Week 14: Maternity Flashcards
How does the airway change within pregnancy?
- full dentitions
- short obese neck
- breast enlargement
How does breathing change in pregnancy?
- splinted diaphragm
- splaying ribs
- increased O2 consumption required
- 40% increase in tidal volume
How does circulation change in pregnancy?
- vena cave compression
- breast enlargement
- splaying ribs
- tachycardia
- ECG changes
How can hormonal changes impact on the pregnant woman?
Tissue growth and development, controlled by the action or hormonal changes within the maternal system and interactions with hormones produced by the detal-placental complex
Define LMP
Last menstrual period
Define EDD
Estimated date of delivery
Define T or D
Term or expected date of delivery
Define CEPH
Cephalic (head)
Define BR
Breech
Define G
Gravida (number of pregnancies inc this one)
Define P
Number of times the woman had given birth (live or stillborn) P3+2, the 2nd number refers to prev miscarriages or terminations
At what point is labour at term?
27-41 weeks of gestation
When is labour considered premature?
Prior to 37 weeks (32-38)
When is labour considered extremely premature?
24-32 weeks
When is labour considered as post mature?
More than 40 weeks
What is the exact number of weeks to be full term?
40 weeks
What occurs in the first stage of labour?
- first stage of progressive cervical dilation
- timed from the onset of regular coordinated contractions
- accompanied by progressive effacement (thinning) and dilation of the cervix
When is a mother fully dilated?
At 10 cms
How is the uterus and cervix divided?
Into the upper and lower segment
What is contained within the upper segment of the uterus and cervix?
Motor muscle fibres in all directions where a contraction is commenced
What is contained in the lower segment of the uterus and cervix?
Soft and stretchy, pulled up and over out the way to allow passage of the baby
What occurs in the second stage of labour?
- fetal expulsion, from the full cervical dilation until the delivery of the baby
- contractions are strong and aided by resp muscles
- can take over an hour or as little as a few minutes in the multigravidae
What are the 4 stages within the second stage of birth?
- presentation of head
- rotation and delivery of anterior shoulder
- delivery of posterior shoulder
- delivery of lower body and umbilical cord
What occurs in the third stage of labour?
Seperation and complete exclusion of the placenta and membranes and control of bleeding from the uteroplacental circulation
What should you consider when attending a labour call?
- detect stage of labour
- deliver or not
- transfer or not
- are contractions coordinated or regular
- how do they palpate and how long
What is the management of normal labour?
- assessment
- quickly assess woman and scene upon approach
- undertake primary survey
- management
- correct any time critical features and transfer to nearest hospital
- pre alert
What is the primary survey within labour?
DR- define risks
A- airway
B- breathing
C- contractions
C- circulation
D- disability
E- equipment
F- fetus
G- gestation
H- home delivery
I- inform maternity unit
What are the external signs of labour?
- flattening of labia and perineum
- gaping of vagina
- raising if the clitoris
- distended aus
- purple colouring around anus and up the cleft
- blood/mucous
- fetal parts
- bulging membranes
Extra primary survey detail:
E- ask for handheld records/ECPR access
F- ask about fetal movement
G- ascertain the period of gestation
H- have a look for operculum, ruptured amniotic membranes, contractions, bleeding
H- external observation
What should you do if birth is imminent?
- remain on scene
- request midwife support
How do you prepare for birth?
- reassure woman,
- ensure the environment is safe/secure
- maternity bag
- maternity bag
- support woman in a comfortable position, discourage lying flat
- offer entonox as pain relief
How can you prevent rapid birth of baby?
Apply gentle pressure to the top of baby’s head, also helping to keep head flexed to allow smallest diameter of the fetal skull to be born, reducing perineal trauma
What should you not do in labour?
- do not pull
- do not remove cord from baby’s neck if wrapped around, focus on mother and pushing/positioning
What should you do when the baby is born?
- hold baby and lift towards mothers abdomen
- towel dry baby
- make initial assessment and remove any blood/mucous from baby’s face
- replace wet towels with warm towels
When should you cut the cord?
Delay cord clamping by at least 3 minutes or until it has stopped pulsating
What does purple pulsating of the cord mean?
Good
What does a white grey cord mean?
Poor
What takes place in the newborn assessment?
- assess colour, tone, breathing, and HR of newborn
- place the handheld stats probe on babies right hand
What is involved in the secondary survey?
DR- define risks
A- airway
B- breathing
C- contractions
C- circulation
D- delivered or not
E- environment
F- baby warm (atleast 3 obs taken)
P- pre-alert to maternity
