حل بنك أسئلة النسا كامل (1) PDF

1. Fertilization: it is union of the sperm with ovum in the fallopian tube. 2. Menstrual cycle: cyclic changes in the endometrium caused by estrogen & progesterone. 3. Menstrual cycle: cyclic changes in the endometrium caused by estrogen & progesterone. 4. Proliferative phase: is the phase of...

1. Fertilization: it is union of the sperm with ovum in the fallopian tube. 2. Menstrual cycle: cyclic changes in the endometrium caused by estrogen & progesterone. 3. Menstrual cycle: cyclic changes in the endometrium caused by estrogen & progesterone. 4. Proliferative phase: is the phase of repair & proliferation. 5. Ante natal care: comprehensive health supervision of apregnant women before delivery. 6. Reproductive health: is a state of complete physical, mental and social wellbeing & not merely absence of disease. 7. Family planning: practice that helps individuals or couples to attain certain objective. 8. Chorion: the outer membrane that lie under the capsular decidua. 9. Amnion: the inner membrane which contains the amniotic fluid is a smooth & tough. 10. Poly hydramnnos: increase amniotic fluid more than 1500ml. 11. Linea nigra: dark line that runs from the umbilicus to the symphysis pubis. 12. Good ell's sign: softening of cervix, uterus & vagina. 13. Braxton Hicks contraction: irregular, mild, painless uterine contract. 14. Leucorrhea: colorless, non effective normal vaginal discharge during pregnancy. 15. Quickening: the first time at which the mothers feels fetal movement. 16. Ballottement: it refer to the fetal movement in amniotic fluid. 17. Eclampsia: life threatening complications of pregnancy characterized by high blood pressure, & protein in the urine & seizures. 18. Abortion: Termination of pregnancy behore 24 weeks, or products of conception weigh below 500gram. 19. Bleeding nearly pregnancy: bleeding before20 week of gestation. 20. Vesicular mole: is gross mal formation of the trophoblast. 21. Abruption placenta: premature separation of normal situated placente. 22. Normallabor: expulsion of mature viable fetus, presenting by vertex through birth canal without fetal or maternal complication. 23. Lie: relationship of the long axis of fetus to the lang axis of mothers. 24. Effacement: shortening or taking up of cervix  Choose 1- Characteristics of lochia serosa are : a) Pinkish yellow discharge 2- All of the following are positive signs of pregnancy excep a) Quickening 3- Once implantation taken place the endometrium called c)Decidous 4- All of the following FP methods don’t protect against STDs except c) Sterilization 5-The schedule of antenatal visit of pregnant woman at (15) of pregnancy is b)One visit everymonth 6- The parts of fallopian tube include all of the following except: b-Endometrium 7- Factors involved in labor related to passenger include b-Fetus 8- Complication of vesicular (hydatiform) mole includes all of the following except: b-cord prolapsed 9- Aysel is pregnant woman and her last menstrual period started at 1- 3- 2016 so the expected date of delivered will be:- c. 8 - 12-2016 ± 15 days 10- The functions of ovaries secretion of:- a-Estrogen and progesterone hormones 11- The external female genitalia are the following except. b. uterus 12- The result of fenthill3 ation is a b. zygote 13- The chorionic villi are b. finger like trophoplastic layer. 14- Morula is a. 16 cell stage. 15- Normal site of the placenta is. b. Upper uterine segment. 16- The ovulation occurs. b. at the middle of the menstrual cycle 17- The ovarian hormones that are produced by the Graafianfollicle and the corpus luteum are b. FSH and LH. 18- During pregnancy. a. Increase in plasma volume is the greater than in the RBCs 19- Signs of placental expulsion include all the following except. b. Rupture of amniotic membranes. 20- During the fourth stage of labor, should be assessed for: a. uterine atony 21- Effacement is the process by which the cervix is: b. pulled up into the lower uterine segment. 22- Ovulation usually occurs in regular menstrual cycle at : c- The 14th day 23- Conception refers to:- c- The union of the ovum and sperm. 24- True labor is characterized by:- d- All of the above. 25- Signs and symptoms inevitable abortion the following except b- Cervix is open 26-Oral contraceptive contain the following c- Estrogen and progesterone 27-Excessive mucous discharge from the genital tract mean: b- Louchiarubra 28-It is a way to make a spacing between child and other: a-family planning 29- Agross malformation of trophoplast in which chorionic villi proliferate and become a vascular b- hydatiform 30- Whitish thick fluid range from 2-6 ml alkaline in PH and special density: a-Semen 31- Repair of the endometrium layer take place for 9 days after menstruat ion under the effect of estrogen and called: b- proliferative phase 32- The lining of the pregnant uterus is called b- Myometrium 33- The umbilical cord contains the following vessels a- Tow arteries and one vein 34- The function of placenta is all of the following expect b- Facilitates movement of the fetus 35- Which of the following health advice would the nurse give to gravid women related her diet f- All of above 36- Fertilization a mature ovum in which of following c- Ampulla of the fallopian tube 37-Which of the following is the normal symptoms of pregnancy in the firsttrimester? d-Nausea and vomiting 38-Danger signs of pregnancy are the following except? d-Sever constipation 39-The side effects of IUD include which of the following: d-A,B ,C 40-The female internal reproductive: d-Fallopian tubes, uterus, vagina, and ovaries. 41-The most certain sign of the onset of the labor is: c-Dilatation of the cervical os. 42-Several factors affecting labor , which of the following factors refers t o the passageway c-The structure of the maternal pelvis. 43-The pregnant uterus reach the umbilical level at: a-12 weeks 44- Follicle stimulating hormone for (mature ovum). 45- Ovulation phase occurs at (mid cycle). 46- Injectable contraceptives are injected into (muscle). 47- Position of postpartum women must be prevented (supine ). 48- (Knee chest position) to prevent retro version flexion (RVF). 49- Gross malformation of the trophoblast in which the chorionic villi proliferate and become avascular (hydatiform mole). 50- Exessive hunger means ( polyphagia ). 51- Ultrasound is done at (18 ) to determine gestational age and detect anomalies. 52- Peeling of the skin occurs within 2-4 weeks (desquamation ) 53- Sudden stimulus causes arms to fly out up tremble slowly relax( moro reflex). 54- Ectoderm forms (skin & nervous system). 55- Protein is transferred across the placenta as (amino acids). 56- Amniotic fluid more than 1500 ml is (polyhydramnos). 57- The length of umbilical cord is (50 cm). 58- Absence of menstruation is (amenorrhea). 59- characterized by high blood pressure, protein in urine and coma (eclampsia). 60- Bleeding before 20 weeks of gestation (early bleeding). 61- Gross malformation of the trophoblast in which the chorionic villi proliferate and become avascular (hydatiform mole). 62- Deceleration means (bradycardia). 63- In forth stage of labor the uterus (firm). 64- is bluish discoloration of cervix, vagina, and labia during pregnancy. (Chadwick's sign) 65- Gravida means (pregnancy). 66- the period from beginning of the third month till the time of birth. (Fetal stage) 67- In gestational hypertension manifest by (without proteinuria). 68- All high risk factors affect on pregnancy except (flu). 69-Excessive growth to baby means(macrosomia). 70-Excessive number of red blood cells means (polycythemia). 71-Normal labor called (eutocia). 72. Conception refers to: c. The union of the ovum and sperm. 73. The result of fertilization is a: b. zygote 74. The thick outer fetal membrane is called: b-Chorion 75. The normal site for the placenta is: b. Upper uterine segment. 