Maternal child final exam
Chapter 6
• ORAL CONTRACEPTION -Some have hormones in them, some women need to not
take an oral contraception as it increases risks of DVT, headache. Patients with known
high blood pressure should not take oral contraption (not the combo). Women who are
hypertensive,35 & older should take the estrogen only oral contraceptive. Smoking is a
contraindication as well as high blood pressure Side effects are weight gain and high
blood pressure.
Chapter 8 & 10
• SUPINE HYPOTENSION SYNDROME- Supine hypotension is caused by pressure
of the enlarging uterus pressing on the inferior vena cava while the woman is in a supine
position. Vena cava compression impedes venous blood flow, reduces the amount of
blood in the heart, and decreases cardiac output, causing dizziness and syncope.
• The uterus pushes up against the inferior vena cava when lying flat or supine position on
back/ should lie on side. Mom will feel dizzy/ reduces the amount of blood going to the
heart/cause’s hypotension/ get out of bed slowly from side line position to sitting up
position. Will help blood pressure changes
• Recommendations; Moms should not lay on their back, lay on their side, move slowly
from a side lying to a sitting position.
Chapter 9
• GTPAL-
❖ (G) Gravida- Number of pregnancies including current.
❖ (T) Term- Number of pregnancies carried to 37-40 weeks.
❖ (P) Preterm- Number of pregnancies carried between 20-36 weeks.
❖ (A) Abortion- Spontaneous (miscarriage) and elective.
❖ (L) Living- Number of living children.
❖ Twins are considered one gestation e.g., T/P = 1, L= 2
❖ Less than 20 weeks is considered a spontaneous abortion.
❖ When answering the question look at the context the question is being asked e.g.,
a patient on an L&D floor might say she has 2 gravida, but include her current
gravida to make 3. A patient coming for her annual well woman exam is not
pregnant, so her gravida is what she says it is, if she was pregnant 2 times, that is
what her total gravida is and so on.
❖ GTPAL has nothing to do with labor, it only concerns pregnancy! Some
women never go into labor like scheduled C-sections but still deliver the baby.
, • NEAGLE’S RULE- This is how you calculate the estimated due date (EDD); Add
7 days then subtract three months, add a year if necessary (due date for pregnancy).
• FUNDAL HEIGHT – Fundal height is an indication of uterine size; periodic
measurements of the fundal height should correlate strongly with fetal growth. The
fundal height measurement correlates to the weeks of gestation from approximately 22 to
34 weeks of gestation. This is how the uterus is measured during prenatal care. Height of
fundus should measure out to the weeks of her gestation. At 20 weeks fundal height
should be 20cm plus or minus 2cm
Chapter 10
• TOBACCO USE DURING PREGNANCY- Smoking during pregnancy causes
a plethora of problems for the woman and the developing fetus.
❖ Carbon monoxide in the cigarette smoke binds more readily than oxygen to
hemoglobin, thereby decreasing the oxygen-carrying capacity of the red blood
cells. This alteration decreases the amount of oxygen traveling to the
placenta, thereby decreasing the amount of oxygen available to the fetus for
growth and development of tissues and organs.
❖ Smoking is associated with spontaneous abortion, low birth weight, intrauterine
growth restriction (IUGR), preterm labor and birth, placenta previa, placental
abruption, and premature rupture of the membranes (bag of water). Infants born to
mothers who smoke are more likely to be small for gestational age (SGA).
❖ Discourage mom from smoking.
• ALCOHOL – Alcohol consumption during pregnancy can cause physical and mental
abnormalities in the developing fetus. It can enter the fetal blood stream.
❖ The current recommendation is that no alcohol consumption during pregnancy is
safe because no safe level has been determined.
❖ The resulting problems are manifested in the facial features associated with fetal
alcohol syndrome (FAS): a low nasal bridge, short nose, flat midface, and short
palpebral fissures, intellectual disabilities, physical disabilities.
❖ Can interfere with growth and developmental of fetus.
, • FOLIC ACID- All women of maternal childbearing age (non-pregnant) should consume
0.4 mg (400 mcg) of synthetic folic acid daily, from supplements and/or fortified
foods, to reduce NTD risk. During pregnancy, a minimum of 800 mcg/day of folic acid
is recommended. Women can have children naturally up to 59 years of age. Oops baby
❖ Folic acid deficiency is primarily responsible for the development of neural tube
defects (NTDs), including spina bifida, cleft lip and palate, and anencephaly.
