Maternal Health and Labor Notes
Overview of Hypertension in Pregnancy
Symptoms: Patients may exhibit various symptoms related to hypertension, including:
Protein in urine
Headaches
Episodes of irritability
Edema (swelling)
Visual disturbances
Note: Avoid memorizing all diagnostic criteria; focus on familiarizing yourself with the symptoms and risks.
Hypertensive Disorders of Pregnancy
Key Terms: Important terms to remember that relate to hypertension include:
Gestational Hypertension
Preeclampsia
Eclampsia
HELLP Syndrome
Association: All these terms should trigger thoughts of hypertension in patients.
Preeclampsia: A specific form of gestational hypertension, which, if left unmanaged, can progress to eclampsia.
Risk Factors for Hypertensive Disorders
Maternal age:
Risk is increased for those younger than 19 or older than 40.
First pregnancy
Obesity (extreme obesity is a risk factor)
Multifetal gestation (carrying multiples)
Chronic hypertension (pre-existing)
Family history of hypertension
Diabetes mellitus history
Clinical Findings Associated with Preeclampsia
High Blood Pressure: Onset occurs after 20 weeks of gestation.
Proteinuria: Presence of protein in urine; specific levels (e.g., 300 mg in 24 hours) are given but not essential to memorize as a student.
Cerebral and Visual Symptoms:
Severe headache not relieved by analgesics
Nausea
Blurred vision, spots, or floaters in vision
Seizure Risk: Preeclampsia can progress to eclampsia, where seizures occur.
Diagnostic Procedures and Nursing Care
24-hour Urine Collection: A procedure to assess protein levels in the urine.
Patients need to collect urine (excluding the first void) over a 24-hour period.
Urine is stored in a large container, typically refrigerated.
Patient Education: Emphasize the importance of baby activity monitoring (kick counts) and reporting any significant changes to their healthcare provider.
Scheduled Non-Stress Tests may be initiated for monitoring.
Management Strategies for Preeclampsia
Self-Monitoring: Encourage monitoring of blood pressure at home.
Activity Regulation: May require bed rest to manage blood pressure and keep the baby healthy.
Medications:
Common medications include labetalol and hydralazine; more advanced treatments will be covered in future courses.
Magnesium sulfate might be administered for severe cases.
Delivery Consideration: Uncontrolled high blood pressure may necessitate early delivery.
Stages of Labor
Labor Signs: Major signs that labor is approaching include:
Pelvic pain, often described as a "lightning crash" effect.
Weight loss and increased vaginal discharge (bloody show).
Braxton Hicks contractions (practice contractions).
Energy bursts or nesting behavior.
True vs. False Labor
True Labor:
Regular contractions that increase in frequency and intensity.
Cervical changes (effacement and dilation).
The 5-1-1 Rule: contractions every five minutes, lasting one minute, over the course of one hour.
False Labor:
Irregular contractions, no cervical change.
Activity diminishes or halts contractions.
Rupture of Membranes (ROM)
Timing: If water breaks, labor typically starts within 24 hours; otherwise, risk for infection increases.
Cord Prolapse Risk: If the cord comes out with the fluid, it is an emergency situation.
Amniotic Fluid Evaluation: Observations include color, quantity, odor, and timing of rupture.
Cervical Assessment
Cervical Dilation: Measured at 1-10 cm; documented as number of centimeters (e.g., "Fundus at U").
Cervical Effacement: Describes the thinning and shortening of the cervix.
Fetal Station: Position of the baby's head compared to the ischial spine; negative numbers indicate higher positions, positive indicate lower positions nearing crowning.
Complications Related to Fetal Position
Breech Presentation:
Baby is butt-first during delivery; can complicate the birthing process.
Sunny Side Up (Occiput Posterior): Baby is face up; often results in increased back pain and complications during delivery.
Leopold's Maneuver: A technique used to assess fetal position externally by palpating the abdomen.
Postpartum Assessment (BUBBLE)
B: Breasts
Monitor for tenderness, redness, and evaluate for signs of breastfeeding readiness.
U: Uterus
Should be firm and centered at the umbilicus within 6-12 hours postpartum, dropping 1 fingerbreadth daily.
B: Bowel Function
Assess for bowel movement (BM) readiness and use stool softeners if necessary.
B: Bladder Function
Ensure adequate voiding and monitor for urinary retention.
L: Lochia
Monitor for bleeding amount and color; classified as scant, light, moderate, or heavy.
E: Episiotomy Assessment
Assess the perineum following delivery using the REEDA scale (Redness, Ecchymosis, Edema, Discharge, Approximation).
Pain Management and Recovery Post-Delivery
Perineum Care: Utilizing warm water sprays during urination can alleviate discomfort due to perineal tears or episiotomies.
Nursing Consideration: Use of ice packs, sitz baths, and over-the-counter pain relief as appropriate.