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Questions and Answers
In which presentation is the fetal head primarily in extension as it enters the pelvis?
In which presentation is the fetal head primarily in extension as it enters the pelvis?
What is a characteristic of shoulder presentation during labor?
What is a characteristic of shoulder presentation during labor?
Which breech presentation involves the fetus's thighs being flexed alongside the body?
Which breech presentation involves the fetus's thighs being flexed alongside the body?
What is a defining feature of compound presentation during labor?
What is a defining feature of compound presentation during labor?
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Which type of breech presentation is characterized by one or both knees being flexed?
Which type of breech presentation is characterized by one or both knees being flexed?
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What is indicated by a visually apparent abrupt increase in fetal heart rate (FHR) above baseline of at least 15 bpm lasting 15 seconds or more?
What is indicated by a visually apparent abrupt increase in fetal heart rate (FHR) above baseline of at least 15 bpm lasting 15 seconds or more?
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What is the significance of the nadir in relation to uterine contractions during labor?
What is the significance of the nadir in relation to uterine contractions during labor?
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What condition is indicated by variable decelerations in fetal heart rate during labor?
What condition is indicated by variable decelerations in fetal heart rate during labor?
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What does the term 'arrest of labor' refer to during the second stage of labor?
What does the term 'arrest of labor' refer to during the second stage of labor?
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What is a common cause of head compression during labor?
What is a common cause of head compression during labor?
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What is the primary purpose of induction of labor (IOL)?
What is the primary purpose of induction of labor (IOL)?
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Which of the following methods is considered a mechanical cervical preparation?
Which of the following methods is considered a mechanical cervical preparation?
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What does a Bishop Score of greater than 8 indicate?
What does a Bishop Score of greater than 8 indicate?
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What is a common indication for labor augmentation?
What is a common indication for labor augmentation?
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Which of the following factors is NOT a risk associated with postpartum hemorrhage?
Which of the following factors is NOT a risk associated with postpartum hemorrhage?
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Which intervention is used to increase contractions during labor?
Which intervention is used to increase contractions during labor?
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What is the greatest risk period for primary postpartum hemorrhage?
What is the greatest risk period for primary postpartum hemorrhage?
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Which condition is associated with an increased risk of labor complications?
Which condition is associated with an increased risk of labor complications?
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What is the primary hormone responsible for lactation?
What is the primary hormone responsible for lactation?
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Which hormone has a suppressive effect on lactation during pregnancy?
Which hormone has a suppressive effect on lactation during pregnancy?
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What is one of the three conditions that must be fulfilled for the lactational amenorrhea method to be effective?
What is one of the three conditions that must be fulfilled for the lactational amenorrhea method to be effective?
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During which phase of life is lactogenesis primarily taking place?
During which phase of life is lactogenesis primarily taking place?
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Which of the following is NOT one of the five P's of taking a health history?
Which of the following is NOT one of the five P's of taking a health history?
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What is the primary cause of respiratory distress syndrome (RDS) in neonates?
What is the primary cause of respiratory distress syndrome (RDS) in neonates?
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What is the expected time frame for the closure of the ductus arteriosus after birth?
What is the expected time frame for the closure of the ductus arteriosus after birth?
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Which of the following is a sign of patent ductus arteriosus (PDA)?
Which of the following is a sign of patent ductus arteriosus (PDA)?
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Meconium aspiration syndrome is most likely to occur in which group of newborns?
Meconium aspiration syndrome is most likely to occur in which group of newborns?
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What typically characterizes breastfeeding jaundice in newborns?
What typically characterizes breastfeeding jaundice in newborns?
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Which principle of discharge teaching emphasizes the importance of the environment during patient education?
Which principle of discharge teaching emphasizes the importance of the environment during patient education?
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Which hormone is primarily associated with the process of lactogenesis?
Which hormone is primarily associated with the process of lactogenesis?
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What nursing action is crucial in managing meconium aspiration syndrome in newborns?
What nursing action is crucial in managing meconium aspiration syndrome in newborns?
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What does an abrupt increase in fetal heart rate (FHR) suggest when it is at least 15 bpm above baseline for at least 15 seconds?
What does an abrupt increase in fetal heart rate (FHR) suggest when it is at least 15 bpm above baseline for at least 15 seconds?
