Obstetrics Flashcards
Common danger signs of pregnancy
Bleeding/leaking fluid
Decrease in baby’s movement
Blurry/impaired vision
Dizziness, fever, pain
Unusual/severe abdomen or back
Induced abortion
Occurs after 20 weeks when dilation and evacuation can no longer be performed, initiated by medications
3 specific nursing responsibilities for a woman with suspected ruptured ectopic pregnancy
Blood typing/cross matching
IV access
Detailed informed consent
Recommended folic acid dose in pregnancy
800 mcg per day. Taken 4 weeks prior to conception until 12th week of pregnancy
What is the use for folic acid?
Helps form the neural tube, preventing neural tube defects (Spina bifida and anencephaly)
Pre-eclampsia
High blood pressure and protein in the urine during pregnancy. Occurs in 3rd trimester. Can progress to eclampsia which is life threatening (seizures & coma)
Gestational diabetes
Body can’t produce enough insulin during pregnancy and the placenta makes hormones that lead to a build up of glucose in the blood.
Maternal risks of gestational diabetes
Increase chance of miscarriage, pre-eclampsia, developing type 2 diabetes post-partum, pre term birth, c-section
Foetus risks of gestational diabetes
High birth weight, low bsl at birth, jaundice, temporary breathing problems
Abruptio placentae
Placenta separates from the uterus wall prior to delivery after 20 weeks gestation. This leads to trauma, hypertension and blood loss
Placenta previa
Cervical dilation causes the placenta and cervix to be pulled apart, causing bleeding and baby not being able to be delivered vaginally
DVT in pregnancy
When the uterus grows and puts pressure on the blood vessels restricting blood flow from legs and pelvis = slower blood flow = DVT
Reasons for an emergency caesarean
Abnormal presentation, failure to progress, fetal distress, cord prolapse, uterine rupture, placental problems, failed induction, failed instrumental delivery, twins/triplets/baby too big
2 main reasons for postpartum hemorrhage
Uterine atony (no contraction of uterus)
Not all of placenta being delivered
Postpartum blues onset
In the first days after birth for several days or weeks
Postpartum depression onset
Onset usually in 4th week postpartum
Low birth weight risks
Early growth retardation, infectious disease, developmental delay, death during infancy and childhood
6 week immunisations
Rotarix (oral)
Infanrix hexa
Synflorix
3 months immunisations
Rotarix (oral)
Infanrix hexa
5 months immunisations
Infanrix hexa
Synflorix
12 months immunisations
Priorix
Synflorix
15 months immunisations
Hiberix
Priorix
Varivax
4 years immunisations
Infanrix IPV
11 and 12 years immunisations
Boostrix
Gardasil 9 (2 doses 6 months apart)
2 natural methods of contraception
Basal body temperature
Cervical mucus charting
Barrier methods of contraception
Condoms, Diaphragm/Cap, IUD
Mod of action of an IUD
Small plastic device that is placed in the uterus to prevent fertilisation of the egg. The copper or hormone stops sperm moving through the uterus towards the egg.
Copper IUD
99 percent effective in preventing pregnancy. No hormonal side effects
Mirena IUD
99.5 percent effective in preventing pregnancy. Uses progestogen. Women will have lighter periods
Best time to insert an IUD
During or just after a menstrual period, 6 weeks after your baby is born, immediately after an abortion
Risks of IUD
1% chance of infection after first being inserted.
Small risk of damage or perforation of the womb (roughly 1 in 1000).
Rare chance of pregnancy with an IUD in place.
Ectopic pregnancy.
Copper IUD may cause more bleeding and cramping during periods. Can also cause an allergic reaction in some people.
Mirena may initially cause irregular, light bleeding for more days than usual.
Roughly 5% chance of IUD coming out itself.
