Fundamentals of Maternal Pathophysiology E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Fundamentals
- Sprache: Englisch
Fundamentals of Maternal Pathophysiology An introduction to pathophysiology specifically tailored to the needs of midwives Professional standards of proficiency require that midwives develop a robust understanding of pathophysiology, the study of disordered physical processes including disease and injury. This dedicated text equips both aspiring and registered midwives with the foundational understanding of pathophysiology required to deliver the best patient care. An understanding of pathophysiology is paramount for the delivery of safe and effective care during the various stages of pregnancy, childbirth and postpartum recovery. This understanding provides midwives with the insight to recognise and respond promptly to complications, fostering optimal outcomes for the mother and the newborn. Early recognition is pivotal, allowing for timely interventions that can significantly influence maternal and fetal well-being. A holistic approach to care is the cornerstone of midwifery and an understanding of pathophysiology allows midwives to consider the physical, emotional and social aspects of a woman's health. This holistic perspective contributes to a more comprehensive and person-centred model of care. This user-friendly introduction is not only a foundational text but also a practical resource for practicing midwives. Informed by the latest research and reflective of current best practices, this book stands as an indispensable tool for this indispensable profession. Tailored for both undergraduate and graduate midwifery students, as well as registered midwives returning to practice, this resource is an invaluable asset in advancing pathophysiological knowledge within midwifery practice.
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication Page
Contributors
Preface
Acknowledgements
About the Companion Website
CHAPTER 1: Learning the Language: Terminology
Anatomy and Physiology
Anatomy
Physiology
Pathophysiology
Determinants of Health
Using a Medical Dictionary: Hints and Tips
Conclusion
References
Further Resources
Glossary
CHAPTER 2: Cell and Body Tissue Physiology
Cell Anatomy
Tissues
Tissue Damage and the Healing Process
Conclusion
References
Further Resource
Glossary
CHAPTER 3: Embryo Development and Fetal Growth
The Germinal Stage
The Embryonic Stage
The Fetal Stage
Complications of Pregnancy
Conclusion
References
Further Resources
Glossary
CHAPTER 4: Genetics and Genetic Conditions
Overview of Genetics
Chromosomes
Genes
What Can Go Wrong with Chromosomes
Screening
Genetic Testing
Future Pregnancies
Conclusion
References
Further Resources
Glossary
CHAPTER 5: The Reproductive System and Associated Disorders
Vulva (External Female Genitalia)
Perineum
Internal Reproductive Organs
Pelvic Organs Prolapse
Breasts
Conclusion
References
Further Resources
Glossary
CHAPTER 6: Homeostasis
Feedback Mechanisms
Homeostasis in Pregnancy
Conclusion
References
Further Resources
Glossary
CHAPTER 7: The Placenta
Structure and Function of the Placenta
Structural Pathology of the Placenta
Screening and Diagnostic Tests Relating to the Placenta
Conclusion
References
Further Resources
Glossary
CHAPTER 8: Inflammation and the Immune Response
The Immune System
Types of Immunity
The Lymphatic System
Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome
Systemic Lupus Erythematosus
Antiphospholipid Syndrome
Rheumatoid Arthritis
Inflammatory Bowel Disease
Myasthenia Gravis
Multiple Sclerosis
Conclusion
References
Further Resources
Glossary
CHAPTER 9: Cardiovascular System and Associated Disorders
Maternal Medicine Network
Cardiovascular Physiology
Approach to Heart Disease in Pregnancy
Acute Presentations in Pregnancy
Pre‐existing Cardiac Disease
Disease Arising in Pregnancy
Care of Women with Cardiac Conditions
Conclusion
References
Further Resources
Glossary
CHAPTER 10: Shock
Pathophysiology of Shock
Stages of Shock
Types of Shock
Primary Assessment
Conclusion
References
Further Resources
Glossary
CHAPTER 11: The Nervous System and Associated Disorders
Anatomy and Physiology of the Nervous System
Structure of the Nervous System
Epilepsy
Multiple Sclerosis
Eclampsia
Stroke
Conclusion
References
Further Resources
Glossary
CHAPTER 12: The Vascular System and Associated Disorders
Structure and Function of the Cardiovascular System
Overview of Blood Pressure
Changes to the Cardiovascular System in Pregnancy, Labour and the Puerperium
Minor Disorders of the Blood Vessels
Major Disorders of the Blood Vessels
Conclusion
References
Further Resources
Glossary
CHAPTER 13: The Blood and Associated Disorders
Composition of Blood
Haemostasis
Blood Groups
Disorders of the Blood
Conclusion
References
Further Resources
Glossary
CHAPTER 14: The Renal System and Associated Disorders
Kidney Structure
Other Kidney Functions
Adrenal Glands in Relation to Kidney Function
Changes in Physiology of the Renal Function in Pregnancy
Pathophysiology of the Renal Function During Pregnancy
Effects of Medicines on Kidneys
Conclusion
References
Further Resources
Glossary
CHAPTER 15: The Respiratory System and Associated Disorders
Overview of the Respiratory System
Physiological Changes in Pregnancy
Respiratory Conditions in Pregnancy
The Respiratory System and the Neonate
Conclusion
References
Further Resources
Glossary
CHAPTER 16: The Gastrointestinal System and Associated Disorders and Nutrition
Structure of the Gastrointestinal Tract
Accessory Structures
Disorders of the Gastrointestinal Tract in Pregnancy
Diet and Nutrition in Pregnancy
Obesity
Conclusion
References
Further Resources
Glossary
CHAPTER 17: The Endocrine System and Associated Disorders
Diabetes Mellitus
Thyroid Disorders
Hyperemesis Gravidarum
Adrenal Disorders
Pituitary Disorders
Chronic Stress
Conclusion
References
Further Resources
Glossary
CHAPTER 18: Pain
Pain Theories
Pathophysiology of Pain
Definitions and Categories of Pain
Importance of Individualised Pain Assessments
Multimodal Management Strategies
Conclusion
References
Further Resources
Glossary
CHAPTER 19: The Musculoskeletal System and Associated Disorders
The Skeleton
Where Bones Meet: Joints and Articulations
Muscles
The Burden of Musculoskeletal Impairment
Musculoskeletal Conditions
Key Musculoskeletal Considerations for Public Health, Pregnancy and the Postnatal Period
Conclusion
References
Further Resources
Glossary
CHAPTER 20: Fluid and Electrolyte Balance and Associated Disorders
Fluid and Electrolyte Distribution
Electrolytes
Maintaining Fluid Balance
Fluid Therapy and Pre‐eclampsia
Fluid Balance During Labour
Hyponatraemia
Hypovolaemia
Postpartum Haemorrhage
Conclusion
References
Further Resources
Glossary
CHAPTER 21: Mental Health and Well‐being
Usual Perinatal Emotional/Psychological Transitions
Maintaining Mental Health and Well‐being
Causes of Perinatal Mental Health Conditions
Risk Factors
Symptoms of Perinatal Mental Health Conditions
Consequences of Poor Perinatal Mental Health
Diagnosing a Mental Health Condition
Perinatal Mental Health Conditions
Conclusion
References
Further Resources
Glossary
Index
End User License Agreement
List of Tables
Chapter 1
TABLE 1.1 Anatomical descriptive terms.
