Pregnancy, birth and the first days after

Danger signs in pregnancy

These are the ones a client is told to report straight away, at any hour.

• Vaginal bleeding, or a gush or trickle of fluid.
• Severe or persistent headache, visual disturbance, or swelling of the face and hands — the preeclampsia triad.
• Epigastric or right upper quadrant pain.
• Reduced or absent fetal movement.
• Painful urination, fever, or persistent vomiting.
• Regular contractions before 37 weeks.

Fetal heart rate patterns

The timing against the contraction identifies the cause, and only one pattern is ominous.

• Early decelerations mirror the contraction. Head compression. Benign.
• Variable decelerations vary in shape and timing. Cord compression. Reposition the mother.
• Late decelerations begin after the peak and recover slowly. Uteroplacental insufficiency. This is the one that acts.

1. Stop the oxytocin.
2. Turn the mother onto her side.
3. Give oxygen by non-rebreather mask.
4. Increase intravenous fluid, and notify the provider.

Moderate variability — the beat-to-beat wobble in the baseline — is the single most reassuring feature on a trace, and its loss matters as much as any deceleration.

After the birth

The mother is assessed for the fundus, lochia, the perineum, the bladder and the legs.

• A boggy fundus is massaged FIRST; if it is also displaced to one side, a full bladder is the reason and emptying it is what keeps it firm.
• Lochia runs red, then pink-brown, then white. Still bright red and heavy at two weeks, or any offensive smell, is reported.
• Saturating a pad within 15 minutes is hemorrhage.
• Unilateral calf pain and swelling raises a deep vein thrombosis.

In the newborn, expect a respiratory rate of 30 to 60 with periodic breathing, a heart rate of 110 to 160, and a temperature kept up by drying and skin-to-skin contact. Report a sustained rate above 60 at rest, grunting or persistent nasal flaring, central cyanosis, a low glucose, or jaundice in the first 24 hours.