Women's Health Exam 2 PDF | Women's Health | Pregnancy

Here is the converted markdown output of the attached document or image: # WOMEN'S HEALTH EXAM 2 Links to Resources Mentioned: * Intra partum & postpartum: [https://quizlet.com/1001428078/exam-2-intrapartum-and-postpartum-flash-cards/?funnelUUID=b2e87d1e-686e-4e5c-b6c9-a9a877e5fe6e](https://quizl...

Here is the converted markdown output of the attached document or image: # WOMEN'S HEALTH EXAM 2 Links to Resources Mentioned: * Intra partum & postpartum: [https://quizlet.com/1001428078/exam-2-intrapartum-and-postpartum-flash-cards/?funnelUUID=b2e87d1e-686e-4e5c-b6c9-a9a877e5fe6e](https://quizlet.com/1001428078/exam-2-intrapartum-and-postpartum-flash-cards/?funnelUUID=b2e87d1e-686e-4e5c-b6c9-a9a877e5fe6e) * HTN & gestation DB: [https://docs.google.com/document/d/16QUhB7Tvy4eodsBXWsKyUtcBViNyINBo/edit](https://docs.google.com/document/d/16QUhB7Tvy4eodsBXWsKyUtcBViNyINBo/edit) * Post partum care [https://quizlet.com/1001978587/exam-2-post-partum-care-flash-cards/?funnelUUID=9d54da88-9cc8-4c4e-9142-13687355a218](https://quizlet.com/1001978587/exam-2-post-partum-care-flash-cards/?funnelUUID=9d54da88-9cc8-4c4e-9142-13687355a218) ## 1. Preconception and Antepartum care * **Preconception** * Discuss folic acid supplementation to prevent neural tube defects (NTD) when attempting and during the 1st trimester. * Discuss strict metabolic control for those with diabetes or phenylketonuria (PKU). * Maintain good control of HTN, asthma, thyroid disorders, IBD, seizures, and SLE. * Maintain healthy weight, exercise; prevent HIV infection; no tobacco/alcohol; avoid pregnancy within 1 month of receiving a live attenuated vaccine (rubella). * **Diagnosis of Pregnancy** * Urine pregnancy test: qualitative, positive 4 weeks post LMP. * Serum pregnancy test: measures Beta-HCG, qualitative (yes or no) or quantitative (provides #) → can provide gestational age. * Abdominal US: used first usually, gestational sac visualized at 5-6 weeks. * Transvaginal US (TVUS): gestational sac visualized at 4.5-5 weeks, cardiac activity at 5.5-6 weeks. * PE: "quickening" * Patients initial perception of fetal movements (16-20 weeks) → feels like flutters. * Heart tones with doppler (10-12 weeks). * Chadwick's sign: bluish discoloration of cervix, vagina, and labia (8-12 weeks). * Hegar's sign: softening of the cervix at 6 weeks, widening. * **Maternal Physiology** * Earliest and most dramatic changes occur in the CV system (hyperdynamic). * CO increases by 30-50%, blood volume increases by 6-8 weeks (peaks at 45% at 32 weeks). * CO may decrease late in pregnancy due to pressure from the gravid uterus. * Venous return from the IVC can be impeded - especially in supine position, left side is best. * At term, >1/5 of CO goes through the uterus: increased risk of postpartum hemorrhage. * During uterine contractions of labor, CO increases approximately 40% > than in late pregnancy. * CO increases immediately after delivery - venous return to heart is no longer impeded by the gravid uterus, and extracellular fluid is quickly mobilized. * Increased risk for stroke or MI. * Those with weakened hearts or connective tissue disorders might not be able to handle this. * Normal (hyperdynamic) findings on PE: increased 2nd heart sound split with inspiration, distended neck veins (because of increased CO), low grade systolic ejection murmurs, HR increased by 10-15 BPM above normal. * Diastolic murmurs should always be further evaluated if found during pregnancy → send to cardiology * BP: highest when seated, lowest when lying on her side * >20 weeks gestation - managed in left lateral position to reduce aortocaval compression by the gravid uterus (or the uterus may be manually displaced). * Fundal height is around the belly button. * Lungs: 15% increase in O2 demand and 25% decrease in functional residual capacity. * Hematology: Increase in plasma volume, red cell volume, and coagulation factors (VII, VIII, IX, XII). * 1000mg of additional iron is needed. * Renal system: enlarges due to