THERAPEUTIC MANAGEMENT OF PROBLEMS OR POTENTIAL PROBLEMS IN LABOR AND BIRTH DIANNA S. GERONA, RN 1
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THERAPEUTIC
MANAGEMENT OFPROBLEMS OR
POTENTIAL PROBLEMSIN LABOR AND BIRTH
DIANNA S. GERONA, RN 1
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TRIAL LABOR
• Done to determine whether labor can
progress normally• Indication:
– Borderline inlet measurement but good
fetal lie and position• Nursing management:
– Monitor FHR and uterine
contractions – Emptying of the bladder
– Prepare for CS
DIANNA S. GERONA, RN 2
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EXTERNAL CEPHALIC VERSION• Done as early as 34-35 weeks but usually
done 37-38 weeks.• Containdications:
– Multiple gestation
–Severe oligohydramnios
– Contraindications to vaginal birth
– Unexplained 3rd trimester bleeding
•
Nursing Management: – Tocolytic agent administration
as ordered
– Record UTZ and FHR continuouslyDIANNA S. GERONA, RN 3
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INDUCTION AND
AUGMENTATION OF LABOR
• Labor induction
– Artificially starting labor
• Labor Augmentation
– Assisting labor that has started
spontaneously to be more effective.
DIANNA S. GERONA, RN 4
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INDUCTION AND
AUGMENTATION OF LABOR
• Primary reasons: – Preeclampsia / Eclampsia
– Rh sensitization
– Postmaturity• Should be used in caution if with:
– Multiple gestation
–Hydramnios
– Grand multiparity
– Previous uterine scars
DIANNA S. GERONA, RN 5
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INDUCTION AND
AUGMENTATION OF LABOR
• Conditions that should be present:
– Must be in a longitudinal lie
– Cervix is ripe
– Presenting part is engaged
– There is no CPD
– Fetus is matured by date
DIANNA S. GERONA, RN 6
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INDUCTION AND
AUGMENTATION OF LABOR
• Cervical Ripening
– Laminaria method
– Prostaglandin gel
• Oxytocin Administration
– Nursing Management:
• Monitor uterine contractions, FHR,
and VS q 15 mins.
• Watch out for signs of water intoxication
and tonic uterine contractions
DIANNA S. GERONA, RN 7
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INSTRUMENTALDELIVERIES
DIANNA S. GERONA, RN 8
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FORCEPS DELIVERY
•Indications: – The woman is unable to push with
contractions
– Spinal anesthesia or spinal cord injury
– Cessation of progress in the
2nd stage of labor
– Abnormal fetal position
DIANNA S. GERONA, RN 9
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FORCEPS DELIVERY
2 TYPES:
• Low forceps birth
– Fetal head at +2 station
• Mid forceps birth
– Fetal head is engaged but less than
+2 station
DIANNA S. GERONA, RN 10
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FORCEPS DELIVERY
• Before forceps are applied: – Ruptured membranes
– No CPD
–Fully dilated Cervix
– Empty bladder
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FORCEPS DELIVERYComplications:
• Urinary stress incontinence• Birth trauma
– Facial paralysis
–Subdural hematoma
– Erythemetous mark on the baby’s cheek
• Cord compression
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VACUUM EXTRACTION
• For a fetus that is positioned far down
the vaginal canal
• A disk shaped cup is pressed
against the posterior fontanlle.
DIANNA S. GERONA, RN 14
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VACUUM EXTRACTION
•Advantage: Fewer lacerations at the birthcanal
• Disadvantage: Caput – noticeable until 7
days
• Contraindications:
– Pre term infants
– Previous scalp blood samplingDIANNA S. GERONA, RN 17
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CESARIAN BIRTH
DIANNA S. GERONA, RN 18
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CESARIAN BIRTH
DELIVERY OF THEBABY THROUGH AN
ABDOMINAL &
UTERINE INCISION.
DIANNA S. GERONA, RN 19
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INDICATIONS:
1.FETAL DISTRESS
2. BREECH PRESENTATION
3. DYSTOCIA
4. CPD
5. PRIOR CESARIAN SURGERY
6. CORD PROLAPSE
7. ABRUPTIO PLACENTA
8. PLACENTA PREVIA
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COMPLICATIONS:
1.INFECTIONS2. HEMORRHAGE
3. BLOOD CLOTS
4. SURGICAL INJURY
TO THE BLADDER OR INTESTINES
5. SURGICAL INJURY TO THE
FETUS.
