WEBVTT 00:00:07.900 --> 00:00:10.740 You're in the bay. Once you get over to the bed, 00:00:10.900 --> 00:00:13.539 we'll give you the story. Everything's going 00:00:13.539 --> 00:00:17.339 to happen super fast. Welcome to the emergency 00:00:17.339 --> 00:00:44.990 room. You know when you first start studying 00:00:44.990 --> 00:00:49.060 the human body there's this like comforting expectation 00:00:49.060 --> 00:00:51.240 of precision. Right, yeah, like it's all mapped 00:00:51.240 --> 00:00:53.840 out. Exactly. It feels like engineering, like 00:00:53.840 --> 00:00:56.679 you break your arm, the x -ray shows a jagged 00:00:56.679 --> 00:00:58.740 white line on a black background, and the doctor 00:00:58.740 --> 00:01:01.100 just points at it and says, you know, there it 00:01:01.100 --> 00:01:04.400 is, that's the problem. Yeah, it's a very binary 00:01:04.400 --> 00:01:07.060 world. Right. Broken or not broken, you cast 00:01:07.060 --> 00:01:09.739 it, it heals, you move on. It is. It's highly 00:01:09.739 --> 00:01:12.930 visible, easily categorized, and well... deeply 00:01:12.930 --> 00:01:16.489 comforting to the analytical mind. We really 00:01:16.489 --> 00:01:18.989 crave that kind of diagnostic certainty. But 00:01:18.989 --> 00:01:21.230 then, you know, you step onto the labor and delivery 00:01:21.230 --> 00:01:23.909 floor, dive into the world of obstetric nursing 00:01:23.909 --> 00:01:26.950 and high -risk pregnancies, and suddenly that 00:01:26.950 --> 00:01:29.730 metaphorical x -ray machine is just like completely 00:01:29.730 --> 00:01:32.090 shattered. Oh, absolutely. It's gone. You're 00:01:32.090 --> 00:01:34.700 looking at a diagnostic landscape that is quite 00:01:34.700 --> 00:01:36.819 honestly, incredibly murky. I mean, you aren't 00:01:36.819 --> 00:01:38.840 dealing with one patient, you're dealing with 00:01:38.840 --> 00:01:41.159 two simultaneously. Right, two entirely different 00:01:41.159 --> 00:01:43.519 physiological systems. Yeah. And the changes 00:01:43.519 --> 00:01:46.379 are completely dynamic, like constantly shifting 00:01:46.379 --> 00:01:49.260 hour by hour, and they're just a million overlapping 00:01:49.260 --> 00:01:52.799 variables. It is the absolute definition of diagnostic 00:01:52.799 --> 00:01:55.579 muddy waters. And if you are studying for your 00:01:55.579 --> 00:01:57.879 nursing exams right now, if you're, you know, 00:01:58.060 --> 00:02:00.959 staring down the NCLEX or your final maternal 00:02:00.959 --> 00:02:03.180 child health exams trying to navigate those muddy 00:02:03.180 --> 00:02:06.069 waters, feel entirely overwhelming. I will for 00:02:06.069 --> 00:02:08.210 sure. You're looking at a textbook that is a 00:02:08.210 --> 00:02:11.210 thousand pages long wondering how to possibly 00:02:11.210 --> 00:02:14.509 memorize every single obscure syndrome. Which 00:02:14.509 --> 00:02:17.219 is... Exactly why we're doing this today. So 00:02:17.219 --> 00:02:20.860 welcome to a highly specialized, intensely focused 00:02:20.860 --> 00:02:23.139 deep dive. Yeah, we're so glad you're here. If 00:02:23.139 --> 00:02:25.300 you're listening to this right now, we know exactly 00:02:25.300 --> 00:02:27.699 what your mission is. You are out to conquer 00:02:27.699 --> 00:02:30.800 obstetric nursing. Your goal isn't just to like 00:02:30.800 --> 00:02:33.300 pass a test. Your goal is to walk onto a clinical 00:02:33.300 --> 00:02:35.840 floor with the sharpest possible clinical judgment 00:02:35.840 --> 00:02:38.860 and be a safe, effective, and frankly, phenomenal 00:02:38.860 --> 00:02:41.900 future nurse. And my role today is to be your 00:02:41.900 --> 00:02:43.650 clinical mentor. We're not going to sit here 00:02:43.650 --> 00:02:45.569 and read a textbook table of contents to you. 00:02:45.689 --> 00:02:48.610 Please no. Right. We are going to aggressively 00:02:48.610 --> 00:02:50.990 apply the Pareto principle to this material. 00:02:51.610 --> 00:02:55.229 So for our listener who might be buried in flashcards 00:02:55.229 --> 00:02:58.289 right now, let's establish what applying the 00:02:58.289 --> 00:03:00.430 Pareto principle actually looks like for an OB 00:03:00.430 --> 00:03:03.310 nursing student. Well, it basically means we 00:03:03.310 --> 00:03:06.889 acknowledge a very practical reality, like 80 00:03:06.889 --> 00:03:09.879 % of your exam points and Honestly, far more 00:03:09.879 --> 00:03:12.919 importantly, 80 % of your most critical, lifesaving 00:03:12.919 --> 00:03:15.780 clinical interventions, they come from just 20 00:03:15.780 --> 00:03:18.800 % of the core concepts. Wow. Just 20%. Yeah. 00:03:19.020 --> 00:03:21.379 So we've sifted through a massive mountain of 00:03:21.379 --> 00:03:24.340 obstetric data, maternal risk factors, fetal 00:03:24.340 --> 00:03:26.639 surveillance guidelines, all those prenatal testing 00:03:26.639 --> 00:03:29.360 protocols. And our singular goal today is to 00:03:29.360 --> 00:03:32.400 extract that high yield 20%. That is so helpful. 00:03:32.699 --> 00:03:33.939 Everything we discuss is going to be filtered 00:03:33.939 --> 00:03:35.979 through a very specific uncompromising lens. 00:03:36.280 --> 00:03:38.400 We're looking at maternal and fetal safety, priority 00:03:38.400 --> 00:03:41.419 nursing interventions, and the classic traps 00:03:41.419 --> 00:03:44.129 that exam writers just love to set. I love that 00:03:44.129 --> 00:03:47.349 approach. The mission is to take these raw, isolated 00:03:47.349 --> 00:03:50.069 medical facts and forge them into clinical judgment. 00:03:50.550 --> 00:03:52.909 Like, we need to help you instantly separate 00:03:52.909 --> 00:03:56.150 the, um, this is an expected annoying part of 00:03:56.150 --> 00:03:58.530 pregnancy finding from the, I need to hit the 00:03:58.530 --> 00:04:00.870 call bell and report this immediately scenario. 00:04:01.129 --> 00:04:04.050 Exactly. That distinction is everything. So let's 00:04:04.050 --> 00:04:06.689 start by unpacking the absolute highest risk 00:04:06.689 --> 00:04:09.889 elements of a pregnancy. Because to really understand 00:04:09.889 --> 00:04:12.969 how things go wrong, we have to look at the giants. 00:04:13.229 --> 00:04:16.050 the two biggest most pervasive culprits that 00:04:16.050 --> 00:04:18.550 damage the placenta and threaten both patients. 00:04:18.730 --> 00:04:20.750 And those are hyperglycemia and hypertension, 00:04:21.209 --> 00:04:22.910 blood sugar and blood pressure. These are the 00:04:22.910 --> 00:04:25.209 heavy hitters. They really are. I always tell 00:04:25.209 --> 00:04:27.310 students if you fundamentally understand how 00:04:27.310 --> 00:04:30.050 these two chronic conditions alter the physiological 00:04:30.050 --> 00:04:32.750 landscape of a pregnancy, you will be able to 00:04:32.750 --> 00:04:34.769 answer countless exam questions without even 00:04:34.769 --> 00:04:36.649 needing to memorize them. Well, that's a great 00:04:36.649 --> 00:04:39.610 tip. Because these two forces dictate placental 00:04:39.610 --> 00:04:42.629 perfusion, and placental perfusion dictates fetal 00:04:42.629 --> 00:04:45.050 survival. OK, let me try out an analogy I use 00:04:45.050 --> 00:04:47.670 to visualize this. And you tell me if the clinical 00:04:47.670 --> 00:04:49.750 physiology actually holds up. All right, let's 00:04:49.750 --> 00:04:53.029 hear it. So I like to think of the placenta as 00:04:53.029 --> 00:04:57.730 this incredibly delicate, highly vital filter 00:04:57.730 --> 00:05:00.959 and life support system for the baby. Yeah. Perfect 00:05:00.959 --> 00:05:03.660 so far. High blood pressure acts like a kinked 00:05:03.660 --> 00:05:06.420 high pressure garden hose. It restricts the flow 00:05:06.420 --> 00:05:09.060 of blood, effectively starving the baby of oxygen 00:05:09.060 --> 00:05:11.740 and nutrients. On the flip side, high blood sugar 00:05:11.740 --> 00:05:14.500 acts like a thick, heavy sludge, clogging up 00:05:14.500 --> 00:05:16.779 that delicate filter and it ends up forcefully 00:05:16.779 --> 00:05:19.589 overfeeding the baby with excess glucose. I mean, 00:05:19.589 --> 00:05:22.110 that is a phenomenal visual and it aligns perfectly 00:05:22.110 --> 00:05:24.089 with the high yield core concepts you need to 00:05:24.089 --> 00:05:26.490 master. Let's look at the thick sludge first 00:05:26.490 --> 00:05:29.029 hyperglycemia. OK, let's get into it. So whether 00:05:29.029 --> 00:05:31.430 a pregnant client has poorly managed pre -existing 00:05:31.430 --> 00:05:33.829 diabetes or they develop gestational diabetes, 00:05:34.170 --> 00:05:36.550 the core issue is maternal insulin resistance 00:05:36.550 --> 00:05:39.569 leading to elevated blood glucose. Now, here 00:05:39.569 --> 00:05:42.029 is the crucial physiological mechanism, right? 00:05:42.709 --> 00:05:45.470 This extra maternal glucose crosses the placenta 00:05:45.470 --> 00:05:47.949 to the fetus through a process called facilitated 00:05:47.949 --> 00:05:50.120 diffusion. Right, the sugar crosses over freely. 00:05:50.800 --> 00:05:53.240 But the maternal insulin does not cross the placenta, 00:05:53.319 --> 00:05:56.160 correct? Exactly. And that is a massive foundational 00:05:56.160 --> 00:05:59.540 concept. Glucose crosses the barrier, but the 00:05:59.540 --> 00:06:02.839 large insulin molecule does not. Picture the 00:06:02.839 --> 00:06:05.360 fetus. OK, I'm picturing it. The fetus is suddenly 00:06:05.360 --> 00:06:07.439 receiving all this excess sugar from the mother, 00:06:07.540 --> 00:06:09.920 but it has no maternal insulin to help process 00:06:09.920 --> 00:06:13.079 it. What happens? The fetal pancreas has to work 00:06:13.079 --> 00:06:15.839 overtime. It hypertrophies or, you know, grows 00:06:15.839 --> 00:06:18.740 larger to produce its own massive amounts of 00:06:18.740 --> 00:06:21.160 insulin just to handle the mother's sugar. Wow. 00:06:21.740 --> 00:06:24.339 And here's the kicker. Fetal insulin acts as 00:06:24.339 --> 00:06:28.100 a very powerful growth hormone. Ah, so that directly 00:06:28.100 --> 00:06:30.279 leads to our first major complication, which 00:06:30.279 --> 00:06:33.240 is fetal macrosomia. Precisely. Macrosomia literally 00:06:33.240 --> 00:06:35.839 translates to large body. We were talking about 00:06:35.839 --> 00:06:39.360 a significantly huge baby, often over 4 ,000 00:06:39.360 --> 00:06:42.379 or 4 ,500 grams. Which obviously cascades into 00:06:42.379 --> 00:06:44.480 a whole host of other intrapartum risks. I mean, 00:06:44.500 --> 00:06:47.160 if you have a massive baby, you have a significantly 00:06:47.160 --> 00:06:50.529 higher risk for a cesarean birth. if a vaginal 00:06:50.529 --> 00:06:52.829 birth is attempted, catastrophic birth trauma 00:06:52.829 --> 00:06:55.470 like shoulder dystocia. Right. Where the baby's 00:06:55.470 --> 00:06:58.370 head delivers, but the broad shoulders get snuck 00:06:58.370 --> 00:07:01.329 behind the maternal pubic bone. It's a terrifying 00:07:01.329 --> 00:07:03.990 emergency. Yeah, absolutely terrifying. But the 00:07:03.990 --> 00:07:06.350 hyperglycemia doesn't just make the baby large, 00:07:06.550 --> 00:07:10.009 it alters the environment itself. It causes polyhydramnios, 00:07:10.069 --> 00:07:12.490 which is an excessive accumulation of amniotic 00:07:12.490 --> 00:07:15.129 fluid. OK, wait. I understand why the baby gets 00:07:15.129 --> 00:07:17.810 big, right? Because insulin is a growth hormone. 00:07:18.519 --> 00:07:21.079 But why does the mother's high blood sugar cause 00:07:21.079 --> 00:07:23.819 the amniotic fluid to increase? Like, does the 00:07:23.819 --> 00:07:26.279 sugar just pull water into the sac osmotically? 