Obstetric and Gynecological Nursing - The Carter Center

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5. Traditional method Up right kneeling/ squatting positions should be recommended when the third stage is passively managed. Gravity and intra abdominal pressure aid & speed the process Advantage – Blood loss can be easily observed About 500-.800ml blood flows through the placental site each minute. Following delivery of the placenta the oblique muscle fibers of the myometrium contract very strongly to compress the blood vessels. All average blood loss after the delivery of the placenta is 150ml. Blood loss should never be more than 500ml. All blood should be measured including clots from the placental surface. Examination of the placenta, membrane and umbilical cord Inspect the fetal side:- a) Check the location of the insertion of the cord /central, marginal or velamentous b) Trace blood vessels on the periphery to detect any torn vessels. It indicates a succentarete or extra lobe of the placenta. c) Check second hole on the memberane 104
Inspect the umbilical cord a) Check the number of blood vessels /two artery and one vein/ b) Check the length of the cord.( Long-50-55cm or short) c) Check for the presence of a true knot or abnormalities Inspect the maternal side: a) Check the cotyledons b) Observe for areas of Abruption, infarction or calcification 4. Control of bleeding Methods:- - Contraction & relaxation of uterine muscles - The actions of living ligatures - Extra clothing power in the blood The third stage is the shortest and easiest but the most dangerous stage. Bleeding after third stage of labour stops spontaneously, because of: 1. “Living ligatures” The oblique muscles fibers of the uterus run in and out between the blood vessels when the uterus is contracted they clump the blood vessels very securely and the bleeding stops. 2. Extra clotting power: The mother has extra clothing power in her blood at this time the clotting mechanism is very powerful. 105
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LECTURE NOTES For Nursing Students
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Preface This lecture note offers nu
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Acknowledgement My deepest apprecia
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2.3.5 Fallopian tube or uterne tube
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CHAPTER SIX : ABNORMAL PREGNANCY 12
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8.5 Subinvolution 225 Review Questi
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LIST OF FIGURES Figuer 1. Normal Fe
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ABBRIVATIONS ACTH Adreno cortico tr
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CHAPTER ONE INTRODUCTION Care of ch
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Hemorrhage, sepsis (infection), tox
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CHAPTER TWO ANATOMY OF FEMALE PELVI
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sacrum is concave and is referred t
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diamond in shape. The obstretrical
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Table 2 .Features of the four types
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The Fetal Skull The fetal head is t
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Regions of the Skull A. The occiput
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. Suboccipitofrontal 10cm from belo
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Figure 6 . Female external genitali
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Position:- In the non-pregnant fema
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• Round ligament - Ligaments form
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• provides a site for fertilizati
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maturation of reproductive organs a
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Thispain, called mitlelschmerz may
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2.5. The Breast Anatomy The female
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Amplulla: the widened-out portion o
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Review Questions 1. List different
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the ampullar portion. The functiona
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Blastocyst Trophoblast Inner cell m
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penetrate. Viruses, however, can cr
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Figure 10 . The fetal circulation (
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Appearance of the Placenta at Term
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Identification On inspection, the p
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Placenta infarction Placental infar
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Oarl cavity feels salivation Gums-
Page 69 and 70: • Creatinine and BUN decrease bec
Page 71 and 72: - Increase in the lower extermities
Page 73 and 74: - Lower part cervix and isthmus cha
Page 75 and 76: 6. Fainting: - In early pregnancy f
Page 77 and 78: women feels it at 18-20 weeks the m
Page 79 and 80: Multipara a woman who has given bir
Page 81 and 82: The Obstetric History 1. Past Obste
Page 83 and 84: Breast Examination Asses the size,
Page 85 and 86: 1.2 Fundal Palpation Purpose- To kn
Page 87 and 88: 3. Deep pelvic Palpation: (3 rd Leo
Page 89 and 90: Auscultation: Check Fetal heart, ra
Page 91 and 92: • Rest at least 10 hrs at night a
Page 93 and 94: CHAPTER FOUR NORMAL LABOUR At the e
Page 95 and 96: - Labour is said to be established
Page 97 and 98: To assess progress of labour - Stat
Page 99 and 100: Relief of pain & promotion of comfo
Page 101 and 102: Uterine contraction - Frequency per
Page 103 and 104: advanced labour women may be assess
Page 105 and 106: Method - by abdominal palpation ide
Page 107 and 108: Eg. Partograph Name _______________
Page 109 and 110: - Caput - Sutures and Fontanelles.
