OB test 1 Flashcards
3 periods occur when baby is born
- 1st period of activity- couple hours after birth- baby is awake, bond with baby, feed, skin to skn
- 2nd period- rest- baby sleeps for about two hours
- 3rd period of activity- awake and bonding
Newborns senses are tested before sent home
KNOW: hearing test on every baby before they go home*
What is formed in the lungs when the fetus is developing and what is its function?
The fetus produces surfactant at 24-25 weeks- this keeps alveoli open.
This is why premature babies born at this time have a chance of survival
-Babies do breath inutero but no gas exchange-
Vessels in the umbilical cord
There are 3: 2 arteries, 1 vein
Oxygen comes from the vein.
AVA
Ductus Venosus
bypasses the LIVER to get to the heart faster
Ductus Arteriosus
bypasses the LUNGS
Foramen Ovale
-shunts blood from RIGHT to LEFT atrium
Types of heat loss
Conduction- prevented by holding, touching
Convection- (air) protect from drafts of air
Radiation- sunlight
Evaporation- dry the baby off
**PRETERM BABIES HAVE A HARD TIME STAYING WARM
Heat loss in a newborn can cause 3 things. What are they?
- Respiratory distress
- Hypoglycemia
- increases oxygen demand
What is brown fat?
-area of skin that has lots of blood vessels, help keep baby warm because babies are unable to shiver. (found in back of neck)
Normal Respiration Rates for Newborn
-30-60 bpm
*periods of APNEA less than 20 seconds is NORMAL!
-See-saw resps are abnormal
Normal Temp for newborn
-97.7-99.1
Anything less than 97.7, you need to intervene.
NO rectal temps, temps are taken axillary
low temp coud be a sign of infection
S/S of respiratory distress
- nasal flaring, GRUNTS, tachypnea, retractions
- Ambu bag should be in every delivery room
What vitamin is given at birth and why?
Vitamin K is given at birth because the gut is sterile, cannot synthesize vitamin K which is needed for clotting.
First feeding
-start with 15mL and increase with next feeding
Babies first stool
*MECONIUM- black and tarry within 12-24 hours
3 causes of bowel movements that occur inside.
- post due dates
- fetal distress
- Breech positioning
When is jaundice normal? When is it not normal?
Jaundice within the first 24 hours is ABNORMAL (pathological)
Jaundice after 24 hours is normal (physiological)
Normal Blood Glucose in a Newborn
40-60mg for the first day
(Babies with diabetic mom are prone to hypoglycemia)
What are the different types of immunty and how does the baby get them?
IGG- diseae is gone- baby gets immunity from mother/placenta.
IGM- disease process is going on. Baby must have infection to get immunity.
IGA- passed only to breast fed babies
What is the Moro Reflex?
Startle reflex- make loud noise and baby becomes startled. (clap hands, raise arms and drop)
Babies hands will be in a C position
Babinski reflex
run finger upwards on sole of foot, toes expand and big toe dorsiflex.
(this is healthy for babies, not for adults)
How to tell the difference between seizure and hypoglycemia?
If baby shakes, hold them close to you. If they stop it is hypoglycemia, if they dont its a seizure
Normal heart rate in newborn
120-160 for newborn- apical for one min
110-160 for fetal heartbeat
APGAR score
2 numbers: taken at 1 MINUTE and 5 MINUTE
A-appearance
P-pulse
G-grimace
A-activity
R-Respiratory effort
(2 points for each; 10 total…. 8-10 baby is well, 4-7 some kind of intervention needed, 0-3 baby is not well.)
Is it normal for a newborn to have 10% weight loss within the first couple days?
YES
For full term babies, how much of theyre feet should have creases?
2/3 is normal - plantar creases.
Flex position
this is normal for a full term baby
Anterior suture
Diamond shaped 4-5cm
Posterior suture
Triangle shaped 0.5-1 cm (closes first)
Caput
- crosses the suture line and is fluid filled. this usually goes away fast
Cephalhematoma
does not cross suture line (one sided) and is usually blood filled
lasts for a while.
Erythema Toxicum
Newborn Rash. this is NORMA. it goes away on its own
Breast is best!! why?
