Maternal Child + Labor and Delivery (Test 1)

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Test Wednesday 2/15/23

Health

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176 Terms

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LDR
Labor delivery recovery room

* normal birth and recovery take place in one room
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LDRP
Labor delivery recovery postpartum room (usually overnight)
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Free standing birth center
* Home like environment
* usually no emergency equipment if something goes wrong
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Birth culture: Hispanic
* keep warm (birth is a cold experience)
* hot and warm beverages
* children are desired
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Birth culture: Asian
* boys are prefered
* keep warm (birth is a cold experience)
* many lactose intolerant
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Birth culture: Middle eastern
* only parents can touch babies head
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Three sections of uterus
Fundus: upper rounder portion

Corpus: middle portion

Cervix: lower portion, projects into vagina
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Fundus and corpus are made of what 3 layers

1. Endometrium: inner lining/mucous membrane (what comes off during menstruation and helps fertilized egg implant)
2. myometrium: middle, thick and muscular layer (functional in pregnancy and labor)
3. perimetrium: outer layer that envelops the uterus
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Females are born with ___ amount of eggs
2 million

* only 400 mature
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What pelvis type is best for vaginal delivery
Gynecoid
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How many chromosomes in each cell
46, or 22 pairs

* 1 pair of gametes (sex cells determining sex of fetus)
* one in each pair is from mother, and the other is from the father
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XX chromosomes =
femaele
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XY chromosomes=
male

* only male sperm can contribute an X or Y, so he is responsible (genetically) for the sex of the baby
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Stages of fetus
Zygote: fertilization to second week

Embryo: 2-8 weeks of gestation (very sensitive to viruses, pesticides, ect \[teratogenic agents\].)

Fetus: 8 weeks of gestation until birth
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Ectoderm
Becomes fetal skin, nails, MM
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mesoderm
Becomes fetal skeleton, muscles, blood vessels, kidneys, gonads
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Endoderm
Becomes fetal bladder, GI tract lining, lining of trachea, pharynx and bronchi
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Amniotic fluid is __ % water and contains _
98%

* looks like urine
* contains protein, glucose, fetal hair, fetal urine and vernix caseosa (cheesy material covering skin of fetus)
* derived from maternal blood
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Normal amount of amniotic fluid present at full term
800-1000 mL
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hydramnios
too much amniotic fluid (more than 2,000mL/2L)

* can cause malformation of the fetal CNS and GI tract
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oligohdraminose
too little amniotic fluid (less than 300mL)

* associated with renal abnormalities
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How many arteries and veins does the umbilical cord have
2 arteries, 1 vein

* assess for these post cord cutting after birth
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How many sections does the placenta have
2

* maternal
* fetal

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Two systems are separate, but fetus dips into mothers supply to receive nutrients and can mix
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During contractions, placental blood flow does what?
Slows down
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Gravida
Pregnancy of any kind, regardless of duration
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nulligravida
women who has never been pregnant
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multigravida
women who has had more than one pregnancy
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Para
number of births after 20 wks

* regardless of if infants were born alive or dead
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When is the fetus viable
20 weeks

* may survive outside of uterus (need NICU however)
* lungs are not ready at this stage
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Nagels rule
Method for determining due date

* identify 1st day of LMP
* subtract 3 months
* add 7 days
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Fundal height
Method for determining due date/checking growth

* measured in cm
* between 18-32 wks, fundal height matches number of weeks
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When can fetal heartbeat be heard
* between 10-12 weeks
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Trimester time frames
1st: 0-14 weeks

2nd: 15-28 weeks

3rd: 29-delivery
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Abortion/miscarriage
Death of fetus before 20 weeks
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Preterm/premature birth
Death of fetus after 20 weeks, but before full term
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Endocrine changes during pregnancy
* Hormones increase drastically
* hCG hormone increases (human chorionic gonadotropin)
* addition of placenta which produces hormones (estrogen and progesterone, hPL, hCG)
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Uterus changes during pregnancy
* enlargement
* circulation increases
* stretches
* (Returns to normal size and shape after birth)
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Cervix changes during pregnancy
* shorter and softer (to prepare for dilation and thinning (effacement) during labor)
* mucus plug forms in cervical canal to prevent entrance of microorganisms
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Vaginal changes during pregnancy
* walls thicken
* discharge increases
* increased glycogen in discharge which can cause UTI
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CV changes during pregnancy
* orthostatic hypo-tension
* cardiac output increases (greatest during labor)
* WBC increase
* increase in blood volume by 40%
* Increase HR
* BP should stay the same
* increase in clotting factors (prevents hemorrhaging and bleeding post birth but increases risk for DVT/PE)
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Cardiac output is best when OB women lays on __
her side
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Lung changes during OB
* capacity stays the same
* inspiration increases to meet increased need for oxygen
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GI changes during OB
* slowed peristalsis
* relaxation of cardiac sphincter (can cause heartburn)
* low carb metabolism
* low fat metabolism
* nausea w/ or w/o vomiting
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To prevent heartburn, encourage what?
Sitting up for 30 minutes after eating
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Supine hypotensive syndrome
Occurs when women lays on back and compresses vena cava and abdominal aorta, causing lowered blood flow

