Maternal Child + Labor and Delivery (Test 1)

Labor delivery recovery room

• normal birth and recovery take place in one room

Labor delivery recovery postpartum room (usually overnight)

• Home like environment

• usually no emergency equipment if something goes wrong

• keep warm (birth is a cold experience)

• hot and warm beverages

• children are desired

• boys are prefered

• keep warm (birth is a cold experience)

• many lactose intolerant

• only parents can touch babies head

Fundus: upper rounder portion

Corpus: middle portion

Cervix: lower portion, projects into vagina

1. Endometrium: inner lining/mucous membrane (what comes off during menstruation and helps fertilized egg implant)

2. myometrium: middle, thick and muscular layer (functional in pregnancy and labor)

3. perimetrium: outer layer that envelops the uterus

2 million

• only 400 mature

Gynecoid

46, or 22 pairs

• 1 pair of gametes (sex cells determining sex of fetus)

• one in each pair is from mother, and the other is from the father

femaele

male

• only male sperm can contribute an X or Y, so he is responsible (genetically) for the sex of the baby

Zygote: fertilization to second week

Embryo: 2-8 weeks of gestation (very sensitive to viruses, pesticides, ect [teratogenic agents].)

Fetus: 8 weeks of gestation until birth

Becomes fetal skin, nails, MM

Becomes fetal skeleton, muscles, blood vessels, kidneys, gonads

Becomes fetal bladder, GI tract lining, lining of trachea, pharynx and bronchi

98%

• looks like urine

• contains protein, glucose, fetal hair, fetal urine and vernix caseosa (cheesy material covering skin of fetus)

• derived from maternal blood

800-1000 mL

too much amniotic fluid (more than 2,000mL/2L)

• can cause malformation of the fetal CNS and GI tract

too little amniotic fluid (less than 300mL)

• associated with renal abnormalities

2 arteries, 1 vein

• assess for these post cord cutting after birth

2

• maternal

• fetal

Two systems are separate, but fetus dips into mothers supply to receive nutrients and can mix

Slows down

Pregnancy of any kind, regardless of duration

women who has never been pregnant

women who has had more than one pregnancy

number of births after 20 wks

• regardless of if infants were born alive or dead

20 weeks

• may survive outside of uterus (need NICU however)

• lungs are not ready at this stage

Method for determining due date

• identify 1st day of LMP

• subtract 3 months

• add 7 days

Method for determining due date/checking growth

• measured in cm

• between 18-32 wks, fundal height matches number of weeks

• between 10-12 weeks

1st: 0-14 weeks

2nd: 15-28 weeks

3rd: 29-delivery

Death of fetus before 20 weeks

Death of fetus after 20 weeks, but before full term

• Hormones increase drastically

• hCG hormone increases (human chorionic gonadotropin)

• addition of placenta which produces hormones (estrogen and progesterone, hPL, hCG)

• enlargement

• circulation increases

• stretches

• (Returns to normal size and shape after birth)

• shorter and softer (to prepare for dilation and thinning (effacement) during labor)

• mucus plug forms in cervical canal to prevent entrance of microorganisms

• walls thicken

• discharge increases

• increased glycogen in discharge which can cause UTI

• orthostatic hypo-tension

• cardiac output increases (greatest during labor)

• WBC increase

• increase in blood volume by 40%

• Increase HR

• BP should stay the same

• increase in clotting factors (prevents hemorrhaging and bleeding post birth but increases risk for DVT/PE)

her side

• capacity stays the same

• inspiration increases to meet increased need for oxygen

• slowed peristalsis

• relaxation of cardiac sphincter (can cause heartburn)

• low carb metabolism

• low fat metabolism

• nausea w/ or w/o vomiting

Sitting up for 30 minutes after eating

Occurs when women lays on back and compresses vena cava and abdominal aorta, causing lowered blood flow

• position on side to correct

• Increased urinary stasis

• increased glycogen in discharge

Increase by 75%, in order to remove mother + babies waste

• GFR increases by 50%, causing 99% sodium re absorption

• (most of this sodium is used by the fetus, but leftover can cause edema of mother)

• Be wary of antidiurtetic effect medications (pictocin) that can cause fluid overload/toxicity

Medications may be sub-therapeutic due to

• Increased GFR

• increased cardiac output

• increased plasma volume

empty her bladder

• take deep breaths during exam

Yes, hot temps can cause damage to the fetus

• maternal body temp should not exceed 100.4 or 38 C

If there is no mucus plug to prevent entry of microorganisms

• beans

• leafy greens

• whole grains

• broccoli

• liver

• shellfish

• fresh fruits and veggies

• peas

• uncooked

• fish limited to 170g or 6 oz of freshwater fish per week

• all raw fish avoided

• Vit A

• Vit C

• Vit D

• Calcium

• phosphorus

• protein

• folic acid

• omega 3s

• fatty acids

• iron (take on empty stomach with vit C)

2nd trimester: increase 340 cals

3rd trimester: increase 500 cals

breastfeeding: increase 500 cals

1500-2000 mL

• limit 2 cups of coffee or tea

LIVE vaccines (vaccines containing live virus)

