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Nursing lectures is proud to share with you a comprehensive review about the Intrapartal period. Included in this lecture are the following
1. A. Admitting the laboring Mother: Personal Data: name, age,
address, etc Baseline Data: v/s especially
BP, weight2. Obstetrical Data: gravida #
preg, para- viable preg, – 22 – 24 wks
Physical Exams,Pelvic Exams3. B. Basic knowledge in Intrapartum .4. A. Theories of the Onset of Labor
o 1.) uterine stretch theoryo -( any hollow organ when stretched,
will always contract & expel its content).
o – contraction action.5.o 2.) Oxytocin Theoryo – post pit gland releases oxytocin.
Hypothalamus produces oxytocin6.
o 3.) Prostaglandin Theoryo – stimulation of arachidonic acid.o – prostaglandin- contraction7.o 4.) progesterone theoryo – before labor, decrease progesterone
will stimulate contractions & labor.8.o 5.) Theory of Aging placentao – life span of placenta 42 wks. At 36
wks degenerates (leading to contraction – onset labor).
9. B. The 4 P’s of laboro Passengero a. Fetal heado – is the largest presenting parto – common presenting parto ¼ of its length.
10.11.o Bones – 6 boneso S–sphenoidF –frontal –sinciputo E–ethmoid O–occipital–occiputo T–temporal P– parietal 2 x
12. Measurement fetal head:o transverse diameter – 9.25cmo biparietal – 9.5cm
o largest transverseo bitemporal 8 cm13.o Sutureso – intermembranous spaces that allow
molding.14. 1.Sagittal Suture – connects 2 parietal bones .
15.o 2.Coronal sutureo – connects parietal & frontal bone
(crown).16. 3.Lambdoidal suture – connects occipital & parietal
bone.17.o Moldings: the overlapping of the
sutures of the skull to permit passage of the head to the pelvis
18.19. Fontanels:
o 1.Anterior fontanelo – bregma, diamond shape, 3 x 4 cm,
( > 5 cm – hydrocephalus), 12 – 18 months after birth- close.
20.o 2.Posterior fontanel or lambdao – triangular shape, 1 x 1 cm. Closes – 2
– 3 months.21.o 4. Anteroposterior diametero - suboccipitobregmatic 9.5 cm,
complete flexion, smallest AP22.o occipitofrontal 12cm partial flexiono occipitomental – 13.5 cm hyper
extension submentobregmatic-face presentation
23.24. 2. Passageway
o Momo 1.) <>o 2.) <>o 3.) Underwent pelvic dislocation
25. Pelvis26. 4 Main Pelvic Types
o Gynecoido – round, wide, deeper most suitable
(normal female pelvis) for pregnancy.27.
28.o 2. Android
o – heart shape “male pelvis”- anterior part pointed, posterior part shallow.
29.30.o 3. Anthropoido – oval, ape like pelvis, oval shape, AP
diameter wider transverse narrow31.
32.o 4. Plattypelloido – flat AP diameter – narrow, transverse
– wider33.34.
35.o 2 hip bones –2 innominate bones
36.37. 3 Parts of 2 Innominate Bones
38.o Ileumo – lateral side of hipso -iliac cresto – flaring superior border forming
prominence of hips.39.o Ischiumo – inferior portion
o - ischial tuberosity where we sito – landmark to get external
measurement of pelvis40.o Pubeso – ant portion – symphysis pubis
junction between 2 pubes41.o 1 sacrumo – post portion – sacral prominence –
landmark to get internal measurement of pelvis
o 1 coccyxo – 5 small bones compresses during
vaginal delivery42. Important Measurements
43.o Diagonal Conjugateo – measure between sacral promontory
and inferior margin of the symphysis pubis.
44.45.o Measurement: 11.5 cm - 12.5 cmo - basis in getting true conjugate. (DC –
11.5 cm=true conjugate)46.
o 2. True conjugate/conjugate verao – measure between the anterior
surface of the sacral promontory and superior margin of the symphysis pubis. Measurement: 11.0 cm.
47.o 3. Obstetrical conjugateo – smallest AP diameter. Pelvis at 10 cm
or more.48.o Tuberoischi Diametero – transverse diameter of the pelvic
outlet. Ischial tuberosity – approximated with use of fist – 8 cm & above.
49.50. 3. Power
o – the force acting to expel the fetus and placenta – myometrium – powers of labor.
51. 4. Psyche/Persono – psychological stress when the
mother is fighting the labor experience.
52.o Cultural Interpretationo b. Preparation
o c. Past Experienceo d. Support System
53. Pre-eminent Signs of Labor54. S&Sx
o 1.Lighteningo – setting of presenting part into pelvic
brim - 2 weeks prior to EDDo -shooting pain radiating to the legso -urinary freq.55.o 2.* Engagement- setting of presenting
part into pelvic inleto 3.Braxton Hicks Contractionso – painless irregular contractions.56.o 4. Increase Activity of the Mothero 5. Ripening of the Cervixo – butter soft.57.o 6. Decreased body wto – 1.5 – 3 lbso 7. Bloody Showo – pinkish vaginal discharge – blood &
leukorrhea58.
