0he
mos
t
imp
orta
&t
topi
c i&
a
+re&
atal
+reme&strual
Sy&drome
6me&orrhea (e&orrha"i
a
(etrorrha"ia
16
MALE CONDOMIUDD
/eHuires withdrawal of the pe&is
from the va"i&a before /elies
o& absti&e&ce from i&tercourse
duri&" fertile period-.dema of
lower e1tremities- +rimary-
-8le1ible device i&serted i&to the
uteri&e cavity
-!t alters uteri&e tra&sport of the
sperm so fertili2atio& do&Et
occur
,AN-$ SI-NS "O $PO"1
. Late or missed menstrual period
.Se#ere abdominal pain
.%e#er and chills
. %oul #a*inal dischar*e
.Spottin*3 bleedin*3 or hea#y
menstrual periods
. Spontaneous e@pulsion occur in
AB.9CB of users in the first
year
- /ubber sheath that fits
over the erect pe&is a&d
preve&ts sperm from
e&teri&" the va"i&a
- 5o&" polyuretha&e sheath
that is i&serted ma&ually
i&to va"i&a with a fle1ible
i&ter&al ri&" e1te&di&" to
cover the peri&eum
- 5ubricated with a
spermicide :&o&-o1y&ol-
A;
- !t ca& be i&serted up to =
hrs before i&tercourse
1. 1a''ie' Met#o(s
*EMALE CONDOM
:;AGINAL "OUCH;
eaculatio&
- 6bdomi&al bloati&"
- %ei"ht "ai&
- 7eadache
--reast te&der&ess
- ?epressio&
- 3ryi&"
- 5oss of co&ce&tratio&
*o '&ow& cause
- Seco&dary-
(ay be caused by
D (easured by ta'i&" &
recordi&" e temperature rally
rectally each mor&i&" before
wa'i&" after at least 3 hours of
sleep
D ?rops before ovulatio& a&d
rises B#2 8-B#= 8
In (asal body temperature
method the patient should ta8e
her temperature e#ery mornin*
upon a)a8enin* and prior to any
acti#ity to a#oid the temperature
bein* influenced by other factors.
D ,ses the appeara&ce,
characteristics a&d amou&t of
cervical mucus to ide&tify
ovulatio&
)vulatory< cervical mucus is clear
a&d abu&da&t
+re-ovulatory / post ovulatory<
cervical mucus is yellowish,
less abu&da&t, a&d stic'y
:i&hibit sperm motility;
.
D
3ou
ple
ma'
es
use
of
com
bi&at
io&
of
cale
&dar,
--0
, a&d
cervi
cal
muc
us
meth
od to
deter
mi&e
fertil
e
perio
d
1$
tumor/i&flammatory co&ditio&s
C 1et<een enst'ual c!clesD soe <oen e,&e'ience &ain
<#en t#e o)a'! 'eleases e$$
8i"ure 1-d 3o&dom
C
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NCLE@ TI"SEE
T#e feale con(o (u'in$ se,
*i$u'e %9(
?uri&" se1 the pe&is is i&serted i&to the ce&ter of the ope& ri&" at the ope&i&" of the va"i&a# ,&til both
part&ers are familiar with the /eality co&dom, the pe&is should be "uided by ha&d i&to the ope& ri&"#
)therwise there is the cha&ce that the pe&is will be i&serted outside the co&dom i&to the va"i&a, thus
defeati&" the co&domIs purpose# ,se of the male co&dom with the female co&dom is &ot recomme&ded,
because rubbi&" the late1 male co&dom a"ai&st the polyuretha&e female co&dom creates frictio& that may
ma'e i&tercourse difficult#
Reo)in$ t#e feale con(o
0he female co&dom should be removed followi&" i&tercourse a&d before sta&di&" up# 0o remove, sHuee2e
a&d twist the outer ri&" to e&sure that seme& remai&s i&side the co&dom# 4e&tly pull the co&dom from the
va"i&a# ?iscard i& the trash# ?o &ot attempt to flush the co&dom dow& the toilet, as it may clo" the toilet or
sewer li&es# ?o &ot reuse#
I&o'tant &oints to 'eebe' <#en usin$ t#e feale con(o
- "he female condom )or8s only if you use it e#ery time you ha#e se@.
. Use a ne) condom each time you ha#e se@ual intercourse. Do not reuse the %e+ale condo+.
. 5ou can still become pre*nant and transmit or ac4uire a se@ually transmitted disease )hile usin* the
female condom. "he ris8 is less than if you do not use the condom3 but there still is a sli*ht ris8.
. Althou*h the eality condom is prelubricated3 it also comes )ith a tube of lubricant in the pac8a*e. 5ou
may )ish to add a fe) drops of lubricant to the openin* of the condom or to the penis. Lubricants reduce
friction and noise those results from friction.
. emo#e tampons before insertin* the female condom.
. Use caution to a#oid tearin* the female condom )ith a sharp fin*ernail3 rin*3 or other ?e)elry )hen
insertin* and remo#in* the condom#
1=
"
H
R
A
G
M
C
*ot &ecessary for
repeated coitus,se
every
coitus3o&ti&uous
protectio& 24 hours
re"ardless of the
&umber of times of
se1ual i&tercourse)&
two hours prior to
se1ual i&tercourse a&d
i& place for 6 hours
after=BC with typical
use
S+./(!3!?.
,S64.
*,55!+6/6J=BC
(50!+6/6J6BC
?.S3/!+0!)*
Small rubber plastic that fits
s&u"ly over cervi1
8le1ible ri&" covered with dome shape
rubber cap
8
it
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F
3ervicitis
?,/60!)*
*ot lo&"er tha& 4= hours *ot lo&"er tha& 24 hours
A diaphra*m should be left in the #a*ina
:.; hours after se@ual intercourse.
Dia,hrag+A should remai& i& place 6-= hours after se1 & maybe left for 24 hours#
AL6A5S C+$C= %O "$AS < +OL$SDDD
#ontraindicated %or" %re4uent U"I3 Prolapsed Cord < etro#erted Uterus3 cystocele < rectocele3 acute
cer#icitis
*i$u'e 1-e ?iaphra"m
C. "#a'acolo$ic et#o(s
&ral #ontrace,tive Pill A sy&thetic estro"e& combi&ed with small amou&ts of sy&thetic pro"estero&e-
preve&ti&" ovulatio& by stoppi&" 8S7 & 57#
- Stops L+ < %S+
STO" I* ?ITH THE **< :637.S;
- A. abdominal pain3 #- Chest pain3 *. +eadaches3 E. eye problems < S.se#ere le* cramps
- A""N1 Se#ere +eadaches maybe an indication of +ypertensionDDDD
CONTRAINDICATEDA
9 "hromboembolism
A C&A3 +PN3 smo8in* < diabetics3,IC3 hyper#iscosity
#ontraindicated %or D)ABE.)#S. "he best for diabetics are (arrier Contracepti#es..Condom <
,iaphra*m
E$a+,les" ?emule& :.thi&yl .stradiol .thyl&odiol ; a mo&ophasic oral co&traceptive a"e&t.
If the patient for*ets to ta8e A tablets for the ne@t A days3 she should ta8e A tablets N$'" A ,A5SDDD
And use another contracepti#e method for the rest of the cycle.
If she misses E or more3 she should discard the remainin* tablets < use another contracepti#e
method for the rest of the cycle.
)/65 3)*0/3.+0!@.S(!*!+!55SS,-?./(65 !(+56*0SS,-3,06*.),S !*K.30!)*S,se to
preve&t co&ceptio& by i&hibiti&" ovulatio& :i&hibits release of 8S7 a&d 57;
3auses atrophic cha&"es i& the e&dometrium to preve&t impla&tatio& of e""
3auses thic'e&i&" of cervical mucus to i&hibit sperm travel
Under ideal conditions the sperm can reach the o#um 9 to F minutes after e?aculation.
3ombi&ed estro"e& a&d pro"estero&e preparatio& i& tablet form a&d are ta'e& daily with combi&atio&s of
hormo&es
22
Oral contracepti#es pre#ent pre*nancy by suppressin* %S+ 0follicle stimulatin* hormone7 and L+
0leuteni2in* hormone7 release from the pituitary *land thereby bloc8in* o#ulation.+ills co&tai& pro"esti& but &o
estro"e&
+ills must be ta'e& each day a&d preferably same time each day to achieve ma1imal effective&ess
0hi&s a&d atrophy e&dometrium a&d thic'e&s cervical mucous
6?@6*064.< ca& be use immediately postpartum if clie&t is &ot breastfeedi&" a&d 6 wee's if breastfeedi&"
6omen ta8in* the minipill ha#e a hi*her incidence of tubal and ectopic pre*nancies3 possibly because
pro*estin slo)s o#um transport throu*h the fallopian tubes. $ndometriosis3 female hypo*onadism3 and
premenstrual syndrome arenGt associated )ith pro*estin.only oral contracepti#es.Si1 soft sillastic rods filled
with sy&thetic pro"estero&e impla&ted i&to the woma&Es arm
+ro"estero&e lea's i&to the blood stream, i&hibiti&" impla&tatio& i&to e&dometrium
*orpla&t
!&serted subdermally i&to the midportio& of the upper arm about =-1Bcm above the elbow crease# 6 impla&table
capsules are i&serted at o&e time(edro1ypro"estero&e :?(+6 or ?.+)@./6;
Birth #ontrol Su++ar/ .a0le
-!/07 3)*0/)5 (.07)?6?@6*064./!SLS )/ +)SS!-5. +/)-5.(S
Spermicides< chemicals i& the form of
foams, creams, ellies, films, or
suppositories that are i&serted i&to the
va"i&a to 'ill sperm before they ca& e&ter
the uterus9 typical use effective&ess< $BC
M 6vailable over the cou&ter
M 3a& be used with other
methods to improve
effective&ess
M )&ly partially effective
a"ai&st se1ually tra&smitted
disease :S0?; tra&smissio&
M +ossible aller"ies or irritatio&
M *ot effective a"ai&st S0?
tra&smissio&M /eusable3ervical 3ap<
thimble-shaped late1 cap i&serted
i&to va"i&a over cervi1 to preve&t
sperm from e&teri&" uterus9 used
with spermicide9 typical use
effective&ess< =2CM *ot effective
a"ai&st S0? tra&smissio&M
/eusable3o&dom< male co&dom is a
sheath of late1 or a&imal tissue
placed o& erect pe&is9 female
co&dom is a plastic sac with a ri&"
o& each e&d i&serted i&to the va"i&a9
both may be used with a spermicide9
typical use effective&ess< =4C
:male; $AC :female;
M *eeds to be fitted by a health care
professio&al
M ?ifficult to fit wome& with a&
u&usual cervi1 si2e
M ?ifficult for some wome& to i&sert
M 3a& last for o&e to two years
C$&ICAL CAP< ca& be retai&ed upto 4=
hours# !t does &ot lea'# 3a&&ot be re-applied
a"ai& after use# (ay use spermicide before
use#
M .ffective a"ai&st S0?
tra&smissio&
M 6vailable over the cou&ter
M 3a& be used with other
methods to further protect
a"ai&st S0?
M +ossible aller"ies to late1 or
spermicide
M 5esse&s se&satio&
M (ay brea' duri&" i&tercourse
#A#oid usin* petroleum ?elly of
oil base productsH it can
cause INC$AS$ %IC"ION
)hich )ill lead to "$AIN-
O% "+$ LA"$' CON,OM#
23
M *eeds to be fitted by a health care
professio&al
M !&creased ris' of bladder i&fectio&
M +ossible aller"ies to late1 or
spermicide
M 3a& last for o&e to two years
-irth 3o&trol +ill< prescriptio& dru"
co&tai&i&" female hormo&es9 o&e pill ta'e&
daily preve&ts ovaries from releasi&" e""s
a&d/or thic'e&s cervical mucus to preve&t
sperm from reachi&" e""9 typical use
effective&ess< A4C?iaphra"m< shallow
late1 cup with fle1ible rim i&serted i&to
va"i&a over cervi1 to preve&t sperm from
e&teri&" uterus9 used with spermicide9
typical use effective&ess< =2C
M (ore re"ular periods
M *o actio& reHuired prior
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
M Some protection a*ainst
o#arian and endometrial
cancer3 noncancerous
breast tumors3 o#arian
cysts
M *ot effective a"ai&st S0?
tra&smissio&
M are but dan*erous
complications3 includin*
blood clottin* and
hypertension3 particularly in
)omen o#er EF years )ho
smo8e
M (ust be ta'e& daily
7ormo&al !mpla&t :*orpla&t;< si1 small
capsules i&serted by a health care
professio&al u&der the s'i& of upper arm
that deliver small amou&ts of hormo&e to
preve&t ovaries from releasi&" e""9 typical
use effective&ess< AAC
M +rotects a"ai&st
pre"&a&cy for up to five
years
M *o actio& reHuired prior
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
M Can be used )hile breast.
feedin* be*innin* si@
)ee8s after deli#erin*
baby
M *ot effective a"ai&st S0?
tra&smissio&
M +ossible scarri&" or, rarely,
i&fectio& at i&sertio& site
M Side effects i&clude irre"ular
bleedi&", headaches, &ausea,
depressio&
M *ot effective a"ai&st S0?
tra&smissio&M .ffective o&e to si1
years, depe&di&" o& type
used7ormo&al !&ectio& :?epo-
+rovera;< in?ection *i#en by a health
care professional in the arm or
buttoc8 e#ery 9A )ee8s to preve&t
ovaries from releasi&" a& e"" a&d/or
thic'e& cervical mucus to 'eep
sperm from reachi&" a& e""9 typical
use effective&ess< AAC
M (ay cause spotti&" betwee& periods a&d
lo&"er, heavier periods
M Increased ris8 of pel#ic inflammatory
disorder0PI,7 )ithin first four months
after insertion
M /are ris' of uteri&e perforatio&
M *o actio& reHuired prior to se1ual
i&tercourse, permits se1ual
spo&ta&eity
M +rotects a"ai&st
pre"&a&cy for 12 wee's
M *o actio& reHuired prior
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
M Can be used )hile breast.
feedin* be*innin* si@
)ee8s after deli#erin*
baby
M +rotects a"ai&st ca&cer of
the uteri&e li&i&" a&d iro&
deficie&cy a&emia
M *ot effective a"ai&st S0?
tra&smissio&
M Side effects i&clude irre"ular
bleedi&", wei"ht "ai&,
headaches, depressio&,
abdomi&al pai&
M Side effects do &ot reverse
u&til medicatio& wears off
M (ay cause delay i& becomi&"
pre"&a&t after i&ectio&s are
stopped
M *ot effective a"ai&st S0?
tra&smissio&*atural 8amily +la&&i&"<
tech&iHues, i&cludi&" chec'i&" body
M +erma&e&t protectio&
from pre"&a&cy
M *o actio& reHuired prior
M *ot effective a"ai&st S0?
tra&smissio&
M /eactio&s to sur"ery may
24
temperature or cervical mucus daily or
recordi&" me&strual cycles o& a cale&dar, to
determi&e the days whe& body is most
fertile9 typical use effective&ess< =1CM *o
medical or hormo&al side effectsM *ot
effective a"ai&st S0? tra&smissio&M
+erma&e&t protectio& from pre"&a&cy0ubal
5i"atio&< sur"ical procedure to perma&e&tly
bloc' woma&Is 8allopia& tubes to preve&t
e""s from reachi&" sperm9 typical use
effective&ess< AAC!&trauteri&e ?evice
:!,?;< small device i&serted by a health
care professio&al i&to the uterus9 preve&ts
e""s from bei&" fertili2ed a&d/or impla&ti&"
i& uterus9 typical use effective&ess< A6C
M /eHuires strict record'eepi&"
M !ll&ess or lac' of sleep may affect body
temperature
M @a"i&al i&fectio&s a&d douches may affect
cervical mucus
M /eHuires absti&e&ce from se1ual
i&tercourse or alter&ative co&traceptio&
duri&" fertile days
M !&e1pe&sive
M 6ccepted by most reli"io&s
M /eactio&s to sur"ery may i&clude
i&fectio&, blood clot &ear testes,
bruisi&", swelli&", or te&der&ess of
scrotum
M !rreversible
M *o actio& reHuired prior to se1ual
i&tercourse, permits se1ual spo&ta&eity
"ubal li*ation1 isthmus part in the
fallopian tube is the usual part bein*
li*hted#
Intra.uterine ,e#ices 0IU,;- a
small plastic obect is i&serted i&to the
uterus where it remai&s i& place# !t
i&terferes with the ability of the ovum to
develop as it tra&sverses the fallopia&
tube#
Most %re4uent Side $ffect<
a# $@cessi#e Menstrual flo)
0menorrha*ia7 b. Spontaneous
$@pulsion of the de#ice1 Myometrium
irritability c. Crampin* < fe#er
Contraindications1
1# +istory of PI,1 a )oman usin* IU,
has FCB chance of *ettin* PI,.
A. $ctopic Pre*nancy3 AI,S
Ne#er use > *i#e IU, to NULLIPAOUS
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
i&clude i&fectio&, bleedi&",
i&ury to i&testi&e, reactio& to
a&esthesia
M !&creased cha&ce of ectopic
pre"&a&cy
M !rreversible
25
6OM$NDDD
eturn to the clinic for e#aluation after
her 9
st
mensesDDD
8i"ure !&tra uteri&e device
:!,?;
@asectomy< sur"ical procedure to perma&e&tly bloc' the maleIs vas defere&s to preve&t sperm
from reachi&" e""s9 typical use effective&ess< AAC
Section II
Ante&a'tu "e'io(
I. Assessent of Ris2 *acto's in t#e "'enatal "e'io(
Age o% Pregnant 1o+en 91$ below< 7ave a hi"her i&cide&ce of
1# +rematurity
2# +re"&a&cy !&duced 7yperte&sio&
3# 3ephalopelvic ?isproportio&
1o+en over 23 /ears old are at is4 %or"
1# 3hromosomal ?isorders i& i&fa&ts
2# +!7
3# 3esarea& ?elivery
"'ii$'a)i(a 9 1st time +re"&a&cy
"'ii&a'a 9 1
st
delivery of a live i&fa&t,
Nulli$'a)i(a 9 &ever bee& pre"&a&t
)n%ections" !se .&#*
T - 0o1oplasmosis
O - )ther i&fectio&s
R - /ubella
C - 3ytome"alovirus
H - 7erpes
6# 0o1oplasmosis :proto2oa;
+roduces symptoms of acute, flu-li'e i&fectio& i& mother
0ra&smitted throu"h raw meat or ha&dli&" cat litter of i&fected cats
S&ontaneous abo'tion li2el! to occu' ea'l! in &'e$nanc!
-# /ubella
E$tre+el/ teratogenic in %irst tri+ester
#auses congenital de%ects o% e/es5 heart5 ears5 and 0rain
26
1o+en 6ith lo6 ru0ella titers should 0e vaccinated at least 2 +onths 0e%ore 0eco+ing ,regnant or %ollo6ing
a deliver/
N&.E" Any )oman in the first trimester of pre*nancy is at ris8 if e@posed to rubella. Con*enital %etal defects
often results from such an infection.
3# 3ytome"alovirus :3(@;
#+roduces flu-li'e or mo&o&ucleosis-li'e symptoms i& the mother
0ra&smitted throu"h the respiratory or se1ual route
(ay cause fetal death, retardatio&, heart defects, deaf&ess
*o effective treatme&t available
?# 7erpes Simples
6ffects the e1ter&al "e&italia, va"i&a, a&d cervi1
3auses drai&i&", ,ain%ul vesicles
?elivery of the fetus is usually by cesarea& sectio& active lesio&s are prese&t i& the va"i&a9 delivery may be
performed va"i&ally if the lesio&s are i& the a&al, peri&eal, or i&&er thi"h area :strict precautio&s are
&ecessary to protect the fetus duri&" delivery;
*o va"i&al e1ami&atio&s are do&e i& the prese&ce of active va"i&al herpetic lesio&s
7aintain #&N.A#. isolation ,rocedures during hos,itali8ation i% the disease is active
*eo&ate a&d mother may be se&a'ate( (u'in$ t#e acti)e &e'io(, or other special precautio&ary measures
may be used to avoid tra&smissio& to &eo&ate
.eratogenic Drugs" BASA-&(code9
1 9 -arbiturates
A 9 6&ti-malarial
S 9 Salicylates
A 9 6&esthetic
O 9 Oral hypo"lycemics
Su0stance A0useA
Alcohol" causes lear&i&" disabilities, (o&"olism, fetal alcohol sy&drome
NicotineA i&creases vasoco&strictio&, retardatio&, S46 :small "estatio&al a"e;, low birth wei"ht
*eroin addictA babies are bor& with an $'A--$A"$,> +5P$AC"I&$ CNS > $%L$'$S or
CNS II"A(ILI"5.
