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LO 1.1 Contracep on efficacy and types Temporary Contracep on Abs nence – 100% effec ve in preven ng pregnancy and STI’s. However, most couples believe that their sexual rela onship adds to the quality of life. Therefore, abs nence is...

LO 1.1 Contracep on efficacy and types Temporary Contracep on Abs nence – 100% effec ve in preven ng pregnancy and STI’s. However, most couples believe that their sexual rela onship adds to the quality of life. Therefore, abs nence is rarely an op on the couple will consider. Hormonal Contracep ves – include one or more of the following effects: preven on ovula on, make the cervical mucus thick and resistant to sperm penetra on, make the uterine endometrium less hospitable if fer lized ovum does arrive. o Oral Contracep ves (“The Pill”) – oral contracep ves are a popular, highly effec ve, and reversible method of birth control. LO 1.2 Obstetrical history and terminology Gravida - any pregnancy, regardless of dura on, including current pregnancy Nulligravida - a woman who has never been pregnant Primigravida – first me pregnancy Mul gravida – 2 or more pregnancy Parity - # of pregnancies that have reached 20 weeks Primipara - a woman who has given birth to 1 child or is pregnant with her first child Mul para - a woman who has given birth to 2 or more children past the age of viability Nullipara - a woman who has not given birth to a child who has reached the age of viability Abor on - premature termina on of pregnancy (spontaneous or induced) Gesta onal age (GA) - prenatal age of the developing fetus Age of viability - a fetus that has reached the stage where it is capable of living outside the uterus (usually 22 weeks gesta on) GTPAL G - Number of all pregnancies (including current one) T - Number of term infants (>37 wks) P - Number of preterm infants (>20 wks; 30kg/m² o Maternal age >35yrs o Hx of GDM or family hx of DM o Cor costeroid medica on Treatment: Diet modifica ons Monitoring of blood glucose Monitoring of ketones Insulin administra on Exercise Fetal assessments Care during labour Care of the newborn Gesta onal hypertension Pregnancy/Labour complica ons Hyperemesis Gravidarum o Defined as excessive nausea and vomi ng that can significantly interfere with food intake and fluid balance. o It is present in about 0.5 – 2% of women, usually between 10 and 20 weeks o Manifesta ons:   Persistent nausea and vomi ng - o en with complete inability to retain food and fluids  Significant weight loss – more than 5% of pregnancy weight  Fetal growth may be restricted  Dehydra on – dry mucous membranes, decreased turgor, decreased u/o, high serum Hct  Impairs perfusion of the placenta  Electrolyte & acid-base imbalance  Ketonuria Bleeding Disorders of Early Pregnancy o Abor on - the spontaneous or inten onal termina on of a pregnancy before 20 weeks. Up to 30% of pregnancies end in spontaneous loss by 20 weeks o Ectopic pregnancy - Occurs when a fer lized ovum is implanted outside of the uterine cavity  95% occur in the fallopian tube  May result from hormonal abnormali es, inflamma on, infec on, adhesions, congenital defects or endometriosis  A woman who has had a previous tubal pregnancy or failed liga on may be more at risk for an ectopic pregnancy Clinical signs: Lower abdominal bleeding, light vaginal bleeding If ruptures, severe lower abdominal pain & signs of hypovolemic shock o Hyda diform mole  Gesta onal trophoblas c disease also known as molar pregnancy  Occurs when the chorionic villi increase abnormally & develop vesicles or small sacs that resemble grapes  May be a complete mole and contain zero fetus, or par al where part of the placenta has the characteris c vesicles  May cause hemorrhage, clo ng abnormali es, hypertension, & poten al later development of cancer (choriocarcinoma) Signs of Hyda diform mole: Bleeding Rapid uterine growth (greater than expected for gesta on) Failure to detect FHR Hyperemesis Gravidarum Unusually early development of GHTN Higher than normal levels of hCG  "snowstorm" on u/s with no evidence of a developing fetus Bleeding Disorders of Late Pregnancy o Placenta previa - Abnormal implanta on of the placenta in the lower uterus  low lying (approaches but does not reach the cervical opening)  par al (par ally covers the cervical opening)  total (completely covers the cervical opening Postpartum complica ons  Infec on – placental site is near the nonsterile vagina  Hemorrhage – lower uterine segment does not contract as effec vely to compress bleeding vessels o Placental abrup on - The premature