OB Lecture Notes

OB Lecture Series

Fall Semester 2009

Alison Harding OB Lecture Series ‘09 Block 3, SCC Nursing Program T (623) 234.0472 E [email protected]

Student Nurse SCCNUR 251

Prep 211 ry

Nutrition:hiatlequate maternal intake — fetal deprivation&ads to treterrn, stilik—n, congenital birth dcfccIs

Daily requirements:

Ca:bs/Grans: 6 servinusldayDairy: 4 servings/dayFnirts: 2/day le deep yellow FOLIC ACID also V1TVegetables: 3/day deep green FOLIC ACIDWeight Cain:2s-35 lbs10-13 lbs %Or

1 lb per wk aller thatFelus: 11 lbsUterus: 2 ibsBlood volume: 4 lbsBreast tissue: 3 lbsMama] stores: 5-10 lbs Moms gaint"1•') 'HI 4,c '§

Lwa 1

Eating disorders:PICA abnormal craving ror Min l'uud substancebICE CUBESAAA iron to dietAnemia issuesOTC Medleatiolis:ONLY PRENATAL VITAMINSSmoking:BadGrowth retardationIVCrR! inta-uteri no growth retardationNc calcitic; de.crezes binh wtFolic Acid:Increase RBQ;Lots of 02 on RBCs good for fetils's brainReduces r:sk of Neural Tube Detects

Pregnancy Hormones:Estrogen:"—lutes uterine deycloprocni tD provide environment for fowl growtaPrepares breast for lactationEICC Owned Chorionic Gonaciotropiu:Urine pregnancy lost e,I'L hormone)Stimulatc3 progesterone/estrogen pruluction to ma;Lutain the pregritine:yHIPL Hillan n Pincental 1.911: WWI] :

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OB Lecture: Pregnancy

Psycholoocal Changes:First trimester (1-12 w ks)Acceptance NCLEXAnn ouneementAmbivalenceSecond trimester (13-24 wks)DifferentiationFetal embodimentVisualization ulaasoundMom feels the baby move the quickening (16-20 wks) NCLEXAcueptine, the baby is realThird trimester (25-40 wla)Preparfng for parenthoodMom is self absorbed with the babySeparation of babyConcerned with sage deliveryChildbirth educationNesting:Baying clothe, baby's mane, baby's roomCouvade: NCLEXWhen date; experience sympathetic preEnancy symptomsWt gains, mom sick pop sick

Signs of Pregnancy: NCLEXPresumptive (subjective):Findirgs reported by the mother that sugges:s present of a pregnancyExamples: atrenorrhea, niv, fatigue, breast changes, quickening (16-20 wks)Probable (objective):Pelvischange

Si4s-rt

_Rra u pet n Effr,A)0,1,c)145

Heger s sign, 5 0144 n W•• t,trika

Goodell's sign,Cv.,Ja Yi /,ʻ

Chadmick's sign, .0 tt.0 k co lo rT ttAto LLJChangs in pigmentation, .;POSA ti VC pregnancy testPod live (diagnostic):Three things ONLY1_ iletai heart teniz: 110-1602. Fetal mow:Amin that HCP can feel 20-24 wks3. 'Ultrasound visual S-6wks vaginal (brain and heart beats Ilwks)Don't have o Subject Title for This:1' trimester discomfort:

07- --:

Breast Chancy,:Fullness I tingling !endemessl darkened areola / prominent blue veins secretion ofcologrum by len wk

5k-in A

c,2 30 '''''

•••

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releasc of imulirlFrees fatty acids available for maternal metabolic useAlso decrease maternal metabolism of glucoseProgesterone;Maintains thn endontetimim and inhibib uterine contractionsHormone of pregnancy lactationPrevents abortionsItc built;Ittl""ts uterine contractionsisoftens colvixMaternal serum from time of 1 missed menses

Adaptations to Pregnancy:PhysiolOgic ChangegPsychological Chasges

Physiologic Changes;

Cardiovascular Sygtera:Physiologic anemia plasma vultulie increme 50%-70/0 decrease in heTriatoerit

Vona cava syndrome:',Items crimps/presses vemi, cavaDecreases blood flow to right atriaNI:Do not put moms on her bnek KNOWPia mom on her left side (light side is ok)Hypercoagalation;Blood vut increasus 45%,RBCs increase 1 H% - 304?/0

Cardiac output increases 3040%Heart rate inereasmMom's bpin increase 10-15Blood pressure changes:Uterus presses on pelvisPostural IFIN14090 max no hiGher

Respiratory System:1%4 asopharyn geal edema:The hormone estrogen = nasal stuffinessShortness of breath

Renal System;GlyeosuriS:Raises plasma glucose levels far above normalKidneys can't reabsorb all the glucoseviolet mom fur gestational diabetes

NCLEX

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G !omen' lar filtration rate (CFR):Urinary frequency;tJtorms pressc,-s on tile bladdel — a lot of pee. I trinicstel

trimesler relieved by uterus moving into abdnrninal areaTti -Reappears in the 3 trimester

