Maternity Nursing

Maternal Risk Factors - Limit weight gain to 15lbs

- Avoid exposure to infections
Infectious Disease
▪ German Measles (Rubella) ✓ During labor:
o deafness, cataracts, cardiac defects - Monitor maternal VS and FHT
▪ Syphilis - Administer oxygen and pain medication sa ordered
o spontaneous abortion, physical - Side-lying or semi-Fowler’s position
abnormalities, mental retardation - Watch out for signs and symptoms of heart failure
▪ Gonorrhea - Provide emotional support
o Neonatal conjunctivitis, pneumonia, sepsis
▪ HIV ✓ Postpartum
- monitor VS, I&O, weight, bleeding
Substance Abuse - Bed rest
▪ Smoking - Assist with ADL
o LBW, prematurity, still birth, SIDS - Prevent infection
▪ Alcohol
o fetal death, FAS, IUGR, Diabetes Mellitus
▪ Marijuana ▪ more difficult to control during pregnancy
o LBW, prematurity, tremors, sensitivity to ▪ changes in insulin requirement during pregnancy
light o First trimester: decrease
▪ Cocaine o Second trimester: increase
o LBW, still birth, tremors, irritability, o Third trimester
tachycardia
▪ Infant of diabetic mother is at risk for hypoglycemia,
Pregnancy and Maternal Disease RDS, congenital defects and stillbirth
▪ gestational diabetes occurs in the 2nd or 3rd trimester
Cardiac Disoders
▪ factors predisposing to gestational DM:
▪ congenital heart disease, rheumatic heart disease
o Age (>35 years old)
▪ increased blood volume and increase cardiac
o Obesity
output
o Multiple gestation
o Family history
Clinical presentation
▪ screening: 26th week of pregnancy
- Cough
- Difficulty of breathing
Clinical Presentation
- Fatigue
- Polyuria
- Palpatations
- Polydypsia
- Rales, murmurs
- Polyphagia
- Tachycardia
- Weight loss
- edema
- Frequent UTI
- Large fetus
Diagnostics
- Chest X ray
Diagnostics
- EKG
- Glucose challenge test
- Echocardiography
- Oral glucose tolerance test
- HbA1C
Management
- Digitalis
Glucose Challenge Test
- Diuretics
▪ screening test (24-28 wks AOG)
- Antiarrhythmics
- Anticoagulant ▪ no need for preparation and fasting50g glucose
- antibiotics load
▪ normal: <140 mg/dl
Nursing Consideration ▪
✓ Prepartum OGTT
- Provide adequate rest
- Limit sodium intake • confirmatory test
 Maternity Nursing
• 3 days high Tuberculosis
• 100g glucose load ▪ droplet infection
• 3 BG determination ▪ perinatal transmission is rare
• abnormal if: ▪ acquired by swallowing infected amniotic fluid
• FBS - > 95 mg/dl
• 2 values > 145 mg/dl
Clinical presentation
1. Mother
2. Neonate
Management
- -lethargy, poor suck, failure to thrive, respiratory
1. Diet
distress, hepatosplenomegaly
2. Exercise
3. Insulin
Diagnostics
▪ mother:
Nursing considerations
skin test (safe during pregnancy)
• Instruct client regarding chest X ray (abdominal shield)
1. Diet sputum examination
2. BG monitoring
3. Complications ▪ neonate:
- Monitor weight, signs of infection, skin test at birth and repeated at 3 – 4 months
preeclampsia bacilli in gastric aspirate or placental tissue
- Assess fetal status
- Assess insulin needs Management

