The outlet of the pelvis is filled with soft tissue and the strong diaphragm of muscle being the most important. The main function of the pelvic floor are2 support the weight of the pelvic &abdominal organs. Afford voluntary control over micturition defeacation& flatulation Diminishes the size of the vagina&causes engorgement of the clitoris during intercourse. Influences movement of the fetus during the seconnstage of labour. The pelvic consists of2layersof muscle:superficial layer which is smaller then the deeplayer.
with both conbined contribute the overall strength of the pelvicfloor & r likely2become damaged during vaginal delivery.
Bulbocavernosus Thismuscle arises from the perineum,passes around the vagina&embed n the clitoris. function:causes erection of the clit&contraction of the vagind during intercourse. Ischiocavernosus:this muscle extends from the ischial tuberosities2 the clitoris. Function contributes to the formation of the urethral spincter&does not become damaged during childbirth. Transverse perineal muscle:this extends from the ischial tub2the perineum,the fibres also intermingle w the perineal body&the anal spincter.
function provides additional support,however will always become damaged during CB.
External anal spincter. This muscle surrounds the anal office&attaches 2the coccyx. Function closes the lumen of the anus&prevents fetal incontinence. Thedeepmusclelayer comprisedof3 pairs of muscles which r known as the levator ani muscles. Pubococcygeus M extends from the pubicbone surrounding the urethra,vagina&rectum attaches2the coccyx. function supports the lower third of the vagina&rectum controls the flow of urincontrols defaecation,contracts during orgasm,aidsCB. Illiococcygeus M extends from the inner aspect of the lilacbone,meet in the perineum&extends2the coccyx. function provides support.
Ischiococcygeus M triangular sheet of M. arises from the ischial spines&pass2the lower sacrum&upper coccyx. Function stabilies&supports the sacroiliac joint&sacroccygeal joint. Damage to the PFM will undermine its overall function. Damage 2thePF is classified according2structures involved. CM 2advise [email protected] of pelvecfloor exercise&perineal massage2minimise trauma. Also2prevent continence,prolapseof pelvic floor&can make birth easier. The function of the Uterus is to prepare monthly to receive a fertilised ovum. The uterus then acts as a shelter for the fetus during pregnancy.
Providing a suitable environment for growth and development of the fetus. The uterus also assists in the expulsion of the fetus, placenta and membranes at delivery. Followed by the uterus returning to its non-pregnant state. the uterus grows in all dimensions and changes shape. Usually the blastocyst implants itself in the fundus (upper part) of the uterus. Size increases2 [email protected] Extra growth results inthe uterus walls thickening. LayersThe Uterus has 3 layers; the endometruim , myometrium and perimetrium. The Endometrium is the lining of the uterus.
It is constantly changing in thickness throughout the menstrual cycle During pregnancy The endometrium thickens into the decidua,helped by progestone&oestrogen,and provides the nourishment for the blastocyst. Myometrium muscles become more defined,inner circular developed 2strechlower segment&cervix during labour. Middle oblique layer developed2 enable contraction2occour&constricy after birth. Outer longitudinal layer is developed2facilitate contraction&retraction. Also the muscle fibres lengthen and widen as the pregnancy increases2 allow the fetus2grow.
Progesterone relaxes smooth muscleallowing the uterus 2strech. Aprrox 10mls/min of blood is passed through the uterus, blood supply is from the ovarian and uterine arteries. during first 10wk the isthmus lengthens&later forms lower segment By 12 weeks, the fetus has filled the cavity and the fundus may just be palpated at the pelvic brim Bywk30uterusispair shaped?d2upper/lower segment. 36wk [email protected] the xiphi sternum level pevic floor muscles soften& lower segment encourages the desent of the presenting part in2 the pelvis. The uterus can weigh upto 900 grams at term&blood flow increases 600-800ml/min
Nice guidelines (2008) states that the routine care that all healthy women can expect to receive during pregnancy. During an AN visit always introduce yourself communicate effectively and listen to the women. Firstly ascertain the women’s well being and always review history before commencing any observations. During 28wk check primarily start w normal obs:BP is taken2 ascertain normality and rule out any abnormalities such as pre eclampsia. Urinalysis: Tested4proteinuria taken to check signs of pre-eclampsia and also any infections &dehydration.
