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Maternity revision
antenatal & postnatal
| Question | Answer |
|---|---|
| what does syntocinon do | contains oxytocin. stimulates rhythmic contraction of the womb during & after delivery |
| What is konakionn for | vit.K to prevent or treat blood clotting problems can be given in multiple tablet doses or 1 I/M |
| What is ergometerine for | treatment of postpartum or postabortion haemorrhage. stimulates contraction of uterine |
| what is the safety formula for baby sleeping. aids in protection from SUDI | Face up. Face clear. Smokefree |
| what's the average weight of neonate | 2700-4000 grams (6-9 pounds) |
| how much weight do baby's loose in the first 3-4 days and why? | 10% of their body weight. Output of meconium & urine exceeds input |
| what is the average length of a newborn | 46-56cm |
| what is the average chest & head circumference of a baby | chest: 30.5-33cm Head:32-36cm (should be 2-3cm larger than chest) |
| what is the normal vital signs of a new born | resp: 30-60 H/R: 120-160 Temp: 36.3-37.5 |
| what is the length of the umbilical cord | about the length of the baby (50cm) |
| what is the purpose of hip checks | to check for congenital dislocation of the hip |
| why is BGL screening important | transient physiological drop may occur in 1st 2 hours of life. screening is directed at infants at risk for pathological hypoglycaemia |
| what is a serum bilirubin test | a blood test to measure levels of bile pigment in blood serum to evaluate their liver function |
| what does an elevated bilirubin test suggest | accelerated RBC destruction or may indicate bilirubin is not being excreted properly |
| what is TORCH/S screen for | a blood test that checks for toxoplasmosis, rubella, cytomagalovirus, herpes simplex, HIV & syphilis |
| what is a guthrie test for | A blood test obtained from the heel tests for PKU a genetic disorder caused by the faulty metabolism of phenylaline. Recommended to be obtained 48-72 hours after birth |
| what are the reflexes of position & movement | Moro reflex: birth-1/3mth Tonic neck: birth-5/7mth Palmar grasp: birth-4mth Babinski: birth-2yr |
| what are the reflexes to sound | blinking response & turning response |
| What are the reflexes of vision | blinking to threat: 6-7mth horizontal following: 4-6wk vertical following: 2-3mth Postrotational nystagmus: birth |
| what are the food reflexes | rooting response: birth- 3/8mth suckling response |
| what is the reflex not categorized | headlag |
| what causes Rh or ABO incompatibility | if mother is Rh- and foetus is Rh+ antibodies are made by mother for foetus's antigens ABO when mother is O & baby is A or B |
| what is 'isoimmunizaton' | if foetal Rh+ blood leaks into Rh- mothers circulation her body may make antibodies to destroy the Rh+ erythrocytes |
| what is the treatment for Rh incompatibility | prevent manufacture of anti-Rh-antibodies by giving Rh(D) immune globulin to the Rh- woman 28wk gestation & 72hours after birth of Rh+ baby |
| what is meconium | The first stools. is made of amniotic fluid, mucus bile, and cells that have been shed from the skin and the intestinal tract |
| how many stools do infants pass a day | Breastfed: 3-6/day Bottlefed: 1-4 then reduce to 1-2/day |
| what is physiological jaundice | normal jaundice due to immature liver & slow processing of bilirubin. Appears 2-4days & disappears 1-2 weeks |
| what is pathological jaundice | evident in first 24hour. liver cannot handle hemolysis & bilirubin levels rise. O2 capacity of RBC diminishes |
| what is kenicterus | Accumulation of bilirubin in the brain tissue. a result from bilirubin toxicity. |
| what are the aims of ante-partum care | maintenance of wellness for mother & child early detection & treatment of problems pregnancy to term followed by healthy birth preparation for breastfeeding preparation for parenting assist other family members to adapt to change |
| what are the blood tests for in ante-partum care | blood group & antibodies Full blood count Hep B, Rubella & Syphilis ?HIV if needed |
| why is folic acid needed 1 month prior to pregnancy & first 3 months in pregnancy | reduces the risk of neural tube defects |
| why is iodine needed in pregnancy | As iodine is essential for normal brain development, it's important that the foetus have adequate intake. needed for thyroid hormones |
| what are the presumptive signs of pregnancy | amenorrhoea, breast changes, nausea/vomiting, quickening, deepening pigmentation, urinary frequency |
| what are the probable signs of pregnancy | Braxon-Hicks contractions, abdominal enlargement, ballottement, vaginal examination (Goodwells, Chadwick, Hegar & macdonald signs) Striae graviderum & + pregnancy test |
