable After 30 minutes of mother to use a prevent this
stitche to nursing donut seat to condition from
s on microorganisms interventions, the avoid sitting on happening to her.
perine and certain mother will be able her bottom. In addition,
al pathogens, to: instructing her to
area thereby use a donut seat
amplifying the 1. Verbalizes to sit on so there is
risk of infection. understan no direct pressure
Subjective ding of the on the perineum
cues: importance for fast recovery,
of reduces
● “I get preventing discomfort and
backa infection to risk of infection.
ches the
freque perineal SOURCE:
ntly area. Pallarito, K.
recentl (2021).
y.” 2. Verbalize Postpartum
on how to Perineum Pain.
do the What to Expect.
proper Retrieved from
perineal Postpartum
care and Perineum Pain:
hygiene. How to Relieve
Vaginal Pain After
Birth
(whattoexpect.co
m)
3. Verbalize 3. Monitoring of 3. Alterations from
understan vital signs, lochia normal may be
ding of the (character, signs of infection,
effects of amount, odor, and retained
constipatio presence of fragments or sub
n on clots), fundal involvement of the
prolonged height and status uterus.
perineal of improvement of
recovery. the sutured SOURCE:
laceration.
Chauhan, G &
Tadi, P. (2021).
Physiology,
Postpartum
Changes. NCBI.
Retrieved from
Physiology,
Postpartum
Changes -
StatPearls - NCBI
Bookshelf
(nih.gov)
4. Continue to 4. An increased
monitor the body temperature
patient's may indicate the
temperature, presence of
check redness, infection.
swelling and pain Redness, swelling
or any abnormal and pain are also
drainage on the associated.
lacerated site.
SOURCE:
Taylor, M. (2021).
Postpartum
Infections:How To
Spot The Signs.
What to Expect.
Retrieved from
Postpartum
Infections: Signs
of a Puerperal
Infection After
Birth
(whattoexpect.co
m)
5. Encourage 5. Appropriate
frequent perineal self-care of the
care and peripad perineum in
changes. Also postpartum and
should be changing peripad,
reinforced. including hand
hygiene, reduces
the risk of
pathogenic
microorganism
invasion.
Information also
should be
reiterated in order
to retain
information and
promote practice.
SOURCE:
Postpartum
Perineal Care.
Drugs.com. Know
More. Be Sure.
(2022). Retrieved
from Postpartum
Perineal Care
(Aftercare
Instructions) -
What You Need to
Know (drugs.com)
6. Advise the 6. In the case of

patient to avoid an OASIS injury
constipation by (Obstetric Anal
drinking plenty of Sphincter Injuries)
water and fiber that is caused by
fruits like papaya. assisted delivery,
constipation may
cause discomfort
and pain for the
patient. As well, it
can irritate the
perineal
laceration leading
to prolonged
recovery.
Considering the
benefits of fiber-
rich food and
regular intake of
water to bowel
movement,
consumption of
the said foods can
reduce pain.
SOURCE:
Ramar, C. &
Grimes, W.R.
(2021). Perineal
Lacerations.
NCBI. Retrieved
from Perineal
Lacerations -
StatPearls - NCBI
Bookshelf
(nih.gov)
8. Provide 8. Mental and

reassurance that emotional Stress
it is within safe is not only
and controlled harmful to the
limits especially patient’s mind but
for worrying it invites a risk of
clients. premature labor
as well as the
chance to stop
labor, leading to
plenty of
complications.
Hence, reducing
the patient’s
anxiety and stress
is a necessity.
SOURCE:
Will Stress
Catapult You Into
Premature Labor?
(2021, June 14).
Verywell Family.
https://www.veryw
ellfamily.com/can-
stress-cause-
premature-labor-
2748464#:%7E:te
xt=Although%20st
ress%20can%20b
e%20more,also%
20known%20as%
20preterm%20lab
or).
Dependent
1. Administration 1. Ergometrine is
of ergometrine as administered to
prevention for prevent
postpartum postpartum
hemorrhage hemorrhage
(PPH) which may lead to
complications. It
does this by
narrowing smooth
muscle tissues in
the blood vessels,
thereby, reducing
blood flow.
SOURCE:
Ergometrine
Injection BP
0.05% w/v -
Summary of
Product
Characteristics
(SmPC) - (emc).
(2020, June 26).
Medicines.Org.
Retrieved
February 12,
2022, from
https://www.medi
cines.org.uk/emc/
product/6265/smp
c#gref
Collaborative
1. Refer the
patient to a
dietician and/or
nutritionist for an
appropriate diet
that may quicken
recovery.
REFERENCES: (alphabetical order please thanks)
Belleza, M. (2021). Problems with Fetal Position, Presentation, Size and Passage. Nurselabs.
Retrieved from Problems with Fetal Position, Presentation, Size, & Passage - Nurseslabs
Cafasso, J. (2018). What Your Baby’s Position in the Womb Means. Healthline. Retrieved from
Baby Positions in Womb: What They Mean (healthline.com)
Kay, C., M.D. (2020). Signs That Your Baby Ha sTurned Into a Head-Down Position. Healthline.
Retrieved from https://www.healthline.com/health/pregnancy/symptoms-of-baby-turning-
head-down
Malposition and Malpresentation. Geneva Foundation for Medical Education and Research.
(2021). Retrieved from Malpresentations and Malpositions ,OP position - D. El-Mowafi
(gfmer.ch)
Occiput Posterior Effect On Labor and Ways to Manage It. Parenting Healthy Babies. (2019).
Retrieved from Occiput Posterior Effect On Labor and How to Manage It
(parentinghealthybabies.com)
Pillai, S. (2021). Occiput Posterior: Does It Affect Labor And How To Manage It? Mom Junction.
Retrieved from
https://www.momjunction.com/articles/ways-to-avoid-having-an-occiput-posterior-
position_0082926/
Vaginal Tears During Childbirth. Cleveland Clinic. (2022) Retrieved from Vaginal Tears (Perineal
Lacerations) (clevelandclinic.org)
Face, breech, brow presentation
Face Presentation
Face presentation which is also referred to as “chin or mentum” is under the examples of
asynclitism which is when the fetal head is presenting at a different angle than expected. It
happens infrequently, however when it does, the diameter of the fetus’ head that presents to the
pelvis is often too large for birth to take action. During Leopold’s maneuver, a face presentation
is said to be when the head is more prominent than normal with no perceptible engagement, as
well as when the head and the back are felt on the same side of the uterus upon palpation. It can
be verified by vaginal examination when the nose, mouth, or chin are felt as the presenting part.
Breech Presentation
The fetal head mostly turns to a cephalic presentation (head down) from a breech presentation
by 38 weeks. If it does not turn, the fetus’ buttocks, feet, or both will be the ones to come out first
during birth. This is called the breech presentation which is when the fetus is in a longitudinal lie
with the buttocks or feet nearest to the cervix. It can be confirmed by Leopold’s maneuver and
vaginal examination. Breech presentation occurs very rarely in about 3-4% of all deliveries and is
more dangerous to the fetus compared to cephalic presentation as it poses higher fetal risks such
as:
● Developing dysplasia,
● Anoxia from prolapsed cord,
● Traumatic injury to the after-coming head (with possibility of intracranial hemorrhage or
anoxia),
● Fracture of the spine or arm,
● Dysfunctional labor.
● Early rupture of the membranes because of the poor fit of the presenting part, and
● Meconium staining.
Brow Presentation
Brow presentation is said to be the rarest of all types of presentations. A fetus in a brow
presentation is when the chin is situated to be untucked and the neck is to some degree extended
backwards. From the word itself “brow”, the forehead is the presenting part or the first to go
through the cervix. The diameter of the presenting part may be too large to fit through the pelvis,
thus a normal spontaneous vaginal delivery can be hard or impossible. It also leaves the infant
with intense ecchymotic bruising on the face. Parents may need supplementary reassurance that
the child is in a well condition after birth when the bruising is over the same area as the anterior
fontanelle.
II. Etiology/Cause
Face Presentation
If a fetus is in a posterior position instead of flexing the head as labor takes action, then the head
may extend causing a face presentation. The causative factors that are linked with face
presentation are also alike to those causing general malpresentation and those that prevent head
flexion. This habitually occurs in a woman with a contracted pelvis or placenta previa, relaxed
uterus of a multipara or with prematurity, polyhydramnios, or fetal malformations. Generally,
something abnormal usually causes face presentation.
Breech Presentation
It is said that the reason why the baby is in a breech presentation is not always known. However,
there are factors that may contribute to it and these are:
● Multiple gestation (as it is harder for each baby to get into the favored position),
● Hydramnios (too much amniotic fluid causes for space for the fetus to move),
● Placenta previa,
● Pre-term (baby may not have turned into a cephalic prevention),
● Uterus is abnormal in shape or has abnormal growth, and
● Birth defect that causes the fetus not to turn the head down.
Brow Presentation
The causes of brow presentation are generally the same to those resulting to a face presentation
and these include the following:
● Cephalopelvic disproportion,
● Increasing parity,
● Prematurity,
● Multigravida, or/and
● A woman with relaxed abdominal muscles.
Types of Face Presentation