* position on side to correct
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Why is UTI risk high in pregnancy?
* Increased urinary stasis
* increased glycogen in discharge
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Kidney flow may do what when pregnant
Increase by 75%, in order to remove mother + babies waste
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Kidney changes during OB
* GFR increases by 50%, causing 99% sodium re absorption
* (most of this sodium is used by the fetus, but leftover can cause edema of mother)
* Be wary of antidiurtetic effect medications (pictocin) that can cause fluid overload/toxicity
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What effect can being pregnant have on medication dose
Medications may be __sub-therapeutic__ due to

* Increased GFR
* increased cardiac output
* increased plasma volume
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Before a pelvic exam, the women should ___
empty her bladder

* take deep breaths during exam
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Should hot tubs and saunas be avoided during pregnancy?
Yes, hot temps can cause damage to the fetus

* maternal body temp should not exceed 100.4 or 38 C
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When are tub baths contraindicated
If there is no mucus plug to prevent entry of microorganisms
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What foods are good for pregnant folk
* beans
* leafy greens
* whole grains
* broccoli
* liver
* shellfish
* fresh fruits and veggies
* peas
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What type of meat should pregnant folk avoid
* uncooked
* fish limited to 170g or 6 oz of freshwater fish per week
* all raw fish avoided
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Vitamins needed for pregnancy
* Vit A
* Vit C
* Vit D
* Calcium
* phosphorus
* protein
* folic acid
* omega 3s
* fatty acids
* iron (take on empty stomach with vit C)
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How much do caloric needs increase
2nd trimester: increase 340 cals

3rd trimester: increase 500 cals

breastfeeding: increase 500 cals
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How much fluid should a pregnant lady drink/day
1500-2000 mL

* limit 2 cups of coffee or tea
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What type of vaccine should pregnant folk NOT receive (unless the benefit outweighs the risk)
LIVE vaccines (vaccines containing live virus)

* flu vaccine however is encouraged during 2nd and 3rd trimester
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How should a pregnant lady wear a seatbelt
* lab belt under the abd, across pelvic bone
* avoid sitting for long periods of time during travel. Max of 6 hours with stops made at least 2 hours for a 10 minute walk
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Is taking ibuprofen during the 3rd trimester bad?
Yes. Can cause premature closing of the ductus arteriosis, leading to fetal distress
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Ultrasound
high frequency waves to visualize baby
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Kick counts
* easy way to determine fetal health
* count kicks for 30-60 min 2x per day
* encouraged after 28 weeks
* 10 kicks in 1-2 hours is healthy
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Biophysical profile (BPP)
* uses 5 observations to check fetal health and oxygenation
* fetal breathing, movements, tone, volume of amniotic fluid, FHR variability (fetal hear rate) (using non stress test)
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Amniocentesis
* Aspiration of amniotic fluid
* can test for genetic disorders
* can test for maternal fetal blood incompatibility
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Triple marker screening
* tests for tristomy (three copies of chromosomes instead of two)
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Contraction stress test
* pictocin is given to cause light contractions
* fetal response is monitored.
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Fetal nonstress test
* monitors fetal heart response to exercise (ability to speed up)
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What happens if a mother is RH negative
* given rhogam
* rhogam after birth if baby is RH positive
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Efflurage
gentle circular motion on abd with fingertips to help with contraction pain

* very light touch
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Breathing techniques for labor
* inspiration and expiration should be equal in length
* do not hold breath or hyperventilate
* during pushing, take a deep breath and push on exhale
* breathing into cupped hand if hyperventilating
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incompetent cervix
* complication of pregnancy
* cervix dilates early in pregnancy, cannot support the weight of growing fetus
* Cervix can be reinforced surgically with either McDonald’s or Shirodkar procedures
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Complication of ectopic pregnancy
Rupture can cause hemorrhage
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Treatment for ectopic pregnancy
Methotrexate to dissolve pregnancy and stop cell division
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Placenta Previa
* placenta implants on/near cervix opening instead of fundus
* may cause (painless) bleeding in 3rd trimester as cervix dilates
* bed rest
* NO vaginal exams


