General Health

In this article, I shall discuss abnormality of amniotic fluids such as polyhydramnios, its causes and treatment. But before then, let us see the table of contents for better understanding. What is Polyhydramnios? Polyhydramnios (hydramnios) occurs when there is excess amount of amniotic fluid in the amniotic sac.   It is the amount of amniotic fluid that exceeds 1500ml but it may not be clinically apparent until it gets to 3000ml (that is, 95% above the amniotic fluid index). How common is polyhydramnios? Polyhydramnios is considered to be more common in multiparous than in nulliparous women. And it occurs one in every 250 pregnancy. What are causes of Polyhydramnios?  The aetiology of polyhydramnios is not known but has been attributed to: Note: Chorioangioma is a small tumor growing from a chorionic villus and consist of enlargement of the blood vessels and connective tissue Classification of polyhydramnios Polyhydramnios is classified based on: Time of its onset Its degree or severity  Acute hydramnios: This is a rare form of polyhydramnios that develops suddenly, usually around 20 week’s gestation. It is characterised by rapid increment of uterine size reaching the level of xiphisterneum within 3 to 4days and the woman’s complaint of severe abdominal ache. Fetal anomalies and monozygotic twins are the commonest risk factors or causes of acute polyhydramnios What are signs and symptoms of acute hydramnios? Acute high liquor amnii is associated with the following: Chronic polyhydramnios: This is a gradual accumulation of amniotic fluid, often noticed in the third trimesters (about 30 weeks’ gestation). It is most common type of amniotic fluid abnormality. What are signs and symptoms of chronic hydramnios? . How to diagnose Hydramnios Maternal history: The woman may complain of abdominal discomfort, over-distension or excessive fetal movements.  In an acute polyhydramnios, she may complain of vomiting, abdominal pain, heartburn, indigestion, constipation and difficulty in breathing —which are all exacerbated by symptoms associated with pregnancy. Abdominal examination:  On inspection: the fundal height is obviously exceeds the expected gestational age. The uterus is globular in shape instead of normal ovoid shape. On palpation: the midwife feels tense uterus and may find it hard to palpate the fetal part. On auscultation: the fetal heart sounds may be hard to hear due to the excessive liquor amnii. Differential diagnosis for hydramnios Multifetal pregnancy, even full bladder and other related causes of large for dates pregnancy like co-existing fibroids, or ovarian cyst should be looked into it. The midwife should also consider hydatidiform mole, fetal macrosomia and wrong dates for their absolute exclusions. Ultrasound screening:  a non-invasive procedure will confirm the diagnosis hydramnios by ruling out or revealing the presence of multiple pregnancy, fetal abnormalities, fetal macrosomia, ovarian cyst, hydatidiform mole and uterine fibroids. The ultrasound scan usually shows that the sum of the liquor depth in each of the four quadrants of the uterus (Amniotic fluid Index, AFI) greater than the 95th centile for gestational age, which is a diagnostic confirmation of hydramnios. Abdominal x-ray: This may reveal skeletal fetal anomalies and exclude multiple pregnancies. However, it must only be used in where ultrasound scan is not available because of the risk factors associated with x-ray radiations. How to manage hydramnios This depends on the condition of the woman and fetus, including the cause and degree of the hydramnios and the gestational age (GA) of the pregnancy. Asymptomatic hydramnios especially where there are no associated fetal abnormalities need no treatment. But when there are gross anomalies of the fetus, the woman has to choose either to electively induced the labour or carry the fetus to term if the fetus has surgicable or operatable deformity like oesophageal atresia which can be managed immediately in neonatal surgical unit. In symptomatic hydramnios where the gestational age is beyond 37weeks with serious maternal distress, labour can be safely induced. Prior to induction, supportive treatment such as encouraging the woman to adopt upright position which relieves any dyspnea and antacids may be administered to alleviate heartburn and nausea. In case of hydramnios where there’s serious maternal distress with GA less than 37 weeks of gestation and no fetal malformation, therapeutic abdominal amniocentesis or amnioreduction could be performed. This may be repeated severally where necessary in order to achieve optimal outcome. The technique is associated with the risks of infections, preterm labour, disseminated intravascular coagulopathy (DIC) and perforation of the fetal vessels with resultant bleeding into the Amniotic sac particularly when performed under poor aseptic techniques and without ultrasound guidance. What are dangers of sudden rupture of membranes in cases of hydramnios? After delivery, the patient may have postpartum haemorrhage because of attendant uterine inertia due to the over-distention of the uterus. Note; abdominal paracentesis should be carefully performed as frequently as the occasion demands. If the fetus is mature, labour may be induced by a slow, controlled forewater or hindwater rupture of membranes. Complications of hydramnios Prevention of hydramnios No specific way for preventing hydramnios. However, the two methods of prenatal treatment of polyhydramnios are amnioreduction and medical treatment with non-steroidal anti-inflammatory drugs (NSAIDs e.g. ibuprofen).  Prenatal administration of NSAIDs such as ibuprofen or Diclofenac has been found to reduce amniotic fluid volumes but these are not without side effects. As per Hamza et al., 2013, some experimental therapeutic studies are still trial that would alter fetal diuresis and in turn control polyhydramnios  The midwife managing woman in labour with hydramnios should anticipate postpartum haemorrhage due to uterine over-distension and get everything handy should emergency arise. The baby should be thoroughly examined at birth to detect any abnormality and initiate prompt care.

