OB Exam 1
Chapter 1: Trends and Issues
1. Trends in the Care of the Childbearing Family
a. Advances in the Care of the Childbearing Family
i. OB is a family centered care always
ii. Our care is always going to be health promotion
iii. Education is key
1. The more we can teach her, the better outcomes with the baby we
will have
2. Anticipatory guidance: teaching before something becomes a
problem
iv. What affects mom, affects baby
v. Make sure we are improving care costs
b. Technological Advances
i. Increase in c-section rates to about 35+ %
ii. We have lactation consultants
c. Baby Friendly Hospitals
i. Babies spending more time in the rooms with the moms
ii. Discouraging use of pacifiers
iii. Encouraging breastfeeding
d. Safe to Sleep Initiative
i. Back to sleep
ii. Decreasing levels of SIDS
2. Maternal & Infant Statistics in R/T Advances
a. 1915 – 607.9 maternal deaths per 100,000 live births
b. 2015 – 14 maternal deaths per 100,000 live births
c. 1915 – 50.1 infant deaths per 1,000 LIVE births
d. 2015 – 5.8 infant deaths per 1,000 live births
e. 1996 – cesarean section rate 20.7%
f. 2009- cesarean section rate 32.9%
g. 2016 – cesarean section rate slightly decreased to 31.9%
h. 1970 – induction of labor only 5%
i. 1990 – induction of labor 9.5%
j. 2012 – induction of labor increased to 23.3%
i. We cannot induce labor unless they are at least 39 weeks; less than 39
weeks- there has to be a medical reason to induce labor
ii. Cytotec/Misoprostol (most commonly used because it’s the cheapest) &
Oxytocin/Pitocin are the drugs used to induce labor
3. Preterm Births (<37 weeks)
1
, a. Very premature
i. Between 28-32 completed weeks
b. Moderately premature
i. Between 32-33 completed weeks
c. Late premature
i. Between 34-36 completed weeks
d. Total U.S. preterm birth rate
e. Leading cause of prematurity
i. Low birth weight
ii. Congenital malformations
iii. Complication that mom had
iv. Increase of SIDS
4. Complications of Preterm Births
a. Leading global cause of deaths under age 5 (prematurity)
i. Low birth weight or some congenital malformation
ii. Increase in SIDS or injuries
iii. Lower the birth weight, the higher the mortality
b. Long-term effects:
i. Respiratory disorders
ii. Cerebral palsy
iii. Seeing and hearing deficits
iv. Developmental delays
5. Neonatal Birth Weights
a. High birth weight
i. > 4,000 grams
ii. Have the highest mortality rate during the first year
iii. #1 cause of having a big baby = gestational diabetes
b. Normal birth weight
i. 2,500 - 3,999 grams
c. Low birth weight
i. 1500 grams - 2500 grams
d. Very low birth weight
i. < 1500 grams
ii. 100x more likely to die in the first year of life
6. Neonate = Infants first 28 days of live
7. Infant Mortality
a. Defined as….Death before the first birthday
i. At birth or during the first year of life
b. Global infant mortality rates
2
, i. Has decreased from 64.8 deaths per 1,000 live births in 2016 to 30.5
deaths per 1,000 live births in 2016
c. U.S. infant mortality rate
i. Has decreased from 26 per 1,000 live births in 1960 to 5.8 in 2017
d. Reflects the infants overall health
e. Leading causes of infant deaths and mortality rates
i. Congenital malformations and chromosomal abnormalities
ii. Disorders r/t short gestation and low birth weight
iii. Sudden infant death syndrome
iv. Respiratory distress of newborns
v. Newborns affected by maternal complications of pregnancy
8. Maternal Mortality (MMR)
a. Definition
i. Death of a woman during pregnancy or with 42 days of pregnancy
termination caused by conditions aggravated by the pregnancy or
associated medical treatments. This category excludes death from
accidents or injuries
b. World Health Organization – causes of maternal mortality
c. Types of maternal mortality
i. Direct obstetric death - results from complications during pregnancy,
labor, birth, and/or postpartum period, including deaths caused by
interventions, omission of interventions, or incorrect treatment. Ex:
postpartum hemorrhage
ii. Indirect obstetric death - is caused by a preexisting disease or a disease
that develops during pregnancy without direct obstetrical cause but is
aggravated by the pregnancy. Ex: death r/t complication of systemic lupus
erythematosus that was aggravated by pregnancy
iii. Late maternal death - occurs more than 42 days after termination of
pregnancy from a direct or indirect obstetrical cause
iv. Pregnancy-related death - is the death of a woman during pregnancy or
within 1 year of the end of pregnancy from a pregnancy complication, a
chain of events initiated by pregnancy, or the aggravation of an unrelated
condition by the physiological effects of pregnancy. Ex: pulmonary
embolism r/t DVT that leads to death during or after pregnancy
d. Maternal mortality ratio
i. The number of maternal deaths per 100,000 live births
e. Rate of change in the U.S.
