2013 maternal and child health nursing reviewer complete

8/13/2019 2013 Maternal and Child Health Nursing Reviewer Complete

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FEMALE REPRODUCTIVE ANATOMY AND PHYSIOLOGY

I. THE EXTERNAL REPRODUCTIVE ORGANS

A. Mons pubis or mons veneris p!" o# #!$ %&i'& (ies over $&e s)mp&)sis pubis 'overe" b) s*in !n" !$ puber$) b) s&or$ &!irs+ pro$e'$s $&e surroun"in, "e(i'!$e $issues #rom $r!um!.

-. L!bi! m! or! $%o #o("s o# s*in %i$& #!$ un"erne!$&+ 'on$!in -!r$&o(in/s ,(!n"s %&i'& !re be(ieve" $ose're$e ! )e((o%is& mu'us %&i'& !'$s !s ! (ubri'!n$ "urin, se0u!( in$er'ourse. T&e openin,s o# $&e-!r$&o(in+s ,(!n"s !re (o'!$e" pos$erior() on ei$&er si"e o# $&e v!,in!( ori#i'e.

C. L!bi! minor! $%o $&in #o("s o# "e(i'!$e $issues+ #orm !n upper #o(" en'ir'(in, $&e '(i$oris 1'!((e" $&e prepu'e1 !n" uni$e pos$erior() 2'!((e" $&e #our'&e$$e1 %&i'& is &i,&() sensi$ive $o m!nipu(!$ion !n"$r!um! $&!$ is %&) i$ is o#$en $orn "urin, ! %om!n/s "e(iver).

D. G(!ns '(i$oris 3 sm!(( ere'$i(e s$ru'$ure !$ $&e !n$erior un'$ion o# $&e (!bi! minor!4 %&i'& is 'omp!r!b(e$o $&e penis in i$s bein, e0$reme() sensi$ive.

E. Ves$ibu(e n!rro% spe!'e seen %&en $&e (!bi! minor! !re sep!r!$e".5. Ure$&r!( me!$us e0$ern!( openin, o# $&e ure$&r!6 s(i,&$() be&in" !n" $o $&e si"e !re $&e openin,s o# $&e

S*ene/s ,(!n"s 2%&i'& !re o#$en invo(ve" in in#e'$ions o# $&e e0$ern!( ,eni$!(i!1.G. V!,in!( ori#i'e or In$roi$us e0$ern!( openin, o# $&e v!,in! 'overe" b) ! $&in membr!n'e 2'!((e"

&)men1 in vir,ins.

H. Perinuem !re! #rom $&e (o%er bor"er o# $&e v!,in!( ori#i'e $o $&e !nus+ 'on$!ins $&e mus'(es 2e.,.4 pubo'o''o),e!( !n" (ev!$or !ni mus'(es1 %&i'& suppor$ $&e pe(vi' or,!ns4 $&e !r$eries $&!$ supp() b(oo"$o $&e e0$ern!( ,eni$!(i! !n" $&e pu"en"!( nerves %&i'& !re impor$!n$ "urin, "e(iver) un"er !nes$&esi!.

II. THE INTERNAL RERODUCTIVE ORGANSA. V!,in! ! 738 in'& (on, "i(!$!b(e '!n!( (o'!$e" be$%een $&e b(!""er !n" $&e re'$um+ 'on$!ins ru,!e

2%&i'& permi$ 'onsi"er!b(e s$re$'&in, %i$&ou$ $e!rin,1+ or,!n o# 'opu(!$ion+ p!ss!,e%!) #or mens$ru!("is'&!r,es !n" #e$us.

-. U$erus9. Ho((o% pe!r3s&!pe" #ibromus'u(!r or,!n 7 in'&es (one4 : in'&es %i"e4 9 in'& $&i'* !n" %ei,&in,

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:.9 In(e$ en$r!n'e%!) $o $&e $rue pe(vis. I$s tra%s)erse *iameter is +i*er $&!n i$s!n$erospos$eior "i!me$er. T&us6:.9.9 Tr!nsverse "i!me$er @ 97.; 'm.:.9.: An$eropos$erior "i!me$er 2AP1 @ 99 'm.:.9.7 Ri,&$ !n" (e#$ ob(i ue "i!me$er @ 9:.B; 'm.

:.: C!vi$) sp!'e be$%een $&e in(e$ !n" $&e ou$(e$. Con$!ins $&e b(!""er !n" $&e re'$um4%i$& $&e u$erus be$%een $&em in !na%te,le'e* posi$ion $o%!r"s $&e b(!""er.

:.7 Ou$(e$ in#erior por$ion o# $&e pe(vis4 boun"e" on $&e b!'* b) $&e 'o'')04 on $&e si"es b)$&e is'&i!( $uberosi$ies !n" in #ron$ b) $&e in#erior !spe'$ o# $&e s)mp&)sis pubis !n" $&e

pubi' !r'&. I$s AP *iameter is +i*er $&!n i$s $r!nsverse "i!me$er.C. T)pes?V!ri!$ions

9. G)ne'oi" norm!( #em!(e pe(vis. In(e$ is %e(( roun"e" #or%!r" !n" b!'*. M"st i*eal ,"rc il*!irt .

:. An$&ropoi" $r!nsverse "i!me$er is n!rro%4 AP "i!me$er is (!,er $&!n norm!(.7. P(!$)pe((oi" in(e$ is ov!(4 AP "i!me$er is s&!((o%8. An"roi" m!(e pe(vis. In$e( &!s ! n!rro%4 s&!((o% pos$erior por$ion !n" poin$e" !n$erior

por$ion.D. Me!suremen$s

9. E0$ern!( su,,es$ive on() o# pe(vi' si>e6

9.9 In$er'ris$!( "i!me$er "is$!n'e be$%een $&e mi""(e poin$s o# $&e i(i!' 'res$s.Aver!,e @ : 'm.

9.: In$erspinous "i!me$er "is$!n'e be$%een $&e !n$erosuperior i(i!' spines.Aver!,e @ :; 'm.

9.7 In$er$ro'&!n$eri' "i!me$er "is$!n'e be$%een $&e $ro'&!n$ers o# $&e #emur.Aver!,e @ 79 'm.

9.8 E0$ern!( 'on u,!$e?-!u"e(o' ue/s "i!me$er "is$!n'e be$%een $&e !n$erior !spe'$ o# $&es)mp&)sis pubis !n" "epression be(o% L;. Aver!,e @ 9 3:< 'm.

:. In$ern!( ,ive $&e !'$u!( "i!me$ers o# $&e in(e$ !n" ou$(e$:.9 Di!,on!( 'on u,!$e "is$!n'e be$%een $&e s!'r!( promon$or) !n" in#erior m!r,in o# $&e

s)mp&)sis pubis. Aver!,e @ 9:.; 'm.:.: Impor$!n$ me!suremen$ be'!use i$ is $&e "i!me$er o# $&e pe(vi' in(e$. Aver!,e @ 9


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B.9 5o((i'(e3s$imu(!$in, &ormone 25SH1B.: Lu$eini>in, &ormone 2LH1

. E##e'$s o# es$ro,en in $&e bo").9 In&ibi$s pro"u'$ion o# 5SH.: C!uses &)per$rop&) o# $&e m)ome$rium.7 S$imu(!$es ,ro%$& o# $&e "u'$i(e s$ru'$ures o# $&e bre!s$s..8 In're!ses u!n$i$) !n" pH o# 'ervi'!( mu'us4 '!usin, i$ $o be'ome $&in !n" %!$er) !n"

'!n be s$re$'&e" $o ! "is$!n'e o# 9e" >),o$e $o survive s&ou(" 'on'ep$ion $!*e

p(!'e4 $&!$ is %&) $&is p&!se in $&e u$erine ')'(e4 $&!$ is %&) $&is p&!se in $&e u$erine ')'(e is%&!$ %e '!(( $r"0estati"%al $ ase. T&is p&!se in $&e u$erine ')'(e is !(so '!((e" secret"r&$ ase be'!use i$ se're$es $&e mos$ impor$!n$ &ormone in pre,n!n'). In vie% o# $&e '&!n,e#rom Gr!!#i!n #o((i'(e $o 'orpus Lu$eum4 i$ is '!((e" luteal $ ase. -e'!use i$ o''urs us$!#$er ovu(!$ion4 i$ is !(so '!((e" $&e $"st1")ulat"r& $ ase. An"4 i$ is !(so '!((e" $&e $re1me%strual $ ase.

99. Up un$i( $&e :8$&

"!) o# $&e mens$ru!( ')'(e4 i# $&e m!$ure ovum is no$ #er$i(i>e" b) ! sperm4$&e !moun$s o# &ormones in $&e 'orpus Lu$eum %i(( s$!r$ $o "e're!se. T&e 'orpus Lu$eum$urnin, %&i$e is no% '!((e" $&e 'orpus !(bi'!ns !n" in 738 "!)s4 $&e $&i'*ene" (inin, o# $&e


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u$erus pro"u'e" b) es$ro,en s$!r$s $o "e,ener!$e !n" s(ou,& o## !n" '!pi((!ries rup$ure. An"$&us be,ins !no$&er mens$ru!( perio".

C. A""i$ion!( In#orm!$ion9. &en $&e ov!r) re(e!ses $&e m!$ure ovum on $&e "!) o# ovu(!$ion4 some$imes ! 'er$!in

"e,ree o# p!in in ei$&er $&e ri,&$ or (e#$ (o%er u!"r!n$s is #e($ b) $&e %om!n. T&is sens!$ionis norm!( !n" $erme" mittelsc mer2.

:. T&e #irs$ 98 "!)s o# $&e mens$ru!( ')'(e is ! ver) v!ri!b(e perio". T&e (!s$ 98 "!)s o# $&emens$ru!( ')'(e is ! #i0e" perio" e0!'$() : %ee*s !#$er ovu(!$ion4 mens$ru!$ion %i(( o''ur2un(ess ! pre,n!n') &!s $!*en p(!'e1 be'!use $&e 'orpus Lu$eum &!s ! (i#e sp!n o# on() :%ee*s. Imp(i'!$ions6 %&en ,iven op$ions re,!r"in, $&e e0!'$ "!$e o# ovu(!$ion4 '&oose t+"+ee/s !e,"re me%struati"%.

7. In ! : 3"!) ')'(e4 ovu(!$ion $!*es p(!'e on $&e 98 $& "!). In ! 7:3"!) ')'(e4 ovu(!$ion $!*es p(!'e on $&e 9 $& "!). In ! :=3"!) ')'(e4 ovu(!$ion $!*es p(!'e on $&e 9: $& "!) 2Sub$r!'$ 98"!)s #rom $&e ')'(e1.

8. Mens$ru!$ion "oes no$ o''ur "urin, pre,n!n') be'!use pro,es$erone "oes no$ "e're!se in!moun$. Corpus Lu$eum 'on$inues $o pro"u'e pro,es$erone un$i( $&e p(!'en$! $!*es over

pro"u'$ion o# &ormones b) $&e $& %ee* o# pre,n!n').;. Mens$ru!$ion '!n o''ur even %i$&ou$ ovu(!$ion 2!s in %omen $!*in, or!( 'on$r!'ep$ives1.

Ovu(!$ion '!n (i*e%ise o''ur even %i$&ou$ mens$ru!$ion 2!s in (!'$!$in, mo$&ers1.

HUMAN SE3UALITY

I. DE5INITION O5 TERMSA. Pu!ert& en'omp!sses $&e p&)sio(o,i' '&!n,es (e!"in, $o $&e "eve(opmen$ o# !"u($ repro"u'$ive

'!p!'i$)+ $&e pro'ess in'(u"es m!$ur!$ion o# $&e &)po$&!(!mus4 pi$ui$!r) ,(!n" !n" ,on!"s. T&ero(e o# $&e !n$erior pi$ui$!r) ,(!n". T&e pi$ui$!r) se're$ion o# ,on!"o$ropin ini$i!$es ,ro%$& !n"m!$ur!$ion. I$ o''urs ini$i!(() "urin, s(eep !n" (!$er in puber$) $&rou,&ou$ %!*e#u(ness.

-. A*"lesce%ce en'omp!sses $&e p&)sio(o,i'4 so'i!(4 !n" 'o,ni$ive '&!n,es (e!"in, $o$&e "eve(opmen$ o# !"u($ i"en$i$). T&e pro'ess in'(u"es in"ivi"u!(4 !'&ievemen$ o# person!(in"epen"en'e !n" m!$ur!$ion o# 'o,ni$ive re!sonin, s*i((s.

C. T elarc e bu""in, o# $&e bre!s$sD. A*re%arc e "eve(opmen$ o# !0i((!r) !n" pubi' &!ir

II. SEXUAL DEVELOPMENT 2T!b(e 91

Criteria Males Females9. S$!r$ o# ,ro%$& spur$ Aroun" 97 )e!rs o(" A#$er onse$ o# menses4

!roun" 9e o# pe(vis8.7 Appe!r!n'e o# bo") &!ir 8.7.9 Pubi' !re! 8.7.: A0i((!8.8 Mens$ru!$ion8.; Ovu(!$ion

Ta!le 6. Se'ual De)el"$me%t

III. TANNER STAGING 2T!b(e : !n" T!b(e 71A. A r!$in, s)s$em #or puber$!( "eve(opmen$


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-. I$ is $&e bio(o,i' m!r*er o# m!$uri$)C. I$ is b!se" on $&e or"er() pro,ressive "eve(opmen$ o#6

9. -re!s$s !n" pubi' &!ir in #em!(es:. Geni$!(i! !n" pubi' &!ir in m!(es

Sta0es Males FemalesI C&i("&oo" si>e o# penis4 $es$es4 s'ro$um Prepuber$!(4 no bre!s$ $issueII En(!r,emen$ o# $es$es !n" s'ro$um Appe!r!n'e o# bre!s$ bu"III Len,$&enin, o# $&e penis

5ur$&er en(!r,emen$ o# $es$es !n"s'ro$umDeepenin, pi,men$!$ion o# s'ro$!( s*in

En(!r,emen$ o# $&e bre!s$s !n"!reo(!

IV i"enin, !n" #ur$&er (en,$&enin, o# penis5ur$&er en(!r,emen$ o# $es$es !n"s'ro$umDeepenin, pi,men$!$ion o# s'ro$!( s*in

Areo(! !n" nipp(e #orm ! moun"!$op un"er()in, bre!s$ $issues

V A"u($ 'on#i,ur!$ion !n" si>e o# ,eni$!(i! A"u($ 'on#i,ur!$ion !n" si>e o#,eni$!(i!Areo(! !n" bre!s$s &!ve smoo$&'on$our

Ta!le -. Ta%%er Sta0es ", Pu!ertal De)el"$me%t7 T elarc e 8 Ge%italia

Sta0es Males FemalesI Prepuber$!(4 no pubi' &!ir 3 s!me 3II Sp!rse4 "o%n) &!ir !$ $&e b!se o# $&e

p&!((usA$ $&e me"i!( !spe'$ o# $&e (!bi!m! or!

III D!r*enin,4 'o!rsenin,4 'ur(in, o# &!ir%&i'& e0$en" up%!r" !n" (!$er!(()

3 s!me 3

IV H!ir o# !"u($ 'onsis$en') (imi$e" $o $&emons pubis

3 s!me 3

V H!ir spre!"s $o $&e me"i!( !spe'$ o# $&e$&i,&s

3 s!me 3

Ta!le 9. Ta%%er Sta0es ", Pu!ertal De)el"$me%t7 A*re%arc e

IV. HUMAN SEXUAL CJCLE

A. E'citeme%t9. V!,in!( (ubri'!$ion !n" v!so'on,es$ion o# $&e ,eni$!(i!.:. Peni(e ere'$ion "ue $o v!so'on,es$ion

-. Plateau9. 5orm!$ion o# or,!smi' p(!$#orm "ue $o prominen$ v!so'on,es$ion.:. Gener!(i>e" mus'(e $ension4 &)perven$i(!$ion4 in're!se" -P4 $!'&)'!r"i! in $&e (!$e p(!$e!u

p&!se.7. Pre3e !'u(!$or) p&!se %i$& (ive sperm!$o>o!

