Pain that is experienced during ovulation is called:

This is not as common in what type of woman?

Middelschmerz.

Prima Gravida women.

Increase.

Thin and watery.

What hormone causes the uterine lining to grow?

Increased _____ is stored to prepare for the fertilized ovum.

Progesterone.

Gycogen.

How long is an egg fertile for after it's released?

How long can sperm live up to?

Is it possible to have sex before the egg is released and still become preggers?

6-24 hours.

72 hours!

YES. =O

200-600 MILLION.

Damn son.

Where does fertilization typically occur?

After fertilization, the egg travels __ days till it implants in the uterine wall and has divided into approximately __ cells.

Fallopian Tubes.

6 days. 107 cells.

The woman will typically continue her current menstrual period and see some bleeding.

True/False?

FALSE. Once implantation occurs, there usually is no bleeding and no menstrual period.

If the woman's menstrual period continues, the periods have diff characteristics (typically shorter in length and less in amount).

The most accurate way to date a pregnancy is by an ultrasound.

True/False?

It has mature lungs

38-41 weeks.

A pregnancy should last about:

___ days from ___________.

___ days from the date of conception.

__ lunar months = __ weeks.

__ calender months.

280 days from the first day of the last menstrual period (LMP).

266  days from date of conception.

20 lunar months = 40 weeks.

9 calender months.

EDD = Estimated date of delivery.

EDC = Estimated date of confinement.

Naegal's Rule = firsty day of last NORMAL menstrual period - 3 months + 7 days.

EDD = EDC = April 26, 2013.

Describe the development of the baby during the first trimester of pregnancy.

The baby will weight about __ grams.

All organ and body shapes are present or the foundations have started.

The heart is beting, eyes are present, fingers and toes can be seen.

50 grams.

If assult occurs to the baby during the first trimester, (ie. ________________), damage can be fixed during the 2nd and 3rd trimesters.

True/False? 

(ie. alcohol, drugs, toxins, food, environmental exposures, etc.

FALSE!!! Don't do stupid things. Really.

Tylenol.

NOT Ibuprofin or Aspirin.

The 2nd semester is a time of very rapid growth.

True/False?

The baby will grow from ___ grams to ___ grams during this time.

TRUE.

50 grams to 1200 grams.

At the end of the second semester, a baby that is born has a good chance of surviving.

True/False?

In the US, the baby is viable at about week ___.

TRUE.

Week 24.

Week 26 2/3 to week 40.

1200 grams to 3200 grams.

(can double or triple during this time).

3-5th week.

Chorionic villi.

Once the chorionic villi of the placenta form, there is a direct exchance of blood between the baby and its mother.

True/False?

Umbilical cord.

1 vein and 2 arteries.

Vein: brings oxygenated blood from the mother to the baby.

2 arteries: return CO2 and waste products from fetal metabolism to the maternal circulation.

1. transfer of gases: functions as the fetal lung in the fetal-maternal gaas exchange.

2. Transfer of nutrients: O2, CO2, sodium, vitamins, glucose, calcium, iron, water, immunoglobulins, etc.

3. Excretion of wastes: Co2, lactic acid.

4. Transfer of Heat.

5. Hormone Production ***

During pregnancy, the ovaries should shut down and the placenta takes over hormone production.

True/False?

Human Chorionic gonadotropin (HcG).

It's detected on the eight day after ovulation.

Trophoblastic cells (surrounding the embryo).

Corpus Luteum.

Make estrogen and progesterone until the placenta is mature enough to take over.

Maternal metabolism.

Maintain a supply of nutrients for the fetus by facilitating transport of glucose acress the placenta.

As the baby grows, it needs more nutrients, especially glucose. Glucose is such a big molecule that it requires a helper (HpL) to get across the membrane.

As the baby continues to grow bigger and faster, the more glucose it needs, and therefore the more HpL is needed to help the additional glucose cross the membrane.

Liposis.

Insulin.

Breast growth.

What importance does estrogen play during pregnancy?

Does it decrease, increase, or remain the same during pregnancy?

It stimulates growth of the uterus and utero-placental blood flow.

