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LUSL4084 Maternity Readings - Saunders Comprehensive Review for the Nclex-Rn Examination

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Chapter 26 - Reproductive System

Female Reproductive Structures

Ovaries  form and expel ova, secrete estrogen and progesterone

Fallopian Tubes  muscular tubes lying near the ovaries and connected to the uterus, tubes that propel the ova from the ovaries to the uterus

Uterus  muscular pear shaped cavity in which the fetus develops, cavity from which menstruation occurs

Cervix  the internal os of the cervix opens into the body of the uterine cavity, located between the internal os and the external os which opens into the vagina

Vagina  muscular tube that extends from the cervix to the vaginal opening in the perineum, known as the birth canal, passageway for menstrual blood flow, for penis for intercourse, and for the fetus

Male Reproductive Structures

Penis  structures include the body, shaft, glans penis, and urethra – primary functions include pathway for urination and is the organ for intercourse

Scrotum  structures include the testes, epididymis, and van deferens – normal temperature is slightly cooler than body temperature

Prostate Gland  secretes a milky alkaline fluid – enhances sperm movement and neutralizes acidic vaginal secretions

Menstrual Cycle

Ovarian Hormones  released by the anterior pituitary gland, include follicle-stimulating hormone (FSH) and luteinizing hormone (LH) – hormones produce changes in the ovaries and in the endometrium – menstrual cycle, the regularly recurring physiological changes in the endometrium that culminate in its shedding, may vary in length, with the average length being about 28 days

Female Pelvis and Measurements

True Pelvis  lies below the pelvic brim, consists of the pelvic inlet, midpelvis, and pelvis outlet

False Pelvis  shallow portion above the pelvic brim, supports the abdominal viscera

Types of Pelvis  - Gynecoid: normal female pelvis, transversely rounded or blunt - Anthropoid: oval shape, adequate outlet with narrow public arch - Android: heart-shaped/angulated, resembles a male pelvis, not favourable for labour & birth, narrow pelvic planes can cause slow descent and mid-pelvic arrest - Platypelloid: flat with an oval inlet, wide transverse diameter, but short antero-posterior diameter, making labour and birth difficult

Fertilization and Implantation

Fertilization  occurs in the ampulla of the fallopian tube when sperm and ovum unite, when fertilized, the membrane of the ovum undergoes changes that prevent entry of other sperm, each reproductive cell carriers 23 chromosomes – sperm catty an X or a Y (XY male, XX female)

Implantation  the zygote is propelled toward the uterus and implants 6-8 days after ovulation

Fetal Development

Preembryonic period  first 2 weeks after conception

Embryonic period  beginning on day 15 through approximetly the 8th week after conception

Fetal period  beginning at the 9th week after conception and ending with birth

Weeks 2 – 3 Lung buds appear – blood circulation begins, heart is tubular and begins to beat Week 5 Double heart chambers appear, heart is beating Week 8 Eyelids begin to form – every organ is present Week 12 Face is well formed – limbs are long – kidneys begin to produce urine – spontaneous movement – heartbeat by Doppler 10-12 weeks – can see gender Week 16 Active movements, fetal skin is transparent – hair develops Week 20 Nails develops – muscles develops – heartbeat by fetoscope Week 24 Skin is reddish – reflex hand grasp functions – fetus can hear Week 28 Limbs are well flexed – brain is developing rapidly – lungs developed Week 32 Bones fully develop Week 36 Skin is pink and body is round/less wrinkled Week 40

Fetal Environment

Amnion  encloses the amniotic cavity – the inner membrane that forms about the 2nd week of embryonic development – forms during second week

Chorion  outer membrane enclosing the amniotic cavity – becomes vascularized and forms the fetal part of the placenta

Amniotic Fluid  consists of 800-1200mL by the end of pregnancy – surrounds, cushions, and protects the fetus and allows for the fetal movement – maintains the body temp – contains fetal urine and is a measure of fetal kidney function – fetus modifies fluid through processes for swallowing, urinating, and movement of fluid through the resp tract

Placenta  provides for exchange of nutrients and waste products between the fetus and mother – begins to form at implantation – the structure is complete by week 12 – produce hormones to maintain pregnancy and assumes full responsibility for the production of these hormones by the 12th week

