Maternity Flashcards
What does family centered maternity and newborn care respond to?
physical, emotional, psychosocial, and spiritual needs of the women, the newborn, and her family.
how does family centered maternity and newborn care view pregnancy and birth?
As normal, healthy life events and recognizes the significance of family support, participation, and informed choice
What are the 17 family centered maternity and newborn care evidence based guidelines?
1) family-centered approach is optimal, 2) pregnancy is a normal, healthy process, 3)early parent-infant attachment is critical, 4)applies to all care environments, 5) is informed by research evidence, 7) involves collab among HCPs, 8) culturally appropriate, 9) indigenous ppl have distinct needs, 10) care as close to home as possible, 11) individualized care is recommended, 12) requires knowledge about their care, 13) families play an integral role in decision making, 14) attitudes and language of HCPs have an impact, 15) respects reproductive rights, 16)functions within a system that requires ongoing eval, 17) best practices from global setting are valuable for Canadian consideration.
when is the placental formed?
at implantation, it is the physical link between the mother and the fetus, it is fully developed and functional by 12 weeks gestation
what is the placental composed of?
maternal and embryonic tissues and blood vessels
what is the placental function?
it functions as an endocrine gland producing hormones that provide support to the developing fetus. O2 is passed from mother to fetus, with CO2 passed from the fetus to mother, which is important as the fetus does not have fully developed lungs and relies on this for respiration. nutrients, water, electrolytes and other essential substances are transferred to the fetus through the placenta.
How and why does vascular volume increase with pregnancy?
blood flow increases as the uterus increases in size. O2 is extracted from the uterine blood during the latter part of the pregnancy. 1/6 of total maternal blood volume is within the uterine vascular system. increase in plasma volume by an average of 1250mls.
What are the signs of pregnancy? (presumptive, probable, and positive)
Presumptive - subjective changes, amenorrhea, breast changes, fatigue
Probable - objective changes, hagar sign (softening in cervix-uterus), ballottement, pregnancy test, chadwick signs (vaginal mucosa and cervix changes to bluish colour, thickening of vaginal mucosa), goodale sign (increase in vascularity, connective tissue loosens)
Positive - objective signs, hearing fetal heart tones, visualizing the fetus, palpating fetal movements, u/s imaging
How do you calculate the EDD using Nagele’s rule?
determine the first day of the last period, then subtract 3 months, and add 7 days and 1 year.
What are the characteristics of post partum blues?
mood disturbances that peak in the first week after delivery due to rapid decrease in hormones, sadness, anxiety, irritability, changes in mood, appetite, energy levels, but does not impair ability to function. risk factors: hormones, traumatic birth, difficult infant, lack of support. blues will dissipate within a few weeks but can progress to depression.
What are the characteristics of past partum depression?
mood disorder that occurs in the first 2 weeks after delivery. symptoms can differ in severity and duration. violent outbursts, uncontrollable sobbing, feeling of worthlessness, thoughts of death or suicide. women with dx of depression have an increased risk. treatment: antianxiety meds, antidepressants, cognitive behavior therapy, ECT
What are the characteristics of post partum psychosis?
a psychiatric emergency, occurs within the first days to weeks after birth. paranoia, delusions, hallucinations, suicidal or homicidal thoughts. drastic mood fluctuations, disorganized thoughts, bizarre behaviour. Risks: previous psych Hx, especially bipolar. immediate intervention and hospitalization is required to prevent harm.
What does GTPAL mean?
Gravidity - # times conceived
Term births - # times pregnancy has been carried to at least 37 weeks
Preterm - # times woman has delivered between 20-37 weeks
Abortion - # times a woman has lost pregnancy either electively or spontaneous before 20 weeks
Living children - # living children or live births
Why is folic acid an important part of prenatal care?
400 mcg of folic acid daily for 12 weeks can prevent birth defects of the brain and spinal cord. inadequate folic acid is associated with fetal neural tube defects.
What is an amniocentesis?
it is performed to obtain amniotic fluid which contains fetal cells to test for chromosomal abnormalities. under u/s guidance a needle is inserted transabdominally into the uterus and amniotic fluid is withdrawn to be tested. it can be done after 14 weeks gestation (this is when the uterus becomes an abdominal organ and there is significant amount of fluid).
What are the complications of amniocentesis?
occur in less than 1% of cases. leakage of amniotic fluid, hemorrhage, fetomaternal hemorrhage, infection, labour, placental abruption, damage to other abdominal organs, fetal death, fetal injury from the needle, miscarriage.
What are the seven cardinal signs of labour?