Placenta praevia: Bleeding in late pregnancy (antepartum haemorrhage) is a disheartening condition that threatens the wellbeing of both mother and fetus. This bleeding condition that occurs during the lasts two trimesters of pregnancy may be due to may be due to placenta previa or placenta abruptio What is placenta praevia? Placenta praevia refers to the placenta situated/ implanted wholly or partially in the lower uterine segment on either anterior or posterior wall which causes unavoidable bleeding from the genital tract. Bleeding from placenta praevia is said to be unavoidable and inevitable because the placenta will definitely separates and haemorrhage must follow as the uterus stretches and dilates in the late pregnancy and early labour. Signs and symptoms of placenta praevia Patient’s condition depends on the amount of blood loss. If the bleeding is slight, your blood pressure, respiratory rate and pulse rate tend to be normal. But if there is severe haemorrhage, hypotension and rapid pulse may be present — suggestive of shock. What are classic signs of placenta praevia? The only sign is vaginal bleeding that is painless. Other signs that will cause a midwife to suspect placenta previa in addition to bleeding are presenting part remains above the pelvis and unstable lie. Causes of placenta praevia The main aetiology of placenta previa is unknown but is associated with the following condition: Note: Multiparous women are more likely to suffer placenta praevia than primiparous women. This is because, in a new pregnancy, the placenta tends to look for a fresh surface to implant avoiding the previous placenta site scan. This may then result in implantation of the placenta in the lower uterus. Who are at higher risk of placental praevia? How common is placenta praevia? Placenta previa occurs 2.8 per 1,000 in every singleton pregnancy and 3.6 per 1,000 in multiple pregnancies. Placenta praevia Diagnosis The degree of shock is associated with amount of bleeding. If there is shock other signs may be present such as rapid respiration (air hunger).  The mother is pale with cold clammy skin. There may be loss of consciousness in a torrential bleeding. General Examination: Check the woman’s general appearance. The woman may be apprehensive due to bleeding. Check the vital signs: If the haemorrhage is slight blood pressure, pulse, respiration may be normal. In severe bleeding there may be hypotension, rapid pulse indicating shock. Abdominal examination: The midwife finds that the fundal height usually corresponds with the gestational age. The consistency of uterus is also normal with no tenderness and no pain. The fetal heart is also heard on auscultation. The fetal lie may be oblique or transverse. No engagement: the fetal head will still be very high near term in a primigravida. Obstetric ultrasonography:  The confirmatory diagnosis of placenta praevia is ultrasonic scanning because it determines its location.  However, X-ray (soft tissue placentography) carried out in the third trimester (after 34th week’s gestation) will show soft tissue radiography and outlining a low-lying placenta. Currently, obstetric ultrasonography is recommended for detecting the placental site. Midwife’s Assessment This would be divided into maternal and fetal assessment: Assessment of mother’s condition: Assess amount of vaginal blood loss. Take history of bleeding which is variable, some may have repeated small bleeding at interval, some may have repeated small bleeding at interval while some may experience sudden single episode after 20th week. Severe bleeding may occur after 34th week and is usually associated with the following which the midwife must take note of: Assessment of fetal condition: What are differences between placenta praevia and abruptio placenta? S/N Placental previa Abruptio placenta 1. Warning bleeding present Absent 2. Usually there is an abnormal lie or malpresentation Usually normal lie and presentation 3. Abdomen not likely to be tender Abdomen is likely to be tender 4. No associated abdominal pain There is associated abdominal pain 5. Blood is usually bright red Blood  may be dark or bright red 6. Mother is usually compromised Fetus is usually compromised 7. Uterus is soft on palpation Uterus is woody-hard on palpation 8. No particular association with pre-eclampsia May be associated with pre-eclampsia 9. No coagulation defect initially coagulation defect occurs early 10. Presenting part is high(unengaged) Presenting part may be  high or engaged Types of Placenta Previa Placenta praevia is classified into four degrees as follow: Type I placenta praevia: This occurs when the whole or majority of your placenta is situated in the upper uterine segment. There may be vaginal bleeding but blood loss is usually mild. Mother and fetus are in good condition and vaginal delivery is possible. Type II placenta praevia:  Thisis also called marginal placenta praevia. Marginal placenta praevia occurs when the placenta is partially situated or located in the lower uterine segment near the internal cervical os.  Blood loss is often moderate but the conditions of both mother and fetus may vary.  Fetal hypoxia is far more likely to present than maternal shock. Vaginal birth is possible only when your placenta is positioned anteriorly because posterior position impedes the fetal descent. Type III placenta praevia: This occurs when placenta is situated over the internal os but not centrally. The patient is far more likely to experience severe bleeding especially when the lower uterine segment stretches and the cervix starts to efface and dilate in the late pregnancy. You can’t have vaginal birth because the placenta precedes the fetus (i.e. the placenta lies before the fetus) Type IV placenta praevia: This is also called Central placenta praevia, which occurs your placenta is located centrally over the internal cervical os. Vaginal delivery is NOT possible because torrential haemorrhage is very likely to occur. Caesarean section is the only way to save your life and that of your baby. Pathophysiology of bleeding in placenta praevia Bleeding with placenta praevia happens when the lower uterine segment starts to grow progressively after 12th weeks and also differentiates from the upper uterine segment during late pregnancy (at about 30 weeks gestation) while the cervix begins to dilate. Bleeding occurs due to placenta’s