TABLE 1.2 Anatomical regions of the head and neck.
TABLE 1.3 Anatomical regions of the trunk (thorax and abdomen).
TABLE 1.4 Anatomical regions of the upper limbs.
TABLE 1.5 Anatomical regions of the lower limbs (legs).
TABLE 1.6 Basic components of a word.
TABLE 1.7 Some prefixes and suffixes, their meanings and examples.
TABLE 1.8 Terms and definitions related to pathophysiology.
TABLE 1.9 Confusing terminology.
Chapter 4
TABLE 4.1 Nuchal translucency.
TABLE 4.2 The rate of aneuploidy is proportional to maternal age.
Chapter 5
TABLE 5.1 The stages of vulval cancer.
TABLE 5.2 Types of female genital mutilation.
TABLE 5.3 Classifications of perineal trauma.
TABLE 5.4 Types of vaginitis.
TABLE 5.5 Menstrual disorders and abnormal bleeding.
TABLE 5.6 Female reproductive hormones.
Chapter 6
TABLE 6.1 Changes that receptors can initiate.
TABLE 6.2 Body systems that play a major role in maintaining homeostasis....
TABLE 6.3 The functions of the placenta.
TABLE 6.4 Hormones of pregnancy and their functions.
Chapter 7
TABLE 7.1 Definitions of vaginal bleeding.
TABLE 7.2 Risk factors for pre‐eclampsia.
TABLE 7.3 Risk factors for fetal growth restriction (FGR).
Chapter 8
TABLE 8.1 First and second lines of defence.
TABLE 8.2 Grades of pyrexia.
TABLE 8.3 Types of antibodies.
TABLE 8.4 Types of acquired immunity.
TABLE 8.5 Disorders of the immune system.
TABLE 8.6 Manifestations of SLE.
TABLE 8.7 Features of Crohn's disease and ulcerative colitis.
Chapter 9
TABLE 9.1 Managing cardiac conditions as part of a maternal medicine network...
TABLE 9.2 Components of maternal medicine network core multidisciplinary tea...
TABLE 9.3 Normal observation ranges and how they may differ in pregnancy.
Chapter 10
TABLE 10.1 Key considerations for rapid assessment.
TABLE 10.2 Risk factors for maternal sepsis in pregnancy.
Chapter 11
TABLE 11.1 Components of the brain and their function.
TABLE 11.2 Effects of sympathetic and parasympathetic nervous systems.
Chapter 13
TABLE 13.1 Blood groups.
Chapter 15
TABLE 15.1 Physiological changes in respiratory function in pregnancy.
Chapter 16
TABLE 16.1 Vitamins and minerals important for pregnancy.
TABLE 16.2 Foods to avoid in pregnancy and while breastfeeding.
Chapter 17
TABLE 17.1 The three major types of diabetes mellitus in women of reproducti...
TABLE 17.2 Risk factors for gestational diabetes (GDM).
TABLE 17.3 Risks associated with diabetes during childbearing, for woman and...
Chapter 18
TABLE 18.1 Example of assessment domains.
TABLE 18.2 Example of non‐pharmacological management strategies.
TABLE 18.3 Examples of non‐opioids and non‐steroidal anti‐inflammatory drug...
TABLE 18.4 Examples of opioids.
TABLE 18.5 Side effects and potential complications associated with epidura...
Chapter 19
TABLE 19.1 Bone cells and their function.
TABLE 19.2 Bone remodelling process.
Chapter 20
TABLE 20.1 Clinical scenarios requiring a fluid balance chart.
TABLE 20.2 Examples of fluid input and output that midwives would need to do...
TABLE 20.3 Key considerations for management of pre‐eclampsia.
Chapter 21
TABLE 21.1 Two systems for diagnosing mental health conditions.
TABLE 21.2 Recommendations for screening for perinatal depression.
TABLE 21.3 Recommendations for screening for perinatal anxiety: the Generali...
TABLE 21.4 Symptoms of postpartum psychosis.
List of Illustrations
Chapter 1
FIGURE 1.1 Anatomical position: anterior view of the body.
FIGURE 1.2 Anatomical position.
FIGURE 1.3 Anatomical planes.
FIGURE 1.4 The cavities of the body.
FIGURE 1.5 Anatomy and physiology of the reproductive system.
FIGURE 1.6 The determinants of health.
Chapter 2
FIGURE 2.1 Basic structure of a cell.
FIGURE 2.2 Anatomy of the cell membrane.
FIGURE 2.3 Cell nucleus.
FIGURE 2.4 Chromosome and DNA.
FIGURE 2.5 Mitotic cell division.
FIGURE 2.6 Meiotic cell division. Credit: Fundamentals of Anatomy and Physio...
FIGURE 2.7 Types of epithelial tissue.
FIGURE 2.8 Muscle cells.
FIGURE 2.9 Nerve cells (neurons). (a) Parts of a neuron. (b, c) Motor neuron...
Chapter 3
FIGURE 3.1 Fertilisation and early embryo development.
FIGURE 3.2 Pre‐implantation development.
FIGURE 3.3 Pre‐implantation development and implantation.
FIGURE 3.4 Human blastocyst and the two progenitor lineages.
FIGURE 3.5 The bilaminar disk of the early embryo.
FIGURE 3.6 The sublayers of the decidua.
FIGURE 3.7 The fate of the three germ layers. GI, gastrointestinal.
Chapter 4
FIGURE 4.1 The nucleus houses genetic material. Within the nucleus, chromati...
FIGURE 4.2 A pictorial representation of a portion of the double helix.
FIGURE 4.3 DNA for a double helix to chromosome.
FIGURE 4.4 Male human chromosomes.
Chapter 5
FIGURE 5.1 The female reproductive organs (sagittal plane view).
FIGURE 5.2 The vulva (external genitalia).
FIGURE 5.3 (a–d) Types of female genital mutilation.
FIGURE 5.4 Muscles of the pelvic floor.
FIGURE 5.5 Vagina, uterus, ovaries and supporting structures.
FIGURE 5.6 Stages of vaginal cancer.
FIGURE 5.7 Phases of the menstrual cycle.
FIGURE 5.8 A typical 28‐day menstrual cycle. (a) Hormonal regulation of chan...
