chapter 11: birth related procedures Flashcards
amniotomy
artificial rupture of amniotic membranes (AROM)
- stimulates or starts labor ithin 12 hours
- considered safe and harmless
- contraindicated: fetal head not engaged in the pelvis, breech presentation, INCREASE risk of infection
nursing care
- make sure pt understands procedure
- ensure all items are sterile
- place disposable pads to absorb fluid
- monitor FHR and pattern for 1 full minute afterward
- notify hcp of abnormal or nonreassuring FHR patterns
- document time, color, quantity, and odor of amniotic fluid
- change pads as they become saturated
- monitor temp every 2 hours and report greater than 100.4 F
amnioinfusion
infuse 0.9% normal saline into amniotic cavity
- adds fluid to relieve cord compression or oligohydramnios
- also used to dilute meconium stained fluid
complications of amnioinfusion
- overfilling the uterus
- prolapsed cord
- placenta abruption
- uterine infection
- maternal chilling
- fetal bradycardia
- fetal tachycardia
nursing care for amnioinfusion
- make sure pt understands procedure
- place disposable pads to absorb fluid
- prepare IV solution and IV tubing
- assist w/ preparing the pt with intrauterine pressure catheter (IUPC)
- note uterine resting tone
- provide the fluid as prescribed
- assess and record uterine resting tone every 30 min
- monitor FHR pattern and notify of nonreassuring patterns
- assess and record amount, color, and odor of fluid on pt’s underpad every 30 min
- discontinue infusion PRIOR to delivery
external cephalic version
moves a malpositioned fetus into a vertex cephalic presentation after 37 weeks gestation
process of external cephalic version
- fetal position first confirmed w/ ultrasound
- locate umbilical cord
- assess placental location
- determine amount of amniotic fluid
- asses fetal age
- assess for fetal anomalies
- conduct external fetal monitoring
- provide tocolytic medications
- fetus moved into a head down position
- success rate 58%
- may need to be repeated w/ epidural anesthesia
risks and complications of external cephalic version
- twisting umbilical cord
- rupture amniotic membranes
- placenta abruption
- ruptured uterus
- bleeding
nursing care before and during external cephalic version procedure
- informed consent
- emotional support
- RhoGAM to prevent isoimmunization
- nonstress test
- IV tocolytics
- monitor FHR patterns
- monitor maternal vital signs and pain
nursing care after external cephalic version procedure
- observe pt and fetus for at least 1 hour
- monitor for contractions and rupture of amniotic membranes
- monitor fetal acitivity
- assessing fo pain: increased pain could mean placental abruption
- obtain an order for Kleihauer-Betke test (fetal blood circulating within mother, monitors Rh status for possible RhoGam over 5ml of circulating blood to prevent cross contamination/reaction)
- pt teaching
labor induction
chemical or mechanical methods to start cervical effacement, dilation, and contractions
augmentation
stimulation of hypotonic uterine contractions
indications for induction
- post term pregnancy
- prolonged rupture of membranes
- pregnancy induced hypertension
- diabetes
- chorioamnionitis
- fetal demise
- hypotonic contractions
bishop score
evaluates cervical ripening and predicts readiness for labor induction
cervical ripening
cervical softening prior to labor