Abruption placenta is the separation of normally located placenta resulting in bleeding occurring after 28 weeks gestation or before the third stage of labour.  It is the premature separation of a normally situated placenta occurring after the 28th week of pregnancy Simply, abruptio placenta is defined as the cause of bleeding in late pregnancy (after 28 weeks gestation), or prior to onset of third stage of labour due to earlier separation of the placenta abruptio. Placental abruption is also the cause of antepartum haemorrhage, postpartum haemorrhage, obstetric shock and maternal mortality. The partial separation of the placenta results in bleeding from the maternal venous sinuses in the placental bed. In this article, I shall consider the causes, types, treatment and prevention of placental abruption. I urge you to exercise patient and read through entire article for better understanding. It is my desire to see that maternal and child morbidity and mortality rate is reduced to its lowest level globally. What is an abruptio placenta? Simply, abruptio is a Latin word that means “breaking away from a mass”. Therefore, abruptio placenta is the process of placental detachment from its site or separation of normally situated placenta after 22nd week of pregnancy. Signs and symptoms of placental abruption These are the clinical manifestations: Pathophysiology of abruptio placentae  Initially there is vasospasm followed by relaxation of the vessels, and then vascular engorgement occurs followed by rupture of vessels. This leads to bleeding into decidua basalis. Decidual haematoma is formed, eventually blood escape through the vagina as revealed bleeding or escape into amniotic cavity causing blood stained liquour. If large volume of blood accumulates under placenta, it will be absorbed into the myometrium causing the uterus to be very tense, rigid and oedematous a condition known as (Couvelaire uterus or uterine apoplexy or uteroplacental apoplexy). It is common with conceal type and causes severe pain and uterine contraction. With placental separation, utero-placental circulation is impaired resulting in fetal hypoxia and eventually death. Decidual degeneration and necrosis may release thromboplasm into maternal circulation causing Disseminated Intravascular Coagulation (DIC). How common is abruptio placenta in pregnancy? Placental abruption occurs in about 10% of all pregnancies and remains the most common cause of prenatal death. It remains an accidental cause of antepartum haemorrhage or the cause of inevitable bleeding in late pregnancy apart from placenta praevia, bleeding from sources such as cervical lesion or cancer of the cervix. What are key signs of Abruptio placenta? The diagnosing cues for placenta abruption are the dark vaginal bleeding with abdominal pain, tender/rigid uterus, uterine contraction and back pain. However, these symptoms can occur without vaginal bleeding especially when the blood is trapped behind the placenta. What are causes and risk factors of placental abruption? The actual cause of early separation of placenta prior to labour is not known. However, the predisposing factors of placenta abruptio are: How is a placental abruption diagnosed? A thorough history-taking from the patient may reveal incidence of pregnancy induced hypertension or external cephalic version. The patient’s uterus has a hard consistency and there is a guarding on palpation of the abdomen. The fetal parts may be difficult to palpate or not palpated at all and the fetal heart is unlikely to be heard with a fetal stethoscope. The key diagnosing cues for placenta abruption is the dark vaginal bleeding withabdominal pain, tender/rigid uterus, and back pain. But these symptoms can occur without vaginal bleeding especially when the blood is trapped behind the placenta. Ultrasound scan performed at this time helps to differentiate placenta praevia from abruptio placenta. However, placenta praevia tends to occur at rest but placenta abruption is often associated with history of trauma or active procedures. Lab Investigations Midwife’s Assessment during management of abruptio placentae Assessment maternal condition Ascertain maternal history, probably history of pre-eclampsia, recent history of headaches, nausea, vomiting epigastric pain, visual disturbances. General Examination Abdominal Examination Assessing Fetal Condition Observations Fetomaternal conditions are assessed and help to determine mode of management. Maternal vital signs should be taken at frequent intervals depending on the severity. What are differences between abruptio placenta and placenta previa? S/N Placental previa Abruptio placenta 1. Warning bleeding present Absent 2. Usually there is an abnormal lie or malpresentation Usually normal lie and presentation 3. Abdomen not likely to be tender Abdomen is likely to be tender 4. No associated abdominal pain There is associated abdominal pain 5. Blood is usually bright red Blood  may be dark or bright red 6. Mother is usually compromised Fetus is usually compromised 7. Uterus is soft on palpation Uterus is woody-hard on palpation 8. No particular association with pre-eclampsia May be associated with pre-eclampsia 9. No coagulation defect initially coagulation defect occurs early 10. Presenting part is high(unengaged) Presenting part may be  high or engaged What are activities contraindicated during placenta abruption? Activities contraindicated for women with placental detachment before labour (placenta abruption) are: What are types of placenta abruption? Specifically, there are three types of abruptio placenta: Revealed placental abruption This accounts for about 48% of all cases of abruption placenta and occurs when there is bleeding from the genital tract which may be mild or severe.  In Revealed abruption, there isblood flow to the external and no blood is accumulated behind the placenta.Patient often experience mild abdominal pain with some degree of tenderness as well as presence of fetal distress depending on the degree of separation. Revealed haemorrhage treatment Management of bleeding in revealed abruptio placenta depends on: Specific care for revealed abruptio placenta is: What is Concealed placental abruption? Concealed placental abruption accounts for about 27% of all cases of abruption placenta. Here, there is bleeding in-utero from the separation of the placenta and blood clots tend to accumulate in the uterus.  That’s, concealed placental abruption is a type of abruption where blood is retained behind the placenta.  This makes the uterus to be greater than gestational age and appears more globular. The patient tends to present with all the signs and symptoms of hypovolemic

