-WEEK 1 Chapters: 1, 3, 4 Female anatomy: internal vs external, introitus (vaginal opening) Concerns of women’s health: Cardiovascular health PAP screening tests start at 21, every 3 years in your 20s Gardasil 9: ages 9 – 12/ HPV Vaccine Mammograms start at 40 yrs old What are all STIs treated with Breast health, structures, normal findings Menstrual cycle/ problems PCOS Endometriosis- laparoscopy is used to diagnose it 1 Week after the menstrual period, do a breast exam Pg. 37 Menses: blood and other matter discharged from the uterus at menstruation Motrin is used for menstrual cramps Sex (Semen) can cause preterm labor Menopause is when a woman has not had a period in 1 calendar year Menarche: The first menstrual cycle Sexual response in 4 phases: Excitement Plateau Orgasmic Resolution 25 and under are the most likely to have STIs Cycle of violence: Phase 1- Tension building Phase 2- Abusive incident Phase 3- The honeymoon period Fecal occult test is done, electrocardiogram after 50 yrs old Everyone should get an annual HIV test Under 25 should be offered an STD screening Amenorrhea: absence of a menstrual period Primary: Due to anatomic issues Secondary: Often caused by pregnancy, a sign of disorders Hypogonadotropic amenorrhea: Can be caused by hormone suppression Management is stress management, exercise, weight loss, Increase in Calcium & vitamin D Dysmenorrhea: Pain during/before menstruation, NSAIDS #1 way to treat Primary: Release of prostaglandins, Treated with NSAIDs, heat, exercise Secondary: Acquired menstrual pain, Treated with the removal of underlying pathology, Diagnosis by pelvic exam, ultrasound, dilation and curettage, endometrial biopsy, laparoscopy Premenstrual syndrome (PMS): Occurs in the luteal phase of the menstrual cycle S/S: Cluster of physical, psychologic, and behavioral symptoms 30% - 80% experience symptoms Treatment: Diet, exercise, herbal therapies, yoga, massage Premenstrual Dysphoric Disorder (PMDD): Symptoms in the last 7 – 10 days of the menstrual cycle Severe variant of PMS, Emphasis on mood change Affects 3% - 8% of women Treatment similar to PMS: Plus, counseling, medications, hypnosis, acupuncture - - - Endometriosis: Growth of endometrial tissue outside of the uterus S/S: Dysmenorrhea, Painful intercourse (Dyspareunia) Treatment: Total Hysterectomy, Lupron depot (Med), Birth control Diagnosed through a laparoscopy, Oligomenorrhea or hypomenorrhea: Bleeding only 1 day, bleeding very little Menorrhagia (Hypermenorrhea): Excessive bleeding, Metrorrhagia: Bleeding in between menstrual cycles Abnormal uterine bleeding: Dysfunctional uterine bleeding Dysfunctional uterine bleeding: Treatments are birth controls STI prevention: Primary: Condoms, STI screening Secondary: Treatment HPV causes cervical cancer Bacterial infections: - - - - - Chlamydia: Most common STI Drugs are Azithromycin 1g/1 time, Doxycycline 100mg/2x day for 10 days Gonorrhea: PAP test Urine sample Drugs are Ceftriaxone 125 – 250 IM S/S green mucus discharge Syphilis: Transmitted through tissue abrasions Stages are- Primary: 5-90 days, Secondary: 6 weeks – 6 months Meds: Penicillin/Pen G. Pelvic Inflammatory Disease (PID): Spread of INFECTION from the vagina to endocervix to upper genital tract Cultures are done At risk for an ectopic pregnancy Symptoms: Salpingitis (uterine tube inflammation) Endometriosis (Growth of endometrial tissue outside of the uterus) At risk for: Ectopic pregnancy Infertility Chronic pelvic pain Management: Prevention Oral/parenteral therapy Bed rest Education Pg. 76/77 Viral Infections: - HPV (Genital warts): More common in pregnant women - - - - - S/S- Irritating vaginal discharge with itching, Dyspareunia Postcoital bleeding PAP screening Skin-to-skin transmission Medications given for discomfort- Tricyclic acid, screening starts at 21 and every 3 years if negative HSV: (HSV-1 is nonsexual) (HSV-2 is sexual) Condoms don’t help prevent S/S: Burning Itching Pain Inguinal tenderness Fever Chills Malaise Severe dysuria Treated with: Antiviral Acyclovir