Anemia ▪ mother:
Multidrug therapy (INH, RIF, EMG) for 6-12 mos
✓ hemoglobin <10 mg/dl or hematocrit <20% most ▪ neonate:
common medical problem during pregnancy causes INH for 3 mos (mother with active TB)
o Iron deficiency BCG
o Folic acid deficiency
Nursing considerations
Effects ▪ Teach mother and family members regarding
✓ Preterm birth transmission and prevention
✓ SGA ▪ Promote breastfeeding only if the mother is
✓ Increased risk of post partum infection and noninfectious
hemorrhage ▪ Mother taking anti TB drugs may breastfeed the infant
▪ During active disease, isolate and separate the infant
Clinical presentation from the mother
- Pallor
- Fatigue DIC
- Dizziness ▪ consumption
- Shortness of breath
▪ coagulopathy
- Palpitations
▪ Increased clot formation in the circulation due to
overstimulation of the clotting process
Management
- Iron supplement
Predisposing factors
- Vitamin C
- Abruptio placenta
- Folic acid supplement
- Amniotic fluid
- Embolism
Nursing considerations
- Dead fetus
Check hemoglobin and hematocrit levels every 2
- PIH
weeks
- H mole
Encourage intake of diet rich in iron and folic acid
- Hemorrhagic shock
Teach client regarding effects of iron ingestion
Assess the need for injectable iron
 Maternity Nursing
Clinical presentation ➢ facial edema
- Uncontrolled bleeding ➢ intractable vomiting
- Petechiae, purpura, ecchymoses ➢ epigastric pain
- Hematuria ➢ fever and chills
- Hematamesis
- Shock Complications of Pregnancy
Diagnostics
Abortion
- Decreased platelet count
termination of pregnancy before the age of viability
- Prolonged PT and PTT
spontaneous or induced, clinical presentation.
- Prolonged clotting time
▪ Vaginal bleeding
▪ Contractions
Fetal Diagnostic Tests ▪ Passage of fetus/placental tissue

Ultrasound Type of Abortion

❖ uses: ▪ Threatened – contractions/bleeding, cervix closed,
✓ Validation and dating of pregnancy fetus not expelled
✓ Assessment of fetal growth and viability ▪ Inevitable – cervix open, heavier bleeding
✓ Measurement of fluid volume ▪ Complete – all products of conception expelled
✓ safe for fetus ▪ Incomplete – membrane or placental tissue
retained
Amniocentesis ▪ Missed – fetus dies in uterus but is not expelled
➢ aspiration of amniotic fluid the 14th week ▪ Habitual – three consecutive pregnancies ending in
spontaneous abortion
uses:
- Identify chromosomal abnormalities Nursing considerations
- Determine fetal sex - Maintain client on bed rest
- IV fluids
Alpha-Fetoprotein Screening - Instruct client to keep all tissues passed
➢ sample used: amniotic fluid done between 15 and - Prepare client for D & C or suction eveat
18 weeks
Incompetent Cervix
uses: - Pailess dilatation of the cervix in the absence of
- To detect presence of neural tube defects and uterine contractions; due to cervical trauma
chromosomal abnormalities - History of repeated abortions
- Management
Lecithin/Sphingomyelin Ratio - Cerclage
➢ (L/S Ratio) - Shirodkar Technique/ McDonals Procedure
➢ sample used: amniotic fluid
Nursing considerations
use: to determine fetal lung maturity normal results - Bed rest
at 35-36 weeks: 2:1 (low risk for developing - Monitor VS, fetal heart rate
respiratory distress syndrome) - Prepare for procedure
- Monitor post-complications:
Chorionic Villi Sampling 1. Rupture of membranes
➢ use: to obtain tissue sample at implantation site 2. Contractions
fetal chromosomal, DNA or metabolic abnormalities 3. bleeding
transabdominal or transcervical earliest test possible on
fetal cells between 9 – 12 weeks of gestation Ectopic Pregnancy
• Pregnancy outside the uterine cavity
DangerSigns of Pregnancy
• Fallopian tubes – most frequent site; ruptures
➢ any form of vaginal bleeding
before the 12th week AOG
➢ sudden gush of fluid from the vagina
➢ presence of regular contractions before the
• Clinical presentation
expected date of confinement
- Bleeding
➢ severe headache and visual disturbance
 Maternity Nursing
- Hypotension o Instruct patient to monitor HCG levels for
- Abdominal pain and abnormal pelvic mass 1 year
- Decreased hemoglobin and hematocrit; o Teach patient how to use contraceptives to
leucocytosis delay pregnancy by at least a year