i. MMR has decreased from 607.9 in 1915 to 12 in 1990
9. Issues: Teen Pregnancy
a. The rate has decreased by almost 50%
3
, b. Children born to teen moms are at an increased risk of :
i. Health problems related to low birth weights
ii. Higher chance of Respiratory Distress Syndrome, SIDS, having visual,
learning, and behavioral problems
10. Issues: Tobacco/ E-Cig Use in Pregnancy
a. Nicotine cigarettes
b. e-Cigarettes
11. Issues: Substance Abuse in Pregnancy
a. Fetal alcohol spectrum disorders
b. Illicit drug use problems
i. Exposure to illicit drugs during pregnancy is associated with preterm birth,
abruptio placenta, drug withdrawal for the neonate, and congenital defects
c. Specific impacts of cocaine and marijuana
i. Cocaine - probably most common drug seen
1. Cocaine use during pregnancy can cause strokes and seizure in the
developing fetus and can affect cognitive performance, information
processing, and attention to tasks in children
2. Potent vasoconstrictor
ii. Marijuana
1. Marijuana use during pregnancy may have a negative effect on the
neurological development of the fetus
12. Issues: Obesity in Pregnancy (BMI: 30 or higher)
a. Risk to the mother
i. Developing gestational HTN
ii. Preeclampsia
iii. Thromboembolism
iv. Gestational diabetes
v. Higher risk of having a c-section bc of shortened labor
vi. Decrease wound healing
vii. Sleep apnea
viii. Anesthesia complications
ix. Shoulder dystocia
b. Risk to infants
i. Spina bifida
ii. Macrosomia - birth injuries
iii. Heart defects
iv. Higher risk for stillbirth (intrauterine fetal demise)
v. Childhood diabetes
13. Issues: Disparities and Health Goals
a. Infant mortality
4
Chapter 1: Trends and Issues
1. Trends in the Care of the Childbearing Family
a. Advances in the Care of the Childbearing Family
i. OB is a family centered care always
ii. Our care is always going to be health promotion
iii. Education is key
1. The more we can teach her, the better outcomes with the baby we
will have
2. Anticipatory guidance: teaching before something becomes a
problem
iv. What affects mom, affects baby
v. Make sure we are improving care costs
b. Technological Advances
i. Increase in c-section rates to about 35+ %
ii. We have lactation consultants
c. Baby Friendly Hospitals
i. Babies spending more time in the rooms with the moms
ii. Discouraging use of pacifiers
iii. Encouraging breastfeeding
d. Safe to Sleep Initiative
i. Back to sleep
ii. Decreasing levels of SIDS
2. Maternal & Infant Statistics in R/T Advances
a. 1915 – 607.9 maternal deaths per 100,000 live births
b. 2015 – 14 maternal deaths per 100,000 live births
c. 1915 – 50.1 infant deaths per 1,000 LIVE births
d. 2015 – 5.8 infant deaths per 1,000 live births
e. 1996 – cesarean section rate 20.7%
f. 2009- cesarean section rate 32.9%
g. 2016 – cesarean section rate slightly decreased to 31.9%
h. 1970 – induction of labor only 5%
i. 1990 – induction of labor 9.5%
j. 2012 – induction of labor increased to 23.3%
i. We cannot induce labor unless they are at least 39 weeks; less than 39
weeks- there has to be a medical reason to induce labor
ii. Cytotec/Misoprostol (most commonly used because it’s the cheapest) &
Oxytocin/Pitocin are the drugs used to induce labor
3. Preterm Births (<37 weeks)
1
, a. Very premature
i. Between 28-32 completed weeks
b. Moderately premature
i. Between 32-33 completed weeks
c. Late premature
i. Between 34-36 completed weeks
d. Total U.S. preterm birth rate
e. Leading cause of prematurity
i. Low birth weight
ii. Congenital malformations
iii. Complication that mom had
iv. Increase of SIDS
4. Complications of Preterm Births
a. Leading global cause of deaths under age 5 (prematurity)
i. Low birth weight or some congenital malformation
ii. Increase in SIDS or injuries
iii. Lower the birth weight, the higher the mortality
b. Long-term effects:
i. Respiratory disorders
ii. Cerebral palsy
iii. Seeing and hearing deficits
iv. Developmental delays
5. Neonatal Birth Weights
a. High birth weight
i. > 4,000 grams
ii. Have the highest mortality rate during the first year
