OB

• 8 women deaths out of 100,000 live births due to hypertension (eclampsia)
• causes: hemorrhage, gestational hypertension, embolism

• 7 out of 1000 live births
• US is 29th in the world
• 6/1000 white infants, 14/1000 black infants

• 54/1000 between 15-19 yrs old
• 3 out of 10 teens will be pregnant before age 19

• 20% of all women have infertility issues
• decreased fertility due to STIs and scarring

Only 60% of women get prenatal care

• Union of mature ovum and sperm equal human life
• Ovum=22 autosomes+XX(sex)=23
• Sperm=22 autosomes+XY(sex)=23
• Ova are viable for 24 hours after ovulation
• Sperm are viable for 72 hours after ejaculation
• Fertilization takes place in ampulla's of fallopian tube
• Scarring in the tube prevents the sperm form getting to the egg

new cell formed when egg is fertilized

• Union of ovum and sperm-zygote (1st week)
• 16 cells-morula (60 hours later)
• morula attaches to uterine wal (4 days later)
• best place for the morula to attach is the fundal area on top of the uterus because we want the baby to come out first then the life line second.
• need uterine muscle at the top to contract to keep from bleeding to death
• Placenta previa-zygote settling at the bottom of the uterus

• 99 tropoblasts forms all supportive structures
• 8 embroblasts froms embryo and eventually the fetus

• zygote secretes hCG which stimulates the corpus luteum of the ovary to remain viable and continue to secrete progesterone for 4 to 12 weeks to secure the pregnancy.
• prevents normal involution of the corpus luteum at the end of menses
• if corpus luteum ceases functioning before 11th week of pregnancy-spontaneous abotion occurs
• in male fetus, it stimulates testes to produce testosterone which causes male sex organs to grow.
• Bases for all pregnancy tests
• Cause of morning sickness (6-12 weeks) 50% of women experience morning sickness

• valium of pregnancy causes profuse vasodilation to calm down contractions
• causes edometrium to change into the decidua which provides nourishment for the embryo
• reduces uterine contraction, thus preventing spontaneous abortions
• drop in progesterone causes early miscarriages
• BP is lowered because vessels are dilated, if BP goes up it is abnormal

• Formed by the end of the 12th week and takes over the responsibility of producing progesterone and other needed hormones
• Thick, disk-shaped organ whose major function are 1. metabolic, 2. transfer of substances between mother and fetus and, 3. endocrine
• 1/6th of weight and the end of a term pregnancy
• total surface area of a full term placenta is 15 square yards
• Maternal side is red, flesh like
• Fetal side is shiny gray-white with vessels visible

• promotes normal nutrition and growth of fetus
• prepares maternal breast development for lactation
• facilitates transport of glucose across the placenta by diffusion, active transport, and pinocytosis
• production increases progressively during 2nd half of pregnancy
• decreases maternal insulin sensitivity and utilization of insulin (an insulin antagonist)

• causes enlargement of the women's uterus, breast and external genitalia
• increases vascularity to reproductive organs

• provides a protective environment for fetus
• clear fluid surrounds baby in utero
• provides stable temperature surrounding fetus (98.6)
• allows rooom and buoyancy for fetal movement
• derives from fetal urine and fluid transported from maternal blood across the amnion.
• exchanged constantly everyday
• volume increases during pregnancy-should have 1000ml at term
• characteristics-98% water, alkaline 2% organic solids, clear in color
• Green-meconium; red-bleeding; cloudy-infection-; amber-bilirubin

• differentiation of ceels and rapid growth
• rudimentary body parts formed
• heart has four chambers and begins beating
• beginning of all major body structure
• external genitalia present-no gender yet
• some movement by limbs

• eyelids fused; nail beds formed
• teeth and bones begin to appear
• kidneys begin to function-amniotic fluid
• begins to swallow
• grasps, sucking and withdrawal reflexes present
• gender distinguishable
• downy lanugo begins development
• normally women do not know they are pregnancy during this time