1. Mentum Anterior (MA)
- The chin is facing the front of the mother and the presenting part of the face.
2. Mentum Posterior (MP)

- The chin is facing the mother’s back and the head, neck, and shoulders pass through the
pelvis at the same time.
3. Mentum Transverse (MT)

- The chin is facing towards the side of the birth canal.
Types of Breech Presentation

1. Complete Breech
- It is when both knees of the baby are bent and his feet and bottom are nearest to the birth
canal.
2. Incomplete / Footling Breech

- It is when one of the baby’s knees are bent and his foot and bottom are the closest to the
birth canal.
3. Frank Breech
- It is when the legs of the baby are folded flat up against the head and the bottom is the
nearest to the birth canal.
Signs Symptoms
I. Face presentation I. Face presentation

● During abdominal examination, a ● N/A
groove may be felt between the occiput II. Breech presentation
and the back ● Mother can feel the baby's head
● During vaginal examination, the face is pressing high up in her belly
palpated, the examiner’s finger enters ● Mother can feel the baby’s kicks in the
the mouth easily and the bony jaws are upper abdomen
felt. III. Brow Presentation
II. Breech presentation ● N/A
● FHS are heard high in the abdomen
● During abdominal examination, the
head is felt in the upper abdomen and
the breech in the pelvic brim.
● During vaginal examination during
labor, the buttocks and/or feet are felt;
thick, dark meconium is normal.
III. Brow Presentation
● During an abdominal examination,
more than half the fetal head is above
the symphysis pubis and the occiput is
palpable at a higher level than the
sinciput.
● During a vaginal examination, the
anterior fontanelle and the orbits are
felt.
V. Management
Management
● Monitor FHR and ● Normal ● In face ● Cesarean birth

uterine Spontaneous presentations with - Cesarean birth is
contractions Vaginal Delivery mentum anterior, usually the method
- Heart rate (NSVD) oxytocin may be of choice when the
abnormalities used. chin is posterior in a
are common in - A birthing method ● Epidural face presentation.
these scenarios in which the infant Anesthesia - Planned cesarean
● Asses fetal is born vaginally - The most effective birth is the usual
condition. and a woman is method of pain method of birth
● Prevent allowed to push control during labor for many cases
unnecessary once full dilatation is epidural with breech
fatigue. has been anesthesia. An presentation.
● Assess maternal achieved. anesthesiologist - Unless the
vital signs, - For face inserts a small presentation
including presentation, if catheter into the spontaneously or
temperature, the chin is anterior lower back to naturally corrects, a
pulse, and the pelvic provide epidural cesarean birth will
respiratory rates, diameters are anesthesia.A be required to
and blood within normal continuous safely deliver the
pressure. limits, it may be infusion of infant.
● Review progress possible for the medication is
of labor using a infant to be born administered
partograph without difficulty through the
● If the (perhaps after a catheter to provide
membranes long first stage of a constant level of
have ruptured, labor because the anesthesia.
note the color of face does not
the draining mold well to make
amniotic fluid: - a firm engaging
Presence of thick part).
meconium - For breech
indicates the presentation:
need for close External cephalic
monitoring and version- is the
possible turning of a fetus
intervention for from a breech to a
management of cephalic position
fetal distress; - before birth. It
Absence of fluid may be done as
draining after early as 34- 45
rupture of the weeks, although
membranes is an the usual time is
indication of by 37-38 weeks of
reduced volume pregnancy
of amniotic fluid,
which may be
associated with
fetal distress.
● Observe infant
for patent airway
● Provide physical
and emotional
support.
● Provide client
and family
education.
https://youtu.be/O6jddbdeFUo
https://youtu.be/-C5RXHUzQhg
Assessment Diagnosi Care
s
Risk problem: Risk for Dystocia Goal: After _ of Measures to

