plenary discussion(1)

8/9/2019 Plenary Discussion(1)

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By: Group22 D

PLENARY DISCUSSION


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PHYSIOLOGICAL CHANGES IN PREGNANCY Reproduc !"e or#$%&

I. Uterus:

The muscular organ hold ng the !etus dur ng "regnanc#$

nour shment o! the !etus through the "lacenta. It s d % ded nto

the &od# 'Cor"us$ and !undus(and the cer% ).

Dur ng "regnanc# $ the uterus ncreases n *e ght !rom +, to

-,,,g. In s e$ t changes !rom +./ to 01 cm. In a non "regnant

state$ the uterus s s tuated n the "el% c ca% t#. Dur ng

"regnanc#$ t e)"ands nto the a&dom nal ca% t#. In add t on to the

gro* ng !oetus$ uter ne e)"ans on s caused an ncrease n

connect %e t ssue and n the s e and num&er o! &lood %essels

su""l# ng the uterus


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Uter ne change dur ng "regnanc#


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:'( L!#$)e% ou& &uppor &: -( Round l gaments are 2&rous cords attach ng to the

uterus and l & a ma3ora Dur ng "regnanc#$ the#&ecome elongated and h#"ertro"h ed. The# su""orttheuterus n ts mo%e !rom the "el% c ca% t# nto thea&dom nal ca% t#.

1( 5road l gaments are large !olds o! "er toneum

se"arat ng the "el% s nto the anter or and "oster ord % s ons. The lo*er "ort on o! the l gament s 6no*n

asthe card nal l gaments$ t attaches the lateral as"ecto! the uterus to the su"ra%ag nal area o! the cer% ). 0( Utero sacral l gaments attach the sacrum to the

"oster or as"ect o! the cer% ) to su""ort the cer% ).


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c( Cer"!*:

The "ort on o! the uterus connect ng the &od# o!

the uterus and the %ag na.

-( The nternal os 3o ns the &od# o! the uterus * th

the cer% ).

1( The e)ternal os o"ens nto the %ag na.

0( Dur ng "regnanc#$ the cer% ) s closed. A mucus

"lug !orms o%er the cer% ) $"ro% d ng a "rotect %e

&arr er &et*een the %ag na and the uter ne

contents.


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7( Dur ng la&our and del %er#$ the cer% ) shortens

'or e8aces( and * dens 'or d lates($ e8ect %el#

d sa""ear ng. A -, cm o"en ng s le!t &et*eenthe uterus and the %ag na to allo* !or "assage o!

the !oetus nto the & rth canal.

/( I! the cer% ) &eg ns d lat ng "rematurel#$ t s

somet mes st tched together dur ng the second

tr mester$ unt l the !oetus n mature. Th s"rocedure s 6no*n as a cerclage.


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II. O"$r!e& :

The organs stor ng o%a. Through hormonal

n9uence $ one o%um s de%elo"ed "er month. It

then tra%els nto the !allo" an tu&e and has the

"otent al to &e !ert l ed. One o%ar# s located on

e ther s de o! the uterus$ encased n the "oster or

as"ect o! the &road l gaments.


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III. +$,,op!$% u'e&:

The ducts &r ng ng mature ova !rom the o%ar es

to the uterus via "er stalt c act on.

a( The !allo" an tu&es connect the uter ne cavity to

the a&dom nal ca% t#$ near to the ovary. The

o"en ng at the a&dom nal s te s l ned * th c l a to

"romote the "er stals s necessar# to con%e# the

ovum nto the tu&e.&( The# are s tuated n the su"er or marg n o! the

&road l gaments


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I-. -$#!%$:

The connect ng "assage &et*een the uterus and

the "er neum$ ser% ng as the & rth canal

a( The anter or &orders nclude the &ladder and the

urethra.

&( Laterall#$ the ureters and &road and round

l gaments l e.

c( Poster orl#$ the "er toneum and the recto%ag nal

!asc a.


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Re&p!r$ ory &y& e) Dur ng "regnanc#$ the &od# s n a state o!

h#"er%ent lat on due to h gh le%el o! "rogesterone.

a. 5reath ng &ecomes more costal than a&dom nal.

Add t onall#$ most *omen are mouth &reathers

dur ng "regnanc#.

&. Anatom call#. the d a"hragm s "rogress %el#

ele%ated. Poss &l# &ecause o! e)"ans on andele%at on o! the r & cage. Uter ne "ressure dur ng

the 2rst and second tr mesters does not a""ear to

&e a !actor n th s "henomenon


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Me $'o,!c $%d e%docr!%e c $%#e&-. Rela) n s a hormone secreted the cor"us luteum. the

endocr ne &od# located n the o%ar# at the s te o! the ru"tured

o%ar an !oll cle.

a. Rela) n so!tens connect %e t ssue dur ng "regnanc# n

"re"arat on !or la&our and del %er#. *hen the "el% s must

o"en to allo* !or the & rth o! the !oetus. Rela) n. o*e%er s

not s"ec 2c to the "el% s. Other 3o nts can also &e a8ected.

