maternity exam 2
Magnesium sulfate
Causes lethargy, drowsiness, flushing, diaphoresis, nausea, vomiting, headache, pulmonary edema, loss of DTRs, respiratory depression, chest pain, pulmonary edema, hypotension, and cardiac arrest; Neonatal neuroprophylaxis with intravenous magnesium sulfate administration is recommended to reduce microcapillary brain hemorrhage in premature birth of the neonate. Accumulated available evidence suggests that magnesium sulfate reduces the severity and risk of cerebral palsy in surviving infants if administered when birth is anticipated before 32 weeks of gestation
Late decelerations
Change maternal position Discontinue oxytocin Assess hydration; give IV fluids Consider fetal scalp stimulation or VAS to assess fetal status Administer O2 at 10 L/min
Variable decelerations
Change maternal position Perform sterile vaginal examination to evaluate cord and labor progress Perform amnioinfusion (if during first-stage of labor) Administer O2 at 10 L/min via nonrebreather Decrease or discontinue oxytocin Consider the need for tocolytic to reduce UCs
false labor
Contractions but no change in cervix Activity does not change pattern Hydration or sedation slows/stops contractions
Category 3
-Absent variability with any of the following: Recurrent late decelerations Recurrent variable decelerations Bradycardia Sinusoidal pattern -Management Prepare for delivery + intrauterine resuscitative measures Evaluations and surveillance
transitions phase of labor
8-10cm
active phases of labor
>6cm labor begins to move more rapidly regular contractions that require the focus and attention of the birthing woman, significant effacement (80% or more), and greater than 5 cm dilation with ongoing cervical change
Who would get RhoGAM?
A RH Negative mother
What is variability?
Absent: Amplitude range is undetectable. Minimal: Amplitude range is visually detectable at 5 bpm or less. Moderate: Amplitude from peak to trough is 6 bpm to 25 bpm. Marked: Amplitude range greater than 25 bpm.
Gestational Trophoblastic Disease
Diagnosis: ultrasound manifestations Pelvic pain pain/pressure Anemia Hyperemesis gravidarum Hyperthyroidism Gestational hypertension or preeclampsia Amenorrhea n/v Uterine bleeding Enlarged uterus Abdominal cramping Nursing mgmt: -Provide support -Assess response to diagnosis and treatment -Offer explanations -Schedule post discharge follow up meeting - Monitor for signs and symptoms of hemorrhage such as abnormal vital signs, abdominal pain, or vaginal bleeding. -Assess the uterus. Teach: -Monitor for severe abdominal pain, excessive bleeding, and signs and symptoms of infection such as fever. -pain management -contraception options and reason to prevent pregnancy for 1 year. -Prophylactic chemotherapy is not routinely recommended
nurses role for latent phase
Admit to the labor unit and orient the laboring woman and support people to the labor room. Review the prenatal record Allergies, tests(CBC, Rh, HIV etc), trends, chronic conditions, pregnancy complications, ultrasounds etc. Complete labor and delivery admission record Review birth plan and laboring expectations Desires and preferences Teach and reinforce relaxation and breathing techniques. Start IV Obtain laboratory tests as per orders -Asses and records Maternal vital signs FHR UCs Cervical dilation and effacement; as well as fetal presentation, position, and station Fetal position with Leopold's maneuvers Deep tendon reflexes Signs of edema Heart and lung sounds Emotional status Pain and discomfort bleeding/ bloody show Amniotic fluid for color, amount, consistency, an odor
Pain management- Epidural anesthesia side effect on mother & baby (nursing interventions)
Adverse effects: maternal hypotension- give plenty of fluids prior to epidural -Bladder distention -Maternal fever -Prolonged second stage -Cesarean birth -Catheter migration -Pruritus -Alterations in FHR :Nursing care Pre-anesthesia care: Obtain consent. Check laboratory values—especially for bleeding or clotting abnormalities, or platelet count. IV fluid bolus with normal saline or lactated Ringer's Ensure emergency equipment is available. Do time-out procedure verification
Prenatal diagnostic testing
Diagnostic tests provide a yes or no answer to whether a fetus is normal or abnormal and can detect many, but not all, birth abnormalities caused by defects in a gene or chromosomes. Amniocentesis Chorionic villi sampling, MRI, ultrasonography, percutaneous umbilical blood sampling
management for GDM
Diet and exercise Oral hypoglycemic agents Teach women to monitor glucose and look for signs of hypoglycemia or hyperglycemia
Dilation
Dilation is the enlargement or opening of the cervical os. When the cervix reaches 10 cm dilation, it is considered completely dilated and can no longer be palpated on vaginal examination.
