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.