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Obstetric Procedures

Obstetric Procedures

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Published by Edward Arlu
I based this one from 2 sources: Pillitteri's and Murray's MCN books. Hope this would be of great help to you! Good luck! God bless you!
I based this one from 2 sources: Pillitteri's and Murray's MCN books. Hope this would be of great help to you! Good luck! God bless you!

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Published by: Edward Arlu on Dec 17, 2009
Copyright:Attribution Non-commercial


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Addition of a sterile fluid (warmed normal saline/LR) into the uterus tosupplement the amniotic fluid
Prevents additional cord compression
Initially, 500 ml is infused and then the rate is adjusted to infuse the leastamount necessary to maintain a monitor pattern without variabledeceleration
Umbilical cord compression
Reduction of recurrent variable deceleration
Dilution of meconium-stained amniotic fluid
Replaces the "cushion" for the umbilical cord
Throughout procedure, urge the woman to lie in a lateral recumbent positionto prevent supine hypotension syndrome
Help maintain strict aseptic technique during insertion and while caring forthe catheter
Continue monitoring FHR and uterine contractions internally during theinfusion
Record maternal temperature hourly to detect infection
Make sure that the infusing solution is warmed to body temperature beforeinfusion to prevent chilling of the mother and fetus
Assess for constant drainage in the vagina
Artificial rupturing of membranes to increase the efficiency of contractionsusing a steroile sharp instrument (Alice forceps/Amniohook)
The woman's cervix must be dilated 3 cm and placed in a dorsal recumbentposition
Usually performed in conjunction with augmentation and induction of labor and to allow internal electronic fetal monitoring
The cord can be compressed between the fetal presenting part inthe woman's pelvis, obstructing blood flow to and from theplacenta and reducing fetal gas exchange
Prolapse of the Umbilical Cord
Vaginal organisms have now free access to the uterine cavity andmay cause chorioamnionitis
Can occur if the uterus is distended with excessive amniotic fluidwhen the membranes rupture
As the uterus collapses with discharge of the amniotic fluid, thearea of placental attachment shrinks
The placenta then no longer fits its implantation site and partiallyseparates
A large area of placental disruption can significantly reduce fetaloxygenation, nutrition and waste disposal
Abruptio Placenta
A disposaple plastic hook (such as Amnihook) is commonly used tpperforate the amniotic sac
Obstetric Procedures
Saturday, December 12, 200912:22 PM
MCN Page 1
Usually deferred when if the fetal presenting part is high or thepresentation is not cephalic
The hook is passed through the cervix, snagging the membranes. Thehole is enlarged with the finger, allowing fluid to drain
Induction andAugmentationof Labor
Performed when a continued pregnancy may jeopardize the health of thewoman or fetus and labor and vaginal delivery are considered safe
-initiation of labor before it begins normally
: stimulation of contractions to become more effective afterthey have begin naturally
Pregnancy induced hypertension-->>reduced placental blood flow
Spontaneous rupture of membranes at or near term (PROM)
Renal disease
Pulmonary disease
Heart disease
Disabling conditions:
Intrauterine fetal growth restriction
Post-term gestation
Maternal-fetal blood incompatibility
Abrupio placenta
Fetal death
Conditions in which the intrauterine environment is hostile to fetal well-being
Indications for INDUCTION:
Considered when labor has begun spontaneously but progress hasslowed or stopped because of poor circumstances (dystocia)
Indications for AUGMENTATION:
Complete placenta previa
Umbilical cord prolapse
Abnormal fetal presentation
High station of the fetus-->>CPD
Active genital herpes infection
Previous surgery in the upper uterus
One or more previous low-transverse cesarean deliveries
Overdistended uterus-->>uterine rupture
Severe maternal conditions such as heart disease and severhypertension
Nonreassuring FHR patterns
Hypertonic (excessive) uterine activity
Uterine rupture
Maternal water intoxication
Increased risk of cesarean birth
Cervical ripening-(See below)
Induction and augmentation of labor at or near term.Maintenance of firm uterine contraction after birth tocontrol postpartum bleeding. Management of inevitable or incomplete abortion
Oxytocin administration
MCN Page 2
Nipple stimulation
Breech, transverse(shoulder) and oblique positions
External Cephalic Version
Used for the vaginal birth of the 2nd twin in multiple gestation
Internal Version
Uterine malformations
Previous cesarean birth with a vertical uterine incision
Placenta previa
Multifetal gestation
Oligohydramnios, ruptured membranes, and a cord around the fetalbody or neck
Uteroplacental insufficiency
Engagement of the fetal head into the pelvis
Fetus may become entangled in the umbilical cord, compressing itsvessels sand resulting in hypoxia
Abruptio placenta
Maternal sensitization to the fetal blood type
Attempted after 37 weeks
Woman is given tocolytic to relax uterus while the version isperformed
Monitor FHR
External cephalic version
The physician reaches into the uterus with one hand and with thehand on the maternal abdomen, maneuvers the fetus into alongitudinal lie to allow delivery
Internal version
Provide information
Assess the woman and the fetus
Help reduce woman's anxiety
Rh negative women should receive Rh immunoglobulin in case minimalbleeding occurs
Nursing considerations
Common adjunct to induction of labor
Change in the cervical consistency from firm to soft
The first step the uterus must complete in early labor
Necessary for dilation and coordination of contractions
Bishop's Scoring System to Evaluate the CervixFactor 0 1 2 3
Dilation 0cm 1-2 cm 3-4 cm 5-6 cmEffacement 0-30% 40-40% 60-70% 80%+Station -3 -2 -1 or 0 +1 or +2Cervical consistency Firm Moderate Soft  
if a woman's score is 8 or more, the cervix is considered ready forbirth and should respond to induction
Position Posterior Middle Anterior 
MCN Page 3

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