Maternal Child Flashcards
Female life expectancy
82 years old
Male life expectancy
79 years old
what % of Canadians live in families
84%
what % of Canadians are lone parents
15.5%
Teenage birth rates have what
decreased and are now 15/1000 women
Canadian health care system is what
publicly administrated
comprehensive
universal/portable
accessible
Additional: eye wear, dental, physio
infant mortality
the rate of deaths per live births that occur within the first 12 months of life
Maternal mortality
the rates of maternal deaths from child births and complications of pregnancy, child birth and puerperium (first 42 days after the end of pregnancy)
Puerperium
post partum where mother goes back into pre pregant state. approximatly 6 weeks
leading cause of infant morbidity
prematurity
low birth weights
congenital illnesses
leading cause of maternal morality
pulmonary embolism
gestational hypertension
diagnosis associated with maternal mortality
disease of circulatory system
indirect causes
postpartum hemorrhages
hypertension
Infant and maternal mortality rates are an index of what
an index of the general health of a country
family-centered maternity and new born care national guide (FCMNC)
is based on 17 principals
childhood health issues
obesity
type 2 diabetes
childhood injuries
mental health
substance abuse
leading cause of infant morbidity
respiratory illness
atraumatic care
providing therapeutic care that minimizes distress and is essential in avoiding harm
the Calgary family assessment model
a framework used by nurses to asses and understand family dynamics
Family genograms
visual family tree
ecomaps
patient condition and relationship with others
implantation (duration and what is it)
between 6-10 days, when the embryo moves down the fallopian tubes and enters the uterine cavity then burrows un the lining of the uterus
Embryo
fertilized egg
placenta
supply’s rich blood and oxygen to the fetus
viability
capability to survive outside the uterus
must have a functioning nervous system and lungs
500grams or 21 weeks
surfactant
reduces surface tension on baby’s lungs in order to survive
Fetal circulation
amniotic fluid goes into the lungs and into the heart.
amniotic fluid
serves as a cushion and exchanges nutrients for the fetus
dizygotic twins
two implantations and two fertilizations
monozygotic twins
one fertilizations and the blastomeres separate
gravida/gravidity
a woman who is pregnant
nulligravida
never been pregnant
primigravida
pregnant for the first time
multigravida
a woman who has had two or more pregnancies (20 weeks gestation or more)
parity
number of pregnancies that have reached viability, weather fetus was born or not.
nullipara
zero pregnancies beyond viability
primipara
one pregnancy that reached viability
multipara
two or more pregnancies that have reached viability
post date/post term
pregnancy beyond 41 weeks
pre term
between 20 and 36 weeks
term
start of week 37 to end of week 40, plus 6 day gestation
pregnancy is how long
9 calendar months
10 lunar months of 28 days (280 days), 40 weeks
When does a positive pregnancy test show
4 to 12 weeks
Negele’s rule
subtract 3 months, add 7 days to the last menstrual period
first trimester
weeks 1 - 13
second trimester
weeks 14 - 26
third trimester
weeks 27 - term
human chronic gonadotropin (hCG)
is a hormone produced by the placenta during pregnancy. Its main role is to support the development of the embryo and maintain the pregnancy by stimulating the ovaries to produce progesterone. It’s also the hormone detected in pregnancy tests.
why is the β-hCG is important
because it is the portion detected in blood and urine pregnancy tests and for confirming pregnancy.
Braxton hicks contractions
16-28 weeks, they are irregular and infrequent and often go away with changing positions. It is the way your body gets prepared
quickening
16-20 weeks, when women starts to feel baby move
vernix
waxy substance that coats and protects babies skin after birth and in the womb
lanugo
soft and unpigmented hair
maternal adaptations cardiovascular
blood volumes increased by 40-60% and RBC increased by 20-30%
major causes of maternal deaths
hypertension disorders
infection
hemorrhage
ages over 35 or under 20
partner violence
maternal health
high risk pregnancy
heath of the mother or fetus is jeopardized. mother could extend all the way to 6 weeks post birth.
gestational hypertension
is a condition characterized by high blood pressure (hypertension) that develops during pregnancy, usually after the 20th week, in women who did not have high blood pressure before pregnancy. Unlike preeclampsia, gestational hypertension does not involve protein in the urine or other signs of organ damage.
