Maternal and Child Care Nursing Module 1

CLINICAL OBSTETRICS (PHYSIOLOGIC) ISABELA STATE UNIVERSITY – CITY OF ILAGAN
I. Human Sexuality
a. Concepts
1. A person’s sexuality encompasses the complex behaviors, attitudes and
emotions and preferences that is related to sexual self and eroticism
2. Sex is basic and dynamic aspect of life
3. During reproductive years, the nurse performs as resource person on human
sexuality
15 – 44 y.o. – age of reproductivity CBQ
b. Definitions related to sexuality

Gender Identity – sense of feminity and masculinity – developed @age 3 or 2 -4 y.o.
Role Identity – attitudes, behaviours and attitudes that differentiate roles
Sex – biologic male or female status. sometimes referred to as specific sexual
behavior such as sexual intercourse
Sexuality - behavior of being a girl or boy and is identity subject to a lifelong dynamic
change
II. Sexual Anatomy and Physiology
a. Female Reproductive System

1. External – Vulva/ Pudenda
a. Mons pubis/ veneris – mountain of venus, a pad of fatty tissues that lies
over the symphysis pubis covered by skin and at puberty covered by
pubic hair that serves as a cushion or protection to the symphysis pubis.
RYAN M. AMIGO, RN. RM. MSN. MAN. DIP.HM. CHA. DPCHA. FRIN.
ASSISTANT CLINICAL PROFESSOR
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Stages of Pubic Hair Development (Tool Used: Tanner’s Scale/ Sexual Maturity Rating)
Stage 1 – Pre adolescence

• no pubic hair, fine body hair
Stage 2 – Occurs bet. 11 – 12 y.o
• sparse, long, slightly pigmented and curly that develop along
labia
Stage 3 – Occurs bet. 12 – 13 y.o.
• hairs become darker and curlier develops along pubis
symphysis
Stage 4 – 13 – 14 y.o.
• hair ssumes normal appearance of an adult but is not so thick
and does not appear to the inner aspect of the upper thigh
Stage 5 – Sexual Maturity
• assumes the normal appearance of an adult, appears at the
inner aspect of thigh
b. Labia Majora – large lips latin, longitudinal fold from perenium to pubis
symphysis
c. Labia Minora – aka Nymphae, soft and thin longitudinal fold created
between labia majora
• Clitoris – “key”, pea – shaped erectile tissue composed of
sensitive nerve endings; sight of sexual arousal in females
• Fourchet – tapers posteriorly of the labia majora. Site for
episotomy
- sensitive to manipulation, torn during pregnancy
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d. Vestibule – almond shaped area that contains the hymen, vaginal orifice
and batholene’s gland
• Urinary Meatus – small opening of urethra/ opening for urination

• Skene’s Gland – aka Paraurethral Gland, 2 small mucus secreting
glands for lubrication.
• Hymen – membranous tissue that covers the vaginal orifice
• Vaginal Orifice – external opening of the vagina
• Bartholene’s Gland – paravaginal gland, secretes alkaline
substance, neutralizes acidity of the vagina
o Doderleins Bacillus – responsible for vaginal acidity
o Parumculae Mystiformes – healing of a hymen
e. Perenium – muscular structure in between lower vagina and anus
2. Internal
a. Vagina – female organ for ovulation, passageway of menstruation, ¾
inches 8 – 10 cm long containing rugae
o Rugae – permits considerable stretching withouit tearing
during delivery CBQ
b. Uterus – hollow muscular organ, varies in size, weight and shape, organ
of menstruation
Size : 1 x 2 x 3
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Shape : pear shaped, pregnant - ovoid

Weight :
Non pregnant : 50 – 60 g
Preganant : 1000 g
4th stage of Labor : 1000 g
2nd week after of Delivery : 500 g
3rd weeks after delivery : 300 g
5 – 6 Weeks after delivery: 50 – 60 g
Uterine involution (CBQ) - is the process by which the uterus is transformed from
pregnant to non-pregnant state. This period is characterized by the restoration of ovarian
function in order to prepare the body for a new pregnancy.
Three Parts of Uterus

• Fundus – upper cylindrical layer
• Corpus/ Body – upper triangular layer
• Cervix – lower cylindrical layer
Isthmus – lower uterine segment during pregnancy
Muscular Composition: 3 main Muscles making possible expansion in all direction

a. Endometrium à muscle layer for menses
o Lines the non-pregnant uterus
o Volumes the non pregnant uterus
o Decidua – slouching off of endometrium during
menstruation
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o Endometriosis
v Ectopic Endometrium
v Common site is ovaries
v Proliferation of abnormal growth of lining of outer part
v Persistent dysmenorrhea, low back pain
v Dx Exam: biopsy,laparoscopy
v Tx: Lupron (luprolide) à inhibits FSH & LH
v Tx: Danazol (Danacrine) DOC
1. Inhibits ovulation
2. stop menstruation
b. Myometrium
o Power of labor
o Smooth muscles is considered to be LIVING LIGATURE
(muscles of delivery, capable of closing) of the body
o Largest portion of the uterus
c. Peremetrium
o Protects the entire uterus
c. Ovaries
• 2 female sex gland
• almond shape
• Fxn: Ovulation,production of 2 hormones( estrogen and
progesterone)
d. Fallopian Tube
• 2 – 3 inches long that serves as a passageway of the sperm from the
uterus to the ampulla or the passageway of the mature ovum or
fertilized ovum from the ampulla to the uterus
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• 4 significant segments
o Infundibulum – most distal part, trumpet shape, has fimbrae
o Ampulla – outer 3rd or 2nd half, site of fertilization, common
site for ectopic preg.
o Isthmus – site for sterilization, site for BTL
o Interstitial – most dangerous site for ectopic pregnancy
b. Male Reproductive System
1. External
• Penis
• The male organ of copulation and urination
• Contains of a body or shaft consisting of 3 cylindrical layers and
erectile tissues
o 2 corpora cavernosa
o 1 corpus spongiosum
o At the tip is the most sensitive area comparable to clitoris =
glans penis
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• Scrotum
• Pouch hanging below the pendulous penis, with medial septum
dividing into 2 sacs each containing testes
• Requires 2 degrees celsius for continuous spermatogenesis
• Cooling mechanism of testes
2. Internal
The Process of Spermatogenesis
Testes
(900 coiled seminiferous tubules)
¯
epididymis
(site of maturation of sperm 6m)
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¯
Vas Deferens
(conduit pathway of sperm)
¯
Seminal Vesicle
(secreted: fructose form of glucose, nutritative value
Prostaglandin: causes reverse contraction of uterus)
¯
Ejaculatory Duct
(conduit of semens)
¯
Prostate Gland
(release alkaline substances)
¯
Cowpers Gland
(release alkaline substance)
¯
Urethra
Hypothalamus GNRH
¯
APG
¯
FSH – maturation of sperm
LH – testosterone production
Leydig Cells – releases testosterone
Male & female Homologues

Male Female
Penile Glans Clitoris
Penile Shaft Clitoral shaft
Testes Ovaries
Prostate Skene’s gland
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Cowper’s Glands Bartholin’s Gland

Scrotum Labia Majora
III. Basic Knowledge on Genetics and Obstetrics
1. DNA – Deoxyribonucleic Acid – carries genetic code

2. Chromosomes – threadlike structure of hereditary material known as the DNA
3. Normal amount of ejaculated sperm – 3 – 5 cc/ 1 teaspoon
4. Ovum is capable of being fertilized within 24 – 36 hours after ovulation.
5. Sperm 48 – 72 days viability
6. Reproductive cells divide by the process of MEIOSIS (haploid number)
• Spermatogenesis – process of maturation of sperm
• Oogenesis – process of maturation of ovum
o 30 weeks AOG – 6 million immature ovum
o @ birth – 1 million immature oocytes
o @ puberty – 300 – 400 immature oocytes
o @ 13 y/o – 300 – 400 mature oocytes
o @ 23 y/o – 180 – 280 mature ovum
o @ 33 y/o – 60 – 160 mature ovum
o @ 36 y/o – 24 – 124 mature ovum
o @46 y/o – 4 mature ovum
• Gametogenesis – process of formation of two haploid into diploid
7. Age of reproductivity – 15 – 44 y/o childbearing age – 20 – 35 y/o
High risk à <18 & >35 y.o. With Risk à 18 – 20; 30 – 35
8. Menstruation
• Menstrual Cycle – beginning of menstruation to the beginning of the next
menstruation
• Average menstrual cycle – 28 days
• Average menstrual period – 5 days
• Normal blood loss – 50 cc/ ¼ cup accompanied by FIBRINOLYSIS –
prevents clot formation
• Related terminologies
o Menarche – 1st menstruation
o Dysmenorrhea – painful menstruation
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o Metrorrhagia – bleeding in between menstruation

o Menorrhagia – Excessive bleeding during menstruation
o Amenorrhea – absence of menstruation
o Menopause – cessation of menstruation (Average Age- 51 y.o.)
§ Tofu – has isoflavone – estrogen of plant that mimics the
estrogen with a woman
9. Functions of Estrogen and Progestin
• ESTROGEN – hormone of woman
o Primary function
§ Responsible for the development of secondary characteristics in
females
§ inhibit production of FSH
o Other function
§ Hypertrophy of the myometrium
§ Spinnbarkeit and Ferning Pattern (Billings Method)
§ Ductile structure of the breast
§ Osteoblastic bone activity (causes increased in height)
§ Early closure of the epiphysis of the bone
§ Sodium retention
§ Increased sexual desire
§ Responsible for vaginal lubrication
• PROGESTERONE – Hormone of the mother
o Primary function – prepares the endometrium for implantation making it
thick and tortous
o Secondary Function – inhibit uterine contractibility
o Others
§ Inhibit LH (hormone of ovulation) production
§ ¯ GI motility
§ Permeability of kidneys to lactose and dextrose causing + 1
sugar in urine
§ Mammary gland development
§ BBT
§ Mood swings
10. Menstrual Cycle
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4 phases of menstrual cycle

