Postpartum And Newborn Flashcards
Sub involution
definition
cause
treatment
When the process of uterine contractions does not take place as it should and it’s either prolonged or stops
Retained placental fragments, myomata, infection
Ergotrate or Methergine by mouth for two weeks then reevaluate in two weeks
Endometritis
definition
symptoms
Postpartum inflammation of the endometrium
Fever to 104, tachycardia, chills, uterine tenderness extending laterally, pelvic pain with bimanual exam, subinvolution, scanty odorless lochia or malodorous seropurulent lochia, variable onset depending on the organism, GBS presents earlier with increased white blood count
Kernicterus
Definition
signs and symptoms
A form of brain damage caused by excessive jaundice
Bilirubin is so high that it moves out of the blood and into the brain tissue
Excessive lethargy, high-pitched cry, decreased muscle tone with periods of increased tone, arching of head and back backwards, jaundiced in extremities, fever
Additional therapy for thrombophlebitis that the midwife can provide
Maintaining strict bedrest, monitoring pedal pulses, applying moist heat to affected area
Women are predisposed to UTIs postpartum because of:
Trauma to the trigone of the bladder
Compared with mature breastmilk colostrum contains less:
Fat and carbohydrates
Breast milk is produced in the:
Alveoli
What birthweight is the established norm for a diagnosis of a large gestational age baby
4000 grams
Between 8 lbs. 13 oz. and 8 lbs. 14 oz.
What would be the most helpful in confirming clinical suspicion of IU GR
To ultrasound measurements of abdominal circumference at least four weeks apart
Failure of tissue perfusion caused by changes in the circulation that occur as a result a severe infection is called:
Septic shock
Postpartum psychosis
Manic or depressive episodes of confusion or disorientation, delusional thinking, suicidal or infanticidal behaviors
Mothers with history of bipolar disorder have increased risk
Postpartum blues
70% of women, begins 2 to 3 days postpartum, associated with hormonal swings, sleep deprivation, impending lactation
Homan’s sign
Have the mother sit in bed with her legs straight, then gently press on her knee and dorsiflex her foot. She has pain in her calf the test is positive for thrombophlebitis
2–0 chromic suture
External anal sphincter, cervical lacerations, lateral vaginal wall, and deep interrupted stitches of pelvic muscles
Muscle requires a stronger suture
Hematoma
primary concern
treatment
Pooled blood readily permits the growth of bacteria, primary danger is infection
This could lead to breakdown of the repair, because surfaces will not adhere and close properly once sepsis develops
Immediately Refer to the physician, as antibiotic therapy should begin ASAP
Hematoma
definition
cause
And asymmetrical and painful swelling in the perineal area
Caused by soft tissue trauma and second stage and a faulty repair job, where bleeding vessels continue to seep below the skin. The blood takes time to reabsorb
How much water should a nursing mother drink daily ( to meet her own needs and produce sufficient breast milk)
3 quarts
What time should the midwife refer to the pediatrician if the newborn has not had a bowel movement?
48 hours
What is a normal temperature increase when the new mothers milk comes in?
101°
Circumoral cyanosis refers to:
Bluish discoloration around the mouth
can indicate heart problems
The newborns head is__the size of the body
1/4
Acrocyanosis in the newborn
Usually temporary with rubbing of foot/hand, should pink up
Beefy redness color in newborn
Normal for the first 24 hours
if prolonged polycythemia
Harlequin color
Half body pink, half red or paler, normal variation
Stork bites
Smooth flat red marks on base of neck, eyelids, bridge of nose
Fades by two years
Erythema toxicum
Read spotty rash, fades naturally
Transient mottling of skin in newborn
Temperature, should not persist
Anterior fontanelle size and shape
Diamond shape, peripheral pulses, 2 1/2 to 4 cm length
Posterior fontanelle
size and shape
1/2to 1 cm
triangle
Fontanelles
depressed
bulging
Depressed =dehydration
Bulging equals increased intracranial pressure or meningitis urgent
Epstein’s pearls
definition
Small white cysts along the hard palate
Normal
Will resolve with sucking
Newborn lungs
Common variations
Momentary apneic spells, should not last longer than 15 seconds
Rales and rhonchi shortly after birth
Rate up to 80 within the first half an hour
Transient tachypnea of newborn
Very rapid respiration rate 80 to 120 usually during first 24 hours
Use o2, BF
If not resolved and baby unable to eat in reasonable amount out of time, TP
What percent of newborn heart murmurs are normal?