C. Or0asmic9. S$ron, r&)$&mi' 'on$r!'$ions o# v!,in! !n" u$erus.:. In m!(es4 v!s "e#erens4 semin!( vesi'(e4 e !'u(!$or) "u'$ !n" pros$!$e 'on$r!'$ 738 $imes over

! #e% se'on"s '!usin, poo(in, o# semin!( #(ui" in $&e pros$!$i' ure$&r!. R&)$&mi''on$r!'$ions in m!(es o''ur !$


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8. Norm!( (i#e sp!n o# sperms @ B "!)s;. Sperms4 on'e "eposi$e" in $&e v!,in!4 %i(( ,ener!(() re!'& $&e 'ervi0 +it i% s la&er be(ieve" $o pro$e'$ $&e #e$us !,!ins$ Treponem!P!((i"um 2e$io(o,i' !,en$ o# s)p&i(is1. Presen$ on() "urin, $&e se'on"$rimes$er o# pre,n!n').

-. S)n')$i!( (!)er ,ives rise $o $&e #e$!( membr!nes69. Am%i"% inner membr!ne %&i'& ,ives rise $o

9.9 Umbi(i'!( 'or"?#unis 'on$!ins $%o arteries a%* "%e )ei%(%&i'& !re suppor$e" b) $&e &!r$on/s e(().

9.: Amnio$i' #(ui"

C(e!r4 !(buminous #(ui" in %&i'& $&e b!b) #(o!$s.-e,ins $o #orm !$ 9939; %ee*s ,es$!$ion.Appro0im!$es %!$er in spe'i#i' ,r!vi$) 29.


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T!b(e 8. Ou$(ine o# Trop&ob(!s$ Di##eren$i!$ion

IV. 5ETAL DEVELOPMENTA. 5irs$ Lun!r Mon$&9. Germ (!)ers "i##eren$i!$ b) $&e : n" %ee*6 2in '!ses o# mu($ip(e 'on,eni$!( !nom!(ies4 $&e s$ru'$ures $&!$

%i(( be !##e'$e" !re $&ose $&!$ !rise ou$ o# $&e s!me ,erm (!)er1.9.9 En$o"erm "eve(ops in$o $&e (inin, o# $&e GIT4 $&e respir!$or) $r!'$4 $onsi(s4 $&)roi" 2#or b!s!(

me$!bo(ism14 p!r!$&)roi" 2#or '!('ium me$!bo(ism14 $&)mus ,(!n" 2#or "eve(opmen$ o# immuni$)14 b(!""er !n" ure$&r!

9.: Meso"erm #orms in$o $&e suppor$in, s$ru'$ures o# $&e bo") 2'onne'$ive $issues4 '!r$i(!,emmus'(es !n" $en"ons1+ &e!r$4 'ir'u(!$or) s)s$em4 b(oo" 'e((s4 repro"u'$ive s)s$em4 *i"ne)s !n"ure$ers

9.7 E'$o"erm responsib(e #or $&e #orm!$ion o# $&e nervous s)s$em4 $&e s*in4 &!ir !n" n!i(s4 !n" $&emu'ous membr!ne o# $&e !nus !n" mou$&.

:. 5e$!( membr!nes 2!mnion !n" '&orion1 !ppe!r b) $&e se'on" %ee*.

7. Nervous s)s$em ver) r!pi"() "eve(ops b) $&e 7 r" %ee*. 2Di>>iness is s!i" $o be $&e e!r(ies$ si,n o# pre,n!n') be'!use !s $&e #e$!( br!in r!pi"() "eve(ops4 ,(u'ose s$ores o# $&e mo$&er !re "ep(e$e"4 $&us'!usin, &)po,()'emi! in $&e (!$$er1.

8. 5e$!( &e!r$ be,ins $o #orm !s e!r() !s $&e 9= $& "!) o# (i#e. 2To $&e ues$ion4 &en "oes $&e #e$!( &e!r$ be,in $o be!$ 4 $&e !ns%er is #irs$ (un!r mon$&. -u$ $o $&e ues$ion4 &en '!n #e$!( &e!r$ $ones $o #irs$&e!r" $&e !ns%er is #i#$& mon$&.1

;. T&e "i,es$ive !n" respir!$or) $r!'$s e0is$ !s ! sin,(e $ube un$i( $&e 7 r" %ee* o# (i#e %&en $&e) s$!r$ $osep!r!$e.

-. Se'on" Lun!r Mon$&9. A(( vi$!( or,!ns !re #orme" b) $&e $& %ee*+ p(!'en$! "eve(ops #u(()

:. Se0 or,!ns 2ov!ries !n" $es$es1 !re #orme" b) $&e $&

%ee*. 2To $&e ues$ion4 &en is se0 "e$ermine"$&e !ns%er is A$ $&e $ime # 'on'ep$ion 1.

7. Me'onium 2#irs$ s$oo(s1 !re #orme" in $&e ins$es$ines b) $&e ; $& $& %ee*.

C. T&ir" Lun!r Mon$&9. Fi"ne)s !re !b(e $o #un'$ion urine is #orme" b) $&e 9: $& %ee*.:. -u"s o# mi(* $ee$& #orm7. -e,innin, bone ossi#i'!$ion8. #e$us s%!((o%s !mnio$i' #(ui";. 5e$o3p(!'en$!( 'ir'u(!$ion is es$!b(is&e" b) se(e'$ive osmosis+ no "ire'$ e0'&!n,e be$%een #e$!( !n"

m!$ern!( b(oo".

D. 5our$& Lun!r Mon$&9. L!nu,o !ppe!rs:. -u"s o# perm!nen$ $ee$& #orm7. He!r$ be!$s m!)be !u"ib(e %i$& #e$os'ope

E. 5i#$& Lun!r Mon$&9. Verni0 '!seos! !ppe!rs:. L!nu,o 'overs en$ire bo")7. ui'*enin, 2#e$!( movemen$s1 #e($8. 5e$!( &e!r$ be!$s ver) !u"ib(e

5. Si0$& Lun!r Mon$&9. S*in m!r*e"() %rin*(e":. A$$!ins propor$ions o# #u(($erm b!b)

G. Seven$& Lun!r Mon$& !(veo(i be,in $o #orm 2: $& %ee*s o# ,es$!$ion is s!i" $o be $&e (o%er (imi$ o# prem!$uri$) be'!use i# b!b) is "e(ivere" !$ $&is $ime4 %i(( 'r) !n" bre!$&e bu$ usu!(() "ies1

H. Ei,&$& Lun!r Mon$&9. 5e$us is vi!b(e:. L!nu,o be,ins $o "is!ppe!r

7. N!i(s e0$en" $o en"s o# #in,ers8. Sub'u$!neous #!$ "eposi$ion be,ins

I. Nin$& Lun!r Mon$&

Es$ro,en !n" Pro,es$erone

:.= Pro$e'$ive b!rrier in&ibi$s $&e p!ss!,e o# s!me b!'$eri! !n" (!r,emo(e'u(es


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9. L!nu,o !n" verni0 "is!ppe!r :. Amnio$i' #(ui" vo(ume some%&!$ "e're!ses

. Ten$& Lun!r Mon$& !(( '&!r!'$eris$i's o# $&e norm!( ne%born.

V. 5OCUS O5 5ETAL DEVELOPMENT

A. 5irs$ $rimes$er perio" o# or,!no,enesis-. Se'on" $rimes$er perio" o# 'on$inue" #e$!( ,ro%$& !n" "eve(opmen$+ r!pi" in're!se in #e$!( (en,$&C. T&ir" $rimes$er perio" o# mos$ r!pi" ,ro%$& !n" "eve(opmen$ be'!use o# r!pi" "eposi$ion o#

sub'u$!neous #!$

VI. NORMAL ADAPTATIONS IN PREGNANCJA. S)s$emi' C&!n,es9. Cir'u(!$or)?C!r"iov!s'u(!r

9.9 -e,innin, $&e en" o# $&e #irs$ $rimes$er $&ere is ! ,r!"u!( in're!se o# !bou$ 7< 3 ;< in $&e $o$!('!r"i!' vo(ume4 re!'&in, i$s pe!* "urin, $&e = $& mon$&. T&is '!uses ! "rop in &emo,(obin !n"&em!$o'ri$ v!(ues sin'e $&e in're!se is on() in $&e p(!sm! vo(ume @ p&)sio(o,i' !nemi! o#

pre,n!n'). Conse uen'es o# in're!se" $o$!( '!r"i!' vo(ume !re69.9.9 E!si() #!$i,!bi(i$) !n" s&or$ness o# bre!$& be'!use o# in're!se" %or*(o!" o# $&e &e!r$9.9.: S(i,&$ &)per$rop&) o# $&e &e!r$4 '!usin, i$ $o be "isp(!'e" $o $&e (e#$4 resu($in, in

$orsion on $&e ,re!$ vesse(s 2$&e !or$! !n" pu(mon!r) !r$er)1.9.9.7 S)s$o(i' murmurs !re 'ommon "ue $o (o%ere" b(oo" vis'osi$)9.9.8 Noseb(ee"s m!) o''ur be'!use o# m!r*e" 'on,es$ion o# $&e n!sop&!r)n0 !s

pre,n!n') pro,resses.

9.: P!(pi$!$ions !re "ue $o69.:.9 S)mp!$&e$i' nervous s)s$em s$imu(!$ion "urin, $&e #irs$ &!(# o# pre,n!n')9.:.: In're!se" pressure o# u$erus !,!ins$ $&e "i!p&r!,m "urin, se'on" &!(" o# pre,n!n')

9.7 -e'!use o# poor 'ir'u(!$ion resu($in, #rom pressure o# $&e ,r!vi" u$erus on $&e b(oo" vesse(s o# $&e(o%er e0$remi$ies6

9.7.9. E"em! o# $&e (o%er e0$remi$ies o''urs. M!n!,emen$ (e,s !bove &ip (eve(. Impor$!n$6 E"em!o# $&e (o%er e0$remi$ies is norm!( "urin, pre,n!n')+ i$ is no$ ! si,n o# $o0emi!

9.7.:. V!ri'osi$ies o# $&e (o%er e0$remi$ies '!n !(so o''ur. M!n!,emen$6Use?%e!r suppor$ &ose or e(!s$i' s$o'*in,s $o promo$e venous #(o%4 $&us preven$in, s$!sisin (o%er e0$remi$iesApp() e(!s$i' b!n"!,e s$!r$ !$ $&e "is$!( en" o# $&e e0$remi$) !n" %or* $o%!r" $&e $run* $o!voi" 'on,es$ion !n" imp!ire" 'ir'u(!$ion in $&e "is$!( p!r$+ "o no$ %r!p $oes so !s $o be!b(e $o "e$ermine !"e u!') o# 'ir'u(!$ion 2Prin'ip(e be&in" b!n"!,in,6 b(o" #(o% $&rou,&

$issues is "e're!se" b) !pp()in, e0'essive pressure on b(oo" vesse(s1Avoi" use o# 'ons$ri'$in, ,!r$ers4 e.,.4 *nee3&i,& so'*s

9.8 -e'!use o# poor 'ir'u(!$ion in $&e b(oo" vesse(s o# $&e ,eni$!(i! "ue $o $&e pressure o# $&e ,r!vi"u$erus4 v!ri'osi$ies o# $&e vu(v! !n" re'$um '!n o''ur. M!n!,emen$6 si"e3()in, posi$ion %i$&&ips e(ev!$e" on pi((o% !n" mo"i#ie" *nee3'&es$ posi$ion.

9.; T&ere is in're!se" (eve( o# 'ir'u(!$in, #ibro,en4 $&!$ is %&) pre,n!n$ %omen !re norm!(()s!#e,u!r"e" !,!ins$ un"ue b(ee"in,. Ho%ever4 $&is !(so pre"isposes $&em $o #orm!$ion o# b(oo"'(o$s 2$&rombi1. T&e imp(i'!$ion is $&!$ pre,n!n$ %omen s&ou(" no$ be m!ss!,e" sin'e b(oo" '(o$s'!n be re(e!se" !n" '!use $&romboembo(ism.

:. G!s$roin$es$in!( '&!n,es:.9 Mornin, si'*ness n!use! !n" vomi$in, "urin, $&e #irs$ $rimes$er is "ue $o in're!se" &um!n

'&orioni' ,on!"o$ropin 2HCG1. I$ m!) !(so be "ue $o in're!se" !'i"i$) or even $o emo$ion!(#!'$ors. M!n!,emen$6 E!$ "r) $o!s$ or 'r!'*ers 7< minu$es be#ore !risin, in $&e mornin, 2or "r)4&i,& '!rbo&)"r!$e4 (o% #!$ !n" (o% spi'es in $&e "ie$1.

:.: H)peremesis ,r!vi"!rum @ e0'essive n!use! !n" vomi$in, %&i'& persis$s be)on" 7 mon$&s+resu($s in "e&)"r!$ion4 s$!rv!$ion !n" !'i"osis. M!n!,emen$6 D9


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:.7.; Avoi" &!rs& (!0!$ives (i*e Du('o(!0+ s$oo( so#$eners4 e.,. Co(!'e4 !re be$$er :.7.= Miner!( oi( s&ou(" no$ be $!*en be'!use i$ in$er#eres %i$& !bsorp$ion o# #!$3so(ub(e

vi$!mins.

:.8 Hemorr&oi"s !re "ue $o pressure o# en(!r,e" u$erus. M!n!,emen$6 'o(" 'ompress %i$& %i$'&&!>e( or Epsom s!($s.

:.; He!r$burn4 espe'i!(() "urin, $&e (!s$ $rimes$er4 is "ue $o in're!se" pro,es$erone %&i'& "e're!ses,!s$ri' mo$i(i$)4 $&ereb) '!usin, reverse peris$!($i' %!ves %&i'& (e!" $o re,ur,i$!$ion o# s$om!'&'on$en$s $&rou,& $&e '!r"i!' sp&in'$er in$o $&e esop&!,us4 '!usin, irri$!$ion. M!n!,emen$6

:.;.9 P!$s or bu$$er be#ore me!(s:.;.: Avoi" #rie"4 #!$$) #oo"s:.;.7 Sips o# mi(* !$ #re uen$ in$erv!(s:.;.8 Sm!((4 #re uen$ me!(s $!*en s(o%():.;.; -en" !$ $&e *nees4 no$ !$ $&e %!is$:.;.= T!*e !n$!'i"s 2e.,. mi(* o# M!,nesi!1 bu$ never so"ium bi'!rbon!$e 2e.,. A(*!

Se($>er or b!*in, so"!1 be'!use i$ promo$es #(ui" re$en$ion.

7. Respir!$or) '&!n,es s&or$ness o# bre!$&7.9 C!uses

7.9.9 In're!se" o0),en 'onsump$ion !n" pro"u'$ion o# '!rbon "io0i"e "urin, $&e #irs$$rimes$er.

7.9.: In're!se" u$erine si>e '!uses "i!p&r!,m $o be pus&e" or "isp(!'e"4 $&us 'ro%"in, $&e'&es$ '!vi$).

7.: M!n!,emen$6 L!$er!( e0p!nsion o# $&e '&es$ $o 'ompens!$e #or s&or$ness o# bre!$& in're!seso0),en supp() !n" vi$!( (un, '!p!'i$).

8. Urin!r) '&!n,es8.9 Urin!r) #re uen')4 $&e on() si,n in pre,n!n') seen "urin, $&e #irs$ $rimes$er "is!ppe!rs "urin, $&e

se'on" !n" re!ppe!rs "urin, $&e $&ir" $rimes$er. E!r() in pre,n!n') is "ue $o in're!se" b(oo"supp() $o $&e *i"ne)s !n" $o $&e u$erus risin, ou$ o# $&e pe(vi' '!vi$)+ in $&e (!s$ $rimes$er is "ue

$o pressure o# en(!r,e" u$erus on $&e b(!""er4 espe'i!(() %i$& (i,&$nin, 2"es'en$ o# $&e #e$us in$o$&e pe(vi' brim1.