1. Proliferative
2. Secretory
3. Ischemic
4. Menses
1. On the initial phase of menstruation, the estrogen level is ¯, this level stimulates the
hypothalamus to release GnRH/ FSHRF
2. GnRH/ FSHRF stimulates the anterior pituitary gland to release FSH
• FSH Function
o Stimulate ovaries to release estrogen
o Facilitate the growth of primary follicle to become
GRAAFIAN FOLLICE à structure that secretes large amount of
estrogen that contain mature ovum
3. Proliferative Phase (estrogen)
Follicular Phase – responsible for the variation and irregularity of menses
Postmenstrual Period – after menstruation
Preovulatory Phase – happen before menstruation
4. 13th day of menstruation, estrogen level is PEAK while progesterone is ¯, these
stimulates the hypothalamus to release GnRH/ LHRF
5. GnRH/ LHRF stimulates the Anterior Pituitary Gland to release LH
• Functions of LH
o Stimulates the release of progesterone
o Hormone for ovulation
6. 14th day estrogen level is while progesterone level is
• S/S
o Rupture of the graafian follicle - OVULATION
o Mittelschsmerz – slight abdominal pain lower
right quadrant
7. 15th day, after ovulation day, graafian follicle starts to degenerate, estrogen level ¯,
progesterone , causing degeneration of the graafian follicle becoming yellowinsh
known as CORPUS LUTEUM – secretes large amount of progesterone
8. Secretory Phase
Lutheal Phase (progesterone)
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Postovulatory phase
Premenstrual Phase
9. 24th day – Corpus Albicans (whitish) corpus luteum degenerates and becomes
white
10. 28th day – if no sperm united the ovum, the uterine begins to slough off to have the
next menstruation
Note:
• if there is no fertilization, corpus luteum continues functioning
• Ovarian Cycle – from primary follicle – corpus albicans
• Stages:
o 1 – 5 days – menses
o 6 – 14 – proliferative
o 15 – 26 – secretory
o 27 – 28 – ischemic
11. Stages of Human Sexual Response
Initial Response:
VASOCONGESTION – constriction of blood vessels
MYOTONIA – increased muscle tension
• Excitement Phase
• muscle tension, moderate VS
• erotic stimuli causing sexual tension, may last from minutes to hours
• Plateu Phase
• and sustained tension near orgasm
• may last 30 sec – 30 minutes
• Orgasm
• Involuntary release of sexual tension accompanied by physiologic and
psychologic release,
• immeasurable peak of experience 2 – 3 seconds
• Resolution
• Return to normal state
• VS return to normal
REFRACTORY PERIOD – only period present in male, wherein he cannot restimulated for
about 10 – 15 minutes
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IV. Wonders of Fertilization

a. Fertilization
Phonones – song of sperm. A phonon is the quantum mechanical description of an elementary
vibrational motion in which a lattice of atoms or molecules uniformly oscillates at a single frequency. In
classical mechanics this designates a normal mode of vibration.
1. Capacitation – ability of sperm to release proteolytic enzyme and penetrate

the ovum
b. Stages of Fetal Growth and Development
1. Pre Embryonic Stage
I. Zygote à fertilized ovum (3 – 4 days travel, 4 days floating)> from fertilization
II. Morula à mulberry-liked ball containing 16 – 50 cells
III. Blastocyst à enlarging cell forming a cavity that later becomes the embryo covered by
thropoblast which later becomes the placenta and membrane
IV. Implantation à 7 – 10 days after fertilization
• Thropoblast – covering of blastocyst that become placenta
• S/Sx of Implantation à Slight pain, Slight Vaginal Spotting
• 3 Processes
o Apposition
o Adhesion
o Invasion
2. Embryonic Stage
Zygote – fertilization to 14 days
Embryo – 15th – 2 mos/ 8 weeks
Fetus – 2 mos to birth
c. Decidua – thickened endometrium, latin word for “falling off”
1. Basalis – located directly under the fetus where placenta developed
2. Capsularis – encapsulates the fetus
3. Vera – remaining portion of endometrium
d. Chorionic Villi – 10 – 11 weeks
1. Chorionic Villi Sampling (CVS) – removal of tissue from the fetal position of
the developing placenta
• For genetic screening
• Fetal limb defects, missing digits of toes
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e. Cytothrophoblast – outer layer, LANGHAN’S LAYER, protect the fetus against

syphilis (24 weeks/ 6 months)
f. Synsitiotrophoblast – syncitial layer – responsible for hormone production
1. Amnion – inner most layer 2. Chorion
I. Umbilical cord (Funis) – whitish gray (50 – 60 cm)
• Short à abruptio placenta, uterine inversion
• Long à cord prolapse, cord coil
• 3 vessels (AVA) – Artery Vein Artery
• Wharton’s Jelly – protects the umbilical cord
II. Amniotic fluid à bag of water à clear color, musty/mousy odor

• With crystallized forming pattern, slightly alkaline
• 500- 1000 cc Normal
o Oligohydramnios – kidney malformation
o Hydramnios – GIT , TEF/ TEA
• Functions
o Cushion the fetus against sudden blow or trauma
o Maintains temperature
o Facilitate muscuskeletal development
o Prevents cord compression
o Helps in development process
Diagnostic Test for Amniotic Fluid à Amniocentesis

• Purpose: obtain sample of amniotic fluid by inserting a needle hrough the abdomen into
the amniotic sac
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• Fluid is tested for:

• Genetic screening
• Determination of fetal maturity primarily by evaluating factors indicative of lung
maturity
• Done with empty bladder
• Complication
> Most common side effect : INFECTION
> Late : pre term labor
> Early : spontaneous abortion
• Indication for Amniocentesis:
> Early in Pregnancyà Advance Maternal Age
> Later in Pregnancyà Diabetic Mothers
• - down syndrome
• ¯ - neural tube defect, spina befida
• L/S ratio : 2:1 (Lecitin/ Spingomyelin)
• Definitive test = Phosphatiglycerol: PG + à best Answer
• Greenish – Meconium Stains (Fetal Distress)
• Yellowish – jaundice, hyperbilirubinemia
• Cloudy – Infection
• Most Important Consideration à Needle insertion site
• Amnioscopy – direct examination through intact fetal membrane via ultrasound
• Fern Test – a test determining if bag of water has rupture or not
• Nitrazine Paper Test – differentiate amniotic fluid and urine Blue geen à + rupture of
bag of H2O
2. Chorion – outermost layer

a. Placenta – AKA Secundines à chorionic Villi and basalis
• Pancake in latin
• 500 grams in weight
• 15 – 28 cotyledons
• 15 – 20 cm in diameter and 2 – 3 cm in depth
• Functions
o Respiratory à 02 – CO2 exchange via simple
diffusion
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o GIT à glucose transport via facilitated diffusion

o Excretory à via 2 arteries, carries unoxygenated
blood then detoxify by maternal liver
o Circulatory à fetoplacental circulation by SELECTIVE
OSMOSIS
o Endocrine
§ HCG – primary maintain corpus luteum/
secondary basis of pregnancy test
§ Human Placental Lactogen – aka
Somatomammothrophin
• Responsible for the development of
mammary gland
• Diabetogenic Effect – insulin
antagonist
§ Relaxin – softening of maternal joints and
bones
o Serves as protective barrier against some
microorganism
§ Can pass: HIV CMV Rubella
§ PINOCYTOSIS – transport of virus
Pregnancy – 266 – 288 days/ 37 – 42 weeks
FETAL STAGE: Fetal Growth and Development
First Trimester : Period of organogenesis, most critical period

First Month
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FHT, CNS Develops, GIT and Respi Tract remains as single tube
Differentiation of Primary Germ Layer
• Endoderm
o Thyroid – responsible for basal metabolism
o Thymus – immunity
o Liver
o GIT
o Linings of Upper GI Tract
• Mesoderm
o Heart
o Musculoskeletal
o Reproductive Organ
o Kidney
• Ectoderm
o Brain
o CNS
o Skin
o 5 senses
o Hair, nails
o Anus
o Mouth
Second Month
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• Life span of corpus luteum ends

• All vital organs are formed
• Placenta is developed
• Sex organ is developed
• Meconium is present
Third Month
• Placenta is complete
• Kidneys are functional
• Fetus begins to swallow amniotic fluid
• Buds of milk appear
• Sex is distinguishable
• FHT audible via dopples @ 10 – 12 weeks
Terratogens – any drug or irradiation, the exposure to which may cause damage to the fetus
• DRUGS
o Streptomycin – anti – TB – (quinine) damage to the 8th cranial nerve à poor
learning and deafness/ ototoxic
o Tetracycline – stoning the tooth enamel, inhibits long bone growth
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o Vitamin K – hemolysis, destruction of RBC, jaundice, hyperbilirubenemia

o Iodides – enlargement of thyroid and goiter
o Thalidomides – anti-emetics à Amelia or Pocomelia à absence of distal part of
extremities
o Steroids – cleft lip or palate and even abortion
o Lithium – congenital maformation
• ALCOHOL – LBW, fetal alcohol syndrome ( characterized by microcephaly)
• SMOKING – LBW
• CAFFEINE – LBW
• COCCAINE – LBW, abruptio placenta
• TORCH – group of infections that can cross the placenta or ascend through the birth canal
and adversely effect fetal growth
o Toxoplasmosis – cat lovers
o Others - Hepa AB, HIV, Syphillis
o Rubella – CHD,
§ Rubella Titer – N @ 1:10 or ¯ = immunity to rubella = notify doctor
§ Rubella vaccine after delivery for 3 mos. No pregnancy for 3 mos.
o Cytomegalo virus
o Herpes Simplex virus
Second Trimester : continuous growth and development (focus à lengh of fetus)

Fourth Month
• Lanugo begins to appear
• Buds of permanent teeth appear
• FHT audible via Fetuscope @ 18 – 20 weeks
Fifth Month
• Quickening : 1st fetal movement Primi: 18 – 20, Nulli - 16 - 18
• Lanugo covers the body
• FHT audible via stethoscope or w/out instrument
• Actively swallow amniotic fluid
• Fetus : 19 – 25 cm
Sixth Month
• Skin is red and wrinkled
• Vernix caseosa covers the skin
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• Eyelids open
• Exhibits startle reflex
3rd Trimester : period of most rapid growth and development Focus: weight
Seventh Month
• Surfactant development
• Male: the testes begins to descent into the scrotal sac
• Female : clitoris is prominent and labia majora are small doesn’t cover the minora
Eight Month
• Active moro reflex
• Lanugo begins to disappear
• Sub-q fats deposits, steady weight gain, nails to fingers
Ninth Month
• Lanugos and vernix caseosa is evident in body fold
• Birth position assumed
• Amniotic fluid somewhat decrease
• Sole of the foot has few creases
Tenth Month
• Bone ossification in the fetal skull
• Vernix caseosa is evident in body
PHYSIOLOGIC ADAPTATION TO PREGNANCY
Systemic Changes
1. Cardiovascular System
• blood volume 30 – 50%
• 1500 cc; additional 500 cc for multiple pregnancy
• plasma volume
• cardiac workload – easy fatigability/ slight ventricular hypertrophy
• Epistaxis due to hyperemia of nasal membrane
• Palpitation due to SNS stimulation
• Physiologic Anemia/ pseudoanemia in pregnacy

o Normal Value
Hct : 32 – 42%
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Hgb: 10.5 – 14 g/dl

o Criteria
1st & 3rd Trimester : Hct > 33% Hgb > 11 g/dl
2nd Trimester : Hct > 32% Hgb > 10.5 g/dl
o Pathologic Anemia
§ Iron Defficiency Anemia is the most common hematologic
disorder. It affects 20% of pregnant women
§ Assessment reveals:
• Pallor
• Slowed capillary refill = Normal = 2 – 3 sec
• Concave fingernails (late sign of progressive anemia) –
clubbing = chronic tissue hypoxia
• constipation
§ Nursing care
• Nutritional instruction
o Source of iron
§ Kangkong
§ Liver = best source due to FERRIDIN Content
§ Red and lean meat
§ Green Leafy Vegetables
• Parenteral Iron (Imferon)
o Z tract IM
o incorrect causes hematoma

o best given 1 hour before meals (results to poor
absorption)
o Maybe given 2 hours after meal (causes GI irritation)
§ Given with orange juice to absorption
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• Oral Iron Supplements (ferrous sulfate 0.3 g 3 x a day)

