Maternal Health/ OB Final Exam Study Guide
Maternal Health/ OB Final Exam Study Guide
Maternal Health/ OB Final Exam Study Guide
OB DRUGS
RUBELLA VACCINE:
• Given sub-Q before discharge in patients that are not immune.
• Give when titer is lower than 1:8
• SIDE EFFECTS: transient rash ***
• NURSING INTERVENTION
• Teach patient to avoid getting pregnant for 1-3months after
immunization.
RhoGAM
• Given to pregnant women who are Rh- but carry an Rh+ fetus
• Intramuscular injection * don’t give intravenously.
• Prevents antibody reaction
• Should be given at 28weeks gestation then 72hours after the
delivery of the fetus.
• *watch for temp increase after giving this shot
OB DRUGS
BETHAMETHASONE
• Corticosteroid that increases the production of
surfactant.
• Intramuscular injection given 24hours before
delivery of the infant.
• USED IN PRETERM LABOR * when the labor
cannot be inhibited and the woman is likely to
deliver in 48hours.
• Prevents RDS in the preterm neonate.
• ADVERSE EFFECTS: pulmonary edema *** (watch
for crackles, wheezing and chest pain).
OB DRUGS
MAGNESIUM SULFATE
• CNS depressant and anticonvulsants
• Tocolytic Used to STOP PRETERM LABOR by relaxing
the smooth muscle and prevent seizures during
eclampsia.
• ADVERSE REACTIONS:
• Decreased DEEP TENDON REFLEX ***
• Decreased resps
• Muscle weakness
• Decreased urine output
• Flushing
• Pulmonary edema
• * contraindicated in women with cardiac iddues because it
can cause heart block
OB DRUGS
• NURSING INTERVENTIONS:
• Test patellar reflex before giving the med.
• Use infusion pump
• Assess deep tendon reflexes every hour *
decrease = sign for toxicity.
• Watch magnesium levels *4-7.5 is therapeutic
range.
• CALCIUM GLUCONATE = antidote for toxicity
• Call doc if resps are less than 12 sign for resp
depression.
• Monitor input and output.
OB DRUGS: MEDS THAT PREVENT HEMORRHAGE:
METHERGINE:
• stimulates uterus contractions and increases the
force, intensity and duration of contractions.
• Also produces vasoconstriction of the coronary artery.
• INDICATION: post partum hemorrhage
• ADVERSE EFFECTS: bradycardia, dysrrythmia,
*severe hypertension.
• NURSING INTERVENTIONS:
• Monitor blood pressure closely
• Vital signs
• Watch for chest pain, SOB, itchiness, pale cold hands
and feet.
OB DRUGS: PITOCIN
PITOCIN
• Stimulate the uterus and causes contractions
of the myocardium.
• Oxytocin promotes milk let down.
• ADVERSE EFFECT:
• Water intoxication *** big one
• NURSING INTERVENTIONS:
• Monitor vital signs closely.
CONTRACEPTION
• CONTRACEPTION= deliberate prevention of conception
using a method or device that avoids the fertilization of the
ovum.
• TWO TYPES OF CONTRACEPTION:
• NATURAL FAMILY PLANNING METHODS
• Rhythm method
• BBT
• Cervical mucus
• Symptothermal
• Ovulation awareness
• Coitus interruptus.
• PHARMACOLOGICAL METHODS
• Condom
• Diaphragm
CONTRACEPTION:PHARMACOLOGICAL METHODS
• Hormonal contraception contains estrogen and progestin or
in some cases progestin alone.
• The Estrogen-progestin combination suppress ovulation and
change the cervical mucus making it difficult for sperm to
enter.
• The Hormones containing Progestin alone are less effective
• Taken for 21days then stopped for 7 days during which the
patient will get her period.
• Useful in controlling irregular periods.
• Factors that increase the adverse risks of contraceptives are
Obesity, smoking and hypertension.
• Contraceptives are contraindicated in people with
hypertension, thromboembolitic diseases, estrogen
dependent cancers and pregnancy.
CONTRACEPTION:PHARMACOLOGICAL METHODS
• Contraceptives increase the toxicity of tricyclic
antidepressants, may alter glucose levels, and
antibiotics decrease the absorption and effectiveness
of oral contraceptives.
• Side Effects: break through bleeding (spotting),
excessive cervical mucus production, breast
tenderness, hypertension, nausea and vomiting.
• ADVANTAGE:
– 99.9% effective
– You can be spontaneous
– May reduce the risk of ovarian cancer, ecptopic
pregnancy, ovarian cysts and non cancerous breast
tumors.
CONTRACEPTION:PHARMACOLOGICAL METHODS
• DISADVANTAGES:
– Don’t protect against STD’s
– Must be taken daily
– Expensive
– Illnesses that cause one to vomit may reduce the effectiveness of the
pills.
• PATIENT TEACHING:
• Reinforce the need to take the medication every day at the
same time if they are pills.
• Keep yearly pap smear exams
• Instruct the patients to do a breast self exam
• When the patient now wants to conceive she may not be able
to do so for 8months after stopping the oral contraceptives
because the pituitary gland requires a recovery period to
begin to stimulate the cyclic gonadotropins FSH & LH (these
regulate ovulation).
CONTRACEPTION
• PATIENT TEACHING …
• Increase vitamin B6 foods in diet (wheat, corn, liver, meat) and folic acid
(liver, greens, leafy vegetables). Because the hormonal contraceptives
have dietary deficiencies in Vitamin B6 and folic acid.
• Use another form of contraception for the first 7 days of using the
contraceptive because the contraceptives don’t take effect for 7 days.
• If you miss one pill , take one as soon as you remember
• Use another form of contraception if you miss two pills in a row.
• If you miss 3 pills in a row, then discard the pack and start a new pack
• ADVERSE REACTIONS:
• Fluid retention
• Weight gain
• Breast tenderness
• Break through bleeding
• Fatigue
• Headache
• Nausea and vomiting
CONTRACEPTION
• TRANSDERMAL PATCH:
• Weekly birth control patch that contains estrogen and
progestin and is worn on the skin,
• The hormones are absorbed into the skin and
transferred into the blood stream.
• The patch remains attached to the sin.
• ADVANTAGES:
• 99.9% effective
• DISADVANTAGES:
• Does not protect against STD’s
• Some patients may react to the adhesive on the patch.
CONTRACEPTION
• PARENTAL AGENTS : DEPO PROVERA
• These are I.M injections administered every 12weeks
• They stop ovulation from occurring by supressing the release of
gonodotropin hormones
• They also change the cervical mucus to prevent the sperm from
entering the uterus.
• ADVANTAGES:
• Long lasting
• Breast feeding patients can use them
• DISADVANTAGES:
• Invasive
• Expensive
• Don’t protect against STDs
• Their effects can be reversed
• * report shortness of breath, chest pain, swelling of the extremities
or heavy vaginal bleeding.