8.: De're!se" ren!( $&res&o(" #or su,!r "ue $o in're!se" pro"u'$ion o# ,(u'o'or$i'oi"s %&i'& '!use(!'$ose !n" "e0$rose $o spi(( in$o $&e urine+ !(so !n e##e'$ o# $&e in're!se" pro,es$erone.2imp(i'!$ion6 i$ %ou(" be "i##i'u($ $o "i!,nose "i!be$es in pre,n!n') b!se" on $&e urine s!mp(e!(one be'!use ! pre,n!n$ %omen &!ve su,!r in $&eir urine.1

;. Mus'o(os*e(e$!( '&!n,es;.9 -e'!use o# $&e pre,n!n$ %om!n/s !$$emp$ $o '&!n,e &er 'en$er o# ,r!vi$)4 s&e m!*es !mbu(!$ion

e!sier b) s$!n"in, more s$r!i,&$ !n" $!((er4 resu($in, in ! (or"o$i' posi$ion 2 pri"e o# pre,n!n') 1;.: Due $o in're!se" pro"u'$ion o# $&e &ormone re(!0in4 pe(vi' bones be'ome more supp(e !n"

mov!b(e4 in're!sin, $&e in'i"en'e o# !''i"en$!( #!((s "ue $o $&e %obb() ,!i$. Imp(i'!$ion6 A"viseuse o# (o%3&ee(e" s&oes !#$er $&e #irs$ $rimes$er

;.7 Le, 'r!mps;.7.9 C!uses

In're!se" pressure o# ,r!vi" u$erus on (o%er e0$remi$ies5!$i,ueC&i((sMus'(e $ensenessLo% '!('ium4 &i,& p&osp&orus in$!*e

;.7.: M!n!,emen$5re uen$ res$ perio"s %i$& #ee$ e(ev!$e"

e!r %!rm4 more 'on#or$!b(e '(o$&in,In're!se '!('ium in$!*e 2'!('ium $!b(e$s !n" "ie$1Do no$ m!ss!,e b(oo" '(o$s '!n '!use embo(ism.Mos$ e##e'$ive $re!$men$6 Press *nee o# $&e !##e'$e" (e, !n" "orsi#(e0 $&e #oo$.

=. Temper!$ure s(i,&$ in're!se in b!s!( $emper!$ure "ue $o in're!se" pro,es$erone4 bu$ $&e bo") !"!p$s!#$er $&e 8$& mon$&

B. En"o'rine '&!n,esB.9 A""i$ion o# $&e p(!'en$! !s !n en"o'rine or,!n4 pro"u'in, (!r,e !moun$s o# HCG4 HPL4 es$ro,en

!n" pro,es$erone.

B.: Mo"er!$e en(!r,emen$ o# $&e $&)roi" ,(!n" "ue $o &)perp(!si! o# $&e ,(!n"u(!r $issues !n"in're!se" v!s'u(!ri$). Cou(" !(so be "ue $o in're!se" b!s!( me$!bo(i' r!$e $o !s mu'& !s :; be'!use o# $&e me$!bo(i' !'$ivi$) o# $&e pro"u'$s o# 'on'ep$ion.

B.7 In're!se" si>e o# $&e p!r!$&)roi"4 prob!b() $o s!$is#) $&e in're!se" nee" o# $&e #e$us #or '!('ium.


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M!n!,emen$5(!,)( #or 9< "!)s p.o. or v!,in!( supposi$ories o# $ri'&omoni'i"!( 'ompoun"s.2e.,.4 Tri'o#uron4 V!,ise' or Deve,!n1.o Is '!r'ino,eni' "urin, $&e #irs$ $rimes$er o Tre!$ m!(e p!r$ner !(so %i$& 5(!,)(.o Avoi" !('o&o(i' "rin*s %&en $!*in, 5(!,)( '!n '!use An$!buse (i*e

re!'$ions6 vomi$in,4 #(us&e" #!'e !n" !b"omin!( 'r!mps.o D!r* bro%n urine ! minor si"e e##e'$ no nee" $o "is'on$inue $&e "ru,.A'i"i' v!,in!( "ou'&e 29 $bsp. %&i$e vine,!r in 9 u!r$ o# %!$er or 9; m(. %&i$evine,!r in 9e resu($s in rup$ure !n" !$rop&) o# 'onne'$ive $issue (!)ers4

seen !s pin* or re""is& s$re!*s 2,en$() rubbin, oi( on $&e s*in &e(ps preven$ "i!s$!sis17.: Umbi(i'us pus&e" ou$

8. S*in8.9 Line! ni,r! bro%n (ine runnin, #rom umbi(i'us $o s)mp&!is pubis8.: Me(!sm! or '&(o!sm! e0$r! pi,men$!$ion on '&ee*s !n" !'ross $&e nose "ue $o in're!se"

pro"u'$ion o# me(!no')$es b) $&e pi$ui$!r) ,(!n"8.7 S%e!$ ,(!n"s un"u() !'$iv!$e"

;. -re!s$s !(( '&!n,es "ue $o in're!se" es$ro,en;.9 In're!se in si>e "ue $o &)perp(!si! o# m!mm!r) !(veo(i !n" #!$ "eposi$s. Proper bre!s$ suppor$

%i$& %e((3#i$$in, br!ssiere ne'ess!r) $o preven$ s!,,in,;.: 5ee(in, o# #u((ness !n" $in,(in, sens!$ion in $&e bre!s$s;.7 Nipp(es more ere'$. 5or mo$&ers %&o in$en" $o bre!s$#ee"4 !"vise6

;.7.9 Nipp(e ro((in,;.7.: Dr)in, nipp(es %i$& rou,& $o%e( $o &e(p $ou,&en $&e nipp(es.;.7.7 No$ $o use so!p or !('o&o( !s $&is '!n '!use "r)in, %&i'& 'ou(" (e!" $o sore nipp(es.

;.8 Mon$,omer) ,(!n"s be'ome bi,,er !n" more pro$ruber!n$;.; Areo(! be'omes "!r*er !n" "i!me$er in're!ses;.= S*in surroun"in, !reo(!e $urns "!r* ;.B -) $&e #our$& mon$&4 ! $&in4 %!$er)4 &i,& pro$ein #(ui"4 '!((e" 'o(os$rums4 is #orme". I$ is $&e

pre'ursor o# bre!s$ mi(*.

=. Ov!ries no !'$ivi$) %&!$soever sin'e ovu(!$ion "oes no$ $!*e p(!'e "urin, pre,n!n'). Pro,es$erone!n" es$ro,en !re bein, pro"u'e" b) $&e p(!'en$!.

Sta0e Presum$ti)e Pr"!a!le P"siti)e5irs$ Trimes$er Amenorr&e!

Mornin, si'*ness-re!s$ '&!n,esUrin!r) #re uen')En(!r,in, u$erus

C&!"%i'*/s si,nGoo"e((/s si,nHe,!r/s si,nPosi$ive HCGE(ev!$ion o# --T

U($r!soun" evi"en'e

Se'on" Trimes$er ui'*enin, S*in pi,men$!$ion

En(!r,e" !b"omen-r!0$on Hi'*s

5e$!( &e!r$ $ones5e$!( movemen$s


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2'&(o!sm! !n" (ine!ni,r!1S$ri!e ,r!vi"!rum

-!((o$emen$ #e($ b) e0!miner 5e$!( ou$(ine on 03r!)

Si0%s ", Pre0%a%c&

VII. THE PRENATAL VISITA. T&e provision o# pren!$!( '!re is $&e prim!r) #!'$or in $&e improvemen$ o# m!$ern!( !n" in#!n$ morbi"i$)

!n" mor$!(i$) s$!$is$i's. To ensure $&e su''ess o# $&e pren!$!( '!re pro,r!ms4 i$ s&ou(" be remembere"$&!$ $&e p!$ien$/s un"ers$!n"in, o# $&e mo"!(i$ies o# '!re is b!si' $o 'ooper!$ive !'$ion.

-. T&e "ur!$ion o# ! norm!( pre,n!n') is :==3: < "!)s4 or 7 38: %ee*s 2!ver!,e is 8< %ee*s14 or '!(en"!r mon$&s or 9< (un!r mon$&s. An) b!b)4 $&ere#ore4 %&o is born be#ore $&e 7 $& %ee* o# ,es$!$ionis '!((e" pre3$erm !n" ! b!b) born !#$er $&e 8: n" %ee* o# ,es$!$ion is s!i" $o be pos$3$erm.

C. Di!,nosis o# Pre,n!n'). Urine e0!min!$ion &um!n '&orioni' ,on!"o$ropin 2HCG1 in $&e urine is $&e b!sis #or pre,n!n') $es$s. I$ is presen$ #rom $&e 8< $& "!) $&rou,& $&e 9


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C(!ss ; 'on'(usive #or m!(i,n!n')C(ini'!( s$!,es $&!$ re#(e'$ (o'!(i>!$ion or spre!" o# m!(i,n!n$ 'ervi'!( '&!n,es.

S$!,e 9 CA 'on#ine" $o $&e 'ervi0S$!,e : CA e0$en"s be)on" $&e 'ervi0 in$o $&e v!,in!4 bu$ no$ in$o $&e pe(vi'%!(( or (o%er 9?7 o# $&e v!,in!S$!,e 7 Me$!s$!sis $o $&e pe(vi' %!((S$!,e 8 Me$!s$!sis be)on" pe(vi' %!(( in$o $&e b(!""er !n" re'$um

:.:.8 Pe(vi' me!suremen$s !re pre#er!b() "one !#$er $&e = $& (un!r mon$&. X3r!) pe(vime$r)2sever!( #(!$ p(!$e X3r!) pi'$ures o# $&e pe(vis $!*en #rom "i##eren$ !n,(es1 is $&e mos$e##e'$ive me$&o" o# "i!,nosin, 'ep&!(ope(vi' "ispropor$ion 2CPD1. -u$ sin'e X3r!)s!re $er!$o,eni'4 $&e pro'e"ure '!n be "one on() : %ee*s be#ore EDC.

:.:.; Leopo("/s m!neuversPurposes

To "e$ermine presen$!$ion4 posi$ion4 !n" ,r!$i$u"eEs$im!$e #e$!( si>eLo'!$e #e$!( p!r$s

Prep!r!$or) s$eps

P!(p!$e %i$& %!rm &!n"s+ 'o(" &!n"s '!use !b"omin!( mus'(es $o 'on$r!'$Use p!(ms4 no$ #in,er$ipsPosi$ion p!$ien$ on supine %i$& *nees #(e0e" s(i,&$() 2"ors!( re'umben$ posi$ion1so !s $o re(!0 !b"omin!( mus'(es.App() ,en$(e bu$ #irm mo$ions

Pro'e"ure5irs$ m!never6 5!'in, &e!" p!r$ o# pre,n!n$ %om!n4 p!(p!$e #or #e$!( p!r$ #oun"in $&e #un"us $o "e$ermine presen$!$ion 2! &!r"4 smoo$&4 b!((o$!b(e m!ss !$ $&e#un"us me!ns $&e #e$us is in bree'& presen$!$ionSe'on" m!neuver6 P!(p!$e si"es o# $&e u$erus $o "e$ermine $&e (o'!$ion o# #e$!(

b!'* 2bes$ p(!'e $o &e!r #e$!( &e!r$ $ones1 !n" sm!(( #e$!( p!r$sT&ir" m!neuver6 Gr!sp (o%er por$ion o## !b"omen us$ !bove $&e s)mp&)sis

pubis $o #in" ou$ "e,ree o# en,!,emen$.5our$& m!neuver6 5!'in, $&e #ee$ p!r$ o# $&e p!$ien$4 press #in,ers "o%n%!r" on

bo$& si"es o# $&e u$erus !bove $&e in,uin!( (i,!men$s $o "e$ermine !$$i$u"e2"e,ree o# #(e0ion o# #e$!( &e!"1

:.7 Vi$!( si,ns $emper!$ure4 pu(se !n" respir!$or) r!$es !re impor$!n$ espe'i!(() "urin, $&e ini$i!( pren!$!( visi$. More impor$!n$4 &o%ever4 !re $&e %ei,&$ !n" b(oo" pressure !s b!se(ine "!$! $o"e$ermine !n) si,ni#i'!n$ in're!ses.

:.8 -(oo" s$u"ies:.8.9 -(oo" T)pin,:.8.: Comp(e$e b(oo" 'oun$4 in'(u"in, H,b !n" H'$4 $o "e$ermine !nemi!:.8.7 Sero(o,i'!( $es$s 2VDRL !n" F!&n !sserm!n1 $o "i!,nose #or s)p&i(is

:.; Urine e0!min!$ions:.;.9 He!$ !n" !'e$i' !'i" $es$ $o "e$ermine !(buminuri!. An) si,n o# !(bumin in $&e urine

s&ou(" be repor$e" imme"i!$e() be'!use i$ is ! si,n o# $o0emi!:.;.: -ene"i'$/s $es$ #or ,()'osuri!4 ! si,n o# possib(e ,es$!$ion!( "i!be$es. Urine s&ou(" be

'o((e'$e" be#ore bre!*#!s$ $o !voi" #!(se posi$ive resu($s. S&ou(" no$ be more $&!n 9su,!r.

:.;.7 De$ermin!$ion o# p)ur!. Urin!r) $r!'$ in#e'$ion &!s been #oun" $o be ! 'ommon '!use o# prem!$ure "e(iver).

7. Impor$!n$ Es$im!$es7.9 A,e o# Ges$!$ion 2AOG1

7.9.9 N!,e(e/s Ru(e '!('u(!$ion o# e0pe'$e" "!$e o# 'on#inemen$ 2EDC1. Coun$ b!'* $&reemon$&s #rom $&e #irs$ "!) o# $&e (!s$ mens$ru!( perio" 2LMP1 $&en !"" B "!)s. Subs$i$u$enumber #or mon$& #or e!s) 'ompu$!$ion. E.,.4 LMP is Sep$ember =Sep$ember is $&e $& mon$& o# $&e )e!r 7 @ = 2 une1A"" B "!)s $o = @ 97EDC une 97

7.9.: M'Don!("/s Me$&o" "e$ermine !,e o# ,es$!$ion b) me!surin, #rom $&e #un"us $o $&es)mp&)sis pubis 2in 'm.1 $&en "ivi"e b) 8 @ AOG in mon$&s. E.G.4 #un"i' &ei,&$ o# 9='m. "ivi"e" b) 8 @ 8 mon$&s AOG @ 9= %ee*s AOG.

7.9.7 -!r$&o(ome%/s Ru(e es$im!$e AOG b) $&e re(!$ive posi$ion o# $&e u$erus in $&e!b"omin!( '!vi$) 25i,ure 81.

-) $&e 7 r" (un!r mon$&4 $&e #un"us is p!(p!b(e s(i,&$() !bove $&e s)mp&)sis pubis


14/40

On $&e ;$& (un!r mon$&4 $&e #un"us is !$ $&e (eve( o# $&e umbi(i'usOn $&e $& (un!r mon$&4 $&e #un"us is be(o% $&e 0ip&oi" pro'ess

-!r$&o(ome%/s Ru(e

7.: H!!se/s Ru(e "e$ermines $&e (en,$& o# $&e #e$us in 'en$ime$ers.7.:.9 Durin, $&e #irs$ &!(# o# pre,n!n')4 s u!re $&e number o# $&e mon$& 2E.,.4 #irs$ (un!r

mon$&6 9 0 9 @ 9 'm.17.:.: Durin, $&e se'on" &!(# o# pre,n!n')4 mu($ip() $&e mon$& b) ; 2E.,.4 = $& (un!r mon$&6 = 0

; @ 7< 'm17.7 o&nson/ss Ru(e es$im!$es $&e %ei,&$ o# $&e #e$us in ,r!ms. 5ormu(!6 #un"i' &ei,&$ in 'm. n 0

* * is ! 'ons$!n$4 i$ is !(%!)s 9;;n is @ 9: 2i# #e$us is en,!,e"1

@ 99 2i# #e$us is no$ )e$ en,!,e"18. He!($& Te!'&in,s

8.9 Nu$ri$ion mos$ impor$!n$ !spe'$ 2T!b(e B !n" 18.9.9 omen %&o nee" spe'i!( !$$en$ion

Pre,n!n$ $een!,ersE0$remes in %ei,&in, s'!(e (o% prepre,n!n$ %ei,&$ !n" $&e obeseLo% in'ome %omenSu''essive pre,n!n'iesVe,e$!ri!ns !($&ou,& %i$& &i,& vi$!min in$!*e4 !re (o% in pro$eins !n" miner!(s

be'!use $&ere !re m!n) essen$i!( !mino !'i"s $&!$ '!n be #oun" on() in !nim!(sour'es

8.9.: Nu$ri$ion!( !ssessmen$ is b!se" on $!*in, ! "ie$ &is$or) #irs$5oo" pre#eren'es?e!$in, &!bi$s

Cu($ur!(?re(i,ious in#(uen'esE"u'!$ion!(?o''up!$ion!( (eve(

8.9.7 Compu$!$ion o# '!(ori' e uiv!(en$sC!rbo&)"r!$es 0 8Pro$eins 0 85!$s 0

8.9.8 5oo" sour'esPro$ein3ri'& #oo"s me!$4 #is&4 e,,s4 mi(*4 pou($r)4 '&eese4 be!ns4 mon,oVi$!min A e,,s4 '!rro$s4 s u!s&4 !(( ,reen !n" (e!#) ve,e$!b(esVi$!min D #is&4 (iver4 e,,s4 mi(*4 2C!u$ion6 e0'ess Vi$. D "urin, pre,n!n') '!n (e!"$o #e$!( '!r"i!' prob(ems1Vi$!min E ,reen (e!#) ve,e$!b(es4 #is&Vi$!min C $om!$oes4 ,u!v!4 p!p!)!5o(i' !'i" espe'i!(() nee"e" $o preven$ me,!(ob(!s$i' !nemi!4 !brup$ion p(!'en$!!n" prem!$uri$) be'!use4 $o,e$&er %i$& iron4 #o(i' !'i" is nee"e" #or &emo,(obin#orm!$ion. E.,.4 !sp!r!,usVi$!min - #oo" ri'& in pro$einC!('ium?p&osp&orus mi(*4 '&eeseIron

Espe'i!(() impor$!n$ "urin, $&e (!s$ $rimes$er %&en $&e pre,n!n$ %om!n is ,oin,$o $r!ns#er &er iron s$ores #rom &erse(# $o &er #e$us so $&!$ $&e b!b) &!s enou,&iron s$ores "urin, $&e #irs$ $&ree mon$&s o# (i#e %&en !(( &e $!*es is mi(* 2%&i'& is"e#i'ien$ in iron1.Iron &!s ver) (o% !bsorpo$ion r!$e+ on() 9< o# iron in$!*e '!n be !bsorbe" b)$&e bo"). T&us4 #or op$imum !bsorpo$ion4 ,ive Vi$!min C.Iron s&ou(" be ,iven !#$er me!(s be'!use i$ is irri$!$in, $o $&e ,!s$ri' mu'os!.5oo"s ri'& in iron6 (iver !n" o$&er in$ern!( or,!ns4 '!mo$e $ops4 *!n,*on,4 e,,)o(*4 !mp(!)!4 !m(un,,!).