• much spontaneous fetal movement
• moro reflex present
• rapid skeletal development
• meconium present in GI tract
• uterine development in female
• lanugo (fine hair) appears over body
• quickening-fetal movement felt by mom

• eyebrown and head hair appears
• skeleton begins to harden
• permanent tooth bud appear-tetracyclin discolor infant teeth
• vernix caseosa appears-surround fetus, thick lotion to preserve skin

• miniature baby in appearance
• extra uterine life possible
• skin has red, wrinkled appearance
• responds to external sounds
• fetus is very active

• eyelids are no longer fused
• testes begin to descend into scrotum for males
• assumes head-down position in uterus
• respiratory-like movement detected
• subcutaneous fat is being deposited under skin

• begins to store fat and minerals
• lanugo disappears from the face
• skin loses reddish color
• exhibits good reflex developent

• fetal body begins to round out
• increas of iron storage by liver
• ear cartilage firm on both ears
• lanugo and vernix caseosa disappear
• high absorption of maternal hormones
• ready for birth

• 1 umbilical vein brings in oxygenated blood via the placenta
• 2 umbilical arteries bring deoxygenated blood back to the placenta
• SpO2 is 40-45% for fetus
• fetal lungs and liver functions are from the placenta

• ductus venosus-bypasses liver to inferior vena cava
• foramen ovale-shunts blood from R to L heart
• ductus arteriosis-bypasses lungs-brings blood to the brain the quickest

termination of pregnancy prior to 20th week gestation

the normal duration of pregnancy 38-40 weeks

occurs after 20 weeks, before 30 weeks

after 42 weeks

• fetus born dead after 20 week gestation
• diabetes is a big risk factor

any pregnancy regardless of duration, including present one

a woman who is pregnant for the first time

a woman who is in her second or subsequent pregnancy

a woman who has never been pregnant

number of pregnancies that have reached viability, regardless of whether the infant was alive or stillborn

a woman who has have one birth greater than 20 weeks regardless of whether the infant is born alive or dead

2 births greater than 20 weeks

• Nageles rule: 1st day of last normal menstrual period (LNMP) subtract 3 months add 7 days and 1 year
• 90% of women will deliver +/-2 weeks of estimated date

• top of uterus
• indicated uterine size by measuring from the top of the symphysis pubis to the top of the fundus
• correlates with weeks of gestation between 20-30 weeks
• order ultrasound, if it does not correlate

• predominant protein in fetal plasma
• can be measured in both maternal serum and in amniotic fluid
• increased levels-indicate open neural tube defects
• decreased levels-could indicate down syndrome, molar pregnancy
• test is done between 15-18 weeks gestation

• minor hemoglobin with glucose attached
• previous 90 days of blood sugar and measurement of glycemic control
• levels of 6 or less: measured from 1-15, 15 i out of control, 6 or less is controlled
• When baby is exposed to high blood glucose levels in first trimester, baby will most likely have cardiac anomalies

• Every 4 weeks until 28 weeks
• Every 2 weeks up to 36 weeks
• Every week after 36 weeks
• More frequent for high risk

• goes from 2oz to 2 lbs at term
• increase in size due to hypertrophy of myometrium cells under estrogen influence
• 1/6 of total masternal blood volume is contained within the vascular system of the uterus by term

• estrogen causes the cervix to become congested with blod, resulting in a bluish color that extends to include the vagina-Chadwick's sign
• increased vascularity causes the cervix to soften-Goodell's sign
• Increased mucus forms the mucus plug to seal off the cervix from outside bacteria

• cease ovum production during pregnancy
• corpus luteum persists til 12 weeks to secrete progesterone til the placenta takes over

• increased vasculaity and hyperplasia
• increased vaginal secretion and decrease in pH to prevent infections

• increase in size and nodularity to prepare for lactation
• nipples increase in size, become more erect and more pigmented
• colostrum-an antibody rich, yellow fluid can be expressed after the 12th week. it converts to mature milk after delivery

