7/30/2019 Case Management for LTCS for non-reassure fetal statuts

1/3

Case Management

Introduction:

A cesarean birth (cesarean or c-section) is major surgery where a baby is delivered by an incision

that is first made on the skin, then the underlying abdominal muscle wall and finally the uterusitself. Cesareans can be done by an obstetrician as planned surgery or as an emergency procedure

when vaginal birth isnt possible. Although cesarean births are considered very safe, there are

risks, including death.

Reasons for the Increasing Rate of C-sections

Greater emphasis on "quality survival" for the newborn, not simply survival There has been a decrease in the number of forceps deliveries, which in turn increases the

number of C-sections

Dystocia. The number one reason for cesarean birth is dystocia. Dystocia refers to anydifficulty in labor. The difficulty can be caused by:

The fetus is not being able to progress down the birth canal. The size of the baby compared to the size of the mothers pelvisif the babys head is too

big to pass through the mothers pelvis it can cause a very difficult vaginal delivery and

even stop the cervix from completely dilating. Some babies are just too big to be born

vaginally; large babies are common with gestational diabetes.

Weak contractions in the mothers uterus; extended labor can be a risk to both the motherand the baby, more so to the baby.

Obstruction or severe distortion of the birth canal (caused by pelvic tumor or fibroid tumors)

Previous cesarean birth.There is a common saying once a cesarean, always a cesarean. Thisthinking led to a large increase in cesarean birth rates.

Position of the fetus within the uterus. The normal position just before the delivery is a head-down (cephalic) position. If the baby presents in one of the positions listed below, vaginal

delivery could lead to the trauma or death of the fetus. Sometimes the baby can be turned to

allow vaginal delivery. Problems can also arise when the umbilical cord is born before the

baby, cutting off the babys blood supply.

oBr eech presentation. When the fetus is in a head-up, feet-first or rump-first position itscalled a breech presentation.

oShoulder. There are many shoulder presentations; however, all transverse positions(sideways) are called shoulder presentations.

oCompound. When two body parts appear at the pelvis at the same time, such as a handbeside the head, its called a compound presentation.

http://healthpages.org/health-care/what-kind-of-doctor-do-i-need/#gynecologistobstetricianhttp://healthpages.org/health-care/what-kind-of-doctor-do-i-need/#gynecologistobstetrician

7/30/2019 Case Management for LTCS for non-reassure fetal statuts

2/3

Fetal distress is used to describe any complications with the fetussuch as abnormal heart ratefrom poor oxygen supplyand usually does not allow vaginal delivery. In most cases, fetal

distress is lack of oxygen to the brain of the fetus (oxygen deprivation).o Abnormal fetal heart rate patterns (non-reassuring fetal status) slowing of fetal

heart rate with uterine contractions which led to cesarean section

Multiple births. When there is more than one fetus most surgeons deliver by cesarean births.Cesarean birth is a much safer method to deliver multiple babies. About half of all mothers who

have twins, have a c-section, while 90% of triplets are born by c-section.

Very premature fetus. Problems with the Umbilical When the umbilical cord is delivered ahead of the fetus, called

cord prolapse, it causes the cord to get compressed by the baby and oxygen and the blood supply

to the baby is cut off. This is an emergency that requires cesarean birth.

Problems with the Placenta. The placenta can detach from the uterine wall (abruptio placentae)before labor begins and be life threatening for both you and your baby. Placenta previa is whenthe placenta partially or completely blocks the opening of the cervix. In this case, the placenta

would have to be born first, leaving the fetus without oxygen. In addition, blood loss for the

mother could be fatal.

Health of the Mother. Certain health conditions of the mother can require a cesarean birth:o History of previous problems during childbirtho Active herpes soreso Narrow cervix (vaginal atresia)o Gestational diabeteso Pregnancy-induced hypertensiono Vaginal infections or tumorso HIVo Cervical cancero Heart disease or risk of strokeo Severe obesityo Repeat Miscarriages.o Rh factor: In erythroblastosis fetalis (difference in the Rh factor of the mother and the

fetus), there is a risk of fetal anemia.

Health of the Baby. If the baby has been diagnosed with health problems, it may be better forthe baby to be born by cesarean birth. Also, monitoring during labor will tell how well your baby

is handling labor and how well the placenta and umbilical cord are working.

Many of these complications happen in a very small number of births. And the decision

for cesarean birth is decided by balancing the risks and benefits to mother and baby.

http://healthpages.org/gestational-diabetes/what-is-gestational-diabetes/http://healthpages.org/pregnancy/pregnancy-induced-hypertension-pih/http://healthpages.org/health-a-z/normal-values-lab-tests/http://healthpages.org/health-a-z/normal-values-lab-tests/http://healthpages.org/pregnancy/pregnancy-induced-hypertension-pih/http://healthpages.org/gestational-diabetes/what-is-gestational-diabetes/

7/30/2019 Case Management for LTCS for non-reassure fetal statuts

3/3

Complications and Management

Problems that may encounter during the surgery is Bleeding and ifits uncontrolled the

management for this is continuously massage the uterus to expel blood and blood clots, if the

Uterus is Atonic (uterine atony) continue to infuse oxytocin and transfuse blood if necessary. If

bleeding is not controlled perform uterine and utero-ovarian artery ligation (hysterectomy). Afterthe surgery the following complications are first is Infections, if there are signs of infections

give combination of antibiotics; Fever may follow so give appropriate analgesic drug. Second is

Urinary retention and bowel injury, Urinary retention could be relieved by attaching anindwelling urinary catheter for 24 hours, assess bowel movement ask the patient if there is a

presence of flatus and Auscultate for bowel sounds. Check clients mental status ask to do

simple movement like shaking of the hands to assess movement and sensation and to check ifthere is impaired Neurosensory due to spinal anesthesia, Also check forrespiratory distress a

reaction from regional anesthesia. Third is assess forpain and discomfort especially in incision

site check if it is dry and intact it is the most common portal of entry for microorganism that may

cause further infections. Deep vein thrombosis may occur, blood clots in the veins of the legs or

in the pelvis that may go to the lungs to prevent this apply compression stockings. After 8 hoursflat on bed ask the client to walk, walking is important to prevent blood clot and pneumonia. Last

is check the clients emotional status inability to express or deal with the current situation mayindicate that she is undergoing post-partum depression, stressed out the importance of her baby

and the enjoyment of motherhood to lessen out her depression and encourage to express her

feelings too.