maternity

• Determining the estimated date of delivery

  Take first day of last menstrual period (LMP), add 7 days and subtract 3 months
• Weight gained during pregnancy

  • 1st trimester (12 weeks): 1 lb per month = Total of 3 lbs
  • 2nd and 3rd trimesters: Add 1 lb every week
  • Ideal weight gained during pregnancy: 28 lbs, plus or minus 3 (between 25 to 31 lbs)
• Alternative method for ideal weight gained during pregnancy

  Take the number of weeks gestation minus 9
• A woman is in her 28th week gestation and gained 22 lbs

  She has 3 lbs extra than her ideal weight
• A pregnant woman at 31 weeks gestation gained 15 lbs

  She has 7 lbs less than the ideal
• Fundal height

  Cannot be palpated until week 12, when the fundus is midway between the umbilicus and the pubic symphysis. The fundus can be palpated at the umbilicus between 20 and 22 weeks
• Significance of being able to palpate fundal height

  • The examiner should be able to determine in what trimester the pregnancy is, and it has diagnostic significance as a much bigger than normal fundus may indicate molar pregnancy
• Positive Signs of Pregnancy

  • Fetal skeleton on x-ray
  • Presence of fetus on ultrasound
  • Auscultation of fetal heart (Doppler)
  • Examiner palpates fetal movement (outline)
• Ranges of Values

  • Fetal Heart: 8 weeks (earliest), 10 weeks (midway), 12 weeks (latest)
  • Quickening (baby Qicks): 16 weeks (earliest), 18 weeks (midway), 20 weeks (latest)
• Maybe Signs of Pregnancy

  • Positive urine/blood hCG tests
  • Chadwick sign—cervical color change to cyanosis
  • Goodell sign—softening of the cervix
  • Hegar sign—softening of lower uterine segment
• Chadwick, Goodell, and Hegar signs move up from the vulva, vagina, cervix to the uterus in alphabetical order
• Patient Teaching for Prenatal Visit

  1. Once a Month until week 28

  2. Every other week between 28 and 36

  3. Once a week after week 36 until delivery or week 42, whichever comes first
• If a woman comes in for her 12th week prenatal checkup

  Her next prenatal visit is at 16 weeks
• Hemoglobin (Hb) level during pregnancy

  1st Trimester: Can fall to 11 and be perfectly normal

  2nd Trimester: Can fall to 10.5 and be perfectly normal

  3rd Trimester: Can fall to 10 and be perfectly normal

  If Hb <9, anemia evaluation
• Morning sickness

  Usually seen during the 1st trimester, treated with dry carbohydrates before getting out of bed
• Urinary incontinence

  Seen in the 1st and 3rd trimesters, patient needs to void every 2 hours from the day she gets pregnant until 6 weeks postpartum
• Difficulty breathing


  A problem during the 2nd and 3rd trimesters, advise patient to assume the tripod position
• Back pain

  Seen during the 2nd and 3rd trimester, advise pelvic tilt exercises

  
• Truest most valid sign of labor


  Onset of regular/progressive contractions
• To Know


  • Dilation: Opening cervix from 0 to 10 cm

  Effacement: Thinning of the cervix from thick to 100% thin

  Station: Relation between fetal presenting part and mother's ischial spines

  Engagement: Station zero, presenting part at ischial spines
• Lie

  Relationship between the spine of the mother and spine of the baby. Vertical lie is compatible with vaginal birth, transverse lie is trouble and requires C-section
• Most common presentation


  ROA (right occiput anterior) or LOA (left occiput anterior)
• Stages of Labor


  • Stage 1 - Onset of Labor (Latent, Active, Transition)

  Stage 2 - Delivery of Baby

  Stage 3 - Delivery of Placenta

  Stage 4 - Recovery (2 hours until bleeding stops)
• A pregnant woman comes in to L&D, 5 cm dilated, with contractions 5 minutes apart, lasting 45 seconds


  She is in the ACTIVE phase of Stage 1 labor
• Active (Phase 2) of Stage 1 labor

  Contractions: 3 to 5 minutes apart, lasting 30 to 60 seconds
• The purpose of uterine contractions in each stage of labor:
• Priorities in each stage of labor:

  Stage 2: Pain management

  Stage 2: Clearing baby's airway

  Stage 3: Checking cervical dilation, Helping pregnant mother with breathing and pain management

  Stage 3: Assess the placenta for smoothness and intactness, and for 3-vessel umbilical cord present

  
• Uterine contraction parameters


  No longer than 90 seconds and no closer than 2 minutes
• Painful Back Pain (OP)


  Position - Push, use knee-chest position and push with fist into sacrum for counter pressure
• Prolapsed Cord


  Push head off the cord of fetus and position mother to knee-chest, prep for C-section
• Interventions for other complications


  LION - Left side, IV, Oxygen, Notify HCP. Stop Pitocin first if running.
• When to administer systemic pain medication


  Do not administer if the baby is likely to be born when the medication peaks