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Nursing Care During Labor & Birth- Chapter 15Learning Objectives/Study GuideDiscuss indications, maternal & fetal risk factors and nursing care for the following:-Methods for labor induction and cervical ripening-Instrument assisted birth-Episiotomy-Cesarean sectionAmniotomyArtificial rupture of amniotic sac- labor augmentation-Usually performed with induction or augmentation of labor-To allow for internal electronic fetal monitoring-Performed with amnihook (only used and performed by provider) -Can happen with FSERisks: -Prolapse of umbilical cordCord can easily be compressed between fetal presenting part and pelvisObstructed blood flow to and from placenta, decreased gas exchange-Infection- if she still doesn’t deliverprolonged ruptureBacteria from vagina to cervix with rupture and repeated cervical examsNo barrier = vaginal organisms have free access to uterine cavity chorioamnionitis (inflammation of amniotic sac, usually caused by bacterial and viral infections)Risk increases as time between rupture and birth is prolonged-Abruptio PlacentaeIncreased incidence with hydramnios and uterine distention. Uterus shrinks down with exodus of fluid and the placenta no longer fits the implantation site separationBloody fluid may show, may be internal- hard, painful abdomenLarge area of separation significantly decreases fetal oxygenation, nutrition, and waste disposalSafety & Nursing Considerations -Obtain baseline information Assess FHR (priority) for reassuring patterns before amniotomy- minimum of 20-30min needed for adequate baselineMonitor Fetal Heart Rate- make sure it doesn’t turn into fetal bradycardia-Multiple underpads on mom’s bed- ease of cleanup -Explain that it is not more painful than vaginal examNursing Assessments:-2cm, head down, 0 Station- above 0 and risk for cord prolapse- engaged. -Assess FHR for at least 1 full minute after procedure- bradycardia (<100) if cord compression-Assess fluid for color/smell/vernixLarge amount of fluid- preterm or hydramniosGreenish meconium- stained fluid- postdate or placental insufficiencyFoul or strong odor, cloudy or yellow- chorioamnionitis Scant fluid- placental insufficiency, fetal GI/GU abnormalities, respiratory problems- calcified lungsNursing Considerations and Care:-No doing frequent vaginal exams-Keep her clean and dry- prevent infection-VS Q2H- temperature and HR (fetus can start showing tachycardia before mom for infection)-If smelly fluid/ baby- think infection-Fetus needs to be engaged at 0 station to prevent cord prolapseInduction & Augmentation of Labor-Artificial method to stimulate contractions and laborArtificial rupture of membranes, medicationsIndications: -When a continued pregnancy may jeopardize the health of the woman or fetus and labor and vaginal birth are considered safe.