Notes.pdf

Test 25mc 45mins Zygote Embryo , Fetus ↓ ↓ ↓ the fusion of orum...

Test 25mc 45mins Zygote Embryo , Fetus ↓ ↓ ↓ the fusion of orum developmental unborn child + stage of from Sweek-term spermatozoon zygote (from fertilizationto (implantation to implantation 5 - 8 weeks) period of time - end of a pregnancy => baby born normally. Term Normally duration = 37-42 weeks Abortion Removal & expulsion of can't survive outside the uterus an embryo/ fetus End of pregnancy => Stetus's condition · before 24 weeks of gestation. ~ Spontaneous /V induced fetus born without sign of life >24 weeks of gestation birth weight> 500gm Stillbirth Estimated date of confinement (EDC) delivery day for a pregnant women ↳ Average 280 40 weeks days : * Expected date of delivery/estimated due day. I trimester : conception - 13 weeks 6 days 2 trimester : 14 Weeks - 27 Weeks 6 day Trimester 3 trimester : 28 weeks - delivery Maturity : Age of fetus , same as gestational age  Pregnant = Gravida (G) G = the number of pregnancies of a pregnant woman Given birth to an infant alive/dead : * after 24 weeks) = 500gm Para/Parity (P) (PO) birth to viable child Nullipara : never given a Primipara (P1)delivered : one viable child Multipara (P2/4) delivered: more than one viable child Grand (P5) delivered five/more viable children multipara :. Primigravida Advanced maternal age ↑35(calculated EDC) Pregnant for the first time Pregnant Elderly Primigravida Multigravida Pregnant for the first time Pregnant for more than once at 1 above 35 age Uterus ~ Pear shape organ ~ thick muscular wall v mucous membrane lining ~ Rich blood supply = Anteflexion ~ Normal bent Slighty forward Fundas : upper portions Structure corpus : Body 3 sections #31 Cervix -ba Endometrium : * contains rich blood supply inner layer -33. Myometrium : thick muscular 3 layers wall. Perimetrium the outer layer :  support bladder and bowel Allow fetus development Functions Accept fertilied orum from fallopian tube Allow orumimplanted into the endometrium & derives nourishment from blood Cervix ~ constituts the lower third of the uterus half of cervix projecting into the vagina. Presence of muches - plug in the cervical v hallow part of the cervix canal => Prevent ascending infection Cervix canal consists of external and internal os Cervix OS During labour Ind trimester - 3ra trimester v Remain closed until onset of labour ~ Effacement and dilation occurs during onset of labour ~ Provide Stable support for the baby's head ~ key determination of labour Allow descend into the uterus in preparation of birth progress dilatation from Ocm-10cm ~ by examination of the external os v Allow descent of fetus and birth canal  passage for menstrual flow ~Passage for spermatozoa which deposited Vagina during sexual intercourse function Barrier to prevent ascending infection because of its acid secretion Exit for the fetus during deliver Fetal Skull · bone frontal bones Parietal bonesoccipital 1 left & (left & right) Right) temporal bone 1 left a right) not been suture FrontalSuture ossified fused in the early adulthood when ossification of skull completes Coronal suture Sagittal Suture Lambdoid Suture ↑  Fontanelles membranous non-ossified area , of the skull found where 314 futures meet. Anterior fontanelle Bregmal Posterior Fontanelle size & ~ Kite shaped I diamond shape ~ small triangular shape ~ closed at. 18 months v close at 6 weeks. futures and fontanelles allow overriding of - > the fetal skull during labour As guiding point in ↓ vaginal in examination locating position. temporary alter the shape Vertex presentation (fully flexed head ~ for safe delivery. ~ most favorable shape for dilating the Cervix & vaginally delivered Bones of vault allow a slight degree change of shape of fetal of bending and override at the sutures head > - take place its passage during through the birth Canal molding of fetal skull Reduction in the ~ protective mechanism and prevent size of the fetal brain from presenting the 1. not excessive being compressed 2. too rapid 3. in an unfavorable direction  Caput succedaneum v Area of edema over presenting part of fetus/ newborn => from the pressure the cervix during labour against ~ occurs in the skin superficial to skull & periosteum usually heal without any medical majoy intervention membrane -> covers Cephalohaematoma. ~ Pressure during between periosteum foringkcause bleeding & skull " v Reason - : difficult/prolonged birth - Cephalopelvic disproportion (baby's head > mother's pelvic opening) - Big baby - Abnormal presentation heal without any - usually major medical intervention - use birth-assisting tool of (forceps/vacuum delivery * If improperly treat Permanent brain damage - - Anaemia - Meningitis  Caput succedaneum VS Cephalohaematoma - Present at birth - Not present at birth present , after birth May cross a suture line Never cross a suture line - - Size depends rate of labour depends of trauma on progress on degree - - - gradually subsides - > tend to grow less - May increase in the first 1-2 days - Pits on pressure - X pit on pressure at about 4-6 weeks -disappear completelyWithin 24-48hrs disappear completely - - Unilateral (Double caput = rare) - Bilateral => common - No harm - Harmful = Neonatal Jaundice , anaemia , brain damage Breast T " Anatomy Hormonal influences = 1 Trimester ~ composed of fat fibrous tissued mammary -4 level of oestrogen and , progesterone glands v fat and fibrous tissue are sensitive to v Rich in hormones lymphatic network ↳ cause milk ductal sprouting and branching Milk production & X Progesterone ↓ after Alveoli contract and eject milk into the ducts Estrogen delivery - through the nipple Prolactin and initiates milk production Mammary gland can produce colostrum - & before - birth can produce milk several days after birth storage & & Milk is transported in lactiferous ducts and - transports stored in lactiferous Sinus.  development of fetal stage I ①Pre-embryonic Stage first 2 weeks beginning : with fertilization ② Embryonic Stage from 3 weeks : to 8 weeks ③ fetal stage Sweeks birth : - 2 surfaces A : dark red in color with > B Fetal. (Shiny white cotyledons 9 covered by amnion and ~ chorion with insertion of umbilical ~ vascular unit for cord. nutrients exchanges gases & size about Locm in Placenta diameter , 2. 5-3cm thickness weight 16 of : birth of weight metabolic & nutrient baby /400-boogi exchange between the embrynoic & Purplish red maternal circulation & round shape Located where embryo attaches to uterine wall & normally in upper uterine segment fluid Surrounds the growing , feths during pregnancy clear , pale straw-coloured alkaline fluid in amniotic a volume 1000m/ in composition : : 98% Water Singleton pregnancy. 2% water organic & nutrients , electrolytes Aminotic fluid metabolites/waste products promote fetus movement & fetus skin cell. Vernix , langolfine hair Provide some maintain constant permit symmetric nutritive substances & fetus maintain fluid a growth development temp for. electrolyte balance Prevent umbilical cord cushions the fetus from trauma - compression yellow = function of Aminoticfluidwine Pregnancy - * Labour during ~ equalize uterine pressure during contractions to protect the placenta and umbilical cord ~ aids effacement of cerrix and dilatation of the cervical OS Duration of Pregnancy : 40 weeks first time pregnancy : Primigravida second time 14 Multigravida · : Full Term : 37 - 42 weeks Quickening : primigravida - 16-22 weeks · 1st Trimester : Conception - 14 weeks 2nd Trimester : 14-28 weeks 3rd Trimester : 28 ~ delivery caloric intake during pregnancy Normal weight ↑ for multiple pregnancy - 1800kcal - first trimester with adding 300 kcal for - 2200 - 2500 + second trimester each baby. - 2400 - 2500 > - third trimester ! Inadequate nutritional intake Excessive nutritional intake # maternal overweight Poor weight gain H ↓ cause cause 1. Fetal macrosomia ( > 4000g) 1. Preterm delivery 2. difficult birth 2. Low birth weight 3. Increased rate of 3. Congenital anomalies instrumental delivery 4. Neonatal hypoglycemia 5. Continued obesity 6. Pre-eclampsia. Gestational 7 diabetes.  First Antenatal visit ① Body weight. height & BP ↳ baseline measurement & BMI ③ Nurse & interview history taking ~ Social history ② urine analysis : Protein & Sugar ~ personal history ↳ ~ menstrual history comprehensive gestational DM and hypertension ~ obstetric history health assessment ~ medical history ⑦ Doctor interview & physical examination v family history ⑤ Antenatal blood investigation present pregnancy Significance & impacts ~ Last Menstrual period ~ Calculating EDD and present ~ Menstrual history gestational age at which menstruation ~ Age ~ Reter early dating ultrasound scan began if LMP not sure/irregularity of ~ Number of days and regularity menstruation ~ Education and advise in the cycle on present pregnancy pregnancy according to the gestation ~ Previous abortion Provides management ~ Previous birth strategies of handling (Gravity ; parity problems and complications in Previous Pregnancies present pregnancy History ~ complication of last pregnancy may be repeated/ even appears earlier in this pregnancy Refer of ~ prenatal diagnosis medical illness previous children with ~ illness , operation ( Congenital disease accident which could complicate pregnancy v To close monitoring past health history the present disease ↓ Surgical illness ~ operation on the spine , may deteriorate of uterns/the pelric flood complicated during ~ direct relationship pregnancy Family medical history ~ ~ Hereditary genetic disease for consideration of the v Chronic disease mode of delivery ~ History of multiple pregnancy Calculation of Estimated date of confinement Method ① take LMP e - g (MP 12/4/2024 ② + + days + Adays : 1914/2024 ③ - 3 months - 3 months : 19/1/2024 & Adjust the year Adjust years : 19/1/2025 Method 2 Method 3 & using the gestational