Fetal Development, Timing & Sensations
- During the pre-embryonic stage, cell division begins and the foundation is set.
- The embryonic stage is critical due to organogenesis and sensitivity to teratogens.
- During the fetal stage, the baby grows and matures in preparation for life outside the womb.
- At eight weeks, the heart chambers are fully developed.
- The sex of the baby is visible on ultrasound around 16 weeks.
- By 20 weeks, lung surfactant begins to develop and the mother may feel quickening.
- Quickening and initial lung development occur around the halfway point of the pregnancy.
- By 24 weeks, more surfactant is produced, which is critical for lung function at birth.
- Testes descend for boys and subcutaneous fat forms occur around weeks 29-32, increasing NICU survival chances if born at this time.
- Muscle tone develops, along with sleep-wake patterns, and maternal antibodies transfer to the baby around week 37, leading to "full term."
Fetal Sensations & Physical Signs
- Quickening refers to the initial fetal movement felt by the mother, usually between 14-16 weeks, but can be later for first-time mothers.
- Lightening is the term for when the baby "drops" into the pelvis late in pregnancy, easing breathing but increasing urination.
- Ballottement is a pelvic exam technique in which the baby bounces back when pushed, indicating fetal presence around 16-28 weeks.
- QUICK is a mnemonic for Development Milestones: Quickening, Ultrasound showing gender, Increase in surfactant, Chubby baby, and Kicks & muscle tone strong.
- Week 24 is considered the point of fetal viability due to surfactant production in the lungs.
Newborn Thermoregulation
- Newborns lose heat faster than adults due to poor insulation.
- Heat loss can lead to cold stress, hypoglycemia, and respiratory distress.
Ways Newborns Lose Heat (Examples & Interventions)
- Convection: Heat loss to cooler air. Prevention: Use a hat and swaddle.
- Radiation: Heat loss to nearby cooler surfaces. Prevention: Keep bassinet away from windows.
- Evaporation: Heat loss when liquid turns into vapor. Prevention: Dry the baby immediately after delivery.
- Conduction: Heat loss to cold surfaces directly touching. Prevention: Use pre-warmed blankets.
- Think "CREEpy Cold" to remember heat loss methods: Conduction, Radiation, Evaporation, and Convection.
- Evaporation is the most common heat loss in the first few days.
- Important Newborn Care Tips for Thermoregulation focus on skin-to-skin contact, hats, pre-warmed blankets, swaddling and drying thoroughly.
- Avoid leaving the baby wet, near cold windows, on cold surfaces, or uncovered.
- Conduction is the method of heat loss that occurs when a newborn is placed on a cold scale.
- Evaporation is the most significant form of heat loss immediately after birth.
- Placing a hat on the newborn's head prevents heat loss from convection.
PROM / PPROM / AROM (Amniotomy)
- Think of the Amniotic Sac like a Water Balloon in a Party
- PROM (Premature Rupture of Membranes) occurs when the "water balloon" pops early, before labor starts.
- PPROM (Preterm Premature Rupture of Membranes) occurs when the "water balloon" pops too early, before the baby is full term.
- AROM (Artificial Rupture of Membranes) involves the provider intentionally popping the "water balloon" to induce labor.
- PROM: Premature Rupture of Membranes is defined as rupture of amniotic sac ≥1 hour before labor begins, at any gestational age.
- PROM is risky because it increases the chance of infection, umbilical cord issues, and stalled labor.
PROM Risk Factors
- Weak membranes, shortened cervix, uterine instability, socioeconomic status, low BMI, smoking, infection.
PPROM: Preterm Premature Rupture of Membranes
- Occurs between 20–36 weeks gestation and carries a high risk for preterm birth and infection.
- Dx with a fetal fibronectin test (fFN) or cervical length.
The Management of PPROM
Do's: bed rest, limit work, monitor for infectionDon'ts: heavy activity and intercourse. Watch for signs of infection.
AROM: Artificial Rupture of Membranes
- AROM involves the intentional "popping" of the amniotic sac to induce or speed up labor.
