Maternal, fetal, and neonatal care in open fetal surgery for myelomeningocele.

Fetal myelomeningocele closure (fMMC) was demonstrated in a randomized, prospective clinical trial to improve outcomes for children diagnosed prenatally. Complex care of the maternal/fetal dyad undergoing fetal surgery requires a well-coordinated multidisciplinary team. Nurses in many roles are essential members of the team that cares for these women across the continuum. In this article we discuss the care of the woman, fetus, and family from initial contact through the discharge of the neonate.

A review of issues surrounding medically elective cesarean delivery.

The rate of cesarean delivery has increased dramatically over the past decade. Medically elective cesareans are a major factor contributing to this rise. This article discusses the most recent evidence on the perinatal risks of cesarean delivery versus vaginal birth, the economic impact of elective cesarean delivery, and ethical principles related to cesareans performed without medical indication. Physicians' rationales and responses to the issues are reviewed and the recommendations and guidelines of professional organizations are summarized. Available evidence does not lend support to a current shift in clinical practice. Research is needed to adequately compare outcomes of planned cesarean delivery and planned vaginal birth. Until evidence supports medically elective cesarean as a birth option that optimizes outcomes for low-risk mothers and their infants, obstetric care providers should continue to support evidenced-based decision making that includes advocacy for vaginal delivery as the optimal mode of birth.

Nursing care of the patient with preterm premature rupture of membranes.

Preterm premature rupture of the membranes (PPROM) is diagnosed when rupture of the amniotic membranes occurs prior to the completion of the 36th week of gestation. PPROM accounts for 25% of all cases of premature rupture of the membranes and is responsible for 30%-40% of all preterm deliveries. In mothers diagnosed with PPROM without evidence of infection, active labor, or fetal compromise, the current standard of care is expectant management. The goal of expectant management is the prolongation of the pregnancy to increase fetal gestational age thus potentially decreasing the effects of prematurity. Expectant management consists of ongoing observation for signs and symptoms of infection, active labor, and/or nonreassuring fetal status. This article provides clinical nursing guidelines for the mother diagnosed with PPROM who is managed expectantly. Eight targeted areas for nursing assessment and intervention are described: preterm labor, side effects of tocolytic therapy, maternal/fetal infection, fetal compromise, side effects of extended bed rest, maternal stress, educational needs, and routine prenatal care.

Limited obstetric ultrasound examinations: competency and cost.

OBJECTIVE: To determine both the actual dollar cost and the amount of time required per nurse to establish competency in limited obstetric ultrasonography (LOBU). DESIGN: Descriptive. SETTING: A tertiary care setting. PARTICIPANTS: Registered nurses who were taught in LOBU. RESULTS: Nurses who attained competency in LOBU completed 12 hours of didactic education and a clinical practicum consisting of 6 to 9 hours and approximating 15 ultrasound scans. For five nurses to concurrently attain competency in LOBU, the cost per nurse was $1,037.55 (includes salaries and employee benefits). CONCLUSION: Registered nurses are able to acquire competency in LOBU at a reasonable cost, thus enhancing the ability of the professional nurse to deliver a fuller scope of services in an obstetric setting. For institutions that have limited access to individuals with this skill, nurses trained in LOBU may present a high-quality, cost-efficient solution to providing needed obstetric services.

Technology in the birthing room.

The use of technology is not benign. As with any health care intervention, there are associated risks and benefits. The practitioner needs to constantly consider the benefits of the technology versus the naturalistic birth experience. The use of technology should optimize birth outcomes while maintaining a balance that provides for the best possible human birth experience. Technology, however, does have merit in the birth setting, regardless of location, but its use should be evaluated on an individual, as needed, basis. The most common technological advances currently available for assessment and maternal/fetal care during birth include electronic fetal monitoring, ultrasonography, blood pressure screening, maternal/fetal pulse oximetry, and infusion pumps. All obstetrical care providers must be familiar with the forms of technology currently available and be aware of emerging technologies for use during the birthing process.