Prenatal check up, Nutritional requirements, Labor & Delivery Flashcards
LABOR ANDDELIVERY ANDPOSTPARTUM (111 cards)
1
Q
NUTRITIONAL COUNSELING DURING PREGNANCY
there are two life forms that need to take nutritional intake.
A
mother and
fetus
2
Q
Calories:
calories per day (non-pregnant)
A
2,000
3
Q
Calories:
calories per day
(pregnant).
A
2,300 (minimum) 2,500
4
Q
Calories:
– common board
exam answer
A
2,500 calories
5
Q
Iron:
____ mg(non-pregnant) to ____ mg (pregnant)
A
30mg(non-pregnant) to 60 mg (pregnant)
6
Q
FolicAcid:
A
400 mcg
7
Q
Calcium:
A
1,200mg
8
Q
Potassium:
A
atleast 700 mg
9
Q
Elemental Iodine:
A
at least 1 capsule of 250 mg
per pregnancy– taken at the 2nd trimester (4th
month) of pregnancy
10
Q
Vitamin A:
A
10,000 units– taken at the 2nd
trimester (4th month) of pregnancy
Bawal inumin sa 1st trimester kasi
magkakaroon ng teratogenic effect.
Increased fluid and fiber is also vital during pregnancy.
11
Q
DIFFERENT EXAMINATIONS DURING PREGNANCY
A
ULTRASOUND VS. AMNIOCENTESIS
12
Q
Visualization
A
ULTRASOUND
13
Q
Non-invasive
A
ULTRASOUND
14
Q
Advice to** increase fluid intake** since increased fluid intake increases visualization
A
ULTRASOUND
15
Q
Ilang weeks during pregnancy and cut-off to
increase fluid intake?–
A
20 weeks
Pinagpatigil na since enough na ang kanyang amniotic fluid.
16
Q
fluid intake
If less than 20 weeks
A
increase fluid intake
17
Q
fluid intake
If 24 weeks na siyang pregnant and maliit pa ang tiyan niya, and the doctor suspects oligohydramnios.
A
require the pregnant women to
increase fluid intake to increase visualization.
18
Q
How much fluid are you going to give?
A
average of 1,000 mL (1L) to 1,500 mL (1.5L)
19
Q
How to give?
How much fluid are you going to give?
average of 1,000 mL (1L) to 1,500 mL (1.5L)
A
1 cup (240 mL) every
15 minutes 1 ½ hours prior to
ultrasound.
Meronganimna15minutessaloobng
isa’t-kalahating oras. (240 x 6 = 1,440
mL)
20
Q
Aspiration
A
AMNIOCENTESIS
21
Q
Only ____ mL of amniotic fluid is
allowed to be aspirated during the procedure.
A
15-30 mL
22
Q
Invasive
A
AMNIOCENTESIS
23
Q
Requireinformed consent
A
AMNIOCENTESIS
24
Q
Performed at the lower abdomen of the
pregnant mother.
A
AMNIOCENTESIS
25
**Void before the procedure** since the **site for
aspiration** is **close to the urinary bladder.**
AMNIOCENTESIS
26
To locate the placenta
ULTRASOUND
27
To determine amount of babies
ULTRASOUND
28
To measure the amount of
amniotic fluid.
ULTRASOUND
29
To determine the gender of the
baby.
ULTRASOUND
30
To determine placental grading.
ULTRASOUND
31
To determine fetal lung maturity.
AMNIOCENTESIS
32
To determine neural tube defects.
AMNIOCENTESIS
33
To determine chromosomal
defects.
AMNIOCENTESIS
34
Requires accompaniment of
ultrasound to locate the placenta
and to avoid puncturing the
bladder
If the mother has placenta previa,
puncture at the upper abdominal
segment.
AMNIOCENTESIS
35
measure the amount of **calcium** (for **fetal bone development**) at the **back** at the **placenta.**
Placental Grading
36
most common type of neural tube defect.
Spina Bifida
37
SpinaBifida
Meningocele
Myelomeningocele
38
a birth defect where there is a
sac protruding from the spinal column.
Meningocele
39
Myelomeningocele
defect of the backbone
(spine), spinal cord and spinal canal. Most
serious form of spina bifida.
40
substances detected in the
amniotic fluid to determine fetal lung maturity.
