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Primary Midwifery Practice > Exam revision > Flashcards

Exam revision Flashcards

1
Q

hCG produced by

A

trophoblast + placental syncytiotrophoblast cells

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2
Q

hCG effect

A

promotes maintainance of corpus luteum, and stimulate corpus luteum to produce Progesterone (and Oestrogen)

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3
Q

hPL produced by

A

placental syncytiotrophoblast cells

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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

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5
Q

Oestrogen produced by

A

Ovaries, corpus luteum and placenta

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6
Q

Oestrogen effect

A

facilitates growth of placenta and fetus. supports thickening of endometrial lining. soften connective tissue. Increases maternal sensitivity to CO2

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7
Q

Progesterone produced by

A

Corpus Luteum and the placenta

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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

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9
Q

Nausea cause

A

? Oestrogen and hCG

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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.

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11
Q

Tiredness cause

A

hormonal changes, increased BV, decreased BP and BGLs, nutrients diverting to fetus

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12
Q

Tiredness help

A

Rest, diet, exercise, adjust schedule/workload

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13
Q

Constipation cause

A

Progesterone relaxes intenstinal muscles, slows digestion, lack of fluid and fibre

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14
Q

Constipation help

A

Increase fluid, increase fibre, stool softeners, laxatives

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15
Q

Reflux cause

A

increase in progesterone, pressure on stomach in later pregnancy

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16
Q

Reflux help

A

antacids, proton pump inhibitors, h2 blockers, sleep on left side, not lying down after eating

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17
Q

carpal tunnel syndrome cause

A

increase in blood volume, oedema causes compression of median nerve

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18
Q

carpal tunnel syndrome help

A

usually resolves after birth, avoid movements that exacerbate, wrist splint

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19
Q

varicose veins cause

A

increase in blood volume, enlarges veins bc increase venous pressure causes pooling of blood in veins

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20
Q

varicose veins help

A

avoid standing for long periods, compression garments

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21
Q

Leg cramps cause

A

decrease in magnesium, vitamins and minerals, increase in blood volume and slowing of circulation

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22
Q

leg cramps help

A

massage, rest, heat, ice, epsom salt baths

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23
Q

morning sickness cause

A

increase in hCG and Oestrogen

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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

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25
Q

Placenta functions

A

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

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26
Q

How does nutrient and gas exchange occur in placenta without fetal and maternal blood mixing?

A

seperate fetal and maternal blood vessels that do not touch but are clos enough together to facilitate diffusion in intervillous space

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27
Q

When is the placenta fully functional?

A

8-10 weeks

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28
Q

Amniotic Fluid Functions

A

protects fetus and facilitates free movement
temperature regulation
immunological role (contains antibodies)
umbilical cord support
lubrication

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29
Q

Amniotic fluid composition

A

98-99% water
1-2% solids (lanugo, skin cells, vernix) proteins, glucose, urea, NPN, uric acid, lipids, hormones, Na, Cl, K

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30
Q

Formation of amniotic fluid

A

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

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31
Q

Fetal development weeks 9-12

A

-eyes can close
-sex distinguishable
-RBC produces in liver
-Urine excreted in amniotic fluid

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32
Q

Fetal development weeks 13-16

A

-head proportionally smaller
-ossification of skeletal system begins
-eyes face anteriorly not laterally
-ovaries differentiate with primordial follicles present (oogonia)

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33
Q

Fetal development weeks 17-20

A

-growth slows
-brown fat formation
-quickening felt
-uterus fully formed
-vagina begins to develop
-lower limbs reach final proportion

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34
Q

Fetal development weeks 21-25

A

-substantial weight gain
-secretion of surfactant in lungs
immature respiratory system
-body more proportionate

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35
Q

Fetal development weeks 26-29

A

-lungs developed
-CNS can direct breathing
-RBC produced in bone marrow
-by 28 weeks testes begin descent