#occaine" "he effect of cocaine in a labor and the fetus is preterm labor thus increased uterine
contractions3 intrauterine *ro)th retardation and the potential for a sic83 addicted infant
II. "#!siolo$ical #hanges in Pregnanc/
Inc'eases (u'in$ &'e$nanc!
!&crease 7eart /ate for 1B-15 beats/mi&ute
!&crease 3ardiac )utput for 2BC - 3BC duri&" 1
st
> 2
&d
trimester to meet i&crease tissue
dema&d
!&crease secretio& of su"ar :4lycosuria;
INC$AS$ PLAMA &OLUM$
!&crease ,ri&ary 8reHue&cy due to pressure to bladder#
2$
!&crease &ormal depe&de&t .dema :bilateral or a&'le edema; &ormal for 36 wee's "estatio&#
Dec'eases (u'in$ &'e$nanc!
?ecrease :sli"htly of blood pressure; i& the 2
&d
trimester due to decrease peripheral resista&ce
?ecrease 7emo"lobi& & 7ematocrit because of !ro& ?eficie&cy 0Pseudo. AN$MIA;
?ecrease "astroi&testi&al motility & peristalsis due to displaceme&t of the i&testi&e & compressio&
of the stomach# ---leadi&" to 3)*S0!+60!)*#
?ecrease ,ri&e Specific "ravity< a result of i&crease ,ri&ary )utput#
Ot#e'sA
#hloas+a " Mas8 of pre*nancy
Leu4orrhea" )hitish #a*inal dischar*e )ithout si*ns of inflammation < itchin*.
&,erculu+" formation of mucus plu* in C$&I' to seal out bacteria.
Lordosis" the Pride of Pre*nancy
ela$in" responsible hormone for the softenin* of the pel#ic cartila*es. Produce by the corpus luteum3
contributes to the )addlin* *ait typically noted in pre*nancy.
Nor+al deliver/ 0lood loss" ECC I JCC ml of blood
#esarean Section" ;CC I 9CCC ml
II a. Ante&a'tu Healt# "'ootion
"'enatal ;isit
Sc#e(ule of )isit if <it# no co&licationsA
a. E)e'! . <ee2sD u& to 3- <ee2s
b. E)e'! - <ee2sD f'o 3-934 <ee2s :o'e f'eFuentl! if &'obles e,ist+
c. E)e'! <ee2 f'o 349.8 <ee2s
Classifications of "'e$nanc!
GRA;IDA > &umber of times pre"&a&t, re"ardless of duratio&, i&cludi&" prese&t pre"&a&cy#
"RIMIGRA;IDA > pre"&a&t for the first time#
ItGs important for the nurse to distin*uish bet)een a client )hoGs ha#in* her first baby and one )ho has already
had a baby. %or the client )hoGs pre*nant for the first time3 4uic8enin* occurs around AC to AA )ee8s. 6omen
)ho ha#e had children )ill feel 4uic8enin* earlier3 usually around 9; to AC )ee8s3 because they reco*ni2e the
sensations.
MULTIGRA;IDA > pre"&a&t for seco&d or subseHue&t time#
"ARA > &umber of pre"&a&cies that lasted more tha& 2B wee's#
NULLI"ARA > a woma& who has &ot "ive& birth to a baby beyo&d 2B wee's "estatio&#
"RIMI"ARA > a woma& who has "ive& birth to o&e baby more tha& 2B wee's "estatio&#
MULTI"ARA > a woma& who has had two or more births at more tha& 2B wee's "estatio&#
Note1 ")ins or triplets counted as 9 para#
PE.E7 I ne)born born before EK )ee8s of *estation.
TERM > &ewbor& bor& after 3$ wee's to 4B wee's of "estatio&#
"OST9TERM > &ewbor& bor& after 4B wee's of "estatio&#
"a'it! :T"AL+
T 9 *umber of terms births,
" 9 *umber of premature births,
A 9 *umber of 6bortio&s,
2=
L 9 *umber of livi&" childre&
NUTRITION
1
st
.ri+ester" A IJ lbs *ain > EC.EF calories>8*>day
2
nd
tri+ester" 9 lb per )ee8 > ACC calories>8*>day
2
rd
tri+ester" 9 lb per )ee8> ACC calories>8*>day
"'e$nant ?oen nee(s 2:: e$tra calories PE DA; fo' a(eFuate nut'ition.
A (iet of 23:: calories ,er da/
An inc'ease of about 3:: calories ,er da/ is nee(e( (u'in$ LA#.A.)&N.
)ron De%icienc/ Ane+ia is a 'esult of P)#A.
Diffe'ent t!&es of E,e'cises
Pelvic (loor #ontractions (Kegel<s E$ercise+A +romotes peri&eal heali&", i&crease se1ual
respo&sive&ess, press stress i&co&ti&e&ce# ?o&e 5B-1BB times# .1amples< 0i"hte&i&" &
stre&"the&i&" the muscles of the @a"i&a, rectum, peri&eum & the& rela1 after# .fficie&t for
,ri&ary 8reHue&cy & 7emorrhoids# !&crease elasticity of the Pubococcy*eus muscle#
A0do+inal +uscle #ontractionsA pre#ent constipation i& pre"&a&cy, do&e i& sta&di&" or lyi&" positio&,
stre&"the&i&" the abdomi&al muscles#
Pelvic oc4ingA elie#es bac8ache duri&" pre"&a&cy, do&e by ti"hte&i&" the buttoc's & flatte&s the
lower bac' a"ai&st the floor for o&e mi&ute#
DI**ERENT T="ES O* 1REATHING TECHNIGUES
6# 6bdomi&al breathi&" : duri&" late&t phase of Sta"e 1 5abor;
1# ,sed u&til labor is more adva&ced
2# 0he abdome& moves outward duri&" i&halatio& a&d dow&ward duri&" e1halatio&
3# 0he rate remai&s slow, with appro1imately si1 to &i&e breaths per mi&ute
-# +a&t-pa&t-blow: duri&" 0ra&sitio&al +hase of Sta"e 1 5abor;
1# ,sed i& adva&ced labor
2# 6 more rapid patter&, co&sisti&" of two short blows from the mouth followed by a lo&"er blow
3# 6ll e1halatio&s are a blowi&" motio&
III. *e'tili3ation to Conce&tion
*e'tili3ationA the u&io& of the ovum & sperm# 0he start of (itotic cell divisio& < fetal se@
determination.
N +rimary oocyte :immature ovum; co&tai&s ?iploid &umber of chromosomes :46;#
N )&e oocyte co&tai&s a haploid :23; &umber of chromosomes after divisio&#
N 4amete :mature ovum;< is a cell or ovum that has u&der"o&e (aturatio& & will be ready for
fertili2atio&#
N )&e "amete carries 23 chromosomes#
N 6 sperm carries 2 types of se1 chromosomes# O & F#
N 4BB millio& sperm cells i& o&e eaculatio&#
N 8u&ctio&al 5ife of spermato2oa is 4= hours
N OOJ female, OFJ male#
2A
*i$u'e %9* Mo'ula
"'ocess of *e'tili3ationA
6fter ovulatio& ovum will be e1pelled from the 4raafia& follicles ovum will be surrou&ded by Lona
Pellucida :mucopolysaccharide fluid; & a circle of cells 0Corona adiata; which i&creases the bul' of the
)vum e1pelled from the 8allopia& 0ube by the 8imbriae :i&fu&dibulum;# Sperms move by fla"ella &
+e&etrate the & dissolve the cell wall of the ovum by releasi&" a proteolytic e&2yme
:+yaluronidase7 6fter pe&etratio& 8usio& will result to Ly*ote# Gy"ote mi"rate for 4 days i& the
body of the uterus :(itosis will ta'e place-3leava"e formatio& will be"i&; 6fter 16-5B cell formatio& from
mitosis, a mulberry & -umpy appeara&ce will follow morula 0%igure 1-(7 ---after 3-4 days, the structure will
be ball li'e i& appeara&ce which will be called (lastocyst# 3ells i& the outer ri&" are called "rophoblast :later it
forms the place&ta, respo&sible for the devEt of place&ta & fetal membra&e9 3ells i& the i&&er ri&" are called
$rythroblas t cells :which will be the embryo;#
Te's to 'eebe'A
&vu+A 8rom ovulatio& to fertili2atio&
=/goteA 8rom fertili2atio& to impla&tatio&
E+0r/oA 8rom impla&tatio& to 5-= wee's#
(etus" 8rom 5-= wee's u&til term
"he o#um is said to be #iable for AJ.36 hours#
Sodium (icarbonate. the freHue&t medicatio& to alter the va"i&al ph, decrease the acidity of the
va"i&a so as to !*3/.6S. 07. ()0!5!0F )8 07. S+./(#
*i$u'e %9G *etal Meb'anes
*etal Meb'anes< membra&es that surrou&d the fetus, & "ive the place&ta the shi&y appeara&ce#
:*i$u'e %-4;
2 5ayers<
a. A+nion< shi&y membra&e o& the 2
&d
wee' of .mbryo&ic ?evelopme&t & e&closes the 6m&iotic
3avity
b. #horion1 )uter membra&e that supports the sac of the am&iotic fluid#
#horionic Villi1 fin*er li8e pro?ections from the chorion. "his is the place )here *ases3 nutrients and
)aste products bet)een the maternal < fetal blood ta8es place.
Aniotic *lui(< surrou&ds the embryo, co&tai&s fetal uri&e, la&u"o from fetal s'i& & epithelial cells#
+h is $# 2# Specific 4ravity< 1#BB5 > 1#B25
Normal Amount1 FCC I 9CCC ml.
Oli*ohydramnios. less than ECC ml.
Polyhydramnios. more than ACCC ml. obser#e for ,o)n syndrome < con*enital defects
8u&ctio&s of 6m&iotic 8luid<
a# +rotects the fetus from cha&"es i& the temperature & cushio& a"ai&st i&ury#
b# +rotects the umbilical cord from pressure, the fetus dri&'s & breaths the fluid
i&to the lu&"s#
Aniotic *lui( Colo's< *ormal color< tra&spare&t, clear, with white ti&y spec's
,ar8 amber or yello)< )mi&ous si"& of prese&ce of -ilirubi&, hemolytic disease
Port 6ine Colored< 6bruptio +lace&ta
-reenish1 (eco&ium Stai&ed / 8.065 ?!S0/.SS< always "o for Cesarian SectionP 6lso if ph is
less than K.A
If )ith odor< deliver withi& 24 hours, may i&dicate i&fectio&#
3B
Ubilical Co'(A 21 i&ches i& le&"th & 2 cm i& thic' &ess, circulatory commu&icatio& of the fetus to the
mother# 3)*06!*S 2 6/0./!.S & 1 @.!*# 3overed by a "elati&ous mucopolysaccharide called
6hartons ?elly.
!mpla&tatio& occurs at the e&d of the 1st wee' after fertili2atio&, whe& the blastocyst attaches to the
e&dometrium# ?uri&" the 2&d wee' :14 days after impla&tatio&;, impla&tatio& pro"resses a&d two "erm layers,
cavities, a&d cell layers develop# ?uri&" the 3rd wee' of developme&t :21 days after impla&tatio&;, the
embryo&ic dis' evolves i&to three layers, a&d three &ew structures Q the primitive strea', &otochord, a&d
alla&tois Q form# .arly duri&" the 4th wee' :2= days after impla&tatio&;, cellular differe&tiatio& a&d
or"a&i2atio& occur#
*i$u'e %9H *e'tili3ation C!cle
0able Summary from 8ertili2atio& to !mpla&tatio& :8i"ure 1-7;
III.a ORIGIN O* 1OD= TISSUE
.issue La/er Bod/ Portion (or+ed
.30)?./( *ervous system, mucus membra&es, a&us & mouth
(esoderm 3o&&ective 0issue, /eproductive, circulatory & upper
,ri&ary system, bo&es, cartilla"e
.&doderm li&i&" of the 4! tract, /espiratory 0ract, bladder & urethra
MULTI"LE "REGNANCIES
Dou0le ovu+ Single &vu+
?i2y"otic/frater&al twi&s (o&o2y"otic/ide&tical twi&s
)va from same or differe&t ovaries u&io& of a si&"le ovum & a si&"le sperm
Same or differe&t se1 same se1 o&e place&ta
2 place&tas but maybe fused
2 chorio&s & 2 am&io&s o&e chorio& & 2 am&io&s
Genetics"
"#enot!&eA !&dividualEs outward appeara&ce
Genot!&e< !&dividuals 4e&etic (a'e up
Ha'!ot!&eA +ictorial a&alysis of i&dividualEs chromosomes
Se'ot!&eA a&ti"e&ic character R6-)S
31
+/.-8./0!5!G60!)*
630!@!0!.S
)vum moves to amulla of
fallopia& tubes
3apacitatio&
6crosome reactio&
3)*3.+0!)*
Go&a reactio&
Gy"ote :fertili2ed ovum9
about 24-4= hrs, divides9
cleava"e divides, travels to
the uterus
!(+56*060!)*
(orula :after 3-4
days impla&tatio&;
-lastocyst
:trophoblast9
embryolast;
!mpla&ts complete
w/& $-1B days
Genetic Disorders"
Autoso+al ecessive DisordersA both me& & wome& are at eHual ris' because the ?.8.30!@. 4.*.
is a& 6,0)S)(.< o&e of 22 pairs of &o&-se1 chromosomes# )ffspri&" of each pre"&a&cy
has a 25C cha&ce of bei&" affected a&d 5BC cha&ce of bei&" a carrier#
E$a+,les are" P=U 0 phenyl8etenuria7 3 "ay . Sachs ,isease3 Cystic %ibrosis3 "hallasemia3
and Sic8le Cell Anemia
Autoso+al Do+inantA a& affected offspri&" has a& affected pare&t#
E$a+,les are" +untinton/s Chorea and Marfan/s Syndrome 0Arachnodactyly7
>-lin4ed do+inant?ecessive Diso'(e's< ab&ormal "e&e is fou&d o& the O chromosome because me&
have o&ly o&e O chromosome, they always e1press the disorder#
E$a+,les are1 +emophillia and ,uchenne Muscular ,ystrophy
I;. *ETAL DE;ELO"MENT
*i$u'e %9 H- *etal De)elo&ent
+lace&
tal
tra&sp
ort of
substa
&ces
: 5
wee's
;
0he
fetus is 2$-31 mm
a&d wei"hs 2-4
"rams
8etus s
mar'edly be&t
7ead
is
disproportio&ately
lar"e due to brai&
developme&t
3e&ter
s of bo&e be"i& to
ossify
4a&"li
o&ic cells :5
th
to
12
th
wee's;
+lace&ta a&d meco&ium
.mbryo is 4-5 mm le&"th
0rophoblasts embedded i& deciduas
8ou&datio&s for &ervous system, "e&itouri&ary system, s'i&, bo&es, a&d
lu&"s are formed
/udime&ts of eyes, ears, &ose appear
Cardio#ascular system functionin*3 heart be*innin* to beat3 be*innin* of heart circulation.
Placenta de#/t.
32
are prese&t, with facial features
1 mo/ 4 wee's
3 mos#/A-12 w's
2 mo/ 5-= wee's
C&S done 0; 9A )ee8s7 e#ery or*an present3 +ead *reatly enlar*ed
6vera"e le&"th is 5B-55 mm a&d wei"hs 45 "ms#
8i&"ers a&d toes are disti&ct#
+lace&ta is complete#
/udime&tary 'id&eys secrete uri&e#
8etal circulatio& is complete#
.1ter&al "e&italia show defi&ite characteristics#
4a&"lio&ic cells
S$' IS &ISUALL5 $CO-NILA(L$# +eart is audible in a ,oppler 0 99
th
)ee87
8etus swallows# %ith &ails# Lid&eys able to secrete#
4 mos# /13-16 wee's A4-14B mm le&"th a&d wei"hs A$-2BB "ms#
7ead is erected, lower limbs are well developed#
7eartbeat is prese&t
*asal septum a&d palate close
8i&"erpri&ts are set
LANU-O APP$AS IN "+$ (O,5
=
mos# /
3B-34
wee's
5e&"t
h
2=B-
32B
mm#
wei"h
t
1$BB-
25BB
"ms#$
mos# /
26-2A
wee's
5e&"t
h
25B-
2$59
wei"h
t A1B-
15BB
"ms#2
8etus is 15B-1AB mm# !& le&"th a&d wei"hs appro1imately 26B-46B
"ms#
5a&u"o covers e&tire body#
.yebrows a&d scalp hair is prese&t#
+eart sounds are perceptible by auscultation.
&erni@ caseosa co#ers s8in#
+eartbeat can be heard in the fetoscope 0 9; )ee8sMAC )ee8s7. Li#er is already pancreas
functionin*.
Quic8enin* felt by a mother. S8eleton be*ins to de#elop.
(ro)n %ats be*in to form. +eart sounds in the stethoscope
Can be heard 0 9K. AC )ee8s7
NO"$1 .here is a ,lacental 0arrier to s/,hilis until the 1@
th
6ee4 o% ,regnanc/.
)% the +other is treated 0e%ore 1@
th
6ee45 the 0a0/ 6ill +ost li4el/ not 0e
a%%ected.
33
1-25
%..
LST
)5?
(6*
Es
863.
5
mos# /
1$-2B
wee's
0oe&ails become
visible
Steady wei"ht
"ai& occurs
@i"orous fetal
moveme&t occurs#
LANU-O ,ISAPP$AS
are fully de#eloped.
A)are
of
sounds
outside
the
body.
Assum
es the
deli#er
y
positio
n.
Increa
sed
chance
of
sur#i#
al.
S'i& red
/hythmic
breathi&" occurs
+upillary
membra&e
disappears from
eyes#
8etus ofte&
survives if bor&
prematurely
(rain de#elops
rapidly. Lecithin. Sphin*omyelin 0L>S
ratio is already A197
(rains fully de#eloped. If born3
34
neonate may sur#i#e.
5e&"th 2BB-24B
mm# %t# 4A5-A1B
"ms#
S'i& appears
wri&'led a&d pi&'
to red#
/.( be"i&s
.yebrows a&d
fi&"er&ails
develop#
&$NI' CO&$S "+$ $N"I$
(O,5. +as the ability to hear.
Production of lun* surfactants.
Passi#e Antibody transfer
0 placental immuno*lobulin -7
Su
stained
)ei*ht
*ain
occurs.
A mos# /35-3$ wee's6
mos# /21-25 wee's
5e&"th 33B-36B mm# wei"ht 2$BB-34BB "ms#
8ace a&d body has a loose wri&'led appeara&ce because of
subcuta&eous fat deposit#
-ody is usually lump a&d la&u"o disappears
*ails reach fi&"ertip ed"e
6m&iotic fluid decreases#
Increase ,e#elopment. Sole of the foot ha#e already
creases. -ood chance of sur#i#al.
.
a
r
l
i
e
s
t
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e
s
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p
o
s
s
i
b
l
e
o
1B mos# / 3=-4B wee's 5e&"th 36B mm#9 %ei"ht 34BB-36BB
"ms#
S'i& is smooth, chest is promi&e&t
.yes are u&iformly slate colored
-o&es of s'ull are ossified a&d are
&early to"ether at sutures#
"estes are in scrotum.
Optimum "ime for sur#i#al.
%ull term. Li*htenin* is present.
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patient/s nausea.
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#
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T#i'(Alte'nate feelin$s of
eotional <ell9bein$
an( liabilit!.
6ccepta&ce of pre"&a&cy#
+ossible i&crease i& se1#
6dustme&t to cha&"e i& body
ima"e#
8eeli&"s of aw'ward&ess a&d
clumsi&ess#
/e&ewed fears a&d te&sio&s
about labor#
Spurt of e&er"y duri&" last
mo&th#
.
+repari&" for pare&thood#
JI AM A MOTHERK
,urin* the third trimester3 a 8ey
psychosocial tas8 is to o#ercome fears
the )oman may ha#e about the
un8no)n3 labor pain3 loss of self.
esteem3 loss of control3 and death.
"he emotions and fears that are
usually felt durin* the third trimester
are feelin*s of Nu*linessO3 alterations
in body self.ima*e and an@iety about
the comin* labor and deli#ery.
A. MATERNAL ADA"TATIONS DURING "REGNANC= / <it# 1IOLOGICAL TASHS O*
"REGNANC=
*i'st T'ieste'A 6(-!@65.*3.- about pre"&a&cy< pre"&a&t woma& focus o&ly to self#
I am pre*nant. QAccept the biolo*ical fact of pre*nancy
Secon( T'ieste'A 633.+06*3.---of the ide&tificatio& of motherhood & aware&ess & i&terest i& the fetus#
I am *oin* to ha#e a babyQ Accept the *ro)in* fetus as distinct from self < as person to care for
T#i'( T'ieste'A .()0!)*65 56-!5!0F- assumi&" already the mother, fears & fa&tasies & dreams about
labor
I am *oin* to be a motherQPrepare realistically for birth < parentin*
1. "ATERNAL ADA"ATATIONS / REACTIONS TO "REGNANC=
#&!VADE S;ND&7E1 identification of the motherH ambi#alence < an@iety about the role chan*e
EEAL&!S; S.AGE" increase interest in mothers care.