- babies stop when theyre full; less chance of overfeeding
- immunity- IGA
- helps uterus contract and body get back to norm
- its convenient- no formula, no warming bottle
- decrease upset stomach, diarrhea and colic
- stimulates growth of + bacteria in the gut
- promotes bonding, proper temp
How do you tell if a baby is being fed adequately?
6-10 wet diapers a day indicate adequate nutrition
Cord care
falls off within 7-10 days.
**its okay to bathe and get the cord wet!
When can newborn be tested for PKU
after eating for 24 hours before test
Small Gestational Age (SGA)
-below 10th percentile (5lbs 8oz)
Large Gestational Age
- 90th percentile- above 8 lbs
at risk for hypoglycemia, and birth trauma
Amnioinfusion
- done during labor to prevent meconium aspiration.
LR in placenta to dilute meconium.
Tracheal suction used if baby is not crying
Post partum is when
the time they deliver till 6 weeks after
pregnancy is a state of?
WELLNESS NOT ILLNESS
Erythromicin is given how? and why
in eyes put in on like toothpaste give to protect from Viruses, STDs
Cephalopelvic disproportion (Baby >8 lbs) can cause probems what are they?
hypoglycemia, polycythemia, jaundice
pre-embyonic period
conception to day 14 of preg. ALL or NOTHING if exposed to tetragens SERIOUS
Embryonic period
day 15-last day of 8 week (56) MOST important time for exposure to tetragens
Fetal period
end of 8th week untill birth of babe
in week 3 of gestation what is developing
CNS, brain, spinal cord, heart
when does the fetus’ face begin to look human?
13th week
When is C-shaped tail formed, face, upper respiratory and when does the neural tube close? (what is vital for this neural tube to close?
4th week gestation, FOLIC ACID very important to NTD
when in utero does the heart beat @ reg rythym and paddel shaped limbs form?
5th week
when does the face fully dev in utero?
6th week
at what time is the fetus at or about the symphis pubis? (pubic bone)
12 weeks
T/F In pregnancy the blood volume increases 40-50%
TRUE
BP 1st trimester: stays same
BP 2nd Trimester: decreases
BP 3rd trimester: Goes back to normal
Pregnant moms are hypercoaguable and have increased leukocytes, this puts momma at risk for?
DVT!
N&V aka Morning sickness is very common @ 6-12 weeks due to what?
increased HCG levels
Progesterone (progestin) levels
supports endometreal lining, keeps baby inside
Levels increase during pregnancy and decrease in labor
Healthy people 2000, 2010, 2020 etc. lol
Increase proportion of pregnant women who receive early prenatal care
Neagels Rule
last period, subtract 3 months, add 7 days
ex. my last period was Jan 29th, subtract 3 months = October, add 7 days = NOVEMBER 5th
- Anonymus
GTPAL?
G- Gravida (# of times pregnant)
T- Babies carried 38+ weeks (TERM)
P- Preterm (20-37 and 6/7 weeks)
A- Abortions (any baby lost miscarried aborted etc) before 20 weeks
L- Living kids
In most hospitals we just use G/P
Gravida = Pregnancies
P- number or preg that ended at 20+ weeks (para)
AFP or quad screening
not a diagnostic test! they all SCREEN for NTD and genetics, follow with an amniocentesis
Chronic Villus sampling (CVS)
after 10 weeks , genetic counseling (ex. 42 year old pregnant girl), never do before 10 weeks can cause limb defects in unborn fetus
Non-stress test (NST) is to see if baby can react under non-stress we put 2 monitors on momma to monitor HR what do we want?
we want it to be reactive!!! so if baby is moving their HR increases this means the CNS of babe is intact
Biophysical profile what are levels
8-10 good! 4-7 BAD <4 Horrible outcome
(same as APGAR)
Normal Hematological dilution w/ pregnancy
H&H decreases
Rubella (Measels) if mom gets the vaccine after she delivers?
tell her wait 1 month to get pregnant again (KEEP EM CLOSED OR USE PROTECTION)
-Anonymus
A couple things to tell mom to aviod when pregnant
no douching (Ew) no skiing (DUH) they can excersice light no body building
Urinary Freq.