59.o 8. Rupture of Membranes
o – rupture of water.60.o Premature Rupture of Membrane
( PROM)o check for cord prolapse.61.o Contraction drops in intensity even
though very painfulo Contraction drops in frequentlyo Uterus is tensed and/or contracting
between contractions62. Nursing Care
63.o Administer Analgesicso Attempt manual rotation for ROP or
LOPo Bear down with contractions64.o Adequate hydration – prepare for CSo Sedation as orderedo Cesarean delivery may be required,
especially if fetal distress is noted65.o Cord Prolapseo – a complication when the umbilical
cord falls or is washed through the cervix into the vagina
66. Danger signso PROMo Presenting part has not yet engagedo Fetal distresso Protruding cord form vagina
67. Nursing care68.o Cover cord with sterile gauze with
saline to prevent drying of cord so cord will remain slippery & prevent cord compression causing cerebral palsy
69.o Slip cord away from presenting parto Count pulsation of cord for FHTo Prep mom for CS70.o Positioning – trendelenberg or knee
chest positiono Emotional support71.o Difference Between True Labor and
False Labor72.o False Laboro Irregular contractionso No increase in intensityo confined to abdomen
o relived by walkingo No cervical changes73.o True Labor Contractions
are regular Increased intensity Pain – begins lower back
radiates to abdomen Pain – intensified by walking Cervical effacement & dilatation
* major sx of true labor.74.75.76. Duration of Labor
o Primiparao – 14 hrs & not more than 20 hrso Multiparao – 8 hrs & not > 14 hrs77.o Effacement – softening & thinning of
cervix. Use % in unit of measuremento Dilation – widening of cervix. Unit used
is cm78. Nursing Interventions in Each Stage of
Labor79.o First Stage
o onset of true contractions to full dilation and effacement of cervix.
80. Latent Phaseo Assessment:o a. Dilationso 0 – 3 cm
81. Frequency
o every 5 – 10 min Intensity mild.82. Nursing Care
1.Encourage walking 2.Encourage to void q 2 – 3 hrs
o 3.Breathing – chest breathing83. Active Phase
o Assessment:o Dilations 4 -8 cmo Intensity: moderateo Mom- fears losing control of self84.o Frequencyo q 3-5 min lasting for 30 – 60 seconds.
85. Nursing Care86.o M –edicationso – have meds readyo A –ssessment
o include: vital signs, cervical dilation and effacement, fetal monitor, etc.
87.o D – dry lipso – oral care (ointment)o dry linens.o B – abdominal breathing
88. Transitional Phaseo Assessment :o Dilationso - 8 – 10 cmo Frequencyo -q 2-3 min contractions89.o Durationso -45 – 90 secondso Intensityo -strongo Mom – mood changes90.o Hyperesthesiao – increase sensitivity to touch, pain all
over.91. Health Teaching
o teach: sacral pressure on lower backo keep informed of the progresso controlled chest breathing
92. Nursing Care T – ires I – nform of progress R – estless support her
breathing technique E – ncourage and praise D – iscomfort
93. Pelvic Examso Effacemento Dilation94.o Stationo – landmark used: ischial spine.95.o - 1 station = presenting part 1cm
above ischial spine if (-) floatingo -2 station = presenting part 2 cm
above ischial spine if (-) floating96.o 0 station = level at ischial spine –
engagemento + 1 station = below 1 cm ischial spineo +3 to +5 = crowning – occurs at 2nd
stage of labor97.
98.o Presentation/lie
o – the relationship of the long axis (spine) of the fetus to the long axis of the mother.
o -spine of mom and spine of fetus.99. Two types
o Longitudinal Lie ( Parallel)o cephalic:
Vertex – complete flexion
o Faceo Browo Chin100.o Breech :
a. Complete Breech – thigh breast on abdomen,
breast lie on thigh101. Incomplete Breech – thigh rest on abdominal
102.o Frank – legs extend to heado Footling – single, double
103.104.
o 2. Transverse Lie (Perpendicular) or Perpendicular lie. Shoulder presentation
105.o c. Positiono – relationship of the fatal presenting
part to specific quadrant of the mother’s pelvis.
106. Varietyo Occipito – LOA left occipito ant (most
common and favorable position)– side of maternal pelvis
o LOP – left occipito posterior107.o LOP – most common mal position,
most painfulo ROP – squatting pos on momo ROTo ROA
108.109.110.111.112.113.114.115.
116.o *Breecho - use sacrumo - put stethoscope above umbilicuso LSA – left sacro anterioro LST, LSP, RSA, RST, RSPo *Shoulder/acromniodorsoo LADA, LADT, LADP, RADA117.o Chin / Mentoo LMA, LMT, LMP, RMP, RMA, RMT, RMP
118. Monitoring the Contractions and Fetal heart Tone
o Spread fingers lightly over fundus – to monitor contractions
119.120. Parts of contractions
o Increment or crescendoo – beginning of contractions until it
increases.o Acme or apexo – height of contraction.121.o Decrement or decrescendo – from
height of contractions until it decreases
o Duration – beginning of contractions to end of same contraction
o Interval – end of 1 contraction to beginning of next contraction
122.o Frequency – beginning of 1 contraction
to beginning of next contractiono Intensity - strength of contraction123.o Contraction – vasoconstrictiono Increase BP, decrease FHTo Best time to get BP & FHT just after a
contraction or midway of contractions124.o Duration of contractions shouldn’t >60
seco Notify MD
125.126.o 5. Fetal Heart Patternso a. Early Decelerations – head
compressiono 1. begins early in contractiono 2. ominouso 3. continue monitoring127.
