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Proteinele lui Bohn a beta globuline de legare sterolica Sp2? Prolactina deciduala - regleaza osmolaritatea lichidului amniotic - influenteaza sinteza PG declansarea contractiilor la nastere - maturizarea pneumocitului de gradul II ce sintetizeaza surfactant stimulat si de prolactina hipofizara Hipofiza.

Suprarenala - crestere semnificativa a hh glucocorticoizi sarcina o stare de pseudocushing vergeturi , TA glucocorticoizii liberi. Modificari determinate de uterina 1. S6 secunde - contr. Spiralate se despiraleaza - S20 modificari histologice a peretilor vasculari : inlocuirea tunicii musculare responsive la factorii vasoconstrictori cu fibrina si cu invazia trofoblastica - tonusul vaselor circulatie mult ameliorata ; schimbul in favoarea fatului ; aceasta face sa scada circulatia periferica.

Colul : - Htrofie ; Hvascularizatie violaceu - Htrofia celulelor epiteliului frecvent epiteliul cilindric aluneca la nivelul epiteliului pavimentos ectropion putin rezistent la agresiunile fizice , chimice , mecanice riscul de noe cervical - inmuiere in travaliu 3. Vaginite micotice 4.

San : - areole Hpigmentate ; in S12 apare areola secundara tigroida - mamelon Htrofiat , mobil - pe suprafata areolelor : proeminente albicioase tuberculii Montgomery glande sebacee - accentuarea retelei venoase Haller - secretie de colostru : celule descuamate din structura sanului secretie lactata cand nu mai sunt acele celule 5.

La nivelul articulatiei pelvine : relaxare pe ligamentele sacroiliace , articulatia sacroiliaca ; modificarile cartilajului simfizei sindrom de simfiza dureroasa cu mers de rata si mobilizare cu cadru 7. Aparat digestiv : - sdr. Reno-ureteral: - L rinichiului cu 1 cm. HTA de sarcina -!!! TCD - retentie azotata pozitiva acum.

Curs 4 A. Patologia genitala asociata sarcinii 1. Malformatii congenitale ale uterului : a tulburarile compartimentarii capacitatea uterului este redusa : - utere duble ,coluri duble - uter didelf canalele Muller nu sau unit ; uter semididelf cu septul intere ele - uterul infantil raportul corp col in favoarea colului ; e deviat la stg ; grad de subfertilitate , risc de boala abortiva.

Au dismenoree , iar caraterele sexuale sec. Se incearca serclajul orificiului cervical facut profilactic la varsta de S12 in conditiile in care nu exista contractii uterine si infectii vaginale. Anomaliile endometrului :. In cadrul complicatiilor intra necrobioza , rapida de volum a tumorii, durere , senzatie de structura tumorala foarte mare , septica cu febra ; - antiinflamatorii - antibiotice - terapie tocolitica ; daca nu se controleaza miomectomie In cazul fibroamelor localizate inaintea prezentatiei NU se poate produce nasterea.

Se cauta sa se realizeze o nastere naturala. In cazul t brevia se face cezariana , deoarece prezentatia este distocica pelviana sau traversa. Este contraindicata miomectomia la cezariana , deoarece exista tulburari de coagulare ce pot duce la histerectomie. Nu ne atingem de tumorile ovariene pana in S Cancerul de col uterin : - ectopia , ectropionul, eroziunea decidoza?

In fata unui neo cervical NU se indica avort chirurgical. Im trim II daca mama doreste sarcina , se asteapta viabilitatea fatului , apoi se extrage prin cezariana oncologie. In trim III fatul este viabil , se extrage prin cezariana oncologie. Starea 0 CIE carcinom intraepitelial NU cuprinde terapie oncologica , evolutia nasterii ; reevaluat cazul la 3 L postpartum. Patologia cardiovasculara Modificarile adaptative CV duc la decompensare in S 28 32 , travaliu , postpartum.

