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MODULE 2 INTRAPARTUM PROCESSES OF LABOR AND BIRTH

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1 MODULE 2 INTRAPARTUM PROCESSES OF LABOR AND BIRTH

2 KEY FACTORS RELATED TO PROGRESS OF LABOR
FORCES OF LABOR INTRAPARTAL ASSESSMENT AND CARE OF MOTHER AND FETUS CARE OF MOTHER AND INFANT IN LABOR, DELIVERY, AND IMMEDIATE POST PARTUM BIRTH RELATED PROCEDURES

3 MODULE 2 PART 1 KEY FACTORS RELATED TO PROGRESS OF LABOR

4 KEY FACTORS RELATED TO PROGRESS OF LABOR
PASSAGEWAY (BIRTH CANAL) PASSENGER (FETUS) POSITION OF THE MOTHER AND FETUS PHYSIOLOGICAL FORCES OF LABOR PSYCHOSOCIAL CONSIDERATIONS

5 BIRTH PASSAGE SIZE OF PELVIS TYPE OF PELVIS
CERVICAL DILATATION, EFFACEMENT ABILITY OF VAGINA AND INTROITUS TO EXPAND

6 BIRTH PASSAGE FOUR CLASSIC PELVIC TYPES GYNECOID ANDROID ANTHROPOID
PLATYPELLOID LLLLLLLLLLLL

7

8 BIRTH PASSAGE CERVICAL DILATATION AND EFFACEMENT
DILATATION—MEASURED IN CENTIMETERS FROM 0 TO 10 0 CM—CERIVX CLOSED 10 CM—FULL DILATATION EFFACEMENT—MEASURED IN PERCENTAGE 0 TO 100%

9 Figure 15–11a Effacement of the cervix in the primigravida
Figure 15–11a Effacement of the cervix in the primigravida. Beginning of labor. There is no cervical effacement or dilatation. The fetal head is cushioned by amniotic fluid.

10 Figure 15–11b Beginning cervical effacement
Figure 15–11b Beginning cervical effacement. As the cervix begins to efface, more amniotic fluid collects below the fetal head.

11 Figure 15–11c Cervix about one-half effaced and slightly dilated
Figure 15–11c Cervix about one-half effaced and slightly dilated. The increasing amount of amniotic fluid exerts hydrostatic pressure.

12 Figure 15–11d Complete effacement and dilatation.

13 UTERINE AND CERVICAL CHANGES
UPPER UTERINE SEGMENT THICKENS AND PULLS UP LOWER SEGMENT EXPANDS AND THINS OUT EFFACEMENT CAUSES OF UTERINE CHANGES ESTROGEN STIMULATES MUSCLE CONTRACTIONS COLLAGEN IN CERVIX BROKEN DOWN INCREASED WATER CONTENT OF THE CERVIX

14 MODULE 2 PART 2 THE PASSENGER (FETUS)

15 FETUS (PASSENGER) SIZE OF FETAL HEAD FETAL ATTITUDE FETAL LIE FETAL PRESENTATION IMPLANTATION SITE OF PLACENTA

16 PASSENGER FETAL HEAD SUTURES FRONTAL SAGITTAL CORONAL LAMBOIDAL
MOLDING FONTANELLES

17 Figure 15–2 Superior view of the fetal skull.

18 PASSENGER LANDMARKS OF FETAL SKULL MENTUM SINCIPUT
ANTERIOR FONTANELLE (BREGMA) VERTEX POSTERIOR FONTANELLE OCCIPUT

19 Figure 15–4a Typical anteroposterior diameters of the fetal skull
Figure 15–4a Typical anteroposterior diameters of the fetal skull. When the vertex of the fetus presents and the fetal head is flexed with the chin on the chest, the smallest anteroposterior diameter (suboccipitobregmatic) enters the birth canal.

20 Figure 15–6a Cephalic presentation. Vertex presentation
Figure 15–6a Cephalic presentation. Vertex presentation. Complete flexion of the head allows the suboccipitobregmatic diameter to present to the pelvis.

21 Figure 15–6c Brow presentation
Figure 15–6c Brow presentation. The fetal head is in partial (halfway) extension. The occipitomental diameter, which is the largest diameter of the fetal head, presents to the pelvis.

