1. The period following parturition

2. Being in the period following parturition

1. The termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus: 

2. spontaneous expulsion of a human fetus during the first 12 weeks of gestation

3. induced expulsion of a human fetus

Providers of

Maternity Care

1. Obstetrician/Family Practice Physicians

2. Nurses (Perinatal)

3. Midwife; Lay midwife

4. CNM:  Certified Nurse Midwife

5. Advanced Practice Roles

1. Maternal age - As we age uterus becomes less hospitable to pregnancy

2. Fibroids - The egg finds it difficult to find a suitable surface for implantation

3. Abnormal endometrial development - The uterus, each month plans for implantation by developing a thick, nurturing endometrium.  If there is no fertilization and implantation it is sloughed off in the menstrual cycle.

4. Endometriosis - May prevent implantation

Egg: ~24 hours

Sperm: ~72 hours

Most eggs are fertilized in the fallopian tube.

The fertilized egg migrates to uterus.

Implantation typically occurs in the top of the uterus (fundus) in the posterior section.

A pregnancy occurring outside the uterus. (Typically in fallopian tube).

Produces increased hormonal changes resulting in positive pregnancy test. As embryo grows it becomes too big for the fallopian tube.  Manifests as strong abdominal pains. 

Ultrasound to diagnose location before tube ruptures.

Pregnancy Test:

Urine

Qualitative test

(use first morning urine)

Quantitative test

Measures level of HCG in blood

(higher levels indicate more viable pregnancy)

Identical twins

(can be single sac or separate sacs)

Fraternal twins

(separate sacs and placentas)

Proliferative Phase:

endometrial lining is building

Secretory Phase:

endometrial lining is shed

(this phase is sometimes missed for

various reasons)

Symptoms experienced by male significant other that mimic symptoms of pregnancy

(feeling like he's retaining water; weight gain, etc)

Pregnancy Tasks:

First Trimester

Birth Stage:

Contraction

Premonitory Signs

of Labor

1. Lightening - when the baby drops

2. Pelvic Pressure - feeling like "insides will

                             drop out"

3. Urinary Frequency

4. Irregular Contractions

5. Diarrhea, indigestion, slight weight loss

6. Loss of mucous plug, bloody show

7. Change in vaginal mucosa

8. Burst of energy

Process is not fully understood.

Combination of maternal and fetal factors... could be one or a combination of the following:

• oxytonin/receptors
  • as pregnancy progresses, uterus develops more oxytonin receptors
• prostaglandins
  • cause cramping
• hydrostatic properties of the amniotic sac

Period of Gestation

(Term)

• 10 Lunar months (40 weeks)
  • "Term" babies are 37 weeks or more gestation
  • "Preterm" babies are <37 weeks

• Irregular contractions that do not increase in
  • Frequency
  • Intensity
  • Duration
• Walking decreases intensity
• Sedation stops contractions
• No cervical changes
• No bloody show

Labor

(Symptoms and Progression)

Causes of

Postpartum Hemorrhage

•  Uterine atony
•  Lacerations of genital tract
•  Hematomas
•  Retained placental fragments
•  Uterine inversion
•  Blood coagulation disorders
  • DIC

Postpartum Hemorrhage

• Blood loss:
  • 500 ml - vaginal birth
  • 1000 ml - cesarean section

Early/Late

Postpartum Hemorrhage

• Early: during the first 24 hours > birth

Postpartum Hemorrhage

Complications

• Hypovolemic shock

• Anemia

Causes of

Postpartum Bleeding

• Uterine atony (lack of normal muscle tone)

• Genital lacerations

Causes of

Postpartum Hematoma

• Forceps manipulation
•  Pressure on pelvic structures (presentation)
•  Macrosomia
•  Prolonged 2^nd stage
•  Epidural anesthesia
•  Excessive fundal pressure

Postpartum

Coagulation Disorders

•  Disseminated Intravascular Coagulation
•  ITP
•  Von Willebrand’s disease

PPH Assessment:

Uterine Atony

•  Boggy uterus

•  Clots

•  Evident bleeding
  • Slow, steady
  • Sudden, massive

• Firm uterus

PPH Assessment:

Hematoma

•  Firm uterus
•  Extreme perineal or pelvic pain
•  Bluish bulging area under skin surface
•  Difficulty voiding
•  s/s shock

• Placenta not intact (check chart for placenta examination after birth)
• Uterus large
• Painless bright red bleeding

• Petechiae
• 
  
• Ecchymosis
• 
  
• Prolonged bleeding from punctures/gums
•  Tachycardia
•  Oliguria
• 
  
• Convulsions
• 
  
• Coma