Follicles
Each ovary contains thousands of follicles and each follicle contains an egg, during each menstrual cycle there will only be one follicle (out of 10-20 that attempt the process each month) that is successful at maturing and is able to release an egg
When does ovulation occur?
Approximately 2 weeks prior to menstruation
Endometrium
The lining of the uterus that begins to thicken and prepare for potential the fertilized egg to implant; If the egg is not fertilized within 36 to 48 hours after ovulation, it will simply die
When does the menstrual flow occur?
On the 28th day of the cycle
Bloody Show
During pregnancy, the cervix contains a mucus plug that seals the uterine opening, preventing contamination from the outside world; when the cervix begins to dilate, this plug is discharged into the vagina as pink-tinged mucus (the bloody show); This smal
Vagina
about 8-12 cm in length and begins at the cervix and ends at the external opening of the body
What to do to prevent the perineum from tearing during birth
You should apply gentle pressure to the baby's head to allow the tissues to stretch and to prevent a precipitous birth (one that occurs to fast)
Episiotomy
Incision to the perineum that a physician may make to prevent the perineum from tearing or ripping
The breasts
Mammary glands
Placenta
a disk-shaped structure that attaches the inner lining of the wall of the uterus and is connected to the fetus by the umbilical cord; after delivery the placenta seperates from the uterus and is delivered
Umbilical cord
Contains 2 arteries and one vein - these vessels supply blood to the fetus; the umbilical vein carries oxygenated blood from the woman to the heart of the fetus, and the umbilical arteries and the umbilical arteries carry deoxygenated blood from the heart
Placental barrier
Consists of 2 layers of cells, keeping the circulation of the women and fetus separated but allowing oxygen, nutrients, waste and most meds to pass between the fetus and woman.
Amniotic Sac
fluid-filled bag like membrane where the fetus develops; contains about 500-1,000 mL of amniotic fluid, which helps insulate and protect the fetus; when this breaks it is the "water breaking"; fluid helps lubricate the birth canal and remove any bacteria
What primary systems are involved in changes during pregnancy?
respiratory, cardiovascular and musculoskeletal systems
What kinds of complications can increased hormone levels cause?
Puts pregnant patient at risk for complications from trauma, bleeding and some medical conditions
What types of problems can arouse from the uterus expanding?
By the 20th week, the uterus is at or above the belly button, subjecting the fetus to being directly injured. The enlarged uterus also makes the organs in the mother shift from their normal positions
When does the most rapid uterine growth occur?
In the second trimester
How does pregnancy effect the respiratory system?
The respiratory system is directly affected because the diaphragm is pushed up and eventually the respiratory capacity changes (increased respiratory rates and decreased tidal volume - pregnancy also increases oxygen demand and workload for the fetus incr
How does pregnancy effect the cardiovascular system?
Overall blood volume increases; during 3rd trimester the woman's entire blood volume passes through the uterus every 8-11 min; by the end, blood volume may increase as much as 50%; # of RBC's increase (which increases her need for iron); Blood can clot fa
How do changes in the GI tract effect pregnant patients?
in 3rd trimester, they have increased risk of vomiting and aspiration following trauma because gastrointestinal motility is under control of key hormones from the CNS combined with displacement of the stomach
Gastrointestinal motility
the filling and emptying of the stomach into the small intestine
How does pregnancy effect the musculoskeletal system?
The increase in weight and work of the heart will have an impact on the musculoskeletal system; increased hormones make the joints more loose or less stable. In the 3rd trimester women also don't have a great center of balance and will trip more
3 stages of delivery
dilation of cervix, delivery of the infant, delivery of the placenta
First stage of delivery
Dilation of the cervix- begins with onset of contractions as the fetus enters the birth canal and ends when the cervix is fully dilated; the longest stage of birth and can last on average 16 hours for first pregnancies
Beginning signs of labor
contractions, bloody show, water breaking
What is the frequency and how long are contractions when someone is truly in labor?
They last about 30 to 60 seconds each and become more regular
Primigravida
A women who is having her first child and the labor will usually last longer
Multigravida
A women who has given birth before and labor will typically be shorter than the first time
Brackston-Hicks contractions
false labor
Premature rupture of the membranes
When the amniotic sac ruptures too early and the fetus is not fully developed or ready to be born; when this occurs the patient may or may not go into labor; these patients are usually placed on bed rest, but we should provide prompt transport
False labor or Braxton-Hicks contractions
-Contractions are not regular and do not increase in intensity or frequency -Pain in lower abdomen, contractions start and stay in the lower abdomen -Activity or changing position will alleviate pain and contractions -If there is any bloody show it is bro
Signs of true labor
-Contractions, once started, consistently get stronger and closer together (change in position does not relieve contractions)
-Pain and contractions start in the lower back and "wrap around" to the lower abdomen
-Activity may intensify contractions. Pain
Lightening
Toward the end of the 3rd trimester the head of the fetus normally descends into the woman's pelvis as the fetus positions itself for delivery; this produces a sensation of "relief" because once the fetus has moved from under the rib cage, breathing becom
When does the second stage of labor begin and end?
