Flashcards in maternity Deck (45)
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1
hormone that induces amenorrhea
progesterone
2
presumptive signs of pregnancy
amenorrhea
n/v
urine frequency
breast tenderness
3
probable s/s of pregnancy
positive test (based on hCG levels)
Goodell's sign (softening of cervix)
chadwick's sign (bluish color of vaginal mucosa and cervix)
Hegar's sign (softening of lower uterine segment)
uterine enlargement
braxton hicks contractions throughout pregnancy
pigmentation changes:
linea nigra (dark line down the center of the abdomen)
facial chloasma (mask of pregnancy)
abdomen striae (stretch marks)
darkening of the areola
4
positive signs of pregnancy
fetal heartbeat:
doppler (10-12wk)
fetoscope (17-20wk)
fetal movement
ultrasound
5
gravidity
number of times someone has been pregnant
6
parity
number of pregnancies in which fetus reaches 20wks
7
viabililty
24 wks gestation
infant can live outside uterus
8
TPAL
T: term
P: preterm
A: abortion (includes spontaneous and elective)
L: living children
9
spontaneous abortion
AKA miscarriage:
bleeding, cramping, backache-- think miscarriage
hCG levels will drop
10
Naegele's rule for EDD
first day of LMP
add 7 days
subtract 3 months
add 1 year
11
first trimester nutrition & supplements
increase protein to 60g/day
weight gain of 1-4pounds
biggest complaint of iron (constipation and GI upset)
always take iron with vitamin C (enhances absorption)
folic acid prevents neural tube defects
12
first trimester exercise
no high impact
walking
swimming
no heavy exercise program
dont let HR get above 140 (can decrease CO/perfusion to baby)
don't overheat (no hot tubs or heating blankets--increase body temp and cause birth defects)
13
danger signs and potential complications of maternity
sudden gush of vaginal fluid
bleeding
***persistent vomiting
severe headache
abdominal pain
increased temp
edema
*** no fetal movement
14
common discomforts
constipation
ankle edema
n/v
breast tenderness
urinary frequency
tender gums
fatigue
heartburn
increased vaginal secretions
nasal congestion
varicose veins
hemorrhoids
backache
leg cramps
15
1st trimester meds, smoking, HCP visits, ultrasounds
no meds unless approved by HCP
stop smoking
can have small gestational age, low birth weight babies, cleft lip or palate, placental abruption
first 28wks = once a month
28-36wks = every 2 wks/twice a month
after 36wks = weekly
drink water before ultrasound to distend the bladder and push uterus up closer to abdominal surface so it's easier to get a picture
ultrasound before procedure (amniocentesis): void
16
2nd trimester nutrition
wk 14-26
increase 300cals
adolescent can increase 500cal
1 pound weight gain/wk
should not experience n/v and urinary frequency
can still have breast tenderness
17
quickening
fetal movement (16-20wks)
18
fetal HR
110-160
less than 110=panic!!!
19
kegel exercise
strengthen pubococcygeal muscles
help stop urine flow
keep uterus from falling out
20
3rd trimester assessment
wk 27-40
term if advances to 40 weeks
no more than 1lb weight per week
monitor BP:
pre-eclampsia develops after 20wks:
they will have high BP
proteinuria
edema
BP 160/110 or greater documented 6 hours apart
***two or more pounds of weight gain in a week, watch close and worry about possible pre-eclampsia:
can have a seizure
magnesium sulfate is drug of choice:
given IV
close supervision
anticonvulsant
sedates
vasodilator
***it is called eclampsia when they have a seizure
FHR: 110-160
fetal position determined by leopold maneuvers:
have them void
if having contractions, do it between contractions
21
signs of labor
lightening:
2wk before term
presenting part (head) descends into the pelvis
abe to breath easier
urinary frequency
engagement:
largest presenting part in pelvic inlet (head)
fetal station:
measured in cm
braxtion hicks (more frequent and stronger than before)
softening of cervix
bloody show
sudden burst of energy called nesting
diarrhea
ruptured membranes
when should they go to the hospital:
contractions are 5minutes apart
membranes rupture
worried about prolapsed cord when membranes rupture
22
non stress test
two or more accelerations of 15beats/min or move with or without fetal movement
acceleration:
FHR has an abrupt increase
increase is greater than 15beat/min
lasts for 15 seconds
should come back to baseline within 2minutes
each increase should last for 15 seconds and recorded for 20minutes
***want it to be reactive
23
biophysical profile test
commonly done in last trimester
measured by ultrasounds and each of the parameters count 2 points
10/10 = perfect score
parameters:
HR
muscle tone
movement
breathing
amount of amniotic fluid
BPP test:
observation time is 30minutes by sonogram
8-10 = good
6 = worrisome
less than 4 = ominous (deliver)
24
contraction stress test
oxytocin challenge test
for high risk pregnancies
determines if baby can handle the stress of contractions
deceleration:
blood flow decreases & causes hypoxia then FHR will decrease
*** do not want to see late decelerations (uteroplaental insufficiency = placenta is wearing out)
** want a negative test
25
types of decelerations
early:
not bad
benign
caused by physiological hypoxia from fetal head compression
late:
bad
caused by uteroplacental insuffiency
variable:
bad
caused by umbilical cord compression
26
true vs false labor
true:
regular contractions
increase in frequency and duration
discomfort in back and radiates to abdomen
pain increases with activity
false:
irregular contractions
discomfort in abdomen (front)
pain decreases/goes away with activity
27
premature/preterm labor
contractions occur with dilation between 20-37 weeks
stop the labor
treat any existing vaginal/UTI
hydrate the mom will often stop preterm labor
bedrest
Meds:
magnesium sulfate (IV relaxes uterus)
betamethasone (IM, steroid helps fetal lungs mature)
terbutaline (SQ)
indomethacin (PO)
nifedipine (PO)
28
epidural anesthesia
lie on L side
legs flexed
prop up over the bedside table
given at 3-4cm dilation
usually no headache
major complication (hypotension)
IVFs (bolus with 1000ml of NS/LR to fight hypotension)
monitor BP close
semi-fowlers
tilt on side to prevent vena cava compression
vena cava compression will decrease venous return (reduces CO and BP)
if BP decreases perfusion to baby goes down
alternate position from side to side hourly
check urine output and assess bladder
29
client receiving oxytocin
considerations:
one-on-one care
complications:
hypertonic labor
fetal distress
uterine rupture
contraction rate of 1 every 2-3 minutes with each lasting 60seconds
discontinue oxytocin when:
contractions are too often
contractions last too long
fetal distress
oxytocin is piggly backed into a main IV fluid so when you turn off turn off IV fluids too
any position except flat
put on L side with any fetal distress
turn it off with any late decelerations
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