Medical brain notes 11

  Introduction   There are varieties of complications that can arise during pregnancy. In this unit we shall discus some of these major complications and the role of the midwife in the prevention, diagnosis and treatment of these complications. They include structural abnormalities, social factors and medical conditions.   Objectives   By the end of the course you would be able to:   ·                Give health instructions that will prevent some of these complications in pregnancy   ·                Make accurate diagnosis of these conditions during antenatal assessment   ·                Identify cases for referral   ·                Counsel and support the women to ena...

  Definition   This is a disparity between the fetal head and the maternal pelvis. It means that the particular head is too big for the particular pelvis through which it must pass, it may be due to:-   ·                A contracted pelvis with a normal sized head.   ·                A normal pelvis with a large baby ,or   ·                A combination of a large baby and a contracted pelvis   Cephalopelvic disproportion cannot be diagnosed before the 36 th  week of pregnancy because before then the fetal head is too small for comparison with the pelvis but at 36 th  week the fetus would have reached its maximum size.   Disproportion There are three degrees of disproportion   ·         ...

  Retroverted Gravid Uterus   The normal position of the uterus is anteverted and anteflexion i.e. leans forward and bends forward on itself but in the case of retroverted gravid uterus, it means the long axis of the uterus is directed backwards during pregnancy.   In the first trimester, retroversion of the uterus is said to occur in 11% of all pregnancies and this is associated with slightly increased risk of early pregnancy bleeding and abortion which may be due to compression of the uterine vessels decreasing blood flow to the deciduas. But as pregnancy progresses most cases correct spontaneously causing no further problems, but in some cases, the uterus becomes incarcerated i.e. it fails to rise out of the pelvic cavity by the 14 th  week. Incidence: 1- 30,000 pregnancies.     Causes   ·                Congenital anomalies of the pelvis and uterus   ·    ...

  Breast Conditions   Inverted nipple and flat nipples: the nipples of women are flat or inverted below the skin surface. These conditions make breast feeding difficult as the infant can not grasp the nipple. Both can be corrected by the use of plastic woolwich shells worn over the nipple from 34 th  weeks.

  Definition   This is excessive vomiting in pregnancy which occurs in the first trimester before the 20 th  week of gestation and this becomes serious when the patient vomits throughout all day until she empties the stomach contents. The vomitus may contain bile in some cases.   The severe nausea and vomiting leads to dehydration, electrolyte imbalance, weight loss, anorexia which could lead to malnutrition and metabolic disturbance and this requires interventions.   Causes   The causes of hyperemisis gravidarium are unknown but the predisposing factors include;   ·                Psychological factors:  It occurs in a case of unwantedpregnancy or when a woman wants sympathy or attention from her husband and relatives. More common among educated and nervous women.   ·                Endocrine factors (ho...