Maternal and Child FINALS REVIEWER PDF

amniocentesis technique is a primary test of fetal maturity. FETAL RESPIRATORY SYSTEM Respiratory distress syndrome, a severe breathing At the third week of intrauterine life, the resp...

amniocentesis technique is a primary test of fetal maturity. FETAL RESPIRATORY SYSTEM Respiratory distress syndrome, a severe breathing At the third week of intrauterine life, the respiratory disorder can develop if there is lack of surfactant or and digestive tracts exist as a single tube it has not changed to its mature form at birth By the end of the fourth week, a septum begins to Synthetically increasing steroid levels in the fetus divide the esophagus from the trachea at the same (the administration of betamethasone to the time, lung buds appear on the trachea. mother) can hurry alveolar maturation and Until the seventh week of life, the diaphragm does surfactant production not completely divide the thoracic cavity from the abdomen If the diaphragm fails to close completely, the stomach FETAL NERVOUS SYSTEM spleen, liver, or intestines may be pulled up into the The nervous system begins to develop extremely thoracic cavity. This causes the child to be born early in pregnancy. During the third and fourth with a diaphragmatic hernia or with intestine weeks of intrauterine life, possibly before the present in the chest, compromising the lungs and woman even realizes she is pregnant active perhaps displacing the heart formation of the nervous system and sense organs has already begun Alveoli and capillaries begin to form between the 24th and 28th weeks Both capillary and alveoli The neurologic system seems particularly prone to development must be complete before gas insult during the early weeks of the embryonic exchange can occur in the fetal lungs. period. Surfactant - a phospholipid substance, is formed Spinal cord disorders such as meningocele and excreted by the alveolar cells at about the 24th (herniation of the meninges) may occur because of week of pregnancy. This decreases alveolar lack of folic acid (Contained in green leafy surface tension on expiration, preventing alveolar vegetables and pregnancy vitamins) collapse and improving the infant's ability to maintain respirations in the outside environment Surfactant has two components: lecithin (L) and sphingomyelin (S) At about 35 weeks, there is a surge in the production of lecithin, which then becomes the chief component by a ratio of 2:1 As a fetus practices breathing movements, surfactant mixes with amniotic fluid FETAL ENDOCRINE SYSTEM Analysis of the L/S ratio regarding whether lecithin As soon as endocrine organs mature in intrauterine or sphingomyelin is the dominant component by life, function begins.   The fetal adrenal glands supply a precursor Ossification (also called osteogenesis or bone necessary for estrogen synthesis by the mineralization) in bone remodeling is the process of placenta laying down new bone material by cells named osteoblasts  The Fetal pancreas produces insulin needed by the fetus Ossification continues all through fetal life and actually until adulthood. Carpals, tarsals, and  (insulin is one of the few substances that sternal bones generally do not ossify until birth is does not cross the placenta from the mother imminent. A fetus can be seen to move on an to the fetus). ultrasound as early as the 11th week  The thyroid and parathyroid glands play vital roles in fetal metabolic function and calcium balance.  The digestive tract separates from the respiratory tract at about the fourth week of intrauterine life and, after that begins to grow extremely rapidly, initially solid, the tract canalizes (hollows out) to become patent. Meconium: a collection of cellular wastes, bile, FETAL REPRODUCTIVE SYSTEM fats, mucoproteins, mucopolysaccharides, and portions of the vernix caseosa, the lubricating If a woman takes an androgen or an androgen-like substance that forms on the fetal skin, accumulates substance during this stage of pregnancy, a child in the intestines as early as the 16th week. who is chromosomally female could appear more Meconium is sticky in consistency and appears male than female at birth. black or dark green If deficient testosterone is secreted by the testes, both the female duct and the male duct could develop (pseudo-hermaphroditism, or intersex) The FETAL MUSCUSKELETAL SYSTEM testes first form in the abdominal cavity and do not The liver is active throughout gestation, functioning descend into the scrotal sac until the 34th to 38th as a filter between the incoming blood and the fetal week. Because of this, many male preterm infants circulation and as a deposit site for fetal stores are born with undescended testes. Surgery is such as iron and glycogen, but is still immature at necessary as undescended testes are associated birth. The liver does not prevent recreational drugs with poor sperm production and testicular cancer or alcohol ingested by the mouth from entering the fetal circulation Two possible digestive complications or serious problems may develop in first 24 hours after birth are hypoglycemia and hyperbilirubinemia First 2 weeks of fetal life:  cartilage prototypes provide position and support. Ossification of this cartilage into bone begins at about the 12th week. FETAL