umbilical tangle fetal hypoxia placental abruption Rh iso-immunization SROM

artificial stimulation of labor when pt is not in labor medical OR elective

hypertonic ctx placental abruption uterine rupture postpartum hemorrhage C/S

breast/nipple stimulation sex acupuncture/pressure

synthetic form of oxytocin causes uterine ctx short t1/2 lower dose needed in augmentation

OB procedures (unit 3) Flashcards by User Unknown

external cephalic version (ECV)

manually change fetal position using abdominal manipulation
37-39 wks
used to prevent C/S d/t breech

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contraindications for ECV

previous C/S
placenta previa (can’t deliver vag anyway)
twins
oligohydramnios
uterine anomalies
abruption/UPI

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risks r/t ECV

umbilical tangle
fetal hypoxia
placental abruption
Rh iso-immunization
SROM

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labor induction

artificial stimulation of labor when pt is not in labor

* medical OR elective

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labor augmentation

•artificial stimulation of labor when pt is IN labor, but not progressing appropriately

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indications for induction

•pre-eclampsia/PIH
•SROM at term
•maternal medical problems
•chorioamnionitis
•IUGR, post term, incompatibility
•IUFD
*NOT convenience

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elective induction for convenience

•not recommended, but done
•should be considered if 
-hx of rapid labor & far from hospital
-specialized neonatal care needed
-41 wks PG

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39 week rule

•no elective inductions prior to 39 wks GA b/c too many risks

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risks r/t induction

hypertonic ctx
placental abruption
uterine rupture
postpartum hemorrhage
C/S

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natural induction

breast/nipple stimulation
sex
acupuncture/pressure

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mechanical induction (cervical ripening)

balloon cath
laminaria tent
osmotic dilators
membrane stripping
amniotomy (AROM)

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chemical induction

•nonhormonal
-herbs/oils
-enemas
•hormonal
-oxy
-prostaglandins
-misoprostol, mifepristone if goal is to soften cervix first

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pitocin

synthetic form of oxytocin
causes uterine ctx
short t1/2
lower dose needed in augmentation

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pitocin admin

•always mix IVPB
•always use pump
•attach as close to insertion site as possible
•start low and slow
-titrate until desired result

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tachysystole

•hyper stimulation of uterus
•ctx > 90 sec
• > 5 U ctx in 10 min
*causes late decel, abnormal FHR, loss of variability

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intrauterine resuscitation for tachystytole

pt on side
stop pit
open main fld. line
O2 @ 10L
vag exam (r/o prolapse)
have Brethine 0.25 mg SQ ready

Brethine (Terbutaline)

muscle relaxer

* relaxes uterus

hemorrhage r/t Pitocin

•PP risk
•all receptors saturated so uterus can’t clamp down anymore
*uterine atony from Pit

Bishop score

estimates how successfully woman’s labor can be induced by determining if her cervix is favorable
based on dilation, effacement, station, consistency, & postion

readiness for induction

Bishop score of 9+ for nullips

* 5+ for multip

cervical ripening

•chemically/mechanically softened day before labor
•thins, allowing for successful induction
*do before inducing if have low Bishop score

mechanical cervical ripening

hydrophobic insertion
attracts liquid, swelling and dilating cervix
Laminaria/Lamicel
takes 8-12 hrs

chemical cervical ripening

Cervidil (Dinoprostone)

* Cytotec

amniotomy

•AROM
•induce/augment labor
•done only if fetal station low and cephalic fetus
*labor w/in 12-24 hr
*WONT shorten labor

RN role amniotomy

•FHR •assess amniotic fld. (color, odor, amnt) •bedpan if have to urinate *excessive fld indicates poly and high station

risks r/t amniotomy

* cord prolapse * infection (fetal tachy) * abruptio placenta

DONT let woman ambulate if...

•ROM and high fetal station | *should not perform amniotomy if head not well-applied to cervix

forceps/vacuum extraction

•operative vaginal delivery that provides traction and aids in descent/rotation of fetus in 2nd stage *can't use for preterm

indications for operative vaginal delivery

* maternal exhaustion * inadequate pushing * cardiac/pulmonary dz * fetal HRN abnormality if can't do C/S fast enough * breech (get head out)

maternal risks r/t operative vaginal delivery

* bladder injury * cervical laceration * vaginal laceration/hematoma

fetal risks r/t operative vaginal delivery

* facial/scalp abrasion/asymm * nerve injury * cephalohematoma * intracranial hemorrhage * scalp edema (caput) * shoulder dystocia

RN role episiotomy

* ice * monitor infection * NEVER give enema/suppository * PO stool softeners

indications for C/S

* placental abnormality * PIH * dysfxnl labor * herpes/HIV * IDDM * previous C/S * cord prolapse * fetal distress * breech presentation * multip

C/S contraindications

*if risk to mom > than baby •IUFD •clotting dz •fetal dz incompatible w/ life

maternal risks r/t C/S

* infection * hemorrhage * bladder/organ damage * DVT * paralytic ileus * psychological

fetal risks r/t C/S

* TTN r/t retaining lung fld. * injury * respiratory distress

C/S incision types

* low transverse (preferred) * low vertical * classical (high vertical)

when is classical C/S incision employed

``` •very premature •placenta previa •emergency birth •morbid obesity *shouldn't labor in subsequent PG ```

vaginal birth after C/S

* only if was LTCS * only if 1 prior C/S * induce w/ Pit * have anesthesia and MD ready