OB Overview (day 1 ppt)
A&P of Pregnancy
★ 40 weeks gestation (9 FULL months, pretty much 10)
★ Weeks divided into trimesters
○ 1: 0-13 & 6 days
○ 2: 14-27 & 6 days
○ 3: 28-41 weeks
★ Stages of pregnancy
○ Preconception
■ Teach: controlling HTN, obesity, etc.
■ Pregnancy-safe medications if needed
○ Antepartum (prenatal)
■ First 12 weeks: rapid cell development
■ Where we see MOST defects appear
○ Intrapartum
■ Labor/delivery period
○ Postpartum
■ The time the newborn/placenta is delivered
■ Monitor mother for the first year of baby’s life
★ Role of the nurse: educate, advocate, team member, care for low and high risk
○ Don't care for the low risk like you do the high risk- intervening TOO much
with the low risk women can cause problems
Essential Skills for Clinical
★ Fetal assessment - EFM
★ Maternal assessment
★ Newborn assessment - APGAR
○ First minute, then five minutes of life
○ Tells us how quickly we need to respond
○ Low score = not good, need to intervene
Fetal assessment
★ Non-stress test (20 min)
○ 20-30 min strip tells us if we can send the mom home (for high risk)
○ Assess contractions and how well the baby is tolerating labor
○ In 3rd trimester for women with high-risk conditions (HTN, preeclampsia,
gestational diabetes, etc.)
○ DEC fetal movement
, ○ Little adipose tissue = mild contractions might seem more intense
■ External monitor (stomach): one checks contractions and one checks
babies HR
■ Internal: once water (cushion membrane protecting baby with amniotic
fluids/fetal urine) has broken and fluid is coming out, the MW/OB may
put in internal monitors because they are more accurate- BUT these
INC r/f infection, better feeling of how strong contractions are
★ In labor
○ Intermittent
○ Continuous
■ Can cause more medical interventions
Why do we monitor fetal HR and contraction patterns during labor?
★ Labor can be stressful on the fetus
Applying the EFM (electronic fetal monitor)
★ Start with the set up
○ TOCO - Pressure reading monitor to see how the uterus contracts
■ Uterus feels like your cheek when its not contracting > then feels like the
nose as contraction begins
■ Intense contraction feels like your forehead
★ Determine fetal position
○ Leopold's maneuver - facing backward head first = normal position and
presentation
■ Try to place the monitor over the fetal back, where you detect the HR the
best
■ Check to see where the head is
★ Apply the EFM transducers
★ Determine maternal HR
○ Pulse ox will help w this
○ You will see 3 lines - moms HR, fetal HR, contraction pattern
Analyzing EFM strip
★ Is it reassuring or not?
★ Determine fetal HR baseline
★ Determine variability
○ WANT to see hills, not valleys
○ We don't like to see a variable (drops below baseline)
■ See if a contraction was heard with it
, ★ Variability
○ Fluctuations in baseline that are irregular in amplitude and frequency
○ Measured in BPM
○ Mild vs moderate vs marked
■ You will mainly see moderate
■ Will look minimal when the baby is sleeping
Uterine Activity
★ Normal = Contractions Q2-3 min
○ Lasting 50-60 secs w resting tone returning to baseline between contractions
★ Tachysystole = contractions Q1-2 min
○ If there is too many contractions, the babies blood supply will be significantly
decreased- need resting periods b/w contractions
VEAL CHOP
★ V - Variable deceleration
★ E - Early deceleration
★ A - Acceleration
★ L - late deceleration (not perfusing well)
★ C - cord compression
★ H - head compression
★ O - OKAY!
★ P - placental insufficiency
***EFM practice App
Maternal assessment - postpartum (BUBBLE HE)
★ B - breast
★ U - uterus
★ B - bowel
★ B - bladder
★ L - lochia (bleeding after having baby, placenta separates and causes bleeding)
★ E - episiotomy (tear/cut during delivery)
★ H - Homan’s sign (looking for clots, not necessarily correlated)
★ E - emotional status
Breast assessment
★ Looking for abnormalities R/T how the baby nurses, look for infection
★ Size
A&P of Pregnancy
★ 40 weeks gestation (9 FULL months, pretty much 10)
★ Weeks divided into trimesters
○ 1: 0-13 & 6 days
○ 2: 14-27 & 6 days
○ 3: 28-41 weeks
★ Stages of pregnancy
○ Preconception
■ Teach: controlling HTN, obesity, etc.
