UWORLD: MATERNITY

Nonreassuring FHR patterns

(eg. Late Decelerations, Fetal Tachycardia, Bradycardia) INTERVENTION: -STOP PITOCIN INFUSION -Reposition client to a side-lying position -Administer oxygen via face mask at 8-10 L/min -Administer IV fluid bolus -Preparing to administer a subcutaneous injection of TERBUTALINE; to relax the uterus if other interventions are unsuccessful -Notifying the health care provider (HCP) after implementing initial interventions (eg, positioning, oxygen, fluids)

*DRUGS TO AVOID IN THIRD TRIMESTER?*

********NSAIDs (eg. Ibuprofen) - RISK of premature closure of Fetal Ductus Arteriosus

Nagele's Rule

- 3 months, + 7 days & 1 year from FIRST DAY of LMP

8 Weeks Gestation

-ALL MAJOR ORGAN SYSTEMS ARE IN PLACE & Functioning in a simple way

TERATOGENIC DRUGS

-Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril, lisinopril, ramipril, -pril drugs) -Angiotensin II receptor blockers (ARB) (eg, losartan, valsartan, telmisartan, -sartan drugs) -Phenytoin, VALPROATE (Valproic Acid) (ANTICONVULSANTS; utilize magnesium sulfate instead) -Lithium!!!!!!!!!!!!!! -Isotretinoin (Accutane) (acne medication) -Methotrexate (immunosuppressant & chemo drug) -WARFARIN!!!!!!!!!!!! -DOXYCYCLINE, CHLOTETRACYCLINE, MINOCYCLINE, OXYTETRACYCLINE (tetracycline abx) -Aspirin in the THIRD TRIMESTER = premature closing of ductus -NSAIDS (eg. ibuprofen) in the THIRD TRIMESTER = premature closing of ductus

Sudden infant death syndrome (SIDS)

-Place infant on the back to sleep on a firm surface every time -DO NOT SHARE BEDS -NOTHING in the bed with the infant is safest & avoid soft objects (eg, stuffed animals, pillows) in the infant's bed -Avoid bumper pads for the crib -Maintain a smoke-free environment. -Avoid overheating. Infants do not require more than one extra layer than adults require to be comfortable. -Breastfeed and ensure immunizations are updated.

PRIORITY:

-Signs of UTI during pregnancy (eg. urinary urgency, DYSURIA) -Signs of Pre-Term Labor (eg. intermittent lower back pain) -Signs of Pre-Eclampsia (eg. headaches) -Signs of Subinvolution (d/t UTERINE INFECTION & Retained Placental Fragment from Delivery) = risk of POST PARTUM HEMORRHAGE -Signs of FETAL TACHYCARDIA (110-160 normal range)

SIGNS Of RESPIRATORY DISTRESS SYNDROME (RDS) IN NEONATE?

-Sustained tachypnea -Nasal flaring -Retractions -AUDIBLE Grunting -CYANOSIS *CONTINUOUS MONITORING & RESPIRATORY SUPPORT MAY BE NEEDED

Preconception counseling

Assess for pregnancy risk factors and implements appropriate interventions to promote a healthy pregnancy. INTERVENTIONS: -Eating a nutritious diet -Exercise -Abstaining from alcohol/tobacco, and illicit drugs -Taking folic acid supplements (at least 400 mcg per day for 3 months prior to pregnancy) -Achieving a normal BMI (18.5-24.9 kg/m2) -Check RUBELLA IMMUNITY; give vaccination & should be avoided for at least 4 weeks after vaccination -PREVENT periodontal disease, which is associated with poor pregnancy outcomes (eg, preterm birth, low birth weight)

PREGNANCY DIET:

INCREASE INTAKE: -Foods containing folic acid (eg. FORTIFIED CEREALS/Milk, peanut butter, enriched bread, pasta, rice, green leafy vegetables, black beans, green peas, dried beans, asparagus, cooked beets), protein, whole grains, iron, and omega-3 fatty acid AVOID: -UNPASTEURIZED MILK PRODUCT d/t risk for bacterial contamination (eg, Listeria, toxoplasmosis -Unwashed fruits and vegetables -COLD, CHILLED Deli meat and hot dogs (unless heated until steaming hot) -Raw fish/meat (RISK OF TOXOPLASMOSIS) -LIVER -Fish high in mercury (eg, shark, swordfish, king mackerel, tilefish).