FIGURE 5.9 Types of uterine fibroids.
FIGURE 5.10 Staging of cervical cancer and life expectancy.
FIGURE 5.11 Types of ovarian cysts.
FIGURE 5.12 Types of pelvic organ prolapse.
FIGURE 5.13 Sagittal view of the breast.
Chapter 6
FIGURE 6.1 Homeostatic regulation of blood pressure by a negative feedback s...
FIGURE 6.2 Modified Early Obstetric Warning Score (MEOWS) chart.
FIGURE 6.3 Positive feedback control of labour contractions during the birth...
Chapter 7
FIGURE 7.1 Velamentous cord insertion.
FIGURE 7.2 Succenturiate lobe of placenta.
FIGURE 7.3 Placenta accreta spectrum.
FIGURE 7.4 Vasa praevia.
FIGURE 7.5 Failure of physiological transformation of the spiral arteries is...
FIGURE 7.6 Sites of placental abruption.
FIGURE 7.7 A schematic representation of fetoscopic laser photocoagulation f...
Chapter 8
FIGURE 8.1 Phases of phagocytosis.
FIGURE 8.2 Anatomical position of the thymus.
FIGURE 8.3 Structure of the spleen.
FIGURE 8.4 Structure of lymph nodes.
Chapter 10
FIGURE 10.1 The Sepsis Six.
FIGURE 10.2 Guedel airway position.
FIGURE 10.3 Endotracheal tube placement.
FIGURE 10.4 Uterine displacement. (a) Left uterine displacement using two‐ha...
Chapter 11
FIGURE 11.1 Structure of neuron. (a) Parts of a neuron. (b, c) Motor neuron...
FIGURE 11.2 Structure of the brain.
FIGURE 11.3 Structure of the spinal cord.
FIGURE 11.4 The process of demyelination.
Chapter 12
FIGURE 12.1 Structure of the adult heart.
FIGURE 12.2 Blood flow.
FIGURE 12.3 Structure of an artery and a vein.
FIGURE 12.4 Interconnections between arteries and Veins in the circulatory s...
FIGURE 12.5 Flow of blood cells through the capillary.
Chapter 13
FIGURE 13.1 Cells of the blood before physiological changes in pregnancy.
FIGURE 13.2 Components of clotted blood following centrifugal separation – c...
FIGURE 13.3 Blood disorders and stages of pregnancy and childbirth.
Chapter 14
FIGURE 14.1 Organs of the renal system.
FIGURE 14.2 Internal structure showing blood vessels.
FIGURE 14.3 The nephron.
FIGURE 14.4 Afferent and efferent arterioles within the glomerulus and the p...
FIGURE 14.5 The actions of the renin‐angiotensin‐aldosterone system (RAAS)....
FIGURE 14.6 This is Categorisation of Kidney Injury in Pregnancy.
Chapter 15
FIGURE 15.1 The respiratory system.
FIGURE 15.2 The anatomical structure of the lower respiratory tract.
FIGURE 15.3 (a–d) The external anatomy of the lungs.
FIGURE 15.4 The structure of a lobule of the lung.
FIGURE 15.5 The structure of the alveolus.
FIGURE 15.6 Changes in chest size, intercostal muscles, diaphragm and rib ca...
FIGURE 15.7 External respiration.
FIGURE 15.8 Internal respiration.
FIGURE 15.9 Summary of internal and external respiration.
FIGURE 15.10 Structures involved in the control of respiration.
FIGURE 15.11 Changes to the diameter of the bronchioles in asthma.
FIGURE 15.12 Pulmonary embolism.
FIGURE 15.13 Organs affected by cystic fibrosis.
Chapter 16
FIGURE 16.1 The digestive system.
FIGURE 16.2 Structure of the gastrointestinal tract.
FIGURE 16.3 The oral cavity.
FIGURE 16.4 Tooth structure. (a) Deciduous (primary) dentition. (b) Permanen...
FIGURE 16.5 The salivary glands.
FIGURE 16.6 Swallowing. (a) Position of structures before swallowing. (b) Du...
FIGURE 16.7 Peristalsis in the oesophagus. Anterior view of frontal sections...
FIGURE 16.8 The stomach. Anterior view.
FIGURE 16.9 Gastric glands and cells.
FIGURE 16.10 The small intestine.
FIGURE 16.11 The cells within the villi of the small intestine. Enlarged vil...
FIGURE 16.12 The large intestine.
FIGURE 16.13 The pancreas, the liver and the gallbladder. Anterior view.
FIGURE 16.14 The Eatwell guide.
Chapter 17
FIGURE 17.1 Changing insulin requirements during pregnancy.
FIGURE 17.2 Negative feedback control of thyroid hormone (TH) production. TR...
FIGURE 17.3 The relationship between hCG and nausea and vomiting in pregnanc...
FIGURE 17.4 Symptoms of polycystic ovary syndrome. FSH, follicle‐stimulating...
FIGURE 17.5 The diverse functions of the anterior pituitary gland.
FIGURE 17.6 The hypothalamic–pituitary–adrenal (HPA) axis.
Chapter 18
FIGURE 18.1 A neuron.
FIGURE 18.2 A neuroglia.
FIGURE 18.3 The spinal cord.
FIGURE 18.4 The spinal nerves.
FIGURE 18.5 Dermatomes.
FIGURE 18.6 The pain pathway.
FIGURE 18.7 Types of pain.
FIGURE 18.8 Placement of epidural and spinal analgesia/anaesthesia.
Chapter 19
FIGURE 19.1 The skeleton. (a) Anterior view. (b) Posterior view.
FIGURE 19.2 Types of bones.
FIGURE 19.3 A long bone – a partially sectioned humerus (arm bone).
FIGURE 19.4 The osteon and Haversian canal.
FIGURE 19.5 A synovial joint.
FIGURE 19.6 Types of synovial joints.
FIGURE 19.7 The major muscles of the body. (a) Posterior view. (b) Anterior ...
FIGURE 19.8 A potential cycle of pain and poor mental health.
FIGURE 19.9 Some common fracture classifications and x‐ray images.
FIGURE 19.10 Steps in repair of a bone fracture.
FIGURE 19.11 The LIVES framework for healthcare response to violence against...
FIGURE 19.12 Contributors to lower back pain and disability.
FIGURE 19.13 Possible sites of lumbopelvic pain in pregnancy.
FIGURE 19.14 Potential sources of postnatal back pain.
FIGURE 19.15 Anterosuperior view of pelvic girdle.
FIGURE 19.16 Possible sites of pain in pelvic girdle pain, seen anteriorly (...
FIGURE 19.17 Themes identified from studies of women's experiences of pelvi...
