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Nursing Care During Obstetric Procedures

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Fetal bruising, facial lacerations, cephalhematoma, intracranial hemorrhage ... Potential for vaginal wall laceration and hematoma ... – PowerPoint PPT presentation

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Title: Nursing Care During Obstetric Procedures


1
Nursing Care DuringObstetric Procedures
  • Chapter 16

2
Amniotomy
  • breaking the water
  • Induction/augmentation
  • Allows for internal monitoring
  • Performed by MD
  • RISKS
  • Umbilical cord prolapse
  • Infection
  • abruption

3
AmniotomyNursing Considerations
  • Obtain baseline FHR
  • Prepare client
  • Assist MD
  • Identify complications
  • Document findings

4
Induction/Augmentation
  • Use of artificial methods to stimulate uterine
    contractions
  • Becoming more common1989 9 live births2002
    19.9 live births
  • Should be limited to medical indications
  • Informed consent

5
Indications
  • Pregnancy Induced Hypertension(PIH)
  • Premature Rupture of Membranes(PROM)
  • Post-term pregnancy(42 wks)
  • Chorioamnionitis
  • Maternal medical conditions
  • Hostile intrauterine environment
  • Fetal demise

6
Contraindications
  • Placenta previa
  • Abnormal fetal presentation
  • Active genital herpes
  • Previous classical uterine incision
  • Overdistended uterus
  • Severe maternal conditions
  • Non-reassuring FHR patterns

7
Risks
  • Hyperstimulation
  • Uterine Rupture
  • Maternal water intoxication
  • Increased risk of cesarean birth
  • Increased risk of operative vaginal delivery
  • Bishops Score lt5

8
Cervical Ripening
  • Bishop scorecervical readinessgt8 more likely to
    be successful
  • Prostaglandin is a drug used to cause cervical
    ripening(PGE1 and PGE2)
  • Prepidil, Cervidil, Cytotec
  • Hydrophilic inserts (Laminaria)

9
Oxytocin(Pitocin)
  • Most common drug given for induction/augmentation
  • 20U/1000CC Lactated Ringers
  • Always give as piggy-back closest port to
    angionever mainline
  • Titrate 1mu3cc start _at_ 2mu and increase by 2mu
    Q 30min. Max 30mu
  • Continuous EFM

10
Nursing Considerations
  • Fetal response hyperstimulation reduces
    uteroplacental blood flow
  • Continuous EFM
  • Initiate intrauterine resuscitative measures for
    non-reassuring FHR patterns
  • Maternal response hyperstimulation, uterine
    rupture, fluid retention, PP hemorrhage
  • Assess VS frequently, monitor IO, watch for
    uterine atony in the PP period

11
Operative Vaginal Delivery
  • The use of forceps or vacuum extraction by the MD
    to apply traction to the fetal head during birth
    to assist maternal expulsive efforts and
    facilitate birth.
  • Assist descent and rotation of the fetal head

12
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13
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14
Indications
  • Maternal
  • Exhaustion
  • Ineffective pushing
  • Cardiac/pulmonary disease
  • Fetal
  • Non-reassuring FHR
  • Failure of presenting part to rotate and descend

15
Contraindications/Risks
  • Severe fetal compromise
  • Acute maternal conditions
  • High fetal station
  • Cephalopelvic disproportion(CPD)
  • Trauma to maternal and fetal tissues
  • Vaginal lacerations and hematoma
  • Fetal bruising, facial lacerations,
    cephalhematoma, intracranial hemorrhage

16
Nursing Considerations
  • Observe for trauma to mother and neonate
  • Potential for vaginal wall laceration and
    hematoma
  • Potential for bruising or lacerations to fetal
    head or face

17
Episiotomy
  • Routine performance remains controversial
  • May be used to reduce pressure on fetal head
  • Midline most common
  • Associated with higher incidence of 3rd and 4th
    degree lacerations

18
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19
Episiotomy
  • Infection main risk
  • Perineal pain may last longer
  • Impairs resumption of sexual intercourse
  • Nursing intervention promote gradual stretching
    by perineal massage and warm compresses to
    perineum

20
Cesarean Birth
  • 1965 US C/S rate 4.5
  • 1980s US C/S rate 24
  • 2003 US C/S rate 27.6 of which, 19.1 were
    primary
  • WHY?? EFM, VBAC, Litigation, Maternal age, Breech
  • Women who are induced are 2-3 times more likely
    to have an operative birth
  • Women are choosing to deliver by C/S

21
C/S Indications
  • Dystocia
  • CPD
  • PIH
  • Maternal Diseases
  • Active genital herpes
  • Previous Classic C/S
  • Persistent non-reassuring FHR
  • Prolapsed cord
  • Fetal malpresentation
  • Placental abnormalities

22
C/S Risks
  • Maternal Risks
  • Infection
  • hemorrhage
  • UTI or trauma
  • DVT/embolism
  • paralytic ileus
  • atelectasis
  • anesthesia complications
  • Fetal Risks
  • inadvertent premature birth
  • TTN due to delayed absorption of lung fluid
  • PPHN pulmonary vasoconstriction
  • Injury
  • Lung immaturity

23
C/S Prep
  • Large bore IV(18g preferred)
  • NPO or Meds to reduce gastric acidity(Reglan/Bici
    tra)
  • Shave prep
  • Insert Foley catheter
  • Routine labs(CBC HC)
  • Regional anesthesia preferred
  • Informed consent

24
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25
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26
Nursing Considerations
  • Providing emotional support
  • Teaching
  • Promoting safety
  • Providing PACU
  • Considering VBAC
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