• oxygen consumption increases by 15-20%
• tidal volume increases 40%
• by the third trimester, the diaphragm is lifted 1.5inches which prevents the lungs from expanding fully
• breath becomes thoracic rather than abdominal in nature

• 45% increase in blood volume which peaks in the 7th month
• 30% increase in total RBC volume (mostly plasma) which causes the hemodilution of pregnancy in the second trimester
• decrease in BP due to decreased peripheral vascular resistance
• WBCs increase throughout gestation
• 12-15 WBC is normal for pregnant women

• reflux of gastric contents common due to relaxation of smooth muscles by progeserone
• ptyalism (excessive salivation) is a common condition of pregnant women
• decreased in intestinal motility-constipation
• nausea and vomiting (morning sickness) is due to high hCG levels from 6-12 weeks

• 50% increase in glomerular filtration rate
• kidneys and ureters dilate due to high progesterone levels
• glycsuria is common during pregnancy due to kidney's inability to absorb all the glucose filter by the glomeruli. this environment increases the risk of UTIs during pregnancy
• UTIs can lead to preterm labor

• increase in activity of sweat and sebaceous glands-perspiration and acne
• hyperpigmentation-chloasma or mask of pregnancy darkens forehead, cheeks and nose
• linea nigra-dark line of pigmentation from umbilicus to the symphysis pubis
• striae (stretch marks) occur on abdomen, breasts, and thighs as pregnancy progresses

• BMR increases to support the additional demands of the growing fetus
• 25-35 lbs is the average weight gain during a single pregnancy
• increase in water retention of 7 liters of water by term

• amenorrhea-earliest symptom of pregnancy
• nausea and vomiting-50% of women experience this
• excessive fatigue-presents in 1st trimester
• urinary frequency-common during 1st and 3rd trimester due to uterine pressure
• breast tenderness-due to growth
• quickening-fetal movement felt by mother

• Goodell's sign-softening of the cervix
• Chadwick's sign-bluish coloration or cervix
• Hegar's sign-softening of isthmus
• Abdominal enlargement-uterine growth
• Pigmentation of skin-occurs in 50%
• palpation of fetal outline-greater than 24 weeks
• Ballottement-passive fetal movement
• Positive pregnancy test-hCG present

• fetal heart beat-110 to 160 bpm
• fetal movement-palpated by trained examiner greater than 20th week gestation
• ultrasound-fetal outline detected

• ambivalence-initial response, no visible body change yet
• acceptance-triggered by quickening in 2nd trimester
• introversion-turning in on one's self
• mood swings-from great joy to despair
• body image change-the picture of your body you have of yourself

• morning sickness-eat 4-5 crackers at the bedside, eat protein meal at the end of night
• urinary frequency-stop caffeine, no sugar
• vaginal discharge-shower twice a day
• heartburn-smaller more frequent meals, tums, no lying down 2 hours after you eat
• hemorrhoids-fiber, witch hazel tucks
• leg cramps-dorsiflex, bananas, calcium
• backache-flat shoes, posture

• sound waves bounce off densities to form picture
• measures bi-parietal diameter, femur length, and crown to rumb length to determine gestational age
• localize placenta
• identifies fetal anomalies
• validates suspected multiple pregnancies
• evaluates amniotic fluid

• predominate protein in fetal plasma; excreted in fetal urine into amniotic fluid
• test is run between 15-18 weeks gestation
• if abnormal results return-amniocentesis is done

• aspiration of amniotic fluid for analysis of chromosomal abnormalities, blood incompatibility and determin fetal maturity
• to determine fetal lung maturity: detects lecithin/sphinogomyelin ratio that make up surfactant; a ratio of 2:1 indicates surfactant is adequate at 35 weeks
• to determine fetal hemolytic disease-bilirubin concentration: levels of bilirubin in amniotic fluid reflects the amount of fetal RBC destruction that had taken place

• maternal age of 35 or above
• previous genetic disorder
• altered chromosomal pattern (trisomy 21)
• history of 3+ spontaneous abortions
• elevates MS-AFP level
• history of neural tube defects
• usually performed between 15-17 weeks
• tissue cultures must be grown for several weeks, thus results aren't available immediately

• uterine infection
• spontaneous abortion
• PROM-premature rupture of membranes
• fetal injury
• placental abruption

• alternative to amniocentesis which can be done earlier
• usually performed between 10-12 weeks
• developing placenta is biopsied via transvaginally or abdominally under ultrasound guidance
• complications-spontaneous loss
• greatest benefit is the option to terminate

• premature rupture of membranes
• hypertension disease
• prolonged rupture of membranes
• placental insufficiency
• all these things causes stress to the baby which secretes cortisol and cortisol increases surfactant production.