SEL(-#&N#EP. #*ANGE" acti#e in#ol#ement in the fears < death of the fetus.
SECTION III
6*0.+6/065 3)(+5!360!)*S
A. Abo'tion
-termination of pre*nancy before the fetus is #iable (2: 6ee4s or a 6eight o% 3:: *7
15A
6-)/0!)*
0herapeutic Spo&ta&eous
!&evitable 0hreate&ed
*i$. ... 0yp e s o f 6b o r t i o &
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ss is
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cervi
cal
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o&Sa
ve
tissue
fra"
me&t
s3#
3om
plete
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ucts
of
co&ce
ptio&
are
totall
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e1pel
led(
i&ima
0he
co&ti&uatio&
of the
pre"&a&cy is
i& doubt
-leedi&"
or
spotti&"
closed
cervi1
-edrest, /estrictive
activity, Sedatio&, 6void
coitus for 2 wee's
followi&" last evide&ce
of bleedi&"
ho*am indicated )hen
a youn* patient has a
threatened abortion in
the first trimester and a
laboratory studies
re#eal an h ne*ati#e
and the husband is h
positi#e
16B
3omplete !&complete (issed 7abitual
l
bleed
i&"3
o&ti&
uous
mo&it
ori&"
1#
0hrea
te&ed
/ete&
tio&
of the
produ
cts of
co&ce
ptio&
after
fetal
death
!&ter
mitte
&t
bleed
i&"9
abse&
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uteri&
e
"rowt
h.va
cuati
o&, ?
&
34#
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e2#
!&evit
able
Some
fra"me&ts
are retai&ed
i&side the
uteri&e
cavity
+rofuse
bleedi&"
?ilatatio& & 3uretta"e9
,se of o1ytoci&<
O@ytocin nasal spray
should be administered
)hile the client is
sittin* )ith her head in
a #ertical position. A
nasal preparation must
not be administered
)ith the client lyin*
do)n or the head tilted
bac8 because this could
cause aspiration.
.vacuatio&
S
i
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&
s
a
6#7abitual / /ecurre&t
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-.&dometriosis
-Smo'i&"
.+istory of IU,
usa*e
.
-@a"i&al -leedi&"
-=nife.li8e abdominal pain
-eferred pain on the ri*ht
shoulder
-Symptoms of Shoc8< decreased -+
i&creased //, fast but thready
pulse# "his is the number 9
complication.
-+elvic pressure of pelvic full&ess
-3ulle&Es si"&
-Pain unilaterally3 )ith crampin*
and tenderness
. Mass in the adne@al or cul.de.
sac
- Sli"ht, dar' va"i&al bleedi&"
- +rofou&d shoc' if rupture occurs
-3uldoce&tesis
-3uldoscopy
-/adioimmu&oassay of
elevated serum Hualitative
--eta-734
-6bdomi&al ,ltrasou&d
--lood samples of 7"b
a&d 7ct9 blood type a&d
"roup
(o&itor amou&t of
bleedi&"
6ssess vital si"&s
6ssess abdomi&al pai&
-lood tra&sfusio&
Sur"ery< Salpi&"ostomy
6dmi&ister /ho"am for
/h :-; clie&t
.he F1 #o+,lication o% Ecto,ic Pregnanc/ is *e+orrhagic Shoc4.
1$5
C. H!(ati(ifo' ole / T'o&#oblastic Disease / Mola' Disease
- 4estatio&al trophoblastic &eoplasm that arise from the chorio&9 characteri2ed
by the proliferatio& a&d de"e&eratio& of the chorio&ic or trophoblastic villi#
A patient )ith +ydatidiform mole has a positi#e si*ns of pre*nancy but is not pre*nant.
"he R9 Complication is #horiocarcino+a
"he "hree + of +.mole
9.*yper . emesis *ra#idarum
A. increase *c*
E. increase incidence for pi*
+/.?!S+)S!*4
8630)/S
0F+.S (6*!8.S060!)*S ?!64*)S0!3
0.S0S
(6*64.(.*0
1# INCOMP$"$N"
C$&I'S/non/+sD/s%unctional
cervi$Predis,osing?#ontri0uting
(actors"e,eated dilatation o% the cervi$5
+aternal DES ( Dieth/lstil0estrol9
E$,osure5 .rau+atic inGuries to the
cervi$. #ongenital ano+al/.he F1
#o+,lication o% *-+ole is
choriocarcino+a7olar evacuation ?
DA#Lo6 socioecono+ic status
2# 0rauma to the cervi1 :sur"ery / birth;
3# ,teri&e a&omaly
4# 7abitual abortio&
5# +re-term labor
1.
ii. D. Inco&etent ce')i,
- +ai&less premature dilatatio& of the cervi1
:usually i& the 9:
th
to AC
th
)ee87
1# 3omplete/ classical parts of the villi are affected
2# !&complete/ partial- some parts are &ormal
1# @a"i&al bleedi&"
2# .1cessive */@
E. apid enlar*ement of the uterus
J. 0P7 Pre*nancy test
5# +ossible +!7
6# 6bdomi&al cramps
$# 6bse&t 87/
=# .levated 734 titer< 1-2 millio& !,9 *ormal level< 4BB,BBB !,
1$6
INCOM"ETENT CER;I@
8i"ure 1A
2. 3hemotherapy
B. (o&itor 734 levels
3. ?elay childbeari&" pla&s for a year
H. +eri&eal pad cou&ts
I. !&struct the couple to have @64!*65 /.S0
: &o se1; for 1 year#
1# %ome& below 1= or above 35
2# !&ta'e of 3lomid :3lomiphe&e 3itrate;
3# %ome& of asia& herita"e
!&itial Si"&s734 titer determi&atio&
9. Ultrasound
2# O-ray of the abdome&
:. Sho) 0a pin8.stained #a*inal dischar*e7
$# F1 Sign1 upture of membranes and dischar*e
of amniotic fluid
1# 0he cervi1 dilates pai&lessly i& the
seco&d trimester of pre"&a&cy#
-loody show5ate si"&s<
2#+/)(
3#+ai&less dilatatio&
=# -irth of dead/&o&-viable fetus
A# +ressure or heavi&ess o& the lower abdome&#
1B# ,ltraso&o"raphy-est maor sur"ery<3ervical
3ercla"e, (c?o&ald 3ercla"eScree&i&" or
i&itial dia"&ostic
test<3ardi&al/+atho"&omo&ic/maor si"&<
11# ,ltrasou&d
+ossible sur"ical complicatio&<3o&formity test< 12# Sterility, rupture of the cervi1 premature
delivery, pelvic bleedi&" a&d i&fectio&#
Side lyi&" positio&?isease
complicatio&
+ro&e positio&
13# X9 +emorrha*e, .ctopic pre"&a&cy, birth
defects, viruses a&d pre"&a&cy diseases,
diabetes i& pre"&a&cy, 7+*
14# 4.S060!)*65 ?!6-.0.SDefinitionA t/,e
o% Dia0etes 6here onl/ ,regnant 6o+en gets
6here her 0lood sugar rate elevates 0ut never
had a high 0lood sugar rate 0e%ore
,regnanc/.S!non!sDiabetes (u'in$
"'e$nanc! *ursi&" ?ia"&osis3ervical
!&compete&ce*ursi&" !&terve&tio& Pre.
op1 $ncoura*e patient to maintain bed
rest(est side e4uipment(est position
before and after sur*ery
(Pillitteri5 7aternal and #hild Nursing5
,.2J1-J29
E. DIA1ETES MELLITUS
Suctio&
1$$
4estatio&al diabetes mellitus :pre"&a&cy
i&duced;
A pre*nant3 insulin.dependent diabetic is at
ris8 for sudden h/,ogl/ce+ia because insulin
needs and metabolism are affected b pre*nancy3
ma8in* sudden hypo*lycemic episodes more
common for diabetics.
3ha&"es i& the "lucose-i&suli& mecha&ism<
o .arly i& pre"&a&cy<
6# !&crease productio& of
i&suli&
-# (ater&al "lucose is
co&sumed by fetus
o 5ate i& pre"&a&cy<
6# (other develops
i&suli& resista&ce
-# 0he prese&ce of
place&tal i&suli&ase
brea's dow& i&suli&
rapidly
-# ?escriptio& of
?iabetes i& +re"&a&cy
*
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+563.*06
+/.@!6Nu'sin$
Consi(e'ationsA
. 3lie&t is hospitali2ed a&d
put o& bed rest
# 3o&ti&ually mo&itor fetal
well- bei&"
# 3aesarea& delivery
i&dicate
# (easure blood loss
throu"h peri&eal pad cou&ts
# *) va"i&al e1ams
# +rovide emotio&al support
Nu'sin$ Consi(e'ationsA
# -ed rest i& wed"e positio& too preve&t supi&e hypote&sio&
.
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# 0reat si"&s of shoc' a&d hemorrha"e
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?efi&itio&
"LACENTA "RE;IA
8i"ure 2B a
N !mproperly impla&ted place&ta i& the lower uteri&e se"me&t &ear or over
the i&ter&al cervical os
N 0otal< the i&ter&al os is e&tirely covered by the place&ta whe& cervi1 is fully
dilated
N (ar"i&al< o&ly a& ed"e of the place&ta e1te&ds to the i&ter&al os
N 5ow-lyi&" place&ta< impla&ted i& the lower uteri&e se"me&t but does &ot
reach the os :Sau&ders pa"e 2AA;
+redisposi&" 8actor N (ater&al a"e
N +arity :&o# )f pre"&a&cy;
N +revious uteri&e sur"ery
3ardi&al (a&ifestatio& N +ai&less bleedi&" as early as $ mo&ths :mild to hemorrha"e;
N Soft uterus
N 6bdomi&al fetal positio& of breech or tra&sverse lie
N ,teri&e co&tractio&s
N 6&emic
3omplicatio& N a&emia, X1hemorrha*e, X2shoc8, re&al failure, X3 disseminated
intra#ascular coa*ulation, cerebral ischemia, mater&al a&d fetal death
:*ursi&" 6lert p#41=;
2=1
0herapeutic !&terve&tio&s N ,ltraso&o"raphy to co&firm the pressure of place&ta previa#
N ?epe&ds o& locatio& of place&ta, amou&t of bleedi&" a&d status of the
fetus#
N 7ome mo&itori&" with repeated ultrasou&ds may be possible with type !-
low lyi&"
N 3o&trol bleedi&"
N /eplace blood loss if e1cessive
N 3esarea& birth if &ecessary
N -etamethaso&e is i&dicated to i&crease fetal lu&" maturity# :(osby,
3omprehe&sive p# 2B3;
*ursi&" ?ia"&osis with
*ursi&" !&terve&tio&
F1 N!S)NG D)AGN&S)S" Potential %luid volu+e de%icit
N (ai&tai& bed rest
N F1 Assess+ent - 7onitor +aternal vital signs5 (*5 and %etal activit/
N 6ssess bleedi&" :amou&t a&d Huality;
N (o&itor a&d treat si"&s of shoc'
N 6void va"i&al e1ami&atio& if bleedi&" is occurri&"
N +repare for premature birth or cesarea& sectio&
N 6dmi&ister !@ fluids as ordered
N 6dmi&ister iro& suppleme&ts or blood tra&sfusio& as ordered :mai&tai&
hematocrit level;
N +repare to admi&ister /h immu&e "lobuli&
-.S0+)S!0!)* .he ,atient 6ith ,lacenta ,revia should 0e +aintained on 0ed rest5
,re%era0l/ in a side-l/ing ,osition. Additional ,ressure %ro+ an u,right
,osition +a/ cause %urther tearing o% the ,lacenta %ro+ the uterine lining.
A+0ulating 6ould there%ore 0e indicated %or this ,atient. Per%or+ing a
vaginal e$a+ination and a,,l/ing internal scal, electrode could also cause
the ,lacenta to 0e %urther torn %ro+ the uterine lining.
2=2
A1RU"TIO "LACENTAEP Left late'al &osition
Confi'ato'! Test
A1RU"TIO "LACENTAE
8i"ure 21
N ,ltrasou&d for place&ta locali2atio&
*)0.<
Manual pel#ic e@aminations are contraindicated
)hen #a*inal bleedin* is apparent in the third
trimester unit a dia*nosis is made and placenta
pre#ia is ruled out. ,i*ital e@amination of the
cer#i@ can lead to maternal and fetal
hemorrha*e. A dia*nosis of placenta pre#ia is
made by ultrasound. "he hemo*lobin and
hematocrit le#els are monitored and e@ternal
electronic fetal heart rate monitorin* is initiated.
$lectronic fetal monitorin* 0e@ternal7 is crucial
in e#aluatin* the status of the fetus )ho is at ris8
for se#ere hypo@ia. 0Saunders Comprehensi#e
ACCA $dition3 p. ECJ7
-est +ositio&
?efi&itio& +remature separatio& of the place&ta from the uteri&e
wall after the 2B
th
wee' of "estatio& a&d before the fetus
is delivered :Sau&ders pa"e 2AA-3BB;
2=3
Pathophysiolo*y S Spontaneous rupture of blood #essels at the
placental bed may due to lac8 of resiliency or to
abnormal chan*es in uterine #asculature.
S May be complicated by hypertension or by an
enlar*ed uterus that can/t contract sufficiently to
seal off the torn #essels
S Conse4uently3 bleedin* continues unchec8ed3
possibly shearin* off the placenta partially or
completely. 0Nursin* Alert p.J7
(a&ifestatio& N +ai&ful va"i&al bleedi&"
N 7yperto&ic to teta&ic, e&lar"ed uterus
N Board-li4e rigidit/ o% a0do+en (#ullen Sign9
N 6b&ormal/abse&t fetal heart to&es
N +allor
N 3ool, moist s'i&
N -loody am&iotic fluid
N /isi&" fu&dal hei"ht from blood trapped behi&d the
place&ta
N Si"&s of shoc'
N (a&ifestatio& of coa"ulopathy
NO"$1
Uterine tenderness accompanies placental abruption3
especially )ith a central abruption and trapped blood
2=4
behind the placenta. "he abdomen )ill feel hard and
boardli8e upon palpation as the blood penetrates the
myometrium and causes uterine irritability.
Obser#ation of the fetal monitorin* often re#eals
increased uterine restin* tone3 caused by failure of the
uterus to rela@ in an attempt to constrict blood #essels
and control bleedin*. 0Saunders Comprehensi#e ACCA
$dition3 p. ECJ7
3omplicatio& S +emorrha*e3 shoc83 renal failure3 disseminated
intra#ascular coa*ulation3 maternal death3
fetal death0Nursin* Alert p.J7
"herapeutic Inter#entions N /eplaceme&t of blood loss#
N %ith moderate or severe separatio& or mater&al or
fetal distress< emer"e&cy childbirth#
*)0.<
.he goal o% +anage+ent in a0ru,tion
,lacentae is to control the he+orrhage and
deliver the %etus as soon as ,ossi0le. Deliver/
is the treat+ent o% choic i% the %etus is at ter+
gestation or i% the 0leeding is +oderate to
severe and +other or %etus is in Geo,ard/.
(Saunders #o+,rehensive 2::2 Edition5 ,.
2:B9
N %ith mild separatio& without fetal distress a&d i&
the prese&ce of some cervical effaceme&t a&d
dilatatio&< i&ductio& of labor may be attempted
N)1y"e& if &ecessary
N (ai&te&a&ce of fluid a&d electrolytes bala&ce#
:(osby, 3omprehe&sive p# 2B4;
*ursi&" ?ia"&osis with !&terve&tio& F1 N!S)NG D)AGN&S)S" is4 %or %luid volu+e
de%icit
T F1 Assess+ent" 7onitor and (*
N 6ssess for va"i&al bleedi&", abdomi&al pai&, a&d
i&crease i& fu&dal hei"ht
N (ai&tai& bed rest
N 6dmi&ister o1y"e& as prescribed
N (o&itor a&d report a&y uteri&e activity
N 6dmi&ister !@ fluid as prescribed
N (o&itor ! & )
N 6dmi&ister blood products as prescribed
N (o&itor blood studies
N +repare for the delivery of the fetus as Huic'ly as
possible
N (o&itor for si"&s of dissemi&ated i&travascular
coa"ulatio& i& the post-partum period
3o&firmatory 0est N ,ltrasou&d detects retro-place&tal bleedi&"
;ENA CA;A S=NDROME
?efi&itio& 0he ve&ous retur& to the heart is impaired by the wei"ht
of uterus#
Sy&o&ym Supi&e 7ypote&sive Sy&drome
2=5
+redisposi&" factors 0hrombophlebitis
*)0.<
3o&tribute to clot formatio& motio& i&clude
i&activity,reduced cordiac output, compressio& of the
vie&s i& pelvis or le"s
"he most li8ely cause of supine hypotension is feelin*
di22y3 short of breath and clammy )hen lyin* bac8 for
lon* periods of time in patients :
th
month of
pre*nancy.
