Hesi maternity
When is the Fetal period and what can exposure to a teratogen during this period cause?
(week 9 to term): may cause learning deficits and behavioral abnormalities. any exposure to a teratogen will not cause major defects in the fetus because organogenesis has already occurred.
A nurse at the prenatal clinic examines a client and determines that her uterus has risen out of the pelvis and is now an abdominal organ. At what week of gestation would the nurse expect this clinical finding to occur?
- 12th week of pregnancy
A client who menstruates regularly every 30 days asks a nurse on what day she is most likely to ovulate. Because the client's last menses started on January 1, the nurse should tell her that ovulation should occur on which day in January?
- 16 - Ovulation should occur on January 16. The time between ovulation and the next menstruation is relatively constant. In a 30-day cycle the first 15 days are preovulatory, ovulation occurs on day 16, and the next 14 days are postovulatory.
What does the presence of fibronectin indicate
- A positive result means that fetal fibronectin is present in your cervical secretions, o If you have a positive result between weeks 22 and 34, you're at increased risk of premature birth within seven days.
A client's temperature is 100.4° F (38° C) 12 hours after a spontaneous vaginal birth. What does the nurse suspect is the cause of the increased temperature?
- Dehydration
How to calculate fertile period?
- by subtracting 18 days from the length of the shortest cycle to determine the first unsafe day and subtracting 11 days from the length of the longest cycle to determine the last unsafe day.
Anteroposterior colporrhaphy
- the surgical repair of a defect in the vaginal wall, including a cystocele (when the bladder protrudes into the vagina) and a rectocele (when the rectum protrudes into the vagina)
Ritgen's technique
-done to prevent the perineal tear. by the nurse supporting the perineum with a sterile towel and pushing the perineum downward with one hand while the other hand is supporting the baby's head as it goes out of the vaginal opening.
second trimester
13-26 weeks
What percent chance does a family who both have an autosomal recessive disorder (cystic fibrosis, Tay Sachs) have at having a child who will have the disorder
25%
What can anticonvulsant medications do to pregnancy tests?
Anticonvulsants may cause false-positive pregnancy test results
What intervention is implemented if a neonates vital signs are low?
Give positive pressure ventilation
Signs and symptoms of preeclampsia
Hypertension: damaged endothelial cells lose their tone causing vasospasm leading to increased pressure in the vessel Proteinuria: Due to kidney damage from kidney deprivation of blood flow. Glomerulus start to lead protein from the blood Urine output decreases, uric and Creatinine levels increase Edema: Protein escapes vessel, where protein goes, water follows Upper abdominal pain Increase in liver enzymes (AST and ALT) Decreased platelets leading to DIC, hemolysis leading to HELLP syndrome
When is internal fetal monitor applied
Internal EFM can be applied only after the patient's membranes have ruptured when the fetus is at least at the -1 station, and when the cervix is dilated at least 2 cm.
When would an internal version be indicated to manipulate the fetus into a vertex position?
Internal version is used only during a vaginal birth to manipulate the second twin into a presentation that allows it to be vaginally born.
What is Danazol and why is it contraindicated during pregnancy
It can treat endometriosis, fibrocystic breast disease, and hereditary angioedema-is a teratogen that may cause masculinization of a female fetus.
What is betamethasone or dexamethasone and what is it used for?
It is a steroid administered to the mother that crosses the placenta and promotes lung maturity in the fetus.
Gray syndrome and what is it caused by?
It is characterized by an ashen-gray colordangerous condition that occurs in newborns who are given chloramphenicol; may lead to fatalities
What teratogenic effect does sulfonamides that contraindicated during pregnancy cause?
Jaundice, poor sucking, and extreme sleepiness are the clinical manifestations of kernicterus. Kernicterus is a condition seen in newborns due to deposition of bilirubin in the brain and is caused by sulfonamides
A client tells a nurse that she does not want an episiotomy and would rather tear naturally. What information should be offered to the client regarding each of these birthing methods?
Lacerations are easier to repair than an episiotomy.
Dystocia
Lack of progress of labor long and more painful Occurs because of problems caused by uterine contractions
The nurse is caring for a high-risk pregnant client who has had a positive contraction stress test (CST). What would the nurse interpret the result to mean?
Late decelerations of the fetal heart rate are occurring with each contraction
post partum depression symptoms
Lethargy, Ambivalence, emotional lability
Maternal insulin needs during first trimester and During 2nd and third trimester
Maternal insulin needs decrease during first trimester and During 2nd and third trimester requires increase in insulin dose
What is an Expected finding for breech position?
Meconium in the amniotic fluid is expected; as the fetus's buttocks are compressed, meconium may be expelled
A pregnant client tells her nurse that she is worried about the blotchy, brownish coloring over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition related to hormonal changes. What is the correct term for this integumentary finding?
Melasma- usually fades after birth
LMA, LOP, LOA
On this image, What Fetal position would D represent
What is the correct term used to describe the mucous plug that forms in the endocervical canal?
Operculum- protects against bacterial invasion.
Preeclampsia interventions (PREECLAMPSIA)
P- proteinuria monitoring at every prenatal visit R- Reflexes hyperactive, watch for 4+ indicates seizure. monitor neuro status, vision changes, ankle clonus. E- Evaluate blood pressure for hypertension at every prenatal visit E- Edema monitoring- Lungs sounds, urinary output, weight gain of 2 lbs C- Calcium c=gluconate for magnesium toxicity L- Left side lying position, bed rest, fetal heart rate monitoring A- Assess for seizure activity (eclampsia) M- Magnesium sulfate administered to prevent seizures P- Protein rich diet S- Severe complication watch for: HELLP, DIC, Placental abruption, stroke, fetal distress I- I&O monitoring. Abnormal sign Low urinary output of less than 30 A- Antihypertensives (labetalol, hydralazine)
When is Expulsion breathing recommended
Should be encouraged when the cervix is fully dilated (10cm)
What phase of labor is best to give a pain medication ?
Should be given in active phase because Respiratory depression of the newborn will not occur
Which breathing pattern should the nurse support for the woman and her coach during the latent phase of the first stage of labor
Slow-paced breathing is approximately one half the woman's normal breathing rate and is used during the early stages of labor when a woman can no longer walk or talk through her contractions.
A pregnant client who has a history of cardiac disease asks how she can relieve her occasional heartburn. The nurse should instruct the client to AVOID antacids containing which ingredient?
