Chapter 21- maternity

Procedures and Complications: Chapter 21 Overview

Introduction

  • Division of Chapter 21:

    • Part One: Procedures – Discussing obstetric maneuvers and techniques.

    • Part Two: Complications – Addressing potential issues during labor.

Procedural Focus

Leopold's Maneuvers

  • Purpose: Determining the fetal position through abdominal palpation.

  • Importance: It's primarily practiced in OB offices rather than labor and delivery.

  • Four steps to determine fetal position:

    1. Palpation of the fundus to check fetal lie.

    2. Identification of fetal position (left/right side of the mother).

    3. Assessing engagement of the fetal head in the pelvis.

    4. Observing fetal attitude (flexed or extended head).

External Cephalic Version (ECV)

  • Definition: Rotating the fetus into the vertex position externally.

  • Indications: For fetuses in transverse or breech presentation.

  • Success Rate: Approximately 70% effective.

  • Timing: Typically performed after 37 weeks of gestation.

Labor Inductions

  • Bishop’s Score: Tool for assessing the cervix's readiness for induction.

  • Definition: A score greater than 8 indicates a higher chance of successful vaginal delivery.

  • Induction methods discussed:

    • Oxytocin: Used to stimulate contractions. May be necessary under certain conditions fitting the criteria of Bishop's Score.

    • Cervical Ripening Agents: Such as Misoprostol and Dinoprostone (Cervidil) to assist in preparing the cervix.

Complication Focus

Identifying Complications in Labor

  1. Hypotonic Labor: Insufficient contractions that may require augmentation (e.g., Oxytocin).

  2. Tachysystole: More than 5 contractions in 10 minutes, potentially leading to fetal distress:

    • It's critical to monitor the frequency and duration of contractions closely.

  3. Shoulder Dystocia: Emergency when baby’s shoulders become lodged during delivery:

    • McRoberts Maneuver: Flexing the mother's thighs to her abdomen.

    • Suprapubic Pressure: Applying downward pressure to help free the shoulder.

  4. Umbilical Cord Prolapse: Occurs when the cord slips ahead of the fetus, leading to reduced blood flow:

    • Nursing action: Maintain upward pressure on the presenting part to relieve cord pressure.

  5. Uterine Rupture: Higher risk in previous C-section patients, can lead to severe hemorrhage.

    • Symptoms include severe abdominal pain and abnormal fetal heart patterns.

  6. Amniotic Fluid Embolism: Rare yet serious condition where amniotic fluid enters maternal circulation:

    • Early signs include respiratory distress and circulatory collapse.

Nursing Considerations and Responsibilities

  • For Tachysystole: Intervention with Oxytocin management and patient position changes.

  • Shoulder Dystocia Protocol: Notify Rapid Response team and prepare for potential surgical intervention.

  • Monitor for Cord Prolapse: Immediate interventions must be enacted to protect fetal wellbeing.

  • Uterine Rupture Management: Continuous monitoring of maternal and fetal status.

Summary and Conclusion

  • This chapter covered critical procedures and complications associated with labor and delivery, emphasizing the need for preparedness and timely interventions during childbirth.

  • A study guide will be provided to assist in preparation for exam three, consolidating knowledge from Chapters 21 and prior topics.