NSG 355 Exam 1

Measuring Fundal Height -

- Measure from pubic symphysis, to top of fundus (upper 1/3 of uterus) - Baby's position can influence height - Multiple babies can cause increase in fundal height - Excess amniotic fluid can increase height - Bladder must be emptied first, otherwise it can add about 3cm to the measurement

Group Beta Strep - Mother to Infant Transmission -

- Most group B streptococcal disease cases among newborns result from mother-to-infant transmission during labor and delivery. - Many women are asymptomatically colonized by group B streptococcus in the genital and gastrointestinal tracts. - it can be harmful to the newborn during pregnancy - Have to be tested within 5 days of delivery day because infection is transient, so it has to be retested for each pregnancy - About half the infants born to colonized mothers are themselves colonized on the skin and mucosal surfaces as a result of passage through the birth canal or as a result of GBS ascending into the amniotic fluid. - The majority of colonized infants, 98%, are asymptomatic. - About 2% will develop early-onset disease, presenting with sepsis, pneumonia or meningitis in the first few days of life.

Intrauterine development is divided into 3 stages during entire pregnancy:

3 Intrauterine Developmental Stages: 1. Ovum (preembryonic): conception through 14 day period of cellular replication. Blastocyst formation, development of embryonic membranes, establishment of primary germ layers 2. Embryo: day 15 until approx. 8 weeks: development of the organ systems and main external features 3. Fetus: 9 weeks until pregnancy ends

Pulmonary embolism, 3 classic signs:

3 classic signs: acute respiratory distress, hemoptysis, coughing. Other Signs - chest pain, dyspnea, cough, respiratory rate increase, tachycardia, febrile, anxiety

3 features allow fetus to obtain sufficient O2 from maternal blood:

3 features allow fetus to obtain sufficient O2 from maternal blood: 1- fetal hemoglobin carries 20-30% more O2 than maternal hemoglobin 2- hemoglobin concentration of fetus is about 50% greater than that of mother 3- FHR is 110-160 bpm-making cardiac output per unit of body weight higher than that of an adult

3 terms used to describe involuntary contractions include -

3 terms used to describe involuntary contractions include: Frequency - time from beginning of one contraction to the beginning of the next contraction Duration - length on contraction Intensity - strength of contraction at its peak

Functions of amniotic fluid include:

> Cushion to prevent injury > Assists in maintaining a constant temperature > Allows for freedom of movement aiding in musculoskeletal development

A precipitous delivery -

A precipitous delivery (total time of labor is 3 hours or less) places great strain on the uterine muscle which is therefore more prone to less effective contractions post delivery and thus postpartum hemorrhage as placenta may not be expelled as quickly and uterus is .

APGAR Score -

APGAR Score: Take at 1 minute and five minutes of life, and then again at 10 minutes if one or both of the first two scores are below 7 Appearance - Skin Color - Cyanotic = 0 ; Some cyanosis = 1 ; Pink all over Body = 2 Pulse - <60 = 0 ; 60<P<100 = 1 ; P>100=2 Grimace - Reflex Irritability to stimulus - No Response = 0 ; Feeble Cry/Grimace = 1 ; Full Cry/Pulls Away = 2 Activity - Movement - No Movement=0 ; Some Flexion = 1 ; Fully Active = 2 Respirations - Breathing - Absent = 0 ; Weak/Shallow = 1 ; Strong/Lusty = 2

Retained Placenta - (3 levels of attachment of placenta)

Accreta - firm attachment, slightly in uterine wall Increta - attached deep into uterine wall Percreta - attachment goes beyond uterine wall into surrounding organs

Amniotic fluid:

Amniotic fluid: Assessment of the overall volume gives a mark for how well the fetus is doing. Normal: 700-1200 ml volume at term Abnormal: > Less than 300ml = Oligohydramnios > Greater than 2000ml = Hydramnios or Polyhydramnios

An upright position (walking, sitting, kneeling, squatting) offers a number of advantages including -

An upright position (walking, sitting, kneeling, squatting) offers a number of advantages including gravity promoting descent of the fetus, uterine contractions are generally stronger and more efficient in effacing and dilating the cervix, resulting in shorter labor. An upright position is also beneficial to the mother's cardiac output.

Name the two intersections of sutures on a babies skull and describe their shapes

Anterior Fontanel (diamond - 3cmx2cm) closes around 18 months after birth , Posterior Fontanel (triangle - 1cmx2cm) closes around 6-8 weeks after birth

Cardiovascular Systems Changes During Pregnancy

Blood volume increases - 40-50%, about double Mostly the blood volume increases due to plasma increase, erythrocyte (RBCs) Physiologic anemia - lack of adequate RBCs H+H (Hgb: 12-16 G/dl) (Hct: 37%-47% ) When diluted a Hct of 33% would be ok. Hgb under 12% would indicate a need for nutritional counseling, under 11% indicate a need for supplements, Iron - can cause constipationwill drop because of anemia Cardiac output goes up at about 20 weeks and stays up until pregnancy From increases cardiac output - increases in respirations, BP may not go up, may go down for first part of pregnancy, pulse is going to go up just a little bit, varicose veins - can be anywhere from labia down to feet - may need to wear support stocking, raise feet when supine Every mom needs prenatal vitamins Can be at increased risk for kidney stones because of increase in mineral intake

