Pregnancy and Childbirth Flashcards
Uterine Changes
Uterus enlarges from 70g to 1000G by term 3
blood flow greatly increases from 60 to 600ml/min
haemorrhoids and varisocse veins more commin due to decreased blood flow to legs
Cervical Changes
Ebdicervical glands secrete thick musous -> musous plug
Cervix softens
Increased uterine blood and lymphatioc flow causes pelvic congestion and odema (CHADWICKS SIGN)
Vulva and breast tissue changes
Vagina increased blood supply, connective tissue is loosend -> facilitates the passage of the newborn
Breasts increase in size and tenderness
colostrum the precuroser to breast milk is produced in the third trimester
Breast milk provides the newborn with essential nutrients and immunoglobins
skeletal changes
Progesterone hormone relaxes ligaments and muscles
Altered centre of gravity, as gravid uterus causes women to lean back -> increased lordosis due to increased interior load
cardiovascular changes
Blood volume is increased by 30-40% by third trimester, pregant women can lose 30-40% of blood before showing signs of shock
resting HR (by 15-20)bpm and internal CO (by 1-1.5L) increase
Systolic BP can fall by 10-15 mmHg in 2nd trimester but RISEs in the third
Spinal position can lead to inferior vena cava obstruction which will decrease cardiac output
Haematological changes
Increase in blood volume
Expanded blood volume
physiological amenia (decrease in red blood cells)
mild neutrophilia (increase WBC)
Mild prothrombic state (hypercoaguability -> Increased risk of blood clots)
Respiratory Changes
Diaphragm is elevated by 4cm (results in mild dyspnoea while supine)
Tidal volume increases by 40% but residual volume decreases by 25%
Barrel chest
O2 demand is increased
Gastrointestinal Changes
displacment od inta-abdo structrues and delayed gastric mobility leads to an INCREASED RISK OF ASPIRATION
Intestines are displaced to upper abdo
decreased GI mobilty & tone + prolonged gastric emptying + relaxation if pyloric sphincter = heart burn & constipation
urinary changes
Bladder is displaced into the abdo, makes it more suscepitable to trauma
Increased glomeraur filtration rate (GFR) and renal blood flow by 20%
Increased renin secreation
Frequent urination
Endocrine System Changes
Oxytocin is produced onmasse in the onset of labour, produced throughout pregnancy
WHat is the purpose of the Follicle Stimulating Hormone?
to stimulate follicles to move egg
What is the purpose of the Lutenzing Hormone (LH)
The LH sycronzises the menstrual cycle
WHat is gestional diabetes Mellitus? (GDM)
Gestional diabetes Mellitus is diabetes mellitus that occurs during gestation. The increased glucose in the bloodstream is a result of pregnancy hormones released by placenta that impact the action of insulin
What are the metabolic changes in pregnancy
Increase in fat stores
- > increase of nurtients
- > increase in body mass
Important questions to ask in history taking of the pregant patient?
Previous Preganancies? Prior c-sections? Pairty and Gravidity of the patient? Complications/problems with previous pregnancies? Length of previous labour
Questions to ask about current pregnancy?
How many weeks pregnant are they?
single or multiple pregnancy?
have the membranes ruptured, if so when and what was the colour of the amniotic fluid?
Are they having contractions? If so assess frequnecy and duration
Do they have the urge to push?
have you felt fetal movements? If so are they normal?
What is a nulliparous women?
Never given birth before
How many times has a primagravdia patient been pregnant?
Just once
How many times has a primaparious women given birth?
Just once
How many times has a mutligravdia person been pregnant?
More then once
HOw many times has a primaparous women given birth?
Multiple times
How many times has a grand multipara or grand multigravida patient been oregnant/birthed?
At least 5 times
What is the Latent Stage of the first stage of labour?
The latent stage is the ifrst step of the first stage of labour, baby is still in womb and contractions are pushing baby to cervix
What is the active stage of the first stage of labour?
The active stage is teh second step of the 1st stage of labour. In this stage the cervix is effaced (flat and dilated to 7-10cm)
What is the contraction pattern in the first stage of labour?
Aiming for contractions every 2-3mins lasting 60-90 seconds
How does the cervix dilate?
