Nursing Bullets: Maternal & Child Health Nursing Reviewer (350 Items)

This !vers t!"i a#!ut la#!r$ "regnan %$ nursing are !& the new#!rn$ devel!"mental stages and man% m!re' This "!st !ntains 350 nursing #ullets'

(nli)e &alse la#!r$ true la#!r "r!du es regular rh%thmi !ntra ti!ns$ a#d!minal dis !m&!rt$ "r!gressive des ent !& the &etus$ #l!!d% sh!w$ and "r!gressive e&&a ement and dilati!n !& the ervi*+ T! hel" a m!ther #rea) the su ti!n !& her #reast,&eeding in&ant$ the nurse sh!uld tea h her t! insert a &inger at the !rner !& the in&ant-s m!uth+ .dministering high levels !& !*%gen t! a "remature ne!nate an ause #lindness as a result !& retr!lental &i#r!"lasia+ .mni!t!m% is arti&i ial ru"ture !& the amni!ti mem#ranes+ /uring "regnan %$ weight gain averages 05 t! 30 l# (11 t! 13+5 )g)+ Ru#ella has a terat!geni e&&e t !n the &etus during the &irst trimester+ It "r!du es a#n!rmalities in u" t! 203 !& ases with!ut interru"ting the "regnan %+ Immunit% t! ru#ella an #e measured #% a hemagglutinati!n inhi#iti!n test (ru#ella titer)+ This test identi&ies e*"!sure t! ru#ella in&e ti!n and determines sus e"ti#ilit% in "regnant w!men+ In a w!man$ a titer greater than 1:4 indi ates immunit%+ 5hen used t! des ri#e the degree !& &etal des ent during la#!r$ &l!ating means the "resenting "art isn-t engaged in the "elvi inlet$ #ut is &reel% m!va#le (#all!ta#le) a#!ve the "elvi inlet+ 5hen used t! des ri#e the degree !& &etal des ent$ engagement means when the largest diameter !& the "resenting "art has "assed thr!ugh the "elvi inlet+ 6etal stati!n indi ates the l! ati!n !& the "resenting "art in relati!n t! the is hial s"ine+ It-s des ri#ed as 71$ 70$ 73$ 72$ !r 75 t! indi ate the num#er !& entimeters a#!ve the level !& the is hial s"ine8 stati!n 75 is at the "elvi inlet+ 6etal stati!n als! is des ri#ed as 91$ 90$ 93$ 92$ !r 95 t! indi ate the num#er !& entimeters it is #el!w the level !& the is hial s"ine8 stati!n 0 is at the level !& the is hial s"ine+ /uring the &irst stage !& la#!r$ the side,l%ing "!siti!n usuall% "r!vides the greatest degree !& !m&!rt$ alth!ugh the "atient ma% assume an% !m&!rta#le "!siti!n+ /uring deliver%$ i& the um#ili al !rd an-t #e l!!sened and sli""ed &r!m ar!und the ne!nate-s ne )$ it sh!uld #e lam"ed with tw! lam"s and ut #etween the lam"s+ .n ."gar s !re !& : t! 10 indi ates n! immediate distress$ 2 t! ; indi ates m!derate distress$ and 0 t! 3 indi ates severe distress+ T! eli it M!r!-s re&le*$ the nurse h!lds the ne!nate in #!th hands and suddenl%$ #ut gentl%$ dr!"s the ne!nate-s head #a )ward+ N!rmall%$ the ne!nate a#du ts

and e*tends all e*tremities #ilaterall% and s%mmetri all%$ &!rms a C sha"e with the thum# and &!re&inger$ and &irst addu ts and then &le*es the e*tremities+ <regnan %,indu ed h%"ertensi!n ("ree lam"sia) is an in rease in #l!!d "ressure !& 30=15 mm Hg !ver #aseline !r #l!!d "ressure !& 120=>5 mm Hg !n tw! ! asi!ns at least ; h!urs a"art a !m"anied #% edema and al#uminuria a&ter 00 wee)s- gestati!n+ <!sitive signs !& "regnan % in lude ultras!und eviden e$ &etal heart t!nes$ and &etal m!vement &elt #% the e*aminer (n!t usuall% "resent until 2 m!nths- gestati!n ?!!dell-s sign is s!&tening !& the ervi*+ @ui )ening$ a "resum"tive sign !& "regnan %$ ! urs #etween 1; and 1> wee)sgestati!n+ Avulati!n eases during "regnan %+ .n% vaginal #leeding during "regnan % sh!uld #e !nsidered a !m"li ati!n until "r!ven !therwise+ T! estimate the date !& deliver% using NBgele-s rule$ the nurse !unts #a )ward 3 m!nths &r!m the &irst da% !& the last menstrual "eri!d and then adds : da%s t! this date+ .t 10 wee)s- gestati!n$ the &undus sh!uld #e at the t!" !& the s%m"h%sis "u#is+ C!w-s mil) sh!uldn-t #e given t! in&ants %!unger than age 1 #e ause it has a l!w lin!lei a id !ntent and its "r!tein is di&&i ult &!r in&ants t! digest+ I& Caundi e is sus"e ted in a ne!nate$ the nurse sh!uld e*amine the in&ant under natural wind!w light+ I& natural light is unavaila#le$ the nurse sh!uld e*amine the in&ant under a white light+ The three "hases !& a uterine !ntra ti!n are in rement$ a me$ and de rement+ The intensit% !& a la#!r !ntra ti!n an #e assessed #% the indenta#ilit% !& the uterine wall at the !ntra ti!n-s "ea)+ Intensit% is graded as mild (uterine mus le is s!mewhat tense)$ m!derate (uterine mus le is m!deratel% tense)$ !r str!ng (uterine mus le is #!ardli)e)+ Chl!asma$ the mas) !& "regnan %$ is "igmentati!n !& a ir ums ri#ed area !& s)in (usuall% !ver the #ridge !& the n!se and hee)s) that ! urs in s!me "regnant w!men+ The g%ne !id "elvis is m!st ideal &!r deliver%+ Ather t%"es in lude "lat%"ell!id (&lat)$ anthr!"!id (a"eli)e)$ and andr!id (maleli)e)+ <regnant w!men sh!uld #e advised that there is n! sa&e level !& al !h!l inta)e+ The &reDuen % !& uterine !ntra ti!ns$ whi h is measured in minutes$ is the time &r!m the #eginning !& !ne !ntra ti!n t! the #eginning !& the ne*t+ Eitamin F is administered t! ne!nates t! "revent hem!rrhagi dis!rders #e ause a ne!nate-s intestine an-t s%nthesiGe vitamin F+ Be&!re internal &etal m!nit!ring an #e "er&!rmed$ a "regnant "atient-s ervi* must #e dilated at least 0 m$ the amni!ti mem#ranes must #e ru"tured$ and the &etus-s "resenting "art (s al" !r #utt! )s) must #e at stati!n 71 !r l!wer$ s! that a small ele tr!de an #e atta hed+

