Download presentation
Presentation is loading. Please wait.
1
Nancy Pares, RN, MSN Metro Community College
NURS UNIT 2 Nancy Pares, RN, MSN Metro Community College
2
External Electronic Uterine Monitoring: Advantages
Noninvasive Easy to place May be used before and following rupture of membranes Can be used intermittently Provides a permanent, continuous recording
3
External Electronic Uterine Monitoring: Disadvantages
The nurse must compare subjective findings with monitor The belt may become uncomfortable The belt may require frequent readjustment The mother may feel inhibited to move
4
Internal Electronic Uterine Monitoring: Advantages
Provides pressure measurements for contraction intensity and uterine resting tone Allows for very accurate timing of UCs Provides a permanent record of the uterine activity
5
Internal Electronic Uterine Monitoring: Disadvantages
Membranes must be ruptured and adequate cervical dilation must be achieved Invasive Increases the risk of uterine infection or perforation Contraindicated in cases with active infections Use with a low-lying placenta can result in placenta puncture
6
Figure 23–3 INTRAN Plus intrauterine pressure catheter
Figure 23–3 INTRAN Plus intrauterine pressure catheter. There is a micropressure transducer (electronic sensor) located at the tip of the catheter and a port for amnioinfusion at the distal end of the catheter. SOURCE: Photographer: Elena Dorfman.
7
Auscultation: Advantages
Uses minimum instrumentation Is portable Allows for maximum maternal movement Convenient and economical
8
Auscultation: Disadvantages
Can only provide the baseline fetal heart rate, rhythms, and obvious increases and decreases Does not provide a permanent record
9
External Electronic Fetal Heart Monitoring: Advantages
Produces a continuous graphic recording Can show the baseline, baseline variability, and changes in the FHR Noninvasive Does not require rupture of membranes
10
External Electronic Fetal Heart Monitoring: Disadvantages
Is susceptible to interference from maternal and fetal movement May produce a weak signal Tracing may become sketchy and difficult to interpret
11
Internal Electronic Fetal Heart Monitoring: Advantages
Clearer tracings Provides information about short term variability
12
Internal Electronic Fetal Heart Monitoring: Disadvantages
Infection Injury Requires ruptured membranes and sufficient cervical dilatation
13
Leopold’s Maneuvers Is the fetal lie longitudinal or transverse?
What is in the fundus? Am I feeling buttocks or head? Where is the fetal back? Where are the small parts or extremities? What is in the inlet? Does it confirm what I found in the fundus? Is the presenting part engaged, floating, or dipping into the inlet?
14
Figure 23–7 Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.
15
Figure 23–7 (continued) Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.
16
Figure 23–7 (continued) Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.
17
Figure 23–7 (continued) Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.
18
Fetal Heart Rate (FHR) Baseline FHR Changes in FHR
Mean FHR during 10 minute period Must be observed for 2 minutes Changes in FHR Episodic – not associated with uterine contractions Periodic – associated with uterine contractions
19
Figure 23–10 Top, An FHR tracing obtained by internal monitoring
Figure 23–10 Top, An FHR tracing obtained by internal monitoring. Normal FHR range is 110 to 160 bpm. This tracing indicates an FHR range of 140 to 155 bpm. Bottom, A uterine contraction tracing obtained by external monitoring. Each dark vertical line marks 1 minute, and each small rectangle represents 10 seconds. The contraction frequency is about every 3 minutes, and the duration of the contractions is 50 to 60 seconds.
20
Changes in FHR Baseline
Fetal tachycardia Baseline greater than 160 bpm for at least a 10-minute period Fetal bradycardia Baseline less than 110 bpm for at least a 10-minute period
21
NICHD Classification: Baseline FHR
Tachycardia Bradycardia Accelerations Sinusoidal
22
Figure 23–14 Types of accelerations. A, Episodic accelerations
Figure 23–14 Types of accelerations. A, Episodic accelerations. B, Periodic accelerations.
23
Figure 23–14 (continued) Types of accelerations
Figure 23–14 (continued) Types of accelerations. A, Episodic accelerations. B, Periodic accelerations.