Sodium If the client consumes more than the usual daily sodium intake, excess fluid retention results;
threatened abortion
Spotting in the first trimester is indicative of this.
If the presenting part is at the ischial spines, what is the station
Station 0
preeclampsia
Types of hypertensive disorder that occurs after 20 weeks of gestation. Diagnosed with a blood pressure reading of greater than 140 systolic or 90 diastolic. MUST be 2 readings 4-6 hours apart
nuchal cord
Umbilical cord around the fetal neck.
What is Terbutaline (tocolytic) used for? § High priority assessment: § Evaluate patient for
Used to stop or delay preterm labor. § High priority assessment: Acts on sympathetic NS B1 causing tachycardia. Monitor maternal and fetal heart rate. § Evaluate patient for gestational diabetes before giving because this drug increases glucose levels
Immediately after birth uterus location?
Uterus is 2cm below umbilicus and will rise slowly several hours later
Right Mentum Anterior (RMA)
What position is this fetus in
Right Occiput Posterior (ROP)
What position is this fetus in
Right Occiput Transverse (ROT)
What position is this fetus in
What position is this fetus in Left Occiput Posterior (LOP)
What position is this fetus in
What is the MOA of clomiphene?
acts by blocking the estrogen receptors in the brain and uterus. This action sends false signals of low estrogen levels to the brain. As a result, the pituitary and the hypothalamus release FSH, LH and Gn-RH respectively. The release of these hormones stimulates the maturation of ovarian follicles, which leads to ovulation
When does the placenta develop?
after implantation and is complete by week 12
Spontaneous abortion risk factor?
alcohol consumption
What is the postcoital test?
also known as Sims test, or Huhner test is a test in the evaluation of infertility. The test examines interaction between sperm and mucus of the cervix.
What is Mifeprex used for?
helps stimulate uterine contractions; this drug can be used for the elective termination of a pregnancy
What is Estradiol and what can it be used for?
is a form of estrogen that helps to alleviate hot flashes by increasing estrogen levels.
What is Indomethacin (Indocin)? what is an adverse effect it could cause?
is a nonsteroidal anti inflammatory agent that may cause gastric irritation so sucralfate is administered along with this drug to help manage preterm labor § may cause premature closure of the ductus arteriosus in newborns receiving long-term maternal dosing
What is Thalidomide and why is it contraindicated during pregnancy
is an anticancer drug that may cause shortened limbs and limb deformities
What is Tamoxifen? § After 5 years of administration there is an increased risk ofwhat?
is an estrogen antagonist antineoplastic medication that has been found to be effective in women with estrogen receptor-positive cancer of the breast. § After 5 years of administration there is an increased risk of complications, and the drug is discontinued. Tamoxifen usually is prescribed for 5 years after initiation of therapy
What is Endometritis? What are symptoms of endometritis?
is an infection of the uterine lining and can occur after prolonged rupture of membranes. § Symptoms include swelling of the abdomen, abnormal vaginal bleeding or discharge, fever, discomfort with bowel movement, and pain in the lower abdomen or pelvic region.
What is Tolbutamide and why is it contraindicated during pregnancy
is an oral hypoglycemic agent used in the treatment of type 2 diabetes mellitus. It is known to have teratogenic effects like neonatal hypoglycemia
What is Tonic neck reflex or fencing position?
is expected in the healthy newborn and disappears within 3 to 4 months. It is an expected newborn response and does not need further intervention. Absence of the fencing reflex may indicate neurologic impairment.
Choriogonadotropin alfa
is given in a timed manner to aid in the maturation of ovarian follicles
Rho(D) immune globulin is given when?
is given to an Rh-negative mother within 72 hours after birth if the infant is Rh positive and the mother was not previously sensitized. § Rh immune globulin needs to be administered within 72 hours of delivery.
bilateral pudendal block
is used for vaginal deliveries to relieve pain primarily in the perineum and vagina. Pudendal block anesthesia is adequate for episiotomy and its repair. This block affects only the perineum but does not impair the ability to push during the second stage of labor.
Raloxifene
is used to prevent postmenopausal osteoporosis
What is Methimazole and why is it contraindicated during pregnancy
is used to treat hyperthyroidism and is contraindicated during pregnancy because its use may cause hypothyroidism in the neonate.
What is Doxorubicin and what teratogenic effect can it cause?
it is a chemotherapy drug and can cause cardiac toxicity
Why is Bromocriptine is contraindicated for lactating women
it suppresses lactation
What is Mifepristone?
known as an abortion pill-used to induce an abortion.
What can Estrogen cause when taken during pregnancy
may cause facial discoloration and congenital defects of the female reproductive system in the fetus.
What Teratogenic effect can vitamin A cause
may cause heart defects as a teratogenic effect.
What is Diethylstilbestrol and why is it contraindicated during pregnancy
nonsteroidal estrogen medication, which is rarely used may cause vaginal cancer in a female child 18 or more years after birth. § may cause gynecologic malignancies such as endometrial, ovarian, and cervical cancers.
Phases- Rubin's theory states that the 3 stages that a mother goes through for maternal adaptation: taking-in, taking-hold and letting-go o taking-in phase: o Taking hold phase: During the letting go phase:
o taking-in phase: usually sets 1 to 2 days after delivery. the mother is passive and dependent on others for care. The woman prefers to talk about her experiences during labor and birth and also her pregnancy. The taking-in phase provides time for the woman to regain her physical strength and organize her rambling thoughts about her new role. o Taking hold phase: the mother begins to assume a more active role in the care of the child. Like calling baby by its name During the letting go phase: the woman finally accepts hero new role and gives up her old roles like being a childless woman or just mother of one child.