BUBBLEEE

Breasts - babies stomach is like a tiny marble, doesn't take much to fill up, need colostrum for immune support, milk comes in 2-3 days, wear supportive bra, can use cool compresses, don't stimulate nipples unless breast feeding, breasts will be uncomfortable, can take NSAIDS, tylenol to help if breast feeding - nipple eversion, inversion, nipple shield for inverted nipples, check nipples for cracking, bleeding, - can rotate position of baby, can use purified lanolin don't want her to stop breast feeding, even with discomfort Uterus - Fundal height - checking for involution through 2 weeks time - starts at Umbilicus or U+1 (1 finger height over U) In 24 hours should go down by 1-3 finger breadths, fundal state - should be firm, if soft is called boggy, fundal placement - deviation from midline (umbilicus) can mean full bladder. Bladder - make sure mom is peeing at least every 2-3 hours whether or not she feels like it. Residual epidural or anesthetic can mask sensitivity of bladder. Women can also be afraid to pee immediately after pregnancy Bowels - check bowel sounds, make sure you hear some kind of bowel sounds in all 4 quadrants. Check for hemorrhoids. normal to have hypoactive movement, but complete absence in quadrants should be reported immediately. Lochia - discharge from lining of uterus, stays heavier if bladder is full. Starts lochia rubra 2-4 days, lochia serosa 3-10 days, lochia alba after 10 days. There may be some blood clots but they should not be any larger than a golf ball. Cannot use tampons, must ONLY use pads. Episiotomy - can be really hard to see, and if there is a problem you will see it - opening, pulling, etc. if everything is okay, you probably will not be able to see anything much Extremities - checking for clots in legs especially (Homan's Sign), need to have hand under thigh to have a slightly flexed knee, don't let patient know you are about to do it. Check pedal pulses. Check for any extra swelling, etc. at increased risk for thrombosis because of increased fibrin levels. Emotions - baby blues up to a few weeks after pregnancy. feelings of worthlessness, wanting to run away can be signs of more serious postpartum depression.

Capacitation - Cleavage - Implantation -

Capacitation - A physiologic change brought on by enzymes produced in the female reproductive tract that removes the protective coating from the heads of the sperm which allow sperm to penetrate protective layers of the ovum to complete fertilization. Cleavage - Mitotic cellular replication called cleavage begins as the zygote travels the length of the uterine tube into the uterus which takes 3-4 days Implantation - occurs about 6-10 days. The blastocyst burrows into the endometrium which is then termed the decidua. Endometrioal blood vessels erode, and some women may have slight bleeding. Some women may interpret this to be a "light period" when in fact they are pregnant.

Chorionic Villi - Decidua - Decidua Basalis - Decidua Capsularis - Decidua Vera - Amnion cavity -

Chorionic Villi - finger-like projections that develop out of the trophoblast and extend into the endometrium that obtain oxygen and nutrients from the maternal bloodstream and dispose of CO2 and wastes. Decidua - after implantation the endometrium is called the decidua. Decidua Basalis - the portion of the decidua (endometrium) directly under the blastocyst where the chorionic villi tap into the maternal blood supply is the decidua basalis. Decidua Capsularis - the portion of the endometrium (now called the decidua) now covering the blastocyst after it has successfully burrowed into the decidua Decidua Vera - portion of the endometrium other than the basalis and capsularis. Chorion - one of the membranes that exist during pregnancy (developed from the trophoblast layer of cells) it is the outermost embryonic membrane and encircles the amnion, embryo and yolk sac. Amnion - developed from the interior cells of the blastocyst, it is a thin protective membrane that will become fluid filled. The space that develops between the amniotic membrane and the embryo is the Amniotic Cavity. The fluid that will fill this cavity is called Amniotic Fluid.

Dilation is -

Dilation is the enlargement or widening of the cervical opening and the cervical canal that occurs once labor has begun. Dilation ranges from less than 1 cm to 10 cm (fully dilated).

Dizygotic twins develop from - Monozygotic twins develop from -

Dizygotic twins develop from two separate ova fertilized by two separate spermatozoa Monozygotic twins develop from a single ovum fertilized by a single spermatozoa

During labor, frequent changes in position -

During labor, frequent changes in position relieve fatigue, increase comfort and promote circulation. therefore a laboring women should be encouraged to find positions most comfortable to her.

During regular vaginal delivery, blood loss is around - During Cesarian blood loss is around -

During regular vaginal delivery - blood loss is around 350-500 mLs During Cesarian blood loss is around 500-1,000 mLs

Dystocia is -

Dystocia is an abnormal or difficult childbirth or labor. Approximately one fifth of human labours have dystocia. Dystocia may arise due to incoordinate uterine activity, abnormal fetal lie or presentation, or (rarely) a massive fetal tumor such as a sacrococcygeal teratoma. Oxytocin is commonly used to treat incoordinate uterine activity, but pregnancies complicated by dystocia often end with assisted deliveries, including forceps, ventouse or, commonly, caesarean section.

