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Unit 3 Table of Contents

MATERNAL & CHILD NURSING Outline


Section I. Anato! & "#!siolo$!
%. Re&'o(ucti)e S!ste
a. *eale Re&'o(ucti)e S!ste
%+ E,te'nal Genitalia
-+ Inte'nal Genitalia
3+ T!&es of "el)ic Li$aents
b. Male Re&'o(ucti)e S!ste
%+ E,te'nal & Inte'nal *eatu'es
-. Maa'! Glan(s
3. Re&'o(ucti)e Ho'ones
a. *eale Re&'o(ucti)e Ho'ones
b. Ot#e' Re&'o(ucti)e Ho'ones
.. Menst'uation
a. Menst'ual C#an$es
b. Menst'ual C!cle
c. O)a'ian C!cle
(. En(oet'ial / Ute'ine C!cle
e. Menst'ual Diso'(e's
0. *ail! "lannin$
a. Natu'al Conce&tion
b. 1a''ie' Met#o(s
c. "#a'acolo$ical Met#o(s
(. 1i't# Cont'ol Sua'!

Section II. Ante&a'tal "e'io(
%. Assessent of "'enatal Ris2 *acto's
-. "#!siolo$ical C#an$es in "'e$nanc!
a. "#!siolo$ical C#an$es
b. Ante&a'tu Healt# "'ootion
3. *e'tili3ation to Conce&tion
a. *e'tili3ation
1
b. O'i$in of 1o(! Tissues
.. *etal De)elo&ent
a. Measu'in$ A$e of Gestation
0. Mate'nal & *etal Dia$nostic Tests

4. Elect'onic *etal Monito'in$
5. Labo'ato'! Stu(ies

6. Ot#e' G!necolo$ical "'oce(u'es
7. T#'ee Coon "'e$nanc! Si$ns
%8. Discofo't Si$ns of "'e$nanc!
%%. "s!c#olo$ical C#an$es in "'e$nanc!
a. Mate'nal C#an$es in "'e$nanc!
b. "ate'nal A(a&tations in "'e$nanc!
Section III. Ante&a'tal Co&lications
%. Abo'tion
-. Ecto&ic "'e$nanc!
3. H9ole
.. Inco&etent Ce')i,
0. Diabetes Mellitus of "'e$nanc!
4. "IH :"'e$nanc! In(uce( H!&e'tension+
5. 1lee(in$ Diso'(e's in "'e$nanc! : Table of Co&a'ison+
a. "lacenta "'e)ia
b. Ab'u&tio "lacenta
6. ;ena Ca)a S!n('oe
7. Diseinate( Int'a)ascula' Coa$ulation
%8. H!&e'eesis G'a)i(a'u
Section I;. Int'a&a'tu Ca'e
%. *i)e *acto's Affectin$ Labo' :Table of Mec#anics of Labo'+
2
a. "assa$e<a!
%. T!&es of "el)is
-. "el)ic Measu'eents
b. "assen$e'
%. *etal Attitu(e
-. *etal Lie
3. *etal &'esentation
.. *etal "osition
c. "o<e'
%. T#'ee "#ases of Cont'action
-. C#a'acte'istics of Cont'actions
(. "lacental *acto's
e. "s!c#e
-. Labo'
a. Si$ns of I&en(in$ Labo'
b. Co&a'ison of T'ue & *alse Labo'
c. Sta$es of Labo'
%. Stations of "'esentin$ "a't
(. Nu'sin$ Consi(e'ations (u'in$ Labo' & Deli)e'!
e. Nu'sin$ Ca'e (u'in$ labo'
f. Assessin$ *etal Hea't Rate
$. Ca'(inal Mec#aniss / Mo)eents of Labo'
.. Anest#e3ia
0. Obstet'ical "'oce(u'es
a. "'ete' Labo'
b. "ROM :"'eatu'e Ru&tu'e of t#e Meb'anes+
c. "'ola&se Co'(
(. D!stocia
e. Infection
3
f. "'eci&itate Deli)e'!
$. Ute'ine Ru&tu'e
#. Aniotic *lui( Ebolis
Section ;. Co&lications of Labo' & Deli)e'!
a. "'ete' Labo'
b. "ROM : "'eatu'e Ru&tu'e of t#e Meb'anes+
c. "'ola&se( Ubilical Co'(
(. D!stocia
e. Infection
f. "'eci&itate Deli)e'!
$. Ute'ine 'u&tu'e
#. Aniotic *lui( ebolis
Section ;I. "ost&a'tu
%. "ost&a'tu 1io&#!sical c#an$es
a. Loc#ia
b. Ute'us
c. Ute'ine In)olution
(. 1'east
e. GI T'act
-. "ost "a'tu Discofo'ts
a. "e'ineal (iscofo'ts
b. E&isioto!
c. 1'east Discofo'ts
4
3. "ost &a'tu Disc#a'$e Teac#in$s
a. 1'east fee(in$s
b. 1u'&in$ & *ee(in$
c. "s!c#olo$ical A(a&tations
SECTION ;II. Neonatal Ca'e
%. Initial "#!sical E,aination & Ca'e of t#e Ne<bo'n
a. Assessent
b. I&leentation
c. ;ital Si$ns
(. 1o(! Measu'eent
-. Hea( to Toe Ne<bo'n Assessent
3. Gestational Assessent
.. Ne<bo'n Refle,es
0. 1asic Teac#in$ Nee(s of Ne< "a'ents
4. "'ete' Neonates
5. "ost te' Neonates
6. Ot#e' Ne<bo'n Abno'alities
a. RDS :Res&i'ato'! Dist'ess S!n('oe+
b. Heol!tic Disease
c. H!&e'bili'ubineia
(. E'!t#'oblastosis *etalis
e. T#e Ne<bo'n of A((icte( Mot#e's
f. SGA :Sall Gestational A$e+
$. Ne')ous S!ste Anoalies
%. S&ina 1ifi(a
-. Menin$ocele
3. M!eloenin$ocele
5
Unit 3
MATERNAL AND CHILD HEALTH NURSING
Section I
ANATOM= AND "H=SIOLOG= O* THE *EMALE RE"RODUCTI;E S=STEM
6
I.a E,te'nal Genitalia :;ul)a/"u(en(u+
MONS "U1IS
-Soft fatty tissue, lies directly over symphysis pubis & becomes covered w/ hair ust before puberty
!t is where the pubic hair "rows#
$
LA1IA MA>ORA
-%/ hair outside but smooth i&side
fatty s'i& folds from ()*S +,-!S to
+./!*.,( a&d protects the labia
mi&ora , uri&ary meatus & va"i&a
LA1IA MINORA
-0hi&, pi&', smooth, hairless, e1tremely
se&sitive to pressure, touch a&d
temperature# 0he "la&ds of labia mi&ora
lubricate the vulva. It is formed by the
frenulum and the prepuce of the clitoris
which is also very se&sitive because it has
rich &erve supply#
URETHRAL MEATUS
;AGINAL INTROITUS
CLITORIS
-.&tra&ce of urethra,
ope&s appro1imately
1cm below clitoris
T?O GLANDS THAT LU1RICATE DURING SE@
1. SKENES GLANDS (Paraurethral Glands+A lubricates the
e1ter&al "e&italia
2. Bartholins Gland (Vulvovaginal Glands+A al'ali&e i& ph,
helps improve sperm survival
Doderleins BacillusA causes the va"i&al ph to be acidic, which
forms lactic acid
H!enA the elastic tissue, symboli2es vir"i&ity# 0hor& &
bloody duri&" forced se1ual act
!GAE" thic' folds of membra&ous stratified epitheliums o&
the i&ter&al wall of the va"i&a, capable of stretchi&" duri&" the
birth process, to accommodate the delivery of the fetus#
-3omposed of "la&s &
shaft that is partially
covered by prepuce
-456*S is small a&d
rou&d a&d is filled w/
ma&y &erve e&di&"s a&d
rich blood supply
-S7680 is a cord
co&&ecti&" the "la&s to
the pubic bo&e9 w/i& it is
the maor blood supply
of clitoris
Co)e's an( &'otects ;ESTI1ULE
*i$u'e %9a Inte'nal St'uctu'e
Ib. Inte'nal Genitalia
:8i"ure 1-a;
)/46* 8,*30!)*S S0/,30,/. *)0.S
,terus
+ear shape muscular
or"a& which has
three:3; mai&
fu&ctio&s
1# receive the ova
from the fallopia&
tube
2# provide a place for
impla&tatio& of the
ova
3# *ourishme&t for
fetal "rowth#
Di)isions of t#e ute'us
!# 3ervi1 < lowest portio& , 1/3 of the
total uterus
.1ter&al )s< where the &urse obtai&
the Pap Smear to the
SQUAMOCOLUMNA !UNC"ION
cells# 0his is where the cercla"e is
do&e for i&compete&t cervi1# *amely<
6# Shirod'ar -arter Suture- perma&e&t
closure of the internal cer#ical os,
u&til the 3=
th
wee' after which is
separated > "$A"M$N" %O
INCOMP$"$N" C$&I' and
P$&IOUS A(O"ION#
-# (c ?o&alds or +urse Stri&"
3ercla"e of the e1ter&al os< usually
*ormal spo&ta&eous delivery will be
do&e for the patie&t#
!!# !sthmus< shortest portion of the
uterus, the portio& that is cut )hen the
fetus is deli#ered durin* cesarean
birth#
!!!# 8u&dus< ,pper se"me&t, this is the
most vascular, the portio& also where
palpatio& is do&e# 6lso touchi&" it by
the tip of the fi&"ers duri&" co&tractio&
is the best method to determi&e the
i&te&sity of co&tractio&s duri&" labor#
La!e's of t#e Ute'usA
%. En(oet'iuA
i&&er layer, most
vascular, S+$,
,UIN-
M$NS"UA"ION."+
$ NON.P$-NAN"
U"$US
-. M!oet'iuA
LA-$S" PO"ION
$'P$LS "+$ %$"US
,UIN- "+$ (I"+
POC$SS. "he part
that contracts durin*
hemorrha*e. Pre#ents
hemorrha*e.
1# "e'iet'iu<
)uter most layer#
6ids for support &
added stre&"th#
=
(andl/s in* 0 Patholo*ical etraction
in*;< see& i& +rolo&"ed 5abor or
?ystocia
8allopia&
tubes
Site of fertili2atio& of
the ovum with perm
4 +arts of the 8allopia& tubes
1# !&terstitial < lies withi& the uteri&e
wall
2# Isthmus1 the portion that is cut or
sealed in "U(AL LI-A"ION 0 site for
sterili2ation;
3# Ampulla1 )here fertili2ation
occurs 3 this is also the LON-$S"
portion3 fre4uent site for ectopic
pre*nancy#
4# Infundibular1 co#ered by the
%imbriae cells that help *uide the o#a
to the %allopian "ube#
8allopia& tubes
tra&sport the ova from
the ovaries to the
uterus#
)varies )vulatio& :the release
of a& ovum;9 Steroid
hormo&e productio&
+air of follicle co&tai&i&" or"a&s o&
the other side of the uterus
O)a'iesA 4 by 2 cm i& diameter, 1#5
cm thic'# /espo&sible for
the productio&,
(aturatio&, a&d
dischar"e of ova
Secretion of estro*en
and pro*esterone
#orte$ o% the &varies' de#elopin*
and *raafian follicles are found here.
0he ovaries lie i& the
upper pelvic cavity#
@a"i&a )r"a& for coitus9
-irth ca&al9 3o&duit
for me&strual flow#
0ube e1te&di&" from the i&troitus to
cervi1
8ibromuscular or"a&
li&ed with mucus
membra&e
I c. T!&es of "el)ic Li$aents
1# Roun(A remai& la1 duri&" &o&-pre"&a&cy & become +5P$"OP+I$, & elo&"ated duri&"
pre"&a&cy#
2# Ca'(inalA chief uteri&e supports
3# 1'oa( li$aentsA drapes over the fallopia& tubes, uterus & ovaries
A
1B
I. 1 MALE RE"RODUCTI;E S=STEM
E$ternal (eaturesA
- E'ectile Tissues in t#e &enisA
a# Corpus ca#ernosa
b# corpus spon*iosum
)nternal (eaturesA
E&i(i(!isA totals 2B ft# 6+$$ SP$MS A$ S"O$,
;as / Ductus Defe'ensA carries the sperm to the i&"ui&al ca&al
Seinal Glan( / ;esicle< Secretes S.(.*
"'ost'ate Glan(< secretes S.(.* also#
Co<&e's Glan(/ 1ulbo9u'et#'alA secretes also seme&
SEMEN sou'cesA %# prostrate "la&d < 6BC
2# Semi&al vesicles < 3BC
3# .pididymis < 5C
4# 3owpers < 5C
Accesso'! St'uctu'es
*i$u'e %9b Maa'! Glan(s
III. Maa'! Glan(s
11
MAMMAR= GLANDS
-2 mammary "la&ds located o& each side of chest wall
-.ach breast 15-2B lobes co&tai&i&" clusters of 65@.)5!
ACINI
-Sacli'e e&d of
the "la&dular
system
-5i&ed both w/
epithelial cells
that secrete
colostrum0 )hic
h is rich in I*A7
& mil' & w/
muscles that
e1pel mil'
DUCTULES
-.1it alveoli & oi&
to form lar"er ca&als
5630!8./),S
?,30S
-?uri&" lactatio&,
mil' flows to the
alveoli a&d the& thru
the duct system
further "oi&" to the
balloo& li'e stora"e
sacs called
5630!8./),S
S!*,S.S
NI""LES
-Si&uses mer"e i&to
ope&i&"s o& &ipple
I;. *eale Re&'o(ucti)e Ho'ones
HORMONES
LUTENIBING HORMONE AND ESTROGEN &ea2 ie(iatel! befo'e o)ulation
(ost wome& ovulate two wee's before the be"i&&i&" of the &e1t period#
12
*ollicle Stiulatin$
Ho'one
DStimulates
4raafia& follicle to
mature a&d resulti&"
i& i&crease levels of
estro"e&
Luteni3in$
Ho'one
-%he& follicle is
ripe a&d mature,
tri""ers follicular
rupture a&d release
of ovum
-Pea8s at 9:.9;
hours before
ovulatio&#
-stimulates
o#ulation <
de#elopment of
corpus luteum
Est'o$en
-+roduce from ovaries,
adre&al corte1, a&d
place&ta
-6ssists i& maturatio& of
4raafia& follicle
-Stimulates thic'e&i&" of
e&dometrium#
Ot#e' functions
a. 3o&tracts smooth
muscles !&hibits the
secretio& of 8S7
b. /espo&sible for the
i&crease #a*inal
secretion in the #a*ina
0L$U=O+$A;
c. 0hic'e&s the
e&dometrium
d. SUPP$SS$S "+$
%S+ < Prolactin
e. /espo&sible for the
devEt of 2&dary se1
characteristics i&
females
f. Stimulates uterine
contractions <
smuscular peristalsis
of the fallopian tubes
for the passa*e of the
o#um to the uterus#
*. (ildly i&creases *a &
water reabsorptio&
h. Stimulates L+
secretion <
responsible for the
production of cer#ical
mucus associated in
fernin* < spinnbar8eit
"'o$este'one
D+roduce from corpus
luteum, place&ta
-Secretes thic'/viscous
cervical secretio&s#
A. Preparation of the
uterus to recei#e a
fertili2ed o#um
B. ,ecrease uterine
motility>
contractility durin*
pre*nancy
#. Increases basal
metabolism
D. $nhances
placental *ro)th
E. Stimulates the
de#/t of acini cells
in the
breast0ma?or cells
for breast mil87
Increase the
endometriums
supply of
*lyco*en3 o@y*en
< amino acids for
maintainin*
pre*nancy
I; a. Ot#e' Re&'o(ucti)e Ho'ones
%. Lactogenic *or+one (Prolactin+
-Stimulates lactatio&
-. Melanoc!te Stiulatin$ Ho'one
-/espo&sible for the li&ea &i"ra & chloasma i& pre"&a&cy
-Secreted by the a&terior pituitary hormo&e (.56*)0/)+!*
-%ill e&d o& the 2
&d
mo&th of pre"&a&cy
3. *u+an #horionic Gonadotro,in
-!&creases i& &ausea a&d vomiti&"
esponsible for +yperemesis -ra#idarum
;. MENSTRUATION
Mena'c#eA 1
st
me&strual period, usually a"e 12, but may be"i& as early as A#
Meno&auseA cessatio& of me&strual cycle that occurs &ormally from 4B & 55 y#o#
Menst'ual C!cleA
1# (e&strual +hase : 1 > 14 days;
-3orpus luteum dies#
-+ro"estero&e & .stro"e& va&ishes- tri""ers/stimulate the productio& of 8S7#
-.&dometrium de"e&erated/ sheds- me&struatio& occurs#
Se@ual intercourse durin* menstruation is not harmful.
2# +roliferative +hase- .stro"e& +hase : 6 > 14 days; 4raafia& 8ollicle< .stro"e&
6&terior +ituitary 4la&d secretes 8S7 stimulates the developme&t of the -raafian
follicle 0secretes $stro*en7 suppresses %S+ < stimulates L+ L+ stimulates
o#ulation !&crease .stro"e& 'ills/decreases 8S7
3# Secretory +hase :15 to 21 days; +ro"estero&e +hase :3orpus 5uteum< +ro"estero&e;
)ther -oo's it is called< 5uteal +hase
6fter )vulatio&-----release of mature ovum from the 4raafia& follicle-----4raafia&
8ollicles die a&d replaced by 3orpus 5uteum-----secretes pro"estero&e 8u&ctio&s of
+ro"estero&e<
4# +re-(e&strual +hase :22 days to 2= days;
-!f fertili2atio& does &ot occur, corpus luteum be"i&s to die
-+ro"estero&e & .stro"e& decreases
-.&dometrium de"e&erates
-Menstruation stops durin* pre*nancy because there is decrease secretion of hormones by the
o#ary.
13
O;ARIAN C=CLE
:63)/?!*4 0) 7)/()*65 630!@!0F;
B $ 14 21 2=
*OLLICULAR "HASE LUTEAL "HASE
)varia& follicles mature u&der i&flue&ce -mittelshmer2
of 8S7 a&d estro"e& -cervical cha&"es
57 sur"e causes ovulatio& -i&crease --0
ENDOMETRIAL/UTERINE C=CLE
:?escribed by varyi&" thic'&ess of the e&dometrium;
:*i$u'e %9c+
14
DE;ELO"ING *OLLICLES O;ULATION COR"US LUTEUM LUTEAL
REGRESSION
(.*S0/,65
+76S.
-(e&struatio&
-?ecrease estro"e&
-?ecrease
pro"estero&e
+/)5.8./60!@.
+76S.
-7ypothalamus
secretes 8S7
-6+4 :a&terior
pituitary "la&d;
secretes 8S7
-(aturatio& of
4raafia& follicle
-!&creased estro"e&
-7ypothalamus stops
8S7 & starts 57
-6+4 stops 8S7 &
starts 57 secretio&
S.3/.0)/F
+76S.
-8ormatio& of corpus
luteum
-!&crease
pro"estero&e
-*)
8./0!5!G60!)*9
corpus luteum
de"e&erates 1B days
after ovulatio&
-%!07
8./0!5!G60!)*9
co&cepts produces
734 that sustai&s
life corpus luteum9
pro"estero&e level is
mai&tai&ed at hi"h
level
-+ro"estero&e level
decreases
-3orpus albica&s
Slou"hi&" off of
e&dometrial li&i&"
+/.-
(.*S0/,65
+76S.
-e&dometrium
de"e&erates
*i$u'e %9c Menst'ual C!cle
;. a Menst'ual Diso'(e's
15
-6S65
-)?F
0.(+./
60,/.3.
/@!365
(,3,S
(.07)?
SF(+)0
7./(65
(.07)?
(!00.5S3
7(./G3)!
0,S
!*0.//,+
0S-
.1cessive or
prolo&"ed
bleedi&"-
!rre"ular
bleedi&" i&
betwee&
periods
+rimary-
?ysme&orrh
eal
;I.
*AMIL
=
"LAN
NING
AND
CONT
RACE
"TION
*ail!
"lannin$
Met#o(s

0he
mos
t
imp
orta
&t
topi
c i&
a
+re&
atal
+reme&strual
Sy&drome
6me&orrhea (e&orrha"i
a
(etrorrha"ia
16
MALE CONDOMIUDD
/eHuires withdrawal of the pe&is
from the va"i&a before /elies
o& absti&e&ce from i&tercourse
duri&" fertile period-.dema of
lower e1tremities- +rimary-
-8le1ible device i&serted i&to the
uteri&e cavity
-!t alters uteri&e tra&sport of the
sperm so fertili2atio& do&Et
occur
,AN-$ SI-NS "O $PO"1
. Late or missed menstrual period
.Se#ere abdominal pain
.%e#er and chills
. %oul #a*inal dischar*e
.Spottin*3 bleedin*3 or hea#y
menstrual periods
. Spontaneous e@pulsion occur in
AB.9CB of users in the first
year
- /ubber sheath that fits
over the erect pe&is a&d
preve&ts sperm from
e&teri&" the va"i&a
- 5o&" polyuretha&e sheath
that is i&serted ma&ually
i&to va"i&a with a fle1ible
i&ter&al ri&" e1te&di&" to
cover the peri&eum
- 5ubricated with a
spermicide :&o&-o1y&ol-
A;
- !t ca& be i&serted up to =
hrs before i&tercourse
1. 1a''ie' Met#o(s
*EMALE CONDOM
:;AGINAL "OUCH;
eaculatio&
- 6bdomi&al bloati&"
- %ei"ht "ai&
- 7eadache
--reast te&der&ess
- ?epressio&
- 3ryi&"
- 5oss of co&ce&tratio&
*o '&ow& cause
- Seco&dary-
(ay be caused by
D (easured by ta'i&" &
recordi&" e temperature rally
rectally each mor&i&" before
wa'i&" after at least 3 hours of
sleep
D ?rops before ovulatio& a&d
rises B#2 8-B#= 8
In (asal body temperature
method the patient should ta8e
her temperature e#ery mornin*
upon a)a8enin* and prior to any
acti#ity to a#oid the temperature
bein* influenced by other factors.
D ,ses the appeara&ce,
characteristics a&d amou&t of
cervical mucus to ide&tify
ovulatio&
)vulatory< cervical mucus is clear
a&d abu&da&t
+re-ovulatory / post ovulatory<
cervical mucus is yellowish,
less abu&da&t, a&d stic'y
:i&hibit sperm motility;
.
D
3ou
ple
ma'
es
use
of
com
bi&at
io&
of
cale
&dar,
--0
, a&d
cervi
cal
muc
us
meth
od to
deter
mi&e
fertil
e
perio
d
1$
tumor/i&flammatory co&ditio&s
C 1et<een enst'ual c!clesD soe <oen e,&e'ience &ain
<#en t#e o)a'! 'eleases e$$

8i"ure 1-d 3o&dom
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D
I
A

NCLE@ TI"SEE
T#e feale con(o (u'in$ se,
*i$u'e %9(
?uri&" se1 the pe&is is i&serted i&to the ce&ter of the ope& ri&" at the ope&i&" of the va"i&a# ,&til both
part&ers are familiar with the /eality co&dom, the pe&is should be "uided by ha&d i&to the ope& ri&"#
)therwise there is the cha&ce that the pe&is will be i&serted outside the co&dom i&to the va"i&a, thus
defeati&" the co&domIs purpose# ,se of the male co&dom with the female co&dom is &ot recomme&ded,
because rubbi&" the late1 male co&dom a"ai&st the polyuretha&e female co&dom creates frictio& that may
ma'e i&tercourse difficult#

Reo)in$ t#e feale con(o
0he female co&dom should be removed followi&" i&tercourse a&d before sta&di&" up# 0o remove, sHuee2e
a&d twist the outer ri&" to e&sure that seme& remai&s i&side the co&dom# 4e&tly pull the co&dom from the
va"i&a# ?iscard i& the trash# ?o &ot attempt to flush the co&dom dow& the toilet, as it may clo" the toilet or
sewer li&es# ?o &ot reuse#

I&o'tant &oints to 'eebe' <#en usin$ t#e feale con(o
- "he female condom )or8s only if you use it e#ery time you ha#e se@.
. Use a ne) condom each time you ha#e se@ual intercourse. Do not reuse the %e+ale condo+.
. 5ou can still become pre*nant and transmit or ac4uire a se@ually transmitted disease )hile usin* the
female condom. "he ris8 is less than if you do not use the condom3 but there still is a sli*ht ris8.
. Althou*h the eality condom is prelubricated3 it also comes )ith a tube of lubricant in the pac8a*e. 5ou
may )ish to add a fe) drops of lubricant to the openin* of the condom or to the penis. Lubricants reduce
friction and noise those results from friction.
. emo#e tampons before insertin* the female condom.
. Use caution to a#oid tearin* the female condom )ith a sharp fin*ernail3 rin*3 or other ?e)elry )hen
insertin* and remo#in* the condom#
1=
"
H
R
A
G
M
C
*ot &ecessary for
repeated coitus,se
every
coitus3o&ti&uous
protectio& 24 hours
re"ardless of the
&umber of times of
se1ual i&tercourse)&
two hours prior to
se1ual i&tercourse a&d
i& place for 6 hours
after=BC with typical
use
S+./(!3!?.
,S64.
*,55!+6/6J=BC
(50!+6/6J6BC
?.S3/!+0!)*
Small rubber plastic that fits
s&u"ly over cervi1
8le1ible ri&" covered with dome shape
rubber cap
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3ervicitis
?,/60!)*
*ot lo&"er tha& 4= hours *ot lo&"er tha& 24 hours
A diaphra*m should be left in the #a*ina
:.; hours after se@ual intercourse.

