Reproduction thoery week 1-20

3 parts of pregnancy

antepartum

intrapartum

postpartum

antepartum

(before birth)
period after pregnancy before labor

from conception to labor

intrapartum

during labor and delivery

postpartum

period after baby is delivered. usually first 6 weeks sometimes till 12

phases and stages of labour

• stage 1

  • latent

  • active

  • transition

• stage 2

• stage 3

stage 1 of labor

longest stage of labor

begins wiht onset of true regular contractions adn whens when cervix is fully dilated at 10cm

devided into three phases

• latent, active, transition

latent phase

cervix dilates from 0 to ~3-4 dm

contractions: mild to moderate, irregular at first then become more regular

mom can still usually talk

active phase

cervix dilates from 4 to 7cm 

Contractions: stronger and longer (40-60 seconds), and mroe frequent (every3-5 minutes)

mom usually needs to focus through contractions

Transition phase

cervix dilates from 8 to 10 cm

Contractions: very strong, every 2 ot 3 minutes lasting 60 to 90 seconds 

shortest phase but most painful. mom may feel pressure shaking, nausea irritablity or urge to push

stage 2:

expulsion of baby

• from full cervical dilation (10cm) to the delivery of baby

• contractions are strong and frequent

• mothers actively push wiht contractions

  • ends with brith of baby

stage 3

expulsion of placenta

• from delivery of baby to delivery of placenta

• usally 5-30 min

• contractions conitnue but less intense

• placenta and membranes are delivered, uterus contracts to control bleeding

stage 4

first 1-2 hours after placenta delivery

period of maternal stabilization - uterus contracts to prevent hemmorhage

GTPAL & G/P

Gravida, Term, Preterm, Abortion, Living

Gravida/ Para

Gravida

• G – Gravida

  • Total number of pregnancies, regardless of outcome.

  • Includes current pregnancy, if applicable.

Term

• T – Term births

  • Number of pregnancies delivered at term (≥37 weeks gestation).

Preterm

• P – Preterm births

  • Number of pregnancies delivered preterm (≥20 weeks but <37 weeks).

Abortion

• A – Abortions

  • Number of pregnancies ending before 20 weeks, either spontaneous (miscarriage) or induced.

Living

L – Living children

• Number of children currently living.

Para

P – Para: Number of pregnancies that reached viable gestational age (≥20 weeks), regardless of whether the child is living.

GA

Gestational age

acceleration

temporary increase in FHR from baseline, seen during a FHT or NST

Individualized Care

one on one appointments with provider throughout pregnancy, scheduled
these are usualy only 15-30 min. quick. on. a schedule

Group Care

• groups of pregnant women in similar GA meet regularly

• every 2 to 4 weeks over 6 months

• usually 90 to 120 min

• there is one provider there, measure fundal heights or BP, weight

• some form of education or group discusion. nutrition, stress, mental health, breastfeeding

• group sessions can replace individualized care

what are the weeks for each trimester of antepartum/ oregnancy

1st trimester: 0-14 weeks

2nd trimester: 15-27

3rd trimester: 28 until delivery. usually 37 weeks

Fundal height

measurement from pubic symphysis to top of uterus

at 24 weeks and beyond fundal height cm = GA + or - 2weeks

this tracks fetus development adn alerts if fetus is too small or too big

typical care/ schedule for first Trimester of pregnancy

• blood panel

• initial ultrasound at 12-14 weeks

• optional genetic testing

• appointments every 4 weels

• health and pregnancy history

  • surgical, ob/gyn histroy, family, medical history

what is included in the blood panel fro 1st trimester

• Blood type & Rh factor

• CBC (complete blood count)

• HIV, Hepatitis B, Syphilis, Rubella immunity

• Urinalysis / urine culture (diabetes)

• STIs (chlamydia, gonorrhea)

• Optional: thyroid, vitamin D, other labs depending on risk

normal values for (Hgb, Hct, PLTs, WBCs)

Lab	Normal Range (Pregnancy)	Physiological Change
Hemoglobin (Hgb)	≥11 g/dL (1st & 3rd trimesters) ≥10.5 g/dL (2nd trimester)	Mild hemodilution → “physiologic anemia”
Hematocrit (Hct)	~32–42%	Decreases due to plasma expansion
Platelets (PLTs)	150,000–400,000 /mm³ (may fall slightly but >100,000)	Mild decrease possible; <100,000 = concern (gestational thrombocytopenia or preeclampsia)
White Blood Cells (WBCs)	5,000–15,000 /mm³ (can rise to 25,000 during labor/postpartum)	Leukocytosis due to stress, hormones