Chapter 28 – Prenatal Period

Gestation: time from fertilization of ovum to the estimated date of delivery (about 280 days)

Nägele’s rule: tool for estimating date of delivery (requires woman to have regular 28-day menstrual cycle) o Subtract 3 months and add 7 days to the first day of the last menstrual period, then add a year. o Or add 7 days to the last menstrual period and count forward 9 months

Gravida: refers to a pregnant woman Gravidity: refers to the number of pregnancies Nulligravida: a woman who has never been pregnant Primigravida: a woman who is pregnant for the first time Multigravida: a woman in at least her second pregnancy Parity: the number of births (not fetuses) carried past 20 weeks gestations regardless of being born alive Nullipara: a woman who has not had a birth at more than 20 weeks of gestation Primipara: a woman who has had 1 birth that occurred after 20 weeks of gestation Multipara: a woman who has had 2 or more pregnancies to the stage of fetal viability

GTPAL o G: is gravidity, the number of pregnancies including the current one o T: is term births, the number of births after 37 weeks o P: is preterm births, number born before 27 weeks o A: abortions or miscarriages (intended/unintended) o L: current living children (GTPA – all have to do w pregnancies, doesn’t matter how many babies) Presumptive pregnancy signs o Amenorrhea o Nausea and vomiting o Increased size and feeling of fullness in breasts o Pronounced nipples o Urinary frequency o Quickening (first perception of fetal movement by mother which may occur at 16th-20th week) o Fatigue o Discoloration of the vaginal mucosa

Probable pregnancy signs o Uterine enlargement o Hegar’s sign (compressibility and softening of the lower uterine segment that occurs around week 6) o Goodell’s sign (Softening of the cervix that occurs at the beginning of the second month) o Chadwicks signs (violet coloration of the mucous membranes of the cervix, vagina and vulva around week 6) o Ballottement (rebounding of the fetus against the examiners fingers on palpation) o Braxton Hicks contractions o Positive pregnancy test for determination of the presence of human chorionic gonadotropin

Positive pregnancy signs o Fetal heart rate detected by device at 10-12 weeks and non-electronic around 20 weeks

o Active fetal movements palpable by examiner o Outline of fetus via radiography or ultrasound Fundal height o Measured to evaluate gestational age o During second and third trimesters (weeks 18-30), fundal height in centimetres approximately equals fetal age in weeks +/- 2cm o At 16 weeks, the fundus is approximately halfway between symphysis pubis and the umbilicus o At 36 weeks, the fundus is at the xiphoid process

Physiological cardiovascular changes o Circulating blood volume, plasma and total red blood cell volume increase o Physiological anemia occurs and the plasma increase exceeds the increase in production of red blood cells o Iron requirements are increased o Heart size increases o The heart is elevated slightly upward and to the left o Retention of sodium and water may occur

Physiological respiratory system changes o Oxygen consumption increases 15-20% o Diaphragm is elevated because of enlarged uterus o SOB may be experienced

Physiological gastrointestinal system changes o Nausea and vomiting may occur, usually subsides by third month o Poor appetite may occur because of decreased gastric mobility o Alterations in taste and smell may occur o Constipation may occur related to increased progesterone or pressure of the uterus resulting in decreased gastrointestinal motility o Flatulence may occur because of decreased motility and slowed emptying o Hemorrhoids may occur because of increased venous pressure o Gum tissue may become swollen bleed easily and ptyalism (excessive saliva) may occur o due to increased estrogen

Physiological renal system changes o Frequency of urination increases in first and third trimesters because of increased bladder sensitivity and pressure of enlarging uterus on the bladder o Decreased bladder tone may occur and is caused by an increase in progesterone and estrogen levels o Bladder capacity increases in response to increasing progesterone o Renal threshold for glucose may be reduced

Physiological endocrine system changes o Basal metabolic rate and metabolic function increases o Anterior lobe of pituitary gland enlarges and produces serum prolactin needed for lactation process o Posterior lobe of pituitary gland produces oxytocin, stimulating contractions o The thyroid enlarges slightly and thyroid activity increases

o Relationship with the fetus o The woman may daydream to prepare for motherhood and the motherly qualities she’d like to possess o First accepts the biological fact that she is pregnant, then accepts the growing fetus as distinct from herself and a person to nurture, finally the woman prepares realistically for the birth and parenting of a child