6etal al !h!l s%ndr!me "resents in the &irst 02 h!urs a&ter #irth and "r!du es letharg%$ seiGures$ "!!r su )ing re&le*$ a#d!minal distenti!n$ and res"irat!r% di&&i ult%+ Earia#ilit% is an% hange in the &etal heart rate (6HR) &r!m its n!rmal rate !& 100 t! 1;0 #eats=minute+ . elerati!n is in reased 6HR8 de elerati!n is de reased 6HR+ In a ne!nate$ the s%m"t!ms !& her!in withdrawal ma% #egin several h!urs t! 2 da%s a&ter #irth+ In a ne!nate$ the s%m"t!ms !& methad!ne withdrawal ma% #egin : da%s t! several wee)s a&ter #irth+ In a ne!nate$ the ardinal signs !& nar !ti withdrawal in lude !arse$ &la""ing trem!rs8 slee"iness8 restlessness8 "r!l!nged$ "ersistent$ high,"it hed r%8 and irrita#ilit%+ The nurse sh!uld !unt a ne!nate-s res"irati!ns &!r 1 &ull minute+ Chl!r"r!maGine (Th!raGine) is used t! treat ne!nates wh! are addi ted t! nar !ti s+ The nurse sh!uld "r!vide a dar)$ Duiet envir!nment &!r a ne!nate wh! is e*"erien ing nar !ti withdrawal+ In a "remature ne!nate$ signs !& res"irat!r% distress in lude n!stril &laring$ su#sternal retra ti!ns$ and ins"irat!r% grunting+ Res"irat!r% distress s%ndr!me (h%aline mem#rane disease) devel!"s in "remature in&ants #e ause their "ulm!nar% alve!li la ) sur&a tant+ 5henever an in&ant is #eing "ut d!wn t! slee"$ the "arent !r aregiver sh!uld "!siti!n the in&ant !n the #a )+ (Remem#er #a ) t! slee"+) The male s"erm !ntri#utes an H !r a I hr!m!s!me8 the &emale !vum !ntri#utes an H hr!m!s!me+ 6ertiliGati!n "r!du es a t!tal !& 2; hr!m!s!mes$ in luding an HI !m#inati!n (male) !r an HH !m#inati!n (&emale)+ The "er entage !& water in a ne!nate-s #!d% is a#!ut :43 t! 403+ T! "er&!rm nas!tra heal su ti!ning in an in&ant$ the nurse "!siti!ns the in&ant with his ne ) slightl% h%"ere*tended in a Jsni&&ingK "!siti!n$ with his hin u" and his head tilted #a ) slightl%+ Argan!genesis ! urs during the &irst trimester !& "regnan %$ s"e i&i all%$ da%s 12 t! 5; !& gestati!n+ .&ter #irth$ the ne!nate-s um#ili al !rd is tied 1L (0+5 m) &r!m the a#d!minal wall with a !tt!n !rd$ "lasti lam"$ !r ru##er #and+ ?ravida is the num#er !& "regnan ies a w!man has had$ regardless !& !ut !me+ <ara is the num#er !& "regnan ies that rea hed via#ilit%$ regardless !& whether the &etus was delivered alive !r still#!rn+ . &etus is !nsidered via#le at 00 wee)sgestati!n+ .n e t!"i "regnan % is !ne that im"lants a#n!rmall%$ !utside the uterus+ The &irst stage !& la#!r #egins with the !nset !& la#!r and ends with &ull ervi al dilati!n at 10 m+

The se !nd stage !& la#!r #egins with &ull ervi al dilati!n and ends with the ne!nate-s #irth+ The third stage !& la#!r #egins a&ter the ne!nate-s #irth and ends with e*"ulsi!n !& the "la enta+ In a &ull,term ne!nate$ s)in reases a""ear !ver tw!,thirds !& the ne!nate-s &eet+ <reterm ne!nates have heel reases that !ver less than tw!,thirds !& the &eet+ The &!urth stage !& la#!r ("!st"artum sta#iliGati!n) lasts u" t! 2 h!urs a&ter the "la enta is delivered+ This time is needed t! sta#iliGe the m!ther-s "h%si al and em!ti!nal state a&ter the stress !& hild#irth+ .t 00 wee)s- gestati!n$ the &undus is at the level !& the um#ili us+ .t 3; wee)s- gestati!n$ the &undus is at the l!wer #!rder !& the ri# age+ . "remature ne!nate is !ne #!rn #e&!re the end !& the 3:th wee) !& gestati!n+ <regnan %,indu ed h%"ertensi!n is a leading ause !& maternal death in the (nited Mtates+ . ha#itual a#!rter is a w!man wh! has had three !r m!re !nse utive s"!ntane!us a#!rti!ns+ Threatened a#!rti!n ! urs when #leeding is "resent with!ut ervi al dilati!n+ . !m"lete a#!rti!n ! urs when all "r!du ts !& !n e"ti!n are e*"elled+ H%dramni!s ("!l%h%dramni!s) is e* essive amni!ti &luid (m!re than 0$000 ml in the third trimester)+ Mtress$ deh%drati!n$ and &atigue ma% redu e a #reast,&eeding m!ther-s mil) su""l%+ /uring the transiti!n "hase !& the &irst stage !& la#!r$ the ervi* is dilated 4 t! 10 m and !ntra ti!ns usuall% ! ur 0 t! 3 minutes a"art and last &!r ;0 se !nds+ . n!nstress test is !nsidered n!nrea tive ("!sitive) i& &ewer than tw! &etal heart rate a elerati!ns !& at least 15 #eats=minute ! ur in 00 minutes+ . n!nstress test is !nsidered rea tive (negative) i& tw! !r m!re &etal heart rate a elerati!ns !& 15 #eats=minute a#!ve #aseline ! ur in 00 minutes+ . n!nstress test is usuall% "er&!rmed t! assess &etal well,#eing in a "regnant "atient with a "r!l!nged "regnan % (20 wee)s !r m!re)$ dia#etes$ a hist!r% !& "!!r "regnan % !ut !mes$ !r "regnan %,indu ed h%"ertensi!n+ . "regnant w!man sh!uld drin) at least eight 4,!G glasses (a#!ut 0$000 ml) !& water dail%+ 5hen #!th #reasts are used &!r #reast,&eeding$ the in&ant usuall% d!esn-t em"t% the se !nd #reast+ There&!re$ the se !nd #reast sh!uld #e used &irst at the ne*t &eeding+ . l!w,#irth,weight ne!nate weighs 0$500 g (5 l# 4 !G) !r less at #irth+ . ver%,l!w,#irth,weight ne!nate weighs 1$500 g (3 l# 5 !G) !r less at #irth+ 5hen tea hing "arents t! "r!vide um#ili al !rd are$ the nurse sh!uld tea h them t! lean the um#ili al area with a !tt!n #all saturated with al !h!l a&ter ever% dia"er hange t! "revent in&e ti!n and "r!m!te dr%ing+ Teenage m!thers are m!re li)el% t! have l!w,#irth,weight ne!nates #e ause the% see) "renatal are late in "regnan % (as a result !& denial) and are m!re li)el% than !lder m!thers t! have nutriti!nal de&i ien ies+