90%
Hypospadias
Urethral opening on the lower side of penis
corrective surgery at three months
Newborn femoral pulses
Right above hip crease
Check both at once. Should be strong and equal
Weak could be a congenital heart defect
If uneven contact pediatrician, coarctation of the aorta
Tonic neck reflex
Turn babies head to one side, extremities on same side straighten and on opposite side flex
Fencing position
Babinski reflex
Stroking foot upward, toes hyperextend
Lanugo in the newborn
term
preterm
postterm
Term: thinning over lower back
Preterm: covered over body no lanugo thinning with some parts still covered
Postterm: half back devoid of lanugo
Esophageal atresia
Definition
symptoms
Serious birthday defect in which the esophagus is segmented and closed off at any point
Usually occurs with TEF, unlikely to survive without surgery
Signs and symptoms; excessive drooling, and immediately regurgitate after eating, choking, coughing, aspirations, pneumonia
Which assessment finding indicates that phototherapy has been effective for the neonate
Elimination of green urine and greenish loose stools
What umbilical cord stump finding is considered normal at three days postpartum
Dryness and atrophy at the stump
Which muscle would not be cut in the midline episiotomy
Pubococcygeus
What is the main significance of lobulated and succenturiate placentas?
Placenta lobes may be retained and not expelled with the rest of the placenta
What is the last step of manual removal of the placenta
Administration of oxytocin
A sulcus is which of the following types of laceration?
Second-degree
Which hormone stimulates and maintains milk production after childbirth?
Prolactin
Shock patients are often thirsty
true or false
True
After shoulder dystocia, once the baby is out you should be prepared for
1.
2.
3.
Hemorrhage
full resuscitation
maternal sepsis
A temperature rise may occur up to 24 hours after birth as a result of dehydration or exertion associated with labor
true or false
True
Late postpartum hemorrhage can occur in the fourth week following delivery
two or false
True
Birth of the head occurs through which of the following mechanisms for an OP delivery?
Flexion then extension
Newborn exam on a three week old baby, reflexes (one or more) of the reflex are not present and they were at birth what is the most appropriate response?
Note it as an alarming variation from normal that merits immediate attention by a pediatrician
At which of the following times is maternal cardiac output highest?
Immediately postpartum
How soon after full-term delivery can a woman who is not breast-feeding safely start taking combined oral contraceptives?
three weeks
About how many times should a healthy, well hydrated infant void during a 24 hour time period?
Six times
What woman is the most likely to suffer from mastitis?
A breast-feeding woman more than a week postpartum
Positive pressure ventilation of the newborn she continue until?
There are spontaneous respirations
In what days surrounding childbirth is it most likely the maternal Varcella infection will be passed to the newborn?
Day six before birth to day 2 afterbirth
How long after birth just complete regeneration of the endometrium at the placental site take?
6weeks
Sign of intracranial trauma and the newborn
Bulging anterior fontanels
Ductus arteriosis
definition
A short broad vessel in the fetus that connects the pulmonary artery with the aorta and conducts most of the blood directly from the right ventricle to the aorta bypassing the lungs
Foramen ovale
definition
when/why does it close
Most oxygenated fetalblood bypasses the lungs and instead flows through the opening between the right and left atria called the Foramen ovale
With the newborns first breasts the combo of pressure that is increasing in the systemic circulation causes increase in the pressure of blood flow to the heart. The pressure from increased blood flow into the left side of the heart causes the foreman ovale to shut
What does sunlight do for excess bilirubin?
Helps the liver conjugate and eliminate
Neonatal infection
signs and symptoms
Lethargy-especially if mother had signs and symptoms of infection during labor
irritability, jitteriness,
fever- Chorioamnionitis, GBS plus post partum infection
dehydration, tachypnea, cyanosis
Lochia Alba
Starts 10 days postpartum resolves over a period of 2 to 4 weeks
Creamy white
Consists of leukocytes and decidual cells
Scant amount
Lochia serosa
Paler than rubra. Serous and pink
Days 3 to 10 or 12 days postpartum
Contain serous fluid, decidual tissue, leukocytes, erythrocytes
Small amount
Lochia rubra
Contains blood, decidual tissue
Immediately after delivery continues for 2 to 3 days postpartum
Heavy to moderate amount
Newborn weight in grams
SGA
AGA
LGA
SGA up to 2500 g
AGA 3,000 to 3,500 g
LGA 4,000 g
Velamentous cord insertion
The three vessels attached to the placenta via the membranes rather than staying in the cord. Not protected by Wharton’s jelly.