❖ Lowers the chances of a woman having a baby with neural tube defects.
❖ You can get fortified folic acid from green leafy veggies or prenatal vitamin.
Chapter 11
• HYPEREMESIS GRAVIDARUM – Hyperemesis gravidarum represents the extreme
end of the nausea/vomiting spectrum in terms of severity, its persistent & not related to
any other causes. Weight loss happens.
❖ Hyperemesis gravidarum may be related to the elevated levels of estrogen or
hCG. Sometimes the smell of the food irritates them.
❖ Management (can be treated outpatient)
▪ Eat small frequent meals of dry, bland foods and include high-
protein snacks in their diet.
▪ Spicy foods should be avoided, avoid foods that cause vomiting.
▪ Eat crackers before rising in the morning
▪ Ginger capsules
▪ Antiemetics.
▪ If the patient requires hospitalization, IV fluids containing dextrose and
vitamins are given, and the patient is placed on a nothing by mouth status
and treated with antiemetics
• RhoGAM – An unsensitized, Rh(D)-negative woman should be given Rho(D)
immune globulin (RhoGAM) to prevent antibody formation.
❖ Women who are RH- and have RH+ve baby, get a dose before and after
discharge. She needs the RhoGAM for subsequent pregnancies, it can lead to
birth defects, fetal death, preterm labor.
❖ Given to a rh negative mother, and a rh positive baby. The first pregnancy will
be fine but it is going to affect future pregnancies, body will attack future babies.
❖ Give 2 shots antepartum between weeks 26-28 and another dose postpartum
within 72 hours of giving birth or before going home.
❖ If the father has a positive RH factor the baby most likely will have a positive RH
factor.
, Chapter 12
• STAGES OF LABOR- 4 stages of labor.
• 1st stage has 3 phases. (The stage of dilation).
❖ Latent Contractions during this phase are typically about 5 minutes apart, last 30
to 45 seconds, and are considered to be mild. Cervical effacement and early
dilation 0-3 centimeters.
▪ During this phase, the woman is usually excited about labor commencing,
and she remains chatty and sociable. Often this phase of labor is
completed at home.
▪ Labor pains are often initially felt as sensations similar to painful
menstrual cramping and are usually accompanied by low back pain.
▪ Longest stage of labor. Can last as long as 10 to 14 hours
❖ Active phase the contractions become more frequent (every 3 to 5 minutes), last
longer (60 seconds), and are of a moderate to strong intensity.4-7 centimeters
cervical dilatation 3-5 mins apart, contractions are moderate to strong.
❖ Transition the is characterized by frequent, strong contractions that occur every
2 to 3 minutes and last 60 to 90 seconds on average, 8-10 centimeters cervix.
▪ Rectal pressure, an increased urge to bear down, an increase in bloody
show, and spontaneous rupture of the membranes, very agitated, mom
feels urge to push, loses inability to push, bloody show. Bag of water
can rupture on its own.
▪ Concrete data: Dilation of cervix this is how you know your patient is in
labor.
• 2nd stage: Full dilation at 10 com to the birth of the baby. Delivery of baby, find
different positions that are comfortable for the woman to push. They have the urge to
push, promote effective pushing, deep breaths, push and bear down, do not hold breath,
provide comfort.
• 3rd stage: Post-delivery of baby and complete delivery of placenta (usually last 5-10 mins
but can last up to 30 mins).
• 4th stage: Delivery of the baby to one to two hours after birth. Monitoring the uterus,
initiating newborn care, looking at placenta, assessing fundus, controlling bleeding,
stabilizing mother.
• OXYTOCIN (PITOCIN) -It is a utero-tonic. Prevention of postpartum bleeding
after expulsion of placenta. Medications to Manage Postpartum Hemorrhage. Causes
the uterus to contract and clamp down on the open blood vessels. IV OR IM,
Methergine (Methylergonovine) IM, Cytotec (Misoprostol)it’s a pill, need to absorb
really quick/ given rectal (suggested route), Hemabate (Carbopost) IM
(contraindicated in asthma).
