Exam revision Flashcards
1
Q
hCG produced by
A
trophoblast + placental syncytiotrophoblast cells
2
Q
hCG effect
A
promotes maintainance of corpus luteum, and stimulate corpus luteum to produce Progesterone (and Oestrogen)
3
Q
hPL produced by
A
placental syncytiotrophoblast cells
4
Q
hPL effect
A
prepares body for breastfeeding and increases maternal insulin sensitivity, acts as insulin antagonist maximising nutrients to fetus, mobilises fat stores and accelarates amino acid transfer
5
Q
Oestrogen produced by
A
Ovaries, corpus luteum and placenta
6
Q
Oestrogen effect
A
facilitates growth of placenta and fetus. supports thickening of endometrial lining. soften connective tissue. Increases maternal sensitivity to CO2
7
Q
Progesterone produced by
A
Corpus Luteum and the placenta
8
Q
Progesterone effect
A
Supports early placental development. Provides ideal environment for implantation and pregnancy. Relaxes uterine muscles. Helps maternal body tolerate foreign DNA. Increases cervical mucous and BBT
9
Q
Nausea cause
A
? Oestrogen and hCG
10
Q
Nausea help
A
discontinuing, changing time of iron containing supplements. increase fluids. small frequent meals. increase protein intake. Ginger. P6 accupressure. Antihistamines. B12 supplement. Anti emetics.
11
Q
Tiredness cause
A
hormonal changes, increased BV, decreased BP and BGLs, nutrients diverting to fetus
12
Q
Tiredness help
A
Rest, diet, exercise, adjust schedule/workload
13
Q
Constipation cause
A
Progesterone relaxes intenstinal muscles, slows digestion, lack of fluid and fibre
14
Q
Constipation help
A
Increase fluid, increase fibre, stool softeners, laxatives
15
Q
Reflux cause
A
increase in progesterone, pressure on stomach in later pregnancy
16
Q
Reflux help
A
antacids, proton pump inhibitors, h2 blockers, sleep on left side, not lying down after eating
17
Q
carpal tunnel syndrome cause
A
increase in blood volume, oedema causes compression of median nerve
18
Q
carpal tunnel syndrome help
A
usually resolves after birth, avoid movements that exacerbate, wrist splint
19
Q
varicose veins cause
A
increase in blood volume, enlarges veins bc increase venous pressure causes pooling of blood in veins
20
Q
varicose veins help
A
avoid standing for long periods, compression garments
21
Q
Leg cramps cause
A
decrease in magnesium, vitamins and minerals, increase in blood volume and slowing of circulation
22
Q
leg cramps help
A
massage, rest, heat, ice, epsom salt baths
23
Q
morning sickness cause
A
increase in hCG and Oestrogen
24
Q
morning sickness help
A
smaller, frequent meals
increase fluid intake
discontinue or take prenatals later in the day
ginger
p6 accupressure
pyridoxine (b12) supplement
25
Placenta functions
gas and nutrient exchange (o2, nutrients, glucose, antibodies to fetus. co2, waste away from fetus)
hormone synthesis (hCL, hPL, progesterone, oestrogen)
Selective barrier, immunoligical protection
metabolism
26
How does nutrient and gas exchange occur in placenta without fetal and maternal blood mixing?
seperate fetal and maternal blood vessels that do not touch but are clos enough together to facilitate diffusion in intervillous space
27
When is the placenta fully functional?
