Maternity and Newborn Care Quiz

• Contraception method considerations: safety, STD protection, effectiveness, acceptability, convenience, education, benefits, side effects, spontaneity, availability, expense, preference, religion, culture, other considerations, and informed consent.

Adolescent and Contraception

• Adolescent knowledge involves misinformation and risk-taking behaviors.
• Counseling adolescents requires sensitivity, respect for secrecy, and understandable terminology.

Perimenopausal Women

• These women may ovulate as long as they have menstrual periods.
• Fertility declines for women between 35-40 years of age.
• Pregnancy after 50 is uncommon.
• Women over 35 with cardiac risk factors should avoid combined hormonal contraceptives.
• Sterilization of the fallopian tubes is a common contraceptive choice for women over 30.

Methods of Contraception

• Available methods include: sterilization, tubal sterilization (ligation), vasectomy, hormonal contraceptives, hormone implants/injections, and oral/emergency contraceptives.
• Other methods include: transdermal patches/ vaginal rings, intrauterine devices (IUDs), barrier methods (chemical/mechanical), and natural family planning.
• Chemical barriers involve creams and gels.
• Mechanical barriers include male/female condoms and sponges/diaphragms/cervical caps.
• Natural family planning includes calendar/rhythm, standard days, mucus/two-day, symptothermal methods, and abstinence.
• Breastfeeding and coitus interruptus are the least reliable contraception methods.

Signs of Ovulation

• As ovulation nears, cervical mucus increases in abundance, becomes clear, slippery, and smooth.
• Spinnbarkeit describes the elasticity of cervical mucus, referring to "egg white stretchiness."
• A slight drop in basal body temperature occurs 1-2 days before ovulation.
• Temperature rises 1-2 days after ovulation (0.5-1 degree) and remains high until the next menses.
• Before ovulation, the average temperature is 97-97.5; afterward, it rises to 97.6-98.6.

Cautions for Oral Contraceptives

• Women with a history of thrombophlebitis, thromboembolic, cerebrovascular, cardiovascular disorders, estrogen-dependent cancer, breast cancer, liver tumors, or migraines with aura should avoid combined oral contraceptives.
• Women over 35 with migraines with aura should also avoid them.
• Oral contraceptives are unsafe for women with diabetes longer than 20 years, impaired liver function, suspected/undiagnosed pregnancy, undiagnosed vaginal bleeding, older than 35 years and smoke, or require major surgery requiring prolonged mobilization.

Client Education: Oral Contraceptives

• Take the pill whole at the same time each day.
• Take a missed pill as soon as remembered or take two the next day.
• More than one missed pill requires another form of birth control.
• Report severe chest pain, cough, shortness of breath, severe abdominal pain, dizziness, weakness, or severe leg pain.

Reproduction Review

• Ovulation, the release of the ovum, occurs about 14 days before menstruation.
• Sperm live about 3 days, and eggs live about 24 hours.
• Avoid intercourse for several days before and after ovulation to prevent pregnancy.
• Day one of bleeding is the first menstruation day on average 28 day cycles.
• If there is no pregnancy, progesterone and estrogen levels drop, triggering menses.
• One sperm penetrates the ovum leading to normal cells with 46 chromosomes, comprised of 22 pairs of autosomes, and one pair of sex chromosomes (XX or XY).

Fertilization and Implantation

• Fertilization typically happens in the outer third of the fallopian tube.
• Implantation occurs in the upper part of the uterus 7-10 days post-fertilization.
• An ectopic pregnancy happens when the egg implants in the fallopian tube.
• An abdominal pregnancy is when the fertilized egg implants on another organ.

Pregnancy Structures

• Pregnancy structures consist of fetal membranes, umbilical cord, and placenta.

Fetal Membranes

• The amnion is a smooth/slippery membrane containing fluid, maintaining temperature, and cushioning the embryo.
• At full term, there is about 500-1000 mL of fluid. Polyhydramnios is >2000 mL, and oligohydramnios is <500 mL.
• The Chorion is the outer membrane that gives rise to placenta.

Umbilical Cord

• The umbilical connects the placenta to the fetus; it contains two arteries and one large vein.
• Wharton's jelly, a gelatinous substance, surrounds and protects the umbilical blood vessels.
• The average cord is 20 inches long and 0.75 inches thick.
• One umbilical vein carries oxygenated blood to the fetus, and two umbilical arteries carry deoxygenated blood from the fetus.
• 1½ of babies blood is in the umbilical cord.

