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Complications of Labor and Delivery - Level 3

Terms in this set (95)

-the physician applies traction to the fetal head during birth w a vacuum extractor or forceps to aid the women's expulsive efforts
-disposable foam pads are available to cushion the fetal head when using forceps
-vacuum extractor uses suction to grasp the fetal head as traction is applied
-not used for breech or face
-most places have a limit of 3 applications
-considered if shortening of the second stage is needed for the well-being of the woman, fetus, or both and if a vaginal birth can be accomplished quickly without undue trauma
-may be needed because of maternal exhaustion, inability to push effectively, cardiac or pulmonary disease, intrapartum infection, cord compression, premature separation of the placenta, or non reassuring FHR patterns
-women's bladder should be empty
-membranes must be ruptured
-cervix must be completely dilated for forceps or vacuum extraction birth
-classified according to how far the fetal head has defended into the pelvis when the instruments are applied
-classified as outlet, low, and mid pelvis
-w correct application the long axis of the forceps blades lies over the fetal checks and parietal bones
-the physician locks the two blades in the center and pulls gently as the women pushes, following the curve of the pelvis
-may keep forceps on until the head is born
-a hand pump is used to create suction to hold the vacuum cup on the fetal head in the midline of the occiput
-applies traction intermittently the woman's push
-a vacuum release allows removal of the cup
-should go no higher than the green zone
-father or support person encouraged to remain w pt during surgery if she had regional anesthesia or possibly after intubation for general anesthesia
-catheter and IV lines usually remain in place no longer than 24 hrs after birth
-use of serial compression devices to reduce risks of venous thrombosis
-explain the during surgery, may feel pressure and pulling but these sensations do not mean that the anesthesia is wearing off
-teach simple technique to promote normal circulation in legs
-NPO status or only ice or clears if cesarean expected
-bony prominences well padded
-safety strap placed across thighs
-leads for cardiac monitor and pulse ox are placed to observe heart and respiratory functions
-grounding pad permits safe use of the electrocautery
-after surgery, incision is cleansed w sterile water and sterile dressing is applied
-temp assessed on admission to the PACU and according to protocol thereafter
-assessments done every 15 mins during the 1st 1-2 hrs, every 30 mins to 1 hr until transfer to postpartum room
-nurse observes for return of motion and sensation if the women had epidural or subarachnoid block anesthesia
-level of consciousness and respiratory status
-Narcan should be available
-HR, RR, and BP provide important clues to status
-supplemental O2 by NC, face tent, or mask is occasionally needed
-small pillow to support incision reduces pain when coughing
-position changes Q2H
-fundus assessed for height, firmness, and position
-pfannenstiel skin incision usually have less pain w fundus checks than vertical incision
-dressing checked for drainage w each fundus check
-urine may be bloody temporarily if the cesarean birth occurred after a long labor or an attempted forceps or vacuum delivery
-observe for gradual clearing
-depends on the gestation and whether there is evidence infection or other compromise
-if there is infection, type must be taken into consideration
-labor induction or cesarean may be reasonable if the fetus is 34-36 weeks of gestation or more
-studies to determine fetal lung maturity are often performed
-if pregnancy if earlier than 34 weeks, management more complex
-risk of infection and preterm birth is weighed against the hazards of actively promoting birth
-accurate gestational age and eval of fetal lung maturity are important
-determine whether the membranes are truly ruptured
-vaginal exam is avoided if the gestation is preterm and there is no evidence of labor
-sterile speculum exam performed to lok for a pool of fluid near the cervix and to estimate cervical dilation and effacement
-pH test or fern test can verify whether the vaginal fluid is amniotic
-tests to assess fetal lung maturity and identify infection
-transvaginal ultrasound to ensure cervical length to identify a short cervix
-if labor does not begin spontaneously and the pregnancy is at or near term and cervix is favorable, labor may be induced
-if cervix is not favorable and no infection is present induction may be delayed 24 hrs or longer to allow cervical softening
-administration of drugs to combat infection
-if fetus is less than 34 weeks, physician weighs the risks of infection against the infants risk for complications of prematurity
-maternal antibiotics may stop the infection that caused or will occur w the rupture
-recommendation to prevent PPROM: IV antibiotics for 48 hrs followed by 5 days oral
-women will either remain hospitalized until birth or return home after a few days of hospital observation
-teach women: avoid sexual intercourse, avoid breast stimulation, take temp at least QID, report any temp > 100, maintain any activity restrictions, note and report uterine contractions or vaginal drainage w a foul odor