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Michelle M. Rupard RNC-OB, MSN, FNP, CLNC. Objectives Following this presentation, the participant will be able to: 1. Calculate estimated date of confinement.

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Presentation on theme: "Michelle M. Rupard RNC-OB, MSN, FNP, CLNC. Objectives Following this presentation, the participant will be able to: 1. Calculate estimated date of confinement."— Presentation transcript:

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

2 Objectives Following this presentation, the participant will be able to: 1. Calculate estimated date of confinement (EDC) 2. Identify common fetal heart rate patterns and associated interventions 2. Recognize abnormal findings of pregnancy 3. 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  Based on first day of LMP  ~ 280 days (from first day of LMP)  9 calendar months  10 lunar months  40 weeks

4  Add 7 days  Subtract 3 months

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8 Lowdermilk and Perry, 2007

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10 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 Assess:  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 ACOG, 1995, Baxi, et al, 1985, Murray, 2007, Rosevear & Hope, 1989, and Tournaire, et al, 1980

11 Baseline less than 110 Causes:  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

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15  Baseline  Moderate variability  No periodic decelerations  Accelerations with fetal movement

16  Progressive change in baseline (up or down)  Tachycardia  Bradycardia  Decrease or absence of variability  Decelerations  Late  Prolonged  Severe variables Lowdermilk & Perry, 2007, Mattson & Smith, 2004 and Murray, 2007

17  “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

18  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

19  Vaginal bleeding  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  Begins with birth  Ends with delivery of placenta

21  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  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

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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  Birth Experience  Maternal Self-image  Maternal Adaptation  Parent-Infant Interaction  Family Structure  Cultural Diversity

26  Parent’s emotional state  Support system  Level of communication  Care-giving skills  Proximity of infant  Parent-infant fit  Positive feedback

27  Risk for infection  Risk for constipation  Disturbed sleep pattern  Acute pain  Risk for injury  Ineffective Breastfeeding


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