MATERNAL AND CHILD HEALTH NURSING

V/V Vulva / vagina

RV Retroverted

AV Anteverted

RF Retroflexed

AF Anteflexed

MP Midplane

EDC Estimated date of confinement

EGA Estimated gestational age

ELF Elective low forceps

LMP Last menstrual period

LNMP Last normal mens. period

PMP Previous mens. period

ROM Ruptured of membrane

PROM Premature ruptured of

membrane

RBOW Ruptured of bag of water

AROM Artificial ruptured of

membrane

SROM Spontaneous ruptured of

membrane
FTT Fetal heart tone

GFM Good fetal movement

IUP Intrauterine pregnancy

IUGR Intra uterine growth restriction

IUFD Intrauterine fetal demise

SVD Midline episiotomy

VTX Vertex

PIH Pregnancy induced hypotension

CST Contraction stress test

NST Non-stress test

OCT Oxytocin challenge test

C/S CS section

U/S Ultrasound

Q Quickening

PP Postpartum

AB Abortion

AFI Amniotic fluid index

AFP Alpha-feto protein

AMA Advance maternal age

BOW Bag of water

BRF Breastfeeding

BUFA Baby up for adoption

CE Cervical examination

VE Vaginal examination

IE Internal examination

FH Fundic height
FHR Fetal heart rate

FM Fetal movement

L & D Labor & delivery

LBW Low birth weight

OA Occiput anterior

OCP Oral contraceptive pill

PTL Preterm labor

SAB Spontaneous abortion

SB Stillbirth

SGA Small for gestational age

SOL Spontaneous onset of labor

SUI Stress urinary incontinence

TAB Therapeutic abortion

TAH Total abdominal hysterectomy

TOLAC Trial of labor after CS section

TOP Termination of pregnancy

TVH Total vaginal hysterectomy

VBAC Vaginal birth after caesarean

AC Abdominal circumference

AFG Adequate fetal growth

ANC Antenatal care

BW Birth weight

BV Bacterial vaginosis

CMV Cytomegalovirus

ECV External cephalic version

EFW Estimated fetal weight

FGM Female genital mutilation

FGR Fetal growth restriction

GD Gestational diabetes

GDM Gestational diabetes mellitus

HC Head circumference

IFG Inadequate fetal growth

IGT Impaired glucose tolerance

IPC Intrapartum care

LGA Large for gestational age

SGA Small for gestational age

PE SPre-eclampsia

PTD Preterm delivery

SPTB Spontaneous preterm birth

FLM Fetal lung maturity

AUB Abnormal uterine bleeding

LOF Leakage of fluid

NTD Neural tube defect

BTL Bilateral tubal ligation

D&C/

D&E

Dilation & curettage / Dilation &

evacuation

US Ultrasound transducer

MLE Midline episiotomy

BPP Biophysical profile

AFI Amniotic fluid index

NPNC No prenatal care

BOA

LPNC Late prenatal care

Born on arrival

VMI/ VFI

Viable male infant /

viable female infant

40 weeks gestational age

the number of completed weeks

counting from the 1st day of the

LMP

38 weeks fetal age

refers to the age of the

developing baby, counting

from the estimated date of

conception.

usually 2 weeks less than the

gestational age.

nausea & vomiting

cravings & aversions

heightened sense of smell

mood swings

round ligament pains

nipple changes

stretch marks

feeling the baby to move

strong kicks from the baby

swollen feet

leaking from the breasts

frequent urination

lochia

fatigue

sore, leaking breasts

"baby blues"

risk of postpartum depression

First trimester

Second trimester

Third trimester

Postpartum

Gravida / Gravidity

a woman who is pregnant / the

number of pregnancies

Parity

the number of pregnancies that

have reach viability (20wks of

gestation) whether the fetus was

born alive or not

Nullipara

means 0

zero pregnancies beyond viability

Primipara

one pregnancy that has reached

viability

Multipara

two or more pregnancies that have

reached viability

Preterm

pregnancies that have reached

20 weeks but ended before 37

weeks

Term

pregnancies that have lasted

between 37- 42 weeks

Postdate/Postterm

pregnancy that goes beyond 42

weeks

GTPAL
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divid

Systematic palpation of the

pregnant women’s abdomen to

determine several data

Explain what you will do to the

pregnant women

To make sure that the results are

accurate- tell the patient to void

Position: Dorsal recumbent

Draping Procedure: horizontal

Warm hands before palpation;

