OB procedures (unit 3) Flashcards
external cephalic version (ECV)
- manually change fetal position using abdominal manipulation
- 37-39 wks
- used to prevent C/S d/t breech
contraindications for ECV
- previous C/S
- placenta previa (can’t deliver vag anyway)
- twins
- oligohydramnios
- uterine anomalies
- abruption/UPI
risks r/t ECV
- umbilical tangle
- fetal hypoxia
- placental abruption
- Rh iso-immunization
- SROM
labor induction
- artificial stimulation of labor when pt is not in labor
* medical OR elective
labor augmentation
•artificial stimulation of labor when pt is IN labor, but not progressing appropriately
indications for induction
•pre-eclampsia/PIH •SROM at term •maternal medical problems •chorioamnionitis •IUGR, post term, incompatibility •IUFD *NOT convenience
elective induction for convenience
•not recommended, but done •should be considered if -hx of rapid labor & far from hospital -specialized neonatal care needed -41 wks PG
39 week rule
•no elective inductions prior to 39 wks GA b/c too many risks
risks r/t induction
- hypertonic ctx
- placental abruption
- uterine rupture
- postpartum hemorrhage
- C/S
natural induction
- breast/nipple stimulation
- sex
- acupuncture/pressure
mechanical induction (cervical ripening)
- balloon cath
- laminaria tent
- osmotic dilators
- membrane stripping
- amniotomy (AROM)
chemical induction
•nonhormonal -herbs/oils -enemas •hormonal -oxy -prostaglandins -misoprostol, mifepristone if goal is to soften cervix first
pitocin
- synthetic form of oxytocin
- causes uterine ctx
- short t1/2
- lower dose needed in augmentation
pitocin admin
•always mix IVPB •always use pump •attach as close to insertion site as possible •start low and slow -titrate until desired result
tachysystole
•hyper stimulation of uterus
•ctx > 90 sec
• > 5 U ctx in 10 min
*causes late decel, abnormal FHR, loss of variability
intrauterine resuscitation for tachystytole
- pt on side
- stop pit
- open main fld. line
- O2 @ 10L
- vag exam (r/o prolapse)
- have Brethine 0.25 mg SQ ready
Brethine (Terbutaline)
- muscle relaxer
* relaxes uterus
hemorrhage r/t Pitocin
•PP risk
•all receptors saturated so uterus can’t clamp down anymore
*uterine atony from Pit
Bishop score
- estimates how successfully woman’s labor can be induced by determining if her cervix is favorable
- based on dilation, effacement, station, consistency, & postion
readiness for induction
- Bishop score of 9+ for nullips
* 5+ for multip
cervical ripening
•chemically/mechanically softened day before labor
•thins, allowing for successful induction
*do before inducing if have low Bishop score
mechanical cervical ripening
- hydrophobic insertion
- attracts liquid, swelling and dilating cervix
- Laminaria/Lamicel
- takes 8-12 hrs
chemical cervical ripening
- Cervidil (Dinoprostone)
* Cytotec
amniotomy
•AROM •induce/augment labor •done only if fetal station low and cephalic fetus *labor w/in 12-24 hr *WONT shorten labor
RN role amniotomy
•FHR
•assess amniotic fld. (color, odor, amnt)
•bedpan if have to urinate
*excessive fld indicates poly and high station
risks r/t amniotomy
- cord prolapse
- infection (fetal tachy)
- abruptio placenta
DONT let woman ambulate if…
•ROM and high fetal station
*should not perform amniotomy if head not well-applied to cervix
forceps/vacuum extraction
•operative vaginal delivery that provides traction and aids in descent/rotation of fetus in 2nd stage
*can’t use for preterm
indications for operative vaginal delivery
- maternal exhaustion
- inadequate pushing
- cardiac/pulmonary dz
- fetal HRN abnormality if can’t do C/S fast enough
- breech (get head out)
maternal risks r/t operative vaginal delivery
- bladder injury
- cervical laceration
- vaginal laceration/hematoma
fetal risks r/t operative vaginal delivery
- facial/scalp abrasion/asymm
- nerve injury
- cephalohematoma
- intracranial hemorrhage
- scalp edema (caput)
- shoulder dystocia
RN role episiotomy
- ice
- monitor infection
- NEVER give enema/suppository
- PO stool softeners
indications for C/S
- placental abnormality
- PIH
- dysfxnl labor
- herpes/HIV
- IDDM
- previous C/S
- cord prolapse
- fetal distress
- breech presentation
- multip
C/S contraindications
*if risk to mom > than baby
•IUFD
•clotting dz
•fetal dz incompatible w/ life
maternal risks r/t C/S
- infection
- hemorrhage
- bladder/organ damage
- DVT
- paralytic ileus
- psychological
fetal risks r/t C/S
- TTN r/t retaining lung fld.
- injury
- respiratory distress
C/S incision types
- low transverse (preferred)
- low vertical
- classical (high vertical)
when is classical C/S incision employed
•very premature •placenta previa •emergency birth •morbid obesity *shouldn't labor in subsequent PG
vaginal birth after C/S
- only if was LTCS
- only if 1 prior C/S
- induce w/ Pit
- have anesthesia and MD ready