Comes @ beginning and end of preg!
lower abdominal pain accompanied by shoulder pain may be indicative of what?
ECTOPIC PREGNANCY :(
Pain in calf can be indicative of what?
DVT
Preeclampsia may occur in 3rd trimester what are some s/s
sudden weight gain, periorbital or facial edema
4 stages of labor
1st stage- 3 parts (onset of labor till fully (10 cm) dilated
- LATENT phase 0-3 sonometers dilated (calm mood)
- Active: 4-7 cm dilated
- TRANSITION 8-10 cm dilated (they dont think here) WATCH OUT
2nd stage- 10 cm dilated to birth of baby (Actively pushin)
3rd stage- after birth of baby———>delivery of placenta
4th stage- from delivery of placenta till 1-4 hrs after (post partum)
the four p’s for how the baby gets thru
passage (pelvis)
passenger (Baby)
Powers (Contractions=Primary) Secondary=Pushing)
Psyche (attitude)
Most common positions of baby (also most preferred)
LOA and ROA, (when baby is born, head is down)
most favorable pelvis shape and best outcome for baby if mom has?
Gynecoid (true pelvis) perfect for fitting baby thru, its wide and round
if the head comes out first this is called what?
If the butt comes out first this is what?
another way the baby can come out?
head out 1st (best) VERTEX
butt out first (Breech)
also shoulder presentation when shoulder comes 1st
we want the baby to be vertical (Longitudinal lie)
Engaged means?
the widest part of the baby’s head is at 0 station (at the isheal spine) now the baby is ready to deliver
True labor means
contractions are longer, stronger, and closer together
FALSE labor= irregular
we can not (not the guys just us girls) push till when
10 cm or 0 station
importance of contractions
- Freq (from the beginning of 1 to the next one)
- Duration (ho long)
- Intensity
Labor relationships to estrogen and progesterone
increased ratio of estrogen to progesterone, increased cortisol also
when do you take a BP in labor?
in between contractions, and have mom on her side
what is the cut off temp for fever or infection and when do we have to intervene
>100.4!
Leopolds maneuver
checking position of baby
the 3 tests that determine if moms water broke
pooling
Ferning
Nitrazine paper- fluid will turn blue if water ruptured or be clear if it didnt
fetal HR (in utero) should be?
110-160
Pain Control (Pharmacological) during labor
Analgesia: Morphine, Nubane, Stadol, Fentanyl-
**causes resp. depression in newborn when born**** make sure to have recessitation in room, o2, ambu bag, etc.
When to give an epidural? where? and some special considerations
like a spinal goes into epidural space usually injected in L3 L4, give it in active labor (4-7 sonometers) *****ACTIVE LABOR***** or maybe before. It can prolong the labor, or make baby not come down right. BEFORE epidural we have to make sure that mom is hydrated b/s S/E is HYPOTENSION! Give at lease 1000 mL or 1 L fluid.If you have this, the baby will have
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C-section, what type of meds are given?
usually a spinal as first line but in an emergency, General Anesthesia is given
when is internal electric fetal monitoring done?
scalp lead and IUPC (membranes must be ruptured so water has to be broken 1st) Needed because of decelerations, when we don’t know whats going on with baby
3 responses that make BP of baby go down
Umbilical cord compression(Variable Deceleration) Head compression(Early Deceleration) Placental insufficiency(LATE deceleration) WORST\*
NSG interventions for Non-reassuring Fetal Heart tones
P-Maternal position change****
O-O²*** 10 L of 02 per mask
I-IV fluids***
S-Sterile Vaginal Exam*** see how much dilation
O-D/C Oxytocin if running***
N-Notify Provider, prepare for possible emergency delivery****
Reassure/support patient and family
POISON
What is the best position to facilitate the 2nd stage of labor?
Squatting!
What to teach pt about breathing techniques?
Open Glottis Pushing
When clearing mucus what order do you use?
Clear mucus from mouth, then nose!
Episiotomy is done when and why
To enlarge vaginal opening is the *only reason and not unless an emergency****
IT IS A 2nd DEGREE LACERATION THAT GOES THRU MUSCLE!*****
What medication would you administer to a baby with respiratory depression if you suspect maternal drug use or the mom was given a narcotic very close to the time of delivery?
