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.