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METHODS OFDELIVERY
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METHODS OF DELIVERY
Forceps Assisted Delivery
Vacuum Extraction
Cesarean DeliveryVaginal Birth After
Cesarean
Normal SpontaneousDelivery
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DESCRIPTION
Delivery of the ayusing ostetrical
instruments
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1. FORCEPS ASSISTED
DELIVERY assist the
irth of afetus yprovidingthe means torotate thefetal head to
an occiput!anterior"poste!riorposition#
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$%o doule!
crossed&spoon li'earticulatedlades thatare used toassist in thedelivery of
the fetalhead
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Indicators
(#FE$A) FAC$*+Sa# second stage of laor fetaldistress
# anormal presentation orarrested descent
c# ,reterm laor to protectfetal head from in-uries
d# premature placentalseparation
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Indicators
.# /A$E+NA) FAC$*+Sa# to shorten the secondstage of laor
# ine0ective expulsivee0ort"poor progress
c# exhaustion
d# medical diseases li'ecardiac arrest
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CRITERIA/PREREQISITE
1# Full dilatation of thecervix
.# +uptured B*12# Engaged head
3# No C,D
4# Episiotomy
5# Anesthesia
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TYPES
1.LOW/OUTLET FORCEPS
6 fetal head on
parietal 7oor2. MIDFORCEPS 6 fetal
head at the level of
ischial spines
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COMPLICATIONS
(#/A$E+NA)
a# lacerations
# hemorrhage
c# uterine rupture
d# uterine prolapse
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COMPLICATIONS
(# FE$A)a# facial paralysis 8Bell9s ,alsy:# increased perinatalmoridity
and mortalityc# intracranial hemorrhaged# rain damage
e# s'ull fracturef# tissue traumag# cord compression
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N!onata" Ris#s1. !cc$%&osis and/or !d!&a a"on'
t$! sid!s o( t$! (ac!
). Ca*+t Sacc!dan!+& or c!*a"$!&ato&a and s+,s!-+!nt"%$%*!r,i"ir+,in!&ia &a% occ+r
. Transi!nt (acia" *ara"%sis
. Lo0 IQ (or c$i"dr!n
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NRSIN IMPLEMENTATION
(#,repare client and family
.#,rovide psychological
support to allay"decreaseanxiety
2#/onitor F;$ continuously
3#Assess mother and infantfor complication
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INDICATIONS
1. Condition2 t$r!at!n t$! &ot$!r or(!t+s and t$at can ,! r!"i!3!d ,%,irt$
). conditions2 $!art ds!4 ac+t!*+"&onar% !d!&a4 intra*arta"in(!ction4 !5$a+stion
. F!ta" conditions2 *r!&at+r!*"ac!nta" s!*aration4 (!ta" distr!ss
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). Vac++& !5traction
A ca* "i#!s+ctiond!3ic! is
a**"i!d tot$! (!ta"$!ad to(aci"itat!!5traction
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. CESAREAN BIRTH
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Cesarean Birth
Birth accomplished through
an abdominal incision into
the uterus.
ne o! the oldest t"pes o!
surgical procedures #no$n.
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%ore ha&ardous than 'aginal
birth
ne o! the sa!est t"pes and
one $ith !e$ complications
$hen compared $ith other
surgical procedures.
most o!ten used as a
proph"lactic measure to
alle'iate problems o! birth.