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Which situation necessitates a period of 30 seconds to reach nadir during a labor scenario for a preterm infant?
Which situation necessitates a period of 30 seconds to reach nadir during a labor scenario for a preterm infant?
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What is a possible cause of variable decelerations in fetal heart rate regarding cervical dilation and membrane status?
What is a possible cause of variable decelerations in fetal heart rate regarding cervical dilation and membrane status?
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What is indicated by a second stage arrest disorder during labor?
What is indicated by a second stage arrest disorder during labor?
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Which of the following presentations might contribute to complications during labor based on fetal positioning?
Which of the following presentations might contribute to complications during labor based on fetal positioning?
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What changes in fetal heart rate (FHR) are typically regarded as a favorable outcome during contractions?
What changes in fetal heart rate (FHR) are typically regarded as a favorable outcome during contractions?
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What is the significance of monitoring the nadir during fetal heart rate assessment?
What is the significance of monitoring the nadir during fetal heart rate assessment?
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Which scenario is characteristic of labor requiring intervention based on patient symptoms?
Which scenario is characteristic of labor requiring intervention based on patient symptoms?
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Which combination of conditions is required for the lactational amenorrhea method to be effective?
Which combination of conditions is required for the lactational amenorrhea method to be effective?
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What is the immediate effect on lactation hormones after the placenta is delivered?
What is the immediate effect on lactation hormones after the placenta is delivered?
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During which phase of life does lactogenesis primarily take place?
During which phase of life does lactogenesis primarily take place?
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Which hormone is primarily responsible for suppressing lactation during pregnancy?
Which hormone is primarily responsible for suppressing lactation during pregnancy?
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What is one of the five P's concerning taking a health history in women's health?
What is one of the five P's concerning taking a health history in women's health?
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Which presentation is characterized by the fetal spine being vertical to the maternal pelvis?
Which presentation is characterized by the fetal spine being vertical to the maternal pelvis?
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What distinguishes the brow presentation from the face presentation?
What distinguishes the brow presentation from the face presentation?
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In which breech presentation are the fetus's thighs flexed alongside the body with feet near the head?
In which breech presentation are the fetus's thighs flexed alongside the body with feet near the head?
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Which fetal presentation involves one or more extremities accompanying the presenting part?
Which fetal presentation involves one or more extremities accompanying the presenting part?
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What defines a footling breech presentation?
What defines a footling breech presentation?
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What is a key purpose of cervical preparation in the process of labor induction?
What is a key purpose of cervical preparation in the process of labor induction?
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What is a risk associated with both shoulder and compound presentations?
What is a risk associated with both shoulder and compound presentations?
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What does a Bishop Score of 6 indicate regarding labor induction?
What does a Bishop Score of 6 indicate regarding labor induction?
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Which abnormal fetal position is characterized by the back of the baby’s head being closest to the mother's back?
Which abnormal fetal position is characterized by the back of the baby’s head being closest to the mother's back?
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Which factor is considered a contraindication for labor augmentation?
Which factor is considered a contraindication for labor augmentation?
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What indicates a higher risk of dysfunctional labor during breech presentations?
What indicates a higher risk of dysfunctional labor during breech presentations?
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What intervention is typically used to artificially rupture membranes during labor?
What intervention is typically used to artificially rupture membranes during labor?
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What is one of the complications associated with face presentation during labor?
What is one of the complications associated with face presentation during labor?
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What complication can arise from performing an artificial rupture of membranes early in labor?
What complication can arise from performing an artificial rupture of membranes early in labor?
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Which of the following presentations pose a significant risk of requiring a C-section?
Which of the following presentations pose a significant risk of requiring a C-section?
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What does augmentation of labor aim to achieve?
What does augmentation of labor aim to achieve?
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Which of the following conditions is a significant risk factor for postpartum hemorrhage?
Which of the following conditions is a significant risk factor for postpartum hemorrhage?
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Which method is classified as pharmacological cervical preparation?
Which method is classified as pharmacological cervical preparation?
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What is the largest risk associated with blood loss postpartum?
What is the largest risk associated with blood loss postpartum?
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An insufficient Bishop Score may suggest what concerning labor induction?
An insufficient Bishop Score may suggest what concerning labor induction?
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What distinguishes postpartum depression from postpartum blues?
What distinguishes postpartum depression from postpartum blues?
