PBL 2

Question 1

define antenatal care

Answer 1

multidisciplinary care during pregnancy

Question 2

defne pregnancy duration

Answer 2

usually 37 to 42 weeks for full term births

Question 3

define premature birth

Answer 3

before 37 weeks

Question 4

what does parturition mean

Answer 4

labour

Question 5

describe antenatal care

Answer 5

Multidisciplinary care coordinated by midwife and GP – regular appointments, tests, screenings, scans

Regular pattern of care for uncomplicated pregnancies

Generally seen every 4 weeks until 28 weeks gestation, then every 2 weeks until 36 weeks, then weekly until delivery

Complicated or high risk pregnancies – seen more often

Question 6

describe what happens in the onset of labour

Answer 6

• Passing of mucus plug
• Spontaneous rupture of membranes (SROM)
• Regular painful contractions (different to Braxton-Hicks contractions)
• Cervical dilation
• Backache

Question 7

describe the stages of labour

Answer 7

Stage 1 – from onset to 10cm cervical dilation
- Latent phase – 0-4cm dilation
- Active phase – 4-10cm dilation
Stage 2 – from full dilation to expulsion of foetus
Stage 3 – from expulsion of foetus to expulsion of placenta

Question 8

when do the stages of labour finish

Answer 8

• Stage 1 usually takes around 6-12 hours from start to finish for first pregnancies, often less for subsequent pregnancies
  >1cm/hr dilation
• Stage 2 usually takes up to 2-3 hours
• Stage 3 usually around 20-30 mins

Question 9

what is required for successful labour

Answer 9

Coordination of 3P’s required for successful labour
Power – uterine myometrial contraction
Passage – birth canal
Passenger – foetal size, positioning and presentation

Question 10

what are the cardiovascular changes in pregnancy

Answer 10

INCREASED: Total blood volume, blood pressure, heart rate (and therefore cardiac output), coagulability
DECREASED: Total peripheral resistance
Increase in blood volume can result in dilutional anaemia for some of the pregnancy

Question 11

why an you not lie a pregnant person on their right side

Answer 11

Distended uterus compresses vena cava and impedes venous return to heart
Decreases preload and therefore stroke volume
Decreased cardiac output
Circulatory shock
(Sarah lying on her back can have similar effect)

When placing pregnant person into recovery position, ALWAYS LIE THEM ON THEIR LEFT SIDE

Question 12

what are the maternal well being tests

Answer 12

• weight
• bp
• urinalysis for protein
• blood and glucose
• ultrasound scan
• rubella
• ABO and Rh group and screening for antibodies

Question 13

what are the foetal well being tests

Answer 13

• fetal ultrasound to confirm viability
• number
• growth
• normal anatomy
• serum screening and nuchal scan for downs syndrome

Question 14

how much does compression of the IVC reduce CO

Answer 14

by 25-30%

Question 15

how much does each uterine contraction increase CO by

Answer 15

15-20%

Question 16

describe how blood pressure changes during pregnancy

Answer 16

• systolic blood pressure does not change whereas diastolic pressure does change in pregnancy
• blood pressure is lower when she is lying down than when she is sitting
• when a pregnant women lies down the uterus obstructs the IVC thus reducing CO, this can make the women feel dizzy and nausea and faint due to less blood supply to the brain
• move the women to the left and this reduces pressure o her IVC and thus returns CO and output to the head