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4. Pyelonephritis
5. DM
6. Multiple fetuses
7. 1st pregnancy
8. Morbid obesity
9. Rh incompatibility
10. Molar pregnancy
11. Diets high in saturated fat, trans fat, cholesterol, calories, alcohol, and salt
12. Diets low in fiber, fruits, and vegetables
13. Smoker
Signs & Symptoms:
1. Sudden weight gain
2. Irritability
3. Severe frontal headache
4. Emotional tension
5. Blurred vision
6. Epigastric pain or heartburn
7. Preeclampsia: 160/110 or >
8. Eclampsia: SBP > 180 with seizures
9. Generalized edema, especially of face
10. Pitting edema of legs and feet
11. Oliguria
12. Hyperreflexia
13. Vascular spasm, papilledema, retinal detachment or edema, arteriovenous nicking
or hemorrhage (seen on ophthalmoscopy)
PRIORITY Nursing DX:
1. Deficient Fluid Volume
2. Risk for Injury
3. Anxiety
4. Deficient Knowledge
IMPLEMENTATION & COLLABORATIVE CARE:
1. Only cure delivery
2. TX: Mag Sulfate before or after PIH onset to depress vascular and neurologic
activity, lower BP, and prevent or stop seizures
3. Goal of care deliver healthy, viable infant while safeguarding mothers health
4. Enforce bedrest in side-lying position
5. Quiet, calm environment
6. Lifestyle changes: weight control, increase physical activity, stop alcohol intake,
sodium restriction, increase fresh fruits, vegetables, and low-fat dairy products,
reduce intake of saturated fats
7. Stop smoking
8. Consume oily fish twice weekly
9. If high risk for CVD325mg ASA daily
10. Limit caffeine
11. Assess fetal maturity and betamethasone treatment to assist maturation of lungs
before delivery if indicated
12. Frequent maternal assessments: BP, HR, RR, edema, deep-tendon reflexes
13. Assess for: HA, visual changes, epigastric pain
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14. Frequent fetal assessments: FHR, fetal compromise, and/or signs of labor
15. Foley monitor renal output; strict I&O; evaluate urine for protein; assess daily
weight
16. Administering anti-hypertensives, magnesium sulfate, and/or oxygen
17. Administer magnesium sulfate
a. Seizure prevention
b. Serum level 5-8mg/dl
c. > 8mg/dl toxic
d. Decreased urine output can increase risk of toxicity
e. Depressed reflexes and respirations < 12-14 may indicate toxicity
f. Calcium gluconate emergency administration to counteract toxicity
18. Induction or C-section when fetus mature or if maternal condition worsens
19. Teaching and support
20. Evaluate NB for signs of depression related to mag/sulfate
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DIABETES: p. 333
TYPE 1: absolute insulin insufficiency
TYPE 2: insulin resistance or deficiency
GESTATIONAL DIABETES: glucose intolerance due to pregnancypancreas unable to meet
increased demands for insulin production during pregnancyusually resolves within weeks of
delivery
Effects of pregnancy on glucose metabolism:
1. 1st trimester insulin needs decreased
2. Late 1st trimester insulin requirements rise as glucose use and glycogen storage by
mother and fetus increase
3. Human placental lactogen (hPL) from placenta causes resistance to action of
maternal insulin increases circulating glucose for fetal use and increases demand
on moms pancreas to produce more insulin
4. Fetus produces own insulin but gets glucose from mom across placenta; amount
of glucose a/v in moms circulation stimulates fetal pancreas to produce insulin
Effects of DM on pregnancy and fetus relate to degree of control of blood glucose (BG levels
between 70-110 and degree of vascular involvement; complications more common with DMI
and include the following:
1. Maternal hydraminosincreased volume of amniotic fluid
2. Preeclampsia, eclampsia, ketoacidosis, and worsening retinopathy
3. Dystocia (abnormal labor or childbirth), shoulder dystocia, and stillbirth
4. Neonatal macrosomnia (large body), hypoglycemia, hyperbiliruinemia, increased incidence
of congenital anomalies, and delayed fetal lung maturity fetal RDS
ASSESSMENT:
1. Risk factors:
a. FH of DM
b. Maternal obesity
c. Maternal age > 30
d. Previous LGA infant
e. Previous unexplained stillbirth