"he cause of supine hypotension durin* pre*nancy
is the )ei*ht of the uterus compresses the inferior
#ena ca#a3 decreasin* the return of blood to the
heart3 thus decreasin* cardiac output3 )hich lo)ers
the blood pressure
!&itial si"& 8atiHue, pro1ymal &octur&al dysp&ea, orthop&ea,
hypo1ia, cya&osis
5ate Si"& /educe re&al perfectio&, ?ecrease "lomerular filtratio&
3ardi&al si"& shoc' such as tachycardia
*)0.<
3aused by reduced cardiac output, respiratory
distress, fatal distress
!&itial / Scree&i&" test 870 mo&itor
*)0.<
6bove 16B or below 12B beats per mi&utes, 8etal +7
below $#5
3o&firmatory test 6m&iotomy<
*)0.<
6bove 'eepi&" the si"&ifica&t other improved of the
pro"ress of care, the fatal status would he the
priority
*ursi&" ?ia"&osis 6ltered tissue perfectio& related to decrease blood
circulatio&
/is' for altered 7ealth mai&te&a&ce related to
i&sufficie&t '&owled"e of treatme&ts, dru"
therapies, home care ma&a"eme&t a&d preve&tio&
of future i&fectio&
6ltered comfort related to maladaptive copi&"
*ursi&" !&terve&tio& 3losely mo&itor for shoc' a&d decreasi&" blood#
+ressure, tachycardia, coal, clammy S'i&
(ai&tai& patie&t o& bed rest to reduce )1y"e&
dema&ds a&d ris' for bleedi&"# (o&itor prescribed
medicatio& "ive& to preserve ri"ht @e&tricular
felli&" pressure a&d i&crease blood pressure
!&struct patie&t i& self > care activities +rovide
i&formatio& about a&ti smo'i&" strate"ies a&d
allow patie&t time to retur& demo&stratio& of
treatme&t to the do&e at home
6ssess physical complai&ts matters of facts
without emphasi2i&" co&cer&# ,se deep >
breathi&", muscle rela1atio&, a&d ima"ery to
relieve discomfort# .1press a cari&" attitude
-est maor Sur"ery 3aesaria& Sectio& > &ote if cervi1 is i&complete deleted#
-est dirt for pre-operative 8ood a&d fluid are withheld before i&vasive procedure
2=6
is &ot resumed u&til the clie&t is stable a&d free of
&ausea & vomiti&"#
-est diet for ?isease 7ypoaller"e&ic !o&ic diet 3alcium i&creased
+ossible Sur"ical 3omplicatio& !&terruptio& of ve&a cava, which reduce cha&&el si2e#
3omplicatio& of ?isease N -leedi&" as a result of treatme&t
*)0.<
)bservatio& of the fetal mo&itori&" ofte& reveal
i&crease uteri&e rustli&" to&e, caused by failure of the
uterus to rela1 i& a& attempt to co&strict blood vesicle
a&d co&trol bleedi&"
N /espiratory failure#
-est positio& pre-operative Sims +ositio&
*)0.<
.urning to the le%t side to shi%t right o% the %etus o%%
the in%erior vena cava#
-ed Side .Huipme&t )1y"e& obtai& eHuipme&t for e1ter&al electro&ic fetal
heart rate mo&itori&" )1y"e& with 3a&&ula
Disse+inated )ntravascular
coagulation7istory of ?isease
6&"i&a, myocardial i&farctio&
3ool&ess a&d mottli&" of e1tremities9 pai&9
dysp&ea9 ab&ormal bleedi&"+redisposi&" /
3o&tributi&" 8actors
*ame of the ?isease
)verwhelmi&" i&fectio&s particularly bacterial sepsis9
F1 a0ru,tion ,lacenta' ecla+,sia' am&iotic fluid
embolism9 !,8?:!&tra-uteri&e fetal death; or rete&tio&
of dead fetus9 bur&9 trauma9 fractures9 maor sur"ery9
fat embolism9 soc'9 hemolytic tra&sfusio& reactio&9
mali"&a&cies particularly of lu&", colo&, stomach, a&d
pa&creas
NO"$1
,isseminated intra#ascular coa*ulation 0,IC7 is a
state of diffuse clottin* in )hich clottin* factors are
consumed. "his leads to )idespread bleedin*. Platelet
are decreased because they are consumed by the
process3 coa*ulation studies sho) no clot formation
0and are thus normal to prolon*ed7H and fibrin plu*s
may clo* the micro#asculature diffusely3 oo2in* from
in?ection sites3 and presence of hematuria are si*ns
associated )ith the presence of ,IC. S)ellin* and pain
in the calf of one le* are more li8ely to be associated
)ith thrompophlebitis. 0Saunders Comprehensi#e ACCA
$dition3 p. ECJ7
5ate Si"&!&itial Si"& 6ltered me&tal status9 acute re&al failure
*ursi&" ?ia"&osis & !&terve&tio& /is' for i&ury related to
bleedi&" due to thrombocytope&ia
2=$
6ltered tissue perfusio& :all
tissues; related to ischemia due to
microthrombi formatio&
?ecreased 8ibri&o"e& level9 i&creased fibri& split
products9 decreased a&ti-thrombi& !!! level-eside
.Huipme&t.349 3@+Scree&i&" or !&itial ?ia"&ostic
0est(i&imi2i&" -leedi&"
1# !&stitute -leedi&" precautio&s
2# (o&itor pad cou&t/amou&t of saturatio& duri&"
me&ses9 admi&ister or teach self-admi&istratio& of
hormo&es to suppress me&struatio& as prescribed#
3# 6dmi&ister blood products as ordered# (o&itor for
si"&s a&d symptoms of aller"ic reactio&s,
a&aphyla1is, a&d volume overload#
4# 6void dislod"i&" costs# 6pply pressure to sites of
bleedi&" for at least 2B mi&s, use topical
hemostatic a"e&ts# ,se tape cautiously#
5# (ai&tai& bed rest duri&" bleedi&" episode#
6# !f i&ter&al bleedi&" is suspected, assess bowel
sou&ds a&d abdomi&al "irth#
$# .valuate fluid status a&d bleedi&" by freHue&t
measureme&t fo vital si"&s, ce&tral ve&ous
pressure, i&ta'e a&d output#
=#
A# +romoti&" 0issue +erfusio&
1# Leep patie&t warm
2# 6void vasoco&strictive a"e&ts :systemic or
topical;#
3# 3ha&"e patie&tEs positio& freHue&tly a&d perform
/)( e1ercises#
4# (o&itor electrocardio"ram a&d laboratory test for
dysfu&ctio& of vital or"a&s casued by ischemia >
arrhythmias, ab&ormal arterial blood "ases,
i&creased blood urea &itro"e& a&d creati&i&e#
5# (o&itor for si"&s of vascular occlusio& a&d report
immediately#
a# -rai& > decreased level of co&scious&ess,
se&sory a&d motor deficits, sei2ures,
coma#
b# .yes > @isual deficits#
c# -o&e > +ai&
d# +ulmo&ary vasculature > chest pai&, short&ess
of breath, tachycardia#
e# .1tremities > cold, mottli&", &umb&ess#
f# 3oro&ary arteries > chest pai&, arrhythmias#
"# -owel > pai&, te&der&ess, decreased bowel
sou&ds#
+09 +009 +latelet cou&t :Smelt2er, S#3# & -are, -#4#,
1AA2#p#=11;
2==
h#
i#
#
6&ticoa"ula&t/efere&cesSmelt2er,S#3#& -are, -#4#
1AA2# -ru&&er a&d SuddarthEs 0e1boo' of (edical-
Sur"ical *ursi&", $
th
ed# K#-# 5ippi&cott compa&y<
+hiladelphia, ,S6#-est ?ru"3o&firmative 0est
0he 5ippi&cott (a&ual of *ursi&" +ractice, $
th
ed#,
2BB1# 5ippi&cott %illiams & wil'i&s<
+hiladelphia, ,S6# +p#==$-===#
7epari& i&hibits clotti&" compo&e&ts of ?!3
Natu'e of t#e D'u$
H!&e'eesis $'a)i(a'u
7yperemesis "ravidarum is persiste&t, u&co&trolled vomiti&" that be"i&s i& #the first wee's of pre"&a&cy a&d
may co&ti&ue throu"hout pre"&a&cy# ,&li'e Rmor&i&" sic'&ess,S hyperemesis ca& have serious complicatio&s,
i&cludi&" severe wei"ht loss, dehydratio&, a&d electrolyte imbala&ce#
N&.E" .he de%ining %actor %or h/,ere+esis gravidaru+ should 0e the ti+e o% occurrence U and that is the
2nd tri+ester5 usuall/ the 1B U 1H
th
6ee4. )% this is on the 1
st
tri+ester5 usuall/ this is +orning sic4ness.
Causes
4o&adotropi&e productio&
+sycholo"ical factors
0rophoblastic activity
Assessent *in(in$s
3o&ti&uous, severe &ausea a&d vomiti&"
?ehydratio&
?ry s'i& a&d mucous membra&es
.lectrolyte imbala&ce
(etabolic acidosis
*o&-elastic s'i& tur"or
)li"uria
Dia$nostic Test Result
6rterial blood "as a&d a&alysis reveals al'alosis#
7b level a&d 730 are elevated#
Serum potassium level reveals hypo'alemia
,ri&e 'eto&e levels are elevated#
,ri&e specific "ravity is i&creased#
Nu'sin$ Dia$noses
8luid volume deficit
6ltered &utritio&9 less tha& body reHuireme&ts
+ai&
T'eatent
0otal pare&teral &utritio& :0+*;
/estoratio& of fluid a&d electrolyte bala&ce
2=A
D'u$ T#e'a&!
6&ti-emetics, as &ecessary for vomiti&", for e1ample +lasil , 7ydro1y2i&e a&d +rochlorpera2i&e
Inte')ention an( Rationales
(o&itor vital si"&s a&d fluid i&ta'e a&d output to assess for fluid volume deficit#
)btai& blood samples a&d uri&e specime&s for laboratory tests, i&cludi&" 7b level, 730, uri&alysis,
a&d electrolyte levels#
+rovide small freHue&t meals to mai&tai& adeHuate &utritio&#
(ai&tai& !#@# fluid replaceme&t a&d 0+* to reduce fluid deficit a&d p7 imbala&ce#
+rovide emBotio&al support to help the patie&t cope with her co&ditio&#
"eachin* "opics
,si&" salt o& foods to replace sodium lost by vomiti&"#
8rom< Spri&"house, pa"es 4=3-4=4
I;. INTRA"ARTUM CARE
Int'a&a'tu &e'io( e1te&ds from the be"i&&i&" of co&tractio&s that cause cervical dilatio& to the first 1-4
hours after delivery of the &ewbor& a&d place&ta#
Int'a&a'tu ca'e refers to the medical a&d &ursi&" care "ive& to a pre"&a&t woma& a&d her family duri&"
labor a&d delivery#
5abor versus 5abor
1# 5abor< 3oordi&ated seHue&ce of i&volu&tary uteri&e co&tractio&s or a result i& the effaceme&t a&d dilatio&
of the cervi1, followed by e1pulsio& of the products of co&ceptio&#
2# ?elivery< 6ctual eve&t of birth
A. *acto's Affectin$ Labo'
*ACTORS A**ECTING LA1OR
+6SS64.%6F +6SS.*4./ +)%./S +563.*065
8630)/S
+SF37.
?iscomfort-e"i&s at lower bac' a&d radiates
arou&d abdome&+rimarily o& the lower abdome&
&
"roi&!rre"ular0/,.865S.3o&tractio&s/e"ular4y&ecoi
d
8etal bo&es
Suture li&es
8o&ta&els head
measureme&ts
8etal lie
+76S.S
N !&creme&t
N 6cme
N ?ecreme&t
2AB
,&cha&"ed
,&cha&"ed or decrease i& freHue&cy a&d i&te&sity
-ecome more freHue&t
4radual i&crease i& duratio& a&d i&te&sity / pro"ressive
freHue&cy & i&te&sity
I "ASSAGE?A=
-refers to the adeHuacy of the pelvis a&d birth ca&al i&
allowi&" the fetal desce&t9 factors i&clude<
6# 0ype of pelvis
-# structure of the pelvis :true versus false pelvis;
3# pelvic i&let diameters
?# ability of the uteri&e se"me&t & va"i&al ca&al to diste&d,
the cervi1 to dilate
A**ECTED 1= THE *OLLO?ING *ACTORSA
A. T!&es of St'uctu'e
PartsA ischium, iluim, coccy1#
Eoints" Sacroiliac, Sacrococcy"eal, symphysis pubis :all softe& duri&"
pre"&a&cy;
#lassi%ications or ./,es o% Pelvis"
a# G!necoi(A *ormal 8emale +elvis< /ou&ded )val#
b# 7&S. (AV&ABLE (& S!##ESS(!L
LAB& A B).*.
c# An('oi(A *ormal (ale +elvis< 8u&&el Shape
d# Ant#'o&oi(A oval
e# "lat!&elloi(A flatte&ed, tra&sverse oval
f#
B. St'uctu'e of t#e "el)is :<it# &el)ic inlet & outlet
(iaete's+
#.
D.
E.
(.
G.
*. *ALSE "EL;IS
). 6bove the li&ea termi&alis, across the top of symphysis
pubis# !t supports the e&lar"e uterus i& the abdomi&al
cavity
M Shallow upper basi& of the pelvis
M Supports the e&lar"i&" uterus but &ot importa&t
obstetrically
M LINEA TERMINALIS
M +la&e dividi&" upper or false pelvis from lower or true
pelvis
8etal attitude
8etal prese&tatio&
8etal positio&
8etal statio&
6SS.SS(.*0
8reHue&cy
?uratio&
!&terval
!&te&sity
2A1
M TRUE "EL;IS
M 5ies below the li&ea termi&alis, the bo&y pelvis
throu"h which the baby pass
M %idest diameter :tra&sverse;
M *arrowest diameter :a&terior > posterior;
M 3o&sists of the pelvic i&let, pelvic cavity, a&d pelvic
outlet#
M -o&y ca&al throu"h which the i&fa&t pass#
M (easureme&ts of true pelvis i&flue&ce the co&duct a&d
pro"ress of labor a&d delivery#
M MID"LANE
M +elvic cavity
M
M
M
M
M OUTLET
M ?i(est (iaete'A 6&terior posterior diameter :reHuires
the i&ter&al /elatio&ship of fetal head for e&try;
M Na''o<est (iaete'< 0ra&sverse !&tertuberous ?iameter
:facilitates delivery i& )ccipital 6&terior +osterior;
M
M
M 1%. "el)ic easu'eents
M a. T'ue conNu$ate o' conNu$ate )e'a
M - measured from upper mar"i& of symphysis pubis to
sacral promo&tory9 should be at least 11 cm#
M - may be obtai&ed by 1-ray or ,/S
M b. Tube'9isc#ial (iaete'/
Inte'tube'ous (iaete'
M 9 (easures the outlet betwee& the i&&er
borders of ischial tuberosities, should be at least =-A
cm#
M - estimated o& pelvic e1am
M c. Obstet'ical ConNu$ate
M - ?ista&ce betwee& the i&&er surfaces
of the symphysis pubis a&d sacral promo&tory
M
M
M II. "ASSENGER :T#e *etus+
M Refe's to t#e fetus an( its abilit! to
o)e t#'ou$# t#e &assa$e<a!.
M A**ECTED 1= THE *OLLO?ING *ACTORS<
M
M a# Attitu(e
M
M 1# 0he relatio&ship of the fetal body parts to o&e a&other
or, a&other word is fetal posture
M
M 2# Nor+al intrauterine attitude is %le$ion, i& which the
fetal bac' is rou&ded, the head is forward o& the chest, a&d
the arms a&d le"s are folded i& a"ai&st the body
M
M - Lie
M - /elatio&ship of the spi&e of the fetus to the spi&e of the
2A2
mother
M
M .ransverse lie is an indication for cesarean deli#ery.
Se#eral maternal and fetal conditions ma8e cesarean
deliver/ necessary ."he commonly accepted indications
include complete placenta pre#ia3 trans#erse lie at term3
cephalopel#ic disproportion3 abruptio placentae3 acti#e
*enital herpes3 umbilical cord prolapse3 failure to
pro*ress in labor3 pro#en fetal distress3 beni*n and
mali*nant tumors that bloc8 the birth canal3 and cer#ical
cercla*e. Other reasons for a cesarean deli#ery are more
contra#ersial3 such as breech presentation3 pre#ious
cesarean birth3 ma?or con*enital anomalies3 and se#ere
isoimmuni2ation. ")ins can sometimes be deli#ered
#a*inally3 especially )hen the lo)ermost t)in is in a
#erte@ presentation.
M
M
M 1### Lon$itu(inal o' )e'tical
M a# 8etal spi&e is parallel to the motherIs spi&e
M b# 8etus is either cephalic or breech prese&tatio&
M 2### T'ans)e'se o' #o'i3ontal
M a# 8etal spi&e is at a ri"ht a&"le, or perpe&dicular, to the
motherIs spi&e
M b# +rese&ti&" part is the shoulder
M c# ?elivery by cesarea& sectio&
M 3... ObliFue
M a# 8etal spi&e is at a sli"ht a&"le from a true hori2o&tal lie
M b# ?elivery is by cesarea& sectio& if u&correctable
M
M 3 "'esentation
M 9 the relatio&ship of a particular refere&ce poi&t of the prese&ti&"
part a&d the mater&al pelvis described with a series of 3 letters or
presentation refers to the part of the fetus at the cer#ical os
M
M +rese&ti&" part< +ortio& of the fetus that e&ters the pelvis
first
M 1# 3ephalic
M a# 0he most commo& prese&tatio&
M b# 8etal head prese&ts first
M 2 -reech
M a# -uttoc's prese&t first
M b# ?elivery by cesarea& sectio& may be
reHuired, althou"h it is ofte& possible to deliver va"i&ally
M 3 Shoulders
M a# 8etus is i& a tra&sverse lie, or the arm, bac',
abdome&, or side could prese&t
M b# !f the fetus does &ot spo&ta&eously rotate or if it is
&ot possible to tur& the fetus ma&ually, a cesarea& sectio& may
be performed
M
M *)0.< "he nurse )ould auscultate abo#e the umbilicus
if the fetus is in breech presentation has the bac8 abo#e or at the
umbilical area. %etal heart tones are ausculated best in the left
2A3
lo)er abdomen )hen the fetus is in a left occipitoanterior
position. %or the heart tones to be located belo) the umbilicus3
the fetus )ould be in a cephalic position. %etal heart tones are
heard best in the ri*ht lateral abdomen )hen the fetus is in a
ri*ht occipitoposterior position.
M ?# "osition
M /elatio&ship of assi"&ed area of the prese&ti&" part or
la&dmar' to the mater&al pelvis or the relationship of the
fetusGs presentin* part to the motherGs pel#is
M
M LEO"OLDOS MANEU;ERS
M
M It is a systematic )ay to e#aluate the presentation3
position and attitude of the fetusH the location of the best
place to auscultate the fetal heart soundsH and the
en*a*ement status of the presentin* part. .he/ don<t
accuratel/ deter+ine ho6 large the %etus is5 6hich is
0est deter+ined 0/ ultrasound.
M
M +reparatio&
M
M 1# 6s' the mother to empty the bladder
M 2# %arm ha&ds a&d apply them to the abdome& with firm
a&d "e&tle pressure
M
M +/)3.?,/.
M
M .he %irst +aneuver deter+ines 6hat %etal ,art is in the
%undal ,ortion o% the uterus. )n this case5 the so%t5 %ir+
+ass indicated the %etal 0uttoc4s are in the %undus5
re%lecting a verte$ ,resentation. .he second +aneuver
docu+ents the location o% the %etal 0ac4. .he side o%
the uterus 6here the 0ac4 is located is s+ooth and
conve$ to the touch5 and the o,,osite side has areas o%
indentation. .he third +aneuver con%ir+s that 6as
6hat ,al,ated in the %undus is correct and also
deter+ines 6hether the ,resenting ,art is engaged. )n
this case5 the hard5 round5 +ova0le o0Gect in the ,u0ic
area is the %etal head. .he %ourth +aneuver deter+ines
id the %etal head is %le$ed or e$tended.
M
M (etal Position
M
M /)6< /i"ht occiput a&terior
M 5)6< 5eft occiput a&terior (the 0est %etal ,osition9
M /)+< /i"ht occiput posterior
M /(6< /i"ht me&tum a&terior
M /(+< /i"ht me&tum a&terior
M 5)+< 5eft occiput posterior
M 5(6< 5eft me&tum a&terior
M /)0< /i"ht occiput tra&sverse
M 5)0< 5eft occiput tra&sverse
M /(+< /i"ht me&tum posterior
M 5S6< 5eft sacrum a&terior
M 5S+< 5eft sacrum posterior
M
2A4
M Se#ere bac8 pain durin* labor maybe related to a fetus in
an OCCIPI"O. POS"$IO POSI"ION. "his means that
the fetal head presses a*ainst the client/s sacrum3 )hich
causes mar8ed discomfort durin* contractions.
epositionin* the client and pro#idin* sacral bac8 rubs
may help alle#iate the discomfort. "rans#erse3 obli4ue
and occiput positions do not cause pressure on the
sacrum.
M
M 0. *etal Lie 9 refers to the relationship of the fetal lon*
a@is to that of the motherGs lon* a@is.
M a# CE"HALIC Q verte1, face, brow
M b# 1REECH > fra&', footli&", complete
M c# SHOULDER > tra&sverse lie
M
M N&.E1 Adolescent clients maturation are usually not yet
complete3 therefore they are #ery common for
cephalopel#ic disproportion.
M
M N&.EA 5ie :spi&e to spi&e; may be lo&"itudi&al
:parallel;, tra&sverse :ri"ht a&"les;, obliHue :sli"ht a&"le
off true tra&sverse lie;#
M
M *ETAL RE*ERENCE "OINT :"RESENTING "ART+
M
M 6# )33!+,0 :);
M -# S63/,( :S;
M 3# S36+,56 :Sc;
M ?# (.*0,( :(;
M
M MATERNAL RE*ERENCE "OINT
M
M 1# S!?. )8 (60./*65 +.5@!S
M 6# 5eft :5;
M -# /i"ht :/;
M 3# 0ra&sverse :0;
M
M 2# +6/0 )8 07. (60./*65 +.5@!S
M 6# 6&terior :6;
M -# +osterior :+;
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
2A5
M
M
M
M
M
M
M
M
M
M
M 1'eec# "RESENTATIONS
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M *RANH 1REECH
*ULL / COM"LETE
M
1REECH
"RESENTATION
M
M
M
M
M
M
M
M
M
2A6
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
SHOULDER 1REECH
M
M
*OOTLING "RESENTATION
M III. "O?ER
M
M 9 /efers to the freHue&cy, duratio&, a&d stre&"th of uteri&e
co&tractio&s to cause complete cervical effaceme&t a&d
dilatio&#
M
M 0he forces acti&" to e1pel the fetus
1# EffaceentA Shorte&i&" a&d thi&&i&" of the cervi1 duri&"
the first sta"e of labor
2# Dilation< .&lar"eme&t of cervical os a&d cervical ca&al
duri&" first sta"e
3#
.. LA1OR CONTRACTIONS
5#
4. THREE "HASES O* CONTRACTION
5.
1# INCREMENT- steep cresce&t slope from be"i&&i&" of
the co&tractio& u&til its pea'#
2. ACME/"EAH > stro&"est i&te&sity#
2. DECREMENT > dimi&ishi&" i&te&sity#
B.
3. CHARACTERISTICS O* CONTRACTIONS
H.
I. *REGUENC= > be"i&&i&" of o&e co&tractio& to
be"i&&i&" of o&e co&tractio&# 5ess tha& 2 mi&utes should
be reported#
@. DURATION > be"i&&i&" of o&e co&tractio& u&til its
completio&#
2A$
(ore tha& AB seco&ds should be reported
because of uteri&e rupture or fetal distress#
J. INTENSIT= > the stre&"th of co&tractio& at its pea' may
be mild, moderate or stro&"#
1:.
11.
12. I;. "LACENTAL *ACTORS
12. - /efers to the site of place&tal i&sertio&#
1B.
13.
1H. ;. "S=CHE
1I. - /efers to the clie&tEs psycholo"ical state, available
support systems, preparatio& for birth, e1perie&ces, a&d
copi&" strate"ies#
1@.
1J.