• Monitor for hemorrhage
§ Alert
• Iron from red meat is better absorbed iron from other
sources
• Iron is better absorbed when taken with foods high in
Vitamin C such as orange juice
• Higher iron intake is recommended since circulating blood
volume is increased and heme is required from production of
RBCs
• Edema
o Impeded venous return due to the gravid uterus
o Nursing Intervention
§ Elevate legs above the hips level
• Varicosities
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o Wear support stockings

o Elevate legs
• Vulvar Varicosities
o D/t pressure of gravid uterus
o Side –lying with pillow under the hips
o Modified knee – chest position
• Thrombophlebitis
o Presence of thrombus in inflamed blood vessels
o + Homan’s Sign – pain on the calf upon dorsiflexion
o Medical Management
§ Anticoagulant/ HEPARIN
• Does not cross the placental barrier
• Monitor APTT
• PTT, PT, BT, CT
• Antidote: PROTAMINE SULFATE
• No aspirin
• Milk Leg/ Plagmasia Alba Dolens

o Shiny white legs due to stretching of skin & hyperfibrinogenemia
o Nursing intervention
§ Check dorsalis pedis pulse (compare both)
§ Never massage
§ Assess for Homan’s sign only once
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2. Respiratory System
• Shortness of Breath d/t gravid uterus
• Nursing intervention: Side-lying – lateral expansion of the lungs
3. Gastrointestinal System
• Nausea and vomiting
• Morning Sickness
o Due to HCG levels
o Crackers 30 min before arising
o AM – Carb diet 30 mins
o PM – small frequent meal
• Constipation
o Due to PROGESTERONE = fluid reabsorption due to ¯ GIT motility
o Nursing intervention
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• Fluid
• Fiber
• Exercise
• Flatulence
o Due to increased progesterone
o Avoid gas forming foods
• Heartburn (pyrosis)
o Reflux of stomach content into esophagus
o Nursing Intervention
• Small frequent meals
• Sips of milk
• Avoid fatty and spicy foods
• Proper body mechanics
o Waist Above – Acid
o Waist Below – Base
• Hemorrhoids
o Due to gravid uterus
o Hot sitz bath for comfort
• Ptyalism
o salivation
o Mouthwashes to relieve
4. Urinary System
• Normal = + 1 sugar due to Progesterone via BENEDICT’S TEST
• First Trimester - Frequency
• Second Trimester - normal
• Third Trimester – Frequency
5. Muscoloskeletal
• Calcium sources
o Milk - Ca P – 1 pint/ day or 3 – 4 servings/ day
o Cheese, Yogurt, Head of Fish, Sardines, Anchovies, Brocolli
• Lordosis
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o Pride of Pregnacy
• Waddling Gait
o Awkward gait while walking due to relaxin
o Prone to accidental falls
§ Wear low healed shoes
• Leg Cramps
o Ca – P Imbalance during pregnancy
o Lumbo-sacral nerves by pressure of gravid uterus during labor
o Over sex
o Dorsiflex the foot affected
o 3-4 servings/ 4 cups/day sa milk, sardines, dilis
A. Local Changes
• Vagina
o Chadwick’s Sign – bluish discoloration
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o Leukorrhea – whitish gray, moderate in amount, mousy odor

• Cervix
o Goodel’s Sign – change in consistency of cervix in preparation to childbirth
o Operculum – mucus plug to seal bacteria/ progesterone
• Uterus
o Hegar’s Sign – softening of the uterine isthmus resulting (change in
consistency of the lower uterine segment) in its compressibility on bi-manual
examination observed y the 6th and 8th week of gestation.
Vagina Chadwick’s
Cervix Goodel’s
Uterus Hegar’s
Problems related to the changes of Vaginal Environment

a. Vaginitis - AVOCADO
• Trichomonas Vaginalis
o Flagellated protoxzoan, Loves alakaline environment
• Signs and Symptoms
o Greenish, cream, colored, frothy, irritably itchy, foul smelling vaginal
discharge
o Vaginal edema
• Management
o Drug of choice: METRONIDAZOLE (Flagyl)
§ Antiprotozoan
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§ Carcinogenic
§ Not given in 1st trimester
• vaginal douche as substitue
o 1 qt Water = 1 tbsp white vinegar
o Treat partner as well to prevent reinfection
o No alcohol – due to antabuse effect rt
b. Moniliasis - CHEESE
• Candida Albicans
• Transvaginal transfer in fetus – Oral Trush
• Signs and Symptoms
o White Cheeselike patches that adheres to the walls of the vagina
• Management
o Antifungals
§ Mycostatin
§ Contrimazole – Canisten
§ Gentian Violet
1. Abdominal Changes
• Striae Gravidarum
o Due to destruction of the subcutaneous tissue by the enlarge uterus
2. Skin Changes
• Melasma/ Chloasma
o White light brown pigmentation related to melanocytes
• Linea Nigra
o Brown pinkish line from symphysis pubis to umbilicus
3. Breast Changes
• Due to hormonal changes
• Change in color and size of nipple and areola
• Precolostrum – 6 weeks
• Colustrum – 3rd trimester
• Supine with pillow under the back
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4. Ovaries – rest period, no ovulation

5. Signs and Symptoms of Pregnancy
Presumptive Probable Positive
S/sx felt and observed by Signs observed by Undeniable signs
the mother but does not the members of confirmed by the use of
confirm the diagnosis of the health care instrument
pregnancy team
First Breast changes Goodel’s sign Ultrasound Evidence
trimester Urinary changes Chadwick’s sign
Fatigue Hegar’s sign
Amenorrhea Elevated BBT
Morning sickness Positive HCG
Enlarge uterus
Second Chloasma Ballotement
Trimester Linea Nigra Enlarge Abdomen etal Heart Tone
Increase Skin Pigmentation Braxton Hicks etal movement
Striae gravidarum Contraction etal outline
Quickening etal parts palpable
CBQ Cancer of the Breast à quadrant B

Mamography 35 and above à 1/ year
Ballotement à bouncing of the fetus
à may be present in uterine myoma
Transvaginal Ultrasound – empty bladder
Abdoiminal ulrasound – full bladder
Placenta Grading System

• Grade 0 – immature
• Grade 1 – slightly mature
• Grade 2 – moderately mature
• Grade 3 – fully mature
• What is deposited? à calcium
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VI. Psychological Adaptation to Pregnancy – Reva Rubin
First Trimester
• No tangible s/sx
• Feeling of surprise
• Ambivalence
• Denial of pregnancy à maladaptation
• Developmental Task: Accept biological facts of pregnancy
• Health Teaching: Body changes of pregnancy and Nutrition
Second Trimester
• Tangible s/sx
• Mother identifies fetus as separate entity due to quickening
• Fantasy
• Developmental Task: Accept growing fetus as a baby to nurture
• Health Teaching: Growth and development of fetus
Third Trimester
• Mother has personally identifies with the appearance of the baby
• Developmental Task: Prepare child birth and parenting the child
• Health Teaching: responsible parenthood, prepare baby’s layette, Lamaze Class
• Address Mother’s fear à let she hear the FHT
VII. Pre – Natal Visit
Basic Consideration
1. Frequency of Visit
• 1 – 7th mos. à once a month
• 8 – 9th mos. à twice per month
• 10th month à every week
Ø Clinical Guidelines (Philippines)
- At least 4 prenatal visits in a NORMAL pregnancy (DOH/WHO)
30
- For high risk pregnancy a specialized schedule depending on clinical

response of the patient.
- From 9 months of pregnancy up to start of labor:
a. Every 2 weeks in normal pregnancy
b. Weekly for high risk pregnancy
2. Personal Data
• Home Based Mother’s Record/ HBMR à determines high risk pregnancy
• Pseudocyesis à false pregnancy à appearance of presumptive & probable
signs
• Comade Syndrome à psycosomatic disorder, father experience what the
mother goes through
3. Diagnosis of Pregnancy
• Urine Exam àHCG à 40 – 100th day; peak 60 – 70th day
• ELISA à beta subunits of HCG is detected as early as 7 – 10th day
• RIA à beta subunits of HCG is detected as early as 8th day
• Home Pregnancy Kit
4. Baseline Data
• Roll – Over Test à test of pre-eclampsia by the use of BP
• Weight monitoring
Normal Weight Gain
1st Trimester = 1.5 – 3 lbs à 1 lb/ mo
2nd Trimester = 10 – 12 lbs à 4 lbs/mo
3rd Trimester = 10 – 12 lbs à 4 lbs/mo
Minimum allowable weight gain à 20 – 25 lbs

Optimal weight gain à 25 – 35 lbs
5. Obstetrical Data
a. Gravida à no. of pregnancy

b. Para à no. of viable pregnancy
Viability à the ability of the fetus to live outside the uterus at the earliest possible gestational age
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1 abortion 1 39TH Week, 1 miscarriage, 1 still birth, 1 2nd mo. preg