76. The hormones of the anterior pituitary gland that control ovulation are: c-Estrogen and Progesterone. 77- Ovulation occurs: b- At the middle of the menstrual cycle *78- Signs and symptoms of the onset of labor are a-True uterine contraction – show and cervical dilation c-Heart burn , broken waters and descent of the head 79- Which of the following symptoms occurs with a hydatidiform mole? c-Positive pregnancy test result in highly diluted urine 1:500. 80- The relationship of presenting part and ischal spine of maternal pelvis c. Station 81- All of the following are signs of concealed type of abruption placenta except b-Lax abdome  put (true ) or ( false ) 1.Barrier methods increase sexual enjoyment. ( F ) 2.Isthmus is the widest portion of fallopian tube. (F ) 3.Maternal surface of the placenta is whites shiny appearance. (F) 4.Pregnant woman permit to fly before 32 weeks. (T) 5.Completely Involution of the uterus done immediately after labor. ( F) 6. Perineum is the muscle and tissue located between vaginal opening and analcanal.(T) 7. Female reproductive cycle composed of ovarian cycle only.( F ) 8. During proliferative phase spiral arteries grow into the super Facial layer.( F ) 9. Dis advantage of oral contraceptive include minor side effect as breast tenderness, headache. ( T ) 10. The outer membrane in the fetal saclscolled amnion( F ) 11. The placenta secrete FSH & LH hormone.( F ) 12. The urethral meatus situated 5cm below the clitoris.( F ) 13. Hegar's sign is softening of the vagina.( F ) 14. Vaginal examination in indicated in case of placenta previa. (F ) 15. During2ndstage of labor push on the uterus to assist women to deliver. ( T ) 16-The most common elements of reproductive health are women nutrition, managements of infertility and family planning services.. ( T ) 17.The upper rounded portion of the uterus is called funds ( T ) 18.The placenta secrets follicle stimulating hormone and luteinizing hormone ( F) 19.IUD is one of the effective hormonal contraceptive methods ( F ) 20.The normal umbilical cord contains two arteries and one vein. (T ) 21. Cervix was full dilated in threatened abortion (F) 22- Secretory phase in menstrual cycle it begin with menstruation and end with ovulation.( F ) 23-Q of placental separation edges of placenta separated first (F ) 24- The primordial follicles start to grow to reach grafian follicle under the effect of LH hormone ( F) 25- Amnion is the outer most layer of the fetal sac. ( F ) 26- Amenorrhea indicates a positive sign of pregnancy. ( F ) 27- Zygote is the result of fertilization ( T ) 28-Abruption placenta is bleeding from abnormally situated placenta ( F ) 29- The average weight gain during pregnancy is 4 kg. ( F ) 30-Show is considered sure sign of normal labor. ( T ). 31-Labor defines as serious event by which the fetus and placenta are expelled from the women’s uterus. ( T ). 32-In labor, frank meconium may indicate a breach presentation. ( F ). 33-Dystocia means difficult labor. ( T ). 34-Postpartum exercises will strength the pelvic floor, and help to prevent uterine prolapse in later life. ( T ). 35-Depression in early postnatal period is due to the sudden changesinhormones level.(T ) 36-Antenatal visits should take place before 28 weeks gestation every 4 weeks, and from 28 weeks -36 the weeks every 3weeks. ( F ) 37- The area between the vaginal opening and anus is called labia minora. ( F ) 38-Patient with placenta previa should have per vaginal examination to confirm the diagnosis of the condition. ( F ) 39-The upper rounded portion of the uterus between the insertion of the fallopian.(F) 40- tubes is called the fundus. ( F ) 42-Scrotum is located inferior to the penis in the pubic region.( T ) 43- From the abdominal palpation of the pregnant women we can detect the condition of vulva and vagina ( F ) 44-The first fetal movement felt by the mother is called effacement. ( F ) 45- A positive hormone's sign during pregnancy indicate the presence of sub involution. ( T ) 46- Hyperglycemia after birth this is complication on the fetus of gestationaldiabetes.(T) 47-Episiotomy is an incision of the perineum for widening vaginal opening ( T ). 48-The female sex hormone is testosterone( F ). 49-Uterus is a pear shaped organ ( T ). 50-Caput succedaneum disappears within several days after birth( T ). 51-Cholosma is brownish pigmentation of the face (T ). 52-Fetal movements must be counted 10 movements within 24 hours ( F ). 53-Lie is relationship of the long axis of the fetus to lung axis of the mother ( T ). 54-The placenta has 20 lobules called cotyledons ( T ). 55-Anterior fontanel is triangular in shape but posterior is diamond in shape ( F ). 56-True labor contractions increase intensity with walking ( T ). 57-Hypothalamus release GnRH, and pituitary secrete oestrogen( F ). 58-From strategy for improving reproductive health is to delay early marriage ( T ). 59-The umblical cord has 1 artery and 2 vein ( F ). 60-Ptyalism is increase of saliva ( T ). 61-During pregnancy increase white blood count and decrease red blood cell ( T ). 62-Abdomen shape is longer if fetal lie is longitudinal ( T ). 63-In latent phase of first stage of labor the cervical dilated between 0-3 cm ( T ). 64-The most common placental separation in less bleeding is Shultz method ( T ). 65-Crowning is distention of the vulva by fetal skull bone and not return again (T ). 66-From non pharmacological pain relief is hydrotherapy ( T ). 67-Lochia color has change from red to white color at the end of purperium(F). 68-Blood volum loss about 1000 ml vaginal delivery but 500 ml in cesarean birth.( F ) 69-Early bleeding during pregnancy means before 20 weeks of gestation( T ). 70-Placenta previa is in upper uterine segment ( F ). 71-Ultrasound is done at 18 weeks to determine gestational age and detect anomalies.(T) 72-Minipill has oestrogen but no progestin ( F ). 73-Combined oral contraceptive may decrease quantity of breast milk but minipill doesn't affect lactation ( T ). 74-Spermicidal products method used from 5-10 minutes before each act of intercourse ( T ). 75-Pre-embryonic stage is the first two weeks following conception ( T ). 76-In cell division when rich 16 cells called morula( T ). 77-Implantation time begins at 4th day after fertilization ( F ). 78The mature sperm live 48-72 hours ( T ). 79-Immediately after fertilization the zygote has 47 chromosomes ( F ). 80-The umbilical cord has 2 artery and 2 vein ( F ). 81-Quicking occurs between 18-20th week in primigravida( F ).PG 82-In mild pre-eclampsiaincrease protein intake and avoid caffeine ( F ). 83-Sedative medication as diazepam ( T ). 84-Tonic stage is convulsion ( F ).Clonic stage 85-Hemolysis is a breakdown of red blood cells ( T ). 86-Abotion is termination of pregnancy before 24 weeks. ( T ) 87-The proliferative phase is a phase of repair and proliferation ( T ). 88-If fertilization doesn't occur HCG hormone secreated in urine ( T ). 89-Ovulation is expulsion of a mature ovum ( T ). 90-Function of amniotic fluid is nutrient fetus ( T ). 91-Antenatal means after delivery ( F ). 92-Vulval laceration if not mended by suture may lead to hematoma formation( T ) 93-Abortions termination of pregnancy after 28th week of Pregnancy. (F) 94-Lochia is alkaline in reaction.( T ) 95-Immediately after birth fundus can be palpated just above symphsispubis.( T ) 96- Effacement of the cervix is shortening of the cervix during labor. ( T ) 97- Immediately after delivery the fundal level should be above the level of the umbilicus.( T ) 98- Acceleration is decrease heart rate less than 100 b/m.( F ) 99-Presence of pulsation in cord is signs of placental separation. ( F ) 100- Duration refers to the strength of uterine contractions. ( F )Intensity 101- In post partum period menstruation is generally profuse and prolonged.