Category 1
Baseline rate 110- 160 Baseline variability moderate Late or variable deceleration absent Early decelerations absent or present Accelerations absent or present nursing care: routine management
Placent abruption
Bleeding that causes partial or complete placental detachment prior to delivery Manifestations: -Vaginal bleeding; can be occult hemorrhage -Severe abdominal pain and tense abdomen, dull back pain -N/V -Decreased renal output -FHR tachycardia or bradycardia Nursing actions: -Monitor fetus and maternal status -Palpate thee uterus for contractions, tenderness, or increasing uterine distention -Monitor I&O -Measure and estimate blood loss
doppler testing
Blood flow velocity measured by Doppler ultrasound reflects downstream impedance. Non invasive evaluates the rate and volume of blood flow through the placenta and umbilical cord vessels using ultrasound. -Increased resistance = poor placenta function and reduced blood flow directed blood flow within the umbilical arteries is calculated using the difference between systolic and diastolic flow Umbilical artery Doppler is considered abnormal if the systolic/diastolic ratio is above the 95th percentile for gestational age, or the end-diastolic flow is absent or reversed factors such as maternal position, fetal heart rate (FHR), and fetal breathing movements can alter the vessel waveforms. Ideally, the Doppler examination should be conducted during times of fetal apnea Nursing care: Provide support/emotional support Schedule appropriate follow-up Explain procedure Address questions
Category 2
Bradycardia /or Tachycardia Minimal /or Absent baseline variability Marked baseline variability Absence of induced accelerations after fetal stimulation Recurrent variable decelerations with minimal or moderate baseline variability Prolonged decelerations greater than 2 minutes but less than 10 minutes Periodic or episodic decelerations Variable decelerations with other characteristics, such as slow return to baseline "overshoots" or "shoulders" -Management: FHR/ moderate FHR variability = continue surveillance + intrauterine resuscitative measures Absent FHR accelerations and absent/ minimal FHR variability = intrauterine resuscitative measure and if not improved or FHR tracing progresses to category 3 consider delivery
Magnesium sulfate infusion and assessing for toxicity -BURP
CNS depressant that helps reduce seizure acitivity Contraindicted in patients with pulomary edema, renal failure, and myasthenia gravis Magnesium sulfate toxicity -Bp decrease -Urine output decrease -Respiratory rate decrease -Patellar reflex absent
types of Hypertension Disorders
Caused by defective spiral artery remodeling that causes placental hypoperfusion Placenta then releases proinflammatory proteins called cytokines into the maternal circulation that causes systemic vasoconstriction which causes hypertension SBP> 140 and DBP> 90 Types: Chronic hypertension of pregnancy -Diagnosed prior to pregnancy or within the first 20 weeks or gestation or present 12 weeks postpartum Gestational hypertension -Diagnosed after 20 weeks or in the immediate postpartum period Preeclampsia -High BP with proteinuria Preeclampsia with severe features -Preeclampsia with one or more of the follow -SBP> 160 or DBP >110 -Platelets <100,000 -LFTs > 2x upper limit of normal -Pulmonary edema -Visual changes or mental staus disturbances Eclampsia -seizures
CCB
Dizziness, flushing, and hypotension; tachycardia, nausea; when used with magnesium sulfate, possible suppression of heart rate, contractility, and left ventricular systolic pressure; and elevation of hepatic enzymes Antibiotics should not be used to prolong gestation or improve neonatal outcomes in women with PTL and intact membranes.
Normal and abnormal contraction patterns, how to read and document.
