<16, >35

lower socioeconomic status

non white

<100 lbs or >200 lbs

< 5 ft

Smoker

Alcohol/Unprescriped Drugs

Previous birth of infant greater than 8.8 lbs

Previous fetal or neonatal death

RH sensitization

Multiparity

DM

Hypothyroidism

Hyperthyroidism

Cardiac Disease

Renal Disease

Concurrent Infections

Detect congenital anomalies

Evaluate condition of fetus

Determeine accurate gestational age

Maternal serum -- decreased levels associated with chromosomal anomalies and down syndrome

Amniotic fluid -- increased levels associated with neural tube defect, anencephaly, and spina bifida

To ID chromosomal or biochemical abnormalities

For pregnancy after 3 or more SAB

To evaluate fetal condition when woman is sensitized to RH positive blood

For maternal RH sensitization

To diagnose amnioitis for maternal age >35 years

For elevated levels of AFP when MSAFP is abbormal

For sex determination

To determine fetal lung maturity

Diagnose hemolytic disease

To check for presence of PG and PI that boose properties of lecithin

To evaluate fetal well-being by ascertaining the FHR during episodes of fetal movement; determines if fetus has an satisfactory 02 supply

Performed after 30 weeks

2 HR acceleraions -- up 15 BPM for 15 seconds (reactive)

Indicates possible fetal hypoxia

Nipple stimulation/Oxytocin to induce some contractions

Looking for no late decelerations

Gross fetal movement

Fetal breathing movements

Fetal tone (extension and flexion of extremities or sucking movements)

Amniotic fluid volume

8-10 reassuring

<4 nonreassuring

DM

PIH

heart disease

42 weeks gestation

hx of stillbirth

What are some highlights of EFM?

What does it measure?

Continuous/Intermittent

Allows total information and ID of subtle trends on how baby responds to labor

Noninvasive

Less accurate than internal monitors

Measures fetal HR, contractions, and baby movement

Membranes must be ruptured

Must be 2-3 cm dilated

Must know presenting part

Internal spiral electrode is screwed on to babies head and detects electrical signals from babies heart

What is the normal fetal heart rate range?

What is considered brachycardic?

What is considered tachycardic?

Normal: 110-160

Brady: <110 -- for at least 10 minutes

Tachy: >160 -- for at least 10 minutes

What is fetal heart rate variability?

What is the difference between short and long term variability?

Variability refers to variations in FHR that cause the strip to have an irregular, wavelike appearance rather than a smooth flat one

STV -- changes from one beat to the next

LTV -- apparent over 1 minutes intervals

Fetal movement

vaginal examination

uterine contraction

mild cord compression

breech presentation

Early decelerations are fetal head compression, which increased intracranial pressure, and causes the vagus nerve to slow the hr -- no intervention is required

Late decelerations imply an impaired exchange of O2 and waste products in the placenta, as well as uteroplacental insufficiency

Early -- beginning of the contraction, HR returns to baseline before contraction is over

Late -- don't begin until after contraction has begun

Variable -- nonperiodic, occuring at times unrelated to contractions

Baseline FHR stable 110-160 BPM

Moderate variability 6-25 BPM

Accelerations with fetal movement

Uterine activity (2 minute contraction frequency, duration of contraction should be between 90 and 120 seconds, uterus should reflex for at least 30 seconds between contractions)

Baseline FHR >160 for at least 10 minutes

Decreased or absent variability (can be caused by UPI, sleeping fetus, fetal hypoxia, and some medications administered to mom)

Late decelerations (can occur bc of mom's hypotension/hypertension, hyperactive uterus during labor, and UPI)

Variable decelerations (associated with prolapsed cord, cord around neck/fetal body parts, knot in the cord, cord compression)

Prolapsed cord

infections

abruptio placenta

Fetal HR for 1 minute

Document color, quantity, odor

Temp for 2 hours, report temp above 100.4

Ineffective pushing

Cardiac disease

Intrapartum infection

Prolapsed Cord

Placenta abruptio

Monitor HR

Observe for hypothermia

12 hours of cold compress

Look for facial symmatry

longrer lasting perineal pain than w/ spontaneous tear

increased blood loss

no guarentee that women will not tear

Advantages: minimal blood loss, neat healing w/ little scarring, less postpartum pain than mediolateral

Disadvantages: added laceration may extend to anal sphincter, limited enlargement of vaginal opening

Advantages: more enlargement of vaginal opening, little risk of extension of episiotomy

Disadvantages: more blood loss, increased post partum pain, more scarring and irregularity in healing, prolonged dyspareunia

Upright position while pushing

observe perineum for hematoma and edema

perineal cold applications for 12 hours, followed by intermittent perineal heat application if needed