24
NICHD Classification: Baseline Variability (BV)
Absent – amplitude undetected Minimal – amplitude range detectable but ≤ 5 bpm Moderate – amplitude range of 6-25 bpm Marked – amplitude greater than 25 bpm
25
Figure 23–12 A and B, Moderate variability. C, Minimal variability
Figure 23–12 A and B, Moderate variability. C, Minimal variability. D, Absent variability.
26
Figure 23–12 (continued) A and B, Moderate variability
Figure 23–12 (continued) A and B, Moderate variability. C, Minimal variability. D, Absent variability.
27
Figure 23–12 (continued) A and B, Moderate variability
Figure 23–12 (continued) A and B, Moderate variability. C, Minimal variability. D, Absent variability.
28
Figure 23–12 (continued) A and B, Moderate variability
Figure 23–12 (continued) A and B, Moderate variability. C, Minimal variability. D, Absent variability.
29
NICHD Classifications: Decelerations
Rate of descent Episodic Periodic Early Late Variable
30
Figure 23–17 Early decelerations. Baseline FHR is 150 to 155 bpm
Figure 23–17 Early decelerations. Baseline FHR is 150 to 155 bpm. Nadir (lowest point) of decelerations is 130 to 145 bpm.
31
Figure 23–19 Late decelerations. Baseline FHR is 130 to 148 bpm
Figure 23–19 Late decelerations. Baseline FHR is 130 to 148 bpm. Nadir (lowest point) of decelerations is 110 to 120 bpm. Absent variability.
32
Figure 23–20 Variable decelerations with overshoot
Figure 23–20 Variable decelerations with overshoot. The timing of the decelerations is variable, and most have a sharp decline. A rebound acceleration (overshoot) occurs after most of the decelerations. Baseline FHR is 115 to 130 bpm. Nadir of decelerations is 55 to 80 bpm. Variability is minimal.
33
Intrapartal high-risk factors
Table 23–1 Intrapartal high-risk factors.
34
Intrapartal high-risk factors
Table 23–1 (continued) Intrapartal high-risk factors.
35
Frequency of maternal-fetal assessment
Table 23–2 Frequency of maternal-fetal assessment and documentation.
36
Contraction and labor progress
Table 23–3 Contraction and labor progress characteristics.
37
Frequency of auscultation
Table 23–4 Frequency of auscultation: assessment and documentation.
38
Electronic fetal monitoring
Table 23–5 Possible indications for electronic fetal monitoring.
39
Fetal Dysrhythmias Table 23–6 Common causes of various types of fetal dysrhythmias.
40
Management of Deceleration
Table 23–7 Guidelines for management of variable, late, and prolonged deceleration patterns.
41
Evaluation of Fetal Monitoring: Uterine Contractions
Determine the uterine resting tone Assess the contractions What is the frequency? What is the duration? What is the intensity (if internal monitoring)?
42
Evaluation of Fetal Monitoring: FHR
Determine the baseline Determine FHR variability Determine whether a sinusoidal pattern is present Determine whether there are periodic changes
43
Nonreassuring Patterns
Variable decelerations Late decelerations of any magnitude Absence of variability Prolonged deceleration Severe (marked) bradycardia
44
Nursing Interventions for Nonreassuring Patterns
Notify MD/Midwife and document Change position Increase IV fluids Provide oxygen Tocolytics Prepare for cesarean or vacuum birth
45
Scalp Stimulation Direct stimulation to fetal scalp to elicit an acceleration Uncompromised fetuses will elicit acceleration of at least 15 bpm for 15 seconds
46
Causes and Sources of Hemorrhage
Table 26–4 Causes and sources of hemorrhage.
47
Classification of Abruption
Table 26–5 Classification of abruption.
48
Placenta Previa Table 26–6 Differential signs and symptoms of placenta previa and abruptio placentae.
49
Variations Table 26–7 Placental and umbilical cord variations.
50
Clues to Contractures Table 26–8 Clues to contractures of maternal pelvis.
