Some key point of Obstetrics and gynecology (obg)

(OBSTETRICS & GYNAECOLOGY)
 External genitalia also called vulva.
 Labia majora contains sebaceous gland, sweat gland and hair follicle.
 Labia majora is homologous to scrotum in the male.
 The lower portion of the labia minora fuse and across the midline to form a
fold of skin called FOURCHETTE.
 Labia minora homologous to penile urethra and foreskin o penis.
 Vestibule contain four openings Urethral opening, Vaginal opening, Bartholin
ducts opening and skene’s gland opening.
 Bartholin gland is first describe by dutch physician casper bartholin .
 Vestibular bulb is homologous to the corpus spongiosum in male.
 Clitoris is homologous to the penis in male.
 Perineum is the space between the fourchette and anal canal in female.
 Vaginal canal is directed upward and backward forming an angle of 450 with
the horizontal in erect posture.
 Diameter of vaginal canal is 2.5 cm being widest in upper part and narrowest
at introitus.
 Fornices is the space between the vaginal part of cervix and vaginal wall.
 The PH of vagina is acidic (3.8-4.5) from puberty to menopause because of
the presence of doderlein’s bacilli.
 Anterior wall of vagina is 7cm long and posterior wall is 9cm long.
 Position of uterus is anti-vertex(900
) and anti flexion(1200
)
 Size of uterus is 8cm long, 5cm wide and 2.5cm thick & weight 50-80gm.
 Implantation is take place in the upper part of the body of uterus.
 Pouch of douglas is a pouch of peritoneum between uterus and rectum.
 Fallopian tube also called uterine tube or oviduct.
 Fallopian tube is about 10 cm long and largest part of fallopian tube is
ampulla.
 Fertilization is usually occurs in ampulla of fallopian tube.
 Ovary is measure about 3cm long, 2cm wide, and 1cm thick.

 Pelvic floor is formed by three muscles the pubococcygeus, iliococcygeus and
ischiococcygeus which collectively called levator ani.
 The breast extended from 2-6 ribs.
 Thelarche is the first sign of puberty in female and testicular enlargement is
the first sign of puberty in male.
 Menarche is the first menstrual period, occur at average age of 12 years.
 The period of onset of menstrual cycle is 21-35days and average of 28 days.
 Amount of blood loss in a menstrual cycle is about 20-80 ml and average 35
ml.
 The end of menstrual phase the thickness is about 1mm only.
 Fertilization occurs within 12 hours of ovulation and 2-3 days of
insemination.
 Implantation completed on 10-11 days after fertilization.
 Bleeding during implantation in uterus is called Hartman’s sign.
 Feto-placental circulation begins at 21-22 days.
 Heart begins to beat at 5 weeks and every system is present at 8 weeks.
 Heart beat is detected by Doppler transducer at 10-12 weeks.
 Fetal daily urine output at term is about 400-1200 ml.
 The fetus swallow about 200-500 ml of liquor every day at term.
 Amniotic fluid is alkaline in nature and straw color at term.
 If amniotic fluid color is Green indicate fetal distress, Golden color indicate
Rh incompatibility, Greenish yellow (saffron) color indicate post maturity,
Dark Red color indicate hemorrhage & Dark Brown color (tobacco juice)
indicate IUD.
 Oligohydramnios is the condition in which amniotic fluid level is less than 200
ml.
 Human placenta is hemochorial deciduate & discoid shape.
 Trophoblastic layer is the fetal part of placenta which form 4/5 part of the
placenta.
 Deciduas basalis is the maternal part of placenta which form 1/5 part of the
placenta.
 At term the placenta is circular disk shape, 15-20cm in diameter, 2.5 cm
thick, 500gm in weight and occupies about 30% of the uterine wall.
 Cytoledon or placentome or stem villi are consider as functional unit of
placenta.
 Maternal blood flow in intervillous space at 500-600ml/min. & fetal blood
flow through placenta at 400ml/min.
 Mature placenta contain 500 ml of blood which is present 150 ml in
intervillous space and 350 ml in villi system.
 Pressure in umbilical artery is 60 mmHg and umbilical vain is 10 mmHg.
 In pregnancy hCG hormone can be detected as soon as 8-9 days of pregnancy
& maximum level at 60-70 days.
 hCG is produced by syncytotrophoblast layer of the chorionic villi of placenta.
 The foremen ovale is functionally closed at just after birth and anatomically
closed after 1 year of birth.
 Umbilical cord is also known as funis.
