OB
Probable sign of pregnancy
…Goodell’s sign (softening of the
cervix)
…enlargement of uterus
Positive sign of pregnancy
…fetal movement
…quickening
…fetal heart beat
Chloasma / melasma – brown
spots on face
Striae gravid arum – stretch mark
on abdomen
Linea nigra – dark vertical line on
abdomen
Chadwick’s s/ - discoloration of
vagina
Amniocentesis – detects maturity
of the fetus
UTZ – gender of the fetus
Chorionic villus sampling –
detects presence of genetic d/o
or fetal abnormality
LMP – 3 months + 7 days =
EDP/EDC
Urine samples in p-test = (+)
chorionic gonadotropin
Rich in Hgb thus iron (livers,
tomato, dried apricots, peas,
prune juice)
Chloasma – mask of pregnancy
Increased vaginal discharge /
bleeding – danger sign of
pregnancy, due to uterine
atony or laceration
Colostrums – (+) in 4th month
Pregnant woman’s breast -
colostrums, tingling sensation
& darkening of areola; no
increased in size
Breast tenderness on first
trimester
Safe to give antibiotics during the
first trimester
Constipation if best treated with
increased bulk and fluid in diet
Normal glycosuria, abnormal with
oliguria
Release of ovarian follicle
happens on the 14th or 15th day
of cycle
Quickening and fetal heart beat –
20th week
If vaginal bleeding occurs, call
the physician first and report
the amount and type of
bleeding
Toxoplasmosis – risk factor is
having a cat in one’s house
True labor – increasing in
frequency and duration
Childbirth education – to have an
emotionally satisfying birth
experience
In birthing center, if both parents
are anxious, demonstrate
comfort measures the father
may use
When a 2-yr old sibling of the
born child seems interested,
this is just his part of
developmental level
Normal = lower abdominal pain
may be experienced at the
time of rupture of the follicle
Cervix 2 cm dilated, moderate
bright red vaginal bleeding =
inevitable abortion
Initial nursing mgt = examine
perineal pads for tissues and
clots
Baby is no longer alive but the
body has not expelled it yet =
missed abortion
McDonald’s procedure = will be
sutured temporarily, to be
removed at term. Important to
recognize the s/sx of labor
Ectopic pregnancy – spotting,
lower abdominal pain radiating
to shoulders
High risk factor is having 3
consecutive spontaneous
deliveries
Placenta previa – small amount of
bright red bleeding, painless,
caused by abnormal
implantation of the placenta
Initial action is to estimate
amount of blood loss, then
keep on bed rest and limit
physical activity
Abruption placenta – bright red
blood, painful
Predisposing factor – multiple
pregnancy
Further assessment – abdominal
examination for s/sx of
tenderness or rigidity
Initial nursing mgt – administer
O2
Complication – DIC (disseminated
intravascular coagulation
syndrome)
S/sx – venipuncture site continues
to bleed for 15 mins
(+)meconium staining in vaginal
discharge – check fetal heart
tome and apply external fetal
monitor first before calling
physician
Prevent convulsion – keep room
dimly lit
Bed rest with PIH – reduce
pressure by lowering body
metabolism
Antagonist for MgSO4 – Ca
Gluconate
Has a minor effect to the baby
Insulin needs will vary throughout
the pregnancy
Diabetic baby – (+) tremors
Breastfeeding predisposes the
mother to infection
Potential problem for pregnant
with a hx of heart d’se –
reduced tolerance of activity
(+) pubertal acceleration in
growth of pregnant
adolescents – basic
consideration in pregnant
adolescents
Hazard – increased mortality rate,
increased incidence of anemia,
vaginitis, UTI, and PIH
Increased demand in iron during
pregnancy is due to an
expansion in total blood cell
volume and Hgb mass by
approx 25-50% during
pregnancy
Most impt ax when ROM occurs-
color of amniotic fluid
Rectal pressure – transitional
phase of labor
Variable deceleration - due to
cord compression
N – early deceleration and good
variability
Late deceleration is Abn
Fetal heart rate drops during
contraction and returns to
baseline at the end of
contraction is NORMAL
Fetal heart rate drops during
contraction and returns to
baseline a minute after
contraction is ABNORMAL
Late deceleration is observed –
turn off the oxytocin
immediately, then determine
