Maternal Newborn Nursing Today

fertility

is the ability to achieve pregnancy without medical intervention

infertility

• inability to get pregnant when having regular, unprotected sexual intercourse for at least 12 months or difficulty w/ the client's ability to reproduce

• increase in age = causes irregularities in the oocytes

32 years

age that fertility begins to decline in females

oocytes

immature egg cell in the ovary

Factors that affect fertility:

• Age

• Diet

• Smoking

• Exercise

• Elevated or Low BMI

ELEVATED OR LOW BMI

• decreased fertility rates for overweight (BMI 25-29.9) or obese (BMI >30)

• for every 5kg (11lb) pt gains = length of time to get pregnant increases by 5%

• ovulatory dysfunction

  • w/ BMI <17

• gonadotropin dysfunction

DIET

• diet that increases fertility→(protein) high amounts of whole grains, fish, unsaturated fats, fruits, veggies, folic acid

• Celiac Disease

  • chronic immune disorder in which the ingestion of gluten causes inflammation of the intestinal lining

  • may lead to problems with fertility by causing later-onset menstruation, early menopause, secondary ammenorrhea

• amenorrhea→lack of menstrual period in females client who is of reproductive age

Celiac Disease

• chronic immune disorder in which the ingestion of gluten causes inflammation of the intestinal lining

• may lead to problems with fertility by causing later-onset menstruation, early menopause, secondary ammenorrhea

EXERCISE

• Can decrease fertility rates

  • increased duration & intensity of exercise

  • vigorous exercise (running, fast cycling, aerobics, swimming, gymnastics) w/ BMI <25

• Decreased fertility could be caused by

  • altered production or metabolism of the hormones involved in ovulation = anovulation

• anovulation→lack of ovulation

• slightly improved fertility = BMI >25 & vigorous exercise

Severe Maternal Morbidity (SMM)

• refers to any unintended, serious complication that occurs during labor, birth, or postpartum and has the potential to lead to death

• Complications:

  • postpartum hemorrhage, amniotic fluid embolism, sepsis, acute renal failure, eclampsia, cardiac arrest

Causes of Pregnancy-Related Deaths

• Suicide & Substance Use Disorders (28%)

  • greatest

• Postpartum Hemorrhage (PPH)

  • leading causes of maternal morbidity & mortality

  • blood loss of greater than 1000 mL during & immediately after giving birth or cumulative loss of greater than 1000 mL within 24hr of birth w/ manifestations of hypovolemia

  • Causes:

    • Uterine atony→loss of uterine tone due to ineffective contractions

    • Trauma to tissues, such as cervical or vaginal lacerations

    • Retained placental tissue

    • Bleeding disorders (e.g., Von Willebrand's disease)

• Peripartum Infections & Sepsis (preventable)

  • Intraamniotic Infection

    • choriamnionitis →infection within the amniotic sac

    • endometritis →infection in the lining of the uterus

    • infection of the placenta or fetus, wound infections, mastitis

• Cardiovascular problems

  • embolism→An obstruction or blockage in the bloodstream caused by a blood clot, fat deposit, or other substance.

  • STOKE

  • BP Disorders:

    • preeclampsia

      • A serious complication of pregnancy occurring after 20 weeks of gestation, in which a client's blood pressure is above 140/90 mm Hg.

      • It can be accompanied by proteinuria, edema, headache, and vision changes.

      • Can become severe, resulting in seizures.

    • eclampsia

  • cardiomyopathy (affects heart muscle

  • cardiac conditions that affect blood flow or electrical rhythm

• Malignant Hyperthermia→Severe reaction to anesthetic agents that causes a fast rise in body temperature and severe muscle contractions.

• Amniotic Fluid Embolism (fluid goes to maternal blood stream)

• Disseminated Intravascular Coagulophathy→A condition in which blood clots excessively form in blood vessels. As a result, clotting factors are used up, and then bleeding occurs excessively anywhere in the body.

• Common Causes of Maternal Morbidity

  • Diabetes

  • High blood pressure

  • Infection

  • Blood clots

  • Hemorrhage

  • Anemia

  • Nausea/vomiting

  • Depression and anxiety

Postpartum Hemorrhage (PPH)

• leading causes of maternal morbidity & mortality

• blood loss of greater than 1000 mL during & immediately after giving birth or cumulative loss of greater than 1000 mL within 24hr of birth w/ manifestations of hypovolemia

• Causes:

  • Uterine atony→loss of uterine tone due to ineffective contractions

  • Trauma to tissues, such as cervical or vaginal lacerations

  • Retained placental tissue

  • Bleeding disorders (e.g., Von Willebrand's disease)

Peripartum Infections & Sepsis (preventable)

• Intraamniotic Infection

  • choriamnionitis →infection within the amniotic sac

  • endometritis →infection in the lining of the uterus

  • infection of the placenta or fetus, wound infections, mastitis

Cardiovascular problems

• embolism→An obstruction or blockage in the bloodstream caused by a blood clot, fat deposit, or other substance.