8-10 weeks
28
Amniotic Fluid Functions
protects fetus and facilitates free movement
temperature regulation
immunological role (contains antibodies)
umbilical cord support
lubrication
29
Amniotic fluid composition
98-99% water
1-2% solids (lanugo, skin cells, vernix) proteins, glucose, urea, NPN, uric acid, lipids, hormones, Na, Cl, K
30
Formation of amniotic fluid
during embryonic period: formed from fluid in maternal blood, coelemic fluid and fluid from amniotic cavity. Towards end of gestation produced almost entirely by fetal urine and lung secretions
31
Fetal development weeks 9-12
-eyes can close
-sex distinguishable
-RBC produces in liver
-Urine excreted in amniotic fluid
32
Fetal development weeks 13-16
-head proportionally smaller
-ossification of skeletal system begins
-eyes face anteriorly not laterally
-ovaries differentiate with primordial follicles present (oogonia)
33
Fetal development weeks 17-20
-growth slows
-brown fat formation
-quickening felt
-uterus fully formed
-vagina begins to develop
-lower limbs reach final proportion
34
Fetal development weeks 21-25
-substantial weight gain
-secretion of surfactant in lungs
immature respiratory system
-body more proportionate
35
Fetal development weeks 26-29
-lungs developed
-CNS can direct breathing
-RBC produced in bone marrow
-by 28 weeks testes begin descent
36
Fetal development weeks 30-34
Pupils react to light
white fat 8% of body weight
37
Fetal development weeks 35-38
Firm grip
circumference of head and abdomen equal
White fat 16% of body weight
38
At what gestation can fetus open it's eyes
approx 27 weeks
39
Surfactant function
lines alveoli to lower surface tension and prevent alveolar collapse
40
Surfactant production
begins at 24-28 weeks gestation, adequate levels around 35-36 weeks gestation
41
Define Blastocyst
distinctive embryonic stage
approx 5 days post fertilization
where a trophoblast, blastocyst cavity and inner cell mass have formed. Blastocysts are able to implant.
42
Define Lanugo
fine, soft, downy hair
appears 16 weeks gestation, abundant by 20 weeks, sheds approx 7-8 months gestation
43
Define brown fat
brown adipose tissue responsible for producing heat to warm the body
44
Brown fat grown by
Maternal glucose
45
Define Vernix
waxy 'cheese-like' substance on fetal skin. antimicrobial properties and aids in thermoregulation.
46
Vernix composition
Sebum, 80% water, 10% lipids, 10% proteins
47
Define Teratogen
any substance that can cause harm or abnormalities in a developing embryo or fetus
48
Define Chorion
outer membrane of embryonic sac, maternal 'side of membrane' attached to decidua
49
Chorion formed from
trophoblastic ectoderm and embryonic mesoderm
50
Define Amnion
inner membrane of amniotic sac, fetal 'side of membrane'
51
Amnion formed from
embryonic ectoderm
52
Define Ovulation
Rupturing of vesicular follicle, release of secondary oocyte at day 14 of menstrual cycle
53
What triggers ovulation
LH surge, rise and fall of oestrogen
54
Define fertilisation
process by which sperm meets ovum and forms a zygote
55
Define implantation
process by which a blastocyst attaches to the endometrial surface of the uterus, invades the epithelium and begins the formation of fetal and maternal sides of the placenta
56
Define cleavage
process by which mitotic divisions increase number of blastomeres of a zygote
57
How does fetal circulation differ from maternal circulation?
diverts majority of blood AWAY from lungs and TO the heart as oxygen needs are met via circulation not respiration
diverts around liver
5 adjustments:
umbillical vein, 2 umbillical arteries, ductus arteriosus, ductus venosus, foramen ovale
58
Define Ductus venosus
low resistance shunt that allows blood flow to bypass the liver, connecting umbilical vein to inferior vena cava
59
Define Ductus arteriosis
short vessel connecting fetal pulmonary artery to the aorta allowing blood to bypass pulmonary circulation and enter system circulation
60
Define Foramen Ovale
Opening in the septum between the right and left atria allowing blood to bypass pulmonary circulation
61
Define umbilical artery
carries deoxygenated blood from fetal circulation to placenta (2)
62
Define umbilical vein
carries oxygenated blood from placenta to fetal circulation (1)
63
How to calculate EDB based off LMP
EBD=LMP + 9 months and 7 days
64
Role of folic acid
Prevention of Neural tube defects
65
Recommended folic acid dose
0.5mgs
66
When to take folic acid
1 month preconception - 12 weeks gestation (after NT fully developed)
67
Food storage
Ensure fridge temperature <5C, leftovers consumed within 24 hrs after being reheated until steaming
68
Sexual activity during pregnancy
Is safe. Practice safe(r) sex to reduce risk of STI transmission. Penetrative sex after ROM poses infection risk.