the extent of cervical dilatation
Impt ax for mother given with
epidural anesthetic – monitor
BP
Most impt discharge instruction –
family planning information
Weight gain:
1st trim = 1 lb/wk = 12 lb
2nd trim = 1 lb/wk = 12 lb
3rd trim = 2 lb/mo = 6 lb
Total = 30 lbs
Some:
1st trim = 3 lb
2nd trim = 12 lb
3rd trim = 12 lb
Total = 27 lbs
Normal FTHR = 120 – 160 bpm
Teratogen – causes px defects on
the fetus
Placenta – carry nourishment,
empty waste, provide several
hormones
Amniotic fluid – prevents fetus
from external injury
Toxoplasmosis
Other infection (hepa a and b)
Rubella
Cytomegalovirus
Herpes simplex
Torch – group of d’se that harms
fetus
Umbilical vein – pathway of O2
Ampulla – fertilization
Isthmus – tied in tubal ligation
Meconium stain in breech
presentation = N
…in cephalic is abnormal = fetal
distress
To determine nutritional needs –
assess first what she eats now
High in calcium – green veggies
esp. broccoli
Milk – 4 servings daily, 1L, 4 cups
Iron is most impt in 2nd trim
Braxton hicks – painless
contractions
CI when having vaginal bleeding –
vaginal exam
Causes of vaginal bleeding
(ectopic or abortion, Hmole,
abruptio, previa)
Nursing care during the 1st
stage of labor
First stage of labor – dilatation of
the cervix 8 – 10 cm and
cervical effacement
Station – degree of descent of the
fetal head or presenting part
Back lying – hypotensive
Semi sitting – venacava
compression
Sim’s position – best and
preferred
FHR normally slows at the onset
of a contraction
FHR is abnormal if it slows at the
peak of the contraction, or
remains unchanged, or slows
immediately after a contraction
(late deceleration)
Transitional phase – most
encouragement and support is
effective when given
End of first stage of labor
(encouraging voiding,
breathing deeply, and lying on
left side; least appropriate is to
have client push with
contraction – 2nd stage of labor)
Nitrazine test – differentiate b/w
urine and amniotic fluid; blue –
af; red – blood
Distended bladder prevent the
descent of the fetus
Offer bedpan in frequent interval
Enema is ordered to prevent
contamination of feces when it
is expelled during delivery
Beginning of contraction until end
of it – duration
End of contraction until another
beginning – interval
Duration count in specified time –
frequency
To feel the contraction – place
hands just above the umbilicus
Feel the FHR during the
contraction and immediately
after the contraction
Prepare vaginal exam – clean
vulva
Very early stage of labor – offer
water or clear liquid because
solid foods result to vomiting
Position – presenting fetal body
part in relation to mother’s
pelvis
Primary reason for episiotomy –
prevent prolonged pressure on
fetal head
Primipara is taken into the
delivery room when the
perineum is bulging
Multipara is taken into the
delivery room when the cervix
is dilated 6-8 cm
ACTIVE - cont q15-20 mins, 10-
30 sec duration, mild intensity,
cervix 3 cm dilated
LATENT – cont q3-5 mins, 30-45
sec duration, mod intensity,
cervix 6 cm dilated; ambulate
TRANSITIONAL - cont q1-2
mins, 45-60 sec duration,
strong intensity, and cervix 8
cm dilated
Nursing care during the 2nd
stage of labor
Begins when cervix is fully dilated
Encourage to push down
Narcotic analgesic given late in
the first stage of labor – may
result in respi depression of the
newborn
To lessen discomfort – assume
sim’s pos’n
Pant b/w contractions
Observe for s/ of hyperventilation
– blurred vision and tingling of
extremities
Have the client breathe into a
small paper bag
Saddle block (subarachnoid
block) – take effect almost
immediately
Nursing care during the 3rd
stage of labor
Delivery of the newborn until
delivery of placenta and
membranes
Relax in b/w contractions –
delivery of the baby
Delivery of the placenta – push
with contraction
Clamp the cord after the cord
stops pulsating
s/e of oxytocin – water retention
and water intoxication
Oxytocin – strengthens
contractions of the uterus
Bonding b/w newborn and
parents – during first hour after
delivery
Prevent of loss of body heat –
placing under radiant source of
heat
Apply in lower conjunctival sac –
silver nitrate
Apgar – ax of physical condition
of the newborn
0-3 = immediate resuscitation
