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
When determining if a woman is pregnant, what hormone are you detecting for?
- BCG - beta human chorionic gonadotropin levels
- produced and released by the placenta so it is a good indication if woman is preggo or not
- can be detected via urine at 8 weeks or by blood work at 6 weeks
What are the parameters for first, second and third trimester (in weeks)?
First trimester: 0-12 weeks
Second trimester: 13-28 weeks
Third trimester: 29-42 weeks (can go up to 42 weeks because we really don’t know when they got pregnant unless IVF procedures) and also because of irregular periods
Where is the uterus height during first trimester?
symphysis pubis
What changes occur during the 2nd trimester (to the uterus, symptoms, etc.)?
- 16 weeks (4 months) uterus is at midpoint between symphis pubis and umbilicus
- This is when the embryo is now considered a fetus
- Low probability of survival: youngest was 24 weeks (high fatality rate)
- N/V goes away, mucosal changes go away, feels back normal
- If the band of the uterus is at umbilicus, halfway mark (20 weeks)
Why is a pregnancy not allowed to go past 42 weeks calculated?
- higher risk of still birth or serious health problems
- baby also becomes too big for vaginal birth
What changes occur during 3rd trimester?
- 32 weeks - baby practices more “breath-like” movements involving compression and expansion of the lungs
- 37 weeks is considered TERM *anything before that is premature
- uterus fundus (top part of uterus) is at sternum
- Week 40 estimated date of delivery
- Baby grows and then drops into birth canal – so it keeps growing and then uterus drops
What does it mean when a baby is considered “term”? At what week of the pregnancy is a baby considered term and why?
TERM: baby can come out and live on without intervention
Sucking reflex develops at 37th week so it can survive outside of uterus
40% of patients may experience bleeding during 1st trimester. What are possible sources of bleeding in pregnancy?
- Implantation – ova burrows into endometrium causing bleeding and drips into cervix and then blood drips out (spotting)
- Ectopic pregnancy – baby grows in fallopian tube (tears and rips tube leading to pelvic bleeding) – if fallopian tube bursts, vaginal bleeding occurs
- Miscarriage/sponaneous abortion – ovum buries into endometrium (D&C - Dilation and Currettage is a therapeutic abortion)
- Cervical pathology – cervix is very vascular; can grow polyps; penis during intercourse can also bump cervix and cause bleeding
Hyperemesis Gravidarum
- uncured nausea and vomiting resulting in weight loss and electrolyte imbalance (dehydration) – IV fluids and nutrition needed
- 1st trimester complication
Gestational Trophoblastic disease
- large tumors that grow along with fetus in uterus after conception
- tumours can continue to grow and cause bleeding or take up space of uterus leading to baby miscarriage because no more space
- 1st trimester complication
The leading cause of death in the first trimester is
ectopic pregnancy (6% of all pregnancy-related deaths are due to ectopic pregnancy)
Increased 4x in the last 20 years (possibly due to birth control and sex at an early age)
Average child bearing years
12-45
Risk factors for ectopic pregnancy
- Age 25-35
- Previous tubal/abdo-surgery
- Previous ectopic pregnancy
- Tubal abnormalities
- STDs
- Use of intrauterine conception
- Reproductive technology
- Smoking
S/S of rupture ectopic pregnancy
- Hypotension (due to henorrhaging) & hypovolemia
- Bradycardia or tachycardia
- Good survival rate for mother with early detection, 0% survival for fetus
- ++pain in lower R or L abdomen depending on fallopian tube injured
- vaginal bleeding
- Mom NEEDS to go into surgery but tubes will be taken out, only left is ovaries but eggs have nothing to travel through
S/S of non-ruptured ectopic pregnancy
Tissues are still intact, no deadly bleed
- hypotension
- tachycardic (compensatory mechanisms kicking in)
____% of miscarriages occur in the 1st trimester, the rest occur before _____ weeks.
80% of all miscarriages occur in 1st trimester, the rest occur before 20 weeks
Types of miscarriages
1) Threatened: Condition that suggests a miscarriage might take place before the 20th week of pregnancy (Treatment options: progesterone suppositories); cervix fails by being open but can stitch cervix close to allow pregnancy to continue)
2) Inevitable: Cervix is open, but the products of conception have not been expelled. Nothing can be done, just waiting at this point
3) Incomplete/Missed: embryo dies but body does not recognize this and will continue to be pregnant for 2-3 weeks; retaining products of conception; body will naturally take care of it in 2 weeks via labour (abdo pain, contractions, body pushes fetal conception out) OR you can do a D&C and suction out the inside of uterus
4) Complete: miscarried and passes all fetal parts; no meds or D&C follow up needed
5) Septic: if some fetal parts have not passed yet (so incomplete miscarriage) and it causes a uterine infection
Early onset of labour is a ___ trimester complication
2nd
Placenta Previa
- 2nd trimester complication where placenta is in the lower segment of the uterus and covers part or all of the cervix - placenta migrates around uterus and can block cervix
- can cause significant bleed before or during delivery (blood dripping into vaginal canal)
- Painless, harmless – the only complication is that cannot give birth = C-section needed (placenta cannot be delivered prior to the baby, this is fatal)
- 40% of women have it; able to be seen on ultrasound
- If the baby comes out at 19 weeks, 0% survivability
- Earliest known survivability is 22 weeks but growing with issues
- Resuscitation: determining if you need to resus baby or not – airway check (is it sealed shut?)
