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32 Cards in this Set
- Front
- Back
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Amniotomy |
artificial rupture of the amniotic sac (implies a commitment to delivery). often done in conjunction with induction or stimulation of labor or to permit internal electronic fetal monitoring. |
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Risks of Amniotomy |
-prolapse of umbilical cord -infection -abruptio placentae |
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Prolapse of the Umbilical Cord |
risk the umbilical cord will slip down with the fluid. cord can be compressed between fetal presenting part and woman's pelvis, obstructing blood flow to and from placenta. |
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Infection |
vaginal organisms have access to uterine cavity. may cause chorioamnionitis (infection of the amniotic sac). birth within 24 hours is desirable, although there is no absolute time when infection occurs. change underpads regularly for comfort and reduce moist environment that favors bacterial growth. |
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Abruptio Placentae |
premature separation of normally implanted placenta. may occur if the uterus is distended when the membranes rupture. risk is greater if there is hydramnios (excessive amniotic fluid in the uterus), because of greater uterine distention. placenta no longer fits and partially separates. |
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Nursing Intervention-Amniotomy |
assess the fetal heart rate (report sustained rate >160 bpm-often precedes maternal fever) and monitor maternal temperature (every 2 hours-report temperature >38 C or >100.4 F). cord compression is suspected if deep or prolonged variable decelerations occur during contractions or persistent bradycardia is present after contractions. |
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Induction & Augmentation of Labor |
use artificial methods to stimulate uterine contractions. |
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Indications for Artificial Initiation of Labor |
when ending the pregnancy benefits the woman or fetus and when labor and vaginal birth are considered safe. |
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Determining Whether Induction is Indicated |
labor is not induced if gestation and/or fetal lung maturity are not established unless there is compelling reason. the Bishop scoring system uses five factors to estimate cervical readiness for labor. |
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The Bishop Scoring System |
factors to determine cervical readiness for vaginal delivery. uses: cervical dilation, effacement, consistency, position, and fetal station. score above 8-woman is okay to have induction. |
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Contraindications for Induction of Labor |
-placenta previa (implantation in lower uterus)-may result in hemorrhage -vasa previa (blood vessels within the placenta or the umbilical cord are trapped between the fetus and the opening to the birth canal)-fetal hemorrhage is a possibility -abnormal presentation (breech) for which vaginal birth is often hazardous -umbilical cord prolapse -cephalopelvic disproportion |
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Risks for Induction and Augmentation of Labor |
-uterine tachysystole (hyperstimulation) -uterine rupture -greater risk for chorioamnionitis and cesarean birth |
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Cervical Ripening (artificial initiation of labor) |
procedures to ripen (soften) the cervix and make it more likely to dilate with the forces of labor are common adjunct to induction. |
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Cervical Ripening...continued |
-medical methods: preparations containing prostaglandin E2 (dinoprostone/cervidil, misoprostol/cytotec) -mechanical methods: laminaria tents (dried seaweed-to absorb H2O and expand), foley bulb (transcervical catheter) |
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Oxytocin (Pitocin) |
stimulates uterine smooth muscle, resulting in increased strength, duration, and frequency of uterine contractions. oxytocin has vasoactive and antidiuretic properties |
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Oxytocin (Pitocin) Administration |
powerful drug, requires precautions to reduce chance of adverse reactions in mother & fetus. diluted and given secondary (piggyback) infusion so it can be stopped quickly. uterine activity & FHR and patterns are monitored. rate may be gradually reduced when woman is in active phase of labor, about 5-6 cm of cervical dilation, after membranes rupture, or uterine tachysystole. |
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Observing Fetal Response After Oxytocin Adiminstration |
uterine contractions may become too strong (hypertonic), and in turn, can reduce placental blood flow, reduce exchange of fetal oxygen and waste products. |
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Observing Fetal Response continued... |
