MCN 4F Flashcards
Use of stainless instruments or vacuum extraction
Mechanical
use of medications
Chemical Procedures
Labor has started artificially
Administration of medicines
Induction of Labor
Total absence of pain
Anesthesia
Abdominal incision in the uterus
Cesarean Delivery
Normal Spontaneous Vaginal Delivery
Normal Delivery
Obstetrical forceps
Stainless steel and they been sterilized
Forceps Delivery
uses vacuum device to assist in extracting delivery
Vacuum Extraction Delivery
Increase by rupturing the amniotic membrane and so there will be an escape of amniotic fluid
Amniotomy
What do you do when cord prolapse happens or cord escapes vagina?
Immediately cover the exposed cord with sterile saline compress to presenting part
Prior to Amniotomy
Dorsal recumbent position
After amniotomy
Time as to when the amniotic membrane has been ruptured followed by assessing for fetal heart rate
Active Genital Herpes/ Human Papillomavirus
AIDS/HIV
Cephalopelvic Disproportion
Cervical Cerclage
Disabling conditions
Failed induction
Obstructive benign or malignant tumor
Previous cesarean birth
Fear of birth
Risk for Operative Delivery: Maternal Factors
Cesarean is advisable because this disease could be transmitted to the baby
Active Genital Herpes/Human Papillomavirus
Pelvis is not conducive for normal delivery
Cephalopelvic Disproportion
Stitching of the cervix due to cervical weakness
Cervical Cerclage
It is when there is attaching of the placenta inside the uterus but is normally positioned near or lower or over cervical opening
Placenta Previa
This would put the life of the baby at risk for possible compression of the cord and lack of oxygen
Umbilical Cord Prolapse
Placenta Previa
Premature Separation of the Placenta
Umbilical Cord Prolapse
Risk for Operative Delivery: Placenta
Macrosomic fetus in breach lie
Extreme low birth weight
Risk for Operative Delivery: Fetal
Initiated before the time when it would have occurred spontaneous contractions
Mother has not started labor yet but fetal heart rate is not normal
Done because fetus is endager
Induction of Labor
Assisting labor that has started
When contractions become weak, irregular, or ineffective
Augmentation of Labor
Pre-eclampsia
Eclampsia
Severe Hypertension
Diabetes
Rh Sensitization
Prolonged ruptured of membranes
Intrauterine growth restrictions and post maturity
Indications of Induction of Labor
Onset of high blood pressure and often a significant amount of protein in the urine
Pre-eclampsia
When there is incompatibility of Rh between the mother and baby
Rh Sensitization
Complete placenta previa
Abrupto Placentae
Transverse Fetal Lie
Prolapsed Umbilical Cord
Prior classic uterine incision that entered uterine cavity
Cephalopelvic Disproportion
Previous Myomectomy
Unknown cause of vaginal bleeding
Invasive Cervical Cancer
Active Genital Herpes
Abnormal FHR patterns
Contraindications of Induction of Labor
When there is an attachment of the placenta near or over cervical opening
Complete placenta previa
Placenta separates early from the uterus before childbirth
Abrupto Placentae
Ultrasound
Pelvimetry
Nonstress Test
Phophatidglycerol
Nitrazine paper or Fern test
CBC and Urinalysis
Vaginal Examination
Considerations of Induction of Labor
It is a glycophospholipid that is found in pulmonary surfactant in the membrane
Phosphatidglycerol
check if there is a premature rupture of membrane wherein upon testing the vaginal fluid, we detect that there will be a change of color
Nitrazine Paper Test
Oxytocin Injection
Amniotomy
Nipple Stimulation
Methods of Induction
A synthetic form of naturally occurring pituitary hormone that can be used to initiate labor contractions
Oxytocin
Other name for Oxytocin
Pitocin
30 is mixed with oxytocin in 1000mL of Ringer’s Lactate
Solution
Inadequate uterine contractions
Premature rupture of membranes
Post term pregnancy
Fetal Demise
Indications of Oxytocin
CPD, Cord Prolapse, Transverse Lie
Placenta Previa
Prior Classic Uterine Incision
Active Genital Herpes
Invasive Cancer of the Cervix
Contraindications of Oxytocin
40-90 mmHg
40-90s
2-3min Interval
1cm/hr
Criteria to maintain dose
Uterine Hyperstimulation
Non reassuring fetal heart rate pattern
Suspected uterine rupture
Inadequate uterine response at 20 mU/min
Reportable Conditions
Odorless
Clear/Straw
pH: 7-7.5
Characteristics of Amniotic Fluid
Increases the efficiency of contractions and therefore increase the speed of labor
Advantage of Amniotomy
Puts the fetus at risk for cord prolapse
Disadvantage of Amniotomy
Identify rupture of amniotic sac
Nitrazine Test
Green to Blue
presence of amniotic fluid
Yellow
No presence of amniotic fluid
Used to determine if the blood cells are maternal or fetal
Maternal: remains colorless
Fetal: turns purple pink
Klelhauer-Betke (Kleihauer-Betke)or Fetal Cell Blood Test
Helps release hormone oxytocin
Shortens labor
Avoids cesarean
Nipple Stimulation