Begins when the fetus begins to enter the birth canal and ends at spontaneous birth
Crowning
When the baby's head begins to show through the vaginal opening
When does the 3rd stage of birth begin and end?
It begins with the birth of the infant and ends with the delivery of the placenta (the placenta must completely separate from the uterine wall)
Separation of the placenta
contractions will continue to assist with the separation process and to clamp down and close the blood vessels that were connecting the placenta to the uterine lining. This may take up to 30 min
Preeclampsia
(pregnancy-induced hypertension)Common in patients who are pregnant for the first time; can develop after the 30th week of gestation and is characterized by headache, seeing spots, swelling of the hands and feet, anxiety, high BP
Eclampsia
Seizures that occur as a result of hypertension
How to treat eclampsia
lie patient on left side, maintain airway, give oxygen, rapid transport and ALS
Supine Hypotensive Syndrome
If a pregnant patient is lying supine, the baby can cause compression on the descending aorta and inferior vena ceva, which reduces the amount of blood that is returned to the heart; hypotension results *Patients in the 3rd trimester should always be tran
Ectopic Pregnancy
Pregnancy that develops outside the uterus, especially in fallopian tubes; occurs about once in every 300 pregnancies
What is the leading cause of maternal death in the 1st trimester?
internal hemorrhage into the abdomen following the rupture of an ectopic pregnancy
Signs of ectopic pregnancy
Woman who have missed their last menstrual cycle and who have a stabbing pain that is usually unilateral in the lower abdomen; a history of pelvic inflammatory disease, tubal ligation, or previous ectopic pregnancies should heighten your suspicion
Abruptio Placenta
placenta separates prematurely from the wall of the uterus most commonly from hypertension in the mother and as a result of a trauma
- patient often complains of severe pain and has vaginal bleeding; trauma is one of the leading causes; you should suspect
Placenta previa
Placenta develops over and covers the cervix
Gestational diabetes
diabetes that develops during pregnancy in many women who have not had diabetes previously and will clear up in most women after delivery; Many mothers experience nausea before delivery and will not have eaten
- this can lead to hypoglycemia and weakness
Pregnant women and shock
Since by the 3rd trimester she may have 50% more blood and a higher heart rate, so they may not show signs of shock until they have lost a lot of blood; the fetus may be in trouble well before signs of shock are apparent
Pregnant women who have sustained trauma
Often the blood supply to the fetus will be reduced so the body can supply blood to the woman only
What percent of all penetrating abdominal traumas in pregnant patients result in fetal injury?
70%
Guidelines of treating a pregnant patient
1.Maintain an open airway (she has an increased risk of vomiting and aspiration)
2. Administer oxygen
3. Ensure adequate ventilation
4. Assess circulation
5.Transport considerations
Meconium
Fetal stool that makes the water in water breaking green; it can indicate a newborn in distress and it is possible for the fetus to aspirate meconium during delivery ; indicates that the newborn is in respiratory distress or has an airway obstruction; abo
Blood Pressure during pregnancy
It is typical for bp to drop during the first and second trimester, but then it returns to normal during the third trimester
What is the most litigated specialties in medicine?
Obstetrics
Ask these questions to determine whether delivery is imminent
-How long have you been pregnant? -When is your due date? -Is this your first baby? -Are you having contractions? How far apart are the contractions? How long does each contraction last? -Do you feel like you have to have a bowel movement? -Have you had a
What does an OB kit contain?
