Edema is ok if it is
fundus is 1 cm above umbillicus
fundus is 1 cm below umbillicus
What station should the fundus be at to be discharged?
If EBL is greater than this the patient is hemorrhaging
S/S of endometritis
lochia that has an odor and a tender uterus
S/S of a DVT
- cool extremity
- asymmetrical edema
If a patient shows a poor patellar reflex what can this mean?
- pregnancy induced HTN
- high BP at hospital
Labs done at admission
- CBC (red and purple top)
- Type and Hold
- Urine sample
#1 priority for the newborn
keep them warm
vessels in the umbillicus
- 2 arteries (non oxygenated blood)
- 1 vein (oxygenated blood)
5 areas of assessment for APGAR
- Resp effort
- Muscle tone
Apgar- Respiratory Effort
- 1- slow, irregular
- 2- good cry
Apgar- Muscle tone
- 1-some flexion
- 2-active motion
- 1- acrocyanosis
- 2- all pink
Best indicator of true labor (2)
- contractions that are not slowed or stopped by change in movement or rest
- progressively get stronger
- consistent contractions
- begins in lower back
- increases in duration, frequency, intensity
- diarrhea, bloody show
- progressive cervical change
- presenting part becomes engaged
- inconsistent contractions
- annoying, not painful
- no increase in duration, frequency or intensity
- no significant cervical change
- presenting part doesn't become engaged
a woman who is or has been pregnant, regardless of the duration or outcome of the pregnancy
In her 3rd pregnancy= gravida 3
a birthing experience of any baby beyond 20 weeks gestation.
Inclusive of any birthing experience-vaginal, c section, even stillbirth.
Twins are considered one birthing experience
A patients current pregnancy is counted as a
How to calculate EDD
LMP + 7 days - 3 months
Look at the year
Explain Leopold's maneuver regarding positioning of the fetus
Tells location and presentation of the fetus
it is a systemic method for palpating the fetus thru the abdominal wall during the latter part of the pregnancy.
When is Leopolds maneuver done?
during admission to figure out where to put the FHR monitor
the orientation of the long axis of the fetus to the long axis of the woman
Longitudinal-vertical, either head or butt is in the pelvis parallel to mom
Transverse-long axis of the fetus is at right angles to mom, perpendicular to mom
Oblique-some angle btwn longitudinal and transverse
the location of a fixed reference point on the presenting part in relation to the 4 quadrants of the maternal pelvis
normal is flexion, with the head and arms and legs flexed tightly against the trunk
EXTENSION IS ABNORMAL
Which presentation will cause more back pain and a longer delivery?
how wide the cervix has opened up and it is measured in cm's
How does the cervix dilate?
as the cervix is pulled upward and the fetus us pushed downward it is pushed open
the thinning and softening of the cervix and it is measured in %
How does effacement occur?
Labor contractions push the fetus downward against the cervix and the cervix pulls upward. This will cause it to become shorter and thinner as it is drawn over the fetus and amniotic sac
How do you figure out the baby's station?
The ischial spine is the marker and is at "0".
above the ischial spine it is -1,-2,-3 (farthest pt)
below the ischial spine it is +1,+2,+3 (hello baby)
What does fetal monitoring tell us?
how the baby is doing hemodynamically and with O2
3 things fetal monitoring keeps track of
- timing of contractions
- fetal response in relation to stress of contractions
What do contractions do to the fetus?
with each contraction blood flow thru the uterus slows, if the contraction is strong enough all blood flow will stop and if it is for too long it can cause stress on the baby
Prolonged FHR lower than this can impair brain and heart perfusion
A persistent FHR faster than this decreases cardiac output due to inadequate ventricular filling time
2 ways to monitor uterine activity (contractions)
- TOCO transducer (external)
- IUPC (internal)
What does a TOCO pick up? What does it look like?
- maternal movement
- fetal movement
uterine contractions look like a bell shape, other movements look like spikes
Where do you place the TOCO?
over the fundus
Rules of applying a IUPC
it is internal and measures intra-amniotic pressure.
