MARK KLIMEK LECTURES

MARK KLIMEK LECTURES

Maternity and OB Lecture Pregnancy -Know how to calculate due date.oFirst day of the last menstrual period + 7 days – 3 months oJune 10 -15 th  due date would be March 17 th

-Ideal total weight gain for pregnancy = week of gestation - 9 oAt week 12 (1 st trimester) = 3lbs normal -Fundal height oFundus not palpable until week 12 (end of the first trimester) Client is the priority oFundus is at the umbilicus at 20-22 weeks of gestation (end of the second trimester) oFundus is above the umbilicus – third trimester -Quickening (baby kicking) occurs 16-20 weeks -Positive oFetal skeleton on xray oFetal presence on ultrasound oAuscultation of a fetal heart (can hear it around 8-12 weeks)

When would u first: 8 weeks

When would u most likely (midpoint): 10 weeks

When should u auscultate (endpoint): 12 weeks

oWhen the examiner palpates fetal movements -Probable/presumptive oAll urine and blood tests oPositive preg. Tests oChadwick’s sign Cervical color change to cyanosis oGoodell sign Softening of cervix oHegar’s sign Softening of the lower uterine segment -Pts should come once a month until week 28 -At week 28, she should come in once every 2 weeks until week 36 -Come once every week until delivery or week 42

-Hbg level : 12-16 (will fall to 11 in first trimester)

-How to treat morning sickness oDry carbohydrates before u get out of bed oBagels, dry cereal and dry toast -How to treat urinary continence o1 st and third trimester problem oBaby is up higher in the abdomen in the second trimester  no urinary continence in second trimester.oVoid every 2 hours all the way until 6 weeks after delivery -Difficulty breathing o2 nd and 3 rd trimester problem

oTeach tripod position.-Back pain o2 nd and 3 rd trimester problem oPelvic tilt exercises (tilt pelvis forward, Labour and Delivery -The true and most valid sign of labor oThe onset of regular progressive contractions -Dilation oOpening of cervix (0-10cm) -Effacement oThinning of the cervix oGoes from thick and 0cm closed and she ends labor in fully dilated to 10cm dilated and 100% effaced.-Station is the relation of the fetal presenting heart to mom’s ischial spine (narrowest part of the pelvis)

oNegative station: baby’s presenting part is above the ischial spine.

oPositive station: baby’s presenting part is below the ischial spine. (already made it through) -Engagement in station 0 oThe presenting part is at the ischial spine -Fetal lie oThe relationship between the spine of the mother and the spine of the baby.oVertical lie (good)  parallel oPerpendicular (bad)  transverse lie -Presentation oPart of the body that enters the birth canal first oROA/LOA Right occiput anterior Left occiput anterior  -4 stages of labor

oStage 1: Labor has 3 phases

Latent active, transition

oStage 2: Delivery of baby

oStage 3: Delivery of placenta

oStage 4: Recovery

Last 2 hours -Purpose of uterine contractions in the first stage oDilate and efface the cervix -In the second stage oPush the baby out -Third stage oPush placenta -Fourth stage oContract uterus to stop bleeding -Post-partum begins 2 hours delivery of placenta -#1 priority in the second phase of labor oPain management -Priority in the second stage oClearing the baby’s airways -Extreme important action to be taken in the third phase oCheck the dilation, check breathing -Nursing action for oCheck for the vessels in the placenta -The labor chart -Latent phase

oDilate: 0-6cm

oContraction freq is 5-30mins apart oLast 15-30s oIntensity is mild -Active oDilation 5-7cm oFreq is 3-5 mins oLast 30-60s oIntensity is moderate -Transition oDilation is 8-10cm oFreq is 2-3 mins oDuration is 60-90s oIntensity is strong -Signs of uterine tetany/Uterine hyperstimulation oContractions should not be longer than 90s and closer than 2 mins -Assessment of contractions oFreq is the beginning of one contraction to beginning of the next oDuration is beginning to end of one contraction oIntensity; palpate with one hand over the fundus with the pads of the finger -Complications of labor o18 complications Painful back labor (LOPosterior /ROPosterior ) Position her in a knee chest position then push into her sacrum Low priority Prolapse cord Emergency Cord is the presenting part (head will press on the cord)

High priority Push the head back up, position in knee chest -Interventions for other complications (Maternal hypotension, toxemia, oLION oTurn on left side oIncrease IV oOxygenation oNotify physician -Pain meds in labor oDo not administer pain med to woman in labor if the baby is likely to be born when the med peaks.Fetal Monitoring Patterns

-7 monitoring patterns (look at the first letter, starts with L: do LION)

oLow fetal HR (<110) Do LION (left side lying, IV, O2 and notify MD)

BAD!

oHigh fetal HR (>160) Baby is fine but take mom’s temperature oLow baseline variability (stable VS) Fetal HR stays same

BAD!

Do LION (left side lying, IV, O2 and notify MD) oHigh baseline variability Fetal HR always changing Document it Good!oLate deceleration Fetal HR slows down near the end or after a contraction.

BAD!

Do LION (left side lying, IV, O2 and notify MD) oEarly deceleration Fetal HR slows down before or at the beginning of contractions.Normal Document oVariable Decelerations

VERY BAD!

Happens in prolapse cord Push then position.-Always check fetal HR