Unit 7 Week 3: Birth Flashcards by Lara Everett

symptoms 1st trimester of pregnancy, 1-12 weeks

fatigue
tender/swollen breasts
mood changes
fodo cravings
headaches
indigestion
need to urinate more
weight changes
constipation
nausea, sometimes with vomiting (morning sickness)

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symptoms 2nd trimester, 13-28 weeks

abdomen expansion
stretch marks
areola darkens
skin on face may darken
ankles, face, fingers swell
itching
morning sickness may reduce or disappear

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itching in second trimeter when to seek help q

if occurs with vomiting, yellowing of eyes or skin

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symptoms of 3rd trimester
29-40 weeks

heartburn
shortness of breath
swelling of ankles face and fingers
insomnia
mood changes
leakage of milk from breasts
other breast/ nipple changes
frequent urination
haemorrhoids
Braxton hicks contractions, doesnt mean labour
real contractions, means labour

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non pharmacological pain relief pregnancy

breathing techniques and exercises
water therapy
massages
acupuncture

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acupuncture

thin needles to specific points of Body to manage pain

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pharmacological options for pain management

gas and air
pethidine injections
epidurals

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gas and air

mixture of oxygen and nitrous oxide gas
inhaled through mouthpiece
can relieve pain and anxiety
side effects: dizziness, nausea and vomiting

moa:
opioid peptide release to brain stem
activates noradrenergic neurons
modulation of nociceptive process in spinal cord

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pethidine injections

type of opioid pain medication that can be given as an injection
binds to opioid receptors in the brain and spinal cords
can help to reduce pain
decreases pain for 2-4 hours
side effects: drowsiness, nausea and dizziness in mother and baby, may affect breastfeeding and cause respiratory depression in baby if given too close to deliver y

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epidurals

regional anaesthesia that involves injecting numbing medication into the epidural space in lower back
help relieve pain in lower body management, one of the most effective pain management
side effects: drop in blood pressure, headache, difficulty urinating

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inducing labour

is a chice
carried out in a maternity unit or birthing centre
elective labour induction= starting for convenience, no medical need
failed induction= another induction or C section

can take minutes to hours

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when is labour induced

post term pregnancy
pre labour rupture of membranes
chorioamnionitis
fetal growth restriction
oligohydraminios
gestational diabetes
pre-eclampsia
placental abruption
certain medical conditions

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post term pregnancy labour induction

1 to 2 weeks beyond the due date

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pre labour rupture of membranes PROM labour induction

when labour doesn’t begin after waters have broken
hole in amniotic fluid allows fluid to drain

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chorioamnionitis labour induction

infection in the uterus

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fetal growth restriction labour induction

baby’s estimated weight is less than 10th percentile for gestational age

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oligohydramnios labour induction

not enough amniotic fluid surrounding the baby

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gestational diabetes labour induction

when diabetes develops during pregnancy

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pre-eclampsia labour induction

developing high blood pressure in combination with signs of damage to organ system

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placental abruption labour induction

when placenta peels away from inner wall of uterus before delivery

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certain medical conditions labour induction

heart, lung, kidney disease
obesity

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how is labour induced

ripen/ soften the cervix
prostaglandins by pessaries/ orally
catheter with inflatable saloon on end filled with saline inserted into cervix
membrane sweep: finger over crossing of amniotic sac, separates sac from cervix and lower uterine wall
amniotomy: rupture amniotic sac so water breaks
IV meds: oxytocin hormone to cause uterine contractions

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vaginal pessaries

induce labour
tablet/ gel/ device inserted into vagina
contains prostaglandins to prime Cervix to stimulate contractions
before using: monitor the baby’s heart for 30 mins continuously
slow release: progress like a tampon stays in vagina for 24 hours and slowly releases hormones to ripen the cervix
side effects: nauseas, feverish, diarrhoea, sore vagina, pristine contractions, prolonged contraction
prostaglandin gel: given when cervix more favourable