51
Dysfunctional Labor Patterns
Dystocia Hypertonic contractions Hypotonic contractions
52
Figure 26–1 Comparison of labor patterns
Figure 26–1 Comparison of labor patterns. A, Normal uterine contraction pattern. Note that the contraction frequency is every 3 minutes; duration is 60 seconds. The baseline resting tone is below 10 mm Hg. B, Hypotonic uterine contraction pattern. Note in this example that the contraction frequency is every 7 minutes with some uterine activity between contractions, duration is 50 seconds, and intensity increases approximately 25 mm Hg during contractions.
53
Precipitous Birth: Maternal Risks
Abruptio placentae Cervical, vaginal, or perineal lacerations Postpartum hemorrhage
54
Impact of Post-term Pregnancy: Maternal
Perineal damage Hemorrhage Increased risk of cesarean birth Anxiety Emotional fatigue Persistence of normal discomforts
55
Impact of Post-term Pregnancy: Fetal
Decreased perfusion Oligohydramnios Small-for-gestational-age (SGA) Macrosomia Increased risk for meconium staining
56
Malposition/Malpresentation
Persistent occiput-posterior (OP) position Brow presentation Face presentation
57
Figure 26–7 Face presentation
Figure 26–7 Face presentation. Mechanism of birth in mentoanterior position. A, The submentobregmatic diameter at the outlet. B, The fetal head is born by movement of flexion.
58
Figure 26–7 (continued) Face presentation
Figure 26–7 (continued) Face presentation. Mechanism of birth in mentoanterior position. A, The submentobregmatic diameter at the outlet. B, The fetal head is born by movement of flexion.
59
Breech Presentation: Types
Frank Single or double footling (incomplete) Complete
60
Figure 26–10 Breech presentation. A, Frank breech
Figure 26–10 Breech presentation. A, Frank breech. B, Incomplete (footling) breech. C, Complete breech in left sacral anterior (LSA) position. D, On vaginal examination, the nurse may feel the anal sphincter. The tissue of the fetal buttocks feels soft.
61
Figure 26–10 (continued) Breech presentation. A, Frank breech
Figure 26–10 (continued) Breech presentation. A, Frank breech. B, Incomplete (footling) breech. C, Complete breech in left sacral anterior (LSA) position. D, On vaginal examination, the nurse may feel the anal sphincter. The tissue of the fetal buttocks feels soft.
62
Figure 26–10 (continued) Breech presentation. A, Frank breech
Figure 26–10 (continued) Breech presentation. A, Frank breech. B, Incomplete (footling) breech. C, Complete breech in left sacral anterior (LSA) position. D, On vaginal examination, the nurse may feel the anal sphincter. The tissue of the fetal buttocks feels soft.
63
Figure 26–10 (continued) Breech presentation. A, Frank breech
Figure 26–10 (continued) Breech presentation. A, Frank breech. B, Incomplete (footling) breech. C, Complete breech in left sacral anterior (LSA) position. D, On vaginal examination, the nurse may feel the anal sphincter. The tissue of the fetal buttocks feels soft.
64
Breech Presentation: Risks
Head trauma Increased risk for infant mortality Neonatal complications Cord prolapse
65
Malpresentation Shoulder presentation (Transverse Lie)
Compound presentation
66
Figure 26–11 Transverse lie. A, Shoulder presentation
Figure 26–11 Transverse lie. A, Shoulder presentation. B, On vaginal examination, the nurse may feel the acromion process as the fetal presenting part.
67
Macrosomia Risks Dysfunctional labor Uterine rupture
Perineal lacerations Postpartum hemorrhage Puerperal infection Shoulder dystocia
68
Multiple Gestation: Pregnancy Risks
Spontaneous abortions Gestational diabetes Hypertension Acute fatty liver disease Pulmonary embolism Maternal anemia
69
Multiple Gestation: Pregnancy Risks (continued)
Hydramnios PROM Incompetent cervix IUGR
70
Multiple Gestation: Labor Risks
Preterm labor Uterine dysfunction Abnormal fetal presentations Instrumental or cesarean birth Postpartum hemorrhage
71
Multiple Gestation: Physical Discomfort
Shortness of breath and/or dyspnea on exertion Backaches Round ligament pain Heartburn Pelvic or suprapubic pressure Pedal edema
72
Abruptio Placentae: Causes
Maternal hypertension Domestic violence Abdominal trauma Presence of fibroids Uterine overdistension Fetal growth restriction
73
Abruptio Placentae: Causes (continued)
Advanced maternal age Alcohol consumption Cocaine use Short umbilical cord High parity
74
Abruptio Placentae: Types
Marginal Central Complete
75
Figure 26–16 Abruptio placentae
Figure 26–16 Abruptio placentae. A, Marginal abruption with external hemorrhage. B, Central abruption with concealed hemorrhage. C, Complete separation.