Lidocaine jelly for pain Increased risk for miscarriage/cervical cancer, Hepatitis A virus (HAV): Acquired through: Fecal-oral route Eating contaminated food Person-to-person contact Vaccination is the #1 way of preventing HAV transmission Hepatitis B virus: Most threatening to the fetus and neonate Vaccine is given 0/2/6 months old Transmitted: Parenterally Perinatally Orally (Rarely) Intimate contact Hepatitis C virus: Most common bloodborne infection in the United States IV drug users at higher risk, NO vaccine available HIV: Primarily from the exchange of body fluids S/S Sever depression of cellular immune system, Symptoms- Fever, headache, night sweats, malaise, lymphadenopathy, myalgias, nausea, diarrhea, weight loss, sore throat, rash Screening- - Antibody testing, Transmission MAY occur to infants Zika virus: Spread through: Mosquito bites Semen Infection increases the risk for microcephaly in infants Prevention Avoid travel to areas with known cases Men should use condoms Vaginal Infections: - - - - - - Vaginitis: General inflammation of the vagina Associated with preterm labor and birth Can be caused by tight clothes/anything that doesn’t allow normal airflow S/S Abnormal fishy vaginal discharge Itching Burning Lower pelvic cramping Treatment Antibiotics (metronidazole) advise the patient to void alcohol Candidiasis (yeast infection): #2 most common type of vaginal infection Predisposition Antibiotic therapy, diabetes, pregnancy, obesity, a diet high in refined sugars, use of corticosteroids, the patient is immunosuppressed Interventions Culture is done, weight loss, diet modification, proper airflow S/S Curdy white discharge, redness Treatment OTC antifungals, prescription fluconazole, ice pack, loose clothing Trichomoniasis: Also, an STI Common cause of vaginal infection Screening/Diagnosis Specular exam or PAP smear Treatment metronidazole 2g/ 1 dose, avoid alcohol Group B streptococci: Poor pregnancy outcomes Screening at 35 – 37 weeks gestation Fibrocystic changes: Caffeine can cause it Can be tender, dense Fibroadenoma: Solid mass Ultrasound, a mammogram is used - Nipple discharge: Test for cytology (cellular changes) to check for any cancer or infection Mammary duct ectasia: Benign, occur in mammary duct Intraductal papilloma: CAN become Malignant Cancer of the breast: 1/8 women Risk increases with age Screening Annual mammogram screening starting at 40 Needle aspiration Treatment: Chemotherapy before surgery Radiation Adjuvant hormonal therapy Surgical interventions o Lumpectomy: Taking a portion of cancer out o Total simple mastectomy: the removal of the entire breast, including the nipple, areola, fascia (covering) of the pectoralis major muscle (main chest muscle), and skin o Modified radical mastectomy: removal of some underarm lymph nodes o Radical mastectomy: removal of all the underarm lymph nodes plus the entire chest muscle, Breast reconstruction Most women will have a Total radical mastectomy Care management: risk for lymph edema, take BP on the opposite side of surgery -Week 2- - Menstrual cycle (3) Phases: Hypothalamic- Pituitary Cycle Ovarian cycle- Involves estrogen, progesterone, testosterone Endometrial cycleMental shirtz- pain Pg. 37 illustration Normal cycle length 21 – 35 days 3 things needed for conception: sperms, eggs, pathway - Sperm- lasts 48 – 72 hours - Egg- lasts 24 hours - Barrier method is 85% efficient - Patient with excessive mood changes, breast tenderness, nausea, crying, need to take the progestin-only pill without estrogen - Estrogen can increase blood pressure causing blood clots - Blood clots, stroke, breast cancer, and smoking are a contraindication by hormonal methods - Sperm gets fertilized in the 3rd portion of the tubes - Contraception: Hormonal- Progesterone-only pill Nonhormonal- Barrier method Progesterone thins lining IUDs are 99.7% effective Assessment of female infertility: Ovarian factors Is the woman ovulating? Tubal and peritoneal factors Is there anything wrong with her tubes? Uterine factors Deformities Septum