Nausea and vomiting o Occurs in first trimester and usually subsides by 3rd month o Caused by elevated levels of human chorionic gonadotropin and other pregnancy hormones as well as changes in carbohydrate metabolism o Interventions: eat dry crackers before arising, avoid brushing teeth after arising, eating small, low-fat meals during the day, drinking liquids between meals rather than at meals, avoid fried and spicy foods, acupressure, herbal remedies, antiemetics

Syncope o Usually occurs in first trimester; supine hypotension occurs particularly in the second and third trimesters o May be triggered hormonally or caused by increased blood volume, anemia, fatigue, sudden position changes, or lying supine o Interventions: sitting with feet elevated, change positions slowly

Urinary urgency and frequency o Usually occurs in 1st and 3rd trimester o Caused by pressure of uterus on bladder o Interventions: drinking no less than 2000 mL of fluid during the day, limiting evening fluid intake, voiding at regular intervals, sleep side-lying at night, wearing perineal pads, performing Kegel exercises

Breast tenderness o Can occur in first through third trimesters o Caused by increased estrogen and progesterone o Interventions: supportive bra, avoiding soap on nipples and areolar area

Increased vaginal discharge o Can occur in first through third trimesters o Caused by hypertrophy and thickening of vaginal mucosa and increased mucus production o Interventions: using proper cleansing and hygiene techniques, wearing cotton underwear, avoid douching, consult HCP if infection suspected

Nasal stuffiness o Can occur in first through third trimesters o Results from increased estrogen which causes edema of the nasal tissues and dryness o Interventions: encouraging use of a humidifier, avoiding nasal sprays and antihistamines

Fatigue o Usually occurs in 1st and 3rd trimester o Usually results from hormonal changes

o Interventions: arranging frequent rest periods throughout the day, using correct posture and body mechanics, obtaining regular exercise, performing muscle relaxation and strengthening exercises for legs and hip joints, avoiding drinking and eating items containing stimulants

Heartburn o Occurs in second and third trimesters o Results from increased progesterone, decreased GI motility, esophageal reflux, and displacement of stomach o Interventions: eating small frequent meals, sitting upright for 30min after meals, drinking milk between meals, avoiding fatty and spicy foods, performing tailor-sitting exercises, consulting about use of antacids

Ankle edema o Occurs in second and third trimesters o Results from vasodilation, venous stasis, and increased venous pressure below the uterus o Interventions: elevating legs at least twice a day and when resting, sleeping in a side-lying position, wearing supportive stockings, avoiding sitting/standing in one position for long periods

Varicose veins o Occurs in second and third trimesters o Results from weakening walls of the veins or valves and venous congestion o Interventions: wearing supportive stockings, elevating feet when sitting, lying with feet and hips elevated, avoiding long periods of sitting/standing, moving while standing to improve circulation, avoid leg crossing, avoid constricting clothing

Headaches o Usually considered benign in first trimester. May require further investigation in second and third trimesters o Result from changes in blood volume and vascular tone o Interventions: change positions slowly, applying cold cloth to forehead, eating small snack, using acetaminophen if prescribed

Hemorrhoids o Occurs in second and third trimesters o Result from increased venous pressure and constipation o Interventions: soaking in warms sitz bath, siting on soft-pillow, eating high fiber foods and drinking sufficient fluids to avoid constipation, increase exercise such as walking, apply ointments, suppositories or compresses as prescribed

Constipation o Occurs in second and third trimesters o Results from increase in progesterone, decreased GI motility, displacement of intestines, pressure from uterus, and taking iron supplements o Interventions: eating high fiber foods such as whole grains, fruits and vegetables, drinking no less than 2000ml a day, exercising regularly such as a daily 20min walk, consulting HCP before use of laxatives, stool softeners or enemas

Backache o Occurs in second and third trimesters

Substance abuse o Threatens normal fetal growth and successful term completion, risks for fetal growth restriction, abruptio placentae, and fetal bradycardia o Smoking can result in low-birth weight, a higher incidence of birth defects and stillbirths o Consumption of alcohol may lead to fetal alcohol syndrome and can cause jitteriness, physical abnormalities, and growth deficits