2. Classic DM symptoms:
a. Polyuriaexcess urine output
b. Polydipsiaexcessive thirst
c. Polyphagiaexcessive hunger
d. Hyperglycemia
e. Blurred vision
f. Excess weight gain
g. Increased candida infections
3. Urine assessment for glycosuria and ketones
4. DM screening: 28 weeks (or earlier if risk factors)
a. 50-gram oral GTT
b. If BG > 140 at one hour 3-hour 100-gram oral GTT completed
PRIORITY Nursing DX:
1. Risk for Imbalanced Nutrition, Maternal & Fetal: More Than Body Requirements
2. Risk for Injury: Maternal and Fetal
3. Anxiety
4. Deficient Knowledge
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HYPERTHYROIDISM: Treat with PTU
S&S:
1. Heat intolerance
2. Diaphoresis
3. Fatigue
4. Anxiety
5. Emotional lability
6. Tachycardia
7. Weight loss d/t nausea, vomiting, diarrhea
8. Low TSH
9. Elevated T3 & T4
HYPOTHYROIDISM: Treat with levothyroxine or Synthroid
S&S:
1. Weight gain
2. Hair loss
3. Constipation
4. Cold intolerance
5. Dry skin
6. Brittle nails
7. Elevated TSH
8. Low T3 & T4
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5.
6.
7.
8.
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ABRUPTIO PLACENTAE: (key words: PAINFUL; DARK RED BLOOD; SUDDEN onset)
Premature separation of placenta from uterine wall
Usually occurs after 20 weeks; most commonly 3rd trimester
Three classifications:
1. Mid-grade or mild separation (marginal):
a. mild separation with internal bleeding between placenta and uterine wall
b. mild to moderate vaginal bleeding
c. vague lower abdominal wall discomfort
d. fetal monitoring indicating possible uterine irritability
e. strong and regular FH tones
2. Moderate grade 2 or moderate separation (central):
a. Continuous abdominal pain
b. Moderate DARK RED vaginal bleeding
c. Severe or abrupt onset of symptoms
d. VS may indicate impending shock
e. Tender uterus, remaining firm between contractions
f. Barely audible or irregular and bradycardic FH tones
g. Labor starts w/I two hours and proceeds rapidly
3. Severe grade 3 or severe separation (complete):
a. ABRUPT onset of agonizing, unremitting uterine pain
b. Moderate vaginal bleeding
c. VS indicate rapidly progressive shock
d. Absence of FH tones
e. Tender uterus with border-like rigidity
f. Possible increase in uterine size if abruption severe & concealed
RISK FACTORS:
1. Previous abruption
2. Chronic HTN or HTN of pregnancy
3. Abdominal trauma
4. Multi-parity
5. PROM
6. Smoking or cocaine or methamphetamine use
7. Uterine anomalies/fibroids
8. Advanced maternal age
9. DM
Risks for Mom:
1. Hemorrhagic shock
2. Disseminated intravascular coagulation (DIC)
3. Hypoxic damage to organs (such as kidneys, liver, brain)
4. Postpartum hemorrhage
Risks for NB:
1. Preterm birth
2. Hypoxia, anoxia, neurological injury, and fetal death r/t hemorrhage
3. IGR
MATERNAL ASSESSMENT FINDINGS:
1. Hypovolemic shock, hypotension, oliguria, thread pulse, shallow/irregular respirations,
pallor, anxiety
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ALERT: ALWAYS assess FHR immediately after ROM whether it is spontaneous or by amniotomy!!
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PROLAPSED UMBILICAL CORD:
Descent of umbilical cord into vagina before presenting part
CAUSES:
1. PROM
2. Fetal position other than cephalic
3. Placenta previa
4. IU tumors preventing presenting part from engaging
5. Small fetus
6. Hydramnios
7. Multiple gestation
8. Factors interfering with fetal descent
SIGNS & SYMPTOMS:
1. Cord palpable at perineum during vaginal exam or may be visible
2. FHR pattern with variable decelerations
3. US confirms prolapse
MANAGEMENT:
1. ALERT: immediate measures to relieve pressure on cord are initiated
a. Place mom in trendelenburg or knee-chest position
b. Sterile-gloved hand may be inserted into vagina to elevate fetal head up and off cord
2. Administer oxygen
3. Monitor FHR
4. If cord exposed, apply saline-soaked sterile dressings over any portion of cord
5. Prepare to assist in vaginal birth if cervix fully dilated; c-section if cervical dilation
incomplete
ALERT: ALWAYS assess FHR immediately after ROM whether it is spontaneous or by amniotomy!!
