Fact Sheet for day of study

Epidurals lengthen 2nd stage labor. Also cause maternal hypotension

Pushing should only be done once fully dilated.
Only true sign of TRUE labor is dilation of the cervix.
Pain in back and lower abdomen is a sign of labor.
Acknowledging fear is a PRIORITY before asking further questions

Cardinal Moves-
Decent Flexion Internal Rotation Extension External Rotation

0 Station is ENGAGEMENT
CROWNING is seen at +5 station.
Fetal heart rate can be monitored w/ mom in any position. Fetal electrode MUST
be placed to do so.
Just like our Hearts when Fetal activity increases so should the fetal HR.
The Uterus rising and feeling globular is a sign of placental separation.

During Contractions-
-Cardiac output
-BP Roughly 35mmhg systolic

Talking means mom is relaxed and not in late stages of labor. Sign of LATENT
labor. Think LAX for LATENT.
Phenergan may be given as antiemetic and as a analgesic potentiator.
 Before regional anesthesia
1. Assess fetal heart rate
2. Give fluid bolus to keep BP up (e.g 1000ml LR)
3. Empty bladder cause she wont know when she needs to pee
Most common SE of epidural is hypotension and Headache
Mom supine? Hypotension due to fetus lying on inferior vena cava.
4% or more weight loss in newborn is SIGNIFICANT
MULTIP Labor 10 hours PRIMIP Labor 20 hours
Blood screening is done for
1. Hypothyroid
2. Sickle cell anemia
3. galactosemia
NIPS Assesses
1. Breathing
2. Facial expressions
3. Crying
4. Movement of extremities
5. State of arousal
NO POWDER FOR BABIES
IF APPLICABLE ALWAYS go with ABCs, Resp issue w/ child, probably the answer.
>5 Bilirubin is significant for child, phototherapy will be done
6 weeks ovary will be enlarged and assessable due to corpeus luteum(preplacenta)
Couvade Syndrome
1. Dad has same S/S as mom ex. Heartburn
 Important fetal landmarks in order-
1. Vernix Caseosa Present
2. Blastocyst development complete
3. Four chambered heart formed
4. Testes descend into scrotum
MAGNESIUM SULFATE
1. Given for Pre-Eclampsia(Risk of Seizures)
2. Decreases neuro excitability
3. 4-6G loading dose then drip
4. Mom and baby assessed Q15 for 1 Q30 for 2 then QHr
5. Should have DTR. Lack of DTR and RESP Depression is significant
Pre-Eclamptics will see Proteinuria Generalized Edema
BUBBLE-HE
1. Breast
2. Uterus
3. Bladder
4. Bowel
5. Lochia **Can be present for 6 weeks
Rubra(Dark Red) Day 1-3
Serosa(Pink/Brown) Day 3-10
Alba(Creamy/yellow) Day 10-28
6. Episiotomy**REEDA(redness,edema,ecchymosis,D/C,approximation)
7. Homens
8. Emotions
HGB & HCT in mom <11.5 and <30% Significant
TACHY in postpartum could be sign of HEMMORHAGE
Fibrinogen (CLOTTING FACTORS) leading up to and at birth.
Prolonged Hypotension HEMMORHAGE
 Menstrual Cycle
1. Menstrual Phase
Day 1 Woman Bleeds due to sloughing of endometrium

Day 6
2. Proliferative Phase
Day 7 Estrogen at exponential rate. Endometrium Thickens

Day 13 Luteinizing Hormone
Day 14 OVULATION- Egg goes on a trip to fallopian tubes.
3. **Secretary Phase**
Day 15 Progesterone Estrogen no fertilization occur?? Ischemic

Day 28
**At some point between Day 15-28 the body will-
Fertilize an egg Progesterone Estrogen
Go ischemic. Progesterone Estrogen
In the meantime the body will be in the secretory phase with a Progesterone
Estrogen

Important Hormones
1. **Estrogen- stimulates the uterine development and ductal
development of the breast
2. **Progesterone- Sole hormone that maintains the pregnancy
3. Prostaglandins maintain the placenta and initiate labor
4. HPL- Helps the fetus grow, like steroids for the fetus.
5. HCG- Stimulates the continuous production of Estrogen and
Progesterone.
 1st Trimester 1-13- Heart Beats, Organs in place, Sex is known
2nd Trimester 14-26.6 - Fetal movement is felt, Brown Fat, Surfactant
starts
3rd Trimester 27-term - NVS regulation, Rapid Brain Growth, Lungs 02 ex,
BORN

XX= Female XY=Male think of the tail of the Y as a penis

Cord missing 2 arteries 1 vein? Midline defects!!!
Three Stages of Human Development
1. Preembryonic Week 1-2
2. Embryonic Week2-8
MOST SUCCEPTIBLE TO TERATOGENS
3. Fetal Week 9-birth.