Ninea nigra$ a dar) line that e*tends &r!m the um#ili us t! the m!ns "u#is$ !mm!nl% a""ears during "regnan % and disa""ears a&ter "regnan %+ Im"lantati!n in the uterus ! urs ; t! 10 da%s a&ter !vum &ertiliGati!n+ <la enta "revia is a#n!rmall% l!w im"lantati!n !& the "la enta s! that it en r!a hes !n !r !vers the ervi al !s+ In !m"lete (t!tal) "la enta "revia$ the "la enta !m"letel% !vers the ervi al !s+ In "artial (in !m"lete !r marginal) "la enta "revia$ the "la enta !vers !nl% a "!rti!n !& the ervi al !s+ .#ru"ti! "la entae is "remature se"arati!n !& a n!rmall% im"lanted "la enta+ It ma% #e "artial !r !m"lete$ and usuall% auses a#d!minal "ain$ vaginal #leeding$ and a #!ardli)e a#d!men+ Cutis marm!rata is m!ttling !r "ur"le dis !l!rati!n !& the s)in+ It-s a transient vas!m!t!r res"!nse that ! urs "rimaril% in the arms and legs !& in&ants wh! are e*"!sed t! !ld+ The lassi triad !& s%m"t!ms !& "ree lam"sia are h%"ertensi!n$ edema$ and "r!teinuria+ .dditi!nal s%m"t!ms !& severe "ree lam"sia in lude h%"erre&le*ia$ ere#ral and visi!n distur#an es$ and e"igastri "ain+ Art!lani-s sign (an audi#le li ) !r "al"a#le Cer) that ! urs with thigh a#du ti!n) !n&irms !ngenital hi" disl! ati!n in a ne!nate+ The &irst immuniGati!n &!r a ne!nate is the he"atitis B va ine$ whi h is administered in the nurser% sh!rtl% a&ter #irth+ I& a "atient misses a menstrual "eri!d while ta)ing an !ral !ntra e"tive e*a tl% as "res ri#ed$ she sh!uld !ntinue ta)ing the !ntra e"tive+ I& a "atient misses tw! !nse utive menstrual "eri!ds while ta)ing an !ral !ntra e"tive$ she sh!uld dis !ntinue the !ntra e"tive and ta)e a "regnan % test+ I& a "atient wh! is ta)ing an !ral !ntra e"tive misses a d!se$ she sh!uld ta)e the "ill as s!!n as she remem#ers !r ta)e tw! at the ne*t s heduled interval and !ntinue with the n!rmal s hedule+ I& a "atient wh! is ta)ing an !ral !ntra e"tive misses tw! !nse utive d!ses$ she sh!uld d!u#le the d!se &!r 0 da%s and then resume her n!rmal s hedule+ Mhe als! sh!uld use an additi!nal #irth !ntr!l meth!d &!r 1 wee)+ O lam"sia is the ! urren e !& seiGures that aren-t aused #% a ere#ral dis!rder in a "atient wh! has "regnan %,indu ed h%"ertensi!n+ In "la enta "revia$ #leeding is "ainless and seld!m &atal !n the &irst ! asi!n$ #ut it #e !mes heavier with ea h su#seDuent e"is!de+ Treatment &!r a#ru"ti! "la entae is usuall% immediate esarean deliver%+ /rugs used t! treat withdrawal s%m"t!ms in ne!nates in lude "hen!#ar#ital (Numinal)$ am"h!rated !"ium tin ture ("areg!ri )$ and diaGe"am (Ealium)+ In&ants with /!wn s%ndr!me t%"i all% have mar)ed h%"!t!nia$ &l!""iness$ slanted e%es$ e* ess s)in !n the #a ) !& the ne )$ &lattened #ridge !& the n!se$ &lat &a ial &eatures$ s"adeli)e hands$ sh!rt and #r!ad &eet$ small male genitalia$ a#sen e !& M!r!-s re&le*$ and a simian rease !n the hands+

The &ailure rate !& a !ntra e"tive is determined #% the e*"erien e !& 100 w!men &!r 1 %ear+ It-s e*"ressed as "regnan ies "er 100 w!man,%ears+ The narr!west diameter !& the "elvi inlet is the anter!"!steri!r (diag!nal !nCugate)+ The h!ri!n is the !uterm!st e*traem#r%!ni mem#rane that gives rise t! the "la enta+ The !r"us luteum se retes large Duantities !& "r!gester!ne+ 6r!m the 4th wee) !& gestati!n thr!ugh deliver%$ the devel!"ing ells are )n!wn as a &etus+ In an in !m"lete a#!rti!n$ the &etus is e*"elled$ #ut "arts !& the "la enta and mem#rane remain in the uterus+ The ir um&eren e !& a ne!nate-s head is n!rmall% 0 t! 3 m greater than the ir um&eren e !& the hest+ .&ter administering magnesium sul&ate t! a "regnant "atient &!r h%"ertensi!n !r "reterm la#!r$ the nurse sh!uld m!nit!r the res"irat!r% rate and dee" tend!n re&le*es+ /uring the &irst h!ur a&ter #irth (the "eri!d !& rea tivit%)$ the ne!nate is alert and awa)e+ 5hen a "regnant "atient has undiagn!sed vaginal #leeding$ vaginal e*aminati!n sh!uld #e av!ided until ultras!n!gra"h% rules !ut "la enta "revia+ .&ter deliver%$ the &irst nursing a ti!n is t! esta#lish the ne!nate-s airwa%+ Nursing interventi!ns &!r a "atient with "la enta "revia in lude "!siti!ning the "atient !n her le&t side &!r ma*imum &etal "er&usi!n$ m!nit!ring &etal heart t!nes$ and administering I+E+ &luids and !*%gen$ as !rdered+ The s"e i&i gravit% !& a ne!nate-s urine is 1+003 t! 1+030+ . l!wer s"e i&i gravit% suggests !verh%drati!n8 a higher !ne suggests deh%drati!n+ The ne!natal "eri!d e*tends &r!m #irth t! da% 04+ It-s als! alled the &irst 2 wee)s !r &irst m!nth !& li&e+ . w!man wh! is #reast,&eeding sh!uld ru# a mild em!llient ream !r a &ew dr!"s !& #reast mil) (!r !l!strum) !n the ni""les a&ter ea h &eeding+ Mhe sh!uld let the #reasts air,dr% t! "revent them &r!m ra )ing+ Breast,&eeding m!thers sh!uld in rease their &luid inta)e t! 0P t! 3 Dt (0$500 t! 3$000 ml) dail%+ .&ter &eeding an in&ant with a le&t li" !r "alate$ the nurse sh!uld rinse the in&ant-s m!uth with sterile water+ The nurse instills er%thr!m% in in a ne!nate-s e%es "rimaril% t! "revent #lindness aused #% g!n!rrhea !r hlam%dia+ Human immun!de&i ien % virus (HIE) has #een ultured in #reast mil) and an #e transmitted #% an HIE,"!sitive m!ther wh! #reast,&eeds her in&ant+ . &ever in the &irst 02 h!urs "!st"artum is m!st li)el% aused #% deh%drati!n rather than in&e ti!n+ <reterm ne!nates !r ne!nates wh! an-t maintain a s)in tem"erature !& at least >:+;Q 6 (3;+2Q C) sh!uld re eive are in an in u#at!r (Is!lette) !r a radiant

warmer+ In a radiant warmer$ a heat,sensitive "r!#e ta"ed t! the ne!nate-s s)in a tivates the heater unit aut!mati all% t! maintain the desired tem"erature+ /uring la#!r$ the resting "hase #etween !ntra ti!ns is at least 30 se !nds+ N! hia ru#ra is the vaginal dis harge !& alm!st "ure #l!!d that ! urs during the &irst &ew da%s a&ter hild#irth+ N! hia ser!sa is the ser!us vaginal dis harge that ! urs 2 t! : da%s a&ter hild#irth+ N! hia al#a is the vaginal dis harge !& de reased #l!!d and in reased leu)! %tes that-s the &inal stage !& l! hia+ It ! urs : t! 10 da%s a&ter hild#irth+ C!l!strum$ the "re urs!r !& mil)$ is the &irst se reti!n &r!m the #reasts a&ter deliver%+ The length !& the uterus in reases &r!m 0PK (;+3 m) #e&!re "regnan % t! 10PK (30 m) at term+ T! estimate the true !nCugate (the smallest inlet measurement !& the "elvis)$ dedu t 1+5 m &r!m the diag!nal !nCugate (usuall% 10 m)+ . true !nCugate !& 10+5 m ena#les the &etal head (usuall% 10 m) t! "ass+ The smallest !utlet measurement !& the "elvis is the intertu#er!us diameter$ whi h is the transverse diameter #etween the is hial tu#er!sities+ Ole tr!ni &etal m!nit!ring is used t! assess &etal well,#eing during la#!r+ I& !m"r!mised &etal status is sus"e ted$ &etal #l!!d "H ma% #e evaluated #% !#taining a s al" sam"le+ In an emergen % deliver%$ en!ugh "ressure sh!uld #e a""lied t! the emerging &etus-s head t! guide the des ent and "revent a ra"id hange in "ressure within the m!lded &etal s)ull+ .&ter deliver%$ a multi"ar!us w!man is m!re sus e"ti#le t! #leeding than a "rimi"ar!us w!man #e ause her uterine mus les ma% #e !verstret hed and ma% n!t !ntra t e&&i ientl%+ Ne!nates wh! are delivered #% esarean #irth have a higher in iden e !& res"irat!r% distress s%ndr!me+ The nurse sh!uld suggest am#ulati!n t! a "!st"artum "atient wh! has gas "ain and &latulen e+ Massaging the uterus hel"s t! stimulate !ntra ti!ns a&ter the "la enta is delivered+ 5hen "r!viding "h!t!thera"% t! a ne!nate$ the nurse sh!uld !ver the ne!nate-s e%es and genital area+ The nar !ti antag!nist nal!*!ne (Nar an) ma% #e given t! a ne!nate t! !rre t res"irat!r% de"ressi!n aused #% nar !ti administrati!n t! the m!ther during la#!r+ In a ne!nate$ s%m"t!ms !& res"irat!r% distress s%ndr!me in lude e*"irat!r% grunting !r whining$ sand"a"er #reath s!unds$ and seesaw retra ti!ns+ Cere#ral "als% "resents as as%mmetri al m!vement$ irrita#ilit%$ and e* essive$ &ee#le r%ing in a l!ng$ thin in&ant+ The nurse sh!uld assess a #ree h,#irth ne!nate &!r h%dr! e"halus$ hemat!mas$ &ra tures$ and !ther an!malies aused #% #irth trauma+

