Obstetric Nursing Lecture Notes PDF

25/11/2024 Obstetric Nursing Romeo T. Papa, DMD RN 1 Anatomy and Physiology 21/11/2024 rtpapadmdrn 2 2 1  25/11/...

25/11/2024 Obstetric Nursing Romeo T. Papa, DMD RN 1 Anatomy and Physiology 21/11/2024 rtpapadmdrn 2 2 1  25/11/2024 Male Reproductive System: External Scrotum Testes Seminiferous tubules Leydig’s cells Penis 21/11/2024 rtpapadmdrn 3 3 Male Reproductive System: Internal Internal Structure Epididymis (20 ft) 5% semen production Vas Deferens (Ductus Deferens) (final maturation of sperm occur) Seminal Vesicles 30% semen production Ejaculatory Ducts Prostate Gland 60% semen production Bulbourethral (Cowper’s) Glands Urethra 21/11/2024 rtpapadmdrn 4 4 2  25/11/2024 Female Reproductive System: External Mons Veneris Labia Minora Labia Majora Other External Organs Hymen Vestibule Two Skene’s glands Front of vaginal opening Bartholin’s Glands Back part of vaginal opening 21/11/2024 rtpapadmdrn 5 5 Female Reproductive System: Ovaries Ovaries Female gonad Function is to produce, mature, and discharge ova (the egg cells) produce estrogen and progesterone and initiate and regulate menstrual cycles 21/11/2024 rtpapadmdrn 6 6 3  25/11/2024 Female Reproductive System: Fallopian Tube Fallopian Tubes approximately 10 cm long Parts: Interstitial portion Isthmus This is the portion of the tube that is cut or sealed in a tubal ligation Ampulla portion that fertilization of an ovum usually occurs Indundibulum funnel shaped 21/11/2024 rtpapadmdrn 7 7 Female Reproductive System: Uterus Functions: receive the ovum from the fallopian tube for implantation and nourishment of fetus Fundus Expands during pregnancy Isthmus Enlarges to accommodate growing fetus Portion cut during C-section Cervix lowest portion of the uterus 21/11/2024 rtpapadmdrn 8 8 4  25/11/2024 Female Reproductive System: Vagina lined with stratified squamous epithelium similar to that covering the cervix contain many folds or rugae Bulbocavernosus at the external opening of the vagina acts as a voluntary sphincter mucus produced in lining has a rich glycogen content When this glycogen is broken down by the lactose-fermenting bacteria that frequent the vagina (Döderlein’s bacillus), lactic acid is formed 21/11/2024 rtpapadmdrn 9 9 QUESTION 21/11/2024 rtpapadmdrn 10 10 5  25/11/2024 Prolapse 21/11/2024 rtpapadmdrn 11 11 Breasts 21/11/2024 rtpapadmdrn 12 12 6  25/11/2024 Sexual Response Cycle By Masters and Johnson 21/11/2024 rtpapadmdrn 13 13 Excitement: occurs with physical and psychological stimulation causing parasympathetic nerve stimulation causing vasocongestion in genitals Women Men clitoris increases in size penile erection occurs vaginal walls lubrication scrotal thickening and elevation of the testes The vagina widens in increase in increase VS diameter and increases in length. Nipples become erect increase in increase VS 21/11/2024 rtpapadmdrn 14 14 7  25/11/2024 Plateau is reached just before orgasm Women Men clitoris is drawn forward and vasocongestion leads to retracts under the clitoral distention of the penis. prepuce Heart rate increases to 100 to the lower part of the vagina 175 beats per minute and becomes extremely congested respiratory rate to approximately (formation of the orgasmic 40 respirations per minute. platform) increased nipple elevation. 21/11/2024 rtpapadmdrn 15 15 Orgasm occurs when stimulation proceeds through the plateau stage, sudden discharges accumulated sexual tension Women Men A vigorous contraction of muscle contractions muscles in the pelvic area surrounding the seminal Expels or dissipates blood and vessels and prostate project fluid from the area of semen into the proximal congestion. urethra. propulsive ejaculatory contractions 21/11/2024 rtpapadmdrn 16 16 8  25/11/2024 Resolution is a 30-minute period during which the external and internal genital organs return to an unaroused state Women Men do not go through this a refractory period occurs refractory period during which further orgasm is possible for women who are impossible. interested and properly stimulated to have additional orgasms immediately after the first. 