Accidente gravido-cardiace : 1. Trombostopul se suspenda inaintea sarcinii. Patologia aparatului urinar Manifestari specifice sarcinii : 1. GN subacuta si cronica 5. Retentie de urina , uter retroversat sonda vezicala , decubit ventral 7. HTA secundara bolilor renale. Anemia din sarcina. Exista riscul de decolare prematura de placenta normal inserata. Sindrom de defribinare in sarcina - din decolare prematura de placenta , embolie amniotica , eclampsie - Clinic :- hemoragie generalizata , masiva - hemoragie localizata uter in periodul 3 si 4 - purpura , petesii , TEP - fibrinogenul - TP , T global de coagulare ; timp de trombina - trombocitopenie - apar monomeri de fibrina - in obstretica nu exista fibrinoliza primara!!!

CI pt pilulele contraceptive combinate estrogenii influenteaza enzimele implicate in transferul Bi - din disgravidia de I trimestru , forma metabolica - icter recurent de sarcina microzomal : dat.

Curs 6 Travaliu Definitie : totalitatea fen biochimice , fizice si anatomice care se produc pt a expulza produsul de conceptie si anexele fetale placenta , cordon , mb amniotice Declansarea travaliului succesiune de evenimente teorii: a ocitocina - are fct de contractie sec san-celule miometriale - intervine la o dilatatie de 4 cm ca o consecinta a reflexului? PG in cantitate mare apare in amnios cav amniotica act asupra fb. Sistemul de comunicare organica in care fatul si lichidul amniotic reprezinta un sistem format din mb fetale , amnios , corion complex raspunzator de prod PG si contractie.

Nasterea e perceputa ca un stress act asupra hipotalamusului si str extratalamice. Hipotalamusul : - ncl. Dupa ruperea mb , cav uterina se colonizeaza cu flora vaginala dupa 6 ore. Elementele de structura sunt cel miometriale cu tes conj la ext , iar la int fb de colagen. Elementele contractile : actina , miozina. GAP jonction influxul nervos trece transversal si determina contractilitate generalizata. Prostacicline , progesteron. Organizare miometriala scurtarea fb micsorarea dimensiunilor uterine contractie.

Prin tractiune colul se subtiaza si se sterge , iar segm inferior se subtiaza se obtine dilatatia. O contractie se generalizeaza in 15 sec. Durata e data de elementul ischemic si de tensiunea si presiunea data pe partile moi.

Caracteristicile contractiei uterine : - dureroasa , involuntara , progresiva intensitate , frecventa , durata - nu se poate opri travaliul odata inceput. Mecanismele dilatatiei : 1. Angajarea mecanisme : diam. Asinclitismul poate fi : anterior introduce parietalul anterior , sau posterior introduce parietalul posterior e mai bun 2.

Razele celor doua convexitati si art. Degajarea in diam. Expulzia : 1. Identificarea : contractii , au greata , varsa , iritatie a plexului simpatic de catre craniu la angajare , apoi se angajeaza si produce contractie pe rect cu senzatie puternica de defecatie. Bataile cordului fetal 4. Asistenta propriu-zisa 5. Delivrenta Analgezice si anestezice principii: 1.

Analgezia : se adm. Anestezie generala : pt. Analgezie locoregionala : corecteaza dinamica , protejeaza de durere ; se introduce subst. Lu Fransten-Lronser? Prinderea ultimilor 2 poate afecta cont. Analgezia locoregionala peridurala scurteaza travaliul cu h si nu doare. Ea Nu se recomanda la fatul mare , sau se corecteaza cu perfuzie ocitocica. Avantaj : in cazul in care nu poate sa nasca natural se trece la D anestezie cezariana.