CONTRACEPTION: MORNING AFTER PILL
• MORNING AFTER PILL: EMERGENCY CONTRACEPTION
• Taken 72hours after unprotected sex.
• Antiemetic taken 1hour prior to taking the morning
after pill to overcome the feeling of nausea that can
occur with high doses of estrogen and progesterone.
• If a period does not come in 21days then the woman
should be evaluated for pregnancy.
• DISADVANTAGE:
• Doesn’t provide long term contraception
• Must be taken within that 72hour window but this
does not guarantee 100% protection.
CONTRACEPTION: BARRIER METHODS
• MALE CONDOMS:
• Synthetic sheath placed over the penis before intercourse.
• Prevents pregnancy by colleting sperm in the tip of the
condom, preventing it from entering the vagina.
• ADVANTAGES:
• Prevents STD’s and pregnancy
• DISADVANTAGE:
• Must be put on before any genital contact because pre
ejaculation may contain spermatozoa.
• There may be an allergic reaction to the latex.
• May beak during intercourse
• Cant be reused
• Sexual pleasure may be affected.
CONTRACEPTION: BARRIER METHODS
• DIAPHRAGM AND SPERMICIDE:
• Dome shaped cup that fits over the cervix with spermicide cream or gel in the cup
and around the rim.
• Its fitted by the primary care giver and must be refitted every 2years.
• The diaphragm must remain in place 6 hours after intercourse and more
spermicide must be applied after each sexual activity.
• Empty the bladder prior to inserting the diaphragm.
• ADVANTAGES:
• Gives the woman control over the contraception.
• DISADVANTAGE:
• Inconvinient
• You cannot be spontaneous
• Requires reapplication of spermicide with each sex act.
• TEACHING:
• Not recommended for patients that have had Toxic Shock Syndrome (caused by a
bacteria S/S high fever, watery diarrhea, drop in blood pressure, nausea and
vomiting, muscle aches) *prevented by proper hand washing and removing the
diaphragm 6 hours after sex, frequent UTI.
CONTRACEPTION
• IMPLANTABLE PROGESTIN LEVONORGESTREL
(NORPLANT):
• 6 rods implanted subdermally on the inner arm.
• They contain levonorgestrel
• PATIENT TEACHING: avoid trauma to the area of
implantation
• ADVANTAGE:
• Effective for 5 years
• Reversible when the woman now wants to concieve.
• DISADVANTAGE:
• Can cause irregular menstrual bleeding
• Does not protect against STD’s
• Use condoms to protect against STD’s.
CONTRACEPTION: INTRAUTERINE METHOD
• INTRAUTERINE DEVICE (IUD)
• T shaped device inserted in the vagina to the cervix
and placed in the uterus.
• Releases chemicals that damage sperm when they are
moving up to the uterine tubes, preventing
fertilization.
• Patient must monitor that the small string that hangs
from the device into the vagina is still there to make
sure the IUD has mot migrated or slipped out during
menstrual cycle.
• ADVANTAGE:
• Provides protection for 1-10 years
• DISADVANTAGES:
CONTRACEPTION:SURGICAL METHODS
• TUBAL LIGATION:
• Female’s fallopian tubes are tied
• NPO after midnight prior to surgery
• Permanent
• Sex is not affected.
• Disadvantage:
• Infection
• Hemorrhage
• Trauma
• There is a risk of an ectopic pregnancy
• The procedure is irreversible.
CONTRACEPTION:SURGICAL METHODS
• VASECTOMY:
• Ligation and severance of the vas deferens
• The male is not sterile until the proximal portion
of the vas deferens is cleared of all sperm (this
will take approximately 20 ejaculations).
• Use another form of birth control until the vas
deferens is cleared of all sperm.
• permanent,, but irreversible when the man finally
decides he would like to conceive.
• Complications are: bleeding, infection and
anesthesia reaction.
ANTEPARTUM PERIOD
NORMAL PHYSIOLOGICAL CHANGES DURING
PREGNANCY
• SYMPTOMS OF PREGNANCY:
• Divided into 3 groups
• PRESUMPTIVE SIGN =
– subject, what the woman says about why she thinks she’s
pregnant e.g missing her period, breast tenderness.
– No periods for an unknown reason
– urinary frequency
– breast enlargement or tenderness
– fatigue
– Quickening = feeling like there's a baby moving in you.
• Multigravida (woman who has had previous pregancies can feel
quickening at 16weeks
• Primigravida ( woman who is pregnant for the first time) feels
quickening at 18weeks.
NORMAL PHYSIOLOGICAL CHANGES DURING
PREGNANCY
• PROBABLE SIGNS = test findings that suggests the woman is
pregnant but not 100% guarantee.
• Hegars sign: softening of the uterus
• Chadwicks sign: when the vaginal mucosa are a bluish-
purplish tint
• Goodells sign = softening of the cervix
• Braxton hicks = contractions that the woman feels through
out the pregnancy. These are painless and irregular
• Positive pregnancy test
• POSITIVE SIGN = confirm pregnancy.
• FHR
• Fetal movement when you palpate the abdomen
• Visualization of the fetus by ultrasound.
NORMAL PHYSIOLOGICAL CHANGES DURING
PREGNANCY
NAGELE’S RULE
• Determines the estimated date of delivery
• 1ST DAY OF LAST MENSES – 3MONTHS + 7
DAYS.
• LATINOS
• Admiring the child without touching it is considered giving the CHILD
THE EVIL EYE.
• Direct eye contact is respectful
• The man is usually in charge of all the decision making
• The fathers prefer not to play an active role in the birthing process.
• The woman prefer to keep their bodies covered during labor
• Some mexican women may wear a cord around their waist because
they believe it prevents morning sickness and ensures a safe birth.
CULTURAL ISSUES DURING PREGNANCY
• ASIAN AMERICANS
• Prolonged eye contact is disrespectful.
• More comfortable with arms length distance
• The head of the baby is considered sacred (gate way to
the soul) so it can only be touched by the relatives
only. * touching the baby’s head when you are a non-
family member is considered bad omen.
• May not want a male physician because the womans
waist and between the knees area is private.
• Modesty is important.
• Father usually does not participate in the delivery of
the infant.
CULTURAL ISSUES DURING PREGNANCY
• FOODS PREFERRED DURING PREGNANCY:
• Asian Families – warm foods during the
pregnancy and after delivery.
• Muslim – halal meats
• Jewish – Kosher foods
ANTERPARTUM PERIOD
COMPLICATIONS OF PREGANCY
COMPLICATIONS DURING PREGNANCY
ABORTION:
• ABORTION = pregnancy ending before 20weeks
gestation
• S/S: spontaneous vaginal bleeding, clots may be
seen through the vagina, lower uterine
contractions, can lead to hemorrhage and shock.
