Maternity

o Day 1 of cycle = First day of menses (bleeding) Ovulation on Day 14

28 days total Sperm 3-5 days, Eggs 24 hrs Fertilization in Fallopian Tube
o Chadwicks Sign = Bluing of Vagina (early as 4 weeks)
o Hegars Sign = Softening of isthmus of cervix (8 weeks)
o Goodells Sign = Softening of Cervix (8 weeks)
o Pregnancy Total wt gain = 25-30 lbs (11-14 kg)
o Increase calorie intake by 300 calories/day during PG Increase protein
30 g/day Increase iron, Ca++, Folic Acid, A & C
o Dangerous Infections with PG TORCH = Toxoplasmosis, other, Rubella,
Cytomegalovirus, HPV
o Braxton Hicks common throughout PG
o Amniotic fluid = 800-1200 mL (< 300 mL = Oligohydramnios = fetal kidney
problems)
o Polyhydramnios and Macrosomia (large fetus) with Diabetes
o Umbelical cord: 2 arteries, 1 vein Vein carries oxygenated blood to fetus
(opposite of normal)
o FHR = 120-160
o Folic Acid Deficiency = Neural tube defects
o Pre-term = 20-37 weeks
o Term = 38-42 weeks
o Post-term = 42 weeks+
o TPAL = Term births, Pre-term births, Abortions, Living children
o Gravida = # of Pregnancies regardless of outcome
o Para = # of Deliveries (not kids) after 20 wks gestation
o Nagales Rule Add 7 days to first day of last period, subtract 3 months,
add 12 months = EDC
o Hgb and Hct a bit lower during PG due to hyperhydration
o Side-lying is best position for uteroplacental perfusion (either side tho left
is traditional )
o 2:1 Lecithin:Sphingomyelin Ratio = Fetal lungs mature
o AFP in amniotic fluid = possible neural tube defect
o Need a full bladder for Amniocentesis early in PG (but not in later PG)
o Lightening = Fetus drops into true pelvis
o Nesting Instinct = Burst of Energy just before labor
o True Labor = Regular contractions that intensify with ambulation, LBP that
radiates to abdomen, progressive dilation and effacement
o Station = Negative above ischial spines, Positive below
o Leopold Maneuver tries to reposition fetus for delivery
o Laboring Maternal Vitals Pulse < 100 (usually a little higher than normal
with PG - BP is unchanged in PG). T < 100.4
o NON-Stress Test Reactive = Healthy (FHR goes up with movements)
o Contraction Stress Test (Ocytocin Challenge Test) Unhealthy = Late
decels noted (positive result) indicative of UPI Negative result = No late
decels noted (good result)
o Watch for hyporeflexia with Mag Sulfate admin . . . Diaphragmatic
Inhibition
Keep Calcium gluconate by the bed (antidote)
o Firsts
Fetal HB 8-12 weeks by Doppler, 15-20 weeks by fetoscope
Fetal movement = Quickening, 14-20 weeks
Showing = 14 weeks
Braxton Hicks 4 months and onward
o Early Decels = Head compression = OK
o Variable Decels = Cord compression = Not Good
o Late Decels = Utero-placental insufficiency = BAD!
o If Variable or Late Decels Change maternal position, Stop Pitocin,
Administer O2, Notify Physician
o DIC Tx is with Heparin (safe in PG) Fetal Demise, Abruptio Placenta,
Infection
o Fundal Heights
12-14 wks At level of symphysis
20 weeks 20 cm = Level of umbilicus
Rises ~ 1 cm per week
o Stages of Labor
Stage 1 = Beginning of Regular contraction to full dilation and effacement
Stage 2 = 10 cm dilation to delivery
Stage 3 = Delivery of Placenta
Stage 4 = 1-4 Hrs following delivery
o Placenta Separation Lengthening of cord outside vagina, gush of blood,
full feeling in vagina Give oxytocin after placenta is out Not before.