Placenta

• The placenta transfers gases, transports nutrients, excretes waste, transfers heat, and produces hormones.
• It passes antibodies from mother to the fetus.
• Some small particles, including viruses and chemicals, can pass through the placenta.
• Chorionic villi, bathed in maternal blood, are where exchange occurs.
• Leaving placental portions in the mother post-birth can cause bleeding, hemorrhage, and infection.

Placental Hormones

• Human chorionic gonadotropin (hCG) increases from 8-70 days, is used in pregnancy tests, and helps preserve the endometrial lining.
• Human placental lactogen (hPL) makes glucose available and increases insulin resistance for the mother allowing more sugar for the baby. Moreover Progesterone is known as the "hormone of pregnancy."
• The placenta stabilizes the endometrium and relaxes smooth muscles. It also leads to estrogen production for the growth of the uterus and breasts.
• Remember, hCG levels indicate pregnancy.

Fetal Development Stages

• Ovum stage (10-14 days) involves implantation through the secretion of hCG to maintain estrogen and progesterone. Possible events are spontaneous abortion, maternal infection, and genetic defects.
• Embryo stage (13 days-8 weeks) involves cell growth, tissue differentiation, and body system formation with potential for mortality, malformations, and teratogenic effects.
• Fetus stage (9 weeks-term) involves body size and organ maturity, potentially leading to preterm delivery, intrauterine growth restriction, or poor organ development.

Fetal Circulation

• The purpose is to carry oxygenated blood to vital areas while shunting it away from less vital areas.
• The lungs are the last to mature in pregnancy.
• In utero not much blood needs to go to the lungs for growth, not function

Three Important Shunts

• Ductus venosus connects the umbilical vein to the inferior vena cava.
• Foramen ovale is an anatomic opening between the right and left atrium.
• Ductus arteriosus connects the main pulmonary artery to the aorta.

Transitional/Neonatal Circulation

• Gas exchange is transferred from the placenta to the lungs.
• Fetal shunts close in response to pressure change.
• Pulmonary vascular resistance decreases, and pulmonary blood flow increases.

Multifetal Pregnancy

• Twins occur about once every 85 pregnancies.
• Triplets occur about once every 8100 pregnancies.
• Long-term handicap risk is higher as the number of pregnancies increases.

Monozygotic Twinning

• This occurs from the division of a single ovum and sperm, leading to identical twins.
• Early separation results in two amnions and one chorion, which is most common.
• Late separation leads to one amnion and one chorion with a risk for cord accident.
• The incidence is not impacted by reproductive technology.

Dizygotic Twinning

• This involves two ova fertilized by different sperm resulting in fraternal twins.
• There is an increased incidence of this with advanced maternal age, infertility therapy, and genetic tendency.

Cervical Changes During Pregnancy

• Goodell's sign is softening about 6 weeks, Chadwick's sign is bluish-violet color after 6-8 weeks.
• Mucus plug inhibits ascent of bacteria into the uterus.

Vaginal & Breast Changes

• The vagina enlarges, softens, thickens, develops a blue-violet hue, with alkaline secretions increasing the risk of vaginitis, and loosens connective tissue.
• Breasts enlarge from the effects of estrogen.
• Nipple and areola become larger and darker.
• Enlarged blood vessels are prominent under skin.

Body Mass & Skin

• Changes in the center of gravity, producing relaxation of joints.
• The total weight gain is 23-28 lbs comprised of 3-4 lb during the first trimester and 1 lb weekly thereafter.
• Increased pigmentation leads to striae gravidarum, linea nigra, and melasma.
• Minute vascular spiders may occur, and sweat/sebaceous glands become more active.

Musculoskeletal & Blood

• Relaxation of joints occurs due to progesterone and lowered back pain.
• Vertical abdominal muscles may separate (diastasis recti).
• Blood volume increases 30%, plasma by 30-60%, and RBC 20-30%.
• Physiologic anemia occurs during pregnancy.
• WBC and clotting factors increase.

Anemia & Venal Caval Syndrome

• Iron supplementation is necessary to reach a hemoglobin goal >11 and hematocrit >33 during pregnancy.
• Venal caval syndrome happens in the last trimester in the supine position.
• In the syndrome , the uterus galls back against the inferior vena cava reducing cardiac output and causing weakness, lightheadedness, syncope.
• Position the mother in a tilt to relieve pressure on the chest.

Digestion & Urinary System

• Nausea and vomiting happens in the first trimester and hyperemesis gravidarum.
• Progesterone-induced relaxation causes heartburn, flatulence, and constipation.
• Use fiber, fluids, and movement to help with digestive problems.
• Pressure on the uterus causes urinary retention, stasis, and urinary frequency.
• Women should be reminded to empty their bladder frequently.