• NURSING INTERVENTIONS: bed rest
• vital signs
• count the # of pads to evaluate blood loss, IV fluids
• Avoid vaginal exams
• Avoid sex with threatened abortions.
COMPLICATIONS DURING PREGNANCY: ABORTIONS
TYPES OF ABORTIONS:
• SPONTANEOUS
• Just occurs naturally before 20weeks gestation
• INDUCED
• Elective choice to terminate pregnancy.
• THREATENED
• Patient may have slight or no cramping at all
• Moderate spotting
• No tissue passes
• The cervical opening is closed
• INEVITABLE
• Spotting and cramping
• Cervix begins to dilate and efface
COMPLICATIONS DURING PREGNANCY: ABORTION
TYPES OF ABORTIONS
• INCOMPLETE
• Severe cramping
• Continuous and severe bleeding
• Partial fetal tissue or placenta
• Dilated with tissue in cervical canal or passage of the tissue.
• COMPLETE
• Loss of all uterine contents (conception products).
• MISSED
• Patient may have a brownish discharge
• The products of conception are retained in utero after fetal
death
• HABITUAL
• Spontaneous abortions in 3 or more pregnancies
PLACENTA PREVIA
• PLACENTA PREVIA = improper implantation of the uterus. Its
implanted on the lower segment or near the internal cervical os.
• TYPES OF PLACENTA PREVIA :
– Total = the placenta covers the cervical os
– Partial = covers the cervical os partially.
– Marginal =
• SIGNS AND SYMPTOMS ?
– Painless, bright red vaginal bleeding
– Uterus is soft, relaxed and nontender.
– Fundal height may be more expected than the gestational age.
• NURSING INTERVENTIONS:
– Fetal heart rate and maternal vital signs should be assessed first.
– There may be a need for a c-section if bleeding is heavy.
– No vaginal exam or anything that will stimulate the uterus.
– Position the patient in side lying position.
ABRUPTIO PLACENTAE
• ABRUPTIO PLACENTAE: this is premature separation of the
placenta from the uterus wall after the 12th week of gestation and
before the fetus is delivered.
• SIGNS AND SYMPTOMS:
– Dark red vaginal bleeding
– Uterine pain and tenderness
– Uterine rigidness
– Severe abdominal pain
– Signs of fetal distress.
– There may be signs of shock
• NURSING INTERVENTIONS:
– Vital signs and FHR
– Bed rest, oxygen, IV fluids and blood products
– Trendelenburg position to decrease the pressure of the fetus on the
placenta.
GESTATIONAL DIABETES, PRE-ECLAMPSIA
AND ECLAMPSIA
• Hypertension that occurs during pregnancy.
• PREECLAMPSIA:
– Non convulsive form
– Occurs after 20weeks gestation.
• ECLAMPSIA:
– Convulsive form
– Occurs at 24weeks gestation or the first postpartum week.
• SIGNS AND SYMPTOMS
– Blood pressure higher than 140/90mmHg.
– Weight gain of more than 5lbs (2.3 kg)/week.
– Protein uria *this is the also the diagnostic finding.
• TREATMENT:
– MAGNESIUM SULFATE (neuromuscular sedative that reduces
the amount of actelycholine preventing seizures).
MAGNESIUM SULFATE
MAGNESIUM SULFATE
• CNS depressant and anticonvulsants
• Tocolytic Used to STOP PRETERM LABOR by relaxing
the smooth muscle and prevent seizures during
eclampsia.
• ADVERSE REACTIONS:
• Decreased DEEP TENDON REFLEX ***
• Decreased resps
• Muscle weakness
• Decreased urine output
• Flushing
• Pulmonary edema
• * contraindicated in women with cardiac iddues because it
can cause heart block
MAGNESIUM SULFATE
• NURSING INTERVENTIONS:
• Test patellar reflex before giving the med.
• Use infusion pump
• Assess deep tendon reflexes every hour * decrease = sign
for toxicity.
• Assess for ANKLE CLONUS but dorsing flexing the patients
ankle 3times if the foot stops moving when you move your
hand then there is no ankle clonus, if the foot doesn’t stop
moving this is a (+) sign for ankle clonus.
• Watch magnesium levels *4-7.5 is therapeutic range.
• CALCIUM GLUCONATE = antidote for toxicity. Keep tab at
bedside.
• Call doc if resps are less than 12 sign for resp
depression.
• Monitor input and output.
HELLP SYNDROME
• HELLP SYNDROME = HEMOLYSIS ELEVATED LIVER ENZYMES & LOW
PLATELETS
• A category of gestational hypertension that involves the changes in
blood components and liver function
• CONTRIBUTING RISK FACTOR: pre- eclampsia.
• Hemolysis due to damage of erythrocytes.
• Elevated liver enzymes caused by the obstrcution in the liver due to
the fibrin deposits.
• SIGNS AND SYMPTOMS:
• *pain in the upper right quadrant due to distended liver, epigastric
area and lower chest pain
• INTERVENTIONS:
• Don’t palpate the abdomen because this increases intra abdominal
pressure which could lead to a rupture and liver hematoma
ECTOPIC PREGNANCY
• Implantation of a fertilized egg outside the uterus
• Usually the abnormal implantation is in the fallopian
tubes tubal rupture.
• TESTING WILL SHOW:
– High hCG levels
– The ultrasound will show an empty uterus
• SIGNS AND SYMPTOMS
– Unilateral stabbing pain
– Missing two periods.
– Dark red or brown vaginal spotting if the ruptures have
ruptured.
– Referred shoulder pain *common symptoms.
– Hemorrhage and shock (hypotension, tachycardia, pallor)
ECTOPIC PREGNANCY
• THERAPEUTIC MEASURES:
– METHOTREXATE = to inhibit cell division and
enlarge the embryo
– Avoid alcohol and folic acid to prevent a toxic
response to the meds
– Laproscopic salpingostomy = removal of the tube
if the tube ruptured
– Linear Salpingostomy = a section is cut to remove
the contents if the tube is not ruptured
MOLAR PREGNANCY
• Aka GESTATIONAL TROPHOBLASTIC DISEASE
• Proliferation and degeneration of trophoblastic villi in the
placenta which become swollen and fluid filled then look
like grape like clusters.
• THERE ARE TWO TYPES OF MOLAR GROWTHS:
• COMPLETE MOLE
– No fetus, placenta and amniotic membranes or fluid.
– Theres no placenta to receive the maternal blood
hemorrhage into the uterus vaginal bleeding.
– COMPLICATION = CHORIOCARCINOMA
• PARTIAL MOLE
• Contains abnormal embryoninc or fetal parts an amniotic
sac and fetal blood.
