Maternity

(prenatal period) begins w/ conception and ends with the onset of labor

assessing for risk factors and implementing interventions for current health, future pregnancies.

provision of information and guidence to women and their familes that enables then to be knowledgeable andprepared as the process of pregnancy unfold

Nutrition, PNV, exercise, self-care, contraception cessation, timing of conception, modifying behaviors to reduce risks

• LGA (large gestational age)
• prolonged labor
• postpartum hemorrhage
• poor wound healing
• preeclampsia, hypertension, GDM, thromboembolism, uti

amenorrhea

N/V

Breast tenderness

Fatigue

Frequency

Quickening-movement at 18weeks

objective signs such as:

-Chadwick's, Goodell's, Hegar's, & Ballottement

-Melasma & Linea Nigra

-Positivie pregnancy test

All of these changes can also have causes other than pregnancy an are not considered diagnostic

bluish-purple coloration of the vaginal mucosa, cervix, and vulva seen at 6-8 weeks

Softening of the cervix and vagina with increased leukorrheal discharge, palpated at 8 weeks

Softening of the lower uterine segment, plapated at 6 weeks

a light tap of the examining finger on the cervix causes fetus to rise in the amniotic flud and then rebound to its original position at 16-18 weeks

-mask of pregnancy, brown pigmentation over forehead, temples, cheek and upper lip

-dark line that runs from the umbilicus to the pubes

• -ascultation of the fetal heart
• -observation and palpation of fetal movement by the examiner
• -sonographic visualization of the fetus w/ cardiac movement (4-8 weeks)

EDD= First day of period - 3 months + 7 days

based on 28 day, regular cycle

5 weeks from 37-42 weeks gestation

First= first day lmp-12 weeks

2nd=13-27 weeks

3rd= 28-40 weeks

• Fundus-upper portion
• Isthmus-lower segment
• Cervix-neck, external posrt of cervix interfaces with the vagina

• underweight < 19.8 (28-40lbs)
• average 19.8-26.0 (25-35)
• Overweight 26.1-29 (15-25lbs)
• Obese > 29 (15lbs)

# of times pregnant, including current pregnancy

any birth that occured after 20 weeks gestation regardless if baby was born alive

(pregnancy ending prior to 20 weeks is abortion)

• Gravida
• T= term infats born after 37 weeks gestation
• P= # of preterm infants born b/e 20-37 weeks gestation
• A= #of pregnanacies ending before 20 weeks
• L= # of children currently living

is a woman who has never been pregnant or given birth

Woman who has been pregnant for the first time

someone who is pregnant for at least the 2nd time

• H & P
• pelvic exam
• uterine growth assessment
• fetal heart tones
• lab and diagnostc studies
• education/anticipatory guidence

• confirm EDD
• Lab and diagnostic studies
• Rhogam

• focused assessment
• fetal well-being
• pelvic exam
• Leopolds maneuver-baby position
• group B

• day 5,6
• progesterone stimulates endometrium
• upper part of posterior wall of uterus

• -1st membrane to form. Outermot layer of developing embryo
• -fingelike projections extend into the endometrium
• -the inner membrane that surrounds the developing embryo, contains the amniotic fluid

• -fully functional 8-10 weeks gestation
• -produces progesterone, estrogen, HCG and human placental lactogen(hPL)
• -Metabolic and nutrient exchange b/w maternal and ebryonic circulation: allows for o2/co2 exchange
• -secretes wastes and hormones

-facilitates implantation and decreases uterine contraction, "maintains pregnancy"

-stimulates placental blood flow, enlargement of breasts and uterus

-rises rapidly in first trimester then declines once placenta able to secrete estrogen and progesterone

-promotes fetal growth by regulating glucose & stimulates bresat development in prep for lactation

Maintains blood flow to placenta

Provides fetus with o2 and nutrients

Removes co2 and waste

bypasses fetal lung b/c they dont carry out respiration enchange; placenta does this

-umbilical vein to inferior vena cava

-o2 able to enter the rght atrium

-opening b/w the right and left atria

-o2 blood shunted to the left atrim via this

-after dleivery closes inresponse to increased blood returning to the left atrium

-connects pulmonary artery with the descending aorta

-o2 bloodis shunted to the aorta via this with small amounts going to lungs

-after delivery constricts in repsonse to o2 levels and prostaglandins

• -protection
• -temp control
• -symmetrical growth
• -prevents from adhearing to amnion
• -promotes movement
• -wedge for labor
• -umbilicall free from compression
• -full term 500-1000ml

