Chikky My Favorite Nurse/Midwife

Chikky My Favorite Nurse/Midwife A PROFFESSIONAL NURSE/MIDWIFE
My goal is to have a healthy mother & child during and after pregnancy.
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POSTPARTUM HEMORRHAGE (PPH) PPH is primarily caused by the "4 T's": 🥚Tone (uterine atony)🥚 Trauma🥚Tissue, and 🥚Thrombin....
27/02/2026

POSTPARTUM HEMORRHAGE (PPH)

PPH is primarily caused by the "4 T's":

🥚Tone (uterine atony)
🥚 Trauma
🥚Tissue, and
🥚Thrombin.

Uterine atony is the most common cause, responsible for roughly 70% of cases, where the uterus fails to contract after childbirth. Other major causes include lacerations, retained placental tissue, and blood clotting disorders.

MAIN CAUSES OF POSTPARTUM HEMORRHAGE (The 4 T's):

✅ Tone (Uterine Atony - ~70-80% of cases): The uterus fails to contract and compress bl@ vessels after the baby and placenta are delivered. Risk factors include a very long or very fast labor,, an enlarged uterus (due to multiple babies, large baby, or too much amniotic fluid), or infections like chorioamnionitis.

✅ Trauma (Lacerations/Rupture): Injuries to the ge***al tract, including the cervix, va**na, or uterus. This can occur during a Cesarean delivery, instrumental delivery (forceps/vacuum), or if a large baby causes significant tearing.

✅ Tissue (Retained Placenta/Clots): Pieces of the placenta or blood clots remain inside the uterus, preventing it from contracting properly.

This is common with placenta accreta (abnormal placental attachment).

✅ Thrombin (Coagulation Disorders): Blood fails to clot effectively, which can be due to pre-existing conditions or conditions developed during pregnancy, such as placenta abruption or severe preeclampsia (e.g., DIC - disseminated intravascular coagulation).

KEY RISK FACTORS:
🥚Prior history of PPH.
🥚Overdistended uterus: Multiple gestations,
🥚polyhydramnios (excess amniotic fluid), or
🥚fetal macrosomia (large baby).
🥚Induced or prolonged labor.
🥚Maternal age over 35.

Immediate management typically involves uterine massage, medication to induce contractions (like oxytocin), and sometimes surgery or bl@ transfusions.

ABNORMAL FUNDAL HEIGHT & CAUSES:📌 Fundal Height Greater than Expected (>2 cm above gestational age)🔺 CAUSES:🥚Macrosomia ...
27/02/2026

ABNORMAL FUNDAL HEIGHT & CAUSES:

📌 Fundal Height Greater than Expected (>2 cm above gestational age)

🔺 CAUSES:

🥚Macrosomia (large fetus)
🥚Polyhydramnios (excess amniotic fluid)
🥚Multiple gestation (twins, triplets)
🥚Gestational diabetes (leading to fetal overgrowth)

📌 FUNDAL HEIGHT SMALLER THAN EXPECTED (>2 cm below gestational age)

🔻 CAUSES:

🥚Fetal growth restriction (IUGR)
🥚Oligohydramnios (low amniotic fluid)
🥚Incorrect gestational dating
🥚Fetal demise

FUNDAL HEIGHT MEASUREMENT IN PREGNANCY Definition:✅ Fundal height is the measurement from the p***c symphysis to the top...
27/02/2026

FUNDAL HEIGHT MEASUREMENT IN PREGNANCY

Definition:
✅ Fundal height is the measurement from the p***c symphysis to the top of the uterus (fundus) in centimeters (cm). It helps assess fetal growth and gestational age.

NORMAL FUNDAL HEIGHT BY GESTATIONAL AGE:
🔴Before 12 weeks: The uterus is not palpable above the p***c symphysis.
🔴12-14 weeks: The fundus rises above the p***c symphysis.
🔴16 weeks: The fundus is midway between the p***c symphysis and the umbilicus.
🔴20-22 weeks: The fundus is at the umbilicus (belly button).
🔴After 20 weeks: Fundal height in cm ≈ Gestational age in weeks (±2 cm).
🔴36 weeks: The fundus reaches the xiphoid process.
🔴40 weeks: The fundal height may drop slightly due to lightening (fetal descent into the pelvis).

HOW TO MEASURE FUNDAL HEIGHT:

1: Have the client lie supine with an empty bladder.

2: Use a tape measure (centimeters) from the p***c symphysis to the fundus.

3: Compare the measurement with gestational norms to assess fetal growth.

FUNDAL HEIGHT AFTER DELIVERY.✅ After delivery, the fundus (top of the uterus) is typically at the level of the belly but...
27/02/2026

FUNDAL HEIGHT AFTER DELIVERY.

✅ After delivery, the fundus (top of the uterus) is typically at the level of the belly button (umbilicus) within 1-12 hours.

✅ It then descends by about 1 cm (one fingerbreadth) per day. By day 7, it is halfway between the umbilicus and symphysis p***s, and by 10-14 days, it is no longer palpable above the pelvic bone.