remain alert for FHR patters that suggest reduced placental exchange secondary to contractions that are too strong, too long, or do not relax at least 30 seconds (tachysystole). Examples: fetal bradycardia, tachycardia, late decelerations, and decreased FHR variability (reduced rate fluctuations). |
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Steps to Reduce Uterine Activity & Increase Fetal Oxygenation |
1). reducing or stopping the oxytocin 2). keeping the woman on her side to prevent aortocaval compression & increase placental blood flow 3). Giving 100% oxygen by facemask at a rate of 8-10 L/min |
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Observing Mother's Response to Oxytocin Administration |
take blood pressure and pulse every 30 minutes or with each oxytocin dose change to identify changes from her baseline. Temperature every 2 hours after rupture, or 4 hours prior to rupture to identify infection. monitor I&O identifies fluid retention, which precedes water intoxication. S&S: headache, blurred vision, HTN, tachypnea, decreased pulse, cough, wheeze. |
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Version |
a method to change fetal position. two methods, internal version and external methods. external version is much more common. |
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External Cephalic Version (ECV) |
the fetus may be changed from breech, shoulder (transverse lie), or oblique presentation to a cephalic presentation. ECV may allow the woman to avoid cesarean birth. |
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Internal Version |
malpresentation in twin gestations is usually manged by cesarean birth, but internal version may be used for vaginal birth of the second twin. |
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Contraindications to Version |
Maternal conditions: -uterine malformations that limit the room available to perform the version -previous cesarean birth -disproportion between fetal seize and maternal pelvic size -fetal size 4000 g or larger (macrosomia) Fetal conditions: -placenta previa (manipulation may cause hemorrhage, this is an indication for cesarean) -multifetal gestation (internal version may be done after the first twin is born) -oligohydramnios (small amount of amniotic fluid), ruptured membranes, or cord around fetal body or neck (nuchal cord)-these can lead to cord compression and fetal hypoxia -uteroplacental insufficiency (indicated by late decelerations on fetal monitoring) |
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Technique of External Version |
usually attempted at 37 weeks or more of gestation. woman may be given a tocolytic drug (terbutaline) to relax the uterus while the version is performed. Ultrasound guides fetal manipulation and monitor FHR. if indicated, RhoGAM is given to the Rh-negative mother after external version. |
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Technique of Internal Version |
an unexpected and urgent procedure. physician reaches into the uterus with one hand and with the other on the maternal abdomen, maneuvers the fetus into a longitudinal lie (cephalic or breech) to allow for delivery. |
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Operative Vaginal Birth |
an operative vaginal birth is one in which the physician applies traction to the fetal head during birth with a vacuum extractor or forceps to aid the woman's expulsive efforts. |
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Risks for Operative Vaginal Birth |
Maternal: -laceration or hematoma of the vagina, perineum, or periurethral area Infant: -ecchymoses, facial and scalp lacerations or abrasions, facial nerve injury, cephalhematoma, subgaleal hemorrhage (bleeding between the potential space between the skull periosteum and the scalp) -vacuum extractor creates circular scalp edema, redness or bruising called a chignon at application area |
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Episiotomy |
or incision of the perineum just before birth. two types: median/midline and mediolateral. |
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VBAC (vaginal birth after cesarean) |
are associated with a small but significant risk of uterine rupture. the risk of uterine rupture increases as the number of prior uterine incision increases. |
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Risks for Cesarean |
Maternal: -infection -hemorrhage -urinary tract trauma or infection -thrombophlebitis, thromboembolism -paralytic ileus -atelectasis (complete or partial collapse of lung) Infant: -inadvertent preterm birth -transient tachypena -persistent pulmonary hypertension -injury (laceration, bruising, fractures, or other trauma) |
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Postoperative Care/Assessments for Cesarean |
vital signs, character of respirations, assessment of returning motion & sensation, level of consciousness, abdominal dressing, uterine firmness/position, lochia, urine output, IV infusion, pain. *respirations of less than 12 breaths/minute suggestion respiratory depression (encourage deep breathing/coughing/position changes (semi-fowlers if not contraindicated)/O2 therapy if ordered. |