Effacement of the cervix is -

Effacement of the cervix is the shortening and thinning of the cervix walls during the first stage of labor. effacement is generally advanced in first-time term pregnancy before more than slight dilation occurs. in subsequent pregnancies, effacement and dilation tend to occur together. effacement is expressed in percentage, ie - the cervix is 50% effaced. The cervix is normally 2-3 cm long and about 1 cm thick.

Most vulnerable time for development in utero:

Embryo: day 15 through week 8-most critical time of development of the organ systems and main external features. Most vulnerable to teratogens during this time frame.

Postpartum Infections -

Endometritis - lining of endometrium can become infected. C-sections are more prone to this than vaginal delivery. Cured with antibiotics Mastitis - infection of tissue around nipple in breast in mammary ducts. The milk has to be well established before this becomes a problem so this won't show up for a least a couple weeks after labor. Nipple cracking, poor hand washing, not emptying all the milk out can exacerbate it. Best to keep breast feeding despite infection. Keeps flushing area out. Will need antibiotics to heal. Massage may help unplug a plugged milk duct to help healing. Other - hemorrhoid infection, perineal incision infection. Cured with antibiotics

Engagement is -

Engagement is the term used to indicate that the largest transverse diameter of the presenting part (usually the biparietal diameter) has passed through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to station 0. Typically occurs 1-2 weeks before birth in nulliparas and before labor or during birth in multiparas

Establishment of primary germ layers:

Establishment of primary germ layers: The blastocyst cells will differentiate into 3 primary cell layers from which all tissues, organs, and organ systems will develop: ectoderm-upper layer mesoderm-middle layer endoderm-lower layer

Fetal Attitude is -

Fetal Attitude is the relation of the fetal body parts to each other. General Flexion is when the arms and legs are pulled into the body with the chin tilted towards the chest.

Fetal Circulation:

Fetal Circulation: - At 4-5 weeks heart develops into four chambered organ - fetal lungs don't function for gas exchange - special circulatory pathway- ductus arteriosus bypasses the lungs

Fetal Lie is the -

Fetal Lie is the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother.

Fetal Position is the -

Fetal Position is the relationship of a reference point on the presenting part (occiput, sacrum, mentum (chin), sinciput (deflexed vertex(head)) to the four quadrants of the mother's pelvis.

Fetal presentation refers to -

Fetal presentation refers to the part of the fetus that enters the pelvic inlet first, and leads through the birth canal

Fetal respiratory system:

Fetal respiratory system: - 16-24 weeks - bronchi, and terminal bronchioles enlarge; vascular structures and primitive alveoli form - Lecithin (L) most critical surfactant, detectable at 21 weeks but increases after week 24 - Spingomyelin (S) this surfactant remains constant through development - L/S ratio of 2:1-infant's lungs are considered mature (usually 35 weeks) - 32 weeks-sufficient surfactant present in developed alveoli to provide infant good chance of survival

Thromboembolic Disease (DVTs) -

For someone who gets a blood clot - don't want to put pressure on area, rub area, or move area vigorously Really depends how often after labor a DVT develops. Usually a patient won't develop a DVT until a couple weeks after labor. Need to teach patient to pay attention to leg pain, look for redness, edema, localized pain. Teach patient to not cross legs, or put pressure for long periods on long and cut off circulation

Four most common causes of Postpartum Bleeding:

Four most common causes of Postpartum Bleeding: 1. #1 cause of postpartum bleeding is Uterine Atony - Interventions - have baby breast feed, massage fundus, initiate pitocin and saline, make sure head of bed down to keep blood in head. 2. Vaginal Lacerations and Hematomas can lead to active bleeding - spurting blood is not a normal bleed following labor 3. retained placental fragments - this is more common in premature delivery 4. coagulation problems - idiopathic thrombocytopenia purpura, von willebrand disease, disseminated intravascular coagulation

Mrs. G has 4 live children; this includes triplets who were delivered at 33 weeks gestation and a singleton born at 38 weeks gestation. Using the GTPAL system, how would her maternal history be denoted? GTPAL

G: 2 T: 1 P: 1 A: 0 L: 4

Goodell's sign - Chadwick's sign - Hegar's sign - Ballottement -

Goodell's sign is an indication of pregnancy. It is a significant softening of the vaginal portion of the cervix from increased vascularization Chadwick's sign is a bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow. It is considered an indication of pregnancy, and can be observed as early as 6-8 weeks after conception,[1] and its presence is an early sign of pregnancy. Hegar's sign - This is softening of the lower uterine segment just above the cervix. When the uterine is compressed between examining fingers, the wall feels tissue paper thin. Ballottement - This is demonstrated during the bimanual exam at the 16th to 20th week. Ballottement is when the lower uterine segment or the cervix is tapped by the examiner's finger and left there, the fetus floats upward, then sinks back and a gentle tap is felt on the finger

GTPAL

Gravidity (#) : any pregnancy of any duration Term (# of births): Early- 37 0/7- 38 6/7 Full- 39 0/7-40 6/7 Late-41 0/7-41 6/7 Post term- 42 0/7 and beyond Preterm (# of births): 20 0/7-36 6/7 Abortion (#) : birth before the completion of the 20th week (or birth weighing less than 500g) Living (#) : currently living children

How are Hg, Hct, WBC, Platelets, and Fibrinogen levels altered?

