Anatomy and physiology

1-Define the following:s

A - Anatomy is the study of the structure of the body

B- Physiology is the study of the function of the body

C-Cell is the basic structural and functional unit of the living organisms.

D- Tissues groups of cells which are similar in structure and which perform common or related
functions.

E- Chromosomes In the nucleus there are a number of long thread-like structures called
chromosomes.

Each cell normally has a fixed number of chromosomes.

Each chromosome is made of two parallel strands called chromatids. Along the length of the
chromosome is a series of structures called genes. They determine the characteristics of the cell
and its progeny.

F- Respiratory system provides the route by which the supply of oxygen present in atmospheric
air enter to the body and it provides the route of excretion of carbon dioxide.

G: Nephron is the functional unit of the kidney.

H: Alveoli is the functional unit of the lung where gas exchange between the air in the lungs and
the blood capillaries takes place.

I-True pelvis is part of the pelvis below the pelvic brim & it has inlet, outlet, and cavity.

J-uterus is otherwise known as worm, is a hollow muscular organ with a thick wall. It has a
central cavity which opens into vagina through cervix. On either side at its upper part, the
fallopian tubes open into it. Uterus communicates with peritoneal cavity through fallopian tubes.

K-vagina is a hollow distensible fibro muscular tube that extends from the vaginal orifice to the
cervix.

L-fertilization (conception) is the fusion of the sperm with secondary oocyte to form the zygote.

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M-ovulation is the process whereby the dominant follicle ruptures and discharges the secondary
oocyte into the oviducts where it awaits fertilization.

2- State two differences between acid and basis?

 Acid as compound that gives hydronium ions to and other compound

 Base compounds that can accept hydronium ions

3- Mention the 5 phase’s mitosis?

1- Interphase: chromosomes are not visible, chromosome make a copy of itself.

2- Prophase: copies of chromosome fasten together, nuclear membrane disappear.
3- Metaphase: chromosomes line up along the center
4- Anaphase: chromosome split apart and are pulled to opposite ends of cells
5- Telophase: chromosome becomes hard to see, cells split and 2 nuclear membranes form.

4- Different between the following:

i. Mitosis and Meiosis

ii. Mitosis: division of somatic (body) cells
iii. Meiosis division of gametes (sex cells)
iv. CF and ECF

Extracellular fluid (ECF) - Fluid environment in which the cells live (fluid outside the
cells)

Two components:

• Plasma

• Interstitial fluid

Intracellular fluid (ICF) - Fluid contained within all body cells

Ovarian cycle and menstrual cycle

-ovarian cycle: is the name given to the physiological change that occur ovaries that are
essential for the preparation and release of an oocyte.

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Menstrual cycle: the menstrual cycle is name given to physiological change that occurs in
uterus which is essential to receive the fertilized oocyte.

5- What are the systems that maintain homeostasis and how they regulate?

Systems that maintain homeostasis are endocrine and nervous systems.

 Nervous system

- Controls and coordinates bodily activities that require rapid responses

- Detects and initiates reactions to changes in external environment

 Endocrine system

- Secreting glands of endocrine regulate activities that require duration rather than
speed

- Controls concentration of nutrients and, by adjusting kidney function, controls

internal environment’s volume and electrolyte composition

6- Demonstrate your understanding of homeostasis with apparent example of it?

Homeostasis: defined as maintenance of a relatively stable internal environment. Does not mean
that composition, temperature, and other characteristics are absolutely unchanging

• Homeostasis involves dynamic mechanisms that detect and respond to deviations in

physiological variables from their “set point” values by initiating effectors responses that
restore the variables to the optimal physiological range.

Factors homeostatically regulated include:

 Concentration of nutrient molecules

 Concentration of water, salt, and other electrolytes

 Concentration of waste products

 Concentration of O2 = 100mmHg and CO2 = 40 mmHg

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 pH = 7.35

 Blood volume 4-6 L

 pressure 120/80

 and Temperature = 37o C

Homeostatic Control system

 Feedforward - term used for responses made in anticipation of a change

 Feedback - refers to responses made after change has been detected

– Types of feedback systems

• Negative

• Positive

 Negative feedback

– original stimulus reversed

– most feedback systems in the body are negative

– used for conditions that need frequent adjustment

 Positive feedback

– original stimulus intensified

– seen during normal childbirth

Negative feedback consists of:

 Receptor - structures that monitor a controlled condition and detect changes

 Control center - determines next action

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  Effector receives directions from the control center & produces a response that restores
the controlled condition

Example of Homeostasis include: high blood glucose level

 Blood glucose concentrations rise after a sugary meal (the stimulus), the hormone insulin
is released and it speeds up the transport of glucose out of the blood and into selected
tissues (the response), so blood glucose concentrations decrease (thus decreasing the
original stimulus).

Positive Feedback during Childbirth

 Stretch receptors in walls of uterus send signals to the brain

 Brain induces release of hormone (oxytocin) into bloodstream

 Uterine smooth muscle contracts more forcefully

 More stretch, more hormone, more contraction etc.

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  Cycle ends with birth of the baby & decrease in stretch

7- Explain pathway of blood through the heart?

The heart works as two pumps one on the right and one on the left , waking simultaneously
blood flows from the right atrium to the right ventricle , and then is pumping to the lungs to
receive oxygen from the lungs’ the blood flows to the left atrium ,then to the left ventricle.

This occurs as follows:

 After passing through the capillaries of the lungs, the blood which is now oxygenated
returns to the heart in the pulmonary veins.
 The left atrium receives blood from the pulmonary vein.
 Blood passes through the mitral valve into the left ventricle.
 Contraction of the left ventricle pushes blood through the aortic semilunar valve into the
aorta. Blood travels to all regions of the body where it feeds cells with oxygen picked up
from the lungs and nutrients from the digestive tract.
 Deoxygenated blood returns from the rest of the body through the superior and inferior
vena cava.
 The right atrium receives the deoxygenated blood.
 Blood then enters the right ventricle through the tricuspid valve.
 Contraction of the right ventricle pushes blood through the pulmonary semilunar valve
into the pulmonary arteries in which it travels to the lungs.

8) State functions of the urinary system?

