THERAPEUTIC MANAGEMENT OF PROBLEMS OR POTENTIAL PROBLEMS IN LABOR AND BIRTH

DIANNA S. GERONA, RN

TRIAL LABOR
Done to determine whether labor can progress normally Indication:
Borderline inlet measurement but good fetal lie and position

Nursing management:
Monitor FHR and uterine contractions Emptying of the bladder Prepare for CS
DIANNA S. GERONA, RN 2

EXTERNAL CEPHALIC VERSION

Done as early as 34-35 weeks but usually done 37-38 weeks. Containdications:
Multiple gestation Severe oligohydramnios Contraindications to vaginal birth Unexplained 3rd trimester bleeding

Nursing Management:
Tocolytic agent administration as ordered Record UTZ and FHR continuously
DIANNA S. GERONA, RN 3

INDUCTION AND AUGMENTATION OF LABOR

Labor induction
Artificially starting labor

Labor Augmentation
Assisting labor that has started spontaneously to be more effective.

DIANNA S. GERONA, RN

INDUCTION AND AUGMENTATION OF LABOR

Primary reasons:
Preeclampsia / Eclampsia Rh sensitization Postmaturity

Should be used in caution if with:

Multiple gestation Hydramnios Grand multiparity Previous uterine scars
DIANNA S. GERONA, RN 5

INDUCTION AND AUGMENTATION OF LABOR

Conditions that should be present:
Must be in a longitudinal lie Cervix is ripe Presenting part is engaged There is no CPD Fetus is matured by date

DIANNA S. GERONA, RN

INDUCTION AND AUGMENTATION OF LABOR

Cervical Ripening
Laminaria method Prostaglandin gel

Oxytocin Administration
Nursing Management:
Monitor uterine contractions, FHR, and VS q 15 mins. Watch out for signs of water intoxication and tonic uterine contractions
DIANNA S. GERONA, RN 7

INSTRUMENTAL DELIVERIES

DIANNA S. GERONA, RN

FORCEPS DELIVERY
Indications:
The woman is unable to push with contractions Spinal anesthesia or spinal cord injury Cessation of progress in the 2nd stage of labor Abnormal fetal position
DIANNA S. GERONA, RN 9

FORCEPS DELIVERY
2 TYPES: Low forceps birth
Fetal head at +2 station

Mid forceps birth

Fetal head is engaged but less than +2 station

DIANNA S. GERONA, RN

10

FORCEPS DELIVERY
Before forceps are applied:
Ruptured membranes No CPD Fully dilated Cervix Empty bladder

DIANNA S. GERONA, RN

11

FORCEPS DELIVERY
Complications: Urinary stress incontinence Birth trauma
Facial paralysis Subdural hematoma Erythemetous mark on the babys cheek

Cord compression

DIANNA S. GERONA, RN

12

VACUUM EXTRACTION
For a fetus that is positioned far down

the vaginal canal

A disk shaped cup is pressed

against the posterior fontanlle.

DIANNA S. GERONA, RN

14

VACUUM EXTRACTION
Advantage: Fewer lacerations at the birth canal Disadvantage: Caput noticeable until 7

days
Contraindications:
Pre term infants
Previous scalp blood sampling
DIANNA S. GERONA, RN 17

CESARIAN BIRTH

DIANNA S. GERONA, RN

18

CESARIAN BIRTH DELIVERY OF THE BABY THROUGH AN ABDOMINAL & UTERINE INCISION.

DIANNA S. GERONA, RN

19

INDICATIONS: 1.FETAL DISTRESS 2. BREECH PRESENTATION 3. DYSTOCIA 4. CPD 5. PRIOR CESARIAN SURGERY 6. CORD PROLAPSE 7. ABRUPTIO PLACENTA 8. PLACENTA PREVIA

COMPLICATIONS:

1.INFECTIONS
2. HEMORRHAGE

3. BLOOD CLOTS
4. SURGICAL INJURY

TO THE BLADDER OR INTESTINES

5. SURGICAL INJURY TO THE

FETUS.