2:. 1. LA1OR
21. %. Si$ns of i&en(in$ labo'
22. -. Co&a'ison of T'ue Labo' f'o *alse
Labo'
22. 3. Sta$es of labo'
2B. 3. a. station of t#e &'esentin$ &a't
23. .. Nu'sin$ Inte')entions (u'in$ labo' &
(eli)e'!
2H. 0. Assessin$ t#e *etal Hea't Rate
2I.
2@.
2J. SIGNS O* IM"ENDING LA1OR
2:.
21.
22. 5i"hte&i&" -ra1to&Es-7ic's co&tractio&
4astroi&testi&al upset -urst of e&er"y -lood
show
22.
2B. F1 sign o% la0or
u,tured 0ag o% 6ater
23.
2H.
2I.
2@. %. "REMONITOR= SIGNS O* LA1OR
%. 5!470.*!*4
-. - ?esce&t of the fetus a&d uterus i&to pelvic cavity
before labor o&set#
3. -)ccurs 2-3 wee's earlier i& primipara#
.. - !& multipara, may &ot occur u&til labor be"i&s#
0. 2# 3./@!365 376*4.S
4. a# E**ACEMENT
5. - +ro"ressive softe&i&" Rripe&i&"S a&d thi&&i&" of
the cervi1#
6. - R-5))?F S7)%S :e1pulsio& of mucous plu";
7. b# DILATION
%8. - )pe&i&" of cervical os duri&" labor#
%%. 3# /e"ular -ra1to& 7ic'sE co&tractio&s#
%-. 4# /upture of am&iotic membra&es#
%3. 5# *.S05!*4 -.76@!)/S
%.. 6# %ei"ht loss of about 1-3 lbs 2-3 days before labor
2A=
o&set#
%0.
%4. -. COM"ARISON O* TRUE AND *ALSE LA1OR
%5.
%6. 376/630./!S0!3S
6&thropoid
6&droid
+latypelloid
.ffects of wal'i&"Stress factors6bruptio place&ta
5eadi&" to hypoto&ia
+lace&ta previa
+lace&ta acreta
+lace&ta media
3o&tractio&s are
i&te&sified
5esse&ed or
&ot affected
3ervical cha&"es +ro"ressive
dilatio& a&d
effaceme&t
*o cha&"e
+ai& does&Et disappear+ai& disappears?uri&"
Sedatio&3o&tractio&s does&Et stop3o&tractio&s
stopsShow
+rese&t *ot prese&t
?uri&" sleep
3. STAGES O* LA1OR
1
S0
S064. 2
*?
S064. 3
/?
S064. 4
07
S064.
3o&tractio& to
dilatio&
"'e&a'ato'!
(i)isionA
1; 5ate&t phase B-
3 cm
?uratio&< 3B >
45 seco&ds
*)0.< Pushin*
durin* the first
sta*e of labor
)hen the ur*e is
felt but the cer#i@
is not yet fully
dilated may
produce cer#ical
s)ellin* and
ma8es labor more
difficult. "he
client should be
encoura*ed to
PAN" (LO6 or
8ull cervical
dilatatio& to
delivery
?elivery to
place&tal
e1pulsio&
"he nurse
should
8no) if the
placenta is
*oin* to be
deli#ered3 is
to )atch for
cord
len*thenin*
3 a sli*ht
*ush of
dar8ened
blood or a
chan*e in
fundal
shape.
1
st
4 hours
postpartum
"he
precautions
you should
ta8e )hen a
postpartum
client starts
ambulatin* are
the fall
precaution and
close
monitorin*
should be done
due to the ris8
of syncopy3
especially the
first fe) times
out of bed.
2AA
(LO6.(LO6
pattern of
breathin* to help
o#ercome the ur*e
to push.
2; 6ctive phase 4-
$ cm
Du'ationA .0948
secon(s
3; 0ra&sitio&al
phase =-1B cm
?uratio& < 6B-AB
seco&ds
*IRST STAGE O* LA1OR
:ONSET O* REGULAR CONTRACTIONS TO *ULL CER;ICAL DILATION
.ANS).)&N P*ASE
0!(.< +/!(!+6/6 :1hour;
(,50!+6/6 :1B > 15 mi&utes;
3./@!O<
.8863.(.*0 - 1BBC
?!560!)* - =-1B cm
3)*0/630!)*S
8/.V,.*3F - 2-3 mi&utes
?,/60!)* - 6B-AB seco&ds
(6*!8.S060!)*S<
3lie&t may be irritable a&d pa&ic'y9 (ay lose co&trol9 6m&esic betwee& co&tractio&s9 +erspiri&",
&auseous a&d vomiti&" commo&9 0rembli&" of le"s9 +ressure o& bladder a&d rectum9 -ac'ache9 !&creased
show9 3ircumoral pallor
NO"$1 If the client is in acti#e labor and there is no chan*e in dilation after A hours3 the nurse should suspect
cephalopel#ic disproportion. "he client is not e@periencin* a prolon*ed latent phase 0C.E cm73 prolon*ed
transitional phase 0pushin*73 and contraction pattern.
NO"$1&a*inal $@amination
"o determine if the client is fully dilated3 the nurse performs a #a*inal e@amination. "o assess the
suture most readily felt3 the nurse )ould determine the position of the cranial suture termed.SA-I"ALL
SU"U$.
3BB
STATION
/efer to the level of prese&ti&" part of fetus i& relatio& to ima"i&ary li&e betwee& ischial spi&es :2ero
statio&; i& mid pelvis of mother#
- 0he measureme&t of the pro"ress of desce&t i& ce&timeters above or below the midpla&e from the
prese&ti&" part to the ischial spi&e
Minus stationA abo)e isc#ial s&ine
90 to Q% in(icates a &'esentin$ &a't abo)e 3e'o station :93*LOATINGD 9% DI""ING+
Station 8A at isc#ial s&ine
: +eans ENGAGE7EN.
"lus stationA belo< isc#ial s&ine
R % TO R 0 in(icates a &'esentin$ &a't belo< 3e'o station
R3 #&1N)NG
NMy baby is comin*O3 the R9 nursin* inter#ention is to loo8 for perineal bul*in* 0cro)nin*7. If the
perineum is bul*in*3 the patient should be coached to pant )ith her contractions so that she doesn/t
push. %etal heart rate is focus on the labor process or potential fetal cord compression and meconium
stained complications
SECOND STAGE O* LA1OR
:COM"LETE CER;ICAL DILATION TO 1IRTH O* NE?1ORN+
0!(.
+/!(!+6/6 :3B-5B mi&utes ;
(,50!+6/6 :2B mi&utes;
3)*0/630!)*S
8/.V,.*3F - 2-3 mi&utes
?,/60!)* - 6B-AB seco&ds
!*0.*S!0F
@./F 76/?< 1BB mm 7"
(6*!8.S060!)*S<
?ecrease i& pai& from tra&sitio&al level9 i&creased bloody show9 .1cited ea"er a&d i& co&trol#
3B1
THIRD STAGE O* LA1OR
:DELI;ER= O* NE?1ORN TO DELI;ER= O* "LACENTA+
0!(.< 5-3B mi&utes
3)*0/630!)*S
Stro&" a&d well-co&tracted uterus cha&"i&" to "lobular shape
(6*!8.S060!)*S<
Increased *ush of blood
Uterus becomin* *lobular )ith fundus risin* in the abdomen
Apparent len*thenin* of cord
*OURTH STAGE O* LA1OR
:DELI;ER= O* "LACENTA TO HOMEOSTASIS+
0!(.
,sually defi&ed as the first hour postpartum# 0his sta"e lasts from 1-4 hours after birth#
,0./,S
0he uterus co&tracts i& the midli&e of the abdome& with the fu&dus midway betwee& the umbilicus a&d
symphysis pubis#
(6*!8.S060!)*S<
5ochia rubra
.1ploratio& of &ewbor&
+are&t-i&fa&t bo&di&" be"i&s
*ewbor& alert a&d respo&sive
8irst period of reactivity
NURSING INTER;ENTIONS DURING LA1OR AND DELI;ER=
M ?uri&" labor, mo&itor 87/#
M +rovide patie&t comfort#
M 6dmi&ister a&al"esics as i&dicated#
M +repare for delivery#
M !mmediate &ewbor& care at delivery#
- .stablish airway#
- )bserve 6p"ar score at 1 a&d 5 mi&utes i&terval#
- 3lamp umbilical cord#
- (ai&tai& warmth#
- 6ssess the &ewbor&Es "estatio&al a"e#
- 6dmi&ister prophylactic eye drops a&d vitami& L#
- +lace ide&tificatio& ba&d o& baby a&d mother#
NURSING CARE DURING LA1OR
3B2
Nursin* care for the client durin* the second sta*e of labor should include assistin* the mother )ith pushin*3 helpin* position her le*s for ma@imum pushin* effecti#eness3 and monitorin* the fetal heart rate
3B3
Mec#aniss of Labo' En$a$eent o' Ca'(inal o)eents b! t#e *etus
Definition< (echa&ism by which the fetus &estles i&to the pelvis# 6 co&ti&uous process from the time of
e&"a"eme&t u&til birth, a&d is assessed by the measureme&t called statio&
Descent
6lso termed li"hte&i&" or droppi&" ?esce&t
0he process that the fetal head u&der"oes as be"i&s its our&ey throu"h the pelvis
*le,ion +rocess of the fetal headIs &oddi&" forward toward the fetal chest
Su0occi,oto0reg+aticA the diameter that prese&ts to the mater&al pelvis duri&" COMPL$"$ %L$'ION#
3B4
Inte'nal Rotation
!&ter&al rotatio& of the fetus9 most commo&ly from the occipital tra&sverse positio&, assumed at e&"a"eme&t
i&to the pelvis, to the occipital a&terior positio& while co&ti&uously desce&di&"
E,tension
.&ables the head to emer"e whe& the fetus is i& a cephalic positio&
-e"i&s after the head crow&s !s complete whe& the head passes u&der the pubis a&d occipital, a&d the a&terior
fo&ta&el, brow, face, a&d chi& pass over the sacrum a&d coccy1 are over the peri&eum
/estitutio&
/eali"&me&t of the fetal head with the body after that head emer"es
E,te'nal Rotation
0he shoulders e1ter&ally rotate after the head emer"es a&d restitutio& occurs, so that the shoulders are
a&teroposterior diameter of the pelvis
E,&ulsion
0he delivery baby
CARDINAL MO;EMENTS O* THE *ETUS
?esce&t 8le1io& !&ter&al /otatio& .1te&sio& .1ter&al /otatio&
.1pulsio&
8i"ure 1= 3ardi&al (oveme&ts or (echa&ism of labor
;II. ANESTHESIA
NOTEA Analgesia ad+inistered during the second stage o% la0or includes continuation o% the lu+0ar
e,idural 0loc45 ,udendal 0loc45 and local in%iltration o% the ,erineu+. Narcotic analgesics and ,ericervical
0loc4 are ad+inistered during the active ,hase o% la0or. A s,inal 0loc4 is given during the active ,hase o%
the %irst stage o% la0or. Sedative h/,notics5 i% ad+inistered5 are given 6hen the ,atient is in earl/ latent la0or
to encourage rest. A s,inal 0loc4 is given during the active ,hase o% the %irst stage o% la0or.
N&.E" *)0.< "he chief concepts of La+a8e teaching include conditioned responses to stimuli throu*h use of
a focal point. An emotionally satisfyin* e@perience is promoted rather than discoura*in* use of anal*esia and
anesthesia.
3B5
?.S3.*0 85.O!)* !*0./*65
/)060!)*
.O0./*65
/)060!)*
.O0.*S!)*
.O+,5S!)*
6# 5ocal a&esthesia
1# ,sed for bloc'i&" pai& duri&" episiotomy
2# 6dmi&istered ust before the birth of baby
3# *o effect o& the fetus
-# +aracervical bloc'
1# ,sed i& the first sta"e of labor
2# +rovides a rapid bloc' of uteri&e pai&
3# *o effect o& the peri&eal area
4# *o effect o& the ability to bear dow&
5# (ay cause fetal bradycardia
3# +ude&dal bloc'
1# 6dmi&istered ust before the birth of the baby
2# !&ectio& site at pude&dal &erve throu"h a tra&sva"i&al route
3# -loc's peri&eal area for episiotomy
4# .ffect lasts about 3B mi&utes
5# *o effect o& co&tractio&s or fetus
*)0.< Pudendal (loc8 Anesthesia
"he R9 purpose is to relie#e pain primarily in the perineum and #a*ina. It does not relie#e pain primarily
in the perineum and #a*ina. Pudendal bloc8 is ade4uate for episiotomy and its repair.
"he fetus should be assessed for (A,5CA,IA )hich is a potential complication of pudendal bloc8
anesthesia. ,ecrease mo#ements3 increase #ariability and meconium stained are NO" associated.
Maternal Ad#erse effects are the follo)in*1 hypotonia3 reduced responsi#eness and sei2ures.
?# .pidural bloc'
1# !&ectio& site i& epidural space at 53-54
2# 6dmi&istered after labor is established or ust before a scheduled cesarea& birth
3# /elieves pai& from co&tractio&s a&d &umbs va"i&a a&d peri&eum
4# (ay cause hypote&sio&
5# Does not cause headache 0ecause the dura +ater is not ,enetrated
6# 6ssess mater&al blood pressure
$# (ai&tai& the mother i& side-lyi&" positio& or place a rolled bla&'et be&eath the ri"ht hip to displace the
uterus from the ve&a cava
=# 6dmi&ister !@ fluids as prescribed A# !&crease fluids as prescribed if hypote&sio& occurs
A# 0he maor complicatio& of epidural a&esthesia is mater&al hypote&sio&#
N&.E" "o minimi2e the hypertensi#e effects of epidural anesthesia prior to the procedure ade4uately
hydrate the patient and position the patient side lyin* to the left.
After epidural anesthesia the #ital si*ns should be monitored e#ery 9.A minutes for the first 9F minutes.
.he assess+ent should 0e a high ,riorit/ a%ter a ,atient has received an e,idural is 0lood ,ressure
0ecause an e,idural can cause h/,otension and its 0loc4s the autono+ic nervous s/ste+.
A patient )ho is about to recei#e epidural anesthesia should empty her bladder before the procedure
because an epidural )ill lessen the sensation to #oid so #oidin* no) may decrease the need for
catheteri2ation later.
*)0.<
3B6
A co++on adverse e%%ect o% e,idural anesthesia is h/,otension5 6hich 6ould cause i+,aired gas
e$change in the %etus. .o ,revent h/,otension5 the ,atient receives a 0olus o% 3:: to 15::: +l o% ).V.
%luid 0e%ore the ,rocedure. .he ,atient isn<t a%%ected 0/ these ,ro0le+s 0ecause she didn<t receive the
e,idural anesthesia.
*)0.< "he patient plans to recei#e an epidural anesthetic for pain relief durin* labor3 it )on/t be
administered until the patient is dilated J to F cm.
.# Spi&al bloc'
1# !&ectio& site i& spi&al subarach&oid space at 53-55
2# 6dmi&istered ust before birth
3# /elieves uteri&e a&d peri&eal pai& a&d &umbs va"i&a, peri&eum, a&d lower e1tremities
4# (ay cause mater&al hypote&sio&
5# (ay cause postpartum headache
6# 0he mother must lie flat = to 12 hours followi&" spi&al i&ectio&
$# +lace a rolled bla&'et u&der the ri"ht hip to displace the uterus from the ve&a cava
=# 6dmi&ister !@ fluids as prescribed
8# 4e&eral a&esthesia
1# (ay be used for some sur"ical i&terve&tio&s
2# 0he mother is &ot awa'e
3# +rese&ts a da&"er of respiratory depressio& vomiti&"
O1STETRICAL "ROCEDURES
6# )1ytoci& !&ductio&
1# 6 deliberate i&itiatio& of uteri&e co&tractio&s this stimulates labor
2# .lective i&ductio& may be accomplished ! o1ytoci& :+itoci&; i&fusio&
3# )btai& baseli&e traci&" of uteri&e co&tractio&s a&d 87/
4# !&crease !@ dosa"e of o1ytoci& as prescribed o&ly after assessi&" co&tractio&s, 87/, a&d mater&al blood
pressure a&d pulse
5# ,o not increase rate of o@ytocin once the desired contraction pattern is obtained 0contraction fre4uency
of A to E minutes and lastin* :C seconds7
6# ,iscontinue o@ytocin as prescribed contraction fre4uency is less than A minutes or duration more than TC
seconds3 or if fetal distress is note
*)0.< )1ytoci& :!&ductio& of 5abor;
(efore the induction of Labor3 the nurse should obtain a baseline measurement of the fetal heart rate. If
the fetal heart rate pattern sho)s fetal distress3 the client is not a candidate or if contractions occur less
than A minutes apart or last lon*er than :C seconds
3# Anioto!
1# 6rtificial rupture of membra&es :6/)(;9 performe by the physicia& to stimulate labor
2# +erformed if the fetus is at ZBZ or ZUZ statio&
3# !&creases ris' of prolapsed cord a&d i&fectic
3B$
4# (o&itor 87/ before a&d after 6/)(
5# /ecord time of 6/)(, 87/, a&d characteristic of fluid
6# (eco&ium-stai&ed am&iotic fluid may be associated with fetal distress
$# -loody am&iotic fluid may i&dicate abrupt place&tae or fetal trauma
=# 6& u&pleasa&t odor to am&iotic fluid is associated with i&fectio&
A# +olyhydram&ios is associated with mater&al diabetes a&d certai& co&"e&ital disorders
1B# )li"ohydram&ios is associated with i&trauteri&e "rowth retardatio& :!,4/; a&d co&"e&ital
disorders
? #E,te'nal )e'sion
1# .1ter&al ma&ipulatio& of the fetus from a& ab&ormal positio& i&to a &ormal prese&tatio&
2# !&dicated for a& ab&ormal prese&tatio& that e1ists after the 34th wee'
3# (o&itor vital si"&s
4# !f the mother is /h-&e"ative, e&sure that /7 immu&e "lobuli& was "ive& at 2= wee's "estatio&
5# +repare for &o&stress test to evaluate fetal well-bei&"
6# !@ fluids a&d tocolytic therapy may be admi&istered to rela1 the uterus a&d permit easier ma&ipulatio& of
fetus
$# ,ltrasou&d is used duri&" the procedure to evaluate fetal positio& a&d place&tal placeme&t a&d "uide
directio& to the fetus
=# 6bdomi&al wall is ma&ipulated to direct fetus i&to a cephalic prese&tatio& if possible
A# (o&itor blood pressure to ide&tify ve&a cava compressio&
1B# (o&itor for u&usual pai&
11# 8ollowi&" the procedure
a# +erform &o&stress test to evaluate fetal well-bei&"
b# #(o&itor for uteri&e activity, bleedi&", ruptured membra&es, a&d decreased fetal activity
c# %ith /h-&e"ative clie&ts, perform Lleihauer -et'e test as prescribed to detect the prese&ce a&d
amou&t of fetal blood i& the mater&al circulatio& a&d to ide&tify clie&ts who &eed additio&al /h
immu&e "lobuli&
i# E&isioto!
J "he purpose of episiotomy is to shorten the A
nd
sta*e of labor3 substitutes a clean sur*ical incision for
a tear and decreases undue stretchin* of perineal muscles. An episiotomy helps pre#ent tearin* of the
rectum but does not necessarily relie#e pressure on the rectum. An episiotomy does not pre#ent perineal
edema3 ensure 4uic8 deli#ery of the placenta or cause enlar*in* the pel#ic inlet.
1# !&cisio& made i&to peri&eum to e&lar"e va"i&al outlet a&d facilitate delivery
2# 3hec' episiotomy site
3# !&stitute measures to relieve pai&
4# +rovide ice pac' duri&" the first 24 hours
5# !&struct the clie&t i& the use of sit2 baths
6# 6pply a&al"esic spray or oi&tme&t as prescribed
$# +rovide peri&eal care, usi&" clea& tech&iHue
=# !&struct the clie&t i& the proper care of the i&cisio&
A# !&struct the clie&t to dry the peri&eal area from fro&t to bac' a&d to blot the area rather tha& wipe it
1B# !&struct the clie&t to shower rather tha& bathe i& a tub
11# 6pply a peripad without touchi&" the i&side surface of the pad
3B=
12# /eport a&y bleedi&" or dischar"e to the physicia&
13# "he ad#anta*e of an episiotomy is that it facilitates the deli#ery of the fetus3 it pre#ents tearin* of the
perineum3 and it pre#ents undo stretchin* of the perineal muscles.
8# *o'ce&s (eli)e'!