As the baby’s head is pushed closer and closer, this will stretch and force it to dilate
What does care in the first stage of labour involve?
try and promote normality and calm as physiological impact of anxiety will result in catecholamine & adreline release. Which will have a large number of impacts, such as decreased; uterine blood flow, contractions, placental blood flow, o2 to baby and will increase the duration of the first stage
What are the characteristics of a normal birth?
Baby in vertext postion, gestation 37-42 weeks, Mother with low risk of complications
What are the three concepts of a successful birth?
The passage - the pelvis & birth canal need to be big enough and stretch wide enough to fit the baby through
THE POWERS - the uterine muscles must contarct hard enough to force baby down birth canal
THE PASSENGER - The baby is in vertex postion so the head is delivered first
What is the significance of the vertex postion?
The head is birthed first, as the head is the largest part of the fetus (if the head can get through so can the rest of the body)
ALSO the skull bones are not fused together yet and are still plates that shift to accodmate birth
What are the 7 Cardinal movements of labour?
- Descent: Force us exerted on fetus by contractions, fetus begins it decent down the birth canal
- Flexion: The head piviots at neck as the head meets resitence of the birth canal
- Internal rotation of the head: The head turns 45 degree to meet change in pelvic diameters
- Extension: as head descends pelvic cavaity, head is extended and visable (crowning)
- Restitution: head is freely mobile and moves to match shoulders which have just entered pelvic brim
- Internal rotation of shoulders: shoulders rotate w/head so it is now facing inside of the thigh
- Lateral flexion: The shoulders are brn and the rest of the body will soon follow
What does the second stage of labour encompass?
From fully dilated (urge to push) through to the birth of the neonate
What are the signs of an imminet birth?
urge to push Contracrions are lengthing and are occuring closer together baby's head on view urge to use bowel/bladder perineal bulging/stretching presenting part on view crowning
What is care in the second stage of labour based on?
The progress and desecnet of the presenting part and supporting the mother
What position should the mother be in?
Sims postion to offset supine hypotension
Place a pillow under L) hip
What are the potenional complications of a prolonged second stage ?
Placental oxygen may be decreased and baby may be born a ‘little flat’ from the distress ensure adqeuqte ventillation
Why do we encourage panting when the baby is crowning?
Slows the baby’s head, prevents explosive delievry of the baby and potential tears
what does the presence of meconium indicate?
fetal distress, is present on baby wipe face and nose to avoid digestion
What is the importance of skin to skin contact after birth?
Stimulates the release of oxytocin. Encourages contractions to stem the bleeding of the placental bed
What is the third stage of labour?
The birth of the placenta, this stage should be very passive and assistance only given if needed
What are the signs of the birth of the placenta
Fresh show of blood, contractions, lengthing of the cord,
What is the goal of delayed cutting of the cord?
To allow the baby to receive the maximum amount of blood and nutrients from the mother. Cut when it has stop pulsating
At what lengths are the clamps placed on the cord?
Placed at 10, 15 and 20 cm from the baby, cut between 15 and 20
What are the basic components of post birth care of the baby?
Clamp cord
Dry and provide tactile stimulation of the baby
Assess airway and resp of the baby
APGAR assessment at 1/60 and 5/60 post delivery
Ensure baby is warm, dry and wrapped including head
What is the importance of tactile stimulation?
It stimulates respiratory activity
What does APGAR stand for?
Apperance of the baby Pulse/perfusion of the baby Grimmace of the baby - face/cry Activity of the baby - a flat baby is a dead baby Respirations of the baby
what is the best apgar score?
Each section can get 0, 1 and 2 points. A happy healthy baby will get 10 points.
A score of 7-9 indicates a slight depression
scoure of 4-6 indicate moderate depression
score of 0-3 indicatye serve depression
Babies less then 6 normally reqire resus
What are normal vaules for the neonate?
weight: 3.5-4kg Hr: Greater then 100bpm (less then 60 require resus) RR: 40-60 bpm BP systolic": 60-70mmhg Blood volume: 80ml/kg
Signs of compromised neonate?
Poor muscle tone Depressed resp. rate Bradycardia Tachypnoea Cyanosis (should be purpule on birth and pink after a few)