o b. Late decelerations – uteroplacental insufficiency
o 1. begins late in contractiono 2. ominouso 3. turn mother to the left lateral
recumbento 4. administer oxygeno 5. d/c oxytocin128.o c. Variable decelerations – umbilical
cord compressiono 1. not related to contractionso 2. not ominous, but requires
interventionso 3. change maternal positiono 4. administer oxygeno 5. assess for prolapsed cord129.o Mom has headache – check BP, if same
BP, let mom rest. If BP increases , notify MD -preeclampsia
130. Health teachingso 1.) Ok to showero 2.)NPO – GIT stops function during
labor if with food- will cause aspiration131.o 3.)Enema administer during labor
o a.) To cleanse bowelo b.) Prevent infectiono c.) Sims position/side lyingo 12 – 18 inch – ht enema tubing.132.o Check FHT after adm enemao Normal FHT= 120-160
133. Signs of fetal distresso 1.) <120>160o 2.) meconium stained- amniotic fluido 3.) fetal thrashing – hyperactive fetus
due to lack O2134.o 2. Second Stageo - fetal stage, complete dilation and
effacement to birth135.o 7 – 8 multi – bring to delivery room.o 10cm primi – bring to delivery roomo Lithotomy pos – put legs at the same
time136.o Bulging of perineumo – sure to come outo Breathingo – panting ( teach mom)137.
o Assist doc in doing episiotomy138.o Episiotomyo – median – less bleeding, less pain
easy to repair, fast to heal, possible to reach rectum (urethroanal fistula).
139.140.
141.o Mediolateralo – more bleeding & pain, hard to repair,
slow to healo -use local or pudendal anesthesia.142.o Modified Ritgens maneuvero – place towel at perineum
1.)To prevent laceration143.o 2.) Will facilitate complete flexion &
extension. (Support head & remove secretion, check cord if coiled. Pull shoulder down & up. Check time, identification of baby.
144. Mechanisms of labor Engagement Descent Flexion
Internal Rotation Extension External rotation Expulsion
145. Parts of Pelviso 1. Inleto – AP diameter narrow, transverse
diameter widero 2. Cavity
146. Two Major Divisions of Pelviso True pelviso – below the pelvic inleto False pelviso – above the pelvic inlet; supports
uterus during pregnancy.147.
148.o Linea Terminaliso -diagonal imaginary line from the
sacrum to the symphysis pubis that divides the false and true pelvis.
149. Nursing Care:o To prevent puerperal sepsiso - <>o Bolus of Pitocin can lead to
hypotension.150.
o Third Stageo Birth to expulsion of Placentao -placental stage placenta has 15 – 28
cotyledons. Placenta delivered from 3-10 minutes.
151. Signs of placental separationo 1.Fundus rises – becomes firm &
globular “ Calkins sign ”o 2.Lengthening of the cordo 3.Sudden gush of blood
152. Types of placental delivery153.
154.o a. Shultze “shiny”o – begins to separate from center to
edges presenting the fetal side shiny155.o b. Duncan “dirty”o – begin to separate form edges to
center presenting natural side – beefy red or dirty.
156.o Slowly pull cord and wind to clamp.o – BRANDT ANDREWS MANEUVER.
157. Nursing care for placenta Check completeness of placenta. Check fundus
Check bp158. Administer methergine IM
(Methylergonovine Maleate) “Ergotrate derivatives
Monitor hpn (or give oxytocin IV) Check perineum for lacerations159. Assist MD for episiorrhapy Flat on bed Chills-due dehydration. Blanket,
give clear liquid-tea, ginger ale, clear gelatin. Let mom sleep to regain energy.
160.o Fourth Stageo -the first 1-2 hours after delivery of
placenta.o – recovery stage. Monitor v/s q 15 for 1
hr. 2nd hr q 30 minutes.o Check placement of fundus at level of
umbilicus.161. If fundus above umbilicus, deviation of
funduso Empty bladder to prevent uterine
atonyo Check lochia
o a.Maternal Observations – body system stabilizes
162.o b. Placement of the Funduso c. Lochia163.o Fully soaked pad : 30 – 40 cc weigh
pad. 1 gram=1cc164.o d.Perineumo R - ednesso E- demao E – cchymosiso D – ischargeso A – approximation of blood loss. Count
pad & saturation165.o Fully soaked pad : 30 – 40 cc weigh
pad. 1 gram=1cc166.o e. Bonding – interaction between
mother and newborn – rooming in types
o 1.Straight rooming in baby: 24hrs with mom.
o 2.Partial rooming in: baby in morning , at night nursery.
167.168.169. Complications of Labor
170.o Dystociao – difficult labor related to:o Mechanical factoro – due to uterine inertiao – sluggishness of contraction171.o 1.hypertonic or primary uterine inertia
Intense excessive contractions resulting to ineffective pushing
172.o Interventions with Hypertonic
Dysfunctiono Short-acting barbiturateso IV fluidso If CPD – c/s.o Provide emotional support.o Provide comfort measures.o Prevent infectiono Prepare patient for c/s if needed.173.o 2. hypotonic secondary uterine inertia
Slow irregular contraction resulting to ineffective pushing.