• COMPLICATIONS = CHORIOCARCINOMA
MOLAR PREGNANCY
• DIAGNOSTIC
– High hCG levels
– Ultra sound shows growths and vesicles but theres no fetus in utero.
– Urine analysis shows proteinuria.
• SIGNS AND SYMPTOMS:
– Rapid uterus growths
– Dark brown vaginal bleeding
– Hyperemesis gravidarum due to high hCG levels
• INTERVENTIONS
– Bring any clots to the physician for testing
– RhoGAM if the woman is Rh –
– Not get pregnant for up to a year (so use contraception).
– Testing of hCG levels for every 1-2weeks until the levels are normal ,
then every 2-4weeks for 6months & 2months for 1 year. * INCREASE
IN HCG LEVELS IS A SIGN FOR MALIGNANT TRANSFORMATION.
– Chemotherapy is done choriocarcinoma.
HYPEREMESIS GRAVIDARUM
• Excessive nausea and vomiting in the first trimester
• Most common in young pregnant ,20yrs; first pregnancy, multifetal
gestation, GTD, Vitamin B6
• HYPEREMESIS CAUSES: weight loss, electrolyte imbalance,
dehydration, ketosis.
• RISKS IT HAS TO THE FETUS: intrauterine growth restriction or pre-
term birth.
• DIAGNOSTICS: *most important lab results shows Ketones and
Acetones (protein & fat breakdown ; hematocrit concentration is
elevated because of the inability to retain fluid leads to hematocrit
concentration.
• NURSING INTERVENTIONS:
• NPO for 24-48hours
• IV fluids of lacated ringers for dehydration
• Vitamin B6
HYPEREMESIS GRAVIDARUM
• Excessive vomiting that lasts for more than 12weeks and causes 5%
weight loss.
• RISK TO THE FETUS: Intrauterine Growth Restriction (IUGR) and
preterm births.
• RISK FACTORS: younger than 20yrs, first pregnancy, multiple
gestation, gestational trophoblastic disease, Vitamin B deficiency.
• S/S: excessive vomiting, electroltye imbalance, dehydration, poor
skin turgor.
• Diagnostics: Urine analysis for Ketones and acetones (protein and
fat break down) is the most important lab; increased hematocrit
concentration.
• NURSING INTERVENTIONS: NPO for 24-48hours, IV fluids of
lacteted ringersm Vitamin B6 or vitamin supplements, if severe
TPN.
GESTATIONAL DIABETES
• Diabetes that starts during pregnancy . Normal glucose levels are
60mg/dl-120mg
• Should be screened for gestational diabetes between 24-28weeks
pregnancy.
• DIAGNOSTIC: 3 hour oral glucose tolerance test (GTT) *confirms
gestational diabetes. (NPO after midnight then 100g oral glucose given,
then serum glucose test done in 1, 2, 3hrs after the dose).
• PREDISPOSING/RISK FACTORS: older than 35years, obesity, family
history of diabetes.
• RISK TO THE FETUS: spontaneous abortions (big one) ; UTI because of the
increased glucose in the urine; Ketoacidosis (increased resistance to
insulin caused by untreated hyperglycemia).
• S/S: excessive thirst, hunger, weight loss, frequent urination, excessive
weight gain during pregnancy, blurred vision.
• NURSING INTERVENTIONS:
– Watch for hypoglycemia (clammy pale skin, shaking, tingling of mouth and
extremities, weak, shallow resps, nervousness).
– Watch for hyperglycemia : excessive thirst and urination,flushed dry skin,
acetone (fruity breath.
TORCH
• TORCH= group of infections that are teratogenes and can cross the placenta to the
fetus.
• TOXOPLASMOSIS = infection caused by the protozoa Toxoplasma gondii.
– s/s: rash and flu like symptoms
– Transmission: eating raw meats or handling cat liter.
– RISK: causes spontaneous abortions.
• OTHER INFECTIONS = GBS most dangerous, transmitted during delivery usually
occurs within 48Hours can cause meningitis, permanent neurological defects,
sepsis and pneumonia.
• RUBELLA =
– Teratogenic during the first semester
– Causes congenital defects of the eyes, heart, ears and brains
– If not immune (has a titer of 1:8 or less) then the mother must be vaccinated
and wait 3months before getting pregnant.
TORCH
• CYTOMEGALOVIRUS=
– Transmitted through droplets, semen vaginal secretions, breast milk, urine
*body secretions.
– There's no treatment
– PREVENT EXPOSURE BY FREQUENT HANDWASHING BEFORE EATING,
AVOIDING CROWDS OF YOUNG CHILDREN.
• HERPES SIMPLEX VIRUS =
– If the woman has herpes then vaginal exams are contraindicated
– Can cause death or permanent neurological defects.
– C-section indicated if the woman has lesions to avoid transmission to the fetus
during delivery.
INTRAPARTUM PERIOD
INTRAPARTUM PERIOD
• PASSENGER
• PASSAGEWAY
• POWERS
• PSYCHE
NORMAL LABOR AND DELIVERY
• PASSENGER: the fetus
• Consider the fetal head, presentation, lie, attitude. All
these affect the fetus ability to pass through the birth
canal.
• PRESENTATION= part of the fetus that enters the
pelvic inlet first.
– Occiput (back of the head)
– Mentum (chin)
– Scapula (shoulder)
– Sacrum (breech)
• LIE = relationship of the moms spine to the fetus spine.
– Longitudinal (cephalic or breech presentation.
– Transverse = lying across/horizontally. C-section needed.
NORMAL LABOR AND DELIVERY
• FETAL POSITIONING: relationship between the
presenting part of the fetus to the direction its
facing in the maternal pelvis.
– Maternal pelvis divided into four quadrants (anterior,
posterior, left, right)
– Example: ROP (first letter is the side of the maternal
pelvis , 2nd letter is the presenting part, 3rd the
direction the presenting part is facing, anterior,
posterior or transverse part of the maternal pelvis.
• TYPES OF VERSION:
• EXTERNAL CEPHALIC VERSION (ECV)
- Done by manipulating the abdomen.
- Pressure is applied to the fetal head and the buttocks so that the fetus
completes a backward flip or a forward roll. (the baby is flipped from
breech to vertex position by applying pressure on the belly).
- The fetus is changed from breech , transverse or oblique to the
CEPHALIC POSITION.
- If this is successful this reduces the chance of non-vertex and cesarean
births.
- Best results are seen in baby’s that are in transverse position.
BIRTH RELATED PROCEDURES-
VERSION
• PODALIC VERSION:
- Used with only a second twin during a vaginal delivery.
- The obstetrician places a hand in the uterus, grabs the feet of the fetus
and turns the fetus from transverse (or any non-vertex positions) to
BREECH.
- The baby is born in breech position
- Better than ECV because it causes fewer decelaration.
- Some obstetricians may choose to do a C-section that use this method.