Hormonal methods of contraception
Combined oral contraceptive pill
Progesterone only pill
Depo provera
ECP
Combined oral contraceptive pill action
Preventing an egg being produced (ovulation)
thickening the cervical mucus (which stops sperm getting through)
altering the lining of the uterus so that if an egg does get fertilised it is less likely to implant and grow.
2 types of combined oral contraceptive pill
Monophasic - contains equal doses of oestrogen and progestogen
Triphasic - contains differing levels of oestrogen and progestogen, which mimics a normal menstrual cycle.
Progesterone only pill action
Thickens mucus layer in cervix to stop sperm from entering uterus and fallopian tubes. Is effective 48 hours after taking. Some can also prevent ovulation.
Reason why women would take progesterone only pill
Can’t tolerate oestrogen, have a history of blood clots, suffer from migraines, other medical conditions, breastfeeding
Important client education if taking progesterone only pill
Must be taken within 3 hours instead of 12 hours (combined pill is 12)
ECP action
Delays release of an egg from your ovary until sperm are no longer active, changes the lining of your uterus so a fertilised egg cannot implant and develop.
Success rate of ECP
95% of expected pregnancies when taken within 24 hours of sex, 85% if taken within 25-48 hours
58% if taken within 49-72 hours
Depo provera action
Contains progesterone - prevents pregnancy by stopping the ovaries releasing an egg each month. There are also changes to the lining of the womb (endometrium). Administered every 12 weeks
Why is a folic acid pill more beneficial than gaining it from leafy greens?
It is more readily absorbed and used in the body (bio-available) and stable than naturally occurring food folate
3 positive signs of pregnancy
foetal heartbeat, foetal movements, visualisation via ultrasound
Signs and symptoms of pregnancy
Amenorrhea, nausea/vomiting, breast changes, fatigue, urinary frequency
Hormone that indicates positive pregnancy test
HCG
Role of Vitamin D in pregnancy
Reduce risk of Vitamin D deficiency in baby.
Lack of Vitamin D in pregnancy can cause
Rickets and bone development issues in baby
Role of Iodine in pregnancy
Helps the body grow and develop, especially the brain
Recommended Iodine dose while pregnant
Take 150mcg iodine-only tablet every day while pregnant and breastfeeding
Name 4 teratogens
Alcohol, Tobacco, NSAIDs, Rubella
What is a teratogen?
An agent that causes an abnormality following fetal exposure during pregnancy
Common discomforts in 1st trimester of pregnancy
Morning sickness, bleeding gums, urinary frequency, nasal stuffiness and epistaxis
Common discomforts in 2nd trimester of pregnancy
Heartburn, constipation, haemorrhoids, faintness/dizziness
Common discomforts in 3rd trimester of pregnancy
Oedema, shortness of breath, varicose veins/phlebitis, backache
Multigravida
Woman who is pregnant for at least the second time
Signs of labour
Contractions, tablespoon of blood or brown sticky mucus, water breaks
First stage of labour
Contractions, mucus, water breaks, cervix dilates to 10cm
Second stage of labour
The neck of the womb is fully open and the baby is born. Can take 1-2 hours to push out first baby
Third stage of labour
More contractions as the whenua/placenta comes away from the wall of your uterus and out your vagina
Points to consider when assisting with emergency delivery
APGAR score, warm baby after birth, clamp umbilical cord, check placenta has been expelled, assess for excessive bleeding and perineal tear, massage uterus if no tear visible, encourage breast feeding
APGAR
Appearance, pulse, grimace, activity, respirations. Performed 1 min and 5 min after birth. Should score 10
Newborn screening tests
Weight, congenital dislocation of hips, guthrie’s test (48hr), hearing test (1 month)
Neonatal jaundice
Liver is not mature enough to remove bilirubin from the blood
How is neonatal jaundice treated
Phototherapy
Low birth weight groups
Pre-term - born before 37 weeks
Small on time - below tenth percentile for gestational age
What is colostrum?