Cold hands stimulate uterine

contraction

When to do Leopold’s Maneuver:

can be done at 5 months but

best at 7-9 months

GENERAL TEST

Pregnancy test

Blood typing

RBC antibody screen

Papsmear test and HPV

testing

Urine screen for glucose

CBC

Immunity to Rubella

HIV screening Gonorrhea, Chlamydia, Syphilis screening Hepatitis B screening Urine culture for

asymptomstic bacteriuria

SELECTIVE TEST

Blood glucose / HbA1C

Testing for women at risk for

Type 2 diabetes

TSH for women with hostory

of thyroid disease

TORCH panel if exposure to

infection is suspected

Varicella zoster

Bacterial vaginosis test

TESTS FOR ABNORMALITIES

First trimester screening Chorionic villus sampling Cell free fetal DNA
BLOOD TESTS

Iron level

Blood glucose level

Rh factor

Pap smear

Monthly

Every 2

weeks

Every week

6 months

36 weeks

37 weeks -

delivery

least indicative

not a definite diagnosis

for pregnancy

S
U

eriod absent (Amenorrhea)

eally tired

nlarged breasts

ore breasts

rination increased (urinary

frequency)

ovement perceived

(quickening)

mesis & nausea

Pregnancy signs that the

nurse or doctor can

observe

L
E

ositive (+) pregnancy test (high

levels of the hormone: hCG)

eturning of the fetus when

uterus is pushed w/ fingers

(ballottement)

Objective

raxton hicks contractions

softened cervix (Goodell's sign)

luish color of the vulva, vagina,

or cervix (Chadwick's sign)

ower uterine segment soft

(Hegar's sign)

nlarged uterus

Definite diagnosis for

pregnancy

etal movement
palpated by a

doctor or nurse

lectronic device

detects heart

tones

he delivery of the

baby

ltrasound detects

baby

eeing visible

movements

Prolactin: Allows for breast milk production

Estrogen: Growth of fetal organs & maternal

tissues

Progesterone & Relaxin: Relaxes smooth muscles

hCG: Produced by placenta, prevents

menstruation

Oxytocin: Stimulates contractions at the start of

labor

• Lordosis: center of gravity shifts forward

leading to inward curve of spine

• Low back pain

• Carpal tunnel syndrome

• Calf cramps

• Striae

-Stretch marks (abdomen, breasts, hips, etc)

• Chloasma

-Mask of pregnancy

Brownish hyperpigmentation of the skin

• Linea Nigra

-“Pregnancy line” dark line that develops across

your belly during pregnancy

• Montgomery glands / Tubercles

-Small rough / nodular / pimple-like appearance

of the areola (nipple)

• ↑ Basal metabolic rate (BMR)

• ↑ O2 needs

• Respiratory alkalosis (MILD)

• ↑ Cardiac output

(↑ Heart rate + ↑ stroke volume)

• Blood pressure stays the same or a slight

decrease

• ↑ in plasma volume

• q Enlarges (May develop systolic

murmurs)

• ↑ GFR from ↑ plasma volume

• Smooth muscle relaxation

of the uterus = ↑ risk of UTI’s!

• ↑ Urgency, frequency & nocturia

• EDEMA

• ↓ FSH/LH due to ↑

Progesterone
• ↑ Prolactin

• ↑ Thyroxine • ↑ Oxytocin

• May have moderate

enlargement of the

thyroid gland (goiter)

• ↑ Metabolism & ↑

appetite

• Pyrosis ↑ Progesterone = LOS to

relax = ↑ heartburn

• Constipation & hemorrhoids ↑

Progesterone = ↓ gut motility

• Pica (Non-food cravings such as

ice, clay,

and laundry starch)

Non-pregnant levels: 200-400

mg/dL

Pregnant levels: up to 600 mg/dL

FIBRINOGEN

ANEMIA

-Dilates the cervix

-Released before ovulation:

14th day

-Mucus is watery, clear,

stretchy

-Spinnbarkheit: 6-12 cm
-Unsafe period

-13th day of the 28th day

cycle

-For 3-5 days

-Ph: 8

-Closes the cervix

-Released on the 16th day

-Mucus is decreased in amount,

sticky, cloudy

-Spinnbarkheit: 3 cm

-Safe Period

-Ph: 6

-Hormone that protects the

baby

-Dec. progesterone (AP) = Inc.

oxytocin (PPG)