During contractions, muscles become firm and can be palpated (assessment is subjective and can be affected by the fat of the pregnant woman) Mild contractions (+1) : feels like tip of the nose easily indented uterus Moderate contractions (+2): feels similar to the chin can slightly indent uterus) Stong contractions (3+): feels similar to the forehead Cannot indent uterus
nurses role for 3rd stage of labor
Facilitate family bonding. Assess maternal vital signs and pain.(every 15min) Assess maternal stability. Prepare for delivery of placenta and need for uterotonics. skin-skin
Gestational Diabetes
Gestational diabetes mellitus (GDM) is glucose intolerance that does not present before pregnancy. Approximately 90% of diabetes cases during pregnancy are GDM Causes: -Increased maternal adiposity -Insulin desensitizing hormones produced by the placenta Diagnosed using a 2-step method -First is a nonfasting 1 hr 50g oral glucose test Positive if sugar is 135-140 If test positive, move onto step 2: fasting 3 hr glucose tolerance test -Ingest 100g glucose and glucose is taken every hour. Positive is 2 or more glucose levels are above these thresholds Fasting: 95 or higher -1 hr: 180 or higher -2 hrs: 155 or high -3 hrs: 140 or higher
Labor positions
Hands and knees Standing and leaning Birth ball In the water With a chair Side laying position On the toilet
nurses role for Active phase
If using intermittent monitoring, assess the fetus every 15 to 30 minutes for low-risk patients and every 15 minutes for high-risk patients or consider using continuous monitoring Low-risk patients usually include : -No meconium staining, intrapartum bleeding, or abnormal or undetermined fetal test results before birth or at initial admission -No increased risk of developing fetal acidemia during labor -No maternal condition that may affect fetal well-being -No requirement for oxytocin induction or augmentation of labor. Monitor maternal pulse,BP, RR, every hour; temperature every 2 hours, unless ruptured, then every 1 hour. Assess pain (location and degree). Administer analgesia as per orders and desire of the laboring patient. Monitor and evaluate the effectiveness of epidural or other pain medication. Monitor I&O, hydration status, and for nausea and vomiting. Offer oral fluids as per orders Offer clear explanations and updates of progress. Promote comfort measures. Assist with elimination (bladder distention can hinder fetal descent). Encourage breathing and relaxation methods Review and reinforce relaxation techniques. Maintain eye contact and physical proximity to the laboring patient. Develop a rhythm and breathing style Use a direct and gentle voice and have a calm and confident "You are in control"; "It is normal to feel so much pressure as the baby moves down"; "You are doing a great job working with your contractions." Use touch or massage if acceptable to the patient. Communicate clearly and promptly with other members of the health-care team Incorporate the support person in care of the patient by: -Role modeling and teaching supportive behaviors -Carefully listening to and addressing the support person's desires and concerns -Assisting the partner with food and rest -Provid
Drugs Used in Preterm Labor
MgSo4, Procardia, Betamethasone, antibiotics
Missed abortion
No vaginal bleeding Closed cervical os No fetal cardiac activity or empty sac No symptoms at all Usually diagnosed at first ultrasound
Early Decelerations
None because it is normal during labor so no interventions are needed
nurses role for 1st stage of labor
Perform admission procedures and orient patient to setting. Review prenatal records. Assess FHR and uterine activity.(15-30min) Assess maternal vital signs (every 2 hrs) and pain.(every 30min) Assist with ambulation and maternal position changes. Provide comfort measures. Discuss pain management options. Administer pain meds PRN. Monitor I&O and provide oral or IV hydration as indicated. Provide ongoing assessment of labor progress. Request an immediate bedside evaluation by a physician or CNM.
nurses role for 2nd stage of labor
Perform more frequent maternal and fetal assessment. Review prenatal records. Assess FHR and uterine activity.(5- 15min) Assess maternal vital signs(every 2 hrs) and pain.(every 15min) Encourage open glottis pushing efforts. Provide comfort measures for pushing efforts. Provide ongoing assessment and encouragement of labor progress. Communicate with interdisciplinary team. Prepare for delivery.