140/90 mm Hg or higher on two separate occasions
factors that go into gestational hypertension
first time pregnancy
family history
history of diabetes
renal disease
age
obesity
intervention for gestational hypertension
delivery is the only definitive treatment
HELLP
potentially life-threatening complication of pregnancy, often considered a variant of preeclampsia. It typically occurs in the third trimester but can also develop after childbirth.
what does HELLP stand for
hemolysis (break town of RBC)
elevated liver enzymes (Liver damage)
low platelets (effect blood clotting)
Complications of HELLP syndrome
Liver rupture or failure
Kidney failure
Placental abruption (early detachment of the placenta)
Disseminated intravascular coagulation (DIC), which can lead to excessive bleeding
Increased risk of preterm birth for the baby
treatment of HELLP syndrome
The only definitive treatment for HELLP syndrome is delivery of the baby, even if preterm. Management may involve medications to stabilize blood pressure, corticosteroids to improve fetal lung maturity (if premature)
Non-severe preeclampsia (MILD)
characterized by elevated blood pressure and some signs of organ dysfunction, but without severe symptoms or complications. It typically develops after the 20th week of pregnancy
blood pressure: 140.90 not exceeding 160/110
MAP: 105 mmHg
proteinuria: >0.3 g in 24 hour
severe pre-eclampsia
dangerous form of preeclampsia, a pregnancy complication characterized by high blood pressure and damage to organs, most often the liver and kidneys. It typically occurs after 20 weeks of pregnancy but can also develop postpartum
blood pressure: 160/110
MAP: 110 mmHg
proteinuria
cerebral disturbances
seizures
/coma
treatment for pre-eclampsia
Antihypertensive drugs to lower blood pressure, magnesium sulfate to prevent seizures, and corticosteroids to help mature the baby’s lungs if early delivery is planned
gestational diabetes mellitus
type of diabetes that develops during pregnancy in women who did not previously have diabetes. It usually occurs in the second or third trimester when the body becomes less sensitive to insulin, a hormone that regulates blood sugar levels.
While GDM typically goes away after childbirth, it can increase the risk of complications for both mother and baby
risk factors for gestational diabetes
35 or older
obesity
use of corticosteroids
family history of type 2 diabetes
previous GDM
polycystic ovary syndrome
hyperemesis gravidarum
is a severe form of nausea and vomiting during pregnancy that goes beyond typical morning sickness. It can lead to dehydration, weight loss, and nutritional deficiencies, requiring medical treatment. Unlike normal pregnancy nausea, which typically subsides after the first trimester, hyperemesis gravidarum can persist throughout the pregnancy.
controlling hyperemesis gravidarum
vitamin B6
antiemetics (zofran)
no gravol until birth
hemorrhagic disorder
50% of bleeding in the third trimester is placenta previa or placental abruption
abortion
loss of pregnancy before the fetus is viable, under 20 weeks or 500 grams. spontaneous or induced
manifestations of an abortion
spotting, uterine, cramping, back pain, pelvic pressure
threatened abortion
vaginal bleeding occurs
inevitable abortions
membranes rupture, cervic dilates, heavy bleeding
incomplete abortions
not all products are expelled. requires oxytocin
complete abortions
all is expelled, cervix closes
missed abortions
fetus dies and half of the pregnancy is retained in the uterus, requiring dilation and cuttage.
medications for spontaneous abortions
misoprostol
what should you eat after an abortion
food high in iron and protein
ectopic pregnancy
occurs when a fertilized egg implants and grows outside the main cavity of the uterus, most commonly in one of the fallopian tubes. Since the fallopian tubes are not designed to hold a growing embryo, the pregnancy cannot proceed normally and can lead to life-threatening complications if untreated.