Surgical scissors or scalpel, Umbilical cord clamps, Umbilical tape, A small rubber bulb syringe, towels, 4"x4" gauze sponges and/or 2"x10" gauze sponges, sterile gloves, infant blanket, sanitary napkins, an infant-sized bvm, goggles, a plastic bag
How to position a woman in delivery
Elevate hips with blankets or pillows 2-4" and elevate the head and neck
*Put a sterile sheet under the patients buttocks and unfold it toward her feet. Wrap another sheet behind the patient's back and drape over each thigh and drape one sheet across the
Precipitous labor
fast labor; more common in patients who have had children before
Abrupt/explosive delivery
Patient is at risk for tearing the perineal space, so always keep your eye on the perineal
How to time patient's contractions
Time from the beginning of one contraction to the beginning of the next and how long each contraction is . You can feel the abdomen tightening then loosening during the duration of a contraction
Steps to deliver an infant
1. Allow the mother to push the head out and support it as it emerges. Feel the neck to see if the cord is wrapped around it (if it is, gently lift it over the infant's head without pulling hard on the cord). Suction fluid from the mouth at first then the
How to deliver head
Once it is obvious that the head is coming out more with each contraction, place your hand over the emerged bony parts of the head and exert very gentle pressure on it, decreasing the pressure in between contractions. Continue to support the head as it ro
Fontanelles
The soft spots on the newborn's skull that cover the brain with only skin and membranes; there are 2 primary fontanelles - one at the top of the head and one near the back of the head
Unruptured amniotic sac
If it has not ruptured by labor, it will appear like a water balloon emerging from the vagina; the sac will suffocate the infant if it is not removed; only remove it when the head is crowning; if it does not spontaneously rupture, you may rupture it with
Nuchal cord
When the umbilical cord is wrapped around the neck (once the head is delivered, feel the neck to check) - usually you can gently lift the cord over the head, but in the case that you can't, clamp the cord 2" apart and cut between the clamps; if it is wrap
Suctioning amniotic fluid from the fetus
Once the head has come out and you have checked for a nuchal cord, ask the mother to stop pushing while you suction the mouth then the nostrils
**If you suction the nose first, you may stimulate the infant to aspirate the fluid in the mouth or pharynx , b
Suctioning the airway of an infant
fully compress the bulb syringe before it is inserted 1" to 1 �" into the infants mouth then release the bulb to suction. Make sure the syringe does not touch the back of the mouth; suction 2 or three times each or until they are clear
Delivering the body
Usually after the head delivers, the body rotates to one side
Vernix caseosa
a white, cheesy substance that covers the baby when it is born
Postdelivery care
Once the baby is born, dry it and wrap it in a towel (so that only the face is exposed and the head is covered), then place it one the side, with the head slightly lower than the rest of the body, make sure the neck is in a neutral postion so the airway r
Why keep the head of an infant lower than the rest of the body?
To prevent aspiration
Why keep the head of the infant at the level of the mother's vagina before the umbilical cord is cut?
if the infant is higher than the level of the mom's vagina, blood will be siphoned from the infant through the umbilical cord back to the placenta
How to cut the umbilical cord
Place the clamps 4 fingerbreadths away from the infant and 2"-4" apart from each other then cut in between them; To tie the umbilical cord, use "umbilical tape" around the cord about 1" nearer to the infant than to the clamp - tighten the tape slowly so t
Delivery of the placenta
Usually delivers on its own from a few minutes to 30 minutes after delivery; The normal placenta is round, about 7" in diameter, and about 1" thick; One surface is smooth and covered with a shiny membrane; the other surface is rough and divided into 2 lob
After delivery of the placenta
Place a sterile pad on the vagina and straighten the mother's legs; you can help slow the bleeding by gently massaging the mother's abdomen with a firm, circular,kneading motion. The abdomen will be wrinkled and very soft (you will be able to feel the fun
Fundus
After delivery of the placenta, there will be a grapefruit sized mass that is firm in the abdomen *As you massage the fundus, the uterus will contract and become firmer and it will help stop bleeding (breast feeding will also stimulate the uterus to contr
What will massaging the uterus and having the baby stimulate the nipples after birth do?
Will cause the production of oxytocin, which is a hormone that will help the uterus contract and control bleeding
Situations that are emergencies in regards to the amount of blood being discharged before delivery of the placenta
(less than 500 mL is normal)
-More than 30 min has gone by after delivery and the placenta has not been delivered
- There is more than 500 mL of bleeding
-There is significant bleeding after the delivery of the placenta
How long does it usually take for a new born to begin spontaneously breathing?
15 to 30 seconds after birth
What is the normal heart rate of a new born?
120 beats per minute or higher
What to do if the infant does not begin breathing spontaneously
Gently tap the or flick the soles of the infant's feet or rub the back of the infant to induce breathing; if the infant does not breath spontaneously after 10 to15 seconds, begin resuscitation efforts
To maximize the affects of helping the baby to stimulate spontaneous breathing
-position the infant on his or her back with the head down and the neck slightly extended. Place a towel or blanket under the infant's shoulders to help maintain this position
-Suction the mouth and then the nose using a bulb syringe or suction device wit
What is the reservoir volume of an infant bvm?