In a non pregnant adults (not needed to know)

Lab	Normal Range (Female)	Notes
Hemoglobin (Hgb)	12–16 g/dL	Measures oxygen-carrying capacity
Hematocrit (Hct)	36–48%	% of blood volume that is RBCs
Platelets (PLTs)	150,000–400,000 /mm³	Clotting function
White Blood Cells (WBCs)	4,000–10,000 /mm³	Immune defense

typical care/ schedule for second Trimester of pregnancy

• Appointments every: 4 weeks

• Ultrasound at: 18–22 weeks – anatomy scan; gender reveal optional

• GTT testing at: 24–28 weeks (1-hour glucose tolerance test for gestational diabetes)

• Fundal Height, FHTs: measured at every visit

• Maternal AFP

typical care/ schedule for third Trimester of pregnancy

• appointments every 2 weeks unitl 36 weeks

• after 36 weeks every week until delivery

• Groub B strep 35-37 weeks

  • vaginal/rectal swab. if positive mom gets iv antibiotics during labor

• fundal heihg

• fetal heart tones each visit

• cervical checks

  • optionacl, typicaly begin 36-38 weels. mainly if indicated or concer for labor progress. or contractions

• discussion of labor / planning

FHT

Fetal Heart Monitoring tracs fetal heart rate to assess well being and fetal viability

• manual listening with a doppler or fetoscope

FHS in 2nd trimester

• HR: usually 120-160bpm (usually slightly higher in early second trimester, slows in late second trimester)

• doppler is most common tool to measure

• Fetal movements: kick counts start around 28 weeks. should feel at least 10 movements in 2 hours

NST

a non stress test is conducted if there are abnormal findings during FHT, maternal conditions such as diabtees, post term pregnancy(>40 weeks),

this is a non invasive test that monitors hetal heart rate response to fetal movements

goal: determin if babt is well oxygenated and neuroligcally intact

how its peformed

• the mother reclines in chair or bed

• two monitors placed on abdomen

  • detects contractions

  • detects fetal heart rate

• mother may press button when she feels the baby move

• usally lasts 20-40 min

how performed

• reactive

  • 2 or greater accelerations in FHR within 20 min,

  • (after 32 weeks)each lasting 15 seconds or geater and rising 15 bpm above baseline

  • (before 32 weeks) criteria are >= 10bpm for 10 seconds

GTT testing and why

Gestation glucose tolerance test

Gestiational diabetes mellitus (GDM) can develop during pregnancy

testing helps prevent complicatoins for both infant and mother

performed at 24-28 weeks

1 hour screening (50g glucose)

• blood drawn 1 hour after drinking sugary solution

• passing value: <140mg/dl

• if equal or greater than moves to a 3 hour test

3 hour GTT (100g glucose)

• blood drawn, fasting, 1 hour, 2 hour, 3 hour after drinking

• diagnosis made if 2 or more values are elevated

management

• diet modification

• excersize

• sometimes insulin or medications

what are teh three types of confirming pregnancy

presumptive

probable

positive

presumptive confirmation of pregnancy

Subjective — reported by the patient. These suggest pregnancy but are not proof (they could have other causes).

• Amenorrhea (missed period)

• Nausea/vomiting (“morning sickness”)

• Breast changes (tenderness, enlargement, darkened areola)

• Fatigue

• Frequent urination

• Quickening (mother feeling fetal movement, around 16–20 weeks — but gas/other movement can feel similar)

probable sings of pregnancy

Objective — observed by examiner. Stronger evidence than presumptive, but still not 100% conclusive (could be due to other conditions like tumors, hormonal changes).

• Positive pregnancy test (hCG in blood or urine — false positives can occur with certain tumors or fertility meds)

• Goodell’s sign (softening of cervix)

• Chadwick’s sign (bluish-purple discoloration of cervix/vagina due to vascularity)

• Hegar’s sign (softening of lower uterine segment)

• Ballottement (fetus rebounds when examiner taps cervix/vagina)

• Braxton Hicks contractions

• Enlargement of abdomen/uterus

positive

absolutely confirm pregnancy. Can only be explained by a fetus.