Narcan
Concerning the placenta what are the types
DIRTY DUNCAN= MATERNAL,
Shiny Shultz- fetal (baby)*
A 4th degree Perineal laceration contains what
Vaginal mucosa, posterior fourchette and perineal skin, perineal muscles, anal sphincter, RECTAL WALL!
*** 1st deg= The first 3
2nd deg= The first 3 + perineal muscle
3rd deg=The first 4 +anal sphincter
The first bleeding that moms have will be what
Lochia Rubra (RED)
Pharmacologial pain management post partum
Ibuprofen works really well or Motrin
What causes a fundus to be deviated to the right or left of the midline?
A Full Bladder;
Encourage them to void often, check to see that she empties bladder often
Rubin’s 3 Post-partum phases
- Taking in (Dependent)
- Taking hold (Both dep/indep)
- Letting go (Independent)
Ductus venosus
oxygenated blood enters through umbilical vein. 1/3 of blood is directed away from liver to inferior vena cava.
Foramen ovale
between R and L atria. 50-60 % goes to left atria, the rest goes to right atria, flow to lungs is restricted by the narrow pulomary artery and pulmonary blood vessels, causing a high pressure in R side of
Ductus arteriosus
connects pulmonary artery and the descending aorta during fetal life. perfusion only.
Fetal Lungs
Contain no air, O2 is delievered through placenta - umbilical vein to ductus venosus.
alveoli secrete fluid to keep them partically open, before delivery start to close so when they take 1st brath dont take much fluid in.
newborn GI
Immature shincter, thats why they spit up a lot.
1st stool - dark and tarry, 2nd stool - green-brown, loose.
Breast milk stool- seedy, mustard type, can stool up to 10x/day = natural laxative
formula stool- yellow-brown, only go 1-2 x/day.
babies stomach only the size of a walnut, commonly are overfed.
newborn urinary system
most newborns void immediatley after birth, indicationg adeqaute renal function.
Full kindey function doesnt happen until 3-4 months.
6-10 wet diapers a day.
newborn immune system
Immature WBC- trabel slow.
Look out for cahnges in activity, color, tone and/or feelings. wont generally see a fever like in adults.
IgG- cross placenta
IgM - after babys born-exposed to environment
IgA- found in colstrum (breast feeding)
thermoregulation
important to keep babies warm, have think skin and little sub-q fat.
Dry babies off completely, warm stethoscope beforing touching the baby, keep a hat on them, they loose heat through head.
Do not over heat the baby either, dangerous as well.
Newborn hepatic system
BS should not be less then 40.
Bilirubin- too much can be toxic to the baby.
Iron is stored in liver/spleen. have enough if breat feed for 3-6 months, supp if not.
Two types of jaundice:
patho- happens within 1st 24 hrs.
physiological- happens after 1st 24 hrs
to test: push finger on skin, when life, if yellow means jaundice.
Newborn hematologic system
Risk for clotting deficiency due to having a Vit K deficiency, they can not produce Vit K until about a week after birth, they get an IM of it at birth.
Range for normal
120-160
take apical
can be higher if baby crying.
range for normal respirations
30-60
periods of apnea
Range for normal temp
36.5-37.3 C or 97.7-99.1 F
NO rectal temps ! only axillary !
range for normal weight
2500-3999 grams or 5#8oz - 8#13oz)
Small for gestational age (SGA)
infants that are below the 10th percentile in size on growth chart.
Problems: perinatal asphyzia (unable to tolerate stress of labor), hypo/hyperthermia, polycythemia, meconium aspiration
Appearance: head disproportionally large, thin skin, wasted appearance of extermities, thin cord, decreased sub-q fat and breat tissue.
Large for gestational age (LGA)
Infants who are about the 90% on intrauterine growth charts.
Problems: bith trauma, hypoglycemia, polycythemia, jaundice secondary to hyperbilirubinemia
risk factors: maternal diabetes, genetics, mutiparity, hx of macrosomic infant, post date gestation, maternal obesity, male fetus
Stork bites
reddish pink areas on eyelids of around neck, that blanch when pressed on, go away by 2 years.