( T ) 111-During the 2nd stage of labor, the patient should be assessed carefully for complete cervical dilatation. ( T ) 112- Duration refers to the strength of uterine contractions( F ) 113-The area between the vaginal opening and anus is called labia minora.( F ) 114-During the 4th stage of labor, the patient should be assessed carefully for uterine atony. ( T )  Matching 1-Number of births after 20 weeks regardless of the a) Lie (4) infants were born alive or dead 2-Shortining or taking up cervical canal b-Para (1) 3-Icrease of saliva c)Effacement (2) 4-The relationship of the long axis of the fetus to d)Attitude (5) long axis of the mother 5-The relationship of the fetal parts to each other’s e)Ptyalism(3) Term Definition 1- Eclampsia(d) a-Is a status of complete physical , mental and social wellbeing and not merely absent of disease in all matters relating to reproductive system and its function 2- Reproductive b- is the process by which the blastocyst health (a) penetrate the superficial layer of the endometrium 3- Abortion (e) c- is expulsion of mature viable fetus, presenting with vertex through birth canal spontaneously 4- normal labor (c) d- Life threatening complication of pregnancy, it is characterized by high blood pressure and protein in the urine, seizures or coma 5- implantation(b) e- it is termination of pregnancy before 24 weeks of gestationggjjjik, Column 1 Column 2 A 1 pregnancy occurring outside the normal An episiotomy (3) uterine cavity. B 2 a gross malformation of the trophoblast in Premature labor (5) which the chorionic villi proliferate and become avascular C StriaeGravidarum 3 is an incision of the perinium used during (Stretch Marks). (4) childbirth for widening the vaginal opening D 4 Fine pinkish white or gray lines resulting Ectopic Pregnancy (1) from streching of skin during pregnancy. E 5 Termination of pregnancy between 28-38 Hydatidiform Mole (2) weeks and fetal weight between (1000 - 2500gm).  A B 1- Products female sex eggs , a- A translucent yellow fluid that meet estrogen , and progesterone (d) the need of the new born 2- Colostrum (a) b- The inner lining of uterus c- The movement that occur when the 3- Chloasma(e) fetus changes position as it moves through the pelvis 4- Endometrium (b) d- ovaries 5- Quickening(c) e- Mask of pregnancy A B 1- Show(d ) a- is one hour after expulsion of placenta and membrane 2- Effacement(e) b- Is the sinking down of fetus to lower uterine segment 3- Full dilated(c) c- Cervix (10 cm) 4- Lightening (b) d- Blood stained mucus discharge 5- Fourth stage(a) e- Taking up of the cervix 1- Show(d) a- It is two hours after expulsion of placenta and membranes. 2- Effacement(e) b- Is the sinking down of the fetus to lower uterine segment. 3- fully dilated(c.) c- cervix ( 10 cm) 4- lightening(b) d- blood stained mucus discharge 5- fourth stage(a) e- taking up of the cervix 6-types of lochia(g) f- bulging of fore water 7-the ischemic phase occur(h) g- lochia serosa, lochia alba, lochia rubra 8- Vasectomy(I) h- 2 days i- The sterilization procedure of male  Column A Column B 1-Goodell's sign.(c) a)To prevent bleeding. b)HCG human chronic 2-Vitamin K.(a) gonadotrophic. 3-Female sex hormone.(e) c)Softening of the cervix. 4-Hormone of pregnancy test.(b) d)Dilatation. 5 ) 1st stage of labor.(d) e)Estrogen and progesterone. Column A Column B False labor pain.(d) a)Lateral position. To prevent RVF.(c) b)Diazepam. Anticonvulsant medication.(e) C)Knee chest position. To help involution uterus.(a) d)Irregular contraction. Sedative medication.(b) e)Magnesium sulfate. Column A Column B 1-Threatened abortion.(c) a)Excessive thirst. 2-Polycythemia.(d) b)Delivery of placenta. 3-3rd stage of labor.(b) c)Cervical os is closed. 4-Polyphagia. (e) d)Excessive number of red blood cells. 5- Polydipsia.(a) e)Excessive hunger. Column A Column B 1-Immediately after fertilization (d) a-Mitosis 2-Cell division is(a) b-Release oxytocin. 3-Implantation occurs at(e) c-Fever. 4-Breast feeding advantage for d-Chromosomes number is 46 mother(b ) 5-Danger signs of postpartum is(c) e-Blastocyst stage  Column A Column B 1-Premature labor(d) A)Within several days after birth. 2-Show(e) b)Disappears within 6 weeks after birth. 3-Caput succedaneum c)Sudden pain, cold, hunger cause air disappears( a) to through vocal cords. 4-Cephalohematoma ( b) d)Termination of pregnancy between 28- 38 weeks. 5-Crying(c) e)Is a blood stained cervical mucus. A B 1. Taken every 21 day cycles or 28 day cycles. ( 2 ) DMPA (150mg). 2. Injected into muscle from which they are ( 4 ) IUD. slowly released, they prevent pregnancy by suppressing ovulation. ( 5 ) Tubal ligation. 3. Surgically inserted under the skin of the ( ) Condom. arm the tubes allow a steady diffusion of the ( 1 ) Pills. drug into the blood stream. ( ) Spermicidal products. 4. Placed in the uterus through the cervical canal. ( 3 ) Norplant. 5. A permanent method of contraception. A B 1. Hegar's sign. ( 4 )Physiological cyclic bleeding that monthly occurs for women in reproductive 2. Intra uterine fetal death. age. 3. Leucorrhea. ( 5 )Imbedding of the fertilized ovum in the upper uterine segment. 4. Menstrual cycle. ( 3 )Excessive vaginal discharge during pregnancy. 5. Implantation. ( 1 )Softening of the lower segment of the uterus. ( 2 )The death of the fetus inside the uterus.  A B 1. Complete abortion. ( 1 ) Pregnancy may go to term. 2. Septic abortion. ( 2) Abortion together with sepsis. 3. Intrauterine fetal death. ( 4 ) Sonar shows an empty uterus. 4. Threatened abortion. ( 3 ) The death of the fetus inside the uterus. 5. Therapeutic abortion. ( 5 ) Used in case of sever congenital anomalies. 1. Show. (5 ) Is two hour after expulsion of placenta and membrane. 2. Effacement. ( 4 ) Is the sinking down of the fetus to lower uterine segment. 3. Fully dilated. ( 3 ) Cervix 10cm. 4. Lightening. ( 1 ) Blood stained mucus discharge. 5. Fourth stage. ( 2 ) Taking up of the cervix. ( 1 ) pregnancy may got term 1- Threat abortion ( ) the embryo elies inside the uterus 2- Cervix ( 2 ) internal gental organ 3- Secretory phase ( 3 ) begins with ovulation and end with menstruation 4- IUD ( 4 ) Very safe if side effects receive proper care 5- Chorion ( 5 ) the outer fetal membrane 6- Complication of prceclampsia ( 7 ) fetal dead and retained inside 7- Missed abortion ( 6 ) Cerebral he 8- Risk Factor of ectopic ( 8 ) Pelvic inflammatory disease 9- placenta previa ( ) heart disease 10- Vesicular mole ( 9 ) Bleeding in late pregnancy ( 10 ) Mal formation of trophoblast  Complete 1* Chadwick’s sign mean bluish discoloration of the cervix, vagina, and labia during pregnancy as a result of vascular congestion while good ll,s sign mean softening of the cervix, uterus and vagina during pregnancy. 2*Types of fetal disposition1-Presentation. 3-Lie. 2-Attitude. 4-Position. 3* Newborn identification(ID bands , Footprints/ mother‘s fingerprint 4* The degree (+2) moulding of fetal head mean…………………………………. Bones are overlapping each other but separate by genital pressure. 5* Degree of placenta previa "Centralis /,Incomplete "Partials,/Lateralis,/ Marginalis 6- The female reproductive system consists of External genitalia andInternal genitalia 7- The purposes of male reproductive tract are to allow for sexual intimacy and reproduction of offspring, and to provide a conduit for urinary elimination 8- Menstrual cycle, control by hormones is a hypothalamus pituitary ovarianAxis. 9- Reproductive health is a status of complete physical, mental and social wellbeing. 10- IUD users must seek medical care to check for pregnancy if menstruation is late or if having abdominal pain, chills, fevers, vaginal discharge or heavy bleeding or spottin 11- The function of amniotic fluid includes. 1. allows for the growth and free movement of the fetus 2. It equalizes pressure and protects the fetus from injury. 3. The fluid maintains a constant temperature to the fetus. 4.It provides small amounts of nutrients. 