Final Maternity

Hormones during ovulation

High: FSH, LH (spikes), Estrogen

Low: Progesterone

GTPAL

Gravida, Term, Preterm, Abortions, Living

Estrogen placental hormone

Uteroplacental blood flow, growth

Progesterone placental hormone

Relaxation and maintenance

Human chorionic gondotropin (hCG)

"Pregnancy hormone," signals to body that pregnancy has taken place

Human placental lactogen

Stimulates maternal metabolism to supply nutrients for fetal growth

Estrogen function

stimulates development of female sex characteristics; helps regulate menstrual cycle

Progesterone function

stimulates development and maintenance of endometrium that prepares it for implantation

Fetal circulation shunts

ductus venosus, ductus arteriosus, foramen ovale

Ductus venosus

Liver

Ductus arteriosus

"Into the major artery," the aorta, bypassing fetal lungs

Foramen ovale

"Over the top" of the fetal heart from R atrium to L atrium

Placenta development

Begins at implantation, complete at 14 weeksChorionic villi burrow into decidua basalis

Placenta function

supply oxygen, remove wastes, immune protection, supply progesterone, estrogen and hCG

Postpartum hemorrhage (PPH)

>500 mL after SVD

> 1000 mL after C/S

PPH etiology

Tone: hypotonia (boggy uterus)

Trauma: lacerations, uterine inversion, hematoma

Tissue: retained placental fragments

Thrombin: clotting disorders

Hypertensive disorders of pregnancy (HDP)

BP > 140/90 mm Hg

Severe if > 160/110 mm Hg

Leading cause of maternal and perinatal morbidity and mortality

Preeclampsia

HTN develops at or after 20 weeks of gestation in previously normotensive woman without proteinuria d/t poor perfusion from vasospasm

What causes preeclampsia?

Poor perfusion from vasospasm

Preeclampsia symptoms

Swelling of face or hands

Fluid retention (decreased urine output)

Sudden weight gain

Persistent headache

Assessment of preeclampsia

Hypertension

Proteinuria

Cerebral disturbances (headache, visual disturbances)

RUQ epigastric pain

Eclampsia

Seizure activity or coma in woman diagnosed with preeclampsia

Gestational diabetes mellitus (GDM)

Hyperglycemia that is first recognized in pregnancy

Interventions for GDM

Antepartum: diet, exercise, blood glucose monitoring, insulin, fetal surveillance

Intrapartum: monitor Q1H, FHR, no glucose IV bolus

Postpartum: returns to normal, reoccurs, risk of NIDM

Interventions to stabilize newborn blood glucose

Skin to skin

BF

Blood sugar levels monitored

Supplementation

NICU for IV D10W

Stages of labour

Stage one: begins with regular uterine contractions, ends with full dilation

Stage two: begins with full dilation, ends with birth

Third stage: begins with birth, ends when placenta is expelled

Three phases of stage one labour

Latent: 0-3cm

Active: 4-7cm

Transition: 8-10cm

Two phases of stage two labour

Latent: passive descent

Active: pushing, urge to bear down

Fetal skull

Anterior fontanelle, diamond

Posterior fontanelle, triangle

Frontal, parietal, occipital, temporal bones

5 P's of labour

Passenger

Passage

Powers

Position

Psyche

5 P's: passenger

Size of fetal head

Presentation of fetus: cephalic, breech, shoulder

Cephalic presentation

birth position in which any part of the head emerges first

Breech presentation

birth position in which the buttocks, feet, or knees emerge first

Shoulder presentation

baby is in transverse position at delivery, must be turned

Fetal position

Lie: relation of spines, longitudinal or vertical

Presentation: vertex

Reference point: occiput (back of head)

Attitude: general flexion

5 P's: power

Primary powers: contractions

Secondary powers: bearing down efforts

7 mechanisms of labour

1. Engagement

2. Descent

3. Flexion

4. Internal rotation

5. Extension

6. Restitution and external rotation

7. Expulsion

(every dog feels intense, extreme, repulsion, everyday)

Fetal station

Measure of the degree of descent of the presenting part through the birth canal

Factors influencing contractions

Frequency, duration, intensity

Effacement

Dilation

Ferguson reflex

Valsalva maneuver (breath holding, forceful pushing)

Non pharmaceutical comfort measures

Preparation

Focusing and relaxation

Breathing techniques

Counterpressure

Touch and massage

Heat and cold

Aromatherapy

Music

Hypnosis

Pharmaceutical comfort measures

Sedatives: relieve anxiety, induce sleep

Analgesia: alleviation of pain

Anesthesia: encompasses analgesia, amnesia, relaxation, and reflex activity

Three stages of extra-uterine adaptation

1. First period of reactivity: first 30 minutes; infant is alert and responsive; HR peaks, irregular respirations

2. Period of relative inactivity: 1-2 hours; decrease in responsiveness and motor activity, sleeping; HR stabilizes, no signs of respiratory distress

3. Second period of reactivity: 4-6 hours after birth, 10 minutes to several hours; tachycardia and tachypnea; passing of meconium

Neonatal abstinence syndrome (NAS)

a condition in which a child, at birth, goes through withdrawal as a consequence of maternal drug use

Effect of alcohol on neonates

FAS, craniofacial features, microcephaly, hyperactivity developmental delays, attention deficits

Effect of cocaine on neonates

Preterm, SGA, microcephaly, poor feeding, developmental delays, congenital anomalies

Effect of heroin on neonates

LBW, SGA, irritability, tachypnea, seizures

Effect of tobacco on neonates

Preterm, LBW, risk for SIDS, risk for bronchitis and pneumonia, developmental delays

Risk factors for respiratory distress

Few alveoli

Lower levels of surfactant

Smaller lumen in airways

Greater collapsibility of airway

Weak gag reflex

Aspiration