• ECV PROCEDURE:-
- Woman must fast for 8 hours prior
- Ultra sound to confirm that theres only one fetus, amount of
amniotic fluid, position of the uterus, position of the umbilical
cord and that the baby is still in breech position.
- Maternal and Fetal vital signs taken external FHR monitor is
used.
- CBC, NST, blood typing and antibody screening.
BIRTH RELATED PROCEDURES- VERSION
- Start by making sure the woman understands the procedure and that she
can tell the doctor to stop if she becomes in too much pain.
- If the EVC fails there is a chance that cesarean birth will need to be done.
(this prepares the woman).
- Explain the the version while the version is being done and answer any
questions.
- Monitor blood pressure and pulse every 2mins throughout the time the
terbutaline (beta mimetic) is being used and for 30mins after.
- Monitor the FHR for 1-2hours after the ECV.
- Assess the response of both the fetus and the mother to the med give
(terbutaline)
- Teach the mother how to monitor the uterine contractions, fetal
movement (a kick) and ways to recognize signs of reversion (excessive
movement which most women describe as “the baby is turning round”).
- RhoGAM shoud be given to all Rh- women.
BIRTH RELATED PROCEDURES- CARE DURING RIPENING
• NURSING INTERVENTIONS:
- Delivery nurses with special training give ripening agents.
- Maternal and fetal vital signs taken for baseline.
- External Fetal Heart rate monitor is used for 30mins.
- The woman must remain lying down with a rolled
blanket or hip wedge under her right hip to tip the
uterus slightly to the left for the first 30-60mins to
maintain the cervical ripening agent in place.
- Monitor for hyperstimulation and FHr variations.
- If TACHYSYSTOLE = hyperstimulation of the uterus occurs
(5 contractions in 10mins) POSITION THE WOMNA IN
THE LEFT SIDE AND ADMINISTER OXYGEN IF THERE IS
FETAL DISTRESS.
BIRTH RELATED PROCEDURES- CARE DURING RIPENING
• OXYTOCIN INFUSION
- Given through IV to create uterine contractions & INDUCE
LABOR.
- THE GOAL IS TO HAVE contractions lasting in about 40-
60seconds in 10mins with good uterus relaxation and return to
the baseline tone when between contractions.
- Oxytocin is also given during augmentation when the labor is not
progressing as it should, the fetus is not descending so Oxytocin
will be given in this case to create the desired uterus contraction
pattern with strong contractions cervical dilation fetal
descent.
• Before administering oxytocin for induced labor or
augmentation the nurse should assess for:
- Assess the mothers pelvis * contraindicated in cephalopelvic
disproportion
- Fetal positioning and fetal station
BIRTH PROCEDURES- AUGMENTATION & INDUCED LABOR
NEWBORN ASSESSMENT
NEWBORN DRUG NEEDS
CIRCUMSICION
NEWBORN NUTRIONAL REQUIREMENTS
POSTPARTUM NEWBORN COMPLICATIONS
APGAR SCORING
• Done 1-5mins after birth
• Assesses the extrauterine adjustment of the neonate.
• Scoring based from 0-2
• 0 = poor / absent
• 2 = excellent
• 5 categories assessed
• Heart rate ( 1= less than 100 bpm; 2= more than 100bpm).
• Respirations (1= slow or weak cry ; 2= good vigorous cry)
• Muscle tone
• Reflex irritability (0= absent ;1 = minimal ; responds promptly)
• Skin color (0 = pallor and cyanosis ;1= normal coloring with blue
extremities; 2= body and extremity coloring is normal)
• When total is added up:
• 0-3 = severe distress
• 4-6 = moderate distress
• 7-10 = no distress
GESTATIONAL ASSESSMENT
• Done within 2-12hours after birth
• Measurements of the newborn and New Ballard
Scale is used to estimate gestational aging & its
used as a baseline to assess growth and
development.
• PHYSICAL MEASUREMENTS :
• WEIGHT = 2500g – 4000g
• LENGTH =45cm- 55cm. Measurement from top of the
head to the heal of the foot.
• HEAD CIRCUMFERENCE= 32cm- 36.8cm (18-22inch)
• CHEST CIRCUMFERENCE = 30 – 33cm (12.6 – 14.5inch)
GESTATIONAL ASSESSMENT
• New ballard scale assesses the neuromuscular and physical
maturity to find the infants gestational age.
• NEUROMASCULAR MATURITY:
• Posture – fully extended and fully flexed
• Square window formation of the wrist
• Arm recoil (the babys arms are extended then just let go and allows it
to spontaneously return to flexion.
• Popliteal angel – degrees to which the knees can extend.
• Scarf sign – crossing the neonates arms over the chest.
• Heel to ear – how far the heels reach the ears.
• PHYSICAL MATURITY
• Skin texture
• Lanugo
• Plantar surface creasess
• Breast tissue
• Genitalia (testes and labia)
INFANT VITAL SIGNS
• RESPIRTIONS
• 30 – 60/ min may have short periods of apnea lasting
15seconds
• Apnea periods occur mostly during REM
• Apnea lasting longer than 15seconds may be a sign for
resp distress.
• Crackles and wheezing can be a sign for fluid in the
lungs or infection
• Grunting and nasal flaring = Respiratory distress.
• HEART RATE
• 120- 160/min
• Listen to apical pulse for full min
INFANT VITAL SIGNS
• BLOOD PRESSURE
• Systolic = 60-80mmhg
• Diastolic = 40-50mmhg
• TEMPERATURE
• 36.5 – 37. 2 degrees celcius (97.7 – 98.9 F)
• High risk for hypothermia and hyperthermia
because of the infants inability to thermoregulate.
• If the baby becomes CHILLED (COLD STRESS)
increased oxygen demands acidosis
• Fetal hypoxia depressed respirations
BODY ASSESSMENT OF THE NEW BORN
• POSTURE: must be flexed and resistant to extension.
• SKIN: pink or acrocyanotic, no jaundice on the first day but it may
appear a day later.
• Texture: dry, soft and smooth. * full term babys may be peeling
*DESQUAMATION.
• SKIN DEVIATIONS:
• Milia= small white spots * don’t pop
• MONGOLIAN SPOTS: bluish purple spots, usually on the neonates
back, shoulder and buttocks.
• TELANGIECTATIC NEVI = * stork bite. flat and pink or red marks
found on the babys upper eyelids or the middle of the forehead.
They fade by the time the baby is 2.
• NEVUS FLAMMEUS: port wine stain. Red or purplish mark, does
not blanch or disappear.
• ERYTHEMA TOXICUM = erythema nenatorum. Rash that appears
suddenly.
BODY ASSESSMENT OF THE NEW BORN
• THE HEAD:
• Should be larger than the chest circumference.
• If the head is greater or equal to 4cm larger than
the chest this could be a sign for
HYDROCEPHALUS.
