Stage 4 labor
The first 1-2 hours after birth.
Oxytocic
Classification of medications that stimulate contraction of the uterine smooth muscle.
Uterine Atony
Failure of the uterine muscle to contract firmly. It is the most frequent cause of excessive bleeding following childbirth.
After-birth pains
Menstrual like cramps experienced by many women as the uterus contracts after childbirth.
Homans sign
Complaint of pain in calf muscles when dorsiflexion of the foot is forced. The presence of pain is associated with the presence of thrombophlebitis.
Kegel exercises
Exercises that can assist women to regain muscle tone that is often lost when pelvic tissues are stretched and torn during pregnancy and birth.
Engorgement
Swelling of breast tissue caused by increased blood and lymph supply to the breasts as they produce milk.
Attachment
Process by which a parent comes to love and accept a child and a child comes to love and accept a parent.
Bonding
Sensitive period after birth when parents have close contact with their infant for later optimal development
Engrossment
The father's absorption, preoccupation, and interest in his infant.
en face
Position in which the parent's face and the infant's face are approximately 8 inches apart and are on the same plane.
Linea Nigra
The linea alba in pregnancy which becomes pigmented. Extends from the umbilicus to the symphysis pubis.
Naegele's rule
A rule for calculating the estimated birth date (EDB/EDD/EDC) by taking the 1st day of the LMP (last menstrual period) - 3 months + 7 days. (add 1 to the year if needed)
Macrosomia
A baby which is large for gestational age (LGA), or > 4000-4500g.
IUGR
Intrauterine Growth Restriction. Fetal weight that is below the 10th percentile for the gestational age. May also be called small for gestational age (SGA).
HELLP syndrome
H = hemolysis of RBC's, EL = elevated liver enzymes, LP = low platelets. Symptoms include headaches, N/V, upper right abdominal pain, malaise, visual disturbances, high blood pressure, protein in urine, edema, bleeding.
Polyhydramnios
Excessive amniotic fluid. Can lead to maternal shortness of breath and preterm labor. Risk factors include uncontrolled maternal diabetes, multifetal pregnancy, isoimmunization, and fetal malformations (e.g. spina bifida)
Oligohydramnios
Deficient amniotic fluid often accompanies congenital malformations of the fetal urinary tract and severe fetal growth restriction.
Striae gravidarum
Stretch marks caused by tearing of the dermis. Will lighten in color after birth, but will not necessarily fully disappear.
Chloasma (mask of pregnancy)
Hyperpigmentation of the face (forehead, cheeks, temple) and occurs primarily in pregnant women. More prevelant in dark-skinned women.
Antepartum
Occurring or existing before birth.
Intrapartum
Occurring during childbirth or delivery.
Postpartum
Occurring after childbirth
Meconium
Viscous greenish-black substance found in the lower intestines of the newborn; it is formed during fetal life from teh amniotic fluid and its constituents, intestinal secretions (including bilirubin), and cells shed from the mucosa.
Surfactant
Protein manufactured in type II cells of the lungs which reduces surface tension, thereby decreasing the pressure required to keep the alveoli open with inspiration and preventing total alveolar collapse upon exhalation: alveolar stability is maintained.
Thermoregulation
Maintenance of balance between heat loss and heat production.
Non-shivering thermogenesis
Primary mechanism for newborn head production accomplished by metabolism of a type of adipose tissue that is unique to a newborn called brown fat.
Epstein's Pearls
Small whitish retention cysts found on the newborn's gum margins and at the juncture of the hard and soft palate.
Wink reflex
Contraction of newborn's anal sphincter muscle in response to touch; a good sign of sphincter muscle tone.
Jaundice
Yellowish discoloration of the newborn's skin that occurs after the first 24 hours of life in response to hyperbilirubinemia.
Kernicterus
Acute bilirubin encephalopathy that occurs when bilirubin is deposited in brain cells.