1# 0wo double-crossed, spoo& li'e articulated blades that are used to assist# i& the delivery of the fetal head
2# /eassure the mother a&d e1plai& the &eed for forceps
3# (o&itor mother a&d fetus duri&" delivery possible i&ury
5# 6ssist with repair of a&y laceratio&s
4# ;acuu e,t'action
1# 6 cap li'e suctio& device is applied to the fetal head to facilitate e1tractio&
2# Suctio& is used to assist i& delivery of the fetal head
3# 0ractio& is applied duri&" uteri&e co&tractio&s u&til desce&t of the fetal head is achieved
4# 0he suctio& device should &ot be 'ept i& place a&y lo&"er tha& 25 mi&utes
5# (o&itor 87/ every 5 mi&utes if e1ter&al fetal mo&itori&" is &ot used
6# 6ssess &ewbor& i&fa&t at birth a&d throu"hout postpartum period for si"&s of cerebral trauma
$# (o&itor for developi&" cephalohematoma
=# 3aput succeda&eum is &ormal a&d will resolve i& 24 hours
7# Cesa'ean (eli)e'!
1# ?elivery of the fetus usually throu"h a tra&s-abdomi&al, low-se"me&t i&cisio& of the uterus
2# +reoperative
a# !f pla&&ed, prepare the mother a&d part&er
b# !f a& emer"e&cy, Huic'ly e1plai& the &eed a&d procedure to the mother a&d part&er
c# )btai& i&formed co&se&t
d# (a'e sure that the preoperative dia"&ostic tests are do&e, i&cludi&" the /h factor
e# +repare to i&sert a& !@ li&e a&d a 8oley catheter
f# +repare the abdome& as prescribed
"# (o&itor the mother a&d fetus co&ti&uously for si"&s of labor
h# +rovide emotio&al support
i# 6dmi&ister preoperative medicatio&s as prescribed
3# +ostoperative
a# (o&itor vital si"&s
b# +rovide pai& relief
c# .&coura"e tur&i&", cou"hi&", a&d deep breathi&"
d# .&coura"e ambulatio&
e# (o&itor for si"&s of i&fectio& a&d bleedi&"
f# -ur&i&" a&d pai& o& uri&atio& may i&dicate a bladder i&fectio&
"# 6 te&der uterus a&d foul-smelli&" lochia may i&dicate e&dometritis
h# 6 productive cou"h or chills may i&dicate
3BA
p&eumo&ia
COM"LICATIONS O* LA1OR AND DELI;ER=
"'ete' Labo'
+reterm labor is labor that be"i&s after 2B wee's "estatio& a&d before 3$ wee's "estatio&#
)btai& thorou"h obstetric
history5ow bac' pai&.0!)5)4F
)btai& specime& for 3-3 & ,/6
?etermi&e freHue&cy, duratio& &
i&te&sity of uteri&e co&tractio&s
?etermi&e cervical dilatatio&s a&d
effaceme&t
6ssess status of membra&es a&d
bloody show
.valuate fetus for distress, si2e
a&d maturity
Suprapubic pressure
@a"i&al pressure
/hythmic uteri&e co&tractio&s :2
uteri&e co&tractio&s lasti&" 3B
seco&ds withi& 15 mi&utes;
3ervical dilatatio& Y4 cm &
effaceme&t 5BC or less
.1pulsio& of cervical mucus plus
-loody dhow
S!4*S /SF(+0)(S 6SS.SS(.*0
(6*64.(.*0+erform measures to ma&a"e or
stop +reterm labor(6*64.(.*0
"ROM :"'eatu'e Ru&tu'e of Meb'ane+
- Spo&ta&eous rupture of am&iotic membra&es prior to
o&set of labor, maybe preterm :before 3= wee's
"estatio&; or term
6SS.SS(.*0
+lace o& 3-/ i& side-lyi&" positio&
+repare fro possible ultrasou&d, am&ioce&tesis,
tocolytic a&d steroid therapy
6dmi&ister meds as prescribed
6ssess S/. such as hypote&sio&, dysp&ea, chest
pai& a&d 87/ e1ceedi&" 1=B b#p#m#
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(6*64.(.*0<
6# ,mbilical cord prolapse
If the fetus is at IA station and the membranes rupture3 the patient is at ris8 for prolapsed cord.
5ou can determine if a prolapsed cord e@ists if you perform a #a*inal e@am.
"ROLA"SE UM1ILICAL CORD
321
8i"ure 23
+/)56+S. ,(-!5!365 3)/?
?efi&itio& 0he umbilical cord is displaced, either betwee& the prese&ti&" post
a&d the am&io& or protrudi&" throu"h the cervi1#
Sy&o&yms 3ord +rolapse
+redisposi&" 8actors
%etal Position other than cephalic presentations
+rematurity<
*)0.< Small fetus allows more space arou&d prese&ti&" part#
+olyhydram&ios
Multiple fetal *estation
8eto+elvic disproportio&
6b&ormally lo&" umbilical cord#
Placenta Pre#ia
Intrauterine tumors that pre#ent the presentin* part from en*a*in*
N -reech prese&tatio&, 0ra&sverse lie, ,&e&"a"ed prese&ti&" part, 0wi&
"estatio&, 7ydram&ios
Small fetus
3a
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!&itial Si"& 3ord +rolapse<
*)0." %irst discovered 6hen there is varia0le decelerated ,attern
87/ patter& variable< ?eceleratio&s with co&tractio&s or betwee&
co&tractio& or fetal bradycardia prese&t
+ersiste&t &o& reassuri&" fetal heart rate > fetal distress
6trophy of the umbilical cord & cord protrudi&" from va"i&a
3ord may be palpated i& cervi1/va"i&a
/efle1 co&strictio& whe& cord is e1posed to air
322
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3o&firmatory 0est
5ate Si"&
6m&iotomy< /upture of (embra&es
F1 7aternal A
(etal )n%ection -
#ausing
co+,ression o% the
cord and
co+,ro+ising %etal
circulation-est
(aor Sur"ery
)07./S< +rematurity,
7ypo1ia, (eco&ium
aspiratio&,8etal death if
delayed or u&dia"&osed
Cesarian Section if the cer#i@ incompletely dilated.
%ast #a*inal deli#ery )ith forceps
7istory of the
?isease8etal
&utrie&ts
supply7epari& !@
.ter&al .lectro&ic
8etal 7eart /ate
mo&itori&"-est
+ositio&
3ompressio& of the
umbilical cord
0o co&trol i&travascular
coa"ulatio& i& the
pulmo&ary circulatio&
-est ?ru"
*ature of the
dru"
)1y"e& with face-
mas'#
Sterile ha&d "love
.rendelen0erg<s ,osition or Knee #hest ,osition -6hich causes the
,resenting ,art to %all 0ac4 %ro+ the cord.
0ur& side to side -7elps may be elevated to shift to fetal prese&ti&"
toward diaphra"m#
324
-edside eHuipme&t
H="ERTONIC LA1OR
"ATTERNS :"'ia'!
ine'tia+H="OTONIC LA1OR
"ATTERNS :Secon(a'!
ine'tia+*ursi&" ?ia"&osis
(Pillitteri5 7aternal and #hild
Nursing5 ,.2::9
(Pillitteri5 7aternal and #hild
Nursing5 ,.3I@-3IJ9
*. D!stocia
G.
7# - ?ifficult,
pai&ful, ab&ormal
pro"ress of labor of
more tha& 24 hours
!#
1# +owers/ uteri&e
i&ertia/ co&tractio&
2#
3#
8luid volume deficit related
to active hemorrha"e
6ltered tissue perfusio&
related to mater&al vital
or"a& a&d fetal related to
hypovolemia
/is' for i&fectio& related
traumati2e tissue
*ursi&" !&terve&tio&N&.E" .he nurse<s F1 ,riorit/ action to a ,rola,se cord is to assess the %etal heart rate.
A ,rola,sed cord interru,ts the o$/gen and nutrient %lo6 to the %etus. )% the %etus doesn<t receive adeDuate
o$/gen5 h/,o$ia develo,s5 6hich can lead to central nervous s/ste+ da+age in the %etus.
(a&a"eme&t<*,/S!*4
!*0./@.*0!)*+redisposi&" 8actors<36,S.S.arly
a&al"esia)1ytoci& a&d am&io&ity0/.60(.*0/est
a&d sedatio&)33,//.*3.
1# (o&itor clie&t a&d fetus closely
2# +ossibly admi&ister tocolytic a"e&ts
3# +repare for emer"e&cy birth
1# (ultiparity
2# 7istory of rapid labor
3# +remature or small fetus
4# 5ar"e bo&y pelvis
5#
6# /is's<
1# +eri&eal laceratio&s & 7emorrha"e
A. 6hen deli#erin* the neonate3 you should
deli#er the head bet)een contractions. "his
)ill pre#ent the head from bein* deli#ered too
suddenly3 thuds pre#entin* a possible tearin*
of the perineum.
E.
4# 3# 8etal 3erebral trauma
4# +assa"eway
a# 3o&tracted pelvis
5ate&t phase of labor
325
b# ,&favorable pelvic shapes
c#
d# (a&a"eme&t<
i# .valuate pelvic diameters
ii# 3o&ti&ue labor with careful mo&itori&"
iii# +erform assisted va"i&al or caesarea&
delivery
iv#
5# +syche
a# 8ear, a&1iety ad te&sio& i&crease stress
a&d decrease uteri&e co&tractility
b# Stress i&terferes with the clie&ts ability
with her co&tractio&s
c# Stress i&crease fati"ue
d#
e# (a&a"eme&t<
i# (o&itor clie&ts psycholo"ic respo&se to
labor
ii# ?etermi&es clie&ts level of stress
iii# +rovide support
iv# .&coura"ed rela1atio&
).
)i.
vii#
)iii. D. Infection
i,.
@. "he infant is at ris8 to de#elop thrush
if the pre*nant )oman has monillial
infection at the time of #a*inal
deli#ery
,i.
,ii.
,iii.
1iv#
1v#
1vi#
1vii#
1viii#
1i1# 3lamydia 4o&orrhea
Syphilis
6!?S 0)/37
11#
11i#
11ii#
11iii#
11iv#
,,). ACGUIRED
IMMUNODE*ICIENC=
S=NDROME :AIDS+
a# 0ra&smissio&
6# 6cross the place&tal barrier
-# ?uri&" the process of labor a&d delivery
326
Infection
3# @ia breast mil'
-7!@ ca& cross some membra&es such as the place&tal
barrier, the blood-brai& barrier, va"i&al mucosa, a&d :i&
the &eo&ate; the walls of the "astroi&testi&al tract
-+re&atal tra&smissio& from i&fected mother to fetus or
&ewbor& via tra&splace&tal tra&smissio&, via
co&tami&atio& with mater&al blood duri&" birth, or
throu"h breast mil'
b# *ursi&" (a&a"eme&t
6void procedures that i&crease the ris' of pre&atal
tra&smissio&, such as am&ioce&tesis a&d fetal scalp
sampli&"
Note that i% the %etus has not 0een e$,osed to *)V in
utero5 the highest ris4 e$ists during deliver/ through
the 0irth canal
*ever use scalp electrodes
6void episiotomy to decrease the amou&t of mater&al
blood i& a&d arou&d the birth ca&al
+romptly remove the &eo&ate from the motherIs blood
followi&" delivery
*)0.< *)V has 0een %ound to 0e
trans+itted through the 0reast +il4 %ro+ +other to
0a0/. .here%ore5 0reast %eeding isn<t reco++ended
%or a +other 6ho is *)V-,ositive. 1hile
trans+ission rates o% *)V in%ection %ro+ +other to
in%ant range %ro+ 2:K to I3K5 ,ro%essionals
esti+ate the actual trans+ission rate at a0out B:K
to 3:K. .he A)DS virus is ,assed trans,lacentall/5
so cesarean deliver/ 6ill not ,revent in%ection o%
the neonate. )n o,tions 25 trans+ission %ro+
+other to %etusVchild can occur trans,lacentall/
throughout ,regnanc/5 trough contact 6ith the
+other<s 0lood and vaginal secretions at deliver/
and through ingestion o% 0rea4 +il4. )n the o,tion
B5 a ne60orn can 0e s/+,to+-%ree at 0irth and still
develo, A)DS. A true diagnostic o% *)V in%ection in
neonates cannot actuall/ 0e +ade until around 13
+onths o% age.
G# "'eci&itate (eli)e'!
32$
A pre*nant patient )ith a 8no)n history of
crac8 cocaine use is in labor must be prepared for a
precipitous labor and notify the neonatolo*ist of the
infant/s hi*h.ris8 status.
6SS.SS(.*0
-owel or bladder diste&tio&
(ultiple "estatio&
5ar"e fetus
7ydram&ios
4ra&dmultiparity
3esarea& sectio& if labor does &ot resume
8etal mo&itori&"
6ctive phase of labor
*. Ute'ine Ru&tu'e
"he t)o findin*s on physical e@am indicate uterine rupture is loss of uterine contour and palpable fetal part.
"he number one ris8 factor for uterine rupture is pre#ious cesarean section.
(6*64.(.*06bdomi&al pai& duri&"
co&tractio&s3)(+5.0.
). Aniotic flui( ebolis
E.
=. An amniotic fluid embolism is
)hen the amniotic fluid lea8s into
the maternal bloodstream b"he
causes of an amniotic fluid
embolism are difficulty in labor3
or hyperstimulation of the uterus.
Polyhydramnios is an e@cessi#e
amniotic fluid.
L.
M. (6*!8.S060!)*
Cont'actions continueD but ce')i, fail to (ilate
;a$inal blee(in$ a! be &'esent
Risin$ &ulse 'ate an( s2in &allo'
Loss of fetal #ea't tones
!*3)(+5.0.
?ysp&eaSudde& sharp abdomi&al pai& duri&"
co&tractio&s
)1y"e&
3+/
32=
Sharp, chest pai&
+allor or cya&osis
8rothy, blood-ti&"ed mucus
6bdomi&al te&der&ess
3essatio& of co&tractio&s
-leedi&" i&to abdomi&al cavity & sometimes i&to
va"i&a
8etus easily palpated, 870 ceased
Si"&s of shoc'
!&tubatio&
?elivery
SECTION ;. "OST"ARTUM
+7FS!)5)4!365 (60./*65 376*4.S
A. L&#*)A > dischar"e from the uterus duri&" the first 3 wee's after delivery#
)ncreasing Lochia as the da/ ,asses 0/ +a/ indicate *e,arin )nto$ication.
L&#*)AL #*ANGES
L&#*)A !BA
M ?ar' red dischar"e occurri&" i& the first 2-3 days#
M 3o&tai&s epithelial cells, erythrocytes a&d decidua#
M 3haracteristic huma& odor#
L&#*)A SE&SA
M +i&'ish to brow&ish dischar"e occurri&" 3-1B days after delivery#
M Serosa&"ui&eous dischar"e co&tai&i&" decidua, erythrocytes, leu'ocytes, cervical mucus a&d
microor"a&isms#
M 7as a stro&" odor#
L&#*)A ALBA
M 6lmost colorless to creamy yellowish dischar"e occurri&" from 1B days to 3 wee's after delivery#
M 3o&tai&s leu'ocytes, decidua,epithelial cells, fat, cervical mucus, cholesterol crystals, a&d bacteria#
M 7as &o odor#
B. !.E!S
M +rocess of i&volutio& ta'es 4-6 wee's to complete#
M %ei"ht decreases from 2 lbs to 2 o2#
M 8u&dus steadily desce&ds i&to true pelvis9 8u&dal hei"ht decreases about 1 fi&"erbreadth :1 cm;/day9
by 1B-14 days postpartum, ca&&ot be palpated abdomi&ally#
#
32A
#. !terine )nvolution
1# ?escriptio&
a# 0he rapid decrease i& the si2e of the uterus as it retur&s to the &o&pre"&a&t state
b# 3lie&ts who breastfeed may e1perie&ce a more rapid i&volutio&
2# 6ssessme&t
a# %ei"ht of the uterus decreases from 2 pou&ds
to 2 ou&ces i& 6 wee'
b# .&dometrium re"e&erates
c# 8u&dus steadily desce&ds i&to the pelvis
d# 8u&dal hei"ht decreases about 1 fi&"erbreadth :1 cm; per day
.# -y 1B days postpartum, uterus ca&&ot be palpated abdomi&ally
*)0.< ,e#iation of the fundus to the ri*ht or left and location of the fundus abo#e the umbilical are si*ns that
the bladder is distended
NO"$1 +ei*ht of the Umbilicus on the %irst Postpartum ,ay
"he hei*ht is usually SLI-+"L5 belo) the umbilicus about AJ hours after deli#ery. "he top of the umbilicus is
normally MI,6A5 bet)een the umbilicus and the symphysis pubis.
D. Breasts
1# -reasts co&ti&ue to secrete colostrum
2# 6 decrease i& estro"e& a&d pro"estero&e levels after delivery stimulates i&creased prolacti& levels, which
promote breast mil' productio&#
3# -reasts become diste&ded with mil' o& the third day
33B
4# .&"or"eme&t occurs i& 4= to $2 hours i& &o& breast feedi&" mothers#
*)0.<
Brad/cardia is a nor+al ,h/siologic change %or H-1: da/s ,ost,artu+
E. Gastrointestinal tract
1# %ome& are usually very hu&"ry after delivery
2# 3o&stipatio& ca& occur
3# 7emorrhoids are commo&
III. "OST"ARTUM NURSING INTER;ENTIONS
(o&itor vital si"&s
*)0.< Maternal temperature durin* the first AJ hours follo)in* deli#ery may rise to 9CC. JU % 0E;UC7
as a result of dehydration. "he nurse can reassure the ne) mother that these symptoms are normal.
+ostpartum .1ercise
Supine Position )ith the 8nee/s fle@ed3 and then inhale deeply )hile allo)in* the abdomen to e@pand
and e@hale )hile contractin* the abdominal muscles. "he purpose of this e@ercise is to stren*then the
abdominal muscles. $@amples are reachin* for the 8neesH push ups and sits ups on the first postpartum
day.
6ssess hei"ht, co&siste&cy, a&d locatio& of the fu&dus
(o&itor color, amou&t, a&d odor of lochia
6ssess lochia a&d color volume
Give hoGA7 to +other i% ordered. hoGA7 ,ro+otes l/sis o% %etal h (N9 B#s.
Ad+inister hoGa+ as ,rescri0ed 6ithin I2 hours ,ost,artu+ to the h-negative client 6ho has
given 0irth to an h-,ositive neonate.
hoga+ (D9 i++une glo0ulin is given 0/ intra+uscular inGection5
3hec' episiotomy a&d peri&eum for si"&s of i&fectio&#
+romote successful feedi&"#
Non-nursing 6o+an- tight 0ra %or I2 hours5 ice ,ac4s5 +ini+i8es 0reast
sti+ulation.
Nursing 6o+an- success de,ends on in%ant suc4ing and +aternal ,roduction o%
+il4.
JPost,artu+ BluesC 0E.K days7 I Normal occurrence of Nroller coasterO emotions
Se$ual activities. abstain from intercourse until episiotomy is healed and lochia ceased
around E.J )ee8s. emind that Assess hei*ht3 consistency3 and location of the fundus
breastfeedin* does not *i#e ade4uate protection.
6ssess breasts for e&"or"eme&t
(o&itor episiotomy for heali&" : assess dehisce&ce & evisceratio&;
6ssess i&cisio&s or dressi&"s of cesarea& birth clie&t : pro&e to i&fectio&;
(o&itor bowel status : pro&e to co&stipatio&;
(o&itor ! &B
.&coura"e freHue&t voidi&" :preve&t uri&ary rete&tio& which will predispose the mother to uterus
displaceme&t & i&fectio&;
.&coura"e ambulatio& : to preve&t thromboplebitis & paralytic ileus;
8i"
ure
2$
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ase
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ia
364
"R
E
TE
R
M
IN
*A
NT
?efi&itio&
+romo
tes
s'i&-
to-s'i&
co&tact
betwee
&
pare&t
a&d
i&fa&t
8eedi&
"s are
opport
u&ities
for
pare&t-
i&fa&t
bo&di&
"
*otify
physici
a& for
si"&s
of
i&fecti
o&
N
&.E"
Sense
o%
.ouch
365
.h
e +ost
highl/
develo
,ed
sense
at
0irth
that is
6h/5
neona
tes
res,on
ds 6ell
to
touch.
6ppl
y
diape
r
loosel
y to
preve
&t
irritat
io&
*otif
y
physi
cia&
for
si"&s
of
i&fect
io&
3!/3,(
3!S!)*
36/.