Hgb - should rise following after pregnancy Hct - should rise following after pregnancy WBC - increases from stress on body a little to around, also increases during third trimester - count can be as high as 30,000 - so this can hide infection - need to look at temp (#1 symptom of postpartum infection is +100.4 F temp after the first 24 hours postpartum (temp has to occur 2 times following the first 24 hours) Platelets - numbers go up to increase clotting ability of blood, natural response of body - around 150,00-400,000 - increases risks of DVT Fibrinogen - goes up to protect body against hemorrhage, natural response, - needed in clotting cascade, turns into fibrin in clotting cascade - increases risks of DVT

Hormonal Changes Following Labor:

Hormonal Changes Following Labor: - progesterone, estrogen being produced by placenta drops off after labor and in particular the expulsion of the placenta which produces these hormones in utero - Drop in estrogen - allows diuresis to occur to rid body of 3L of extra fluid, sweating and urinary expulsion - Drop in progesterone - allows lactation to occur (during pregnancy, competes with prolactin for receptor sites) - Shift in hormones also responsible for the "pink period" and then the "baby blues" period - Prolactin - allows for milk production, breast feeding stimulates uterus to contract because of oxytocin link - Oxytocin - causes cells in breast to contract to squeeze milk into breast ducts so that it can be released when baby sucks - Human placental Lactogen - produced by placenta - drops after pregnancy, lets insulin start to work efficiently again so mother's blood sugar will drop back down to normal levels

Gastrointestinal System during Pregnancy -

Human chorionic gonadotropin - hcG Decreased motility, decreased absorption of nutrients Increased bloating and constipation Progesterone is changing the gut, also causing GERD, reverse peristalsis - remain elevated, don't lay down after eating Constipation, hemorrhoids, increased bleeding in gums, increased salivation Becoming more of an abdominal breather from 2nd to 3rd trimester - 15-20% increase in oxygen consumption Diaphragm can be pushed up by as much as 4 cm - SOB is okay, expected but should not be present when she is at rest

Hyperemesis Gravidarum

Hyperemesis Gravidarum - severe nausea/vomiting - generally lasts for most of pregnancy, will need IV management to avoid dehydration, small frequent meals, avoid intense smells - runs in families - genetic link. Possible causes of Hyperemesis Gravidarum - Vitamin B deficiency, also extra high hormone of ACG (put out by placenta), also found some genetic mutations on ACG receptors True cause still unknown, Multiple gestation can raise hCG levels extra high

Coagulation Problems - (3)

ITP - idiopathic thrombocytopenic purpura - autoimmune disease - low platelet count - under 100,000 Von Willibrand Disease - inherited - protein factor - part of clotting cascade - factor 8 - needed to help platelets work together - different types of von willibrand disease DIC - Disseminated Intravascular Coagulation - over stimulation of coagulation process - clots all over body after trauma, use up all clotting factors, then they end up bleeding out

In terms of presentation, longitudinal lies are either -

In terms of presentation, longitudinal lies are either cephalic or breech presentations.

3 Initial Nursing Considerations During Labor:

Initial Nursing Considerations During Labor: 1. Cultural beliefs and practices 2. Birth plan and pain management expectations 3. True vs. False Labor

Involution -

Involution - shrinking of uterus to normal size after pregnancy - contractions may be uncomfortable for up to a week postpartum - may be exacerbated by breastfeeding

Meiosis - Mitosis -

Meiosis - a special type of cell division necessary for sexual reproduction in eukaryotes, such as animals, plants and fungi. The number of sets of chromosomes in the cell undergoing meiosis is reduced to half the original number, typically from two sets (diploid) to one set (haploid). The cells produced by meiosis are either gametes (the usual case in animals) or otherwise usually spores from which gametes are ultimately produced (the case in land plants). In many organisms, gametes are called sperm in males and egg cells or ova in females. Since meiosis has halved the number of sets of chromosomes, when two gametes fuse during fertilization, the number of sets of chromosomes in the resulting zygote is restored to the original number. In other words, meiosis is the process by which gametes (ova and sperm) are formed. It occurs during gametogenesis (oogenesis and spermatogenesis) and consists of two successive cell divisions which produce a gamete with 23 chromosomes - the haploid number of chromosomes for humans. Meiotic division occurs twice. Once when the oocyte matures and the second time with fertilization. Therefore from each original cell, four genetically distinct haploid cells are produced. These cells can mature into gametes. Mitosis - The process by which additional body cells are formed. It provides growth and development of organs and replacement body cells.