Dia,hrag+A should remai& i& place 6-= hours after se1 & maybe left for 24 hours#
AL6A5S C+$C= %O "$AS < +OL$SDDD
#ontraindicated %or" %re4uent U"I3 Prolapsed Cord < etro#erted Uterus3 cystocele < rectocele3 acute
cer#icitis

*i$u'e 1-e ?iaphra"m
C. "#a'acolo$ic et#o(s
&ral #ontrace,tive Pill A sy&thetic estro"e& combi&ed with small amou&ts of sy&thetic pro"estero&e-
preve&ti&" ovulatio& by stoppi&" 8S7 & 57#
- Stops L+ < %S+
STO" I* ?ITH THE **< :637.S;
- A. abdominal pain3 #- Chest pain3 *. +eadaches3 E. eye problems < S.se#ere le* cramps
- A""N1 Se#ere +eadaches maybe an indication of +ypertensionDDDD
CONTRAINDICATEDA
9 "hromboembolism
A C&A3 +PN3 smo8in* < diabetics3,IC3 hyper#iscosity
#ontraindicated %or D)ABE.)#S. "he best for diabetics are (arrier Contracepti#es..Condom <
,iaphra*m
E$a+,les" ?emule& :.thi&yl .stradiol .thyl&odiol ; a mo&ophasic oral co&traceptive a"e&t.
If the patient for*ets to ta8e A tablets for the ne@t A days3 she should ta8e A tablets N$'" A ,A5SDDD
And use another contracepti#e method for the rest of the cycle.
If she misses E or more3 she should discard the remainin* tablets < use another contracepti#e
method for the rest of the cycle.
)/65 3)*0/3.+0!@.S(!*!+!55SS,-?./(65 !(+56*0SS,-3,06*.),S !*K.30!)*S,se to
preve&t co&ceptio& by i&hibiti&" ovulatio& :i&hibits release of 8S7 a&d 57;
3auses atrophic cha&"es i& the e&dometrium to preve&t impla&tatio& of e""
3auses thic'e&i&" of cervical mucus to i&hibit sperm travel
Under ideal conditions the sperm can reach the o#um 9 to F minutes after e?aculation.
3ombi&ed estro"e& a&d pro"estero&e preparatio& i& tablet form a&d are ta'e& daily with combi&atio&s of
hormo&es
22
Oral contracepti#es pre#ent pre*nancy by suppressin* %S+ 0follicle stimulatin* hormone7 and L+
0leuteni2in* hormone7 release from the pituitary *land thereby bloc8in* o#ulation.+ills co&tai& pro"esti& but &o
estro"e&
+ills must be ta'e& each day a&d preferably same time each day to achieve ma1imal effective&ess
0hi&s a&d atrophy e&dometrium a&d thic'e&s cervical mucous
6?@6*064.< ca& be use immediately postpartum if clie&t is &ot breastfeedi&" a&d 6 wee's if breastfeedi&"
6omen ta8in* the minipill ha#e a hi*her incidence of tubal and ectopic pre*nancies3 possibly because
pro*estin slo)s o#um transport throu*h the fallopian tubes. $ndometriosis3 female hypo*onadism3 and
premenstrual syndrome arenGt associated )ith pro*estin.only oral contracepti#es.Si1 soft sillastic rods filled
with sy&thetic pro"estero&e impla&ted i&to the woma&Es arm
+ro"estero&e lea's i&to the blood stream, i&hibiti&" impla&tatio& i&to e&dometrium
*orpla&t
!&serted subdermally i&to the midportio& of the upper arm about =-1Bcm above the elbow crease# 6 impla&table
capsules are i&serted at o&e time(edro1ypro"estero&e :?(+6 or ?.+)@./6;
Birth #ontrol Su++ar/ .a0le
-!/07 3)*0/)5 (.07)?6?@6*064./!SLS )/ +)SS!-5. +/)-5.(S
Spermicides< chemicals i& the form of
foams, creams, ellies, films, or
suppositories that are i&serted i&to the
va"i&a to 'ill sperm before they ca& e&ter
the uterus9 typical use effective&ess< $BC
M 6vailable over the cou&ter
M 3a& be used with other
methods to improve
effective&ess
M )&ly partially effective
a"ai&st se1ually tra&smitted
disease :S0?; tra&smissio&
M +ossible aller"ies or irritatio&
M *ot effective a"ai&st S0?
tra&smissio&M /eusable3ervical 3ap<
thimble-shaped late1 cap i&serted
i&to va"i&a over cervi1 to preve&t
sperm from e&teri&" uterus9 used
with spermicide9 typical use
effective&ess< =2CM *ot effective
a"ai&st S0? tra&smissio&M
/eusable3o&dom< male co&dom is a
sheath of late1 or a&imal tissue
placed o& erect pe&is9 female
co&dom is a plastic sac with a ri&"
o& each e&d i&serted i&to the va"i&a9
both may be used with a spermicide9
typical use effective&ess< =4C
:male; $AC :female;
M *eeds to be fitted by a health care
professio&al
M ?ifficult to fit wome& with a&
u&usual cervi1 si2e
M ?ifficult for some wome& to i&sert
M 3a& last for o&e to two years
C$&ICAL CAP< ca& be retai&ed upto 4=
hours# !t does &ot lea'# 3a&&ot be re-applied
a"ai& after use# (ay use spermicide before
use#
M .ffective a"ai&st S0?
tra&smissio&
M 6vailable over the cou&ter
M 3a& be used with other
methods to further protect
a"ai&st S0?
M +ossible aller"ies to late1 or
spermicide
M 5esse&s se&satio&
M (ay brea' duri&" i&tercourse
#A#oid usin* petroleum ?elly of
oil base productsH it can
cause INC$AS$ %IC"ION
)hich )ill lead to "$AIN-
O% "+$ LA"$' CON,OM#
23
M *eeds to be fitted by a health care
professio&al
M !&creased ris' of bladder i&fectio&
M +ossible aller"ies to late1 or
spermicide
M 3a& last for o&e to two years
-irth 3o&trol +ill< prescriptio& dru"
co&tai&i&" female hormo&es9 o&e pill ta'e&
daily preve&ts ovaries from releasi&" e""s
a&d/or thic'e&s cervical mucus to preve&t
sperm from reachi&" e""9 typical use
effective&ess< A4C?iaphra"m< shallow
late1 cup with fle1ible rim i&serted i&to
va"i&a over cervi1 to preve&t sperm from
e&teri&" uterus9 used with spermicide9
typical use effective&ess< =2C
M (ore re"ular periods
M *o actio& reHuired prior
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
M Some protection a*ainst
o#arian and endometrial
cancer3 noncancerous
breast tumors3 o#arian
cysts
M *ot effective a"ai&st S0?
tra&smissio&
M are but dan*erous
complications3 includin*
blood clottin* and
hypertension3 particularly in
)omen o#er EF years )ho
smo8e
M (ust be ta'e& daily
7ormo&al !mpla&t :*orpla&t;< si1 small
capsules i&serted by a health care
professio&al u&der the s'i& of upper arm
that deliver small amou&ts of hormo&e to
preve&t ovaries from releasi&" e""9 typical
use effective&ess< AAC
M +rotects a"ai&st
pre"&a&cy for up to five
years
M *o actio& reHuired prior
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
M Can be used )hile breast.
feedin* be*innin* si@
)ee8s after deli#erin*
baby
M *ot effective a"ai&st S0?
tra&smissio&
M +ossible scarri&" or, rarely,
i&fectio& at i&sertio& site
M Side effects i&clude irre"ular
bleedi&", headaches, &ausea,
depressio&
M *ot effective a"ai&st S0?
tra&smissio&M .ffective o&e to si1
years, depe&di&" o& type
used7ormo&al !&ectio& :?epo-
+rovera;< in?ection *i#en by a health
care professional in the arm or
buttoc8 e#ery 9A )ee8s to preve&t
ovaries from releasi&" a& e"" a&d/or
thic'e& cervical mucus to 'eep
sperm from reachi&" a& e""9 typical
use effective&ess< AAC
M (ay cause spotti&" betwee& periods a&d
lo&"er, heavier periods
M Increased ris8 of pel#ic inflammatory
disorder0PI,7 )ithin first four months
after insertion
M /are ris' of uteri&e perforatio&
M *o actio& reHuired prior to se1ual
i&tercourse, permits se1ual
spo&ta&eity
M +rotects a"ai&st
pre"&a&cy for 12 wee's
M *o actio& reHuired prior
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
M Can be used )hile breast.
feedin* be*innin* si@
)ee8s after deli#erin*
baby
M +rotects a"ai&st ca&cer of
the uteri&e li&i&" a&d iro&
deficie&cy a&emia
M *ot effective a"ai&st S0?
tra&smissio&
M Side effects i&clude irre"ular
bleedi&", wei"ht "ai&,
headaches, depressio&,
abdomi&al pai&
M Side effects do &ot reverse
u&til medicatio& wears off
M (ay cause delay i& becomi&"
pre"&a&t after i&ectio&s are
stopped
M *ot effective a"ai&st S0?
tra&smissio&*atural 8amily +la&&i&"<
tech&iHues, i&cludi&" chec'i&" body
M +erma&e&t protectio&
from pre"&a&cy
M *o actio& reHuired prior
M *ot effective a"ai&st S0?
tra&smissio&
M /eactio&s to sur"ery may
24
temperature or cervical mucus daily or
recordi&" me&strual cycles o& a cale&dar, to
determi&e the days whe& body is most
fertile9 typical use effective&ess< =1CM *o
medical or hormo&al side effectsM *ot
effective a"ai&st S0? tra&smissio&M
+erma&e&t protectio& from pre"&a&cy0ubal
5i"atio&< sur"ical procedure to perma&e&tly
bloc' woma&Is 8allopia& tubes to preve&t
e""s from reachi&" sperm9 typical use
effective&ess< AAC!&trauteri&e ?evice
:!,?;< small device i&serted by a health
care professio&al i&to the uterus9 preve&ts
e""s from bei&" fertili2ed a&d/or impla&ti&"
i& uterus9 typical use effective&ess< A6C
M /eHuires strict record'eepi&"
M !ll&ess or lac' of sleep may affect body
temperature
M @a"i&al i&fectio&s a&d douches may affect
cervical mucus
M /eHuires absti&e&ce from se1ual
i&tercourse or alter&ative co&traceptio&
duri&" fertile days
M !&e1pe&sive
M 6ccepted by most reli"io&s
M /eactio&s to sur"ery may i&clude
i&fectio&, blood clot &ear testes,
bruisi&", swelli&", or te&der&ess of
scrotum
M !rreversible
M *o actio& reHuired prior to se1ual
i&tercourse, permits se1ual spo&ta&eity
"ubal li*ation1 isthmus part in the
fallopian tube is the usual part bein*
li*hted#
Intra.uterine ,e#ices 0IU,;- a
small plastic obect is i&serted i&to the
uterus where it remai&s i& place# !t
i&terferes with the ability of the ovum to
develop as it tra&sverses the fallopia&
tube#
Most %re4uent Side $ffect<
a# $@cessi#e Menstrual flo)
0menorrha*ia7 b. Spontaneous
$@pulsion of the de#ice1 Myometrium
irritability c. Crampin* < fe#er
Contraindications1
1# +istory of PI,1 a )oman usin* IU,
has FCB chance of *ettin* PI,.
A. $ctopic Pre*nancy3 AI,S
Ne#er use > *i#e IU, to NULLIPAOUS
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
i&clude i&fectio&, bleedi&",
i&ury to i&testi&e, reactio& to
a&esthesia
M !&creased cha&ce of ectopic
pre"&a&cy
M !rreversible
25
6OM$NDDD
eturn to the clinic for e#aluation after
her 9
st
mensesDDD

8i"ure !&tra uteri&e device
:!,?;
@asectomy< sur"ical procedure to perma&e&tly bloc' the maleIs vas defere&s to preve&t sperm
from reachi&" e""s9 typical use effective&ess< AAC
Section II
Ante&a'tu "e'io(
I. Assessent of Ris2 *acto's in t#e "'enatal "e'io(
Age o% Pregnant 1o+en 91$ below< 7ave a hi"her i&cide&ce of
1# +rematurity
2# +re"&a&cy !&duced 7yperte&sio&
3# 3ephalopelvic ?isproportio&
1o+en over 23 /ears old are at is4 %or"
1# 3hromosomal ?isorders i& i&fa&ts
2# +!7
3# 3esarea& ?elivery
"'ii$'a)i(a 9 1st time +re"&a&cy
"'ii&a'a 9 1
st
delivery of a live i&fa&t,
Nulli$'a)i(a 9 &ever bee& pre"&a&t

)n%ections" !se .&#*
T - 0o1oplasmosis
O - )ther i&fectio&s
R - /ubella
C - 3ytome"alovirus
H - 7erpes
6# 0o1oplasmosis :proto2oa;
+roduces symptoms of acute, flu-li'e i&fectio& i& mother
0ra&smitted throu"h raw meat or ha&dli&" cat litter of i&fected cats
S&ontaneous abo'tion li2el! to occu' ea'l! in &'e$nanc!
-# /ubella
E$tre+el/ teratogenic in %irst tri+ester
#auses congenital de%ects o% e/es5 heart5 ears5 and 0rain
26
1o+en 6ith lo6 ru0ella titers should 0e vaccinated at least 2 +onths 0e%ore 0eco+ing ,regnant or %ollo6ing
a deliver/
N&.E" Any )oman in the first trimester of pre*nancy is at ris8 if e@posed to rubella. Con*enital %etal defects
often results from such an infection.
3# 3ytome"alovirus :3(@;
#+roduces flu-li'e or mo&o&ucleosis-li'e symptoms i& the mother
0ra&smitted throu"h the respiratory or se1ual route
(ay cause fetal death, retardatio&, heart defects, deaf&ess
*o effective treatme&t available
?# 7erpes Simples
6ffects the e1ter&al "e&italia, va"i&a, a&d cervi1
3auses drai&i&", ,ain%ul vesicles
?elivery of the fetus is usually by cesarea& sectio& active lesio&s are prese&t i& the va"i&a9 delivery may be
performed va"i&ally if the lesio&s are i& the a&al, peri&eal, or i&&er thi"h area :strict precautio&s are
&ecessary to protect the fetus duri&" delivery;
*o va"i&al e1ami&atio&s are do&e i& the prese&ce of active va"i&al herpetic lesio&s
7aintain #&N.A#. isolation ,rocedures during hos,itali8ation i% the disease is active
*eo&ate a&d mother may be se&a'ate( (u'in$ t#e acti)e &e'io(, or other special precautio&ary measures
may be used to avoid tra&smissio& to &eo&ate
.eratogenic Drugs" BASA-&(code9
1 9 -arbiturates
A 9 6&ti-malarial
S 9 Salicylates
A 9 6&esthetic
O 9 Oral hypo"lycemics
Su0stance A0useA
Alcohol" causes lear&i&" disabilities, (o&"olism, fetal alcohol sy&drome
NicotineA i&creases vasoco&strictio&, retardatio&, S46 :small "estatio&al a"e;, low birth wei"ht
*eroin addictA babies are bor& with an $'A--$A"$,> +5P$AC"I&$ CNS > $%L$'$S or
CNS II"A(ILI"5.
#occaine" "he effect of cocaine in a labor and the fetus is preterm labor thus increased uterine
contractions3 intrauterine *ro)th retardation and the potential for a sic83 addicted infant


II. "#!siolo$ical #hanges in Pregnanc/
Inc'eases (u'in$ &'e$nanc!
!&crease 7eart /ate for 1B-15 beats/mi&ute
!&crease 3ardiac )utput for 2BC - 3BC duri&" 1
st
> 2
&d
trimester to meet i&crease tissue
dema&d
!&crease secretio& of su"ar :4lycosuria;
INC$AS$ PLAMA &OLUM$
!&crease ,ri&ary 8reHue&cy due to pressure to bladder#
2$
!&crease &ormal depe&de&t .dema :bilateral or a&'le edema; &ormal for 36 wee's "estatio&#
Dec'eases (u'in$ &'e$nanc!
?ecrease :sli"htly of blood pressure; i& the 2
&d
trimester due to decrease peripheral resista&ce
?ecrease 7emo"lobi& & 7ematocrit because of !ro& ?eficie&cy 0Pseudo. AN$MIA;
?ecrease "astroi&testi&al motility & peristalsis due to displaceme&t of the i&testi&e & compressio&
of the stomach# ---leadi&" to 3)*S0!+60!)*#
?ecrease ,ri&e Specific "ravity< a result of i&crease ,ri&ary )utput#
Ot#e'sA
#hloas+a " Mas8 of pre*nancy
Leu4orrhea" )hitish #a*inal dischar*e )ithout si*ns of inflammation < itchin*.
&,erculu+" formation of mucus plu* in C$&I' to seal out bacteria.
Lordosis" the Pride of Pre*nancy
ela$in" responsible hormone for the softenin* of the pel#ic cartila*es. Produce by the corpus luteum3
contributes to the )addlin* *ait typically noted in pre*nancy.
Nor+al deliver/ 0lood loss" ECC I JCC ml of blood
#esarean Section" ;CC I 9CCC ml
II a. Ante&a'tu Healt# "'ootion
"'enatal ;isit
Sc#e(ule of )isit if <it# no co&licationsA
a. E)e'! . <ee2sD u& to 3- <ee2s
b. E)e'! - <ee2sD f'o 3-934 <ee2s :o'e f'eFuentl! if &'obles e,ist+
c. E)e'! <ee2 f'o 349.8 <ee2s
Classifications of "'e$nanc!
GRA;IDA > &umber of times pre"&a&t, re"ardless of duratio&, i&cludi&" prese&t pre"&a&cy#
"RIMIGRA;IDA > pre"&a&t for the first time#
ItGs important for the nurse to distin*uish bet)een a client )hoGs ha#in* her first baby and one )ho has already
had a baby. %or the client )hoGs pre*nant for the first time3 4uic8enin* occurs around AC to AA )ee8s. 6omen
)ho ha#e had children )ill feel 4uic8enin* earlier3 usually around 9; to AC )ee8s3 because they reco*ni2e the
sensations.
MULTIGRA;IDA > pre"&a&t for seco&d or subseHue&t time#
"ARA > &umber of pre"&a&cies that lasted more tha& 2B wee's#
NULLI"ARA > a woma& who has &ot "ive& birth to a baby beyo&d 2B wee's "estatio&#
"RIMI"ARA > a woma& who has "ive& birth to o&e baby more tha& 2B wee's "estatio&#
MULTI"ARA > a woma& who has had two or more births at more tha& 2B wee's "estatio&#
Note1 ")ins or triplets counted as 9 para#
PE.E7 I ne)born born before EK )ee8s of *estation.
TERM > &ewbor& bor& after 3$ wee's to 4B wee's of "estatio&#
"OST9TERM > &ewbor& bor& after 4B wee's of "estatio&#
"a'it! :T"AL+
T 9 *umber of terms births,
" 9 *umber of premature births,
A 9 *umber of 6bortio&s,
2=
L 9 *umber of livi&" childre&
NUTRITION
1
st
.ri+ester" A IJ lbs *ain > EC.EF calories>8*>day
2
nd
tri+ester" 9 lb per )ee8 > ACC calories>8*>day
2
rd
tri+ester" 9 lb per )ee8> ACC calories>8*>day
"'e$nant ?oen nee(s 2:: e$tra calories PE DA; fo' a(eFuate nut'ition.
A (iet of 23:: calories ,er da/
An inc'ease of about 3:: calories ,er da/ is nee(e( (u'in$ LA#.A.)&N.
)ron De%icienc/ Ane+ia is a 'esult of P)#A.
Diffe'ent t!&es of E,e'cises
Pelvic (loor #ontractions (Kegel<s E$ercise+A +romotes peri&eal heali&", i&crease se1ual
respo&sive&ess, press stress i&co&ti&e&ce# ?o&e 5B-1BB times# .1amples< 0i"hte&i&" &
stre&"the&i&" the muscles of the @a"i&a, rectum, peri&eum & the& rela1 after# .fficie&t for
,ri&ary 8reHue&cy & 7emorrhoids# !&crease elasticity of the Pubococcy*eus muscle#
A0do+inal +uscle #ontractionsA pre#ent constipation i& pre"&a&cy, do&e i& sta&di&" or lyi&" positio&,
stre&"the&i&" the abdomi&al muscles#
Pelvic oc4ingA elie#es bac8ache duri&" pre"&a&cy, do&e by ti"hte&i&" the buttoc's & flatte&s the
lower bac' a"ai&st the floor for o&e mi&ute#
DI**ERENT T="ES O* 1REATHING TECHNIGUES
6# 6bdomi&al breathi&" : duri&" late&t phase of Sta"e 1 5abor;
1# ,sed u&til labor is more adva&ced
2# 0he abdome& moves outward duri&" i&halatio& a&d dow&ward duri&" e1halatio&
3# 0he rate remai&s slow, with appro1imately si1 to &i&e breaths per mi&ute
-# +a&t-pa&t-blow: duri&" 0ra&sitio&al +hase of Sta"e 1 5abor;
1# ,sed i& adva&ced labor
2# 6 more rapid patter&, co&sisti&" of two short blows from the mouth followed by a lo&"er blow
3# 6ll e1halatio&s are a blowi&" motio&
III. *e'tili3ation to Conce&tion
*e'tili3ationA the u&io& of the ovum & sperm# 0he start of (itotic cell divisio& < fetal se@
determination.
N +rimary oocyte :immature ovum; co&tai&s ?iploid &umber of chromosomes :46;#
N )&e oocyte co&tai&s a haploid :23; &umber of chromosomes after divisio&#
N 4amete :mature ovum;< is a cell or ovum that has u&der"o&e (aturatio& & will be ready for
fertili2atio&#
N )&e "amete carries 23 chromosomes#
N 6 sperm carries 2 types of se1 chromosomes# O & F#
N 4BB millio& sperm cells i& o&e eaculatio&#
N 8u&ctio&al 5ife of spermato2oa is 4= hours
N OOJ female, OFJ male#
2A

*i$u'e %9* Mo'ula
"'ocess of *e'tili3ationA
6fter ovulatio& ovum will be e1pelled from the 4raafia& follicles ovum will be surrou&ded by Lona
Pellucida :mucopolysaccharide fluid; & a circle of cells 0Corona adiata; which i&creases the bul' of the
)vum e1pelled from the 8allopia& 0ube by the 8imbriae :i&fu&dibulum;# Sperms move by fla"ella &
+e&etrate the & dissolve the cell wall of the ovum by releasi&" a proteolytic e&2yme
:+yaluronidase7 6fter pe&etratio& 8usio& will result to Ly*ote# Gy"ote mi"rate for 4 days i& the
body of the uterus :(itosis will ta'e place-3leava"e formatio& will be"i&; 6fter 16-5B cell formatio& from
mitosis, a mulberry & -umpy appeara&ce will follow morula 0%igure 1-(7 ---after 3-4 days, the structure will
be ball li'e i& appeara&ce which will be called (lastocyst# 3ells i& the outer ri&" are called "rophoblast :later it
forms the place&ta, respo&sible for the devEt of place&ta & fetal membra&e9 3ells i& the i&&er ri&" are called
$rythroblas t cells :which will be the embryo;#
Te's to 'eebe'A
&vu+A 8rom ovulatio& to fertili2atio&
=/goteA 8rom fertili2atio& to impla&tatio&
E+0r/oA 8rom impla&tatio& to 5-= wee's#
(etus" 8rom 5-= wee's u&til term
"he o#um is said to be #iable for AJ.36 hours#
Sodium (icarbonate. the freHue&t medicatio& to alter the va"i&al ph, decrease the acidity of the
va"i&a so as to !*3/.6S. 07. ()0!5!0F )8 07. S+./(#

*i$u'e %9G *etal Meb'anes
*etal Meb'anes< membra&es that surrou&d the fetus, & "ive the place&ta the shi&y appeara&ce#
:*i$u'e %-4;
2 5ayers<
a. A+nion< shi&y membra&e o& the 2
&d
wee' of .mbryo&ic ?evelopme&t & e&closes the 6m&iotic
3avity
b. #horion1 )uter membra&e that supports the sac of the am&iotic fluid#
#horionic Villi1 fin*er li8e pro?ections from the chorion. "his is the place )here *ases3 nutrients and
)aste products bet)een the maternal < fetal blood ta8es place.
Aniotic *lui(< surrou&ds the embryo, co&tai&s fetal uri&e, la&u"o from fetal s'i& & epithelial cells#
+h is $# 2# Specific 4ravity< 1#BB5 > 1#B25
Normal Amount1 FCC I 9CCC ml.
Oli*ohydramnios. less than ECC ml.
Polyhydramnios. more than ACCC ml. obser#e for ,o)n syndrome < con*enital defects
8u&ctio&s of 6m&iotic 8luid<
a# +rotects the fetus from cha&"es i& the temperature & cushio& a"ai&st i&ury#
b# +rotects the umbilical cord from pressure, the fetus dri&'s & breaths the fluid
i&to the lu&"s#
Aniotic *lui( Colo's< *ormal color< tra&spare&t, clear, with white ti&y spec's
,ar8 amber or yello)< )mi&ous si"& of prese&ce of -ilirubi&, hemolytic disease
Port 6ine Colored< 6bruptio +lace&ta
-reenish1 (eco&ium Stai&ed / 8.065 ?!S0/.SS< always "o for Cesarian SectionP 6lso if ph is
less than K.A
If )ith odor< deliver withi& 24 hours, may i&dicate i&fectio&#
3B
Ubilical Co'(A 21 i&ches i& le&"th & 2 cm i& thic' &ess, circulatory commu&icatio& of the fetus to the
mother# 3)*06!*S 2 6/0./!.S & 1 @.!*# 3overed by a "elati&ous mucopolysaccharide called
6hartons ?elly.
!mpla&tatio& occurs at the e&d of the 1st wee' after fertili2atio&, whe& the blastocyst attaches to the
e&dometrium# ?uri&" the 2&d wee' :14 days after impla&tatio&;, impla&tatio& pro"resses a&d two "erm layers,
cavities, a&d cell layers develop# ?uri&" the 3rd wee' of developme&t :21 days after impla&tatio&;, the
embryo&ic dis' evolves i&to three layers, a&d three &ew structures Q the primitive strea', &otochord, a&d
alla&tois Q form# .arly duri&" the 4th wee' :2= days after impla&tatio&;, cellular differe&tiatio& a&d
or"a&i2atio& occur#

*i$u'e %9H *e'tili3ation C!cle
0able Summary from 8ertili2atio& to !mpla&tatio& :8i"ure 1-7;
III.a ORIGIN O* 1OD= TISSUE
.issue La/er Bod/ Portion (or+ed
.30)?./( *ervous system, mucus membra&es, a&us & mouth
(esoderm 3o&&ective 0issue, /eproductive, circulatory & upper
,ri&ary system, bo&es, cartilla"e
.&doderm li&i&" of the 4! tract, /espiratory 0ract, bladder & urethra
MULTI"LE "REGNANCIES
Dou0le ovu+ Single &vu+
?i2y"otic/frater&al twi&s (o&o2y"otic/ide&tical twi&s
)va from same or differe&t ovaries u&io& of a si&"le ovum & a si&"le sperm
Same or differe&t se1 same se1 o&e place&ta
2 place&tas but maybe fused
2 chorio&s & 2 am&io&s o&e chorio& & 2 am&io&s
Genetics"
"#enot!&eA !&dividualEs outward appeara&ce
Genot!&e< !&dividuals 4e&etic (a'e up
Ha'!ot!&eA +ictorial a&alysis of i&dividualEs chromosomes
Se'ot!&eA a&ti"e&ic character R6-)S
31
+/.-8./0!5!G60!)*
630!@!0!.S
)vum moves to amulla of
fallopia& tubes
3apacitatio&
6crosome reactio&
3)*3.+0!)*
Go&a reactio&
Gy"ote :fertili2ed ovum9
about 24-4= hrs, divides9
cleava"e divides, travels to
the uterus
!(+56*060!)*
(orula :after 3-4
days impla&tatio&;
-lastocyst
:trophoblast9
embryolast;
!mpla&ts complete
w/& $-1B days
Genetic Disorders"
Autoso+al ecessive DisordersA both me& & wome& are at eHual ris' because the ?.8.30!@. 4.*.
is a& 6,0)S)(.< o&e of 22 pairs of &o&-se1 chromosomes# )ffspri&" of each pre"&a&cy
has a 25C cha&ce of bei&" affected a&d 5BC cha&ce of bei&" a carrier#
E$a+,les are" P=U 0 phenyl8etenuria7 3 "ay . Sachs ,isease3 Cystic %ibrosis3 "hallasemia3
and Sic8le Cell Anemia
Autoso+al Do+inantA a& affected offspri&" has a& affected pare&t#
E$a+,les are" +untinton/s Chorea and Marfan/s Syndrome 0Arachnodactyly7
>-lin4ed do+inant?ecessive Diso'(e's< ab&ormal "e&e is fou&d o& the O chromosome because me&
have o&ly o&e O chromosome, they always e1press the disorder#
E$a+,les are1 +emophillia and ,uchenne Muscular ,ystrophy
I;. *ETAL DE;ELO"MENT

*i$u'e %9 H- *etal De)elo&ent
+lace&
tal
tra&sp
ort of
substa
&ces
: 5
wee's
;
0he
fetus is 2$-31 mm
a&d wei"hs 2-4
"rams
8etus s
mar'edly be&t
7ead
is
disproportio&ately
lar"e due to brai&
developme&t
3e&ter
s of bo&e be"i& to
ossify
4a&"li
o&ic cells :5
th
to
12
th
wee's;
+lace&ta a&d meco&ium
.mbryo is 4-5 mm le&"th
0rophoblasts embedded i& deciduas
8ou&datio&s for &ervous system, "e&itouri&ary system, s'i&, bo&es, a&d
lu&"s are formed
/udime&ts of eyes, ears, &ose appear
Cardio#ascular system functionin*3 heart be*innin* to beat3 be*innin* of heart circulation.
Placenta de#/t.
32
are prese&t, with facial features
1 mo/ 4 wee's
3 mos#/A-12 w's
2 mo/ 5-= wee's
C&S done 0; 9A )ee8s7 e#ery or*an present3 +ead *reatly enlar*ed
6vera"e le&"th is 5B-55 mm a&d wei"hs 45 "ms#
8i&"ers a&d toes are disti&ct#
+lace&ta is complete#
/udime&tary 'id&eys secrete uri&e#
8etal circulatio& is complete#
.1ter&al "e&italia show defi&ite characteristics#
4a&"lio&ic cells
S$' IS &ISUALL5 $CO-NILA(L$# +eart is audible in a ,oppler 0 99
th
)ee87
8etus swallows# %ith &ails# Lid&eys able to secrete#
4 mos# /13-16 wee's A4-14B mm le&"th a&d wei"hs A$-2BB "ms#
7ead is erected, lower limbs are well developed#
7eartbeat is prese&t
*asal septum a&d palate close
8i&"erpri&ts are set
LANU-O APP$AS IN "+$ (O,5
=
mos# /
3B-34
wee's
5e&"t
h
2=B-
32B
mm#
wei"h
t
1$BB-
25BB
"ms#$
mos# /
26-2A
wee's
5e&"t
h
25B-
2$59
wei"h
t A1B-
15BB
"ms#2
8etus is 15B-1AB mm# !& le&"th a&d wei"hs appro1imately 26B-46B
"ms#
5a&u"o covers e&tire body#
.yebrows a&d scalp hair is prese&t#
+eart sounds are perceptible by auscultation.
&erni@ caseosa co#ers s8in#
+eartbeat can be heard in the fetoscope 0 9; )ee8sMAC )ee8s7. Li#er is already pancreas
functionin*.
Quic8enin* felt by a mother. S8eleton be*ins to de#elop.
(ro)n %ats be*in to form. +eart sounds in the stethoscope
Can be heard 0 9K. AC )ee8s7
NO"$1 .here is a ,lacental 0arrier to s/,hilis until the 1@
th
6ee4 o% ,regnanc/.
)% the +other is treated 0e%ore 1@
th
6ee45 the 0a0/ 6ill +ost li4el/ not 0e
a%%ected.

33
1-25
%..
LST
)5?
(6*
Es
863.
5
mos# /
1$-2B
wee's
0oe&ails become
visible
Steady wei"ht
"ai& occurs
@i"orous fetal
moveme&t occurs#
LANU-O ,ISAPP$AS
are fully de#eloped.