| what are the positive signs of pregnancy | fetal heart, movement & fetal parts able to be palpated. Visualization on ultrasound |
| what is engorgement | when vessels enlarge around breasts. Breasts become hard & painful & baby cannot fix on |
| what is chloasma | increased pigmentation of face. A presumptive sign of pregnancy |
| what is linea nigra | a line extending in the midline of abdomen from just above the umbilicus to the symphysis pubis |
| what is quickening | fetal movement felt by mother. first perceived at 16-20weeks as a faint fluttering in lower abdo. |
| what are braxton hicks contractions | are irregular painless, uterine contractions that begin in the 2nd trimester & become progressively noticeable as term approaches |
| what are the dates for the trimesters | 1st trimester is to 12-14 weeks gestation, the 2nd trimester up to 28 weeks gestation, and the 3rd trimester is till term. 3 months each |
| what is ballottement | a maneuver by which the fetal part is displaced by a light tap of a finger on the cervix and then rebounds quickly |
| what are the readings for gestational hypertension | 130/90 two readings over a period of 6hours. 30 above systolic baseline & 15 above diastolic |
| what are the signs of pre-eclampsia | oedema, increased BP & protein urea |
| what are the main signs of worsening pre-eclampsia | complain of frontal headache oedema around retina egigastric pain |
| what is eclampsia | cerebral oedema causes convulsions. affects circulation O2 (hypoxia of mother & baby). Placental abruption. Death. Convulsions can continue 48-72 hours after birth |
| what is the treatment for eclampsia | I/V magnesium sulfate postpartum (for convulsions) I/V hydralasine (for BP) |
| what is HELLP syndrome | Heamolysis of RBC ELevated liver enzymes Low Platelets |
| how much folic acid is needed to reduce effects of neural tube defects | 0.4mg 0.5-0.6mg for pregnant or breastfeeding 0.8mg if hx of neural tube defect |
| how much blood loss is considered post partum heamorrhage | >500ml |
| what can you do to help a woman with a post partum heamorrhage | stimulate fudus. becomes tight & stops bleeding. Bladder must be empty so it can contract down |
| what is DIC ( disseminated intravascular coagulation) | the proteins that control blood clotting become abnormally active. Won't return to normal until placenta is removed |
| gestational diabetes and baby weight | >4kg baby tend to become diabetic 20% more than normal expected weight gain (normal 9-11kg) |
| what are the signs of impending labour | braxton hicks contractions Increased vaginal discharge Bloody show Rupture of membranes Energy spurt weight loss |
| what are the mechanisms of labour | descent, engagement, flexion, internal rotation, extensions, external roataions & expulsion |
| what are the 3 types of lochia | rubra, serosa, alba |
| define lochia rubra | red because composed mostly of blood. Lasts for 3 days |
| Define lochia serosa | pinkish because of blood & mucus content. lasts 3-10days |
| define lochia alba | is mostly mucus & is clear or colourless. Lasts 10-21 days |
| what are the 4 P's of the birth process | Power Passage passenger Psyche |
| What does APGAR test for | Activity Pulse Grimace Appearance Respiration |
| when should APGAR be done | one & 5 min after birth May be repeated at 10min |
| what score of APGAR indicates intervention | points out of 10. Below 7 indicates intervention |
| what does a score of 1 for activity in APGAR show | arms & legs extended |
| What does a score of 1 for pulse in APGAR mean | pulse above 100 |
| What does a score of 1 indicate in APGAR for appearance | pink body, blue extremeties |
| what is pelvic inflammatory disease | a spectrum of inflammatory disorders of the upper female genital tract. endometriosis, salpigitis, tubo-ovarian abcess, pelvic peritonitis |
| what is acute P.I.D | sudden violent attack. often with high fever, abcess may occur |
| what is recurrent P.I.D | if untreated or not cleared. May be related to inappropraite use of antibiotics or reinfection by partner |
| What causes chronic P.I.D | when untreated or inadequate treatment causes ongoing pain. |
| what causes P.I.D | ascending spread of micro-organisms from vagina & endocervix to upper GI tract. often occurs at end or after menses |
| Define exclusive breast feeding | infant has never had any other liquid or solid foods only breast milk prescribed medicines have been given since birth |
| Define full breast feeding | within past 48 hours the infant has had BM only, no other liquids/solids, except minimal water or prescribed meds |
