Chapter 27 Birth-Related Procedures

  1. What is used for cervical ripening?
    - Prostaglandin E2 or PGE2 gel is used for cervical ripening

    - This helps with softening and effacing the cervix

    - It is used in women at or near term for the induction of labor
  2. What are forms of PGE2?
    - Prepidil a form of PGE2 gel is a intracervical application

    - Cervidil is a intravaginal insert, it is 2-cm-square piece of cardboard like material and placed on the posterior vagina. It is slow releasing
  3. Advantages of Prostaglandin Use?
    • can be removed easliy
    • causes cervical ripening
    • shorter labor
    • lower requirements for oxytocin
    • vaginal birth w/in 24 hrs
    • reduced need for C-section
  4. Disadvantages of Prostaglandin Use?
    • uterine hyperstimulation
    • nonreassuring fetal status
    • higher incidence of postpartum hemorrhage
    • uterine rupture in absence of previous incision
  5. Contraindications of PGE2?
    • previous uterine incision (C-section)
    • compromised cardiovascular
    • hepatic or renal function
    • women with asthma or glaucoma
    • sensitivity to PGE2
    • unexplained vaginal bleeding
  6. PGE2 insertion procedure (Prepidil)?
    • used only by hospital birthing unit
    • comes in prefilled syringe
    • a catheter is inserted into the endocervix
    • gel is injected
    • cath has sheild so gel can't pass to internal os
  7. PGE2 insertion procedure (Cervidil)?
    • vaginal insert is placed in the posterior vagina
    • if it becomes dislodge reinsert by nurse
    • if hyperstimulation occurs remove insert
    • if active labor occurs remove insert
  8. The use of Misoprostol (Cytotec)?
    • a synthetic PGE1
    • used to soften and ripen the cervix to induce labor
    • available in tablet of insert
    • increased rate of uterine rupture
    • delivery w/in 24 hours
    • low ceserean birth rates
  9. Guidelines for the use of Misoprostol (cytotec)?
    • use one in 3rd trimester for ripening and induction
    • 1/4 of tab or 25 mcg for initial dose
    • wait 4 hours before Pitocin is given
  10. Contraindication of Misoprostol (Cytotec)?
    • three uterine contractions in 10 minutes
    • maternal asthma
    • previous cesarean or other uterine scar
    • placenta previa
    • nonreassuring fetal status
  11. Transcervical Catheter?
    • this is the use of a balloon catheter
    • used for cervical ripening and mechanical dilation
    • a 25 mL to 80 mL balloon is used to dilate the cervix with inflation
    • can be used w/ vaginal Cytotec, Pitocin, or extra-amniotic saline infusion
  12. Nurse Care Management
    • assess maternal vital signs
    • apply EFM
    • intruct women to remain lying down after insertion
    • put rolled blanket or wedge under right hip to shift uterus
    • monitor for hyperstimulation
    • monitor FHR abnormalities
    • administer tocolytic if hyperstimulation occurs
    • give antiemetics, antipyretics and antidiarrheal agents
    • assess location of cathether
    • women should remain in recumbent position
    • no vaginal examinations
    • provide bedpan avoid ambulation
  13. Labor Induction?
    Is the stimulation of uterine contractions before the spontaneous onset of labor, with or w/o ROM, for the purpose of accomplishing birth
  14. Labor Augmentation?
    Is the stimulation of uterine contractions when spontaneous contractions have failed to result in progresssive cervical kiationor the descent of the fetus
  15. Indications of Induction or Augmentation?
    • DM
    • Renal disease
    • Preeclampsia
    • HTN disorders
    • PROM
    • Chorioamnionitis
    • Fetal demise
    • Postterm gestation
    • IUGR
    • Isoimmunization
    • Hx of rapid labor or precipitous labor
    • Nonreassuring antepartal testin
    • Severe oligohydramnios
    • Macrosomia
  16. Contraindications of Labor Induction or Augmentation?
    • abnormal FHR patterns
    • breech presentations
    • unknown presentations
    • multiple gestation
    • polyhydramnios
    • presenting fetal part above the maternal inlet
    • severe HTN
    • maternal heart disease
  17. Methods for Inducing or Augmenting Labor
    • Stripping membranes
    • nonpharmalogic method
    • physician inserts fingers as far as possible into internal cervical os
    • rotates the finger 360 degrees, twice
    • motion seperates the amniotic membranes
    • stripping is thought to release PGF2oc from amniotic membranes or PGE2 from cervix
    • after procedure: uterine contractions, cramping, and bloody discharge can occur
  18. .....continue
    • Oxytocin infusion:
    • requires IV adminstration
    • intiates uterine contractions to induce labor
    • goal is to achieve 3 UCs in 40-60 seconds in 10 min
  19. .....continue
    • Complementary methods:
    • sexual intercouse/love making:-)
    • self or partner stimulation of women's nipple
    • blue/black cohosh
    • evening primrose oil
    • red rapberry leaves
    • homeopathic solutions: caulophyllum, pulsatilla
    • castor oil
    • acupressure/acupuncture
  20. Nursing Care Management on Induction and Augmentation
    • obtain vital signs
    • begin oxytocin infusion
    • obtain fetal monitor recording
    • inform women of blood tinge d/c from procedure
    • monitor frequency, intensity, and duration
  21. Amiotomy?
    • it is artificial rupture of amniotic membranes
    • most common procedure for induction of labor
    • the cervix has to be dilated at least 2 cm
    • can be used to augment labor too
    • labor will be shortened 1-2 hours
    • allows you to insert a fetal monitor electrode
    • allows you to insert intrauterine pressure cath
  22. Advantages of an Amniotomy?
    • contractions elicited are similiar to SROM
    • women does not require intensive monitoring as with oxytocin
    • EFM is possible
    • color and composition of fluid can be evaluated
  23. Disadvantages of Amniotomy?
    • birth needs to happen w/in 24 hours b/c of increase risk for infection
    • danger of prolapsed cord is increased esp. if presenting part is not pressed down on cervix
    • molding and compression of fetal head b/c of loss of amnio fluid
    • fetal injury due to the amniohook
    • bleeding due to undiagnosed vasa previa
    • severe variable decels which increases C-section
  24. Amniotomy Procedure?
    • first assess fetus presentation, position, station, and FHR
    • physician introduces an amniohook into vagina, through the cervix, and against the amniotic membrane
    • a small tear is made in the amniotic membrane
    • amniotic fluid is now allowed to escape slowly
  25. Nursing management for an Amniotomy?
    • Assess fetal presentation, position, and station (amniotomy is usually delayed until engagement)
    • Place disposable pads and towel under buttocks
    • Assess FHR immediately before and after amniotomy
    • Check for prolapsed cord
    • Inspect amnio fluid for amount, color, odor, meconium and blood
    • Clean and dry perineal area
    • Advise women fluid will continue to come out
    • Strict sterile technique vaginal exam should be used
    • Reduce the amount of vaginal exams done b/c of increase infection
    • Monitor temperature every 2 hours
    • Bed rest is maintained
  26. Amnioinfusion?
    Is a technique by which a volu
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Chapter 27 Birth-Related Procedures
Procedures for birth