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Vacuum Assisted Deliveries
Transcript of Vacuum Assisted Deliveries
Nursing 385 Vacuum Assisted Deliveries What do I look for? Assessment ? What is a Vacuum
Assisted Delivery? Let's take a trip to the Delivery room! Learn the Systematic approach and proper technique for performing an assisted vaginal birth using a vacuum extractor. Discuss the benefits and risks of low operative births. Objectives Identify the indications and contraindications to assisted vaginal birth for vacuum extraction. Select the appropriate candidates and manage them as appropriate, including pre/intra/post operative care. Recognize the importance of correct documentation for vacuum assisted births. An assisted vaginal birth refers to the use of a vacuum or forceps to achieve a vaginal birth in the second stage of labour. Designed to produce traction upon the fetal scalp in order to assist the maternal expulsive effort. Not a device for applying rotational forces, nor is it likely to succeed in the absence of maternal expulsive effort, but may be used to correct attitude (deflexion) if properly applied. Epidemiology Did you know?... Approximately 5% (1 in 20) of all deliveries in the United States are operative vaginal deliveries. The past 20 years have seen a progressive shift away from the use of forceps in favor of the vacuum extractor as the instrument of choice. Operative vaginal delivery refers to the application of either forceps or a vacuum device to assist the mother in effective vaginal delivery of a fetus. What do we want to achieve? Incident rate: In Canada (2004-2005): between 9.4% and 11.2%. Prerequisites: informed consent
absence of fetal contraindications
maternal bladder empty
cervix fully dilated adequate uterine contractions
no evidence of cephalopelvic disproportion (cpd)
adequate facilities and resources available
operator knowledge of their instruments, their use, and the complications that can arise
ongoing fetal and maternal assessment (vitals)
backup plan in case the procedure is unsuccessful Indications Atypical or abnormal fetal heart rate pattern. Medical indications to avoid inadequate progress of labour.
Ex: cardiac conditions or cerebral vascular disease Lack of effective maternal expulsive effort. Contraindications Non cephalic, face or brow presentation. Fetal conditions. Any contraindication for vaginal birth:
complete Placental Previa, active genital Herpes Simplex virus lesions, untreated Human Immunodeficiency Virus Less than 34 weeks gestation. Need for operator-applied rotation. Nursing Diagnosis Patient at risk for tissue trauma, secondary to a difficult birth process, related to the vacuum assisted delivery, as evidenced by atypical/abnormal fetal heart rate pattern/lack of effective maternal expulsive effort.
Patient at risk for fatigue, related to prolonged inadequate progress of labor, as evidenced by feelings of exhaustion, reducing their capacity of physical and mental work.
Patient at risk for disturbance of self-esteem, related to the vacuum assisted delivery, as evidenced by prolonged inadequate progress of labor. Treatment Goals To Reduce Risk Indication be convincing, compelling, documented.
Informed consent obtained.
Operator have training, experience, judgement, and ability in the use of the instrument.
Care in diagnosis of station.
Avoid excessive traction force and fetal head compression.
Be prepared for shoulder dystocia.
Establish stopping rules with willingness to abandon the procedure.
Have a backup plan ready.
Ongoing fetal and maternal assessments. After Care: Active management of the third stage of labour.
Obtain umbilical arterial blood gas analysis.
Careful examination for maternal and neonatal trauma.
Documentation includes indication, station, position, and method of operative technique. Nursing Interventions Rationale For Intervention Why would we Intervene? Evaluation Morbidity and Mortality: Maternal soft tissue damage (hematoma, laceration)
Fetal scalp trauma (hemorrhage, laceration)
Hyperbilirubinemia due to cephalohematoma
Retinal hemorrhage (temporary, no long term damage)
Temporary changes in your pelvic and perineal nerves and muscles.
Pain from epesiotomy--> resist moving your bowels -->constipation
Vitals every 15 minutes/1 hour>>every 30 minutes/1 hour>>q4hours>>once a shift (HAVEABODA, BUBBLEHEN, Newborn Assessment)
Family's emotional status Information #1 HERE Information #2 HERE Information #3 HERE Information #4 HERE Information #5 HERE Field Trip, Anyone? Insert Link HERE. Sources ? ? ? ? ? ? ? ? ? ? ? ! ! ! ! ! ! ! ! ! ! ! *Note the nurse does not perform the delivery, but it is good to know what is going on ;) "Get this thing out of me!!!" A B 5+7= (cc) image by anemoneprojectors on Flickr C D E F G H I J Address the patient, consent
Anesthesia/Analgesic adequate for pain relief
Assistance (NICU, pediatrician) for neonatal support available Bladder empty Cervix fully dilated, membranes ruptured Determine: position, station, pelvic adequacy
Anticipate shoulder dystocia Equipment: inspect cup, pump, tubing, pressure Fontanelle under or posterior to cup Gentle traction with contractions Halt! if no progress after:
20 minutes Incision--> consider an epesiotomy Jaw- when reachable, remove traction *support!
*pass ob/gyn equipment
*remain with mom, NICU & pediatricians will take care of babe
*energy-snacks, ice cubes, fluids after
*cool clothes, fan, warm blankets "Your wish is
my command!" correct placement of the vacuum cup on the fetal scalp
application of a vacuum to suck part of the scalp into the cup and create an artificial caput succedaneum (known as a chignon)
application of a traction force to the fetus in concert with uterine contractions to expedite delivery.
deliver the baby! Within 20 minutes... PREOPERATIVE
teaching normal procedures and likely outcomes
providing comfort, information, and reassurance to client and support people
check vitals and lochia flow every 15 mins/hour>>every 30 mins/hour>>q4hours
HAVEABODA & BBBLEHEN
discharge teaching of rest,
infection, activity restrictions,
contraception use dr's jobs...
pressure's on! So that's how
it is done! WOW! Atypical= 100-110 bpm; less than or equal to 5 bpm of variability in 40- mins; rising baseline; repetitive decels (greater than or equal to 3)
Abnormal= Bradycardia (less than 100 bpm), tachycardia (greater than 160 bpm, erratic baseline Ali, Unzila A., & Norwitz, Errol R. (2009). Vacuum-assisted vaginal delivery. Reviews in obstetrics & gynecology, 2(1):5-7. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672989/
BabyCenter Canada. (2010). Assisted birth (forceps and vacuum). Retrieved from: http://www.babycenter.ca/pregnancy/labourandbirth/labourcomplications/assisteddelivery/
BabyCenter Canada. (2010). Assisted vaginal delivery. Retrieved from: http://www.babycenter.com/0_assisted-vaginal-delivery_1451360.bc?page=1
Cargill, Yvonne M., & MacKinnon, Catherine J. (2004). Guidelines for operative vaginal birth. SOGC clinical practice guidelines, No 148. Retrieved from : http://www.sogc.org/guidelines/public/148E-CPG-August2004.pdf
More OB Taking Care of Life. (2012). Assisted vaginal birth. USA.
Smith, Roger P. (2009). Procedures. In Smith, Roger P., Netter's obstetrics and gynecology (p 628). Kansas, MO: Saunders
Watts, Nancy. (2010). High-risk labour and childbirth. In Evans, Robin J., Evans, Marilyn K., Brown, Yvonne M. R., Orshan, Susan A., Canadian maternity, newborn, & women's health nursing (p 655-661). Philadelphia, PA:Lippincott Williams & Wilkins.
World Health Organization. (2012). Managing complications in pregnancy and childbirth. Retrieved from: http://hetv.org/resources/reproductive-health/impac/Symptoms/table_S12.html Alberta had a rate of 12.% deliveries being vacuum assisted in 2008-2009.