OB final 2

• calculate EDD


  Naegele's rule= LMP +7 days - 3 mo
• normal maternal weight gain

  23-25 lbs, 3 lbs first trimester, then 1 lb per week (weeks-9 rule)
• fundal height

  palpable after 12 weeks, at umbilicus 18-20 week, (=gestational age of 24-36 +/- 2 weeks)
• when can hear fht

  8-12 weeks
• quickening


  feeling baby move, occurs at 16-20 weeks
• recommended prenatal visits

  once monthly until 28 weeks, then every 2 weeks until 36 weeks, then weekly until delivery
• term


  37-42 weeks, deliver prior to 42 weeks
• every visit these tests are run

  urine, BP, wt, FHTs, fundal ht, assess for problems
• possible problems found at weekly appointments 


  bleeding, ROM, ctx, fetal mvmt, discomfort
• vaccines recommended in preg

  flu, TDAP, postpartum rubella (MMR)
• initial visit tests


  type and screen, tests for infection including, RPR, Rubella, Hep B, HIV, Gonorrhea, Chlamydia, and pap smear, first trimester dating ultrasound
• when is genetic screening

  1st and 2nd trimester
• every visit urine is tested- what for

  glucose, protein, and nitrites, negative is normal
• anatomy ultrasound

  20 weeks
• 28 week tests


  1 hr GTT, H/H, Rhogam given if needed
• 36 week test

  GBS
• drop in Hgb normal, normal range is 12-16 but may drop to 11 in second trimester and 10 in last trimester
• warning signs to report: regular preterm contractions, preterm bleeding, decreases fetal movement after 28 weeks, infection, persistent vomiting, leaking of fl, s/s of preeclampsia
• first stage of labor- onset of regular contractions to full dilation, laten phase is effacement of 0-6 cm, active phase is 6-10cm
• second stage of labor- full dilation to birth
• third stage of labor- birth of infant to delivery of placenta
• fourth stage of labor-delivery of placenta to two hours
• think backwards positioning! anterior is facing moms back and right is facing left

  
• lie= horizontal or vertical
• presentation= breech, cephalic, shoulder
• presenting part= part of fetus lying closest to internal os- part of body felt by examining finger (ex occiput, sacrum, scapula)
• fetal attitude= relation of fetal body parts to one another,
• position= presenting part in relation to quadrants of mother's pelvis (three letters, ex rom would be right occiput anterior
• station= relation of presenting part to ischial spine (backwards again- up is negative (bc its bad and we don't want it) and down is positive (bc thats where we want baby for delivery)
• engagement= when the largest transverse diameter of presenting part (usually at station 0)
• normal fhr= 110-160
• category I= baseline fhr of 110-160, baseline variability of moderate, no late or variable decels, early decels present or absent, accels present or absent
• category II- bradycardia without absent variability, tachycardia, minimal variability, absent variability without recurrent decels, marked variability, no accels, decels with minimal or moderate variability, prolonged decels (btwn 2-10 mins), late decels with moderate variability, variable decels with overshoots or shoulders
• category III- absent baseline variability, recurrent late decels, recurrent variable decels, bradycardia, sinusoidal pattern
• variability- irregular waves or fluctuations in baseline fhr of 2 cycles/min or greater, measures peak to trough of single cycle
• accels- abrupt increase in fhr above baseline, at least 15 beats/min above baseline
• decels may be benign or normal
• early decels- gradual decrease and return to baseline fhr, mirrors contractions
• late decels- begin after cxn has started decrease and return to baseline fhr
• variable decels- decrease is at least 15 beats/min below baseline, lasts at least 15 seconds, returns to baseline in less than 2 mins from time of onset