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A. %ATERNA( )ACTRS*
C+,+,
Acti'e genital herpes or
cti'e genital herpes or
papilloma
apilloma
+re'ious CS b" classicre'ious CS b" classic
incision
ncision
,isabling condition *
isabling condition *
Se'ere H+N o! pregnanc"
e'ere H+N o! pregnanc"
Heart dse that pre'enteart dse that pre'ent
pushing
ushing
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B. +lacental
)actors*
+lacenta pre'ia+lacenta pre'iaAbruptio placentaAbruptio placenta
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C. )etal )actors*
Trans'erse lie
rans'erse lie
presentation
resentation
E-treme lo$ birth $eight-treme lo$ birth $eight
)etal distress
etal distress
Compound conditions
ompound conditions
macrosomic !etus in amacrosomic !etus in a
breech lie/
reech lie/
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Types of Cesarean Birth
1. Sc$!d+"!d CS6 t$!r! is ti&! (or t$oro+'$6 t$!r! is ti&! (or t$oro+'$
*r!*aration*r!*aration). E&!r'!nc% CS
6 *r!*aration &+st ,! don!6 *r!*aration &+st ,! don!&+c$&+c$ &or! ra*id"%&or! ra*id"%E72E72
6 *"ac!nta *r!3ia6 *"ac!nta *r!3ia
6 a,r+*tio *"ac!nta6 a,r+*tio *"ac!nta6 (!ta" distr!ss6 (!ta" distr!ss6 (ai"+r! to *ro'r!ss6 (ai"+r! to *ro'r!ss
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0. (o$ Segment Incision1
Tran'erse
%ade hori&ontall" across the
abdomen2ust abo'e the
s"mph"sis pubisacross the
uterus2ust o'er the cer'i- A.#.a. p!annenstielor 3bi#ini4
incision
%ost common t"pe o! CS
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Ad'antages*
5 less li#el" to rupture in
subse6uent labor
5 less blood loss
5 easier to suture
5 decreases postpartal uterine
in!ections
5 less 7I complications
,isad'antage*
5 it ta#es longer to per!orm 8
impractical !or ECS
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T%*!s o( C!sar!an Incisions
9. C(ASSICA( CESAREAN INCISIN8
made 'erticall"through
both the abdominal s#in and the
uterus5 The scar could rupture during
labor
5 :ill not be able to ha'e a
subse6uent 'aginal birth
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. Va'ina" 8irt$ A(t!r
C!sar!an 8irt$ 9V8AC:Pati!nt 0$o $as $ad a *r!3io+sPati!nt 0$o $as $ad a *r!3io+s
"o06trans3!rs! c!sar!an ,irt$."o06trans3!rs! c!sar!an ,irt$.
No &!dica" or o,st!tricNo &!dica" or o,st!triccontraindication to "a,orcontraindication to "a,or
No $istor% o( *rior +t!rin!No $istor% o( *rior +t!rin!
r+*t+r! !5istsr+*t+r! !5istsIncid!nc! o( d!$isc!nc!2 1;Incid!nc! o( d!$isc!nc!2 1;
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NORMAL SPONTANEOSDELIVERY 9NSD:
act+a" !3!nt o( t$!!5*+"sion o( t$! *rod+ctso( conc!*tion (ro& t$!
&at!rna",od%
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PURPOSE:
To &aintain t$! *$%sio"o'icsta,i"it% o( t$! 0o&ant$ro+'$o+t t$! sta'!s o( "a,or
To *r!3!nt co&*"ications,!(or!4 d+rin' and a(t!r "a,or
and d!"i3!r% ,ot$ t$! &ot$!rand to t$! ,a,%
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GENERAL
CONSIERATIONS: H!"* t$! *art+ri!nt *artici*at!
to t$! !5t!nt s$! 0is$!s in t$!d!"i3!r% o( t$! in(ant4 to &!!tt$! 0o&an
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Cons!r3! t$! 0o&an
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R!"a5ation and r!d+ction o(str!ss incr!as!s 0o&an
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T$! c"i!nt s$o+"d ,!assist!d in contro""!d c$!st,r!at$in' d+rin'contractions and r!"a5,!t0!!n contractions.
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T$! c"i!nt is disco+ra'!d to,!ar +nti" c!r3ica" di"ationis co&*"!t!.
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Monitor c"os!"% t$!*ro'r!ss o( "a,or and ,!a0ar! o( t$! 0arnin' si'ns(or t$! s!cond sta'! o("a,or.