Three stages of transition of newborn
First period of reactivity birth to first 30 minutes
Period of unresponsive sleep 30 minutes to two hours
Second period of reactivity two hours to six hours
Recognizing failure to thrive
Poor weight gain, lethargy, poor feedings, behind on developmental milestones
How many cotyledons are there in a healthy term placenta
15 to 20
Caput
"does not stay put" Collection of fluid causing swelling of scalp at birth, trauma Reabsorbed in 12 hours can cross suture line appear shortly after birth
Cephalohematoma
Collection of blood between cranial bone and periosteal membrane
Does not cross suture lines
Appears 1 to 2 days, disappears 2 to 3 weeks or months
Bruising under the skin
Most appropriate management for retained placental membranes
Methergine to achieve rapid expulsion of the retained fragments
What is the most appropriate management of placenta accreta?
Contact the physician and prepare the woman for immediate surgery
Following birth a woman’s bowels tend to be sluggish due to
1.
2.
Dehydration from the birth
effects of progesterone and decreased abdominal muscle
Why does the umbilical cord evulse with minimal pressure after the birth or while waiting for the placenta
Velamentous insertion
infection in womb
prematurity
fetal death
Percent of diabetic mothers that give birth to LGA babies
40%
What factors can increase the incidence of jaundice?
Pitocin IV during labor vitamin K Cephalohematoma liver malfunction neonatal infection ABO incompatibility
Kernicterus
Lab values
Over 20 for unconjugated bilirubin
Newborn reflexes should be present through
The first three months
Sepsis in the newborn
symptoms
Lethargy, irritability, jitteriness, fever, dehydration, tachypnea cyanosis
When does the cervix completely close afterbirth?
The external os has assumed it’s nonpregnant form by the fourth week postpartum
Judging hematocrit by blood loss
Two percentage points is roughly equivalent to a unit 500 mL of blood loss
Continuous stitching
when used
Closure of the subcutaneous layer
Continuous mattress stitch
when used
Subcuticular closure of an episiotomy or perineal laceration
Three associations of SGA babies
Mental retardation, visual and hearing defects, poor infant growth and development
What can an elevated pulse or temperature indicate postpartum in the mother
1-5
Dehydration, UTI, uterine infection, breastmilk coming, hematoma
Hypoglycemia
normal range
when to refer
risk factors
50 to 60 is normal for a newborn
below 30 is of serious concern
Infants at risk
LGA, SGA, premature, postmature, those with diabetic mothers,
Otherwise healthy babies who suffered hypoxia during labor or were depressed at birth
Describe IUGR
Asymmetrical
Normal head circumference
With decreased weight and decreased body length
Deep thrombophlebitis
symptoms
treatment
High fever, severe pain, edema, tenderness along the entire length of the leg
Stay in bed, keep the leg elevated contact a physician immediately
Uterine infection postpartum
puerperal infection or Endometritis
risk factors
symptoms
Anemia, compromised immune system, premature rupture of membranes, many vaginal exams in labor, maternal exhaustion, delayed placental delivery, hemorrhage, uterine exploration, postpartum dehydration, improper perineal hygiene
Fever over 101, elevated pulse, pelvic pain, subinvolution of the uterus
Newborn general measurements
head chest abdomen weight length
Head 12 1/2 to 14 1/2 inches Chest 11 1/2 to 14 inches Abdomen in line with umbilicus Wait 5.8 to 8.13 pound Length 18 to 22 inches
How long does it normally take for the newborns temperature to stabilize
8 to 12 hours
Findings in placenta previa
Onset: quiet and sneaky bleeding: external color of blood: bright red anemia: =blood loss Shock: = blood loss Toxemia:absent Pain: only contraction Uterine tenderness: absent Uterine tone: soft and relaxed Uterine contour: normal Fetal heart tones: usually present Engagement: absent Presentation: May be abnormal
Findings in placental abruption
Onset: sudden and stormy Bleeding: external and/or concealed Color of blood: dark Venous Anemia: larger apparent blood loss Shock: larger apparent blood loss Toxemia: May be present Pain: severe and steady Uterine tenderness: present Uterine tone: firm to stony hard Uterine contour: May enlarge and change shape Fetal heart tones: present or absent Engagement: May be present Presentation: zero relationship
