Maternity and Newborn Health Flashcards
Normal lab values during third trimester
Hgb: >11g/dL (110g/L)
Hematocrit: > 33%
RBC: 5-6.25 x 10^6/mm^3 (5-6.25 x 10^12/L)
WBC: 5000-15000/mm^3
Plt: 150 000- 400 000/mm^3
Contraindications for epidural
- uncorrected hypotension
- coagulopathies (extremely low plts, clotting disorders) -> risk for bleeding at epidural site -> hematoma formation -> spinal cord compression -> neurologic dysfunction
- infection at epidural site
Info to collect if pt arrives at ER w/ ruptured membranes
- recent meds
- multiple gestations?
- color of amniotic fluid (meconium stained fluid may indicate fetal stress or hypoxia, could require newborn resuscitations)
- due date (<37 weeks -> risk for resp distress)
Predictor of successful induction
Bishop score of 10
Fundus height at 12 weeks
just above the symphysis pubis
Chloasma s/s
benign
hormonally stimulate increase in pigmentation over the bridge of the nose and cheeks, usually appears in second trimester
fades postpartum
Condylomata acuminata s/s
fleshy, nontender bumps on genital/anal areas aka anogenital warts, caused by HPV
tx = trichloroacetic acid
Pruritic urticarial papules and plaques of pregnancy (PUPPP) s/s
pruritic, raised lesions form within abdominal striae, not umbilicus, and can spread to thighs, arms, legs, and back
Intrahepatic cholestasis of pregnancy
intense, generalized itching, w/o rash
Pica s/s
- compulsive craving for and consumption of substances normally not considered edible (ice, cornstarch, chalk, clay, dirt, and paper)
- not exclusive to pregnancy, but many women only experience it when pregnant
- often accompanied by iron deficiency anemia -> HCP will order hgb + htc levels
Preeclampsia s/s
- proteinuria + htn
- headache, visual disturbances, and facial swelling
- complications = thrombocytopenia, liver dysfunction, renal insufficiency, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome
Teaching for miscarriage
- no sex or tampons for 2 weeks
- report foul smelling vaginal discharge, heavy vaginal bleeding, + severe pains (s/s of infection or retained fetal tissue)
- continue prenatal vits w/ iron to prevent anemia + use ibuprofen for cramps
Hyperemesis gravidarum (HG) s/s
- severe, persistent nausea and vomiting
- weight loss, poor skin turgor, dry mucous membranes, hypotension, tachycardia
- hypokalemia/hyponatremia, ketonuria, increased urine specific gravity, hemoconcentration, metabolic alkalosis
Purpose of mag sulf in pregnancy
seizure prevention in preeclampsia
Foods to prevent neural tube defects
foods with folic acid (e.g. fortified grain products), green leafy veggies
Nagele’s rule
first day of last period - 3 months + 7 days + 1 year
Initial interventions for morning sickness
- dry, high-carb foods + low fat proteins
- eat several small meals during the day
- drink fluids between rather than with meals
- foods w/ ginger
- foods high in vit B6
Fetal tachycardia
- baseline HR >160 for >10 mins
- may be caused by fetal anemia, maternal fever, or infection
Zika virus
- transmitted through mosquitoes, sexual contact, + infected bodily fluids
- causes microcephaly (small brain + head), developmental dysfunction, + encephalitis in babies born to Zika-infected women
- pregnant women should avoid travelling to Zika-affected places + women who live in Zika-affected areas should take precaution against mosquitos (DEET) + safe sex
Magnesium sulfate toxicity s/s
mild: nausea, flushing, headache, hyporeflexia
mod: areflexia, hypocalcemia, somnolence
severe: resp paralysis, cardiac arrest
tx: stop mg + give IV calcium gluconate
When can fetal HR be detected by Doppler
10-12 weeks
Foods to avoid during pregnancy
- unpasteurized milk products
- unwashed fruits + veggies
- deli meat + hot dogs (unless heating until steaming hot)
- raw fish/meat
- fish high in mercury (e.g. shark, swordfish, king mackerel, tilefish)
- liver
When to give narcotics during labor
peak of contractions to decrease sedation of fetus and risk of newborn resp depression
Sinusoidal FHR
- repetitive, wave-like fluctuations w/ absent variability + no response to contractions
- ominous + requires immediate intervention
- suggests severe fetal anemia potentially due to fetomaternal hemorrhage (abdominal trauma) or some infections (parovirus B19)
Early decelerations
- mirror contraction with an apparent, gradual decrease in FHR (>30 seconds from onset to nadir)
- indicate fetal head compression
- normal finding
Variable decelrations
- abrupt decrease in FHR (<30 seconds from onset to nadir) + at least 15bpm below baseline for >15seconds-<2 mins
- usually corrected w/ maternal position change to relieve umbilical cord compression
- if recurrent/prolongs, can impair fetal oxygenation
Late decelerations
- occur after onset of contractions and continue after its end
- occur when fetal O2 is compromised
- to correct: stop oxytocin, reposition to left/right side, administer O2, IV bolus
Normal newborn weight loss
- 5-6%
- weight loss usually ceases around 5 days + babies return to their birth weight by 7-14 days
- weight loss of >7% needs further investigation
Increased htc in newborns is associated w/
poorly controlled maternal diabetes
Delayed meconium passage is associated w/
cystic fibrosis or Hirschsprung disease (portion of colon inhibits peristalsis)
yawning, sneezing, high pitched cry, poor feeding, and loose stools are associated w/
neonatal abstinence syndrome
smooth philtrum, thin upper lip, and short palpebral fissures associated w/
fetal alcohol syndrome
Candida albicans infection s/s
- white patches on oral mucosa, palate, and tongue
- infant may have trouble sucking or feeding due to associated pain
What is vitamin K given to newborns for
to prevent newborn hemorrhagic disease
Vaginal hematoma s/s
- persistent, severe vaginal pain or a feeling of fullness
- uterus is firm and at the midline on palpation