Prenancy-Induced Hypertension
• Management • Vasopastic hypertesion, edema and proteinuria
- surgery: salpingostomy; salpingectomy
• Onset: after 20th week of pregnancy
- Blood transfusion
• Nursing considerations Classification:
- Obtain vital signs 1. Preecclampsia (mild or severe)
- Monitor bleeding 2. Eclampsia
- Prepare patient for surgery
- Allow client to express feelings about loss of Management: termination of pregnancy
pregnancy Complication: HELLP syndrome (hemolysis,
elevated liver enzymes, low platelet count)
Hyperemesis Gravidarum
• Intractable nausea and vomiting that last beyod the
first trimester Mild Preeclampsia
• Most pronounced upon waking up • Onset: between 20th and 24th week of pregnancy
• Hypertension of 15-30 mmHg above the baseline
• Clinical presentation • Sudden weight gain (1 lb/wk), edema of the hands
- Persistent nausea and vomiting and face, (+1) protenuria
- Dehydration
- Electrolyte imbalance
• Nursing considerations:
- Weight loss
- Bed rest in left position
- Monitor blood pressure, weight, deep tendon
• Nursing considerations reflexes
- Monitor vital signs, fetal heart rate and fetal - Increase dietary carbohydrate and protein
activity
- Monitor I&O, electrolytes and hematocrit
- Small feedings
Severe Preeclampsia
- Dry diet, alternate liquids and solids • Blood pressure of 150/100 – 160/110
- Weight patient daily • Headache, epigastric pain, nausea and vomiting,
- Assess fetal growth visual disturbance
• (+4) protenuria, oliguria, hyperreflexia
Hydatidiform mole • Management: magnesium SO4, hydralazine
• Developmental anomaly of placenta
• Grape-like clusters • Nursing considerations:
• Common in women over 40 - Daily funduscopic examinations; monitor
reflexes
- Seizure precautions
• Clinical presentation
- Continue to monitor 24 -48 hours post partum
- Increasing size of uterus
- Increased levels of HCG
- Vaginal bleeding Eclampsia
- Absent fetal heart sounds • C0nvulsions, coma, cyanosis, fetal distress
- Ultrasound: snowstorm pattern • Bp > 160/110, severe edema, 4+ proteinuria

• Management • Nursing considerations:

o Evacuation of the uterus (suction - Administer oxyden
curretage) - Minimize all stimuli
o Hysterectomy - Seizure precautions
o chemothearapy - Monitor vital signs
- Prepare for C section
• Nursing considerations
 Maternity Nursing
o Uterine tenderness
Placenta Previa o Hypotension, tachycardia, pallor
• Abnormal implantation of the placenta in the lower o Concealed hemorrhage: abdominal rigidity,
uterine segment increase in fundal height
• Classification
1. Complete (total, central) ▪ Management
2. Partial o Cesarian section
3. Marginal (low lying) o Blood transfusion
o IV fluids
o O2 inhalation

▪ Nursing consideration
o Relieve pressure on the cord
o Elevation of the presenting part
o Oxygen at 8 – 10 LPM via face mask
o Cesarian section

