Problems With the Passageway
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Transcript of Problems With the Passageway
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PROBLEMS WITH THE
PASSAGEWAY
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ABNORMAL SIZE OR SHAPE OF
THE PELVIS
The Android pelvis is so calledbecause it resembles the male pelvis.
The anthropoid pelvis, you will havediscovered, shows very definitefeatures. The fetus commonly
presents as a direct occipito-anterioror occipito-posterior position.
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The distinct shape of the
platypelloid pelvis with the
kidney shaped brim in which the
anteroposterior diameter isreduced and the transverse
increased, means the head
must engage with the sagittalsuture in the transverse
diameter.
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Cephalopelvic disproportion
(CPD)
Occurs when a babys
head or body is too large tofit through the mothers
pelvis.
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It is believed that true CPD israre, but many cases of failureto progress during labor are
given a diagnosis of CPD. Whenan accuratediagnosis of CPDhas been made, the safest type
of delivery for mother and babyis a cesarean.
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The causes of cephalopelvic
disproportion
Possible causes of cephalopelvic
disproportion (CPD) include:
Large baby due to:
Hereditary factors
Diabetes
Postmaturity (still pregnant after
due date has passed)
Multiparity (not the first pregnancy)
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Abnormal fetal positions
Small Pelvis
Abnormally shaped pelvis
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The diagnosis of cephalopelvicdisproportion is often used when
labor progress is not sufficient and
medical therapy such as use ofoxytocin is not successful or not
attempted.
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CPD can rarely be diagnosed
before labor begins even if
the baby is thought to belarge or the mothers pelvis is
known to be small.
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During labor, the babys headmolds and the pelvis joints
spread, creating more room for
the baby to pass through the
pelvis. Ultrasound is used in
estimating fetal size but nottotally reliable for determining
fetal weight.
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A physical examination that
measures pelvic size can oftenbe the most accurate method
for diagnosing CPD. If a truediagnosis of CPD cannot be
made, oxytocin is often
administered to help laborprogresssion or change fetal
postioning.
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Shoulder Dystocia
In a small percentage of births, thebabys shoulder will become locked
under the mothers pubic bone
immediately after delivery of the
head. The doctor or midwife may be
unable to deliver the baby with the
usual hand skills.
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Every doctor and midwife is
trained in the handling of this
emergency, and there areseveral different approaches.
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Occasionally, the baby is injured
during the process to free the
captured shoulder. The mostcommon injury is a stretching and
tearing of the nerves of the babys
arm.
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Although most of the these injuriesresolve without future problems,
occasionally the damage to the
nerve is permanent and results inweakness or paralysis of the arm.
Less frequently, the collarbone
(clavicle) or upper arm bone(humerus) are broken in an attempt
to free the shoulder.
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Shoulder dystocias are almost alwaysassociated with big babies. However,the majority of big babies are bornwithout involving shoulder dystocia.
There is also a relationship betweenshoulder dystocia and laborprotractions and
arrests..especially those whichlengthen the duration of Second Stage(after the cervix is dilated).
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PROBLEMS WITH THE POWERS
Dystocia or Difficult labor
Premature labor
Precipitate labor and birthUterine prolapse
Uterine rupture
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DYSTOCIA
Dystocia may arise due to
incoordinate uterine activity,
abnormal fetal lie or presentation,
absolute or relative cephalopelvic
disproportion, or (rarely) a massive
fetal tumor such as
a sacrococcygeal teratoma.
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PREMATURE LABOR
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Oxytocin is commonly used totreat incoordinate uterine
activity, but pregnanciescomplicated by dystocia oftenend with assisted deliveries,
including forceps, ventouse or,commonly, caesarean section.
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HYPERTONIC UTERINE
DYSFUNCTION
An elevated tone of the uterus that
generally occurs in the latent phase
of labor. The condition causesfrequent and intense contractions,
but they are not effective. This may
be caused by the mid segment of theuterus contracting with such a force
that is greater than the fundus or a
lack of nerve .
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HYPOTONIC UTERINE
DYSFUNTION
The number of contractions is
unusually low or infrequent(notmore two or three occuring in a 10-
minute period).The resting tone of
the uterus remains less than 10mmHg, and the strenght of
contractions does not rise above
25mm Hg.
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ABNORMAL PROGRESS IN
LABOR
Abnormal Labour
Recognition of prolonged 1stand2nd stages
Common causes of prolonged labour
Complications - maternal
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RETRACTION RINGS
Bandl's ring(also known as
pathological retraction ring) is the
abnormal junction between the twosegments of the human uterus, which is
a late sign associated with obstructed
labor. Prior to the onset of labour, thejunction between the lower and upper
uterine segments is a slightly thickened
ring
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In abnormal and obstructed labours,
after the cervix has reached full
dilatation further contractions cause the
upper uterine segment musclefibres myometrium to shorten, so that
the actively contracting upper segment
becomes thicker and shorter.
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The ridge of the pathological ring ofBandl's can be felt or seen rising as far
up as the umbilicus. The lower segment
becomes stretched and thinner and ifneglected may lead to uterine rupture.
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PREMATURE LABOR
Pregnancy is normally a time of
happiness and anticipation, but it can
also be a time of uncertainty. Manywomen have concerns about what is
happening with their baby and wonder
"Is everything okay"? Some womenhave concerns about going into labor
early.
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Premature labor occurs inabout 12% of all pregnancies.
However, by knowing thesymptoms and avoiding
particular risk factors, a woman
can reduce her chance of goinginto labor prematurely.
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PRECIPITATE LABOR AND BIRTH
Occur when uterine contractions
are so strong that a woman gives
birth with only a few, rapidlyoccuring contractions.It is often
defined as a labor that is completed
in fewer than 3 hours.
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Is cervical dilatation thatoccurs at a rate of 5cm or
more per hour in a primiparaor 10cm or more per hour in
a multipara.
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UTERINE PROLAPSE
Is falling or sliding of the womb (uterus)
from its normal position into the vaginal
area. Uterine prolapseis a form of female
genital prolapse. It is also called pelvic
organ prolapseor prolapse of theuterus (womb).
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UTERINE RUPTURE
Rupture of the uterus during
labor,although rare ,is always a
possibility.It is always serious,because itaccounts for as many as 5% of all
material deaths.
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Uterine rapture occurs when a
uterus undergoes more strain
than it is capable of sustaining.
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THANK YOU!!!
SHERYLL B. NELSON