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R!s*!ct and *ro&ot! t$!0o&an and $!r s+**ort*!rson
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NORMAL SPONTANEOS
DELIVERY
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MECHANISM OF LA8OR
a!"!a! as #ar$ina% &o'e&ents of
%a(or are the $ifferent
&o'e&ents or positiona%
#han)es that the fet*s &a"es$*rin) the first an$ se#on$ sta)e
of %a(or in or$er to pass
s*##essf*%%y thro*)h theirre)*%ar shape of the (irth
#ana%!
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EQIPMENTS/ARTICLES NEEDEDEQIPMENTS/ARTICLES NEEDED
1! + Peritonea% ,or#eps Strai)ht
+! 1 Peritonea% ,or#eps C*r'e
-! 1 Th*&( for#eps
.! 1 Tiss*e ,or#eps
/! 1 Nee$%e 0o%$er
! 1 2ayo S#issor Strai)ht
3! 1 2ayo S#issor C*r'e
4! + Petri ish
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Pr!*ar! D!"i3!r% Pac#
5! Tray 6ith %inin)
17!Nee$%e 8 #*ttin) 9 ro*n$11!;e%%y Pa$
1+!Le))in)s
1-!OR 2as"
1.!OR Cap1/!Pai%
1!Green To6e%
13!OR )o6n
14!0ypo tray
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+! 2aintain S*r)i#a% Asepsis+! 2aintain S*r)i#a% Asepsis
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-! O(ser'es 6arnin) si)ns-! O(ser'es 6arnin) si)ns
of the +of the +n$n$ sta)e ofsta)e of
%a(or%a(or
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.! S#r*(s $*rin) a#t*a%.! S#r*(s $*rin) a#t*a%
$e%i'ery$e%i'ery
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/! Gi'e e&otiona% s*pport/! Gi'e e&otiona% s*pport
to the &otherto the &other
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3! oes pro#e$*re in a3! oes pro#e$*re in a
syste&ati# &annersyste&ati# &anner
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PROCEDREACTIONACTION RATIONALERATIONALE
1.Position the woman1.Position the womanin lithotomy on thein lithotomy on thedelivery table,delivery table, legs tolegs to
be put up slowly atbe put up slowly atthe same time on thethe same time on thestirrup.stirrup. Same shouldSame shouldbe done whenbe done when
straightening the legsstraightening the legsor putting them downor putting them downafter delivery.after delivery.
To preventTo preventtrauma to thetrauma to theuterineuterine
ligaments,ligaments,andandbackaches orbackaches or
leg crampsleg cramps
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2. Encourage2. Encouragethe woman tothe woman todo strongdo strongpushing withpushing withcontractionscontractions
Best timeBest time
to performto performstrongstrongpush topush to
facilitatefacilitatedescent ofdescent ofthe fetuthe fetuss
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Tell the womanTell the woman
to use lowto use lowreathingreathingpatternpattern
etween eachetween eachcontractionscontractions
To pre!entTo pre!ent
pushingpushingetweenetweencontractioncontraction
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As soon asAs soon asthe headthe head
crowns,crowns,instruct theinstruct thewoman notwoman notto pushto push
insteadinsteadshe isshe isadvised toadvised topantpant
ToTopreventprevent
rapidrapiddelivery ofdelivery ofthe fetus.the fetus.
ToTo
preventpreventdural/subddural/subdural tearsural tears
ToTo
preventpreventvaginal orvaginal orperinealperineallacerationslacerations
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"erform Ritgen#s"erform Ritgen#smaneu!er $maneu!er $supporting withsupporting with
the palm againstthe palm againstthe rectumthe rectum
To pre!entTo pre!ent
laceration of thelaceration of thefourchettefourchette
To ring fetal chinTo ring fetal chindown the chest sodown the chest so
that thethat the smallestsmallestdiameter of thediameter of thefetal headfetal head is theis the
one presented atone presented atthe irth canalthe irth canal
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Assist in !*isioto&% as n!!d!d2
"rimaril$ to pre!ent"rimaril$ to pre!entlacerationlaceration
"re!ent prolonged"re!ent prolonged
and se!ere stitchingand se!ere stitchingof the muscleof the musclesupporting thesupporting theladder and rectumladder and rectum
Reduce duration ofReduce duration ofthe 2the 2ndndstage of laorstage of laor
Enlarge !aginalEnlarge !aginaloutlet in reechoutlet in reechpresentation ofpresentation offorcep deli!er$forcep deli!er$
%pare the%pare theinfant#s head frominfant#s head from
prolongedprolongedpressure whichpressure whichma$ result toma$ result torain damage&rain damage&
especiall$ inespeciall$ in
premature a$.premature a$.
