Maternity Flashcards
(46 cards)
Probable signs of pregnancy
• A positive pregnancy test – since it is based on the presence of hCG levels.
• There are other conditions that can ↑ hCG levels: hydatidiform mole; drugs.
• Goodell’s sign (softening of cervix; second month)
• Chadwick’s sign (bluish color of vaginal mucosa and cervix; week 4)
• Hegar’s sign (softening of the lower uterine segment; 2nd/3rd month)
• Uterine enlargement
• Braxton Hicks contractions (throughout pregnancy; move blood through the placenta).
• Pigmentation/changes of skin Linea nigra
Abdominal striae
Facial chloasma (mask of pregnancy) Darkening of the areola (around the nipple)
Presumptive signs of pregnancy
- Amenorrhea – what is the name of the hormone that causes this? Progesterone
- N/V
- Frequency – can be one of the first signs.
- Breast Tenderness – excess hormones
Positive signs of pregnancy
Fetal heartbeat: Doppler→ 10 - 12 weeks
• Fetoscope→ 17 - 20weeks
• Fetal movement
• Ultrasound
Pregnancy calculations
1) Gravidity: # of times someone has been pregnant
2) Parity: # of pregnancies in which the fetus reaches 20 weeks.
3) Viability 24 weeks = Infant has the ability to live outside the uterus.
• A 20 week baby is NOT considered viable.
4) TPAL: acronym that gives you further information on parity
T= term
P= preterm
A= abortion – this includes spontaneous and elective abortions
L= living children
5) Naegele’s Rule:
• Find the first day of the LMP
• Add 7 days
• Subtract 3 months
• Add 1 year
Nutrition and wt gain
a. Nutrition:
• 4 food groups
• Increase calories by 300 per day after the first trimester
Adolescent: ↑ calories by 500 after first trimester
• Increase protein to 60 grams per day. Normal is 40-45
b. Weight Gain:
• Expect to gain 4 pounds in the first trimester
Prenatal supplements
Why don’t women like to take iron? It causes constipation and GI upset. Take iron with vitamin C to enhance absorption.
Folic acid prevents neural tube defects
Daily dose? 400 mcg/day
Exercise rules
• No high impact; walking and swimming are best.
• No heavy or unaccustomed exercise program.
• No overheating (no hot tubs or electric blanket either☺)
• Why? Increased body temperature = birth defects
Exercise Rule: Don’t let your heart rate get above 140.
• If the heart rate goes over 140bpm = CO and uterine perfusion will drop.
Danger signs
Sudden gush of vaginal fluid Bleeding Persistent vomiting Severe headache Abdominal pain Increased temps Edema No fetal movement
Doctors visits and ultrasound
How often should a pregnant client visit the physician?
• First 28 weeks: 1x month
• 28-36 weeks: 2 weeks
• 36 weeks: weekly until delivery
j. Ultrasounds:
• Before an ultrasound what will you ask the client to do? Drink water
To distend the bladder → pushes uterus to abdominal surface.
What about an ultrasound prior to a procedure? Empty bladder for amniocentesis
2nd trimester
Wks 14-26
1. Weight Gain:
• Expected weight gain per week 1lb
2. Should the client still be experiencing?
• Nausea and vomiting NO
• Breast tenderness YES
• Frequency NO
3. Quickening: FETAL MOVEMENT 16-20 wks
4. Fetal Heart Rate:
What should the fetal heart rate be during the second trimester? 120-160
5. Miscellaneous Information:
• Kegel Exercise:
Exercise to strengthen the pubococcygeal muscles; these muscles help stop urine flow, help prevent uterine prolapse.
• Pregnancy is considered term if it advances to 37 to 40 weeks.
Third trimester
Wks 27-40
1. Assessment:
a. Expected weight gain per week? s maneuvers
• What should you have the client do first? Void
• If the client is having contractions, should these maneuvers be done during or
between contractions? Between
Fetal heart rate
- 120 to 160: normal
* 110 to 120: worried and watching *Less than 110 panic
Signs of labor
1) Lightening:
• Usually occurs 2 wksbefore term.