- The provider performs it using an AmniHook or clamp when labor is started or medically progressed for high blood pressure or distress.
- It is not done routinely because it increases pain, raises the risk of infection, or could cause cord prolapse if the baby's head isn't engaged.
- Nursing Actions: immediately check FHR, assess fluid color.
Nursing Considerations for AROM
- Monitor for cord prolapse if the baby's head isn't engaged and fetal heart tones.
- Green fluid is meconium, foul smell is infection.
Uterine Relaxants (Tocolytics)
These meds help STOP labor, like pressing the pause button when the baby's trying to come too early (before 37 weeks)!
Remember "It's Not My Time!" → I.N.M.T.
It's Not My Time! Breakdown*
Indomethacin - Block prostaglandins
Nifedipine - Relaxes smooth muscle
Magnesium Sulfate - electrolyte for fetal brain
Terbutaline - Relax uterus, causes tachycardia
Metabolic Disorders in Pregnancy
- GDM (Gestational Diabetes Mellitus) is glucose intolerance that develops during pregnancy, typically in the 2nd or 3rd trimester.
- GDM is caused by placental hormones that increase insulin resistance in the mother's body.
- Glucose crosses the placenta, but insulin does not leading to a big baby and other risks.
- GDM is screened for at 24-28 weeks due to placental hormones.
Screening for GDM
- Use a 1 hour glucose challenge and if over >140 mg/dL move to a 3 hour OGTT.
- During antespartum make sure the pregnant patient gets balanced meals, complex carbs, protein and fiber.
Antepartum care for GDM patients
- Monitor with exercise, blood glucose monitoring, insulin, Fetal surveillance.
- Diet and exercise should maintain these levels: fastingBG: <95mg/dL, 1-hourpost-meal: <140mg/dL, 2-hourpost-meal: <120mg/dL.
Fetal & Neonatal Risks of GDM
- Stillbirth, Congenital malformations, Cardiac defects, CNS defects, Skeletal anomalies, Neonatal morbidity.
Maternal Risks & Complications of GDM
- Macrosomia, Hydramnios, Ketoacidosis, Hyperglycemia, Hypoglycemia.
- Monitor blood glucose- even slight elevations can impact fetal development.
- Insulin is preferred.
- Teach patients about sick day rules – check ketones if ill, maintain fluid intake, call provider if BG rises.
- "MOM'S BIG BABY" Mnemonic for GDM Complications
- Overdistended uterus (hydramnios),
- Maternal hyper/hypoglycemia
- Stillbirth risk
- Brain defects
- Insulin therapy
- Glucose monitoring 4x/day
- Beta-cell stress in baby
- Amniotic fluid excess
- Big baby & C-section likely
Placenta Abnormalities: Emergent & Non-Emergent
- The placenta is the baby's lifeline & attachments, any issue
- Placenta Previa "PREVIA = Placement Problem"
- Attachment issue
- Placenta attaches too low
Placenta Previa: Key Features
- Implants in the lower uterine segment, near or covering the cervix.
- Bleeding is bright red and painless.
- Occurs in the 2nd or 3rd trimester, often detected.
- Causes maternal and fetal outcomes
Abruptio Placentae (Placental Abruption)
- "ABRUPTION = Detachment Disaster"
- Placenta separates from the uterine wall too early (before delivery)
Key Features of Abruptio Placentae
Medical emergency with dark red bleeding that is PAINFUL.
Associated with hypertension, trauma, cocaine use, smoking, or previous abruption, maternal or fetal outcomes.
Key Signs to watch
- Dark red blood + sharp abdominal pain & Rigid, tender, board-like*
Management for Placenta
- Action / Why is it happening*
- Manage with continuous fetal monitoring, emergency delivery (C-section)
- IV fluids
- Blood Products
- AVoid vaginal exams
Mnemonics to remember
- Previa = Painless, Pretty Red Blood"
- Abruption = Angry Abdomen
Summary between Abruptio and Previa
- Feature & Key Notes to understand the difference*
- Previa is attachment too low to cervix instead of correct uterine placement. It is light red and painless.