iii. #1 cause of having a big baby = gestational diabetes
b. Normal birth weight
i. 2,500 - 3,999 grams
c. Low birth weight
i. 1500 grams - 2500 grams
d. Very low birth weight
i. < 1500 grams
ii. 100x more likely to die in the first year of life
6. Neonate = Infants first 28 days of live
7. Infant Mortality
a. Defined as….Death before the first birthday
i. At birth or during the first year of life
b. Global infant mortality rates
2
, i. Has decreased from 64.8 deaths per 1,000 live births in 2016 to 30.5
deaths per 1,000 live births in 2016
c. U.S. infant mortality rate
i. Has decreased from 26 per 1,000 live births in 1960 to 5.8 in 2017
d. Reflects the infants overall health
e. Leading causes of infant deaths and mortality rates
i. Congenital malformations and chromosomal abnormalities
ii. Disorders r/t short gestation and low birth weight
iii. Sudden infant death syndrome
iv. Respiratory distress of newborns
v. Newborns affected by maternal complications of pregnancy
8. Maternal Mortality (MMR)
a. Definition
i. Death of a woman during pregnancy or with 42 days of pregnancy
termination caused by conditions aggravated by the pregnancy or
associated medical treatments. This category excludes death from
accidents or injuries
b. World Health Organization – causes of maternal mortality
c. Types of maternal mortality
i. Direct obstetric death - results from complications during pregnancy,
labor, birth, and/or postpartum period, including deaths caused by
interventions, omission of interventions, or incorrect treatment. Ex:
postpartum hemorrhage
ii. Indirect obstetric death - is caused by a preexisting disease or a disease
that develops during pregnancy without direct obstetrical cause but is
aggravated by the pregnancy. Ex: death r/t complication of systemic lupus
erythematosus that was aggravated by pregnancy
iii. Late maternal death - occurs more than 42 days after termination of
pregnancy from a direct or indirect obstetrical cause
iv. Pregnancy-related death - is the death of a woman during pregnancy or
within 1 year of the end of pregnancy from a pregnancy complication, a
chain of events initiated by pregnancy, or the aggravation of an unrelated
condition by the physiological effects of pregnancy. Ex: pulmonary
embolism r/t DVT that leads to death during or after pregnancy
d. Maternal mortality ratio
i. The number of maternal deaths per 100,000 live births
e. Rate of change in the U.S.
i. MMR has decreased from 607.9 in 1915 to 12 in 1990
9. Issues: Teen Pregnancy
a. The rate has decreased by almost 50%
3
, b. Children born to teen moms are at an increased risk of :
i. Health problems related to low birth weights
ii. Higher chance of Respiratory Distress Syndrome, SIDS, having visual,
learning, and behavioral problems
10. Issues: Tobacco/ E-Cig Use in Pregnancy
a. Nicotine cigarettes
b. e-Cigarettes
11. Issues: Substance Abuse in Pregnancy
a. Fetal alcohol spectrum disorders
b. Illicit drug use problems
i. Exposure to illicit drugs during pregnancy is associated with preterm birth,
abruptio placenta, drug withdrawal for the neonate, and congenital defects
c. Specific impacts of cocaine and marijuana
i. Cocaine - probably most common drug seen
1. Cocaine use during pregnancy can cause strokes and seizure in the
developing fetus and can affect cognitive performance, information
processing, and attention to tasks in children
2. Potent vasoconstrictor
ii. Marijuana
1. Marijuana use during pregnancy may have a negative effect on the
neurological development of the fetus
12. Issues: Obesity in Pregnancy (BMI: 30 or higher)
a. Risk to the mother
i. Developing gestational HTN
ii. Preeclampsia
iii. Thromboembolism
iv. Gestational diabetes
v. Higher risk of having a c-section bc of shortened labor
vi. Decrease wound healing
vii. Sleep apnea
viii. Anesthesia complications
ix. Shoulder dystocia
b. Risk to infants
i. Spina bifida
ii. Macrosomia - birth injuries
iii. Heart defects
iv. Higher risk for stillbirth (intrauterine fetal demise)
v. Childhood diabetes
13. Issues: Disparities and Health Goals
a. Infant mortality
4
