This document provides guidance on examining the abdomen in pregnancy. It outlines how to determine gestational age by measuring the fundal height and assessing fetal presentation and position. The exam involves general inspection of the abdomen and specific palpation of the uterus and fetus to evaluate size, lie, presentation, head engagement, fetal heart rate and movements. Close monitoring of the amount of amniotic fluid and signs of uterine irritability are also described. The goal is to accurately assess fetal growth, position and well-being during routine prenatal exams.
Maternal Care: Skills workshop Examination of the abdomen in pregnancySaide OER Africa
Maternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers: the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning, regionalised perinatal care
This document provides information on physiological changes, nursing interventions, complications, and psychological adaptation during the postpartum period. [1] Key physiological changes include lochia, uterine involution, breast changes, and common discomforts like perineal pain and breast engorgement. [2] Nursing interventions focus on monitoring vital signs, fundal checks, assessing lochia, encouraging feeding and ambulation. [3] Potential postpartum complications discussed are hemorrhage, thrombophlebitis, infection, and mood disorders.
The document provides information on various topics related to maternal and child health nursing for the upcoming December 2012 PNLE exam, including:
1. Stages of pregnancy, signs of pregnancy, diagnostic tests during pregnancy such as ultrasound and amniocentesis.
2. Discomforts of pregnancy like nausea and vomiting, and ways to manage them.
3. Details of the stages of labor, nursing care during labor, and complications like abortion and ectopic pregnancy.
4. Postpartum topics like lochia, perineal lacerations, micronutrient supplementation during pregnancy.
The document provides information on various diagnostic tests performed during pregnancy including amniocentesis, chorionic villi sampling, ultrasound, and alpha-fetoprotein screening. It discusses signs and symptoms of pregnancy such as breast changes, nausea, and a positive pregnancy test. Common discomforts of pregnancy like heartburn and constipation are also outlined along with recommended health teachings. The document concludes with an overview of electronic fetal monitoring including the non-stress test to monitor fetal heart rate.
This document provides an overview of prenatal care and health teachings. It discusses common signs and discomforts of pregnancy and provides recommendations for managing common issues like nausea, heartburn, constipation, hemorrhoids, leg cramps, and more. Formulas are also presented for estimating dates of confinement and fetal weight based on measurements taken during prenatal exams.
Management of normal labour involves careful history taking, examination of the patient and fetus, and monitoring progress through each stage of labour. The first stage focuses on preparing the mother, allowing light foods and mobility. Fetal wellbeing is assessed through monitoring the heart rate, fluid color and scalp sampling if needed. The second stage has the mother push on contractions while in position for delivery. Episiotomy may be done and perineal support given. The third stage uses active management including oxytocin to deliver the placenta to prevent hemorrhage.
This document defines several key terms used in obstetrical examinations and fetal monitoring:
1) It describes fetal lie, presentation, and position - referring to the relationship of the fetus to the uterus. It also defines common presentations like cephalic and breech.
2) It provides an overview of the Leopold maneuvers used to assess fetal position, including palpating the fundus, sides, and lower uterine segment.
3) It distinguishes early decelerations that occur with uterine contractions from late decelerations that begin after the contraction, which are more concerning.
It incluids complete information about Pregnancy
1. Defination of Pregnancy
2.Trends in midwifery and obstetrical nursing
3. Sign and symptoms of pregnancy
4. Diagnosis of pregnancy
5. Investigation of pregnancy
6. Minor disords in pregnancy
7. Warning signs of pregnancy
8. Nursing care plan for normal pregnancy
9. Principles of managing drugs in pregnancy.
10. Antenatal advice
11. Diet in normal pregnancy
12. Antenatal hygiene
13. Antenatal couselling
Maternal Care: Skills workshop Examination of the abdomen in pregnancySaide OER Africa
Maternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers: the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning, regionalised perinatal care
This document provides information on physiological changes, nursing interventions, complications, and psychological adaptation during the postpartum period. [1] Key physiological changes include lochia, uterine involution, breast changes, and common discomforts like perineal pain and breast engorgement. [2] Nursing interventions focus on monitoring vital signs, fundal checks, assessing lochia, encouraging feeding and ambulation. [3] Potential postpartum complications discussed are hemorrhage, thrombophlebitis, infection, and mood disorders.
The document provides information on various topics related to maternal and child health nursing for the upcoming December 2012 PNLE exam, including:
1. Stages of pregnancy, signs of pregnancy, diagnostic tests during pregnancy such as ultrasound and amniocentesis.
2. Discomforts of pregnancy like nausea and vomiting, and ways to manage them.
3. Details of the stages of labor, nursing care during labor, and complications like abortion and ectopic pregnancy.
4. Postpartum topics like lochia, perineal lacerations, micronutrient supplementation during pregnancy.
The document provides information on various diagnostic tests performed during pregnancy including amniocentesis, chorionic villi sampling, ultrasound, and alpha-fetoprotein screening. It discusses signs and symptoms of pregnancy such as breast changes, nausea, and a positive pregnancy test. Common discomforts of pregnancy like heartburn and constipation are also outlined along with recommended health teachings. The document concludes with an overview of electronic fetal monitoring including the non-stress test to monitor fetal heart rate.
This document provides an overview of prenatal care and health teachings. It discusses common signs and discomforts of pregnancy and provides recommendations for managing common issues like nausea, heartburn, constipation, hemorrhoids, leg cramps, and more. Formulas are also presented for estimating dates of confinement and fetal weight based on measurements taken during prenatal exams.
Management of normal labour involves careful history taking, examination of the patient and fetus, and monitoring progress through each stage of labour. The first stage focuses on preparing the mother, allowing light foods and mobility. Fetal wellbeing is assessed through monitoring the heart rate, fluid color and scalp sampling if needed. The second stage has the mother push on contractions while in position for delivery. Episiotomy may be done and perineal support given. The third stage uses active management including oxytocin to deliver the placenta to prevent hemorrhage.