5hen a "atient is admitted t! the unit in a tive la#!r$ the nurse-s &irst a ti!n is t! listen &!r &etal heart t!nes+ In a ne!nate$ l!ng$ #rittle &ingernails are a sign !& "!stmaturit%+ /esDuamati!n (s)in "eeling) is !mm!n in "!stmature ne!nates+ . m!ther sh!uld all!w her in&ant t! #reast,&eed until the in&ant is satis&ied+ The time ma% var% &r!m 5 t! 00 minutes+ NitraGine "a"er is used t! test the "H !& vaginal dis harge t! determine the "resen e !& amni!ti &luid+ . "regnant "atient n!rmall% gains 0 t! 5 l# (1 t! 0+5 )g) during the &irst trimester and slightl% less than 1 l# (0+5 )g) "er wee) during the last tw! trimesters+ Ne!natal Caundi e in the &irst 02 h!urs a&ter #irth is )n!wn as "ath!l!gi al Caundi e and is a sign !& er%thr!#last!sis &etalis+ . lassi di&&eren e #etween a#ru"ti! "la entae and "la enta "revia is the degree !& "ain+ .#ru"ti! "la entae auses "ain$ whereas "la enta "revia auses "ainless #leeding+ Be ause a maC!r r!le !& the "la enta is t! &un ti!n as a &etal lung$ an% !nditi!n that interru"ts n!rmal #l!!d &l!w t! !r &r!m the "la enta in reases &etal "artial "ressure !& arterial ar#!n di!*ide and de reases &etal "H+ <re i"itate la#!r lasts &!r a""r!*imatel% 3 h!urs and ends with deliver% !& the ne!nate+ Meth%lerg!n!vine (Methergine) is an !*%t! i agent used t! "revent and treat "!st"artum hem!rrhage aused #% uterine at!n% !r su#inv!luti!n+ .s emergen % treatment &!r e* essive uterine #leeding$ 0+0 mg !& meth%lerg!n!vine (Methergine) is inCe ted I+E+ !ver 1 minute while the "atient-s #l!!d "ressure and uterine !ntra ti!ns are m!nit!red+ Bra*t!n Hi )s !ntra ti!ns are usuall% &elt in the a#d!men and d!n-t ause ervi al hange+ True la#!r !ntra ti!ns are &elt in the &r!nt !& the a#d!men and #a ) and lead t! "r!gressive ervi al dilati!n and e&&a ement+ The average #irth weight !& ne!nates #!rn t! m!thers wh! sm!)e is ; !G (1:0 g) less than that !& ne!nates #!rn t! n!nsm!)ing m!thers+ Culd!s !"% is visualiGati!n !& the "elvi !rgans thr!ugh the "!steri!r vaginal &!rni*+ The nurse sh!uld tea h a "regnant vegetarian t! !#tain "r!tein &r!m alternative s!ur es$ su h as nuts$ s!%#eans$ and legumes+ The nurse sh!uld instru t a "regnant "atient t! ta)e !nl% "res ri#ed "renatal vitamins #e ause !ver,the, !unter high,"!ten % vitamins ma% harm the &etus+ High,s!dium &!!ds an ause &luid retenti!n$ es"e iall% in "regnant "atients+ . "regnant "atient an av!id !nsti"ati!n and hem!rrh!ids #% adding &i#er t! her diet+ I& a &etus has late de elerati!ns (a sign !& &etal h%"!*ia)$ the nurse sh!uld instru t the m!ther t! lie !n her le&t side and then administer 4 t! 10 N !& !*%gen "er minute #% mas) !r annula+ The nurse sh!uld n!ti&% the "h%si ian+ The side,l%ing "!siti!n rem!ves "ressure !n the in&eri!r vena ava+ A*%t! in (<it! in) "r!m!tes la tati!n and uterine !ntra ti!ns+

Nanug! !vers the &etus-s #!d% until a#!ut 00 wee)s- gestati!n+ Then it #egins t! disa""ear &r!m the &a e$ trun)$ arms$ and legs$ in that !rder+ In a ne!nate$ h%"!gl% emia auses tem"erature insta#ilit%$ h%"!t!nia$ Citteriness$ and seiGures+ <remature$ "!stmature$ small,&!r,gestati!nal,age$ and large,&!r, gestati!nal,age ne!nates are sus e"ti#le t! this dis!rder+ Ne!nates t%"i all% need t! !nsume 50 t! 55 al "er "!und !& #!d% weight dail%+ Be ause !*%t! in (<it! in) stimulates "!wer&ul uterine !ntra ti!ns during la#!r$ it must #e administered under l!se !#servati!n t! hel" "revent maternal and &etal distress+ /uring &etal heart rate m!nit!ring$ varia#le de elerati!ns indi ate !m"ressi!n !r "r!la"se !& the um#ili al !rd+ C%t!megal!virus is the leading ause !& !ngenital viral in&e ti!n+ T! !l%ti thera"% is indi ated in "remature la#!r$ #ut !ntraindi ated in &etal death$ &etal distress$ !r severe hem!rrhage+ Thr!ugh ultras!n!gra"h%$ the #i!"h%si al "r!&ile assesses &etal well,#eing #% measuring &etal #reathing m!vements$ gr!ss #!d% m!vements$ &etal t!ne$ rea tive &etal heart rate (n!nstress test)$ and Dualitative amni!ti &luid v!lume+ . ne!nate wh!se m!ther has dia#etes sh!uld #e assessed &!r h%"erinsulinism+ In a "atient with "ree lam"sia$ e"igastri "ain is a late s%m"t!m and reDuires immediate medi al interventi!n+ .&ter a still#irth$ the m!ther sh!uld #e all!wed t! h!ld the ne!nate t! hel" her !me t! terms with the death+ M!lding is the "r! ess #% whi h the &etal head hanges sha"e t! &a ilitate m!vement thr!ugh the #irth anal+ I& a w!man re eives a s"inal #l! ) #e&!re deliver%$ the nurse sh!uld m!nit!r the "atient-s #l!!d "ressure l!sel%+ I& a w!man suddenl% #e !mes h%"!tensive during la#!r$ the nurse sh!uld in rease the in&usi!n rate !& I+E+ &luids as "res ri#ed+ The #est te hniDue &!r assessing Caundi e in a ne!nate is t! #lan h the ti" !& the n!se !r the area Cust a#!ve the um#ili us+ /uring &etal heart m!nit!ring$ earl% de elerati!n is aused #% !m"ressi!n !& the head during la#!r+ .&ter the "la enta is delivered$ the nurse ma% add !*%t! in (<it! in) t! the "atient-s I+E+ s!luti!n$ as "res ri#ed$ t! "r!m!te "!st"artum inv!luti!n !& the uterus and stimulate la tati!n+ <i a is a raving t! eat n!n&!!d items$ su h as dirt$ ra%!ns$ hal)$ glue$ star h$ !r hair+ It ma% ! ur during "regnan % and an endanger the &etus+ . "regnant "atient sh!uld ta)e &!li a id #e ause this nutrient is reDuired &!r ra"id ell divisi!n+ . w!man wh! is ta)ing l!mi"hene (Cl!mid) t! indu e !vulati!n sh!uld #e in&!rmed !& the "!ssi#ilit% !& multi"le #irths with this drug+ I& needed$ ervi al suturing is usuall% d!ne #etween 12 and 14 wee)s- gestati!n t! rein&!r e an in !m"etent ervi* and maintain "regnan %+ The suturing is t%"i all% rem!ved #% 35 wee)sgestati!n+

