Transcript No Slide Title

Birth Related Procedures
• Linda L. Franco RN MSN NE-BC
• Blue = history
• Green = Need to know
• Red = important to know
Version (turning of the fetus)
• Methods
– External
• External cephalic version (ECV) fetus is changed from
breech to cephalic thru external measures
– Internal
• Rarely used, occurs when the 2nd fetus during a vaginal
twin birth isn’t doing well. Med is given to relax uterus and
dr reaches in and pulls the fetus out. Usually the woman is
given a c-section
• Risks
– Hypoxia
– Fetal Distress
– Abruptio Placentae
Criteria for External Version
• Must be at least 36 or more weeks
gestation
• Must have a Reactive NST immediately
prior
• Fetal breech is not engaged
– So if they baby is breech and is not engaged
(or dropped)
Contraindications for Version
• Maternal problems
– Uterine anomalies, uncontrolled PIH (pregnancy
induced hypertension), third trimester bleeding
– Make sure the mom has IV access for meds or blood
or whatever
• Complications of pregnancy
– ROM, oligohydramnios, polyhydramnios, placenta
previa
• Previous C/S or uterine surgery
• Multiple gestation
• Nonreassuring FHR
• IUGR
Amniotomy
• Defined as: Artificial rupture of the amniotic
membrane
– Need 2 cm of dilation
• Indications
– Induce labor
– Internal monitoring
• Risks
– Infection
– Prolapse of cord
– Abruptio placentae
Cervical Ripening
• Soften the cervix
• Cervical readiness is the most important
thing when thinking about inducing labor
in a mom
• Successful induction
• Management of intrauterine fetal death
• Drugs – Prostaglandins, Cytotec
Induction & Augmentation of Labor
• Indicated – health of mother & baby
• Elective – convenience
• Risks
– Hypertonic uterine activity
– Uterine rupture
– Water intoxication
• Retention of water with sodium depletion. Pt is
lethargic, nauseated, vomiting, and in severe cases may
convulse or go into coma
• Antidiuretic effect of oxytocin decreases water exchange
in the kidney and reduces urinary output leading to fluid
overload
Induction con.
• Amniotomy
• Cervical Ripening (or readiness)
– Bishop score of 8 or 9
• Table 23-1 – 1 pg. 540
• The higher the score the more likely it is that labor will occur
• Cervical readiness is the most important criteria for labor induction
• Natural methods – sexual intercourse, breast stimulation,
enemas, castor oil
• Drugs
– Oxytocin
– Prostaglandins
• Oxytocin Administration
– Secondary IV
– Infusion started slowly
– Contractions q 2-3 min with relaxation between
Bishop Scoring System
Oxytocin Infusion
• RL 1,000 ml with 10 - 20 units pitocin; infuse at 1-2 mu/min
• Observe fetal response
• Observe for uterine hypertonus
– Nursing actions
•
•
•
•
•
Stop Pitocin
Increase primary IV rate
Turn to left side
Give Oxygen
Notify physician
• You want stable contractions every 2-3 mins that last 40-60
seconds, this is why we give pitocin
• Risk of pitocin is hyperstimulation of the uterus. If this
happens we must discontinue the pitocin. If you don’t then
placenta perfusion isn’t taking place and the baby isn’t
getting oxygen
PITOCIN INFUSION CALCUALTION – 20 u
pitocin (don’t need to know for exam)
1000ml x 2mu x 1u x 60min = 6ml
20u
min
1000mu
1hr
hr
1000ml x 1mu x 1u x 60min = 3ml
20u
min
1000mu
1hr
hr
PITOCIN INFUSION CALCUALTION – 10u
pitocin (don’t need to know for exam)
1000ml x 2mu x 1u x 60min = 12ml
10u
min
1000mu
1hr
hr
1000ml x 1mu x 1u x 60min = 6ml
10u
min
1000mu
1hr
hr
Amnioinfusion
• Infusion of warmed sterile Normal saline into
the uterus through an IUPC (intrauterine
pressure catheter)
• If the mom’s bag of water isn’t enough then
we put more fluid in there. Helps the baby
move around.
• May also be used to dilute miconium (sp?) if
the infant inhales the miconium and it’s not
diluted they can inhale it, which is bad
• Indications
– Oligohydramnios, relieve cord compression, dilute
meconium stained amniotic fluid
Episiotomy
• Surgical incision of the perineum
• Indications
–
–
–
–
Decrease pressure on fetal head
Control direction of extension of the vaginal opening
Clean incision easier to repair and heals better
Cuts by the dr heal faster than if they rip on their own…
• Risks
– Infection
– Kind of makes it more likely to have an anal sphincter tear
• Nursing care
– Ice to perineum
– Observe for edema, hematoma, redness
• Controversial
Forceps Assisted Birth
• Metal Instruments shaped to grasp fetal head
• Indications
– Shorten second stage of labor
– Any condition that threatens the mother or baby
that will be relieved with birth
– Regional anesthesia has effected the moms motor
functions… like they are too drugged to push
• Risks
– Vaginal laceration or hematoma
– Trauma to baby’s face or scalp
– Intracranial or subgaleal hemorrhage
Forceps Assisted Birth
Vacuum Extraction
• Suction to help deliver fetal head
• Risks
– Cephalhematoma
– Hyperbilirubinemia
• Because of bruising
– Intracranial hemorrhage
Vacuum Extraction
Cesarean Section
• Incision in abdominal and uterine walls
• Indications
–
–
–
–
–
–
–
Complete placenta previa or abruption
CPD
Malpresentations
Herpes – active lesions
Fetal distress
Chronic Maternal Disease
Previous C/S
Cesarean Section con.
• Risks
–
–
–
–
Anesthesia
Infection
Hemorrhage
Trauma to baby
• Procedure
– Skin incision
• Cut into the uterus…
• Transverse is usually low and invisible once healed,
takes longer
• Vertical is better, used when baby needs to be out quick
– Uterine incision
Vaginal Birth After Cesarean
VBAC
• Low transverse uterine incision
• Contraindication with vertical uterine incision
• Risks
–
–
–
–
–
Hemorrhage
Uterine Rupture
Hysterectomy
Infant death
Neurological complications