Intrapartum Part 2 Flashcards
Ceserean Birth
surgical delivery of the fetus that is performed when awaiting a vaginal birth would compromise the mother, fetus or both
birth of infant through abdominal and uterine incision
Indications for C/S
- dystocia (diff or prolonged labor)
- CPD (cephalopelvic disproportion)
- severe gest. HTN when delivery is needed
- maternal diseases when labor is not advisable
- active genital herpes
- previous uterine surgical procedures, where the upper uterus has been incised
- persistent non reassuring FHR patterns
- prolapsed umbilical cord
- breech, transverse position
- hemorrhagic conditions: abruptio placenta, placenta previa
Skin incisions
vertical
transverse: Pfannenstiel (bikini cut)
uterine incisions
lower uterine segment -transverse -vertical classic incision -upper uterine segment (no longer used)
General anasthesia
most often used for emergency C/S
RN interventions general anastesia
risk for regurgitation and aspiration
watch for s/s resp distress, give pain relief PRN
epidurals
spinal, combined epidural-spinal
less risk than general anasthesia
pain relief
requires informed consent- invasive procedure
Epidural Block
local anesthetic is injected into the epidural space to provide pain relief from waist down
Epidural block side effects
maternal hypotension, bladder distention, prolonged 2nd stage, catheter migration, itching, n/v, resp depress, shivering
Epidural block RN management
prehydrate, baseline vs, assess BP, bladder asssessments
monitor for HA, may need blood patch if spinal HA occurs
monitor FHR: late decels
Spinal block
injection of anesthetic directly into subarachnoid space, total loss of sensation, used for c/s
Spinal Block side effects
risk for hypotension, headache following procedure, fetal hypoxia, resp depression
Spinal Block RN management
keep well hydrated
assess RR per protocol
have easy access to Narcan