Dysfunctional dysfuncti (dysfunctional nursing promote safety
labor onal labor labor) refers to interventions, the during labor and
r/t difficult labor client will be able delivery and
Objective Cues: complete caused by uterine to carry out a safe prevent further
breech dysfunction, fetal labor and delivery. complications.
● Primipara presentati malpresentation/a
● Leopold’s on in bnormality, or
maneuver evidence pelvic Specific Independent:
indicates a with abnormality. Objectives: 1. Provide 1. The
breech Leopold’s During accurate client's
presentatio Maneuver pregnancy, the After _ of client- informatio ability to
n normal fetal nurse interaction n in easy- understan
● Palpation presentation is the client will be to- d the
of a hard, vertex, with the able to: understan informatio
round, occiput anterior. d terms n needed
mobile In terms of 1. Verbalize and clarify to make
structure at malpresentation, understan misconce informed
the fundus breech ding of the ptions. decisions
● Head is not presentation is situation can be
felt in the considered as the along with hampered
pelvis second most the by the
during common possible stress of
pelvic abnormal risk the
examinatio presentation factors. situation. If
n (buttocks before they do not
the head) and is 2. Participate understan
more common in in the d the
Subjective Cues: nulliparous decision- terminolog
● Mother can women. In a making y, they
feel the complete breech, process. may be
baby's the fetus seems unable to
head to be sitting with process
pressing hips and knees the new
high up in flexed. It is a informatio
her belly problem primarily n.
because the Source: Wayne,
presenting part is G. (2022, January
a poor dilating 28). 11 Cesarean
wedge, which can Birth (C-Section)
cause the head,
Nursing Care
which follows, to
Plans. Nurseslabs.
be trapped during
delivery, often https://nurseslabs.
compressing the com/cesarean-
umbilical cord. If birth-nursing-
delivery is care-plans/
vaginal, breech
presentation may
increase risk of
birth trauma,
dystocia (difficult 2. Assess 2. The fetal
delivery) and fetal heart rate
perinatal death. condition may
and change as
Source: monitor the baby
Moldenhauer, J. fetal heart responds
S. (2021, July 6). rate. to
Fetal Dystocia. conditions
MSD Manual inside the
Professional uterus. An
Edition; MSD abnormal
Manuals. fetal heart
https://www.msd rate may
manuals.com/prof mean that
essional/gynecolo the baby is
gy-and- not getting
obstetrics/abnorm enough
alities-and- oxygen or
complications-of- that there
labor-and- are other
delivery/fetal- problems.
dystocia Source: Fetal
Heart Monitoring.
(2022).
Hopkinsmedicine.
org.
https://www.hopk
insmedicine.org/h
ealth/treatment-
tests-and-
therapies/fetal-
heart-monitoring
3. Monitor 3. The
the client’s woman's
labor labor
status. status is
determine
d by
assessing
her
contractio
n pattern,
performing
vaginal
examinati
on if there
are no
contractio
ns, and
determinin
g whether
her
membrane
s have
ruptured.
Source: Abraham,
Kylene (2018).
"Nursing
Management
During Labor and
Delivery."
Lippincott Manual
of Nursing
Practice 11th
Edition, 990-1014.
4. Provide 4. Active
informatio participati
n about on of the
birthing client/coup
alternative le is
s, if important
available in the
and decision-
appropriat making
e. process.
Source: 36 Labor
Stages, Induced
and Augmented
Labor Nursing
Care Plans.
(2017, May 3).
Nurseslabs.
https://nurseslabs.
com/labor-stages-
labor-induced-
nursing-care-
plan/#a1
5. Assess if 5. Most
the client women
is a who are 37
candidate weeks
for pregnant
external with a
cephalic baby in the
version breech
(ECV). position
are
candidate
s for an
ECV. The
procedure
has been
found to
be
successful
in turning
these
babies into
a head-
down
position in
around 50
percent of
cases.
Source:
Young, B.
(2018,
April 12).
What Is
External
Cephalic
Version
and Is It
Safe?
Healthline;
Healthline
Media.
https://ww
w.healthlin
e.com/hea
lth/pregna
ncy/extern
al-
cephalic-
version
6. Obtain 6. When
informed procedure
consent s involve
for the client's
procedure body, it is
s, e.g., critical that
external the client
cephalic has
version. adequate
Explain informatio
the n to make
procedure informed
s and the decisions.
possible Source: 36 Labor
risks Stages, Induced
associate and Augmented
d with Labor Nursing
labor and
Care Plans.
delivery.
(2017, May 3).
Nurseslabs.
com/labor-stages-
labor-induced-
nursing-care-
plan/#a1
7. Encourag 7. This
e use of reduces
relaxation anxiety,
technique promotes
s, relaxation,
including and gives
patterned the client a
breathing. sense of
control,
allowing
them to
cope
positively
with the
situation.
Source: Martin, P.
(2019, June 2). 4
Dysfunctional
Labor (Dystocia)
Nursing Care
Plans. Nurseslabs.
com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/
Dependent 8. External
8. Assist the cephalic
physician version
in (ECV) is
performin an attempt
g external to turn the
cephalic fetus so
version. that he or
she is
head
down.
ECV can
improve
the
chance of
having a
vaginal
birth.
Source: If Your
Baby Is Breech.
(2019). Acog.org.
https://www.acog.
org/womens-
health/faqs/if-
your-baby-is-
breech#:~:text=In
%20the%20last%
20weeks%20of,c
ome%20out%20fi
rst%20during%20
birth.
9. Assist in 9. When
preparing ECV is
for a done
vaginal successful
birth or a ly, it is
planned possible to
cesarean try for a
delivery. vaginal
birth.
However,
for those
who are
not
candidate
s or
decline
ECV, a
planned
cesarean
section is
recommen
ded for
delivery
sometime
after 39
weeks.
Source: Gray, C.
J., & Shanahan,
M. M. (2021,
August 11).
Breech
Presentation.
Nih.gov;
StatPearls
Publishing.
https://www.ncbi.
nlm.nih.gov/books
/NBK448063/#:~:t
ext=Diagnosis%2
0of%20a%20bree
ch%20presentatio
n,should%20be%
20visualized%20a
nd%20documente
d.
Interdependent:
10. Collaborat 10. An
e with an obstetrician is a
obstetricia doctor who
n for the specializes in
appropriat childbirth and
e method providing medical
of birth care to women
and during pregnancy
postnatal and after
care. childbirth.
Obstetricians are
trained to manage
complex or high-
risk pregnancies
and births, as well
as to perform
interventions and
cesarean
sections.
Source: What
does an
obstetrician do?
(2021, January).
Pregnancybirthba
by.org.au;
Healthdirect
Australia.
https://www.preg
nancybirthbaby.or
g.au/the-role-of-
your-
obstetrician#:~:te
xt=An%20obstetri
cian%20is%20a%
20doctor,can%20
perform%20interv
entions%20and%
20caesareans.
REFERENCES:
36 Labor Stages, Induced and Augmented Labor Nursing Care Plans. (2017, May 3). Nurseslabs.
https://nurseslabs.com/labor-stages-labor-induced-nursing-care-plan/#a1
Breech Baby. (2021, October 7). Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/21848-breech-baby
Breech presentation: diagnosis and management | Better Safer Care. (2020). Vic.gov.au.
https://www.bettersafercare.vic.gov.au/clinical-guidance/maternity/breech-presentation-
diagnosis-and-management#goto-management
Breech - series—Types of breech presentation. (2020, December 3). MedlinePlus.