increased renal blood flow. * GI systems: stomach & intestines are displaced as the uterus enlarges. * Progesterone lowers esophageal sphincter tone → reflux (GERD). * Morning sickness (between 4-8 weeks of gestation) → related to increased levels of hormones. * Hemorrhoids can develop. * Skin changes: striae gravidarum, chloasma gravidarum, Linea nigra. * Pregnancy is considered a hypercoagulable state. * Increased to 5.5x normal risk. * Likely adaptive mechanism to reduce the risk of hemorrhage during/after delivery. * **Fetal Physiology** * Placenta: crucial point of connection between mother and fetus. * O2 & CO2 dissolve across here; uses glucose for metabolism. * Fetal blood is oxygenated in the placenta, not the lungs. * Fetal lungs are bypassed until birth. * Patent ductus arteriosus (PDA). The image is a diagram of fetal circulation. It depicts a fetus inside the uterus, connected to the placenta via the umbilical cord. The umbilical cord has one umbilical vein which carries oxygenated blood to the fetus, and two umbilical arteries return deoxygenated blood to the placenta. The diagram highlights the following structures: * Ductus venosus: Shunts oxygenated blood from the umbilical vein away from the liver and towards the heart. * Foramen ovale: Allows blood to pass from the right atrium to the left atrium, bypassing the lungs. * Ductus arteriosus: Connects the pulmonary artery to the aorta, further bypassing the lungs. * Connects the main pulmonary artery to the left branch of the proximal descending aorta. * Allows most of the blood from RV to bypass fetus fluid-filled non-functioning lungs. * Abnormal if it remains after the neonatal period. * **Foramen Ovale** * Allows blood to enter the LA from RA. * 1 of 2 fetal cardiac shunts, the other being the ductus arteriosus (allows blood that escapes to RV to bypass pulmonary circulation). * Normally closes as BP rises in the left side of the heart after birth. * If it doesn't close is an abnormality. * **Ductus venosus** * Shunts a portion of left umbilical vein blood flow directly to IVC. * Allows oxygenated blood from the placenta to bypass the liver. *There should be 2 umbilical arteries and 1 umbilical vein (there is an abnormality if these #s are incorrect) * **Antepartum care** * First Visit * History * OBGYN history, PMH, diet, meds, tobacco, ETOH, Drug use, risk assessment, physical exam, pelvic exam. * Routine labs * Blood type (ABO) & Rh factor, CBC, cervical cytology in women > 21, U/A, urine culture, Rubella titer. * STIs (syphilis, chlamydia, gonorrhea), HIV, Hep B & C, TB. * Routine Ultrasound * Fetal #, fetal lie, biometry (measures dimensions to estimate age & weight), documents fetal cardiac activity, placenta appearance & location, surveys fetal anatomy, assesses amniotic fluid volume. * Determining Gestational Age (EDD) * Estimated Date of Delivery. * Gestational Age: # of weeks from the 1st day of LMP to the current date. * Typical pregnancy: 40 weeks +/- 2 weeks. * Nagels rule: LMP + 1 year, - 3 months, + 7 days (*know how to do an example). * US (most accurate) (+/- 2 weeks): repeated after 36 weeks. The image depicts a cartoon of the NAEGELE'S RULE which states the following: to calculate the estimated date of confinement (EDC), begin on the first day of the last menstrual period, subtract 3 months and add 7 days along with one bear which symbolizes the year. * **Antenatal Evaluation** * Office visits: every 4 weeks until 28 weeks, every 2 weeks from 30-36, weekly after 36 * History at each visit: vaginal bleeding or discharge, N/V, dysuria, decreased fetal movement * Normal to have some mucoid discharge * Bloody or odorous NOT normal * U/A for glucose & protein at every visit. * PE at every pre-natal visit: maternal BP, weight, U/A for ketones, protein, glucose, assess for edema (facial more worrisome), Fetal heart tones * Fetal heart tones * Good indicator of fetal well-being. * Audible at 10 weeks gestation by US, at 8-14 weeks using a fetal doppler (normal 120-160). * Obstetric PE findings * From 18-20 