* can cause hemorrhage, fetal death, ect.
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What can you not do with a pt who has placenta previa
Vaginal exams

* can cause more/worse bleeding
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Abruptio Placentae
* placenta seperates too early
* occurs after 20 wks gestation
* SUDDEN ONSET PAINFUL BLEEDING, dark red vaginal bleeding
* Leading cause of maternal death
* can cause DIC
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Causes of abruptio placentae
* blunt trauma to abdomen
* vasoconstriction drugs
* maternal hypertension
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DIC
Death is coming

* blood runs out of clotting factors, massive hemorrhage
* termination of pregnancy may be needed, administer blood products, oxygen. Correct underlying cause
* NO HEPARIN
* Bleeding from gums, injection sites, petechiae on skin are s/s that DIC is developing
* usually secondary to another complication such as abruptio placenta, GH, retained dead fetus, mole, hemorrhagic shock, septic abortion
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Blood incompatibility (RH)
* mothers blood produces antibodies that destroy fetal RBC (fetus can have anemia and heart failure and die in the womb)
* RH positive is dominant trait, so chances are good that baby will be RH positive
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ABO blood compatibility
* women has group O blood
* fetus has A, B or AB blood
* Mother has antibodies for A and B
* Do not need to treat in the womb, only after birth
* can cause jaundice
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Gestational Hypertension
Exceeds 140/90 after 20th week of pregnancy; No
proteinuria; B/P returns to normal after 6 weeks PP

* considered preeclampsia when renal involvement leads to proteinuria
* considered eclampsia when CNS involvement leads to seizures
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Preeclampsia
GH with proteinuria; renal involvement leads to
proteinuria

* can lead to seizures if progresses to eclampsia
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Severe Eclampsia
B/P 160/110, elevated serum creatinine, Headache,
blurred vision, hepatic dysfunction, thrombocytopenia

* can lead to seizures
* termination of pregnancy may be considered at 32-34 weeks
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Hyperemisis Gravidarum
* Persistent vomiting causing weight loss, dehydration, electrolyte imbalance
* fetus at risk for poor growth (fetal intrauterine growth restriction)
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Gestational DM
* impaired glucose tolerance during pregnancy
* should dissapear after birth
* 50% of these patients get DM type 2 within 5 years after delivery
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Are oral hypoglycemic agents contraindicated in gestational DM
Yes

* limited use of glyburide
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Pregnancy increases risk of what clotting problems?
* DVT
* Pulmonary Embolism
* thrombophlebitis

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Changes in coagulability and fibrinolysis occur during pregnancy that increases risk for these conditions
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What % of pregnancy ends in spontaneous abortion
15%
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When a pregnant women is admitted with bleeding, what is the nurses role?
* vs
* observe for s/s of shock (pallor, cold, clammy, restlessness, perspiration)
* weigh perineal pads to determine amount of bleeding
* asess fetal heart rate
* emotional support
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Can UTI cause miscarriage
YES
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what causes a RH incompatibity?
Fetus RH positive, mother RH negative
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Hydaiform mole
* condition where vili of the placenta become swollen/fluid filled and take on a grape like appearance
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Fetal lie
relationships of fetal spine to mothers spine

* longitudal, transverse, oblique lies
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Presentation
How fetus presents

* breech (feet or buttocks first, c-section needed) 3% of births
* cephalic (head first, normal) 95% of all births
* face
* shoulder (shoulder down)
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Lightening
fetus drops into outlet of pelvis

* mother can breathe, but has to pee all the time
* “baby has dropped down”
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Station
relationship of fetal head to mothers pelvis

* starts at 0 after lightening, as number increases positively, baby is on the way out.
* measured in cm
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Contractions cause
* cervix to efface/thin
* cervix to dilate
* push fetus downwards
* each should be followed by period of rest
* you can ascertain the start of contractions by placing hands on fundus
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Measuring contractions
Frequency = count time from beginning of one contraction to the beginning of the next

Duration = time from start of contraction to the end (usually about 45-90 seconds)

Interval = time uterus relaxes between contractions
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Cervical changes during labor
* Ripening: softening
* Effacement: shortening/thinning of cervix
* Dilation: opening 1-10 cm
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True labor vs false labor
Cervix only dilates with true labor