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TYPES:
1. LOW SEGMENT / LOW TRANSVERSE /
LOW CERVICAL ( LTCS) /PFANNENSTIEL INCISION
ADVANTAGES
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ADVANTAGES:
1. INVOLVES LESS BLOOD LOSS
2. LESS POSSIBILITY OF RUPTURE OFCS SCAR DURING SUBSEQUENTPREGNACY
3. LESS INCIDENCE OFPOSTOPERATIVE COMPLICATIONS:INFECTION, ADHESION OF BOWELTO THE INCISIONAL LINE,
INTESTINAL OBSTRUCTION.
4. ALLOWS A VAGINAL DELIVERYAFTER A PREVIOUS CESARIAN
SECTION.(VBAC)
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DISADVANTAGES:
1.DIFFICULT & LONGER TO PERFORMTHAN THE CLASSICAL TYPE.
2. NOT RECOMMENDED WITH ANTERIOR
PLACENTA PREVIA
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2. CLASSICAL TYPE
- A VERTICAL INCISION IS MADE DIRECTLY INTO THE WALLS OF THE CORPUS, WHICH
IS THE MOST CONTRACTILE PORTION.
ADVANTAGES:1.EASIEST & QUICKEST INCISION TO
PERFORM
2. RAPID EXTRACTION OF FETUS CAN BE
DONE.
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DISADVANTAGES:
1. INVOLVES MORE BLOOD LOSS BECAUSE
INCISION IS MADE ON THE THICK VASCULAR
PORTION OF THE UTERUS
2. HIGHER INCIDENCE OF POST-OP
COMPLICATIONS
3. RUPTURE OF CS SCAR ON SUBSEQUENT
PREGNANCY IS MORE LIKELY.
4.INVOLVES MORE HEALING DISCOMFORT & A
WIDER CS SCAR.
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Post Partum Complications
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Hematoma
• Bluish or purple discoloration of SQ tissue of
vagina or perineum.
• Mgt:
• cold compress every 30 minutes with rest
period of 30 minutes for 24 hrs
• incision on site, scraping & suturing
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Late Post Partum Hemorrhage
• Bleeding after 24 hrs
• Mgt:
–D&C or manual extraction of fragments
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Sub Involution
• Management:
– D&C
– Proper position - prone
– Cold compress – to prevent bleeding
– Mefenamic acid
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DIC
• Disseminated Intravascular Coagulopathy.
• Management:
– hysterectomy if with abruption placenta
– Heparin
– Platelet concentrate
– cryoprecipitate or fresh frozen plasma
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Puerperal Infection
General signs of inflammation:• – calor (heat), rubor (red), dolor (pain)tumor(swelling)
– Purulent discharges
–Fever
• Supportive care
– CBR -Paracetamol
– Hydration - Culture & sensitivity
– TSB - Antibiotics as ordered
– Cold compress
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Mastitis
• Inflammation of the mammary gland
• Signs & Symptoms
– Fever
– Chils
– Malaise
– Flu like symptoms
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Management
• Antibiotic therapy for 7 to 10 days
• May continue with BF unless there is an open
abcess formation
• If with abcess, use pump to evacuate milk
until it heals
• May continue to breastfeed on the unaffected
side
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Deep Vein Thrombosis
• Inflammation of the lining of a blood vessel in
conjunction with clot formation
• Idiopathic
•Most common is Femoral usually manifestedby (+) Homan’s Sign
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MAnagement
• Bed rest
• Anticoagulants
• Antibiotics
• Anlagesics
• Moist heat applications
•Never massage affected area
• Elevation of affected extremity
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• Postpartum Depression
–A feeling of overwhelming feeling of sadnesswhich cannot be accounted for
– Symptoms:
• Excessive anxiety
• Irritability
• Fatigue
• Loss of apetite
• Feelings of worthlessness
– Management:
• Psychological counseling
• Encourage talking about her feelings
DIANNA S. GERONA, RN 40
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• Postpartum Psychosis
– Mental state which involves a loss of contact with
reality
– May result from unrecognized and untreated
depression.
– Symptoms:
• Agitation
• Euphoria
• Delusions
• Disorganized behavior
– Management:
• Psychiatric counseling
• Anti-psychotic drugs