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MIDWIFERY 2

STUDY GUIDE

NORMAL LABOUR AND PUERPERIUM




Welwitchia University
Bachelor of Nursing science
Compiled by: Mrs E Kawerema



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,TABLE OF CONTENTS



UNIT 1: PHYSIOLOGICAL CHANGES IN PREGNANCY ............................................................................... 3

UNIT 1:1 SIGNS, SYMPTOMS & DIAGNOSIS OF PREGNANCY.............................................................. 7

UNIT 2: PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV DURING PREGNANCY .............. 11

UNIT 3.1: PHYSIOLOGICAL CHANGES TO THE WOMAN DURING FIRST STAGE OF LABOUR ............. 27

UNIT 3.2 THE ROLE OF THE MIDWIFE IN FIRST STAGE OF LABOUR.................................................. 31

UNIT 3.3 PAIN RELIEF DURING LABOUR .......................................................................................... 40

UNIT 3.4 PHYSIOLOGY AND MANAGEMENT OF SECOND AND THIRD STAGE OF LABOUR .............. 43

UNIT 3.5 THE MANAGEMENT OF A WOMAN IN FOURTH STAGE & NEW BORN CARE .................... 57

UNIT 4: PUERPERIUM............................................................................................................................ 64

UNIT 4.1 ASSESSMENT AND CARE OF A WOMAN IN PUERPERIUM ................................................. 70

UNIT 4.2: THE NEW BORN................................................................................................................. 76




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,UNIT 1: PHYSIOLOGICAL CHANGES IN PREGNANCY
Dynamic changes take place in the body of a pregnant woman in order to
maintain the pregnancy and accommodate the growing foetus, nourish the
foetus during the period of growth provide the woman with energy for delivery
and prepare for lactation


UTERUS

 Increase in size 7.5x5x 2.5cm to 30x23x20 cm

 Increase in weight 50 -60 g to 900 -1000g

 Increase in volume 6ml to 5000ml

 Upper portion of the body containing the blastocyst enlarges and is called
the upper uterine segment

 The lower portion of the uterus adjacent to the cervix called isthmus
softens and lengthens in early pregnancy
 After the first trimester the elongated isthmus is drawn up and forms the
lower uterine segment
 At 12 weeks the uterus can be felt above the pelvis

CERVIX

 In second trimester the cervix widens and softens and secretes mucus
which forms a mucus plug- this act as a barrier for against ascending
infections

 Later the cervix becomes partly effaced(taken up) due to Blackston Hicks
contractions

 the cervix changes from pink to dark purplish colour

 The blood supply to the uterus increases with uterine growth. At term
blood flow ranges from 500mls to 700mls

VAGINA


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,  The muscles fibres of the vagina hypertrophy during pregnancy. The
vagina develops a larger lumen and increase in the ability to stretch. It
becomes very vascular and becomes dark purplish

VULVA

 Increases in vascularity resulting in a darker colour. Vulva veins may
occur

FALLOPIAN TUBES

 Hypertrophy and become more vascular

 As the uterus grows they are lifted out of the pelvis

OVARIES
 The blood supply increase and they are drawn up into the abdominal
cavity
BREASTS
 3 to 4 weeks- there is a pricking and tingling sensation. The ducts and
alveolar system enlarge due to oestrogen and progesterone
 6 weeks to 8 weeks breasts increase in size and vascularity
 12 weeks the nipples enlarge and become more prominent
 16 weeks there is secondary areola
 Colostrum can be expressed

THE SKIN

 Due to hormones there is increase in pigmentation on the face its called
chloasma

 Linea nigra develops( darkening of a thin line extending from the
syphysis pubis to the umbilicus

 Stria gravidarum develops-(rapid stretching of the skin of abdomen,
thighs and breasts


CARDIOVASCULAR SYSTEM
The heart
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