Antenatal exercises plays a very important role in pregnancy. Pregnancy is a time of great physical and mental changes for both the mother and the fetus. There are a variety of exercises that pregnant women can do to maintain their health and well-being, both during and after pregnancy. These  exercises help pregnant women to maintain a healthy weight, improve circulation, and reduce stress. In this article, we  shall discuss : What are the benefits of antenatal exercises? Exercise in pregnancy not only improves the overall health of the mother, but also influences the fetal health positively as well as fostering a favourable birth experience. Specifically,  antenatal exercises can: Generally, exercises  increase strength and flexibility as well as breastfeeding success; better breathing and circulation, better balance and coordination. Contraindications for Exercise during Pregnancy What are the best exercises for pregnant women according to the American College of Obstetricians and Gynecologists(ACOG)? ACOG and National Institutes of Health recommended the following for  exercise in pregnancy:  Mayo Clinic also recommended these tips for exercises in pregnancy: What are safe exercises during pregnancy? 1.Walking: A moderate amount of walking is beneficial for pregnant women. ACOG recommends at least 150 minutes of moderate-intensity aerobic activity per week, including at least 30 minutes of walking.  Walking can help improve your circulation, help you maintain your weight, and help you get pregnant. It also helps improve your mood, increase your endurance, and help you keep up with your daily routine. 2.Strength Training:  ACOG recommends at least 30 minutes of strength training per week, including at least two days of resistance training that includes mild weightlifting and two days of aerobic activity. Strength training can help you maintain your weight, improve your posture, and help you get pregnant. 3.Yoga:  Yoga has been shown to reduce stress and  anxiety. It improves your flexibility, balance,strength and endurance, which can help you maintain your pregnancy and improve your overall health. 4.Swimming:  Swimming can help improve your flexibility and balance, which can help you maintain your pregnancy and improve your overall health. It helps your body to release endorphins, which can improve your mood and reduce stress. 5.Dancing:  Dancing has been shown to improve your cardiovascular health, which can help you maintain your pregnancy and improve your overall health. 6.Prenatal massage:  Prenatal massage can help to improve relaxation, circulation, and overall health. 7.Strength training: Strength training can help you maintain your pregnancy weight, build muscle, and reduce your risk of pregnancy-related complications. 8.Aerobic exercises: moderate-intensity aerobic exercise such as brisk walking, running, biking and using an elliptical machine, is beneficial for pregnant women. It can help to improve heart health, blood pressure, and blood sugar. 9.Kegels: This is a pelvic floor strengthening exercise, which helps improve childbirth experiences, lower the need for episiotomy or risk of lacerations during delivery. Tofort’s Recommendations for exercise in pregnancy We at Tofort via our experts make the following tips for prenatal exercises: The bottom line Antenatal exercises have been shown to have many benefits for both mother and baby. There are a variety of exercises that pregnant women can do, and the best way to find the ones that are best for them is to ask their doctor or health care provider for recommendations.

Men should examine their testicles monthly for any lumps or other changes. They should also do a self-examination of their testicles before starting any new medication or treatment. A man will know his testicles by touch, but it can be difficult to find them in the groin area without looking.  A man should pull back the skin of his scrotum and look for two round, oval-shaped organs that are about the size of large eggs.  The left and right testicles are not always the same size, but they should be similar in size to one another. A man may notice an increase in discomfort if he has a hernia or if he has been sitting in one position for too long. What is Testicular Self-examination (TSE) Testicular Self-examination (TSE) refers to the procedure which involves observing or assessing one’s testicles by the person so as to find out any abnormality such as nodules, inflammation and mass on the testes. The change in th size, shape and colour are detected via the examination.  Examination of the scrotum can unveil some disorders such as hernia, hydrocele or tumour of the testicle. It’s therefore crucial that every male becomes conversant with TSE because it helps in early detection of testicular cancer.  Testicular cancer remains the commonest cancer affecting men between the ages of 15 and 34 and can as well occur in men outside this age range.   Conducting Testicular Self-examination (TSE) once a month greatly increases the chances of detecting a cancerous lump or mass early enough in order to seek effective treatment. Testicular cancer  like breast cancer is usually detected by the man himself as a firm, painless lump in the testicles. As early diagnosis is crucial in achieving successful treatment, men should endeavour to carry out testicular Self-examination once a month — looking for unusual changes in the appearance  and feel of the scrotum. TSE should commence during adolescence so as to know what is normal for you and also make you confident in your examination.  The time is not difficult or time-consuming. The most convenient time to carry out the procedure is usually after a warm bath or shower when the scrotum is loose and more relaxed. You should use both hands during the examination. Read : Discover Incredible Facts About Human Placenta Purposes of Testicular Self-examination Specifically, it is carried out:  Procedure for Testicular Self-examination Recommendations We recommend that every Tofortians (male) should endeavour to perform testicular examination regularly and report to the doctor any abnormality discovered. This is because testicular cancer and prostate cancer can be detected earlier and prompt treatment can be given to save the man. 