Conditions under which fetal asphyxia is likely:
Cord prolapse, placenta previa, abruptio placentae, cord compression, fetal isoimmunization, placental insufficiency, maternal vascular disease, maternal hypotension, uterine overstimulation
Signs of normal newborn transition
Tone: flexed
sucking reflex: intact
behavior: alertness alternating with sleep
Bowel sounds: present after 30 minutes
Heart rate: 120 to 160, 100 to 180 with sleep or crying
Respirations 30 to 60, diaphragmatic with abdominal movement
Temperature: 97.7 to 98.6 axillary 96.8 to 97.7 skin
Puerperal infection
definition
A bacterial infection originating from the reproductive track during labor or the puerperim
Historically known as childbed fever
Still responsible for a significant percent of puerperal morbidity
What is the most frequent reason for seizures in the neonatal period
Hypoxic ischemic encephalopathy
Bulbocavernosus muscle
Arise in the perineum, pass around the vagina and embed in the clitoris
The pelvic floor
superficial muscle layer
Smaller than Levatol ani, but important in maintaining the overall strength of the pelvic floor
Includes:ishiocavernosus muscles
Bulbocavernosus muscles
Transverse perineal muscles
The pelvic floor
deep muscle layer
More important of the two muscle layers
directly supports the vagina
indirectly supports the uterus
collectively known as the levator ani muscles
What is the leading cause of perinatal mortality and morbidity as it accounts for 75% of all perinatal deaths and up to 50% of the neurological handicaps found in infancy?
Preterm labor
Any woman had one preterm birth in the past pregnancy, has ___ percent risk of reoccurrence
20 to 40%
Define puerperal morbidity
A fever of 100.4- the temp to occur on any two of the first 10 days postpartum except for first 24 hours and to be taken PO at least four times a day
Morbidity may be caused by infections and conditions other than puerperal infection- such as dehydration, UTI, upper respiratory infection, and mastitis
Transient tachypneaof the newborn
TTN
Inadequate absorption of lung fluid after the birth
signs and symptoms: tachypnea, rales or rhonchi, nasal flaring, intercostal retractions
Only last 48 to 72 hours, newborns may need assistance with feedings and extra 02
Levels of uterine involution postpartum
Immediately after delivery: 2/3 to 3/4 of the way between pubis and umbilicus
Day of delivery and day one: at umbilicus
Day 2 to 10: gradually descends
Day 10+: nonpalpable above the symphysis pubis
Crown stitch
when used
purpose
To reunite the cut bulbocavernosus muscle
To reduce gaping of the vagina introitus and to facilitate the return of good muscle tone by deliberate approximation of this muscle
Facilitates enjoyable sex
Treatment for colic
Massage and warm compresses on belly
chiropractic/craniosacral therapy
fennel, Caraway, chamomile, gripe water
Newborn appearance
recognize glucose disorders
If chest is the same or larger than the head, and the baby is over 9 pounds the mother may have some degree of glucose intolerance and the baby should be checked for hypoglycemia
jittery
Lethargic
Newborn appearance
recognize polycythemia
SGA
LGA
beefy redness color, prolonged (normal in first 24 hours)
check hematocrit and refer to pediatrician
Postpartum trickle bleed
response
Assess origin assess fundal height and uterine size fundal massage assess vital signs BF or nipple stem express clots nonallopathic treatment
What inhibits ovulation during breast-feeding
The hormone prolactin
What is the most appropriate time to cut an episiotomy in relation to contractions
As the contraction ends, position two fingers inside the perineum to protect the head, insert scissors between them and as the next contraction brings the head forward, cut straight down about a half to 1 inch
Give counterpressure and support the wound to prevent any extension
A woman’s vitals should be monitored how often during the normal fourth stage of labor
At least every 15 minutes until stable at prelabor levels
To elicit the plantar reflex you should:
Press the ball of the newborn’s foot
What is the most likely cause of asymmetrical IUGR?