- Eyelids – if they are fused shut (there is no opening) – means airway have sealed
- Wrap baby, transport but nothing much else you can do (products of conception – not considered a person)
- Mom can choose death certificate if bb comes out at 22 weeks – medical waste vs human being
Gestational Diabetes
- Pregnancy accompanied by relative insulin resistance; 2nd trimester complication
- Develops in women whose pancreatic function is insufficient to overcome this state ⇒ hormones of pregnancy are shutting down other endocrine system parts and stunt pancreas
- Risk factors: obesity - higher risk of developing this
- Cure: giving birth and not being pregnant
-
Complications:
- acceleration growth of fetus (macroplasia)
- preecamplsia
- eclampsia
- polyhydramnios (excessive amount of growth of amniotic fluid which increases risk of stillbirth because baby is free floating in space and can flip around and hang itself on cord)
- stillbirth
- neonatal morbidty
5 P’s of labour
five essential factors that affect the process of labor and delivery
- Passenger: presentation, position, and size of fetus
- Passageway: resistance in birth canal, if she’s given birth before, diameter
- Powers: force and frequency of uterine contractions
- Position: of the placenta
- Psyche: psychological state of the woman
If preterm labour occurs before 20 weeks, it is termed _____________.
If preterm labour occurs after 20 weeks, it is termed _____________.
miscarriage
pre-term birth
Preeclampsia
Widespread vascular endothelial malfunction; a 3rd trimester complication
- Vasospasm
- mother have ++ high BP which reduces the blood supply to the fetus, which may get less oxygen and fewer nutrients
- You can have preeclampsia from >20 weeks to 6 weeks postpartum (so once you have a baby, you are still considered preeclamptic)
- and also if you ask them if they are >20 weeks and they say no then they DO NOT have preeclampsia
-
Clinical signs: if pt presents with all these, they have preeclampsia
- HTN > 140/90
- Proteinuria
- Sometimes edema
Polyhydramnios
Excessive amniotic fluid, can be fatal
may cause premature birth, water to break early, umbilical cord positioning
2nd or 3rd trimester complication
What is the one clinical manifestation that causes a mother to progress from preeclampsia to eclampsia?
seizure
Eclampsia
- Complication of severe preeclampsia; 3rd trimester complication
- New onset of grand mal seizure activity or unexplained coma during pregnancy or postpartum women with S/S of preeclampsia
- Woman and baby can die from this
- Consider preeclampsia in >20 weeks GA (gestational age)
- Non-specific complaints of headache, N/V, blurred vision, fatigue, generalized swelling and ++weight gain (from fluid)
Placental abruption (abruptio)
- Occurs when placenta separates from inner wall of uterus before birth (when there is still a baby intact); 3rd trimester complication
- Can deprive baby of oxygen and nutritents and cause heavy bleeding in the mother; ++painful
- fetal parts can be palpated easily
- maternal and fetal death can result
- idiopathic or trauma-related (common in low velocity MVCs, punched in stomach, trip and fall and land on belly)
- Bleeding may be concealed (the mom will bleed out from the inside) OR bleeding may be visible and coming out
- This is different than placental separation – THIS IS NORMAL AND SHOULD HAPPEN
- Abruption can be the smallest tear (esp with fender benders) or full thickness tear – needs to be quite preggo
Is placental separation difference than placental abruption?
YES! Placental separation is normal and should happen with childbirth
Uterine rupture/abruptio
Ruptured uterus
- Full-thickness disruption of uterine wall
- This is horrible and everybody dies (very rare but catastrophic) – only mom will survive maybe, with early detection
-
Risk factors:
- uterine scarring
- uterine abnormalities
- multiparity (nulparity is pregnant for first time; multiparity is multiple births hx)
- fetal macrosomia (big baby)
- labour induction
- uterine trauma
- You only have 10-37 minutes from the time that the uterus ruptures to save the baby (until ++ fetal morbidity is inevitable)
Ax and Presentation of uterine rupture
- Non-specific and inconsistent S/S
- Fetal distress, loss of uterine contractility
- Recession of the baby’s head back into the birth canal
- Hemorrhage shock
- Soft belly – boggy
Assessment:
- Determine if its actually a rupture
- Monitor for progression to shock
What are the two questions you want to be able to answer after your obstetrical assessment?