• -protected by whartons jelly
• -attaches fetus to placenta
• -2 arteries: takes blood frm fetus to mother
• -1 vein: mother to fetus

-1st-14 days starting with fertilization

-day15-end of 8th week

• -8th week-9 1/2 lunar month
• (every organ present by 8th week,  remainder of gestation devoted to refining structures and perfecting function)

• -ensuring that mother & baby emerge from pregnancy healthy
• -ensure social acceptence of child by significant others
• -maternal-fetal attachment
• sacrificing for pregnancy and child

• -Acceptence of pregnancy: responding to changes
• -Identification of the motherhood role: woman-with-child
• -relationship to her mother
• -reordering relationship with her husband/partner
• -preparation for labor
• -prenatal fear of control in labor
• -prenatal fear of loss of self-esteem in labor

• Parity (multiple pregnancies)
• maternal age
• sexual orientation
• single parenting
• multifetal pregnancies
• socioeconomic factor
• abuse

men expirience pregnancy symptoms

-announcement phase

-moratorium phase-emotional distance, resentment, disruption in communiation

-focusing phase-redefines himself as dad

originate from the mother or fetus and impact the development or function of the mother or fetus

maternal behaviors/lifestyles that have a negative effect on the mother or fetus

are vriables that pertain to the woman and her family and place the mother and the fetus at increased risk

hazards in the workplace/environment that impact pregnancy outcomes

aspiration of a small amount of placental tissue fr chromosomal, mtabolic , or DNA testing

• -10 to 12 weeks
• -tests for cystic fibrosis (not neural tube)

combines AFP, HCG, and estriol level for detection of trisomies and neural tube defects; quad adds inhibin A to test downs at 80% accuracy

to detect hypoxic fetuses: 4 movements in one hour

records accelerations in the fetal heart rate in relation to fetal actvity. Widely accepted method for evaluation of fetal status.

-reactive when FHR increases 15 beats above baseline for 15 seconds twice in 20 minutes

used in conjuction with NST and EFM, fake larynx that stimulates baby to move

identifies fetus at risk for cmpromise through observation of the fetal response to intermittent resuction in utero placental bloos flow associated with stimulated uterine contractions

• -monitor fetal activty 20 minutes
• -if no spontaneous UC's, stimulate UC's with oxytocin via IV until 3 UC's in 10 o 20 minutes lsting 40 seconds

abnormal is below 5cm = oligohydramnios

abnormal is above 24cm = polyhydramnios

ultrasund assessment of fetal status with an NST. Evaluation of fetal reflex activities that are CNS controlled; detect hypoxia through fetal breathing movement, gross body movement, fetal tone, amniotic fluid volume, and heart rate reactivity

score of 8-10 is good, 6 is ?, and 4 or less is non-reassuring

Modified BPP includes an AFI test

labor that occurs b/w 20-36 weeks

gestational age at birth of less than 37 weeks

-born b/w 34-36 weeks

-born b/w 32-36 weeks

-born before 32 weeks 

-weighs less than 2500 grams regardless of gestational age

-weighs less than 1500 grams at birth

-weighs less than 1000 grams at birth

-Tocolytic drugs-surpress uterine contractions; usually terbutaline or nifedipine

-bed rest

-IV hydration

-Antibiotics

-Corticsteroid therapy- betamethasone/dexamethasone accelerate feta lung maturity; given 24-34 weeks

• -diation of 4cm
• -at risk for PIH
• -lethal fetal anomaly
• -severe maternal disease
• -hemorrhage
• -acute fetal distress

is a protein detected via immunoassay; it is better at predicting if a patient will not go into preterm labor within the next 7-14 days.

gestational age of >20 weeks and <37 weeks

UC's >6/hour

and/or: rupture of membranes, cervix >1cm or 80% effaced

• *contraindicated in preterm labor, used for hypertension
• -turn off excess noise and dim lights
• -vitals every 5-15 mins.
• -monitor signs of decreased reflexes, resp. depression, I & O
• -Keep Calcium gluconate available for toxicity

-Delays delivery 48+ hours; b/c of fetal sde effects generally used short term and not before 32 weeks

-fetal side effects heart, hypertension, oligohydraminosis, and hemorrhages

-oral medication

-GI upset for mommy

-block calcium available for muscle contraction, delays deliver for 48-72 hours

-10-20 mg po q 4-6 hours

-Monitor FHR and UC's, maternal BP and HR (hold if BP <90/50 or HR >120)

