Obstetric and Gynecological Nursing - The Carter Center

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10.4 Version Version is the manipulation of the fetus to obtain a more favorable presentation of the baby. E.g. From breech to vertex Type of Version External version - Used to change the presentation in to cephalic. Internal version - Used to make the presentation in to breech and extract the baby. 10.4.1 Internal Version It is the direct manipulation of the fetus inside the uterus. It is usually done to convert the malpresentation of second twin. Internal version poses significant risk to the fetus and is now done only in extreme emergencies, such as profound fetal distress with a prolapsed cored or the need for the immediate delivery of a second twin when there is not enough time for caesarian delivery. In this procedure the physician reaches up into the uterine cavity grapes feet of the fetus and draws them through the cervix and delivers the fetus as in breech presentation. This 248
procedure is extremely rare in contemporary obstetric practice. 10.4.2 External Cephalic Version External version is turning the fetus from a breech to a cephalic presentation after 34 weeks & before 37 weeks of gestation. Danger of External Version a. Separation of placenta b. Rupture of membrane c. One set of premature labor d. Knotting of the umbilical cord e. Rupture of uterus Contra indications for external versions a. Ante partum hemorrhage b. Rh negetive mother c. Previous caesarian section d. Hydrocephalus e. Hypertension or pre-eclamsia f. Premature labor g. Multiple pregnancy 249
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LECTURE NOTES For Nursing Students
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Preface This lecture note offers nu
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Acknowledgement My deepest apprecia
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2.3.5 Fallopian tube or uterne tube
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CHAPTER SIX : ABNORMAL PREGNANCY 12
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8.5 Subinvolution 225 Review Questi
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LIST OF FIGURES Figuer 1. Normal Fe
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ABBRIVATIONS ACTH Adreno cortico tr
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CHAPTER ONE INTRODUCTION Care of ch
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Hemorrhage, sepsis (infection), tox
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CHAPTER TWO ANATOMY OF FEMALE PELVI
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sacrum is concave and is referred t
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diamond in shape. The obstretrical
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Table 2 .Features of the four types
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The Fetal Skull The fetal head is t
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Regions of the Skull A. The occiput
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. Suboccipitofrontal 10cm from belo
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Figure 6 . Female external genitali
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Position:- In the non-pregnant fema
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• Round ligament - Ligaments form
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• provides a site for fertilizati
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maturation of reproductive organs a
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Thispain, called mitlelschmerz may
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2.5. The Breast Anatomy The female
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Amplulla: the widened-out portion o
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Review Questions 1. List different
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the ampullar portion. The functiona
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Blastocyst Trophoblast Inner cell m
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penetrate. Viruses, however, can cr
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Figure 10 . The fetal circulation (
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Appearance of the Placenta at Term
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Identification On inspection, the p
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Placenta infarction Placental infar
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Oarl cavity feels salivation Gums-
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• Creatinine and BUN decrease bec
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- Increase in the lower extermities
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- Lower part cervix and isthmus cha
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6. Fainting: - In early pregnancy f
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women feels it at 18-20 weeks the m
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Multipara a woman who has given bir
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The Obstetric History 1. Past Obste
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Breast Examination Asses the size,
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1.2 Fundal Palpation Purpose- To kn
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3. Deep pelvic Palpation: (3 rd Leo
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Auscultation: Check Fetal heart, ra
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• Rest at least 10 hrs at night a
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CHAPTER FOUR NORMAL LABOUR At the e
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- Labour is said to be established
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To assess progress of labour - Stat
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Relief of pain & promotion of comfo
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Uterine contraction - Frequency per
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advanced labour women may be assess
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Method - by abdominal palpation ide
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Eg. Partograph Name _______________
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- Caput - Sutures and Fontanelles.
