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Maternal G2P1A0L1 GA 39+4 wks. with Fetal distress - Coggle Diagram
Maternal G2P1A0L1 GA 39+4 wks. with Fetal distress
Treatment
NPO
On EFM
Syntocinon10 U+5%DN/2 1000 mlvien drip 20 ml/hr
Lab G/M,CBC
set C/S
Retain foley's catheter
Personal information
Name : Orrapan Age : 21 yrs.
Wt : 90 kg. Ht : 155 cm.
Occupation : Houseewife
Status : marry
CC : Labour pain 2 hr.PTA
PI : 2 hr PTA have pelvic pain with uterine contraction no vaginal bleeding no membrane rupture
PH : No underlying
Pregnancy history
Maternal G2P1A0L1 GA 39+4 wks. ANC at rongkam hospital and Kalasin hospital. First ANC at 31+2 wks.7 time for ANC .LMP 22.02.2020.EDC 29.11.2020.
Lab:Hct 34.8 vol%, Blood group O+ ,VDRL =Non reactive,HBsAg= Negative,Anti HIV=Non reactive,
MCV 72.3 fl, DCIP =Negative
Pregnancy examination
HF : 3/4>o, 37 cm ,vertex presentation,position ROA, FHS=136 /min, EFW=3250g,
PV : Cx 4 cm,eff 50%, MI,-1, I=8' D=40"
Fetal distress
Fetal distress involves hypoxic or acidotic condition of
fetus during intrauterine life or during intra partum.
Etiology
Low oxygen carried by RBC (severe anemia).
Acute bleeding
Obstructed utero-placental blood flow
Dysfunction of placenta =
case study : newborn have true knot and infarction
Intrauterine infection.
Malformations of cardiovascular system=
case study : have true knot and The umbilical cord is wrapped around the neck 3 times.
Causes of Hypoxia (Maternal factors)
Pregnancy-induced or chronic hypertension
Maternal infection
Diabetes
Chronic substance abuse
Asthma
Seizure disorders
Clinical diagnosis of fetal distress
Electronic fetal heart rate monitoring.=
case study:on EFM=Early deceleration and fetal heart rate drop.
Fetal movement
Diagnosis of fetal Acidosis by FBS
Cardiotomography
Intra-partum causes of fetal hypoxia
Premature onset of labor
Prolonged labor =
case study: prolong active phase 2 hr / 1 cm.
Administration of narcotics and anesthetics
Rupture of membrane more than 24 hours prior to
delivery
Maternal hypoventilation
Maternal hypoxia
Nursing
Management of intra-partum fetal distress
A) Maternal care
Hydration: For correction of maternal hypotension.
Change in maternal position:Left lateral position to mother avoids compression of vena cava and increases cardiac output and uteroplacental perfusion.
B) Tocolysis
Use of tocolytic drugs to decrease
hypertonus uterus.
C) Amnioinfusion:
Increase intrauterine fluid volume
with warm normal saline.
Cord Compression.
To dilute or to wash out meconium
D) Immediate delivery:
If fetal distress continues urgent elivery by safest method should be done is elivery by safest method should be done is
Case Study
Change in maternal position:Left lateral position.
Oxygen mask with bag 10 LPM.
On EFM = Early deceleration and observe fetal heart rate.
Giving medication is Syntocinon10 U+5%DN/2 1000 mlvien drip 20 ml/hr to speed up delivery.
set C/S because On EFM = Early deceleration and fetal heart rate drop. But Cervix dilatation 10 cm to normal delivery.