o Schultz Presentation = Shiny side out (fetal side of placenta)
o Postpartum VS Schedule
Every 15 min X 1 hr
Every 30 min X next 2 hours
Every Hour X next 2-6 hours
Then every 4 hours
o Normal BM for mom within 3 days = Normal
o Lochia no more than 4-8 pads/day and no clots > 1 cm Fleshy smell is
normal, Foul smell = infection
o Massage boggy uterus to encourage involution empty bladder ASAP
may need to catheterize Full bladder can lead to uterine atony and
hemorrhage
o Tears 1st Degree = Dermis, 2nd Degree = mm/fascia, 3rd Degree = anal
sphincter, 4th Degree = rectum
o APGAR = HR, R, mm tone, Reflex irritability, Color 1 and 5 minutes 7-
10 = Good, 4-6 = moderate resuscitative efforts, 1-3 = mostly dead
o Eye care = E-mycin + Silver Nitrate for gonorrhea
o Pudendal Block = decreases pain in perineum and vagina No help with
contraction pain
o Epidural Block = T10-S5 Blocks all pain First sign = warmth or tingling
in ball of foot or big toe
o Regional Blocks often result in forceps or vacuum assisted births because
they affect the mothers ability to push effectively
o WBC counts are elevated up to 25,000 for ~10 days post partum
o Rho(D) immune globulin (RhoGAM) is given to Rh- mothers who deliver
Rh+ kids Not given if mom has a +Coombs Test She already has
developed antibodies (too late)
o Caput Succedaneum = edema under scalp, crosses suture lines
o Cephalhematoma = blood under periosteum, does not cross suture lines
o Suction Mouth first then nostrils
o Moro Reflex = Startle reflex (abduction of all extremities) up to 4 months
o Rooting Reflex up to 4 months
o Babinski Reflex up to18 months
o Palmar Grasp Reflex Lessens by 4 months
o Ballard Scale used to estimate gestational age
o Heel Stick = lateral surface of heel
o Physiologic Jaundice is normal at 2-3 days Abnormal if before 24 hours
or lasting longer than 7 days Unconjugated bilirubin is the culprit.
o Vitamin K given to help with formation of clotting factors due to fact that
the newborn gut lacks the bacteria necessary for vitamin K synthesis initially
Vastus lateralis mm IM
o Abrutio Placenta = Dark red bleeding with rigid board like abdomen
o Placenta Previa = Painless bright red bleeding
o DIC = Disseminated Intravascular Coagulation clotting factors used up
by intravascular clotting Hemorrhage and increased bleeding times result
Associated with fetal demise, infection and abruptio placenta.
o Magnesium Sulfate used to reduce preterm labor contractions and prevent
seizures in Pre-Eclampsia Mg replaces Ca++ in the smooth mm cells
resulting relaxation Can lead to hyporeflexia and respiratory depression
Must keep Calcium Gluconate by bed when administering during labor =
Antidote Monitor for:
Absent DTRs
Respirations < 12
Urinary Output < 30/hr
Fetal Bradycardia
o Pitocin (Oxytocin) use for Dystocia If uterine tetany develops, turn off
Pitocin, admin O2 by face mask, turn pt on side. Pitocin can cause water
intoxication owing to ADH effects.
o Suspect uterine rupture if woman complains of a sharp pain followed by
cessation of contractions
o Pre-Eclampsia = Htn + Edema + Proteinuria
o Eclampsia = Htn + Edema + Proteinuria + Seizures and Coma Suspect if
Severe HA + visual disturbances
o No Coumadin during PG (Heparin is OK)
o Hyperemesis Gravidarum = uncontrollable nausea and vomiting May be
related to H. pyolori Reglan (metaclopromide)
o Insulin demands drop precipitously after delivery
o No oral hypoglycemics during PG Teratogenic Insulin only for control of
DM
o Babies born without vaginal squeeze more likely to have respiratory
difficulty initially
o C-Section can lead to Paralytic Ileus Early ambulation helps
o Postpartum Infection common in problem pregnancies (anemia, diabetes,
traumatic birth)
o Postpartum Hemorrhage = Leading cause of maternal death Risk factors
include:
Dystocia, prolonged labor, overdistended uterus, abrutio placenta, infection
Tx includes Fundal massage, count pads, VS, IV fluids, Oxytocin, notify
physician
o Jitteriness is a symptom of hypoglycemia and hypocalcemia in the newborn
o Hypoglycemia tremors, high pitched cry, seizures
o High pitched cry + bulging fontanels = IICP
o Hypothermia can lead to Hypoxia and acidoisis Keep warm and use
bicarbonate prn to treat acidosis in newborn.
o Lay on right side after feeding Move stomach contents into small
intestine
o Jaundice and High bilirubin can cause encephalopathy < 12 = normal
Phototherapy decomposes bilirubin via oxidation Protect eyes, turn every 2
hours and watch for dehydration The dangerous bilirubin is the
unconjugated indirect type.