Treatments for Childbirth
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Hospital statistics for Childbirth:
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- 24.0% of hospitalisations for pregnancy, childbirth and the puerperium in public hospitals are single day in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
- 300,644 admissions to public hospitals because of pregnancy, childbirth and the puerperium in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
- 5.1% of hospitalisations for pregnancy, childbirth and the puerperium disorders in private hospitals are single day in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
- 71,979 patient days spent in private hospitals for pregnancy, childbirth and the puerperium disorders in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
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Premature labor:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment is intended to suppress premature labor when tests show immature fetal pulmonary development, cervical dilation is less than 1½"(4 cm), and the absence of factors that contraindicate continuation of pregnancy. Such treatment consists of bed rest and, when necessary, drug therapy, but neither has been proven beneficial in all patients.
The following pharmacologic agents can suppress premature labor for up to 48 hours:
❑ Beta-adrenergic stimulants (terbutaline, isoxsuprine, or ritodrine): Stimulation of the beta2-adrenergic receptors inhibits contractility of uterine smooth muscle. Adverse effects include maternal tachycardia and hypotension, and fetal tachycardia.
❑ Magnesium sulfate: Direct action on the myometrium relaxes the muscle. It also produces maternal adverse effects, such as drowsiness, slurred speech, flushing, decreased reflexes, decreased GI motility, and decreased respirations. Fetal and neonatal adverse effects may include central nervous system (CNS) depression, decreased respirations, and decreased sucking reflex.
Maternal factors that jeopardize the fetus, making premature delivery the lesser risk, include intrauterine infection, abruptio placentae, placental insufficiency, and severe preeclampsia. Among the fetal problems that become more perilous as pregnancy nears term are severe isoimmunization and congenital anomalies.
Ideally, treatment for active premature labor should take place in a regional perinatal intensive care center, where the staff is specially trained to handle this situation. In such settings, the neonate can remain close to his parents. (Community health care facilities commonly lack the equipment necessary for special neonatal care and transfer the neonate alone to a perinatal center.)
Treatment and delivery require an intensive team effort, focusing on:
❑ continuous assessment of the neonate’s health through fetal monitoring
❑ administration of antenatal steroids to assist fetal lung development, unless contraindicated
❑ maintenance of adequate hydration through I.V. fluids.
Prevention of premature labor requires good prenatal care, adequate nutrition, and proper rest. Insertion of a purse-string suture (cerclage) to reinforce an incompetent cervix at 14 to 18 weeks’gestation may prevent premature labor in patients with histories of this disorder. However, this can be dangerous if an incompetent cervix is misdiagnosed and premature labor is the true cause.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Cesarean birth:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The most common type of cesarean birth is the lower segment cesarean, in which a transverse incision across the lower abdomen opens the visceral peritoneum over the uterus. The lower anterior uterine wall is then incised (transversely or longitudinally) behind the bladder.
The classic cesarean — in which a longitudinal incision is made into the body of the uterus, extending into the fundus and opening the top of the uterus — is rarely performed because it exaggerates the risk of infection and of uterine rupture in subsequent pregnancies. Cesarean hysterectomy removes the entire uterus and is reserved for such cases as malignant tumors, severe infection, and placenta accreta.
Patients may have general or regional anesthetic for surgery, depending on the extent of maternal or fetal distress. Possible maternal complications of cesarean delivery include respiratory tract infection, wound dehiscence, thromboembolism, paralytic ileus, hemorrhage, and genitourinary tract infection.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Low birth weight:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
Because low birth weight may be associated with poorly developed body systems, particularly the respiratory system, your priority is to monitor the neonate’s respiratory status. Be alert for signs of distress, such as apnea, grunting respirations, intercostal or xiphoid retractions, or a respiratory rate exceeding 60 breaths/minute after the first hour of life. If you detect any of these signs, prepare to provide respiratory support. Endotracheal intubation or supplemental oxygen with an oxygen hood may be needed.
Monitor the neonate’s axillary temperature. Decreased fat reserves may keep him from maintaining normal body temperature, and a drop below 97.8° F (36.5° C) exacerbates respiratory distress by increasing oxygen consumption. To maintain normal body temperature, use an overbed warmer or an Isolette. (If these are unavailable, use a wrapped rubber bottle filled with warm water, but be careful to avoid hyperthermia.) Cover neonate’s head to prevent heat loss.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Low birth weight:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Initiate feedings as soon as possible and continue to feed the neonate every 2 to 3 hours.
▪ Provide gavage or I.V. nutrition for the sick or very premature neonate.
▪ Check abdominal girth daily or more frequently if indicated, and check stools for blood to detect necrotizing enterocolitis.
▪ Prepare for a sepsis workup if signs of infection are associated with low birth weight.
▪ Check the neonate's vital signs every 15 minutes for the first hour and at least once every hour thereafter until his condition stabilizes.
▪ Be alert for changes in temperature or behavior, feeding problems, respiratory distress, or periods of apnea—possible indications of infection.
▪ Monitor blood glucose levels and watch for signs and symptoms of hypoglycemia, such as irritability, jitteriness, tremors, seizures, irregular respirations, lethargy, and a high-pitched or weak cry.
▪ If the neonate is receiving supplemental oxygen, carefully monitor arterial blood gas values and the oxygen concentration of inspired air to prevent retinopathy.
▪ Monitor the neonate's urine output by weighing diapers before and after voiding.
▪ Check urine color, measure specific gravity, and test for the presence of glucose, blood, or protein.
▪ Watch for changes in the neonate's skin color because increasing jaundice may indicate hyperbilirubinemia.
Patient teaching
▪ Explain disorder and all procedures and treatments to the parents.
▪ Encourage the parents to participate in their neonate's care to strengthen bonding.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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