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36
Q

Fetal development weeks 30-34

A

Pupils react to light
white fat 8% of body weight

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37
Q

Fetal development weeks 35-38

A

Firm grip
circumference of head and abdomen equal
White fat 16% of body weight

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38
Q

At what gestation can fetus open it’s eyes

A

approx 27 weeks

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39
Q

Surfactant function

A

lines alveoli to lower surface tension and prevent alveolar collapse

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40
Q

Surfactant production

A

begins at 24-28 weeks gestation, adequate levels around 35-36 weeks gestation

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41
Q

Define Blastocyst

A

distinctive embryonic stage
approx 5 days post fertilization
where a trophoblast, blastocyst cavity and inner cell mass have formed. Blastocysts are able to implant.

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42
Q

Define Lanugo

A

fine, soft, downy hair
appears 16 weeks gestation, abundant by 20 weeks, sheds approx 7-8 months gestation

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43
Q

Define brown fat

A

brown adipose tissue responsible for producing heat to warm the body

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44
Q

Brown fat grown by

A

Maternal glucose

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45
Q

Define Vernix

A

waxy ‘cheese-like’ substance on fetal skin. antimicrobial properties and aids in thermoregulation.

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46
Q

Vernix composition

A

Sebum, 80% water, 10% lipids, 10% proteins

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47
Q

Define Teratogen

A

any substance that can cause harm or abnormalities in a developing embryo or fetus

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48
Q

Define Chorion

A

outer membrane of embryonic sac, maternal ‘side of membrane’ attached to decidua

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49
Q

Chorion formed from

A

trophoblastic ectoderm and embryonic mesoderm

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50
Q

Define Amnion

A

inner membrane of amniotic sac, fetal ‘side of membrane’

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51
Q

Amnion formed from

A

embryonic ectoderm

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52
Q

Define Ovulation

A

Rupturing of vesicular follicle, release of secondary oocyte at day 14 of menstrual cycle

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53
Q

What triggers ovulation

A

LH surge, rise and fall of oestrogen

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54
Q

Define fertilisation

A

process by which sperm meets ovum and forms a zygote

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55
Q

Define implantation

A

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

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56
Q

Define cleavage

A

process by which mitotic divisions increase number of blastomeres of a zygote

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57
Q

How does fetal circulation differ from maternal circulation?

A

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

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58
Q

Define Ductus venosus

A

low resistance shunt that allows blood flow to bypass the liver, connecting umbilical vein to inferior vena cava

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59
Q

Define Ductus arteriosis

A

short vessel connecting fetal pulmonary artery to the aorta allowing blood to bypass pulmonary circulation and enter system circulation

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60
Q

Define Foramen Ovale

A

Opening in the septum between the right and left atria allowing blood to bypass pulmonary circulation

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61
Q

Define umbilical artery

A

carries deoxygenated blood from fetal circulation to placenta (2)

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62
Q

Define umbilical vein

A

carries oxygenated blood from placenta to fetal circulation (1)

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63
Q

How to calculate EDB based off LMP

A

EBD=LMP + 9 months and 7 days

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64
Q

Role of folic acid

A

Prevention of Neural tube defects

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65
Q

Recommended folic acid dose

A

0.5mgs

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66
Q

When to take folic acid

A

1 month preconception - 12 weeks gestation (after NT fully developed)

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67
Q

Food storage

A

Ensure fridge temperature <5C, leftovers consumed within 24 hrs after being reheated until steaming

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68
Q

Sexual activity during pregnancy

A

Is safe. Practice safe(r) sex to reduce risk of STI transmission. Penetrative sex after ROM poses infection risk.

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69
Q

Exercise recommendation

A

Low to moderate exercise recommended, be mindful of injury risk

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70
Q

Role of iron

A

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.

