EXAM 3
1
, EXAM 3
ATI FINAL MATERNAL HEALTH EXAM 3
Postpartum Hemorrhage (PPH)
From delivery up to 6wks postpartum
SVD Spontaneous vaginal delivery: greater than 500ml (considered PPH)
o Estimated blood loss
o Quantitative blood loss (weighing everything)
CS C-Section: greater than 1000ml
Two main reasons for PPH
Full bladder
Retained placenta
What you will assess when you walk into a patient’s room for PPH
1. Assess Fundus
-should always be right at umbilicus
If it feels like your cheek: boggy; (massage it) Don’t stop unless it firms up
2. Call for help
3. Call Dr.
4. Meds
5. VS and O2 stat
6. Weigh under pads (add this amount of blood loss to what she lost at delivery
7. Change under pads
8. Empty bladder (foley)
9. Start 2nd IV; may need to give patient blood
o Once you start to feel the fundus firm up you can stop massaging
o Only thing that can misplace the fundus is a full bladder
The uterus has to contract to stop bleeding
Meds (all usually standing orders)
Pitocin: usually IV sometimes IM every patient after they deliver will get this drug
(immediately)
o If there is a fetus in the uterus; has to be on pump and is piggybacked
o If not given wide open
Methergine: given IM; if patient has HTN CANNOT be given this drug
Hemabate: given IM; CANNOT give if patient has asthma (can cause explosive diarrhea)
Cytotec: rectally; given 800-1000 mcg
*Methergine and Hemabate: work within 2-3 minutes
If all of this doesn’t work then back to the OR
Should be dark brown
Firm w/ Bright red blood- laceration
2
, EXAM 3
After delivery check every 15 minutes x 4
Every 30 minutes x 4
Oxygen
8-10L
Non-rebreather mask
Never nasal cannula
Menstrual cycle
28, 32, or 36-day cycle
36-day cycle, go back 14 days, she will ovulate on day 22 (can get pregnant on this day)
Have sex on the 17th and the 27th
Ovulation: go back 14 days from very last day of cycle
Sperm lives 3-5 days (200,000,000-800,000,000 per ejaculation)
Ova can only be penetrated for the first 24 hrs
If you want to get pregnant start intercourse 5 days before or 5 days after ovulation
Should have sex every 6 hrs during that time period
Progesterone levels decrease signals hypothalamus to anterior pituitary gland to
stimulate the follicle stimulating hormone and luteinizing hormone; which increase
estrogen and progesterone (~36 hours)
Corpus luteum: hole where egg left. increases/produces progesterone; you need
increase in progesterone to carry a pregnancy
Progesterone levels have to go up in order to hold a pregnancy
Placenta takes over hormone level regulation after 6 - 7 weeks
* Naegele’s Rule (estimated due date)
1st day of last period (minus) 3 months (plus) 7 days
-3 months + 7 days
30 days has September, April, June & November
1st Trimester
Conception – 13 6/7 weeks (13 weeks & 6 days)
nd
2 trimester
14 weeks -26 6/7 weeks (26 weeks & 6 days)
3rd Trimester
27 weeks-40 6/7 weeks (40 weeks & 6 days)
Term: 37 weeks or greater
20 weeks gestation when the organs are done being formed
3
, EXAM 3
G- # of pregnancies
T- # of term deliveries
P- # of preterm deliveries (20- 36 6/7 weeks)
A- # of abortions (less than 20 weeks)
L- # of living children
Fetus cannot survive before 20 weeks
Antepartum
o fetus in uterus
Prenatal Visit (1st things that need to be checked)
Vital signs
Estimated Date of Confinement (Estimated Due Date)
Medical hx
CBC
Hep B
HIV
VDRL- STI
Blood type- Rh factor
Rubella titters; drawn at prenatal visit (if nonimmune she needs Rubella titters w/in
72hrs after delivery)
TB skin test
Pap smear
Weight
UA- urinalysis
Fetal heart tones (can be heard at 6 weeks)
If mother is Rh-(negative), she needs Rhogam (26-28wks), she needs that because negative
antigens may try to fight off pregnancy
If mom is negative and baby blood positive; mom needs Rhogam within 72hrs after
delivery to protect next pregnancy
*Only run babies cord blood to find out blood type if moms blood type is negative
Next visits
VS
Weight
UA
Fetal heart tones
Measure abdomen
Office Visits- doctor for normal pregnancies
1 week (conception) - 28 6/7 weeks:
4
1
, EXAM 3
ATI FINAL MATERNAL HEALTH EXAM 3
Postpartum Hemorrhage (PPH)
From delivery up to 6wks postpartum
SVD Spontaneous vaginal delivery: greater than 500ml (considered PPH)
o Estimated blood loss
o Quantitative blood loss (weighing everything)