FIGURE 19.18 Birthing positions with pelvic girdle pain.
FIGURE 19.19 Carpal tunnel syndrome and median nerve location.
FIGURE 19.20 Area of hand served by median nerve (yellow) and affected by ca...
FIGURE 19.21 Visual pain scale.
FIGURE 19.22 Alternative feeding positions with carpal tunnel syndrome.
Chapter 20
FIGURE 20.1 Fluid components.
FIGURE 20.2 Fluid balance chart.
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Dedication Page
Contributors
Preface
Acknowledgements
About the Companion Website
Begin Reading
Index
WILEY END USER LICENSE AGREEMENT
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Fundamentals of Maternal Pathophysiology
EDITED BY
Claire Leader, MA PGCAP BSc (Hons) RN RM FHEA
Faculty Director of Inter‐professional Education and Assistant Professorin Nursing and Midwifery at Northumbria University.Editorial Board Member for the British Journal of Midwifery.
Ian Peate, OBE FRCN EN(G) RGN DipN(Lond) RNT BEd (Hons) MA(Lond) LLM
Editor in Chief, British Journal of Nursing; Consultant Editor, Journal of Paramedic Practice; Consultant Editor,International Journal for Advancing Practice; Visiting Professor, Northumbria University; Visiting Professor,St Georges University of London and Kingston University London; Professorial Fellow, Roehampton University;Visiting Senior Clinical Fellow, University of Hertfordshire.
This edition first published 2024© 2024 by John Wiley & Sons Ltd
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Library of Congress Cataloging‐in‐Publication DataNames: Leader, Claire, editor. | Peate, Ian, editor.Title: Fundamentals of maternal pathophysiology / edited by Claire Leader, Ian Peate.Description: Hoboken, NJ : Wiley‐Blackwell, 2024. | Includes bibliographical references and index.Identifiers: LCCN 2024000519 (print) | LCCN 2024000520 (ebook) | ISBN 9781119864684 (paperback) | ISBN 9781119864691 (adobe pdf) | ISBN 9781119864707 (epub)Subjects: MESH: Pregnancy Complications–physiopathology | Reproductive Physiological Phenomena | Pregnancy–physiology | Female Urogenital Diseases–physiopathology | Perinatal Care–methodsClassification: LCC RG525 (print) | LCC RG525 (ebook) | NLM WQ 240 | DDC 618.2–dc23/eng/20240205LC record available at https://lccn.loc.gov/2024000519LC ebook record available at https://lccn.loc.gov/2024000520
Cover Image: © magicmine/Adobe Stock PhotosCover Design by Wiley
This book is dedicated to my late brother Marc Davenport
Contributors
Alison Anderson, BSc (Hons), PGCE, MA Ed., BSc (Hons), RM, MScPractice Development Midwife and Specialist BAC Midwife, South Tees NHS Foundation Trust, MiddlesbroughConvenor, Virtual International Day of the Midwife CommitteeAlison enjoyed thirteen years as a secondary science teacher, specialising in Biology before re‐training as a midwife through Teesside University and Darlington Memorial Hospital. Alison began her career as a midwife at South Tees NHS Foundation Trust where she became the Specialist BAC (Birth After Caesarean) Midwife and then Practice Development Midwife. Alison's passions are the humanisation of childbirth and psychological safety in maternity. Alison also has a great interest in global midwifery and is convenor for the Virtual International Day of the Midwife committee and annual 24‐hour virtual conference.
Komal Bhatt, BMBS, BMedSciObstetrics and gynaecology registrar, Birmingham Women’s HospitalKomal completed her medical training in 2017 from the University of Nottingham before starting Obstetrics and Gynaecology training in 2019. She is currently working as an obstetrics and gynaecology registrar in the West Midlands deanery.
Suzanne Britt, RM, FHEA, ADM, BA (Hons), BMedSci Midwifery (Hons), MSc Midwifery Studies, PGCHEPostgraduate Researcher, University of NottinghamAfter a teaching career in modern foreign languages, Sue qualified as a midwife in 2002. She has worked in all areas of midwifery practice, beginning her career at Chesterfield Royal Hospital before moving to Sherwood Forest Hospital in 2008 for a community midwifery post. In 2011 she completed her Master's degree and started a secondment as a research midwife at Nottingham University Hospital. In 2013 she moved into midwifery education, working as an Assistant Professor of Midwifery at the University of Nottingham, where she received global and local recognition for teaching. She has delivered on all areas of the curriculum, leading modules on public health, perinatal mental health and contemporary midwifery care. Her interest and knowledge around the musculoskeletal system span her personal and professional life, and she has qualifications in both fitness and nutrition. In 2022 she left her teaching role to start a full‐time PhD at the University of Nottingham, focusing on healthcare professional response to domestic abuse.
James Castleman, MA, MD, MRCOGConsultant in Maternal and Fetal Medicine, Birmingham Women's and Children's NHS Foundation TrustJames is a Consultant Obstetrician at Birmingham Women's and Children's Hospital, UK. He graduated with distinction from the University of Cambridge and completed Foundation training in the East of England before moving home to the Midlands for his Obstetrics and Gynaecology clinical and research training. James has subspecialty accreditation in Maternal and Fetal Medicine from the Royal College of Obstetricians and Gynaecologists. He has a monthly prenatal genomics clinic alongside a clinical geneticist and is part of the regional multidisciplinary team providing this service. His other interests include fetal therapy and obstetric cardiology, as well as maintaining a passion for delivering high‐quality intrapartum care alongside midwifery colleagues.
Suzanne Crozier, DBA, SFHEA, RGN, RMAssociate Professor in Midwifery, Edinburgh Napier UniversitySuzanne studied nursing in Leeds before returning to Newcastle to become a midwife in 1984. She worked as a midwife at the Princess Mary Maternity Hospital for eight years, during which time she completed an Advanced Diploma in Midwifery before moving into midwifery education. Suzanne completed an MSc and was promoted to principal lecturer at Northumbria University, where she remained for many years undertaking the role of Lead Midwife for Education as well as acting as an educational consultant for the Nursing and Midwifery Council and the Office for Students. In 2021 she took up a post as Associate Professor at Edinburgh Napier University and has recently completed a professional doctorate exploring employability in midwifery.
Claire Ford, PGCap, PhD, FHEA, PGDip, RN, BScAssistant Professor Northumbria UniversityCo‐creator and Leader for Skills for Practice WebsiteClaire joined the teaching team at Northumbria University in 2013, having spent time working within perioperative care and completing a Postgraduate Diploma in Midwifery. She studied for her BSc (Hons) and PG Dip at Northumbria University and won academic awards for both and the Heath Award in 2009. As an Assistant Professor she teaches a range of national/international healthcare programmes and is also a joint Programme Leader for the MSc Nursing Programme. She has a passion for pain management, clinical skills, women’s health, gynaecology, perioperative care, simulation and immersive technologies. She has published many articles and is actively involved in several research projects examining the use of media and technology to facilitate deep learning. She is the co‐founder of the ‘Skills for Practice’ website, which was shortlisted for the Student Nursing Times Awards 2016 – Teaching Innovation of the Year.
