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What are the current indications and recommendations for a forcep assisted delivery?
- Indications are for ineffective expulsive forces
- To shorten the second stage of labor
- Suspicion of immediate or potential fetal compromise
- Recommended that fetus must be at least +2 station
- Fetal head should be visible on the perineum
What are the indications and contraindications for a vacuum extraction during delivery?
- -prolonged second stage
- -nonreassuring FHT
- -vag delivery is not indicated
- -max is 3 attempts, then c-birth
What are the maternal and fetal risks during an operative vaginal birth?
- Maternal Risk:
- -vaginal or cervical lacerations
- -extension of the episiotomy
- -hemorrhage r/t uterine rupture or atony
- -bladder trauma
- Fetal Risk:
- -intracranial hemorrhage
- -retinal hemorrhage
- -scalp lacerations
- -erb's palsy (forceps)
- -skin lacerations or bruising (forceps)
- -skull fracture (forceps)
What are the indications, advantages, disadvantages, complications, and necessary comfort measures of an episiotomy?
- Indications: macrosomia or small perineum
- Advantages: clean suture line
- Disadvantages: pain, infection
- Comfort: ice, tucks pads, wound care, dermoplast, sitz bath, proper positioning, stool softeners, increase fluids & fiber
- Complications: pain, infections
Describe the different degrees of perineal lacerations
- First degree: skin & mucosa
- Second degree: skin, mucosa, perineal muscle
- Third degree: as above, through anal sphincter
- Fourth Degree: through rectal mucosa
What are the different kinds of cesarean birth incisions and what kinds of anesthesia are used (and why!)?
- Incisions can be low cervical transverse, Lower uterine segment vertical, Classical vertical midabdom
- Anesthesia can be epidural (epidural space, continous), spinal (subarachnoid space, 3 hrs), or general anesthesia (for emergencies, spinal problems, or low platelets)
What is a VBAC and what are the selection criteria?
- Vaginal Birth After (previous) Cesarean
- Selection Criteria:
- -one previous c/s
- -low transverse incision
- -adequate pelvis
- -no other uterine scar
- -MD avail in house to perform repeat c/s if necessary
- -In house anesthesia
- -consideration of reason for first c/s
Describe the terms: early term, full term, late term, and post term
- Early term: 37 wks through 38 wks 6 days
- Full term: 38 wks through 40 wks 6 days
- Late term: 41 wks through 41 wks 6 days
- Post term:42 + weeks
What is a post term pregnancy?
- Pregnancy that extends >42 wks
- Most causes r/t inaccurate dating
- Maternal risks:
- -induction of labor with an unfavorable cervix
- -cesarean birth
- -prolonged labor
- -postpartum hemorrhage
- -traumatic birth
What are the fetal risks for postterm pregnancy? What clinical therapy is done for these babies?
- Decreased amniotic fluid
- Decrease in placental perfusion (dysmaturity syndrome, or macrosomia if placenta continues to perfuse)
- Perinatal morality is 2x at 42wks & 6x at 43wks
- Clinical therapy: NST, BPP, induction at 41 wks
What is shoulder dystocia and what are the maternal and fetal risks?
- *** OB EMERGENCY
- Head is out by the shoulders get stuck
- After delivery, both mom and babies need to be assessed for injuries
- Maternal risks:
- -perineal trauma
- -uterine atony leading to pp hemorrhage
- Fetal Risks:
- -brachial plexus injury
- -clavicle fracture
- -neurological injury
- pressure on pubic bone
- break fetal clavicles
What are the different types of prolapsed umbilical cord?
- Frank: Rare, cord is visible
- Complete: cord can be felt but not seen
- Occult: not seen or felt, but suspected based on abnormal FHT
What are the risk factors for a prolapsed umbilical cord?
- Fetus not engaged
- Multiple Gestation
- High Parity
- Small Fetus (premature, IUGR)
- Abnormal presentation (breech, transverse lie)
What is the nursing care for a prolapsed umbilical cord?
- Call for help!!
- Displace the infant upward to stop compression
- Change maternal position into trendelenburg with roll under one hip to prevent Vena cava hypotension
- 02 at 10L via mask
- Tocolytic drug (terbutaline)
- Immediate delivery, usually by c-birth (prepare for immediate surgery)
- If birth is imminent, proceed with birth
- Explain procedures and provide emotional support
What constitutes fetal demise?
- Death of the fetus in utero
- Prolonged retention of dead fetus may lead to DIC
- Induction of labor within 24-48 hrs of confirmation of fetal demise