■ Pregnancy-safe medications if needed
○ Antepartum (prenatal)
■ First 12 weeks: rapid cell development
■ Where we see MOST defects appear
○ Intrapartum
■ Labor/delivery period
○ Postpartum
■ The time the newborn/placenta is delivered
■ Monitor mother for the first year of baby’s life
★ Role of the nurse: educate, advocate, team member, care for low and high risk
○ Don't care for the low risk like you do the high risk- intervening TOO much
with the low risk women can cause problems
Essential Skills for Clinical
★ Fetal assessment - EFM
★ Maternal assessment
★ Newborn assessment - APGAR
○ First minute, then five minutes of life
○ Tells us how quickly we need to respond
○ Low score = not good, need to intervene
Fetal assessment
★ Non-stress test (20 min)
○ 20-30 min strip tells us if we can send the mom home (for high risk)
○ Assess contractions and how well the baby is tolerating labor
○ In 3rd trimester for women with high-risk conditions (HTN, preeclampsia,
gestational diabetes, etc.)
○ DEC fetal movement
, ○ Little adipose tissue = mild contractions might seem more intense
■ External monitor (stomach): one checks contractions and one checks
babies HR
■ Internal: once water (cushion membrane protecting baby with amniotic
fluids/fetal urine) has broken and fluid is coming out, the MW/OB may
put in internal monitors because they are more accurate- BUT these
INC r/f infection, better feeling of how strong contractions are
★ In labor
○ Intermittent
○ Continuous
■ Can cause more medical interventions
Why do we monitor fetal HR and contraction patterns during labor?
★ Labor can be stressful on the fetus
Applying the EFM (electronic fetal monitor)
★ Start with the set up
○ TOCO - Pressure reading monitor to see how the uterus contracts
■ Uterus feels like your cheek when its not contracting > then feels like the
nose as contraction begins
■ Intense contraction feels like your forehead
★ Determine fetal position
○ Leopold's maneuver - facing backward head first = normal position and
presentation
■ Try to place the monitor over the fetal back, where you detect the HR the
best
■ Check to see where the head is
★ Apply the EFM transducers
★ Determine maternal HR
○ Pulse ox will help w this
○ You will see 3 lines - moms HR, fetal HR, contraction pattern
Analyzing EFM strip
★ Is it reassuring or not?
★ Determine fetal HR baseline
★ Determine variability
○ WANT to see hills, not valleys
○ We don't like to see a variable (drops below baseline)
■ See if a contraction was heard with it
, ★ Variability
○ Fluctuations in baseline that are irregular in amplitude and frequency
○ Measured in BPM
○ Mild vs moderate vs marked
■ You will mainly see moderate
■ Will look minimal when the baby is sleeping
Uterine Activity
★ Normal = Contractions Q2-3 min
○ Lasting 50-60 secs w resting tone returning to baseline between contractions
★ Tachysystole = contractions Q1-2 min
○ If there is too many contractions, the babies blood supply will be significantly
decreased- need resting periods b/w contractions
VEAL CHOP
★ V - Variable deceleration
★ E - Early deceleration
★ A - Acceleration
★ L - late deceleration (not perfusing well)
★ C - cord compression
★ H - head compression
★ O - OKAY!
★ P - placental insufficiency
***EFM practice App
Maternal assessment - postpartum (BUBBLE HE)
★ B - breast
★ U - uterus
★ B - bowel
★ B - bladder
★ L - lochia (bleeding after having baby, placenta separates and causes bleeding)
★ E - episiotomy (tear/cut during delivery)
★ H - Homan’s sign (looking for clots, not necessarily correlated)
★ E - emotional status
Breast assessment
★ Looking for abnormalities R/T how the baby nurses, look for infection
★ Size