/uring the &irst trimester$ a "regnant w!man sh!uld av!id all drugs unless d!ing s! w!uld adversel% a&&e t her health+ M!st drugs that a #reast,&eeding m!ther ta)es a""ear in #reast mil)+ The 6!!d and /rug .dministrati!n has esta#lished the &!ll!wing &ive ateg!ries !& drugs #ased !n their "!tential &!r ausing #irth de&e ts: .$ n! eviden e !& ris)8 B$ n! ris) &!und in animals$ #ut n! studies have #een d!ne in w!men8 C$ animal studies have sh!wn an adverse e&&e t$ #ut the drug ma% #e #ene&i ial t! w!men des"ite the "!tential ris)8 /$ eviden e !& ris)$ #ut its #ene&its ma% !utweigh its ris)s8 and H$ &etal an!malies n!ted$ and the ris)s learl% !utweigh the "!tential #ene&its+ . "atient with a ru"tured e t!"i "regnan % !mm!nl% has shar" "ain in the l!wer a#d!men$ with s"!tting and ram"ing+ Mhe ma% have a#d!minal rigidit%8 ra"id$ shall!w res"irati!ns8 ta h% ardia8 and sh! )+ . "atient with a ru"tured e t!"i "regnan % !mm!nl% has shar" "ain in the l!wer a#d!men$ with s"!tting and ram"ing+ Mhe ma% have a#d!minal rigidit%8 ra"id$ shall!w res"irati!ns8 ta h% ardia8 and sh! )+ The me hani s !& deliver% are engagement$ des ent and &le*i!n$ internal r!tati!n$ e*tensi!n$ e*ternal r!tati!n$ restituti!n$ and e*"ulsi!n+ . "r!#a#le sign !& "regnan %$ M /!nald-s sign is hara teriGed #% an ease in &le*ing the #!d% !& the uterus against the ervi*+ .men!rrhea is a "r!#a#le sign !& "regnan %+ . "regnant w!man-s "artner sh!uld av!id intr!du ing air int! the vagina during !ral se* #e ause !& the "!ssi#ilit% !& air em#!lism+ The "resen e !& human h!ri!ni g!nad!tr!"in in the #l!!d !r urine is a "r!#a#le sign !& "regnan %+ Radi!gra"h% isn-t usuall% used in a "regnant w!man #e ause it ma% harm the devel!"ing &etus+ I& radi!gra"h% is essential$ it sh!uld #e "er&!rmed !nl% a&ter 3; wee)s- gestati!n+ . "regnant "atient wh! has had ru"ture !& the mem#ranes !r wh! is e*"erien ing vaginal #leeding sh!uldn-t engage in se*ual inter !urse+ Milia ma% ! ur as "in"!int s"!ts !ver a ne!nate-s n!se+ The durati!n !& a !ntra ti!n is timed &r!m the m!ment that the uterine mus le #egins t! tense t! the m!ment that it rea hes &ull rela*ati!n+ It-s measured in se !nds+ The uni!n !& a male and a &emale gamete "r!du es a G%g!te$ whi h divides int! the &ertiliGed !vum+ The &irst menstrual &l!w is alled menar he and ma% #e an!vulat!r% (in&ertile)+ M"ermat!G!a (!r their &ragments) remain in the vagina &!r :0 h!urs a&ter se*ual inter !urse+ <r!la tin stimulates and sustains mil) "r!du ti!n+ Mtra#ismus is a n!rmal &inding in a ne!nate+ . "!st"artum "atient ma% resume se*ual inter !urse a&ter the "erineal !r uterine w!unds heal (usuall% within 2 wee)s a&ter deliver%)+

. "regnant sta&& mem#er sh!uldn-t #e assigned t! w!r) with a "atient wh! has %t!megal!virus in&e ti!n #e ause the virus an #e transmitted t! the &etus+ 6etal demise is death !& the &etus a&ter via#ilit%+ Res"irat!r% distress s%ndr!me devel!"s in "remature ne!nates #e ause their alve!li la ) sur&a tant+ The m!st !mm!n meth!d !& indu ing la#!r a&ter arti&i ial ru"ture !& the mem#ranes is !*%t! in (<it! in) in&usi!n+ .&ter the amni!ti mem#ranes ru"ture$ the initial nursing a ti!n is t! assess the &etal heart rate+ The m!st !mm!n reas!ns &!r esarean #irth are mal"resentati!n$ &etal distress$ e"hal!"elvi dis"r!"!rti!n$ "regnan %,indu ed h%"ertensi!n$ "revi!us esarean #irth$ and inadeDuate "r!gress in la#!r+ .mni! entesis in reases the ris) !& s"!ntane!us a#!rti!n$ trauma t! the &etus !r "la enta$ "remature la#!r$ in&e ti!n$ and Rh sensitiGati!n !& the &etus+ .&ter amni! entesis$ a#d!minal ram"ing !r s"!ntane!us vaginal #leeding ma% indi ate !m"li ati!ns+ T! "revent her &r!m devel!"ing Rh anti#!dies$ an Rh,negative "rimigravida sh!uld re eive Rh!(/) immune gl!#ulin (Rh!?.M) a&ter delivering an Rh, "!sitive ne!nate+ I& a "regnant "atient-s test results are negative &!r glu !se #ut "!sitive &!r a et!ne$ the nurse sh!uld assess the "atient-s diet &!r inadeDuate al!ri inta)e+ I& a "regnant "atient-s test results are negative &!r glu !se #ut "!sitive &!r a et!ne$ the nurse sh!uld assess the "atient-s diet &!r inadeDuate al!ri inta)e+ Ru#ella in&e ti!n in a "regnant "atient$ es"e iall% during the &irst trimester$ an lead t! s"!ntane!us a#!rti!n !r still#irth as well as &etal ardia and !ther #irth de&e ts+ . "regnant "atient sh!uld ta)e an ir!n su""lement t! hel" "revent anemia+ /ire t antigl!#ulin (dire t C!!m#s-) test is used t! dete t maternal anti#!dies atta hed t! red #l!!d ells in the ne!nate+ Nausea and v!miting during the &irst trimester !& "regnan % are aused #% rising levels !& the h!rm!ne human h!ri!ni g!nad!tr!"in+ Be&!re dis harging a "atient wh! has had an a#!rti!n$ the nurse sh!uld instru t her t! re"!rt #right red l!ts$ #leeding that lasts l!nger than : da%s$ !r signs !& in&e ti!n$ su h as a tem"erature !& greater than 100Q 6 (3:+4Q C)$ &!ul,smelling vaginal dis harge$ severe uterine ram"ing$ nausea$ !r v!miting+ 5hen in&!rmed that a "atient-s amni!ti mem#rane has #r!)en$ the nurse sh!uld he ) &etal heart t!nes and then maternal vital signs+ The durati!n !& "regnan % averages 040 da%s$ 20 wee)s$ > alendar m!nths$ !r 10 lunar m!nths+ The initial weight l!ss &!r a health% ne!nate is 53 t! 103 !& #irth weight+ The n!rmal hem!gl!#in value in ne!nates is 1: t! 00 g=dl+ Cr!wning is the a""earan e !& the &etus-s head when its largest diameter is en ir led #% the vulv!vaginal ring+