76
Placenta Previa: Causes
Multiparity Increasing age Placenta accreta Defective development of blood vessels in the decidua Prior cesarean birth Smoking
77
Placenta Previa: Causes (continued)
Recent spontaneous or induced abortion Large placenta
78
Placenta Previa: Types
Total Partial Marginal Low-lying
79
Figure 26–17 Placenta previa. A, Low placental implantation
Figure 26–17 Placenta previa. A, Low placental implantation. B, Partial placenta previa. C, Total placenta previa.
80
Umbilical Cord Complications
Succenturiate placenta Circumvallate placenta Battledore placenta Prolapsed umbilical cord Velamentous insertion
81
Figure 26–19 Prolapse of the umbilical cord.
82
Umbilical Cord Complications (continued)
Vasa previa Cord length problems
83
Amniotic Fluid Complications
Amniotic fluid embolism Hydramnios (polyhydramnios) Oligohydramnios
84
Pelvic Complications Cephalopelvic disproportion Uterine rupture
Maternal soft tissue damage Cord prolapse Extreme molding Trauma to fetal skull and CNS
85
Third and Fourth Stage Complications
Retained placenta Lacerations Placental adherence Accreta Increta Percreta
86
Impact of Procedures on Childbearing Woman
Disappointment Guilt Conflict between expectation and need for intervention
87
Contraindications to Induction
Table 27–1 Absolute contraindications to labor induction or augmentation.
88
Relative Contraindications
Table 27–2 Relative contraindications to labor induction.
89
Prelabor Status Evaluation
Table 27–3 Prelabor status evaluation scoring system.
90
VBAC Complications Table 27–4 Complications associated with VBAC.
91
Version External Cephalic Version (ECV) Podalic Version (Internal)
92
Figure 27–1 External (or cephalic) version of the fetus
Figure 27–1 External (or cephalic) version of the fetus. A new technique involves applying pressure to the fetal head and buttocks so that the fetus completes a “backward flip” or “forward roll.”
93
Figure 27–2 Use of podalic version and extraction of the fetus to assist in the vaginal birth of the second twin. A, The physician reaches into the uterus and grasps a foot. Although a vertex birth is always preferred in a singleton birth, in this instance of assisting in the birth of a second twin it is not possible to grasp any other fetal part. The fetal head would be too large to grasp and pull downward, and grasping the fetal arm would result in a transverse lie and make vaginal birth impossible. B, While applying pressure on the outside of the abdomen to push the baby’s head up toward the top of the uterus with one hand, the physician pulls the baby’s foot down toward the cervix. C, Both feet have been pulled through the cervix and vagina. D, The physician now grasps the baby’s trunk and continues to pull downward on the baby to assist the birth.
94
Figure 27–2 (continued) Use of podalic version and extraction of the fetus to assist in the vaginal birth of the second twin. A, The physician reaches into the uterus and grasps a foot. Although a vertex birth is always preferred in a singleton birth, in this instance of assisting in the birth of a second twin it is not possible to grasp any other fetal part. The fetal head would be too large to grasp and pull downward, and grasping the fetal arm would result in a transverse lie and make vaginal birth impossible. B, While applying pressure on the outside of the abdomen to push the baby’s head up toward the top of the uterus with one hand, the physician pulls the baby’s foot down toward the cervix. C, Both feet have been pulled through the cervix and vagina. D, The physician now grasps the baby’s trunk and continues to pull downward on the baby to assist the birth.