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As soon as the headAs soon as the head
is orn& suction oral'is orn& suction oral'phar$n( with smallphar$n( with smallul s$ringe.ul s$ringe.
%uction nares ne(t.%uction nares ne(t.
To e(pedite drainageTo e(pedite drainage
and pre!entsand pre!entsaspiration of amnioticaspiration of amnioticfluid& mucus andfluid& mucus andmaternal lood.maternal lood.
To pre!ent inspirationTo pre!ent inspirationfollowing stimulationfollowing stimulationof nares efore naresof nares efore naresis clear.is clear.
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As soon as the headAs soon as the headhas een deli!ered&has een deli!ered&
inspect if a loop ofinspect if a loop ofcord is around thecord is around thenec). If present& slip itnec). If present& slip itdown the shoulder* ifdown the shoulder* if
too tight& appl$ 2too tight& appl$ 2clamps an inch apartclamps an inch apartefore cutting theefore cutting thecord etween thecord etween the
clamps.clamps.
To a!oid cordTo a!oid cordcompression whilecompression while
the a$#s od$ isthe a$#s od$ iseing deli!eredeing deli!ered
To pre!ent accidentalTo pre!ent accidentalpulling of the cordpulling of the cord
resulting to detachingresulting to detachingof the cord from theof the cord from thease of the placentaase of the placentaor from the a$#sor from the a$#s
na!el.na!el.
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After e(ternalAfter e(ternalrotation& gi!e arotation& gi!e a
gentle stead$gentle stead$downward pulldownward pulland then a gentleand then a gentle
upward liftupward lift
To deli!er theTo deli!er theanterior andanterior and
posterior shouldersposterior shoulders
Lateral traction toLateral traction to
deli!er the shoulderdeli!er the shouldershould ne!er eshould ne!er edone to pre!entdone to pre!entner!e in+uries.ner!e in+uries.
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,hile supporting,hile supporting
the a$#s headthe a$#s headand nec) withand nec) withone hand& glideone hand& glide
the other handthe other handtowards the od$towards the od$then grasp oththen grasp oth
of the a$#sof the a$#san)le.an)le.
To pre!entTo pre!ent
in+ur$ as thein+ur$ as thea$#s od$ isa$#s od$ isslipper$.slipper$.
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Ta)e note ofTa)e note of
thethe timetimethethea$ isa$ isdeli!ereddeli!ered
..
-or proper-or proper
documentation.documentation.
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Immediatel$Immediatel$afterafter
deli!er$& thedeli!er$& thea$ is helda$ is heldelow theelow thele!el of thele!el of the
mother#smother#s!ul!a!ul!a
The loodThe loodfrom thefrom the
placentaplacentacan entercan enterthetheinfant#sinfant#s
od$ onod$ onthe asisthe asisof gra!it$of gra!it$
flow.flow.
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"lace the"lace thea$ ona$ on
top oftop ofmother#smother#sadomenadomen
%timulates%timulatesthe releasethe release
of o($tocinof o($tocinfrom thefrom the" thus" thusstimulatingstimulating
uterineuterinecontractioncontractionwhich aidwhich aidinin
placentalplacentalseparation.separation.
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Appl$ 2Appl$ 2clamps toclamps to
thetheumilicalumilicalcord as itscord as itspulsationpulsationceases.ceases.
Cutting ofCutting ofthe cord isthe cord ispostponedpostponeduntiluntil
pulsationpulsationisisstoppedstopped
It isIt iselie!edelie!ed
that/0'100that/0'100mL ofmL oflood islood isflowingflowingfrom thefrom the
placentaplacentato the NBto the NBat thisat thistime.time.