12- Parts of the fallopian tube. 1. Interstitial part 2.Isthmus 3.Ampulla 4.Infundibulum 13- Reproductive health rights. - Right to life, liberty and security. - Right to marry and found a family. - Right to education and information. - Right to health and health care. 14- Benefits of family planning for the women. - Decrease maternal mortality and morbidity - Improve health and the quality of life. - Avoidance of hazards & complications -Enjoyment of marital life - Supporting women's rights and opportunities for education 15- Advantage of IUD.- Highly effective, long term, easy to use, no re-supply problems, reversible, inexpensive. - Very safe if side effects receive proper care. 16- Stages of fetal development.(.Pre-embryonic stage.,*Embryonic stage "embryo" ,Fetalstage 17- Presumptive signs of pregnancy. (Amenorrhea ,,Nausea& vomiting,, Fatigue,, Quicken in, Urinary frequency, Breast& skin changes.) 18- Significance of antenatal. -To reduce maternal and prenatal mortality and morbidity -To improve the physical and mental health -To prepare the woman for labor, lactation and care of her infant. - Promotion of health for both maternal & fetal wellbeing. 19- Danger signs during pregnancy.(Persistent vomiting ,Vaginal bleeding ,Chills or fever and Blurring of vision.) 20- Stages of eclampsia (Premonitory stage ,,Tonic stage ,, Clonic stage ,,- Coma ) 21- Signs and symptoms' of septic abortion.( Tender and painful uterus,,, Shock. Offensive vaginal bleeding,,, High temperature. Rapid pulse..Unstable blood pressure.) 22- Risk factors of vesicular mole.( Maternal age above 40 years or below 19 year,Malnutrition 23- Complication of gestational diabetes on the mother. 1-. increase in the volume of amniotic fluid 2-Placenta previa or abruption and Abortion 3-.Increase risk for vaginitis and urinary tract infection 4-Obstructed labor. , 5-Preeclampsia 24- true pelvic composed of (1-inlet, 2. cavity 3.outlet ) 25-External female genitalia include(Mons pubis,, Labia major ,,Labia minor, Clitoris ,Perineum- The vestibule: (Urethral &Vaginal opening) 26-Nurse must provide health teaching during menstrual cycle about ------------Sanitary pads and tampons–Diet ( -Nutritional self-care - Exercise -Heat and massage) 27-Basic elements of reproductive health include (Employment of women,, Male involvement Woman's nutrition.,,.- Care of adolescent ,,Safe sexual behavior,, Safe motherhood.) 28-Primigravidaa (woman pregnant for the first time). 29-Types of abortion include: --( Spontaneous abortion - Threatened abortion - Missed abortion - Inevitable abortion - Complete abortion - Incomplete abortion - Habitual abortion - Therapeutic abortion - Criminal abortion - Septic abortion) 30-(Dietary modifications)Theraputic diet for patient with pre-eclampsia is (-increase protein intake , Eating less salt , Caffeine avoidance, Drinking plenty of water) 31-Female genital tract is divided into. (internal genitalia and external genitalia) 32-Sever pre-eclampsia is associated with (hypertension and Proteinuria and Pulmonary edema) 33-Pregnancy outside uterine cavity is (Ectopic Pregnancy) 34-16 cells are (morula) 35-The umbilical cord contain (2 arteries and 1 vein.) 36-The signs of placental separation in the following 1. The uterus becomes smaller, harder, higher, and more globular. 2. A suprapubic bulge appears 3. The passage of gush of blood per vagina. 4. Elongation the umbilical cord. 5. Loss of pulsation in the cord 37-The relationship of fetal parts to each other isAttitude 38-Surgical of perineum during second stage of labor isEpisiotomy 39-Signs of second stage of labor:(-Full dilatation of cervix,, Flushing of the face. Urge to bear down., Plugging of perineum, Strong uterine contraction, Changing in woman voice) 40-Benefits of breast feeding for mother and baby *For mother: - Oxytocin release aids uterine involution. -Strong relationship. - Convenient.- Cost effective - Less incidence of cancer breast) *For baby: ( 1-Easily digested 2-Promotes development offacial muscles 3-Calcium is better absorbed 4- Less sodium and protein 41-Ampullais a widened lateral area of the tube wherefertilization normally occurs. 42-Average number of fertile male is 60-120 millionsperm but in infertile male is less than 20m. 43-Implantation begins about 6th or 7th dayand complete about 11th dayafter fertilization. 44-The placental hormonal are Human chorionic gonadotrophin (HCG) Estrogens and Progester 45-The hormone of pregnancy test is Human chorionic gonadotrophin (HCG). 46-VernixcaseosaIs a soft yellowish cream which covers the neonate at birth to protect the skin from sebaceous gland. 47-Miliais small pinpoint white or yellow spots due to increased fat secretion. 48- supine is preferable position to prevent retroversion flexion(RVF) and keen chest position must be avoided in postpartum. 49-Anterior pituitary gland secrete prolactin To secrete milk but posterior pituitary gland secrete oxytocin To initiate labor. 50-During pregnancy, felt fundus of uterus at symphysispubis by 12 weeks gestation, at 24 weeks the funds is at umbilical level., and by 36 weeks is atxiphoid process. 51-The approximate weight gain during pregnancy is12kg. 52-Calcium and iron are vital in pregnancy, calcium is found in milk And egg, but iron is found in red meat and offal and high fiber foods found in bread, cereals and pulses. 53-High risk pregnancyis defined as one in which the mother or the fetus has significantly increased chance of death. 54-Hemolysis isthe breakdown of red blood cells. 55-Severe preeclampsia manifested by Hypertension,Proteinuria And Pulmonary edema. 56-Anticonvulsant medication as mild preeclampsia But…………… …… is a sedative medication. 57-In tonic stage manifested by (Generalized tonic spasm with Cyanosis.And ,Tongue may be bitten between the clenched teeth.) 58-The women that delivers several times before called Multipara 59-LieIs relationship of the long axis of the fetus to the long axis of the mother. 60-APGAR score is recorded at 1 min and 5. Min after delivery. 61-Fertilizationisunion of the sperm with ovum in the fallopian 62-DeciduascapsulariesCovering the blastocyst. 63-Bleeding in early pregnancyIs bleeding before 20 weeks of gestation. 64-Hydatidiform Mole (Vesicular Mole)is a gross malformation of the trophoblast in which the chorionic villi proliferate and become avascular. 65-Gametogenesisis the formation and release of mature eggs in women or sperm in men. 66-Second stage of labor begins with fully cervical dilatation and ends to complete delivery of the baby 67-The expected date of delivery (EDD) based on the last menstrual period (LMP) for woman her (LMP) is (29) January is 1st day of LMP + 7 days + 9 months= 5/11 68- The Lochia serosa is Pinkish yellow in color containing less blood and more serum 69-duration of third stage of labor in multipara is 10-20 min. 70-Involuation of the uterus occurs by two process Autolysis “self-digestion and Ischemia “Decreased blood supply 71-endometrial regeneration is completed by about3weeks.except for the placental site at 6 weeks 72-Lockia alba is Creamy or white in colour containing leucocytes and mucus 73-Placenta is completely formed and functioning from 10-12 weeks after fertilization. 74-The placenta has The Maternal and The Fetal Surface. 75-The length of the cord is 50cm. 76-The ductusvenosus Connects umbilical vein with inferior vena cava. 77- Secretory Phase , is a phase which beginning with ovulation and end with menstruation. 