95
Nursing Management Maternal/fetal assessments NST Lab studies
Psychological support Education Monitor VS
96
Nursing Management (continued)
EFM Mediation administration – Beta-mimetics, RhoGAM
97
Uses of Amniotomy Labor induction Labor augmentation
Allow access to fetus and uterus to Apply an internal fetal heart monitoring scalp electrode Insert an intrauterine pressure catheter Obtain a fetal scalp blood sample
98
Cervical Ripening: Prostaglandin E2
Advantages Cervical ripening Shorter labor Lower requirements for oxytocin during labor induction Vaginal birth is achieved within 24 hours for most women Incidence of cesarean birth is reduced
99
Cervical Ripening: Prostaglandin E2 (continued)
Risks Uterine hyperstimulation Nonreassuring fetal status Higher incidence of postpartum hemorrhage Uterine rupture
100
Labor Induction: Stripping Membranes
Advantages Labor usually occurs in hours Disadvantages Can be painful Uterine contractions Bloody discharge
101
Labor Induction: Oxytocin
Risks Hyperstimulation of the uterus Uterine rupture Water intoxication Nonreassuring fetal heart rate patterns
102
Labor Induction: Natural Methods
Sexual intercourse/lovemaking Self or partner stimulation of the woman’s nipples and breasts Use of herbs Blue/black cohosh Evening primrose oil Red raspberry leaves
103
Labor Induction: Natural Methods (continued)
Use of homeopathic solutions Caulophyllum or pulsatilla Castor oil, enemas Acupressure/acupuncture Mechanical dilatation with balloon catheter
104
Amnioinfusion Prevent the possibility of variable decelerations
Treat nonperiodic decelerations Meconium dilution
105
Episiotomy Types Midline Mediolateral
106
Figure 27–3 The two most common types of episiotomies are midline and mediolateral. A, Right mediolateral. B, Midline.
107
Nursing Management Support Assist with communication of woman’s needs
Pain relief measures Assessment Education
108
Forceps-Assisted Birth: Maternal Indications
Heart disease Acute pulmonary edema or pulmonary compromise Certain neurological conditions Intrapartal infection Prolonged second stage Exhaustion
109
Figure 27–5 Application of forceps in occiput-anterior (OA) position
Figure 27–5 Application of forceps in occiput-anterior (OA) position. A, The left blade is inserted along the left side wall of the pelvis over the parietal bone. B, The right blade is inserted along the right side wall of the pelvis over the parietal bone. C, With correct placement of the blades, the handles lock easily. During uterine contractions, traction is applied to the forceps in a downward and outward direction to follow the birth canal.
110
Figure 27–5 (continued) Application of forceps in occiput-anterior (OA) position. A, The left blade is inserted along the left side wall of the pelvis over the parietal bone. B, The right blade is inserted along the right side wall of the pelvis over the parietal bone. C, With correct placement of the blades, the handles lock easily. During uterine contractions, traction is applied to the forceps in a downward and outward direction to follow the birth canal.
111
Figure 27–5 (continued) Application of forceps in occiput-anterior (OA) position. A, The left blade is inserted along the left side wall of the pelvis over the parietal bone. B, The right blade is inserted along the right side wall of the pelvis over the parietal bone. C, With correct placement of the blades, the handles lock easily. During uterine contractions, traction is applied to the forceps in a downward and outward direction to follow the birth canal.
112
Forceps-Assisted Birth: Fetal Indications
Premature placental separation Prolapsed umbilical cord Nonreassuring fetal status
113
Types of Forceps Outlet forceps Midforceps Breech forceps
114
Figure 27–4 Forceps are composed of a blade, shank, and handle and may have a cephalic and pelvic curve. (Note labels on Piper and Tucker-McLean forceps.) The blades may be fenestrated (open) or solid. The front and lateral views of these forceps illustrate differences in blades, open and closed shanks, and cephalic and pelvic curves. Elliot, Simpson, and Tucker-McLean forceps are used as outlet forceps. Kielland and Barton forceps are used for midforceps rotations. Piper forceps are used to provide traction and flexion of the aftercoming head (the head comes after the body) of a fetus in breech presentation.
