Maternity Nursing Review

Thinning of the Cervix

• Effacement: Thinning of the cervix.
• Dilation: Opening of the cervix.
• Station: Descending of the fetus.

Pelvis Types

• Gynecoid pelvis: Most favorable for vaginal delivery.
• Android pelvis: Male pelvis.
• Anthropoid pelvis.
• Platypoid pelvis: Least favorable.

Preeclampsia

• Key Signs:
  • Blood pressure > 140/90. Any blood pressure above this range warrants attention.
  • Blurred vision and headache.
• Be on guard for preeclampsia in pregnant women exhibiting these signs.

Placenta Previa

• Contraindications:
  • Nothing should be inserted into the vagina.
  • Deliver via C-section.
  • Abdominal ultrasound is indicated, and transvaginal ultrasound is contraindicated.
• Reason for Contraindication:
  • Risk of hemorrhage due to potential puncture of the placenta, endangering both mother and baby.

Sexually Transmitted Diseases (STDs)

• Syphilis: Vaginal birth is NOT contraindicated; babies are treated with antibiotics, and eye drops are administered.
• Herpes: If the patient has an active breakout or has had one within the last few weeks, a vaginal delivery is contraindicated.

Rubella Exposure

• Best Action: Contact the provider and review titers.
• Rubella titer is checked at the beginning of pregnancy to check for immunity.
• A booster vaccine cannot be administered during pregnancy.

Fetal Heart Rate Patterns

• Accelerations: Generally indicate good oxygenation and tissue perfusion; a good sign.
• Variable Decelerations: Associated with cord compression (VEAL CHOP).
• Early Decelerations: Associated with head compression (VEAL CHOP).
• Late Decelerations: Not good.
• Marked Variability: Clinical significance not well known.
• VEAL CHOP:
  • V: Variable decelerations, C: Cord compression.
  • E: Early decelerations, H: Head compression.
  • A: Accelerations, O: Okay.
  • L: Late decelerations, P: Placental insufficiency

Placenta Previa Presentation

• Painless bright red bleeding.

Abruptio Placentae Presentation

• Painful dark red bleeding.

Uterine Rupture Presentation

• Sudden abdominal pain.

UTI Presentation

• Painful urination.

Disseminated Intravascular Coagulation (DIC)

• Hallmark Feature: Uncontrolled bleeding due to depletion of clotting factors following excessive clotting.
• Symptoms: Bleeding from IV sites, Foley catheters, gums, etc.
• Treatments: Blood transfusions, administering platelets and fibrinogen.

Umbilical Cord Prolapse

• Nursing Priority: Trendelenburg or knee-chest position.
• Simultaneously: Call for help as it's an emergency.

Toxic Shock Syndrome

• Key Sign: Sunburn-like rash and fever.
• Lupus Rash: Butterfly rash.

Fetal Heart Rate

• Normal Range: 110-160 bpm.
• Outside Normal Range: Seek help.
• Below Normal: Could be due to hemorrhage.
• Above Normal: Usually indicative of a fever; if elevated without maternal fever, suspect impending fever.

Risk Factors for Postpartum Hemorrhage

• Instrumented delivery (forceps or vacuum).
• Precipitous delivery.
• Gestation greater than 41 weeks.
• Preeclampsia.
• Prolonged labor.
• Lots of Pitocin use.

Chorioamnionitis

• Signs and Symptoms: Fetal tachycardia, maternal tachycardia, and fever.
• If the baby's heart rate is >180 bpm and the mother has no fever, suspect the mother will soon develop a fever due to chorioamnionitis.

Braxton Hicks Contractions

• Benign practice contractions.
• Instruct the patient to return if contractions become stronger and increase in duration and intensity.

Postpartum Depression

• Onset: May appear two weeks postpartum.
• Symptoms: Persistent signs of withdrawal and sadness, difficulty bonding with the baby.
• Postpartum Blues: Occurs a few days after birth and typically resolves.

Mastitis

• Symptom: Painful, red, swollen area of the breast.

Acrocyanosis

• Bluish discoloration of the hands and feet with a pink trunk.
• Normal in newborns due to the body prioritizing blood flow to vital organs.
• Cyanosis: Blue lips and face is an emergency.

DIC Risk

• Key Sign: Bleeding that doesn't stop easily.
• Manifestation: Oozing from IV sites and gums; hemorrhaging.
• Treatment: Transfuse with platelets and fibrinogen.

Medications Contraindications

• Methergine: Contraindicated in patients with hypertension; may cause a hypertensive stroke.
• Hemabate: Contraindicated in asthmatics; can cause respiratory spasm requiring intubation.

Heat Loss Prevention in Newborns

• Evaporation: Dry the infant with towels immediately after birth.
• Conduction: Place under a heat lamp, closing a window

Fetal Heart Rate Decelerations

• Early Decelerations: Indicate head compression.
• Late Decelerations: Indicates placental insufficiency; often seen with maternal hypotension.
• Maternal Hypotension: Can manifest as placental insufficiency and late decelerations; address hypotension to resolve.