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HYPEREMESIS GRAVIDARUM:
Nausea & vomiting secondary to elevated HCG becomes extreme.
Prolonged beyond 12 weeks
Causes weight loss of 5% or more
Dehydration, electrolyte imbalance, ketosis, acetonuria
HISTORY MAY REVEAL:
1. 1st pregnancy
2. < 20 years old
3. Obese
4. Multiple birth pregnancy
5. History of psychiatric disorder
6. Hyperthyroidism
7. Vitamin B deficiencies
8. Elevated stress level
9. GESTATIONAL TROPHOBLASTIC DISEASE: growth and degeneration of cells in placenta to
grape-like clusterscomplete mole with no fetus or partial mole with genetic material
derived from fertilized ovum
SIGNS & SYMPTOMS:
1. Vomiting over prolonged period
2. Dehydration: poor skin turgor, dry mucous membranes
3. Weight loss
4. hypotension
5. tachycardia
TEST RESULTS:
1. UA: ketones, acetones, elevated specific gravity
2. Electrolytes: reduced Na, P, Cl
3. Acidosis due to vomiting
4. Elevated liver enzymes
5. Thyroid test may be elevated
6. Hematocrit may be elevated due to dehydration
TX:
1. IV fluids: lactated ringers
2. Electrolyte replacement as indicated
3. Vitamin B6 and other vitamins as indicated
4. Antiemetic to control nausea and vomiting (promethazine or metoclopramide)
5. NPO for 24-48 hours
6. Advance diet if no vomiting within 24 hours to 6 small meals
7. Enteral nutrition by tube or TPN if vomiting persists
PATIENT SAFETY:
Assess mental status for signs of depression, anxiety, or irritability, which may indicate adverse
reactions to medications.
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TEST RESULTS:
1. Maternal serum alpha-fetoprotein (MSAFP)high levels
2. Amniocentesis: if MSAFP hightest for alpha-fetoprotein in amniotic fluid (+)
3. US: to assess neural tube defect
4. Transillumination of sac: done after birth. Differentiates between myelomeningocele and
meningocele. Meningocele sac DOES NOT transilluminate.
Nursing Interventions after birth:
1. Infant on side to prevent pressure on sac
2. Keep sac covered with sterile dressing soaked in warm saline
3. Measure head circumference to determine if hydrocephalus develops
4. Monitor for infection around sac
5. Assess for leakage
6. Assess for bladder and bowel function
7. Assess neurologic signs
8. Reposition infant q2h to prevent pressure ulcers and contractures
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STIs: Sexually Transmitted Infections:
Infections spread through sexual contact with an infected partner
Increased risks for mom, fetus, or neonate
Possible maternal complications:
1. Preterm labor
2. PROM
CAUSES:
1. Fungi
2. Bacteria
3. Protozoa
4. Parasites
S&S:
1. Typically involve some type of vaginal discharge or lesion
2. Vulvar or vaginal irritation, causing pruritus
MANAGEMENT:
1. Provide antifungal or antimicrobial
2. Teach patient about safer sex practices
3. Explain mode of transmission and how to reduce risk of transmission
4. Urge patient to refrain from intercourse until active infection completely resolve
5. Advise patient partner(s) need to be examined and treated
6. Encourage vulvar hygiene and dryness
7. Avoid soaps, creams, douching, or other ointments
8. Suggest cotton underwear and avoid tight-fitting clothing
Selected STI & pregnancy:
1. Chlamydia
a. May be asymptomatic
b. Dysuria may be in both males and females
c. Heavy, gray-white vaginal discharge
d. Painful urination
e. TX: amoxicillin or azithromycin
f. Most common STI
g. Can be transmitted to neonate during delivery and cause neonatal conjunctivitis and
pneumonia
2. Gonorrhea:
a. May be asymptomatic
b. Yellow-green vaginal discharge
c. Dysuria
d. Urinary frequency
e. Vulval inflammation/cervical swelling
f. Male partner experiencing severe pain on urination and purulent yellow discharge
g. TX: Ceftriaxone or cefexime (and must also give ATB for chlamydiaazithromycin or
amoxicillin)
h. Associated with spontaneous miscarriage, preterm birth, and endometritis in
postpartum
i. Treatment of sexual partner required
j. Severe eye infection leading to blindness in the neonate if infection present at birth
3. Candidiasis:
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4.