Emotional & Second Trimester Reactions

• These emotional changes can occur: Ambivalence, introversion, acceptance, mood swings, and change in body image.
• Ambivalence wanes in the second trimester and acceptance of pregnancy occurs.
• Pregnancy becomes “real,” and maternal-fetal bonding signs occur.

Safety & Assessments

• Stay hydrated, wear a seat belt, avoid prolonged sitting, ensure medical care, and avoid hot tubs.
• Verify pregnancy through presumptive findings (subjective reports)
• Probable (increased suspicion) indicates positive urine tests, and positive/definite signs include fetal heartbeat, ultrasound visualization.

Estimated Birth Date and History

• Term pregnancy is 38-42 weeks, and the measurement of fundal height assists the determination of gestational age.
• Naegle's rule is used to calculate birth date Start with the first day of LMP Subtract 3 months from the LMP Add 7 days, correct for year, plus or minus 2 weeks

Obstetrical History

• Gravida measures the total number of pregnancies.
• Para measures pregnancies at 20 weeks or more, and abortion measures pregnancies terminating before 20 weeks.
• Nulligravida is a woman who has never been pregnant.
• Primigravida is her first pregnancy.
• Multigravida is a woman pregnant for at least the third time.

Health and Pregnancy

• Health factors include illness, surgeries, medications, menstrual cycle, contraception and infection.
• Other factors include: personal, social, cultural, material, sexual, environmental, education, occupational, drugs, caffeine, and exercise.
• It is also important to note the pre-pregnancy weight.

Nutrition

• It is important to consume 300 kcal/d.
• No attempt should be made at weight reduction.
• Protein: 60g/d and Iron: 30mg/d are often required for the supplement along with calcium 1200 mg/d.
• Special Considerations: Folic acid (400 mcg/d) decreases neural tube defects.
• It’s important to note dark green vegetables, baked beans, citrus fruits, cereal, and liver.

Important Nutrition

• Fish is a major source of omega-3 fatty acids.
• Recommend 12 ounce weekly of tuna, shrimp, salmon, pollock, and catfish but to avoid swedish, shark, mackerel, and tilefish since avoid mercury.

Physical Assessment

• The initial visit includes a complete physical exam A pelvic exam with Pap Smear is done for gonorrhea/chlamydia culture with pelvic measurements.

Lab Testing

• Lab tests should include: Blood typing and Rh factor, CBC, rubella titer (positive = good antibodies, no vaccine if pregnant & give after birth), hepatitis B, HIV, cervical smears, urinalysis, and glucose/protein in urine.

Rubella Status

• Rubella may have teratogenic effects in the 1st trimester, leading to congenital rubella syndrome Rubella titer >10 10 IU/ml equals immunity, and women who are "non-immune" should receive the vaccine postpartum.

Blood Type Importance

• Sometimes fetal blood enters maternal circulation, during abortion, ectopic pregnancy, fetal diagnostic products, abdominal trauma, or delivery.
• ABO incompatibility is not usually a problem.
• Rhesus (RH) incompatibility is a problem when an Rh-negative woman carries an Rh-positive infant.

Maternal Sensitization

• In RH (-) women with a EH (+) fetus, the immune system develops antibodies, which destroys fetal blood cells.

The Outcome

• In sensitized RH (-) women carrying an Rh (+) fetus there can be hemolysis First borns are usually ok, second borns are mildly anemic, and subsequent infants suffer anemia/death - nurse play a key role in observing infants for s/s of illness

Rhogam

• Rhogam Prevents maternal antibody formation by routinely given at 29-32 weeks and 72 hours of delivery.

Prenatal Visits

• Occurs in the following timeline: Every 4 weeks up to 28 weeks, every 2 weeks from 29-36 weeks, every week from 37 weeks to birth to monitor: vital signs, weight, fetal heart tones, fundal height/outline with an ultrasound screen for due date, growth, well being.
• Glucose is screened at: 24-28 weeks, glucose challenge test
• Pelvic exam should: at initial visit and at 36 weeks w/ Pelvic exam at initial bist and at 26 weeks to collect group beta strep (GBS) culture.

Other Prenatal Info

• GBS is a normal flora in 20% of women which screening with vaginal/rectal culture is vital at 36 weeks or preterm labor
• What is labor? It Opens the Cervix, then baby Descends through the Vagina out..
• A complex multifaceted interaction between the mother and the baby; It is NOT dangerous to the normal immune system but can cause newborn death, so keep intact fetal membranes.

