2 powers of Labor
maternal pushing efforts
whats the best passageway?
If passageway is platypelloid what usually happens?
C-section and transverse lie.
What is included with passenger
fetus, membranes, and placenta
Why is it important that head is present first?
squishes out amniotic fluid
What is engagement?
widest diameter of fetal presenting part has passed through pelvic inlet
How is engagement determined?
When does engagement occur with a primigravida?
or a multipara?
primigravida- usually 2 weeks before delivery
multipara-can occur before 2 weeks
With variables on a strip what does it look like?
with early and late?
What is lightening?
head moves down in pelvis.
mom starts to wobble, urinary frequency, belly flattens
increase in FHR of 15 ppm above baseline for atleast 15 seconds to less than 2 minutes.
sign of fetal well being
decrease in FHR below baseline. classified according to shape, timing and duration r/t contraction.
symmetrical, mirror image to contraction.
begins at beginning and returns at end of contraction
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.
what to do if late decelerations?
full dilation to birth of infant
effective pushing with urge
directed pushing- bear down
exhale while pushing down, don't hold breath,
1st degree laceration
perineal skin, vaginal membranes
2nd degree laceration
skin, mucous membranes, fascia
3rd degree laceration
4th degree laceration
dr cuts to make bigger. surgical incision.
delay for atleast 60 seconds or until cord pulsation ceases
2 long of delay of cord clamping could cause what?
what is polycythemia?
too much blood from cord.
can cause jaundice
Third stage is?
birth of baby to delivery of placenta
shiny side of placenta
Dirty side of placenta delivery
What to give to control blood loss?
Methergine & Hemabate
time of delivery of placenta to the first 1-2 hours after birth
Latent stage is what cm
Active is what cm?
Transitional is what cm?
When is surfactant adequate?
importance of surfactant?
Keeps lungs inflated so baby can keep breathing
decreased in moms who are diabetic
4 factors that influence newborn respiration
normal range of temp for newborn
po2 and ph drop and pco2 rises and prompts respiratory center
removal of fluid from lungs with subsequent replacement of air.
lungs in babies you see ?
if babies use too much brown fat what can it lead to?
babies have no shivering response (non shivering thermogenesis)
use brown fat found in neck and between scapula to keep warm
transfer of blood from cord to neonate.
clamping the cord depends on ?
deciding when to clamp the cord will be on how much baby needs of blood
WBC count in baby?
fluctuates..usually 18,000 but can range from 9000-30,000
Platelets in baby?
Lack vitamin K
Vit K injection given when?
within 1 hour after birth
Signs of hypoglycemia
weak, high pitched cry
irregular respiratory effort
blood glucose level less than 40 by heel stick
if blood glucose is low what should you do
have mom breastfeed or give formula immediately
stores for up to 6 months
how do they get iron after 6 months?
supplement- best is breast milk, fortified milk
not eating enough. peaks 3-5 days
What to do for physiological billirubin
frequent breast feeding
monitor feedings and stools
have a problem before getting into world
present in first 24 hours from break down of RBC's
What can cause pathological billirubin
bruising, hematoma, trauma, abo or rh incompatability
No bowel sounds until 15-30 min after birth
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
Signs of infection in baby
change of behavior
hard time regulating temp
Active Acquired Immunity
pregnant woman exposure to illness and immunizations
Passive Acquired Immunity
antibodies that have been passed through the placenta (6 months)
protects newborn against bacterial and viral infections
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.
How is neonates cardiovascular transition assessed?
Pulse, capillary refill and stable b/p
what do you want to make sure of when assessing cardiovascular?
the 3 shunts have closed
neutral thermal environment
range of temp in which newborns body temp can be maintained with minimal metabolic demands and oxygen consumption
Factors related to cold stress
large body area
limited subcutaneous fat
limited ability to shiver
blood vessels close to body surface
heat loss occurs by which 4 mechanisms?
Conduction- warm utensils before using
Convection- warm environment
Radiation- keep in warmer
SGA is ? and what percentile?
small for gestational age and less than 10th percentile
LGA is ? and what percentile
large for gestational age and over 90th percentile
conditions associated with SGA
congenital heart disease
conditions associated with LGA
large preg. wt gain
Expected reference range of weight
AGA- appropiate for gestational age
between 10-90th percentile
Signs of respiratory distress
grunting and nasal flaring
Blood pressure normals
0-6 on day 1
8 mg or less on day 2
12 mg or less on day 3
Normals for glucose in baby
Signs of hypothermia
temp less than 97.7
increased respiratory rate
what do they use for prophylactic eye ointment?
when do babies get hep b immunization
given within 12 hours of birth
then 1 month, 2 month and and 12 months
do you give vitamin k shot and hep b shot in same leg
no! rotate sites