78-The duration of first stage of labor in multipara is 8 hrs 79-The size of the uterus in pregnant is increased 20 times 80-Estrogen and progesterone is secreted by the (Ovaries and corpus luteum )then after 12 weeks by placenta 81-The vaginal opening show the fetal head between contractions is Crowning and it occur at 2th stage of labor 82-……………………..falls and fetal perfusion is affected by mother lying flat on her back. 83-3rd stage of labour begins with complete delivery of the baby& ends with complete delivery of the placenta 84- Sign and symptoms of secondary postpartum hemorrhage? General: Tachycardia and Low grade fever. Abdominal examination: Subinvolution of uterus. Vaginal examination: Lochia heavier in amount, fresh in color & offensive in odor. If infection occurs retained placenta may present.  Give short account on: 1- Function of vagina. - As a passageway for the menstrual flow - As the birth canal during labor - help With two Bartholin's gland becomes lubricated during sexual intercourse - Passage to uterine secretions 2- Nursing management of septic abortion. - complete bad rest in fowler's position and Isolation - monitoring for vital signs and fluid chart - fluid infusion to maintain urine flow - clinical bacteriological to identify the infectious organisms - administration of medication - the soiled pads should be properly collected and burned 3- Difference between true and false labor pain. True labor contractions False labor contractions - regular - irregular - increase in frequency & - not increase in frequency , duration & intensity duration & intensity - short interval between - usually no change contractions - relived by analgesic - not relived by analgesic - pain usually in the abdomen - colicky pain begins in the lower - not productive back and around to abdomen - not increased with walking - stretching & dilatation - intensity increases with walking 4- Disadvantage of bearing down during first stage of labor. - weakness of pelvic muscles - genital or cord prolapsed - aids in cervical dilatation - edema of the cervix - placental insufficiency - exhausted mother 5-Sign and symptoms of secondary postpartum hemorrhage. - general: tachycardia and low grade fever - abdominal examination : Subinvolution of uterus - vaginal examination : lochia heavier in amount fresh in color & infection occurs retained placenta may present 6- Signs and symptoms of ectopic pregnancy - short periods of amenorrhea - sudden , colicky in lower abdominal - blood stained vaginal discharge - signs of shock - dyspareunia 7-The functions of the mature placenta 1 –Respiration - the fetus obtains oxygen and excretes carbon dioxide through the placenta 2- Nutrition - food for the fetus from the mother - protein is transferred as amino acids - protein is transferred across amino acids , carbohydrates as glucose as fatty - pass water and vitamins and minerals - the placenta can break down complex nutrients 3- storage - the placenta metabolizes glucose - stores iron and fat and soluble vitamins 4- excretion - carbon dioxide excreted from the fetus - bilirubin and very small amounts of urea and uric acid 5- protection - a limited barrier to infection - some bacteria cross the placenta -rubella virus and some drugs also cross the fetus - antibodies are transferred to the fetus from the mother 6- endocrine - HCG forms the basis of pregnancy tests as it is excreted in the mother's urine - its function is to stimulate the growth and activity of the corpus luteum *estrogens are produced by the placenta * progesterone is secreted by the placenta in large amounts * Human placental lactogen (HPL) has a role in glucose metabolism in pregnancy 8 - Complications of vesicular mole - hemorrhage - shock - perforation - uterine sepsis - choriocarcinoma 9 - Factors affecting the bearing dawn - maternal condition ( fatigue , severe pain ) - fear and anxiety led to muscle tension increase pain - child births education - motivation of child bearing 10 - Criteria of second stage of labor - full dilatation ,complete effacement of cervix -strong uterine contraction - spontaneous rupture of membranes -urge to bear down - appearance of presenting part from the vulva -plugging of perineum -flushing of the face -changing in woman voice begin to cry 11 - Comfort measures during first stage of labor Non-pharmacologica pain relieve: Hydrotherapy :warm water for relaxation and relief of discomfort - Acupressure: firm finger or massage at the same trigger points to reduce the pain sensation - Attention focusing and lmagery -Breathing techniques - Homeopathy: prepared from plant extracts &from minerals such aconitum to relieve anxiety 12 - Contraindications of vaginal examination during first stage of labor -ante partum hg -premature rupture ofmembrane -cord prolepse -urinary tract infection -previous history of abortion -obstructed labour 13 - Methods of placental separation Shultze method Duncan"s methods -97%of cases -3% of cases -separation started at the center -theedges of placenta than at the edges as an inverted separated first umbrella - more liability fir bleeding -less liability for bleeding -less retention of membranes - retention of membranes 14 - Mechanism of normal labor -Full dilatation , complete effacement of cervix - Strong uterine contraction -Spontaneous rupture of membranes - Urge to bear down -Appearance of presenting part from the vulva - Plugging of perineum -Changing in woman voice begin to cry - Flushing of the face 15 - Elements of antenatal care - complete history taking - physical examination - laboratory investigation -health education - general examination 16 - Positive signs of pregnancy - visualization of fetal sae by ultrasound - hearing FHS by doppler or stethoscope - palpate fetal parts 17- Disadvantages of bearing down during 1st stage of labor. - Weakness of pelvic muscles - Genital or cord prolapsed - Edema of the cervix - Placental insufficiency - Exhausted mother 18 -Sure signs &symptoms of labor. - True labor pain. - Show is present. - Cervical dilatation. 19 -Degrees of placenta previa. 1.Complete "Centralis";placenta completely covers the internal os even when it is fully dilated. 2. Incomplete "Partials";placenta covers the internal os when it is closed, but covers it partially when it is fully dilated. 3. Lateralis:placenta on LUS but does not reach internal os. 4. Marginalis:placenta reaches internal os but does not cover it 20 - Benefits of family planning. A. For women: - Decrease maternal mortality and morbidity by reducing high-risk pregnancies - Improve health and the quality of life. - Avoidance of hazards & complications B. For children: -Deceased child Mortality - Improve intellectual development - Prevent genetic diseases and improve genetic potentials. - Prevent communicable diseases C. For the family: - Improves the financial status. - Improves the educational opportunities for children. - Improves nutrition and quality of life. D. For the community: - Less drain on resources - High levels of socioeconomic development - Fighting HIV/AIDS through providing information 21 - The maternal causes of abortion - Infections e.g. influenza, malaria, syphilis ,HIV. - Disease such as chronic nephritis,TB. - Drug intake during pregnancy. - Rh and ABO incompatibility. - Incompetent cervix. - Uterine malformation. - Acquired uteine defect as uterine fibroid or adhesions - Trauma - criminal interference, - Endocrinal disorder as hypothyrodism , daibetes mellitus 22 - Causes of bleeding in early pregnancy - Abortion. - Vesicular mole. - Ectopic pregnancy. - Local lesions - cervical polyps - cervical cancer 23 - Advantage of bearing dawn - Help in pushing down of the fetus - Help in facilitate descend of the head - Aids in cervical dilatation - Facilitate labor - Shortening of the 2nd stage of labor 24 - Complications of preeclampsia Maternal: -Convulsions and coma -Cerebral hemorrhage. -Renal failure. -Liver failure.. -Abruption placenta. -HELLP Syndrome -Residual chronic hypertension. -Recurrent pre-eclampsia in next pregnancies. -Retinal detachment -hemolytic anemia Fetal: -Intrauterine growth retardation (IUGR). -Intrauterine fetal death. -Prematurity and its complications as respiratory distress, hge and infection in newborn. 