Fibroids Vaginal-cervical factors Increase of Ph, preventing sperm living Septum Infections Other factors Test or Examination: Evaluation of the anatomy Detection of ovulation Hormone analysis Ultrasonography Endometrial biopsy Hysterosalpingography Laparoscopy Assessment of male infertility Hormonal factors Is there enough sperm Is the sperm motile Testicular factors Factors associated with sperm transport Idiopathic male infertility Semen analysis Check hormone levels Hormone analysis Scrotal ultrasound Medications to give women to hyper stimulate FSH hormone and inhibit ovulation Clomiphene Surgical therapies Hysterosalpingography Contrast is injected into the uterus X-ray test shows the internal shape of the uterus, and shows if Fallopian tubes are blocked Laparoscopy Poke a hole in the umbilicus and fill the abdomen with C02 to look for structural damage Look for endometriosis Coitus interrupts (pulling out) Fertility Awareness Methods (FAMs) Calendar rhythm method to keep track of cycles Basal body temperature method Must be taken before getting out of bed Predictor test kits for ovulation (OTC) Abstinence Barrier methods Spermicides A chemical that kills sperm Condoms, Male (STI protection) Vaginal sheath (STI protection) Diaphragm Must be fitted Can only leave them in 24 hours Cervical cap, lasts 1 YEAR Contraceptive sponge Hormonal methods- 99.7% efficacy Combined estrogen-progestin contraception Progestin IS the contraception Progestin-only pill for women who have: High BP Smoker over 35 History of blood clot or stroke Estrogen CONTRAINDICATIONS: High BP Smoker over 35 History of blood clot or stroke Transdermal contraception Put around underwear lining Change the patch once a week for 3 weeks, 1 week off Progestin-only contraceptives Oral progestins (Mini pill) Injectable progestins Implantable progestins (Nexplanon) Emergency Contraception Plan B Can be taken 72 hours after intercourse IUD ‘T’ shaped device wrapped in copper Inserted in the uterine cavity Good for 10 years Mirena good for 3/5/7 years Does not stop menstruation The copper used for getting rid of sperm Sterilization Female Tubal occlusion Tubal reconstruction Male - - - - Vasectomy o Tubal tying Tubal reconstruction (Anastomosis) Abortion Termination of pregnancy before 20 weeks gestation Can be: Elective Therapeutic st 1 -trimester abortion Surgical aspiration abortion Medical abortion o Methotrexate & Misoprostol o Mifepristone & Misoprostol nd 2 -trimester abortion Dilation and evacuation Cervix prepared with prostaglandins Induced abortion in the 1st trimester is the safest and least complex Common complications: Infection Retained products of conception Excessive vaginal bleeding The preconception period is an ideal time to review family history and provide personalized recommendations based on: Family history A monosomy is the product of the union between a normal gamete and a gamete that is missing a chromosome The product of the union of a normal gamete with a gamete containing an extra chromosome is a trisomy Oogenesis, the process of egg (ovum) formation The amniotic cavity initially derives its fluid by diffusion from the maternal blood Amniotic fluid serves many functions: It helps maintain a constant body temperature. It serves as a source of oral fluid and as a repository for waste Assists in the maintenance of fluid and electrolyte homeostasis. Cushions the fetus from trauma by blunting and dispersing outside forces. Allows freedom of movement for musculoskeletal development. A barrier to infection and allows fetal lung development Keeps the embryo from tangling with the membranes Facilitates symmetric growth If the embryo does become tangled with the membranes, amputations of extremities or other deformities can occur from constricting amniotic bands The yolk sac is formed during the formation of the amniotic cavity The yolk sac aids in transferring maternal nutrients and oxygen Which diffuse through the chorion, to the embryo Hematopoiesis (The formation of blood) o Occurs in the yolk