Blood type and Rh factor o ABO typing is performed to determine the woman’s blood type in the ABO antigen system o Rh typing is done to determines the woman’s blood type in the rhesus antigen system. ( + indicates presence of antigen) o If Rh – and has a negative antibody screen, she will need repeat antibody screens and should receive Rh0(D) immune globulin (RhoGAM) at 28 weeks of gestation

Rubella titer o If client has negative titer (less than 1:8), indicating susceptibility to rubella virus, she should receive appropriate immunization postpartum o Client must be using effecting birth control at time of immunization and must be counseled not to become pregnant for 1-3 months after immunization and to avoid contact with anyone immunocompromised o If vaccine administered at same time as Rho(D) immune globulin, it may not be effective o Administered postpartum via subq if titer less than 1:8, inquire about sensitivity to eggs

Hemoglobin and hematocrit levels o Levels decline during gestation as a result of increased plasma volume o A decrease in hemoglobin level to less than 10g/dL (100mmol/L) or in the hematocrit level to less than 30% indicates anemia

Papanicolaou’s smear Done during prenatal examination to screen for cervical neoplasia

TB skin test o May prefer to perform skin test after birth o Positive test indicates need for a chest radiograph to rule out active disease (not until after 20 weeks). Positive may be referred for treatment with medication after birth

Hepatitis B surface antigens o Testing is recommended for all women

Urinalysis and urine culture o A urine specimen for glucose and proteins determination should be obtained at every antepartum visit o Glycosuria is a common result of decrease renal threshold, if it persists, it may indicate diabetes o White blood cells in the urine may indicate infection o Ketonuria may result from insufficient food intake or vomiting o Levels of 2+ to 4+ protein in the urine may indicate infection or preeclampsia

Ultrasonography

o Outlines and identifies fetal and maternal structures o Assists in confirming gestational age, estimated date of delivery, and evaluating amniotic fluid volume o May be done abdominally or transvaginally during pregnancy o Can be used to determine presence of premature dilation. A transvaginal ultrasound is used during first trimester to check length of cervix

Biophysical profile o Non-invasive assessment of the fetus that includes fetal breathing movements, fetal movements, fetal tone, amniotic fluid index, and fetal heart rate patterns through a non -stress test o Normal fetal biophysical activities indicate that the central nervous system is functional and that the fetus is not hypoxemic

Doppler blood flow analysis Non-invasive method of studying the blood flow in the fetus and placenta

Percutaneous umbilical blood sampling o Is performed if fetal blood sampling is necessary o Involves insertion of a needle into the fetal umbilical vessel under ultrasound guidance o Fetal heart rate monitoring is necessary for one hour after and a follow up ultrasound to check for bleeding is done one hour after

a-fetoprotein screening o Assesses the quantity of fetal serum proteins, abnormal protein levels are associated with open neural tube and abdominal wall defects o Assists in screening for spina bifida and Down syndrome o If abnormal, repeat test, false-positive common o Level is determined by a maternal blood sample drawn between 16-18 weeks o If level is abnormal and gestation less than 18 weeks, a second sample is taken o Ultrasound is performed for elevated levels to rule out abnormalities or multiple gestation

Deoxyribonucleic acid (DNA) genetic testing o Can be used to detect abnormalities related to an inherited condition o Assists in determining if the woman is at risk for having a fetus with Down syndrome, Edwards syndrome, or Patau syndrome o Can be done as early as 7 weeks and a blood sample is used

Chorionic villus sampling o Performed for the purpose of detecting genetic abnormalities o The HCP aspirates a small sample of chorionic villus tissue at 10-13 weeks o Rh- negative women may be given Rho (D) immune globulin because chorionic villus sampling increases risk of Rh sensitization

Amniocentesis o Aspiration of amniotic fluid; best performed between 15-20 weeks o Performed to determine genetic disorders, metabolic defects and fetal lung maturity o Risks: maternal hemorrhage, infection, Rh isoimmunization, abruptio placentae, amniotic fluid emboli, premature rupture of membranes

o Diet high in folic acid or folic acid supplementation is necessary for all women of childbearing age to prevent neural tube defects and orofacial clefts in the fetus o Ideally should start taking before you get pregnant o At least 8-10 8oz glasses of fluid are needed each day (4-6 should be water) o Sodium is not restricted unless specifically prescribed

