HALO - Term Test 1 Normal Childbirth Flashcards
Label the following diagram.
What % of babies come out with complications?
<3%
Describe the structure of the vulva
-
Vulva: outside appearance of reproductive organs
- 4 lips: labia majora & labia minora (inner folds and outer folds)
- when a baby is born, labia majora is the only external structure visible but during puberty labia minora (inner folds) will blossom out
Vagina
internal structure (birth canal)
Perineum
area between anus and sex organs (vagina or scrotum)
When you are inspecting labial tears, you remember that these are common in what situations?
childbirth (rare)
sexual assault (forceful penetration)
consider there may also be tears within vaginal canal or perineal space
What are the three holes in the groin region in females?
anus
urethra
vulva
Describe the shape of the cervix and how it changes over the course of a menstrual cycle.
- shaped like a donut with an opening in the middle
- Closed - opening of donut is flat (linear opening)l happens ~day 7 of cycle
-
Open - cervix becomes low and open (linear opening now becomes a hole); happens ~day 10-14. Allows sperm to swim through and go into the uterus
- aka fertile window for ~3 days
- lots of vaginal secretions during these days, also nourishing for sperm
- Closed - cervix closes again and goes back to normal for 2 weeks before it will open again and bleed
A cervix that is high and back (posterior position) means _____________.
A cervix that is low and open means ____________.
non-fertile
fertile
Describe the process of fertilization.
1) ovum (egg) is released once a month and takes 3-4 days to travel to the uterus
2) fertilization happens in the fallopian tube as sperm meets the egg there (forms a zygote)
3) once fertilized egg continues to travel down the fallopian tubes and becomes a morula.
4) Goes into uterus (is a blastocyst at this point, which is after 5-6 days) where it implants in endometrium, takes about 2 weeks (some of the cells eventually turns into placenta); if no implantation then endometrial lining will shed and becomes menstruation
After the fertilized egg becomes a blastocyst, the cells and the egg arrange themselves into grouping. The innder cell mass will become the ___________, the outer cells will become the ___________ and __________.
inner cell mass: baby
outer cells: amniotic sac and placenta
Prior to the blastocyst burrowing into the uterine wall (implantation), what process does it undergo?
hatching - shedding its protective casing (i.e. the zona pellucida)
At approximately what week will your baby be the size of a sesame seed and undergo further organizing and arranging to give shape to the embryo and form organs?
week 5
At around what week does your baby;s circulatory system start to form and heart start to beat?
~Week 4-5
At ~week 9, what structure in the enbryo disappears?
What size is the baby?
embryonic tail disappears
size of a grape, weighs less than an ounce
Implantation in the fallopian tube falls under a condition known as
ectopic pregnancy
LKMP
Last Known Menstrual Period
The only way a patient has no chance of preganancy is through
abstinence babyyy
When does puberty start?
~8-11 (so really starting from 8 y.o. a patient is considered child-bearing age)
A mother is pregnant for only 9 months but technically a full term pregnancy is 10 months (40 weeks). What explains this difference?
- A mother’s pregnancy cycle starts on day 1 (of getting their menstrual cycle)
- Week 1 - bleed
- Week 2 - preparing for fertilization
- Weeks 3 & 4 - the amount of time it takes for the egg to get down through the fallopian tubes (so in total 4 weeks ON TOP of the 9 months pregnant)
Pregnancy tests are typically first done around what time?
5-6 weeks
The only organ in the human body that can be grown and shed multiple times is
placenta
Functions of the placenta
1) Circulatory system (supplying blood) - also transporting nutrients; transferring heat
2) oxygenation (supplying oxygen) - exchange respiratory gases
3) filtration (organ of exchange; similar to liver and kidneys, baby’s waste gets filtered through the placenta)
an active endocrine gland (hormones involved)
The placenta is attached to the fetus via ____________.
umbilical cord
How many main blood vessels does the umbilical cord have?
2 arteries, 1 vein (3 vessel cord)
True or False. The placenta is highly vascularized.
