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What immunization can you NOT have during pregnancy? - Rubella (live virus) How many extra calories does a mom need if she has a normal-weight BMI? - about 300 calories (a bagel) What is a psychosocial assessment? - history of emotional or physical abuse history of emotional problems Support systems acceptance of pregnancy, plans for care feeding preference for baby How long are trimesters? - 13 weeks what is nagele's Rule? - First day of last menstrual period- 3 months + 7 days= EDD antepartum is considered when? - conception to labor Intraparum is considered when? - active labor until 2 hrs after baby is born Postpartum is considered when? - 2 hrs after baby is born to 6 weeks How often should prenatal visits be scheduled for a mom from conception to 28weeks? - Every 4 weeks How often should a prenatal visit be scheduled for a mom thats 29-36 weeks? - every 2- 3 weeks How often should a mom have a prenatal visit between 37 weeks to birth? - Every week Nulligravida - never been pregnant primigravida - woman who is pregnant for the first time multigravida - woman who is pregnant for at least the 2nd time para - given birth to one or more children who are passed age of "viability" which is 20 weeks (twins count as 1) abortion - termination of pregnancy before viability of 20 weeks; induced or spontaneous term - 37 weeks or greater (para) Preterm - 20-36.6 weeks (para) GTPAL(M) - Gravida Term Preterm Abortions Living Multiple what are some danger signs of pregnancy? - gush of fluid from vagina vaginal bleeding abdominal pain fever over 100.4 blurred vision, dizziness, spots before eyes persistent vomiting pre-tibial edema muscular convulsions RUQ pain (liver) un-relievable headaches oliguria/dysuria decrease/absence of fetal movement umbilical cord contains which vessels and how many? - one vein and two arteries (always 3 vessels) the umbilical arteries carry which kind of blood? - deoxygenated blood What type of blood does the umbilical vein carry? - oxygenated blood what is the normal length of the umbilical cord? - 55cm What is the substance that protects the umbilical cord? - wharton's jelly, protects from compression or breakage How does the fetus breath in uteuro? - placenta supplies oxygen and allows fetus to excrete CO2 into the maternal blood stream. What are the three fetal shunts? - foramen ovale ductus venosus ductus arteriosus when is the placenta fully developed to take over baby's hormones and such? - 21 weeks What does hCG do? - caused by increase of estrogen and progesterone. stops sperm from fertilizing another egg hormone tested in pregnancy tests goes away after placenta development where would you expect the top of the fundus to be located at 20 weeks? - umbilicus supine hyptension - aka vena cava syndrome weight of uterus compresses vena cava, decreasing blood return to mom. Happens when they lay flat on back pseudoanemia - fluid part of blood increases more than RBC component and gives hemodilution. palpatations - increases in thoracic pressure w/ sudden movement why do pregnant women waddle? - relaxin causes round ligaments to be compressed, causing waddling when should nausea and vomiting subside? - by the second trimester what causes morning sickness and constipation? - hCG how does human placental lactogen (HPL) effect glucose levels? - its an insulin antagonist, increases glucose levels; causes gestational diabetes what causes eye and cognitive changes in pregnant women? - estrogen thickens cornea pituitary enlarges and causes blurred vision and slight memory loss what is couvade? - when father has same cravings as mother and gains weight with her what is nuchal translucency testing looking for? - trisomy 21 (down syndrome); combo of ultra sound and serum test; nuchal translucency is the extra padding behind neck of baby what does triple and quad screening look for? - AFT, hCG, and estriol levels to detect trisomies and neural tube defects, quad screens inhibin A to increase detection of trimsomys what is chorionic villi sampling? - looking for genetic disorders, takes a portion of placenta to test villi what is a amniocentesis? - prenatal genetic screening, lung maturity, and infection from sample of amniotic fluid what is an ectopic pregnancy? - where fetus grows outside of uterus, usually in fallopian tube non stress test - electronic fetal monitoring to observe acceleration of FHR in relation to movement what does a reactive non stress test mean? - 2 or more accelerations in 20 minutes (15bpm x 15 secs) 32 weeks; means baby's nervous system is intact and healthy Non reactive non stress test - lacks insufficient FHR accelerations over 40 mins. no accelerations contraction stress test - FHR in relation to uterine contractions. Negative results- good thing. theres no abnormal late decelerations during contraction Positive results- abnormal decelerations what do late decelerations mean? - uteroplacental insufficiency what is a biophysical profile? - non stress test (showing intact nervous system) and amniotic fluid volume index (reflecting kidney perfusion)............ *FHR acceleration, fetal breathing, fetal movements, fetal tone, and amniotic fluid* what is a toco? - fetal monitoring that is put on fundus to assess contractions how is intensity assessed for contractions? - palpation intrauterine pressure catheter that measures intensity in mmHg right occiput anterior (ROA) - fundus is at right lower quadrant. babies back is facing that way left occiput anterior (LOA) - babies back is facing left and forward, put monitor on left lower quadrant early deceleration intervention - reassure the parents that everything is fine what is a variable? - cord compression by fetal head nursing intervention for a variable - reposition mom to the left, amniofusion What is an uteroplacental insufficiency (UPI) invention? - stop patocene (or reduce) if being used for induction. start IV bolus, turn mom to left to open up vena cava, non rebreather at 10L, what does estrogen do during labor? - stimulates contractions, causes effacement, increases progesterone during labor - decreases, increases myometrial activity due to the decrease 100% effacement means - thinnest stage of cervix full cervical dilation marks the beginning of what stage? - stage 2 what is true labor? - contractions are at regular intervals, shortened intervals between contractions, increasing intensity with walking, *cervical dilation and effacement occur* false labor - contractions are irregular, no change in frequency, duration, and walking has no effect. No change in dilation or effacement what are braxton hicks contractions - regular and strong first stage of labor - from beginning of dilation to full dilation latent= 0-3cm active= 4-7cm transition=8-10cm second stage of labor - lasts from full dilation to birth; averages at about 50 mins.; mom relieved she can push, third stage of labor - lasts from birth to expulsion of placenta fourth stage of birth - first 2 hrs after birth, physiologic readjustment, homeostasis is reastablished, uterus begins to contract down to smaller size, promoting decrease in vaginal bleeding latent phases - mild contractions, comfortable without meds; can walk around like this for weeks 1-3cm psychologic adaptions to latent phase - feels able to cope with discomfort, relieved that labor started, anxiety starts coming up; they begin to nest active phase - progressive fetal descent, more painful, increase in strength frequency and duration of contractions (3-6cm) psychologic adaptions at active phase - anxiety increases, fears loss of control, decreased ability to cope transition stage - progressive fetal descent, dilation from 7-10cm psychologic adaptions for transition phase - withdraws into herself doubts ability to cope apprehensive and irritable terrified to be alone doesn't want anyone to touch her or talk to her What is the ferguson reflex? “primary powers" - fetus on top of ferguson plexus nerve causing the urge to push secondary powers (pushing) - presentation at pelvic floor, expuslive contractions, involuntary urge to push, "bearing down" efforts; can take about 3 hrs for first pregnancy why can't they push before 10cm? - if its not dilated enough it will swell and impede progress of labor open glottis - preferred method; provider supports you and you push when you feel the urge. closed glottis - provider tells when to push, FHR issues what are the 7 mechanisms of labor? (DEFIEEE) - Descent Engagement (0- -1 station) Flexion Internal Rotation Extension (under symphysis pubis) External Rotation Expulsion what is a birth plan? - legal document, must abide by it. Allocating for baby Spontaneous rupture of membranes (SROM) - water breaking on its own Artificial rupture of membranes (AROM) - causing water to break causes prostaglandins to be released, causing contraction with oxytocin, therefore inducing labor What color should amniotic fluid always be? - clear what does green amniotic fluid mean? - meconium present, neonatologist needed for possible intubation if baby is non-vigorous (floppy, not breathing) what is chorioamnionitis? - infection of amniotic fluid; document time, color, odor, and amount Is vaginal bleeding normal? - no. document amount, characteristics, and color 3rd degree lacerations - skin, mucous membranes, muscle of perineal body and extend to retail sphincter Ath degree lacerations - extends into the rectal mucosa and exposes lumen of rectum what is an episiotomy? - An episiotomy is a surgical cut in the muscular area between the vagina and the anus (the area called the perineum) made just before delivery to enlarge your vaginal opening. nursing interventions for the third stage of labor - promote newborn-family attachment (early contact, eye contact, talking, breast feeding) watch for signs of placenta encourage relaxation meds palpate fundus what are signs of placental separation? - fundal height rises, cord elongates, blood gush from vagina what is a kelly clamp? - clamps the cord cut from baby and other end to avoid mess immediate postpartum care - prevent hemorrhage pain bladder function newborn care, bonding, breast feeding fundal assessment every 15 mins for first hour, every 30 mins for second hour, and hourly until transfer to the PP unit APGAR score includes what? - heart rate (2) RR effort (2) muscle tone (2) Reflex irritability (2) Color (pink, 2) total of 10 acrocyanosis - extremities are blue in baby (common) wait an hour to do newborn assessment to allow bonding unless the APGAR is less than what? - 7; bring down to nursery for assessment what does it mean when the fundus is above umbilicus and deviated right? - full bladder, void immediately nursing interventions for fourth stage of labor - assess fundus every 15 mins for first hour (position, tone, location) lochia (color, amount, clots) assess and care for perineal vital signs every 15 mins monitor for swelling or hematoma ice for perineum pain, bonding, breast feeding where