sac beginning in the third week. During the 4th week the shape of the embryo changes from straight to a ‘C’ shape A part of the yolk sac is incorporated into the body from head to tail as the primitive gut (digestive system) - - - Umbilical cord is compressed during the 5th week by the amnion & forms a narrower umbilical cord 2 arteries carry blood from the embryo to the chorionic villi & 1 vein returns blood to the embryo Placenta begins to form at implantation Carbohydrates, proteins, calcium, and iron are stored in the placenta to meet fetal needs. Water, inorganic salts, carbohydrates, proteins, fats, and vitamins pass from the maternal blood supply across the placental membrane into the fetal blood, supplying nutrition The two most reported maternal medical risk factors are HTN associated with pregnancy & diabetes Both of which are associated with obesity -Week 3- Five Ps: o Position: Both baby and mom o Power: Uterine contractions o Passenger: Baby o Pathway: Female Pelvis o Psyche.: Mom Pg. 166 & 167 Know the signs stated on pages Urinary frequency can indicate pregnancy Increased estrogen can cause increased discharge Ballotable: o The cervix floats up and down Quickening: o The first time the baby moves o 16 – 20 weeks gestation Lightening: o When the baby drops into the pelvis (Baby Drop) Round ligament pain: o Around 20 weeks Braxton hicks’ contractions: o Are felt during pregnancy and can be mistaken for true labor contractions. Unlike true labor o Braxton Hicks are irregular in frequency and less intense What makes a pregnant woman constipated: o Not enough water intake, should drink 1 gallon a day Figure 7.3 on page 153 Ovaries stop producing during pregnancy Women who have not had a pregnancy are at higher risk for ovarian cancer Women who have had babies are at lower risk for ovarian cancer Prolactin suppresses FSH Ravda Naegele’s Rule: o It assumes that the woman has a 28-day cycle and that fertilization occurred on the 14th day. o According to Naegele’s rule, after determining the first day of the LMP, Subtract 3 calendar months and add 7 days & 1 years Prenatal care: o Prenatal vitamins- Folic Acid LMP: Last menstrual period What not to take in pregnancy: o Blood thinners o Come off of any nonessential medications What to know for pregnancy: o First day of last menstrual period o Any medical problems o Blood type o STI screening o Any previous pregnancies o History o Genetic defects They should come in every 4 weeks until 24 weeks then every week after 36 weeks Heartbeat is at 7 weeks Blood work is done 15 – 20 weeks Syphilis is taken in the third trimester Collect weight every week Urine samples are looking for: o Glucose o Leukocytes o Protein o Ketones Ketones in urine can indicate not eating Hyperemesis: o S/S: Severe nausea Vomiting Weight loss Electrolyte disturbance 30 mins of activity a day No heavy weights after 20 weeks UTIs are more possible during pregnancy UTIs can cause preterm labor due to uterine irritation Go to the dentist during pregnancy during the 2nd trimester to make sure health is good You can travel after 36 weeks because traveling can induce labor No sex during preterm labor Educate patients on bleeding, cramping, headaches, epigastric pain, Prenatal period care: Teaching, 30 mins of exercise a day, Pregnancy trimesters: First: 1-13 weeks Second: 14-26 weeks Third: 27-40 weeks Nagele Rule: First day of last menstrual period, SUBTRACT 3 months, ADD 7 days PLUS 1 year Most Women give birth 7 days before and 7 days after the EDB Three phases of parental adaptation: Denial/worry about the pregnancy Adjusting to the pregnancy Figuring out roles Folic Acid before pregnancy Good nutrition is pushed during pregnancy Organogenesis: The first 12 weeks of pregnancy Lab Tests: Full STD screening Vaginal cervical cultures PAP screening Blood type CBC Urine Pg. 178 Fundal height: Measured from super pubic bone to the fundus Measured in cm Measured in supine position HR- 110-160 18-20 weeks an anatomy scan is ordered Group B streptococcus test between 