weeks, assess uterine size by pelvic exam (state as the # of weeks size). * After 20 weeks, measure fundal height using tape measure. * At 20 weeks, the fundus is at the height of the umbilicus. * After 34 weeks palpate the uterus for fetal presentation * Cephalic (head down) head is hard. * Breech (bottom down) the bottom is soft. * **Prenatal Labs** * Screening tests assess the risk of having a common birth defect (this is a personal choice). * Cannot tell whether the fetus actually has a birth defect. * No risk to the fetus. * Dx tests can detect many, but not all, birth defects. * May be done instead of a screening if a couple: * \+ FH birth defect, certain ethnic, has a child w/ defect. * Available for all pregnancy women, regardless of risk factor. * Can involve a small risk of pregnancy loss (CVS, amniocentesis). * Initial assessment. * By the end of the 1st trimester: * Fetal nuchal translucency (enlargement of hypoechoic space in the posterior fetal neck, Down Syndrome) plus PAPP-A (pregnancy-associated plasma protein A) OR free or total B-hCG * Screens for trisomy 21,18 & 13 * 15-18 weeks - maternal serum AFP * Screens for open neural defects * 15-20 weeks - quad screen (serum B-hCG, unconjugated estriol, AFP, inhibin) * Done if 1st trimester screening is missed * Chorionic Villus Sampling (CVS) * For prenatal diagnosis of a genetic disorder (Down Syndrome). * Samples of the placenta are obtained for chromosome or DNA analysis. * Same info as amniocentesis but faster, low risk of fetal loss within 30 days. * Safer than early amniocentesis. * 2 methods: transcervical, transabdominal. The image depicts Amniocentesis. It shows a needle being inserted into an amniotic sac through the abdomen. A chorionic villi is labeled. * Amniocentesis * Possible after 11 weeks gestation → procedures performed before 15 weeks are associated with fetal loss. * Common indications: prenatal genetic studies, assessment of fetal lung maturity. * Withdraws amniotic fluid from a uterine cavity by needle via the transabdominal approach. * Assessment of Fetal Well-Being * Subjective - fetal movements felt by mother (kick counts). * 10 fetal movements during 12 hours of normal activity. * 4 movements in 1 hour when the mother is at rest. * Objective - problems suspected or with multiple risk factors, fetal monitoring tests: * Non-stress test (NST) - noninvasive method, records baby movement & heartbeat in response to contractions by the use of an external monitor (done after 26-28 weeks or prn). * External transducer monitors FHR in response to fetal activity (fetal heart tracing). * Reassuring: >2 HR accelerations (15 BPM above the baseline, lasting 15 seconds) in 20 minutes. * If the NST is abnormal, move on to: * Contraction stress test (CST) - after an abnormal NST (after 34 weeks gestation or prn). * Oxytocin maybe used (Oxytocin Challenge Test (OCT), measure FHR in response to contraction. * Biophysical Profile (BPP)- uses US during a NST to evaluate a fetus * Used more often than CST * Recommended for at risk of pregnancy loss, not routine * Goal- prevent pregnancy loss and detect fetal hypoxia * Usually done after 32 weeks * assesses: fetal breathing; movement; tone; & amniotic fluid volume * VEAL CHOP for Fetal Acceleration * Variable * Early Accelerations * Late * Cord Compression * Head Compression * Okay * Placental Insufficiency * Patient Education * Nutrition: weight gain between 25-35 lbs, supplemental iron required, pica (often associated with anemia). * Air travel ok up to 36 weeks - avoid long periods of inactivity. * Common Symptoms * HA, edema, N/V (hyperemesis gravidarum), heartburn, constipation, fatigue, leg cramps, back pain, varicose veins, hemorrhoids, vaginal discharge. ## 2. HTN and Gestational Diabetes in Pregnancy * **Hypertension in Pregnancy** * Transient HTN * HTN occurring in late pregnancy without other features of preeclampsia & with normalization of BP postpartum (PP). * Patho is unknown - may be a forerunner of chronic HTN later. * Chronic HTN * BP > 140 mm Hg systolic &/or 