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Textbook of Midwifery
TK Indrani
UNIT ONE:
Historical Perspectives of Midwifery and Terminology Used in Midwifery References
TERMINOLOGY USED IN MATERNITY NURSING
Obstetric History
UNIT TWO:
Antenatal Care for Normal Pregnancy
GENITOURINARY SYSTEM
CIRCULATORY SYSTEMS
SKIN
NERVOUS SYSTEM
DISORDERS OF THE AMNIOTIC FLUID
Reference 2
Polyhydramnios
Abdominal Examination
Complications
Reference 1
Treatment Management
Reference 3
Promoting Mobility
Reference 1
Reference 2
Oligohydramnios
Reference 1
Diagnostic Evaluation
Complications
Management
SPECIALISED ANTENATAL INVESTIGATIONS
Reference 2
Screening for Congenital Abnormalities
Alpha–foeto Protein
Maternal Serum Screening for Down's Syndrome
Reference 1
Indicated Sonography
Cardiac Anomalies
Gastroinstestinal Disorders
Renal Disorders
Reference 2
Linear Measurements
Non-linear Measurements
INVASIVE PROCEDURES UNDERTAKEN DURING PREGNANCY
Reference 1
Laboratory Procedures and Interpretation
Results
High Risk Pregnancy
Stool Examination
Indications
AMNIOCENTESIS FOR PRENATAL DIAGNOSIS
UNIT THREE:
Normal Labour
REFERENCE 2
Definition of Labour
Normal Labour (Eutocia)
Abnormal Labour (Dystocia)
Date of Onset of Labour
REFERENCE 2
Four Stages
Management of First Stage
Urinalysis
Fluid Balance
Obstetrical Abdominal Examination
Foetal Heart Rate
Foetal Distress
Management of Foetal Distress
Factors of Normal Labour
Bony Passage
Physiology of Primary Force
Secondary Forces
Mechanism of Cervical Dilatation in labour.
Foetal Axis Pressure
Physiology and Management of the Second Stage of Labour
Physiological changes
Soft Tissue Displacement
Active Phase
Foetal Condition
Pushing
Bladder Care
Preparation for Delivery
Conducting the Delivery
Asepsis
Scrubbing
Delivery of the Head
Delivery of the Shoulder
Method of Delivering the Shoulder
Physiology and Management of the Third Stage of Labour
Separation and Descent of the Placenta
Delivery of the Placenta and Membranes
Cord Blood Sampling
Completion of the Third Stage
Examination of Placenta and Membranes
Disposal of Placenta
Immediate Care
Oxytocic Agents
Partogram (or) Partograph
Reference 2
Reference 1
The Cervicograph
Reference 2
Labour Disorders
Three main types
Vaginal Examination
During Pregnancy
Reference 2
PARTOGRAM OR PARTOGRAPH
The Partogram
Example of Partogram
Reference 2
Causes for Atony
VI Traumatic
Symptom
Signs
Management of Third Stage
Management of Secondary Postpartum Haemorrhage
RETAINED PLACENTA
PUERPERAL INVERSION OF THE UTERUS
AMNIOTIC FLUID EMBOLISM
RISK FACTORS
SHOCK IN OBSTETRICS
Reference 2
Primary Postpartum Haemorrhage
Causes of Atonic Uterine Action
Symptoms
Signs
TREATMENT OF POSTPARTUM HAEMORRHAGE
Reference 1
Method
Partially Adherent
Retained Placenta
Blood Coagulation Disorders
UNIT FOUR:
Normal Puerperium
BREAST FEEDING
PROBLEMS IN BREAST FEEDING
MULTIPLE PREGNANCY
Definition
Twin Pregnancy
Types of Twin
Determination of Zygosity and Chorionicity
Diagnosis of Twin Pregnancy
Abdominal Examination
Effects of Pregnancy:
Polyhydramnios
Pressure Symptoms
Antenatal Screening
Ultrasound Examination
Labour and Delivery
Management of Labour
Management of Delivery
Polyhydramnios
Foetal Abnormality
Delay in the Birth of the Second Twin
Premature Expulsion of the Placenta
UNIT FIVE:
Antepartum Haemorrhage
PAGE'S CLASSIFICATION
Pathology
Changes in Liver and Kidneys
Renal changes
Reference 2
Incidence
Reference 2
Management
Shock
Observations
Investigations