A)are
of
sounds
outside
the
body.
Assum
es the
deli#er
y
positio
n.
Increa
sed
chance
of
sur#i#
al.
S'i& red
/hythmic
breathi&" occurs
+upillary
membra&e
disappears from
eyes#
8etus ofte&
survives if bor&
prematurely
(rain de#elops
rapidly. Lecithin. Sphin*omyelin 0L>S
ratio is already A197
(rains fully de#eloped. If born3
34
neonate may sur#i#e.
5e&"th 2BB-24B
mm# %t# 4A5-A1B
"ms#
S'i& appears
wri&'led a&d pi&'
to red#
/.( be"i&s
.yebrows a&d
fi&"er&ails
develop#
&$NI' CO&$S "+$ $N"I$
(O,5. +as the ability to hear.
Production of lun* surfactants.
Passi#e Antibody transfer
0 placental immuno*lobulin -7
Su
stained
)ei*ht
*ain
occurs.
A mos# /35-3$ wee's6
mos# /21-25 wee's
5e&"th 33B-36B mm# wei"ht 2$BB-34BB "ms#
8ace a&d body has a loose wri&'led appeara&ce because of
subcuta&eous fat deposit#
-ody is usually lump a&d la&u"o disappears
*ails reach fi&"ertip ed"e
6m&iotic fluid decreases#
Increase ,e#elopment. Sole of the foot ha#e already
creases. -ood chance of sur#i#al.
.
a
r
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i
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t
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p
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1B mos# / 3=-4B wee's 5e&"th 36B mm#9 %ei"ht 34BB-36BB
"ms#
S'i& is smooth, chest is promi&e&t
.yes are u&iformly slate colored
-o&es of s'ull are ossified a&d are
&early to"ether at sutures#
"estes are in scrotum.
Optimum "ime for sur#i#al.
%ull term. Li*htenin* is present.
35
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psychosocial tas8 is to o#ercome fears
the )oman may ha#e about the
un8no)n3 labor pain3 loss of self.
esteem3 loss of control3 and death.
"he emotions and fears that are
usually felt durin* the third trimester
are feelin*s of Nu*linessO3 alterations
in body self.ima*e and an@iety about
the comin* labor and deli#ery.
A. MATERNAL ADA"TATIONS DURING "REGNANC= / <it# 1IOLOGICAL TASHS O*
"REGNANC=
*i'st T'ieste'A 6(-!@65.*3.- about pre"&a&cy< pre"&a&t woma& focus o&ly to self#
I am pre*nant. QAccept the biolo*ical fact of pre*nancy
Secon( T'ieste'A 633.+06*3.---of the ide&tificatio& of motherhood & aware&ess & i&terest i& the fetus#
I am *oin* to ha#e a babyQ Accept the *ro)in* fetus as distinct from self < as person to care for
T#i'( T'ieste'A .()0!)*65 56-!5!0F- assumi&" already the mother, fears & fa&tasies & dreams about
labor
I am *oin* to be a motherQPrepare realistically for birth < parentin*

1. "ATERNAL ADA"ATATIONS / REACTIONS TO "REGNANC=
#&!VADE S;ND&7E1 identification of the motherH ambi#alence < an@iety about the role chan*e
EEAL&!S; S.AGE" increase interest in mothers care.
SEL(-#&N#EP. #*ANGE" acti#e in#ol#ement in the fears < death of the fetus.
SECTION III
6*0.+6/065 3)(+5!360!)*S
A. Abo'tion
-termination of pre*nancy before the fetus is #iable (2: 6ee4s or a 6eight o% 3:: *7
15A
6-)/0!)*
0herapeutic Spo&ta&eous
!&evitable 0hreate&ed
*i$. ... 0yp e s o f 6b o r t i o &
0F+.
S
?.8!*!0!)
*
S/S *,/S!*4
!*0./@.*0!)*
0hrea
te&ed
loss
that
ca&
be
preve
&ted9
aborti
ve
proce
ss is
"oi&"
o&-l
eedi&
" a&d
cervi
cal
dilati
o&Sa
ve
tissue
fra"
me&t
s3#
3om
plete
+rod
ucts
of
co&ce
ptio&
are
totall
y
e1pel
led(
i&ima
0he
co&ti&uatio&
of the
pre"&a&cy is
i& doubt
-leedi&"
or
spotti&"
closed
cervi1
-edrest, /estrictive
activity, Sedatio&, 6void
coitus for 2 wee's
followi&" last evide&ce
of bleedi&"
ho*am indicated )hen
a youn* patient has a
threatened abortion in
the first trimester and a
laboratory studies
re#eal an h ne*ati#e
and the husband is h
positi#e
16B
3omplete !&complete (issed 7abitual
l
bleed
i&"3
o&ti&
uous
mo&it
ori&"
1#
0hrea
te&ed
/ete&
tio&
of the
produ
cts of
co&ce
ptio&
after
fetal
death
!&ter
mitte
&t
bleed
i&"9
abse&
ce of
uteri&
e
"rowt
h.va
cuati
o&, ?
&
34#
!&co
mplet
e2#
!&evit
able
Some
fra"me&ts
are retai&ed
i&side the
uteri&e
cavity
+rofuse
bleedi&"
?ilatatio& & 3uretta"e9
,se of o1ytoci&<
O@ytocin nasal spray
should be administered
)hile the client is
sittin* )ith her head in
a #ertical position. A
nasal preparation must
not be administered
)ith the client lyin*
do)n or the head tilted
bac8 because this could
cause aspiration.
.vacuatio&
S
i
"
&
s
a
6#7abitual / /ecurre&t
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siv
el
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-*arrowi&" of
tube
-+elvic i&fectio&
-.&dometriosis
-Smo'i&"
.+istory of IU,
usa*e
.
-@a"i&al -leedi&"
-=nife.li8e abdominal pain
-eferred pain on the ri*ht
shoulder
-Symptoms of Shoc8< decreased -+
i&creased //, fast but thready
pulse# "his is the number 9
complication.
-+elvic pressure of pelvic full&ess
-3ulle&Es si"&
-Pain unilaterally3 )ith crampin*
and tenderness
. Mass in the adne@al or cul.de.
sac
- Sli"ht, dar' va"i&al bleedi&"
- +rofou&d shoc' if rupture occurs
-3uldoce&tesis
-3uldoscopy
-/adioimmu&oassay of
elevated serum Hualitative
--eta-734
-6bdomi&al ,ltrasou&d
--lood samples of 7"b
a&d 7ct9 blood type a&d
"roup
(o&itor amou&t of
bleedi&"
6ssess vital si"&s
6ssess abdomi&al pai&
-lood tra&sfusio&
Sur"ery< Salpi&"ostomy
6dmi&ister /ho"am for
/h :-; clie&t
.he F1 #o+,lication o% Ecto,ic Pregnanc/ is *e+orrhagic Shoc4.
1$5
C. H!(ati(ifo' ole / T'o&#oblastic Disease / Mola' Disease
- 4estatio&al trophoblastic &eoplasm that arise from the chorio&9 characteri2ed
by the proliferatio& a&d de"e&eratio& of the chorio&ic or trophoblastic villi#
A patient )ith +ydatidiform mole has a positi#e si*ns of pre*nancy but is not pre*nant.
"he R9 Complication is #horiocarcino+a
"he "hree + of +.mole
9.*yper . emesis *ra#idarum
A. increase *c*
E. increase incidence for pi*
+/.?!S+)S!*4
8630)/S
0F+.S (6*!8.S060!)*S ?!64*)S0!3
0.S0S
(6*64.(.*0
1# INCOMP$"$N"
C$&I'S/non/+sD/s%unctional
cervi$Predis,osing?#ontri0uting
(actors"e,eated dilatation o% the cervi$5
+aternal DES ( Dieth/lstil0estrol9
E$,osure5 .rau+atic inGuries to the
cervi$. #ongenital ano+al/.he F1
#o+,lication o% *-+ole is
choriocarcino+a7olar evacuation ?
DA#Lo6 socioecono+ic status
2# 0rauma to the cervi1 :sur"ery / birth;
3# ,teri&e a&omaly
4# 7abitual abortio&
5# +re-term labor
1.
ii. D. Inco&etent ce')i,
- +ai&less premature dilatatio& of the cervi1
:usually i& the 9:
th
to AC
th
)ee87
1# 3omplete/ classical parts of the villi are affected
2# !&complete/ partial- some parts are &ormal
1# @a"i&al bleedi&"
2# .1cessive */@
E. apid enlar*ement of the uterus
J. 0P7 Pre*nancy test
5# +ossible +!7
6# 6bdomi&al cramps
$# 6bse&t 87/
=# .levated 734 titer< 1-2 millio& !,9 *ormal level< 4BB,BBB !,
1$6
INCOM"ETENT CER;I@

8i"ure 1A
2. 3hemotherapy
B. (o&itor 734 levels
3. ?elay childbeari&" pla&s for a year
H. +eri&eal pad cou&ts
I. !&struct the couple to have @64!*65 /.S0
: &o se1; for 1 year#
1# %ome& below 1= or above 35
2# !&ta'e of 3lomid :3lomiphe&e 3itrate;
3# %ome& of asia& herita"e
!&itial Si"&s734 titer determi&atio&
9. Ultrasound
2# O-ray of the abdome&
:. Sho) 0a pin8.stained #a*inal dischar*e7
$# F1 Sign1 upture of membranes and dischar*e
of amniotic fluid
1# 0he cervi1 dilates pai&lessly i& the
seco&d trimester of pre"&a&cy#
-loody show5ate si"&s<
2#+/)(
3#+ai&less dilatatio&
=# -irth of dead/&o&-viable fetus
A# +ressure or heavi&ess o& the lower abdome&#
1B# ,ltraso&o"raphy-est maor sur"ery<3ervical
3ercla"e, (c?o&ald 3ercla"eScree&i&" or
i&itial dia"&ostic
test<3ardi&al/+atho"&omo&ic/maor si"&<
11# ,ltrasou&d
+ossible sur"ical complicatio&<3o&formity test< 12# Sterility, rupture of the cervi1 premature
delivery, pelvic bleedi&" a&d i&fectio&#
Side lyi&" positio&?isease
complicatio&
+ro&e positio&
13# X9 +emorrha*e, .ctopic pre"&a&cy, birth
defects, viruses a&d pre"&a&cy diseases,
diabetes i& pre"&a&cy, 7+*
14# 4.S060!)*65 ?!6-.0.SDefinitionA t/,e
o% Dia0etes 6here onl/ ,regnant 6o+en gets
6here her 0lood sugar rate elevates 0ut never
had a high 0lood sugar rate 0e%ore
,regnanc/.S!non!sDiabetes (u'in$
"'e$nanc! *ursi&" ?ia"&osis3ervical
!&compete&ce*ursi&" !&terve&tio& Pre.
op1 $ncoura*e patient to maintain bed
rest(est side e4uipment(est position
before and after sur*ery
(Pillitteri5 7aternal and #hild Nursing5
,.2J1-J29

E. DIA1ETES MELLITUS
Suctio&
1$$
4estatio&al diabetes mellitus :pre"&a&cy
i&duced;
A pre*nant3 insulin.dependent diabetic is at
ris8 for sudden h/,ogl/ce+ia because insulin
needs and metabolism are affected b pre*nancy3
ma8in* sudden hypo*lycemic episodes more
common for diabetics.
3ha&"es i& the "lucose-i&suli& mecha&ism<
o .arly i& pre"&a&cy<
6# !&crease productio& of
i&suli&
-# (ater&al "lucose is
co&sumed by fetus
o 5ate i& pre"&a&cy<
6# (other develops
i&suli& resista&ce
-# 0he prese&ce of
place&tal i&suli&ase
brea's dow& i&suli&
rapidly

-# ?escriptio& of
?iabetes i& +re"&a&cy

1. (ater&al "lucose crosses the place&ta but


i&suli& does &ot
2. ?uri&" the first trimester, mater&al i&suli&
&eeds decrease
2. 0he fetus produces its ow& i&suli& a&d pulls
"lucose from the mother, which predisposes
the mother to hypo"lycemic reactio&s
B. ?uri&" the seco&d a&d third trimesters,
i&creases i& place&tal hormo&es cause a&
i&suli&-resista&t state, reHuiri&" a& i&crease
i& the clie&tIs i&suli& dose
3. ?iabetes mellitus is more difficult to co&trol
duri&" pre"&a&cy & occurs duri&" the
seco&d or third trimester# +remature
delivery is more freHue&t# 0he &ewbor&
i&fa&t of a diabetic mother may be lar"e i&
si2e but will have fu&ctio&s related to
"estatio&al a"e rather tha& si2e# 0he
&ewbor& i&fa&t of a diabetic mother is
subect to h/,ogl/ce+ia5
h/,er0iliru0ine+ia5 res,irator/ distress
s/ndro+e5 and congenital ano+alies.
Still0orn and neonatal +ortalit/ rates are
higher in ,regnancies o% a dia0etic 6o+an
H.
1$=
I. N&.E" .he greatest incidence o% insulin
co+a during ,regnanc/ occurs during the
second and the third +onths5 the incidence o%
the dia0etic co+a during ,regnanc/ occurs
around the si$th +onths.
@.
J.
GESTATIONAL DIA1ETES
Post.op1 Chec8 for e@cessi#e #a*inal dischar*e
and se#ere pain.
9. (ed rest in trendelenbur* position
A. Administer tocolytic medications as ordered $*H
itodrine +ydrochloride 05utopar71 "erbutaline
sulfate 0(rethine71 Ma*nesium Sulfate
J. +ydro@y2ine hydrochloride 0&istaril7 is a
common dru* ordered to counteract the effect of
terbutaline 0(rethine7
:. Sur*ery1 Cer#ical Cercla*e
a. Shirod8ar.(arter "echni4ue
0 internal os7 permanent suture1 subse4uent
deli#ery by C>S.
b. Mc ,onald Procedure 0 e@ternal
os7.suture remo#ed at term )ith #a*inal
deli#ery
c.
Usually J.: )ee8s after #a*inal deli#ery is the
safe period for a patient to resume se@ual
acti#ity3 )hen the episiotomy has healed
and the lochia had stopped
. Monitor &>S and report +PN (o&itor
87/
5imit activities
)bserve for /uptured -)%
6void va"i&al douche
6void coitus
15# 3-+Es< +olyuria, +olydipsia a&d
+olypha"ia+redisposi&"/3o&tributi&"
8actors
16# (60./*65 S!4*S & SF(+0)(S<
1$# 1#.1cessive thirst
1=# 2# 7u&"er
1A# 3# %ei"htless
2B# 4# -lurred visio&
21# 5# 8reHue&t uri&atio&
22# 6# /ecurre&t uri&ary tract i&fectio&s a&d
va"i&al yeast i&fectio&s
23# $# 4lycosuria a&d 'eto&uria
24# =# Si"&s of pre"&a&cy-i&duced
hyperte&sio&
25# A# +olyhydram&ios
2$# 7yper"lycemia develops duri&" pre"&a&cy
because of the secretio& of place&ta hormo&es
such as +rolacti&, +ro"estero&e& 3orticosteroids
(ater&al a"e more tha& 35
+revious macrosomic i&fa&t
+revious u&e1plai&ed stillbirth
+revious pre"&a&cy with 4?(
8amily history of ?(
)besity
7yperte&sio&
2=# 8-S more tha& 14B m"/dl
1$A
26# 1B# 8etus lar"e for "estatio&al a"e
5ate si"&s!&itial Si"&s 2A# 8ati"ue, wea'&ess, sudde& visio& cha&"es,
ti&"li&" or &umb&ess i& ha&ds
3ardi&al/+atho"&ome&ic/maor si"& 3B# %ei"ht loss, fati"ue, &ausea, a&d vomiti&"
e1cessive thirst, decrease uri&atio&
Scree&i&" or i&itial dia"&ostic test 31# 5B "ms oral "lucose challe&"e test
G
+
r
o
m
o
t
e
r
e
s
t
+
r
o
m
o
t
e
a
h
e
a
l
t
h
y

d
i
e
t
.
d
u
c
a
t
e
r
3o&firmative test 22# 3- hour "lucose
tolera&ce test will be
performed to
co&firm diabetes
mellitus
23#4lycosolated
7emo"lobi& less
tha& =C
-est diet
1=B
e
"
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r
d
i
&
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8
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let
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+
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ify
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phy
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1=3
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ct
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icat
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ivit
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ivit
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intra#ascular coa*ulation, cerebral ischemia, mater&al a&d fetal death
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N -etamethaso&e is i&dicated to i&crease fetal lu&" maturity# :(osby,
3omprehe&sive p# 2B3;
*ursi&" ?ia"&osis with
*ursi&" !&terve&tio&
F1 N!S)NG D)AGN&S)S" Potential %luid volu+e de%icit
N (ai&tai& bed rest
N F1 Assess+ent - 7onitor +aternal vital signs5 (*5 and %etal activit/
N 6ssess bleedi&" :amou&t a&d Huality;
N (o&itor a&d treat si"&s of shoc'
N 6void va"i&al e1ami&atio& if bleedi&" is occurri&"
N +repare for premature birth or cesarea& sectio&
N 6dmi&ister !@ fluids as ordered
N 6dmi&ister iro& suppleme&ts or blood tra&sfusio& as ordered :mai&tai&
hematocrit level;
N +repare to admi&ister /h immu&e "lobuli&
-.S0+)S!0!)* .he ,atient 6ith ,lacenta ,revia should 0e +aintained on 0ed rest5
,re%era0l/ in a side-l/ing ,osition. Additional ,ressure %ro+ an u,right
,osition +a/ cause %urther tearing o% the ,lacenta %ro+ the uterine lining.
A+0ulating 6ould there%ore 0e indicated %or this ,atient. Per%or+ing a
vaginal e$a+ination and a,,l/ing internal scal, electrode could also cause
the ,lacenta to 0e %urther torn %ro+ the uterine lining.
2=2
A1RU"TIO "LACENTAEP Left late'al &osition
Confi'ato'! Test
A1RU"TIO "LACENTAE
8i"ure 21
N ,ltrasou&d for place&ta locali2atio&
*)0.<
Manual pel#ic e@aminations are contraindicated
)hen #a*inal bleedin* is apparent in the third
trimester unit a dia*nosis is made and placenta
pre#ia is ruled out. ,i*ital e@amination of the
cer#i@ can lead to maternal and fetal
hemorrha*e. A dia*nosis of placenta pre#ia is
made by ultrasound. "he hemo*lobin and
hematocrit le#els are monitored and e@ternal
electronic fetal heart rate monitorin* is initiated.
$lectronic fetal monitorin* 0e@ternal7 is crucial
in e#aluatin* the status of the fetus )ho is at ris8
for se#ere hypo@ia. 0Saunders Comprehensi#e
ACCA $dition3 p. ECJ7
-est +ositio&
?efi&itio& +remature separatio& of the place&ta from the uteri&e
wall after the 2B
th
wee' of "estatio& a&d before the fetus
is delivered :Sau&ders pa"e 2AA-3BB;
2=3
Pathophysiolo*y S Spontaneous rupture of blood #essels at the
placental bed may due to lac8 of resiliency or to
abnormal chan*es in uterine #asculature.
S May be complicated by hypertension or by an
enlar*ed uterus that can/t contract sufficiently to
seal off the torn #essels
S Conse4uently3 bleedin* continues unchec8ed3
possibly shearin* off the placenta partially or
completely. 0Nursin* Alert p.J7
(a&ifestatio& N +ai&ful va"i&al bleedi&"
N 7yperto&ic to teta&ic, e&lar"ed uterus
N Board-li4e rigidit/ o% a0do+en (#ullen Sign9
N 6b&ormal/abse&t fetal heart to&es
N +allor
N 3ool, moist s'i&
N -loody am&iotic fluid
N /isi&" fu&dal hei"ht from blood trapped behi&d the
place&ta
N Si"&s of shoc'
N (a&ifestatio& of coa"ulopathy
NO"$1
Uterine tenderness accompanies placental abruption3
especially )ith a central abruption and trapped blood
2=4
behind the placenta. "he abdomen )ill feel hard and
boardli8e upon palpation as the blood penetrates the
myometrium and causes uterine irritability.
Obser#ation of the fetal monitorin* often re#eals
increased uterine restin* tone3 caused by failure of the
uterus to rela@ in an attempt to constrict blood #essels
and control bleedin*. 0Saunders Comprehensi#e ACCA
$dition3 p. ECJ7
3omplicatio& S +emorrha*e3 shoc83 renal failure3 disseminated
intra#ascular coa*ulation3 maternal death3
fetal death0Nursin* Alert p.J7
"herapeutic Inter#entions N /eplaceme&t of blood loss#
N %ith moderate or severe separatio& or mater&al or
fetal distress< emer"e&cy childbirth#
*)0.<
.he goal o% +anage+ent in a0ru,tion
,lacentae is to control the he+orrhage and
deliver the %etus as soon as ,ossi0le. Deliver/
is the treat+ent o% choic i% the %etus is at ter+
gestation or i% the 0leeding is +oderate to
severe and +other or %etus is in Geo,ard/.
(Saunders #o+,rehensive 2::2 Edition5 ,.
2:B9
N %ith mild separatio& without fetal distress a&d i&
the prese&ce of some cervical effaceme&t a&d
dilatatio&< i&ductio& of labor may be attempted
N)1y"e& if &ecessary
N (ai&te&a&ce of fluid a&d electrolytes bala&ce#
:(osby, 3omprehe&sive p# 2B4;
*ursi&" ?ia"&osis with !&terve&tio& F1 N!S)NG D)AGN&S)S" is4 %or %luid volu+e
de%icit
T F1 Assess+ent" 7onitor and (*
N 6ssess for va"i&al bleedi&", abdomi&al pai&, a&d
i&crease i& fu&dal hei"ht
N (ai&tai& bed rest
N 6dmi&ister o1y"e& as prescribed
N (o&itor a&d report a&y uteri&e activity
N 6dmi&ister !@ fluid as prescribed
N (o&itor ! & )
N 6dmi&ister blood products as prescribed
N (o&itor blood studies
N +repare for the delivery of the fetus as Huic'ly as
possible
N (o&itor for si"&s of dissemi&ated i&travascular
coa"ulatio& i& the post-partum period
3o&firmatory 0est N ,ltrasou&d detects retro-place&tal bleedi&"
;ENA CA;A S=NDROME
?efi&itio& 0he ve&ous retur& to the heart is impaired by the wei"ht
of uterus#
Sy&o&ym Supi&e 7ypote&sive Sy&drome
2=5
+redisposi&" factors 0hrombophlebitis
*)0.<
3o&tribute to clot formatio& motio& i&clude
i&activity,reduced cordiac output, compressio& of the
vie&s i& pelvis or le"s
"he most li8ely cause of supine hypotension is feelin*
di22y3 short of breath and clammy )hen lyin* bac8 for
lon* periods of time in patients :
th
month of
pre*nancy.
"he cause of supine hypotension durin* pre*nancy
is the )ei*ht of the uterus compresses the inferior
#ena ca#a3 decreasin* the return of blood to the
heart3 thus decreasin* cardiac output3 )hich lo)ers
the blood pressure
!&itial si"& 8atiHue, pro1ymal &octur&al dysp&ea, orthop&ea,
hypo1ia, cya&osis
5ate Si"& /educe re&al perfectio&, ?ecrease "lomerular filtratio&
3ardi&al si"& shoc' such as tachycardia
*)0.<
3aused by reduced cardiac output, respiratory
distress, fatal distress
!&itial / Scree&i&" test 870 mo&itor
*)0.<
6bove 16B or below 12B beats per mi&utes, 8etal +7
below $#5
3o&firmatory test 6m&iotomy<
*)0.<
6bove 'eepi&" the si"&ifica&t other improved of the
pro"ress of care, the fatal status would he the
priority
*ursi&" ?ia"&osis 6ltered tissue perfectio& related to decrease blood
circulatio&
/is' for altered 7ealth mai&te&a&ce related to
i&sufficie&t '&owled"e of treatme&ts, dru"
therapies, home care ma&a"eme&t a&d preve&tio&
of future i&fectio&
6ltered comfort related to maladaptive copi&"
*ursi&" !&terve&tio& 3losely mo&itor for shoc' a&d decreasi&" blood#
+ressure, tachycardia, coal, clammy S'i&
(ai&tai& patie&t o& bed rest to reduce )1y"e&
dema&ds a&d ris' for bleedi&"# (o&itor prescribed
medicatio& "ive& to preserve ri"ht @e&tricular
felli&" pressure a&d i&crease blood pressure
!&struct patie&t i& self > care activities +rovide
i&formatio& about a&ti smo'i&" strate"ies a&d
allow patie&t time to retur& demo&stratio& of
treatme&t to the do&e at home
6ssess physical complai&ts matters of facts
without emphasi2i&" co&cer&# ,se deep >
breathi&", muscle rela1atio&, a&d ima"ery to
relieve discomfort# .1press a cari&" attitude
-est maor Sur"ery 3aesaria& Sectio& > &ote if cervi1 is i&complete deleted#
-est dirt for pre-operative 8ood a&d fluid are withheld before i&vasive procedure
2=6
is &ot resumed u&til the clie&t is stable a&d free of
&ausea & vomiti&"#
-est diet for ?isease 7ypoaller"e&ic !o&ic diet 3alcium i&creased
+ossible Sur"ical 3omplicatio& !&terruptio& of ve&a cava, which reduce cha&&el si2e#
3omplicatio& of ?isease N -leedi&" as a result of treatme&t
*)0.<
)bservatio& of the fetal mo&itori&" ofte& reveal
i&crease uteri&e rustli&" to&e, caused by failure of the
uterus to rela1 i& a& attempt to co&strict blood vesicle
a&d co&trol bleedi&"
N /espiratory failure#
-est positio& pre-operative Sims +ositio&
*)0.<
.urning to the le%t side to shi%t right o% the %etus o%%
the in%erior vena cava#
-ed Side .Huipme&t )1y"e& obtai& eHuipme&t for e1ter&al electro&ic fetal
heart rate mo&itori&" )1y"e& with 3a&&ula
Disse+inated )ntravascular
coagulation7istory of ?isease
6&"i&a, myocardial i&farctio&
3ool&ess a&d mottli&" of e1tremities9 pai&9
dysp&ea9 ab&ormal bleedi&"+redisposi&" /
3o&tributi&" 8actors
*ame of the ?isease
)verwhelmi&" i&fectio&s particularly bacterial sepsis9
F1 a0ru,tion ,lacenta' ecla+,sia' am&iotic fluid
embolism9 !,8?:!&tra-uteri&e fetal death; or rete&tio&
of dead fetus9 bur&9 trauma9 fractures9 maor sur"ery9
fat embolism9 soc'9 hemolytic tra&sfusio& reactio&9
mali"&a&cies particularly of lu&", colo&, stomach, a&d
pa&creas
NO"$1
,isseminated intra#ascular coa*ulation 0,IC7 is a
state of diffuse clottin* in )hich clottin* factors are
consumed. "his leads to )idespread bleedin*. Platelet
are decreased because they are consumed by the
process3 coa*ulation studies sho) no clot formation
0and are thus normal to prolon*ed7H and fibrin plu*s
may clo* the micro#asculature diffusely3 oo2in* from
in?ection sites3 and presence of hematuria are si*ns
associated )ith the presence of ,IC. S)ellin* and pain
in the calf of one le* are more li8ely to be associated
)ith thrompophlebitis. 0Saunders Comprehensi#e ACCA
$dition3 p. ECJ7
5ate Si"&!&itial Si"& 6ltered me&tal status9 acute re&al failure
*ursi&" ?ia"&osis & !&terve&tio& /is' for i&ury related to
bleedi&" due to thrombocytope&ia
2=$
6ltered tissue perfusio& :all
tissues; related to ischemia due to
microthrombi formatio&
?ecreased 8ibri&o"e& level9 i&creased fibri& split
products9 decreased a&ti-thrombi& !!! level-eside
.Huipme&t.349 3@+Scree&i&" or !&itial ?ia"&ostic
0est(i&imi2i&" -leedi&"
1# !&stitute -leedi&" precautio&s
2# (o&itor pad cou&t/amou&t of saturatio& duri&"
me&ses9 admi&ister or teach self-admi&istratio& of
hormo&es to suppress me&struatio& as prescribed#
3# 6dmi&ister blood products as ordered# (o&itor for
si"&s a&d symptoms of aller"ic reactio&s,
a&aphyla1is, a&d volume overload#
4# 6void dislod"i&" costs# 6pply pressure to sites of
bleedi&" for at least 2B mi&s, use topical
hemostatic a"e&ts# ,se tape cautiously#
5# (ai&tai& bed rest duri&" bleedi&" episode#
6# !f i&ter&al bleedi&" is suspected, assess bowel
sou&ds a&d abdomi&al "irth#
$# .valuate fluid status a&d bleedi&" by freHue&t
measureme&t fo vital si"&s, ce&tral ve&ous
pressure, i&ta'e a&d output#
=#
A# +romoti&" 0issue +erfusio&
1# Leep patie&t warm
2# 6void vasoco&strictive a"e&ts :systemic or
topical;#
3# 3ha&"e patie&tEs positio& freHue&tly a&d perform
/)( e1ercises#
4# (o&itor electrocardio"ram a&d laboratory test for
dysfu&ctio& of vital or"a&s casued by ischemia >
arrhythmias, ab&ormal arterial blood "ases,
i&creased blood urea &itro"e& a&d creati&i&e#
5# (o&itor for si"&s of vascular occlusio& a&d report
immediately#
a# -rai& > decreased level of co&scious&ess,
se&sory a&d motor deficits, sei2ures,
coma#
b# .yes > @isual deficits#
c# -o&e > +ai&
d# +ulmo&ary vasculature > chest pai&, short&ess
of breath, tachycardia#
e# .1tremities > cold, mottli&", &umb&ess#
f# 3oro&ary arteries > chest pai&, arrhythmias#
"# -owel > pai&, te&der&ess, decreased bowel
sou&ds#
+09 +009 +latelet cou&t :Smelt2er, S#3# & -are, -#4#,
1AA2#p#=11;
2==
h#
i#
#
6&ticoa"ula&t/efere&cesSmelt2er,S#3#& -are, -#4#
1AA2# -ru&&er a&d SuddarthEs 0e1boo' of (edical-
Sur"ical *ursi&", $
th
ed# K#-# 5ippi&cott compa&y<
+hiladelphia, ,S6#-est ?ru"3o&firmative 0est
0he 5ippi&cott (a&ual of *ursi&" +ractice, $
th
ed#,
2BB1# 5ippi&cott %illiams & wil'i&s<
+hiladelphia, ,S6# +p#==$-===#
7epari& i&hibits clotti&" compo&e&ts of ?!3
Natu'e of t#e D'u$
H!&e'eesis $'a)i(a'u
7yperemesis "ravidarum is persiste&t, u&co&trolled vomiti&" that be"i&s i& #the first wee's of pre"&a&cy a&d
may co&ti&ue throu"hout pre"&a&cy# ,&li'e Rmor&i&" sic'&ess,S hyperemesis ca& have serious complicatio&s,
i&cludi&" severe wei"ht loss, dehydratio&, a&d electrolyte imbala&ce#
N&.E" .he de%ining %actor %or h/,ere+esis gravidaru+ should 0e the ti+e o% occurrence U and that is the
2nd tri+ester5 usuall/ the 1B U 1H
th
6ee4. )% this is on the 1
st
tri+ester5 usuall/ this is +orning sic4ness.
Causes
4o&adotropi&e productio&
+sycholo"ical factors
0rophoblastic activity
Assessent *in(in$s
3o&ti&uous, severe &ausea a&d vomiti&"
?ehydratio&
?ry s'i& a&d mucous membra&es
.lectrolyte imbala&ce
(etabolic acidosis
*o&-elastic s'i& tur"or
)li"uria
Dia$nostic Test Result
6rterial blood "as a&d a&alysis reveals al'alosis#
7b level a&d 730 are elevated#
Serum potassium level reveals hypo'alemia
,ri&e 'eto&e levels are elevated#
,ri&e specific "ravity is i&creased#
Nu'sin$ Dia$noses
8luid volume deficit
6ltered &utritio&9 less tha& body reHuireme&ts
+ai&
T'eatent
0otal pare&teral &utritio& :0+*;
/estoratio& of fluid a&d electrolyte bala&ce
2=A
D'u$ T#e'a&!
6&ti-emetics, as &ecessary for vomiti&", for e1ample +lasil , 7ydro1y2i&e a&d +rochlorpera2i&e
Inte')ention an( Rationales
(o&itor vital si"&s a&d fluid i&ta'e a&d output to assess for fluid volume deficit#
)btai& blood samples a&d uri&e specime&s for laboratory tests, i&cludi&" 7b level, 730, uri&alysis,
a&d electrolyte levels#
+rovide small freHue&t meals to mai&tai& adeHuate &utritio&#
(ai&tai& !#@# fluid replaceme&t a&d 0+* to reduce fluid deficit a&d p7 imbala&ce#
+rovide emBotio&al support to help the patie&t cope with her co&ditio&#
"eachin* "opics
,si&" salt o& foods to replace sodium lost by vomiti&"#
8rom< Spri&"house, pa"es 4=3-4=4
I;. INTRA"ARTUM CARE
Int'a&a'tu &e'io( e1te&ds from the be"i&&i&" of co&tractio&s that cause cervical dilatio& to the first 1-4
hours after delivery of the &ewbor& a&d place&ta#
Int'a&a'tu ca'e refers to the medical a&d &ursi&" care "ive& to a pre"&a&t woma& a&d her family duri&"
labor a&d delivery#
5abor versus 5abor
1# 5abor< 3oordi&ated seHue&ce of i&volu&tary uteri&e co&tractio&s or a result i& the effaceme&t a&d dilatio&
of the cervi1, followed by e1pulsio& of the products of co&ceptio&#
2# ?elivery< 6ctual eve&t of birth
A. *acto's Affectin$ Labo'
*ACTORS A**ECTING LA1OR
+6SS64.%6F +6SS.*4./ +)%./S +563.*065
8630)/S
+SF37.
?iscomfort-e"i&s at lower bac' a&d radiates
arou&d abdome&+rimarily o& the lower abdome&
&
"roi&!rre"ular0/,.865S.3o&tractio&s/e"ular4y&ecoi
d
8etal bo&es
Suture li&es
8o&ta&els head
measureme&ts
8etal lie
+76S.S
N !&creme&t
N 6cme
N ?ecreme&t
2AB
,&cha&"ed
,&cha&"ed or decrease i& freHue&cy a&d i&te&sity
-ecome more freHue&t
4radual i&crease i& duratio& a&d i&te&sity / pro"ressive
freHue&cy & i&te&sity
I "ASSAGE?A=
-refers to the adeHuacy of the pelvis a&d birth ca&al i&
allowi&" the fetal desce&t9 factors i&clude<
6# 0ype of pelvis
-# structure of the pelvis :true versus false pelvis;
3# pelvic i&let diameters
?# ability of the uteri&e se"me&t & va"i&al ca&al to diste&d,
the cervi1 to dilate
A**ECTED 1= THE *OLLO?ING *ACTORSA
A. T!&es of St'uctu'e

