Complications - operative obstetrics 1

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

A day in a labour Room…… 3

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 4

Operative Delivery 5

Traction 6

Incidence (Birth 2002) % Forceps Vacuum Caesarean

Complications related to Operative Obstetrics: Nursing Challenge

Problems arising from Episiotomy 9 PainEdemaBleedingInfection Defects in wound closure Sexual discomfort /dysfunction

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

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

Chignon 12

Cephalhematoma 13

Cephalhematoma 14

Subgaleal Hematoma 15

Subgaleal Hematoma 16

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

Birth Asphyxia & Injuries 19

Cesarean delivery complications BleedingAtelectasis Bladder injury GIT injury Ureter injury Paralytic ileus Wound infection 20 Wound dehiscence UTIEndometritisThrombophlebitisDVTAdhesions Intestinal Obstruction

Cesarean Section Complications University hospital, Glostrup –7782 women –c/sec rate: 929 (11.9%) –Emergency c/sec rate : 636(68.5%) 21 Acta Obstet Gynecol Scand 2003 : 82:

Incidence of Intraoperative Complications Type of complication TotalEmergency Elective Cervical laceration 3.6%(33) 4.6%(29) 1.4%(4) Corporal laceratoin 0.3%(3) 0.3%(2) 0.3%(1) Vaginal laceration 1.2%(11) 1.7%(11) 0.0%(0) Bladder laceration 0.5%(5) 0.8%(5) 0.0%(0) Bowel laceration 0.0%(0) Lacerations in total 5.2%(48) 6.8%(43) 1.7%(5) Blood transfusion 1.0%(9) 1.1%(7) 0.7%(2) EBL ≥ 1000ml 9.2%(77) 9.0%(57) 6.8%(20) Uterine rupture 0.3%(3) 0.5%(3) 0.0%(0) Hysterectomy 0.2%(2) 0.2%(1) 0.3%(1) Total12.1%(112)14.5%(92) 6.8%(20)

Effect of Delivery on Neonatal Injury DeliveryDeathICHOther NSVD1/5,0001/1,9001/216 C/S in Labor 1/1,2501/9521/71 C/S w/o Labor 1/1,2501/2,0401/105 Vacuum1/3,3331/8601/122 Forceps1/2,0001/6641/76 Vacuum & Forceps 1/1,6661/2801/58 23

Postpartum maternal complications Postpartum hemorrhage Postpartum infections ThrombophelebitisSubinvolutionMastitis 24

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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

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

Soft cup Metal cup 28 Release suction between Pushes 2 pop-offs, abandon procedure

Vacuum Procedure Check for vaginal or vulvar tissues trap between the cup and fetal surface. Gradual Vs Rapid Application of Vacuum Pressure 29

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Fear during labour Worries Review labour process Frequent progress report Personal availability of nurse Promise postnatal debriefing sessions 31

Nursing considerations AvailabilityOrganizationCalmnessCommunicationDelegationConsentPreparationTeamwork Tackling failure Be prepared, except the unexpected 32

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 33

THEY NEED YOU THEY NEED YOU & YOUR CARE & YOUR CARE 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 34