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Which of the following is a significant cause of secondary postpartum hemorrhage?
Which of the following is a significant cause of secondary postpartum hemorrhage?
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What condition results from the body breaking down clots faster than it can form them?
What condition results from the body breaking down clots faster than it can form them?
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Which of the following is NOT a symptom indicative of postpartum blues?
Which of the following is NOT a symptom indicative of postpartum blues?
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What is a common symptom of respiratory distress syndrome in neonates?
What is a common symptom of respiratory distress syndrome in neonates?
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Which condition is characterized by a 'boggy' fundus in postpartum assessment?
Which condition is characterized by a 'boggy' fundus in postpartum assessment?
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What is a potential complication that can arise from lower genital tract lacerations?
What is a potential complication that can arise from lower genital tract lacerations?
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What physiological changes occur in the uterus during subinvolution?
What physiological changes occur in the uterus during subinvolution?
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What are the two primary factors that infant health and survival depend on?
What are the two primary factors that infant health and survival depend on?
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Which condition involves the collection of blood within connective tissues after a ruptured vessel?
Which condition involves the collection of blood within connective tissues after a ruptured vessel?
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Study Notes
Fetal Dystocia Presentations
- Occiput posterior: Baby's head is positioned towards the mother's back instead of the front, causing potential discomfort and labor difficulties.
- Face presentation: Baby's head is extended instead of flexed, leading to a larger diameter of the head entering the pelvis.
- Brow presentation: Baby's head is in a position between full flexion and extension, presenting a large diameter of the head into the pelvis.
- Shoulder presentation: Baby's spine is vertical to the pelvis, increasing risk of a prolapsed cord. A C-section is typically required.
- Compound presentation: One or more fetal extremities accompany the presenting part. This also creates a higher risk of a prolapsed cord and a C-section is indicated.
Breech Presentations
- Frank breech: Baby's thighs are flexed, and feet are close to the head.
- Complete breech: Baby's knees are flexed.
- Footling breech: One or both feet present before the buttocks.
Breech Presentations Complications
- Breech presentations can lead to dysfunctional labor, fetal injury, increased risk of prolapsed cord, and often necessitate a C-section.
Induction of Labor (IOL)
- IOL deliberately stimulates labor onset before spontaneous labor occurs to facilitate a vaginal birth.
- There must be a medical indication for IOL.
IOL Interventions
-
Cervical preparation: This process involves physically softening, thinning, and dilating the cervix to prepare for labor and birth.
- Mechanical cervical preparation options include using a balloon catheter.
- Pharmacological methods use misoprostol or cervidil to prepare the cervix.
- Oxytocin (Pitocin) is titrated to stimulate contractions and labor.
- Amniotomy (AROM): Artificial rupture of membranes used to induce or augment labor. AROM early in labor increases the risk of a C-section.
Bishop Score
- This score determines how close a woman is to labor.
- A score of 8 or higher indicates a successful induction outcome, similar to spontaneous labor.
- A score of 6 is considered favorable for successful induction.
Labor Augmentation
- Labor augmentation stimulates contractions when labor does not progress after spontaneous labor begins.
- The goal is to strengthen and regulate contractions.
- Indications for Augmentation:
- Blood loss exceeding 1000cc with a 10% drop in hemoglobin or hematocrit.
Postpartum Hemorrhage (PPH)
- PPH is a significant complication with the greatest risk in the first hour after birth.
- Primary PPH: Occurs within 24 hours of birth.
- Secondary (delayed) PPH: Occurs between day 1 and 6 weeks after birth.
- Treatment focuses on identifying the cause and preventing hypovolemic shock.
Postpartum Hemorrhage Risk Factors
- Neonatal Macrosomia (large baby)
- Placenta previa/accreta
- Multiple gestation (twins, triplets, etc.)
- Previous C-sections or uterine surgery
- Polyhydramnios (excess amniotic fluid)
- Prior PPH
- High BMI
- Operative vaginal delivery
- Chorioamnionitis (infection of the amniotic sac)
- Congenital or coagulation defects
Respiratory Distress Syndrome (RDS)
- A life-threatening lung disorder, primarily affecting premature infants due to underdeveloped alveoli and insufficient surfactant levels.
