SROM VS AROM + Episiotomy Flashcards
SROM
AROM
Data to support it…
fluid?
exam?
tests? (3)
SROM - spontaneous rupture of sac
AROM - artificial rupture that isn’t painful
Gush of fluid Pooling of fluid during speculum exam. Dark blue Nitrazine test Ferning \+ ROM swab (typically all of these criteria are needed for srom but regardless, if you are arom ruptured all of these would show too)
AROM requirements?
What do they use to do it
Must be 2cms dilated already and an engaged fetal head.
No genital infections
No HIV
Use a Amnihook
How can AROM be helpful?
Can illicit contractions
And can help baby’s head be a dilating wedge
Overall, faster labor.
Nurse’s role in AROM
Pre-op
Pre op: Explain the procedure Pull drapes Make sure to know fetal status vitals Check fetal position (bc you want them to be cephalic) Put pad underneath mom
Nurse’s role in AROM post-op
In general?
Post op:
Check FHR and compare it to what it was before!!
Assess for prolapsed cord if you see marked changes
Hygiene so maybe clean up the fluid
Advocate for limited exams due to risk of infection
Monitor moms temp or signs of infection
What if presenting part of fetus is high?
What if the head is high?
What can happen to placenta
Other risks?
Documentation?
If presenting part of fetus is high - Umbilical cord compression risk and variable decel risk
Head is high - Apply fundal pressure
Abruptio Placenta due to decompression
infection
embolus due to fluid entering moms circulatory system on accident - very deadly due to pulmonary emboli. Unpreventable
COAT
- color, odor, amount of fluid , time of rupture
What is stripping/sweeping of membranes?
Inserting a gloved finger into the cervix to rotate 360 degrees twice in order to separate the membranes and release prostaglandins
- labor can then onset in 24-48 hrs usualy
Why are episotomies done?
To reduce risk of bad lacerations but we don’t really do them anymore. Doing one though helped the perineal area heal quicker and less anal tearing
Reasons why an episiotomy may be done?
Large baby, positioning is wrong, shoulder dystocia difficulty
How to reduce need for episiotomy or having lacerations
Kegel exercises perineal massages spontaneous pushing in 2nd stage Don't pull back on legs Counter pressure on perineum gradual pushing
Degrees of lacerations
1st - skin tear so no suture
2nd - tear of skin including muscle so suture
3rd - skin, muscle, and anal sphincter so suture
4th - skin, muscle, anus, and mucosa so deep rectal tearing
How long can you ice pack after episiotomy?
What type of assessment?
How should hygiene be?
Baths?
20 minutes then leave off for an hour
REEDA assessment
Goo hygiene so front to back wiping, and change pads
sitz bath
Education for episiotomy or laceration for 3rd and 4th degree
long term consequences of not complying?
No sex , MOM or stool softeners needed
Sphincter control issues, loose stools, perineal pain