TERATOGENIC DRUGS

A
S

halidomide

pileptic medications

etinoid (vit A)

ce inhibitors, ARBS

hird element (lithium)

ral contraceptives

arfarin (coumadin)

lcohol

ulfonamides &

sulfones

TORCH INFECTIONS

TORCH infections are a group of infections that cause

fetal abnormalities. Pregnant women should avoid these

infections!

oxoplasmosis

Par Virus-B19 (fifth disease)

ubella

ytomegalovirus
erpes simplex virus

Moving the fetus, placenta,

& the membranes out of the

uterus through the birth

canal

• Lightening

• Increased vaginal discharge

(bloody show)

• Return of urinary frequency

• Cervical ripening

• Rupture of membranes

"water breaking"

• Persistent backache

• Stronger Braxton Hicks

contractions

• Days preceding labor

- Surge of energy

- Weight loss (1- 3.5

pounds) from a fluid shift

→Used for estimating the expected date of

delivery (EDD) based on LMP (last menstrual

period)

1st day of last period: September 2, 2015

Minus 3 calendar months: June 2, 2015

Plus 7 days: June 9, 2015

Plus 1 year: June 9, 2016

LABOR

Date of LMP

+ 7 days

+9 months

anuary

arch

pril

ecember

Date of LMP

+ 7 days -3 months

+ 1 year

TRUE LABOR FALSE LABOR

• Occur regularly

- Stronger

- Longer

- Closer together

• More intense with walking

• Felt in lower back -> radiating to the lower

portion of the abdomen

• Continue despite the use of comfort measures

• Irregular

• Stops with walking / position change

• Felt in the back or the abdomen

above the umbilicus

• Often stops with comfort measures

• Progressive change

- Softening

- Effacement

- Dilation signaled by the

appearance of bloody show

- Moves to an increasingly anterior position

(baby's head facing mom's back)

• May be soft

• NO significant change in....

- Effacement

- Dilation

• No bloody show

• In posterior position

(baby's head facing mom's front of belly)

• Presenting parts become engaged in the pelvis

• Increased ease of breathing

(more room to breathe)

• Presenting part presses downward &

compresses the bladder = urinary frequency

• Presenting part is usually not

engaged in the pelvis

Using tape measure to get fundic

height in cm x 8 / 7

= AOG in weeks

Usually higher

Fundal height matches the

number of weeks between the

20th and 36th

ngagement

ecent

lexion

nternal

otation

xtension

xternal

otation

xpulsion

Beginning of the contraction

to the END of that same

contraction

• Lasts 45 - 80 seconds

• Should not exceed 90 seconds

Only measured through external

monitoring
Number of contractions from

the BEGINNING of one

contraction to the BEGINNING

of the next

• 2 - 5 contractions every 20 minutes

• Should not be more FREQUENT

then every 2 minutes

Only measured through external

monitoring

Strength of a contraction at its

PEAK

• 25 - 50 mm Hg

• Should not exceed 80 mm HG

Can be palpated Mild - nose

Moderate - chin

Strong - forehead

TENSION in the uterine

muscle between contractions

(relaxation of the uterus =

fetal oxygenation between

contractions)

• Average: 10 mm HG

• Should not exceed 20 mm HG

Can be palpated Soft = good

Firm = not resting

enough

The Birth Canal

Fetus & Placenta

Contractions

• Head first

• Presenting part: Occipital

(back of head/skull)

• Buttocks, feet, or both first

• Presenting part: Sacrum

• Shoulders first

• Presenting part: Scapula

FETAL STATION

Where the baby's presenting part is

located in the pelvis

PRESENTING PART?

Measured in centimeters

-Head, foot, butt

-Find the ischial spine = zero

-Above the ischial spine (-)

-Below the ischial spine (+)

+4 / +5 = birth is about to happen

ENGAGEMENT

Fetal station zero = baby is "engaged"

Presenting parts have entered down into

the pelvis inlet & is at the ischial spine

line (0)

When does this happen?