URINARY SYSTEM FETAL IMMUNE SYSTEM Although rudimentary kidneys are present as early Immunoglobulin G (lgG) maternal antibodies cross as the end of the fourth week of intrauterine life, the the placenta into the fetus as early as the 20th presence of kidneys does not appear to be week and certainly by the 24th week of intrauterine essential for life before birth because the placenta life to give a fetus temporary passive immunity clears the fetus of waste products against diseases for which the mother has Urine is formed by the 12th week and is excreted antibodies. The level of these acquired passive into the amniotic fluid by the 16th week of 1gG immunoglobulins peaks at birth and then gestation. At term, fetal urine is being excreted at decreases over the next 8 months as the infant the rate of 500 mU/day. builds up his or her own stores of lgG, as well as IgA and IgM. An amount of amniotic fluid that is less than normal suggests that fetal kidneys are not secreting adequate urine The skin of a fetus appears thin and almost AMNIOCENTESIS translucent until subcutaneous fat begins to be Amniocentesis is the aspiration of amniotic fluid deposited at about 36 weeks. Skin is covered by from the pregnant uterus for examination It is soft downy hairs (lanugo) that serve as insulation to typically scheduled between the 14th and I6th preserve warmth in utero and a cream cheese-like weeks of pregnancy Amniocentesis is a technically substance, vernix caseosa, which is important for easy procedure, but it can be frightening to a lubrication and for keeping the skin from woman. macerating in utero. NURSING CONSIDERATIONS In preparation for amniocentesis, ask the woman to void to reduce the size of the bladder and prevent an inadvertent puncture place her in a supine position on an examining table and drape her appropriately, exposing only her abdomen. Place a folded towel under her right buttock to tip her body  help increase a couple's overall enjoyment slightly to the left and move the uterus off the vena of and satisfaction with the childbirth cava, to prevent supine hypotension syndrome. experience Attach fetal heart rate and uterine contraction monitors Take her blood pressure and measure the In addition to teaching about normal labor, they fetal heart rate for baseline levels include several exercises to ready the body for labor, as well as methods of pain prevention or pain relief in labor. FETUS A biophysical profile combines: PRENATAL YOGA  five parameters  helping a woman relax and manage stress better for all times in her lite, not just  fetal reactivity pregnancy  fetal breathing movements  yoga exercises help a woman stay overall fit  fetal body movement by their focus on gentle stretching and deep breathing  fetal tone  amniotic fluid volume PERINEAL AND ABDOMINAL EXERCISES Supple perineal muscles allow for stretching during birth, reduce discomfort, and help muscles revert more quickly to their normal condition and function Biophysical profiles may be done as often as daily more efficiently after childbirth during a high-# pregnancy. If the fetus score on a complete profile is 8-10, the fetus is considered to A pregnant woman should not participate in a be doing well. A score of 6 is considered formal exercise program without their physician’s, suspicious; a score of 4 denotes a fetus probably in nurse’s, or midwife’s approval and any danger jeopardy. signs of pregnancy that are present, and shouldn’t exercise that causes fatigue PREPARING A FAMILY FOR CHILDBIRTH TAILOR SITTING mainly on explaining the birth process rather than pregnancy and ways to prevent or reduce the pain it is done in a way that stretches perinium muscles of childbirth. common goals of preparation are to without occluding blood supply to the lover les prepare an expectant woman and her support person for the childbirth experience a woman should not put one ankle on top of the other but should place one leg in front of the other.  create clients who are knowledgeable As she sits in this position, she should gently push consumers of obstetric care on her knees toward the floor until she feels her perineum stretch. If is good to plan on sitting in this  help women reduce and manage pain with position for at least 15 minutes every day. both pharmacologic and nonpharmacologic methods SQUATTING mother or fetus or newborn should have a complication Squatting also stretches perineal muscles and can be a useful position for second-stage labor. Should be practiced 15 minutes a day for the pelvic muscles to stretch and keep the feet flat on the floor ALTERNATIVE BIRTHING CENTERS (АВС) designed to remove childbirth from the acute care PELVIC FLOOR CONTRACTIONS hospital setting while still providing enough medical resources for emergency care should a (KEGEL EXERCISES) complication of labor or birth arise. The birth attendants tend to be nurse-midwives. perineal muscle-strengthening exercises are helpful in the postpartum period to reduce pain and ADVANTAGES OF ABC'S promote perineal healing A woman is encouraged to be prepared to control the discomfort of ABDOMINAL MUSCLE CONTRACTIONS labor through nonmedication measures such as controlled breathing. help strengthen abdominal muscles during pregnancy and may help prevent constipation as A woman is