4-6 = guard the baby
7-10 = free from immediate
distress
Placental separation – sudden
gush of blood from the vagina,
lengthening of the umbilical
cord, upward rise in the uterus
Nursing care during the 4 th
stage of labor
Time when placenta is delivered
upto 2-4 hours after delivery of
the placenta
Fundus should be firmly
contracted in b/w navel and
symphisis pubis
After 12 hrs – level of navel
After 24 hrs – 1 cm below
umbilicus
Fundus should be checked for the
first hour every 15 minutes;
fundus should be massaged if
it feels soft and boggy
One hand on the fundus, other
just over the pubic bone
Nursing care during
postpartum
Delivery of newborn until 6 wks
after birth
Lochia:
1-3 rubra (bright red)
4-9 serosa (pink)
10-15 alba
Hematoma s/sx - swelling and
discoloration of the skin around
perineum, pain
Encourage ambulation to prevent
circulatory system problem
Complain of discomfort due to
episiotomy – place heat lamp
18-24 inches from the
perineum (as prescribed)
At home – sitz bath
1st 24 hr – cold
After 24 hr – hot
Propoxyphene HCL (Darvon) –
relieves pain
Perineal care – front to back
Breast engorgement – occurs on
the 3rd postpartum day
Taking in phase – 1-2nd day,
passive
Taking hold phase – holds
responsibility; 2-4th day
Postpartum blues – 1st 2 weeks,
withdrawal of maternal
hormones, hypothyroidism ,
lack of family support, dec
progesterone and estrogen and
inc prolactin
Postpartum depression – 6mos
to 1 yr
Postpartum psychosis –
requires hospitalization
Chronic sorrow – prolonged
grief
Complications of pregnancy
Bleeding
1st trim – abortion, ectopic
2nd trim – hmole, incompetent
cervix (weight of the fetus
causes the cervix to dilate)
3rd trim – apruptio (painful, hard
board like – couvelaire’s
uterus, premature separation
of normally implanted
placenta, in severe AP, observe
for shock) previa (painless,
check for decreased BP and
increased PR, abnormal
implantation)
Abundant vaginal discharge
during prenatal – infection, std,
protozoan flagellate
Hyperemesis gravid arum –
vomits 4 times / day,
emergency
Cause of PIH – unknown, common
among the poor
HEP (HPN, edema, proteinuria)
Convulsion – eclampsia, provide
safe env’t (dimly lit room)
Prepared drug – Mg SO4, 4-7
mEq/L
Nursing resp – check for RR,
reflexes (tendon and patellar),
and urine output (measures
hourly)
Ectopic – outside uterus, WOF
hemorrhage
Spontaneous abortion – occurs
without the client having done
anything to cause it
Threatened SA – observe for
uterine cramping and loss of
amniotic fluid
Glucose – 70 to 150 mg/dl
Problems – macrosomic baby,
larger than average
Constipation – increase fluid, high
fiber, exercise
Varicose – avoid crossing legs,
knees, and ankle
…gentle massage on affected
area
…elastic bandage
…contact physician if soreness,
redness, or warmth develops in
the veins (life threatening, can
cause embolism)
Skin itches – use of lotion on
areas of dryness
Edema on late pregnancy –
pressure of an enlarged uterus
on pelvic veins
Lower daily intake of salt – 3g/day
Also elevate legs and feet for
short periods during the day
Dyspnea is often normal during
third trimester
Urinary frequency during late in
pregnancy – enlarging uterus is
causing pressure on the
bladder
nd
2 month – less frequency
because uterus rises into the
abdominal cavity
Backache /pelvic rock – wear low
heeled shoes
Nausea / Heat5burn – sff
Calcium tabs – for leg cramps
Fetal alcohol syndrome – joint and
limb abnormalities,
microcephaly, abn cns
Newborns of mothers addicted to
narcotic such as heroin – suffer
withdrawal sx
Smoking – newborn is smaller
CS
Apply gel before fetal transducer
to improve conduction of
sound
Catheter – keep bladder empty
during the procedure
CS delivery – care is most likely of
that who undergone abdominal
surgery
Shock – hypo tachytachy
INC ICP – hyper bradybrady
Patient controlled analgesia –
device gives a larger than
normal dose of the drug to
provide instant pain relief
Postop abdominal distention –
ambulation
Multigravida, past babies came
fast..when shouts THA BABY IS
COMING!, provide immediately
a clean field for delivery
It head continues to crown, allow
head to emerge slowly and
deliver it between contraction.