The P's of the birth process
Powers (the contractions and pushing efforts) Passage (the pelvis and birth canal) Passenger (the fetus) Psyche (the response of the woman) Position (positions that facilitate labor and birth)
Resting tone
Pressure in the uterus between contraction Measured by palpation or IUPC internally Relaxation time between UC's
Preterm labor
Preterm labor (PTL) is defined as regular contractions of the uterus resulting in changes in the cervix before 37 weeks of gestation. preterm or premature infant is born before 37 weeks (36 6/7 weeks) of gestation Risk factors: causes of Preterm labor -The pathophysiological events that trigger PTL are largely unknown but may include decidual hemorrhage (abruption), mechanical factors such as uterine overdistention or cervical incompetence, hormonal changes indicated by fetal or maternal stress, infection, and inflammation . A history of delivering preterm is one of the strongest predictors for subsequent PTBs. Excessive uterine stretch or distention -Prostaglandins can be produced, stimulating the uterus to contract when overdistended from multiple gestation, polyhydramnios, or uterine abnormalities. Decidual activation -From hemorrhage -From fetal-decidual paracrine system -From upper genital tract infection Premature activation of the normal physiological initiators of labor and activation of the maternal-fetal hypothalamic-pituitary adrenal (HPA) axis. Inflammation and infection in the decidua, fetal membranes, and amniotic fluid are associated with PTB. Prenatal stress has been associated with contributing to the development of PTL.
Cesarean section indications
Previous cesarean birth Placental abnormalities Cephalopelvic disproportion, which occurs when ineffective uterine contractions lead to prolonged first stage of labor, Previous uterine surgery cardiac disease, severe diabetes mellitus, severe hypertension, or preeclampsia. Increasing maternal age and obesity rates malpresentation, abnormal FHR patterns, and maternal failure to progress through labor
true labor
Regular contractions increase in frequency and intensity Change in cervix Causing effacement and dilations
Non-pharmacological pain relief methods during labor-nursing interventions
Relaxation and breathing techniques Massage and effleurage( lightly stroking a body part in a circular motion with the palm of the hand. ) Counterpressure Hydrotherapy(warm baths or showers) -stimulation of nerves in the skin and promotes vasodilation, reversal of sympathetic nervous system response, and reduction in catecholamine production. -96.8°F and 99.5°F Guided imagery Positioning Aromatherapy Continuous labor support
PTL nursing care & management
Review RF Asses for ROM, vaginal/urinary infection, sterile speculum exam for ferning of amniotic fluid, vaginal bleeding, dehydration Assess FHR and UCs (report tachycardia or increased UCs) Cultures Strict I&Os while on tocolytics -Monitor for AE -Auscultate lungs Position pt on side to increase uteroplacental perfusion and decrease pressure Provide emotional support Explain purpose and side effects
RF and teaching on Hypertension disorders
Risk factors: -Maternal age older than 35 -Prepregancny obesity BMI > 30 -Family history -Multiple gestation -Gestational diabetes -Previous preeclampsia or eclampsia -Assisted reproduction Teaching: -Antihypertensive meds -Frequent visits, BP monitoring -Planned early delivery
Chorionic Villus Sampling: biochemical test
Sampling of the villi chromosomal, metabolic, or DNA testing Performed during 10 to 13 weeks of gestation Can be performed earlier than amniocentesis and examine fetal chromosomes Results within a week -Risk: Bleeding Pregnant women who have hepatitis B virus, hepatitis C virus, or HIV should be counseled about the possibility of an increased risk of transmission to the newborn that may come with CVS or amniocentesis. -Nursing actions: Lithotomy for transvaginal aspiration Supine for transabdominal aspiration Review procedure Instruct the woman in breathing and relaxation techniques Provide emotional support Label specimen Auscultate FHR twice in 30 minutes. report abdominal pain or cramping, leaking of fluid, bleeding, fever, or chills
Genetic Screening
Screening tests are designed to identify those who are not affected by a disease or abnormality. Assess the risk AFI, biophysical profile, contraction stress test, fetal movement count, alpha-fetoprotein screening, quad marker, NST, ultrasonography, umbilical artery doppler flow
Duration
Seconds from the beginning to end of one contraction
hyperemesis
Severe vomiting that leads to dehydration, electrolyte and acid-base imbalance, starvation ketosis, and weight loss. Manifestations: -Persistent vomiting not related to other causes -Large ketonuria -Weight loss -Signs of dehydration Low BP, high HR, poor skin tugor, dry mucus membranes, dark urine, sunken eyes. Lightheadedness, Managment: -IV hydration, short period of gut rest -B6 to treat nausea -Weight the aptiennt -Give antimetics Zofran Reglan Pepcid
Intensity
Strength of contraction Measured by palpation or internally by IUPC
Beta adrenergic agonist
Tachycardia, arrhythmias, palpitations, shortness of breath, chest discomfort, pulmonary edema, hyperglycemia, hypokalemia, hypotension, tremor, nausea and vomiting Maternal death Fetal tachycardia, alterations in fetal glucose metabolism, hyperglycemia, and hyperinsulinemia
What is the normal baseline?