Clare Gordon, RM, SCPHN – SN, BSc (Hons), MSc (S’ton), MSc (UWL), PG Cert Academic Practice, SFHEASenior Lecturer in Midwifery, Programme Leader – Berkshire – Midwifery, University of West LondonClare began her midwifery career in at the North Hampshire Hospital, becoming a qualified midwife in 2005. She practised as a Registered Midwife at Frimley Park Hospital, where she gained a wide range of experience before setting up a specialist weight management clinic for pregnant women. She also undertook the Specialist Community Public Health Nurse – School Nurse training and was awarded an MSc in Public Health Practice from University of Southampton in 2010. She has always enjoyed learning and educating others and joined the Midwifery team at the University of West London in 2013. She has subsequently been awarded an MSc with distinction in Professional Practice with Healthcare Education. She is a Senior Midwifery Lecturer and programme lead with a specialist interest in public health, the normality of pregnancy and birth and the foundations for safe midwifery practice.
Deborah Gurney, RN, RM, BSc, MA (Med ed), FHEASenior Midwifery LecturerDebbie began her career in healthcare by training as an adult nurse at the University of Hertfordshire in 2000. Midwifery training followed and once qualified, Debbie worked in a rotational midwifery post at the QE2 Hospital in Welwyn Garden City. Debbie developed a passion for education and worked within NHS practice development teams while undertaking a master’s degree in Medical Education before securing a post as a lecturer. Debbie's key areas of interest include bridging the theory–practice gap, preceptorship, high‐risk maternity care and perineal repair.
Leo Gurney, MBBS, MD, MRCOGConsultant in Fetal and Maternal MedicineSub‐speciality Trained Consultant in Fetal and Maternal MedicineClinical Lead for Fetal Medicine/Day Assessment Unit at Birmingham Women's Hospital West Midlands Fetal Medicine Network Clinical LeadLeo is a Consultant Obstetrician and sub‐specialist in maternal and fetal medicine (MFM) at Birmingham Women’s Hospital. He graduated and trained in O&G in North East England and sub‐specialised in MFM in Birmingham. He is the clinical lead for fetal medicine for the hospital and the West Midlands fetal medicine network and has a specialist clinical interest in fetal anomaly, fetal intervention and complex twin pregnancy, stillbirth and maternal cardiac disease.
Rosalind Haddrill, PhD, MA, BSc (Hons), PGCE, RM, SFHEALecturer in Midwifery, Edinburgh Napier UniversityRoz trained in Sheffield and qualified as a midwife in 2005, after previous careers as a landscape architect and lecturer. She worked clinically in a variety of midwifery roles until 2019 and has worked as a midwifery lecturer since 2010 in a number of British universities. Her PhD explored delayed access to antenatal care. Her areas of interest include women's perceptions of maternity care, gestational diabetes, postnatal care and infant feeding. Roz is currently programme leader for the Master’s in Midwifery programme at Edinburgh Napier University.
Cathy Hamilton, DHres, MSc, DipHE, Bsc (Hons), RN, RMAssociate Dean Academic Quality Assurance Practice Enhancement, School of Health and Social Work, University of HertfordshireCathy completed her Registered General Nurse (RGN) training at St Bartholomew's Hospital London in 1984 having undertaken an integrated degree programme at the City University leading to a Bsc (Hons) Psychology and registration as an adult nurse. In 1987 she qualified as a midwife at the West Hertfordshire School of Midwifery based at Watford Maternity Unit. She worked in all areas of Hemel Hempstead and St Albans Maternity Units and as a research assistant before becoming a lecturer at the University of Hertfordshire in 2001. She gained an MSc in Midwifery at Southbank University, London in 2001 and a postgraduate diploma in teaching and learning in higher education in 2003. She completed a Doctorate in Heath Research at the University of Hertfordshire in August 2018. The title of her thesis was ‘A qualitative study of midwifery practices during the second stage of labour’. She was Professional Lead (Midwifery) and Lead Midwife for Education at the University of Hertfordshire from January 2018. Since January 2023 she has been Associate Dean Academic Quality Assurance Practice Enhancement in the School of Health and Social Work, University of Hertfordshire.
Annabel Jay, DHRes, MA, PGDip (HE), DipHE, BA(Hons), RMVisiting lecturer (Midwifery), University of HertfordshirePrincipal lecturer (Retd.), University of HertfordshireAnnabel qualified as a direct‐entry midwife at the University of Hertfordshire in 1997. She worked clinically in all areas of midwifery care at Hemel Hempstead General Hospital until 2001, when she moved into midwifery education. She continued to work part‐time for West Herts Hospitals NHS Trust and East and North Herts NHS Trust until 2014. Annabel gained a doctorate in health education in 2014 and has published extensively over the past 15 years. Annabel retired in 2020, but continues to work as a visiting lecturer and PhD supervisor.
Claire Leader, MA, PGCAP, BSc (hons), RN, RM, FHEAFaculty Director of Inter‐professional Education and Assistant Professor in the Department of Nursing, Midwifery and Health at Northumbria University, Newcastle Upon Tyne.Editorial board member for the British Journal of Midwifery.Claire qualified as a Registered Nurse from York University in 1998, after which she moved to Leeds, working in the areas of cardiothoracic surgery and emergency nursing. In 2003 she commenced her midwifery education at Huddersfield University where she was awarded a First Class BSc (Hons). Working initially at Sheffield Teaching hospitals, she later moved to the North East where she commenced her role as a staff midwife before moving into the area of research as a research nurse and midwife, developing and delivering a range of research in the specialty of Reproductive Health and Childbirth. She was awarded a distinction for the MA in Sociology and Social Research at Newcastle University in 2012. Claire moved to Northumbria University in 2018 and is now Assistant Professor for Adult Nursing and Midwifery, while also studying for her PhD in the area of leadership in healthcare.
Sarah Malone, MBBS, MRCOG, FRANZCOG, CertClinRes, DDU (O&G)Consultant Obstetrician: The Royal Women’s Hospital, Parkville, AustraliaSarah Malone is an obstetrician with specialist training in Maternal and Fetal Medicine. She began her medical career in North East England and after spending a year working in Auckland, New Zealand, was inspired to complete training in Obstetrics and Gynaecology in Melbourne, Australia. Sarah undertook additional subspecialty training in Maternal Fetal Medicine, which included time spent working in Fetal Medicine in Birmingham, UK. Sarah is experienced in the management of complex pregnancy with particular emphasis in diagnostic ultrasound, fetal anomalies, multiple pregnancy and genetics.