What is active immunity?
occurs when the individual's cells produce antibodies in response to an agent or its products; these antibodies will destroy the foreign agent (antigen) should it enter the body again.
what is Dysmenorrhea: § Primary dysmenorrhea: § Secondary dysmenorrhea:
pain with period § Primary dysmenorrhea: very common and normal · Excessive release of prostaglandins causes pain § Secondary dysmenorrhea: acquired menstrual pain that develops later in life, typically after 25 years. · Usually associated with pelvic pathophysiology (PID, endometriosis, polyps)
Labor-inducing drugs are contraindicated in women who have what?
pelvic inflammatory disease
What is Mittelschmerz pain?
pelvic pain caused by ovulation
Ortolani test:
performed by the examiner flexing the hips and knees to 90 degrees. A positive Ortolani sign is noted if the hip is dislocated and there is an audible click
When is the Presomite period and what can exposure to a teratogen during this period cause?
period (conception through week 2): teratogens act in an all-or-nothing fashion. When the concentration is low, the fetus may have normal growth. Exposure to high concentrations of a teratogen during this period may cause fetal death. may cause a spontaneous abortion
What medication will be given if you are pregnant and have heart disease
prophylactic antibodies will be given to reduce their risk for bacterial endocarditis
What important complication of a hysterectomy is important to report
report decreased urine output because it could indicate accidental ligation of a ureter which a serious complication
At what stage of labor and delivery does a primigravida differ mainly from a multigravida?:
stage 1- during normal vaginal delivery of a vertex presentation, the multigravida may have about 8 hours of labor while the primigravida may have up to 12 hours labor.
What is the Basal body temperature (BBT) technique?
the sign that ovulation has occurred: - The release of the hormone progesterone in the body following ovulation causes a slight elevation of basal body temperature of about 0.2 - 0.4 degrees centigrade. Temperature will drop then rise
Adverse effect of clomiphene
this drug may cause multiple pregnancies, Tachycardia, Breast pain, photophobia.
What is oligohydramnios?
too little amniotic fluid
What is Hysterosalpingography: o Indication fallopian tubes are patent:
type of X-ray that looks at a woman's uterus (womb) and fallopian tubes o Indication fallopian tubes are patent: Experiencing shoulder pain
What is clomiphene?
used for fertility is a serum selective receptor modulator
bethanechol
used for urine retention to help you urinate § Bethanechol will increase GI motility, which may cause nausea, belching, vomiting, intestinal cramps, and diarrhea. Bethanechol directly stimulates cholinergic receptors in the parasympathetic nervous system while stimulating the ganglia to a lesser extent.
Tocolytics therapy(magnesium sulfate (MgSO4), indomethacin, and nifedipine): teaching
used to delay your delivery for a short time (up to 48 hours) if you begin labor too early in your pregnancy § Teaching: Bed rest recommended
Clients with bleeding disorder are contraindicated for administration of ________ as they may increase the risk of bleeding
uterine stimulants
What is Lochia: Types of lochia § Lochia rubra: §Lochia serosa § Lochia alba
vaginal discharge after giving birth that continues 4-6 weeks after childbirth Lochia rubia: is the first and heaviest stage of lochia and will be bright red and may contain blood clots. · typically lasts for the first three days following delivery. § Lochia serosa: is the second stage of postpartum bleeding and is thinner in consistency and brownish or pink in color. · typically lasts from day four through day 10, following delivery Lochia alba: is the final stage of lochia. There will be a white or yellowish discharge that's generated during the healing process of the endometrium. · Expect this discharge to continue for around six weeks after birth, but keep in mind that it may extend beyond that if the second phase of lochia lasted longer than ten days.
what is Clemastine and why is it contraindicated in lactating women?
§ Antihistamine In neonates, the fat content is low due to a large amount of total body water. As a result, the drug readily enters the brain due to the neonate's immature blood-brain barrier. Neonates have immature kidneys; therefore, the glomerular filtration rate is decreased.
What intervention can limit breast swelling and pain associated with Premenstrual syndrome (PMS):
§ Intervention: Eliminating food and beverages containing caffeine can limit breast swelling
Signs and symptoms of an ectopic pregnancy: intervention
· A sharp pain in the lower right or left side of the abdomen, radiating to the shoulder. Any blood from the rupture will accumulate, causing phrenic nerve irritation and pain · Intervention: methotrexate may be prescribed to inhibit cell division
placenta previa
Abnormal attachment of the placenta. Placenta should normally lie on top or stop of uterus. This is in the lower parts of the uterus
Signs of magnesium toxicity
Absence of patellar DTR Urine less than 30 mL/hr Respiratory depression is a late indicator of toxicity
The obstetric provider has informed the nurse that she will be performing an amniotomy on the client to induce labor. What is the nurse's highest priority intervention after the amniotomy is performed?
Assessing the fetal heart rate (FHR)
What is the Ballard score (Dubowitz scale)?
Based on neonates physical and neuromuscular maturity and can be used up to 4 days after birth.
·What can administering high levels of oxygen do to a premature neonate?
Can cause blindness as a result of retrolental fibroplasia
Adverse effect of an Epidural & intervention
Can cause hypotension (nausea, pale, clammy) § Intervention: raise foot of bed which increases venous return. Check platelet count because increased risk of bleeding if low.
Late decelerations
Caused by uteroplacental insufficiency, bad. * Turn mom on side, stop pitocin, administer 10L of O2, maintain IV access, determine FHR variability, contact doctor
Inevitable abortion o Intervention-
Cervical dilation, moderate bleeding with mild abdominal cramping o Intervention- Bed rest
Latent (early) phase
Cervix dilation 1-4cm or 0-6cm Contractions: every 15-30 minutes Longest phase Intervention: Monitor contractions, encourage voiding
What Coombs test?
Checks blood for antigens that attack RBC like the Rh- factor
What is Methotrexate and why is it contraindicated during pregnancy
Chemotherapy and Immunosuppressive drug- exposure in the fetal stage of development may cause mental retardation in the baby. § may cause limb malformations. is a folate antagonist and folate is required for healthy DNA and protein synthesis,
After an Anteroposterior colporrhaphy what kind of nutrition should the patient be advised to follow
Client should eat a high fiber diet
Which client would not be a suitable candidate for internal EFM?
Client who still has intact membranes
Why is it important to monitor a patient temperature after birth? how frequently should it be taken?
Clients temperature should be taken every 4 hours after birth. Temperatures up to 100.4 in first 24 hours after birth means dehydration so increase fluids
As part of the physical assessment, a nurse inspects a newborn for the presence of an umbilical hernia. Which infant behavior will assist the nurse in identifying this problem?
Crying Increased intraabdominal pressure associated with crying, coughing, or straining will cause protrusion of the hernia.
Abruptio placenta Signs and symptoms (DETACHED)
D- Dark red bleeding E- Extended fundal height from concealed bleeding T- Tender uterus A- Abdominal pain/ contractions C- Concealed bleeding: patient can enter shock without seeing bleeding H- Hard abdomen E- Experiences DIC D- Distressed baby: FHT abnormalities
Abruptio placenta
Detachment issue, detaches before birth. Placenta normally detaches after the birth of baby
What does serum alpha-fetoprotein test detect? What does an increased level indicate? What does a decreased level indicate?
