Ob

OB Probable sign of pregnancy …Goodell’s sign (softening of the cervix) …enlargement of uterus Positive sign of pregnancy …fetal movement …quickening …fetal heart beat Chloasma / melasma – brown spots on face Striae gravid arum – stretch mark on abdomen Linea nigra – dark vertical line on abdomen Chadwick’s s/ - discoloration of vagina Amniocentesis – detects maturity of the fetus UTZ – gender of the fetus Chorionic villus sampling – detects presence of genetic d/o or fetal abnormality LMP – 3 months + 7 days = EDP/EDC Urine samples in p-test = (+) chorionic gonadotropin Rich in Hgb thus iron (livers, tomato, dried apricots, peas, prune juice) Chloasma – mask of pregnancy Increased vaginal discharge / bleeding – danger sign of pregnancy, due to uterine atony or laceration Colostrums – (+) in 4th month Pregnant woman’s breast colostrums, tingling sensation & darkening of areola; no increased in size Breast tenderness on first trimester Safe to give antibiotics during the first trimester Constipation if best treated with increased bulk and fluid in diet Normal glycosuria, abnormal with oliguria Release of ovarian follicle happens on the 14th or 15th day of cycle Quickening and fetal heart beat – 20th week If vaginal bleeding occurs, call the physician first and report the amount and type of bleeding Toxoplasmosis – risk factor is having a cat in one’s house True labor – increasing in frequency and duration Childbirth education – to have an emotionally satisfying birth experience In birthing center, if both parents are anxious, demonstrate comfort measures the father may use When a 2-yr old sibling of the born child seems interested, this is just his part of developmental level Normal = lower abdominal pain may be experienced at the time of rupture of the follicle

Cervix 2 cm dilated, moderate bright red vaginal bleeding = inevitable abortion Initial nursing mgt = examine perineal pads for tissues and clots Baby is no longer alive but the body has not expelled it yet = missed abortion McDonald’s procedure = will be sutured temporarily, to be removed at term. Important to recognize the s/sx of labor Ectopic pregnancy – spotting, lower abdominal pain radiating to shoulders High risk factor is having 3 consecutive spontaneous deliveries Placenta previa – small amount of bright red bleeding, painless, caused by abnormal implantation of the placenta Initial action is to estimate amount of blood loss, then keep on bed rest and limit physical activity Abruption placenta – bright red blood, painful Predisposing factor – multiple pregnancy Further assessment – abdominal examination for s/sx of tenderness or rigidity Initial nursing mgt – administer O2 Complication – DIC (disseminated intravascular coagulation syndrome) S/sx – venipuncture site continues to bleed for 15 mins (+)meconium staining in vaginal discharge – check fetal heart tome and apply external fetal monitor first before calling physician Prevent convulsion – keep room dimly lit Bed rest with PIH – reduce pressure by lowering body metabolism Antagonist for MgSO4 – Ca Gluconate Has a minor effect to the baby Insulin needs will vary throughout the pregnancy Diabetic baby – (+) tremors Breastfeeding predisposes the mother to infection Potential problem for pregnant with a hx of heart d’se – reduced tolerance of activity (+) pubertal acceleration in growth of pregnant adolescents – basic consideration in pregnant adolescents Hazard – increased mortality rate, increased incidence of anemia, vaginitis, UTI, and PIH Increased demand in iron during pregnancy is due to an expansion in total blood cell volume and Hgb mass by approx 25-50% during pregnancy