Redness

Edema

Echymosis

Discharge, Drainage

Approximation

dystocia

cephalopelvic disproportion

materna diseases such as diabetes, hear disease, or cervical cancer

active genital herpes at time of birth

previous uterine surgical procedures, such as classical cesaraen incision

persistent non reassuring fetal heart rate pattern

prolapsed umbilical cord

fetal malpresentations, such as breech or transverse lie

hemorrhagic conditions, such as abruptio placenta or placenta previa

fetal death

fetus too immature to survive

maternal coagulation defects

infection

hemorrage

urinary tract trauma/infection

thrombophlebitis, thromboembolism

paralytic ileus

atelectasis

anesthesia complications

transient tachypnea of newborn caused by delayed absorbtion of lung fluid

persistent pulmonary hypertension of the newborn

injury, such as laceration, bruising, fractures, and other traumas

monitor fetus prior to delivery

clear anatacid to decrease respiratory secretions

NPO

lab studies -- CBC and blood typing

epidural block/spinal block/general anesthesia

emotional support -- remaining calm and confident

preoperative teaching about procedures

safety promotion

postoperative care

coordinated, but too weak to be effective

infrequent, brief, and can be easily indented with fingertip pressure at peak

usually occur during the active phase of labor, when progress normally quickens

maternal position change to favor fetal descent and promote effective contractions

amniotomy or oxytocin augmention may be used to stimulate labor (monitor HR for 1 minute)

provide emotional support

uncoordinated, erratic in their frequency, duration, and intensity

uterine resting tone is high, reducing uterine blood flow

occurs in latent phase of labor, before 4 cm

light sedation

side lying on left side

greater risk for fetal hypoxia

increased risk of dysfunctional labor because of uterine overdistension, which contributes to hypotonic dysfunction and abnormal presention of one or both fetuses

increased risk of postpartum hemorrhage as a result of uterine atony

abnormal fetal presentation

# of fetus

satisfactory pelvis

monitor each fetus HR separately, continue after 1st baby is born

staff prepared for care and resuscatation of each baby (cord clamp, bulb syringe, resuc equip)

one or more neonatal nurse and a neonatal nurse practitioner/ped/neonatologist should be available for each infant

check funal height/firmness/lochia/vitals

infection of vagina or cervix

amniotic sac with weak structure

chorioamniotitis

hydroamnios

fetal abnormalaties/presentation

incompetent cervix

overdistenstion of cervix

recent sexual intercourse

maternal nutrtional deficiencies

infection for fetus/mother

oligohydromnios may cause umbilical cord compression, reduced lung volume, and deformities restulting from compression

precipitous preterm birth

determine if membranes are truly ruptured -- fern test

if past 35 weeks, a favorable cervix indicates that induction may begin

with PPROM, fetal lung maturity may be asessed

avoid sexual intercourse, orgasm, or anything in the vagina

avoid breast stimulation if gestation is preterm

monitor temp, report anything over 100.4

maintain activity restriction

note and report any uterine contractions

uterine contractions that may or may not be painful

sensation that baby is "balling up"

cramps similiar to menstrual cramps

constant low backache, intermittent or irregular mild low back pain

sensation or pelvic pressure or a feeling that baby is pushing down

pain, discomfort, pressure in vulva or thighs

abdominal cramps w/ or w/o diarrhea

sense of feeling bad

gestation from 20 weeks to before 37 weeks

persistant uterine contractions (4 in 20 minutes or 8 in 60 minutes) and

documented cervical change or

cervical effacement of 80% or

cervical dilation of greater than 1 cm

determine if any contraindication for stopping labor (i.e. preeclampsia, hypovolemia, serious infection, inability to correct nonreassuring fetal heart tones)

treat any infection

restrict activity

hydrate women

tocolytics

accelerate fetal lung maturity

teach women signs

help change risk factors

help improve diet (WIC)

report signs/symptoms to care provider

moniter heart tones

cord that slips down after ROM b/t the fetus and pelvis

interrupts blood flow to fetus, worst during contraction

poor fit b/t fetal presenting part and mother's pelvis

fetus remains at high station

very small fetus

breech presentation

transverse lie

hydroamnios

complete: cord visible at vaginal opening

partial: not visible, but palpable on vaginal examanation

occult: cord slips alongside fetal head and shoulders, and is not visible or palpable

relieve pressure on cord to restore blood flow

woman should be placed with her hips higher than her head to shift fetal presenting part toward diaphragm

if position change does not relieve compression, vaginal elevation of presenting part using a sterile glove hand may be required (maintained until delivery)

02 at 8-10L/min

tocolytic drugs may be ordered to slow contractions

warm saline moistened towel over cord

emotional support

decreased placental perfusion

PROM/preterm labor/spon abortion

early or low birth weight

correlation with SIDS

increased spontaneous abortion

fetal alcohol syndrome

withdrawel after 48-72 hours

severity depends on last dose of drug

uncoordinated suck and swallow

evidence in baby urine specimen/meconium

What is mastisis?

When does it usually occur?

infection in lactating breast

2nd 3rd week after life

engorgement and stasis milk

pain, redness, inflammation, malaise, fever, chills

can lead to breast abcess

analegesics/antibiotics

moist heat

good latch

frequent breastfeeding

frequent changing of nursing pads

avoid continous pressure

breast should be emptied completely

antipsychotic meds

constant assessment

hospitilization

history of depression

sleep disturbances

confusion

agitation

irritability

hallucianations

delusions

tearfulness

guilt/worthlessness

hyper: uterine distension, sedation in early labor, CPD, multiple pregnancy

hypo: same

hyper: occur q 2 minutes, lasting more than 90 seconds, sever intensity

hypo: irregular, painless, poor intensity

hyper: none

hypo: slow or arrest of

hyper: latern

hypo: active

hyper: early fetal distress, excessive moulding, caput succedaneum, cephalohemotoma

hypo: late fetal distress, neonatal sepsis

hyper: exhausted, dehydrated

hypo: intrauterine infection, risk of prolonged labor, PROM, uterine atony, PP hemorrhage

hyper: rest and sedation, rehydration, possible C/S

hypo: r/o cause, ROM, IV oxytocin, possible C/S