5.
6.
7.
8.
9.
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a. Yeast infection
b. May cause oral yeast infection in neonatecalled thrush
c. TX: low-dose Diflucan
Group B Streptococci infection:
a. May be asymptomatic
b. May lead to UTI, intra-amniotic infection leading to preterm birth, and postpartum
endometritis
c. CDC recommends screening at 35-38 weeks in all pregnant women
Trichomoniasis:
a. Yellow-green, frothy, odorous vaginal discharge
b. Vulvar itching, edema, and redness
c. TX: metronidazole (Flagyl)
d. May be associated with preterm labor, PROM, and post-cesarean infection
e. Treatment of partner required, even if asymptomatic
BV: bacterial vaginosis
a. Risk factors:
1. Frequent sexual intercourse without condom
2. Trauma from douching
3. New sexual partner or multiple partners
4. Maternal vitamin D deficiency
b. Thin, watery, white or gray vaginal discharge with FISHY odor
c. clue-cells on wet-mount
d. TX: metronidazole (Flagyl)
Genital Herpes
a. PAINFUL, small vesicles with erythematous base in cervical, vaginal, or anal areas
b. Low-grade fever, flu-like symptoms
c. dysuria
d. Dyspareunia
e. Positive viral culture
f. TX: acyclovir
g. NO cure
h. Abstinence until vesicles completely healed
i. Transmission to neonate possible if active lesions present at birth, which can be fatal
j. C-section if patient has active lesions
Syphilis
a. PAINLESS chancreulcer on vulva or vagina
b. Fever, weight loss, and malaise may be noted
c. Hepatic and/or splenic enlargement, HA, anorexia, maculopapular rash on palms and
soles
d. TX: penicillin G or benzathine
e. Possible transmission across placenta after about 18 weeks gestation spontaneous
miscarriage, preterm labor, stillbirth, or congenital defects
f. Standard screening1st prenatal visit; at 36 weeks if mom has multiple partners
g. Jarisch-Herxheimer RX: sudden hypotension, fever, tachycardia, and muscle aches that
occur within 6-12 hours of treatment, but resolve in 24 hours.
Condyloma acuminate
a. Caused by HPV
b. Genital warts
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HEPATITIS A
1. Fecal-oral
2. Acute infection
3. Immunization available
4. S&S: jaundice, anorexia, nausea, vomiting, malaise, and fever
HEPATITIS B
1. Blood/body fluids
2. CHRONIC infection
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3. Immunization available
4. S&S: Similar to hep A but includes arthralgias, arthritis, and skin eruptions or rash
HEPATITIS C
1. Blood/body fluids
2. CHRONIC
3. No immunization
4. S&S: Similar to hep A but includes arthralgias, arthritis, and skin eruptions or rash
5. People at higher risk:
a. IV drug users
b. Healthcare workers who receive needle stick
c. Multiple sexual partners
HEPATITIS D
1. Blood/body fluids
2. CHRONIC
3. No immunization
4. S&S: Similar to hep A but includes arthralgias, arthritis, and skin eruptions or rash
HEPATITIS E
1. Fecal/oral
2. Acute infection
3. No immunization
4. S&S: jaundice, anorexia, nausea, vomiting, malaise, and fever
5. South Central Asia & Middle East
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Rh or ABO incompatibility:
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CV DISEASE: p. 332
CLASS I: ASYMPTOMATICno limitations
CLASS II: asymptomatic at rest, symptomatic with heavy physical activity, slight limitations
CLASS III: asymptomatic at rest, symptomatic with minimal physical activity; considerably limitations
CLASS IV: symptomatic at rest and with any activity; SEVERE limitations
Class I & IIusually do well during pregnancy
Class III & IVsignificantly increased risk of morbidity and mortality with pregnancy
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ASSESSING PREGNANCY BY WEEKS:
WEEKS 1-4:
1. Amenorrhea
2. HCG positive 9-10 days after amenorrhea
3. Breasts changes/tenderness
4. Increased fatigue
5. Nausea/vomiting between 4-6 weeks
WEEKS 5-8:
1. Goodells sign (softening of cervix and vagina)
2. Ladins sign (softening of uterine isthmus)
3. Hegars sign (softening of lower uterine segment)
4. Chadwicks sign (purple-blue coloration of vagina, cervix, and vulva)
5. McDonalds sign
6. Cervical mucus plug forms
7. Uterus changes from pear shape to globular
8. Urinary frequency and urgency occur
WEEKS 9-12:
1. FHR detected with US
2. N/V and urinary frequency and urgency decrease