35-37 weeks Kegel exercises to strengthen pelvic floor and helps in delivering Dental needs taken care of in the second trimester Rubella is taken AFTER pregnancy because it is a live virus At 28 weeks given ROGAM Uterus causes pelvic pressure Preterm labor symptoms: Cramping Low back pain Midwife vs Certified nurse Midwife Midwifes do not have certification Certified nurse midwife is certified and works with a physician Gravida: Woman who is pregnant Gravidity: Pregnancy Nulligravida: Woman who has never been pregnant Primigravida: Woman pregnant for first time Multigravida: Woman who has had two or more pregnancies past 20 weeks Parity: Number of pregnancies that have gone to 20 weeks Term: Preterm: 20 – 37 weeks Late preterm: 34 – 36 weeks 6 days Early term: 37 – 38 weeks 6 days Full Term: 39 – 40 weeks 6 days Post Term: 41 – 42 weeks Viability: Capacity to live outside the uterus 22 – 25 weeks gestation These premature infants are vulnerable to brain injury, neurological defects Obstetric History: - - Two Digits: (GP) Gravida: number of pregnancies Para: Number of pregnancies that went to at least 20 weeks Five Digits: (GTPAL) Gravida: Number of pregnancies Term: Number of pregnancies full term Preterm Deliveries: 20 – 37 weeks Abortions: Spontaneous or planned Living children Table 7.1 hCG is an early biomarker for pregnancy Pregnancy tests are based on hCG or b subunit of hCG Detected in serum of urine as early as 7 – 8 days after ovulation Signs of pregnancy: Presumptive: Changes felt by the woman (Subjective) Probable: Changes observed by the examiner (Objective) Positive: Signs only attributed to the presence of the fetus -3 Positive signs of pregnancy: (Confirmed by a Provider) See a baby (Ultrasound) Hear a baby (Doppler/Ultrasound) Feel a baby (Feel it with hands on abdomen) Ballottement: Inserting a finger in vagina and pushing up on the lower uterine segment to feel it float up and down Quickening: Mothers feeling of the babies first movement, felt 14 – 16 weeks Goodells Sign: Blue coloration Hegar’s Sign: Softening of the lower uterine segment Leukorrhea: Caused by increased blood flow, discharge is white or slightly gray with musty odor Between 36 – 40 weeks the uterus changes shape, into a more ‘O’ shape from a ‘0’ shape Enlarged heart in pregnancy is caused by increased blood supply Supine hypotension: Caused by compression of the vena cava Increased fluid volume: About 1500 more: 1000 is plasma 500 is RBC Coagulation factors is increased in pregnancy: -Sitting for a long time -Smoking can increase coagulation Respiratory System: -Snore more -Diaphragm is compressed Renal System: Dilation of the ureters Fluid balance shift Sodium retention Kidney damage evidenced by urinating protein, sugar Integumentary System: Striae Linea nigra, caused by hormonal change Angiomas, BENIGN tumors Musculoskeletal System: Loosened joints Hips will curve because of pregnancy NO bicycling, crunches Nerve compression LORDOSIS BACK BRACE is used McBurney’s Point: Movement of the appendix during pregnancy GI System: Appetite decreases early on Appetite increases in the 2nd trimester Increased heartburn resulting from decreased muscle tone PICA: Craving of things that are not food like: Ash Starch Stucco Baking soda 2nd Trimester is the best time for dental cleaning Before conception: Folate (From dietary sources): Chicken, turkey, goose, lamb, beef, veal, peas, beans, spinach, bread, egg, corn Folic Acid (0.4 mg or 400 mcg prior to pregnancy) (4 mg every day for the first 3 months) Foods high in Folate include: Leafy vegetables Dried peas Seeds Orange juice Neural Tube Defects result from poor folic acid intake Blood volume peaks around 28 – 34 weeks Recommended weight gain is supported through eating carbs, fats, and protein during pregnancy Underweight women are more likely to have preterm labor and have LBW infants 1st trimester weight gain is only: 2 – 4 Lbs 1st trimester Kcal intake is: 1800/day 2nd trimester Kcal intake is: 2200/day 3rd trimester Kcal intake is: 2400/day