 Umbilical cord contain 2 vain & 2 artery but after 4 months of gestation right
umbilical vain is disappear and remain 1 vain & 2 artery.
 The length of umbilical cord is about 50cm.
 Placenta circumvallate is the condition in which an opaque ring is seen on the
fetal surface of the placenta.
 If the umbilical cord attached to the margin of placenta is called battledore
placenta.
 Single umbilical artery is seen in twin pregnancy, baby born with diabetic
mother & polyhydramnios.
 Sex of fetus is visually recognizable at 12 weeks of pregnancy.
 At 20 weeks of pregnancy heart is detected by fetoscope.
 At 24 weeks of pregnancy fetus has ability to hear.
 At 32 weeks L:S (lecithin:sphingomylin) ratio is 1.2:1 & at 36 weeks L:S is 2:1.
 Symphysis pubis is a cartilaginous joint formed by junction of two pubic bone
along the midline.
 True pelvic is diamond in shape.
 Diagonal conjugate is line from the sacral promontory toward the lower
border of the symphysis pubis and measure about 12cm.
 Most common type of pelvic is gynaecoid pelvic.
 Suture are cranial joints and are formed where two bones adjoin and where
two or more suture meet form fontanels.
 Anterior fontanels is also called bregma which is diamond shape and closed
at 12-18 months after birth.
 Posterior fontanels is also called lambda which is triangular shape and close
at 2 months after birth.
 The largest anterior posterior diameter of fetal skull is mento-vertex which is
about 14cm in diameter.
 Caput succedaneum is the formation of swelling due to stagnation of fluid in
the layer of scalp beneath the girdle of contact.
 Cephalo hematoma is the collection of blood in between the periostium and
the flat bone of skull, due to rupture of small vein.
 Most common presentation is vertex presentation.
 The point between the eye brow is called glabella.
 In prenatal period the first trimester is consider from 0-12 weeks, second
trimester 13-28 weeks and third trimester is 29-40 weeks.
 Uterus is become abdominal organ after 12 weeks of pregnancy.
 Jacquemier/Chadwick sign is discoloration of the cervix and vagina, visible at
8weeks of pregnancy.
 Osiander sign is increase pulsation of vagina, felt through the lateral fornices
at 8 weeks.
 Goodell’s sign is softening of cervix, at 6 weeks of pregnancy.
 Hegar’s sign is softening of lower uterine segment, at 6-10 weeks.
 Palmer’s sign is regular and rhythmic uterine contraction, at 4-8 weeks.
 Uterus is hen’s egg size at 6 weeks, cricket ball size at 8 weeks, and fetal head
size at 12 weeks.
 Pyriform shape of uterus is become globular at 12 weeks of pregnancy.
 Asymmetric enlargement of uterus if there is lateral implantation is called
PISKACEK’S SIGN.
 Perception of active fetal movement by mother is called quickening, felt at
18 weeks in primigravida and at 16 weeks in multigravida.
 Pigmentation over the forehead and cheek is called chloasma/butterfly sign,
appears at 24 weeks.
 Fetal skeletal shadow may be visible in radiological examination at 16 weeks.
 Lightening is the sense of relief of pressure symptoms. It is also called
welcome sign of pregnancy.
 Nagele’s rule for estimating the date of confinement is first day of the last
menstrual cycle + 9 months + 7days.
 Gravidity is refers to number of pregnancy.
 Parity is the number of previous pregnancy past 20 weeks of gestation.
 Pregnancy outcome can be describe the acronym GTPAL.
 Presumptive sign of pregnancy are amenorrhea, pronounced nipple, urinary
frequency, quickening etc.
 Probable sign of pregnancy are uterine enlargement, hager sign, goodell’s
sign, Chadwick sign, etc.
 Positive sign of pregnancy is fetal heart sound and active fetal movement
palpable by examiner.
 During the second and third trimester, fundal height in centimeter
approximately equals the fetus age in weeks plus or minus 2cm.
 Fundal grip is also called first Leopold, which is use to determine the part of
fetus in the fundus of uterus.
 Lateral grip is also called umbilical grip or second Leopold.
 First pelvic grip is also called fourth Leopold, used to determine how far fetus
has descended into pelvic inlet.

 Second pelvic grip is also called pawlik grip or third Leopold, used to confirms
fetal position.
 During pregnancy the total blood volume is increased by 40-50% of total
blood volume.
 In pregnancy physiological anemia occur as the blood plasma increase
exceeds the increase in the red blood cell production.