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23

24 PASSENGER FETAL LIE AND PRESENTATION
FETAL LIE-- Relation of long axis of fetus to long axis of the mother Longitudinal Transverse FETAL PRESENTATION—the body part of the fetus that first enters the pelvis

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26 PASSENGER (PRESENTATION)
CEPHALIC PRESENTATION (95%) VERTEX—SUBOCCIPTOBREGMATIC MILITARY--OCCIPITOFRONTAL BROW--OCCIPITOMENTAL FACE--SUBMENTOBREGMATIC

27 PASSENGER (PRESENTATION)
BREECH PRESENTATION (3%) COMPLETE—HIPS FLEXED, KNEES FLEXED FRANK—HIPS FLEXED, KNEES EXTENDED FOOTLING—HIPS & FEET EXTENDED, FEET,FOOT PRESENT TO MATERNAL PELVIS KNEELING—HIPS EXTENDED, KNEES FLEXED

28 PASSENGER (PRESENTATION)
SHOULDER (TRANSVERSE) PRESENTATION (2%) TRANSVERSE LIE—SHOULDER IS USUAL PRESENTING PART COMPOUND—USUALLY ARM OR HAND PRESENTING ALONG PRESENTING PART

29

30 MODULE 2 PART 3 POSITION OF MOTHER AND FETUS

31 POSITION OF FETUS IN RELATION TO MOTHER’S PELVIS
ENGAGEMENT WHEN THE WIDEST DIAMETER OF THE PRESENTING PART HAS REACHED OR PASSED THE PELVIC INLET ENGAGEMENT USUALLY CORRESPONDS TO O STATION FLOATING—WHEN PRESENTING PART IS ENTIRELY OUT OF THE PELVIS AND FREELY MOVABLE IN THE INLET

32 Figure 15–8 Measuring the station of the fetal head while it is descending. In this view the station is 22/23.

33 POSITION STATION RELATIONSHIP OF FETAL PRESENTING PART TO THE LEVEL OF THE ISCHIAL SPINES THE ISCHIAL SPINES ARE O STATION ABOVE THE SPINES IS A NEGATIVE VALUE BELOW THE SPINES IS A POSITIVE VALUE

34 MODULE 2 PART 4A PHYSIOLOGICAL FORCES OF LABOR

35 PHYSIOLOGIC FORCES OF LABOR
CONTRACTION PHASES---INCREMENT, ACME, DECREMENT DESCRIBED WITH FREQUENCY, DURATION, AND INTENSITY PRIMARY AND SECONDARY FORCES OF LABOR EFFECTIVENESS OF PUSHING DURATION OF LABOR

36 Figure 15–10 Characteristics of uterine contractions.

37 SIGNS OF LABOR LIGHTENING “BRAXTON HICKS” CONTRACTIONS CERVIAL CHANGES
BLOODY SHOW RUPTURE OF MEMBRANES SUDDEN BURST OF ENERGY WEIGHT LOSS N&V, DIARRHEA, BACKACHE

38 TRUE LABOR/FALSE LABOR
CONTRACTIONS REGULAR, INCREASE IN DURATION & STRENGTH INTERVAL SHORTENS DILATATION & EFFACEMENT PROGRESS INTENSITY INCREASES WITH WALKING FALSE CONTRACTIONS IRREGULAR, NO CHANGE IN DURATION, STRENGTH INTERVAL IRREGULAR OR NO CHANGE NO DILATATION OR EFFACEMENT WALKING LESSENS OR HAS NO EFFECT ON CONTRACTIONS

39 MODULE 2 PART 4B STAGES OF LABOR

40 FIRST STAGE OF LABOR STARTS WITH BEGINNING OF REGULAR CONTRACTIONS TO FULL DILATATION FIRST STAGE IS DIVIDED INTO THREE PHASES: LATENT, ACTIVE, AND TRANSITION

41 PHASES OF LABOR—FIRST STAGE
LATENT CENTIMETERS, CONTINUING EFFACEMENT ACTIVE CENTIMETERS, COMPLETE EFFACEMENT TRANSITION CENTIMTERS ENGAGEMENT