90 mmHg diastolic. * Before pregnancy or before 20 weeks of gestation or use of antihypertensive med before pregnancy or persistence for >12 weeks after delivery. * Management: goal to reduce the risk of CV and cerebrovascular events. * 2 criteria * Mild: SBP 140-159, DBP 90-109 * Severe: SBP > 160, DBP < 110 * Treat- MC labetalol (can also use methyldopa or nifedipine or hydralazine) * Medication is reserved unless severe: Systolic >160 or Diastolic >110. * Major risk- development of preeclampsia or eclampsia later on. * Pregnancy-Induced Hypertension (PIH) * Aka gestational HTN * 2nd half of pregnancy after 20 weeks. * No proteinuria * Develops in * 5-10% of pregnancies, 30% multiple gestations, 50% progress to pre/eclampsia. * Causes 20% of maternal deaths, Associated w/ * perinatal M&M for mother and fetus. * Pre-eclampsia * New onset HTN with proteinuria after 20 weeks gestation. * Mild: SBP > 140, DBP > 90, and proteinuria 300 mg in 24 hr urine. * Severe: SBP > 160 or DBP > 110 and > 5 g protein in 24 hr urine. * Risk factors: nulliparous, >35 yrs, FMH of eclampsia, pre-existing HTN, renal disease, multiple gestation, pre-gestational DM, obesity. * S&S: HA, visual disturbances (blurred vision or spots-scotomata), weight gain, edema (especially in hands or face), elevated BP, proteinuria. * Management of mild: * Prior to 37 weeks: expectant management, frequent maternal & fetal evaluation, rest, monitor, testing for fetal growth restriction twice weekly, assess amniotic fluid every 3 weeks. * At or beyond 37 weeks: induce labor or C-section. * Management of severe: * $MgSO_4$: loading dose followed by maintenance, monitor therapeutic level. * Titrate hydralazine to acceptable BP. * Delivery is the ultimate Rx- * At or beyond 34 weeks, induce labor or C section. * Before 34 weeks, hospital admission with expectant management if the mother is stable and the fetal condition is reassuring. * HELLP syndrome * Preeclampsia with: * Hemolysis, Elevated Liver enzymes, Low Platelet count. * Life-threatening condition, occurs with severe preeclampsia or eclampsia. * Usually occurs before the 37th weeks of pregnancy but can occur shortly after delivery. * S&S: HA, worsening N/V, RUQ pain/tenderness, fatigue, malaise, visual disturbances (usually subsides within 2-3 days of delivery). * Rx: delivery is the best therapy * >34 weeks delivery, natural or Caesarian. * <34 weeks - same treatment as severe preeclampsia * Complications: placental abruption, pulmonary edema, DIC, adult & infant respiratory distress syndrome, acute renal failure, intrauterine growth restriction. * Eclampsia * Presence of convulsions with preeclampsia that are not explained by another neurologic disorder. * Usually occurs within 24 hours of delivery. * Management * Seizure precautions - protect airway; pulse of oxygen; O2 with a face mask, fetal monitoring. * BP with hydralazine &/or labetalol. * Usually self-limited: $MgSO_4$ IV with seizures. * Await delivery until the seizure subsides. * Drugs to avoid in Pregnancy * ACE inhibitor, ARBs, direct renin inhibitors. * Options for breastfeeding mothers * B-blockers & A/B-blockers (labetalol, propranolol, metoprolol, AVOID atenolol & acebutolol). * CCBs - diltiazem, nifedipine, nicardipine, verapamil, AVOID amlodipine. * ACE inhibitors - captopril, enalapril. * Diuretics are compatible but may reduce the supply. * **Gestational diabetes** * Consider induction in well-controlled patients without complications at 38-39 weeks. * The lifetime risk of developing diabetes after pregnancy increases to >50%. * Glucose tolerance screening 2-4 months post-partum (60-90% recurrence in subsequent pregnancies). * Children are 8X more likely to develop T2DM & obesity in teens or early adulthood. | Clinical features | Usually asymptomatic | | :--------------- | :----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Risk factors | Obesity (BMI >25) Personal or FH of DM, previous GDM Advanced maternal age, non-white ethnicity | | Patho | Insulin resistance occurs during pregnancy due to