Jacinta H. Martin, PhD, B. Biotechnology (Hons Class I)Lecturer, School of Environmental and Life Sciences, College of Engineering, Science and Environment, University of Newcastle, AustraliaPostdoctoral Researcher, Infertility and Reproduction Research Program, Hunter Medical Research Institute (HMRI), AustraliaJacinta is a dual Lecturer and Postdoctoral Researcher at the University of Newcastle in Australia and an HMRI fellow within the Infertility and Reproduction Research Program. Jacinta works with a multidisciplinary group of researchers using human and animal models to explore the effects of reproductive toxicants on reproduction and offspring development. Her current focus centres on exploring the biological impacts of perfluoroalkyl and polyfluoroalkyl substances. Prior to this, Jacinta was a Postdoctoral Research Fellow at the McGill University Health Centre and McGill University in Montreal, Canada.
Thomas McEwan, FRCM SFHEA RM, DipHE, BSc, TCH, PgCert (TLHE), V300, PgDip (ANNP), MScConsultant Editor, British Journal of MidwiferyHonorary Advanced Neonatal Nurse Practitioner, NHS Greater Glasgow and ClydeTom has practised as a team midwife delivering caseload‐based care, a senior charge midwife within a neonatal unit and an advanced neonatal nurse practitioner. He is currently a Head of Programme for the Women’s, Children, Young People and Families team within NHS Education for Scotland (NES) and has been a midwife since 1999. He is the strategic lead for the Scottish Multiprofessional Maternity Development Programme (SMMDP) and has additional responsibility for national midwifery, maternity and neonatal workforce and educational developments. He is a board member for the Scottish Cot Death Trust, and he has contributed internationally to evidence‐based guidance for newborn skin care and taught neonatal nurses in Vietnam. He has also published numerous peer‐reviewed articles and book chapters. He was awarded a fellowship of the Royal College of Midwives in 2023.
Janet G. Migliozzi, RGN, BSc (Hons), MSc (London), PGDEd, FHEAPrincipal Lecturer in Public Health, School of Life & Medical Sciences, University of HertfordshireJanet commenced her nursing career in London. She has worked at a variety of hospitals across London, predominantly in vascular, orthopaedic and high‐dependency surgery, before specialising in infection prevention and control. Janet has worked in nurse education since 1999 and her key interests include microbiology, particularly in relation to healthcare‐associated infections, vascular/surgical nursing, public health and nurse education. Janet is currently a Principal Lecturer and a member of the Infection Prevention Society & European Federation of Nurses Associations.
Kate Nash, RGN, RM, BSc (Hons), MSc, Practice Educator/Lecturer, Doctorate in Clinical PracticeLead Midwife for Education, University of WinchesterKate began her nursing career at the Royal Free Hospital in 1991 and later trained as a midwife in 2000 at the University of Hertfordshire. Kate is an experienced clinician and professional midwifery advocate, having held varied roles and responsibilities within midwifery in London, the Midlands and the South East of England. Kate has worked within midwifery education since 2012 and is a passionate advocate for the safe personalised care of women, birthing people, babies and families. Kate is committed to enabling the development of attitudes, skills and knowledge to ensure this.
Maria Noonan, PhD, MSc, BSc (Hons), RNT, RM, RGNAssociate Professor in Midwifery, Department of Nursing and Midwifery, University of Limerick, IrelandMaria began her nursing career in Beaumont Hospital. She then undertook her midwifery training and practised as a midwife in the University Maternity Hospital, Limerick. She has worked in education since 2006. Maria's key areas of interest are optimising women's and families' psychological health and care during the continuum of pregnancy, childbirth and parenthood, systematic review methodology and midwifery education, and she has published widely in the area of perinatal mental health.
Matthew Robertson, BSc (Hons) Operating Department PracticeLecturer, Department of Nursing, Midwifery and HealthMatthew is a registered Operating Department Practitioner with the HCPC. He is also a member of the College of Operating Department Practitioners. Matthew completed his BSc (Hons) at the University of Central Lancashire in Operating Department Practice, where he was able to experience a range of complex surgical specialities. Once qualified, Matthew was employed by Newcastle Hospitals within the Cardiothoracic Surgical Department where he undertook the role of the scrub practitioner, specialising in paediatric and congenital cardiac surgery. Matthew commenced employment at Northumbria University in 2017 and since then he has developed a specialist interest in human factors within the perioperative environment and is completing a PhD on this topic, focusing on staff well‐being and stress management. Recently, Matthew has had several publications regarding the care of the surgical patient and has written two book chapters on the use of analgesics in practice and other related pharmacology. Matthew also sits as a registrant panel member for the Health and Care Professionals Tribunal Service and provides expertise on the disciplinary cases that are presented.
Vikki Smith, PhD, MSc, PgCert, BSc, RM, FHEAClinical Academic Midwife SonographerVikki is a Clinical Academic Midwife Sonographer at Northumbria University and has a joint role at the Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTH). She has been a midwife for 30 years, with most of her career based in antenatal and fetal medicine settings. Vikki completed a Postgraduate Certificate in Obstetric Ultrasound in 1999 and has extensive experience of providing pregnancy ultrasound scans. She joined the department of Nursing, Midwifery and Health at Northumbria University in 2018 and contributes to midwifery undergraduate and postgraduate teaching and supervision. Vikki is the midwife sonographer lead for a regional Placenta Accreta Spectrum screening service, and is the Programme Lead for the MSc Midwifery Studies programme. Vikki completed a PhD in 2012 and her specific research interests include antenatal ultrasound, the use of technology in maternity services and the organisation of antenatal care.
Joyce Targett, RN (Adult) HND Nursing Studies, RM BSc (HONS) Midwifery Studies, Postgraduate Certificate in Medical UltrasoundRegistered Midwife, Registered NurseJoyce started her career as a Medical Assistant in the Royal Air Force before commencing three years’ nurse training with the University of York in 1994. During her nurse training her exposure to maternity care inspired her to become a midwife, training with the University of Northumbria. On qualifying, Joyce worked as a staff midwife in a consultant‐led unit and in the community setting. In 2005, Joyce completed her training as a sonographer with the University of Teesside and continues to work as a Midwife Sonographer in a clinical setting. She primarily works within a Maternity Day Unit alongside a midwifery‐led unit, where Joyce also has an active role as a Professional Midwifery Advocate.