Vernix Caseosa- thick white substance that provides a protective covering for baby in utero, sometimes born with some still on them, more term thy are , the less there is.
Lanugo
fine har that covers fetus intrauterine, some are born with it still on them, found on shoulders, forehead, sides of face, upper back,
Vernix Caseosa
thick white substance that provides a protective covering for baby in utero, sometimes born with some still on them, more term thy are , the less there is.
Mongolian spots
bluish-black marks that look like bruises - found on darker skin tones around sacral areas, sometimes found on shoulders, arms and buttocks.
Document these at birth so they arent mistake as bruises.
Erythema toxicum
newborn rash- common- goes away.
Milia
White cysts, 1-2 mm in size, they disappear without treatment.
Occur on face over forhead, nose, cheeks, and chin
Harlequin sign
half pale. half red- usually fixes it self
Nevux flammeus/vasculosus
Flammeus (port-wine stain) permanent, flat, pink to dark reddish-purple mark that varies in size.
Vasculosus (strawberry hemangioma) enlarged capillaries in the outer layers of the skin. dark red and rasied with a rough surface. can get larger for 5-6 months but usually goes away by early school years.
Molding is important why?
to help the babys head get into a shape that it can move through the birth canal.
babies head should move bakc into shape.
The soft spot should close after how long?
14-18 months, allows for brain to develop
Caput succedaneum
often appears over vertex of newborns head as a result fo pressure againts mothers cervix.
the edematous area crosses suture lines, is soft, and varies in size.
resolves quickly and generally disappears within 12-48 hrs after birth.
Cephal hematoma
Bleeding between the periosteum and the skull, as the result of pressure during birth.
occurs on one or both sides of head over parietal bones or sometimes occipital bone. swelling may not present at birth but may develop within first 24-48 hours.
does not cross sutures lines.
preterm labor (PTL) risk factors
maternal medical conditions, present and past OB conditions, fetal conditions, social and enviornmental factors,
Diabetes, drugs, lupus, infections, STDS, can cause an unsuccessful pregnancy
pre-term characteristics
birth weight chest, poor tone, minimal sub-q fat, undescended testes, lots of lanugo, soft ear pinna, fused eyelids, spongy skull bones, absent to few sole and palm creases, minimal rugae or prominent labia and clitoris, think skin, visible veins, lots of vernix
problems with premature babies
problems with: respirations, thermoregulation, fluid and electrolyte balance, infections, and pain.
they should be be prone, laying on side to decrease secretions.
Post-term problems
if placenta function decreased, the amniotic sluid will decrease, could lead to a compressed umbilical cord.
If not getting enough 02 and nutrients the baby can become hypoxic or malnurished.
Fetus may pass meconium which is bad if the baby aspirates it.
Post-term characteristics
dry, cracked wrinkled skin, long thin extermities, creases cover entire soles of feet, wide-eyed, alert expression, abundant hair on scalp, thin umbilical cord, limited vernix and lanugo, meconium stained skin, long nails
Transient-tachypnea of the newborn (TTN)
liquid in lungs removed slowly or incompletely, will see grunting, nasal flaring, tachypnea and retractions, usually resolves in 24-48 hours.
Seen commonly in c-section babies, sent to nicu.
Treatment: supportive, NPO, 02, neutral thermal environment, assessment.
Meconium aspiration
happens when the baby has its first bowel movement when he has not delivered yet, and then the baby aspirates some of it.
10-15% of babies have meconium before delievery of those 5% get meconium aspiration
Usually happens to hypoxic babies that dont handle labor well.
Get put on ECMO (
hyperbilirubinemia: Pathological jaundice
Happens with first 24 hours, starts in face,moves down.
Put them by light (phototherapy), breast feed to help excrete through urine and stool.
Can result in kernicterus = staining of brain - learning disabilites, mental disorders, could cause death.
Usually happens with RH incompatibility or ABO incompatibilty.
Zygote
The developing baby from conception through the first week of prenatal life.
Increases in size as it travels towards the uterus
Fertilization and conception
Usually takes place in the ampulla (outer most 1/3 of the fallopian tube). sperm enters the egg (conception)
The union of the sperm and egg (fertilization)
Blastocyte has two parts..
trophoblast - placenta and membranes
embryoblast - embryo
pre-embryonic stage of development
conception through week 2.