Give oxytocin.174.o Management:
Amniotomy (artificial ROM). Oxytocin augmentation of labor. If CPD, prepare for c/s. Emotional support, comfort
measures, prevent infection.175. Normal length of Labor
o Primi 14 – 20 hrso Multi 10 -14 hrs
176. Prolonged Laboro > 14 hrs in multi &o > 20 hrs in primio Maternal effect – exhaustion.o Fetal effect – fetal distress, caput
succedaneum or cephalhematoma177. Precipitate Labor
o Labor of <>o extensive lacerations, profuse
bleeding, hypovolemic shock if with bleeding.
178.o Outstanding Nursing dx: fluid volume
deficito IV: fast drip due to fluid volume def
179. Signs of Hypovolemic Shock:
o Hypotensiono Tachycardiao Tachypneao Cold clammy skin
180. Inversion of the uteruso Situation: uterus is inside out.
181. Factors leading to inversion of uterus short cord hurrying of placental delivery ineffective fundal pressure
182. Uterine Ruptureo Causes:
1.)Previous classical CS 2.)Large baby 3.) Improper use of oxytocin (IV
drip)183. Uterine Rupture
o Sx: Sudden pain Profuse bleeding Hypovolemic shock TAHBSO
184. Physiologic retraction ringo Boundary bet upper/lower uterine
segmento BANDL’S pathologic ring – suprapubic
depression
185. Amniotic Fluid Embolism or Placental Embolism
o Amniotic fluid or fragments of placenta enters natural circulation resulting to embolism
186. Amniotic Fluid Embolism or Placental Embolism
o Sx:o dyspnea, chest pain & frothy sputum
187. Trial Laboro Measurement of head & pelvis falls on
borderline.o Mom given 6 hrs of laboro Multi: 8 – 14, primi 14 – 20
188. Preterm Laboro Labor Abortion: <20>
189. Preterm Laboro Sx:
1. premature contractions q 10 min 2. effacement of 60 – 80% 3. dilation of 2-3 cm
190. Preterm Laboro Home Mgt:
1. complete bed rest 2. avoid sex 3. empty bladder 4. drink 3 -4 glasses of water
5. consult MD if symptoms persist191. Preterm Labor
o Hosp:o 1. If cervix is closed
dilation is saved by administering Tocolytic agents
halts preterm contractions. Ritodrine HCl (Yutopar)
150mg incorporated 500cc Dextrose piggyback.
Terbutaline (Brethine)192. Preterm Labor
o steroid dexamethazone (betamethazone)If cervix is open : MD
o Preterm: Cut cord ASAP193. Postpartal Period : 5th stage of labor
o After 24hrs: Normal increase WBC up to 30,000 mm3
o covers 1st 6 wks post partumPuerperium
o Hyperfibrinogenemiao prone to thrombus formationo early ambulation
194. Principles underlying PUERPERIUMo To return to Normal and Facilitate
healingo Systemic changes
195. Cardiovascular Systemo The first few minutes after delivery is
the most critical period in mothers196. Genital tract
o a. Cervix – cervical openingo b. Vaginal and Pelvic Flooro c. Uterus – return to normal 6 – 8 wks.
197. Genital tracto Birth pain:o 1. position proneo 2. cold compress – to prevent bleedingo 3. mefenamic acid
198. Genital tracto bld, wbc, deciduas, microorganism.
NsdLochia & Cs with lochia.o red 1st 3 days present, musty/mousy,
moderate amt1. Rubra o pink to brown 4 – 9th day, limited
amt2. Serosa o créme white 10 – 21 days very
decreased amt3. Alba 199. Genital tract
o Dysuriao - urine collectiono - alternate warm & cold compresso - stimulate bladder
200. Urinary tract
o Freq in urination after deliveryo Urinary retention with overflow
201. Colono Constipation due to:
NPO Fear of bearing down
202. Perineal Areao Painful – episiotomy siteo when perineum has healedSex
203. Provide Emotional Support – Reva Rubin
o Psychological Responses:o Taking in phaseo Taking hold phaseo Letting go
204. Taking hold phaseo Dependent to independent phase (4 to
7 days).o active, can make decisionsMom
205. Letting go phaseo Interdependent phase – 7 days &
above.206. Complication: HEMORRHAGE
o Bleeding of > 500cco CS – 600 – 800 cc normalo NSD 500 cc
207. Early postpartum hemorrhage
o Bleeding within 1st 24 hrs.208. Early postpartum hemorrhage
o Complications :o Hypovolemic shock.
209. Early postpartum hemorrhageo Breast feeding – post pit gland will
release oxytocin so uterus will contract.
o Well contracted uterus + bleeding = laceration
210.211. LACERATION
o 1st degree laceration – affects vaginal skin & mucus membrane.
o 2nd degree – 1st degree + muscles of vagina
o 3rd degree – 2nd degree + external sphincter of rectum
o 4th degree – 3rd degree + mucus membrane of rectum
212.213. DIC
o failure to coagulate.Disseminated Intravascular Coagulopathy. Hypofibrinogen
214. Late Postpartum hemorrhage
o retained placental fragmentsBleeding after 24 hrs
215. Late Postpartum hemorrhageo Accretao Incretao Percretao Hematoma
216. Late Postpartum hemorrhageo too much manipulationo large babyo pudendal anesthesia
217. Infectiono Sources of infectiono 1.) endogenouso 2.) exogenouso Anaerobic streptococci
218. Infectiono General signs of inflammation:
Inflammation – calor (heat), rubor (red), dolor (pain) tumor(swelling)
Purulent discharges Fever
219. INFECTIONo Gen mgt:o supportive careo inflammation of perineum
o 2 to 3 stitches dislocated with purulent discharge
220. INFECTIONo Mgt:
Removal of sutures & drainage, saline, between & resulting.