Discuss with women fetal movements, has she experienced the baby’s pattern of movements, if so advise to contact CM of any change in pattern reassuring mother at the same time. Abdonimal examination, always gain verbal consent, primarily measure fundal height which is commenced from around 26-28weeks gestation and taken every 2-3wks(preferably by the same midwife),r best first line of assessment. Taken with a tape from the fundas (top of the uterus)2the top of the symphysis pubis, and documented on the womens personal growth chart.
Liquor, a gentle examination of the abdomen can give an idea whether the amount is about right record longitudinal, oblique transverse and which part it presents. NAD. Lie [email protected] may be able2be determined but2 early2b definate, as so with regards to engagement would be free however always document any findings. Secondary taken of [email protected] Offer repeat Haemoglobin, level if below 10. 5g/dl then consider iron supplementation,rpt screening4 animia&atypical red-cell antibodies, also if women is Rh negative offer Anti D.
Information exchange &review of care plan, document & book nxt appointment 4 32wk check. Definition:is that of expultion of the fetus. It begins when the cervix is fully dialated&is complete when the baby is completely born. NICE guideline states that: healthy women who r giving [email protected] weeks(term). Active phase is that the baby is visable, maternal effort on full dilatation of cervix without expulsive contractions,contractions become strong&last about 1min. External signs of progress,vaginal discharge show (red blood)Fundus moves down with contraction on palpation.
Decent of presenting part, well engaged&rotated4birth @Ischial Spines. Maternal signs: unable2talk focused on breathing technique slows down w each contraction, grunting sounds & cries w expiration. Her mood becomes more focused on shelf &withdraws, energy withdrawn. Stays in1position withorwithout contractions. Environment:ensure privacy,room is equipped wbirthing ball, stool2facilitate movement&change of position,encourage women2mobilize as much as possible as gravity helps the birthing process. Observations:primarly gain verbal consent every5mins or after each contraction check fhr.
Every30min document frequency of contractions,hrly checkBP,pulse offer ve. every 4hrly check temp. Regulary check if bladder is empty as a full bladder can impede the baby’s progress down the birth canal. Assess progress of fetal position&station. If there is no urge to push when fully dialated assess after1hr. offer water&pain relief and provide support& encouragement. Physiology:membrains may [email protected] stage allowing the firm pressure of the presenting part2strech the tissue. The liquor also warms,cleanses&moistises the vagina. ressure from the presentingpart stimulates the nerve receptors in the pelvicfloor=urge2pushThe mother naturally contractsher abdominal muscles&uses her diaphragm2exert downwards pressure. The bladder is drawn upin2 the abdomen2minimize trauma. The rectum is squashed back in2 the sacral curve often expelling faecal matter. The perineal body is flattened,stretched&thinned allowing the head(PP)2advance until crowning takes place. The placenta&membraines should b carefully examined by the midwife soon after delivery so if incomplete immediate action can commence.
The examination is 2detect normality and any abnormalities which may suggest any problems in the neonate. Primarily the placenta is checked for 2 membraines,the chorion the outer membraine which lines the uterine cavity &the amnion the inner membraine which secretes amniotic fluid or liquor, Membrains can be regged& must be pierced2ensure completeness. A hole where the baby has passed through may be seen. The placenta,rounded in shape, is examined,the maternal surface is a large surface area made 4actice&passive transport of nutrients&gases.
