Maternal Newborn Nursing Study Notes

Maternal Newborn Nursing Overview

  • Focus on disorders and complications in maternal newborn nursing.

  • Main responsibilities of LPNs in this field:

    • Patient education.

    • Communication of warning signs to patients.

    • Safety protocols and direct communication with doctors.

  • Advanced topics will be covered in future semesters.

Female Reproductive System Overview

  • The female reproductive system is depicted in a diagram. Details about anatomy not covered extensively.

Fetal Development

Key Components of Fetal Development

  • Topics include placenta, umbilical cord, amniotic fluid, and expected growth.

The Placenta

  • Type and Structure:

    • Formed from both fetal and maternal tissues.

    • Disc-shaped organ.

  • Functionality:

    • Contains fetal tissue with chorionic villi.

    • Villi embed to form fetal blood vessels.

    • Divided into compartments to separate maternal and fetal blood, ensuring metabolic gas and nutrient exchange.

    • Nutrients and gases exchanged through diffusion.

    • The placenta acts as a lifeline for the fetus, connecting to the mother for nutrient transport.

  • Post-Delivery Checks:

    • After delivery, the placenta must be examined for completeness.

    • Retained fragments may increase hemorrhage risk.

Images of the Placenta

  • Top side: Silvery appearance.

  • Bottom side: Bloody appearance.

The Umbilical Cord

  • Structure:

    • Composed of two arteries and one vein (remember as AVA: artery, vein, artery).

  • Protective Features:

    • Surrounded by Wharton's Jelly, providing firmness and protecting vessels.

  • Length: Approximately 55 cm.

  • Functions:

    • The vein carries oxygenated blood and nutrients to the fetus.

    • Arteries transport waste and carbon dioxide back to the mother.

    • Importance emphasized for umbilical cord cutting practices.

Amniotic Fluid

  • Composition:

    • Mainly water; includes proteins, carbohydrates, lipids, fetal cells, lanugo, and vernix caseosa.

  • Production:

    • Mainly produced by fetal kidneys, with a clear appearance in early pregnancy.

  • Functions:

    • Acts as a cushion, protects fetus, promotes symmetrical development, and regulates fetal temperature.

  • Abnormal Signs:

    • If the water breaks and is murky or has an odor, it requires immediate medical attention.

Fetal Development Stages

Month-by-Month Overview

  • Month 1:

    • Fertilized egg develops an amniotic sac; placenta starts to form.

    • Primitive face starts to form; heart begins to beat by week four.

  • Month 2:

    • Facial features develop, including ears, limbs, and early organ formation.

    • Baby is approximately 1 inch long by month’s end.

  • Month 3:

    • All organs and extremities fully formed.

    • Fetus is about 4 inches long and weighs around 1 ounce.

  • Month 4:

    • Visible development of nails and reproductive organs.

    • Heartbeat audible by Doppler.

  • Month 5:

    • Movement begins; hair growth starts (lanugo).

    • Baby around 10 inches long and weighs about 1 pound.

  • Month 6:

    • Baby responds to stimuli; visible veins.

    • Approximately 12 inches long and weighs around 2 pounds.

  • Month 7:

    • Development of body fat; hearing becomes fully developed.

    • Baby is about 14 inches long.

  • Month 8:

    • Brain development and coordinated reflexes begin.

    • Baby is about 18 inches and 5 pounds.

  • Month 9:

    • Final growth and preparation for delivery.

    • Baby’s average length is between 18 to 20 inches and weighs around 7 pounds.

Pregnancy and Prenatal Care

Signs and Symptoms of Pregnancy

Presumptive Signs

  • Changes experienced subjectively by the client:

    • Amenorrhea (absence of menstruation).

    • Fatigue, nausea, breast changes, quickening (movement felt by the mother).

Probable Signs

  • Signs tracked by the examiner that suggest pregnancy, but could relate to other conditions:

    • Abdominal enlargement.

    • Hegar’s sign: Softening of the lower uterus.

    • Chadwick’s sign: Violet or bluish discoloration of the cervix and mucus.

    • Godel’s sign: Softening of the cervical tip.

    • Braxton Hicks contractions: False, irregular, and painless contractions not indicative of true labor.

Positive Signs

  • Definitive indicators of pregnancy:

    • Fetal heart sounds detectable.

    • Visualization of the fetus via ultrasound.

    • Fetal movements palpated by a qualified examiner.

Laboratory Tests for Early Pregnancy Confirmation

Human Chorionic Gonadotropin (hCG)

  • Secreted post-implantation, detectable 7-8 days prior to expected menses via:

    • Blood Test: Indicates multiples if values are high; lower values may suggest miscarriage.

    • Urine Test: Home pregnancy tests; ideal to test with the first morning urine for accuracy.

  • Risk of false positives/negatives influenced by certain medications (e.g., diuretics, anticonvulsants).

Estimated Delivery Date (EDD) Calculation

Nygold’s Rule

  • Calculate EDD by:

    • First day of the last menstrual period.

    • Subtract 3 months, add 7 days, change the year if necessary.

  • Practical examples are necessary for understanding EDD calculations.

GTPAL Acronym Explained

GTPAL: Gravidity, Term, Preterm, Abortion, Living

  • G (Gravidity): Total number of pregnancies (including current).

  • T (Term): Number of term births (born after 37 weeks).

  • P (Preterm): Number of preterm births (from 20 weeks to 37 weeks).

  • A (Abortion): Any loss or termination prior to 20 weeks (miscarriages count here).

  • L (Living): Number of currently living children.

Additional Terminology

  • Nulligravida: A patient who has never been pregnant.

  • Primigravida: A client in their first pregnancy.

  • Multigravida: A client with two or more pregnancies.

Physiological Changes During Pregnancy

  • Changes include skin hyperpigmentation, compression of inferior vena cava, and fundal height measurement.

  • Fundal height usually correlates with weeks of gestation measured in centimeters; indicates fetus growth and development.

  • Variances beyond 2 cm may indicate conditions like macrosomia, polyhydramnios, or intrauterine growth restrictions.

Conclusion

  • Understanding these concepts is critical for nursing practice in maternal newborn nursing.

  • Focus on patient safety, education, and physiological changes during pregnancy is essential for effective nursing care and outcomes.