Flashcards in 1229 exam 3: C section Deck (24)
the birth of a fetus through a transabdominal incision of the uterus. It's purpose is to preserve the life or health of the mother and/or her fetus. It is usually the best choice when there is evidence of material or fetal complications.
indications for a cesarean section:
-Performed for the benefit of the fetus
- Abnormal heart rate and pattern
- Malpresentation (Breech or shoulder)
-Placental abnormalities (Previa or Abruptio)
-umbilical cord prolapse
- Dysfunctional labor pattern
- multiple gestation
-medical factors (hypertensive, active genetal herpes, positive HIV, diabetes)
the placenta is implanted in the lower uterine segment near or over the internal cervical OS.
occurs because body contours change in reaction to the force of collision
classic and lower
Incision is made vertically into upper body of the uterus.
rarely performed today
used when rapid birth is necessary and with placenta previa
shoulder presentation and multiple gestation
associated with higher incidence of blood loss, infection and uterine rupture
labor and vaginal birth is contraindicated after classic.
segment cesarean incision
horizontal or transverse incision into the uterus.
easier to perform
associated with less blood loss
fewer postoperative infections
less likely to rupture with subsequent pregnancies.
Complications and Risks.
Injuries to bladder, uterus, or bowel
anesthesia related complications
fetal injury during surgery
economic risk because of the higher cost
Nursing Care: Preoperative
Discuss need for Cesarean
Lab (CbC, CMP, T&CM, UA)
lower abd hair removed
teach post op expectations
Nursing Care: Intraoperative
if possible, partner is gowned
it is important to position so uterus is displaced laterally to prevent compressing the vena cava
keep family informed
care of infant delegated to pediatric team
encourage skin to skin contact for mother and infant
**Make sure you have consent before answering questions from the family members.
Nursing care: Immediate postoperative
Transfer to recovery room
vital signs every 15 minutes for 1-2 hours
assess condition incision dressing, fundus, and amount of lochia
assess iv intake and urinary catheter output
TCDB every two hours
give mother and her partner alone time with baby.
initiate breastfeeding within 30 to 60 minutes after birth if possible.
Medications: Opioids or NSAIDS
splinting the incision
relaxation and breathing techniques
ambulation and rocking in a rocking chair helps relieve gas
Avoid gas forming foods and carbonated beverages.
Post op Nursing
be alert to psychological needs
Couplet care. (Mother and baby care.)
showering after dressing removed
discharge is usually third postop day.
Spinal, epidural, and general are used for cesarean
the medical history plays a role in making the decision of type of anesthesia. (Spinal injury, hemorrhage, or coagulopathy may rule out spinal or epidural)
vaginal birth after c-section
VBAC: nursing care
physician must be available throughout the labor process.
risk of uterine rupture with TOL (Trial of labor)
psychological needs: Anxiety
risk involeved to the mother and fetus attempting VBAC
Rupture uterus causes
prior classic uterine incision
single layer rather than double layer closure
two or more previous cesareans
maternal age over 30
congenital uterine anomaly
intense spontaneous uterine contrations
labor stimulation with oxytocin
difficult forceps delivery
**Occurs more commonly in multigravidas than primigravidas.
**Most common cause is separation of previous cesarean scar.
Classifications of Ruptured Uterus
Complete and incomplete
Extends through the entire uterine wall and into the peritoneal cavity or broad ligament.
extends into the peritoneum but not into the cavity or broad ligament.
bleeding is usually internal
can be a partial separation of an old cesarean scar
Signs and symptoms of Ruptured uterus
vary with extent of rupture
may be silent or dramatic
if incomplete, pain may not be present
late and variable DCELLS
decreased baseline variability
increased or decreased heartrate
woman may experience vomiting, faintness, increased abdominal tenderness and lack of labor or fetal station progress.
FHT may be lost
complete rupture S&S
sudden, sharp or ripping pain
may state "something gave way"
signs of hypovolemic shock
hypotension, tachypnea, pallar, cool, clammy skin