Maternity Exam 2

Begin with the first day of last missed period, subtract 3 months and add 7 days and add 1 year

Complete blood count (CBC)

Blood typing

rubella titer

hepatitis B

HIV testing

STI screening

cervical smears

1-13 weeks

12-27/28 weeks

28 weeks 38-42

by the bellybutton

diabetes

folic acid deficiency

hepatitis B

HIV/AIDS

Obesity

STIs

smoking

alcohol

Try pelvic floor exercises to increase control over leakage

empty bladder when you first feel full sensation

avoid caffeinated drinks

reduce fluid intake after dinner to reduce nighttime urination

avoid an empty stomach at all times

eat dry crackers/toast before arising

avoid brushing teeth right after eating to avoid gag reflex

drink fluids between meals rather than with them

avoid greasy foods

Fetal movement counts (kick counts)

from week 28-38

encourage mom to lay on side

encourage mom to eat

images produced by sound waves to check for possible birth defects

noticed 16-20 weeks

to estimate gestational age, fetal weight, and growth

location of placenta and amniotic fluid volume

accompanying invasive procedures

Intiated at 15 weeks

measures blood flow changes in maternal and fetal circulation

assessment of placental function

if ratio is elevated may indicate baby not growing well

looks at sys/dias of heart

If mother has diabetes or baby is not growing well

A procedure to obtain amniotic fluid

Allows testing of amniotic fluid

This test can provide information about genetic disorders and fetal maturity

Hemorrhage

Amniotic fluid embolism

Loss of pregnancy

Rh isoimmunization

Can hurt the fetus

Infection

Cause bleeding

Rupture placenta

Cramping

Large needled going into amniotic cavity

Catheter is used to withdraw a sample of placental tissue to test for chromosomal abnormalities. Test done after 10-13 weeks.

Increased risk of injury to fetus

Inability to detect neural tube defects

Risk of failure to obtain placental tissue

risk of contamination of specimen

risk of leakage of amniotic fluid

risk of intrauterine infection

risk of Rh isoimmunization

Checks the baby's risk of birth defects and genetic disorders, such as high levels for neural tube defects or low levels for Down syndrome. It is done at 15 to 22 weeks gestation.

used to assess fetal status using an electronic fetal monitor

If baby moves and heart rate increases-healthy baby

If baby heart rate goes down- unhealthy

Provides reassurance of fetal well being(movement 10 x an hour)

FHR acceleration of 15 bpm for 15 seconds in response to fetal movement after 32 weeks

for less than 32 weeks 10 bpm for 10 seconds is acceptable

Measurement of baby form crown of the head to the buttock shows if the pregnancy is dated correctly

An intravaginal ultrasound that measures fluid collection in the subcutaneous space between the skin and the cervical spine of the fetus

-Trisomy 21 -looks to see if there is to much fluid -if there is to much fluid further genetic testing is needed

BHCGPAPP-A this is complete the screening for chromosomal abnormalties

Age 35 and older family history of genetic defects blood test or ultra sound hinting at defects

110-160

can be done out patient can be done if the mother is past her due date can be done if there is a medical problem

reactive/nonreactive

lay on left side give sweets wait 30 min give the baby time baby may be sleep they are tiny humans

Given contraction to see how the baby would tolerate labor- would not be done during preterm stage or mother getting a C-section

Enables identification of fetal risk for asphyxia

Fetal monitor is used

Fetal heart rate response to contractions is noted

Healthy fetus usually tolerates contractions

Placenta is not working well because baby is not reacting well to contractions(heart rate decelerates)

- Fetal breathing - Fetal movements body and limbs -Fetal Tone( extension, flextion) - amniotic fluid volume - reactive fetal HR with Reactive NST

MOM NEEDS ROHGAM

28 wees pregnant

MUST GET RHOGAM WITHIN 72 HOURS

its done under ultrasound guidance may expirence cramping pressure after

Can cause fetal Heart deceleration

Usually for specific circumstances

-to do a blood transfusion

-take blood out

It goes through umbilical cord

Placenta previa

-Hemorrhage -C- Section/ baby will not be able to pass through the cervix

Up to 28 weeks: every 4 weeks

29-36 weeks: every 2 weeks

37 weeks to birth: every weeks

weight and blood pressure (vital signs)

urine testing for protein, glucose, ketones and nitrites

Fundal height measurement to asses fetal growth

Edema

Blood tests

assessment for quickening (fetal movement)

assessment of fetal heart rate- 110-160

dropping of baby

below belly button

like 2 cm above the belly button

spotting/ bleeding (miscarriage)

painful urination (infection)

severe vomiting (hyperemesis gravidarum)

fever higher than 100 (infection)

lower abdominal pain with dizziness and shoulder pain (indicative of ruptured or ectopic pregnancy)

regular uterine contractions (preterm labor)

pain in calf, increased foot flexion (DVT)

sudden gush or leakage of fluid from vagina(pre labor rupture of membranes)

absence of fetal movement for more than 12 hours (possible fetal distress or demise)

-sudden weight gain; periorbital or facial edema, severe upper abdominal pain; headache with visual changes (indicative of gestational hypertension and/or preeclampsia

-decrease in fetal daily movement for more than 24 hours (possible demise)