. multi"ara is a w!man wh! has had tw! !r m!re "regnan ies that "r!gressed t! via#ilit%$ regardless !& whether the !&&s"ring were alive at #irth+ In a "regnant "atient$ "ree lam"sia ma% "r!gress t! e lam"sia$ whi h is hara teriGed #% seiGures and ma% lead t! !ma+ The ."gar s !re is used t! assess the ne!nate-s vital &un ti!ns+ It-s !#tained at 1 minute and 5 minutes a&ter deliver%+ The s !re is #ased !n res"irat!r% e&&!rt$ heart rate$ mus le t!ne$ re&le* irrita#ilit%$ and !l!r+ Be ause !& the anti,insulin e&&e ts !& "la ental h!rm!nes$ insulin reDuirements in rease during the third trimester+ ?estati!nal age an #e estimated #% ultras!und measurement !& maternal a#d!minal ir um&eren e$ &etal &emur length$ and &etal head siGe+ These measurements are m!st a urate #etween 10 and 14 wee)s- gestati!n+ M)eletal s%stem a#n!rmalities and ventri ular se"tal de&e ts are the m!st !mm!n dis!rders !& in&ants wh! are #!rn t! dia#eti w!men+ The in iden e !& !ngenital mal&!rmati!n is three times higher in these in&ants than in th!se #!rn t! n!ndia#eti w!men+ M)eletal s%stem a#n!rmalities and ventri ular se"tal de&e ts are the m!st !mm!n dis!rders !& in&ants wh! are #!rn t! dia#eti w!men+ The in iden e !& !ngenital mal&!rmati!n is three times higher in these in&ants than in th!se #!rn t! n!ndia#eti w!men+ The "atient with "ree lam"sia usuall% has "u&&iness ar!und the e%es !r edema in the hands (&!r e*am"le$ JI an-t "ut m% wedding ring !n+K)+ Fegel e*er ises reDuire !ntra ti!n and rela*ati!n !& the "erineal mus les+ These e*er ises hel" strengthen "elvi mus les and im"r!ve urine !ntr!l in "!st"artum "atients+ M%m"t!ms !& "!st"artum de"ressi!n range &r!m mild "!st"artum #lues t! intense$ sui idal$ de"ressive "s% h!sis+ The "reterm ne!nate ma% reDuire gavage &eedings #e ause !& a wea) su )ing re&le*$ un !!rdinated su )ing$ !r res"irat!r% distress+ . r! %an!sis (#lueness and !!lness !& the arms and legs) is n!rmal in ne!nates #e ause !& their immature "eri"heral ir ulat!r% s%stem+ T! "revent !"hthalmia ne!nat!rum (a severe e%e in&e ti!n aused #% maternal g!n!rrhea)$ the nurse ma% administer !ne !& three drugs$ as "res ri#ed$ in the ne!nate-s e%es: tetra % line$ silver nitrate$ !r er%thr!m% in+ Ne!natal testing &!r "hen%l)et!nuria is mandat!r% in m!st states+ The nurse sh!uld "la e the ne!nate in a 30,degree Trendelen#urg "!siti!n t! &a ilitate mu us drainage+ The nurse ma% su ti!n the ne!nate-s n!se and m!uth as needed with a #ul# s%ringe !r su ti!n tra"+ T! "revent heat l!ss$ the nurse sh!uld "la e the ne!nate under a radiant warmer during su ti!ning and initial deliver%,r!!m are$ and then wra" the ne!nate in a warmed #lan)et &!r trans"!rt t! the nurser%+ The um#ili al !rd n!rmall% has tw! arteries and !ne vein+

5hen "r!viding are$ the nurse sh!uld e*"!se !nl% !ne "art !& an in&ant-s #!d% at a time+ Nightening is settling !& the &etal head int! the #rim !& the "elvis+ I& the ne!nate is sta#le$ the m!ther sh!uld #e all!wed t! #reast,&eed within the ne!nate-s &irst h!ur !& li&e+ The nurse sh!uld he ) the ne!nate-s tem"erature ever% 1 t! 0 h!urs until it-s maintained within n!rmal limits+ .t #irth$ a ne!nate n!rmall% weighs 5 t! > l# (0 t! 2 )g)$ measures 14L t! 00L (25+5 t! 5; m) in length$ has a head ir um&eren e !& 13PK t! 12L (32 t! 35+5 m)$ and has a hest ir um&eren e that-s 1L (0+5 m) less than the head ir um&eren e+ In the ne!nate$ tem"erature n!rmall% ranges &r!m >4Q t! >>Q 6 (3;+:Q t! 3:+0Q C)$ a"i al "ulse rate averages 100 t! 1;0 #eats=minute$ and res"irati!ns are 20 t! ;0 #reaths=minute+ The diam!nd,sha"ed anteri!r &!ntanel usuall% l!ses #etween ages 10 and 14 m!nths+ The triangular "!steri!r &!ntanel usuall% l!ses #% age 0 m!nths+ In the ne!nate$ a straight s"ine is n!rmal+ . tu&t !& hair !ver the s"ine is an a#n!rmal &inding+ <r!staglandin gel ma% #e a""lied t! the vagina !r ervi* t! ri"en an un&av!ra#le ervi* #e&!re la#!r indu ti!n with !*%t! in (<it! in)+ Mu"ernumerar% ni""les are ! asi!nall% seen !n ne!nates+ The% usuall% a""ear al!ng a line that runs &r!m ea h a*illa$ thr!ugh the n!rmal ni""le area$ and t! the gr!in+ Me !nium is a material that !lle ts in the &etus-s intestines and &!rms the ne!nate-s &irst &e es$ whi h are #la ) and tarr%+ The "resen e !& me !nium in the amni!ti &luid during la#!r indi ates "!ssi#le &etal distress and the need t! evaluate the ne!nate &!r me !nium as"irati!n+ T! assess a ne!nate-s r!!ting re&le*$ the nurse t!u hes a &inger t! the hee) !r the !rner !& the m!uth+ N!rmall%$ the ne!nate turns his head t!ward the stimulus$ !"ens his m!uth$ and sear hes &!r the stimulus+ HarleDuin sign is "resent when a ne!nate wh! is l%ing !n his side a""ears red !n the de"endent side and "ale !n the u""er side+ M!ng!lian s"!ts an range &r!m #r!wn t! #lue+ Their !l!r de"ends !n h!w l!se melan! %tes are t! the sur&a e !& the s)in+ The% m!st !mm!nl% a""ear as "at hes a r!ss the sa rum$ #utt! )s$ and legs+ M!ng!lian s"!ts are !mm!n in n!n,white in&ants and usuall% disa""ear #% age 0 t! 3 %ears+ Eerni* ase!sa is a heeseli)e su#stan e that !vers and "r!te ts the &etus-s s)in in uter!+ It ma% #e ru##ed int! the ne!nate-s s)in !r washed awa% in !ne !r tw! #aths+ Ca"ut su edaneum is edema that devel!"s in and under the &etal s al" during la#!r and deliver%+ It res!lves s"!ntane!usl% and "resents n! danger t! the ne!nate+ The edema d!esn-t r!ss the suture line+

