Maternity Flashcards
Nagele’s rule
(to estimate due date
- Requires that woman has 28-day menstrual cycle
- Subtract 3 mths and add 7 days to the first day of the last period; then add 1 year
Nulligravida
never been pregnant
Primigravida
first time
Multigravida
at least second pregnancy
Parity
Number of births carried past 20 weeks gestation (regardless of whether alive or not when born)
Nullipara
has not had birth at more then 20 weeks
Primipara
one birth after 20 weeks
Multipara
two or more pregnancies to stage of viability
GTPAL
*used to assess pregnancy outcomes G = gravidity, number of pregnancies T = term births, number born at term (longer than 37 weeks) P = preterm births, before 37 weeks A = abortions/miscarriages L = number of living children Example: female 26 weeks pregnant. Miscarriage at 10 weeks. 3 yr old born at 39 weeks. G=3, T=1, P=0, A=1, L=1
difference between presumptive, probably, and positive signs of pregnancys
presumptive - signs & symptoms experience by woman
probable - signs from examiner
positive - scientific confirmation of pregnancy
Hegar’s sign
probable sign of pregnancy
■ Compressibility and softening of lower uterine segment (approx. week 6)
Goodell’s sign
probable sign of pregnancy
■ Softening of cervix (beginning of 2nd mth)
Chadwick’s sign
probable sign of pregnancy
■ Violet colouration of the mucous membranes of cervix, vagina, vulva (approx. week 4)
Ballottement
probable sign of pregnancy
■ Rebounding of fetus against examiners fingers on palpation
why should women take folic acid during pregnancy?
Prevents neural tube defects and orofacial clefts
what is abruptio placentae?
the premature separation of the placenta from the uterus
how many stages of labour are there?
4
describe latent phase (stage, frequencyduration of contractions, dilation, intensity of contractions)
stage 1, 15-30 min, 15-30 sec, 1-4 cm, mild
describe active phase (stage, frequencyduration of contractions, dilation, intensity of contractions)
stage 1, 3-5 min, 30-60 sec, 4-7 cm, moderate
describe transition phase (stage, frequencyduration of contractions, dilation, intensity of contractions)
stage 1, 2-3 min, 45-90 sec, 8-10 cm, strong
describe stage 2 of labour
complete dilation, progress measured by station, contractions q2-3 min, 60-75 sec, strong, urge to bear down, neonate born in 2nd stage
describe stage 3 labour
placental separation & expulsion 5-30 min after birth
describe stage 4 of labour
Period 1-4 hours after delivery
in induction, what is the desired labour pattern during infusion of Pitocin?
Frequency q2-3 minutes, duration 60 seconds
at what point should Pitocin be discontinued when infusing for induction?
if uterine contraction frequency is less than 2 minutes or duration longer than 90 seconds, or if fetal distress noted
what is placenta previa?
Improperly implanted placenta in lower uterine segment near or over the internal cervical os
characteristics of placenta previa
Sudden onset painless, bright red bleeding in last half of the pregnancy
Uterus soft, relaxed, nontender
Fundal height may be more than expected for gestational age
characteristics of abruptio placentae
Dark red vaginal bleeding (but could be absence of visible blood) Uterine pain tenderness or both Uterine rigidity Severe abdominal pain Signs of fetal distress
what is placenta accreta?
Abnormally adherent placenta
what is placenta increta?
Placenta penetrates into uterine muscle itself
what is placenta percreta?
Goes all the way through the uterus
what is the main concern with placental abnormalities?
hemorrhage and therefore shock
signs of fetal distress
FHR <110 bpm or >160 bpm Meconium-stained amniotic fluid Fetal hyperactivity Progressive decrease in baseline variability Severe variable decelerations Late decelerations
what is a potential serious complication of intrauterine death?
DIC
signs of postpartum hematoma
severe pain
pressure
bulging mass perineal area, discoloured skin
inability to void
when should a woman worry about her elevated temperature?
temp of 38 is normal within first 24 hours d/t dehydration, a temp of 100.4/38 or greater after 24 hours postpartum indicated infection
is it ok for a woman with mastitis to continue breastfeeding?
Yes
what is the postpartum period?
immediately after birth to 6 weeks post delivery
what is involution?
Rapid decrease in size of uterus as it returns to nonpregnant state
what should a non-breastfeeding mother do about engorgement?
should not express milk
cool compressess, supportive bra, ibuprofen
what do newborn stools look like?
light yellow, seedy, watery, and frequent
in what order to you suction a newborn?
mouth first then nares
what are the indicators that make up the APGAR score?
Heart rate Respiratory rate/effort Muscle tone Reflex irritability Skin colour
what is the intervention for apgar score of 4-7?
Stimulate; rub newborn’s back; admin oxygen; rescore at specific intervals
what is the intervention for apgar score of 0-3?
Requires full resuscitation; rescore at specific intervals
what is the normal interval for apgar scoring?
at 1 minute, at 5 minutes, (and at 10 if needed)
normal newborn HR
resting 120-160 beats / min
Sleeping 80-100
Up to 180 if crying
normal newborn respirations
30-60 per minute, assess for full minute
normal newborn head circumference
33-35 cm
number and type of vessels that should be found in umbilical cord
2 arteries, 1 vein
when does pathological jaundice happen ad what does it mean?
within first 24 hours
hemolysis of RBCs
care for circumcision
petroleum jelly gauze, removed after first voiding post-circumcision
meconium
greenish black with a thick, sticky, tarlike consistency, usually passed within first 24 hours of life
what does meconium staining put the newborn at risk for?
meconium aspiration syndrome
what does HELLP syndrome stand for?
Hemolysis, Elevated Liver enzymes, Low Platelet count|
*severe form of preeclamspia
what is the clinical presentation of HELLP syndrome?
RUQ pain, Nausea, vomiting, malaise
when can fetal sex be determined?
usually by end of 12th week by visualizing external genitalia on ultrasound`
what is the cause of late decelerations?
uteroplacental insufficiency
what is the cause of variable decelerations?
cord compression
what is the significance of TORCH infections?
cause fetal abnormalities
what are the TORCH infections?
Toxoplasmosis, Other [parvo-B19/varicella zoster], Rubella, Cytomegalovirus, Herpes simplex virus
signs of ICP infants
bulging fontanels irritability high-pitched cry increased head circumference setting sun eyes (eyes appear t be looking down and prominent sclera over iris)
