Class 6: Intrauterine Resus, C-Section

Question 1

what is included in intrauterine resus for abnormal and atypical FHR pattern (4)

Answer 1

• change maternal position (to left or right lateral)
• stop or decrease oxytocin (if applicable)
• improve maternal hydration (ex. IV bolus)
• perform vaginal exam to assess progress in labor or relieve pressure of presenting part on cord

Question 2

what 2 interventions can be considered w intrauterine resus

Answer 2

• admin of O2 (only if maternal O2 sats low)
• amnioinfusion (only if worried abt oligohydramnios)

Question 3

what are maternal indications for forceps assisted birth

Answer 3

• shorten second stage in event of dystocia

Question 4

what are fetal indications for forceps assisted birth (4)

Answer 4

• abnormal FHR tracing
• abnormal presentation
• arrest of rotation
• delivery of head in a breech presentation

Question 5

forceps can be used in birth to..

Answer 5

• make basic changes to fetal head, can increase flexion

Question 6

for forceps assisted birth, what is the criteria? (5)

Answer 6

• fully dilated
• membranes should be ruptured
• presenting part engaged
• bladder fully empty
• want vertex position

Question 7

what is the nurses role in forceps assisted birth (4)

Answer 7

document
- time when forceps were applied
- how long each pull occurs
- document on FHR tracing to see how pulling impacts FHR
- work w birther to encourage pushing

Question 8

what is the nurse’s role after a forceps assisted birth (3)

Answer 8

• monitor for bleeding
• assess for fractures or injuries in skin
• monitor for lacerations, vaginal bleeding, injuries to maternal tissue

Question 9

what fetal & maternal risks are associated w forceps assisted birth

Answer 9

• maternal: forceps may catch vagina, cervix, hematoma, injuries to bladder
• fetus: trauma (ex. fracture) to skull

Question 10

what is vacuum assisted birth

Answer 10

• attachment of vacuum cup to fetal head, using negative pressure to assist birth of head

Question 11

what risks to the newborn are there w vacuum assisted birth (3)

Answer 11

• cephalhematoma
• scalp lacerations
• subdural hematoma

Question 12

what is the criteria for vacuum-assisted birth (4)

Answer 12

• should be fully dilated
• membranes should be ruptured
• presenting part engaged
• bladder empty

Question 13

what is the nurse’s role for vacuum assisted birth (6)

Answer 13

• document any pop offs of the vacuum
• document timing of each pull and note on FHR monitor
• notify physician when contraction starts
• work w birther to encourage pushing efforts @ time of pulls
• monitor FHR closer
• document when suction places

Question 14

what maternal and fetal (4) risks are there w vacuum assisted birth

Answer 14

• maternal: maternal issue to tissue
• fetal: abrasions to fetal scalp, hematoma, jaundice, kaput (swelling @ newborn head)

Question 15

what is the difference between vacuum and forceps assisted birth

Answer 15

• vacuum = cannot adjust head, more common, less skill required

Question 16

what is a trial of labor

Answer 16

• observance of a woman and her fetus for a reasonable period of spontaneous active labor to assess the safety of vaginal birth for both

Question 17

trial of labor is evaluated for.. (3)

Answer 17

the occurrence of active labor including:
- adequate contractions
- engagement and descent of the presenting part
- dilation of cervix

Question 18

TOL may occur with…

Answer 18

• conditions where we think fetus might not tolerate birth but arent sure

Question 19

what are examples of conditions where TOL is done (2)

Answer 19

• oligohydramnios
• issues w FHR

Question 20

what are indications for primary c-section birth (3) what is the occurrence of these

Answer 20

• dystocia
• breech presentation
• abnormal FHR patterns
• these are often nonrecurring

Question 21

describe vaginal birth after c-section (VBAC)

Answer 21

• a woman who has had a c-section may subsequently become pregnant and not have any contraindications to labor and vaginal birth in that pregnancy and may attempt a VBAC

Question 22

VBAC will only be allowed if..

Answer 22

• they have had 1 previous c-section
• if the previous c-section was a lower segment, not classical

Question 23

what is a c-section

Answer 23

• transabdominal incision of uterus

Question 24

what are indications for c-section

Answer 24

• preserve life or health of mother & her fetus

Question 25

a c-section can be.. (2)

Answer 25

• elective
• scheduled
• unplanned
• forced

Question 26

what surgical techniques can be used for a c-section

Answer 26

• classic
• lower segment (low transverse, low vertical)

Question 27

what is a classical c-section

Answer 27

• cut thru the uterus down the middle

Question 28

a classical c-section can cause?

Answer 28

• ruptured uterus w any contraction

Question 29

why might a classical c-section be done

Answer 29

• preterm infants (bc lower segment is very low or in the pelvis)

Question 30

an elective c-section for an uncomplicated pregnancy can be chosen in 2 scenarios:

Answer 30

• if a previous c-section wad done & mother can try for vaginal but doesnt want to
• uncomplicated twins

Question 31

describe anesthesia use during c-section; why is this?

Answer 31

• avoid GA
• can cause neonatal resp depression

Question 32

where is lower segment incision done?

Answer 32

• close to the vaginal hairline

Question 33

what is included in preop care for a c-section (7)

Answer 33

• CBC
• T&S
• BW
• foley
• IV
• stocking for DVT
• antibiotics

Question 34

what is included in intraop care for c-section (2)

Answer 34

• emotional support for birther and partner
• epidural

Question 35

what is included in postop care for c-section

Answer 35

• pain relief
• discharge teaching and planning