1) engagement
2) Descent
3) flex ion
4) internal rotation
5) extension
6) restitution and external rotation
7) expulsion
What is engagement? (Cardinal signs of labour)
When the fetus head passes through pelvic inlet, For Nulliparous pregnancies engagement happens before labour as firm abdominal muscles direct the head to the pelvis,For multiparous pregnancies the mothers abdominal muscles are more relaxed and the head remains above the pelvis to move freely
What is descent? (Cardinal signs of labour)
The process of the presenting part through the pelvis. It depends on 4 things: Amniotic fluid pressure, pressure contracting fundus on fetus, force of contraction’s on muscle and diaphragm, straightening and bending of the fetus body. descent occurs in the first stage of labour and increases in the active phase
What is flexion? (Cardinal signs of labour)
Flexion refers to the fetus head encountering resistance from the cervix pelvic floor or pelvic wall Causing the fetus to flex its chin to his chest
What is internal rotation? (Cardinal signs of labour)
The act of rotating from occiput transverse to occiput. This happens at the ischial spine and is completed when the presenting part comes in contact with the lower pelvis.
What is extension? (Cardinal signs of labour)
When the head reaches the perineum
What is restitution and external rotation? (Cardinal signs of labour)
The act of the head return back to its state it was in while in the inlet, External rotation is when the shoulders descend similar to the head
What is expulsion? (Cardinal signs of labour)
Immediately after external rotation the shoulders move out from under the pubic symphisis , once the head and shoulders are birth the trunk of the fetus is flexed out
What are the stages of labour?
- Effacement and dilation of the cervix, the onset of contractions to full dilation of the cervix a) latent phase: cervix opens to 5 cm, contractions are mild and last about 30 to 45 seconds, 5 to 10 minutes apart; b) Active phase: cervix dilate 4 to 7 cm, contractions are 40 to 60 seconds, and 3 to 5 minutes apart; c)transition phase: cervix dilated to 10 cm, contractions are 60 to 90 seconds, with 30 seconds in between
- Cervix is 10 cm dilated and 100% effaced: fetus descends into birth canal and mother voluntarily bears down
- From birth to delivery of the placenta
- Recovery: after delivery of placenta until bonding established with baby
What is the estimated blood loss during labour?
With vaginal delivery blood loss is an estimated 500 ml and for C-section delivery blood loss is an estimated 1000 ml
What are the characteristics of contractions?
Duration: timing of the onset and the end of a contraction, measured in seconds, ranges from 45 to 80 seconds and should not last longer than 90 seconds
Frequency: ranges from 2 to 5 contractions per 10 minute period
Intensity: strength of a contraction at its peak determined by palpation or intrauterine pressure catheter (IUPC) measured in mmHg
Resting tone: tension in the uterine muscles between contractions, 10mmHg is the average resting tone during labour
What is false labor?
Braxton Hicks are irregular, painless uterine contractions that are normal and may occur from the 4th month of pregnancy. These contractions facilitate uterine blood flow and promote oxygen delivery to the fetus. After the 28th week these contractions become more definite, but ease with walking or exercise. They can be mistaken for true labour but do not intensify and duration or cause cervical dilation
What is gravida?
A woman who is pregnant
What is gravidity?
Pregnancy
What is multigravida?
A woman who has had two or more pregnancies
What is multipara?
A woman who has completed two or more pregnancies to 20 weeks of gestation
What is nulligravida?
A woman who has never been pregnant and is not currently pregnant
What is Nullipara?
A woman who has not completed a pregnancy with a fetus or fetuses is beyond 20 weeks of gestation
What is parity?
The number of pregnancies in which the fetus or fetuses have reached 20 weeks gestation, not the number of fetuses born
What is primigravida?
A woman who is pregnant for the first time
What is primipara?
A woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks gestation
What is viability?
The capacity to live outside the uterus usually occurring about 22 to 25 weeks of gestation
What is term?
A pregnancy from the beginning of week 37 of gestation
What is preterm?
A pregnancy that has reached 20 weeks but prior to the completion of 36 weeks gestation
What is early term?
A pregnancy between 37 weeks and 38 weeks six days gestation
What is full-term?
A pregnancy between 39 weeks and 40 weeks and six days
What is late term?
A pregnancy in the 41st week gestation
What is post term?
A pregnancy after 42 weeks gestation
What are the three main presentations for the fetus at birth?
1) Cephalic which occurs in 96% of births
2) Shoulder which occurs in less than 1% of births
3) Breach which occurs in 3% of births
What are the three different breach presentations?
1) Frank breech: legs point up with feet by babies head so the bottom would emerge first
2) Complete breech: legs folded with feet at the level of the baby’s bottom
3) Footling breech: one or both feet down so the legs emerge first
When is it safer to do a C-section over a vaginal birth?
When the baby is in footling breach position, the placenta is low lying over the cervix, when the umbilical cord comes out first, and when the labour is not progressing normally
What are comfort measures during labor?
With Latent labour, a warm shower or bath, soothing back or foot massages, warm liquids, and diversional activities.