00:07:26.360 --> 00:07:28.199 You know, that is a very common misconception. 00:07:28.439 --> 00:07:31.199 It's actually driven by the fetus. Really? Yeah. 00:07:31.680 --> 00:07:34.199 Because the fetus is experiencing hyperglycemia, 00:07:34.379 --> 00:07:37.319 its own blood sugar is too high, the fetal kidneys 00:07:37.319 --> 00:07:40.279 try to flush out that excess sugar. The fetus 00:07:40.279 --> 00:07:43.360 experiences polyuria. Oh, wow. Basically, the 00:07:43.360 --> 00:07:45.819 fetus is peeing excessively into the amniotic 00:07:45.819 --> 00:07:48.509 sac. Since amniotic fluid in the second half 00:07:48.509 --> 00:07:51.029 of pregnancy is primarily composed of fetal urine, 00:07:51.709 --> 00:07:54.709 excessive fetal urination directly equals polyhydraminoids. 00:07:54.870 --> 00:07:57.069 That is fascinating. So the high sugar leads 00:07:57.069 --> 00:07:59.689 to a big baby and literally a swimming pool of 00:07:59.689 --> 00:08:02.149 excess fluid. Now, let's look at the kinked hose 00:08:02.149 --> 00:08:04.750 hypertension. Whether we're dealing with chronic 00:08:04.750 --> 00:08:06.949 hypertension or pregnancy -induced hypertension, 00:08:07.519 --> 00:08:09.839 What is the high yield takeaway for the exams? 00:08:10.279 --> 00:08:12.779 So hypertension fundamentally damages the maternal 00:08:12.779 --> 00:08:16.660 vasculature. It causes vasoconstriction and damages 00:08:16.660 --> 00:08:19.279 the endothelial lining of the blood vessels, 00:08:19.519 --> 00:08:22.160 particularly the spiral arteries that feed the 00:08:22.160 --> 00:08:24.660 placenta. OK, so making them narrower and stiffer. 00:08:24.779 --> 00:08:27.819 Right. This increases peripheral vascular resistance 00:08:27.819 --> 00:08:30.939 and directly causes utero placental insufficiency. 00:08:31.420 --> 00:08:34.759 The placenta is simply not receiving enough oxygenated 00:08:34.759 --> 00:08:37.210 blood. And if the placenta isn't getting blood, 00:08:37.429 --> 00:08:40.070 the baby isn't getting fed. Exactly. Because 00:08:40.070 --> 00:08:42.690 the fetus is essentially being starved of resources 00:08:42.690 --> 00:08:45.769 over a long period, it leads to fetal growth 00:08:45.769 --> 00:08:48.509 restriction. This results in a baby that is small 00:08:48.509 --> 00:08:51.409 for gestational age, or SGA. Oh, that's a perfect 00:08:51.409 --> 00:08:53.549 contrast. Yeah. So right there, you have a beautiful 00:08:53.549 --> 00:08:56.490 contrast for exam. Diabetes gives you macrosomia, 00:08:56.610 --> 00:08:59.590 large baby. Hypertension gives you SGA, small 00:08:59.590 --> 00:09:01.870 baby. Makes total sense. Furthermore, hypertension 00:09:01.870 --> 00:09:04.269 can worsen into a terrifying systemic condition 00:09:04.269 --> 00:09:07.669 called preeclampsia. left untreated, it progresses 00:09:07.669 --> 00:09:10.690 to eclampsia. And eclampsia means seizures, which 00:09:10.690 --> 00:09:12.649 is a life -threatening emergency that can easily 00:09:12.649 --> 00:09:15.570 lead to maternal and fetal death. It is the ultimate 00:09:15.570 --> 00:09:19.090 nightmare scenario on a labor floor. Preeclampsia 00:09:19.090 --> 00:09:22.409 severely limits placental perfusion, but it also 00:09:22.409 --> 00:09:24.789 causes multi -organ damage in the mother. I mean, 00:09:24.870 --> 00:09:27.610 it damages the kidneys, the liver, and the brain. 00:09:28.350 --> 00:09:30.490 So as the nurse at the bedside or, you know, 00:09:30.590 --> 00:09:32.970 taking vitals in the prenatal clinic, How do 00:09:32.970 --> 00:09:35.409 we differentiate between an expected annoying 00:09:35.409 --> 00:09:38.710 pregnancy symptom and a life threatening preeclampsia 00:09:38.710 --> 00:09:41.149 red flag? Because let's be honest, pregnant clients 00:09:41.149 --> 00:09:43.350 get swollen ankles all the time. Yes, they do. 00:09:43.350 --> 00:09:45.409 And that is a critical distinction for your clinical 00:09:45.409 --> 00:09:48.009 judgment. If a patient comes in at 34 weeks and 00:09:48.009 --> 00:09:50.730 says, my shoes don't fit, you need to investigate 00:09:50.730 --> 00:09:54.250 further, but don't panic. Mild dependent ankle 00:09:54.250 --> 00:09:56.789 edema from standing all day where the fluid pools 00:09:56.789 --> 00:09:58.669 in the lowest part of the body due to gravity 00:09:58.669 --> 00:10:00.990 and the heavy uterus pressing on pelvic veins 00:10:00.990 --> 00:10:03.669 is an expected biophysical change. It's totally 00:10:03.669 --> 00:10:06.970 normal. So when does that puffiness become a 00:10:06.970 --> 00:10:10.169 priority report? When the edema stops being dependent 00:10:10.169 --> 00:10:13.509 and becomes systemic, if you see sudden facial 00:10:13.509 --> 00:10:16.269 edema, a client says, my eyelids are puffy and 00:10:16.269 --> 00:10:19.110 I can't get my wedding ring off my hand. That 00:10:19.110 --> 00:10:22.629 is concerning. OK, systemic is bad. Right. But 00:10:22.629 --> 00:10:25.669 the true red flags that elevate this to an immediate 00:10:25.669 --> 00:10:28.690 crisis are when you see protein in the urine, 00:10:28.909 --> 00:10:31.429 known as proteinuria, or when the client reports 00:10:31.429 --> 00:10:34.509 sudden severe headaches, visual disturbances 00:10:34.509 --> 00:10:37.529 like seeing spots or flashing lights, or severe 00:10:37.529 --> 00:10:40.129 pain in their upper right abdomen. Let's break 00:10:40.129 --> 00:10:42.679 down the why there. Why are headaches and vision 00:10:42.679 --> 00:10:46.059 changes such a massive, glaring red flag on an 00:10:46.059 --> 00:10:48.580 NCLE -X exam? Because they indicate that the 00:10:48.580 --> 00:10:50.460 hypertension has compromised the blood brain 00:10:50.460 --> 00:10:53.700 barrier. They indicate cerebral edema and profound 00:10:53.700 --> 00:10:56.159 central nervous system irritability. The brain 00:10:56.159 --> 00:10:58.350 is swelling. The brain is literally swelling 00:10:58.350 --> 00:11:01.210 and becoming hyperreactive. When a pre -eclampsic 00:11:01.210 --> 00:11:03.210 patient reports a severe headache that won't 00:11:03.210 --> 00:11:05.649 go away with Tylenol or changes in their vision, 00:11:05.970 --> 00:11:07.710 it means they are teetering on the edge of a 00:11:07.710 --> 00:11:10.309 seizure. Those symptoms require an immediate 00:11:10.309 --> 00:11:12.330 report to the provider. You do not wait. You 00:11:12.330 --> 00:11:15.049 do not reevaluate in an hour. You act. Priority 00:11:15.049 --> 00:11:17.789 nursing actions are huge on these exams. What 00:11:17.789 --> 00:11:20.710 is the nurse doing to catch this cascade early? 00:11:20.970 --> 00:11:23.470 Your baseline defense is consistent assessment. 00:11:23.720 --> 00:11:26.700 At every single prenatal visit without fail, 00:11:27.200 --> 00:11:29.519 you assess the maternal blood pressure and you 00:11:29.519 --> 00:11:32.159 perform a urine dipstick. You are looking for 00:11:32.159 --> 00:11:35.240 protein, which indicates kidney damage from preeclampsia, 00:11:35.500 --> 00:11:38.559 and glucose, which indicates uncontrolled diabetes. 00:11:38.779 --> 00:11:40.559 Okay, let's pivot back to the diabetic mother 00:11:40.559 --> 00:11:43.759 for a moment because here is where the pathophysiology 00:11:43.759 --> 00:11:46.059 gets incredibly interesting and this is without 00:11:46.059 --> 00:11:49.200 a doubt a top exam trap. Oh yeah, the sugar drop. 00:11:49.309 --> 00:11:51.830 Exactly. Let's call it the sugar drop trap. We 00:11:51.830 --> 00:11:54.029 just established that the diabetic mom has high 00:11:54.029 --> 00:11:56.090 blood sugar. So her baby has been swimming in 00:11:56.090 --> 00:11:58.909 a high sugar environment for months. Why on earth 00:11:58.909 --> 00:12:01.129 is the priority nursing action to monitor the 00:12:01.129 --> 00:12:03.269 newborn for low blood sugar immediately after 00:12:03.269 --> 00:12:06.509 birth? If the mom is hyperglycemic, wouldn't 00:12:06.509 --> 00:12:09.009 the baby be born hyperglycemic? This trips up 00:12:09.009 --> 00:12:11.549 nursing students all the time because they follow 00:12:11.549 --> 00:12:14.169 the logic halfway. They think mom has high sugar, 00:12:14.269 --> 00:12:16.870 baby gets high sugar, but they forget the actual 00:12:16.870 --> 00:12:21.490 mechanism of birth. Do not confuse maternal hyperglycemia 00:12:21.490 --> 00:12:24.870 with neonatal hypoglycemia. Let's walk through 00:12:24.870 --> 00:12:27.049 the timeline. Okay, walk me through it. In utero, 00:12:27.330 --> 00:12:29.730 the fetus was producing massive amounts of its 00:12:29.730 --> 00:12:32.029 own insulin to deal with the mother's constant 00:12:32.029 --> 00:12:34.450 sugar supply. Right, the fetal pancreas is basically 00:12:34.450 --> 00:12:37.110 bodybuilding, pumping out tons of insulin. Exactly. 00:12:37.330 --> 00:12:39.990 Now, the moment of birth happens, the baby is 00:12:39.990 --> 00:12:42.389 delivered, and the umbilical cord is clamped 00:12:42.389 --> 00:12:45.809 and cut. In that split second, the massive maternal 00:12:45.809 --> 00:12:48.460 glucose supply is instantly, permanently cut 00:12:48.460 --> 00:12:50.559 off. But the baby's pancreas doesn't know the 00:12:50.559 --> 00:12:53.080 cord was cut. Precisely. The fetal pancreas is 00:12:53.080 --> 00:12:55.120 still operating on the assumption that a sugar 00:12:55.120 --> 00:12:57.639 avalanche is coming. So the neonatal insulin 00:12:57.639 --> 00:13:00.100 levels remain incredibly high, but the sugar 00:13:00.100 --> 00:13:02.480 supply is suddenly gone. Oh, wow. The result. 00:13:03.139 --> 00:13:06.100 That excess insulin rapidly drives whatever glucose 00:13:06.100 --> 00:13:07.879 is left in the newborn's blood straight into 00:13:07.879 --> 00:13:11.019 the cells. The neonatal blood sugar absolutely 00:13:11.019 --> 00:13:15.179 plummets. Wow. That is a massive crash. A profound 00:13:15.179 --> 00:13:18.690 crash. you will see severe neonatal hypoglycemia. 00:13:19.370 --> 00:13:21.509 As a nurse, you are watching this newborn like 00:13:21.509 --> 00:13:23.730 a hawk for signs. What are the signs we're looking 00:13:23.730 --> 00:13:26.789 for? You're looking for lethargy, apnea, or paused 00:13:26.789 --> 00:13:30.309 breathing, a high -pitched cry, temperature instability, 00:13:30.610 --> 00:13:34.200 and a very specific jitteriness or tremors. If 00:13:34.200 --> 00:13:36.559 it's not caught and treated quickly with early 00:13:36.559 --> 00:13:40.120 feeding or IV glucose, it leads to neonatal seizures 00:13:40.120 --> 00:13:42.320 and permanent brain damage. That makes perfect 00:13:42.320 --> 00:13:44.679 sense when you map out the why. Like you aren't 00:13:44.679 --> 00:13:46.399 just memorizing a symptom, you're watching a 00:13:46.399 --> 00:13:48.940 physiological event unfold. Let's cement this 00:13:48.940 --> 00:13:51.320 with a simple memory anchor. High sugar in the 00:13:51.320 --> 00:13:54.720 mom equals a big baby. and low sugar at birth. 