Fetal Presentation: Chin = Forehead = Top of head = Back of head =

Mentum = Chin Sinciput = Forehead Vertex = Top of head Occiput = Back of Baby's head

Methergine causes -

Methergine causes uterine contraction. This in turn controls bleeding that has resulted from uterine atony.

Morula - Zygote - Trophoblast - Blastocyst -

Morula - A 16-cell morula is a solid ball of cells, which is produced within 3 days following fertilization and is still surrounded by a zona pellucida. Zygote - the united egg and sperm following fertilization Trophoblast - part of zona pellucida which gives rise to the placenta Blastocyst -a cavity forms within the growing cell mass, when the cavity becomes recognizable, the whole structure of the developing embryo is known as the blastocyst.

Oxytocin - Pitocin - Merthergine - Hemabate (Carboprost)-

Oxytocin - produced by hypothalamus, breast feeding stimulates release of oxytocin which helps uterus contract. Pitocin - synthetic oxytocin, stimulates uterine contractions, involution 10 units/amp IV/IM. Can also use pitocin to induce labor. Also used to induce abortion before fetus is developed to term. Methergine - constrict blood vessels and cause uterus to contract, .2 mg IM or PO - CANNOT be given to hypertensive patient. used to treat bleeding after childbirth (postpartum). Hemabate - prostaglandin producing swift uterine contraction - does cause nausea, vomiting, diarrhea 250mcg deep IM - don't use this first off, only when needed. Often used with zofran or other anti -emetic - Carboprost is used to treat severe bleeding after childbirth (postpartum).

What are the five P's of Labor and Delivery

Passenger - fetus and placenta Passageway - birth canal Powers - contractions Position - of mother Psychological - response of mother

Placenta:

Placenta: Structure- begins to form at implantation; trophoblast cells of chorionic villi continue to tap into the deciduas bacilis. The projecting deciduas will separate into areas called COTYLEDONS. Approximately 15-20 cotyledons within each chorionic villi branch out and a complex system of fetal blood vessels form. The cotyledon is the functional unit. The entire structure is know as the placenta. The structure is complete by the 12th week and will grow wider until 20 weeks when it covers about half of the uterine surface. After this time it will begin to form in thickness as the branching villi continue to develop to allow for an increasing functional surface area. Function >Metabolic functions include fetal respiration, nutrition, and excretion >Oxygen diffuses from the maternal blood across the placental membrane into the fetal blood and carbon dioxide diffuse in opposite manner >Carbohydrates, proteins, calcium and iron are stored in the placenta for ready access to meet fetal needs Because of the direct maternal /fetal link with the placenta, caution is needed!!! What mom "takes" the fetus "takes". This means that any medication, alcohol, nicotine, and multiple other toxic substances readily cross the placental barrier to the fetus.

Placental Hormones:

Placental Hormones: The placenta functions early on as an endocrine gland and produces four separate hormones that are necessary to maintain and support the pregnancy. - Human Chorionic Gonadotropin (hCG) - - Chorionic Somatomammotropin (Human placental lactogen hPL) - Progesterone - Estrogen

Position is denoted by -

Position is denoted by a three-part abbreviation. First letter: L or R denotes location of presenting part in relation to mother's pelvis. Second Letter: O (occiput), S (sacrum), M (mentum), Sc (Scapula) Third Letter: A (anterior), P (posterior), T (transverse) Examples: ROA - Right occiputanterior, LSP - Left sacralposterior

How does a patient know if they are experiencing preterm labor?

Pre-term Labor - Labor occurring after week 20 and before completion of week 37 - Contractions every 10 minutes or more, for 1 hr or more - Discomfort described in a variety of ways - Change of vaginal discharge

Precipitate delivery refers to -

Precipitate delivery refers to a delivery which results after an unusually rapid labor (less than three hours) and culminates in the rapid, spontaneous expulsion of the infant. Delivery often occurs without the benefit of asepsis.

Signs of Pregnancy -

Presumptive - morning sickness, late/missed period (ammenorhea), emotional changes, breast tenderness (subjective signs seen by the mother), frequent urination, breast changes, skin changes, positive home pregnancy test Probable - sign's seen by an examiner, fetal palpation (leopold's maneuver), changes to cervix (chadwick's sign, goodell's sign), urine pregnancy test (could still be a false positive - molar pregnancy), fetal heart sounds, ballottement, striae gravida, increase in basal body temperature Positive - ultrasound, palpation of fetal movement by someone other than mother (quickening - 20th week), visualization of fetus, fetal heart sounds

2nd Trimester Diagnostics -

Quad Marker Screening: between 15-20 weeks - tests for birth defects involving neural tube Amniocentesis: between 15-20 weeks- diagnostic tool, ultrasound used to guide needle, retrieve amniotic fluid Glucola Screening : between 24-28 weeks - routine, done earlier if high risk for gestational diabetes. If glucola test positive, 3 hour glucose tolerance test indicated, if positive then gestational diabetes is diagnosed.