69
Exercise recommendation
Low to moderate exercise recommended, be mindful of injury risk
70
Role of iron
Iron is part of hemoglobin in a RBC, which carries the oxygen in the blood.
Increased demand for oxygen for uterus and fetus and increased blood volume= increased demand for iron.
71
What foods should be avoided
-soft cheeses, raw and cured meats (listeria)
-mindful of fish and canned fish intake (mercury)
-raw chicken, runny eggs, mayonnaise (salmonella)
72
Normal Blood Pressure changes related to pregnancy
BP may fall in 1st trimester
rising from 28 weeks to reach pre-conception levels by term
73
Why is BP recorded during pregnancy?
High BP can indicate pre-eclampsia
Low BP may indicate maternal illness
74
What position should BP be taken
seated, feat supported, semi-recumbent
75
Complete Blood Picture screens
WBC, RBC & Platelets, haemoglobin concentration and hematocrit
76
CBP may indicate
underlying medical conditions or pregnancy complications
77
Blood group and antibody screening
indicates blood group and rhesus factor/antibody status
78
Blood group and screening importance
Determining Rh incompatibility important to avoid heomolytic disease in newborn
79
Rubella screening
checks for Rubella antibodies (iGg)
If the woman has the antibodies, she is Rubella immune and some antibodies will be passed onto fetus.
If Rubella non-immune, recommend vaccine for mother after birth
If a woman gets Rubella during pregnancy, there is an increased risk of birth defects (congenital rubella syndrome), stillbirth, miscarriage and preterm birth.
80
Rubella screening importance
Rubella infection in 1st trimester carries high risk of congenital abnormalities
81
Syphilis screening
diagnoses syphilis
82
Syphilis screening importance
without treatment can cause adverse pregnancy outcomes, IUFD, neonatal death, premature and low birth weight and neonatal syphilis infection
83
Hepatitis B screening
diagnoses Hep B
84
Heb B screening importance
serious infection with high risk of transmission to neonates without treatment (>90%). Neonatal Hep B can be catastrophic in newborns.
85
Hepatitis C screening
diagnoses Hep C
86
Hep C screening importance
(5-15% transmission to neonates) infants may recover from infection but may require medical treatment and experience adverse outcomes
87
HIV test
diagnoses HIV
88
HIV test importance
Without treatment 25-30% risk of transmission to fetus. HIV is treatable but not curable.
89
Rh incompatibility risk
Rh incompatability can cause maternal immune response resulting in maternal cells attacking fetal cells, potentially resulting in HDFN.
90
Anti D prophylaxis
prevents body from entering immune response
91
Anti D when
28 and 34 weeks
and at birth if baby is rhesus positive
92
Anti D benefits
greatly reduces risk of immune response and HDFN
93
Anti D risks/considerations
Anti D is a blood product, tiny potential for allergic reaction
94
Urine screening test
MSSU, presence of blood, proteins and infections, urine pH
95
Urinalysis importance
detection of kidney problems, UTI/bladder/kidney infections, diagnosis of pre-eclampsia
96
2 main aims of abdominal assessment
1. Assess fetal growth
2. Locate fetal position
97
Indications for abdominal assessment
assess fetal positioning and growth non-invasively from 24 weeks gestation
in labour 4 hourly and before every VE
98
Contraindications for abdominal assessment
Non-consent, history of antepartum haemorrhage, severe abdominal pain, preterm labour
99
What are you looking for visual abdominal assessment
bruises, scars, rashes, skin conditions, hernia, linea negra, size, shape
100
When you palpate abdomen what are you feeling for
fundus, lie, presentation, position, fetal anatomy, fetal poles, 5ths above brim, fetal movements, AFV, tone
101
Where is best place to auscultate fetal heart rate
fetal anterior shoulder/chest
102
Normal FHR range
110-160bpm
103
What information do you record abdominal assessment
visual inspection, lie, presentation, position, descent, FHR, fetal movements, midwifery management, AFV
104
Define Lie
Relationship between long axis of uterus and long axis of fetus
105
Lie type
longditudinal, oblique, transverse
106
Define presentation