Nevus &lammeus$ !r "!rt,wine stain$ is a di&&use "in) t! dar) #luish red lesi!n !n a ne!nate-s &a e !r ne )+ The ?uthrie test (a s reening test &!r "hen%l)et!nuria) is m!st relia#le i& it-s d!ne #etween the se !nd and si*th da%s a&ter #irth and is "er&!rmed a&ter the ne!nate has ingested "r!tein+ T! assess !!rdinati!n !& su )ing and swall!wing$ the nurse sh!uld !#serve the ne!nate-s &irst #reast,&eeding !r sterile water #!ttle,&eeding+ T! esta#lish a mil) su""l% "attern$ the m!ther sh!uld #reast,&eed her in&ant at least ever% 2 h!urs+ /uring the &irst m!nth$ she sh!uld #reast,&eed 4 t! 10 times dail% (demand &eeding)+ T! av!id !nta t with #l!!d and !ther #!d% &luids$ the nurse sh!uld wear gl!ves when handling the ne!nate until a&ter the &irst #ath is given+ I& a #reast,&ed in&ant is !ntent$ has g!!d s)in turg!r$ an adeDuate num#er !& wet dia"ers$ and n!rmal weight gain$ the m!ther-s mil) su""l% is assumed t! #e adeDuate+ In the su"ine "!siti!n$ a "regnant "atient-s enlarged uterus im"airs ven!us return &r!m the l!wer hal& !& the #!d% t! the heart$ resulting in su"ine h%"!tensive s%ndr!me$ !r in&eri!r vena ava s%ndr!me+ T! !l%ti agents used t! treat "reterm la#!r in lude ter#utaline (Brethine)$ rit!drine (Iut!"ar)$ and magnesium sul&ate+ . "regnant w!man wh! has h%"eremesis gravidarum ma% reDuire h!s"italiGati!n t! treat deh%drati!n and starvati!n+ /ia"hragmati hernia is !ne !& the m!st urgent ne!natal surgi al emergen ies+ B% !m"ressing and dis"la ing the lungs and heart$ this dis!rder an ause res"irat!r% distress sh!rtl% a&ter #irth+ C!mm!n !m"li ati!ns !& earl% "regnan % (u" t! 00 wee)s- gestati!n) in lude &etal l!ss and seri!us threats t! maternal health+ 6etal em#!diment is a maternal devel!"mental tas) that ! urs in the se !nd trimester+ /uring this stage$ the m!ther ma% !m"lain that she never gets t! slee" #e ause the &etus alwa%s gives her a thum" when she tries+ EisualiGati!n in "regnan % is a "r! ess in whi h the m!ther imagines what the hild she-s arr%ing is li)e and #e !mes a Duainted with it+ Hem!diluti!n !& "regnan % is the in rease in #l!!d v!lume that ! urs during "regnan %+ The in reased v!lume !nsists !& "lasma and auses an im#alan e #etween the rati! !& red #l!!d ells t! "lasma and a resultant de rease in hemat! rit+ Mean arterial "ressure !& greater than 100 mm Hg a&ter 00 wee)s !& "regnan % is !nsidered h%"ertensi!n+ The treatment &!r su"ine h%"!tensi!n s%ndr!me (a !nditi!n that s!metimes ! urs in "regnan %) is t! have the "atient lie !n her le&t side+ . !ntri#uting &a t!r in de"endent edema in the "regnant "atient is the in rease !& &em!ral ven!us "ressure &r!m 10 mm Hg (n!rmal) t! 14 mm Hg (high)+ H%"er"igmentati!n !& the "regnant "atient-s &a e$ &!rmerl% alled hl!asma and n!w re&erred t! as melasma$ &ades a&ter deliver%+

The h!rm!ne rela*in$ whi h is se reted &irst #% the !r"us luteum and later #% the "la enta$ rela*es the !nne tive tissue and artilage !& the s%m"h%sis "u#is and the sa r!ilia C!int t! &a ilitate "assage !& the &etus during deliver%+ <r!gester!ne maintains the integrit% !& the "regnan % #% inhi#iting uterine m!tilit%+ Nadin-s sign$ an earl% indi ati!n !& "regnan %$ auses s!&tening !& a s"!t !n the anteri!r "!rti!n !& the uterus$ Cust a#!ve the uter! ervi al Cun ture+ /uring "regnan %$ the a#d!minal line &r!m the s%m"h%sis "u#is t! the um#ili us hanges &r!m linea al#a t! linea nigra+ In ne!nates$ !ld stress a&&e ts the ir ulat!r%$ regulat!r%$ and res"irat!r% s%stems+ A#stetri data an #e des ri#ed #% using the 6=T<.N s%stem: o 6=T: 6ull,term deliver% at 34 wee)s !r l!nger <: <reterm deliver% #etween 00 and 3: wee)s .: .#!rti!n !r l!ss !& &etus #e&!re 00 wee)s N: Num#er !& hildren living (i& a hild has died$ &urther e*"lanati!n is needed t! lari&% the dis re"an % in num#ers)+ <arit% d!esn-t re&er t! the num#er !& in&ants delivered$ !nl% the num#er !& deliveries+ 5!men wh! are arr%ing m!re than !ne &etus sh!uld #e en !uraged t! gain 35 t! 25 l# (15+5 t! 00+5 )g) during "regnan %+ The re !mmended am!unt !& ir!n su""lement &!r the "regnant "atient is 30 t! ;0 mg dail%+ /rin)ing si* al !h!li #everages a da% !r a single e"is!de !& #inge drin)ing in the &irst trimester an ause &etal al !h!l s%ndr!me+ Ch!ri!ni villus sam"ling is "er&!rmed at 4 t! 10 wee)s !& "regnan % &!r earl% identi&i ati!n !& geneti de&e ts+ In "er utane!us um#ili al #l!!d sam"ling$ a #l!!d sam"le is !#tained &r!m the um#ili al !rd t! dete t anemia$ geneti de&e ts$ and #l!!d in !m"ati#ilit% as well as t! assess the need &!r #l!!d trans&usi!ns+ The "eri!d #etween !ntra ti!ns is re&erred t! as the interval$ !r resting "hase+ /uring this "hase$ the uterus and "la enta &ill with #l!!d and all!w &!r the e* hange !& !*%gen$ ar#!n di!*ide$ and nutrients+ In a "atient wh! has h%"ert!ni !ntra ti!ns$ the uterus d!esn-t have an !""!rtunit% t! rela* and there is n! interval #etween !ntra ti!ns+ .s a result$ the &etus ma% e*"erien e h%"!*ia !r ra"id deliver% ma% ! ur+ Tw! Dualities !& the m%!metrium are elasti it%$ whi h all!ws it t! stret h %et maintain its t!ne$ and !ntra tilit%$ whi h all!ws it t! sh!rten and lengthen in a s%n hr!niGed "attern+ /uring r!wning$ the "resenting "art !& the &etus remains visi#le during the interval #etween !ntra ti!ns+ (terine at!n% is &ailure !& the uterus t! remain &irml% !ntra ted+ The maC!r ause !& uterine at!n% is a &ull #ladder+

I& the m!ther wishes t! #reast,&eed$ the ne!nate sh!uld #e nursed as s!!n as "!ssi#le a&ter deliver%+ . sma )ing s!und$ mil) dri""ing &r!m the side !& the m!uth$ and su )ing n!ises all indi ate im"r!"er "la ement !& the in&ant-s m!uth !ver the ni""le+ Be&!re &eeding is initiated$ an in&ant sh!uld #e #ur"ed t! e*"el air &r!m the st!ma h+ M!st auth!rities str!ngl% en !urage the !ntinuati!n !& #reast,&eeding !n #!th the a&&e ted and the una&&e ted #reast !& "atients with mastitis+ Ne!nates are nearsighted and &! us !n items that are held 10L t! 10L (05 t! 30+5 m) awa%+ In a ne!nate$ l!w,set ears are ass! iated with hr!m!s!mal a#n!rmalities su h as /!wn s%ndr!me+ Me !nium is usuall% "assed in the &irst 02 h!urs8 h!wever$ "assage ma% ta)e u" t! :0 h!urs+ B!%s wh! are #!rn with h%"!s"adias sh!uldn-t #e ir um ised at #irth #e ause the &!res)in ma% #e needed &!r !nstru tive surger%+ In the ne!nate$ the n!rmal #l!!d glu !se level is 25 t! >0 mg=dl+ He"atitis B va ine is usuall% given within 24 h!urs !& #irth+ He"atitis B immune gl!#ulin is usuall% given within 10 h!urs !& #irth+ HONN< (hem!l%sis$ elevated liver enG%mes$ and l!w "latelets) s%ndr!me is an unusual variati!n !& "regnan %,indu ed h%"ertensi!n+ Maternal serum al"ha,&et!"r!tein is dete ta#le at : wee)s !& gestati!n and "ea)s in the third trimester+ High levels dete ted #etween the 1;th and 14th wee)s are ass! iated with neural tu#e de&e ts+ N!w levels are ass! iated with /!wn s%ndr!me+ .n arrest !& des ent ! urs when the &etus d!esn-t des end thr!ugh the "elvi avit% during la#!r+ It-s !mm!nl% ass! iated with e"hal!"elvi dis"r!"!rti!n$ and esarean deliver% ma% #e reDuired+ . late sign !& "ree lam"sia is e"igastri "ain as a result !& severe liver edema+ In the "atient with "ree lam"sia$ #l!!d "ressure returns t! n!rmal during the "uer"eral "eri!d+ T! !#tain an estri!l level$ urine is !lle ted &!r 02 h!urs+ .n estri!l level is used t! assess &etal well,#eing and maternal renal &un ti!ning as well as t! m!nit!r a "regnan % that-s !m"li ated #% dia#etes+ . "regnant "atient with vaginal #leeding sh!uldn-t have a "elvi e*aminati!n+ In the earl% stages !& "regnan %$ the &inding !& glu !se in the urine ma% #e related t! the in reased shunting !& glu !se t! the devel!"ing "la enta$ with!ut a !rres"!nding in rease in the rea#s!r"ti!n a"a#ilit% !& the )idne%s+ . "atient wh! has "remature ru"ture !& the mem#ranes is at signi&i ant ris) &!r in&e ti!n i& la#!r d!esn-t #egin within 02 h!urs+ In&ants !& dia#eti m!thers are sus e"ti#le t! ma r!s!mia as a result !& in reased insulin "r!du ti!n in the &etus+