• diabetes
• nonhypertensive glomerulonephritis
• blood incompatibilities

• daily maternal assessment of fetal activity by counting the number of fetal movement within a specified time period
• usually starts at 28 weeks for high risk
• side lying position utilized after eating a meal
• a count of 3+ movement/hour needs further evaluation
• is a non-invasive no cost method to evaluate fetal well being in last trimester of pregnancy

• assesses fetal well being by evaluating FHR acceleration in association with fetal movement
• FHR accelerations indicate adequate oxygenations, a healthy CNS, and the ability of the fetal heart to respond to stimuli
• procedure: client is placed in semi-fowlers position, an external fetal monitor is applied, a baseline strip is obtained, fetal movement indicated by the mother, interpretation reactive 2 accelerations/10 minutes 15bpm lasting 15 seconds

• is used to identifty the fetus at risk for intrauterine hypoxia by observing the response o the FHR to contraction
• if fetal hypoxia is demonstrated-late decelerations
• FHR and patterns are evaluate in response to contractions (stress)
• Methods: nipple stimulation to produce 3 contractions within a 10 minute period
• interpretation: 50% late decelerations with contractions in 10 minute is a problem

• FHR
• fetal breathing
• gross fetal movement
• fetal tone
• amniotic fluid volume
• criterion: up to 10 points are assigned
• each parameter is either present=2 or absent=0
• 8-10 points is normla

• use leopold maneuvers to identify the best postion to locate the transducer to hear the loudest FHR
• usually heard the loudest through the fetal back
• typically found in the mother's lower quadrant on left side if fetus is in a LOA position

• tachycardia 160bpm+for 10 minutes
• in prematurity, chronic fetal hypoxia, maternal fever (#1 reason), fetal anemia

• bradycardia 110 or below bpm for 10 minutes
• in fetal hypoxia, maternal drugs, compressed cord, maternal supine position (convenient for HCP)

• fetal head compression
• mirrors the contraction below
• begins and ends with the contraction below
• FHR usually stays within normal range
• generally benign and seen in late labor
• head compression stimulates vagus nerve to slow HR
• no interventation considered category 1, benign

• due to uteroplacental insufficiency (UPI) causes by being on back, baby isnt getting oxygen
• onset is late-after peak of contraction
• tend to occur with every contraction
• degree of fall doesnt reflect insufficiency
• usually goes below normal range
• Interventions: turn client to left side, give oxygen, increase IV
• turn pitocin off if infusing
• document and report observations

• due to cord compression
• FHR goes below normal range
• deceleration dont have a uniform shape
• they fall and rise abruptly
• occurs at times unrelated to contractions
• interventions: change maternal position, C-section if can't change pattern within 30 minutes

• predictive of normal acid base balance
• accelerations with fetal movements
• no periodic changes to baseline

• tracings are indeterminate and not predictive
• tachycardia or bradycardia
• minimal or absent variability
• late or variable decelerations

• tracings are abnormal
• predictive of abnormal acid base status
• absent baseline variability
• recurrent late and/or variable decelerations
• requires prompt evaluation and interventions:
• maternal oxygen
• changes in maternal position
• discontinue pitocin
• treatment of maternal hypotension

• identify the cause of the specific pattern
• stop pitocin infusion if being administered
• reposition the client several times
• administer oxygen via face mask at 8-10liters/minute
• call to have HCP put in internal monitor
• notify HCP of category assessed
• notify other staff to prepare for c-section

