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Copy of Operative Obstetrics
Transcript of Copy of Operative Obstetrics
behind this frame! Double click to crop it if necessary (cc) photo by Metro Centric on Flickr (cc) photo by Franco Folini on Flickr (cc) photo by jimmyharris on Flickr (cc) photo by Metro Centric on Flickr Forceps are curved metal instruments used by physician to provide traction to deliver the baby's head, assist the rotation of the head, or both. Purpose: To provide traction in a difficult delivery and facilitate the birth of the fetal head by augmenting the mechanism of descent or internal rotation. Indications:
1. Fetal distress
2. Fetal malpresentation
3. Large fetal size
4. Aftercoming head in breech presentation
5. Prolonged labor
6. Maternal exhaustion
7. Maternal illness Equipments:
2. Sterile gloves
3. Episiotomy set
4. Different types of forceps. Steps:
1. Explain the procedure.
2. Be sure that membranes are ruptured and cervix are completely dilated.
3. Monitor FHR and report if lower than 100 bpm.
4. Apply a vacuum extractor cup to the occiput of the fetal head after the cervix is fully dilated and when the head is on the pelvic floor.
5. Apply traction during contraction.
6. When the head crowns, assist the doctor for episiotomy.
7. After the head is born, release the vacuum cup.
8. The time of application of the vacuum extractor cup should not exceed 25 minutes.
9. Assist in repairing of episiotomy.
10.Observe for vaginal,cervical or perineal lacerations for the mother; presence of chignon for the newborn. Indications:
1. Maternal Exhaustion
2. Maternal medical problems
3. Failure of descent and rotation.
4. Fetal distress Involves applying a cup, called a vacuum extractor, to the fetal head, and withdrawing air from the cup. This creates a vacuum within the cup which secures it to the fetal head. Equipments:
1. Vacuum extractor - consists of a metal or
plastic cup connected by a flexible silastic
or rubber tubing to a vacuum pump.
2. Sterile gloves
3. Episiotomy set
4. Local anesthesia
5. Syringe is a surgical procedure in which the birth is accomplished through an abdominal and uterine incision. A cesarean birth may
planned or unplanned. Indications:
2. Cephalopelvic disproportion.
3. Hypertension, if prompt delivery is necessary.
4. Maternal diseases such DM, heart dse.,or cervical cancer, if labor is not advisable.
5. Active genital herpes.
6. Previous uterine surgical procedures such as classic CS.
7. Persistent nonreassuring FHR.
8. Prolapsed umbilical cord.
9. Fetal malpresentation.
10. Hemorrhagic conditions such as abruptio placenta or placenta previa. 1. Tucker-McLean forceps - extract
fetus with unmolded, rounded heads
commonly used in multiparas who
have briefer labors. 2. Simpson Forceps - extract fetus
with elongated. molded; commonly
used with multiparas who have long
labors. 3. Piper Forceps - deliver aftercoming head in breech presentation. 4. Kielland forceps - rotate head from
transverse or posterior position to an
anterior position; used to deliver women
with anthropoid pelvis. 5. Barton Forceps - rotate head from
transverse to an anterior position;
designed for use in women with
flat pelvis. Assist in Forcep Delivery assist in cesarean delivery Classic cesarean incision - vertically
through both the abdominal skin
and the uterus.
Pfannensteil incision - skin incision is made
horizontally while the uterine incision is
11. Sterile towels maybe placed in the incision to separate the uterus from the organs.
12. When the uterus is opened, the child's head maybe delivered manually or by the application of forceps.
13. The mouth and the nose of the baby are suctioned by a bulb syringe, before the remainder of the child is delivered.
14. When the baby has been delivered completely, clamp and cut the cord quickly and collect blood for analysis.
15. Care of the infant is then delegated to the pediatrician and nursery staff nurse.
16. After the infant's birth, the internal cavity of the uterus is inspected and the membranes and placenta are removed manually.
17. Administer oxytocin per IV to contract the uterus firmly and to decrease blood loss.
18. Before closing the uterine and abdominal incisions, both the circulating and scrub nurse do sponge counting, including the instruments.
19. Some physicians flush the operative area with saline or antibiotic solutions before abdominal closure.
20. After the abdominal closure, again sponge counting is done.
21. Clean the incision site with sterile water and apply sterile dressing.
22. After the procedure, the woman is transferred to the recovery room.
1. The surgical nurse will assist the woman to move
from the transport stretcher to the OR table.
2. If spinal anesthesia is to be given, place the woman in side-lying position and help her to curve her back to separate the vertebra and facilitate entry of the spinal needle.
3. After anesthesia is administered, place a wedge under one hip to move abdominal contents up away from the surgical field and to lift the uterus off the vena cava to promote circulation to the placenta.
4. Place a safety strap across her thighs to secure her on the narrow OR table.
5. During positioning, keep the drain tube of the indwelling catheter under her leg and place the urine bag near the anesthesiologist to monitor the urine output.
6. The nurse verifies proper function of equipment such as suction devices, monitors and electrocautery and performs an initial sponge count.
7. Do an abdominal scrub before sterile drapping.
8. When the woman is anesthetized and drape, the doctor makes the skin incision. The scrub nurse assist and handles sterile instruments to the doctor.
9. Keep the suction device available to suction blood and amniotic fluid from the uterus when it is incised.
10. Once the surgical incision is complete, retractors are slipped in to the incision to keep the incision spread apart.
Carmencita Pacis, RN,MAN The End!!!! NOT!!!!!