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Glossary of Antepartum and Labor and Delivery

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Stages of Labor
-Dilation (w/3phases)
-Elpulsion
-Placenta
-Physical Recovery
Phases of Stage 1: Dilation
-Latent
-Active
-Transition
Phase 1
-Phase 1: Latent
*Cervix: begin - 4cm
*Contraction freq: 10-20 then 5" regular
*Intensity: Mild to mod
*Duration: 30 sec
Phase 2
-Phase 2: Active
*Cervix: 4 - 7cm
*Contraction freq: 3 - 5"
*Intensity: mod to strong
*Duration: 45sec
Phase 3
-Phase 2: Transition
*Cervix: 8 - 10cm
*Contraction freq: 2 - 3"
*Intensity: strong
*Duration: 60 - 90 sec
Indications of Pregnancy
-Presumptive
-Probable
-Positive
Presumptive
-Amenorrhea
-N&V
-Fatigue
-Urinary frequency
-Cervical color changes
-Brease and skin changes
-Quickening
Probable
-Abdominal enlargement
-Braxton-Hicks Contractions
-Palpation of fetal outline
-Positive pregnancy test
-hCG: human chorionic Gonadotropin
Positive
-Auscultation of fetal heart sounds (18-20 wks)
-Doppler 10-12 wks
-Fetoscope 18wks
-Fetal movement
-Visualization of fetus by ultrasound
Terms
-Hegar's Sign: softening of the uterus
-Goodell's sign: softening of the cervix
-McDonald's sign: Uterus flexed
-Chadwick's sign: color change in the cervix, vagina, and labia (bluish)
-Ballottement: during vaginal exam the cervix is tapped, fetus floats upward and then returns to cervical area
Routine Lab Tests for Pregnancy
-CBC, UA, BG
-ABO and Rh typing
-Hgb electrophoresis
-VDRL/FTA: syphilis
-Rubella Titer
-TB skin test
-Cervical culture
-Pap
-HIV
-Hep B
-AFP: alpha fetoprotein to detect for fetal anomalies
Luteinizing Hormone
-Anterior Pituitary Gland
-Target organs: ovaries and testes
-Action: Stimulated final maturation of follicle
-Causes ovulation
-Stimulates transformation of graafin follicle into corpus luteum
Follicle Stimulating Hormone
-Anterior Pituitary
-Ovaries
-Stimulates production of estrogens, progesterone
-Stimulates growth and maturation of graafin follicles before ovulation
Progesterone
-Ovary, corpus luteum, placenta
-Acts on uterine and breasts
-Stimulates secretion of endometrial glands, in preperation for possible embryo
-Pregnancy induces growth of cells of fallopian tubes and uterine lining to hourish embryo
-Decreases contraction of uterus
-Prepares breasts for lactation but inhibits prolactin secretion
Prolactin
-Anterior Pituitary
-Female breasts
-Stimulates secreion of milk
-Sucking of breast by infant stimulates prolactin production
-Estrogen and progesterone from placenta have inhibiting effect on milk production
Oxytocin
-Posterior Pituitary
-Uterus, female breasts
-Stimulates in uterus contractions during child birth and postpartum contractions to compress uterine vessels and control bleeding
-Stimulates let-down or milk ejection reflex during breast feeding
Dip Stick Urine
-Protein: for PIH
-Glucose: for Diabetes
-UTI
hCG
-Human chorionic gonadotropin
-Causes the corpus luteum to persist and secrete estrogens and progesterone
Metabolic Changes
-Average wht gain is 30lbs
-Caloric needs: 2500 a day
-Protein: 60g per day
-Vitamins: B6, D, E & folic acid
Negal's Rule
-Subtract 3 months and add 7 days to 1st day of last normal menstral period
Umbelical Cord
-2 veins
-1 artery
GTPAL
-Gravida, term, preterm, abortions, and live births
Gravida
-Number of pregnancies
Para
-Number of pregnancies that have progressed past 20 weeks
Umbilicus Cord
-Contains:
*2 arteries
*1 vein
PIH
-Pregnancy Induced Hypertension
-BP > 140/90 OR > 30 baseline SBP OR > 15 DBP
-S/S:
*seizures
*headaches
*spots in front of eyes
*pariorbital edema
*stroke and other complications
Nursing Priorities with PIH
-PEACE
-P: promote bedrest
-E: ensure high protein diet