Cervical & Membrane Components

• There should be labor as in effacement of shorting/thinning of the cervix when it dilates in cm till is 10 cm and is ready
• Keep vaginal exams a minimum Components come from Passageway (birth canal) Passenger (fetus and placenta) Powers (contractions) Position (maternal) Psychological response

Powers and The Way

• Effect of gravity rhythmic smooth muscle contractions, make position upright to push open cervix head
• Mother feels like she has to go to the bathroom because the head is sitting of the rectum so encourage mom to push while contraction occur

Passageway

• Passageway that has tissues and walls, and for the mom w epidural she might need catheter

The Passengers & position

• Size, attitude, presentation, and position must be accounted in the fetus
• Meconium, don't want baby doing that to them

Fetal Presentation & Position

• Cephalic: (head down) is the desirable w face down position
• Measures descent +2 thought to bc crowding, that engagement is when fetus meets ischial spine then contracts the skull during the fetal decent

Position & Normal Stages

• Squatting for ideal position to increase outlet avoid back lying/ bed rest with births comes responsibility as influence as influences
• Be aware of early signs to normal to labor is: contractions, lighting baby drops, bloody show (mucus and pink/brownish, lose weight.

Labor & Phases

• 1st: ROM or regular contractions and regular
• 2nd Stage: 10 cm to delivery of that fetus
• 3rd: Fetus birth to placenta
• 4th: 1-4 hr after to delivery that uterus contract, so energy wise important to have it conserved
• Lastent phase
• Active will be 4-7cm
• Transion

Complications Stage's

• Care 1 - start w help
• Attention is nutrition to hydration because women don't eat, eliminate
• Rupture of membranes (ROM) assessment: artificial is amnihook spontaneous if assessing prolapsed cord is there on way to knee/chest of child

Complications Labor

• Take note after water is out
• When, color, smell matters with clear to be great
• Amniotic fluid
• 2 hr average for mom w multiple
• active listen

Recomber

• Hard is to be dilate
• Delivery and contract
• Patient must be prepare

C sections

• Complications arise on stage like source of pain, what is going up and down w Fetus, intervention what caregivers must prepare a lot of this,
• Any drug patient affect

Medication & Discomfort & Risk Factors

• Timing and how that patient takes it with FHR taken frequently
• IV is preferred must be vigilant after
• High risk drug to be monitoring every 10 -15 after to 1-2 hrs
• High risk drugs must have all time for U.S for increase rates to C sections like Gestational hypertension/ diabetes so use Piotion w assessments

Potion Drug

• Contratrion can be great but too close is dangerous, can turn of bit and be close monitor
• Cut down peritoneum, forceps to make the baby move and not cause C section be the default option ( nearly 30 % of what happens)

Csection/ Post

• Cut down peritoneum, forceps to make the baby move and not cause C section be the default option during assessment to monitor ( nearly 30 % of what happens in U.S)
• Psychologically be prepare for new change and not dismiss fears

1ST Breath Post Birth

• Trigger sound
• Air fluid goes with tranient breath so slow and shallow as they slowly do fluid
• Monitor rates from 30 -60 which should get better
• After blood, then closes, the heart close and work fine

Infant

• Assess every 1-5 at what they should do w the tone of muscles, the reflex, the skin tone, and
• Babies under 97.5 should be have assess immediately Neurological adaptation is important to prevent depletion, blood, or lose skin
• The blood, the fluid, and the heat should and be balance

Labs & Test Infants

• Know where to stick baby, why and how long
• Weight - ranges to measurement for the infant should be there

Baby Face/Body

• Face to be with symmetry because of dislocated hips

• In detail when babies in need safe sleep advice teach is so important

Chapter 17

• Assessment should be in detail for what that HR is important

Heart Rate (FHR) & Fetal Monitoring

• Listen 10-160 as normal
• Monitor external or internal
• What you seeing , if a increase or decrease
• There variability, and the assessment as you make

VEAL CHOP

• *V**ariable decelerations: Cord compression
• *E**arly decelerations: Head compression
• *A**ccelerations: Oxygenation (baby is well)
• *L**ate decelerations: Placental perfusion problems

Assessment

• This is test do see after a while what FHR is during the pregnancy
• Nurse have an important role in this time to listen what the heart is telling for a new baby Breastfeeding, what moms is saying, and how the baby doing in first time is the first step to there long one

Feedings & Advantages

Breast milk give less Cow's milk give less And they must always support with how help mom do what they are doing