Pregnency And Childbirth

Question 1

Pregnancy-Anatomy (7)

Answer 1

Anatomy:

• Vagina
• Cervix (cervical dilation/effacement)
• Uterus (where baby and placenta grow)
• Fallopian tubes (where egg is fertilised)
• Ovaries (where eggs are stored and released 14 days into period)
• Amnion/Amniotic sack (where baby grows)
• Meconium/Meconium liquor (baby’s first stool, sometimes comes out with amniotic fluid-problem)

Question 2

First trimester

Development of mother (4)
Development of baby (2)

Answer 2

First trimester-Roots
(Week 1-12)

Mother

• Blood volume increases
• BP decreases to protect baby (10-15 by third trimester)
• Complexion reddens (vasodilation)
• No apparent stomach

Baby

• Placenta begins to develop (grows outwards-widens)
• Baby grows from 1 cell to size of palm

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Question 3

Second trimester

Development of mother (5)
Development of baby (3)

Answer 3

Second trimester-Growth
(Week 12-24)

Mother

• Heart grows and HR increases
• BP continues to decline, blood volume continues to increase
• Woman gains weight (~10kg)
• Hormonal changes (estrogen, mammary glands)
• Anatomical changes:
  
  • skeletal; hips and spine
  • respiratory organs rise (assistive breathing)
  • digestive system; constipation, frequent urination
  • vascular system; pressure on vena cava that is relieved by lying on left side.

Baby

• Baby starts to grow in amnion, umbilical cord grows away from placenta, uterus expands.
• Skeleton, nerves and organs (HR ~220) begin to develop-skin is still translucent.
• From palm size to ~20cm.

Question 4

Third trimester

Development of mother (4)
Development of baby (2)

Answer 4

Third trimester (Week 24-37/42)

Mother

• Blood volume peak (9-10 liters)
• BP, HR and weight
• RV (residual volume) decrease 30-40%
• Stomach plummets, hip restructure

Baby

• Head tilts down towards cervix
• Lungs and skin are fully developed

Question 5

Childbirth-Stages
Pre birth (3)
Birth (1)
Afterbirth (1)

Answer 5

Childbirth-Stages

1) Cervical effacement (cervix begins to open as head comes through)
2) Mucus plug comes out (small bleeding)
3) Amnion breaks fluid comes out
4) Contractions and crowning
- Contractions
1) every 3 minutes
2) for 45-90 seconds
3) strong urge to use toilet
- Crowning (10cm dilation)
5) Baby comes out head first (1 contraction) then one shoulder comes out and body turns then second shoulder and legs (2-3 contractions)
6) Minor contractions and placenta comes out.

Question 6

Birth on ambulance

9

Answer 6

Birth

1) Call ICU
2) Preparation for birth
- Turn on heating
- Wear sterile gear
- Place sheets around woman (under bottom, two sheets by each leg, one between vagina and rectum for faeces)
3) Place hand (L-shape/fist) on perineum to prevent tear (tearing on top of side of vagina is normal-episiotomy hospital)
4) Let woman do all the work! Pace the woman; breathing in between contractions, break in between baby’s exit (place hand on head).
5) As soon as head comes out #2 performs suction to give baby oxygen.
6) When baby’s first shoulder comes through, slightly lift baby to allow second shoulder.
7) Cut umbilical cord
8) Hold baby well (baby is slippery) then dry, heat and cover (chest and back, thermal blanket, regular blanket)
8) APGAR test x3 (1. Check appearance. 2.Finish rest of tests (baby calms down and vitals stabilize) 3. Final test (organized))
9) Try to avoid placenta birth. If comes out put in sterile pot.

Question 7

Problematic birth-4 Stages (10% medical assistance, 1% CPR)

Answer 7

Problematic birth (APGAR 0-3)
If APGAR fails, wait 3 minutes and perform second test. 

1) Suction and touch
2) Oxygen (mask)
3) Artificial respiration (3 seconds)
4) Full CPR (3:1)

Question 8

APGAR Test

Answer 8

Appearance (red/blue)
Pulse (<100/>100 (120-160))
Grimace (recoil/no response)
Activity (strong kicks/flaccid)
Respiration (no crying/40-60 breaths)

Question 9

Pregnancy and Childbirth complications

Pregnancy (7)
Childbirth (3)
After birth (4)

Answer 9

Pregnancy

1) hypertension
2) gestational diabetes
3) pre-eclampsia/eclampsia
4) ectopic conception
5) miscarriage
6) uterine prolapse
7) vaginal bleeding

Childbirth

1) Breech positions (frank and footling)
2) Umbilical cord around neck
3) Placental abruption

Afterbirth

1) Meconium liquor
2) APGAR failure
3) Vaginal bleeding
4) Amniotic embolism