Vegan and vegetarian diets o Ensure clients eats sufficient varied foods to meet normal nutrient and energy needs o Should be educated on consuming complementary proteins (whole grains, legumes, seeds, nuts, vegetables) o Potential deficiencies include: energy, protein, vitamin B12, zinc, iron, calcium, omega-3 fatty acids and vitamin D o To enhance absorption of iron, a good source of iron and vitamin C needed with each meal

Lactose intolerance o Needs sources of calcium other than dairy o Milk may be tolerated in cooked form o Lactase, an enzyme, may be prescribed

PICA

o Refers to eating non-food substances such as dirt, clay, starch and freezer frost o Cause is unknown o Iron deficiency anemia may occur as a result

Chapter 29 – Risk Conditions Related to Pregnancy

Abortion  Pregnancy that ends spontaneously or electively before 20 weeks gestation

 Assessment should include: o Spontaneous vaginal bleeding o Low uterine cramping or contractions o Blood clots or tissues through vagina o Hemorrhage and shock can result with excessive bleeding  Interventions: o Maintain bed rest as prescribed o Monitor VS o Monitor for cramping and bleeding o Count pads to assess blood loss and save tissues/clots o Maintain IV fluids as prescribed, assess/monitor for hemorrhage or shock o Prepare for dilation and curettage (D&C) when prescribed for incomplete abortion o Administer Rh(D) immune globulin, as prescribed (for Rh-negative women) o Provide psychological support

Types of Abortion Spontaneou s

Pregnancy ends because of natural causes

Induced Therapeutic or elective reasons exist for terminating pregnancy Threatened Spotting and cramping occur without cervical changes Inevitable Spotting and cramping occur, and cervix begins to dilate and efface Incomplete Loss of some of the products of conception occurs, with part of the products retained (ex. placenta) Complete Loss of all products of conception Missed Products of conception are retained in utero after fetal death Habitual Spontaneous abortions occur in 2 or more successive pregnancies

Anemia  Iron deficiency anemia is a condition that results from inadequate serum iron  Predisposes client to postpartum infection  Assessment should include: o Fatigue o Headache o Pallor o Tachycardia o Hemoglobin value is usually less than 10 g/dl (100 mmol/L); hematocrit value is usually less than 30%  Interventions: o Monitor hemoglobin and hematocrit levels (q2weeks) o Administer folic acid and iron supplements and provide relevant teaching o Instruct client to take iron with source of VIT C to increase absorption and to avoid taking with tea, milk products, or caffeine. Absorbed best if taken between meals o Teach client to monitor for S&S of infection o Prepare to administer parenteral iron or blood transfusions: may be prescribed for severe anemia o Prepare for administration of oxytoxic medications in postpartum period of excessive bleeding is a concern

Group III (Mortality Rate, 25%-50%)  Aortic coarctation (complicated)  Myocardial infarction  Marfan syndrome  True cardiomyopathy  Pulmonary hypertension

Chorioamnionitis  Bacterial infection of the amniotic cavity; can result from premature or prolonged rupture of the membranes, vaginitis, amniocentesis, or intrauterine procedures. May result in the development of postpartum endometritis and neonatal sepsis  Assessment should include: o Uterine tenderness and contractions o Elevated temperature o Maternal or fetal tachycardia o Foul order to amniotic fluid o Leukocytosis  Interventions o Monitor materal VS and fetal HR o Monitor for uterine tenderness, contractions, and fetal activity o Monitor for results of blood cultures o Prepare for amniocentesis to obtain amniotic fluid for Gram stain and leukocyte count o Administer antibiotics as prescribed after cultures are obtained o Administer oxytocic medications as prescribed to increase uterine tone o Prepare to obtain neonatal cultures after birth

Diabetes Mellitus  Pregnancy places demands on carbohydrate metabolism and causes insulin requirements to change. Maternal glucose crosses the placenta, but insulin does not. The fetus produces its own insulin and pulls glucose from the mother, which predisposes the mother to hypoglycemic reactions. The newborn of a diabetic mother may be large in size, but has functions related to gestational age rather than size. The newborn of a diabetic mother is at risk for hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, and congenital anomalies.

