final maternal exam.
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
• After delivery check every 15 minutes x 4
• Every 30 minutes x 4
1
, final maternal exam.
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) 2nd 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
G- # of pregnancies
T- # of term deliveries
P- # of preterm deliveries (20- 36 6/7
weeks) A- # of abortions (less than 20
2
, final maternal exam.
weeks)
3
, final maternal exam.
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:
o Mom will visit Dr. every 4 weeks
• 29 weeks- 36 6/7 weeks:
o Mom will visit Dr. every 2 weeks
• 37 weeks and greater:
o Mom will visit Dr. every week
4
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
• After delivery check every 15 minutes x 4
• Every 30 minutes x 4
1
, final maternal exam.
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) 2nd 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
G- # of pregnancies
T- # of term deliveries
P- # of preterm deliveries (20- 36 6/7
weeks) A- # of abortions (less than 20
2
, final maternal exam.
weeks)
3
, final maternal exam.
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:
o Mom will visit Dr. every 4 weeks
• 29 weeks- 36 6/7 weeks:
o Mom will visit Dr. every 2 weeks
• 37 weeks and greater:
o Mom will visit Dr. every week
4