This document defines several key terms used in obstetrical examinations and fetal monitoring:
1) It describes fetal lie, presentation, and position - referring to the relationship of the fetus to the uterus. It also defines common presentations like cephalic and breech.
2) It provides an overview of the Leopold maneuvers used to assess fetal position, including palpating the fundus, sides, and lower uterine segment.
3) It distinguishes early decelerations that occur with uterine contractions from late decelerations that begin after the contraction, which are more concerning.
It incluids complete information about Pregnancy
1. Defination of Pregnancy
2.Trends in midwifery and obstetrical nursing
3. Sign and symptoms of pregnancy
4. Diagnosis of pregnancy
5. Investigation of pregnancy
6. Minor disords in pregnancy
7. Warning signs of pregnancy
8. Nursing care plan for normal pregnancy
9. Principles of managing drugs in pregnancy.
10. Antenatal advice
11. Diet in normal pregnancy
12. Antenatal hygiene
13. Antenatal couselling
The document provides information on managing the normal postpartum period, or puerperium. It defines the puerperium as lasting 6 weeks after delivery of the placenta. During this time, the mother's body returns to its non-pregnant state through physical changes in organs like the uterus, breasts, cardiovascular and gastrointestinal systems. Proper management of the first hour after delivery and routine observations are important to prevent postpartum hemorrhage. With no complications, patients can typically be discharged 6 hours after a normal vaginal delivery or after 3 days for a Cesarean section. Follow-up postnatal care is also required during the 6-week period.
This document discusses the normal process of labor and delivery. It begins by defining labor and childbirth as the period from the onset of regular uterine contractions until expulsion of the placenta. It then discusses fetal positioning including lie, presentation, attitude, and position. The cardinal movements of labor are also summarized, including engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. Mechanisms of labor for both vertex and occiput posterior presentations are presented. Changes in fetal head shape during labor from molding and caput succedaneum formation are also described.
The document discusses several antepartal (before birth) pregnancy complications including abortion (threatened, inevitable, complete, incomplete, missed), ectopic pregnancy, hydatidiform mole/trophoblastic disease, and incompetent cervix. Abortion is the termination of pregnancy before viability and can be threatened, inevitable, complete, or incomplete. Ectopic pregnancy occurs outside the uterus usually in the fallopian tubes and can cause medical emergencies from blood loss. Hydatidiform mole results in abnormal proliferation of chorionic villi and has risks of choriocarcinoma while incompetent
1) Prolapsed umbilical cord occurs when the umbilical cord is displaced into or through the cervix during labor, putting pressure on the cord and restricting blood flow to the fetus.
2) Risk factors include non-cephalic fetal position, prematurity, polyhydramnios, multiple gestation, and disproportion between the fetus and pelvis.
3) Signs include variable fetal heart decelerations, palpation of the cord in the vagina or cervix, and fetal distress. Immediate management involves positioning the mother to relieve pressure on the cord and expedited delivery by cesarean section if the cervix is not fully dilated.
This document provides information on nutrition and protein-energy malnutrition. It defines nutrition and discusses caloric requirements for children of different ages. It also covers topics like breastfeeding, vitamins, protein requirements, and types of malnutrition like marasmus and kwashiorkor. Causes of protein-energy malnutrition include social, economic, biological and environmental factors. The clinical presentation depends on the type, severity and duration of dietary deficiencies.
Intrapartum Care: Monitoring and management of the first stage of labourSaide OER Africa
Intrapartum Care was developed for doctors and advanced midwives who care for women who deliver in district hospitals. It contains theory chapters and skills workshops adapted from the labour chapters of Maternal Care. monitoring the mother, fetus, and progress of labour, the second and third stages of labour, managing pain, the puerperium and family planning
This document provides information on the management of normal labor. It defines labor and delivery and outlines the cardinal movements of labor. It discusses assessing and monitoring labor through the stages including fetal wellbeing, maternal wellbeing, and labor progress using a partogram. It covers managing each stage of labor including the first stage of dilation, the second stage of delivery, and the third stage of delivery of the placenta. Key points like positioning, pushing techniques, and care of the newborn are summarized.
In obstetrics, Leopold maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus; they are named after the gynecologist Christian Gerhard Leopold. They are also used to estimate term fetal weight.
The aim of Leopold maneuvers is to determine the fetal presentation and position by systematically palpating the gravid abdomen.
ctto Marie Belen Tamayor - Leopold's Maneuver, Miss Marie's presentation provided the slides that explain Leopold's maneuver.
The physical examination during antenatal care is important to detect any physical problems and establish baseline measurements. The examination includes assessing vital signs, cardiovascular and musculoskeletal systems, weight and height, abdominal examination including fetal position, listening to the fetal heart rate, and pelvic measurements. Laboratory tests are also performed to screen for infections and other issues. Regular antenatal visits include physical exams, ultrasounds, and health education to monitor the mother's and baby's health. Women are advised to follow-up according to the schedule or immediately if any danger signs appear.
This document provides guidance on performing a gynecological examination. It discusses obtaining consent and ensuring patient privacy and comfort. It describes examining the external genitalia, performing a speculum exam to inspect the cervix and vaginal walls, and obtaining specimen samples. It also covers the bimanual exam to palpate the uterus, ovaries, and surrounding structures to identify any masses or tenderness. Proper draping, positioning, infection control and communication with the patient are emphasized throughout the exam.
This document provides definitions for various medical terms related to obstetrics and gynecology. It defines terms such as alpha-fetoprotein, amniocentesis, amnion, amniotic fluid, amniotic sac, anencephaly, and many other terms beginning with letters A through M. Each term is defined concisely and may include a related image for visualization. The document serves as a glossary of OB/GYN terms for medical professionals.