PartsA ischium, iluim, coccy1#
Eoints" Sacroiliac, Sacrococcy"eal, symphysis pubis :all softe& duri&"
pre"&a&cy;

#lassi%ications or ./,es o% Pelvis"
a# G!necoi(A *ormal 8emale +elvis< /ou&ded )val#
b# 7&S. (AV&ABLE (& S!##ESS(!L
LAB& A B).*.
c# An('oi(A *ormal (ale +elvis< 8u&&el Shape
d# Ant#'o&oi(A oval
e# "lat!&elloi(A flatte&ed, tra&sverse oval
f#
B. St'uctu'e of t#e "el)is :<it# &el)ic inlet & outlet
(iaete's+
#.
D.
E.
(.
G.
*. *ALSE "EL;IS
). 6bove the li&ea termi&alis, across the top of symphysis
pubis# !t supports the e&lar"e uterus i& the abdomi&al
cavity
M Shallow upper basi& of the pelvis
M Supports the e&lar"i&" uterus but &ot importa&t
obstetrically
M LINEA TERMINALIS
M +la&e dividi&" upper or false pelvis from lower or true
pelvis
8etal attitude
8etal prese&tatio&
8etal positio&
8etal statio&
6SS.SS(.*0
8reHue&cy
?uratio&
!&terval
!&te&sity
2A1
M TRUE "EL;IS
M 5ies below the li&ea termi&alis, the bo&y pelvis
throu"h which the baby pass
M %idest diameter :tra&sverse;
M *arrowest diameter :a&terior > posterior;
M 3o&sists of the pelvic i&let, pelvic cavity, a&d pelvic
outlet#
M -o&y ca&al throu"h which the i&fa&t pass#
M (easureme&ts of true pelvis i&flue&ce the co&duct a&d
pro"ress of labor a&d delivery#
M MID"LANE
M +elvic cavity
M
M
M
M
M OUTLET
M ?i(est (iaete'A 6&terior posterior diameter :reHuires
the i&ter&al /elatio&ship of fetal head for e&try;
M Na''o<est (iaete'< 0ra&sverse !&tertuberous ?iameter
:facilitates delivery i& )ccipital 6&terior +osterior;
M
M
M 1%. "el)ic easu'eents
M a. T'ue conNu$ate o' conNu$ate )e'a
M - measured from upper mar"i& of symphysis pubis to
sacral promo&tory9 should be at least 11 cm#
M - may be obtai&ed by 1-ray or ,/S
M b. Tube'9isc#ial (iaete'/
Inte'tube'ous (iaete'
M 9 (easures the outlet betwee& the i&&er
borders of ischial tuberosities, should be at least =-A
cm#
M - estimated o& pelvic e1am
M c. Obstet'ical ConNu$ate
M - ?ista&ce betwee& the i&&er surfaces
of the symphysis pubis a&d sacral promo&tory
M
M
M II. "ASSENGER :T#e *etus+
M Refe's to t#e fetus an( its abilit! to
o)e t#'ou$# t#e &assa$e<a!.
M A**ECTED 1= THE *OLLO?ING *ACTORS<
M
M a# Attitu(e
M
M 1# 0he relatio&ship of the fetal body parts to o&e a&other
or, a&other word is fetal posture
M
M 2# Nor+al intrauterine attitude is %le$ion, i& which the
fetal bac' is rou&ded, the head is forward o& the chest, a&d
the arms a&d le"s are folded i& a"ai&st the body
M
M - Lie
M - /elatio&ship of the spi&e of the fetus to the spi&e of the
2A2
mother
M
M .ransverse lie is an indication for cesarean deli#ery.
Se#eral maternal and fetal conditions ma8e cesarean
deliver/ necessary ."he commonly accepted indications
include complete placenta pre#ia3 trans#erse lie at term3
cephalopel#ic disproportion3 abruptio placentae3 acti#e
*enital herpes3 umbilical cord prolapse3 failure to
pro*ress in labor3 pro#en fetal distress3 beni*n and
mali*nant tumors that bloc8 the birth canal3 and cer#ical
cercla*e. Other reasons for a cesarean deli#ery are more
contra#ersial3 such as breech presentation3 pre#ious
cesarean birth3 ma?or con*enital anomalies3 and se#ere
isoimmuni2ation. ")ins can sometimes be deli#ered
#a*inally3 especially )hen the lo)ermost t)in is in a
#erte@ presentation.
M
M
M 1### Lon$itu(inal o' )e'tical
M a# 8etal spi&e is parallel to the motherIs spi&e
M b# 8etus is either cephalic or breech prese&tatio&
M 2### T'ans)e'se o' #o'i3ontal
M a# 8etal spi&e is at a ri"ht a&"le, or perpe&dicular, to the
motherIs spi&e
M b# +rese&ti&" part is the shoulder
M c# ?elivery by cesarea& sectio&
M 3... ObliFue
M a# 8etal spi&e is at a sli"ht a&"le from a true hori2o&tal lie
M b# ?elivery is by cesarea& sectio& if u&correctable
M
M 3 "'esentation
M 9 the relatio&ship of a particular refere&ce poi&t of the prese&ti&"
part a&d the mater&al pelvis described with a series of 3 letters or
presentation refers to the part of the fetus at the cer#ical os
M
M +rese&ti&" part< +ortio& of the fetus that e&ters the pelvis
first
M 1# 3ephalic
M a# 0he most commo& prese&tatio&
M b# 8etal head prese&ts first
M 2 -reech
M a# -uttoc's prese&t first
M b# ?elivery by cesarea& sectio& may be
reHuired, althou"h it is ofte& possible to deliver va"i&ally
M 3 Shoulders
M a# 8etus is i& a tra&sverse lie, or the arm, bac',
abdome&, or side could prese&t
M b# !f the fetus does &ot spo&ta&eously rotate or if it is
&ot possible to tur& the fetus ma&ually, a cesarea& sectio& may
be performed
M
M *)0.< "he nurse )ould auscultate abo#e the umbilicus
if the fetus is in breech presentation has the bac8 abo#e or at the
umbilical area. %etal heart tones are ausculated best in the left
2A3
lo)er abdomen )hen the fetus is in a left occipitoanterior
position. %or the heart tones to be located belo) the umbilicus3
the fetus )ould be in a cephalic position. %etal heart tones are
heard best in the ri*ht lateral abdomen )hen the fetus is in a
ri*ht occipitoposterior position.
M ?# "osition
M /elatio&ship of assi"&ed area of the prese&ti&" part or
la&dmar' to the mater&al pelvis or the relationship of the
fetusGs presentin* part to the motherGs pel#is
M
M LEO"OLDOS MANEU;ERS
M
M It is a systematic )ay to e#aluate the presentation3
position and attitude of the fetusH the location of the best
place to auscultate the fetal heart soundsH and the
en*a*ement status of the presentin* part. .he/ don<t
accuratel/ deter+ine ho6 large the %etus is5 6hich is
0est deter+ined 0/ ultrasound.
M
M +reparatio&
M
M 1# 6s' the mother to empty the bladder
M 2# %arm ha&ds a&d apply them to the abdome& with firm
a&d "e&tle pressure
M
M +/)3.?,/.
M
M .he %irst +aneuver deter+ines 6hat %etal ,art is in the
%undal ,ortion o% the uterus. )n this case5 the so%t5 %ir+
+ass indicated the %etal 0uttoc4s are in the %undus5
re%lecting a verte$ ,resentation. .he second +aneuver
docu+ents the location o% the %etal 0ac4. .he side o%
the uterus 6here the 0ac4 is located is s+ooth and
conve$ to the touch5 and the o,,osite side has areas o%
indentation. .he third +aneuver con%ir+s that 6as
6hat ,al,ated in the %undus is correct and also
deter+ines 6hether the ,resenting ,art is engaged. )n
this case5 the hard5 round5 +ova0le o0Gect in the ,u0ic
area is the %etal head. .he %ourth +aneuver deter+ines
id the %etal head is %le$ed or e$tended.
M
M (etal Position
M
M /)6< /i"ht occiput a&terior
M 5)6< 5eft occiput a&terior (the 0est %etal ,osition9
M /)+< /i"ht occiput posterior
M /(6< /i"ht me&tum a&terior
M /(+< /i"ht me&tum a&terior
M 5)+< 5eft occiput posterior
M 5(6< 5eft me&tum a&terior
M /)0< /i"ht occiput tra&sverse
M 5)0< 5eft occiput tra&sverse
M /(+< /i"ht me&tum posterior
M 5S6< 5eft sacrum a&terior
M 5S+< 5eft sacrum posterior
M
2A4
M Se#ere bac8 pain durin* labor maybe related to a fetus in
an OCCIPI"O. POS"$IO POSI"ION. "his means that
the fetal head presses a*ainst the client/s sacrum3 )hich
causes mar8ed discomfort durin* contractions.
epositionin* the client and pro#idin* sacral bac8 rubs
may help alle#iate the discomfort. "rans#erse3 obli4ue
and occiput positions do not cause pressure on the
sacrum.
M
M 0. *etal Lie 9 refers to the relationship of the fetal lon*
a@is to that of the motherGs lon* a@is.
M a# CE"HALIC Q verte1, face, brow
M b# 1REECH > fra&', footli&", complete
M c# SHOULDER > tra&sverse lie
M
M N&.E1 Adolescent clients maturation are usually not yet
complete3 therefore they are #ery common for
cephalopel#ic disproportion.
M
M N&.EA 5ie :spi&e to spi&e; may be lo&"itudi&al
:parallel;, tra&sverse :ri"ht a&"les;, obliHue :sli"ht a&"le
off true tra&sverse lie;#
M
M *ETAL RE*ERENCE "OINT :"RESENTING "ART+
M
M 6# )33!+,0 :);
M -# S63/,( :S;
M 3# S36+,56 :Sc;
M ?# (.*0,( :(;
M
M MATERNAL RE*ERENCE "OINT
M
M 1# S!?. )8 (60./*65 +.5@!S
M 6# 5eft :5;
M -# /i"ht :/;
M 3# 0ra&sverse :0;
M
M 2# +6/0 )8 07. (60./*65 +.5@!S
M 6# 6&terior :6;
M -# +osterior :+;
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
2A5
M
M
M
M
M
M
M
M
M
M
M 1'eec# "RESENTATIONS
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M *RANH 1REECH
*ULL / COM"LETE
M
1REECH
"RESENTATION
M
M
M
M
M
M
M
M
M
2A6
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
SHOULDER 1REECH
M
M
*OOTLING "RESENTATION
M III. "O?ER
M
M 9 /efers to the freHue&cy, duratio&, a&d stre&"th of uteri&e
co&tractio&s to cause complete cervical effaceme&t a&d
dilatio&#
M
M 0he forces acti&" to e1pel the fetus
1# EffaceentA Shorte&i&" a&d thi&&i&" of the cervi1 duri&"
the first sta"e of labor
2# Dilation< .&lar"eme&t of cervical os a&d cervical ca&al
duri&" first sta"e
3#
.. LA1OR CONTRACTIONS
5#
4. THREE "HASES O* CONTRACTION
5.
1# INCREMENT- steep cresce&t slope from be"i&&i&" of
the co&tractio& u&til its pea'#
2. ACME/"EAH > stro&"est i&te&sity#
2. DECREMENT > dimi&ishi&" i&te&sity#
B.
3. CHARACTERISTICS O* CONTRACTIONS
H.
I. *REGUENC= > be"i&&i&" of o&e co&tractio& to
be"i&&i&" of o&e co&tractio&# 5ess tha& 2 mi&utes should
be reported#
@. DURATION > be"i&&i&" of o&e co&tractio& u&til its
completio&#
2A$
(ore tha& AB seco&ds should be reported
because of uteri&e rupture or fetal distress#
J. INTENSIT= > the stre&"th of co&tractio& at its pea' may
be mild, moderate or stro&"#
1:.
11.
12. I;. "LACENTAL *ACTORS
12. - /efers to the site of place&tal i&sertio&#
1B.
13.
1H. ;. "S=CHE
1I. - /efers to the clie&tEs psycholo"ical state, available
support systems, preparatio& for birth, e1perie&ces, a&d
copi&" strate"ies#
1@.
1J.
2:. 1. LA1OR
21. %. Si$ns of i&en(in$ labo'
22. -. Co&a'ison of T'ue Labo' f'o *alse
Labo'
22. 3. Sta$es of labo'
2B. 3. a. station of t#e &'esentin$ &a't
23. .. Nu'sin$ Inte')entions (u'in$ labo' &
(eli)e'!
2H. 0. Assessin$ t#e *etal Hea't Rate
2I.
2@.
2J. SIGNS O* IM"ENDING LA1OR
2:.
21.
22. 5i"hte&i&" -ra1to&Es-7ic's co&tractio&
4astroi&testi&al upset -urst of e&er"y -lood
show
22.
2B. F1 sign o% la0or
u,tured 0ag o% 6ater
23.
2H.
2I.
2@. %. "REMONITOR= SIGNS O* LA1OR
%. 5!470.*!*4
-. - ?esce&t of the fetus a&d uterus i&to pelvic cavity
before labor o&set#
3. -)ccurs 2-3 wee's earlier i& primipara#
.. - !& multipara, may &ot occur u&til labor be"i&s#
0. 2# 3./@!365 376*4.S
4. a# E**ACEMENT
5. - +ro"ressive softe&i&" Rripe&i&"S a&d thi&&i&" of
the cervi1#
6. - R-5))?F S7)%S :e1pulsio& of mucous plu";
7. b# DILATION
%8. - )pe&i&" of cervical os duri&" labor#
%%. 3# /e"ular -ra1to& 7ic'sE co&tractio&s#
%-. 4# /upture of am&iotic membra&es#
%3. 5# *.S05!*4 -.76@!)/S
%.. 6# %ei"ht loss of about 1-3 lbs 2-3 days before labor
2A=
o&set#
%0.
%4. -. COM"ARISON O* TRUE AND *ALSE LA1OR
%5.
%6. 376/630./!S0!3S
6&thropoid
6&droid
+latypelloid
.ffects of wal'i&"Stress factors6bruptio place&ta
5eadi&" to hypoto&ia
+lace&ta previa
+lace&ta acreta
+lace&ta media
3o&tractio&s are
i&te&sified
5esse&ed or
&ot affected
3ervical cha&"es +ro"ressive
dilatio& a&d
effaceme&t
*o cha&"e
+ai& does&Et disappear+ai& disappears?uri&"
Sedatio&3o&tractio&s does&Et stop3o&tractio&s
stopsShow
+rese&t *ot prese&t
?uri&" sleep
3. STAGES O* LA1OR
1
S0
S064. 2
*?
S064. 3
/?
S064. 4
07
S064.
3o&tractio& to
dilatio&
"'e&a'ato'!
(i)isionA
1; 5ate&t phase B-
3 cm
?uratio&< 3B >
45 seco&ds
*)0.< Pushin*
durin* the first
sta*e of labor
)hen the ur*e is
felt but the cer#i@
is not yet fully
dilated may
produce cer#ical
s)ellin* and
ma8es labor more
difficult. "he
client should be
encoura*ed to
PAN" (LO6 or
8ull cervical
dilatatio& to
delivery
?elivery to
place&tal
e1pulsio&
"he nurse
should
8no) if the
placenta is
*oin* to be
deli#ered3 is
to )atch for
cord
len*thenin*
3 a sli*ht
*ush of
dar8ened
blood or a
chan*e in
fundal
shape.
1
st
4 hours
postpartum
"he
precautions
you should
ta8e )hen a
postpartum
client starts
ambulatin* are
the fall
precaution and
close
monitorin*
should be done
due to the ris8
of syncopy3
especially the
first fe) times
out of bed.
2AA
(LO6.(LO6
pattern of
breathin* to help
o#ercome the ur*e
to push.
2; 6ctive phase 4-
$ cm
Du'ationA .0948
secon(s
3; 0ra&sitio&al
phase =-1B cm
?uratio& < 6B-AB
seco&ds
*IRST STAGE O* LA1OR
:ONSET O* REGULAR CONTRACTIONS TO *ULL CER;ICAL DILATION
.ANS).)&N P*ASE
0!(.< +/!(!+6/6 :1hour;
(,50!+6/6 :1B > 15 mi&utes;
3./@!O<
.8863.(.*0 - 1BBC
?!560!)* - =-1B cm
3)*0/630!)*S
8/.V,.*3F - 2-3 mi&utes
?,/60!)* - 6B-AB seco&ds
(6*!8.S060!)*S<
3lie&t may be irritable a&d pa&ic'y9 (ay lose co&trol9 6m&esic betwee& co&tractio&s9 +erspiri&",
&auseous a&d vomiti&" commo&9 0rembli&" of le"s9 +ressure o& bladder a&d rectum9 -ac'ache9 !&creased
show9 3ircumoral pallor
NO"$1 If the client is in acti#e labor and there is no chan*e in dilation after A hours3 the nurse should suspect
cephalopel#ic disproportion. "he client is not e@periencin* a prolon*ed latent phase 0C.E cm73 prolon*ed
transitional phase 0pushin*73 and contraction pattern.
NO"$1&a*inal $@amination
"o determine if the client is fully dilated3 the nurse performs a #a*inal e@amination. "o assess the
suture most readily felt3 the nurse )ould determine the position of the cranial suture termed.SA-I"ALL
SU"U$.
3BB
STATION
/efer to the level of prese&ti&" part of fetus i& relatio& to ima"i&ary li&e betwee& ischial spi&es :2ero
statio&; i& mid pelvis of mother#
- 0he measureme&t of the pro"ress of desce&t i& ce&timeters above or below the midpla&e from the
prese&ti&" part to the ischial spi&e
Minus stationA abo)e isc#ial s&ine
90 to Q% in(icates a &'esentin$ &a't abo)e 3e'o station :93*LOATINGD 9% DI""ING+
Station 8A at isc#ial s&ine
: +eans ENGAGE7EN.
"lus stationA belo< isc#ial s&ine
R % TO R 0 in(icates a &'esentin$ &a't belo< 3e'o station
R3 #&1N)NG
NMy baby is comin*O3 the R9 nursin* inter#ention is to loo8 for perineal bul*in* 0cro)nin*7. If the
perineum is bul*in*3 the patient should be coached to pant )ith her contractions so that she doesn/t
push. %etal heart rate is focus on the labor process or potential fetal cord compression and meconium
stained complications
SECOND STAGE O* LA1OR
:COM"LETE CER;ICAL DILATION TO 1IRTH O* NE?1ORN+
0!(.
+/!(!+6/6 :3B-5B mi&utes ;
(,50!+6/6 :2B mi&utes;
3)*0/630!)*S
8/.V,.*3F - 2-3 mi&utes
?,/60!)* - 6B-AB seco&ds
!*0.*S!0F
@./F 76/?< 1BB mm 7"
(6*!8.S060!)*S<
?ecrease i& pai& from tra&sitio&al level9 i&creased bloody show9 .1cited ea"er a&d i& co&trol#
3B1
THIRD STAGE O* LA1OR
:DELI;ER= O* NE?1ORN TO DELI;ER= O* "LACENTA+
0!(.< 5-3B mi&utes
3)*0/630!)*S
Stro&" a&d well-co&tracted uterus cha&"i&" to "lobular shape
(6*!8.S060!)*S<
Increased *ush of blood
Uterus becomin* *lobular )ith fundus risin* in the abdomen
Apparent len*thenin* of cord

*OURTH STAGE O* LA1OR
:DELI;ER= O* "LACENTA TO HOMEOSTASIS+
0!(.
,sually defi&ed as the first hour postpartum# 0his sta"e lasts from 1-4 hours after birth#
,0./,S
0he uterus co&tracts i& the midli&e of the abdome& with the fu&dus midway betwee& the umbilicus a&d
symphysis pubis#
(6*!8.S060!)*S<
5ochia rubra
.1ploratio& of &ewbor&
+are&t-i&fa&t bo&di&" be"i&s
*ewbor& alert a&d respo&sive
8irst period of reactivity
NURSING INTER;ENTIONS DURING LA1OR AND DELI;ER=
M ?uri&" labor, mo&itor 87/#
M +rovide patie&t comfort#
M 6dmi&ister a&al"esics as i&dicated#
M +repare for delivery#
M !mmediate &ewbor& care at delivery#
- .stablish airway#
- )bserve 6p"ar score at 1 a&d 5 mi&utes i&terval#
- 3lamp umbilical cord#
- (ai&tai& warmth#
- 6ssess the &ewbor&Es "estatio&al a"e#
- 6dmi&ister prophylactic eye drops a&d vitami& L#
- +lace ide&tificatio& ba&d o& baby a&d mother#
NURSING CARE DURING LA1OR
3B2
Nursin* care for the client durin* the second sta*e of labor should include assistin* the mother )ith pushin*3 helpin* position her le*s for ma@imum pushin* effecti#eness3 and monitorin* the fetal heart rate
3B3
Mec#aniss of Labo' En$a$eent o' Ca'(inal o)eents b! t#e *etus
Definition< (echa&ism by which the fetus &estles i&to the pelvis# 6 co&ti&uous process from the time of
e&"a"eme&t u&til birth, a&d is assessed by the measureme&t called statio&
Descent
6lso termed li"hte&i&" or droppi&" ?esce&t
0he process that the fetal head u&der"oes as be"i&s its our&ey throu"h the pelvis
*le,ion +rocess of the fetal headIs &oddi&" forward toward the fetal chest
Su0occi,oto0reg+aticA the diameter that prese&ts to the mater&al pelvis duri&" COMPL$"$ %L$'ION#
3B4
Inte'nal Rotation
!&ter&al rotatio& of the fetus9 most commo&ly from the occipital tra&sverse positio&, assumed at e&"a"eme&t
i&to the pelvis, to the occipital a&terior positio& while co&ti&uously desce&di&"
E,tension
.&ables the head to emer"e whe& the fetus is i& a cephalic positio&
-e"i&s after the head crow&s !s complete whe& the head passes u&der the pubis a&d occipital, a&d the a&terior
fo&ta&el, brow, face, a&d chi& pass over the sacrum a&d coccy1 are over the peri&eum
/estitutio&
/eali"&me&t of the fetal head with the body after that head emer"es
E,te'nal Rotation
0he shoulders e1ter&ally rotate after the head emer"es a&d restitutio& occurs, so that the shoulders are
a&teroposterior diameter of the pelvis
E,&ulsion
0he delivery baby
CARDINAL MO;EMENTS O* THE *ETUS