00:13:55.259 --> 00:13:57.100 High pressure on the mom equals a small baby 00:13:57.100 --> 00:13:59.399 due to poor perfusion. That is the perfect way 00:13:59.399 --> 00:14:02.000 to distill it. If you were taking notes, here 00:14:02.000 --> 00:14:03.940 are the core takeaways from the giants of high 00:14:03.940 --> 00:14:07.039 -risk OB. Pre -eclampsia physically limits placental 00:14:07.039 --> 00:14:09.779 perfusion by damaging blood vessels. If you leave 00:14:09.779 --> 00:14:12.460 pre -eclampsia untreated, the brain swells until 00:14:12.460 --> 00:14:14.779 the client has eclaptic seizures. On the other 00:14:14.779 --> 00:14:17.720 side, maternal diabetes causes fetal macrosomia 00:14:17.720 --> 00:14:20.870 because insulin is a growth hormone. Polyhydraminoids 00:14:20.870 --> 00:14:23.330 is directly linked to diabetes because the hyperglycemia 00:14:23.330 --> 00:14:25.570 makes the fetus urinate excessively into the 00:14:25.570 --> 00:14:28.970 amniotic sac. And finally, always watch for neonatal 00:14:28.970 --> 00:14:31.970 lethargy, apnea, or jitteriness. These are the 00:14:31.970 --> 00:14:35.429 classic, highly testable signs of neonatal hyperglycemia 00:14:35.429 --> 00:14:38.190 in an infant born to a diabetic mother. All right, 00:14:38.190 --> 00:14:40.889 we have thoroughly covered the internal chronic 00:14:40.889 --> 00:14:43.090 illnesses that a mother might bring into a pregnancy. 00:14:43.529 --> 00:14:45.409 But what happens when the threat comes from the 00:14:45.409 --> 00:14:48.539 outside? The external threats. Yeah. Well, let's 00:14:48.539 --> 00:14:50.460 talk about environmental hazards, teratogenic 00:14:50.460 --> 00:14:53.779 substances, and psychosocial risks. Yeah. And 00:14:53.779 --> 00:14:56.820 I have to ask, everyone knows smoking is bad 00:14:56.820 --> 00:14:59.259 for a developing baby. That's just common sense. 00:14:59.279 --> 00:15:01.539 Right. But when you look at exam study guides, 00:15:01.580 --> 00:15:03.620 you see some really weird specific warnings. 00:15:03.870 --> 00:15:06.730 Why is a leftover turkey sandwich or a cat litter 00:15:06.730 --> 00:15:09.309 box suddenly treated like a mortal enemy to a 00:15:09.309 --> 00:15:11.509 pregnant patient? I know. It sounds completely 00:15:11.509 --> 00:15:14.330 bizarre and arbitrary until you look at the microbiology. 00:15:14.830 --> 00:15:17.830 These are external environmental threats that 00:15:17.830 --> 00:15:20.450 have the specific ability to cross the placental 00:15:20.450 --> 00:15:22.809 barrier, which is normally, you know, very good 00:15:22.809 --> 00:15:25.409 at keeping pathogens out. Let's start with the 00:15:25.409 --> 00:15:27.809 cat litter box. We're talking about toxoplasmosis. 00:15:28.029 --> 00:15:30.669 What exactly is toxoplasmosis? Is it a bacteria? 00:15:30.960 --> 00:15:34.580 It's actually a protozoan parasite, Toxoplasma 00:15:34.580 --> 00:15:37.320 gondii. It reproduces in the intestines of infected 00:15:37.320 --> 00:15:40.320 cats, and the eggs are shed in feline feces. 00:15:40.700 --> 00:15:43.059 But it is also commonly found in contaminated 00:15:43.059 --> 00:15:46.519 garden soil, unwashed raw produce, and raw or 00:15:46.519 --> 00:15:48.519 undercooked meat from animals that grazed on 00:15:48.519 --> 00:15:50.580 contaminated soil. And what does this parasite 00:15:50.580 --> 00:15:52.740 do if it actually gets across the placenta? Well, 00:15:52.740 --> 00:15:55.139 if a pregnant client contracts toxoplasmosis, 00:15:55.159 --> 00:15:57.440 especially early in the pregnancy, it targets 00:15:57.440 --> 00:15:59.899 the developing fetal neural tissue. It can cause 00:15:59.899 --> 00:16:03.539 severe neonatal complications, specifically choreoretinitis, 00:16:03.600 --> 00:16:05.889 which leads to blindness, profound deafness, 00:16:06.090 --> 00:16:08.450 microcephaly, and severe cognitive disabilities. 00:16:08.549 --> 00:16:10.509 So a simple chore like cleaning a litter box 00:16:10.509 --> 00:16:13.289 can cause permanent fetal brain damage. Yes. 00:16:13.690 --> 00:16:16.009 Which is why the priority nursing action, the 00:16:16.009 --> 00:16:18.990 patient education, is so vital. You must instruct 00:16:18.990 --> 00:16:21.490 the client to delegate litter box duties to someone 00:16:21.490 --> 00:16:24.629 else entirely. Just don't do it. Exactly. And 00:16:24.629 --> 00:16:26.610 if they must garden, they have to wear thick 00:16:26.610 --> 00:16:29.129 gloves to avoid soil contact with their hands, 00:16:29.149 --> 00:16:31.610 and they must wash all produce meticulously. 00:16:31.769 --> 00:16:35.059 Okay, what about the turkey sandwich? the deli 00:16:35.059 --> 00:16:37.700 meats. I hear pregnant women lamenting all the 00:16:37.700 --> 00:16:39.360 time that they just want a cold cut sandwich. 00:16:39.580 --> 00:16:43.320 That restriction is all about Listeria monocytogens. 00:16:44.000 --> 00:16:47.580 Listeria is a very hardy, harmful bacteria found 00:16:47.580 --> 00:16:51.279 in unpasteurized foods, soft cheeses like brie 00:16:51.279 --> 00:16:54.539 or feta, and processed deli meats. Unlike most 00:16:54.539 --> 00:16:57.120 bacteria, Listeria can survive and even multiply 00:16:57.120 --> 00:16:59.220 at refrigerator temperatures. Oh, so keeping 00:16:59.220 --> 00:17:01.139 the turkey cold doesn't make it safe. Not at 00:17:01.139 --> 00:17:03.039 all. And the insidious thing about Listeria is 00:17:03.039 --> 00:17:04.599 that in a healthy adult, it might just cause 00:17:04.599 --> 00:17:07.700 a mild flu -like illness or a stomach ache. The 00:17:07.700 --> 00:17:10.039 mother might barely notice she's sick. But for 00:17:10.039 --> 00:17:12.880 the baby... For the baby, it's devastating. Listeria 00:17:12.880 --> 00:17:15.259 aggressively crosses the placenta. It can cause 00:17:15.259 --> 00:17:17.819 overwhelming fetal sepsis, meningitis, and frequently 00:17:17.819 --> 00:17:19.940 leads to spontaneous abortion or stillbirth. 00:17:20.119 --> 00:17:22.720 That is terrifying. So the rule is absolutely 00:17:22.720 --> 00:17:26.099 no deli sandwiches for nine months. Not necessarily. 00:17:26.200 --> 00:17:28.619 And this is a great nuance for clinical practice. 00:17:29.059 --> 00:17:31.420 The priority education here is that the client 00:17:31.420 --> 00:17:34.140 can consume deli meats or hot dogs, but they 00:17:34.140 --> 00:17:36.660 must be heated until they are literally steaming 00:17:36.660 --> 00:17:40.579 hot. Heat kills the Listeria bacteria. So a cold 00:17:40.579 --> 00:17:43.400 turkey sandwich is a massive risk, but a steaming 00:17:43.400 --> 00:17:45.859 hot turkey panini is safe. OK, good to know. 00:17:46.089 --> 00:17:48.170 Let's talk about another environmental hazard 00:17:48.170 --> 00:17:51.049 mentioned in our sources, lead exposure. We do 00:17:51.049 --> 00:17:53.269 not hear about lead poisoning as much these days. 00:17:53.450 --> 00:17:56.289 It feels like a 1970s problem, but it is still 00:17:56.289 --> 00:17:59.170 a massive risk in OB nursing. It absolutely is, 00:17:59.170 --> 00:18:01.789 and it's deeply tied to socioeconomic status 00:18:01.789 --> 00:18:04.589 and living environments. We are talking about 00:18:04.589 --> 00:18:07.569 clients living in homes built before 1978 with 00:18:07.569 --> 00:18:10.269 chipping lead paint, drinking from old lead pipes, 00:18:10.650 --> 00:18:12.789 or living near regional airports where aviation 00:18:12.789 --> 00:18:14.950 fuel still leaves lead in the surrounding soil. 00:18:15.109 --> 00:18:17.670 Right. But here is the most fascinating and frankly 00:18:17.670 --> 00:18:20.650 terrifying physiological aspect of lead in pregnancy. 00:18:21.269 --> 00:18:23.190 The danger doesn't just come from what the mother 00:18:23.190 --> 00:18:25.049 is exposed to today. Wait, what do you mean? 00:18:25.160 --> 00:18:27.599 If a client was exposed to lead at any point 00:18:27.599 --> 00:18:29.640 in their past, say, during their own childhood, 00:18:30.240 --> 00:18:32.380 that lead accumulates and is permanently stored 00:18:32.380 --> 00:18:35.640 in their bones. Now, fast forward to their pregnancy. 00:18:36.559 --> 00:18:38.640 The developing fetus requires massive amounts 00:18:38.640 --> 00:18:41.630 of calcium to build its skeleton. So the mother's 00:18:41.630 --> 00:18:43.910 body starts breaking down her own bone to give 00:18:43.910 --> 00:18:46.410 calcium to the baby. Exactly. The maternal bone 00:18:46.410 --> 00:18:48.910 remodeling process accelerates to meet the fetal 00:18:48.910 --> 00:18:51.630 calcium demand. And as the bone breaks down, 00:18:51.809 --> 00:18:54.569 it releases that decades old stored lead right 00:18:54.569 --> 00:18:58.359 back into the maternal bloodstream. Wow, so past 00:18:58.359 --> 00:19:00.759 childhood exposure becomes a present danger to 00:19:00.759 --> 00:19:03.920 the fetus. That is wild. Yes. And the lead crosses 00:19:03.920 --> 00:19:07.019 the placenta effortlessly. It competes with calcium 00:19:07.019 --> 00:19:09.440 in the developing fetal brain, causing severe 00:19:09.440 --> 00:19:11.460 damage to the nervous system and the developing 00:19:11.460 --> 00:19:15.019 ketal kidneys. This leads to profound, irreversible 00:19:15.019 --> 00:19:18.299 neurocognitive impairment, lower IQ, and severe 00:19:18.299 --> 00:19:20.400 behavioral problems later in the child's life. 00:19:20.759 --> 00:19:23.140 What about substances and mental health? Obviously, 00:19:23.339 --> 00:19:25.420 these are psychosocial factors, but they have 00:19:25.420 --> 00:19:28.059 direct, measurable biophysical impacts on the 00:19:28.059 --> 00:19:31.220 pregnancy. They do, and they are incredibly testable. 00:19:31.660 --> 00:19:34.740 Let's look at nicotine first. Nicotine, whether 00:19:34.740 --> 00:19:36.980 delivered via traditional combustible tobacco 00:19:36.980 --> 00:19:40.759 or a modern vape pen, is a potent vasoconstrictor. 00:19:40.859 --> 00:19:42.460 It's basically doing the same thing as hypertension 00:19:42.460 --> 00:19:44.980 kinking the hose. Exactly. It clamps down the 00:19:44.980 --> 00:19:47.839 blood vessels in the placenta, drastically decreasing 00:19:47.839 --> 00:19:51.480 fetal oxygenation. Furthermore, if the client 00:19:51.480 --> 00:19:54.359 is smoking combustible cigarettes, they're inhaling 00:19:54.359 --> 00:19:57.839 carbon monoxide. Right, which is toxic. Extremely. 00:19:57.980 --> 00:20:00.220 Carbon monoxide actually has a higher affinity 00:20:00.220 --> 00:20:02.880 for hemoglobin than oxygen does, so it binds 00:20:02.880 --> 00:20:05.980 to the maternal and fetal red blood cells, physically 00:20:05.980 --> 00:20:08.440 blocking oxygen from being carried to the tissues. 00:20:08.640 --> 00:20:10.599 The baby is suffocating on a cellular level. 00:20:10.740 --> 00:20:13.680 Yes. Smoking during pregnancy is directly linked 00:20:13.680 --> 00:20:17.759 to sudden unexpected infant death, or SUI, severe 00:20:17.759 --> 00:20:20.309 low birth weight, preterm birth and structural 00:20:20.309 --> 00:20:23.890 anomalies like neonatal cleft lip. And post -birth, 00:20:24.009 --> 00:20:26.269 the newborn can experience neonatal abstinence 00:20:26.269 --> 00:20:28.150 syndrome. They literally go through nicotine 00:20:28.150 --> 00:20:30.650 withdrawal. And mental health. I feel like in 00:20:30.650 --> 00:20:32.910 obstetric nursing, we often focus so heavily 00:20:32.910 --> 00:20:35.190 on the physical body, the uterus, the blood pressure, 00:20:35.609 --> 00:20:37.990 that we forget the mother's brain. It's a huge 00:20:37.990 --> 00:20:40.269 blind spot, which is why it's a priority focus 00:20:40.269 --> 00:20:44.029 now. Up to 20 % of pregnant clients experience 00:20:44.029 --> 00:20:47.369 perinatal anxiety or depression. When a client 00:20:47.369 --> 00:20:49.609 is chronically stressed or severely depressed, 00:20:49.869 --> 00:20:52.009 their body is flooded with high levels of cortisol, 00:20:52.410 --> 00:20:54.710 the stress hormone, which can trigger premature 00:20:54.710 --> 00:20:58.089 labor. Untreated depression leads to a devastating 00:20:58.089 --> 00:21:02.410 cascade of risks, preterm birth, low birth weight, 00:21:02.690 --> 00:21:05.150 and decreased adherence to prenatal care. Right. 