Artificial Management of Labor Flashcards
induction
promotion of labor in a non laboring mother
- adv: labor in about 24-48 hrs
- dis: contractions less gradual, dysfunctional uterine contraction, inc blood discharge
what is a bishop score
the likelihood that a mom will deliver spontaneously
- the higher the score the better than chances
categories of bishop score
dilation
effacement
fetal station
cervical consistency
cervical position
what is an amniotomy
artificial rupture of the membrane
- use amnihook
- HCP or midwife
nursing intervention for amniotomy
- FHR
- date and time
- clear, bloody, meconium
- scant, moderate, copious
- foul odor
- start checking mom’s temp q 2 hours
types of induction
amniotomy
cervical ripening
stripping of membrane
pitocin
what is cervical ripening
mechanical induction that uses foley bulb
what is a foley bulb
balloon inserted into cervix that applies pressure
- pressure inc release of prostaglandins, which inc contractions and cramping
risks of cervical ripening
- uterine hyperstimulation
- non reassurring fetal states
- higher incidence of post partum hemorrhage
- uterine rupture
prostaglandin medications
cytotec
cervidil
cytotec (misoprostol)
given vaginally to stimulate contractions and thin cervix
- do start pit until 4 hours after (it will inc contractions)
- cant remove once placed
cervidil (dinoprostone)
given vaginally to stimulate contractions and to thin cervix
- bed rest for 2 hours
- pat dry after voiding
- remove by pulling strings
what is stripping of the membranes
separation of the amniotic membranes from the lower uterine segment which stimulates release of prostaglandins
- some bleeding
- OB, midwife, NP
administration of pit risks
- uterine tachysystole
- uterine rupture
- water intoxication
- non reassuring FHR
- post partum hemorrhage
what can water intoxication occur with pit and how do you treat it
pit has similar affects to ADH to inc water retention which causes hypoNa
- treat by stopping med, admin NS, and give furosemide
what must be done before starting pit
- reactive NST
- vaginal exam
- Bishop score
- sometimes used with foley bulb so would need to place
- titrate: inc 1-2 mu/30 mins
why are pit patients at risk for postpartum hemorrhage
uterus is overstimulated for so long that it stops reacting to the drug
- as a result the uterus doesnt contract anymore after birth and bleed
what a volutrol
allows for 2 hours of medication worth
- prevents bolus (bolus would cause constant contraction that would dec perfusion to the baby)
what is labor augmentation
stimulating labor that is naturally occurring
- have hypotonic contractions
- pitocin and AROM
what is an amnioinfusion
warmed NS or LR that is placed into uterus via IUPC
- fluid should still be leaking out of mother, if not SVE and lift baby’s head to release
why do you have an amnioinfusion
- replacement of lost or absence amniotic fluid
- repetitive variable decels with inc intensity (adding fluid prevents cord clamp)
- meconium dilution
what is an episiotomy
surgical incision of the perneum to enlarge the vaginal outlet
types of episiotomy
midline: straight down
mediolateral: to side at an angle
what is forceps assisted birth used for
- mother’s with heart disease
- acute pulm edema or pulm compromise
- intrapartum infection
- prolonged second stage
- exhaustion
- non reassuring fetal strip
what are the types of forceps
mid forceps: fetal head engaged
low forceps: fetal head at 2+
outlet forceps: fetal head at perineum
when do you use pull with forceps and vacuum
when the mother is contracting and pushing
maternal risks when use forceps
lacerations
extension of episiotomy
anal sphincter injury
perineal edema
neonatal risks when use forceps
bruising, edema
caput succedaneum or cephalhematoma
transient facial paralysis
cerebral hemorrhage
fractures
elevated bilirubin levels
nursing management for forcep births
- explain procedure
- monitor contractions
- push during contractions
- document length of time forceps used
*only used when indicated
what is vacuum assisted birth
suction cup placed on fetal occiput
- pull when mom contracts and pushes
- fetus should descent with each contraction
- document : pressure applied, pressure off, vacuum off (time used)
indications for a c/s