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Inform theInform themothermotheraout theaout these( of these( of thea$ anda$ andhelp tohelp tohold andhold andinspectinspecther a$her a$as sheas shewishes.wishes.
aternalaternaland infantand infantondingondingis initiatedis initiatedas soonas soonas theas themothermotherhas e$e'has e$e'to'e$eto'e$econtactcontactwith herwith hera$.a$.
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,ait for the signs,ait for the signsthat placenta hasthat placenta hasseparated eforeseparated eforeattempting toattempting to
deli!er thedeli!er theplacenta.placenta.
a$ tear thea$ tear thecordcord
%eparate the%eparate theplacentaplacenta
In!ert the uterusIn!ert the uterus
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Once placenta isOnce placenta is
out it is carefull$out it is carefull$inspectedinspected
"lacental"lacental
fragments ma$fragments ma$causecausesuse3uentsuse3uent
hemorrhage.hemorrhage.
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4etermine the degree4etermine the degreeof uterine contractionof uterine contraction
and perform initialand perform initialnursing inter!entionnursing inter!entionfor signs of nonfor signs of noncontracting orcontracting or
5ogg$6 uterus.5ogg$6 uterus. gentle massagegentle massage
Appl$ ice capAppl$ ice cap
To stimulateTo stimulatecontractioncontraction
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Administer o($tocicsAdminister o($tocics
as ordered.as ordered.
Assess or monitor B"Assess or monitor B"of the motherof the mother
To ensure contractionTo ensure contraction
to pre!entto pre!enthemorrhagehemorrhage
A common sideA common sideeffects of o($tocicseffects of o($tocicsspecificall$ ergotspecificall$ ergotderi!ati!es isderi!ati!es is78"ERTEN%ION78"ERTEN%ION
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Inspect perineumInspect perineum
for lacerations.for lacerations.
An$time theAn$time the
uterus is firmuterus is firmand leedingand leedingcomes out incomes out in
spurts& suspectspurts& suspectfor lacerations.for lacerations.
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Assist theAssist the
doctordoctorduring theduring theepisior'episior'rhaph$rhaph$
LaceratioLaceratio
ns if notns if notrepairedrepairedcan leadcan leadto oo9ingto oo9ing
red loodred loodfrom thefrom thelaceratedlaceratedpart of thepart of the
perineum.perineum.
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E!acuate loodE!acuate loodclots and watchclots and watch
for signs offor signs ofplacentalplacentalfragments.fragments.
Non'contractionNon'contractionof uterus afterof uterus after
placentalplacentaldeli!er$ ma$ edeli!er$ ma$ ecaused of eithercaused of either
lood cuts orlood cuts orretainedretainedplacental tissues.placental tissues.
-undus chec)-undus chec) To monitorTo monitor
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-undus chec)-undus chec)is done e!er$is done e!er$1/ mins1/ mins
"erform"erformperineal careperineal careaspeticall$ andaspeticall$ andappliesappliesperipadperipad
appropriatel$.appropriatel$.
To monitorTo monitoruterineuterinecontractioncontraction
To pro!ideTo pro!idecomfortcomfort
%er!es as%er!es asasis forasis formonitoringmonitoringlochiallochialdischarge.discharge.
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A POSITION
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A! POSITION
LIT0OTO2Y POSITION: The %e)s sho*%$ (eLIT0OTO2Y POSITION: The %e)s sho*%$ (e
p*t *p s%o6%y at the sa&e ti&e!p*t *p s%o6%y at the sa&e ti&e!