The functions of the urinary system are 4

i. Excretion of Metabolic Wastes

• Most are nitrogenous
– Urea (primary nitrogenous waste)
– Ammonium
– Creatinine
– Uric acid

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 ii. Osmo regulation
• Maintenance of the proper balance of water and Salt in the blood
• Blood volume and pressure related to salt balance
iii. Maintenance of Acid-Base Balance
• Along with the respiratory system, the kidneys regulate the acid-base balance of the blood.
• PH is kept at around 7.4.
iv. Secretion of Hormones
• Renin – leads to secretion of aldosterone (involved in reabsoption of Na+)
• Erythropoietin – stimulates red blood cell production
• Vitamin D activation – to promote calcium absorption
9) Mention layers of heart wall?
• Three layers of tissue
– Epicardium: This serous membrane of smooth outer surface of heart
– Myocardium: Middle layer composed of cardiac muscle cell and responsibility for
heart contracting
– Endocardium: Smooth inner surface of heart chambers
10) Mention the function of the following:
a) Uterus
b) Vagina
c) Fallopian tube
d) Placenta
a) Function of uterus
 Nourish the fertilized egg prior to birth.
 Prepare for pregnancy each month
 And following pregnancy expels the products of conception.
b) Function Of Vagina
 vagina allows escape of menstrual fluid
 it receive penis and ejected sperm during sexual intercourse
 provide exit fetus during birth

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c) Function of Fallopian tube
 they propel the ovum in to the uterus
 receives the spermatozoan as they travel upwards
 it provide site for fertilization (ampulLa)
 it supplies the fertilized ovum with nutrition during its journey to the uterus
d) Functions of Placenta

a. Respiration - As pulmonary exchange of gases does not take place in the

uterus the fetus must obtain oxygen and excrete carbon dioxide through the
placenta.
b. Nutrition - Food for the fetus derives from the mother’s diet and has already
been broken down into forms by the time reaches the placenta site. The placenta
is able to select those substances required by the fetus, even depleting the
mother’s own supply in some instances.
c. Storage - The placenta metabolizes glucose and can also store it in the form of
glycogen and reconverts it to glucose as required. The placenta store iron and the
fat soluble vitamins.
d. Excretion -The main substance excreted from the fetus is carbon dioxide;
bilirubin will also be excreted as red blood cells are released relatively frequently.
e. Protection - It provides a limited barrier to infection with the exception of the
trepaneoma of syphilis and, few bacteria can penetrate. Viruses, however, can
cross freely and may cause congenital abnormalities as in the case the rubella
virus and HIV virus.
Towards the end of pregnancy, antibodies in the form of immunoglobulin G (igG)
are transferred across the placental barrier to the fetus giving passive for the fast 3
months of extra uterine life.
f. Endocrine- it secretes several hormones:
 human chronic gonotrophin (HCG) is produced by the cytotrophoplast layer
of the chrionic villi to situmulate the growth & activity of the corpus leutum
 oestrogen are growth stimulating hormones, which are secreted in large
amounts throughout pregnancy

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  progesterone is made in large amounts until immediately before the onset of
labor when its level falls
 human placental lactongen has a role in glucose metabolism in gregnancy.

11) Explain the diameters of the pelvic inlet and outlet?

Pelvic inlet:
The pelvic brim, which is also known as the inlet, has tree principal diameters:
transverse diameter, oblique diameter and anteroposterior diameter.
A-The anteroposterior diameter extends from the upper border of the symphysis pubis
to the sacral promontory & measures 11cm.
B-The transverse diameter between the linea terminals & measures 13cm.
C-The oblique diameter extends the sacroiliac joint to iliopectineal eminence &
measures is 12cm.
The sacral promontory projects into the brim. This tends to make the anteroposterior
diameter less than the transverse diameter, thus forcing the oval head of the foetus to
engage the brim in the more accommodating transverse diameter.
Pelvic outlet:
A-The anteroposterior diameter extends from the lower border of the symphysis pubis to the
sacrococcygeal joint and the ligament joining the ischial tuberosities to the sacrum which are
known as sacrotuberous ligaments & measures 13cm.
B-The transverse diameter is between the ischial tuborosities and measures 10-11cm.
C-The oblique diameter, although there no fixed points, is said to be between the obturator
foramen & sacrospinous ligament & measurement is taken as being 12cm.
Hence the foetal head lies with its long axis in the antero-posterior position
12) the hip bone is composed three fused bones namely Ilium, ischial and pubic, Describe
each one?
1-the Ilium is large flared-out part when the hand is placed on the hip. It rests on the iliac crest
which is the upper border. At point of the iliac crest can be felt a bony prominence known as the
anterio superior iliac spine a short distance below it is anterio inferior iliac spine, there are two
similar points at the other end of the iliac crest posteriorly (posterior superior iliac spine &
posterior inferior iliac spine).

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2-the ischium: is the thick lower part that has a large prominence known as the ischial tuberosity
on which the body rests when sitting. Behind and a little above the tuberosity is an inward
projection known as the ischial spine. It has:
 a large body that projects superiorly to join with the ilium and the superior ramus
of the pubis;
 a ramus that projects anteriorly to join with the inferior ramus of the pubis.
3-the pubis: The pubis forms the anterior part, it has a body & two oar-like projections known
as the superior &inferior rami (arms). The body is flattened dorsoventrally and articulates with
the body of the pubic bone on the other side at the pubic symphysis. The body has a rounded
pubic crest on its superior surface that ends laterally as the prominent pubic tubercle.
The superior pubic ramus projects posterolaterally from the body and joins with the ilium and
ischium at its base, which is positioned toward the acetabulum. The sharp superior margin of
this triangular surface is termed the pectineal line (pecten pubis), which forms part of the linea
terminalis of the pelvic bone and the pelvic inlet.
The two pubic bones meet at the symphysis pubis & the two inferior rami form the pubic arch
merging into a similar ramus on the ischium. The space enclosed by the body of the pubic bone,
the rami & the ischium is known as the obturator foremen.
The innominate bone has a deep cup to receive the head of the femur in a proportion of: two-
fifth of ilium, two fifth of ischium &one fifth of pubis.
On the lower border of the innominate bone have two curves.
One curve extends from the anterior superior iliac spine up to the ischial spine & is called the
greater sciatic notch, it is wide & rounded.
The other notch lies between the ischial spine &ischial tuberosity & is called the lesser sciatic
notch.
13) State pelvic joints?
They are 4 joints
o Anterior: symphysis pubic (cartilaginous joints)
o Posterior lateral: 2 sacroiliac joints (synovial joints)
o Posterior: Sacrococcxygeal joint (cartilaginous joints)

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14- The fallopian tube is divided into four portions, what are they?

