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ATI Proctored OB Maternal Newborn Study Guide.

OB Maternal Newborn ATI Exam Study Guide

Video #1: Contraception & Infertility

 Diaphragms: client must be refitted for a diaphragm for the following conditions:

1. It’s been 2 years since she has been fitted

2. Gained more than 15 pounds (7kg)

3. Had a full-term pregnancy

4. Had a second term abortion

o When you use a diaphragm, you need to use spermicide with every act of coitus

(withdrawal of penis from vagina prior to ejaculation). Every time you withdrawal,

instill more spermicide.

o Diaphragm must stay inserted for 6hrs after act of coitus.

 Hormonal Contraceptives (Oral)

o Side effects: Chest pain, SOB, Leg pain (from a possible clot), headache or eye

problems (from a stroke or hypertension)

o Contraindications: Women with a history of blood clots, stroke, cardiac

problems, smoker, breast or estrogen related cancers (pill contains estrogen)

 Depo-Provera/Medroxyprogesterone

o Injectable progestin

o Can cause decreased bone mineral density or loss of calcium

 Nursing action: Ensure patient has adequate intake of calcium and vitamin D

 IUD

o Increase risk for PID

o Can cause uterine perforation or ectopic pregnancy (increases risk for ectopic pregnancy)

o Look out for/Notify PCP:

 Change in string length IUD is moving and not in the right place

 Foul smelling vaginal discharge

 Pain with intercourse

 Fever/Chills (infection)

Infertility is defined as an inability to conceive desire engaging in unprotected sexual intercourse for a

prolonged period of time or at least 12 months.

 Common factors associated with infertility include:

o Decreased sperm production (Sperm analysis)

o Endometriosis

o Ovulation disorders

o Tubal occlusions If you test and use DYE (used in the fallopian tubes), make sure the

woman is not allergic to iodine or shellfish/seafood

Video #2: Signs of Pregnancy

Presumptive: Can be defined by things/reasons other than pregnancy

 Amenorrhea Can be anorexic or exercising too much

 Fatigue Didn’t sleep well

 Nausea/Vomiting Sick

 Urinary Frequency UTI

 Quickening/Fluttering in stomach Gas

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ATI Proctored OB Maternal Newborn Study Guide.

Probable: Changes that make the examiner suspect a woman is pregnant (primarily related to physical

changes of the uterus).

Abdominal enlargement: Related to changes in uterine size, shape, and position

Hegar’s Sign: Softening and compressibility of the lower uterus

 Chadwick’s Sign: Deepend violet bluish color of cervix and vaginal

mucosa Goodell’s Sign: Softening of cervical tip

Ballottement: Rebound of unengaged uterus

 Braxton Hicks Contractions: False contractions that are painless, irregular, and usually relieved

by walking

 Positive Pregnancy Test: Woman’s hormonal level may not be normal

Fetal Outline:

Positive: Very distinct things.

 Fetal Heart Sounds

 Fetal Heartbeat can be heard

 Can see the baby with ultrasound

 Can feel movement in the uterus

Naegele’s Rule: Last menstrual period minus (– ) 3 months + 7 days + 1-year ;Cathy’s Rule: + 9

months + 1 week

Gravidity and Parity:

 Gravida: a woman who is pregnant

 Gravidity: number of pregnancies

o Nulligravida: a woman who has never been pregnant

o Primigravida: a woman who is pregnant for the first time

o Multigravida: a woman in at least her second pregnancy.

 Parity: the number of births (not the number of fetuses [ex: twins]) carried pat 20

weeks gestation, whether or not the fetus was born alive.

o Nullipara: a woman who has not had a birth at more than 20 weeks of gestation.

o Primipara: a woman who has had one birth that occurred after 20 weeks of gestation.

o Multipara: a woman who has had two or more pregnancies to the stage of fetal viability.

Know how to find out GTPAL numbers:

 G= Gravidity (# of times a woman has been pregnant PLUS current pregnancy)

 T= Term Births (How many babies were delivered at term 38 WEEKS OR MORE)

 P= Preterm Births (Below 38 weeks)

 A= Abortion (spontaneous or not) or miscarriages L= Living children

Fundal height:

 Measured to evaluate the gestational age of the fetus.

 During the second and third trimesters (weeks 18-30), the fundal height in

centimeters approximately equals the fetus’s age in weeks, plus or minus 2 cm.

 At 16 weeks, the fundus can be found approximately halfway between the symphysis pubis

and the umbilicus.

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ATI Proctored OB Maternal Newborn Study Guide.

 At 20 to 22 weeks, the fundus is

approximately at the location of

the umbilicus.

 At 36 weeks, the fundus is at the

xiphoid process.

* When assessing fundal

height, monitor the client

closely for supine

hypotension when place

in the supine position.

 Measuring fundal height:

1. Place the client in a supine position

2. Place the end of the tape measure

at the level of symphysis pubis

3. Stretch the tape to the tope of

the uterine fundus

4. Note and record the measurement.

Physiological Maternal Changes:

Cardiovascular system:

 Circulating blood volume increases by approximately 40 – 50%; physiological anemia may

occur as the plasma increase exceeds the increase in the production of red blood cells.

 Heart size is increased, and the heart is elevated upward and to the left because of displacement

of the diaphragm as the uterus enlarges.

 There is an increase in the body’s demand for iron.

 Sodium and water retention may occur, which can lead to weight gain.

Respiratory system:

 Oxygen consumption increases by approximately 15% to 20%

 Diaphragm is elevated as a result of the enlarged uterus

 Shortness of breath may be experienced.

* During pregnancy, a woman’s pulse rate may increase about 10 to 15 beats/minute, the

blood pressure slightly decreases in the second trimester, then increases in the third

trimester but not above the pregnancy level; and the respiratory rate remains

unchanged or slightly increases.

Gastrointestinal System:

 Nausea and vomiting, which usually subsides by the 3rd month, may occur as a result of the

secretion of human chorionic gonadotropin (hCG); hCG stabilizes or decreases around week

12

 Poor appetite may occur because of decreased gastric motility.

 Alterations in taste and smell may occur.

 Constipation may occur because of an increase in progesterone production or pressure of

the uterus, resulting in decreased GI motility.

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