OB REVIEW

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OB REVIEW
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OB TERMS

• Gravidity- 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

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OB terms

• Antepartum- 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

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Nageles rule

• Due 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?

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Common discomforts of pregnancy

• Urinary frequency or incontinence
• Fatigue
• Backache
• Nausea/vomiting
• Leg cramps
• Heartburn/indigestion
• Braxton hicks contractions
• Constipation/hemorrhoids

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FETAL ASSESSMENT TESTS

• Ultrasound- 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-Downs
  syndrome.

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Pregnancy disorders

• Abortion-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.

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Cardiac disease

• Congenital 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

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Abruptio placenta

• Premature 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.

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Placenta previa

• Attachment 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

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Gestational Diabetes

• Insulin 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

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Hyperemesis of pregnancy

• Nausea and vomiting severe enough to lead to
  dehydration, electrolyte imbalance and
  significant weight loss.
• monitor intake
• Monitor weight
• Dietary consult
• Provide nausea meds appropriately.

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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.

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Hypertensive pregnancy disorders

• Chronic 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!!!

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Labor and Delivery

• True 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?

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Labor and delivery procedures

• Induction of labor- pitocin
• Cervical ripening-
• Forceps delivery
• Vacuum extraction
• External version

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Nursing care during labor

• Evaluate labor pattern- effective?
• Evaluate pain management-
• Assess fetus- FHR, engagement, presentation
• NPO status for mom- why?

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Labor and Delivery complications

• Cord prolapse
• Precipitous labor
• Amniotic fluid embolism
• Post-term labor

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Labor complications

• Pre-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

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Postpartum care

• B-Breasts
• U-Uterus
• B-Bowels
• B-Bladder
• L-Lochia
• E-episiotomy
• H-Homans sign
• E-Emotions
• N-Nutrition

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Postpartum complications

• Infection
• Postpartum hemorrhage
• Thromboembolic disease
• Postpartum depression
• Postpartum psychosis

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Pharmacology

• Drugs used during labor
• Demerol, Stadol, Nubain- implications for fetus?
• Epidural- consents, time out

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Pharmacology-OB

• Pregnancy risk categories ABCDX
• Teratogens