ch.37 OBSTERICS AND CARE OF THENEWBORN

the female gonades or sex glands

thin flexible structure that extend from the uterus to the ovaries
also known as UTERINE

pear shape organ in which a child develop from fertilized egg until birth.

the child from third month of pregnancy to birth; prior to that it is called the embryo

top portion of the uterus

the middle portion of the uterus

the neck of the uterus and connects to the vagina

3
endometrium(inner),myometrium(thick middle), and perimetrium (outter) covers the corpus of the uterus

the mucus and blood that are expelled from the vagina as labor begins

the organ throught which the fetus exchanges nourishment and waste products during pregnancy

the placenta and other tissues that are expelled immediately after the birth of a child usually weights about 1 lb

an extension of the placenta through which the fetus receives nourishments its about 22in long 1 in diameter

a substance that covers protects umbilical cord vein that give the baby 02 blood & nutrients arteries carry deoxygenated blood and waste back to the placenta

(aka bag of water) filled with amniotic fluid in which the infant floats insulating and protecting it during pregnancy

the passageway through which the fetus is delivered the lower part of the birth canal 8 to 12 centimeter

see the baby's head from the vagina opening and a sign of imminent delivery

controlled by estrogen & progesterone first day is about 60 to 80 ml of blood in a 3 to 5 day period

neonate the fetal stage 8 wk in
gestation refer to as pregnacy

3 week after fertilized eggs the placenta is developed 1 to 3 mth is 1st trimester 4 to 6 mths is 2nd trimester 7 to 9 3rd trimester full term pregnancy is 40 weeks or 280 days

most ER occur in the third trimester

-uterus wt 2 oz hold about 10ml in the beginning at the end the uterus wt more than 2lb and holds 5,000 ml
-contains 1/6th blood volume of the mother mucus plug forms at the at opening to protect fetus from infection. breast become larger for milk.

O2 demands of the mom increase respirator hormone dilates smooth muscles -tide volume increase by 40 percent
RR increases only slightly 02 consumption appx 20%

cardiac output increases
blood volumn increse by 45%
HR increase by 10 to 15bpm
1&2 trimester bp decreases the 3 it returns back to normal

nausea & vomiting occur uring the 1st trimester from hormoes and carbohydrates and bloating & constipation from gastro tract

renal blood increases glomerular filitrtion increases by 50% 2nd trimester uninary bladder is displaced above and below increaseing the risk of injury increase in urinations

pelvis joints loosen result from hormoneal changes lower back pains and center of gravity changes

the period of pregnancy prior to the onset of labor complicatoins can cause sever bleeding fetal death

(miscarriage) may occur for any number of reasons and is defined as delivery of the fetus and placenta before teh fetus is viable( before it can live on its own) before the 20wk of pregnancy appx 80% 12th wk gestation 1st

occurs in 15 to 20 percent pregnancy causes usually genetic or by drugs, infections,matnal disease cramping vaginal bleeding present at 8 to 12 wk uterine abnormality patient history is extemly important

*cramplike lower abdomin pain similar to labor
*moderate to severe vaginal bleeding maybe bright or dark red
*passage of tissue or blood clots

spontaneous naturally occurring expulsion of the fetus that relates to a genitic abnormality Elective the termination of pregnancy by request of mother in a medical setting transport patient if you suspect a spontaneous don't mistake vaginal bleed as spontaneous ask about history

!occurs in about 1 in 250 births major cause 3rd trimester bleeding where the placenta is covering the opening of the cervix
signs painless bleeding

Total complete cover the os.block the birth canal and prevents delivery cervix dilates and effaces and bleeds
Partial cover the os and cervix partially may obstuct delivery of baby
Marginal placenta is implanted near the of the cervix when efface and dilates cause placenta to partially tear

*more that two delivers Multiparity
*rapid succession of pregnancy
* >35yrs
*prev placenta previa
*hist early vaginal bleeding
*bleeding immediately after intercourse
hallmark sign vaginal bleeding hypovolemic shock air and trst for shock

is the abnormal separation of the placenta to the uterine wall prior to brith
occurs 1 in 120 births
causes 2 major problems poor gas,nutrients and waste exchange from fetus to placenta severe blood loss

Complete the placenta completely seperates from teh uterine wall which is 100% fetal mortality rate
Partial partial torn from eh uterine wall 30-60%

hypotension, use of cocaine or other vasoactive drugs, preeclampsia,multipartity,prev abruption,smoking,short umbilical cord premature ruture of the aminotic sac diabetus mellitus

-vaginal bleeding with abdominal pain hallmark signs
-abdominal pain due to muscle spasm of the uterus may be --mild sharp or acute
-lower back pain
-uterine contractions are -present
-abdomin is tender on palpation
-bleeding dark or bright
vaginal bleeding can be severe or absent depending on the location of head
sign & symptoms of hypovolemic shock present
2,500ml can bleed in uterus

wall in the uterus become extra thin especially around the cervix lead to spontaneous or traumaic rupture fetus is release in abdominal cavity mother mortaity rate 5-20% fetus mortality rate over 50%

history of: prev uterine rupture
finding abdominal trauma, large fetus,borne more than 2 children, prolong or difficult labor, prior c section , uterine surgery, a tearing or shering sensation in the abdominal, constant or severe pain in the abdominal, nausea, able to palpate infant in the abdominal cavity vaginal bleeding

egg is implanted outside the uterus fallopian tube appx90% abdominal peritoneal covering overy or cervix 3rd leading cause maternal death 2% of all pregnancy most common in women 25to34 yr
pelvic inflammatory disease
adhesions from surgery, tubal surgery including elective tubal ligation

dull aching type pain poorly localized and become sudden shape knife-like ab pain localize on one side lower quad shoulder pain bllod in the ab cavity irritate diaphragm vaginal bleeding heavy light or absent discoloration aroung the naval incease pulse weak ore dizz when seating up or sitting.

