OB Final Study Guide

ANTEPARTUM
Prenatal Tests
Monthly for 7 months, every 2 weeks during the 8th month, and every week during th last month. Lab tests Rh Factor,
Blood Type, Irregular antibodies, CBC/H&H, Rubella titer, GBS 35 to 37 Weeks, Hep B screen,Glucose checks, PAP test
checking for cervical cancer, herpes smplex or papilloma virus, HIV, Syphillis LAW, Maternal serum alpha-fetoprotein
15 to 22 weeks down syndrome.
Naegele's Rule
Date of the Last Menstrual Period, subtract 3 months and add 7 days
Weight Gain
30lbs = 7.5lbs birth weight, blood volume 4lbs, Uterus 2lbs, Breast tissue 2lbs, placenta 1.5lbs, Maternal fluid volume 4lbs,
Maternal fat tissue 7lbs, amniotic fluid 2lbs.
Couvade
When the father begins to experience the same symptoms during her pregnancy; Such as vomitting, bloating, weight gain,
fatigue etc.
Prenatal Visit Assessments
Contraception use, gynecological diagnosis and obsterical difficulties;
Rubella and Hepatitis B status, Genetic disorders, Recent/Current illnesses or infections,
Current Medications, substance abuse and alcohol consumption (observe for signs of and symptoms such as lack of
grooming).
Warning Signs During Pregnancy
Gush of fluid from the vagina (rupture of amniotic fluid) BEFORE < 37 weeks of gestation, Vaginal bleeding abruption
or previa, Abdominal pain premature labor, abruptio placentae or ectopic pregnancy, changes in fetal activity such as a
decrease in movements can indicate fetal distress, persistent vomiting hyperemesis gravidarum, severe headaches
gestational HTN, increased temperature infection, Dysuria UTI
Edema of face and hands gestational HTN, epigastric pain gestational HTN;
flushed dry skin, fruity breath, rapid breathing increased thirst and urination and headache hyperglycemia, clammy pale
skin, weakness, tremors, irritability and lightheadness hypoglycemia
Discomforts During Pregnancy Pg. 37 ATI
N/V eat crackers or dry toast 30 min to 1hr before rising in the morning to relieve discomfort, avoid having an empty
stomach and ingesting spicy, greasy or gas forming foods, and drink fluids in between meals.
Tender Breasts wear a support fitting bra
Urinary frequency empty her bladder frequently, decrase fluids before bed time, and use perineal pads; Kegels to help
with stress incontinence
UTI wipe front to back, avoid bubble baths, wear cotton underwear, avoid tight fitting pants, drink 8 glasses of water,
urinate before and after sex, call doctor if urine is foul smelling or contains blood or appears cloudy.
Fatigue rest periods
Heartburn eat small frequent meals, sit up for 30 mins after meals, and check with Dr. before using OTC antacids.
Backaches exercise, pelvic tilt (arching and straightening the back), use proper body mechanics, side lying position.
SOB Good posture, sleep with pillows, Call Dr. if symptoms worsen.
Leg Cramps extend the affected leg and keep the knee straight and dorsiflex the foot; apply heat and massage the foot.
Implantation
Fertilization takes place in the ampulla of the fallopian tube
Union of sperm and ovum forms a zygote (46 chromosomes)
Cleavage cell division continues to form a morula (mass of 16 cells)
The inner cell mass is called a blastocyst which forms the embryo and amnion
The outer cell mass is called a trophoblast which forms the placenta and chorion
Implantation occurs 7 to 10 days after conception in the endometrium.