Normal labour involves the spontaneous expulsion of a single, mature fetus through the birth canal within 3-18 hours without complications. It occurs when hormonal and mechanical factors cause the cervix to efface and dilate in stages from 3cm to full 10cm dilation. Labour proceeds through four stages: 1) cervical dilation, 2) expulsion of the fetus, 3) expulsion of the placenta, and 4) recovery. The fetus descends through the birth canal with increased flexion to facilitate delivery of the head.
This document summarizes the stages of labour and management of pain. It describes:
1. Labour is defined as the process of expelling the fetus and placenta from the uterus via contractions after 20 weeks of gestation. It typically occurs between 36-42 weeks.
2. The signs of labour include regular contractions, mucus discharge, and the waters breaking in some cases. Labour progresses through three stages - dilation of the cervix in stage 1; birth of the baby in stage 2; and delivery of the placenta in stage 3.
3. Non-pharmacological approaches to pain management include relaxation, breathing techniques, positioning, water immersion and TENS. Epidural anaest
This document provides information on abdominal palpation of an antenatal mother. It defines antenatal period and abdominal examination. It describes the steps of abdominal palpation including obtaining verbal consent, having the mother lie in dorsal position, inspecting, palpating, and auscultating the abdomen. Palpation includes assessing fundal height and using obstetric grips to determine lie, position, attitude, and presenting part of the fetus. Abdominal examination is important for predicting delivery outcomes.
The document discusses complications that can occur during labor and delivery. It describes complications that can arise from ineffective uterine contractions, including dysfunctional or prolonged labor. It also discusses complications related to the fetus, such as precipitate labor, and complications related to the birth canal, such as uterine rupture. Nursing priorities for a woman experiencing labor or birth complications include monitoring for issues with uterine contractions, the fetus, and the birth canal.
Newborn assessment involves a head-to-toe examination to evaluate various body systems and identify any abnormalities. Key aspects include assessing vital signs like temperature, heart rate, respiration; evaluating skin color, tone, and jaundice; examining the head, eyes, ears, mouth, chest, abdomen, genitals, extremities, and back; and identifying transitional or abnormal findings that require medical follow up. The newborn's temperature may be unstable initially but usually stabilizes within 8-10 hours, and periodic apnea is common in preterm infants. Jaundice typically starts on the head and spreads downward.
The document discusses the physiology of labor, including theories of labor initiation and premonitory signs that labor is imminent. It describes the stages of uterine contractions that characterize true labor, cervical changes like effacement and dilation, and other signs like bloody show. Nursing considerations are outlined for events like rupture of membranes, including actions to take for problems like cord prolapse.
The document provides information on common physiological changes, complications, and nursing care during the postpartum period. It discusses uterine involution, lochia, breast changes, weight loss, and psychological adaptation to motherhood. Potential complications addressed include postpartum hemorrhage, puerperal infection, mastitis, thrombophlebitis, and subinvolution. Nursing goals are outlined to promote healing, prevent infection, establish breastfeeding, and support the new mother.
This document contains definitions and key points related to obstetrics nursing. It defines terms like impending delivery, Ritgen's maneuver, fundal height, hemorrhage and infection checks postpartum. It also outlines stages of labor like cervical dilation, placental delivery, and lochia checks post-fourth stage. Other topics covered include sexual intercourse during pregnancy, HCG function, fluid retention causes, oxytocin production, and vitamin K dosage for full and preterm infants. Fundal pressure techniques and dangers are also defined.
The document outlines the steps for performing a pregnant abdomen examination, including gathering equipment, introducing oneself to the patient, inspecting and palpating the abdomen, assessing fetal position and presentation, measuring fundal height, listening for the fetal heartbeat, and summarizing findings. The examination provides information on the pregnancy and well-being of the mother and fetus. Further assessments like blood pressure, urinalysis, and ultrasound may also be performed.
Primary Maternal Care: Assessment of fetal growth and condition during pregnancySaide OER Africa
Primary Maternal Care addresses the needs of healthcare workers in level 1 district hospitals and clinics who provide antenatal and postnatal care, but do not conduct deliveries. It is adapted from theory chapters and skills workshops from Maternal Care. This book complements the national protocol of antenatal care in South Africa. It covers: booking for antenatal care, assesing fetal growth and wellbeing, hypertensive disorders of pregnancy, antepartum haemorrhage, preterm labour, important medical conditions
The document provides information on managing the normal postpartum period, or puerperium. It defines the puerperium as lasting 6 weeks after delivery of the placenta. During this time, the mother's body returns to its non-pregnant state through physical changes in organs like the uterus, breasts, cardiovascular and gastrointestinal systems. Proper management of the first hour after delivery and routine observations are important to prevent postpartum hemorrhage. With no complications, patients can typically be discharged 6 hours after a normal vaginal delivery or after 3 days for a Cesarean section. Follow-up postnatal care is also required during the 6-week period.
This document discusses the normal process of labor and delivery. It begins by defining labor and childbirth as the period from the onset of regular uterine contractions until expulsion of the placenta. It then discusses fetal positioning including lie, presentation, attitude, and position. The cardinal movements of labor are also summarized, including engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. Mechanisms of labor for both vertex and occiput posterior presentations are presented. Changes in fetal head shape during labor from molding and caput succedaneum formation are also described.
The document discusses several antepartal (before birth) pregnancy complications including abortion (threatened, inevitable, complete, incomplete, missed), ectopic pregnancy, hydatidiform mole/trophoblastic disease, and incompetent cervix. Abortion is the termination of pregnancy before viability and can be threatened, inevitable, complete, or incomplete. Ectopic pregnancy occurs outside the uterus usually in the fallopian tubes and can cause medical emergencies from blood loss. Hydatidiform mole results in abnormal proliferation of chorionic villi and has risks of choriocarcinoma while incompetent
1) Prolapsed umbilical cord occurs when the umbilical cord is displaced into or through the cervix during labor, putting pressure on the cord and restricting blood flow to the fetus.