should the fundus be post delivery? - at umbilicus or below how do you assess amount of lochia? - scant small moderate large when does lochia become a concern? - golf ball sized clot or larger saturated pad in one hour doesn't go away in set amount of time what does a postpartum mom have if she is shaky or vomiting? - hypotension disadvantages of spinal block - intense blockade of the sympathetic fibers which may result in *hypotension* What should you give before a spinal block? - IV bolus of LR to increase cardiac output lumbar epidural blocks are injected where? - between the dura mater and the arachnoid advantages- pain, awake during birth disadvantages-*hypotension* nursing interventions for an epidural? - IV bolus, fetal monitoring for 30 mins, BP checks, foley cath always what causes a spinal headache? what can treat it? - caused by leakage from spinal fluid at the site of dural puncture. no headache when lying flat, but when sitting up. Treatment- blood patch when should a pain med be administered to decreessae the impact on the baby? - during the peak of contraction Prostaglandins stimulate..... - oxytocin Why can progesterone cause UTI - dilation of ureters, higher pH when is antenatal screening done? - women over 40 or family history antibiotics uterine inversion - uterine fundus collapses into endometrial cavity through cervix and is turned inside out after birth what do you do if you see part of uterus outside of vagina? - HOLD and CALL FOR HELP management for uterine inversion - immediate replacement tocolytics IV fluid (no oxytocin) surgery, blood, antibiotics, watch for signs of shock uterine rupture - separation of uterine myometrium or previous uterine scare with rupture of membranes what clinical manifestations are common with uterine rupture? - severe abdominal pain, changing uterine tone fetal distress/ bradycardia syncope vaginal bleeding shoulder plain, maternal tachycardia and hypotension management of uterine rupture - hemodynamic stabilization immediate C section delivery reparation of uterine defect hysterectomy subinvolution - late PPH fundal height remains high (failure to descend) lochia doesn't progress from rubra result of retained placenta how do you treat sub involution? - oral methergine for up to a week how to remove retained placental fragment - sonography to diagnose manual removal surgical procedure (dilation and curettage) what do tocolytics do? - relax the uterus involution - rapid reduction in size of uterus and return to prepregnant state How long does it take the uterus to descend? - level of umbilicus within first day of labor one finger breadth lower each day as muscle cells contract back to normal by day 10 exfoliatione - allows for healing of placenta site and important part of involution; may take up to 6 weeks hemostasis - compression of intramyometrial blood vessels as the uterine muscle contracts rather than platelet aggregation and clot formation. What hormone coordinates contractions? - oxytocin; promotes hemostasis what can breesast feeding stimulate? - oxytocin releases from pituitary gland and subsequent contraction what does slow trickling blood indicate? - laceration, assess mom and document blood's color amount and consistency what can persistent discharge of rubra indicate? - subinvolution late PPH when can ovulation start after birth? - 27 days after delivery what does persistent prolactin levels do to ovulation? - suppresses it when does breast milk start producing? - 2-Sdays PP What leads to rapid filling of bladder? - puerperal diuresis; women need to empty bladder every hour what can bladder distension cause? - excess uterine bleeding due to uterine ligaments being stretched, displacing the uterus white blood cell count after delivery - elevated to 30,000 (leukocytosis) how much blood is normally lost from a vaginal delivery? - 200-500 ml how much blood is normally lost in a C-section? - 700-1000mI when should anemia from blood loss return back to normal? - within 2-6 weeks How long does it take for hemostatic system to reach non-pregnant stage? - 3-4 weeks; risk of thromboembolism lasts 6 weeks when MUST you give a rh - mom Rhogam if her baby is rh +? - within 72 hours after birth; prevents sensitization to occur in mom labor augmentation - artificial stimulation of uterine contractions when spontaneous contractions have failed to result in cervical dilation or descent of fetus induction of labor - stimulation of uterine contractions before the spontaneous onset of labor, with or without ruptured fetal membranes for the purpose of accomplishing birth. when are induction or augmentation indicated? - maternal medical conditions (diabetes, etc) preclampsia/ eclampisa Premature ROM chorioamnionitis fetal demise Post term pregnancy non reactive FHR tachysystole labor patterns - contraction frequency of more than 5 contractions in a 10 minute period with less than 60 seconds of relaxation between contractions or uterine contractions lasting greater than 2 minutes; prolonged pressure on baby's head. When does tachysystole labor patterns normally occur? - high dose of oxytocin cocaine uterine rupture placental abruption homan's sign - pain in the calf of the leg upon dorsiflexion of the foot with the leg extended that is diagnostic of thrombosis in the deep veins of the area. what is the importance of testing DTR and clonus in a PP woman? - it is indicative of eclampsia/ preclampsia lightening - the feeling a mom gets when she feels the baby descend or "drop" 