After admission to hospital: a family centred care approach, a pillow for comfort, music, orientation to the room, and nurse reassurance and answering questions
What is postpartum hemorrhage?
It is the leading cause of maternal death and occurs in 5% of births, it is preventable in more than half of the cases. It is defined as the loss of more than 500 mL of blood during a vaginal birth and more than 1000 mL in a C-section. Early or acute occurs within 24 hours of birth, late or secondary occurs more than 24 hours or less than six weeks after birth.
What are the risk factors for postpartum hemorrhage?
Over-distended uterus, anaesthesia or analgesic, previous history of uterine atony, high parity, prolonged labour or oxytocin induced labor, the administration of magnesium sulfate, uterine sub-involution, lacerations of the birth canal, trauma during labour and birth, forceps assisted birth, vacuum assisted birth, caesarean birth, ruptured uterus, manual removal of retained placenta, retained placenta fragments, placenta accreta, placenta increta, placenta per creta, placental abruption, placenta previa, and coagulation disorders
What is RH incompatibility and how is it treated?
If a pregnant woman is RH negative and baby is RH positive antibodies can form, which can cause fetal anemia, jaundice, brain damage, or death. RH immune globin is a blood product that is given whenever there is a chance of RH negative woman giving birth to an RH positive baby.It is given at 29 weeks gestation and at delivery. It can reduce foetal haemolytic disease in 99% of cases.
What is normal involution?
It is the return of the uterus to nonpregnant state. The process begins after expulsion of placenta with contraction of uterine smooth muscle. At the end of the third stage of labor the uterus is midline, 2 cm above the umbilicus, the fundus is resting on the sacral Promontary. Within 12 hours of birth the fundus may rise to 1 cm above the umbilicus and by 24 hours the uterus is the same size as it was 20 weeks gestation. The uterus descends 1 to 2 cm every 24 hours. Involution progresses rapidly during the next few days and by the sixth day it is located halfway between umbilicus and symphysis pubis. The uterus should not be palpable after two weeks.
What is sub involution?
It is the failure of the uterus to return to a non-pregnant state. The most common cause is retained placenta fragments or infection
What is pregnancy induced hypertension?
It is one of the three main causes of maternal death and approximately 5 to 10% of pregnancies are complicated by hypertension. It is most common in women over the age of 40 with their first pregnancy. A blood pressure of 140/90 or greater taken at two separate measurements at least 15 minutes apart
What are the three main causes of maternal death?
Hypertensive disorder’s, infection, and haemorrhage
What are the complications of severe hypertension in pregnant women?
Hepatic rupture, placental abruption, and eclampsia
What is pre-existing hypertension?
Hypertension that predates the pregnancy or appears before 20 weeks gestation
What is gestational hypertension with comorbid conditions?
Comorbid conditions include pre-gestational type one or type two diabetes or kidney disease and require tight BP control outside of pregnancy to alleviate the heightened cardiovascular risk
What is Gestational hypertension with evidence of preeclampsia?
Gestation hypertension with One or more of the following symptoms:
- new or worsening proteinuria,
- one or more adverse conditions,
- one or more severe complications.
What is gestational hypertension?
Hypertension that appears for the first time at or beyond 20 weeks gestation
What is preeclampsia?
It develops after the second trimester and is defined as a hypertensive disorder with new onset proteinuria. It causes reduced maternal Organ perfusion and as a result decrease placental perfusion and fetal hypoxia. Non-severe preeclampsia can be managed at home by monitoring vital signs, deep tendon reflexes, balanced diet, and antihypertensive medications.
What is severe preeclampsia?
It is defined when one or more severe complication is present.
What characteristics does non-severe preeclampsia have?
A BP reading of greater than 140/90 on two separate readings 15 minutes apart, proteinuria of less than 0.3 g in a 24 hour specimen, reflexes may be normal, urine output matches fluid intake, headache may be present, there may be visual problems, right upper quadrant or epigastric pain may be present, serum creatinine may be elevated, thrombocytopenia may occur, liver enzymes may be elevated, fetal heart rate may be normal abnormal, placental perfusion is reduced.
What are the characteristics of severe preeclampsia?
A blood pressure of >160/110 on two separate readings that are 15 minutes apart, proteinuria of greater than 0.3 g in a 24 hour specimen, hyperreflexia of >3, decreased urine output to 15 ml per hour, severe headache, blurred vision or Blind spot’s, hepatic haematoma or rupture, elevated serum creatinine to > than 150, platelets are less than 50, hepatic disfunction is present, foetal heartbeat heart rate may be abnormal, decreased perfusion to placenta, foetal heart rate may show late deceleration in labor, placenta appears smaller than normal and premature ageing is apparent with numerous areas of ischemic necrosis
What are adverse conditions that will increase the risk of severe complications of preeclampsia?