MODERATE SEPARATION OF THE PLACENTA
SEVERE SEPARATION OF THE PLACENTA
OBSTETRIC MANAGEMENT FOR CONCEALED AND MIXED TYPE
Placental Abruption or Abruptio placentae
Causes (Risk factors)
Types
Classification
General Examination
Abdominal Examination
ASSESSING FOETAL CONDITION
Obstetric Treatment
Care of the Baby
PRE-ECLAMPSIA
Reference 1
Reference 2
Transient (Gestational) Hypertension
Blood Pressure
Proteinuria
GROUP B
VOMITING IN PREGNANCY
Reference 1
Medical
Surgical
Gynaecological
Hyperemesis Gravidarum
Clinical Features
Symptoms
Signs
Clinical Types
Investigations
Treatment
Curative
Drugs
Vitamins
Maternal vital signs
Obstetric Care
Procedure of termination
UNIT SIX:
Obstetric Operations
EPISIOTOMY
Reference 2
Justifiable Indications
Dubious Indications
The Timing of the Incision
Types of Incision
Infiltration of the Perineum
Method of Infiltration
The Incision
Reference 2
Structures Incised in Episiotomy
Repair of Mediolateral Episiotomy
Postoperative Care
Complications
OBSTETRIC OPERATIONS FORCEPS DELIVERY
Reference 2
Reference 1
Types of Forceps Operation
Reference 1
Indications for Obstetric Forceps
Low Forceps Operation
Outlet Forceps Operation
Reference 1
Method of Applying Forceps
Forceps Delivery
Types of Obstetric Forceps
Complications
In the Infant
Cephalhaematomas
Facial Palsy
In the Mother
VACUUM EXTRACTOR AND VACUUM EXTRACTION
Reference 2
Reference 1
Reference 1
Indications
Contraindicators
Reference 1
Principles of Ventouse Delivery
Reference1
Complications and Advantages
Description of the Instrument
Technique of Application
Conclusion
CAESAREAN SECTION
Reference 1
Common Current Indications
Reference 2
Advantages
Indications for Caesarean section
Physical Preparation
Antacid Therapy
Intravenous Infusion
Bowel Care
Bladder Care
Clothing and Valuables
Immediate Postoperative Care
Observations
Reference 1
Immediate
Complications due to Anaesthesia
INDUCTION OF LABOUR
Reference1
Definition
Types of Induction of Labour
Indications for Induction of Labour
Contraindications
Reference1
Indications
Procedure of Induction of Labour
Procedure
Risks
Contraindications
Success Rate
Reference 2
Cervical Ripening
Prostaglandins
Reference 2
Cervical Structure
Reference 2
UNIT SEVEN:
Malpositions
OCCIPITOPOSTERIOR POSITIONS
Causes
Abnormal Pelvis
Antenatal Diagnosis
Diagnosis during Labour
Vaginal Examination
Management of Labour
First Stage of Labour
Second Stage of Labour
Possible Course and Outcomes of Labour
Long Internal Rotation
Short Internal Rotation Persistent Occipitoposterior
Second Stage of Labour
Management of Delivery
Deep Transverse Arrest
Diagnosis of Deep Transverse Arrest
Management of Deep Transverse Arrest
OCCIPITOPOSTERIOR POSITIONS
Reference 2
Causes
Antenatal Diagnosis
Abdominal Examination
Diagnosis during Labour
Vaginal Examination
Management of Labour
First stage of Labour
Second stage of Labour
Possible course and Outcomes of Labour
Long Internal Rotation
Second Stage of Labour
Short Internal Rotation
Diagnosis
Management of Delivery
Deep Transverse Arrest
Neonatal Trauma
Cerebral Haemorrhage
Breech Presentation
Types of Breech Presentation
Causes
Antenatal Diagnosis
Abdominal Examination
Auscultation
Ultrasound Examination
Diagnosis During Labour
Vaginal Examination
Antenatal Management
Complications of External Version
Separation of the Placenta
Uterine Scar
History of Premature Labour
Planned Caesarean Section
Complications of Breech Presentation
Impacted Breech
Foetal Hypoxia
Premature Separation of the Placenta.
