1. Maternal-Child Review
Michelle M. Rupard
RNC-OB, MSN, FNP, CLNC

2. Objectives Following this presentation, the participant
will be able to:
Calculate estimated date of confinement (EDC)
Identify common fetal heart rate patterns and
associated interventions
Recognize abnormal findings of pregnancy
State appropriate client positioning during
cesarean section
5. Appropriately assess maternal fundus in the
postpartum period
6. Promote maternal psychosocial adaptation during the
Taking-In Phase

3. Gestational Age Based on first day of LMP
~ 280 days (from first day of LMP)
9 calendar months
10 lunar months
40 weeks

4. Naegele’s Rule
Add 7 days
Subtract 3 months

5. Fetal Heart Rate Accelerations

6. Nonreactive NST

7. What pattern is this?

8. Early Decelerations Gradual decrease in FHR.
Onset to nadir is at least 30 seconds.
Nadir occurs at peak of ctx.
Lowdermilk and Perry, 2007

9. Variable Decelerations
Variable decel characteristics:
Abrupt decrease in FHR with onset to nadir LESS than 30 seconds.
The decrease in FHR is at least 15 bpm, lasts at least 15 seconds, but less than 2 minutes.
Variables VARY in timing, shape and duration.
Lowdermilk and Perry, 2007

10. Tachycardia Assess: BL greater than 160 for 10 minutes or longer
Fetal well-being
Drug use
Fever
WBC
Abd tenderness
Hyperthyroidism
Intervene:
O2 at 8-10 l/min via face mask
Assist with scalp pH testing
Prepare for possible cesarean
section
BL greater than 160 for 10 minutes or longer
Increased Risk:
Asphyxia
Respiratory distress
Chorioamnionitis, sepsis
Neonatal pneumonia
Possible Causes:
Drugs
Anxiety
Hyperthyroidism
Fever
Fetal hypoxia, anemia,
acidosis
ACOG, 1995, Baxi, et al, 1985, Murray, 2007, Rosevear & Hope, 1989, and Tournaire, et al, 1980

11. Bradycardia Baseline less than 110 Causes: Interventions:
Vagal response
Cord prolapse
Arrhythmia
Possible maternal HR
Drug use
Interventions:
Assess maternal HR, BP
Increase fetal
oxygenation
Limit maternal bearing
down
Prepare for delivery
and neonatal
resusitation
Murray, 2007
Nubain, beta blockers can cause
Cocaine, cigarettes can cause abruption or fetal compromise
Vagal response can be due to head compression, cord compression, forceps application

12. Absent Variability

13. Minimal to Moderate variability

14. Moderate Variability

15. Reassuring FHR in the Term Fetus
Baseline
Moderate variability
No periodic decelerations
Accelerations with fetal movement

16. Nonreassuring FHR in the Term Fetus
Decelerations
Late
Prolonged
Severe variables
Progressive change in baseline (up or down)
Tachycardia
Bradycardia
Decrease or absence of variability
Lowdermilk and Perry, pg 498
Murray, 2007, pg 59-71
Mattson and Smith pg 309
Lowdermilk & Perry, 2007, Mattson & Smith, 2004 and Murray, 2007

17. Spinal/Epidural Nursing Care
“Time Out”/Consent
Notify anesthesia if platelet count is low
Support during placement
Assess VS, FHR frequently per P&P
Position with wedge under hip afterward
Assess adequacy of contractions
Foley as ordered
Be prepared for interventions related to maternal hypotension, high block, fetal distress
Assess level of block
Discuss controversy regarding IV bolus-

18. Cesarean Birth Nursing Interventions
Start/maintain IV with #18 gauge cathlon
Shave abdomen
Insert foley
Check chart for consent, labwork (CBC, blood-type and cross- match x 2 units PRBC).
Advocate for informed consent
Support mom and her coach
Involve couple as much as possible in decision making
Obtain OR attire for coach and orient to expectations
Continually assess maternal/fetal status
Gilbert & Harmon, 2003
Shave at least 2 inches below pubic hair line
Discourage thoughts of C/S as a failed delivery. It is an alternative delivery route

19. Danger Signs Vaginal bleeding Abdominal pain
Sudden gush of fluid from vagina
Edema of hands, face
Severe headache
Dizziness, visual disturbances
Abdominal pain
Chills, fever (101ºF)
Painful urination
Oliguria
Persistent vomiting
Decrease or absence
of fetal movement

20. Third Stage of Labor
Begins with birth
Ends with delivery of
placenta

21. Nursing Interventions During Third Stage
Promote skin to skin contact with infant
(if newborn is stable)
Assessment, possible resuscitation of newborn
Assess maternal VS, lochia frequently
Assist with fundal massage prn
Have Pitocin readily available

22. Following Delivery… Administer oxytocic medication as ordered
Pitocin 20 units in 1000 ml IV fluid or Pitocin 10 units IM
Methergine 0.2 mg IM (contraindicated with HTN)
Assist provider prn in repair of lacerations, episiotomy
Clean perineum with warm water, apply ice pack prn
Replace foot of bed
Massage fundus and assess lochia per protocol
Complete newborn assessment and care
Promote breastfeeding (prn) and family bonding
Discuss Pitocin after placenta vs after baby

23. Massage the fundus...
Hands on practice!!

24. Transition to Parenthood - Chapter 24
Period of change and instability for those with new infants; occurs over time
Influences include: meanings, expectations, level of knowledge, environment, level of planning, emotional and physical well-being
Depends on the new parent’s experiences with their parents (infant’s grandparents)

25. Psychosocial Needs Birth Experience Maternal Self-image
Maternal Adaptation
Parent-Infant Interaction
Family Structure
Cultural Diversity

26. Attachment and Bonding Influences
Parent’s emotional state
Support system
Level of communication
Care-giving skills
Proximity of infant
Parent-infant fit
Positive feedback

27. Nursing Diagnoses and Expected Outcomes
Risk for infection
Risk for constipation
Disturbed sleep pattern
Acute pain
Risk for injury
Ineffective Breastfeeding