Ob postpartum

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  • Staph or strep epidermidis from the neonates pharynx Seen 1 to 4 wks postpartum
  • Ob postpartum

    1. 1. THERAPEUTIC MANAGEMENT OF PROBLEMS ORPOTENTIAL PROBLEMS IN LABOR AND BIRTH DIANNA S. GERONA, RN 1
    2. 2. TRIAL LABOR• Done to determine whether labor can progress normally• Indication: – Borderline inlet measurement but good fetal lie and position• Nursing management: – Monitor FHR and uterine contractions – Emptying of the bladder – Prepare for CS DIANNA S. GERONA, RN 2
    3. 3. EXTERNAL CEPHALIC VERSION• Done as early as 34-35 weeks but usually done 37-38 weeks.• Containdications: – Multiple gestation – Severe oligohydramnios – Contraindications to vaginal birth – Unexplained 3rd trimester bleeding• Nursing Management: – Tocolytic agent administration as ordered – Record UTZ and FHR continuously DIANNA S. GERONA, RN 3
    4. 4. INDUCTION AND AUGMENTATION OF LABOR• Labor induction – Artificially starting labor• Labor Augmentation – Assisting labor that has started spontaneously to be more effective. DIANNA S. GERONA, RN 4
    5. 5. INDUCTION AND AUGMENTATION OF LABOR• Primary reasons: – Preeclampsia / Eclampsia – Rh sensitization – Postmaturity• Should be used in caution if with: – Multiple gestation – Hydramnios – Grand multiparity – Previous uterine scars DIANNA S. GERONA, RN 5
    6. 6. INDUCTION AND AUGMENTATION OF LABOR• Conditions that should be present: – Must be in a longitudinal lie – Cervix is ripe – Presenting part is engaged – There is no CPD – Fetus is matured by date DIANNA S. GERONA, RN 6
    7. 7. INDUCTION AND AUGMENTATION OF LABOR• Cervical Ripening – Laminaria method – Prostaglandin gel• Oxytocin Administration – Nursing Management: • Monitor uterine contractions, FHR, and VS q 15 mins. • Watch out for signs of water intoxication and tonic uterine contractions DIANNA S. GERONA, RN 7
    8. 8. INSTRUMENTAL DELIVERIES DIANNA S. GERONA, RN 8
    9. 9. FORCEPS DELIVERY• Indications: – The woman is unable to push with contractions – Spinal anesthesia or spinal cord injury – Cessation of progress in the 2nd stage of labor – Abnormal fetal position DIANNA S. GERONA, RN 9
    10. 10. FORCEPS DELIVERY2 TYPES:• Low forceps birth – Fetal head at +2 station• Mid forceps birth – Fetal head is engaged but less than +2 station DIANNA S. GERONA, RN 10
    11. 11. FORCEPS DELIVERY• Before forceps are applied: – Ruptured membranes – No CPD – Fully dilated Cervix – Empty bladder DIANNA S. GERONA, RN 11
    12. 12. FORCEPS DELIVERYComplications:• Urinary stress incontinence• Birth trauma – Facial paralysis – Subdural hematoma – Erythemetous mark on the baby’s cheek• Cord compression DIANNA S. GERONA, RN 12
    13. 13. VACUUM EXTRACTION• For a fetus that is positioned far down the vaginal canal• A disk shaped cup is pressed against the posterior fontanlle. DIANNA S. GERONA, RN 14
    14. 14. VACUUM EXTRACTION• Advantage: Fewer lacerations at the birth canal• Disadvantage: Caput – noticeable until 7 days• Contraindications: – Pre term infants – Previous scalp blood sampling DIANNA S. GERONA, RN 17
    15. 15. CESARIAN BIRTH DIANNA S. GERONA, RN 18
    16. 16. CESARIAN BIRTH DELIVERY OF THEBABY THROUGH AN ABDOMINAL &UTERINE INCISION. DIANNA S. GERONA, RN 19
    17. 17. INDICATIONS:2.FETAL DISTRESS2. BREECH PRESENTATION3. DYSTOCIA4. CPD5. PRIOR CESARIAN SURGERY6. CORD PROLAPSE7. ABRUPTIO PLACENTA8. PLACENTA PREVIA
    18. 18. COMPLICATIONS:2.INFECTIONS2. HEMORRHAGE3. BLOOD CLOTS4. SURGICAL INJURY TO THE BLADDER OR INTESTINES5. SURGICAL INJURY TO THE FETUS.