Postnatal Exercises: After you have a baby, it is crucial to take care of your body. This means getting enough rest, eating healthy foods, and exercising. Exercise can help you lose the pregnancy weight, get stronger, and feel good about yourself. However, it is important to know what kind of exercises are safe to do after you have a baby. You have to avoid exercises that put too much strain on your body. I hope this article will help you find the best post-natal exercise routine that suits your pre-pregnancy body. What are postnatal exercises? This is an exercise carried out by a woman soon after delivery in order to improve circulation, strengthen pelvic floor and abdominal muscles and prevent transient long-term problems. These exercises may include circulatory exercises, pelvic exercise, abdominal exercises, abdominal tightening, pelvic tilting, rectus check, and  knee rolling. Read: The best and safe exercises during pregnancy. Postnatal exercises are designed to reduce the risk of developing certain problems and make it easier to recover from the birth. They are important for the mother’s body to return to its pre-pregnancy shape. These exercises can be done at home, but they should be done under supervision of a health professional. Different types of postnatal exercises Postnatal exercises include: Why It’s So Important to Exercise During Postpartum period Exercises during puerperium is associated with the following benefits:  Guidelines for Postnatal Exercises If you’re a new mom, you’re probably wondering what kind of exercise you can do to get your body back into shape. Here’s a quick rundown of what to do and what to avoid when it comes to postnatal exercises. Do: Avoid: The bottom line After giving birth, it’s important to give your body time to recover. This means no strenuous exercise for at least the first six weeks. But that doesn’t mean you have to just sit around and do nothing. There are plenty of gentle postnatal exercises that can help you heal, feel better and get your strength back. So what kind of exercise is safe after pregnancy? Walking is a great place to start. It’s low impact and easy on your body. You can also do some light stretching and strengthening exercises. But avoid anything that puts too much strain on your abdomen or back. This includes sit-ups, crunches and any other exercises that involve rounding your back. If you want to start a more formal exercise routine, talk to your doctor or midwife first. They can give you the green light and let you know what exercises to avoid. In general, it’s best to wait until your six-weeks postpartum period before engaging yourself in strenuous activities.

Appearance of the placenta at term Human placenta is a circular flat organ through which the fetus obtains oxygen and nourishment in-utero and performs functions which the fetus cannot perform itself in-utero. Its name is derived from Latin for “pancake,” which is descriptive of its size and appearance at term. It is also describe as a descoid-shaped organ, which otherwise called “afterbirth“. Situation/Location: Before delivery, the placenta is situated in the upper uterine segment. Shape: The human placenta is a flat, roughly circular structure. Size: It’s about 20–22cm in diameter and 2.5cm thick in the centre and becomes thinner towards the circumference. Weight: Normal human placenta weighs about one-sixth of the baby’s weight(450g). Gross structure of Human Placenta The human placenta has two surfaces which are: maternal and fetal surfaces. Maternal surface This surface is dark red in colour due to maternal blood in intervillous spaces and part of the basal decidua will have been separated with it. The surface is arranged in about 18–20 lobes which are separated by sulci.  The lobes are made of lobules, each of which contains a single villus with its branches. Sometimes, deposits of lime salts are present — making the surface gritty. Although it has no clinical significance. Fetal surface This is the surface that faces the baby in-utero and it has a white shiny appearance or bluish gray in colour with a smooth surface. The amnion covering the fetal surface of  the  placenta  gives  it  a whitish, shiny  appearance.  Branches of the umbilical veins and arteries are visible and spreading out from the insertion of the umbilical cord which is normally in the centre.. The umbilical cord is inserted usually at the centre and blood vessels radiating down to its circumference. The amniotic membrane covers the fetal surface, which consists of a double membrane:  The Chorion: This is derived from the trophoblastic tissue. It is a thick, opaque, friable membrane which continues with a placental edge and cannot be separated from it.  The chorion is the outer layer of amniotic membrane adherent to the uterine wall. The Amnion: This is a smooth, tough translucent membrane derived from the inner cell mass. It covers the placenta and the umbilical cord and secretes the amniotic fluid. The inner layer of the amniotic sac contains an amniotic fluid and covers the fetal surface of the placenta and is what gives the placenta its typical shiny appearance. Functions of human placenta Respiratory function: As pulmonary exchange of gases does not take place in the uterus the fetus must obtain oxygen and excrete carbon dioxide through the placenta. It also aids exchange of oxygen and carbon dioxide from the mother to the fetus. Nutrition functions: Food for the fetus derives from the mother’s diet and has already been broken down into forms by the time it reaches the placental site. Nutrients such as glucose, amino acids, and minerals pass into the foetal circulation through it. The placenta is able to select those substances required by the fetus, even depleting the mother’s own supply in some instances. Storage: It metabolizes glucose and can also store it in the form of glycogen and reconverts it to glucose when it is needed by the fetus. It also stores  iron  and  other  fat  soluble vitamins. Excretory functions: The waste products of metabolism such as urea, or  uric acid are returned to maternal circulation through the placenta. The main substance excreted from the fetus is carbon dioxide.  