It increases steadily throughout pregnancy.

It maintains the endometrium (inner wall of uterus).

It brings about uterine growth.

It inhibits uterine contractability.

It stimulates alveolar development of the maternal breast.

T: Term Prgnancies (# delivered at 38+ weeks).

P: Premature (# of premies born (20-27 weeks) - includes stillborn).

A: Abortions (# born/aborted before 20 weeks).

L: # of Living kids.

Define Primipara.

Someone who has given birth to 2+ viable babies.

(Para II = 2; Para III = 3; etc.)

Note... "Viable babies" may still not survive.

Also... Twins count as ONE pregnancy (G1P1).

1. Menstrual suppression.

2. Nausea and vomiting.

3. Frequent micturtion (1st trimester).

4. Breast changes (first tenderness and then enlargement).

5. Quickening (the first time movement is felt).

6. Vaginal Changes (increase in secretions).

7. Skin changes (pigmentation and abdominal striae).

1. Enlargement of the abdomin.

2. uterine changes (Hegar's sign: size, shape, and consistency change).

3. Fetal Outline (palpated).

4. Cervical Changes.

5. Braxton-Hicks contractions (don't produce anything; r/t changes in the cervix).

6. A positive pregnancy test.

1. Fetal heart tones.

2. Fetal movements felt by examiner.

3. Sonography (Ultrasound).

4. X-rays.

Once preggers, the ovaries (should) stop producing hormones. the Corpus Luteum grows and persists, producing horomes for 10-12 weeks until the placenta can take over.

It's progesterone maintains the endometrium.

During pregnancy, all endocrine glands hypertrophy and activity increases.

True/False.

What happens to cartilage and ligaments during pregnancy?

Why?

Give 2 examples why this is necessary.

They soften and can stretch more, due to increased progesterone and relaxin.

1. Lordosis: to keep woman balances.

2. Smphasis Pubis cartiledge: allows pelvis to stretch for baby to pop out!

NOTE: this causes pain in the woman's joints, esp weight bearing joints.

Cardiac Rate: increased by 20%.

Cardiac Output: increased by 20-30%.

Progesterone! Decreases motility = constipation and bloating.

Superior placement of the stomach and increased pressure on intestines from the growing baby.

DONT DENY THE URGE TO GO. And remember your fiber one bars.

Glomerular Filtration Rate increases by 50%.

Renal Blood Flow increases by 20-50%.

For a NORMAL pregnancy:

Every four weeks until 28 weeks.

Ever 2 weeks until 36 weeks.

Ever week until delivery.

USE CAUTION WHEN TAKING THE PT's HISTORY IN THE PRESENCE OF HER FAMILY.

Also: establish rapport with the family; perform a complete physical and psychosocial assessment; educate both the client and the family.

Calculate the gravidity and parity (Use TPAL).

Record weights of previous infants deliverd, the length of gestation, and if there were any sort of complications.

IUD's can cause these pregnancy complications:

How do we avoid these?

Abortion.

Prematurity.

Sepsis.

TAKE THEM OUT!!

Continued use of oral contraceptives just prior to or during early pregnancy does will not be a concern for the baby.

True/False?

Age, race,ethnic backgrounds, occuption.

Childhood illnesses and immunizations.

Chronic illnesses.

Previous surgeries (esp. C-sections.)

Alcohol and caffeine consumed each day.

Prescription or other drugs.

General nutrition or eating disorders.

Allergies.

Who has a higher risk for sickle cell?

Who has a higher risk for tay-sachs?

African Americans.

Europeans.

Either can affect the child.

Or, may use all of the $$$ for drugs/alcohol and not leave any for the right type of food.

Chronic Diseases?

Drug/alcohol use?

Smoking?

Blood type and RH factor of father?

Before 13.33 weeks.

One natural abortion does not increase your risk of having another one. However... when it starts to become a reoccuring thing, be worried.

Gynecoid: Normal, good birth.

Android: like a male's pelvis; narrow at bottom; should have a c-section.

Anthropoid: An apelike pelvis with a long anteroposterior diameter and a narrow transverse diameter; more common in African Americans; longer, more painful birth.