The normal range is 110 to 160 bpm. FHR baseline above 160 bpm for at least 10 minutes is tachycardia. FHR baseline below 110 bpm for at least 10 minutes is bradycardia.
Frequency
Time from beginning of one contraction to the beginning of another. It is recorded in minutes
External Fetal Monitoring pros and Cons
Use Leopold's maneuvers to locate the fetal back. detects FHR baseline, variability, accelerations, and decelerations. External uterine monitors cannot measure the pressure or intensity of contractions.
Complete abortion
Vaginal bleeding Closed cervical os Products of conception completely expelled
Threatened abortion
Vaginal bleeding and cramping Cervix closed and soft Fetal cardiac activity -Viable pregnancy Send home and monitor -Educate on sign of abortion -Monitor HCG
Incomplete abortion
Vaginal bleeding and cramping Dilated cervical os Some products of conception expelled May need a procedure to clear out remaining products
inevitable abortion
Vaginal bleeding and cramping Rupture of membranes Dilated cervical os Products of conception may be seen or felt at or above cervical os Stay in the hospital
What is VEAL CHOP?
Variable decelerations = Cord Compression Early deceleration = Head Compression Acceleration = Ok Late deceleration = Placental insufficiency
spontaneous abortion
a nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity within the first 12 6⁄7 weeks of gestation;early pregnancy loss is spontaneous pregnancy demise before 10 weeks of gestational age.
What is a Cervical cerclage?
a type of purse-string suture placed cervically to reinforce a weak cervix .The standard transvaginal cerclage methods currently used include modifications of the McDonald and Shirodkar techniques.
Betamethasone
antenatal corticosteroids have significantly lower severity, frequency, or both of respiratory distress syndrome, intracranial hemorrhage, necrotizing enterocolitis, and death Given to women at 24 and 34 weeks' gestation with signs of PTL or at risk to deliver preterm in the next 7 days. Stimulate the production of more mature surfactant in the fetal lungs to prevent respiratory distress syndrome (RDS) raise blood sugar and may require temporary insulin 12 mg IM every 24 hours × 2 doses A single repeat course of antenatal corticosteroids may be considered in women who are less than 34 weeks of gestation, who are at risk of preterm delivery within the next 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously.
CST
assess the ability of the fetus to maintain a normal FHR in response to UCs in women with a nonreactive NST at term gestation identify a fetus that is at risk for compromise through observation of the fetal response to intermittent reduction of in utero placental blood flow
GDM -Risks to Mom & fetus before and after delivery
before for MOM and BABY -Hypoglycemia and DKA Preeclampsia C-section Delayed healing, infection -Macrosomia (weight of 4,000g - 4500g)-baby after. delivery mom -Development of nongestational diabetes -Postoperative mortality after delivery baby -Hypoglycemia during first few hrs after birth -Shoulder dystocia -RDS -Birth trauma -Still birth
3rd stage of labor
begins after delivery of the baby and ends with delivery of the placenta. uterine myometrium spontaneously contracts, reducing its surface area and resulting in shearing forces at the placental attachment site and subsequent placental separation
2nd stage of labor
begins with complete dilation of the cervix and ends with delivery of the baby. UCs every 2-3 min , no more than 5 in 10 min,Contractions are intense moderate/strong urge to bear down (Ferguson reflex.) urge to push as intense rectal pressure may feel a burning sensation as the fetus crowns. Bloody show increases. perineum flattens and the rectum and vagina bulge.
