Maternal Flashcards

2 powers of Labor

uterine contractions
maternal pushing efforts

whats the best passageway?

Gynecoid

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?

By palpitation

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?

V& W
Swoop

Impending labor

38 weeks
Lightning
cervical changes
bloody show
braxton hicks

What is lightening?

head moves down in pelvis.
mom starts to wobble, urinary frequency, belly flattens

Accelerations

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

Decelerations

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

early decelerations

symmetrical, mirror image to contraction.
begins at beginning and returns at end of contraction

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.

what to do if late decelerations?

stop labor
call dr
immediate action

Second Stage

full dilation to birth of infant
effective pushing with urge
directed pushing- bear down

Involuntary Pushing

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

includes muscle

4th degree laceration

includes rectum

Episiotomy

dr cuts to make bigger. surgical incision.

Cord clamping

delay for atleast 60 seconds or until cord pulsation ceases

2 long of delay of cord clamping could cause what?

polycythemia
hypovolemia
maternal hemorrhage

what is polycythemia?

too much blood from cord.
can cause jaundice

Third stage is?

birth of baby to delivery of placenta

Schultze

shiny side of placenta

Duncan

Dirty side of placenta delivery

What to give to control blood loss?

Methergine & Hemabate

Fourth Stage

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

Latent stage is what cm

0-3

Active is what cm?

4-7 cm

Transitional is what cm?

8-10 cm

When is surfactant adequate?

34-36 weeks

importance of surfactant?

Keeps lungs inflated so baby can keep breathing
decreased in moms who are diabetic

4 factors that influence newborn respiration

1. sensory
2. tactile
3. Chemical
4. Mechanical

normal range of temp for newborn

97.7-98.6

chemical factor

po2 and ph drop and pco2 rises and prompts respiratory center

mechanical factor

removal of fluid from lungs with subsequent replacement of air.

lungs in babies you see ?

crackles, moist

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

metabolic acidosis

thermogenic

babies have no shivering response (non shivering thermogenesis)
use brown fat found in neck and between scapula to keep warm

hematopoietic?

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
150,000-300,000

Vit K injection given when?

within 1 hour after birth

Hepatic?

Immature

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

if blood glucose is low what should you do

have mom breastfeed or give formula immediately

Iron storage

stores for up to 6 months

how do they get iron after 6 months?

supplement- best is breast milk, fortified milk

Physiological Billirubin

not eating enough. peaks 3-5 days

What to do for physiological billirubin

frequent breast feeding
maintain temp
monitor feedings and stools

Pathological billirubin

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

Bowel Sounds

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

lower wbc
irritability
change of behavior
poor feeding
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)

Humoral immunity

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
thin skin
blood vessels close to body surface

heat loss occurs by which 4 mechanisms?

Conduction- warm utensils before using
Convection- warm environment
Evaporation-keep dry
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

hypertension
asthma
drug use
congenital heart disease
diabetes
TORCH infections

conditions associated with LGA

maternal age
prolonged pregnancy
maternal obesity
glucose intolerance
large preg. wt gain

Expected reference range of weight

2500-4000 g

length

45-55 cm

head circumference

32-36.8 cm

chest circumference

30-33 cm

AGA- appropiate for gestational age

between 10-90th percentile

Signs of respiratory distress

grunting and nasal flaring

Blood pressure normals

60-80 systolic
40-50 diastolic

Normal billirubin

0-6 on day 1
8 mg or less on day 2
12 mg or less on day 3

Normals for glucose in baby

40-60

normal hgb

14-24

normal hct4

44-64

normal respirations

25-60

Signs of hypothermia

temp less than 97.7
cyanosis
increased respiratory rate

what do they use for prophylactic eye ointment?

Erythromycin

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