42 CONTRACTION CHARACTERISTICS
LATENT PHASE MILD—10-30MIN. LASTING SECONDS MODERATE—5-7MIN. LASTING SECONDS ACTIVE PHASE MODERATE TO STRONG—2-3 MIN. LASTING SECONDS TRANSITION STRONG—1-1/2-2 MIN. LASTING SECONDS

43 PSYCHOLOGIC ADAPTIONSTO LABOR: LATENT PHASE
FEELS ABLE TO COPE WITH DISCOMFORT MAY BE RELIEVED THAT LABOR HAS FINALLY STARTED USUALLY ABLE TO TALK THROUGH CONTRACTION IS ABLE TO RECOGNIZE AND EXPRESS FEELING OF ANXIETY

44 PSYCHOLOGIC ADAPTIONSTO LABOR: ACTIVE PHASE
ANXIETY INCREASES FEARS LOSS OF CONTROL MAY HAVE DECREASED ABILITY TO COPE LESS TALKATIVE

45 PSYCHOLOGIC ADAPTIONS TO LABOR: TRANSITION PHASE
WITHDRAWS INTO HERSELF DOUBTS ABILITY TO COPE APPREHENSIVE AND IRRITABLE TERRIFIED OF BEING ALONE DOES NOT WANT ANYONE TO TALK TO HER OR TOUCH HER DIFFICULT TO CONCENTRATE ON TASK

46

47 SECOND STAGE OF LABOR BEGINS WITH COMPLETE CERVICAL DILATATION AND ENDS WITH THE BIRTH OF THE INFANT

48 THIRD STAGE OF LABOR BEGINS WITH BIRTH OF INFANT AND ENDS WITH THE DELIVERY OF THE PLACENTA

49 FOURTH STAGE OF LABOR BEGINS WITH DELIVERY OF PLACENTA TO 4 HOURS AFTER

50 LABOR REVIEW DESCRIBE THE FIVE CRITICAL FACTORS THAT INFLUENCE LABOR IN THE ASSESSMENT OF A MOTHER’S AND FETUS’ PROGRESS IN LABOR AND BIRTH, GIVING TWO EXAMPLES OF EACH

51 MODULE 2 PART 5 MATERNAL PHYSIOLOGIC ADAPTION TO LABOR

52 RENAL -- >IN RENIN, PLASMA RENIN ACTIVITY, ANGIOTENSIN
VOIDING CAN BE AFFECTED BY EDEMA,DISPLACEMENT GI—DECREASED MOTILITY, DELAYED STOMACH EMPTYING

53 CARDIAC OUTPUT INCREASES
WBC CAN INCREASE TO 25,000mm BP INCREASES ACID/BASE BALANCE—MAY SEE > Ph EARLY IN LABOR

54 INTRAPARTAL NURSING ASSESSMENT
HISTORY PERSONAL DATA HX PREVIOUS ILLNESS PROBLEMS IN PRENATAL PERIOD PREGNANCY DATA INFANT FEEDING METHOD CHOSEN ANY PRENATAL EDUCATION ? BIRTH PLAN

55 MATERNAL PSYCHOSOCIAL HISTORY
POVERTY NUTRITION PRENATAL CARE CULTURAL BELIEFS ENVIRONMENT USE OF DRUGS/ALCOHOL DOMESTIC VIOLENCE

56 MATERNAL PSYCHOSOCIAL ISSUES
EMOTIONAL STATUS SOCIOCULTURAL BELIEFS PREVIOUS CHILDBIRTH EXPERIENCE SUPPORT MENTAL AND PHYSICAL PREPARATION

57 INTRAPARTAL ASSESSMENT-- STAGE ONE
VITAL SIGNS WEIGHT LUNGS FUNDUS EDEMA HYDRATION PERINEUM

58 INTRPARTAL ASSESSMENT STAGE ONE
LABOR STATUS FETAL STATUS LAB VALUES CULTURAL INFLUENCES RESPONSE TO LABOR CHILDBIRTH PREPARATION ANXIETY SUPPPORT

59 LABOR EVALUATION METHODS
CERVICAL ASSESSMENT VAGINAL EXAM DILATATION EFFACEMENT STATION

60 Figure 16–2 To gauge cervical dilatation, the nurse place the index and middle fingers against the cervix and determines the size of the opening. Before labor begins, the cervix is long (approximately 2.5 cm), the sides feel thick, and the cervical canal is closed, so an examining finger cannot be inserted. During labor, the cervix begins to dilate, and the size of the opening progresses from 1 cm to 10 cm in diameter.