Around the 4th day after conception, the fertilized ovum, now called a zygote, enters the uterus.
In this stage teratogens either kill the baby or nothing happens.
Embryonic stage of development
day 1 of week 3 thru last day of week 8.
Basic structures of all major organs are completed during this time.
In this stage teratogens exert the greatest affect on fetal development.
Fetal stage of development
week 9 through delivery
Dramatic growth and refinement occur during this stage. Teratogens may damage already formed structures but less likely to cause major stuctural alterations.
Amniotic fluid (AF)
about 450-750 ml @ 40 wks
it should be transparent and odorless.
Functions: temp regulation, cushion againts trauma, allows for movement and development.
baby will swallow fluid and then void it back into the fluid, some most of the end AF is urine.
low fluid could mean kidney issues for baby.
Fetal veins do what..
pick up 02 and nutrients and give them to baby.
fetal arteries do what..
retuen waste and carbon dioxide, whic is diffused, transported to maternal veins.
Metabolic placental function
Synthesizes substances needed by fetus and placenta
Transfer functions of placenta
Gas exchange, nutrient transfer, waste removal, antibody transfer, hormone transfer.
IGg- can cross placenta
Endocrine placental functions
produce 5 hormones:
hcG - early on in preg can test blood/or urine to see if its a viable preg. If it goes down during preg then could be miscarrying.
HPL, estrogen, progestrone - relazes smooth muscles, and relaxin.
placenta perfusion
blood in the intervillous space is changed about 3-4 times per min, requiring circulation of 450-750 ml/min
maternal vasoconstriction causes
hypertension
maternal vasodilation causes
hypotension
s/s of decreased CO
decreased HR
Surfactant
is produced around 24-34 weeks, most is produced by 33 weeks.
diabetics have slow production of it.
hyperinsulinemia babies will have decreased surfactant production
Fetal Cardio
by 5th wk
Viability
That ability of the fetus to survive outside the uterus
MI state law says 20 wks
clinically its 24 wks
presumtive signs of pregnancy
amenorrhea
fatigue
N/V
urinary frequency
skin changes
breast changes(color, size, tenderness)
vaginal and cerivcal color changes(chadwicks sign-darkish purple color)
fetal movement (quickening)
probable signs of pregnancy
abd enlargement
cervical softening (Goodell’s sign)
thining of uterine lining (hegar’s sign)
ballottement - can palpate on uterus and fetus will rise and fall and doc will feel this
braxton hicks contractions
palpation of fetal outline
uterine souffle- sound that can be heard that is made from the exchange of fluids from mom to baby
positive pregnancy test
positive signs of pregnancy
Fetal
fetal movement felt by examiner
ultrasound verification of fetus
Fundal height
less than 12 wks - in pelvis
12 wks = at symphsis pubis
20 wks - at umbilicus
36 wks - at zyphoid
Cardio changes in pregnancy
Total volume- increase overall, plasma increased about 1000, RBCs increase about 500, hgb does down.
Cardiac output is increase 50-60%
progestrone increase- relaxes smooth muscles so the BP does not go up
can get supine hypotension due to presure on vena cava when lying flat.
hemodilution (physiological anemia pregnancy)
result of there being more plasma in the mom then there is RBCs.
Normal about or RBCs they are just diluted by the plasma
Dick-read childbirth education method
His theory was that fear of childbith results in tension and pain. To prevent the fear-tension-pain cycle, he developed a method of slow breathing in early labor and rapid chest breathing in advanced labor.
Bradley childbirth education method
First to include father as a support person. Abd breathing to increase relaxation and breath control is taught in classes that last baout 12 wks. emphasizes avoidance of all medication and other interventions.
Lamaze childbirth education method
Involves concentration and conditiong to help the woman respond to contractions with relaxation and various techniques to decrease pain.