TYPES:

1. LOW SEGMENT / LOW TRANSVERSE / LOW CERVICAL ( LTCS) / PFANNENSTIEL INCISION

ADVANTAGES: 1. INVOLVES LESS BLOOD LOSS

2. LESS POSSIBILITY OF RUPTURE OF

CS SCAR DURING SUBSEQUENT PREGNACY

3. LESS INCIDENCE OF POSTOPERATIVE COMPLICATIONS: INFECTION, ADHESION OF BOWEL TO THE INCISIONAL LINE, INTESTINAL OBSTRUCTION.
4. ALLOWS A VAGINAL DELIVERY AFTER A PREVIOUS CESARIAN SECTION.(VBAC)

DISADVANTAGES:

1.DIFFICULT & LONGER TO PERFORM THAN THE CLASSICAL TYPE.

2. NOT RECOMMENDED WITH ANTERIOR PLACENTA PREVIA

2. CLASSICAL TYPE - A VERTICAL INCISION IS MADE DIRECTLY INTO THE WALLS OF THE CORPUS, WHICH IS THE MOST CONTRACTILE PORTION.

ADVANTAGES:
1.EASIEST & QUICKEST INCISION TO PERFORM 2. RAPID EXTRACTION OF FETUS CAN BE DONE.

DISADVANTAGES:

1. INVOLVES MORE BLOOD LOSS BECAUSE

INCISION IS MADE ON THE THICK VASCULAR PORTION OF THE UTERUS 2. HIGHER INCIDENCE OF POST-OP COMPLICATIONS 3. RUPTURE OF CS SCAR ON SUBSEQUENT PREGNANCY IS MORE LIKELY. 4.INVOLVES MORE HEALING DISCOMFORT & A WIDER CS SCAR.

Post Partum Complications

Hematoma
Bluish or purple discoloration of SQ tissue of vagina or perineum. Mgt: cold compress every 30 minutes with rest period of 30 minutes for 24 hrs incision on site, scraping & suturing

lgeblancomd

maternal disorders

31

Late Post Partum Hemorrhage

Bleeding after 24 hrs Mgt: D&C or manual extraction of fragments

lgeblancomd

maternal disorders

32

Sub Involution
Management: D&C Proper position - prone Cold compress to prevent bleeding Mefenamic acid

lgeblancomd

maternal disorders

33

DIC
Disseminated Intravascular Coagulopathy. Management:
hysterectomy if with abruption placenta Heparin Platelet concentrate cryoprecipitate or fresh frozen plasma

lgeblancomd

maternal disorders

34

Puerperal Infection
General signs of inflammation: calor (heat), rubor (red), dolor (pain) tumor(swelling) Purulent discharges Fever Supportive care CBR Hydration TSB Cold compress
lgeblancomd

-Paracetamol - Culture & sensitivity - Antibiotics as ordered

maternal disorders 35

Mastitis
Inflammation of the mammary gland Signs & Symptoms Fever Chils Malaise Flu like symptoms

lgeblancomd

maternal disorders

36

Management
Antibiotic therapy for 7 to 10 days May continue with BF unless there is an open abcess formation If with abcess, use pump to evacuate milk until it heals May continue to breastfeed on the unaffected side

lgeblancomd

maternal disorders

37

Deep Vein Thrombosis

Inflammation of the lining of a blood vessel in conjunction with clot formation Idiopathic Most common is Femoral usually manifested by (+) Homans Sign

lgeblancomd

maternal disorders

38

MAnagement
Bed rest Anticoagulants Antibiotics Anlagesics Moist heat applications Never massage affected area Elevation of affected extremity
maternal disorders 39

lgeblancomd

 Postpartum Depression
A feeling of overwhelming feeling of sadness which cannot be accounted for Symptoms:
Excessive anxiety Irritability Fatigue Loss of apetite Feelings of worthlessness

Management:
Psychological counseling Encourage talking about her feelings
DIANNA S. GERONA, RN 40

 Postpartum Psychosis
Mental state which involves a loss of contact with reality May result from unrecognized and untreated depression. Symptoms:
Agitation Euphoria Delusions Disorganized behavior

Management:
Psychiatric counseling Anti-psychotic drugs
DIANNA S. GERONA, RN 41