Midwifery Questions and Answers

Midwifery Questions and Answers Lie the relationship of the long axis of the fetus to the long axis of the uterus Attitude The relationship of the fetal head and limbs to the fetal trunk. Presentation The part of the fetus which lies in the lower segment of the uterus. Denominator A fixed point on the presenting part used to describe position. Position The relationship of a denominator to the quadrants of the maternal pelvis eg. left occipto anterior (LOA) Engagement The largest diameter of the presenting part has passed through the pelvic brim. Pelvic brim widest from side to side. At the level of the ischial spines 0 = engagement. Station refers to the level of presenting part in relation to the maternal ischial spines, whihc represent the narrowest diameter through which the fetus must pass, +stations indicates that the presenting part of the fetus has descended past the ischial spines. Mechanisms of labour Passive movements of the fetus as it passes through the birth canal, adapting to the shape of the maternal pelvis. Normal labour A process by which the fetus, placenta and membranes are expelled through the birth canal. normal labour begins spontaneously without intervention, with the fetus presenting by the vertex-duration 4-24hours. Pre term labour onset of labour before 37weeks of pregnancy. Antenatal period time of conception until the onset of labour. Post Partum/Puerperium the period taken for the reproductive organs to return to their pregravid state which is usually six weeks following childbirth Gravid pregnant Para this term is used to describe a woman who has produced one or more living children Parous a woman who has borne one or more viable offspring Primigravida a woman pregnant for the first time Multigravida a pregnant woman who has had previously more than one pregnancy. Grande Multigravida a woman in her fourth or subsequent pregnancy but who has not necessarily borne live children in previous pregnancies. Primipara a woman who has give birth to a viable infant, living or stillborn. Nullipara a woman who has never given birth to a viable child but may have been pregnant. Multipara a woman who has borne more than one viable infant Grand multipara a woman of high parity usually one who has borne 4 or more children Maternal morbidity illness or injury from the time of conception until the end of the puerperium and attributed to childbirth. Maternal mortality death from the time of cenception until the time completion of the puerperium and attributed to childbirth. Viable capable of independent life neonatal period pertains to the first four weeks after birth upper uterine segment the upper part of the uterus in pregnancy developed from the body. lower uterine segment lower part of the uterus in pregnancy developed from the isthmus and cervix braxton hicks contractions contractions in the uterus during pregnancy which are painless. retraction the process of permanent and pregressive shortening of the muscles of the uterus which accompanies contractions during labour- to dilate the cervix, to expel the fetus and to expel the uterus, membranes and to control bleeding. Physiological retraction ring the line of demarcation which develops at the junction of the upper and lower uterine segment in normal labour polarity co-ordination between the upper and lower uterine segments during normal labour fabourable/ripe cervix the cervix is soft and is considered favourable for labour effacement this refers to the thinning of the cervix in preparation for birth and is expressed in percentages. Mum needs to be 100% effaced to be able to push. Dilatation the extent to which the cervix has opened in preparation as a result of uterine contractions, full dilatation is 10cm. first stage of labour begins with the onset of labour until complete dilatation of the cervix second stage of labour from complete dilatation of the cervix until the birth of the infant third stage of labour from the birth of the infant until the placenta and membranes are delivered Fundal dominence The greatest strength of contractions occurs in the fundus of the uterus, moving down the upper segment in diminishing strength liquor amniotic fluid forewaters bag of membranes and liquor in front of the presenting part hindwaters liquor contained in the uterus behind the presenting part secondary powers abdominal muscles, diaphragm used to push in second stage of labour fetal axis pressure force of the fundal contraction is transmitted to the upper pole of the fetus down to the long axis of the fetus moulding alteration in the shape and diameteres of the fetal head during labour caput succedaneum occurs on the fetus scalp as a result of odema from obstructed venous return and pressure on the birth canal. lightening the presenting part enters the pelvis usually after 36weeks partograph provides graphical record of the progression of labour, particularly the dilatation of the cervix. progress can be assessed from the visual patterns of cervical dilatation and descent of the presenting part in conjunction with the record of the maternal and fetal wellbeing. involution return of the uterus to its pre-pregnant state crowning when the babys head has passed through the birth canal and the top or crown stays visible at the vaginal opening. progesterone acts on smooth muscles, promotes breast development and growth human chorionic gonadtrophin (hCG) secreted by trophoblast, stimules corpus luteum to produce oest/prog until placenta takes over. stops the mum rejecting the baby, values are present in maternal urine-pregnancy test, causes morning