Endometriosis – inflammation of endometrial lining
221. INFECTIONo Sx:
Abdominal tenderness,222.223. Family Planning
o determine one’s own beliefs 1sto never advise a permanent method of
planningo method of choice is an individual’s
choice.224. Family Planning
o Natural Method – the only method accepted by the Catholic Church
o Billings / Cervical mucus – test spinnbarkeit & ferning (estrogen)
o clear, watery, stretchable, elastic – long spinnbarkeit
225.
o Basal Body Temperature 13th day temp goes down before ovulation – no sex
o get before arising in bed226.227. Family Planning
o LAM – lactation amenorrhea method – hormone that inhibits ovulation is prolactin.
228. Family Planningo Symptothermal – combination of BBT &
cervical. Best methodo Social Method – 1.) coitus interruptus/
withdrawal - least effective methodo coitus reservatus – sex without
ejaculation –o calendar method
229. OVULATIONo count minus 14 days before next mens
(14 days before next mens)o Origoknause formula – monitor cycle
for 1 yearo get shortest & longest cycle from Jan –
Deco shortest – 18o longest – 11
230. OVULATION
o June 26 Dec 33o - 18 - 11o 8 - 22 unsafe dayso 21 day pill- start 5th day of menso 28day pill- start 1st day of menso missed 1 pill – take 2 next day
231. Pillso Combined oral contraceptives prevent
ovulation by inhibiting the anterior pituitary gland production of FSH and LH which are essential for the maturation and rupture of a follicle.
o 99.9% effective.232. OCP Alert
o If a new oral contraceptive is prescribed the mother should continue taking the previously prescribed contraceptive and begin taking the new one on the first day of the next menses.
233. Pillso Signs of hypertensiono Immediate Discontinuationo A – abdominal pain C – chest pain H -
headache E – eye problemso S – severe leg crampso If mom HPN – stop pills STAT!
o Adverse effect: breakthrough bleeding234. Pills
o If forgotten for one day , immediately take the forgotten tablet plus the tablet scheduled that day.
o If forgotten for two consecutive days , or more days, use another method for the rest of the cycle and the start again.
235. DMPAo Depoprovera – has progesterone
inhibits LH – inhibits ovulationo Depomedroxy progesterone acetate –
IM q 3 monthso Never massage injected site, it will
shorten duration236. DMPA
o Norplant – has 6 match sticks – like capsules implanted subdermally containing progesterone.
237. Mechanism and Chemical Barrierso IUDo Condomo Diaphragmo Cervical capo Foams, Jellies, Creams
238. Intrauterine Device (IUD)
o Action: prevents implantation – affects motility of sperm & ovum
o right time to insert is after delivery or during menstruation
o primary indication for use of IUDo parity or # of children, if 1 kid only
don’t use IUD239.240. Intrauterine Device (IUD)
o ALERTS:o prevents implantationo most common complications:
excessive menstrual flow and expulsion of the device (common problem)
241. Intrauterine Device (IUD)o OTHERS:o P eriod late (pregnancy suspected)o Abnormal spotting or bleedingo A bdominal pain or pain with
intercourseo I nfection (abnormal vaginal discharge)o N ot feeling well, fever, chillso S trings lost, shorter or longero Uterine inflammation, uterine
perforation,ectopic pregnancy242. CONDOM
o – latex inserted to erected penis or lubricated vagina
o Adv: gives highest protection against STD – female condom
o Alerts:243.244.245. Diaphragm
o – rubberized dome shaped material inserted to cervix preventing sperm to get to the uterus. REVERSIBLE
o S/effect: Toxic shock syndromeo Alerts: Should be kept in place for
about 6 – 8 hours246.247.248. Cervical Cap
o – more durable than diaphragm no need to apply spermicide
o C/I: abnormal pap smearo Foams, Jellies, Creams
249. Surgical Methodo BTL , Bilateral Tubal Ligation – can be
reversed 20% chance. HT: avoid lifting heavy objects
o Vasectomy – cut vas deferens.o HT: >30 ejaculations before safe sex
o O – zero sperm count , safe250.o High Risk Pregnancy
251. Hemorrhagic Disorderso General Managemento CBRo Avoid sexo Assess for bleeding (per pad 30 – 40cc)
(wt – 1gm =1cc)252.o Ultrasound to determine integrity of
saco Signs of Hypovolemic shocko Save discharges – for histopathology
253. First Trimester Bleedingo Abortiono Ectopic pregnancy
254. Abortiono – termination of pregnancy before age
of viability (before 20 weeks)o Spontaneous Abortion- miscarriageo Causes:o 1.) chromosomal alterationso 2.) blighted ovumo 3.) plasma germ defect
255. Classifications:o Threatened
o Inevitableo Completeo Incompleteo Habitualo Missedo Induced Abortion
256. Threatenedo – pregnancy is jeopardized by bleeding
and cramping but the cervix is closed257. Inevitable
o Moderate bleeding, cramping, tissue protrudes form the cervix (Cervical dilation)
258. Complete – all products of conception are expelled. No mgt just emotional support! Incomplete – Placental and membranes retained. Mgt: D&C
259. Habitualo 3 or more consecutive pregnancies
result in abortion usually related to incompetent cervix.