Most impt ax when ROM occurscolor of amniotic fluid Rectal pressure – transitional phase of labor Variable deceleration - due to cord compression N – early deceleration and good variability Late deceleration is Abn Fetal heart rate drops during contraction and returns to baseline at the end of contraction is NORMAL Fetal heart rate drops during contraction and returns to baseline a minute after contraction is ABNORMAL Late deceleration is observed – turn off the oxytocin immediately, then determine the extent of cervical dilatation Impt ax for mother given with epidural anesthetic – monitor BP Most impt discharge instruction – family planning information Weight gain: 1st trim = 1 lb/wk = 12 lb 2nd trim = 1 lb/wk = 12 lb 3rd trim = 2 lb/mo = 6 lb Total = 30 lbs Some: 1st trim = 3 lb 2nd trim = 12 lb 3rd trim = 12 lb Total = 27 lbs Normal FTHR = 120 – 160 bpm Teratogen – causes px defects on the fetus Placenta – carry nourishment, empty waste, provide several hormones Amniotic fluid – prevents fetus from external injury Toxoplasmosis Other infection (hepa a and b) Rubella Cytomegalovirus Herpes simplex Torch – group of d’se that harms fetus Umbilical vein – pathway of O2 Ampulla – fertilization Isthmus – tied in tubal ligation Meconium stain in breech presentation = N …in cephalic is abnormal = fetal distress To determine nutritional needs – assess first what she eats now High in calcium – green veggies esp. broccoli Milk – 4 servings daily, 1L, 4 cups Iron is most impt in 2nd trim Braxton hicks – painless contractions CI when having vaginal bleeding – vaginal exam Causes of vaginal bleeding (ectopic or abortion, Hmole, abruptio, previa) Nursing care during the 1st stage of labor

First stage of labor – dilatation of the cervix 8 – 10 cm and cervical effacement Station – degree of descent of the fetal head or presenting part Back lying – hypotensive Semi sitting – venacava compression Sim’s position – best and preferred FHR normally slows at the onset of a contraction FHR is abnormal if it slows at the peak of the contraction, or remains unchanged, or slows immediately after a contraction (late deceleration) Transitional phase – most encouragement and support is effective when given End of first stage of labor (encouraging voiding, breathing deeply, and lying on left side; least appropriate is to have client push with contraction – 2nd stage of labor) Nitrazine test – differentiate b/w urine and amniotic fluid; blue – af; red – blood Distended bladder prevent the descent of the fetus Offer bedpan in frequent interval Enema is ordered to prevent contamination of feces when it is expelled during delivery Beginning of contraction until end of it – duration End of contraction until another beginning – interval Duration count in specified time – frequency To feel the contraction – place hands just above the umbilicus Feel the FHR during the contraction and immediately after the contraction Prepare vaginal exam – clean vulva Very early stage of labor – offer water or clear liquid because solid foods result to vomiting Position – presenting fetal body part in relation to mother’s pelvis Primary reason for episiotomy – prevent prolonged pressure on fetal head Primipara is taken into the delivery room when the perineum is bulging Multipara is taken into the delivery room when the cervix is dilated 6-8 cm ACTIVE - cont q15-20 mins, 1030 sec duration, mild intensity, cervix 3 cm dilated LATENT – cont q3-5 mins, 30-45 sec duration, mod intensity, cervix 6 cm dilated; ambulate TRANSITIONAL - cont q1-2 mins, 45-60 sec duration, strong intensity, and cervix 8 cm dilated Nursing care during the 2nd stage of labor Begins when cervix is fully dilated Encourage to push down

Narcotic analgesic given late in the first stage of labor – may result in respi depression of the newborn To lessen discomfort – assume sim’s pos’n Pant b/w contractions Observe for s/ of hyperventilation – blurred vision and tingling of extremities Have the client breathe into a small paper bag Saddle block (subarachnoid block) – take effect almost immediately Nursing care during the 3rd stage of labor Delivery of the newborn until delivery of placenta and membranes Relax in b/w contractions – delivery of the baby Delivery of the placenta – push with contraction Clamp the cord after the cord stops pulsating s/e of oxytocin – water retention and water intoxication Oxytocin – strengthens contractions of the uterus Bonding b/w newborn and parents – during first hour after delivery Prevent of loss of body heat – placing under radiant source of heat Apply in lower conjunctival sac – silver nitrate Apgar – ax of physical condition of the newborn 0-3 = immediate resuscitation 4-6 = guard the baby 7-10 = free from immediate distress Placental separation – sudden gush of blood from the vagina, lengthening of the umbilical cord, upward rise in the uterus th