Maternal HYPOTENSION

INTERVENTION: -Increase the rate of IV fluids -start O2 by face mask (10 L) -Turn the patient on LEFT SIDE

Pyrosis (Heartburn):

INTERVENTION: -Keeping the head of the bed elevated using pillows -Sitting upright after meals -Eating small, frequent meals throughout the day -Avoiding tight-fitting clothing -Eliminating common dietary triggers (eg, fried/fatty foods, caffeine, citrus, chocolate, spicy foods, tomatoes, carbonated drinks, peppermint) -LOW-FAT DIET DO NOT: -Drink a lot of water during meals -Lie down immediately after eating

Umbilical Cord Prolapse

INTERVENTION: -Place patient in TRENDELENBURG position (supine with feet elevated) OR KNEE-CHEST POSITION (on hands & knees) & keep cord WARM and MOIST & attempt to push the cord back in. ***TRENDELENBURG POSITION - can increase pressure of the vena cava and result in MATERNAL HYPOTENSION (assess - pallor, perspiration) = HELP client to a sitting position; move uterus off the client's vena cava to alleviate maternal hypotension!

PRETERM LABOR

Progressive cervical dilation and/or effacement resulting from uterine contractions before term gestation (before 37 weeks) INTERVENTION: -IM antenatal glucocorticoids (eg, betamethasone, dexamethasone) to stimulate fetal lung maturation and promote surfactant development -Antibiotics (eg, penicillin) to prevent group B Streptococcus infection in the newborn if preterm birth occurs *-IV Magnesium Sulfate: SEIZURE PRECAUTION* -Tocolytic medications (eg, nifedipine, indomethacin) = to suppress uterine activity -Monitoring pertinent laboratory results & *Place on continuous fetal monitoring* *X - AROM (or Amniotomy) = done to augment labor or assess amniotic fluid; CONTRAINDICATED IN PRETERM LABOR*

AMNIOCENTESIS

Removal of amniotic fluid of evaluation; can be performed as early as 15-17th weeks of pregnancy. INTERVENTION: -Ultrasound (sonogram) done prior for DETERMINATION of PLACENTAL LOCATION (position of placenta & fetus). **Reveals: Lecithin/Sphingomyelin (L/S) ratio & presence of Phosphatidylglycerol (PG); L/S ratio > 2 & + PG presence = FETAL LUNG MATURITY

*Mastectomy*

Removal of the whole breast; commonly coupled with lymph node dissection. Intervention: -ELEVATE the affected arm on a pillow/above the heart (restore FUNCTION & reduce fluid retention & prevent lymphedema in the affected arm) -AVOID VACCINATION in the affected arm -Perform ISOMETRIC EXERCISES; but *DO NOT PERFORM FULL RANGE OF MOTION EXERCISES = d/t placement of suction drain post-operation* -Use intermittent pneumatic compression sleeve *LYMPH NODES*: Usually not palpable in adults; however, CAN be palpable, superficial, small (0.5-1 cm), mobile, firm, and nontender. *ABNORMAL: -Tender, Hard, Fixed, or ENLARGED node; usually d/t inflammation or MALIGNANCY!*

Leopold Maneuvers (Abdominal Palpation)

Used as a systematic approach to palpating the pregnant abdomen to identify fetal presentation, position, and engagement of fetus ^^^have patient VOID before initiating maneuvers.

LATE DECELERATIONS

Decrease in FHR that begins AFTER a contraction, reaches its lowest point (nadir) after the contraction peak, and then gradually returns to baseline. = impaired fetal oxygenation associated with decreased uteroplacental perfusion (eg, due to maternal hypotension after epidural placement or uterine tachysystole, intrauterine growth restriction, preeclampsia, diabetes). INTERVENTION: -DISCONTINUE OXYTOCIN -PUT ON LEFT-SIDE -ADMINISTER O2 via FACE MASK (8-10 L) -IV FLUID (BOLUS OF ISOTONIC FLUIDS) -NOTIFY HCP

VACCINATIONS THAT CANNOT BE GIVEN DURING PREGNANCY:

-INFLUENZA NASAL SPRAY -MMR -VARICELLA ^live virus vaccines; increased risk of illness d/t suppressed immune systems in pregnant women