2) Risk factors include non-cephalic fetal position, prematurity, polyhydramnios, multiple gestation, and disproportion between the fetus and pelvis.
3) Signs include variable fetal heart decelerations, palpation of the cord in the vagina or cervix, and fetal distress. Immediate management involves positioning the mother to relieve pressure on the cord and expedited delivery by cesarean section if the cervix is not fully dilated.
This document provides information on nutrition and protein-energy malnutrition. It defines nutrition and discusses caloric requirements for children of different ages. It also covers topics like breastfeeding, vitamins, protein requirements, and types of malnutrition like marasmus and kwashiorkor. Causes of protein-energy malnutrition include social, economic, biological and environmental factors. The clinical presentation depends on the type, severity and duration of dietary deficiencies.
Intrapartum Care: Monitoring and management of the first stage of labourSaide OER Africa
Intrapartum Care was developed for doctors and advanced midwives who care for women who deliver in district hospitals. It contains theory chapters and skills workshops adapted from the labour chapters of Maternal Care. monitoring the mother, fetus, and progress of labour, the second and third stages of labour, managing pain, the puerperium and family planning
This document provides information on the management of normal labor. It defines labor and delivery and outlines the cardinal movements of labor. It discusses assessing and monitoring labor through the stages including fetal wellbeing, maternal wellbeing, and labor progress using a partogram. It covers managing each stage of labor including the first stage of dilation, the second stage of delivery, and the third stage of delivery of the placenta. Key points like positioning, pushing techniques, and care of the newborn are summarized.
In obstetrics, Leopold maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus; they are named after the gynecologist Christian Gerhard Leopold. They are also used to estimate term fetal weight.
The aim of Leopold maneuvers is to determine the fetal presentation and position by systematically palpating the gravid abdomen.
ctto Marie Belen Tamayor - Leopold's Maneuver, Miss Marie's presentation provided the slides that explain Leopold's maneuver.
The physical examination during antenatal care is important to detect any physical problems and establish baseline measurements. The examination includes assessing vital signs, cardiovascular and musculoskeletal systems, weight and height, abdominal examination including fetal position, listening to the fetal heart rate, and pelvic measurements. Laboratory tests are also performed to screen for infections and other issues. Regular antenatal visits include physical exams, ultrasounds, and health education to monitor the mother's and baby's health. Women are advised to follow-up according to the schedule or immediately if any danger signs appear.
This document provides guidance on performing a gynecological examination. It discusses obtaining consent and ensuring patient privacy and comfort. It describes examining the external genitalia, performing a speculum exam to inspect the cervix and vaginal walls, and obtaining specimen samples. It also covers the bimanual exam to palpate the uterus, ovaries, and surrounding structures to identify any masses or tenderness. Proper draping, positioning, infection control and communication with the patient are emphasized throughout the exam.
This document provides definitions for various medical terms related to obstetrics and gynecology. It defines terms such as alpha-fetoprotein, amniocentesis, amnion, amniotic fluid, amniotic sac, anencephaly, and many other terms beginning with letters A through M. Each term is defined concisely and may include a related image for visualization. The document serves as a glossary of OB/GYN terms for medical professionals.
Normal labour involves the spontaneous expulsion of a single, mature fetus through the birth canal within 3-18 hours without complications. It occurs when hormonal and mechanical factors cause the cervix to efface and dilate in stages from 3cm to full 10cm dilation. Labour proceeds through four stages: 1) cervical dilation, 2) expulsion of the fetus, 3) expulsion of the placenta, and 4) recovery. The fetus descends through the birth canal with increased flexion to facilitate delivery of the head.
This document summarizes the stages of labour and management of pain. It describes:
1. Labour is defined as the process of expelling the fetus and placenta from the uterus via contractions after 20 weeks of gestation. It typically occurs between 36-42 weeks.
2. The signs of labour include regular contractions, mucus discharge, and the waters breaking in some cases. Labour progresses through three stages - dilation of the cervix in stage 1; birth of the baby in stage 2; and delivery of the placenta in stage 3.
3. Non-pharmacological approaches to pain management include relaxation, breathing techniques, positioning, water immersion and TENS. Epidural anaest
This document provides information on abdominal palpation of an antenatal mother. It defines antenatal period and abdominal examination. It describes the steps of abdominal palpation including obtaining verbal consent, having the mother lie in dorsal position, inspecting, palpating, and auscultating the abdomen. Palpation includes assessing fundal height and using obstetric grips to determine lie, position, attitude, and presenting part of the fetus. Abdominal examination is important for predicting delivery outcomes.
The document discusses complications that can occur during labor and delivery. It describes complications that can arise from ineffective uterine contractions, including dysfunctional or prolonged labor. It also discusses complications related to the fetus, such as precipitate labor, and complications related to the birth canal, such as uterine rupture. Nursing priorities for a woman experiencing labor or birth complications include monitoring for issues with uterine contractions, the fetus, and the birth canal.
Newborn assessment involves a head-to-toe examination to evaluate various body systems and identify any abnormalities. Key aspects include assessing vital signs like temperature, heart rate, respiration; evaluating skin color, tone, and jaundice; examining the head, eyes, ears, mouth, chest, abdomen, genitals, extremities, and back; and identifying transitional or abnormal findings that require medical follow up. The newborn's temperature may be unstable initially but usually stabilizes within 8-10 hours, and periodic apnea is common in preterm infants. Jaundice typically starts on the head and spreads downward.
The document discusses the physiology of labor, including theories of labor initiation and premonitory signs that labor is imminent. It describes the stages of uterine contractions that characterize true labor, cervical changes like effacement and dilation, and other signs like bloody show. Nursing considerations are outlined for events like rupture of membranes, including actions to take for problems like cord prolapse.