Abbie Tomson, RM BSc (Hons), MScMidwife at University Hospitals Plymouth NHS TrustAbbie trained and currently works as a midwife at University Hospitals Plymouth NHS Trust, working in both the hospital and community settings. Following her Bachelor’s degree in midwifery, Abbie commenced a Master’s in Advanced Professional Practice at the University of Plymouth, widening her knowledge in an array of health areas and training as a Professional Midwifery Advocate. Abbie is currently a Midwifery Ambassador and a strong advocate for the midwifery profession. Abbie has a keen interest in both anatomy and physiology, and has deepened her knowledge through completion of her yoga teacher training qualification and is now working on specialising in pregnancy and postnatal yoga.
Kristian Tomson, BSc (Hons), McParaEnhanced Paramedic with Bosvenna HealthBank Paramedic with South Western Ambulance Service NHS Foundation TrustKristian began his career as an emergency call handler with South East Coast Ambulance Service while applying to study paramedicine. Kristian trained as a paramedic in South West Ambulance Service, spending the first few years of his career in Plymouth. Over the last year Kristian has changed clinical setting from full‐time pre‐hospital care to primary care, working in a GP practice in Cornwall and through the Primary Care First Contact Practitioner Pathway. He has completed a number of MSc modules in Advanced Practice, including advance assessment and minor injuries and illnesses. He has interests in anatomy and physiology, maternal care, as well as pre‐hospital and primary care.
Raya Vinogradov, BA, PgD, MClinResSenior Research Sonographer/Radiographer, Newcastle upon Tyne NHS Hospitals Foundation TrustIn‐practice Fellow for the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC)PhD Fellow at Newcastle Upon Tyne NHS Hospitals Foundation Trust Researcher Development InstituteRaya is a radiographer with a broad clinical experience in obstetric ultrasound and reproductive health research within NHS settings. Her clinical expertise evolved around antenatal care of women at increased risk of pre‐eclampsia and fetal renal anomalies. Raya’s research interests focus on prevention of adverse outcomes of pregnancy and on delivery of a high standard of antenatal care. In particular, Raya’s work involves co‐production of a behaviour intervention aiming to support women to adhere to aspirin prophylactic treatment in pregnancies at increased risk of pre‐eclampsia.
Amanda Waterman, BSc (Hons), RM, MClinRes, PgCert, FHEASenior Lecturer in Midwifery, University of HertfordshireAmanda is a Senior Lecturer in Midwifery at the University of Hertfordshire and has previously worked as a Registered Midwife at West Hertfordshire Trust and University College London Hospital. She gained her BSc (Hons) in Medical Biochemistry at the University of Birmingham in 1997, before gaining a BSc (Hons) Pre‐registration Midwifery degree at University of Hertfordshire in 2015. In 2019, Amanda completed her masters in Clinical Research at King's College London. Amanda's interests include lecturing in research. She was a member of the James Lind Alliance Priority Setting Partnership Steering Committee and contributed to the publication in the British Journal of Haematology (2019) of ‘The top 10 research priorities in bleeding disorders: a James Lind Alliance Priority Setting Partnership’. Other publications include the ‘Antibiotics and Antibacterials’ chapter in the Fundamentals of Pharmacology for Midwives.
Preface
Maternal pathophysiology refers to the study of abnormal physiological processes that occur in pregnant individuals. It focuses on understanding the changes in the maternal body that may arise during pregnancy and the impacts they can have on maternal health and the well‐being of the developing fetus. Pregnancy involves significant physiological adaptations to support the growth and development of the fetus. Maternal pathophysiology explores the alterations that occur in various body systems during pregnancy and any deviations from the normal physiological processes. This field of study aims to identify and understand the underlying mechanisms of maternal health conditions, complications and diseases that can arise during pregnancy. Pathophysiology involves examining the alterations in cellular, tissue and organ functions, as well as the interactions between different body systems, to gain insight into the progression and impact of disease. By studying pathophysiology, midwifery students and healthcare professionals can better comprehend the underlying causes and mechanisms of diseases, which in turn helps inform diagnostic and treatment approaches.
The intricacies of human reproduction, pregnancy and childbirth intersect with the fascinating field of disease processes. Fundamentals of Maternal Pathophysiology helps readers unravel the complex web of physiological changes and pathological conditions that affect the health of women and birthing people and their babies with confidence and competence.
Pregnancy is an incredible journey that brings with it profound physiological transformations. However, alongside these remarkable changes there exist numerous challenges and potential risks that can arise during this unique period in a woman's life. Understanding the fundamental mechanisms behind the pathophysiology of these complications is crucial for midwifery students and those healthcare professionals who are involved in maternal care.
Fundamentals of Maternal Pathophysiology serves as a comprehensive guide, providing readers with a deep exploration of the maternal pathophysiological processes that can disrupt the normal course of pregnancy. We delve into the intricate workings of the reproductive system, hormonal fluctuations, placental physiology and the impact of maternal health conditions on the developing fetus.
There are 21 chapters in Fundamentals of Maternal Pathophysiology, taking readers on an enlightening journey through the major categories of maternal pathophysiology. We discuss the normal physiology of reproduction and the astonishing event of fertilisation. Building on this foundation, we explore the physiological adaptations that occur during pregnancy, examining the changes in the cardiovascular, respiratory, endocrine, immune and other systems.
With a solid understanding of the normal processes, we then turn our attention to the disorders and complications that can arise during pregnancy. Maternal conditions such as gestational diabetes, hypertensive disorders and autoimmune diseases are addressed in detail, providing insight into their underlying mechanisms, diagnostic criteria and management approaches.
Our overall aim is to equip the student midwife with the knowledge necessary to recognise, diagnose and manage these conditions effectively, ultimately promoting optimal outcomes for both mother and baby. It is important to note that this book is not intended to replace clinical experience or professional guidance. It serves however as a companion to extend your existing knowledge and offer a solid foundation in maternal pathophysiology. Each chapter is designed to present the information in a clear and concise manner, with an emphasis on clinical relevance and evidence‐based practices.
We are grateful to the authors, clinician and academics, who are experts in their respective fields, whose contributions have made this book a reality. Their expertise, dedication and passion for maternal health are evident through these pages and we hope their expertise and insight will inspire and empower midwives in their ongoing pursuit of excellence in maternal care.
We sincerely hope that Fundamentals of Maternal Pathophysiology will serve as a valuable resource for midwifery students, academics and healthcare professionals alike. May it provoke in you a curiosity and thirst for knowledge, fostering a deeper understanding of the intricate world of maternal pathophysiology as we strive towards improving the health and well‐being of pregnant individuals and their families.
Finally, a note on language. Inclusive language in health and care is crucial for promoting equality, respecting diversity and ensuring that everyone feels represented and valued. It involves using language that is inclusive of all individuals, regardless of their gender identity, sexual orientation, race, ethnicity, disability or other characteristics. By employing inclusive language, we can foster a more inclusive and accessible environment for readers, patients and professionals alike.