Uteroplacental insufficiency
Ortolani’s sign
definition
A test of hip laxity used, to diagnose hip dysplasia
A positive sign is a snap as the head of the femur moves back into the acetabulum after being moved to the rim of the acetabulum
Direct Coombs’ test versus indirect Coombs test
Direct: for newborn (direct anti-globulin test)
Indirect: for mom
antibody screen
What does it mean if the neonates wrists and ankles looks cracked and wrinkly
Baby is dehydrated needs to nurse more often
Ways to facilitate perineal wound healing postpartum:
Diet high in protein and vitamin C
perineal cleanliness
warm sitz bath
these actions are aimed at: infection prevention, provision of tissue building and healing, increased circulation to the area
Treatment for a plugged breast duct
Apply warm moist heat to area before and during feedings
feed first from the sore breast
Press from behind the sore area toward the nipple during feedings massage breasts while showering
Change nursing positions to change pressure from babies mouth check fit of bra and baby carrier
Care of uncircumcised penis
Regular bathing will keep the area clean
do not try to pull back the foreskin
Rectocele
Bulging at the lower (vulvar) end of the posterior vaginal wall by bulging upward into the vagina and outward toward the introitus
First, second, third degree
Ask the woman if she has difficulty with bowel elimination
Treatment of thrush
Dry nipples after nursing
wash hands
nonallopathic topical acidophilus swabs three times a day gentian violet and calendula
allopathic antifungal nipple cream
Care of cradle cap
Apply a natural oil to the scalp before bed and leave it on all night
the scales can then be removed with a soft toothbrush and natural shampoo
A condition in the newborn that is commonly associated with Polyhydramnios is:
Urinary problems
Interrupted stitches
when used
For deep muscle repair
Blanket stitch
when used
Closing the vaginal mucosa
Levator ani muscles
definition
main groups
They are attached anteriorly to the pubic bone laterally to the ischial spines and posteriorly to the coccyx and sacrum
Three main muscle groups make up levator ani
Pubococcygeus muscle
Iliococcygeus muscle
Ishiococcygeus muscle
Pubococcygeus muscles
Extend from inner aspect of pubic bone to the coccyx
three main bands
surrounds urethra
surrounds vagina, vaginal walls, perineum
surrounds anus into anal canal
most vital of deep muscles supports urethra, lower one third of vagina and rectum
During the newborn exam the midwife would expect the chest circumference to be_____ related to the head circumference
1inch smaller
Cystocele identification first-degree second-degree third-degree
Evidence by bulging of the anterior vaginal wall. Nearly every woman who has born a child has first-degree
First-degree: bulging of anterior vaginal wall
Second degree: bulging reaches The vaginal orifice, without stress incontinence/sexual problems, it is considered asymptomatic
Third-degree: bulging extends beyond the introitus requires physician consultation for possible surgical repair
What muscle group is the most likely to be damaged during birth
The perineal body
External sphincter of the urethra
Arises and embeds in the pubic bone, having passed above and below the urethra
Regardless of whether the postpartum woman has received RhoGAM during pregnancy, any postpartum woman who meets the following criteria or should receive RhoGAM:
She is Rh negative
she is not sensitized to Rh D antibodies based on a current screen
the infant is Rh+
that infant had a negative Coombs test
Perineal body
definition
Muscles and connective tissue situated between the vaginal and rectal canals
Triangular with the base being the skin lying between the vaginal and anal orifices, and the apex the point where the vagina and rectum are in close proximity. Each side of the triangle is 3.5 to 4 cm long
Breast milk culture
when and why
Culture may be done in the cases of stubborn breast infections that are recurrent, don’t respond to the usual nonallopathic remedies, or in cases that the milk is lumpy, chunky, discolored or foul-smelling
Physiologic jaundice
definition
Wollin you to Rosa, the babies need for O2 is often met by a high percentage of red blood cells in it’s bloodstream, higher than in most adults. Once the baby is born and breathing, it no longer needs all the red cells, so the excess are broken down for illumination. A byproduct of the breakdown is billirubin which imparts a yellow tinge to the baby skin.