?esce&t 8le1io& !&ter&al /otatio& .1te&sio& .1ter&al /otatio&
.1pulsio&

8i"ure 1= 3ardi&al (oveme&ts or (echa&ism of labor
;II. ANESTHESIA
NOTEA Analgesia ad+inistered during the second stage o% la0or includes continuation o% the lu+0ar
e,idural 0loc45 ,udendal 0loc45 and local in%iltration o% the ,erineu+. Narcotic analgesics and ,ericervical
0loc4 are ad+inistered during the active ,hase o% la0or. A s,inal 0loc4 is given during the active ,hase o%
the %irst stage o% la0or. Sedative h/,notics5 i% ad+inistered5 are given 6hen the ,atient is in earl/ latent la0or
to encourage rest. A s,inal 0loc4 is given during the active ,hase o% the %irst stage o% la0or.
N&.E" *)0.< "he chief concepts of La+a8e teaching include conditioned responses to stimuli throu*h use of
a focal point. An emotionally satisfyin* e@perience is promoted rather than discoura*in* use of anal*esia and
anesthesia.
3B5
?.S3.*0 85.O!)* !*0./*65
/)060!)*
.O0./*65
/)060!)*
.O0.*S!)*
.O+,5S!)*
6# 5ocal a&esthesia
1# ,sed for bloc'i&" pai& duri&" episiotomy
2# 6dmi&istered ust before the birth of baby
3# *o effect o& the fetus
-# +aracervical bloc'
1# ,sed i& the first sta"e of labor
2# +rovides a rapid bloc' of uteri&e pai&
3# *o effect o& the peri&eal area
4# *o effect o& the ability to bear dow&
5# (ay cause fetal bradycardia
3# +ude&dal bloc'
1# 6dmi&istered ust before the birth of the baby
2# !&ectio& site at pude&dal &erve throu"h a tra&sva"i&al route
3# -loc's peri&eal area for episiotomy
4# .ffect lasts about 3B mi&utes
5# *o effect o& co&tractio&s or fetus
*)0.< Pudendal (loc8 Anesthesia
"he R9 purpose is to relie#e pain primarily in the perineum and #a*ina. It does not relie#e pain primarily
in the perineum and #a*ina. Pudendal bloc8 is ade4uate for episiotomy and its repair.
"he fetus should be assessed for (A,5CA,IA )hich is a potential complication of pudendal bloc8
anesthesia. ,ecrease mo#ements3 increase #ariability and meconium stained are NO" associated.
Maternal Ad#erse effects are the follo)in*1 hypotonia3 reduced responsi#eness and sei2ures.
?# .pidural bloc'
1# !&ectio& site i& epidural space at 53-54
2# 6dmi&istered after labor is established or ust before a scheduled cesarea& birth
3# /elieves pai& from co&tractio&s a&d &umbs va"i&a a&d peri&eum
4# (ay cause hypote&sio&
5# Does not cause headache 0ecause the dura +ater is not ,enetrated
6# 6ssess mater&al blood pressure
$# (ai&tai& the mother i& side-lyi&" positio& or place a rolled bla&'et be&eath the ri"ht hip to displace the
uterus from the ve&a cava
=# 6dmi&ister !@ fluids as prescribed A# !&crease fluids as prescribed if hypote&sio& occurs
A# 0he maor complicatio& of epidural a&esthesia is mater&al hypote&sio&#
N&.E" "o minimi2e the hypertensi#e effects of epidural anesthesia prior to the procedure ade4uately
hydrate the patient and position the patient side lyin* to the left.
After epidural anesthesia the #ital si*ns should be monitored e#ery 9.A minutes for the first 9F minutes.
.he assess+ent should 0e a high ,riorit/ a%ter a ,atient has received an e,idural is 0lood ,ressure
0ecause an e,idural can cause h/,otension and its 0loc4s the autono+ic nervous s/ste+.
A patient )ho is about to recei#e epidural anesthesia should empty her bladder before the procedure
because an epidural )ill lessen the sensation to #oid so #oidin* no) may decrease the need for
catheteri2ation later.
*)0.<
3B6
A co++on adverse e%%ect o% e,idural anesthesia is h/,otension5 6hich 6ould cause i+,aired gas
e$change in the %etus. .o ,revent h/,otension5 the ,atient receives a 0olus o% 3:: to 15::: +l o% ).V.
%luid 0e%ore the ,rocedure. .he ,atient isn<t a%%ected 0/ these ,ro0le+s 0ecause she didn<t receive the
e,idural anesthesia.
*)0.< "he patient plans to recei#e an epidural anesthetic for pain relief durin* labor3 it )on/t be
administered until the patient is dilated J to F cm.
.# Spi&al bloc'
1# !&ectio& site i& spi&al subarach&oid space at 53-55
2# 6dmi&istered ust before birth
3# /elieves uteri&e a&d peri&eal pai& a&d &umbs va"i&a, peri&eum, a&d lower e1tremities
4# (ay cause mater&al hypote&sio&
5# (ay cause postpartum headache
6# 0he mother must lie flat = to 12 hours followi&" spi&al i&ectio&
$# +lace a rolled bla&'et u&der the ri"ht hip to displace the uterus from the ve&a cava
=# 6dmi&ister !@ fluids as prescribed
8# 4e&eral a&esthesia
1# (ay be used for some sur"ical i&terve&tio&s
2# 0he mother is &ot awa'e
3# +rese&ts a da&"er of respiratory depressio& vomiti&"
O1STETRICAL "ROCEDURES
6# )1ytoci& !&ductio&
1# 6 deliberate i&itiatio& of uteri&e co&tractio&s this stimulates labor
2# .lective i&ductio& may be accomplished ! o1ytoci& :+itoci&; i&fusio&
3# )btai& baseli&e traci&" of uteri&e co&tractio&s a&d 87/
4# !&crease !@ dosa"e of o1ytoci& as prescribed o&ly after assessi&" co&tractio&s, 87/, a&d mater&al blood
pressure a&d pulse
5# ,o not increase rate of o@ytocin once the desired contraction pattern is obtained 0contraction fre4uency
of A to E minutes and lastin* :C seconds7
6# ,iscontinue o@ytocin as prescribed contraction fre4uency is less than A minutes or duration more than TC
seconds3 or if fetal distress is note
*)0.< )1ytoci& :!&ductio& of 5abor;
(efore the induction of Labor3 the nurse should obtain a baseline measurement of the fetal heart rate. If
the fetal heart rate pattern sho)s fetal distress3 the client is not a candidate or if contractions occur less
than A minutes apart or last lon*er than :C seconds
3# Anioto!
1# 6rtificial rupture of membra&es :6/)(;9 performe by the physicia& to stimulate labor
2# +erformed if the fetus is at ZBZ or ZUZ statio&
3# !&creases ris' of prolapsed cord a&d i&fectic
3B$
4# (o&itor 87/ before a&d after 6/)(
5# /ecord time of 6/)(, 87/, a&d characteristic of fluid
6# (eco&ium-stai&ed am&iotic fluid may be associated with fetal distress
$# -loody am&iotic fluid may i&dicate abrupt place&tae or fetal trauma
=# 6& u&pleasa&t odor to am&iotic fluid is associated with i&fectio&
A# +olyhydram&ios is associated with mater&al diabetes a&d certai& co&"e&ital disorders
1B# )li"ohydram&ios is associated with i&trauteri&e "rowth retardatio& :!,4/; a&d co&"e&ital
disorders
? #E,te'nal )e'sion
1# .1ter&al ma&ipulatio& of the fetus from a& ab&ormal positio& i&to a &ormal prese&tatio&
2# !&dicated for a& ab&ormal prese&tatio& that e1ists after the 34th wee'
3# (o&itor vital si"&s
4# !f the mother is /h-&e"ative, e&sure that /7 immu&e "lobuli& was "ive& at 2= wee's "estatio&
5# +repare for &o&stress test to evaluate fetal well-bei&"
6# !@ fluids a&d tocolytic therapy may be admi&istered to rela1 the uterus a&d permit easier ma&ipulatio& of
fetus
$# ,ltrasou&d is used duri&" the procedure to evaluate fetal positio& a&d place&tal placeme&t a&d "uide
directio& to the fetus
=# 6bdomi&al wall is ma&ipulated to direct fetus i&to a cephalic prese&tatio& if possible
A# (o&itor blood pressure to ide&tify ve&a cava compressio&
1B# (o&itor for u&usual pai&
11# 8ollowi&" the procedure
a# +erform &o&stress test to evaluate fetal well-bei&"
b# #(o&itor for uteri&e activity, bleedi&", ruptured membra&es, a&d decreased fetal activity
c# %ith /h-&e"ative clie&ts, perform Lleihauer -et'e test as prescribed to detect the prese&ce a&d
amou&t of fetal blood i& the mater&al circulatio& a&d to ide&tify clie&ts who &eed additio&al /h
immu&e "lobuli&
i# E&isioto!
J "he purpose of episiotomy is to shorten the A
nd
sta*e of labor3 substitutes a clean sur*ical incision for
a tear and decreases undue stretchin* of perineal muscles. An episiotomy helps pre#ent tearin* of the
rectum but does not necessarily relie#e pressure on the rectum. An episiotomy does not pre#ent perineal
edema3 ensure 4uic8 deli#ery of the placenta or cause enlar*in* the pel#ic inlet.
1# !&cisio& made i&to peri&eum to e&lar"e va"i&al outlet a&d facilitate delivery
2# 3hec' episiotomy site
3# !&stitute measures to relieve pai&
4# +rovide ice pac' duri&" the first 24 hours
5# !&struct the clie&t i& the use of sit2 baths
6# 6pply a&al"esic spray or oi&tme&t as prescribed
$# +rovide peri&eal care, usi&" clea& tech&iHue
=# !&struct the clie&t i& the proper care of the i&cisio&
A# !&struct the clie&t to dry the peri&eal area from fro&t to bac' a&d to blot the area rather tha& wipe it
1B# !&struct the clie&t to shower rather tha& bathe i& a tub
11# 6pply a peripad without touchi&" the i&side surface of the pad
3B=
12# /eport a&y bleedi&" or dischar"e to the physicia&
13# "he ad#anta*e of an episiotomy is that it facilitates the deli#ery of the fetus3 it pre#ents tearin* of the
perineum3 and it pre#ents undo stretchin* of the perineal muscles.
8# *o'ce&s (eli)e'!
1# 0wo double-crossed, spoo& li'e articulated blades that are used to assist# i& the delivery of the fetal head
2# /eassure the mother a&d e1plai& the &eed for forceps
3# (o&itor mother a&d fetus duri&" delivery possible i&ury
5# 6ssist with repair of a&y laceratio&s
4# ;acuu e,t'action

1# 6 cap li'e suctio& device is applied to the fetal head to facilitate e1tractio&
2# Suctio& is used to assist i& delivery of the fetal head
3# 0ractio& is applied duri&" uteri&e co&tractio&s u&til desce&t of the fetal head is achieved
4# 0he suctio& device should &ot be 'ept i& place a&y lo&"er tha& 25 mi&utes
5# (o&itor 87/ every 5 mi&utes if e1ter&al fetal mo&itori&" is &ot used
6# 6ssess &ewbor& i&fa&t at birth a&d throu"hout postpartum period for si"&s of cerebral trauma
$# (o&itor for developi&" cephalohematoma
=# 3aput succeda&eum is &ormal a&d will resolve i& 24 hours
7# Cesa'ean (eli)e'!

1# ?elivery of the fetus usually throu"h a tra&s-abdomi&al, low-se"me&t i&cisio& of the uterus
2# +reoperative
a# !f pla&&ed, prepare the mother a&d part&er
b# !f a& emer"e&cy, Huic'ly e1plai& the &eed a&d procedure to the mother a&d part&er
c# )btai& i&formed co&se&t
d# (a'e sure that the preoperative dia"&ostic tests are do&e, i&cludi&" the /h factor
e# +repare to i&sert a& !@ li&e a&d a 8oley catheter
f# +repare the abdome& as prescribed
"# (o&itor the mother a&d fetus co&ti&uously for si"&s of labor
h# +rovide emotio&al support
i# 6dmi&ister preoperative medicatio&s as prescribed
3# +ostoperative
a# (o&itor vital si"&s
b# +rovide pai& relief
c# .&coura"e tur&i&", cou"hi&", a&d deep breathi&"
d# .&coura"e ambulatio&
e# (o&itor for si"&s of i&fectio& a&d bleedi&"
f# -ur&i&" a&d pai& o& uri&atio& may i&dicate a bladder i&fectio&
"# 6 te&der uterus a&d foul-smelli&" lochia may i&dicate e&dometritis
h# 6 productive cou"h or chills may i&dicate
3BA
p&eumo&ia
COM"LICATIONS O* LA1OR AND DELI;ER=
"'ete' Labo'
+reterm labor is labor that be"i&s after 2B wee's "estatio& a&d before 3$ wee's "estatio&#
)btai& thorou"h obstetric
history5ow bac' pai&.0!)5)4F
)btai& specime& for 3-3 & ,/6
?etermi&e freHue&cy, duratio& &
i&te&sity of uteri&e co&tractio&s
?etermi&e cervical dilatatio&s a&d
effaceme&t
6ssess status of membra&es a&d
bloody show
.valuate fetus for distress, si2e
a&d maturity
Suprapubic pressure
@a"i&al pressure
/hythmic uteri&e co&tractio&s :2
uteri&e co&tractio&s lasti&" 3B
seco&ds withi& 15 mi&utes;
3ervical dilatatio& Y4 cm &
effaceme&t 5BC or less
.1pulsio& of cervical mucus plus
-loody dhow
S!4*S /SF(+0)(S 6SS.SS(.*0
+/)(
(6*64.(.*0+erform measures to ma&a"e or
stop +reterm labor(6*64.(.*0
"ROM :"'eatu'e Ru&tu'e of Meb'ane+
- Spo&ta&eous rupture of am&iotic membra&es prior to
o&set of labor, maybe preterm :before 3= wee's
"estatio&; or term
6SS.SS(.*0
+lace o& 3-/ i& side-lyi&" positio&
+repare fro possible ultrasou&d, am&ioce&tesis,
tocolytic a&d steroid therapy
6dmi&ister meds as prescribed
6ssess S/. such as hypote&sio&, dysp&ea, chest
pai& a&d 87/ e1ceedi&" 1=B b#p#m#

,yspnea on e@ertion and increased #a*inal


mucus are common discomforts caused by
the physiolo*ic chan*es of pre*nancy.
+rovide adeHuate hydratio&
+rovide emotio&al support
*,/S!*4 (6*64.(.*0
31B
3)*0/!-,0!*4 8630)/ 4oal<
+/.@.*0!)* )8 +/.0./( ?.5!@./F
1# !&compete&t cervi1
2# 0rauma
3# !&fectio&
S!4*S 6*? SF(+0)(S
1# 5ea'a"e of am&iotic fluid
2# p7 hi"her tha& 6#5
3# *itra2i&e paper reactio& J blue
/!SL 8)/<
1# +rolapsed cord
2# !&fectio&
3# /?S
3o&servative 0reatme&t<
-ed rest i& lateral positio&
7ydratio& w/ !@8 a&d co&ti&uous fetal a&d uteri&e
co&tractio& mo&itori&"
0ocolytic 0herapy<
-eta mimetic a"e&ts< /itodri&e :Futopar;
Use of ritodrine can lead to pulmonary edema.
"herefore3 the nurse should assess for crac8les and
dyspnea. (lood *lucose le#els may temporarily rise3
not fall3 )ith ritodrine. itodrine may cause
tachycardia3 not bradycardia. itodrine may also
cause hypo8alemia3 not hyper8alemia.
itodrine 05utopar7 can cause tremor and ?ittery
feelin*s3 so it must be assessed )hether the feelin*s
are from the medication or from the Preterm labor
Steroid therapy
(6*64.(.*0<
1# %ith i&fectio&< a&tibiotics a&d delivery of i&fa&t
2# %ithout i&fectio&<
34-36 wee's of "estatio&J delay birth,
am&ioce&tesis a&d mo&itor 5S ratio of the
baby
2=-32 wee's of "estatio&J delay birth,
admi&ister steroids to haste& maturity of the
lu&"s a&d decreased /?S
"he *ood indicator of fetal lun* maturity in a
pre*nant diabetic is presence of phosphatid*lycerol in
the amniotic fluid.
6# ,mbilical cord prolapse
If the fetus is at IA station and the membranes rupture3 the patient is at ris8 for prolapsed cord.
5ou can determine if a prolapsed cord e@ists if you perform a #a*inal e@am.
"ROLA"SE UM1ILICAL CORD

8i"ure 23
+/)56+S. ,(-!5!365 3)/?
?efi&itio& 0he umbilical cord is displaced, either betwee& the prese&ti&" post
a&d the am&io& or protrudi&" throu"h the cervi1#
Sy&o&yms 3ord +rolapse
+redisposi&" 8actors
311

%etal Position other than cephalic presentations
+rematurity<
*)0.< Small fetus allows more space arou&d prese&ti&" part#
+olyhydram&ios
Multiple fetal *estation
8eto+elvic disproportio&
6b&ormally lo&" umbilical cord#
Placenta Pre#ia
Intrauterine tumors that pre#ent the presentin* part from en*a*in*
N -reech prese&tatio&, 0ra&sverse lie, ,&e&"a"ed prese&ti&" part, 0wi&
"estatio&, 7ydram&ios
Small fetus

3a
0
h
e
c
o
r
d

m
a
y

t
h
e
&

p
r
e
s
e
&
t
/
v
i
s
i
b
l
e
[

t
h
e
v
!&itial Si"& 3ord +rolapse<
*)0." %irst discovered 6hen there is varia0le decelerated ,attern
87/ patter& variable< ?eceleratio&s with co&tractio&s or betwee&
co&tractio& or fetal bradycardia prese&t
+ersiste&t &o& reassuri&" fetal heart rate > fetal distress
6trophy of the umbilical cord & cord protrudi&" from va"i&a
3ord may be palpated i& cervi1/va"i&a
/efle1 co&strictio& whe& cord is e1posed to air
312
u
l
v
a
#

N
o
t
e
"
D
o

n
o
t
a
t
t
e
+
,
t
t
o

,
u
s
h

t
h
e

c
o
r
d

i
n
t
o

t
h
e

u
t
e
r
313
u
s
#
?
y
s
t
o
c
i
a
3o&firmatory 0est5ate Si"& 6m&iotomy< /upture of (embra&es
F1 7aternal A
(etal )n%ection -
#ausing
co+,ression o% the
cord and
co+,ro+ising %etal
circulation-est
(aor Sur"ery
)07./S< +rematurity,
7ypo1ia, (eco&ium
aspiratio&,8etal death if
delayed or u&dia"&osed
Cesarian Section if the cer#i@ incompletely dilated.
%ast #a*inal deli#ery )ith forceps
7istory of the
?isease8etal
&utrie&ts
supply7epari& !@
-est ?ru".ter&al
.lectro&ic 8etal
7eart /ate
mo&itori&"-est
+ositio& ?isease
3omplicatio&
3ompressio& of the
umbilical cord
0o co&trol i&travascular
coa"ulatio& i& the
pulmo&ary circulatio&
*ature of the
dru"
)1y"e& with face-
mas'#
Sterile ha&d "love
.rendelen0erg<s ,osition or Knee #hest ,osition -6hich causes the
,resenting ,art to %all 0ac4 %ro+ the cord.
0ur& side to side -7elps may be elevated to shift to fetal prese&ti&"
toward diaphra"m#
H="ERTONIC LA1OR
"ATTERNS :"'ia'!
ine'tia+H="OTONIC LA1OR
"ATTERNS :Secon(a'!
8luid volume deficit related
to active hemorrha"e
6ltered tissue perfusio&
related to mater&al vital
*ur
si&"
!&te
rve&
314
ine'tia+*ursi&"
?ia"&osis-edside
eHuipme&t
(Pillitteri5 7aternal and #hild
Nursing5 ,.2::9
(Pillitteri5 7aternal and #hild
Nursing5 ,.3I@-3IJ9
*. D!stocia
G.
7# - ?ifficult,
pai&ful, ab&ormal pro"ress of
labor of more tha& 24 hours
!#
1# +owers/ uteri&e i&ertia/
co&tractio&
2#
3#
or"a& a&d fetal related to
hypovolemia
/is' for i&fectio& related
traumati2e tissue
tio&
7anage+ent"N!S)NG
)N.EVEN.)&NPredis,osing
(actors"#A!SESEarl/ analgesia&$/tocin and
a+nionit/.EA.7EN.est and
sedation&##!EN#EN&.E" .he nurse<s F1
,riorit/ action to a ,rola,se cord is to assess the %etal
heart rate. A ,rola,sed cord interru,ts the o$/gen
and nutrient %lo6 to the %etus. )% the %etus doesn<t
receive adeDuate o$/gen5 h/,o$ia develo,s5 6hich
can lead to central nervous s/ste+ da+age in the
%etus.
1# (o&itor clie&t a&d fetus closely
2# +ossibly admi&ister tocolytic a"e&ts
3# +repare for emer"e&cy birth
1# (ultiparity
2# 7istory of rapid labor
3# +remature or small fetus
4# 5ar"e bo&y pelvis
5#
6# /is's<
1# +eri&eal laceratio&s & 7emorrha"e
A. 6hen deli#erin* the neonate3 you should
deli#er the head bet)een contractions. "his
)ill pre#ent the head from bein* deli#ered
too suddenly3 thuds pre#entin* a possible
tearin* of the perineum.
E.
4# 3# 8etal 3erebral trauma
4# +assa"eway
a# 3o&tracted pelvis
b# ,&favorable pelvic shapes
c#
d# (a&a"eme&t<
i# .valuate pelvic diameters
ii# 3o&ti&ue labor with careful mo&itori&"
iii# +erform assisted va"i&al or caesarea&
5ate&t phase of labor
315
delivery
iv#
5# +syche
a# 8ear, a&1iety ad te&sio& i&crease stress
a&d decrease uteri&e co&tractility
b# Stress i&terferes with the clie&ts ability
with her co&tractio&s
c# Stress i&crease fati"ue
d#
e# (a&a"eme&t<
i# (o&itor clie&ts psycholo"ic respo&se to
labor
ii# ?etermi&es clie&ts level of stress
iii# +rovide support
iv# .&coura"ed rela1atio&
).
)i.
vii#
)iii. D. Infection
i,.
@. "he infant is at ris8 to de#elop
thrush if the pre*nant )oman has
monillial infection at the time of
#a*inal deli#ery
,i.
,ii.
,iii.
1iv#
1v#
1vi#
1vii#
1viii#
1i1# 3lamydia
4o&orrhea
Syphilis 6!?S
0)/37
11#
11i#
11ii#
11iii#
11iv#
,,). ACGUIRED
IMMUNODE*ICIENC=
S=NDROME :AIDS+
a# 0ra&smissio&
6# 6cross the place&tal barrier
-# ?uri&" the process of labor a&d delivery
3# @ia breast mil'
-7!@ ca& cross some membra&es such as the place&tal
barrier, the blood-brai& barrier, va"i&al mucosa, a&d
:i& the &eo&ate; the walls of the "astroi&testi&al tract
316
Infection
-+re&atal tra&smissio& from i&fected mother to fetus or
&ewbor& via tra&splace&tal tra&smissio&, via
co&tami&atio& with mater&al blood duri&" birth, or
throu"h breast mil'
b# *ursi&" (a&a"eme&t
6void procedures that i&crease the ris' of pre&atal
tra&smissio&, such as am&ioce&tesis a&d fetal scalp
sampli&"
Note that i% the %etus has not 0een e$,osed to *)V in
utero5 the highest ris4 e$ists during deliver/ through
the 0irth canal
*ever use scalp electrodes
6void episiotomy to decrease the amou&t of mater&al
blood i& a&d arou&d the birth ca&al
+romptly remove the &eo&ate from the motherIs blood
followi&" delivery
*)0.< *)V has 0een %ound to 0e
trans+itted through the 0reast +il4 %ro+ +other
to 0a0/. .here%ore5 0reast %eeding isn<t
reco++ended %or a +other 6ho is *)V-,ositive.
1hile trans+ission rates o% *)V in%ection %ro+
+other to in%ant range %ro+ 2:K to I3K5
,ro%essionals esti+ate the actual trans+ission rate
at a0out B:K to 3:K. .he A)DS virus is ,assed
trans,lacentall/5 so cesarean deliver/ 6ill not
,revent in%ection o% the neonate. )n o,tions 25
trans+ission %ro+ +other to %etusVchild can occur
trans,lacentall/ throughout ,regnanc/5 trough
contact 6ith the +other<s 0lood and vaginal
secretions at deliver/ and through ingestion o%
0rea4 +il4. )n the o,tion B5 a ne60orn can 0e
s/+,to+-%ree at 0irth and still develo, A)DS. A
true diagnostic o% *)V in%ection in neonates
cannot actuall/ 0e +ade until around 13 +onths
o% age.

G# "'eci&itate (eli)e'!

9 5abor that is completed


withi& 3 hours

A pre*nant patient )ith a 8no)n history of


crac8 cocaine use is in labor must be prepared for a
precipitous labor and notify the neonatolo*ist of the
infant/s hi*h.ris8 status.
31$

If a patient has a precipitous labor at ris83


the result of the labor process )ould be laceration of
the soft tissues3 uterine rupture3 and e@cessi#e
uterine bleedin*.