NEVER push back firmly on the
head. NEVER place pressure on
the vaginal meatus. NEVER let
the legs close. NEVER slide
finger into the vagina and
delivers the head during
contractions
Most common fetal complication
in elective cs – prematurity
Major indication –
disproportionate is the fetal
head to birthing canal
Care for the young family
Crede’s prophylaxis – prevent
opthalmia neonatorum; silver
nitrate 1% sol’n, penicillin,
erythromycin (occurs in
contact with gonoccocus)
Inappropriate agent – mycostatin
(fungus)
Don’t rinse eyes after instillation
Administer within 2 hrs after birth
Vitamin K – antihemorrhagic;
anterior/lateral thigh; IM; being
administered because of
lacking bacterial flora in colon
Rectal temp – check for patency
(these days, not being
practiced)
F – 32 / 1.8
C x 1.8 + 32
Regurgitation of small amount of
mucus – suctions and
considers it normal
Hexacholorophene soap – can
cause neurologic damage
Healing of cord stump – 7th day
Initial ax – includes px
appearance, neurologic
reflexes, gestational age
Babinski – stroking foot from
heal to toe
Moro – providing sudden change
in equilibrium
Plantar – infant’s feet to touch
surface
Tonic neck reflex – flexion of
left arm and leg and extension
of the right arm and leg when
the head is turned toward the
right
Moro reflex absent and
diminished within first 24 hrs –
normal due to temporary
variation in CNS conditions
Sterile water for first feeding – if
it was aspirated due to GI
anomaly, sterile water is less
irritating to the lungs
Intercostal retractions – abnormal
Comfortable position in
breastfeeding the baby – lying
on your side
Sore nipples – expose nipples to
air after feeding
To break suction of the baby –
place finger in the corner of
the mouth
To alert baby to grab and hold –
brush the nipple against the
mouth
To make nipple more prominent –
hold it b/w 2 fingers
Physiologic weight loss – 5-10%
of its weight
Pregnant mother – additional 300
kcal
Lactating mother – additional 500
kcal
Maturational crisis- disequilibrium
related to anticipated
developmental task
Be directive and offer client
specific guidelines for reducing
stress
Milk production – prolactin; APT
Let down of milk – oxytocin
In 3rd trim where maternal
antibodies are transferred to
the fetus
IgG – most abundant, 80%,
crosses placenta
IgA – 15 %
IgM – largest macrophage, obese
member
IgA – colostrums
Black and sticky stool –
meconium stool; normal
Brick dust – normal; pinkish, brick
colored, powder stain stool
Opponent of circumcision – penile
ulceration and meatal stenosis
Proponent of it – physical hygiene
Cord care – wipe with alcohol on
and around it a couple times a
day; when it falls off, I can put
the baby down in bath water
PKU – for inherited cause of
mental retardation; early dx
Baby 3 day old, (+) jaundice –
physiologic; inability to
conjugate indirect bilirubin;
normal in 2nd to 3rd day;
disappears in 4th or 5th day
Pathologic – 1st 24 hrs
Preterm – born before 38th week
Preterm, posterm, sga, and lga –
all prone to hypoglycemia
SGA – 13 inches head (13.5), 11
inches chest (13), 21 and half
inches length, 6 and half lbs
(7); skin dry, desquamation,
loose folds, abdomen appears
sunken
Preterm and sga – highest risk for
mortality
Preterm 30 weeks – thick layer of
vernix, no palpable breast