61 FETAL ASSESSMENT FETAL POSITION PALPATION—LEOPOLD’S MANEUVER
INSPECT SIZE AND SHAPE OF WOMAN’S ABDOMEN VAGINAL EXAM TO DETERMINE PRESENTING PART FETAL HEART RATE ULTRASOUND

62 Figure 16–4 Top: The fetal head progressing through the pelvis
Figure 16–4 Top: The fetal head progressing through the pelvis. Bottom: The changes that the nurse will detect on palpation of the occiput through the cervix while doing a vaginal examination. Source: Myles, M. F. (1975). Textbook for midwives (p. 246). Edinburgh, Scotland: Churchill-Livingstone.

63 Figure 16–5d Fourth maneuver: Facing the woman’s feet, place both hands on the lower abdomen and move hands gently down the sides of the uterus toward the pubis. Note the cephalic prominence or brow.

64 GROUP EXERCISE LIST THREE POTENTIAL PROBLEMS RELATED TO: PASSENGER POSTION PASSAGEWAY PHYSIOLOGICAL FORCES OF LABOR PSYCHOSOCIAL ISSUES

65 MODULE 2 PART 7A FETAL HEART RATE (FHR) MONITORING

66 ELECTRONIC FETAL HEART RATE MONITOR--DOPPLER BASELINE RATE—120-160BPM
WHAT CAUSES: FETAL TACHYCARDIA FETAL BRADYCARDIA

67 ELECTRONIC MONITORING OF CONTRACTIONS
TOCO—EXTERNATION ASSESSMENT OF CONTRACTIONS IUPC—INTERNAL ASSESSMENT OF CONTRACTIONS

68 EXTERNAL MONITORING EXTERNAL—ULTRASONIC TRANSDUCER (DOPPLER)
HIGH FREQUENCY SOUND WAVES REFLECT MECHANICAL ACTION OF FETAL HEART DIFFICULT TO OBTAIN CONTINUOUS, ACCURATE RECORD AT TIMES

69 Figure 16–8 Electronic fetal monitoring by external technique
Figure 16–8 Electronic fetal monitoring by external technique. The tocodynamometer (“toco”) is placed over the uterine fundus. The toco provides information that can be used to monitor uterine contractions. The ultrasound device is placed over the area of the fetal back. This device transmits information about the fetal heart rate. Information from both the toco and the ultrasound device is transmitted to the electronic fetal monitor. The fetal heart rate is displayed in a digital display (as a blinking light), on the special monitor paper, and audibly (by adjusting a button on the monitor). The uterine contractions are displayed on the special monitor paper as well.

70 INTERNAL FHR MONITORING
MEMBRANES MUST BE RUPTURED CERVIX SUFFCIENTLY DILATED PRESENTING PART LOW ENOUGH FOR PLACEMENT SMALL ELECTRODE ATTACHED TO PRESENTING PART MOST ACCURATE APPRAISAL OF FETAL WELL-BEING IN LABOR

71 Figure 16–9a Technique for internal, direct fetal monitoring
Figure 16–9a Technique for internal, direct fetal monitoring. Spiral electrode.

72 Figure 16–9b Attaching the spiral electrode to the scalp.

73 FHR MONITORING ABSENT MODERATE MARKED VARIABILITY
BEAT TO BEAT CHANGES IN FETAL HEART RATE INDICATION OF AN INTACT CNS ABSENT MODERATE MARKED

74 Figure 16–10 Normal fetal heart rate pattern obtained by internal monitoring. Note normal FHR, 140 to 158 beats/min, presence of long- and short-term variability, and absence of deceleration with adequate contractions. Arrows on bottom of tracing indicate beginnings of uterine contractions.