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71
Q

What foods should be avoided

A

-soft cheeses, raw and cured meats (listeria)
-mindful of fish and canned fish intake (mercury)
-raw chicken, runny eggs, mayonnaise (salmonella)

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72
Q

Normal Blood Pressure changes related to pregnancy

A

BP may fall in 1st trimester
rising from 28 weeks to reach pre-conception levels by term

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73
Q

Why is BP recorded during pregnancy?

A

High BP can indicate pre-eclampsia
Low BP may indicate maternal illness

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74
Q

What position should BP be taken

A

seated, feat supported, semi-recumbent

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75
Q

Complete Blood Picture screens

A

WBC, RBC & Platelets, haemoglobin concentration and hematocrit

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76
Q

CBP may indicate

A

underlying medical conditions or pregnancy complications

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77
Q

Blood group and antibody screening

A

indicates blood group and rhesus factor/antibody status

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78
Q

Blood group and screening importance

A

Determining Rh incompatibility important to avoid heomolytic disease in newborn

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79
Q

Rubella screening

A

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.

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80
Q

Rubella screening importance

A

Rubella infection in 1st trimester carries high risk of congenital abnormalities

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81
Q

Syphilis screening

A

diagnoses syphilis

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82
Q

Syphilis screening importance

A

without treatment can cause adverse pregnancy outcomes, IUFD, neonatal death, premature and low birth weight and neonatal syphilis infection

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83
Q

Hepatitis B screening

A

diagnoses Hep B

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84
Q

Heb B screening importance

A

serious infection with high risk of transmission to neonates without treatment (>90%). Neonatal Hep B can be catastrophic in newborns.

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85
Q

Hepatitis C screening

A

diagnoses Hep C

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86
Q

Hep C screening importance

A

(5-15% transmission to neonates) infants may recover from infection but may require medical treatment and experience adverse outcomes

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87
Q

HIV test

A

diagnoses HIV

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88
Q

HIV test importance

A

Without treatment 25-30% risk of transmission to fetus. HIV is treatable but not curable.

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89
Q

Rh incompatibility risk

A

Rh incompatability can cause maternal immune response resulting in maternal cells attacking fetal cells, potentially resulting in HDFN.

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90
Q

Anti D prophylaxis

A

prevents body from entering immune response

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91
Q

Anti D when

A

28 and 34 weeks
and at birth if baby is rhesus positive

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92
Q

Anti D benefits

A

greatly reduces risk of immune response and HDFN

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93
Q

Anti D risks/considerations

A

Anti D is a blood product, tiny potential for allergic reaction

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94
Q

Urine screening test

A

MSSU, presence of blood, proteins and infections, urine pH

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95
Q

Urinalysis importance

A

detection of kidney problems, UTI/bladder/kidney infections, diagnosis of pre-eclampsia

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96
Q

2 main aims of abdominal assessment

A
  1. Assess fetal growth
  2. Locate fetal position
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97
Q

Indications for abdominal assessment

A

assess fetal positioning and growth non-invasively from 24 weeks gestation

in labour 4 hourly and before every VE

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98
Q

Contraindications for abdominal assessment

A

Non-consent, history of antepartum haemorrhage, severe abdominal pain, preterm labour

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99
Q

What are you looking for visual abdominal assessment

A

bruises, scars, rashes, skin conditions, hernia, linea negra, size, shape

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100
Q

When you palpate abdomen what are you feeling for

A

fundus, lie, presentation, position, fetal anatomy, fetal poles, 5ths above brim, fetal movements, AFV, tone

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101
Q

Where is best place to auscultate fetal heart rate

A

fetal anterior shoulder/chest

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102
Q

Normal FHR range

A

110-160bpm

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103
Q

What information do you record abdominal assessment

A

visual inspection, lie, presentation, position, descent, FHR, fetal movements, midwifery management, AFV