&. Rela) n "ea6s n earl# and late "regnanc#. ;omen * th

chron c 3o nt nsta& l t# ma# not ce an ncrease n s#m"toms

dur ng these t mes.


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Mu&cu,o&/e,e $, Sy& e)A&dom nal muscles are stretched to the "o nt o! the r

elast c l m t the end o! "regnanc#. ormonal

n9uence on the l gaments s "ro!ound "roduc ng

s#stem c decrease n l gamentous tens le strength

and an ncrease n mo& l t# o! structures su""orted

l gaments and ma# "red s"ose the "at ent to 3o nt

n3ur# es"ec all# n the *e ght


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Po& ur$, c $%#e&:

Dur ng "regnanc#$ "ostural changes occur to accommodate !or

a&dom nal gro*th.a. These changes nclude !or*ard head$ rounded shoulders$

ncreased lum&ar lordos s$ h#"ere)tended 6nees$ and

"ronated !eet.

&. The center o! gra% t# changes$ result ng n changes n

&alance.

c. =uscular changes are also t#" cal. o!ten noted alterat ons

nclude shortened h " 9e)ors$ lo*er &ac6 musculature$ and

"ectorals. A&dom nal muscles$ nec6$ and u""er &ac6 muscle

grou"s elongate. Th s ma# "romote stretch *ea6ness or

ada"t %e shorten ng.


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Po& ur$, c $%#e& !% pre#%$%cy


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Bo%e& $%d 0o!% &:

There s tendenc# to decalc 2cat on o! &ones$

su&la)at on o! 3o nts due to so!ten ng o!

l gaments rela) n hormone. It s more mar6ed

n sacro l ac 3o nt and s#m"h#s s "u& s$ lead ng to

*addl ng ga t.


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Cu $%eou& &y& e)Cu $%eou& &y& e)

Due to o%erstretch ng o! the s6 n$ the elast c 2&er

ma# ru"ture together * th small &lood %essels and so

red strea6s a""ear> 6no*n as str ae gra% da rum.

The# are usuall# more mar6ed &elo* the um& l cus$

on the &reasts and ma# a""ear on the &uttoc6s and

th ghs. In some *omen the# are not mar6ed or e%endon?t a""ear dur ng "regnanc#. A!ter la&our$ the red

str ae &ecome "ale s l%er# *h te due to 2&ros s and

are 6no*n as 'str ae al& cantes(.


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L!%e$ %!#r$


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P gmentat on: It s due to su"rarenal changes$ t

usuall# &eg ns to a""ear a!ter the 7th month. The

" gmentat on ma# a""ear an#*here &ut thecommonest s tes are:

-. L nea n gra: *h ch s a l ne o! " gmentat on

&et*een the um& l cus and the s#m"h#s s "u& s.

1. Increased " gmentat on o! the n ""le as "r mar#areola and a""earance o! the secondar# areola.


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S r!$ #r$"!d$ru)


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0. Cloasma gra% darum or mas6 !ace o! "regnanc#

*h ch s &utter9# " gmentat on o! the !orehead$

nose$ u""er l " and the ad3o n ng "arts o! the

chec6s. Th s " gmentat on ma# "ers st &ut the

cloasma gra% darum usuall# d sa""ears. @all ng

o! ha rs and &r ttleness o! na ls ma# occur dur ng

"regnanc#.


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Bu er y p!#)e% $ !o%


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M$ er%$, e!# #$!% There are no rel a&le data a%a la&le !or *e ght ga n n the 2rst -1

*ee6s o! "regnanc#. 5ut n normal "regnanc# the a%erage ga n

s ,.0 gB*ee6 u" to - *ee6s$ ,.7/ gB*ee6 !rom -


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;e ght ga n s "roduced :

@etus 0.+0


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Ner"ou& &y& e)

@unct onal changes ma# a""ear es"ec all# nneurot c *omen as :


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1. Intrauter ne !etalde%elo"ment


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A cou"le o!hours a!ter!ert l at on

The clea%age stage o! the got.

0 da#s a!ter The got has &een chang ng nto the morulla stage.G telus s the energ# source !or clea%adg ng. Then$the % telus s decreas ng n num&er &ecause o!

recurl# ut l at on.7 da#s a!ter The morula has &een chang ng nto the &lastula

stage. The outer s de o! the &lastoc#st$ thereHs atro!o&las$ *h ch * ll &e !unct on to m"lant on theendometr um. Tro!o&las also "roduce the hChormones.