https://medlineplus.gov/ency/presentations/100193_3.htm
Fischer, R. (2022, January 20). Breech Presentation. eMedicine.

https://emedicine.medscape.com/article/262159-overview
Gray, C. J., & Shanahan, M. M. (2021, August 11). Breech Presentation. Nih.gov; StatPearls
Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK448063/#:~:text=Diagnosis%20of%20a%20bree
ch%20presentation,should%20be%20visualized%20and%20documented.
If Your Baby Is Breech. (2019). Acog.org. https://www.acog.org/womens-health/faqs/if-your-baby-

is-
breech#:~:text=In%20the%20last%20weeks%20of,come%20out%20first%20during%20
birth.
Marino, T. (2021, December 22). Face and Brow Presentation. eMedicine.

https://emedicine.medscape.com/article/262341-overview
MCPC - Diagnosis of malpresentations - Health Education To Villages. (2022). Hetv.org.

https://hetv.org/resources/reproductive-
health/impac/Symptoms/table_S12.html#:~:text=On%20abdominal%20examination%2C
%20the%20head,thick%2C%20dark%20meconium%20is%20normal.
Meera, K. (2018, August 1). SASGOG Pearls of Exxcellence | the Society for Academic
Specialists in General Obstetrics & Gynecology. https://exxcellence.org/list-of-
pearls/management-of-brow-face-and-compound-malpresentations/
Moldenhauer, J. S. (2021, July 6). Fetal Dystocia. MSD Manual Professional Edition; MSD
Manuals. https://www.msdmanuals.com/professional/gynecology-and-
obstetrics/abnormalities-and-complications-of-labor-and-delivery/fetal-dystocia
Tidy, C. (2021, June 22). Malpresentations and Malpositions. Patient.info.

https://patient.info/doctor/malpresentations-and-malpositions
Wayne, G. (2022, January 28). 11 Cesarean Birth (C-Section) Nursing Care Plans. Nurseslabs.
https://nurseslabs.com/cesarean-birth-nursing-care-plans/
Transverse Lie
Also called as lying sideways, transverse lie happens when the fetus inside the womb of
a woman is in horizontal position across the uterus, and not vertically. In this case, the back of
the baby may be positioned:
a. Down (back is facing toward the birth canal)
b. With one shoulder directing toward the birth canal
c. Up (hands and feet are facing toward the birth canal)
II.Etiology/Cause
There is no definite reason as to why some babies are positioned in transverse lie.
However, there are certain factors that are believed to cause this to happen, such as:
a. Body structure - The pelvis structure of the mother does not allow the head of the baby to
engage in later pregnancy.
b. Uterine structure - This also prevents the head of the baby from engaging in later
pregnancy, including fibroids and/or cysts that can be found in the uterus.
c. Polyhydramnios - The amount of amniotic fluid is too many, making the room of the baby
move as they begin to engage the pelvis. This situation, however, only happens to around
1 to 2 percent of pregnancies.
d. Multiples - Once there are two or more babies inside, one or more may be breech or
transverse as they compete for space inside the uterus during the pregnancy.
e. Placental issues - The event where the cervical opening is covered by the placenta during
the latter part of the pregnancy, or placenta previa, is likewise linked to breech or
transverse presentation.

- None

Signs Symptoms
a. Abdominal examination - Kicks on the right or left side of the

- Presenting part is the shoulder abdomen
- Head or buttocks cannot be - Pressure caused by the head or back
determined below the uterus of the baby pushed against the belly
- Head is often felt in one side
b. Vaginal Examination
- Fetal arm might slide forward
- Hand or elbow can be felt as pelvic
examination is done
c. Confirmation
- Ultrasound scan is used to verify if the
fetus is actually in transverse lie
position
V. Management
Management
Inform doctor In Pregnancy: N/A In pregnancy:

Immediately The causes should be
investigated by the doctor In the case of contracted
Frequently check the and the position can be pelvis and placenta praevia
mother and the baby’s appropriately managed an elective ceasarean
vital signs prior to labor. section is done at term.
If there are no In labor:

contraindications, a Ceasarian section is
longitudinal cephatic necessary in the cases of
version is performed failed external cephalic
during the 34th week. version, when the
membranes are ruptured,
In labor: cord prolapse, and
During early labor while prolonged labor.
the membranes are still
intact, an external
cephalic version could be
done followed by rupture
of the membranes and
oberseration to ensure
longitudinal lie.
During late labor with

ruptured membranes, an
internal podilac version is
performed under general
anesthesia. The baby will
be delivered by breech
extraction.

https://www.youtube.com/watch?v=BkqoPayVdsw
Risk Risk for fetal The term Goal: After 1 Measures to

problem: injury related presentation month of nursing ensure a
Fetal injury to fetal refers to the way interventions, the childbirth that is
malpresentati the fetus is facing client will be able safe and
Objective on towards the birth to have a safe uncomplicated:
Cues: canal. The most delivery without
- Fetal ideal one is when the baby getting Independent:
should the crown of the injuries upon birth. 1. Assess for 1. Determini
er is head of the baby malpositio ng the fetal
the is the presenting Specific ning using lying,
prese part. In objectives: leopold’s position,
nting malpresentation, maneuver and
part it may be that After 12 hours of and presentati
either the face, client-nurse findings on might
- Head brow, buttocks, interaction the on internal help
is felt foot, shoulder, patient will be able examinati identify the
on the arms, legs or the to: on factor(s)
right umbilical cord of that are
side of the fetus is/are 1. Participate causing
the against the in the labor
abdo cervix. Once it is interventio to be
men not the head that ns in order dysfunctio
of the first comes out to improve nal.
mothe from the birth labor Source:
r canal, there is a pattern Martin, P. B.
chance for the and/or (2019, June 1). 4
- Elbow head to get stuck reduce the Dysfunctional
of the or for umbilical identified Labor (Dystocia)
baby cord prolapse to risk factors Nursing Care
is felt happen. Plans.
upon Moreover, this 2. Properly Nurseslabs.
vagina situation may follow the https://nurseslabs
l require assisted actions .com/4-
exami delivery where that she dysfunctional-
nation forceps are used has to take labor-dystocia-
or vacuum as nursing-care-
- Ultras extraction is instructed plans/
ound done. This type of for her
shows delivery may baby to
fetus cause birth display 2. Identify 2. Simple
is in injuries, including normal maternal measures
transv a fracture or fetal heart factors such as
erse damage in the rate with such as shifting the
lie baby’s nerve or good dehydratio client to a
brain. variability n, lateral
Subjective and no late acidosis, recumbent
Cues: Source: deceleratio anxiety position
Malpresentation. n. and etc. can
- Mothe (2020, February sometime
r can 26). Healthdirect s improve
feel Australia. the flow of
the https://www.preg blood and
kicks nancybirthbaby.or oxygen to
of her g.au/malpresenta the uterus
baby tion and
on her placenta,
right which can
abdo help to
men prevent or
correct
- Mothe fetal
r is hypoxia.
able to
feel Source:
pressu Martin, P. B.
re as (2019, June 1). 4
the Dysfunctional
head Labor (Dystocia)
of the Nursing Care
baby Plans.
is Nurseslabs.
presse https://nurseslabs
d .com/4-
toward dysfunctional-
her labor-dystocia-
belly nursing-care-
plans/
3. Teach the 3. Simple