encouraged to be knowledgeable well as help restore abdominal tone after about the labor process and to help care providers pregnancy with decision making. A woman is encouraged to consider breastfeeding to aid uterine contraction and infant bonding after THE BIRTH SETTING birth. Women having uncomplicated pregnancies may Family integrity can be maintained because family choose hospitals, birthing centers, or their homes members may accompany a woman to the birthing as settings for birth. center. Women with high-risk pregnancies have less choice: DISADVANTAGES OF ABC'S women with potential complications are advised to give birth at hospitals where immediate emergency Extended high-risk care is not immediately care will be available available A woman may be fatigued after birth because of brief health care setting stay HOSPITAL BIRTH She must independently monitor her postpartal major advantage of a hospital is that equipment status because of brief health care setting stay and expert personnel are readily available if the  DIFFERENTIATION BETWEEN TRUE AND FALSE LABOR CONTRACTIONS False Labor  Begin and remain irregular Felt first abdominally and remain confined to the НОМЕ BIRTH abdomen and groin. Often disappear with ambulation or sleep. Do not increase in a woman must be in good health, must be able to duration, frequency, or intensity. Do not adjust to changing circumstances, and must have achieve cervical dilatation. adequate support people who will sustain her during labor and assist her for the first few days True Labor after birth. Women with any complication of  begin irregularly but become regular and pregnancy are not candidates for home birth. predictable Women with any complication of pregnancy are not  felt first in lower back and sweep around to candidates for home birth the abdomen in a wave  continue no matter what the woman's level THEORIES OF LABOR of activity 1 - Uterine muscle stretching, which results in  increase of duration, frequency, and release of prostaglandins intensity 2 - Pressure on the cervix, which stimulates the  achieve cervical dilatation release of oxytocin from the posterior pituitary 3 - Oxytocin stimulation, which works together with COMPONENTS OF LABOR prostaglandins to initiate contractions 1) THE PASSAGE 4 - Change in the ratio of estrogen to progesterone 2) THE PASSENGER 5 - Placental age, which triggers contractions at a set point 3) POWERS 6 - Rising fetal cortisol levels, which reduces 4) PSYCHOLOGICAL OUTLOOK progesterone formation and increases prostaglandin formation 7 - Fetal membrane production of prostaglandin, which stimulates contractions THE PASSAGE  refers to the route a fetus must travel from the uterus through the cervix and vagina to  the external perineum Because the cervix suture lines are crucial in birth as membranous and vagina are contained inside the pelvis, interspaces that allows cranial bones to move and a fetus must also pass through the bony overlap molding so that it can pass through the pelvic ring birth canal more readily THE PASSENGER  is the fetus; the head is the widest diameter and is the part least likely to pass through the pelvic ring  a fetal skull can pass depends on both structure (bones, fontanelles, and suture lines) and its alignment with the pelvis POWERS OF LABOR  supplied by the funds of the uterus, implemented by uterine contractions; a natural process that causes cervical dilatation and then expulsion of the fetus from the uterus fontanelles: found at the junction of the main suture lines; membrane-covered spaces PSYCHE anterior fontanelle (bregma): diamond shaped;  refers to the psychological state that a lies at the junction of the coronal and sagittal woman brings into labor sutures. Closes when the infant is 12 – 18 mos.  posterior fontanelle: triangular shaped; lies at the THE FETAL SKULL junction of the lambdoidal and sagittal sutures. Due to its small size, it closes when an infant is about 2  composed of 8 bones which are crucial in months of age childbirth; other 4 bones of the skull (sphenoid, ethmoid, and two temporal bones) lie at the base of the cranium MOLDING sagittal sutures: joins two parietal bones of the  Molding is a change in the shape of the skull fetal skull produced by the force of uterine contractions pressing the vertex of the coronal suture: the line of juncture of the frontal dead against the not-yet-dilated cervix. bones and two parietal bones  Parents can be reassured that molding lambdoid sutures: the line of the juncture of the only lasts a day or two and is not a occipital bone and the two parietal bones permanent condition.   Two other factors play a part in whether a fetus is lined up in the best position to be born: Fetal Presentation and Position ENGAGEMENT AND STATION  Engagement refers to the settling of the presenting part of a fetus far enough into the pelvis to be at the level of the ischial spines, a midpoint of the pelvis.  A presenting part that is not engaged is ATTITUDE said to be "floating." One that is  Attitude describes the degree of flexion a descending but has not yet reached the fetus assumes during labor or the relation ischial spines is said to be "dipping." of the fetal parts to each other.  