Cervical Edema, Rigidity, Anterior Lip, Retained Placental Fragments

What is the midwifery management for cervical edema?

-Arnica (po, or in some lube) -Position change (side lying, knee chest) - move or change pressure on the cervix -Ice in a glove

What are signs of retained placental fragments?

-Boggy-firm uterus (won't stay firm) -PP Hemorrhage after placenta has been delivered, Slow trickle of blood, clots, and gushes -Missing placenta lobes

What are other helpful things that can be done for rigidity?

-Gelsimium - 3 drops in hot water, hold each sip under tongue before swallowing. Another dose can be tried in a couple of hours - don't exceed 10 drops in 24 hours, as it is a CNS depressant. -Relaxation techniques: Water, low open sounds, soft throat and jaw, Hypnobirthing .

What are some reasons for cervical edema?

-Low presenting part prior to full dilation. -The cervix got messed with too much. -The cervix is not dilating, but the pressure from the head is impeding venous return. (may happen with an anterior lip)

What is the etiology for rigidity?

-May be caused by psychological factors as well as physiological variations of the cervix: -A scarred cervix may not dilate well or evenly -Primiparous cx's can take longer to dilate and can be rigid.

What are the steps once you've determined that there are retained fragments?

-Monitor vital signs and estimated blood loss. -Attempt uterine massage (massage as if you are expressing clots) -Manual removal of fragments -Activate transfer

List the steps on how to manually reduce an anterior lip.

1. Place your fingers on the anterior lip. 2. During a contraction, use your fingers to push the cervical lip backwards until it slips over the fetal head and above the interior border of the pubic symphysis 3. Hold the cervical lip in this position while waiting for the next contraction. 4. Allow your fingers, but not the cervix, to be pushed downwards and out as the fetal head descends with contractions and maternal pushing 5. Remove your fingers when the cervix reduces or if the procedure is unsuccessful or poorly tolerated

What do we call a cervix that is not dilating even with strong, regular contractions?

A rigid cervix.

What is the cause for concern with an anterior lip?

An anterior lip can slow the woman's progress from the 1st to 2nd stage of labor, because the swelling will usually take time to reduce, before enabling the woman's cervix to be pulled up, and around, the baby's head.

What is an anterior cervical lip?

An anterior lip occurs when the top of the cervix swells, but the rest of the cervix has completely dilated.

What are the parameters for a persistent cervical lip?

An anterior lip that persists for greater than 30 minutes. It may be a variation of normal or may indicate a labor abnormality/malposition, such as occiput posterior presentation. An abnormality or malposition is more likely if the lip becomes edematous.

Cervical edema or swelling is also known as...(think medical terminology)

Cervicitis.

What oil can be more effective if used preventatively for a rigid cervix?

Evening Primrose Oil.

True or false: Massaging the swollen cervix is contraindicated.

False. Massage can be helpful.

Name some risks to retained placental fragments.

Hemorrhage, infection, subinvolution

How can cervical massage help with a rigid cervix?

It can soften and open the cervix with just a little pressure. Anne Frye recommends strong massage for a cervix that has been stuck for a long time with strong contractions.

What are possible reasons for retained placental fragments?

Mismanagement of the third stage including uterine massage and pulling on the cord

What should be done if the slow trickle will not resolve?

Transfer. It can be dangerous especially if the uterus is not contracting because she could continue to bleed in her sleep without knowing. Uterus should stay firm on its own after massage. If it doesn't, don't discharge until it does.

True or false: Manually reducing an anterior lip is suggested as management.

True.

Is there a cause for concern with cervical swelling? Why or why not?

Yes, because the cervix will not dilate readily if it's edematous.