00:21:05.190 --> 00:21:07.450 I mean, if a client is severely depressed, they 00:21:07.450 --> 00:21:09.369 simply might not have the executive function 00:21:09.369 --> 00:21:11.779 to show up for appointments. or their nutrition 00:21:11.779 --> 00:21:14.420 might suffer. And after birth it can severely 00:21:14.420 --> 00:21:17.079 impair mother -infant attachment, leading to 00:21:17.079 --> 00:21:19.869 failure to thrive for the infant. This highlights 00:21:19.869 --> 00:21:21.950 why all of this matters so much for the nurse. 00:21:22.410 --> 00:21:25.269 These are largely modifiable risk factors. You 00:21:25.269 --> 00:21:27.490 can't unbreak a pelvis, but you can teach someone 00:21:27.490 --> 00:21:30.529 how to avoid listeria. Patient education and 00:21:30.529 --> 00:21:32.789 screening here are literally life -saving. That 00:21:32.789 --> 00:21:35.190 is the core of the nurse's role. Yeah. It isn't 00:21:35.190 --> 00:21:37.569 just taking blood pressure, it's the conversation. 00:21:37.750 --> 00:21:40.609 You must screen for mental health, tobacco use, 00:21:40.869 --> 00:21:43.029 and substance abuse at every single encounter. 00:21:43.109 --> 00:21:45.109 And you must do it non -judgmentally. That's 00:21:45.109 --> 00:21:47.819 so important. It's everything. If you walk into 00:21:47.819 --> 00:21:50.440 a room and use a harsh tone or your body language 00:21:50.440 --> 00:21:52.559 shows disgust because a pregnant client smells 00:21:52.559 --> 00:21:55.539 like smoke, that client will shut down. They 00:21:55.539 --> 00:21:58.059 will stop being honest with you. Or worse, they 00:21:58.059 --> 00:22:00.680 will stop coming to their prenatal visits entirely. 00:22:01.180 --> 00:22:03.519 Your judgment could literally cost that baby 00:22:03.519 --> 00:22:05.980 its life by driving the mother away from medical 00:22:05.980 --> 00:22:09.579 care. That is a sobering reality. Let's run through 00:22:09.579 --> 00:22:12.980 a rapid fire of expected versus concerning findings 00:22:12.980 --> 00:22:15.420 for these external threats to take our clinical 00:22:15.420 --> 00:22:18.079 judgment. A pregnant client tells you they drink 00:22:18.079 --> 00:22:20.900 a cup of coffee every morning to get going. Expected 00:22:20.900 --> 00:22:23.880 or concerning? Expected. The current clinical 00:22:23.880 --> 00:22:26.819 guideline is that up to 200 milligrams of caffeine 00:22:26.819 --> 00:22:29.859 a day is generally safe. That equates to about 00:22:29.859 --> 00:22:32.599 one standard eight ounce cup of home brewed coffee. 00:22:32.779 --> 00:22:35.039 Okay, what if they're working night shifts and 00:22:35.039 --> 00:22:36.980 drinking a couple of large energy drinks to stay 00:22:36.980 --> 00:22:40.119 awake? Highly concerning. Energy drinks are dangerous 00:22:40.119 --> 00:22:42.880 in pregnancy because they have wildly varying 00:22:42.880 --> 00:22:45.940 unregulated amounts of caffeine plus massive 00:22:45.940 --> 00:22:48.420 excess sugar and herbal supplements that have 00:22:48.420 --> 00:22:51.460 never been tested for teratogenic effects. High 00:22:51.460 --> 00:22:54.180 caffeine intake constricts blood vessels, limiting 00:22:54.180 --> 00:22:57.319 oxygen and nutrients to the fetus, directly leading 00:22:57.319 --> 00:22:59.900 to fetal growth restriction. What about a client 00:22:59.900 --> 00:23:02.759 who proudly tells you, I know smoking is bad 00:23:02.759 --> 00:23:05.299 so I quit cigarettes. I'm just vaping now so 00:23:05.299 --> 00:23:07.549 it's safe for the baby. concerning. And this 00:23:07.549 --> 00:23:10.990 is a massive modern exam trap. Instructors love 00:23:10.990 --> 00:23:13.509 testing this because vaping is so prevalent. 00:23:13.910 --> 00:23:16.369 Do not ever let a client assume vaping is a safe 00:23:16.369 --> 00:23:19.410 alternative. It still delivers concentrated nicotine, 00:23:19.769 --> 00:23:21.930 which causes the exact same vasoconstriction 00:23:21.930 --> 00:23:24.809 and oxygen restriction as smoking. Plus, the 00:23:24.809 --> 00:23:26.670 aerosolized chemicals carry their own unknown 00:23:26.670 --> 00:23:28.910 risks. What if a client in their first trimester 00:23:28.910 --> 00:23:31.009 says they like to relax in a hot tub for an hour 00:23:31.009 --> 00:23:33.099 every night? to ease their back pain. Highly 00:23:33.099 --> 00:23:35.680 concerning. The use of saunas and hot tubs, especially 00:23:35.680 --> 00:23:38.559 in the first trimester, raises the maternal core 00:23:38.559 --> 00:23:41.539 body temperature above 101 degrees Fahrenheit. 00:23:41.859 --> 00:23:43.740 Why is that heat so dangerous? It's just a bath. 00:23:44.019 --> 00:23:46.160 Because the first trimester is when organogenesis 00:23:46.160 --> 00:23:48.839 occurs, the organs are forming. Specifically, 00:23:49.180 --> 00:23:52.480 around days 21 to 28, the fetal neural tube is 00:23:52.480 --> 00:23:54.920 attempting to close to form the brain and spinal 00:23:54.920 --> 00:23:58.119 cord. Maternal hyperthermia disrupts cell division 00:23:58.119 --> 00:24:00.839 and protein function, and it is directly linked 00:24:00.839 --> 00:24:03.380 to an increased risk of severe birth defects, 00:24:03.900 --> 00:24:06.200 particularly neural tube defects like spina bifida. 00:24:06.500 --> 00:24:09.380 That is wild. A hot bath can stop the spinal 00:24:09.380 --> 00:24:12.119 cord from closing. Okay, what about exercise? 00:24:12.680 --> 00:24:14.160 We're always told that pregnant women should 00:24:14.160 --> 00:24:16.200 stay active. What if a client wants to start 00:24:16.200 --> 00:24:18.319 a rigorous running program? This is another top 00:24:18.319 --> 00:24:21.380 exam trap. If you think all exercise is universally 00:24:21.380 --> 00:24:23.539 good for all pregnant clients, you will get the 00:24:23.539 --> 00:24:26.000 question wrong. While generally encouraged for 00:24:26.000 --> 00:24:28.339 healthy pregnancies, physical activity is strongly 00:24:28.339 --> 00:24:30.339 contraindicated if the client has a history of 00:24:30.339 --> 00:24:33.779 preterm labor, cervical insufficiency, or placenta 00:24:33.779 --> 00:24:36.359 previa. Let me make sure I understand why. Placenta 00:24:36.359 --> 00:24:38.579 previa is when the placenta implants low and 00:24:38.579 --> 00:24:41.640 covers the cervix, right? Exactly. If the placenta 00:24:41.640 --> 00:24:44.380 is covering the exit, or if the cervix is weak 00:24:44.380 --> 00:24:46.880 and prematurely dilating, putting repetitive 00:24:46.880 --> 00:24:49.440 physical stress and gravity on the body by running 00:24:49.440 --> 00:24:51.940 or doing heavy lifting is incredibly dangerous. 00:24:52.400 --> 00:24:55.000 It can provoke massive, life -threatening hemorrhage 00:24:55.000 --> 00:24:57.440 or premature birth. Okay, so if I'm studying 00:24:57.440 --> 00:24:59.279 this tonight, the biggest traps are assuming 00:24:59.279 --> 00:25:01.779 vaping is safe, assuming any amount of caffeine 00:25:01.779 --> 00:25:05.319 is fine, and thinking exercise has no contraindications. 00:25:06.160 --> 00:25:08.240 The memory anchor from our sources is perfect. 00:25:08.460 --> 00:25:11.859 No hot tubs, no cold cuts, no cat boxes. That 00:25:11.859 --> 00:25:14.819 is a great hook. To summarize the absolute highest 00:25:14.819 --> 00:25:17.339 yield points here, heat deli meat until it is 00:25:17.339 --> 00:25:20.480 steaming to kill listeria. Toxoplasmosis hides 00:25:20.480 --> 00:25:22.960 in litter boxes and unwashed produce wear gloves 00:25:22.960 --> 00:25:25.519 and delegate the chores. Keep caffeine under 00:25:25.519 --> 00:25:27.819 200 milligrams a day to ensure the baby grows 00:25:27.819 --> 00:25:30.359 properly. Avoid hot tubs in the first trimester 00:25:30.359 --> 00:25:32.519 to prevent neural tube defects. And remember 00:25:32.519 --> 00:25:34.900 that both vaping and smoking restrict oxygen 00:25:34.900 --> 00:25:37.240 and cause low birth weight. Neither is a safe 00:25:37.240 --> 00:25:40.380 option. All right, moving forward. We know the 00:25:40.380 --> 00:25:42.900 internal risks like diabetes and the external 00:25:42.900 --> 00:25:46.319 risks like listeria, but how do we actually test 00:25:46.319 --> 00:25:48.400 for all of this? And I have to complain for a 00:25:48.400 --> 00:25:50.400 second because obstetric nursing seems to pride 00:25:50.400 --> 00:25:53.140 itself on having way too many acronyms. We have 00:25:53.140 --> 00:25:59.900 CVS, AFP, PPPA. RHG, NST, CST, BPP. It is an 00:25:59.900 --> 00:26:02.259 absolute alphabet soup. It is incredibly intimidating 00:26:02.259 --> 00:26:04.200 when you first look at it, but we're going to 00:26:04.200 --> 00:26:06.519 break these down chronologically. These tests 00:26:06.519 --> 00:26:09.339 are the roadmap of a pregnancy. They reveal severe 00:26:09.339 --> 00:26:12.039 genetic anomalies, structural defects, or life 00:26:12.039 --> 00:26:14.279 -threatening blood incompatibilities. Let's start 00:26:14.279 --> 00:26:15.900 at the beginning, first trimester. What are the 00:26:15.900 --> 00:26:18.460 big tests? The first major diagnostic procedure 00:26:18.460 --> 00:26:21.299 is CVS or chorionic villus sampling. This is 00:26:21.299 --> 00:26:23.759 done very early, usually between 10 and 13 weeks 00:26:23.759 --> 00:26:25.660 of gestation. What exactly are they sampling? 00:26:25.869 --> 00:26:29.529 The cordionic villi are tiny finger -like projections 00:26:29.529 --> 00:26:32.390 of placental tissue that share the baby's exact 00:26:32.390 --> 00:26:35.970 genetic makeup. A needle is inserted either through 00:26:35.970 --> 00:26:38.890 the abdomen or the cervix to snip a tiny piece 00:26:38.890 --> 00:26:41.730 of this tissue for genetic karyotyping. Because 00:26:41.730 --> 00:26:44.069 it is an invasive procedure happening very early 00:26:44.069 --> 00:26:46.930 while the pregnancy is still fragile, there are 00:26:46.930 --> 00:26:50.190 significant risks blaring infection, premature 00:26:50.190 --> 00:26:52.730 rupture of membranes, and pregnancy loss. And 00:26:52.730 --> 00:26:54.890 there's a non -invasive ultrasound test done 00:26:54.890 --> 00:26:57.349 in the first trimester too, right? Yes, the fetal 00:26:57.349 --> 00:26:59.549 neutral translucency ultrasound usually done 00:26:59.549 --> 00:27:02.690 between 11 and 13 weeks. The ultrasound tech 00:27:02.690 --> 00:27:05.099 specific measures the fluid collection at the 00:27:05.099 --> 00:27:08.079 back of the fetal neck. Why the neck? In fetuses 00:27:08.079 --> 00:27:10.720 with certain chromosomal anomalies, particularly 00:27:10.720 --> 00:27:14.119 trisomy 21 or Down syndrome, there is a delay 00:27:14.119 --> 00:27:16.539 in the development of the lymphatic system. This 00:27:16.539 --> 00:27:19.259 causes lymphatic fluid to back up and pool at 00:27:19.259 --> 00:27:21.539 the nape of the neck. If the ultrasound shows 00:27:21.539 --> 00:27:23.880 an increased abnormally thick measurement of 00:27:23.880 --> 00:27:26.380 fluid there, it is highly associated with trisomy 00:27:26.380 --> 00:27:28.759 21. Okay, that makes so much sense. Now let's 00:27:28.759 --> 00:27:31.720 move into the second trimester. We have amniocentesis. 