Surgical incision of the perineum made to prevent tearing of the perineum
Episiotomy
Incision made with blunt-tipped scissors in the midline of the perineum
Midline Episiotomy
Less painful
Heals easily
Decreases blood loss
Less postpartum discomfort
Midline Episiotomy
Begun in the midline but directed away from the rectum
Creates less danger of a rectal mucosal tear
Mediolateral
Surgical repair of injury to the vulva by suturing
Episiorraphy
Monitor Vitals
Observe Aeseptic Technique
Support Perineum properly
During/Immediate Nursing Responsibilities for Episiotomy
Do perineal care
Apply ice pack or cold compress within three hours
Provide hot sitz bath
Render perilite exposure after 24hrs
After/Postpartum Nursing Responsibilities for Episiotomy
Primigravida
Macrosomic Fetus
Output Posterior Position
Forceps or Vacuum Extractor
Shoulder Dystocia
Factors that Predispose to Episiotomy
is the change in cervical consistency from firm to soft
Cervical Ripening
Prostaglandin E1: Misoprostol (Cytotec)
- encourage faster delivery of the baby since your cervix is ripe and soft to facilitate labor
Prostaglandin E2: Dinoprostone (Cervidil)
- used before induction to ripen
Chemical Agents
Laminaria tents
Hydroscopic dilators
Synthetic dilators
Stripping the membranes
Mechanical Methods of Cervical Ripening
Natural cervical dilators made from seaweeds
Laminaria tents
substances that absorb fluid rom surrounding tissues and then enlarge
Hydroscopic dilators
inserted into the endocervix without rupturing the membranes
Synthetic dilators containing magnesium sulfate (Lamicel)
separating the membrane from the lower uterine segment
Stripping the membranes
Prevent pressure from being exerted on the fetal head
Avoid subdural hemorrhage in the fetus as fetal head reaches perineum
Purpose of Forceps Delivery
Mother at Risk
Fetal Conditions
Cessation of progress in the 2nd stage of labor
Indications of Forceps Delivery
forceps are applied when the fetal skull has reached the perineum
scalp is visible between the contractions
sagittal sutures is not more than 45 degrees from the midline
Outlet Forceps
presenting part of the skull must be at a station of +2 or below (+3) but not on the pelvic floor
rotation of the fetal head less than 45 degrees
Low Forceps
Fetal head must be engaged but the presenting part is above station +2 (+1, 0, -1, -2)
Midforceps
Membranes must be ruptured
CPD is not present
Cervix must be fully dilated to avert lacerations and hemorrhage
Presenting must be engaged
Woman’s bladder must be empty
Conditions before Forceps Delivery
Barton
Kielland’s
Piper
Simpson’s
Tarnier’s
Types of Forceps Delivery
used to rotate fetal head to a more favorable position (ROP-ROA)
Barton
with short handles and marked cephalic curve
Kielland’s
used to deliver head in breech position
Piper
used most commonly as outlet forceps
Simpson’s
axis traction forceps
Tarnier’s
Laceration of Vaginal Canal
Cerebral Trauma of the Baby
Low IQ
Increased perinatal morbidity and mortality
Complications of Forceps Delivery
Birth method involving the attachment of a vacuum cup to the fetal head, using negative pressure to assist in the birth of fetal head
Vacuum Extraction Delivery
Little Anesthesia
Fever Lacerations of the Birth Canal occur
Advantages of Vacuum Delivery
causes marked caput that may be noticeable as long as 7days after birth
Tentorial tears from extreme pressure
Disadvantages of Vacuum
Prolonged Labor
Mother with Cardiopulmonary
Mother with high BP
Indications of Vacuum Extraction
Preterm (soft skull)
Fetus who undergone scalp blood sampling
Contraindications of Vacuum Extraction
pressure that is applied to the fetal head
Some under material complications:
Perennial
Vaginal cervical laceration of soft tissue trauma
Risk of Vacuum Extraction
Cephalohematoma
Scalp Laceration
Subdural Hematoma
Newborn Complications
turning of the fetus ap from one presentation to another; externally or internally
Version
externally moving by massaging the client’s abdomen
breech to cephalic
attempted in labor and birth setting after 37 weeks of gestation
Tocolytic agent such as Magnesium sulfate is given to relax the uterus
No contraindications to be happening to manipulate with administration of tocolytic agents
tocolytic agents given IM near buttocks
External Cephalic Version
Uterine anomalies
Previous cesarean
CPD
Placental Previa
Multifetal
Oligohydramnios (deficiency of amniotic fluid)
Rh incompatibility
unexplained 3rd trimester bleeding
Ruptured amniotic membrane
History of Premature labor
Contraindications of External Cephalic Version
Continuously monitor FHR esp Bradycadia
Check maternal VS
Ultrasound must be recorded continuously
Assess woman’s level of comfort
Nursing Responsibilities of External Cephalic Version
Fetus is turned by the physician who inserts a hand into the uterus and changes the presentation
May be used for multifetal
Internal Version
Lack of Anesthesia