Ketonuria is associated with preterm labor Omega-3 fatty acids (DHA) are essential to fetal growth Eat seafood 8 – 12 ounces/ week Fluids are important to avoid preterm labor: 8 – 10 glasses (2.3 L) / DAY Iron: Is needed for the expansion of RBC for pregnancy Increased RBC depends on the iron available Women are anemic if the hemoglobin is less than 11g/dL Calcium is not increased during pregnancy because a normal healthy mom makes enough of it Calcium is given for leg cramps Magnesium is managed when its low by: Eating nuts Whole grains Leafy greens Dairy Sodium can be gotten from: Grain Milk Meat Sodium restriction for Renal or liver failure Hypertension Sodium intake should be: 1.5 g/day Potassium intake reduces the risk for Hypertension 8 – 10 servings for fruits and vegetables help with providing adequate potassium Zinc deficiency causes: Malformations of the CNS in infants Iron and Folic acid lower: Zinc levels Zinc and copper are given for women with: Anemia Fluoride is NOT used in intake Vitamins A, D, E, K: Vitamin E is the most likely vitamin lacking Vitamin E is used for oxidative stress Vitamin D helps absorb vitamin C Pyridoxine (Vitamin B6) is involved in Synthesizing RBCs Antibodies Neurotransmitters Vitamin B12 is involved in producing: Nucleic acids Protein RBC formation Vitamin C plays a role in: Tissue formation Enhanced absorption of IRON CONTRAINDICATIONS IN PREGNANCY: -Alcohol Causes birth defects -Caffeine Coffee Tea Soft drinks Chocolate Artificial sweeteners PICA Eating nonfood substances Exercise is recommended: (20 – 30 minutes) Lactation needs increase in Vit. C Zinc Protein Oral contraceptives interfere with Folic acid metabolism Test for hematocrit/hemoglobin levels to check for anemia -Week 4- 5 factors that affect labor: Five P’s: Position of mom: Both baby and mom Power: Uterine contractions and mom pushing Passenger: Baby Pathway: Female Pelvis Psychological response: Mom Pg. 322- fetal presentation Babies want to be preferably ROA or LOA positions Fontanels should be soft and nondistended Frank breach: Baby comes out butt first, legs up Complete breach: Babies’ legs are crossed Single footing breach: Babies leg comes out first Shoulder presentation: C-section birth Vertex presentation is the IDEAL baby position for delivery Primary powers: Contractions Secondary powers: Mom pushing Moms must be repositioned every 2 HOURS Pg.325 Female pelvis anatomy Pelvic inlet is the narrowest part of the pelvis Cervix thins and dilates during pregnancy Signs before labor: Lightening/Dropping Bloody show (burst capillaries) Stages of labor: 1st Stage- onset of contractions Latent phase: 0-4 cm Active phase: 4-7 cm Transitional phase: 7-10 cm Check heart tones every 30 mins Visceral pain 2nd Stage- Full dilation Mom is going to be pushing, and positioning Check heart tones every 5 mins Somatic pain 3rd- Birth of the fetus until delivery of the placenta Placenta takes 20 mins to detach Visceral pain 4th- 2 hours postdelivery of the placenta Vitals taken every 15 mins SEVEN cardinal movements: Engagement Decent Flexion Internal rotation Extension Restitution and external rotation Expulsion (BIRTH) Hormones during labor: Decreased progesterone Increased estrogen, prostaglandins, oxytocin Monitor glucose levels Visceral pain: From cervical changes, distention of lower uterine segment, and uterine ischemia, usually during labor Somatic pain: intense, sharp, burning, usually during delivery Pg, 336, visual of pain areas Non-Pharmacologic pain management: Breathing exercises, childbirth classes, shower, rocking back and forth, Pharmacologic pain management: Sedatives (Ambien), Analgesia, Anesthesia Drugs used: Ambien, Newfane, tarbagan, Morphine, Demerol, Opioids are not used when close to giving birth to avoid the drug being in the baby’s system at birth Systemic analgesia Opioid agonist analgesics Opioid agonist-antagonist analgesics Opioid antagonists Spinal block anesthesia goes into the actual spine for a C-section Epidural block anesthesia goes lower than a spinal