• LESS THAN OR EQUAL TO THE CHEST
CIRCUMFERENCE = MICROCEPHALY (abnormally
small head).
• BULGING FONTANELS = Increased intercranial
pressure, infection or hemorrhage
• DEPRESSED FONTANELS = dehydration.
CAPUT SUCCEDANEUM & CEPHALOHEMATOMA
• CAPUT SUCCEDANEUM
• Localized swelling of the soft tissue on the scalp. (the
swelling is over the bone)
• The swelling cross over the suture line
• Caused by pressure on the head during labor
• Usually resolves within 3-4days .
• CEPHALOHEMATOMA:
• Swelling caused by bleeding into an area between the bone.
*collection of blood between the periosteum and the skull
bone.
• Absorbed within 6 weeks with no treatment.
• Caused by trauma during birth for instance pressure of the
fetal head against the maternal pelvis in a prolonged
difficult labor or the use of forcep delivery.
• Appears within 1-2days after birth.
NEW BORN ASSESSMENT
• EYES:
• Permanent eye color is established in 3-12months.
• Immature lacrimal glands so there is tearless crying.
• EARS:
• The upper tip of the pina should be In line with the outer canthus of
the eye.
• Low set ears could be a sign for downs syndrome.
• Lack of cartilage = sign for immaturity.
• NOSE:
• Babys are nose breathers
• They get the skill to breath with their mouths at 3weeks.
• MOUTH
• EPSTEIN PEARLS = white spots found in the palate and gums.
Caused by accumulation of epithelial cells * normal.
• Tongue: if its large and protruding this is a sign for downs
syndrome.
NEW BORN ASSESSMENT
• REFLEXES:
• MORO = you act like you are going to let go of the
baby or strike the surface that they are sleeping on. *
the baby will extend the body and form a C with the
hands (act like they are griping onto something).
• Palmar grasp = you touch the palm of the baby and
they will try to grasp the object.
• Plantar grasp = the baby’s toes curl downward when
the sole of the foot is touched.
• Stepping = you pick up the baby as if you are making
them stand and they respond by dancing or stepping.
• Startle = loud noise * the baby will abduct his arms and
flex his elbows.
NEW BORN ASSESSMENT
• Most important adjustments to extrauterine life are
Respiratory and Circulatory. They must occur rapidly.
• Respirations established by the cutting of the umbilical
cord *most important extrauterine adjustment
because the infant now has to breath by themselves.
Air enters the lungs with that first breath.
• ASSESSMENT OF THE NEONATE ARE:
• Initial assessment immediately after birth (APGAR
SCORE)
• GESTATIONAL AGING ASSESSMENT WITHIN 2HOURS
• COMPLETE IN DEPT PHYSICAL EXAM WITHIN 24HOURS
NURSING CARE OF THE NEWBORN
• CARE OF THE NEWBORN IS DIVIDED INTO THREE PHASES:
• PHASE 1: STABILIZATION
• Stabilize or resuscitate to relieve airway obstructions if there's any
• Thermoregulation to maintain body temperature.
• PHASE 2: ASSESSMENT COMPLETION
• Apgar score, physical exam, measurements and monitoring the
infants labs).
• PHASE 3: NURSING INTERVENTIONS AND FAMILY TEACHING
• Umbilical cord care
• Prophylatic measures
• New born screening
• Infant feeding and bathing
• Helping parent – infant attachment.
NURSING CARE OF THE NEWBORN
• Highest priority is the abduction safety * use identification
bracelets for bothe the mother and the infant.
• Anyone coming in contact with the infant should be wearing an
indentification bracelet.
• Children with respiratory distress are at risk for HYPOTHERMIA
• Infants of mothers with diabetes are at highest risk for
HYPOGLYCEMIA
• Infants delivered by c-section are at highest risk of FLUID IN THE
LUNGS.
• NURSING ASSESSMENTS:
• Vital signs q30mins x2; q1hr x2 then every 8hours.
• Weight, length and chest circumference
• Chest the umbilical cord
• Watch periods of reactivity
NURSING CARE OF THE NEWBORN
• PERIODS OD REACTIVITY :
• 1st period: the infant is exploring the world
making sucking noises, rapid resps and heart
Rate which stabilize in 15-30mins.
• Period of relative inactivity: the infant is
resting and sleeping.
• 2nd period of reactivity : the infant awakens
and becomes alert again. Baby may be
choking on their saliva and mucus this may
last from 10mins to
NURSING CARE OF THE NEWBORN: THERMOREGULATION
• ELIMINATION:
• The newborn should void at least once in the 24hours after birth ,
then 6-10 days the day after or 4 days after.
• Meconium should be passed in the first 24hours
• Poo for breast fed infants is yellow and seedy
• Formular fed babies have lighter and looser stool.
• HEPATITIS B VACCINE
• Given at birth , 1 month then at 6months if the
woman is Hep B –
• If the mother is Hep B positive then they should
get Hep B immuno globulin and the Hep B vaccine
in addition within 12hours of birth.
• The Hep B vaccine is then given at 1month,
2months and 12months
• Do not give the vitamin k and Hep B vaccine on
the same thigh.
NEW BORN CARE DRUGS: VITAMIN K
• VITAMI K (AQUAMEPHYTON) injection
• Used to prevent hemorrhagic disorders
• Infants don’t priduce Vitamin K is not produced in
the GI tract of the newborn until Day 8.
• Vitamin K is produced in the colon by the bacteria
that forms once formula or breast milk is
introduced into the the GI system of the newborn.
• Shot is given IM into the VASTUS LATERALIS
because this is where the muscle is most
developed within 2hours after birth.
NEWBORN CARE: UMBILICAL CORD
• Should have 1 vein 2 arteries. LESS = ABNORMALITY
• Odorless and have not intestinal structures
• Small thin cord = poor fetal growth.
• Should be clamped for 24hours until the the cord is dry and occluded.
• Clean with alcohol.
• Signs of umbilical cord infection = moistness, oozing, discharge and
reddened base.
• Bleeding umbilical cord = due to a cord that was pulled or loosened cord
clamp.
• Foul smelling drainage = infection *treat immediately to prevent
septicimia.
• Umbilical cord hernia is caused by patent omphalomesentric duct *
common in african infants.
• Serous or serosanguineous drainage that continues after the cord falls off
is a sign for GRANULOMA (you will see a small red button deep in the
umbilicus). TREATMENT = SILVER NITRATE STICK.
• MOISTNESS OR DRAINING URINE AT THE BASE OF THE UMBILICAL CORD IS
A SIGN FOR PATENT URACHUS (abnormal connection between the
umbilical cord and the bladder)
NEWBORN CARE: CIRCUMSICION
• CIRCUMCISIONS = removal of the foreskin
• Jewish = do this 8days after birth
• NOT DONE IMMEDIATELY AFTER BIRTH BECAUSE:
• Low levels of Vitamin K so theres increased risk for bleeding
• Danger of cold stress.
