Chapter 13 Flashcards
Braxton hicks contraction
Irregular painless contractions throughout pregnancy
Many don’t notice until the third trimester
Women who are unsure or have more than 5 or 6 regular contractions in an hour or have other early signs or labor should call their doctor
Explain normal growth of fundus weeks 8,12,16,20,36,40
8-?
12- symphysis pubis
16- midway between symphysis pubis and umbilicus
36- xiphoid process
40- uterus sinks to lower level after fetal head descends
Chadwick’s sign
Bluish purple color of cervix extending to the vagina and labia
Goodell’s
Cervix softens
Mucus plug
Blocks bacteria from getting to uterus
Bloody show
One of the earliest signs of labor
Blood volume
Increase as much as 45%
Increased plasma volume
Rbc Mass increase by 250-450
Hemodilution
Blood pressure
Supine hypotension- occluding vena cava or aorta
Turn to left side unless baby is in distress then turn to right side
Wedge pillow under the hip
5 causes of decreased systemic vascular resistance
- Vasodialation due to progesterone and prostaglandins
- Uteroplacental unity provides low resistance and greater area for circulation
- Heat production causes vasodilation
- Decreased sensitivity to angiotensin 2
- Relaxant factors example nitric oxide
Melisma, cholasma
Increase pigmentation brownish patches on forehead cheeks and nose that occur as early as 8weeks due to elevate estrogen, progesterone and melanocytes-stimulating hormone
Changes by placental hormones
Human chorionic gonadotropin
Estrogen- stimulates uterine growth and increase blood supply, aids in developing the ductal system and associated with hyperpigmentation
Progesterone
Human chorionic somatomammotropin- increases availability of glucose
Relaxin-inhibits uterine activity, softens tissue in cervix, lengthens pubic ligaments
Presumptive signs
Amenorrhea Nausea and vomiting Fatigue Urinary frequency Breast and skin changes Vaginal and cervical color changes Fetal movement
Probably signs
Abdominal enlargement Cervical softening Changes in uterine consistency Fetal movements at 16 weeks Ballottement-fluid Braxton hicks contractions Palpating of the fetal outline Palpating of fetal outline Uterine soufflé Pregnancy tests
Positive signs
Auscultation of fetal heart signs
Fetal movement felt by examiner
Visual of the fetus
Preconceptual/interconceptual care
Complete history and physical exam Medications are reviewed and changed if necessary Obese women to lose weight Smoking cessation Vaccinations varicella and hep b Folic acid
Obstetric history
G pregnancies T erm >38weeks P remature 21-37 weeks A bortions <20 weeks L iving today
Negels rule
First day of lmp -3months +7days
Don’t forget to change year
Lab tests done during pregnancy
Blood grouping with Rh and antibody screen(rhogam during pregnancy and after birth) CBC, hgb, hct Venereal disease research lab or rapid plasma regain- syphilis Rubella titer- determine immunity Genetic testing Tb test Hep B Hbig HIV Pap & culture Ua Multiple marker screen- fetal abnormalities/ abnormal indicate chromosomal abnormalities Glucose challenge test
Risk factors r/t demographics
Under 16 or over 35- increased risk for preterm labor, preeclampsia, congenital defects, infant mortality
Low socioeconomic status- increased risk for preterm or low birth weight
Multiparity-higher parity increases risk for antepartum or post partum hemorrhage, c section
Risk factors related to current diabetes mellitus
Preeclampsia C section Preterm birth Infants small or larger for age Neonatal hypoglycemia Congenital abnormalities
Nausea and vomiting during pregnancy
Crackers before arising Small frequent meals Fluids separate from meals Avoid dried greasy foods Ginger, peppermint or combo spicy foods Acupressure band that applies pressure to wrist or arm
Heart burn
Small meals avoid fatty or spicy foods, eliminate smoking, carbonated beverages, try chewing gum, do not eat before bedtime, sleep with extra pillow, walk upright after meals Avoid bending over Loose fitting clothes Deep breath sip water Anti acids as ordered by dr
Back ache
Correct posture head up shoulders back Avoid high heels Squat don't bend Do not lift heavy objects Use foot supports, arm rest, and pillows behind back when sitting Exercises
Round ligament pain
Good body mechanics
Do not make sudden movements or position changes
Avoid stretching and twisting at the same time
Bend toward the pain, squat or bring the knees to chest to relieve pain
Apply heat or lie on the right side to relieve pain
Urinary frequency
Decrease fluids in the evening
avoid caffeine
Perform kugel exercises
Varicosities
Avoid constricting clothing And crossing knees
Rest frequently with legs elevated
Wear hoes or elastic stockings
Walk around at least every 2 hours
Constipation
Drink 8 glasses of liquids
Add foods high in fiber
Restrict cheese
Reduce sweets(empty calories)
Do not discontinue iron
Exercise- swimming, stationary bike, take a walk
Use a foot rest to decrease straining during elimination
Hemorrhoids
Avoid constipation
Take frequent tempid baths
Leg cramps
Elevate legs often during the day
Extend effected legs and flex feet
Avoid excessive foods high in phosphorus
Teaching points for first ob visit and to continue though pregnancy
Bathing- use nonskid pads d/t change in center of gravity
Hot tubs and saunas- avoid maternal hyperthermia especially In 1st trimester hot tub 10min sauna 15min
Douching- don’t do it! Increased risk for bacterial vaginosis
Breast care- avoid soap on nipples gets rid of natural lubricant, wear a supportive bra, do not stimulate breasts if you have a history of preterm labor
Avoid tight clothing and high heels
Sleep and rest
Nutrition
Employment
Travel
Immunizations
Lifestyle changes
What should you go to the hospital for immediately
Vaginal bleeding
Swelling of fingers- excessive edema
Visual disturbances- preeclampsia