True. Therefore tears will lead to ++hemorrhaging which can be fatal to both mom and baby
The delivery of the placenta is also known as
after birth
After the placenta is delivered, what is it being inspected for?
- WHOLENESS - nothing is broken off or looks like shredded meat on a smooth surface (i.e. tears)
- discolouration = bad
- calcification typically means hard filtration of drugs, nicotine, alcohol
What are the four factors that affect placental blood flow?
1) Blood pressure of the mom → The most important factor in uterine blood flow
2) Pain → catecholamines, hyperventilation causing vasoconstriction (of the mom or the baby)
3) Contractions → Temporarily decreases or stop blood flow to baby
4) Vasopressors → decrease uterine blood flow
What are Braxton Hicks contractions?
- prodromal or false labor pains
- contractions that occur early to strengthen the uterus for delivery, can start midway through pregnancy and occur up until the end
- Can cause decreased blood flow to the baby temporarily
Physiological changes to the mother during pregnancy.
Magic number 30
- HR will go up within 30% (normal resting HR: high 80s into 100s)
- BP will have a 30% increase
- Blood volume up to 30%
- those changes allow more fat to grow to stay warmer and cervix to create mucus (stops and seals the cervix so no other sperm or other microorganisms can get in to prevent infection)
Optimal age for delivering a baby
18-24 y.o.
Babies are (cyanotic/pink) when they are delivered. Why?
Cyanotic - because they get all their oxygen from placenta
What makes them pink up is from the CO2 in ambient air
VBAC
- Vaginal Birth After Caesarian - considered a safe choice for most who have had a c-section
- chances of having a VBAC are increased if
- previous vaginal birth
- reason for last c-section is not a factor this pregnancy
- chances are decreased if:
- you are given drugs to induce labour
- high BMI
- geriatric pregnancy
Indications for C-section
- Labour dysplosia:?shoulder dystocia
- Breech and elderly wormen (35+): geriatric pregnancies and mother not being able to push
- Macroplasia: large baby
- Transverse baby: baby is sideways
Anatomy of the amniotic sac
- Thin-walled sac that surrounds the fetus during pregnancy, develops in early pregnancy (8 weeks)
- Sac is filled with liquid (extracellular fluid initially) made by the fetus (amniotic fluid) and the membrane that covers the fetal side of the placenta (amnion)
- Surrounds and cushions to protect the fetus with a stable environment
- When the baby turns from embryo into a fetus (11-12 weeks) fluid turns into urine
The amniotic sac is formed by two embryonic membrane layers. These are:
Outside sac: chorion
Inside sac: amnion
Coddle babies
- known as an En Caul birth
- babies that are born in the amniotic sac
- The sac needs to be ruptured in order to get the baby out (gently rub the sac for it to burst)
What does it mean when someone says “my water broke”?
- amniotic sac ruptures!
- this usually means the baby is coming in at least 24hrs (but can be 48-72 hours)
- Mucus plug is also gone, which gravitational pull helps with labour (dilation starts and usually means you’ll have your baby within a week)
Why is it a concern if the mucus plug is gone but the baby does not come out?
The purpose of the mucus plug is to prevent foreign material and other unwanted things going pass the cervix into the uterus so when it’s gone, the cervix is open and nothing is protecting the baby
if the baby does not come out, then you run the risk of infection and the patient will have to be induced
Resp rate (increases/decreases) during pregnancy. Why?
increases. Lung volume decreases due to a growing fetus so RR has to go up to continue meeting physiological demands
What sort of changes to ovulation occur when the mother is pregnant?
Mother does not ovulate as it will be catastrophic for both embryos (via hormone signaling)
What changes to the areola, vagina and vulva are seen during pregnancy?
- become deep dark purple (all due to blood flow) - nose too!
- areolas darken because baby cannot see colour so it need to be dark to know where to go when breastfeeding
Full gestation is considered how many weeks/months?
How is this calculated?
40 weeks or 9 months
When you’re counting pregnany weeks, you are counting from the first day of your last period (the day you get your period is day one of the ‘pregnancy cycle’)
so 0 weeks pregnant = day 1 of period cycle