Primary Nursing Diagnosis

Risk for injury of mother or fetus related to traumatic delivery OUTCOMES. Risk control; Risk detection

INTERVENTIONS. Labor induction; Intrapartal care: High-risk delivery; Electronic fetal monitoring: Intrapartum; Intrapartal care


MEDICAL. Medical management of FPD can include the use of pitocin to induce or augment labor contractions, manual or forceps rotation of the fetus into an occiput anterior position, and vaginal delivery assisted by outlet forceps or vacuum extractor. The cutting of a midline or mediolateral episiotomy is often necessary. If shoulder dystocia occurs, the McRoberts maneuver (extreme flexion of the mother's legs at the hips) and firm suprapubic pressure may accomplish delivery. In some cases, intentional fracture of the infant's clavicle is used to accomplish deliv ery in the presence of severe shoulder dystocia. When vaginal delivery appears to be impossible or likely to be very traumatic, cesarean delivery is indicated.

Labor patients using analgesia or anesthesia require careful monitoring. For patients using narcotic analgesics, monitor the maternal pulse, blood pressure, and respirations. Watch for signs of respiratory depression. Since intravenous (IV) narcotics readily cross the placenta, observe the fetal heart rate; often, a temporary loss of variability is seen. For patients using regional anesthesia, monitor maternal pulse, blood pressure, and respirations. Check the mother's blood pressure every 1 to 5 minutes for 15 minutes after the epidural or spinal bolus dosage and then every 30 minutes. Watch for lowered blood pressure.



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