Nursing care during the 4 stage of labor Time when placenta is delivered upto 2-4 hours after delivery of the placenta Fundus should be firmly contracted in b/w navel and symphisis pubis After 12 hrs – level of navel After 24 hrs – 1 cm below umbilicus Fundus should be checked for the first hour every 15 minutes; fundus should be massaged if it feels soft and boggy One hand on the fundus, other just over the pubic bone Nursing care during postpartum Delivery of newborn until 6 wks after birth Lochia: 1-3 rubra (bright red) 4-9 serosa (pink) 10-15 alba Hematoma s/sx - swelling and discoloration of the skin around perineum, pain

Encourage ambulation to prevent circulatory system problem Complain of discomfort due to episiotomy – place heat lamp 18-24 inches from the perineum (as prescribed) At home – sitz bath 1st 24 hr – cold After 24 hr – hot Propoxyphene HCL (Darvon) – relieves pain Perineal care – front to back Breast engorgement – occurs on the 3rd postpartum day Taking in phase – 1-2nd day, passive Taking hold phase – holds responsibility; 2-4th day Postpartum blues – 1st 2 weeks, withdrawal of maternal hormones, hypothyroidism , lack of family support, dec progesterone and estrogen and inc prolactin Postpartum depression – 6mos to 1 yr Postpartum psychosis – requires hospitalization Chronic sorrow – prolonged grief Complications of pregnancy Bleeding 1st trim – abortion, ectopic 2nd trim – hmole, incompetent cervix (weight of the fetus causes the cervix to dilate) 3rd trim – apruptio (painful, hard board like – couvelaire’s uterus, premature separation of normally implanted placenta, in severe AP, observe for shock) previa (painless, check for decreased BP and increased PR, abnormal implantation) Abundant vaginal discharge during prenatal – infection, std, protozoan flagellate Hyperemesis gravid arum – vomits 4 times / day, emergency Cause of PIH – unknown, common among the poor HEP (HPN, edema, proteinuria) Convulsion – eclampsia, provide safe env’t (dimly lit room) Prepared drug – Mg SO4, 4-7 mEq/L Nursing resp – check for RR, reflexes (tendon and patellar), and urine output (measures hourly) Ectopic – outside uterus, WOF hemorrhage Spontaneous abortion – occurs without the client having done anything to cause it Threatened SA – observe for uterine cramping and loss of amniotic fluid Glucose – 70 to 150 mg/dl Problems – macrosomic baby, larger than average Constipation – increase fluid, high fiber, exercise

Varicose – avoid crossing legs, knees, and ankle …gentle massage on affected area …elastic bandage …contact physician if soreness, redness, or warmth develops in the veins (life threatening, can cause embolism) Skin itches – use of lotion on areas of dryness Edema on late pregnancy – pressure of an enlarged uterus on pelvic veins Lower daily intake of salt – 3g/day Also elevate legs and feet for short periods during the day Dyspnea is often normal during third trimester Urinary frequency during late in pregnancy – enlarging uterus is causing pressure on the bladder nd 2 month – less frequency because uterus rises into the abdominal cavity Backache /pelvic rock – wear low heeled shoes Nausea / Heat5burn – sff Calcium tabs – for leg cramps Fetal alcohol syndrome – joint and limb abnormalities, microcephaly, abn cns Newborns of mothers addicted to narcotic such as heroin – suffer withdrawal sx Smoking – newborn is smaller CS Apply gel before fetal transducer to improve conduction of sound Catheter – keep bladder empty during the procedure CS delivery – care is most likely of that who undergone abdominal surgery Shock – hypo tachytachy INC ICP – hyper bradybrady Patient controlled analgesia – device gives a larger than normal dose of the drug to provide instant pain relief Postop abdominal distention – ambulation Multigravida, past babies came fast..when shouts THA BABY IS COMING!, provide immediately a clean field for delivery It head continues to crown, allow head to emerge slowly and deliver it between contraction. NEVER push back firmly on the head. NEVER place pressure on the vaginal meatus. NEVER let the legs close. NEVER slide finger into the vagina and delivers the head during contractions Most common fetal complication in elective cs – prematurity Major indication – disproportionate is the fetal head to birthing canal Care for the young family Crede’s prophylaxis – prevent opthalmia neonatorum; silver nitrate 1% sol’n, penicillin,

