S3 M2 Reproduction Flashcards
S/S of pregnancy
subjective
Urinary frequency N/V Breast tenderness Uterine/breast enlargement Hyperpigmentation of skin
S/S of pregnancy objective
Braxton hicks Abdominal enlargement Ballottement Goodells sign Chadwicks sign Hegars sign
Braxton hicks
when the womb contracts and relaxes
objective sign of pregnancy
Chadwicks sign
Dark blue or purplish red congested appearance of vag mucose
First trimester
Softening of uterus at junction with cervix
Hegars sign
First trimester
Softening of uterus at junction with cervix
Goodwells sign
Softening and cyanosis of the cervix
At of after 4 weeks
Ladins sign
Softening of uterus after 6 weeks
Pregnancy adaptation
Ptyalism
overproduction of saliva
GI pregnancy adaptations
Ptyalism Gingivitis Decreased peristalsis Hemorrhoids Heartburn N/V
Cardiovascular pregnancy adaptation
50% more blood
^ cardiac output
v blood pressure at first, increase later
^ RBC x2^ plasma causing hemodilution (anemia)
^ in demands for iron, fibrin, and clotting factors leading to hypercoagulable state
Resp pregnancy adaptations
Breathing more diaphragmatic
^ in O2 consumption
Congestion secondary to increased vascularity
Renal/urinary pregnancy adaptations
Dilation of pelvis and ureters
^ length/weight of kidneys
^ Glomerulofiltration rate (pee more)
^ kidney activity when lying down
Musculoskeletal pregnancy adaptations
Softening of sacroiliac ligaments
^swayback and upper spine extension
Lordosis
Waddle gait
Center of gravity shifts forward
Integument pregnancy adaptation
Hyperpigmentation
Linea nigra
Varicosities
Decline in hair growth
Increase in nail growth
Thyroid pregnancy adaptation
^BMR
Pituitary pregnancy adaptation
v TSH GH
inhibition of FSH and LH
^ Prolactin MSH oxytocin
Pancreas pregnancy adaptation
Insulin resistance in second half of pregnancy
Adrenal pregnancy adaptation
^ Cortisol and aldosterone
What does the placenta secrete
hCG hPL - insulin inhibitor relaxin estrogen progesterone
Pregnancy insulin and glucose
early pregnancy
^ in glucose demand due to baby growth
Fetus must make its own insulin
mid pregnancy
^ in insulin production to work against hPL and extra cortisol which desensitize insulin to give more sugar to baby
Nutrition pregnancy
intake IDRECTLY = wellbeing/outcome of birth
Need vitamins and minerals
Avoid mercury fish
Increase protein, iron, folate, and calories
MyPlate
Nutritional sugestion
1/2 plate, fruit and veg Whole grain ^ Fiber NO Hydrogenated fats 2 quarts of water daily 2 servings of fish weekly, 1 of them fatty
Bad food during pregnancy
NO Artificial sweeteners
NO Mercury fish (king, mackerel, ahi tuna, shark/sword fish) smoked seafood
NO processed meats (lunch meat, hotdogs, spreads)
NO soft cheeses (feta, brie, camembert)
NO unpasteurized milk
NO store made salads
Good fish for pregnancy
shrimp
salmon
pollock
catfish
up to 12 ounces
When is the embryo at greatest risk
17 to 56 days after conception
First prenatal visit points
Establish trust
Educate wellness
Detection/prevention of problems
Comprehensive history/examination/labs
Pregnancy history
suspicion of pregnancy
date of last period
s/s
urine or blood test for hCG
past history
what do you test urine and blood for for pregnancy
hCG
Gravida
I
II
Pregnant woman
first pregnancy
second pregnancy
etc
Para
woman who produced VIABLE/OR NOT offspring carrying 20 weeks or more
Primipara (Primip)
Multipara (Multip)
Nullipara (Nullip)
One birth after 20 week prego
2 or more pregnancies with viable offspring post 20 weeks
No viable offspring
Primipara
Multipara
Nullipara
One birth after 20 week prego
2 or more pregnancies with viable offspring
No viable offspring
GTPAL
Gravida Term births Preterm births Abortions Living children
Term birth
birth with 37 weeks gestation
preterm
birth with 20 to 37 weeks gestation
abortion
nonviable birth
less than 20 weeks gestation
OB history
GTPAL
So Primigravida means
first pregnancy
Menstrual history
Age at menarche Days in cycle Flow characteristics Discomforts Use of contraception
NAGELEs RULE
Calculate expected date of birth
Last menstrual period LMP date
LMP - 3 months + 7 days + 1 year
BEST method is ultrasound
Weight gain during pregnancy
BMI less than 18 - 28-40lb
BMI more than 25 - 12-25lb
Normal BMI 18 to 25 - 25-35lb
First Prenatal visit focus not sensitized
Rh - if negative, repeat at 28 weeks
if still negative give Rh immune Globulin (RhoGAm) to prevent sensitization
First Prenatal visit sensitized
Monitor closely blood work check ABX doppler ultrasound to fetal brain aminocentesis at 15 weeks to check fetal blood type Mother will see preinatologist
Rhogam will NOT work if woman is already sensitized
Good for 12 weeks
If mother is Rh sensitized Rhogam will
NOT work
Amniocentesis
blood type check at 15 weeks
If Rh is sensitized, mother will need to see a
perinatologist
Coombs test
determines weather mother has developed isoimmunity to the Rh antigen
detects antibodies harmful to fetus
If Coombs test is negative the woman is a candidate for
RhoGAM
Current standard of giving RhoGAM
between 28 and 32 weeks
again 72 hours after birth
Which Rh destroys Which
Rh negative blood will attack Rh positive blood
this is called Sensitization
Why is Rh a problem during second pregnancy
Mother and baby blood does not mix until birth, so first baby is good.