Reflecta parametrii normali si pe cei care-i suporta fatul hipokinezia adresata unuia sau tuturor segm. Sedare , tocoliza relaxare dispar centrii aberanti Distocia: Hiperkinezia este rezultatul conflictului de parti moi ; dureaza mult fatul sufera , ramane hipoxic. Daca conflictul este mare solicitarea segmentului inferior de contractie ruptura uterina Hipokinezia este mai frecventa decat hiperkinezia ; este cel mai frecvent motiv de angoasa , complicatii te pacaleste , nu-ti vine sa iei atitudine fata de ceva ce nu se intampla : , fat hipoxic dupa expulzie nu se retrage uterul sangerare retractia pe un organ gol ce isi micsoreaza dimensiunile prin scurtarea fibrelor.

La ridicarea in picioare curburii la nivelul liniilor nenumite diam. Bazin legat de coloana vertebrala sau membre : Morb Pott impingerea promontor coccis anterior , se angajeaza , dar nu poate sa iasa C. Bazin de schiopatare : apare la fetite bazin oblic ovalar ; se modifica zona pe care se afla piciorul de sprijin. In nastere craniul se angajeaza in diam cel mai mare. Curs 8 Prezentatii deflectate Cauze : - materne - fetale - anexe Mecanismele deflexiei : - craniul este o parghie cu brate inegale : gaura occipitala occiput brat scurt ; mentongaura occipitala brat lung - coloana vertebrala este punctul fix.

Frecarea ex pe bratul lung mentonul coboara prezentatie flectata Deflectarea se face cu consum de energie , printr-un ostacol.

Cauze fetale : - feti mici - suferinta fetala - feti mari - gemeni 3. Prezentatie bregmatica : - vertex si bregma in mijloc - diam de angajare occipito-frontal nu permite angajarea - prezentatie distocica op cezariana III. Prezentatia frontala :. Prezentatia compusa : vine capul si o mama sau 2 maini ; vine pelvisul si un picior mai rar VII. In jur de 7 luni craniana ; luni pelviana. La fundul uterului semnul bulgarelui de gheata craniul.

Pelviana merge mai prost decat craniana pt ca : 1. Atitudinea in travaliu : - nu se rup mb - anomalia de rotatie il rotam pt a veni cu spatele la pube - proba de nastere Riviera? Complicatii : - materne: mici lezare vagin , col , rect - fat : fractura de humerus , clavicula ; soc obstreticat hipoxie hemoragie mare Pronostic bun. Curs 9 Suferinta fetala Definitie : alterarea homeostaziei fatului in ultimul trim de sarcina si travaliu hipoxie anoxie - acuta fact agresivi , apar brusc , fara un fond premorbid sau premorbid necunoscut - cronica fact subletal alterarea schimburilor materno-fetale Final : moartea fatului i.

Fatul este in uter ca o unitate neurovasculara a carui buna stare depinde de cele 2 gene? Fatul este supus unor agresiuni. Particularitati ale fatului : A. Circulatia fatului i. Factori agresivi : I. Intrapartum : - act pe un fat in buna stare sau care si-a pus in act toate mec compensatorii - Hkinezia , hipotonia , travalii lungi , nasteri precipitate - infectia corio-amniotica acuta, cronica - complicatii obstreticale : prolabarea de cordon , decolarea prematura de placenta III.

Postpartum : droguri pt - declansarea travaliului cauze iatrogene - controlul HTA diuretice, trombostop - anestezice generale si locoregionale - betasimpatomimeticele avort tardiv - PG , ocitocic Diagnostic: 1.

Cresterea uterului 4. Eliminarea de meconiu in lichidul amniotic peristaltica prin vasoconstrictie ; daca mb se rup lichidul este verde. Meconiul poate ajunge in arborele respirator dand pneumonia meconiala.

Trasee cardiace de baza : a activitatea cordului fetal : - ex vareabilitate bataie cu bataie : distanta intre 2 unde R succesive pe termen scurt ; oscilatii pe minut pe termen lung. Aceste variatii dureaza ,5 minute. Determinarea echilibrului acido-bazic fetal : la dilatatie de 2 cm , mb rupte incizie de 2 mm adancime pe scalpul fetal , 2 ml sange pe parafina pH , pO2 , pCO2. Dozarea bilirubinei : - cordocenteza - fetoscopia - amnioscopia si amniocenteza Tratament : - ameliorarea fluxului uterin decubit nstang , reducerea CU - ameliorarea circulatiei ombilicale - cresterea aportului de O2 : glucoza hipertona , O2 pe masca.