block for a vaginal birth EVERYONE IS PREHYDRATED prior to getting an epidural injection with an isotonic solution 500-1000 mL (Lactated Ringers) Checking pulse oximeter General anesthesia is only used in emergencies Pg. 338- Non-Pharmacologic pain management TABLE Electronic fetal monitoring is used to see fetal heart rate Primarily used for intrapartum assessment in the US Frequent monitoring for HIGH-risk pt. Q5-15 mins Frequent monitoring for LOW-risk pt. Q30 mins Fetal O2 supply can be decreased by: Decreased maternal O2 in blood Hypertension Hypotension Blood loss Cord compression Reduction of blood flow through the placenta External monitoring: Tocotransducer Monitors CONTRACTIONS Ultrasound transducer Monitors FETAL HEART RATE Internal monitoring: (Invasive) Internal fetal heart rate monitor Attaches to the SCALP of fetus Montevideo units Measures contraction patterns, 80-120 Baseline fetal heart rate: The average between a 10-minute segment Normal Fetal Heart Rate is: 110-160 bpm Variability: Absent and minimal A sign of hypoxemia Moderate Normal Marked Unclear Sinusoidal pattern When it looks like an ‘S’ shape, is a sign of fetal infection Baseline Fetal Heart Rate: 110-160 bpm Tachycardia More than 160 bpm for 10 mins or longer Bradycardia Less than 110 bpm for 10 mins or longer Deceleration: Dips below the Base line Types: Early: Head compression, MIRRORS CONTRACTIONS Variable: Cord compression Late: O2 insufficiency Prolonged: O2 issues V.E.A.L. C.H.O.P. V- Variable Deceleration C- Cord Compression E- Early Deceleration H- Head Compression A- Acceleration O- OKAY!!! L- Late Deceleration P- Placental Insufficiency Prolonged Deceleration Prolapsed umbilical cord Acceleration: 15 beats high by 15 seconds long Dips above the Base line Shows that a baby is oxygenated and healthy Late Deceleration: A sign of a bad placenta or bad placenta supply DISCONTINUE oxytocin if in late deceleration Interventions: Reposition patient on their side: (LEFT SIDE) to increase blood supply to the placenta Increase IV Fluids: To increase the fluid volume Put a non-rebreather mask on mom (10L): To increase O2 concentration Variable Deceleration: A sign of cord compression ‘U’ ‘V’ or ‘W’ sign on strip Interventions: Repositioning Increase fluid volume Tocolytic therapy: Used to decrease contractions Used for preterm labor Fetal tachycardia is a sign of Maternal fever Pg. 360 THE 3 CATEGORIES Category 1: normal baseline No intervention: it’s normal Category 2: bradycardia; deceleration, minimal variability, variable deceleration Intervention: Lessen Pitocin, use the bathroom Category 3: absent variability, sinusodal Intervention: Lower Pitocin, lower contractions Placenta goes bad after “post 8”: (after the expected birth date) Pitocin: Causes contractions Methylergonovine Promotes uterine contractions Montevideo numbers: DEFINITE NUMBERS: 3 – 5 minutes lasting 45 – 60 seconds Latent phase can last 2 weeks Newbane, ambien, is given as a: Short acting narcotic in latent phase 1 cm per hour in ACTIVE PHASE No epidural BEFORE 4 cm NO narcotics after 4 cm Peudenal block: Is injected in the cervix, numbs the peudenal nerve Epidurals take about 20 mins to kick in Facial edema indicates: Kidney issue True labor is: Cervical change Lochia: Scant: Less than 2.5 cm Light: 2.5 – 10 cm Moderate: More than 10 cm Heavy: 1 pad saturated within 2 hours Saturated: Saturation in 15 mins or less Pre-eclampsia Treated with magnesium Antidote for magnesium is calcium gluconate Cullen’s sign: Blood in the peritoneum Oral contraception Contraindications Cholecystitis HTN Migraine headaches Visual changes BMI: BMI 18.5 or less--Underweight BMI 18.5 to 24.9-Normal weight BMI 25.0 to 29.9-Overweight BMI 30.0 to 34.5-Obese BMI 35.0 to 40--Very obese ASK ABOUT WEIGHT GAIN DURING PREGNANCY - How much weight gained in each trimester, DEPENDING ON BMI Normal weight gain: 11.5-15.9kg (25-35 lbs.) Underweight weight gain: 12.7-18.1kg (28-40 lbs.) Overweight weight gain: 6.8-11.3kg (15-25 lbs.) Normal/Abnormal contraction rates