The OB Crash Course The Mighty Uterus Can gradually increase in size to accommodate a human being A muscle can stretch and have a chance in circulation to provide enough oxygen nutrients low in the pelvis and winds up being up in the diaphragm a pregnant womens abdomen comes full with the uterus the etus the average fetus at term is about 32 40 weeks gestation A newborn baby will weight 7 7 5 lbs The only thing it doesn t have to do is breathing air it does have breathing movements but it is fluid filled and they don t have bowel movements while in utero in utero the baby will blink going to clench and fist its hands it will have startle moro responses they have hiccups The fetus is part of the whole system of interchanging fluid and part of the pumping system as part of changing fluid inside the uterus Inside the uterus during pregnancy we have the growing fetus the placenta inside the uterus most likely will attach in the fundus the fundus of the uterus is the top highest part that causes contraction does most of the work during labor make sure mother is not hemorrhaging bc it s a place that is most close to fallopian tubes placenta can be implanted any part of the uterus even very low When the cervix begins to dilate the patient will actually bleed or hemorrhage Normal tissue that lines the uterus and proliferates everytime the women menstruates to prepare for pregnancy potential when a fertilized eggs become a trophoblast embryo when it burrows into uterus lining it forms the placenta can attach itself anywhere Amniotic fluid changes about every 72 hours not stagnant fetus part of plumbing it swallows and urinates part of allowing circulation to enter from the mother to the placenta to the fetus and sends fluids and wastes back via this system so that amniotic fluid is there to help buoy the umbilical cord the baby allows for temp regulation and there for insulin regulation as well The umbilical cord has a membrane that comes off the placenta like a sticky ceran wrap and it covers 3 vessels in the core 2 arteries and 1 vein AVA 2 arteries and 1 vein there is no valve Three vessels in the umbilical cord and what protects those are whirtons jelly helps with temp regulation and specifically for insulation and a reminder is that fetal circulation is backwards to human or newborn circulation so in fetal circulation you have the veins that are bringing oxygenating blood and your arteries are taking away oxygenated blood 1 first thing on initial assessment is check umbilical cord to make sure there are three cord vessels bc sometimes it will be one artery and one vein and that could be a congenital anomaly in the fetus Inside the mighty uterus as it is growing and housing a human the uterus itself has changes it has to undergo to prepare for the process of labor there are several layers of muscle three layers that run up and down the abdomen and then another set that runs across muscles that run up and down pull with contraction when the might uterus contracts it causes the muscles to move up and the cervix to get shorter and the muscles that run side to side those open up We assume that in the first months of majority of pregnancy that you will see mother month month periods look at term gestation 38 42 weeks gestation trimesters 3 month periods by middle of pregnancy 28 weeks gestation the uterus will be against the moms umbilicus assess uterus as it grows up and make sure afterwards delivery involution returning to prepregnant stage Has to prepare for the stages of labor in the last trimester the mighty uterus starts practicing for labor by false labor contractions or Braxton hick contractions these work for the mother and cause the uterus to change and the cervix as the lower part of the uterus does the most changing and preparing to be opened to allow the fetus to escape from the uterus not an easy passage the uterus has to get the cervix to change so that labor will be more efficient and less stressful to the woman and fetus When a woman is not pregnant her cervix has the consistency of a nose cartilage at the end of the nose is a dimple if you imagine that is an open just to let sperm in and allow flowing in of cells that can conceive pregnancy and also allows the endometrium fluids to get out and produced every month to prepare for a baby These contractions are stimulated by the hormone Pitocin and in labor we need to give some extra if anterior pituitary is not produced enough oxytocin Pitocin but early on in the last trimester there is some secretion of Pitocin to soften the uterus and relax it Softening of the Cervix Needs to cause the cervix to soften consistency of cartilage and before labor the cervix should be as soft as a lip the tissue is easily distensible and stretchable very responsive to pushing Effacement of the Cervix thinning Thinning shortening of the cervix it starts out very small and during labor the lower uterine segment of the cervix is gradually pulled up into the body of the uterus and is shortened Dilation of the Cervix 0 10 centimeters intermittent contractions 2 The uterus pulls up and out the cuff of the sleeve is pulled up into a lower uterine segment it does not disappear during contractions it is just pulled up and dilated so much Check to see if the cervix is soft or ripe ready for labor also assess if its thinning of efface and with the pelvic exam we can see how long the cervix is if its not thinned or effaced its 0 if half its 50 if all the cervix is pulled up its 100 effaced thinned out The mouth of the cervix has to open to allow the head of the baby to be delivered The cervix when it is completely dilated is about 4 inches across 10 cm and it would allow for the head of the baby to be delivered as the baby is turning we want the smallest part of the head to come out there is a lot of turning If you look at the pelvis itself its not a cylinder the inlet of the pelvis is angled or opened from left to right so that it is an oval at the rim of the pelvis the midpoint is the smaller diameter where the head comes through which is anterior and posterior the coccyx makes it even less of a straight shot for the baby to come out As the fetus enters the pelvis it has to turn and if it doesn t fit one way the power of the mighty uterus cause it to turn another way in the majority of labor the woman is pelvis needs to be as relaxed as possible the first stage of labor she cant do anything its all about …