Mechanism of Left Sacroanterior Position: L.S.A. Mechanism
Lateral Flexion of the body
Restitution of the Buttocks
Internal Rotation of the Shoulders
Internal Rotation of the Head
External Rotation of the Body
Birth of the Head
SUMMARY
FACE PRESENTATION
Causes
Anterior Obliquity of the Uterus
Contracted Pelvis
Polyhydramnios
Congenital Abnormality
Antenatal Diagnosis
Intrapartum Diagnosis
On Vaginal Examination
Possible Course and Outcomes of Labour
Mentoanterior Positions
Mentoposterior Positions
Persistent Mentoposterior Position
MANAGEMENT OF LABOUR
MECHANISM OF A LEFT MENTOANTERIOR POSITION
SHOULDER PRESENTATION
BROW PRESENTATION
Unstable Lie
Causes
Intrapartum
Cephalopelvis Disproportion
Causes of Contracted Pelvis
Course of Labour
First and Second stage
Muller Kerrs Method (Mullers Method)
Clinical Pelvimetry
Steps of Management of Trial Labour
First Stage
UNIT EIGHT:
Relationship of Foetus to the Pelvis
THE MECHANISM OF NORMAL LABOUR
LOA Mechanism
Definition of Mechanism of Normal Labour
Descent
Flexion
Internal Rotation of the Head
Restitution
Lateral flexion
MECHANISM OF LEFT SACROANTERIOR POSITION
UNIT NINE:
Abnormal Labour and Preterm Labour
REFERENCE 3
PRETERM LABOUR
Definition
Spontaneous Preterm Labour
Maternal Diseases
Uterine causes
Placental Causes
Foetal Causes
Premature Rupture of Membranes: The Most Common Risk Factor
Poor Social Factors:
Idopathic: Cause unknown in 30%.
Diagnosis
Curative for Patient in Preterm Labour
Indications for tocolytic Drugs
Contraindications
Management of Labour
Caesarean Section
Neonatal Care
Premature Rupture of Membranes (PROM)
Diagnosis – clinical
Effects of PROM
Management
PREMATURE RUPTURE OF MEMBRANES
Reference 3
Pathophysiology/Aetiology
Diagnostic Evaluation
Reference-2
Risks of PROM
Reference 3
Preventing Infection
Reference 1
Management
UNIT TEN:
Medical and Blood Disorders in Pregnancy
ANAEMIA IN PREGNANCY
Factors of Haemopoiesis in pregnancy
Minerals
Vitamins
Protein
Erythropoietin
Causes of Anaemia Placental and Puerperium
Physiological Anaemia of Pregnancy
Acquired Anaemia
Incidence of Anaemia in pregnancy
Investigations
Clinical features
Mild Case
Symptoms
Severe Case
Foetal
Treatment
Treatment of Iron Deficiency Anaemia
Other causes of Anaemia
Curative
For Folic Acid Deficiency
Severe Anaemia in Late Pregnancy
Reactions of Blood of Blood Transfusion in Severe Anaemias
Prognosis for Mother
For Foetus
HAEMORRHAGE ANAEMIAS
HAEMOGLOBINOPATHIES
Reference 1
Types of Thalassaemia and Their Inheritance
Thalassaemia
Sickle Cell Anaemias (HbSS)
Antenatal Care
During Labour
Postnatal Care
HEART DISEASE IN PREGNANCY
Reference 1
Reference 2
Reference 2
Diagnosis of Heart Disease in Pregnancy
Diagnosis of Organic Heart Disease in Pregnancy
Management
Preconception Care and Advice
Physical Care
Intrapartum Care:
Positioning
Reference 1
Reference 2
Contraception
GESTATIONAL DIABETES
Maternal and Foetal Monitoring
Time of Delivery
Reference 1
Management Plan for Diabetes Mellitus in Pregnancy
Reference 1
Diet for Diabetes
Reference2
Investigation
Reference 2
Antenatal Care
Control of Diabetes in Pregnancy
Management of Labour and Delivery