erythromycin (occurs in contact with gonoccocus) Inappropriate agent – mycostatin (fungus) Don’t rinse eyes after instillation Administer within 2 hrs after birth Vitamin K – antihemorrhagic; anterior/lateral thigh; IM; being administered because of lacking bacterial flora in colon Rectal temp – check for patency (these days, not being practiced) F – 32 / 1.8 C x 1.8 + 32 Regurgitation of small amount of mucus – suctions and considers it normal Hexacholorophene soap – can cause neurologic damage Healing of cord stump – 7th day Initial ax – includes px appearance, neurologic reflexes, gestational age Babinski – stroking foot from heal to toe Moro – providing sudden change in equilibrium Plantar – infant’s feet to touch surface Tonic neck reflex – flexion of left arm and leg and extension of the right arm and leg when the head is turned toward the right Moro reflex absent and diminished within first 24 hrs – normal due to temporary variation in CNS conditions Sterile water for first feeding – if it was aspirated due to GI anomaly, sterile water is less irritating to the lungs Intercostal retractions – abnormal Comfortable position in breastfeeding the baby – lying on your side Sore nipples – expose nipples to air after feeding To break suction of the baby – place finger in the corner of the mouth To alert baby to grab and hold – brush the nipple against the mouth To make nipple more prominent – hold it b/w 2 fingers Physiologic weight loss – 5-10% of its weight Pregnant mother – additional 300 kcal Lactating mother – additional 500 kcal Maturational crisis- disequilibrium related to anticipated developmental task Be directive and offer client specific guidelines for reducing stress Milk production – prolactin; APT Let down of milk – oxytocin In 3rd trim where maternal antibodies are transferred to the fetus

IgG – most abundant, 80%, crosses placenta IgA – 15 % IgM – largest macrophage, obese member IgA – colostrums Black and sticky stool – meconium stool; normal Brick dust – normal; pinkish, brick colored, powder stain stool Opponent of circumcision – penile ulceration and meatal stenosis Proponent of it – physical hygiene Cord care – wipe with alcohol on and around it a couple times a day; when it falls off, I can put the baby down in bath water PKU – for inherited cause of mental retardation; early dx Baby 3 day old, (+) jaundice – physiologic; inability to conjugate indirect bilirubin; normal in 2nd to 3rd day; disappears in 4th or 5th day Pathologic – 1st 24 hrs Preterm – born before 38th week Preterm, posterm, sga, and lga – all prone to hypoglycemia SGA – 13 inches head (13.5), 11 inches chest (13), 21 and half inches length, 6 and half lbs (7); skin dry, desquamation, loose folds, abdomen appears sunken Preterm and sga – highest risk for mortality Preterm 30 weeks – thick layer of vernix, no palpable breast tissue, soft pinna folded, smooth soles without creases, lanugo entirely, prominent clitoris, widely separated labia, no arm recoil Hypothermia (immature cns regulatory mechanism, tightly flexed position, decreased stores of brown fat and glycogen) Cold stress – compromised heat production ability due to decreased brown fat storage Humidified O2 is warmed to prevent cold stress Other problem that may occur with cold stress – increased metabolic rate Brown fat – abundant vascular and nerve supply Respi distress – head slightly elevated and neck slighty hyperextended to open airway …due to decreased surfactant Alveolar collapse – leads to respi acidosis and metabs alkalosis Retrolental fibrolpasia – administer O2 at 40% concentration or less Dextrosix – detects presence of hypoglycemia Rationale: an IDM (infant of diabetic mother) has hyperinsulinemia and decreased gluconeogenesis Prone also to polycythemia – increased RBC Safe rule of thumb – offer 2 to 4 cc the first 24 hrs, then