25 - Factors affecting labor - Passage: (Bony pelvis & Soft tissue (Birth canal). - Passenger: ( Fetus& Placenta & membranes). - Power: (Primary (uterine contraction) & Secondary (Bearing down). - Prejudice (place & personnel) - Psychological aspect 26 - relive measures during fourth stage of labor - Icepacks: Apply an ice pack to the perineum promptly after vagina. - Analgesia: The nurse should encourage the woman to take analgesics and Massage, abdominal effleurage, breathing exercise..ect. - Warmth; A warm blanket shortens the chill common after birth and Encourage the mother take warm fluids initially. - Voiding; Encourage the mother to empty her bladder - Psychological support 27 - What are the component of pantograph? Part 1: Fetal condition:to monitor and assess fetal condition: Fetal heart rate , Membranes and liquor , and Moulding the fetal skull bones Part 2 : Progress of labor: Cervical dilatation , Descent of the fetal head , Uterine contractions Part 3: Maternal condition:Assess maternal condition regularly by monitoring : vital signs , Drugs , IV fluids, Urine volume 28 - Mechanism of normal labor 1. Descent 2. Engagement 3. Flexion 4. Internal rotation 5. Extension 6. Restitution 7. External rotation 8. Delivery of shoulder 29 - Dangers sign during the fourth stage of labor -Sever perineal pain suggestive for haematoma formation. - Rapid pulse increases hypotension. - Sever headache hypereflexia may precede eclampsia. - Distended bladder often visible will lead to enhanced uterine bleeding, catheterization for retention when necessary. 30 - Schedule of Antenatal visits Regular antenatal care can detect anemia, hypertensive disease, infections and other existing conditions and diseases that lead to high-risk pregnancy. Antenatal visits should take place: - Before 28th weeks gestation (every 4 weeks) - From 28th-36th weeks (every 2 weeks) - Thereafter (every week) - In a normal pregnancy, with no complications, a minimum of three antenatal visits is acceptable in the first 20 weeks. 31 -What are the component of antenatal care? 1. Complete history taking(personal history, menstrual history, family history, past history of previous pregnancy, obstetric history, present complain 2. Physical examination 3. Laboratory investigation 4. Health education 5. General examination 32 - What are the classifications of preeclampsia? 1- Mild preeclampsia - Hypertension, but not reaching 160/110 mmHg after 20 weeks gestation. - Proteinuria 1+ dipsticks (300 mg / 24 hrs) - Manifestation disappearing < 12 weeks postpartum. 2-Severe preeclampsia - Bp ≥ 160 / 110 mmHg, plus one or more of the following criteria. - Proteinuria ≥ +2 or +3 dipstick (2 gms or 5gms / 24 hrs). - Serum creatinine ≥ 1.2 mg / dl unless known to be previously elevated. - Persistent headache, visual disturbance and persistent epigastria pain. - Oliguria or anuria. - Pulmonary edema. 34 - What are the danger signs during pregnancy? - Persistent vomiting. - Severe persistent abdominal pain. - Vaginal bleeding. - Vaginal discharge with odor or itching - Chills or fever. - Severe headache. - Marked changes of fetal movements. - Dysuria or burning sensation. - Sudden swelling of face, fingers and feet. - Blurring of vision.. - Sudden enlargement of the abdomen. - Premature onset of contractions. - Sudden escape of fluid from the vagina. - Dysuria, oliguria or anuria. 35 - Prenatal Visits: *Initial Visit 1- Taking history 2- Physical Ex. (general& local) 3- Investigations (urine, stool & blood) ***************List the following*************** 36 - Nursing management during second stage of labor 1. Preparation: (Place, attendant & mother) 2. Observation: V.S, UC, FHR, FD 3. Assist doctor during delivery: 4. Documentation 37 - Criteria of second stage of labor. - Full dilatation, complete effacement of cervix. - Strong uterine contraction. - Urge to bear down. - Plugging of perineum. - Flushing of the face. - Spontaneous rupture of membranes - Appearance of presenting part fromthe vulva. - Changing in woman voice begin tocry. 38 - Criteria of normal labor. -Mature viable fetus -Without interference except episiotomy -Vertex presentation -Without complication for the mother and fetus -Through birth canal -Spontaneously -Within reasonable time 39 - Phases of endometrium cycle. - Menstrual cycle changes in the endometrium caused by estrogen and progesterone 1-Menstrual Phase Starts with 1st day of menstrual cycle and Lasts for 4-5 days layer of uterine wall is sloughed off and discardedin the menstrual flow Blood discharge from vagina with small pieces of endometrial tissue 2-Proliferative phase phase of repair and proliferation and Lasts for 9 days Controlled by estrogen secreted by follicles Endometrium thickens under the influence of estrogen and progesterone 3-Secretory Phase It begins with ovulation and end with menstruation Spiral arteries grow into the superficial layer Arteries become increasingly coiled Large venous network develops 4-Ischemic Phase Decreased levels of estrogen & progesterone and it is Lasting about 13 days Loss of interstitial fluid and Marked shrinking of endometrium Rupture of damaged vessel wall 40 - Complications of preeclampsia. Maternal Fetal Convulsions and coma (eclampsia 1-2%ofcases).Cerebral hemorrhage. Intrauterine growth retardation Renal failure. Liver failure. (IUGR). Abruption placenta. Intrauterine fetal death. Residual chronic hypertension Prematurity and its complications In about 1/3 of cases. as respiratory distress and infection Recurrent pre-eclampsia in next in the newborn pregnancies. Retinal detachment hemolytic anemia 41 - Nursing management of placenta previa. Bed rest and decrees of physical activity for 24 Avoid constipation, enemas, and vaginal and rectal examinations Follow strict aseptic technique to avoid infection. listening FHR every 4 hours. Continuous observation of bleeding and signs of shock. accurate recording of intake and output. I.V fluids & o2 mask 42 - Types of abruption placenta - Revealed : almost all the blood expelled through the cervix. - Concealed : almost all the blood is retained inside the uterus. - Combined : some blood is retained inside uterus and some is expelled through cervix 43 - Danger signs during postpartum period. for the mother: - Excessive bleeding - Foul smelling vaginal discharge - Fever with or without chills and Severe abdominal pain - Excessive tiredness or breathlessness - Swollen hands, face and legs with severe headaches or blurred vision - Painful, engorged breasts or sore, cracked, bleeding nipples for the baby: - Fever or Low body temperature - Fast breathing (more than 60 breaths per minute) - Severe diarrhea or constipation Colic - Repeated vomiting esp. projectile vomiting - Bleeding or offensive odor from the site of the cord 44 - Stages of eclampsla. 1-Premonitory stage (1/2 minute): - Eye rolled up. - Twitches of the face and hands. 2-Tonic stage (1/2 minute): - Generalized tonic spasm with -Cyanosis. -Tongue may be bitten between the clenched teeth. 3-Clonic stage (1-2 minutes): - Convulsions. - Tongue may be bitten. - Temperature may rise. - Blood stained froth from the mouth. - Gradually convulsions stop. - Involuntary passage of urine or stool.. 4-Coma: - Variable duration due to respiratory and metabolic acidosis. - Deep coma may occur (cerebral hemorrhage). - Labor usually starts shortly after the fit. 45 - Proper positioning during purperium. - prone position : should be encouraged in order to facilitate involution and to help drainage of lochia. -Sitting position : is also recommended since it promotes contraction of the abdominal muscles, aids pelvic circulation, and helps drainage of lochia -Knee-chest position : is indicated in certain conditions because it prevents RVF of the uterus and hastens its involution -Both supine and semi-sitting positions should be avoided. 