21/11/2024 rtpapadmdrn 17 17 Infertility/Subfertility Subfertility investigation is usually limited to three assessments: Semen analysis Ovulation monitoring Tubal patency Ultrasound 21/11/2024 rtpapadmdrn 18 18 9  25/11/2024 Management Therapeutic insemination deposition of sperm into a woman’s cervix or uterus In-vitro fertilization (IVF) the union of sperm and ovum under laboratory conditions Gamete intrafallopian transfer (GIFT) uses multiple eggs collected from the ovaries eggs are placed into a thin flexible tube (catheter) along with the sperm to be used The gametes (both eggs and sperm) are then injected into the fallopian tubes using a surgical procedure called laparoscopy 21/11/2024 rtpapadmdrn 19 19 Stages of Fetal Development 21/11/2024 rtpapadmdrn 20 20 10  25/11/2024 Fetal growth and development Three periods: preembryonic (first 2 weeks, beginning with fertilization) embryonic (weeks 3 through 8) fetal (from week 8 through birth) 21/11/2024 rtpapadmdrn 21 21 Fertilization AKA conception the union of an ovum and a spermatozoa OVA life span = 24 hours Sperm 48 -72 hours ovum and spermatozoon fuse to form a zygote 21/11/2024 rtpapadmdrn 22 22 11  25/11/2024 Implantation zygote migrates over the next 3 to 4 days toward the body of the uterus mitotic cell division, or cleavage,begins zygote reaches the body of the uterus, it consists of 16 to 50 cells it is termed a morula 21/11/2024 rtpapadmdrn 23 23 EMBRYONIC STRUCTURES: The Decidua After fertilization, the corpus luteum in the ovary continues to function rather than atrophying, because of the influence of human chorionic gonadotropin (hCG) Decidua is the thickened endometrial lining Three parts: 1. Decidua basalis 2. Decidua capsularis 3. Decidua vera 21/11/2024 rtpapadmdrn 24 24 12  25/11/2024 EMBRYONIC STRUCTURES: Chorionic Villi As early as the 11th or 12th day, Chorionic villi is formed It reach out from the single layer of cells into the uterine endometrium to begin formation of the placenta. 21/11/2024 rtpapadmdrn 25 25 EMBRYONIC STRUCTURES: The Placenta At 4 weeks, the blastocyst is splitting into an embryo and placenta At week 10 - 12 placenta takes over from a structure known as the corpus luteum 21/11/2024 rtpapadmdrn 26 26 13  25/11/2024 EMBRYONIC STRUCTURES: Amniotic Membranes smooth chorion eventually becomes the chorionic membrane form the sac that contains the amniotic fluid Hydramnios Increased amniotic fluid Oligohydramnios reduction in the amount of amniotic fluid Slightly alkaline 21/11/2024 rtpapadmdrn 27 27 EMBRYONIC STRUCTURES: The Umbilical Cord transport oxygen and nutrients to the fetus from the placenta and to return waste products from the fetus to the placenta. The bulk of the cord is a gelatinous mucopolysaccharide called Wharton’s jelly AVA one vein (carrying blood from the placental villi to the fetus) two arteries (carrying blood from the fetus back to the placental villi) 21/11/2024 rtpapadmdrn 28 28 14  25/11/2024 Cardiovascular System first systems to become functional in intrauterine life. Formation starts as early as 16th day Heart beats as early as the 24th day Can be heard in doppler = 10th to 12th week End of 16th week = FHT is audible using Stethoscope 28th week of pregnancy, when the sympathetic nervous system has matured, the heart rate begins to show a baseline variability of about 5 BPM Normal FHT = 120-160 bpm 21/11/2024 rtpapadmdrn 29 29 Fetal Circulation 21/11/2024 rtpapadmdrn 30 30 15  25/11/2024 Respiratory System Alveoli and capillaries begin to form between the 24th and 28th weeks Surfactant a phospholipid substance, is formed and excreted by the alveolar cells at about the 24th week of pregnancy. Surfactant has two components: lecithin (L) Sphingomyelin (S) At about 35 weeks, a surge in the production of lecithin becomes the chief component by a ratio of 2:1 21/11/2024 rtpapadmdrn 31 31 Nervous System Develop during 3rd and 4th weeks of IUL A neural plate (a thickened portion of the ectoderm) is apparent by the third week of gestation. 