Platypoid (rare): flattened pelvis.

Protein.

Glucose.

Bacteria.

Ketones.

Down Syndrome.

Trisomy 18.

Neural Tube Defects.

Hydrocephaly.

Ancephaly.

Meningial Stuff (sp?).

Ultrasounds to check for nuchal translucency. This is a test to assess the thickness of the skin and amount of fluid at the base of the neck; babies at risk for down syndrome will typically have increased fluid around their neck.

Ultrasound and blood levels; must offer a maternal alpha-fetaprotein.

High levels indicate possible: neural defects; esophagus problems.

Low levels indicate possible: trisopmy 21 (Down's) or 18 (Edwards).

Glucose on everyone! Preventative screening of gestational diabetes.

Also, movement tests: count baby's kicks - should get about 10/hour. The baby's heartrate should slightly increase with activity.

How many times ought a psychococial assessment be done during pregnancy?

What specifically should be asked about?

2-3 times.

SEXXX. How is it? Are you happy? Is your partner?

VAGINAL bleeding.

Any escape of fluid from the vag (ROM - rupture of membrane). Typically watery gushing.

Swelling of the fingers, face, and eyes.

Continuous pounding headache.

Persistant abdominal pain.

Chills or fever.

Painful urination.

Change/lack of kick counts.

Edema of the face, fingers, eyes, and legs is completely normal when first preggers.

True/false.

Excersize is normal and OK for the baby during pregnancy.

True/False?

True; continue with normal activity patters.

DONT overdo it though or start brand new activities. Hmm, I think I'll become a marathon runner while I'm preggers, even though I've never ran more than 1/2 mile...

Should women increase or decrease their typically calorie diet during pregnancy? How much?

How much weight total should women expect to get during pregnancy?

INCREASE, duh. Up it to about 2400 cal/day.

25-30 lbs is the ideal weight gain during pregnancy.

Pregnant women should never fly during pregnancy. It will put them into labor.

True/False.

Certain vitamins and minerals are necessary to having a healthy baby.

True/False?

ALCOHOL and CIGARETTES.

Hot tubs and Saunas (too hot...)

DOUCHING.

Employment! Haha jk, but sort of. Just be careful where you work.

What 2 supplements are good to take?

If low, what are the potential risks?

IRON and FOLIC ACID.

Low iron can result in infection, SGA (sm. for gest age), and postpartum hemorrhage.

Having 400 mg folic acid/day will decrease the chance of neural tube defects by FIFTY PERCENT. Big Deal.

Citrus Acid (OJ!!) - this increases the absorbancy by 50%.

Don't take with milk... decreases it.

8 weeks: size of an orange.

12 weeks: size of a grapefruit. Over symphysis.

16 weeks: 1/2 way bw symphysis and umbilicus.

20 weeks: at umbilicus.

20+: should be +/- 2 cm from estimated weeks gestation.

40: settling occurs and measurement dips slightly.

INCREASE

15

15

2-3 times

20 minutes.

Administration of oxytocin by IV until 3 contractions (CTX) occur in a 10 min period.

You are looking for a late deceleration of the FHR with CTX - should only see a deceleration in compromised babies.

Positive CST = FHR deceleration = BAD.

Negative CST = no FHR deceleration = GOOD.

Same thing as a CST. Stimulating the nips triggers the brain to release oxytocin and contract the uterin.

Warm towles to the breast; roll the nips for 5 min, stop for 5, repeat.

Same results as CST (+ = decel = bad; vise versa).

Amniocentesis is a dangerous procedure with a good chance for causing a miscarriage.

True/False.