Prolapsed Cord
▪ Protusion of the umbilical cord into the vagina

▪ Risk factors
o Ruptured membranes
o Small fetus
o Breech presentation
o Transverse lie
• Clinical presentation o Excessive amniotic fluid
- Painless vaginal bleeding (third trimester)
- Abnormal fetal position ▪ Clinical presentation
- anemia o Visible cord at the vaginal opening
• Management o Palpable cork on vaginal examination
- Based on maternal and fetal condition o Fetal bradycardia
- Conservative
- Cesarian section ▪ Management
o Relieve pressure on the cord
o Elevation of the presenting part
• Nursing considerations
o Oxygen at 8-10 LPM via face mask
- Bed rest
o Cesarian section
- IV fluids
- Blood transfusion as needed
▪ Nursing considerations
- Monitor vital signs, FHR, fetal activity
o knee-chest or Trendelenberg position
- Avoid vaginal examinations
o Monitor fetal heart tones
- Prepare for ultrasound
o Avoid palpatation or handling of the cork
- Prepare for cesarian section
o Prepare client for surgery
o Allay client’s anxiety
Abrputio Placenta
▪ Premature separation of a normally implanted
placenta
Uterine Rupture
▪ Tear in the uterine wall
▪ Risk factors
▪ Most serious complication of labor
o Maternal hypertension
o Short umbilical cord ▪ Risk factors
1. Previous cesarian section
o Abdominal trauma
2. Mulitiparity
o Smoking/use of cocaine
3. Intense uterine contractions
▪ Clinical presentation
Clinical presentation
o Vaginal bleeding
1. Complete rupture
o Abdominal and low back pain
o sudden, severe abdominal pain
o Frequent contractions
 Maternity Nursing
o Abdominal rigidity ▪ No fetal descent and cervical dilation
o Cessation of contractions ▪ No “bloody show”
o Absence of FHR
o Shock Stages of Labor
First Stage (Dilation)
2. Incomplete rupture 1. Latent phase (0-4cm)
o Abdominal pain with contractions 2. Active phase (4-8cm)
o Slight vaginal bleeding 3. Transition (8-10cm)
o Failure of cervical dilatation
o Absence of FHR Nursing considerations
- Monitor maternal and fetal VS
Management - Monitor progress of labor
o Surgery (c section, hysterotomy, hysteretomy) - Teach breathing techniques
o Blood trasfusion as needed - Discourage pushing until cervix is dilated

Nursing consideration Second Stage (Expulsion)

o Monitor maternal vital signs and FHR ▪ Full cervical dilation to fetal expulsion
o Watch out for signs and symptoms of shock
o Prepare client for surgery ▪ Nursing considerations
o Provide emtional support for the client - Perform assessment every 5 minutes
- Monitor maternal vital signs
Labor – coordinated sequence of uterine contractions - Monitor FHR before, during and after
resulting in cervical effacement and dilation followed by contractions
expulsion of the products conception - Prepare for delivery
- Maintain privacy
Effacement – shortening and thinning of the cervix - Catheterize if bladder is distended

– descent of the fetus into the pelvic inlet 2 weeks prior to APGAR Scoring
onset of labor ▪ Performed at 1 and 5 minutes
Lightening
▪ Parameters:
- Heart rate
Lie – relationship of the long axis of the fetus to the long - Respiratory rate
axis of the mother - Muscle tone
- Reflex irritability
Presentation – part of the fetus that first enters the mother’s - Color
pelvis
Score interpretation
Position – relationship of the presenting part to the ▪ 7-10: no need for resuscitation
maternal pelvis ▪ 3-6: requires resuscitation
▪ 0-2: needs immediate critical care
Station – measurement of the descent of the presenting part
into the maternal pelvis ▪ Third Stage (Placental)
▪ Placental separation and expulsion
True Labor ▪ 5-10 minutes after delivery of the baby
▪ Near term ▪ Signs of placental separation:
▪ Increasing frequency, duration and intensity - Sudden gush of blood
▪ Pain begins in the back, radiates to the abdomen - Lengthening of the cord
▪ Progressive fetal descent and cervical dilation - Change in uterine shape
▪ “bloody show” ▪ Schultze’s mechanism
▪ Duncan’s mechanism
False Labor
▪ Early in pregnancy Nursing considerations
▪ Irregular; non progressing - Assess maternal vital signs
▪ Discomfort in the abdomen and groin - Assess uterine status
- Check completeness of the placenta
 Maternity Nursing
- Inspect perineum Regional (lidocaine, tetracanine, bupivacaine
- Promote bonding - Lumbar epidural, caudal, subarachnoid