1. neural tube, which will form the central nervous system (brain and spinal cord) 2. neural crest, which will develop into the peripheral nervous system 21/11/2024 rtpapadmdrn 32 32 16  25/11/2024 Neural tube defects also known as spinal dysraphisms are a category of neurological disorders related to malformations of the spinal cord such as: spina bifida Anencephaly Meningocele Myelomeningocele Cause: Lack of folic acid Genetics Encourage intake of folic acid (contained in green leafy vegetables and pregnancy vitamins) 21/11/2024 rtpapadmdrn 33 33 Determination of Estimated Birth Date EDD or EDC = 38 to 42 weeks Naegel’s Rule: LMP Jan to Mar = +9(mos.), +7(days) Apr – Dec = -3(mos.),+7(days), +1(yr) McDonald’s rule: symphysis-fundal height measurement method of determining during midpregnancy Uterine fundus to Symphysis pubis 1cm = 1week AOG between the 20th and 31st weeks of pregnancy. Easy milestone: Symphysis pubis = 12 weeks umbilicus = 20 weeks, xiphoid process = 36 weeks 21/11/2024 rtpapadmdrn 34 34 17  25/11/2024 Fetal Movement Fetal movement that can be felt by the mother (quickening) 18 to 20 weeks of pregnancy at least 10 times a day 28 to 38 weeks 10–12 times an hour assure a woman that fetal movements do vary, especially in relation to sleep cycles 21/11/2024 rtpapadmdrn 35 35 Fetal Heart Rate/Tone Fetal hearts beat at 120 to 160 beats per minute Rhythm Strip Testing Attach an external fetal heart rate monitor abdominally Record for 20 mins Baseline reading refers to the average rate of the fetal heartbeat per minute. Variability refers to small changes in rate absent (none apparent) minimal (extremely small fluctuations) moderate (amplitude range of 6–25 beats per minute) marked (amplitude range over 25 beats per minute) 21/11/2024 rtpapadmdrn 36 36 18  25/11/2024 Nonstress Testing A nonstress test measures the response of the fetal heart rate to fetal movement. attach both a fetal heart rate and a uterine contraction monitor. Usually done for 10 – 20 mins Instruct a woman to push a button whenever she feels the fetus move. When the fetus moves, the fetal heart rate should increase about 15 beats per minute and remain elevated for 15 seconds. If no increase in beats per minute is noticeable on fetal movement, poor oxygen perfusion 21/11/2024 rtpapadmdrn 37 37 Contraction Stress Testing fetal heart rate is analyzed in conjunction with contractions Before it was initiated with intravenous infusion of oxytocin Nowadays source of oxytocin for contraction stress testing currently is achieved by nipple stimulation. baseline fetal heart rate is obtained Next, the woman stimulates nipple until uterine contractions begin, which are recorded by a uterine monitor. Three contractions with a duration of 40 seconds or longer must be present in a 10-minute window 21/11/2024 rtpapadmdrn 38 38 19  25/11/2024 Contraction Stress Testing Negative (normal) if no fetal heart rate decelerations are present with contractions. Positive (abnormal) if 50% or more of contractions cause a late deceleration 21/11/2024 rtpapadmdrn 39 39 Ultrasonography Diagnose pregnancy as early as 6 weeks’ AOG Confirm the presence, size, and location of the placenta and amniotic fluid Establish sex if a penis is revealed Establish the presentation and position of the fetus Predict maturity by measurement of the biparietal diameter of the head discover complications of pregnancy 21/11/2024 rtpapadmdrn 40 40 20  25/11/2024 Ultrasonography Encourage to drink a full glass of water every 15 minutes beginning 90 minutes before the procedure Do not void until after the procedure place a towel under her right buttock To prevent supine hypotension syndrome Be certain that the gel is at room temperature or even slightly warmer To prevent uncomfortable uterine cramping. 