manifestations of ectopic pregnancy
missed periods, abdominal pain. pelvic pain, vaginal spotting
interventions for ectopic pregnancy
methotrexate (inhibits cell production)
surgical is required if ruptured salpingostomy
placenta previa
complication where the placenta partially or completely covers the cervix, the opening of the uterus. This condition can lead to severe bleeding during pregnancy and delivery.
placenta previa diagnosis
by a transabdominal ultrasound or transvaginal ultrasound
placenta previa management
caesarean birth, doubble set up procedure
placenta previa risk factors
no vaginal exams or oxytocin
age
previous c-section or surgical abortion
multiple gestations
manifestations of placenta previa
sudden onset of painless bleeding, bleeding is caused by placenta villli being torn. delay birth administer corticosteroids for maturation of fetal lungs
marginal:
the placenta is next to the cervix but does not cover the opening
partial:
the placenta is covering part of the cervix opening
complete
the placenta covers the whole cervical opening
placental abruption
serious pregnancy complication in which the placenta detaches from the inner wall of the uterus before childbirth, either partially or completely. This separation can deprive the baby of oxygen and nutrients, and it can cause heavy bleeding in the mother
partial abruption
concealed bleeding, you cant see and it only detaches partially
marginal abruption
external bleeding, may escape through cervix, does not significantly impact baby if it is managed
complete abruption
severe or heavy bleeding, lack of oxygen and nutrients. high risk if completely detaches
HIV and AIDS
perinatal transmission and obstetrical complications. strict adherence to medications and does not accelerate conditions
HIV and AIDS after birth
No vaginal delivery no breast feeding, new born must be cleared of all fluids and stuff must adhere to infectious control
substance use from mother to baby
can easily be passed through placenta when cutting the cord, the fetus is automatically cut off and may go through with drawls.
health risks to baby when mother is using substances
miscarriage
still born
prematurity/low birth weights
sudden infant death
what should you treat the mother with who is using substances
Methadone
Rh incompatibility
woman has Rh-negative blood and the fetus has Rh-positive blood, inherited from the father. This difference can lead to the mother’s immune system producing antibodies against the Rh factor, treating the baby’s Rh-positive red blood cells as foreign invaders. If these antibodies cross the placenta, they can attack the fetal red blood cells, causing probelms
RohGam
a medication used to prevent Rh incompatibility in Rh-negative individuals, especially during pregnancy. It works by preventing the immune system from forming antibodies that could target Rh-positive red blood cells.
cervical ripening and induction
medical interventions used to initiate the labor process when it does not start naturally or there are health concerns for the mother or fetus.
indwelling catheter
prostaglandins (prostin)
Oxytocin
artifical rupture
when is premature labor
true labor before 37 weeks, 7.6% in Canada
cord prolapse
obstetric emergency that occurs when the umbilical cord descends into the birth canal ahead of or alongside the presenting part of the fetus (usually the head). This can lead to compression of the cord, restricting blood flow and oxygen to the baby, which may cause fetal distress or even death if not managed promptly.
cesarean section
surgical procedure used to deliver a baby through incisions made in the mother’s abdomen and uterus. It is performed when vaginal delivery would pose a risk to the mother or baby
cesarean section incision
classical, low cervical vertical, low transverse
monitoring signs of labor
cervical changes
lightening (fetus will drop)
increased energy level
bloody show spotting
braxton hicks contractions
spontaneous rupture of membranes
process of labor
moving fetus and placenta and membranes out of uterus and through birthing canal
mechanism of labor
Cardinal movements, is when the fetus undergoes several position changes
true labor
contractions are 5 minutes apart lasting 30-60 seconds, becomes stronger there is pressure felt
1st stage of labor
0-10 cm dilation
-latent phase
-active phase
-transition phase
latent phase
0-3 cm, contractions every 5-10 minutes, for 30-45 seconds
active phase
4-7 cm, contractions every 2-5 minutes, for 45-60 seconds
transition phase
8-10 cm, contractions every 1-2 minutes, for 60-90 seconds
2nd stage of labor
10 cm to birth (1hour)
- pelvic phase
- perineal phase
pelvic phase
period of fetal descendance
perineal phase
crowning, babys exsit
3rd stage
separation and delivery of placenta
- placenta separation phase
- placenta expulsion phase
placenta separation phase
detach from uterine wall
placenta expulsion phase
placenta coming out
4th stage of labor
1 to 4 hours after birth
5 P’s that effect labor
-Passenger (fetus and placenta)
- Passageway (birth canal)
- Powers (contractions)
- Position of mother
- Psychological response
Passenger
size of head
fetal presentation
fetal position
amniotic membrane
placenta and cord
fetal head
5 bones that are not fused together, sutures and fontanels provide landmark to determine position
leopards maneuver
determine the position, presentation, and engagement of the fetus in the uterus.
