complete narrated powerpoint

Views:
 
Category: Entertainment
     
 

Presentation Description

EBR presentation

Comments

By: GroupIV (124 month(s) ago)

Make sure to click to slide 16 for our last of our 3 references. The computer just stopped after the second reference and did not go to the 3rd reference.

Presentation Transcript

Delayed Pushing in Second Stage of Labor:

Delayed Pushing in Second Stage of Labor Rachael Mooberry Melissa Reidy Kelsey Schmidt Creighton University School of Nursing

Clinical Problem:

Clinical Problem Prolonged pushing during the second stage of labor has increased: Maternal complications Fetal complications

Purpose:

Purpose Evaluate the effects of delayed pushing on labor outcomes based on critiquing and synthesizing evidenced based research

PICO Statement:

PICO Statement For women in the second stage of labor, will delayed pushing compared to immediate pushing improve maternal and neonatal outcomes?

Article 1:

Article 1 77 nulliparous women, with epidurals who reached the second stage of labor Level 2- Well Designed Randomized Controlled Trials Moderate Strength

Article 2:

Article 2 44 nulliiparous women laboring with a epidural running Level 2- Well Designed Randomized Controlled Trials Moderate Strength

Article 3:

Article 3 1862 nulliparous women, who were included in the PEOPLE trial Level 5- Systematic Reviews of Descriptive and Qualitative Studies Moderate Strength

Synthesis:

Synthesis Sample Findings Level of Research Article 1 77 nulliparous women, with epidurals No significant differences between delayed and immediate pushing Moderate Article 2 44 nulliiparous women laboring with a epidural running No significant differences between groups Moderate Article 3 1862 nulliparous women, who were included in the PEOPLE trial, epidural Decreased overall time of pushing increased maternal and fetal outcomes Moderate

Summary of Findings:

Summary of Findings No clear evidence that delayed pushing was beneficial 1, 2, 3 Longer pushing results in increased complications 3

Nursing Recommendations:

Nursing Recommendations Nurses should be educated about pushing duration in the second stage of labor Knowing alternatives for safer practices based on evidence based practice Nurses should address potential complications with mother before they arise

Recommendations for Future Research:

Recommendations for Future Research Bigger sample size Sensitive/Specific Tests Standardized Limitations

Implications for Change:

Implications for Change Clinical Non-reassuring fetal heart tones Perineal lacerations Postpartum hemorrhage Quality Maternal satisfaction Fatigue Cost Length of stay Complications

Interdisciplinary Implications:

Interdisciplinary Implications Physicians 3 Nurses 1, 2, 3 Midwives 3 Doulas Prenatal Educators 1 Social Work Counselors Nutritionists

References:

References 1 Gillesby, E., Burns, S., Dempsey, A., Kirby, S., Mogensen, K., Naylor, K., …Whelan, B. (2010). Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 39, 635-644. doi: 10.1111/j.1552-6909.2010.01195.x

References:

References 2 Kelly, M., Johnson, E., Lee, V., Massey, L., Purser, D., Ring, K., Sanderson, S., Styles, J., & Wood, D. (2010). Delayed versus immediate pushing in the second stage of labor . The American Journal of Maternal Child Nursing, 35 (2), 81-88. doi:10.1097/NMC.0b013e3181cae7ad

References:

References 3 Le Ray, C., Audibert, F., Goffinet, F., & Fraser, W. (2009). When to stop pushing: effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia. American Journal of Obstetrics & Gynecology, 201 (4), 361.e1-7. doi:10.1016/j.ajog.2009.08.002

authorStream Live Help