- Abruptio is premature detachment that's DARK red and VERY painful with a rigid uterus
Obstetric Emergencies - Meconium-Stained Amniotic Fluid (MSAF)
- What it is: Fetal stool (meconium) passed before birth into the amniotic fluid
- Why it matters indicates fetal stress or hypoxia
- MSAF: have a neonatal resuscitation team present in case suctioning or ventilation is needed
- Green or brown stained amniotic fluid during ROM =
Shoulder Dystocia
- What is it: Baby’s head delivers but the anterior shoulder gets stuck behind moms pubic bone
- The McRoberts maneuver flexes thighs to widen pelvis. DON"T do fundalpressure!
###Proplapsed Umbilical Cord
- Key facts if emergent!*
- Umbilical cord slips down through the cervix before the presenting part of the fetus
- YES! Cord compression = oxygen to baby
- Manually lift presenting part off cord (via sterile-gloved hand) & place in knee-chest or Trendelenburg position
Uterine Rupture
Key emergency to understand due to prior C-Section*
A tear in the uterine wall, most commonly at the site of a prior C-section scar EMERGENCY!
Abnormal fetal heart rate or loss of fetal station baby can move upwards" are key distress calls
Uterine Rupture Chart
Monitor with all the other top items for FHR, Fetal station signs & call for C section NOW*
Summary Chart: Obstetric Emergencies
Action / KeySign / Nursing Intervention tips for success*
Meconium stained: Green/brown; Prepare for neonatal resuscitation
Head out, shoulder stuck: McRoberts + suprapubic pressure
Cord v/ bradycardia: Hand in vagina, knee-chest, C-section
Tearing pain, fetal loss: Oxygen fluid & C section now
Quick Mnemonics “HELP ME SIR” for Emergencies:
- H = Help (call team)
- E - Evaluate FHR
- L - Left lateral or knee-chest
- P - Prepare for C-section
- M = McRoberts (shoulder dystocia)
- E - Emergency delivery if neededS - Saline for cord
- I - Insert hand to relieve cord compression
- R - Rupture? Watch for tearing pain & shock
Signs of Pregnancy: Presumptive, Probable, & Positive
Know what each category is known for + if you know the correct test you can ACE this section for sure*
Presumptive: Subjective signs felt by the woman~nausea, quickening, missed period"
Probable: Objective signs seen by the provider~Positive test, abdominal growth"
Positive: Only signs that confirm pregnancy"Ultrasound, fetal tones, fetal movement by Examiner"
ATI-Style Tip: Positive pregnancy test is NOT a "positive" sign —— it’s probable!
###Fetal Heart Monitoring:VEAL CHOP
- VEAL CHOP is a mnemonic that helps you match each type of fetal heart rate change with its cause and clinical meaning.
Remember!!:Early decels = head compression (OK)Variable decels = Cord Compression (Bad)Late Decels - Placental Insufficency (Not Good)A is good. means oxygenation
- Detailed Breakdown of Each pattern: monitor actions and steps to complete / solve*
Fetal Lung Assessment
Lungs are the last major organ! Must assess to see if you need to intervene for delivery
L/S = Lungs Safe"
PG = Pretty Good!"
Neonatal Jaundice & Treatment
Know each! Physio and Patho
- PhysiologicaJaundice*Affects 60% babies normally
AFTER 24 hour timeframe
Liver is still maturing
- Pathologic*
WITHIN 24 hrs
High levels and can cross a blood brain barrier to permanent damage
Quick Mnemonic: "P is for Problem
"Nàegele's Rule: Calculating (EDD)
Follow the below easy steps to take to check
- 1st day of the LMP- Sub 3 Months, add 7 days, add a 1yr*
Apgar Scoring System
Quick assessment of a newborn’s overall health immediately after birth.