3. By week 12, uterus palpable just above symphysis pubis
WEEKS 13-17:
1. Mom gains 10-12 lbs during 2nd trimester
2. Moms HR increases by about 10 beats/minute
3. Uterine fundus palpable way between symphysis pubis and umbilicus
4. Fetal movements or quickening between 16-20 weeks
WEEKS 18-22:
1. Uterine fundus: just below umbilicus
2. FHR heard with fetoscope at 20 weeks
WEEKS 23-27:
1. Umbilicus level with abdominal skin
2. Striae present
3. Uterine fundus at umbilicus
4. Braxton Hicks start
WEEKS 28-31:
1. Gains 8-10 lbs in 3rd trimester
2. Uterine fundus way between umbilicus and xiphoid process
3. Fetal outline palpable
4. Fetus mobile and found in any position
WEEKS 32-35:
1. May experience heartburn
2. Striae more evident
3. Braxton Hicks increase in frequency and intensity
4. Mom may experience S.O.B.
WEEKS 26-40:
1. Umbilicus protrudes
2. Ankle edema
3. Urinary frequency recurs
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4. Engagement, or lightening, occurs
5. Mucus plug expelled
6. Cervical effacement and dilation begin
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FETAL DEVELOPMENT:
4 WEEKS:
1. C-shaped embryo
2. Head prominent
3. Extremities appear as buds
8 WEEKS:
1. Organ formation complete
2. Heart beating & has separate septum and valves
3. Arms and legs developed
4. Abdomen large
5. Facial features visible
6. Gestational sac visible on US
12 WEEKS:
1. Nail beds beginning to form
2. Heartbeat can be heard using Doppler
3. Kidney function beginning
4. Placenta formation complete with presence of fetal circulation
5. Gender distinguishable
16 WEEKS:
1. FH audible with stethoscope
2. Lanugo present
3. Fetus demonstrates active swallowing of amniotic fluid
4. Skeleton begins ossification
5. Intestines normal position in abdomen
20 WEEKS:
1. Mom can feel fetal movement
2. Hair begins to form eyebrows and scalp hair
3. Fetal sleep and wake patterns
4. Brown fat begins to form
5. Meconium evident in upper portion of intestines
6. Lower extremities are fully formed
7. Vernix covers skin
24 WEEKS:
1. Well-defined eyelashes and eyebrows are visible
2. Eyelids open and pupils react to light
3. Meconium may be present to the rectum
4. Hearing is developing; fetus able to respond to sudden sound
5. Lungs producing surfactant
6. Passive antibody transfer from mother begins
28 WEEKS:
1. Surfactant appears in amniotic fluid
2. Alveoli in lungs begin to mature
3. Male-testes start descend
4. Eyelids can open and close
5. Skin appears red
32 WEEKS:
1. Fetus appears more rounded as more subcutaneous fat is deposited
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STAGES OF LABOR:
STAGE 1:
Begins at onset of true labor and has 3 phases
Lasts until complete dilation
Divided into latent, active, and transitional phases
a. Latent phase:
1. Cervical dilation 0-3cm
2. Contractions irregular, short, last 20-40 seconds; frequency every 3-30 minutes
3. Lasts 4.5-8.6 hours
4. Mom calm, laughing, talkative
b. Active phase:
1. Cervix dilation 4-7cm with rapid effacement
2. Progressive fetal descent
3. Contractions regular every 3-5 minutes, lasting 40-70 seconds
4. Mom anxious, and restless as contractions intensify; helplessness
c. Transitional phase:
1. Cervical dilation 8-10cm
2. Contractions regular, strong to very strong, every 1.5-3 minutes, lasting 60-90 seconds
3. Mom tired, irritable, restless, helpless
4. Nausea and vomiting may occur
5. Sensation of needing to have BM
6. Urge to push noted
7. Bloody show increases
STAGE 2:
Complete dilation to birth of baby
2-60 minutes
Occurs in seven cardinal movements:
1. Descent-head enters inlet
2. Flexion-fetal chin flexes downward onto chest
3. Internal rotation-fetal head rotates to fit diameter of pelvic cavity
4. Extension-of fetal head as it passes under symphysis pubis
5. Restitution-the turning of head to one side as neck untwists
6. External rotation-head turned father to one side as shoulders rotate
7. Expulsion-shoulders and rest of body delivered
STAGE 3:
Time from birth of baby until placenta completely delivered
Placenta separates and is expelledone of two surfaces presents:
1. Schultze: SHINY fetal side
2. Duncan: DULL maternal side
STAGE 4:
1-4 hours after birth in which mothers body goes through readjustment. Vital signs stable.