1 *ee6s a!ter The n%as ! tro!o&las has "enetrated nto &lood%essels n endometr um. The ntertro!o&last c s nushas !ormed.

*ee6s a!tergestat on

the got has n%ated the s"ral s arter#. The n%atedarter# s a&out 7,


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the gastro ntest ne s#stem : the de%elom"ment o! Icould &e chec6ed through US a!ter the -1 *ee6s o!gestat on. On the 1+th *ee6s o! gestat on$ the

en #mesHs start ng to "roduce.

Renal s#stem : On the 11nd *ee6s o! gestat on$ the renalcor"usclesH !ormed n the 3u6staglomerulus one *h ch!unct on to 2ltrate the &lood. The renalHs com"letel#!ormed on the 0+th *ee6s o! gestat on.

The res" rator# s#stem : the res" rator# mo%ement could&e chec6 a!ter -1 *ee6s o! gestat on. On the 07th

*ee6s o! gestat on$ the regular res" rator# mo%ement s7,


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0. Antenatal Care ' ANC (


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ANC s a "re%entat %e measure o! o&stetr ccare !or maternal and neonatal statethrough a ser es o! mon tor ng dur ng"regnanc#

ANC ncludes 0 th ngs:O&ser%at onEducat on=ed cal Treatment


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Schedule % s ts$ n h gh r s6 "regnanc#$

attent on and schedule a % s t should &emore str ngent. In normal "regnanc#$ 3ust7 % s ts ' -: &e!ore 1 *ee6s$ 1: &et*een1


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=ed cal Treatment$ there aresome th ngs #ou should *atch

out !or health care *or6ers a&outthe "ro&lems that occur n"regnant *omen.

e)am"le:5leed ng 'st ll the lead ng causeo! death t nggu(

"reeclam"s aSe%ere "a n n thea&dom no"el% 6um area.


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7. Normal Del %er#Process

4 rd L O


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De,!"ery

U er!%e co% r$c !o%

cer"!c$, d!,$ $ !o%

3e $, $%d p,$ce% $ e*pu,&!o%.

4 rd L.O.


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T e c,!%!c$, & $#e& o3 ,$'or )$y 'e

&u))$r!5ed $& 3o,,o &:

1. S $#e o3 cer"!c$, e6$ce)e%$%d d!,$ $ !o%

2. S $#e o3 3e $, e*pu,&!o%4. S $#e o3 p,$ce% $, &ep$r$ !o%

$%d e*pu,&!o%


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De2n t on ! a &a s &orn * th the &ac6 o! the head

* thout the a d o! tools or hel" and not hurtthe mother and the &a

del %er# mechan sms :a. Stage I&. Stage IIc. Stage III

Stage I


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Stage Is the o"en ng o! the cer% ) .

d % ded nto 1 "hases :

- . latent "hased latat on o! - to 0 cm $ *h ch s %er# slo* !or hours .

1 . act %e "hased % ded nto 0 "hases :

a. Accelerat on "hase

o"en ng occurs 0 to 7 cm !or 1 hours

&. =a) mum d lat on "hase

o"en ng occurs %er# Ju c6l# that o"en ng 7 to cm !or 1 hours

c. Decelerat on "hases

o"en ng &ecomes slo* aga n !rom the o"en ng to -, cm ' !ull o"en ng ( !or 1

hours

So$ the act %e "hase lasted !or + hours $ a total o! all that !or -7 hours .

=em&ranes : mem&ranes * ll ru"ture on ts o*n at the o"en ng o! the 2rst stage scom"lete ' -, ( .

ru"tured mem&ranes s less than the o"en ng / s called "remature ru"ture o!mem&ranes .


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Stage IIa ch ld s"end ng "rocess.

a!ter ru"ture o! the mem&ranes &e!ore$ IS "ressure * ll &e !eltmore strongl# and more Ju c6l# dur ng the t me n 1 to 0 m nutes

Usuall# the &a?s head has entered the "el% c nlet$ so that * ll&e !elt "ressure on the "el% c muscles$ and re9e) %el# ra sedcur os t# stra n ng

And also !elt the "ressure n the rectum that ma6es the "er neum andrectum stand o"en$ and the la& a * ll o"en and * ll loo6 a l ttle "art o! the &a?s head


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And then rela)at on o! the "el% c 9oor * llthen$

* th h s "ressure and stra n ng "ressure$ e) t@orehead and r ght shoulder *as then go ng

to"la# and then e) t out the le!t shoulder l m&s


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Stage IIIIs the detachment o! the "lacenta !rom the uterus*alls and e)"end ture .

a!ter the &a *as out$ the uterus * ll &e !elt hard

n the to" o! the center$ a !e* m nutes later$ theuterus contracts to the "lacenta detaches !rom

theuter ne *all$ the "lacenta * ll come out n + unt l

-/m nutes * th s"ontaneous and e)"end tureaccom"an ed * th &lood .