increase 1 cc every other feeding to a max of 10 cc Tube meas’t – ear to the nose/mouth to the xyphoid process Lubricate with sterile water NOT water based lubricant nor petrolatum 15 cc is ordered; 5 cc is aspirated = 15 – 5 = 10 cc is to be taken Common cause of sepsis – group B beta streptococcus and gram negative organism Asphyxia – inc CO2, ph under 7.35 and dec o2 level Coombs test RBC – direct Plasma – indirect Mother Rh (-) and type A Baby Rh (+) and type O = baby has jaundice due to Rh incompatibility Mother Rh negative Baby Rh positive …rhogam is ordered 72 hrs after delivery to prevent maternal antibody formation Sepsis Early sign – fever Late signs – hyperactivity, poor feeding, tachypnea (+) hcg in the urine 10 days after the missed period Counting back s months from the first day of last normal menstrual period and aading 7 days VDRL and Rubella titer – detects syphilis and german measles Albumin and glucose test – detects kidney infection, preeclampsia, and diabetes Sudden vaginal discharge and facial swelling SHOULD be reported Mood changes (ambivalence, moodswings, self focused) Nutrition: 4-6 servings of meat, 56 of fruits and vegetables, 4 of cereals, 4 of milk; NO FATS AND SIMPLE CHO Increased vit c: broccoli, baked potato, cantaloupe, green peppers 5th month – fundal height at the umbilicus, FHT, fetal mov’t Irritating vaginal discharge – trichomonas or candida albicans Heartburn / Pyrosis – burning sensation in esophageal area that radiates upward, freq burping of small amount of sour tasting liquid; avoid greasy foods and reaching for items by bending at the knees; to relieve, use of nonsodium antacids (milk of Magnesia) and sips of milk or hot tea Preventing leg cramps at night – decreasing milk intake and increasing calcium lactate

Fertilization – fallopian tube Single fertile ejaculation – 3 to 4 million; 3-5 cc; 1 tsp Mitosis – cell division; same number and pattern of chromosomes Zygote – union of male and female gamete; 2 weeks Cellular change (morula to blastocyst to trophoblast) Embryo – 2 weeks – 2 months; organ development Fetus – 2 months – delivery Completion of fertilization – 7 to 9 days Embedded ovum is surrounded by deciduas basalis and capsularis Placenta’s primary purpose – metabolic exchange b/w maternal and fetal.. Body flexed, fetal heart beat, neural tube closed, liver conspicuous – 4 weeks Digits well formed, ossification, some movement – 8 weeks Scalp hair, nails, kidney secretes urine, sex determination, meconium – 16 weeks (4mos) Vernix, lanugo, teeth enamel and dentin, fetal movement felt by mother (quickening) – 20 weeks (5 mos) Surfactant, pupils reacting to light, eyebrows and eyelashes – 28 weeks (7 mos) Fetal circulation – high vascular resistance Ductus arteriosus – shunts blood from pulmonary artery to the descending aorta …becomes ligamentum arteriosum Umbilical vein – carries arterial blood from the placenta to the fetus Twins – gravida 1 Most likely to have twins – eldest among options and multigravida Most likely to have down syndrome – “ “ Genetic dx and counseling – 3 months or 12th week Rheumatic heart disease Class 1 – no limitation Class 2 - slight Class 3 - moderate Class 4 – unable to carry on activity Major complication – increased blood volume and potential congestive heart failure; fetal hypoxia and/or death If delivered normally – should be carefully monitored because high risk for postpartal hemorrhage Cardiac decompensation – cough, dyspnea, edema, arrhythmia Class I cardiac disease, on penicillin and Coumadin prophylaxis – continue pregnancy and penicillin, change coumadin to heparin Minimal morning sickness in diabetic pregnant –