- Done twice, add 1 min and 5 min*
Activity (Muscle Tone): Limp or not
Pulse (Heart Rate): absent?Grimace (Reflex Irritability):Appearance (Skin Color)
Respiration (Breathing Effort)
Each of these 5 scored from 02 / = range a full score of 10
(4 -10 is the normal range for baby)
Mnemonic: "APGAR = Quick Baby Check"
Tests in pregnancy: Daily Fetal Movement & Ultrasound(Do at these times and in the normal range"
Fetal Well Being
- Best to Worst
- assessment
- Doppler = perfusion
- AFI is the fluid
- BPP
- Assess all four with assessment tests and ultrasound
Amniocentesis or Chorionic Villus Sampling
- Aspirate fluids to learn what's the best for baby, learn when to check if the mom has risk issues, never be the risk issue for mom"
Hypertensive Disorders in Pregnancy
Overview / Definition is super important!*
Definition (Chronic or Preeclampsic)• what can happen and what levels can change if you do the right process
Mild
≥ 140/90 mmHg: monitor and move on. Be aware of
- Severe
≥ 160 systolic or ≥ 110 diastolic: Mag sulfate IV or watch out! "
H-E-L-L-P" Mnemonic for key finding of Preeclmapsia!
H " Hemolysis,E + Elevated Liver Enzymes,L+ Low Platelets.Watch out: Notify providers ASAP with pain (epigastric)!
"Mag sulfate, calcium is the antidote for over toxicity!"
- *Eclampsia : this is now deadly- so monitor seizure + give O2 & protect airway"
Postpartum Nursing Assessment
BubbleHE:
- Breasts: soft, no abnormal color
- Uterus: firm, midline
- Bladder: voids normal
- Bowel: make sure the Pt is having normal bowl sounds before you touch your Pt
- Lochia: (what color/ smell = how much bleeding Pt is going through)
- Epiosotomy: make sure the pain level is at normal level (and at ease)
- Homans sing: check all Pts legs for signs of abnormal
- Emotional status: the Pt has reached to normal
Mastasis
- Common in breast/ breastfeeding and causes inflammation. So give support on meds
Lochia type -
types / duration & meaning*
Rubra Dark red1-3/4 = normal
Serosa 4 -10 Pinkish/brown = normal
Alba 10-8 yellow/ white normal at the final phase
Lochia amount scale levels: what is normal and how to test levels*
Small: 2-10cm / Pt is OK
Moderate: 10 -15 cm
Heavy >: call ASAP
Teaching Before Discharge
Know to go back and report issues ASAP as a Pt"
Most of the symptoms below are abnormal signs to be careful*
Report any new odd-fullings the Pt has right after pregnancy
A fever @ 100.4°F (100+ is not good even if a bit off!)
Postpartum infections
- Checklist what is normal VS, and signs of risk on tests that are in the abnormal range*
-Common PP Infections
- Endmometritis is in the linings
- Wound in the site after C section
- Mastiasis mostly one side of each
- UTI
Important Meds Before and After pregnancy
- Before*Vitamin C, Folic Acid, Rhogam if needed, Insulin if has Pts
- During*Check GBS,Erepdiral / Antibiotics / Oxytocin.
- After*RhoGram, Rubella, TDAP (after Pt test is taken"
Signs for pregnancy loss
- Help the parents: acknowledge / allow time / comfort to know the signs are real"
Auxially pregnancy items - what is used for in each part of pregnancy.
- the list that needs all of the Pts to be used and checked*
AM notic fluid level. The baby. Placenta.
Know Fetal positions and why they are used
-What their meaning is VS what you are trying to figure out"
PreNatel/ Post Natile
- "Pre for you, post for the baby"*
Vitamins - what to look for and eat + keep a reminder
Energy / Weight - how to control if a Pt gains a lot more than normal
- "Eat less in these stages & eat small portions"*
How to assess to see if baby is growing well
- "1 cm a level"*
- Remember and measure what area the test is at"" The area the size must be in the right range!"*
