Lifespan of ovum and sperm
ovum = 24 hours sperm = 72 hours
progesterone
a thermogenic hormone that raises the temperature, an objective sign that ovulation has occurred
psychosocial changes of pregnancy
1st trimester
2nd trimester
ambivalence is normal in 1st but not in second.
when does menstruation occur
14 days after ovulation
verifying pregnancy
- what hormone
- how long until this hormone is elevated
- what meds can cause a false-positive/false-negative
- human chorionic gonadotropin (hCG)
- 6-11 days in serum and 26 days in urine
- Anticonvulsants, diuretics, tranquilizers
what is Nageles rule
used to estimate date of birth. Subtract 3 months and add 7 days to first day of last menstrual period
Non-stress test
- what is it
- normal finding
- abnormal
- positioning the client
- intervention if no accelerations
- noninvasive way of monitoring response of FHR to fetal movement
- a normal finding is 2 or more accelerations (increase in FHR of atleast 15 that lasts 15 seconds) within a 20 minute period
- does not do above. Indication of Contraction stress test (CST) or biophysical profile (BPP)
- semi fowlers or left lateral
- give a snack
Contraction stress test
- methods
- indications
- normal finding
- abnormal finding
- nipple stimulation or oxytocin IV
- non reactive NST
- negative = 3 contractions over 10 mins with no decelerations
- a positive CST = late decelerations occur with 50% of contractions is suggestive of uteroplacental insufficiency
Biophysical profile
- what is it
- normal vs abnormal
- uses ultrasound to visualize physiological characteristics of fetus. A score of 0 or 2 is given for each category
- (a)breathing: 1 episode of 30 seconds in 30 mins
(b) gross body movements-atleast 3 body or limb extensions with return to flexion in 30 mins
(c) fetal tone: atleast 1 episode of extension with return to flexion
(d) reactive NST
(e) amniotic fluid volume:atleast 1 pocket of fluid greater then or equal to 2 cm or more then 5 cm total
Amniocentesis
- what can it do
- when is it done
- why would it be done in late pregnancy
- detects presence of AChe in neural tube defects and can identify genetic diseases (trisomy 21, 18, 13)
- performed at 14-16 weeks
- assess fetal lung maturity LLS ratio of 2:1 indicates fetal lung maturity
Rho(d) immune globulin (Rhogam).
give to Rh-negative mothers. Must be an RN b/c its a blood product
Percutaneous umbilical blood sampling (PUBS)
1.what does it do
directly access fetal circulation and can be used for fetal blood sampling -> transfusion
Chorionic villi sampling
- what is it
- whats it for
- when is it done
- obtaining a sample of chorionic villi tissue (placental)
- assess for fetal genetic abnormalities
- first trimester
Maternal serum alpha fetoprotein screen (MSAFP)
- what is it for
- when should it be performed
- what do low levels indicate
- what do high levels indicate
- screening tool for neural tube defects (NTD)
- 16-18 weeks
- down syndrome
- neural tube defect
normal fetal assessments
HR
normal kick count
FHR =110-160
10 kicks/2 hr (most active after meals and in the evening)
Oxytocin
- whats it do
- what should you monitor
- when should you stop and what should you do
- stimulates uterine contractions
- monitor vitals, contractions, FHR
- stop for late decelerations or tachysystole and have a tocolytic such as terbutaline
Methylergonovine Maleate
- whats it for
- what should you monitor
- what should you do
- For postpartum hemorrhage it stimulates uterine contractions
- uterine tone and bleeding
- massage fundus if uterine tone is shit
Terbutaline
- uses
- monitor
- adverse effects
- when should you hold
- antidote
- tocolytic
- contractions, FHR, vitals
- (a)tremors, dizziness, headache, tachycardia, hypotension, anxiety
- chest pain, low BP 90, pulse greater 130, or signs of pulmonary edema or FHR greater then 180
- bblocker
Indomethacin
- use
- monitor
- considerations
- tocolytic
- contractions, FHR, vitals
- (a)give with food to prevent adverse GI
(b) can mask maternal fever
(c) only give before less then 32 weeks of gestation
signs of hyperstimulation
- more then 1 contraction every 2 mins or 5 in 10 mins
- contractions longer then 90 secs
- intensity greater then 90 mmHG
- no relaxation of uterus between contractions
what do you do for hyperstimulation
give terbutaline
eye prophylaxis for newborns
- make sure erythromycin/tetracycline is given within 1 hr
- vitamin K IM within 1 hr
- Hepatitis vaccine within 12 hours
Bulb syringe consideration
M before N
pathologic vs physiologic jaundice
pathologic jaundice occurs before 24 hours or is persistant for more than 7 days. It indicates increased RBC production or breakdown. This is usually caused by ABO or Rh incompatibility or infection