Vernix caseosa
Cheeselike substance that covers and protects the skin of the fetus after 35 weeks gestation.
Acrocyanosis
Slightly bluish tinge of newborn's hands and feet caused by vasomotor instability, capillary stasis, and a high hemoglobin level. It is normal and can occur over the first 7-10 days of life, especially when exposed to cold.
Petachiae
Pinpoint hemorrhagic areas that can normally be present on the face and neck of a newborn as a result of delivery
Languno
Fine, downy hair that can be found over the face, shoulders, and back of the newborn.
Desquamation
Peeling of the newborn skin often associated with postmaturity.
Milia
White pimples-like spots found on the newborn face as a result of plugged sebaceous glands.
Mongolian spots
Bluish-black areas of pigmentation that most commonly appear on the back and buttocks of dark-skinned babies.
Erythema toxicum
Transient newborn rash that is characterized by lesions in different stages: macules, papules, and small vesicles.
Pseudomenstruation
Mucoid vaginal discharge that may be slightly bloody; it is associated with a decrease in estrogen following birth.
Molding
Distorted cranial size and shape as a result of overlapping of fetal cranial bones to facilitate movement through the birth canal during labor.
Polydactyly
Extra digits (>5)
Syndactyly
Fusing of the digits (fingers or toes).
Oligodactyly
Missing digits (<5)
Puerperium
Interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state.
Involution
Return of the uterus to a nonpregnant state after birth.
Subinvolution
Failure of the uterus to return to a nonpregnant state. Most commonly caused by placental fragments and infection.
Lochia rubra
1st stage of postbirth uterine discharge which is bright red consisting primarily of blood and decidual and trophoblastic debris. Typically lasts no more than the first 3-5 days after birth.
Lochia serosa
2nd stage of postbirth uterine discharge which is pink or brown consisting of old blood, serum, leukocytes, and tissue debris. Follows lochia rubra and lasts ~10 days.
Lochia alba
3rd stage of postbirth uterine discharge which is yellow to white consisting of leukocytes, deciduas, epithelial cells, mucus, serum, and bacteria. Follows lochia serosa, around 7-10 days postpartum and lasts ~ 2-3 weeks.
Pelvic relaxation
Lengthening and weakening of the fascial supports of pelvic structures that can occur later in a woman's life as a result of changes associated with childbirth.
Diastasis recti abdominis
Separation of the abdominal wall muscles.
Postpartum diaphoresis
Profuse sweating / perspiration that often occurs at night for the first 2-3 days after childbirth in order to eliminate excess tissue fluid accumulated during pregnancy.
Postpartum diuresis
Increased urinary output after childbirth in order to eliminate excess tissue fluid accumulated during pregnancyy.
Colostrum
Clear yellow fluid present in the breasts during the first 24hrs after birth. It has high concentrations of carbohydrates, protein, and antibodies, and is low in fat. It has a mild laxative effect and helps the newborn pass its first stool, meconium.
Hemorrhoids
Anal varicosities.
Vitamin K
Vitamin K controls the formation of coagulation factors. A sterile gut in newborns causes an initial deficiency of Vitamin K, therefore it is given to newborns to prevent hemorrhagic disease of the newborn. 0.5 - 1.0 mg I.M. within 1 hour of birth.
acetaminophen (Tylenol)
Nonnarcotic analgesic, antipyretic. Blocks pain impulses by inhibiting prostaglandin synthesis. It also acts on the hypothalamic heat-regulating center to relieve fever.
To relieve MILD PAIN or fever, give 325-650mg P.O. or P.R. every 4-6 hours, p.r.n. with a MAX of 4g daily. Caffeine may enhance analgesic effects of acetaminophen. Alcohol use may increase risk of hepatic damage. Assess patient's history as other OTC meds may have acetominophen included. Drug is for short-term use only.
codeine (Tylenol 3 - with Codeine)
Opiod: analgesic, antitussive. Controlled substance. Binds with opiate receptors in the CNS, altering both perception of and emotional response to pain. Also suppresses cough reflex by direct action on cough center in the medulla.
