13. Pregnancy, Parturition and Delivery Flashcards
what does PRIMIPAROUS/PRIMIP mean
FIRST pregnancy
what does MULTIPAROUS/MULTIP mean
SUBSEQUENT pregnancy (not first)
what does GRAVIDITY refer to
the NUMBER OF TIMES been PREGNANT
what does PARITY refer to
the NUMBER of PREGNANCIES BEYOND 20 WEEKS
(could have miscarried,termination)
eg what would G3P1 mean
Gravidity 3 - pregnant for 3rd time
Parity - 1st time pregnant beyond 20 weeks
times for the 3 TRIMESTERS
1st trimester: UPTO 12 weeks
2nd trimester: 12-24 WEEKS
3rd trimester: OVER 24 WEEKS
when is referred to as TERM
37-40 WEEKS
when is PRETERM
BEFORE 37 WEEKS
when is POST TERM
AFTER 40 WEEKS
NHS aims to have all women delivered by … weeks
42 WEEKS
how to calculate an ESTIMATED DUE DATE (EDD)
LMP: date from LAST MENSTRUAL PERIOD
NOT conception
can subtract 3 months from LMP + 7 days
MORE ACCURATE way of calculating ESTIMATED DUE DATE
CRL - CROWN RUMP LENGTH
(from viability scan)
reliable +/- 7 days
other forms of calculating EDD
- TIMED COITUS (used for conception, can be very reliable)
- EMBRYO TRANSFER (IVF)
usually performed on day 3 or 5 of blastocyst development
approx how many women will deliver on DUE DATE
5%
(7-12% deliver preterm
10% beyond DD)
what is DUE DATE useful for
- REGULARISING PREGNANCY
- GUIDING INTERVENTION
MORNING SICKNESS is related to..
hCG LEVELS (PEAK)
nausea and vomiting common in 1st trimester
(50% or more women)
what is Hyperemesis Gravidarum
variant of MORNING SICKNESS
extreme nausea and vomiting
PHYSIOLOGICAL CHANGES of PREGNANCY on RESPIRATORY:
- INCREASED TIDAL VOLUME
- INCREASED RESPIRATORY RATE
- MILD RESPIRATORY ALKALOSIS (from high CO2)
- REDUCED MAX INSPIRATORY VOLUME in 3rd Trimester
(lead to hypoxia - low oxygen levels)
PHYSIOLOGICAL CHANGES of PREGNANCY on GASTROINTESTINAL:
- DELAYED GUT MOTILITY
- CONSTIPATION
- INCREASED ALKALINE PHOSPHATASE
PHYSIOLOGICAL CHANGES of PREGNANCY on
RENAL:
- 60% INCREASED BLOOD FLOW
- 50% INCREASED GFR
- LOW CREATININE & UREA
- minimal GLYCOSURIA is normal (glucose in urine, due to increased filtration and so less reabsorption)
- minimal PROTEINURIA, LESS than 30mg is NORMAL
PHYSIOLOGICAL CHANGES of PREGNANCY on SKELETAL:
- OSTEOPENIA (weaker bones, less proteins and minerals)
- INCREASED OSTEOBLAST ACTIVITY
PHYSIOLOGICAL CHANGES of PREGNANCY on
CARDIAC:
(early effect)
- INCREASED HEART RATE
- INCREASED STROKE VOLUME
- INCREASED CARDIAC OUTPUT
-INCREASED PLASMA VOLUME (by 15%)
- INCREASED TOTAL BLOOD VOLUME (by 1.5L)
- OVER 1L/min to uterus and placenta
PHYSIOLOGICAL CHANGES of PREGNANCY on
BLOOD:
- RED CELL MASS INCREASES
but FALL in HAEMOGLOBIN due to PERIPHERAL VASODILATION - FALL in Hct (HEMATOCRIT - percentage red blood cells), RCC (RED CELL COUNT)
Hb (HAEMOGLOBIN) - IRON DEFICIENCY is common
HORMONAL CHANGES of pregnancy:
- INCREASED PROGESTERONE
- INCREASED OESTROGEN
- RELAXIN
why is high PROGESTERONE important in PREGNANCY
- PROMOTES UTERINE QUIESCENCE (inactivity/ relaxation)
- THICKENS CERVICAL MUCUS
why is high OESTROGEN important in PREGNANCY
- CERVICAL DEVELOPMENT (cervical ectropian)
- THICKENS VAGINAL EPITHELIUM and INCREASED vaginal DISCHARGE (acidic)
- MYOMETRIAL HYPERTROPHY (increase muscle size)
- INCREASES PROSTAGLANDIN PRODUCTION and OXYTOCIN RECEPTORS
- INCREASE in MYOMETRIAL GAP JUNCTIONS for ELECTRICAL CONDUCTANCE
role of RELAXIN in PREGNANCY
- SOFTENS LIGAMENTS and JOINT INSTABILITY
(especially Pubic Symphysis) - VASODILATOR
what is their RISK of during PREGANCY due to HIGH OESTROGEN and PELVIC MASS
THROMBOSIS (blood clots block veins/arteries)
(addition 4-6x increase, 22x higher postpartum)
Treatment:
can be given Prophylactic LMWH (low molacular weight Heparin) (does not cross placenta so safe)
Investigations:
- D-dimer
- USS leg Doppler
- VQ
- CT
THROMBOSIS RISK during PREGNANCY is due to..