Fourth Stage (Recovery) Nursing considerations

▪ 1-4 hours after delivery ▪ Monitor maternal/fetal vital signs
▪ Monitor progress of labor
▪ Nursing considerations ▪ Check for allergies
- Check vital signs ▪ Record drug used, time, amount, route, site, client
- Palpate fundus for firmness site
- Monitor color and amount of lochia ▪ Empty patient’s bladder
- Inspect perineum; apply ice packs ▪ Position client appropriatel

Duration of Labor Dystocia

Primipara ▪ Difficult or prolonged labor
Stage 1: 12 – 13 hours
Stage 2: 1 hour ▪ Problem in any of the following
Stage 3: 3 – 4 minutes 1. Passenger
Stage 4: 1 -2 hours 2. Passage way
3. Powers
Multipara 4. Placenta
Stage 1: 8 hours 5. Psychological response of the mother
Stage 2: 20 minutes
Stage 3: 4 – 5 minutes Signs of fetal distress
Stage 4: 1 – 2 hours ▪ Slowing down of the fetal heart rate
▪ Meconium-stained amniotic fluid
Induction of Labor
▪ Deliberate stimulation of uterine contraction prior to Nursing intervention
labor ▪ Monitor FHR
▪ Place patient on left side
1. Medical ▪ Prepare for emergency delivery
o Oxytocin (pitocin) ▪ Provide emotional support
o Methergine
o Prostaglandin Electronic Fetal Monitoring
▪ Purpose: evaluate fetal condition and tolerance of labor
2. Amniotomy ▪ external/interna;
o Deliberate rupture of membranes ▪ Heart rate

Nursing considerations ▪ Pattern of Fetal Heart Rate Deceleration

▪ Continuous fetal monitoring
▪ Monitor: maternal BP, PR and progress of labor 1. Early deceleration
▪ Discontinue oxytocin infussion if 2. Late deceleration
a. There is fetal distress 3. Variable deceleration
b. Hypertonic contractions develop
c. Signs of complications are present Early deceleration
(hemorrhage, shock, abruptio placenta, ▪ Deceleration begins early in contraction
amniotic fluid embolism) ▪ Fall in heart rate stays within the normal range
▪ Inform physician ▪ Heart rate returns to baseline
▪ Due to compression of fetal head against the cervix
▪ Not a dangerous pattern
Obstetric Analgesia ▪ No intervention needed
Goal: to relieve pain and discomfort of labor and delivery
with the least effect on fetus Late Deceleration

Routes: • Deceleration start late in contraction

Inhalation (methoxyflurane, nitrous oxide) • Fall in heart rate > 20 bpm
IV (sodium pentothal)
 Maternity Nursing
• Heart rate does not return to baseline
• Due to uteroplacental insufficiency
• Dangerous pattern
• Change maternal position, administer O2,
discontinue oxytocin, prepare for immediate
delivery if pattern is consistent
Variable Deceleration
• Onset not related to contractions
• Abrupt and dramatic swings in heart rate; rapid
return to baseline
• Due to compression of the umbilical cord
• Not a dangerous pattern
• Change maternal position, administer O2,
discontinue oxytocin infusion
• If persistent, CS will be needed
• Explain procedure
• Reassure patient
• Monitor mother and fetus continuously
• After delivery, check mother and fetus for injuries
Vacuum Extraction
• Used to assist delivery of the fetal head
• Suction device applied to fetal head and traction
applied during contractions
Nursing considerations
• Do not keep suction device longer than 25 minutes
• Continuous fetal monitoring
• Assess infant fro cerebral trauma