Manifests on the second to third day
Jaundice from ABO incompatibility
Definition
If blood from an O type mother transfers to her A or B type baby during the birth, the baby will have more trouble illuminating excess red blood cells and so will have excess billirubin
4.0 chromic suture
For repair of anterior rectal wall, clitoral laceration
delicate areas
very fine suture
3.0 chromic suture
Repair of vaginal mucosa, subcutaneous stitches, subcuticular stitches, periurethral lacerations
What size suture is used to repair cervical laceration
20 chromic strongest suture for muscle
Ishiocavernosus muscles
Extend from each ischial tuberosity to the clitoris
Ishiococcygeus muscles
Arise from the ischial spines and pass to the lower sacrum and upper coccyx
these muscles help support the sacroiliac and sacrococcygeal joints of the pelvis
External anal sphincter
Surrounds the anal orifice, with some fibers extending back through the perineal body to attach to the coccyx
Perineal body
function
To assist in the process of birth and defecation
maybe torn during birth and need suturing
Iliococcygeus muscles
Extends from the inner aspect of the iliac bone, and fibers from each side meet in the middle in the perineum, before extending into the coccyx
Average total amount of lochial discharge ____ ounces
8 to 9 ounces
Postpartum sudden reoccurrence of bright red bleeding
Not a normal finding requires evaluation
Causes: excessive physical activity, retained placental/membranous product, uterine atony
In shock, a person’s pulse: and the respirations?
Rises
rise
In shock a person’s blood pressure:
Rises then falls
As the blood pressure falls, the perfusion of vital organs falls with it; the best indication of whether the brain is being adequately perfused is the:
Level of consciousness
if there is arterial bleeding the blood will:
Spurt
Defined the fourth stage of labor
The period beginning with the birth of the placenta and ending one hour later
Breastmilk jaundice
definition
Non-threatening condition caused by a hormone in the mothers milk that can interfere with the babies ability to process billirubin. It manifests after the milk comes in
Perineal body
consists of
Place where many of the muscles of the pelvic floor join
consists of
one layer of skin that the base
bulbocavernosus and transverse perinei of the superficial muscles
the pubococcygeus of the deep muscles
Transverse perineal muscle
Extend from the ischial tuberosities to the perineum, where they intermingle with the muscles of the perineal body
Postpartum if the mother complains of chronic fatigue, nervous irritability, or upper respiratory infection prescribe______
More protein, more calories, good sources of vitamins B and C, and trace mineral supplements
Symptoms of hypoglycemia in the newborn
risks
Apathy irregular respirations inability to regulate body temperature refusal to nurse irritability tremors CNS damage can result if levels are insufficient. Consulting physician is levels dip below 45
Separation of symphysis pubis
management
A wide lateral stance must be avoided for 2 to 3 months
if the condition does not gradually improve improve refer care
Meconium aspiration syndrome
signs and symptoms
Uneven breath sounds
barrel chested appearance
rails and rhonchi
cyanosis
Hematoma
risk factors
Unrepaired laceration of a blood vessel
rough handling of tissues
operative delivery
causes extreme pain
Hematoma
Management
Small and moderate sized hematoma may be spontaneously absorbed
if the hematoma continues to enlarge, the midwife should notify physician
there may be a need for surgical intervention, blood replacement, antibiotics
vulvar are most obvious
vagunal are generally identifiable with care inspection
Iron supplementation
low dose
how taken
Low dose: 20 mg/day, from week 20 to birth
Taken by mouth best when taken with vitamin C as this enhances absorption and should not be taken with calcium this decreases absorption
What substances can be used to relieve postpartum cramping
Ibuprofen acetaminophen Blackhaw Comfort measures: heat, pressure on uterus Motherwort tincture
Predisposing factors to puerperal infection
Prolonged labor, prolonged rupture of membranes, lots of vaginal exams, poor aseptic technique, poor handwashing, intrauterine manipulation, extensive tissue trauma, hematoma, hemorrhage greater than 1000 mL, operative delivery, C-section, retention of placental fragments and membranes, improper perineal care, untreated vaginal/cervical infection or STD
Organism in puerperal infection come from three sources
Those that normally exist in the lower genital tract or in the bowel infections of the lower genital tract
bacteria that are in the nasopharynx or on the hands of the attending personnel or in the air and dust of the environment
Treatment for an infected episiotomy or laceration
First removing the sutures, opening the debriding and clearing the wound, and administering a broad spectrum antibiotic, resuturing the laceration