8.9.; M!(nu$ri$ion "urin, pre,n!n') '!n resu($ in prem!$uri$)+ pree'(!mpsi!4 !bsorp$ion4 (o%

bir$& %ei,&$ b!bies4 'on,eni$!( "e#e'$s or even s$i((bir$&s.

Nu$rien$s Non3Pre,n!n$ Pre,n!n$


15/40

omenC!(ories 2*'!(1Pro$eins 2Gm1Vi$!min A 2IU1Vi$!min D 2IU1Vi$!min E 2IU1As'orbi' !'i"?Vi$!min C 2m,15o(i' !'i" 2m,1

Ni!'in 2m,1Ribo#(!vin 2m,1T&i!mine 2m,1Vi$!min -9: 2u,1Vi$!min -= 2m,1C!('ium 2m,1P&osp&orus 2m,1Io"ine 2u,1Iron 2m,1M!,nesium 2m,1

:


16/40

Deep()3en,!,e" presen$in, p!r$

8.= Emp(o)men$ !s (on, !s $&e ob "oes no$ en$!i( &!n"(in, $o0i' subs$!n'es4 or (i#$in, &e!v)ob e'$s4 or e0'essive p&)si'!( or emo$ion!( s$r!in4 $&ere is no 'on$r!in"i'!$ion $o %or*in,. A"vise

pre,n!n$ %omen $o %!(* !bou$ ever) #e% &ours o# &er %or* "!) (on, perio"s o# s$!n"in, or si$$in,$o promo$e 'ir'u(!$ion.

8.B Tr!ve(in, no $r!ve( res$ri'$ions bu$ pos$pone ! $rip "urin, $&e (!s$ $rimes$er. On (on, ri"es4 9;3:< minu$e res$ perio"s ever) :37 &ours $o %!(* !bou$ or emp$) $&e b(!""er is !"vis!b(e.

8. E0er'ises8. .9 C&ie# !im6 To s$ren,$&en $&e mus'(es use" in (!bor !n" "e(iver)8. .: S&ou(" be "one in mo"er!$ion8. .7 S&ou(" be in"ivi"u!(i>e"6 !''or"in, $o !,e4 p&)si'!( 'on"i$ion4 'us$om!r) !moun$ o#

e0er'ises 2s%immin, or $ennis no$ 'on$r!in"i'!$e" un(ess "one #or $&e #irs$ $ime1 !n" $&es$!,e o# pre,n!n')1

8. .8 Re'ommen"e" e0er'isesS u!$$in, 25i,ure ;1 !n" T!i(or Si$$in, 25i,ure =1 $o s$re$'& !n" s$ren,$&en perine!(mus'(es+ in're!se 'ir'u(!$ion in $&e perineum+ m!*e pe(vi' oin$s more p(i!b(e. &ens$!n"in, #rom s u!$$in, posi$ion4 r!ise bu$$o'*s #irs$ be#ore r!isin, $&e &e!" $o

preven$ pos$ur!( &)po$ension.Pe(vi' ro'* m!in$!ins ,oo" pos$ure+ re(ieve" pressure !b"omin!( pressure !n" (o%

b!'*!'&e+ s$ren,$&ens !b"omin!( mus'(es #o((o%in, "e(iver)Mo"i#ie" *nee3'&es$ posi$ion 3 re(ieves pe(vi' pressure !n" 'r!mps in $&e $&i,&s or

bu$$o'*s+ re(ieves "is'om#or$ #rom &emorr&oi"sS&ou("er3'ir'(in, s$ren,$&ens mus'(es o# $&e '&es$

!(*in, s!i" $o be $&e bes$ e0er'isesFe,e( re(ieves 'on,es$ion !n" "is'om#or$ in pe(vi' re,ion+ $ones up pe(vi' #(oormus'(es

8. Prep!re" C&i("bir$&?C&i("bir$& E"u'!$ion prep!rin, $&e pre,n!n$ 'oup(e #or '&i("be!rin,8. .9 Oper!$es b!si'!(() on $&e G!$e Con$ro( T&eor) o# p!in6 p!in is 'on$ro((e" in $&e spin!(

'or". To e!se p!in in one bo") p!r$4 $&e ,!$e $o $&is p!in s&ou(" be '(ose" .8. .: Premises

Dis'om#or$ "urin, (!bor '!n be minimi>e" i# $&e %om!n 'omes in$o (!bor in#orme"!bou$ %&!$ is &!ppenin, !n" prep!re" %i$& bre!$&in, e0er'ises $o use "urin, (!bor Dis'om#or$ "urin, (!bor '!n be minimi>e" i# $&e %om!n/s !b"omen is re(!0e" !n"$&e u$erus is !((o%e" $o rise #ree() !,!ins$ $&e !b"omin!( %!(( "urin, 'on$r!'$ions.

8. .7 M! or !ppro!'&es $o prep!re" '&i("bir$& pre,n!n$ 'oup(es !re $!u,&$ !bou$ !n!$om)4 pre,n!n')4 (!bor !n" "e(iver)4 re(!0!$ion $e'&ni ues4 bre!$&in, e0er'ises4 &),iene4 "ie$'om#or$ me!sures

Gr!n$() Di'* Re!" Me$&o" #e!r (e!"s $o $ension !n" $ension (e!"s $o p!in.

L!m!>e ps)'&opro&)(!'$i' me$&o"+ b!se" on s$imu(us3response 'on"i$ionin,. To be e##e'$ive4 #u(( 'on'en$r!$ion on bre!$&in, e0er'ises "urin, (!bor s&ou(" beobserve" 2Imp(i'!$ion6 Nurse s&ou(" no$ in$errup$ $&e 'oup(e "oin, bre!$&in,e0er'ises.1

8.9< Te$!nus immuni>!$ion ,iven


17/40

-. Cr!ni!( bones 3 $&e #irs$ 7 !re no$ impor$!n$ p!r$ o# $&e #e$us be'!use i$ is $&e6

9. Sp&enoi":. E$&moi"7. Tempor!(8. 5ron$!(;. O''ipi$!(=. p!rie$!(

C. Membr!ne sp!'e su$ure (ines !re impor$!n$ be'!use $&e) !((o% $&e bones $o move !n" over(!p4'&!n,in, $&e s&!pe o# $&e #e$!( &e!" in or"er $o #i$ $&rou,& $&e bir$& '!n!(4 ! pro'ess '!((e"mo("in,.

9. S!,i$$!( su$ure (ine $&e membr!nous in$ersp!'e %&i'& oins $&e p!rie$!( bones:. Coron!( su$ure (ine $&e membr!nous in$ersp!'e %&i'& oins $&e #ron$!( bone !n" $&e p!rie$!(

bones7. L!mb"oi" su$ure (ine $&e membr!nous in$ersp!'e %&i'& oins $&e o''ipu$ !n" $&e p!rie$!(s.

D. 5on$!ne(s membr!n'e 'overe" sp!'es !$ $&e un'$ion o# $&e m!in su$ure (ines9. An$erior #on$!ne( $&e (!r,er4 "i!mon"3s&!pe" #on$!ne( %&i'& '(oses be%een 9:39 mon$&s

in !n in#!n$:. Pos$erior #on$!ne( $&e sm!((er4 $ri!n,u(!r s&!pe" #on$!ne( %&i'& '(oses be$%een :37 mon$&s

in $&e in#!n$

E. Me!suremen$s $&e s&!pe o# $&e #e$!( s*u(( '!uses i$ $o be %i"er in i$s !n$eropos$erior 2AP1"i!me$er $&!n in i$s $r!nsverse "i!me$er

9. Tr!nsverse "i!me$ers o# $&e #e$!( s*u((9.9 -ip!rie$!( @ .:; 'm.9.: -i$empor!( @ 'm.9.7 -im!s$oi" @ B 'm.

:. An$eropos$erior "i!me$ers 25i,ure 991:.9 Subo''ipi$obre,m!$i' 2A1 #rom be(o% $&e o''ipu$ $o $&e !n$erior #on$!ne( @ .; 'm.

2$&e n!rro%es$ AP "i!me$er1:.: O''ipi$o#ron$!( 2-1 #rom $&e o''ipu$ $o $&e mi"3#ron$!( boe @ 9: 'm.:.7 O''ipi$omen$!( 3 #rom $&e o''ipu$ $o $&e '&in @ 97.; 'm 2$&e %i"es$ AP "i!me$er1

A%ter"$"steri"r Diameters ", t e Fetal S/ull

&i'& one o# $&ese "i!me$ers is presen$e" !$ $&e bir$& '!n!( "epen"s on $&e "e,ree o# #(e0ion 2*no%n !s!$$i$u"e1 $&e #e$!( &e!" !ssumes prior $o "e(iver). In #u(( #(e0ion 2ver) ,oo" !$$i$u"e %&en $&e '&in is #(e0e" on

$&e '&es$14 $&e sm!((es subo''ipi$obre,m!$i' "i!me$er 2A1 is $&e one presen$e" !$ $&e bir$& '!n!(. I# in poor#(e0ion4 $&e %i"es$ o''ipi$omen$!( "i!me$er 2D1 %i(( be $&e one presen$e" !n" %i(( ,ive mo$&er !n" $&e b!b)more prob(ems.

II. THEORIES O5 LA-OR ONSETA. U$erine S$re$'& T&eor) !n) &!((o% bo") or,!n %&en s$re$'&e" $o '!p!'i$) %i(( ne'ess!ri() 'on$r!'$

!n" emp$).-. O0)$o'in $&eor) (!bor4 bein, 'onsi"ere" ! s$ress#u( even$4 s$imu(!$es $&e &)pop&)sis $o pro"u'e

o0)$o'in #rom $&e pos$erior pi$ui$!r) ,(!n". O0)$o'in '!uses 'on$r!'$ion o# $&e smoo$& mus'(es o# $&e bo")4 e.,.4 u$erine mus'(es.

C. Pro,es$erone Depriv!$ion $&eor) pro,es$erone4 bein, $&e &ormone "esi,ne" $o promo$e pre,n!n')4 is

be(ieve" $o in&ibi$ u$erine mo$i(i$). T&us4 i# i$s !moun$ "e're!ses4 (!bor p!ins o''ur.D. Pros$!,(!n"in $&eor) ini$i!$ion o# (!bor is s!i" $o resu($ #rom $&e re(e!se o# !r!'&i"oni' !'i" pro"u'e" b) s$eroi" !'$ion on (ipi" pre'ursors. Ar!'&i"oni' !'i" is s!i" $o in're!se pros$!,(!n"in s)n$&esis %&i'&4in $urn4 '!uses u$erine 'on$r!'$ions.

E. T&eor) o# A,in, P(!'en$! be'!use o# $&e "e're!se in b(oo" supp()4 $&e u$erus 'on$r!'$s.

III. PRELIMINARJ?PRODROMAL SIGNS O5 LA-OR A. Li,&$enin, $&e se$$(in, o# $&e #e$!( &e!" in$o $&e pe(vi' brim. In primis4 i$ o''urs : %ee*s be#ore EDC+

in mu($is4 on or be#ore (!bor onse$. Li,&$enin, s&ou(" no$ be 'on#use" %i$& en,!,emen$+ en,!,emen$o''urs %&en $&e presen$in, p!r$ &!" "es'en"e" in$o $&e pe(vi' in(e$. Li,&$enin, resu($s in6

9. in're!se in urin!r) #re uen')

:. re(ie# o# !b"omin!( $i,&$ness !n" "i!p&r!,m!$i' pressure7. s&oo$in, p!ins "o%n $&e (e,s be'!use o# pressure on $&e s'i!$i' nerve8. in're!'e in $&e !moun$ o# v!,in!( "is'&!r,es


18/40

-. In're!se" !'$ivi$) eve( "ue $o in're!se" epinep&rine se're$e" $o prep!re $&e bo") #or $&e 'omin,%or* !&e!". A"vise $&e pre,!n!n$ %om!n no $o use $&is in're!se" ener,) #or "oin, &ouse&o(" '&ores.

C. Loss o# %ei,&$ !bou$ :37 (bs. 9 $o : "!)s be#ore (!bor onse$+ prob!b() "ue $o "e're!se in pro,es$erone pro"u'$ion (e!"in, $o "e're!se in #(ui" re$en$ion.

D. -r!0$on Hi'*s 'on$r!'$ions p!in(ess4 irre,u(!r pr!'$i'e 'on$r!'$ions.E. Ripenin, o# $&e 'ervi0 #rom Goo"e((/s si,n4 $&e 'ervi0 be'omes bu$$er3so#$5. Rup$ure o# $&e membr!nes i$ is impor$!n$ $o remember $&!$ one membr!nes 2-O 1 &!ve rup$ures6

9. L!bor is inevi$!b(e. I$ %i(( o''ur %i$&in :8 &ours.:. T&e in$e,ri$) o# $&e u$erus &!s been "es$ro)e". In#e'$ion4 $&ere#ore4 '!n e!si() se$ in. T&!$ is

%&) on'e membr!nes &!ve rup$ure6:.9 Asep$i' $e'&ni ues s&ou(" be observe" in !(( pro'e"ures:.: Do'$ors "o (ess obs$e$ri' m!nipu(!$ions 2e.,. IE1:.7 Enem! is no (on,er or"ere":.8 Temper!$ure s&ou(" be $!*en re,u(!r() so $&!$ #ever4 ! si,n o# in#e'$ion4 '!n be

"e$e'$e".

7. Umbi(i'!( 'or" 'ompression !n"?or 'or" pro(!pse" '!n o''ur 2espe'i!(() in bree'& presen$!$ion1. Nursin, !'$ion "epen"s on $&e spe'i#i' si$u!$ion6

7.9 A %om!n in (!bor see*in, !"mission $o $&e &ospi$!( !n" s!)in, $&!$ &er -O

&!s rup$ure s&ou(" be pu$ $o be" imme"i!$e()4 !n" $&e #e$!( &e!r$ $ones $!*en'onse uen$()

7.: I# ! %omen in L!bor Room s!)s $&!$ &er membr!nes &!ve rup$ure4 $&e ini$i!(nursin, !'$ion is $o $!*e $&e #e$!( &e!r$ $ones.

7.7 s&e #ee(s ! (oop o# $&e 'or" 'omin, ou$ o# $&e v!,in! 2'or" pro(!pse14 $&e #irs$nursin,

5ALSE LA-OR PAINS TRUE LA-OR PAINS9. Rem!in irre,u(!r

:. Gener!(() 'on#ine" $o $&e !b"omen

7. No in're!se in "ur!$ion4 #re uen')!n" in$ensi$)

8. O#$en "is!ppe!rs i# $&e %omen!mbu(!$es

;. Absen$ 'ervi'!( '&!n,es

7. M!) be s(i,&$() irre,u(!r !$ #irs$ bu$

be'ome re,u(!r !n" pre"i'$!b(e in !m!$$er o# &ours.