 Blood pressure may decline in second trimester due to decrease in systemic
vascular resistance due to smooth muscle relaxing effects of progesterone.
 Supine hypertension syndrome or vena cava syndrome is the condition in
which the weight of uterus on vena cava decrease the venous returns to
heart and decrease placental blood flow.
 Nursing role during pregnancy is to advise patient to elevate legs, avoid
prolonged sitting, change position slowly and increase fluid intake.
 Nasal congestion and epistaxis are seen in pregnancy due to increase level of
estrogen.
 During pregnancy oxygen consumption is increase by 15-20%.
 Nausea and vomiting are common in pregnancy due to increased hCG.
 Heart burn and gastric reflux are seen in pregnancy due to delayed emptying
of stomach and pressure of uterus.
 During pregnancy GFR is increased by 50%.
 Progesterone and estrogen is secrated by corpus luteum in 1st trimester and
by placenta in 2nd & 3rd trimester.
 During pregnancy uterus weight is increased from 60 mg to 1000mg.
 During pregnancy sebaceous glands are hypertrophied, are called
montgomery’s tubercles.
 In pregnancy patient have fasting hypoglycemia due to fetal consumption
and post prandial hyperglycemia due to anti insulin factor like estrogen,
progesterone, prolectin.
 In pregnancy PCo2 Fall from 40 to 32 and Po2 rise from 95 to 105 mmHg, it
causes respiratory alkalosis.
 Tidal volume is increase in pregnancy at 700 ml.
 Total weight gain in during pregnancy is about 11kg.
 If the weight gain is more than 0.5kg a week, it may be early sign of pre-
eclampsia, and falling in weight suggest IUGR or IUD.
 During pregnancy calories should be increase 300cal/day.
 Sodium is never restricted during pregnancy, given in normal amount
 Nurse should advise the patient to take multivitamin with 400mcg folic acid
daily before conception and during pregnancy to prevent neural tube
defects.
 Avoid smoking, alcohol and excessive standing or work that cause severe
physical strain/fatigue during pregnancy.
 Caffeine is increase the risk of spontaneous abortion and intrauterine growth
retardation during pregnancy.
 If hCG levels increases may indicate ectopic pregnancy, hydatidiform mole, or
down syndrome.
 USG is used to assess bi-parital diameter, abdominal circumference, head
circumference, crown rump length and amniotic fluid volume etc.
 Chronic villus sampling is used to detecting genectic abnormality, performed
at 10-13 weeks.
 Spotting is expected for 3days after chronic villus sampling through trans-
cervical route.
 Maternal serum alpha-fetoprotein (MS-AFP) screening is performed to
determine neural tube defect, abdominal wall defect, spina bifida and down
syndrome.
 MS-AFP is performed at 16-18 weeks of pregnancy.
 Cordocentesis is performed at 17 weeks of pregnancy.
 Amniocentesis the aspiration of amniotic fluid through the abdominal wall
below the umbilicus, done on 15-20 weeks of pregnancy for identifies
chromosomal abnormalities.
 Nitrazine test and fern test is used to determine amniotic fluid with ruptured
membrane.
 To assess the risk of pre-term labor fetal fibronectin test is performed.
 Non stress test is determine the fetal well being and fetal heart rate response
to fetal movement.
 During non stress test left lateral position is given to decrease the risk of
vena cava syndrome.
 Contraction stress test is done after nonreactive non stress test.
 Lie is the relationship of the long axis of the fetus to the long axis of the
mother’s uterus, and normal lie is longitudinal lie.
 Attitude is the relationship of the fetal part one another and normal attitude
is flexion.
 Presenting part is the part of fetus felt at lower part of uterus during vaginal
examination.
 Presentation is the part of the fetus in the lower pole of the uterus and the
normal presentation is vertex.
 Position is the relationship of the denominator to the six areas of the
mother’s pelvis, normal position is anterior.
 Denominator is the part of fetus which determine the position,(vertex-
occipito, breach-sacrum, face-mentum).
 Pre-eclampsia is characterized by increased blood pressure(140/90) and
protein urea after 20 weeks of pregnancy.
 In case of hydatidiform mole and polyhydroamnios the pre-eclampsia feature
may appear before 20 weeks of pregnancy.
 In case of pre-eclampsia the deep tendon reflex should be monitor, hyper
reflexia indicate increased CNS irritability.
 HELLP Syndrome (hemolytic anemia, elevated liver enzyme low platelet
count) is seen in pre-eclampsia.