Detects open neural tube defects. An increased level of alpha-fetoprotein (AFP), has been found to reflect open neural tube defects such as spina bifida and anencephaly. What does a decreased level indicate?: Down syndrome
Drugs used to manage gestational trophoblastic disease
Dinoprostone is a synthetic drug derived from naturally occurring prostaglandins.
Fetal head Crowning
Distribution of the fingers around the head will prevent a rapid change in intracranial pressure while the head is being born and keeps the head from "popping out," which could result in maternal perineal trauma.
When does the embryo become the fetus:
During the eighth week of the pregnancy
What is the longest phase of stage 1 labor
Early (latent phase)
Risk factors for endometrial cancer
Early-onset, menarche, A high-fat diet, hypertension, and obesity are all risk factors for endometrial cancer.
What can cause nasal congestion in pregnancy?
Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract, which may result in edema in the nose, larynx, trachea, and bronchi.
Contraction stress test (CST) o Instruction: o Negative contraction test: o Positive result:
Fetus is exposed to the stress of contractions to assess the adequacy of placental perfusion. Test is performed if NST is abnormal. If fetal heart rate is acceptable then labor won't be induced. o a type of fetal heart rate that is late constitutes a no reassuring outcome. o Instruction: Empty the bladder, Position for test in semi fowlers o Negative contraction test: represented by no decelerations of the FHR o Positive result: A positive CST indicates a compromised fetus during contractions, which is associated with uteroplacental insufficiency (late decelerations)
An infant is born in the breech position, and assessment indicates the presence of Erb palsy (Erb-Duchenne paralysis). Which clinical manifestation supports this conclusion?
Flaccid arm with the elbow extended on the affected side With Erb-Duchenne paralysis there is damage to spinal nerves C5 and C6, which causes paralysis of the arm.
What fetal structures change after birth: - What can happen if the Foramen ovale fails to close: - What can happen if the ductus arteriosus fails to close:
Foramen ovale, ductus arteriosus - What can happen if the Foramen ovale fails to close: the infant will have an atrial septal defect o An atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of your heart (atria) - What can happen if the ductus arteriosus fails to close: the pressure in the lungs and heart will be abnormal, resulting in chronic heart disease
What does GTPAL stand for?
G: Number of pregnancies T: Term births at 37 weeks P: Preterm births before 37 weeks A: Abortions/ miscarriages L: Living children
What is statins and why is it contraindicated during pregnancy
HMG-CoA reductase inhibitors (statins): lowering total cholesterol (TC), may cause fetal facial malformations and central nervous system anomalies, including holoprosencephaly and neural tube defects. Simvastatin: HMG-CoA reductase inhibitor- associated with Neural tube defects and single-lobed brains are teratogenic effects in a newborn
Gestation fundal location at 16 weeks
Half the distance to the umbilicus
Early decelerations
Head pressed on Babys heart rate mirrors mothers contractions. This is ok, keep monitoring
What anticoagulant medication can be given to a pregnant client with thromboembolism
Heparin and enoxaparin because does not cross the placental barrier
What are the Antibodies in breast milk?
IgA
What Antibodies is the only immunoglobulin that crosses the placenta?
IgG is the only immunoglobulin that crosses the placenta; it provides passive acquired immunity to specific bacterial toxins. However, the fetus produces IgM by the end of the first trimester.
With a Premature rupture of the membranes (PROM), what is the patient at risk for and interventions
Infection is a risk, administer antibiotics, avoid vaginal examinations
Oxytocin Purpose Monitoring Stop it if what occurs?
Intensifies contractions of the uterus and promotes return of the uterus to its prepregnant state. used after delivery to prevent hemorrhage caused by uterine atony. § The nurse should monitor fluid intake and output because prolonged oxytocin infusion may cause severe water intoxication, leading to seizures, coma, and death § Oxytocin, a posterior pituitary hormone, has an antidiuretic effect, acting to reabsorb water from the glomerular filtrate § STOP oxytocin if contractions frequency is less than 2 minutes or duration is longer than 90 seconds. o Oxytocin is used for spontaneous or induced abortions. § Complications: Uterine tetany
How should iron be supplemented in pregnancy
Iron should be taken before breakfast, on an empty stomach, to permit maximal absorption; the ascorbic acid in orange juice enhances the absorption of iron.
What can Magnesium sulfate be used for when in labor
Is a CNS depressant drug of choice for maintaining pregnancy in preterm labor in hypertensive clients. Can also protect against cerebral palsy. The purpose of administering magnesium sulfate is to stop preterm labor. It is a tocolytic agent that relaxes uterine smooth muscle.
Variable decelerations
Looks like V, Not good caused by umbilical cord compression. * Change mothers position, administer O2, Stop pitocin, contact doctor
Relief from postpartum contractions intervention
Lying prone with a pillow on abdomen helps keep fundus contracted
What is Lithium and why is it contraindicated during pregnancy
Mood stabilizer: may cause Ebstein anomaly as a teratogenic effect
Erythema toxicum:
Newborn rash referred to as a flea bite, it is a normal popular rash that requires no further action
How does preeclampsia occur?
Normally during pregnancy, the spinal arteries in the uterus widen in diameter to help increased blood flow to the placenta to give the baby nutrients and oxygen. If trophoblast fail, spinal arteries stay narrow and fail to widen. Which will become ischemic sending out hormones into the mom's circulation in hopes of increases blood flow, however, the hormones are toxic to moms endothelial cells damaging them causing vasospasm (Lose tone causing vessel contraction) and increase permeability (vessels leak)
Gravida
Number of times a women has been pregnant
What is Turner Syndrome? Characteristics:
Occurs in females when they only have one X chromosome Characteristics: Webbed neck, female sex organs, widely spaced nipples
RSA
On this image, What Fetal position would A represent
LSA
On this image, What Fetal position would B represent
ROP, RMA, ROA
On this image, What Fetal position would C represent
Signs of placenta previa (PREVIA)
P- painless bright red bleeding R- Relaxed soft non tender uterus E- Episodes of bleeding V- Visible bleeding I- Intercourse post bleeding A- Abnormal fetal position breech or transverse lie, FHR normal
Which clinical finding in a primiparous client at 32 weeks of gestation might be an indication of anemia?
Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated.
A pregnant woman's amniotic membranes have ruptured. A prolapsed umbilical cord is suspected. What intervention would be the nurse's highest priority?
Placing the woman in the knee-chest position
What is Uterine atony? § Assessment: § Intervention:
Poorly contracted uterus that does not adequately compress large open vessels and can result in hemorrhage § Assessment: A soft boggy uterus noted on palpation of the uterine fundus § Intervention: message the uterus until firm, empty the women bladder, notify OB if it does not resolve
A client with heart disease is admitted to the birthing suite. Which nursing intervention may help prevent the development of cardiac decompensation during her labor?
Positioning her on the side with her shoulders elevated The side-lying position, particularly the left, takes the weight off large blood vessels, increasing blood flow to the heart; elevating the shoulders relieves pressure on the diaphrag
What will need to happen if a pregnant women contracts Streptococcus B:
Pregnant women will need to be treated with an IV antibiotic throughout the labor process to prevent transmission of the infection to the neonate. § intrapartum antibiotic prophylaxis for a client infected with GBS is an initial dose of 2 g followed by a 1-g dose every 4 hours.
The musculoskeletal system adapts to the changes that occur throughout the pregnancy. Which musculoskeletal alteration should the client expect?
She will have increased lordosis. An increase in the normal lumbosacral curve (lordosis) develops
Shultz mechanism
Shiny side of the placenta comes out first
Cephalhematoma?
Swelling caused by a collection of blood between the skull bone and its periosteum that results from trauma during birth. It resolves spontaneously within 6 weeks. Does not cross the suture line. As the hematoma resolves, hemolysis of red blood cells occurs, and jaundice may result (watch for this)
Acrocyanosis
Temporary cyanotic condition, usually in newborns resulting in a bluish color around the lips, hands and fingernails, feet and toenails. May last for a few hours and disappear with warming.
What is chorionic villus sampling (CVS)? When is this test done? and why cant it be done earlier ?
Test is done during early pregnancy to find problems with the fetus by testing placental tissue This test is done between the 10th and 12 weeks of pregnancy, cant be done sooner because it may cause fetal anomalies
What Antibiotics are contraindicated with breastfeeding
Tetracycline and chloramphenicol should be avoided during breast-feeding. Chloramphenicol can cause gray syndrome
biophysical profile (BPP)
The BPP evaluates fetal health by assessing five variables: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic fluid volume. A normal response for each variable receives 2 points; an abnormal response receives 0 points. A score between 8 and 10 is considered normal, indicating that the fetus has a low risk of oxygen deprivation and isn't in distress.
Which cervical changes are observed during pregnancy?
The cervical tip becomes soft, The volume of cervical muscles increases, The elasticity of cervical collagen-rich connective tissue increases.
Potential risk in regard to continued use of birth control pills:
The estrogen and/or progesterone in birth control pills increases the amount of renin produced in the kidneys. Increased renin will stimulate the production of angiotensin, a potent pressor substance, resulting in hypertension.
A nurse performs Leopold maneuvers on a newly admitted client in labor. Palpation reveals a soft, firm mass in the fundus; a firm, smooth mass on the mother's left side; several knobs and protrusions on the mother's right side; and a hard, round, movable mass in the pubic area with the brow on the right. On the basis of these findings, the nurse determines that the fetal position is what?
The fetus is in a left occiput anterior (LOA) position because the buttock (firm mass) is in the fundus, the back is on the left, the small parts are on the right, and the head is flexed, indicating an anterior occiput.
What complication of pregnancy can occur when discontinuing asthma medications
The risk of stillbirth is very high in women who discontinue asthma medication during pregnancy.
What are chorionic villi
These are finger like projections that form the fetal portion of the placenta. The villi obtain oxygen and nutrients from the maternal bloodstream
If the fundal height is greater than expected or higher earlier what kind of complications can this indicate
This early fundal height increase indicates a hydatidiform mole, a multiple gestation, or a fetal congenital anomaly
Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is the primary purpose of prostaglandin administration?
To ripen the cervix in preparation for labor induction
prolapsed umbilical cord: assessment interventions
Umbilical cord is displaced between the presenting part and the amnion causing compression of the cord compromising fetal circulation § Assessment: umbilical cord visible, FHR slow and irregular § Intervention: Emergency situations- place patient in Trendelenburg position, Stay with client and ask another nurse to call HCP wrap the cord loosely in a sterile towel saturated with warm sterile normal saline
Intervention after Episiotomy to prevent swelling
Use ice packs to prevent swelling
What is the Silverman Anderson score used to assess?
Used to assess severity of respiratory distress in new born and preterm infants. Score 0= no distress, 10= maximum distress
What is Topiramate and why is it contraindicated during pregnancy
Used to treat epilepsy, may have teratogenic effects that cause a newborn to develop a cleft lip with cleft palate.
What is uterine inversion? Assessment: Intervention:
Uterus turns completely or partly inside out § Assessment: depression in the fundal area of the uterus, Patient in severe pain, hemorrhage is evident, client shows signs of shock § Intervention: Monitor for shock, prepare for return of uterus
What is an Indication of a Laceration of the cervix?
Uterus will be firm with blood
Which alteration in the FHR pattern would indicate the potential need for an amnioinfusion?
Variable decelerations Amnioinfusion is used during labor to either dilute meconium-stained amniotic fluid or supplement the amount of amniotic fluid to reduce the severity of variable FHR decelerations caused by cord compression
Right Mentum Posterior (RMP)
What position is this fetus in
Right Occiput Anterior (ROA)
What position is this fetus in
Nullipara
Women who has never completed a pregnancy at 20 weeks gestation or greater
What is Dinoprostone?
a prostaglandin cervical ripening drug, which is indicated for uterine evacuation in cases of miscarriage. It also stimulates uterine contractions to promote the progression of labor. Administered intravaginal § This drug is used for cervical ripening when there is an obstetric need for labor induction.
respiratory distress syndrome
a respiratory complication in the newborn, especially in premature infants Signs: Flaring of the nostails
What is developmental dysplasia of the hip (DDH) and a sign of it?
a result of the displacement of the head of the femur in the acetabulum. Sign: DDH there are extra skinfolds on back of the affected thigh
Menotropins
a standardized mixture of follicle-stimulating hormones and luteinizing hormones. These chemicals are derived from the urine of postmenopausal women. - are administered for infertility act at the pituitary level
Bishop score
a system used to decide how likely it is that you will go into labor soon. They use it to determine whether they should recommend induction, and how likely it is that an induction will result in a vaginal birth.
nulligravida
a woman who has never been pregnant
primigravida
a woman who is pregnant for the first time
Gestation fundal location at 24 weeks
above the umbilicus
During labor, when is an analgesic administered?
administered at the beginning of a contraction uterine muscle tension increases resistance to the absorption of the medication, thereby slowing its passage through the placenta to the fetus.