6SS.SS(.*0
-owel or bladder diste&tio&
(ultiple "estatio&
5ar"e fetus
7ydram&ios
4ra&dmultiparity
3esarea& sectio& if labor does &ot resume
8etal mo&itori&"
.he ,ri+ar/ goal 6ith a ,rola,sed o% the u+0ilical
cord is to re+ove the ,ressure %ro+ the cord.
#hanging the +aternal ,osition is the %irst
intervention. Acce,ta0le ,ositions include 4nee-
chest5 side-l/ing and elevation o% the hi,s. .he nurse
+a/ also ,er%or+ a vaginal e$a+ination and atte+,t
to ,ush the ,resenting ,art o%% the cord.
Ad+inistering the o$/gen 0ene%its the %etus onl/ i%
circulation through the cord has 0een reesta0lished.
Start or mai&tai& a& !@ as prescribed# ,se of
lar"e-"au"e catheter whe& starti&" the !@ for
blood a&d lar"e Hua&tities of fluid i&ta'e#
6dmi&ister o1y"e& by face >mas' to provide hi"h
o1y"e& co&ce&tratio& at = >1B5/mi&#
!&struct patie&t to clea&se from the fro&t to the
bac'#
.1plai& the importa&ce of ha&d washi&" before
a&d after peri&eal care#
)07./ (6*64.(.*0<
/epositio& clie&t to tre&dele&bur" or '&ee-
chest positio&
)1y"e&
+ush prese&ti&" part upward
6pply moiste&ed sterile towels
?elivery as soo& as possible

6ctive phase of labor


*. Ute'ine Ru&tu'e
"he t)o findin*s on physical e@am indicate uterine rupture is loss of uterine contour and palpable fetal part.
"he number one ris8 factor for uterine rupture is pre#ious cesarean section.
31=
(6*64.(.*06bdomi&al pai& duri&"
co&tractio&s3)(+5.0.
). Aniotic flui( ebolis
E.
=. An amniotic fluid embolism is
)hen the amniotic fluid lea8s into
the maternal bloodstream b"he
causes of an amniotic fluid
embolism are difficulty in labor3
or hyperstimulation of the uterus.
Polyhydramnios is an e@cessi#e
amniotic fluid.
L.
M. (6*!8.S060!)*
Cont'actions continueD but ce')i, fail to (ilate
;a$inal blee(in$ a! be &'esent
Risin$ &ulse 'ate an( s2in &allo'
Loss of fetal #ea't tones
!*3)(+5.0.
?ysp&eaSudde& sharp abdomi&al pai& duri&"
co&tractio&s
Sharp, chest pai&
+allor or cya&osis
8rothy, blood-ti&"ed mucus
6bdomi&al te&der&ess
3essatio& of co&tractio&s
-leedi&" i&to abdomi&al cavity & sometimes i&to
va"i&a
8etus easily palpated, 870 ceased
Si"&s of shoc'
)1y"e&
3+/
!&tubatio&
?elivery
SECTION ;. "OST"ARTUM
+7FS!)5)4!365 (60./*65 376*4.S
A. L&#*)A > dischar"e from the uterus duri&" the first 3 wee's after delivery#
)ncreasing Lochia as the da/ ,asses 0/ +a/ indicate *e,arin )nto$ication.
L&#*)AL #*ANGES
L&#*)A !BA
M ?ar' red dischar"e occurri&" i& the first 2-3 days#
M 3o&tai&s epithelial cells, erythrocytes a&d decidua#
M 3haracteristic huma& odor#
L&#*)A SE&SA
31A
M +i&'ish to brow&ish dischar"e occurri&" 3-1B days after delivery#
M Serosa&"ui&eous dischar"e co&tai&i&" decidua, erythrocytes, leu'ocytes, cervical mucus a&d
microor"a&isms#
M 7as a stro&" odor#
L&#*)A ALBA
M 6lmost colorless to creamy yellowish dischar"e occurri&" from 1B days to 3 wee's after delivery#
M 3o&tai&s leu'ocytes, decidua,epithelial cells, fat, cervical mucus, cholesterol crystals, a&d bacteria#
M 7as &o odor#
B. !.E!S
M +rocess of i&volutio& ta'es 4-6 wee's to complete#
M %ei"ht decreases from 2 lbs to 2 o2#
M 8u&dus steadily desce&ds i&to true pelvis9 8u&dal hei"ht decreases about 1 fi&"erbreadth :1 cm;/day9
by 1B-14 days postpartum, ca&&ot be palpated abdomi&ally#
#
#. !terine )nvolution
1# ?escriptio&
a# 0he rapid decrease i& the si2e of the uterus as it retur&s to the &o&pre"&a&t state
b# 3lie&ts who breastfeed may e1perie&ce a more rapid i&volutio&
2# 6ssessme&t
32B
a# %ei"ht of the uterus decreases from 2 pou&ds
to 2 ou&ces i& 6 wee'
b# .&dometrium re"e&erates
c# 8u&dus steadily desce&ds i&to the pelvis
d# 8u&dal hei"ht decreases about 1 fi&"erbreadth :1 cm; per day
.# -y 1B days postpartum, uterus ca&&ot be palpated abdomi&ally
*)0.< ,e#iation of the fundus to the ri*ht or left and location of the fundus abo#e the umbilical are si*ns that
the bladder is distended
NO"$1 +ei*ht of the Umbilicus on the %irst Postpartum ,ay
"he hei*ht is usually SLI-+"L5 belo) the umbilicus about AJ hours after deli#ery. "he top of the umbilicus is
normally MI,6A5 bet)een the umbilicus and the symphysis pubis.
D. Breasts
1# -reasts co&ti&ue to secrete colostrum
2# 6 decrease i& estro"e& a&d pro"estero&e levels after delivery stimulates i&creased prolacti& levels, which
promote breast mil' productio&#
3# -reasts become diste&ded with mil' o& the third day
4# .&"or"eme&t occurs i& 4= to $2 hours i& &o& breast feedi&" mothers#
*)0.<
Brad/cardia is a nor+al ,h/siologic change %or H-1: da/s ,ost,artu+
E. Gastrointestinal tract
1# %ome& are usually very hu&"ry after delivery
2# 3o&stipatio& ca& occur
3# 7emorrhoids are commo&
III. "OST"ARTUM NURSING INTER;ENTIONS
(o&itor vital si"&s
*)0.< Maternal temperature durin* the first AJ hours follo)in* deli#ery may rise to 9CC. JU % 0E;UC7
as a result of dehydration. "he nurse can reassure the ne) mother that these symptoms are normal.
+ostpartum .1ercise
Supine Position )ith the 8nee/s fle@ed3 and then inhale deeply )hile allo)in* the abdomen to e@pand
and e@hale )hile contractin* the abdominal muscles. "he purpose of this e@ercise is to stren*then the
abdominal muscles. $@amples are reachin* for the 8neesH push ups and sits ups on the first postpartum
day.
6ssess hei"ht, co&siste&cy, a&d locatio& of the fu&dus
(o&itor color, amou&t, a&d odor of lochia
6ssess lochia a&d color volume
Give hoGA7 to +other i% ordered. hoGA7 ,ro+otes l/sis o% %etal h (N9 B#s.
Ad+inister hoGa+ as ,rescri0ed 6ithin I2 hours ,ost,artu+ to the h-negative client 6ho has
given 0irth to an h-,ositive neonate.
321
hoga+ (D9 i++une glo0ulin is given 0/ intra+uscular inGection5
3hec' episiotomy a&d peri&eum for si"&s of i&fectio&#
+romote successful feedi&"#
Non-nursing 6o+an- tight 0ra %or I2 hours5 ice ,ac4s5 +ini+i8es 0reast
sti+ulation.
Nursing 6o+an- success de,ends on in%ant suc4ing and +aternal ,roduction o%
+il4.
JPost,artu+ BluesC 0E.K days7 I Normal occurrence of Nroller coasterO emotions
Se$ual activities. abstain from intercourse until episiotomy is healed and lochia ceased
around E.J )ee8s. emind that Assess hei*ht3 consistency3 and location of the fundus
breastfeedin* does not *i#e ade4uate protection.
6ssess breasts for e&"or"eme&t
(o&itor episiotomy for heali&" : assess dehisce&ce & evisceratio&;
6ssess i&cisio&s or dressi&"s of cesarea& birth clie&t : pro&e to i&fectio&;
(o&itor bowel status : pro&e to co&stipatio&;
(o&itor ! &B
.&coura"e freHue&t voidi&" :preve&t uri&ary rete&tio& which will predispose the mother to uterus
displaceme&t & i&fectio&;
.&coura"e ambulatio& : to preve&t thromboplebitis & paralytic ileus;

6ssess bo&di&" with the &ewbor& i&fa&t : to preve&t failure to thrive;


*)0.<
A ,ositive 0onding e$,erience is indicated 6hen the +other turns her %ace to6ard the 0a0/ to
initiate e/e-to-e/e contact. &0servation o% ne6 +others has sho6n that a %airl/ regular
,attern o% +aternal 0ehaviors is e$hi0ited at %irst contact 6ith the ne60orn. .he +other
%ollo6s a ,rogression o% touching activities %ro+ %ingerti, e$,loration to6ard ,al+ar contact
to en%olding the in%ant 6ith the 6hole hand and ar+. .he +other also increase the ti+e
s,ent in the en %ace ,osition. .he +other arranges hersel% or the ne60orn so that her %ace
and e/es are in the sa+e ,lane as in her in%ant.
I;. "OST"ARTUM DISCOM*ORTS
6# Perineal disco+%ort
A,,l/ ice ,ac4s to the ,erineu+ during the %irst 2B hours to reduce s6elling a%ter the %irst 2B hours5 a,,l/
6ar+th 0/ sit8 0aths
-# E,isioto+/
1# !&struct the clie&t to admi&ister peri&eal care after each voidi&"
2# .&coura"e the use of a& a&al"esic spray as prescribed
3# 6dmi&ister a&al"esics as prescribed if comfort measures are u&successful
3# Breast disco+%ort
+/.@.*0!)*<
"he ($S" P$&$N"ION "$C+NIQU$ IS "O $MP"5 "+$ ($S" $-ULAL5 AN, %$QU$N"L5 6I"+
%$$,IN-S. "he A
nd
is $'P$SSIN- A LI""L$ MIL= ($%O$ NUSIN-3 MASSA-IN- "+$ ($AS"S
-$N"L5 O "A=IN- A 6AM S+O6$ ($%O$ %$$,IN- MA5 +$LP "O IMPO&$ MIL= %LO6.
322
Placin* as much of the areola as possible into the neonate/s mouth is one method. Other methods include
chan*in* position )ith each nursin* so that different areas of the nipples recei#e the *reatest stress from
nursin* and a#oidin* breast en*or*ement3 )hich ma8e I difficult for the neonate to *rasp. In addition3 nursin*
more fre4uently3 so that a ra#enous neonate is not suc8in* #i*orously at the be*innin* of the feedin*s3 AN,
%$$,IN- ON ,$MAN, to pre#ent o#er hun*er is helpful. AI,5IN- "+$ NIPPL$S AN, $'POSIN-
"+$M "O "+$ LI-+" +A&$ ALSO ($$N $COMM$N,$,. 6arm "ea ba*s3 )hich contain tannic acid
also3 )ill sooth soreness. 6$AIN- A SUPPO"I&$ (ASSI$$ ,O$S NO" P$&$N" ($AS"
$N-O-$M$N". APPL5IN- IC$ and LANOLIN ,O$S NO" $LI$&$ ($AS" $N-O-$M$N". 0Pa*e
9K; .9KT lippincot7
!*0./@.*0!)*<
Measures that help relie#e nipple soreness in a breast.feedin* client include lubricatin* the nipples )ith a fe)
drops of e@pressed mil8 before feedin*s3 applyin* ice compresses ?ust before feedin*s3 lettin* the nipples air dry
after feedin*s3 and a#oidin* the use of soap on the nipples.
*)0.< Specific &ursi&" care for breast .&"or"eme&t
1. Breast%eed %reDuentl/
2. A,,l/ 6ar+ ,ac4s 0e%ore %eeding
2. A,,l/ ice ,ac4s 0et6een %eedings
*)0.< Specific *ursi&" 3are for 3rac'ed &ipples
1. E$,ose ni,,les to air %or 1: to 2: +inutes a%ter %eeding
2. otate the ,osition o% the 0a0/ %or each %eeding
2. Be sure that the 0a0/ is latched on to the areola5 not Gust the ni,,le
*)0." Do not use soa, on the 0reasts5 as it tends to re+ove natural oils5 6hich increases the chance o%
crac4ed ni,,les
NO"$1 In#erted Nipples
Push the areola tissues a)ay from the nipples3 and then *rasp the nipples to tease them out of the tissue. Usin* a
6oolrich breast shield3 )hich pushes the nipples throu*h openin*s in the shield3 also can help o#ercome in#erted nipples
Phenyl8etonuria
outine Screenin* is done after the neonate has been breast feed for J; hours. "he LA"$AL +$$L 0+$$L
S"IC=7 is the best site because it pre#ents dama*e to the posterior tibial ner#e and artery and plantar artery.

"OST"ARTUM DISCHARGE TEACHINGS
A. Gene'al "'inci&les/Consi(e'ations
A. 1'east *ee(in$
0he 6merica& 6cademy of +ediatrics recomme&ds be"i&&i&" breast feedi&" as soo& as possible after
delivery or duri&" the first period of reactivity# 6 &eo&ate that will be breast fed should &ot be "ive& formula by
bottle at this time# 7an/ institutions ,rovide sterile 6ater %or the initial %eeding to assess %or eso,hageal
atresia. Because colustru+ is not irritating i% as,irated and is readil/ a0sor0ed 0/ the neonate<s res,irator/
s/ste+5 0reast %eeding can 0e done i++ediatel/ a%ter 0irth. #olustru+ contains anti0odies that the neonate
lac4s5 such as )++unoglo0ulin A. -reast feedi&" stimulates the o1ytoci& secretio&, which causes the uteri&e
muscles to co&tract#
323
*)0.< &ral contrace,tives containing estrogen are not reco++ended %or 0reast%eeding
+others' ,rogestin-onl/ 0irth control ,ills are less li4el/ to inter%ere 6ith the +il4 su,,l/ 1B.
Ba0/ 6ill develo, his or her o6n %eeding schedule. *or+onal contrace,tives +a/ cause a
decrease in the +il4 su,,l/ and are 0est avoided during the %irst H 6ee4s a%ter 0irth.
*)0.< .he condo+ is the onl/ sa%e5 non ,rescri,tion contrace,tive to use 6hile a 6o+an
lactating and before there is normal uterine in#olution at this time.
*)0.< LE. D&1N E(LE> &( .*E BEAS.
&$/to$in is the F1 %actor that sti+ulates the let do6n re%le$ 6hile Prolactin is the one that
sti+ulates the acini cells to ,roduce +il4.
A. *i'st 1'east *ee(in$
0he mother should be e&coura"ed to &urse freHue&tly duri&" the first few days after delivery# ($AS"
%$$,IN- %O A" L$AS" K.9C MINU"$S P$ SI,$ %O "+$ L$" ,O6N $%L$' "O ($-IN#
-
n(
b'east *ee(in$
680./ 07. 8!/S0 -/.6S0 8..?!*4, the mother should breast feed her i&fa&t 2-3 hours u&til her
mil' supply is established#
1'east il2 contents )e'sus co<Is il2
($AS" MIL= is hi*her in fat content than co)/s mil8H EFB . FFB of the calories in breast mil8 are from fat.
Co)/s mil8 is hi*her in iron3 sodium calcium < phosphorus.
3)%S (!5L
6ccordi&" to the 6merica& 6cademy of +ediatrics :66+; recomme&ds that i&fa&ts be "ive& breast mil' of
formula UN"IL 9 5$A O% A-$. "he AAP Committee decreed that co)/s mil8 could be substituted in the
S$CON, : MON"+S O% LI%$3 (U" ONL5 I% "+$ AMOUN" O% MIL= CALOI$S ,O$S NO" $'C$,,
:FB of total calories a&d iro& is replaced by solid foods# "he protein content o co)/s mil8 is too hi*h3 and
therefore is poorly di*ested3 and may cause *astrointestinal tract bleedin*
S,++5.(.*0!*4 -/.6S0 8..?!*4 %!07 -)005.? 8..?!*4
(ottle supplements tend to cause a decrease in the breast mil8 supply and demand for breast feedin*3 AN,
S+OUL, ($ A&OI,$,
*)0.< Breast +il4 Storage
Never store it in clean glass containers 0ecause i++unoglo0ulins tend to stic4 to glass 0ottles and
the containers should BE S.E)LE. .he client should use S.E)LE PLAS.)# #&N.A)NES
la0eled 6ith ti+e5 date and a+ount. Store 0reast +il4 at the re%rigerator %or B@ hours or in a %ree8er
%or 2 +onths. (ro8en 0reast +il4 should 0e tha6ed in the re%rigerator %or a %e6 hours5 ,laced under
6ar+ ta, 6ater5 then sha4e it.
*)0.< S.A. &( S&L)D (&&D is usuall/ B +onths.
1. 1UR"ING & *EEDING
-,/+!*4
6&other word is bubbli&" the &eo&ate should be do&e after 5 mi&utes of feedi&", i& the middle of the feedi&",
a&d at the e&d o the feedi&"#0he &eo&ate should be held i& a& upri"ht positio& a&d patted o& the bac'#
+)S!0!)* 8)/ 8..?!*4
324
"he neonate should be placed on the ri*ht side3 placin* the patient on prone position has been associated )ith
SI,S 0Sudden Infant ,eath Syndrome7
NO"$1
If the bottle nipple is 8ept full of formula3 the infant )ill suc8 less air3 the infant is less li8ely to spit up and less
li8ely to s)allo) air. S)allo)in* air can lead to colic. A 0ottle should never 0e ,ro,,ed 0ecause o% the
chance o% as,iration. Bur,ing should occur a%ter each 2 o8. (urpin* fre4uently decreased the chance of
spittin* up. "he nipple should be all the )ay in the infant/s mouth so the infant can create a *ood suc8.
NO"$1 Bottle-%ed in%ants are usuall/ %ed 6ithin the %irst %e6 hours a%ter 0irth. .he nurse +ust deter+ine i%
the ne60orn is read/ %or this %eeding. Signs are indicative o% readiness %or %eeding include ,resence o%
rooting and suc4ing re%le$es5 active 0o6el sounds5 a0sence o% a0do+inal dissension5 and a0sence o% signs o%
res,irator/ distress.
*)0.< 7ow to stimulate the !&fa&tEs lips to ta'e the &ipple\
Li*htly brushin* the neonates lips )ith nipple causes the neonate to open the mouth the be*in suc8in*. Such
techni4ues as pullin* do)n on the chin3 s4uee2in* the chee83 or placin* the nipple directly in the mouth force
the mouth open or force the neonates to ta8e the nipple.
C. "s!c#olo$ical A(a&tation
0a'i&"-i& +hase +ostpartum blues<
overwhelmi&" sad&ess
RubinOs "ost&a'tu "#ases of Re$ene'ation : "OST"ARTUM "S=CHOSOCIAL ADA"TATION+
W.AK)NG )NC P*ASE (DEPENDEN.9 *i'st 3 Da!s
#?uri&" this time, food a&d sleep are a maor focus for the clie&t# !& additio&, she wor's throu"h the birth
e1perie&ce to sort out reality from fa&tasy a&d to clarify a&y misu&dersta&di&"s# 0his phase lasts 1 to 3 days
after birth# 0he primary co&cer& is to meet her ow& &eeds#
M 0a'es place 1-2 days postpartum
M 7other is ,assive and de,endent' concerned 6ith o6n needs#
M @erbali2es about the delivery e1perie&ce#
M Sleep/food importa&t#
M 7other %ocuses on her o6n ,ri+ar/ needs5 such as slee, and %ood
!mporta&t for the &urse to liste& a&d to help the mother i&terpret the eve&ts of delivery to
ma'e them more mea&i&"ful
*ot a& optimum time to teach the mother about baby care
W.AK)NG *&LDC P*ASE
(DEPENDEN.?)NDEPENDEN.9
0he clie&t is co&cer&ed re"ardi&" her &eed to resume co&trol of all facets of her life i& a compete&t ma&&er# 6t
this time, she is ready to lear& self-care a&d i&fa&t care s'ills#
325
M 3-1B days postpartum
M (other strives for i&depe&de&ce a&d be"i&s to reassert herself#
M (ood swi&"s occur# (ay cry for &o reaso&#
M (a1imal sta"e of lear&i&" readi&ess#
M (other reHuires reassura&ce that she ca& perform tas's of motherhood#
M -e"i&s to assume the tas's of motheri&"
M 6& optimum time to teach the mother about baby care#
WLE..)NG G&C P*ASE ()N.EDEPEN#E9
M 1B to 6 wee's postpartum
M /ealistic re"ardi&" role tra&sitio&#
M Shows patter& of life-style that i&cludes the &ew baby but still focuses o& e&tire family as a u&it#
M 6ccepts baby as separate perso&#
(other may feel deep loss over separatio& of the baby from part of the body a&d may "rieve
over the loss
(other may be cau"ht i& a depe&de&t/i&depe&de&t role, wa&ti&" to feel safe a&d secure yet
wa&ti&" to ma'e decisio&s
0ee&a"e mothers &eed special co&sideratio& because of the co&flict ta'i&" place withi&
them as part of adolesce&ce
"OST"ARTUM ?ARNING S/S TO RE"ORT TO THE "H=SICIAN
!&creased bleedi&", clots or passa"e of tissue#
-ri"ht red va"i&al bleedi&" a&ytime after birth#
+ai& "reater tha& e1pected#
0emperature elevatio& to 1BB#4] 8#
8eeli&" of full bladder accompa&ied by i&ability to void#
.&lar"i&" hematoma#
8eeli&" restless accompa&ied by pallor9 cool, clammy s'i&9 rapid 7/9 di22i&ess9 a&d visual disturba&ce#
+ai&, red&ess, a&d warmth accompa&ied by a firm area i& the calf#
?ifficulty breathi&", rapid heart rate, chest pai&, cou"h, feeli&" of apprehe&sio&, pale, cold, or blue s'i& color
)V. P&S. PA.!7 #&7PL)#A.)&NS
A. HEMORRHAGE
8luid replaceme&t-o""y
uterus :does &ot respo&d
to massa"e;36,S.S
.mer"e&cy lay
)1y"e&
@ital si"&s
+eri&eal pad cou&t
+sycholo"ical support
Massa*in* the lo)er
abdomen after deli#ery is
done to maintain a firm
uterus3 )hich )ill aid in the
clumpin* do)n of blood
#essels in the uterus3 thereby
pre#entin* any further
S!4*S )8 7.()//764. (6*64.(.*0
326
bleedin*.
N(O--5 U"$US
Uterine atony means that the
uterus is not firm or it is not
contractin*. "he nurse
should *ently massa*e the
uterus )hich )ill contract
the uterus and ma8e it firm.
Clients )ho are predisposed
are usually MUL"IPL$
-$S"A"ION3
POL5+5,AMNIOS3
POLON-$, LA(O and
L-A 0LA-$
-$S"A"IONAL A-$ fetus.
A bo**y uterus )ould be
palpable abo#e the umbilicus
and )ould be soft and poorly
contracted.
6b&ormal clots u&usual
pelvic discomfort or headache
.1cessive or bri"ht-red
bleedi&"
Si"&s of shoc'
$arly +emorrha*e starts on
the first AJ hours3 or more
than FCC ml of blood on the
first AJ hrs in a Normal
spontaneous deli#ery..
1. 0he X1 cause of +)S0+6/0,( 7.()//764. !S /.06!*.? +563.*065
8/64(.*0S# ,teri&e ato&y a&d va"i&al & cervical tears are associated with early
postpartum hemorrha"eTHROM1O"LE1ITIS
- !&flammatio& of the vei& caused by a clot
"he positi#e +oman/s si*n indicate is possibility of thrombophlebitis or a deep #enous thrombosis that is
present in the lo)er e@tremities.
6hen assessin* for +oman/s si*n as8 the patient to stretch her 8e*s out )ith the 8nee sli*htly fle@ed )hile
dorsifle@ the foot. A positi#e si*n is present )hen pain is felt at the bac8 of the 8nee or calf.
It is normal for a patient on ma*nesium sulfate to feel tired because it acts as a central ner#ous depressant
and often ma8es the patient dro)sy.
(6*!8.S060!)* (6*64.(.*0 3,/60!@.
.dematous e1tremities
8ever with chills
+ai& a&d red&ess i& affected
area
+ositive 7oma&Es si"&
+reve&tive !mmobili2e e1tremity
6&al"esics
6&ticoa"ula&t
0hrombolytics
C. IN*ECTION
+/.?!S+)S!*4 8630)/S (6*!8.S060!)* (6*64.(.*0
32$
6SS.SS(.*0/upture of
membra&es over 24 hours
before delivery
D. MASTITIS
6SS.SS(.*0<
.levated temperature,
chills, "e&eral achi&",
malaise a&d locali2ed pai&
.&"or"eme&t, hard&ess
a&d redde&i&" of the
breasts
*ipple sore&ess a&d
fissures
!&flammatio& of the breast
as a result of i&fectio&
Pri+aril/ seen in
0reast%eeding +others 2
to 2 6ee4s a%ter deliver/
0ut +a/ occur at an/
ti+e during lactation
*,/S!*4
!(+.(.*060!)*<
!&struct the mother i&
"ood ha&d washi&" a&d breast
hy"ie&e tech&iHues
6pply heat or cold to site
as prescribed
7aintain lactation in
0reast%eeding +others
Encourage +anual
e$,ression o% 0reast +il4 or use
o% 0reast ,u+, ever/ B hours
.&coura"e mother to
support, breasts by weari&" a
supportive bra
6dmi&ister a&al"esics
& a&tibiotics as prescribed
E. "ost&a'tu Moo(
Diso'(e's
())? ?!S)/?./S
Retaine( &lacental
f'a$ents
Inte'nal fetal onito'in$
;a$inal infection
*e)e'
C#ills
"oo' a&&etite
Gene'al bo(! alaise
Ab(oinal &ain
*oul9sellin$ loc#ia
Puer,erial in%ection is an in%ection o% the genital tract.
Earl/ signs and s/+,to+s o% ,uer,erial in%ection include chills5 %ever5
and %lu-li4e s/+,to+s. )t can occur u, to one +onth a%ter deliver/.
O%-COLOR"ale1o(! )&set< 1-1B days +ostpartum depressio& )&s
32=
&in2D e,t'eities blue
Totall! &in2"ost&a'tu
&s!c#osisOnsetA 390 (a!s
&ost&a'tu"ost&a'tu
bluesAntibiotics
SECTION ;II
"H=SIOLOGIC STATUS
O* NE?1ORN
NOTEA .he 0est ti+e %or
,h/sical assess+ent is
+id6a/ 0et6een %eedings.
.he hungr/ is o%ten %uss/5
irrita0le5 +a4ing ,h/sical
e$a+ination di%%icult.
7ani,ulation a%ter eating
+a/ cause the neonate to
regurgitate or vo+it.
A. INITIAL
"H=SICAL
E@AMINAT
ION &
CARE O*
THE
NE?1ORN
%. Assessent
Gene'al $ui(elines
%. Hee& ne<bo'n
<a' (u'in$ t#e
e,aination
-. 1e$in <it# $ene'al
obse')ationsS t#en
&e'fo'
assessents t#at
a'e least (istu'bin$
to t#e ne<bo'n
fi'st
3. Initiate nu'sin$
inte')entions fo'
abno'al fin(in$s
.. Docuent all
abno'al fin(in$s
%. Obse')e o'
assist <it# initiation
of 'es&i'ations
-. Assess A&$a'
postpartum lasti&"
2 wee's or less
8ati"ue
%eepi&"
a&1iety
(ood
i&stability
Normal processes
durin* postpartum
include the )ithdra)al
of pro*esterone and
estro*en and lead to
the psycholo*ical
response 8no)n as
Vthe blues.V
Postpartum depression
is a psychiatric
problem that occurs
later in postpartum
and is characteri2ed
by more se#ere
symptoms of
inade4uacy. (ecause
the clientGs beha#ior is
normal3 notifyin* her
physician and
conductin* a home
assessment arenGt
necessary.
et<
3-5
day
s
lasti
&"
mor
e
tha&
2
wee
's

A
32A
sco'e
3. Note
c#a'acte'istics of c'!
.. Monito' fo'
nasal fla'in$D
$'untin$D
'et'actionsD
abno'al
'es&i'ations
0. Obtain )ital
si$ns
4. Obse')e
ne<bo'n fo'
si$ns of
#!&ot#e'ia
o'
#!&e't#e'ia
5. Assess fo' $'oss
anoalies
-. I&leentation
%. Suction
out#D t#en na'esD <it#
bulb s!'in$e
-. D'! ne<bo'n
an( stiulate c'!in$ b!
'ubbin$
3. Maintain
te&e'atu'e
stabilit!S <'a&
ne<bo'n in
<a' blan2ets
an( &lace a
stoc2inette ca&
on ne<bo'nOs
#ea(
NOTEA
Te&e'atu'e ta2in$
.he 0est site
6ithout
co+,lications
is the ta4ing it
in a$illa. )t is
not advisa0le to
,ut it in the
+outh5 anus or
ear since all o%
the+ are
sensitive.
.. Hee& ne<bo'n
33B
<it# ot#e' to
facilitate
bon(in$
0. "lace
ne<bo'n at
ot#e'Os
b'east if
b'eastfee(in$
is &lanne(D o'
&lace on
ot#e'Os
ab(oen
4. "lace
ne<bo'n in <a'e'
5. "osition
ne<bo'n on
si(e o'
ab(oen o' in
o(ifie(
T'en(elenbu'$
&osition to
facilitate
('aina$e of
ucus
6. Ensu'e
ne<bo'nOs &'o&e'
i(entification
7. *oot&'int
ne<bo'n an(
fin$e'&'int
ot#e' on
i(entification
s#eetD &e'
a$enc! &olicies
an( &'oce(u'es
%8. "lace
atc#in$ i(entification
b'acelets on ot#e' an(
ne<bo'n
NOTEA Con)ectionD
Con(uctionD Ra(iation
an( E)a&o'ation
Eva,oration occurs 6hen
6et sur%aces such as
neonate<s s4in are e$,osed
to air.
#onduction o% heat a6a/
%ro+ the 0od/ +a/ occur
6hen the neonate co+es
in direct contact 6ith cold
331
sur%aces such as scale or
cold stethosco,e.
adiation is the trans%er o
heat to cooler o0Gects that
are not in direct contact
6ith the neonate.
#onvection- 4ee,ing a6a/
the neonate %ro+ the air
conditioning or cooling
ducts ,revents heat loss
3. ;ital si$ns
6+46/ 3/!0./!6
6+46/ S3)/.
Symptoms of
depressio& plus
delusio&s
6uditory
halluci&atio&s
7yperactivity
O,!tocin
Anal$esics
Maintain #!$iene
Sei9fo<le's
&ositions
;ital si$ns
Ea'l! abulations
Assess loc#ia
Bright red 0lood is a
nor+al lochial
%inding in the %irst
2B hours a%ter
deliver/. Lochia
should never
contain large clots5
tissue %rag+ents5 or
+e+0ranes. A %oul
odor +a/ signal
in%ection5 as +a/
a0sence o% lochia.
*o respo&se4rimace
@i"orous cry7.6/0
/60.
6bse&t 5ess tha& 1BB b#p#m# )ver 1BB b#p#m#
(,S35. 0)*./.85.O
!//!06-!5!0F
5imp Some fle1io& 6ctively moves
/.S+!/60)/F .88)/0 6bse&t Slow, irre"ular 4ood cry
332
"he components of Ap*ar scorin* system are tone3 color3 irritability3 respiration and heart rate.
1# +erform a&d record the 6p"ar score at 1 mi&ute a&d at 5 mi&utes
2# !f the score is less tha& $ at 5 mi&utes, the 6p"ar score should be performed at 1B mi&utes
3# 6ssess each of five items to be scored, a&d assi"& value of C :very poor; to 2 :e1celle&t; for each item
4# 6dd the poi&ts to determi&e the &ewbor&Es total score
a# 6 score of $ to 1B i&dicates a health
-in(icates t#at t#e ne<bo'n is (oin$ <ell.
b# 6 score of 3 to 6 is co&sidered moderately depressed
c# 6 score of B to 2 is severely depressed
- in(icates t#at t#e ne<bo'n nee(s assistance.
1# 7eart rate< 1BB to 1$B beats per mi&ute :apical;9 assess for a full mi&ute because of irre"ularities
afterbirth
2# /espiratio&s< 3B to =B breaths per mi&ute9 assess or a full mi&ute
3# 61illary temperature< A6#= to AA^ 8
4# -lood pressure< $3/55 mm 7"
.. 1o(! easu'eents
1# 5e&"th< 45 to 55 cm :1= to 22 i&ches;
2# %ei"ht< 25BB to 43BB " :5#5 to A#5 pou&ds;
3# 7ead circumfere&ce< 33 to 35#5 cm :13 to 14 i&ches;
4# 3hest circumfere&ce< 3B to 33 cm :12 to 13 i&ches; a&d should be eHual to or 2 to 3 cm less tha& the head
circumfere&ce
*)0.< Neonates +ead #ersus Chest circumference
At birth3 the neonates head circumference is about Acm LA-$ "+AN "+$ C+$S"
CICUM%$$NC$. "he A#era*e +ead circumference is 9E .9J inches 0EE.EF cm7 3 a#era*e Chest
circumference is 9A.F to 9J inches 0 E9.EF cm7
1 . Hea( to Toe Ne<bo'n Assessent
333
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
,ri&e prese&t i& the bladder at birth but *- may &ot void doe 1
st
12-24 hours
5ater patter& is 6-1B voidi&"s/ day > i&dicative of sufficie&t fluid i&ta'e
,ri&e is pale a&d straw colored > i&itial voidi&"s may leave bric'-red spots o&
diaper : d/t passa"e of uric acid crystals i& uri&e;
!&fa&t u&able to co&ce&trate uri&e for the 1
st
3 mo&ths

