OB PEDS EXAM 1

Time from conception to start of labor

Start of true labor to delivery of baby and placenta

Post delivery

• Time of normal pregnancy
• 38-42 weeks

Any pregnancy that ends before the 20th week

37-42 weeks

Prior to 37 weeks

Delivery after 42 weeks

# of pregnancies

Never been preg

1st preg

2+ preg

# of babies born after 20 weeks

No babies born

1st baby born

2+ babies born

Any delivery after 20 weeks that is not born alive

Softening and compression of lower uterus

Violet blue cervix d/t extra blood supply

Softening of cervical tip

• False labor
• irregular
• painless contractions
• relieved by walking
• NO cervical change

1st day LMP , subtract 3 months and add 7 days

• Measure from symphysis to fundus
• cm = weeks in pregnancy
• usually used later in pregnancy

• movement of baby
• usually starts at 18-20 weeks

• Extremely dangerous during preg
• can cause fetal deafness if not death

• #1 killer of babies
• screen mom at 35-37 weeks

Biggest cause of early labor

• T - toxoplasmosis
• O - Other infections (hep)
• R - Rubella
• C - Cytomegalvirus - common, passed in urine
• H - Herpes Simplex

CAN ALL CAUSE SERIOUS FETAL PROBLEMS

• Increased CO peaks at 25-30 weeks
• Pulse increases 10-15 bpm
• BP decreases slightly
• Blood flow return impaired
• Edema, varicosity of LE

• In supine position
• Pressure from enlarging uterus decreases venous return to RA
• Have woman lie of left side or place pillow under right hip

• IRON SUPPLEMENTS
• Blood volume increases but hemoglobin doesnt

• Increased weight
• Facial edema
• Vision Changes

Turns head to sound

• Rolls from front to back
• grasp rattle near hand

• Transfer object hand to hand
• rolls from back to front
• head control (no head lag)

Sit without support

Moves by crawling or creeping

• Pulls to stand
• Pincer grasp
• vocalize 1+ words

Breast milk or formula

Solid (pureed) foods

• Ween bottle
• start sippy cup with whole milk

• Starts at 6-7 months
• shows healthy relationship and good bonding

• Sudden infant death syndrome
• Unexplained death before age 1
• most common 2-4 months
• leave NOTHING in crib
• lay on back

• remembers where objects are hidden
• routines, same story, same toy, etc
• seperation anxiety peaks

• 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

• Toddlers 
• same foods over and over

2-2.5 years

• Toddlers
• sooth themselves

• Toddlers
• play next to each other

• Preschooler
• start to interact

• Until 57 inches tall
• 8-12 years old

• Ability to play together
• increased desire to be with friends

• girls - 9-10 y.o
• boys - 10-14 y.o

• NOT live
• IM at birth

• PO
• 2-3 doses
• 2,4,6 months

• NOT live
• IM

NOT live

• NOT live
• IM

• NOT live
• IM or Sub Q

• Nasal - LIVE > 2 y.o
• Given annually
• egg allergy
• IM NOT live

• Chicken Pox
• LIVE
• Sub Q

• NOT live
• Recently added

• NOT live
• IM

• Male and female
• 3 doses
• given before sexually active
• NOT live
• IM

Intrauterine growth restriction

given to jump start fetal lung maturity

• after 16th week
• US guided
• Rare complications
• empty bladder

• 120-160 bpm
• Fetal heart starts to beat at 8 weeks

Downs syndrome

• Confirm or deny chromosome problem
• increased fluid collection at back of neck = + result

• Measures blood flow from placenta to umbilical  cord
• must be perfect for proper development

• Decreased movement = IMMEDIATE attention
• give sugar to stimulate

at least 2, 15 bpm accelerations over the baseline, lasting 15+ seconds in a 20 min window

• Used to stimulate baby movement
• "zap" baby

During contraction the blood flow to the placenta is reduced, decreased O2 to the fetus and causes pain

35 weeks --> L/S ratio is 2:1 - risk of respiratory distress syndrome is low

• Chorionic Villus Sampling
• early dx (10-12 wks), short wait time
• can cause limb issues
• empty bladder

• excessive vomiting
• < 1% of preg
• cause is unclear
• severe K+ loss
• fetal/embryonic death

• early pregnancy causes increased insulin production
• risk for acidosis with morning sickness

• Secreted by placenta
• interferes with insulin
• will go away when placenta seperates

Very big baby with big chest

• HPL also interferes with surfactant
• can give steroids

Jaundice

• Symptoms appear
• cervix is closed
• bleeding and cramping

• symptoms appear
• cervical os is open

All products of conception are expelled

• Some products are retained 
• os is open

3+ pregnancies

infection is present

• 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

• #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

Hemolysis Elevated Liver enzymes Low Platelets

NV, flu like symptoms and epigastric pain

Infants

toddlers

• Protest
• Despair
• Denial - abnormal

Preschoolers

School age

Adolescents

• Switching IV to PO
• PO dose needs to be higher to have same effects

• exact cause unknown
• progesterone - relaxes muscle
• estrogen - contracts muscle
• CRH

• Passage
• Fetus
• Relationship between passage and fetus
• physiologic forces of labor
• psychological aspects of labor

Most common and favorable for vaginal birth

favorable for vaginal birth

• Soft spot
• closes up to 12-18 months

• Soft spot
• closes up to 8-12 weeks

• Bump on head
• does not cross suture lines
• may develop jaundice
• 2 weeks to 3 months to disappear

• Cone head
• Crosses suture lines
• may take days to months to disappear

• Relationship of the fetal body parts to one another
• Normal - Moderate flexion

• Relationship of the cephalocaudal axis of the fetus to the axis of mom
• Longitudinal or transverse

• 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

Uterine muscular contractions cause effacement and dilation of cervix

Abd muscles while pushing

• 1. increment - building up
• 2. acme - peak 
• 3. Decrement - letting up

• 0-3 cm
• reg contractions
• able to cope

• Increasing contractions
• 4-7 cm
• increased anxiety and fear of loss of control

• Increased contractions
• 8-10 cm
• rectal pressure
• very anxious
• increased need of partner or nurse

Begins with complete cervical dilatation and ends with birth of infant

After birth of baby until delivery of placenta

• 1-4 hours after delivery
• 250-500 cc blood loss
• decrease in BP and increase in HR
• Uterus contracted midline between symphysis and umbilicus