11.1

• Perinatal period


  The interval between the birth of a neonate born after 20 weeks' gestation and the 28 completed days after that birth

  
• Birth


  The complete expulsion or extraction from the mother of a fetus after 20 weeks' gestation
• Birthweight


  Neonatal weight determined immediately after delivery or as soon thereafter as feasible. It should be expressed to the nearest gram.

  
• Birth rate


  The number of live births per 1000 population
• Fertility rate


  The number of live births per 1000 females aged 15 through 44 years
• Live birth


  The term is used to record a birth whenever the newborn at or sometime after birth breathes spontaneously or shows any other sign of life such as a heartbeat or definite spontaneous movement of voluntary muscles
• Stillbirth or fetal death

  The absence of signs of life at birth
• Early neonatal death


  Death of a liveborn neonate during the first 7 days after birth
• Late neonatal death


  Death after 7 days but before 29 days
• UTERUS


  • Size: 5-6 times increase
  • Weight: 20-fold increase
  • Capacity: 500- 1000 fold increase
  • Blood flow: 10-fold increase

  
• Myocyte arrangement


  • Outer: hoodlike layer over the fundus
  • Middle: muscle fibers perforated in all directions with blood vessels
  • Internal: sphincter-like fibers at orifices
• Stillbirth rate or fetal death rate


  The number of stillborn neonates per 1000 neonates born, including live births and stillbirths
• Permits myocytes to contract after delivery and constrict vessels to halt bleeding
• CERVIX


  • Chadwick's sign – Dark-bluish cervix due to increased vascularity in the venous plexus
  • Goodell's sign - Softening due to cervical edema
  • Aria-Stella reaction - Hormone-related atypical endometrial change, hypertrophy and vacuolization of glandular epithelial cells, marked nuclear pleomorphism, enlargement, and hyperchromasia

  
• OVARY


  • Ovulation ceases during pregnancy, and maturation of new follicles is suspended
  • Corpus luteum functions maximally during the first 6 to 7 weeks of pregnancy
  • Corpus luteum produces estrogen, progesterone, and relaxin

  
• Relaxin


  Remodels the extracellular matrix of reproductive-tract connective tissue to accommodate labor, important in initiating augmented renal hemodynamics, lowering serum osmolality, and increasing arterial compliance
• Neonatal mortality rate


  The number of neonatal deaths per 1000 live births
• FALLOPIAN TUBES


  • Myosalpinx shows little hypertrophy
  • Endosalpinx flattens
• VAGINA


  • Hypertrophied, edematous and more vascular
  • Increased blood supply of the venous plexus (Chadwick's sign)
  • Length of the anterior vaginal wall is increased
  • Increased production of lactic acid, pH: acidic (3.5- 6)

  
• BREAST


  • Tenderness, paresthesia
  • Engorged veins beneath the surface of the skin
  • Nipples deeply pigmented and erectile
  • Areola - broader and more deeply pigmented
  • Glands of montgomery - hypertrophic sebaceous glands
  • Colostrum can be expressed

  
• Weight gain


  Average weight gain: 12.5 kg or 27.5 lbs, includes uterus and its contents, breasts, expanded blood, extravascular ECF volumes, "maternal reserves"

  
• Water metabolism


  • Average woman retains 6.5 L of extra water during pregnancy, many pregnant women experience edema in the legs and ankles, carpal tunnel syndrome may occur
• Perinatal mortality rate


  The number of stillbirths plus neonatal deaths per 1000 total births
• Protein metabolism


  One-half of total pregnancy increase in protein found in the fetus and placenta, the other half added to uterus, breasts, and maternal blood
• Maternal protein intake does not appear to be a critical determinant for birthweight among well-nourished women
• Average protein requirements


  1.22g/kg/d of protein for early pregnancy and 1.52g/kg/d for late pregnancy
• Infant death


  All deaths of liveborn infants from birth through 12 months of age
• Carbohydrate metabolism


  • Mild fasting hypoglycemia, postprandial hyperglycemia, hyperinsulinemia, pregnancy-induced state of peripheral insulin resistance
• Fat metabolism


  • Maternal hyperlipidemia, augmented lipid synthesis and food intake contribute to maternal fat accumulation in 1st and 2nd trimesters, fat storage declines or ceases in 3rd trimester due to enhanced lipolytic activity and decreased lipoprotein lipase activity, leptin is important for implantation, cell proliferation, and angiogenesis, leptin deficiency is associated with anovulation and infertility
• Infant mortality rate


  The number of infant deaths per 1000 live births
• Electrolyte and mineral metabolism

  • Serum K and Na slightly decreased, non-ionized Ca decreased due to lowered albumin, serum ionized Ca unchanged, significant demand on maternal Ca homeostasis by developing fetus, Mg levels slightly decline, increased requirement for Fe and I
• Hematologic changes


  • Plasma volume increases by 40-45%, red cell mass increases by 15-20%, physiological anemia of pregnancy, pregnancy is considered a hypercoagulable state

  
• INSIGNIS COMPILATION FOURTH BIMONTHLY
• Hematologic parameters


  • White cell count - INCREASED
  • Erythrocyte sedimentation rate - INCREASED
  • Fibrinogen concentration - INCREASED
  • Red cell count - DECREASED
  • Hemoglobin concentration - DECREASED
  • Hematocrit - DECREASED
  • Plasma folate concentration - DECREASED

  
• Low birthweight


  A newborn whose weight is <2500 g
• Parturition


  The bringing forth of the young
• Coagulation parameters


  • Fibrinogen - INCREASED to 450 (300-600 mg/dl)
  • Factors VII, VIII, IX, and X - INCREASED
  • WBC count - INCREASED to as high as 15,000/UI
  • Prothrombin, Factor V, and XII - NO CHANGE
  • Bleeding time - NO CHANGE
  • Platelet Count - DECREASED

  
• INSIGNIS COMPILATION THIRD BIMONTHLY
• Very low birthweight


  A newborn whose weight is <1500 g
• Phases of parturition


  • Prelude
  • Preparation
  • Processes
  • Recovery