what part of the fetus is presented to the cervix/birth canal
107
Presentation types
when cephalic- vertex, brow, face
108
Define Position
Relationship betwen presenting part and the pelvic outlet
109
Position types
Right, Left, Anterior, Posterior, Lateral
ROA,LOA,ROP,LOP,ROT,
LOT, OP, OA
110
Define descent
engagement of presenting part in pelvis, measured in 5ths above pelvic brim
111
Two main purposes of vaginal examination
Locate fetal position and presenting part
Assess cervical dilation/effacement
112
Contraindications of VE
non-consent, antepartum haemorrhage, placenta previa, vaginal infection or UTI, pre term ROM
113
Define effacement
length of cervix- refers to thinning and shortening of cervix
114
Define dilation
opening of cervix during labour, 0-10cm
115
Define ischial spines
part of the posterior body of the ischium bone of the pelvis, palpable as 'pointy' notches during VE
116
When is morphology ultrasound performed
18-20 weeks
117
Purpose of morphology ultrasound
assess fetal and placental anatomy, placenta position, and maternal pelvic organs, cervix, amniotic fluid
118
Accuracy of US in dating
highly accurate in early and mid pregnancy, more variability +-7 days in 3rd trimester
119
Factors that affect US accuracy
gestational age, sonographer experience, fetal position, variation in maternal anatomy
120
Common anomalies identified during morphology US
spina bifida, anacephaly, hyrdocephaus, heart defects, limb abscence and limb difference, diaphragmatic hernia, gasrtochisis, major kidney problems
121
what is the cFTS
maternal serum screening of hCG and PAPP-A and US of FNT
122
what does cFTS screen for
T18, T21, T13
123
benefits of cFTS
screens for chromosomal abnormalities
124
risks of cFTS
potential increase for intervention and medical coercion, blood test poses minor infection risk
125
what is the STS
maternal serum screening of alpha fetoprotein, B-hCG, estradoil +- inhibin A
126
What does STS screen for
T21, T18 and NTD
127
benefits of STS:
screens for chromosomal abnormality
128
risks of STS
inaccurate in multiple pregnancy, less accurate than cFTS, potential for increased intervention and medical coercion, small infection risk from blood test
129
when is cFTS performed
11-13+6 weeks
130
When is STS performed
14-20 weeks (most accurate at 16 weeks)
131
What is CVS
sampling of placental tissues taken via needle under US guidance through abdomen of cervix
132
When is CVS performed
11-14 weeks
133
CVS accuracy
98-99%
134
Risks of CVS
singleton pregnancy 1-2% risk of pregnancy loss, multiple pregnancy 3-4% risk of pregnancy loss, 1/3 chance of bleeding
135
What is Amniocentesis
sampling of amniotic fluid taken under US guidance through abdomen
136
When is AC performed
15+ weeks
137
Accuracy of AC
99-100% accurate
138
RIsks of AC
singleton pregnancy 0.5-1% chance of pregnancy lsos, multiple pregnancy 3% risk of pregnancy lose
2.6% risk of fetomaternal haemorrhage
1% risk of fetal injury
139
Occurance rate of GDM
2-9% of pregnancy
140
When is OGTT performed
24-28 weeks gestation
141
What does OGTT involve
fasting blood test, consume glucose rich fluid, blood test at 1 hr, blood test at 2 hr
142
Normal OGTT range
Fasting: <5.1
1 hr: <10.0
2 hr: <8.5
143
OGTT risk
failed OGTT, nausea, vomiting, fainting, blood test small infection risk, risk of increased intervention and coercion if + GDM
144
What is GBS
Group B strep is a bacteria naturally present in a woman's vagina (about 20-40% have it present). GBS does not cause any illness for the woman but it can make 1% of babies of mothers colonised with GBS become infected at time of birth, causing sepsis, pneumonia or meningitis.
145
What does GBS swab involve
(usually) self-performed swab of vagina and rectum
146
When is GBS swab taken
36 weeks
147
Treatment of GBS+
antibiotics administered during and after labour
148
Risk of GBS infection to neonate
0.02% chance of GBS transmission, 5% mortality rate in infected infants
149
Myometrial activation
myometrial cells undergo changes, increase in electrical activity, increase in responsiveness, increase in ion channels that faciliatte myometrial contractability
150
Cause of cervical ripening
Hormones Prostaglandin (and oestrogen and progesterone) and relaxin.