Gestation fundal location at 20 weeks
at the umbilicus
Chorioamnionitis:
bacterial infection of the amniotic cavity causing foul odor to amniotic fluid
Why is Atenolol (Tenormin) contraindicated in lactating woman?
because it enters the breast milk and may cause adverse effects to the neonate.
Nursing interventions for placenta previa
bed rest, No vaginal examinations, or sexual intercourse throughout the rest of pregnancy No abdominal manipulation
Expected hematocrit level for a healthy newborn?
between 45% and 65%
What is Myelomeningocele? § Intervention:
birth defect in which the backbone and spinal canal do not close before birth. The condition is a type of spina bifida § Intervention- Apply a sterile saline dressing
How long is the postpartum period?
birth until 6 weeks
What is Misoprostol? When to follow up?
can be used for cervical ripening and as a stomach protectant. § The most widely used off-label drug for cervical ripening and the enhancement of uterine muscle tone because it is relatively affordable § helps in inducing labor when the uterus is insensitive to oxytocin. § Follow up 4-8 days after abortion with misoprostol for examination or ultrasound to confirm termination
If the placenta is not delivered promptly after detachment, what can happen
can lead to DIC
What is Dutasteride and why is it contraindicated during pregnancy
can treat enlarged prostate is a 5-alpha-reductase inhibitor that causes malformations of external genitalia in males
What is Ophthalmia neonatorum? intervention: When is it evident?
caused by gonorrheal and/or chlamydial infections present in the vaginal tract o nurse instills an antibiotic ophthalmic ointment into a newborn's eyes to prevent this Untreated ophthalmia neonatorum becomes apparent on the third or fourth postnatal day and provides evidence that the mother may have had gonorrhea or a chlamydial infection.
why is tetracycline contraindicated in pregnancy
causes tooth and bone anomalies in fetuses
What is Cephalopelvic disproportion (CPD)? Assessment finding indicating this condition? Intervention:
condition preventing normal delivery through the birth canal; either the baby's head is too large or the birth canal is too small Floating fetal head is indicative of this occurrence, prepare for cesarean birth
What characteristics of the newborn are evident if the mother contracted rubella during pregnancy
congenital cataracts, microcephaly, deafness, and cardiac anomalies
WHat is Esophageal atresia: 3C's What is it caused by?
coughing, chocking, cyanosis caused by overflow of secretions into the trachea
Caput succedaneum:
crosses the suture line because it is outside the periosteum § is a diffuse pattern of edema above the periosteum; it results from an even distribution of pressure on the fetal head during labor. Subsides within a few days
Stage 3 of labor
delivery of placenta. The longer this stage the increased risk for hemorrhage and retained placenta. (Shultz or Duncan mechanism) Intervention: monitor BP administer oxytocin as ordered AFTER the delivery of the placenta ( helps uterus contract)
What is Cyclophosphamide and why is it contraindicated during pregnancy
drug used in the treatment of cancer. The teratogenic effect includes shortened limbs, internal organ defects, limb malformations, and central nervous system malformation.
What physical property of drugs should be avoided when breast feeding?
drugs with a longer half-life stay in the body for a longer time and may enter the breast milk, which can produce unwanted pharmacologic effects in the child. o Drugs that are highly lipid soluble can enter the breast milk in high concentrations.
What can a higher hCG level indicate?
ectopic pregnancy or Down syndrome, or multiple pregnancies
What can clomiphene cause
esophageal burns.
Betamimetics (tocolytics) have the unpleasant side effects of
nervousness, tremors, and palpitations; clients should be informed that these side effects are expected
What is epitaxis?
nose bleeds
What could circumoral pallor indicate ?
not a normal newborn finding o Notify the practitioner, because circumoral pallor may indicate cardiac problem
After an Anteroposterior colporrhaphy what nonpharmacological measures should be implemented
warm compresses
What are The cardinal movements of the mechanism of labor that occur in a vertex presentation?
(1) Descent of the fetal presenting part through the true pelvis. (2) Engagement of the fetal presenting part as its widest diameter reaches the level of the ischial spines of the mother's pelvis. (3) Flexion of the fetal head so that the smallest head diameters pass through the pelvis. (4) Internal rotation to allow the largest fetal head diameters to match the largest maternal pelvic diameters. (5) Extension of the fetal head as it passes beneath the mother's symphysis pubis. (6) External rotation of the fetal head to allow the shoulders to rotate internally to fit the mother's pelvis. (7) Expulsion of the fetal shoulders and fetal body.
When is the Embryonic period and what can exposure to a teratogen during this period cause?
(week 3 to week 8): internal organ developmental defects may occur, Gross malformations may occur during the embryonic period when the basic shape of the fetus starts to develop.
When is the postcoital test performed?
- Best performed within 1 to 2 days of presumed ovulation
hydatidiform mole - Assessment: - Intervention: - Teaching:
- Mole is form of gestational trophoblastic disease that occurs when the trophoblasts attach to the fertilized ovum and develop abnormally. The mole manifests as a grape-like cluster. - Assessment: Characteristic snowstorm pattern shown on ultrasound, fundal height greater than expected gestational age, elevated HCG levels - Intervention: prepare for uterine evacuation by vacuum aspiration, Hcg levels are monitored every 1-2 weeks until normal pregnancy levels are attained and then checked every 1-2 months for 1 year. - Teaching: instruct to not get pregnant for 1 year
A client at 36 weeks' gestation is admitted to the high-risk unit with the diagnosis of severe preeclampsia, and antiseizure therapy is instituted. A fetal monitor and an electronic blood pressure machine are applied. Which complication of severe preeclampsia requires diligent monitoring of the blood pressure?
- Stroke - The likelihood of a stroke increases with a rising blood pressure reading.
