Midwifery - Anatomy and Physiology - Year 1 Questions and answers

Midwifery - Anatomy and Physiology - Year 1 Questions and answers What is the dosage of diamorphine and how is it given? 5-10mg (dependent on patient size), 4 hourly and IM. What is Pica? Craving of non-food items such as clay, soap, coal, etc. When should the nuchal translucency scan take place and what is it for? Between 11+2 and 14+1 weeks. It checks the fluid at the back of the baby's neck and is an indicator for Down's syndrome. What is tachysystole? More than 5 contractions in 10 minutes in spontaneous labour. What is tachycardia? A maternal pulse rate of over 100bpm. Name 5 non-pharmacological methods of pain relief. Water Distraction techniques TENS machine Position Massage Hypnotherapy Aromatherapy Acupuncture Breathing techniques What changes occur in the maternal respiratory system during pregnancy? Oxygen consumption increases by up to 20-30% Rib cage expands Tidal volume increases by up to 30-40% Name 3 types of abnormal placenta. Battledore insertion - cord inserted on the edge Velementous insertion - cord inserted through the membranes, some distance from the placenta Succenturiate lobe - a lobe which is separated from the main body but connected by the placental blood vessels Circumuallate - opaque ring Bipartite - two separate lobes and a bifurcated cord The zygote undergoes mitotic cellular division (clevage), resulting in the formation of smaller cells. What is the zygote called at each of these changes (day 1, day 3 and day 4)? Day 1 - blastomere Day 3 - morula Day 4 - blastocyst There are 3 primary germ layers that are the main embryonic tissues, from which structures and organs develop. What are they and what develops from them? Ectoderm - epidermis layer of skin, hair, nails and the nervous system Mesoderm - muscle, skeleton, dermis of skin, connective tissue, urogenital gland, blood vessels, blood and lymph cells Endoderm - epithelial lining of the digestive, respiratory and urinary systems and glandular organs, such as the liver and the pancreas What is the dosage of meptid and how should it be given? 75-150mg, 2-4 hourly and IM. What is haemoglobin broken down into? Iron - which produces more red blood cells Globin - a protein used in the body Un-conjugated bilirubin - toxic, fat-soluble, not easily excreted in bile/urine, causes yellow discolouration of skin and deposits in the brain Sensory receptors that respond to pain are called? Nocioceptors What should you look for when performing a vaginal examination. Labia - varicosities, oedema, warts, sores, etc Perineum - scars, epis, FGM, etc Vaginal orifice - discharge, show, liquor, bleeding etc Liquor - clear, bloodstained, offensive smell, mec etc Rectum - loaded, or not (can impede descent) Cervix - position, consistency, presenting part, effacement and dilation Membranes - intact or not Position of presenting part Caput or moulding Station What is fetal axis pressure? The force of a contraction, transmitted down the upper pole of the fetus and down the long axis, onto the presenting part. Does the pH of blood increase or decrease during pregnancy? Increases - due to an increased respiration rate (more oxygen and less CO2). What are the names of the 5 temporary structures in the fetal circulation, prior to birth? Ductus venosus - connects the umbilical vein to the inferior vena cava Foramen ovale - opening between the left and right atria Ductus arteriosus - leads from bifurcation of the pulmonary artery to the descending aorta. Umbilical arteries - branch from the internal iliac arteries and carry deoxygenated blood from the placenta to the heart. Umbilical vein - carries oxygenated blood back to the fetus. Bypasses the liver and connects to the IVC. What changes/symptoms occur, relating to the gastrointestinal system, during pregnancy? Bleeding and tender gums Increased acidity of saliva Possible nausea, vomiting and heartburn, due to the relaxing effects of progesterone Enlargement of the gall bladder - which also empties more slowly Increased flatulence - due to pressure of the uterus on the bowel Constipation - the uterus mechanically limits colonic emptying What is the valsalva manoeuvre? Breath holding and attempting to exhale against closed airways (used in directed pushing). Immediately after birth, where can the uterus be palpated? Midway between the umbilicus and the symphysis pubis. What 3 things should you