question archive Mary's 1st baby was delivered via c/section due to the baby being in the breech position

Mary's 1st baby was delivered via c/section due to the baby being in the breech position

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Mary's 1st baby was delivered via c/section due to the baby being in the breech position. She is requesting a VBAC (vaginal birth after c/section) for this her second baby. By ultrasound this baby is in the vertex position. In reviewing the postoperative report from her first surgery - it is noted that she had a low transverse uterine incision.Mary is not progressing in labor appropriately, and the decision has been made to move toward a cesarean section. She understands, agrees, and signs the consent for surgery. You will again accept this patient in the recovery - or initial postpartum period.

 

QUESTION:Recognize that you will complete BUBBLEHE assessment. In addition, the abdominal assessment will also include assessment of the incision. Note the type of dressing used to cover the incision. Is it approximated? Is there any bleeding? Does she have bowel sounds? Is the abdomen distended? Is it soft? Do you assess the fundus and where is it located? It should be firm. Note pain assessment.

 

 

Susan P. had a SVD (spontaneous vaginal delivery) today approximately 2 hours ago. The labor and delivery nurse is calling to give you report. She is new and not sure what you want to know from her.

 

QUESTin: What questions do you need to ask to provide comprehensive care to this patient once she is transferred into your care?

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To provide comprehensive care to the patient in the recovery room, I would ask the following:

What is the vital signs of the patient after delivery?

Were the vital signs stable since delivery?

Is the patient awake and conscious?

Was there evidence of obstetric hemorrhage or persistent bleeding during delivery?

Was Oxytocin given? If yes, what was the dose?

What are the pain medications given? And when is the next due medication?

What is the rate of the IV fluid?

Does the patient have any subjective complaints such pain on abdomen?

What time is the patient allowed to eat?

Does the patient have any allergies? Any co-morbidities?

 

Reference: Williams Obstetrics 25th edition