Birth related procedures 10


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Birth related procedures 10

  1. 1. <ul><li>Birth-Related Procedures </li></ul>
  2. 2. Learning Outcome <ul><li>Explain the methods, purpose, and contraindications of external and podalic versions that determine nursing care management. </li></ul>
  3. 3. External Version <ul><li>May be done after 36 weeks’ gestation to change breech presentation to cephalic presentation </li></ul><ul><li>Physician applies external manipulation to maternal abdomen </li></ul><ul><li>Fetal part must not be engaged </li></ul>
  4. 4. External Version <ul><li>Reactive NST performed to establish fetal well-being </li></ul><ul><li>Tocolytic given during procedure to relax the uterus </li></ul>
  5. 5. Internal Version <ul><li>Podalic version – used to turn second twin during vaginal birth </li></ul><ul><li>Used only if second fetus does not descend readily and heartbeat is not assuring </li></ul><ul><li>Physician reaches into uterus and grabs feet of fetus and pulls them down through cervix </li></ul>
  6. 6. Internal Version <ul><li>Tocolytic given during procedure to relax uterus </li></ul>
  7. 7. Learning Outcome <ul><li>Describe the use of amniotomy and the nursing care management of woman and fetus. </li></ul>
  8. 8. Purpose of Amniotomy <ul><li>Stimulate or induce labor </li></ul><ul><li>Apply internal fetal or contraction monitors </li></ul><ul><li>Obtain fetal scalp blood sample for pH monitoring </li></ul><ul><li>Assess color and composition of amniotic fluid </li></ul>
  9. 9. Learning Outcome <ul><li>Compare the methods for inducing labor, explaining their advantages and disadvantages in determining the nursing management for women during labor induction. </li></ul>
  10. 10. Cervical Ripening <ul><li>Consists of effacement and softening of the cervix </li></ul><ul><li>May be used at or near term to enhance success of and reduce time needed for labor induction when continuing pregnancy is undesirable </li></ul><ul><li>May hasten beginning of labor or shorten course of labor </li></ul>
  11. 11. Cervical Ripening <ul><li>May cause hyperstimulation of uterus </li></ul><ul><li>Pharmacologic agents include Cytotec and prostaglandin agents – can cause uterine stimulation after insertion </li></ul>
  12. 12. Stripping of the Membranes <ul><li>Mechanical method: Gloved finger inserted into internal os and rotated 360 degrees twice – separating amniotic membranes lying against lower uterine segment </li></ul>
  13. 13. Stripping of the Membranes <ul><li>Does not require monitoring or other assessments – often done as outpatient service </li></ul><ul><li>May not induce labor – if labor is initiated, it typically begins within 48 hours </li></ul><ul><li>May cause bleeding </li></ul>
  14. 14. Pitocin Infusion <ul><li>Usually effective at producing contractions – may cause hyperstimulation of the uterus </li></ul><ul><li>Requires small, precise dosage </li></ul><ul><li>Maximum rate and dosing interval based on facility protocol, clinician order, individual situation, and maternal-fetal response </li></ul>
  15. 15. Pitocin Infusion <ul><li>Palpating uterus essential, unless IUPC in place </li></ul><ul><li>May initially decrease blood pressure </li></ul>
  16. 16. Learning Outcome 23-4 <ul><li>Describe the measures to prevent episiotomy, the types of episiotomy and associated nursing care management. </li></ul>
  17. 17. Episiotomy Types <ul><li>Surgical incision of perineal body to enlarge outlet – commonly used to avoid spontaneous laceration </li></ul>
  18. 18. Episiotomy Types <ul><li>Two types </li></ul><ul><ul><li>Midline: Incision begins at bottom center of perineal body and extends straight down midline to fibers </li></ul></ul><ul><ul><li>Mediolateral: Incision begins in midline of posterior fourchette and extends at 45 degree angle downward to right or left </li></ul></ul><ul><li>Episiotomy usually performed with regional or local anesthesia </li></ul>
  19. 19. Types of Episiotomy
  20. 20. Nursing Care <ul><li>During procedure, provide mother with support and comfort </li></ul><ul><li>Use distraction if needed – if procedure is uncomfortable, act as advocate for mother </li></ul><ul><li>Document type of episiotomy in records and report to subsequent caregivers </li></ul><ul><li>After procedure, provide comfort and apply ice pack </li></ul>
  21. 21. Nursing Care <ul><li>Assess perineal area frequently – inspect every 15 minutes during first hour after birth for redness, edema, tenderness, ecchymosis, and hematomas </li></ul><ul><li>Apply ice pack immediately in fourth stage </li></ul><ul><li>Instruct mother in perineal hygiene and comfort measures </li></ul>