46 - Reproductive health rights. - Right to be free from all forms of discrimination. - Right to life, liberty and security. - Right to marry and found a family. - Right to education and information. - Right to benefit from scientific progress. - The right of sexual equality. - Right to health and health care. - The Egyptian women work law. - Right of adolescents to meet their needs 47 - Nursing care during the first stage of labor 1- Assessment at admission: It is divided into: - Initial assessment - Ongoing assessment - Initial assessments 1- History taking: 2- Physical examination: A-General examination: vital signs and Fetal Heart Rate / 2hrsweight and hight. and edema B- Local examination: (Abdominal examination) - Examination of the vulva : observe color and odor of amniotic fluid and check - Vaginal examination: to assess progress of labor, - Previous history of abortion and labor *Obstructed labour. 3- Investigation: *Hematology test, includes, "Hb, RH &Blood group". *Urine analysis; includes," Glucose, acetone, and albumin" 2- Planning management according to assessment: a-Comfort measures: b-Voiding. c) General hygiene: d) Nutrient and fluid intake: e) Pain relievers measures: 3-Observation of the progress of labor a- Empty the bladder. b- Perinea care. c- Apply a sterile pad. 48 - Nursing care during pregnancy antenatal care: 1. Complete history taking(personal history, menstrual history, family history, past history of previous pregnancy, obstetric history, present complain 2. Physical examination (general and local) 3. Laboratory investigation 4. Health education 5. General examination Schedule of Antenatal Care Visits: Regular antenatal care can detect anemia, hypertensive disease, infections and other existing conditions and diseases that lead to high-risk pregnancy. Antenatal visits should take place: - Before 28th weeks gestation (every 4 weeks) - From 28th-36th weeks (every 2 weeks) - Thereafter (every week) 49 - General measurement and nursing care of patient with seizers. * Airway and respiratory management - Place patient in left lateral decubitus position - Anesthesia at bedside for possible intubation - Consider Oral Airway - Suction oral secretions - Supplemental Oxygen -Arterial Blood Gas *Prevent injury (- Padding on side rails of bed) * Other post-Seizure measures - Foley Catheter to monitor urinary out put - Internal fetal monitor (Internal Scalp electrode) - Consider central venous pressure catheter - Fluid administration needed to be monitored by central 50 - Nursing management of gestational diabetes - needs clear explanations and teaching to gain good outcome. - needs to understand what changes she can expect during pregnancy. - Preconception care focuses on stringent blood glucose - food divided three meals the bed time snack is should include protein and complex carbohydrates to prevent night-time hypoglycemia - Glucose monitoring to assess glucose control -Non stress test - have to come weekly for assessment of her fasting glucose levels - Many women need insulin to maintain normal glucose levels - Evaluation of fetal status Daily and determine gestational by Ultrasound 51-Signs of placental separation. 1. The uterus becomes smaller, harder, higher, and more globular. 2. A suprapubic bulge appears due to presence of the placenta in the lower uterine 3. The passage of gush of blood per vagina. 4. Elongation the umbilical cord. 5. Loss of pulsation in the cord. 52-Involution of uterus during postpartum changes in reproductive organs, especially the uterus, under go after childbirth to return to their nearly pre-pregnancy size and condition The involution occurs by 2 processes 1- Autolysis "self-digestion " protein material of the muscle fibers is broken down by protolytic enzyme and absorbed in the blood stream, and excreted by the kidneys in the urine 2- Ischemia " Decreased blood supply " Contraction and retraction of the uterine muscle. The blood vessels reduces the blood supply to the uterus old blood vessels obliterated by thrombosis, and then under go degenerative changes Endometrial regeneration is completed by about 3 weeks and placental site complete on 6 weeks * Involution rate ↓ * - Immediately following delivery, the size of uterus as large and can be palpated between the symphysis pubis and umbilicus. - Within 1 hour, the fundus rises to the level above the umbilicus and should remain at this level for about 24 hours. - After 24 hours, the fundus begins to descend by approximately 1cm, or one, per day, so by 10th day it is in the pelvic cavity cannot be palpated abdominally 53 - Who should not use the IUD as a family planning method - Women who have had pelvic inflammatory disease - pelvic infection or sexually transmitted diseases. - Women with very heavy menstruation or abnormal vaginal bleeding, with anemia. - Possible pregnancy. - Women with history of tubal pregnancy. - Women with cervical or uterine cancer.r: 54 - Nursing management of Eclampsia A- General measurements and nursing care. B- Medical measurements for Control of seizure by: ----- Parenteral administration of Mag. Sulfate ,and antihypertensive ----- Delivery and Prevention and treatment of complications of eclampsia. A) General measurements and nursing care of a patient with seizers: - Airway and respiratory - Place patient in his left side position - Suction oral secretions and determine Arterial Blood Gas ( ABG ) - Anesthesia at bedside for possible intubation - Consider Oral Airway and Supplemental Oxygen - Prevent injury - post-Seizure measures - Foley Catheter to monitor urinary out put - Internal fetal monitor (Internal Scalp electrode) - Consider central venous pressure ( cvp ) catheter and monitor fluid - Continuous hourly monitoring of vital signs B) Medical measurements - Magnesium sulfate treatment - anti-hypertensive drugs to prevent cerebral hge and left ventricular heart failure. c) Delivery : Eclampsia frequently precipitates preterm labor. - If the patient in not in labor within few hours (3-4) after the last seizure, labor should be induced by pitocin drip. - C.S. ‫ القيصرية‬should not be a routine for all eclamptic patients.. 55 - Nursing management during 3rd stage of labor - Assist with placental delivery and Inspect the placenta immediately for any missing lobe, which may cause hemorrhage, sepsis and sub-involution. - Administering an oxytocic if ordered and indicated after placental to prevent postpartum hemorrhage. - Help in repairing the episiotomy. - prepared to administer of blood or I.V fluids and assessed the contractility of uterus - Observe the amount of blood loss and estimate it. (normal 200 – 600 ml) - Perineal care by ante septic solution. - apply sterile pad on the perineal area and give Health education about it 56 - Effect ( Influence ) of diabetes on pregnancy On Mather - Hydramnios. - Preeclampsia. - Nephropathy and retinopathy. - Premature rupture of membranes may be problem with hydramnios. - Hyperglycemia can lead to Ketoacidosis as a result of increase in ketone bodies ,can lead to coma and death for mother and fetus. - Increase risk for vaginitis and urinary tract infection. - Placenta previa or abruption and Abortion and Obstructed labor. - Woman also more likely to develop gestational diabetes in future pregnancies, and are at a higher risk of developing type 2 diabetes later on life. Complications on the fetus - Congenital anomalies, malformation including (congenital cardiac, nervous system anomalies, and skeletal malformations ) - Macrosomia (excessive growth to baby ), glucose. - Macrosomic infant is at increased risk for shoulder dystocia and traumatic injuries, if born vaginally. - IUGR and IUFD. - Hypoglycemia after birth. - Prematurity. - Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. - Polycythemia (excessive number of red blood cells) in the newborn. - Hyperbilirubinemia may result from in ability of immature liver enzymes to metabolize the increased bilirubin resulting from Polycythemia, red blood cell destruction. - It becomes more liable to develop obesity and cardiovascular disease. 