1 pregnancy 3rd mos. G4P2 G4 T1 P1 A1 L1
G2P0 G2 T0 P0 A1 L0
c. Important Estimates
1. Nagele’s Rule
• Use to determine expected date of delivery
• For LMP Jan – Mar à +9 months +7 days
• For LMP Apr – Dec à -3 months +7 days + 1 year
2. McDonald’s Rule
• Determines age of gestation in weeks
• Fundic Height x 7/8 = AOG in weeks
3. Bartholomew’s Rule
• Determines age of gestations
o 3 mos – above pubis symphysis
o 5 mos – level of umbilicus
o 9 mos – below xiphoid process
o 10 mos – level of 8th mos
4. Haases Rule
• Determines the length of fetus in cm.
• 1st half à square each month
• 2nd half à month x 5
d. Tetanus Immunization
• TT1 – anytime or early during pregnancy
• TT2 – 1 month after TT1 à 3 years protection
• TT3 – 6 months after TT2 – 5 years of protection
• TT4 – 1 year after TT3 à 10 years of protection
• TT5 – 1 year after TT4 à lifetime protection
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5. Physical Examinations
a. Danger Signs of Pregnancy
Chills & Fever
Cerebral Disturbances
Abdominal Pain à epigastric pain à aura of impending convulsion
Boardlike Abdomen à Abruptio placenta
Blurred Vission à pre eclampsia
Bleeding à abortion/ ectopic pregnancy – 1st trimester
à H Mole/ Incompetent Cervix – 2nd trimester
à Placental Anomalies – 3rd Trimester
BP ↑
Swelling
Scotoma – spots in the eye
Sudden gush of fluid – PROM – premature rupture of membrane
6. Pelvic Examination
§ Pelvic examination or IE – empty bladder, precaution
§ 1st visit – Chadwicks, Goodle’s sign, etc.
§ Position : dorsal recumbent, lithotomy
§ Pap smear – done 1st visit
§ Cytological exam – determine presence of cancer cells.
§ Result :
o Class I – normal
o Class II A – cytology without evidence of malignancy
B – suggestive of inflammation
o Class III – cytology suggestive of malignancy
o Class IV – cytology suggestive og malignancy
o Class V – conclusive for malignancy
§ Most common cancer report organ : cervical cancer
§ Most common site for pap smear – external OS of cervix (squamocolumnar tissue)
§ Common site of cervical cancer. maternal – speculum (open)
§ Stages of cervical cancer
o 0 – carcinoma in situ
o 1 – Ca strictly confined to cervix
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o 2 – from cervix extends to the vagina

o 3 – pelvic metastasis
o 4 – affectation to bladder & rectum
7. Leopolds Maneuver
§ Purpose: Done to determine the attitude, fetal presentation, lie, presenting part, degree of
descent an estimate of the size, and no. of fetuses
§ Procedure
1. 1st maneuver
o place patient in supine position with knees slightly flexed. Put towel under head and
right hip. With both hands palpate uppe4r abdomen and fundus. Assess size,
shape, movement and firmness of the part
o determine the presenting parts:
2. 2nd maneuver
o with both hands moving down, identify the back of the fetus where the ball of the
stethoscope is placed to determine FHT.
o PR of mother : uterine soufflé – MHR
o fundic soufflé – FHR
3. 3rd maneuver
o using the right hand, grasp the symphysis pubis part using the thumb and fingers.
o Assess whether the presenting part is engaged in the pelvis.
o Alert! If the head is engaged it will not be movable
4. 4th maneuver
o the examiner changes the position by facing the patient’s feet. With two hands,
assess the descent of the presenting part by locating the cephalic prominence or
brow.
o When the brow is on the same side as the back, the head is extended. When the
brow is on the same side as the small parts, the head 8is flexed and vertex
presenting.
§ Attitude – relationship of fetus to one another.
§ Full Flexion – when the chin touches the chest
8. Assessment of Fetal Well-being
34
a. Daily fetal Movement Counting (DFMC)

§ Done starting 27th week
§ Consideration
§ fetal sleep wake pattern
§ maternal food intake
§ drug-nicotine use
§ environmental stimuli
§ maternal dose
§ Cardiff count to 10 method – one method currently available
o begin at the same time each day (usually in the morning after breakfast )
and count each fetal movement, noting how long it takes to count 10 fetal
movements (FMs)
o expected findings – 10 movements in 1hrs or less
o warning signs – 10-12 movements in 1hr or less
§ more than 1hr to reach 10 movements
§ less than 10 movements in 12hrs
§ longer time to reach 10 FMs than on previous days.
§ movements are becoming weaker, less vigorous
§ movement alarm signal <3 FMs in 12hrs
o warning signs should be reported to healthcare provider immediately; often
require further testing. Eg. Non stress test (NST), biophysical profile (BPP)
b. Nonstress Test
o to determine the response of the fetal heart rate to the stress to activity.
o Indications – pregnancies at risk for
o placental insufficiency
o Postmaturity
• pregnancy induced hypertension (PIH), diabetes
• warning signs noted during DFMC
• maternal history of smoking, inadequate nutrition
o Procedure :
• Done within 30mins wherein the mother is in semifowlers position; external
monitor is applied to document fetal activity; mother activates the “mark
35
button” on the electronic monitor when she feels fetal movement. Attach
external noninvasive fetal monitors
• tocotransducer over fundus to detect uterine contractions and fetal
movements (FMs)
• ultrasound transducer over abdominal site where most distinct fetal heart
sounds are detected
• monitor until at least 2 FMs are detected in 20mins.
o if no FM after 40mins provide women with a light snack or gently stimulate fetus
through abdomen
o If no FM after 1hr further testing may be indicated, such as a CST
o Result :
• Noncreative Nonstress Not Good
• Reactive Response is Real Good
o Interpretation of results
• Reactive result – real good
§ baseline FHR between traction between 120 and 160 beats per min.
§ at least two accelerations of the FHR of at least 15 beats per min.,
lasting at least 15secs in a 10 to 20 min period as a result of FM
§ good variability – normal irregularity of cardiac rhythm representing a
balanced interaction between the parasympathetic (↓ FHR) and
sympathetic (↑ FHR) nervous system; noted as an uneven line on the
rhythm strip
§ result indicates a healthy fetus with an intact nervous system
o Nonreactive result – not good
§ stated criteria for a reative result are not met
§ could be indicative of a compromised fetus requires further evaluation
with another NST, biophysical profile, (BPP) or contraction stress test
(CST)
9. Health Teachings
o do nutritional assessment
o daily food intake
o determine habit
o if ↓ folic acid – lead to spina bifida/open neural tube defect
36
o HIGH RISK MOTHERS

• pregnant teenagers – poor compliance to health regimen
• extremes in wt – underwt – eg. Elite models overwt – eg. DM/HPN
• low social economic status. Refer to OSWD
• vegetarian mothers because ↓ intake of vit B12 (Cyanocobalamin) –
formation of folic acid (cell DNA & RNA formation)
• types :
§ strict vegetarian – prone to develop anemia
§ lacto vegetarian – milk
§ lacto-ovo vegetarian – milk & egg
a. Recommended Nutrient Requirement that Increases During Pregnancy

Nutrients Requirements Food sources
Calories
Essential to supply energy for 300 calories/day above the Caloric ↑ should reflect
• ↑ metabolic rate prepregnancy daily • foods of high nutrient value
• Utilization of nutrients requirement to maintain ideal such as protein, complex
• Protein sparing so it can be body weight and meet energy carbohydrates (whole grains,
used for : requirement of activity level vegetables, fruits)
o growth of fetus • begin ↑ in 2nd Trimester • variety of foods representing
o development of • use wt-gain pattern as an food sources for the nutrients
structures requires indication of adequacy of required during pregnancy
for pregnancy calories intake • no more than 30% fat
including placenta, • failure to meet caloric
amniotic fluid, tissue requirements can lead to Na – 3gms/day – eat in
growth ketosis as fat & protein are moderation
used for energy, ketosis has CHON x 4K Cal
been associated with fetal CHO x 4K Cal
damage. Fats x 9K Cal
Non pregnant: 2200 calories

Pregnant: 2500 calories
2200+500 @ lactation=2700
cal
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Protein
Essential for 60mg/day or an ↑ of 10% Protein ↑ should reflect
• fetal tissue growth above daily requirements for • Lean meat, poultry, fish
• maternal tissue growth age group • Eggs, cheese, milk
including uterus and • Dried beans, lentils, nuts
breasts. Adolescents have a higher • Whole grains
• Development of essential protein requirement than
pregnancy structures mature women since Vegetarians must take note of
• Formation of RBC and adolescents must supply the amino acid content of
plasma proteins protein for their own growth as CHON foods consumed to
well as protein to meet the ensure ingestion of sufficient
Inadequate protein intake has pregnancy requirement quantities of all amino acids
been associated with onset of
pregnancy induced
hypertension (PIH)
Calcium-Phosphorous
Essential for Calcium ↑ of Calcium ↑ should reflect
• Growth and development of • 1200mg/day representing an • Dairy products, milk, yogurt,
fetal skeleton and tooth ↑ of 50% above pre ice cream, cheese, egg yolk
buds pregnancy daily requirement • Whole grain, tofu
• Maintenance of • 1600mg/day is • Green leafy vegetables
mineralization of maternal recommended for • Canned salmon & sardines
bones and teeth adolescent with bones
• Current research is • 10mcg/day of vitamin D is • Ca fortified foods such as
demonstrating an required since it enhances orange juice
association between absorption of both calcium • Vitamin D sources fortified
adequate calcium intake and phosphorous milk, margarine, egg yolk,
and the prevention of butter, liver, seafood
pregnancy induced
hypertension
Iron
Essential for Non Pregnat:15mg/day
• Expansion of blood volume & Pregnant : 30mg/day Iron ↑ should reflect
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RBC formation - representing a doubling • liver, red meat, fish,