• When the presenting part of the fetus (usually the head) descends into the
pelvis.
• The client will feel less congested, and breathe easier, but urinary urgency is a problem (again).
2) Engagement:
• The largest presenting part is in the pelvic inlet.
• Hopefully, the fetal head is presenting first.
3) Fetal stations: measured in cm, measures the relationship of the presenting
part of the fetus to the ischial spines of the mother.
4) Signs of labor (cont.):
• Braxton Hicks Contractions: More frequent and stronger
• Softening of the cervix
• Bloody show
• Sudden burst of energy, called nesting
• Diarrhea
• Rupture of the membranes
b. When should the client go to the hospital?
• When the contractions are 5 minutes apart or when the membranes rupture
• What are we worried about when membranes rupture? Prolapsed cord
Non stress test
a. Want to see two or more accelerations of 15 beats/minute (or more) with fetal movement.
• Acceleration is when the fetal heart rate has an abrupt increase from the baseline. This is visualized on the fetal heart monitor. The increase is > 15 beats/min. above the baseline and lasts at least 15 seconds but the heart rate should come back to baseline within 2 min.
b. Each increase should last for 15 seconds and recorded for 20 min.
c. Do you want this test to be reactive or non-reactive? Reactive
Biophysical profile
a. Done in the 3rd trimester, but can be done at 32-34 weeks in high risk pregnancy.
• High risk pregnancy may have a BPP every week or twice a week in 3rd trimester.
b. Measurements are done by ultrasound, each parameter counts 2 points.
• 10/10 is great
c. Measurements
1) Heart rate – was Non-Stress Test (NST) reactive?
2) Muscle tone
• Does baby have at least 1 flexion – extension movement in 30 minutes?
3) Movement
• Does the baby move at least 3 times in 30 minutes?
4) Breathing
• Does the baby have breathing movements at least once in 30 minutes?
5) Amniotic fluid
• Is there enough fluid around the baby?
d. Observation time is 30 minutes.
e. Resultsareevaluated:
8-10 good 6 worrisome <4 ominous
Contraction stress test- oxytocin challenge
a. Done when the NST is non-reactive.
b. Performed on high risk pregnancies: preeclampsia, maternal diabetes, and any condition in which placental insufficiency is suspected.
c. This determines if the baby can handle the stress of a uterine contraction.
d. Uterine contractions decrease blood flow to the uterus and to the placenta.
e. If blood flow decreases enough to cause hypoxia in the fetus the fetal heart rate will decrease from the baseline HR.
• This is called deceleration
f. Do not want to see late decelerations?
• This means uteroplacental insufficiency.
g. Do you want a positive or negative test? Negative
h. This test is rarely performed before how many weeks? 28
Results are good for one week
Decelerations
- Early decelerations: (not bad) benign – caused by physiological hypoxia from fetal head compression (HC)
- Late decelerations: (bad) – caused by uteroplacental insufficiency (UPI)
- Variable decelerations: (bad) – caused by umbilical cord compression (CC)
True vs false labor
- True labor:
a. Contractions? Regular
b. Contractions? Increase in frequency and duration
c. Discomfort in back and radiates to abdomen
d. What happens to the pain level with a change in activity? Increases - False labor
a. Contractions? Irregular
b. Where is the discomfort? Abdomen
c. What happens to the pain with a change in activity? Contractions decrease or go away
Epidural
Position: Lie on left side, legs flexed, not as arched as with lumbar puncture
Given in stage 1 at 3-4 cm dilation
Usually no headache. Try not to get in spinal fluid
Major complication? Hypotension
Monitor BP
IVFs: Bolus with 1000mL of NS or LR to fight hypotension
Positioning: Put in semi-fowlers on side to prevent vena cava compression.
If the vena cava is compressed…it will decrease venous return, reduce cardiac output and blood pressure, and decrease placental perfusion.
Alternate position from side to side hourly.
Oxytocin
1) Need one-on-one care
2) Be alert for complications:
Hypertonic labor
Fetal distress
Uterine rupture
• Complete Uterine Rupture: through the uterine wall into the peritoneal cavity (there is a direct communication between the inside of the uterus and the peritoneal cavity)
S/S: sudden, sharp, shooting pain (“something gave away”); if in labor the contractions may stop and the pain will be relieved; signs of hypovolemic shock due to hemorrhage; if the placenta separates, the fetal heart tones will be absent.
