Cindy OB HESI

1. menstrual phase: days 1-5 of cycle
2. proliferation/follicular phase: day 5 til ovulation
3. secretory/luteal phase:ovulation to 3 days before menstrual cycle
4. ischemic phase: approx. 3 days before and up to the onset of menstruation

rise in body temp
abundant cervical mucus, watery, clear and alkaline, stretchy egg white consistency
ferrying of mucus seen under microscope

outer (third) ampulla of the fallopian tubes

about 3-4 days

it takes 7-10 days to complete the process of implantation (nidation)

eggs live about 24 hours
sperm live from 48-72 hours, approx 3 days

0-2 weeks are zygotes
3-8 weeks are embryos
9-38+ weeks are fetus

during the embryonic stage of growth

13 weeks

1st trimester is from the first day of the last menstrual period up to13 weeks
2nd trimester from 14-26 weeks
3rd trimester from 27-40 weeks

softening of the cervix

softening of the isthmus of the cervix

bluing of the vagina

at 12 weeks

only about 300 calories more per day is necessary

quickening/movement is usually felt around 20 weeks, may be as early as 16 weeks but first time mothers don't usually notice it as early

as early as 16 weeks gestation

2-4lbs gained for the whole first trimester and approx one pound per week for the rest of the pregnancy

about 20 weeks

between 24-28 weeks gestation

about 28 weeks

approximately 32 weeks, this insulates the baby following birth

when the spouse experiences sympathy symptoms, weight gain, nausea, etc.

the number of times a woman has been pregnant, regardless of the outcome.

the number of deliveries (not children) that have occurred after 20 weeks gestation

T= term births
P= preterm births
A= abortions (spontaneous or elective)
L= living children

estimating date of birth by taking the date of the first day of the LMP, count back 3 months and add 7 days and one year

fish and red meats
cereals and yellow vegetables
green leafy vegetables and citrus fruits
egg yolks and dried fruits

left side, this promotes greatest blood flow and oxygenation to the fetus

fetal breathing movements
gross body movements
fetal tone
reactivity of fetal heart
amniotic fluid volume

chorionic villus sampling, removal of a small piece of villi during the period of time from 8-12 weeks gestation under ultrasound guidance.

results back in one week, for genetic testing, but does not replace amnio

removal of an amniotic fluid sample from the uterus, done as early as 14-16 weeks but can be done any time.

early on done for genetic testing, later done for lung maturity testing

spontaneous abortion
fetal injury
infection

FACT: when amniocentesis is done later in pregnancy, the bladder must be empty to prevent it from being punctured.

the time from its beginning to its end, on the strip, it is the width of the curve.

it is the beginning of one contraction to the beginning of the next contraction. 3-5 contractions must be measured

it is the height of the curve of the contraction at its peak, it is measured with an intrauterine pressure catheter after amniotic membranes have ruptured
30mmHg is mild, 70mmHg is strong at its peak

110-160 bpm

absent= no range detectable
minimal=up to 5bpm variation off of baseline
moderate =6-25 bpm variation off of baseline
marked=greater than 25 bpm variation off of baseline

hypoxia
acidosis
maternal drug ingestion (depressants)
fetal sleep pattern

may be a late sign of fetal hypoxia
medication induced slowing (narcotics or mag sulfate)
maternal hypotension
fetal heart block
prolonged umbilical cord compression

early sign of fetal hypoxia
fetal anemia
dehydration
maternal infection or fever
maternal hyperthyroid disease
medication induced (atropine, terbutaline)

change in maternal position
stimulate fetus if needed
stop pitocin
give O2 at 10L by mask
increase fluids
vaginal exam for cord prolapse
report to doctor and chart

change mom's position to knee chest to relieve pressure on cord, or push fetus off of ford and hold until c-section performed

later decals indicate uteroplacental insufficiency and are associated with conditions like post maturity, preeclampsia, diabetes mellitus, cardiac disease and abrubtio placentae

FACT: cord compression results in a pattern of variable decelerations

it is used to determine fetal well being in high risk pregnancy and is useful in post maturity cases.

a healthy fetus will usually show accelerations of at least 15 beats off of baseline, lasting at least 15 seconds, occurring twice in 20 minutes time, if the fetus responds this way it is healthy and considered "reactive"

percutaneous umbilical blood sampling, done during pregnancy under ultrasound guidance.
can test for hemoglobin, clotting disorders, sepsis and genetics

lung maturity, lung surfactant (LS) ratio of 2:1 or higher is needed.

there are four stages of labor:
1st: from beginning of regular contractions until 10cm dilation and 100% effacement
2nd: 10cm dilation to delivery of baby
3rd: from delivery of baby until delivery of placenta
4th: the time after delivery of placenta, approx. 2hrs recovery

latent phase: beginning of true labor to 3-4cm dilation, contractions 10-20 min apart and last 15-40 seconds
active phase: 4-7cm dilation, contractions 2-3 minutes apart and last about 30-60 seconds
transition phase:8-10cm dilation, contractions about 1.5 min apart and last 60-90 seconds duration

feeling abdomen to determine fetal positioning

stage zero…if the baby is at a (-) it is above the ischial spines, if the baby is at a (+) it is below the ischial spines and closer to being outside the body.

the relationship of th long axis (spine) of the baby to the long axis (spine) of the mother, it can be longitudinal, transverse or oblique (slanted).

the position of the baby's parts to itself, either flexed or extended, flexion is desired.

heart rate (absent, fast, slow)
respiratory effort(no cry, weak, vigorous)
muscle tone (flaccid, slight flexed, very flexed)
reflex irritability (no response, grimace, cry or pulls away)
color (totally blue, blue extremities and pink core, totally pink)

apgar score taken at 1 and 5 minutes post delivery and again at 10 minutes if baby scores 6 or under at the five minute test.

