Maternal Crash Course

Assesment/care during pregnancy or complications occurring during pregnancy

Antepartum Care

Gravidia “G”

Number of times a client is pregnant no matter what the outcome was

G1 = First time being pregnant

Para “P”

Number of deliveries that are greater than 20 weeks of gestation

TPAL stands for

Term: Greater than 37 weeks of gestation

Preterm: Less than 37 weeks of gestation but before 20 weeks.

Abortions: Miscarriage, and Elective Abortions

Living children

What does G3, P2, T1, P1 A0 L2 mean

G3 = Pregnant 3 times

P2 = Gave birth 2 times over 20 weeks

T1 = Birth over 37 weeks (term)

P1 = Birth less than 37 weeks but greater than 20 weeks

A0 = No abortions

L2 = 2 living children

Normal pregnancy discomforts are

-Blocked Nose

-Backache

-Insomnia

-Leg Cramps

-Lower Extremity edema

-Heartburn & Constipation

-Bladder problems

-Nausea & Vomiting

Naegele’s Rule → Estimating the due date of a mother

1) Due date of last menstrual period (LMP) Ex: April 14

2) Subtract 3 months

3) Add 7 days

Answer: January 21st

McDonald’s Method → Fundal Height measurement

Measuring from the pubic symphysis to the fundus, the cm correlates with the baby's gestational age.

Ex: 20cm = ~20 weeks

McDonald’s Method Key Anatomical Structures

-16 weeks: Fundus is halfway between pubic symphysis and umbilicus

-20 weeks: Fundus is found at the umbilicus

-36 weeks: The fundus is located at the xiphoid process.

Gestational age classifications

Preterm → Before 37 weeks

Early term → 37-38 weeks

Full term → 39-40 weeks

Late term → 40-41 weeks

Post term → After 42 weeks

Multisystem disorder that causes vasospasm, endothelial dysfunction & decreased organ perfusion is called

Preeclampsia

Preeclampsia key characteristics

-HTN

-Proteinuria

-Hyperactive Reflexes (+3 or +4)

-Upper Body Edema (hands & face)

Preeclampsia complication

Eclampsia → Seizures

Treatment for Preeclampsia

Magnesium sulfate & baby delivery

Elevated blood glucose levels due to the pregnancy hormone hPL, which causes insulin resistance and affects nutrient metabolism

Gestational Diabetes

How do you characterized Gestational Diabetes

Abnromal GTT test

Key complications of Gestational Diabetes

-Macrosomia → Large baby

-Shoulder dystocia → Baby's shoulder is stuck in mother's

Treatment for Gestational Diabetes

Diet, activity, insulin, & baby delivery

Non Stress Test Graph Orientation

Top = Fetal HR

Bottom = Uterine Contractions

Reactive Non-Stress Test

-IS GOOD!
-Normal baseline → Fetal HR stays consistent on a line in between accelerations

-Acceleration of Fetal HR aligns with a Uterine Contraction

-Moderate Variability → Moderate Squiggles

-No decelerations noted

Non-reactive Non-stress Test

-IS BAD

-Abnormal baseline

-Absence of accelerations

-Presence of decelerations

Assessment/ care during labor and birth or complication during labor and birth

Intrapartum

Prenatal Record components

1) Gestational Age

2) Prenatal labs → Blood type, Rh, Hep B, HIV, GTT test, Group B strep status (can cause neonatal sepsis)

3) Obstetrical & Med/Surg history

4) Any other risk factors

How to determine labor status

Sterile Vaginal Exam (SVE)

Sterile Vaginal Exam Steps

1) Dilation on a scale of 0 to 10 cm

2) Effacement → Thinning of the cervix (0-100)

3) Station → Where the baby’s head (vertex or cephalic) is in relation to the ischial spine. (Above = neg ; Inline with spine = 0 ; Below = pos)

4) Presenting part → Head vs Buttocks (We want head down)

Stage 1 of labor

Early Phase: 0-5 cm cervix dilated

Active Phase: 6-10 cm cervix dilated

Stage 2 of labor

Birth of baby

Stage 3 of delivery

Delivery of Placenta

Stage 4

Body readjusts after giving birth

Greater than 5 contractions in 10 minutes is called

Tachysystole

In between contractions do we want the uterus to feel firm or soft?