• Establishment of fetal iron of the prepregnant daily poultry, eggs
stores for first few months of life requirement • enriched, whole grain
• Begin supplementation at cereals & breads
30mg/day in second • dark green leafy
trimester, since diet alone is vegetables, legumes
unable to meet pregnancy • nuts, dries fruits
requirement • vitamin C sources: citrus
• 60 – 120mg/day along with fruits & juices,
copper and zinc strawberries, cantaloupe,
supplementation for women tomatoes, green peppers,
who have low Hgb values broccoli or cabbage,
prior to pregnancy or who potatoes
have iron deficiency anemia • iron form food sources is
• 70mg/day of vitamin C which more readily absorbed
enhances iron absortion when served with foods
o Inadequate iron intake high in vit C
results in maternal
effects anemia, depletion
of iron stores, ↓ energy
and appetite, cardiac
stress especially during
labor & birth
o fetal effects ↓ availability
of oxygen thereby
affecting fetal growth
• iron deficiency anemia is the
most common nutritional
disorder of pregnancy
Zinc
Essential for 15 g/day representing an ↑ of Zinc ↑ should reflect
• the formation of enzymes 3mg/day over prepregnant • liver, meats
• maybe be important in the daily requirement • shell fish
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prevention of congenital • ↑ grains, legumes, nuts

malformation of the fetus
Folic acids, folacin, folate

Essential for 400mcg/day representing an ↑ ↑ should reflect
• Formation of RBC & of more than 2x the daily • Liver. Kidney, lean beek,
prevention of anemia prepregnant requirement veal
• DNA synthesis & cell • Dark, green leafy
formation; may play a role in 300mcg/day supplement for vegetables, broccoli,
the prevention of neural women with low folate levels or asparagus, artichokes,
tube defects (spina bifida), dietary deficiency legumes
abortion, abruption placenta • Whole grains, preanuts
Additional requirements
Minerals ↑ requirements of pregnancy
• Iodine 175mcg/day can easily be met with a
• Magnesium 320mg/day balanced diet that meets the
• selenium 65mcg/day requirement for calories and

includes food sources high in
the other nutrients needed
during pregnancy
Vitamins
E 10mg/day
Thiamine 1.5mg/day
Riboflavin 1.6mg/day
Pyridoxine (B6) 2.2mg/day
B12 2.2mcg/day
Niacin 17mg/day
b. Sexual Activity
• Principles of sex in Pregnancy
o Should be done in moderation
o Should be done in a private place
o That the mother should be placed in a comfortable position
40
o It must be avoided 6 weeks prior to EDD

o Avoid blowing of air during cunnilingus
• Contraindication in sex:
o vaginal spotting – 1st tri
o incompetent cervix – 2nd tri
o placenta previa, abruption placenta – 3rd tri
o pre-term labor R: prostaglandin – oxytocin – contraction
o PROM – infection
• Changes in sexual appetite during pregnancy:
o 1st tri - ↓
o 2nd tri - ↑
o 3rd tri - ↓
c. Exercise
• strengthen muscle to be used during the delivery process
• Walking – best form of exercise
• Squatting – strengthen perineum & ↑circulation to the perineum (raise the buttocks before
head to prevent postural hypotension)
• Tailor sitting – same purpose with squatting
• Kegel exercise – strengthen pubococcygeal muscle
• Abdominal exercise – muscle of the abdomen ( done as if blowing a candle)
• Shoulder circling exercise – strengthen muscle of the chest
• Pelvic rocking exercise or pelvic tilt – relieve low back pain & maintain good posture
(arching back for 3 sec)
• Principles of exercise
o must be done in moderation
o must be individualized
d. Childbirth Preparation
• Overall goal: To prepare patents physically & psychologically while promoting wellness
behavior that can be used by parents & family thus, helping them achieved a satisfying &
enjoying childbirth experiences.
• Psychological
o Bradley Method – Dr. Robert Bradley – discoverer
41
§ advocated active participation of husband during labor & delivery to serve

as coach, based on “imitation of nature”
§ Features:
• darkened room
• quiet & calm environment
• relaxation technique
• close eyes
o Grantly Dick Read Method
§ fear can lead to tension while tension can lead to pain. (break cycle by
removing the fear-by abdominal breathing exercises & relaxation technique)
• Psychosexual
o Kitzinger Method – Dr. Shiella Kitzinger
§ pregnancy, labor & birth & the care of the newborn is an important turning
point in a woman’s life cycle. “flowing with contractions rather than struggle
with contractions”
• Psychoprophylaxis
o Lamaze – Dr. Ferdinand Lamaze
§ Prevention of pain thru mind & requires discipline, conditioning &
concentration with the husband’s help.
§ Features:
• conscious relaxation
• cleansing breathe – inhaling thru nose & exhaling thru mouth
• effleurage – gentle circular massage
• over abdomen to relieve pain
• imaging
• Different methods of delivery
o birthing chain – semi-fowlers – mother
o bathing bed – dorsal recumbent
o squatting – position relieve on back pain & maintain good posture
o Leboyer’s method
§ features :
• darkly lighted room
• quiet & calm environment
• room temp.
42
• soft music
o Birth under water
IX. INTRAPARTAL NOTES

A. Admitting the laboring Mother
• Personal data
• Baseline data – bp, pr, rr, t, wt, lmp, edc/edd
• Obstetrical data – G P (T-P-A-L)
• Physical exams – FH (inches), FHR, IE
IE: Cervical Dilatation, Cervical Effacement, Fetal Presenting Part, Status of the BOW,
Station (Ischial spines)
• Pelvic exams
B. Basic knowledge in intrapartum
• Theories of the Onset of Labor
o Uterine Stretch Theory – any hollow organ once stretched to its maximum
potential will always contract & expel its content
o Oxytocin Theory – released by PPG, contraction effect
o Prostaglandin Theory – stimulation by Arachidonic acid, causes contraction of
uterus
o Aging Placenta – 42wks (lifespan) by 36wks placenta begins to degenerate
causes contraction
o Progesterone deprivation theory - ↓ level of progesterone will facilitate
contraction of the uterus
• The 4 Ps of Labor
o Passenger – fetus
§ fetal head
• is the largest presenting part
• ¼ of its length
• Bones – 6 bones (sphenoid, temporal, ethmoid) Frontal, occipital & 2
parietal bones
• Sutures/intermembranous spaces – allows molding
• Molding – the overlapping of the sutures of the skull to permit
passage of the head to the pelvis
o Sagittal suture/bones – connect to parietal bones
43
o Coronal suture/bones – connect to parietal & frontal bones

o Lambdoidal suture/bones – connect to parietal & occipital
bones
• Fontanels
o 6 fontanels only 2 palpable
§ anterior fontanel/Bregma
• diamond in shape
• 3cm x 4cm size
• close 12-18 mos post delivery
• ↑ 5cm – hydrocephalus
§ posterior fontanel/lambda
• triangular in shape
• 1 x 1cm size
• close 2-3mos post delivery
• Measurements of fetal head :
o transverse diameter
§ Bi-parietal - largest transverse diameter- 9.25cm
§ Bi-temporal - 8cm
§ Bi-mastoid - smallest transverse diameter - 7cm
o AP diameter
§ Suboccipitobregmatic – complete flexion
§ Occipitofrontal – partial flexion - 12cm
§ Occipitotemporal – largest AP diameter;
hyperextended (13.5cm)
§ Submentobrgmatic - face presentation; poor flexio
o Passageway – vagina & pelvis
§ Pelvis
• 4 main pelvic types
o gynecoid – round, wide, deeper, most suitable for pregnancy
o android – heart shape “male pelvis” – anterior pointed post
part – shallow
o Anthropoid – oval “ape-like pelvis“ AP wider transverse
narrow
44
o Platypelloid – flat transverse oval AP narrow transverse –

wider – c/s for delivery
• Problem :
o mother who encounter accident
o ↓ 4’9”
o ↓ 18y/o – R: pelvis not achieve its full pelvic growth (CPD)
§ Bones of pelvis
• 4bones
o 2 hips (2 innominate bones)
§ 3parts of 2 innominate bones
• Ileum – lateral/side of hips
o Iliac crest – flaring superior border that
forms prominence of hips; common
site for bone marrow aspiration
• Ischium – inferior portion
o Ischial tuberosities of the area where
we
o Sit; basis in getting external
measurement of pelvis
• Pubis – anterior portion
o Symphysis pubis – junction in between
o sacrum – posterior portion
§ Sacral prominence – basis internal measurement of
pelvis
o 1 coccyx - 4 small bones that compresses during vaginal
delivery
• universal precaution is the stand point for client and health workers
safety.
• nursing consideration in measurement of pelvis is to empty bladder
first prior to the clinical pelvimetry.
• Important Measurements
o Diagonal Conjugate
§ measure between Sacral promontory & inferior
margin of the symphysis pubis
45
§ Measurement 11.5-12.5 cm
§ Basis in getting the true conjugate.
o True Conjugate/Conjugate Vera
§ Measure between the anterior surface of the sacral
promontory & superior margin of the symphysis pubis.
§ Measurement: 11.0 cm
§ Diagonal conjugate: 1.5 cm = true conjugate.
o Obstetrical Conjugate
§ smallest AP diameter of the pelvis measuring 10cm or
more.
o Bi-ischeal Diameter
§ transverse diameter of the pelvic outlet.
§ Approx by a fist- 8cm & above.
o Power
§ the forces acting to expel the fetus & placenta
• involuntary contractions
• voluntary bearing down efforts
• characteristics: wave like
• timing: frequency, duration, intensity
§ myometrium – power of labor
o Psyche/person
§ psychological stress exist when the mother is fighting the labor experience.
• cultural interpretation preparation
• past experience
• support system
• Pre-eminent signs of labor
o Preeminent Signs
§ lightening
• settling of the presenting part into the pelvis brim (shooting pain
radiating to the legs, urinary frequency)
• primi- early 2 weeks prior to EDD
46
• engagement – settling of presenting part into pelvic inlet (not signs of

labor)
§ Braxton Hicks Contractions – painless irregular contractions
§ Increase Activity of the Mother – Nesting
• Instinct (mgt: save energy)
• epinephrine production (hormone that ↑ the activity of the mother)
§ Ripening of the cervix –butter softness
§ Decrease in weight – 1.5-3 lbs.
§ Bloody show
• pinkish vaginal discharge (blood + leucorrhea + operculum = pink in
color)
§ Rupture of membranes
• check FHT
• IE check for cord prolapse
• after several hrs – check temp.
o Premature Rupture of Membranes (PROM)
§ contraction drop in intensity even though very painful
§ contraction drop in frequency
§ uterus tense &/or contracting between contractions
§ abdominal palpitations
§ Nursing Care:
• administer analgesics (morphine)
• attempt manual rotation for ROP or LOP
• bear down with contractions
• adequate hydration
• sedation as ordered
• cesarean delivery may be required, especially if fetal distress is
noted
o Cord Prolapse
§ a complication when the umbilical cord falls or is washed through the cervix
into the vagina.
§ Danger Signs:
• PROM
• Presenting part has not yet engaged
47
• Fetal distress
• Protruding cord from vagina – cerebral palsy – ↑ 5 mins., irreversible
brain damage mgt: CS
§ Nursing Care
• Positioning – knee chest or trendelenberg, place wet sterile gauze R:
to make it slippery
• Observe for fetal distress
• Provide emotional support
• Prepare for cesarean section
Difference Between True and False Contraction