client technique
about s (such as
positionin shifting the
g and its client to a
importanc lateral
e for her recumbent
own position)
comfort can
and for the sometime
good of s improve
the baby. the flow of
blood and
oxygen to
the uterus
and
placenta,
preventing
or
correcting
fetal
hypoxia.
Source:
Martin, P. B.
(2019, June 1). 4
Dysfunctional
Labor (Dystocia)
Nursing Care
Plans.
Nurseslabs.
.com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/
4. Promote 4. Finding
avoidance out about
of the
unnecess challenges
ary stress of having a
to the baby who
patient by is in
giving transverse
physical lie can be
and very
emotional stressful
support; a for the
support mother
person and
can also through
be of great continuou
help. s support,
other risks
will be
prevented
such as
the
occurrenc
e of mental
condition,
and also
for the
mother to
still feel
confident
to follow
the
necessary
measures.
Source:
Mental wellbeing
during pregnancy.
(2019,
November).Pregn
ancy, Birth and
Baby.
https://www.pregn
ancybirthbaby.org
.au/mental-
wellbeing-during-
pregnancy
5. When the 5. Because

membran the
es rupture, presenting
look for part is not
apparent firmly
cord engaged,
prolapse nor is it
and occult completely
cord blocking
prolapse, the os as
which is in vertex
indicated presentati
by on, cord
fluctuating prolapse is
decelerati more
ons on the common
monitor with
strip, breech
especially presentati
if the fetus on.
is in
breech Source:
presentati Martin, P. B.
on. (2019, June 1). 4
Dysfunctional
Labor (Dystocia)
Nursing Care
Plans.
Nurseslabs.
.com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/
Dependent:
1. Administer 1. The
antibiotics medicatio
(such as ns
Penicillins, indicated
vancomyci are
n, antibiotics
nitrofurant safe for
oin, pregnacy
metronida that
zole, prevent/tre
clindamyci at
n, and ascending
fosfomyci infections
n) to the while also
client as protecting
indicated the fetus.
Source:
Martin, P. B.
(2019, June 1). 4
Dysfunctional
Labor (Dystocia)
Nursing Care
Plans.
Nurseslabs.
.com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/
2. Monitor 2. This is to
the fetal detect
heart rate abnormalit
noting the ies such
variability, as
periodic exaggerat
changes ed
and variability,
baseline bradycardi
rate as a, and
ordered by tachycardi
the a, which
attending can be
physician. caused by
stress,
hypoxia,or
acidosis.
Source:
Martin, P. B.
(2019, June 1). 4
Dysfunctional
Labor (Dystocia)
Nursing Care
Plans.
Nurseslabs.
.com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/
3. Assist the 3. External

doctor in cephalic
performin version
g external can at
cephalic times feel
version discomfort
(ECV) by and/or
providing pain. It can
comfort to also be
the client. quite scary
for the
mother
which is
why it is
important
for the
mother to
stay calm
during the
procedure
for it to go
smoothly
and
quickly.
Souce:
Bonvissuto, D.
(2018, February
21). External
Cephalic Version
(ECV). WebMD.
https://www.web
md.com/baby/ext
ernal-cephalic-
version-
overview#:%7E:te
xt=guide%20the%
20process.-
,Does%20ECV%
20Hurt%3F,an%2
0ECV%20without
%20any%20paink
illers.
Interdependent:
1. Collaborat 1. Many
e with the collaborati
client’s ons and
OB-GYN, cooperatio
Midwife or n between
doula different
healthcare
workers
with
varying
levels of
education
and
profession
al
certificatio
ns are
required in
the
delivery of
health
care. In a
dynamic
and
complicate
d care
setting,
effective
collaborati
on of
nurses
and
midwives
with
physicians
help to
improve
patient
well-being,
quality of
treatment,
and
provider
satisfactio
n.
Source:
Melkamu, E.
(2020, April 26).
Inter-professional
collaboration of
nurses and
midwives with
physicians and
associated factors
in Jimma
University
specialized
teaching hospital,
Jimma, south
West Ethiopia,
2019: cross
sectional study -
BMC Nursing.
BioMed Central.
https://bmcnurs.bi
omedcentral.com/
articles/10.1186/s
12912-020-
00426-w
REFERENCES:
Cheriyedath, S. (2019, February 26). What is a Transverse Baby? News-Medical.Net. https://
www.news-medical.net/health/What-is-a-Transverse-Baby.aspx#:~:text=Diagnosis%20of
%20Transverse%20Presentation&text=Vaginal%20examination%E2%80%94%20A%20
shoulder%20may,confirms%20the%20transverse%20lie%20position.
Crider, C. (2020, October 16). Where Do You Feel Baby Kicks During Pregnancy? Healthline.
https://www.healthline.com/health/pregnancy/where-do-you-feel-baby-kicks#how-soon
Fetal presentation before birth. (2020, August 11). Mayo Clinic. https://www.mayoclinic.org/healt
hy-lifestyle/pregnancy-week-by-week/multimedia/fetal-positions/sls-20076615?s=6#:~:te
xt=This%20baby%20is%20in%20a,back%20facing%20the%20birth%20canal
Johnson, S. (2021, September 7). Placenta Previa. Healthline. https://www.healthline.com/healt
h/placenta-previa
Marcin, A. (2020, February 28). Can You Turn a Transverse Baby? Healthline. https://www.healt
hline.com/health/pregnancy/transverse-baby
Martin, P. (2019, June 2). Dysfunctional Labor (Dystocia) Nursing Care Plans. Nurseslabs.
https://nurseslabs.com/4-dysfunctional-labor-dystocia-nursing-care-plans/
Macrosomia
Macrosomia is an oversized infant who weighs more than 4,000g to 5,000g
(approximately 9lbs to 10lbs).
II. Etiology/Cause
This condition is most frequently born to women who enter pregnancy with
diabetes or who develop gestational diabetes. Higher amounts of sugar in the mother’s
system pass through the placenta and convert into fat, leading to a larger baby. Other
than diabetes, other causes of fetal macrosomia are:
● Having a family history of fetal macrosomia
● Excessive weight gain during pregnancy
● Obesity during pregnancy
● Multiple pregnancies
● A pregnancy lasting more than 40 weeks
● A mother with an above-average height and weight
● Having a male child
III. Signs and Symptoms

