Obstetrics & Neonates Unit 49 Adonis K. Lomibao, R.N. 11/29

Cord-less...

Objectives Identify basic terminology regarding obstetrics. Understand differences between the prenatal, labor & delivery, and postpartum stages. Understand postpartum care for both the mother and infant.

Introduction Fetus- The baby before it is born. Amniotic sac-a membranous bag that surrounds the fetus. Amniotic fluid-fluid that the fetus floats in. Umbilical cord-provides nourishment for the baby Placenta-attached to uterine wall, and the umbilical cord.

Introduction cont. After baby is born and seaprated from cord, Placenta, amniotic sac, and remaining cord are expelled as the afterbirth. Three phases of pregnancy: -Prenatal-before birth -Labor & Delivery -Postpartum- after birth

Prenatal Care Begins in prenatal period, when woman learns she is pregnant. Obstetrical-pregnancy Trimester-(3 months) A normal pregnancy lasts about 280 days. Each trimester has specific signs and symptoms. (p.862-3) Routine procedures during prenatal visits on (p.863) i.e. weighing the mother, taking B/P & Pulse, etc. Unusual items to report (p.863) i.e. persistent headache, elevated B/P, bleeding, etc.

Preparation for Birth Both parents encouraged to participate in birth. Most parents elect to use natural childbirth. Can take birth training classes to learn about the birth process, vaginal and cesarean deliveries, support systems, etc.

Prenatal Testing Can sometimes identify congenital abnormalities. May include: -Ultrasound:uses sound waves to identify gestation age(time of development) and defects in the structure of the fetal organs. Amniocentesis: needle inserted into sac and cells extracted. Fetoscopy: direct visualization of fetus through an endoscope.

Labor & Delivery At the end of 40 weeks, +/- 2 weeks signs of labor will be noted: -Engagement of lightening: the fetus moves downward. -Mucous plug expelled from cervix (bloody show) -Dilation of cervix begins -Amniotic membranes rupture before or during labor -Uterin contractions begin Fetal monitor may be used during labor

The Fetus

The Doula They provide support & comfort, and enhance communication between mother & healthcare professionals. They DO NOT provide hands on care or assist with clinical procedures.

Dilation & Effacement Dilation(opening)-begins with the first regular uterine contraction, and ends when the cervix is fully dilated. Effacement- the cervix thins so the fetus can move down into the birth canal and out of the mother's body. Vaginal Examination- the process of measuring the degree of dilation & effacement.

Dilation & Effacement

Expulsion Expulsion stage-the period from the point of full cervical dilation until the baby is delivered. May be 1-2 hours or more. The baby moves down the birth canal and mother bears down with each contraction. Episiotomy- enlarging the vaginal opening by making a cut in the perineum.

Episiotomy

Placental Stage Lasts from delivery of the baby to the delivery of the placenta. Placenta usually delivered an hour after baby. The placenta separates from the wall of the uterus and uterine contractions push it downward and out through the birth canal.

Placenta

Cesarean Birth The baby is delivered through an incision in the abdomen. Spinal or epidural anesthetic is administered. Medication goes into the CSF and blocks sensation from abdomen and down. Epidural- the patient can't feel or move their legs. Indications for C-section. (p.868) i.e. fetal distress

C-Section

Postpartum Care Promote a home-like environment involving family members. -Mother assisted onto a bed -Protective pad placed under patients buttocks -Wear gloves & use standard precautions: will mostly come into contact with blood, mucous membranes, urine, or breast milk. Anesthesia- post-operative care on (p.868). Checking blood pressure important! Tell nurse if patient hasn't voided by end of your shift.

Postpartum Care Drainage: check perineum & pad for amount & color of drainage. -Lochia:red vaginal discharge. Called lochia rubra if discharge occurs during first 3 days after delivery. -Inform nurse if mother saturates pad in minutes. The Uterus: size and firmness should be reported. Soft and enlarged=indicated excessive bleeding. Fundus(top of the uterus) is massaged so stimulate muscles to contract, firming the uterus.

Measuring the Fundus

Postpartum Care Measuring the height of Uterus:place fingers lengthwise across the abdomen between the fundus and the (umbilicus)navel. Cramping- may occur as the uterus begins to return to its normal size, or during breastfeeding. Voiding-should be encouraged 6-8 hours after the delivery. Monitor for signs of urine retention.(p.870). Infection control important when toileting. (p.870).

Apgar Scoring Is an evaluation of the neonate. (0-10) Made 1,5, and 10 minutes after birth. Evaluates: -Heart rate -Respiratory effort -Muscle tone -Reflex, irritability -Color

APGAR

Care of the Newborn Vital signs are taken. Axillary temp taken q min. till stable. Then every 4 hours. Eyes treated with silver nitrates or antibiotics. Footprints taken Baby is cleaned and kept warm Male may be circumsized. Instruct mother to wash hands/breasts before feeding.

Circumcision

Handling the Infant When lifting, carrying, and positioning an infant, - Support head, neck, and back. -Hold baby securely -Back through doorways when carrying a baby -Never turn your back on an infant when on unproducted surface.

PKU Test Blood is tested for presence of PKU. PKU is a congenital, hereditary, abnormality that may lead to mental retardation if not detected and treated early. In PKU, protein cannot be digested normally.

Elimination Urinatation- normally 6 to 10x a day. Elimination activity is recorded and color of stool documented. Stools change from dark& pasty meconium stools to brown-yellow, to yellow and loose. If circumcised, check circumcision every time diaper is changed.

Security ID bands to wrist & ankle Mother & father is given matching wristband Policies on checking identification Nursing personnel wear ID Badge Infant abduction is an issue: prevention measures include, alarms, GPS, etc.