MATERNAL-CHILD REVIEW

Michelle M. RupardRNC-OB, MSN, FNP, CLNC

ObjectivesFollowing this presentation, the participant will be able to:

1. Calculate estimated date of confinement (EDC)2. Identify common fetal heart rate patterns and associated interventions3. Recognize abnormal findings of pregnancy4. State appropriate client positioning during cesarean section5. Appropriately assess maternal fundus in the postpartum period6. Promote maternal psychosocial adaptation during the Taking-In Phase

GESTATIONAL AGE

Based on first day of LMP~ 280 days (from

first day of LMP)9 calendar months10 lunar months40 weeks

NAEGELE’S RULE

Add 7 days

Subtract 3 months

FETAL HEART RATE ACCELERATIONS

NONREACTIVE NST

WHAT PATTERN IS THIS?

EARLY DECELERATIONS

Lowdermilk and Perry, 2007

VARIABLE DECELERATIONS

Lowdermilk and Perry, 2007

TACHYCARDIABL greater than 160 for

10 minutes or longerIncreased 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

BRADYCARDIABaseline 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

ABSENT VARIABILITY

MINIMAL TO MODERATE VARIABILITY

MODERATE VARIABILITY

REASSURING FHR IN THE TERM FETUS

Baseline 110-160

Moderate variability

No periodic decelerations

Accelerations with fetal movement

NONREASSURING FHR IN THE TERM FETUS

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

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

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

DANGER SIGNS

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

THIRD STAGE OF LABOR Begins with birth

Ends with delivery of placenta

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

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

MASSAGE THE FUNDUS...

Hands on practice!!

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)

PSYCHOSOCIAL NEEDS Birth Experience Maternal Self-image Maternal Adaptation Parent-Infant

Interaction Family Structure Cultural Diversity

ATTACHMENT AND BONDING INFLUENCES

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

NURSING DIAGNOSES AND EXPECTED OUTCOMES Risk for infection Risk for constipation Disturbed sleep pattern Acute pain Risk for injury Ineffective Breastfeeding