1. Check maternal alpha fetaprotein for genetic abnl.

2. Fetal lung maturity (L:S) ratio.

3. Transfusions: can inject directly into umbilical cord.

4. Drug administration.

5. Fetal Surgery; esp. shunts for hydrocephaly.

6. Determine sex of baby; typically to check sex-linked disorders.

7. Determine bilirubin levels of fetus.

1. If there is a questionable NST or CST.

2. If maternal HTN, DM, or cardiac disease.

3. If post-due date (41 weeks +).

4. If suspected Intra-Uterine Growth Retardations (IUGR).

1. Fetal tone: 1 or more active extension with return to flexion of limb, trunk, or hand.

2. Fetal movement: 3 or more separate limb movements in 30 minutes.

3. Fetal breathing Movementes: 1 or more episodes in 30 min.

4. Amniotic Fluid Index (AFI): Fluid volume; one or more pockets of at least 1 cm in 2 planes.

5. Reactive NST: 2 or more accels in 20 minutes.

How many points are given for each parameter in the Biophysical Profile (BPP)?

What do the different scores indicate?

2 Points per parameter.

10: is a perfect score.

< 6: probable hypoxia.

< 4: if gestation above 36 wks, deliver. If less than 36 wks and with an immature L:S ratio, wait 24 hrs, repeat BPP. If same score, deliver.

< 2: deliver.

AGA: Average for Gestational Age (2500-4000 g).

LGA: Large for Gestational Age.

SGA: Small for Gestational Age (*NOT necessarily a premie).

What is Leopold's Maneuver?

What does it help locate?

Palpation of the maternal abdomen to determine the fetus's presentation and postition. Do this by pushing one way to feel if it's the baby's back of front and then feel for the head near the symphasis pubis.

Fetal Heart Tones (FHT).

A description of how the baby is positioned in the mother; the long axis of the mother to the long axis of the baby.

-Longitudinal (most common and best).

- Transverse.

- Oblique.

Fetal Position: the exact position of the presenting part in relationship to the pelvis.

Fetal Attitude: the relationship of the fetal body parts to each other.

What are the three descriptions of Fetal Positioning?

What are the most common presentations?

Occiput, Sacrum, and the Mentum (chin).

Left Occiptal Anterior (LOA) and Right Occipital Anterior (ROA) are the most common.

* Note: the L/R and Ant/Post descriptions always refer to the mother's position.

What are the four possible cephalic presentations?

Which one is the most dangerous?

Vertex, Military, Brow, and Face.

The Brow; this position sends the widest diamter out first and may require a c-section.

Frank Breech: butt presenting first with hips flexed, feet up by the fetal head.

Complete Breech: butt presenting with all joints flexed.

Footling breech: one or both feet presenting first.

Large Parity: the uterus gets all stretched out.

Pelvic abnormalities: soft butts have a knack of settling into the pelvis.

Monitor VS frequently and compare them to the baseline.

Observe for shock (clammy, white, pale, etc.)

Check FHT if past 12 wks.

Prep for IV and exam.

Have O2 ready.

Spontaneous Abortion.

Abortions.

The chances of carrying the next prgnancy to term after one spontaneous aboration decrease compared to the general population.

True/False.

False; the chances of carrying the baby to term after one abortion does NOT change.

Only be concerned if there are multiple abortions.

Ultrasound.

Methotrexate is given to induce a spontaneous abortion.

Molar Pregnancy.

No FHT.

Elevated hCG.

Very Low AFP.

Do an ultrasound!

It sounds like this is a case of Placenta Previa: the placenta is improperly implanted in the lower uterine segment covering all of part of the cervix.

NO VAGINAL EXAMS!! Could accidentally poke the placenta.

Bed rest in the hospital.

Measure all bleeding.

Have blood products ready (there is the potential for MAJOR bleeding if the placenta separates from the wall).

Abruptio Placenta: the premature separation of the placenta from the uterine wall; catastrophic event due to hemorrhage and the HUGE amount of blood lost.

The cause is unknown but is thought to be abrupt costriction of veins (cocaine? airplanes?)

What is a major complication associated with Abruptio Placenta?

What can be done to help with this?

DIC! There is so much bleeding in the uterus that all of the clotting factors are sent there. Fibrinogen levels drop and no coagulation elsewhere causes mom to bleed from everywhere: cervix, IV, etc.

Give heparine! It, somehow, reduces the hemorrhage.

What is a HTN disease that is seen only in pregnancy and in which the cause is unknown?

When is it seen during the pregnancy?

Preeclampsia.

