Procedures to Facilitate Delivery Flashcards
What is the purpose of forceps?
Aids in descent / internal rotation of the fetal head
______ is needed for forceps delivery
Epiostomy
Describe the process of vacuum extraction (2)
- Cup is applied to the head
- Traction is applied during contractions
What are the advantages of vacuum extraction? (3)
- Anesthesia not needed
- Decreased bladder trauma
- Decreased perineal lacerations
What is the most important requirement for the use of vacuum extraction?
MUST be 10 cm dilated with ROM
The time of vacuum extraction application should not exceed ______
30 minutes
Describe the education associated with vacuum extraction
Trauma to the baby’s head will resolve within 48 - 72 hours
What are the indications of forceps / vacuum extraction? (4)
- Maternal exhaustion / ineffective pushing
- Prolonged second stage of labor
- Failure of internal rotation
- Non-reassuring FHR
What are the contraindications of forceps / vacuum extraction? (3)
- Severe fetal compromise
- High fetal station
- CPD
What maternal complications are associated with forceps / vacuum extraction? (3)
- Uterine rupture
- Hematoma
- Laceration
What fetal complications are associated with forceps / vacuum extraction? (5)
- Ecchymosis
- Facial nerve injury
- Intracranial hemorrhage
- Caput succedaneum
- Cephalhematoma
What is caput succedaneum?
Clear fluid accumulation around the fetal skull
What is cephalhematoma?
Blood accumulation around the fetal skull
What is an episiotomy?
Surgical incision of the perineum
When can an epiostomy be performed?
Just before birth - typically during crowning
What are the types of epiostomy incisions? (2)
- Midline
- Mediolateral
What are the advantages of a midline epiostomy? (3)
- Decreased blood loss
- Decreased scarring
- Decreased postpartum pain
What are the advantages of a mediolateral epiostomy? (2)
- Creates larger vaginal opening
- Decreased risk of laceration extending into anal sphincter
What are the indications of an epiostomy? (2)
- Premature infant - to ease passage of the fetal head
- Fetal distress - to shorten the second stage of labor
Why might an epiostomy be used for cardiac / pre-eclamptic patients?
To prevent HTN from bearing down
What factors contribute to perineal stretching / increased need for an epiostomy? (4)
- Primigravida
- Macrosomia
- Breath holding during pushing
- Occiput posterior presentation
When is epiostomy repair typically most painful?
When only a few remaining stitched are required - local anesthetic worn off
Describe the frequency of ice pack application following forceps delivery / vacuum extraction / epiostomy
Apply for 30 minutes, remove for 20 minutes, repeat
What is the method of choice when maternal / fetal complication prevents vaginal birth?
Cesarean delivery
What are the indications of a cesarean delivery? (5)
- CPD
- Cord prolapse
- Genital herpes
- Breech / transverse lie
- Placenta previa / abruptio placenta
Describe psychosocial considerations associated with a cesarean delivery (2)
- Some consider a c-section failure
- Increased risk of postpartum depression
Describe the preparation for a cesarean delivery (3)
- Insert foley
- Establish IV site
- Lateral tilt - place wedge under a hip
What is the last assessment made by the nurse prior to draping the patient for a caesarean delivery?
Listen to fetal heart tones
What are the 3 types of c-section incisions?
- Low transverse incision
- Vertical incision
- Classical incision
Describe low transverse c-section incision (3)
- “Bikini cut”
- Less likely to rupture
- Future vaginal delivery possible
Describe vertical c-section incision (3)
- Incision in lower uterus
- Prone to rupture
- Future vaginal delivery unlikely
Describe classical c-section incision (3)
- Incision in middle of uterus
- Prone to rupture
- Future vaginal delivery impossible
Describe the consideration regarding fetal lungs in a cesarean delivery compared to a vaginal delivery
Since the fetal chest is not squeezed, lungs may be fluid filled / require suctioning - can cause transient tachypnea of the newborn (TTN)
What are the risks associated with vaginal birth after previous cesarean delivery (VBAC)? (2)
- Hemorrhage
- Uterine rupture