Is this an uncomplicated or complicated pregnancy?
Is delivery imminent and need to deliver on-scene or can we initiate transport?
Para and Gravida
Para: number of live fetuses delivered via birth canal or C-section
Gravida: number of pregnancies
If twins and first pregnancy, what para and gravida is the mother?
Gravida 1 para 2
meconium
first stool of the newborn
When checking uterine fundus height if uterus easily palpable, at what week is it just above symphysis pubis?
12 weeks
When checking uterine fundus height if uterus easily palpable, at what week is it midway between symphysis pubis and umbilicus?
16 weeks
When checking uterine fundus height if uterus easily palpable, at what week is it at the umbilicus?
20 weeks
When checking uterine fundus height if uterus easily palpable, at what week is it at the costal margins?
36 weeks
Abdomen inspection includes:
- Size of uterus
- Fetal movements?
- Fetal parts?
→ note contractions (frequency, intensity, duration)
→ palpate between contractions (note tenderness, rigidity)
→ note palpable fetal parts, movement
What are you inspecting/looking for dduring perineal inspection?
ALWAYS WEAR GLOVES AND ASK FOR CONSENT
- Presenting part
- Bulging
- Bloody show – lots of fluid and blood mixed
- Prolapsed cord
- Frank bleeding
- Meconium
- Fluid discharge
WHEN are you doing a perineal inspection?
- Pt is in 2nd stage of labour
- Hx suggestive of ROM (rupture of mucus) or cord prolapse
- Pt is near term, LOC decreased or seizure, hx is unavailable, inconclusive or indicates that labour was ongoing prior to decrease in/LOC
- Heavy vag bleeding and pt is hypotensive (in shock)
What is the ideal position for the baby to be in for labour?
Cephalic presention: the baby is positioned head-down, facing your back, with the chin tucked to its chest and the back of the head ready to enter the pelvis
97% of births are normal with this presentaiton
Occiput vs face presentation
Occiput: occipital first (back of baby’s head)
Face presentation: sunny side up - head comes out of vaginal canal first - may have lots of ripping and tearing, potential neck injuries for the baby as well
% of abnormal deliveries
1% breech
1% shoulder or labour dystocia
1% other (prolapsed cord, foot hanging, etc.)
Cardinal movements in the fetus during birth (Mechanism of Labour)
Cardinal movements: Every Darn Fool In Egypt Eats Raw Eggs
- Engagement - head is locked into the side and passed the pelvic inlet
- Descent - moving down through pelvic cavity
- Flexion: baby’s head pushes against pelvic tissue, aligning head so chin tucks into chest
-
Internal rotation: rotates his/her head and body from side to side to front to back
to navigate the changing diameters of the pelvis - Extension: where gaping and dilation starts
- External Rotation: restitution
- Expulsion: Anterior shoulder can be delivered now; once the shoulder is delivered, the next contraction the baby comes right out
Restitution
As baby is being delivered, it rotates itself to accommodate for and fit under pubic arch (rotates from face down to facing one side of mother’s inner thigh so shoulders are vertical/linear) - uterine contractions cause this to happen
this is needed because the widest space in the pevlic outlet it in the AP position
this happens during the short pause in labour after the head is born
If a baby does not restitute, what could happen?
develop complications in the delivery (such as shoulder dystocia)
What factors are you considering when making transport decisions?
- Multip (mom has delivered before) vs primip
- Hx of precipitous delivery (Means a quick birth)
- Rapid progress since arrival on scene
- Distance to closest ER
- Traffic and environmental conditions
- Onset and/or increase in vaginal bleeding
- Multiple births
- Premature labour
- Face up presentation
- Pre-eclampsia
- ASK FOR YOUR 2nd CREW
What marks the start and end the first stage of labour?
from onset of labour to full dilation of cervix
Start: when contractions are ~10min apart
- No gaping, baby is not coming out yet
- baby is not being delivered on scene
Ends:
- if nullips (mom’s first baby): >2 min apart
- if multips (multiple babies): >5 min apart (bc muscle memory, don’t need for it to be that long to change)
- and length of contractions are 30-90 seconds in duration (avg 1 min)
How are you transporting the mother who’s in the first stage of labour?
- Transport minimum Code 3
- Notify receiving facility – going to L&D
- Monitor for signs for 2nd stage of labour; prepare for delivery if becomes imminent
- Be alert for precipitous delivery in multips
How to transport the mom
- <20 weeks: whatever – position of comfort or as dictated by concurrent problems
- >20 weeks, left lateral position or supine with R butt elevated
What marks and ends the second stage of labour?