station
to the position of the presenting part of the fetus (usually the head) in relation to the mother’s pelvis during labor. It measures how far the baby has descended into the birth canal and is an important factor in assessing the progress of labor. (you want + 1, 2, 3, never negative)
passageway is composed of
bony tissue
cervix soft tissue
pelvic floor
vagina
introitus (external opening of vagina)
gynecoid
circle shape pelvis, classic female in 50% of women
android
heart shape pelvis, resembling the male pelvis shape
anthropoid
oval shape
platypelloid
flat pelvis, least common
Powers (contractions)
primary powers
- contraction (pushing)
- dilation (opening)
- effacement (thinning of cervix)
Secondary powers
- maternal pushing efforts
Ritgen maneuver
help reduce tearing of the pernium, by controlling the speed of delivery by pressure with hand on babys head
delivery of placenta
- separation and expulsion
- cord and blood collection
- maternal physical status
- umbilical cord blood banking
visceral pain
lower position of abdomen, in fallopian tubes, ovaries and ligaments
referred pain
abdomen wall, illiac crest, gluteal area
somatic pain
intense, sharp, burning sensation
after birth in the 4th stage of labor what happens
uterus returns to normal size and shape, vaginal discharge, bladder beings to function normally, perineal tissue heals, hormones adjust for milk production
uterus returns to normal size and shape is called what
involution
vaginal discharge is called what
lochia
how often are post partum vital signs taken
Q15 minutes for the first hour then as needed
Blood loss expectancy
500ml for vaginal and 1000ml for c-section
Cause of bleeding 4 T’s
tone
tissue
trauma
thrombin
amount of blood loss (compensation, mild, moderate, severe)
- compensation (500-1000ml, 10-15%)
no changes - mild (1000-1500ml, 15-25%)
slight BP fall - moderate (1500-2000ml, 25-35%)
Fall in BP - severe (2000-3000ml, 35-45%)
perfomed fall
post anesthesia recovery
1-2 hours, must recover before discharge
laparotomy
incision in abdominal wall
hysterotomy
incision in uterus
pfannenstiel incision
that allows access into abdomen
Post partum assessment
BUBBLLEE
breast
uterine
bladder
bowel
lochia
legs
epistomy
emotional
Post partum assessment - breast
firmness and nipples and lactation
Post partum assessment - uterine
fundus and location, decreases by 1-2 cm every 24 hours returns to normal size after 6 weeks, edges are firm. 2 weeks after uterus should lye in true pelvis
subinvolution
failure to return to non pregnant state
Post partum assessment - bladder
amount and freqauncy
Post partum assessment - bowels
passing gas and bowel movements
Post partum assessment - lochia
lochia ruba - red
lochia serosa - pink
lochia alba - white
Post partum assessment - legs
peripheral edema
Post partum assessment - epistomy /laceration
first degree - involving only the vaginal mucosa (the lining of the vagina
second degree - involves both the vaginal mucosa and the perineal muscles, which help support the pelvic floor
third degree - ear involves the vaginal mucosa, perineal muscles, and extends into the anal sphincter
fourth degree - the vaginal mucosa, perineal muscles, anal sphincter, and into the rectal mucosa
Post partum assessment - emotional status
energy level, interactions, posture,
comfort level, sleep and rest patterns
lochia ruba
red, 1-3 days post partum, blood fragments
lochia serosa
pink, 3-10 days, blood mucus and invading leucocytes
lochia alba
white, 10-14 days, mucus, leucocyte count is high
scant
2 inch stain
small
4 inch stain
moderate
6 inch stain
large
more than 6 inch stain
assess of perineum REEDA
redness
ecchymosis
edema
drainage
approximation
early forms of contact with mother and baby
skin to skin
nursing baby
postnatal depression screening
should be done and then reassess if needed, 80% of women experience mild depression “baby blues”. 10-15% experience serious depression.