8. 5irs$ #e($ in $&e (o%er b!'* !n"s%eep !roun, $o $&e !b"omen in !,ir"(e3(i*e #!s&ion.

;. In're!se in "ur!$ion4 #re uen') !n"in$ensi$).

=. Con$inue no m!$$er %&!$ $&e%om!n+s (eve( o# !'$ivi$) is.

B. A''omp!nie" b) 'ervi'!( e##!'emen$!n" "i(!$!$ion 2$&e mos$ impor$!n$

"i##eren'1

Di,,ere%ces 5et+ee% False a%* True La!"r Pai%s

G. E##!'emen$ s&or$enin, !n" $&innin, o# $&e 'ervi'!( '!n!( !s "is$in'$ #rom $&e u$erus. I$ is e0presse" in per'en$!,e.

H. Di(!$!$ion en(!r,emen$ o# $&e e0$ern!( 'ervi'!( os up $o 9< 'm prim!ri() !s ! resu($ o# u$erine'on$r!'$ions !n" se'on"!ri() !s ! resu($ o# pressure o# $&e presen$in, p!r$ !n" $&e -O .

I. U$erine C&!n,es9. T&e u$erus is ,r!"u!(() "i##eren$i!$e" in$o $%o "is$in'$ por$ions

8.9. Upper u$erine se,men$ be'omes $&i'* !n" !'$ive $o e0pe( ou$ #e$us8.:. Lo%er u$erine se,men$ be'ome $&in3%!((e"4 supp(e !n" p!ssive so $&!$ #e$us '!n be pus&e"

ou$ e!si().

;. P&)sio(o,i'!( re$r!'$ion rin, is #orme" !$ $&e boun"!r) o# $&e upper !n" (o%er u$erine se,men$s. In"i##i'u($ (!bor %&en $&e #e$us is (!r,er $&!n $&e bir$& '!n!(4 $&e roun" (i,!men$s o# $&e u$erus be'ome$ense "urin, "i(!$!$ion !n" e0pu(sion4 '!usin, !n !b"omin!( in"en$!$ion '!((e" -!n"(/s p!$&o(o,i'!(re$r!'$ion rin,4 ! "!n,er si,n o# (!bor si,ni#)in, impen"in, rup$ure o# $&e u$erus i# $&e obs$ru'$ion is no$re(ieve".

=. Nursin, C!re

III.9 Hospi$!( !"mission provi"e priv!') !n" re!ssur!n'e #rom $&e ver) s$!r$III.9.9 Person!( "!$! n!me4 !,e4 !""ress4 'ivi( s$!$usIII.9.: Obs$e$ri'!( "!$! "e$ermine EDC+ obs$e$ri'!( s'ore 2,r!vi"!4 p!r!4 TPAL1+ !moun$ !n"

'&!r!'$er o# s&o%+ !n" %&e$&er or no$ membr!nes &!ve rup$ure".


19/40

III.: Gener!( p&)si'!( e0!min!$ion4 in$ern!( e0!m !n" Leopo("/s m!neuvers !re "one $o "e$ermine6III.:.9 E##!'emen$ !n" "i(!$!$ionIII.:.: S$!$ion re(!$ions&ip o# $&e #e$!( presen$in, p!r$ $o $&e (eve( o# $&e is'&i!( spine 25i,ure 981

S$!$ion < !$ $&e (eve( o# $&e is'&i!( spines+ s)non)mous $o en,!,emen$S$!$ion 39 presen$in, p!r$ !bove $&e (eve( o# $&e is'&i!( spinesS$!$ion 9 presen$in, p!r$ be(o% $&e (eve( o# $&e is'&i!( spinesS$!$ion 7 or 8 s)non)mous $o 'ro%nin, 2en'ir'(in, o# $&e (!r,es$ "i!me$er o# $&e #e$!( &e!"

b) $&e vu(v!r rin,1

III.:.7 Presen$!$ion re(!$ions&ip o# $&e (on, !0is o# $&e mo$&er $o $&e (on, !0is o# $&e #e$us+ !(so*no%n !s (ie. Presen$in, p!r$ i# $&e #e$!( p!r$ %&i'& en$ers $&e pe(vis #irs$ !n" 'overs $&ein$ern!( 'ervi'!( os

I. VERTICALA. Cep&!(i' &e!" is $&e presen$in, p!r$9. Ver$e0 &e!" s&!rp() #(e0e"4 m!*in, $&e p!rie$!( bones $&e presen$in, p!r$s:. I# in poor #(e0ion

:.9 5!'e:.: -ro%:.7 C&in

-. -ree'& bu$$o'*s !re $&e presen$in, p!r$s9. Comp(e$e $&i,&s #(e0e" on $&e !b"omen !n" (e,s !re on $&e $&i,&s:. 5r!n* $&i,&s !re #(e0e" !n" (e,s !re e0$en"e"4 res$in, on $&e !n$erior sur#!'e o# $&e bo")

C. 5oo$(in,9. Sin,(e one (e, un#(e0e" !n" e0$en"e"+ one #oo$ presen$in,:. Doub(e (e,s un#(e0e" !n" e0$en"e"+ #ee$ !re presen$in,

II. HORIKONTAL @ Tr!nsverse (ie @ S&ou("er presen$!$ionIn )erte' $rese%tati"%( 5HS !re usu!(() (o'!$e" in ei$&er $&e (e#$ or ri,&$ (o%er u!"r!n$2LL or RL 1+ in !reec $rese%tati"%( !$ or !bove $&e (eve( o# $&e umbi(i'us4 ei$&er (e#$ orri,&$ u$$er ua*ra%t 2LU or RU 1H!>!r"s o# bree'& "e(iver)

Cor" 'ompressionAbrup$io p(!'en$!Erb Du'&enne p!r!()sis

Hori>on$!( (ie is ver) r!re 29 1 !n" m!)be "ue $o ! re(!>e" !b"omin!( %!(( be'!use o#mu($ip!ri$)4 pe(vi' 'on$r!'$ion or p(!'en$! previ!

7.:.8. Posi$ion re(!$ions&ip o# $&e #e$!( presen$in, p!r$ $o ! spe'i#i' u!"r!n$ in $&e mo$&er/s pe(visT&e pe(vis is "ivi"e" in$o #our u!"r!n$sRi,&$ !n$erior Le#$ !n$erior Ri,&$ pos$erior Le#$ pos$erior o Pos$erior posi$ions resu($ in more b!'*!'&es be'!use o# pressure o# $&e #e$!(

presen$in, p!r$ on $&e m!$ern!( s!'rumPoin$s o# "ire'$ion in $&e #e$us

O''ipu$ in ver$e0 presen$!$ionsC&in 2men$um1 in #!'e presen$!$ionsS!'rum in bree'& presen$!$ionsS'!pu(! 2!'romio1 in &ori>on$!( presen$!$ions

Possib(e #e$!( posi$ionsVer$e0o LOA 4 (e#$ o''ipi$o!n$erior 2mos$ 'ommon !n" #!vor!b(e posi$ion !$ bir$&1o LOP 4 (e#$ o''ipi$opos$erior o LOT 4 (e#$ o''ipi$o$r!nsverseo ROA 4 ri,&$ o''ipi$o!n$erior o ROP 4 ri,&$ o''ipi$opos$erior o ROT 4 ri,&$ o''ipi$o$r!nsverse

-ree'&o LSA 4 (e#$ s!'ro!n$erior o LSP 4 (e#$ s!'ropos$erior o LST 4 (e#$ s!'ro$r!nsverse


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o RSA 4 ri,&$ s!'ro!n$erior o RSP 4 ri,&$ s!'ropos$erior o RST 4 ri,&$ s!'ro$r!nsverse5!'eo LMA 4 (e#$ men$o!n$erior o LMP 4 (e#$ men$opos$erior o LMT 4 (e#$ men$o$r!nsverseo

RMA 4 ri,&$ men$o!n$erior o RMP 4 ri,&$ men$opos$erior o RMT 4 ri,&$ men$o$r!nsverseS&ou("er o LADA 4 (e#$ !'romio"orso!n$erior o LADP 4 (e#$ !'romio"orsopos$erior o RADA 4 ri,&$ !'romio"orso!n$erior o RADP 4 ri,&$ !'romio"orsopos$erior

7.7 Moni$orin, !n" ev!(u!$in, impor$!n$ !spe'$s7.7.9 U$erine 'on$r!'$ions ,i%0ers s "ul* !e s$rea* li0 tl& ")er t e ,u%*us.

25i,ure 9;1Durati"% 4 #rom $&e be,innin, o# one 'on$r!'$ion $o $&e en" o# $&e s!me 'on$r!'$ion 2A $o -1I%ter)al 4 #rom $&e en" o# one 'on$r!'$ion $o $&e be,innin, o# $&e ne0$ 'on$r!'$ion 2- $o C1

In$erv!( e!r() in (!bor 8< 8; minu$esIn$erv!( (!$e in (!bor : 7 minu$es

Fre ue%c& 4 #rom $&e be,innin, o# one 'on$r!'$ion $o $&e be,innin, o# $&e ne0$ 'on$r!'$ion2A $o C1. Observe 7 8 'on$r!'$ions $o &!ve ! ,oo" pi'$ure o# $&e #re uen') o# 'on$r!'$ionsI%te%sit& 4 $&e s$ren,$& o# 'on$r!'$ion+ m!)be mi("4 mo"er!$e or s$ron,. In$ensi$) isme!sure" b) $&e 'onsis$en') o# $&e #un"us !$ $&e !'me o# $&e 'on$r!'$ion. &en es$im!$in,in$ensi$)4 '&e'* #un"us !$ $&e en" o# 'on$r!'$ion $o "e$ermine %&e$&er i$ re(!0es.

BBBBBBBBBBB BBBBBBBBBB BBBBBBBBBBB A 5 C D

Fi0ure 6?. As$ects ", C"%tracti"%

7.7.: -(oo" Pressure s&ou(" no$ be $!*en "urin, ! 'on$r!'$ion !s i$ $en"s $o i%crease. -e'!use no b(oo" supp() ,oes $o $&e p(!'en$! "urin, ! 'on$r!'$ion4 !(( o# $&e b(oo" is in $&e perip&er) $&!$ is%&) $&ere is in're!se" -P "urin, u$erine 'on$r!'$ions.

-P re!"in,s s&ou(" be $!*en !$ (e!s$ ever) &!(# &our "urin, !'$ive (!bor &en ! %om!n in (!bor 'omp(!ins o# ! &e!"!'&e4 $&e #irs$ nursin, !'$ion is $o ta/e 5P. I# i$

is norm!(4 i$ is on() s$ress &e!"!'&e+ i# $&e -P is in're!se"4 re#er imme"i!$e() $o $&e "o'$or 2i$

'ou(" be ! si,n o# $o0emi!17.7.7 5e$!( &e!r$ r!$e 25HR1 s&ou(" no$ be mis$!*en #or u$erine sou##( 2s)n'&roni>es %i$& m!$ern!( pu(se r!$e1

Norm!(() 6-= t" 6 = $er mi%uteS&ou(" no$ be $!*en "urin, ! u$erine 'on$r!'$ion be'!use i$ $en"s $o *ecrease. Compressiono# $&e #e$!( &e!" %&en $&e u$erus 'on$r!'$s s$imu(!$es $&e v!,!( re#(e0 %&i'&4 in $urn4 '!uses

br!")'!r"i!S&ou(" be $!*en ever) &our "urin, $&e (!$en$ p&!se o# (!bor4 ever) &!(# &our "urin, $&e !'$ive

p&!se !n" ever) 9; minu$es "urin, $&e $r!nsi$ion perio"5or !n) !bnorm!(i$) in 5HR4 $&e ini$i!( nursin, !'$ion is t" c a%0e t e m"t er>s $"siti"%Si0%s ", ,etal *istress

-r!")'!r"i! 25HR (ess $&!n 9


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A #u(( bo%e( &in"ers $&e pro,ress o# (!bor e##e'$iveness o# enem! in (!bor '!n be"e$ermine" b) e)aluati%0 c a%0e i% uteri%e t"%e a%* t e am"u%t ", s "+E0pu(sion o# #e'es "urin, se'on" s$!,e o# (!bor pre"isposes mo$&er !n" b!b) $o in#e'$ion5u(( bo%e( pre"isposes $o pos$p!r$um "is'om#or$

Pro'e"ure o# enem! !"minis$r!$ionEnem! so(u$ion m!) ei$&er be so!p su"s or 5(ee$ enem! 2'on$r!in"i'!$e" in p!$ien$s %i$&$o0emi! be'!use o# i$s so"ium 'on$en$1

Op$imum $emper!$ure o# $&e so(u$ion 9


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7.B.7 T)pes o# Anes$&esi!2purp(is& "is'o(or!$ion o# $&e s*in "ue $o b(oo" in sub'u$!neous $issues1 !re! or &em!$om! in $&e

perineum m!) be !n !#$erm!$&. No spe'i!( $re!$men$ is nee"e"6 i'e b!, !pp(ie" $o $&e !re! on $&e#irs$ "!) m!) re"u'e $&e s%e((in,

7.B.8 F"rce$s !re ,ener!(() nee"e" in "e(iver) o# p!$ien$ un"er !nes$&esi! be'!use o# (oss o#'oor"in!$ion in se'on" s$!,e pus&in,.

7.B.; Pos$spin!( &e!"!'&es m!)be "ue $o (e!*!,e o# !nes$&e$i' in$o $&e CS5 or in e'$ion o# !ir !$ $imeo# nee"(e inser$ion. M!n!,emen$6 Flat "% !e* ,"r 6- "urs a%* i%crease ,lui* i%ta/e

7.B.= Common si"e e##e'$sH&$"te%si"% 4 be'!use X)(o'!ine is v!so"i(!$or. Ma%a0eme%t 4 $urn $o si"e+ promp$ e(ev!$iono# (e,s+ !"minis$r!$ion o# v!sopressor !n" o0),en4 !s or"ere".5e$!( br!")'!r"i!De're!se" m!$ern!( respir!$ions

7. A sure si,n $&!$ $&e b!b) is !bou$ $o be born is $&e !ul0i%0 ", t e $eri%eum. In ,ener!(4 primi,r!vi"!s !re$r!nspor$e" #rom $&e L!bor Room $o $&e De(iver) Room %&en $&e 'ervi0 is #u(() "i(!$e" or %&en $&ere is

bu(,in, o# $&e perineum. Mu$ip!r!s4 on $&e o$&er &!n"4 !re $r!nspor$e" %&en 'ervi'!( "i(!$!$on iis B 'm.