Once it mixes, mother develops antibodies, bad for second baby
Rh Sensitization can cause what in baby
Anemia
Jaundice
Hemolytic anemia (erythrocytosis fetalis)
Visits for pregnancy
Q4 weeks up to 28 weeks
Q2 weeks 29 to 36 weeks
Every week after 37 weeks to birth
What is measured during pregnancy follow ups
Wight and BP Urine for protein, glucose, ketones, nitrites Fundal height Quickening/fetal movement Fetal HR
Teach danger signs
Measure fundal height
Top of uterus to pubic bone
When does fetal movement begin
Second trimester
First perception of fetal movement
Range of movement determins
“Quickening”
Gentle fluttering
Pregnancy outcome
Good movement = good outcome
Fetal heart rate
Women lies down
Use doppler on abdomen
Normal range for fetus 110 to 160 bpm
1st trimester
includes
0-13 weeks
History
Lab
First visit
2nd Trimester includes
14-27 weeks visit every 4 weeks V/S Wt BP gluc, prot FH FHT
3rd trimester includes
28-40 weeks Visit every 2 weeks till 36 week then Q1 week V/S Wt BP Gluc Prot FH FHT
1st trimester lower abdominal pain with dizziness and shoulder pain
spotting and bleeding
severe vomiting
ruptured ectopic pregnancy
miscarriage
hyperemesis gravidarum
2nd trimester pain in calf with felxion
2nd trimester absence of fetal movement for 12h
regular contractions
sudden gush or leakage
DVT
fetal distress or demise
preterm labor
premature rupture
3rd trimester edema abdominal pain
visual changes and headache
3rd trimester 24h without fetal movement
What else
Gestational hypertension or preeclampsia
possible demise
Literally everything from first 2 trimesters
Congenital malformation checks happen at
18-20 weeks
Nuchal translucency ?
is done at
test for downs
11-14 weeks
Alpha fetoprotein ?
is done at
Down
16-18 weeks
Aminocentesis
Chorionic Villus
Genetic testing for abnormalities in fetus MOST ACURATE
Less accurate
Anemia in fetus
Mild more common than normal pregnancy
moderate - may need transfusion or early delivery
severe - hemolytic anemia, WILL need transfusion and early delivery
Hemolytic anemia
Erythrocytosis fetalis
RBC destroyed faster than produced
No RBC to Oxygen
Breakdown = ^bilirubin = jaundice/brain damage
No Oxygen = ^HR = HF
Hydrops fetalis
Labor contractions
4-6 min apart
lasting 30-60 sec
Stronger over time
feeling of vaginal pressure
Contractions start in back and radiate to front of abdomen
NO alleviation with positional change
STAY HOME UNTIL contractions are 5min apart lasting 45-60 sec
and conversation is not possible
Primary power of labor
Uterine contractions which are
involuntary
Normal rate of contractions
Tachysystole or hyperstimulation
5 or less in 10 min
More than 5 contractions in 10 min
Effacement
Thinning of the cervix
Cervical ripening agents
Dinoprostone - vaginal insert
Prepidil gel - must be at room temp
Misoprostol - orab or vag tab
Cervical ripening
softening and opening the cervix before labor starts
Assessment of contractions includes
Frequency
Duration
Intensity
Uterine resting tone
Intensity of contractions is measured in
MVUs
What class of drugs is given for analgesia to women in labor
Opioids
Antiemetics
Benzodiazepines
narcan if OD
Early/Latent phase
Cervical dilation to 3cm Cervical effacement to 40% Contractions q5-10min Contractions last 30-45 sec Contraction intensity mild
Nullipara
Multipara
A woman who has never given birth
A woman who has given birth before
Phases of 1st stage of labor
Latent/early
Active
Transition
Active phase
4-7cm dilation 40%-80% effacement Contractions q2-5min Contraction duration 45-60sec Contraction intensity Moderate
Transitional phase
8-10cm dilation 80%-100% effacement Contractions q1-2min Contraction duration 60-90sec Strong intensity
Pitocin(oxytocin)
used to initiate or improve contractions
used in 3rd stage to CONTROL BLEEDING
given via DRIP
MONITOR uterine activity and FHT fetal heart tone
Pitocin(oxytocin) dosing
10 units to 1000ml NS
start at 0.5-1 MU/min
increased to 1-2 MU/min until desired contraction pattern