Lecithin and Sphingomyelin
41
# Lecithin and Sphingomyelin
NORMAL RESULT:
2 (Lecithin) : 1 (Sphingomyelin)
| 2 is to 1
2 : 1
42
best position for ultrasound
Dorsal Recumbent Position
## Footnote
However, you need to **elevate 1 buttock**– put a **small rolled towel under the right buttock.**
Rationale: Kapag **umangat ang right**
side, **displaced ang uterus** so that the
** inferior vena cava** will **not** be
**compressed**. This **prevents vena caval
syndrome.**
43
CVS
CHORIONIC VILLI SAMPLING (CVS)
44
MSAFP
MATERNAL SERUM
ALPHA-FETOPROTEIN (MSAFP)
45
To determine chromosomal defects.
## Footnote
CHORIONIC VILLI SAMPLING (CVS) VS. MATERNAL SERUM
ALPHA-FETOPROTEIN (MSAFP)
CHORIONIC VILLI SAMPLING (CVS)
46
10th-12thweek
## Footnote
CHORIONIC VILLI SAMPLING (CVS) VS. MATERNAL SERUM
ALPHA-FETOPROTEIN (MSAFP)
CHORIONIC VILLI SAMPLING (CVS)
47
Normal Result: Negative (means
nochromosomal defect)
## Footnote
CHORIONIC VILLI SAMPLING (CVS) VS. MATERNAL SERUM
ALPHA-FETOPROTEIN (MSAFP)
CHORIONIC VILLI SAMPLING (CVS)
48
Insertion of catheter into the
vagina until it reaches the chorion
## Footnote
CHORIONIC VILLI SAMPLING (CVS) VS. MATERNAL SERUM
ALPHA-FETOPROTEIN (MSAFP)
CHORIONIC VILLI SAMPLING (CVS)
49
Requires accompaniment of
ultrasound
## Footnote
CHORIONIC VILLI SAMPLING (CVS) VS. MATERNAL SERUM
ALPHA-FETOPROTEIN (MSAFP)
CHORIONIC VILLI SAMPLING (CVS)
50
To determine chromosomal and neuraltubedefects.
MATERNAL SERUM
ALPHA-FETOPROTEIN (MSAFP)
51
14th-16thweek
MATERNAL SERUM
ALPHA-FETOPROTEIN (MSAFP)
52
Normal Value: 38 - 45ng/dl of
blood
<38=chromosomal defect
>45=neuraltube defect
MATERNAL SERUM
ALPHA-FETOPROTEIN (MSAFP)
53
Blood sampling
MATERNAL SERUM
ALPHA-FETOPROTEIN (MSAFP)
54
NST
NON - STRESS TEST
55
CST
CONTRACTION STRESS TEST
56
Will not stress the baby
## Footnote
NON-STRESS TEST (NST) VS. CONTRACTION STRESS TEST (CST)
NON-STRESSTEST(NST)
57
Non-stimulation of the nipple of
the mother.
## Footnote
NON-STRESS TEST (NST) VS. CONTRACTION STRESS TEST (CST)
NON-STRESSTEST(NST)
58
To determine reaction of fetal
heart rate to fetal activity
(movement).
## Footnote
NON-STRESS TEST (NST) VS. CONTRACTION STRESS TEST (CST)
NON-STRESSTEST(NST)
59
# NON-STRESSTEST(NST)
30th-32ndweek
## Footnote
NON-STRESS TEST (NST) VS. CONTRACTION STRESS TEST (CST)
NON-STRESSTEST(NST)
60
Normal Result: Reactive, Positive,
Fetal Heart Rate Acceleration
## Footnote
NON-STRESS TEST (NST) VS. CONTRACTION STRESS TEST (CST)
NON-STRESSTEST(NST)
61
Eat meals prior to examination to
wake up the baby.
| NON-STRESS TEST (NST) VS. CONTRACTION STRESS TEST (CST)
## Footnote
Kelangan
tumaas ang glucose levelng
mommy para magising si baby.
If hindi nakakain, bigyan ng juice
para mabilis.
Dapat at least 10 minutes gising
and baby. Get the FHT and give a
buzzer to a patient. Kapag
naramdaman ni patient na
gumalaw ang baby, instruct her
to press the buzzer to alert the
nurse.
After 10 minutes, bibilangin ng
nurse ang fetal heart rate.
If hindi parin gumagalaw ang
baby, possible na hindi kumain
ang nanay and it means tulog pa
ang baby. Para magising agad
ang baby, ring a bell above the
abdomen of the mother.