CS C-Section: greater than 1000ml
Two main reasons for PPH
Full bladder
Retained placenta
What you will assess when you walk into a patient’s room for PPH
1. Assess Fundus
-should always be right at umbilicus
If it feels like your cheek: boggy; (massage it) Don’t stop unless it firms up
2. Call for help
3. Call Dr.
4. Meds
5. VS and O2 stat
6. Weigh under pads (add this amount of blood loss to what she lost at delivery
7. Change under pads
8. Empty bladder (foley)
9. Start 2nd IV; may need to give patient blood
o Once you start to feel the fundus firm up you can stop massaging
o Only thing that can misplace the fundus is a full bladder
The uterus has to contract to stop bleeding
Meds (all usually standing orders)
Pitocin: usually IV sometimes IM every patient after they deliver will get this drug
(immediately)
o If there is a fetus in the uterus; has to be on pump and is piggybacked
o If not given wide open
Methergine: given IM; if patient has HTN CANNOT be given this drug
Hemabate: given IM; CANNOT give if patient has asthma (can cause explosive diarrhea)
Cytotec: rectally; given 800-1000 mcg
*Methergine and Hemabate: work within 2-3 minutes
If all of this doesn’t work then back to the OR
Should be dark brown
Firm w/ Bright red blood- laceration
2
, EXAM 3
After delivery check every 15 minutes x 4
Every 30 minutes x 4
Oxygen
8-10L
Non-rebreather mask
Never nasal cannula
Menstrual cycle
28, 32, or 36-day cycle
36-day cycle, go back 14 days, she will ovulate on day 22 (can get pregnant on this day)
Have sex on the 17th and the 27th
Ovulation: go back 14 days from very last day of cycle
Sperm lives 3-5 days (200,000,000-800,000,000 per ejaculation)
Ova can only be penetrated for the first 24 hrs
If you want to get pregnant start intercourse 5 days before or 5 days after ovulation
Should have sex every 6 hrs during that time period
Progesterone levels decrease signals hypothalamus to anterior pituitary gland to
stimulate the follicle stimulating hormone and luteinizing hormone; which increase
estrogen and progesterone (~36 hours)
Corpus luteum: hole where egg left. increases/produces progesterone; you need
increase in progesterone to carry a pregnancy
Progesterone levels have to go up in order to hold a pregnancy
Placenta takes over hormone level regulation after 6 - 7 weeks
* Naegele’s Rule (estimated due date)
1st day of last period (minus) 3 months (plus) 7 days
-3 months + 7 days
30 days has September, April, June & November
1st Trimester
Conception – 13 6/7 weeks (13 weeks & 6 days)
nd
2 trimester
14 weeks -26 6/7 weeks (26 weeks & 6 days)
3rd Trimester
27 weeks-40 6/7 weeks (40 weeks & 6 days)
Term: 37 weeks or greater
20 weeks gestation when the organs are done being formed
3
, EXAM 3
G- # of pregnancies
T- # of term deliveries
P- # of preterm deliveries (20- 36 6/7 weeks)
A- # of abortions (less than 20 weeks)
L- # of living children
Fetus cannot survive before 20 weeks
Antepartum
o fetus in uterus
Prenatal Visit (1st things that need to be checked)
Vital signs
Estimated Date of Confinement (Estimated Due Date)
Medical hx
CBC
Hep B
HIV
VDRL- STI
Blood type- Rh factor
Rubella titters; drawn at prenatal visit (if nonimmune she needs Rubella titters w/in
72hrs after delivery)
TB skin test
Pap smear
Weight
UA- urinalysis
Fetal heart tones (can be heard at 6 weeks)
If mother is Rh-(negative), she needs Rhogam (26-28wks), she needs that because negative
antigens may try to fight off pregnancy
If mom is negative and baby blood positive; mom needs Rhogam within 72hrs after
delivery to protect next pregnancy
*Only run babies cord blood to find out blood type if moms blood type is negative
Next visits
VS
Weight
UA
Fetal heart tones
Measure abdomen
Office Visits- doctor for normal pregnancies
1 week (conception) - 28 6/7 weeks:
4