life threatening prolong seizure can produce hypoxia and hyercarbia or injury mother or fetus

occurs in the late trimester to women in there 20'sfirst timers aka toxemia effect 1in 20 pregnancy women women with heart disease or kidney problem or high bp have teh greatest risk
Eclampsia is more severe and incudes comas,or seizures

history of hypertension ,diabetic,kidney,liver,heart disease, no prev pregnancies, poor nutrition sudden wt gain, alt mental status abdominal pain, blurred vision swelling to face finger legs or feet, < peeing severe headache persistent vomitting elevated bp greater than 140/90mmhg

weight of the fetus compression on the inferior vena cava when mom is laying on her back
assment dizzy or light headed decrease in bp fast heart pale cool clammy skin

high blood pressure in pregnant women greater than 140/90mmhg on two or more occassion at 6 hours apart

HAVING TO DO WITH PRAGNANCY OR CHILDBIRTH

gravida refers to pregnancy how many time the women has been pregnant
Para refers to a women who has given birth and how many

is a mother who has given birth for the first time

the process of birth consist of contraction and the expelled of the fetus and placenta out of the uterus 3 stages dilation,expulsion,placental

FALSE LABOR PAINS 13week occur

dialtes at 10m recur at regulate intervals one lasting 30 to 60 sec
when contractons are 3 to 4 min apart lasting about 60 sec each and very intense

2 TO 3 MIN APART LAST LONGER THAT 60 TO 90 SEC CROWING OCCURS SHOULDER MAY COME THIS STAGE SHOULD LAST ABOUT 50 TO 60 MIN FIRST TIMER SECOND TIMER IT LAST FOR ONLY 20 TO 30 MIN

THE PLACENTA SEPARATES FROM THE WALL DELIVERED 5 TO 20 MIN FOLLOWING BIRTH sign teh placenta is imminent 1)increase in blood from vagina 2) the uterus becomes smaller 3) umbilical cord begins to lengthen 4)the mother has the urge to push

- are you feeling pain o discomfort-what is thew quality of your pain? how intense is the pain?did the pain have a sudden or gradual onset? can you point to the pain?what is the duration of the pain or cramps? last period?

*abdominal pain nausea,vomitting
*vaginal bleeding, passage of tissue, * weakness,dizziness altered mental status , seizures, excessive swelling to the face and other extremities abdominal trauma shock and hypertension

1. ensure that ABC's are intact
2. care for bleeding from the vaginal 3.treat for shock(hypoperfusion) 3.provide emergency medical care as you would for a normal person 5.transport patient on left or right side to the hospital and reassess every 5min

any fetus presentation other than the normal crowning of he fetus head
*the abnormal color and smell of amniotic fluid
* labor before 38wk of pregnancy
*recurrence of contractions after the infant is born

*The period of time from the onset of labor to the actual delivery of the baby

*When fetus body part is laying on the umbilical cord cutting off blood and oxygen flow.
STEP 1: Tell patient to "pant" (like a dog) to keep from contracting
STEP 2: Lie patient on stretcher knee/chest position (kneeling, head down)
STEP 3: Insert hand with sterile glove into vagina and gently push fetus body part away from cord. DO NOT try to pull cord back into vagina.
STEP 4: cover umbilical cord with sterile moist dressing
STEP 5: Transport patient while maintaing pressure off cord

Any delivery where the fetus head DOES NOT come out FIRST

When an arm or leg is first to come out of the vagina

Twins
Infants smaler in size and proportion to the mothers stomach. Contractions can be stronger after the first baby

greenish borwnish yellow amnionic fluid, baby's first bowel movement resulting from distress

Infant that weighs less than 5lbs or infant is born before 38 weeks
STEP 1: Keep infant warm and dry
STEP 2: Gently suction the mouth and nose
STEP 3: Prevent bleeding from umbilical cord
STEP 4: administer oxygen by blowing oxygen across infants face with oxygen tube
STEP 5: Prevent contamination or infection
STEP 6: Heat ambulance to 85 degrees while in transport

Birth of baby occurs after less than 3 hours of labor

When the fetus' shoulders are bigger than the baby's head

After the 20t but Prior to the 37th week of pregnancy/gestation

Spontaneous rupture of the amniotic sac prior to true labor and before the end of the 37th week

Involves Mother bleeding more than 500ml
Embolism clot formation in the venus system can lead to a pulmonary embolism

Appearance:
0 points for blue/pale skin
1 point for blue hands n feet but pink body at core
2 points everything pink
PULSE:
0-No Pulse
1-Less than 100
2-Greater than 100
GRIMACE:
0-No reflective movement
1-Only facial
2-Sneeze/cries/cough
ACTIVITY:
0-No movement
1-Little movement
2-moving everything
REPORATIONS:
0-Nothing
1-Weak cry
2-Strong cry
7-10 points: good
4-6 Points: moderate
below: not good/de-stressed

appearance: look at baby
Pulse: Check at brachial artery
Grimace: Flick newborn's feet or finger next to mouth
Activity: Straighten out leg and newborn should pull back in
Resperations: rub on chest, should cry

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