Lochia scant progressing to moderate rubra
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FHR:
1. Normal: 110-160 with slight variability (change in FHR over a brief period of seconds to
minutes)
2. Acceleration: brief rise in FHR may occur with fetal stimulation (increased O2 demand) or
uterine contractions (due to brief hypoxia)indicates a healthy fetal autonomic nervous
system.
3. Decreased variability: may indicate fetal sleep or more serious fetal problems such as
sedation from drugs, fetus < 32 weeks with immature neurologic control of HR, neurological
damage, fetal anomalies of the heart, fetal dysrhythmias, or hypoxia with acidosis.
4. Absence of variability: SERIOUS WARNING SIGN
INITIATE continuous electronic monitoring (CEM) if anomaly noted:
1. HX previous stillbirth at 38 weeks or more
2. Complication of pregnancy:
a. Preeclampsia
b. Placenta previa
c. Other
3. Induction of labor
4. Preterm labor
5. Decreased movement of fetus
6. Fetal signs of distress (nonreassuring)
7. Meconium staining of amniotic fluid
8. Maternal fever
9. Placental complications (inadequate oxygenation of fetus)
IF internal probe attached:
1. Mom must be confined to bed
2. Membranes have ruptured
3. Cervix must be dilated to 2cm or >
4. Presenting fetal part must be against cervix
DECELERATIONS: decreases in FHR from baseline that occur early, late, or at variable times
during contractions
1. Early decelerations:
a. At onset or early stage of contractionsecondary to compression of head by uterine
contraction
b. Peak depression of rate as the contraction peaks
c. Return to baseline rate after contraction
d. NORMAL
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CAPUT SUCCEDANEUM:
Result of birth trauma results in serum and blood accumulation in tissue OVER the suture lines
of scalp
1. Noted OVER sutures lines of scalp
2. Infant asymptomatic
3. Will resolve in few days
CEPHALHEMATOMA:
Result of blood vessels broken during L&D and bleeding occurs between the bone and
periosteum
1. Usually not present at birth
2. Appear within 24-48 hours
3. Normally resolves within 2 weeks to couple months
4. Infant at risk for jaundice
HYDROCEPHALUS:
Condition involving disruption of circulation and absorption of CSF, resulting in accumulation of
CSF in ventricles of brain increased ICP
1. Noncommunicating hydrocephalus: caused by obstruction of CSF flow
2. Communicating hydrocephalus: caused by disruption of CSF absorption
S&S:
1. Rapidly increasing head circumference
2. Bulging and widening of fontanels
3. Underdeveloped neck muscles
4. Shiny thin scalp
5. Distended scalp veins
6. Irritability
7. Projectile vomiting
8. Shrill cry
9. Anorexia
10. Weak sucking
11. Nuchal rigidity
12. Arnold-Chiari malformation
TX:
1. Surgical removal or bypass of obstruction using a shunt
2. Tylenol prn pain
3. VP shunt infection or malfunctions:
a. IV vanco
b. Tylenol for temp > 101.3
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SPONTANEOUS ABORTION:
TYPES:
Abortionfetus lost before 20 weeks; less than 500g or less than 25cm
Threatened abortionvaginal bleeding before 20 weeks without dilation of cervix
Inevitable abortionvaginal bleeding & dilation of cervixno expulsion of products
Incomplete abortionexpulsion of some products before 20 weeks, but not allsepsis risk
Complete abortioncomplete expulsion of all POC (products of conception) before 20 weeks
Missed abortion: death of embryo or fetus before 20 weeks with complete retention
Septic abortionsigns of infectionchills, pain, fever or hypothermia, vaginal discharge,
hypotension possible, oliguria, RD from sepsis
Recurrent abortiontwo or more previous miscarriages