ketoacidosis may occur, putting the fetus at risk Diabetic control – self monitoring of dextrostix values; split insulin doses; use of mixed insulins; increased insulin doses as required Amniocentesis – evaluate lecithin/sphingomyelin (L/S) ratio – indicative of lung maturity is 2:1 Serial urinary estriol – indicator of near impending death is 4 mg in 24 hrs Rhythm method – changes in basal body temp; increase in progesterone secretion Falls 0.2˚ for 1-3 days and rises 0.5 – 0.8˚ for 3rd day Effectiveness of this is to take note of oral and cervical mucus changes Condom – mechanical blockage of sperm Spermacide – killing of sperm, decreasing sperm motility, chemical blockage to sperm Oral contraceptive – suppression of ovulation, alteration in endometrial maturation, alteration in cervical mucosa Complication: thromboembolitic disease Probable cause of infertility if there is a hx of PID – stricture of fallopian tubes Rubin’s infertility test – controlled amt of CO2 is introduced under pressure into the intrauterine cavity Gravida 2 Para 2 – pregnant for the 4th time and had 2 previous pregnancies carried to the period of variability -4-3-2-1 0+1+2+3+4 Don’t eat during labor – aspiration SS enema – cleanse the large bowel and allow more room in the birth canal Full bladder impedes descent of the fetus Nitrazine tape test: urine (red); AFluid (blue) Positive bloody show happens with increased in cervical dilatation Pushes down before one’s cervix is fully dilated may develop cervical edema Breech – fetal sacrum presentation Frank breech – with legs extending over the anterior surface of the body Complete breech – sitting When giving PRN medications for pain – it is important to assess fht and maternal v/s Hyperventilate – alkalosis; tingling of face, fingers, and feet If mother is alkalosis – fetus will experience acidosis and vise versa

To correct alkalosis / hyperventilation – breathe into a paper bag Gynecoid pelvis – rounded inlet, nonprominent ischial spines, wide and deep sacral curve; most favorable type for childbearing Android – male, prominent ischial spine Anthropoid – AP diameter is longer than transverse diameter Platypelloid – shallow pelvis Conjugates True Obstetric – most important Diagonal – 1.5 cm; used to asses inlet; distance b/w sacral promontory and the lower margin of the symphysis pubis Biischial diameter – transverse diameter of the pelvic outlet Attitude – refers to the relation of the fetal parts to one another or to the posture of the fetus in utero Suture and fontanels are great diagnostic value Lightening – engagement of the presenting part; pressure on diaphragm is relieved Left occiput anterior – most common position Right occiput anterior – vertex presentation toward the right front quadrant of the maternal pelvis Presentation – part of the fetus which enters pelvic passageway first Transverse lie – scapula presenting part; due to placenta previa, small pelvis, or relaxed abdominal walls Major cause of perinatal death; breech presentation = trauma sustained delivery FHT b/w symphisis and navel – cephalic FHT above navel – breech Steps Descent – flexion – internal rotation – extension – external rotation – expulsion Complete flexion – advantageous because fetus is presenting the smallest antero-posterior diameter of the skull True labor vs. false labor = cervical dilatation and effacement; 2ndly regular contractions Onset of true labor – regular and predictable contractions Increased estrogen, oxytocin, and fetal corticosteroids NOT progesterone Cervical dilatation and effacement are accomplished by uterine contractions only 3 contractions/10 min period – adequate uterine contractility

