Nursing care of child bearing Families Session 3:

This is OB session 3, we finally came around to more involved information, and there is more information that needs to be known in this session. Happy studying!

-Peter

Session 3

    • Gestational age starts from the first day of the last menstrual period.
      • the fetal age is about two weeks after that: the time to ovulation.
    • any infections can cause preterm labor, so these infections will be treated more aggressively than in a nonpregnant woman
    • advanced maternal age is greater than 35 and paternal age is greater than 50
    • SAB = spontaneous abortion or miscarriage
    • hCG human chronotropic gonadotropin
    • KNOW THE SIGNS OF PREGNANCY
      • Presumptive
        • subjective things that point towards pregnancy but are not diagnostic
          • ie amenorrhea, QUICKENING (movement of baby)
      • Probable
        • objective: changes in uterus size, braxton hicks, enlargement of abdomen, subtle dark skin on face and linea alba from estrogen, pregnancy test, palpation of fetal outline.
      • Positive
        • Fetal heart beat, movement, ultrasound of fetal.
    • Pregnancy term
      • 10 lunar months each 28 days (40 weeks)
        • 38 weeks to 42 due to ovulation variability
      • 266 days after ovulation
      • 280 after LMP
    • Abortion
      • more than 20 weeks and less than 37 6/7 weeks
    • Dating pregnancy
      • EDD/EDC/EDB- estimated date of…
      • Naegele’s rule
        • one year minus three months plus 7 days
          • +- two weeks (due month)
        • LMP 7/4/13: 7-3= 4 + 7days =april 11 2015
        • LMP 2/1/13: EDD 11/8/13
        • LMP 10/31/13: 10-3=7(july) + 7 days = august 7 14
      • think of it like a “Due month” not day. Due to the date +- 2 weeks
      • Don’t change the due date after it is calculated.
        • this helps us know that a baby is growing to fast or too slow.
    • get a good health history
      • previous preg
      • STI
      • + normal health history
      • DM, thyroid, clotting Dx, HTN
      • C sections are sugery
    • NSVD – normal spontaneous vaginal delivery
    • GA – gestational age
    • PPD – postpartum depression
    • epis – episiotomy, cutting the posterior perineum to allow for the baby’s head (not often done)
    • abruption is when the placenta tears from the uterine wall.
    • VBAC – vaginal birth after cesarean
      • risk of uterine rupture due to the previous scar of C section
    • Labs:
  • RH factor, blood type, ABS
    • CBC with hgb/hct/ plt
    • chlamydia, gonorrhea
    • wet prep for vaginal discharge
    • bacterial culture
    • TORCH – infections: toxoplasmosis, other, rubella, cytomegalovirus, herpes
  • Lab changes that are normal
    • increased WBC with left shift
    • increased fibrinogen
    • some anemia due to iron deficiency
    • increased alkaline phosphatase
    • Lower BUN and Creatinine due to more urine (from more blood circulation)
    • trace protein and glu in urine
    • Blood types
      • the actual blood does not cross the placenta (in a perfect world)
      • Rh + baby has a Rh- mom
        • the first baby has the mom make antibodies aginst the Rh factor, but does not harm baby
        • the second baby that is Rh + will be attacked by the IgG and identified by the antibodies.
        • Rh immune Globulin (rhogam) given to Rh – women who have not yet been sensitized by a Rh-baby.
          • IM or IV
          • it is a very small dose of Rh anti-D antibodies, this trick the woman’s body into thinking that there are enough antibodies so the mom’s body does not make any more.
          • given at 26-28 weeks, and postpartum if the baby is Rh +
          • given in the first pregnancy so the mom is never sensitized and doesn’t make her own antibodies.
            • given after any sign or chance of bleeding
          • do not give to a mom who has been sensitized
            • it will show up in the blood test with the Rh + antibodies (the Rhogam will not last long into a blood test of the next baby)
      • TORCH infections
  • PREVENT!
      • can cause fetal death
      • do not eat raw or uncooked meat
      • toxoplasmosis
        • watch for cats that go outside, there is a risk for toxoplasmosis in their poop.
      • Parovirus
        • high risk in day care workers
    • Evaluation of risk
      • BMI – the amount of weight that a person should gain goes down with increase in mom’s weight
      • head to toe exam
      • uterine exam
      • for how the uterus feels, and how far it is up from the symphysis pubis to the umbilicus  
    • Clinical pelvimetry
      • false pelvis is the iliac crest
      • true pelvis is below the iliac crest
      • the mid pelvis is the most narrow (ischial spines)
    • 1st trimester weight gain is 3-5 lbs
      • .5 – 1 lbs per week after 1st trimester
    • Heart rate symptoms
      • headache, scotoma, vaginal bleeding, loss of fetal movements,
    • fetal wellbeing
      • Heartbeat at 6 weeks on ultrasound, 10 week GA for the doppler
      • fetal movement at 18-22, it is sooner in women who have been pregnant previously, (multips)
      • fetal kick counts measure fetal wellbeing
      • US are usually completed in the 2nd or 3rd trimester
        • for presentation, fetal #
        • GI issues: can see an omphalocele, or gastroschisis (organs outside of the body)
        • Cardiac issues: transposition, 2 chamber heart
    • visit every four week from 26 to 38 weeks every 2 weeks till 40, and every week after that.
    • when traveling make sure there is a good medical center, and bring your medical records
      • walk around a lot to prevent DVT
    • die hair ok, massage by a trained person for pregnant women, no hot tubs, pedicure ok, can still have sex.
    • work changes: may need extra breaks, put feet up.
    • can pain room with safe paint without fumes
  • Layers of the pregnancy
  • Fetus, amnion, chorion (synonymous with placenta)
  • chorionic villi exchange the blood products with the mother’s blood vessels.
  • chorionic villi come from the trophoblast and the trophoblast line the chorionic villi
    • by 10 weeks all of the systems/organs have formed
    • Heartbeat at 6 weeks on ultrasound, 10 week GA for the doppler
    • fetal movement at 18-22, it is sooner in women who have been pregnant previously, (multips)
    • Breathing of the fluid starts around, 16 weeks (visible at 24-40 weeks)
  • 2 arteries and a vein and are in the umbilical cord, three total
  • the arteries carry the DEoxygenated blood away from baby
  • the vein carries OXYgenated blood to the baby
  • wharton’s jelly is inside the cord and keeps the cord from kinking
    • Placenta
      • maternal part is the ….
      • the fetal par is the chorionic
      • hormone function
        • produces: hPL, HCG estrogen, progesterone
  • Gravidity – any pregnancy (have to count current pregnancy!!!!)
  • parity – the # of births after 20 weeks regardless of outcome  (twins = 1 as well)
  • Nulligravida – never been pregnant
  • primapara – given birth to a fetus less than 20 week GA
  • multigravida – multiple pregnancies
  • TPAL
  • Term – # babies >37 6/7 weeks
  • Preterm – # babies < 37 6/7 weeks
  • Abortions – Miscarriages, or therapeutic
  • Living children –
  • the format for this will look like G1P1
    • one pregnancy, and one birth
  • G3P1112
    • 3 pregnancies, one full term baby, one preterm, one abortion, 2 living children.
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