Station refers to the relationship of the  A fetus in good attitude is in complete presenting part of a fetus to the level of flexion: the spinal column is bowed the ischial spines. forward, the head is flexed forward so much that the chin touches the sternum, the arm are flexed and folded on the chest, the thighs are flexed onto the abdomen, and the calves are pressed against the posterior aspect of the thighs. FETAL LIE  Lie is the relationship between the long (cephalocaudal) axis of the fetal body and the long (cephalocaudal) axis of a woman's body; in other words, whether the fetus is lying in a horizontal  (transverse) or a vertical (longitudinal) position TYPES OF FETAL PRESENTATION  Fetal presentation denotes the body part that will first contact the cervix or be born first. This is determined by a combination of fetal lie and the degree of fetal flexion (attitude).  Cephalic Presentation  Breech Presentation  Shoulder Presentation CEPHALIC PRESENTATION  A cephalic presentation is the most frequent type of presentation, occurring as BREECH PRESENTATION often as 95% of the time. The four types  A breech presentation means that either of cephalic presentation are vertex, bra the buttocks or the feet are the first body face, and mentum. parts that will contact the cervix Breech During labor, the area of the fetal skull that contacts the presentations occur: approximately 3%. cervix often becomes edematous from the continued Three types of breech presentation pressure against it. This edema is called a caput (Complete, frank, and footing) are succedaneum. In the newborn, the point of presentation possible. can be analyzed from the location of the caput SHOULDER PRESENTATION  In a transverse lie, a fetus lies horizontally in the pelvis so that the longest fetal axis is perpendicular to that of the mother. The presenting part is usually one of the  shoulders, an iliac crest, a hand, or an elbow. CERVICAL EFFACEMENT AND DILATATION Effacement  Is shortening and thinning of the cervical canal. Normally, the canal is MECHANISMS (CARDINAL MOVEMENTS) approximately 1 to 2 cm long. With OF LABOR effacement, the canal virtually disappears  Passage of a fetus through the birth canal involves several different position changes to keep the smallest diameter of the fetal head always presenting to the smallest diameter of the pelvis. These position Dilatation changes are termed the cardinal movements of labor.  refers to the enlargement or widening of the cervical canal from an opening a few millimeters wide to one large enough (approximately 10 cm) to permit passage of a fetus STAGES OF LABOR  Labor is traditionally divided into three stages   The first 1 to 4 hours after birth of the ACTIVE PHASE placenta is sometimes termed the "fourth  Cervical dilation occurs more rapidly and stage" to emphasize the importance of the increasing from 4 – 7 cm close maternal observation needed at this time.  Contractions grow stronger and lasts 40 – 60 seconds and occurs every 3 – 5 mins.  This phase lasts 3 hours in a nullipara and 1ST STAGE 2 hours in a multipara: spontaneous  Begins with the initiation of true labor rupture occurs contractions and ends when the cervix is TRANSITION PHASE fully dilated  Contractions occurring every 2 – 3 3 separate divisions: latent, active, transition minutes with a duration of 60 – 90 phase seconds  Cervical dilation of 8 – 10 cm  If the membranes have not previously ruptured or been ruptured by amniotomy, they will rupture as a rule at a full dilatation  This cause the woman an intense discomfort, nausea and vomiting, feeling of loss of control, anxiety, panic, or irritability  Focus is on the task of birthing the baby LATENT PHASE (PREPARATORY PHASE) 2ND STAGE  The onset of regularly perceived uterine  The period from full dilatation and cervical contractions and ends when rapid cervical effacement to birth of the infant; with such dilatation begins force that she perspires and blood vessels in neck may be distended  Contractions are from 20 – 40 seconds; mild and short Crowning: the opening is slit-like; becomes oval then circular. The circle enlarges from the size of  Cervical effacement occurs and the cervix a dime then a quarter then half a dollar dilates from 0 – 3 cm  Interval of each contraction is 5 – 20 mins.  This phase lasts 6 hours in a nullipara and 4.5 hours in a multipara 3RD STAGE (PLACENTAL STAGE)  Birth of the infant and ends with the delivery of the placenta 3RD STAGE (PLACENTAL EXPULSION) 2 phases: Placental Separation and Placental Crede’s maneuver: after separation, placenta is Expulsion delivered either by the natural bearing-down effort of the mother or by gentle pressure on the contracted uterine fundus by a physician or nurse  After the birth of an infant, uterus midwife becomes firm as palpated, round mass just inferior to the level of the umbilicus  Pressure must never be applied to a uterus in a noncontracted state, it may  After few minutes of rest, uterine cause the uterus to evert and hemorrhage contractions begin again and the organ assumes a discoid shape M 3RD STAGE (PLACENTAL SEPARATION)  The following signs indicate that the placenta has loosened and is ready to deliver:  Lengthening of the umbilical cord  Sudden gush of vaginal blood  Change in the shape of the uterus  Firm contraction of the uterus  Appearance of the placenta at the vaginal opening