-First time moms: 38 weeks

-Already had babies: can happen when

labor starts

Assessed through

pelvimetry

Hip bones (innominate

bones)

Ilium, ischium and

pubis, coccyx, sacrum

False Pelvis- where the

uterus is

Linea terminalis-

separates false pelvis from

true pelvis

True Pelvis

Diagonal Conjugate
Distance of anterior

margin of the pubic to

the sacrum (pelvic inlet)

Widest anteroposterior

diameter

11.5-12.5cm

Pelvis (more important) True Conjugate (Vera)

From lower margin of pubis to

sacrum

Less than 1.5 or 2 cm from the

diagonal conjugate

Ischial Diameter (bi-ischial/inter-

tuberous)

Outlet (transverse diameter)

Always greater than 8 cm

Gynecoid

Round-shaped; most ideal

Wide antero-posterior

diameter

Anthropoid

Wide inlet, narrow outlet

Allows vaginal delivery

through forceps

Platypelloid

Oval
Wide transverse, narrow AP

diameter

Wide inlet, narrow outlet

CS delivery

Android

Pelvis that is narrow

on all sides

We are all android

before

Bone of women thins

-- widens

Height less than 4”10

Linea Terminalis

Imaginary line that

separates the false

from the true pelvis

Cephalopelvic

Disproportion

Baby’s head size is

not in proportion to

the maternal pelvic

size

Soft tissues

FIRST TRIMESTER

SECOND TRIMESTER
THIRD TRIMESTER

Ectopic

Abortion

H mole

Placenta previa

Abruptio placenta

Abortion

Loss of pregnancy before

fetus is viable (<20 weeks)

Early Abortion- before 16

weeks AOG

Late abortion- after 16

weeks AOG

o More dangerous

o Possible DIC

Spontaneous Abortion

Also known as miscarriage; 15-

30% of abortion

Chromosomal abnormality

Infection that damages

organs of the baby

Endocrine disturbance

(Hyperthyroid)

Trauma

Incompetent cervix – dilates

w/o uterine contraction

Induced

Abortion/Therapeutic

Performed to save the mother

Ectopic pregnancy

Habitual Abortion

3 consecutive times or

more abortions

Incomplete Abortion

Fetus is expelled

Placenta retained

Management- D&C,

suction curettage

Complete Abortion

All products of

conception expelled

Mgt: methergine,

antibiotic (pennicillins),

pain meds (mefenamic)

Threatened Abortion

Painless spotting with not effect on fetus

2 weeks rest: Complete bed rest; soft diet

given sedatives to prevent stimulus for

contractions; sex resume after 2 weeks

Missed
Abortion

Fetus dies in utero and is

retained

No caesarean section

Drugs to contract the

uterus

Laminaria – dried

seaweed that is

sterilized, absorb the

fluids, expand and

painlessly expand, then

given misoprostol

(Cytotec) intravaginally

and Oxytocin (Pitocin)

per IV

D&C to remove the

placenta

Signs & symptoms

Threatened Abortion- cervix is still closed

Vaginal bleeding/spotting

Painless

Inevitable/ Imminent

Fetus and clot expelled

Vaginal bleeding may be heavy, pain

on abdominal area and radiates to the

back

Contractions

Cervix dilated
Management

Complete bed rest

Soft diet: Prevent constipation; prevent

straining

Sedatives - stress can predispose the

abortion of baby

Admission in hospital only for observation

to observe for further bleeding

Cerclage

McDonald’s- temporary (12-14 weeks)

(NSD)

Shirodkar-bar- permanent

Purse String

Delivery by CS

D&C

Safe all the tissue that passes out for

histopathology

Might scar endometrium possible

placenta previa on the next pregnancy

Help cervix dilate (induction of Labor)

Laminaria- seaweed introduced into the

cervix; will swell if absorbed water --

cervical dilation

Misoprostol (Cytotec)- prostaglandin that

increases blood supply to the cervix

(more dilatable) -- softening of the cervix

Oxytocin (Pitocin/Syntocinon)

contraction of uterus

Dead baby can be expelled

Placenta removed through D&C

Possible DIC to mother

Management Restriction at home for 2 weeks

Can have sex after 2 weeks

Can go back to work after 2 weeks

50% of threatened abortions lose their babies

Causes

Genetic defect in the baby

Endocrine factors

Hyperthyroidism

DM (rare)

Infection

Systemic disorders

Psychological factors

Medications can be terratogenic

Incompetent cervix

Can be managed surgically

Dilates without uterine contraction

Frequent dilation- D and C

Habitual Abortion

Complication: Missed Abortion - DIC

Classical CS incision - forever CS

Home Management

Medical Therapeutic for

Spontaneous Abortion

1. Ultrasound

2. Bed rest

3. Intravenous fluids

4. Possible blood transfusions

5. D&C

6. RhoGAM given within 72 hours

post-delivery, post

amniocentesis and after D&C

ECTOPIC PREGNANCY Pregnancy outside the uterus

Fallopian

If in isthmus - more bloody (closer to

uterus); can be expelled vaginally 70%

tubal

If in ampulla- chronic bleeding (more

dangerous)

Acute – on the isthmus; bleeding form

rupture may go to the uterus and

manifest outside

Chronic – on the ampulla; bleeding form

rupture goes back and goes to the cul-

de- sac (Cullen’s Sign)

May compress phrenic nerve; shoulder pain

upon respiration; same side with ruptured

Manifestations
Cullen’s Sign

Bluish discoloration in the

umbilicus – hematoma because

of the bleeding underneath the

peritoneum

Cul-de-sac mass

Normally it is hollow

Shoulder pain

Referred pain

Compression of the phrenic

nerve

Side of implantation

Unilateral, lower quadrant, on and

of colicky pain (not ruptured),

sharp one- sided pain (rupture)

Ovarian Ectopic

Rhythmic contractions of the

fallopian tube pushes the

zygote backward to the ovary

Cervical Ectopic

Hypermotility of the zygote

then implants itself in the

cervix - IUD

Cervix has low blood supply

cannot fully nourish the baby

Remove the portion of with the

fetus then cerclage is done

Abdominal
Laparotomy done to get the

baby

Placenta is retained in the

attached organ

ECTOPIC PREGNANCY Pregnancy outside the uterus

Medical Treatment for Ectopic

Pregnancy

Administration of methotrexate IM

(prevent multiplication)

Surgical treatment – salpingostomy

via laparoscope

Risk Factors:

History of PID

IUD

Abnormal tube

Endometriosis

Abnormal thickening of the

endometrium due to hormonal

imbalance

Estrogen

Management- androgen (male

hormones)

Can damage the liver

Given Depo-Provera

40% of young women are at risk

HYATIDIFORM MOLE/MOLAR PREGNANCY

Gestational trophoblastic disease - proliferation of the trophoblasts (bigger than age

of gestation); no embryoblast

Trophoblast > formation of amniotic fluid > elevated HCG

Benign - precursor of choriocarcinoma (malignancy)

Inc. FH, No FHT, hyperemesis, red or brownish vaginal bleeding which may also include

vesicles (diagnostic!)

Degeneration of the chorion into the fluid-filled grape like chorionic epithelioma

NO KNOWN CAUSE

Extremes of age - very

young and very old

Genetic - Asian women

Low protein diet

Use of Clomid – stimulate

excretion of egg cell that is

empty (fertility drug)

Risk Factors

Increase in fundic height

Increased hCG

Hyperemesis

No fetal heart tones

Red, brown vaginal

discharge

Ultrasound reveals mass

without fetal skeleton

Snowstorm pattern

Manifestations
Suction evacuation of the mole

hCG monitored after

Curettage - if she still wants to

become pregnant

Labs drawn – serial hCG

monitoring (blood)

CXR – to establish if metastasis is

seen

Birth control for minimum of one

year

If mole is cancerous –

chemotherapy (methotrexate)

Management

Hysterectomy

Monitor level of hCG for 1 year after

surgery

Teach the patient to delay pregnancy for 1

year

Follow up for choriocarcinoma

Provide emotional support

Methotrexate- drug of choice for

choriocarcinoma

Since it is folic acid antagonist, free from

folic acid diet since it will neutralize the

effect

Chest x-ray

To determine if there was metastasis to

another area
Lungs- most lymphatic organ

Use birth control (Combined birth control)

Management PLACENTA PREVIA

Low lying placenta/ attachment in

the lower uterine segment

Risk Factors

Uterine abnormalities

No invasive History of uterine

surgery

Causes:

Unfavorable deciduas

Multiparity

Twins (dizygotic/fraternal) –

different placenta

Manifestations: Painless, bright red

bleeding from the placenta, soft

uterus

Diagnosis

Ultrasound

Types

Low lying - placenta is very

near the cervix but does not

cover it

May be NSD, may have

minimal bleeding, double

set up when bleeding

occurs
Marginal - 1 cm before you

touch the placenta

Partial – placenta covers 50%

of the cervical ox

Complete/Total - placenta

covers the entire cervical O

Excessive bright red

bleeding with no pain, not

in bleeding

Directly CS

No IE in suspected previa

treatments

Only through CS (partial

and total)