FHT
Fetal heart tone
Document V/S, contractions and fetal well being q_min when giving pitocin(oxytocin)
15
Fetal Heart Rate
Tachycardia
Bradycardia
110-160bmp
greater than 160
less than 110
Treatment for variable in FHR baseline
FIRST change mothers position
give O2 to mother
give IV fluids
Slow or stop pitocin
Slow or stop pushing
Prolapse cord
If prolapse cord, push head off cord and DO NOT remove your hand
this is an EMERGENCY requiring IMMEDIATE c-section
VEAL CHOP
FHR Decelerations
Variable deceleration - Cord compression
Early deceleration - Head compression
Acceleration - Okay
Late deceleration - Placental insufficiency
Early deceleration
Head compression
Deceleration and contraction mirror one another
lowest point at peak of contraction
40bpm decrease
No intervention required
Variable deceleration
Cord compression
Abrupt unpredictable decrease
usually good outcome
Late decel
Placentae insufficiency
occurs AFTER peak of contraction
fetal hypoxia, asphyxia, acidosis, cns depression
Always abnormal
EMERGENCY
Conditions that can lead to late decel, placental insufficiency
maternal hypotension
gestational hypertension
placental aging due to diabetes
hyperstimulation via oxytocin
Late decel
placental insufficiency treatment
AND
Prolonged decel treatment
Stop oxytocin
Turn client on side and do knee to chest - increases placental perfusion
Admin O2
^IV rate
Assess
Notify MD
Prolonged decel
abrupt FHR decline of at least 15bpm that lasts between 2 and 10 min
USUALLY rate drops to less than 90bpm
If late or prolonged decel is unresolved
immediate c-section
Second stage of labor
Dilation to birth
Contractions ever 2-3 min
contraction duration 60-90 sec
Phases of the second stage of labor
Pelvic phase (fetal descent) Perineal phase (active pushing)
Third stage of labor
Delivery of placenta
Gush of blood
Cord lengthening
Globular and firm uterus
Uterus rises anteriorly
Massage uterus until firm to promote constriction of blood vessels
Blood loss during birth
vaginal 500ml
cesarean 1000ml
blood loss over 1000ml SEVERE
Nursing management of hyperstimulation
STOP pitocin admin O2 Lateral position Flush IV Notify MD
Forth stage of labor
Post partum time
Attachment with baby
fundal massage
Focus is to prevent hemorrhage, urinary distention and venous thrombosis
Monitor mom every 15min
Placental function
Nutrition to fetus
Pregnancy hormones
Immune protection
Gas exchange for baby
Removes waste
Does placenta and mother blood mix
NO
all process is done by diffusion
Shultz
Duncan
Amniotic sac
Fetal side
Maternal side
sac
Episiostomy cut made at the opening of the vagina during childbirth healing
REEDA
Redness Edema Ecchymosis (bruising) Discharge Approximation (closing)
Post partum check
BUBBLE-HE
Breasts Uterus Bladder Bowel Lochia Episiotomy (perineum) Homans' sign Emotions (psych)
Uterus descend after birth
1cm per a day for 10 days
everything falls back into true pelvis
Lochia
Rubra
Serosa
Alba
Lochia rubra
1st stage
Deep red mucus and debris first 3 day
Lochia serosa
2nd stage
pinkish brown
3 to 10 days
Lochia alba
Creamy white or light brown
10 days to 6 weeks
Normal pregnancy length
38-42 weeks
Biophysiological risk factors for baby
examples
Genetics
Pre-existing conditions
Psychosocial risk factors for baby
Examples
Poor fam support, abuse, mental health issues
Sociodemographic risk factors for baby
Single parent, education, age
Environmental risk factors for baby
lead exposure, viruses
Lab diagnostics for preeclampsia
H EL LP
H Hemolysis
EL Elevated liver enzymes
LP Low platelet count
Vaccines for mothers
TORCH
T-toxoplasmosis O-other; hep, hiv varicella R-rubella C-cytomegalovirus H-herpes
antithyroid drugs in mom can lead to
hypothyroidism in mom can lead to
fetal demise
fetal demise or cretinism
Labor and delivery is also called
intrapartum
False labor
IRREGULAR contractions NO change in intensity Discomfort in abdomen NOT back to front Walking helps Cervix unchanged Rest helps
In L/D lie means
