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Notes for Maternity
Maternity/Pediatrics (NURS 4130)
Nova Southeastern University
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Signs of pregnancy Chadwicks sign o Bluish-purple discoloration of the vaginal mucosa and cervix Goodell’s sign o Softening of the cervix Hegar’s sign o Softening of the lower uterine segment or isthmus Presumptive Signs Fatigue Breast tenderness Nausea and vomiting Amenorrhea Urinary frequency Hyperpigmentation of the skin Fetal movements Uterine enlargement Breast enlargement
Probable signs Braxton hicks contractions Positive pregnancy test Abdominal enlargement Ballottement Goodell’s sign Chadwick’s sign Hegars sign
Positive Signs Ultrasound verification of embryo Fetal movement felt by experienced clinician Auscultation of fetal heart tones via doppler
Period of greatest environment sensitivity Greatest consequent risk developing embry 17 to 56 days after conception
Menstrual history Nagelle Rule 9 months + 7 days Or subtract 3 months from last day of menstrual period, add 7 days, and 1 year.
Encourage folic acid (6oo mcg) *prenatals with folic acid to prevent neural tube defects
Elevated levels of maternal serum AFP or amniotic fluid AFP were first linked to the occurrence of fetal neural tube defects.
Follow up visits Every 4 weeks up to 28 weeks Every 2 weeks from 29 to 36 weeks Every week from 37 weeks to birth
First trimester discomforts Nausea and vomiting Urinary frequency or incontinence Constipation Breast tenderness Nasal stuffiness, bleeding gums, epistaxis Cravings Leukorrhea
Second trimester discomforts Backache Varicosities of the vulva and legs Hemorrhoids Flatulence with bloating
Third trimester Return of first trimester discomforts SOB and dyspnea Heartburn and indigestion Dependent edema Braxton hick’s contractions
Amenorrhea Absence of menses during reproductive years Two types of primary amenorrhea o Absence of menses by age 14 with absence of development of secondary sexual characteristics.
DUB (dysfunctional uterine bleeding) Occurs most often at the beginning and end of the menstrual cycle. Etiology related to hormone disturbance
Premenstrual Syndrome More serve variant: Premenstrual Dysphoric disorder *Multidimensional approach
HELLP
Hemolysis, elevated liver enzymes, low platelets Nursing assessment: similar to that for sever preeclampsia
Blood incompatibility ABO incompatibility: Type O mothers and fetuses with type A or B blood Rh incompatibility: Exposure of Rh-negative mother to Rh-positive fetal blood RhoGAM @ 28 weeks and 72 hours after birth
Hydramnios Amniotic fluid > 2,000 mL Therapeutic management: close monitoring; removal of fluid, indomethacin Amniocentesis
Oligohydramnios < 500 mL of amniotic fluid Amnioinfusion Fluid leaking from vagina Nursing management – assist with amnioinfusion.
Premature Rupture of Membrane ( WATER BREAKING)
Treatment: no unsterile digital cervical exams until woman is in active labor Expectant management if fetal lungs are immature Nitrazine test, fern test, ultrasound
Neonatal Abstinence Syndrome Harmful effect of heroin and other narcotics on newborns is withdrawal, or neonatal abstinent syndrome. This collection of symptoms may include irritability, hypertonicity, jitteriness, fever, excessive and often high-pitched cry, vomiting, diarrhea, feeding disturbances, respiratory distress, excessive sneezing and yawning
Factors influencing the onset of labor Uterine stretch Progesterone withdrawal
Increased oxytocin sensitivity Increased release of prostaglandins
Premonitory signs of labor Cervical changes Lightening Increased energy level Bloody show Braxton Hicks contractions Spontaneous rupture of membranes
True vs False Labor Contraction timing Contraction strength Contraction discomfort Change in contraction activity
Stages of Labor First stage: true labor to complete cervical dilation Consists of two stages: Latent phase Active phase
Second stage: cervix 10 cm dilated to birth of baby
Third stage: birth of infant to placental separation - Placental separation - Placental expulsion Fourth stage: 1 to 4 hours following delivery
Signs of placental separation The uterus rises upward The umbilical cord lengthens A sudden trickle of blood is released from the vaginal opening The uterus changes its shape to globular
Omphalocele A defect of the umbilical ring that allows evisceration of the abdominal contents into an external peritoneal sac.
Notes for Maternity
Course: Maternity/Pediatrics (NURS 4130)
University: Nova Southeastern University