TEST RESULTS:
Urine positive for Hcgbut without progressive increase as expected
Absent or low serum Hcgabortion complete
USEmpty uterus or partial POC
CAUSES:
Chromosomal abnormalities
Infectionbacteriuria & chlamydia
Maternal anatomical defects
Endocrine disorders
Maternal systemic diseaseLupus
Exposure to fetotoxic agents
Trauma
Alcohol/drug abuse
SIGNS & SYMPTOMS:
Bleeding
Cramping
Abdominal pain
Decreased symptoms of pregnancy
Cervical changes
TREATMENTS:
Bedrest to reduce cramping & bleeding
Abstain from sexual intercourse to prevent infection
Medical induction of labor and evacuation of POCfor late abortion16 weeks or after
D&C after 12 weeks
Antibiotics as prescribed
NURSING INTERVENTIONS:
Assessment for risk factors
Monitor for signs of retained productsbleeding, signs of infection
Monitor for uterine rupture
Emotional support and/or refer to counseling
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INCOMPETENT CERVIX:
Painless dilation of cervix without uterine contractionsunable to contain fetusnormally
around 20 weeks
SIGNS & SYMPTOMS:
Vaginal drainage or bleeding
ROM
Pelvic pressure
Expulsion of fetus and POC
TESTS:
USfunneling or shortening of cervix
TREATMENTS:
Cerclage: purse string suture of cervix to close the cervix
Usually removed at 37 weeks of gestation
New cerclage needed with each pregnancy
NO new cerclage needed if left in place and c-section completed
NURSING INTERVENTIONS:
VS
Observe for vaginal drainage or bleeding or c/o pressure
Strict bedrest
Avoid dehydrationcan stimulate contractions
Educate signs of preterm labor
Home health care nurse
f/u visits
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PRETERM LABOR (PTL):
Labor between 20-36 weeks
CAUSES/RISK FACTORS:
Abnormal cervical length
Prior history of preterm birth or PTL
Infection
Non-white race
Abdominal trauma
Cervical incompetence
Cervical dilation
Bleeding after 12 weeks
Uterine abnormality
Stress
Prolonged standing
Inadequate weight gain
Clotting disorders
Pregnancy within 6-9 months of previous one
SIGNS & SYMPTOMS:
Uterine contractions: 4 in 20 minutes or 8 in one hour at 20-37 weeks
Cervical dilation of > 1 cm or effacement of 80% or greater at 20-37 weeks
Cervical shortening before term is abnormal
TESTS RESULTS:
Cervicovaginal swab fetal fibronectin (fFN) (fetal protein not normally found in vaginal tract
after 22 weeks)high predictor of PTL
Hyperglycemiauncontrolled DM
Thyrotoxicosiselevated thyroid hormones
CBC, CRP, vaginal and urine culturesto detect infections
US: short cervical length & determine fetal status
MANAGEMENT:
BedrestSide lying position to maintain uterine blood flow
IV infusion if dehydration
Tocolysisto hault labormost common magnesium sulfate or Brethine (terbutaline sulfate)
CCBnifedipine (Procardia) may be effective in arresting PTL
NURSING INTERVENTIONS:
Assess for risk factors
Monitor at-risk mothers for uterine activity and educate on S&S of PTL
PT EDUCATION:
S&S PTL
Bedrest
Side lying position
Avoid overexertion
Stop sexual intercourse
Empty bladder every 2 hoursminimum
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HELLP SYNDROME:
A form of gestation HTN with severe preeclampsia with hepatic dysfunction in addition to
coexisting hematologic conditions
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MULTIPLE GESTATION:
MONOZYGOTICidentical twinsone fertilized evum, same sex, identical in appearance
(maternal twins)
DIZYGOTIC: fraternal twinstwo separate ova (eggs) have been fertilized by two different
sperm, two chorions, two amnionsmost common
TWINShigh-risk pregnanciesLevel III facility
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