OB REVIEW

OB TERMSGravidity- Number of times woman has been pregnant

Parity- number of deliveries after 20 weeks gestation regardless of outcome. Not the # of fetus (twins).

GTPAL

Gravida-# of pregnancies

T-Term deliveries; 37 weeks +

P-preterm deliveries; between 20 and 37 weeks

A-abortion; delivery before 20 weeks

L-living children

OB termsAntepartum- conception till delivery

Visit OB physician once monthly until 28 weeks gestation; then every 2 weeks till 36 week gestation, then weekly till delivery

Assess in office: BP, weight, FHT, urine for protein, other.

Focused assessment on pregnancy complications.

Intrapartum

Postpartum

Nagele’s ruleDue date determined by LMP date- three months + 7 days.

LMP- 7/1/2011- what is EDC (estimated date of confinement)?

LMP- 3/1/2011- what is EDC

LMP- 11/14/2011?

LMP- 12/3/2011?

Common discomforts of pregnancyUrinary frequency or incontinence

Fatigue

Backache

Nausea/vomiting

Leg cramps

Heartburn/indigestion

Braxton hicks contractions

Constipation/hemorrhoids

FETAL ASSESSMENT TESTSUltrasound- non-invasive, abdominal vs. transvaginal

Biophysical profile-NST and ultrasound (breathing, movement, fetal tone, HR, amniotic fluid volume?)

Amniocentesis-14 weeks till delivery-genetic disorders, lung maturation. Risks-hemorrhage, infection, labor, ROM, miscarriage.

Chorionic Villus Sampling-less than 10 weeks gestation-genetic disorders.

Alpha-Fetoprotein-16-18 weeks gestation( high values-neural tube defects; low values-Down’s syndrome.

Pregnancy disordersAbortion-spontaneous vs elective

50% of time no known cause

Vaginal bleeding, cramping.

Nursing diagnoses: Anticipatory grieving related to risk of loss of pregnancy

Acute pain related to uterine cramping

Fear related to potential for losing pregnancy.

Cardiac diseaseCongenital heart disease

Acquired

Ischemic

Pregnancy is the great “un-masker” of hidden issues

Circulatory volume increased by 40-50%

Nursing diagnoses: activity intolerance r/t decreased CO

Risk for fetal injury t/t effect of cardiac disease on pregnancy

Abruptio placentaPremature separation of a normally implanted placenta later 20 weeks gestation- may be complete or partial.

Patient presents with bleeding and abdominal rigidity (boardlike)

Assess vital signs, FHT.

Monitor Pt, PTT, platelets- mom is bleeding!

If clotting factors consumed could lead to DIC.

Placenta previaAttachment of the placenta in the lower uterine segment near or covering the internal cervical os. May be complete, partial, or a low-lying placenta (not covering the os).

Painless vaginal bleeding.

No vaginal exams!!

Nursing diagnosis: anxiety r/t unknown outcome for patient and infant

Risk for infection r/t blood loss and open vessels near cervix

Gestational DiabetesInsulin resistance increases in pregnancy. Increased insulin needs in 2nd and 3rd trimesters.

Risks for fetus-macrosomia, hypoglycemia, respiratory distress syndrome.

Monitor FBS during labor

Possible diabetic teaching in antepartum period

Hyperemesis of pregnancyNausea and vomiting severe enough to lead to dehydration, electrolyte imbalance and significant weight loss.

monitor intake

Monitor weight

Dietary consult

Provide nausea meds appropriately.

Infections

T-toxoplasmosis-hydro or microcephaly

O-Other-Syhphillis, varicella, mumps, HIV

R-Rubella-hearing loss, IUGR, cardiac defects

C- cytomegalovirus-mental retardation, blind, deaf, seizures

H- Herpes simplex-vesicles or encephalitis.

Hypertensive pregnancy disordersChronic HTN-before 20 weeks gestation and after 12 weeks postpartum

Pre-eclampsia- increased BP after 20 weeks gestation with proteinuria

Eclampsia- pre-eclampsia complicated by seziure or coma

HELLP syndrome- liver dysfunction from worsening pre-eclampsia

Delivery is the only cure!!!

Labor and DeliveryTrue labor vs. false labor

Regular, rhythmic contractions in a pattern resulting in cervical change.

Phases of labor:

Stage 1- start of true labor to full dilation

Stage 2- full dilation to birth of infant

Stage 3- delivery of placenta

Stage 4- delivery of placenta to 4 hours postpartum

Which is the longest stage?

Labor and delivery procedures:Induction of labor- pitocin

Cervical ripening-

Forceps delivery

Vacuum extraction

External version

Nursing care during laborEvaluate labor pattern- effective?

Evaluate pain management-

Assess fetus- FHR, engagement, presentation

NPO status for mom- why?

Labor and Delivery complications Cord prolapse

Precipitous labor

Amniotic fluid embolism

Post-term labor

Labor complicationsPre-term labor-definition, risks, management, tests

Dystocia-difficult, prolonged, risks

DIC-s/s, labs, impact on fetus

Ceserean section- elective vs. urgent- client preparation

VBAC- one on one management, risks

Postpartum careB-Breasts

U-Uterus

B-Bowels

B-Bladder

L-Lochia

E-episiotomy

H-Homan’s sign

E-Emotions

N-Nutrition

Postpartum complicationsInfection

Postpartum hemorrhage

Thromboembolic disease

Postpartum depression

Postpartum psychosis

PharmacologyDrugs used during labor

Demerol, Stadol, Nubain- implications for fetus?

Epidural- consents, time out

Pharmacology-OBPregnancy risk categories: ABCDX

Teratogens