 OPERATIVE OBSTETRIC

 INDUCTION OF LABOR

 Pharmacologic & non pharmacologic measures to initiate contractions &

cervical change

 Deliberate initiation of labor or uterine contractions before spontaneous onset

 INDICATIONS:

1. Diabetic mother

2. Postmaturity; placental insufficency

3. PIH

4. Severe erythroblastosis fetalis; prolonged PROM

5. Maternal or physician’s convenience (not a valid indication)


Methods of induction

a. Cervical ripening

1. Prostaglandins gel

2. Laminaria – when inserted into the cervix, it absorbs water

from cervical mucus,

expands, & dilates

the cervix

b. Amniotomy or artificial rupture of membranes (AROM)

1. Auscultate FHR prior to & imediately after AROM to detect prolapse of the
umbilical cord or fetal

distress

2. Take maternal temp

q 1-2 hours ffg AROM

to detect signs of infection

c. Misoprostol (Cytotec) administration

 1. A synthetic prostaglandin agent administered intravaginally &/or orally to
stimulate the onset of contractions

2. Continuous monitoring of the FHR, uterine activity & maternal VS is essential

d. OxytocIn (Pitocin) administration

1. The Bishop score may be used to assess maternal readiness for induction by
determining:

 Dilatation

 Effacement

 Station

 Cervical consistency

 Position of the cervix

2. Prior to induction, begin external fetal monitoring

3. Assess & record maternal VS, I&O, & contraction frequency & intensity

C/I to induction of labor

a. Placenta previa

b. Transverse lie & other malpresentation

c. Prior classic uterine incision

d. Prolapsed umbilical cord

e. Active genital herpes

f. Invasive cervical cancer

 Forceps-assisted Delivery

 Forceps-assisted Delivery

 Delivery of the baby using obstetrical instruments – the forceps w/c consist of
a blade, shank, handle & a lock

INDICATORS/RISK FACTORS

1. fetal factors

 Second stage of labor fetal distress

  Abnormal presentation or arrested descent

 Preterm labor to protect head from injuries

2. maternal factors

 To shorten 2nd stage of labor

 Ineffective expulsive effort/poor progress

 Exhaustion

 Medical disease like cardiac disease

 Forceps-Assisted Delivery

• Risks

– Fetus

• Facial edema or lacerations

• Caput succedaneum or cephalhematoma

– Maternal

• Lacerations of birth canal

• Perineal bleeding, bruising, edema

• Nursing Care

– Preventive measures to decrease need for forceps

– Patient teaching

– After – assessment of newborn and assessment of woman’s perineum.

 CESAREAN DELIVERY

 CESARIAN SECTION

a. Cesarean section delivery refers to a surgical incision made into the abdomen
and uterus to deliver the fetus.

b. It requires the same postsurgical care as any other abdominal surgical

patient.

 Purpose:
  To facilitate delivery to preserve the health of the mother & the fetus

 Major indications for CS

1. Dystocia or CPD

2. Fetal distress

3. Breech presentation

4. Previous cesarian section

 Maternal risks

1. Aspiration

2. Hemorrhage

3. Infections

4. injury to the bladder or bowel

5. Thrombophlebitis

6. Pulmonary embolism

 Fetal/neonatal risks

1. Prematurity

2. Injury at birth

3. Respiratory problems related to delayed absorption of fetal lung fluid

Types of Cesarean Delivery

1. Uterine Incisions

 Low segment transverse - incision made transversely in lower segment of

uterus.

 Incision is made in thinnest portion so blood loss is minimal and uterus

is easier to open.

 Lower segment is area of least uterine activity.

 Postoperative convalescence is more comfortable.

 Possibility of later rupture is lessened.

  Incidence of postoperative adhesions and danger of intestinal
obstruction are reduced.

 It is the incision of choice.

 Classic vertical incision is made directly into the wall of the body of the
uterus; usually done in emergency situations only.

 Useful when bladder and lower segment are involved in extensive

adhesions.

 Selected when anterior placenta previa or emergency situation exists.

 Useful when fetus is in a transverse lie.

 Increased blood loss with classic cesarean.

 Increased risk of uterine rupture in subsequent deliveries.

 T-extension (low transverse with vertical cut made in the middle of the
horizontal incision)

 May be extended upward into a classical incision if extra room is

needed for delivery.

 Commonly used with preterm deliveries.

2. Abdominal Incisions

 Pfannenstiel - a horizontal incision right above the pubic hair line

 Cosmetic advantage of not being seen because pubic hair covers

incision

 Decreased chance of dehiscence or hernia formation

 Vertical - a vertical incision made in the midline of the abdomen below the
umbilicus to the pubis

 Quicker procedure to perform

 Provides better uterine visualization

 Cosmetically less appealing

 Greater chance of wound dehiscence and hernia formation

b. Postpartal care.
(1) Observe incision site for bleeding or infection.

(2) Ambulate early.

(3) Have patient turn, cough, and deep breathe especially if general anesthesia was
used.

(4) Monitor intake and output, especially voiding the first 24 hours after a foley
catheter is removed.

(5) Observe lochia flow as ordered.

(6) Monitor fundal muscle tone-gently, according to the same frequency as checking
for lochia.

(7) Assist with breast-feeding as soon as possible (immediately if desired--there is

no reason to refrain).

(8) Encourage maternal-infant bonding as soon as possible.