Class 6: Intrauterine Resus, C-Section Flashcards
what is included in intrauterine resus for abnormal and atypical FHR pattern (4)
- 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
what 2 interventions can be considered w intrauterine resus
- admin of O2 (only if maternal O2 sats low)
- amnioinfusion (only if worried abt oligohydramnios)
what are maternal indications for forceps assisted birth
- shorten second stage in event of dystocia
what are fetal indications for forceps assisted birth (4)
- abnormal FHR tracing
- abnormal presentation
- arrest of rotation
- delivery of head in a breech presentation
forceps can be used in birth to..
- make basic changes to fetal head, can increase flexion
for forceps assisted birth, what is the criteria? (5)
- fully dilated
- membranes should be ruptured
- presenting part engaged
- bladder fully empty
- want vertex position
what is the nurses role in forceps assisted birth (4)
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
what is the nurse’s role after a forceps assisted birth (3)
- monitor for bleeding
- assess for fractures or injuries in skin
- monitor for lacerations, vaginal bleeding, injuries to maternal tissue
what fetal & maternal risks are associated w forceps assisted birth
- maternal: forceps may catch vagina, cervix, hematoma, injuries to bladder
- fetus: trauma (ex. fracture) to skull
what is vacuum assisted birth
- attachment of vacuum cup to fetal head, using negative pressure to assist birth of head
what risks to the newborn are there w vacuum assisted birth (3)
- cephalhematoma
- scalp lacerations
- subdural hematoma
what is the criteria for vacuum-assisted birth (4)
- should be fully dilated
- membranes should be ruptured
- presenting part engaged
- bladder empty
what is the nurse’s role for vacuum assisted birth (6)
- 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
what maternal and fetal (4) risks are there w vacuum assisted birth
- maternal: maternal issue to tissue
- fetal: abrasions to fetal scalp, hematoma, jaundice, kaput (swelling @ newborn head)
what is the difference between vacuum and forceps assisted birth
- vacuum = cannot adjust head, more common, less skill required
what is a trial of labor
- observance of a woman and her fetus for a reasonable period of spontaneous active labor to assess the safety of vaginal birth for both
trial of labor is evaluated for.. (3)
the occurrence of active labor including:
- adequate contractions
- engagement and descent of the presenting part
- dilation of cervix
TOL may occur with…
- conditions where we think fetus might not tolerate birth but arent sure
what are examples of conditions where TOL is done (2)
- oligohydramnios
- issues w FHR
what are indications for primary c-section birth (3) what is the occurrence of these
- dystocia
- breech presentation
- abnormal FHR patterns
- these are often nonrecurring
describe vaginal birth after c-section (VBAC)
- 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
VBAC will only be allowed if..
- they have had 1 previous c-section
- if the previous c-section was a lower segment, not classical
what is a c-section
- transabdominal incision of uterus
what are indications for c-section
- preserve life or health of mother & her fetus
a c-section can be.. (2)
- elective
- scheduled
- unplanned
- forced
what surgical techniques can be used for a c-section
- classic
- lower segment (low transverse, low vertical)
what is a classical c-section
- cut thru the uterus down the middle
a classical c-section can cause?
- ruptured uterus w any contraction
why might a classical c-section be done
- preterm infants (bc lower segment is very low or in the pelvis)
an elective c-section for an uncomplicated pregnancy can be chosen in 2 scenarios:
- if a previous c-section wad done & mother can try for vaginal but doesnt want to
- uncomplicated twins
describe anesthesia use during c-section; why is this?
- avoid GA
- can cause neonatal resp depression
where is lower segment incision done?
- close to the vaginal hairline
what is included in preop care for a c-section (7)
- CBC
- T&S
- BW
- foley
- IV
- stocking for DVT
- antibiotics
what is included in intraop care for c-section (2)
- emotional support for birther and partner
- epidural
what is included in postop care for c-section
- pain relief
- discharge teaching and planning