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/. "re"aturat on


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Puer"eral "er od s the "er od start ng !e*hours a!ter & rth "lacenta unt l + *ee6sa!terch ld& rth 'Pusd 6na6es$1,,0:,,0(.

The "ur"ose o! the "ro% s on o! care n the!uture"artur t on !or:-. =a nta n ng the health o! the mother

and&a$ &oth "h#s call# and"s#cholog cal.


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1. Im"lement screen ng o!&othcom"rehens %e$ earl# detect on$treat orre!er *hencom"l cat ons n the motherand&a.0. Pro% de health educat ona&out health carethemsel%es$nutr t on$ !am l# "lann ng$ ho*and &ene2ts&reast!eed ng$ mmun at onas*ell as the da l# &a care.7. Pro% de !am l# ser% ces"lans/. ett ng emot onal health.


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Puer"eral "er od s d % ded nto threestages$namel#:-. Earl# "uer"er umA reco%er# "er od n *h chthe motherallo*ed to stand anda *al6.1. Puer"eral ntermed alA "er od n *h ch thereco%er# o!re"roduct %e organsdur nga""ro) matel# s ) *ee6s


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.0. Remote "uer"eralThe t me reJu red toreco%erand health# aga n dlam state"er!ect$es"ec all# the mother ! the motherdur ng"regnanc# or dur ng la&ore)"er enc ngcom"l cat ons.


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+. @etal Imag ng

SONOGRAPHY IN


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SONOGRAPHY INOBSTETRICS

The real


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C,!%!c$, App,!c$ !o%&Accurate assessment o! gestat onal age$!etal gro*th$ and the detect on o! !etal and"lacental a&normal t es are ma3or &ene2tso! sonogra"h#.

The sens t % t# o! sonogra"h# !or detect ng!etal anomal es %ar es accord ng to !actorssuch as gestat onal age$ maternal ha& tus$"os t on o! the !etus$ !eatures o! theeJu "ment$ s6 ll o! the sonogra"her$ andthe s"ec 2c a&normal t# n Juest on


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+!r& 7Tr!)e& er E"$,u$ !o%


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Earl# "regnanc# can &e e%aluated us ngtransa&dom nal or trans%ag nalsonogra"h#$ or &oth.; th trans%ag nal scann ng$ the gestat onalsac s rel a&l# seen n the uterus /*ee6s$ and !etal echoes and card acact % t# + *ee6s

The cro*n


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; th 2rst


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Anem&r#on c gestat on


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Ecto" c "regnanc es

Parasag ttal % e*s sho*s an em"t# uter ne ca% t# '*h te

arro*s( and a mass lateral to the uter ne !undus 'red arro*(


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=olar "regnanc es


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=ult !etal gestat on


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+e $, B!o)e ryGar ous !ormulas and nomograms allo*accurate assessment o! gestat onal ageand descr &e normal gro*th o! !etalstructures.

EJu "ment so!t*are com"utes theest mated gestat onal age !rom the cro*n<rum" length. It also est mates gestat onalage and !etal *e ght us ng measurements

o! the & "ar etal d ameter$ head anda&dom nal c rcum!erence$ and !emurlength.


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Ge& $ !o%$, A#eCro*n


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The !emur length '@L( correlates *ell * th&oth 5PD and gestat onal age.It s measured * th the &eam "er"end cularto the long a) s o! the sha!t$ e)clud ng thee" "h#s s$ and has a %ar at on o! to --da#s n the second tr mester


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S %d7 $%d T ! d7T !) &


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Seco%d7 $%d T !rd7Tr!)e& erE"$,u$ !o%&


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. Drugs n "regnanc#


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Categor# o! the sa!et#ness o! drug n"regnanc#:A : sa!e !or "regnant *oman. Eg: !ol c

ac d$ % t c$ "rasetamol$ etc5: sa!e &ut l m ted !or usage. Eg:amo) c l n$ eretrom s nC: &ad e8ect to !etus. Eg: am no2l n$d go6s nD: caused mal!ormat on. Eg:tetras 6l n$ d a e"am

: contra nd cat on. Eg: thal dom d


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Drugs that needed to &e care!ul !or lactat on:

-. Ant 6oagulan. Eg: *ar!ar n. Onl# g %en toa&normal &lood case. 5ecause the amount o!the drug n ASI s h gher than n the "lasma.Danger


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. E8orts to "re%entcom"l cat on n"regnanc#$la&or and

"artur t on


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Partur t on< ensur ng the uterus rema ns contracted* th n one hour a!ter del %er#< "lacenta manual$ ! "lacenta does notcome out a!ter an hour o! la&or< n!ect on "re%ent on< soc al su""ort


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