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104
Q

Define Lie

A

Relationship between long axis of uterus and long axis of fetus

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105
Q

Lie type

A

longditudinal, oblique, transverse

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106
Q

Define presentation

A

what part of the fetus is presented to the cervix/birth canal

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107
Q

Presentation types

A

when cephalic- vertex, brow, face

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108
Q

Define Position

A

Relationship betwen presenting part and the pelvic outlet

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109
Q

Position types

A

Right, Left, Anterior, Posterior, Lateral

ROA,LOA,ROP,LOP,ROT,
LOT, OP, OA

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110
Q

Define descent

A

engagement of presenting part in pelvis, measured in 5ths above pelvic brim

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111
Q

Two main purposes of vaginal examination

A

Locate fetal position and presenting part
Assess cervical dilation/effacement

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112
Q

Contraindications of VE

A

non-consent, antepartum haemorrhage, placenta previa, vaginal infection or UTI, pre term ROM

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113
Q

Define effacement

A

length of cervix- refers to thinning and shortening of cervix

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114
Q

Define dilation

A

opening of cervix during labour, 0-10cm

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115
Q

Define ischial spines

A

part of the posterior body of the ischium bone of the pelvis, palpable as ‘pointy’ notches during VE

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116
Q

When is morphology ultrasound performed

A

18-20 weeks

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117
Q

Purpose of morphology ultrasound

A

assess fetal and placental anatomy, placenta position, and maternal pelvic organs, cervix, amniotic fluid

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118
Q

Accuracy of US in dating

A

highly accurate in early and mid pregnancy, more variability +-7 days in 3rd trimester

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119
Q

Factors that affect US accuracy

A

gestational age, sonographer experience, fetal position, variation in maternal anatomy

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120
Q

Common anomalies identified during morphology US

A

spina bifida, anacephaly, hyrdocephaus, heart defects, limb abscence and limb difference, diaphragmatic hernia, gasrtochisis, major kidney problems

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121
Q

what is the cFTS

A

maternal serum screening of hCG and PAPP-A and US of FNT

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122
Q

what does cFTS screen for

A

T18, T21, T13

123
Q

benefits of cFTS

A

screens for chromosomal abnormalities

124
Q

risks of cFTS

A

potential increase for intervention and medical coercion, blood test poses minor infection risk

125
Q

what is the STS

A

maternal serum screening of alpha fetoprotein, B-hCG, estradoil +- inhibin A

126
Q

What does STS screen for

A

T21, T18 and NTD

127
Q

benefits of STS:

A

screens for chromosomal abnormality

128
Q

risks of STS

A

inaccurate in multiple pregnancy, less accurate than cFTS, potential for increased intervention and medical coercion, small infection risk from blood test

129
Q

when is cFTS performed

A

11-13+6 weeks

130
Q

When is STS performed

A

14-20 weeks (most accurate at 16 weeks)

131
Q

What is CVS

A

sampling of placental tissues taken via needle under US guidance through abdomen of cervix

132
Q

When is CVS performed

A

11-14 weeks

133
Q

CVS accuracy

A

98-99%

134
Q

Risks of CVS

A

singleton pregnancy 1-2% risk of pregnancy loss, multiple pregnancy 3-4% risk of pregnancy loss, 1/3 chance of bleeding

135
Q

What is Amniocentesis

A

sampling of amniotic fluid taken under US guidance through abdomen

136
Q

When is AC performed

A

15+ weeks

137
Q

Accuracy of AC

A

99-100% accurate

138
Q

RIsks of AC

A

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
Q

Occurance rate of GDM

A

2-9% of pregnancy

140
Q

When is OGTT performed

A

24-28 weeks gestation

141
Q

What does OGTT involve

A

fasting blood test, consume glucose rich fluid, blood test at 1 hr, blood test at 2 hr

142
Q

Normal OGTT range

A

Fasting: <5.1
1 hr: <10.0
2 hr: <8.5

143
Q

OGTT risk

A

failed OGTT, nausea, vomiting, fainting, blood test small infection risk, risk of increased intervention and coercion if + GDM