Examples:

• Ultrasound evidence of fetus (gestational sac, fetal pole, cardiac activity)

• Fetal heart tones heard by Doppler (around 10–12 weeks) or fetoscope (16–20 weeks)

• Fetal movement palpated by examiner (not just reported by mom)

EDD and how is it calculated

estimated due date

uses naegeles rule

• takes day of last menstrual period (LMP)

• subtract 3 months and add 3 days, adjust for year

• OR add 9 months and 7 days

determining Gestation age

GA assessment with crown rump length (top of head to bottom) done less than 14 weeks has an accuracy of +- 5-7 days

why is determining GA important

helps in letting providers know what developmental milestones a baby should/ is hitting

• should there be a HR, should there be fetal movement rn

accurate plannig and care testing

• GTT, GBS, anatomy scan

safe timing of interventions and deliver

• induction of labor, stopping preterm labo

viability GA

~23/24 weeks

if preterm parents have to decide if they will go through resucitation or hospice and ensure baby is given a peaceful time before death. 

Maternal afp testing 2nd tri

Maternal alpha fetoprotein 

protein that devloping baby makes and passes into maternal blood

high or low levels indicate complications

blod test around 15-20 weeks (around time of NT ultrasound

GBS testing

group b streptococcus often found in vagina/rectum

many women carry harmlessly but during delivery can pass to baby and cause serious infection

routinely done at 35-37 weeks

mother given antibiotics during pregnancy to reduce infant exposrue 

this is very common. more of a coincidence that anything indicitave of the mother. colinization is unpredictable and does not consider someone as sick

passenger position and why is it iimportant

orientation of baby as it moves through mothers pelvis

1. What side of the mother’s pelvis the baby’s presenting part is facing

2. Which part of the baby is presenting (the part that’s entering the pelvis first)

3. Which direction that presenting part is facing within the pelvis

seperated into three letters

Fetal position tells us how the baby is oriented in the mother’s pelvis, which affects how easily labor and birth happen.

first letter of passenger position

First letter — Left (L) or Right (R)

This tells you which side of the maternal pelvis the fetal reference point (a landmark on the presenting part) is pointing toward.

• L = toward mother’s left

• R = toward mother’s right

So it’s not about which way the baby’s face points overall — it’s about which side the reference point is closer to.

second letter of passenger position

Fetal presenting part (the landmark)

This letter shows what part of the baby is presenting — it depends on what’s coming out first.

Presentation	Landmark	Letter	Meaning
Vertex (head flexed)	Occiput (back of head)	O	Occiput
Face	Mentum (chin)	M	Mentum
Breech	Sacrum (butt)	S	Sacrum
Shoulder	Acromion process	A	Acromion

So:

• O = head first (normal)

• S = butt first (breech)

• M = face presentation

• A = shoulder presentation

third letter of passenger position

hird letter — Anterior (A), Posterior (P), or Transverse (T)

This shows which way the fetal reference point is facing relative to the mother’s pelvis (front or back).

• A = toward anterior (mother’s front)

• P = toward posterior (mother’s back)

• T = transverse, facing sideways

dialation 

measured in cm, range from 0-10

must reach 10 cm before pushing

this is to assess progress of labour, stages and phases. is the woman ready to push

effacement

how thin and short the cervix has become (cervix needs to be soft and thin for baby to be

measured in percent 0 to 100%

Measurement	Meaning
0%	Thick, long cervix
50%	Half thinned
100%	Completely thinned out (“paper-thin”)

must reach 100% before pushing

station

How low the baby’s presenting part (usually the head) is in relation to the ischial spines of the mother’s pelvis.

Station	Meaning
–5	High in pelvisthe
0	Level with ischial spines (“engaged”)
+5	Crowning — visible at vaginal opening

How it’s measured:
By feeling where the baby’s head is during a vaginal exam, compared to the ischial spines.

• When lowermost portion of presenting part is 1 cm below spines said to be (+1)

criteria for contraction assesment

• frequency 

• duration 

• intenisty

  • Palpation (feeling with your hands)

    • The provider feels the top of the uterus (fundus) during a contraction.

    • They estimate how hard it feels:

      • Mild: feels like the tip of your nose

      • Moderate: feels like your chin

      • Strong: feels like your forehead

    • B. Internal monitoring (intrauterine pressure catheter — IUPC)

      • A thin catheter goes inside the uterus and measures pressure in mmHg.

