Braxton Hicks Contraction, Edema, and Supine Hypotension (Nursing)

00:01 Braxton Hicks, we've talked about this a couple of times and Braxton Hicks are those contractions, it sort of like a warm-up for labor, so if you think about if you ever heard musicians play before they start, there's lots of noise and it sort of irregular, nothing sounds like it's particularly good, it's just noise, and that's what Braxton Hicks are, they're kind of like those warm up contractions, they're just all over the place, no real pattern.

00:25 They can start as early as six weeks but most pregnant patients really don't feel that.

00:30 They usually start to feel that in the second and third trimester.

00:34 Now our rule of thumb is that Braxton Hicks contractions don't really hurt, I don't find that always to be true.

00:40 I do find it's always something we say, but for some people, Braxton Hicks contractions are uncomfortable.

00:47 So we want to think about the physiology first which is that irregular uterine contraction are just part of the uterus stretching and growing, there's something in there that's not usually there, muscles respond by contracting.

00:58 We also know that Braxton Hicks don't lead to cervical change, so if you find that those contractions are becoming regular and stronger, remember our five-one-one rule, if it falls into that category at all, we need to make sure there is no sign of preterm labor, so the cervix is not changing, we don't have regular contractions.

01:20 Braxton Hicks are not regular and they're not usually painful.

01:25 We also want to make sure that there's not a urinary tract infection, because sometimes when you have an infection, then your uterus will begin to contract in response to that, not because of labor but just because of an infection so we want to rule that out.

01:39 How do we treat Braxton Hicks? Rest, doesn't always make it go away but it's definitely something that we talk about with the client and sometimes if you're having Braxton Hicks in relationship to maybe stress or not getting enough rest, this will calm things down enough to quiet the uterus.

01:57 Also teaching about what Braxton Hicks are because it can make you nervous if you're not used to feeling those contractions in your uterus all of a sudden, because even if it's not preterm labor, it might run through your mind and then make you stressed-out which will then make you have more contractions, so education is key.

02:14 Also increasing fluids because being dehydrated can also cause you to start to have contractions so having more fluids may help, so we increase that amount.

02:25 Thinking about edema, so edema would be swelling and we might experience this towards the third trimester and if we think about why and what's going on physiologically, it makes sense.

02:38 First of all our hormones can cause sodium retention but bigger than that, the weight of the fetus and that venous return can cause what we call dependent edema, so if you think about someone who wakes up in the morning and everything's great, but as they go through the day their ankles and their feet get puffier and puffier and by the end of the day they can't get their shoes on, that's dependent edema.

03:01 That's pretty common especially during a first pregnancy, not particularly unusual.

03:06 So when do we worry about it? Well, the weight of the fetus is really not significant in the first trimester, so if someone presents with edema in the first trimester, then your thought should go perhaps to an underlying cardiovascular issue and not pregnancy-related edema.

03:23 Also thinking about edema that's not dependent.

03:26 Remember I've described dependent edema, as you wake up in the morning and there's no swelling and over the period of the day you have swelling in your lower extremities.

03:35 What about swelling in your face? Or swelling in your fingers? That tends not to be dependent edema and is a little more ominous and it's worthy of a check to see if there's some other underlying disorder.

03:48 What do we do about it? We rest. Not just resting for the sake of resting, but resting on your side to increase cardiac output, to increase the flow so we can get rid of that extra fluid.

03:59 And getting rid of extra fluid requires fluid, you take more fluid to get more fluid out, it works that way, it really does.

04:06 It helps get the kidneys going and we can actually decrease the amount of edema.

04:11 We want to elevate the legs especially if we're talking about dependent edema, if we get the legs above the heart, so just propping them up is not enough, it got to be be above the level of the heart so that we can get the fluid to move back and out.

04:25 And also those good old compression hose will sometimes help with the edema as well.

04:29 It keeps the fluid moving and helps with that venous return.

04:33 Supine hypotension has many names.

04:37 Vena cava syndrome, supine hypotension, they are the same.

04:42 This tends to happen after 20 weeks.

04:45 Well, let's talk about what it is and this will make sense.

04:48 So, supine hypotension happens when a pregnant client is lying on their back and their gravid uterus is also lying on top of their vena cava.

04:58 Big uterus, vena cava running underneath, smash, smash, smash, well, when that happens the blood pressure goes down and the patient might begin to feel dizzy or light-headed or like they may need to vomit, these are all very common symptoms to this particular condition.

05:17 So, what we want to do is try to have the client lie in the left-lateral position or really the right-lateral would work or really semi-fowlers would work, really, any position except lying flat on your back.

05:31 So, if you were perhaps examining doing McDonald's procedure or Leopold, and the client starts to complain of feeling hot, or dizzy, or nauseous all of a sudden, then recognize that the cause may be the fact that you have them lying flat on their back and they may be experiencing supine hypotension or vena cava syndrome. Fancy term.