INFANT FORMULA

-Keep bottles, nipples, caps, and other parts as clean as possible (ie, boil or wash in dishwasher). -Wash the tops of formula cans (eg, concentrated formula) with hot water and soap prior to opening to prevent contamination -Refrigerate any unused, prepared formula or unused, opened formula (eg, ready-to-feed, concentrated), but use within 48 hours OR DISCARD -Warm bottles in a pan of hot water or under warm tap water for several minutes. -Test formula temperature on the inner wrist before serving to the infant (should feel lukewarm, not hot). NEVER: -OVERDILUATE/OVERCONCENTRATE FORMULA -NEVER MICROWAVE -THROW AWAY ANY FORMULA LEFR OVER

Normal Frequency of Uterine Contractions

Every 2-4 minutes; duration of 60 seconds *IF THERE IS NO PAUSE BETWEEN CONTRACTIONS OR CONTRACTIONS LAST PAST 60 SECONDS = STOP OXYTOCIN! *ASSESS FOR: *Hypertonic Uterine Contractions* = painful, frequent, uncoordinated contractions. Main Intervention: Resolution of underlying cause & provide *RELIEF OF PAIN & REST*

Ancephaly

FATAL; severe neural tube defect (NTD) resulting in little to no brain tissue or skull formation in utero. PROVIDE COMFORT CARE

INFERTILITY

Fails to conceive after 12 months (women age <35) OR 6 months (women age ≥35) *Assess for PSYCHOSOCIAL DISTRESS RISK: -Endometriosis -Maternal Age > 35 years -Polycystic Ovarian Syndrome -Recurrent Chlamydial Infection

COPPER IUD

Form of long-acting, reversible contraception. Has immediate contraceptive effect; unlike Levonorgestrel IUDs. INSERTION: commonly causes mild discomfort, cramping, and/or light vaginal bleeding SIDE EFFECT: HEAVIER and increased cramping during menses INTERVENTION: -Check for the strings at least monthly -MISSED PERIOD = PREGNANCY TEST!

EPIDURAL BLOCK

Form of regional anesthesia; can provide effective pain relief during labor. RISK OF: SNS inhibition = peripheral vasodilation = hypotension (ie, systolic blood pressure <100 mm Hg, ≥20% decrease from baseline), lightheadedness, nausea, etc *RISK OF: DISLODGMENT OF THE EPIDURAL CATHETER (d/t catheter not being sutured in place* INTERVENTION: -Assess blood pressure to confirm the presence of hypotension (risk of SNS inhibition) -Administer an IV fluid bolus -Position the client in the LEFT lateral position

"Back Labor"

Lower back pain with contractions d/t fetus being in the RIGHT OCCIPUT POSTERIOR (ROP) position *(or Occiput Posterior position in general)* Intervention: *-POSITION: HANDS AND KNEES = FACILITATES FETAL ROTATION TO AN OCCIPUT ANTERIOR POSITION = more optimal for vaginal birth* -APPLY SACRAL PRESSURE

Cervical Cancer

Malignant tumor of the cervix RISKs: -Human Papillomavirus Infection -Long-Term corticosteroid therapy -Multiple sexual partners -Oral Contraceptive use -Sexual activity before age 18

Coombs test

Performed to screen for Rh sensitization; can be DIRECT (in baby) or INDIRECT (in pregnant women) eg. If an Rh-negative mother (eg, O negative blood type) is exposed to Rh-positive fetal blood (if the father is Rh positive), the pregnant client develops antibodies to the Rh antigen (ie, Rh sensitization), placing the current fetus and all future pregnancies at risk for serious complications (eg, hemolytic anemia)

*Breast Cancer*

Non-modifiable breast cancer risk factors: -Female sex and age ≥50 -First-degree relative (mother or sister) with history of breast cancer -BRCA1 and BRCA2 genetic mutations (Option 2) -Personal history of endometrial or ovarian cancer -Menarche before age 12 or menopause after age 55 Modifiable breast cancer risk factors: -Hormone therapy with estrogen and/or PROGESTERONE (*can INCREASE BASAL BODY TEMPERATURE*) (increased risk if taken after menopause) -Postmenopausal weight gain and obesity as fat cells store estrogen -History of smoking and alcohol consumption -Dietary fat intake -Sedentary lifestyle DIAGNOSED via MAMMOGRAPHY SYMPTOMS: -Breast tissue that becomes red & warm -Orange peel (peau d'orange), pitting appearance on the skin surface of BREAST

POSITION/PRESENTATION OF INFANT:

