Obstetirics + Neonatal Care (Chapt 34)

Menarche

First period

Ovulation

• release of egg

• 2 weeks prior to mentruation

endometrium

• lining of inside uterus

• thicken to prepare for potential implantation of fertilized egg

• egg not fertilized in 36-48 hrs after release from follicle endometrium sheds

embryo

• 0-10 weeks after fertilization

• fertilized egg develops into

bloody show

• pink mucus

• signals start of labor

perieum

area b/w vagina + anus

vagina

• outermost cavity

• lower part of birth canal

• 3-5 inches

placenta

• disk shaped attached to uterine wall

• nourishes fetus through umbilical cord

• 2 layers of cells: keeps circulation b/w mother + fetus seperate

umbilical cord

• connects women + fetus through placenta

• 2 arteries + 1 vein

• vein carries oxygenated blood from placenta to fetus heart

• arteries carry deoxygenated blood from heart of fetus to placenta

amniotic sac

• bag of waters

• where fetus develops

• 500-1000 ml of fluid

term gestation

full term pregnancy (39 weeks)

pregnancy effects

1. inc blood vol (50%)

2. # red blood cells (need iron)

3. speed of clotting

4. inc HR (20%)

5. inc cardiac output

gestational diabetes

• most women after delivery

• treatment: diet, exercise, insulin injections

gestational hypertension in pregnancy

• high bp in absence of other systemic effects

• systolic bp > 140 mm Hg: severe > 160 mm Hg

• diastolic bp > 90 mm Hg severe > 110 mm Hg

preeclampsia

• second half pregnancy (after 20 wks gestation)

• new onset hypertension w/ systemic effects (protein in urine)

preeclampsia signs

signs:

1. hypertension (sys > 140 + dia > 90)

2. severe ongoing headache

3. edema (swelling)

4. upper abdominal + epigastric pain

5. dyspnea + retrosternal chest pain

6. anxiety

7. altered LOC

eclampsia

• hypertension + seizures

seizure treatment w pregnancy

1. lay left side

2. patent airway

3. admin O2

4. suction airway if vomiting

supine hypotensive syndrome

• compression of inferior vena cava by preg uterus if layed supine

• reduces blood returned to heart

• hypotension

ectopic bleeding

• early (6-8 wks) after missed period

• embryo dev outside uterus (most in fallopian tube)

ectopic pregnancy pain

1. severe low abdominal pain unilateral

2. may radiate to one shoulder

3. bleeding: scant brown spotting to bright red

abruptio placentae

• later preg (after 20 wks)

• placenta separates from wall of uterus early

abruptio preg pain

1. low abdominal + back pain

2. may associate w contractions

3. mod vaginal bleeding

4. most bleeding is internal

5. signs of shock (weak rapid pulse, pale, cool diaphoretic skin)

placenta previa

• later preg- after 20 wks

• placenta dev over + covers cervix

placenta previa pain

1. painless

2. bleeding: mod → life-threatening hemorrhage

ectopic preg rick factors

risks:

1. history of pelvic inflammatory disease

2. tubal ligation

3. previous ectopic pregs

abruptio placentae causes

hypertension + trauma

spontaneous abortion

• miscarriage

• prior 20 wks gestation

• signs: abdominal cramping + vaginal bleeding

abortion complications

1. bleeding

2. infection

False labor (Braxton-hicks contractions)

signs:

1. irreg contractions in lower abdomen

2. pain

3. physical activity/change in pos alleviate pain

4. brown bloody show

5. urine

true labor signs

signs:

1. stronger + closer contractions

2. in lower back + wrap around to low abdomen

3. phys. activity intensify contractions

4. pink or red bloody show w mucus

5. amniotic sac may break

6. sweet smelling fluid

lightening

fetus moves down to pelvis

APGAR Score

• assess newborn status (0, 1, 2)

  1. appearance (cyanosis (0) → pink (2))

  2. pulse: chest auscultation or brachial pulse (>100 beats/min (2)

  3. grimace/irritability: snap finger against sole feet

  4. activity/muscle tone: oxygenation of tissues (hips/knees flexed + resists attempts to straighten)

  5. respirations: reg, rapid → good

• Calc at 1 min + at 5 min

• score 7+ good

prolapse of umbilical cord

• umbilical cord comes out vagina before fetus

• fetus head may compress cord + cut circulation

• treatment: supine, foot end stretcher raise 6-12 in higher than head + hips elevated or knee-chest pos

spina bifida

• dev defect where spinal cord or meninges protrude outside vertebrae/body

• cover w moist sterile dressing + occlusive dressing after birth

postpartum risks

1. venous embolism

2. pulmonary embolism: sudden difficulty breathing/shortness of breath, altered LOC

20th week pregnancy

• top of uterus at or above belly button (inc chance of direct fetal injury in trauma)

meconium stained amniotic fluid risk

• inc w gestational age

• postterm newborns (42 weeks +)

• treatment: suction newborn mouth then nose after delivery before ventilations

premature newborns

• 36 weeks gestation

• weighs < 5 lbs

• vernix caseosa absent or min

• less body hair

postterm pregnancy

• over 41 weeks gestation

• weigh > 10 lbs

• possible c section

• risk for meconium, aspirations, infection, stillborn