21/11/2024 rtpapadmdrn 41 41 Amniocentesis aspiration of amniotic fluid scheduled between the 14th and 16th weeks of pregnancy ask the woman to void (to reduce the size of the bladder and prevent an inadvertent puncture) Do not suggest that she take a deep breath and hold this lowers the diaphragm against the uterus and shifts intrauterine contents. Increased alpha-Fetoprotein = anencephaly, myelomeningocele If the woman has Rh-negative blood, Rho(D) immune globulin (RhIG; RhoGAM) is administered after the procedure to prevent fetal isoimmunization. 21/11/2024 rtpapadmdrn 42 42 21  25/11/2024 Pregnancy: Presumptive (Subjective) Signs Nausea, vomiting Amenorrhea Quickening Fetal movement felt by woman Linea nigra Line of dark pigment on the abdomen Melasma Dark pigment on face Striae gravidarum Red streaks on abdomen 21/11/2024 rtpapadmdrn 43 43 Pregnancy: Probable Signs objective documented by an examiner Serum laboratory test Chadwick’s sign Color change of the vagina from pink to violet Goodell’s sign Softening of the cervix Hegar’s sign Softening of the lower uterine segment Ballottement lower uterine segment is tapped on a bimanual examination, the fetus can be felt to rise against abdominal wall Braxton Hicks Periodic uterine tightening occurs 21/11/2024 rtpapadmdrn 44 44 22  25/11/2024 Pregnancy: Positive Signs FHT Fetal movements felt by an examiner Visualization of the fetus by ultrasound 21/11/2024 rtpapadmdrn 45 45 Obstetric History Term Gravida Number of full-term infants born (infants born at 37 weeks or after) number of pregnancies including present Preterm pregnancy Number of preterm infants born (infants born before 37 weeks) Para Abortion Number of pregnancies Number of spontaneous miscarriages or therapeutic that have reached abortions viability, regardless of whether the infants were Living born alive Number of living children Multiple Multiple pregnancies 21/11/2024 rtpapadmdrn 46 46 23  25/11/2024 21/11/2024 rtpapadmdrn 47 47 SIGNS INDICATING COMPLICATIONS OF PREGNANCY 21/11/2024 rtpapadmdrn 48 48 24  25/11/2024 SIGNS INDICATING COMPLICATIONS Vaginal Bleeding Persistent Vomiting Chills and Fever Sudden Escape of Clear Fluid From the Vagina Pregnancy-Induced Hypertension Increase or Decrease in Fetal Movement 21/11/2024 rtpapadmdrn 49 49 HEALTH PROMOTION DURING PREGNANCY 21/11/2024 rtpapadmdrn 50 50 25  25/11/2024 HEALTH PROMOTION DURING PREGNANCY Self-Care Needs Sexual Activity help separating fact from fiction Hx of spontaneous miscarriage Bathing have ruptured or vaginal spotting Tub baths are restricted side-by-side position Dental Care Love on top Routine OP Exercise Perineal Hygiene walking is best Prevent douching Swimming Clothing Recommend loose-fitting, comfortable garments 21/11/2024 rtpapadmdrn 51 51 Discomforts of Early Pregnancy: The First Trimester Breast Tenderness Palmar Erythema Constipation Nausea, Vomiting, and Pyrosis Muscle Cramps 21/11/2024 rtpapadmdrn 52 52 26  25/11/2024 Discomforts of Early Pregnancy: The First Trimester Hypotension Varicosities Hemorrhoids Frequent Urination Kegel Exercises strengthen the pubococcygeal muscles 21/11/2024 rtpapadmdrn 53 53 Discomforts of Middle to Late Pregnancy Backache lumbar lordosis develops Pelvic rocking or tilting Dyspnea uterus places pressure on the diaphragm 21/11/2024 rtpapadmdrn 