Chapter 6
• ORAL CONTRACEPTION -Some have hormones in them, some women need to not
take an oral contraception as it increases risks of DVT, headache. Patients with known
high blood pressure should not take oral contraption (not the combo). Women who are
hypertensive,35 & older should take the estrogen only oral contraceptive. Smoking is a
contraindication as well as high blood pressure Side effects are weight gain and high
blood pressure.
Chapter 8 & 10
• SUPINE HYPOTENSION SYNDROME- Supine hypotension is caused by pressure
of the enlarging uterus pressing on the inferior vena cava while the woman is in a supine
position. Vena cava compression impedes venous blood flow, reduces the amount of
blood in the heart, and decreases cardiac output, causing dizziness and syncope.
• The uterus pushes up against the inferior vena cava when lying flat or supine position on
back/ should lie on side. Mom will feel dizzy/ reduces the amount of blood going to the
heart/cause’s hypotension/ get out of bed slowly from side line position to sitting up
position. Will help blood pressure changes
• Recommendations; Moms should not lay on their back, lay on their side, move slowly
from a side lying to a sitting position.
Chapter 9
• GTPAL-
❖ (G) Gravida- Number of pregnancies including current.
❖ (T) Term- Number of pregnancies carried to 37-40 weeks.
❖ (P) Preterm- Number of pregnancies carried between 20-36 weeks.
❖ (A) Abortion- Spontaneous (miscarriage) and elective.
❖ (L) Living- Number of living children.
❖ Twins are considered one gestation e.g., T/P = 1, L= 2
❖ Less than 20 weeks is considered a spontaneous abortion.
❖ When answering the question look at the context the question is being asked e.g.,
a patient on an L&D floor might say she has 2 gravida, but include her current
gravida to make 3. A patient coming for her annual well woman exam is not
pregnant, so her gravida is what she says it is, if she was pregnant 2 times, that is
what her total gravida is and so on.
❖ GTPAL has nothing to do with labor, it only concerns pregnancy! Some
women never go into labor like scheduled C-sections but still deliver the baby.
, • NEAGLE’S RULE- This is how you calculate the estimated due date (EDD); Add
7 days then subtract three months, add a year if necessary (due date for pregnancy).
• FUNDAL HEIGHT – Fundal height is an indication of uterine size; periodic
measurements of the fundal height should correlate strongly with fetal growth. The
fundal height measurement correlates to the weeks of gestation from approximately 22 to
34 weeks of gestation. This is how the uterus is measured during prenatal care. Height of
fundus should measure out to the weeks of her gestation. At 20 weeks fundal height
should be 20cm plus or minus 2cm
Chapter 10
• TOBACCO USE DURING PREGNANCY- Smoking during pregnancy causes
a plethora of problems for the woman and the developing fetus.
❖ Carbon monoxide in the cigarette smoke binds more readily than oxygen to
hemoglobin, thereby decreasing the oxygen-carrying capacity of the red blood
cells. This alteration decreases the amount of oxygen traveling to the
placenta, thereby decreasing the amount of oxygen available to the fetus for
growth and development of tissues and organs.
❖ Smoking is associated with spontaneous abortion, low birth weight, intrauterine
growth restriction (IUGR), preterm labor and birth, placenta previa, placental
abruption, and premature rupture of the membranes (bag of water). Infants born to
mothers who smoke are more likely to be small for gestational age (SGA).
❖ Discourage mom from smoking.
• ALCOHOL – Alcohol consumption during pregnancy can cause physical and mental
abnormalities in the developing fetus. It can enter the fetal blood stream.
❖ The current recommendation is that no alcohol consumption during pregnancy is
safe because no safe level has been determined.
❖ The resulting problems are manifested in the facial features associated with fetal
alcohol syndrome (FAS): a low nasal bridge, short nose, flat midface, and short
palpebral fissures, intellectual disabilities, physical disabilities.
❖ Can interfere with growth and developmental of fetus.
, • FOLIC ACID- All women of maternal childbearing age (non-pregnant) should consume
0.4 mg (400 mcg) of synthetic folic acid daily, from supplements and/or fortified
foods, to reduce NTD risk. During pregnancy, a minimum of 800 mcg/day of folic acid
is recommended. Women can have children naturally up to 59 years of age. Oops baby
❖ Folic acid deficiency is primarily responsible for the development of neural tube
defects (NTDs), including spina bifida, cleft lip and palate, and anencephaly.