-surpress uterine activity, delays delivery for 3 days

-Give IV or SQ

-Monitor FHR and UC's, I & O for overload, Auscultate lungs for pulmonary edema, HR >120, maternal blood glucose

-contraindicated in women with cardia disease

*can tx COPD

rupture of the chorioamniotic membranes before the onset of labor

rupture of membranes with a premature gestation of < 37 weeks

>24 hours

-Artificial Rupture of membraes; MD

-Spontaneous Rupture of membranes

• -previous PPROM
• -Previous preterm delivery
• -bleeding during pregnancy
• -multiple gestation
• -STD's
• -cigarette smoking

Confirms the rupture of membranes

-mechanical defect in the cervix that results in painless cervical dilation and ballooning of the membranes into the vagina followed by epxpulsion of a premature fetus during the second trimester

-short cervical length, hx fetal loses in 2nd trimester, live fetus w/ intact membranes

-us or cervical length and funneling, cerclage (purse string)

pregnancies with more than one fetus

-one zygote that divides in 1st trimester (always same gender)

-fertilization of two eggs

-maternal risks include: preterm labor, PPROM, HTN, Preeclampsia, Gestational Diabetes, Anemia, SOB, Pulmonary edea and c-section

-vomiting during pregnancy that is so sever it leads to dehydration, electrolyte and acid-base imbalance, and starvation ketosis

-r/t rising levels of HCG in 1st trimester

-dry mucous membranes, poor skin turgor, malaise, low BP

-Vitamin B and antiemetics, IV hydration, Labs to monitor kidney and liver function

type 1- autoimmunity of beta cells in the pancrease, insulin deficiency, managed w/ insulin

tpye 2-insulin resistence & inadequate insulin production, obesity, managed w/ diet, exercise, meds

placenta produces-Human placental lactogen,Progesterone, Growth Hormone, and Corticotropin-releasing hormone

• -hypoglycemia
• -Diabetic Ketoacidosis
• -hypertension & preeclampsia
• -polhydraminos/ oligohydraminos
• -infection
• -c-section
• -induction of labor

• -hypoglycemia r/t fetal hyperinsulinemia
• -hypocalcemia and hypomagnesmia
• -IUGR
• -asphyxia
• -hyperbilirubinemia r/t polycythemia and RBC   breakdown (jaundice)
• -macrosomia

Chronic Hypertnsion

Pre-eclampsia-eclampsia

Pre-eclampsia superimposed on chronic

hypertensionGestational Hypertension

hypertension before conception or before 20th week of gestation; may put  the woman at high risk for developing preeclampsia

systemic disease with hypertension accompanied by proteinuria after the 20th week of gestation

eclampsia =seizure

hypertensive women who develop new-onset proteinuria; proteinuria before the 20th week gestation; r sudden uncontrolled hypertension

high BP detected for the 1st time after mid-pregnancy w/o proteinuria.

• mild-
• bp > 140/90
• proteinurea 1+ 2+
• generalized edema of face, hands, ankles

• severe-
• b/p 160-100
• preoteinurea 3+ 4+
• oliguria- urine output < 500ml in 24 hrs, generalized edema
• headache
• blurred vision
• n/v
• epigastric pain= convulsion

• -bedrest
• -left lateral recumbent position
• -monitor bp
• -diet of 80-100 mg protein
• -limit sodium and salt
• -weekly nst's

-occurence of seizure activity in the presence of preeclapsia. Eclampsia is triggered by cerebral: vasospasm, hemorrhage, ischemia, edema

-symptoms of headsches, n/v, spigastric pain, hyperreleca w clonus, restlessnedd

-Assess vitals before and q 5-15 minutes p during loading dose, then 30-60 minutes until pt stablizes

-assess DTR's deep tendon reflexes

-I&O (renal disease and oligo at risk for toxicity)

-Sob or RR <24

-Chest Pain

-If toxicity suspected, discontinue and notify Dr. (calcium gluconate available)

-variant chages in lab values that can occur as a complication of severe eclampsia

• -Hemolysis is a result of RBC destruction as they travel through constricted vessels
• -Elevated Liver Enzymes results from decrased blood flow and damage to the liver
• -Low platlets result from platelets aggregating at the site of damaged cascular endothelium causing platelet consumption and thrombocytopenia

-only tx is dleivery

• platelets <100,000/mm
• Liver enzymes: AST >70, ALT>50
• Bilirubin >1.2
• LDH >600