 Depressed/absent deep tendon reflex, respiratory rate below 12/minute,
and MgSo4 blood level above 8 mg/dl is the sign of MgSo4 toxicity.
 Calcium gluconate is the antidote of MgSo4.
 If the pre-eclampsia is occur with seizure is called eclampsia.
 In tonic phase of seizure respiration ceases and in clonic phase the tongue
biting occurs.
 Drug of choice for eclampsia is MgSo4.
 During seizure the safety and airway protection is the first prority of the
nurse.
 In case of eclampsia always be prepare for cesarean section.
 Polyhydramnios is the condition in which the amount of amniotic fluid is
more than 2000ml .
 Diabetes mellitus in mother causes hyperglycemia in fetus and resulting
polyurea in fetus and causes polyhydramnios.
 During pregnancy the pre-mature repture of membrane is the most common
complication.
 In case of polyhydramnios, endomethacine 25 mg orally give to mother to
decrease fetal urine output.
 Amnion reduction or therapeutic amniocentesis is also used in some cases of
polyhydramnios. The amniotic fluid is removed at the rate of 500 ml/hrs.
 Oligohydramnios is a condition in which the amount of amniotic fluid is less
than 200 ml.
 Oligohydramnios with fetal symmetric growth retardation is associated with
increased chromosomal abnormality.
 Potter syndrome is the condition caused by oligohydramnios, in which fetus
develop pulmonary hypoplasia, limb deformities, and characteristic facies.
 A molar pregnancy is a gestational trophoblastic disease which grows into a
mass in the uterus that has swollen chorionic villi, these villi grow in the
clusters that resemble like grapes.
 Hydatidiform moles are a common complication of pregnancy, occurring
once in every 1000 pregnancies in the US, with much higher rate in Asia.
 Women under 20 years or over 40 years of age have higher risk of developing
molar pregnancy/hydatidiform mole.
 In case of molar pregnancy the ultrasound show the molar resembles as
bunch of grapes(cluster of grapes or honeycombed uterus or snow-storm)
 Hydatidiform moles should be treated by evaluating the uterus by uterine
suction or by surgical curettage as soon as possible after diagnosis, in order
to avoid the risk of choriocarcinoma.
 Gestational diabetes can develop in overweight, hyperinsulinemia, insulin
resistant women or in thin women .relatively insulin deficient women.
 Oral glucose tolerance test or a single plasma glucose measurement is used
for diagnosis of gestational diabetes.
 In gestational diabetes mother the postpartum insulin requirement is may
decrease by up to 50%.
 Congenital malformations of major organs are predicated by elevated HbA1C
levels at conception and during the first 8weeks of the pregnancy.
 Anti-partum hemorrhage (APH) is genital bleeding during pregnancy from the
24 weeks gestational age to term.
 Anti-partum hemorrhage is should be considered as medically emergency.
 Most common cause of APH is bloody show (benign).
 Most common pathological cause of APH is placental abruption.
 Most common secondary pathological cause of APH is placenta previa.
 Placenta previa is the condition in which placenta implanted partially or
completely in the lower uterine segment.
 Placenta previa is the leading cause of APH.
 Women with placenta previa often present with painless, bright red vaginal
bleeding, occurs around 32 weeks of gestation but can be as early as late mid
trimester.
 Placenta previa is a risk factor of placenta accrete.
 Vaginal examination is avoided in known cases of placenta previa.
 Confirmatory test for placenta previa is ultrasound.
 In minor degrees of placenta previa (grade I & II), vaginal delivery and in
major degrees (grade III & IV) caesarean section indicated.
 Placental abruption/abruption placentae is complication of pregnancy,
where in the placenta has separated from the uterus after 20 weeks of
pregnancy and prior to birth.
 Placental abruption is the most pathological cause of late pregnancy
bleeding.
 Pain full vaginal bleeding is the most common sign of placental abruption.
 Risk factor of placental abruption are pre-eclampsia, chronic hypertension,
maternal smoking, multiparity, cocaine abuse during pregnancy etc.
 The risk of placental abruption is can be reduced by maintaining a good diet
including taking folic acid, regular sleep patterns and correction of pregnancy
induced hypertension.
 Postpartum bleeding or postpartum hemorrhage(PPH) is defined as the loss
of more then 500ml of blood within the 24 hours following delivery.
 PPH can occur up to six weeks following delivery.
 The non-pneumatic anti shock garment is used in PPH to control bleeding
until other measures such as surgery can be carried out.
 Uterine atonicity is the most common cause of PPH, others are trauma,
retained placenta, and coagulopathy.
