A nurse is planning care for a client in active labor whose fetus is in an occipital brow presentation. Which of the following complications should the nurse anticipate as a result of this fetal presentation?
A.
Umbilical cord prolapse
B.
Precipitous labor
C.
Hypertonic uterine dysfunction
D.
Prolonged labor
The Correct Answer and Explanation is:
D. Prolonged labor
In the case of an occipital brow presentation, the most likely complication that a nurse should anticipate is prolonged labor. Here’s why:
Understanding Occipital Brow Presentation
In a typical fetal presentation, the fetal head is positioned such that the occiput (the back of the head) is presenting first. This position allows the cervix to dilate efficiently and the fetal head to mold and descend through the birth canal. However, in an occipital brow presentation, the fetus’s head is tilted such that the brow (forehead) is the presenting part. This position can lead to several challenges during labor.
Prolonged Labor
An occipital brow presentation can lead to prolonged labor due to several factors:
- Ineffective Fetal Positioning: In the brow presentation, the fetus’s head is in an extended position. This extension can cause the fetal head to present with the largest diameter facing the birth canal, which can result in a less efficient descent and engagement. The baby’s head has to flex to the optimal position (occipito-flexion) to fit through the birth canal more effectively.
- Increased Resistance: The brow presentation can lead to increased resistance during the labor process because the widest part of the fetal head (the brow) is attempting to pass through the cervix and pelvis. This can result in prolonged dilation and effacement of the cervix.
- Risk of Cephalopelvic Disproportion (CPD): If the fetal head does not change to a more favorable position, there is an increased risk of cephalopelvic disproportion, where the size and shape of the fetal head are not proportional to the maternal pelvis, further contributing to prolonged labor.
Other Options
- Umbilical Cord Prolapse (A): This is less directly related to occipital brow presentation and more related to abnormal fetal positioning or a high fetal station.
- Precipitous Labor (B): This is characterized by an unusually rapid labor and delivery (less than 3 hours) and is not a common outcome of brow presentation.
- Hypertonic Uterine Dysfunction (C): This involves excessively frequent or intense contractions and is not specifically associated with brow presentations.
Thus, the primary concern with an occipital brow presentation is prolonged labor due to the difficulties in fetal positioning and descent. This requires careful monitoring and potential interventions to facilitate a safe delivery.