o Present: 2nd trimester260. Missed
o fetus dies ; product of conception remain in uterus 4 weeks or longer; signs of pregnancy ceases; (-) preg test; scanty dark brown bleeding
o Mgt: induced labor with oxytocin or vacuum extraction
261. Induced Abortiono – Therapeutic abortion to save life of
mom.262. Ectopic Pregnancy
o – occurs when gestation is located outside the uterine cavity.
o Common site: tubal or ampularo Dangerous site - interstitial
263.264. Unruptured
o missed periodo abdominal pain within 3 -5 weeks of
missed period (maybe generalized or one sided)
o scant, dark brown, vaginal bleeding265.o Nursing care:o Vital signso Administer IV fluidso Monitor for vaginal bleedingo Monitor I & O
266. Tubal ruptureo sudden , sharp, severe pain . Unilateral
radiating to shoulder.o + Cullen’s Sign
o syncope (fainting)267.o Mgt:o Surgery depending on sideo Ovary: oophorectomyo Uterus : hysterectomy
268. Second trimester bleedingo Hydatidiform Moleo Gestational anomaly of the placenta
consisting of a bunch of clear vesicles.269. Second trimester bleeding
o Hydatidiform Moleo This neoplasm is formed from the
selling of the chronic villi and lost nucleus of the fertilized egg.
o The nucleus of the sperm duplicates, producing a diploid number 46 XX, it grows & enlarges the uterus vary rapidly.
270.271. Hydatidiform
o Use: methotrexate to prevent choriocarcinoma
272. Hydatidiformo Early in pregnancy
High levels of HCG Preeclampsia at about 12 weeks
o Late signs: hypertension before 20th week Vesicles look like a “ snowstorm”
on sonogram Anemia Abdominal cramping
273. Hydatidiformo Nursing care:
Prepare D&C Do not give oxytoxic drugs
274.o 2 . Incompetent Cervix – cervical
dilation without uterine contractionso Assessment:
1. Hx of previous abortions 2. Cervical dilatation/effacement 3. Membrane present in cervical os
o Interventions 1. bedrest 2. cervical cerclage
275.276.o McDonalds procedure – temporary
cerclage on cervixo S/E: infection. During delivery,
cerclage is removed. NSD
o Sheridan – permanent surgery cervix. CS
277.o Third Trimester Bleeding “Placenta
Anomalies”278. Placenta Previa
o Abnormal lower implantation of placenta .
o Candidate for CSo Sx:
Bright red Painless bleeding
279.280. Placenta Previa
o Dx:o Ultrasoundo Avoid: sex, IE, enema – may lead to
sudden fetal blood losso Double set up: delivery room may be
converted to OR281. Placenta Previa
o Assessment:o Engagement (usually has not
occurred)o Fetal distresso Presentation ( usually abnormal)
o Surgeon – in charge of sign consent, RN as witness
o MD explain to patient282. Placenta Previa
o Nursing Careo NPOo Bed resto Prepare to induce labor if cervix is ripeo Administer IV
283.284. Abruptio Placenta
o Outstanding Sx: dark red, painful bleeding , board like or rigid uterus.
285. Abruptio Placentao Assessment:o Concealed bleedingo Couvelaire uterus (caused by bleeding
into the myometrium) Dropping coagulation factor (a potential for DIC)
286. Abruptio Placentao Complications:o Sudden fetal blood losso Placenta previa & vasa previa
287. Abruptio Placentao Nursing Care:o Infuse IV, prepare to administer bloodo Type and crossmatch
o Monitor FHRo Insert Foley catho Measure blood loss; count padso Report s/sx of DICo Monitor v/s for shocko Strict I&O288.o Placenta succenturiatao Placenta Circumvallatao Placenta Marginatao Battledore Placenta289.o Placenta Bipartitao Velamentous Insertion of cordo Vasa Previa
290. Hypertensive Disorderso I. Pregnancy Induced Hypertension
(PIH )291. Pregnancy Induced Hypertension (PIH )
o HPN after 20 wks of pregnancy, solved 6 weeks post partum.
o Gestational hypertension - HPN without edema & proteinuria
o Pre-eclampsia – HPN with edema & protenuria or albuminuria HE P/A
o HELLP syndrome – hemolysis with elevated liver enzymes & low platelet count
292. Chronic or pre-existing Hypertensiono – HPN before 20 weeks not solved 6
weeks post partum.293. Three types of pre-eclampsia
o Mild preeclampsia – earliest sign of preeclampsia
o a.) increase wt due to edemao b.) BP 140/90o c.) proteinuria +1 - +2
294. Three types of pre-eclampsiao Severe preeclampsiao Signs present: cerebral and visual
disturbances, epigastric pain and oliguria
o BP 160/110o Proteinuria +3 - +4
295. Three types of pre-eclampsiao Eclampsia – with seizure!o Increase BUN – glomerular damage.o Provide safety.
296. Cause of preeclampsiao Idiopathic or unknown common in
primio Common in multiple pregnancy (twins)
o Common to mom with low socioeconomic status
297. Nursing care: PPPEACEo P – romote bed resto P – prevent convulsions by nursing
measures or seizure precaution298. Nursing care: PPPEACE
o turning to side is done AFTER seizure! Observe only!