Page 111 and 112: Echanism of Labour in a Normal Vert
Page 113 and 114: ERGOMETRINE: 0.5mgs. in a syringe w
Page 115 and 116: 1. Separation of the placenta Mecha
Page 117 and 118: 3. Controlled cord traction with ou
Page 119: Advantage: It allows the placenta t
Page 123 and 124: Ergometrine Route Time to act Durat
Page 125 and 126: The guiding principles is to watch
Page 127 and 128: B. Delayed cord clamping The cord c
Page 129 and 130: - Method of delivery- spontaneous o
Page 131 and 132: 4.4. Episiotomy Definition: The mak
Page 133 and 134: 4. Lateral: The incision is begun o
Page 135 and 136: Layers to be repaired 1. Vaginal wo
Page 137 and 138: CHAPTER FIVE THE NORMAL PUERPERIUM
Page 139 and 140: Lochia- discharge from the uterus d
Page 141 and 142: 5.2 Management of the Puerperium An
Page 143 and 144: answer her questions and through ou
Page 145 and 146: CHAPTER SIX ABNORMAL PREGNANCY At t
Page 147 and 148: One fetus may be died and be retain
Page 149 and 150: Management of Pregnancy - Early dia
Page 151 and 152: are labeled as ‘ Twin one ‘ and
Page 153 and 154: a) Both twins presenting by the ver
Page 155 and 156: - The urine will smell of acetone,
Page 157 and 158: The liver is affected in sever case
Page 159 and 160: Moderate - Preeclampsia is usually
Page 161 and 162: Management during labour The nurse/
Page 163 and 164: 35% with in the first few hours aft
Page 165 and 166: - The volume of urine and the album
Page 167 and 168: Type 1 placenta praevia - The major
Page 169 and 170: Diagnosis - Using ultrasonic scanni
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Complications • Post partam haemo
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If the blood loss is revealed; More
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- Rarely, Rhesus- isoimmunization -
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The mother should rest in bed. An u
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The first encounter may not result
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The degree of haemolysis and the nu
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Transmission of infection to the fe
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Post natal care Separation of the b
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giving several short pushes during
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- Maternal hyperglycemia should be
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Review Questions 1. List the differ
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All ill fitting part is associated
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On auscultation The fetal heart bea
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cord prolapse). - Sedation often ne
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up gently delivery slowly taking 2
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Diagnosis On palpation - the head i
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Complications Maternal Fetal - Obst
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make sure no cord prolapsed and to
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If diagnosed during the first stage
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Management Encourage the mother to
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7.2.1 Atonic Postpartum Hemorrhage
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Cause - Delivery through partially
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Management of Severe PPH in a Healt
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Cause in 1 st stage 1) In-efficient
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4 Reduced pelvic out let. A forceps
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- If the fetus is not alive and the
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Methods of determining C.P.D. 1. De
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3 Placenta percrata- through muscle
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2. Tonic contraction and Bandl’s
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Condition of the baby - Usually sti
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3. Control head, keep it flexed, so
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Review Questions 1. What are the co
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More severe infection may consist o
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Prevention The best method of treat
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Managing Puerperal sepsis 1. Isolat
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8.5 Subinvolution Sub involution is
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CHAPTER NINE INDUCTION OF LABOUR At
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Table 6 .Bishops Score System Induc
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- Fluid balance chart - Urine test
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Nipple stimulation, which releases
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Conditions in which trial of scar i
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CHAPTER TEN OBSTETRIC OPERATIONS At
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Indication for forceps delivery - F
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In the infant: Bruising: Severe bru
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10.2 Caesarean Section Caesarean se
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Possible indications include: - The
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types of decapitating hooks and kni
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procedure is extremely rare in cont
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- The head must be engaged. - The w
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CHAPTER ELEVEN CONGENITAL ANOMALIES
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A single remiuterus results when on
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E. Persistence of male (Wolffcan) d
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CHAPTER TWELVE INFECTION OF THE FEM
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Sign Major Minor Cervical motion Ab
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- Gentamycin iv or in loading dose
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In those persons with recurrent les
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Presentation Sign and symptom A wom
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Risk Factor Studies have indicates
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ecto vaginal fistula. Other types m
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12.6 Prolaps of the Uterus A descen
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- If no symptoms are present and th
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Forced inversion caused by excessiv
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therapy may be initiated to prevent
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Local disorders of the genital trac
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. Missed abortion This is the term
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The membranes may have ruptured and
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operation. Many mothers do not make
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I. Septic abortion Infection may oc
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Dysmenorrhea Definition-Dysmenorrhe
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esult from tension, anxiety (stress
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Implantation may occur in the fimbr
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the rupture is on the mesenteric si
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Diagnosis - The presence of interna
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Causes of infertility Female - Vagi
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Benign A. Fibrocystic breast diseas
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- Pain in the breast - Blood staine
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Treatment - Oestrogen - Progesteron
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E. Gently squeeze the nipple of eac
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- Poor uterine contraction - Subinv
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cervical canal and are multiple. Th
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Vulval Cysts Bartholin’s cyst- It
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GLOSSARY Abortion Termination of pr
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Intra uterine growth retardation Fe
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Obstetric and Gynecological Nursing - The Carter Center

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