OA = facing the back; OPTIMAL POSITION FOR BIRTH OP = facing the front; *"BACK LABOR"* & prolonged labor = place on hands and knees OT = facing the side = MANUAL ROTATION; risk of Shoulder Dystocia & prolonged labor BREECH = FEET/BUTT FIRST; risk of CORD PROLAPSE & prolonged labor

*Shoulder Dystocia*

Obstetrical emergency in which the fetal head emerges but the anterior shoulder remains wedged behind the maternal symphysis pubis; eg. fetal head retracting back toward the maternal perineum after birth of the head (ie, TURTLE sign). Associated with: -Macrosomia (fetal weight >8 lb 13 oz [4000 g]) -Gestational diabetes mellitus INTERVENTION: -Document EXACT time of events (eg. birth of fetal head -Verbalize passing time to guide HCP *-McRoberts maneuver (ie, sharp flexion of maternal thighs toward abdomen to widen space between pubic bone and sacrum)* *-APPLYING SUPRAPUBIC PRESSURE (downward pressure applied to maternal pubic bone to dislodge fetal shoulder)* -REQUEST ADDITIONAL HELP FROM STAFF ASAP *X - DO NOT USE FORCEPS* ANY ACTION THAT WILL NOT EXPEDITE BIRTH IS NOT A PRIORITY!

Ovulation

Occurs 14 + 2 days BEFORE next menses. ASSESS for: high LUTEINIZING HORMONE (triggers ovulation) ***To figure out date of ovulation: SUBTRACT 14 from length (total amount of days) of normal menstrual cycle.

ECTOPIC PREGANCY

Occurs when a fertilized ovum implants outside the uterine cavity, often in the FALLOPIAN TUBES. Fetus may develop normally in the first several weeks; can lead to distention or ruptured fallopian tube eventually. SYMPTOMS: *-SUDDEN STABBING/SEVERE LQ (LOWER QUADRANT) ABD PAIN on ONE SIDE* -Mild to Moderate Vaginal Spotting -Missed or Delayed Menses *****RUPTURES (can lead to Hypovolemic Shock, Hemorrhage - Hypotension, Tachycardia, Referred SHOULDER Pain, Peritoneal Tenderness/Rigidity)

*Cervical Cerclage (Shirodkar's procedure/McDonald Procedure/Shirodkar-Barter Procedure)*

Placement of sutures around the cervix at the level of the internal OS; used to prevent preterm delivery & REINFORCE INCOMPETENT CERVIX. Placement usually occurs at 12-14 weeks gestation for clients with a history of cervical insufficiency (ie, painless, premature cervical dilation and miscarriage or preterm delivery) or up to 23 weeks gestation if signs of cervical insufficiency (eg, short cervix) are noted. INTERVENTION: -Activity restriction -Recognition of signs of preterm labor (eg, low back aches, contractions, pelvic pressure) and rupture of membranes; REPORT IMMEDIATELY!

Placenta Previa

Placental implant in the lower uterine segment that partially or completely covers the cervix SYMPTOMS: -Painless -Soft relaxed abdomen -Bright RED vaginal bleeding INTERVENTION: -Ultrasound -Scheduled Cesarean Birth BEFORE onset of labor ***DO NOT PERFORM VAGINAL EXAMINATIONS & place on bed rest ^can be discharged if bleeding subsides and fetal status is reassuring depending on gestation

MEDICATION TO AVOID IN PRE-ECLAMPTIC PATIENTS

-Methylergonovine [Methergine] is contraindicated for clients with high blood pressure d/t vasoconstriction

Fundal Height

not palpable until 12-13 weeks & rises out of the symphysis; +/- 2 cm from current gestation ****After 20 weeks gestation, the fundal height, measured in centimeters from the symphysis pubis to the top of the fundus, correlates closely to the weeks of gestation. *AT 20 WEEKS - at LEVEL OF THE UMBILICUS*

Tachysystole

≥5 contractions in 10 minutes! A potential adverse effect of oxytocin. Excessive uterine contractions; can decrease placental blood flow and compromise fetal oxygenation. INTERVENTION: -Decrease or STOP Oxytocin infusion -Administer IV fluid bolus or TOCOLYTIC DRUGS (eg. Terbutaline)

Precipitous Birth (Precipitous Labor)