144
Q

What is GBS

A

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
Q

What does GBS swab involve

A

(usually) self-performed swab of vagina and rectum

146
Q

When is GBS swab taken

A

36 weeks

147
Q

Treatment of GBS+

A

antibiotics administered during and after labour

148
Q

Risk of GBS infection to neonate

A

0.02% chance of GBS transmission, 5% mortality rate in infected infants

149
Q

Myometrial activation

A

myometrial cells undergo changes, increase in electrical activity, increase in responsiveness, increase in ion channels that faciliatte myometrial contractability

150
Q

Cause of cervical ripening

A

Hormones Prostaglandin (and oestrogen and progesterone) and relaxin.
Macrophages and lymphocytes trigger release of proteolytic enymes that breakdown collagen fibres

151
Q

Hormones influencing cervical ripening

A

Prostoglandins and Relaxin

152
Q

General hormonal adaptations onset of labour

A

increase in hormone synthesis, increase in receptors at target sites, increase in plactental uterotonic hormones, decrease in hormone binding proteins

153
Q

CRH onset of labour

A

CRH increases rapidly from 35 weeks under influence of oestrogen

154
Q

CRH stimulates

A

fetal cortisol and placental oestriol

155
Q

Fetal cortisol onset of labour

A

Increases triggering increase in prostoglandins and oxytocin synthesis

156
Q

Prostoglandins onset of labour

A

responsible for uterine contraction, role in cervical effacement and dilation

157
Q

Relaxin onset of labour

A

role in cervical ripening

158
Q

Oxytocin onset of labour

A

stimulates uterine contractions

159
Q

Oxytocin receptors

A

increase in decidua 300X over preganncy

160
Q

Oestrogen onset of labour

A

Increase from 34 weeks, increases sensitivity of oxytocin receptors, promotes prostoglandin synthesis, facilitates myometrial contractability

161
Q

Progesterone onset of labour

A

suppresses uterine excitability, levels don’t decrease but available receptors decrease

162
Q

Mild contraction

A

<20 seconds, uterus becomes somewhat firm but can be indented by gentle pressure

163
Q

Moderate contraction

A

20-40 seconds, requires firmer pressure to indent

164
Q

Strong contraction

A

40-60+ seconds, uterus ‘wood-like’ hardness, at height of contraction cannot be indented

165
Q

Vaginal examination indications

A

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
Q

VE visual assessment

A

signs of infection, FGM, anatomical anamoly/abnormality, varicose veins, labial or perineal trauma, dischare, bleeding, AF loss

167
Q

VE internal assessment

A

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
Q

Define intermittent auscultation

A

listening and counting FHR for short periods of time throughout labour, usually with a doppler or pinnards

169
Q

How long should FHR be listened to

A

1 minute

170
Q

What information needs to be gathered for hospital admission

A

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
Q

Normal maternal BP

A

110-140/60-80mmHg

172
Q

Normal range maternal HR

A

60-100bpm

173
Q

Normal range maternal temperature

A

36.5-37.5C, 35-38C during labour

174
Q

Normal range respiratory rate

A

12-20bpm

175
Q

PPG midwifery practices for admission

A

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
Q

During labour frequency of maternal pulse

A

with every FHR

177
Q

During labour frequency of maternal temperature

A

every 4 hours, hourly if hypo or hyperthemic

178
Q

During labour frequency of maternal respiratory rate

A

every 4 hours, every hour during active labour

179
Q

During labour frequency of maternal BP

A

latent: every 4 hours, active: hourly

180
Q

During labour frequency of urination

A

every 2 hours

181
Q

During labour frequency of PV loss check

A

hourly

182
Q

During labour frequency of abdominal palpation

A

every 2 hours, prior to every VE

183
Q

During labour frequency of VE

A

4 hourly and if clinically indicated

184
Q

N2O2 route

A

inhaled

185
Q

Onset and duration of N2O2

A

felt within 15 seconds, cleared from maternal system within 5 minutes

186
Q

Benefits of N202

A

almost instant relief, doesn’t effect mobility, cleared from system rapidly, no noted effect on fetus and exits fetal system rapidly