1st stage of labor
begins with onset of labor and ends with complete cervical dilation. The bag of waters usually ruptures during this stage. Gastrointestinal motility decreases, longest stage
Group beta strep infection and CDC protocol
colonizes the female genital tract and rectum. Cause of UTI,pyelonephritis, chorioamnionitis, PTL, vaginal discharge, postpartum endometritis, post-cesarean section wound infection, Risk: Neonatal prematurity Transmission Maternal intrapartum fever for prolonged ROM Management: -Collect vaginal-rectal culture for screening. -Treat positive test results with ampicillin or penicillin during labor -Cef or clindamycin is the alternative for women with a high anaphylactic risk -Women who have a cesarean before labor onset do not need treatment even with a positive test.
Uterine activity
frequency, duration, intensity, resting tone
AFP
glycoprotein produced in the fetal liver, gastrointestinal tract, and yolk sac in early gestation 15 to 20 weeks' gestation Between 80% and 85% of all open NTDs and open abdominal wall defects and 90% of anencephalies can be detected early in pregnancy -Nursing care: Provide information Assist in scheduling diagnostic testing when results are abnormal Support
Fetal ultrasound imagining
high-frequency sound waves to produce an image of an organ or tissue meaning sonography should only be performed for a valid indication using the lowest possible exposure. performed either transabdominally or transvaginally Used for: Presence of gestational sac Gestational age Fetal growth Fetal anatomy Placental location Fetal activity Number of fetuses Viability amount of amniotic fluid Visual assistance for amniocentesis Nursing care: Explain procedure Assess for latex allergy Provide comfort/emotional support Schedule follow up appt Documentation
VBAC interventions and postpartum care
nursing care: -Review the prenatal record for documentation of prior uterine scar because VBAC is contraindicated in vertical uterine incisions. Closely and continuously monitor uterine activity and FHR. -Assess the progress of labor. -Provide information, reassurance, and support to the woman. -Report any complaints of severe pain
Quad testing
performed in the second trimester that gives information regarding the risk of open fetal defects -trisomy 21 and 18. 15 to 22 weeks' gestation
Placenta previa
placenta atteaches to the lower uterine segment Types: -Low implantation -Partial placena previa -Total placenta previa Risk factors: -Endometrial scarring -Increased placental mass Risk to woman: -Hemmorhage and hypovelmic shock Manifestations: -Painless vaginal bleeding in the third trimester -FHR chnages associated with maternal blood loss Nursing care: -Avoid vaginal exam -Assess color, amount, and character of vaginal bleeding -Assess bp and rr -Iniate bed rest with bathroom privileges -Anticipate C section if mother or baby is unstable
Ectopic pregnancies
pregnancy that occurs outside of the uterine cavity. An ectopic pregnancy occurs when a fertilized egg grows outside the uterus as a result of the blastocyst implanting somewhere other than the endometrial lining of the uterus Most occur in the fallopian (95%) RF: Smoking, increased age, STDs, prior tubal surgery, infertility, previous ectopic, PID Management: surgical treatment (laparoscopic surgery, medication treatment (methotrexate) nursing care: -Ensure stabilization of cardiovascular status. -Explain plan of care -Assess anxiety, fear and guilt -Provide support -Acknowledge feelings -Follow up care -Teach to monitor for severe abdominal pain, excessive bleeding, and signs and symptoms of infection such as fever. -Teach about an iron-rich diet if the woman experiences high estimated blood loss (EBL). -Teach pain management Methotrexate :side effects, such as nausea, vomiting, and stomatitis, are the most common. -No NSAIDs and alcohol -May experience abdominal pain for 2- 3 days
FKC
pregnant woman counts fetal movements in a specified time period to identify potentially hypoxic fetuses palpate her abdomen and track fetal movements daily for 1 to 2 hours. Nursing care: Teach how to do kick count and provide a means to record them (lie on side while counting) If fetal movement is decreased, the woman should be instructed to eat something, rest, and focus on fetal movement for 1 hour. Four movements in 1 hour are considered reassuring,
station
relationship of fetal head to mothers pelvis from -3 to +3
free cell DNA
screens for aneuploidies using the analysis of cell-free DNA fragments in the maternal circulation starting at about 9 to 10 weeks of pregnancy potential for false-positive and false-negative results
what is Gestational Trophoblastic Disease
spectrum of placental-related tumors. GTD is a group of rare diseases in which abnormal trophoblast cells grow inside the uterus after conception Gestational trophoblastic neoplasia (GTN) = always malignant molar pregnancy is a benign proliferating growth of the trophoblast Seen in younger than 18 and older than 40 and previous molar pregnancy
Effacement
the softening, shortening, and thinning of the cervix Before the onset of labor, the cervix is 2 to 3 cm long When completely effaced, the cervix is just a few sheets of paper thick.
lie and nursing education
two primary lies are longitudinal and transverse longitudinal lie, the long axes of the fetus and the woman are parallel, occurring in 99% of labors transverse lie, the long axis of the fetus is perpendicular to the long axis of the woman. The fetal head is positioned in one iliac fossa and the buttocks and feet are in the other. -A fetus cannot be delivered vaginally in the transverse lie..
