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Back Again

Back Again. High Risk Intrapartum Nursing –Part II. Developed by D. Ann Currie RN, MSN. Birth Related Procedures. Version Cervical Ripening Induction / Augmentation Amniotomy Amnioinfusion Episiotomy Assisted Vaginal Birth: Forceps-assisted birth Vacuum Extraction

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Back Again

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  1. Back Again

  2. High Risk Intrapartum Nursing –Part II Developed by D. Ann Currie RN, MSN

  3. Birth Related Procedures • Version • Cervical Ripening • Induction / Augmentation • Amniotomy • Amnioinfusion • Episiotomy • Assisted Vaginal Birth: • Forceps-assisted birth • Vacuum Extraction • Cesarean Section • VBAC

  4. Version- turning the fetus • External Cephalic Version is the changing of the fetal presentation from breech, transverse lie or oblique lie to a cephalic presentation. • Podalic Version is used only with the second twin during a vaginal birth.

  5. External Cephalic Version

  6. Podalic Version

  7. External Cephalic Version • May be attempted after 36-37 weeks gestation. • Criteria: • Single fetus • Not engaged • Adequate amount of amniotic • fluid • A Reactive NST

  8. External Cephalic Version Contraindications • Suspected IUGR • Fetal Anomalies • Abnormal FHR Pattern • Rupture of Membranes • Cesarean birth indications • Maternal Problems-GDM, Preeclampsia/eclampsia cardiac disease etc. • Amniotic Fluid abnormalities • Other

  9. External Cephalic Version Done in Labor Unit Client is NPO for least 8 hours Ultrasound for : single fetus, AFI, location of placenta, position and presentation of fetus and cord Vital signs NST Blood type and Rh and antibody screen Informed consent IV started with LR Possible Tocolytic medications

  10. Cervical Ripening • Softening and effacing of the cervix • Can be done with several agents: • Prostaglandin E2( PGE2) gel • Dinoprostone ( Cervidil)- • vaginal insert • Dinoprostone ( Prepidil) • Misoprostol ( Cytotec) • Can be done prior to induction with Pitocin

  11. Bishop Score

  12. Induction or Augmentation of Labor • Labor Induction is the stimulation of uterine contractions before the spontaneous onset of labor. • Labor Augmentation is the stimulation of uterine contractions after labors onset and there is failure in progression of cervical dilation or descent of fetus.

  13. Induction Indications: • Diabetes mellitus • Postterm gestation • Fetal Demise • PROM • Hx of precipitous labor and birth • Other indications see text

  14. Contraindications for induction of labor with Pitocin • Prematurity • Abnormal Presentation • Multiple Gestation • Severe Hypertension • Maternal Heart Disease • Abnormal FHR Pattern • Polyhydramnios • Presenting part not engaged • Severe Preeclampsia/ eclampsia • CPD • Macrosomic fetus • Cord prolapse • Placenta previa • Previous Classical Incision C/S • See text for other contraindications

  15. Amniotomy • It is the artificial rupture of the amniotic membranes. (AROM) • Before procedure : • Do pericare • Assess for contraindications or risk factors. • Assess the fetus for presentation, position, station, and FHR • Prep bed for fluid • Immediately after: • Assess FHR • Check fluid color and amount

  16. Amnioinfusion • It is a procedure by which warm, sterile saline is put into the uterus via an IUPC. It can be used to increase volume of fluid in oligohydramnios, decrease pressure on cord ,or dilute meconium. • First place IUPC • Assess FHR • Bolus 150-250 ml of saline using infusion pump over20-30 minutes • Monitor vital signs, FHR ,and contraction status and resting tone

  17. Episiotomy

  18. Episiotomy • It is a surgical incision into the perinium. • Types: • Midline • Mediolateral • Episiorrhaphy is a repair of the episiotomy or any lacerations.

  19. Assisted Vaginal Birth • Forceps Assisted Vaginal Birth • Vacuum Extraction

  20. Types of FORCEPS

  21. Vacuum Extraction

  22. Cesarean Section • Cesarean birth is the birth of the baby through abdominal and uterine incision. Hsyterotomy • Indications: • CPD, placenta previa, Abruptio placenta, Umbilical cord prolapse, nonreassuring FHR pattern, previous section, breech presentation, fetal congenitial anomalies and others. • Preoperative • Prep • Intraoperative • Postoperative

  23. VBAC • Vaginal Birth After Cesarean • ACOG Guidelines • Complications

  24. The End of Part II

  25. A Little Love Always Makes It Better

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