They are:

 The interstitial portion is 1.25cm long and lies within the wall of the uterus.
 The isthmus is another narrow part that extends for 2.5cm from the uterus.
 The ampulla is the wider portion where fertilization usually takes place. It is 5cm long.
 The infundubulum is the funnel- shaped fringed end that is composed many processes
known as fimbria. One fimbria is elongated to form the ovarian fimbria, which is attached
to ovary.

15- Explain the three primary germ layers in the embryonic development?

 Endoderm: inner layer forms:

 Lining of digestive tract
 Lining of trachea, bronchia and lungs
 Liver, pancreas
 Thyroid, parathyroid, thymus, urinary bladder
 Mesoderm: middle layer forms:
 Bones and muscles
 Blood and blood vessels
 Reproductive and excretory system
 Inner layer(dermis) of skin
 Ectoderm: outer layer forms:
 Nervous system including brain, spinal cord, and nerves
 Lining of the mouth, nostrils, and anus
 Ectoderm of skin, sweating glands, hair, nails

16-Write down the hormones involved in regulation of

 Menstrual cycle
 Testicular function
Hormones involved in regulation of menstrual cycle are:
1- Hypothalamic hormone-GnRH
2- Anterior pituitary hormones – FSH and LH
3- Ovarian hormones – Estrogen and progesterone

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Testicular function:

The hypothalamus release Gonadotropin releasing hormone (GNRH)

GNRH stimulates the anterior pituitary to secret FSH and LH

FSH causes sustanticular cells to release androgen building protein ABP and inhibition

LH stimulates interstitial cells to release testosterone

Testosterone: ABP bilnding of testosterone enhances spermatogenesis

Secondary sex characteristics

17- Label the fallowing diagram

18- Write down the cavities which appear in the inner cell mass?

There are two Cavities in the inner cell mass called:

- Amniotic sac
- Yolk sac.

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19- Mention the functions of amniotic sac and yolk sac?

 In humans the yolk sac produces blood cells and future sex cells
 The amniotic cavity becomes the cavity in which the embryo floats. Its functions are:
 it allows for growth and free movement of the fetus,
 it protects from injury and heat loss,
 In labour it protects placenta and umbilical cord from the pressure of uterine contractions.
 It also helps the effacement and dilatation of the cervix.

20-What are the types of female pelvis and which one is normal female pelvis?

 Gynaecoid pelvis: is the normal female pelvis. It has an almost round brim and will
permit the passage of an average-sized baby with the least amount of trauma to the
mother and baby in normal circumstances.
 Android pelvis: It has a heart-shaped brim. The pelvic cavity and outlet is often
narrow, straight and long. The ischial spines are prominent. This type of pelvis is least
suited for childbearing.
 Anthropoid pelvis: It has an oval brim and a slightly narrow pelvic cavity.
 Platypeloid pelvis: It has a kidney-shaped brim and the pelvic cavity is usually
shallow and may be narrow in the antero-posterior diameter.

21. List the male & female reproductive organs?

 the male reproductive organs

Prepuce, penis, tests, epydidimis, vas deferens, prostate gland,seminal vesicle, ejacualatory
duct, bulbo urethral gland

 . The external female organs

Mons pubis
Prepuce
Clitoris
Mons pubis
Labia minora
Labia majora
Urethral opening
Hymen
vagina
Perineum

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  and internal organs:
Uterus
Fallopian tube
Ovaries

22. Mention the position, measurement, weight, layers, situation, and parts of the uterus?

 Position of the uterus is horizontal

 Measurements it measures about 7.5 cm in length, 5 cm in breadth at it is upper part and about
2.5 cm in thickness.
 Weight in non pregnant women is 60gram
 Layers of uterus include :
 Perimetrium: outer serous membrane
 Myometrium: middle muscle
 Endometrium: inner mucosal lining
 Situation of the uterus is behind the bladder & in front of the rectum
 Parts of the uterus include:
 Fundus
 Body
 Cervix: Internal os of the cervix and external os of the cervix

23. Draw and label the female internal organs?

24. Mention the parts of the ovary?

 medulla: is the supporting frame work of the ovary

 Cortex: is the functional part of the ovary it produces hormons eg:
progesterone ,ostrogen, estrone , estriale, esdrole.

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25. Mention the place that produces ostrogen and hormone that influence to produce
ostrogen?

 Place that produce estrogen is: Graafian follicle, Adrenal cortex and Placenta
 Hormone influence to produce estrogen is follicle stimulating hormone (FSH)

26. Mention the places that produce progesterone and the hormone that influence to
produce progesterone?

 Place that produce progesterone is: Corpus Luteium, Adrenal cortex and Placenta
 Hormone influence to produce luteazing hormone (LH )

PART TWO TRUE AND FALSE: (T) IF THE STATEMENT IS TRUE OR (F) IF THE
STATEMENT IS FALSE.
1. Clitoris is the one of the primary female reproductive organ (f)
2. Test produce sperm and lie with scrotum then sperm are delivered exteriorly through
system of ducts namely: epididymis, ducts deferens, ejaculated duct and urethra (T)
3. The tests are kept 2c0 less than core body temperature by cremaster muscle (F)
4. Male sexuality takes place in two phases erection and ejaculation (T)
5. Vagina is composed structurally of mucus, muscle and fascia (T)
6. Estrogen is present in the plasma in two forms only which are estradiol and estrone(F)
7. Chorionic membrane is opaque membrane derived from the trophoblastic layer of the
zygote (T)
8. The true pelvic is divided into inlet, cavity and outlet (T)
9. HCG is present as early as 8 to 12 days after fertilization to keep corpus leutum active
until placenta takes over its function(T)
10. Estrogen is concerned mainly with the final preparation of uterus for pregnancy (F)
PART THREE: FILL THE BLANK SPACES WITH APPROPRIATE WORDS

The menstrual blood is inhibited from clotting an enzyme called……

plasmin………………………….contained in the endometrium

 The proliferative endometrium is consist of three layers Basal layer, functional layer cuboid
epithelium layer
 The uterine wall is composed of the following layers:
Endometrium, myometrium, premetrium

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 The fetal surface of placenta has shiny appearance due to amnion covering it
 ………………bulbourethral glands…….. produce thick clear mucosa prior to ejaculation
 Human body is constituted four main elements they are:……oxygen , carbon , hydrogen &
nitrogen,……………

PART FOUR MULTIPLE QUESTIONS CIRCLE THE CORRECT ANSWER ONLY:

1) follicular phase of the ovarian cycle is period of the follicular growth.in 28 days
cycle from day
A. 5-14
B. 14-28
C. 1-14
D. 4-5

2) Which of the following hormones controls the growth and maturity of the graafian
follicle

A. FSH

B. HCG

C. LH

D .OESTROGEN

3) The following suture separates the two parietal bone.