Occurs when labor lasts <3 hours from contraction onset until birth SYPMTOMS: -involuntary pushing -bearing down with contractions -grunting -report of sensations of having a bowel movement *IF Birth is imminent = apply gloves and observe the perineum for bulging or crowning of the presenting fetal part

Toxoplasmosis

Parasitic infection d/t exposure to infected cat feces or ingestion of undercooked meat or soil-contaminated fruits/vegetables; TERATOGENIC AVOID UNDERCOOKED MEATS & GARDENED FRUITS/VEGGIES

NEONATE 1-HOUR POST BIRTH

-Decreased GLUCOSE LEVELS 1 hour after birth, then rise and stabilize within 2-3 hours *-Optimal glucose levels are 70-100 mg/dL (3.9-5.6 mmol/L)* *-Respiratory rate is 30-60 breaths per minute* -Breathing may be slightly irregular, diaphragmatic, and shallow & *Expect BILATERAL RALES (fluid in the lungs)* expected immediately after birth; will clear. HOWEVER, report: *WHEEZES, STRIDOR, or PERSISTENCE OF CRACKLES* -*MILIA (white papules)* form due to plugged sebaceous glands and are frequently found on the nose and chin -*EPSTEIN'S PEARLS* (white pearl-like epithelial cysts on gum margins and the palate; benign) -Plantar CREASES UP THE ENTIRE SOLE -Babinski Reflex (toes fan outward when the lateral sole surface is stoked; disappears at 1 year) INTERVENTION: -Standard precautions (GLOVES during CARE d/t BLOOD) -Maintain a clear AIRWAY: Suction the pharynx first followed by the nasal passages to prevent ASPIRATION -Thermoregulation (97.5-99 F [36.4-37.2 C]) -Vitamin K is administered intramuscularly in the vastus lateralis (midanterior lateral thigh) within 6 hours of birth -Ophthalmic ointment - Prophylactic antibiotic eye ointment; may be delayed up to 1 hour after delivery. -Initial bathing of the newborn is limited to removing blood, bodily fluids, or meconium; NOT Vernix! FOR MOTHER: *-Take Temperature Every 4 hours; expect slight elevation d/t DEHYDRATING effects of labor = INCREASE ORAL FLUIDS!* -Assess for any signs of INFECTION or HEMORRHAGE (*Eg. FOUL-SMELLING LOCHI = S/SX OF ENDOMETRIAL INFECTION*) (High Fever, Retained Uterine Pieces, Uterine Infection, etc) -INCREASE WBCs TO BE EXPECTED POST-24 HOURS POST-BIRTH

12 Weeks Gestation

-FETAL SEX CAN BE DETERMINED -The arms and legs move. -All body parts and organs are present. *UTERINE FUNDUS SHOULD BE JUST ABOVE THE SYMPHYSIS PUBIS

6 Weeks & 7 Weeks Gestation

-Fetal heart tones can be detected with external electronic doppler devices or Ultrasound machine d/t *heart forming double chambers and beginning to beat around 6-weeks*

DEFINITIVE POSITIVE SIGNS OF PREGNANCY

-Fetal heartbeat heard with Doppler device -Fetal movement palpated by health care provider or visible fetal movements -Visualization of fetus by use of ultrasound

*Stages of Labor*

1 - Latent (1-3cm) 1 - Active (4-8 cm) *^BEST TIME TO ADMINISTER IV OPIOIDS; clients who will give birth 2-4 hours after administration so that the opioid effect has time to wear off before the birth. * 1 - Transition (8-10cm) = *VOMITING* & IRRITABLE d/t Severe Pain 2 - 10cm complete cervical dilation to birth; desire to PUSH during contraction & can feel *BACKACHE* (Apply Strong Sacral Pressure during contractions as needed) ^BACK PAIN - increased d/t positioning of fetus (eg. OCCIPUT POSTERIOR) 3 - Expulsion of the Placenta

SECOND TRIMESTER (14 weeks - 27 weeks)

18 weeks - QUICKENING, or awareness of fetal movements ^14 weeks in multigravida 18-20 weeks - Ultrasound to evaluate fetal anatomy + Assess for Pre-Term Labor Signs & Pre-Eclampsia 24-28 weeks - RISK OF GESTATIONAL DIABETES MELLITUS; perform screening -Weight gain of 1 lb PER WEEK if pre-pregnancy BMI was normal -INCREASE IRON-INTAKE (risk of Pernicious Anemia)

