Chapter 34 - Obstetrics and Neonatal Care

Explain the normal changes that occur in the body during pregnancy

• Hormone levels increase

• Uterus grows

• Reduced tidal volume in second trimester

• Increase demand for O2

• Blood volume increases

• HR increase in third trimester (20 beats more)

• Weight gain

What is the purpose of amniotic fluid?

Protects and insulates the fetus

How should gestational diabetes be treated?

Same for any other diabetic patient

What is gestational hypertension?

the presence of high blood pressure in the absence of other systemic effects (>140 mm Hg systolic, >90 mm Hg diastolic)

What is preclampsia?

a condition that occurs in the second half of pregnancy (after 20 weeks’ gestation), involves new-onset hypertension along with other systemic effects, such as protein in the urine.

Sign/symptoms of preclampsia

• Hypertension (systolic blood pressure >140 mm Hg, diastolic blood pressure >90 mm Hg)

• Severe or persistent headache

• Visual abnormalities such as seeing spots, blurred vision, or sensitivity to light

• Swelling in the hands and feet (edema)

• Upper abdominal or epigastric pain

• Dyspnea and/or retrosternal chest pain

• Anxiety

• Altered mental status

What is eclampsia?

the presence of seizures.

By 20 weeks, where is the top of the uterus? Why is this important to know?

To the level of the belly button. This position is more prone to injury.

When should delivery of the placenta occur?

Within 30 min of the delivery

What are the three stages of labor?

1. Dilation of the cervix

2. Delivery of the fetus

3. Delivery of the placenta

What is the difference between Braxton-Hicks contractions and true labor contractions?

Braxton hicks contractions will be irregular, pain in lower abdomen, and physical activity alleviates the pain. True contractions get stronger and closer together with time and pain starts in the lower back.

How should a pregnant patient be positioned for delivery?

A pillow should be placed under hips to elevate 2 to 4 inches. Support the head, neck and back.

How to handle a nuchal cord?

gently unloop if possible

Post delivery care

• If willing, hand newborn to mother, cover with blanket

• Dry the newborn

• Wrap newborn in a clean towel or blanket

What is the Apgar score?

The standard scoring system used to assess the status of a newborn where a numeric value (0, 1, or 2)to five areas of activity of the newborn:

• Appearance

• Pulse

• Grimase/irritability

• Activity/muscle tone

• Respirations

How to ventilate a newborn

Use a newborn bag-mask, begin ventilation with high flow O2 at 40-60 breaths per min. Use gentle pressure to make chest rise and fall good.

What can be done to help postpartum hemorrhage?

Fundal massage.

How to deal with a breech delivery?

• Immediate transport

• Insert fingers in vagina to prevent the walls from compressing the fetus’s airway

What to do when the umbilical cord is prolapsed?

• Transport and keep the fetus’s head from compressing the cord

• Position the patient to prevent the weight of the fetus off the umbilical cord

• Insert sterile gloved hand in vagina and push the head away from the umbilical cord

• Keep pressure off the cord continuously

• Administer high-flow O2