Nursing Care of The Client With High-Risk Labor and Delivery

Nursing Care of
the Client with

High-Risk Labor
and Delivery

By: Jamaica F. Aytona

BSN - 2

Dr. Rosemarie Sistosa

Instructor
Outline of What we'll
talk about
Contents
1. Factors of High-Risk Pregnancy
2. Management of Fetal
Malposition and Malpresentation
3. Screening Tests
4. Specimen Collection
5. Administering Blood Transfusion

1.Factors of High-Risk
Pregnancy
Sometimes a high-risk
pregnancy is the result of a
medical condition present before
pregnancy. In other cases, a
medical condition that develops
during pregnancy for either you
or your baby causes a pregnancy
to become high risk.
Specific factors that might contribute to

a high-risk pregnancy include:
Advanced
maternal age.
Pregnancy risks are higher for mothers
older than age 35.
Women who will be under age 17 or over
age 35 when their baby is due are at greater
risk of complications than those between
their late teens and early 30s. The risk of
miscarriage and genetic defects further
increases after age 40.
Lifestyle
choices.
Many lifestyle factors such as the age at
which to start a family, nutrition, weight,
exercise, psychological stress,
environmental and occupational exposures,
and others can have substantial effects on
fertility; lifestyle factors such as cigarette
smoking, illicit drug use, and alcohol and
caffeine consumption.
Maternal health
problems.
High blood pressure, obesity, diabetes,
epilepsy, thyroid disease, heart or blood
disorders, poorly controlled asthma, and
infections can increase pregnancy risks.
Pregnancy
complications.
Various complications that develop during
pregnancy can pose risks. Examples
include an unusual placenta position, fetal
growth less than the 10th percentile for
gestational age (fetal growth restriction) and
rhesus (Rh) sensitization — a potentially
serious condition that can occur when your
blood group is Rh negative and your baby's
blood group is Rh positive.
Multiple
pregnancy.
Pregnancy risks are higher for women
carrying more than one fetus.
While the great majority of multiple
pregnancies result in healthy babies, any
pregnancy with twins or more is considered
high risk. The more babies you're carrying,
the higher your risk of complications.
Pregnancy
history.
A history of pregnancy-related hypertension
disorders, such as preeclampsia, increases
the risk of having this diagnosis during the
next pregnancy. If you gave birth
prematurely in your last pregnancy or you've
had multiple premature births, you're at
increased risk of an early delivery in your
next pregnancy.
Fetal Malpresentation
Determined by fetal lie and by the
Management of
body part of the fetus that enters the Fetal Malposition
pelvic passage first (presenting part)
and
There are three presentations. Malpresentation
•Most common: Cephalic
•Malpresentations: Breech and
Shoulder
Fetal Causes:
Gestational age <40 weeks
Malpresentation: Abnormality in fetus,
Breech Presentation anencephaly, hydrocephalus, or

meningocele
Polyhydramnios that allows free
fetal movement
Congenital anomaly of the
uterus ie midseptum
Space-occupying mass in pelvis
(fibroid tumor or placenta
previa)
Pendulous abdomen
Multifetal gestation
Fetal Malpresentation: Breech
Presentation
Assessment: fetal heart sounds

heard HIGH in the abdomen
Leopold maneuvers & vaginal
examination
Ultrasound - confirmatory
Always monitor FHR & uterine
contractions to detect FETAL
DISTRESS
Management: Assisted breech

delivery
CS
Fetal Malpresentation: FACE &
BROW PRESENTATIONS
ASYNCLITISM - fetal head presenting at a

different angle than expected. Face &
Brow presentations are examples
Face Presentation usually occurs with:

fetus in posterior
position woman with contracted pelvis
placenta previa
relaxed uterus of multipara
premature fetus
polyhydramnios
fetal malformation
A warning signal that something
ABNORMAL is causing the face to present
first
Fetal Malpresentation: FACE &
BROW PRESENTATIONS
Brow presentation is the rarest

Occurs with:
relaxed uterus of multipara
woman with relaxed abdominal
muscles
Management:
Cesarean birth
*extreme ecchymotic bruising on face:
reassure parents
TRANSVERSE LIE
Occurs with:
in women with pendulous abdomens
uterine fibroid tumors that obstruct the
lower uterine segment
contraction of the pelvic brim
congenital abnormalities of the uterus
polyhydramnios
fetus with hydrocephalus
premature infants
multifetal gestation
short umbilical cord
Assessment:
Usually obvious. OVOID is horizontal
Ultrasound - confirmatory
TRANSVERSE LIE
Management: if fetal head arrests on in

TRANSVERSE LIE or if rotation doesn't
occur, cesarean birth may have to be
resorted to
Provide frequent reassurance to the
mother
Forceps may also be used (RARE)
Fetal Malposition:
Occipitoposterior position
Right Occipitoposterior (ROP)
Left Occipitoposterior (LOP) Posterior
positions occur in women with
android, anthropoid, or platypelloid/
contracted pelvises
Assessment:
prolonged active phase, arrested
descent, fetal heart sounds best
heart at lateral sides of abdomen
Management:
Hands-and-knees position, squatting
or lateral position; "Lunging" Back
rubs Rebozo Method
OVERSIZED FETUS (MACROSOMIA)
Fetus weighs more than 4000-4500g

(approx 9-10lbs)
Occurs with women who enter
pregnancy with diabetes or who
develop gestational diabetes
may cause uterine rupture from
obstruction fetal
pelvic disproportion
Management: CS
if vaginally, at risk for cervical nerve
palsy, diaphragmatic nerve injury,
fractured clavicle
woman has increased risk of
hemorrhage
REFERENCES:
Hopkins Medicine. (n.d.). Retrieved March 10, 2022, from
https://www.hopkinsmedicine.org/gynecology_obstetrics/specialty_areas/maternal_fetal_medicine/research/PDFs/
nature-dna-double-helix-1953.pdf
Anticoagulants. Johns Hopkins Lupus Center. (2019, March 27). Retrieved March 10, 2022, from
https://www.hopkinslupus.org/lupus-treatment/common-medications-conditions/anticoagulants/
Fetal movement counting. Fetal Movement Counting - Health Encyclopedia - University of Rochester Medical
Center. (n.d.). Retrieved March 10, 2022, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?
contenttypeid=90&contentid=P02449#:~:text=Fetal%20movement%20counting%20is%20a,in%20a%20certain%20ti
me%20period.
High-potassium diet. Winchester Hospital. (n.d.). Retrieved March 10, 2022, from
https://www.winchesterhospital.org/health-library/article?id=570140
Mayo Foundation for Medical Education and Research. (2021, January 6). How to add more fiber to your diet. Mayo
Clinic. Retrieved March 10, 2022, from https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-
depth/fiber/art-20043983
Mayo Foundation for Medical Education and Research. (2021, September 8). Glucose Challenge Test. Mayo Clinic.
Retrieved March 10, 2022, from https://www.mayoclinic.org/tests-procedures/glucose-challenge-test/about/pac-
20394277
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Nursing Care of

the Client with

By: Jamaica F. Aytona

Dr. Rosemarie Sistosa

Specific factors that might contribute to

Breech Presentation anencephaly, hydrocephalus, or

Assessment: fetal heart sounds

Management: Assisted breech

ASYNCLITISM - fetal head presenting at a

Face Presentation usually occurs with:

Brow presentation is the rarest

Management: if fetal head arrests on in

Fetus weighs more than 4000-4500g

Thank you for

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