Unskilled healthcare team member in internal podalic version
Retracted cervix or contracted thickened uterus
Contraindications for Internal Version
Support from a doula or couch doula
Hypnosis
Acupressure
Yoga
Nonpharmacologic Methods for Intrapartum Pain Management
emphasized the use of relaxation and proper breathing with contractions as well as family support
Dick-read method
combines relaxation, concentration, focusing, and complex well paced breathing patterns to reduce perception of pain through conditioned response of labor contractions
Lamaze Method
husband takes a active role in assisting the woman to relax during labor and use correct breathing techniques
Bradley Method
Given in labor because of analgesia effect
contraindicated in preterm labor
Narcotic Analgesics
Demerol (meperidine hydrochloride)
Morphine sulfate
Nalbuphine
Fentanyl
Naloxone
Narcotic Analgesics
has additional sedative and antispasmodic actions
crosses the placental barrier thereby causing fetal depression
Demerol (meperidine hydrochloride)
narcotic antagonist should be available
Naloxone (Narcan)
compliments the action of narcotics
Sedative-Hypnotics and Ataratics
Secobarbital sodium (seconal)
Promethazine (phenergan)
Sedative-Hypnotics and Ataratics
patient administer doses of IV narcotic analgesics
Patient Controlled Analgesia
Transmission of electrical impulses/current across the skin
two electrodes are positioned on each side of the abdominal surgical incision
effective in controlling pain
Transcutaneous Nerve Stimulation
injection of a local anesthesia to block specific nerve pathways interspace
Regional Anesthesia
injection of bupivacaine (Marcaine) into the subarachnoid space at the level of 3 rd and 4th lumbar interspace
block nerves and suspend sensation and motion to the black nerves and suspend sensation and motion to the lower extremities, perineum and lower abdomen
Spinal Anesthesia
Hypotension - validation
turn the woman to her left side to reduce a vena cava compression
Spinal Headache - advise lie flat and administer analgesic
Epidural - introduced in epidural space
blocks sympathetic nerve in order to increase contraction strength and blood flow to the uterus
Side Effect: Spinal Headache rarely happens (painless delivery)
Major Complications
used with heart problem, pulmonary disease
diabetic mother
Advantage of Regional Anesthesia
Induced hypotension
Nursing Responsibilities
Injection in the right or left pundendal nerves level with ischial spine
dorsal recumbent
provides relief in perineal
check FHR and maternal bo
2-10 mins for effect and lasts 60 mins
given if there will be a Physiography or the repair of surgical side of episiotomy
Local Anesthesia (Pudendal Block/Pudendal Nerve Block)
never preferred for childbirth due to hypoxia, possible inhalation of vomitus
General Anesthesia
Inhalant (nitroud axide, Halothanol)
Intravenous (Penthotal)
General Anesthesia
Ephedrine - used when blood pressure falls
Atropine Sulfate - dry and respiratory secretions to prevent aspiration
Thiopental Sodium- rapid induction of general anesthetic in an emergency
Succinylcholine - to achieve laryngeal relaxation for intubation in an emergency
Diazepam - controls convulsions
Isoproterenol - reduce bronchospasm
General Anesthesia: Drugs that should be readily available
done to preserve life of the mother and her fetus
Cesarean Delivery
Dystocia
Placenta Previa
Fetal Distress
Multiple births
Large tumors of the uterus
Genital herpes or infections
Uncontrolled diabetes or hypertension
Indications for Cesarean
IV Line
Catheter
Regional/General Anesthesia
Prior to Cesarean
3-5 day hospital stay
Breastfeed, nap when the baby sleeps, get out of bed
6-8 weeks full recovery
Scar lightens as it heals
After Cesarean
Scheduled & Emergency Cesarean
2 Types of Cesarean Section
CPD
Severe Hypertension during pregnancy
Active Genital Herpes
Previous C-section
Indications Maternal Factors
Transverse fetal lie
breech presentation
fetal distress
extreme low birth weight
macrosomic
multifetus
Indications Fetal Factors
Placenta previa
Abrupto Placentae
Indications Placental Factors
Incision made Vertically
Classical Incision
bigger space
larger version, less trauma
used in placenta previa
Advantage for Classical Incision
most common type
pfannestiel incision or bikini incision
Low Segment Incision
less uterine rupture
less blood loss
easier suture
less likely to cause gastrointestinal or postpartum complications
Advantages of Low Segment Incision
interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state
Postpartum Period
Contraction of Muscle a fibers
Catabolism - process of converting cells into simpler compounds
Regeneration of uterine epithelium
Involution of Uterus
T/F: Immediately after the delivery of the uterus is about the size of a grapefruit and weighs 1000g (2.2lbs)
TRUE
How many hours until the fundus rises about the level of the umbilicus?
