summary

• Genetic Disorders:

  • Mendelian Inheritance: homozygous dominant vs. homozygous recessive
  • Autosomal Dominant: 50% chance of child being affected by the condition
  • Autosomal Recessive: child inherits one copy of a mutated gene from each parent
• Who should go for genetic counselling:

  • Couples with a child with a congenital disorder or inborn error of metabolism
  • Couples with close relatives who have a child with a genetic disorder
  • Individuals with an inborn error of metabolism or chromosomal disorder
  • Consanguineous (closely related) couples
  • Women older than 35 years and men older than 55 years
• Genetic Disorder Assessment Risks:

  • Maternal serum screening
  • Chorionic villi sampling
  • Amniocentesis
  • Percutaneous umbilical blood sampling
• Anti-violence against women and their children Act of 2004:

  • Defines acts by an intimate partner against a woman
  • Types of abuse: physical, sexual, psychological, economic
  • Protection Orders: Barangay, Temporary, Permanent
• High-Risk Pregnancy Factors:

  • Lower economic level
  • Age below 18 and above 35 years old
  • Alcohol dependence
  • BMI of 17.8
• Abortion / Miscarriage Types:

  • Threatened
  • Inevitable
  • Habitual abortion
• Abruptio Placenta:

  • Sudden onset of vaginal bleeding and severe abdominal pain
  • Management: prepare for emergency CS
• Placenta Previa:

  • Painless, bright red vaginal bleeding
  • Immediate management: Determine fetal heart sounds using an external monitor
• Precipitate Labor:

  • Expected birth within approximately 3 hours
  • Signs: back-to-back contractions, complete effacement, 9 cm dilation, fetal head showing
• Gestational Trophoblastic Disease (H-mole):

  • Signs: dark brown vaginal discharge, grape-like vesicles, nausea, vomiting
  • Risk factors: low protein intake, Asian, above 35 years old
• Ectopic Pregnancy:

  • Sudden, stabbing pain in lower quadrant radiating to the shoulder
  • Most common site: fallopian tube
• Preterm Labor Management:

  • Betamethasone for fetal lung maturity
  • Management for no rupture of membranes, mild cramping, no bleeding, reassuring fetal heart monitor pattern, 3 cm dilated cervix, 30% effacement: admission to hospital, bed rest, tocolytic agent
• Rh Isoimmunization:

  • Management: Rho(D) immune globulin at 28 weeks' gestation
• Cardiac Disease in Pregnancy:

  • Symptoms: cough, FHT of 100 bpm, pedal edema
  • New York State Heart Association Heart Disease Classification: Class I to IV
• Classes of heart disease in pregnancy:

  • Class I (mild) - normal pregnancy and birth
  • Class III (markedly compromised) - shortness of breath and easy fatigue, can complete pregnancy with almost complete bed rest
  • Class IV (severely compromised) - poor candidates for pregnancy due to cardiac failure even at rest, usually advised to avoid pregnancy
• Left-sided heart failure symptoms include pulmonary congestion, changes in respiration, profound shortness of breath, and a cough that produces blood-speckled sputum
• Peripartum cardiomyopathy: symptoms include shortness of breath, chest pain, edema, and heart enlargement, occurring a few weeks before the birth of the first child
• Management of gestational hypertension, pre-eclampsia, and eclampsia:

  • Report decreased fetal movement to the doctor immediately
  • Headache and blurred vision indicate worsening pre-eclampsia
  • During eclampsia, avoid placing the patient in a supine position during a seizure
• Management of PROM (Premature Rupture of the Membrane):

  • Immediately position the mother in Trendelenburg (hips higher than the head) if indicated
  • Cloudy amniotic fluid with a strong odor indicates a potential infection
• Risk factors for gestational diabetes:

  • Above 35 years old
  • Multigravida
  • Family history of Type 2 diabetes
  • BMI 25 and above
  • The nurse prepares to rescreen the patient at 24 to 28 weeks
• Intrapartal complications:

  • Dystocia can be related to difficulties with the 4 Ps: Power, Passenger, Passage, Placenta
  • Shoulder Dystocia management includes the McRoberts Maneuver and checking the infant's clavicle after delivery
• Postpartum complications:

  • Nursing priority for heavy bleeding is to assess the woman's fundus
  • Uterine Atony and Endometritis are common causes of postpartum hemorrhage
• Psychological Changes/Adaptation after birth:

  • Taking In phase: passive dependent, need to talk about labor and birth experience, focused on own needs
  • Taking-Hold phase: more independent, ready to care for self and newborn, displays maternal role behaviors
  • Letting-Go phase: establishes a new identity, focuses on the family unit