calendar By ultrasound ② the using gestational table measure rump length crown , head and abdominal circumferences. femur length estimate gestational age. ↑ ~=  Labour * Presence of regular uterine contractions with progressive cervical dilation and effacement · premonitory Signs of labour Lightening Braxton Hicks Contractions (False Labour ( ~ descent of the fetal presenting part v irregular : intermittent into pelvis contraction -> occurring & occurs approximately 10-14 days before throught out the pregnancy labour begins ~ Activites of toning the uterine ~ Fundus height slightly falls below xyphoid process muscle ↓ Lighter' uterus will be felt by mother ~ Contractions usually felt in lower abdomen / groin show ~ blood-tinged mucus inside the cervical canal expelled Repture of membrane at the onset of labour cleaking) ~ Sudden gush & scanty, ~ Normal : small amount in slow seeping of clear fluid bloody/pinkish mucus based pale yellow fluid from Vagina ↓ 80 % -90%, labour will ~ Abnormal : large amount Occur within 24 hrs of fresh blood noted Signs ~ occur is in anytime of of labour , onset with/without labour onset r leaking prolonged : Risk of infection ↑ v leaking can be sometimes Test of aminotic fluid leaking confused with urinary ~ Amniotic test incontinence ↓ Non-invasive ~ pool of fluid Uterine Contractions dipping to the involuntary and without warning in the vagina during speculum ~ test ~ Start : fundus of uterns I back & lower abdomen ~ Nitraline-based amnicators swab Progressive 4 in frequency , duration & intensity and will response to pH medium from ~ Push the fetus againsts and dilate the cervix blue uterine contraction be taken by cadiotocography yellow to v can up * Signs of labour onset ↳ Cervical effacement cervical dilatation Regular reterine contraction + +  Stage of Labour First Stage : (Effacement & Stage dilatation Second Stage : (Expulsion Stage) >baby delivery Third Stage : (Placental Stage Fourth Stage : Post-placenta delivery Stage ↳ check mother's condition Passenger fetus Passage/passageway& - (birth canal : maternal pelvis Soft tissues ↓ fetus head attitude ,. ~ size of the maternal pelvis presentation and position (diameter of pelvic inlet , mid-pelvis ~ Placenta & membranes and outlets ↓ types of pelvis (gynecoid = best) Power uterine contractions ~ Ability of the cervix to dilate and efface ~ frequency , duration & ~ The Stretching of the perineum intensity Factors affecting labour process ↓ effacement & dilatation (5P) of cervix v controlled by maternal expulsive forces , used of intra-abdominal pressure Position (maternal Psyche-level V passive counter pressure ~ squatting , water birth of the pelvic floor v excitement , fear and tension experienced by the women Vaginal delivery ~ safest for the fetus and for the mother when the newborn is full-term ~ Always a preferred method for childbirth v ↑ morbidity & mortality associated with caesarean section  Vaginal deli very Satest for * the tetus & for the mother when the newborn is full term & Preferred method for childbirth /4 mobility & mortally associated with Caesarean section Indicators Contra-indications ~ Fetal distress ~ spontaneous labour ~ Maternal distress ~ complicated gestation v Malposition / Post - term pregnancies ~ Malpositon of the placenta ~ Induction of labour ~ Genital tractInfection ~ HIV cases Assisted delivery & devices+ used to help vaginally deliver the fetus faster at end of second of labour stage Maternal exhaustion & distress (e. g high BP) Prolonged second stage (more than 1 hours) unfavorable fetal position Clinical large baby high fetal head Vaginal breech delivery (Protect the baby's last coming head from the perineum) - Preterm baby delivery (Protect the soft head from perimnem baby' birth by - Assist onlywe me applying added pullstraction down the birth 9 -gradually help lift Canal > - tetus Ventrose (Vacuum) delivery Forceps delivery out the perium Maternal fetal Fetal Maternal I risk of operative delivery ventrose site Marks & bruise of episiotomy ~ ~ Chigon on ~ on ~ rate of fetal application attempt higher failing rate) (limited , scalp area ~ Genital tract injury I rate of ~ episiotomy ~ ↑ develop Cephalohaematoma ~ Perineal tear ~ injury to perinal muscle ~ ↑ neonatal jaundice v Laceration/cutson ↑ Postpartum baby face haemorrhage.  Caesarean Section * use of surgery to delivery baby through incisions in the abdomen and uterus Planned/Emergency - Presentation Breech - Multiple Pregnancy - Preterm birth - Placenta Previa -small for gestational age baby - Predicted cephalopelivic disproportion in labour - Previous Caesarean section - obstructed labour Maternal request · Lower Segment Caesarean Section Classical Caesarean Section (LSCS) (CCS) ~ vertical incision in uterns carity ~ Lower transverse incision in uterine ~ for rapid/ very preterm delivery cavity ~ CS for future pregnancy ↓ Most common ~ used after lower segment of uterus is formed