Usually in the last 10-12 weeks of pregnancy, during labor, or in the first 48 hours postpartum.

Increase in the systolic BP of 20 mm Hg or an increase in diastolic pressure of 15 mm Hg over baseline noted on at least 2 occasions that are 6 hrs apart, 

OR

One BP that is avoer 140/90.

What 2 S/S must be present for someone to be diagnosed with preeclampsia?

What are other s/s that are important to monitor for?

Rise in BP of 30 mm Hg systolic/15 mm Hg diastolic OR 140/90+.

Protein in the urine 2+ on dipstick.

Note: another s/s used to also be weight gain of 2 lb or greater in one week (this manifests as edema of the hands/face)

OTHER: Hyperreflexia (clonus: tapping of foot when toe pulled d/t increased intracellular Na and decreased intracellular K). Frontal or occipital, constant headache (d/t cerebral spasms; if bad enough, could lead to cerebral hemorrhae, convulsions, and STROKE). Convulsions.

Vasospasms occur resulting in increased BP and edema above the wasit.

Circulating fluid vol decreases and the HCT rises.

Decrease in the glomerular filtration rate and decreased blood flow to major organs, including the uterus.

160/110+

HOSPITALIZATION. (With seizure precautions.)

Bed rest on L side to increase blood flow to the uterus.

What can be given to the pt. to help with the convulsions of a pt. with ecclampsia?

How does it work?

What happens in the case of an OD, and what should be kept IN THE ROOM as an anecdote?

Magnesium Sulfate IV (2 g/hr) or IM.

It is a central nervous system dpressant and an anti-convulsant (does NOT lower the BP).

OD: Loss of reflexes (watch output) and lowered respers (12 or blow is considered toxicity). KEEP CALCIUM GLUCONATE IN THE ROOM.

Giving diuretics is not helpful because lowering the BP will only hurt the baby because blood supply is already limited.

Also, decreased blood flow to the kidneys in addition to decreased glomerular filtration could result in kidney failure. We would like to see a minimum of 15 CC or urine/hr.

H: Hemolysis (constriction of vessels and increase in billirubin).

EL: Elevated liver enzymes d/t decrease in blood to the liver.

LP: Low platelet count.

Hemolysis d/t the destruction or fragmentation of RBC's as the try to get through constricted, damged blood vessles.

Elevated liver enzymes occur d/t restricted blood flow to the liver that is obstructed d/t fibrin deposits. This results in elevated bilirubin livels and jaundise as well as liver distention resulting in epigastric pain.

aggregate at sites of damage.

Thrombocytopenia (low platelet count).

The lack of insulin increases the circulating glucose and decreases the amount that enters the cells.

Therefore, with this energy depletion, the cells begins to oxidize fats and proteins for energy with resulting wasting of fat and muscle tissue. This yields ketosis d/t fat metabolim.

DM.

High circulating glucose.

How do infants counter the hyperglycemia of a mother with DM?

This combination leads to a baby that is LGA/SGA?

They secrete high levels of insulin.

Sustained hyperinsulinism and hypergylcemia lead to excessive growth (macrosomia) and deposition of fat.

After a birth of a pt with DM, what is critical to monitor when cutting the umbilical cord?

What is a good way to counter this?

The baby's blood sugar. Because they've been recieving so much sugar through the cord, cutting it will cause the child's blood sugars to crash.

Often times, start the baby at D50 through umbilicus to ween off of its sugar high.

What do L and S stand for in the L:S Ratio?

How do we test the L:S Ratio and what must the L:S ration be before a baby is born?

L: Lecithin.

S: Sphingomyelin.

Amniocentesis.

L:S = 2:1.

What cardiac problems are most common in US women?

Why is there a concern when pregnant?

Congenital Heart Defects (Repaird heart), Rheumatic Heart Disease, Marfan Syndrom, Mitral Valve Prolapse.

The 30-50% incrrease in circulating fluid volume plus the increased cardiac output of the heart during pregnancy puts stress on the already damaged heart.

LIMIT ACTIVITY (risk of heart attacks).

Wt. gain to 15 lbs.

Na intake to 2-4 g/day.

