Labor and Delivery Procedures

Amnioinfusion

• Procedure of putting fluid back into the uterus
• Baby may become hypotonic (unable to move freely)
• Indications include severe variable deceleration due to cord compression
• Also used for oligohydramnios (due to placental insufficiency)

Induction of Labor

• Medical or mechanical initiation of labor
• Cervix ripening (softening and dilation) may be required
• Indications include maternal exhaustion, gestational hypertension/diabetes, prolonged labor, and prolonged premature ROM
• Prolonged gestation or dystocia (difficult labor)
• Bishop Score of 6+ is favorable for VBAC (Vaginal Birth After Cesarean)

Score, Dilation, Effacement, Station, and Cervical Consistency

• Bishop Score is used to assess potential VBAC candidates
• Score is based on dilation (cm), effacement (%), cervical station, and cervical consistency
• Different score values correlate with specific cervical positions, ranging from posterior to anterior

Forceps and Vacuum-Assisted Deliveries

• Forceps: used to assist in delivery, assessed for potential facial palsy (petechiae).
• Vacuum extraction assessed for cephalohematoma (swelling that doesn't cross suture lines).
• Swelling generally appears 2-3 days after birth and resolves within weeks or months.
• Caput succedaneum: swelling that crosses suture lines, resolves in 3 days.

Cord Prolapse

• Partial or total cord occlusion with rapid fetal deterioration
• This is a common issue in breech babies.
• Cord can be hanging outside vagina or occult (hidden, at the back of the vagina)
• Client should be in hands and knees position to relive compression.

Postpartum Complications

• Breast assessment (contour, size, pain, temperature)
• Uterine assessment (fundal height, firmness, midline)

Bladder and Bowel Function

• Assess bladder (distention, voiding, dysuria [painful urination]), report burning, or incomplete emptying.
• Assess bowels (bowel movements).

Lochia

• Lochia is vaginal discharge postpartum
• Rubra (dark red): 1-4 days
• Serosa (pinkish brown): 5-9 days
• Alba (creamy white): >10 days
• Report any unusual odor or changes in color/amount.

Episiotomy/Perineum

• Proper wound healing is crucial
• Report any pain, inflammation (swelling, redness, discharge), or calf pain with dorsiflexion of foot.

Emotional Status

• Assess for depression or mood swings

Causes of Postpartum Hemorrhage (Four T's)

• Tone (uterine atony), Tissue (retained placenta/clots/subinvolution), Trauma (lacerations/hematoma/inversion/rupture), and Thrombin (coagulopathy)

Uterine Atony

• Multiple gestations, gestational diabetes/hypertension, polyhydramnios, and/or prolonged labor are associated causes
• Assess for adequate uterine contractions postpartum

Dystocia

• Obesity, macrosomia, maternal exhaustion, ineffective pushing, and age is often factors contributing to problems in childbirth

Baby Weight Loss

• Normal for newborn to lose weight after birth, weight loss should not exceed 10%

Ortolani Test

• A test for determining hip dysplasia
• Assessing for proper range of motion and sound during hip abduction (spreading the legs apart) and adduction (bringing the legs together)

Necrotizing Enterocolitis (NEC)

• Inflammation of the stomach and colon
• Breastmilk may help fight against NEC.

Retinopathy of Prematurity (ROP)

• Excess oxygen exposure in premature newborns can cause retinopathy.

Temperature Control

• Maintain newborn temperature above 97.7°F.
• Skin-to-skin contact (kangaroo method) and radiant warmer are crucial.

Postterm Babies

• Thin umbilical cord
• Dry,cracked skin
• Macrosomia
• Long fingernails

Transient Tachypnea of the Newborn (TTN)

• Mild respiratory distress
• Results from delayed clearance of fetal lung fluid, often associated with Cesarean births

Tracheoesophageal Fistula (TEF)

• Congenital condition where trachea and esophagus are connected
• Choking may occur during the initial feedings.

Newborn Sleeping

• Alone on the back, in a crib
• Alone and supervised

Umbilical Cord Care

• Clean umbilical cord with antibacterial soap and water.

PKU

• Part of newborn screening
• Heel stick test.

Respirations in Newborns

• Irregular/shallow breating, abdominal breathing, short periods of "non-breathing".

Skin Variations in Newborns

• Vernix (thick, white wax substance), often seen in folds.

Reflexes in Newborns

• Rooting, tonic neck, Moro, grasping, babinski, gag, and blink reflexes.

Transient Emotions

• Passive immunity: Antibodies from mother to newborn (breastmilk and immunoglobulins)
• Active immunity: Individual's own immune system (through disease or vaccines)
• Natural immunity: Physical barriers like skin and mucous membranes protect the body.

Chemical Barriers

• Gastric acids and digestive enzymes.
• Acquired immunity: Development of antibodies and lymphocytes.

Subinvolution

• Incomplete uterus shrinking; treated with antibiotics.

Cesarean Section (C-Section)

• Types include low transverse (most suitable for VBAC) and classical (more risky for VBAC).