o E – ensure high protein intake ( 1g/kg/day)
Na – in moderationo A – anti-hypertensive drug Hydralazine
(Apresoline)299. Nursing care: PPPEACE
o C – convulsion, prevent! – give Mg So4 – CNS depressant
o E – evaluate physical parameters for Magnesium sulfate
300.o DIABETES MELLITUS
301. Diabetes Mellituso Absence of insulin (Islet of Langerhans
of pancreas)o is an endocrine disorder in which the
PANCREAS cannot produce adequate insulin to regulate body glucose levels
302.o Classifications of Diabetes Mellitus
( American Diabetes Association)o Type 1 Insulin-dependent DMo Type 2 Non-insulin- dependent DMo Gestational Diabeteso Impaired Glucose Homeostasis -A state
between normal and diabeteso
303.o Dx: 1 hr 50gr glucose tolerance test
GTTo 80 – 120 mg/dl;Normal glucose o <>o > hyperglycemia120 o 3 degrees GTT of > 130 mg/dL304.o 3 hour oral glucose tolerance testo 100 g oral glucose solutiono fasting 95mg/dLo 1 hour 180mg/dLo 2 hour 155mg/dLo 3 hour 140mg/dL
305. Diabetes Mellituso Maternal effect DMo Hypo or hyperglycemiao Frequent infection
o Polyhydramnioso Dystocia306.o Hyperglycemia- fatigue , flushed hot
skin, dry mouth, excessive thirst, frequent urination, rapid deep respirations, fruity odor, depressed reflexes, drowsiness, headache
307.o Hypoglycemia-o shakiness, dizziness, sweating, pallor,
cold clammy skin, disorientation, irritability, headache, hunger, blurred vision, nervousness, weakness, fatigue, shallow respirations, normal PR
308. Diabetes Mellituso Insulin requirement: decrease in
insulin by 33% in 1st tri; 50% increase insulin at 2nd – 3rd trimester.
o Post partum decrease 25%309. Fetal effect: DM
o hyper & hypoglycemiao macrosomia – large gestational age –
baby delivered > 4000g or 4kgo preterm birth to prevent stillbirth
310. Newborn Effect : DM
o hyperinsulinismo hypoglycemiao hypoglycemic <>o Heel stick test – get blood at heel
311. Newborn Effect : DMo Hypoglycemia: high pitch shrill cry
tremors, administer dextroseo Hypocalcemia - <>
Calcemia tetany Trousseau sign Give calcium gluconate if decrease
calcium312.o HEART DISEASE
313.314. Heart disease
o Class I – no limit to physical activityo Class II – slight limitation of activity.
315. Heart diseaseo Class III - moderate limitation of
physical activity.o Class IV - marked limitation of physical
activity.316. Recommendation
o Therapeutic abortiono If push through with pregnancy
Antibiotic therapy
Anticoagulant317. Recommendation
o Class I & II- good progress for vaginal delivery
o Class III & IV- poor prognosis, for vaginal delivery, not CS!
318.o RH INCOMPATIBILITY
(ISOIMMUNIZATION)o Occurs when an Rh-negative mother
(one negative for a D antigen or one with a dd genotype) is CARRYING A FETUS WITH AN Rh-positive blood type (DD or Dd genotype).
319.o Subsequent exposure to Rh-positive
blood can cause a serious reaction that results in agglutination and hemolysis of red blood cells
o * A fetus can become so deficient in red blood cells that sufficient O2 transport to the body cannot be maintained=HEMOLYTIC DISEASE OF THE NEWBORN or ERYHTROBLASTOSIS FETALIS
320.o CAUSES:
o 1. SEPARATION OF PLACENTAo 2. AMNIOCENTESISo 3. PERCUTANEOUS UMBILICAL BLOOD
SAMPLING321.
322.o ANTIBODY SCREENING TEST (indirect
Coomb’s test) -done on the mother’s blood to
measure the number of Rh-positive antibodies
323.o DIRECT COOMBS’ TEST
-done on the infant’s blood to detect antibody-coated Rh-positive RBC’s
324.325. ASSISTED BIRTH
326.o Cesarean Deliveryo Indications:o Multiple gestationo Diabeteso Active genital herpes IIo Severe toxemiao Complete Placenta previao Abruptio placenta
o Prolapse of the cord327.o UTERINE INCISIONSo a. kerro b. sellheim- vertical incision in the
lower uterine segmento c. classic
328.329.o FORCEPS DELIVERYo 3 Categorieso Outlet forcepso Low forcepso midforcepso
330.331.o INDICATIONS:o Heart dseo Pulmonary edemao Infectiono Exhaustiono Premature placental separationo Fetal nonreassuring status332.o Conditions before forceps delivery:
Cervical dilatation is complete
Membranes must be ruptured Type of pelvis should be known Maternal bladder should be empty
and adequate anesthesia given No degree of CPD can be present
333.o VACUUM- ASSISTED BIRTHo used to facilitate the birth of a fetus by
applying suction to the fetal heado Composed of soft suction cup attached
to a suction bottle (pump) by tubingo Suction cup is placed against the fetal
occiput.334.335.336. INFERTILITY
o Inability to achieve pregnancy. Within a year of attempting it
o Manageable337.o In order to get pregnant:o 1. A woman must release an egg from
one of her ovaries (ovulation).o 2. The egg must go through a fallopian
tube toward the uterus (womb).o 3. A man's sperm must join with
(fertilize) the egg along the way.
o 4. The fertilized egg must attach to the inside of the uterus (implantation).