The document provides information on common physiological changes, complications, and nursing care during the postpartum period. It discusses uterine involution, lochia, breast changes, weight loss, and psychological adaptation to motherhood. Potential complications addressed include postpartum hemorrhage, puerperal infection, mastitis, thrombophlebitis, and subinvolution. Nursing goals are outlined to promote healing, prevent infection, establish breastfeeding, and support the new mother.
This document contains definitions and key points related to obstetrics nursing. It defines terms like impending delivery, Ritgen's maneuver, fundal height, hemorrhage and infection checks postpartum. It also outlines stages of labor like cervical dilation, placental delivery, and lochia checks post-fourth stage. Other topics covered include sexual intercourse during pregnancy, HCG function, fluid retention causes, oxytocin production, and vitamin K dosage for full and preterm infants. Fundal pressure techniques and dangers are also defined.
The document outlines the steps for performing a pregnant abdomen examination, including gathering equipment, introducing oneself to the patient, inspecting and palpating the abdomen, assessing fetal position and presentation, measuring fundal height, listening for the fetal heartbeat, and summarizing findings. The examination provides information on the pregnancy and well-being of the mother and fetus. Further assessments like blood pressure, urinalysis, and ultrasound may also be performed.
Primary Maternal Care: Assessment of fetal growth and condition during pregnancySaide OER Africa
Primary Maternal Care addresses the needs of healthcare workers in level 1 district hospitals and clinics who provide antenatal and postnatal care, but do not conduct deliveries. It is adapted from theory chapters and skills workshops from Maternal Care. This book complements the national protocol of antenatal care in South Africa. It covers: booking for antenatal care, assesing fetal growth and wellbeing, hypertensive disorders of pregnancy, antepartum haemorrhage, preterm labour, important medical conditions
Maternal Care: Assessment of fetal growth and condition during pregnancySaide OER Africa
Maternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers: the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning, regionalised perinatal care
Intrapartum Care: Skills workshop Examination in labourSaide OER Africa
Intrapartum Care was developed for doctors and advanced midwives who care for women who deliver in district hospitals. It contains theory chapters and skills workshops adapted from the labour chapters of Maternal Care. monitoring the mother, fetus, and progress of labour, the second and third stages of labour, managing pain, the puerperium and family planning
This document provides information on examining a pregnant patient and summarizing the stages of labor. It begins with guidelines for conducting the abdominal examination, including obtaining consent and maintaining privacy. It then describes assessing the abdomen through inspection, palpation, and auscultation to determine fetal position, presentation, and other details. Finally, it divides labor into three stages - the first stage from onset to full dilation, the second from full dilation to delivery, and the third being delivery of the placenta. Key points on assessing cervical dilation and the definition and typical durations of each stage are also provided.
An obstetric physical examination involves a full examination of the pregnant woman, including abdominal and pelvic examinations. The abdominal examination assesses the size, shape, and position of the uterus to determine information like fetal presentation, position, and lie. The pelvic examination allows assessment of cervical dilation, effacement, and fetal station and engagement. Together these examinations provide important information about the fetus and progress of the pregnancy or labor.
Primary Maternal Care: Skills workshop Virginal examination in pregnancySaide OER Africa
Primary Maternal Care addresses the needs of healthcare workers in level 1 district hospitals and clinics who provide antenatal and postnatal care, but do not conduct deliveries. It is adapted from theory chapters and skills workshops from Maternal Care. This book complements the national protocol of antenatal care in South Africa. It covers: booking for antenatal care, assessing fetal growth and well being, hypertensive disorders of pregnancy, antepartum haemorrhage, preterm labour, important medical conditions
The document summarizes the management of the three stages of labour. The first stage involves assessing the patient's history and examining cervical dilation and fetal descent using a partogram. The second stage focuses on monitoring the mother and baby, maintaining an optimal birthing position, and gently guiding the baby's head and shoulders out. Immediate newborn care is also described. The third stage centers on delivering the placenta through controlled cord traction and examining for completeness or anomalies. Perineal tears are repaired to prevent bleeding and infection.
Identify the onset of the second stage of labour.
Decide when the patient should start to bear down.
Communicate effectively with the patient during labour.
Use the maternal effort to the best advantage when the patient bears down.
Make careful observations during the second stage of labour.
Assess the fetal condition during the time the patient bears down.
Accurately evaluate progress in the second stage of labour.
Manage a patient with a prolonged second stage of labour.
Diagnose and manage impacted shoulders.
Maternal Care: Skills workshop Vaginal examination in labourSaide OER Africa
Maternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers: the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning, regionalised perinatal care
BREECH DELIVERY By Odokoyero Abdalah Fadhil and Nanfuka MariamOdokonyerofadhil
This document provides an overview of breech delivery, including:
1. Definitions of breech presentation and breech birth, as well as the epidemiology and types/classifications of breech presentations.
2. Risk factors for breech presentation, the diagnosis process, and management options including external cephalic version and vaginal breech delivery.
3. Details on the procedure for a vaginal breech delivery, including positioning, maneuvers to assist delivery of the legs, shoulders, and head, as well as potential complications.
Maternal Care: Skills workshop Vaginal examination in pregnancySaide OER Africa
Maternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers: the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning, regionalised perinatal care
This document outlines the key components of an obstetric physical examination. It defines presentation, attitude, position, station, and engagement of the fetus. It describes inspecting the uterus size and shape and palpating the fundus, back, and head using Leopold's maneuver and lateral palpation. Auscultation is used to assess fetal well-being. During labor, contractions, cervical dilation, effacement, consistency, and position are examined along with status of membranes. The goals are to determine fetal lie, attitude, presentation, position, and engagement as well as assess fetal and maternal health.
The first stage of labor involves the dilation of the cervix from 0-10cm as contractions become stronger and more frequent. It is divided into three phases: latent, active, and transitional. Several factors influence the progress of labor including uterine contractions, cervical effacement and dilation, fetal descent, and pressure from amniotic fluid. Monitoring includes regular assessment of maternal and fetal vital signs, uterine contractions, cervical dilation, and fetal heart rate. Natural pain management methods include breathing exercises, hydrotherapy, and doula support.