- Signs and symptoms of RDS:
- Tachypnea (rapid breathing)
- Gray or dusky skin
- Lethargy and hypotonia (low muscle tone)
Patent Ductus Arteriosus (PDA)
- Occurs when the ductus arteriosus, a blood vessel connecting the aorta and pulmonary artery, remains open after birth.
- Normally closes within a few hours to 96 hours after birth.
- Signs and symptoms of PDA:
- Tachycardia (rapid heartbeat)
- Tachypnea (rapid breathing)
- Recurrent apnea (temporary cessation of breathing)
- Bounding pulses
Meconium Aspiration Syndrome
- This occurs when meconium fluid, a first stool in the womb, enters the lungs, partially obstructing airflow and causing respiratory failure.
- Increases in post-mature newborns (born after 41 weeks).
- Nursing actions:
- Assess for respiratory distress
- Administer oxygen if indicated
Breastfeeding Jaundice
- Jaundice is a condition where a newborn's skin and eyes appear yellow due to high bilirubin levels.
- Breastfeeding jaundice is associated with ineffective breastfeeding causing early onset jaundice (within the first few days of life).
- Associated with delayed passage of meconium stool.
- Treatment:
- Encourage effective breastfeeding without supplementation.
Five Principles of Discharge Teaching
- Right Time: The ideal time for the information to be given.
- Right Context: An environment should be quiet, free of distractions, private, soothing, or stimulating, depending on the information.
- Right Goal: Patient actively involved in the setting and achieving mutually set goals. Goals should be realistic and valued by the patient.
- Right Content: The information should be clear, concise, and appropriate for the patient's understanding.
- Right Method: The information should be presented in a way that the patient understands and can remember.
Lactogenesis
- Lactogenesis refers to the process of milk production.
- Starts during the second trimester.
- Hormones involved:
- Prolactin: Primary hormone responsible for lactation.
- Estrogen and Progesterone: Suppress lactation during pregnancy.
- After delivery, prolactin levels increase, and estrogen and progesterone levels decrease. Estrogen levels will then re-increase approximately one week after delivery.
- The lactational amenorrhea method uses breastfeeding as a form of birth control.
Women's Health Phases
- Adolescence
- Childbearing Years
- Perimenopause
- Post-Menopause/Geriatric
5 Ps of Women's Health History
- Partners: Current and previous intimate partners
- Practices: Sexual practices, including frequency and type
- Protection from STIs: Methods used to prevent STIs
- Past history of STIs: Previous diagnoses and treatments of STIs
- Pregnancy intention: Future pregnancy plans or intentions.
Long-Acting Reversible Contraception (LARC)
- Currently available in the United States.
- Examples include:
- Intrauterine devices (IUDs)
- Implants
- Hormonal injections
Fetal Presentations that may lead to Dystocia (Malpresentations)
- Occiput posterior: the back of the baby's head is in the posterior portion of the pelvis (closest to your back) instead of the anterior (occiput anterior = back of baby's head is closest to your front)
- Face presentation: Fetal head is in extension rather than flexion as it enters the pelvis
- Brow presentation: Fetal head presents in a position midway between full flexion and extreme extension – largest diameter of the head in the pelvis
- Shoulder presentation: Fetal spine is vertical to the maternal pelvis – higher risk of prolapsed cord, C-section is indicated
- Compound presentation: One or more fetal extremities accompany the presenting part – also higher risk of prolapsed cord and C-section is indicated
Breech Presentations
- Dysfunctional labor, fetal injury, risk of prolapsed cord, C-section
- Frank Breech: Fetus’s thighs are flexed alongside the body, feet are close to the head
- Complete Breech: One or both knees are flexed
- Footling Breech: Either one (single footing) or both (double footing) feet present before the buttocks
Induction of Labor
- Deliberate stimulation of labor onset of spontaneous labor to facilitate a vaginal birth
- Interventions:
- Cervical preparation: the process of physical softening, thinning, and dilating of the cervix in preparation of labor and birth
- Mechanical cervical preparation ➔ balloon catheter
- Pharmacological methods of preparation ➔ misoprostol, cervidil
- Oxytocin (Pitocin) titration used to stimulate contractions and labor
- Amniotomy (AROM): artificial rupture of membranes used to induce or augment labor
- AROM in early labor ➔ increased risk of C-section
- Cervical preparation: the process of physical softening, thinning, and dilating of the cervix in preparation of labor and birth
Bishop Score
- A calculation to predict how close you are to labor
- Bishop score >8: Same likelihood of vaginal delivery with induction of labor as that following spontaneous labor, indicates a successful induction
- Bishop score 6: Favorable for successful induction
Indications and Contraindications of Labor Augmentation
- Augmentation = stimulation of contractions when labor does not progress after the onset of spontaneous labor, goal is to strengthen and regulate contraction
- Indications:
- 1000cc C/S + 10% drop in Hgb/Hct
- How do we assess it? EBL >> QBL (estimated blood loss >> quantitative blood loss)
- Greatest risk is in the first hour after birth!