Episiotomy
- Surgical cut made to the opening of the vagina during childbirth to aid a difficult delivery and prevent rupture
Fetal station above ischial spines
-1 to -4 station
Fetal station below ischial spines
1+ to 4+ station: When the head enters the vagina it is below the ischial spines
first trimester
1-12 weeks
Uterus location after birth: o 12 hours after birth= o 2 post partum day= o 3 post partum day= o What does it mean when the Uterus is above umbilicus and to the right?
12 hours after birth= uterus 1cm above umbilicus o 2 post partum day= uterus 2cm below the umbilicus o 3 post partum day= fundus 3cm below umbilicus The bladder has become overdistended, have client go to the bathroom
What is considered adequate immunity of rubella for an infant
1:8
What does the umbilical cord contain?
2 arteries and 1 vein
When does ovulation occur?
2 weeks before menstruation
What is considered preterm?
20-37 weeks
Most ova remain fertile for approximately how long after ovulation?
24 hours after ovulation
Third trimester
27-40 weeks
When does a Chlamydia trachomatis infection occur in the eyes after birth
3 to 4 days. if it is not treated prophylactically with an antibiotic at birth or within 3 days, chronic follicular conjunctivitis with conjunctival scarring will occur.
What is the normal neonate respiratory rate
30-60 a min
What is the percent chance that a child of a parents with an autosomal dominate disorder (huntingtons disease) will have the disease
50%
How long should a diaphragm contraceptive remain in place after intercoarse
6 hours
Transitions phase of the first stage of labor
8-10cm cervical dilatation;Shortest phase but most intense. Lasts 30min-2 hours changed behavior, sudden nausea extreme irritability contractions are severe 2-3 minutes apart and 60-90 seconds duration
In a Footling breech presentation what will most likley be performed
A cesarean birth may be performed
Amniocentesis o Disorders that can be detected: o When is this done: o Prepare client for test:
Amniocentesis o Disorders that can be detected: error of metabolism (tay-sachs and thalassemia) o When is this done: between 14 weeks and 20 weeks o Prepare client for test: Instruct her to void immediately before the test to prevent bladder injury
What is the most effective exercise to prevent DVT
Ankle pumping is the most effective exercise presented to prevent DVT
What is Carbamazepine and why is it contraindicated during pregnancy
Anticonvulsant safe to administer in a lactating woman but may cause neural tube defects as a teratogenic effect in pregnant women.
during which phase of the menstrual cycle should an intrauterine device (IUD) should be inserted?
Between the first and fourth days of the cycle because the cervical os is slightly dilated at this time
What kind of breathing techniques should be used in fetal head crowning
Blowing breathing patterns should be done to controls the strong urge to push and allows for a controlled birth of the head
While reviewing laboratory results of clients seen at the maternity clinic, the nurse notes that one client's maternal serum alpha-fetoprotein level is lower than expected. What does the nurse recognizes that this may be associated with?
Down syndrome Chromosomal trisomies such as Down syndrome may be marked by a lower-than-typical level of alpha-fetoprotein.
A client at 35 weeks' gestation calls the prenatal clinic, concerned that she has "not felt the baby move as much as usual." The most appropriate recommendation by the nurse is to have the client call the clinic with the results after she has done what?
Drunk a glass of orange juice and timed 10 fetal movements Drinking orange juice can increase fetal movement.
Sonogram teaching:
Ensuring that the client drinks two 8-oz (237 mL) glasses of water
Laparoscopy teaching:
Expect shoulder pain for 12-24 hours caused by insufflated carbon dioxide that presses on the diaphragm
Duncan mechanism
Expulsion of placenta with maternal surface emerging first. DUll and rough
What is the most reassuring fetal heart rate
Fetal accelerations
Oligohydramnios is associated with what fetal affect
Fetal renal congential anomalies
What is coarctation of the aorta?
High BP in the arm due to a CONGENITAL FORM OF NARROWING, must check thigh pressure bc it will be lower note: in normal cases, thigh pressure will be higher than the arm
What is leukocytosis? and when does it occur?
High WBC count. It is an expected postpartum finding that typically occurs during the postpartum period as a compensatory defense mechanism
A nurse identifies a right cephalhematoma on an otherwise healthy 1-day-old newborn. What should the nurse teach the parents at the time of discharge?
How to monitor their child for signs of jaundice - Bilirubin is a yellow pigment derived from the hemoglobin released with the breakdown of red blood cells as the hematoma resolves. Signs of jaundice should be reported
Abruptio placenta risk factors
Hypertension, preeclampsia, previous placental abruption, trauma to abdomen, cocaine or smoking, PROM,
parity
Number of times she has given birth
Down syndrome characteristics:
Protruding tongue, epicanthic eye folds, single trans palmar crease
Jaundice intervention Receive phototherapy o Normal bilirubin level: o Interventions to lower Bilirubin: o Vitals are done every:
Receive phototherapy o Normal bilirubin: 6-12 o Interventions: Give breast milk to lower high levels of bilirubin, Cover the infants eyes and genital area o Vitals are done every 2 hours because hyperthermia can occur due to the phototherapy lights.
Carcinoma in situ: o Stage 0 means: o Stage 2 involves:
Refers to cancer in which abnormal cells have not spread beyond where they have first formed. "Situ" means original place. o Stage 0 means: it Has a 100% 5 year survival rate o Stage 2 involves: the vaginal wall
What is the Apgar score
Represents neonate response to the environment. Newborns score is frequently assessed and recorded 1 minute and 5 minutes after birth.
Opioid drug withdrawal symptoms
Symptoms: neonate is hyperactive and jittery, sneezes frequently, has a high-pitched cry, and is having difficulty suckling. Further assessment reveals increased deep tendon reflexes and a diminished Moro reflex.
What are the 2 Neonate Fontanelles?
The anterior fontanelle is a diamond shape with the anteroposterior diameter being longer than the transverse diameter. Closes 12-18 months o The posterior fontanelle is a triangular shape. Closes end of 2nd month
in a client with heart failure, what is the most critical time the cardiovascular system is compromised?
The first 2 days after the birth is the most critical period because of the rapid shift of extravascular fluid as it returns to the bloodstream
The nurse is helping a mother breast-feed her newborn. What is the best indication that the newborn has achieved an effective attachment to the breast?
The mouth covers most of the areolar surface.
A client at 39 weeks of gestation has been admitted for an external version. Which intervention would the nurse anticipate the provider to order?
Tocolytic drug A tocolytic drug will relax the uterus before and during the version, thus making manipulation easier
What is Nifedipine (Procardia)? When is it contraindicated?