00:27:31.819 --> 00:27:35.180 Correct. Amniocentesis is an amniotic fluid draw. 00:27:35.599 --> 00:27:37.619 A long needle is inserted through the maternal 00:27:37.619 --> 00:27:40.680 abdomen, guided by ultrasound, directly into 00:27:40.680 --> 00:27:43.579 the amniotic sac. It collects fetal skin cells 00:27:43.579 --> 00:27:46.599 and waste products floating in the fluid. Like 00:27:46.599 --> 00:27:50.259 CVS, it is a diagnostic test to definitively 00:27:50.259 --> 00:27:53.500 confirm genetic or inherited anomalies. Why do 00:27:53.500 --> 00:27:56.000 an amnio if they already did a CVS? Timing and 00:27:56.000 --> 00:27:58.640 fluid volume. You can't do an amnio at 10 weeks 00:27:58.640 --> 00:28:01.150 because there isn't enough amniotic fluid. the 00:28:01.150 --> 00:28:03.410 needle would likely injure the fetus. You wait 00:28:03.410 --> 00:28:05.890 until 15 to 20 weeks for an amnio. And then we 00:28:05.890 --> 00:28:08.529 have the maternal blood tests, the AFP and the 00:28:08.529 --> 00:28:10.900 quad screen. The quad screen is performed between 00:28:10.900 --> 00:28:13.640 16 and 18 weeks. It tests the mother's blood 00:28:13.640 --> 00:28:16.660 for four specific markers, alpha -fetoprotein, 00:28:16.680 --> 00:28:20.380 or AFP, human chorionic gonadotropin HCG estriol, 00:28:20.579 --> 00:28:22.680 and inhibin A. Let's talk about the exam traps 00:28:22.680 --> 00:28:24.460 here, because I know from personal experience 00:28:24.460 --> 00:28:26.440 that instructors love to test the quad screen. 00:28:26.619 --> 00:28:28.619 The biggest, most dangerous trap here is the 00:28:28.619 --> 00:28:31.019 screening versus diagnostic trap. You absolutely 00:28:31.019 --> 00:28:33.299 must know the difference. The AFP and quad screens 00:28:33.299 --> 00:28:36.319 are screenings. They only indicate risk or probability. 00:28:36.619 --> 00:28:39.039 They do not diagnose a disease. Let's play that 00:28:39.039 --> 00:28:42.559 out. What does AFP actually measure? AFP is basically 00:28:42.559 --> 00:28:44.980 the fetal version of albumin, a protein made 00:28:44.980 --> 00:28:47.700 in the fetal liver. Normally, a tiny amount crosses 00:28:47.700 --> 00:28:50.140 into the amniotic fluid and then into the mother's 00:28:50.140 --> 00:28:53.000 blood. But if the fetus has an open neural tube 00:28:53.000 --> 00:28:56.039 defect, like spina bifida, where the spine hasn't 00:28:56.039 --> 00:28:58.099 closed massive amounts of this protein leak out 00:28:58.099 --> 00:29:00.619 of the open wound into the fluid, and maternal 00:29:00.619 --> 00:29:04.240 blood levels skyrocket. So a high AFP level suggests 00:29:04.240 --> 00:29:06.880 a risk for a neural tube defect. Exactly. But 00:29:06.880 --> 00:29:09.500 it only suggests a risk. It could also just mean 00:29:09.500 --> 00:29:11.980 the mother's due date is wrong or she is carrying 00:29:11.980 --> 00:29:15.380 twins. You cannot diagnose a fetus based on a 00:29:15.380 --> 00:29:17.980 quad screen. So if a patient calls in a panic 00:29:17.980 --> 00:29:20.599 because their screening is positive, what is 00:29:20.599 --> 00:29:22.779 the priority nursing action? You can't just say, 00:29:22.819 --> 00:29:25.400 well, your baby has kind of bifida. Never. Your 00:29:25.400 --> 00:29:27.680 priority action is to provide calm education, 00:29:27.960 --> 00:29:30.420 emotional support, and refer them for diagnostic 00:29:30.420 --> 00:29:33.039 testing. You tell them, this test just means 00:29:33.039 --> 00:29:35.200 we need to take a closer look. You then prepare 00:29:35.200 --> 00:29:37.339 them for a targeted high resolution ultrasound 00:29:37.339 --> 00:29:40.759 or an amniocentesis. Amnio and CVS give you a 00:29:40.759 --> 00:29:43.799 definitive karyotype. They are diagnostic. OK, 00:29:43.960 --> 00:29:47.099 let's talk about expected versus concerning findings 00:29:47.099 --> 00:29:50.400 with these obscure acronyms. PPA is one that 00:29:50.400 --> 00:29:53.759 shows up a lot. Pregnancy associated plasma protein 00:29:53.759 --> 00:29:56.660 A. PPGA is an enzyme produced by the trophoblast, 00:29:56.839 --> 00:29:59.140 the outer layer of the early placenta. You want 00:29:59.140 --> 00:30:02.319 expected normal levels of PPA because it indicates 00:30:02.319 --> 00:30:04.720 the placenta is implanting and functioning well. 00:30:05.380 --> 00:30:08.880 Low levels of PPPA are highly concerning. Why? 00:30:08.940 --> 00:30:11.140 What does it mean? Low levels mean the placenta 00:30:11.140 --> 00:30:14.079 is failing at a cellular level. It directly correlates 00:30:14.079 --> 00:30:16.119 with poor pregnancy outcomes later on, fetal 00:30:16.119 --> 00:30:19.319 demise, severe growth restriction, preeclampsia, 00:30:19.400 --> 00:30:21.680 and it's also a marker for genetic anomalies 00:30:21.680 --> 00:30:25.730 like trisomy 13, 18, and 21. Another priority 00:30:25.730 --> 00:30:27.910 nursing action regarding these tests especially 00:30:27.910 --> 00:30:30.670 the ultrasounds and amniocentesis is bladder 00:30:30.670 --> 00:30:32.930 management. It sounds so basic but it's constantly 00:30:32.930 --> 00:30:35.950 tested. Yes. Always ensure the patient has the 00:30:35.950 --> 00:30:38.289 appropriate bladder status based on gestational 00:30:38.289 --> 00:30:41.250 age and the procedure. For early first trimester 00:30:41.250 --> 00:30:43.670 abdominal ultrasounds you want the client to 00:30:43.670 --> 00:30:45.970 have a completely full bladder. The full bladder 00:30:45.970 --> 00:30:48.670 acts as an acoustic window and literally pushes 00:30:48.670 --> 00:30:51.150 the small uterus up out of the pelvis so the 00:30:51.150 --> 00:30:53.319 ultrasound waves can see it. but for an amnio 00:30:53.319 --> 00:30:55.619 later in pregnancy. You want an empty bladder. 00:30:56.079 --> 00:30:58.500 By 20 weeks, the uterus is high enough and a 00:30:58.500 --> 00:31:00.200 full bladder would just be in the way of the 00:31:00.200 --> 00:31:02.880 needle, risking a bladder puncture. And post 00:31:02.880 --> 00:31:06.200 procedure for an amnio or CVS, the nurse's priority 00:31:06.200 --> 00:31:09.200 is strict monitoring for vaginal bleeding, fever 00:31:09.200 --> 00:31:11.720 or signs of infection, and premature rupture 00:31:11.720 --> 00:31:14.000 of membranes. You are watching to ensure the 00:31:14.000 --> 00:31:15.700 invasive needle didn't trigger a miscarriage. 00:31:15.930 --> 00:31:17.789 Okay, we need to talk about the blood typing 00:31:17.789 --> 00:31:19.769 test because this is historically one of the 00:31:19.769 --> 00:31:22.589 most confused, twisted topics in OB nursing. 00:31:23.170 --> 00:31:25.750 The Coombe test and RH incompatibility. This 00:31:25.750 --> 00:31:28.269 is a guaranteed exam question on every single 00:31:28.269 --> 00:31:30.430 nursing board exam. Let's break it down to its 00:31:30.430 --> 00:31:33.250 physiological roots. The Coombe's test checks 00:31:33.250 --> 00:31:35.789 for antibodies in the maternal blood that are 00:31:35.789 --> 00:31:38.910 designed to attack red blood cells. We are specifically 00:31:38.910 --> 00:31:41.329 looking at the RH factor, the positive or negative 00:31:41.329 --> 00:31:44.220 sign on your blood type. Every pregnant client 00:31:44.220 --> 00:31:47.460 gets an indirect Coombs test. What is the expected 00:31:47.460 --> 00:31:50.339 happy finding? The expected finding is a negative 00:31:50.339 --> 00:31:52.900 Coombs test. It means the mother's immune system 00:31:52.900 --> 00:31:55.880 has not developed antibodies against RH -positive 00:31:55.880 --> 00:31:58.470 blood. And the concerning finding. A positive 00:31:58.470 --> 00:32:00.910 Coombs test. This is bad. This means the mother 00:32:00.910 --> 00:32:03.769 is sensitized. She has formed permanent antibodies 00:32:03.769 --> 00:32:06.210 that will cross the placenta and attack the red 00:32:06.210 --> 00:32:09.170 blood cells of an Rh -positive fetus. This causes 00:32:09.170 --> 00:32:12.450 severe fetal hemolytic anemia where the baby's 00:32:12.450 --> 00:32:15.109 blood cells literally burst, leading to profound 00:32:15.109 --> 00:32:17.549 jaundice and potentially fatal heart failure 00:32:17.549 --> 00:32:20.680 in utero. So how do we prevent this immune system 00:32:20.680 --> 00:32:23.299 warfare? This is where the medication RHIG comes 00:32:23.299 --> 00:32:26.799 in, right? Rho. Rho. Immune globulin, often known 00:32:26.799 --> 00:32:30.579 by the brand name Rhojam. Yes. And here is the 00:32:30.579 --> 00:32:36.299 massive bold print RH trap on exams. RIG is given 00:32:36.299 --> 00:32:39.960 to RH negative mothers only. Never ever give 00:32:39.960 --> 00:32:42.519 RH negative mother. An RH positive mother already 00:32:42.519 --> 00:32:45.710 has the RH protein. Her body will never make 00:32:45.710 --> 00:32:48.130 antibodies against it. OK, so if I have an Rh 00:32:48.130 --> 00:32:50.589 negative mother, when do I give her this injection? 00:32:50.809 --> 00:32:54.049 You give it prophylactically at 28 weeks of gestation 00:32:54.049 --> 00:32:56.910 and then you give a second dose within 72 hours 00:32:56.910 --> 00:32:59.849 after birth. But only if the newborn is tested 00:32:59.849 --> 00:33:02.710 and confirmed to be Rh positive. And here is 00:33:02.710 --> 00:33:04.769 the mind blowing part that students always trip 00:33:04.769 --> 00:33:06.710 over this medication doesn't really protect the 00:33:06.710 --> 00:33:08.690 current baby in the uterus, right? I always thought 00:33:08.690 --> 00:33:10.529 it was like a shield for the baby she's currently 00:33:10.529 --> 00:33:12.609 carrying. That is the ultimate misconception. 00:33:12.829 --> 00:33:15.559 Let's look at the biology. If the mother is Rh 00:33:15.559 --> 00:33:18.200 negative and her first baby is Rh positive, their 00:33:18.200 --> 00:33:20.059 blood doesn't usually mix during the pregnancy. 00:33:20.579 --> 00:33:22.579 The placenta keeps them separate. But during 00:33:22.579 --> 00:33:24.980 the trauma of birth or during a miscarriage or 00:33:24.980 --> 00:33:27.880 an amniocentesis, fetal blood cells inevitably 00:33:27.880 --> 00:33:30.019 spill into the mother's bloodstream. And the 00:33:30.019 --> 00:33:32.220 mother's immune system sees those Rh positive 00:33:32.220 --> 00:33:35.759 cells as a foreign invader. Exactly. Her immune 00:33:35.759 --> 00:33:37.880 system sounds the alarm and creates permanent 00:33:37.880 --> 00:33:40.640 IgG antibodies to destroy them. But by the time 00:33:40.640 --> 00:33:43.019 her body manufactures those antibodies, that 00:33:43.019 --> 00:33:45.240 first baby is already born and perfectly safe 00:33:45.240 --> 00:33:47.460 in the nursery. But the mother is now permanently 00:33:47.460 --> 00:33:51.039 armed. Yes. She is sensitized. If she gets pregnant 00:33:51.039 --> 00:33:53.619 again a year later with another Rh -positive 00:33:53.619 --> 00:33:56.500 baby, those pre -made antibodies will immediately 00:33:56.500 --> 00:33:58.900 cross the placenta and aggressively attack the 00:33:58.900 --> 00:34:02.589 second baby. RhIG is passive immunity. It is 00:34:02.589 --> 00:34:04.670 a dose of synthetic antibodies that circulates 00:34:04.670 --> 00:34:07.529 in the mother's blood and quietly sweeps up and 00:34:07.529 --> 00:34:10.070 hides any stray, fetal red blood cells before 00:34:10.070 --> 00:34:12.769 her immune system ever notices them. So it stops 00:34:12.769 --> 00:34:14.989 her from ever forming her own permanent antibodies. 00:34:15.670 --> 00:34:17.510 It protects her future pregnancies. Exactly. 