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Antepartum
Time from conception to start of labor
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Intrapartum
Start of true labor to delivery of baby and placenta
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Gestation
- Time of normal pregnancy
- 38-42 weeks
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Abortion
Any pregnancy that ends before the 20th week
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Preterm
Prior to 37 weeks
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Post term
Delivery after 42 weeks
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Nulligravida
Never been preg
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Para
# of babies born after 20 weeks
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Still birth
Any delivery after 20 weeks that is not born alive
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Hegars Sign
Softening and compression of lower uterus
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Chadwicks sign
Violet blue cervix d/t extra blood supply
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Goodwells sign
Softening of cervical tip
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Braxton-hicks
- False labor
- irregular
- painless contractions
- relieved by walking
- NO cervical change
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Nageles Rule
1st day LMP , subtract 3 months and add 7 days
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McDonalds Method
- Measure from symphysis to fundus
- cm = weeks in pregnancy
- usually used later in pregnancy
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Quickening
- movement of baby
- usually starts at 18-20 weeks
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Rubella (preg)
- Extremely dangerous during preg
- can cause fetal deafness if not death
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Group B strep sepsis
- #1 killer of babies
- screen mom at 35-37 weeks
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UTI in preg
Biggest cause of early labor
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TORCH Testing
- T - toxoplasmosis
- O - Other infections (hep)
- R - Rubella
- C - Cytomegalvirus - common, passed in urine
- H - Herpes Simplex
CAN ALL CAUSE SERIOUS FETAL PROBLEMS
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Cardiac changes in preg
- Increased CO peaks at 25-30 weeks
- Pulse increases 10-15 bpm
- BP decreases slightly
- Blood flow return impaired
- Edema, varicosity of LE
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Vena-Cava Syndrome
- In supine position
- Pressure from enlarging uterus decreases venous return to RA
- Have woman lie of left side or place pillow under right hip
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Anemia in pregnancy
- IRON SUPPLEMENTS
- Blood volume increases but hemoglobin doesnt
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Symptoms of Eclampsia
- Increased weight
- Facial edema
- Vision Changes
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Infant developmental milestones
2 months
Turns head to sound
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Infant developmental milestone
4 months
- Rolls from front to back
- grasp rattle near hand
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Infant developmental milestone
6 months
- Transfer object hand to hand
- rolls from back to front
- head control (no head lag)
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Infant developmental milestone
8 months
Sit without support
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Infant developmental milestone
9 months
Moves by crawling or creeping
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Infant developmental milestone
12 months
- Pulls to stand
- Pincer grasp
- vocalize 1+ words
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Infant Nutrition
1 month
Breast milk or formula
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Infant nutrition
4-6 months
Solid (pureed) foods
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Infant nutrition
12 months
- Ween bottle
- start sippy cup with whole milk
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Stranger/seperation anxiety
- Starts at 6-7 months
- shows healthy relationship and good bonding
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SIDS
- Sudden infant death syndrome
- Unexplained death before age 1
- most common 2-4 months
- leave NOTHING in crib
- lay on back
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Toddler development
- remembers where objects are hidden
- routines, same story, same toy, etc
- seperation anxiety peaks
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Toddler Nutrition
- 1 y.o - Whole milk
- 2 y.o - Low fat milk
- 3 y.o - completely feed selves
- 16-24 oz milk at 2-3 y.o
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Food Jags
- Toddlers
- same foods over and over
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Age to start potty training
2-2.5 years
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Parallel Play
- Toddlers
- play next to each other
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Associative Play
- Preschooler
- start to interact
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Booster seats in cars
- Until 57 inches tall
- 8-12 years old
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Cooperative Play
- Ability to play together
- increased desire to be with friends
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Growth Spurt
- girls - 9-10 y.o
- boys - 10-14 y.o
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Inactivated Poliovirus (IPV)
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Flu Vaccine
- Nasal - LIVE > 2 y.o
- Given annually
- egg allergy
- IM NOT live
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HPV Vaccine
- Male and female
- 3 doses
- given before sexually active
- NOT live
- IM
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IUGR
Intrauterine growth restriction
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Betamethasone
given to jump start fetal lung maturity
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Amniocentesis
- after 16th week
- US guided
- Rare complications
- empty bladder
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Normal fetal HR
- 120-160 bpm
- Fetal heart starts to beat at 8 weeks
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Depressed and flat fetal nasal bone...