NSD (marginal and low

lying)

Double set-up: NSD and CS

Bleeding because area of

attachment (lower part of

uterus) does not contract

Management

Complication

ABRUPTIO PLACENTA Sudden complete/partial separation of a

normally implanted placenta after 20th

weeks AOG
OBSTETRIC EMERGENCY

HPN

History of placental abruption

Multipara

Substance Abuse

Risk Factors

Partially or Completely Separate

Concealed

Separation at the middle

More dangerous

Blood will not b able to come out

-- sink into muscles -- board-like

rigidity (internal bleeding)

Shultz, Couveaire

Apparent – separation from

marginal area where blood mixes

with amniotic fluid

Types

Sharp like abdominal pain

Board-like abdominal pain (Couvelaire)

Changes in the shape of the uterus

Usually w/ vaginal bleeding - Dark red (not

fresh blood)

Middle of pad- scant

Fully saturated pad- 30 ml of blood

1/3 pad- 10 ml
S/Sx of shock fetal distress (bradycardia)

Assess abnormal coagulation

99% of babies die

Assessment

ABRUPTIO PLACENTA Sudden complete/partial separation of a

normally implanted placenta after 20th

weeks AOG

OBSTETRIC EMERGENCY

Position on modified trendelenburg

Blood from the extremity will go to more important organs

Keep patient warm

Cover her with several layers of sheets

Monitor CVP

Right pressure of the heart

If increased- slow down the IVF to KVO

Fluid volume deficit

Priority nursing intervention

Then altered perfusion

Management

ABRUPTIO PLACENTA PLACENTA PREVIA

Sudden separation Low implantation

With or without bleeding Bright red

Painful

Couvelaire uterus

Painless

Soft uterus

Alert the health team to provide maximum coordination of care

Place woman on modified trendelenberg or left side lying (minimal bleeding)

Begin IV with a gauge 18-19 needle in anticipation of blood infusion

NPO in anticipation of surgery

Administer oxygen PRN at 2-4 L/min to provide adequate fetal oxygenation despite

decreasing circulating volume of blood

Assess blood loss (weigh pads), FHR, VS, I and O, Uterine contractions

Omit vaginal or rectal exam

Order type and cross match 2 “U” whole blood to restore maternal circulating

blood

Assist with placement of CVP (assess pressure of blood that goes to the heart)

Pulmonary wedge pressure (pressure that leaves the heart)

Rise in CVP – put to KVO

Low in CVP – hasten delivery

Set aside 5 ml of blood in a test tube and observe if it will clot in 5 mins. If it did not

clot, suspect DIC

Maintain a positive attitude towards fetal outcome to maintain bonding

Emergency Implementation for Bleeding in Pregnancy

Primipara - highest

Young and old

(+) HPN in hypertension

Low socioeconomic group

Low protein diet

Edema – generalized anasarca

Proteinuria

HTN

Has convulsion

Corrected within 6 weeks after delivery

Cause is unknown; due to hormonal

change

Risk

Manifestation

Seen on 20-24 weeks

Accompanying symptoms are hypertension, edema, and proteinuria

Eclampsia - convulsions

BP will be normal after 6 weeks

Noted in the second trimester

Stage 1 (Pre-eclampisia)

Mild Severe

BP 140/90

Edema of finger and

face

Proteinuria +1 (<2g/day)

– less than 2 g of

protein per liter

BP 160/110 or above

Anasarca – third

spacing edema

Proteinuria + 3 or 4

(more than 2g/day)

Epigastric pain

(aura)

Visual disturbances

– inc ICP

Altered sensory and

perceptual function

Stage 1 (Pre-eclampisia)

Management

Bed rest on left side

Diet alterations: High protein, low fat, low salt

Normal CHO to avoid use of protein for energy

Monitor fetal status – times two of normal visit

Twice a week on the last month

Mild

Altered perfusion

Altered sensory and perceptual function (priority) – promote quiet, non stimulating

environment

Room of patient is 20 feet away from the nurses station

Limit visitors to visiting time to promote rest and sleep

No TV and close eye work

High protein, low salt, low fat

Bed rest anticonvulsant medications

Fluid and electrolyte replacement

Corticosteroids are given: bethamethasone

Anti HTN meds

Severe

Stage 1 (Pre-eclampisia)