Attempt to get a full nights sleep without interruptions

Eat a healthy balanced diet

Schedule a nap in the early afternoon daily

when feeling tired, pause, and rest

Avoid standing or sitting in one position for long periods

Apply heating pad (low setting) to the small back

Support lower back with pillows when sitting

Use proper body mechanics for lighting anything

Avoid excessive bending, lifting, walking without rest periods

Wear supportive low heeled shoes: avoid heels

Stand with shoulders back to maintain posture

Elevate legs above heart level throughout day

If you catch cramp, straighten both legs and flex feet toward body

Ask health care provider about taking calcium supplements

Stocking to promote better circulation (compression socks)

Try to establish regular time for bowel movement

Avoid constipation and straining during defecation

Prevent straining by drinking plenty of fluids and eating fiber rich foods and exercise daily

Use warm site baths and cool witch hazel compresses

Increase intake foods high in fiber and drink at least 8 glasses of fluid

Ingest prunes or prune juice (natural laxative )

Consume warm liquids

Exercise each day to promote movement

Reduce amount of cheese consumed

Avoid spicy or greasy foods

Sleep on several pillows so that head is elevated 30 degrees

Avoid laying down 3 hours after meals

take antacids sparingly

-Uterine stretch -Oxytocin increases -Increased prostaglandins -Progesterone withdrawal

occpital bone (O) Chin (M)Buttocks (S)Scapula ( A)

- Cervical changes- Lightening- Increased energy level ( Nesting )- "Bloody show"- Braxton Hicks contractions- Spontaneous rupture of membranes( water breaks )

Patient will have a cervical change !! Contactions increase in duration , intensity , and frequency Pain that starts in your back-and radiates to belly bloody show spontaneous rupture

irregular contractions, discomfort is abdominal, contractions decrease with either rest or activity, NO CERVIX CHANGE !

Passage way ( birth canal ) Passenger ( Fetus ) , powers (contractions) , position( maternal ) , and psychological response

Make sure the mothers Pelvis can accommodate for the Fetus

*Gynecoid( preferable )-Android( male shaped not favorable ) *Anthropod (usually adaquate)-Platypelloid ( Not favaroble )

Cervix pelvic floor muscles vagina

Fetal skullFetal attitudeFetal lieFetal presentationFetal positionFetal stationFetal engagement

Brow & Face makes birthing process very difficult

thinning of the cervixcervix pulls back 0/ 50/100

Baby location baby presentation in the pelvis

contractions - frequency , duration , intensity

Increased heart rate , Increased cardiac out put , increased blood pressure ( during contractions )Decreased GI NPO Decreased glucose NPO

Decrease in fetal oxygen Fetal heart rate accelerations and decelerations

Stages 1-4 stage 1 ( contractions get to 10 cm ) stage 2 ( delivery of baby goal push out baby ) stage 3 placenta delivery stage 4 ( postpartum recovery do not make pt bleed )

Stage 1 is considered true labor and consists of 3 phases Latnet 0-6cmactive 6-8cmTransition phase 8-10cm SHORTEST STAGE MONITOR FETAL HR

0-6 cm moms relaxed contractions every 5-10 min Lonest stage of labor

6-8 cm dilated contractions every 2-5 min

8-10 cm mom is ready to push

10 cm moms fully effaced Birth of the baby encourage mom to bear down when pushing

birth of placenta within 30 min Never pull umblicusduring this phase there is an increased risk of infection if placenta isn't fully removed PITOCIN ( Prevents hemmorage )

Decreased blood pressure Increased Heart Rate

1-4 hours after delivery assess : mom assess : Temerature not over 100.4 assess Hemmorage

uterus rises upward umblicus lenghtens sudden trickle of blood uterus changes to globular PLACENTA SEPERATION HAPPENS IN THE 3rd TRIMESTER

Should be

firm midlineleveled with umblicus check the fundus and massage it until it is firm if it is soft ( boggy )

3 x eveyr 5 min

displaced above umblicus one sided = bladder distention

Methylergonovine is a medication that treats excessive bleeding after childbirth cannot be given if mom has preeclamisia or HTN

"Every Day Fine Infants Enter Ready (Eager) and Excited"Engagement, descent, flexion, internal rotation, extension, restitution (external rotation), expulsion

Vertex- normal

Breech- butt legs up

Shoulder

LOP- Left Occiput posterior (back to back)

LOT- Left Occiput transverse

LOA- Left Occiput Anterior (facing front)

ROP- Right Occiput posterior

ROT- Right Occiput transverse

ROA- Right Occiput Anterior

recumbent position

left lateral sims

squatting

semi fowlers

sitting

hand and knees

understanding and preparing for childbirth

support from others

present emotional status

beliefs and values

-increased cardiac output

-increased heart rate

-increased blood pressure during uterine contractions

-increased WBC

-increased respiratory rate

-increase in temperature

-decreased GI motility and absorption

-decreased blood glucose level

Schultze presentation- shiny and smooth

(s for shiny)

Duncan presentation- rough and irregular

(D for dirty)

Can cause excessive bleeding

High estrogens in amniotic fluid cause crystallization of the salts ; crystals appear as a blade of fern

external fetal monitoring records the frequency and duration of the contractions placed on fundus

Fetal Heart tones bottom

* cant pick up mothers contractions * obese patients * Oliohydramus * baby Heart rate decreases CERVIX MUST BE OPEN 2 CM water needs to be broken