28 Weeks Gestation

28 Weeks Gestation -Abundant LANUGO (hair) over most of the body -Smooth, pink skin with visible veins as skin is thin and transparent with lack of subcutaneous fat -Areolae of extremely premature infants may be barely visible, with no raised breast buds 33 Weeks Gestation -Vernix Caseosa (white waxy substance) forms; recedes over time

AMNIOTOMY

Artificial rupture of membranes (AROM); performed by HCP to augment or induce labor. ***PLACE IN UPRIGHT POSITION POST-AROM to allow for drainage of amniotic fluid. Intervention: -RISK OF UMBILICAL CORD PROLAPSE -Fetal Bradycardia d/t Cord Compression =Assess fetal hr before AND after the procedure -Check the client's temperature every 2 hours; INFECTION RISK -Noting the characteristics of the amniotic fluid

IV Magnesium Sulfate

Administered for seizure (eclampsia) prophylaxis in pregnant clients with pre-eclampsia & to reduce BP; CNS Depressant/Anticonvulsant/Relaxes smooth muscles. ***Seizure Precaution: remove stimulus (light, noise). Therapeutic magnesium levels = 4-8 mEq/L TOXICITY: -Absent or decreased deep tendon reflexes (DTRs) -OLIGURIA (below 400 mL daily in adults) -RISK OF Respiratory depression & CARDIAC ARREST *ASSESS BP (slight decrease in BP during pregnancy expected = HYPOTENSION RISK)

RhoGAM (Rh immune globulin)

Administered to *ALL Rh-NEGATIVE* pregnant clients at 28 weeks gestation and *WITHIN 72 hours postpartum* & as well as after any maternal trauma (eg. motor vehicle accident) = prevent the development of permanent Rh antibodies. *ADMINISTER IF:* -POST-BIRTH OF FIRST CHILD + Indirect Coombs Test is NEGATIVE & does NOT contain any Rh antibodies (RhoGAM treatment ineffective if antibodies have already formed) -Mother is Rh NEGATIVE -Baby is Rh POSITIVE ^^^^^REPEAT *RhoGAM is not effective once sensitization has occurred.*

Placenta Accreta

Abnormal placental adherence in which the placenta implants directly in the myometrium rather than the endometrium. INTERVENTION: -HEMORRHAGE RISK; at least TWO large bore IVs (eg. 18-gauge) and a blood type and crossmatch are PRIORITY! -Cesarean Birth

Pica

Abnormal, compulsive craving for and consumption of substances normally not considered nutritionally valuable or edible (eg. ice, cornstarch, chalk, clay, dirt, and paper). OFTEN ACCOMPANIED BY: iron deficiency anemia d/t insufficient nutritional intake or impaired iron absorption ^ASSESS HgB and HCT

Abstinence Syndrome

Abrupt withdrawal from the drug due to delivery in NEONATE; commonly seen with opioid & benzodiazepines use. SYMPTOMS: -Autonomic nervous system symptoms (eg. stuffy nose, sweating, frequent yawning and sneezing, tachycardia, and tachypnea) -Central nervous system symptoms (eg. irritability, restlessness, high-pitched crying, abnormal sleep pattern, and hypertonicity/hyperactive primitive reflexes) -Gastrointestinal symptoms (eg. poor feeding, vomiting, and diarrhea. These are treated with small, frequent feedings) X - lethargy, sleepiness INTERVENTION: -Swaddling -KEEP NASAL PASSAGE CLEAR -Protect the skin

Abruptio Placentae

Complete or partial separation of placenta from uterine wall SYMPTOMS: -PAINFUL (Lower Abdominal Pain) -Rigid BOARDLIKE abdomen -Dark vaginal bleeding -Increased FHR -Hypertonicity of the uterus INTERVENTION: -Prep for emergency C-Section! NO VAGINAL BIRTH! -Perform a AMNIOCENTESIS to reveal LECITHIN-SPHINGOMYELIN (L/S) RATIO: ratio of at least 2:1 hints at fetal lung maturity & likely survival of the fetus (eg - L/S Ratio of 1:1 hints at LUNG IMMMATURITY = LOWER SURVIVAL RATE OF FETUS)

