Use of multiple interventions from the onset of labor including Amniotomy

Use of multiple interventions from the onset of labor

This preview shows page 6 - 11 out of 19 pages.

Use of multiple interventions from the onset of labor including: Amniotomy Timing of contractions Augmentation of labor with oxytocin IV Frequent VEs to monitor progress of labor
Image of page 6
Post Term Pregnancy A pregnancy that extends beyond the 42 nd completed week of gestation Post date – pregnancy that extends beyond the due date May often be inaccurate dating More often occurs in primigravidas and in women with a history of post term pregnancy Maternal risks: increased risk of need for interventions, such as induction or forceps/vacuum assisted delivery, increased risk of infection, macrosomia, dystocia, hemorrhage or thromboembolism Fetal/neonatal risks: decreased placental perfusion, oligohydramnios, meconium aspiration, low Apgar, SIDS, acidemia, fetal demise, stillbirth, IUGR After 40 th week, NST and BPP testing to assess fetal well-being CSTs Induction or cesarean birth as indicated
Image of page 7
Fetal Malposition Any position that is not Right Occiput Anterior, Left Occiput Anterior, or Occiput Anterior Most common malposition is occiput posterior Most OP positions will migrate to an OA position during labor Persistent OP occurs in <10% Causes: poor contractions, abnormal flexion of the head, inadequate pushing efforts, fetal anomalies Risks: Maternal- 3 rd or 4 th degree lacerations, extension of midline episiotomy, prolonged birth, morbidity; Fetal: increased risk mortality, need for interventions Clinical management: monitoring, use of forceps or vacuum to assist delivery Nursing interventions: changing maternal posture to enhance rotation to OA, pelvic rocking, knee-chest position, hands-and-knees position
Image of page 8
Fetal Malpresentation Malpresentation-any position that is not the occiput. Includes: brow, face, breech, shoulder (transverse), and compound Risks of many of these are prolonged labor, slow or arrested fetal descent, dysfunctional labor patterns, risk of need for intervention, including cesarean birth. Breech deliveries also increase risk of spinal cord injuries to infant, brachial plexus injuries, and carry a higher risk of neonatal morbidity and mortality Vaginal birth may occur with face/brow presentations Do not use internal fetal scalp electrodes, forceps/vacuum, oxytocin Monitor for signs of CPD, facial edema Breech presentations may also be delivered vaginally, but carries higher risk of morbidity/mortality Version may be attempted before labor Cesarean birth most often used
Image of page 9
Fetal Malpresentation Transverse lie Watchful waiting if before term-may fetuses will orient to an OA position If not, version may be attempted If unsuccessful, delivery by cesarean Compound lie Occurs when there are more than one presenting part Most resolve spontaneously Others may require manipulation at birth
Image of page 10
Image of page 11

You've reached the end of your free preview.

Want to read all 19 pages?

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture