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1. Anatomy and Physiology Reproduction Female: myometrium, External: protective (vulva) endometrium Internal: o Fallopian Tube: connect o Vagina: birth canal, fornix peritoneal cavity c vagina (where sperm collect) and uterus  Protect against trauma  Isthmus o Uterus: implantation site  Ampule- fertilization  Cervix= external  Fimbria- funnel like opening, protective enlargement entrance to uterus  Transport ovum  Corpus = uterine body o Ovaries: produce female = perineum, gametes and hormones Male: o Epididymis External: penis and scrotum o Vas deferens Internal: o Urethra o Testes Female reproductive structures: support weight of uterus Bony pelvis o Directs presenting part o Support and protect o Form axis of birth canal • True pelvis: below pelvic brim o Size and shape must be Ischial spines: reference point adequate during labor o Female = gynecoid o Evaluate descent • Breast False pelvis: above pelvic brim, o Nourishment and antibodies 2. Family Centered Address whole family • Family at center • Family-professional collaboration • Family professional communication • Cultural diversity 3. Culture Norms: Care Coping differences and support Family-centered peer support Specialized service and support systems Holistic perspective

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Value of children Number desired Gender and status Influenced by: status of family unit and role of extended family

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View of pregnancy Taboos o Sitting in doorways, hot vs cold, bad air • Discipline • Prenatal care (natural state) Cultural competence o Self awareness, Understand and respond to understanding of different individual needs from a different cultures, ability to adapt background • Biological: Identify and integrate family beliefs o Genetic, physical, disease Requires:

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pattern (B: sickle cell anemia, H: DM and lactose intolerance, W: CF, celiac, Crohn’s) Communication: o Language

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o Nonverbals Time orientation Nutrition/food: o Rituals, special occasions, fasting, value large children (H)

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4. Legal and Ethical Issues Legal Scope of practice • Informed consent: protect patients rights Standards of care o Emancipated minor <18; self o Protect public, judge quality support o ANA, AWHONN o Mature minor: 14-15; o Clinical practice guidelines understand treatment risks Client/Patient safety • Right to privacy: o JCAHO; infant at high risk due o HIPPA to: dosage calculations, o Patient self-determination dilutions, communication act: advance directives, living barriers will, DNR Ethical: religion—shape views Maternal-fetal conflict: fetus = separate client • IU fetal surgery: therapeutic o Forced c/s, coercion of high research for anatomic lesions risk behaviors • Reproductive assistance: ART; IVFET; surrogate Abortion: period of viability (20 weeks) • Embryonic stem cell o Personal beliefs, cultural • Cord blood banking norms, life experiences, 5. Dysmenorrhea vs. PMS Dysmenorrhea o NSAIDS (prostaglandin Painful period inhibitor) Primary= craps s underlying o Self care (exercise, rest, disease heat, good diet) o Uterine contractility,  Vitamin B and E decrease uterine artery blood flow • S2: a/c pathology of reproductive tract Tx: oral contraceptives (inhibit o Endometriosis; residual PID, ovulation) fibroids, cysts, IUD PMS prostaglandin inhibitors a/c Luteal phase (2weeks prior to o Diuretics, COC’s menses) o Vitamin B and E, calcium, s/s repeat at same stage avoid Na and caffeine Tx: progesterone agonists and 6. Methods of Contraception Fertility Awareness methods: Natural family planning • Free safe, acceptable- religious

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believs A: natural, non invasive D: extensive initial counseling; requires abstinance periods +: cheap, easy to get -: apply prior to sex, ‘messy’

E: may be less reliable o Ex: basal body temp, calander/rhythm; ovualtion method, symptothermal e: minimally effective when alone

Spermicides: •

Barrier: male and female condoms, cervical • cap, diaphragm, IUD +: easy; no side effects, prevent • spread of STIs IUD: +: up to 5 years (Mirana) or 10 years (ParaGuard) • -: cramps/bleeding 1st 3-6months; Hormonal: +: menstrual sx decrease; predictable • -: increase risk of blood clot; no Sterilization: +: permanent; no added cost after -: nonreversible; requires gen •

-: some fitted by doctor, placed prior to sex, spermicide e: excellent when used correctly check placement after every period; not protect against STIs e: very while in place smoking; no heart condition e: highly effective when used correctly anesthesia for women; local for men e: completely

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7. Endometriosis o Surgical removal of uterus cells found in endometrium travel and ovaries outside endometrial cavity o Hormonal therapy (through fallopian tube, embedded outside uterus o Min sx: tx c observation, analgesics, NSAIDS Women 20-45 • Implication s/s o Infertility o pelvic pain o dyspareuria  May have difficulty; o abnormal uterine bleeding seek help, find out endometriosis, tx c Tx: surgical removal COC’s and hormone o Relieves pain therapy 8. Toxic Shock Syndrome o Rash on trunk Causes: o Hypotension o Toxin released by o Dizziness Staphylococcus auerus o V/D Risk factors: o Myalgia o Superabsorbent tampons o Cervical cap or diaphragm • Tx: o Colonization of staph aureus o Hydration o Broad spectrum antibiotics S/S: o Fever ( >102) • NI:

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ERYTHROMYCIN dysuria. future 10. lesions cuttrettage/laser AIDS fatal • profound implications to fetus Nurse: provide information about: fertility. white/gray d/c (w cream. of both partners implications on pregnancy. frothy. pulrulent d/c. no tampons 6-8 weeks postpartum • • • • • • • • • • • • • • • 9. chancre sores • Tx: BENZATHINE PENICILLIN G Secondary: chancre sores • ***BLOOD TEST ON EVERY disappear. Sexually Transmitted Diseases Prevention Limit sexual contacts • Decrease high risk behaviors Protection Trichomoniasis Yellow-green. immunosuppressants. flu • Tx: antiviral: ACYLOVIR.o Educate about prevention  Correct use of tampons. thin. Yeast infection vs. dysuria. cauliflower like • tx: cryotherapy. asymptomatic • Tx: ANTIBIOTICSL CEFIXIME AND Purulent green-yellow d/c. Bacterial Vaginosis Bacterial Vaginosis: Cause: o Diagnosis: ‘clue’ cells seen on wet mount  alteration on normal o Tx: METRONIDAZOLE bacterial flora S/S:  Alternate use of Clindamycin vaginal  thin. methods of transmission. general health. treatment infection. like sx VALACYCLOVIR No cure Syphilis Primary: flu-like. oral fishy smell) clindamycin Vulvovaginal Candidiasis: Most common form of vaginitis Cause:  r/t use of COC’s. DOXYCYCLINE Herpes Blister-like vesicles on genitals. diaphragm. lower abdominal pain • Tx: DOXYCYCLINE/ AZITHROMYCIN May cause disease in NB: o If pregnant: AMOXICILLIN Gonorrhea urinary frequency May cause PID. odorless d/c • Tx: METRONIDAZOLE Vaginal itching Chlamydia prophylactic antibiotic: Asymptomatic. wart like PREGNANT WOMANS Condylomata acuminata: HPV genital warts.  Candida albicans o o o o . surgical removal.

cream. curdy. frequency. problems with fertility Risk factors: o sexually active females (15o early onset of sex 29) o recent gynecologic procedure o multiple sex partners o IUD S/S: o chills and fever o Purulent d/c and irregular o Bilateral cramping of lower vaginal bleeding o Malaise. dyspareuria o Diagnosis: hyphae and spores seen on wet mount • o Tx: antifungal drugs  Intravaginal butoconazole. malaise Less common. tablets o Recurrence: monitor glucose (for glycosuria) • • • 11. more severe • Tx: S/S: sudden onset: o Hospitalization o Chills. prevention of union b/t sperm and ova. white vaginal d/c  Severe itching. Pyelonephritis Cystitis: lower UTI S/S: • Dx: urine culture o Dysuria. prevention of mobility of fertilized ova through fallopian tube. V.antibiotics o S/S:  Thick. PID Cause Chlamydia or gonorrhea—usually tubal infection o Infection may cause: scarring of fallopian tubes. • Tx: PO antibiotics (SEPTRA DS) low grade fever Pyelonephritis: upper UTI o May have N. increased temp. Cystitis vs. frequency antibiotics • • • • • • . miconozole  Nystatin suppository. flank o IV antibiotics or oral pain. Pap Smear Cervical cytology testing • Herpes or trich detection o Yearly • Bethesda system o Examine cells from cervix • Inflammation of IUD can cause and endocervical canal • Tx: repeat in 3-6mo o Detects cellular abnormalities o Colposcopy Abnormal: o Endocervical biopsy o Abnormal cervical cells or o Cryotherapy malignancy o Laser conization Best indicator of cervical cancer 13. urgency. urgency. N. dysuria. dysuria. V abdomen Tx: o Iv fluids o Tx of partner o Antibiotics o Removal of IUD 24-48h after start of antibiotics 12.

nutrition • • • • . neonatal • Partners history: presence of complications genetic conditions. anesthesia used. # of living o Immunizations children.10 days o Quickening after implant o 20th week 15. complications. blood type. attitude Current medical history o Blood type and Rh factor • Social history: for teaching o Age.• • • • • • • • • • • • 14. # of abortions o Presence of abnormal sx Hx of previous pregnancies: length • Occupation hx: physical demands of pregnancy. tobacco. o Emotional problems caffeine o SES. type of job of birth. Prenatal History and Care Initial Prenatal history: o Illicit drug use and drug Current pregnancy st allergies o 1 day of LMP o Presence of disease Past pregnancy conditions o # of pregnancies. length of L&D. Signs of Pregnancy Subjective (presumptive) changes: veins more visable Amenorrhea: absense of period st • Quickening NVP: in 1 trimester o Fluttering sensation in o Morning sickness abdomen Excess fatigue o Occurs ~18-20weeks after Urinary frequency LMP (as early as 16wks) Breast changes o Gradually increase in o Increased pigmentation. Hx of chronic illness. educational background o Medications (herbals: o Ethnic background contraindicated b/c not regulated by FDA o Housing (stability) o Use of alcohol. intensity and frequency Objective (probable) changes: body of uterus against cervix Change in pelvic organs (only st physical change in 1 3mo) • Enlargement of abdomeno Caused by increase vascular especially if continuous and a/b amnorrhea congestion • Braxton Hicks contractions Goodell’s sign: softening of cervix o Palpated after 28th week Chadwicks sign: blue/purple discoloration • Change in skin pigmentation Hegar’s sign: softening of isthmus • Positive pregnancy test (detect of uterus hCG) McDonald’s sign: easy in flexing Diagnostic (+) changes: Fetal heartbeat • Visualization by US: o Doppler: 10-12 wks o Gestational sac: 4-5wks o Transvaginal o Fetal parts and fetal mvt: 8wks Fetal movements o Transvag-gest-sac.

38-42wks regardless if born dead or alive Antepartum: time between • Nullipara: no births at >20wks conception and onset of labor. gestation prenatal • Primipara: 1 birth at >20weeks Intrapartum: time from onset of gestation. glucose (GTT: 2428wks) o 28-36wks: q2wks o Vaginal swab for GBS o 36+: every week (36wks) Assessment: o Expected psychological stage o VS/Wt 16. o Spider nevi Hct: <30 • Nose WT o Nosebleeds.• • • • Subsequent Prenatal History: o Mcdonalds method Discomforts o Edema Danger signs: vaginal bleeding. o Urinalysis edema. oliguria. thoracic  Over wt: limit to 15lbs breathing • Skin o Supine Hypotensive o Linea nigra syndrome o Striae gravidarum o Temp an BP: WNL o Mask of pregnancy o Pseudoanemia: Hgb: <10. o Uterine size and FHB abdominal pain. dysuria o Blood type of AFP (16Antepartal visits: o 0-28wks: q4wks 18wks). Normal physiological changes of Pregnancy o Recommendations VS (CV) o Pulse may increase by  Normal wt: 25-35lbs 10bpm  Under wt: up to 40lbs o R increase. stuffiness o Varies but should be • Mouth proportional c gestational o Gingival hypertrophy age • Chest/lungs • • • • • • • • • • • • . Common Obstetric Terms pregnant Gestation: #weeks since 1st day of LMP • Primigravida: pregnant for 1st time Abortion: birth <20weeks gestation • Multigravida: in 2nd or subsequent or weighs <500g pregnancy Term: normal duration of • Para: birth after 20 weeks pregnancy. HA. regardless of alive or true labor until birth of placenta dead Postpartum: time from delivery of • Multipara: woman c 2+ births at placenta and membranes until >20 weeks gestation woman’s body returns to • Stillbirth: infant born dead after prepregnant state 20weeks Preterm: labor after 20 weeks but • TPAL: before completion of 37 weeks o T: # of term infants Postterm: labor after 42 weeks o P: # of preterm Gravida: any pregnancy (g) o A: # of abortions o L: # of living children Nulligravida: woman never been 17. pain >101F. V.

Abnormal signs during pregnancy 20. fluids before • Breast tenderness: well supporting meals. ask for help • Nasal stuffiness: cool mist vaporizer • • • .• • • • • o Transverse diameter > anteroposterior diameter Abdomen: o Progressive enlargement o FHR heard by Doppler ~12 weeks Extremeties o Possible edema late: H20 retention Spine o Lordosis Pelvic area: o Vagina s d/c o Cervix closed o Growth of uterus Lab tests: o Physiologic edema (Hct) o Small degree of glycosuria • • • • • • • Uterus: enlargement. Commonly used methods to determine EDC Naele’s Rule 280 days = mean pregnancy • accurate if menses q28 days begin c 1st day of LMP • delay in ovulation effects formula o subtract 3months o irregular cycle o add 7 days o birth control Physical exam fundus uterine size in 1st 10-12 weeks o FH in cm correlates well c Fundal height wks gestation o McDonalds method: o Increase lag in progression  From top of symphysis  M2M or W2W may pubis to top of uterine signal IUGR Ultrasound head visualized Measure fetal parts o Biparietal diameter (BPD) o C-R measurement  12/13 weeks. nipples more erectile. Braxton Hicks ~4mo Cervix: mucous plug o Increased cervical vascularity also causes: Goodell’s and Chadwicks sign Vagina: acidic secretions. susceptible to Candida infection Breasts: more nodular. at night cotton underwear Fatigue: plan rest. no greasy foods bra Urinary frequency: decrease intake • Increased vaginal d/c: bathe daily. but most  Fetal age until fetal accurate 20-30weeks 19. areolae darken o Montgomery’s tubercles enlarge o Colostrum: antibody rich yellow secretion N/V: due to elevated hCG Constipation Slow peristalsis and motility: Miralax • • • • • 18. Discomforts of pregnancy (and nursing interventions) 1st trimester: N/V: avoid odors.

avoid overeating and lying • leg cramps: heat. jitteriness. small HC.• • • • • 2nd and 3rd Trimester: pelvic tilt exercises Heartburn: eat small. altered brain development. dialated pupils. increased incidence of infection. increased risk of spontaneous abortion. FAS. varicose veins: elevate. IUGR. BM suppression (anemic). Illicit drug use during Alcohol: CNS depressant. high • • • • • • • • • • • • • • . cerebral hemorrhage. Marijuana Associated with impaired • coordination. increase arm use ice packs PRN backache: good body mechanics. Pulmonary edema. cerebral infarctions. stillbirth • Fetal: o Increased risk for IUGR. apnea Increased risk of IUGR SIDS born to heavy users Withdrawal sx: o Trembling. highly addictive a/c malnutrition • Pregnancy delirium tremens (PP) Fetal: o Mental retardation. Cocaine: Maternal: o Seizures/hallucinations. exaggerated startle reflex Exposed in utero o Increased risk for SIDS o Breast milk o Extreme irritability and V. breathing problems fetus: o high risk for IUGR and mech aspiration o hypoxia o restlessness/shrill. preterm birth. memory and critical • thinking • Risks r/t dose Ecstasy MDMA • Produce euphoria and empathy • Death Critical issue during fetal brain Heroin CNS depressant narcotic Alters perception. frequent meals. malformations of GU tract o Lower APGAR (breathing and CV problems) o Marked irritability. ankle edema: elevate legs. cardiac anomalies. midface hypoplasia. w/d seizures. FAE shorter body length. support avoid gas-forming foods hose • Carpal Tunnel: avoid repetitive hemorrhoids. 21. D. potent tetratogen • Maternal: o malnutrition. hand movements. avoid constipation. microcephaly. dorsiflex feet down after meals • dyspnea: good posture to sit/stand. liver disease. excessive crying development Possibility w other amphetamines Withdrawal sx: o Drowsiness. abruptio placenta. euphoria IV administration. sleep: semi-fowlers dorsiflex feet • flatulence: chew food completely.

prevent of fatty acids production of  If untreated. cells breakdown stores of fat and protein for energy. nephropathy renal threshold glycosuria may result from renal Influence of DM on pregnancy: Maternal risks  Major cause of death in o Hydraminos: increased infants amniotic fluid. 1st diagnosed o Type 2: insulin secretory during pregnancy Influence of pregnancy on diabetes: o Difficult to control. insulin impairment. excessive urination b/c of CNS. lead to surfactant coma and death o Polycythemia o Infections  Decreased ability of  Monilial vaginitis and glycosylated Hgb to UTI because of release O2 increased glycosuria o Hyperbilirubinema (favor bacterial growth)  Inability of liver Fetal risks enzymes to metabolize o Congenital anomalies the increased billirubin . risk for ketoacidosis. result of  Most involve heart. Diabetes Mellitus in Pregnancy endocrine dx: inadequate insulin. retinopathy may develop. beta cells destroyed intolerance. decreased requirements vary. V Methadone used for opioid dependents • blocks withdrawal symptoms • decreases or eliminates cravings and seixures o seizures = ~72 hours a/c pregnancy complications and abnormal fetal presentation prenatal exposure: o reduced HC and LBW • • • 22. N. result: nitrogen balance and keytones (fat metabolism) S/S o Polyuria o Polyphagia o Polydipsia o Weight loss Classification o Type 1: absolute insulin defect. insulin resistance o Gestational DM: glucose deficiency. V. glucose metabolism impaired.• • • pitched cry o irritability and fist sucking. skeletal system fetal hyperglycemia  Sacral agenies: sacrium  PROM and onset of and L spine fail to labor can occur develop and LE may o Preeclampsia-eclampsia develop imcompletely o Macrosomia  Diabetic pregnancy b/c of vascular changes  Excessive growth o Ketoacidosis: o IUGR o RDS  Increase in keytone bodies released in  Increased levels of fetal blood from metabolism insulin.

Incompetent Cervix multiple gestation a/c repeated 2nd trimester abortions • Dx: positive history of repeated 2nd possible causes trimester abortions o cervical trauma • Tx: o congenital cervical/uterine o Shirodkar procedure anomalies (cerclage) o increased uterin volume (as c • • • • • . hypoxic o Bring on a vaso-occlusive crisis. 50g o 3 hour GTT. fetal death. increase carbs for 3 days. Autosomal recessive Folic Acid deficiency o F: abortion. 100g o blood gluecose monitoring o Assessment of LT gluecose control: HbA1c  polycythemia Measure RBC and glucose over 120 days (RBC life) • HbA1c: 5 = WNL assessment: US at 18 weeks Repeat at 28 weeks (growth for IUGR or macrosomia) BPP o Fetal    • • • • 23. Anemia a/c pregnancy destruction of inherited dx Hb < 10g/dL o 8-12 weeks Hb/Hct test • S/S o Fatigue due to insufficient Hb production r/t o Paleness nutritional deficiency in iron or folic o Lack of energy acid during pregnancy or Types: o Infant: NTD Iron deficiency o Want green leafy vegetables • Sickle cell o Fetal: LBW. Gestational Trophoblastic Disorder (molar pregnancy) o Vaginal bleding Pathologic proliferation of o Hyperemesis gravidarum (b/c trophoblastic cells hCG levels so high) Hydratidiform mole o Abnormal development of • Therapy: o Suction evacuation placenta occurs resulting in hydropic vesicles  Cutterage to remove o Trophoblastic tissure placental fragments proliferates  Hysterectomy for Classic sign: uterine enlargement > excess bleeding gestational age 25. 1 hour. o Multivitamin/prenatal vitamin IUGAR o Take with OJ (increases • Thalassemia absorption of iron) o Blood disorder 24. preterm.resulting from Client Therapy • • Goal: maternal plasma glucose control Screenings: o 1 hour GTT  at 24-28 weeks.

Placenta Previa covered Cause of bleeding during 2 half o Marginal: edge of placenta (last 20 weeks) covered Placenta implants in lower uterine o Low-lying: close proximity segment rather than upper portion but not covering os As the lower uterine segment • Monitor FHR closely contracts/dilates later. Ectopic Pregnancy Implantation of fertilized ovum in other site than uterus o Positive hCG present in blood and urine Chorionic villi grow into tube wall or • Tx: implantation site o Rupture and bleeding into abdominal cavity o o Results in sharp unilateral pain and syncope (fainting) Only on site she ovulated from Referred shoulder pain. placental o Fetus may develop villi torn from wall exposing uterine sinuses at placental site  Hypoxia o Complete: internal os  Anemia completely covered • Never vaginal exam if suspected o Partial: internal os partially nd • • • • • • • 28. lower abdominal pain. nutrition alkalosis. Hyperemesis gravidarum o Correct dehydration: IV fluids Excessive vomiting during o Improve nutritional status pregnancy Increased hCG may play role  Vitamin supplements Severe cases dehydration  Total paranteral o Fluid-electrolyte imbalance. metabolic acidosis. vaginal bleeding  METHOTREXATE IM if future pregnancy is desired Surgical therapy: salpingostomy or sapingectomy .   • • • Reinforces weakened cervix by encircling it at the levels of the internal os c suture material Purse-string suture: places in 1st trimester or early in 2nd c/s may be planned  • NI: suture may cut at term and vaginal birth o Monitor for premature labor o Monitor for premature rupture o Teach client signs of both o Contact HCP immediately • 26. • Nuring care: supportive decreased urinary output o Maintain relaxed Tx: environment o Control vomiting: Antiemetics o Maintain oral hygiene (ZOFRAN)  Acidic state o Control F&E imbalance: o Monitor weight (qd) POTASSIUM CHLORIDE o Monitor signs of (prevent Hypokalemia) complications 27.

NDD. Polyhydraminos and Oligohydraminos Polyhydraminos >2000mL amniotic fluid • Fetal Implications o Malformations. prepare for IV therapy Nursing responsibilities: o Assess FHR.29. monitor BP and P. observe signs of shock. preterm. large placenta  Vaginally: (danger of prolapsed cord and Maternal implications inability to do it slowly) o SOB. IUGR r/t placental insufficiency. diabetes. support Oligohydraminos: Approx < 500mL Causes: o Postmaturity. Non-stress Test • • • • at 30-32 weeks gestation assess fetal status using electronic fetal monitor basis: when fetus has adequate O2 and intact CHS. edema in LE from vena cava compression  Amniocentesis (sterile o Fundal height > gestational technique) weeks • Care: monitor for complications. monitor for expulsion of fluid o left tilt semilfowlers or side lying o 2 belts: tocodynamometer (holds device of detection. Abruptio Placenta • • • • • Premature separation May result in severe hemorrhage o Death to mother. cord compression (variable decels) Therapy: o if term: induction o fetal monitoring. prepare equipment. or both May lead to clotting dx of mother Frequent assessment of uterine tone and measurement of abdominal girth NI: o Assess bleeding. slow progress Fetal implications o Abnormalities. there are acels of FHR and FM procedure: • . Rh sensit. amnioinfusion c ROM. renal malformations Fundal height < gestational weeks Fetus easily palpated Fetus not blottable Maternal Implications: o Dysfunctional labor. amount of bleeding over time. fluid removed o anencephaly. collect/organize data. fetus. hypertensive disorder. assess coping of woman in crisis • • • • • 30. pulmonary hypoplasia. 2 holds US transducer that detects FHR Interpretation • • • • • • • • 31. swallow and inspire fluid and prolapsed cord (when ROM) urinate • Therapy: a/c malformations and neuro dx o Supportive. obtain order to type and cross match for blood. O2 available.

Aminocentesis the 3rd trimester procedure to obtain amniotic fluid for genetic testing (early: 15/16 weeks) for fetal abnormalities or to • may be used to screen for: determine fetal lung maturity in o down syndrome . not good o Unsatisfactory  Cannot be interpreted • • • • • • 32. Contraction Stress test quality lasting 40+ Demonstrates reaction of FHR to seconds in 10minutes s stress of uterin contraction evidence of late decels Enables identification of fetal risk • indicates fetus for asphyxia can handle FHR response to contractions hypoxic stress of If placental reserve is insufficient: UC o Fetal hypoxia o Positive o Depression of myocardium  Shows repetitive o Decrease in FHR persistent late decels Procedure with >50% of the o Contractions: spontaneous or contractions induced with Pitocin o Eqivocal or suspicious: Interpretation:  Nonpersistent late o Negative: decels or decels r/t  3 contractions of good hyperstimulation 33. over 20 minutes o Nonreactive  Reactive criteria not met.o Reactive  >/=2 accels of FHR c FM of 15bpm lasting >/= 15 seconds. L/S ratio • 2:1 @ 35 weeks = normal fetus o low risk of RDS • • • • 35. Bipophysical profile test Comprehensive assessment of 5  FT >/= 1 episode of biophysical variables extension and flexion o Fetal breathing movement  AFV: single vertical o Fetal movements posket >2cm o Fetal tone • AFI >/= 5cm o Amniotic fluid volume  NST >/= 2 accels of o Reactive FHR c activity >/= 15bpm for >/= 15 seconds in 20 min Interpretation: o Max score: 10. no partial o Normal findings credit  FBM >/=1 episode o Combination of US and NST lasting >/= 30 seconds o Help id healthy or within 30 minutes compromised fetus  FM >/= 3 movements o Indicated when risk of in 30 minutes placental insufficiency Lecithin/sphingomyelin 34.

maternal lab studies  4 in 20 minutes or 8 in • Management: 1 hour o IV infusion---promotes o documented cervical changes maternal hydration o cervical dilation >1cm and o Tocolytics—medication to cervical effacement of 80% stop PTL or more • Nursing: Management: o Id woman at risk o Assess cervicovaginal o Assess progress of labor fibronectin o Administer medications  +fFN test b/t 22 and 37 weeks = at risk • Possible causes and risk factors: .o trisomy 18 and neural tube defects • • • 36. thromboembolis m  • • • • • 37. assess early contractions S/S. Preterm labor o assess cervical length via US Occurs between 20-36 weeks o obtain Hx of previous PTL Diagnosis: o asses presence of infections. PROM spontaneous rupture before labor preterm PROM: before 37 weeks maternal risk for infection increases o chorioamnionitis: intraamniotic infection r/f bacterial infection before birth o endometriosis: postpartal infection of endometrium o risk for abruptio placenta Fetal risks: o Risk of RDS • o Sepsis o Malpresentation and prolapse of umbilical cord • Prevention of infection: o Sterile spectrum to detect amniotic fluid o Limit vaginal exams o Maternal infection present:  Antibiotics asap. o Documented uterine educate clients. depends on what infection is caused by • Macrolids and penicillins o Absence of fetal infection: gestational age <37 o information about fetal lung maturity Hospitalization and bedrest  CBC  C-reactive protein and urinalysis  Continuous and intermittent fetal monitoring  Regular NST or BPP • Look for color/odor  VS q4h Fetal fibermectin—swab to determine if going into preterm labor Fetal lung maturity studies: o Maternal corticosteroid administration  BETAMETHASONE (CELESTONE) • IM x 2 doses 24h apart (12 mg each) • SE: increased blood sugar • S/S: HTN.

o Excess contractions.uch AFI. anticonvulsants o Corticosteroids: (Betamethasone (enhance babys lungs) o Antihypertensive: Procardia: stops calcium from getting to the heart= slows down HR = not contracting as much = less pressure on arteries • • • • • . bacterial infection • • 39. BP Magnesium Sulfate decreases o Anticonvulsant o NI to watch: o LAST LINE. placental abruption. causes problems for  Seizures st o 1 use: PTL baby. seizures. 8 in 1hr) Indomethecin  respirations (before o NSAID. decreased AFI o 2nd use: PIH Nifedipine (Procardia) o Antihypertensive • Terbutaune: o Calcium-channel blocker. PIH Pregnancy induced hypertension o Gestational or transient HTN. IV only  Increase heart rate— o Stops threshold and CNS assess for tachycardia. Chronic PIH o Cannot start before 20weeks gestation o Resolves within 72 hours after placenta releases o Resolves by itself o Any BP above 140/90 Pathophysiology o Decreased levels of vasodilators o Less of normal vadodilation capability o Increase level of vasoconstrictors o Concurrent vasospasm o BP begins to rise after 20 weeks • Maternal risks: o Hyperreflexia and HA. Premature. too . Tocoyltics excitability Uterine relaxants: STOP PRETERM o NI to watch: LABOR  contraction pattern (4 INMT (ITS NOT MY TIME) in 20min. increased morbidity and mortality Management: o Bed rest. abruptio placenta o DIC o Ruptured liver and PE o HELLP syndrome Fetal risks o SGA. PPROM. take HR o Watch to see if slows before contractions o When P increases. renal failure. high protein diet. ischemia. extra babies. helps stop PTL adm) o Can only stay on 72h (NI and  DTRs/Clonus SE) o Monitor. educate 38. o Commonly used (Adrenergic blocks calcium from getting Agonist) to uterus o Given subQ 2/5mg. cervical • • • factor. hypermagnesemia. preeclampsia-eclampsia. hormonal permissions.

if not maternal circulation sensitized. placenta previa marked jaundice (anytime mixture of Prevention blood) o Screen for Rh incompatibility  Invasive procedure and sensitization • Anemia marked fetal edema o Antibody screen: CHF marked jaundice  Indirect Coombs test: • • • • • • . CHF.  Destruction of RBC o Elevated Liver enzymes cannot be used for RBC. measures positive baby number of Rh positive Fetal blood cells cross into antibodies. jerly. • abnormal 3+ brisker than average  2+average response  1+ diminished response. low normal  0 no response.• NI: o VS q4h (respirations) o Auscultate lungs q shift o NST daily. antibodies • If positive: 1st child not affected 300mcg RhoGam subsequent preg: at 28 weeks and o Rh antibody enters fetal 12h after delivery circulation o Give RhoGam when…  Result: hemolysis of  Pregnant Rh.women fetal RBC and fetal with no antibody titer anemia  At 28 week gestation Fetal risks  Mother whose FOB is o Rh hemolytic disease st Rh positive or unknown o Anemia (1 )  After each abortion and o Erythoblastosis fetalis 72h PP  Marked fetal edema  Amniocentesis and (hydrops fetalis). edema = PIH  • 40. clonic respirations. high bp. daily weight o Check proteinuria once daily (urine dipstick) o Assess DTR and clonus  4+ hyperactive. pressure from high BP—  From blood flow artery bursts obstructed by fibrin o bleed from every orphus deposits (LFT) o very hard to stop o Low platelet count 41. Rh Imcompatibility measure of mothers Rh negative women carries Rh blood. abnormal sudden weight gain. HELLP syndrome and DIC HELLP:  Thrombycytopenia rd o 3 stage of cascade of • DIC waterfall o 4th stage of cascade of o Hemolysis waterfall. Monitor I and O. 2nd test o Result in production of Rh done at 28weeks. after DIC = death o all clotting factors used up.

both hands gently down on pubis  cephalic prominence or brow  45. Leopold’s maneuver Indicates probably location of FHR Prep o o Empty bladder. presentation. mobility 2: move hands on pelvis  back feels smooth 3: 1 hand just above symphysis  head? Breach? Engaged? 4: facing feet. lie of fetus o Methods o 1: palpate abdomen w both hands note shape. stages of labor • 1st stage o cervical dilation  onset of true labor cervix dilated 10cm . consistency. notify 43. Dilatiation and Effacement 46. Methods for recording fetal activity Dr Maternal assessment o Kick counts • ALONE o Amniocentesis o NST o L/S ratio o CST o Oxytocin test o Count FM at same time of o Non-stress test day o Estriol level  If <10 in 3 hours.radiates to front o Intensity increase c walking o Dilation and effacement are • False o o o o o o progressive labor Irregular contractions Do not increase in duration and intensity No change in interval b/t contractions Pain in abdomen No effects with walking No change on cervix • • • • • 44. lie on back. False and True labor • True labor o Contractions at regular intervals o Increase in duration and intensity o Interval b/t contractions shorten o Pain in back. feet on bed o Purpose: o Evaluate maternal abdomen o Evaluate position.neurologic damage (Kernicterus) 42.

Induction or Augmentation of Labor (23) Amniotomy: o Descent and indirect • Induction of labor pressure on uterus • AROM. • Manipulates hormones and composition. uterus cramps th 4 stage Hemostatic stabilization o Increase pulse. decrease BP (tachycardia) o Uterus remains contracted o Thirsty and hungry 47. frequency and duration. no turning back. Rectal pressure. fetal descent  Transition (8-10cm): painful. V 2nd stage • • • o expulsion o complete dilation end of birth o urges to push o sense of purpose rd 3 stage o placental  separation and delivery  hormones released  rush of blood. Fetus descents rapidly. intense contractions. E&D begin.• o 3 phases:  Latent (0-3cm): regular mild contractions. increased anxiety/excitement  Active (4-7cm): Contractions increase in intensity. increase in intensity. accelerates labor • Allows assessment of color. N. odor mechanical factors • Delayed until engagement o Prostaglandins Labor Induction Methods: Cervical Ripening: .

Nonreassuring fetus (1st hour) o Misoprostol (CYTOTEC)  Stimulate onset of contractions  Various routes   o +: no required monitoring o -: uncomfortable—cramping. bleeding o may not induce labor • goal: stable contractions q2-3min lasting 40-60 seconds o changes in effacement.Softening and effacing Medications: o Prostaglandin agents (CERVIDIL)  Intravaginally  When induced is indicated but not emergent • GDM. dilation and station Monitor for: o BP and P changes.labor induction • Cause fetal head to move down Contractions become stronger cause ROM • • • At full term +: shortened labor. increased risk of infection 49. determine presence of meconium (distress). postdates. Internal and External FHR monitoring (18) Progress of labor assessment o preterm labor • indications: o decreased FM o previous hx of stillborn at o Nonreassuring fetal status 38+ weeks o presence of complication of o Meconium staining pregnancy o TOL for VBAC o induction of labor External: Ultrasound sound waves) placed on abdomen • Transducer (emits continuous . hypertonicity (not soft) o FHR and rhythm Stop if: o Contractions >90seconds o Contractions <2min apart o Fetal late decels • • 48. contractions. SROM vs AROM SROM • Spontaneous rupture AROM: • Artificial. Stripping of membranes: • Mechanical method • Internal os rotation 360 degrees 2x o Separating amniotic membranes Pitocin: • initiating uterine contractions • enhance ineffective contractions (augmentation) • assess FHR and contractions prior • begin primary IVF o mixed in 500-1000mL of IVF (LR) o piggybank Pitocin into primary IVF at closes port  control/titrate at IV pump • • LGA +: sent home -: SE: hyperstimulation. FHR monitoring -: increased risk of umbilical cord prolapse.

Tachycardia and BL (18) Baseline: • normal: 110-160bpm Bradycardia: • ominous if a/b: • <110 o decreased LT variability o late decels • causes: o profound hypoxia o = Nonreassuring o maternal HTN Tachycardia: o cord compression o fetal arrhythmias • >160bpm o uterine hyperstimulation • causes o early hypoxia o abruptio placenta o maternal fever (accel fetal o uterine rupture .o Sound waves bounce off the Toco fetal heart and are picked up • by electronic monitor • Moment by moment FHR displayed on screen • Internal: Internal spiral electrode • Screws into occipit • • Must: o Membranes ruptured o cervix dilated 2cm o presenting part down against cervix IUCP: • replaces TOCO. NI for non-reassuring FHR patterns o Persistant and severe variable decels o Prolonged decles Intrauterine resuscitation o Corrective measures used to optimize O2 exchange within maternal-fetal circulation should start without delay Perform vaginal exam o Detect prolapsed cord Decrease uterin activity by d/c IV Pitocin or administer a tocolytic (terbutaline) to decrease contraction frequency and intensity Administer O2 via facemask • • • • 51. rest between fetus • and side of uterine wall Signs: • variations from normal heart rate pattern and decreased fetal movement • Meconium-stained amniotic fluid and presence of ominous FHR pattern o Persistant late decels Nursing Interventions: • Optimize maternal position (L side) • Begin IV infusion or increase flow rate o Or if cord prolapse is suspected • Assume knee chest position (Tocodynamometer) Telemetry system: battery operated transmits signal to receiver connected to monitor Placed over uterine fundus o know presenting part provides more accurate continuous data than external o signal is clearer o movement does not interrupt it 2cm and ROM 50. FHR Bradycardia.

short duration o 4-7cm (active) may aid . distraction. Systemic pain medications during labor vs regional pain medications Systemic pain medication: relaxation • Goal: provide max pain relef at min o 7-10cm (transition) min use risk to mom and fetus to woman and may lead to • All systemic meds cross placental resp depression of newborn barrier by simple diffusion • Opioid analgesics • Med action in the body depends on o Stadol or Neubain rate metabolized by liver enzymes and excreted by kidneys  Most common in active phase of 1st stage • High med doses may remain in fetus for long periods of time  Less SE than Demerol because fetal liver enzymes and or morphine kidney excretion are inadequate for  Stadol: IV. rapid onset • Timing:  Neubain: IV.o o o o metabolism maternal dehydration maternal HTN amnionitis Maternal hyperthyroidism • o Brethezine (cardiac stimulant) o Fetal anemia Ominous if a/b: o Late decels. less o Perineal massage for pain. Crowning 54. o <4cm (latent)prolong labor q3h PRN and depress fetus  Advantages: rapid onset. o Controlled breathing pattern perineal discomforts (gradual expulsion o Supportive. cervical. severe variable decels. pain. 3-4th degree laceration) nulligravida o mediolateral (larger. infection. pain) o Side-lying for pushing o Warm/hot compress • additional complications: o blood loss. Episiotomies and Lacerations (23) Episiotomy: • 2 types: • Preventative measures o midline (heal faster. comfort measures. perineal o Precipitous birth (<3hours) • Trickle of blood o Macrosomia • Risk factors: o Pitocin o Forceps or vacuum assisted o nulliparity 53. evaluate REEDA Laceration: use • Vaginal. avoid o Natural pushing during labor rectal. 10-20mg. 0.5-2mg metabolizing analgesic agents q4h. decreased variability 52.