54 54 27  25/11/2024 Discomforts of Middle to Late Pregnancy Ankle Edema normal occurrence in pregnancy so long as no proteinuria Braxton Hicks Contractions 8th to 12th week AOG Non pathological uterine contractions 21/11/2024 rtpapadmdrn 55 55 Teratogenic Maternal Infections 21/11/2024 rtpapadmdrn 56 56 28  25/11/2024 Toxoplasmosis protozoan infection spread most commonly with uncooked meat through handling cat stool in soil or cat litter S/Sx: (almost no symptoms) few days of malaise and posterior cervical lymphadenopathy if the infection crosses the placenta = could lead to CNS damage Tx: sulfonamides or Pyrimethamine 21/11/2024 rtpapadmdrn 57 57 Rubella causes only a mild rash and mild systemic illness in a woman but the teratogenic effects on a fetus can be devastating hearing impairment, cognitive and motor challenges, cataracts, cardiac defects woman who is not immunized before pregnancy cannot be immunized during pregnancy If planning to get pregnant have immunization After a rubella immunization, a woman is advised not to become pregnant for 3 months 21/11/2024 rtpapadmdrn 58 58 29  25/11/2024 Cytomegalovirus member of the herpes virus family, is another teratogen that can cause extensive damage to a fetus infant may be born severe neurologically challenged (hydrocephalus, microcephaly, spasticity) or with eye damage (optic atrophy) no treatment for the even if it presents in the mother with enough symptoms to allow detection 21/11/2024 rtpapadmdrn 59 59 Herpes Simplex Virus (Genital Herpes Infection) virus spreads into the bloodstream (viremia) and crosses the placenta to a fetus posing substantial fetal risk first trimester: severe congenital anomalies or spontaneous miscarriage second or third trimester: premature birth intrauterine growth restriction infection of the newborn at birth Treatment: Intravenous or oral acyclovir (Zovirax) can be administered to women during pregnancy If genital lesions at time of birth= C-section is advised 21/11/2024 rtpapadmdrn 60 60 30  25/11/2024 Syphilis fetus at risk for intrauterine or congenital syphilis If treated with benzathine penicillin in the first trimester a fetus is rarely affected. If left untreated beyond the 18th week of gestation hearing impairment, cognitive challenge, osteochondritis, and fetal death are possible. 21/11/2024 rtpapadmdrn 61 61 21/11/2024 rtpapadmdrn 62 62 31  25/11/2024 Nutritional Health During Pregnancy A weight gain of 11.2 to 15.9 kg (25 to 35 lb) is recommended as an average weight gain in pregnancy. 21/11/2024 rtpapadmdrn 63 63 Energy (Calorie) Needs The DRI of calories for women of childbearing age is 2200. An additional 300 calories, or a total caloric intake of 2500 calories, is recommended. 21/11/2024 rtpapadmdrn 64 64 32  25/11/2024 Protein Needs The DRI for protein in women is 46 g/d. During pregnancy, the need for protein increases to 71 g daily. Vitamin Needs Requirements for both fat-soluble and water-soluble vitamins increase during pregnancy Most vitamins comes with Folic Acid which is essential for fetal health 21/11/2024 rtpapadmdrn 65 65 Mineral Needs and Fluid Calcium and Extra amounts of water Phosphorus are needed during pregnancy Iodine Promote kidney Iron function Zinc 21/11/2024 rtpapadmdrn 66 66 33  25/11/2024 Preparing a Family for Childbirth 21/11/2024 rtpapadmdrn 67 67 Perineal and Abdominal Exercises Tailor Sitting 15 minutes every day stretches perineal muscles without occluding blood supply to the lower legs By 3rd trimester a woman’s perineum should be so supple that when she tailor sits, her knees will almost touch the floor if pushed. 21/11/2024 rtpapadmdrn 68 68 34  25/11/2024 Perineal and Abdominal Exercises Squatting also stretches perineal muscles useful position for second-stage labor Practice 15 minutes a day For pelvic muscles to stretch, a woman should keep her feet flat on the floor. Incorporating squatting into daily activities such as picking up toys reduces the amount of time a woman must devote to daily exercises. 