- Tr!nsi$ion Perio" %&en $&e moo" o# $&e %om!n su""en() '&!n,es !n" $&e n!$ure o# 'on$r!'$ions in$ensi#)9. C&!r!'$eris$i's

9.9 I# membr!nes !re s$i(( in$!'$4 $&is perio" is m!r*e" b) ! su""en ,us& o# !mnio$i' #(ui" !s #e$us is pus&e" in$o $&e bir$& '!n!(. I# spon$!neous rup$ure "oes no$ o''ur4 !mnio$om) 2snippin, o# -O%i$& ! s$eri(e poin$e" ins$rumen$4 e.,.4 Fe(() or A((is #or'eps or !mnio&oo* $o !((o% !mnio$i' #(ui" $o"r!in1 is "one $o preven$ #e$us #rom !spir!$in, $&e !mnio$i' #(ui" !s i$ m!*es i$s "i##eren$ #e$!(

posi$ion '&!n,es. Amnio$om)4 &o%ever4 '!n no$ be "one i# s$!$ion is s$i(( minus 4 !s $&is '!n (e!" $o'or" 'ompression

9.: S&o% be'omes more prominen$.9.7 T&ere is !n u%c"%tr"lla!le ur0e t" $us +it c"%tracti"%s( ! si,n o# impen"in, se'on" s$!,e o#

(!bor. Pro#use perspir!$ion !n" "is$en$ion o# ne'* veins !re seen.9.8 N!use! !n" vomi$in, is ! re#(e0 re!'$ion "ue $o "e're!se" ,!s$ri' mo$i(i$) !n" !bsorp$ion.9.; In primis4 b!b) is "e(ivere" %i$& -= c"%tracti"%s := mi%utes # in mu($is4 !#$er6= c"%tracti"%s -=

mi%utes .:. Nursin, !'$ions !re prim!ri() c"m,"rt measures

:.9 S!'r!( pressure 2!pp()in, pressure %i$& $&e &ee( o# $&e &!n" on $&e s!'rum1 re(ieves "is'om#or$ #rom'on$r!'$ions

:.: Proper be!rin, "o%n $e'&ni ues6 pus& %i$& 'on$r!'$ions:.7 Con$ro((e" '&es$ 2'os$!(1 bre!$&in, "urin, 'on$r!'$ions:.8 Emo$ion!( suppor$

C Se'on" S$!,e 2 Sta0e ", e'$ulsi"% be,ins %i$& 'omp(e$e "i(!$!$ion o# $&e 'ervi0 !n" e%*s +it t e*eli)er& ", t e !a!&.9. Po%ers?#or'es6 invo(un$!r) u$erine 'on$r!'$ions !n" 'on$r!'$ions o# $&e "i!p&r!,m!$i' !n" !b"omin!(

mus'(es:. Me'&!nisms o# (!bor?5e$!( Posi$ion C&!n,es 2D 5IRE ERE1

7.9 Des'en$ m!) be pre'e"e" b) en,!,emen$.7.: F (e0ion3 !s "es'en$ o''urs4 pressure #rom $&e pe(vi' #(oor '!uses $&e '&in $o ben" #or%!r" on$o $&e

'&es$.7.7 In$ern!( R o$!$ion #rom AP $o $r!nsverse4 $&e AP $o AP7.8 E 0$ension !s &e!" 'omes ou$4 $&e b!'* o# $&e ne'* s$ops bene!$& $&e pubi' !r'&. T&e &e!" e0$en"s

!n" $&e #ore&e!"4 nose4 mou$& !n" '&in upper.7.; E 0$ern!( R o$!$ion 2!(so '!((e" res$i$u$ion1 !n$erior s&ou("er ro$!$es e0$ern!(() $o $&e AP posi$ion.7.= E 0pu(sion "e(iver) o# $&e res$ o# $&e bo").

7. Nursin, C!re7.9 &en posi$ionin, (e,s "% lit "t"m&( $ut t em u$ at t e same time $o preven$ in ur) $o $&e u$erine

(i,!men$s7.: As soon !s $&e #e$!( &e!" 'ro%ns4 ins$ru'$ mo$&er no$ $o pus&4 bu$ $o $a%t r!pi" !n" s&!((o%

bre!$&in, $o preven$ r!pi" e0pu(sion o# $&e b!b)1. I# p!n$in, is "eep !n" r!pi"4 calle*&$er)e%tilati"%( $&e p!$ien$ %i(( e0perien'e (i,&$&e!"e"ness !n" $in,(in, sens!$ion o# $&e #in,ers

(e!"in, $o '!rpope"!( sp!sms be'!use o# respir!$or) !(*!(osis. M!n!,emen$6 (e$ $&e p!$ien$ !reat ei%t" a !r"+% $a$er !a0 $o re'over (os$ '!rbon "io0i"e+ ! 'uppe" &!n" over $&e mou$& !n" nose %i((serve $&e s!me purpose.

7.7 Assis$ in episio$om) 2in'ision m!"e in $&e perineum prim!ri() t" $re)e%t lacerati"%s .7.7.9 O$&er purposes

Preven$ pro(on,e" severe s$re$'&in, o# mus'(es suppor$in, $&e b(!""er or re'$umRe"u'e "ur!$ion o# se'on" s$!,e %&en $&ere is &)per$ension or #e$!( "is$ressEn(!r,e ou$(e$4 !s in bree'& presen$!$ion or #or'eps "e(iver)

7.7.: T)pes o# episio$om)


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Me"i!n #rom mi""(e por$ion o# $&e (o%er v!,in!( bor"er "ire'$e" $o%!r"s $&e !nusMe"io(!$er!( be,un in $&e mi"(ine bu$ "ire'$e" (!$er!(() !%!) #rom $&e !nus. O#$en "one

be'!use i$ preven$s 8 $& "e,ree (!'er!$ion s&ou(" i$ o''ur "espi$e episio$om).7.7.7 Natural A%est esia is use" in episio$om)4 i.e.4 no !nes$&e$i' is in e'$e" be'!use pressure o#

#e$!( presen$in, p!r$ !,!ins$ $&e perineum is so in$ense $&!$ nerve en"in,s #or p!in !remomen$!ri() "e!"ene"

7.8 App() $&e M"*i,ie* Rit0e%>s Ma%eu)er7.8.9 Cover $&e !nus %i$& s$eri(e $o%e( !n" e0er$ up%!r" !n" #or%!r" pressure on $&e #e$!( '&in4

%&i(e e0er$in, ,en$(e pressure %i$& $%o #in,ers on $&e &e!" $o 'on$ro( emer,in, &e!". T&is %i((no$ on() suppor$ $&e perineum4 $&us preven$in, (!'er!$ions4 bu$ %i(( !(so #!vor #(e0ion so $&!$ $&esm!((es$ subo''ipi$obre,m!$i' "i!me$er o# $&e #e$!( &e!" is presen$e".

7.8.: E!se $&e &e!" ou$ !n" imme"i!$e() %ipe $&e nose !n" mou$& o# se're$ions $o es$!b(is& ! p!$en$!ir%!) 2remember6 $&e #irs$ !n" mos$ impor$!n$ prin'ip(e in $&e '!re o# $&e ne%born is esta!lisa%* mai%tai% a $ate%t air+a& . T&e &e!" s&ou(" be "e(ivere" in be$%een 'on$r!'$ions.

7.8.7 Inser$ : #in,ers in$o $&e v!,in! so !s $o #ee( #or $&e presen'e o# ! 'or" (oope" !roun" $&e ne'*2nui'&!( 'or"1. I# so4 bu$ (oose4 s(ip i$ "o%n $&e s&ou("ers or up over $&e &e!"+ bu$ i# $i,&$4 '(!mp$&e 'or" $%i'e4 !n in'& !p!r$4 !n" $&en 'u$ i$ in be$%een.

7.8.8 As $&e &e!" ro$!$es4 "e(iver $&e !n$erior s&ou("er b) e0er$in, ! ,en$(e7.; Imme"i!$e() !#$er "e(iver)4 $&e ne%born s&ou(" be &e(" be(o% $&e (eve( o# $&e mo$&er/s vu(v! #or !

#e% minu$es $o en'our!,e #(o% o# b(oo" #rom $&e p(!'en$! $o $&e b!b)7.= T&e in#!n$ is &e(" %i$& is &e!" in ! "epen"en$ posi$ion 2&e!" (o%er $&!$n $&e res$ o# $&e bo")1 $o

!((o% #or "r!in!,e o# se're$ions. Remem!er7 never s$imu(!$e ! b!b) $o 'r) un(ess )ou &!ve "r!ine"&im ou$ o# &is se're$ions.

7.B r!p $&e b!b) in ! s$eri(e $o%e( $o *eep &im %!rm. Remember6 C illi%0 i%crease t e !"*&>s %ee*,"r "'&0e%

7. Pu$ $&e b!b) on $&e mo$&er/s !b"omen. T e +ei0 t ", t e !a!& +ill el$ c"%tract t e uterus.7. Cu$$in, $&e 'or" is pos$pone" un$i( $&e pu(s!$ions &!ve s$oppe" be'!use i$ is be(ieve $&!$ ;< 91+ < o# p(!'en$!s

sep!r!$e in $&is m!nner.:.: Dun'!n i# p(!'en$! sep!r!$es #irs$ !$ i$s e",es4 i$ s(i"es !(on, $&e u$erine sur#!'e !n" presen$s %i$&

$&e m!$ern!( sur#!'e %&i'& is r!%4 re"4 bee#)4 !n" irre,u(!r !n" "ir$) 2 Dir$) #or Dun'!n1. On()!bou$ :< o# p(!'en$!s sep!r!$e $&is %!).

7. Nursin, C!re7.9 Do no$ &urr) $&e e0pu(sion o# $&e p(!'en$! b) #or'e#u(() pu((in, ou$ $&e 'or" or "oin, vi,orous

#un"!( pus& !s $&is '!n '!use u$erine inversion. us$ %!$'& #or $&e si,ns o# p(!'en$!( sep!r!$ion.7.: Tr!'$ $&e 'or" s(o%()4 %in"in, i$ !roun" $&e '(!mp un$i( $&e p(!'en$! spon$!neous() 'omes ou$4

s(o%() ro$!$in, i$ so $&!$ no membr!nes !re (e#$ insi"e $&e u$erus4 ! me$&o" '!((e" 5ra%*t 4A%*re+s ma%eu)er.

7.7 T!*e no$e o# $&e $ime o# p(!'en$!( "e(iver). I$ s&ou(" be "e(ivere" +it i% -= mi%utes a,ter t e

*eli)er& ", t e !a!&. O$&er%ise4 re#er imme"i!$e() $o $&e "o'$or !s $&is '!n '!use severe b(ee"in, in$&e mo$&er.

7.8 Inspe'$ #or 'omp(e$eness o# 'o$)(e"ons+ !n) p(!'en$!( #r!,men$ re$!ine" '!n !(so '!use severe b(ee"in, !n" possib(e "e!$&.

7.; P!(p!$e $&e u$erus $o "e$ermine "e,ree o# 'on$r!'$ion. I# re(!0e" bo,,) or non 3 'on$r!'$e"4 #irs$nursin, !'$ion is $o massa0e ,en$() !n" proper(). An i'e '!p over $&e !b"omen %i(( !(so &e(p'on$r!'$ $&e u$erus sin'e 'o(" '!uses v!so'ons$ri'$ion.

7.= In e'$ o0)$o'in 2 Met er0i% @


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Se'on" "e,ree invo(ves no$ on() $&e mus'(es4 v!,in!( mu'ous membr!nes !n" s*in4 bu$!(so $&e mus'(es.T&ir" "e,ree invo(ves no$ on() $&e v!,in!( mu'ous membr!nes !n" s*in4 bu$ !(so $&ee0$ern!( sp&in'$er o# $&e re'$um5our$& "e,ree invo(ves no$ on() $&e e0$ern!( sp&in'$er o# $&e re'$um4 $&e mus'(es4 v!,in!(mu'ous membr!nes !n" s*in4 bu$ !(so $&e m mu'ous membr!nes o# $&e re'$um.

7.B.: Assis$ $&e "o'$or in "oin, episiorr&!p&) rep!ir o# episio$om) or (!'er!$ions1. In v!,in!(episiorr&!p&)4 p!'*in, is "one $o m!in$!in pressure on $&e su$ure (ine4 $&us preven$ #ur$&er

b(ee"in,. No$e6 V!,in!( p!'*s &!ve $o be rem")e* a,ter -: 4 : "urs

7.H M!*e mo$&er 'om#or$!b(e b) perine!( '!re !n" !pp()in, '(e!n s!ni$!r) n!p*in snu,() $o preven$ i$smovin, #or%!r" #rom $&e !nus $o $&e v!,in!( openin,. Soi(e" n!p*ins s&ou(" be remove" #rom #ron$$o b!'*.

7.I Posi$ion $&e ne%() "e(ivere" mo$&er #(!$ on be" %i$&ou$ pi((o%s $o preven$ "i>>iness "ue $o"e're!se in in$r!!b"omin!( pressure.

7. T&e ne%() "e(ivere" mo$&er m!) su""en() 'omp(!in o# '&i((s "ue $o "e're!se" b(oo" pressure4#!$i ue or 'o(" $emper!$ure in $&e "e(iver) room. M!n!,emen$6 $r")i*e a**iti"%al !la%/ets t"/ee$ er +arm.

7.FM!) ,ive ini$i!( nouris&men$+ e.,.4 mi(*4 'o##ee or $e!7.L A((o% p!$ien$ $o s(eep in or"er $o re,!in (os$ o# ener,).

E 5our$& S$!,e #irs$ 9 : &ours !#$er "e(iver) %&i'& is s!i" $o be $&e mos$ 'ri$i'!( s$!,e #or $&e mo$&er be'!use o# uns$!b(e vi$!( si,ns.9. Assessmen$

9.9 5un"us s&ou(" be '&e'*e" ever) 9; minu$es #or 9 &our $&en ever) 7< minu$es #or $&e ne0$ 8&ours. 5un"us s&ou(" be ,irm( i% t e mi*li%e( !n" "urin, $&e #irs$ 9: &ours pos$p!r$um4 is ! littlea!")e t e um!ilicus. 5irs$ nursin, !'$ion #or ! non3 'on$r!'$e" u$erus6 massa0e.

9.: L"c ia 4 s&u(" be mo"er!$e in !moun$. Imme"i!$e() !#$er "e(iver)4 ! perine!( p!" '!n be'omp(e$e() s!$ur!$e" !#$er 7< minu$es. I# s!$ur!$e" in 9; minu$es or e!r(ier4 m!) me!n&emorr&!,e.

9.7 5la**er 4 ! #u(( b(!""er is evi"en'e" b) ! #un"us %&i'& is $o $&e ri,&$ o# $&e mi"(ine !n" "!r* re" b(ee"in, %i$& some '(o$s. i(( preven$ !"e u!$e u$erine 'on$r!'$ion.

9.8 Peri%eum 4 is norm!(() $en"er4 "is'o(ore" !n" e"em!$ous. I$ s&ou(" be '(e!n4 %i$& in$!'$ su$ures.9.; -(oo" pressure !n" pu(se r!$e m!) be s(i,&$() in're!se" #rom e0'i$emen$ !n" e##or$ o# "e(iver)4

bu$ norm!(i>e %i$&in one &our.:. L!'$!$ion suppressin, !,en$s es$ro,en !n"ro,en prep!r!$ions ,iven %i$&in $&e #irs$ &ours

pos$p!r$um $o preven$ bre!s$ mi(* pro"u'$ion in mo$&ers %&o %i(( no$ 2or '!nno$1 bre!s$#ee". E.,.4"ie$&)(s$i(bes$ro(4 TACE4 P!r(o"e( !n" "e(!"umone. T&ese "ru,s $en" $o in're!se u$erine b(ee"in, !n"re$!r" mens$ru!( re$urn

7. R""mi%0 4 i% c"%ce$t 4 mo$&er !n" b!b) !re $o,e$&er %&i(e in $&e &ospi$!(. T&e 'on'ep$ o# ! #!mi()4$&ere#ore4 is #e($ #rom $&e ver) be,innin, be'!use p!ren$s &!ve $&e b!b) %i$& $&em4 $&us provi"in,oppor$uni$ies #or "eve(opin, ! posi$ive re(!$ions&ip be$%een p!ren$s !n" ne%born 2m!$ern!( in#!n$

bon"in,1. E)e $o e)e 'on$!'$ is imme"i!$e() es$!b(is&e"4 re(e!sin, $&e m!$ern!( '!re$!*in, responses.


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PUERPERUM

I. DE5INITION O5 TERMSA. Puer$erium P"st$artum 4 re#ers $o $&e si0 %ee* perio" !#$er "e(iver) o# $&e b!b)-. I%)"luti"% 1 re$urn o# $&e repro"u'$ive or,!ns $o $&eir prepre,n!n$ s$!$e

II. PRINCIPLS O5 POSTPARTUM CAREA. Promo$in, !n" re$urn $o norm!( 2invo(u$ion1 o# "i##eren$ p!r$s o# $&e bo").

9. Vascular c a%0es

9.9 T&e 7< 3 ;< in're!se in $o$!( '!r"i!' vo(ume "urin, pre,n!n') %i(( be re!bsorbe" in$o $&e,ener!( 'ir'u(!$ion %i$& ; 9< minu$es !#$er p(!'en$!( "e(iver). Imp(i'!$ion6 $&e #irs$ ; 9 b!$&s $%i'e ! "!) v!so"i(!$!$ion in're!ses b(oo" supp()!n"4 $&ere#ore4 promo$es &e!(in,

:.;.7 App(i'!$ion o# $opi'!( !n!(,esi's or !"minis$r!$ion o# mi(" or!( !n!(,esi's !s or"ere":.= Se0u!( !'$ivi$) m!)be resume" b) $&e 7 r" or 8 $& %ee* pos$p!r$um i# b(ee"in, &!s s$oppe" !n"

episiorr&!pp) &!s &e!(e". De're!se" p&)sio(o,i' re!'$ions $o se0u!( s$imu(!$ion !re e0pe'$e" #or$&e #irs$ 7 mon$&s pos$p!r$um be'!use o# &ormon!( '&!n,es !n" emo$ion!( #!'$ors.