resp. can be combined o Anesthesia to lower vagina. little/no urge stage. 2nd stage. fetal o Bruising. V. tremors RD  Considerations: Regional analgesia and anesthesia: Anesthesia • May produce breakthrough pain. perineum • -: numbness of LE. relief during • Transvaginal—intercepts signal at prolonged labor and PP. status o Monitor contractions and tell Epidural block: woman when to bear down • Entire pelvis Pudendal Block: • +: fully awake. decreased 15min. perforation of rectum. heavy regional block • indications: • Newborn risks: o maternal exhaustion. decreased • Pain relief for latter part of 1st uterine contractions. • Agents contribute to increase blood smaller med volume flow (vasodilation) • -: blockade of sympathetic nerve Analgesia fibers = increased rate of HTN • Pain relief to body region alt. edema. with opioids vulva.reverses narcotic Disadvantages: cross depression placenta  RD. east of adm.  Se: tachy. HTN tissue Spinal Block: • Block conduction of nerve impulses • Directly into cerebral spinal fluid • Absorption depends on vascularity • Mostly for c/s of area • +: immediate onset. Uteroplacental blood flow trauma to sciatic nerve. premature placental lacerations. bladder episiotomy repair • Nursing care: • +: ease of adm/absense of o Monitor BP q1-2min for maternal HTN. position. HTN. may o Fentanyl not be adequate  50-100mcg over 1o Narcan 2min  Counteracts RD effects  SE: brady. facial distress. o BP monitoring monitor VS. increased ability to cough  55. rest and pudendal nerve regain strength. of FHR and hypoxia • Injecting opioid—fentanyl—along • Nursing care: with anesthesia o Bolus • Nursing care: void. then q15min discomforts of low forceps or o Continuous FHR monitor vacuum o Bladder (cath) • -: possible broad ligament o Side lying to maximize hematoma. RD produced by injecting local • Hot spots anesthesia directly into nervous • SE: itching. must inject Continuous Epidural Block: along with presenting part • Less N. Forceps and Vacuum extraction (23) Forceps-assisted birth: of labor. shorten 2nd stage cephalohematoma. transient . birth and to push. HTN. N. • Temporary loss of sensation sedation. separation. no RD. hypotension.

increased bleeding. cerebral hemorrhage • Maternal risks: o Lacerations of birth canal. post op meds. Newborn Reflexes (25) Protective: • Blinking • Yawning • Coughing Others: • Rooting o Adequate for nutritional intake o Turns head and opens mouth to suck when one side of face is stroked • Sucking • • Sneezing Drawing back from pain o Object inserted in mouth. adm antibiotics. IV lines. perineal edema Vacuum Extraction: • Facilitate birth by suction to fetal head • • • In coordination with contractions. lap sponge count. descent occurs. infection s2 lacerations.facial paralysis. systems. FOB at head. automatically sucks Tonic neck o Fencing position o Head to one side. promote bonding Antacid. fetal head is born Progressive descent with 1st 2 pushes Procedure limited to prevent (risks): o Cephalohematoma o Brain injury o Jaundice (reabsoprtion of bruising at attachment site) • • • • • • 56. bruising. Cesarean Birth (23) Most common Indications: o Nonreassuring fetal status o Cephalopelvic disproportion o Lack of labor progression o Placenta previa o Maternal infection o Previous c/s Preparation: o Informed consent. positioning. arm and leg on same side extend while opposite side flexed • . abdominal prep. fundal checks. care o Displace uterus 15 degrees of incision. assist Nursing care: o Routine postpartal care system and returning bowel sound including fundal checks o Assessment of maternal pain o Care of incision level and provision of pain o Monitoring I and O relief o Assessment of respiratory Most common risks: o Hemorrhage o Infant death o Uterine rupture Care: o Continuous EFM o IV fluid o Internal monitoring Prostaglandin agents induction should be avoided if possible 57. adm. assess cath.

coordinated with sucking .• • • o Persists until 3 months Plantar grasp o Pressure on ball of foot elicits curiling of toes Palmar grasp: o Pressure on palm elicits grasp Moro o Sudden disturbance = startled o Response: flexion of knees. barrel shaped o Cry o Breasts: engorgement Measurements: o Abdomen: soft. dome shaped o Weight  Umbilical cord: o Length • White. may before d/c appear asymmetrical d/t • Falls off within 1molding 2 weeks o Fontanelles o Genitourinary:  Anterior: diamond.  Void pale yellow and closes at 8-12 weeks urine 6-10x a day o Hair o Hips o Face  Abduct to >60 degrees o Eyes with no clicks or snaps  True color change at  Ortolani’s maneuver: 6mo spine and knees flexed  Blocked tear duct and hip is abducted opens at 2mo  Barlows maneuver o Nose: sneeze a lot. pug nose • Adduct thigh.  May not void 12-24 close at 18months hours after birth  Posterior: triangle. o Mouth: gag. may cry  • Disappears by 6months • • Babinski o Stroke sole upward and across ball of foot o Elicits fanning and extension of toes o Disappears by 12months Stepping o Held upright with one foot on flat surface.. moro reflex o Respirations o Chest: clavicles straight and o Bp intact. attention o Heartrate to sound. gelantious o Head circumference with 2 arteries 1 o Chest circumference vein General: • Clamp removed o Head: 1/4th of body size. stiffen body. will ‘step’ Trunk incurature (Galant reflex) o Stroking spine cause pelvis to turn to one side o Newborn is prone • • • • • 58. arms in tense extension  Finger spread forming ‘C’. swallowing press down. Newborn assessment (25) reflex Time of birth  Epstein pearls = small APGAR white specks on gum VS lines o Temp o Ears: hearing test.

may have small dimple at base but without connection to spinal cord o Skin  Acryocyanosis: bluish discoloration of hands and feet  Mottling: pattern of dilated blood vessels caused by fluctuation in circulation  Milia: baby acne • • • • Mongolian spots: dark flat bluish pigments on lower back and butt • On asian afrian and Hispanic  Lanugo • Begins to decrease 3640weeks  Vernix caseosa • Decreases with increased gestational age st o Anus: 1 stool: black and tarry  12-24h after delivery  becomes greenishbrown for 203 days  formula: pale yellow  Brease: loose golden  • • • • 59. length. ice packs. ‘positional’ clubfoot o Spine:  C shaped. no hot showers o Nursing  Support lactation  Dependent on infant sucking. cabbage. Ballard Gestational age assessment Evaluates 6 neuromuscular and 6 physical characteristics performed • 6 neuromuscular 1st few hours after birth o posture o square window sign Score of 1-5 assigned to each o arm recoil Total is related to gestational age o popliteal angle (degree of Ratings marked on graph with knee flexion) weight. BUBBLE-HEB • Breasts o Engorgement/tenderness? o Nonnursing  Suppress lactation • Tight bra. Postpartum Assessment.dislocation felt as femoral head slips out of acetabulum o Feet  Creases on soles. and HC to classify o scarf sign newborn based on maturity and IUG o heal to ear extension SGA • 6 physical characteristics: o <10% o skin o lanugo AGA o 10-90% o plantar surface (creases should cover at least 2/3rd’s LGA foot surface) o >90% o breasts SGA and LGA: frequent glucose o eyes/ears monitoring and early feedings o genitalia 60. successful .