False True
• No in intensity • There is an in intensity
• Pain confined in the abdomen • Pain begins @ the lower back
• Pain is relieved by walking to abdomen
• No cervical changes • Pain is intensified by walking
Cervical effacement (thinning of
the cervix, measured thru %) &
dilatation (widening of the
cervix, measurement thru cm)
*best/major sign of true labor
• Duration of Labor
o Primipara – 14 hrs but not more than 120 hrs
o Multipara – 8 hrs but not more than 14 hrs
• Nursing Interventions in Each Stage of Labor
o First Stage: onset of contractions to full dilatation & effacement of the cervix
o stage of effacement & dilatation
§ Latent Phase:
• Assessment:
o Dilatations 0-3 cm
o Frequency 5-10 mins
o Duration 20-40 sec.
48
o Intensity mild
o Mother is excited, apprehensive but can communicate
• Nursing Care:
o Encourage walking : shortens 1st stage of labor
o Encourage to void q 2-3 hrs : full bladder inhibits uterine
contraction
o breathing (chest breathing technique)
§ Active Phase:
• Assessment:
o Dilatations 4-8 cm
o Frequency q 3-5 mins lasting for 30-60 secs
o Duration 30-60 secs
o Intensity moderate
• Nursing Care:
o M – edications – have meds ready
o A – ssessment include: v/s, cervical dilatation & effacement,
fetal monitor, etc
o D – ry lips – oral care (ointment), dry linens
o Breathing – abdominal breathing
§ Transitional Phase:
• Assessment:
o Dilatations 8-10cm
o Frequency q 2-3 mins contractions
o Duration 45-90 sec
o Intensity strong
o Mood of mother suddenly change accompanied by
hyperesthesia (hypersensitivity of mother to touch) of the skin
• Management
o ‹
• Nursing care:
o T – tires
o I – inform of progress (to relieve emotional support)
o R – restless support her breathing technique
o E – encourage & praise
49
o D – discomfort
o Pelvic Exams
§ Effacement & Dilatation
• Station – relationship of the presenting part to the ischial spine
o 5 - -1 = the presenting part is above the ischial spine
o Engagement 10 = the presenting part is in line with the
ischial spine
o (-) fetus is floating
o (+) below the ischial spine
• Presentation
o the relationship of the long axis of the fetus to the long axis of
the mother.
o spine relationship of the spine of the mother & the spine of
the fetus
o Two Types
§ Longitudinal Lie (Parallel)/ Vertical
• Cephalic – when the fetus is completely
flexed
o Vertex
o Face
o Brow
o Chin
50
• Breech
o Complete breech – thigh rest on
abdomen while legs rest on thigh
o Incomplete breech
§ Frank – thigh resting on
abdomen while legs extend to
the head
§ Footling
§ Kneeling
51
§ Transverse Lie (Perpendicular)/Horizontal lie

• Position – relationship of the fetal presenting
part to specific quadrant of the mother’s
pelvis.
o ROA/LOA
§ left occipito anterior
§ most common & favorable
position
o ROT/LOT – left occipito transverse
o ROP/LOP – left occipito posterior
o L/R- side of maternal pelvis

o Middle – presenting part
o ROP/ROT – most common malposition

o ROP/LOP – most painful mgt: pelvis
squatting
o Breech – sacro
§ place the stethoscope above
the umbilicus
o Chin – mentum
o Shoulder – acromnio / dorso
§ Monitoring the contractions & fetal heart tone
• spread the finger lightly over the fundus to monitor the contraction
• Increment/Cresendro - beginning of contraction until it increases
• Apex/Acne – height of contraction
• Decrement/Decresendro – from height of contraction until it
decreases
• Duration – beginning of contraction to the end of the same
contraction
• Interval – from end of contraction to the beginning of the next
contraction
52
• Frequency – from the beginning of 1 contraction to the beginning of

next contraction
• Intensity – strength of contraction
• if contract – blood vessel constricts; the fetus will get the oxygen on
the placenta reserve which is capable of giving oxygen to the fetus
up to 1min.
• Duration of placenta to the fetus should not exceed 1min.
• Significance During active phase, if ↑ to 1min should notify the AMD
• ↑ BP; ↓ FHT : best time to get BP & FHT just after a contraction
NURSING CONSIDERATION DURING THE FIRST STAGE OF LABOR

Ø Bath is necessary
Ø Monitor VS especially BP
o Same BP = rest
o Elevated = notify the physician
Ø NPO
o Prevent aspiration à chemical pneuminitis
Ø Enema (per hospital policy)
o Purpose
§ Cleanse the bowel
§ Prevent infection
o 12 – 18 inches normal length of tube
o 18 inches optimal length
o Lateral sims position
o If there is contraction à clump the tube
o If there is resistance à slowly remove
o Before and after administration: check FHT (120 – 160) and contractions
Ø Encourage mother to void
Ø Perennial preparation (rule of 7)
Ø Rest on left side lying position
o Prevent supine vena cava syndrome or supine hypotension
Ø If membrane doesn’t rupture à amniotomy
Ø FETAL TRASHING - hyperactivity of fetus due to lack of Oxygen
Ø For Pain
53
o Systemic analgesic
§ DEMEROL (Meperidine HCl)
• Narcotic and antispasmodic
• Don’t give during latent phase
• Given @ 6-8 cm dilated
• WOF : Respiratory depression
• Narcan (Naloxone, nalorfan, nalline)
o Antidote for toxicity
o Injected on the baby
§ Epidural Anesthesia
• WOF : Hypotension
• Prehydrate the client to prevent hypotension
• In case of Hypotension
o Elevate leg
o Fast Drip IV
SECOND STAGE OF LABOR (FETAL STAGE)

Ø Complete dilatation and effacement to birth
Ø Crowning occurs
Ø PRIMI – transfer to DR @ 10 cm dilatation
Ø MULTI – transfer to DR @ 7 – 8 cm dilatation
Ø Position in lithotomy both legs at the same time
Ø BULGING OF PERENIUM à surest sign of delivery initiation
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Ø PANT & BLOW Breathing, fetal pushing should be done on an open glottis
Ø Respiratory alkalosis
o Due to incorrect breathing
o Hyperventilation
o S/sx
§ RR
§ Lightheadedness
§ Tingling sensation
§ Carpopedal spasm
§ Circumoral numbness
Episiotomy
Ø Prevent laceration
Ø Widen the vaginal canal
Ø Shortens the 2nd stage of labor
Ø 2 types
o MEDIAN
§ Less bleeding
§ Less pain
§ Easy repair
§ Possible 4 degree laceration à risk of rectovaginal fistula à major
disadvantage
o MEDIOLATERAL (Common: Right Medio-Lateral Episiotomy - RMLE)
§ More bleeding
§ More pain
§ Hard to repair and slow healing
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Ø Ironing the Perenium à prevent laceration
Mechanism of Labor (ED FIRE ERE)

Ø Engagement
Ø Descent
Ø Flexion
Ø Internal Rotation
Ø Extension
Ø External Rotation
Ø Expulsion
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PELVIS
Ø 3 Parts
o Inlet – AP diameter narrow, transverse wider
o Cavity – between inner and outer
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o Outlet – AP diameter wider, transverse narrow

Ø LINEA TERMINALES
Nursing Care
Ø MODIFIED RIGEN’S MANEUVER

o Done by supporting the perenium with a towel during delivery
o Facilitates complete flexion
o Avoids laceration
Ø First intervention: Support the head and suction secretion
Ø Do not milk the cord, wait for pulsation to stop before cutting
o Milking may cause too much blood going to the baby that may cause cardiac
overload
Ø Where there is still birth, let the mother see the baby to accept the finality of death
THIRD STAGE OF LABOR (PLACENTAL STAGE)

Ø 3 – 10 minutes after child birth
Ø 1st sign à Fundus rises à CALKIN’S SIGN
Ø Signs of Placental Separation
o Fundus becomes globular and rises à calkin’s sign
o Lengthening of the cord
o Sudden gush of blood
o Maneuver in placental delivery: Controlled cord traction with counter traction.
Ø BRANT – ANDREW’S MANEUVER
o slowly pulling the cord and wind at the clamp
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o rapidly à may cause uterine inversion
Types Placental Delivery

Ø SHULTZ (Shiny)
o From center to the edges
o Presenting fetal side
Ø DUNCAN (Dirty)
o Form edges to center
o Presenting the maternal side
Nursing Considerations during placental delivery

Ø Check placental completeness
o Should be 500 g
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Ø Check Fundus – Massage if Boggy

Ø BP Check
Ø Methergine, methylergonovine mallate (IM)
Ø Oxytocin (IV) if methergine is not present
Ø Check perenium for lacerations
Ø Assist in episioraphy
Ø Vaginoplasty/ Vaginal Landscape – Virgin again
FOURT STAGE OF LABOR (Recovery Stage)

Ø First 1 – 2 hours after delivery of placenta
Ø Maternal observation – body system stabilize
o 1st hour – q15 min 2nd hour - q 30 min
o Mother: BP; PR; RR: Temp: O2 Sat
o Newborn: Temp; PR (CR); RR; O2 Sat
Ø Placement of fundus
o In between umbilicus and pubis symphysis
o Check bladder, assist in voiding, May lead to uterine atony à hemorrhage
Ø Lochia
Ø Perineum
o Check REEDA
Ø R edness
Ø E dema
Ø E cchymosis
Ø D ischarge
Ø A pproximation
o Fully saturated – 30 – 40 cc
o Weighing – 1 cc = 1 gram Common Board Question
Nursing Consideration during Recovery

Ø Flat on bed to prevent dizziness
Ø If with Chills à give blanket due to dehydration
Ø Give nourishment (progression of meal)
o Clear liquids – gatorade, ginger juice, gelatins
o Full liquid – milk, ice cream
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o Soft diet
o Regular diet
Ø Check VS/ Pain
Ø Pychic State
Ø Bonding – interaction between mother and newborn
o Strict – 24 hours with mother
o Partial – morning with mother, night nursery
COMPLICATIONS OF LABOR
Dystocia
Ø Difficult labor related to mechanical factor
Ø Primary cause on the arrest of Uterine Inertia
Abnormality Uterine Inertia

Ø Sluggishness of contraction
Ø Types
o Primary/ Hypertonic
§ Intense contraction resulting to ineffective pushing
§ Management : Sedation
o Secondary/ Hypotonic
§ Slow, irregular contraction resulting to ineffective pushing
§ Management : Oxytocin Augmentation
Prolonged Labor
Ø > 20 H for primi
Ø > 14 H for multi
Ø proper pushing should be encourage if inappropriate:
o may cause fetal distress
o caput succedaneum
o cephalhematoma
o maternal exhaustion
Ø monitor contractions and FHT
Precipitate Labor
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Ø labor less than 3 hours

Ø causes excessive laceration leading to profuse bleeding à hypovolemic shock
Ø s/sx of hypovolemic shock HYPO TACHY TACHY
o HYPOtension
o TACHYpnea
o TACHYcardia
o Cold clammy skin
o Management
§ Modified trendelenburg
§ Fast Drip IV
Inversion of Uterus
Ø Situation in which uterus is turn inside out due to:
o Short cord
o Hurrying of placental delivery
o Ineffective fundal push
Ø Cause profuse bleeding à hypovolemic
Ø Hysterectomy
Uterine Rupture
Ø Rupture of uterus
Ø Caused by
o Previous classical CS
o Very large baby
o Improper use of oxytocin
Ø S/sx
o Sudden pain
o Profuse bleeding
Ø Prepare fore TAHBSO or TAH
Physiologic Retraction Ring à boundary between upper and lower uterine segment
Bandl’sPathologic Ring à suprapubic depression sign of uterine rupture
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Amniotic Fluid/ Placental Embolism