• CONTRAINDICATIONS:
• Congenital abnormalities (hypospadias, Epispadias).
• Hypospadias = abormal positioning of the urethra on the ventral
under surface of the penis.
• EPISPADIAS = urethral canal terminates at the dorsum of the
penis
• History of bleeding in the family
• Ambiguous genitalia (both male and female parts)
• Illness or infection
NEWBORN CARE: CIRCUMSICION
• TYPES OF PROCEDURES:
• YELLEN, MOGEN, GOMCO CLAMP PROCEDURES:
• Clamp is applied to the penis, foreskin is loosened and a
cone is inserted under th foreskin to provide a cutting
surface.
• The wound is covered with a petroleum gauze to prevent
infection and bleeding.
• PLASTIBELL METHOD:
• Plastibell is placed between the foreskin and the glans of
the penis.
• The physician ties a suture tightly around the foreskin at
the coronal edge of the glans.
• The suture becomes ischemic and atrophies
• 5-8 days later the foreskin drops off with the plastibell
attached leaving the clean well healed incision.
NEWBORN CARE: CIRCUMSICION
• POSSIBLE COMPLICATIONS OF CIRCUMCISIONS:
• BLEEDING:
• Apply gentle pressure with gelfoam powder or sponge to
stop bleeding.
• Tell the physician if the bleeding continues, continue to
apply pressure until the physician arrives.
• COLD STRESS/HYPOGLYCEMIA
• Watch for excessive heat loss from increased respirations
and lower body temp.
• Use a radiant warmer during this procedure during the
procedure and swaddle the baby after.
• OTHER COMPLICATIONS:
• Monitor for infections, urethra fistula, delayed healing,
scarring.
POSTPARTUM: NEWBORN NUTRIONAL
NEEDS
NEWBORN CARE: CIRCUMSICION
NURSING INTERVENTIONS AND TEACHINGS:
• Tell the parents anesthesia will be given
• Do not bottle feed 4hours prior the procedure to prevent the vomiting
and aspiration.
• Breast feeding infants may nurse until the procedure.
• Signed consent should be in the chart prior to the procedure.
• Keep the area clean (change diaper q4hrs and clean the penis with
warm water with ach diper change, with clamp procedures apply
petrolium jelly with each diaper change for at least 24hours after the
circumcision)
• Fan fold the diaper to prevent pressure on the circumcised area.
• Don’t wrap the penis in tight gauze
• No tub bath until its completely healed
• Tell the physician if there is any rednessm swelling, strong odor,
tenderness, decreased urination, excessive crying of the infant
• There may be a yellowish mucus over the penis by day 2 * do not
wash it off
• No baby wipes because they have alcohol.
NEWBORN CARE: NUTRITIONAL NEEDS
• Normal Weight Loss and Weight Gain:
• 5-10% weight loss immediately after birth gained after 10-
14days.
• 110- 200g/week weight gain for the first 3months.
• Breast feeding the best nutritional source of food for the first
6months.
• COLOSTRUM =contains immunoglobulins providing passive
immunity. Secreted 1-3days.
• FEEDING FREQUENCY:
• Q2-3hours for breast feeding
• Q 3-4hours for bottle feeding
• Feed Q4hours at night
• Healthy newborn fluid intake 100-10mml/kg/24hours
• They receive enough water from breast milk so no need to
supplement with water.
NEWBORN CARE: NUTRITIONAL NEEDS
• CALORIE INTAKE :
• 110/kg/day for the first 3months
• 100/kg/day when they are now 3-6months
• Baby’s cannot digest fat from cows as easily this is why cow
milk is not given.
• They may be a need for vitamin D supplementation (especially
in dark skinned women who have limited exposure to the sun,
vegetarian mothers who exclude meat from their diert, fish
and dairy products.
• Iron = after 6 months the babys need to be given iron fortified
cereal; babys that are bottle fed should receive iron fortified
formula until they are 12months.
• Fluoride low in breast milk too so should be supplemented.
• SOLIDS should be given at 6months
NEWBORN CARE: NUTRITIONAL NEEDS
• BENEFITS OF BREASTFEEDING:
• Reduce infection by providingantibodies, leukocytes
• Large amounts of lactose provides rapid brain growth
• Has electrolytes and minerals
• Sucking associated with breastfeeding reduces dental
problems.
• Colostrum provides IgA antibodies.
• NEWBORN FACTORS THAT COULD CAUSE FAILURE TO
THRIVE:
• Inadequate breastfeeding
• Illness
• Infection
• Malabsorption
NEWBORN CARE: NUTRITIONAL NEEDS
• MATERNAL FACTORS THAT CAN CAUSE FAILURE TO THRIVE:
• Pain when feeding
• Inappropriate timing of feeding
• Inadeqaute breast tissue
• Maternal hemorrhage
• Illness
• Infections
• Breasts are not emptying well
• THINGS TO ASSESS FOR :
• Growth and weight gain
• Weigh daily while I nursery
• Weigh when 2weeks for breast fed infants
• Weigh at 6 weeks for formula fed infants.
• Adeqaute wieght gain is within the 10th to 90th percentile
• Monitor length and head circumference
• Calculate the newborns 24hour intake
NEWBORN CARE: NUTRITIONAL NEEDS
• NURSING INTERVENTIONS:
• Feed when the infant is showing signs of hunger rather than waiting
for the infant to start crying.
• Signs of hunger (hand to mouth, or hand to hand movements,
sucking motions, rooting, mouthing.
• SUCCESSFUL BREASTFEEDING:
• Get comfortable, wash hands before holding the breast and have
fluids to maintain hydration and allow let down
• Stimulation of the nipple releases oxytocin let down.
• Uterine cramps are normal during breastfeeding (they care cuased
during oxytocin).
• Show proper latch position (support the breast with one hand and
compress the breast, stimulate the infant by rubbing our nipple on
the baby's mouth, the mouth should cover the areola as well as the
nipple.
• Squeeze some colostrum and spread it over the nipple to lubricate
the nipple
NEWBORN CARE: NUTRITIONAL NEEDS
• Teach the mother to breastfeed for at least 15mins each breast
• Insert the finger in the mouth to break the suctioning from the nipple this prevents
nipple trauma.
• Burp between births.
• Start the next feeding with the breast that she stopped the infant with in the last
feeding.
• To make sure that the infant is receiving enough feeding the infant will gain weight,
void 6-8 times a day
• Loose pale, yellow stools are normal with breast feeding
• Place the baby in supine position after feeding
• STORAGE OF BREAST MILK:
• If the mother is using a breast pump store the milk in the fridge for up to 48hr after
being pumped.