115
Fetal Risks Ecchymosis, edema, or both along the sides of the face
Caput succedaneum or cephalhematoma Transient facial paralysis Low Apgar scores Retinal hemorrhage Corneal abrasions
116
Fetal Risks (continued)
Ocular trauma Other trauma (Erb’s palsy, fractured clavicle) Elevated neonatal bilirubin levels Prolonged infant hospital stay
117
Maternal Risks Lacerations of the birth canal Periurethral lacerations
Extension of a median episiotomy into the anus More likely to have a third- or fourth-degree laceration Report more perineal pain and sexual problems in the postpartum period Postpartum infections
118
Maternal Risks (continued)
Cervical lacerations Prolonged hospital stay Urinary and rectal incontinence Anal sphincter injury Postpartum metritis
119
Nursing Management Explains procedure to woman Monitors contractions
Informs physician/CNM of contraction Encourages woman to avoid pushing during contraction Assessment of mother and her newborn Reassurance
120
Indications for Vacuum Extraction
Prolonged second stage of labor Nonreassuring heart rate pattern Used to relieve the woman of pushing effort When analgesia or fatigue interfere with ability to push effectively Borderline CPD
121
Vacuum Extraction Procedure
Suction cup placed on fetal occiput Pump is used to create suction Traction is applied Fetal head should descend with each contraction
122
Figure 27–6 Vacuum extractor traction
Figure 27–6 Vacuum extractor traction. A, The cup is placed on the fetal occiput, creating suction. Traction is applied in a downward and outward direction. B, Traction continues in a downward direction as the fetal head begins to emerge from the vagina. C, Traction is maintained to lift the fetal head out of the vagina.
123
Figure 27–6 (continued) Vacuum extractor traction
Figure 27–6 (continued) Vacuum extractor traction. A, The cup is placed on the fetal occiput, creating suction. Traction is applied in a downward and outward direction. B, Traction continues in a downward direction as the fetal head begins to emerge from the vagina. C, Traction is maintained to lift the fetal head out of the vagina.
124
Figure 27–6 (continued) Vacuum extractor traction
Figure 27–6 (continued) Vacuum extractor traction. A, The cup is placed on the fetal occiput, creating suction. Traction is applied in a downward and outward direction. B, Traction continues in a downward direction as the fetal head begins to emerge from the vagina. C, Traction is maintained to lift the fetal head out of the vagina.
125
Nursing Management Inform woman about procedure Pumps the vacuum
Supports the woman Assesses the mother and neonate for complications
126
Neonatal Risks with Vacuum Extraction
Scalp lacerations and bruising Shoulder dystocia Subgaleal hematomas Cephalhematomas Intracranial hemorrhages Subconjunctival hemorrhages
127
Neonatal Risks with Vacuum Extraction (continued)
Neonatal jaundice Fractured clavicle Erb’s palsy Damage to the sixth and seventh cranial nerves Retinal hemorrhage Fetal death
128
Maternal Risks with Vacuum Extraction
Perineal trauma Edema Third- and fourth-degree lacerations Postpartum pain Infection More sexual difficulties in the postpartum period
129
Indications for Cesarean Birth
Complete placenta previa CPD Placental abruption Active genital herpes Umbilical cord prolapse Failure to progress in labor
130
Indications for Cesarean Birth (continued)
Proven nonreassuring fetal status Benign and malignant tumors that obstruct the birth canal Breech presentation Previous cesarean birth Major congenital anomalies Cervical cerclage
131
Indications for Cesarean Birth (continued)
Severe Rh isoimmunization Maternal preference for cesarean birth
132
Impact on the Family Stress and anxiety
Sense of loss of vaginal birth experience Fear Relief
133
Preparation for Cesarean Birth
Preoperative teaching Coughing and deep breathing Splinting What to expect
134
Nursing Management Before Cesarean Birth
Assisting with the epidural Monitoring maternal vital signs and fetal heart rate Inserting an indwelling urinary catheter Preparing the abdomen and perineum Making sure that all necessary personnel and equipment are present Positioning the woman on the operating table
135