❖ Lowers the chances of a woman having a baby with neural tube defects.
❖ You can get fortified folic acid from green leafy veggies or prenatal vitamin.
Chapter 11
• HYPEREMESIS GRAVIDARUM – Hyperemesis gravidarum represents the extreme
end of the nausea/vomiting spectrum in terms of severity, its persistent & not related to
any other causes. Weight loss happens.
❖ Hyperemesis gravidarum may be related to the elevated levels of estrogen or
hCG. Sometimes the smell of the food irritates them.
❖ Management (can be treated outpatient)
▪ Eat small frequent meals of dry, bland foods and include high-
protein snacks in their diet.
▪ Spicy foods should be avoided, avoid foods that cause vomiting.
▪ Eat crackers before rising in the morning
▪ Ginger capsules
▪ Antiemetics.
▪ If the patient requires hospitalization, IV fluids containing dextrose and
vitamins are given, and the patient is placed on a nothing by mouth status
and treated with antiemetics
• RhoGAM – An unsensitized, Rh(D)-negative woman should be given Rho(D)
immune globulin (RhoGAM) to prevent antibody formation.
❖ Women who are RH- and have RH+ve baby, get a dose before and after
discharge. She needs the RhoGAM for subsequent pregnancies, it can lead to
birth defects, fetal death, preterm labor.
❖ Given to a rh negative mother, and a rh positive baby. The first pregnancy will
be fine but it is going to affect future pregnancies, body will attack future babies.
❖ Give 2 shots antepartum between weeks 26-28 and another dose postpartum
within 72 hours of giving birth or before going home.
❖ If the father has a positive RH factor the baby most likely will have a positive RH
factor.
, Chapter 12
• STAGES OF LABOR- 4 stages of labor.
• 1st stage has 3 phases. (The stage of dilation).
❖ Latent Contractions during this phase are typically about 5 minutes apart, last 30
to 45 seconds, and are considered to be mild. Cervical effacement and early
dilation 0-3 centimeters.
▪ During this phase, the woman is usually excited about labor commencing,
and she remains chatty and sociable. Often this phase of labor is
completed at home.
▪ Labor pains are often initially felt as sensations similar to painful
menstrual cramping and are usually accompanied by low back pain.
▪ Longest stage of labor. Can last as long as 10 to 14 hours
❖ Active phase the contractions become more frequent (every 3 to 5 minutes), last
longer (60 seconds), and are of a moderate to strong intensity.4-7 centimeters
cervical dilatation 3-5 mins apart, contractions are moderate to strong.
❖ Transition the is characterized by frequent, strong contractions that occur every
2 to 3 minutes and last 60 to 90 seconds on average, 8-10 centimeters cervix.
▪ Rectal pressure, an increased urge to bear down, an increase in bloody
show, and spontaneous rupture of the membranes, very agitated, mom
feels urge to push, loses inability to push, bloody show. Bag of water
can rupture on its own.
▪ Concrete data: Dilation of cervix this is how you know your patient is in
labor.
• 2nd stage: Full dilation at 10 com to the birth of the baby. Delivery of baby, find
different positions that are comfortable for the woman to push. They have the urge to
push, promote effective pushing, deep breaths, push and bear down, do not hold breath,
provide comfort.
• 3rd stage: Post-delivery of baby and complete delivery of placenta (usually last 5-10 mins
but can last up to 30 mins).
• 4th stage: Delivery of the baby to one to two hours after birth. Monitoring the uterus,
initiating newborn care, looking at placenta, assessing fundus, controlling bleeding,
stabilizing mother.
• OXYTOCIN (PITOCIN) -It is a utero-tonic. Prevention of postpartum bleeding
after expulsion of placenta. Medications to Manage Postpartum Hemorrhage. Causes
the uterus to contract and clamp down on the open blood vessels. IV OR IM,
Methergine (Methylergonovine) IM, Cytotec (Misoprostol)it’s a pill, need to absorb
really quick/ given rectal (suggested route), Hemabate (Carbopost) IM
(contraindicated in asthma).