If 140 ang unang kuha , dapat
madagdagan ito ng 15 bpm after
10 mins na gumagalaw ang baby
para maging positive ang test.
Kapag greater than or equal kay
155, reactive and kapag less than
155 non-reactive ang baby
If non-reactive ang results, the
baby is depressed. Another test is
needed which is CST
NON-STRESSTEST(NST)
62
Will stress the baby (contraction
stresses the baby).
CONTRACTION STRES STEST (CST)
63
Stimulation of the nipple of the
mother (nipple-rolling ) to
stimulate uterine contraction.
CONTRACTION STRES STEST (CST)
64
To determine reaction of fetal
heart rate to uterine contraction.
CONTRACTION STRES STEST (CST)
65
34th-36thweek
## Footnote
Bakit late ginagawa?
–During the test you will stimulate
contraction. If sobrang lakas na
contraction ang ma stimulate,
posibleng mag-rupture ang bag
of water which can lead to labor.
If ma-deliver man ang baby,
mataas na ang surfactant.
**24th week**–production of
surfactant starts
CONTRACTION STRES STEST (CST)
66
Normal Result: No deceleration
of Fetal Heart Rate
CONTRACTION STRES STEST (CST)
67
The mother is not in labor during
the test.
The mother will roll her nipple for
10 minutes to stimulate uterine
contraction. Ensure privacy of the
patient.
Nipple rolling will send a signal to
the PPG to produce small
amounts of oxytocin that causes
mild uterine contraction.
Strong uterine contraction is
present in actual labor and it can
decrease fetal heart rate.
## Footnote
Procedure:
Allow the patient to rest before
the procedure.
Get the fetal heart rate and
maternal vital signs.
Instruct the patient to change
into the patient’s gown.
Instruct the patient to roll her
nipples for 10 minutes. Provide
privacy.
Wait for a window of 3-5minutes
na may contraction. The baby
needs to be exposed to
continuous uterine contractions.
Sample FHR: 140bpm
Normal Result: Still 140bpm
hindi dapat mag bagoang FH
Implication if there is
deceleration of FHR
-Hindi pa nag lalabor,
bumabagal na ang FHR,
mild uterine
contractions palang.
Kapag naglabor na at
strong uterine
contractions na, mas
lalong bababa ang FHR
which can be fatal to
the fetus (fetal distress).
This test can predict the
possibility of fetal distress during
normal delivery.
CONTRACTION STRES STEST (CST)
68
Expulsion of the product of conception.
LABOR AND DELIVERY
69
# LABOR AND DELIVERY
LENGTH OF GESTATION
○ 9 Months
○ 35-42 weeks
○ 280 days
70
The number 1 hormone that prevents contraction
Progesterone
71
The 4 hormones that promote contraction
Oxytocin,
Estrogen, Prostaglandin, Fetal Cortisol
## Footnote
During pregnancy, progesterone levels are high. It
overpowers the 4 hormones that promote contraction
which results in the minimal uterine contraction during
pregnancy.
72
painless, irregular
contractions during pregnancy.
Braxton Hicks Contractions
73
relaxing/loosening of pelvic joints
Lightening
74
Around____lbs of weight loss happens prior to
labor and delivery.
Happensbecauseofincreased tension and
fatigue and loss of appetite.
2-3lbs
75
Effacement and Dilatation
Cervical Changes
76
Last minute preparation for labor and
delivery.
Nesting Behavior
77
becoming regular and painful
Braxton Hicks Contraction
78
# FALSE VS. TRUE LABOR
Pain is originating from the back
to the abdomen.
TRUE LABOR
79
# FALSE VS. TRUE LABOR
Pain is intensified by walking
TRUE LABOR
80
# FALSE VS. TRUE LABOR
BOW ruptured
TRUE LABOR
81
# FALSE VS. TRUE LABOR
Sedation does not affect
contraction.
TRUE LABOR
82
# FALSE VS. TRUE LABOR
Contractions are progressive or
regular
TRUE LABOR
83
# FALSE VS. TRUE LABOR
Presence of bloody show
(natanggal ang operculum
thickened cervical mucus)
TRUE LABOR
84
# FALSE VS. TRUE LABOR
Pain is relieved by walking
FALSE LABOR
85
# FALSE VS. TRUE LABOR
Pain originates from the
abdomen.
FALSE LABOR
86
# FALSE VS. TRUE LABOR
Sedation decreases contraction
FALSE LABOR
87
# FALSE VS. TRUE LABOR
Intact BOW
FALSE LABOR
88
# FALSE VS. TRUE LABOR
No cervical changes.