21/11/2024 rtpapadmdrn 69 69 Perineal and Abdominal Exercises Kegel Exercises tighten the muscles of perineum strengthen the pubococcygeal muscles and bulbocavernosus 1. Hold for 3 seconds. Relax. Repeat this sequence 10 times. 2. Contract and relax the muscles surrounding the vagina as rapidly as possible 10 to 25 times. 3. Imagine that you are sitting in a bathtub of water and squeeze muscles as if sucking water into the vagina. Hold for 3 seconds. Relax. Repeat this action 10 times. 21/11/2024 rtpapadmdrn 70 70 35  25/11/2024 Perineal and Abdominal Exercises Pelvic Rocking helps relieve backache during pregnancy and early labor making the lumbar spine more flexible. increases flexibility and helps relieve back pain Holds the position for 1 minute, then hollows her back. Do it five times a day 21/11/2024 rtpapadmdrn 71 71 Perineal and Abdominal Exercises Water exercise is the best for maintaining cardiovascular fitness without stressing the body since the buoyancy of the water lessens the impact on joints and ligaments. Water's mild resistance helps to increase muscle strength and flexibility. 21/11/2024 rtpapadmdrn 72 72 36  25/11/2024 PREPARATION FOR LABOR 21/11/2024 rtpapadmdrn 73 73 Preliminary Signs of Labor Lightening Show Lightening is the settling of the fetal Show is the common term head into the inlet of the true pelvis. used to describe the release of It occurs approximately 2 weeks the cervical plug (operculum) before labor in primiparas but at It consists of a mucous, often unpredictable times in multiparas. blood-streaked vaginal A woman notices she is not as short discharge and indicates the of breath beginning of cervical frequency of urination or sciatic dilatation. pain (pain across a buttock radiating Keep monitoring until there is down her leg) regular contraction 21/11/2024 rtpapadmdrn 74 74 37  25/11/2024 Preliminary Signs of Labor Excess Energy Ripening of the Cervix It occurs as part of the body’s Internal examination physiologic preparation for labor. Goodell’s sign If she can recognize she can Earlobe consistency throughout conserve energy in preparation for pregnancy labor. Ripened Cervix If not recognize she may use this Cervix becomes softer (“butter-soft”) burst of energy in chores and Indicating true labor is close exhaust herself before labor begins. 21/11/2024 rtpapadmdrn 75 75 Preliminary Signs of Labor Braxton Hicks Contractions In the last week or days: May feel extremely strong Braxton Hicks contractions These are false contractions and doesn’t require admission Keep on monitoring until true labor contractions occur 21/11/2024 rtpapadmdrn 76 76 38  25/11/2024 Signs of TRUE Labor Show Show is the common term used to describe the release of the cervical plug (operculum) It consists of a mucous, often blood-streaked vaginal discharge and indicates the beginning of cervical dilatation. Keep monitoring until there is regular contraction 21/11/2024 rtpapadmdrn 77 77 Signs of TRUE Labor Uterine Contractions surest sign that labor has begun is productive uterine contractions. contractions last about 30 to 70 seconds and come about 5 to 10 minutes apart 21/11/2024 rtpapadmdrn 78 78 39  25/11/2024 Signs of TRUE Labor Rupture of the Membranes A sudden gush of clear fluid (amniotic fluid) from the vagina Rush to the primary care provider immediately Possible danger of cord prolapse and uterine infection. 