This is it man, go go go Flashcards
• Recognize when to admit a patient to Labor & Delivery
What Physiologic Changes Prior to Labor ? •Lightening(when baby goes down there is a feeling of lightness above the baby)
–About 2 wks before labor in first pregnancy
–Settling of fetal head into brim of pelvis
–If multip, lightening does not occur until labor
–Increases pelvic discomfort, pressure, urinary frequency
–Woman may feel less discomfort with SOB, heartburn
What other Physiologic Changes Prior to Labor ? (prodromal)
Bloody show
–Expulsion of mucous plug in some pts
–Result of cervical dilatation and effacement days to 2 wks before labor
–Multips can be 1-3 cm dilated for wks and not even know it
•GI upset
–Sx similar to early pregnancy with n/v, may have diarrhea, heartburn a week before labor
• Describe the causes for 3rd trimester vaginal bleeding
Third trimester bleeding that presents to L&D –Multiple causes, many benign •Mucous plug •Normal bloody show •Laceration/trauma •Infection •Ruptured uterus –Placenta previa and abruption can be life threatening
what are Braxton Hicks contractions
false labor
Painless, irregular contractions that may occur at any time during the pregnancy
–4-8 wks before delivery intensify in frequency and strength
–Sometimes dubbed “false labor” aka “prelabor”
•They can be intensely uncomfortable and go on for weeks without changing the cervix
•They often go away if the woman starts walking
• Understand the stages and normal progression of labor
Normal labor is usually painful –Intensity depends on fetopelvic relationships, quality and strength of UCs, emotional and physical status of pt •Contractions start with a gradual build- up of intensity that climaxes and dissipates
What are the “5 P’s” of labor?
Passenger=estimated fetal wt calculated here, how is baby doing, chronic problems, flexion(the babies neck is ready to get pushed through)
-Position=In the vertex position? Presenting body part, station?(lowestmost body part presenting in relation to the ischial spines=station zero)
Passage=How dilated is the cervix/effacement, 1cm/2hrs nulliparious, 1cm/hrmultiparous
Power=•Frequency, force and duration of UCs
–Psych status
•Coping, accepting, fearful, in pain/denial
and which factors may halt the progression of labor
Placenta Previa
•Malposition of the placenta in the lower uterine segment that completely or partially covers the os
–Partial, complete, low-lying, migrating
•Risk factors
these are little details from Tana?
Note: can have eclamsia for up to 6wks postpartum.
Monitor b/p and pulse for hemorrage.
Watch for sepsis due to endometriatis within the 1st 24hrs.
With epidurals there can be huge post epidural headaches….
Placental should be delivered within half hour…..
• Understand basic postpartum care guidelines
Postpartum Care;Regular diet ad lib; stool softener PRN
Postpartum Nutrition ;Minimal caloric requirement for adequate milk production on average is 1800 kcal per day
Fluid intake is important
Balanced, nutritious diet ensures healthy mother and baby
Vitamin supplements routinely not needed; may recommend to continue PNV
including care of the vulva
Care of the Vulva ;Teach patient to cleanse vulva from anterior to anus, look for signs of infection
Application of an ice bag to the perineum during first 24 hours post delivery
Warm sitz baths beginning 24 hrs after delivery
including care of the and bladder
Care of the Bladder ;Encourage patient to void as soon as possible after delivery
Catheter placement may be necessary if voiding is too difficult
Trauma to the bladder during L&D
Regional anesthesia
Vulvar/perineal pain/swelling or episiotomy
care of the breats postpartum
Care of the Breasts; Ideally begin on-demand breastfeeding <1 hr post delivery
Ice packs and analgesics for engorgement if not breastfeeding
Lactation suppression meds discouraged
Avoid nipple stimulation
Milk production should stop within a week
Postpartum Immunizations
An unsensitized, Rh(D)-negative woman who delivers an Rh(D)-positive baby should receive 300 µg of anti-Rh(D) immune globulin (RhoGAM) within 72 hours of delivery
May protect up to 14-28 days after delivery
A woman who is not protected against rubella virus should receive the rubella (MMR) vaccine postpartum
Tdap recommended if due
Hep B may be given
Hospital Stay; Without complications?
48 hours for vaginal delivery
96 hours for Cesarean delivery
Not including day of delivery
Short Stay Criteria;Mother afebrile, stable vital signs
Amount and color of lochia appropriate Firm uterine fundus Adequate urine output No evidence of infection in wound or repair sites Mother able to ambulate with ease No abnormal physical or emotional findings Mother able to eat and drink Postpartum follow-up care arranged
Postpartum Visits;
Visit and exam 4-6 weeks after an uncomplicated vaginal delivery
Visit and exam 7-14 days after a Cesarean or complicated delivery
Most women may resume regular work and activities by 4-6 weeks postpartum
• Understand the physiology of lactation
Lactation =3 stages of lactation
Mammogenesis – mammary growth & development
Requires estrogen and progesterone
Lactogenesis – initiation of milk secretion
Requires prolactin
Galactopoiesis – maintenance of milk secretion
Requires prolactin, oxytocin (suckling)
Multiple, complicated hormonal interactions involved in lactation
• Understand the physiology of lactation part 2
Lactation =Lactation is initiated when plasma estrogens, progesterones, and human placental lactogen levels fall after delivery
Maintenance of established milk secretion requires suckling and the emptying of mammary ducts and alveoli
Prolactin levels will return to nonpregnant level in the absence of suckling 2-3 weeks postpartum
• Understand the synthesis of human milk and the colostrum
Human Milk ;Prolactin drives milk production
Other hormones involved (insulin, cortisol, etc)
Substrates for milk are derived from the maternal gut and liver
Principal carbohydrate is lactose
and immunoglobulins secretory 90% IgA
Breast milk is also highly anti-infective
Primarily leukocytes
Cells: macrophages, neutrophils, lymphocytes
the synthesis of human milk and the colostrum)=Premilk secretion present in the first 2-3 days postpartum
Yellowish alkaline secretion
May begin in the last months of pregnancy
Higher specific gravity, protein Lower carb, K, fat content than mature breast milk
Normal laxative action
Advantages of Breastfeeding to Infants
Easily digestible, ideal composition & temp
Free of contamination; good source of Ig
Decreased incidence of diarrhea, lower RTIs, necrotizing enterocolitis, invasive bacterial infections, SIDS, obesity, childhood allergies, Type 1 DM, Crohn’s disease, UC, and lymphoma
Improved cognitive development and intelligence
Breastfeeding Recommendations
Exclusive breastfeeding up to 6 months of age, partial breastfeeding 6-12 months or longer
Ongoing practitioner support increases the proportion of mothers who breastfeed
Disadvantages of Breastfeeding to Infants
Slightly increased risk of neonatal jaundice in the first few weeks
Not usually possible for infants that are weak, ill, or very premature
Cleft palate, choanal atresia, PKU
May be fed expressed breast milk
Mothers with CF have high Na content in milk
Breastfeeding =(don’t use pacifiers or fake nipples for first 6wks)
Ideal to begin breastfeeding within 1-2 hours of delivery
Milk usually comes in on the 3rd or 4th postpartum day
Maternal Advantages of Breastfeeding
Improves GI motility and absorption
Delays ovulation
May protect against ovarian cancer
Increased weight loss postpartum?
Maternal Disadvantages of Breastfeeding
mastitis may develop Contraindications to breastfeeding: Use of illicit drugs or excess alcohol Human T-cell leukemia virus type 1 and HIV Breast cancer (active) Active pulmonary TB or varicella infection Galactosemia of the newborn Maternal intake of some medications