REEDA for episiotomies:

Redness Edema Ecchymosis Drainage Approximation

Relaxin - hormone - Diastesis recti -

Relaxin - can cause postural changes, released in 3rd trimester, secreted to make joints more flexible, helps birthing process by making hips more flexible in pelvis joints, but can also cause aches in other joints Diastesis recti - separation of abdominal muscles

Rubella - Hepatitis B - HIV -

Rubella - German measles, teratogen, cause birth defects. Can't give a vaccine once pregnant because it is a live vaccine. Hepatitis B - All pregnant women tested for Hep B. Any fluid transfer can transmit Hep B So if mom is Hep B positive, we give baby shot of Hep B antibodies (must be given within 12 hours of birth) (immunoglobulin -ready made antibodies - work about 12 weeks max, but gives baby a chance to make it's own antibodies because the regular vaccine is given at the same time). Mother can breast feed if she has Hep B HIV - Mother to Child Transfer - MTCT - a mother who is HIV+ can transmit HIV to children through birth, breast-feeding, They now highly recommend treatment for HIV for mother during pregnancy. Treatment is not started until all major organs are developed (about 28 weeks) Having a scheduled C-section and not breast-feeding are important If all things are done right, risk for baby is low about 2% infections rate, without compliance is about 30%

Shoulder dystocia is -

Shoulder dystocia is a specific case of dystocia whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below, or requires significant manipulation to pass below, the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly after the fetal head. Shoulder dystocia is an obstetric emergency, and fetal demise can occur if the infant is not delivered, due to compression of the umbilical cord within the birth canal

Some highlights of fetal development:

Some highlights of fetal development: -4 weeks Heart is a a double chamber but begins to beat -8 weeks Digits are well formed -12 weeks nails appear, sex is recognizable -16 weeks scalp hair appears -20 weeks the mother can feel movement (quickening); vernix caseosa and lanugo appear, primitive respiratory movements appear -24 weeks the fetus can hear and responds to sounds outside of the uterus -28 weeks pupils are capable of reacting to light -32 weeks skin appears less wrinkled/red as subcutaneous fat is begins to be deposited -35 weeks fingernails reach the ends of the fingers -38 weeks vernix caseosa left only in creases and skin folds. Lanugo on upper arms and shoulders only -40 weeks active, sustained movement with good tone. Fetus has strong suck reflex.

Sperm capable of fertilizing ovum for about -

Sperm capable of fertilizing ovum for about 2-3 after being implanted into the female reproductive tract. Most sperm are lost in the vagina, within the cervical mucus or in the endometrium, or they enter the uterine tube that contains no ovum. Some sperm can reach the site of fertilization within 5 minutes but average transit time is 4-6 hours.

Subinvolution - Causes of Sub Involution -

Subinvolution - slower than normal involution, not proceeding fast enough Causes of Sub Involution - Grand Multiparity, Extremely long labor (especially third stage - time between baby and placenta over 30 mins), Infection, Retained Placental Fragments

Reva Rubin's Maternal Framework: - best time to teach a patient following pregnancy is when.

Taking In -First 48 hours, not a good time to teach, talk about pregnancy, about herself mostly and what she went through Taking Hold - 2nd or 3rd day, and may last several weeks, ready to learn, best time to teach is now. A lot of reassurance and helping Letting Go - mom is taking control and feeling confident about being mom.

The 7 cardinal movements of labor are -

The 7 cardinal movements of labor are: 1. Engagement 2. Descent 3. Flexion 4. Internal Rotation 5. Extension 6. External Rotation (Restitution) 7. Expulsion (Birth) EDFIERE

The Furgeson reflex is -

The Furgeson reflex is the maternal urge to bear down triggered by oxytocin released by the posterior vagina as a result of stretch receptors being activated by the presenting part of the fetus reaching the perineal floor.

The Stages of Labor are -

The Stages of Labor are: 1-4 Stage 1 - onset of regular contractions to full effacement and dilation. Longest of the stages. Divided into 3 phases - Latent Phase, Active Phase, Transition Phase Stage 2 - lasts from full effacement and dilation to the birth of the fetus. Divided into two phases - Latent Phase, Active Pushing (Descent) Phase. Stage 3 - lasts from birth of fetus until placenta is delivered. placenta is usually expelled around 15 mins after baby is delivered. Stage 4 - arbitrarily lasts 1-2 hours after delivery of placenta. period when homeostasis is reestablished.

The first nursing intervention when a nurse observes profuse postpartum bleeding in a patient is:

The first nursing intervention when a nurse observes profuse postpartum bleeding in a patient is to palpate the uterine fundus and massage in an effort to stimulate uterine contraction to slow bleeding. The nurse would put on her call bell and the team of nurses coming in to help would be sure an IV is running with Pitocin in it/ Methergine is given if indicated for the patient/ Vital Signs are monitored/ Urine Output is monitored.

