ob gyne postpartum nursing

7/29/2019 ob gyne postpartum nursing

http://slidepdf.com/reader/full/ob-gyne-postpartum-nursing 1/41

THERAPEUTIC

MANAGEMENT OFPROBLEMS OR

POTENTIAL PROBLEMSIN LABOR AND BIRTH

DIANNA S. GERONA, RN 1



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




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



INDUCTION AND

AUGMENTATION OF LABOR

• Labor induction

– Artificially starting labor

• Labor Augmentation

– Assisting labor that has started

spontaneously to be more effective.




INDUCTION AND


• Primary reasons: – Preeclampsia / Eclampsia

– Rh sensitization

– Postmaturity• Should be used in caution if with:

– Multiple gestation

–Hydramnios

– Grand multiparity

– Previous uterine scars




INDUCTION AND


• 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




INDUCTION AND


• 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




INSTRUMENTALDELIVERIES




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




FORCEPS DELIVERY

2 TYPES:

• Low forceps birth

– Fetal head at +2 station

• Mid forceps birth

– Fetal head is engaged but less than

+2 station




FORCEPS DELIVERY

• Before forceps are applied: – Ruptured membranes

– No CPD

–Fully dilated Cervix

– Empty bladder




FORCEPS DELIVERYComplications:

• Urinary stress incontinence• Birth trauma

– Facial paralysis

–Subdural hematoma

– Erythemetous mark on the baby’s cheek

• Cord compression




VACUUM EXTRACTION

• For a fetus that is positioned far down

the vaginal canal

• A disk shaped cup is pressed

against the posterior fontanlle.




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



CESARIAN BIRTH




CESARIAN BIRTH

DELIVERY OF THEBABY THROUGH AN

ABDOMINAL &

UTERINE INCISION.




INDICATIONS:

1.FETAL DISTRESS

2. BREECH PRESENTATION

3. DYSTOCIA

4. CPD

5. PRIOR CESARIAN SURGERY

6. CORD PROLAPSE

7. ABRUPTIO PLACENTA

8. PLACENTA PREVIA



COMPLICATIONS:

1.INFECTIONS2. HEMORRHAGE

3. BLOOD CLOTS

4. SURGICAL INJURY

TO THE BLADDER OR INTESTINES

5. SURGICAL INJURY TO THE

FETUS.



TYPES:

1. LOW SEGMENT / LOW TRANSVERSE /

LOW CERVICAL ( LTCS) /PFANNENSTIEL INCISION

ADVANTAGES



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)



DISADVANTAGES:

1.DIFFICULT & LONGER TO PERFORMTHAN THE CLASSICAL TYPE.

2. NOT RECOMMENDED WITH ANTERIOR

PLACENTA PREVIA



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.



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.



Post Partum Complications



lgeblancomd maternal disorders 31

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




Late Post Partum Hemorrhage

• Bleeding after 24 hrs

• Mgt:

–D&C or manual extraction of fragments




Sub Involution

• Management:

– D&C

– Proper position - prone

– Cold compress – to prevent bleeding

– Mefenamic acid




DIC

• Disseminated Intravascular Coagulopathy.

• Management:

– hysterectomy if with abruption placenta

– Heparin

– Platelet concentrate

– cryoprecipitate or fresh frozen plasma




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




Mastitis

• Inflammation of the mammary gland

• Signs & Symptoms

– Fever

– Chils

– Malaise

– Flu like symptoms




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




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




MAnagement

• Bed rest

• Anticoagulants

• Antibiotics

• Anlagesics

• Moist heat applications

•Never massage affected area

• Elevation of affected extremity



• 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




• 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

ob gyne postpartum nursing

Documents

Transcript of ob gyne postpartum nursing