auscultate bowel sounds x 4 o Bowels sluggish o NI: stool softeners. cracks. encourage ambulation and encourage fluids o c/s: hypoactive Lochia o Amount. clots  Foul odor = infection o d/c of blood and debris after delivery o c/s: less Lochia  higher risk of PP hemorrhage o no large clots o 3 types  Rubra: day 1-3 dark red  Serosa: day 4-9. topical anesthesia.. erectility) Avoid soaps on nipples • • • • • > input) o Routine I &O Bowel o Perineum: sims position: REEDA. pink/brown  Alba: day 10+. grand multiparas (>6). character. complete expulsion of placenta and membranes  Slow: subinvolution: prolonged L&D. full urinary bladder. infection. sitz bath. then 1finger breadth each day for 10 days  Firm or boggy: • Boggy = soft/spongy = not good o Can cause hemorrhag e  Midline or deviated: • Always deviated to the right • Midline = good • R = bladder is full o Afterpains o Involution  Enhancing: uncomplicated L&D. constipation. urgency. overdistension of uterus Bladder o Should void 6-8hours after delivery o Assess frequency. burning o Evaluate ability to empty o Palpate for bladder distension o Postpartum diuresis (output production and delivery of milk Assess nipples (redness. retained placental fragments. yellowwhite (creamy o BF mom speed up involution so more Lochia in beginning  Get to Alba quickly Episotomy or perineal lacerations o Inspect perineum for REEDA o Inspect for hemorrhoids o NI: observe s/s infection  Manage ice packs. odor. early ambulation. hemorrhoids o Flatus. not diagnostic Emotional Status . BF. • •  Uterus o Fundal height: position  Height: when placenta is expelled—goes down to umbilicus. analgesic (Ibuprofen)  Teach peri-care o must look at from back Homans sign o Pain in calf on dorsi-flexion of food is recorded as positive o Indicates thrombophlebitis  Deep pain = DVT st o 1 line predictor. anesthesia.

Rubella • Routine screening of pregnant women for rubella immunity is recommended 63. Mag Sulfate If uterus is firm and still bleeding suspect laceration (firm = constricted Q15min x 4 Every labor gets 2 units cross matched blood waiting o Lochia flow fails to progress from rubra to serosa to alba normally o Tx with Methergine • • • • • • 62. multiple gestation. condition: hemolytic disease of • .• o Determine phase of • Bonding psychological adjustment o Emotional relationship with o Postpartum blues: infant st  1 14 days Other assessments o Pulse: 50-90 bpm Vital signs o R: 18-24 o Temp elevations (only 24 hours) • Education o BP remains consistant with o Self care BL during pregnancy 61. Postpartum Hemorrhage (32) Blood Loss • Vaginal: >/= 500mL • C/S: >/= 1000mL Cause • uterine atony (boggy uterus) • lacerations—especially forceps • subinvolution: start involution then stops o usually fragments Risk for uterine atony: relaxation of uterus • overdistension of uterus d/t large baby. multiparity o polyhydraminos o grand multiparity Nursing Interventions: • Assess vaginal bleeding • Assess uterus for bogginess o If boggy fundal massage • Assess hg and hct • Assess for bladder distension Late Hemorrhage • Frequent result of subinvolution or retention of placental fragments • Subinvolution: o Fundal height > expected • • • 10pt drop in Hct uterine rupture: placental abruption uterine inversion: top of fundus comes in on itself and does not contract o macrosomia retained placental fragments (main reason) low platelet count d/t PIH Med’s: Pitocin. RhoGAM Given IM to prevent immuniological o Vaccination in case of susceptible pregnant women is often given immediately after giving birth.

nadir. Cephalopelvic Disproportion (22) pelvis Fetal head too large to pass bony o No descent • .• • • newborn Prevents sensitization of maternal immune system Prevents Rh imcompatability o Prevent development of antibodies against Rh+ blod If Rh negative: • o Women receive injection:  Every pregnancy. pulsation bedrest until fetal head is o Immediate c/s well engaged o FHR monitoring o FHR measured 1 min at o Trendelenburg or knee-chest beginning and end of contractions 69. after injury to abdomen Given at 28 weeks and 72 hours postpartum • • 64. Variables • Abrupt onset to nadir </= 30 seconds with drops of 15bpm below baseline for >/= 15 seconds but <2 minutes • • o < 5 bpm Moderate: amplitude 6-25 bpm Marked: not great. miscarriage or abortion. GOOD Before contraction • Onset to nadir > 30 seconds Nadir of decel matches peak of contraction • HEAD COMPRESSION Baby head presses on cervix— Umbilical cord compression 66. recovery of decel follow beginning. after prenatal tests. Prolapsed Cord (22) cord precedes presenting part • If loop is discovered o Firm pressure on head fetus not fully engaged o Administer O2 via face mask prevention preferred o Determine presence of o confirmed ROM: horizontal. Early Decels headed down. all over the place o > 25 bpm • • • • Variability: • Average long term variability • Absent: o Amplitude undetectable o No variability (hypoxic) • Minimal: amplitude detectable • r/t fetal movement 67. peak and end insufficient blood flow to uterus • UTEROPLACENTAL INSUFFICIENCY 65. Accelerations • reassuring sign = accompany with contractions • • • 68. cervix dilated. Late Decles after contraction • onset.

Meds. respiratory effort. • medications BF better) o most pass to breast milk • no additional cost Bottle feeding Advantages: Disadvantages: • good nutrition • May need to try different formulas before finding one well tolerated • father can participate • Proper preparation necessary for • AAP recommends formula until 12 nutrition adequacy months o Especially so don’t grow bacteria 100. unequal feeding o hormone changes responsibilities o skin to skin (> physiologic • diet restriction stability. Meds.• • Maternal risks o Prolonged labor o Hemorrhage Fetal risks: o Hypoxia o Birth trauma At 1 min and 5 min Evaluate neonate condition 5 signs: o heartbeat. labor ball  Avoid lithotomy irritability. muscle tone. knee chest. Breastfeeding and Bottle feeding (27) Breastfeeding: Advantages: • no preparation • immuonologic protection • min 6mo prefer 1 year • digest and absorb easier • speeds up involution • more vitamins Disadvantages: • mother burns more calories making • pain milk • leaking milk (‘let down’) • maternal-infant attachment • embarrassment. rolling side to side. Meds . sitting. some flexion Weak cry Acrocyanosis 71. sleep longer. reflex Heart rate Respiratory effort Muscle tone Reflexes Color 0 Absent Absent Flaccid No response Blue/pale • • TOL o When boarderline or dubious Increase pelvic diameter by: o Squatting. APGAR score (19) • • • • each o o o 1 Slow (<100) Slow. color 0-2 score 7-10 good 4-6 fair 0-3 extremely poor 2 Normal (>100) Good cry Active Vigerous cry All pink 70. < cry. irregulat Slow.