00:34:17.929 --> 00:34:19.989 It is entirely about protecting the next baby. 00:34:20.250 --> 00:34:22.329 That is so clearly explained. Let's lock this 00:34:22.329 --> 00:34:24.769 in with memory anchors. Rh negative needs the 00:34:24.769 --> 00:34:27.150 needle. That reminds you exactly who gets the 00:34:27.150 --> 00:34:30.150 RHE. And for the early procedures, C comes before 00:34:30.150 --> 00:34:32.670 A in the alphabet, just like CVS comes before 00:34:32.670 --> 00:34:35.409 Amnio in the pregnancy timeline. CVS's first 00:34:35.409 --> 00:34:38.260 trimester, Amnio's second. Excellent. So if I'm 00:34:38.260 --> 00:34:40.780 highlighting my notes, the traps to avoid are 00:34:40.780 --> 00:34:44.719 AFP is just a screening, not a diagnosis. CVS 00:34:44.719 --> 00:34:47.300 is done early, but carries higher risks of disrupting 00:34:47.300 --> 00:34:50.159 the pregnancy. Neutral translucency screens for 00:34:50.159 --> 00:34:52.920 trisomy 21 by looking at lymphatic fluid on the 00:34:52.920 --> 00:34:56.099 neck. A positive Coombs test is a dangerous finding. 00:34:56.300 --> 00:34:59.380 It means the mother is sensitized. And RKG is 00:34:59.530 --> 00:35:02.329 only for Rh negative moms to protect their future 00:35:02.329 --> 00:35:04.730 babies. We are building a really solid foundation 00:35:04.730 --> 00:35:07.449 here. Let's move to the next phase. We have run 00:35:07.449 --> 00:35:09.769 all the early labs. We check the genetics. We 00:35:09.769 --> 00:35:12.329 check the blood types. But fast forward to the 00:35:12.329 --> 00:35:14.630 third trimester. How do we know if the baby is 00:35:14.630 --> 00:35:17.199 safe right now? That is the entire purpose of 00:35:17.199 --> 00:35:19.159 fetal surveillance. These tests generally begin 00:35:19.159 --> 00:35:21.400 around 32 weeks for high -risk clients. They 00:35:21.400 --> 00:35:23.639 give the care team a real -time snapshot to answer 00:35:23.639 --> 00:35:26.139 a crucial question. Is this fetus thriving or 00:35:26.139 --> 00:35:28.420 is the placenta failing? Meaning we need to intervene 00:35:28.420 --> 00:35:30.780 and deliver immediately. I have an analogy for 00:35:30.780 --> 00:35:32.860 the two main monitor tests. Tell me if this works 00:35:32.860 --> 00:35:37.219 clinically. A non -stress test or NST is like 00:35:37.219 --> 00:35:40.000 checking the baby's resting pulse while they're 00:35:40.000 --> 00:35:43.000 just chilling on the couch. A contraction stress 00:35:43.000 --> 00:35:46.219 test, or CST, is like putting the baby on a treadmill 00:35:46.219 --> 00:35:48.420 to see if their heart fails under the pressure 00:35:48.420 --> 00:35:51.260 of a heavy workout. That is a brilliant clinical 00:35:51.260 --> 00:35:53.559 way to view it. But before we get to the monitors, 00:35:54.019 --> 00:35:57.480 let's start with the absolute simplest zero technology 00:35:57.480 --> 00:36:00.139 surveillance kit counts, or daily fetal movement 00:36:00.139 --> 00:36:02.000 counts. The pregnant client does this at home. 00:36:02.380 --> 00:36:04.679 What is the standard we teach them? We want to 00:36:04.679 --> 00:36:07.260 see 10 distinct movements in a two -hour window. 00:36:07.360 --> 00:36:10.820 Why? Because fetal movement is a direct physiological 00:36:10.820 --> 00:36:13.360 indicator of fetal central nervous system integrity 00:36:13.360 --> 00:36:16.860 and oxygenation. A fetus that is well oxygenated 00:36:16.860 --> 00:36:19.679 has the energy to move. A hypoxic fetus will 00:36:19.679 --> 00:36:21.900 conserve energy and stop moving. So if a patient 00:36:21.900 --> 00:36:24.000 calls triage and says, my baby hasn't moved much 00:36:24.000 --> 00:36:26.539 today, I've only felt three kicks, what is the 00:36:26.539 --> 00:36:28.539 priority nursing action? Do we tell them to rush 00:36:28.539 --> 00:36:31.320 to the OR? You do not panic immediately, but 00:36:31.320 --> 00:36:34.119 you absolutely take action. The fetus might simply 00:36:34.119 --> 00:36:36.500 be in a deep sleep cycle, which usually lasts 00:36:36.500 --> 00:36:38.960 20 to 40 minutes, instruct the mother to drink 00:36:38.960 --> 00:36:41.699 something cold and sweet like juice, eat a small 00:36:41.699 --> 00:36:44.320 snack, or take a brisk walk to wake the baby 00:36:44.320 --> 00:36:46.440 up and then lie on her side and count again. 00:36:46.960 --> 00:36:49.039 If there is still insufficient movement after 00:36:49.039 --> 00:36:51.179 those interventions, they must report to the 00:36:51.179 --> 00:36:54.460 clinic or triage immediately for an NST. Okay, 00:36:54.460 --> 00:36:56.340 let's look at the baby on the couch, the non 00:36:56.340 --> 00:36:58.920 -stress test. What is the high yield core here? 00:36:59.019 --> 00:37:02.760 The NST uses an external electronic fetal monitor 00:37:02.760 --> 00:37:05.800 strapped to the mother's abdomen. We are evaluating 00:37:05.800 --> 00:37:08.559 the fetal autonomic nervous system. When a healthy 00:37:08.559 --> 00:37:11.199 baby moves, its sympathetic nervous system causes 00:37:11.199 --> 00:37:13.739 the heart rate to temporarily accelerate, just 00:37:13.739 --> 00:37:15.539 like your heart races when you stand up quickly. 00:37:16.039 --> 00:37:18.679 We are looking for a reactive strip. What makes 00:37:18.679 --> 00:37:21.139 it officially reactive? To be considered reactive 00:37:21.139 --> 00:37:23.920 and reassuring, we want to see at least two accelerations 00:37:23.920 --> 00:37:26.659 in the fetal heart rate rising at least 15 beats 00:37:26.659 --> 00:37:29.360 above the baseline and lasting for at least 15 00:37:29.360 --> 00:37:32.059 seconds all within a 20 minute window. We call 00:37:32.059 --> 00:37:35.260 this the 15 by 15 rule. What if it is non -reactive? 00:37:35.420 --> 00:37:37.900 I'm watching the monitor for 20 minutes and the 00:37:37.900 --> 00:37:40.500 heart rate is just a flat line. No accelerations. 00:37:40.820 --> 00:37:43.099 Is the baby dying? Not necessarily. Again, they 00:37:43.099 --> 00:37:46.219 might just be sleeping. You can try vibroacoustic 00:37:46.219 --> 00:37:48.699 stimulation, which is basically placing an artificial 00:37:48.699 --> 00:37:51.119 larynx or a buzzer on the mother's belly to startle 00:37:51.119 --> 00:37:53.940 the baby awake. But if the strip remains nonreactive 00:37:53.940 --> 00:37:56.840 after 40 to 60 minutes despite stimulation, it 00:37:56.840 --> 00:37:59.639 is highly concerning. It presumes the fetus is 00:37:59.639 --> 00:38:02.380 compromised and hypoxic. The priority action 00:38:02.380 --> 00:38:05.179 is to immediately escalate to a biophysical profile, 00:38:05.320 --> 00:38:08.739 or BPP. Let's define the BPP. It sounds comprehensive. 00:38:08.969 --> 00:38:12.409 A BPP combines the NST with a detailed ultrasound. 00:38:12.889 --> 00:38:15.269 It evaluates five variables, scoring each one 00:38:15.269 --> 00:38:17.909 with either a 2 for normal or a 0 for abnormal. 00:38:18.309 --> 00:38:21.030 The maximum score is 10. The variables are the 00:38:21.030 --> 00:38:23.969 NST results, amniotic fluid volume, fetal breathing 00:38:23.969 --> 00:38:26.630 movements, gross body movements, and fetal muscle 00:38:26.630 --> 00:38:29.090 tone. Why do we care about tone versus breathing? 00:38:29.250 --> 00:38:30.829 Don't they all just mean the baby is moving? 00:38:31.099 --> 00:38:33.780 This is a beautiful piece of physiology. The 00:38:33.780 --> 00:38:36.019 fetal brain centers develop at different gestational 00:38:36.019 --> 00:38:38.559 ages, and they shut down in response to hypoxia 00:38:38.559 --> 00:38:41.300 in the reverse order of their development. Fetal 00:38:41.300 --> 00:38:44.119 breathing is a complex, recently developed reflex. 00:38:44.599 --> 00:38:46.840 It's the first thing to stop when oxygen drops 00:38:46.840 --> 00:38:50.139 because the baby is conserving energy. Fetal 00:38:50.139 --> 00:38:52.219 tone, the ability to keep the limbs flexed, is 00:38:52.219 --> 00:38:55.219 a primitive brainstem reflex. If the baby has 00:38:55.219 --> 00:38:57.360 lost fetal tone and is completely flaccid, it 00:38:57.360 --> 00:39:00.530 means the hypoxia is severe and late stage. So 00:39:00.530 --> 00:39:03.369 expected versus concerning for the BPP. An 8 00:39:03.369 --> 00:39:06.389 to 10 is reassuring. A score of 6 means equivocal. 00:39:06.610 --> 00:39:09.789 Monitor closely. A score of 4 or less is highly 00:39:09.789 --> 00:39:13.329 concerning. It indicates severe acute fetal hypoxia. 00:39:13.670 --> 00:39:15.949 And the team must prepare for immediate delivery, 00:39:16.210 --> 00:39:18.570 likely via cesarean. Now let's talk about the 00:39:18.570 --> 00:39:20.670 treadmill test, the contraction stress test. 00:39:21.110 --> 00:39:23.989 A CST evaluates how the fetus will tolerate the 00:39:23.989 --> 00:39:26.650 massive physiological stress of labor. During 00:39:26.650 --> 00:39:28.610 a contraction, the uterine muscle bears down 00:39:28.610 --> 00:39:31.150 and literally squeezes the spiral artery shut, 00:39:31.349 --> 00:39:33.309 temporarily cutting off oxygen to the placenta. 00:39:33.929 --> 00:39:36.469 A healthy, robust placenta has enough respiratory 00:39:36.469 --> 00:39:39.250 reserve to handle this temporary squeeze. A failing 00:39:39.250 --> 00:39:42.250 placenta does not. How do we do a CST if the 00:39:42.250 --> 00:39:45.610 mother isn't in labor? We induce contractions 00:39:45.610 --> 00:39:48.070 either by administering intravenous oxytocin 00:39:48.070 --> 00:39:50.610 or by having mother perform nipple stimulation, 00:39:50.949 --> 00:39:53.730 which releases endogenous oxytocin. We need three 00:39:53.730 --> 00:39:55.849 contractions in a 10 -minute window. And here 00:39:55.849 --> 00:39:58.409 is the positive negative word trap. that instructors 00:39:58.409 --> 00:40:01.429 absolutely love to use to fail students. This 00:40:01.429 --> 00:40:04.550 is crucial for exams. Yes. Listen carefully to 00:40:04.550 --> 00:40:07.449 this. In normal medical terminology, hearing 00:40:07.449 --> 00:40:10.489 a test is positive usually means you have a disease 00:40:10.489 --> 00:40:12.570 you test positive for strep throat. That's bad. 00:40:13.010 --> 00:40:16.670 But for a CST, a positive test is profoundly 00:40:16.670 --> 00:40:19.769 BAD. It means the baby had a positive reaction 00:40:19.769 --> 00:40:23.010 to the stress, which manifests as late decelerations. 00:40:23.469 --> 00:40:25.489 The baby's heart rate dropped after the contraction 00:40:25.489 --> 00:40:27.579 peaked, meaning the placenta failed. to provide 00:40:27.579 --> 00:40:30.260 enough oxygen. And a negative CST. A negative 00:40:30.260 --> 00:40:33.099 CST is good. It means there were no late decelerations. 00:40:33.480 --> 00:40:35.739 The baby tolerated the stress perfectly. And 00:40:35.739 --> 00:40:37.539 for the NST, we don't use positive or negative, 00:40:37.599 --> 00:40:40.039 right? Correct. For an NST, we want a reactive 00:40:40.039 --> 00:40:42.019 result. So the memory anchor you must memorize 00:40:42.019 --> 00:40:44.880 is positive stress is bad stress for the CST. 00:40:45.300 --> 00:40:48.019 And reactive is reassuring for the NST. I love 00:40:48.019 --> 00:40:49.860 that. So summarizing our surveillance traps, 00:40:50.019 --> 00:40:53.159 10 kicks in two hours is the standard. A reactive 00:40:53.159 --> 00:40:57.159 NST requires the 15 by 15 rule. A positive CST 00:40:57.159 --> 00:41:00.440 is a critical failure indicating hypoxia. A BPP 00:41:00.440 --> 00:41:02.780 scores five variables out of 10, and a score 00:41:02.780 --> 00:41:04.860 of four or less means we are heading to the OR 00:41:04.860 --> 00:41:07.579 immediately. Exactly. Let's shift gears slightly. 