Amniotomy and Amnioinfusion Nursing Actions

Amniotomy

• Amniotomy refers to the artificial rupture of amniotic membranes (AROM) performed by a healthcare provider.
• It is done to induce or augment labor, or to facilitate the application of internal fetal or maternal monitors.
• Risks associated include prolapsed umbilical cord and infection.

Nursing Actions for Amniotomy

• Assess fetal heart rate (FHR) before and immediately after the procedure to detect cord compression.
• Assess amniotic fluid for color, odor, and consistency.
• Document the characteristics of the amniotic fluid.
• Limit client activity after the procedure.

Amnioinfusion

• Amnioinfusion involves instilling normal saline or lactated Ringer's solution into the amniotic cavity via a transcervical catheter.
• This reduces the severity of variable decelerations caused by cord compression.
• It is also used to dilute meconium-stained amniotic fluid.

Nursing Actions for Amnioinfusion

• Continuously assess uterine tone to prevent overdistention of the uterus.
• Monitor fluid return to avoid fluid overload.

Vacuum-Assisted Delivery

• Vacuum-assisted delivery uses a vacuum cup attached to the fetal head to apply traction during delivery.
• Indications include maternal exhaustion and fetal distress.
• Risks include scalp lacerations and cephalohematoma.

Nursing Actions for Vacuum-Assisted Delivery

• Assess FHR frequently during the procedure.
• Observe the neonate for signs of trauma after delivery.

Forceps-Assisted Birth

• Forceps-assisted birth involves using forceps to assist in the delivery of the fetal head.
• Indications are similar to those for vacuum extraction.
• Risks include maternal lacerations and fetal bruising.

Nursing Actions for Forceps-Assisted Birth

• Ensure the bladder is empty before the procedure.
• Assess the neonate for signs of trauma after delivery.

Episiotomy

• Episiotomy involves making an incision in the perineum to enlarge the vaginal outlet.
• It aims to shorten the second stage of labor and prevent severe perineal lacerations.

Nursing Actions for Episiotomy

• Apply ice packs to the perineum for the first 24 hours to reduce edema and pain.
• Encourage sitz baths after the first 24 hours to promote healing.
• Administer analgesics as prescribed.

Cesarean Birth

• Cesarean birth involves delivering the fetus through an incision in the maternal abdomen and uterus.
• Indications include fetal distress, malpresentation, and placental abnormalities.

Nursing Actions for Cesarean Birth

• Preoperative care includes NPO status, IV fluids, and Foley catheter insertion.
• Postoperative care includes pain management, monitoring for infection, and assessing bowel function.

Vaginal Birth After Cesarean (VBAC)

• VBAC is an option for some women with a previous cesarean birth.
• Criteria include a low transverse uterine incision and the absence of other contraindications.

Nursing Actions for VBAC

• Continuously monitor the FHR and uterine contractions.
• Be prepared for an emergency cesarean birth if necessary.

External Cephalic Version (ECV)

• ECV is a procedure used to turn a fetus from a breech to a cephalic presentation.
• It involves applying manual pressure to the maternal abdomen.
• Risks include umbilical cord compression and placental abruption.

Nursing Actions for ECV

• Monitor the FHR and maternal vital signs during and after the procedure.
• Administer Rho(D) immune globulin to Rh-negative women.

Induction of Labor

• Induction of labor involves stimulating uterine contractions before the spontaneous onset of labor.
• Indications include post-term pregnancy and maternal medical conditions.
• Methods include administration of oxytocin and cervical ripening agents.

Nursing Actions for Induction of Labor

• Monitor the FHR and uterine contractions continuously.
• Assess maternal vital signs frequently.
• Be prepared to discontinue oxytocin if signs of fetal distress occur.

Augmentation of Labor

• Augmentation of labor involves stimulating uterine contractions during labor to facilitate vaginal delivery.
• Methods include amniotomy and oxytocin administration.
• Nursing Actions are similar to those for induction of labor.

Prolapsed Umbilical Cord

• A prolapsed umbilical cord occurs when it precedes the fetal presenting part.
• This can result in cord compression and fetal hypoxia.

Nursing Actions for Prolapsed Umbilical Cord

• Call for assistance immediately.
• Use a sterile gloved hand to elevate the fetal presenting part off the umbilical cord.
• Reposition the mother to relieve pressure on the cord.
• Administer oxygen and prepare for an emergency cesarean birth.

Shoulder Dystocia

• Shoulder dystocia occurs when the fetal shoulders become impacted in the maternal pelvis after delivery of the head.
• This can result in fetal brachial plexus injury and maternal postpartum hemorrhage.

Nursing Actions for Shoulder Dystocia

• Assist with maneuvers such as McRoberts maneuver and suprapubic pressure.
• Document the time of delivery of the head and body.
• Assess the neonate for signs of brachial plexus injury.

Retained Placenta

• Retained placenta occurs when the placenta fails to deliver within 30 minutes after delivery of the infant.
• This can result in maternal hemorrhage and infection.

Nursing Actions for Retained Placenta

• Assist with manual removal of the placenta.
• Administer uterotonic medications as prescribed.
• Monitor for signs of hemorrhage and infection.

Uterine Rupture

• Uterine rupture is a rare but life-threatening complication of labor.
• It involves the tearing of the uterine wall.
• Risk factors include previous cesarean birth and uterine surgery.

Nursing Actions for Uterine Rupture

• Prepare for emergency surgery.
• Administer blood transfusions as prescribed.
• Provide emotional support to the mother and family.

Amniotic Fluid Embolism (AFE)

• AFE is a rare but often fatal complication of labor.
• It occurs when amniotic fluid enters the maternal circulation.

Nursing Actions for AFE

• Provide oxygen and respiratory support.
• Administer medications to treat hypotension and coagulopathy.
• Prepare for emergency delivery of the fetus.

Precipitous Labor

• Precipitous labor is labor that lasts less than 3 hours from the onset of contractions to delivery.
• This can increase the risk of maternal trauma and fetal distress.

Nursing Actions for Precipitous Labor

• Provide emotional support to the mother.
• Prepare for delivery.
• Monitor the FHR closely.