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29 Cards in this Set
- Front
- Back
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Reasons for requesting a C-section
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fear of labor pain
fetal moridity maternal pelvic floor damage more convenient to have a planned date of birth |
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Other factors rising incidence of C-section
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Use of electronic fetal monitoring (earlier indications of fetal distress)
Increased malpractice suits Labor induction and augmentation |
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Reasons for emergency C-section
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failure to progress in labor
non-reassuring fetal heart rate tracings breech presentation placenta previa fetal malposition |
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Transverse incision (lower uterine segment) is chosen for several reasons
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the lower uterine segment is the thinnest portion of the uterus with the least activity, incision at this site minimizes blood loss, easier to repair, rupture of scar in subsequent pregnancies are minimized.
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Transverse incision also has a decreased risk for
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paralytic ileus
peritonitis bowel adhesions |
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To perform a transverse incision (after opening the abdominal cavity), the surgeon makes the initial incision transversely across
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the uterine peritoneum, where it is attached loosely just above the bladder, then he dissects the lower periotoneal flap and bladder from the uterus and incises the uterine muscle.
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After performing the transverse incision,
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the membranes are ruptured
the fetus is removed the placenta is extracted and IV oxytocin is administered to facilitate uterine contractions |
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Suturing (transverse) of the uterine wall occurs in
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two layers, which seals off the incision and helps prevent lochia from entering the peritoneal cavity
A layer of absorbable suture is used to reapproximate the visceral peritoneum Packs are removed from the abdominal cavity, with the abdomen closed in layers |
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With a CLASSIC cesarean, the surgeon makes a
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VERTICAL incision directly into the wall of the uterine body
After extraction of the uterine contents, three layers of absorbable sutures are used to close the incision. |
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This approach (classic) requires cutting into the
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full thickness of the uterine corpus.
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Indications for a classic (vertical) are
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extensive adhesions involving the bladder and lower uterine segment from previous C-births, transverse lie, and anterior placenta previa
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Classic (vertical) provides RAPID access to the fetus and may be used in
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cases of acute hemorrhage or other emergencies that threaten maternal/fetal safety
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Other factors (class-vertical)
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fetus less than 34 weeks who presents breech
maternal fibroids that restrict lower uterine segment need for maternal hysterectomy immediately following invasive maternal cervical cancer rescue living fetus from dead mother |
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Rare type of incision is the
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low (cervical) vertical approach. Generally used only if surgeon is having trouble extracting from other methods
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Preadmission (C-Birth) should include
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discussion of postoperative pain management
realistic understanding of pain and surgical recovery warning signs of infection |
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Team members (heightened anxiety of pt) need to concentrate on
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alleviating fears
correcting misperceptions teaching normal procedures likely outcomes communicating findings |
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If C-section is elective, providers should
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verify the pregnancy's gestation
review maternal/pregnancy history |
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Common diagnostic studies to ensure maternal/fetal well being include
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CBC
urinalysis blood type and cross match ultrasound (fetal position/placental location) if gestation is PRETERM (an amniocentesis may be needed to check fetal lung maturity |
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The doctor (c-birth) usually discusses the need
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for the surgery
the risks the type of anesthesia (spinal, epidural or general) EPIDURAL used most frequently |
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The nurse (c-section) should document the mom's last
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oral intake and what was eaten, assist with preparing the necessary equipment, including newborn resuscitation equipment and a warm crib
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The nurse (c-section) can begin teaching inter.ventions that reduce
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postoperative complications (including use of deep breathing exercises and the incentive spirometer
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Team members will prepare the
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surgical site and begin an IV infusion for fluid replacement therapy, the client will need a Foley for approximately 24 hours.
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The nurse should administer (c-section)
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any ordered preoperative medications and record when they were given as well as any side effects, gown the father.
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The team typically involved in a c-birth includes the
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OB, surgical assistant, anesthesiologist, registered nurses and pediatrician. Nurses are particularly helpful during this time at providing comfort, information, and reassurance to the client and her support people.
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Postpartum (c-section) care
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Vitals signs and lochia flow checked every 15 min for 1 hr
every 30 min for next hour and then every 4 hours if stable If the patient received sedation, her LOC needs to be monitored; if she received general, the nurse needs to document when sedation to her legs returns |
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Postpartum care (con't)
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The patient should cough, perform deep breathing and use the incentive spirometer every 2 hours
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Assessments will include
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regular assessments of her abdominal dressing and drainage
uterine fundus for firmness urinary output perineum |
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Some clients are able to
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eat regular food 12-18 hours postpartum
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The client should avoid sexual intercourse until
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lochia has ceased and she no longer has any abdominal or perineal discomfort
provide contraception education return appointment: 6 weeks after discharge |