• -abrupto placenta
• -renal failure
• -liver hematoma and possibl rupture
• -death
• preterm birth and infant death

• -epigastric pain
• -unexplained bruising, mucosal bleeding
• -petechiae
• -bleeding from IV site

placenta attaches to the lower uterine segment of the uterus, near or ver the internal cervialooos, instead of in the body of fundus of the uterus

-the placenta completely covers the internal cervical os

-the placenta partially covers

-pacenta is at the margin

-implanted in the lower uterine segment in close proximity to the cervix

seperation of the placenta

grade 1-3

abnormality of implantation defined by degree of invasion into uterine wall of trophblast of placenta

-invasion of the trophoblast beyond the normal boundary

-invasion of the trophoblast extends into uterine myometrium

-invasion of th etrophoblast extends into the uterine musculature and can adhere to to other pelvic organs

-medical/surgical termination of pregnancy before fetal viabilit

-termination at the request of the woman, but not for impaired health of mother or fetus

-termination of pregnancy fo serious maternal medical condition or serious fetal anomalies

-abortion occurring w/o medical or mechanical means, miscarriage

blastocyst implanting somewhere other than the endometrial lining of the uterus; occur in the fallopian tube

benign proliferating growth ofte trophoblast in which the chrionic villi develop into endomatous, cystiv vascular transparent vesicles that hang in grapelike clusters w/o a viable fetus

leadto PTL, PROM, and uterine infection

can also lead to PID, infertiltiy, chronic hepatitis, and cervical cancer

torch infection are teratogenic to a developing fetus

is the leading cause of maternal death during pregnancy and is more likely to cause maternal death than any other compliation of pregnancy

avoid eating raw meat and contact with cat feces

Infant recieves HBIG and hepatitis vaccine at delivery

woman recieved immunity injection p delivery

virus of herpes group transmitted by contact droplet and transplacetally; no tx

acyclovir to suppress outbreak of lesions; c-section in having aan active outbreak

catorgorized as hemoglobin < 10g and hematocrit < 30%

• Powers- the contractions
• Passage- the pelvis and birth canal
• Passenger-the fetus
• Psyche-the response of the woman

frequency-begining of one to begining of another

duration-time from the beginning of a contractin to the end of the contraction

• Intensity- strength of the contraction
•   Mild-easily indented during contraction
•   Moderate- resistant to indentation
•   Strong-cannot be indented

Increment- ascending/buildup of the contraction that begins in the fundus and spreads throughout the uterus

acme- peak of intensity

Decrement- descending/relaxation of the uterine musce

precedes dilation in a first time pregnancy; effacement and dilation preogression of the cervix occurs together in subsquent pregnancies

the maternal pelvis is the greatest determinate in the vaginal delivery of the fetus

includes te bony pelvis and the soft tissues of the cervix, pelvic floor, vagina, and introitus(external opening to the vagina)

• Gynecoid-most common
• Android
• anthropoid
• Platypoid

refers to the relationship of the ischial spine to the presenting part of the fetus and assists in assessing for fetal descent during labor. 0 is the narrowest diameter the fetus must pass through + is outside the pelvis

-ability of the fetal head to change shape to accomodate/fit throuh the maternal pelvis

-membranous space b/w bons is the sutures; intersections of these sutures are fontanels

relationship of fetal parts to one another; flexion/extension of the fetal joints

-long axis (spine) of the fetus in relationship to the long axis (spine) of the woman

-longitudal (yes) and transverse (no)

cephalic-head, breech-pelvis, shoulder

• right/left occiput anterior
• right/left occiput posterior

satisfaction during labor and birthing process is enhanced with coordination of collaborative goals

selfesteem, self confidence, relationship to others and general view she holds of life

refers to the descent of the fetus into the true pelvis that occurs approximately w weeks before term in first time pregnancies

-is placed in a visble pool of fluid around the cervix. the paper turnsblue when in contact with amniotic fluid

-a sterile speculum exam may be performed to confirm rupture of membranes; fluid is viewed under microscope "ferning pattern"

• stage 1: onset of labor through 10cm dilitation
• stage 2: complete dilitatio of cervix through delivery of baby
• stage 3: begins after delivery of baby and ends with delivery of placenta
• stage 4: begins after delivery of the placenta and is completed 4 hours later, it is the immediate postpartum period

• latent 0-3
• active 4-7
• transistion 8-10

done at 1 and 5 minutes

• hr
• RR
• muscle tone/flexion
• reflex irritability/tactile stimulation
• color