Maternity Flashcards
1
Q
Calculating due date (Nagele’s Rule)
A
- Take first date of last menstrual period → add 7 days → subtract 3 months
2
Q
Total weight gain during pregnancy
A
- 28 lbs +/- 3 (25-31)
- 1st-trimester weight gain
- 1 lb per month (3 lbs total)
- 2nd/3rd trimester weight gain
- 1 lb per week
- For expected weight gain, take the week of gestation and subtract 9.
3
Q
Fundus (top of uterus)
A
- Not palpable until week 12
- Fundus typically reaches the umbilical at 20-22 weeks
4
Q
Positive signs of pregnancy
A
- Fetal skeleton on x-ray
- Fetal presence on ultrasound
- Auscultation of the fetal heart (doppler)
- Examiner palpates fetal movement/outline
5
Q
Probable/Presumptive signs of pregnancy
A
- All urine and blood pregnancy tests
- Chadwick’s sign (color changes of the cervix to cyanosis)
- Goodell’s sign (cervical softening)
- Hegar’s sign (uterine softening)
- order of Chadwick/Goodell/Hegar alphabetical
6
Q
Discomforts of Pregnancy
A
-
Morning sickness
- 1st trimester
- Treatment
- Dry carbs before getting out of bed
- Avoid empty stomach
-
Urinary incontinence
- 1st/3rd trimester
- Treatment
- Void Q2H
-
Dyspnea
- 2nd/3rd trimester
- Treatment
- Tripod position
-
Back pain
- 2nd/3rd trimester
- Treatment
- Pelvic tilt exercises (put foot on stool)
7
Q
Labor
A
- Most valid sign of labor
- Onset of regular contractions
-
Dilation
- Opening of cervix (0-10cm)
-
Effacement
- Thinning of cervix (thick-100%)
-
Station
- Relationship of fetal presenting part to mom’s ischial spine (tightest squeeze for baby’s head)
- Negative = above spine
- Positive = below spine
- Engagement = station 0 at ischial spines
- If numbers don’t go positive, C-section
-
Lie
- relationship between spine of baby and spine of mom
-
Presentation
- part of baby that enters birth canal first
- most commonly ROA or LOA
8
Q
Patient education
A
- Pattern of office visits
- Once a month until week 28
- Starting at week 28, once every 2 weeks until week 36
- Starting at week 36, weekly until week 42 (induction or c-section)
- Hemoglobin
- normal to fall in pregnant women
- Can fall to 11 in 1st trimester and be normal
- Can fall to 10.5 in 2nd trimester and be normal
- Can fall to 10 in 3rd trimester and be normal
9
Q
Stages of Labor and Delivery
A
- Stage 1: Labor
- Purpose of uterine contractions: Dilate and efface the cervix
- 3 phases
- Latent → Active → Transitional
- Stage 2: Delivery of baby
- Purpose of uterine contractions: push the baby out
- Stage 3: Delivery of the placenta
- Purpose of uterine contractions: push the placenta out
- Stage 4: Recovery
- Purpose of uterine contractions: stop bleeding
- Lasts 2 hours to stop bleeding
- Postpartum begins 2 hours after delivery of the placenta
10
Q
Stage 1: Labor
A
-
Latent
- 0-4 cm dilated
- 5-30 minute contraction frequency
- 15-30 second contraction duration
- Mild intensity
-
Active
- 5-7 cm dilated
- 3-5 minute contraction frequency
- 30-60 second contraction duration
- Moderate intensity
-
Transitional
- 8-10 cm dilated
- 2-3 minute contraction frequency
- 60-90 second contraction duration
- Strong intensity
- Contractions should not be longer than 90 seconds or closer than every 2 minutes
- Stop Pitocin if times exceed 90 seconds and 2 minutes
- Intensity
- Palpate with pads of fingers of one hand over the fundus
11
Q
Stage 2: Delivery of baby
A
- Nursing interventions
- Deliver the head (stop pushing)
- Suction mouth
- Suction nose
- Check for nuchal cord (cord around neck)
- Deliver shoulders and body
- Make sure baby has ID band
12
Q
Stage 3: Delivery of the placenta
A
- Check if intact
- Check vessels
- Should be 2 arteries and 1 vein (AVA)
13
Q
Stage 4: Recovery
A
- Assessments Q15 minutes for first 2 hours after delivery
- Vital signs (assess for s/s of shock - pressures decrease, rates go up, pale, cold, clammy)
- Check fundus (if boggy, massage; if displaced, void/cath)
- Check perineal pads (excessive lochia = pad sat Q15 minutes)
- Roll on to side (check for bleeding under patient)
14
Q
Complications of Labor
A
-
Intense back pain during labor (OP position “oh pain”)
- Baby turned around backward
- Low priority
- Position, then push
- Position knee/chest on hands and knees
- Push fist into the sacrum
-
Prolapsed cord
- High priority
- Push, then position
- Push head back in off cord
- Position in knee/chest or trendelenburg
- Prep for C-section
-
For all other complications of labor and birth
- LION PIT
- Left side/lateral
- IV increase rate
- Oxygen increase rate
- Notify PCP
- PIT (stop Pitocin)
- LION PIT
15
Q
Fetal Heart Tracing
A
-
Low FHR (<110)
- bad
- LION Pit
-
High FHR (>160)
- not a problem
- document
- Take mother’s temp
-
Low baseline variability (FHR does not change)
- bad
- LION Pit
-
High baseline variability (FHR always changing)
- good
- document
-
Late decelerations (FHR slows at end of contraction)
- bad
- LION Pit
-
Early decelerations (FHR slows at beginning of contraction)
- document
- normal
-
Variable decelerations
- very bad
- prolapsed cord
- Push, position
- VEAL CHOP
- Variable = Cord compression
- Early = Head compression
- Accelerations = OK
- Late = Placental insufficiency