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problem with prolonged contractions

can affect baby’s heart rate

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oxytocin injections

Rtocen hormone produced by hypothalamus: helps start or sustain uterine contractions, reduces bleeding after birth and helps milk secretion can be used to deliver the placenta: if it isn'tseparating, patient bleeding heavier than normal, patient has induction, epidural, assisted birth, c section given IV/M side effects: nausea, vomiting, rash, itching, swelling

antenatal appointments

in the 3rd trimester update the patient history offer exams and investigations (blood pressure and urine dipstick to test hypertension and pre-eclampsia) plot symphysis-fundal height on graph discuss the babies movements advice not to sleep on back after 28 weeks discuss and give information on prepping for labour and birth, recognising active labour, post natal periods, physical emotional and relationship changes, support and baby bonding review bloods from other appointments update antenatal records

why is it advised not to sleep on your back afte 28 weeks pregnant

still birth risk as supine positions causes uterus to put pressure on inferior vena can and abdominal aorta reduced O2 ti placenta

further antenatal appointments

mat b1 form

confirms pregnant woman is expected week of childbirth EWC and confirms pregnancy usually around week 20 pregnant given to employer so employee can claim statutory maternity pay

mother post natal care before discharge

perineum inspection for trauma pain management vital signs: includes lochia assessment, uterine inoculation, uterine volume mothers mental well-being

child post natal care before discharge

crying skin to skin contact and breastfeeding APGAR score physical exam: eyes, heart, hips and testicles

6 weeks postnatal check up

physical symptoms psychological symptoms social problems examination sex and contraception pelvic floor exercises

how should a baby present at birth if healthy

tongue and lips= pink rest cyanosed/ blue as lower O2 sats in utero, when they take first few breaths will become well perfused crying/ coughing RR: 30-60 HR: 100-160 umbilical stays on (falls off in 1/52) fontanelles vernix 2/52 eyes following you swelling/ head bruising blood shot eyes jaundice sucking reflex

vernix

sticky white substance fights infection

APGAR score

functional anatomy of the breast

six key hormones in pregnancy

HCG progesterone oestrogen prolactin relaxin oxytocin

HCG pregnancy

produced by placenta after implantation support function of corpus leuteum detected by pregnancy tests

progesterone pregnancy

helps establish placenta stimulates growth of blood vessels that support the womb inhibits contraction of the uterus so it grows as baby does strengthens pelvic wall muscles fo labour

oestrogen pregnancy

helps uterus grow maintains lining helps foetal organs develop activates and regulates production of other hormones with progesterone will stimulate breast growth and milk duct development

prolactin pregnancy

main hormone needed to produce breast milk contributes to enlargement of mamamary glands and prepares them for milk production inhibits lactation during pregnancy

relaxin pregnancy

inhibits uterine contraction to prevent premature birth relaxes blood vessels increasing blood flow to placenta and kidneys relaxes joints of pelvis and softens and length cervix during birth

oxytocin pregnancy

rise at start of labour stimulating contractions of uterine muscle triggers production of prostaglandins increase contractions further if labour doesnt start naturally can be used to induce it

lactogenesis

cellular changes by which mammary epithelial cell switches from growing non-secretory tissue to secretory non-growing tissue

stage 1 lacotgenesis

breast development and colostrum production from 16 weeks gestation differentiation of alveolar epithelial cells to lactocytes secrete colostrum

stage 2 lactogenesis

onset of increased milk secretion 32-96 hours post birth in response to rise in prolactin decrease in pregnancy hormones milk will "come in" regardless

stage 3 lactogenesis

maintenance of milk production approx 10 days post natal

prolactin in breast feeding

oxytocin in breast feeding

breast milk composition

prolactin receptor theory

controlling lactation, feedback inhibitor of lactation role

normal physiological changes to mother in pregnancy

cardiovascular hematological urinary respiratory gastorintestinal dermatological immune tolerance endocrine

cardiovascular normal physiological changes

haematological normal physiological changes

urinary normal physiological changes

respiratory normal physiological changes

gastrointestinal normal physiological changes

dermatological normal physiological changes

stages of labour

stage 1 labour

stage 2 Labour

stage 3 labour

initation of labour

cervical ripening

myometrial excitability

oxytocin role in labour

vaginal changes in labour

muscle layer thickens, more elastic= vaginal dilatation in 2nd phase of labour number of squamous cells increases due to glycogen does predispose to thrust

stages of delivery

descent engagement neck flexion internal rotation crowing extension of presenting part restitution external rotation lateral flexion

descent