• Throw away after 48hours
• Label the containers so you know the dates and time the milk was expressed.
• Can be stored in the freezer for up to 1 year.
• If kept in the freezer thaw the milk in the fridge for 24hours ( this preserves the
immunoglobulins.
• Do not thaw by microwave.
NEWBORN CARE: NUTRITIONAL NEEDS
• SUCCESSFUL BOTTLE FEEDING:
• Prepared formular can be kept in the fridge for 48hours
• Cradle the baby in a semi-upright position when holding the baby *
don’t feed the baby while in supine position this will cause
aspiration.
• The nipple of the bottle must be kept filled to prevent the newborn
from swallowing air if partially filled.
• Throw away any unused formula as it can cause bacterial
contamination
• FAILURE TO THRIVE
• This is slow weight gain
• The baby falls in the 5th percentile
• Evaluate the latch during breast feeding
• Massage the breast during feeding to encourage let down
• If the baby is formula feeding evaluate how much they feeding
• Vomiting a lot if they are bottle feeding may be a sign that they are
allergic to cow milk and they may need to be moved to soy milk.
POSTPARTUM: NEW BORN
COMPLICATIONS
CARE OF THE NEWBORN: COLD STRESS
PHYSIOLOGICAL CHANGES
POST PARTUM MATERNAL
COMPLICATIONS
POSTPARTUM PHYSIOLOGICAL
CHANGES
DIC
• DIC = DISSEMINATED INTRAVASCULAR COAGULATION is a clotting
disorder in which the clotting and anticlotting mechanism is
activated at the same time.
• Increased clotting consumes and destroys the amounts of clotting
factor (platelets, fribinogen, prothrombin and factors V & VII).
• The decrease in clotting factor external and Internal bleeding
formation of small clots in the microcirculation triggering vascular
occlusion of the small vessels ischemia.
• FIRST SIGN OF COAGGULATION PROBLEMS ?
• When the ways usually used to stimulate uterus contractions and
contractions fails to stop vaginal bleeding.
• COMPLICATIONS OF DIC ?
• Hemorrhage ; renal failure; organ ischemia tissue death
major organ failure.
DIC
• RISK FACTORS OF DIC ?
• Abruptio placenta
• Amniotic fluid embolism
• Missed abortion
• Fetal death in utero
• Septicimia
• Gestational hypertension
• SIGNS AND SYMPTOMS OF DIC ?
• Unusual spontaneous bleeding from the clients gums or nose
• Oozing or trickling of blood from the incision, lacerations and
episiotomy
• Hematuria, hematemesis or vaginal bleeding
• Presence of blood in stools.
• Increase in Pt and PTT, clotting time fibrinogen degeneration
products.
DIC
• NURSING INTERVENTIONS ?
• The focus should be on assessing for the
correction of the underlying cause (removal of
the dead fetus, treatment of infection,
preclampsia or removal of placenta abruption).
• Monitor vital signs and signs for shock
• Oxygen, volume replacement, blood component
therapy and possibly heparin.
• Monitor for signs of complications associated
with the fluid and blood replacement.
• Monitor urine output and maintain at 30ml/hr
(because renal failure is a complication of DIC).
CHP 34: POSTPARTUM PHYSICAL ADAPTATION
• POST PARTUM STAGE:
• 4th stage of labor.
• Starts after the delivery of the placenta to when the body returns to its
nonpregnant state.
• Usually takes about 6weeks
• The initial dangers are = hemorrhage, shock and infection.
• The body starts to satbilize the internal organs returning to the non-
pregnant state.
• Parent-infant bonding starts at this stage.
• POSTPARTUM ASSESSMENT IMMEDIATELY AFTER DELIVERY SHOULD
LOOK AT :
• Vital signs
• Uterus : firmness, location in relation to the umbilicus, uterus position in
relation to the midline of the abdomen and the amount of vaginal
bleeding.
• Cervix, vaginal and perineal healing
• Bladder functions
POSTPARTUM PHYSICAL ADAPTATION: FUNDUS
• WHAT IS INVOLUTION OF THE UTERUS ?
• Involution = decrease in the size of the uterus returning to its non
pregnant state.
• Immediately after breastfeeding the fundus is found midline at
approximately the level of the umbilicus. 12hours postpartum its 1cm
above the umbilicus
• Breast feeding stimulates the release of Oxytocin from the pituitary gland
which strengthens uterus contractions rapid involution. 8 encourage
early breast feeding
• the uterus decreases in weight from 2.2lbs to 2oz in 6weeks.
• The fundal height decreases about 1cm (1 finger breadth) per day.
• By day 10 the uterus is now within the true pelvis & cannot be palpated
abdominally.
• Tender fundus = infection
• Boggy (non firm uterus )= uterine atony massage till firm.
• NURSING INTERVENTION ?
• Document the consistency (firm or boggy), location & height of the fundus
• Give Pitocin or methergene to promote uterine contractions.
POSTPARTUM PHYSICAL ADAPTATION: LOCHIA
• WHAT IS LOCHIA ?
• Blood flow from the uterus during the postpartum stage
• Lochia is made up of ?
• Blood from the vessels of the placenta attachment site to the
uterus, debris from the exfoliation of the decidua (thickening
lining of uterine endometrium during pregnancy).
• ASSESSMENT OF LOCHIA ?
• Color, amount and consistency
• Usually trickles down but may gush down on
ambulation or massaging the uterus.
• SIGNS OF ABNORMAL LOCHIA ?
• Excessive spurting of bright red blood from the
vagina. Could be a sign of a tear.
• Numerous large clots
• Persistent lochia rubra beyond 3 days *this is a sign
that they are retained placenta fragments.
• Continued flow of lochia for more than the
expected days with a fever or abdominal
tenderness.
POSTPARTUM PHYSICAL ADAPTATION: LOCHIA
• URINARY TRACT:
• Urinary retention is the major issue due to the lack of
elasticity and tone and loss of sensation in the bladder
from trauma, meds, anesthesia,
• Diuresis usually starts within the first 12hours after
delivery.
• GI TRACT
• Hunger
• *constipation
• Hemorrhoids are common (tuck is the herb for
hemorrhoids).
• Eat high fiber diet
• Encourage ambulation
• Give stool softner.
POSTPARTUM: BONDING & INTERGRETING THE INFANT INTO THE
FAMILY
• FACTORS AFFECTING INFANT BONDING ?
• Mothers emotional and physical condition: unwanted
pregnancy, teen pregnancy, depression, difficult pregnancy and
delivery infants physical conditions.
• Separation of the mother and infant after birth due to
complications this delays the bonding process.
• Culture, age and socioeconomic status.
• Stage 2: reality = the expectations may be different from reality. May have
some sadness, jealousy of the infant, ambivalence, feeling of surprise at
the reward of parenting.