RATIONALERATIONALE1!1! To pre'ent tra*&a to the *terine %i)a&entsTo pre'ent tra*&a to the *terine %i)a&ents
+!+! To Pre'ent (a#"a#hes an$ or %e)s #ra&psTo Pre'ent (a#"a#hes an$ or %e)s #ra&ps
T$! sa&! s$o+"d ,! don! 0$!n *+ttin'T$! sa&! s$o+"d ,! don! 0$!n *+ttin't$! "!'s do0n (ro& t$! stirr+*s a(t!rt$! "!'s do0n (ro& t$! stirr+*s a(t!r
d!"i3!r%d!"i3!r%
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8. 8EARIN DO=N TECHNIQE
T$! s!condT$! s!condsta'! is t$!sta'! is t$!,!st ti&! to,!st ti&! to
!nco+ra'!!nco+ra'!stron'stron'*+s$in'*+s$in'
0it$0it$contractionscontractions!
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PSHINPSHIN
Vo"+ntar% ,!arin'6do0nVo"+ntar% ,!arin'6do0n!((ort!((ort
S!condar% *o0!r in3o"3!d inS!condar% *o0!r in3o"3!d in
"a,or."a,or.N!!d!d to $!"* t$! *ri&ar%N!!d!d to $!"* t$! *ri&ar%
*o0!r > t!rin! Contraction?*o0!r > t!rin! Contraction?
in *ro&otin' !5*+"sion o( t$!in *ro&otin' !5*+"sion o( t$!(!t+s(!t+s
=HEN TO PSH @
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=HEN TO PSH @
1! ++NN Sta)e of La(or or fro& theSta)e of La(or or fro& the&o&ent the #er'i< is f*%%y&o&ent the #er'i< is f*%%y
$i%ate$ or 17 #&! open$i%ate$ or 17 #&! open
+!+! Uterine Contra#tionUterine Contra#tion
=HEN NOT TO PSH @
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=HEN NOT TO PSH @
1! Int!r3a" o( ContractionInt!r3a" o( Contraction9 P!riod ,!t0!!n9 P!riod ,!t0!!n
contractions: and incontractions: and in
cro0nin'.cro0nin'.
).). 8!(or! co&*"!t! c!r3ica"8!(or! co&*"!t! c!r3ica"
di"atationdi"atation
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CONSEQENCES
1! r!at!r &at!rna" (ati'+!r!at!r &at!rna" (ati'+!).). Add!d (!ta" strainAdd!d (!ta" strain
.. Possi,"! In+r% to t$! (!ta"Possi,"! In+r% to t$! (!ta"
*r!s!ntin' *art*r!s!ntin' *art
.. Ca+s!s &or! strain to t$!Ca+s!s &or! strain to t$!
dis!as!d $!art in 0o&!n 0it$dis!as!d $!art in 0o&!n 0it$
cardiac ai"&!ntcardiac ai"&!ntB.B. Possi,"! In+r% in t$! c!r3i5Possi,"! In+r% in t$! c!r3i5
In+r% in t$! c!r3i5
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In+r% in t$! c!r3i5
1.1. CERVICAL EDEMA d+! to c$ronicCERVICAL EDEMA d+! to c$ronic
*assi3! con'!stion*assi3! con'!stion
EFFECTS2EFFECTS2
D!"a% in c!r3ica" di"atationD!"a% in c!r3ica" di"atation
Pr!dis*os!s to c!r3ica" "ac!rationPr!dis*os!s to c!r3ica" "ac!ration
). CERVICAL 8RISIN / TRAMA as it is). CERVICAL 8RISIN / TRAMA as it is
(orc!d a'ainst t$! s%&*$%sis *+,is d+rin'(orc!d a'ainst t$! s%&*$%sis *+,is d+rin'*+s$in'*+s$in'
TIPS RELATED TO PSHIN
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TIPS RELATED TO PSHIN
1! PROPER POSITION2PROPER POSITION2
ros! to B d!'r!!s i( not contraindicat!dros! to B d!'r!!s i( not contraindicat!d
