MATERNAL HEALTH THE NEWBORN

MATERNAL HEALTH & THE NEWBORN 1.Calculating a due date a.Take the first day of the last menstrual period, add 7 days, and then subtract 3 months.i.First day of menstrual period + 7 days – 3 months = Due date ii.June 10 th (first day) + 7 days – 3 months = March 17 th 2.Weight gain during pregnancy a.Total weight gain during full term pregnancy is expected to be 28 lbs, plus or minus 3 lbs.i.1-2 lb. difference is okay ii.3 lb. difference, need to have an assessment iii.4 lb. difference is trouble.Proper Weight Gain During Pregnancy TrimesterExpected Weight Gain First trimester (1-12 weeks) 1 lb. each month (total of 3 lbs. in first 12 weeks) Second trimester (13-27 weeks) 1 lb. each week (total of 9 lbs. in 9 weeks) Third trimester (week 27- delivery)1 lb. each week

-How to calculate:

• take the week of gestation – 9 + ideal weight gain

3.Fundal Height a.The fundus is the top part of the uterus i.It is not palpable until week 12 (can’t be felt during first trimester) ii.After the first trimester (week 13) the fundus should be palpable under the umbilicus iii.The fundus is at the level of the umbilicus (belly button) at 20-22 weeks gestation, (second trimester) the date of viability is 22-24 weeks 4.Positive signs of pregnancy a.Fetal skeleton on x-ray b.Fetal presence on ultrasound c.Auscultation of fetal heart rate (heard between 8-12 weeks) i.If a question says, “When would you first hear a heartbeat?” you would say 8 weeks.ii.If a question says, “when would you most likely hear a heartbeat?” you would say 10 weeks. This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 19:22:26 GMT -05:00 https://www.coursehero.com/file/32398561/MATERNAL-HEALTH-newborn-mark-klimek-docx/ This study resource was shared via CourseHero.com

iii.“When should you auscultate a fetal heart rate by?” – you say 12 weeks.

**WATCH HOW THEY WORD THE QUESTIONS

iv.same with quickening (kicking) 16-20 weeks.

1.When would you first? -16 weeks 2.When would you most likely? -18 weeks 3.When should you by? – 20 weeks d.When examiner palpates fetal movement, only positive if the examiner palpates.

5.Presumptive(maybe) signs of pregnancy a.All urine and blood tests b.Chadwick’s, Goodell’s, and Hegar’s sign- THEY OCCUR IN ALPHABELTICAL ORDER i.Chadwick’s sign- Cervical Color Change to Cyanosis. – all C’s ii.Goodell’s sign- Cervical softening iii.Hegar’s sign- Uterine softening 6.Patient teaching in pregnancy a.Pattern of office visits- good prenatal care is a major factor in reducing infant mortality Office visit patterns Once a month Until week 28 (first & second trimester, some of third) Once every two weeks Until week 36 Once a week Until delivery or week 42 (either C section or induction at that point) b.Hgb will drop- TOLERATE THESE DROPS IN PREGNANT WOMEN (12-16 normal) i.In 1 st trimester, a hemoglobin may drop to 11 and be normal ii.In 2 nd trimester, a hemoglobin may drop to 10.5 and be normal iii.In 3 rd trimester, a hemoglobin may drop to 10 and be normal c.Teaching on the discomforts of pregnancy i.Morning sickness (first trimester)- Tx w/ dry carbohydrates before you get out of bed ii.Urinary incontinence (first & third trimester problem)- Tx void every 2 hours iii.Difficulty breathing (second & third trimester)- teach tripod positioning iv.Back pain (second & third trimester) – pelvic tilt exercises (tilt forward) 7.Labor & Birth a.Onset of regular progressive contractions (most valid sign a woman is in labor) i.Little review*** 1.Dilation- opening of the cervix (0-10cm) 2.Effacement- thinning of the cervix (thick-100%) This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 19:22:26 GMT -05:00 https://www.coursehero.com/file/32398561/MATERNAL-HEALTH-newborn-mark-klimek-docx/ This study resource was shared via CourseHero.com