 Uterine atony is the inability of the uterus to contact and may led to
continuous bleeding.
 Oxytocin and misoprostol may is used after delivery to prevent the PPH.
 Encouraging the baby to baby to suckle soon after birth may reduce the risk
of PPH, because breastfeeding triggers the release of natural oxytocin.
 Uterine massage is the simple first line treatment of the PPH.
 IV oxytocin is the drug of choice for PPH.
 Abortion is the spontaneous or planned expulsion of products of conception
before the period of viability(before 22 weeks), weighing less than 500 mg.
 If abortion is occurs before 12 weeks of gestation it is referred to early
abortion and thereafter is term as late abortion.
 The product of abortion is known as aborts.
 The incidence of the abortion is 10-20% in clinical pregnancy and 10%
induced in illegal cases.
 75 % of abortion is occur before 16 weeks and out of these 75 % cases, 75%
cases occur before 8 weeks.
 Chromosomal abnormalities is the most common cause of the abortion.
 Cervical incompetency is second most common cause of the abortion.
 Threatened abortion is type of abortion in which the process of the abortion
is started but continuation of the pregnancy is possible and less vaginal
bleeding occur.
 In Inevitable abortion the process of abortion is started but we cannot
continue the pregnancy.
 If the entire product of the conception is come out followed by less or scanty
vaginal bleeding is known as complete abortion.
 If the some product of conception is expel out and some remain inside the
uterus is known as incomplete abortion.
 Recurrent abortion is refers to any case in which there have three or more
continuous abortions.
 Main cause of the recurrent abortion is cervical incompetence.
 In recurrent abortion if patient have no history of parity abortion is called
primary recurrent abortion and if patient have history of parity before
abortion is called secondary recurrent abortion.
 For the management of the recurrent abortion circcalge operation is done at
14 weeks of gestation.
 In MCDONALD Circcalge operation 3-4 stitch is done, and in shirodkar
circcalge operation 1 stitch is done at cervix.
 The non absorbable suture material used in circcalge operation is removed at
36 weeks of gestation.
 Any abortion which is associated with infection is called septic abortion.
 Missed abortion is the abortion in which the fetus is dead and remain in
uterus more than 4 weeks and female is not aware about.
 In case of missed abortion the fibrinogen levels should be checked until the
fetus and placenta are expelled.
 MTP act is formed in 1971, and came in force in april 1972, and amended in
1975.
 Induced abortion is the safe hygienic and legal termination of pregnancy by a
qualified medical practitioner, who’s assisted 25 MTP and 6 moths diploma in
obstetrics and gynecology.
 In MTP the informed consent must be sign by self if the patient age is above
18 years.
 MTP reports must be kept confidential.
 MTP kit (DGHS) contain tab. Mifepristone(200 mg) orally, and tab.
Misoprostol (200 mcg) vaginally.
 If the mother is Rh negative than administer RhoGAM with 72 hours of
abortion, delivery.
 In case of abruption placenta the risk of disseminated intravascular
coagulation (DIC) is increased.
 Hyperemesis gravidarum is the condition in which excessive nausea &
vomiting beyond 1st trimester causing fluid & electrolytes and nutritional
imbalance.
 Trichlorpromazine is the drug of choice in hyperemesis garvidrum in
pregnancy.
 When more than one fetus is develop simultaneously in the uterus, it is
called multiple pregnancy.
 Simultaneously development of the fetus in the uterus is called twins.
 Twins are dizygotic or monozygotic types.
 Dizygotic twins are also called feternal or binovular twins, which results from
fertilization of two ova.
 Monozygotic twins are also called identical or uniovular twins, which results
from one ova.
 If twins are joined by thorax, called thoracopyophagus.
 If twins are joined by back, called pyopagus.
 If twins are joined by cephalic (head), carniopagus.
 If twins are joined by caudal, called ischiopagus.
 During multiple pregnancy commonest presentation is vertex, and
commonest lie is longitudinal.
 Superfecundation is the fertilization of the two different ova released in
same cycle, by separate coitus in short period.
 Superfetation is the fertilization of two different ova release in different
cycle.
 Fetus papyraceous or compress is the state in which one the fetus dies early
and dead fetus is flattened and compress between the membrane of the
living fetus and uterine wall.
 Fetus acardius occur only in monozygotic twins, in which one fetus become
parasitic without heart.
 In vanishing twins, death of one fetus and continue the pregnancy with the
surviving one fetus. The dead fetus is simply vanish by reabsorption.