Macrophages and lymphocytes trigger release of proteolytic enymes that breakdown collagen fibres
151
Hormones influencing cervical ripening
Prostoglandins and Relaxin
152
General hormonal adaptations onset of labour
increase in hormone synthesis, increase in receptors at target sites, increase in plactental uterotonic hormones, decrease in hormone binding proteins
153
CRH onset of labour
CRH increases rapidly from 35 weeks under influence of oestrogen
154
CRH stimulates
fetal cortisol and placental oestriol
155
Fetal cortisol onset of labour
Increases triggering increase in prostoglandins and oxytocin synthesis
156
Prostoglandins onset of labour
responsible for uterine contraction, role in cervical effacement and dilation
157
Relaxin onset of labour
role in cervical ripening
158
Oxytocin onset of labour
stimulates uterine contractions
159
Oxytocin receptors
increase in decidua 300X over preganncy
160
Oestrogen onset of labour
Increase from 34 weeks, increases sensitivity of oxytocin receptors, promotes prostoglandin synthesis, facilitates myometrial contractability
161
Progesterone onset of labour
suppresses uterine excitability, levels don't decrease but available receptors decrease
162
Mild contraction
<20 seconds, uterus becomes somewhat firm but can be indented by gentle pressure
163
Moderate contraction
20-40 seconds, requires firmer pressure to indent
164
Strong contraction
40-60+ seconds, uterus 'wood-like' hardness, at height of contraction cannot be indented
165
Vaginal examination indications
locate fetal position, assess cervical dilation, determine presenting part, diagnose cord prolapse, at maternal request, perform AROM, apply fetal scalp electrode, augmentation or induction of labour
166
VE visual assessment
signs of infection, FGM, anatomical anamoly/abnormality, varicose veins, labial or perineal trauma, dischare, bleeding, AF loss
167
VE internal assessment
vaginal health, rectal fullness, cervical dilation, effacement, consistency, fetal position and application of presenting part, descent per ischial spines, membranes (ruptured or intact), fetal sutures, pelvic outlet
168
Define intermittent auscultation
listening and counting FHR for short periods of time throughout labour, usually with a doppler or pinnards
169
How long should FHR be listened to
1 minute
170
What information needs to be gathered for hospital admission
frequency, duration and strength of contractions, PV loss (mucous plug, liqour, blood, discharge), gravidum and parity, gestation, pain level and tolerance, relevent dx and pregnancy history, cervical dilation at last check (if known)
171
Normal maternal BP
110-140/60-80mmHg
172
Normal range maternal HR
60-100bpm
173
Normal range maternal temperature
36.5-37.5C, 35-38C during labour
174
Normal range respiratory rate
12-20bpm
175
PPG midwifery practices for admission
abdominal assesment (lie, position, engagement, presentation, contractions)
maternal observations (HR, BP, RR, T, SpO2)
Vaginal examination (cervical consistency, effacement and dilation, application of PP, descent, membrane status, PV loss)
Fetal wellbeing (FHR, fetal movements)
176
During labour frequency of maternal pulse
with every FHR
177
During labour frequency of maternal temperature
every 4 hours, hourly if hypo or hyperthemic
178
During labour frequency of maternal respiratory rate
every 4 hours, every hour during active labour
179
During labour frequency of maternal BP
latent: every 4 hours, active: hourly
180
During labour frequency of urination
every 2 hours
181
During labour frequency of PV loss check
hourly
182
During labour frequency of abdominal palpation
every 2 hours, prior to every VE
183
During labour frequency of VE
4 hourly and if clinically indicated
184
N2O2 route
inhaled
185
Onset and duration of N2O2
felt within 15 seconds, cleared from maternal system within 5 minutes