Signs Symptoms
● Fundal height can be longer than what ● Abdominal pain

is expected for age of gestation
● Having a longer pregnancy may
indicate a larger baby
● Excessive amniotic fluid
● Birth weight of more than 9lbs to 10lbs
IV. Management
Management
● Obtain a ● Induction of Labor N/A ● Ceasarian Delivery

comprehensive of Induction of labor was This reduces the risk of
the patient’s associated with reduced some complications with
medical history risk of shoulder dystocia. having a macrosomia
● Assist and perform This also did not increase baby. However, it is not
a detailed physical the cesarean section rate. recommended since it may
examination ● Ultrasound place the mother at risk
● Monitor the Toward the end of the third because not all cases of
patient’s weight at trimester, the health care nerve injuries are
each prenatal visit provider might do an prevented by cesarian
● Perform maternal ultrasound to take delivery.
and fetal measurements of parts of
evaluation the baby's body, such as ● Operative vaginal
● Appropriate health the head, abdomen and deliveries (e.g.,
education femur. forceps vacuum)
regarding This is also performed with
excessive weight ● Antenatal Testing caution in infants with risk
gain during Nonstress tests or a fetal factors for macrosomia.
pregnancy biophysical profile are
● Suggest a diet some antenatal testing to
plan for mothers monitor the baby's well-
with gestational being.
diabetes
● Propose a change
of lifestyle
V. Relevant Pictures/Videos
https://www.youtube.com/watch?v=dYIYL_rNwoc
VI. One (1) priority Nursing Care Plan for each complication
Physiologic Ineffective Ineffective Goal: After 1 INDEPENDENT:

Deficit childbearing Childbearing month of nursing
process in Process is the interventions, the 1. Determine Research studies
Ineffective relation to inability to client will be able maternal have found a
Childbearing macrosomia prepare for and/or to safely deliver health/nutritional positive
Process baby maintain a the baby during status, usual correlation
healthy labor. pregravid weight, between
OBJECTIVE pregnancy, and dietary pregravid
CUES: childbirth Specific pattern. maternal obesity
process, and care objectives: and increased
Estimated of the newborn for perinatal
birth weight: ensuring After 12 hours of morbidity rates
10 pounds wellbeing client-nurse (e.g.,
interaction the hypertension
Fundal height Fetal macrosomia patient will be able and gestational
is larger can cause a baby to: diabetes)
appropriate to become associated with
for it wedged in the 1. Acknowledge preterm
gestational birth canal like and apply the births and
period shoulder necessary lifestyle macrosomia.
dystocia, sustain changes in order
Amniotic fluid birth injuries, or to prevent Source:
is over require. This may ineffective Doenges, M. E.,
2000mL require the childbearing Moorhouse, M. F.,
physician to use Murr, A. C. (2019).
Shortness of forceps or a 2. Psychologically Nurse’s
breath vacuum device and physically Pocket
Inadequate during delivery prepared for the Guide
prenatal care (operative vaginal childbearing Diagnoses,
or lifestyle delivery). process. Prioritized
Sometimes a C- Interventions, and
Insufficient section is needed. Rationales. 15th
access of ed. Philadelphia:
support Source: F.A. Davis
system Fetal Company
macrosomia.
(2020). MAYO
SUBJECTIVE CLINIC. 2. Note the use of Maternal
CUES: https://www.mayo alcohol and/or pregnancy
clinic.org/disease other drugs. complications and
Patient s-conditions/fetal- negative effects
expresses macrosomia/sym on the developing
heaviness ptoms- fetus is increased
and back causes/syc- with the use of
pains 20372579#:~:text tobacco, alcohol,
=Fetal%20macro and illicit drugs.
Patient somia%20can%2 Note: Prescription
expresses 0cause%20a,a% medications may
sleeplessness 20C%2Dsection also
%20is%20neede be dangerous to
d. the fetus,
requiring a
risk/benefit t
analysis
for therapeutic
choices and
appropriate
dosage.
Source:
Doenges, M. E.,
Moorhouse, M. F.,
Murr, A. C. (2019).
Nurse’s
Pocket
Guide
Diagnoses,
Prioritized
Interventions, and
Rationales. 15th
ed. Philadelphia:
F.A. Davis
Company
3. Determine 3. to identify
individual family necessary
stressors, referrals. Impact
economic of pregnancy on
situation/ family with
financial needs, limited resources
and can create added
availability/use of stress and result
resources in
limited prenatal
care and
preparation for
newborn.
Source:
Doenges, M. E.,
Moorhouse, M. F.,
Murr, A. C. (2019).
Nurse’s
Pocket
Guide
Diagnoses,
Prioritized
Interventions, and
Rationales. 15th
ed. Philadelphia:
F.A. Davis
Company
4. Ascertain the 4. The

client’s client’s/couple’s
understanding coping skills are
and expectations more challenged
of the during
labor process and the active and
who will transitional
participate/provid phases as
e support. contractions
become
increasingly
intense. Lack of
knowledge,
misconceptions,
or unrealistic
expectations can
have a negative
impact on
coping abilities.
Source:
Doenges, M. E.,
Moorhouse, M. F.,
Murr, A. C. (2019).
Nurse’s
Pocket
Guide
Diagnoses,
Prioritized
Interventions, and
Rationales. 15th
ed. Philadelphia:
F.A. Davis
Company
5. Monitor labor 5. Fear of

progress and abandonment can
maternal and fetal intensify as labor
wellbeing per progresses,
protocol. Provide and client may
continuous experience
intrapartal increased anxiety
professional and/
support/ or loss of control
doula. when left
unattended.
Source:
Doenges, M. E.,
Moorhouse, M. F.,
Murr, A. C. (2019).
Nurse’s
Pocket
Guide
Diagnoses,
Prioritized
Interventions, and
Rationales. 15th
ed. Philadelphia:
F.A. Davis
Company
DEPENDENT:
6. Consult with the 6. Most
physician the macrosomia
appropriate cases are usually
delivery during done through
labor. cesarean delivery
or assisted
vaginal delivery
with forceps
INTERDEPENDE
NT:
7. Discuss with 7. Most pregnant
nutritionist the mothers who are
appropriate expecting
dietary changes macrosomia
that the patient babies have
needs to uphold. obesity or
gestational
diabetes. Doing
the appropriate
dietary changes
can help promote
the effectiveness
of childbirth.
REFERENCES: (alphabetical order please thanks)

Brennan, D. (2021). What is Fetal Macrosomia? Grow by WebMD.
https://www.webmd.com/parenting/what-is-fetal-
macrosomia#:~:text=Fetal%20macrosomia%20is%20most%20commonly,leading%20to
%20a%20larger%20baby.
Patel, E. A., (2020). Macrosomia Treatment & Management. Medscape.