Hyperemesis Gravidarum
Severe form of morning sickness leads to dehydration, electorylate imbalance and the need to be hospitalized. The patient is
hypokalemic and hypernatremic. Occurs 8 to 12 weeks of pregnancy and symptoms usually resolve by week 20. Avoid
noxious stimuli, Eat small frequent meals throughout the day, avoid tight fitting clothing, separate solids from liquids by
consuming fluids in between meals,
Avoid lying down for at least 2 hours after eating, avoid foods high in fat, drink herbal teas that contain peppermint or
ginger, schedule rest periods, toast,crackers, and soda help settle the stomach.
Incompetent Cervix
Cervical insufficiency, also called premature dilation of the cervix, describes a weak, structurally defective cervix that
spontaneously dilates in the absence of contractions in the 2nd or early 3rd trimester.
Assessment complaints of pink tinged vaginal discharge or an increase in low pelvic pressure, cramping to vaginal
bleeding and loss of amniotic fluid.
Management bed rest, pelvic rest, avoid heavy lifting or surgically via cerclage.
Cervical cerclage involves using a heavy purse-string suture to secure and reinforce the internal cervical os of the cervix.
Placenta Previa
When the placenta moves over the opening in the cervical OS, clinical presentation is painless, bright red bleeding,
occurring during the second or third trimester.
COMPREHENSIVE
Newborn Reflexes
Sucking: elicited by stimulating newborns lips by touching them and the NB will open
mouth and begin sucking motion.
Moro: abduction and extension of arms and release to startle infant; NB should throw
arms outward and flex knees.
Stepping: hold NB upright and inclined forward with soles of feet flat and baby should
make stepping motion.
Tonic neck: lie NB on back and turn heard to one side; the arm toward that side should
extend straight away from body with hand partially open and the other is flexed with a
fist (fencing).
Rooting: stroke NB cheek and they should turn toward side that was troke and making
sucking movements
Babinski: disappears at 1 year of age. Stroke lateral sole of NB foot and toes should fan
out.
Feeding The Baby Bottle/Breast
Lactation suppression is moms choice. Wear supporting/tight-fitting bra. Apply an ice pack to breast prn. Avoid breast
manipulation. Do not use breast pump to deplete breast milk supply. Make it a relaxing time. Promote bonding. Powered
formula mixes faster with room-temp water. Dont microwave formula due to hot spots. Hold newborn when feeding.
Discard any formula not taken. Burp infant frequent.
Breastfeeding = supports optimal grown/development for the first 6 months of life and should be done for at least the first
year. Skin-to-skin (kangaroo care) immediately after newborn is dry and stable. Nurse should encourage and instruct mom
how to breast feed. Use a rocking chair. Take long, slow deep breaths to relax. Drink during to replenish body fluids.
Contraindications = drugs that enter the breast milk; HIV positive mom; galactosemia or phenylketonuria (PKU)
Newborn Medications
Phytonadione (Vitamin K) Provides the newborn with clotting factors
Vitamin K shot: 0.5-1mg shot. Prevents hemorrhage. Vastus lateralis injection. Vitamin K is fat soluble and promotes
blood clotting by increasing synthesis of prothrombin. Deficiency delays clotting and leads to hemorrhage. Newborn
bowel is sterile so vitamin K is not produced in the intestines until after the microorganisms have been introduced like with
the first feeding. It usually takes about a week for the newborn to produce enough vitamin K.
Erythromycin opthalmic provides bactericidal and bacteriostatic actions to prevent Neisseria gonorrhea and Chlamydia
trachomatis conjunctivis; required by law to have this ointment placed in the eyes, don't let the eye drop touch the eye, wipe

off excess after a minute, apply pressure to the inner canthus.