(d/t proteinuria)
-A: antihypertensives drug (Apresoline does not cross placenta barrier)
-C: convulsion (prevent w/Mg sulfate, antidote calcium gluconate)
E: evaluate physical parameter (complications of mg sulfate)
Bleeding Conditions
-Spontaneous Abortion: termination of the pregnancy prior to 20wks gestation
-Inevitable abortion: vaginal bleeding with cramping, cervical changes and rupture of membranes (not reversible)
-Incomplete abortion: D&C usually needed (<6wks >14wks)
-Habitual abortion: SAB in >3 consecutive pregancies
Differential Diagnosis
-Ectopic pregnancy
-Implantation bleeding
-Molar pregnancy: hydatidiform mole proliferation of the chorionic villi
Placenta Previa
-Placenta implants in the lower part of the uterus
-S/S: painless. bleeding, sometimes found by ultrasound
-Types include:
*Total
*Partial
*Marginal
-C-section must be preformed
Abruptio Placenta
-Seperation of the placenta before delivery
-Can be caused by cocaine use, trauma
-S/S: sometimes vaginal bleeding, abdominal pain, board-like abdomen, uterine tenderness, concealed bleeding, may be noted by pain, fetal distress and shock symptoms in the mother
-DIC: disseminated intravascular coagulation
*may occur as a sequela to abruptio
-C-section required
Toxoplasmosis
-Protozoan found in cat liter that can cause severe fetal damage
Amniocentesis
-Aspiration of amniotic fluid for exam
-Usually done at 15-18wks
Midtrimester Amniocentesis
-To examine fetal cells for any chromosomal abnormalities
Third trimester Amniocentesis
-Done to determine fetal maturity or to diagnose fetal hemolytic disease
Eary Amniocentesis
-Usually done between 11-14wks
Non Stress Test
-To assess fetal well being
-Assess ability of fetal heart to speed up in response to fetal movement
-Requires 30 - 40 minutes
-Response is a good thing
Gestational Diabetes vs DM
-GD:
*multiple risk factors
*FBG > 140
*Obesity, high birth wght, previous preg. or birth
-DM:
*no oral insulin
*Mom Type 1 is at risk for DKA or SAB
*Pt education for hyper/hypo glycemia
Magnesium Sulfate Toxicity
-BURP
-B: blood pressure decreased
-U: Urine output decreased
-R: Respirations decreased
-P: Patella reflex absent
Danger Signs of Pregnancy
-CABS
-C: Chills and fever, cerebral disturbances
-A: Abdominal pain
-B: Blurred vision, blood pressure, bleeding
-S: Swelling, sudden escape of fluid
Auscultation of Fetal heart sounds
-18-20weeks
-Doppler: 10-12weeks
Preterm Labor
-Labor that occurs between 20 and 37 weeks of gestation
*may be due to DES exposure which will cause birth defects
-Fetal factors:
*multiple pregnancy
*hydraminos: too much amniotic fluid
*fetal infection
*plecenta previa
*abruptio placenta
Tocolysis
-Medication to stop labor
-Examples:
*Mag sulfate
*Beta-adrenergic: yutopar
*Prostaglandin synthesis inhibitors
*Calcium channel blockers
-
Magnesium Sulfate
-6-8mg/dl is effective range
Betamethasone
-Corticosteroid
-Acceleration of fetal lung maturation
-12mg IM for 2 doses, 24 hours apart
-Up to 34wks
Onset of Labor: True
-**Cervix progressive effacement and dilation (most important sign)**
-Contractions are consistent and increase in intensity and frequency
-Discomfort in lower back to abdomen
***Contractions start in the fundus and do down the uterus
Dilation
Cervix progresses from 0-10cm in diameter
Effacement
The thinning of the cervix
S/S of Labor and Delivery
-WORLD
-W: wgt loss
-O: observe change in sensations
-R: rupture of membranes (baby should be delivered in 24 hours to prevent infection)
-L: lightening: baby droppin
-D: dilation & effacement
-S: show bloody (mucous plug)
Stage 1
-Latent phase:
*mild and frequent contractions
*every 5min lasting 30-40"
-Active phase:
*increase in FID (freq. inten. dura.)