Biophysical profile
ultrasound assessment of fetal status along with an NST. The BPP was first introduced as an intrauterine Apgar score in response to a high proportion of false-positive NSTs and CSTs real-time ultrasound with EFM to assess five fetal variables: NST reactive, fetal movement, tone, breathing, and amniotic fluid volume. indicated in pregnancies involving increased risk of fetal hypoxia and placental insufficiency, such as maternal diabetes and hypertension. -Procedure: Nst reactive Fetal breathing - 1 or more rhythmic breathing movement of 30 sec.within 30 min Fetal movement- 3 or more discrete body or limb movement in 30min Delta tone- 1 or more extremity extensions with return fetal flexion or opening and closing of the hand in 30min Amniotic fluid volume- 2cm in 2 planes perpendicular to each other -Scoring: 2(present) or 0 (absent) assigned to each component 8/10 reassuring 6/10- possible fetal asphyxia; repeat in 12 to 24hrs of delivery 4/10- probable fetal asphyxia; consider delivery Fetal activity decreases or stops to reduce energy and oxygen consumption
Latent phase of labor:
up to 5cm Contractions stronger, more regular, and more frequent over time and are associated with cervical change. may be talkative and able to relax with the contractions.
Amnio (genetic and 3rd trimester),
used for obtaining fetal cells for genetic testing a needle is inserted through the maternal abdominal wall into the uterine cavity to obtain amniotic fluid -Can be used for fetal lung maturity, assessment of hemolytic disease, or intrauterine infection and therapy for polyhydramnios. 15 and 20 weeks for genetic testing. -Risk: Pregnancy loss Trauma to fetus/placenta Preterm labor Infection Bleeding Transmission of Hep. B/C, HIV, to baby -Nursing care: Review procedure Explain procedure Explain that discomfort will be minimized during needle aspiration with a local anesthetic. Provide support Prep the abdomen with an antiseptic such as betadine if indicated. Label specimens. monitoring and evaluating the FHR. Instruct the woman not to lift anything heavy for 2 days. report abdominal pain or cramping, leaking of fluid, bleeding, decreased fetal movement, fever, or chills
Tocolytic drugs
used to suppress uterine contractions (UC) in PTL. Interventions to reduce the likelihood of delivery should be reserved for women with PTL at a gestational age at which a delay in delivery will provide benefit to the newborn. Tocolytic therapy is typically administered between 24 to 34 weeks' gestation.
NST
uses FHR patterns and accelerations as an indicator of fetal well-being -records accelerations in the FHR in relation to fetal activity. for high-risk pregnant women with complications such as hypertension, diabetes, multiple gestation, trauma, or bleeding; reactive when the FHR increases 15 beats above baseline for 15 seconds twice or more in 20 minutes less than 32 weeks' gestation, two accelerations peaking at least 10 bpm above baseline and lasting 10 seconds in a 20-minute period is reactive Nursing care: Explain procedure Have pt void before hand Semi-fowler Document date and time ,reason for text and maternal vs
internal fetal monitoring pros and Cons
uses a fetal scalp electrode (FSE) or internal scalp electrode applied to the presenting part of the fetus to directly detect FHR. involves an IUPC placed in the uterine cavity to directly measure UCs membranes must be ruptured contrainindicated :chorioamnionitis, active maternal genital herpes, HIV, positive group B streptococcus testing and conditions that preclude vaginal exams detects FHR baseline, variability, accelerations, decelerations, and limited information on some types of arrhythmias. IUPC provides an objective measure of the pressure of contractions
VBAC risk
uterine rupture failed TOLAC Neonatal morbidity