187
Q

Risks of N2O2

A

May increase HR and decrease RR, may cause nausea, vomiting and vertigo

188
Q

Fentanyl route

A

subcutaneous (recommended) and IV

189
Q

Onset and duration of fentanyl

A

15 minute onset, lasts 1-2 hours

190
Q

Risks of fentanyl

A

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
Q

Epidural what is it and route

A

combination of local anaesthetic and opiods administered via catheter into the epidural space

192
Q

Epidural effect

A

blocks transmission via the spinal nerves causing lack of sensation below epidural catheter

193
Q

Epidural risks

A

-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
Q

Common signs of transition

A

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
Q

Recommendations to help reduce perineal trauma

A

-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
Q

Define descent

A

descent of PP through pelvis, measured in relation to anatomical marker of pelvis

197
Q

Flexion

A

Chin to chest
Pressure on fetal spine causes flexion of head leading to occiputal presentation (smallest part of fetal head)

198
Q

Internal rotation of the head

A

fetal head aligns with anteroposterior diameter of pelvic outlet and moves occiput to lie under the symphisis pubis

199
Q

Crowning

A

fetal head emerges under pubic arch and pushes and present against the vaginal orifice and is able to be visually identified

200
Q

Extension

A

occiput moves from beneath the pubic arch, pushes against pelvic orifice and pivots on the subocciputal region around the pubic bone

201
Q

Restitution

A

After the birth of the head, the head returns to alignment with the shoulders

202
Q

Internal rotation of the shoulders

A

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
Q

Lateral flexion

A

Fetal spine undergoes lateral flexion to accommodate the curved birth canal

204
Q

First degree perineal tear

A

tearing of skin only

205
Q

Second degree perineal tear

A

tearing of perineal muscles

206
Q

Third degree perineal tear

A

partial or complete disruption of the anal sphincter

207
Q

Fourth degree perineal tear

A

complete disruption of the internal and external anal sphincter including rectal mucousa

208
Q

Implications of perineal trauma

A

urinary and fetal incontinence, pain, sexual discomfort and dysfunction, lower levels of vaginal lubrication, arousal and frequency of orgasm

209
Q

Management of perineal trauma 24-48hrs

A

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
Q

HIPPS

A

Hygeine, Ice, Pelvic floor exercises, Pain relief, Support

211
Q

Neonatal respiratory adaptation following birth

A

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
Q

Absorption/expulsion of lung fluid 1st 24 hrs

A

80% absorption by 2hrs, 100% absorption by 12-24hrs

213
Q

neonatal cardiovascular transition following birth

A

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
Q

neonatal temperature regulation

A

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
Q

What is optimal/delayed cord clamping

A

clamping >1 min after birth of placenta or until cord stops pulsating

216
Q

benefits of optimal cord clamping

A

increase in haemoglobin concentration and iron stores, higher birth weight, potential improvement in brain mylenation

217
Q

Process of active management of placental birth

A

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
Q

Process/considerations physiological birth of placenta

A

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
Q

Steps of checking placenta

A

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
Q

Central cord insertion

A

centre of placenta

221
Q

Eccentric cord insertion

A

> 2cm from placental margin

222
Q

Battledore cord insertion

A

<2cm from placental margin

223
Q

Velamentous cord insertion

A

insertion into fetal membranes

224
Q

Mean placental diameter

A

22cm

225
Q

what covers fetal surface of placenta

A

amnion and chorionic plate

226
Q

How many cotyledons

A

15-20

227
Q

Implications of incomplete placenta

A

PPH, infection, need for manual or surgical removal of remaining placental tissue