A. lambda

B. coronal

C. sagittal

D. frontal

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4) The lumen of the fallopian tube is

A. 2.5cm

B. 5mm

C. 7.5 cm

D. 1 mm

5) The vessels which supply the uterus are:

A. The ovarian artery

B. Uterine artery and ovarian artery

C. Uterine artery

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 Normal pregnancy questions
1. Define the terms/ following?
a. Trimester
 .its refers to three clender months
b. Gravida
 Is number of pregnancy
c. Parity
 Is number of delivered
d. Primagravida
 It’s the pregnant for first time
e. Prima para
 Its women having nad one delivery
f. Multigravida
 It’s a women who has had two or more pregnancy
g. Multpara
 Is a women who has had two or more deliveries
h. Nulliparous
 It’s a women who has never delivered
i. Grand nultipara
 It’s a women having had 6 or more deliveries
j. Quickening
 This is when mother feels the first movement
2. What is the average duration of pregnancy?
 Its 266 days
3. What can you express in month during pregnancy?
 It can be calendar months or lunar months
4. How can we diagnose normal pregnancy?
 Is made on basis of symptoms signs and investigation of pregnancy

5. What are the signs and symptoms of pregnancy? Include: Amenorrhea, enlargement and
tenderness of breast, nausea, excessive salivation(ptylism), frequency of maturation tireness,
weakness and depression
6. Some women become ammorrhea without pregnancy so what is the cause?
Include: great emotional stress, change environment, high expectation of pregnancy or
great fear of getting pregnancy.
7. What is the cause’s pregnancy maturation during first 12 weeks of pregnancy?
Is due to the pressure of gravid uterus on the urinary bladder.
8. In early pregnancy women experiences constitutional symptoms such as depression what is
the real causes?

It may be hormonal change

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9. When the prima gravid women recognize this movement?
She recognized about 20thwks
10. When the multi Para women recognize this movement?
She recognized about 16th wks
11. What are the kinds of investigation?
There are:
Pregnancy test
Ultrasound scanning
X-ray
12. What is depends on the human gonadatropine?
It depends on secreted in the mothers’ urine and to be certain early in a morning.
13. When it becomes positive?
It’s after 6 wks of pregnancy.

14. How the expected date is calculated?

Is calculated by adding 7day first day of the last menstrual period and subtracting 3
months also adding 1 year

In 28 April 2016 what is her expected date?

28\4\2016
+7\-3\+1
=5\2\2017
15. What are the physiological changes during pregnancy?
Include:
 Reproductive system
 Cardiovascular system
 Respiratory system
 Gastrointestinal system
 Skin
 Skeletal system
 Maternal weight
 Breast change
16. What is the changes in skin during pregnancy?
During pregnancy there is increased activity of the melanin stimulating hormone causing
deeper pigmentation known as chloasma and line running from the pubis to umbilical
known as lineanegra and thin stretch mark called streagarvidrum, and increase blood
supply to the skin leads to sweating often feels hotter due to progesterone.
17. Tell changes in maternal weight?
Include:
 2.0kg in first 20wks.
 0.5kg per week until term.
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  12 kg approximately total.
18. What are the factors women more vulnerable?
 Low social
 Large families to take care of all
 Poor nutrition
 Infection disease
 Anemia
19. What is the common discomfort of pregnancy?
o Urinary frequency
o Fatigue
o Leg cramps
o Hear burn
o Nausea and vomiting
o Shortness breathing
o Edema
o Ptyalism and excessive salivation
o Breast enlargement and sensitivity
o Hemorrhoid
o Constipation
o Backache
o Varicosities
o Leucorrhea
20. Define ANC?
Comprehensive health supervision of a pregnant woman before delivery.
Or it is planned examination, observation and guidance given to the pregnant woman from
conception till the time of labor.

21. Goals of ANC?

A: to reduce maternal and prenatal mortality and morbidity rate.,
B: to improve the physically and mental health of women and children.
C: to decrease financial recourses for care of mother.
D:To prepare the women for labor, lactation, and care for her infant.
22. What is the importance of ANC ?
 To ensure that the pregnant woman and her fetus are in the best possible health.
 To detect early and treat properly complications
 Offering education for parenthood
 To prepare the woman for labor, lactation and care of her infant


23. What are the WHO recommendations of ANC visits?

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  FIRST visit; as early as possible at least before 12 weeks of gestation
 Second visit; at or near 26 weeks
 Third visit near at 32 weeks
 Fourth visit at 36.38 weeks
24. What are the women at high risks of developing pregnancy?
Women with bad past obstetric history:
 Previous post partum hemorrhage or retained placenta.
 Previous caesarean section or any operation on uterus.
 Operative delivery on last baby.
 Stillbirth or neonatal death in last pregnant.
 History of three consecutive abortion.
 History of several years of infertility.
 Pre-eclampsia and eclampsia in the previous pregnant.
Women who currently:
 Grand multiprous
 Age women –is below 16 years or above 35 years
 Short stature women height below 150cm
 Aged more than 35 years and expected her first baby
 General medical disorders like diabetes renal disease .severe malnutrion .heart
disease.
 Pelvis deformity.
25. What are the activities at first antenatal visits?
 Registration
 Height and weight measurement
 History taking
 Physical examination
 Laboratory investigation
 Management of `complains and prophylaxis
 Immunization
 Healthy education
26. Explain methods of abdominal examination?
 Preparations
 Inspection
 Palpation
 Auscultation

NORMAL LABOUR

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1. Define the following:
A. Gravida: Is number of pregnancy
B. Parity: Is number of delivered
C. Primagravida: It’s the pregnant for first time
D. Multigravida: It’s a women who has had two or more pregnancy
E. Nulliparous: It’s a women who has never delivered
2. What is normal labour?
 Spontaneous expulsion
 Single
 Living
 Full term fetus
 Presenting by the vertex
 Through the natural passage
 Without complications to the mother and fetus only minimal episiotomy
 The whole process is completed within 20 hrs.
3. Tell sign the onset of labour
 True labour pain
 Passage of show
 Cervical dilatation and effacement
 Formation of the bag for waters and sometimes rupture of membrane
4. Explain mechanisms of labour with occipital anterior presentation?
o Engagement: in transfer position,
o Descent downward to pelvis
o Flexed as the head descends due to the shape of the bony pelvis.
o Rotate in mid pelvis, or Internal rotation
o Crowing,
o Extension of the neck,
o Restitution or external rotation
o Expulsion: delivery of the rest of the fetal body.
5. Explain the indications of vaginal examination &what are the points to note?