Intrapartum Care: Skills workshop Vaginal examination in labourSaide OER Africa
Intrapartum Care was developed for doctors and advanced midwives who care for women who deliver in district hospitals. It contains theory chapters and skills workshops adapted from the labour chapters of Maternal Care. monitoring the mother, fetus, and progress of labour, the second and third stages of labour, managing pain, the puerperium and family planning
This document discusses breech delivery, including definitions, types, incidence, diagnosis, management, and risks. It defines breech delivery as presentation where the fetus is in a longitudinal lie with the buttocks presenting at the pelvis. The main types are complete and frank breech. Incidence is low where high parity births are minimal and cephalic version is routinely performed. Management includes attempting external cephalic version after 37 weeks or planning for cesarean section. Vaginal breech delivery carries risks to the fetus like intracranial damage so careful maneuvers are needed during the second stage of labor to prevent complications.
This document summarizes the normal labor process and its stages. It describes the first stage of labor as dilation of the cervix, usually taking 12 hours for first-time mothers and 6 hours for mothers who have given birth before. The second stage is described as beginning with full cervical dilation and ending with delivery of the fetus, typically taking 2 hours for first-time mothers and 30 minutes for others. The third stage involves delivery of the placenta, usually within 15 minutes. Key parameters like fetal position and presentation are also defined. The document provides details on managing each stage of labor.
The document describes the normal mechanism of labor, including the three stages of labor and the fetus' seven passive movements that enable it to navigate the birth canal. The first stage involves cervical dilation. The second stage is when the fetus is delivered. The third stage involves delivery of the placenta. Key movements include engagement, descent, flexion, internal rotation, extension, restitution/external rotation, and expulsion. Close monitoring of the fetus and mother is important throughout labor.
This document provides information on various obstetric emergencies including definitions, causes, signs and symptoms, diagnosis, and management. It discusses conditions like vasa previa, cord prolapse, shoulder dystocia, hydrocephalus, neural tube defects, and amniotic fluid embolism. For each condition, it outlines the risk factors, diagnostic criteria, potential maternal and fetal complications, and treatment approaches. The document aims to educate medical professionals about life-threatening situations that can arise during pregnancy, labor, and delivery.
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Asp openly licensed stories for early reading in africa mar 2015 slideshareSaide OER Africa
A recent presentation made by Tessa Welch, the African Storybook Project leader, to University of Pretoria Education students on the project and on openly licensed stories for early reading in Africa.
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Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Primary Maternal Care: Skills workshop examination of the abdomen in pregnancy
1. 1B
Skills workshop:
Examination of
the abdomen
in pregnancy
A Preparation of the patient
Objectives for examination
1. The patient should have an empty bladder.
When you have completed this skills 2. She should lie comfortably on her back with
a pillow under her head. She should not
workshop you should be able to:
lie slightly turned to the side, as is needed
• Determine the gestational age from the when the blood pressure is being taken.
size of the uterus.
• Measure the symphysis-fundus height. B General appearance of the abdomen
• Assess the lie and the presentation
The following should be specifically looked for
of the fetus. and noted:
• Assess the amount of liquor present.
1. The presence of obesity.
• Listen to the fetal heart.
2. The presence or absence of scars. When
• Assess fetal movements. a scar is seen the reason for it should be
• Assess the state of fetal wellbeing. specifically asked for (e.g. what operation
did you have?), if this has not already
become clear from the history.
GENERAL EXAMINATION 3. The apparent size and shape of the uterus.
OF THE ABDOMEN 4. Any other abnormalities.
C Palpation of the abdomen
There are 2 main parts to the examination of
the abdomen: 1. The liver, spleen and kidneys must be
specifically palpated (felt) for.
1. General examination of the abdomen.
2. Any other abdominal mass should be
2. Examination of the uterus and the fetus.
noted.
3. The presence of an enlarged organ, or a
mass, should be reported to the responsible
2. SK ILLS WORKSHOP : EXAMINATION OF THE ABDOMEN IN PREGNANC Y 41
Lower edge of sternum
Left hand
Uterus
Pelvic inlet
Figure 1-2 A: Determining the fundal height
doctor, and the patient should then be • If the fundus is palpable just above the
assessed by the doctor. symphysis pubis, the gestational age is
probably 12 weeks.
• If the fundus reaches halfway between
EXAMINATION OF THE the symphysis and the umbilicus, the
UTERUS AND THE FETUS gestational age is probably 16 weeks.
• If the fundus is at the same height as
the umbilicus, the gestational age is
D Palpation of the uterus probably 22 weeks (one finger under
the umbilicus = 20 weeks and one
1. Check whether the uterus is lying in the
finger above the umbilicus = 24 weeks).
midline of the abdomen. Sometimes it is
rotated to either the right or the left.
2. Feel the wall of the uterus for irregularities. F Determining the height of the
An irregular uterine wall suggests either: fundus from 18 weeks gestation
• The presence of myomas (fibroids) The symphysis-fundus height should be
which usually enlarge during measured as follows:
pregnancy and may become painful.