*During the first trimester, maternal insulin needs decrease. During the second and third trimesters increases in placental hormones cause an insulin resistant state, requiring an increase in client’s insulin dose. After placental delivery, placental hormone levels abruptly decrease and insulin requirements decrease. Gestational diabetes mellitus:  Gestational diabetes occurs in pregnancy (during the second or third trimester) in clients not previously diagnosed as diabetic and occurs when the pancreas cannot respond to the demand for more insulin  Pregnant women should be screened for gestational diabetes between 24-28 wks of gestation  A 3h oral glucose tolerance test is performed to confirm gestational DM (BW before than after)  GDM frequently can be treated by diet alone; however, some clients may need insulin  Most women with GDM return to a euglycemic state after birth; however, these individuals have an increased risk of developing DM in their lifetime

 Predisposing conditions to GDM: o Older than 35 o Obesity o Multiple gestation o Family Hx of DM o Large for gestational age fetus  Assessment should include: o Excessive thirst o Hunger o Weight loss o Frequent urination o Blurred vision o Recurrent UTIs and yeast infections o Glycosuria and ketonuria o Signs of gestational HTN o Polyhydramnios o Large for gestational age fetus  Interventions o Employ diet, medications (if diet cannot control blood glucose levels), exercise, and blood glucose determinations to maintain blood glucose levels between 65 mg/dL (3 mmol/L) and 130 mg/dL (7 mmol/L) as prescribed o Observe for signs of hyperglycemia, glycosuria and ketonuria, and hypoglycemia o Monitor weight o Increase caloric intake as prescribed, with adequate insulin therapy so that glucose moves into the cells o Assess for signs of maternal complications such as preeclampsia (hypertension and proteinuria) o Monitor for signs of infection o Instruct the client to report burning and pain on urination, vaginal discharge or itching, or any other signs of infection to the HCP o Assess fetal status and monitor for signs of fetal compromise  Interventions during labor o Monitor fetal status continuously for signs of distress and, if noted, prepare the client for immediate C-section o Carefully regulate insulin and provide glucose IV as prescribed because labor depletes glycogen  Interventions during the postpartum period o Observe the mother closely for a hypoglycemic reaction because a precipitous decline in insulin requirements normally occurs (the mother may not require insulin for the first 24 h) o Reregulate insulin needs as prescribed after the first day, according to blood glucose testing o Assess dietary needs, based on blood glucose testing and insulin requirements o Monitor for signs of infection or postpartum hemorrhage

Disseminated Intravascular Coagulation (DIC)  DIC is a maternal condition in which the clotting cascade is activated, resulting in the formation of clots in the microcirculation

The rapid and extensive formation of clots that occurs in DIC causes the platelets and clotting factors to be depleted; this results in bleeding and the potential vascular occlusion of organs from thromboembolus formation

Endometritis  Is an infection of the lining of the uterus occurring in the postpartum period and caused by bacteria that invade the uterus at the placental site. The infection may spread and involve the entire endometrium and cause peritonitis or pelvic thrombophlebitis  Assessment should include: o Chills and fever o Increased pulse o Decreased appetite o Headache o Backache o Prolonged, severe afterpains o Tender, large uterus o Foul odor to lochia or reddish brown lochia o Ileus o Elevated WBC count, with left shift of immature cells  Interventions: o Monitor VS o Position the client in Fowler’s position to facilitate drainage of lochia o Provide a private room for the mother; inform the mother that isolation of the newborn from the mother is unnecessary o Instruct the mother in proper hand-washing techniques o Initiate contact precautions as necessary o Monitor intake and output an encourage fluid intake o Administer antibiotics as prescribed o Administer comfort measures such as back rubs and position changes and pain medication as prescribed o Administer oxytocic medications as prescribed to improve uterine tone o Provide psychological support

Fetal Death in Utero  Refers to death of a fetus after the 20th week of gestation and before birth  Client can develop DIC if the dead fetus is retained in the uterus for 3-4 wks or longer  Assessment should include o Absence of fetal movement o Absence of fetal heart tones o Maternal weight loss o Lack of fetal growth or decrease in fundal height o No evidence of fetal cardiac activity o Other characteristics suggestive of fetal death noted on ultrasound  Interventions o Prepare for the birth of the fetus o Support the client’s decision about labor, birth, and the postpartum period o Accept behaviours such as anger and hostility from the parents o Refer the parents to an appropriate support group

Cultural, spiritual, and religious practices and beliefs are important to consider when caring for the parents of a fetus who has died. Be aware of the cultural, spiritual, and religious practices and beliefs of the client.