- complete placenta previa
- cephalopelvic disproportion
- placental abruption
- active genital herpes
- cord prolapse
- failure to progress
- tumor obstructing birth canal
- breech presentation
- previous c/s
- congenital abnormalities
- bad fetal status
types of c/s incisions
skin incision and muscle incisions are different
- skin: transverse (most common) and vertical
- muscle: low transverse, classical, low vertical
which is the best c/s incision
low transverse
- classical and low vertical inc risk for rupture later
nursing care before c/s
- epidural
- bolus
- pepcid and reglan and bicitra (neutralizes stomach acid)
- monitor VS
- FHR
- foley
- prepare abdomen and perineum
- all ppl and equipment
nursing care during c/s
- position: wedge to left tilt prior to delivery
- instrument count
- time out
- document: incision, delivery of infant, APGARS, AROM, placenta extracted, EBL (est. blood loss), meds given
what is supine hypotension and how to treat it
mom lays on back and baby squished vena cava
- place wedge on R hip to lie on L side
nursing care after c/s
- newborn care
- VS 15 mins
- surgical dressing
- palpate fundus
- check lochia
- I and Os
- admin oxy and pain meds
what is a vbac
vaginal birth after c/s
what is a tolac
trial of labor after c/s
- classified as this until the mom gives birth
vbac qualifications
- low transverse uterine incision
- adequate pelvis
- no other uterine scars or rupture
- HCP and anesthesia
referred pain
contractions felt else where in the body
visceral pain
slow, dull, achy pain
somatic pain
sharp and localized
- burning, tearing pain
- transition or push pain
systemic analgesia
provides maximum pain relief at minimum risk for the mother or fetus
- all meds cross placental barrier
- fetal liver and kidneys can metabolize meds so only admin when necessary
butorphanol tartrate
opioid
- onset 30-60
- mom: drowsiness, dizziness, fainting, hypotension
- fetus: resp depression
nalbuphine hydrochloride
opioid
- onset 15-20mins
- mom: resp depression, drowsiness
- fetus: resp depression
- higher doses don’t indicate inc risk of depression
*dont give to women with substance abuse problems
meperidine
opioid
- mom: resp depression, constipation, dizziness, itching
- fetus: neurobehavioral depression, resp acidosis
* not reversed by naloxone *
fentanyl
short acting opiate
- IV immediate response
- IM 5-7 mins
- mom: hypotension, N, V, resp depression
- fetus: some neurobehavioral depression
* short half life and rapidly crosses placenta*
naloxone
opioid reversal agent
- if mother had substance abuse problems, giving naloxone will inc risk for wdrawal seizures
regional anesthesia
temporary and reversible loss of sensation
- prevent initiation and transmission of nerve impulses for pain control
disadvantages or epidural
- maternal hypotension
- post delivery back pain
- meningitis
- cardiac arrest
- vertigo
difference between epidural and spinal anesthesia
epidural is constant medication into epidural space while spinal anesthesia is an injection and no catheter remains
nursing management prior to epidural
- maternal and fetal status
- assess labor process
- IV with warmed LR
- get into position
what position does a woman need to be in for an epidural
- chin to chest to round out back
- nurse should put hands on shoulder in support
what is the biggest thing you need to assess for after an epidural
bp for hypotension
how do you correct hypotension post epidural
- fluid bolus
- ephedrine will inc BP
- oxygen non rebreather
pudendal block
perineal anesthesia used during second stage of labor and episiotomy repair
advantages of pudendal block
ease of administration (to access nerve)
absence of maternal hypotension
disadvantage of pudendal block
urge to bear down may be decreased
- will need to push longer
general anesthesia
emergent deliveries
low platelet count
scheduled c/s delivery and unable to place spinal (scoliosis)
cricoid pressure
diminished chance of aspiration during placement of endotracheal tube for general anesthesia
- press on cartilage to close until anesthesia tells you to lift
potential problems with anesthesia
- fetal resp depression
- sore throat
- higher risk of aspiration
- inc risk of postpartum hemorrhage
- less feeling of control
- everyone misses birth