| Define partial breast feeding | infant taken some BM & some formula or other solids in past 48 hours |
| Define artificial feeding | infant had no BM but has had alternative liquid such as formula, with/without solid food in past 48 hours |
| what is WHO hierarchy of infant feeding | 1. Breast 2. Expressed BM given in another way 3. Milk from another human mum 4. Artificial milk |
| risks of formula for infant from WHO | Decreased resistance against illnesses, Reduced cognitive development & visual acuity. Increase risk of 1 & 2 diabetes, child obesity & coeliac. Increased mortality in 1st year.long term negative impacts for heart health |
| What are the long term benefits for breast fed children (WHO) | Lower BP. Lower total cholesterol. Less likely of being overweight. less likely to get type 2 diabetes. better school performance in late adolescent or young adulthood |
| What are the benefits for mothers that breast feed. (WHO) | prevent post partum haemorrhage, breast & ovarian cancer & potentially prevent post manopausal hip fracture |
| name the benign breast diseases (6) | fibroadenoma. Fibrocystic disease. Fat necrosis. Breast abscess. Ductal papiloma. Mammary duct ectasia |
| what is fibroadenoma | smooth, hard movable lumps, not painful. common in mid 30s. AKA breast mice |
| what is fibrocystic disease | round tumors, may be multiple. common 35-45. associated with menustruation, hormonal changes, tender, larger than normal breast |
| what is fat necrosis | common in women over 50. can mimic cancer, is usually painless. Is responsive to tissue injury (MVA) |
| what is a breast abscess | often seen in breast feeding women. Staph aureus reaching breast via cracked nipple from pharynx of infant. very hot, tender & women systemically unwell. Antibiotics needed & sometimes surgical draining |
| what is ductal papiloma | benign tumor of ductal epithelium. Lump in areola region. may present as blood stained discharge, causes discomfort. Duct surgically removed [microdochectomy] |
| What is mammary duct ectasia | common 40-50. abnormal involution of breast ducts, dilated ducts, leakage & inflammatory changes, pain & nipple discharge (not bloody) and lumpiness. Lumps treated with anti inflammatory |
| what is breast cancer | a malignant area of the breast. most in milk ducts but other begin in lobules. may develop over years. Spreads to lymph nodes then commonly to lungs, bones & liver. may also spread in blood |
| what are the risk factors for breast cancer | ageing. Previous breast biopsy identifying risk. family Hx genetic factors exposure to repeated radiation obesity, weight gain after 18. alcohol intake not having kids first kid after 35. HRT, oral contraception & depo provera ovarian cancer, t |
| what are the signs of breast cancer | a new lump or thickening. Change in shape/size. Pain that is unusual. Puckering/dimpling of skin. Changes in nipple, inverted/discharge. Rash/ redness only on 1 breast |
| whats the best way to find breast cancer early | educate women, breast models to enable detection. Fine needle biopsy, mammography & ultrasound |
| what is mammography | women 45-69, every 2 years. can detect tissue changes in breast before being seen/felt. Can detect 75-90% of unsuspected cancer. Early detection does not prevent cancer. |
| what are the surgical options for breast cancer | total mastectomy& axillary node dissection or local excision of breast tumor with axillary node dissection |
| what are the treatments options, other than surgery, for breast cancer | radiotherapy to breast & axillary. Hormonal therapy & chemotherapy. counselling ect |
| breast screening in NZ | Breastscreen Aoteroa is a free national screening for 45-69years. Uses mammography to detect early breast cancer-only proven method |
| What is used for Cervical screeing | Gardisal 12-18 years vaccine. Screeing in 3 yearly intervals until age of 70 commencing at beginning of sexual activity. Colposcopy & biopsy to detect changes in cervix |
| Define the Cervical intraepithelial neoplasm 1 | 1. low grade, mild dysplasia, cells mildly abnormal, seen within 5-6mths of referral then one follow up appointment |
| Define the Cervical intraepithelial neoplasm 2 | high grade changes or moderate dysplasia, cells moderately abnormal, seen withing 4wk of referal. 2 follow up after treatment |
| Define the Cervical intraepithelial neoplasm 3 | high grade changes, sever dysplasia or carcinoma in situ seen within 4wk of referal. 2 follow up after treatment |
| breast screening in NZ | Breastscreen Aoteroa is a free national screening for 45-69years. Uses mammography to detect early breast cancer-only proven method |
