Electronic Fetal Monitoring Internal Fetal monitoring o o Used when MD cant trace FHR externally Trying to determine if uterine

e contractions are strong enough. If not: NI-VBAC Cesarean so that uterus doesnt rupture during labor NI NL give pitocin to strengthen and augment labor

o o

Advantages more accurate monitoring for FHR/UC Disadvantages invasive procedure must be sterile (infection potential) V variable Cord o Generally ok, not much intervention

E early

Head o Check for head, must return at rest

A accelerations L late/prolonged

OK Placenta (insufficiency) o to to Not doing what it needs

o Severe nuchal compressions o NI mom needs O2, Left side, Section o w/epidural hypotension give ephedrine, fluid and O2 Tachycardia o Choreoinfection (in uterus)

o ROM

Mom has infection (flu, UTI, etc.)

Safe if within 24 hours of delivery of baby Check for color, odor (meconium dark/green fluid) PROM o o Cervical cerclage if plenty of fluid or add saline Betamethasone given if before 37 weeks and labor is immenent Develop fetal lungs and brain

Preterm Labor Risk Factors o Multiple gestation, smoking, incompetent cervix, prior history, infection

Complications/Risks o Immature lung/organ development of fetus Neonate must be able to regulate temp, eat (suck reflex), breath, hold steady weight (marginal weight loss)

Braxton Hicks Doesnt change cervix, can start as early as 4 mo. Check for UA if early

Fundus Hard, midline, firm o o Empty bladder, fundal massage, give drugs Boggy is severe

DIC producing clotting factors in addition to heparin factors o o Heavy bleeding, Get pitocin, 4 anal pills

Postpartum Blues Most women experience blues

It peaks on the 5th day and lasts til the 10th General feelings of crying, fatigue, headache, anxious, anger, sadness Has levels of severity: mild, moderate, and severe Some moms regret the loss of the mother to unborn child relationship. Most women experience fatigue after the birth and the demands of a new baby compound the feelings of depression 10-15% of women will develop PPD, a more severe condition Routine screening should be done because parents wont admit to the feelings. Tell patient blues are normal and resting will help. They need to rely on their support systems to give her a break from the baby.

Hemorrhage Greater than 500 ml blood loss after vaginal birth, < 1000 ml blood loss after c-section. If it happens within 24 hrs of birth then its considered primary/early hemorrhage. Anytime after that is a late hemorrhage. If uterus is firming check for lacerations, if uterus isnt firm then its still trying to expel things (i.e. placental pieces left behind the body is trying to clean things out) Risks factors o Uterine atony hypotonia of the uterus (low muscle tone) Multiple gestation, hydramnios, over distended uterus, prolonged labor, pitocin, trauma during birth/labor (forceps, vacuum), c-section, high parity (numerous pregnancies)

Lacerations, retained placental fragments, ruptured uterus, manual removal of placenta, any magnesium (because uterus is relaxed if given recently), chorioamnionitis

Assessment/interventions o Feel fundus and frequent VS schecks, check bleeding for color and amount, check bladder for distention, check H&H and lab values Massage fundus, empty bladder, make sure IV is patent, make sure pitocin is running, notify provider, provide fluid blood replacement as

ordered, provide ordered drugs, provide explanations to family and woman Pitocin, methergine( cant use if BP is more than 140/90), Hemabate (cant use if asthmatic) , Cytotec (to augment labor), make contractions come Tighten uterus/increase contractions

Kegel exercises exercises vaginal muscles to strengthen pelvic floor Prevent passage of intestinal gas or stopping urine midstream

Couplet care taking care of mother and baby Pessory ring to push up a prolapsed uterus Taken out at night, cleaned and replaced it in the morning If kept in longer then pH should be kept at 4-4.5

Bereavement Let the woman grieve and dont say you can have another kid or I understand.

Afterpains First time moms usually have less pains, more pregnancies will make uterus flabby o Breastfeeding makes it worse (pitocin)