  22. 22. Learning Outcome <ul><li>Explain the indications, maternal and neonatal risks that impact nursing care management during forceps-assisted birth. </li></ul>
  23. 23. Indications <ul><li>Maternal heart disease </li></ul><ul><li>Maternal pulmonary edema </li></ul><ul><li>Maternal infection </li></ul><ul><li>Maternal exhaustion </li></ul><ul><li>Fetal stress </li></ul>
  24. 24. Indications <ul><li>Premature placental separation </li></ul><ul><li>Need for shorter second stage of labor </li></ul><ul><li>Heavy regional block with ineffective pushing </li></ul>
  25. 25. Applications of Forceps
  26. 26. Applications of Forceps
  27. 27. Applications of Forceps
  28. 28. Risks <ul><li>Newborn may experience </li></ul><ul><ul><li>Bruising </li></ul></ul><ul><ul><li>Edema </li></ul></ul><ul><ul><li>Facial lacerations </li></ul></ul><ul><ul><li>Cephalhematoma </li></ul></ul><ul><ul><li>Transient facial paralysis </li></ul></ul><ul><ul><li>Cerebral hemorrhage </li></ul></ul>
  29. 29. Risks <ul><li>Woman may experience </li></ul><ul><ul><li>Vaginal or perineal lacerations </li></ul></ul><ul><ul><li>Infection secondary to lacerations </li></ul></ul><ul><ul><li>Increased bleeding </li></ul></ul><ul><ul><li>Bruising </li></ul></ul><ul><ul><li>Perineal edema </li></ul></ul>
  30. 30. Learning Outcome <ul><li>Describe the use of and risk of vacuum extraction use to assist birth. </li></ul>
  31. 31. Vacuum Extractor <ul><li>Assists birth by applying suction to fetal head </li></ul><ul><li>Should be progressive descent with first two pulls, procedure should be limited to prevent cephalhematoma – risk increases if birth not within six minutes </li></ul><ul><li>Increases risk for jaundice – due to reabsorption of bruising at cup attachment site </li></ul>
  32. 32. Vacuum Extractor
  33. 33. Learning Outcome <ul><li>Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing care. </li></ul>
  34. 34. Indications <ul><li>Most common indications for cesarean birth </li></ul><ul><ul><li>Fetal distress </li></ul></ul><ul><ul><li>Active genital herpes </li></ul></ul><ul><ul><li>Multiple gestation (three or more fetuses) </li></ul></ul><ul><ul><li>Umbilical cord prolapse </li></ul></ul><ul><ul><li>Tumors that obstruct birth canal </li></ul></ul><ul><ul><li>Lack of labor progression </li></ul></ul>
  35. 35. Indications <ul><li>Most common indications for cesarean birth </li></ul><ul><ul><li>Maternal infection </li></ul></ul><ul><ul><li>Pelvic size disproportion </li></ul></ul><ul><ul><li>Placenta previa </li></ul></ul><ul><ul><li>Previous cesarean section </li></ul></ul>
  36. 36. Preparation <ul><li>Preparation for cesarean birth requires </li></ul><ul><ul><li>Establishing IV lines </li></ul></ul><ul><ul><li>Placing indwelling catheter </li></ul></ul><ul><ul><li>Performing abdominal prep </li></ul></ul>
  37. 37. Teaching <ul><li>Teaching needs include </li></ul><ul><ul><li>What to expect before, during, and after delivery </li></ul></ul><ul><ul><li>Why it is being done </li></ul></ul><ul><ul><li>What sensations the woman will experience </li></ul></ul><ul><ul><li>Role of significant others </li></ul></ul><ul><ul><li>Interaction with newborn </li></ul></ul>
  38. 38. Nursing Care <ul><li>Routine postpartal care including: </li></ul><ul><ul><li>Fundal checks </li></ul></ul><ul><ul><li>Care of incision </li></ul></ul><ul><ul><li>Monitoring Intake & Output and maintaining IV access </li></ul></ul><ul><ul><li>Administer and teach about post-op medications </li></ul></ul><ul><ul><li>Assessment of respiratory system </li></ul></ul><ul><ul><li>Assessment of bowel sounds </li></ul></ul>
  39. 39. Uterine Incisions for Cesarean Birth
  40. 40. Uterine Incisions for Cesarean Birth
  41. 41. Uterine Incisions for Cesarean Birth
  42. 42. Learning Outcome <ul><li>Examine the risks, guidelines, and nursing care of the woman undergoing vaginal birth following cesarean birth. </li></ul>
  43. 43. Vaginal Birth After Cesarean Birth <ul><li>Can occur after trial of labor in cases of nonrecurring indications for cesarean birth </li></ul><ul><li>Most common risks are </li></ul><ul><ul><li>Hemorrhage </li></ul></ul><ul><ul><li>Surgical injuries </li></ul></ul><ul><ul><li>Uterine rupture </li></ul></ul><ul><ul><li>Infant death or neurological complications </li></ul></ul>
  44. 44. Nursing Care <ul><li>Continuous EFM </li></ul><ul><li>Internal Monitoring </li></ul><ul><li>IV fluids </li></ul><ul><li>Avoid Pitocin if at all possible </li></ul><ul><li>Classic or T uterine incision is contraindication to VBAC </li></ul>
  45. 45. Nursing Care <ul><li>Important for nurse to support couple, explore their feelings, and provide information throughout labor </li></ul>