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 - To diagnostic gynecological in any time and obstetrical Abnormalities: during pregnancy,
labour, puerperium.
- To assess any abnormality in the pelvic to do pelvic examination
- To check if patience is in labour and what stage of labour, to Assess progress of labour
- To check if there is cord prolapsed when the membrane ruptured.
- To perform Artificial rupture of membrane

The points to note are:

- If there any abnormalities in gynecological problems.

- In obstetrics: progress of labour, presentation, membrane intact or rupture,
pelvicadequate, cervical diltation, soft or hard, affacement, decend, moulding and liquor.
6. Explain the stages of labour?

The stages of labor are:

 first stage: - Starts with the onset of true labor pain and ends with full dilation of the
cervix
 Second stage: - Starts with full cervical dilation and ends with delivery of the fetus.
 Third stage:- Starts with delivery of the fetus and ends with the expulsion of the placenta
and membranes
 Fourth stage:- start after delivery placenta and membranes until 24hours to observe
conditions mother and baby
7. List the signs of placenta separation?
 The time
 The uterus contracted and rises.
 The umblical cord suddenly lengthens
 A gush of blood occurs.
8. Explain the partograph and the important of partogram women in labour?

The partograph: an essential tool for decision making during labour and recording
progress of labor:
It is the best tool to help you whether labor is progressing normally or abnormally,
and to warn you as soon as possible if there are signs of fetal distress or if the mother’s
vital signs deviate from the normal range.

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And the importance to know is:

 To detects abnormal progress of labor early possible.

 To Assess Cervical dilatation, Descent and Uterine contractions
 To recognizes earlier if their Cephalopelvic disproportion before obstructed labor.
 To asses in early decisionon transfer augmentation or termination of labor.
 To increase quality and regularity of all observation of mother and fetus.
 To prevent prolong labor

9. Define the Episiotomy and indication of Episiotomy?

- Episiotomy also known as perineotomy: is surgical incision done by a midwife or
obstetrician during second stage of labor to enlarge the vaginal opening to facilitate the
delivery of the baby.
- The incision, which can be done at a 90 degree angle is performed under local
anesthetic, and suturedclosed after delivery.

Indications of episiotomy are:

Fetal

1-large head 2- breech delivery 3- fetal distress 4- preterm baby 5- delivery as face to pubis
6- shoulder dystocia

Maternal

1- Rigid perineum 2-primigravida 3-after repair prolapse, previous complete perineal tear,
instrumental delivery, previous pre-natal repair surgery, .previous pelvic floor surgery

10. How to perform physical examination women in labour?

Head to Toe examination:

 HEAD:
- hair color
- injury
- dandruff
- any parasite
- hair distribution
- texture
 EARS:
- excessive wax
- discharge
- any hearing problem

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 - size and position
 EYES
- Conjunctiva for pallor
- Jaundice
- discharge
- vision defects
- retina hemorrhages
 NOSE
- discharge
- nasal septum
- position
- breathing

 MOUTH
- pallor
- bleeding gums
- oral thrush
- bad breathing
- tonsils
- number of teeth present and absent
 NECK
- swelling
- goiter
- engorged jugular vein
 ARMS
- edema
balm for pallor
- size and abnormality
- both arms summitry
 CHEST
- Condition of skin
- nipples
- prominent
- fiat
- enlargement
- axillary gland
- tender
- shape of breast
 LEGS
- varicose viens
- both Legs symmetry
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  BACK
- sacral edema
- curved
- hip dislocation

ABDOMENAL EXAMINATION

- inspection: shape, size, scars, stare gravid rum, linea Ingra, Distention
- Palpation ( Leopold maneuver)
- Auscultation fetal heart sound
- Uterine contraction

PELVIC AND VAGINAL EXAMINATION

- Vulva: discharge, warm, redness, edema.

- Pelvic: pelvic Adequate
- Vaginal: progress of labour, presentation part, membrane, cervical dilatation, effacement,
descend, molding and color & amount of liquor.
11. Mention difference between false labor and true labor?

FACTORS TRUE LABOUR FALSE LABOUR

Contractions Regularly spaced Irregularly spaced

Interval between Gradually shortens Remains long

contractions

Intensity of contractions Gradually increases Stays the same

Location of pain Back and abdomen Mostly lower abdomen

Effect of analgesics Do not abolish the pain Often abolish the pain

Cervical changes Progressive effacement and No changes

dilatation

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 12. What are the indications for induction of labor?
 Post term pregnancy (more than42 weeks or equal)
 Placenta abruption If the baby is died and try to deliver as SVD
 Missed abortion
 Slow progress of labor
 Hypertension
 Diabetic
 PROM
 IUGR
 IUFD
13. Describe the management you will give women in labor and her baby until to go
back her home?
 Taking history
 perform physical examination
 perform Abdominal Examination (Observation, palpation and Auscultation)
 Investigation,
 Making partograph
 Psychological support both mother and her relative

Technique
Prepare yourself; environment of mother and new baby’ as well as all the equipment

 Scrub the hands for at least five minutes before any vaginal procedure in labour.
 Put on sterile gloves and at least put on a clean gown or apron, and a sterile gown would be
preferred.
 Make the patient lie on her back with the knees flexed and abducted at the hip. This is known
as lithotomy position.
 Swab the thighs and vulva with an antiseptic. Repeat this if the patient passes stool or if the
second stage is prolonged
Apply an antiseptic lubricant to the right hand and introduce the first two fingers into the vagina

 Vaginal examination including: pelvic examination, cervical dilation, membrane, presenting

part, molding, station, descent of the head and condition of liquid (amniotic fluid)

27
  Check the following:
- pulse of the mother, every 15 minutes
- fetal heart rate, after every contraction if possible
- make sure the bladder is empty
 Encourage drink and walk.
 Avoidance unnecessary intervention.
 Encourages the mother to push during contraction if cervix full dilated.
 Perform episiotomy if necessary when you see the crowding of head

After delivery of the head swab the face of the baby to open the airway and delivery the rest of
the body.

