Managing Complications in Pregnancy and Childbirth: - IAWG

LABOUR WITH AN OVERDISTENDED UTERUS S-87PROBLEM• A woman in labour has an overdistended uterus or symphysisfundalheight more than expected for the period of gestation.GENERAL MANAGEMENT• Prop up the woman.• Confirm accuracy of calculated gestational age, if possible.DIAGNOSIS• If only one fetus is felt on abdominal examination, consider wrongdates, a single large fetus (page S-88) or an excess of amniotic fluid(page S-88).• If multiple fetal poles and parts are felt on abdominal examination,suspect multiple pregnancy. Other signs of multiple pregnancyinclude:- fetal head small in relation to the uterus;- uterus larger than expected for gestation;- more than one fetal heart heard with Doppler fetalstethoscope.Note: An acoustic fetal stethoscope cannot be used to confirmthe diagnosis, as one heart may be heard in different areas.• Use ultrasound examination, if available, to:- identify the number, presentations and sizes of fetuses;- assess the volume of amniotic fluid.• If ultrasound service is not available, perform radiologicalexamination (anterio-posterior view) for number of fetuses andpresentations.