21/11/2024 rtpapadmdrn 79 79 COMPONENTS OF LABOR 21/11/2024 rtpapadmdrn 80 80 40  25/11/2024 1. Passage A woman’s pelvis (the passage) is of adequate size and contour. Two measurements: diagonal conjugate (anteroposterior) transverse diameter 21/11/2024 rtpapadmdrn 81 81 2. Passenger The passenger (the fetus) is of appropriate size and in an advantageous position and presentation. Fetal Biparietal diameter should present in maternal anteroposterior diameter to allow engagement Degree of flexion Suboccipitobregmatic Occipitofrontal occipitomental 21/11/2024 rtpapadmdrn 82 82 41  25/11/2024 Passenger: Fetal Attitude 21/11/2024 rtpapadmdrn 83 83 Passenger: Station refers to the relationship of the presenting part of a fetus to the level of the ischial spines 0 station (synonymous with engagement) “floating” presenting part that is not engaged is said to be “dipping” One that is descending but has not yet reached the ischial spines 21/11/2024 rtpapadmdrn 84 84 42  25/11/2024 Passenger: Fetal Lie Lie Presentation relationship between the Cephalic long (cephalocaudal) axis of Needs continuous Valsalva the fetal body and the long during delivery (cephalocaudal) axis of a Breach woman’s body buttocks or feet Horizontal (transverse) Shoulder Vertical (longitudinal) If small fetus manual rotation If normal or big Consider C-section 21/11/2024 rtpapadmdrn 85 85 3. The powers of labor Uterine Contractions Dilatation effective uterine contractions is enlargement or widening of the rhythmicity and progressive cervical canal lengthening and intensity. few millimeters wide to full Cervical Changes dilatation (approximately 10 cm) Effacement shortening and thinning of the cervical canal Approx 1 – 2 cm dilatation In primi effacement before dilatation In multi possible dilatation may proceed before effacement 21/11/2024 rtpapadmdrn 86 86 43  25/11/2024 4. Psyche Refers to the psychological Feeling of apprehension or state or feelings fright Excitement or awe without adequate support can have an experience so strong sense of self-esteem and frightening and stressful a meaningful support person can develop a posttraumatic stress syndrome 21/11/2024 rtpapadmdrn 87 87 STAGES OF LABOR 21/11/2024 rtpapadmdrn 88 88 44  25/11/2024 First Stage TRUE LABOR to Full dilatation Lumbar epidural block may be administered Latent phase onset of regularly uterine contractions and ends when rapid cervical dilatation Active phase cervical dilatation 4 to 7 cm Contractions 40 to 60 seconds, 3 to 5 mins interval Transition phase cervical (full) dilatation 9 to 10 cm Full effacement Contractions 60 to 90 seconds, 2 to 3 mins interval 21/11/2024 rtpapadmdrn 89 89 Second Stage from full dilatation and cervical effacement to birth of the infant Pudendal block may be administered Crowning takes place episiotomy Midline Mideolateral WOF signs of uterine Tetany!!! 21/11/2024 rtpapadmdrn 90 90 45  25/11/2024 Third Stage the placental stage Signs of Placental Separation approximately 5 minutes Lengthening of the cord after the birth of the infant Sudden gush of blood Change in the shape of the uterus birth of the infant to Firm contraction of the uterus delivery of the placenta Appearance of the placenta at the vaginal opening Two phases: Schultze placental separation Separate at center first placental expulsion Duncan Valsalva or by Crede’s Separate from edge first Manual evacuation oxytocin 21/11/2024is usually ordered to be administered rtpapadmdrn intramuscularly or intravenously 91 91 Fourth Stage first few hours after birth Perineal Repair 21/11/2024 rtpapadmdrn 92 92 46  25/11/2024 Phases of the Puerperium 21/11/2024 rtpapadmdrn 93 93 Taking-In Phase time of reflection 2- to 3-day period Mother is passive Dependency in activity usually wants to talk about her pregnancy rather than new role Expressed little interest in caring for her child holds her new child with a sense of wonder 21/11/2024 rtpapadmdrn 94 94 47  25/11/2024 Taking-Hold and Letting Go Taking-Hold Phase Letting-Go Phase begins to initiate action woman