placental secretion of hormones. Cause postprandial (after eating) hyperglycemia & carbohydrate intolerance; allows the fetus to consume more nutrients Can cause lower fasting blood glucose levels; the pancreas can compensate here. GDM develops when the pancreas cannot compensate for insulin resistance. Due to Beta cell deficits. | | Testing | Risk factors & undiagnosed DM at 1st prenatal visit (do urine, not blood). Women are without DM: at 24-28 weeks Women with GDM: 4-12 weeks postpartum Women with H/O GDM: lifelong screening for pre/diabetics at least every 3 years | | Lab studies | Screen at 24-28 weeks 50-g 1 hour oral glucose challenge. Draw blood after 3 hours: If > or equal to 130 mg/dL requires 3-hour GTT Requires 100-g loading dose; Diagnosis is positive if 2 of 3-hour values are increased Screen high-risk patients earlier | | Dx | GDM requires at least 2 of these values Fasting >95 mg/dL, 1 hr: >180 mg/dL, 2 hr: >155 mg/dL, 3 hr: >140mg/dL | | :----- | :--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Rx | Lifestyle modifications best: diet and exercise Insulin- First line therapy Frequent blood sugar monitoring (4x daily), daily injections or continuous sc infusions Goal: FBS <95, 1 hr postprandial <140, 2 hr postprandial <120 | | Risks | Mother Increased rate of C-section, spontaneous abortion, intrauterine fetal demise, stillbirth, preeclampsia, polyhydramnios (increased the risk of placental abruption, preterm labor, PP uterine atony), infection Fetus Macrosomia (big baby), shoulder dystocia, neonatal hypoglycemia after birth | | Management | Strict control of glucose levels Exogenous insulin PRN (monitor pts at 1-2 wks to adjust insulin) Oral hypoglycemia agents (new) Home glucose monitoring (fasting should be <95) Monitor patients at 1-2 week intervals to adjust insulin PRN | ## 3. Intrapartum & postpartum care * **Stress and Pregnancy** * Stress hypothesis for perinatal outcomes - focuses on 2 types & time periods of psychosocial stress * Acute stress during pregnancy and lifetime exposure to stressors prior to conception. * Acute perinatal stressors may be pregnancy-related anxiety or major life events. * Pre-conceptional stressors - a major life event that occurred unrelated to pregnancy (Can be chronic). * **Disparities Statistics** * Non-Hispanic black women experience maternal deaths at 3-4X that of white women. * Half of all pregnancy-related deaths were caused by hemorrhage, CV & coronary conditions, cardiomyopathy, pre/eclampsia, embolism, or infection. * **Changes of Late Pregnancy (Intrapartum)** * Uterine contractions increase in strength and frequency * Braxton-Hicks contractions * "Lightening" * Shape of changes, sensation that the baby is lighter. * Fetal head descends into the pelvis - breathing may improve, need to urinate more * Ruptured Membranes (ROM) * Sudden gush of liquid or constant leakage of fluid (Water broke). * Bloody show * Passage of blood-tinged mucus, the cervix begins to thin (effacement), mucus plug is expelled along with bleeding from small blood vessels. * Cervical effacement is common before true labor - the internal os is drawn into the lower uterine segment, thinning. * True Labor * Regular, painful uterine contractions, causing cervical dilation and birth. * **Braxton Hicks VS True Labor** | Braxton Hicks Contractions | True Labor Contractions | | :-------------------------------------- | :------------------------------------------------- | | Not associated with progressive cervical dilation | Associated with progressive cervical effacement & dilation | | Shorter, less intense | Increasingly intense, frequent | | Discomfort in the lower abd, groin | Felt over uterine fundus with radiation to low back & low abd | | Relieved by ambulation/hydration | | * **Labor** * Most patients undergo spontaneous labor between 37-42 weeks. * Go to the hospital: contractions every 5 mins X 1 hour, water break, significant bleeding, a significant decrease fetal movement. * Initial evaluation * Leopold maneuvers - a series of 4 palpations of the