The following assessment finding is associated with postpartum infection:

The following assessment finding is associated with postpartum infection: Fever after the 1st 24 hours postpartum that persists or recurs

The menstraul cycle and hormones involved:

The menstrual cycle has three phases. In each of these phases the body produces different hormones that have distinct functions. The first phase of your cycle is called the follicular phase. This begins on Day one of your cycle, which is the first full day of menstrual bleeding when the lining of the uterus starts to shed. When an egg isn't fertilized during the previous cycle, the body must shed the uterine lining to prepare for the next cycle. For most women this lasts from 3 to 5 days, but can be more or less. Immediately following the shedding of the uterine lining, your body begins to prepare for the next phase in the cycle, the ovulatory phase. But first, hormones must prepare your body for ovulation before this phase can begin. The pituitary gland releases two hormones, FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone). A follicle is one of the many tiny sacs within an ovary that contains a developing egg. FSH stimulates a follicle to grow and the egg within it to ripen. LH stimulates the follicle to manufacture and secrete estrogen. You're in the ovulatory phase now, increasing estrogen levels cause the lining of the uterus to re-nourish with nutrients and blood. The heightened levels of estrogen also produce a change in cervical mucus, causing it to thin and take on a slippery consistency. The change in cervical fluid makes it easier for sperm to make their way toward a waiting egg. All of this usually takes place between days 7 and 11 in a woman's cycle. When the amount of estrogen produced in your body reaches a certain level, it causes the pituitary gland to release a surge of LH. 24 to 36 hours after the LH surge, the follicle will burst, releasing the completely ripened egg into the Fallopian tube. The LH surge is what triggers the almost-ripened egg to become fully matured and break through the follicle. The release of the egg is what is known as ovulation. The liberated egg now floats down the fallopian tube toward the womb. If it isn't fertilized, it has a survival window of about 24 hours. Sperm can live longer and may already be present before the egg is released. Or sperm may arrive in the 24 hours after the egg has been released. Therefore, the day before ovulation and the day of ovulation are the two days in your cycle when you are most fertile — the two days you are most likely to conceive. Since the LH surge always precedes ovulation, detecting this hormone is critical in predicting your two peak fertility days. The FIRST RESPONSE™ Ovulation plus Pregnancy Test and FIRST RESPONSE™ Daily Digital Ovulation Test are over 99% accurate (in laboratory testing) in detecting the LH surge in your urine. Next, the follicle in which the egg burst through (called the corpus luteum) starts to shrink and begins to release progesterone and estrogen. Progesterone further prepares for a fertilized egg by building the lining of the womb with an increase in blood vessels. The final and third phase of your menstrual cycle is called the luteal phase and follows ovulation. If the egg is fertilized, hCG is produced by the body and pregnancy tests are designed to detect it. hCG keeps the follicle from shrinking completely so it can continue to produce progesterone and estrogen. The increased production of progesterone keeps the uterus intact so that the fertilized egg — the pregnancy — is maintained. If the egg is not fertilized within 24 hours, the corpus luteum dies and progesterone production slows. When there is no longer enough progesterone to supply the uterine lining with blood, after around 11-14 days, the start of your period — your menstrual cycle — begins again.

Human Chorionic Gonadotropin (hCG) - Chorionic Somatomammotropin (Human placental lactogen hPL) - Progesterone - Estrogen -

The placenta functions early on as an endocrine gland and produces four separate hormones that are necessary to maintain and support the pregnancy. Human Chorionic Gonadotropin (hCG). This can be detected in maternal serum by 8-10 days after conception. This hormone is the basis for pregnancy tests. hCG preserves the function of the ovarian corpus luteum, ensuring a continued supply of estrogen and progesterone needed to maintain the pregnancy. In other words this hormone aides in allowing corpus luteum function until the placenta can produced sufficient progesterone and estrogen to maintain the pregnancy. Chorionic Somatomammotropin (Human placental lactogen hPL). This stimulates the maternal metabolism to supply nutrients needed for fetal growth. It increases resistance to insulin, facilitates glucose transport across the placental membrane and stimulates breast development to prepare for lactation along w/Progesterone. Progesterone. The placenta will eventually produce more progesterone than the corpus luteum. It is an essential hormone for pregnancy. It maintains the endometrium (deciduas), decreases the contractility of the uterus to prevent spontaneous abortion, and aides in breast development along w/hPL. Estrogen. Estrogen is also produced by the placenta and stimulates uterine growth and uteroplacental blood flow. It also causes proliferation of the breast glandular tissue and stimulates myometrial contractility. One theory for the cause of the onset of labor is the decrease in circulation levels of progesterone and an increase in levels of estrogen!

The predominantly used physician-attended birthing position in the US is the -

The predominantly used physician-attended birthing position in the US is the lithotomy position

The presenting part of the fetus is the -

The presenting part of the fetus is the part which lies closest to the internal os of the cervix. it is the first part of the fetus felt during vaginal examination during labor

The three main presentations of a fetus are -

The three main presentations of a fetus are: Cephalic (Vertex) - head first (96% of births) Breech - buttocks, feet or both first (3%) Shoulder - shoulder first (1%)

The two categories of Powers during labor are -

The two categories of Powers during labor are: Primary Powers - involuntary uterine contractions, which signal the beginning of labor Secondary Powers - voluntary bearing down efforts by the mother which augment the primary powers

Umbilical Cord:

