Developed by D. Ann Currie RN, MSN

 Version  Cervical Ripening  Induction / Augmentation  Amniotomy  Amnioinfusion  Episiotomy  Assisted Vaginal Birth:  Forceps-assisted birth  Vacuum Extraction  Cesarean Section  VBAC

 External Cephalic Version is the changing of the fetal presentation from breech, transverse lie or oblique lie to a cephalic presentation.  Podalic Version is used only with the second twin during a vaginal birth.

 May be attempted after weeks gestation.  Criteria:  Single fetus  Not engaged  Adequate amount of amniotic  fluid  A Reactive NST 

 Suspected IUGR  Fetal Anomalies  Abnormal FHR Pattern  Rupture of Membranes  Cesarean birth indications  Maternal Problems-GDM, Preeclampsia/eclampsia cardiac disease etc.  Amniotic Fluid abnormalities  Other

Done in Labor Unit Client is NPO for least 8 hours Ultrasound for : single fetus, AFI, location of placenta, position and presentation of fetus and cord Vital signs NST Blood type and Rh and antibody screen Informed consent IV started with LR Possible Tocolytic medications

 Softening and effacing of the cervix  Can be done with several agents:  Prostaglandin E2( PGE2) gel  Dinoprostone ( Cervidil)-  vaginal insert  Dinoprostone ( Prepidil)  Misoprostol ( Cytotec)  Can be done prior to induction with Pitocin

 Labor Induction is the stimulation of uterine contractions before the spontaneous onset of labor.  Labor Augmentation is the stimulation of uterine contractions after labors onset and there is failure in progression of cervical dilation or descent of fetus.

 Diabetes mellitus  Postterm gestation  Fetal Demise  PROM  Hx of precipitous labor and birth  Other indications see text

 Prematurity  Abnormal Presentation  Multiple Gestation  Severe Hypertension  Maternal Heart Disease  Abnormal FHR Pattern  Polyhydramnios  Presenting part not engaged  Severe Preeclampsia/ eclampsia  CPD  Macrosomic fetus  Cord prolapse  Placenta previa  Previous Classical Incision C/S  See text for other contraindications

 It is the artificial rupture of the amniotic membranes. (AROM)  Before procedure :  Do pericare  Assess for contraindications or risk factors.  Assess the fetus for presentation, position, station, and FHR  Prep bed for fluid  Immediately after:  Assess FHR  Check fluid color and amount

 It is a procedure by which warm, sterile saline is put into the uterus via an IUPC. It can be used to increase volume of fluid in oligohydramnios, decrease pressure on cord,or dilute meconium.  First place IUPC  Assess FHR  Bolus ml of saline using infusion pump over20-30 minutes  Monitor vital signs, FHR,and contraction status and resting tone

 It is a surgical incision into the perinium.  Types:  Midline  Mediolateral  Episiorrhaphy is a repair of the episiotomy or any lacerations.

 Forceps Assisted Vaginal Birth  Vacuum Extraction

 Cesarean birth is the birth of the baby through abdominal and uterine incision. Hsyterotomy  Indications:  CPD, placenta previa, Abruptio placenta, Umbilical cord prolapse, nonreassuring FHR pattern, previous section, breech presentation, fetal congenitial anomalies and others.  Preoperative  Prep  Intraoperative  Postoperative

 Vaginal Birth After Cesarean  ACOG Guidelines  Complications

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