186
Benefits of N202
almost instant relief, doesn't effect mobility, cleared from system rapidly, no noted effect on fetus and exits fetal system rapidly
187
Risks of N2O2
May increase HR and decrease RR, may cause nausea, vomiting and vertigo
188
Fentanyl route
subcutaneous (recommended) and IV
189
Onset and duration of fentanyl
15 minute onset, lasts 1-2 hours
190
Risks of fentanyl
respiratory depression, pruritis (itching), nausea and vomiting, crosses placenta rapidly and is present in breastmilk, associated with decrease in infant suckling and breastfeeding difficulties, may lower APGAR scores particularly lower neonatal HR
191
Epidural what is it and route
combination of local anaesthetic and opiods administered via catheter into the epidural space
192
Epidural effect
blocks transmission via the spinal nerves causing lack of sensation below epidural catheter
193
Epidural risks
-requires CTG monitoring
-limits maternal mobility
-decreases maternal sensation and 'urge to push'
-maternal hypotension
-increased rate of instrumental birth
-increased length of 2nd stage and use of oxytocin
-1/100 dural puncture
-1/1000 nerve damage
-effect on fetomaternal attachment and attunement due to reduced maternal mobility postnatally
194
Common signs of transition
anal cleft line, dilation and gaping of anus, appearance of PP, increase in intensity, guttual sounds, maternal sense of "I can't do this"
195
Recommendations to help reduce perineal trauma
-hands off/hands poised technique
-warm perineal pack
-maternal lead pushing
-allowing time for slow controlled perineal stretching
-birthing in an upright or semi-recumbent position
-digital antenatal perineal massage
196
Define descent
descent of PP through pelvis, measured in relation to anatomical marker of pelvis
197
Flexion
Chin to chest
Pressure on fetal spine causes flexion of head leading to occiputal presentation (smallest part of fetal head)
198
Internal rotation of the head
fetal head aligns with anteroposterior diameter of pelvic outlet and moves occiput to lie under the symphisis pubis
199
Crowning
fetal head emerges under pubic arch and pushes and present against the vaginal orifice and is able to be visually identified
200
Extension
occiput moves from beneath the pubic arch, pushes against pelvic orifice and pivots on the subocciputal region around the pubic bone
201
Restitution
After the birth of the head, the head returns to alignment with the shoulders
202
Internal rotation of the shoulders
Shoulders turn to fit the widest diameter of the pelvis. Anterior shoulder rotates forward to lie under symphysis pubis, posterior shoulder passes over perineum
203
Lateral flexion
Fetal spine undergoes lateral flexion to accommodate the curved birth canal
204
First degree perineal tear
tearing of skin only
205
Second degree perineal tear
tearing of perineal muscles
206
Third degree perineal tear
partial or complete disruption of the anal sphincter
207
Fourth degree perineal tear
complete disruption of the internal and external anal sphincter including rectal mucousa
208
Implications of perineal trauma
urinary and fetal incontinence, pain, sexual discomfort and dysfunction, lower levels of vaginal lubrication, arousal and frequency of orgasm
209
Management of perineal trauma 24-48hrs
Ice to reduce oedema 10-20min intervals, avoiding upright position, panadol and ibuprofen, wound support during coughing and defecation, avoiding constipation, wash and pat dry after toileting, frequent showers and pad changes
210
HIPPS
Hygeine, Ice, Pelvic floor exercises, Pain relief, Support
211
Neonatal respiratory adaptation following birth
first breath triggered by too much CO2 and first lung expansion, RR increased to 40-60bpm, lungs fluid expelled through upper airway or absorbed by temporarily permeable epithelium.