Control of Diabetes in Labour
Postnatal Care
Reference 1
Contraception
CARE OF BABY
Urinary Tract Infection
Asymptomatic Bacteriuria
Site of Infection
Clinical Features
Treatment
Cystitis in Pregnancy
Aetiology and Pathogenesis
Clinical Types
Effect on Pregnancy
Prevention
Curative
Oral Therapy
Other Care
Test of Cure
Chronic Type
Obstetrical Treatment
Followup
Haematuria in Pregnancy
SEXUALLY TRANSMITTED DISEASES IN PREGNANCY
Syphilis in Pregnancy
Clinical Features
Tertiary Syphilis
Infected Baby
Treatment
Gonorrhoea in Pregnancy
Investigations
Chlamydia in Pregnancy
Pathogenesis
Clinical Features
Diagnosis
Treatment
Trichomonas Vaginitis
Clinical Features
Monilial Vaginitis
Clinical Features
Treatment
Human Papilloma Virus (HPV)
Clinical Features
AIDS in Pregnancy
Mother-foetus Infant Transmission
Clinical Features
Diagnosis During Pregnancy
Obstetric Care
During Delivery
INFECTIOUS DISEASE IN PREGNANCY
Reference 1
Torch Syndrome in Pregnancy
Toxoplasma in Pregnancy
Foetal Effect
Congenital Toxoplasma in Newborn
Diagnosis
Treatment
Rubella (German Measles)
Maternal Infection
Foetal Effect
Neonatal Effect
Diagnosis
Treatment Prevention
Cytomegalo Virus (CMV)
Neonatal Effects
Diagnosis
Herpes Simplex
Maternal Infection
Effects on Foetus
Effect on Newborn
Diagnosis
Treatment
Other Viral Diseases in Pregnancy
Foetus Neonatal Effect
Vaccine
Chickenpox
Treatment
Mumps (Viral)
Rabies
UNIT ELEVEN:
Epidemiology in Obstetrics
PERINATAL, NEONATAL, MATERNAL MORTALITY RATE
Reference 1
Perinatal Mortality
Causes of Perinatal Mortality in India
Precipitating Causes of Perinatal Mortality
Biological Factors
Social Factors
Prevention of Perinatal Mortality
Prevention of Rhesus Immunization
Risk Approach in MCH Care
Perinatal Morbidity
Definition
Congenital Malformations
Maternal Mortality and Morbidity Reference-1
Maternal Mortality Rate (MMR)
Prevention of Maternal Mortality in India and Developing Countries
Maternal Morbidity
Level I Care
Perinatal Care
Intranatal Care
Level II Care
Perinatal Care
Intranatal and Neonatal Care
Level III Care
MCH Care I
High-risk Neonates
DIPHTHERIA
Definition
Pathology: Local lesions.
Clinical Features
Conjunctival Diphtheria
Skin Infection
Complications
Diagnosis
Prognosis
Prevention/Control
Prevention
Treatment
Antitoxin
Treatment of Complications
Eclampsia
Reference 1
Aetiology
Causes
Clinical Features
Complications
Remote
Complications of Eclampsia
Cardiovascular
Renal
Haematological
Neurological
Hepatic
Foetal
MEASLES
Epidemiology
Pathology
Complications
Encephalitis
Diagnosis
Treatment
Treatment of Complications
Prevention
WHOOPING COUGH OR PERTUSSIS
UNIT TWELVE:
Third Stage of Labour
DEFINITION
Separation and Descent of Placenta
Mechanical Factors
Haemostasis
Management of the Third Stage
Clamping of the Umbilical Cord
Delivery of the Placenta and Membranes
Completion of Third Stage
Examination of Placenta and Membranes
Fourth Stage of Labour
Stage Four
Records
Transfer from the Labour Ward
POSTTERM PREGNANCY: ABNORMAL LABOUR
SUMMARY
OXYTOCIC AGENTS
Definition
Prophylatic Use of Oxytocics
Therapeutic Oxytocic Administration
Intravenous Ergometrine 0.25 mg
Syntocinon
