http://www.youtube.com/watch?v=x5kisPBwZOM

Developed by D. Ann Currie RN, MSN2012

Version Cervical Ripening Induction / Augmentation Amniotomy Amnioinfusion Episiotomy Assisted Vaginal Birth: Forceps-assisted birth Vacuum Extraction Cesarean Section VBAC

External Cephalic Version is the changing of the fetal presentation from breech, transverse lie or oblique lie to a cephalic presentation.

Podalic Version is used only with the second twin during a vaginal birth.

May be attempted after 36-37 weeks gestation.

Criteria: Single fetus Not engaged Adequate amount of amniotic fluid A Reactive NST

Suspected IUGR Fetal Anomalies Abnormal FHR Pattern Rupture of Membranes Cesarean birth indications Maternal Problems-GDM,

Preeclampsia/eclampsia cardiac disease etc.

Amniotic Fluid abnormalities Other

Done in Labor UnitClient is NPO for least 8 hoursUltrasound for : single fetus, AFI, location of placenta,

position and presentation of fetus and cordVital signsNSTBlood type and Rh and antibody screenInformed consentIV started with LRPossible Tocolytic medications

Softening and effacing of the cervix Can be done with several agents: Prostaglandin E2( PGE2) gel Dinoprostone ( Cervidil)- vaginal insert Dinoprostone ( Prepidil) Misoprostol ( Cytotec) Can be done prior to induction with Pitocin

Labor Induction is the stimulation of uterine contractions before the spontaneous onset of labor.

Labor Augmentation is the stimulation of uterine contractions after labors onset and there is failure in progression of cervical dilation or descent of fetus.

Diabetes mellitus Postterm gestation Fetal Demise PROM Hx of precipitous labor and birth Other indications see text

Prematurity Abnormal Presentation Multiple Gestation Severe Hypertension Maternal Heart Disease Abnormal FHR Pattern Polyhydramnios Presenting part not

engaged

Severe Preeclampsia/ eclampsia

CPD Macrosomic fetus Cord prolapse Placenta previa Previous Classical

Incision C/S See text for other

contraindications

It is the artificial rupture of the amniotic membranes. (AROM)

Before procedure : Do pericare Assess for contraindications or risk factors. Assess the fetus for presentation, position,

station, and FHR Prep bed for fluid Immediately after: Assess FHR Check fluid color and amount

It is a procedure by which warm, sterile saline is put into the uterus via an IUPC. It can be used to increase volume of fluid in oligohydramnios, decrease pressure on cord ,or dilute meconium.

First place IUPC Assess FHR Bolus 150-250 ml of saline using infusion pump

over20-30 minutes Monitor vital signs, FHR ,and contraction status

and resting tone

It is a surgical incision into the perinium. Types: Midline Mediolateral Episiorrhaphy is a repair of the episiotomy

or any lacerations.

Forceps Assisted Vaginal Birth

Vacuum Extraction

Cesarean birth is the birth of the baby through abdominal and uterine incision. Hsyterotomy

Indications: CPD, placenta previa, Abruptio placenta,

Umbilical cord prolapse, nonreassuring FHR pattern, previous section, breech presentation, fetal congenitial anomalies and others.

Preoperative Prep Intraoperative Postoperative

Vaginal Birth After Cesarean ACOG Guidelines Complications

http://www.youtube.com/watch?v=HUm15jxuMvM