a nurse is assisting a client who is in the second stage of labor This is a topic that many people are looking for. g4site.com is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, g4site.com would like to introduce to you Maternal Newborn (OB) Nursing – Procedures to Assist with Labor and Delivery. Following along are instructions in the video below:
In this video. We are going to talk about some procedures that are used during during the labor and delivery process. So the first thing.
Im going to talk is internal fetal monitoring. So this is where we place an electrode on the fetuses scalp to closely monitor the fetal heart rate also with this we can use whats called an eye upc. Which which is an intra uterine pressure catheter to monitor the strength of moms contractions.
If we are doing this we would expect a contraction strength between 50 and 85 mm hg. So if were getting a contraction strength over 90 mmhg. Then that would be cause for concern.
So in order to place this internal fetal monitor moms membranes must be ruptured. She must be dilated at least 2 centimeters and the presenting part must be descended in order to place this electrode. Also there are some risks associated with internal fetal monitoring.
So this includes a risk of infection for both the baby and the mom so were not doing this as part of our standard practice for all moms who are getting ready to deliver babies. We would only use this for high risk pregnancies. Ok.
Next. Lets talk about external cephalic. Version.
Or ecf. So. Ecf is where we would manipulate the moms.
Abdominal wall under ultrasound guidance to help move the baby from either a transverse or breech position into a vertex position. Where the head is down. Where the presenting part is the head and the head is facing down.
It is performed after 37 weeks. Gestation and it also carries a risk. So it has an increased risk for umbilical cord compression as well as for placental abruption.
So you definitely need to remember those things in terms of nursing care. If mom is rh negative. You want to make sure she received rhogam at 28 weeks gestation and then following the ecf procedure.
We would perform a test thats called the kleihauer betke test and hopefully. I said that right but what this test does is it checks for the presence of fetal blood in the maternal circulation and if a significant amount of fetal blood is found in maternal circulation. Then we would administer additional program to mom so during this procedure.
Were also going to be giving mom iv fluids and were also going to give her some tocolytics medications to help relax the uterus and make it easier to manipulate the fetus right and then were gonna continually monitor the field heart rate and the maternal vital signs during this procedure okay next lets talk about some different ways that we can induce labor. So one way is through cervical ripening. So this is where we would allow for cervical softening.
Effacement and dilation and we can do this through a number of different ways. We can use balloon catheters. We can do membrane stripping we can use dilators and we can also use chemical agents.
So one such chemical agent that id be familiar with is misoprostol and they actually use that for me. When i was having actually both my kids. So you can administer a lot of these medications either orally or vaginally and it just helps to kind of soften dilate and efface the cervix and prepare for delivery.
We can also use whats called oxytocin. If you have been at the clinical site for maternal newborn. Then chances are youve seen.
A mom who is getting oxytocin. So oxytocin is a uterine stimulant. It is used to increase the strength the frequency.
And the length of uterine contractions. So while mom is on oxytocin. You want to closely monitor her contractions as well as the fetal heart rate.
If there are certain things certain circumstances present you will want to discontent new oxytocin. So im gonna go over four important circumstances. That would indicate we need to dc oxytocin.
So the first is if contractions are happening more frequently than every two minutes. Okay if theyre only happening one minute apart. Thats a problem and we would need to dc oxytocin.
If contractions last for more than 90 seconds. This is a problem. If the contraction intensity is over 90 mmhg when were using an iu pc.
Then that would also be cause for concern and indicate that we need to dc oxytocin. And then if moms resting tone. Is greater than 20 mmhg.
We also need to dc the oxytocin okay so we just need to make sure. These contractions are not happening. Too frequently.
Theyre not too strong. And that they are not lasting too long right and that theres some resting time between contractions if we need to we can administer terbutaline to help decrease uterine activity and i go over to rudy terbutaline in more detail in my pharmacology series if you want to check that out there okay now lets talk about an amniotic and an amnio infusion. So an amniotic is where we rupture the moms amniotic membranes using a sharp instrument.
Its performed by the provider in order to either induce our augment labor or in preparation for an amnio infusion. Which were going to talk about next keep in mind that an amniotic carries a risk of cord prolapse. Okay.
So this is super important risk factor to know when were doing this procedure. So we want to ensure the presenting part of the fetus is engaged prior to performing an amniotic also with an amniotic. There is an increased risk for infection.
So we ideally want delivery to occur within 24 hours of performing an amniotic an amnio infusion is where were in whew using either lactated ringers or normal saline into the amniotic cavity. So we would use this if mom has insufficient amniotic fluid in that cavity or if fetal cord compression is present okay. The last couple procedures.
I want to touch on in this video are the use of a vacuum or forceps. So with a vacuum. We are applying traction to the fetal head using a cup like device the baby must be in a vertex position.
So head down and we would use this if mom is exhausted or not pushing effectively. So it does carry an increased risk of maternal lacerations. As well as infant subdural hematoma or possibly kaput succedaneum.
Which well talk more about in a future video forceps forceps. Pretty much look like salad tongs. Im honestly if you google.
It they pretty much look like salad tongs. Theyre like spoon. Like blades that are used to assist in delivery.
When theres like an abnormal fetal presentation or fetal distress. So this use of forceps also carries some risks. So if theres increased risk for maternal lacerations as well as bladder injury for the mom and then on the baby.
We could end up with facial bruising as well as nerve palsy. So thats it for these procedures. And i will pick it up with my next video thanks for watching.
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