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Echanism of Labour in a Normal Vert
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ERGOMETRINE: 0.5mgs. in a syringe w
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1. Separation of the placenta Mecha
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3. Controlled cord traction with ou
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Advantage: It allows the placenta t
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Inspect the umbilical cord a) Check
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Ergometrine Route Time to act Durat
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The guiding principles is to watch
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B. Delayed cord clamping The cord c
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- Method of delivery- spontaneous o
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4.4. Episiotomy Definition: The mak
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4. Lateral: The incision is begun o
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Layers to be repaired 1. Vaginal wo
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CHAPTER FIVE THE NORMAL PUERPERIUM
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Lochia- discharge from the uterus d
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5.2 Management of the Puerperium An
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answer her questions and through ou
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CHAPTER SIX ABNORMAL PREGNANCY At t
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One fetus may be died and be retain
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Management of Pregnancy - Early dia
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are labeled as ‘ Twin one ‘ and
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a) Both twins presenting by the ver
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- The urine will smell of acetone,
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The liver is affected in sever case
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Moderate - Preeclampsia is usually
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Management during labour The nurse/
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35% with in the first few hours aft
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- The volume of urine and the album
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Type 1 placenta praevia - The major
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Diagnosis - Using ultrasonic scanni
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Complications • Post partam haemo
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If the blood loss is revealed; More
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- Rarely, Rhesus- isoimmunization -
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The mother should rest in bed. An u
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The first encounter may not result
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The degree of haemolysis and the nu
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Transmission of infection to the fe
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Post natal care Separation of the b
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giving several short pushes during
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- Maternal hyperglycemia should be
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Review Questions 1. List the differ
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All ill fitting part is associated
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On auscultation The fetal heart bea
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cord prolapse). - Sedation often ne
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up gently delivery slowly taking 2
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Diagnosis On palpation - the head i
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Complications Maternal Fetal - Obst
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make sure no cord prolapsed and to
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If diagnosed during the first stage
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Management Encourage the mother to
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7.2.1 Atonic Postpartum Hemorrhage
Page 213 and 214: Cause - Delivery through partially
Page 215 and 216: Management of Severe PPH in a Healt
Page 217 and 218: Cause in 1 st stage 1) In-efficient
Page 219 and 220: 4 Reduced pelvic out let. A forceps
Page 221 and 222: - If the fetus is not alive and the
Page 223 and 224: Methods of determining C.P.D. 1. De
Page 225 and 226: 3 Placenta percrata- through muscle
Page 227 and 228: 2. Tonic contraction and Bandl’s
Page 229 and 230: Condition of the baby - Usually sti
Page 231 and 232: 3. Control head, keep it flexed, so
Page 233 and 234: Review Questions 1. What are the co
Page 235 and 236: More severe infection may consist o
Page 237 and 238: Prevention The best method of treat
Page 239 and 240: Managing Puerperal sepsis 1. Isolat
Page 241 and 242: 8.5 Subinvolution Sub involution is
Page 243 and 244: CHAPTER NINE INDUCTION OF LABOUR At
Page 245 and 246: Table 6 .Bishops Score System Induc
Page 247 and 248: - Fluid balance chart - Urine test
Page 249 and 250: Nipple stimulation, which releases
Page 251 and 252: Conditions in which trial of scar i
Page 253 and 254: CHAPTER TEN OBSTETRIC OPERATIONS At
Page 255 and 256: Indication for forceps delivery - F
Page 257 and 258: In the infant: Bruising: Severe bru
Page 259 and 260: 10.2 Caesarean Section Caesarean se
Page 261 and 262: Possible indications include: - The
Page 263: types of decapitating hooks and kni
Page 267 and 268: - The head must be engaged. - The w
Page 269 and 270: CHAPTER ELEVEN CONGENITAL ANOMALIES
Page 271 and 272: A single remiuterus results when on
Page 273 and 274: E. Persistence of male (Wolffcan) d
Page 275 and 276: CHAPTER TWELVE INFECTION OF THE FEM
Page 277 and 278: Sign Major Minor Cervical motion Ab
Page 279 and 280: - Gentamycin iv or in loading dose
Page 281 and 282: In those persons with recurrent les
Page 283 and 284: Presentation Sign and symptom A wom
Page 285 and 286: Risk Factor Studies have indicates
Page 287 and 288: ecto vaginal fistula. Other types m
Page 289 and 290: 12.6 Prolaps of the Uterus A descen
Page 291 and 292: - If no symptoms are present and th
Page 293 and 294: Forced inversion caused by excessiv
Page 295 and 296: therapy may be initiated to prevent
Page 297 and 298: Local disorders of the genital trac
Page 299 and 300: . Missed abortion This is the term
Page 301 and 302: The membranes may have ruptured and
Page 303 and 304: operation. Many mothers do not make
Page 305 and 306: I. Septic abortion Infection may oc
Page 307 and 308: Dysmenorrhea Definition-Dysmenorrhe
Page 309 and 310: esult from tension, anxiety (stress
Page 311 and 312: Implantation may occur in the fimbr
Page 313 and 314: the rupture is on the mesenteric si
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Diagnosis - The presence of interna
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Causes of infertility Female - Vagi
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Benign A. Fibrocystic breast diseas
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- Pain in the breast - Blood staine
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Treatment - Oestrogen - Progesteron
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E. Gently squeeze the nipple of eac
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- Poor uterine contraction - Subinv
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cervical canal and are multiple. Th
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Vulval Cysts Bartholin’s cyst- It
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GLOSSARY Abortion Termination of pr
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Intra uterine growth retardation Fe
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Obstetric and Gynecological Nursing - The Carter Center

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