1. Feel for the fundus of the uterus. This is
• A congenital abnormality such as a
done by starting to gently palpate from
bicornuate uterus.
the lower end of the sternum. Continue to
palpate down the abdomen until the fundus
E Determining the size of the uterus is reached. When the highest part of the
before 18 weeks gestation fundus has been identified, mark the skin at
1. Anatomical landmarks are used, i.e. the this point with a pen. If the uterus is rotated
symphysis pubis and the umbilicus. away from the midline, the highest point
2. Gently palpate the abdomen with the left of the uterus will not be in the midline but
hand to determine the height of the fundus will be to the left or right of the midline.
of the uterus: Therefore, also palpate away from the
3. 42 PRIMAR Y MATERNAL CARE
24 weeks
Umbilicus 22 weeks
20 weeks
16 weeks
12 weeks
Figure 1-2 B: Determining the uterine size before 24 weeks
Incorrect
Correct
Figure 1-2 C: Measuring the symphysis-fundus height
midline to make sure that you mark the 2. Measure the symphysis-fundus (s-f) height.
highest point at which the fundus can be Having marked the fundal height, hold
palpated. Do not move the fundus into the the end of the tape measure at the top of
midline before marking the highest point. the symphysis pubis. Lay the tape measure
over the curve of the uterus to the point
4. SK ILLS WORKSHOP : EXAMINATION OF THE ABDOMEN IN PREGNANC Y 43
marking the top of the uterus. The tape H Methods of palpation
measure must not be stretched while
There are 4 specific steps for palpating the
doing the measurement. Measure this
fetus. These are performed systematically. With
distance in centimetres from the symphysis
the mother lying comfortably on her back, the
pubis to the top of the fundus. This is the
examiner faces the patient for the first 3 steps,
symphysis-fundus height.
and faces towards her feet for the fourth.
3. If the uterus does not lie in the midline
but, for example, lies to the right, then the 1. First step. Having established the height
distance to the highest point of the uterus of the fundus, the fundus itself is gently
must still be measured without moving the palpated with the fingers of both hands, in
uterus into the midline. order to discover which pole of the fetus
(breech or head) is present. The head feels
Having determined the height of the fundus,
hard and round, and is easily movable and
you need to assess whether the height of the
ballotable. The breech feels soft, triangular
fundus corresponds to the patient’s dates, and
and continuous with the body.
to the size of the fetus. From 18 weeks, the S-F
2. Second step. The hands are now placed
height must be plotted on the SF growth curve
on the sides of the abdomen. On one side
to determine the gestational age. This method
there is the smooth, firm curve of the
is, therefore, only used once the fundal height
back of the fetus, and on the other side the
has reached 18 weeks. In other words when
rather knobbly feel of the fetal limbs. It is
the S-F height has reached two fingers width
often difficult to feel the fetus well when
under the umbilicus.
the patient is obese, when there is a lot of
liquor or when the uterus is tight, as in
G Palpation of the fetus some primigravidas.
The lie and presenting part of the fetus only 3. Third step. The examiner grasps the lower
becomes important when the gestational age portion of the abdomen, just above the
reaches 34 weeks. symphysis pubis, between the thumb and
fingers of one hand. The objective is to feel
The following must be determined: for the presenting part of the fetus and to
1. The lie of the fetus. This is the relationship decide whether the presenting part is loose
of the long axis of the fetus to that of above the pelvis or fixed in the pelvis. If
the mother. The lie may be longitudinal, the head is loose above the pelvis, it can be
transverse, or oblique. easily moved and balloted. The head and
2. The presentation of the fetus. This is breech are differentiated in the same way as
determined by the presenting part: in the first step.
• If there is a breech, it is a breech 4. Fourth step. The objective of the step
presentation. is to determine the amount of head
• If there is a head, it is a cephalic palpable above the pelvic brim, if there
presentation. is a cephalic presentation. The examiner
• If no presenting part can be felt, it is a faces the patient’s feet, and with the tips
transverse or oblique lie. of the middle 3 fingers palpates deeply in
3. The position of the back of the fetus. This the pelvic inlet. In this way the head can
refers to whether the back of the fetus is on usually be readily palpated, unless it is
the left or right side of the uterus, and will already deeply in the pelvis. The amount
assist in determining the position of the of the head palpable above the pelvic brim
presenting part. can also be determined.
5. 44 PRIMAR Y MATERNAL CARE
Figure 1-2 D: The 4 steps in palpating the fetus
I Amount of head palpable above pelvis 3. 3/5 of the head palpable means that the
head cannot be lifted out of the pelvis. On
The amount of head is assessed by feeling how
doing the deep pelvic grip, your fingers
many fifths of the head are palpable above the
will move outwards from the neck of the
brim of the pelvis:
fetus, then inwards before reaching the
1. 5/5 of the head palpable means that the pelvic brim.
whole head is above the brim of the pelvis. 4. 2/5 of the head palpable means that most
A normal thyroid gland is usually slightly of the head is below the pelvic brim, and
enlarged during pregnancy. on doing the deep pelvic grip, your fingers
2. 4/5 of the head palpable means that a only splay outwards from the fetal neck to
small part of the head is below the brim the pelvic brim.
of the pelvis and can be lifted out of the 5. 1/5 of the head palpable means that only
pelvis with the deep pelvic grip. A normal the tip of the fetal head can be felt above
thyroid gland is usually slightly enlarged the pelvic brim.
during pregnancy.
6. SK ILLS WORKSHOP : EXAMINATION OF THE ABDOMEN IN PREGNANC Y 45
Figure 1-2 E: An accurate method of determining the amount of head palpable above the brim of the pelvis.
J Special points about the palpation K Special points about the palpation
of the fetus of the fetal head
1. When you are palpating the fetus, always 1. Does the head feel too small for the size of the
try to assess the size of the fetus itself. uterus? You should always try to relate the
Does the fetus fill the whole uterus, or size of the head to the size of the uterus and
does it seem to be smaller than you would the duration of pregnancy. If it feels smaller
expect for the size of the uterus, and the than you would have expected, consider the
duration of pregnancy? A fetus which possibility of a multiple pregnancy.
feels smaller than you would expect for 2. Does the head feel too hard for the size of
the duration of pregnancy, suggests intra- the fetus? The fetal head feels harder as the
uterine growth restriction, while a fetus pregnancy gets closer to term. A relatively
which feels smaller than expected for the small fetus with a hard head suggests the
size of the uterus, suggests the presence of presence of intra-uterine growth restriction.
a multiple pregnancy.