57 - Nursing role during menstrual cycle *Nurse must provide health teaching about the following items Sanitary pads and tampons: -Wash hands before and after giving self perineal care. - Washing or wiping the perineum should be always done from front to back. - Reduce use of tampons by sanitary pads part at night. - Apply perineal pad snugly enough and don't touch the side. - Frequently take warm bath to maintain personal hygiene. * Diet: - Eat six small meals a day , Increase fluid intake and Avoid alcohol. -Decrease intake of ( caffeine , simple sugars , salty food to reduce fluid retention ) Nutritional self-care: -Vitamin B complex and B6 - Vit E - intake Iron, Calcium *Exercise: - Daily exercise can prevent cramps, relieves constipation. - Deep breathing and Aerobic activities. * Heat and massage. l Po 58 - The immediate newborn care (ABCW) Airway. Breathing. Circulation. Warmth. airway: - clear the airway, and improve infant's color. The APGAR Score: (Heart rate /Respiration /Muscle tone / Reflex irritability /Color) - Warmth: - It is very important to keep the infant warm. Umbilical cord : - Double ligation may be used. - The excess cord is cut off. - The first at 5 cm from umbilicus to prevent strangulation of a congenital umbilical hernia. - The second at 2 cm further for security. - A disposable plastic clamp may also be used and placed 3-5 cm from the umbilicus. - Nowadays, alcohol gauze and bandage are not applied to the stump. Weight and measurements: Weigh the infant after birth.Measure its length. Measure. The head and chest circumferences Care of eyes: The eyes are washed with sterile warm water. Vitamin K should be given to prevent bleeding. Identification: is very important to identify the infant by its sex, and its mother's name. Position: head of the infant should be placed lower than the body Examinations: determine any abnormalities are present from head to toes. Early Breastfeeding: to prevent hypoglycemia and stimulate milk secretion in Mother. 59 - nursing care for the women in fourth stage of labor Observation: - Vital signs; should be assessed every 15 minutes in the first hour - Uterus : Assess the firmness, height, and positioning of the uterine and fundal livel - Lochia; assess the amount, color and Oder of lochia - Perineal and Labial : Observe areas for hematoma formation using REEDA scale. The nurse should be alert for the danger signs during this stage: - Sever perineal pain suggestive for haematoma formation. - Rapid pulse increases hypotension. - Sever headache hypereflexia may precede eclampsia. - Distended bladder often visible will lead to enhanced uterine bleeding, catheterization for retention when necessary. Newborn: - The nurse should observe VS, reflexes, cord, defecation / urination, skin color Comfort measures: - Position: The mother is allowed to sleep in any comfortable position, prone position to facilitate involution and to help drainage of lochia. Hygienic measures: - Clean the vulva and perineal area with warm water and antiseptic. - Breast care should be done before and after feeding. The nurse teaches the mother the technique of breast care. - Instruct the mother how to care an episiotomy; - Avoid touching the open wound to avoid infection. - Don't sit in a warm bath three or four times a day after perineal cleanse the wound. - Apply a topical spray to the perineum to relieve pain. - Sit on a pillow or inflatable ring to avoid pain. - Walking can be good exercise to increase blood flow & speed healing. - Call your provider if; the area of the episiotomy becomes reddened, swollen Pain relievers measures; //nursing care for the women in fourth stage of labor// - Icepacks: * Apply an ice pack to the perineum promptly after vaginal birth - Analgesia: The nurse should encourage the woman to take analgesics  Massage, abdominal effleurage, breathing exercise. -Warmth:  Encourage the mother take warm fluids initially. * A portable radiant warmer provides warmth to both the mother and infant. -Voiding; Encourage the mother to empty her bladder. - Psychological support Promoting early family attachment: Provide privacy when parents observe their baby. Put the baby in the parent‘s arm and Encourage the breast-feeding. 60 - contraceptives stratum A) Hormonal Methods )1( Oral Contraceptive: " Ocs , Pills ", Combined Oral Contraceptive What it is and how it works: progesterone and estrogen. -OCS stop ovulations ,endometrial changes and make cervical mucus thick Advantages of OCS Highly effective and Reduce risk of ectopic pregnancy and ovarian or uterine cancer Disadvantages of OCS Heart attack , strokes, High blood pressure , blood clots and decrease of breast milk -Who should not use the method : Women over age 35*- Smoker - heart attacks )2)Progestin-only Pill (mini pill) ?What is it and how it works: progestin-only -.causes thick cervical mucus impenetrable to sperm end atrophic endometrium.Advantages / less risk of cardiovascular side effects and Does not affect lactation Disadvantage / a higher pregnancy and cause menstrual irregularity -Who should not use the method.Women who experience genital bleeding* And ectopic pregnancy )3) Inject able Contraceptives What it is and how it works: progestin hormones injected into muscle.suppressing ovulation , thin atrophic endometrium and causing thick cervical mucus :Advantage only every 3 months, one of the most effective reversible, no serious side effects * Does not interfere with lactation -Disadvantages //Amenorrhea and Inter menstrual bleeding 4) Norplant how it works? The progestin works by blocking ovulation, causing thick cervical mucus impenetrable to sperm, and inducing thin endometrium B) Intrauterine method or device (IUD, CU. T, lippes loop ) how it works:. IUD seems to induce an environment in the uterus which make it In.hospitable both egg and sperm Advantages of IUD : Highly effective, long term, Very safe and inexpensive Disadvantages of IUD : Insertion and removal need to trained health personnel and cause heavy bleeding and severe abdominal cramping. Who should not use the method Women who have (pelvic infection) and Possible pregnancy ,history of tubal pregnancy, cervical or uterine cancer, abnormal vaginal bleeding  C) Barrier Methods (1)Condom What it is and how it works a sheath of thin rubber which is put on penis before sex to collect the semen Advantages : Easy to use, effective, inexpensive, Protect from sexually disease Disadvantages : May tear and users find sexual pleasure decreased )2)Spermicidal products What it is and how it works it spreads over the vagina and cervix. inactivate sperm from entering uterus Advantages* protect from sexually transmitted diseases. (AIDS) Can used anyone Disadvantages unreliable method and maybe produce a slight genital irritation D) Surgical Methods 1-Tubal ligation. (Female sterilization) What it is and how it works the fallopian tubes are closed so that the ovum cannot travel through them to meet the sperm Advantages Highly effective method Disadvantages need to skills medical practitioners. rare Complications )Bleeding, infection) 2-)Vasectomy (Male sterilization)- Definition of vasectomy : a surgical method in the vas deferens is cutted. And,sperm cannot move out of the.testes Advantages Very effective and Permanent No apparent long-term health risks Disadvantages of vasectomy -Common minor short-term complications of surgery ,Usually uncomfortable for 2 or 3 days – ,Pain in the scrotum, swelling and bruising – Uncommon complications of surgery ,Bleeding or infection and Blood clots in the scrotum Requires surgery by a specially group Who should not use the method )Contraindication) -Diabetic patient - Anemic patient - Skin infection