Signs and symptoms of infected episiotomy, lacerations, or other trauma:
Localized pain, dysuria, low-grade temp seldom above 101, edema, red and inflamed repair edges, oozing or pus, separation or dehiscence
Signs and symptoms of Endometritis
Persistently elevated fever to 104, tachycardia, chills with severe infection, uterine tenderness extending laterally, pelvic pain with bymanual exam, sub involution, scanty, odorless lochia, or malodorous lochia, variable onset depended on organism, GBS early, elevated white blood count
Parametritis
Bacterial infection of parametrium
Extension of infection via the blood vessels and lymphatics from a primary wound infection in the external genitalia , perineum, vagina,cervix, or uterus
Parametritis
s/s
Treatment
Fever, uterine sub involution, chills, sweats, abdominal pain that spreads laterally, and if untreated, the formation of a large abscess and signs of peritonitis, it occurs btw the 3-9th day
Antibiotics, bed rest, IV fluids, and drainage of any abscess
Possibly oxytocics to augment involution
Peritonitis
Def
s/s
Sepsis that affects not only the uterus, but the pelvic ligaments, connective tissue, and the Peritoneal cavity from untreated uterine sepsis
Acute onset of severe steady pain in abdomen, pain worsened by movement or pressure on abdomen. Board like rigidity of abdomen, swollen, bloated, chills and fever, profuse sweating, and N & V, weakness, pale cold skin and shock
Peritonitis
Diagnosis
Treatment
Diagnosis based on exam in which the abdomen is tender to the touch. Abdomen is also rigid, usually bowel sounds are absent
Treatment: massive antibiotic therapy, nothing by mouth, analgesics, surgery may be needed
Superficial thrombophlebitis
Leg pain localized heat tenderness inflammation at site palpation of a knot/cord
Deep venous thrombophlebitis
signs and symptoms
Possible temp elevation
mild tachycardia
abrupt onset of severe leg pain worsening with motion or when standing
edema of ankle, leg, and thigh
positive Homan’s sign
pain with calf pressure
tenderness along the entire course of that involved vessel and palpable cord
Treatment for thrombophlebitis
Bed rest elevation of extremity hot packs elastic stockings analgesia if needed referral for antibiotics anticoagulant no massaging
Which organism is the most common cause of mastitis
Staph aureus
` Course of healing of the vagina perineum from birth and on
Immediately after delivery of the vagina remains stretched open, may have edema and bruising
1 to 2 days postpartum it regains enough tone that it does not gate open, is now smooth walled and generally lax
Size decreases with the return of the vaginal rugae by approximately three weeks postpartum
Mastitis
cause
Prevention
Non infective may result from plugged ducts
Infective is associated with nipples fissure or other trauma creating an entryway. The most common organism is staff aureus
Ensure adequate drainage of the breast, continued on demand breast-feeding
Avoid milk back up and open wounds on nipples/areolas
After delivery, A cardiac patient should not breast-feed if she is
Receiving warfavin Coumadin therapy
Battledore placenta
The umbilical cord inserts in the edge or margin of the placenta
A condition caused by failure of the uterine muscle to stay contracted after delivery is
Uterine atony
Average weight loss following delivery
Women lose an average of 12 lbs at the time of delivery
Represents weight a baby, placenta, amniotic fluid
Another 5 pounds maybe lost during the first week postpartum as a result of fluid loss
Maternal mortality refers to death attributed to complications of pregnancy per ______women
100,000
Rubella vaccine
Timing
Women should have dependable birth control for three months after vaccine to prevent CRS
Wound healing
three phases
Inflammation
proliferation
maturation
Amniotic fluid embolism
symptoms
Usually during hard labor gasping for air drop in blood pressure depressed cardiac function hypoxia seizures DIC
For non-breast-feeding women menstruation typically resumes in
8-12 weeks
When does the bladder, urethra, rectum return to normal function postpartum
Immediate postpartum the bladder is edematous, congested and hypertonic which may result in over distention, incomplete emptying
Urethra maybe sensitive as a result of prolonged labor with the fetal head in the pelvis
Unless a woman develops a UTI, the effects of labor on the bladder and urethra diminish in the first 24 hours postpartum
Immediate postpartum
respirations
Resolves to the woman’s normal range during the first hours postpartum
SOB, rapid respiration or other changes warrant valuation for conditions ranging from fluid overload to an asthma exacerbation to pulmonary embolism
Immediate postpartum
pulse
Resolves over the first few hours postpartum to its normal level Affects the normal decrease: hemorrhage fever during labor acute/persistent pain