post partum depression
low mood or lack of interest in activities, treatment - antidepressants, anxiety medications
post partum psychosis
depression, hallucinations, delusions and thoughts to harm baby or self could be a psychiatric emergency treatment is with antipsychotics and mood stabilizers like lithium
Assessing complications in the 4th stage - pulse
may decrease due to labor, it might be due to post partum hemorrhages
Assessing complications in the 4th stage - blood pressure
mild rise, could be due to eclampsia or gestational hypertension
Assessing complications in the 4th stage - lochia
moderate rube, more than 2 pads saturated in one hour, post partum hemorrhages or by laceration
Assessing complications in the 4th stage - bladder
should not be palpated, distention may be due to urinary retention
Assessing complications in the 4th stage - perineum
pink, no bruising or edema, bruised edema may be due to hematoma or trauma from delivery
post partum infection
infection in genital canal within 28 days after abortion or delivery may cause endometris, wound infection and uti and mastitis. usually from streptococcal or anaerobic
post partum hemorrhages
tone, tissue trauma, thrombin. determined by blood work, vital signs q4h and RPN. administer hemabate
Criteria for discharge
women and baby are stable
no complications for 24 hours
must complete (vitals, bubble and lab tests)
lab tests: hemoglobin and hematocrit
Rubella vaccination
Rubella vaccination is crucial for pregnant women, due to the severe risks rubella poses to the fetus. Rubella infection during pregnancy, especially in the first trimester, can lead to congenital rubella syndrome (CRS)
- birth defects
- developmental delays
- Still born/ miscarage
Rh immunoglobin
RhoGAM is administered at specific times during and after pregnancy to prevent sensitization
If the baby is Rh-positive, the mother will receive another dose of RhoGAM within 72 hours after delivery to prevent her body from forming antibodies against the baby’s Rh-positive blood. This ensures future pregnancies are not at risk.
perinatal bereavement
loss of what was hoped for, dreamed about or planned. loss during child birth, child complications, neonatal
what is oxytocin used for
augment of labor by strengthening and regulating contractions
what drug is used if you notice the newborns central nervous system is depressant.
Narcan (Naloxone)
TPAL stands for what
term births
pre term births
abortions
living children
what foods should you avoid if your pregnant
sushi- toxoplasma (harms the fetus)
hot dogs- complications may cause still born
tuna fish - affects babys nervous system
deli meat - complications still born
alcoholic beverages - FADS birth defects or delays
when is a vaginal exam done
no only at final weeks of gestation because it may simulate contractions or cause infection
what does infertile mean
inability to conceive after 1 year of unprotected intercourse
Primary vs secondary infertility
primary couples who have never conceived
Secondary who have before and now cant
how often should you go see the doctor when you being pregnant
o Up to 28 weeks: Every 4 weeks.
o 28-36 weeks: Every 2 weeks.
o 36 weeks to delivery: Weekly.
family centered trends
technology
consumer and professional participation
health care restructuring
evidence based practice
diversity in canadian population
Hegar sign
compressibility and softening of the cervical isthmus. In the 4 to 6th week of pregnancy
Chadwick’s sign
Estrogen causes the cervix to become congested with blood, resulting in the characteristic bluish purple color that extends to include the vagina and labia.
Goodell’s sign
Collagen fibers in the connective tissue of the cervix decrease, causing the cervix
to soften.