https://emedicine.medscape.com/article/262679-treatment#d6
Silbert-Flagg, J., Pillitteri, A. (2018). Maternal and Child Health Nursing. Eigth Edition. Wolters
Kluwer.
Stephens, C. (2021). What is fetal macrosomia? MedicalNewsToday.

https://www.medicalnewstoday.com/articles/fetal-macrosomia-definition-causes-
complications-and-more
Shoulder Dystocia
I. Definition/Description of the Disease or Complication:
- When one or both of a baby's shoulders get locked within the mother's pelvis during
labor and birth, this is known as shoulder dystocia (also known as birth trauma).
Babies are born normally in the majority of the cases of shoulder dystocia.
However, it has the potential to harm both the mother and the child.
II. Etiology/Cause
The following factors that may cause shoulder dystocia:
● Fetal Macrosomia - is a newborn who’s much larger than average.
● Fetus is in the wrong position
● The mother’s pelvic opening is too small
● Excessive prenatal weight gain
● The mother has risks such as gestational diabetes

- None

- There are no symptoms for shoulder dystocia, It is impossible to determine
whether or not shoulder dystocia will occur. The obstetrician may only notice the
condition after the mother delivers the baby’s head. It becomes evident when the
baby’s head emerges and pulls back in against the area between the vagina and
rectum. This is called the “turtle sign”
Signs Symptoms
V. Management
Management
● Alerting all ● McRoberts ● There is no ● Episiotomy- When a

appropriate Maneuver - This pharmacologic shoulder dystocia
members of the maneuver is used methods done for occurs, episiotomy
obstetrics team to relieve shoulder dystocia should be
shoulder considered;
● Applying primary dystocia. The however, because
maneuvers maternal hips are the fundamental
flexed and problem is a bony
● Assisting the abducted, and the impaction,
provider as maternal thighs episiotomy will not
necessary with are positioned up remove the
secondary onto the maternal impaction on its
maneuvers abdomen. This own.
position flattens ● Symphysiotomy - is
● Regularly the sacral a procedure that
communicating promontory and expands the pelvic
the time to team causes the pubic outlet so that a baby
symphysis to can be delivered via
● Briefing and rotate cephalad. vaginal delivery.
debriefing with ● Cleidotomy - The
the team to ● Suprapubic clavicles are
thoroughly and pressure - It’s surgically divided to
accurately goal is to to allow a fetus with
document the decrease the fetal broad shoulders to
dystocia bisacromial be delivered.
treatment diameter by
measures, adducting the
including the anterior fetal
order of shoulder. The
maneuvers. doctor applies
pressure on the
● Help the mother's lower
mothers reduce abdomen above
confusion and the pubic bone in
anxiety. an attempt to
release the
baby's shoulder.
● Enter maneuver
(internal rotation)
- The aim of this
maneuver is to
get the fetus to
rotate his or her
anterior shoulder
into an oblique
plane and under
the maternal
symphysis.
● Zavanelli
Maneuver - In
cases of shoulder
dystocia, an
obstetric
procedure that
involves pushing
the delivered
head back into
the birth canal.
https://www.youtube.com/watch?fbclid=IwAR3iN85_6JvJS4rMmwlbVw-
ODlroFsizPH3HExdne3RXUTv0_mylkRxo4Vw&v=j_bibDLPW98&feature=youtu.be&ab_channel
=TrialExhibits%2CInc.
I. Physio Risk for Postpartum Goal: After 1 Measures to

logic Maternal hemorrhage, week of nursing provide the safety
Overlo Injury r/t cervicovaginal care, the client and welfare of the
ad shoulder lacerations, will be able to mother upon
Risk for dystocia fourth-degree ensure her safety delivering the
Maternal rectal lacerations, upon delivering infant.
Injury bladder atony, her infant, reduce
and uterine the complications
Objective rupture are all and engage in Independent
cues: common maternal measures that
consequences of will aid her during 1.) Review 1. By
● The shoulder treatment. the history reviewing
mothe dystocia.In a of labor the
r has recent large Specific onset, and history,
a retrospective objectives: duration this helps
small study of 285 in
pelvic cases with After 8 hours of determinin
openin shoulder client-nurse g potential
g dystocia, the total interaction the causes,
● The rate of fetal harm patient will be diagnostic
mothei (nerve or bone able to: studies
s injury) was found and
obese to be 25%.Overly 1. Safely appropriat
● The aggressive deliver the e
mothe hyperflexion of infant's interventio
r is the maternal legs shoulders ns
diabeti has been linked to wherever Source: Paul
c symphyseal they are Martin is a
separation and trapped in registered nurse
maternal femoral the with a bachelor of
neuropathy. mother’s science in nursing
pelvis since 2007.
Having worked as
a medical-surgical
2. Maintain a nurse for five
normal years. (2019,
blood June 1). 4
count after dysfunctional
vaginal labor (Dystocia)
bleeding. Nursing Care
Plans.
Nurseslabs.
3. Obtain
Retrieved
normal
February 11,
values of
2022, from
vital signs
after the
.com/4-
delivery of
dysfunctional-
the infant.
labor-dystocia-
nursing-care-
4. Understan
plans/#ineffective
d shoulder
_individual_copin
dystocia
g
and the
safety
measures
2.) Assess 2. A hard or
upon
the unripe
delivering
condition cervix will
the infant.
of the not dilate,
mother’s impending
cervix. fetal
descent/pr
ogress
Source: Paul
Martin is a
registered nurse
with a bachelor of
science in nursing
since 2007.
Having worked as
a medical-surgical
nurse for five
years. (2019,
June 1). 4
dysfunctional
labor (Dystocia)
Nursing Care
Plans.
Nurseslabs.
Retrieved
February 11,
2022, from
.com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/#ineffective
_individual_copin
g
3.) Evaluate 3. Excessive

the current maternal
level of exhaustio
fatigue, as n might
well as cause
activity subseque
and rest nt
prior to dysfunctio
onset of n or be the
labor. outcome
of a
prolonged
or false
labor.
Source: Paul
Martin is a
registered nurse
with a bachelor of
science in nursing
since 2007.
Having worked as
a medical-surgical
nurse for five
years. (2019,
June 1). 4
dysfunctional
labor (Dystocia)
Nursing Care
Plans.
Nurseslabs.
Retrieved
February 11,
2022, from
.com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/#ineffective
_individual_copin
g
4.) Note 4. A
effacemen contributin
t,fetal g reason
station for
and fetal prolonged
presentati labor
on. could be
identified
using
these
labor
progress
indicators.
Source: Martin, P.
B. (2019, June 1).
4 Dysfunctional
Labor (Dystocia)
Nursing Care
Plans.
Nurseslabs.
Retrieved
February 12,
2022, from
.com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/
5.) Review 5. The