Protective functions: It provides partial protection from infection (e.g. micro-organisms). It provides a limited barrier to infection with the exception of the treponeona of syphilis and few bacteria can penetrate. Viruses, however, can cross freely and may cause congenital abnormalities as in the case of the rubella virus and HIV virus. Endocrine functions: It produces hormones such as Human   chorionic   gonadotropin (HCG) produced by the cytotrophoblastic layer of the chorionic villi; human placental lactogen(hpL) that has a role in glucose metabolism in pregnancy; oestrogen and progesterone which all help to maintain the viability of the gestation.  When  the activity of the corpus luteum begins to decline, the  placenta  takes  over  the  production  of  oestrogen, which   is   secreted   in   large   amounts   throughout pregnancy. Anchorage/stability: The chorionic villi passes deeply into the decidua and anchors the placenta firmly. Examination of placenta Requirements for the procedure Aims of the examination Procedure Complications Arising from Human Placenta Placenta remains an essential organ that connects mother and foetus for exchange of gases and nutrients as well as removal of waste products of metabolism. However, anomalies or complications can occur in it which include: 

Umbilical cord is a key structure because fetus in-utero can not  survive without obtaining oxygen and nutrients from maternal blood stream which is connected to the fetal surface of the placenta by  umbilical cord.   Abnormal cord either in structure or function can absolutely affect the fetal growth and development.  Hence, healthy umbilical cord is very essential for healthy pregnancy.  What is umbilical cord? Umbilical cord is otherwise known as funis, refers to a thread-like structure that extends from the fetal surface of the placenta to the umbilical portion of the fetus.  Normal length of umbilical cord The  diameter of umbilical cord is about 1-2cm while that of length is 40-60cm with an average of 50cm.  A cord is considered to be short when it measures less than 40cm. However, there is no definite length considered to be an anomaly.  Development of umbilical cord Umbilical cord is formed at the 5th week of pregnancy. It is highly essential for life and any disruption in its structure can result  in a fetal stillborn. It transmits blood vessels (two umbilical arteries and one large vein which supply the fetus with nutrients and aid in removal of waste products.  These vessels are protectively embedded within a white gelatinous substance called  Wharton’s jelly which is developed from primary(embryonic) mesoderm. Loss of Wharton’s jelly may put the fetus at risk of cord compression and, hence fetal distress. Naturally, the umbilical cord falls off within 7-10 days after birth through a process known as dry gangrene. Nerve supply to Umbilical cord The cord has no nerve supply and this makes cutting it at birth painless to the baby.  The whole cord is covered with a layer of amnion which is continuous with that covering of the placenta.  Umbilical cord  appears helical(95%) due to winding of the blood vessels.  However, umbilical cords of absolutely straight(5%) appearances are more prone to disruptions of blood flow.   Placental attachments can be in the center, off-center, on the edge, or in the membranes. The membranous insertions of the umbilical cord are known as velamentous insertions. These placental cord designs have flaws that can lead to cord tears.   Function of the umbilical cord  Care of the newborn umbilical cord  The cord normally falls off within 7-10 days by necrotic dry gangrene.  There is no specific care for cord, rather maintenance of optimal environmental and personal hygienes are advocated for the baby. Below are tips for cord care: Physiological changes in umbilical cord during delivery: Considerable physiological changes occur in umbilical cord following delivery and clamping of the cord by the midwife.  We shall look into these changes for better understanding. Labour and delivery cause a lot of changes in the baby’s systems and not only in the umbilical cord. The birth of a baby brings the essential functions of the cord in-utero to an end. The baby needs to adapt to extrauterine life. Therefore, at clamping and cutting of the umbilical cord by midwife during delivery, the followings occur: Major changes in umblical cord after delivery The cessation of the placental results in the collapse of the umbilical veins, the ductus venosus, and hypogastric arteries: Other subsequent changes: Examination of umbilical cord at birth During the examination of the placenta and  membranes following delivery, the cord is usually examined for any abnomality. These steps are involved:  Steps in educating newly delivered  primigravida on umbilical cord care General baby care poses a great concern and challenge to first time mothers. The tips on cord care above will be of help to the  midwife instructing the mother. However, below are simple steps to follow: Phase 1: Preparation  Phase 2: Demonstrate the procedure as follows: Phase 3: Observe the following while you do the procedure Complications resulting from improper cord care Failure to observe these simple tips about cord care could result to the following problems: Conclusively, I hope you have learnt more on umbilical cord and what to expect during health education on care of umbilical cord. With these hints you can no longer feel naive when your midwife is teaching you or with other women the proper cord care.  Read: Abnomalities of umbilical cord and their management. Proper umbilical cord care helps to keep your baby free from infections. This in turn boosts his/her health and fitness. If you find this piece resourceful, share to others. I hope to hear from you via your comment below. Always stay safe. Tofort cares!