- HIGH OESTROGEN
- PELVIC MASS
TREATMENT for THROMBOSIS (safe in pregnancy)
PROPHYLACTIC LMWH
(HEPARIN)
does not cross placenta
when LABOUR STARTS what happens
- REGULAR PAINFUL UTERINE CONTRACTIONS (more than 1 every 10 minutes)
- DESCENT of PRESENTING part of FETUS
- CERVICAL DILATION and EFFACEMENT (thins out)
- RELEASE of MUCUS PLUG
what causes the smooth muscle CONTRACTIONS
OXYTOCIN RECEPTOR for intracellular promotion of CALCIUM CHANNEL
- CALCIUM INFLUX and intracellular release causes smooth muscle contraction
(Repeated and prolonged exposure of myometrium to oxytocin may lead to reduced response)
what are critical for smooth muscle CONTRACTIONS in labour
OXYTOCIN RECEPTORS
- CALCIUM INFLUX
what is the 1st STAGE of LABOUR
from ONSET of labour to FULL DILATATION (10cm)
- LATENT PHASE - up to 3cm
- ACTICE PHASE - from 3cm to 10cm
what is 2nd STAGE of LABOUR
from FULL DILATATION to DELIVERY of fetus
what is 3rd STAGE of LABOUR
from BIRTH of fetus to DELIVERY of PLACENTA
which STAGE of LABOUR is usually LONGER
1ST
average 8 hours (usually less than 18)
SUBSEQUENT LABOURS average length
5 hour active 1st stage
usually less than 12 hours
ACTIVE PHASE average length in LABOUR
Primip: 1cm every 2 hours
Multip: >1cm every 2 hours
what is CERVICAL EFFACEMENT
softness
- INFLUX of WATER into cervix to DISRUPT COLLAGEN FIBRES
thins
what is DILATION
OPENING of the CERVIX
what is checked in VAGINAL/CERVICAL ASSESSMENT
- EFFACEMENT
- DILATION
- POSITION of FETAL HEAD
What is the Quantitative Tool from Cervical ASSESSMENT used to assess favourability for labour (used for induction of labour)
BISHOP SCORE
(More than 6 then favourable for labour)
what happens to FETUS during LABOUR (steps)
- ENGAGEMENT
Presenting part enters PELVIS - DESCENT
presenting part moves down BIRTH CANAL - FLEXION
of fetal HEAD to NARROW DIAMETER - INTERNAL ROTATION
HEAD rotates to direct OA (OCCIPUT ANTERIOR) - EXTENSION
CROWNING - EXTERNAL ROTATION
to allow shoulders to pass through pelvic inlet
BIRTH consists of 3:
POWER
(uterine, anterior abdominal wall and diaphragm muscle contractions)
PASSAGE
(birth canal, pelvic inlet, pelvic cavity, pelvic outlet)
PASSENGER
(fetus, presentation and position)
how long is the THIRD STAGE of LABOUR usually (from delivery of baby to delivery of Placenta)
usually 30 MINUTES
During pregnancy and After BIRTH what does OESTROGEN PROMOTE
FAT DEPOSITION and development of GLANDULAR DUCTS in BREAST DEVELOPMENT
during pregnancy and after birth what do PROGESTERONE and hPL INCREASE for BREAST DEVELOPMENT
ALVEOLI in BREASTS
what hormone INCREASES in PREGNANCY and promotes breast development but is ANTAGONISED by OESTROGEN
PROLACTIN
PROLACTIN is ANTAGONISED (inhibition) by..
OESTROGEN
what happens to OESTROGEN levels at BIRTH
RAPID FALL
(removes inhibition to Prolactin)
what does SUCKLING on breast stimulate release of
PROLACTIN & OXYTOCIN
what does PROLACTIN PROMOTE
BREAST ENGORGEMENT
- ALVEOLI FILL with milk
what does OXYTOCIN cause in breasts
MILK EJECTION
how does OXYTOCIN cause MILK EJECTION
causes CONTRACTION of MYOEPITHELIAL CELLS AROUND ALVEOLI
BENEFITS of BREAST FEEDING
- BONDING
- good NUTRITION
- PASSIVE IMMUNTIY (less asthma and infections)
- LESS DIABETES
- LESS SIDS
what do you get BEFORE BREAST MILK comes in
COLOSTRUM
- thick
- yellow
- rich in Immunoglobulins
POSTPARTUM RISKS
- THROMBOSIS
- INFECTION
- CONTRACEPTION (periods usually commence after 6 weeks)
- BLEEDING
- VAGINAL SORENESS
- BLADDER weakness
PSYCHOLOGICAL WELLBEING after birth
- immediate feelings
- Baby Blues (3-10 days after)
- POSTNATAL DEPRESSION
- PUERPERAL PSYCHOSIS
PSYCHOLOGICAL WELLBEING after birth
- immediate feelings
- Baby Blues (3-10 days after)
- POSTNATAL DEPRESSION
- PUERPERAL PSYCHOSIS
when do PERIODS usually RECOMMENCE after birth
after 6 WEEKS
during 3rd stage labour (birth to placenta delivery) active management CORD TRACTION REDUCES RISK of..
Haemorrhage