• Incomplete Uterine Rupture: through the uterine wall but stops in the peritoneum but not the peritoneal cavity
S/S: internal bleeding, pain may not be present, fetus may or may not have late decels, client may vomit, faint, have hypotonic uterine contractions and lack of progress, fetal heart tones may be lost.
Vaginal Birth After C-Section (VBAC)
Clients are at a high risk for uterine rupture. The scar from the c-section is prone to open when under stress. Those at highest risk are those that are receiving Oxytocin (Pitocin®).
3) Want a contraction rate of 1 every 2-3 minutes with each lasting 60 seconds
4) Discontinue the Oxytocin (Pitocin®) if:
• The contractions are too often.
• The contractions last too long.
• Fetal distress
5) Oxytocin (Pitocin®) is piggy backed into a main IV fluid, so when you discontinue the Oxytocin (Pitocin®) make sure you do not turn off your main IV fluid
6) What position should the client receiving Oxytocin (Pitocin®) be placed?
• Any position except flat on their back.
• Now, if the client has any unreassuring fetal heart tones (like fetal bradycardia) then we will put the client on her left side to enhance uterine perfusion.
7) What should be done with the infusion if late decelerations occur? Turn off.
Label bag and tubing, attach to port closest to body, always remove when done with, use a pump
Emergency delivery
Tell client to pant/blow to decrease urge to push.
• The client should not push between contractions. The mother should only push during contractions.
Wash hands.
ElevateHOB.
Place something clean under buttocks.
Decreasetouchingofvaginalarea.
As head crowns tear amniotic sac.
• You will only have to tear the amniotic sac if it has not already ruptured.
Place hand on fetal head and apply gentle pressure.
• This will prevent the baby from coming out too fast.
When the head is out feel for cord around neck. Ease each shoulder out – do not pull on the baby. The rest will deliver fast.
Keep baby’s head down.
Dry baby.
Keep baby at level of uterus.
Place on mother’s abdomen.
Cover baby.
Wait for placenta to separate/deliver.
Can push to deliver placenta
Inspectplacentaforintactness.
Tie the cord off with a piece of cloth or shoestring.
• Place one knot about 4 inches from the baby’s navel and the second knot about 8 inches from the baby’s navel.
Check firmness of uterus.
Post partum
Vitals, breast, abdomen, GI, UO
- Assessment:
a. Vital signs:
• T→ may increase to 100.4 during 1st 4 hours
• BP→ stable
• HR→ 50-70 common for 6-10 days
TACHYCARDIA + POSTPARTUM………THINK HEMORRHAGE
b. Breasts:
• Soft for 2 to 3days, then engorgement.
c. Abdomen:
• Soft/loose; diastasis recti separation abdominal muscles
d. GI:
• Is hunger common? Yes
e. urine output: diuresis should begin 24 hours after delivery.
• Is dehydration possible? Yes
• Why should the legs be inspected closely? DVT
Post partum
Uterus
• Immediately after birth the fundus is midline 2 to 3 fingers breadths below umbilicus.
• A few hours after birth it rises to level of umbilicus or one FB above.
• Want fundus to be firm
• What is the first thing you do if the fundus is boggy? massage the fundus until it is firm and then check for bladder distention.
Bladder distention is suspected when the uterus is above the expected level or is not in the midline. (Usually moved to the right)
A distended bladder will not allow the uterus to contract normally which increases the chance of hemorrhage.
• Fundal height will descend one FB/day.
• What is the proper term used when the fundus descends and the uterus returns
to its pre-pregnancy size? Involution
• Afterpains are common for the first 2-3 days and will continue to be common if the mother chooses to breast feed
Lochia
- Rubra: 3-4 days: Color: dark red
- Serosa: 4-10 days: Color: pinkish brown
- Alba: 10-28 days (can be as long as 6 weeks): Color: whitish yellow
- Clots are okay as long as they are no larger than a nickel