Nursing Management Before Cesarean Birth (continued)
Supporting the couple Instrument count
136
Nursing Management After Cesarean Birth
Normal newborn post-delivery care Monitoring vital signs Checking the surgical dressing Palpating the fundus and checking lochia Monitoring intake and output Administration of oxytocin and pain management
137
Vaginal Birth After Cesarean (VBAC): Criteria
One previous cesarean birth and a low transverse uterine incision An adequate pelvis No other uterine scars or previous uterine rupture An available physician who is able to do a cesarean In-house anesthesia personnel
138
Vaginal Birth After Cesarean (VBAC): Risks
Uterine rupture Stillbirths Hypoxia
139
Dysfunctional Labor Patterns: Hypertonic Labor
Characterized by uterine irritability, poor resting tone, frequent contractions Risks Maternal exhaustion, pain Infection Maternal/fetal injury Management Rest, hydration, sedation Labor augmentation (oxytocin, AROM) Contributing factors Primip, fetal position, flexion of fetal head, size of baby
140
Nursing Process Assessment
Uterine activity, cx change, membranes, fetus, and mom Fetal tolerance of labor EFM pg 579 FHR Variability Periodic changes See additional handout for EFM
141
Nursing Dx- hypertonic
Risk for infection Acute pain Deficient knowledge Fatigue Anxiety Outcome statements –pg 580
142
Outcome evaluation Hypertonic can evolve into normal pattern
If ineffective continues: c/delivery RN responsible for reporting and documenting data in time current
143
Dysfunctional Labor Patterns: Hypotonic Labor
Characterized by contractions that are inadequate in frequency, duration, intensity Risks Maternal exhaustion from long labor Infection Maternal/fetal injury Management Rest, hydration, sedation Labor augmentation (oxytocin, AROM) Contributing factors Large fetus,malpresentation,early or repeated maternal sedation
144
Nursing Process The same in all aspects of process to hypertonic
145
Precipitate delivery Labor that progresses rapidly (< 3hrs after onset of uterine activity) Contributing factors Grand multip, small fetus, relaxed pelvic muscles, hx of same Risks Uncontrolled delivery ACOG allows for induction with contributing factors
146
Nursing process- precip del
Assessment Thorough hx, EFM, fetal position changes, (U/S), client responses, fetal tolerance Be alert for amniotic fluid emboli, uterine atony Nursing dx Risk for soft tissue injury Risk for infection Anxiety
147
Factors Resulting in High-Risk Deliveries
Malpositions Cephalopelvic disproportion Macrosomia Multiple gestation Fetal distress Uterine rupture Placenta previa Abruptio placentae Umbilical cord prolapse Polyhydramnios/ oligohydramnios
148
Shoulder Presentation
Options for delivery are external version or cesarean section
149
Face and Brow Presentation
May be able to deliver vaginally .
150
Anterior shoulder impinged behind the symphysis
Shoulder Dystocia Anterior shoulder impinged behind the symphysis McRoberts maneuver
151
CPD Macrosomia Contributing factors Passenger too big
Irregular shaped pelvis Fetal macrosomia Hx of crushed or fx pelvix Macrosomia Passenger too big Can lead to shoulder dystocia Maternal diabetes Excessive mat wt gain Adv. Mat age Erb’s palsy
152
Interventions for shoulder dystocia
Mc Roberts maneuver Suprapubic pressure Woods corkscrew Push ant chest wall of fetus and turn 180 degrees Rubin maneuver push against scapula of ant. Shoulder to rotate forward 180
153
Prolapsed Cord Occult (hidden, cannot be seen or felt)
Complete (cannot be seen, but may be felt) Visible (can be seen protruding from vagina)
154
Cord abnormalities Velamentous insertion Vasa previa Cord compression
Developmental abnormality which may cause decreased fetal perfusion Vasa previa Cord vessels over os Cord compression During descent Cord wrapping Cord prolapse Cord precedes fetus Check EFM
155
Multiples Evaluate for shared amnion and chorion
Higher incidence of PTL Cojoining abnormalities 1:1 ratio of nurse to baby in delivery Perinatal abnormalities 5 x greater Maternal complications increase Financial concerns
156
Twin Gestation Fetuses can assume a variety of positions in utero
Similar presentations
© 2024 SlidePlayer.com Inc.
All rights reserved.