00:41:08.019 --> 00:41:09.860 We have talked about the placenta, the genetics, 00:41:10.039 --> 00:41:12.380 the heart rate, but what happens when the protective 00:41:12.380 --> 00:41:14.559 bubble around the baby that the amniotic fluid 00:41:14.559 --> 00:41:18.260 itself goes wrong? We were talking obstetric 00:41:18.260 --> 00:41:21.539 complications and fluid volume disasters. Amniotic 00:41:21.539 --> 00:41:24.559 fluid is not just water. It is a highly dynamic 00:41:24.559 --> 00:41:27.300 essential fluid. It acts as a physical cushion, 00:41:27.760 --> 00:41:30.099 it allows for symmetrical musculoskeletal growth 00:41:30.099 --> 00:41:32.400 because the baby has room to stretch, it prevents 00:41:32.400 --> 00:41:34.460 the umbilical cord from being pinched, and it 00:41:34.460 --> 00:41:36.780 maintains a stable temperature. When the volume 00:41:36.780 --> 00:41:39.500 is abnormal, it is a huge red flag for underlying 00:41:39.500 --> 00:41:43.480 pathology. Let's define the two extremes, oligohydromyos 00:41:43.480 --> 00:41:46.980 and polyhydromyos. Oligohydramnios means severely 00:41:46.980 --> 00:41:49.780 decreased fluid volume. This is highly concerning. 00:41:50.260 --> 00:41:53.239 It is often caused by maternal hypertension causing 00:41:53.239 --> 00:41:57.199 placental insufficiency or by fetal renal anomalies 00:41:57.199 --> 00:41:59.840 like renalogenesis where the kidneys don't form. 00:42:01.130 --> 00:42:03.909 fetal kidneys dictate the fluid volume. Because, 00:42:04.130 --> 00:42:06.210 as we discussed with diabetes, in the second 00:42:06.210 --> 00:42:08.809 half of pregnancy, amniotic fluid is predominantly 00:42:08.809 --> 00:42:12.170 fetal urine. The baby pees it out, then swallows 00:42:12.170 --> 00:42:14.329 it, then pees it out again. It's a continuous 00:42:14.329 --> 00:42:17.389 cycle. If the fetal kidneys are failing or accident, 00:42:17.849 --> 00:42:20.469 urine production drops and fluid volume plummets. 00:42:20.809 --> 00:42:23.289 And what is the immediate life -threatening risk 00:42:23.289 --> 00:42:25.690 with low fluid? Cord compression. Without that 00:42:25.690 --> 00:42:27.809 generous fluid cushion, the fetus can easily 00:42:27.809 --> 00:42:29.989 shift and pinch the umbilical cord between its 00:42:29.989 --> 00:42:32.690 body and the rigid uterine wall. This instantly 00:42:32.690 --> 00:42:35.230 cuts off the fetal oxygen supply, which you will 00:42:35.230 --> 00:42:37.510 see on the monitor as variable decelerations. 00:42:37.630 --> 00:42:40.190 What about polyhydramnios? Too much fluid. We 00:42:40.190 --> 00:42:42.969 covered one cause earlier maternal diabetes causing 00:42:42.969 --> 00:42:46.030 fetal polyuria, but it is also heavily linked 00:42:46.030 --> 00:42:50.429 to fetal gastrointestinal anomalies, like a tracheoesophageal 00:42:50.429 --> 00:42:53.980 fistula or esophageal atresia. In these conditions, 00:42:54.119 --> 00:42:56.300 the fetal esophagus doesn't connect to the stomach 00:42:56.300 --> 00:42:58.920 properly, so the fetus cannot swallow the fluid 00:42:58.920 --> 00:43:01.599 to regulate the volume. They keep peeing, but 00:43:01.599 --> 00:43:04.480 they can't drink, so the fluid builds up massively. 00:43:04.699 --> 00:43:07.099 And what is the risk for the mother having two 00:43:07.099 --> 00:43:09.960 gallons of fluid in her uterus? An overdistended 00:43:09.960 --> 00:43:12.500 uterus. When you stretch the uterine muscle fibers 00:43:12.500 --> 00:43:14.639 at far beyond their normal capacity, they lose 00:43:14.639 --> 00:43:17.360 their elasticity. After the baby is born, that 00:43:17.360 --> 00:43:19.619 stretched out muscle has a very hard time clamping 00:43:19.619 --> 00:43:22.199 down and contracting. This severely increases 00:43:22.059 --> 00:43:24.139 increases the risk for uterine atony and life 00:43:24.139 --> 00:43:26.340 -threatening postpartum hemorrhage. Okay, let's 00:43:26.340 --> 00:43:28.519 talk about the membranes breaking, the water 00:43:28.519 --> 00:43:31.699 breaking. We have PROM and PPROM. What is the 00:43:31.699 --> 00:43:34.000 difference and what is the exam trap here? PROM 00:43:34.000 --> 00:43:37.059 stands for pre -labor rupture of membranes. The 00:43:37.059 --> 00:43:39.880 water breaks before the onset of true labor contractions, 00:43:40.300 --> 00:43:43.480 but the pregnancy is at term 37 weeks or more. 00:43:44.119 --> 00:43:47.659 PPROM is preterm pre -labor rupture of membranes. 00:43:47.920 --> 00:43:51.099 The water breaks early before 37 weeks. Why does 00:43:51.099 --> 00:43:52.599 it matter so much if the water breaks early? 00:43:52.750 --> 00:43:55.230 Because the moment that amniotic sac ruptures, 00:43:55.389 --> 00:43:57.389 the sterile intruder and environment is completely 00:43:57.389 --> 00:44:00.030 compromised, the protective seal is gone. The 00:44:00.030 --> 00:44:02.429 biggest risk is an ascending bacterial infection 00:44:02.429 --> 00:44:05.829 called chorioamnionitis. It can cause overwhelming 00:44:05.829 --> 00:44:08.889 maternal sepsis and fetal pneumonia. Therefore, 00:44:08.929 --> 00:44:11.289 the priority nursing action with suspected PROM 00:44:11.289 --> 00:44:14.090 or PPROM is strict, frequent monitoring of the 00:44:14.090 --> 00:44:16.610 maternal temperature and vital signs and avoiding 00:44:16.610 --> 00:44:19.329 unnecessary vaginal exams that could push bacteria 00:44:19.329 --> 00:44:21.369 upward. But practically speaking, if a patient 00:44:21.369 --> 00:44:23.710 comes to Tria and says, I think my water broke, 00:44:23.769 --> 00:44:26.070 but I might have just peed myself. How do we 00:44:26.070 --> 00:44:28.869 know it is amniotic fluid? That is a crucial 00:44:28.869 --> 00:44:31.369 nursing assessment. You must test the fluid. 00:44:31.550 --> 00:44:33.829 You can look at a swab of the fluid under a microscope. 00:44:34.449 --> 00:44:36.309 Amniotic fluid contains sodium chloride, and 00:44:36.309 --> 00:44:38.590 when it dries on a slide, it crystallizes and 00:44:38.590 --> 00:44:41.409 looks exactly like a fern leaf. We call it furning. 00:44:42.210 --> 00:44:45.090 Or more commonly, you use nitrazine pH paper. 00:44:45.340 --> 00:44:47.940 And here is the pH exam trap. I remember getting 00:44:47.940 --> 00:44:50.940 this wrong in school. Yes. Normal vaginal secretions 00:44:50.940 --> 00:44:54.480 are naturally acidic to prevent infection. Amniotic 00:44:54.480 --> 00:44:57.119 fluid is alkaline. Nitrazine paper turns deep 00:44:57.119 --> 00:44:59.519 blue in the presence of an alkaline fluid. So 00:44:59.519 --> 00:45:02.199 the memory trick is blue equals amniotic. If 00:45:02.199 --> 00:45:04.380 the paper stays yellow or olive green, it is 00:45:04.380 --> 00:45:06.539 just acidic vaginal fluid or urine, and her water 00:45:06.539 --> 00:45:09.289 has not broken. Let's discuss one more complication 00:45:09.289 --> 00:45:11.750 from the sources that sounds incredibly obscure 00:45:11.750 --> 00:45:14.769 but is highly tested on the NCLE -X colostasis 00:45:14.769 --> 00:45:16.989 of pregnancy. It is intensely testable because 00:45:16.989 --> 00:45:19.230 the presentation is so unique. The pregnant client 00:45:19.230 --> 00:45:21.530 will complain of intense, severe itching prudus. 00:45:21.849 --> 00:45:24.309 But here is the key. The itching is specifically 00:45:24.309 --> 00:45:26.349 located on the palms of their hands and the soles 00:45:26.349 --> 00:45:28.510 of their feet, and it is usually much worse at 00:45:28.510 --> 00:45:31.550 night. The absolute crucial detail to look for 00:45:31.550 --> 00:45:34.889 in an exam question. There is NO rash. If there's 00:45:34.889 --> 00:45:37.349 no rash, what is happening internally to cause 00:45:37.349 --> 00:45:40.429 the itching? It is a liver issue. Due to hormonal 00:45:40.429 --> 00:45:43.150 changes, the flow of bile from the maternal liver 00:45:43.150 --> 00:45:46.289 is diminished. Bile acids back up and accumulate 00:45:46.289 --> 00:45:48.829 in the maternal bloodstream, causing the intense 00:45:48.829 --> 00:45:51.710 peripheral itching. And why is this an obstetric 00:45:51.710 --> 00:45:54.610 emergency requiring an immediate report to the 00:45:54.610 --> 00:45:56.869 provider? It's just itching, right? For the mother, 00:45:56.969 --> 00:45:59.210 it's just miserable itching. But for the fetus, 00:45:59.269 --> 00:46:02.380 it is lethal. Those high circulating bile acids 00:46:02.380 --> 00:46:05.420 cross the placenta and are incredibly toxic to 00:46:05.420 --> 00:46:08.679 the fetal heart. Colostasis carries a very high 00:46:08.679 --> 00:46:11.639 sudden risk of intratraterine fetal demise due 00:46:11.639 --> 00:46:14.440 to cardiac arrhythmias, as well as preterm birth 00:46:14.440 --> 00:46:16.880 and meconium aspiration. So what are the priority 00:46:16.880 --> 00:46:19.920 actions if a patient reports itchy palms? You 00:46:19.920 --> 00:46:21.960 immediately draw labs to monitor the maternal 00:46:21.960 --> 00:46:24.699 total bile acid levels and liver enzymes. You 00:46:24.699 --> 00:46:27.400 anticipate an order for a medication funded ursodeoxycholic 00:46:27.400 --> 00:46:30.570 acid or UDCA, which helps bind and lower the 00:46:30.570 --> 00:46:33.170 bile acids. And you prepare the patient for frequent 00:46:33.170 --> 00:46:35.889 fetal surveillance, likely bi -weekly BPPs, and 00:46:35.889 --> 00:46:37.630 almost certainly an early induction of labor 00:46:37.630 --> 00:46:40.170 to get the baby out before the bile acids cause 00:46:40.170 --> 00:46:44.030 cardiac arrest. Let's anchor this segment. Polyhydrominoes 00:46:44.030 --> 00:46:47.110 equals much fluid, much sugar, pointing to diabetes 00:46:47.110 --> 00:46:49.789 and hemorrhage risk. Oligohydrominoes equals 00:46:49.789 --> 00:46:52.409 little fluid, pointing to poor perfusion and 00:46:52.409 --> 00:46:54.820 cord compression. Spot on. And for the exams, 00:46:55.239 --> 00:46:57.519 remember PROM and PPRI PROM require immediate 00:46:57.519 --> 00:47:00.119 strict monitoring for maternal temperature spikes. 00:47:00.699 --> 00:47:03.260 Nitrazine paper turning blue confirms membranes 00:47:03.260 --> 00:47:06.000 have ruptured because amniotic fluid is alkaline, 00:47:06.519 --> 00:47:08.599 and severe itching on the palms and soles without 00:47:08.599 --> 00:47:11.440 a rash equals cholestasis, which you must report 00:47:11.440 --> 00:47:13.980 immediately due to the high risk of sudden fetal 00:47:13.980 --> 00:47:16.599 demise. All right, we have reached the culmination 00:47:16.599 --> 00:47:18.639 of all this data. We have armed our listener 00:47:18.639 --> 00:47:21.639 with the high yield facts, the intricate pathophysiology, 00:47:21.739 --> 00:47:24.280 and the glaring red flags. But how does a nursing 00:47:24.280 --> 00:47:26.440 student actually apply this on a brutal exam 00:47:26.440 --> 00:47:28.800 or in a chaotic clinical setting? Let's bring 00:47:28.800 --> 00:47:31.380 it back to the absolute core of nursing the clinical 00:47:31.380 --> 00:47:34.650 judgment model. Exams like the NCLE -X have evolved. 