vag check & infection

  1. Hi,
    I'm not an OB nurse, rather a student working on a case study, and I"m stuck on a question. Can someone help?
    Would you do a vaginal check on a 33 weeker with confirmed amniotic fluid that is cloudy, mom has a slight temp, baby's heartbeat is 162-170 and has average variability. Patient has occasional contraction lasting 20 to 30 seconds.
    I know you would need to know where she's at and if cord is compressed, but what throws me off is the infection... don't vaginal checks introduce more infection or risk of? Would she probably go C section anyways and since her contractions aren't that signficant would you bypass the vag check or do it?

    Thanks
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  2. 8 Comments

  3. by   SmilingBluEyes
    I would bypass vaginal checks for mild, non painful and non-regular contractions, if at all possible. Especially true once a patient's membranes have ruptured, as statistically, you have roughly 6 to 7 SVE's before you sharply increase chances of infection, due to introducing microbes from the introitus into the cervix and beyond. Particularly in the non-laboring woman, you want to avoid vag checks for infection control reasons---also repeated vaginal checks can increase irritation and bring about more contractions.

    A csection may or may not follow, depending on the fetal and maternal status. I don't have quite enough information to say what would happen in this case, but it looks likely, as you say the fluid is "cloudy" and mom is beginning to spike a temp. Particularly true, if the fetal baseline is rising---this indicates mom's temp climbing more, and indicates potential infection. I would hope the mom is on IV Abx already, given the prematurity situation and likely delivery of preterm infant in the next 24 hours.

    Usually, if the patient is afebrile and not in labor, many OBs would give steroids (Celestone) 12 mg, IM, X2 (24 hr apart) and manage the patient conservatively (observe for labor and/or fever). Most OBs would like to hold labor off as long as possible, as each day can see improvements in lung maturity in the baby before he/she is born. But if the uterus becomes a "hostile" environment (as in case of infection) prompt delivery is indicated.
    Last edit by SmilingBluEyes on Oct 22, '06
  4. by   bagladyrn
    Quote from PNS
    Hi,
    I'm not an OB nurse, rather a student working on a case study, and I"m stuck on a question. Can someone help?
    Would you do a vaginal check on a 33 weeker with confirmed amniotic fluid that is cloudy, mom has a slight temp, baby's heartbeat is 162-170 and has average variability. Patient has occasional contraction lasting 20 to 30 seconds.
    I know you would need to know where she's at and if cord is compressed, but what throws me off is the infection... don't vaginal checks introduce more infection or risk of? Would she probably go C section anyways and since her contractions aren't that signficant would you bypass the vag check or do it?

    Thanks
    Hi - I'm not going to answer your question outright as thinking this through is part of what you are learning, but will try to give you a couple of thoughts to lead you along.
    First of all, look at your fetal heart rate - what does that tell you about the possibility of cord compression as an issue? Do you see any of the things you would expect to see in the FHR pattern if there was cord compression?
    What do you know about the chance of infection being introduced by vaginal exam? If she is leaking amniotic fluid, what does that tell you about the natural barrier to infection? By what other method might the provider determine cervical dilation? (think visual) Did the doctor do a speculum exam to check for rupture of membranes? Are "occasional, 20-30 second contractions" likely to produce cervical change? And finally - what is the providers plan of care - induction,or postponing delivery with an eye to getting treatment to mature the lungs before delivery?
    All these factors will influence the decision as to whether or not to do a vag. exam on this patient.
    Good luck with your assignment!
  5. by   babyktchr
    Quote from bagladyrn
    Hi - I'm not going to answer your question outright as thinking this through is part of what you are learning, but will try to give you a couple of thoughts to lead you along.
    First of all, look at your fetal heart rate - what does that tell you about the possibility of cord compression as an issue? Do you see any of the things you would expect to see in the FHR pattern if there was cord compression?
    What do you know about the chance of infection being introduced by vaginal exam? If she is leaking amniotic fluid, what does that tell you about the natural barrier to infection? By what other method might the provider determine cervical dilation? (think visual) Did the doctor do a speculum exam to check for rupture of membranes? Are "occasional, 20-30 second contractions" likely to produce cervical change? And finally - what is the providers plan of care - induction,or postponing delivery with an eye to getting treatment to mature the lungs before delivery?
    All these factors will influence the decision as to whether or not to do a vag. exam on this patient.
    Good luck with your assignment!

    How excellent is that??????????? :yeahthat:
  6. by   PNS
    Thank you This helps.
  7. by   SmilingBluEyes
    I agree, baglady, well-done. You would be an excellent nursing instructor or teacher!!!!

    Hope this helps and good luck in your studies, PNS.
  8. by   bagladyrn
    Quote from SmilingBluEyes
    I agree, baglady, well-done. You would be an excellent nursing instructor or teacher!!!!

    Hope this helps and good luck in your studies, PNS.
    Thanks SBE! Though my boys used to hate when I'd do that with their homework!
  9. by   SmilingBluEyes
    rofl well I hear you. But I really did like your answer. Bravo!!! We need you in here more often! I am sure I would learn a thing or two from you.
  10. by   bagladyrn
    Thanks Deb!
    I'm hanging around here a lot, but when I get to a thread you've already answered, usually all I can add is "Yeah - What she said!"
    I do try to chime in when I can.

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