separa on of the placenta from the uterus. This is a medical EMERGENCY and may cause fetal and/or maternal death  Can be caused by: cocaine use, hypertension, trauma to the abdomen  May be par al (marginal or central) or total  Manifesta ons:  Bleeding along with lower back pain (most or all bleeding may be concealed behind the placenta)  Tender & firm uterus  Uterine irritability - frequent cramp-like contrac ons May be complicated by disseminated intravascular coagula on (DIC)- a complex disorder that can cause further complica ons Hypertensive Disorders o Hypertension that exists before pregnancy or develops before 20 weeks' gesta on is pre-exis ng or chronic hypertension o Gesta onal hypertension is a transient form of hypertension that occurs a er 20 weeks' gesta on but can become chronic later in life o Hypertension during pregnancy can cause vasospasm impeding blood flow to the organs including the placenta o Severe HPD can cause complica ons in the CNS, eyes, urinary tract, liver, GI system, and blood clo ng func ons  Pre-eclampsia - An increase in blood pressure a er 20 weeks' gesta on with proteinuria present Risk Factors include:  Pregnancy in extremes of maternal age (adolescents or woman >40)  Diagnosis of preeclampsia in a previous pregnancy  Obesity, pre-exis ng hypertension  Diabetes or renal disease   Nulliparity or pregnancy with a new partner  Mul ple gesta on  Pre-exis ng autoimmune disorders Non-severe: NBP >140/90 mmHg x2 readings 15 mins apart Proteinuria 1+ Prescence of 1 or more adverse condi ons (headache, visual problems, epigastric pain, elevated crea nine, low platelets) Severe: NBP >160/110mmHg x2 readings 15 mins apart Proteinuria 2-3+ on two separate specimens Prescence of 1 or more severe complica ons ( severe headache, blurred vision, photophobia, blind spots, low platelets(5mins apart Dura on 30-45 seconds Mild to moderate intensity Maternal Behaviours Alert and talka ve Happy and excited Welcomes diversions Thirsty May be at home, rests or sleeps if possible o Ac ve phase  Approximately 2-8 hours   Cervix dila on is 4-8cm  ROM  Effacement of cervix  Contrac ons 2-5 minutes apart Dura on 40-90 seconds Moderate to strong intensity Maternal Behaviours Less social, apprehensive or anxious Focused on breathing Facial flushing and perspiring May request pain relief Fears losing control, irritable Rejects support person Restless and tremor of legs o Transi on phase  Cervix dila on 8-10cm  Contrac ons 1-3 minutes apart Dura on 60-90 sec Strong intensity  Maternal Behaviour/Observa on Nausea Swea ng Trembling or shaking Second Stage o Pushing of Fetus  30 minutes to 2+ hours  Cervical dila on is 10cm  Contrac ons every 2-3 minutes Dura on 60-80 seconds Strong intensity  Ends with birth of infant  Maternal Behaviours/Observa ons Bulging perineum Mother may defecate Uncontrollable urge to push States “baby is coming” or “get it out!” Exhaus on a er each contrac on Excitement for imminent birth Third Stage o Expulsion of Placenta   5-30 minutes  Contrac ons intermitent with mild to moderate intensity  Umbilical cord is cut  Placenta is expelled  Uterus contracts to size of a grapefruit  Lacera on or episiotomy is repaired  Behaviours/Observa ons Ela on Relief Tremors Increased physical energy Curiosity about infant Desire to breas eed Pain is minimal as placenta is expelled Uterine contrac ons - Contrac ons cause the cervix to efface (thin) and dilate (open) to allow the fetus to descend in the birth canal. They simultaneously push the fetus downward as they pull the cervix upward, causing the cervix to become thinner and shorter. Effacement and dila on are determined by vaginal examina on. There are 3 phases of contrac ons: 1. Increment – the period of increasing strength 2. Peak or acme – the period of greatest strength 3. Decrement – the period of decreasing strength Contrac ons are described by their frequency, dura on, and intensity. Frequency – the elapsed me from the beginning of one contrac on un l the beginning of the next contrac on Dura on – is the elapsed me from the beginning of one contrac on to the end of the same contrac on Intensity – the approximate strength of the contrac on Described in words such as mild, moderate, or strong Res ng tone of the fundus should be so. If it is firm, there is not enough me for the fetus to recover between contrac ons. Important Safety Note: Report to the primary health care provider the following: any contrac ons that occur more frequently than q2min Contrac ons las ng >90 seconds when res ng tone and the interval between contrac ons is