• relationship of presenting part to maternal pelvis
• LOP-left, occipital, posterior

degree of flexion of body parts

occurs when the largest diameter of the presenting part (BPD) reaches or passes through the pelvic inlet

• frequency: refers to the time between the beginning of one contraction and the beginning of the next one
• duration: measured from the beginning of the increment to the end of the dcrement (45-90 seconds)
• intensity: refers to the strength of the contractions during the acneme or peak

• begins when true labor start through complete cervical dilations
• latent stage-mild contractions 0-3 cm
• active phase-progressive fetal descent 4-7cm
• transition-increase fetal descent 8-10 cm significant anxiety, restless, irritabl, contractons are 1 to 2 minutes apart, strong intensity and lasting 60-90 seconds

• begins when cervix is 10 cm and ends with birth of infant, pushing stage
• crowning occurs
• usually 1 hour long or less
• laboring down-10cm let the woman's body do the work before we tell them to push. pushing time is decreased and maternal exhaustion are less likely

• begins from birth of infant to placental separation, about 5 mins
• signs of placental separation are globular shaped uterus, rise of fundus in abdomen, sudden gush of blood, further lengthening of cord form vagina fetal side of placenta delivers first

• 1-4 hours after delivery when physiological adjustment of the mother's body takes place
• uterus remains contracted and in the midline
• bladder may be hypotonic
• vitals taken q15 minute-bradycardic pulse
• lochia rubra-moderate amount
• emotional state-excited, fatigued, or quiet

• lochia rubra-reddish color with a few small clots occur for up to three days
• lochia serosa-thinner, brownish pink for 4-10 days
• lochia alba-yellowish which discharge for 10 to 21 days
• lochia should be gone by 6 week check up
• lochia usually has a fleshy smell

• turn client to either side to examine area with adequate lighting, separate buttocks
• inspect REEDA-redness, edema, ecchymosis, discharge, and approx of skin edges
• severe intractable episiotomy pain-hematoma
• check status of hemorrhoids

• at birth fetal circulation must switch to newborn circulation with elimination of 3 fetal structures
• foramen ovale: closes with clamping of cord which increase pressures in left side of heart
• ductus arteriosis (shunting blood from the lungs): closes with an increase in oxygen levels
• duvtus venosus (shunted blood away from liver) cloes within days after placenta is absent

• hypercapnia, hypoxia and acidosis stimulated the newborns first breath
• adequate surfacant levels prevent alveolar collapse at the end of expiration and promotes gas exchange
• fluid fills lungs now and become air filled and pressure in the left side of the lungs become greater than the right side
• thoracic sqeeze gets rid of lungs fluids

• stores iron for about 4-6 months
• bilirubin conjugation to prevent overload
• RBC breakdown occurs every 80 days
• enters the GI tract and kidneys to be excreted
• bilirubin overload-jaundice in newborn
• bilirubin is toxic to brain and must be removed or bilirubin encephalopathy develops

• vitamin K production is dependent on bacterial colonization via milk intake
• stomach capacity is small and CNS control is immature, so regurgitation is frequent
• 5-10% loss of their birth weight within the 1st week due to inadequate digestion and absorption of nutrients
• meconium passed within the 1st 24 hours

• inability to concentrate urine until 3 months
• urine has a low specific gravity
• voids frequently 6-12 times daily
• limited ability to excrete salt, water loads, and drugs

• head is disproportional large for body
• head constitutes 1/4 of body size
• body appears long and exremities short
• flexed extremities that resist extension
• hands are tightly clenched
• no neck appearance

• average weight is 7.5lbs
• 75% of body weight is water
• 5-10% weight loss in first 3 days of life

average length is 20 inches-will grow 1 inch/month for next 6 months

• head circumference is 13-14 inches
• head is 2cm<chest circumference
• chest circumference is 12-13cm

• temp is 97.5-98.6 axillary
• heart rate is 110-160bpm; regular rhythm
• respirations 30-60bpm: irregular, shallow, unlabored
• symmetrical chest movements