APGAR Score

After delivery of the baby, an assessment of the general condition is done at one minute and at five
minutes. This involves consideration of five signs and the degree to which they are present or
absent. The factors assessed are:

 Heart rate
 Respiratory rate
 Muscle tone
 Reflex or response to stimuli
 Colour

Immediate care of the baby

 As soon as the baby is born, clean his mouth carefully. Make the airways free by sucking
mucus from the mouth and nostrils
 When the pulsations of the cord have stopped, tie the cord 5 cm away from the umbilicus
 Make sure the ligature is really tight before you cut the cord
 Wrap the baby in a clean cloth and give him to the mother to put to her breast
 Wait until u seen placenta separation and delivery the placenta gently.
 massage the uterus
 give oxytocin or ergometrin
 monitoring the mother birth canal for any laceration

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  monitor the mother vital signs, bleeding, pain and any discomfort

Record the following about the baby

 date
 time of delivery
 sex and if the genitals are normal
 weight
 circumference of the head
 check whether the anus is patent or imperforate
 Give the baby with his/her mother to breast feed if possible.
 Give health education, counseling, advice for the mother, registration and baby condition
and make the tine for flow up.
 Clean the delivery room
 Sterilize all delivery instruments and supplies after use
 Store them protected and ready for the next use
 Leave the room ready for use in case of an emergency
 Hand over all patients and equipments
14. Describe possible preventive of measurement in both types of fistula?
1. Educate local communities about the culture social and physiological foctor that condition and
contribute to the risk for fistula
2. Access obstetric care
3. Support from trained health care professionals throughout pregnancy
4. Provide access to family planning, promoting the practice of spaces b/w births
5. Nutritional needs of female children to prevent malnutrition as well as improve physical
maturity of young mothers are important fistula prevention strategies.
6. Availability and provision emergency obstetric care as well as quick and save c/section for
women in obstructed labor
7. Discourage early marriages 8. Punish heavily the rapists
15. How to manage placenta retained?
If the placenta is undelivered after 30 mintis:
 Empty bladder

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  Breast feeding and nipple stimulation
 Change of position-encourage an upright position
If bleeding: immediately:
Inform anesthetist
Insertion of large cannula
Insert urinary catheter
Commence/contentious oxytocin infusion 10 unit in 1 lit-/rate -60 drop/mint
Measure and accurately record blood loss
Prepare and transfer patient to theater for manual removal placenta.
16. What is the difference b/w lie and attitude in pregnancy?
The lie is the rotation of the long exist of the fetal to the mother, While attitude is the posture of
the fetus folded is posture on its self to communicate its shape.

17. Explain briefly abnormal lie malpresentation and malposition?

 Abnormal lie: any lie rather than longitudinal lie and may be either oblique or
transverse and unstable lie.
 Malpresentation any presentation rather than vertex where the fetus is lying
longitudinally, but presenting part is Breech, Face, Brow, Shoulder, Cord or Compound
presentation.
 Malposition whether the fetal is lying longitudinal and the vertex is presenting but is not
occipito anterio position.
18. Explain causes of 3 delays?

A: Delay in descion making to seek care:

 Low status of women

 Previous poor experience of health care
 Acceptance of maternal death.
 Financial implications

B: Delay in reaching care:

 Distance to health centers and hospitals

 Availability and cost of transportation

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  Poor transportation
 Geography e.g.- mountainous , terrain ,rivers

C: Delay in receiving adequate health care

 Poor facilities a lot of medical supplies

 Inadequately trained and poorly motivated medical staff
 Inadequate referral system
19. MISS A 3o old mother, gravita 6 para 5 came to your clinic as first for her life.
A. explain history taking for this mother
B. describe the physical examination
C. important investigations will consider
D. advice you will give her

A: Full history taking:

1- Personal data:
 Name
 Age
 Sex
 Marital status
 IP Number
 Occupation
 Date of Admission
 Time of Admission
 Gravida
 Para
 Abortion

2- Present history
 Chief complain at this time
 What you do for that patient such as : observation Assessments
3- Past obstetric history

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  History of previous pregnancy
 Number of pregnancy
 Type of delivery
 Number of abortion
 Number of children’s live and death
4- Past medical history
 Previous and current chronic illness
 History of blood transfusion
5- Past surgical history

Previous operations such as:

 Previous uterine surgery, myoma and fibroids

 Other operation in the body
6- Gynecological history
 Menstrual history
 Menarche
 Length
 Interval
 Regular
 History of STDs
 History of gynecological operation
7- Socio-economic history
 Marital status
 Occupation
 Level of education
8- Immunization history
 Number of vaccine that taked ( TT1-TT5)
9- Family history
 Family member
 Type of house
 Number of rooms, kitchen, toilet.

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  Habits of family eg if one of family has cigarette smoking

.B: Physical Examination

General appearance
Head to toe assessment
Abdominal examination
 Inspection
 Palpation
 Auscultation

C: Investigations

 HB control
 Blood sugar
 Blood grouping
 HIV test
 Hepatitis C $ B

D: Advice you will give about

 Nutrition
 Talk about danger signs in pregnancy such as headache, bleeding if you see visited at
clinic or MCH
 Hygiene
 Birth plan
 Breast feeding
 Family planning
 Fallow up

20. MISS A is 20 years old gravita 2 para one full term .complaining abdominal pain?
A. State signs of true labour?
B. List requirement for vaginal examination?
C. state stages of labour

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 D. Explain managent role of midwife from first stage to third stage?
E. State importance of pantograph?

A: Signs of true labour

 Regular uterine contraction

 Cervical dilatation and effacement
 Passage of show
 Formation of pag of water

B: Requirement for vaginal examination

 Tray
 Hand washing
 Sterile gloves
 3 cotton sterile within the galipot
 Iodine or other antiseptics

C: stages of labour

 first stage: - Starts with the onset of true labor pain and ends with full dilation of the
cervix
 Second stage: - Starts with full cervical dilation and ends with delivery of the fetus.
 Third stage: - Starts with delivery of the fetus and ends with the expulsion of the
placenta and membranes.
 Four stages: - observation stage the first two hours of monitoring.

D: Management role of midwife from first stage to third stage

Role during first stage

 Emotional support to the mother

 Adequate hydration to prevent ketosis
 Monitoring of fetal wellbeing every third minutes
 Fallow up progress of labour:
 Cervical dilation

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  Descent of presenting part
 Antibiotics to prevent early onset of neonatal infection

Role during second stage

 Confirm by full dilatation of cervix, fetal station , fetal position.

 Monitor vital and maternal vital signs closely.
 Assess uterine contraction.
 Delivery is imminent at crowding (+5 stations).
 Episiotomy
 Delivery of head
 Delivery of the baby
 Clamp cord when pulsation stops
 Look Apgar score of the baby and then cover well.

Role during third stage

 Delivery of placenta and membrane

 Do not pull the cord
 Apply gently traction
 Check placenta for competence

E: Importance partograph:

 To detects abnormal progress of labor early possible.