• STOKE

• BP Disorders:

  • preeclampsia

    • A serious complication of pregnancy occurring after 20 weeks of gestation, in which a client's blood pressure is above 140/90 mm Hg.

    • It can be accompanied by proteinuria, edema, headache, and vision changes.

    • Can become severe, resulting in seizures.

  • eclampsia

• cardiomyopathy (affects heart muscle

• cardiac conditions that affect blood flow or electrical rhythm

Malignant Hyperthermia

Severe reaction to anesthetic agents that causes a fast rise in body temperature and severe muscle contractions.

Disseminated Intravascular Coagulophathy

A condition in which blood clots excessively form in blood vessels. As a result, clotting factors are used up, and then bleeding occurs excessively anywhere in the body.

Common Causes of Maternal Morbidity

• Diabetes

• High blood pressure

• Infection

• Blood clots

• Hemorrhage

• Anemia

• Nausea/vomiting

• Depression and anxiety

perinatologist

A medical doctor (either a primary care provider or consultant) who specializes in care for high-risk pregnancies, fetal therapy, and fetal and maternal testing.

Risk Factors of Maternal Morbidity:

mental health conditions, cardiovascular disease, asthma, diabetes

intrauterine fetal demise

Also known as stillbirth. Legal definitions vary somewhat by state, but it is generally considered to be a fetal death occurring at around 20 weeks of gestation or if the fetus weighs 350 to 500 g or more.

vasa previa

A condition that occurs when some of the umbilical cord blood vessels run near or across the internal cervical orifice.

infant mortality

An infant death occurring before the first birthday.

sudden unexpected infant death (SUID)

The unexpected death of an infant under the age of 1 year. Prior to investigation, there may not be a known cause of death.

All nurses must follow ethical principles in their practice. There are nine basic principles that guide nurses in their ethical practice.

• The nurse practices with empathy and respect for every client and family.

• The client is the nurse's primary commitment.

• The nurse advocates for and defends the rights of the client.

• The nurse has accountability for their nursing practice.

• The nurse owes the same duty to themselves as to clients.

• The nurse creates, upholds, and improves the ethical environment they work in.

• The nurse advances the profession through education.

• The nurse works cooperatively with other health care providers.

• The profession of nursing maintains the integrity of the profession and integrates principles of social justice.

COMMUNITY-BASED CARE

• Community-based care can be further identified in different models, such as community as setting, community as target, community as resource, and community as agent.

• Community as setting refers to maternal and client skilled care in the community where they live. This care could include management of the client and/or newborn in their home.

• Community as target refers to the community being the target of change that can help to improve client outcomes. An example of community as target are caregivers providing postnatal care in the home.

• Community as resource refers to community-based health promotion resources. An example of this care could be promoting childhood vaccinations to reduce certain illness or providing breastfeeding classes within the community to improve breastfeeding rates.

• Community as agent is like community as resource, with an emphasis on mobilizing support within the community. An example of this could be a rerring the patient to health care facilities in the community.

induction

use of pharmacological or mechanical interventions to prompt labor to begin

augmentation

Use of pharmacologial or mechanical interventions to increase contraction frequency, strength, or duration after the onset of labor.

episiotomy

A surgical incision made to the perineum during the labor process.

A certified nurse-midwife (CNM)

A certified nurse-midwife (CNM)

A certified midwife (CM)

has attained a graduate degree and completed science and health training required by a midwife program. They do not have an RN license.

Certified professional midwives (CPM)

are required to have a high school diploma or equivalent. Educational prerequisites vary by midwife program. CPMs are required to demonstrate clinical competency prior to certification. CPMs provide care and education during pregnancy, birth, and postpartum time. CPMs can perform a physical exam and administer medication, but they cannot write prescriptions.

ectopic pregnancy

Implantation of a pregnancy in an area outside the uterus, often occurring in the fallopian tubes.

Medications used in combination to induce first-trimester abortions

mifepristone, misosprostol

Reproductive Rights

Some reproductive health services (birth control, fertility meds, procedures) remain protected because→Patient Protection & Affordable Care Act

statue of limitations

period in which a lawsuit is filled

burden of proof

amount of evidence needed for a lawsuit to be considered

breach of contract

The provider did not give care that met the standard and/or act as a reasonably prudent health care professional would act.

Postpartum Depression

• intense mood alterations, disrupted ability to complete self-care & newborn care

• occur 1 week after birth

• risk factors: stressful life events, poor social & financial support, partner violence, <25 years, family history of depression

Postpartum Blues

• manifestations are mild and go away after a short time

• risk factors: postpartum depression, premenstrual syndrome, depression prior to pregnancy

• manifestations: crying, sadness, anxiety, irritability, insomnia, exhaustion, labile moods, decreased concentration

• begin 2-3 days after deliver, peak quickly, disappear within two weeks

• Edinburgh Postnatal Depression Scale

Postpartum Psychosis

• occurs mostly who have bipolar, major depression, schizophrenia, schizoaffective

• manifestations: hallucinations, delusions, bizarre behavior, confusion

• unknown cause

• suicide & infanticide can occur

meconium

earliest stool of a mammalian infant resulting from defecation