75 Figure 16–11a Short- and long-term variability
Figure 16–11a Short- and long-term variability. Increased LTV; STV present.

76 Figure 16–11b Average LTV; STV absent.

77 Figure 16–11c Absent LTV; STV present.

78 Figure 16–11d Absent LTV; STV absent.

79

80 FHR MONITORING ACCELERATIONS DECELERATIONS EARLY LATE VARIABLE

81 Figure 16–12 Types and characteristics of early, late, and variable decelerations. Source: Hon, E. (1976). An introduction to fetal heart rate monitoring (2nd ed., p. 29). Los Angeles: University of Southern California School of Medicine.

82 V C E H A O L P

83

84

85

86 FETAL ASSESSMENT SCALP STIMULATION FETAL BLOOD SAMPLING (FBS)
NORMAL SCALP pH > 7.25, BORDERLINE, <7.20 NONREASSURING MEMBRANES MUST BE RUPTURED CERVIX DILATED 2-3CM PRESENTING PART -2 STATION OR LOWER

87

88

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90 MODULE 2 PART 8 NURSING INTERVENTIONS IN FIRST AND SECOND STAGES OF LABOR

91 FIRST STAGE-- LATENT PHASE
DILATATION, EFFACEMENT, STATION MEMBRANE ASSESSMENT COMFORT LEVEL VS, FHR UTERINE CONTRACTIONS EVERY MIN. TEACHING

92 LATENT PHASE ENCOURAGE AMBULATION ENCOURAGE VOIDING Q2H
COMFORT MEASURES NUTRITION OFFER FLUIDS PAIN ASSESSMENT EPIDURAL MONITORING IDENTIFY AND OBSERVE SUPPORT PERSON(S)

93 FIRST STAGE-- ACTIVE PHASE
ENCOURAGE TO VOID Q1-2 HOURS AUSCULTATE FHR Q15-30 MIN. PALPATE CONTRACTIONS Q15 MIN. VAGINAL EXAMS TO ACESS PROGRESS EPIDURAL MONITORING, VS Q15-30 MIN. START IV INFUSION IF UNABLE TO TOLERATE FLUIDS ACCESS COLOR AND ODOR OF AMNIOTIC FLUID

94 FIRST STAGE-- TRANSITION
PALPATE CONTRACTIONS Q15 MIN. STERILE VAGINAL EXAMS TO ACCESS LABOR PROGRESS ASSESS FHR EVERY MIN., DEPENDING ON RISK FACTORS ASSIST WITH BREATHING KEEP WOMAN FROM PUSHING UNTIL 10 CM. STAY WITH PATIENT!

95 INTRAPARTAL NURSING INTERVENTIONS SECOND AND THIRD STAGE OF LABOR
ENCOURAGMENT, ASSIST WITH PUSHING,DO NOT LEAVE PATIENT ASSIST WITH DELIVERY DELIVERY OF PLACENTA APGAR SCORE, IMMEDIATE CARE OF NEWBORN PITOCIN INFUSION

96 MODULE 2 PART 9 INTRAPARTUM NURSING INTERVENTIONS THE DELIVERY

97 THE DELIVERY PUSHING BIRTHING POSITIONS LABOR SUPPORT

98 Figure 15–13 Mechanisms of labor. A, B, Descent. C, Internal rotation
Figure 15–13 Mechanisms of labor. A, B, Descent. C, Internal rotation. D, Extension. E, External rotation.

99

100

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103 INTRAPARTAL NURSING CARE: THE THIRD STAGE
DELIVERY OF THE PLACENTA SCHULTZ MANUEVER DUNCAN MANUEVER PLACENTA ACCRETA RETAINED PLACENTA

104 INTRAPARTAL NURSING CARE: THE FOURTH STAGE
VS FUNDUS LOCHIA PERINEUM/ABDOMINAL INCISION BLADDER COMFORT LEVEL COMFORT MEASURES—WHAT ARE THEY?