Obstetrical Procedure
Episiotomy

• Incision made into the perineum to enlarge the

opening
• Prevents perineal laceration
• Types:
1. Midline (median)
2. Mediolateral Cesarian Section
• Delivery of the fetus through an abdominal and
uterine incision
Indications:
• Fetal distress
• Abnormal presentation (breech, face, shoulder)
• CPD
• Placental abnormalities
• Multiple gestation
• Previous CS
• Arrest in labor

Nursing considerations Nursing considerations

• Apply ice packs for the 24 hours • Obtain inform consent
• Hot sitz bath to promote healing • Explain procedure to the mother
• Check for signs of bleeding/infection • Monitor mother and fetus continuously
• Instruct client about perineal hygiene • Prep abdomen and pubic area
• Insert IV and catheter
• Pain relief
Forcep Delivery
• Encourage turning, coughing and deep breathing
Indication: to shorten second stage of labor
• Monitor for signs of bleeding and infection
• Fetal distress
• Poor maternal effort Physiologic Changes
• Medical condition • Involution of the Uterus
• Maternal fatigue • Return of the uterus to its nonpregnant size
• Large infant - 1 hour postpartum: fundus at the level of the
Nursing considerations umbilicus
 Maternity Nursing
- Fundus decrease by 1cm per day • Reassure the mother that she can perform the tasks
- Fundus no longer palpable by the 10th day of being a mother
Lochia
1. Lochia rubra – red; 1-3 days “Letting Go”
2. Lochia serosa – pinkish-brown; 4-10 days • Fifth or sixth week postpartum
3. Lochia alba – yelowish-white; 11-21 days • New baby is included in new lifestyle
• Focus on entire family
• Foul smelling lochia indicates infection • Mother may be overwhelmed by demands on her
time and energy
• Menstrual flow resumes within 8 weeks in Postpartum Complications
nonbreastfeeding mothers, within 3-4 months in Postpartum Hemorrhage
breastfeeding mothers. Loss of more than 500 ml of blood
Causes:
• Normal blood loss: 500cc (vaginal delivery); 1 L • Uterine atony
(CS) • Lacerations
• Increased WBC count (up to 20,000) • Retained placental fragments
• Fever may be present Nursing considerations
• Colostrum secreted from 1-3 days • Monitor vital signs
• Hemorrhoids are common • Monitor fundus
• IV fluids
Postpartum Discomfort Intervention
• Administer medications
Perineal discomfort
• Measure I and O
• Ice packs (1st 24 hrs) warm
• Keep client warm
• sitz bath (after 24hrs
Postpartum Infection
Episiotomy
Occurs within 10 days after birth
• Analgesics spray Predisposing factors;
• perineal care after voiding • Prolonged rupture of membranes
Breast engorgement
• Cesarean section
• Analgesics
• Trauma
• breastfeed frequently
• Maternal anemia
• Ice packs between feedings
• Retained placental fragments
• warm soaks before feedings Clinical presentation
Postparutum blues Fever (100.4 F or 37.8 C) for 2 consecutive days
• Encourage verbalization • Chills
• Abdominal or pelvic pain
Cracked nipples
• Foul-smelling vaginal discharge
• Air dry nipples 1-20 minutes after feeding
• Dysuria
• rotate baby’s position after feeding
• Increased wbc count
• Make sure baby is latched on the areola
Management
• Do not use soap when cleaning the breast
• Antibiotics
Phase of Maternal Adjustmet
• Warm sitz bath
1. “Taking In”
Nursing considerations:
• 1-2 days post partum
• semi-Fowler’s or high Fowler’s position
• Predominance of mother’s needs (sleep and food)
• High-calorie, high protein diet
• Help with daily activities as well as child care
• Increase oral fluids (>3 L/day)
