High Risk Delivery

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High Risk Delivery
2014-11-17 21:12:32
LCCC nursing delivery ob highrisk

For Siegmunds Exam 3
Show Answers:

  1. 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
  2. What are the indications and contraindications for a vacuum extraction during delivery?
    • Indications:
    • -prolonged second stage
    • -nonreassuring FHT
    • Contraindications:
    • -vag delivery is not indicated
    • -max is 3 attempts, then c-birth
  3. 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
    • -infection
    • Fetal Risk:
    • -cephalohematoma
    • -intracranial hemorrhage
    • -retinal hemorrhage
    • -scalp lacerations
    • -erb's palsy (forceps)
    • -skin lacerations or bruising (forceps)
    • -skull fracture (forceps)
  4. 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
  5. 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
  6. 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)
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
    • -asphyxia
    • -death
    • Treatment:
    • pressure on pubic bone
    • break fetal clavicles
  12. 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
  13. What are the risk factors for a prolapsed umbilical cord?
    • Fetus not engaged
    • Polyhydramnios
    • Multiple Gestation
    • High Parity
    • Small Fetus (premature, IUGR)
    • Abnormal presentation (breech, transverse lie)
  14. 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
  15. 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