Labour remains challenging moment for the skilled birth attendant as he or she would be striving to ensure safe mother and healthy baby during delivery. Most pregnant women appear to be happier as they approach the last day of their third trimester due to the joy of having their baby in their arms. While some are embattled psychologically with fear of pain.  In this article, we shall consider why the uterus goes into labour and what labour is all abour. What is labour? Labour is the physiological process involving regular and rhythmic uterine contractions and retractions with progressive cervical dilation, in which the foetus, placenta and membranes are expelled from the uterus through the birth canal after 24th weeks of gestation. It can also be defined as the process by which a woman gives birth.  The whole process is achieved by the rhythmic contraction and retraction of the uterine fibres and progressive dilatation of the cervical Os.  The foetus is considered to be viable — capable of surviving outside the uterus after 24th weeks of gestation. Thus, evacuation of the product of conception by the contraction and retraction of the uterus before the 24th week of gestation is not labour but abortion . The uterine contractions can occur naturally and spontaneously or through artificial use of medicines. Labour is considered to be normal when it occurs spontaneously at term (37-40 weeks of gestation) with the foetus presenting by vertex, the whole process completed by unaided naturally maternal efforts, does not exceed 24 hours without any complications to both mother and baby.  It is also said to be established when there are  regular painful rhythmic uterine contraction and cervical dilatation of about 4 cm in primigravida and 3cm in multigravida.  Causes of onset of  labour The uterus has the intrinsic power to expel its contents before term as cases of miscarriage, preterm labour or induction before term. You might wonder why throughout pregnancy, the uterus remains sedated.  The actual cause of onset of  labour is not properly known. However, reasons why the uterus remains quiescent during pregnancy and triggers off contraction at term could be associated with the following: Probable/warning/premonitory signs of labour These are signs that show that labour is likely to occur soonest and may include the following: Lightening:  This occurs towards the last week of the third trimester of pregnancy when women experience a sign of relief as the gravid uterus no longer crowds the lungs because of the sinking down of the lower uterine segment into the pelvis, causing the presenting part to descend.  This is usually referred to as “Give of the pelvis“. Lightening occurs because of the widening of the joints and ligaments of pelvic joints, symphysis pubis and the softening, relaxation and sagging of the pelvic floor muscles in combination with the  formation of the lower uterine pole. This physiologic effect is caused by pregnant hormones particularly the relaxin  synthesized by the placenta.  Frequency of micturition:  This occurs during the first trimester due to pressure of weighing the pregnant  uterus on the urinary bladder resulting in frequent urge to micturate but it gets relieved during the second trimester.   During the third trimester, there is Increased irresistible  urge to void because the foetal head has descended,  causing greater pressure on the bladder (lightening).  Braxton Hicks’ contractions:  These ‘practice’ contractions begin from the 16th week of pregnancy and improve the uterine blood flow to the placenta. They also help in the formation of the lower uterine pole towards the last trimester of pregnancy.  This is Nature’s way  of training and sensitising the uterus for the anticipatory future functions (delivery).  Reduction in the Amniotic fluid:  Amniocentesis helps to detect reduction in liquor, which may account for the drop in the maternal weight towards term or that the uterus is approaching labour. Effacement of the cervix:  This refers to when the cervix is “ripped” and ready to go into delivery. It implies that the cervix can cooperatively dilate with commensurate uterine contractions.    Effacement can also refer to the “taking up” of the cervix, which means the cervical ring has been drawn up to form part of the lower uterine segment. When the cervix shortens, the cervical Os can admit a tip of one or two fingers.  Shortening of the cervix is usually looked for in the interest of mother or baby, or when labour has to induced.   True labour Vs False Labour True labour is also called true pain and refers to a physiological  process characterized by regular uterine contractions, dilatation of the cervix and expulsion of fetus, placenta and membranes.  Recognition of true labour Regular uterine contractions: When the uterine contraction and retraction occurs in a regular interval — maintaining a consistent rhythm, the uterus is said to be in labour. Dilatation of the cervix:  This refers to the opening of the neck of the womb. Cervical dilatation occurs in agreement with the contraction and shortening of the longitudinal and oblique muscle fibres of the upper segment.  When the cervix dilates, it becomes obvious that the uterus is definitely trying to empty its contents. Show: “Show” refers to blood-stained mucus which is released or discharged from the cervix as it dilates. The “show” is a tenacious mucus that plugs the cervix during pregnancy. It mixes with blood from severed blood vessels around the cervix as it dilates. However, false labour otherwise called false pain or spurious labour and refers to irregular and erratic uterine contractions lasting 2 to 3 minutes and pain a pregnant woman experienced with no accompanying changes in cervix(e.g. no “Show” or cervical dilatation).  Difference between true labour and false labour True labour False labour Regular rhythmic uterine contractions Uterine contractions are irregular and erratic. Duration of contraction rarely exceeds 60 seconds. Contractions may last  2 to 3 minutes Back ache may be present Back ache absent Cervix is effaced Cervix is not effaced Progressive cervical dilatation Cervix may not dilate “Show” is present No “show” Membranes may or may not be intact.