334
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
!((60,/. 36/?!63
S+7!*30./ > may allow reflu1 of
food, burped, /.4,/4!060.-
placed *- ri"ht side after feedi&"
*ewbor& ca&Et move food from lips
to phary&1# !&sert &ipple well to
mouth
8..?!*4 +600./S vary
- *ewbor&s may &urse vi"orously
immediately afterbirth or may &eed
as lo&" as several days to suc'
effectively
- +rovide support a&d e&coura"eme&t
to &ew mothers duri&" this time as
i&fa&t feedi&" is very emotio&al
doe most mothers
NO"$1 ,istin*uishin* Neonatal
&omitin* from e*ur*itation
&omitin* is usually sour3 loo8s li8e
curdled mil8 due to +CL3 )ith a sour
odor3 )hile re*ur*itation has no sour
odor or curdlin* of mil83 or occurs
durin* or immediately after feedin*.
!(+)/06*0 3)*S!?./60!)*S<
(reastfeedin* can usually
be*in immediately after birthH
bottle.fed ne)borns may be
offered fe) milliliters of
sterile )ater or FB de@trose 9
to J hours after birth prior to
a feedin* )ith formula
335
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
5iver respo&sible for cha&"i&" 7"b i&to co&u"ated bilirubi&, which is further
cha&"ed i&to co&u"ated :water soluble; bilirubi& that ca& be e1creted
.1cess u&co&u"ated bilirubi& ca& permeate the sclera a&d the s'i&, "ivi&" a
au&diced or yellow appeara&ce to these tissues
HEAT "RODUCTION i& &ewbor& accomplished by<
a# (etabolism of R -/)%* 860S
- 6 special structure i& *- is a source of heat
- !&creased metabolic rate a&d activity
61illary temperature< A6#= to AA8
*ewbor& ca&Et shiver as a& adult does to release heat
*ewbor&s are u&able to mai&tai& a stable body temperature because they have a&
immature vasomotor ce&ter, a&d u&able to shiver to i&crease body heat#
*-Es body temperature drops Huic'ly after birth > after stress occurs
easily
-ody stabili2es temperature i& =-1B hours if u&stressed
Cold stress increases oA consumption I may lead to metabolic acidosis
and respiratory distress
N( de#elops o)n antibodies durin* 9
st
E months but at ris8 for infection durin* the
first : )ee8s
6bility to develop a&tibodies develops seHue&tially
-irth wei"htJ25BB-4BB "rams :5 lbs# =o2# > = lbs# 13 o2#;
336
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
*ose breathers for first few mo&ths of life
33$
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
Short a&d wea' with deep fold of s'i&
3haracteri2ed by cyli&drical thora1 a&d fle1ible ribs
*)0.<
appears circular si&ce a&teroposterior a&d lateral diameters are about eHual
/espiratio&s appear diaphra"matic
*ipples promi&e&t a&d ofte& edematous
7il4/ secretion (6itchXs +il49 co++on ( e%%ect o% estrogen9
33=
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
33A
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
34B
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
341
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
342
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
343
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
344
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
345
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
346
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
Should be strai"ht a&d flat
6&us should be pate&t without a&y fissure
?impli&" at the base is associated with spi&a bifida
A degree o% h/,otonicit/ or h/,ertonicit/ is indicative o% central nervous s/ste+ (#NS
da+age
Assess+ent %or
Eaundice
.he F1
techniDue is to
0lanch the s4in
over the 0on/
,ro+inence such
as the %orehead5
chest or ti, o%
the nose.
NOTEA
starts at the head
first3 spreads to
the chest3 then the
abdomen3 then the
arms and le*s3
follo)ed by the
hands and feet3
)hich are the last
to be ?aundiced.
!aundice in the
first AJ hours
after the birth is
a cause for
concern that
re4uires further
assess+ent.
C.GESTATIONAL
ASSESSMENT
+6/6(.0./
*,/S!*4 630!)*
34$
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
Possi0le causes
o% earl/
Gaundice are
0lood
inco+,ati0ilit/5
o$/tocin
induction5 and
severe
he+ol/tic
,rocess
Acrocyanosis of
the hands and
feet is normal3
resultin* from
slu**ish
peripheral
circulation
Mon*olian Spots
-ary3 blue or
blac8 mar8s that
are fre4uently
found on the
sacral area3
buttoc8s3 arms
shoulders or
other areas.
+arle4uins Si*n
Occurs on one
side of the body
turns deep red
color. It occurs
)hen blood
#essels on one
34=
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
side constrict3
)hile those on
the other side of
the body dilate.
Acrocyanosis
#ersus Central
Cyanosis
Acrocyanosis
in#ol#es the
e@tremities of the
neonate3 for
e@ample bluish
hands and feet
due to neonates
bein* cold or
poor perfusion of
the blood to the
periphery of the
body.
6hile central
cyanosis3 )hich
in#ol#es the lips3
ton*ue and trun8
indicatin*
+5PO'IA )hich
needs further
assessment by the
nurse.
.
E,stein<s ,earls
are small3 )hite
cysts on the hard
palate or *ums of
34A
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
the ne)born.
"hey are nor
abnormal and
)ill disappear
shortly after
birth.
7ilia are
bloc8ed
sebaceous
*lands located
on the chin and
the nose of the
infant.
+eman*iomas >
&ascular "umors
Ne#i flammeus or
port )ine stains
&$NI'
CAS$OASA
Should not be
remo#ed by oil or
hand lotion3
because it is a
protecti#e layer
of the neonate
after birth3 and it
disappears after
birth 0 pa*e 9TT
lippincot7 Ne#er
remo#e it )ith
alcohol or cotton
balls3 unless
35B
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
meconium
s8inned.
*)0.<
@er&i1 3aseosa
.rythema
to1icum
&eo&aturum
0ela&"iectasia
+ort wi&e stai&
:&evus flamus;
Strawberry
hema&"ioma
+eman*ioma is
beni*n #ascular
tumor that may
be present on the
ne)born
8i"ure 24
7ema&"ioma
8i"ure 25
.rythema
to1icum
&eo&aturum a&d
(ilia
8old the pi&&a
:auricle; forward
Pinna recoils 0sprin*s
bac87
Pinna opens slo)ly or stays folded
in #ery premature infants
351
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
(easure it E mm Less than E mm
)bserve Labia ma?ora co#er
labia minora
Labia minora are more prominentH
#a*inal openin* can be seen
)bserve $@tend A>E of the )ay
from the toes to the heel
Soles are smoother3 creases e@tend
less than A>E of the )ay from the
toes to the heel
D.NE?1ORN RE*LE@ES
0he rooti&" refle1 is elicited by stro'i&" the &eo&ateIs chee' or stro'i&" &ear the cor&er of the &eo&ateIs mouth#
0he &eo&ate tur&s the head i& the directio& of the stro'i&", loo'i&" for food# 0his refle1 disappears by 6 wee's#
)ther optio&s refer to other refle1es see& i& &eo&ates< 0he palmar "rasp refle1 is elicited by placi&" a& obect i&
the palm of a &eo&ate9 the &eo&ateIs fi&"ers close arou&d it# 0his refle1 disappears betwee& a"es 6 a&d A
mo&ths# 0he -abi&s'i refle1 is elicited by stro'i&" the &eo&ateIs foot, o& the side of the sole, from the heel
toward the toes# 6 &eo&ate will fa& his toes, produci&" a positive -abi&s'i si"&, u&til about a"e 3 mo&ths# 0he
suc'i&" refle1 is see& whe& the &eo&ateIs lips are touched a&d lasts for about 6 mo&ths#
/ooti&" a&d suc'i&"
refle1 usually
disappears after 3-4
mo&ths but may
persists for up to 1
year+65(6/
4/6S+ /.85.O
*ewbor&Es fi&"ers curl arou&d the e1ami&erEs fi&"ers a&d the &ewbor&Es toes curl
dow&ward#
+almar respo&se lesse&s withi& 3-4 mo&ths
+almar respo&se lesse&s withi& = mo&ths
-e"i&&i&
" at the
heel of
the foot,
"e&tly
Symmetric & bilateral abductio& & e1te&sio& of arms a&d ha&ds
0humb & forefi&"er form a 3
R.(-/63.S refle1
+rese&t at birth, complete respo&se may occur up to = wee's
6 persiste&t respo&se lasti&" more tha& 6 mo&ths may i&dicate the occurre&ce of
352
stro'e
upward
alo&" the
lateral
aspect of
the sole9
the& the
e1ami&er
moves
the
fi&"ers
alo&" the
ball of
the
foot()/
)
/.85.O
/))0!*
4
/.85.O
.he ne60orn<s
toes
h/,ere$tend
6hile the 0ig
toe dorsi%le$es
e%le$
disa,,ears
a%ter the
ne60orn is 1
/ear old
6bse&ce of this
refle1 i&dicates
the &eed for a
&eurolo"ical
e1ami&atio&
brai& dama"e duri&" pre"&a&cy
A normal refle@ in a youn* infant caused by a sudden loud noise. It results in dra)in*
up the le*s3 an embracin* position of the arms3 and usually a short cry.

8i"ure 26 (oro /efle1 or .mbrace /efle1
%hile the
&ewbor&
is falli&"
asleep or
sleepi&",
"e&tly
a&d
Huic'ly
tur& the
head to
o&e
sideS0.+
+!*4 )/
0he &ewbor& simulates wal'i&", alter&ately fle1i&" a&d e1te&di&"
the feet
0he refle1 is usually prese&t 3-4 mo&ths
353
%65L!*
4
/.85.O
-6-!*S
L!E S!4*
6s the
&ewbor&
faces the left
side, the left
arm & le"
e1te&d
outward
while the
ri"ht arm &
le" fle1
%he& the
head is
tur&ed to the
ri"ht side,
the ri"ht arm
& le" e1te&d
outward
while the left
arm & le"
fle1
,sually
disappears
withi& 3-4
mo&ths
3/6%5!*40)*!
3 *.3L
/.85.O
a# +lace the &ewbor& o& the abdome&
b# 0he &ewbor& be"i&s ma'i&" crawli&" moveme&ts with the arms a&d le"s
c# .he re%le$ usuall/ disa,,ears a%ter a0out H 6ee4s
E. 1ASIC TEACHING NEEDS O* NE? "ARENTS
+/
.
0.
/
(
!*
86
*
3)/? 36/. 3lea&se the cord with alcohol a&d sometimes triple dye o&ce a day
Leep the area clea& a&d dry
Leep the &ewbor&Es diaper below the cord to preve&t irritatio&
Si"&s of i&fectio&< red&ess, drai&a"e, swelli&", odor
*otify physicia& for si"&s of i&fectio&
*)0.<
Note any bleedin* or draina*e from the cord
"riple dye may be applied for initial cord care because it
minimi2es microor*anisms and promotes dryin*H use a cotton.
354
0
-
)
*
?!
*
4
.&
co
ur
a"
e
pa
re
&t
to
tal
'
to,
ho
ld,
a&
d
si&
"
to
i&f
a&t
)b
ser
ve
for
ble
edi
&"
,
fir
st
uri
&at
io
&
6
&e
o&
ate
tipped applicator to paint the dye3 one time3 on the cord on 9 inch
of surroundin* s8in
Application of KCB isopropyl alcohol to the cord )ith each
diaper chan*e and at least t)o r three times a day to minimi2e
microor*anisms and promote dryin*.
*)0.< "he s8in is surrounded )ith alcohol )hich promotes dryin* and
cleans the area. "he umbilical cord dries and falls off about 9J days.
Pero@ide and lanolin promote moisture3 )hich can inhibit dryin* and
allo) *ro)th of bacteria. 6ater doesn/t promote dryin*.

It is best to care for the neonate/s umbilical cord area by cleanin* it )ith
cotton pled*ets moistened )ith alcohol. "he alcohol promotes dryin* and
helps decrease the ris8 of infection. An antibiotic ointment maybe used
instead of alcohol3 because there are a lot of bacteria )hich is resistant
a*ainst some bacteria. Other a*ents such as )ipes3 sterile )ater and soap
< )ater are not as effecti#e as alcohol.
355
bo
r&
be
for
e
3=
we
e'
s
a"
e
of
"e
sta
tio
&


8i"
ure
2$
+re
ma
tur
e
i&f
a&t
s
sol
e
cre
ase
s,
ear
lob
e
a&d
pre
ma
tur
e
fe
ma
le
"e&
ital
ia

356

"R
E
TE
R
M
IN
*A
NT

?efi&itio&
+romo
tes
s'i&-
to-s'i&
co&tact
betwee
&
pare&t
a&d
i&fa&t
8eedi&
"s are
opport
u&ities
for
pare&t-
i&fa&t
bo&di&
"
*otify
physici
a& for
si"&s
of
i&fecti
o&
N
&.E"
Sense
o%
.ouch
35$
.h
e +ost
highl/
develo
,ed
sense
at
0irth
that is
6h/5
neona
tes
res,on
ds 6ell
to
touch.

6ppl
y
diape
r
loosel
y to
preve
&t
irritat
io&
*otif
y
physi
cia&
for
si"&s
of
i&fect
io&
3!/3,(
3!S!)*
36/.
Sy&o&ym
Lo) birth )ei*ht
0Mosby/s Comprehensi#e e#ie) of Nursin* for NCL$'.N pa*e A9F7
3o&tributi&" factors 5ow socioeco&omic level
+oor &utritio&al status
5ac' of pre &atal care
(ultiple pre"&a&cy
+rior previous early birth
/ace :&o& whites have a hi"her i&cide&ce of prematurity tha&
whites;
3i"arette smo'i&"
0he a"e of the mother : the hi"hest i&cide&ce is i& motherEs
you&"er tha& a"e 2B#;
35=
)rder of birth : early termi&atio& is hi"hest i& first pre"&a&cies
a&d i& those beyo&d the forth ;
3losely spaced pre"&a&cies
6b&ormalities of the reproductive system such as i&trauteri&e
septum
!&fectio&s : specially uri&ary tract i&fectio&s;
)bstetric complicatio&s such as premature rupture of membra&es
or premature separatio& of the place&ta
.arly i&ductio& of labor
.lective cesaria& birth
3ardi&al si"&s 6ppears small a&d u&derdeveloped
0he head is disproportio&ately lar"e : 3 cm or more "reater tha&
chest si2e;
S'i& is thi& with visible blood vessel a&d mi&imal subcuta&eous
fat pads
@er&i1 caseosa is abse&t
-oth a&terior a&d posterior fo&ta&elles are small
/e
su
sci
tat
io
&
*
)
0
.<
res
us
cit
ati
on
0e
co
+e
s
i+
,o
rta
nt
%or
in%
an
t
6h
o
%ai
ls
to
ta4
e
6b&ormal laboratory values ?ecreased /-3Es
?ecreased serum "lucose
!&creased co&ce&tratio& of i&direct bilirubi&
?ecreased serum albumi&
*)0.< .he nor+al range o% urine out,ut %or a ,reter+
0a0/ is 1 to 2+l?4g?da/. .he nor+al s,eci%ic gravit/ %or a
,reter+ 0a0/ is 1.:2:. .he nor+al range %or 0lood glucose
level in a ,reter+ 0a0/ is B: to H: +g?dl.
35A
%ir
st
0r
eat
h
or
di%
%ic
ult
/
+a
int
ai
ni
ng
ad
eD
ua
te
res
,ir
ato
r/
+o
ve
+e
nts
on
his
o6
n.

Su
cti
o&i
&"
*)
0.
<
all
o6
s
re
+o
vin
g
+
uc
us
an
d
,r
ev
ent
s
as
36B
,ir
ati
on
o%
an
/
+
uc
us
an
d
a+
ni
oti
c
%lu
id
,r
ese
nt
in
the
+o
ut
h
an
d
no
se
o%
the
ne
60
or
n
to
est
a0l
ish
cle
ar
air
6a
/.

!&t
uba
tio
&s
*)
0.<
he
ad
o%
the
in%
361
ant
in
ne
utr
al
,os
itio
n
6it
h
to
6el
un
der
sh
oul
der
.

-est
procedure
-est positio& +ositio&i&" the i&fa&t o& the bac' with the head of the mattress
elevated appro1imately 15 de"rees to allow abdomi&al co&te&ts to
fall away from the diaphra"m affordi&" optimal breathi&" space#
-est positio& for suctio&i&"<
!&fa&t o& the bac' a&d slide a folded towel or pad u&der shoulders
to rise, head is i& &eutral positio&#
3omplicatio&s 6&emia of prematurity
7yperbilirubi&emia/ 'er&icterus
+ersiste&t pate&t ductus arteriosus
+erive&tricular / i&trave&tricular hemorrha"e
/espiratory distress sy&drome
etino,ath/ o% ,re+aturit/
etrolental fibroplasias are a complication that occurs if the infant is
o#ere@posed to hi*h o@y*en le#els.
Necroti8ing enterocolitis
7ost
severe
%or+
o%
s,ina
0i%ida .
( ,.
@J@5
.e$t0o
o4 o%
Basic
Nursin
g
Li,,in
cott H
th
ed.9&n
e o% the
"'ete' si3e
la'!n$osco&e
ET tube
Suction cat#ete' <it#
s!nt#etic su'factant
Isolettes :incubato'+
D'u$ stu(!
362
+enin
ges
(the
S,inal
cord
coverin
g9
,rotru
des or
herniat
ed
throug
h
o,enin
g in
verte0r
al
colu+
n. (,.
@J@5
.e$t0o
o4 o%
Basic
Nursin
g
Li,,in
cott H
th
ed.9Des
c'i&tio
n)s an
o,enin
g in
the
verte0r
al
colu+
n 6ith
no
a,,are
nt
reason.
( ,.
@J@5
.e$t0o
o4 o%
Basic
Nursin
g
Li,,in
cott H
th
ed.9S,i
na
0i%ida
occulta
7enin
gocele
363
7/elo
+enin
gocele
./,esS
,ina
0i%ida
occulta
S/non/
+sS,in
al
D/sra,
hia
e%ers
to
+al%or
+ation
o%
s,ine
in
6hich
the
,osteri
or
,ortion
o% the
la+ina
e o% the
verte0r
ae %ails
to
close.N
ursing
interve
ntions1
.
Nursin
g
diagno
ses1.
)ne%%ec
tive
air6a/
0reathi
ng
Positio
ning
the
in%ant
on the
0ac4
6ith
the
head
o% the
+attres
s
364
elevate
d
a,,ro$
i+atel/
13
degree
s to
allo6
a0do+i
nal
content
sA0nor
+al
la0orat
or/
values)
ncreas
ed total
no. o%
B#<s
#lassic
signs)n
trauter
ine
6eight
loss5
deh/dr
ations
and
chroni
c
h/,o$i
a Wold
+an
%aces<
Nursin
g
interve
ntion.
he
nurse<s
%irst
,riorit/
in
,re,ari
ng a
sa%e
enviro
n+ent
%or a
,reter
+
ne60or
n 6ith
lo6
A,gar
365
scores
is to
,re,ar
e
res,ira
tor/
resusci
tation
eDui,+
ent.
Air6a/
+ainte
nance
is the
%irst
,riorit/
.Nursi
ng
diagno
sis)+,
aired
gas
e$chan
ge
related
to
i++at
ure
,ul+o
nar/
%unctio
ning
"'ot'
usion
of t#e
s&inal
co'(
&'ot'u
(es
t#'ou$
# t#e
bac2.
Sacs
a'e
co)e'e
( b!
t#in
eb'
ane &
ne')e
a'e
e,&ose
(
Neu'o
lo$ical
366
(eficits
a'e
e)i(ent
Menin
$es o'
&'otect
i)e
co)e'i
n$
a'oun(
t#e
s&inal
co'(
#as
&us#e(
out
t#'ou$
# t#e
o&enin
$ in
t#e
)e'teb
'ae in
a sac.
S&inal
co'(
intact
Neu'o
lo$ical
(eficit
a'e
usuall!
NOT
"RES
ENT
Can
be
'e&ai'e
( </
little o'
no
(aa$
e to t#e
ne')e
&at#<
a!s.
7ost
co++o
n site
o%
inGur/
U
lu+0os
acral
area
36$
( 7os0
/<s
#o+,r
ehensi
ve
revie6
o%
Nursin
g %or
N#LE
>-N
,. 22H9
: enin$o!el
ocele+

Menin$oc
ele
M!eloe
nin$ocele

o
O
A.
RES"IR
ATOR=
DISTRE
SS
S=NDRO
ME
9
D
9
C
9
A
9
9 N
O
T
E
"
7
or
e
36=
c
o
+
+
o
n
in
n
e
o
n
at
es
d
el
iv
er
e
d
0
/
ce
sa
re
a
n
se
ct
io
n
th
a
n
in
th
os
e
d
el
iv
er
e
d
v
a
gi
n
al
l/
.
9
9 C
O
M
M
O
36A
N
SI
G
N
S
9
!a
n
os
isD
(
!s
&
ne
aD
st
e'
n
al
a
n
(/
o'
co
st
al
'e
t'
ac
ti
o
ns
D
ta
c#
!
&
ne
aD
$'
u
nt
in
$D
a
n
(
n
as
al
fl
a'
in
$D
%l
ar
3$B
in
g
n
ar
es
5
E
$
,i
ra
to
r/
gr
u
nt
in
g
9
9 M
A
N
A
G
E
M
E
N
T
9
ai
nt
ai
n
a
&
at
en
t
ai
'
<
a!
D
&l
ac
e
t#
e
in
fa
nt
in
a
<
a'

3$1
is
ol
le
te
<i
t#
o,
!$
en
D
a
(

in
ist
e'
a
nt
ib
io
ti
cs
as
&'
es
c'
ib
e(
a
n
(
co
''
ec
t
ac
i(
os
is
9

1.
HEMOL
=TIC
DISEAS
E
9
A
9
9 COM
MON
SIGN
S
9
E
3$2
9
9
9 "RE;
ENTI
ON
INDI
RECT
COO
M1IS
TEST
9
T
9
"
9
9 RESU
LTSA
9
If
9
R
9
If
9
9 DIRE
CT
COO
M1IS
TEST
9
T
9
9 RESU
LTS
9
If
9
N
9
R
9
C.
H="E
R1IL
IRU1
3$3
INEM
IA
9
Se
9
A
9 E
)a
lu
at
io
n
is
in
(i
ca
te
(
<
#e
n
se
'u

A
o
ve
r
1
2
+
g?
d
L
in
th
e
te
r
+
n
e
6
0
or
n
9 T
#e
'a
&
!
is
3$4
ai

e(
at
&'
e)
en
ti
n
$
'e
su
lts
in
&e
'

a
ne
nt
ne
u'
ol
o$
ic
al
(
a

a$
in
$
f'
o

t#
e
(e
&
os
iti
o
n
of
bi
li'
u
bi
n
3$5
in
ce
lls
9
9
T
9
9
T
9
9
"
9
9
N
9
9
9
9
9
E,&ose as
uc# of
t#e
ne<bo'nOs
s2in as
&ossible
#over the
genital
area5 and
+onitor
genital
area %or
s4in
irritation
or
0rea4do6
n
( ,ria,is+
+a/
3$6
occur9
#over the
ne60ornXs
e/es 6ith
e/e shields
or
,atches'
+a4e sure
e/elids are
closed
6hen
shields or
,atches
are
a,,lied
e+ove
the shields
or ,atches
at least
once ,er
shi%t to
ins,ect the
e/es %or
in%ection
or
irritation
and to
allo6 e/e
contact
. Measu'e
t#e
Fuantit!
of li$#t
e)e'! 6
#ou's
Monito'
s2in
te&e'atu
'e closel!
)ncrease
%luids to
co+,ensat
e %or 6ater
loss
3$$
E$,ect
loose
green
stools and
green
urine
7onitor
the
ne60ornXs
s4in color
6ith the
%lorescent
light
turned o%%5
ever/ B to
@ hours
7onitor
the s4in
%or 0ron8e
0a0/
s/ndro+e5
a gra/ish
0ro6n
discolorati
on o% the
s4in
e,osition
ne60orn
ever/ 2
hours
R#
anti$e
ns
f'o
t#e
bab!Os
bloo(
3$=
ente'
t#e
ate'
nal
bloo(s
t'ea
Dest'
uction
of
R1Cs
t#ose
'esult
s f'o
an
anti$e
n
antibo
(!
'eacti
on
E,c#a
n$e of
fetal
an(
ate'
nal
bloo(
ta2es
&lace
&'ia
'il!
<#en
t#e
&lacen
ta
se&a'
ates at
bi't#
T#e
ot#e
'
&'o(u
ces
anti9
R#
antibo
(ies
a$ains
t t#e
3$A
fetal
bloo(
cells
Antib
o(ies
a'e
#a'l
ess to
t#e
ot#e
' but
attac#
to t#e
e'!t#'
oc!tes
in t#e
fetus
an(
cause
#eol
!sis
Sensit
i3atio
n is
'a'e
<it#
t#e
fi'st
&'e$n
anc!
AB&
inco+
,ati0il
it/ is
usuall
/ less
severe
1.
Assess
ent
%.
#!&e'
bili'u
bine
ia &
#eol
!tic
anei
3=B
a
-.
Eaund
ice
that
develo
,s
ra,idl
/ a%ter
0irth
and
0e%ore
2B
hours
(PA.
*&L
&G)#
AL
EA!N
D)#E
9
C.
I&le
enta
tion
1. A(iniste
' R#o:D+
iune
$lobulin to
t#e
ot#e'
(u'in$ t#e
fi'st 5-
#ou's
afte'
(eli)e'! if
t#e R#9
ne$ati)e
ot#e'
(eli)e's
an R#9
&ositi)e
fetus but
'eains
unsensiti3
e(
2. T#e
bab!Os
bloo( is
3=1
'e&lace(
<it# R#9
ne$ati)e
bloo( to
sto& t#e
(est'uctio
n of t#e
bab!Os 'e(
bloo(
cellsS t#e
R#9
ne$ati)e
bloo( is
'e&lace(
<it# t#e
bab!Os
o<n bloo(
$'a(uall!
2.
B. NOTEA
.he *
negative
+other
6ho has
no titer
(negative
#oo+0s<
test
results5
non
sensiti8ed9
and 6ho
has
delivered
an *
,ositive
%etus is
given an
intra
+uscular
inGection
o% anti-*
(D9
(*oGA
79.
Paternal
0lood t/,e
+ight 0e
deter+ine
d %or the
,regnant
*
negative
3=2
6o+an in
order to
hel,
deter+ine
%etal 0lood
t/,e..
3.
H. *oGA7
0loc4s
anti0od/
,roduction
0/
attaching
to %etal
*
,ositive
0lood cells
in the
+aternal
circulation
0e%ore an
i++unolo
gical
res,onse
is
initiated.
I.
@. *oGA7
+ust 0e
ad+inister
ed to
unsensiti8
ed
,ost,artu
+ 6o+en
a%ter the
0irth o%
each *
,ositive
in%ant to
,revent
,roduction
o%
anti0odies.
)% the
%ather o%
%uture
%etuses is
*
,ositive
hetero8/go
us5 there is
a 3:K
chance o%
an *
negative
3=3
in%ant' i%
he is *
,ositive
ho+o8/go
us5 all
in%ants
6ill 0e *
,ositive.
J.
1:.
11. THE
ADDICT
ED
NE?1OR
N