*2-5min frequency
*lasting 40-60"
-Transition phase:
*very strong contractions
*1.5-2min frequency
*lasting 60"
Hypertonic Contractions
-Contractions that
*have 1-2min frequency
*last 90sec
-No time for the uterus to relax and allow blood to flow back to the placenta and fetas
Lacerations
-1st degree: vaginal mucousa, skin of perineum
-2nd degree: vagina, perineum, fascia muscle
-3rd degree: all perineum, external anal sphincter
-4th degree: all perineum, rectal sphincter, some rectal mucus membrane
Morphine
-Can be reversed by 0.4mg narcan via IVP
Epidural
-Can only be give during 2nd phase of labor
-Local: for perineum repair and pudendal block for vaginal/forceps delivery
-Regional:
*Epidural: outside the dura mater
*Intrathecal: into the subarachnoid space
*Spinal: subarchnoid space with loss of motor and sensory function
-General: usually used for life threatening emergencies
Anesthesia
-REGION
-R: respiratory paralysis
-E: elimination
-G: gastrointestinal
-I: inform of procedure
-O: observe for hypotension
-N: no trauma (prevent trauma to extremeties
Mechanics of Labor
-4Ps
-Power of uterine contraction
-Passenger: size, lie, presentation, attitude, postion, station
-Passage: pelvic inlet, midcavity and outlet
-Pstchy of mother
Active Phase
-4-7cm dilated
-Contractions every 3-5min
-Lasting 30-60"
-MAD
-M: medication (can only be given in this phase
-A: assess and anticipate needs
-D: dry lips (ointment) and dry linens
Transition Phase
-8-10cm dilated
-Contractions every 2-3min
-Lasting 45-90"
-TIRED
-T: Tires (needs support)
-I: Inform of progress
-R: Restless
-E: Encourage and praise
-D: Discomfort (no pain meds)
Dysfunctional Labor
-Problems with: power, passage, passenger, psyche
-Problems of: presentation, position, effacement, dilatoin, and descent
PROM
-Prolonged premature rupture of membranes
-Hypovolemic shock???
-Nitrazine or fern test on fluid (will be blue if amniotic fluid is present)
Prolapse Cord
Compression of cord can happen after water breaks
Uterine Rupture
Hypertonic dysfunction
Amniotic fluid embolism
-in baby's circulatory system
Early Decelerations
-Fetal head compression
-Intracranial pressure
-Cause vagus nerve to slow HR
-HR > 100 BPM
-Return to baseline at end of contraction
-Mirror images of contractions
-Are not associated with fetal compromise and require no added interventions
Late Decelerations
-Decrease in oxygen
-Less water exchange
-Indicates danger d/t uterus/placenta insufficiency
-Variable HR due to stimuli are ok
-Late decelerations are not good
-Begin well after the contraction begins (right shift)
-Return to baseline after contraction ends
-Reflect impaired placenta exchange
-Placenta blood flow and fetal oxygen supply needs to be addressed
Variable Decelerations
-Shape like a v or flat u
-can occur at any time and may be non-repetitive
-Cause: cord compression
-Nursing care: change position of the mother
-Mother may need oxygen to help the fetus
Nursing Intervention for Late Deceleration
-COIL
-C: change position (left lateral position)
-O: oxygen (admin oxygen to morther to correct fetal insufficiency, if oxytocin is infusin stop infusion)
-I: IV fluids (will increase the maternal blood pressure and the uteroplacenta circulation)
-L: lower head of bed (to encrease perfusion to uterus)
Side Effects of Pitocin
-PITOCIN
-P: pressure elevated
-I: intake and output (watch)
-T: Tetanic contractions
-O: Oxygen decrease in fetus
-C: Cardiac arrhythmia
-I: Irregular fetal HR
-N: N&V
-Stop the pitocin drip
H&H
-RBC mass and Plasma volume increases during pregnancy
-The resulting dilution of RBCs (d/t greater and earlier increase in plasma volume) causes a decline in maternal hematocrit
-Hmg: >10.5
-Hct: >33%
Nausea and Vomiting Causes
-Generally beginning about 6wks after last period
-Believed to be caused by the increased levels of hormones hCG, estrogen..., decreased gastric motility and relative hypoglycemia
Rhogam
-Admin to women who are Rh- at 28 wks gestation and 72 hours after delivery
Chorionic Villus Sampling
-Removal of a small sample of chorionic tissue
-Dx for genetic disorders
-9-ll wks optimal time
-Indications:
*family history of genetic abnormalities
*Advanced maternal age
*mother is carrier for x-linked disease
*parents known carriers of autosomal recessive disorders
*History >3 successive SAB
Precipitate Labor
Labor that lasts <24 hours???
Macrosomia
Unusually large fetal size, infant birth > 4000g
Shoulder Dystocia
-Delayed or difficult birth of the fetal shoulders after the head is born
Ritodrine
-Beta-adrenergic drug
-Yutopar
-S/S: tachycardia (M and F), decreased BP
-May be given: IV, SC, oral
Nitrazine Paper
-Paper to determine pH
-Helps to determine whether the amniotic sac has ruptured
Fern Test
-Microscopic appearance of amniotic fluid that resembles fern leaves when the fluid is allowed to dry on slide
Fetal Heart Rate
110-160 BPM
Fetal head engagement
-Descent of the widest diameter of the fetal presenting part to at least zero station
Fundal Height
-22wks roughly when fundus reaches the umbilicus

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