Postpartum Hemorrhage (PPH)
- Primary PPH → happens within 24 hours of birth
- Secondary (delayed) PPH→ occurs between day 1 to 6 weeks
- Treatment goal→ identify cause and prevent hypovolemic shock
- Other risk factors:
- Neonatal macrosomia
- Placenta previa/accrete
- Multiple gestation
- Previous C/S or uterine surgery
- Polyhydramnios
- Prior PPH
- High BMI
- Operative vaginal delivery
- Chorioamnionitis
- Congenital/coagulation defects
Causes of Postpartum Hemorrhage
- The Four T’s:
- Tone: uterine atony (boggy [meaning soft and tender] fundus), subinvolution (delayed return of the enlarged uterus to normal size and function)
- Tissue: retained placental fragments – common cause of secondary PPH
- Trauma: lower genital tract lacerations – 2nd most common cause of primary PPH
- Hematomas can develop – when blood from a ruptured vessel collects within the connective tissues of the vagina or perineal areas
- Thrombin disorders: disseminated intravascular coagulation (DIC), DVT, PE
- The body breaks down clots faster than it can form them→depleting the body of clotting factors→ leading to hemorrhage and death
Postpartum Blues (Baby Blues) vs. Postpartum Depression
- PPB (Baby Blues) → symptoms disappear without medical intervention, occurs within the first 2 weeks postpartum, able to safely care for self and baby
- PPD → mild to severe depression requires psychiatric interventions, occurs within the first 6-12 months postpartum, unable to safely care for self-and/or baby
- 2 weeks of:
- Loss of interest or pleasure in daily activities
- Insomnia
- Decreased energy/fatigue
- Decreased concentration
- Feelings of worthlessness or guilt
- Weight changes
- 2 weeks of:
Infant Health and Survival
- Length of gestation
- Birth weight
Respiratory Distress Syndrome in the Neonate
- Signs and symptoms:
- Rapid breathing
- Grunting
- Nasal flaring
- Retractions (skin pulling in between ribs or above the collarbone)
- Cyanosis (bluish color of the skin, especially around the mouth)
Lactogenesis
- Begins during the 2nd trimester: milk is produced in the alveolar glands and transported to the nipple through lactiferous ducts
- Hormones associated with lactogenesis:
- Prolactin – primary hormone responsible for lactation
- High levels of estrogen and progesterone SUPPRESS lactation
- Once placenta is delivered ➔ prolactin levels increase, estrogen/progesterone levels decrease→ estrogen will re-increase 1 week PP
- Lactation amenorrhea method
- Ovulation suppressed longer for lactating parent
Women’s Health Phases
- Adolescence ➔ Childbearing years ➔ Perimenopause ➔ post-menopause/geriatric
Five P’s of Taking a Health History
- Partners
- Practices
- Protection from STIs
- Past History of STIs
- Pregnancy Intention
Lactational Amenorrhea Method of Birth Control
- Using breastfeeding as your birth control – breastfeeding temporarily helps prevent pregnancy since breastfeeding hormones may stop your body from releasing eggs
- Must be used correctly for it to work – the three simultaneous conditions that must be fulfilled is:
- The baby is under 6 months
- The mother is still amenorrheic
- The mother practices exclusive or quasi-exclusive breastfeeding on demand
Long-Acting Reversible Contraception in the United States
- Hormonal implants
- Intrauterine devices (IUDs)
- Copper IUD
- Hormonal IUD
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Description
Test your knowledge on fetal dystocia presentations such as occiput posterior, face, brow, shoulder, and compound presentations. Additionally, explore the different types of breech presentations: frank, complete, and footling. This quiz will help you understand the implications of these positions in childbirth.