look for, when checking the placenta? That there are two membranes and they are intact. That all of the cotyledons fit together and form a complete circle. That there are 2 umbilical arteries and 1 umbilical vein. What is hypovolaemia? A decrease in blood volume. It can lead to hypovolaemic shock, as severe blood/fluid loss prevents the heart from pumping enough blood around the body. During the follicular phase of the ovarian cycle, what hormones are released and from where? GnRH - from the hypothalamus FSH and LH - from the anterior pituitary gland Name 5 functions of the placenta (think SERPENT). Storage Endocrine Respiration Protection Excretion Nutrition Transfer of substances What is the name of the ridge that develops between the lower and upper uterine segment? The retraction ring NOT Bandls ring - this occurs in mechanically obstructed labour and the retraction ring becomes visible above the symphysis pubis - now referred to as Bandls ring. Associated with fetal compromise. What is thought to cause the onset of labour? (Four hormones/gases) Oestrogen - stimulates the placenta to release prostaglandin Progesterone - metabolises to oestrogen increasing uterine sensitivity to prostaglandins causing myometrial contractions Nitric oxide - produced by the placenta, causes smooth muscle relaxation Corticotrophin-releasing hormone - stimulates the placenta to produce prostaglandins Name some external signs of full dilation. Expulsive pushing Rupture of forewaters (not always) Dilation and gaping of anus Anal cleft line/purple line Rhomboid of Michaelis Show/fresh blood Appearance of presenting part Change in woman's behaviour The process that leads to the inclusion of the cervical canal into the lower uterine segment is called? Effacement Pain in labour is caused by? Ischemia of the uterus and pressure of fetal parts. What are the 4 main joints in the pelvis? Symphysis pubis joint Sacroiliac joints x2 Sacrococcygeal joint Name the 3 innominate bones of the pelvis. Ilium Ischium Pubis What is the difference between caput and moulding? Caput - swelling on the baby's head Moulding - change in shape of the baby's head where the bones move over each other to allow passage through the birth canal The placenta and chorion are derived from which part of the blastocyst? The trophoblast How might an epidural affect the normal mechanisms of labour? An epidural causes the pelvic floor to relax which causes a delay in rotation of the head. What observations should be taken in labour and how often? Pulse - hourly Contractions - every 30 mins VE - 4 hourly Temperature - 4 hourly BP - 4 hourly Fluid balance - all fluids given and all urine output, as and when Auscultation of fetal heart - every 15 minutes for 1 full minute in the first stage and every 5 minutes in the second stage What is the physiological importance of resting between contractions? Allows perfusion of the placenta and fetal recovery. Name and detail the 4 ways in which a newborn baby may lose heat. Evaporation - if left wet Convection - from a cool/draughty environment Conduction - if in contact with a cold surface/object Radiation - if left uncovered near cold windows or walls Name the 5 superficial muscles of the perineal floor. Membranous sphincter of the urethra Ischiocavernosus muscle Bulbocavernosus muscle (bulbospongiosus) Transverse perineal muscle External anal sphincter Name 3 functions of amniotic fluid. Allows fetal growth and movement Allows symmetrical muscoskeletal development Protects fetus from jarring/injury Maintains a constant temperature Protects the placenta and cord from pressure during contractions (labour) Aids effacement and dilation, especially if the presenting part is poorly applied Name 5 hormones that are produced by the placenta. Oestrogen Progesterone hCG hPL hPGH (human placental growth hormone) What is cervical effacement? The cervical canal is taken up into the lower uterine segment due to the contraction and retraction of muscle fibres. What changes occur in the urinary system of a pregnant woman? The kidneys lengthen by up to 1.5cm Kidney volume increases by up to 30% The ureter increases in length The bladder becomes an abdominal organ by the 3rd trimester Increased urinary output What is polarity? Neuromuscular harmony between the upper and lower uterine segments. The upper segment contracts strongly and downwards to expel the fetus and the lower segment contracts lightly