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Complications - operative obstetrics

Complications - operative obstetrics. “ Poverty is lot like childbirth – you know it is going to hurt before it happens, but you’ll never know how much until you experience it” Joanne Kathleen Rowling . A day in a labour Room……. For successful vaginal delivery….

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Complications - operative obstetrics

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  1. Complications - operative obstetrics

  2. “Poverty is lot like childbirth – you know it is going to hurt before it happens, but you’ll never know how much until you experience it”Joanne Kathleen Rowling

  3. A day in a labour Room……

  4. For successful vaginal delivery…. • Perineal massage  and regular pelvic floor exercises. • Perfect “P”s • Changes in maternal positioning • Reduction in neuraxial anesthesia • Increased emotional support • Laboring down

  5. Operative Delivery

  6. Traction

  7. Incidence (Birth 2002)

  8. Complications related to Operative Obstetrics: Nursing Challenge

  9. Problems arising from Episiotomy • Pain • Edema • Bleeding • Infection • Defects in wound closure • Sexual discomfort /dysfunction

  10. Complications of AVD - Maternal • Lacerations: Vaginal / perineal / cervical • Hematoma / Haemorrhage • Incontinence / retention of urine • Infection • Painful perineal scars • Low back pain • Dyspareunia • SUI • Nerve Injury

  11. Neonatal Morbidity • Low Apgar scores • Scalp trauma • Facial mark/injury • Cephalhematoma • Subgaleal hematoma

  12. Chignon

  13. Cephalhematoma

  14. Cephalhematoma

  15. Subgaleal Hematoma

  16. Subgaleal Hematoma

  17. Neonatal Morbidity • Intracranial hemorrhage • Retinal hemorrhage • Neonatal jaundice • Erb palsy • Fractured clavicle • Nerve injury • Shoulder dystocia

  18. Birth Asphyxia & Injuries

  19. Cesarean deliverycomplications • Bleeding • Atelectasis • Bladder injury • GIT injury • Ureter injury • Paralytic ileus • Wound infection • Wound dehiscence • UTI • Endometritis • Thrombophlebitis • DVT • Adhesions • Intestinal Obstruction

  20. Cesarean Section Complications • University hospital, Glostrup • 7782 women • c/sec rate: 929 (11.9%) • Emergency c/sec rate : 636(68.5%) Acta Obstet Gynecol Scand 2003 : 82: 251-256

  21. Incidence of Intraoperative Complications

  22. Effect of Delivery on Neonatal Injury

  23. Postpartum maternal complications • Postpartum hemorrhage • Postpartum infections • Thrombophelebitis • Subinvolution • Mastitis

  24. Clinical Awareness of Complications

  25. Prevention is better • Experienced provider • Assessment of maternal pelvis • Selection of procedure • Adequate anesthesia • Fulfillment of prerequisites • Willingness to abandon attempt • Ability to perform c-section

  26. Some tips…… Center of the cup over the sagittal suture, about 2 cm in front of the posterior fontanel.

  27. Metal cup Soft cup • Release suction between Pushes • 2 pop-offs, abandon procedure

  28. Vacuum Procedure • Check for vaginal or vulvar tissues trap between the cup and fetal surface. • Gradual Vs Rapid Application of Vacuum Pressure

  29. Fear during labour • Worries • Review labour process • Frequent progress report • Personal availability of nurse • Promise postnatal debriefing sessions

  30. Nursing considerations • Availability • Organization • Calmness • Communication • Delegation • Consent • Preparation • Teamwork • Tackling failure Be prepared, except the unexpected

  31. As a midwife……. • Confidence & Competence • Open mind, accepting attitude, hands-on skills, and broad deep understanding • Surveillance of fetus and mother • Data acquisition: interpret data • Verbal and nonverbal cues • Patient-centered care - “high tech” and “high touch” • Conducive environment and low stress

  32. Speak tenderly to them. Let there be kindness in your face, in your eyes, in your smile, in the warmth of our greeting. Always have a cheerful smile. Don't only give your care, but give your heart as well. - Mother Teresa THEY NEED YOU & YOURCARE

  33. THANK YOU

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