When discussing gender and sex, one of the significant challenges is the complexity and fluidity of the terminology that is and that can be used. The concept of gender is multifaceted and may vary across cultures, communities and individuals. Understanding and navigating this terminology requires sensitivity, open‐mindedness and a willingness to learn and adapt to evolving perspectives. It is recognised that not all birthing people will identify with their biological sex and a ‘gender additive’ approach to language has been advocated in the context of contemporary maternity services. This acknowledges that women may be negatively affected by reproductive health inequalities. The terms ‘woman’ and ‘women’ are used in this book along with a range of terms to identify and describe those people to whom we have the privilege to offer maternal care.
Claire Leader, Northumbria
Ian Peate, London
Acknowledgements
Claire would like to thank her husband Gavin for all the support and encouragement over the years.
Ian thanks his partner Jussi for his continued support.
We would like to thank the amazing contributors who gave of their time to help the text come to fruition.
We are grateful to the team at Wiley who were receptive and encouraged us to take this project forward.
About the Companion Website
This book is accompanied by a companion website.
www.wiley.com/go/leader/maternalpatho
This website includes:
Multiple choice questions
CHAPTER 1Learning the Language: Terminology
Joyce Targett
Midwife Sonographer, UK
AIM
This chapter aims to provide insight and understanding with regard to the terminology used in the provision of healthcare related to anatomy, physiology and pathophysiology.
LEARNING OUTCOMES
On completion of this chapter the reader will be able to:
Discuss the terms and context around anatomy, physiology and pathophysiology
Further understand prefixes and suffixes used in anatomy, physiology and pathophysiology
Understand directional terms
Describe the anatomical planes, the anatomical regions of the body and the body cavities
Test Your Prior Knowledge
What do you understand by the term pathology?
What is the difference between a sign and a symptom?
How is the root word altered by a prefix or a suffix?
Name and define the nine regions of the abdomen.
Science, particularly in terms used in the provision of healthcare, is inundated with Latin and Greek terminology. For all parts of the body Latin names are used and Greek terms are also common, as the Greeks are said to be the founders of modern medicine. Healthcare staff use pathophysiological concepts as they work with people to whom they offer care and as they offer treatment to those who are experiencing some type of health condition or disease.
Red Flag
Like any country with its own language(s), the medical field has its own language too. This is important so that communication between healthcare professionals can take place quickly and efficiently without the need for too much explanation. It is a specific language that is not just used by midwives, nurses, doctors and other people who are actively involved in the medical arena. It is important for all those who work in healthcare, for example pharmacists, physiologists and dentists. Its correct use can have a significant impact on ensuring the best care.
What is important is that we are all speaking the same language. Failure to do so or making assumptions about what is meant can lead to error and mistakes.
Anatomy and Physiology
Anatomy is the study of the structure and location of body parts, while physiology is the study of the function of body parts. Both of these terms are interlinked. Understanding where the body parts are located can help you understand how they function. McGuiness (2010) explains that when thinking of the various functions of the heart and the four chambers along with the valves, this is the anatomy. Visualising these many structures can assist in understanding how blood flows through the heart and how the heart beats, which are related to its function and as such its physiology.
Anatomy
The Body Map
Learning anatomical terminology is like learning a new language. When your learning has developed and you understand more and add different terms to your vocabulary, this can help you talk confidently about the body. The anatomical directional terms and body planes present a universally recognised language of anatomy.
Red Flag
When undertaking the study of anatomy and physiology, it is essential that you have key or directional terminology so that you can give a precise description when you or others refer to the location of a body part or structure.
Learning Event
When you are next on placement, identify how many times during a shift you hear the various clinicians describe and discuss anatomy, physiology and pathophysiology. Note the terminology being used and how between the team there is a clear understanding when using one language – anatomical and physiological terminology.
All parts of the body are described in relation to other body parts and a standardised body position, known as the anatomical position, is used in anatomical terminology. An anatomical position is established from an imaginary central line that runs down the centre or midline of the body.
Orange Flag
While you are encouraged to use the correct anatomical and physiological terms when conversing with other colleagues, caution must be exercised when speaking in front of and with families. Midwives and other healthcare professionals can inadvertently use words and jargon that are strange, and they may not realise that the meaning is not clear. There are some concepts that are familiar and obvious to the multidisciplinary team but may be alien to patients.
Try first to establish what the woman knows and understands before launching into a discussion that begins at a level that is either too complex or too simple. Too often, our healthcare environments fail to recognise the needs of people with different levels of understanding about their health, and this can mean that they may fail to receive the right care at the right time.
Using jargon can instil fear, cause confusion and result in poor care.
The standard body ‘map’ or anatomical position (just like a map) is that of the body standing upright (orientated with the north at the top). When in this position the body is erect and faces forwards, with the arms to the side, the palms face forwards with the thumbs to the side, and the feet are slightly apart with the toes pointing forwards (see Figure 1.1). Humans are usually bilaterally symmetrical. This position is used to describe body parts and positions of patients irrespective of whether they are lying down, lying on their side or facing down.
As well as understanding the anatomy and the physiology (the structure and the function), you also need to understand directional terms and the position of the various structures. Table 1.1 lists common anatomical descriptive terms that you will need to become acquainted with. Figure 1.2 gives a more detailed depiction of anatomical positions.
FIGURE 1.1 Anatomical position: anterior view of the body.
TABLE 1.1Anatomical descriptive terms.
Anatomical term
Relationship to the body
Anterior
Front surface of the body or structure
Posterior
Back surface of the body or structure
Deep
Further from the surface
Superficial
Close to the surface
Internal
Nearer the inside
External
Nearer the outside
Lateral
Away from the midline
Median
Midline of the body
Medial
In the direction of the midline
Superior
Located above or towards the upper part
Inferior
Located below or towards the lower part
Proximal
Nearest to the point of reference
Distal
Furthest away from the point of reference
Prone
Lying face down in a horizontal position
Supine
Lying face up in a horizontal position
FIGURE 1.2 Anatomical position.
Anatomical Planes of the Body
A plane is an imaginary two‐dimensional surface that passes through the body. There are three planes that are generally referred to in anatomy and healthcare (see Figure 1.3):
Sagittal
Frontal
Transverse
The sagittal plane, the vertical plane, is the plane that divides the body or an organ vertically into right and left sides. If this vertical plane runs directly down the middle of the body, this is known as the midsagittal or median plane. If it divides the body into unequal right and left sides, then it is called a parasagittal plane.
The frontal plane is the plane dividing the body or an organ into an anterior portion and a posterior portion. The frontal plane is often referred to as a coronal plane (the word corona is Latin for crown).