2. If you find an abnormal lie when you L Assessment of the amount
palpate the fetus, you should always of liquor present
consider the possibility of a multiple
pregnancy. When you suspect that a patient This is not always easy to feel. The amount of
might have a multiple pregnancy, she liquor decreases as the pregnancy nears term.
should have an ultrasound examination. The amount of liquor is assessed clinically by
7. 46 PRIMAR Y MATERNAL CARE
feeling the way that the fetus can be moved is, therefore, done to rule out an intra-
(balloted) while being palpated. uterine death.
3. How long should you listen for? You should
1. If the liquor volume is reduced
listen long enough to be sure that what
(oligohydramnios), it suggests that:
you are hearing is the fetal heart and not
• There may be intra-uterine growth
the mother’s heart. When you are listening
restriction.
to the fetal heart, you should, at the same
• There may be a urinary tract obstruction
time, also feel the mother’s pulse.
or some other urinary tract abnormality
in the fetus. This is uncommon.
2. If the liquor volume is increased O Assessment of fetal movements
(polyhydramnios), it suggests that one of The fetus makes 2 types of movement:
the following conditions may be present:
• Multiple pregnancy. 1. Kicking movements, which are caused by
• Maternal diabetes. movement of the limbs. These are usually
• A fetal abnormality such as spina bifida, quick movements.
anencephaly or oesophageal atresia. 2. Rolling movements, which are caused by
the fetus changing position.
In many cases, however, the cause of
polyhydramnios is unknown. However, When you ask a patient to count her fetal
serious problems can be present and the movements, she must count both types of
patient should be referred to a hospital where movement.
the fetus can be carefully assessed. The patient If there is a reason for the patient to count
needs an ultrasound examination by a trained fetal movements and to record them on a fetal
person to exclude multiple pregnancy, or a movement chart, it should be done as follows:
congenital abnormality in the fetus.
1. Time of day. Most patients find that the
late morning is a convenient time to record
M Assessment of uterine irritability
fetal movements. However, she should be
This means that the uterus feels tight, or has encouraged to choose the time which suits
a contraction, while being palpated. Uterine her best. She will need to rest for an hour. It
irritability normally only occurs after 36 is best that she use the same time every day.
weeks of pregnancy, i.e. near term. If there is 2. Length of time. This should be for 1 hour per
an irritable uterus before this time, it suggests day, and the patient should be able to rest
either that there is intra-uterine growth and not be disturbed for this period of time.
restriction or that the patient may be in, or is Sometimes the patient may be asked to rest
likely to go into, preterm labour. and count fetal movements for 2 or more
half-hour periods a day. The patient must
N Listening to the fetal heart have access to a watch or clock, and know
how to measure half- and one-hour periods.
1. Where should you listen? The fetal heart 3. Position of the patient. She may either sit or
is most easily heard, by listening over lie down. If she lies down, she should lie on
the back of the fetus. This means that her side. In either position she should be
the lie and position of the fetus must be relaxed and comfortable.
established by palpation before listening 4. Recording of fetal movements. The fetal
for the fetal heart. movements should be recorded on a chart
2. When should you listen to the fetal heart? as shown in Table 1-2 F.
You need only listen to the fetal heart if a
patient has not felt any fetal movements
during the day. Listening to the fetal heart
8. SK ILLS WORKSHOP : EXAMINATION OF THE ABDOMEN IN PREGNANC Y 47
Table 1-2 F: An example of fetal movements re- patient must make a tick on the chart. The
corded on a fetal movements chart time and day should be marked on the chart.
If the patient is illiterate, the nurse giving her
Date Time Total the chart can fill in the day (and times if the
3 July 8–9 6 chart is to be used more than once a day). It is
4 July 11–12 9 important to explain to the patient exactly how
to use the chart. Remember that a patient who
is resting can easily fall asleep and, therefore,
5 July 8–9 3
miss fetal movements.
Between 08:00 and 09:00 on 3rd of July the P Assessment of the state of fetal wellbeing
fetus moved 6 times.
It is very important to assess the state of fetal
Between 11:00 and 12:00 on 4th July the fetus well being at the end of every abdominal
moved 9 times. palpation. This is done by taking into account
Between 08:00 and 09:00 on 5th July the fetus all the features mentioned in this skills
moved 3 times. workshop.
All the movements should be recorded.
Therefore, every time the fetus moves, the
9. 1C
Skills workshop:
Vaginal
examination in
pregnancy
A Indications for a vaginal
Objectives examination in pregnancy
1. At the first visit:
When you have completed this skills • The diagnosis of pregnancy during the
first trimester.
workshop you should be able to:
• Assessment of the gestational age.
• List the indications for a vaginal • Detection of abnormalities in the
examination. genital tract.
• Insert a bivalve speculum. • Investigation of a vaginal discharge.
• Perform a bimanual vaginal • Examination of the cervix.
examination. • Taking a cervical (Papanicolaou) smear.
2. At subsequent antenatal visits:
• Take a cervical smear.
• Investigation of a threatened abortion.
• Confirmation of preterm rupture of the
membranes with a sterile speculum.
INDICATIONS FOR A • To confirm the diagnosis of preterm
labour.
VAGINAL EXAMINATION • Detection of cervical effacement and/or
dilatation in a patient with a risk for
A vaginal examination is the most intimate preterm labour, e.g. multiple pregnancy,
examination a woman is ever subjected to. It a midtrimester abortion, previous
must never be performed without: preterm labour or polyhyramnios.
1. A careful explanation to the patient about • Assessment of the ripeness of the cervix
the examination. prior to induction of labour.
2. Asking permission from the patient to • Identification of the presenting part in
perform the examination. the pelvis.
3. A valid reason for performing the • Performance of a pelvic assessment.
examination. 3. Immediately before labour:
• Performance of artificial rupture of the
membranes to induce labour.