week 7

• Amniotomy


  it is the artificial rupturing of membraneduring labor if they do not rupture spontaneously toallow the fetal head to contact the cervix more directlywhich increases the efficiency of contractions andtherefore increases the speed of labor.
• Position for Amniotomy


  Dorsal Recumbent
• Disadvantage for Amniotomy

  At Risk for Cord Prolapse
• EPISIOTOMY


  A surgical incision of the perineum made to release pressure on the fetal head with birthand possibly shorten the last portion of the 2nd stage of labor.
• 2 types of episiotomy

  1. midline episiotomy (heal easily)

  2. mediolateral episiotomy
• Midline episiotomy


  Incision begins at bottom center of perineal body and extends straight down midline to fibers
• mediolateral episiotomy


  extends from the vaginal outlet posterolateral, either to the left or right of the midline, and is used when posterior extension is likely. Third-degree laceration can occur. Blood loss is greater, and the repair is more difficult and painful. Local anesthetic is administered to the perineum prior to the incision.
• EPISIORRHAPHY


  surgical repair of injury to the vulva by suturing
• CESAREAN BIRTH


  > Birth accomplished through an abdominal incision into the uterus

  > One of the oldest types of surgical procedures known > More hazardous than vaginal birth

  > If compared with other surgical procedures, it is one of the safest type

  > It came from the latin word, "Caedore" which means to cut
• Placenta Previa


  implantation of the placenta over the cervical opening or in the lower region of the uterus
• Abruptio Placenta


  premature separation of the placenta from the wall of the uterus
• Fetal macrosomia


  A situation in which a fetus is large, usually

  defined as weighing more than 4,500 grams or almost

  9 pounds; also known as "large for gestational age."

  fetus The developing, unborn infant inside the uterus.
• Fetal Distress


  lack of oxygen to the fetus because of decreased blood flow through the placenta or umbilical cord
• Hydrocephalus


  abnormal accumulation of fluid (CSF) in the brain
• Scheduled C/S


  needs thorough preparation for the experiencethroughout the antepartal period
• Emergency C/S


  preparation is done rapidly but with the same concern
• Effects of Cesarean Birth

  Stress Response

  Interference with Body Defense

  Interference with Circulatory Function

  Interference with Body Organ Function

  Interference with self- image or self-esteem
• Stress Response


  Body is subject to stress, this results in the release of epinephrine andnorepinephrine from adrenal medulla
• Interference with Body Defense


  >Skin serves as the primary line of defense against bacterial invasion

  >When skin is incised for surgical procedure, the important line of defenseis lost

  >Sterile technique is important before, during the surgery and in the daysfollowing procedure
• Interference with Circulatory Function


  > Some blood loss always occurs with surgery, even though vessels wereimmediately ligated and clamped after cutting Complications:

  Hypovolemia - lowered BP, - ineffective perfusion of all body tissues
• Interference with Body Organ Function


  >Pressure from edema or inflammation as fluid moves into arefurther impairs function of the primary organs as well as that of thesurrounding organs

  >Edema may be the result-deprivation of blood flow-impairedfunctions of these organs

  >Uterus is handled during the procedure - can lead to failure tocontract that leads to postpartum bleeding
• Interference with self- image or self-esteem


  Incisional scar can be noticed to some extent
• Classic cesarean Birth


  incision is made through both theabdominal skin and the uterus, made high on the uterus so that itcan be used on a placenta previa

  Disadvantage: leaves a wide skin scar also runs through the activecontractile portion of the uterus
• Low Segment Incision


  >Bikini incision or bikini cut,Misgav-Ladach, Plannenstielincision, made horizontally across the abdomen just overthe cervix,

  
  

  Disadvantage - takes longer to perform

  Advantage-less blood loss, easier to suture, decreaseinfection and postpartum complication
• VBAC


  vaginal birth after cesarean
• Woman is obese


  Interfere with wound healing-tissue that containabundant fatty cells is difficult to suture, incision may take longer to heal -

  
  

  Prolonged healing period increases the risk for infection and rupture ofthe incision (dehiscense)

  Heart - may increase workload -physiologic shock of surgery, may placegreater stress on an already overworked organ
• pneumonia or thrombophlebitis


  Difficulty of turning and ambulating after the procedure - high risk forrespiratory or circulatory complications
• Homan's sign


  pain in calf upon dorsiflexion of foot possiblethrombophlebitis; pedal edema
• Woman with protein and Vitamin Deficiency


  at risk for poorer woundhealing because these has something to do with cell formation at theincision site
• Vitamin K Deficiency


  is is very necessary for blood clotting aftersurgery
• Iron Deficiency


  this places the woman at high risk - can lead tofatigue that affects parent-child bonding
• Age Variations


  can decrease circulatory and renal functions
• Altered General Health Condition

  woman with secondary illness is atgreater risk, may have an accompanying nutritional or elective orelectrolyte imbalance related to her primary illness
• Fluid and Electrolyte Imbalance


  emergency C/S -subject to be placed on NPOf.Fear - C/S is performed through epidural anesthesia
• Operative Risk to newborn


  when fetus is placed through birth canal, pressureon the chest helps to rid the lungs of lung fluid - infants may have some degreeof respiratory difficulty for a day or two.
• Deep Breathing Exercise


  aerate the lungs through periodicbreathing exercise and help prevent stasis of lung mucus,can happen due to prolonged stay in supine position during surgery.
• Incentive Spirometry


  common device used postoperativelyto encourage deep breathin
• Turning


  remind the client to do it to prevent both respiratory andcirculatory complications
• Ambulation


  to stimulate lower extremity circulation, surgeonsprefer client to ambulate or walk 4H after surgery ( as soon asthe effect of the anesthesia has worn out), it can be difficult forthe woman due to fatigue and pain, help client to understand theimportance of this. Antiembolic Stocking (TEDS) may beprescribed to support and encourage venous return
• MMEDIATE PREOPERATIVE CARE MEASURES

  1. >Informed consent

  2. >Overall hygiene- bath, removal of makeup, eye lenses, hair ornaments