- dilated to 2-3cm
- ruptured membranes
How do you apply an external fetal heart rate monitor?
it is applied to the maternal abdomen with the transducer over the fetus back for best recording
What does a FHR monitor reflect?
fetal oxygenation status
How do you apply an internal FHR monitor?
electrodes are put on the fetus scalp which allows for direct tracing of the HR
Rules of putting on an internal FHR monitor
- dilated to 2-3 cm
- ruptured membranes
- put on the scalp....but avoid the face, fontanelles and genitalia
assessed btwn contractions
- avg rate for 10 minutes ranges from
FHR baseline is below 110bpm OR
decreased from previous baseline rate by 20bpm for at least 10 minutes
FHR baseline is above 160bpm or increased from previous baseline rate by 20bpm for at least 10 min
wave like appearance, alternating small accelerations and decelerations centering around the baseline
When will you see sinusoidal FHR
in severely anemic fetus and requires immediate attention
What do abrupt decelerations look like?
What do late decelerations look like?
- they begin after the contraction begins
- the lowest point is after the peak of the contraction
- recovery occurs after the contraction has ended
Describe Early Decelerations
- mirrors the contraction
- lowest point is at the peak of the contraction
- recovery is by the end of the contraction
What causes early decelerations?
head compression...the fetal head is descending in to the pelvic cavity
What causes early decelerations?
head compression against the mom's pelvis or cervix
How long should decelerations last?
What causes late decelerations?
fetus is experiencing hypoxia from decreased utero-placental perfusion
What causes utero-placental insufficiency?
late decelerations= hypoxia
What causes variable decelerations?
umbilical cord compression
Interventions for early decelerations
none....no fetal compromise
Interventions for late decelerations
- position change
- IV bolus
- contraction eval
- if pit on, turn off
- 100% O2 by face mask at 8-10L/min
- check mom's VS
Interventions for Variable Decelerations
- **position change to release cord compression**
- give O2
- Amnio-infusion to suspend baby and cord
- Have the mom lie on her left side or knees to chest
- Decrease/Stop Pitocin
- Initiate tocolyisis to decrease uterine activity and increase placental blood flow
- IV bolus
- O2 10-12L/min
- Apply internal monitors
What is the cut off point for intra-uterine resuscitation?
30 min....possible c section
Babies who need interventions have....
- Apgar below 8
- RR below 30 or above 60 w/ retractions/grunting
- Apical pulse below 110 or above 160
- Quiet baby
- Skin temp less than 98
- stimulates growth
- cell reproduction and regeneration
Thyroids Stimulating Hormone
stimulates the thyroid gland to produce thyroxine which stimulates metabolism
secreted during stress to increase production of corticosteroids
promotes growth of breast tissue and milk production
Follicle Stimulating Hormone
regulates the development, growth, pubertyand reproduction process of body
stimulates ovarian follicles
- retain water
- constrict blood vessels
- stimulates uterine contractions
- milk ejection reflex
balances estrogen levels
menstrual cycle covers events in the
When is 1st trimester?
2 things to think about
most susceptible to damage from teratogens
sex differentiation occurs....but not identifiable
What is developing during 4th week of development of embryo?
- neural tube
- starting of following structures:
When can you see the fetal heart beat and movement on an ultra sound?
When are the eyelids, ears and tip of nose, arms and legs forming and fingers and toes are there but now just getting longer?
When is the heart beat audible with a dopler and the baby the size of a walnut?
What is the main theme of what is occurring in the second trimester?
body parts are completely formed...but they are now maturing
When will the babys eyes blink?
Fingers and toes have Fingerprints
When is the babys heart and blood vessels fully formed?
When will the woman start to be aware of fetal movements?
When can a gender be determined by ultrasound?
When does the baby hae hair
When will the baby have respiratory movements
response to sound by moving or increase in pulse
When are lungs fully developed?
When should the head be positioned down in the pelvis?
When is the pregnancy considered full term?
Rule of thumb for the primigravida (nulipara)
UC's q 5 min lasting 1 minute for 1 hour
Rule of thumb for the mulitpara
UC's q 8-10 min. lasting 1 min for 1 hour
Rule for ruptured membranes
a gush or trickle of fluid from the vagina should be evaluated even if there aren't any cotnractions
Bleeding vs. normal bloody show
bright red bleeding that isn't mixed with mucus should be evaluated promptly
normal bloody show is thicker, pink or dark red and mixed with mucus
Upon admission of a woman what do you do to determine fetal lie
Meds administered to newborn at birth
- V. K
- Erythro ointment
- Hep B
What will help to constrict uterine blood vessels and stop bleeding after birth
Pitocin via IV
Calling time for Apgars
1 and 5 minutes
Woman getting a c section will have these 2 things