Endocrine System:Thyroid gland;Enlarged due to iracrcase in nictaL')oliu rateParathyroid:Slight enlargement allows for better use of calcium and vitamin])Pancreas: NCLEX

Pituitary gland:Increase secretions of Prolactin to prepare breas:s for lactation

D r.sw,r1 A ...bi-:wpm. em rim cob awn n

trIA 1,11,4,1A jaLt..m•Uterus:

Palpable by iterease of size by I 211' wk of gestation

LA, re • NCI.EX

Flaby'b 'mud t!usucitila imp pclvib (2 wks bcfbic birth)Hewer's Sign! NCLEX61h 8Ih mks softening of lower uterine segment

'TV-Ien the area boAreen the cervix and •uterus softensAn I Idjc4..v.L cot-catty plcgiluticyItmxton Hicks Con tractinn NCI ,EXFalse laborContractions don't elcser together.Contractions don't get stronger_Contractions don11 last longerair •n•••r;•••

•••-•1•1 T

Coodelt's Sign:Effacement: Thinning of the cervix.Significant softening of the cervixDue to the inc.-mod blood now to II Ie vaginal aL-eaMucus Plug:Barrier to protect baby from Lnfection (estrogen',

NCLEX

NCLEK

%•• •El meA. a4161.1 la2 •

Chadwick's Sign: NCI.EXA Iuish, purplish discoloration of the cervix, vagina and vulva caused by venous

congestionIliercast: in vaginal discliarAc:

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't thy of last oitnLivai pcliod

Subtract 3 monthsAdd 7 daysExample:11/7/07 go back Oct, Sept, Aug, add 7 days - Aug. 14, 07Don't forget to change the year if necessaryObstetrical History:Gravida = # of times pregnantParity = A of infants delivered > 20 wksFPAL or TPA L:

full term = 38 wks and upP - pi-comics up to uompleted 37 wks or >20 wks abortion

A = Ahcntinn <M wksL - livingMultiple births count as 1 gavidaMedical DX Pat Medical DX;SurgeriesChromosomal abnormalitiesPrior inkctionsS'iDsGYNLast Pap smear normal or abnormalFollow up prenatal visits NCLEXEvery 4 wks until 28 wksEven, 2 wks until 36 wks

Every wk until deli very

Laboratory Screening:Initial I a haRiff i WBCBlood type and Cross R1-1RubellaVSRL SyphilisGC: Gonorrhea, ChlamydiaMSAFP: blood, otwal tube defeuLs (SP)lf tesulls are low Downs SyndromeDiabetes screen: neirqive if BSL <: 140Genetic Screening

TORCH:Toxoplasmosis:Protozoal in leetion horn undercooked meats or cat feces/litterOther Infections;111WhenatitisIGBS/SvphillisNarieellaRubellaCytomegalovims 1:CMV):Mental retardation

KNOW

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Nil! (stops by 2'1 trimester)'Breast tendernessSaliva big time2" and 3rd trimetter discomfort:

HeartburnAnkle edemaVaricose veinsHemorrhoidsConstipationBackacheLeg cramps (drink a quart of milk a day)SOBDifficaltv sleeping

Warning Signs or Pregnancy:Report these 1 m mcdiatcly1. Bleeding: bright rtalAbruptio placentae! EmergencyThe premature separation of the placenta from the uterusPlaceutne L'mergeneyA condition in -which the placental tissue lies abnormally close to the internal cervical es

11. Decreased fetal movementsBaby Inows everyday3. Headache4. Edcma of bind. and face5. VisJal changes3,45 and 5 all are indicative or pregnancy induced HTN

Et.niM. 1.1111

7. Symptoms of infection;Fever > 104ITTChest or abdominal pathPersiKent vomiting

Prenatal Screenings:..11AL Lel. idsa cum d 1 gappy...1, yv not 1,p0Trii evy yi3111.

Wt,Fundus ht (rd and 3rd trimester),

Fetal heint tunes.,I irillP dipstiel (ellic.oge and prctiein)EdemaGestational age:

D.I.

Baby's expected date of birth / liDC. or EDD

KNOW THESE NCLEX

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ITerrAs Simplex:If active out break at birth then C-Section

Diagnostic Tests:Ultrasound;Confirms preptanoy and geslational ageCvS - Chorio rt lc ViIlus Sampling (10-12 weeks)Chorionie villas sampling is a diagnostic tos: for identifying oltf(Pulosolne abnormalitiesand ot'ler inherited di3ordersUsually not done

Determines fetal karvoty-pe (detection of chromosomal anet.ploidy, especially Trisomy

21)Sickle cellPKIJikinnicceritcsis:ASSCSS US ratio normar iN 2:1 this is for lung maturity (1,—Longs) NCLEX

MSA FP:Maternal serum alpha feta protein spinal bifidaPUBS:

Percutaneous Umbilical Blood SamplingEPP — Biophysical Profile (3rd tri)Fetal breathing movement, teial movemeat, fetal tone (extension & flexion), amnioticfluid volume, non stross test that has lo be loactivePlacenta last only 40 licksNST:Nos Stress Tegt NCLENFetal RR, fetal movement, monitors 2 intervals 2•) inaluts each & has to have - in fetalHR >15 B PM sustained for at least 15, seconds (2 or mon accelerations per interval)

7:40trnal is :10-160

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THEORIES ON THE ONSET OF LABOR

PELVIS

CHILDBIRTH

increase in es-trogen vs. 1, decrease in progesterone

thinning and stretching of cervix to get ready forincrease in prostaglandins4eauscs smooth musok contractility and is a potentvasodilator.

uterine distension-)causes cervical pressure, irritability and contractibility due tohormonal role in action4, decrease in relazin3causes mom's intravertebral joints relax

preparing lungs to breath

In order for labor co start, we need hormones! Labor starts from balancing of hormones.

Passage4 this is maternal pelvis and soft tissue that baby must pass through, goingthrough the birth canal.

pelvis: this is -what you want, regLitur vabinal Nal; pelvic ialct iin upptx

border, a mid pelvis, und the pelvic 0.tite., an o FilICI r baby to cnme through

Fake Leivis; you do not want this, as be baby cannot deliver, re(iuires C-section.Directs the presenting part into the true pelvis. False pelvis is the part above thebrim and docs not aid in childbirth

Poweit+ these are the contractions;• primary powers are involuntary uterine contractions, responsible for effacement

and dilation of the cervix and descent of the fetus• secondary powers are voluntary bearing down efforts (diaphragm and abdominal

muscles)Passenger-) baby and how the baby is rmitioned; refers to the fetus.Psych-> ail about the mom and what she goes through.

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OB Lecture: Delivery

Pelvis Types: The type of pelvis influence the fetal descent into pelvis, progression oflabor and the type of labor to expect. *I* Look these up***

Android Pe1vi54 Heart shaped pelvis. Most men have this shape, but if mom has this, shewould most likely need a C-Section, use of forceps or vacuum ex-indicaGynocold Pelvis (50%) the elassie female pelvis, resulting in very cominwn and nonralvaghlat detiveriegwtth more found shape,

Platypellold Pelvis (3i) 4 a Rai oval shaped pelvis (less common)

Anthropoid (20%) 4 resembles the pelvis ofantbropoidape3 (less common)

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OB Lecture: Infant

o Simian Creases in the palm or hand indicates Down Syndrome (occasionally seenin normal neonates)

o Syndactyly: webbed fingers or toeso Polydactyly: extra digits or exlra fingers

Ortolani's Maneuver - method ol. essessine tor hip dysplasia or dislocation - audibleclunk ol click is sometimes heard or felt. If hip dysplairia is present, head of Ctail Lli canbe felt to slip 1I)LVLLU in inxtubultun f.hp Nockf,i) alai ilip back when pressure is

rele;Ised Erna ieLmnre renirned to the F r originni poqition NCT t"-j3- SKIN - softismoothiwarm to touch

O Lanugo: fine downy hair; oremies have this hair growth

o Mongolian Spots - hregalar area ofdeep pigmenta7ion, bluish-black areas of pigmentationmost commonly notes on back and buttoAs of dark skin ethnicity peopk ( irrieao,Mediterranean, Latin American or Asian).

o Erythmema Toxicun - "newborn rash" reddish rasho Acrocyanosis - bluish-purplish skin discoloration

Stork Dile -Telangleetie Nevi - fiat deep pink or red

c Port Wine Stain - pale red to deep purple, strawberry mark - capillary hemangloma,may remain ontil 5-6 years Or longer

C- yanosts - blue or dusky appearance of skin (extremely emergent sign)Jaundice - yellow skin discoloration due to ineffective liver functionin

11. Prophylactic Meds administration and Screening -given to all babies within I hoar after

birth:n Ikel injection of vitamin K (thigh)O Erythromycin ointmot

E) 01.11,xpsu 5c1 VCiling , is alit IOU nal reading cOr 1310t Id glucose- done 30 -60 minutes afterbirth if diabetic mom, prrin h I re baby or has had signs of asphyxia.

Reflexes Provides an indirect evaluation of cranial nerve function:o Rooting_ turning race from side to side to find breast

c; Coughingo Sneezmg- GaggingL..; 'Ionic Neck - normal reaction, site bead is turned to, arms and ,egs will extend and other arm is

flexedMoro/startle:infant annuctairctendel arms anti lingers fanned out, makes a "C" shape withthumb and forefi ugee - NCI ,EX Qo Prirnative reflexes:• Paimar Grasp - NCLEX- Plantar Grasp• Stepping

0 Babinski: toes open when foot is stroked

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OB Lecture: Infant

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OB Lecture Notes