long axis of fetus to long axis of mother
In L/D presentation means
Part of fetus to first enter pelvis
In L/D attitude means
Relationship of fetal head to fetal spine
in L/D station means
fetal head to maternal ischial spine
+5 to -5
+ means BELOW
- means ABOVE
0 means level
in L/D Effacement means
Shortening/thinning of the cervix
in L/D Dilation means
Opening of cervix in centimeters
Multigravida
Multipara
Woman who has multiple pregnancies
Woman who has carried past 20 weeks
in L/D lightening means
Occurs at 38 week
fetus has settles into pelvis “Dropped”
eases breathing
pressures bladder
in L/D bloody show means
passing of protective blood stained mucus before birth
Vaginal exam is done at
is not done at
Admission, client in labor with no contractions
NOT DONE if active bleeding
Postpartum time
first 6-8 weeks
Mothers body returns to normal
Immediate period during hospital stay within 2-3 days
Assessment
Comfort
Potential complications
Interventions for breast pain postpartum
Warm compress if lactating
Cold compress if not
Interventions for back pain post partum
Pelvic tilt, change positions
Interventions for perineum pain post partum
Ice x24h then sitz bath,
stool softeners
sprays
tucks
Interventions for leg pain post partum
Assess
NO massage
Walk if no indication of DVT
Interventions for bladder pain post partum
^fluid
help void
straight cath
antibiotics
Position for uterine infection
Semi fowler to help drain
Ductus venosus
a shunt that allows oxygenated blood in the umbilical vein to bypass the liver and is essential for normal fetal circulation
Foramen ovale
a small opening between the two upper chambers of the heart, the right and the left atrium
Ductus arteriosus
Helps bypass lungs in fetus as O2 is gotten from placenta
Assessment of new born
Weight
Head and chest
Gestational aging
SGA
LGA
Small for gestational age
Large for gestational age
Late premature
Bork between 34 and 36 weeks
Antepartum
1st week till birth starts which is called intrapartum
Amenorrhea
Absence of menstruation
Ballottement
Objective sign of pregnancy
pressure on one side of belly, baby moves to the other
Positive signs of pregnancy
Ultrasound
Fetal movement felt by provider
Fetal heart beat
What is done at first visit
Rubella VDRL/RPR Blood type and Rh CBC UA Hep B HIV TB V/S Weight Height of fundus FHT's Blood glucose Pap GC
how long is RhoGAM good for
12 weeks
If you are Rh negative then you MUST get
RhoGAM
Tests for fetal well being
18-20 and 11-14 week
Doppler flow
Alpha fetoprotein
Triple/quad
screenings for malformities tests are
NOT DIFINITIVE
If dates are off of twins = false positive
Male pelvic shape
Female pelvic shape
Android
Gynecoid
Leopold Maneuver
Hands at top of fundus looking for butt, we WANT hand to be down
Bring hands down the middle to look for hard surface, that’s the back. THIS IS WHERE WE MEASURE FETAL HEART BEAT
the soft surface is the chest arms and legs aka place to move
Feel lower to find the head, it will be HARD
LOA
vs
ROP
how the baby lies in relation to mama
Left Occipital Anterior
Babys back is on mothers left leaning to the back
Right Occipital Posterior
Babys back in on mother right leaning to the front
You wan the baby to face the _ before birth
Anterior
Mothers spine
STOP pitocin if
Contractions are 90 seconds or less than 2 min apart
More than 5 contractions in 10 min
GIVE O2
Place mother in lateral position
Goal of cervical ripening agents
To help achieve effacement
Sings of 3rd stage that you NEED TO KNOW
Gush of blood
Cord lengthening
Globular and firm uterus
Uterus rises anteriorly
Where should the fundus be at about 12 weeks of pregnancy
at the symphyses pubis
Fundus at 20 weeks of pregnancy
At about the belly button
Fundus location at 36 weeks
Xiphoid process
fundal location at 37 to 40 weeks
Goes DOWN from xiphoid by 4 cm
getting ready to pop
Treatment for variable deceleration
Change moms position
Cervical exam for CORD
Give O2 and IV fluids
Slow contraction/Stop pitocin
Push every OTHER contraction