 To prevent prolong labor
 To recognizes cpd long before obstructed labor.
 To asses in early decision on transfer augmentation or termination of labor.
 To increase quality and regularity of all observation of mother and fetus.

Normal puerperium

1- Define normal puerperium?

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 Puerperium or postnatal period Begins as soon as placenta is expelled lastsfor 6 weeks
(42 days and its period of adjustment after delivery when the anatomic and physiologic
changes of pregnancy are reversed , and body return to the normal ,non pregnant state .

2-Outline the types of Lochia?

Lochia Rubra= 1-4 days it characteristic red color

Lochia Serosa =5-6 days, the lochia become the pinkish and brownish.
LochiaAlba = 10-15 days, the uterine discharge has reduce content and is largely
composed of leukocytes.
3-Mention General Physiological Changes thatoccur during puerperium?
(1)Uterine Involution
It rapidly decreases in weight from 1000 g - 100 g
In the first 3 weeks postpartum.
(2) Return of menstruation
*non-nursing mothers:
Menstruation returns by 6 – 8 weeks.
* Nursing mothers:
May develop lactating amenorrhea.
(3) Vagina
The supportive tissues of the pelvic floor gradually returns its former tone.
Women who deliver vaginally should be taught & encouraged to perform
Kegel exercises.
(4) Cardiovascular system
* Cardiac output & plasma volume gradually
Returns to normal during the first 2 weeks.
* Marked weight loss occurs in the first week
As a result of the decrease of plasma volume
And the diuresis of the extracellular fluid.
(5) Gastrointestinal system
Abdominal discomfort result from gaseous distention related to decreased motility and
abdominal muscle relaxation.

36
(6) Musculoskeletal system
During the first few days after child birth, the women may experience muscle fatigue and general
body aches from extension of labor and delivery of the baby
(7) Neurological system
 Fatigue and discomfort are common complain after childbirth.
 Alter sleep, headache may result from the leakage of the cerebra spinal fluid in to the
extradural space atterns that contribute to increase maternal fatigue.
 During labor and birth may cause transient maternal neurological changes such as
numbness in the legs or dizziness.
(8) Integumentary system
Chloasma of the pregnancy usually disappear at the end of pregnancy

4- Explain Management you will give woman with Puerperium ?

 To restore health of mother

 Rest and early ambulation
 Emotional support
 Diet of patients choice
 Sleep
 Immunization
 Maternal-infant Bonding
 Postnatal exercise
 To prevent infection
 Care of bladder and vulva
 Care of episiotomy
 Maintainance of asepsis and proper hygiene
 Immunization-vaccine TT
 After pains
 Uterus massage
 Anti-spasmodic
 Pain at site of preneum
 Analgesics
 Treatment of anemia
 Supplementary iron therapy

5- Describe the term of lochia ?

37
Lochia is composed of erythrocytes, epithelial cells,blood;and fragments of deciduas,mucus,and
bacteria

6-state the advice that you will give woman with puerperium period?

 Women should be offered advise and how to care their prenium including information of
sign and symptoms of infection ,which require immediate medical referral.
 Women should avoid prolonged sitting and standing
 Women should encourage to use appropriate maternity sentry pads which is softer and
prevent friction on preneal wound
 changed their pads regulary during the day to reduce risk of infection
 Wash hands before an after changed pads
 Eaten on adiet with with plenty of fluids, vegetables,and rich wih vitaminc
 Wash the nipples and areola with warm water before each feed
 Midwife role in postpartum observe, monitor, health of mother and new born support
and guidance in b/f and parenting skills
 Movement in and outside the bed and breathing exercise to minimize deep vien
thrombosis
7-discribe the advantage of breast milk mother & her baby as well as the family?
Mother

 Prevent postpartum hemorrhage

 More rapid uterine involution
 Weight loss
 Prevent breast cancer and ovarian cancer
 Lactational amenorrhea

Baby

 Easy digestion
 First vaccination of baby
 Antibody
 Protect from infection
 Promote prober born growth
 Improve mental and physical health
 Prefect temperature

Family benefits

38
  Safe money
 Safe time
 Baby and mother loved it

8- what is Uterine size and weight by the end of the second week ?

Uterine weights 300g by the end of the week and not palpable pelvic organ

9-How to deal and support as a midwife, mother during puerperium?

 Observe an monitor health of motherand new born support and guidance in breast feeding
an parenting skills
 After birth care of the new mother

Provide education and information to enable you to confidently care of yourself and your baby in
preparation for going to home

 To provide postnatal perineal care

Keep the premium area clean by showering each day

Local asepsis the valve and premium are washed with antiseptic

 Bed rest for two days is advised after un complicated vaginal delivery and for a longer
few days in complicated operational delivery
 Movement in and outside the bed and breathing exercise are advised during the this
period to minimize the of D.V.T
 Diet

It’s important to eat healthily after the birth of your baby

Advice on a diet whit plant fluids vegetables and fruits rich in vitamin c may prevent
constipation and could support wound healing

 Care of the bowel

39
 Constipation is prevented by plant of green vegetables and fruits sufficient fluids and
local glycerin suppositories if need

 Care of the bladder

Patient is encouraged to micturate frequently

If there is retention a catheter is applied under aseptic conditions

 Care of the breast - Wash the nipple and areola withwarmwater before each feed
 Immuniszation

Give immunization directlyYou may be protected you and her baby

 Family planning

Advice exclusive breast feeding

Use contraceptive method

10- Define Involution?

Involution is a term that describes the process where by the uterus returns to non-pregnant state

11- Define colostrums? And its advantages to the new born?

Colostrums is the first milk your breasts produce during pregnancy.

Advantages colostrums to the new born?

 -colostrums is the perfect food for your baby’s very first feeds as his stomach can easily
digest it.
 -colostrums prepare your baby digestive system for mature milk that he will receive in the
next few days.
 -colostrums is high in leukocytes {protective white blood cells}. That can help to protect
against several bacterial and viral infection.
 Colostrums is high in cholesterol which is essential for growth of the baby’s nervous system
at this stage.
 -Colostrums is rich in nutrients such as zinc, calcium, and vitamins like vit k, B6, B12.