GIVE THEM GOOD PAIN RELIEF. Epidurals are highly recommended.

Also, deliver the baby with forceps to prevent pushing.

The first baby that is Rh positive in an Rh mom will most likely have congenital defects because of the Rh sensitization.

True/False.

FALSE. The first baby will be fine, the second, jaundice, and the third + stillborn.

The mother has to first build up antibodies before the baby can be affected.

What and when do Mothers who are Rh Negative receive to prevent Rh Sensitization?

What does it do?

RhoGAM at 38 weeks gestation and within 72 hours postpartum.

It may also be given after amniocentesis, previa bleeds, abdominal trauma, etc.

It prevents the Mom from building antibodies.

Toxoplasmosis: get from cats/raw meat. Dont empty litter box!

Others: always expanding.

Rubella.

Cytomeglovirus (CMV): May not even know you have had it; smart to get tested. Results in Mental Retardation.

Herpes: BE CAREFUL WITH BIRTH. Often deliver via C-Section to prevent baby from getting it. OR... You can deliver immediately after the water breaks.

What are the four P's of the Birth Process?

Describe them.

Powers.

- Uterine contractions (nourish for good blood flow).

- maternal pushing efforts.

Passage.

- (-) #'s signify baby is still high; +4 means baby's head is out.

- maternal perlvis size and shape.

- maternal soft tissue (more babies = softer = easier birth).

Passenger.

- presenting part: size, poisiton, lie, attitude.

Psyche.

- Inc knowledge = Dec Pain and Anxiety = Inc speed of labor.

- Culturally based.

Braxton-Hicks contractions.

Lightening.

Increased clear vaginal secretions.

Mucous Plus is lost.

Spurt of energy (nesting).

Diarrhea.

T: Progressive Cervical dilatation. F: NO dilatation.

T: Discomfort starts in back and travels to tummy. F: only in tummy.

T: Progressive increase in frequency and intensity. F: Irregular with no increase.

T: regular contractions q5min x 2 hrs.

Duration: timed from beg --> end. Ave time = 30-90 sec.

Frequency: timed from beginning of one to the beginning of the next, NOT the time in between.

Intensity: palpated at fundus by nurse --> mild, medium, strong.

1st stage: from onset of quality contractions through full cervical dilatation.

2nd stage: fromfull dilatation of cervix to delivery.

3rd stage: from delivery of the baby through the delivery of the placenta.

Phase 1: latent or early labor, 0-4 cm.

Phase 2: active labor, 4-8 cm.

phase 3: transition labor, 8-10 cm.

Stage 1

Phase 1: excited, controlled breathing, walking, sleeping, etc.

Phase 2: scared, restless, fearful, MUST trust healthcare providers for care (pee, breath, etc.).

Phase 3: unrecognizable, bloody, amotional, panic, amnesia.

Stage 2:

Regains control and begins to be herself again.

Stage 3:

Totally different; back to old self, bonding with baby begins.

Stage 1, phase 1.

For prima gravida, can be up to 20 hrs and still be nl (ave is 8) and 5 hrs in 2nd, 3rd, etc.

Stage 3. Should take 10 minutes, and up to 30.

DONT PULL CORD!!!

Manual removal will be needed and is very painful.

Assess mom.

Give parents (esp Dad's in teen cases) time alone with infant.

1. Descent.

2. Flexion.

3. Internal Rotation.

4. Extension.

5. External Rotation.

6. Restitution.

7. External Rotation.

8. Expulsion.

- Sustained by another human.

- Relief from pain.

- Assurance of safe outcome for herself and baby.

- Acceptance of attitude.

- Bodily cares.

How often should you monitor maternal temperature during labor?

What can an increase temp indicate?

q4h if BOW intact, q1-2h if BOW ruptured.

Increased temp indicates:

- Fever/infection (herpies? vag exam infection, etc).

- Dehydration: mom needs 100-125 mL/hr of fluid (either IV or clears)

How often should maternal BP be measured during labor?

What are concerns of BP?

qhr in early labor c increased freq. closer to birth.

Concerns:

- Changes from baseline.