00:47:34.889 --> 00:47:37.150 They do not just ask you to regurgitate a definition 00:47:37.150 --> 00:47:40.030 of preeclampsia anymore. They give you a complex, 00:47:40.389 --> 00:47:43.110 messy scenario and ask, what will the nurse do 00:47:43.110 --> 00:47:46.110 first? Or, which of these four patients do you 00:47:46.110 --> 00:47:48.730 see first? They are strictly testing your clinical 00:47:48.730 --> 00:47:51.579 judgment using the assessment. analysis, planning, 00:47:51.840 --> 00:47:54.960 implementation, and evaluation model. Let's run 00:47:54.960 --> 00:47:57.599 a scenario using telehealth, since our sources 00:47:57.599 --> 00:48:00.079 heavily emphasized how vital telemedicine has 00:48:00.079 --> 00:48:03.280 become for managing high -risk OB clients. Imagine 00:48:03.280 --> 00:48:06.199 you are the triage nurse. A 32 -week pregnant 00:48:06.199 --> 00:48:08.360 patient calls the clinic via telehealth and says, 00:48:08.739 --> 00:48:10.659 I feel really puffy today, my head is pounding, 00:48:10.739 --> 00:48:13.139 and I have this weird pain right under my ribs 00:48:13.139 --> 00:48:15.800 on the right side. How do we prioritize that 00:48:15.800 --> 00:48:18.699 using the nursing process? Step one is to recognize 00:48:18.699 --> 00:48:21.019 cues. This is your assessment phase. You hear 00:48:21.019 --> 00:48:23.860 puffy, head pounding, and right upper quadrant 00:48:23.860 --> 00:48:26.539 pain. Are these expected biophysical changes, 00:48:26.539 --> 00:48:28.639 or are they red flags? Based on what we discussed 00:48:28.639 --> 00:48:31.199 earlier, mild puffiness might be expected. But 00:48:31.199 --> 00:48:33.260 a pounding headache means cerebral edema and 00:48:33.260 --> 00:48:34.840 that right upper quadrant pain. Wait, what does 00:48:34.840 --> 00:48:37.820 that pain mean? That is a classic cue for severe 00:48:37.820 --> 00:48:41.579 preeclampsia progressing to HLLP syndrome. The 00:48:41.579 --> 00:48:44.199 liver capsule is swelling and dispending, causing 00:48:44.199 --> 00:48:47.019 pain on the right side. So you have recognized 00:48:47.019 --> 00:48:51.900 the cues. Step two. Analyze and prioritize. Is 00:48:51.900 --> 00:48:54.059 this an airway, breathing, or circulation issue? 00:48:54.460 --> 00:48:56.840 Yes. Severe hypertension affects circulation 00:48:56.840 --> 00:49:00.000 of the brain and the liver. Exactly. The priority 00:49:00.000 --> 00:49:02.539 here goes entirely to the mother's safety. She 00:49:02.539 --> 00:49:04.800 is at imminent risk for an eclamptic seizure 00:49:04.800 --> 00:49:07.619 or liver rupture. Which brings up a great fundamental 00:49:07.619 --> 00:49:10.539 memory anchor for all OB prioritization questions. 00:49:11.219 --> 00:49:13.940 Mom safety secures the baby safety. You cannot 00:49:13.940 --> 00:49:16.340 save a hypoxic fetus if the mother's physiology 00:49:16.340 --> 00:49:18.940 completely collapses. Always. You prioritize 00:49:18.940 --> 00:49:21.500 maternal physiological stability first. Now, 00:49:21.639 --> 00:49:23.460 steps three and four, generate solutions and 00:49:23.460 --> 00:49:25.699 take action. On a telehealth call, your action 00:49:25.699 --> 00:49:28.440 cannot be administer intravenous libidolol. You 00:49:28.440 --> 00:49:30.780 aren't there. Your action is to direct them to 00:49:30.780 --> 00:49:33.019 immediately go to labor and delivery triage for 00:49:33.019 --> 00:49:35.420 evaluation or call an ambulance if the symptoms 00:49:35.420 --> 00:49:37.760 are severe enough. And let's talk about the biggest, 00:49:37.840 --> 00:49:39.940 most consistent exam trap when it comes to the 00:49:39.940 --> 00:49:42.659 nursing process. Choosing an intervention before 00:49:42.659 --> 00:49:45.139 completing an assessment. This fails students 00:49:45.139 --> 00:49:48.639 constantly. If an exam question says, a pregnant 00:49:48.639 --> 00:49:51.460 client reports decreased fetal movement, and 00:49:51.460 --> 00:49:53.699 one of the multiple choice answers is, prepare 00:49:53.699 --> 00:49:56.920 the client for a stat cesarean section, that 00:49:56.920 --> 00:49:59.500 is wrong. You do not intervene with major surgery 00:49:59.500 --> 00:50:02.260 before you assess the situation. The correct 00:50:02.260 --> 00:50:04.719 answer will always be something like, apply the 00:50:04.719 --> 00:50:07.139 external fetal monitor to assess the fetal heart 00:50:07.139 --> 00:50:10.260 rate. Always recognize cues and assess first, 00:50:10.699 --> 00:50:13.420 unless the scenario describes an obvious, active, 00:50:13.460 --> 00:50:15.840 life -threatening emergency like a visible hemorrhage 00:50:15.840 --> 00:50:18.579 or an active seizure. Telehealth isn't just for 00:50:18.579 --> 00:50:20.739 triaging emergencies, though. It's also huge 00:50:20.739 --> 00:50:22.820 for addressing socio -demographic factors, right? 00:50:23.199 --> 00:50:25.079 Because the data shows that delayed prenatal 00:50:25.079 --> 00:50:28.079 care drastically increases the risk of stillbirth. 00:50:28.239 --> 00:50:31.639 Yes, profoundly. Lack of reliable transportation. 00:50:31.980 --> 00:50:34.480 Lack of childcare for older siblings. Living 00:50:34.480 --> 00:50:37.579 two hours away from a high -risk clinic. These 00:50:37.579 --> 00:50:41.019 are massive systemic barriers to care. Telehealth 00:50:41.019 --> 00:50:43.579 bridges that gap. It allows for home monitoring 00:50:43.579 --> 00:50:46.300 of blood glucose for our diabetic clients and 00:50:46.300 --> 00:50:48.840 home blood pressure monitoring for our hypertensive 00:50:48.840 --> 00:50:51.880 clients. It keeps them in the system, which directly 00:50:51.880 --> 00:50:54.639 reduces neonatal mortality. And the nurse's personal 00:50:54.639 --> 00:50:57.360 attitude plays a critical role here too, especially 00:50:57.360 --> 00:50:59.940 with vulnerable populations. An absolutely critical 00:50:59.940 --> 00:51:02.519 role. A concerning finding during an assessment 00:51:02.519 --> 00:51:04.760 isn't just a physical symptom, it's also a patient 00:51:04.760 --> 00:51:07.340 skipping appointments. If a nurse is overtly 00:51:07.340 --> 00:51:09.320 judgmental, if they lecture a client about their 00:51:09.320 --> 00:51:11.599 weight, scold them for substance use, or show 00:51:11.599 --> 00:51:14.320 frustration over a lack of health literacy, that 00:51:14.320 --> 00:51:16.400 client will shut down and simply not return. 00:51:16.760 --> 00:51:19.340 A non -judgmental active listening approach from 00:51:19.340 --> 00:51:21.679 the nurse directly impacts whether a high -risk 00:51:21.679 --> 00:51:23.900 patient receives the continuous life -saving 00:51:23.900 --> 00:51:26.800 care they need. Your empathy is quite literally 00:51:26.800 --> 00:51:29.360 clinical intervention. That is a powerful way 00:51:29.360 --> 00:51:32.199 to frame it. Empathy as an intervention. It truly 00:51:32.199 --> 00:51:35.920 is. So for clinical judgment remember always 00:51:35.920 --> 00:51:38.800 assess and recognize cues before you take action. 00:51:39.219 --> 00:51:41.739 Prioritize maternal physiological stability to 00:51:41.739 --> 00:51:44.840 ensure fetal stability. Telehealth is a valid 00:51:44.840 --> 00:51:47.460 ACOG endorsed tool for high -risk monitoring 00:51:47.460 --> 00:51:50.179 and the nurse's non -judgmental attitude directly 00:51:50.179 --> 00:51:53.119 impacts patient adherence and survival. We have 00:51:53.119 --> 00:51:55.460 covered a truly tremendous amount of ground today. 00:51:55.659 --> 00:51:57.980 We have waded deep into the muddy waters. We 00:51:57.980 --> 00:52:00.119 really have. We've gone from the cellular level 00:52:00.119 --> 00:52:03.039 of insulin resistance all the way to systemic 00:52:03.039 --> 00:52:05.599 telehealth protocols. Let's do a quick conversational 00:52:05.599 --> 00:52:07.699 summary to luck it all in for the listener before 00:52:07.699 --> 00:52:10.599 their exam. High blood pressure kinks the hose, 00:52:11.059 --> 00:52:13.519 damaging the placenta, leading to small babies 00:52:13.519 --> 00:52:16.179 and preeclampsia. And we are watching like hawks 00:52:16.179 --> 00:52:18.599 for headaches and vision changes. And high blood 00:52:18.599 --> 00:52:20.840 sugar acts like sludge, leading to big babies 00:52:20.840 --> 00:52:24.019 and polyhydramnios. But remember, the trap watch 00:52:24.019 --> 00:52:27.059 for severe neonatal hypoglycemia when that umbilical 00:52:27.059 --> 00:52:30.420 cord is cut and the sugar supply crashes. Toxoclasmosis 00:52:30.420 --> 00:52:33.019 hides in the litter box, listeria hides in cold 00:52:33.019 --> 00:52:35.579 deli meats, and hot tubs in the first trimester 00:52:35.579 --> 00:52:37.860 will halt the neural tube from closing. For the 00:52:37.860 --> 00:52:40.760 alphabet soup, CVS is done early and is diagnostic. 00:52:41.480 --> 00:52:44.519 AFP is merely a screening for neural tube defects, 00:52:44.800 --> 00:52:48.639 not a diagnosis. RHIG is for Rh negative mothers 00:52:48.639 --> 00:52:50.860 only, and it functions to protect their next 00:52:50.860 --> 00:52:53.780 baby from immune attack. Reactive NSTs mean the 00:52:53.780 --> 00:52:57.059 baby is autonomic and happy. Positive CSTs are 00:52:57.059 --> 00:52:59.059 terrible news. The baby is failing under the 00:52:59.059 --> 00:53:02.159 stress of contractions. Oligohydramnios leads 00:53:02.159 --> 00:53:04.989 to cord compression. Nitrazine paper turns blue 00:53:04.989 --> 00:53:07.530 for amniotic fluid. And severe itching on the 00:53:07.530 --> 00:53:09.949 palms without a rash means cholestasis, which 00:53:09.949 --> 00:53:12.130 requires immediate intervention. And through 00:53:12.130 --> 00:53:15.409 it all, always assess first. Mom's safety secures 00:53:15.409 --> 00:53:17.840 the baby's safety. As we wrap up this incredibly 00:53:17.840 --> 00:53:19.780 deep dive, I want to ask you for a final thought. 00:53:20.059 --> 00:53:22.860 We've talked so much about complex pathophysiology, 00:53:23.260 --> 00:53:25.920 fetal surveillance monitors, lab values, and 00:53:25.920 --> 00:53:28.260 diagnostic acronyms. We have. And as a future 00:53:28.260 --> 00:53:30.079 nurse, you need all of that science. But I want 00:53:30.079 --> 00:53:31.500 to leave you with a thought regarding the true 00:53:31.500 --> 00:53:33.880 art of obstetric nursing. We rely so heavily 00:53:33.880 --> 00:53:36.460 on ultrasounds to see the unseen inside the uterus. 00:53:36.880 --> 00:53:39.559 We rely on blood draws and amniocentesis to tell 00:53:39.559 --> 00:53:42.159 us the exact chemical and genetic balance. The 00:53:42.159 --> 00:53:44.579 technology is genuinely amazing. It is. It saves 00:53:44.579 --> 00:53:49.010 lives every day. It does, but never ever underestimate 00:53:49.010 --> 00:53:51.789 the diagnostic power of simply listening to a 00:53:51.789 --> 00:53:54.150 mother. When a pregnant client looks at you and 00:53:54.150 --> 00:53:56.409 says, something doesn't feel right, the baby 00:53:56.409 --> 00:53:59.389 feels different, or I just feel off. In a landscape 00:53:59.389 --> 00:54:02.010 of diagnostic muddy waters, a mother's intuition 00:54:02.010 --> 00:54:04.809 is often the very first and most accurate clinical 00:54:04.809 --> 00:54:07.750 cue we ever get. Long before the blood pressure 00:54:07.750 --> 00:54:10.369 spikes on the cuff, long before the electronic 00:54:10.369 --> 00:54:13.150 monitor shows a late deceleration, the mother 00:54:13.150 --> 00:54:16.010 often knows. So when that metaphorical x -ray 00:54:16.010 --> 00:54:19.050 machine is broken and the waters are murky, let 00:54:19.050 --> 00:54:21.170 the mother's voice be your compass. Listen to 00:54:21.170 --> 00:54:23.730 her. Exactly. Let her guide your assessment. 00:54:24.230 --> 00:54:26.610 To our listener, take a deep breath. You are 00:54:26.610 --> 00:54:28.829 not just memorizing flashcards. You are learning 00:54:28.829 --> 00:54:31.650 how to save lives. You have the tools. You understand 00:54:31.650 --> 00:54:33.869 the deep physiological patterns. And you are 00:54:33.869 --> 00:54:36.369 building razor sharp clinical judgment. You're 00:54:36.369 --> 00:54:38.769 going to absolutely crush your exams. And more 00:54:38.769 --> 00:54:40.190 importantly, you're going to be an incredibly 00:54:40.190 --> 00:54:42.170 safe, phenomenal future nurse.