Very first milk produced by breast
Benefits of colostrum
Rich in antibodies, high in protein, vitamins and minerals
4 signs to know baby is receiving enough milk
Latches off alone, breast feels softer as baby empties milk, begins to gain weight after initial weight loss, wet nappies 6-8 times a day
Complementary feeding
Introduction of solid foods once breast milk no longer meets sufficient nutritional value for infant
Exclusive breastfeeding
Usually up to 6 months, only received breast milk and prescribed medication
Does breastfeeding count as contraception?
No. However, it does delay return of period
6 educational factors for mothers using formula
Instructions for amount, sterilise equipment, warm formula by placing in bowl of warm water, check ingredients, check seal is not broken, don’t take anywhere that bacteria may grow
Positives of breastfeeing
Maternal immunity, bonding, easily digestible for baby, assists mothers body to return to normal, convenient, safe, may lower risk of SIDS
SIDS
Sudden Infant Death Syndrome
Risks associated with incomplete abortion
Anaemia, septicaemia, increased risk of infection, excessive PV loss
When does rupture of an ectopic pregnancy usually occur?
5-8 weeks
Why is ectopic pregnancy potentially life threatening?
Can cause internal bleeding if ruptures
Eclampsia
Progression of pre-eclampsia, seizures and coma potentially occur
Hypertension in pregnancy
SBP 140, rise of 30 or more from baseline. DBP greater or equal to 90, rise of 15
Signs and symptoms of pre-eclampsia
Proteinuria greater than or equal to 3g/L in 24hr urine collection, 1kg oedema, headache, visual disturbances, oliguria, convulsions, RUQ pain
RUQ
Right upper quadrant
At risk groups for developing gestational diabetes
Overweight prior to pregnancy, normally high blood sugar, maternal age over 25-30, family history, previous history
Life-threatening child birth emergencies
Breach presentation, cord presentation and prolapse, eclampsia, trauma, rupture of uterus
What is lochia?
Vaginal discharge during post-partum period
What does lochia look like?
Bright red and blood in first few days, will become like discharge after 2-4 days, small amount of white or yellow after 10 days
How long does lochia last?
Usually 4-6 weeks
Braxton-hicks contractions
Intermittent, weak contractions of the uterus occurring during pregnancy
How early can Braxton-hicks occur?
Second trimester
What is mastitis?
Inflammation of the breast that may or may not be infective
What causes mastitis?
A blocked milk duct or bacteria entering the breast via cracked nipple
Advice points for mastitis
Continue to breastfeed, wash hands pre and post, position infant correctly, change nipple pads when wet, feed from tender breast
Why is it important to feed from tender breast?
To encourage movement of milk
Breastfeeding premature baby
Baby cannot suck on nipple, must express milk via NG tube
Why can’t a premature baby suck nipple?
Babies do not have co-ordinated sucking reflex until 34 weeks
Full term neonates blood volume
85 mL/kg
Premature neonates blood volume
95 mL/kg
Hyperemesis gravidarum
Excessive vomiting during pregnancy
What percentage of pregnant women does hyperemesis gravidarum occur in?
0.3% to 2%
What are the risks of hyperemesis gravidarum?
Dehydration, electrolyte imbalance
Nursing management of hyperemsis gravidarum in outpatient setting
Antiemetics, IV therapy, hospitalisation if not resolving
Nursing considerations of hyperemsis gravidarum in hospital setting
Relaxed, quiet environment away from food odours and strong smells, encourage oral hygiene, monitor weight, emotional support
Bleeding in pregnancy
Approx 1/4 pregnancies have some bleeding in first trimester
Non-emergent bleeding during pregnancy
Sex, implantation bleeding, infection, hormones
More serious bleeding during pregnancy
Ectopic pregnancy, miscarriage, anembryonic gestation, molar pregnancy
Diagnostic testing for pregnancy
Urine pregnancy test, transvaginal ultrasound, blood type with Rh factor, haemoglobin, blood B-hCG levels