Pulmonary embolism
Signs and symptoms
Tachypnea Dyspnea sharp chest pain of sudden onset altered lung/heart sounds apprehension as the woman's blood O2 level decreases
urgent physician a valuation
Mastitis
signs and symptoms
Severe engorgement flu like symptoms rapid increase of temp up to 103/104 increased pulse chills general malaise painful swollen and inflamed hard area of the breast
Broad ligament hematoma
Lateral uterine pain sensitivity to Extension of pain into the flank Painful swelling with high rectal exam Ridge of tissue just above the pelvic brim extending Abdominal distention Contact physician
Care of circumcised penis
Vaseline gauze covered for 24 hours
Watch for bleeding, inability to urinate, or swelling
The new Ballard scale
newborn maturity
Assessed neuromuscular activity and physical maturity
Can date newborns of gestational age as low as 20 weeks
Accurate within a range of two weeks
Newborn is either: preterm, term or postterm
Normal range of newborn respirations is ___ to ___ 1 min
30-60
In CPR for the newborn, you should compress the heart ____ timed per min
90
Square window, popliteal angle, and scarf sign are all tests that refer to
Neurological maturity
During phototherapy for neonatal jaundice, the midwife should cover up ____ and _____ on a baby boy and also ___________
Eyes and genitals
Turn him frequently
Mongolian spots
More common with darker skin pigmentation
usually over sacrum
fade by two years
Petechiae in NB
Pinpoint, flat, round, red spots
clears in first weeks
Milia
Blocked sebaceous glands on face
Clears in first month
The first period of newborn reactivity is
First 30 minutes after the birth
When is maternal to infant (vertical) transmission of HIV most likely to happen
Labor and delivery
Gastroschisis
Intestines on the outside of the body
newborn most at risk for dehydration
What percent of infants born with only one umbilical artery will have multiple, severe malformations
30%
What is the effect on the newborns cardiovascular system of clamping of the umbilical cord
Interesting systemic vascular resistance
The effects of cold stress on the newborn
Metabolic acidosis
pulmonary vasoconstriction
hypoglycemia
Which is most directly responsible for closure of the Foramen ovale
Increased pressure in the left atrium
Delee
Steps
Check that the lid is screwed on tight
insert tubing 4 1/2 inches into babies mouth
withdraw slowly while sucking sharply and repeatedly
Normal weight gain in the newborn is between______ and _____ oz. per week
Four and eight
Desquemation
Peeling skin
An abnormal inability to retract foreskin
Phimosis
What is the largest diameter of the fetal head
Occipitomental
Breast-feeding and HIV
HIV can be transmitted through breastmilk about 15% rate
Mother can start breast-feeding or bottlefeeding, but cannot start bottlefeeding and then switch to breast-feeding
Formula creates microfissures. in the intestines, making the baby more susceptible to infection if then exposed breast milk
What is the function of surfactant in the lungs of the newborn
Reducing the pressure needed for respiration by stabilizing the walls of the alveoli
Newborn ears
normal findings
A direct horizontal line with the eye and top of the ear
Newborn female genitalia
common findings
Swelling of labia and clitoris majora should be covering minora at full-term hymenal tag urethral meatus just below clitoris Vernix between labia
Newborn male
Common findings
Urethral opening at tip of penis testes palpable on both sides scrotum large, edematous, pendulous deeply pigmented in non-Caucasians Rugae
Newborn extremities
usual finding
10 fingers 10 toes
full ROM
nailbeds pink
crease on anterior two thirds soles of feet
symmetry of crease on back of legs and hips
bilaterally equal muscle tone
Popliteal angle
Preterm
term
postterm
Thigh held in the knee chest position knee will naturally bend leg extended toward head Pre180 degrees Term 130 Post 90
Scarf sign
Pre
Term
post
NB hand, try to put towards back of neck on opposite side of the baby
where does elbow lineup with newborns midline
Pre- elbows across midline
Term- elbow at midline
Post-elbow does not reach, closer to arm being flexed
Which reaction would indicate possible esophageal atresia in the neonate?
a baby ingesting colostrum
Choking
At what age should a newborn receive her initial dose of the dtap vaccine
Two months
Baby boy is undergoing phototherapy for jaundice, covering the genitals prevents
Priapism-sustained painful erection
In a neonatal with erythoblastosis fetalis, it is known that the disease results from
Destruction of red blood cells
Unequal bilateral femoral pulses in the neonate typically indicates
Coarctation of the aorta
To assess the integrity of the neonate spinal nerves the midwife should attempt to elicit the
Crossed extension reflex
Breast milk while feeding a term infant who is 2 weeks old typically looks
Bluish white and thin