Stop oxytocin if having too strong contraction Late deceleration – turns on left side then calls the physician Place the Doppler over the area where the FHT are heard best Beta-to-beat variability – interval b/w FHT Baseline FHR – range of FHR obtained b/w contractions or when the pt is not in labor Maternal fever – common cause of fetal tachycardia Saddle block anesthesia – may use forcep delivery because of loss of the mother’s urge to bear down; fetal bradycardia and maternal hypotension Laceration 1st – perineal skin and vaginal mucosa 2nd - + muscles and fascia 3rd - +anal sphincter 4th - +exposure of rectal lumen When in active labor, check perineum first When head crowns – asks px to pant When delivering placenta – asks px to bear down When there is no sign of placental separation – do not manipulate, wait further When PROM – check for cord prolapse; first priority – check the FHT When cord prolapsed, primary obj is to relieve pressure on the umbilical cord When pre eclampic – probable seizure Readily available – O2 and suction machine Classic signs of pre eclampsia (proteinuria, weight gain excessively, hypertension) Predisposing factors – DM, Multiple pregnancy, Hmole, NOT placenta previa or abruption placenta Drug – Mg SO4; sedative anticonvulsant, vasodilator Don’t administer when (-) knee jerk reflex First sign of recovery is diuresis If complains headache – check BP immediately Hyperactive DTR and pattelar reflex – pt may convulse Abortion – termination of pregnancy at any time before variability Most frequent cause of early spont abortion – defect of the embryo Shirodkar – procedure for incompetent cervix Complication of abruption placenta – hypofibrinogenemia Hmole – dev’t normally of placenta, rapin enlargement of uterus with bleeding, degenerating vili, distended with fluid, in grapelike clusters Celestone – increase fetal lung maturity

If uterus is boggy – massage until firms Proper technique in massaging – supporting lower portion while massaging the upper portion Height of fundus decreases normally ½ to ¾ inch daily Uterus should return to nonpregnant state on the 6th wk 1 and ½ month Temporary glycosuria and proteinura is normal Normal estrogen levels – 5-10 weeks postpartum External cervical os is oval shaped – always identify her as having borne a child (+) breast milk – decreased prolactin, increased fsh Milk let down can be achieved by sucking, hearing an infant’s cry and seeing the infant Colostrums – (+) antibodies and IgA Breastfeeding helps mother to a more rapid involution Postpartal hemorrhage can lead the mother to be anxious and restless; hypotension; defined as estimated bld loss of more than 500 cc from delivery through he 28th day postpartum Retained placental fragments – heavy vaginal discharge, (+) clots, boggy uterus, massage expels more clots Uterine atony – complication that can lead to moderate bright red bleeding, fundus firm on palpation Uterine rupture – severe agonizing pain, contraction ceases, shocky, minimal vaginal bleeding, no FHT Uterine subinvolution – dragging backache Endometritis – red discharge, small amount, foul odor, uterine cramping Parametritis – infection extending to pelvic connective tissue around the uterus Pelvic thrombophlebitis – onset is on 2nd week postpartum involving uterine or ovarian veins with chills and high fever Sheehan’s syndrome / anterior pituitary necrosis – postpartal hemorrhage, severe hypovolemic shock, increased breast size, loss of pubic and axillary hair, genital atrophy, amenorrhea Extrauterine life – closure of foramen ovale and ductuc arteriosus Kidney function of baby – glomerular function is low Molding – fetal skull bones shift position to ease passage of the baby Capput succedaneum – swelling of scalp tissue Trendelenburg – to facilitate drainage of mucus

Brown fat – major energy source of neonate Normal – erythema toxicum neonatorum, stork bite marks, Mongolian spots Abnormal – impetigo (bacterial infection) Congenital cataracts – opacity of pupils, special attention is neede Visual capacity – short distance First parent-child activity - human faces, black and white objects Tactile stimulation – stroking baby gently from head tot toe; suggestive play for parents and baby Diabetic mother – WOF for hypoglycemic baby Epstein pearls – small raised white bump on the palate, does not bleed Spitting up after feeding – immature cardiac sphincter Anterior – 12 -18 months Posterior – 2 – 3 months