450 mL
Where do you palpate a newborn's pulse?
at the base of the umbilical cord or at the brachial artery
Baby CPR
use hand-encircling technique or 2 finger technique; bvm ventilation is performed during a pause after every 3rd compression; the compression to ventilation ratio should be 3 to 1 (this will yield a total of 120 actions per minute or 90 compressions and 3
APGAR Score
standard scoring system used to assess the status of a newborn; assigns value of 0,1 or 2 to 5 areas of activity of the newborn infant (the total of the 5 numbers is the score)
- Appearance (skin color), Pulse (should be at least 100 beats per minute, rea
Newborns who are in cardiac arrest
Usually show signs of pulmonary arrest first
What oxygen flow rate do you set an infant's bvm at?
5 L/min at a rate of 40-60 breaths per minute
Presentation
The position in which the infant is born or the body part that is delivered first
Vertex presentations
Most infants are born this way; it is when the infant is born head first
Breech presentation
When the buttocks is delivered first; the infant is at great risk for trauma during delivery; prolapsed cords are more common; this type of birth usually takes longer; if the buttocks have already passed through the vagina, the birth has begun; If the mot
How to deliver a breeched birth
allow the buttocks and legs to deliver spontaneously - the buttocks is usually easy; let the legs dangle on either side of your arm while you support the trunk and chest; the head is almost always faced down and should be allowed to deliver spontaneously;
Limb presentation
When a limb comes out first during delivery; you cannot successfully deliver a an infant with limb presentation in the field; if the limb is protruding cover it with a sterile towel; place patient on her back with her head down and pelvis elevated and giv
Prolapse of the umbilical cord
When the umbilical cord comes out before the infant; must be treated in the hospital; the head will compress the cord during birth and cut off circulation to the infant; usually occurs early in labor when the amniotic sac ruptures
How to treat prolapse of umbilical cord
Place pregnant woman on backboard in Trendelenburg's position, with her hips elevated on a pillow or a sheet; she can also be placed in a knee-chest position (kneeling and bent forward face down); pace your hand into the vagina and push the head off of th
Spina Bifida
developmental defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae or outside of the body; easily seen on the newborn's back and usually occurs in the lower third of the back in the lumbar area
How to treat spina bifida
cover the open area of the spinal cord with a sterile, moist dressing immediately after birth to prevent infection; have someone hold newborn against the body to make sure the moist dressing doesn't cool the baby down
Abortion
Passage of the fetus and placenta before 20 weeks
Abortion complications
Incomplete abortion (when part of the fetus or placenta is left in the uterus - causes major bleeding) or when the wall of the uterus or the adjacent bowel or bladder is injured
- Infection is likely
How often do twins occur?
once in every 80 births
When to suspect twins
If the first baby is small or if the abdomen is still remains fairly large **The second twin will usually be born within 45 seconds of the first; about 10 minutes after the first birth, contractions begin again and the birth process will repeat itself
How do you know if there is one or two placentas when delivering multiple babies?
If you see only one umbilical cord coming out of the first placenta, then there will be another placenta
How to identify newborn twins
Identify the first born baby as "baby A" and tape an umbilical cord tape around its foot
What percent of pregnant women are victims of physical or sexual abuse?
15%- 25%
Fetal alcohol syndrome
describes the conditions of infants born to mothers who have abused alcohol
What is the average weight of a single infant?
7 lbs
What is considered premature?
Any infant born before 8 months (36 weeks) or is 5 lbs or less **the vernix (cheesy white coating on the skin that is found on a full-term infant) will be missing or minimal on a premature infant
Afterterm (postterm) pregnancy
happens about 10% of the time, occurs when a pregnancy last 42 weeks or more; they can weigh 10 lbs or more; increased chance of injury to the baby during birth and more possible c-section; the women is more at risk for perineal tears; the baby is more at
Fetal Demise
Stiil birth; if an intrauterine infection has caused the still birth, there may be a very fowl odor; the delivered infant may have skin blisters, skin sloughing, and a dark discoloration, depending on the stage of decomposition; the head will perhaps be s
If you are delivering without an OB kit
Wipe the inside of the infant's mouth after birth; don't cut or tie umbilical cord; as soon as the placenta delivers, wrap it in a clean towel or put it into a plastic bag and transport it with the infant and mother; always keep the placenta and infant at
What is excessive bleeding after birth usually caused by?
the muscles of the uterus not fully contracting - This can be from multiple births, a long labor process so the uterus is tired, or parts of the placenta being left in the uterus
Postpartum pulmonary embolism
Pregnant patients are at risk because their blood clots more readily, especially in pregnant women who are on bed rest