Sy&o&ym
Lo) birth )ei*ht
0Mosby/s Comprehensi#e e#ie) of Nursin* for NCL$'.N pa*e A9F7
3o&tributi&" factors 5ow socioeco&omic level
+oor &utritio&al status
5ac' of pre &atal care
(ultiple pre"&a&cy
+rior previous early birth
/ace :&o& whites have a hi"her i&cide&ce of prematurity tha&
whites;
3i"arette smo'i&"
0he a"e of the mother : the hi"hest i&cide&ce is i& motherEs
you&"er tha& a"e 2B#;
366
)rder of birth : early termi&atio& is hi"hest i& first pre"&a&cies
a&d i& those beyo&d the forth ;
3losely spaced pre"&a&cies
6b&ormalities of the reproductive system such as i&trauteri&e
septum
!&fectio&s : specially uri&ary tract i&fectio&s;
)bstetric complicatio&s such as premature rupture of membra&es
or premature separatio& of the place&ta
.arly i&ductio& of labor
.lective cesaria& birth
3ardi&al si"&s 6ppears small a&d u&derdeveloped
0he head is disproportio&ately lar"e : 3 cm or more "reater tha&
chest si2e;
S'i& is thi& with visible blood vessel a&d mi&imal subcuta&eous
fat pads
@er&i1 caseosa is abse&t
-oth a&terior a&d posterior fo&ta&elles are small
/e
su
sci
tat
io
&
*
)
0
.<
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on
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+e
s
i+
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rta
nt
%or
in%
an
t
6h
o
%ai
ls
to
ta4
e
6b&ormal laboratory values ?ecreased /-3Es
?ecreased serum "lucose
!&creased co&ce&tratio& of i&direct bilirubi&
?ecreased serum albumi&
*)0.< .he nor+al range o% urine out,ut %or a ,reter+
0a0/ is 1 to 2+l?4g?da/. .he nor+al s,eci%ic gravit/ %or a
,reter+ 0a0/ is 1.:2:. .he nor+al range %or 0lood glucose
level in a ,reter+ 0a0/ is B: to H: +g?dl.
36$
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in
ne
utr
al
,os
itio
n
6it
h
to
6el
un
der
sh
oul
der
.
-est
procedure
-est positio& +ositio&i&" the i&fa&t o& the bac' with the head of the mattress
elevated appro1imately 15 de"rees to allow abdomi&al co&te&ts to
fall away from the diaphra"m affordi&" optimal breathi&" space#
-est positio& for suctio&i&"<
!&fa&t o& the bac' a&d slide a folded towel or pad u&der shoulders
to rise, head is i& &eutral positio&#
3omplicatio&s 6&emia of prematurity
7yperbilirubi&emia/ 'er&icterus
+ersiste&t pate&t ductus arteriosus
+erive&tricular / i&trave&tricular hemorrha"e
/espiratory distress sy&drome
etino,ath/ o% ,re+aturit/
etrolental fibroplasias are a complication that occurs if the infant is
o#ere@posed to hi*h o@y*en le#els.
Necroti8ing enterocolitis
7ost
severe
%or+
o%
s,ina
0i%ida .
( ,.
@J@5
.e$t0o
o4 o%
Basic
Nursin
g
Li,,in
cott H
th
ed.9&n
e o% the
"'ete' si3e
la'!n$osco&e
ET tube
Suction cat#ete' <it#
s!nt#etic su'factant
Isolettes :incubato'+
D'u$ stu(!
3$B
+enin
ges
(the
S,inal
cord
coverin
g9
,rotru
des or
herniat
ed
throug
h
o,enin
g in
verte0r
al
colu+
n. (,.
@J@5
.e$t0o
o4 o%
Basic
Nursin
g
Li,,in
cott H
th
ed.9Des
c'i&tio
n)s an
o,enin
g in
the
verte0r
al
colu+
n 6ith
no
a,,are
nt
reason.
( ,.
@J@5
.e$t0o
o4 o%
Basic
Nursin
g
Li,,in
cott H
th
ed.9S,i
na
0i%ida
occulta
7enin
gocele
3$1
7/elo
+enin
gocele
./,esS
,ina
0i%ida
occulta
S/non/
+sS,in
al
D/sra,
hia
e%ers
to
+al%or
+ation
o%
s,ine
in
6hich
the
,osteri
or
,ortion
o% the
la+ina
e o% the
verte0r
ae %ails
to
close.N
ursing
interve
ntions1
.
Nursin
g
diagno
ses1.
)ne%%ec
tive
air6a/
0reathi
ng
Positio
ning
the
in%ant
on the
0ac4
6ith
the
head
o% the
+attres
s
3$2
elevate
d
a,,ro$
i+atel/
13
degree
s to
allo6
a0do+i
nal
content
sA0nor
+al
la0orat
or/
values)
ncreas
ed total
no. o%
B#<s
#lassic
signs)n
trauter
ine
6eight
loss5
deh/dr
ations
and
chroni
c
h/,o$i
a Wold
+an
%aces<
Nursin
g
interve
ntion.
he
nurse<s
%irst
,riorit/
in
,re,ari
ng a
sa%e
enviro
n+ent
%or a
,reter
+
ne60or
n 6ith
lo6
A,gar
3$3
scores
is to
,re,ar
e
res,ira
tor/
resusci
tation
eDui,+
ent.
Air6a/
+ainte
nance
is the
%irst
,riorit/
.Nursi
ng
diagno
sis)+,
aired
gas
e$chan
ge
related
to
i++at
ure
,ul+o
nar/
%unctio
ning
"'ot'
usion
of t#e
s&inal
co'(
&'ot'u
(es
t#'ou$
# t#e
bac2.
Sacs
a'e
co)e'e
( b!
t#in
eb'
ane &
ne')e
a'e
e,&ose
(
Neu'o
lo$ical
3$4
(eficits
a'e
e)i(ent
Menin
$es o'
&'otect
i)e
co)e'i
n$
a'oun(
t#e
s&inal
co'(
#as
&us#e(
out
t#'ou$
# t#e
o&enin
$ in
t#e
)e'teb
'ae in
a sac.
S&inal
co'(
intact
Neu'o
lo$ical
(eficit
a'e
usuall!
NOT
"RES
ENT
Can
be
'e&ai'e
( </
little o'
no
(aa$
e to t#e
ne')e
&at#<
a!s.
7ost
co++o
n site
o%
inGur/
U
lu+0os
acral
area
3$5
( 7os0
/<s
#o+,r
ehensi
ve
revie6
o%
Nursin
g %or
N#LE
>-N
,. 22H9
: enin$o!el
ocele+
Menin$oc
ele
M!eloe
nin$ocele
o
O
A.
RES"IR
ATOR=
DISTRE
SS
S=NDRO
ME
9
D
9
C
9
A
9
9 N
O
T
E
"
7
or
e
3$6
c
o
+
+
o
n
in
n
e
o
n
at
es
d
el
iv
er
e
d
0
/
ce
sa
re
a
n
se
ct
io
n
th
a
n
in
th
os
e
d
el
iv
er
e
d
v
a
gi
n
al
l/
.
9
9 C
O
M
M
O
3$$
N
SI
G
N
S
9
!a
n
os
isD
(
!s
&
ne
aD
st
e'
n
al
a
n
(/
o'
co
st
al
'e
t'
ac
ti
o
ns
D
ta
c#
!
&
ne
aD
$'
u
nt
in
$D
a
n
(
n
as
al
fl
a'
in
$D
%l
ar
3$=
in
g
n
ar
es
5
E
$
,i
ra
to
r/
gr
u
nt
in
g
9
9 M
A
N
A
G
E
M
E
N
T
9
ai
nt
ai
n
a
&
at
en
t
ai
'
<
a!
D
&l
ac
e
t#
e
in
fa
nt
in
a
<
a'
3$A
is
ol
le
te
<i
t#
o,
!$
en
D
a
(
in
ist
e'
a
nt
ib
io
ti
cs
as
&'
es
c'
ib
e(
a
n
(
co
''
ec
t
ac
i(
os
is
9
1.
HEMOL
=TIC
DISEAS
E
9
A
9
9 COM
MON
SIGN
S
9
E
3=B
9
9
9 "RE;
ENTI
ON
INDI
RECT
COO
M1IS
TEST
9
T
9
"
9
9 RESU
LTSA
9
If
9
R
9
If
9
9 DIRE
CT
COO
M1IS
TEST
9
T
9
9 RESU
LTS
9
If
9
N
9
R
9
C.
H="E
R1IL
IRU1
3=1
INEM
IA
9
Se
9
A
9 E
)a
lu
at
io
n
is
in
(i
ca
te
(
<
#e
n
se
'u
A
o
ve
r
1
2
+
g?
d
L
in
th
e
te
r
+
n
e
6
0
or
n
9 T
#e
'a
&
!
is
3=2
ai
e(
at
&'
e)
en
ti
n
$
'e
su
lts
in
&e
'
a
ne
nt
ne
u'
ol
o$
ic
al
(
a
a$
in
$
f'
o
t#
e
(e
&
os
iti
o
n
of
bi
li'
u
bi
n
3=3
in
ce
lls
9
9
T
9
9
T
9
9
"
9
9
N
9
9
9
9
9
E,&ose as
uc# of
t#e
ne<bo'nOs
s2in as
&ossible
#over the
genital
area5 and
+onitor
genital
area %or
s4in
irritation
or
0rea4do6
n
( ,ria,is+
+a/
3=4
occur9
#over the
ne60ornXs
e/es 6ith
e/e shields
or
,atches'
+a4e sure
e/elids are
closed
6hen
shields or
,atches
are
a,,lied
e+ove
the shields
or ,atches
at least
once ,er
shi%t to
ins,ect the
e/es %or
in%ection
or
irritation
and to
allo6 e/e
contact
. Measu'e
t#e
Fuantit!
of li$#t
e)e'! 6
#ou's
Monito'
s2in
te&e'atu
'e closel!
)ncrease
%luids to
co+,ensat
e %or 6ater
loss
3=5
E$,ect
loose
green
stools and
green
urine
7onitor
the
ne60ornXs
s4in color
6ith the
%lorescent
light
turned o%%5
ever/ B to
@ hours
7onitor
the s4in
%or 0ron8e
0a0/
s/ndro+e5
a gra/ish
0ro6n
discolorati
on o% the
s4in
e,osition
ne60orn
ever/ 2
hours
R#
anti$e
ns
f'o
t#e
bab!Os
bloo(
3=6
ente'
t#e
ate'
nal
bloo(s
t'ea
Dest'
uction
of
R1Cs
t#ose
'esult
s f'o
an
anti$e
n
antibo
(!
'eacti
on
E,c#a
n$e of
fetal
an(
ate'
nal
bloo(
ta2es
&lace
&'ia
'il!
<#en
t#e
&lacen
ta
se&a'
ates at
bi't#
T#e
ot#e
'
&'o(u
ces
anti9
R#
antibo
(ies
a$ains
t t#e
3=$
fetal
bloo(
cells
Antib
o(ies
a'e
#a'l
ess to
t#e
ot#e
' but
attac#
to t#e
e'!t#'
oc!tes
in t#e
fetus
an(
cause
#eol
!sis
Sensit
i3atio
n is
'a'e
<it#
t#e
fi'st
&'e$n
anc!
AB&
inco+
,ati0il
it/ is
usuall
/ less
severe
1.
Assess
ent
%.
#!&e'
bili'u
bine
ia &
#eol
!tic
anei
3==
a
-.
Eaund
ice
that
develo
,s
ra,idl
/ a%ter
0irth
and
0e%ore
2B
hours
(PA.
*&L
&G)#
AL
EA!N
D)#E
9
C.
I&le
enta
tion
1. A(iniste
' R#o:D+
iune
$lobulin to
t#e
ot#e'
(u'in$ t#e
fi'st 5-
#ou's
afte'
(eli)e'! if
t#e R#9
ne$ati)e
ot#e'
(eli)e's
an R#9
&ositi)e
fetus but
'eains
unsensiti3
e(
2. T#e
bab!Os
bloo( is
3=A
'e&lace(
<it# R#9
ne$ati)e
bloo( to
sto& t#e
(est'uctio
n of t#e
bab!Os 'e(
bloo(
cellsS t#e
R#9
ne$ati)e
bloo( is
'e&lace(
<it# t#e
bab!Os
o<n bloo(
$'a(uall!
2.
B. NOTEA
.he *
negative
+other
6ho has
no titer
(negative
#oo+0s<
test
results5
non
sensiti8ed9
and 6ho
has
delivered
an *
,ositive
%etus is
given an
intra
+uscular
inGection
o% anti-*
(D9
(*oGA
79.
Paternal
0lood t/,e
+ight 0e
deter+ine
d %or the
,regnant
*
negative
3AB
6o+an in
order to
hel,
deter+ine
%etal 0lood
t/,e..
3.
H. *oGA7
0loc4s
anti0od/
,roduction
0/
attaching
to %etal
*
,ositive
0lood cells
in the
+aternal
circulation
0e%ore an
i++unolo
gical
res,onse
is
initiated.
I.
@. *oGA7
+ust 0e
ad+inister
ed to
unsensiti8
ed
,ost,artu
+ 6o+en
a%ter the
0irth o%
each *
,ositive
in%ant to
,revent
,roduction
o%
anti0odies.
)% the
%ather o%
%uture
%etuses is
*
,ositive
hetero8/go
us5 there is
a 3:K
chance o%
an *
negative
3A1
in%ant' i%
he is *
,ositive
ho+o8/go
us5 all
in%ants
6ill 0e *
,ositive.
J.
1:.
11. THE
ADDICT
ED
NE?1OR
N
NOTED
*EATURESA
Short
,al,e0r
al
%issures5
*/,o,la
stic
,hiltru
+D
short5
u,turne
dnose5
*lat
i(face
T#in u&&e' li&D
Lo< nasal 0ridge5
Abno'al &ala'
c'easesD
Res&i'ato'!
(ist'ess Ta&neaD
c!anosis+D
Con$enital #ea't
(iso'(e'sD
)rrita0ilit/5
h/,ersensitivit/ to
sti+uli5 .re+ors
Poor
%eeding5
Sei3u'es
.
N&.E"
.hese
3A2
are
signs o%
*eroine
6ithdra
6al
usuall/
occurs
6ithin
2B to B@
hours o%
0irth.
.he
ne60or
n +a/
0e Gitter/
and
h/,eract
ive. .he
cr/ is
o%ten
shrill
and
,ersiste
nt 6ith
/a6ning
and
snee8ing
. .endon
re%le$es
are
increase
d5 and
7oro<s
re%le$ is
decrease
d.
NOTEA
*eroin
6ithdra6al
neonates
*igh
,itch
cr/5
increase
)#P5
h/,ogl/
ce+ia5
loud
and
lust/ cr/
NURSING
INTER;ENTI
ONA
3A3
%. 7onitor
%or
res,irator/
distress
-. "osition
ne<bo'n on
si(e to
facilitate
('aina$e of
sec'etions
3. Hee&
'esuscitatio
n
eFui&ent
at t#e
be(si(e
.. 7onitor
%or
h/,ogl/ce+
ia
0. Assess
suc2 an(
s<allo<
'efle,
4.
A(iniste'
sall
fee(in$s
an( bu'&
<ell
5. Suction
as
necessa'!
6.
Monito' I
& 8
7. 7onitor
6eight and
head
circu+%eren
ce (#hec4
%or )ncrease
)#P9
%8.
Dec'ease
en)i'onen
tal stiuli
%%. .he
use o%
narcotic
antagon
ists to
3A4
reverse
res,irat
or/
de,ressi
on in
the drug
addicted
neonate
is
contrain
dicated
0ecause
these
drugs
+a/
,reci,it
ate
acute
6ithdra
6al in
the
neonate.
NE? 1ORN
O*
DIA1ETIC
MOTHER
A. Desc'i&tion
Neonate
bo'n to an
insulin9
(e&en(ent
ot#e' o'
$estationa
l (iabetic
ot#e'
an( <it#
#i$#
inci(ence
of
con$enital
anoalies.
COM"
LIC
ATI
ON
SA
*ig
h
inci
den
3A5
ces
o%
h/,
ogl/
ce+
ia5
res,
irat
or/
dist
ress
5
h/,
ocal
ce+
ia5
and
h/,
er0i
liru
0ine
+ia
1. Assessent
7A#
&S&
7)A
A
LGA
as a
result
o%
e$cess
%at
and
gl/cog
en in
tissue
s
E(e
a o'
&uffin
ess in
t#e
face
an(
c#ee2
s
Signs
o%
h/,og
l/ce+i
a5
3A6
such
as
t6itch
ing5
di%%icu
lt/ in
%eedin
g5
lethar
g/5
a,nea
5
sei8ur
es5
and
c/ano
sis
H!&e'
bili'u
bine
ia
Signs
o%
res,ir
ator/
distres
s5
such
as
tach/
,nea5
c/ano
sis5
retrac
tions5
grunti
ng5
and
nasal
%larin
g
NO
TE
*O
R
CH
AR
AC
TE
RIS
TIC
S
3A$
O*
H=
"O
GL
=C
EM
IAA
Abno'
all!
lo<
le)el
of
$lucos
e :less
t#an
38
$/(
L in
t#e
fi'st
5-
#ou'
.0
$/(
L
afte'
t#e
fi'st 3
(a!s
of life
N -.
No'
al
bloo(
$lucos
e le)el
is .8
to a %9
(a!9
ol(
neona
te an(
08 to
78
neona
te
ol(e'
t#an %
(a!
)ncre
ased
res,ir
ator/
rate
.6itc
3A=
hing5
nervo
usnes
s5 or
tre+o
rs
!nsta
0le
te+,e
rature
#/ano
sis
NURS
IN
G
INT
ER
;E
NTI
ON
A
%.
Mo
nito
'
fo'
si$n
s of
'es
&i'a
to'!
(ist
'ess
-.
Mo
nito
'
bili
'ub
in
an(
blo
o(
$luc
ose
le)e
ls
3.
Mo
nito
'
<ei
$#t
..
3AA
(ee
d
earl
/5
6it
h
1:
K
glu
cos
e in
6at
er5
0re
ast
+il
45
or
%or
+ul
a as
,re
scri
0ed
0.
Ad
+in
iste
r )V
glu
cos
e to
trea
t
nec
ess
ar/
and
as
,re
scri
0ed
4.
Monito'
fo'
e(ea
5.
Moni
4BB
to'
fo'
t'eo
's &
sei3u'
es
SMALL *OR
GESTATION
AL AGE
A.
Desc'i
&tionA
A
neona
te
<#o is
&lotte
( at
o'
belo<
t#e
%Ot#
&e'ce
ntile
on t#e
int'au
te'ine
$'o<t
#
cu')e
N&.
E" F1
Predis
,osin
g
%actor
is
7ater
nal
S+o4i
ng
1.
Assess
ent
4B1
%.
*etal
(ist'e
ss
-.
Gestat
ional
a$e
an(
&#!sic
al
atu'
it!
3.
Lo<e'
e( o'
ele)at
e(
bo(!
te&e
'atu'e
..
"#!sic
al
abno'
aliti
es
0.
H!&o
$l!ce
ia
4.
Si$ns
of
&ol!c!
t#ei
aA
a.
Ru((!
a&&ea'a
nce
b.
C!anosi
s
c.
>aun(ic
e
4B2
5.
Si$ns
of
infecti
on
6.
Si$ns
of
as&i'a
tion of
econ
iu
N&.
E"
&0tai
ning a
0lood
sa+,l
e to
deter
+ine
glucos
e level
6ould
have
the
highe
st
,riorit
/ to
on
SGA.
A
co++
on
co+,l
icatio
n o%
the
SGA
ne60o
rn
i++e
diatel
/ a%ter
0irth
is
h/,og
l/ce+i
a
4B3
0ecau
se o%
the
increa
sed
+eta0
olic
rate in
res,o
nse to
heat
loss
and
,oor
he,ati
c
gl/cog
en
stores.
.he
SGA
ne60o
rn
+a/
also
have
su%%er
ed
intrau
terine
h/,o$
ia5
6hich
de,let
es
glucos
e.
C.
I&le
enta
tion
%.
Maintai
n
ai'<a!
-.
Maintai
n bo(!
te&e'a
tu'e
3.
Obse')e
fo'
4B4
si$ns of
'es&i'at
o'!
(ist'ess
..
Monito'
fo'
infectio
n an(
initiate
easu'e
s to
&'e)ent
se&sis
0.
Monito'
bloo(
$lucose
le)els
an( fo'
si$ns of
#!&o$l!
ceia
4.
Initiate
ea'l!
fee(in$s
an(
onito'
fo'
si$ns of
as&i'ati
on
5.
"'o)i(e
stiulat
ionD
suc# as
touc#
an(
cu((lin
$
A. NER;OUS
S=STEM
ANOMALIES
9
M
4B5
9
9
9
9
S
9
9
9
D
Assess
ne<bo
'nIs
'es&i'
ato'!
'ateD
(e&t#
an(
'#!t#
.
Auscu
ltate
lun$
soun(
.
NoteA
7econi
u+
stained
s/ndro
+e o%
P&S.
7A.!
E
neonat
es
As,irat
ion o%
+econi
u+ is
0est
,revent
ed 0/
suction
ing the
neonat
e<s
naso,h
ar/n$
4B6
i++edi
atelt
a%ter
the
head is
delivere
d and
0e%ore
the
shoulde
rs and
chest
are
delivere
d. As
long as
the
chest is
co+,re
ssed in
the
vagina5
the
in%ant
6ill not
inhale
and
as,irat
e
+econi
u+ in
the
u,,er
res,irat
or/
tract.
