00:01
Today we're going to talk about
11 procedures.
00:05
So these are going to be
things that are done by the provider
to assist when there
are complications in labor.
00:11
We're going to talk about
11 complications.
00:14
They are:
external version,
cervical ripening,
induction of labor,
augmentation of labor,
amniotomy,
amnioinfusion,
vacuum-assisted birth,
forceps-assisted birth,
episiotomy,
cesarean birth,
and finally,
vaginal birth after cesarean.
00:37
That's a lot,
but I know we can do it.
00:39
Here we go.
00:41
The first procedure is called
an external version.
00:44
Sometimes it's also called
an external cephalic version.
00:49
During this procedure,
the fetus is actually rotated
from a breech presentation
all the way
to a cephalic presentation.
00:58
The reason we do this procedure
is because the cephalic presentation
is the safest
for vaginal delivery.
01:04
And so when the fetus presents
in any other position,
we have an opportunity to try
to rotate the fetus to cephalic.
01:13
Now, it's not without risks
that we do that.
01:16
So it's important that we
understand what those are.
01:19
When we do
the cephalic version,
it can cause
rupture of the membranes.
01:23
It might lead to bleeding.
It can cause fetal distress.
01:29
Cletus the fetus doesn't always like
to be moved around too much.
01:33
And it can also cause someone
to go into spontaneous labor.
01:37
So how should the nurse
prepare the client
for the external version?
First, due to the risks
that we just talked about,
it's very important
that a consent form is signed.
01:48
The second thing to make sure
that Cletus is doing okay,
before we start this procedure,
the nurse should obtain a
baseline nonstress test.
01:56
Remember,
we're looking for a reactive strip.
02:00
Hopefully you remember
back in antepartum,
when we talked about RhoGAM.
02:04
It's the shot
that we give for clients
who are Rh-negative
to protect them from sensitization
from an Rh-positive fetus.
02:11
So double check that chart
and make sure that the client
if they're Rh-negative,
has received the RhoGAM.
02:18
Also, it's important to make sure
that an IV is established.
02:22
In case there are
any complications,
labor starts, or we experienced
fetal distress,
that access is going to be
really important.
02:30
Also to calm the uterus down,
because sometimes
it's a little irritated.
02:34
Even before,
we start this procedure,
the provider may order a tocolytic
to help calm things down.
02:41
And finally,
after the procedure is done,
the nurse is going to again,
repeat that nonstress test
and make sure that Cletus is
a okay, before we move on.
02:51
The next procedure is
cervical ripening.
02:53
Cervical ripening is a
procedure done for a client
who may be induced
for their birth.
02:59
So what it actually is,
is a mechanical or
pharmacological process
to actually open
and help soften the cervix
and get it ready for labor.
03:09
When do we do cervical ripening?
If we have a client
who's had a baby before,
then we use a test
called a Bishop score,
which I'll explain in just a second.
03:18
And if that score
is less than eight,
then we will need to consider
cervical ripening.
03:24
If the client has never delivered
a baby before,
then that Bishop score
will be less than 10.
03:31
So let's talk about
what that Bishop score looks like.
03:34
So this is a table
that explains it pretty well.
03:37
So let's break it down.
03:39
They're going to be five elements
that we want to consider
in this assessment.
03:42
The dilation of the cervix.
How open it is?
The position of the cervix.
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So this is in relationship
to the vaginal opening.
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The cervix actually shifts
as it labor's.
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And so the closer it gets,
as it lines up
to the vaginal opening,
the more ripe it is.
03:58
So, it's not the position
of the patient.
04:00
It's the position of the cervix.
04:02
If you remember back
from our discussion
of the stages
and phases of labor,
we also want
to think about effacement.
04:09
So that's sort of the thinness
or the shortness of the cervix.
04:13
We want to think about the station.
04:15
So how close is the presenting part
to the cervix?
And to the ischial spines?
We also want to think
about cervical consistency.
04:24
So thinking about
how something feels.
04:26
So a cervix that's not really
ready for labor
is going to feel pretty firm
like the tip of your nose.
04:32
And as it gets more and more
ready for labor,
it's going to soften up
and feel more mushy.
04:37
So usually mushy things are bad,
but in labor, actually
a nice soft cervix is pretty good.
04:44
So if you look across
the top of this chart,
you'll see numbers.
0, 1, 2, and 3.
04:49
And depending on how the client
scores on that assessment,
we'll add those numbers together
to come up with a Bishop score.
04:56
So remember, if it's someone
who's had a baby before,
we're going to use a score
of less than eight
as an indicator for the need
for cervical ripening.
05:05
And if they've never been
pregnant before,
never had a baby before,
then we'll use the number 10.
05:11
So how do we do cervical ripening?
How's it done?
Well, there are two possibilities.
05:17
It could be mechanical,
where we actually use a device
that's inserted into the cervix,
and it helps to physically
push open the cervix
and apply pressure.
05:27
Or we can use medication.
05:28
And there's several
different options such as
Dinoprostone, Misoprostol,
or low-dose oxytocin.
05:35
So either one could be used
depending on the provider,
and the particular needs
of the client.
05:40
So what are the risks
because there's certainly some?
First of all, anytime we use
any sort of mechanical device
to open up something
that's closed,
there's a potential for trauma.
05:51
We could also,
as we begin to open the cervix
send that oxytocin
which is released from the cervix
into the uterus,
and it will start contracting
too much
and that's called
hyperstimulation.
06:03
There could also be bleeding.
06:05
And finally, of course,
if we overstimulate the uterus,
there can be fetal distress.
06:11
So how does the nurse prepare
for cervical ripening?
Well, the very first thing
is you want to make sure
those dates are correct.
06:18
The last thing
that needs to happen
is that we ripen the cervix
and then find out that the client
is really not do.
06:25
Finding out they're preterm
after you've already
tried to open the cervix
is not a good day.
06:31
The next thing because
some of the medications
may cause contractions,
and therefore put some stress
on poor Cletus the fetus,
we want to do a baseline
nonstress test
to make sure,
he's doing okay.
06:43
The next thing is we want
to make sure that the client
and maybe the other people
that are there with the client,
the support team
knows what to expect.
06:51
Sometimes cervical ripening
can take place over a few days
and everyone needs to be
ready for that.
06:57
It's important to gather all
the equipment that you need.
06:59
So cervical ripening balloon
or the medication
or whatever might be needed
in order to perform
the cervical ripening.
07:08
And then once the device is placed,
or the medication
has been placed on the cervix
or around the cervix,
then making sure there are
no signs of fetal distress,
or hyperstimulation.
07:19
So that can be accomplished
by continuous monitoring
for just a little while.