Nagele’s rule
take the 1st day of LMP minus 3 months and add 7 days.. that gives you and estimated due date
comprehensive hx done on inital visit to OB/GYN
current pregnancy -LMP, EDD
OB/GYN hx - GTPAL
medical hx
surgical hx
nutritional status
review of systems
tertogen exposure
psychosocial hx
hx of abuse
medications (OTC & Rx)
allergies
family hx
Overal risk assess- risk for complications
inital visit PE
VS
Heat to toe
Additional OB assess
-funfal height
-fetal
-speculum exam-cervix
-bimanual exam: ovaries size and shape, uterine size, contour, tenderness, and position.
-pelvic exam: pelvic measurements/adequacy
inital lab tests done on preggers
CBC, blood type and RH, antibody screen, rubella titer, TB skin test, HIV, HBSag, U/A & C&S, pap, GC/chlamydia, RPR/VDRL, triple/quad screen (MSAFP), GCT (glucola) - not always done, Ultrasound (not always done), GBS (not always done)
follow up visits done when?
monthly until 28 wks; q 2 wks 28-36 & q wk 36 wks to delivery.
CVS ( chorionic villus sampling)
done at 10-12 wks for genetic testing.
nonstress test (NST)
the mother is asked to void, and VS are take, she lies down with head slightly elevated and on her side to avoid supine hypotension.
reactive (reassuring) - the babies HR goes up at least 15 bpm for at least 15 secs after fetal movement or w/o FM
nonreactive (non reassuring)
Contraction stress test
done if a NST findings are non reactive.
Records the FHR in response to uterine contractions
negative (reassuring) - no late decelerations (decreases in the FHR persisting after the contractions ends) although the fetus was stressed by 3 contractions of at least 40 secs
positive (abnormal) - late decelerations accompanying at least 50% of contractions even when fewer than 3 contractions occur in 10 min.
healthy people 2010 prenatal care goals..
at least 90% of US women to begin antepartum care in 1st trimester.
Stages of labor
1st- onsent of labor to complete dilation and effacement
2nd- complete dilation to delivery of baby
3rd- delivery of baby to the delivery of placenta
4th - 1st 4 hours after delivery of placenta
3 phases of 1st stage of labor
LATENT - 1 - 3 cm
ACTIVE - 4 - 7 cm
TRANSITION - 8 - 10 cm
Fetal station
measurement of the fetal head to maternal ischial spines
At ischial spine = 0
above ischial spinea = negative numbers (-1, -2, -3, -4, -5)
below ischial spine = positive numbers (+1, +2, +3, +4, +5)
Depo-provera side effects
amenorrhea, weight gain, headaches,depression, hair loss, nervousness, decreased libido, breat discomfort, and spotting.
oral contraceptive side effects
breakthrough bleeding, weight gain or loss, fluid retention, amenorrhea, melasma.
risk for developing DVTs is higher when taking these especially in women who are smokers and/or over the age 35
Rubin’s stages
- Taking-in = 1 -2 days, this stage is all about the mom, she is mainly concerned about herself
- Taking-hold = this is the best time to teach the mom
- letting- go = this is when moms expectations are let go and she accepts reality. wanted a girl but got a boy
when is RhoGAM given and why?
If the mom is RH- and baby is RH+ she needs rhogam.
usually given around 20-28 wks gestation.
will be given if any trauma happends during preg.
given 72 hours after birth to help with next pregnancy
Hormones after delievery
estrogen, progestrin, relaxin go down right away
hcg hangs aruond for a while.
oxytocin is responsible for let down reflex, when baby sucks- the milk comes down
GI after delivery
motility is decreased may take a while to get back ti normal.
may not have a BM for a few days, resist urge to defecate, constipation common. Don’t force down. use stool softeners.
Hungry and thirsty after labor, small portions are best.
Urinary system after delivery
Kidneys return to normal after 2 -3 months
urinary output 3000 ml/day
make sure they are voiding after delivery and have the urge to go.
overdistention of bladder can cause UTI or hemorrhage, bladder causes uterus to rise, which releases pressure, causing hemorrhage.
VS post partum
temp can increase 24hrs r/t dehydration
pulse will decrease.. watch for tachycardia.. shouldnt have this
resp - normal within 6-8 wks
BP- small tranisent rise for 4 days because of the high volume
risk for DVTs
promote getting up asap, check homans sign
