Nursing Tips: Maternity

Car seat safety for newborns includes installing the car seat in the back/middle seat, using a rear-facing seat with a 5-point harness until at least age 2, installing the seat at a 45 degree angle, positioning straps at or below the level of the child's shoulders, and ensuring the chest clip is at the nipple level (NOT resting on the abdomen!)

Acrocyanosis is the bluish discoloration of fingers/hands and toes/feet and is an expected finding in the newborn. Report persistent central cyanosis to the provider.

Two types of ultrasonography used in pregnancy are transvaginal (ultrasound transducer placed in the patient's vagina) and abdominal (transducer placed on the outside of the abdomen). 

When beginning testing for infertility, semen analysis is often the first test performed. This is non-invasive and less expensive than further testing!

Treatment for infertility is unique to the individual, but some treatments include: Intrauterine Insemination (IUI), In Vitro Fertilization (IVF), Embryo Transfer (ET), the use of donor eggs/sperm/embryo, and the use of a gestational carrier (surrogate).

Toxoplasmosis is a teratogenic parasitic infection acquired by consumption of raw or undercooked meat, or by handling cat feces.

The fetal heart tones cannot be assessed using a doppler until around 12 weeks gestational age. Prior to this time, heart tones can only be identified using ultrasound.

Probable signs of pregnancy include Chadwick's Sign, Goodell's Sign, Hegar's Sign, ballottement, and a positive pregnancy test. These findings are probably related to pregnancy, but could have other explanations.

A patient's estimated date of delivery can be determined using Naegele's Rule. After determining the first day of the patient's last period, subtract 3 months, then add 1 week and 1 year. 

Supine hypotensive syndrome is caused by a pregnant patient's heavy uterus compressing the inferior vena cava when lying supine. Educate patients to rest either in a side-lying position, or with a pillow under one hip.

A patient who was rubella non-immune during pregnancy should receive the MMR vaccine after delivery (this vaccine is contraindicated during pregnancy).

Educate the patient that pregnancy must be avoided for at least 28 days after immunization.

A macrosomic infant (large for gestational age) is one who is over 4,000 g (or 8 lbs., 13 oz.). 

Positive signs of pregnancy include identification of fetal heart sounds, fetal movement felt by a healthcare provider, and ultrasound visualization of the fetus. There is no other explanation for these findings than pregnancy. 

One test that can be performed for infertility is a hysterosalpingogram (HSG). Because this test uses contrast dye to assess the patency of the fallopian tubes, be sure to assess for allergies to shellfish or iodine prior to the procedure!

Natural family planning methods involve avoiding intercourse during fertile periods by tracking the patient's menstrual cycle, or assessing the basal body temperature or cervical mucus consistency daily.

Maternal Serum Alpha-fetoprotein (MSAFP) is a test for genetic abnormalities performed between 15 and 20 weeks gestation.

First trimester lab testing should include: CBC, urinalysis, STI testing, pap test, blood typing (including Rh factor), rubella titer, Hepatitis B, and HIV. High risk patients may also require quantitative hCG level testing.

Educate patients about warning signs in pregnancy for which they should notify their provider: diarrhea, fever, chills, severe abdominal cramping or pain, severe vomiting, vaginal bleeding, and decreased fetal activity should be reported and assessed fully!

Combined oral contraceptive pills (contain estrogen and progestin) are contraindicated for patients who are breastfeeding, smoke, or have a history of blood clots, stroke, coronary artery disease, or hypertension.

Any pregnant patient complaining of unilateral stabbing pain in the lower abdomen/pelvis should be evaluated for ectopic pregnancy.

Expected weight gain during pregnancy differs depending on the mother's pre-pregnancy weight.

A nonstress test (NST) is a non-invasive test done to examine the fetal heart rate and response to fetal movement.

A Bishop score is used to determine maternal readiness for labor induction based on cervical readiness.

An Indirect Coombs test is used to determine if a pregnant patient is Rh-positive or Rh-negative.

During amniocentesis, alpha-fetoprotein (AFP) levels are measured. HIGH levels of AFP are associated with neural tube defects. LOW levels of AFP are associated with chromosomal disorders (such as Down Syndrome).

 A person who gets medroxyprogesterone (Depo-Provera) shots for contraception needs to increase their intake of Calcium and Vitamin D because a key side effect of this medication is decreased bone density!

MSAFP is a test performed at 15-20 weeks gestation to test for genetic abnormalities.

To confirm Premature Rupture of Membranes (PROM), you can use one of these tests: Nitrazine paper test, Ferning test

Presumptive Signs of pregnancy are things that can be explained by OTHER reasons besides pregnancy.

Injectible medroxyprogesterone can cause bone loss. Advise patient to take Calcium and Vitamin D supplements to reduce the risk of bone loss.

Important patient teaching about diaphragms: Diaphragms should remain in place for 6 hrs after intercourse; Reapply spermicide after intercourse.

Hydatiform mole is a type of Gestational Trophoblastic Disease. Key S&S include: "Prune juice" discharge; Hyperemesis (severe n/v); Elevated hCG levels

During pregnancies, an ultrasound is typically performed ~ 18-20 weeks gestation to assess for growth, development, and age of the fetus.

Chorionic Villus Sampling (CVS) is a procedure used to identify chromosomal abnormalities in the fetus.

Maternal Phenylketonuria (PKU) is a genetic disease that causes the amino acid phenylalanine to build up in the body, which can cause birth defects in the developing fetus.

Care of an infant born to a HIV-positive patient

Causes of bleeding during pregnancy

Fetal lung maturity is determined by the L/S ratio.

Cathy's method for calculating a pregnant woman's due date: Add 9 months PLUS 1 week from the woman's last menstrual period.

Between 18 and 32 weeks gestation, the fundal height = gestational age.

Supine vena cava syndrome is maternal hypotension due to the weight of the uterus on the vena cava when mom is supine. Teach mom to lay on her left side or place a wedge under one hip when supine.

Key patient teaching with IUDs: Report foul smelling discharge, change in IUD string length, fever/chills, or pain with intercourse!

To understand the cause of different fetal heart rate patterns, remember VEAL CHOP.

Variable decelerations -> Cord compression.

Early deceleration -> Head compression.

Accelerations -> OK.

Late decelerations -> Placental Insufficiency. 

Folic acid is SUPER important during pregnancy because it helps to prevent neural tube defects.