Area is cleared of any bloodclots&examined to ensue all cotyledons(15-20) r present. The placenta should be smooth 2touch if grittie this would signify that the mother smoked during pregnancy, the colour should be of a rich red colour. fetal surface shud b shiny& covered in amniotic membraines. the placenta edge is examined4blood vessels running in2 the membraines. Secondary:the cord is twisted2+strenthg, is examined noting its insertion(should be central), anytrue knots, which can reduce blood flow 2the fetus. number of vessels. xarteries &1xvein,which r protected by Wharton’s jelly. After birth vessels constrict&blood starts2clot. The placenta is usually weighed &@term shud weigh at least1/6 of baby’s birthweight. Finally any blood loss is measured& added2 the estimated loss soaked in2 pads. Findings should be documented in the mothers notes & any referrals needed should be made immediately 2the Dr if concerns of any tissue that has been retained. From the birth of the baby2the delivery of the placenta&membraines&the control of bleeding cud also ad in perinea repair.
Lasts anything from 1-60min. Reaction of the uterine muscles&begins w the contractio that delivers babys body, contraction&retraction continue, there is also a reduction in the size of the uterus&placenta site shrinks. When this occurs the placenta becomes compressed however if the cord is not clamped some transfer of fetal bld is forced from placenta2baby. Uterine walls thicken further causing placenta2come away. There r2ways which placenta is expelled. Schltze is where the fetal surface appears first w membranes trailing&blood loss will be encased in the membrains.
MatthewDuncan is were the placenta slips from the vagina sidewys&maternal surface appears first this is associated as a slower seperation. 2controll bleeding the uterus fully contracts, contraction&retraction continue&living ligatures constrict torn blood vessels. Manegment:Physiological:use no oxytocic drug:women adapts position cord left intact&placenta expelled by maternal effot&contraction. Active:oxytocic drugIM early clamping of cord:controlled cord traction skin-skinWimmediat breast feeding releases natural hormone oxytocin which can help the process.
Deliveryof platenta:guard uterus,control cord traction downward motion when placenta is visible apply upward motion,deliver placenta in2 a bowel&carefully deliver membrains. Check&document. Jaundice that requires treatment around day 3 to day 7 A common condition in newborns jaundice refers2the yellow colour of the skin+whites of the eyes caused be excess bilirubin in the blood. Bilirubin is produced by the normal breakdown of the RBC. Bilirubin passes through the liver and is excreted as bile through the intestines. Jaundice occurs when billi builds up faster that the liver can break it down+pass from the body.
This is because newborns make more billi then adults (more turnover of RBCAduls last 120days where fetal lasts 80 . Liver is still developing therefore not able2remove enough billi from blood& unable to change billi from fat soluble 2water sol. Occurring in most newborns this mild jaundice is due2immaturity of the babies liver. Generally appears at around 2days usually fades within 1-2wks.. Plenty of feeds +light therapy 2help clear condition&break down RBC+be excreted via urine+feaces. BP 2 detect pregnancy induced hypertension/pre eclampsia. BP may cause severe headachs or flshing lights advice lady 2 inform midwife/dry immediately. Urine. Mid stream urine sample checked for leukocytes which is sign4 infection dehydaratin/protien sign of pre-eclampsia. Fetal Movement explain reg move. FHHR 110-160. palpertate lie/pres longitudinal oblique,transverse& which part presents 2wards birth canal cephalic/breech. Engag presenting part is measured by the proportion which can still b felt through abdomen explain. Also birth preferences where,who length of stay, what2take, students, signs of labour contractions 3:10lasting 60-70sec watersbreaking.
Methods inducing 42w+ y! assesmet during labour mom/baby posture labour/birth pain relief entonox peth up2 7cm epidural. Csection. Assisted deliv 4ceps vontous perineum tear 3rdstage physiological maternal up2 hour active syntoinjection minimize bleed. Vitk prevention bleeding disorder IM/3 drops. Initial examination isa screening tool,&should be undertaken bythe midwife. This is2confirm normality as well as any abnormalities, identify any problems which may need a referral. APGAR score should b commenced at 1min and 5min after birth which is primary used for the decision2resuscitate a neonate. HR absent0 slow
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