Newborn VS and Measurements

Taking infant VS/Normal VS: Heart rate and RR are assessed immediately with apgar scoring. Apical pulse taking for 1 full
minute is typically 120-160 bpm. Respirations are assessed when quiet with stethoscope on right side of chest and count
beats for 1 full minute; normal RR is 30-60 bpm. Usually assessed q30 minute until stable for 2 hours. Axillary temperature
is assessed but not immediately after birth; normal is 97.7=99.5 F or 36.5-37.5 C. BP is only assessed if there is a clinical
indication that its low; normal BP is 50-75/30-45.
Length: average is 50cm (20in) bur ranges from 44-55cm. Measure unclothed NB lying on warmed blanket on a flat surface
with knees in extended position.
Weight: average NB weighs 3,400 g (7.5lbs) but ranges from 2,500-4,000g. NB weighed immediately after birth and then
daily. Usually lose up to 10% of birth weight within first few days of life but regain it at approximately 10 days. Balance
scale first, place warm cloth then recalibrate scale to zero. Place unclothed newborn in center.
Head circumference: avg NB is 32-38cm. should be of the newborns length. Wrap tape around eyebrows.
Chest circumference: avg is 30-36cm, about 2-3cm less than head circumference. Measure around nipple line.
Vital signs: taken on admission to nursery, once every 30 minutes until stable for 2 hours, then once every 4-8 hours until
discharge.
Newborn Bath
NB bath: dry NB immediately after birth and remove blood to lower risk of infection. Bathing is postponed until thermal
and cardiorespiratory stability are ensured. Start from cleanest area (eyes) to dirtiest. Wash, rinse, and dry each area before
moving to next. Perform bath quickly to avoid heat loss. After bath, place NB under radiant warmer and wrap securely.
Clear water and mild soap are appropriate to cleanse diaper areas. Frequent bathing may dry skin. Do not fully immerse NB
until after umbilical cord area is healed (2 weeks). If circumcised, wait until that area is healed (1-2 wks).
Circumcision
Circumcision advantages: hygiene and medical reasons. Religious rite. Less UTIs. Less STDs. Lower rate of penile cancer.
Assess for bleeding q30 minutes for 2 hours; document first voiding to evaluate obstruction; squeeze soapy water over area
daily and rinse with warm water; small amount of petroleum jelly with every diaper change if plastibell was used; fasten
diaper loosely over penis. Plasibell will fall off by itself in a week.
PKU
Autosomal recessive inherited deficiency in one of the enzymes necessary for the metabolism of phenylalanine to tyrosineessential amino acids found in most foods.
Signs and Symptoms irritability, vomiting of protein feedings and musty odor to skin or body secretions of the newborn;
if not treated mental and motor retardation, seizures, microcephaly and poor growth and development can occur.
Treatment diet low in phenylalanine (low protein) and monitoring of blood levels, Phenex and Lofenalac
Screening 24-48 hours after protein feeding

Clearing Airway At Birth

As soon as the head emerges, the health care provider suction the new born's mouth first (because the newborn is an
obligate nose breather) and then the nares with the bulb syringe to prevent aspiration of mucus, amniotic fluid, or
meconium.

Newborn Physical Exam

Skin: turgor determines hydration status. Acrocyanosis (abnormal) blue hands and feet. Skin variations include vernix
caseosa which is a thick white substance formed by secretions from oil glands first 2-3 days after birth and will be
absorbed into skin; stork bites usually found on nape of neck or eye lids and between eyes and upper lip and are caused by
concentration of immediate blood vessels and are most visible when NB is crying; milia: unopened sebaceous glands
frequently on the nose, chin, and forehead and disappear on their own in 2-4 weekswhen they appear in the mouth and
gums they are epsteins pearls; Mongolian spots are blue or purple splotches on the lower back and buttocks that are
concentrated pigmented cells usually disappearing within 4 years of life and generally on dark-skinned NBs; erythema

toxicum (NB rash) occurs first week of life and common on face, chest, and back and shows an abundance of eosinophils;
Harlequin sign (abnormal) is the dilation of blood vessels on only one side of the body looking like a clown suit; nevus
flammeus is port-wine stain on the face or other body areas, usually removed with lasers and optimal tx time is before 1
years of age; nevus vasculosis is strawberry mark commonly found in head region within few weeks after birth and can
increase in size but tends resolve on its own by age 3.

Head: fontanels: unossified membranous tissue at junction of sutures. Anterior fontanel: diamond shape,
closes between 12-18 months. Posterior fontanel triangle shape, closes between birth and 2-3 months.
Bulging fontanel is increased ICP usually after forceps delivery. Molding is asymmetry due to pressure
and is normal, disappears in 72 hours; suture lines may overlap. Cephalhematoma is blood between
periosteum and skull and is associated with hyperbilirubenemia; does not cross suture lines. Absorbed in
6 weeks without treatment. Caput succedaneum is associated with presenting part pressure against cervix;
edema of soft scalp tissue r/t slow venous return. Crosses sagittal suture. Disappears in a few days.
Eyes: tearless crying, peripheral vision. Can fixate on near objects. Perceive faces/shapes/colors. Blinks
in response to light. Pupillary reflex present.
Nose: small and narrow. Must breathe through nose.
Mouth: lips are pink. Taste buds present.
Ears: soft and pliable. Ready recoil. Pinna parallel with inner and outer canthus.
Neck: short with skin folds.
Chest: cylindrical. Breasts engorged with whitish secretions. Respirations 30-60 bpm; HR 120-160bpm.
Abdomen: bowel sounds present by 1 hour after birth. Umbilical cord usually white and gelatinous; two
arteries, one vein.
Genitalia: female = labia majora covers labia minora. Male = testes descended, pendulous scrotum.
Extremities: short, flexible, move symmetrically. Legs are equal with symmetrical creases.