tissue, soft pinna folded,
smooth soles without creases,
lanugo entirely, prominent
clitoris, widely separated labia,
no arm recoil
Hypothermia (immature cns
regulatory mechanism, tightly
flexed position, decreased
stores of brown fat and
glycogen)
Cold stress – compromised heat
production ability due to
decreased brown fat storage
Humidified O2 is warmed to
prevent cold stress
Other problem that may occur
with cold stress – increased
metabolic rate
Brown fat – abundant vascular
and nerve supply
Respi distress – head slightly
elevated and neck slighty
hyperextended to open airway
…due to decreased surfactant
Alveolar collapse – leads to respi
acidosis and metabs alkalosis
Retrolental fibrolpasia –
administer O2 at 40%
concentration or less
Dextrosix – detects presence of
hypoglycemia
Rationale: an IDM (infant of
diabetic mother) has
hyperinsulinemia and
decreased gluconeogenesis
Prone also to polycythemia –
increased RBC
Safe rule of thumb – offer 2 to 4
cc the first 24 hrs, then
 increase 1 cc every other
feeding to a max of 10 cc
Tube meas’t – ear to the
nose/mouth to the xyphoid
process
Lubricate with sterile water NOT
water based lubricant nor
petrolatum
15 cc is ordered; 5 cc is aspirated
= 15 – 5 = 10 cc is to be taken
Common cause of sepsis – group
B beta streptococcus and gram
negative organism
Asphyxia – inc CO2, ph under
7.35 and dec o2 level
Coombs test
RBC – direct
Plasma – indirect
Mother Rh (-) and type A
Baby Rh (+) and type O
= baby has jaundice due to Rh
incompatibility
Mother Rh negative
Baby Rh positive
…rhogam is ordered 72 hrs after
delivery to prevent maternal
antibody formation
Sepsis
Early sign – fever
Late signs – hyperactivity, poor
feeding, tachypnea
(+) hcg in the urine 10 days after
the missed period
Counting back s months from the
first day of last normal
menstrual period and aading 7
days
VDRL and Rubella titer – detects
syphilis and german measles
Albumin and glucose test –
detects kidney infection,
preeclampsia, and diabetes
Sudden vaginal discharge and
facial swelling SHOULD be
reported
Mood changes (ambivalence,
moodswings, self focused)
Nutrition: 4-6 servings of meat, 5-
6 of fruits and vegetables, 4 of
cereals, 4 of milk; NO FATS
AND SIMPLE CHO
Increased vit c: broccoli, baked
potato, cantaloupe, green
peppers
5th month – fundal height at the
umbilicus, FHT, fetal mov’t
Irritating vaginal discharge –
trichomonas or candida
albicans
Heartburn / Pyrosis – burning
sensation in esophageal area
that radiates upward, freq
burping of small amount of
sour tasting liquid; avoid
greasy foods and reaching for
items by bending at the knees;
to relieve, use of nonsodium
antacids (milk of Magnesia)
and sips of milk or hot tea
Preventing leg cramps at night –
decreasing milk intake and
increasing calcium lactate
Fertilization – fallopian tube
Single fertile ejaculation – 3 to 4
million; 3-5 cc; 1 tsp
Mitosis – cell division; same
number and pattern of
chromosomes
Zygote – union of male and
female gamete; 2 weeks
Cellular change (morula to
blastocyst to trophoblast)
Embryo – 2 weeks – 2 months;
organ development
Fetus – 2 months – delivery
Completion of fertilization – 7 to 9
days
Embedded ovum is surrounded
by deciduas basalis and
capsularis
Placenta’s primary purpose –
metabolic exchange b/w
maternal and fetal..