NOTED
*EATURESA
Short
,al,e0r
al
%issures5
*/,o,la
stic
,hiltru
+D
short5
u,turne
dnose5
*lat
i(face
T#in u&&e' li&D
Lo< nasal 0ridge5
Abno'al &ala'
c'easesD
Res&i'ato'!
(ist'ess Ta&neaD
c!anosis+D
Con$enital #ea't
(iso'(e'sD
)rrita0ilit/5
h/,ersensitivit/ to
sti+uli5 .re+ors
Poor
%eeding5
Sei3u'es
.
N&.E"
.hese
3=4
are
signs o%
*eroine
6ithdra
6al
usuall/
occurs
6ithin
2B to B@
hours o%
0irth.
.he
ne60or
n +a/
0e Gitter/
and
h/,eract
ive. .he
cr/ is
o%ten
shrill
and
,ersiste
nt 6ith
/a6ning
and
snee8ing
. .endon
re%le$es
are
increase
d5 and
7oro<s
re%le$ is
decrease
d.
NOTEA
*eroin
6ithdra6al
neonates
*igh
,itch
cr/5
increase
)#P5
h/,ogl/
ce+ia5
loud
and
lust/ cr/
NURSING
INTER;ENTI
ONA
3=5
%. 7onitor
%or
res,irator/
distress
-. "osition
ne<bo'n on
si(e to
facilitate
('aina$e of
sec'etions
3. Hee&
'esuscitatio
n
eFui&ent
at t#e
be(si(e
.. 7onitor
%or
h/,ogl/ce+
ia
0. Assess
suc2 an(
s<allo<
'efle,
4.
A(iniste'
sall
fee(in$s
an( bu'&
<ell
5. Suction
as
necessa'!
6.
Monito' I
& 8
7. 7onitor
6eight and
head
circu+%eren
ce (#hec4
%or )ncrease
)#P9
%8.
Dec'ease
en)i'onen
tal stiuli
%%. .he
use o%
narcotic
antagon
ists to
3=6
reverse
res,irat
or/
de,ressi
on in
the drug
addicted
neonate
is
contrain
dicated
0ecause
these
drugs
+a/
,reci,it
ate
acute
6ithdra
6al in
the
neonate.
NE? 1ORN
O*
DIA1ETIC
MOTHER
A. Desc'i&tion
Neonate
bo'n to an
insulin9
(e&en(ent
ot#e' o'
$estationa
l (iabetic
ot#e'
an( <it#
#i$#
inci(ence
of
con$enital
anoalies.
COM"
LIC
ATI
ON
SA
*ig
h
inci
den
3=$
ces
o%
h/,
ogl/
ce+
ia5
res,
irat
or/
dist
ress
5
h/,
ocal
ce+
ia5
and
h/,
er0i
liru
0ine
+ia
1. Assessent
7A#
&S&
7)A
A
LGA
as a
result
o%
e$cess
%at
and
gl/cog
en in
tissue
s
E(e
a o'
&uffin
ess in
t#e
face
an(
c#ee2
s
Signs
o%
h/,og
l/ce+i
a5
3==
such
as
t6itch
ing5
di%%icu
lt/ in
%eedin
g5
lethar
g/5
a,nea
5
sei8ur
es5
and
c/ano
sis
H!&e'
bili'u
bine
ia
Signs
o%
res,ir
ator/
distres
s5
such
as
tach/
,nea5
c/ano
sis5
retrac
tions5
grunti
ng5
and
nasal
%larin
g
NO
TE
*O
R
CH
AR
AC
TE
RIS
TIC
S
3=A
O*
H=
"O
GL
=C
EM
IAA
Abno'
all!
lo<
le)el
of
$lucos
e :less
t#an
38
$/(
L in
t#e
fi'st
5-
#ou'
.0
$/(
L
afte'
t#e
fi'st 3
(a!s
of life
N -.
No'
al
bloo(
$lucos
e le)el
is .8
to a %9
(a!9
ol(
neona
te an(
08 to
78
neona
te
ol(e'
t#an %
(a!
)ncre
ased
res,ir
ator/
rate
.6itc
3AB
hing5
nervo
usnes
s5 or
tre+o
rs
!nsta
0le
te+,e
rature
#/ano
sis
NURS
IN
G
INT
ER
;E
NTI
ON
A
%.
Mo
nito
'
fo'
si$n
s of
'es
&i'a
to'!
(ist
'ess
-.
Mo
nito
'
bili
'ub
in
an(
blo
o(
$luc
ose
le)e
ls
3.
Mo
nito
'
<ei
$#t
..
3A1
(ee
d
earl
/5
6it
h
1:
K
glu
cos
e in
6at
er5
0re
ast
+il
45
or
%or
+ul
a as
,re
scri
0ed
0.
Ad
+in
iste
r )V
glu
cos
e to
trea
t
nec
ess
ar/
and
as
,re
scri
0ed
4.
Monito'
fo'
e(ea
5.
Moni
3A2
to'
fo'
t'eo
's &
sei3u'
es

SMALL *OR
GESTATION
AL AGE
A.
Desc'i
&tionA
A
neona
te
<#o is
&lotte
( at
o'
belo<
t#e
%Ot#
&e'ce
ntile
on t#e
int'au
te'ine
$'o<t
#
cu')e

N&.
E" F1
Predis
,osin
g
%actor
is
7ater
nal
S+o4i
ng
1.
Assess
ent
3A3
%.
*etal
(ist'e
ss
-.
Gestat
ional
a$e
an(
&#!sic
al
atu'
it!
3.
Lo<e'
e( o'
ele)at
e(
bo(!
te&e
'atu'e
..
"#!sic
al
abno'
aliti
es
0.
H!&o
$l!ce
ia
4.
Si$ns
of
&ol!c!
t#ei
aA
a.
Ru((!
a&&ea'a
nce
b.
C!anosi
s
c.
>aun(ic
e
3A4
5.
Si$ns
of
infecti
on
6.
Si$ns
of
as&i'a
tion of
econ
iu
N&.
E"
&0tai
ning a
0lood
sa+,l
e to
deter
+ine
glucos
e level
6ould
have
the
highe
st
,riorit
/ to
on
SGA.
A
co++
on
co+,l
icatio
n o%
the
SGA
ne60o
rn
i++e
diatel
/ a%ter
0irth
is
h/,og
l/ce+i
a
3A5
0ecau
se o%
the
increa
sed
+eta0
olic
rate in
res,o
nse to
heat
loss
and
,oor
he,ati
c
gl/cog
en
stores.
.he
SGA
ne60o
rn
+a/
also
have
su%%er
ed
intrau
terine
h/,o$
ia5
6hich
de,let
es
glucos
e.
C.
I&le
enta
tion
%.
Maintai
n
ai'<a!
-.
Maintai
n bo(!
te&e'a
tu'e
3.
Obse')e
fo'
3A6
si$ns of
'es&i'at
o'!
(ist'ess
..
Monito'
fo'
infectio
n an(
initiate
easu'e
s to
&'e)ent
se&sis
0.
Monito'
bloo(
$lucose
le)els
an( fo'
si$ns of
#!&o$l!
ceia
4.
Initiate
ea'l!
fee(in$s
an(
onito'
fo'
si$ns of
as&i'ati
on
5.
"'o)i(e
stiulat
ionD
suc# as
touc#
an(
cu((lin
$

A. NER;OUS
S=STEM
ANOMALIES
9
M
3A$
9
9

9
9
S
9
9
9
D
Assess
ne<bo
'nIs
'es&i'
ato'!
'ateD
(e&t#
an(
'#!t#
.
Auscu
ltate
lun$
soun(
.

NoteA
7econi
u+
stained
s/ndro
+e o%
P&S.
7A.!
E
neonat
es
As,irat
ion o%
+econi
u+ is
0est
,revent
ed 0/
suction
ing the
neonat
e<s
naso,h
ar/n$
3A=
i++edi
atelt
a%ter
the
head is
delivere
d and
0e%ore
the
shoulde
rs and
chest
are
delivere
d. As
long as
the
chest is
co+,re
ssed in
the
vagina5
the
in%ant
6ill not
inhale
and
as,irat
e
+econi
u+ in
the
u,,er
res,irat
or/
tract.
7econi
u+
as,irati
on
0loc4s
the air
%lo6 to
the
alveoli5
leading
to
,otenti
all/ li%e
threate
ning
res,irat
or/
co+,lic
ations.

3AA
Suctio
n
e)e'!
-
#ou's
o'
o'e
often
as
necess
a'!
"ositi
on
ne<bo
'n on
si(e
o'
bac2
<it#
t#e
nec2
sli$#tl
!
e,ten
(e(
A(i
niste'
O-D
antici
&ate
t#e
nee(
fo'
C"A"
o'
"EE"
Conti
nue to
assess
t#e
ne<bo
'nIs
'es&i'
ato'!
status
closel
!.
Encou
'a$e
as
uc#
&a'en
tal
&a'tic
i&atio
4BB
n in
t#e
ne<bo
'nIs
ca'e
as
con(it
ion
allo<s

-.
A(i
niste'
I;
flui(s
afte'
bi't#
to
&'o)i
(e
Gluco
se to
&'e)e
nt
#!&o$
l!cei
aD
onit
o'
closel
! t#e
infusi
on
'ate.
He&t
t#e
infant
un(e'
a
'a(ia
nt
#eat
<a'
e' to
&'ese'
)e
ene'$
!
Monit
o'
bab!Is
<ei$#
tD
se'u
elect'
4B1
ol!tes
an(
ensu'
e
a(eFu
ate
flui(
inta2e
Meas
u'e
u'ine
out&u
t b!
<ei$#i
n$
(ia&e'
s
C#ec2
fo'
bloo(
stools
to
e)alua
te fo'
&ossib
le
blee(i
n$
f'o
intesti
nal
t'act.
Hee&
a
'estful
en)i'o
nent
.

3.

Antici
&ate
t#e
infant
s nee(
to be
b'east
fee(
Deo
nst'at
e
tec#ni
Fue
fo'
4B2
fee(in
$ to
ot#e
'D note
&'o&e
'
&ositi
onin$
of t#e
infant
D
Jlatc#
in$
onK
tec#ni
FueD
'ate
of
(eli)e
'! of
fee(in
$ an(
f'eFue
nc! of
bu'&i
n$
"'o)i
(e a
'ela,e
(
en)i'o
nent
(u'in
$
fee(in
$
A(Nus
t
f'eFue
nc!
an(
aou
nt of
fee(in
$
acco'
(in$
to
infant
s
'es&o
nse
Alte'n
ate
fee(in
$
4B3
&'oce
(u'e
:ni&&l
e an(
$a)a$
e
fee(in
$+
acco'
(in$
to
infant
s
abilit!
.
Monit
o'
ot#e
'Is
effo'tD
&'o)i
(e
fee(b
ac2
an(
assista
nce as
nee(e
(
Su$$e
st
ot#e
' to
onit
o'
infant
s
<ei$#
t
&e'io(
icall!

-.
Ris2 fo'
flui( )olue
(eficit
'elate( to
insensible
<ate' loss at
bi't#
3.
Ineffecti)e
infant
fee(in$
&atte'n
4B4

%.
;ita
in H
:AFua
e&#
!ton+
Use
fo'
&'o&#
!la,is
to
t'eat
#eo'
'#a$ic
(iseas
e of
t#e
ne<bo
'n
Si(e
effectsA
H!&e'
bili'u
binu'i
a

-. E!e
&'o&#
!la,is
3. :E'!t
#'o!cin
8.0M
Ilot!cinD
Tet'ac!cli
ne %M
Sil)e'
Nit'ate
%M
"'o&#
!lactic
easu
'e to
&'otec
t
a$ains
t
Neisse
'ia
$ono'
'#oea
e an(
C#la
!(ia
t'ac#o
4B5
atis
Si(e
effectsA
Sil)e'
nit'at
e can
cause
c#ei
cal
conNu
cti)iti
s

D'u$
stu(!
ET
tube
Suctio
n
cat#et
e'

1e(si
(e
eFui&
ent
Meco
niu
as&i'a
tion
s!n('
oe
Res&i
'ato'!
(ist'e
ss
s!n('
oe


NOTEA
Post +ature
neonates
have
di%%icult/
+aintainin
g glucose
reserves.
&ther
co++on
,ro0le+s
include
7econiu+
as,iration
s/ndro+e5
4B6
,ol/c/the+i
a5
congenital
ano+alies5
sei8ure
activit/ and
cold stress.

N&.
E" .he
in%ant 6ho
are
e$,osed to
high
0lood-
glucose
levels in
utero +a/
e$,erience
ra,id and
,ro%ound
h/,ogl/ce
+ia a%ter
0irth
0ecause o%
the
cessation
o% a high
in-utero
glucose
load. .he
s+all-%or-
gestational
-age
in%ant has
use u,
gl/cogen
stores as a
result o%
intrauterin
e
+alnutriti
on and
has
0lunted
he,atic
en8/+atic
res,onse
6ith
6hich to
carr/ out
gluconeog
enesis.

NOT
4B$
EA .he
,atient
6ith ,ost-
ter+
,regnanc/
is at high
ris4 %or
decreased
,lacental
%unctionin
g5
there%ore
increasing
the ris4 o%
inadeDuat
e o$/gen
circulation
to the
%etus

Co&
licatio
ns

1est
&ositi
on
Resus
citatio
n
NOT
EA
'esus
citati
on
beco
es
i&o
'tant
fo'
infan
t <#o
fails
to
ta2e
fi'st
b'eat
# o'
(iffic
ult!
ain
taini
n$
a(eF
uate
4B=
'es&i
'ato'
!
o)e
ent
s on
#is
o<n.

Suctio
nin$
NOT
EA
all
o<
s
'e
o
)in
$

uc
us
an
(
&'
e)
ent
s
as
&i'
ati
on
of
an
!

uc
us
an
(
a
nio
tic
flu
i(
&'
ese
nt
in
t#e
o
ut
4BA
#
an
(
no
se
of
t#e
ne
<b
o'
n.

To
est
abl
is#
cle
a'
ai'
<a
!.

Intub
ations
NOT
EA
#e
a(
of
t#
e
inf
an
t
in
ne
ut
'al
&o
sit
io
n
<i
t#
to
<e
l
un
(e
'
s#
ou
l(
e'.

41B
1est
&'oce
(u'e
Sono$
'a

Sc'ee
nin$
test
Inc'ea
se(
#eat
oc'it
le)el
Dec'e
ase(
se'u
$lucos
e

Long
A thin
6ith
crac4
ed
s4in
6hich
is
loose5
6rin4l
ed
and
strain
ed
greeni
sh
/ello6
5 6ith
no
verni$
nor
lanug
o
Long
nails
6ith
%ir+
s4ull
1ide
e/ed
alertn
ess o%
one
+onth
old
411
0a0/

Mate'
nal &
c#il(
nu'sin
$S a
(e)elo
&ent
al
a&&'o
ac# to
co&'
e#ensi
)e
c$fns
an(
ncle,
'e)ie
<S 0
t#

e(.
"a$e
%3%
Lo<
socioe
cono
ic
le)el
"oo'
nut'iti
onal
status
Lac2
of &'e
natal
ca'e
Multi
&a'ou
s
ot#e
'Is
Ci$a'
ette
so2i
n$
T#e
a$e of
t#e
ot#e
' :t#e
#i$#es
t
inci(e
nce is
412
in
ot#e
'Is
!oun$
e'
t#an
a$e
-8.+
Mot#e
'Is
<it#
(iabet
es
ellit
us
Con$e
nital
abno'
aliti
es
suc#
as
o&#
alocel
e.
1o(!
is
co)e'e
( <it#
lanu$
o
Ol(
an
facies

Cont'
ibutin
$
facto'
s
"OST
TER
M
IN*A
NT
A
neona
te
bo'n
afte'
.-
<ee2s
a$e of
$estati
on
413

"OST
TER
M
IN*A
NT


*i$u'
e -6

Defini
tion
Give
the
+othe
r
o$/ge
n 0/
+as4
durin
g the
0irth
to
,rovid
e the
,reter
+
in%ant
6ith
o,ti+
al
o$/ge
n
satura
tion at
0irth (
@3-
J:K9.
Kee,i
ng
+ater
nal
analg
esia
and
anest
414
hesia
to a
+ini+
u+
also
o%%ers
the
in%ant
the
0est
chanc
e o%
initiat
ing
e%%ecti
ve
res,ir
ation.
Bedsi
de
larng/
osco,
e5
endotr
achea
l tu0e5
suctio
n
cateth
ers
and
s/nthe
tic
sur%ac
tant to
0e
ad+in
istere
d 0/
the
endotr
achea
l tu0e.
)n%ant
+ust
0e
4e,t
6ar+
durin
g
resusc
itation
,roce
dures
so he
or she
415
is not
e$,en
ding
e$tra
energ
/ to
increa
se the
+eta0
olic
rate to
+aint
ain
0od/
te+,e
rature
.
&0ser
ve %or
chang
es in
res,ir
ations
5 color
and
vital
signs
#hec4
e%%ica
c/ o%
)solett
e"
+aint
ain
heat5
hu+id
it/
and
o$/ge
n
conce
ntrati
on5
ad+in
ister
o$/ge
n onl/
i%
necess
ar/
7aint
ain
ase,ti
c
techni
416
Due to
,reve
nt
in%ecti
on
Adher
e to
the
techni
Dues
o%
gavag
e
%eedin
g %or
sa%et/
o%
in%ant
&0ser
ve
6eigh
t-gain
,atter
ns
Deter
+ine
0lood
gases
%reDue
ntl/ to
,reve
nt
acidos
is.
)nstit
ute
,hotot
hera,
/
6hen
h/,er
0iliru
0ine+
ia
occur
s
Su,,o
rt
,arent
s 0/
letting
the+
ver0al
i8e
and
41$
as4
Duesti
ons to
reliev
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an$iet
/.
Provi
de
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visitin
g
hours
%or
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s5
allo6
the+
to
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in
care.
Arran
ge
%ollo6
-u,
0e%ore
and
a%ter
discha
rge 0/
a
visitin
g
nurse.
(7os0
/<s
#o+,rehe
nsive
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Nursing
%or
N#LE>-
N ,age
21H9
1. is4
%or
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+e
de%ici
t
relate
d to
41=
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loss
at
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and
s+all
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ation
relate
d to
6ea4
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nt
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ation
o%
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ngs
2. */,o
ther
+ia
relate
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utane
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and
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n %at
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ther
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and?o
r
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d the
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B. is4
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and?
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lance
d
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42B
ion"
less
than
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reDui
re+e
nts
relate
d to
lac4
o%
energ
/ to
suc4
and?o
r
6ea4
or
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nt
suc4i
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$.
( 7o
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#o+
,rehe
nsive
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6 o%
Nursi
ng
%or
N#L
E>-
N
,age
21H9
1e(si(e
eFui&ent
"'e(is&osin$ *acto'#hild undergoes a gro6th s,urt during ,u0ert/. (,. @J@5 .e$t0oo4 o% Basic Nursing
Li,,incott H
th
ed.9!n4no6n 0ut generall/ thought to result %ro+ triggered environ+ent.N&.E" sa+e 6?
+enigocele #linical 7ani%estationDi+,le is ,resent over the 0ac40one. (,. @J@5 .e$t0oo4 o% Basic Nursing
Li,,incott H
th
ed.9E$ternal c/st de%ect in the s,inal cord usuall/ at the +idline 7eningitis U in%la++ation o%
the +eninges covering the s,inal cord.Screening ? Diagnostic .est>-ra/ (s+all tu%t o% hair or ,ort urine
strain is so+eti+es ,resent in the verte0ral are9 ( ,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th

ed.9Neurologic E$a+ination-indicate loss o% neurologic %unctions 0elo6 the de%ect.Note" sa+e 6ith
+eningocele7aGor Surger/Surger/ i% necessar/ (,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th

ed.9La+inecto+/La+inecto+/Pur,ose o% Surger/.o ,revent %urther deterioration o% neural %unction..o
,revent %urther co+,lications.Post-&,erative Nursing care7easure head si8e to deter+ine i% h/roce,halus is
develo,ing7easure head si8e to deter+ine i% h/roce,halus is develo,ingPossi0le surgical
co+,lication*/droce,halus*/droce,halusBest Position (or Pre-o,?Post-o, A dseNote" Sa+e 6?
7eningceleDisease #o+,lication7eningitis-i% sac 6ill ru,tured then in%ection 6ill occurDrugs"Anti0iotics-
to ,revent in%ectionNote" Sa+e 6? 7eningceleNursing Diagnosis and )ntervention)+,aired s4in )ntegrit/
related to i+,aired +otor A sensor/ %unction.Note" Sa+e 6? 7eningcele
421
#
#
Nursing alert"
1. Prevent %urther da+age.
2. 7ost co++on ,ro0le+ is loss o% sensation in the legs (,rotect child against ,ossi0le leg inGur/.
2. S4in e$a+ination" ,ressure areas and tight clothing.
B. #hange dia,ers i% necessar/ a%ter voiding and de%ecating.
3. Patient is e$tre+el/ sensitive to late$. .he nurse +ust +a4e sure the/ do not co+e in contact 6ith
ite+s such as tourniDuets5 catheters5 ru00er 0ands5 gloves5 0alloons5 various tu0es +ade o% late$.
H. (olic acid (%olate9 ta4es during ,regnanc/ to reduce the severit/.
I. (,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9
@.
J.
1:.
Ris2 fo' Infection 'elate( to containation
Nu'sin$ Inte')entionsA "'otectin$ t#e s2in inte$'it!
%. Avoid ,ositioning on the in%antXs 0ac4 to ,revent ,ressure on the sac.
-. Do not &lace an! co)e'in$ (i'ectl! o)e' t#e sac.
3. Obse')e sac fo' e)i(ence of i''itation o' lea2a$e of CS*
.. !se ,rone ,osition 6? hi,s slightl/ %le$ed to decrease tension on the sac.
0. Place a %oa+ ru00er ,ad? s+all ,illo6 or roll dia,er 0et6een the in%ant<s legs to +aintain hi,s in
a0duction A to ,revent or counteract su0lu$ation.
4. "'o)i(e s2in ca'e es&eciall! an2lesD 2neesD ti& of noseD c#ee2s & c#in.
5. "'o)i(e &assi)e 'an$e of otion e,e'cise.
6. Use foa o' fleece &a( to 'e(uce &'essu'e of t#e att'ess a$ainst t#e s2in.
7. A)oi( touc#in$ t#e sac.
422
"'e)entin$ Infection
%. Hee& a'ea clean f'o u'ine an( feces
-. Hee& t#e infant clean es&. buttoc2s & $enitalia
3. A&&l! ste'ile $au3e /oistene( to<el an( <atc# fo' an! si$ns of infection.: fe)e'D i''itabilit!D
let#a'$!D oo3in$ of flui( o' &us f'o t#e sac+

6&ticholi&er"ic-to improve the uri&ary i&co&ti&e&ce


5a1ative- to achieve bowel co&ti&e&ce i& the child
6&tipasmodics-to co&trol bladder spasm

ScoliosisD Cont'actu'e & Noint (islocation


S2in b'ea2(o<n in senso'! (ene')ate( a'eas & un(e' b'aces.

"'one9 to inii3e t#e tension on t#e sac/'is2 fo' t'aua :RationaleATo &'e)ent &'essu'e on t#e
incision+
*i, slightl/ %le$ed and a0ducted
(eet hanging5 %ree o% +attress and slight trendelen0urg ( reduce s,inal %luid9 (,.22H5 7os0/<s
#o+,rehensive evie6 %or Nursing N#LE> N9
Paral/sis5 hi, destruction5 4nee %le$ion contracture5 sensor/ loss (,. 2HH5 Ph/sical 7edicine A
eha0ilitation Basic5 Garrison9
)n%ection (,atient is o,en catheteri8ed9. (,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9

Monito' fo' si$n of inc'ease int'ac'annial &'essu'e
A)oi( s&inal co'( (aa$e
ange o% +otion (,assive and active9 ( ,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9

Monito' fo' si$n of inc'ease int'ac'annial &'essu'e


Loo4 %or sign o% in%ection ( ,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9

0o preve&t &eural deterioratio&


0o facilitate ha&dli&" of i&fa&t#

0o mi&imi2e the da&"er of rupture & i&fectio&


0o improve cosmetic effect#
0o facilitate ha&dli&" of i&fa&ts#
- 3losure of the ope& lesio&
- /emoval of sac
- closu'e of t#e o&en lesion
- 'eo)al of sac

"'enatal Sc'eenin$:%
st
T'ieste'+
1loo( test Jt'i&le sc'eenK
- Inc'ease( se'u al&#a &'otein.
"'enatal ult'asoun(
Aniocentesis
Elective a0ortion ( ,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9
423

Afte' bi't#
S&ine @9'a! 'e)eals t#at e,act e,tent & location of t#e (efect.
S&ine Ult'asoun( to (ete'ine s&inal co'( abno'alities.
CT scan/ MRI

Ence,halitis (,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H


th
ed.9
Roun(D 'aise( &oo'l! e&it#eliali3e( a'ea a'e at t#e le)el of t#e s&inal colunD coonl! at t#e
lubosac'al
Loss of oto' an( sensation belo< t#e le)el of t#e lesion.
Cont'actu'e in t#e an2lesD 2neesD o' #i&s a! occu'.
Clubfeet9 '/t t#e &a'a&le$ic feet in t#e ute'us.
1la((e' (!sfunction
*ecal incontinence & consti&ation9 cause( b! &oo' inne')ations of t#e anal s&#incte' & bo<el
usculatu'e
Sei3u'eD b'ain (aa$eD blin(ness ca& be a late si"&#
?ea2ness of t#e le$s & lac2 of s&#incte' cont'ol
are ,aral/sis (,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9

;al&'oic aci(92no<n to cause neu'al tube (efect if a(iniste'e( (u'in$ &'e$nanc!.


Genetic
Malfo'ation of t#e )e'teb'al a'c# & s&inal co'( (u'in$ eb'io$enesis on t#e .
t#
94
t#
<ee2s.

1# *alo1o&e :*arca&;
2# *ature of the dru"<
*arcotic a&ta"o&ist
Side effects<
7yperte&sio&, irritability, tachycardia

2. Sur%actan ( Survanta9
B. Nature o% the drug"
Lung sur%actant to i+,rove lung co+,liance
Side e%%ect"
.ransient 0rad/cardia5 rales

5# @itami& L :6Huamephyto&;
,se for prophyla1is to treat hemorrha"ic disease of the &ewbor&#
Side effects<
7yperbilirubi&uria

6# .ye prophyla1is
$# :.rythromyci& B#5C !lotyci&, 0etracycli&e 1C
=# Silver Nitrate 1K ( not alread/ used U causes che+ical conGunctivitis;
+rophylactic measure to protect a"ai&st *eisseria "o&orrhoeae a&d 3hlamydia trachomatis
Side effects<
Silver &itrate ca& cause chemical co&uctivitis

"he RA cause is O&$.


424
,IS"$N"ION O% "+$ U"$US from more than 09C7 pounds3 O"+$S A$1 JCCC *ms3 neonate3 e@cessi#e
o@ytocin use3 Polyhydramnios and Placental ,isorders.
5ou should assess for uterine atony after a c.section deli#ery. "his is more common after a c.section than after
a #a*inal deli#ery.
!&compete&t cervi1
(ultiple "estatio&
+revious history of +reterm labor
?.S e1posure
.motio&al stress
7ydram&ios
+lace&ta previa
6bruptio place&ta
(ater&al a"e Y1= or N35
2B. # #alories in diet should consist o% 3:K to H:K car0oh/drates5 12K to 2:K ,rotein5 and 2:K to 2:K %at
23.
2H. NO"$1 Because insulin does not ,ass into the 0reast +il45 0reast%eeding is not contraindicated %or
the +other 6ith dia0etes. (reastfeedin* is encoura*edH it decreases the insulin re4uirements for
insulin.independent clients. (reastfeedin* does not increase the ris8 of maternal infectionH it leads to
an increased caloric demand. Infants of diabetic mothers often display ?itteriness in response to
hypo*lycemia after birth
-oodell/s si*n is a softenin* of the cer#i@3 )hich occurs in pre*nancy
+alpati&" fetal co&tours
-ra1to&-7ic's co&tractio&s
(allotment1 bouncin* of the fetus in the amniotic fluid a*ainst the e@aminers hand. ,urin* the 9:
th
.AC
th
)ee8.
(ra@ton +ic8s Contractions1 painless contractions felt for AC.EC minutes occurs
on the 9:
th
)ee8#

Chad)ic8/s si*n is a bluish colorin* of the #a*inal mucosal that occurs as early
as : )ee8s *estation. ationale1 due to increase #ascularity < blood #essel
en*or*ement.
Increase si2e of the uterus

W P Pre*nancy "est
S Secretion of +C- in the urine 0%ro* "est7. ,etectable 9C days after the missed
period

. "he fetal heartbeat typically can be heard and fetal rebound is possible bet)een
9; and AA )ee8s. "he fetal outline becomes palpable and the fetus is hi*hly
mobile bet)een A; and E9 )ee8s. (ra@ton +ic8s contractions increase in
fre4uency and intensity bet)een EA and EF )ee8s.
Sur*ical sterili2ation of the male in#ol#es cuttin* the ductus deferens.
&asectomy1 &as ,eferens is cut. "he man can resume se@ after one )ee8 or )hen the sperm count
indicates C count or A ne*ati#e sperm count ha#e been e@amined.
4e&erally it reHuires 6 > 36 eaculatio&s to re&der &e"# sperm cou&t

425
In order to *et for semen analysis3 collect them in a clean *lass not plastic3 because it may affect the
spermato2oa. No se@ for E days before the semen collection < no drin8in* of alcohol for 9 day. "he first
portion of the semen has a hi*h ration of sperm.

D /arely accompa&ied by sca&t va"i&al spotti&"


D Some couple uses this as si"&al of the be"i&&i&" period a&d to avoid se1ual i&tercourse
u&til the fertile period passes
426

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