Anticonvulsant

IM bolus, Buttocks, Deep IM, Z- track

Check DTR,RR, BP, FHR,

I&O(released through the kidneys; monitor

I&O; maintain

30 ml before giving next dose) before giving

first dose

Prepare calcium gluconate; max of 8 hours

May be replaced by

Hydralazine (vasodilator)

Potassium sparing (non-thiazine) because

loss of potassium can affect the heart

12 gms- respiratory distress

>12 gms- circulatory collapse

If IV- use soluset - over a period of 20

minutes

Stinging to the tissue - lidocaine is added to

decrease pain

Magnesium sulfate first before lidocaine

Magnesium Sulfate (TL: 4-8 mg/dl)

Stimulates Surfactant

production for the baby

Given for possible preterm birth

Injection within 2 days before

birth

Betamethasone – better but

expensive ( 2 injections)

Dexamethasone – cheaper (4

doses)

Corticosteroids

Epigastric Pain (aura for seizure)

Grand mal

With loss of consciousness

Tonic-clonic

Delivery: CS

Given epidural if NSD to anesthesize -

prevent seizures

Greatest risk for convulsion

1st 24 hours after delivery because of

loss of fluid-- increased BP to

compensate for the fluid loss

ECLAMPSIA

Grand mal (generalized tonic clonic seizure w/ loss of consciousness)

Invasion
When VS is fluctuating, restless

Aura (warning) – epigastric pain! (may

signal HELLPS – hemolysis, elevated

liver enzymes (DIC), decreased

platelet)

Protect the tongue

Side-lying position (DO THIS

FIRST!)

Tongue depressor is NOT safe, use

mouth gag

Tongue blade (rubber)

Stages

Tonic-clonic / Contraction

20 sec tonus (muscle contraction) before clonus

(alternate contraction and relaxation)

Prevent self-inflicted injuries: Time the duration of

seizure

to know how much time brain lost

oxygenation

Lock jaw

Prepare for safe environment; padded side rails

Do not restrain or stop

Post-ictal

Coma/Resuscitation
Oxygen first before suction

Reorient the client to prevent anxiety

which may cause another seizure

Antianxiety medication (Valium)

*Status epilipticus – may cause death

Mild preeclampsia

Bed rest on the left side

Diet alteration

Monitor for fetal status

Severe preeclampsia

Bed rest

Anticonvulsant medication

Fluid and electrolyte replacement

Corticosteroids are given:

bethamethasone to increase surfactant

production antiHPN meds

Mgt: Forceps assisted, analgesia to prevent

stimulation

Nursing Care

Human placental lactogen (HPL) –

counteract effect of insulin

Estrogen and progesterone –

antagonist of insulin

Placental insulinase – enhances

degradation of insulin

Placental insufficiency – Maternal

insulin utilization
Effect on baby

Macrosomia – wide shoulders,

fractured clavicle

Organomegaly – heart, liver

Preterm delivery

Hypoglycemia – due to

hyperinsulinism inside the mother

Effect on mother

More prone to infection; UTI – sugar

is increase in urine

Greater incidence of PIH and

eclampsia

Inc incidence of hydramnios

Distocia – CS management

Atony of uterus after delivery -

hemorrhage

Not diagnosed in the 1st trimester

Diagnosed in 2nd trimester- 5th month

OGTT (glucose challenge)

Ability to use glucose in the body

Get FBS – baseline; if abnormal, patient is

diabetic

Intake of 50 gms of oral glucose

Check blood glucose 1 hour after

<7.8mmol, 140 mg/dl or less

7.8 mmol of less - normal

>7.8, 140- abnormal

If abnormal, ingest 100 gms of oral glucose

Check blood glucose 3 times for every hour

2 positive- (+) for GDM

Dx:

Only INSULIN is given – 2nd trimester

Later half of pregnancy more insulin

requirement

No OHA

Crosses placental barrier, teratogenic

Further aggravate insulin production in baby

Insulin

Last trimester (increased demand)

Labor- will have insulin pump

Postpartum- at risk for hypoglycemia

Postpartum- 6 weeks, diabetes should resolve

Management

6 meals- because of

insulin to prevent

hypoglycemia

200 calories

additional in GDM, in

normal 300cal

45- CHO

35- protein - delays

absorption of

glucose

20- fat
Eat a light meal

before exercising

Returns to pre-

pregnancy state after

6 months

Diet:

GESTATIONAL DIABETES

Breast

3rd day woman will start to release milk (colostrum)