MAGNESIUM SULFATE ANTIDOTE

CALCIUM GLUCONATE

Mastitis

Infection and inflammation of breast tissue; may result from inadequate milk duct drainage or poor breastfeeding technique INTERVENTION: *-MASSAGE DISTENDED AREAS AS THE INFANT NURSES TO PREVENT DEVELOPMENT OF MASTITIS* -CONTINUE breastfeeding frequently (ie, every 2-3 hr) to ensure adequate milk drainage -Ensure proper breastfeeding technique (eg, alternate newborn feeding positions, proper latch) -Apply warm compresses and massage the breast to facilitate complete emptying -Cool compresses BETWEEN feeding -Ensure adequate rest, nutrition, and hydration (eg. ORAL FLUID) -Relieve pain and inflammation with analgesics compatible with breastfeeding (eg, acetaminophen, ibuprofen) -Wash hands before and after feeding. -DO NOT WEAR TIGHT BRAS; restricts milk flow

Pudendal Nerve Block

Infiltrates local anesthesia (ie, lidocaine) into the areas surrounding the pudendal nerves that innervate the lower vagina, perineum, and vulva (relieves PERINEAL PRESSURE & PAIN) **USED WHEN BIRTH IS IMMINENT = LEAST MATERNAL/FETAL SIDE EFFECTS

Can NEONATES SHIVER?

NO; RISK OF COLD STRESS (irritability, lethargy, bradycardia, tachypnea, hypoglycemia, hypotonia, weak cry)

Spina Bifida

Neural tube defect occurring when spinal vertebrae do not close during fetal development, potentially allows spinal cord contents to protrude through the opening (usually located at the fifth lumbar or first sacral vertebra) SYMPTOMS: -Potentially no impairments -Neurologic disturbances (eg, bowel/bladder incontinence, sensory loss) of varying severity. *-TUFT OF HAIR/HEMANGIOMA/NEVUS or DIMPLE ALONG THE BASE OF THE SPINE; NOTIFY IMMEDIATELY!*

McRoberts Maneuver

SHARP flexion of the maternal hips/thighs onto the maternal abdomen that decreases the inclination of the pelvis/straighten the sacrum ^used for SHOULDER DYSTOCIA

*Tamoxifen*

Selective estrogen receptor modulator; prescribed to treat certain types of breast cancer and to prevent breast cancer recurrence. Side Effects: -hot flashes -vaginal dryness -menstrual irregularities RISK OF: -Thromboembolic events (eg, deep venous thrombosis, pulmonary embolism, stroke) -Endometrial cancer (eg, abnormal vaginal bleeding)

*CLOMIPHENE*

Selective estrogen receptor modulator; stimulates ovulation (release of egg) = increased chance of becoming pregnant! ***TAKEN PO FOR 5 DAYS EARLY IN THE MENSTRUAL CYCLE; HAVE SEX TYPICALLY 5-9 DAYS AFTER COMPLETION OF MEDICATION! Side Effects: -Hot flashes -Mood swings -Nausea -Headache -INCREASED RISK OF HAVING MORE THAN ONE BABY

FUNDUS (upper portion of the uterus)

Should be AT the midline and palpable halfway between the symphysis pubis and the umbilicus & should be FIRM! INTERVENTION: -Located laterally to the umbilicus or displaced i.e deviated? Urine Retention or a distended bladder; have the client void or utilize foley catheter -Post-Delivery & BOGGY? MASSAGE UNTIL FIRM to prevent hemorrhage & express any clots; take note the amount and character of lochia. ^^^Prepare to administer: METHYLERGONOVINE (METHERGINE), a Uterotonic Given post-partum to contract the uterus and control POSTPARTUM HEMORRHAGE

*Uterine Atony*

Soft, "boggy," and poorly contracted uterus = early PPH (occurring ≤24 hours after birth). *Delayed PPH (>24 hours after birth) usually results from retained placental fragments associated with a long third stage of labor (ie, time from birth of baby to expulsion of placenta, lasting >30 minutes). **ONLY ONE PERINEAL PAD SHOULD BE SATURATED FOR ONE HOUR D/T: -Overdistension of the Uterus -Macrosomia -Multiple Gestation -Multiparity *PPH Intervention:* -FIRM Fundal Massage -Have the client URINATE; may require foley catheter -OXYTOCIN BOLUS -Administer Misoprostol -Start a second IV-line (preferably 18-gauge) for blood trasnfusions Risk factors for PPH (POST PARTUM HEMORRHAGE) include: -History of PPH in prior pregnancy -Uterine distension due to: Multiple gestation, Polyhydramnios (ie, excessive amniotic fluid), MACROSOMIC infant (≥8 lb 13 oz [4000 g]) -Uterine fatigue (labor lasting >24 hours) -High parity -Use of certain medications: Magnesium sulfate, Prolonged use of oxytocin during labor, Inhaled anesthesia (ie, general anesthesia) -*UTERINE INVERSION (rare emergency; uterine fundus collapse = hemorrhage, severe pelvic pain, hypovolemic shock)* ^STOP ANY UTEROTONIC MEDICATIONS (eg. oxytocin, carboprost) UNTIL HCP HAS MANUALLY CORRECTED THE INVERSION!