• flu vaccine however is encouraged during 2nd and 3rd trimester

• lab belt under the abd, across pelvic bone

• avoid sitting for long periods of time during travel. Max of 6 hours with stops made at least 2 hours for a 10 minute walk

Yes. Can cause premature closing of the ductus arteriosis, leading to fetal distress

high frequency waves to visualize baby

• easy way to determine fetal health

• count kicks for 30-60 min 2x per day

• encouraged after 28 weeks

• 10 kicks in 1-2 hours is healthy

• uses 5 observations to check fetal health and oxygenation

• fetal breathing, movements, tone, volume of amniotic fluid, FHR variability (fetal hear rate) (using non stress test)

• Aspiration of amniotic fluid

• can test for genetic disorders

• can test for maternal fetal blood incompatibility

• tests for tristomy (three copies of chromosomes instead of two)

• pictocin is given to cause light contractions

• fetal response is monitored.

• monitors fetal heart response to exercise (ability to speed up)

• given rhogam

• rhogam after birth if baby is RH positive

gentle circular motion on abd with fingertips to help with contraction pain

• very light touch

• inspiration and expiration should be equal in length

• do not hold breath or hyperventilate

• during pushing, take a deep breath and push on exhale

• breathing into cupped hand if hyperventilating

• complication of pregnancy

• cervix dilates early in pregnancy, cannot support the weight of growing fetus

• Cervix can be reinforced surgically with either McDonald’s or Shirodkar procedures

Rupture can cause hemorrhage

Methotrexate to dissolve pregnancy and stop cell division

• placenta implants on/near cervix opening instead of fundus

• may cause (painless) bleeding in 3rd trimester as cervix dilates

• bed rest

• NO vaginal exams

• can cause hemorrhage, fetal death, ect.

Vaginal exams

• can cause more/worse bleeding

• placenta seperates too early

• occurs after 20 wks gestation

• SUDDEN ONSET PAINFUL BLEEDING, dark red vaginal bleeding

• Leading cause of maternal death

• can cause DIC

• blunt trauma to abdomen

• vasoconstriction drugs

• maternal hypertension

Death is coming

• blood runs out of clotting factors, massive hemorrhage

• termination of pregnancy may be needed, administer blood products, oxygen. Correct underlying cause

• NO HEPARIN

• Bleeding from gums, injection sites, petechiae on skin are s/s that DIC is developing

• usually secondary to another complication such as abruptio placenta, GH, retained dead fetus, mole, hemorrhagic shock, septic abortion

• mothers blood produces antibodies that destroy fetal RBC (fetus can have anemia and heart failure and die in the womb)

• RH positive is dominant trait, so chances are good that baby will be RH positive

• women has group O blood

• fetus has A, B or AB blood

• Mother has antibodies for A and B

• Do not need to treat in the womb, only after birth

• can cause jaundice

Exceeds 140/90 after 20th week of pregnancy; No proteinuria; B/P returns to normal after 6 weeks PP

• considered preeclampsia when renal involvement leads to proteinuria

• considered eclampsia when CNS involvement leads to seizures

GH with proteinuria; renal involvement leads to proteinuria

• can lead to seizures if progresses to eclampsia

B/P 160/110, elevated serum creatinine, Headache, blurred vision, hepatic dysfunction, thrombocytopenia

• can lead to seizures

• termination of pregnancy may be considered at 32-34 weeks

• Persistent vomiting causing weight loss, dehydration, electrolyte imbalance

• fetus at risk for poor growth (fetal intrauterine growth restriction)

• impaired glucose tolerance during pregnancy

• should dissapear after birth

• 50% of these patients get DM type 2 within 5 years after delivery

Yes

• limited use of glyburide

• DVT

• Pulmonary Embolism

• thrombophlebitis

Changes in coagulability and fibrinolysis occur during pregnancy that increases risk for these conditions

15%

• vs

• observe for s/s of shock (pallor, cold, clammy, restlessness, perspiration)

• weigh perineal pads to determine amount of bleeding

• asess fetal heart rate

• emotional support

YES

Fetus RH positive, mother RH negative

• condition where vili of the placenta become swollen/fluid filled and take on a grape like appearance

relationships of fetal spine to mothers spine

• longitudal, transverse, oblique lies

How fetus presents

• breech (feet or buttocks first, c-section needed) 3% of births

• cephalic (head first, normal) 95% of all births

• face

• shoulder (shoulder down)

fetus drops into outlet of pelvis

• mother can breathe, but has to pee all the time

• “baby has dropped down”

relationship of fetal head to mothers pelvis

• starts at 0 after lightening, as number increases positively, baby is on the way out.

• measured in cm

• cervix to efface/thin

• cervix to dilate

• push fetus downwards

• each should be followed by period of rest

• you can ascertain the start of contractions by placing hands on fundus

Frequency = count time from beginning of one contraction to the beginning of the next

Duration = time from start of contraction to the end (usually about 45-90 seconds)

Interval = time uterus relaxes between contractions

• Ripening: softening

• Effacement: shortening/thinning of cervix

• Dilation: opening 1-10 cm

Cervix only dilates with true labor