212
Absorption/expulsion of lung fluid 1st 24 hrs
80% absorption by 2hrs, 100% absorption by 12-24hrs
213
neonatal cardiovascular transition following birth
closure of foramen ovale and ductus arteriosis by 24 hrs. adjustment in blood flow so deoxygenated blood flows to lungs due to decrease in pulmonary vascular resistance
214
neonatal temperature regulation
reliant on maternal contact for thermoregulation, by 24-38 hours infants are able to increase heat production up to 2.5x in response to cold
215
What is optimal/delayed cord clamping
clamping >1 min after birth of placenta or until cord stops pulsating
216
benefits of optimal cord clamping
increase in haemoglobin concentration and iron stores, higher birth weight, potential improvement in brain mylenation
217
Process of active management of placental birth
Administer oxytocic after birth of neonate
Clamp and cut cord
Feel for uterine contraction
apply CCT with counter pressure to the uterus above symphysis pubis
apply sustained downwards pressure until uterus is visible
gradually apply upwards traction to follow curve of birth canal
twist placenta an dmembranes as the appear
palpate uterus to ensure contracyion
218
Process/considerations physiological birth of placenta
wait for signs of seperation
continuosly observe blood loss
encourage comfortable upright position
encourage woman to push placenta out
clamp and cut cord after pulsation ceases
palpate uterus to ensure contractio n
219
Steps of checking placenta
check that seperation has occured completely
check for abnormalities
condition of placenta and membranes
count cotyledons (15-20), check for presence of extra/succenturiate lobes
seperate chorion and amnion to ensure 2 membranes
determine site of cord implantation
check for 3 cord vessels
measure diameter
weigh
220
Central cord insertion
centre of placenta
221
Eccentric cord insertion
>2cm from placental margin
222
Battledore cord insertion
<2cm from placental margin
223
Velamentous cord insertion
insertion into fetal membranes
224
Mean placental diameter
22cm
225
what covers fetal surface of placenta
amnion and chorionic plate
226
How many cotyledons
15-20
227
Implications of incomplete placenta
PPH, infection, need for manual or surgical removal of remaining placental tissue
228
Normal post partum blood loss
500mL after vaginal birth, 1000mL after LUSCS
229
Benefits of skin to skin
forms attatchment and attunement
big factor in successful initiation of breastfeeding
neonatal thermoregulation
biggest factor in infant environmental adjusment
facilitates neonatal metabolic changes
230
what does APGAR stand for
Appearance, Pulse, Grimace, Activity, Respiratory effort
231
Heart Rate APGAR 0
No pulse
232
Heart Rate APGAR 1
below 110bpm
233
Heart Rate APGAR 2
above 100bpm
234
Respiratory Effort APGAR 0
Absent
235
Respiratory Effort APGAR 1
gasping, irregular
236
Respiratory Effort APGAR 2
good, crying, 40-60bpm
237
Muscle Tone APGAR 0
no movement
238
Muscle Tone APGAR 1
arms and legs flexed
239
Muscle Tone APGAR 2
spontaneous activity
240
Grimace APGAR 0
absent
241
Grimace APGAR 1
minimal response to stimulation
242
GRIMACE APGAR 2
cough, sneeze, cry
prompt response to stimulation
243
Colour APGAR 0
cyanotic or pale all over
244
Colour APGAR 1
blue/pale extremities, well perfused trunk
245
Colour APGAR 2
well perfused all over
246
Postnatal hormonal changes
removal of placental hormones: hCG, hPL, oestrogens and progesterone
247
Postpartum uterus change
uterus contracts and returns to prepartum size
cellular barrier formed at placental site, decidua regeneration complete 6-7weeks postpartum
248
Average blood loss in following weeks post partum
150-400mL pv blood loss
249
Post partum oxygen consumption
returns to pre partum levels
250
Post partum gastrointestinal function
increases as progesterone levels drp
251
Prolactin triggers
Lactogenesis
252
Successful breastfeeding ONE
Hospital Policy
253
Successful breastfeeding TWO
Staff Competency
254
Successful breastfeeding THREE
Antenatal care
255
Successful breastfeeding FOUR
Care right after birth
256
Successful breastfeeding FIVE
Support mothers with breastfeeding
257
Successful breastfeeding SIX
Supplementing
258
Successful breastfeeding SEVEN
Rooming in
259
Successful breastfeeding EIGHT
Responsive feeding
260
Successful breastfeeding NINE
Bottles, teats and pacifiers
261
Successful breastfeeding TEN
Discharge
262
Define mammogenesis