LABOR AND POSTPARTUM

Precipitous Delivery
Abrupt onset of higher- intensity contractions occuring in a shorter period of time instead of the more gradual
increase in frequency, duration and intensity that typifies most spontaneous labors.
Nursing Job closely monitor woman with previous history, anticpate use of scheduled induction to control labor rate,
Administer tocolytics to slow labor.
Magnesim Sulfate, Indocin, Nifedipine, and Betamethasone
Second Stage of Labor
Support in making active decisions about care and labor management, implementing strategies
to prolong the early passive phase of fetal descent, supporting involuntary bearing-down efforts,
providing instruction and assistance, and using maternal positions that can enhance descent and
reduce pain. The primary rationale for directing women to push is to shorten the second stage of
labor. Supporting spontaneous pushing and encouraging women to choose their own method of pushing
should be accepted as best clinical practice. You are not there to control this stage of labor but
rather empower. Lacerations/episiotomies should be assessed. The second stage of labor ends
with the birth of the newborn (first cries)
Assessing Contractions
Tip of the nose is mild, chin is moderate, and forehead is strong.
Uterine Contractions with an intensity of 30 mmHg or greater to initiate cervical dilation. During active labor the intensity
usually reaches 50 to 80 mm Hg.
Fetal Monitoring Heart Strips
Variables Cord Compressions
Early Decels Head Compressions
Accelerations Okay
Late Decelerations Placental Insufficiency
Rh Compatibility
Rhogam= Rh negative mother with an Rh positive fetus results in maternal antibodies produced that attack fetus through

hemolysis of red blood cells and rapid production of erythroblasts and hyperbilirubinemia. If mother is Rh negative, must
receive rhogam within 72 hours after delivery. Prophylaxis treatment for Rh negative mom is at 28 weeks or with
miscarriage, abortions, invasive procedures, and trauma. The mother must have no titer (+) in her blood for the RhoGam to
be effective.

Rubella = viral infection, greatest risk to infant is if mother gets virus during first trimester when fetal organs are
developing
Maternal titer of 1:8 or greater = immunity
Pt must sign consent form
Do not get pregnant for 3 months post injection
Receive rhogam first, then the rubella shot must be given at the 6 week f/u visit (rhogam interferes with
the live virus of the rubella vaccine)

Breastfeeding Benefits and Techniques

Human milk is digestible and requires no preparation, promotes bonding, cheaper than formula, oxytocin is relased to
promote more rapid uterine involution with less bleeding, the immunologic properties such as colostrum and
immunoglobulin A that helps with respiratory and otitis media infections, breast milk helps develop infants jaw, food
allergies are less likely to occur, less likely to become obese, less prone to vomiting, mother and baby bonding, constipation
is less likely, absorption of lactose and minerals in the newborn is improved.
Best to breastfeed tummy to tummy and make sure the baby latches on to the areola not just the nipple.

Breast feeding: Oxytocin (posterior pituitary) is the let-down effect. Prolactin (anterior pituitary) is the milk production.
Give progesterone-only BCP during breast feeding because estrogen causes dry mouth.Breast engorgement is congestion
of the lymphatic system in breast. Treat with increased feedings, expressing milk, applying cabbage leaves. Breast feeding
causes low estrogen levels which cause vaginal dryness leading to painful intercourse (dyspareunia)
Bottle feeding
Lactation suppression is moms choice. Wear supporting/tight-fitting bra. Apply an
ice pack to breast prn. Avoid breast manipulation. Do not use breast pump to deplete
breast milk supply. Make it a relaxing time. Promote bonding. Powered formula mixes
faster with room-temp water. Dont microwave formula due to hot spots. Hold newborn
when feeding. Discard any formula not taken. Burp infant frequent.
Fetal Development Pg. 286 287 Textbook
Heart beat heard at 12 weeks.

Ballard Score Assessment

Low Prenatal Care

Changes During Each Trimester Pg 36