T! "revent heat l!ss in the ne!nate$ the nurse sh!uld #athe !ne "art !& his #!d% at a time and )ee" the rest !& the #!d% !vered+ . "atient wh! has a esarean deliver% is at greater ris) &!r in&e ti!n than the "atient wh! gives #irth vaginall%+ The ! urren e !& thrush in the ne!nate is "r!#a#l% aused #% !nta t with the !rganism during deliver% thr!ugh the #irth anal+ The nurse sh!uld )ee" the sa !& mening!m%el! ele m!ist with n!rmal saline s!luti!n+ I& &undal height is at least 0 m less than e*"e ted$ the ause ma% #e gr!wth retardati!n$ missed a#!rti!n$ transverse lie$ !r &alse "regnan %+ 6undal height that e* eeds e*"e tati!ns #% m!re than 0 m ma% #e aused #% multi"le gestati!n$ "!l%h%dramni!s$ uterine m%!mata$ !r a large #a#%+ . maC!r devel!"mental tas) &!r a w!man during the &irst trimester !& "regnan % is a e"ting the "regnan %+ (nli)e &!rmula$ #reast mil) !&&ers the #ene&it !& maternal anti#!dies+ M"!ntane!us ru"ture !& the mem#ranes in reases the ris) !& a "r!la"sed um#ili al !rd+ . lini al mani&estati!n !& a "r!la"sed um#ili al !rd is varia#le de elerati!ns+ /uring la#!r$ t! relieve su"ine h%"!tensi!n mani&ested #% nausea and v!miting and "aleness$ turn the "atient !n her le&t side+ I& the !vum is &ertiliGed #% a s"ermat!G!!n arr%ing a I hr!m!s!me$ a male G%g!te is &!rmed+ Im"lantati!n ! urs when the ellular walls !& the #last! %te im"lants itsel& in the end!metrium$ usuall% : t! > da%s a&ter &ertiliGati!n+ Im"lantati!n ! urs when the ellular walls !& the #last! %te im"lants itsel& in the end!metrium$ usuall% : t! > da%s a&ter &ertiliGati!n+ Heart devel!"ment in the em#r%! #egins at 0 t! 2 wee)s and is !m"lete #% the end !& the em#r%!ni stage+ Methergine stimulates uterine !ntra ti!ns+ The administrati!n !& &!li a id during the earl% stages !& gestati!n ma% "revent neural tu#e de&e ts+ 5ith advan ed maternal age$ a !mm!n geneti "r!#lem is /!wn s%ndr!me+ 5ith earl% maternal age$ e"hal!"elvi dis"r!"!rti!n !mm!nl% ! urs+ In the earl% "!st"artum "eri!d$ the &undus sh!uld #e midline at the um#ili us+ . ru#ella va ine sh!uldn-t #e given t! a "regnant w!man+ The va ine an #e administered a&ter deliver%$ #ut the "atient sh!uld #e instru ted t! av!id #e !ming "regnant &!r 3 m!nths+ . 1;,%ear,!ld girl wh! is "regnant is at ris) &!r having a l!w,#irth,weight ne!nate+ The m!ther-s Rh &a t!r sh!uld #e determined #e&!re an amni! entesis is "er&!rmed+ Maternal h%"!tensi!n is a !m"li ati!n !& s"inal #l! )+ .&ter deliver%$ i& the &undus is #!gg% and deviated t! the right side$ the "atient sh!uld em"t% her #ladder+

Be&!re "r!viding a s"e imen &!r a s"erm !unt$ the "atient sh!uld av!id eCa ulati!n &!r 24 t! :0 h!urs+ The h!rm!ne human h!ri!ni g!nad!tr!"in is a mar)er &!r "regnan %+ <ainless vaginal #leeding during the last trimester !& "regnan % ma% indi ate "la enta "revia+ /uring the transiti!n "hase !& la#!r$ the w!man usuall% is irrita#le and restless+ Be ause w!men with dia#etes have a higher in iden e !& #irth an!malies than w!men with!ut dia#etes$ an al"ha,&et!"r!tein level ma% #e !rdered at 15 t! 1: wee)s- gestati!n+ T! av!id "un turing the "la enta$ a vaginal e*aminati!n sh!uldn-t #e "er&!rmed !n a "regnant "atient wh! is #leeding+ . "atient wh! has "!st"artum hem!rrhage aused #% uterine at!n% sh!uld #e given !*%t! in as "res ri#ed+ Na erati!n !& the vagina$ ervi*$ !r "erineum "r!du es #right red #leeding that !&ten !mes in s"urts+ The #leeding is !ntinu!us$ even when the &undus is &irm+ H!t !m"resses an hel" t! relieve #reast tenderness a&ter #reast,&eeding+ The &undus !& a "!st"artum "atient is massaged t! stimulate !ntra ti!n !& the uterus and "revent hem!rrhage+ . m!ther wh! has a "!sitive human immun!de&i ien % virus test result sh!uldn-t #reast,&eed her in&ant+ /in!"r!st!ne (Cervidil) is used t! ri"en the ervi*+ Breast,&eeding !& a "remature ne!nate #!rn at 30 wee)s- gestati!n an #e a !m"lished i& the m!ther e*"resses mil) and &eeds the ne!nate #% gavage+ I& a "regnant "atient-s ru#ella titer is less than 1:4$ she sh!uld #e immuniGed a&ter deliver%+ The administrati!n !& !*%t! in (<it! in) is st!""ed i& the !ntra ti!ns are >0 se !nds !r l!nger+ 6!r an e*tramural deliver% (!ne that ta)es "la e !utside !& a n!rmal deliver% enter)$ the "ri!rities &!r are !& the ne!nate in lude maintaining a "atent airwa%$ su""!rting e&&!rts t! #reathe$ m!nit!ring vital signs$ and maintaining adeDuate #!d% tem"erature+ Mu#inv!luti!n ma% ! ur i& the #ladder is distended a&ter deliver%+ The nurse must "la e identi&i ati!n #ands !n #!th the m!ther and the ne!nate #e&!re the% leave the deliver% r!!m+ Or%thr!m% in is given at #irth t! "revent !"hthalmia ne!nat!rum+ <elvi ,tilt e*er ises an hel" t! "revent !r relieve #a )a he during "regnan %+ Be&!re "er&!rming a Ne!"!ld maneuver$ the nurse sh!uld as) the "atient t! em"t% her #ladder+ . !rding t! the (nang Ia)a" "r!gram$ the !rd sh!uld n!t #e lam"ed until "ulsati!ns have st!""ed (that-s a#!ut 1,3 minutes)+