Body flexed, fetal heart beat,
neural tube closed, liver
conspicuous – 4 weeks
Digits well formed, ossification,
some movement – 8 weeks
Scalp hair, nails, kidney secretes
urine, sex determination,
meconium – 16 weeks (4mos)
Vernix, lanugo, teeth enamel and
dentin, fetal movement felt by
mother (quickening) – 20
weeks (5 mos)
Surfactant, pupils reacting to
light, eyebrows and eyelashes
– 28 weeks (7 mos)
Fetal circulation – high
vascular resistance
Ductus arteriosus – shunts blood
from pulmonary artery to the
descending aorta
…becomes ligamentum
arteriosum
Umbilical vein – carries arterial
blood from the placenta to the
fetus
Twins – gravida 1
Most likely to have twins – eldest
among options and
multigravida
Most likely to have down
syndrome – “ “
Genetic dx and counseling – 3
months or 12th week
Rheumatic heart disease
Class 1 – no limitation
Class 2 - slight
Class 3 - moderate
Class 4 – unable to carry on
activity
Major complication – increased
blood volume and potential
congestive heart failure; fetal
hypoxia and/or death
If delivered normally – should be
carefully monitored because
high risk for postpartal
hemorrhage
Cardiac decompensation – cough,
dyspnea, edema, arrhythmia
Class I cardiac disease, on
penicillin and Coumadin
prophylaxis – continue
pregnancy and penicillin,
change coumadin to heparin
Minimal morning sickness in
diabetic pregnant –
ketoacidosis may occur,
putting the fetus at risk
Diabetic control – self
monitoring of dextrostix
values; split insulin doses; use
of mixed insulins; increased
insulin doses as required
Amniocentesis – evaluate
lecithin/sphingomyelin (L/S)
ratio – indicative of lung
maturity is 2:1
Serial urinary estriol –
indicator of near impending
death is 4 mg in 24 hrs
Rhythm method – changes in
basal body temp; increase in
progesterone secretion
Falls 0.2˚ for 1-3 days and rises
0.5 – 0.8˚ for 3rd day
Effectiveness of this is to take
note of oral and cervical mucus
changes
Condom – mechanical blockage of
sperm
Spermacide – killing of sperm,
decreasing sperm motility,
chemical blockage to sperm
Oral contraceptive – suppression
of ovulation, alteration in
endometrial maturation,
alteration in cervical mucosa
Complication: thromboembolitic
disease
Probable cause of infertility if
there is a hx of PID – stricture
of fallopian tubes
Rubin’s infertility test – controlled
amt of CO2 is introduced under
pressure into the intrauterine
cavity
Gravida 2 Para 2 – pregnant for
the 4th time and had 2 previous
pregnancies carried to the
period of variability
-4-3-2-1 0+1+2+3+4
Don’t eat during labor –
aspiration
SS enema – cleanse the large
bowel and allow more room in
the birth canal
Full bladder impedes descent of
the fetus
Nitrazine tape test: urine (red);
AFluid (blue)
Positive bloody show happens
with increased in cervical
dilatation
Pushes down before one’s cervix
is fully dilated may develop
cervical edema
Breech – fetal sacrum
presentation
Frank breech – with legs
extending over the anterior
surface of the body
Complete breech – sitting
When giving PRN medications for
pain – it is important to assess
fht and maternal v/s
Hyperventilate – alkalosis;
tingling of face, fingers, and
feet
If mother is alkalosis – fetus will
experience acidosis and vise
versa
To correct alkalosis /
hyperventilation – breathe into
a paper bag
Gynecoid pelvis – rounded inlet,
nonprominent ischial spines,
wide and deep sacral curve;
most favorable type for
childbearing
Android – male, prominent ischial
spine
Anthropoid – AP diameter is
longer than transverse
diameter
Platypelloid – shallow pelvis
Conjugates
True -
Obstetric – most important
Diagonal – 1.5 cm; used to asses
inlet; distance b/w sacral
promontory and the lower
margin of the symphysis pubis
Biischial diameter – transverse
diameter of the pelvic outlet
Attitude – refers to the relation of
the fetal parts to one another
or to the posture of the fetus in
utero
Suture and fontanels are great
diagnostic value
Lightening – engagement of the
presenting part; pressure on
diaphragm is relieved
Left occiput anterior – most
common position
Right occiput anterior – vertex
presentation toward the right
front quadrant of the maternal
pelvis
Presentation – part of the fetus
which enters pelvic
passageway first
Transverse lie – scapula
presenting part; due to
placenta previa, small pelvis,
or relaxed abdominal walls
Major cause of perinatal death;
breech presentation = trauma
sustained delivery
FHT b/w symphisis and navel –
cephalic
FHT above navel – breech
Steps
Descent – flexion – internal
rotation – extension – external
rotation – expulsion
Complete flexion – advantageous
because fetus is presenting the
smallest antero-posterior
diameter of the skull
True labor vs. false labor =
cervical dilatation and
effacement; 2ndly regular