• Listen to the mother’s experience during labor and
delivery
Mastitis
• Not the best time to do teaching about care of the
• Infection of the breast
neonate
• Usually, bilateral
“Taking Hold”
• Staphylococcus aureus
• 3-10 days post partum
• Clinical presentation
• Mother starts assuming the care of the neonate
- Redness and tenderness
• Emotional lability may be present
- Fever and chills
• Best time to teach about baby care
 Maternity Nursing
- malaise
• Breast abscess Labor
Management First Stage
• Antibiotics - Beginning gots short, mild, lasting 10-15 minutes
• ice apart, mild discomfort
Nursing considerations - Progressively got longer, stronger, lasting 60-90
• Teach importance of hand washing seconds, ends woth complete dilatation
- Latent=0.3cm, 3hrs primip, 2 hrs multip.
• Empty breast regularly
- Transition=8-10cm, loss of control, urge to push
• Mother may continue breastfeeding
Second Stage
Labor and Delivery
- Complete dilatation of the cervix
Labor
- 50 minutes for a primip, 20 minutes for multip
Maternal Weight Gain
- Pushing
• Underweight woman: 28-40 lbs - Crowning
• Normal weight woman: 25-35 lbs - Ends with delivery of baby
• Overweight woman: 15-25 lbs Third Stage
• Obese woman: less than: 15 lbs • Begins after delivery of baby and terminates with
the birth of the placenta
Labor • Signs of Placental Separation
Maternal weight gain distribution - globular and firmer uterus
• fetus, placenta, amniotic fluid = 11 lbs - rise of uterus in abdomen
• Uterus = 2 lbs - descend of umbilical cord
• Increase blood volume = 4 lbs - sudden gush of blood
• Breast tissue = 3 lbs • Placental expulsion
• Maternal stores = 5-10 lbs
Fouth Stage
Labor • First hour post partum
Umbilical cord • Restoration of physiological stability
• One large vein • Assessments
• Two smaller vein • Vital signs
• Made of Whaton’s Jelly • Fundus checks
• Fetal Circulation • Amount lochia
➢ ductus venosus • Perineum
➢ Ductus arteriosus • Bladder function or distention
➢ Foramen ovale • Family education- handling/breastfeeding
Labor
• Adequacy of the maternal environment Position changes of the fetus
- Nutrition • Descent
- Hyperthermia • Flexion
- Chronic disease, diabetes, thyroid, cardiac, and
• Internal rotation
circulatory
• Extension
- Substance abuse
- TORCH (T=toxoplasmosis, O=other; gonorrhea, • External rotation
syphilis, varicella, hep B, group B strep. HIV, • Expulsion
R=rubella, C=cytomegalovirus, H=herpes

Labor
Stages of Labor
- First Stage Dilating
- Second Stage – Epulsion
- Third Stage – Placental
- Fourth Stage – Post Partum
 Maternity Nursing
1. Palpate the upper abdomen to determine contents
of fundus
2. Locate the fetal back in relation to the right and left
sides
3. Locate the presenting part at the inlet and check
for engagement by evaluating mobility
4. Palpate just above the inguinal ligament on either
side to determine the relationship of the presenting
part to the pelvis

Perineum
- Episiotomy
✓ lateral
✓ medbilateral
✓ median

Postpartum
• Breastfeeding
• Teaching
• Safety
• Family planning
Fetal Presentation • siblings
L.O.A. – Left occipitoanterior
L.O.T. – Left occipitotransverse Post-Partum
L.O.P. – Left occipitoposterior • Lochia
R.O.T. – Right occipitoanterior • Rubra
R.O.T. – Right occipitotransverse • Serosa
R.O.P. – Right occipitoposterior • Alba

Delivery
Fetal position-Assessment
Five ways
1. Abdominal palpation
2. Vaginal examination
3. Combined auscultation and examination
4. Ultrasound
5. X-ray

Abdominal Palpation
- Leopoid Maneuver