- 140/90 or rise of 30 systolic or 15 diastolic = preeclampsia.

Laying on back!

S/S: drop in BP, white, clamy, dec FHR, etc.

How often should the maternal pulse be monitored during labor?

When should there be cause for concern?

qhr in early pregnancy and as protocol indicates.

Increases are common, but be concerned if pulse is steadily over 100 bpm.

q1/2hr in early labor; q15min in active labor; q5min in 2nd stage.

110-160 is normal with transient increases and decreases based on activity.

- Transient changes expected and wanted (less then 5bpm change indicates hypoxia).

Variability in the baby's FHR is indicitive of a _________.

The FHR can flatten d/t:

_____.

_____.

_____.

a good nervous system.

- Fetal Sleep (periods of 20 min).

- Drugs given to mom.

- Hypoxia.

(Still, never should see completely static; < 5bpm bad, 2-25 mod, > 25 good!)

Measure on the fundus.

1+ = cheek.

2+ = tip of nose.

3+ = forehead.

q2hr.

- A full bladder impedes descen of the fetal head.

- Epidurals impede urged to pee.

- Women forget as labor progresses.

- Spontaneous (SRBOW or SROM).

- Artificial (ARBOW or AROM): only do this at -1.0, 1. Too low results in prolapse.

- Premature (PROM or PSROM): assess color an amount!

1. CHECK FETAL HEART TONES!!

- the cord can get wrapped around the neck and choke the baby... put mom in reverse trendelenberg and deliver baby by c-section.

2. Assess color of the fluid for meconium.

- green = meconium = hypoxic baby has stimulated the vagal response to stool.

- This is a problem because baby's first breath will get stool and can/will develop meconium pneumonia.

What is a prolapsed cord and what must be done about it?

What increases the risk of this?

A prolapsed cord is when the umbilical cord presents first. This is an EMERGENCY and requires c-section for delivery.

Higher presentations of the presenting part of breech presentations increase the risk.

Releases prostaglandin and causes the uterus to contract more frequently and intensely.

Helps fetus go through the mechanisms of labor and hastens labor using gravity.

Position changes do what for labor? How often should a woman in labor be repositioned?

What position should be avoided? Why?

Speed labor up!

A woman should be repositioned every 30 min and never onto back!

Putting on the back restricts the blood flow from the lower extremities bc the uterus is lying on the Vena Cava = VENA CAVA SYNDROME.

As the woman progresses in the labor process, it is important to provide comfort measures; massaging the legs/calves is a good way to reduce nl. leg cramps and encourage breathing.

True/False.

FALSE!!

Often times, there will be pooling in the legs due to the dialated veins. In the chance that a clot would form, we do NOT want to dislodge it!!

It tests the relaxation of the woman. Being tense restricts blood flow, O2, and effectively causes MORE pain.

Encourage limp arms and legs and relaxation of facial muscles.

If the mom says that something "doesn't feel right," encourage her to relax and teach her that it is all part of the normal birthing process.

True/False?

Electronic Fetal Monitoring (EFM) monitors the average time between the fetal heart beats and traces the number on paper.

Note: the tracing will show the length and frequency of the contractions but NOT the actual strength.

an internal spiral electrode is attached to the presenting part (cervix must be dilated and presenting part accecible).

Provides instantaneous and continuous recording of the FHR; clearer than the exterior monitor; actual heart rate (not EKG) shown.

How is the baseline FHR decided upon? When is the baby considered Tachycardic?

What are possible causes?

the range of FHR observed between contractions during a 10 min period and averaged.

160+ over 10 minutes is considered tachy.

May be due to maternal fever, early fetal hypoxia, or drugs (esp those to suppress labor).

How is the baseline FHR decided upon? When is the baby considered Bradycardic?

What are possible causes?

the range of FHR observed between contractions during a 10 min period and averaged.

100 or below over 10 minutes is considered tachy.

May be due to late fetal hypoxia, maternal hypotension, prolonged umbilical cord compression..

What is Baseline Variability?

What are the 2 types?

Baseline Variability: is the measure of the interplay (the "push-pull" effect) between the sympathetic (increases heart rate) and parasympathetic (decreases heart rate).