:.B Mens$ru!$ion i# no$ bre!s$#ee"in,4 re$urn o# mens$ru!( #(o% is e0pe'$e" %i$&in %ee*s !#$er"e(iver). I# bre!s$#ee"in,4 mens$ru!( re$urn is e0pe'$e" in 738 mon$&s+ in some %omen4 nomens$ru!$ion o''urs "urin, $&e en$ire (!'$!$ion perio". 2 im$"rta%t7 !menorr&e! "urin, (!'$!$ionis no ,u!r!n$ee $&!$ $&e %om!n %i(( no$ be'ome pre,n!n$. S&e m!) be ovu(!$in, $&e !bsen'e o#mens$ru!$ion m!) &er bo")/s %!) o# 'onservin, #(ui"s #or (!'$!$ion. Imp(i'!$ion6 s&e s&ou(" be

pro$e'$e" !,!ins$ ! subse uen$ pre,n!n') b) observin, ! me$&o" o# 'on$r!'ep$ion4 e0'ep$ $&e pi((1.

:. Pos$p!r$um '&e'* up s&ou(" be "one !#$er $&e = $& %ee* pos$p!r$um $o !ssess invo(u$ion.7. Uri%ar& C a%0es

7.9 T&ere is m!r*e" "iuresis %i$&in 9: &ours pos$p!r$um $o e(imin!$e e0'ess $issue #(ui"!''umu(!$ion "urin, pre,n!n').

7.: Some ne%() "e(ivere" mo$&ers m!) 'omp(!in o# #re uen$ urin!$in in sm!(( !moun$s+ e0p(!in $&!$$&is is "ue $o uri%ar& rete%ti"% +it ")er,l"+. O$&er4 on $&e o$&er &!n"4 m!) &!ve "i##i'u($)

voi"in, be'!use o# "e're!se" !b"omin!( pressure or $r!um! $o $&e $ri,one o# $&e b(!""er.V"i*i%0 ma& !e i%itiate* !&7

7.:.9 Pourin, %!rm !n" 'o(" %!$er !($ern!$e() over $&e vu(v!7.:.: En'our!,in, $&e '(ien$ $o ,o $&e 'om#or$ room7.:.7 Le$ &er (is$en $o $&e soun" o# runnin, %!$er 7.:.8 I# $&ese me!sures #!i(4 '!$&e$eri>!$ion4 "one ,en$() !n" !sep$i'!(()4 is $&e (!s$ resor$ on

"o'$or/s or"er. 2i# $&ere is resis$!n'e $o $&e '!$&e$er %&en i$ re!'&es $&e in$ern!(sp&in'$er4 !s* p!$ien$ $o bre!$&e $&rou,& $&e mou$& %&i(e ro$!$in, $&e '!$&e$er be#oremovin, i$ in%!r" !,!in1.

8. Gastr"i%testi%al c a%0es 4 "e(!)e" bo%e( ev!'u!$ion pos$p!r$!(() m!) be "ue $o68.9 De're!se" mus'(e $one

8.: L!'* o# #oo" enem! "urin, (!bor 8.7 De&)"r!$ion8.8 5e!r o# p!in #rom perine!( $en"erness "ue $o episo$om)4 (!'er!$ions or &emorroi"s

;. Vital Si0%s;.9 Temper!$ure m!) in're!se be'!use o# $&e "e&)"r!$in, e##e'$s o# (!bor. Imp(i'!$ion6 !n) in're!se

in bo") $emper!$ure "urin, $&e #irs$ :8 &ours pos$p!r$um is no$ ne'ess!ri() ! si,n o# pos$p!r$umin#e'$ion.

;.: -r!")'!r"i! 2&e!r$ r!$e o# ;< B< per minu$e1 is 'ommon #or = "!)s-. Provi"e emo$ion!( suppor$ $&e ps)'&o(o,i'!( p&!ses "urin, $&e pos$p!r$um perio" !re6

9. Ta/i%0 4 i% $ ase 4 #irs$ 9 : "!)s pos$p!r$um %&en mo$&er is p!ssive !n" re(ies on o$&ers $o '!re#or &er !n" &er ne%born. S&e *eeps on verb!(i>in, &er #ee(in,s re,!r"in, $&e re'en$ "e(iver) #or &er

$o be !b(e o$ in$e,r!$e $&e e0perien'e in$o &erse(#.:. T!*in, &o(" p&!se be,ins $o ini$i!$e !'$ion !n" m!*e "e'isions. P"st$artum !lues !n

over%&e(min, #ee(in, o# s!"ness $&!$ '!nno$ be !''oun$e" #or1 m!) be observe". Cou(" be "ue $o&ormon!( '&!n,es4 #!$i,ue or #ee(in, o# in!"e u!') in $!*in, '!re o# ! ne% b!b). M!n!,emen$6e0p(!in $&!$ i$ is norm!(+ 'r)in, is $&er!peu$i'4 in #!'$.

C. Preven$ pos$p!r$um 'omp(i'!$ions9. Hem"rr a0e 2see p!,e = 3= 1-. I%,ecti"%

D. Es$!b(is& su''ess#u( (!'$!$ion 2T!b(e 9:1e" !n" ,ener!( resis$!n'e is (o%ere".

9.: E0o,enous sour'es p!$&o,ens in$ro"u'e" #rom e0$ern!( sour'es. 2Mos$ 'ommon is!n!erobi' s$rep$o'o''i1. Common e0o,enous sour'es6

9.:.9 Hospi$!( personne(9.:.: E0'essive obs$e$ri' m!nipu(!$ions9.:.7 -re!*s in !sep$i' $e'&ni ues #!u($) &!n"%!s&in,4 uns$eri(e e uipmen$s !n"

supp(ies9.:.8 Coi$us in (!$e pre,n!n')9.:.; Prem!$ure rup$ure o# $&e membr!nes

:. Gener!( s)mp$oms6 m!(!ise !nore0i!4 #ever4 '&i((s !n" &e!"!'&e7. Gener!( m!n!,emen$

7.9 Comp(e$e be" res$ 2C-R17.: Proper nu$ri$ion7.7 In're!se" #(ui" in$!*e7.8 An!(,esi's7.; An$ip)re$i's !n" !n$ibio$i's4 !s or"ere"

8. T)pes o# in#e'$ion8.9 I%,ecti"% ", t e $eri%eum

8.9.9 Spe'i#i' s)mp$omsP!in4 &e!$ !n" #ee(in, o# pressure in $&e perineumIn#(!mm!$ion o# $&e su$ure (ine4 %i$& 9 or : s$i$'&es s(ou,&e" o##

i$& or %i$&ou$ e(ev!$e" $emper!$ure8.9.: Spe'i#i' m!n!,emen$

Do'$or removes su$ures $o "r!in !re! !n" resu$uresHo$ si$> b!$& or %!rm 'ompress

8.: E%*"metritis8.:.9 Spe'i#i' s)mp$oms

Ab"omin!( $en"ernessU$erus no$ 'on$r!'$e" !n" p!in#u( $o $ou'&D!r* bro%n4 #ou(3sme((in, (o'&i!

8.:.: Spe'i#i' m!n!,emen$O0)$o'in !"minis$r!$ion5o%(er/s posi$ion $o "r!in ou$ (o'&i! !n" preven$ poo(in, o# in#e'$e""is'&!r,e

8.7 T r"m!"$ le!itis in#e'$ion o# $&e (inin, o# ! b(oo" vesse( %i$& #orm!$ion o# '(o$s+ usu!(()!n e0$ension o# en"ome$ri$is

8.7.9 Spe'i#i' s)mp$omsP!in4 s$i##ness !n" re"ness in $&e !##e'$e" p!r$ o# $&e (e,Le, be,ins $o s%e(( be(o% $&e (esion be'!use venous 'ir'u(!$ion &!s been

b(o'*e"S*in is s$re$'&e" $o ! poin$ o# s&in) %&i$eness4 '!((e" mi(* (e, or p&(e,m!si!!(b! "o(ensPosi$ive Hom!n/s si,n p!in in $&e '!(# %&en $&e #oo$ is "orsi#(e0e"

8.7.: Spe'i#i' m!n!,emen$-e" res$ %i$& !##e'$e" (e, e(ev!$e"An$i'o!,u(!n$s4 e.,.4 Di'um!ro( or Hep!rin4 $o preven$ #ur$&er '(o$ #orm!$ionor e0$ension o# ! $&rombus

o An!(,esi's !re ,iven bu$ never Aspirin be'!use i$ in&ibi$s pro$&rombin #orm!$ion $&ere#ore '!uses &emorr&!,e

8.8 Mastitis in#(!mm!$ion o# bre!s$ $issues8.8.9 P!$&op&)sio(o,) (o'!( in#(!mm!$or) response $o b!'$eri!( inv!sion+ suppur!$ion

m!) o''ur+ or,!nism '!n be re'overe" #rom bre!s$ mi(*.8.8.: E$io(o,) mos$ 'ommon6 S$!p&)(o'o''us !ureus8.8.7 Assessmen$

Si,ns o# in#e'$ion 2m!) o''ur sever!( %ee*s pos$p!r$um1.5ever C&i((sT!'&)'!r"i!


31/40

M!(!iseAb"omin!( p!in

-re!s$Re""ene" !re!sLo'!(i>e"?,ener!(i>e" s%e((in,He!$4 $en"erness4 p!(p!b(e m!ss.

8.8.8 Nursin, '!re ,o!(6 preven$ in#e'$ion. He!($& $e!'&in, in e!r() pos$p!r$umH!n"%!s&in,

-re!s$ '!re!s& %i$& %!rm %!$er on() 2no so!p1

Le$ bre!s$ mi(* "r) on nipp(es $o preven$ "r)in, o# $issue.C(e!n br! 2%i$& no p(!s$i' p!"s or (iners1 $o suppor$ bre!s$s4 re"u'e#ri'$ion4 minimi>e e0posure $o mi'roor,!nisms.Goo" bre!s$#ee"in, $e'&ni ues

II. -LEEDING?HEMORRHAGEA. -(ee"in, in pre,n!n') 2T!b(e 971

I. 5irs$ Trimes$er -(ee"in, A. Abor$ion

9. Spon$!neous 9.9 T&re!$ene" 9.: Imminen$

9.:.9 Comp(e$e9.:.: In'omp(e$e

:. In"u'e"7. Misse"

-. E'$opi' pre,n!n')9. Tub!( mos$ 'ommon:. Cervi'!(7. Ov!ri!n

II. Se'on" Trimes$er -(ee"in, A. H)"!$i"i#orm Mo(e -. In'ompe$en$ Cervi'!( OsIII. T&ir" Trimes$er -(ee"in, A. P(!'en$! Previ! -. Abrup$io P(!'en$!

Ta!le 69. 5lee*i%0 i% Pre0%a%c&

9. A!"rti"% !n) in$errup$ion in pre,n!n') be#ore $&e !,e o# vi!bi(i$)9.9 Spon$!neous

9.9.9 N!$ur!( '!uses-(i,&$e" ovum?,erm p(!sm! "e#e'$ @ mos$ 'ommon '!use. I$ is n!$ure/s %!)o# e(imin!$in, $&e bir$& o# ! 'on,eni$!(() "e#e'$ive b!b)Imp(!n$!$ion or &ormon!( !bnorm!(i$)5o((o%in, $r!um!4 in#e'$ion 2e.,.4 rube((!4 in#(uen>!1 or emo$ion!( prob(ems

9.9.: T)pesT&re!$ene"

S)mp$om6 bri,&$ re" v!,in!( b(ee"in, %&i'& is mo"er!$e in !moun$M!n!,emen$

o Comp(e$e be" res$ #or :838 &ours+ i# b(ee"in, %i(( s$op i$usu!(() s$ops %i$&in $&is $ime

o Coi$us is res$ri'$e" #or : %ee*s !#$er b(ee"in, &!s s$oppe" inor"er $o preven$ #ur$&er b(ee"in, or in#e'$ion

o

En"o'rine?&ormon!( $&er!p)o A"vise p!$ien$ $o s!ve !(( p!"s4 '(o$s !n" e0pe((e" $issues

Imminen$?inevi$!b(eS)mp$om6 -ri,&$ re" v!,in!( b(ee"in, %&i'& is mo"er!$e in !moun$!n" !''omp!nie" b) u$erine 'on$r!'$ions !n" 'ervi'!( "i(!$!$ion.Loss o# $&e pro"u'$s o# 'on'ep$ion is inevi$!b(e.M!n!,emen$ "epen"s on %&e$&er i$ is6

o Comp(e$e !bor$ion !(( pro"u'$s o# 'on'ep$ion !re e0pe((e"+ b(ee"in, is minim!( !n" se(#3(imi$in,. No in$erven$ion is$&ere#ore nee"e".

o In'omp(e$e !bor$ion p!r$ o# $&e 'on'ep$us 2usu!(() $&e#e$us1 is e0pe((e"4 bu$ membr!nes or p(!'en$!( #r!,men$s !rere$!ine". D C is in"i'!$e" !s m!n!,emen$.

9.: In"u'e" !bor$ion is never !((o%e" in $&e P&i(ippines9.:.9 T&er!peu$i' per#orme" b) ! "o'$or in ! 'on$ro((e" &ospi$!( or '(ini' se$$in, #or !

me"i'!( or ! (e,!( re!son. A(so *no%n !s me"i'!(4 p(!nne" or (e,!( !bor$ion.


32/40

9.7 Misse" !bor$ion #e$us "ies in u$ero bu$ is no$ e0pe((e". Usu!(() "is'overe" !$ ! pren!$!(visi$ %&en #un"!( &ei,&$ is me!sure" !n" no in're!se is "emons$r!$e" or %&en previous()&e!r" #e$!( &e!r$ $ones !re no (on,er presen$. In $%o %ee*s/ $ime4 si,ns o# !bor$ion s&ou("o''ur+ o$&er%ise4 (!bor %i(( &!ve $o be in"u'e" $o preven$ &)po#ibrino,inemi! or sepsis.

:. Ec"t"$ic Pre0%a%c& !n) ,es$!$ion (o'!$e" ou$si"e $&e u$erine '!vi$).:.9 Si,ns !n" s)mp$oms sin'e $&e %!(( o# $&e 5!((opi!n $ube is no$ su##i'ien$() e(!s$i'4 i$

rup$ures %i$&in $&e #irs$ 9: %ee*s o# ,es$!$ion !s i$ '!n no (on,er ,ive %!) #or ,ro%in, #e$us:.9.9 Severe4 s&!rp4 *ni#e3(i*e s$!bbin, p!in ei$&er $&e ri,&$ or (e#$ (o%er u!"r!n$ 2in

b(ee"in, %&erein $&ere is no e0i$ or e,ress o# b(oo" #rom $&e bo")4 p!in is $&eou$s$!n"in, s)mp$om+ $&is p!in "i##eren$i!$es E'$opi' pre,n!n') #rom !bor$ion1

:.9.: Ri,i" !b"omen:.9.7 2 1 Cu((en/s si,n b(uis& umbi(i'us:.9.8 E0'ru'i!$in, p!in %&en 'ervi0 is move" on IE:.9.; Si,ns o# s&o'*6 #!((in, -P4 PR more $&!n 9


33/40

C!n es$!b(is& $&!$ $&e #e$us is in're!sin, in si>e !n"4 $&ere#ore4 '!n pre"i'$EDCC!n "e$ermine ,es$!$ion!( !,e b) me!surin, $&e bip!rie$!( "i!me$er o# $&e#e$!( s*u(( 2i# i$ is more $&!n .; 'm.4 i$ is more $&!n :;e !n" ,ro%$& r!$e o# $&e !mnio$i' s!'+ $&ere#ore+ '!ni"en$i#) po()3 or o(i,o3&)"r!mios

C!n 'on#irm presen'e4 si>e !n" (o'!$ion o# $&e p(!'en$!+ $&ere#ore4 is v!(u!b(e be#ore !mnio'en$esisC!n "i!,nose mu($ip(e pre,n!n')C!n visu!(i>e !s'i$es4 po()')s$i' *i"ne)s4 ov!ri!n ')s$s4 e$'.C!n "e$ermine b!b)/s se' 2"urin, $&ir" $rimes$er !n" i# in 'ep&!(i'

presen$!$ion1;.8 Si,ns !n" S)mp$oms #irs$ !n" mos$ 'ons$!n$6 p!in(ess4 bri,&$ re" v!,in!( b(ee"in, "ue $o

$e!rin, o# p(!'en$!( !$$!'&men$ !s ! 'onse uen'e o# "i(!$!$ion o# $&e in$ern!( 'ervi'!( os;.; M!n!,emen$

;.;.9 Comp(e$e be" res$;.;.: Moni$or vi$!( si,ns o# $&e mo$&er !n" $&e #e$!( &e!r$ r!$e;.;.7 Prep!re o0),en !n" b(oo"

;.;.8 In$ern!( e0!min!$ion 2IE1 is no$ "one. I# ever i$ is $o be "one4 i$ &!s $o be !"oub(e se$3up 2"one in $&e oper!$in, room %&erein $&e p!$ien$ &!s !(re!") si,ne"$&e 'onsen$ #orm4 preop me"i'!$ion &!ve been ,iven4 !b"omin!( prep &!s been"one4 e$'.4 so $&!$ i# ever p(!'en$! is !''i"en$!(() "e$!'&e" CS4 '!n be "oneimme"i!$e().

