Mark K Lecture #10

calculating a due date

first day of last menstrual cycle, add 7 days, subtract 3 months

fundus

top part of uterus

non-palpable until 12 weeks

@ the umbilicus 20-22 weeks

weight gain in pregnancy

total weight gain = 28 lbs +/- 3 lbs

first trimester = 1 lb/month

second/third trimester = 1 lb/week

take week of gestation, subtract 9

4 positive signs of pregnancy

fetal skeleton on x-ray

fetal presence on ultrasound

fetal movement felt by examiner

auscultation of fetal heart rate (8-12 weeks)

maybe signs of pregnancy

all blood/urine test

chadwick's sign = cervical color change to cyanosis

goodall's sign = cervical soften

hegar's sign = uterine soften

how do you treat morning sickness?

dry carbohydrate before getting out of bed

how do you deal with urinary retention?

void every 2 hours

how do you treat difficulty breathing?

tripod position

how do you treat back pain?

pelvic tilt excercise

Pt teaching in pregnancy

hemoglobin will fall

visit office once every month until 28 weeks, then once every two weeks until 36 weeks, then weekly until birth/42 weeks

what is the most valid sign a women is in labor

regular progressive contractions

dialation

opening of the cervix

0-10 cm

effacement

thinning of the cervix

thick-100%

lie

relationship of the mother's spine to the baby's spine

presentation

part of baby that enters the birth canal first

station

fetal presenting part to mom's ischial spines

negative = above spines

engagement = station = 0 at the spines

positive = below the spines

4 stages of labor and delivery

1. labor > 3 phases. latent, active, transistion

2. delivery of baby

3. delivery of placenta

4. recovery (last 2 hours)

when does post partum begin?

2 hours after delivery of the placenta

latent phase

dilate = 0-4 cm

contractions = 5-30 minutes

duration = 15-30 seconds

intensity = mild

active phase

dilate = 5-7 cm

contractions = 3-5 minutes

duration = 30-60 seconds

intensity = moderate

transition phase

dilate = 8-10 cm

contractions = 2-3 minutes

duration = 60-90 seconds

intensity = strong

what do you do in a crisis

stop pitocin, if it is running

pain medication in labor

do not give if the baby is likely to be born when the medication peaks

how to time contractions

frequency = beginning of one contraction to beginning of the next

duration = beginning to end of 1 contraction

intensity = strength of contraction (subjective)

-teach to palpate with one hand over the fundus, with the pads of fingers

painful back labor

position > knee chest

push > into sacrum

prolapsed cord MEDICAL EMERGENCY

push > head off cord

position > knee chest

DO NOT LEAVE PT. will be in bed on the way to OR

all other labor/birth complications

left side

increase IV

oxygen

notify HCP