Headache and visual disturbances, chest pain or dyspnea, oxygen saturation of less than 97%, elevated WBC, elevated INR or PTT, low platelets, elevated creatinine, nausea or vomiting, epigastric pain, elevated liver enzymes, abnormal foetal heart rate.
What are severe complications of preeclampsia that would warrant delivery of the fetus?
Cortical blindness or retina detachment, a GCS of less than 13, stroke, severe hypertension for greater than 12 hours, oxygen saturation <90 with the need for 50% O2 for one hour, intubation, pulmonary edema, MI, platelet count of <50, transfusion of any blood product, acute kidney injury, hepatic dysfunction, maternal or fetal compromise.
What is the treatment for preeclampsia?
Abstinence from alcohol, smoking cessation, multivitamins containing fully, calcium supplements, regular exercise.
What is placenta previa?
It is when the placenta is implanted in the lower uterine segment and completely or partially covers the cervix or as close enough to cause bleeding when the cervix dilate. A complete placenta previa covers the opening of the cervix entirely. A partial or marginal placenta previa covers less than 2 cm of the cervical opening.
What are the symptoms of placenta previa?
Bright red vaginal bleeding during second or third trimester, vitals may be normal because of the compensatory mechanism of pregnancy, 40% of blood volume can be lost without showing signs of shock, it can result in decreased output, increase fundal height.
What are the maternal and fetal risk factors associated with placenta previa?
The maternal risks are hemorrhage and hysterectomy. the fetal risks are preterm birth, stillbirth, malpresentation, and fetal anemia.
How is placenta previa managed?
Reduced activity, ultrasound every two weeks, fetal surveillance, lab work to include haemoglobin and hematocrit, antepartum steroids to promote fetal lung maturity, C-section after 37 weeks.
What are the clinical findings for placenta previa?
Bleeding is minimal to severe, blood loss varies, blood is bright red, shock is uncommon, uterine tone is normal, there is no pain, ultrasound findings of placenta are abnormal, fetal position is commonly transverse, breech or oblique,There is normal fetal heart rate pattern, station of presenting part is high and not engaged.
What are the three classes of placental abruption
Class one: mild separation of 10 to 20%, class two: moderate separation of 20 to 50%, class three: severe separation of greater than 50%.
What are the clinical findings of a class 1 placental abruption?
Minimal bleeding, less than 500 mL blood loss, dark red blood, shock is rare, uterine tone is normal, pain is absent, location of placenta is normal, station of presenting part is variable to engaged, usual distribution of fetal position, normal foetal heart rate.
What are the clinical findings of a class 2 placental abruption?
Bleeding can be moderate, 1000 to 1500 mL of blood loss, dark red blood, mild shock, occasional DAC, uterine tone is increased and may be localized, pain is present and is moderate to severe, location of placenta is normal, the station of presenting part is variable to engaged, there is usual distribution of fetal position, gestational hypertension is common, There is atypical fetal heart rate pattern.
What are the clinical findings of a class 3 placental abruption?
Bleeding can be heavy, blood loss is greater than 1500 mL, blood is dark red, shock is very common and can be sudden, frequent DIC, uterine tone is Tetanic with persistent uterine contractions, pain is agonizing, the location of the placenta is normal the station of presenting part is variable to engaged, there is usual distribution of foetal position, gestational hypertension is commonly present, there is abnormal foetal heart rate pattern and death can occur.
What is gestational diabetes?
High blood glucose levels during pregnancy. It can begin during the first trimester and can cause problems with fetal development. It usually does not emerge until second or third trimester. Maternal nutrient ingestion induces greater or more sustained levels of blood glucose well insulin resistance is increased.
What risk factors are associated with gestational diabetes?
Preeclampsia, fetal macrosomia which can lead to lacerations and episiotomy, c-section, fetal shoulder dystocia and birth trauma, fetal hyperglycemia, difficulty breathing due to increased surfactant production,
What clinical findings would you be concerned about in a fetus born from a woman who has gestational diabetes?
Jitteriness, lethargy, poor feeding, abnormal cry, hypothermia or temp instability, respiratory distress, apnea, and seizures.
What is Group B streptococcus?
It is a normal flora in a woman who is not pregnant and is present in 10 to 30% of healthy pregnant women but can be vertically transmitted from the birth canal to the infant and leads to increased perinatal and neonatal morbidity and mortality.
What are the risk factors of Group B streptococcus?
Positive prenatal culture, preterm labour of less than 37 weeks, prolonged rupture of membranes greater than 18 hours, intrapartum maternal fever, positive history for early onset neonatal GBS. Intrapartum antibiotic prophylaxis should be offered if a culture is not available.
What is the treatment for Group B streptococcus?
treatment is penicillin G, 5 million units IV loading dose then 2.5 million units IV every four hours during labor. Alternative therapy is ampicillin 2 g IV loading dose followed by 1 g IV every four hours.