;.= Comp(i'!$ions;.=.9 Hemorr&!,e;.=.: In#e'$ion;.=.7 Prem!$uri$)

=. A!ru$ti" Place%ta prem!$ure sep!r!$ion o# $&e p(!'en$!=.9 Pre"isposin, #!'$ors

=.9.9 M!$ern!( &)per$ension or $o0emi!

=.9.: In're!sin, p!ri$) !n" m!$ern!( !,e=.9.7 Su""en re(e!se o# !mnio$i' #(ui"=.9.8 S&or$ umbi(i'!( 'or"=.9.; Dire'$ $r!um!=.9.= H)po#ibrino,inemi!

=.: Si,ns !n" s)mp$oms=.:.9 Severe4 s&!rp4 *ni#e3(i*e4 s$!bbin, p!in &i,& in $&e #un"us=.:.: H!r"4 bo!r"(i*e u$erus+ ri,i" !b"omen=.:.7 Si,ns o# s&o'* =.:.8 Con'e!(e" b(ee"in,4 i# e0$ensive4 '!uses u$erus $o (ose i$s !bi(i$) $o 'on$r!'$. I$

be'omes e''&)mo$i' !n" 'opper3'o(ore"4 '!((e" Couve(!ire u$erus4 '!usin,severe b(ee"in,. Sin'e $&e u$erus no (on,er &!s $&e !bi(i$) $o 'on$r!'$4

&)s$ere'$om) %i(( &!ve $o be "one.-. Pos$p!r$um Hemorr&!,e:.9.9 U$erine A$on) u$erus is no$ 'on$r!'$e"4 re(!0e" or bo,,)+ mos$ #re uen$ '!use

Pre"isposin, #!'$orsOver"is$en$ion o# $&e u$erus e.,.4 mu($ip(e pre,n!n')4 mu($ip!ri$)4e0'essive() (!r,e b!b)4 po()&)"r!mniosC!es!ri!n se'$ionP(!'en$!( !''i"en$s 2previ! or !brup$io1Pro(on,e" !n" "i##i'u($ (!bor

M!n!,emen$M!ss!,e #irs$ nursin, !'$ionI'e 'ompressO0)$o'in !"minis$r!$ionEmp$) $&e b(!""er -im!nu!( 'ompression $o e0p(ore re$!ine" p(!'en$!( #r!,men$sH)s$ere'$om) (!s$ resor$

:.9.: L!'er!$ions:.9.7 H)po#ibrino,inemi! ! '(o$&in, "e#e'$4 M!n!,emen$6 b(oo" $r!ns#usion

:.: L!$e pos$p!r$um &emorr&!,e:.:.9 Re$!ine" p(!'en$!( #r!,men$s m!n!,emen$6 "i(!$!$ion !n" 'ure$$!,e 2D C1:.:.: Hem!$om! "ue $o in ur) $o b(oo" vesse(s in $&e perineum "urin, "e(iver)

In'i"en'e6 Common() seen in pre'ipi$!$e "e(iver) !n" $&ose %i$& perine!(v!ri'osi$ies

Tre!$men$I'e 'ompress "urin, #irs$ :8 &oursOr!( !n!(,esi's4 !s or"ere"Si$e is in'ise" !n" b(ee"in, vesse( is (i,!$e"


34/40

III. TOXEMIA?PREGNANCJ3INDUCED HJPERTENSION 2PIH1 3 ! v!s'u(!r "ise!se o# un*no%n '!use %&i'&o''urs !n)$ime !#$er $&e :8 $& %ee* o# ,es$!$ion up $o $%o %ee*s pos$p!r$um.A. Tri!" o# s)mp$oms

9. H)per$ension:. E"em!7. Pro$einuri! 2spe'i#i'!(() !(bumiuri!1.

-. Pre"isposin, #!'$ors9. A,e primis un"er :< !n" over 7< )e!rs:. Gr!vi"! ; or more pre,n!n'ies7. Lo% so'ioe'onomi' s$!$us 2SES18. Mu($ip(e pre,n!n');. i$& un"er()in, me"i'!( 'on"i$ions4 e.,.4 &e!r$ "ise!se4 &)per$ension or "i!be$es

C. C(!ssi#i'!$ion 2T!b(e 981D. P!$&o,enesis6 25i,ure 9B1E. Di!,nosis6 ro((3over $es$ !ssesses $&e prob!bi(i$) o# "eve(opin, $o0emi! %&en per#orme" be$%een $&e

: $& !n" 7: n" %ee* o# pre,n!n').9. Pro'e"ure

9.9 P!$ien$ (ies in (!$er!( re'umben$ posi$ion #or 9; minu$es un$i( -P &!s s$!bi(i>e"9.: T&en ro((s over $o supine posi$ion9.7 -P is $!*en !$ 9 minu$e !n" ; minu$es !#$er &!vin, ro((e" over.

:. In$erpre$!$ion6 i# "i!s$o(i' in're!ses :< mm H, or more4 p!$ien$ is prone $o $o0emi!.

I. A'u$e $o0emi! s)mp$oms !ppe!r !#$er $&e :8 $& %ee* o# ,es$!$ion

A. Pree'(!mpsi!9. Mi(e:. Severe

-. E'(!mpsi!II. C&roni' &)per$ension %i$& pre,n!n')III. Un'(!ssi#ie"

Ta!le 6:. Classi,icati"% ", T"'emia

PERIPHERAL ARTERIOLAR VASOCONSTRICTION

HYPERTENSIONBlood supply & oxygenperfusion to vital

PLACENTAKIDNEYS LIVER

Tissue isc e!ia"lo!erular degeneration

"lo!erular #iltiration Tissueisc e!ia

$ascular stasis"lo!erular per!e%ility Tu%ular rea%sorptionof sodiu!

Epigastric painl%u!in& glo%ulin crossinto t e urine

'ater retentionreleaset ro!%oplastinli(e su%stances

PROTEIN)RIE*E+ O,I")RI

#luid diffuses fro!circulatory syste! toextracellular spaces

"enerali-ed.ater retention

LUNGS BRAIN

Pul!onaryede!a

cyanosis /ere%ralede!a

ypoxia

CHF /ere%ralirrita%ility

CONVULSIONS

#etalnutrient

%ruptioplacenta

Pre!ature placental

deterioration

#etal *istress

Pre!ature ,a%orand *elivery


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9.9.: Gener!(i>e" v!so'ons$ri'$ion !n" !sso'i!$e" mi'ro!n,iop!$&) "ise!se o#'!pi((!ries

9.9.7 Abnorm!( re$en$ion o# so"ium !n" %!$er b) bo") $issues9.: Me"i'!( 'omp(i'!$ions

9.:.9 Cerebrov!s'u(!r &emorr&!,e9.:.: A'u$e pu(mon!r) e"em!9.:.7 A'u$e ren!( #!i(ure

9.7 T)pes9.7.9 Mil* $reeclam$sia si,ns !n" s)mp$oms

Su""en4 e0'essive %ei,&$ ,!in o# 93; (bs. per %ee* 2e!r(ies$ si,n o# pree'(!mpsi!1 "ue $o e"em! %&i'& is persis$en$ !n" #oun" in $&e upper&!(# o# $&e bo") 2e.,. in!bi(i$) $o %e!r $&e %e""in, rin,1S)s$o(i' -P o# 98


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7.8 -!rbi$ur!$es se"!$ion b) me!ns o# CNS "epression7.; An!(,esi's+ !n$i&)per$ensives+ !n$ibio$i's+ !n$i'onvu(s!n$s+ se"!$ives7.= M!,nesium su(#!$e $&e "ru, o# '&oi'e

7.=.9 A'$ionsCNS "epress!n$ (essen $&e possibi(i$) o# 'onvu(sionsV!so"i(!$or "e're!ses $&e -PC!$&!r$i' '!uses ! s&i#$ o# #(ui" #rom $&e e0$r!'e((u(!r sp!'es in$o $&ein$es$ines #rom %&ere $&e #(ui" '!n be e0're$e".

7.=.: Dos!,e6 9< ,ms. ini$i!(()4 ei$&er b) s(o% IV pus& over ;39< minu$es4 or"eep IM4 ; ,ms?bu$$o'*4 $&en IV "rip o# 9 ,m. per &our 29 ,m?9


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9.8 in're!se" !'$ion o# !"reno'or$i'!( &ormones $&!$ #!vor p!ss!,e o# ,(u'ose #rom mo$&er $o#e$us

:. Con,eni$!( !nom!(ies !re o#$en seen7. Cus&in,oi" !ppe!r!n'e 2pu##)4 bu$ (imp !n" (e$&!r,i'18. More o#$en born prem!$ure4 so respir!$or) "is$ress s)n"rome is 'ommon;. Lose ! ,re!$er propor$ion o# %ei,&$ $&!n norm!( ne%borns be'!use o# (oss o# e0$r! #(ui"=. Are prone $o $&e #o((o%in, 'omp(i'!$ions

=.9 H)po,()'emi! b(oo" su,!r (eve( (ess $&!n 7< m, . I$ is $&e mos$ 'ommon 'omp(i'!$ion$o %!$'& #or

=.9.9 C!use6 %&i(e insi"e $&e u$erus4 $&e #e$us $en"s $o be &)per,()'emi' be'!use o#m!$ern!( &)per,()'emi!. T&e #e$!( p!n're!s $&us respon"e" $o $&e &i,& ,(u'ose(eve( b) pro"u'in, m!$'&in, &i,& (eve(s o# insu(in. 5o((o%in, "e(iver)4 $&e,(u'ose (eve( be,ins $o #!(( be'!use $&e b!b) &!s been severe" #rom $&e mo$&er.Sin'e $&ere &!s been previous pro"u'$ion o# &i,& (eve(s o# insu(in4 &)po,()'emi!"eve(ops.

=.9.: C(ini'!( si,ns o# &)po,()'emi!S&ri((4 &i,&3pi$'&e" 'r)Lis$(essness? i$$eriness?$remorsLe$&!r,)+ poor su'* Apne!+ ')!nosis

'onvu(sions=.9.7 Conse uen'es6 &)po,()'emi!4 i# no$ $re!$e"4 '!n (e!" $o br!in "!m!,e !n" even"e!$&

=.9.8 M!n!,emen$6 #ee" %i$& ,(u'ose %!$er e!r(ier $&!n usu!(4 or !"minis$er IV o#,(u'ose.

=.: H)po'!('emi! serum '!('ium (eve( o# (ess $&!n B m, .=.:.9 Si,ns6 s!me !s &)po,()'emi!=.:.: Se ue(!6 S!me !s $&!$ o# &)po,()'emi!=.:.7 M!n!,emen$6 C!('ium ,(u'on!$e $o preven$ b)po'!('emi' $e$!n)

V. HEART DISEASEA. C(!ssi#i'!$ion

9. C(!ss I no (imi$!$ion p&)si'!( !'$ivi$):. C(!ss II s(i,&$ (imi$!$ion o# p&)si'!( !'$ivi$)+ or"in!r) !'$ivi$) '!uses #!$i,ue+ p!(pi$!$ion4 ")spne!or !n,in!

7. C(!ss III mo"er!$e $o m!r*e" (imi$!$ion o# p&)si'!( !'$ivi$)+ (ess $&!n or"in!r) !'$ivi$) '!uses#!$i,ue4 e$'.

8. C(!ss IV un!b(e $o '!rr) on !n) !'$ivi$) %i$&ou$ e0perien'in, "is'om#or$-. Pro,nosis

9. C(!sses I !n" II norm!( pre,n!n') !n" "e(iver):. C(!sses III !n" IV poor '!n"i"!$es

C. Si,ns !n" s)mp$oms9. -e'!use o# in're!se" $o$!( '!r"i!' vo(ume "urin, pre,n!n')4 &e!r$ murmurs !re observe":. C!r"i!' ou$pu$ m!) be'ome so "e're!se" $&!$ vi$!( or,!ns !re no$ per#use" !"e u!$e()+ o0),en !n"

nu$ri$ion!( re uiremen$s4 $&ere#ore4 !re no$ me$.7. Sin'e $&e (e#$ si"e o# $&e &e!r$ is no$ !b(e $o emp$) $&e pu(mon!r) vesse(s !"e u!$e()4 $&e (!$$er

be'ome en,or,e"4 '!usin, pu(mon!r) e"em! !n" &)per$ension. Mois$ 'ou,& in ,r!vi"o'!r"i!'s4$&ere#ore4 is ! "!n,er si,n.

8. Liver !n" o$&er or,!ns be'ome 'on,es$e" be'!use b(oo" re$urnin, $o $&e &e!r$ m!) no$ be &!n"(e"!"e u!$e()4 '!usin, $&e venous pressure $o rise. 5(ui" $&en es'!pes $&rou,& $&e %!((s o# en,or,e"'!pi((!ries !n" '!use e"em! or !s'i$es.

;. Con,es$ive &e!r$ #!i(ure is ! &i,& prob!bi(i$) !(so be'!use o# $&e in're!se" '!r"i!' p!in on e0er$ion4!n" ')!nosis o# n!i(be"s !re obvious.

D. M!n!,emen$ 'onsi"er $&e #un'$ion!( '!p!'i$) o# $&e &e!r$9. -e" res$ espe'i!(() !#$er $&e 7< $& %ee* o# ,es$!$ion $o ensure $&!$ pre,n!n') is '!rrie" $o $erm or !$

(e!s$ 7= %ee*s ,es$!$ion:. Die$ s&ou(" ,!in enou,&4 bu$ no$ $oo mu'& !s i$ %ou(" !"" $o $&e %or*(o!" o# $&e &e!r$7. Me"i'!$ions

7.9 Di,i$!(is7.: Iron prep!r!$ions4 e.,.4 5er3in3so( or 5eoso( !nemi! s&ou(" be preven$e" be'!use $&e bo")

'ompens!$es b) in're!sin, '!r"i!' ou$pu$4 $&us #ur$&er in're!sin, '!r"i!' %or*(o!".8. C(!sses III !n" IV !re no$ p(!'e" in (i$&o$om) posi$ion "urin, "e(iver) $o !voi" in're!sin, venous

re$urn. T&e semi3si$$in, posi$ion is pre#erre" $o #!'i(i$!$e e!s) respir!$ions.;. Anes$&e$i' o# '&oi'e is '!u"!( !nes$&esi! #or e##or$(ess4 pus&(ess !n" p!in(ess "e(iver). Remember6

Gr!vi"o'!r"i!'s !re no$ !((o%e" $o pus& %i$& 'on$r!'$ions 2$o preven$ V!(s!(v! m!neuver %&i'&in're!ses venous re$urn $o !n !(re!") %e!*4 "!m!,e" &e!r$1. Lo% #or'eps4 $&ere#ore4 is $&e bes$me$&o" o# "e(iver).

=. er,o$r!$e !n" o$&er o0)$o'i's4 s'opo(!mine4 "ie$&)(s$i(bes$ro( !n" or!( 'on$r!'ep$ives !re'on$r!in"i'!$e" be'!use $&e) '!use #(ui" re$en$ion !n" promo$e $&romboembo(i>!$ion.

B. Mos$ 'ri$i'!( perio" $&e perio" imme"i!$e() #o((o%in, "e(iver) be'!use $&e 7< 3 ;


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9. Mono>),o$i'?I"en$i'!( $%ins be,in %i$& ! sin,(e ovum !n" sperm4 bu$ in $&e pro'ess o# #usion or inone o# $&e #irs$ 'e(( "ivisions4 $&e >),o$e "iv

2013 maternal and child health nursing reviewer complete

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