FALSE LABOR
89
# FALSE VS. TRUE LABOR
Contractions are not progressive
and irregular.
FALSE LABOR
90
Ifthe cervix is 5cm dilated and 50% effaced and the BOW
is intact, the pregnant woman is in
TRUE LABOR.
91
Is it possible that the woman is experiencing true labor
even if the bag of water is intact?
Yes
## Footnote
Yung intact na bag of water, ang nagpapatagal
sa delivery ng nanay. Some doctors would
rupture the bag of water themselves
(amniotomy).
92
THEORIES OF LABOR ONSET
- PROSTAGLANDIN THEORY
- OXYTOCIN THEORY
- UTERINESTRENGTH THEORY
- PLACENTAL DEGENERATION THEORY and PROGESTERONE
DEPRIVATION THEORY
93
# THEORIES OF LABOR ONSET
To prevent uterine rupturing of the uterus, the
endometrium produces prostaglandin to aid in
uterine contraction.
PROSTAGLANDIN THEORY
94
At the same time, the PPG also releases oxytocin
to aid in uterine contraction.
OXYTOCIN THEORY
95
As the baby grows, the uterus stretches and it
gets thinner.
The uterus stretches until it reaches its
maximumpoint of being stretched.
UTERINE STRENGTH THEORY
96
When the placenta reaches 9months, it is aging.
Therefore, its ability to produce progesterone
decreases. Thus, this will not allow prevention of
contraction.
PLACENTAL DEGENERATION THEORY and PROGESTERONE
DEPRIVATION THEORY
97
4 STAGES OF LABOR AND DELIVERY
STAGE OF DILATATION
STAGE OF EXPULSION
STAGE OF PLACENTAL DELIVERY
STAGE OF RECOVERY
98
Starts with true labor contraction and ends with full
dilatation of the cervix.
STAGE OF DILATATION
99
Considered the longest stage of labor and delivery
STAGE OF DILATATION
100
3 PHASES of STAGE OF DILATATION
○ Latent
○ Active
○ Transitional
101
Starts with the full dilatation of the cervix and ends with
the delivery of the baby.
102
Starts with the delivery of the baby and ends with the
delivery of the placenta.
STAGE OF PLACENTAL DELIVERY
103
Starts with the delivery of the placenta and ends with the
first 2 hours of post-delivery.
STAGE OF RECOVERY
104
5 Ps OF LABOR AND DELIVERY
POWER
PASSAGEWAY
PASSENGER
PSYCHE
PLACENTAL FACTOR
105
Forces are work that push the baby out.
POWER
106
SOURCES OF POWER DURING LABOR
1. Uterine Contraction
2. Ability of the mother to bear down or push
107
----
Source: Fundus, Myometrium, Upper
Uterine Segment
Frequency: Increment to Increment
Interval: Decrement to Increment
Primary source of power
Uterine Contraction
108
– promote contraction
Syntocinon----
Pitocin
Oxytocin– EINC
Methergine
Oxytocic Drugs
## Footnote
● Oxytocin na ang ginagamit sa EINC
since bawal ang IV incorporation. Kaya
di na ginagamit si Syntocinon at
Pitocin.
● Main Reason: Kapag nag-incorporate
ng Syntocinon at Pitocin, it augments labor (Masyadong lumalakas ang
uterine contraction during labor and
delivery. Kaya nauubos na ang ability
ng uterus to contract after delivery.
Kaya ang main side effect ng
Syntocinon at Pitocin ay postpartum
bleeding
109
prevent contraction
(pampakapit)
## Footnote
----
Duvadilan
(most used)
Dactyl OB
Yutopar
Bricanyl/Terbutaline
widely
(also
used for asthmatic patients)
Tocolytic Drugs
110
Correct way of pushing: Ideally, mouth
open muna para di masyadong
malakas. If hindi kaya, then mouth
close para lumakas.
Ability of the mother to bear down or push
111
SAMPLEBOARDQUESTION:
The woman is experiencing threatened
abortion. The doctor ordered the nurse to
administer Terbutaline/Bricanyl SC. The patient
asked the nurse, "why are you giving me
Terbutaline?" What is your response?
a. It relaxes the smooth muscles of the
uterus.
b. It promotes bronchodilation.
c.Both A and B
d. None of the above
a. It relaxes the smooth muscles of the
uterus.