KEY POSTPARTUM FUNDAL HEIGHT Facts:

🔴Initial Position: Immediately after birth, the uterus is roughly halfway between the symphysis p***s and the umbilicus, but it rises to the level of the umbilicus within 1–2 hours.

🔴 Involution: The process of the uterus shrinking back to its pre-pregnancy size is called involution.

🔴 Assessment: The fundus should feel firm. A "boggy" or soft fundus indicates the uterus is not contracting properly, which increases the risk of postpartum hemorrhage.

🔴Bladder Impact: A full bladder can displace the fundus, typically to the right side, which can interfere with contractions.

🔴Rate of Descent: The uterus shrinks approximately 1 cm per day.

🔴Return to Normal: By 6 weeks postpartum, the uterus should return to its pre-pregnancy size.

🔴 If the fundus remains high or does not descend as expected, it may indicate complications.

What is an External Cephalic Version (ECV)? An ECV is where the doctor will attempt to try to turn your baby from bottom...
27/02/2026

What is an External Cephalic
Version (ECV)?

An ECV is where the doctor will attempt to try to turn your baby from bottom down (breech) to head down (cephalic) presentation.

They will apply pressure on your abdomen to encourage your baby to do a forward or backward roll.

EXTERNAL CEPHALIC VERSION (ECV) 🔴 ECV is a non-surgical procedure performed (usually after 36-37 weeks) to turn a breech...
27/02/2026

EXTERNAL CEPHALIC VERSION (ECV)

🔴 ECV is a non-surgical procedure performed (usually after 36-37 weeks) to turn a breech or transverse baby into a head-down (vertex) position, increasing the chance of a safe va**nal delivery.

🔴 Physicians apply gentle pressure to the mother’s abdomen to manually rotate the fetus, boasting a success rate of roughly 50%. While generally safe, potential, though rare, risks include fetal distress, preterm labor, or membrane rupture, with serious complications occurring in only 1–2% of cases.

KEY DETAILS ABOUT ECV:

✅ Purpose: To avoid a Cesarean section for breech presentation.

✅ Procedure: Performed in a hospital setting, sometimes using medication to relax the uterus.

✅ Safety: It is considered safe, with about a 1 in 200 chance of requiring an emergency C-section.

✅ Contraindications: May not be recommended with placenta previa, low amniotic fluid, or multiples.

✅ Success Factors: More likely to succeed if the patient has given birth before.

27/02/2026

🙏🙏🙏🙏 thank You Jesus

MANAGEMENT AND TREATMENT OF BREECH What are the options for delivering a breech baby?If a baby is breech at 37 weeks of ...
27/02/2026

MANAGEMENT AND TREATMENT OF BREECH

What are the options for delivering a breech baby?

If a baby is breech at 37 weeks of pregnancy, there are three possible options:

✅Turn the baby at 37 to 38 weeks.
✅Plan a C-section birth at 39 to 40 weeks.
✅Most providers will avoid a va**nal breech birth unless the baby is crowning and ready to deliver

27/02/2026

Thank You Jesus

What are some complications of having a breech baby?🌍 A breech baby doesn’t usually affect your pregnancy. 🛑 The complic...
26/02/2026

What are some complications of having a breech baby?

🌍 A breech baby doesn’t usually affect your pregnancy.

🛑 The complications mainly occur when it’s time to deliver.

🌍 Some breech births can happen va**nally, but there are risks.

The risks of a va**nal breech birth include:

✅ Injuries to your baby’s legs or arms such as dislocated or broken bones.

✅Your baby’s head can get stuck or trapped.
Umbilical cord problems.

✅ The umbilical cord can flatten or twist during delivery.

✅ This can cause nerve or brain damage due to a lack of oxygen to your baby’s brain.

WHAT CAUSES A BABY TO BE BREECH?It’s not always known why a fetus is breech. Some factors that may contribute to a fetus...
26/02/2026

WHAT CAUSES A BABY TO BE BREECH?

It’s not always known why a fetus is breech. Some factors that may contribute to a fetus being breech are:

🥚You’re expecting twins, triplets or more.

🥚You’ve been pregnant before.

🌍There’s too much or too little amniotic fluid.

🥚Your uterus is irregularly shaped. This can be due to a growth like fibroids, a uterine septum or other medical conditions.

🥚The placenta covers all or part of your cervix (placenta previa).

🥚Your baby is preterm. This means it may not have turned to a headfirst position yet.

🥚The fetus has a condition that causes it to not turn head down

WHAT ARE THE TYPES OF BREECH POSITIONS?There are four different breech positions:✅ Frank breech: The baby's buttocks aim...
26/02/2026

WHAT ARE THE TYPES OF BREECH POSITIONS?

There are four different breech positions:

✅ Frank breech: The baby's buttocks aim towards your va**na. Its legs are sticking straight up in front of its body (its feet are near its face).

✅ Complete breech: The baby's buttocks point downward, and both its hips and knees are flexed (the fetus is sitting on its folded legs).

✅ Footling breech: One or both of the baby's feet point downward and will deliver before the rest of its body.

✅ Transverse lie: This is when the baby lays across your uterus horizontally instead of vertically. This would make its shoulder enter your va**na first.

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