To relieve MILD to MODERATE PAIN, give 15-60mg P.O. Use with extreme caution if patient has COPD, asthma, & respiratory depression. Causes respiratory depression, sedation ,N/V, constipation. Do not use alcohol while taking med. Give drug before patient has intense pain. Give with food/mild to minimize GI effects.
docusate salts (Colace)
Emollient laxative. Reduces surface tension of interfacing liquid contents of bowel. The detergent activity promotes incorporation of additional liquid into stool, forming a softer mass.
As stool softener, 50-360mg P.O. daily until BM's are normal. Ensure patient has adquate fluid and fiber intake. Do not use more than 1 week without prescriber's knowledge.
erythromycin
Antibiotic. Inhibits bacterial protein synthesis by binding to 50S ribosome subunit, thus inhibiting bacterial growth. Used to prevent neonatal eye infection (opthomalia neonaturum) from N. gonorrhea or Chlamydia.
0.5-1.0 cm ribbon of ointment into each lower conjunctival sac once after birth.
hydromorphone hydrochloride (Diluadid)
Opiod: analgesic, antitussive. Controlled substance. Binds with opiate receptors in the CNS, altering both perception of and emotional response to pain. Also suppresses cough reflex by direct action on cough center in the medulla.
To relieve MOD to SEVERE pain, 2-4mg P.O. every 4-6 hrs, p.r.n. or 1-2mg I.M., subcutaneously or I.V. very 4-6hrs, p.r.n. Causes respiratory depression, sedation, constipation, N/V. Do not use alcohol while taking med. Give drug before patient has intense pain. Ensure enough liquid & fiber in diet.
ketorolac tromethamine (Toradol)
NSAID: analgesic, anti-inflammatory. Inhibits prostaglandin synthesis, blocking pain impulses. Relieves pain and inflammation.
For short-term management of PAIN, give 60mg I.M. or 30mg I.V. as single dose or as doses every 6 hrs. MAX = 120mg daily. AVOID in pregnant or breastfeeding women. Causes headache, nausea, GI pain. Intended for short term use only. Have patient report persistent or worsening pain...be on lookout for signs and symptoms of GI bleeding.
naproxen (Anaprox)
NSAID: analgesic, antipyretic, anti-inflammatory. Inhibits prostaglandin synthesis. Relieves pain, fever, and inflammation.
For MILD to MOD PAIN, 550mg P.O. initially, then 275mg P.O. every 6-8 hours, p.r.n. with MAX = 1.375 g daily. Contraindicated with patients with asthma, rhinitis, or nasal polyps. AVOID in breastfeeding women. Causes headache, drowsiness, peripheral edema, epigastric distress, occult blood loss, nausea. Take with full glass of water.
oxycodone (OxyContin)
Opioid: analgesic. Controlled substance. Binds with opioid receptors in CNS, altering response to pain.
For MOD to SEVERE PAIN, 5mg P.O. every 6 hours p.r.n. or 10-40mg P.R. p.r.n. t.i.d. or q.i.d. Use with caution if patient has asthma or COPD. Do not use Alcohol with med. Causes sedation, hypotension, bradycardia, respiratory depression. Give with food/mild to avoid GI upset. Withhold if respirations below 12breaths/minute. Give drug before pain becomes intense.
simethicon (mylicon)
Antiflatulent, antifoam agent. Causes gas bubbles to coalesce and allows gas to pass through GI tract via belching or passing of flatus. Also forms a film of low surface tension that causes foam bubbles to collapse.
For excess gas in GI tract, 40-125mg P.O. q.i.d. after meals and at bedtime with MAX = 500mg/day.
Tylenol 3 with Codeine
300 mg acetaminophen
30 mg codeine phosphate
Use for MILD to MOD pain and fever, 1-2 tabs every 4 hours. MAX = 12 tabs/24 hours.