and dilates to open the cervix. What dosage of pethidine should be given and how? 25-100mg, 4 hourly and IM. Maximum dose of 400mg in 24 hours. What changes occur in the maternal cardiovascular system during pregnancy? The heart increases in size The heart is displaced upwards and to the left Vasodilation An increase in blood volume Haemodilution Cardiac output increases by 30-50% Diastolic BP reduces by week 24, rising to pre-pregnancy values at term Name the 4 portions of the uterine tube. The interstitial portion The isthmus The ampulla The infundibulum with fimbriae What is placenta praevia? An abnormally situated placenta - wholly or partially covering the os. What are normal fetal blood gas readings? Above 7.25 7.21-7.24 is borderline Below 7.2 is abnormal What are the individual lobes of the placenta called? Cotyledons. The maternal side of the placenta consists of 22 cotyledons, made up of thousands of chorionic villi, separated by sulci. How are the forewaters and hindwaters formed? As the lower uterine segment stretches, the chorion detaches and becomes trapped by the presenting part as it fits into the cervix. What is retraction? When uterine muscle fibres retain the shortening of contractions instead of completely relaxing. What are the components of syntometrine? 0.5mg of ergometrine 5 units of syntocinon in 1 ml When are scans normally performed in pregnancy? Dating scan - between 8 and 14 weeks Anomaly scan - between 18 and 20+6 weeks Which is the largest diameter of the brim? Transverse (13cm) Anterposterior is 11cm and oblique is 12cm. How does cervical dilation occur? The external os enlarges from 0-10cm. Uterine actions and counter pressure from the membranes and presenting part cause the fundus to respond via contraction and retraction. List the 8 mechanisms of labour. Descent (engagement) Flexion Internal rotation Crowning Extension Restitution Internal rotation of the shoulders Lateral flexion Name the 8 pelvic landmarks. Sacral promontory Sacral ala or wing Sacroiliac joint Illiopectineal line Illiopectineal eminence Superior ramus of pubic bone Upper inner border of pubic bone Upper inner border of symphysis pubis What's another name for the mucus plug? Operculum What are the single and plural names for sperm? Spermatozoon - singular Spermatozoa - plural Where is oxytocin secreted from? Posterior pituitary gland Which hormone maintains the corpus luteum once fertilisation has occured? hCG Name the 4 sutures of the fetal skull. Lambdoidal Sagittal Coronal Frontal Where is sperm made? Seminiferous tubules in the testes Name the 3 layers of the uterus. Perimetrium (outer) Myometrium (middle) Endometrium (inner) Which are the smallest diameters of the fetal skull? Submentobregmatic and the suboccipitobregmatic - 9.5cm Which fetal skull diameter measures 13.5cm? Mentovertical How long does capacitation take? 7 hours What is hyperstimulation? More than 5 contractions in 10 minutes, in induced labour. What is the linea negra? A brown line that runs from the umbilicus to the pubic area. Why is the postnatal woman at increased risk of developing a thromboembolism? She has an increase in clotting factors. The blastocyst consists of 2 parts - what are they? The trophoblast and the inner cell mass. What are the alternative names for the anterior and posterior fontanelles? Bregma and lambda, respectively. The lower uterine segment is formed from what? The isthmus. What is chloasma? A skin condition that occurs on the face - dark brown discolouration caused by oestrogen and progesterone. The inner cell mass of the blastocyst develops into what? The embryo, amnion and umbilical cord. Name the 4 bones of the pelvis. Innominate bones x2 Sacrum Coccyx What does amenorrhoea mean? Failure to menstruate. What is the outermost layer of the oocyte called? Corona radiata. When do breasts start producing colostrum? From 16 weeks. Name the features of a gynaecoid pelvis. Shallow cavity Rounded Broad, well curved sacrum Sub-pubic angle of 90 degrees Blunt ischial spines Straight side walls Rounded sciatic notch Generous fore pelvis What is hypertonicity? Failure to relax during contractions - contractions lasting over 2 minutes. Which ligament connects the sacrum and ilium? Sacroiliac ligament. Name the 4 categories of pelves. Gynaecoid Anthropoid Android Platypelloid The 'true' pelvis is divided into 3 compartments - what are they called? Brim, cavity and outlet.