sickness human placental lactogen (hPL) begins 5-10days after implantation, facilitates growth, low levels are facilitated with miscarriage. bones of the pelvis 2 innominate hip bones, one sacrum, one coccyx hip bone are made up of: illium (large flared out part), ischium (thick lower part) and pubic bone. ischial tuberosity is a large prominence when the body rests when sitting ischial spines lies above the ischial tuberosity, inward projections, situation of fetal head is estimated in terms of centimeters above or below. what are the joints of the pelvis one symphysis pubis, two sacroilliac joints and one sacrococcygeal joint. ligaments of the pelvis intepubic, sacroiliac, sacrococcygeal, sacrotuberous, sacrospinous. CTG fetal assesment, trace of fetal heart rate and maternal contractions. baseline CTG Normal FHR is 110-160, the mean level of the FHR at rest, in the absence of fetal movement, uterine activity, accelerations and decelerations. variability the minor fluctuations in baseline FHR of 5-25 beats in amplitude. Inteaction between parasympathetic and sympathetic nervous system. indeicates adequate fetal perfusion. the effects of decrease variability on the fetus is? CNS depression, deep fetal sleep, drugs, prematurity, hypoxia. accelerations the transient increase in FHR of 15bpm, or more above the baseline lasting at least 15seconds. decelerations decrease FHR below the baseline of more than 15bpm lasting at least 15seconds. may be early, variable, prolonged or late. BRIM anterior/posterior = 11, oblique = 12, transverse= 13 CAVITY anterior/posterior=12, Oblique =12, transvers = 12. OUTLET anterior/posterior = 13, oblique = 12 transverse = 13 four different types of pelvis are? gynacoid (ideal for child bearing), android (least favourable, male pelvis), anthropoid (long oval brim), platyoelloid (increased risk of obstruction). Why do an abdominal examination? to observe pregnancy, assess fetal size, fetal growth, location of fetal parts, detect deviations from normal, Three main compents of abdo exam inspect- uterine size and shape, skin changes. palpate-fundal height, lateral palpation, pelvic palpation. Auscultation-FHR. latent phase of labour in first stage of labour- beginning of effective labour, effacement and dilatation, until 3cm dilatate, irregular contractions, braxton hicks, early labour! Active phase of labour cervix dilates approx 3-8cms, contractions are regular, stronger, closer together, the outcome of labour is dependent on the 4 P's 1/ POWER=uternie contractions 2/ PASSENGER=fetus size and presentation 3/ PASSAGES=cervix, bony pelvis, tissues 4/ PSYCHE=knowledge, expectations, support, environment. transitional 8-10cms dilated, bloody show, restless labouring woman. fully effaced care in the latent phase of labour encourage woman to stay at home, walk around, eating, hydration, activities or rest, agree on plan for next stage. care in the active phase of labour create an environment conductive to meet the womans needs, assessment and documentation related to risk factors, provide supportive care, assessment and documentation related to progress. assessing progress of labour-contractions measure strength, intensity, length and frequency, measured and documented for ten mins each half hour. assessing progress of labour-vaginal loss blood stained, mucous stained indicates progress of labour, detachment of membranes as cervix dilates, ROM can occur any time, report mech stained liquor=fetal distress. offensive smell=infection. assessing progress of labour-abdo exam palpate inbetween contractions, determine descent of presenting part, identify lie, presentation, position, engagement, descent. FHR. assessing progress of labour- VE descent, flexion, anterior rotation of fetal head, softening and effacement, dilatation of cervix, application of cervix to presenting part, vaginal abnormalities. assessing progress of labour- cervix position, consistency, effacement, dilatation, application, presenting part-position, station, caput/moulding, membranes-intact, bulging or ruptured, colour of liquour, FHR. maternal risk assessment on going 4hrly BP, Temp. 1/2 hourly maternal pulse, fluid input and output. vaginal loss. fetal assessment during labour intermittent auscultation after a contraction, FHR every 30mins, liqour assessment each 30mins when ROM. Mechanisms of normal birth LIE=longitudinal, PRESENTATION=cephalic, POSITION=ROA or LOA, ATTITUDE=flexed, DENOMINATOR=occiput. signs of second stage no palpable cervix felt on VE, urge to push, bloody show, change in contractions, bowel pressure, anal pouting, perineal stretching, audible grunting, increase vocalisation. two phases of second stage passive-no maternal urge to push, presenting part is still high and active- fetal head is low triggers the maternal urge to bear down, involuntary pushing. oxytocic any drug that stimulates contractions of the uterus in order to induce or accelerate labour controlled cord traction active management- only do it if oxytocic agent is given, ensure uterus in well contracted, guard the uterus, place cord clamp close to the intoritus, apply downward continuous steady traction to the cord via the cord clamp, once placenta is seen move upwards. the aims of the abdominal examination observe signs of pregnancy, assess fetal size and growth, assess fetal health, diagnose and locate fetal parts, detect any deviations from normal. in the late stages of pregnancy the lie should be longitudinal an example of the fetus attitude is flexed, deflexed or partially or completey extended in the 32nd week what position would the fetus be in cephalic (head down)