105 INTRAPARTAL NURSING CARE: THE FOURTH STAGE
CONTINUE PITOCIN ADMINISTRATION---WHY? PAIN MEDICATION DIET HEMODYNAMIC CHANGES CULTURAL CONSIDERATIONS

106 ADAPTION TO EXTRAUTERINE LIFE
IMMEDIATE CARE OF THE NEWBORN RESPIRATORY ASSESSMENT CIRCULATORY ASSESSMENT THERMOREGULATION—HOW WOULD YOU ACHIEVE THIS?

107 IMMEDIATE CARE OF THE NEWBORN
APGAR SCORE MAINTAIN RESPIRATIONS PROVIDE AND MAINTAIN WARMTH UMBILICAL CORD CARE CORD BLOOD COLLECTION HANDS OFF ASSESSMENT NEWBORN IDENTIFICATION FACILITATE ATTACHMENT

108 IMMEDIATE POSTPARTUM CARE OF MOTHER
VS HEMODYNAMIC CHANGES FUNDUS, LOCHIA VOIDING STATUS EPISIOTOMY/LACERATION ASSESSMENT PAIN

109

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112 MODULE 2 PART 10 MATERNAL ANALGESIA AND ANESTHESIA

113 MATERNAL ANALGESIA & ANESTHESIA
PAIN PERCEPTION AFFECTED BY: PREVIOUS EXPERIENCE CULTURAL EXPECTATIONS, BELIEFS FATIGUE, FEAR, ANXIETY ENVIRONMENT SUPPORT SYSTEM

114 MATERNAL ANALGESIA STADOL DEMEROL MORPHINE OPIATE ANTAGONIST—NARCAN
REGIONAL ANALGESIA

115

116 MATERNAL ANESTHESIA REGIONAL ANESTHESIA EPIDURAL CONTINUOUS EPIDURAL
SPINAL

117 A B C D Figure 18–3c Tip of needle in epidural space. Source: Bonica, J. J. (1972). Principles and practice of obstetric analgesia and anesthesia (p. 631). Philadelphia: Davis.

118 Figure 18–4 Levels of anesthesia for vaginal and cesarean births
Figure 18–4 Levels of anesthesia for vaginal and cesarean births. Source: Reprinted with permission of Ross Laboratories, Columbus, OH. From Clinical Education Aid No. 17.

119 MATERNAL ANESTHESIA LOCAL INFILTRATION PUDENDAL GENERAL

120 ANALGESIA AFTER DELIVERY
EPIDURAL NARCOTIC ANALGESIA (DUROMORPH) CONTRAINDICATIONS SIDE EFFECTS DOSAGE

121 MODULE 2 PART 11A BIRTH RELATED PROCEDURES

122 BIRTH RELATED PROCEDURES
AMNIOTOMY ARTIFICIAL RUPTURE OF MEMBRANES (AROM SPONTANEOUS RUPTURE (SROM)

123 AMNIOTOMY AFTER 3CM MAY SHORTEN LABOR (AROM) CAN BE A STIMULATION OF LABOR FHR ASSESSED BEFORE AND AFTER AROM—WHY?

124 BIRTH RELATED PROCEDURES
LABOR INDUCTION—STIMULATION OF UTERINE CONTRACTIONS INDICATED INDUCTION—WHAT CONDITIONS WOULD WARRANT AN INDICATED INDUCTION? ELECTIVE INDUCTION

125 BIRTH RELATED PROCEDURES
ELECTIVE INDUCTIONS INCREASE IN LAST 10 YEARS CONTROVERSY, CONTROVERSY!!!!!!! RISKS EVIDENCE BASED PRACTICE—LATE PRETERM NEWBORNS WEEKS

126 BIRTH RELATED PROCEDURES
LABOR INDUCTION: STRIPPING OF MEMBRANES ADVANTAGES: LABOR USUALLY OCCURS WITHIN 24HOURS DISADVANTAGES: CAN BE PAINFUL UTERINE CONTRACTIONS BLOODY DISCHARGE

127 BIRTH RELATED PROCEDURES
LABOR INDUCTION/AUGMENTATION RISKS: HYPERSTIMULATION OF THE UTERUS UTERINE RUPTURE WATER INTOXICATION NONREASSURING FETAL HEART RATE PATTERNS

