Amniotomy, Leopold Maneuvers and Cervical Ripening

• Amniotomy is the artificial rupture of the amniotic membranes (AROM) by a provider.
• It is performed to induce or augment labor.
• AROM can shorten labor by 1 to 2 hours.
• Risks of AROM include infection, umbilical cord prolapse, and fetal injury.

Indications for Amniotomy

• Need to induce or augment labor
• Need to apply internal fetal or contraction monitors
• Assessment of amniotic fluid

Leopold Maneuvers

• Leopold maneuvers are a series of four steps used to palpate the fetal presentation and position through the abdomen.
• Palpate the fundus to identify the fetal part, feel for the fetal back, palpate for the fetal part presenting at the inlet, and palpate the cephalic prominence.
• Leopold's maneuvers helps determine the fetal position and presentation
• It assists in locating the fetal heart rate for auscultation.

Cervical Ripening

• Cervical ripening is the process of softening and thinning the cervix to prepare it for labor and birth.
• Methods include mechanical (balloon catheters), surgical (amniotomy), and pharmacological (prostaglandins).
• Prostaglandins such as misoprostol and dinoprostone can be administered vaginally or orally to ripen the cervix.
• Mechanical methods like Foley catheters can be used to apply pressure to the cervix.

Induction of Labor

• Labor induction is stimulating contractions before the spontaneous onset of labor.
• Indications include post-term pregnancy, maternal medical conditions, fetal compromise, and history of rapid labor.
• Induction methods include amniotomy and medication such as oxytocin.
• Oxytocin is a synthetic hormone that stimulates uterine contractions.
• Closely monitor maternal and fetal response to oxytocin.
• Stop infusion for signs of hyperstimulation or fetal distress.

Labor Augmentation

• Labor augmentation is enhancing ineffective uterine contractions after labor has begun.
• Methods include oxytocin infusion and amniotomy.
• Amniotomy can release prostaglandins that promote contractions.
• Oxytocin helps to increase the intensity and frequency of contractions.

External Cephalic Version (ECV)

• ECV is a procedure to turn a fetus from a breech or shoulder presentation to a vertex presentation.
• It is typically performed after 36 weeks of gestation.
• Ultrasound is used to guide the manipulation.
• Tocolytic medications may be given to relax the uterus.
• Contraindications include placental abnormalities, oligohydramnios, and fetal distress.
• Monitor the mother and fetus closely after the procedure.

Forceps-Assisted Delivery

• Forceps-assisted delivery involves using forceps to assist in the delivery of the fetal head.
• Indications include prolonged second stage of labor, fetal distress, or maternal exhaustion.
• Risks include maternal lacerations, hematomas, and fetal injury.
• The woman should be informed about the procedure and its potential risks.

Vacuum-Assisted Delivery

• Vacuum-assisted delivery uses a vacuum cup attached to the fetal head to assist in delivery.
• Indications are similar to those for forceps-assisted delivery.
• Risks include cephalohematoma, scalp lacerations, and maternal soft tissue injury.
• Limit the amount of pressure and duration of application to reduce fetal injury.
• Assess the newborn for signs of trauma after delivery.

Episiotomy

• Episiotomy is an incision made in the perineum to enlarge the vaginal opening.
• Performed to expedite delivery or prevent severe perineal tears.
• Not routinely recommended due to increased risk of complications.
• Types include midline and mediolateral.
• Risks include pain, infection, and prolonged healing.

Cesarean Birth

• Cesarean birth is the surgical delivery of a baby through incisions in the abdomen and uterus.
• Indications include fetal distress, breech presentation, placental abnormalities, and previous cesarean birth.
• Types of incisions include low transverse and classical.
• Nursing care includes preoperative teaching, intraoperative monitoring, and postoperative care.
• Postoperative care focuses on pain management, wound care, and preventing complications.

Vaginal Birth After Cesarean (VBAC)

• VBAC is a trial of labor and vaginal birth in women who have had a previous cesarean birth.
• Candidates must meet specific criteria, including having a low transverse uterine incision.
• Risks include uterine rupture.
• Continuous fetal monitoring is essential during labor.
• VBAC offers benefits such as shorter recovery time and avoidance of major surgery.
• Requires careful selection of candidates and close monitoring during labor.

Nursing Care during birth related procedures

• Continuous maternal-fetal monitoring to assess well-being.
• Provide emotional support and clear explanations of procedures.
• Administer medications as prescribed.
• Assess maternal vital signs, contractions, and fetal heart rate patterns.
• Document all interventions and observations.
• Ensure informed consent is obtained prior to procedures.
• Promote comfort and relaxation techniques to manage pain and anxiety.
• Monitor for complications such as infection, bleeding, and fetal distress.
• Collaborate with the healthcare team to provide optimal care.
• Provide postpartum care and education to promote recovery and bonding.