Week 14: Maternity Flashcards by Frances Rose

How does the airway change within pregnancy?

full dentitions
short obese neck
breast enlargement

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How does breathing change in pregnancy?

splinted diaphragm
splaying ribs
increased O2 consumption required
40% increase in tidal volume

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How does circulation change in pregnancy?

vena cave compression
breast enlargement
splaying ribs
tachycardia
ECG changes

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How can hormonal changes impact on the pregnant woman?

Tissue growth and development, controlled by the action or hormonal changes within the maternal system and interactions with hormones produced by the detal-placental complex

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Define LMP

Last menstrual period

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Define EDD

Estimated date of delivery

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Define T or D

Term or expected date of delivery

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Define CEPH

Cephalic (head)

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Define BR

Breech

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Define G

Gravida (number of pregnancies inc this one)

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Define P

Number of times the woman had given birth (live or stillborn) P3+2, the 2nd number refers to prev miscarriages or terminations

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At what point is labour at term?

27-41 weeks of gestation

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When is labour considered premature?

Prior to 37 weeks (32-38)

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When is labour considered extremely premature?

24-32 weeks

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When is labour considered as post mature?

More than 40 weeks

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What is the exact number of weeks to be full term?

40 weeks

What occurs in the first stage of labour?

first stage of progressive cervical dilation
timed from the onset of regular coordinated contractions
accompanied by progressive effacement (thinning) and dilation of the cervix

When is a mother fully dilated?

At 10 cms

How is the uterus and cervix divided?

Into the upper and lower segment

What is contained within the upper segment of the uterus and cervix?

Motor muscle fibres in all directions where a contraction is commenced

What is contained in the lower segment of the uterus and cervix?

Soft and stretchy, pulled up and over out the way to allow passage of the baby

What occurs in the second stage of labour?

fetal expulsion, from the full cervical dilation until the delivery of the baby
contractions are strong and aided by resp muscles
can take over an hour or as little as a few minutes in the multigravidae

What are the 4 stages within the second stage of birth?

presentation of head
rotation and delivery of anterior shoulder
delivery of posterior shoulder
delivery of lower body and umbilical cord

What occurs in the third stage of labour?

Seperation and complete exclusion of the placenta and membranes and control of bleeding from the uteroplacental circulation

What should you consider when attending a labour call?

- detect stage of labour - deliver or not - transfer or not - are contractions coordinated or regular - how do they palpate and how long

What is the management of normal labour?

- assessment - quickly assess woman and scene upon approach - undertake primary survey - management - correct any time critical features and transfer to nearest hospital - pre alert

What is the primary survey within labour?

DR- define risks A- airway B- breathing C- contractions C- circulation D- disability E- equipment F- fetus G- gestation H- home delivery I- inform maternity unit

What are the external signs of labour?

- flattening of labia and perineum - gaping of vagina - raising if the clitoris - distended aus - purple colouring around anus and up the cleft - blood/mucous - fetal parts - bulging membranes

Extra primary survey detail:

E- ask for handheld records/ECPR access F- ask about fetal movement G- ascertain the period of gestation H- have a look for operculum, ruptured amniotic membranes, contractions, bleeding H- external observation

What should you do if birth is imminent?

- remain on scene - request midwife support

How do you prepare for birth?

- reassure woman, - ensure the environment is safe/secure - maternity bag - maternity bag - support woman in a comfortable position, discourage lying flat - offer entonox as pain relief

How can you prevent rapid birth of baby?

Apply gentle pressure to the top of baby's head, also helping to keep head flexed to allow smallest diameter of the fetal skull to be born, reducing perineal trauma

What should you not do in labour?

- do not pull - do not remove cord from baby's neck if wrapped around, focus on mother and pushing/positioning

What should you do when the baby is born?

- hold baby and lift towards mothers abdomen - towel dry baby - make initial assessment and remove any blood/mucous from baby's face - replace wet towels with warm towels

When should you cut the cord?

Delay cord clamping by at least 3 minutes or until it has stopped pulsating

What does purple pulsating of the cord mean?

Good

What does a white grey cord mean?

Poor

What takes place in the newborn assessment?

- assess colour, tone, breathing, and HR of newborn - place the handheld stats probe on babies right hand

What is involved in the secondary survey?

DR- define risks A- airway B- breathing C- contractions C- circulation D- delivered or not E- environment F- baby warm (atleast 3 obs taken) P- pre-alert to maternity