    19. 19. TYPES:1. LOW SEGMENT / LOW TRANSVERSE / LOW CERVICAL ( LTCS) / PFANNENSTIEL INCISION
    20. 20. ADVANTAGES:2. INVOLVES LESS BLOOD LOSS2. LESS POSSIBILITY OF RUPTURE OF CS SCAR DURING SUBSEQUENT PREGNACY3. LESS INCIDENCE OF POSTOPERATIVE COMPLICATIONS: INFECTION, ADHESION OF BOWEL TO THE INCISIONAL LINE, INTESTINAL OBSTRUCTION.4. ALLOWS A VAGINAL DELIVERY AFTER A PREVIOUS CESARIAN SECTION.(VBAC)
    21. 21. DISADVANTAGES:2.DIFFICULT & LONGER TO PERFORM THAN THE CLASSICAL TYPE.2. NOT RECOMMENDED WITH ANTERIOR PLACENTA PREVIA
    22. 22. 2. CLASSICAL TYPE - A VERTICAL INCISION IS MADEDIRECTLY INTO THE WALLS OF THECORPUS, WHICH IS THE MOSTCONTRACTILE PORTION.ADVANTAGES:1.EASIEST & QUICKEST INCISION TOPERFORM2. RAPID EXTRACTION OF FETUS CAN BEDONE.
    23. 23. DISADVANTAGES:1. INVOLVES MORE BLOOD LOSS BECAUSEINCISION IS MADE ON THE THICK VASCULARPORTION OF THE UTERUS2. HIGHER INCIDENCE OF POST-OPCOMPLICATIONS3. RUPTURE OF CS SCAR ON SUBSEQUENTPREGNANCY IS MORE LIKELY.4.INVOLVES MORE HEALING DISCOMFORT & AWIDER CS SCAR.
    24. 24. Post Partum Complications
    25. 25. Hematoma• Bluish or purple discoloration of SQ tissue of vagina or perineum.• Mgt: • cold compress every 30 minutes with rest period of 30 minutes for 24 hrs • incision on site, scraping & suturinglgeblancomd maternal disorders 31
    26. 26. Late Post Partum Hemorrhage• Bleeding after 24 hrs• Mgt: – D&C or manual extraction of fragmentslgeblancomd maternal disorders 32
    27. 27. Sub Involution• Management: – D&C – Proper position - prone – Cold compress – to prevent bleeding – Mefenamic acidlgeblancomd maternal disorders 33
    28. 28. DIC• Disseminated Intravascular Coagulopathy.• Management: – hysterectomy if with abruption placenta – Heparin – Platelet concentrate – cryoprecipitate or fresh frozen plasmalgeblancomd maternal disorders 34
    29. 29. Puerperal InfectionGeneral signs of inflammation: • – calor (heat), rubor (red), dolor (pain) tumor(swelling) – Purulent discharges – Fever• Supportive care – CBR -Paracetamol – Hydration - Culture & sensitivity – TSB - Antibiotics as ordered – Cold compresslgeblancomd maternal disorders 35
    30. 30. Mastitis• Inflammation of the mammary gland• Signs & Symptoms – Fever – Chils – Malaise – Flu like symptomslgeblancomd maternal disorders 36
    31. 31. Management• Antibiotic therapy for 7 to 10 days• May continue with BF unless there is an open abcess formation• If with abcess, use pump to evacuate milk until it heals• May continue to breastfeed on the unaffected sidelgeblancomd maternal disorders 37
    32. 32. Deep Vein Thrombosis• Inflammation of the lining of a blood vessel in conjunction with clot formation• Idiopathic• Most common is Femoral usually manifested by (+) Homan’s Signlgeblancomd maternal disorders 38
    33. 33. MAnagement• Bed rest• Anticoagulants• Antibiotics• Anlagesics• Moist heat applications• Never massage affected area• Elevation of affected extremitylgeblancomd maternal disorders 39
    34. 34. • Postpartum Depression – A feeling of overwhelming feeling of sadness which cannot be accounted for – Symptoms: • Excessive anxiety • Irritability • Fatigue • Loss of apetite • Feelings of worthlessness – Management: • Psychological counseling • Encourage talking about her feelings DIANNA S. GERONA, RN 40
    35. 35. • Postpartum Psychosis – Mental state which involves a loss of contact with reality – May result from unrecognized and untreated depression. – Symptoms: • Agitation • Euphoria • Delusions • Disorganized behavior – Management: • Psychiatric counseling • Anti-psychotic drugs DIANNA S. GERONA, RN 41

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