      • Gives a quantitative number for intensity:

        • Mild: ~25 mmHg

        • Moderate: ~50 mmHg

        • Strong: 50–100 mmHg or more

criteria for fetal heart rate

• baseline

• variability

• accelerations

• decelerations

baseline

• The average fetal heart rate over 10 minutes when the baby is not experiencing contractions or accelerations/decelerations.

Normal range:

• 110–160 beats per minute (bpm)

Why it matters:

• Shows the baby’s overall oxygenation and well-being.

variability

What it is:

• The fluctuations in the FHR around the baseline,(not random troughs beat-to-beat changes.

Types:

• Absent: undetectable

• Minimal: <5 bpm

• Moderate: 6–25 bpm (normal, reassuring)

• Marked: >25 bpm

Why it matters:

• Reflects the baby’s autonomic nervous system and oxygenation.

• Moderate variability = good, baby is healthy.

accelerations

What it is:

• Temporary increases in FHR above baseline.

Definition:

• ≥15 bpm above baseline for ≥15 seconds (≥32 weeks gestation)

• Shorter/milder for <32 weeks

Why it matters:

• Usually a reassuring sign that the baby is doing well.

decellerations

What it is:

• Temporary decreases in FHR below baseline.

Types:

1. Early decelerations – mirror contractions, caused by head compression, usually benign.

2. Variable decelerations – abrupt drops, caused by cord compression. May need intervention if severe.

3. Late decelerations – start after contraction begins, caused by uteroplacental insufficiency, concerning.

4. Prolonged Decelerations

   What it is:

   • A drop in fetal heart rate below the baseline that lasts longer than 2 minutes but less than 10 minutes.

   • If it lasts 10 minutes or more, it’s considered a baseline change, not just a deceleration.

Why it matters:

• Helps detect fetal distress or potential oxygen problems.

different deceleration types physiological cuase and nursing intervention

DECELERATION TYPE	PHYSIOLOGIC CAUSE	NURSING INTERVENTION
Early	Fetal head compression (often benign and occurs with contractions)	Continue to monitor; no intervention usually needed; assess labor progress
Variable	Umbilical cord compression	Reposition mother (side to side, knee-chest); administer oxygen; discontinue oxytocin if infusing; consider amnioinfusion; notify provider
Late	Uteroplacental insufficiency (decreased oxygen transfer to fetus)	Reposition to left side; stop oxytocin; administer oxygen via face mask; increase IV fluids; notify provider; prepare for possible delivery
Prolonged	Cord prolapse, maternal hypotension, uterine tachysystole, or prolonged cord compression	Reposition mother; administer oxygen; stop oxytocin; IV fluid bolus; assess for cord prolapse; notify provider immediately; prepare for emergency intervention if unresolved

Bishops score

Low Score (< 5) = “unfavorable” =
• High Score (>8) = “favorable” =

regional anesthesia (epidural)

Combination of local anesthetic (bupivacaine),
opioid analgesic (fentanyl) or BOTH
• Time of Action ~ 15-20 minutes for full relief
• Duration ~ entirety of labor/ deliver

Nursing Considerations
• IV fluid bolus before procedure
• Assist with patient positioning
• Continuous pulse oximeter
• Frequent VS (q 5 mins, q15 mins, q 30 mins)
• Assess pain and sensory levels
• Foley catheter or I/O cathete

Nitrous oxide

laughing gas,” reduces perception of pain
• 50:50 mix of nitrous + oxygen using blender device and mask
• Rapid onset and quick clearance with exhalation
• Side Effects: nausea, dizziness
• Nursing Considerations:
• Teach woman how to self-administer
• Apply mask during start of contraction, breath slowly, remove in between
contractions
• NO ONE ELSE except the patient can use/ administer it
• Cannot use in combination with IV/ IM narcotics
Image Credit

induction of labor

Medical Indications vs Elective (Non-medically Indicated) Delivery

• Medical:

  • Condition makes it safer or better for mother or baby to deliver

  • Examples: preeclampsia, fetal growth restriction, maternal diabetes, placental issues, prolonged rupture of membranes, fetal compromise

• Elective (non-medically indicated):

  • Labor or delivery is chosen without a medical reason

  • Must wait until ≥39 weeks gestation (full-term) to reduce risks of neonatal complications

• Brief Summary: Induced Labor

  Induction of labor = starting labor artificially instead of waiting for spontaneous contractions.