Downs syndrome
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Nuchal Translucency Testing
- Confirm or deny chromosome problem
- increased fluid collection at back of neck = + result
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Umbilical Velocimetry
- Measures blood flow from placenta to umbilical cord
- must be perfect for proper development
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Fetal Activity Monitoring
- Decreased movement = IMMEDIATE attention
- give sugar to stimulate
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Reactive Non-stress test results
at least 2, 15 bpm accelerations over the baseline, lasting 15+ seconds in a 20 min window
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Vibroacoustic Stimulation
- Used to stimulate baby movement
- "zap" baby
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What causes contraction pain?
During contraction the blood flow to the placenta is reduced, decreased O2 to the fetus and causes pain
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Eval of fetal maturity
35 weeks --> L/S ratio is 2:1 - risk of respiratory distress syndrome is low
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CVS
- Chorionic Villus Sampling
- early dx (10-12 wks), short wait time
- can cause limb issues
- empty bladder
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Hyperemesis Gravidarum
- excessive vomiting
- < 1% of preg
- cause is unclear
- severe K+ loss
- fetal/embryonic death
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Diabetes and Gestational diabetes
- early pregnancy causes increased insulin production
- risk for acidosis with morning sickness
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Human Placental Lactogen (HPL)
- Secreted by placenta
- interferes with insulin
- will go away when placenta seperates
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Macrosomia
Very big baby with big chest
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Resp distress syndrome
- HPL also interferes with surfactant
- can give steroids
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Hyperbilirubinemia
Jaundice
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Threatened Abortion
- Symptoms appear
- cervix is closed
- bleeding and cramping
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imminent/inevitable abortion
- symptoms appear
- cervical os is open
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Complete abortion
All products of conception are expelled
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Incomplete abortion
- Some products are retained
- os is open
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Recurrent abortion
3+ pregnancies
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Septic Abortion
infection is present
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Ectopic pregnancy
- Implantation of a fertilized ovum in a site other than the endometrial lining of the uterus
- at risk for profound blood loss and shock
- may need ICU monitoring
- Methotrexate if ovum < 4cm
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Preeclampsia and eclampsia
- #1 disorder of pregnancy
- sudden increase in BP after 20 weeks
- gestation with proteinuria
- facial edema
- eclampsia = seizures
- only tx for preeclampsia is to get rid of placenta
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HELLP Syndrome
Hemolysis Elevated Liver enzymes Low Platelets
NV, flu like symptoms and epigastric pain
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Trust VS mistrust
Infants
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Autonomy VS shame and doubt
toddlers
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Separation anxiety stages
- Protest
- Despair
- Denial - abnormal
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Initiative VS guilt
Preschoolers
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Industry VS inferiority
School age
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Identity VS role confusion
Adolescents
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Equianalgesia
- Switching IV to PO
- PO dose needs to be higher to have same effects
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Possible causes of labor
- exact cause unknown
- progesterone - relaxes muscle
- estrogen - contracts muscle
- CRH
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5 important factors of labor and birth
- Passage
- Fetus
- Relationship between passage and fetus
- physiologic forces of labor
- psychological aspects of labor
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Gynecoid pelvis
Most common and favorable for vaginal birth
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Anthropoid
favorable for vaginal birth
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Anterior fontanelle
- Soft spot
- closes up to 12-18 months
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Posterior Fontanelle
- Soft spot
- closes up to 8-12 weeks
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Cephalohematoma
- Bump on head
- does not cross suture lines
- may develop jaundice
- 2 weeks to 3 months to disappear
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Caput Succedaneum
- Cone head
- Crosses suture lines
- may take days to months to disappear
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Fetal Attitude
- Relationship of the fetal body parts to one another
- Normal - Moderate flexion
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Fetal Lie
- Relationship of the cephalocaudal axis of the fetus to the axis of mom
- Longitudinal or transverse
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Station
- refers to the relationship of the presenting part to an imaginary line between the ischial spine of the maternal pelvis
- -5,-4,-3,-2,-1,0,+1,+2,+3,+4,+5
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Primary force of labor
Uterine muscular contractions cause effacement and dilation of cervix
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Secondary force of labor
Abd muscles while pushing
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3 phases of contractions
- 1. increment - building up
- 2. acme - peak
- 3. Decrement - letting up
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Latent Phase of Labor
- 0-3 cm
- reg contractions
- able to cope
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Active Phase of Labor
- Increasing contractions
- 4-7 cm
- increased anxiety and fear of loss of control
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Transition Phase of Labor
- Increased contractions
- 8-10 cm
- rectal pressure
- very anxious
- increased need of partner or nurse
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2nd stage of labor
Begins with complete cervical dilatation and ends with birth of infant
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3rd stage of labor
After birth of baby until delivery of placenta
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4th stage of labor
- 1-4 hours after delivery
- 250-500 cc blood loss
- decrease in BP and increase in HR
- Uterus contracted midline between symphysis and umbilicus
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