2 Types: long term and short term variability.

Accelerations: usually caused by fetal movement and are a positive indicator of fetal well-being.

Symmetric, uniform in shape and represent an intact central nervous system.

What are periodic decreases in fetal heart rate from the normal baseline called?

How many types are there? What are they called? And how are they classified?

Decelarations.

There are 3 types that are classified as to when they occur in the contraction cycle and to their wavelength. They are: Early, Variable and Late Decelarations.

Describe Early Decelerations...

What causes it?

Is it normal?

When is it seen?

Early Decelerations are due to pressure on the fetal head as it progresses down the birth canal; an increased intracranieal pressure stimulates the vagus nerve which slows the heart rate.

They begin at the onset of a contractions, end when contraction ends, and are benign and normally seen in early active labor.

They have a uniform appearance that inversely mirrors the corresponding contraction.

NOT associated with loss of variability, tachy, hypoxia, acidosis or low apgar scores, but rather viewed as reassuring unless seen with lack of descent of fetal head.

Describe Variable Decelerations...

What causes it?

Is it normal?

When is it seen?

Variable Decelerations vary in onset, occurance, and wavelength.

The most common VD are due to umbilical cord compression (dec. blood flow and therefore O2 to the baby) - this can be caused by the fetus sqeezing, rolloing over onto/pressing on the cord, or when the cord wraps around the neck (common close to birth).

If occasional/isolated, they are normal; if repetitive or worsen during labor (dont come back to baseline), cause concern. Frequently seen in labor when the previously cushioning bag of waters is ruptured.

Tell mom to reposition.

Describe Late Decelerations...

What causes it?

When is it seen?

Is it normal?

Late Decelerations are due to uteroplacental insufficiency (vena cava syn, inc/dec BP, epidural, etc) and result in dec blood flow/O2 to baby causing hypoxemia.

These have a smooth uniform shape, that inversely mirrors the contractions, BUT they are late in their onset and recovery (begin at peak of contraction and end after contraction is finished).

Thes are considered ominous signs and requires prompt attention and intervention. Maintain oxygenation and eliminate the stressor (mom in trendelenberg, on O2, L side, etc). If not fixed, deliver emergency c-sect.

Fear -> Tension -> Pain -> Fear

etc.

EDUCATE to reduce fear.

RELAXATION to reduce Tension.

DISTRACTION/BREATHING or pharm measures to reduce pain.

What are some diffenet types of childbirth preparation?

What is different about them?

Lamaze Method (psychoprophylactic), Bradly Method, Natural Childbirth by D. Grantly Dick-Read, Self Hypnosis, etc.

Breathing techniques differ slightly.

Describe what Systemic Analgesia does in terms of pain.

How is it given?

Analgesia: absence of nl sense of pain; mom can still percieve pain but doesnt care anymore; no loss of conciousness.

Given IV; NOT PO (dec peristalsis).

Will it cross the placental barrier?

What should you have in the case of resp depression or toxicity in the baby?

YES. Fetus slow to metabolize substances so higher doses remain active in fetal circ longer.

Have NARCAN ready for baby.

Don't give in latent or too close to the 2nd phase.

If given too early, can slow down/stop.

If given too late, will provide no real relief for mom and baby will be born with respiratory depression (be ready with Narcan).

What is the most often systemic analgesic given during pregnancy?

Why is this prefered?

What is this an antagonist to?

What is the Opiate antagonist of this dru?

NUBAIN: a synthetic agonist-antagonis narcotic analgesic.

- shorter acting than most other narcs.

- peak action is in 15-20 min and clears mom's system in 2-3 hours (less chance of baby being born with it in its system).

Antagonist to Fentenol.

Opiate antagonist: Narcan.

How do regional anesthetics affect pain?

How are they given?

What are the most common types and drugs?

Temporary and reversible loss of sensation.

Injecting an anesthetic agent (local) into the area that will bring the agent into direct contact with nerve tissue.

Most common: Epidural and spinal blocks.

Caine drugs and opiates to potentiate the analgesic (ie. Fentanyl.)