IV is preferred over IM because IV is faster onset and the peak is faster and the duration of action is shorter, so less impact on baby.

IV: onset in 5 min, peak in 30 min, duration 1 hour

IM: onset in 30 min, peak 1-3 hrs, duration 4-6 hrs.

immediately turn onto left side
increase IV fluids
begin O2 at 10L/min by mask
notify doc and have ephedrine ready at bedside
monitor FHR

2-3 days postpartum

pale pinkish, brownish, lasting abt 1 week postpartum

thicker, whitish yellowish, lasts up to act 4 weeks postpartum

it is given to an rh negative mother who delivers an rh positive baby and has a negative coombs test. If the mother has a positive coombs test there is no need to give rhogam because the mother is already sensitized

taking in: dependency behaviors in the first 2 days, mom is needy

taking hold: most receptive to teaching, begins to take care of baby and focus less on self

letting go: confident in taking care of newborn and self.

when narcotics are given late in the L&D process and they impact the baby, causing decreased respirations and hypotonia (flaccid limbs)

can cause hypermagnesemia in neonate leading to depressed respirations, hypocalcemia and hypotonia

suction the mouth first, then the nares because stimulation of nares can make the baby inhale and possibly aspirate mucus in oral pharynx.

caput is edema under the scalp that crosses suture lines and is present at birth

cephalahematoma is blood under the periosteum and usually appears a few hours after birth, it does not cross suture lines. more localized and poses a greater risk for jaundice due to excess RBC breakdown

check to make sure it has three vessels, one vein (carrying oxygenated blood to fetus) and two arteries (carrying deoxygenated blood to placenta)

cord anomalies usually indicate cardiovascular or renal anomalies

rooting, baby turns head to touch
moro, startle reflex
tonic neck, turn head and arm and leg change position
babinski, foot stroked, toes fan
palmar grasp, fingers close if touched
plantar, toes grip if touched
stepping, lift baby upright and looks like it wants to walk or step

it leads to depletion of glucose and causes the neonate to use brown fat stores to maintain heat, this results in possible ketoacidosis and possible shock.

40-80mg/dL

if the baby's sugar is low, you may need to give little bit of glucose water, but follow with breast feeding asap because the protein and fats from the milk will keep blood sugars up and stable longer.

make a V shape with your fingers on bottom of foot, and do the stick outside the V areas, on the sides of the heel, not center.

occurs at 2-3 days of life and it is due to the immature liver's ability to keep up with RBC destruction and bind to blirubin.

unconjugated (unbound) bilirubin is the problem

it occurs before 24 hours old, or persists longer than 7 days

after 24 hours of ingestion of breast milk or formula.

a baby needs about 50 calories per pound of body weight or 108 calories per kilogram of body weight for the first 6 months

threatened: spotting without cervical changes

inevitable: moderate to heavy bleeding with tissue, open cervical os

complete: all products of conception are passed, cervix closed

septic: fever, abdominal pain, foul smelling discharge, bleeding from scant to heavy

missed: fetus is dead, placenta is atrophied but products of conception have not passed. cervix closed

recurrent/habitual: loss of three or more pregnancies

cerclage, a.k.a. McDonald suture is placed around cervix to close the os. Will be removed prior to birth if vaginal birth is planned.

when the chorionic villi degenerate into a bunch of fluid filled vesicles in grape like clusters.
an embryo is rarely present, this condition reacts like a pregnancy so the woman thinks she is pregnant but it is not viable. It may lead to cancer called choriocarcinoma

vaginal bleeding in first trimester
size and date discrepancy, uterus is larger than expected for gestational age
anemia
excessive nausea and vomiting
abdominal cramping
early symptoms of preeclampsia

because this condition causes an increase in hcg levels and these higher levels can lead to cancer, the woman's hcg levels will be tested frequently after she has the mass removed, to make sure they go down. Since pregnancy causes increased levels she shouldn't get pregnant so that the doctor can distinguish cancer risk .

abrupt placentae is when the placenta begins to separate or pull away from the inside of the uterus. The abdomen will be board like and the woman in extreme pain, also may have dark red bleeding

placenta pre via is painless, bright red bleeding due to the placenta being attached at the bottom of the uterus. No vaginal exams should be performed due to risk to fetus.

disseminated intravascular coagulation syndrome. It is an abnormal clotting issue due to depleted clotting factors, it causes widespread external and internal bleeding.