Soft

Different Anesthesia for different births

Epidural Anesthesia → Vaginal Birth

Spinal Anesthesia → C-Section

Pudendal/Local Anesthesia→ Episiotomy Repair

What does electronic fetal monitoring measure?

1) Assess fetal well-being & uterine activity

2) Measure fetal oxygenation

Intermittent Vs Continuous External Vs Continuous Internal

Intermittent → Low risk pts

Continuous External → Low to High risk pts

Continuous Internal → High risk (usually for C-section births)

Normal Fetal HR

110-160 BPM

Bradycardic Fetal HR

Less than 110 BPM

Tachycardic Fetal HR

More than 160 BPM

Irregular fluctuations in the FHR baseline measured as amplitude

Variability

We want moderate variability because it indicates adequate oxygenation & CNS function

Moderate Variability

6-25 beats

Minimal Variability

1-5 beats

Absent Variability

0 beats

Marked Variability

Over 25 beats

Early Decelerations

-Not a concern due to Head compression

-Slow & gradual

Causes: Active stage of labor, pushing, crowning

Variable Decelerations

-High levels of Concern

-Abrupt decrease and then return to baseline

-Unpredictable shape

-Caused by cord compression

Late Deceleration

-Most Concerning effect

-Gradual, but NADIR (lowest point of bubble) happens AFTER contraction

-Indicates not enough oxygen to the baby

-Causes: HTN, Vascular damage, Uterine tachysystole

BOLT Pneumonic

If these do not work, we will have to do an emergency C section

External manipulation of the fetus to a vertex presentation is called

External Cephalic Version

Artificial rupture of membranes is called

Amniotomy

Incision between the vaginal opening and butt

Episiotomy

What is the most common medication to induce labor

Oxytocin

What complication causes the most emergency c sections for pregnant women

Non-reassuring Fetal Heart Tracking (FHT’s)

Assessment/care after birth or complications occuring after birth

Postpartum

Fundus assessment postpartum

Constituency → Firm

Location → 1st day it is usually around Umbilicius. (Above = + ; Below = -)

Position → Midline in stomach (deviation occurs due to a pts full bladder)

Vaginal bleeding that happens after birth is called

Lochia

Normal vs Not normal Lochia

Scant, Small, Moderate = Normal

Large = Not normal

What medication is given to prevent postpartum hemorrhage

Prophylactic Oxytocin

Pain medication for pts who have had a C section

Ketorolac

What is the most common complication for postpartum mothers

Postpartum Hemorrhage

What are the five Ts of Postpartum Hemorrhage

Tone → Uterine Atony “Boggy Uterus”

Tissue → Retained Placenta

Trauma → Lacerations/hematoma

Thrombin → Coagulation

Traction → Inverted uterus

Other complications for postpartum mothers

-DVT’s

-Infection → UTI, mastitis

-Alterations in emotional status

Discharge Planning for postpartum patients

Vaginal Birth → 1 to 2 days

C-section → 3 to 4 days

-Stable VS

-Able to perform self & neonatal care

-Address emotional status

Seconds after birth, what is the nurse’s job

To dry and stimulate the baby to make sure it clears its airways.

What 3 medications are administered to the baby right after birth

1) Erythromycin eye ointment

2) Vitamin K injection

3) Hepatitis B vaccine

APGAR Scoring

1 Minute after birth

5 minutes after birth

APGAR between 7-10 is Good

HR → 0 Absent ; 1 Below 100 ; 2 Above 100

Respiratory Effort → 0 Absent ; 1 Irregular → 2 Crying

Muscle Tone → 0 Flaccid ; 1 Some flexion ; 2 Active motion

Reflex irritability → 0 No Reaction ; 1 Grimace ; 2 Vigorous Crying

Color → 0 Pale Blue ; 1 Body pink with blue extremities ; 2 Pink

Breastfeeding vs Bottle feeding babies

Breast Feeding → Every 2-3 hours

Bottle Feeding → Every 3-4 hours

What are the 2 most common neonate complications

Hypoglycemia → Less than 40 mg/hr before 4 hr or less than 45 mg/hr after 4 hr

Jaundice → Less than 5 mg/dL