Comprehensive Maternal Newborn Nursing: Pregnancy, Labor, and Postpartum

Gravida

The total number of times a woman has been pregnant

Primigravida

Pregnant for the first time

Multigravida

Has been pregnant multiple times

Nulligravida

A woman who has never been pregnant

Para

Delivered after 20 weeks

Nullipara

Has not produced a viable offspring

Multipara

Woman who has had two or more delivered after 20 weeks

Early term

37-38 weeks

Full term

39-40 weeks

Late term

41-41 weeks

Post term

≥42 weeks

Abortion

A loss of pregnancy < 20 weeks

GTPAL

Gravida, Term, Preterm, Abortion, Living

Naegele's Rule

LMP (last menstrual period) - 3 months + 7 days

Presumptive signs of pregnancy

Signs that the mother can perceive, such as fatigue, breast tenderness, nausea

Probable signs of pregnancy

Signs that can be detected on physical examination by the HCP, such as abdomen enlargement, ballottement, positive pregnancy test

Positive signs of pregnancy

Signs that confirm there is a fetus growing in the uterus, such as ultrasound verification of the fetus, fetal movement felt by HCP, auscultation of heart tones

Quickening

Fetal movement that is felt by the mother

Fundal Height

Measured to evaluate the gestational age of the fetus

Fundal height at 12 weeks

Can feel it at pubic symphysis

Fundal height at 16 weeks

Can feel it at halfway point between pubic symphysis and umbilicus

Fundal height at 20 weeks

Can feel it at the umbilicus

Fundal height at 36 weeks

The fundus reaches its highest level at the xiphoid process

Varicose veins

Result from weakening walls of the vein or valves and venous congestion.

Hypercoagulable state

Risk for DVT.

Physiological anemia

Occurs as the plasma increase exceeds the increase in production of RBCs.

Lordosis

Inward curvature of the lower back.

Relaxation and increased mobility of pelvic joints

Permit enlargement of pelvic dimensions.

Center of gravity changes

Begin in the second trimester due to hormones relaxin and progesterone.

Shortness of breath

Due to enlargement of the uterus pressing against the diaphragm.

Constipation

Results from increased progesterone, decreased intestinal motility, and pressure of the uterus.

Nausea and vomiting

Common symptoms during pregnancy.

Weight gain during pregnancy

Normal BMI should gain about 25-35 lbs.

Caloric intake in 1st trimester

No calorie change.

Caloric intake in 2nd and 3rd trimester

Increase by 300-450 calories from carbs and proteins.

Prenatal vitamins

Need more iron and folic acid during pregnancy.

RhoGAM

Used to prevent development of antibodies to Rh-positive red cells.

First prenatal visit

Includes comprehensive health history and physical examination.

Urinalysis

Includes testing for protein, glucose, and UTI.

Fundal height measurement

Assesses fetal growth by measuring distance from pubic bone to uterus.

Glucose Challenge Test

Performed at 24 to 28 weeks to screen for gestational diabetes.

Kick counts

Assess fetal well-being; at least 10 movements in 2 hours.

Nonstress Test (NST)

Assesses placental function and fetal well-being.

Reactive NST

At least two fetal HR accelerations of at least 15 bpm for 15 seconds.

Biophysical Profile

Noninvasive assessment of fetal movements, tone, and breathing.

Station

Measurement of the progress of descent in cm above or below the ischial spine.

Effacement

Shortening and thinning of the cervix.

Dilation

Opening of the cervix.

Premonitory signs of labor

Can happen before true labor begins.

Braxton Hicks contractions

Practice contractions that can occur before labor.

Lightening

Fetus descends into the pelvis.

Bloody show

Brownish or blood-tinged mucus passed before labor.

True Labor

Contractions occur regularly, become stronger, last longer, and are closer together with cervical change.

False Labor

Irregular contractions without progression; improves with walking.

Signs to go to the hospital

Water breaks, baby not moving, or bleeding.

Nursing Care at Admission

Assess impending birth, fetal status, contraction status (heart beat best heard in baby's back).

Engagement

The head enters the pelvis.

Descent

The fetal position changes.

Flexion

The fetal position changes (head to chest).

Internal Rotation

The fetal position changes while continuing to descend.

Extension

Head passes under the symphysis pubis.

External Rotation

The shoulders externally rotate after the head emerges.

Expulsion

The baby is expelled.

Stage 1 of Labor

Onset of labor to complete dilation (can last 12-14 hours).

Latent Phase

0-4 cm; contractions 5-6 minutes apart, lasts for 45-50 seconds.

Active Phase

4-7 cm; contractions get longer and harder.

Transition Phase

8-10 cm; very intense contractions 3 minutes apart, lasts 30 seconds.

Nursing Care during Labor

Frequent monitoring of baby and contractions, vitals, history records, and pain relief.

Stage 2 of Labor

Complete dilation to delivery (pushing stage).

Stage 3 of Labor

Delivery of infant to delivery of placenta (5 to 15 mins).

Stage 4 of Labor

Delivery of placenta to 2 hours post delivery.

General Anesthesia

Usually for emergencies; patient is put to sleep.

Regional Anesthesia

Effects a certain area.

Epidural

Small catheter in back, numbs area; does not directly affect the baby.

Spinal Anesthesia

Numbing medication in subarachnoid space; takes effect immediately.

Induction

Deliberate initiation of uterine contractions that stimulate labor.

Augmentation

In labor already; labor progressing slowly.

Pitocin

Artificial med of oxytocin; must have IV.

Tachysystole

Contractions coming too close together with insufficient rest time.

Forceps

Used by doctor to assist in delivery; fitted around baby's head.

Vacuum Extraction

Handheld device with suction on baby's head.

Laceration

Tear through vaginal tissue; can be 1st to 4th degree.

Fetal Monitoring

Includes intermittent auscultation and electronic fetal monitoring.

Duration of Contraction

Beginning of the contraction to the end of it; how long does it last?

Frequency

Beginning of one contraction to the beginning of the next contraction

Intensity

Measured as mild, moderate, and strong on external monitor; measured by mmHg with internal monitor

Normal FHR

Term 110-160; preterm may be a little higher

Bradycardia

Baseline of less than 110 for 10 min

Tachycardia

Greater than 160 for 10 min

Variability

Ability of the HR to vary (in 10 min)

Absent variability

Essentially no change, basically a straight line

Minimal variability

Less than 5 bpm change

Moderate variability

6-25 bpm ideal

Marked variability

Greater than 25 bpm

Acceleration

Visually apparent abrupt increase in FHR; peak must be greater than 15 bpm, must last greater than 15 seconds, but less than 2 min from the onset to return (15 x 15)

Postpartum period

Starts immediately after birth and is usually completed by week 6 following birth

Involution

The rapid decrease in the size of the uterus as it returns to the nonpregnant state

Lochia

Discharge from the uterus that consists of blood from the vessels of the placental site and debris from the decidua

Rubra lochia

Bright red (day 1-3)

Serosa lochia

Brownish pink (days 4-10)