It is related to fetal demise, infection and sepsis, pregnancy induced hypertension (preeclampsia) and abruptio placentae.

1st trimester: Hgb less than 11g/dL and Hct less than 37%

2nd trimester: Hgb less than 10.5g/dL and Hct less than 35%

3rd trimester: Hgb less than 10g/dL and Hct less than 32%

*levels are the lowest in the 3rd trimester.

constipation
diarrhea
gastric irritation
nausea or vomiting

REMEMBER: take iron supplements with vitamin C to increase absorption.

if taken with eggs, milk or cereal it may decrease absorption

may turn stools dark green or black

chlamydia, HPV, gonorrhea, syphilis, toxoplasmosis, hepatitis, rubella, cytomegalovirus (CMV), herpes virus, HIV/AIDS, bacterial vaginosis, candida albicans yeast infections, trichomoniasis

it is related to cat letterboxes, gardening and raw meat...

if the woman has not had rubella or her immunity is low, she should stay away from sick people during pregnancy and after she gives birth she should be given the rubella vaccine. Since it is a live vaccine she should not get pregnant for three months due to teratogenic effects on the fetus, but she can still breastfeed.

FACT: adolescents need more nutrition during pregnancy since they are not fully developed themselves and they are growing another person.

the onset of labor between 20 and 37 6/7 weeks.

diabetes, cardiac disease, preeclampsia and placenta previa, infections (especially UTI) over distention of uterus from multiple fetuses or too much fluid (hydraminos) or a large for gestational age baby

calcium gluconate.

tocolytic drugs:

ritodrine
terbutaline
magnesium sulfate
nifedipine
indomethacin

these drugs can relax muscles and depress the CNS so watch respirations, also, tachycardia is a major side effect of tocolytic drugs so monitor pulse prior to using.

difficult birth resulting from any cause.

power (contractions)
passage (size of pelvis)
passenger (fetus or placenta)
psyche (woman's response to labor)
position (position of woman)

if you know pelvis is too small to accommodate baby (cephalopelvic disproportion)
fetal stress
placenta previa
prior classical incision of uterus (top to bottom/vertical)
active genital herpes infection
floating fetus
unripe cervix

women with previous uterine scars are prone to rupture, this is a medical emergency, requiring immediate surgery to save both mom and baby.

BP elevation occurs for the first time after mid pregnancy

there is NO proteinuria present

gestational hypertension, with no other signs of preeclampsia, it is present at time of birth.

it usually occurs after 20 weeks gestation, it involves gestational hypertension AND protienuria.

seizures (with no known cause, such as epilepsy) that occur in women with preeclampsia.

HTN that is observed before pregnancy or diagnosed before the 20th week of pregnancy

it is characterized by an increase in BP of 30mmHg systolic or 15 mmHg diastolic over the previous usual baseline with other S&S of preeclampsia

preeclampsia
eclampsia, seizures and coma
HELLP syndrome

there is no known cause of preeclampsia

hemolysis
elevated liver enzymes
and
low platelets

family hx of diabetes
hx of more than 2 spontaneous abortions
hydraminos
previous baby over 4000g (9lbs)
high parity
obesity
recurrent (monilial) yeast infections
glycosuria

between 24-26 weeks gestation

suspected if glucose is greater than 140 mg/dL after one hour, then a 3 hour tolerance test needs to be done.

anesthesia complications
complications of abdominal surgery
sepsis
thromboembolism
injury to the urinary tract

FACT: abdominal surgery like cesarean, can cause paralytic ileus, symptoms may include absent bowel sounds and distentions, early ambulation can help.

uterine atony
lacerations of the vagina
hematoma
retained placental fragments
full bladder
high parity (lots of pregnancies)
dystocia and prolonged labor
cesarean delivery
over distention of uterus
abruptio placentae
previous hx of hemorrhage
infection
placenta previa

fundal massage!!!!
notify doctor if the funds does not become firm with massage
count and weigh pads to estimate blood loss
assess and record vitals
increase IV fluids
administer oxytocin as prescribed

it may indicate hypoglycemia, hypocalcemia or possibly drug withdrawal

babies cannot shiver so if they get too cold their bodies need to compensate by burning brown fat. baby may experience tachypnea and tachycardia.

excessive accumulation of bilirubin (usually unconjugated) in the blood due to RBC hemolysis.

Rh incompatability
ABO incompatability
induction using oxytocin because of IUGR
prematurity
sepsis
perinatal asphyxia
maternal diabetes mellitus or infections
cephalahematoma

apply pressure with thumb over bony prominences to blanch skin and check for yellowing, in areas like nose, forehead and sternum.

in dark skinned its, look at conjunctival sac and oral mucosa

irritability
hyperactivity/jittery
high pitched cry
coarse flapping tremors
poor feeding, frantic sucking, vomiting and diarrhea
nasal stuffiness

microcephaly (small head)
growth retardation
short palpebral fissures
maxillary hypoplasia
strabismus
abnormal palmar creases
irregular hair whorls
poor suck
cleft lip
cleft palate
small teeth

mental retardation
hyperactivity
developmental delays
attention deficits
poor coordination
facial abnormalities
irritability
cardiac and joint abnormalities