). HO= TO PSH@). HO= TO PSH@ As 0o&an ,!'ins to (!!" a contraction As 0o&an ,!'ins to (!!" a contraction
ta#! a d!!* ,r!at$ and ,"o0 it a"" o+tta#! a d!!* ,r!at$ and ,"o0 it a"" o+t
=o&an ta#!s a )=o&an ta#!s a )ndndd!!* ,r!at$ 0$ic$ s$!d!!* ,r!at$ 0$ic$ s$!$o"ds as s$! c"os!s $!r &o+t$4 *+ts $!r$o"ds as s$! c"os!s $!r &o+t$4 *+ts $!r
c$in on $!r c$!st and ,!ars contin+!c$in on $!r c$!st and ,!ars contin+!*+s$in'*+s$in'
TIPS RELATE TO PUS0ING
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TIPS RELATE TO PUS0ING
=o&an r+ns o+t o( air ,!(or! t$!=o&an r+ns o+t o( air ,!(or! t$!contraction !nds4 ta#! anot$!r d!!*contraction !nds4 ta#! anot$!r d!!*
,r!at$ and contin+! *+s$in',r!at$ and contin+! *+s$in'
S$ort *+s$!s ar! in!((!ct+a"4 ,+tS$ort *+s$!s ar! in!((!ct+a"4 ,+t
*ro"on'!d *+s$in' so t$at 0o&an is*ro"on'!d *+s$in' so t$at 0o&an is
$o"din' $!r ,r!at$!s FOR MORE THAN B$o"din' $!r ,r!at$!s FOR MORE THAN BSECONDS IS NOT RECOMMENDEDSECONDS IS NOT RECOMMENDED
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=ALSAL=A 2ane*'erpro%on)e$ (reath ho%$in) 6hi%e (earin) $o6n
1!1!i&inishe$ ,eto> P%a#enta% )asi&inishe$ ,eto> P%a#enta% )as
e
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NO PSHIN IN CRO=NINNO PSHIN IN CRO=NIN
Instr+ction s$o+"d ,! SIMPLE4 CLEAR4Instr+ction s$o+"d ,! SIMPLE4 CLEAR4
and co&in' (ro& ONE COACH to a3oidand co&in' (ro& ONE COACH to a3oidcon(+sioncon(+sion
Nor&a% Spontaneo*s
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Nor&a% Spontaneo*s
e%i'ery1! Prepares $e%i'ery roo&@Prepares $e%i'ery roo&@
&other@ pa#"s@ instr*&ents@&other@ pa#"s@ instr*&ents@e*ip&ents!e*ip&ents!
+! 2aintains s*r)i#a% asepsis!+! 2aintains s*r)i#a% asepsis!-! O(ser'es 6arnin) si)ns in the-! O(ser'es 6arnin) si)ns in the
se#on$ sta)e of %a(or!se#on$ sta)e of %a(or!
.! S#r*(s $*rin) a#t*a% $e%i'ery.! S#r*(s $*rin) a#t*a% $e%i'ery/! Gi'es e&otiona% s*pport to/! Gi'es e&otiona% s*pport to
&other&other
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! Do!s *roc!d+r! in a s%st!&atic &ann!r.Do!s *roc!d+r! in a s%st!&atic &ann!r.. A**"i!s Rit'!n
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11. ras* ,a,%
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1.1.O,s!r3!s (or si'ns o( *"ac!nta"O,s!r3!s (or si'ns o( *"ac!nta"
s!*aration.s!*aration.1. A(t!r !5*+"sion o( *"ac!nta41. A(t!r !5*+"sion o( *"ac!nta4ins*!ct (or co&*"!t!n!ss.ins*!ct (or co&*"!t!n!ss.
1. R!&o3! ,"ood c"ots.1. R!&o3! ,"ood c"ots.
1G. C"!an *!rin!+&4 a**"i!s1G. C"!an *!rin!+&4 a**"i!s
antis!*tic.antis!*tic.
). P"ac! *!rin!a" *ad.). P"ac! *!rin!a" *ad.
)1. A(t!r car! o( instr+&!nts4)1. A(t!r car! o( instr+&!nts4!-+i*&!ntJs.!-+i*&!ntJs.
)). Do!s c$artin'.)). Do!s c$artin'.
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THANK YOUTHANK YOU
ANDANDGOOD LUCK!GOOD LUCK!