Percocet 2.5/325
325mg acetaminophen
2.5mg oxycodone hydrochloride
Use for MOD-MOD SEVERE pain, 1-2 tabs every 4-6hrs. MAX = 12 tabs/24 hours.
Percocet 10/650
650mg acetaminophen
10mg oxycodone hydrochloride
Use for MOD to MOD SEVERE pain, 1 tab every 4 hours. MAX = 6 tabs/24 hours
NSAID drugs
Nonsteroidal anti-inflammatory drugs. Inhibit synthesis of prostaglandins peripherally and possibly centrally, thereby blocking pain impulses. Also exert anti-inflammatory effect that results in part from inhibition of prostaglandin synthesis and release during inflammation.
Adverse reactions chiefly involve the GI tract, particularly erosion of the gastric mucosa. Most common symptoms are dyspepsia, heartburn, epigastric distress, nausea, and abdominal pain. AVOID in 3rd trimester of pregnancy and NOT RECOMMENDED during breastfeeding.
Opioids
Act as agonists at specific opiate-receptor binding sites in the CNS and other tissues, altering the patient's perception of and emotional response to pain.
Respiratory depression and circulatory depression are major hazards. CNS effects include dizziness and visual disturbances. GI effects include nausea, vomiting, and constipation. Codeine appears in breastmilk.
Physiologic hyperbilirubinemia
Occurs in almost all neonates. Shorter neonatal RBC life span increases bilirubin production; deficient conjugation due to the deficiency of UGT decreases clearance; and low bacterial levels in the intestine combined with increased hydrolysis of conjugated bilirubin increase enterohepatic circulation. Bilirubin levels can rise up to 18 mg/dL by 3 to 4 days of life (7 days in Asian infants) and fall thereafter. Usually is not clinically significant and resolves within 1 wk. Frequent formula feedings can reduce the incidence and severity of hyperbilirubinemia by increasing GI motility and frequency of stools, thereby minimizing the enterohepatic circulation of bilirubin. The type of formula does not seem important in increasing bilirubin excretion.
Breastfeeding jaundice
Develops in one sixth of breastfed infants in the first week of life. Breastfeeding increases enterohepatic circulation of bilirubin in some infants who have decreased milk intake and who also have dehydration or low caloric intake. The increased enterohepatic circulation also may result from reduced intestinal bacteria that convert bilirubin to nonresorbed metabolites. May be prevented or reduced by increasing the frequency of feedings. If the bilirubin level continues to increase > 18 mg/dL in a term infant with early breastfeeding jaundice, a temporary change from breast milk to formula may be appropriate; phototherapy also may be indicated at higher levels. Stopping breastfeeding is necessary for only 1 or 2 days, and the mother should be encouraged to continue expressing breast milk regularly so she can resume nursing as soon as the infant's bilirubin level starts to decline. She also should be assured that the hyperbilirubinemia has not caused any harm and that she may safely resume breastfeeding. It is not advisable to supplement with water or dextrose because that may disrupt the mother's production of milk.
Breast mild jaundice
Breast milk jaundice is different from breastfeeding jaundice. It develops after the first 5 to 7 days of life and peaks at about 2 wk. It is thought to be caused by an increased concentration of ?-glucuronidase in breast milk, causing an increase in the deconjugation and reabsorption of bilirubin.
APGAR scoring
Scoring taken at 1 and 5 minutes after birth to indicate the neonates cardiopulmonary adaptation to outside the uterus. Scores are from 0-10. Scoring based on: Color, Heart Rate, Reflexes, Muscle Tone, and Respiration.
Scores between 8-10 indicate normal adaptation: no intervention.
Neonatal normal vital signs
Heart Rate: 110-160 bpm (100 sleeping; 180 crying)
Respirations: 30-50 breaths / minute
Temperature: 97.5 - 99F
Blood Pressure: 60-80mmHg / 40-50mmHg