finally redefines her begins to take a strong interest new role for her child 21/11/2024 rtpapadmdrn 95 95 Pregnancy Complication 21/11/2024 rtpapadmdrn 96 96 48  25/11/2024 Diabetes Mellitus Patient with DM Decrease insulin need in early pregnancy Increase insulin as pregnancy progresses (24th week) Type 1 is of higher risk of birth defects GDM Midpoint of pregnancy there is occurrence insulin resistance and degradation Due to Hormone human placental lactogen (chorionic somatomammotropin) and high levels of cortisol, estrogen, progesterone, and catecholamines. Placental Insulinase may cause increased breakdown or degradation of insulin. symptoms fade again at the completion of pregnancy risk of developing type 2 diabetes later in life 21/11/2024 rtpapadmdrn 97 97 Bleeding During Pregnancy 21/11/2024 rtpapadmdrn 98 98 49  25/11/2024 21/11/2024 rtpapadmdrn 99 99 21/11/2024 rtpapadmdrn 100 100 50  25/11/2024 21/11/2024 rtpapadmdrn 101 101 Ectopic Pregnancy 2nd most frequent cause of bleeding early in pregnancy Sites: Fallopian tube – most common Surface of uterus Cervix S/Sx: sharp, stabbing pain in one of her lower abdominal quadrants at the time of rupture scant vaginal spotting. 21/11/2024 rtpapadmdrn 102 102 51  25/11/2024 Ectopic Pregnancy If raptured early No treatment required as it will be reabsorbed If raptured late WOF for signs of shock Hemorrhage management Laparoscopy and ligation of bleeding site If failed to rupture Methotrexate folic acid antagonist chemotherapeutic agent Mifepristone, an abortifacient If Rh(-) mother: give Rhogam 21/11/2024 rtpapadmdrn 103 103 Placenta Previa is a condition of pregnancy in which the placenta is implanted abnormally in the uterus. most common cause of painless bleeding in the third 3rd of pregnancy 21/11/2024 rtpapadmdrn 104 104 52  25/11/2024 Placenta Previa cautioned to avoid coitus to get adequate rest Report any sign of vaginal bleeding Management: Side lying Bed rest Preterm labor is apparent due to bleeding 21/11/2024 rtpapadmdrn 105 105 Abruptio Placenta primary cause: unknown Predisposing factors: high parity advanced maternal age, short umbilical cord chronic hypertensive disease pregnancy-induced hypertension direct trauma 21/11/2024 rtpapadmdrn 106 106 53  25/11/2024 Abruptio Placenta S/Sx: sharp, stabbing pain. high in the uterine fundus Heavy bleeding If blood infiltrates the uterine musculature Couvelaire uterus or uteroplacental apoplexy, forming a hard, boardlike uterus DIC syndrome can occur 21/11/2024 rtpapadmdrn 107 107 PREGNANCY-INDUCED HYPERTENSION 21/11/2024 rtpapadmdrn 108 108 54  25/11/2024 PIH is a condition in which vasospasm occurs during pregnancy in both small and large arteries Cause: Unknown Maybe related to antiphospholipid syndrome or the presence of antiphospholipid antibodies CLASSIC SIGNS: hypertension, proteinuria, and edema 21/11/2024 rtpapadmdrn 109 109 PIH Risk Factor: occur most frequently in women of color Multiple pregnancy primiparas younger than 20 years or older than 40 years women from low socioeconomic backgrounds those who have had five or more pregnancies 21/11/2024 rtpapadmdrn 110 110 55  25/11/2024 PIH Classification Gestational hypertension elevated blood pressure (140/90 mm Hg) but has no proteinuria or edema Preeclampsia Classic signs are present Eclampsia Classic signs + seizure cerebral edema is so acute that a grand-mal seizure (tonic-clonic) or coma occurs 21/11/2024 rtpapadmdrn 111 111 PIH management Low dose aspirin and monitor Antiplatelet Therapy Promote Bed Rest Monitor Fetal Well-being Support a Nutritious Diet Medication: hydralazine (Apresoline), labetalol, nifedipine Magnesium sulfate - Muscle relaxant via piggyback infusion over 15–30 min Diazepam (Valium) 21/11/2024 rtpapadmdrn 112 112 56  25/11/2024 21/11/2024 rtpapadmdrn 113 113 57