 In multiple pregnancy the patient should be assess for PPH, because of
uterine atony due to over distention of uterus.
 Infertility is the failure to conceive with one or more year of regular
unprotected coitus.
 In 40-50% cases of infertility female are responsible, in 30-40% cases male
and in 10 % cases both are responsible.
 Aspermia is the absence of the semen.
 Azoospermia is the absence of spermatozoa in semen.
 Oligospermia is the lack of sperm (less than 20 million).
 Polyspermia is the excess of sperm (more than 250 million).
 Nacrospermia is the sperm more than 25% are dead sperm.
 Asthenospermia is the lack of motility, 50% sperm are non motile.
 Taratospermia is the changes in morphology of sperm, more than 70% are
abnormal sperm.
 Toxoplasmosis is transmitted by feces of infected cats and raw meat.
 Rubella is the teratogenic in 1st trimester.
 If the client is not immunized to rubella(titer less than 1:8), the client should
be vaccinated in post partum period.
 Rubella vaccine should be given3 months before pregnancy or after birth.
 If patient is infected with genital herpes, prepare for cesarean section.
 In case of HIV in pregnancy mother take antiviral therapy 2nd and 3rd
trimester and neonate treated for 6 months to decrease transmission.
 Disease transmission from mother to baby is known as trans-
placental/vertical.
 HAART (highly active anti-retroviral therapy) therapy is used for treatment of
HIV during the pregnancy.
 In HIV mother from onset of labor zudovudine drug is given.
 In case of Chlamydia the sexual partner should also be treated.
 Syphilis is a sexually transmitted infection caused by treponema palladium.
 Penicillin is the drug of choice for syphilis.
 Gonorrhea is caused by the bacterium nesseria gonorrhoeae.
 Yellowish or greenish vaginal discharge is seen in trichomoniasis.
 In case of vaginal candidiasis, discharge from vagina is usually white, similar
cottage cheese and may smell like yeast/bread.
 In case of bacterial vaginosis discharge is gray or whitish with foul fishy odor.
 Oxytocics is the drugs which induce uterine contraction.
 Oxytocin is the most sensitive to uterus during third trimester of pregnancy.
 Complication of oxytocin drug is hyper stimulation of the uterus, nausea,
bradycardia.
 Complication of the ergot derivatives are nausea, vomiting, severe
hypertension, confusion, respiratory depression.
 Most severe complication of prostaglandin is bronchospasm.
 Those drugs which causes the uterine relaxant, is called tocolytic drugs.
 Tocolytic drugs are turbutaline, indomethacine, diazepam, MgSo4, etc.
 Paracervical anesthesia is given inside the lateral fornix.
 Pudandal nerve block is used during forceps delivery/vaccum extractor.
 Labor is the serious of passive movement of the fetus during its passing
through maternal pelvis.
 I
st stage of labor is start from true labor pain and end with fully cervical
dilation.
 In latent phase of the labor the cervix dilation is 0-4 cm, mother is alert
excited, verbalizes concerns, may rest/sleep.
 In active phase of labor the cervix dilation is 5-7cm, moderate/strong
contraction, mother is alert but anxious, restless, may seek pain relief.
 In transition phase the cervix dilation is 8-10 cm, strong contraction, mother
is restless and agitated.
 IInd stage is begins with full cervical dilation to end with birth of fetus(Pushing
phase).
 IIIrd stage is begins with birth of fetus and end with delivery of
placenta(placental phase).
 IVth stage is first four hours after placental delivery(recovery phase).
 In recovery stage the nurse should assess for position & tone of uterus,
bleeding perineum, bladder, vital sign in every 15 minutes.
 Episiotomy is the making an incision into the perineum to enlarge the vaginal
orifice.
 Most common type of the episiotomy is medio-lateral, others are midian,
lateral, J-shaped.
 During uterine contraction the increased in fetal heart 15bpm for 15 sec and
return to baseline at end is expected fetal response.
 Amniotomy is the artificial rupture of the membranes.
 Low transverse incision is most common incision on cesarean section.
 Vertical incision in cesarean section increase the risk of uterine rupture in
future pregnancies.
 Birth with less than three hours labor is called precipitous labor.
 Dystocia is the prolonged, difficult and painful labor due to large fetus,
cephalopelvic disproportion, malpresentation.
 Pre-term labor, when labor start before expected date of delivery.
 In post partum period (first 6 weeks after birth) the nurse should assess for
hematoma, hemorrhoids, and episiotomy site for redness,ecchymosis,
edema, discharge, and approximation(REEDA).

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