Tocolytic is used to prevent preterm labor because it inhibits myometrial activity by blocking the influx of calcium. Contraindicated in hypotension because it can cause hypotension
What is the purpose of vernix caseosa?
Vernix caseosa protects the fetal skin from the amniotic fluid.
Abruptio placenta nursing interventions
Watch for symptoms of DIC: Low platelets, gum bleeding oozing at injection site Assess bleeding with vital signs every 15 minutes, pad count. MONITOR and mark fundal height and abdominal girth - No abdominal manipulation or vaginal exams - Left side lying position NO SUPINE - Monitor baby continually with external monitoring
Left Mentum Anterior (LMA)
What position is this fetus in
Left Occiput Transverse (LOT)
What position is this fetus in
Left Occiput anterior (LOA)
What position is this fetus in
Left Sacrum Anterior (LSA)
What position is this fetus in
Left Sacrum Posterior (LSP)
What position is this fetus in
What is meperidine (demerol) used for?
an opioid that can cause respiratory depression in the neonate if administered less than 4 hours before birth.
gestational trophoblastic disease
an ultrasound performed after the 3rd month shows grapelike clusters of transparent vesicles rather than a fetus. Usually, no embryo (and therefore no fetus) is present because it has been absorbed.
What is Nitrofurantoin and why is it contraindicated during pregnancy
antibacterial medication used to treat bladder infections- Causes abnormally small eyes, heart defect, cause cleft lips with cleft palates
When do Babies start to respond to sound?
approximately 24 weeks of gestation.
What are cervical polyps?
are growths on the cervical canal, the passage that connects the uterus to the vagina. They're often reddish, purplish, or grayish in color. - Polyps are usually benign; however, a biopsy should be performed because epidermoid cancer occasionally
Jaunice 24 hours after birth is a sign of?
erythroblastic fetalis (the abnormal presence of erythroblasts in the blood.)
Nonstress test (NST): o Positive test/reactive o Nonreactive NST:
evaluating fetus response to movement by comparing the fetal heart rate (FHR) with fetal physical activity. Asked to press a button every time fetal movement is felt for 20 minutes o Positive test/reactive- indicates that the fetus is healthy because there is an active pattern of fetal heart rate acceleration with movement. The result is positive and desired; § Fetal reactivity: Two accelerations of 15 beats/min lasting 15 seconds o Non reactive NST: No accelerations or less than 15 seconds per minute occur during a 40 minute period
menorrhagia
excessive bleeding during menstruation
What is the very first assessment that is done after an amniotomy
fetal heart tones then do a sterile vaginal examination to determine complication of umbilical cord prolapse
primipara
first birth
Stage 4 of labor
first four hours after delivery Interventions: - Monitor vital signs: especially BP and HR due to risk of hemorrhage - Monitor discharge lochia: Red, moderate w/ small clots is normal. Assess how many peri pads, if changing every 15 min this is abnormal - Monitor fundus of the uterus: SHould be firm and midline. If soft of boggy perform fundus massage and make sure bladder is empty.
What drug can Clomiphene interact with and cause infertility
methyldopa
What hormone is essential for maintaining pregnancy?
progesterone
What kind of diet should be initiated in a pregnant client with preeclampsia
protein rich
Bacterial vaginosis: Signs
signs of bacterial vaginosis include a milky gray vaginal discharge that has a characteristic fishy odor. "Clue cells" noted on wet smear are indicative of bacterial vaginosis. Clue cells are vaginal epithelial cells coated with bacteria.
Wharton's jelly
surrounds vessels to prevent compression
When is Pant-blow breathing recommended?
when the cervix is not completely dilated, As your contraction starts, take a deep breath in through your nose.
stage 2 of labor
starts with full dilation to the birth. Interventions: monitor mothers and babys HR. Watch for changes that indicate baby is coming (Bulging perineum, parts of baby present, increase in bloody show)
Active labor
the cervix dilates 4-7 cm Contractions every 3-5 min 30-60 seconds in length Lasts about 4-8 hours Intervention: if at home go to the hospital, monitor meconium stained fluid, positive means baby could go into distress. Encourage frequent urination
A nurse is assessing a newborn with suspected retention of a fetal structure that will result in a congenital heart defect. Which fetal structures should undergo change after birth?
- Foramen ovale & Ductus arteriosus - If the foramen ovale fails to close, the infant will have an atrial septal defect. If the ductus arteriosus fails to close, the pressure in the lungs and heart will be abnormal, resulting in chronic heart disease.
Before discharge, what suggestion should the nurse give to a nonnursing mother to help limit breast engorgement?
- Fresh, raw cabbage leaves placed over the breasts between feedings can help relieve engorgement
A client who has placenta previa now has started bleeding heavily and is being admitted to the high-risk unit. Why should the nurse place the client in the knee-chest position?
- It prevents shock - The knee-chest position shunts blood to the upper body and vital organs
HELLP syndrome & symptoms
hemolysis, elevated liver enzymes, low platelets. A serious complication of high blood pressure during pregnancy Symptoms: Headache, abdominal pain, flu-like symptoms
How to know if baby is getting enough food:
hydrated babys urine is dilute/ straw colored and voids 6-10x a day
When does the placenta transfer maternal immunoglobulin providing the fetus with passive immunity
in the 3rd trimester
What are ACE inhibitors and why is it contraindicated during pregnancy
in the second and third trimesters of pregnancy may cause skull hypoplasia in the newborn. § may cause poor development or absence of the proximal tubule as a teratogenic effect.
Most frequently occurring cancer of the breast:
invasive ductal carcinoma
Normal birth weight of a full-term baby
is 2,500 gms or 2.5 Kg.
Fetal lung maturity lecithin/sphingomyelin (L/S) ratio: WHat is considered mature?
is a test of fetal amniotic fluid to assess for fetal lung immaturity. o When the L/S ratio reaches 2:1, the fetus' lungs are considered mature.
What is an early sign of Cervical cancer?
is blood spotting after intercourse
Striae gravidarum
known as stretch marks.
What is Methylergonovine? What is important to obtain prior to administration of this drug?
used to prevent postpartum uterine atony and hemorrhage but is not given to augment labor. Can cause hypertension § Have to obtain blood pressure prior to giving, contraindicated in hypertension
A vertex presentation in the occiput posterior position will usually cause what kind of pain in the mother during pregnancy?
usually causes back pain
