Assisted delivery with Forceps Extraction

Shanthi R

Nursing Incharge, Kauvery hospital, Tirunelveli

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Abstract

The series of events that take place in the genital organ in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called labour. Sometimes a woman’s perineum may tear as their baby comes out.In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly.

Background

The patient was a 25 years female 38 + 2 weeks, GDM on OHA, ASD unoperated L-R shunt, admitted for safe confinement of the pregnancy (primi).

As per gynecologist advice patient came to hospital. The gynecologist did the antenatal evaluation, and initiated the induction process.

Examination

  1. PR: 100/min, BP: 110/70 mm Hg, CVS: S1 S2 (+), SAO2: 99%,RR: 24/min
  2. P/A: Relaxed FH (+)
  3. Patient conscious and oriented.

Investigation

  1. HB: 13.4g/dl, PCV: 33.1%, Platelet: 269000Cells/Cumm
  2. Urea: 16.2 mg/dl, Creatinine: 0.60mg/dl,Uric Acid: 3.73mg/dl
  3. HIV, HCV, HBsAg: Negative

FHR : 140/min

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Course in the hospital

Patient was planned for induction of labour on 15/07/23 at 6.30 am, Under sterile conditions, cervi prime gel was inserted in to cervical canal. At 12 pm inj. Syntocin 5 units were started in iv infusion. Started having uterine contraction. ARM done at 3 pm. 4-5 cm cervical dilatation, Antibiotic Inj. Ampicillin 1.2 gm IV stat given. Around 5pm Epidural labour analgesics given by anesthetist.

Delivery: Outlet Forceps with Episiotomy done

Indication

Second stage of labour: Patient in position with good uterine contraction and full cervical dilatation, left medio-lateral episiotomy given outlet forceps applied. Application locking and traction were easy to deliver on alive term female baby at 7.01 pm., cried at birth cord clamped and cut, Baby weight 3.28 kg. Apgar Score : 8/10 Placenta and its membrane delivered. Post delivery Inj. Syntocin 5 units IM given. Episiotomy wound sutured in layers. Dressing done. Vitals are stable

Treatment

Oral antibiotics given.

Tab. Augmentin 625 mg 1-1-1

Tab . Dolo 650 mg 1-1-1

Tab. Pan 40mg 1-0-0

Inj. Paracetamol 1 gm iv stat

Inj.LMWX 40Mcqs 1-0-0

Baby

Inj. Vit K 1mg stat given

Vaccination given

Inj. BCG 0.1ml

Inj. Hep B 0.5ml IM (on anterolateral aspect of thigh)

OPV Drops 2drops oral given.

Diet Advice

Mother: Normal diet and adequate intake of oral liquids.

Baby: Exclusive Breastfeeding

Nursing Management

  1. Nurses used the communication tool AIDET for communication
  2. Assessed the pain level using the pain scale 2 hourly
  3. Every 2-3hrs analgesics were administered as an intervention for pain
  4. Monitored the vital signs regulary
  5. Cleaned the perineum with warm water
  6. Dressing done on a daily basis
  7. Assessed the perineal area to prevent infection
  8. Encouraged high fiber diet
  9. Encouraged patient for early walking
  10. Encouraged breast feed for the baby every 2nd hourly
  11. Educate the patient about breast care
  12. Ensured warmth of both mother and baby
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Postnatal Exercises

Exercise is also good for your mental wellbeing

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Outcome

On discharge, mother and child was hemodynamically stable.

Ms.-Shanthi2023-10-2007:01:27am

Ms. Shanthi

Nursing Incharge

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