338.o Is infertility a common problem?339.o Is infertility just a woman's problem?
340. NO
341.o What causes infertility in men?342.o Infertility in men is most often caused
by:o problems making sperm -o problems with the sperm's ability to
reach the egg and fertilize ito Sometimes a man is born with the
problems that affect his sperm. Other times problems start later in life due to illness or injury.
343.o What increases a man's risk of
infertility?o The number and quality of a man's
sperm can be affected by his overall health and lifestyle.
344.
o What causes infertility in women?345.o Problems with ovulation account for
most cases of infertility in women. Without ovulation, there are no eggs to be fertilized.
346.o Less common causes of fertility
problems in women include:o blocked fallopian tubes physical
problems with the uteruso uterine fibroids347.o What things increase a woman's risk of
infertility?o Many things can affect a woman's
ability to have a baby. These include: 1.age 2.stress 3.poor diet 4.athletic training
348.o How long should women try to get
pregnant before calling their doctors?349.o Some health issues also increase the
risk of fertility problems. So women
with the following issues should speak to their doctors as soon as possible :
o irregular periods or no menstrual periods
o very painful periodso endometriosiso pelvic inflammatory diseaseo more than one miscarriage350.o How will doctors find out if a woman
and her partner have fertility problems?
351.o For a woman, the first step in testing is
to find out if she is ovulating each month.
352.o Some common tests of fertility in
women include :o Hysterosalpingography : In this test,
doctors use x-rays to check for physical problems of the uterus and fallopian tubes.
353.o Laparoscopy:
o During this surgery doctors use a tool called a laparoscope to see inside the abdomen.
354.o How do doctors treat infertility?o Infertility can be treated with
medicine, surgery, artificial insemination or assisted reproductive technology.
355.o Doctors often treat infertility in men in
the following ways:o Sexual problems: Behavioral therapy
and/or medicines can be used in these cases.
o Too few sperm:, doctors can surgically remove sperm from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
356.o Intrauterine insemination (IUI) - is
known by most people as artificial insemination.
IUI is often used to treat:o mild male factor infertility
o women who have problems with their cervical mucus
o couples with unexplained infertility357.o What medicines are used to treat
infertility in women?358.o Some common medicines used to treat
infertility in women include:o 1.Clomiphene citrate ( Clomid ): This
medicine causes ovulation by acting on the pituitary gland.
o 2.Human menopausal gonadotropin or hMG ( Repronex, Pergonal ): This medicine is often used for women who don't ovulate due to problems with their pituitary gland.
359.o 3.Follicle-stimulating hormone or FSH (
Gonal-F, Follistim ): FSH works much like hMG..
o 4.Gonadotropin-releasing hormone (Gn-RH) analog : These medicines are often used for women who don't ovulate regularly each month.
360.
o 5. Metformin ( Glucophage ): Doctors use this medicine for women who have insulin resistance and/or Polycystic Ovarian Syndrome (PCOS) . This drug helps lower the high levels of male hormones in women with these conditions.
o 6. Bromocriptine ( Parlodel ): This medicine is used for women with ovulation problems due to high levels of prolactin.
361.o Many fertility drugs increase a
woman's chance of having twins, triplets or other multiples.
362.o What is assisted reproductive
technology (ART)?o Assisted reproductive technology
(ART) is a term that describes several different methods used to help infertile couples.
363.o How often is assisted reproductive
technology (ART) successful?o age of the partnerso reason for infertility
o clinico type of ARTo if the egg is fresh or frozeno if the embryo is fresh or frozen364.o What are the different types of
assisted reproductive technology (ART)?
365.o Common methods of ART include:o 1. In vitro fertilization (IVF) . Once
mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.
366.o 2. Zygote intrafallopian transfer (ZIFT)
or Tubal Embryo Transfer - Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
367.o 3.Gamete intrafallopian transfer (GIFT)
involves transferring eggs and sperm into the woman's fallopian tube.
368.o 4. Intracytoplasmic sperm injection
(ICSI)o In ICSI, a single sperm is injected into a
mature egg. Then the embryo is transferred to the uterus or fallopian tube.
369.370.371.372. 2 types of infertility
o 1.) primaryo 2.) Secondaryo Sims Huhner test
373. Infertilityo Normal: cervical mucus must be
stretchable 8 – 10 cmo Best criteria- sperm motility for
impotency374. Infertility
o Mgt:o GIFT= Gamete Intra Fallopian Transfer
for low sperm count375.o Mom: anovulation – no ovulationo hyperprolactinemia376.
o Tubal Occlusion – tubal blockageo = dx: hysterosalphingographyo Mgt: IVF – invitrofertilization
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