Umbilical Cord: Initially shown as a connection between the infant and mother and called a "connecting stalk", this will become the umbilical cord during week 3 when it moves to the ventral side of the embryo and blood vessels develop. > There are TWO small arteries which carry blood FROM the embryo to the chorionic villi (and on to mom) > There is ONE large vein which returns oxygen and nutrient rich blood TO the embryo (from the mom) > At term the length is approximately 55 cm long and 2 cm in diameter. > Compression in utero of the cord (and the vessels within) is prevented by a special connective tissue known as Wharton's jelly as well as by the high blood volume that pulsates through the cord. > No sensory or motor innervation is located in the cord, therefore there is no pain caused by the cutting of the cord at birth > The cord has a twisting/spiraling appearance which is thought to be due to fetal movement. > A True knot occurs when the fetus loops around and THROUGH the cord tying it in a knot... These are rare. Unfortunately they can be the cause of fetal death if the knot tightens and constricts the flow of blood through the cord.

Bakri Balloon -

Used to control bleeding to control PPH - post partum hematoma - inserted like a catheter and then blown up with fluid to put pressure on bleeding internally

Ventouse is -

Ventouse is a vacuum device used to assist the delivery of a baby when the second stage of labor has not progressed adequately.

vernix caseosa

Vernix caseosa, also known as vernix, is the waxy or cheese-like white substance found coating the skin of newborn human babies. Vernix starts developing on the baby in the womb around 18 weeks into pregnancy. Vernix is theorized to serve several purposes, including moisturizing the infant's skin, and facilitating passage through the birth canal. It serves to conserve heat and protect the delicate newborn skin from environmental stress. Vernix is also thought to have an antibacterial effect

What it Viability?

Viability - The ability of the fetus to survive outside of the uterus. In the past, the earliest age at which fetal survival could be expected was 28 weeks after conception. With modern technology and advancements in maternal and neonatal care, viability is now possible at 20 weeks after conception (22 weeks after last menstrual period, fetal weight of 500 gram or more). The limitation on survival outside the uterus are based on central nervous system function and oxygenation capability of the lungs.

Visceral Pain - Somatic Pain -

Visceral Pain - Visceral pain is internal pain. It comes from the organs or the blood vessels, which are not as extensively innervated, or supplied by, sensory nerves. Unlike somatic pain, visceral pain may feel dull and vague, and may be harder to pinpoint. Some common types of visceral pain include: Irritable bowel syndrome Vulvodynia Bladder pain (such as cystitis) Endometriosis pain Prostate pain Somatic Pain - Somatic pain is generally described as musculoskeletal pain. Because many nerves supply the muscles, bones and other soft tissues, somatic pain is usually easier to locate than visceral pain. It also tends to be more intense. Some chronic pain conditions caused by somatic pain include: Fibromyalgia Tension headaches Pelvic pain caused by pelvic joint instability Chronic back pain that is not caused by nerve damage Arthritis

Yolk Sac:

Yolk Sac: Very small and functions only in early embryonic life. Initially it will form primitive red blood cells until the liver takes over at approximately 6 weeks. It will then be incorporated into embryo/umbilical cord and the rest will degenerate. By 5-6 weeks the remnant is separated from the embryo.

Zygote -

Zygote - the first cell of the baby - it is borne from the joining of sperm and ovum which is restoring the diploid number of chromosomes (46)

during labor, slight overlapping of head bones occurs which is called -

during labor, slight overlapping of head bones occurs which is called molding

This hormone is the basis for pregnancy tests -

hCG - human chorionic gonadotropin

Respiratory System during Pregnancy -

increase O2 consumption shortness of breath nasal stuffiness/epistaxis Becoming more of an abdominal breather from 2nd to 3rd trimester - 15-20% increase in oxygen consumption

involuntary contractions begin in the uterus at -

involuntary contractions begin in the uterus at specific pacemaker points in the upper uterine segment. contractions move downward over the uterus in waves.

Station is the -

relationship between the presenting fetal part and an imaginary line drawn between the ischial spines on the mother's pelvis. It is also a measure of the degree of descent of the presenting fetal part above or below the ischial spines measured in centimeters. -5 is 5 cms above ischial spines, +5 is 5 cms below ischial spines. BIrth is imminent when station is +4 to +5.

some of the signs that typically precede labor are -

some of the signs that typically precede labor are: lightening, return of urinary frequency, backache, stronger Braxton Hicks contractions, weight loss of 0.5-1.5 kg, surge of energy, increased vaginal discharge (bloody show), cervical ripening (softening, dilation), possible rupture of membranes

the heads of most newborns assume their final shape -

the heads of most newborns assume their final shape around 3 days after birth

the true pelvis is divided into these three planes -

the true pelvis is divided into these three planes: 1 Inlet or Brim - upper border of true pelvis, 2 Mid-pelvis or Pelvic Cavity - 3 Outlet - lower border of true pelvis Info p. 373 The false pelvis plays no part in labor.

the two primary positions of fetal lie are -

the two primary positions of fetal lie are: Longitudinal or Vertical - spines are roughly parallel to one another Transverse, Horizontal, or Oblique - spines are roughly at right angles to one another