breast formatio: occurs during embryonic and fetal life, development accelerated during puberty and then steadily throughout pregnancy
263
Lactogenesis I
SECRETORY DIFFERENTIATION
begins 16 weeks gestation-2/3 days postpartum mammary gland development acceleration, colostrum moves from cell membrane to ductules
264
Hormones influencing lactogenesis I
hPL, progesterone, prolactin
265
Lactogenesis II
SECRETORY ACTIVATION
2-3>8 days post partum
Increase in milk production, decrease in sodium, chloride and proteins, increase in lactose and milk lipids
266
Hormones influencing lactogenesis II
rapid drop in progesterone and presence of prolactin
267
Lactogenesis III
GALACTOPOESIS
day 9- 6 weeks post partum
production and maintainance of mature breast milk
268
Lactogenesis III caused by
repeated breast milk removal
269
Weaning
cessation of breastfeeding, breastmilk becomes similar to colostrum, secretory deactivation of mammary gland
270
Prolactin role in milk release and synthesis
levels follow circadian rythym, highest at night, more often infant feeds, higher levels of circulating prolactin
271
Oxytocin role in milk release and synthesis
released in response to suckling and triggers milk ejection reflex
272
5 fetal benefits breastfeeding
1. reduced risk of SIDS
2. immunological protection
3. reduced risk of obesity and DM over lifetime
4. facilitates gut colonisation
5. fulfils all infant nutritional needs
273
5 maternal benefits breastfeeding
1. supports attachment and attunement
2.Promotes post partum recovery, uterine contraction
3. Reduces risk of PPH and post partum depression
4.Reduces risk of breast, ovarian and uterine cancer
5. reduces risk of stroke, T2DM and heart disease
274
infant breastfeeding cues
rooting, sticking tongue out, hand to mouth, fussing, suckling, increased physical movement, agitation, crying
275
Foremilk
milk ejected at the beginning of feed, lower in fat content
276
Hindmilk
milk ejected at the end of a feed, higher in fat content
277
4 ways infants can lose heat
Evaporation
Conduction
Convection
Radiation
278
Evaporation
when fluid evaporates from wet skin
279
Conduction
when skin comes into conduct with cold surface
280
Radiation
heat is radiated to cooler objects where there is no skin contact
281
Convection
when surrounding air is cooler than infant
282
Number 1 way to prevent infant heat loss
skin to skin
283
strategies to prevent infant heat loss
immediate drying, skin to skin, cover body, beanie/hat, postpone bathing, maintain warm environment
284
APGAR normal range at 5 minutes
>7
285
Neonatal Temperature normal range
36.5-37.5C
286
Erythmea Toxicum Neonatum appearance
red flat patches, papules and pustules on face trunk and limbs
287
Erythmea Toxicum Neonatum incidence
50% of full term infants
288
Erythmea Toxicum Neonatum treatment
will spontaneously resolve within weeks
289
Neonatal Milia appearance
tiny white bumps just under skin surface, common on nose, inside of mouth, scalp, face and upper trunk
290
Neonatal Milia incidence
40-50% of term infants
291
Neonatal Milia treatment
will resolve spontaneously within weeks
292
Milaria (heat rash) appearance
1-3mm papules arising from sweat ducts, neck, groin, armpit, face
293
Milaria treatment
remove from heated environment, bath in cooler water or use cool compresses
294
Pityrosoprum Folliculitis (milk spots) appearance
dome shaped papules and pustules: cheek, nose, forehead
295
Pityrosoprum Folliculitis treatment
should resolve within weeks. can be treated using 1:5 ketoconazole shampoo and water on cotton bud x2 daily
296
Congenital dermal melanocytosis (mongolian blue spot) appearance
flat blue or grey birth mark common on spine, buttocks, back and shoulders
297
Congenital dermal melanocytosis (mongolian blue spot)
Benign, often fades within first years of life
298
What is screened in NST/Guthrie test
congenital hypothyroidism, cystic fibrosis, phenylketonuria, congenital adrenal hyperplasia, amino acid disorders, fatty acid oxidization disorders
299
AABR stands for
Automated Auditory Brainstem Response
300
AABR involves
earphones that play clicking noises and sensors placed on infant forehead and behind ears that measure auditory nerve response to noises
301
Vitamin K administration and timing
IM injection after birth
Orally after birth, 3 weeks, 4 weeks
302
Vitamin K helps
blood to clot, prevents vitamin K deficiency bleeding
303
Mechanisms of birth DFICERIL
Descent
Flexion
Internal rotation of head
Crowning
Extension
Restitution
Internal rotation of shoulders
Lateral flexion