228
Q

Normal post partum blood loss

A

500mL after vaginal birth, 1000mL after LUSCS

229
Q

Benefits of skin to skin

A

forms attatchment and attunement
big factor in successful initiation of breastfeeding
neonatal thermoregulation
biggest factor in infant environmental adjusment
facilitates neonatal metabolic changes

230
Q

what does APGAR stand for

A

Appearance, Pulse, Grimace, Activity, Respiratory effort

231
Q

Heart Rate APGAR 0

A

No pulse

232
Q

Heart Rate APGAR 1

A

below 110bpm

233
Q

Heart Rate APGAR 2

A

above 100bpm

234
Q

Respiratory Effort APGAR 0

A

Absent

235
Q

Respiratory Effort APGAR 1

A

gasping, irregular

236
Q

Respiratory Effort APGAR 2

A

good, crying, 40-60bpm

237
Q

Muscle Tone APGAR 0

A

no movement

238
Q

Muscle Tone APGAR 1

A

arms and legs flexed

239
Q

Muscle Tone APGAR 2

A

spontaneous activity

240
Q

Grimace APGAR 0

A

absent

241
Q

Grimace APGAR 1

A

minimal response to stimulation

242
Q

GRIMACE APGAR 2

A

cough, sneeze, cry
prompt response to stimulation

243
Q

Colour APGAR 0

A

cyanotic or pale all over

244
Q

Colour APGAR 1

A

blue/pale extremities, well perfused trunk

245
Q

Colour APGAR 2

A

well perfused all over

246
Q

Postnatal hormonal changes

A

removal of placental hormones: hCG, hPL, oestrogens and progesterone

247
Q

Postpartum uterus change

A

uterus contracts and returns to prepartum size
cellular barrier formed at placental site, decidua regeneration complete 6-7weeks postpartum

248
Q

Average blood loss in following weeks post partum

A

150-400mL pv blood loss

249
Q

Post partum oxygen consumption

A

returns to pre partum levels

250
Q

Post partum gastrointestinal function

A

increases as progesterone levels drp

251
Q

Prolactin triggers

A

Lactogenesis

252
Q

Successful breastfeeding ONE

A

Hospital Policy

253
Q

Successful breastfeeding TWO

A

Staff Competency

254
Q

Successful breastfeeding THREE

A

Antenatal care

255
Q

Successful breastfeeding FOUR

A

Care right after birth

256
Q

Successful breastfeeding FIVE

A

Support mothers with breastfeeding

257
Q

Successful breastfeeding SIX

A

Supplementing

258
Q

Successful breastfeeding SEVEN

A

Rooming in

259
Q

Successful breastfeeding EIGHT

A

Responsive feeding

260
Q

Successful breastfeeding NINE

A

Bottles, teats and pacifiers

261
Q

Successful breastfeeding TEN

A

Discharge

262
Q

Define mammogenesis

A

breast formatio: occurs during embryonic and fetal life, development accelerated during puberty and then steadily throughout pregnancy

263
Q

Lactogenesis I

A

SECRETORY DIFFERENTIATION
begins 16 weeks gestation-2/3 days postpartum mammary gland development acceleration, colostrum moves from cell membrane to ductules

264
Q

Hormones influencing lactogenesis I

A

hPL, progesterone, prolactin

265
Q

Lactogenesis II

A

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
Q

Hormones influencing lactogenesis II

A

rapid drop in progesterone and presence of prolactin

267
Q

Lactogenesis III

A

GALACTOPOESIS
day 9- 6 weeks post partum
production and maintainance of mature breast milk

268
Q

Lactogenesis III caused by

A

repeated breast milk removal

269
Q

Weaning

A

cessation of breastfeeding, breastmilk becomes similar to colostrum, secretory deactivation of mammary gland

270
Q

Prolactin role in milk release and synthesis

A

levels follow circadian rythym, highest at night, more often infant feeds, higher levels of circulating prolactin