uterus & fetus through the abdominal wall. * Aids in determining: * Fetal lie: the relation of the long axis of the fetus to the maternal long axis, longitudinal is the more common presentation * Presentation: portion of the fetus lowest in the birth canal (breech or cephalic). * Position: the relation of the fetal presenting part to the right or left side of the maternal pelvis. * Fetal heart tones * Reassuring patterns: absence of late or variable decelerations, moderate FHR variability (6-25 BPM), age-appropriate FHR accelerations. * Non-Reassuring: absent/minimal variability with decelerations or bradycardia, recurrent late or variable decelerations, bradycardia: FHR<110 BPM. * Rx: * Variable decels - put mom in the knee-chest position (gets the baby's head off the cord) * Early decels - the baby is descending into the pelvis, continue to monitor. * Accelerations: normal reassuring * Lat decel - worrisome, resposition mom, IV fluids, dc or decrease oxytocin, admin tocolytic to decrease contractions * Vaginal exam * Determine the degree & consistency of effacement & dilation of the cervix, not done with premature ROM or vaginal bleeding. * Station * Level of the fetal presenting part to the level of the ischial spine * Zero station - the presenting part has reached the ischial spines (engaged). * \+1-\+5 station: the presenting part is moving into the introitus. * Labor & delivery * Management: * VS every 15-30 mins. * Continuous fetal monitoring in high-risk pregnancy or following the administration of analgesics or anesthetics. * NPO (ice chips allowed). * Pain Management * Non-Pharm approaches * Epidural Block: local anesthetic \+ opioid, admin via epidural route using continuous IV infusion pumps. * Spinal Anesthesia: more rapid onset than epidural but short-lived, preserves ambulation. * Combined Spinal-Epidural: epidural catheter if delivery has not occurred before the intrathecal dose wears off. * Local Block: BL pudendal nerve blocks, used as a supplement for epidural analgesia. * General Anesthesia: used with complications if epidural or spinal isn't in place. Stages of labor stages * 1st stage: Painful uterine contractions result in cervical dilation &/or effacement * Between onset of labor contractions to full cervical dilation (10cm) * Latent phase * Active phase * 2nd stage: Complete cervical dilation to delivery of the fetus * Passive phase: complete cervical dilation to active maternal pushing * Active phase: From active pushing to actual delivery * 3rd stage: Postpartum to delivery of placenta * 4th stage: 1-2 hrs Post-delivery, the mother is assessed for complications (highest risk here) * Cardinal movements of labor (mechanisms of labor) * Changes in fetal positions as passes through birth canal (vertex position is present in the most full term). * Engagement, flexion, descent, internal rotation, extension, external rotation/restitution, expulsion. * Eval of placenta - spontaneously extrudes * Examined to make sure intact - any pieces of placenta must be extracted * Incomplete delivery of placenta can lead to hemorrhage pP, infection, DiC or sepsis * Umbilical cord should have to arteries, 1 vein * Eval maternal blood loss: palpate uterine funds for firmness Or atony.Inspect and repair laceration * **Postpartum (PP) care** * Maternal care * Palpate the uterus to assess tone * IV oxytocin (Pitocin) - ensures uterine contraction & involution. * Involution- return of the uterus to nonpreg state (normal size w/in 4-6 wks) * Perineal Pads applied * Monitor amount of blood and the mother's BP for hours of post-delivery to assess blood loss. * P hemorrhage is acommon cause of death with in 24 hours * changes PP * Puerperium: 6-8 weeks after birth, * lochia : heavy X 2/3 days, last several wks * lochia rubra is is like the menses for bleeding * lochia serosa lessblood * lochia alba is is kind of like a whitish dicharge * cervix: os appears slit-like * Average time to ovulation: 45 days in non lactating, 189 in lactating * walls abd- striae gravidarum, disastasis retri- sepertation