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normal adult HR
70 (range 60-100)
Oral temp rage
33.2-38.1
Rectal temp range
36.8-37.1
Tympanic temp range
35.7-37.5
temp in pregnancy
-0.3°C (0.5°F) decrease in first trimester
-further decrease of 0.1°C (0.2°F) per month through 37 wk
increases HR
pain, fear, pyrexia, exercise, hemmorhage, anemia
HR in pregnancy
increases 10-20 bpm
respiration in adults
12-20 /minute
respiration in pregnant women
12-20/ min (Rate unchanged, Depth greater,
Breathing largely diaphragmatic)
normal BP in adults
100/60 - 140/90mmHg
Blood Pressure in Pregnancy
-decrease steadily until 20 weeks
-then increases until delivery
-average increase of 8 % between mid gestation & delivery
I.M. injection
-21 gauge
-90 degrees
-syringe 3 ml/cc
-deltoid (1")
-vastus lateralis (1.5 ")
-rectus femoris (1.5 ")
-gluteus maximus (1.5 ")
-oxytocin
Subcut. Inject
-25g small needle
-45 degrees
-1"
-syringe 1-3 ml/cc
-into fat and conn. tissue
-insulin, haparin
-slowly absorbed b/c not in muscle
Intradermal Injection
-25 gauge
-10-15 degrees
-5/8 or 3/8 "
-syringe 1 ml/cc
-bevel upwards so small wheal forms and is seen on the skin
-sterile water
naegele's rule
subtract 3 months, add 7 days to first day of LMP
breast tenderness
week 5-7 after LMP
chadwick's sign
wk 6-8
goodell's sign
wk 8
hegar's sign
wk 8-10
NVP
-starts around week 8 (as early as wk 6)
-worse by week 10
-better by week 12
-gone by week 14
quickening
wk 17-20
hear heart with doppler
week 10-12
fundus at umbilicus
week 20
U/S dating - up to 12 wk
+/- 3 days
SIPS 1
10-13 +6
-best at 10+2-11+6
SIPS 2
15-20+6
-best at 15+2-17
NT scan
11-13+6
best done at 12-13+3
SIPS 1 measures
PAPP-A (Pregnancy Associated Plasma Protein A)
SIPS 2 measures
a) AFP (alpha-fetoprotein)
b) unconjugated estriol (uE3)
c) hCG
d) inhibin-A
CVS
11-12+6 weeks
detailed ultrasound
18-20 wk
GBS screen
35-37 weeks
blood vol increase
30-50%
number of chromosomes in a gamete
23
number of chromosomes in a regular cell
46 (23 pairs)
incidence of PP blues
50-80%
incidence of PPD
15%
incidence of PP thydroiditis
5-10%
incidence of pp psychosis
2-3/ 1000
fetal HR 12-20 wk
-160
-regular rhythm
fetal HR 0-12 weeks
-<90bpm until approx 10 wk
heart neurologically functioning by
16 wk
fetal HR 20-30 weeks
-150-155 bpm
Labour: song of the heart
-good variability (> 5 bpm)
- unchanged rate from previous baseline
- Baroreceptor response frequent
zygote arrives in uterus
-day 3-5 from conception, 17-19 from LMP (about 2.5 weeks)
implantation begins
- day 6 after conception (stables & rankin)
- day 20 after LMP (around 3 weeks)
zygote begins producing hCG & decidua secretes glycogen
-3 weeks from LMP
yolk sac making RBCs & cardio system starting to form
-4-5 weeks from LMP
fetus most vulnerable to teratogens
-wk 3-8 (embryonic period)
hcg falls
-wk 8-12 b/c placenta now able to make est & progest, corpus luteum no longer needed
organogenesis starts
-5 wk from LMP
risk factors for PPH
-full bladder (can displace uterus)
-high parity
-overdistension of the uterus: multiples, polyhydramnios, large fetus
-fibroids
-antepartum haemorrhage
-prolonged labour w weak or uncoordinated contractions
-atony caused by drugs
- Inversion of the uterus
- fiddling with the uterus in 3rd stage
-coagulation/clotting defects
-retained products in the uterus( secondary PPH)
respiration in newborns
-30-60 per minute
-very irregular is normal - listen for a full minute
newborn HR
-110-160 bpm
-varies with respiration - count for a full minute
Lactogenesis I
-milk components first seen in breast tissue and colostrum expressed from the breast
-from mid-pregnancy until day 2 after birth
- physical changes in breast and & hormonal changes
-culminates in the initiation of lactation
Lactogenesis II
-'milk comes in'
-days 2-3 after birth until about day 8 when mature milk is established
-drop in progest, prolactin remains high
colostrum
-thick yellow fluid
-16th week of pregnancy _> 3rd and 14th day PP
-high density, low vol
-more protein, minerals and fat-soluble vitamins (A and K) than mature milk
-less lactose, fats and water-soluble vitamins
-more anti-infective agents
-facilitates good gut flora & passage of mec
Chloasma
-due to hormonal changes
-pregnancy mask, usually on face
-AKA melasma
1st trimester
-wk 1-13
-implantation
-embyronic period -> organogenesis
-fetus vulnerable
-body adapt to pregnancy, many complaints
2nd trimester
-wk 14-28
-spinal cord closed by end
-baby growing tissues rather than new organs
-often feeling better
3rd trimester
-wk 28-term
-rapid weight gain, fetus much larger
-fetus: fat, vernix, thicker skin, lungs maturing
-mother may become uncomfortable again
microcytic anemia
-small RBC
-caused by iron deficiency
macrocytic anemia
-large RBC
-caused by folate deficiency, or B12 deficiency, chemotherapy
labour
progression of contractions, dilation of the cervix leading to birth of the baby, expulsion of the placenta and membranes
prodromal labour
-'non-progressive'; before dilatation really begins
-body's preparation for labor
-not everyone is aware of this stage, some women feel it more than others
lightening is due to
thinning of the lower uterine segment, allows more room for the head to descend
pelvic brim
-widest diameter: transverse (13.5 cm)
-anteroposterior: 11 cm
-oblique: 12
pelvic cavity
-considered circular: all diameters equal (12 cm)
pelvic outlet
-widest diameter: anteroposterior diameter (13.5)
-transverse: 11 cm
-oblique: 12 cm
station
- presenting part in relation to ischial spines
how often do you listen to the FHR: 1st stage
every 15min
how often do you listen to the FHR: 2st stage
every 5 min or after each contraction
take BP & temp
-every 4 hours in labour
-check temp every 2 hr if GBS+ or PROM
take pulse in labour
every hour
an abnormal HR in a mother
over 120, under 70
a abnormal HR in a fetus
baseline under 110 or over 160
some of the things newborn screen tests for
-Phenylketonuria (PKU)
-Maple Syrup Urine Disease (MSUD)
-Galactosemia (GALT)
-Cystic fibrosis (CF)
-Congenital Hypothyroidism (CH)
ideal time frame for prenatal screen
-after 24 hrs, day 2-3 is ideal