- 1. THERAPEUTIC MANAGEMENT OFPROBLEMS ORPOTENTIAL PROBLEMS IN
LABOR AND BIRTHDIANNA S. GERONA, RN 1
2. TRIAL LABOR Done to determine whether labor canprogress
normally Indication: Borderline inlet measurement but goodfetal lie
and position Nursing management: Monitor FHR and
uterinecontractions Emptying of the bladder Prepare for CSDIANNA S.
GERONA, RN2 3. EXTERNAL CEPHALIC VERSION Done as early as 34-35
weeks but usuallydone 37-38 weeks. Containdications: Multiple
gestation Severe oligohydramnios Contraindications to vaginal birth
Unexplained 3rd trimester bleeding Nursing Management: Tocolytic
agent administrationas ordered Record UTZ and FHR
continuouslyDIANNA S. GERONA, RN 3 4. INDUCTION AND AUGMENTATION OF
LABOR Labor induction Artificially starting labor Labor
Augmentation Assisting labor that has startedspontaneously to be
more effective.DIANNA S. GERONA, RN 4 5. INDUCTION ANDAUGMENTATION
OF LABOR Primary reasons: Preeclampsia / Eclampsia Rh sensitization
Postmaturity Should be used in caution if with: Multiple gestation
Hydramnios Grand multiparity Previous uterine scarsDIANNA S.
GERONA, RN 5 6. 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 7. 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 intoxicationand
tonic uterine contractions DIANNA S. GERONA, RN 7 8.
INSTRUMENTALDELIVERIES DIANNA S. GERONA, RN 8 9. FORCEPS DELIVERY
Indications: Thewomanis unable to push withcontractions Spinal
anesthesia or spinal cord injury Cessation of progress in the 2nd
stage of labor Abnormal fetal position DIANNA S. GERONA, RN9 10.
FORCEPS DELIVERY2 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 11. FORCEPS DELIVERY Before forceps are
applied: Ruptured membranes No CPD Fully dilated Cervix Empty
bladderDIANNA S. GERONA, RN 11 12. FORCEPS DELIVERYComplications:
Urinary stress incontinence Birth trauma Facial paralysis Subdural
hematoma Erythemetous mark on the babys cheek Cord
compressionDIANNA S. GERONA, RN12 13. 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, RN14 14.
VACUUM EXTRACTION Advantage: Fewer lacerations at the birth canal
Disadvantage: Caput noticeable until 7 days Contraindications: Pre
term infants Previous scalp blood samplingDIANNA S. GERONA, RN 17
15. CESARIAN BIRTHDIANNA S. GERONA, RN 18 16. CESARIAN BIRTH
DELIVERY OF THEBABY THROUGH ANABDOMINAL &UTERINE INCISION.
DIANNA S. GERONA, RN 19 17. INDICATIONS:2.FETAL DISTRESS2. BREECH
PRESENTATION3. DYSTOCIA4. CPD5. PRIOR CESARIAN SURGERY6. CORD
PROLAPSE7. ABRUPTIO PLACENTA8. PLACENTA PREVIA 18.
COMPLICATIONS:2.INFECTIONS2. HEMORRHAGE3. BLOOD CLOTS4. SURGICAL
INJURY TO THE BLADDER OR INTESTINES5. SURGICAL INJURY TO THE FETUS.
19. TYPES:1. LOW SEGMENT / LOW TRANSVERSE /LOW CERVICAL ( LTCS)
/PFANNENSTIEL INCISION 20. ADVANTAGES:2. INVOLVES LESS BLOOD LOSS2.
LESS POSSIBILITY OF RUPTURE OF CS SCAR DURING SUBSEQUENT PREGNACY3.
LESS INCIDENCE OFPOSTOPERATIVE COMPLICATIONS:INFECTION, ADHESION OF
BOWELTO THE INCISIONAL LINE,INTESTINAL OBSTRUCTION.4. ALLOWS A
VAGINAL DELIVERYAFTER A PREVIOUS CESARIANSECTION.(VBAC) 21.
DISADVANTAGES:2.DIFFICULT & LONGER TO PERFORMTHAN THE CLASSICAL
TYPE.2. NOT RECOMMENDED WITH ANTERIORPLACENTA PREVIA 22. 2.
CLASSICAL TYPE- A VERTICAL INCISION IS MADEDIRECTLY INTO THE WALLS
OF THECORPUS, WHICH IS THE MOSTCONTRACTILE
PORTION.ADVANTAGES:1.EASIEST & QUICKEST INCISION TOPERFORM2.
RAPID EXTRACTION OF FETUS CAN BEDONE. 23. DISADVANTAGES:1. INVOLVES
MORE BLOOD LOSS BECAUSEINCISION IS MADE ON THE THICK
VASCULARPORTION OF THE UTERUS2. HIGHER INCIDENCE OF
POST-OPCOMPLICATIONS3. RUPTURE OF CS SCAR ON SUBSEQUENTPREGNANCY IS
MORE LIKELY.4.INVOLVES MORE HEALING DISCOMFORT & AWIDER CS
SCAR. 24. Post Partum Complications 25. Hematoma Bluish or purple
discoloration of SQ tissue ofvagina or perineum. Mgt: cold compress
every 30 minutes with rest period of 30 minutes for 24 hrs incision
on site, scraping & suturinglgeblancomd maternal disorders 31
26. Late Post Partum Hemorrhage Bleeding after 24 hrsMgt: D&C
or manual extraction of fragmentslgeblancomdmaternal disorders 32
27. Sub Involution Management: D&C Proper position - prone Cold
compress to prevent bleeding Mefenamic acidlgeblancomd maternal
disorders33 28. DIC Disseminated Intravascular Coagulopathy.
Management: hysterectomy if with abruption placenta Heparin
Platelet concentrate cryoprecipitate or fresh frozen
plasmalgeblancomd maternal disorders34 29. Puerperal
InfectionGeneral 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 compresslgeblancomdmaternal disorders35
30. Mastitis Inflammation of the mammary gland Signs & Symptoms
Fever Chils Malaise Flu like symptomslgeblancomd maternal disorders
36 31. Management Antibiotic therapy for 7 to 10 days May continue
with BF unless there is an openabcess formation If with abcess, use
pump to evacuate milk untilit heals May continue to breastfeed on
the unaffectedsidelgeblancomd maternal disorders37 32. Deep Vein
Thrombosis Inflammation of the lining of a blood vessel
inconjunction with clot formation Idiopathic Most common is Femoral
usually manifestedby (+) Homans Signlgeblancomdmaternal disorders
38 33. MAnagement Bed rest Anticoagulants Antibiotics Anlagesics
Moist heat applications Never massage affected area Elevation of
affected extremitylgeblancomd maternal disorders 39 34. 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,
RN40 35. Postpartum Psychosis Mental state which involves a loss of
contact withreality May result from unrecognized and
untreateddepression. Symptoms: Agitation Euphoria Delusions
Disorganized behavior Management: Psychiatric counseling
Anti-psychotic drugsDIANNA S. GERONA, RN 41