Pre-Eclampsia/Maternal Hypertension:

Symptoms: -HYPERTENSION -Edema of Face/Hands (also assess for Weight Gain d/t retention of sodium ions and FLUID) -PROTEINURIA -Vision Changes -Severe Headache. *Monitor BLOOD PRESSURE (REPORT: 12mm Hg rise in SYSTOLIC/18mm Hg rise in DIASTOLIC) & place on MODERATE-to-HIGH PROTEIN diet d/t loss of protein via urine

Membrane Rupture:

Symptoms: -Large gush of clear fluid from vagina -FETAL DESCENT ASSESS/AUSCULTATE fetal heart rate or FHR) -Potential for cord prolapse *-MATERNAL TACHYCARDIA* *^Hard to Assess: Maternal Pulse Rate increases slowly by 10-15 bpm between 14-20 weeks gestation* Intervention: -Assess/Auscultate FHR -Administer O2 via Face Mask!

Ovarian Cancer

Symptoms: -VERY SUBTLE -abdominal bloating -PELVIC PAIN or pressure -abdominal girth increase -abdominal, back, or leg pain -urinary URGENCY/FREQUENCY -gastrointestinal disturbances *CONCERNING; most death than any other gynecologic cancer

*Misoprostol*

Synthetic prostaglandin. 1) Used to prevent PEPTIC ULCERS via reduction of stomach acid & commonly given for patients on long-term NSAID therapy. *Take with FOOD!* & 2) LABOR INDUCER; -USE reliable birth control -Expect possible sensation of uterine cramping *-DO NOT TAKE IF PREGNANT; unless prescribed to induce labor OR if fetus has DIED (eg. no fetal heart rate detected even after intervention)*

Bishop Score

System for the assessment and rating of cervical favorability and readiness for induction of labor; rates 0-3 to Cervix consistency/position/dilation/effacement/station. HIGHER SCORE = SUCCESSFUL INDUCTION (eg. a score > 8)

Oxytocin

Uterotonic drugs; used to INDUCE or AUGMENT labor and to stop postpartum hemorrhage by promoting uterine contractions. *MUST be administered via infusion pump and requires continuous electronic fetal monitoring -Assess uterine contraction pattern -Initiate continuous FHR monitoring -Place IV Oxytocin on an electronic infusion pump & administer via SECONDARY IV line -Assesses and documents the fetal heart rate and contraction pattern every 15 minutes during the first stage of labor with oxytocin -Gradual titration to achieve contractions every 2-3 minutes. -NONREASSURING FHR PATTERNS (eg. Late Decelerations, fetal tachycardia - 110-160 normal range, bradycardia) = STOP OXYTOCIN IMMEDIATELY RISK: -Category II or III fetal heart rate (FHR) patterns (eg, late decelerations, bradycardia) *-POSTPARTUM HEMORRHAGE d/t uterine atony & fatigue caused by prolonged exposure to oxytocin* -Water intoxication d/t antidiuretic effect when administered at high doses over prolonged periods. -Uterine tachysystole (ie, >5 contractions in 10 minutes) (Option 5)

Supine Hypotensive Syndrome

Weight of the abdominal contents compresses the vena cava causing decreased venous return to the heart = low cardiac output (maternal hypotension) and reflex tachycardia SYMPTOMS: -LOW CO -MATERNAL HYPOTENSION -Tachycardia -Dizziness, Pallor, Cold Clammy Skin INTERVENTION: -IMMEDIATELY Reposition onto the right or left side until the symptoms subside -PLACE wedge under the client's hip while in a supine position

Can you give NARCOTICS during pregnancy?

YES; can be given DURING PEAK of contractions to decrease sedation for the fetus & reduce risk of subsequent newborn respiratory depression at birth.