MATERNAL LAST MIN NOTES:
PREGNANCY
 FUNDAL HEIGHTS
o midline and firm
o what should it be when baby is engaged?
 after birth?
 FETAL PRESENTATIONS
o ATTITUDE
 head posture
o PRESENTATION = PELVIC INLET
 part of baby that enters pelvic inlet first
 cephalic
 breech
 shoulder
 STATION
 where presenting part is located in pelvis
 zero = baby engaged
 negative = higher than ischial spine
 positive = lower
o “I’m positive that I’m getting this baby out”

 RISK OF DRUG USE DURING PREG:
 TESTS
o BPP
 “APGAR” for baby in utero
 normal = 8-10
 tests for: fetal movements, fetal breathing movements, muscle
tone, amniotic fluid index,
 non stress test
o NON-STRESS TEST
 REACTIVE IS NORMAL!
 2 accelerations in FHR within 20 mins
 indicates fetal well being
o CONTRACTION STRESS TEST
 oxytocin challenge test
 NEGATIVE = NORMAL
o 3 contractions in 10 mins
 PROCEDURES:
o AMINIOCENTESIS
 withdraws amniotic fluid
 after 14 weeks to test for genetic disorders
 only done with genetic concern
o CHORIONIC VILLUS SAMPLING
 tissue sample from fetus after 10-13 weeks
 only done with genetic concern  tests for genetic
disorders
o EPIDURAL
 watch for hypotension
 tx with fluids
o
 COMPLICATIONS
o PLACENTA PREVIA
 dark red blood
 abdominal pain & tenderness
 fetal distress
o PLACENTA ABRUPTO
 bright red blood
 painless
 normal FHR
o CORD PROLAPSE
 STRIPS: veal chop
 HELLP SYN
o complication of preeclampsia to BABY
o hemolysis of RBC
o Elevated Liver enzymes
o Low Platelet count
 LEOPOLD’S MANUVER
o way to determine position of fetus from outside uterus
 MEDS TO STOP OR START LABOR
o START
 OXYTOCIN
 SE – N/V, fetal bradycardia
o STOP (tocolytics)
 Mag sulfate (also used for seizure precautions)
 tox s/s
o resp depression
o dec deep tendon reflexes
o neuro changes
o antidote – calcium gluconate
 flushing and sweating is normal
 terbutaline (also used for asthma)
 relaxes uterine muscle
 SE = tachy, tremors
 Nifedipine (also a CCB)
 blocks calcium to uterus (causes relaxation)
 flushing, orthohypotension
 TERA-TOWAS  tetraogenic – drugs that can cause birth defects from
developing fetus
o Thalidomide
o Epi meds
o Retinoid (Vit A)
o Ace inhibitors & ARBs
o Third element (lithium)
o Oral contraceptives
o Warfarin
o Alcohol
o Sulfonamides
BIRTH/PP:
 STAGES
o 1st
 latent – 1-4 cm
 active 4-7
 transitional – 7-start of labor
 contractions should not be sooner than 2-3 mins apart
or longer than 60 secs long
o 2nd “push phase”
 fully dilated – baby delivered
rd
o 3 “Delivery complete”
 baby – placenta
 shouldn’t take longer than 30 mins
th
o 4
 1st 4 hours after placenta is delivered
 fundus should be midline and firm
 MEMBRANE RUPTURE
o RISKS – infection and prolapsed cord
 COMPLICATIONS
o SHOULDER DYSTOCIA
o NUCHAL CORD
 MEDS FOR HEMORRHAGE
o Misoprostol – PO, vag, rectal
 cervical ripening and hemorrhage prevention
 increases uterine contraction & softens cervix
 SE = N/V/D, headache, dizzy
o oxytocin – IV
 se = N/V, fetal bradycardia
 BLEEDING
o lochia rubra (red)
 1- 3 days
o lochia serosa (pink, brown)
 4-10 days
o lochia alba (yellow, white)
 up to 6 weeks ;p
NEWBORN:
 NEWBORN REFLEXES:
 PREMATURE INFANTS:
 MECONIUM ASPIRATION RISK/SYMPTOMS
 SURFACTANT
 APGAR
 SGA
OTHER:
 CONTRACEPTIVES:
o ORAL
 estrogen & progesterone used together
 risk for blood clots
 se – N/V, breast tenderness, spotting, HTN
 MOLAR
o benign growth of trophoblasts (what normally develop into placenta)
 2 types: complete or partial mole
o asymptomatic but can find with vaginal US
o have high HcG later on  N/V, bleeding, anemia, preeclampsia
o TX
 most will abort on their own
 suction curettage if not
 pelvic exams
 weekly Hcg tests
 must avoid pregnancy for a year
 ECTOPIC – pregnancy in fallopian tubes
o s/s
 stabbing pain on one side
o TX
 methotrexate
 cause preg to end
 sx