OB REVIEW
OB TERMS
Gravidity- Number of times woman has been pregnant
Parity- number of deliveries after 20 weeks gestation regardless
of outcome. Not the # of fetus (twins).
GTPAL
Gravida-# of pregnancies
T-Term deliveries; 37 weeks +
P-preterm deliveries; between 20 and 37 weeks
A-abortion; delivery before 20 weeks
L-living children
OB terms
Antepartum- conception till delivery
Visit OB physician once monthly until 28 weeks gestation; then
every 2 weeks till 36 week gestation, then weekly till delivery
Assess in office: BP, weight, FHT, urine for protein, other.
Focused assessment on pregnancy complications.
Intrapartum
Postpartum
Nagele’s rule
Due date determined by LMP date- three months + 7 days.
LMP- 7/1/2011- what is EDC (estimated date of confinement)?
LMP- 3/1/2011- what is EDC
LMP- 11/14/2011?
LMP- 12/3/2011?
Common discomforts of pregnancy
Urinary frequency or incontinence
Fatigue
Backache
Nausea/vomiting
Leg cramps
Heartburn/indigestion
Braxton hicks contractions
Constipation/hemorrhoids
FETAL ASSESSMENT TESTS
Ultrasound- non-invasive, abdominal vs. transvaginal
Biophysical profile-NST and ultrasound (breathing, movement,
fetal tone, HR, amniotic fluid volume?)
Amniocentesis-14 weeks till delivery-genetic disorders, lung
maturation. Risks-hemorrhage, infection, labor, ROM,
miscarriage.
Chorionic Villus Sampling-less than 10 weeks gestation-genetic
disorders.
Alpha-Fetoprotein-16-18 weeks gestation( high values-neural
tube defects; low values-Down’s syndrome.
Pregnancy disorders
Abortion-spontaneous vs elective
50% of time no known cause
Vaginal bleeding, cramping.
Nursing diagnoses: Anticipatory grieving related to risk of loss
of pregnancy
Acute pain related to uterine cramping
Fear related to potential for losing pregnancy.
Cardiac disease
Congenital heart disease
Acquired
Ischemic
Pregnancy is the great “un-masker” of hidden issues
Circulatory volume increased by 40-50%
Nursing diagnoses: activity intolerance r/t decreased CO
Risk for fetal injury t/t effect of cardiac disease on pregnancy
Abruptio placenta
Premature separation of a normally implanted placenta later 20
weeks gestation- may be complete or partial.
Patient presents with bleeding and abdominal rigidity (boardlike)
Assess vital signs, FHT.
Monitor Pt, PTT, platelets- mom is bleeding!
If clotting factors consumed could lead to DIC.
Placenta previa
Attachment of the placenta in the lower uterine segment near or
covering the internal cervical os. May be complete, partial, or a
low-lying placenta (not covering the os).
Painless vaginal bleeding.
No vaginal exams!!
Nursing diagnosis: anxiety r/t unknown outcome for patient and
infant
Risk for infection r/t blood loss and open vessels near cervix
Gestational Diabetes
Insulin resistance increases in pregnancy. Increased insulin
needs in 2nd and 3rd trimesters.
Risks for fetus-macrosomia, hypoglycemia, respiratory distress
syndrome.
Monitor FBS during labor
Possible diabetic teaching in antepartum period
Hyperemesis of pregnancy
Nausea and vomiting severe enough to lead to dehydration,
electrolyte imbalance and significant weight loss.
monitor intake
Monitor weight
Dietary consult
Provide nausea meds appropriately.
Infections
T-toxoplasmosis-hydro or microcephaly
O-Other-Syhphillis, varicella, mumps, HIV
R-Rubella-hearing loss, IUGR, cardiac defects
C- cytomegalovirus-mental retardation, blind, deaf, seizures
H- Herpes simplex-vesicles or encephalitis.
Hypertensive pregnancy disorders
Chronic HTN-before 20 weeks gestation and after 12 weeks
postpartum
Pre-eclampsia- increased BP after 20 weeks gestation with
proteinuria
Eclampsia- pre-eclampsia complicated by seziure or coma
HELLP syndrome- liver dysfunction from worsening preeclampsia
Delivery is the only cure!!!
Labor and Delivery
True labor vs. false labor
Regular, rhythmic contractions in a pattern resulting in cervical
change.
Phases of labor:
Stage 1- start of true labor to full dilation
Stage 2- full dilation to birth of infant
Stage 3- delivery of placenta
Stage 4- delivery of placenta to 4 hours postpartum
Which is the longest stage?
Labor and delivery procedures:
Induction of labor- pitocin
Cervical ripeningForceps delivery
Vacuum extraction
External version
Nursing care during labor
Evaluate labor pattern- effective?
Evaluate pain managementAssess fetus- FHR, engagement, presentation
NPO status for mom- why?
Labor and Delivery complications
Cord prolapse
Precipitous labor
Amniotic fluid embolism
Post-term labor
Labor complications
Pre-term labor-definition, risks, management, tests
Dystocia-difficult, prolonged, risks
DIC-s/s, labs, impact on fetus
Ceserean section- elective vs. urgent- client preparation
VBAC- one on one management, risks
Postpartum care
B-Breasts
U-Uterus
B-Bowels
B-Bladder
L-Lochia
E-episiotomy
H-Homan’s sign
E-Emotions
N-Nutrition
Postpartum complications
Infection
Postpartum hemorrhage
Thromboembolic disease
Postpartum depression
Postpartum psychosis
Pharmacology
Drugs used during labor
Demerol, Stadol, Nubain- implications for fetus?
Epidural- consents, time out
Pharmacology-OB
Pregnancy risk categories: ABCDX
Teratogens