271
Q

Oxytocin role in milk release and synthesis

A

released in response to suckling and triggers milk ejection reflex

272
Q

5 fetal benefits breastfeeding

A
  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
Q

5 maternal benefits breastfeeding

A
  1. supports attachment and attunement
    2.Promotes post partum recovery, uterine contraction
  2. Reduces risk of PPH and post partum depression
    4.Reduces risk of breast, ovarian and uterine cancer
  3. reduces risk of stroke, T2DM and heart disease
274
Q

infant breastfeeding cues

A

rooting, sticking tongue out, hand to mouth, fussing, suckling, increased physical movement, agitation, crying

275
Q

Foremilk

A

milk ejected at the beginning of feed, lower in fat content

276
Q

Hindmilk

A

milk ejected at the end of a feed, higher in fat content

277
Q

4 ways infants can lose heat

A

Evaporation
Conduction
Convection
Radiation

278
Q

Evaporation

A

when fluid evaporates from wet skin

279
Q

Conduction

A

when skin comes into conduct with cold surface

280
Q

Radiation

A

heat is radiated to cooler objects where there is no skin contact

281
Q

Convection

A

when surrounding air is cooler than infant

282
Q

Number 1 way to prevent infant heat loss

A

skin to skin

283
Q

strategies to prevent infant heat loss

A

immediate drying, skin to skin, cover body, beanie/hat, postpone bathing, maintain warm environment

284
Q

APGAR normal range at 5 minutes

A

> 7

285
Q

Neonatal Temperature normal range

A

36.5-37.5C

286
Q

Erythmea Toxicum Neonatum appearance

A

red flat patches, papules and pustules on face trunk and limbs

287
Q

Erythmea Toxicum Neonatum incidence

A

50% of full term infants

288
Q

Erythmea Toxicum Neonatum treatment

A

will spontaneously resolve within weeks

289
Q

Neonatal Milia appearance

A

tiny white bumps just under skin surface, common on nose, inside of mouth, scalp, face and upper trunk

290
Q

Neonatal Milia incidence

A

40-50% of term infants

291
Q

Neonatal Milia treatment

A

will resolve spontaneously within weeks

292
Q

Milaria (heat rash) appearance

A

1-3mm papules arising from sweat ducts, neck, groin, armpit, face

293
Q

Milaria treatment

A

remove from heated environment, bath in cooler water or use cool compresses

294
Q

Pityrosoprum Folliculitis (milk spots) appearance

A

dome shaped papules and pustules: cheek, nose, forehead

295
Q

Pityrosoprum Folliculitis treatment

A

should resolve within weeks. can be treated using 1:5 ketoconazole shampoo and water on cotton bud x2 daily

296
Q

Congenital dermal melanocytosis (mongolian blue spot) appearance

A

flat blue or grey birth mark common on spine, buttocks, back and shoulders

297
Q

Congenital dermal melanocytosis (mongolian blue spot)

A

Benign, often fades within first years of life

298
Q

What is screened in NST/Guthrie test

A

congenital hypothyroidism, cystic fibrosis, phenylketonuria, congenital adrenal hyperplasia, amino acid disorders, fatty acid oxidization disorders

299
Q

AABR stands for

A

Automated Auditory Brainstem Response

300
Q

AABR involves

A

earphones that play clicking noises and sensors placed on infant forehead and behind ears that measure auditory nerve response to noises

301
Q

Vitamin K administration and timing

A

IM injection after birth
Orally after birth, 3 weeks, 4 weeks

302
Q

Vitamin K helps

A

blood to clot, prevents vitamin K deficiency bleeding

303
Q

Mechanisms of birth DFICERIL

A

Descent
Flexion
Internal rotation of head
Crowning
Extension
Restitution
Internal rotation of shoulders
Lateral flexion

Primary Midwifery Practice (1 decks)

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