Engorgement in 2-3 days in multipari; primi in 5 days

First time – 7 mins max (primi)/ 12 mins max (multi)

Marmet’s technique - gently pull the nipple twice if inverted nipple

Football hold - benefits CS -- no pressure in abdomen

Uterus decends 1-2cm fingerbreaths per day (involution)

In 10 days, uterus is not palpable

Uterus

Firm and contracted

Fundus

After birth, midway between the umbilicus and pubis

Fundus goes down by 1-2cm (fingerbreadths) a day

About 1oth day, uterus is not palpable anymore

Bladder

First 24 hours urine = 2500-3000ml

May have dehydration; inc temp

Bowel
Give full meal even with IV

IV is only for dehydration

2 days after delivery, resume of BM

if not able to defecate (constipation) -- laxative or

suppository

Lochia

Episiotomy

R – redness

E- edema

E – ecchymosis

D – discharge

A – approximation

Needs order form MD, perineal prep, must be 12

inches away

postpartum bleeding, is a normal discharge of

blood and mucus from the uterus after

childbirth

Homan

s Sign

Emotions

Major sign of sepsis – low grade fever/chills

B – best for baby

R – reduced allergic reaction

E – economical

A – always available

S – safe

T – temperature always right

F – fresh always

E – emotional bonding

E – easily established

D – digestible

I – immunity

N – nutritious

G – GIT disorder decreased

Unique Characteristics of Breastmilk

Respiratory rate: 30-60 BREATHS /

MIN

Heart rate: 110-160 BPM

180 if crying

100 if sleeping

Take apical pulse for 1 full min.

Temperature: 36.5 - 37.5 C

Blood pressure:

not done routinely

Systolic: 60 -80 mmHg

Diastolic: 40 - 50 mmHg

Retractions

Nasal Flaring

Grunting ig
ns

of Respiratory Distres

Head circumference:

32-39 cm

14-15 inches

measure above the eyebrows

Chest circumference:

30-36 cm

12-1 inches

measure above the nipple

Length:

44-55 cm

17-22 inches

Weight

2,500-4,500g

Suction with bulb

syringe / deep suction

Newborns are obligatory

nose breathers

Dry with a blanket or

place in warmer.

1st Priority = AIRWAY

2nd Priority = WARMTH

Caput Succedaneum
edema

crosses the suture lines

Molding

abnormal head shape that results from

pressure (normal)

Fontanelles

Bulging: increase ICP or hydrocephalus

Sunken: dehydration

Cephalohematoma

birth trauma

does not cross the suture lines

Should have:

2 Arteries & 1 Vein

Should be dry, no odor,

& no drainage

Blood flow from umbilical vessels & placenta

stop at birth

Acrocyanosis

Blueness of hands and feet (normal

during the first 24 hrs of life)

Closure of:

Ductus arteriosus

Foramen ovale

Ductus venosus

Transient murmurs are normal

PROGESTERONE
The hormone that promotes development of

endometrium

It relaxes smooth muscle of the uterus

ESTROGEN The hormone that promotes growth of the

uterus and breasts during pregnancy

Renders connective tissue in the pelvic region

more flexible

15-20% by term Pregnancy metabolic rate

GLUCOSE Primary energy source of fetus

FATS Primary energy source of the mother

doubles (2nd tri) Plasma volume during pregnancy

HEMODILUTION Result of increase plasma volume

Dilution of the blood

increases

Glomerular filtration rate during pregnancy

low birth weight

SGA status

Consequences of inadequate weight gain

during pregnancy

SGA

Infant born at a lower weight than expected

for length of gestation

<5.5 lbs at birth Low birth weight

25-35 lbs. NORMAL weight gain (preg)

28-40 lbs. UNDERWEIGHT weight gain (preg)

15-25 lbs. OVERWEIGHT weight gain (preg)

11-20 lbs. OBESE weight gain (preg)

I can do all things through Christ

who strengthens me.

Good luck future RN!

PHILIPPIANS 4:13

References

Brown Trial Firm (n.d.). APGAR Score. Retrieved from https://browntrialfirm.com/birth-injury-

lawyer/understanding-apgar-score/
MSD Manual (2021). Leopold maneuver. Retrieved from https://www.msdmanuals.com/en-

kr/professional/multimedia/figure/gyn_leopold_maneuver

Tuttle, K. (2020). The Complete Nursing School Bundle. NurseInTheMaking LLC.

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