contractions
Onset of true labor – regular and
predictable contractions
Increased estrogen, oxytocin, and
fetal corticosteroids NOT
progesterone
Cervical dilatation and
effacement are accomplished
by uterine contractions only
3 contractions/10 min period –
adequate uterine contractility
Stop oxytocin if having too strong
contraction
Late deceleration – turns on left
side then calls the physician
Place the Doppler over the area
where the FHT are heard best
Beta-to-beat variability – interval
b/w FHT
Baseline FHR – range of FHR
obtained b/w contractions or
when the pt is not in labor
Maternal fever – common cause
of fetal tachycardia
Saddle block anesthesia – may
use forcep delivery because of
loss of the mother’s urge to
bear down; fetal bradycardia
and maternal hypotension
Laceration
1st – perineal skin and vaginal
mucosa
2nd - + muscles and fascia
3rd - +anal sphincter
4th - +exposure of rectal lumen
When in active labor, check
perineum first
When head crowns – asks px to
pant
When delivering placenta – asks
px to bear down
When there is no sign of placental
separation – do not
manipulate, wait further
When PROM – check for cord
prolapse; first priority – check
the FHT
When cord prolapsed, primary obj
is to relieve pressure on the
umbilical cord
When pre eclampic – probable
seizure
Readily available – O2 and
suction machine
Classic signs of pre eclampsia
(proteinuria, weight gain
excessively, hypertension)
Predisposing factors – DM,
Multiple pregnancy, Hmole,
NOT placenta previa or
abruption placenta
Drug – Mg SO4; sedative
anticonvulsant, vasodilator
Don’t administer when (-) knee
jerk reflex
First sign of recovery is diuresis
If complains headache – check BP
immediately
Hyperactive DTR and pattelar
reflex – pt may convulse
Abortion – termination of
pregnancy at any time before
variability
Most frequent cause of early
spont abortion – defect of the
embryo
Shirodkar – procedure for
incompetent cervix
Complication of abruption
placenta – hypofibrinogenemia
Hmole – dev’t normally of
placenta, rapin enlargement of
uterus with bleeding,
degenerating vili, distended
with fluid, in grapelike clusters
Celestone – increase fetal lung
maturity
If uterus is boggy – massage until
firms
Proper technique in massaging –
supporting lower portion while
massaging the upper portion
Height of fundus decreases
normally ½ to ¾ inch daily
Uterus should return to
nonpregnant state on the 6th
wk 1 and ½ month
Temporary glycosuria and
proteinura is normal
Normal estrogen levels – 5-10
weeks postpartum
External cervical os is oval
shaped – always identify her as
having borne a child
(+) breast milk – decreased
prolactin, increased fsh
Milk let down can be achieved by
sucking, hearing an infant’s cry
and seeing the infant
Colostrums – (+) antibodies and
IgA
Breastfeeding helps mother to a
more rapid involution
Postpartal hemorrhage can lead
the mother to be anxious and
restless; hypotension; defined
as estimated bld loss of more
than 500 cc from delivery
through he 28th day
postpartum
Retained placental fragments –
heavy vaginal discharge, (+)
clots, boggy uterus, massage
expels more clots
Uterine atony – complication that
can lead to moderate bright
red bleeding, fundus firm on
palpation
Uterine rupture – severe
agonizing pain, contraction
ceases, shocky, minimal
vaginal bleeding, no FHT
Uterine subinvolution – dragging
backache
Endometritis – red discharge,
small amount, foul odor,
uterine cramping
Parametritis – infection extending
to pelvic connective tissue
around the uterus
Pelvic thrombophlebitis – onset is
on 2nd week postpartum
involving uterine or ovarian
veins with chills and high fever
Sheehan’s syndrome / anterior
pituitary necrosis – postpartal
hemorrhage, severe
hypovolemic shock, increased
breast size, loss of pubic and
axillary hair, genital atrophy,
amenorrhea
Extrauterine life – closure of
foramen ovale and ductuc
arteriosus
Kidney function of baby –
glomerular function is low
Molding – fetal skull bones shift
position to ease passage of the
baby
Capput succedaneum – swelling
of scalp tissue
Trendelenburg – to facilitate
drainage of mucus
Brown fat – major energy source
of neonate
Normal – erythema toxicum
neonatorum, stork bite marks,
Mongolian spots
Abnormal – impetigo (bacterial
infection)
Congenital cataracts – opacity of
pupils, special attention is
neede
Visual capacity – short distance
First parent-child activity - human
faces, black and white objects
Tactile stimulation – stroking baby
gently from head tot toe;
suggestive play for parents
and baby
Diabetic mother – WOF for
hypoglycemic baby
Epstein pearls – small raised
white bump on the palate,
does not bleed
Spitting up after feeding –
immature cardiac sphincter
Anterior – 12 -18 months
Posterior – 2 – 3 months