  Methods:

  1. Medications

     • Prostaglandins (gel or insert) → soften cervix (ripening)

     • Oxytocin (Pitocin) → stimulate contractions

  2. Mechanical

     • Foley balloon → stretches cervix to trigger labor

  3. Other

     • Amniotomy → breaking the water to start contractions

  Reasons for induction:

  • Medical indications (see above)

  • Post-term pregnancy (>41–42 weeks)

  • Maternal conditions that make waiting risky

  Goal:

  • Achieve effective contractions and progressive cervical changes for safe vaginal delivery.

involution

• process of uterus returning to pre pregnancy size shape and position after birth

cervical ripening agents

Agent	Type	Route	Key Points	Adverse Effects
Dinoprostone (Cervidil, Prepidil)	Prostaglandin E₂	Vaginal insert or gel	Most commonly used; Cervidil can be easily removed if uterine hyperstimulation occurs	Uterine tachysystole, fetal distress, nausea, vomiting
Misoprostol (Cytotec)	Prostaglandin E₁	Vaginal, oral, or sublingual tablet	Inexpensive and effective; also used for postpartum hemorrhage	Higher risk of uterine tachysystole; contraindicated in previous cesarean (risk of rupture)

Method	Description	Advantages	Disadvantages
Foley balloon catheter	A balloon inserted into cervix and inflated with saline to exert pressure	Low cost, less risk of hyperstimulation	Discomfort, infection risk

oxytocin in labor

. It stimulates uterine contractions

• Oxytocin acts directly on uterine smooth muscle receptors.

• It causes rhythmic contractions that push the baby down toward the cervix and eventually through the birth canal.

• These contractions help dilate and efface the cervix, moving labor along.

Postpartum

After the baby and placenta are delivered, the uterus needs to firmly contract to clamp down on the open blood vessels where the placenta was attached.
If it doesn’t, the vessels stay open → postpartum hemorrhage (excessive bleeding).

Oxytocin stimulates strong, rhythmic uterine contractions to:

1. Compress uterine blood vessels → ↓ bleeding

2. Promote uterine involution → uterus shrinks back to pre-pregnancy size

3. Expel any remaining clots or tissue

in almost all births, oxytocin is routinely given postpartum.

This is part of what’s called “Active Management of the Third Stage of Labor (AMTSL)”, a globally recommended practice (by WHO, ACOG, etc.) to prevent postpartum hemorrhage (PPH) — the leading cause of maternal death worldwide.

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preeclampsia and why its a concern

Preeclampsia is diagnosed when a pregnant woman has:

• Blood pressure ≥ 140/90 mmHg on two occasions at least 4 hours apart after 20 weeks,
  AND

• Evidence of protein in the urine (proteinuria) or signs of organ dysfunction (like abnormal labs or symptoms).

poses risk for btoh mother and. baby

Abnormal placental development

• The placenta doesn’t implant deeply enough into the uterine wall.

• The blood vessels that feed it stay narrow and high-resistance, so the placenta doesn’t get enough oxygen (placental ischemia).

Placenta releases harmful substances

• The stressed placenta releases factors into the mother’s bloodstream.

• These damage blood vessel linings (endothelium) and cause vasoconstriction and inflammation throughout her body.

Widespread vascular damage and organ effects

• Damaged vessels raise blood pressure, leak fluid, and form tiny clots.

• This reduces blood flow to the kidneys, liver, brain, and placenta, leading to proteinuria, headaches/vision changes, and fetal growth restriction.

uterine tachyssytole

More than 5 contractions in 10 minutes, averaged over a 30-minute window.
Can occur spontaneously or due to excess uterotonic stimulation (like oxytocin or misoprostol).

transition of lochia after birth

lochia rubra, lochia serosa, lochia silba,

lochia rubra, seros and alba

Lochia Type	Time	Normal	Abnormal
Lochia rubra	Days 1-3	Bright red, blood consistency; fleshy odor; temporary increase with breastfeeding and rising	Numerous large clots; foul smell; saturation of pad in half hour or less
Lochia serosa	Usually days 4-9 (can last to 27 days)	Pinkish brown; serosanguineous consistency	Foul smell; saturation of perineal pad in 1 hour or less
Lochia alba	Day 10 to about 6 weeks	Creamy white; fleshy odor	Foul smell; persistent lochia discharge over 3 weeks; return to pink or red discharge

also measure amount

fundal assesmment

• Tone – firm or boggy

• Height – where it is relative to the umbilicus

• Position – midline or deviated (often right if the bladder’s full)