precipitous labor & emergency delivery 11-19 · descent flexion ... decreased placental...
TRANSCRIPT
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Engagement Descent Flexion Internal Rotation Extension Restitution/External rotation Expulsion
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Labor less than 3 hours from onset to delivery
Causes/Contributing Factors› Hypertonic contractions› Low resistance› Lack of painful sensation› Preterm birth
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Lacerations of the Cervix, Perineum, Vagina
Ruptured Uterus Post-Partum Hemorrhage
Fetal Implications/Risks Decreased Placental Perfusion & Fetal
Hypoxia Head Trauma/Intracranial Hemorrhage Risk of Unattended Birth
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Follow Labor Closely Notify Physician/Midwife Early No Oxytocin Tocolytics Prioritization
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Monitor Cervical Change
Monitor Fetal Status
IV & Blood Work
Keep Mother Calm cont.
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Anesthesia?
Full Physical Assessment - Only When Time
Documentation - Often after the fact.
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Involuntary Breath Holding Bearing Down Restlessness Increased Bloody Show Perineal Fullness Crowning
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Stay with mother/call for help.
Prepare equipment and supplies
Coach & calm mom.
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Position mom. › Semi-Fowlers with knees bent
› Side-lying
› Don't break bed
Scrub prep (PRN)
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Slow controlled delivery of the head Clear airway prn (suction mouth & nose) Check for nuchal cord – reduce or loosen Delivery shoulders
› Anterior then posterior Support head & body as baby slips out Baby to Mom - skin-to-skin – cut cord PRN Dry/Stimulate newborn (if needed) Deliver placenta Promote involution – Breastfeed, Massage
fundus
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Deliver slowly and controlled› possibly the nurse's most important contribution
Assist with pushing until head is crowning› Then feather blow
Apply gentle pressure as head emerges.
ROM if necessary
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Suction Mouth and Nose ?› Possibly more important with meconium.
Check for Nuchal Cord› If loose, gently pull over head.› If tights, clamp x 2 and cut between
clamps.
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Hands over baby’s ears. Gentle traction downward to deliver
anterior shoulder. Gentle traction upward to deliver
posterior shoulder.
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Slow controlled delivery of the head Clear airway prn (suction mouth & nose) Check for nuchal cord – reduce or loosen Delivery shoulders
› Anterior then posterior Support head & body as baby slips out Baby to Mom - skin-to-skin – cut cord PRN Dry/Stimulate newborn (if needed) Deliver placenta Promote involution – Breastfeed, Massage
fundus
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McRoberts Maneuver
Suprapubic Pressure
Gaskin Maneuver
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Will easily deliver. Support head and back or buttocks.
› Don’t drop the baby Suction mouth and nose.
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Delay for 30-60 seconds (or longer)Advantages most beneficial for
preterm infants Less anemia Decreased IVH Decreased necrotizing enterocolitis Slight increase risk of jaundice
Only use sterile instruments.Collect cord blood.
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Support the Baby as the Body Delivers
Clamp and Cut the Cord
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Prevent Heat Loss› Dry thoroughly & remove the wet linen› Radiant warmer, or skin-to-skin, or warm
blankets Clear Airway prn
› Suction mouth & nose Initiate Breathing
› Stimulate
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Slow controlled delivery of the head Clear airway prn (suction mouth & nose) Check for nuchal cord – reduce or loosen Delivery shoulders
› Anterior then posterior Support head & body as baby slips out Baby to Mom - skin-to-skin – cut cord PRN Dry/Stimulate newborn (if needed) Deliver placenta Promote involution – Breastfeed, Massage
fundus
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Can take up to 30 minutes. Signs of placental separation:
› Sudden gush of blood› Cord lengthens› Uterus becomes “globular” & rises in
abdomen Don’t tug on cord. Deliver downward, then upward.
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Prevents Hemorrhage
Massage Fundus
Baby to Breast
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Slow controlled delivery of the head Clear airway prn (suction mouth & nose) Check for nuchal cord – reduce or loosen Delivery shoulders
› Anterior then posterior Support head & body as baby slips out Baby to Mom - skin-to-skin – cut cord PRN Dry/Stimulate newborn (if needed) Deliver placenta Promote involution – Breastfeed, Massage
fundus