7econi
u+
as,irati
on
0loc4s
the air
%lo6 to
the
alveoli5
leading
to
,otenti
all/ li%e
threate
ning
res,irat
or/
co+,lic
ations.
4B$
Suctio
n
e)e'!
-
#ou's
o'
o'e
often
as
necess
a'!
"ositi
on
ne<bo
'n on
si(e
o'
bac2
<it#
t#e
nec2
sli$#tl
!
e,ten
(e(
A(i
niste'
O-D
antici
&ate
t#e
nee(
fo'
C"A"
o'
"EE"
Conti
nue to
assess
t#e
ne<bo
'nIs
'es&i'
ato'!
status
closel
!.
Encou
'a$e
as
uc#
&a'en
tal
&a'tic
i&atio
4B=
n in
t#e
ne<bo
'nIs
ca'e
as
con(it
ion
allo<s
-.
A(i
niste'
I;
flui(s
afte'
bi't#
to
&'o)i
(e
Gluco
se to
&'e)e
nt
#!&o$
l!cei
aD
onit
o'
closel
! t#e
infusi
on
'ate.
He&t
t#e
infant
un(e'
a
'a(ia
nt
#eat
<a'
e' to
&'ese'
)e
ene'$
!
Monit
o'
bab!Is
<ei$#
tD
se'u
elect'
4BA
ol!tes
an(
ensu'
e
a(eFu
ate
flui(
inta2e
Meas
u'e
u'ine
out&u
t b!
<ei$#i
n$
(ia&e'
s
C#ec2
fo'
bloo(
stools
to
e)alua
te fo'
&ossib
le
blee(i
n$
f'o
intesti
nal
t'act.
Hee&
a
'estful
en)i'o
nent
.
3.
Antici
&ate
t#e
infant
s nee(
to be
b'east
fee(
Deo
nst'at
e
tec#ni
Fue
fo'
41B
fee(in
$ to
ot#e
'D note
&'o&e
'
&ositi
onin$
of t#e
infant
D
Jlatc#
in$
onK
tec#ni
FueD
'ate
of
(eli)e
'! of
fee(in
$ an(
f'eFue
nc! of
bu'&i
n$
"'o)i
(e a
'ela,e
(
en)i'o
nent
(u'in
$
fee(in
$
A(Nus
t
f'eFue
nc!
an(
aou
nt of
fee(in
$
acco'
(in$
to
infant
s
'es&o
nse
Alte'n
ate
fee(in
$
411
&'oce
(u'e
:ni&&l
e an(
$a)a$
e
fee(in
$+
acco'
(in$
to
infant
s
abilit!
.
Monit
o'
ot#e
'Is
effo'tD
&'o)i
(e
fee(b
ac2
an(
assista
nce as
nee(e
(
Su$$e
st
ot#e
' to
onit
o'
infant
s
<ei$#
t
&e'io(
icall!
-.
Ris2 fo'
flui( )olue
(eficit
'elate( to
insensible
<ate' loss at
bi't#
3.
Ineffecti)e
infant
fee(in$
&atte'n
412
%.
;ita
in H
:AFua
e&#
!ton+
Use
fo'
&'o&#
!la,is
to
t'eat
#eo'
'#a$ic
(iseas
e of
t#e
ne<bo
'n
Si(e
effectsA
H!&e'
bili'u
binu'i
a
-. E!e
&'o&#
!la,is
3. :E'!t
#'o!cin
8.0M
Ilot!cinD
Tet'ac!cli
ne %M
Sil)e'
Nit'ate
%M
"'o&#
!lactic
easu
'e to
&'otec
t
a$ains
t
Neisse
'ia
$ono'
'#oea
e an(
C#la
!(ia
t'ac#o
413
atis
Si(e
effectsA
Sil)e'
nit'at
e can
cause
c#ei
cal
conNu
cti)iti
s
D'u$
stu(!
ET
tube
Suctio
n
cat#et
e'
1e(si
(e
eFui&
ent
Meco
niu
as&i'a
tion
s!n('
oe
Res&i
'ato'!
(ist'e
ss
s!n('
oe
NOTEA
Post +ature
neonates
have
di%%icult/
+aintainin
g glucose
reserves.
&ther
co++on
,ro0le+s
include
7econiu+
as,iration
s/ndro+e5
414
,ol/c/the+i
a5
congenital
ano+alies5
sei8ure
activit/ and
cold stress.
N&.
E" .he
in%ant 6ho
are
e$,osed to
high
0lood-
glucose
levels in
utero +a/
e$,erience
ra,id and
,ro%ound
h/,ogl/ce
+ia a%ter
0irth
0ecause o%
the
cessation
o% a high
in-utero
glucose
load. .he
s+all-%or-
gestational
-age
in%ant has
use u,
gl/cogen
stores as a
result o%
intrauterin
e
+alnutriti
on and
has
0lunted
he,atic
en8/+atic
res,onse
6ith
6hich to
carr/ out
gluconeog
enesis.
NOT
415
EA .he
,atient
6ith ,ost-
ter+
,regnanc/
is at high
ris4 %or
decreased
,lacental
%unctionin
g5
there%ore
increasing
the ris4 o%
inadeDuat
e o$/gen
circulation
to the
%etus
Co&
licatio
ns
1est
&ositi
on
Resus
citatio
n
NOT
EA
'esus
citati
on
beco
es
i&o
'tant
fo'
infan
t <#o
fails
to
ta2e
fi'st
b'eat
# o'
(iffic
ult!
ain
taini
n$
a(eF
uate
416
'es&i
'ato'
!
o)e
ent
s on
#is
o<n.
Suctio
nin$
NOT
EA
all
o<
s
'e
o
)in
$
uc
us
an
(
&'
e)
ent
s
as
&i'
ati
on
of
an
!
uc
us
an
(
a
nio
tic
flu
i(
&'
ese
nt
in
t#e
o
ut
41$
#
an
(
no
se
of
t#e
ne
<b
o'
n.
To
est
abl
is#
cle
a'
ai'
<a
!.
Intub
ations
NOT
EA
#e
a(
of
t#
e
inf
an
t
in
ne
ut
'al
&o
sit
io
n
<i
t#
to
<e
l
un
(e
'
s#
ou
l(
e'.
41=
1est
&'oce
(u'e
Sono$
'a
Sc'ee
nin$
test
Inc'ea
se(
#eat
oc'it
le)el
Dec'e
ase(
se'u
$lucos
e
Long
A thin
6ith
crac4
ed
s4in
6hich
is
loose5
6rin4l
ed
and
strain
ed
greeni
sh
/ello6
5 6ith
no
verni$
nor
lanug
o
Long
nails
6ith
%ir+
s4ull
1ide
e/ed
alertn
ess o%
one
+onth
old
41A
0a0/
Mate'
nal &
c#il(
nu'sin
$S a
(e)elo
&ent
al
a&&'o
ac# to
co&'
e#ensi
)e
c$fns
an(
ncle,
'e)ie
<S 0
t#
e(.
"a$e
%3%
Lo<
socioe
cono
ic
le)el
"oo'
nut'iti
onal
status
Lac2
of &'e
natal
ca'e
Multi
&a'ou
s
ot#e
'Is
Ci$a'
ette
so2i
n$
T#e
a$e of
t#e
ot#e
' :t#e
#i$#es
t
inci(e
nce is
42B
in
ot#e
'Is
!oun$
e'
t#an
a$e
-8.+
Mot#e
'Is
<it#
(iabet
es
ellit
us
Con$e
nital
abno'
aliti
es
suc#
as
o&#
alocel
e.
1o(!
is
co)e'e
( <it#
lanu$
o
Ol(
an
facies
Cont'
ibutin
$
facto'
s
"OST
TER
M
IN*A
NT
A
neona
te
bo'n
afte'
.-
<ee2s
a$e of
$estati
on
421
"OST
TER
M
IN*A
NT
*i$u'
e -6
Defini
tion
Give
the
+othe
r
o$/ge
n 0/
+as4
durin
g the
0irth
to
,rovid
e the
,reter
+
in%ant
6ith
o,ti+
al
o$/ge
n
satura
tion at
0irth (
@3-
J:K9.
Kee,i
ng
+ater
nal
analg
esia
and
anest
422
hesia
to a
+ini+
u+
also
o%%ers
the
in%ant
the
0est
chanc
e o%
initiat
ing
e%%ecti
ve
res,ir
ation.
Bedsi
de
larng/
osco,
e5
endotr
achea
l tu0e5
suctio
n
cateth
ers
and
s/nthe
tic
sur%ac
tant to
0e
ad+in
istere
d 0/
the
endotr
achea
l tu0e.
)n%ant
+ust
0e
4e,t
6ar+
durin
g
resusc
itation
,roce
dures
so he
or she
423
is not
e$,en
ding
e$tra
energ
/ to
increa
se the
+eta0
olic
rate to
+aint
ain
0od/
te+,e
rature
.
&0ser
ve %or
chang
es in
res,ir
ations
5 color
and
vital
signs
#hec4
e%%ica
c/ o%
)solett
e"
+aint
ain
heat5
hu+id
it/
and
o$/ge
n
conce
ntrati
on5
ad+in
ister
o$/ge
n onl/
i%
necess
ar/
7aint
ain
ase,ti
c
techni
424
Due to
,reve
nt
in%ecti
on
Adher
e to
the
techni
Dues
o%
gavag
e
%eedin
g %or
sa%et/
o%
in%ant
&0ser
ve
6eigh
t-gain
,atter
ns
Deter
+ine
0lood
gases
%reDue
ntl/ to
,reve
nt
acidos
is.
)nstit
ute
,hotot
hera,
/
6hen
h/,er
0iliru
0ine+
ia
occur
s
Su,,o
rt
,arent
s 0/
letting
the+
ver0al
i8e
and
425
as4
Duesti
ons to
reliev
e
an$iet
/.
Provi
de
li0eral
visitin
g
hours
%or
,arent
s5
allo6
the+
to
,artici
,ate
in
care.
Arran
ge
%ollo6
-u,
0e%ore
and
a%ter
discha
rge 0/
a
visitin
g
nurse.
(7os0
/<s
#o+,rehe
nsive
evie6 o%
Nursing
%or
N#LE>-
N ,age
21H9
1. is4
%or
%luid
volu
+e
de%ici
t
relate
d to
426
insen
si0le
6ater
loss
at
0irth
and
s+all
sto+
ach
ca,a
cit/
2. is4
%or
as,ir
ation
relate
d to
6ea4
or
a0se
nt
gag
re%le
$ a
nd?or
ad+i
nistr
ation
o%
tu0e
%eedi
ngs
2. */,o
ther
+ia
relate
d to
lac4
o%
su0c
utane
ous
and
0ro6
n %at
de,os
its5
inade
Duate
shive
r
res,o
nse5
i++a
ture
42$
ther
+ore
gulat
ion
cente
r5
large
0od/
sur%a
ce
area
in
relati
on to
0od/
6eig
ht5
and?o
r
lac4
o%
%le$io
n o%
e$tre
+itie
s
to6ar
d the
0od/.
B. is4
%or
in%ect
ion
relate
d to
i++a
ture
i++
une
res,o
nse5
stasis
o%
res,i
rator
/
secre
tions5
and?
or
as,ir
ation
3. )+0a
lance
d
nutrit
42=
ion"
less
than
0od/
reDui
re+e
nts
relate
d to
lac4
o%
energ
/ to
suc4
and?o
r
6ea4
or
a0se
nt
suc4i
ng
re%le
$.
( 7o
s0/<s
#o+
,rehe
nsive
evie
6 o%
Nursi
ng
%or
N#L
E>-
N
,age
21H9
1e(si(e
eFui&ent
"'e(is&osin$ *acto'#hild undergoes a gro6th s,urt during ,u0ert/. (,. @J@5 .e$t0oo4 o% Basic Nursing
Li,,incott H
th
ed.9!n4no6n 0ut generall/ thought to result %ro+ triggered environ+ent.N&.E" sa+e 6?
+enigocele #linical 7ani%estationDi+,le is ,resent over the 0ac40one. (,. @J@5 .e$t0oo4 o% Basic Nursing
Li,,incott H
th
ed.9E$ternal c/st de%ect in the s,inal cord usuall/ at the +idline 7eningitis U in%la++ation o%
the +eninges covering the s,inal cord.Screening ? Diagnostic .est>-ra/ (s+all tu%t o% hair or ,ort urine
strain is so+eti+es ,resent in the verte0ral are9 ( ,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9Neurologic E$a+ination-indicate loss o% neurologic %unctions 0elo6 the de%ect.Note" sa+e 6ith
+eningocele7aGor Surger/Surger/ i% necessar/ (,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9La+inecto+/La+inecto+/Pur,ose o% Surger/.o ,revent %urther deterioration o% neural %unction..o
,revent %urther co+,lications.Post-&,erative Nursing care7easure head si8e to deter+ine i% h/roce,halus is
develo,ing7easure head si8e to deter+ine i% h/roce,halus is develo,ingPossi0le surgical
co+,lication*/droce,halus*/droce,halusBest Position (or Pre-o,?Post-o, A dseNote" Sa+e 6?
7eningceleDisease #o+,lication7eningitis-i% sac 6ill ru,tured then in%ection 6ill occurDrugs"Anti0iotics-
to ,revent in%ectionNote" Sa+e 6? 7eningceleNursing Diagnosis and )ntervention)+,aired s4in )ntegrit/
related to i+,aired +otor A sensor/ %unction.Note" Sa+e 6? 7eningcele
42A
#
#
Nursing alert"
1. Prevent %urther da+age.
2. 7ost co++on ,ro0le+ is loss o% sensation in the legs (,rotect child against ,ossi0le leg inGur/.
2. S4in e$a+ination" ,ressure areas and tight clothing.
B. #hange dia,ers i% necessar/ a%ter voiding and de%ecating.
3. Patient is e$tre+el/ sensitive to late$. .he nurse +ust +a4e sure the/ do not co+e in contact 6ith
ite+s such as tourniDuets5 catheters5 ru00er 0ands5 gloves5 0alloons5 various tu0es +ade o% late$.
H. (olic acid (%olate9 ta4es during ,regnanc/ to reduce the severit/.
I. (,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9
@.
J.
1:.
Ris2 fo' Infection 'elate( to containation
Nu'sin$ Inte')entionsA "'otectin$ t#e s2in inte$'it!
%. Avoid ,ositioning on the in%antXs 0ac4 to ,revent ,ressure on the sac.
-. Do not &lace an! co)e'in$ (i'ectl! o)e' t#e sac.
3. Obse')e sac fo' e)i(ence of i''itation o' lea2a$e of CS*
.. !se ,rone ,osition 6? hi,s slightl/ %le$ed to decrease tension on the sac.
0. Place a %oa+ ru00er ,ad? s+all ,illo6 or roll dia,er 0et6een the in%ant<s legs to +aintain hi,s in
a0duction A to ,revent or counteract su0lu$ation.
4. "'o)i(e s2in ca'e es&eciall! an2lesD 2neesD ti& of noseD c#ee2s & c#in.
5. "'o)i(e &assi)e 'an$e of otion e,e'cise.
6. Use foa o' fleece &a( to 'e(uce &'essu'e of t#e att'ess a$ainst t#e s2in.
7. A)oi( touc#in$ t#e sac.
43B
"'e)entin$ Infection
%. Hee& a'ea clean f'o u'ine an( feces
-. Hee& t#e infant clean es&. buttoc2s & $enitalia
3. A&&l! ste'ile $au3e /oistene( to<el an( <atc# fo' an! si$ns of infection.: fe)e'D i''itabilit!D
let#a'$!D oo3in$ of flui( o' &us f'o t#e sac+
"'one9 to inii3e t#e tension on t#e sac/'is2 fo' t'aua :RationaleATo &'e)ent &'essu'e on t#e
incision+
*i, slightl/ %le$ed and a0ducted
(eet hanging5 %ree o% +attress and slight trendelen0urg ( reduce s,inal %luid9 (,.22H5 7os0/<s
#o+,rehensive evie6 %or Nursing N#LE> N9
Paral/sis5 hi, destruction5 4nee %le$ion contracture5 sensor/ loss (,. 2HH5 Ph/sical 7edicine A
eha0ilitation Basic5 Garrison9
)n%ection (,atient is o,en catheteri8ed9. (,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9
Monito' fo' si$n of inc'ease int'ac'annial &'essu'e
A)oi( s&inal co'( (aa$e
ange o% +otion (,assive and active9 ( ,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9
"'enatal Sc'eenin$:%
st
T'ieste'+
1loo( test Jt'i&le sc'eenK
- Inc'ease( se'u al&#a &'otein.
"'enatal ult'asoun(
Aniocentesis
Elective a0ortion ( ,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9
431
Afte' bi't#
S&ine @9'a! 'e)eals t#at e,act e,tent & location of t#e (efect.
S&ine Ult'asoun( to (ete'ine s&inal co'( abno'alities.
CT scan/ MRI
1# *alo1o&e :*arca&;
2# *ature of the dru"<
*arcotic a&ta"o&ist
Side effects<
7yperte&sio&, irritability, tachycardia
2. Sur%actan ( Survanta9
B. Nature o% the drug"
Lung sur%actant to i+,rove lung co+,liance
Side e%%ect"
.ransient 0rad/cardia5 rales
5# @itami& L :6Huamephyto&;
,se for prophyla1is to treat hemorrha"ic disease of the &ewbor&#
Side effects<
7yperbilirubi&uria
6# .ye prophyla1is
$# :.rythromyci& B#5C !lotyci&, 0etracycli&e 1C
=# Silver Nitrate 1K ( not alread/ used U causes che+ical conGunctivitis;
+rophylactic measure to protect a"ai&st *eisseria "o&orrhoeae a&d 3hlamydia trachomatis
Side effects<
Silver &itrate ca& cause chemical co&uctivitis
?isease 3omplicatio&
2# %ith i&fectio&< a&tibiotics a&d delivery of i&fa&t
3# %ithout i&fectio&<
34-36 wee's of "estatio&J delay birth, am&ioce&tesis a&d mo&itor 5S ratio of the baby
2=-32 wee's of "estatio&J delay birth, admi&ister steroids to haste& maturity of the lu&"s a&d
decreased /?S
"he *ood indicator of fetal lun* maturity in a pre*nant diabetic is presence of phosphatid*lycerol in
the amniotic fluid.
+/)(
!&compete&t cervi1
(ultiple "estatio&
+revious history of +reterm labor
?.S e1posure
.motio&al stress
7ydram&ios
+lace&ta previa
6bruptio place&ta
(ater&al a"e Y1= or N35
2B. # #alories in diet should consist o% 3:K to H:K car0oh/drates5 12K to 2:K ,rotein5 and 2:K to 2:K %at
23.
2H. NO"$1 Because insulin does not ,ass into the 0reast +il45 0reast%eeding is not contraindicated %or
the +other 6ith dia0etes. (reastfeedin* is encoura*edH it decreases the insulin re4uirements for
insulin.independent clients. (reastfeedin* does not increase the ris8 of maternal infectionH it leads to
an increased caloric demand. Infants of diabetic mothers often display ?itteriness in response to
hypo*lycemia after birth
-oodell/s si*n is a softenin* of the cer#i@3 )hich occurs in pre*nancy
433
+alpati&" fetal co&tours
-ra1to&-7ic's co&tractio&s
(allotment1 bouncin* of the fetus in the amniotic fluid a*ainst the e@aminers hand. ,urin* the 9:
th
.AC
th
)ee8.
(ra@ton +ic8s Contractions1 painless contractions felt for AC.EC minutes occurs
on the 9:
th
)ee8#
Chad)ic8/s si*n is a bluish colorin* of the #a*inal mucosal that occurs as early
as : )ee8s *estation. ationale1 due to increase #ascularity < blood #essel
en*or*ement.
Increase si2e of the uterus
W P Pre*nancy "est
S Secretion of +C- in the urine 0%ro* "est7. ,etectable 9C days after the missed
period
. "he fetal heartbeat typically can be heard and fetal rebound is possible bet)een
9; and AA )ee8s. "he fetal outline becomes palpable and the fetus is hi*hly
mobile bet)een A; and E9 )ee8s. (ra@ton +ic8s contractions increase in
fre4uency and intensity bet)een EA and EF )ee8s.
Sur*ical sterili2ation of the male in#ol#es cuttin* the ductus deferens.
&asectomy1 &as ,eferens is cut. "he man can resume se@ after one )ee8 or )hen the sperm count
indicates C count or A ne*ati#e sperm count ha#e been e@amined.
4e&erally it reHuires 6 > 36 eaculatio&s to re&der &e"# sperm cou&t
In order to *et for semen analysis3 collect them in a clean *lass not plastic3 because it may affect the
spermato2oa. No se@ for E days before the semen collection < no drin8in* of alcohol for 9 day. "he first
portion of the semen has a hi*h ration of sperm.