128 BIRTH RELATED PROCEDURES
CERVICAL RIPENING—PROSTAGLANDIN E2 RISKS UTERINE HYPERSTIMULATION NONREASSURING FETAL STAUS HIGHER INCIDENCE OF POSTPARTUM HEMORRHAGE UTERINE RUPTURE

129 BIRTH RELATED PROCEDURES
CERVICAL RIPENING ADVANTAGES SHORTER LABOR LOWER REQUIREMENTS FOR OXYTOCIN IN LABOR VAGINAL BIRTH IS USUALLY ACHIEVED WITHIN 24 HOURS INCIDENCE OF CESAREAN BIRTH IS REDUCED

130 VERSION EXTERNAL EXTERNAL MANIPULATION INTERNAL USED TO DELIVER SECOND TWIN DURING VAGINAL BIRTH IF NOT DESCENDING OR IN DISTRESS--RARE

131 MODULE 2 PART 11B BIRTH PROCEDURES

132 BIRTH RELATED PROCEDURES
VACUUM EXTRACTION SUCTION CUP PLACED ON FETAL OCCIPUT PUMP IS USED TO CREATE SUCTION TRACTION IS APPLIED FETAL HEAD SHOULD DESCEND WITH EACH CONTRACTION

133 INDICATIONS FOR VACUUM EXTRACTION
PROLONGED SECOND STAGE OF LABOR NONREASSURING FETAL HEART RATE PATTERN USED TO RELIEVE PUSHING EFFORT (MATERNAL FATIGUE) WHEN ANALGESIA INTERFERES WITH ABILITY TO PUSH EFFECTIVELY BORDERLINE CPD (CEPHALO-PELVIC DISPROPORTION)

134 BIRTH RELATED PROCEDURES
VACCUM EXTRACTION MATERNAL RISKS NEONATAL RISKS

135

136 EPISIOTOMY SURGICAL INCISION OF PERINEUM TO ENLARGE OUTLET
RESEARCH—EVIDENCE BASED PRACTICE PREVENTATIVE MEASURES TWO TYPES: MEDIAN MEDIOLATERAL

137 BIRTH RELATED PROCEDURES
INDICATIONS FOR CESAREAN BIRTH CPD PLACENTAL ABRUPTION ACTIVE GENITAL HERPES UMBILICAL CORD PROLAPSE FAILURE TO PROGRESS IN LABOR PROVEN NONREASSURING FHR PATTERN COMPLETE PLACENTA PREVIA

138 BIRTH RELATED PROCEDURES
INDICATIONS FOR CESAREAN BIRTH BREECH PRESENTATION PREVIOUS CESAREAN BIRTH MAJOR CONGENITAL ANOMALIES CERVICAL CERCLAGE NON-REASSURING FHR PATTERNS

139 BIRTH RELATED PROCEDURES
CESAREAN BIRTH SKIN INCISIONS TRANSVERSE (PFANNENSTIEL) VERTICAL UTERINE INCISIONS TRANSVERSE SELHEIM (LOWER UTERINE SEGMENT) CLASSIC (UPPER SEGMENT OF CORPUS)

140

141

142 BIRTH RELATED PROCEDURES
PREPARATION FOR C-BIRTH MAJOR SURGERY SPINAL ANESTHESIA MANY TIMES PARENTS HAVE LITTLE TIME TO PREPARE PSYCHOLOGICALLY

143 BIRTH RELATED PROCEDURES
AMNIOINFUSION INCREASES FLUID VOLUME IN UTERUS BY INSTILLATION OF NORMAL SALINE INTO THE UTERUS DECREASES PRESSURE ON THE CORD—VARIABLE DECELERATIONS PROMOTES INCREASED PERFUSION TO FETUS CAN DILUTE HEAVY MECONIUM FLUID USED IN PRETERM LABOR WITH PPROM

144 BIRTH RELATED PROCEDURES
VBAC (VAGINAL BIRTH AFTER CESAREAN) CRITERIA: PREVIOUS C-BIRTH, LOW TRANSVERSE UTERINE INCISION AN ADEQUATE PELVIS NO OTHER UTERINE SCARS OR PREVIOUS UTERINE RUPTURE AN IN HOUSE PHYSICIAN AND ANESTHESIOLOGIST


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