3.Station- relationship of the fetal presenting part to mom’s ischial spines (smallest diameter through which the baby has to fit to be born vaginally) negative stations means the head is above the tight squeeze, positive stations means the baby has already made it through the tight squeeze. (little rule** REMEMBER NEGATIVE STATIONS ARE NEGATIVE NEWS & POSITIVE STATIONS ARE POSITIVE NEWS) (engagement is station 0) 4.Lie-between spine of the mother and spine of the baby a.Vertical lie is good, uncomplicated/compatible with vaginal birth b.Transverse lie is not good/Trouble- (makes a T) c.Breech with booty first 5.Presentation- part of baby that enters the birth canal first (most common ROA & LOA -pick those* good guess)

b.Four stages of delivery:

i.Stage 1- Labor which has 3 phases within it (the first three letters of the first phase tell you what order the phases are in- LAT-ent) 1.Latent- in this phase you dilate from 0-4cm, your contractions are every 5-30 min apart, duration is 15-30 sec, intensity is mild 2.Active- in this phase dilation goes from 5-7 cm, frequency is every 3-5 min, duration is 30-60 sec, intensity is moderate 3.Transition- in this phase dilation is 8-10 cm, frequency 2-3 min, duration 60-90 sec, intensity is strong Phases of stage 1Dilation Frequency Duration Intensity Latent 0-4cm 5-30 min 15-30 sec mild Active 5-7cm 3-5 min 30-60 sec moderate Transition 8-10cm 2-3 min 60-90 sec strong *if you remember the middle active row, then anything less intense is latent, and anything more intense is transition

*NOTE-KNOW THIS: How would you know a woman is in trouble in labor?

*Contractions should not be longer than 90 sec or closer than every 2 min.

THEY LOVE TO TEST THIS ONE

Assessment of contractions:

Frequency- Beginning of one contraction to the beginning of the next Duration- Is beginning to end of one contraction Intensity- strength of contraction-purely subjective, teach to palpate w/ one hand over fundus w/ the pads of the fingers ii.Stage 2- delivery of the baby This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 19:22:26 GMT -05:00 https://www.coursehero.com/file/32398561/MATERNAL-HEALTH-newborn-mark-klimek-docx/ This study resource was shared via CourseHero.com

iii.Stage 3- delivery of the placenta iv.Stage 4- is recovery (lasts just 2 hours) then they are in postpartum

***DON’T CONFUSE STAGES WITH PHASES

8.Complications of Labor

1.Bad news: there are 18 complications in labor and you must know them all

2.Good news: there are only 3 protocols you need to know for all 18 complications a.Painful back labor- what do you do for it? POSITION THEN PUSH

i.2 things: position (on her hands & knees with her head down and rear-

end up) then push into her sacrum b.Prolapsed cord (BAD/EMERGENCY)- the baby could kill itself, it’s when the cord comes out first, and when the baby comes out it presses against the cord and then the baby dies. What do we do here? PUSH THEN POSITION i.Push the head back up, then position her in knee chest and stay that way until they can remove the baby via C-section

c.Interventions for ALL OTHER labor complications: L.I.O.N.

i.L- means first you turn them on their lef side ii.I- means you increase their IV iii.O- means you oxygenate them iv.N- means to notify physician **IN AN OB CRISIS- If PITOCIN is running- STOP IT *** Hold pit would take precedence over L in the LION trick.

9.Pain medication for labor a.Do not administer a pain medication to a woman in labor if the baby is likely to be born when the med peaks

i.Scenario: you have a prim gravida (first timer) who is 5 cm dilated wants

their IV push pain med. Will you give it to her or not?

1.Is it likely that a prima gravida is going to have her baby in the next 15 to 30 min? –NO, so you give her the med.

2.You have a multi gravida at 8 cm who wants their IM pain med? Is it likely that a multi gravida at 8 cm to deliver in the next hour?-Yes, so you don’t give the med.

10.Fetal monitoring patterns: the bad ones start with letter “L” do L.I.O.N, unless it’s variable then it is very bad then you need to Push-Then-Position.a.Low fetal heartrate: (under 110) this is BAD. What do you do? -do L.I.O.N. This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 19:22:26 GMT -05:00 https://www.coursehero.com/file/32398561/MATERNAL-HEALTH-newborn-mark-klimek-docx/ This study resource was shared via CourseHero.com