| what is the reason for a cone biopsy of the cervix | Gardisal 12-18 years vaccine. Screeing in 3 yearly intervals until age of 70 commencing at beginning of sexual activity. Colposcopy & biopsy to detect changes in cervix |
| Define the Cervical intraepithelial neoplasm 1 | cryotherapy- ice expands, cracks, scab breaks away away leaving healthy epithelium. Laser- local. destorys cells, strict aftercare to avoid infection. Diathermy-local. abnormal cells cut away from cervix |
| Define the Cervical intraepithelial neoplasm 2 | high grade changes or moderate dysplasia, cells moderately abnormal, seen withing 4wk of referal. 2 follow up after treatment |
| Define the Cervical intraepithelial neoplasm 3 | high grade changes, sever dysplasia or carcinoma in situ seen within 4wk of referal. 2 follow up after treatment |
| what is a cone biopsy | minor surgical procedure under general A when a cone shaped segment moved from cervix. |
| what are the reasons for a cone biopsy | lesions not adequately seen in coloscopy. abnormal cells in high neck of cervix unable to be reached. abnormal area developing below surface of cervix |
| treatment for abnormal cervix cells | cryotherapy-ice expands, cracks, scabs break away leaving healthy cells laser- under local. destroys cells, after care to avoid infection, minimal bleeding Diathermy- under local. abnormal cells cut away in segments |
| what are the tubal causes for infertility (14%) | inability to conceive after 12mths of unprotected intercourse aprox. affects 10-15% of couples |
| What is the difference between primary & secondary infertilty | Primary- woman never been able to conceive. Secondary- conception has taken place regardless of outcome |
| what are the 4 main causes of infertility | anovulation (no release of ovum) tubular factor/adhesions endometriosis male factors- semen abnormalities |
| what are male factors of infertility (24%) | testicular disease, orchitis (inflam. of tetes) trauma, drugs. Obstruction of ductus deferens- surgical functional cystic fibrosis Sperm antibodies |
| tubular factor affecting infertility (14%) | PID, endometriosis, surgical adhesions, bowel disease-ruptured appendix, chrons |
| what are miscellaneous factors affecting infertility | endometriosis 6% sexual dysfunction 6% cervical mucus hostility 3% unexplained infertility 27% |
| ART ( assisted reproductive therapy) options for infertility - In vitro fertilisation | indicated for tubal disease, unexplained infertility, endometriosis, male infertility, failed donor insemination or cervical hostility |
| ART ( assisted reproductive therapy) options for infertility- donor | donor oocytes used with ovarian disorder e.g early menopause |
| ART ( assisted reproductive therapy) options for infertility - Gamete intrafallopian transfer | suitable for all indications of IVF except where there may be a blockage or absent tubes. Not a common choice for ART |
| ART ( assisted reproductive therapy) options for infertility - intracytoplasmic sperm injection | used for sperm dysfunction. sperm are harvested from epidydimis or testes & injected into ovum. embryo is transferred to uterus |
| Name the types of contraception | combined pill, mini pill, depo provera, intra-uterine device, diaphragm & caps, condoms, emergency pill, fertility awareness, female sterilisation, vasectomy |
| what is endometriosis | endometrial tissue in parts of the body other than in the uterine cavity |
| what is the average age for endometriosis | 20-45 Highest in 40-44 |
| what are the S&S of endometriosis | worsening menstrual cramps. painful poo & diarrhoea painful sex abnormal bloating heavy bleeding stomach upset infertility |
| what are the management options for endometriosis | suppression of oestrogen levels- reduction in endometrial growth Contraception for menstruation surgery if needed |
| what is a complete miscarriage | the entire pregnancy is lost |
| what is an incomplete miscarriage | part of the pregnancy is lost. parts of the placenta & blood remain in the uterus |
| what is an inevitable miscarriage | the woman experiences bleeding, the cervix opens thus the products of contraception will be expelled |
| what is a missed abortion | the pregnancy has stopped growing, often due to an abnormal ovum, the woman will expel the products of contraception |
| what is secondary health for addictions | early detection & intervention: screening, advice, assistance programmes, media campaigns, community education programmes, stress management techniques |
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