day 1 Flashcards
terminology
Antepartum, intrapartum, postpartum, gravid, gravida, nulligravida, primigravida, multigravida
Antepartum / antenatal / prenatal: pregnancy
Intrapartum: from onset of labour to delivery of placenta
Postpartum / postnatal: after childbirth
Gravid: Pregnant
Gravida: A person who is pregnant
Nulligravida: A person who has never been pregnant and is not currently pregnant
Primigravida: A person who is pregnant for the first time
Multigravida: A person who has had two or more pregnancies
terminology
partity, nullipara, primipara, multipara
Parity:
- The number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation, not the number of fetuses (e.g., twins) born.
- Parity is not affected by whether the fetus is born alive or is stillborn (i.e., showing no signs of life at birth).
Nullipara:
- A person who has not completed a pregnancy with a fetus or fetuses beyond 20 weeks of gestation.
Primipara:
- A person who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks gestation.
Multipara:
- A person who has completed two or more pregnancies to 20 weeks of gestation or more
fetal position
firt letter is direction baby is facing (right or left)
seond letter is specific part presenting –> occipput, sacrum, Mentrum (chin), Sc (shoulder)
third letter is way of facing in relation to the part of the maternal pelvis ( anterior (A), posterior (P) or transverse (T) ))
Posterior is occiput facing the back so face is facing forward
anteririor is facing the front so face is facing backward
transverse is if facing sideways so face is facing the direction
4 stages of labour
1st stage:
- begins with the onset of regular uterine contractions that result in cervical change and ends with complete cervical effacement and dilation
- 2 phases: latent (early and longest phase) & active
2nd stage:
- begins with full cervical dilation (10cm) and complete effacement (100%) and ends with the baby’s birth (pushing/birth stage)
- 2 phases: latent & active (pushing)
- Labouring down (when using anestheisa)
3rd stage:
- starts at birth of baby to expulsion of placenta (p. 390) (placenta stage)
4th stage:
- begins with the expulsion of the placenta and lasts until the birthing person is stable in the immediate postpartum period
- usually the first 2 hours after birth (recovery stage)
station
Refers to the relationship between the fetal presenting part and the ischial spines (narrowest diameter).
Is a measure of the degree of descent of the bb through the birth canal
- Station is 0 at ischial spines (‘engaged’)
- Station is -5, -4, -3, -2, -1 (cm above 0) when high in pelvis
- Station is +1, +2, +3, +4, +5 (crowning)
landmarks of the fetal skull
- anterior and posterior fontanelle
- infornt of anterior, 2 frontal sutures
- behdind the anterior is the parietal bones
- behind posterior fontalenne is occipital
sutures
- saggital suture is in between parietal bones
- coronal suture is innetween frontal and parietal
- lamboid suture inbetween parietal and occipital
pospatrum assesment findings - maternal VS after labour
- Temperature in 1st 24 hrs can be high (< 38 C), should normalize after.
- Pulse is elevated for ~ the first hour after birth, then begins to decrease to non-pregnant rate (60-100).
- Respiratory rate within their usual pre-pregnancy range (12-24)
- Blood pressure should be “normal” (check prenatal records to see pattern). - May see a transient increase of ~5% during the first few days after childbirth.(Watch for orthostatic hypotension when they stand (especially first 48 hrs)
BUBBLLEE
Breasts
breastfeeding vs non breastfeeding
Breastfeeding mothers
- Soft (days 1-2)
- filling (days 2-3); full,
- soften with breastfeeding (days 3-5)
Nipples – skin intact, no soreness
- (cracked and bruised nipples is not normal)
BUBBLLE
uterus
involution and assesment
Uterus
- Endometrial regeneration
- Decidua (tissue lining uterus) → lochia is almost complete after 3 weeks
- Except at placental site - regeneration by 6-7 weeks
- “Afterpains” that are felt more intensely by multiparas and during breastfeeding (Importance of pain management)
Assessment of uterine involution by palpating the fundus:
- Should be firm and midline
- Boggy fundus → must look at lochia → make sure were not touching the blader
- Mom needs to pee to reasses
- At end of third stage, ~ 2 cm below umbilicus
- During the first 12 hours, at approx. the level of umbilicus
- First day following birth (first postpartum day): fundus at 1cm below umbilicus
- Descends 1-2 cm daily
- By 6th day: halfway btwn umbilicus & symphysis pubis
- Not palpable by 2 weeks
Uterus ctd : subinvolution
Subinvolution
- is the failure of the uterus to return to a non-pregnant state.
Factors that slow involution
- Full bladder
- Prolonged or difficult labour
- Incomplete expulsion of placenta or membranes
- Infection
- Grandmultiparity
- Overdistension of uterus
- Anesthesia
BUBBLLE
Bladder
Urination
- Should void spontaneously by 8 hours
- Bladder tone and sensation diminished due to birth trauma
- Diuresis begins within first 12hrs & can be profuse x 3 days
Assessment
- Look for frequency of voiding / if had catheter watch S&S UTI.
BUBBLLE
bowels
Bowel sounds +
- Bowel movements (by 2-3 days)
Assess for causes of decreased bowel activity:
- Fear of pain, tearing sutures (reccoment to her to hold stitches with toiletpaper while pooping)
- Hemorrhoids
- Dehydration
- Immobility
BUBBLLE
Lochia
types, amount
Lochia
Lochia: post-birth uterine discharge
- 240-400ml in total
- Assess colour, amount / odour? Clots?
- Anything up to the size of a small egg is normal → we must check if its a clot or placenta
- Placenta is steak, blood is warm jello
Amount
- Scant: <5cm
- Light: 10cm
- Moderate: 15cm
- Heavy: <15cm (saturated in 2hrs)
Types
Lochia rubra
- Dark red (may be bright red initially)
- May contain small clots
- Duration of 3 to 4 days (after day 6 → something is bad → placenta)
Lochia serosa
- Pink or brownish red
- Old blood, serum, leukocytes, and tissue debris
- Day 4 to 2 weeks (up to 4 weeks)
Lochia alba
- Yellowish white
- After 10-14 days
- Leukocytes and decidual cells
- May continue until 4 to 6 weeks after birth
BUBBLLEE
Legs
Legs
- Some ankle edema normal first few days PP
- Assess for signs indicating thrombophlebitis (DVT):
- < 1% of births
- Encourage ambulation (ambulation even after c-section is encouraged 6-8 hours after birth)
- Assess legs for redness, tenderness, pain
BUBBLLEE
episiotomy
and Cesarian inscision
To encourage healing & decrease pain:
- Ice packs in first 24 hours
- Perineal hygiene
- Sitz baths
Cesarean incision
- Dressing clean and dry
- Suture line intact
