OB Passenger

• OCCIPITOPOSTERIOR POSITION

  -complains of back pain
• OCCIPOPOSTERIOR POSITION - Occurs more in women with android, anthropoid and contracted pelvis
• Gynecoid - optimal shape for birth, women
• Android - typical shape for male
• Anthropoid - narrow pelvis
• platypelloid - wide pelvis
• OCCIPITOPOSTERIOR POSITION - Fetal heart sounds heard best at the lateral sides of the abdomen
• OCCIPITOPOSTERIOR POSITION - May experience INTENSE pressure and pain in the lower back (fetal head rotates against the sacrum) – sacral nerve compression
• Peanut ball between the woman’s legs has been found to open the cervix and reduce total labor time
• Rebozo method – jiggling and massaging the uterus maybe helpful when assisting the fetus to rotate to a better position
• OCCIPITOPOSTERIOR POSITION - CS delivery if resulted to uterine dysfunction (maternal exhaustion)
• OCCIPITOPOSTERIOR POSITION - If born vaginally, the baby is born looking at the ceiling or sunny side up
• Forceps - to aid fetus for internal rotation
• low forceps or outlet forceps - usually applied after crowning
• Vacuum extraction - disk shaped cup placed over vertex of head and vacuum applied
• Episiotomy - surgical incision to allow more room
• Breech presentation - Presenting part is buttocks
• Breech presentation - Most of the fetuses are in this presentation early in pregnancy and by 38th week 97% turns to cephalic presentation
• Meconium staining - Inevitable contraction of fetal buttocks from cervical pressure
• Meconium excretion - Can lead to meconium aspiration if the infant inhales the amniotic fluid
• polyhydramnios - too much amniotic fluid builds during pregnancy
• breech presentation - FHB heard high in the abdomen
• Pressure changes occur instantaneously (result to tentorial tears – gross motor and mental incapacity or lethal damage to the fetus)
• AFTERBIRTH

  Frank breech

  -Legs extended at level of head for first 2-3 days
• AFTERBIRTH

  Footling breech

  -legs remain in the same position for first few days
• ASYNCLITISM

  -head presenting at a different angle than expected. Chin/mentum. Too large for birth to proceed
• Face presentation -Heads feel prominent than normal

  -No engagement on Leopold's

  -Head and back felt at the same side

  -Back extremely concave
• breech presentation - It will still follow the same mechanisms of labor (flexion, descent, internal rotation, expulsion and external rotation)
• face presentation - Fetal heart tones heard on the side of the fetus where feet and arms can be palpated. Nose, mouth and chin can be palpated during vaginal examination
• face presentation - Usually a warning signal that something is abnormal
• Facial edema - purple from ecchymotic bruising
• Lip edema - unable to suck for a day or two
• If chin is anterior and pelvic diameters are within normal –infant maybe born without difficulty
• If chin is posterior – CS
• BROW presentation

  -Most rare

  -Occurs in multipara or woman with relaxed abdominal muscles

  -Results in obstructed labor

  -Head becomes jammed in the brim of the pelvis as the occipitomental diameter presents

  -CS is necessary
• TRANSVERSE LIE

  -Tumors that obstruct the lower uterine segment

  -Obvious on inspection (ovoid abdomen)

  -Membranes rupture at the beginning of labor

  -The umbilical cord may prolapse or an arm because there is no firm presenting part

  -Shoulder may obstruct the cervix

  -CS is necessary
• MACROSOMIA - Oversized fetus

  -Weighs more than 4,000-4,500 g (9-10 lbs)

  -Frequently born to women with diabetes or gestational diabetes
• FETAL DISTRESS

  -Placental blood flow to the fetus is compromised

  -Uteroplacental insufficiency
• hypovolemia - Decreased maternal blood volume
• Fetal scalp blood monitoring:

  -          pH >7.25 - repeat if cardiotocography (CTG) continues to deteriorate

  -          pH 7.21-7.24 - repeat in 30 minutes

  -          pH <7.20 - urgent delivery