within 12hours
What day does the fundus descends one fingerbreadth per day?
2nd Day
are composed of vaginal blood tissue and nucleus loss after birth lasting up to 6-8 weeks
Lochia
1-3 days
Blood with small particles of decidua and mucus
large clots, saturated pad, foul odor
Lochia Rubra
3-10 days
Serous exudate, leukocytes, erythrocytes, and cervical mucus
Excessive amount, foul smell, continued recurrent reddish color
Lochia Serosa
10-14 could last until 6 weeks (yellow or white)
leukocytes, decidua, epithelial cells, fat and cervical mucus
Persistent lochia serosa, return to lochia rubra, foul odor, continuing discharge
Lochia Alba
Immediately after childbirth the cervix is formless, flabby, and open wide
healing is rapud
firm and dilated the first week
Cervix
Round cervix
Nulliparous
Cervix shape remain slightly open and appears slitlike
Parous
Intermittent contractions and are source of discomfort
Afterpains
Afterpains
Ice packs on abdomen
Prone position with pillow under abdomen
Cause by episiotomy wound or laceration
Perineal Pain
Perineal Pain
provide ice packs on the 1st 24hrs
Perilite and Hot sitz after 24hrs
Perineal care - prevent infections
Analgesics as ordered
Mother experiences diaphoresis
Sweating or Excessive Perspiration
Sweating or Excessive Perspiration
Offer fresh dry gown
Encourage showers
Increase fluid intake
Nipple Soreness
Rotate breast feeding positions
Instruct mother to use finger to break suction before removing infant
Cold compress
Breast support
Urinary Incontinence
Kegel exercises
hot tea
running water in sink
pouring water over vulva
Mother is focused primarily on her own need for fluid, food, and sleep
1-3 day woman is passive
Major Task: Integrate her birth experience to reality
Taking In Phase
Mother becomes more independent
3-10 days
Optimum time to teach about baby care
Taking Hold Phase
Woman finally redefines her new role
Gives up fantasy image and accepts real one
Happens when her own needs are no longer predominate
Letting Go Phase
Major Role Attainment
Anticipatory Stage
Formal Stage
Informal Stage
Positive Stage
Concerned about regaining their normal figure and may have unrealistic expectations
Concerns on Body Image
Baby blues, maternity blues or mild depression
last no longer than 2 weeks
insomnia, fatigue, mood instability, anxiety
Postpartum Blues
34-35cm Head Circumference
32-33cm Chest Circumference
30-33cm Abdomen
7.5-13cm Midarm
47-52cm Length
2.5-4kg Weight
Measurements of a Newborn
Bluish black marks that resembles bruises on the sacrum, buttock, arms and shoulders
Mongolian Spots
Thick white substance that provides protective covering opportunities the fetal skin in the uterus
Vernix Caseosa
Fine hairs that covers the fetus during intrauterine life
Lanugo
White spots
1-2mm in size
caused by distention of sebaceous glands
Milia
sign of Dehydration
Sunken Fontanelle
Newborn is experiencing Intracranial Pressure/Hydrocephalus
Bulging Fontanelle
Placement of a newborn with its mother rather than nursery
Rooming In
father’s developing bond with the newborn
Engrossment
Position that allows eye to eye contact between the newborn and parent
En face
Factors that Affect Adaptation
Lingering discomfort or pain
Chronic fatigue
Knowledge of infant needs
Available support system
Expectations of newborn
Previous experience with infants
Maternal temperament
Infant characteristics
Preparation of Breasts (Mammogenesis)
Synthesis and Lactation (Lactogenesis)
Ejection of Milk (Galactokenesis)
Maintenance of Lactation (Galactopesis)
4 Phases in the Physiology of Lactation
Composition of Breast Milk
Colostrum
Transitional Milk
Mature Milk
Initial Goals once the baby is out
Airway
Warmth
Signs of Respiratory Distress
Retractions
Nasal flaring
Cyanosis