Description of Breasts The breasts are the two mammary glands and accessory organs of reproduction. Shape: They are hemi-spherical in shape but many times the shape depends on the amount of adipose tissue. Circular in nullipara but pendiclous in women who have borne children and lactated. Situation: They are situated on the superficial fascia of the anterior chest wall, lying over the pectoralis major muscle. They extend from the second rib above to the sixth rib below and from the lateral margin of the sternum to the mid axillary line. Gross Structure of  Breasts Areola: Over the centre of each breast is a circular area about 2.5cm in diameter. The areolar is pink coloured Caucasian, brown for blacks in nullipara and brownish in women who have born respectively. Nipple: In the centre of the areolar is the nipple. It is a flat shaped protuberance situated about the level of the 4th intercostal space. It is composed of erectile tissue and about 6mm in length. Its surface is perforated by 15-20 minutes opening of the lactiferous ducts. Montgomery’s tubercle: Within the areolar are situated about 18 sebaceous glands which become enlarged into tubercles during pregnancy. Axillary Tail of Spence: This is the part of the breast which extends up into the axilla reaching as high as the 3rd rib thus making the circular shape of the breast to be incomplete. Microscopic structure of the Breasts The breast is composed of glandular tissue gathered into about 18-20 lobes. These lobes radiate outward from the areolar and are separated from each other by fibrous connective tissue and lies next to but does not communicate with its fellow.  Each of the 18 lobes is divided by smaller partitions into numerous lobules which are made up of masses of milk secreting units known as alveoli.  Each alveolus consists of a number of milk forming cells surrounding a small duct in which they pour their secretions. The duct from the alveoli joins together to form larger ducts, these unite with ducts from other lobules until finally a larger duct known as a lactiferous tubule emerges from the entire lobe and runs towards the nipple. Ampulla: As it passes beneath the areolar, each lactiferous tubule expands and forms a dilated sac. The ampulla which serves as a reservoir for milk from here the tubule from each lobe enters the nipple and opens independently upon a surface. Myoepithelial or Breast cells:These are spider shaped contractile cells surrounding the alveoli. Fatty Tissue: The gland is stabilized in the fat of the chest wall by numerous fibrous processes. The gland tissue is covered by subcutaneous tissue and finally by the skin. Blood, Nerve & Lymphatic Supply to Breasts  Blood supply: Breasts received blood through internal mammary artery which is a branch of subclavian artery; external mammary artery which is a branch of lateral thoracic artery and the upper intercostal artery which is a branch from the aorta. Venous Return:The veins form a circular network around the nipple and drain to the internal mammary and axillary veins. Lymphatic Drainage:The lymph vessels form a plexus beneath the areolar and between the lobes of the breast. The lymphatics of the breasts communicate freely with each other. The lymph drains into the following regional nodes: Nerve Supply: The functioning of the breast is contributed by hormones as it has poor nerve supply. Some sympathetic fibres pass to it. The skin over the breast is supplied by cutaneous branches of 4th,5th and 6th thoracic nerves. Functions of Breasts The physiology of the Breast Development At puberty, the breasts enlarge and assume the adult female size and shape. This is in response to stimulation by oestrogens which mainly promote the growth and development of the lactiferous tubules and ducts and also cause a certain amount of growth of the nipples and the areolar.  Further development and enlargement of the breasts occur during pregnancy. The most important feature at this time is the hypertrophy of the alveoli in response to progesterone stimulation, preparatory to the later manufacture of milk About 3 days after delivery, milk appears in the breast as a result of stimulation by prolactin and the breasts can then be said to have reached their full development. The physiology of Lactation The process of lactation can be considered to take place in three stages: The production of milk Milk is formed as small fatty globules in the base of these cells and gradually unite to form small developments. As new globules are produced, the droplets are pushed towards the surface of the cell until finally they burst through the cell membranes and enter the lactiferous tubules.  Here, they join with droplets from other cells and eventually the terminal portions of the tubules within the alveoli become filled with milk.  The manufacturer of milk is under the control of prolactin from anterior pituitary gland. The action of this hormone is suppressed by the progesterone and oestrogen until a few days after the expulsion of the placenta. When the level of these hormones (oestrogen and progesterone) fall to allow prolactin to function.  Once lactation has been established by prolactin, growth hormone from the anterior pituitary plays some part in its maintenance. Note: The breasts require a large blood supply for the secretion of milk. The flow of milk Milk is pushed along the ducks towards the nipple by the milk which is being continually formed behind it in the alveoli. Some of the milk is stored in the ampullae underneath, the areolar until the time of the baby’s next feed. When milk is drawn off by the infant, the smooth muscle and basket cells in the wall of the duct and alveoli contact and force more milk towards the nipple. This mechanism occurs as a result of a neuro- hormonal reflex.  Thus, the stimulus of the baby’s mouth on the sensitive nipple oxytocin is liberated from the posterior pituitary gland. This hormone stimulates the muscle and basket cells to contact and therefore cause more milk to