Ø Anaphylactic syndrome of pregnancy
Ø Situation in which placental fragment and amniotic fluid enters maternal circulation
Ø S/Sx
o Dyspnea
o Chest Pain
o Frothy Sputum
o End Stage – DIC
Ø Prepare for CPR, Suction and emergency etc
Trial Labor
Ø Fetal head measurement = measurement of pelvis
Ø 6 hours labor allowance given to mother
Ø monitor FHT and contractions
Preterm Labor
Ø labor after 20 weeks and before 37 weeks
Ø Triad signs
o Premature conditions every 10 minuets
o Effacement of 60 – 80%
o Dilatation of 2 – 3 cm
Ø Home Management
o CBR
o Avoid Sex
o Empty bladder
o Drink 3 – 4 Glasses of H2O
§ Full bladder inhibit contraction
Ø Hospital Management
o If Cervix Close (Criteria: cervix is closed if it is 2 – 3 cm dilated only)
§ 2 – 3 cm dilated, pregnancy can be saved
§ Tocolytic Therapy
• Yutupar (Ritodine HCl)
o Side effect maternal BP < 90/60
o Check Impt. Presence of crackles
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• Brethine (terbutaline) Bricanyl

o DOC
o Side effect: sustained tachycardia
o Antidote: propanolol/ inderal
• Mg SO4
o If cervix is dilated ( > 4cm)
§ Give steroid dexamethasone
• Promote surfactant maturation
• Immediately cut the cord after delivery to prevent jaundice/
hyperbilirubinemia
POSTPARTAL PERIOD
Puerperium – 5th stage of labor, 1st 6 weeks post partum

Characterize by involution
Involution - return to the normal stage of reproductive organ after pregnancy
Return to Normal Healing

Physiologic Changes
Systemic Changes
Ø Cardiovascular System
o plasma volume
o sudden ¯ in blood volume
o elevated WBC’s up to 30, 000 mm3
o hyperfibrinogenemia
o orthostatic hypertension can be possible
o early ambulation prevents thrombos formation
§ steps in ambulation
• Flat
• Semifowlers
• Fowlers with dangling
• Walk with assist
Ø Genital Tract
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o Fundus
§ goes down 1 finger breadth a day
§ 10th day – non palpable behind the symphysis pubis
§ Subinvolution
• delayed healing of uterus containing quarters or clots of blood
• may lead to puerperal sepsis
• Management : D&C
o After Pains
§ After birth pains
§ Multiparous breastfeeding – most common to develop
§ Position = prone
§ Cold compress
§ Mefenamic acid
o Lochia
§ Components
• Blood
• Deciduas
• WBC
• Microorg
§ 3 types
• Rubra – 1 – 3 days, musty, moderate amount
• Serosa – 4 – 10th day, pink or brown
• Alba – 10 – 21th day, crème white, ¯ amount
Ø Urinary Tract
o Urinary Frequency – due to urinary retention with overflow
o Dysuria
§ Damage to trigone of the bladder
§ Urine collection for culture and sensitivity
§ Stimulate navel to urinate
§ Palpate bladder
§ Running water listening
§ Pull pubic hair - stimulate cremasteric reflex
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Ø Colon
o Constipation
§ Due to NPO
§ Bearing down may cause pain
Ø Perenium
o Pain relieved by sim’s position
o Cold compress 1st 24 hours if there is pain at episioraphy followed by warm
EMOTIONAL SUPPORT
1. Taking phase
• 1st 3 days
• dependent phase
• passive, can’t make decision
• tells about childbirth experience
• focus on: Hygiene
2. Taking Hold
• 4 – 7th day
• dependent to independent phase
• active, decides actively
• focus: care of newborn
• health teaching : Family planning
3. Letting Go
• Interdependent phase
• Redefines goals, new roles as parents
• May extend till the child grows
Post Partum Blues

• 4th – 5th days
• overwhelming feeling of depression, inability of sleep and lack of appetite
• 50 – 80% incidence rate
• cause by sudden hormaonal change – progesterone suddenly decreases
• allow crying: therapeutic
• may lead to postpartum psychosis/ depression
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Postpartal Complications
Hemorrhage
Ø bleeding within 24 hours postpartum
Early Pospartal Hemorrhage
1. Uterine Atony
Ø boggy fundus
Ø profuse bleeding
Ø interventions
o massage the uterus
o cold compress – not necessary anymore
o modified trendelenburg
o fast drip IV
o breastfeeding – to release oxytocin
2. Laceration
Ø well contracted uterus with profuse bleeding
Ø assess perenium for laceration
Ø degrees of laceration
o 1st degree – vaginal skin and mucus membrane
o 2nd degree – 1st degree + muscles
o 3rd degree – 2nd degree + external sphincter of rectum
o 4th degree – 3rd degree + mucus membrane of rectum
3. Hematoma
Ø bluish discoloration of subQ tissues of vagina or perenium
Ø candidates
o delivery of very large babies
o pudendal block
o excessive manipulation due to excessive IE
Ø intervention
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o cold compress 10 – 20 min then allow 30 minutes rest period for 24 h
4. DIC – disseminated intravascular coagulation

Ø Consumption of pregnancy (otherterm)
Ø Failure to coagulate
Ø Bleeding in the eyes, ears, nose
Ø Oozing blood
Ø Seen in cases with
o Abruptio placenta
o Still birth / IUFD
Ø Management
o Blood transfusion of cryoprecipitate or fresh frozen plasma
o hysterectomy
Late Postpartum Hemorrhage
Retained placental fragments

Ø manual extraction of fragments is done
Ø uterine massage
Ø D&C except for cases of
o Placenta Acreta – unusual attachment of the placenta to the myometrium
o Placenta Increta – deeper attachment of placemat to the myometrium
o Placenta Percreta – invasion of placenta to the perimetrium
§ Candidates of these disorders are
• Grand multiparous
• Post CS
§ All these requires hysterectomy
Infection
Ø Sources
o Endogenous – from normal flora of the body
o Exogenous – from the health care team
§ Most common – Anaerobic Streptococci
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Ø Management
o Supportive care
o Fluid intake
o TSB if there is fever/ cold compress + paracetamol may also be given
o Analgesics
Ø Given on time to achieve maximum effect
o Culture and sensitivity
Perenial Infection
Ø Same s/ sx with infection
Ø 2 – 3 stitches are dislodges
Ø with purulent drainage
Ø Tx – resuturing
Endometritis
Ø Inflammation of the endometrium
Ø Gen s/sx of infection + abdominal tenderness
Ø Management
o High fowler’s – facilitates drainage & localize infection
o Administer oxytocin
FAMILY PLANNING METHOD
Guiding Principles
1. determine your own beliefs first
2. never advise a permanent method of family planning
3. informed concent
4. the method is an individual decision
Natural Method – accepted by the church
Billing’s/ Cervical Mucus/ Spinnbarkeit
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• clear watery & stretchable

• 13th day – longest due to estrogen
Basal Body Temp – in the morning before arising/ 13th – 14th day due to peak of progesterone
LAM – Lactational Amenorrhea Method
Ø prolactin – inhibits ovulation
Ø breastfeeding – 4 – 6 months no menstrual cycle
Ø bottle fed – 2 – 3 months
Sympthothermal – combination of Billings and BBT – most effective method
Social Methods
Coitus Interuptus
Ø withdrawal
Ø least effective method
Coitus Reservatus
Ø sex w/o ejaculation
Coitus interfemora
Ø between femor
Calendar Method
Ø 14 days before menstrual cycle – ovulation day (regular)
Ø - 4, + 4 days – unsafe period
Origoknause Formula ( irregular menstrual cycle)
Ø get the longest and shortest cycle
Ø subtract 18 to shortest
Ø 11 to the longest
Ø the difference is the unsafe period
PILLS
Ø combined oral contraceptives preventovulation by inhibiting the anterior pituitary gland
roduction of FSH and LH which are essential for he maturation and rupture of a follicle.
Ø Estrogen inhibit FSH which is responsible in the mturation of ovum. Progesterone inhibit
LH which is responsible for ovulation.
Ø contains estrogen that inhibits FSH and progesterone that inhibit LH
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Ø 99.9% effective
Ø 21 day feel on the 5th day of mense start taking
Ø 28 day – 1st day of mense
Ø if forgotten, take 2 tablets the following day
Ø adverse effect : breakthrough bleeding
Ø if mother wants to get pregnant
o wait 3 monts
o another 3 months if unsuucessful before consulting gyne
Ø contraindications
o chain smoking
o Hypertension
o DM
o Extreme obesity
o Thrombophlebitis
Ø Side effects (ressembles Hypertension)/ Immediate Discontinuation
o Abdominal paon
o Chest pain
o Headache
o Eye problem
o Severe leg cramp
Ø Alerts on oral contraceptives :
o In case a Mother who is taking an oral contraceptive for almost a long time and
plans to have a baby, she would wait for at least 3mos before attempting to
conceive to provide time for estrogen and progesterone levels to return to normal.
If after 6months the mother did not get pregnant, consult AMD.
o If a new oral contraceptive is prescribed, the mother should continue taking the
previously prescribed contraceptive and begin taking the new one on the first day of
the next menses.
o Discontinue oral contraceptive if there is signs of severe headache as this are an
indication of hypertension associated with increase incidence of CVA and
subarachnoid hemorrhage.
o If forget to drink pill for 1 day, take 2 pills the next day. If forget to drink pills for
2days, stop the pill and wait for the next mens.
Ø Adverse reaction : breakthrough bleeding
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DMPA – Depoprovera
Ø Contains progesterone
Ø Depomedroxy progesterone Acetate
Ø IM q 3 months – never massage the site à may decrease effectiveness
NORPLANT
Ø 6 match stick like capsules/ rod
Ø contain progesterone
Ø sub Q planted
Ø good for 5 years
Mechanical Device
IUD
Ø prevent implantation
Ø alters mobility of sperm and ovum
Ø 99.7% effective
Ø best inserted after delivery and during menstruation
Ø Common complication – EXCESSIVE MENSTRUAL FLOW
Ø Common problem – EXPULSION OF THE DEVICE
Ø No protection against STD
Ø Side effects include
o Uterine infection
o Uterine perforation
o Ectopic pregnacy
Ø Major indication for the use is PARITY
Ø HT: monthly check up and regular pap smear
CONDOM
Ø Made up of latex
Ø Put in erected penis or lubricated vagina
Ø Prevents sperm to enter the uterus
Ø FEMALE CONDOM – higher protection than that of male
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DIAPRAGHM
Ø Dome shaped rubberied material inserted at the cervix to prevent sperm getting inside the
uterus
Ø Reusable
Ø HT : Proper hygiene
o Check for holes
o Must be refitted in case of weight gain of 15 lbs - - board question
o Kept in place for about 6-8 Hours – Board question
Ø Contraindicated to
o Frequent UTI
CERVICAL CAP
Ø More durable than the diaphram
Ø Could stay on place for more than 24 hours
Ø No need to apply spermicides
Ø Contraindicated to – abnormal papsmear
CHEMICAL
SPERMICIDES
Ø FOAMS – most effective
Ø Jellies
Ø Creams
Ø These may cause toxic shock syndrome
SURGICAL METHOD
Ø Bilateral tubal Ligation
o @ isthmus
o 20% probability of reversal
Ø Vasectomy
o Vas deferens is cut
o More than 30 x or 0 sperm count or 2 x negative sperm count before it could be
consider safe sex
HIGH RISK PREGNANCY
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HEMORRHAGIC DISORDERS
General management
Ø CBR
Ø Avoid sex
Ø Prepare ultrasound – determine the sac integrity
Ø Assess bleeding and approximation
Ø Assess hypovolemia
Ø Save discharge for histopathology
o Determine whether the product of labor has been expelled
First Trimester Bleeding