of rectus muscles and facia * care * hoslital stayt: 48 hrs after vaginal ,96 after C Ambulation encouraged ASAP * Breast engorgment :ice packs ,analgesia ,bra, discourage manual expresssion of milk if mother doesnt want to brest feed * Complications: is blocked milk duct Mastits breast abcess * perineal care: NSAIDs, ice packs, topical anesthetics & Sitz bath 24 hrs after delivery * Contraception OC might inhibit milk supply, progestin only * is "safe" for breastfeeding * Begin at 3 weeks if not breastfeeding, 6 weeks if breastfeeding * IUD 4-6 weeks post partum * Anxiety and depression *pp: Blues *70-80%* of women, abates in *1-2 weeks* is P depression10% of women, lasts weeks to months * pp pschosis 1-4 wks after chillbirth overt presntation of bipolar that coincides shifts hormonal occuring after delivery * Metritis (endomyometritis, endometritis, metritis w/ cellulitis) - infection in truerine cavity & is tissue addajcent ascending infecyion from the genetial tract; * MC infection if there it is a C-section and polumicrobial, anaerobic * S and S- fever, uterine tenderness * Top DDx for fever after birth * rx- IV, a bx prophylaxis and is section C * fu after 6 weels Discussion: breastfeeding menstraution ,sex, return to worrk, mnetal state * PE bimanual check-check is involation of uderus ,pap smeaer * evalation and the infant * Wipe and you can mucus from mouth and if suctioning unncessart APgar SCORE 1 and 5 mints * you have to is clamp is cut cord keep is baby warm, PE, skin to skin, Kangaroo (incubators for preemies)i llotycin anrtibiotics * you put your the plase to get newborne is t prevent eys (opthalmia neonatatum) effective with chlyamdia Gonrrhea and E coli * breastfeedingi * demand feeling you are going recc 8-12 24hrs. avoid aritificial is nipples * colostrm:smail amunts it and few,day ,slowly and you replaced by milk reocmmended is exculsively 6 months * benfits decreasd ear infection, improve maternal and oxytocin is released the involution accelerat * ci of 3 ps Hiv the 3 ps; labor what in and at * **Abnormal Labor and Postpartum Hemorrhage** * The 3 Ps * When labor abnormality is diagnosed, the 3 Ps should be evaluated * **Powers, Passenger, Pelvis** * Dystocia- difficult labor * Abnormally slow progress of labor *MC prob- dysfunctional uterine contractions resulting in prolonged labor. Powers -* strength, duration & frequency of uterine contractions * Occur every 2-3 mins, the uterus is firm upon palpation, last 40 -60 sec * Measured by- external tocodynamometry, intrauterine pressure catheters (IUPCS) Passennger: the estimate the weight, and the increased the greater indication of shoulder dystocia with weight to be 400 * Evaluate the longitudinal fetallie transverse or * Presentation, vertex breach ( faces presentation of 100 sectiom * BReah rate and M mater and fr us higher * Leopold manuevers,, Pelvic exam * RX : EXternal Cepahic Version. E CV > attmpts tp manially move ba by * suceesfull in seletec cases: *statio * risk 40 labor artifical of mmeabrnes Footling 37 bceesh ays and to examine the cor d prolapse, rope like cord felt a Vaginal exam. RX Digitally Elevate presenting emergentyc section : * **Pelvis** *aka Passage** * Progress * descent preseniotng part labour the to test of pelvic adeacuacy * Caphoeloelvic diproptiondity size the to the presenting * Section Consider o **Abnormal Labor anagemnt of protration ad arrest** * the Proacted Stage: latment and observationed, Iv oxytocin. active pahase monitor. * unmitited * motehr and and well support is and support birthing postitiond * isk prolngd 1 labor Materianl infection * to with haamorhageble and of Me conium sindroma *thick greenish sustance linces is of the fetal first *Before labor let may press m ecomium into amniotic flujd ***LAbor induction -im *Stimulation of uterine contractions before labor begins on its own, AIM is to achieve vaginal birth *indications ,concern for maternal is it orfetal the is labor it partially effeaced used it from term pregnancy prom and fetal restrucitons, olygohydrsmn