Childbearing Flashcards
Fundal height
Above symphysis- 12-14 weeks
At umbilicus or 20 cm- 20 weeks
Rises 1 cm/ week until 36 weeks
Naegeles rule
First day of LMP- subtract 3 months add 7 days plus 1 year.
Gravida
Total number of of preg regardless of duration (include present)
Para
Numb of past preg regardless of duration (included present preg)
After 20 weeks or greater then 500g
Term
38-42 weeks
Weight gain during preg
First trimester- 2-4 lbs
Second 12-14
Third 8-12
Total 24-28
Chadwick’s sign
Chadwick’s sign- bluish color of cervix
Striae gravidarum
Pink or reddish streaks
Chloasma
Increased pigmentation on face
Linea nigra
Dark line from umbilicus to symphysis
Positive preg sign
Fetal heartbeat (8-12 weeks doptone and by 18-20 with auscultation) palpating of fetal movement
Fetal heart rate
At term 120-160
Fetal movement
A reg pattern of 10 movements in 20 min to 2 hours twice a day is a good indicator of fetal well being
Fewer then 3 movements in one hour should be reported
Alpha fetal protein test
Afp used to predict neural tube defects
Decreased levels may predict Down syndrome
Done b/w 16-18 weeks
**High incidence of false positives
Amniocentesis
At 16 weeks detects genetic disorder
At 30 weeks- determines lung maturity
Void before procedure
Ultrasound used to determine position of placenta and fetus
Complications - premature labor, infection, abrupto placentae, RH isoimmunization
Effacement
Progressive thinning and shortening of cervix (0-100%)
Dilation
Opening of cervix os (0-10cm) at 10 it’s ready for expulsion of baby
Prolapsed umbilical cord
Symptoms Premature rupture of membranes Presenting part not engaged Fetal distress Protruding cord
Nursing care- handle things quickly, call for help
Push against presenting part
Place in trendelenburg or knee-chest position
Successful if no changes in FHT
FHT monitoring
External or internal monitoring
Tachycardia- 169 Bpm lasting longer than 10 min
Early sign of fetal hypoxia
Fetal or maternal infection
Non-reassuring sign when associated with late decelerations, severe variable decelerations or absence of variability
FHR: bradycardia
<110 Bpm lasting longer than 10 min ***Late sign of fetal hypoxia Maternal drugs Prolonged cord compression Maternal hypotension syndrome Non- reassuring sign when associated with loss of variability and late decelerations
Things that decrease blood flow to baby
Variability
Irregular fluctuations in the baseline of the FHR
Absent (0-2) (no variability)or decreased (3-5) associated with fetal sleep, prematurity, drugs, hypoxia, acidosis
Moderate (6-25 Bpm) deviations from baseline may be significant
Accelerations
15 Bpm rise above baseline by a return
Indicates well-being
Caused by fetal movement or contractions
Occurs frequently with breeched presentations
Decelerations- early
Early decelerations Occur before peak of contraction Inversely mirror the peak of contraction Associated with head compression Associated with pushing in 2nd stage if labor Benign
Decelerations- late
Onset after contraction is established with slow return to baseline
Low point of decelerations occurs after peak of contraction
Caused by PIH, maternal diabetes, placenta prévia, abruptio placentae
Non- reassuring sign
Nursing interventions for late decelerations
Position left side lying If no change, move to other side or knee chest Administer oxygen by mask Start IV or increase flow rate Disco time oxytocin
Variable decelerations
Transient decrease in FHR occurring anytime during uterine contraction phase
Indicates cord compression Relieved by change in maternal position If prolonged Administer oxygen Discontinue oxytocin
Lie
Relationship of spine of fetus to spine of mother
Longitudinal- parallel
Transverse- right angles
Oblique- slight angel off true transverse
Presentation
Part of fetus it enters maternal pelvic inlet Cephalic/vertex (3-4%) Frank- hips flexed/ knees extended Complete- Buddha style Footing Shoulder- transverse lie (rare)
Position
Relationship of fetal reference point to maternal pelvis
Fetal reference point most common presentation
-occiput (o)
-sacrum (s)
Maternal pelvis is designated right/left (R/L) anterior posterior A/P
Station
Level of presenting part in relation to imaginary line between ischial spines (zero station)
-5–1- floating getting ready to come down
+1-+5 below station 0
Contractions
Frequency of leas then 2 min, baby is moving down into pelvic, ready to be born
Duration of greater then 90- stressful for baby
Stages of labor
Stage 1- beginning of labor to complete cervical dilation (0-10)
Stage 2- complete dilation to birth
Stage 3- birth to delivery of placenta
Stage 4- first 4 hours after delivery of placenta
First stage of labor
Phases
Phase 1 (latent) 0-3 cm Phase 2 (active) 4-7 Phase 3 (transition 8-10 contractions 45-90 sec 2-3 min apart, strong
