Maternal

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created 3 years ago by kahoffman
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updated 3 years ago by kahoffman
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1

2 powers of Labor

uterine contractions

maternal pushing efforts

2

whats the best passageway?

Gynecoid

3

If passageway is platypelloid what usually happens?

C-section and transverse lie.

4

What is included with passenger

fetus, membranes, and placenta

5

Why is it important that head is present first?

squishes out amniotic fluid

6

What is engagement?

widest diameter of fetal presenting part has passed through pelvic inlet

7

How is engagement determined?

By palpitation

8

When does engagement occur with a primigravida?

or a multipara?

primigravida- usually 2 weeks before delivery

multipara-can occur before 2 weeks

9

With variables on a strip what does it look like?

with early and late?

V& W

Swoop

10

Impending labor

38 weeks

Lightning

cervical changes

bloody show

braxton hicks

11

What is lightening?

head moves down in pelvis.

mom starts to wobble, urinary frequency, belly flattens

12

Accelerations

increase in FHR of 15 ppm above baseline for atleast 15 seconds to less than 2 minutes.

sign of fetal well being

13

Decelerations

decrease in FHR below baseline. classified according to shape, timing and duration r/t contraction.

14

early decelerations

symmetrical, mirror image to contraction.

begins at beginning and returns at end of contraction

15

late decelerations

decrease in FHR associated with contraction. mirror contraction. similar to early. decals has late onset beginning around peak of contraction. decreased blood flow to placenta.

16

what to do if late decelerations?

stop labor

call dr

immediate action

17

Second Stage

full dilation to birth of infant

effective pushing with urge

directed pushing- bear down

18

Involuntary Pushing

exhale while pushing down, don't hold breath,

19

1st degree laceration

perineal skin, vaginal membranes

20

2nd degree laceration

skin, mucous membranes, fascia

21

3rd degree laceration

includes muscle

22

4th degree laceration

includes rectum

23

Episiotomy

dr cuts to make bigger. surgical incision.

24

Cord clamping

delay for atleast 60 seconds or until cord pulsation ceases

25

2 long of delay of cord clamping could cause what?

polycythemia

hypovolemia

maternal hemorrhage

26

what is polycythemia?

too much blood from cord.

can cause jaundice

27

Third stage is?

birth of baby to delivery of placenta

28

Schultze

shiny side of placenta

29

Duncan

Dirty side of placenta delivery

30

What to give to control blood loss?

Methergine & Hemabate

31

Fourth Stage

time of delivery of placenta to the first 1-2 hours after birth

32

Latent stage is what cm

0-3

33

Active is what cm?

4-7 cm

34

Transitional is what cm?

8-10 cm

35

When is surfactant adequate?

34-36 weeks

36

importance of surfactant?

Keeps lungs inflated so baby can keep breathing

decreased in moms who are diabetic

37

4 factors that influence newborn respiration

1. sensory

2. tactile

3. Chemical

4. Mechanical

38

normal range of temp for newborn

97.7-98.6

39

chemical factor

po2 and ph drop and pco2 rises and prompts respiratory center

40

mechanical factor

removal of fluid from lungs with subsequent replacement of air.

41

lungs in babies you see ?

crackles, moist

42

if babies use too much brown fat what can it lead to?

metabolic acidosis

43

thermogenic

babies have no shivering response (non shivering thermogenesis)

use brown fat found in neck and between scapula to keep warm

44

hematopoietic?

transfer of blood from cord to neonate.

45

clamping the cord depends on ?

deciding when to clamp the cord will be on how much baby needs of blood

46

WBC count in baby?

fluctuates..usually 18,000 but can range from 9000-30,000

47

Platelets in baby?

Lack vitamin K

150,000-300,000

48

Vit K injection given when?

within 1 hour after birth

49

Hepatic?

Immature

50

Signs of hypoglycemia

jitteriness

twitching

weak, high pitched cry

irregular respiratory effort

cyanosis

lethargy

eye rolling

seizures

blood glucose level less than 40 by heel stick

51

if blood glucose is low what should you do

have mom breastfeed or give formula immediately

52

Iron storage

stores for up to 6 months

53

how do they get iron after 6 months?

supplement- best is breast milk, fortified milk

54

Physiological Billirubin

not eating enough. peaks 3-5 days

55

What to do for physiological billirubin

frequent breast feeding

maintain temp

monitor feedings and stools

56

Pathological billirubin

have a problem before getting into world

present in first 24 hours from break down of RBC's

57

What can cause pathological billirubin

bruising, hematoma, trauma, abo or rh incompatability

58

Bowel Sounds

No bowel sounds until 15-30 min after birth

59

When should baby void?

within first 24 hours then after that 2-6x a day for first couple days then more than 6x after that

60

Signs of infection in baby

lower wbc

irritability

change of behavior

poor feeding

hard time regulating temp

61

Active Acquired Immunity

pregnant woman exposure to illness and immunizations

62

Passive Acquired Immunity

antibodies that have been passed through the placenta (6 months)

63

Humoral immunity

protects newborn against bacterial and viral infections

64

Normal neonatal behavior

alert wakefulness right after birth for about 30 min then a period of sleep that can last from minutes to 2-4 hours. then second period of reactivity which show sucking, rooting, bowel sounds, tachypneic, tachycardia.

65

How is neonates cardiovascular transition assessed?

Pulse, capillary refill and stable b/p

66

what do you want to make sure of when assessing cardiovascular?

the 3 shunts have closed

67

neutral thermal environment

range of temp in which newborns body temp can be maintained with minimal metabolic demands and oxygen consumption

68

Factors related to cold stress

large body area

limited subcutaneous fat

limited ability to shiver

thin skin

blood vessels close to body surface

69

heat loss occurs by which 4 mechanisms?

Conduction- warm utensils before using

Convection- warm environment

Evaporation-keep dry

Radiation- keep in warmer

70

SGA is ? and what percentile?

small for gestational age and less than 10th percentile

71

LGA is ? and what percentile

large for gestational age and over 90th percentile

72

conditions associated with SGA

hypertension

asthma

drug use

congenital heart disease

diabetes

TORCH infections

73

conditions associated with LGA

maternal age

prolonged pregnancy

maternal obesity

glucose intolerance

large preg. wt gain

74

Expected reference range of weight

2500-4000 g

75

length

45-55 cm

76

head circumference

32-36.8 cm

77

chest circumference

30-33 cm

78

AGA- appropiate for gestational age

between 10-90th percentile

79

Signs of respiratory distress

grunting and nasal flaring

80

Blood pressure normals

60-80 systolic

40-50 diastolic

81

Normal billirubin

0-6 on day 1

8 mg or less on day 2

12 mg or less on day 3

82

Normals for glucose in baby

40-60

83

normal hgb

14-24

84

normal hct4

44-64

85

normal respirations

25-60

86

Signs of hypothermia

temp less than 97.7

cyanosis

increased respiratory rate

87

what do they use for prophylactic eye ointment?

Erythromycin

88

when do babies get hep b immunization

given within 12 hours of birth

then 1 month, 2 month and and 12 months

89

do you give vitamin k shot and hep b shot in same leg

no! rotate sites