Prostaglandins
ECTOPIC PREGNANCY OR INTRAUTERINE PREGNANCY
Reference-2
Tubal Pregnancy
Causes of Ectopic Pregnancy
Physiology of Tubal Pregnancy
Abdominal Pregnancy
Outcome of Tubal Pregnancy
Clinical Presentation
OBSTETRIC EMERGENCIES
Rupture of the Uterus
Cause of Rupture of the Uterus
Signs of Intrapartum Rupture of the Uterus
Incomplete Rupture of the Uterus
Management
ACUTE INVERSION OF THE UTERUS
Classification of Inversion
Causes of Acute Inversion of the Uterus
Recognition of Acute Inversion of Uterus
Immediate Action
Medical Measurement
PUERPERAL COMPLICATIONS
Septic Shock
Clinical signs of Septic Shock
Management of Septic Shock
Shock
Hypovolemic Shock
Initial Stage
Compensatory Stage
Progressive Stage
Management of Shock
Assessment of clinical condition
Central Venous Pressure
AMNIOTIC FLUID EMBOLISM
Pathophysiology
Predisposing factors
Clinical Signs and Symptoms
Emergency Action
Complication of Amniotic fluid Embolism
PUERPERAL INFECTION AND CAUSATIVE ORGANISMS
Causative Organisms
Puerperal Complications
Puerperal Pyrexia
Uterus and Involution
Genital Tract Infection
Signs and Symptoms
Effects of Genital Tract Infection
Signs and Symptoms:
Bladder and Urinary Tract
THROMBOEMBOLISM
Predisposing Factor
Superficial Thrombophlebitis
Deep-vein Thrombosis (DVT)
Clinical Signs and Symptoms
Management and Treatment of DVT
Pulmonary Embolism
Management and Treatment
Surgical Embolectomy
BREAST COMPLICATIONS
BREASTS PROBLEMS
UNIT THIRTEEN:
The Female Pelvis
PELVIC ORGANS
Bones of the Pelvis
The Sacrum
Coccyx
Joints of the Pelvis
Ligament of the Pelvis
Spines of the Pelvis
Division of the Pelvis
False Pelvis
True Pelvis
Sacrocotyloid Diameter
Cavity
The Pelvic Outlet
Slope of the Pelvis
Classical Types of Pelvis
FOETAL SKULL
CONCEPTION AND EMBRYONIC DEVELOPMENT
Surface of the placenta
The Maternal Surface
The Foetal Surface
THE FOETUS
At Four Weeks
At 8 Weeks
At 12 Weeks
At 16 Week
At 20 week
At 24 week
At 28 week
AT 32 week
At 36 weeks
At 40 weeks
Important Development at each week
DEVELOPMENT OF THE FERTILIZED OVUM
The Decidua
The Trophoblast
The Inner Cell Mass
The Embryo
Circulation through the Placenta
Functions of Placenta
Estrogens
Progesterone
Human Placental Lactogen (HPL)
Appearance of the Placenta at Term
Foetal Sac
Amniotic fluid
Constituents
Anatomical Variations of the Placenta and the Cord
Circumvallate Placenta
Bipartite Placenta
PHYSIOLOGICAL CHANGES IN THE REPRODUCTIVE SYSTEM
Changes in the Endocrine System
Placental Hormones
Estrogen
Progesterone
Pituitary Hormones
Thyroid Function
Adrenal Glands
FOETAL CIRCULATION
Adaptation to Extrauterine Life
UNIT FOURTEEN:
Obstetric Emergencies
OBSTETRIC EMERGENCIES
Presentation and Prolapse of the Umbilical Cord
Definition
Predisposing Factors
Clinical findings
Cord Prolapse
Immediate Action
SHOULDER DYSTOCIA
Definition
Risk Factors
Management
Noninvasive Procedures
Suprapubic Pressure
Manipulative Procedures
Positioning of the Mother
Outcomes following Shoulder Dystocia
VASA PRAEVIA
Ruptured Vasa Previs
Diagnosis
Management
REFERENCE 1
Apgar Score
Curative
Drugs
Prognosis
INDEX
TOC
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