NORMAL NEWBORN

40
 1. What are Cause of low birth weight and when do you say that the infant is low birth
weight?
 Causes of low birth weight;
 Poor nutrition status of the mother
 Un regulated fertility { too many too closely birth }
 Twines
 Infection
 Other illness in pregnant ;eclampsia,and and ante partum hemorrhage
 We can say: when newborn weight less than 2.5 kg
2. What are the risk of low birth weight and how to manage low birth weight?
 Difficult feeding
 Danger aspiration of milk into the lungs
 Infection
 Anemia
 Hypocalcaemia
 The baby’s body has limited iron stores leading to letter anemia
 Management of low birth weight ; Given vitamin k IM to prevent bleeding
 Umbilical cord is tired with double ligeter
 Feed him as soon as possible
 If sucking is not possible ‘ expressed breast milk is given

3. Make a menu of Apgar score and assess a baby with 7 Apgar score?

Sings 0 1 2
Respiration Irregular
Hear rate Less than 100b\m
Colour Body pink extremities
blue
Muscle torn Active movement
Reflex Active crying

4. Mention the neurological responses in the newborn and define each of them?

41
 Rooting response: when a flat surface e.g. palms of the hand is brought in contact with
the baby’s cheeks he turns his head to that side searching for the mother’s nipples.
 Moro reflex: the baby’s body and head are supported in the supine position the baby
throws his arms briskly with extension of the elbows and fingers followed by an arm
embracing movement.
 Grasping response: the baby grasps firmly a finger placed in the palm of his hand.
 Traction response: when the baby raised to the sitting position, by traction on the wrists,
the preterm baby does not resist, the full term infant offers strong resistance.
 Stepping response: the baby when grasping by the body in standing position with his
feet on flat surface makes stepping movement.
5. What are the causes of respiratory depression?
 Cause s of respiration distress;
 Obstruction of baby’s airway by mucus ,blood ,liquor or moconium
 Desperation of respiration distress may be due to :the effects of drug admistration
to mother EG diazepam,
 Cerebral hypoxia during labor or traumatic delivery
 Antenatal pneumonia which is due to rupture of membrane during labor
 Anemia {severe} caused by feto maternal hemorrhage or rhesus in compatibility
which reduces the oxygen –carrying capacity of blood
 Major congenital abnormality of central nervous system or respiratory tract
6. Mention the aims of resuscitation?
 Establish and maintain clear airway
 Ensure effective circulation
 Correct acidosis
 Prevent hypothermia and hemorrhage

7. Mention the things that you should protect from newborn baby?

42
 Include:
 Hypothermia
 Hypocalcaemia
 Outside injury
 asphyxia
 Light
 Wind
 Infection

8. How the baby can lose his heat?

Four types:
 Evaporation: wet surface exposed to air.
 Conduction: direct contact with the cool object.
 Convection: surround cool air drafts.
 Radiation: transfer of the heat to cooler objects not in direct contact with infant.

9. List the advantages of breast feeding at 15 points?

1-breast milk is easily digested and absorbed.

2- breast milk promotes the growth of the baby.

3- it improves the physical and mental health of the baby.
4- Breast feeding prevents breast and ovarian cancer.
5- Breast feeding Prevent post partum hemorrhage.
6- Breast milk costs no money.
7- breast milk is always available.
8-Breast milk needs no preparation
9- Breast milk are clean and sterile.
10- Breast feeding continues special relationship of mother and baby.
11-Breast milk is always safe, fresh and exactly the right temperature.
12- Exclusive breast feeding may also delay return of menstruation for at least a little
while.

43
 13- Breast milk contains valuable antibodies that help prevent disease and may reduce
the risk of your baby developing allergies.
14- Breast feeding is the First vaccination of baby.
15-breast feeding safes time because its ready for your baby at a moment’s notice
and you don’t have to heat it , boil water, or sterilize bottles.

10-Mention normal weight measurement and head circumstance and chest

circumference of new born?

 The normal weight of the baby is 2.5-3.5 kg

 Normal head circumference is 34-35cm
 Normal chest circumference is 32-33 cm

11-what is kangaroo mother care and mention the indications for kmc?

Kangaroo mother care is a care given to a new born infant’s secured skin to skin to the mother.

Indication of kmc;-

 Low birth weight

 Preterm infants
 Also term infants

12- How do you establish and maintain respirations of the new born?

 Wipe mouth and nose of secretion after delivery of the head

 Suction secretion from mouth and nose
 Crying infant is breathing infant. Stimulate the baby to cry if baby does not cry
spontaneously or if the cry is weak.
 Oral mucous may cause the newborn to choke cough or gag during the first 12 to
18 hours of life.
 Keep the nares patent remove mucus and other particles that may be cause
obstruction.

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12- How do you establish and maintain respirations of the new born?

 Wipe mouth and nose of secretion after delivery of the head

 Suction secretion from mouth and nose
 Crying infant is breathing infant. Stimulate the baby to cry if baby does not cry
spontaneously or if the cry is weak.
 Oral mucous may cause the newborn to choke cough or gag during the first 12 to
18 hours of life.
 Keep the nares patent remove mucus and other particles that may be cause
obstruction.
 Care of the eyes erythromycin and tetracycline are ophthalmic ointments are the
drugs used for the purpose because they not cause eye irritation.
 Vitamin k injection should be given to a new born because the new born does not
possess the intestine bacteria that manufactured vit k which is necessary for the
formation of clotting factor.
 The dose will be: At term o.5 mg is given while full term is given 1mg.
 Care of the cord;-cord is clamped and cut the cord when a pulsation stopped the
clamp is applied 3-4 inchs from abdomen and the area of the cord are cleansed
with antiseptic solution.
 Educate mother instruction about the cord care not tap bathing until cord falls off.
 Do not apply anything of the cord such as baby powder, or antibiotic except the
prescribed antiseptic solution.
 Avoid wetting the cord.
 Leave cord exposed to air.
 If you notice the cord to be bleeding applied firm pressure and check cord
clamp if loose and fasten.
 Report any unusual sign and symptoms which indicate infection
 foul odor in the cord
 presence discharge
 redness and swelling around the cord

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Part II write T if true or write F if false

1) there is a cure for spinal bifida (F)

2) toxoplasmosis cannot transmit to the unborn baby by the mother (F)
3) congenital abnormality are important causes of childhood ( T)
4) congenital abnormality also know as birth defect (T)
5) advanced maternal age increases the risk of chromosomal abnormality include down
syndrome (T)
6) Consanguinity increases the prevalence of rare genetic congenital abnormality. (T)
7) 7. Babies infected with Chlamydia may not develop pneumonitis. (F)
8) The human nervous system develops from a small, specialized plate of cells (T)
9) Chiari II malformation may not be a result in blockage of cerebrospinal fluid (F)
10) Mild asphyxia has a long duration. (F)

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