bowel uterine
habits and activity
regularity and fetal
of descent
evacuatio may be
n hampered
by a bowel
fullness.W
hen a
woman's
bladder is
full during
labor, it
may
become
distended,
making it
difficult for
the baby to
move
down into
the
pelvis.It's
also
possible
that a baby
won't be
able to
rotate into
a good
birthing
position.
Source: Martin, P.
B. (2019, June 1).
4 Dysfunctional
Labor (Dystocia)
Nursing Care
Plans.
Nurseslabs.
Retrieved
February 12,
2022, from
.com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/
6.) Assess 6. Due to the

and baby's
evaluate unusual
the position
patient's during
vaginal birth,
tearing shoulder
and dystocia
bladder may cause
injury vaginal
risks. bleeding in
the patient
Source: Dystocia
nursing care plans
and diagnosis
interventions.
NurseStudy.Net.
(2020, December
5). Retrieved
February 11,
2022, from
https://nursestudy
.net/dystocia-
nursing-care-
plans/
7.) If there is 7. This is for

indication the client
of serious to regain
bleeding energy
after and keep
delivery, the client
place the safe.
patient in Source: Dystocia
complete nursing care plans
bed rest. and diagnosis
interventions.
NurseStudy.Net.
(2020, December
5). Retrieved
February 11,
2022, from
.net/dystocia-
nursing-care-
plans/
Dependent
8.) Prepare 8. An
the patient episiotomy
for an is a
emergenc procedure
y surgical in which
procedure an incision
to deliver is
the baby performed
with in the
shoulder perineum,
dystocia the area
as ordered between
by the the vagina
physician. and the
anus. It
prevents
tearing
and
expands
the
delivery
canal,
allowing
the infant
to slide
through
more
easily.
Source: Dystocia
nursing care plans
and diagnosis
interventions.
NurseStudy.Net.
(2020, December
5). Retrieved
February 11,
2022, from
.net/dystocia-
nursing-care-
plans/
9.) As 9. It can help
prescribed distinguish
by the the
physician, difference
administer between
a narcotic false and
or true
sedative,s labor.Morp
uch as hine aids
morphine, in the
pentobarbi elimination
tal of
(Nembutal hypertonic
), or contractile
secobarbit patterns
al and
(Seconal), promotes
for sleep. deep
sedation.T
o alleviate
fatigue, a
period of
rest
conserves
energy
and lowers
the use of
glucose.
Source:Martin, P.
B. (2019, June
1). 4
Dysfunctional
Labor (Dystocia)
Nursing Care
Plans.
Nurseslabs.
Retrieved
February 12,
2022, from
https://nurseslab
s.com/4-
dysfunctional-
labor-dystocia-
nursing-care-
plans/
Interdependent
10.) Co 10. Excessive
llaborate prenatal
with a weight
dietitian gain of the
for the mother is
mother to one of the
monitor causes of
her food shoulder
intake. dystocia.
By
assessing
the
mothers
diet, this
will ensure
a healthier
pregnancy
and
postpartu
m period.
Source: CM;, J.
(2021, August 9).
Shoulder
dystocia: Etiology,
common risk
factors, and
management.
Journal of
midwifery &
women's health.
Retrieved
February 12,
2022, from
https://pubmed.nc
bi.nlm.nih.gov/16
260363/
REFERENCES:
BrainKart. (2018). Transverse Lie/ Shoulder Presentation: Causes, Diagnosis, Management.

https://www.brainkart.com/article/Transverse-Lie--Shoulder-Presentation--Causes,-
Diagnosis,-Management_22455/
Shoulder dystocia. (2019, June). March of Dimes. Retrieved February 12, 2022, from
https://www.marchofdimes.org/complications/shoulder-dystocia.aspx

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Cebu Doctors’ University

NCM 109: Care for the Mother and Child at-Risk

Facilitator: Mrs. Dee Jane A. Dumagan, MAN, RN

III. Types if Applicable

IV. Signs and Symptoms

● a non-engaged or ill-fitting presenting ● Severe abdominal pain

● To avoid ● Seeing or ● Tocolytic drug - ● Amnioinfusion - It

VI. Relevant Pictures/Videos

Overt Cord Prolapse Funic Presentation Occult Cord Prolapse

Nursing Nursing Objectives of

Risk Problem: Risk fo The umbilical General Measures to maintain

4. Teach the 4. Obtaining

8. Ensure that all 8. Umbilical

10. Collaborate 10. Counselin

Cord Prolapse Nursing Management. (2018, August). Retrieved from rnpedia:

Prolapse, U. C. (2017, December 22). Teachme ObGyn. Retrieved from

Multiple Gestation or what we called multiple pregnancies is when a woman is

III. Types if Applicable

Triplets and 'higher order multiples' (HOMs)

- A combination of identical and fraternal multiples can result in triplets, quadruplets,

IV. Signs and Symptoms

● Multiple embryos on ultrasound ● Intense morning sickness

Nursing Management Medical Management Pharmacologic Surgical Management

● Assess the patient’s ● A Maternal-Fetal ● Analgesia is mainly ● Cesarean section is

● Support the ● If preterm labor

Nursing Nursing Scientific Basis Objectives of Nursing Actions Rationale

I. Physio Risk for Fetal Multiple Gestation General Independent:

4. Assess for 4. This allows the

5. Note the 5. Contractions

6. If preterm labor 6. Tocolytic

7. Make sure that 7. Cesarean

8. Assist the 8. This different

Heard, A. J., MD.

10. Collaborate 10. Allowing good

Belleza, R. M. N. (2021, April 22). Labor Complications. Nurseslabs.

Types of multiple pregnancy. (2019, December). Pregnancy Birth and Baby.

III. Types if Applicable

IV. Signs and Symptoms

● Shortness of breath or inability to ● Uterine discomfort or contractions

- Maintain bed rest. This - Schedule additional - Tocolytics may be - Amniocentesis is a

VI. Relevant Pictures/Videos

1.) Obtain 1.) Severe cases

1.) Administer 1.) The doctor

Hydramnios - Health Encyclopedia - University of Rochester Medical Center. (n.d.).

Hydramnios. (n.d.). Medlineplus.Gov. Retrieved February 10, 2022, from

II. Types if Applicable

B. Right Occipitoposterior Position - the right occipitoposterior position has the

C. Direct/ Straight Occipitoposterior Position- as the name suggests, the straight

During abdominal examination: ● Backache

● Apply ● Manual Rotation ● Oxytocin infusion ● Operative vaginal

ROP LOP STRAIGHT OP

Physiologica Studies have General Independent

6. Advise the 6. In the case of

8. Provide 8. Mental and

REFERENCES: (alphabetical order please thanks)

III. Types if Applicable

Types of Face Presentation

2. Mentum Posterior (MP)

3. Mentum Transverse (MT)

Types of Breech Presentation

2. Incomplete / Footling Breech

I. Face presentation I. Face presentation

● Monitor FHR and ● Normal ● In face ● Cesarean birth