Hepatitis B:  The risks of prematurity, LBW, and neonatal death increase if the mother has hepB infection. Is transmitted through blood, saliva, vaginal secretions, semen, and breast milk and across the placental barrier.  Interventions should include: o Minimize the risk for intrapartum ascending infections (limit the # of vaginal examinations) o Remove maternal blood from the neonate immediately after birth o Suction the fluids from the neonate immediately after birth o Bathe the neonate before any invasive procedures o Clean and dry the face and eyes of the neonate before instilling eye prophylaxis o Infection of the neonate can be prevented by the administration of HepB immune globulin and HepB vaccine soon after birth o Discourage the mother from kissing the neonate until the neonate has received the vaccine o Inform the mother that the HepB vaccine will be administered to the neonate and that a second dose should be administered at 1 month after birth and a third dose at 6 months after birth

Support breast-feeding after neonatal treatment for HepB; breast-feeding is not contraindicated if the neonate has been vaccinated Hematoma:  Occurs following the escape of blood into the maternal tissue after birth. Predisposing conditions include operative delivery with forceps or injury to a blood vessel.  Assessment should include: o Abnormal, severe pain o Pressure in perineal area (may feel like she needs to have BM) o Palpable, sensitive swelling in the perineal area, with discolored skin o Inability to void o Decreased hemoglobin and hematocrit levels o Signs of shock, such as pallor, tachycardia, and hypotension, if significant blood loss has occurred  Interventions: o Monitor VS o Monitor client for abnormal pain, especially when forceps delivery has been performed o Apply ice to the hematoma site o Administer analgesics as prescribed o Monitor intake and output o Encourage fluids and voiding; prepare for urinary catheterization of the client is unable to void o Administer blood replacements as prescribed o Monitor for signs of infection, such as increased temp, pulse rate, and WBC count o Administer antibiotics as prescribed because infection is common after hematoma formation o Prepare for incision and evacuation of the hematoma if necessary

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS):  HIV is causative agent of AIDS

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LUSL4084 Maternity Readings - Saunders Comprehensive Review for the Nclex-Rn Examination

Course: Nursing Praxis and Professional Caring VII (NURS-4084EL)

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Maternity Readings 1

Chapter 26 - Reproductive System

1. Female Reproductive Structures

Ovaries  form and expel ova, secrete estrogen and progesterone

Fallopian Tubes  muscular tubes lying near the ovaries and connected to the uterus, tubes that propel

the ova from the ovaries to the uterus

Uterus  muscular pear shaped cavity in which the fetus develops, cavity from which menstruation

occurs

Cervix  the internal os of the cervix opens into the body of the uterine cavity, located between the

internal os and the external os which opens into the vagina

Vagina  muscular tube that extends from the cervix to the vaginal opening in the perineum, known as

the birth canal, passageway for menstrual blood flow, for penis for intercourse, and for the fetus

2. Male Reproductive Structures

Penis  structures include the body, shaft, glans penis, and urethra – primary functions include pathway

for urination and is the organ for intercourse

Scrotum  structures include the testes, epididymis, and van deferens – normal temperature is slightly

cooler than body temperature

Prostate Gland  secretes a milky alkaline fluid – enhances sperm movement and neutralizes acidic

vaginal secretions

3. Menstrual Cycle

Ovarian Hormones  released by the anterior pituitary gland, include follicle-stimulating hormone (FSH)

and luteinizing hormone (LH) – hormones produce changes in the ovaries and in the endometrium –

menstrual cycle, the regularly recurring physiological changes in the endometrium that culminate in its

shedding, may vary in length, with the average length being about 28 days

4. Female Pelvis and Measurements

True Pelvis  lies below the pelvic brim, consists of the pelvic inlet, midpelvis, and pelvis outlet

False Pelvis  shallow portion above the pelvic brim, supports the abdominal viscera

Types of Pelvis 

- Gynecoid: normal female pelvis, transversely rounded or blunt

- Anthropoid: oval shape, adequate outlet with narrow public arch

- Android: heart-shaped/angulated, resembles a male pelvis, not favourable for labour & birth,

narrow pelvic planes can cause slow descent and mid-pelvic arrest

- Platypelloid: flat with an oval inlet, wide transverse diameter, but short antero-posterior

diameter, making labour and birth difficult