Important Milestones of fetal development

Week 4- Tubular Heart beats at 28 days(Billboards)
*Organs Present Week 8- all organs present from here on. Organogenesis
* Sex is known Week 9-12 Fetal Heart tones present. GENITALS WELL DEFINED
Week 13-16 Baby can suck, Lanugo Grows
AFTER WEEK 16 MOM CANT LAY ON BACK. Blood to fetus
Week 20- Movement felt by mother aka Quickening
Everything Week 20 and younger is considered an abortion
not included in the P for preterm GFPAL.
RESPIRATORY Week 24- surfactant production begins, alveoli form, startle
and grasp reflexes.
Week 28- Rapid Brain development, NS regulation, Lungs capable of
gas exchange. VENT, NICU probable.
Week 35-36- Surfactant sufficient, born w/o resp issues
Week 37- head bigger than chest, IGG present from mom
Week 37-40 is full term.
 Amniotic Sac Fluid amounts
1. oligohydramnios- <400ml in sac
2. polyhydramnios >2000ml in sac
Amniotic Sac
1. Protects
2. Thermoregulates
3. Allows movement
Fetal VS
1. 110-160
2. Tach 160 Brady110
3. Tach-Medicate mom, Brady- Baby is lacking 02.
4. BABY TACHY??? Check Temp of mom!!!!
Decelerations
1. Early is good
2. Variable is the cord being squeezed
3. Late- Baby lacking 02.
Variability-measured trough to peak
1. 25 Marked
2. 5-25 Moderate
3. 5 Minimal
4. Absent
IV ANALGESIA GIVEN LATENT TO EARLY LABOR, NARCAN ON HAND
DIF for each stage Duration and Frequency
1. Latent-5-8hrs 3cm dilated 30-40secs mildmoderate q10-30
2. Active 2-4hrs 4-7cm dialted 40-60secs moderatestrong q2-5min
3. Transition <1hr-3hr dilation 8-10cm 60-90secs strong q1-2min
 3 reasons to give Pitocin
1. to induce labor
2. to augment(promote)
3. to reduce hemorrhage of uterus(fundus)
HIGH RISK FOR BABY, OVERDOSE CAN CAUSE 02 IN BABY LEADING TO DEATH.
Baby should eat 8 times per day. Or Q3.
36.5 Hypothermic 37.2 Hyperthermic
Reflexes that should be present at birth
Moro-Scare rxn
Babinski-running up side of the foot
Root- touch face and they turn
Grasp reflex- Plamar and Plantar
Sucking reflex
Hypothermia is the PRIORITY immediately after birth!
Early DECELERATIONS common in second stage of labor due to head in the pelvis
being compressed.
LGA BABY? High Risk for hypoglycemia. Mothers uncontrolled DM can lead to
baby being hypoglycemic. <45 Feed the baby. 20-25 Start Hypoglycemia protocols
Presence of fever >38C 2 days other than first 24 is sign of INFECTION.
1. First 10 days only
Presumptive- signs of labor are totally subjective. What mom feels.
Probable- signs are things that could be assessed, soft cervix, uterine shape.
Positive- fetal HR, detecting fetal movement, US.

MOM URGE TO PEE

1. 1st Trimester -Yes
2. 2nd Trimester -No
3. 3rd Trimester Yes
 HCT 32% HGB-11 in pregnant mom means she is Anemic
WOMAN SHOULD LIE ON THEIR LEFT Side. Mom can passout if not.
1. Renal perfusion
2. CO
3. Stabilizes fluid and electrolytes
4. Maintains BP
Moms Weight
1. Trimester Weight ( 4lb )
2. Trimester Weight (1lb a week) ADD 300CALS to accomplish
3. Trimester Weight (1lb a week) ADD 300CALS to accomplish
Overweight still encouraged to gain 15-20lbs.
OBESITY is HIGH RISK
1. Preeclampsia
2. Spontaneous abortion
3. Gestational DM
4. C-section
5. LGA child
6. Midline defects
MAP for BABY
1. Normal MAP 50-55
2. Abnormal MAP 56 Hypertension 45 Hypotension

TRIMESTER AND EMOTIONS

1. 1st Not sure, ambilvelant
2. 2nd Ambivelance and acceptance is jumped between
3. 3rd Anxiety and fear, surge of energy at the end
 Mommy Diet-
AVOID THESE FISH(any high in mercury)-
1. Swordfish
2. Shark
3. Macrole
4. Tilefish
5. Albacore
Mom should drink 100ml an hour or 24ooml/daily
MOM MAP > 100 DANGER IN PREGNANCY
Mom will have appointments
1. Q4weeks 1st 28 weeks
2. Q2weeks until 36
3. Qweek every visit after
REPORT FOUL SMELL OF D/C
Can have SEX until ROM
NTD testing 2nd trimester
Amniocentesis 17-20 weeks 2nd trimester
CVS is done 1st trimester 10-12 weeks
BPP is a assessment for fetal hypoxia and assesses 6 things!
1. Best Score is 10. 0=Bad 10=Good
2. Each category gets either 0-1-2 grade.
3. Assesses 6 things Fetal accels, Fetal breathing, fetal movements, Fetal
tone, fluid volume of amniotic sac.