FINAL MATERNAL EXAM STUDY GUIDE

FINAL MATERNAL EXAM STUDY GUIDE 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 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