Evolutie : netratata evolutie dramatica dezlipire de placenta , eclampsie , repercusiune grava asupra fatului si mamei chiar deces. VD adaptarea teritoriului matern la un spatiu mai mare : - PG E2 , F2 , I2 - bradikinina , progesteron blocanti enzimatici ai catecolaminelor - antitrombina II - leziuni la niv vaselor mici Etiopatogenia: 1. La S18 apare invazia miometrului si dupa 2S a II a invazie trofoblastica distrugerea structurilor musculare din structura arteriolei structura numai cu endoteliu p care vine din vasc utero-placentare lac sanguin sange in spatiul intervilos.

Daca nu se produce a II a invazie trofoblastica sfincterului in ejectul sg sp intervilos ischemic HTA materna , hipoperfuzie fetala Test Roll-over : TA cu 10 mmHg presiune la niv vaselor 3. Certitudine : 1. In sarcina vol sg in HTA nu vl sg vasospasm vol de sg circulant conc mare a sg ca la negravida. Tratamentul : -cedare vasospasm , diurezei la HTA la negravida - la gravida nu se poate diureza , facem VD pt a baga apa in vas , apoi sa fie scoasa Epitolioza : - se depune fibrina sub foma de filamente?

Forme clinice : 1. Alterarea functiilor hepatice enzimelor. Eclampsia : aparitia de convulsii clonico-tonice pe fondul unei HTA la o gravida in trim III si in primele ore postpartum. Perioade :- aura : dureaza zeci de secunde 1 minut ; au fosfene , acufene , cefalee occipitala , letargie ; - convulsii tonice : 30 secunde 1 minut ; spasm al musc care face flexie ; pozitie de opistontonus , facies vultuos , cianoza , nu respira - convulsii clonice : inspir adanc , convulisii 1 min , apoi se.

Gravitatea depinde de profunzimea comei , durata comei , repetarea accesului eclamptic. Complicatii : - oligurie anurie - tulb de vedere amauroza - tulb psihice lez cerebrale - tulb de coagulare - EPA , hemoragie cerebrala hemoragie meningee medie Cauza excitabilitatii nervoase prin edem.

Principii de tratament : - controlul convulsiilor - corectarea hipoxiei si a acidozei - coborarea TA la valori acceptabile - rezolvarea nasterii - imobilizare - asigurarea cailor respiratorii , caii venoase , cateterism vezical Tratament medical : 1.

Vasa praevia: - vase coriale care sangereaza pe mb , in aria orificiului uterin - sangerarea fat Diagnostic : - tuseu cu valve - hematii fetale IV. Ruptura uterina : Clasificare : 1 - in timpul sarcinii spontana uter cicatriceal - traumatica. Baudl Frommel de preruptura uterina - uter de clepsidra - ascensionarea inel Baudl limita intre corp si segm inf - tensiune in lig rotund - anxietate - durere hipogastrica vie - sg vaginala unica Sangerarea caducai care se fisureaza datorita intinderii si arata iminenta de ruptura uterina.

viata sexuala dupa nastere

Am avut dupa sarcina usoara, viata de emotii pozitive, credeam ca sunt una dintre fericitele mamici care vor naste usor si natural. Fiind tan Dupa internat, a venit asistenta si mi-a spus ca azi nasc, ca bebe este nastere, emotiile m-au cuprins si M-am lasat pe sexuala lor. Mi-au dat calciu, mi-au rupt membranele dupa perfuzie cu oxitocina.

Aveam hemoragie provenita in urma dezlipiri placentei de pe uter. Jump to. Sections of this page. Accessibility help. Email or Phone Password Forgotten account? See more of Histerectomie la nastere on Viata.

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