Full cervical dilation to the delivery of the baby
- Contractions <2 minutes lasting 60-90 seconds (for multips contractions can be <5 minutes in this stage)
- Urge to push/bear down with contractions
- Heavy red show visible at vaginal orifice
- Stooling – poops due to anus opening when vagina opens
- Amniotic fluid draining
- Uterus rises up in abdomen with contractions and allows mom to then pushes down
- Perineal pressure/distention (the gaping)
- Crowning
Avg length of stage 2 of labour
nullips: 50 minutes
multips: 20 mins
Fontanelles
soft spot between the skull bones of an infant - allows the skull to move and shift into the birthing canal
The 6 cranial bones a newborn has are what?
At what age do fontanelles become 100% fused?
- R and L sphenoid
- Mastoid
- Anterior
- Posterior
- 100% fused: 8 y.o.
Signs of imminent delivery
- Crowning or bulging
- Strong contractions lasting 60-90 seconds
- primips : <2-3 mins
- Multips: <5 minutes
- Urge to push/bear down
- patient says “baby is coming”
- Bloody show
- Stooling (if they poop the baby is coming)
If delivery has not occured within ____ minutes after initial assessment, consider rapid transport.
10 minutes
How would you deliver the head?
- 1 hand on infant’s head, other on lower end of perineum (don’t want vaginal tears so you give a bit of pressure)
- as top of head passes through vaginal outlet the extension of the head occurs and forehead and chin becomes visible
- check for umbilical cord - if you need to unloop it around baby, do so
- If meconium present consider wiping mouth and suctioning
How do you deliver the shoulders?
- Usually occurs spontaneously during next contraction with little manipulation
- Gentle downward pressure on head to deliver anterior shoulders
- After shoulder, rest of body can come out
- DO NOT EVER PULL ON HEAD OR NECK NEVERRRRR
Vernix Caseosa
- a white, cheese-like substance that acts as a protective layer for your baby (made of endothelial cells)
- acts like fat and protects fetus in utero in all the fluid
- just rub and massage it into the baby
What happens during post delivery (i.e. right after baby comes out)
- Gush of amniotic fluid (it is blood tinged but NOT grossly bloody)
- Hold infant supine along your arm in slight head-down position (and away from perineum) – gravitational draining
- Wipe mouth first and then nose
- Provide warmth (skin-to-skin)
- Dry baby and stimulate infant using APGAR scoring (to determine resus efforts for baby)
APGAR
a quick test performed on a baby at 1 and 5 minutes after birth
Scored out of 10, resus if score less than 7
7-10 : do not resus (but if you’re at 7, then just watch for S/S)
After baby is delivered and taken care of (wiped, dried, APGAR), what is the next step?
Clamping and cutting the cord
- wait 2-3 minutes or until cord stops pulsating
- Put the OBS Kelly clamp 15 cm/6 inches from the baby’s abdomen
- 5-7cm/1-2inches from the first clamp is the second clamp and you cut in the middle of them with OBS scissors
- if uncomplicated birth, the birth parent (secondary birth parent) can do it or paramedic
- the cord is fibrous and typically ~22 inch (50-60cm)
What marks the beginning and end of the third stage of labour?
How long is this stage?
delivery of infant to delivery of placenta
usually 2-10 mins in duration
Signs of placental separation
i.e. the placenta is coming and ready to be delivered
- Fresh show of blood at the labial margins (gush of blood from vagina) *AKA red show
- Umbilical cord lengthens (because placenta separated and drops into uterus)
- Uterine fundus rises up, becoming firm, globular (pushes it out in one fell swoop)
Placental separation is induced by what two hormones?
oxytocin
lactation hormone
How would you deliver the placenta?
- DO not pull on umbilical cord
- Gentle downward, controlled traction to lift placenta out of vagina
- The delivery of the placenta should not delay transport (you can deliver on route)
- Check the placenta for wholeness
- If you have two babies there could be 2 placentas
- Put in bag and label - NO KNOTS
Why is retained placental products bad for the mother?
Any retained placenta product can result in PE or sepsis, and death
Post-partum care with the mother
- Assess fundus and bleeding every 5 minutes for the first 15 minutes
- Place obs Pad over perineum (More than 5 pads of bleeding +/- clots = assume hemorrhage) & manage post-partum hemorrhage
- Position mother supine
- Assess uterine fundus ⇒ Soft, boggy: gentle fundal massage
- Inspect perineum for lacerations, obvious bleeding – apply direct pressure
- Encourage mother to nurse
- mother produces cholostrum – so nutritious for baby can feed up to 8 hours for 1 drop
- Massaging the fundus/uterus post partum will help shrink the uterus and we should do this!
- Breastfeeding also shrinks uterus