Abortion – termination of labor before age of viability
Ø SPONTANEOUS
o AKA miscarriage
o Causes
1. Chromosomal aberrations due to advanced maternal age
2. Blighted ovum
3. germ plasm defect
o Natures way of expelling defective babies
o Classifications :
1. Threatened
• pregnancy is jeopardized by bleeding and cramping but the cervix is
closed and can be saved.
2. Inevitable
• moderate bleeding, cramping, tissue protrudes from the cervix and
the cervix is open.
o Types :
1. Complete
• all products of conception are expelled.
• Mgt : emotional support
2. Incomplete
• placenta and membranes retained.
• Mgt : D&C
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Ø HABITUAL
o 3 or more consecutive pregnancies result in abortion usually related to incompetent
cervix.
o Management (suture of cervix)
1. McDonald procedure
• Temporary circlage
• Side effect – infection
• May have NSD
2. Shirodkar
• CS delivery
Ø MISSED
o fetus dies; product of conception remain in uterus 4 weeks or longer
o signs of pregnancy cease
1. (-) pregnancy test
2. Dark brown
3. Scanty bleeding
o Mgt : induction of labor/ vacuum extraction
Ø INDUCED
o Therapeutic abortion à principle of 2 fold effect
1. Done when mother has class 4 heart disease
Ectopic Pregnancy
• occurs when gestation is location outside the uterine cavity
• Common site : Ampulla or Tubal
• Dangerous site: Interstitial
Unruptured Ruptured
• Missed period • sudden, sharp severe unilateral
• Abdominal pain within 3- 5wks of pain, knife like
missed period (maybe generalized • shoulder pain (indicative of
of one sided) intraperitoneal bleeding that extends
• Scant, dark brown vaginal bleeding to diaphragm & phrenic nerve)
• Vague discomfort • (+) Cullen’s sign – bluish tinged
umbilicus
• syncope/fainting
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• Nursing Care :
o vital signs
o administer IV fluids
o monitor for vaginal bleeding
o monitor I&O
o prepare for culdocentesis to determine
o hemoperitoneum
• Mgt : non-surgical à Methotrexate
SECOND TRIMESTER BLEEDING

Hydatidiform Mole / “bunch of grapes”
• Gestational Trophoblastic Disease – progressive degeneration of Chorionic Villi
• gestational anomaly of the placenta consisting of a bunch of clear vesicles. This neoplasm
is formed from the swelling of the chronic villi and lost nucleus of the fertilized egg. The
nucleus of the sperm duplicates, producing a diploid number 46xx. It grows and enlarges
the uterus very rapidly.
• Cause : Unknown
• Assessment :
o Early signs
§ vesicles passed thru the vagina
§ Hyperemesis gravidarum due to ↑ HCG
§ Fundal height
§ Vaginal bleeding (scant or profuse)
o Early in pregnancy
§ high levels of HCG
§ Pre ecclampsia at about 12wks
§ Vesicles look like a “snowstorm” on sonogram
§ Anemia
§ Abdominal cramping
o Serious late complications
§ Hyperthyroidism
§ Pulmonary embolus
• Nursing care :
o prepare for D&C
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o do not give oxytocin drugs due to proneness to embolism

o Health Teaching:
§ return for pelvic exams as scheduled for one year to monitor HCG and
assess for enlarged uterus and rising titer could be indicative of
choriocarcinoma
§ Avoid pregnancy for at least one year
§ Methotrexate therapy
Incompetent Cervix Management:

• McDonald procedure
o temporary circlage of incompetent cervix.
o Delivery : NSVD
o SE: infection
o Health teaching
§ observe for signs of infection
§ signs of labor
• Shhirodkar procedure
o permanent procedure.
o Delivery : caesarian section required.
THIRD TRIMESTER BLEEDING “PLACENTAL ANOMALIES”
Placenta Previa
• it occurs when the placenta is improperly implanted in the lower uterine segment,
sometime covering the cervical os.
• Assessment
o Outstanding sign : frank, bright red, painless bleeding
o enlargement (usually has not occurred)
o fetal distress
o abnormal presentation
• Nursing care :
o Initial mgt : NPO à candidate for CS
o Bedrest
o prepare to induce labor if cervix is ripe
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o administer IV
o No IE, No Sex, No enema – complication : Sudden fetal blood loss
o prepare Mother for double set –up –DR is converted to OR
Abruptio Placenta
• it is the premature separation of the placenta from the implantation site.
• It usually occurs after the twentieth week of pregnancy
• Cause:
o Cocaine user
o Severe PIH
o Accident
• Assessment:
o Outstanding sign : dark red & painful bleeding
o concealed hemorrhage (retroplacental)
o couvelaire uterus (caused by bleeding into the myometrium) (-) contraction
o rigid boardlike abdomen
o severe abdominal pain
o dropping coagulation factor (a potential for DIC)
o sx : bleeding to any part of the body. Mgt : for hysterectomy
• General Nursing care :
o infuse IV, prepare to administer blood
• type and crossmatch
o monitor FHR
o insert Foley catheter
o measure bllod loss; count pads
o report s/s of DIC
o monitor v/s for shock
o strict I&O
Placental Succenturiata – 1 or 2 lobes connected to the placenta by a blood vessel

Placenta Bipartita – placenta divided into 2 lobes
Pregnancy Induced Hypertension
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o HPN after 24wks resolved 6wks postpartum which cause pregnancy.

o Types :
o Gestational HPN
§ HPN without edema & proteinuria.
§ Mgt : monitor BP
o Pre-eclampsia – triad
o sx : HPN with edema, proteinuria or albuminuria (HEP/A) which cause is unknown
or idiopathic but multifactoral
§ primis d/t 1st exposure to chorionic villi
§ multiple pregnancies due to ↑ exposure to chorionic villi
§ Mothers of low socio-economic status due to ↓ protein intake
§ Teenagers d/t low compliance to protein intake
o HELLP syndrome – hemolysis with elevated liver enzymes & low platelet count
Transitional Hypertension – HPN between 20-24wks

Chronic or Pre-existing Hypertension
o HPN before the 20th wk not resolved 6wks postpartum
o 3 types of pre-eclampsia
o Sign of pre-eclampsia :
o > 30mmHg systolic
o > 15mmHg diastolic
o Roll over test
§ 10-15min side lying
§ Then supine
§ Then take BP
o mild pre-ecclampsia
§ 140/90mmHg, w/ +1 O2, +2 proteinuria Early signs : ↑ wt, inability to wear
wedding ring due to developing edema
§ Signs present
• cerebral & visual disturbances, epigastric pain to liver edema and
oliguria usually indicates an impending convulsion
• Before convulsion : if you see sign of epigastric pain, 1º mgt is to
place tongue depressor and put the side rales up
• During convulsion : observe the Mother for safety
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• After convulsion – turn to side to facilitate drainage

o Severe pre-ecclampsia
§ 160/110, +3 or +4, proteinuria, visual disturbances
§ Nursing care
§ P – promote bedrest
§ Prevent convulsions by nursing measures
• to ↑ O2 demand & facilitate Na excretion
• Management: quiet & calm environment, minimal handling, avoid
moving the bed
• Heat Acetic Acid – determine protein in the urine
• Prepare the following at bedside
o tongue depressor, Suction machine & O2 tank
§ E – ensure high protein intake (1g/kg/day)
• Na in moderation
§ A – antihypertensive drug with hydraluzine
§ C – CNS depressant with Mg Sulfate for anti-convulsion
• Mgt : evaluate for hypermagnesiumenimia
§ E – evaluate physical parameters for Magnesium Sulfate toxicity :
• B – BP ↓
• U – Urine output ↓
• R – RR ↓
• P – Patellar reflex is absent
• Antidote : Ca gluconate
o Eclampsia – with seizure
§ ↑ BUN – sign of glumerular damage
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Diabetes Mellitus
o cause by absent & lack of Insulin
o Action of Insulin is to facilitate transfer of glucose into the cell
o Dx test : 50gm 1hr Glucose Tolerance Test
o ↑ 130 – hyperglycemia
o ↓ 70 – hypoglycemia
o 80-120 – euglycemia
o if > 130mg/dl, the Mother needs to undergo a 3hr GTT
o Maternal Effects :
o hypoglycemia during the 1st trimester development of the brain à sinisipsip ng
fetus yung glucose ng nanay.
o Hyperglycemia during the 2nd & 3rd trimester
§ HPL effect Mgt : give insulin. OHA are teratogenic.
§ 1st trimester - ↓ insulin, 2nd trimester - ↑ insulin, post partum – drop
suddenly
§ Frequent infections à eg. Moniliasis
§ Polyhydramnios
§ Dystocia
o Fetal Effects :
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o hypoglycemia during the 1st trimester and Hyperglycemia during the 2nd & 3rd
trimester thru facilitated diffusion
o Macrosomia/LGA .4000gms
o IUGR due to prolonged DM
o Preterm birth à promote still birth
o Newborn Effects :
o Hyperinsulinism and Hypoglycemia
§ 40mg/dl
§ Normal : 45-55mg/dl
§ Borderline : 40mg/dl
§ Sx : ↑ pitched shrill cry, tremors, jitteriness
§ Dx test : heel stick test to check glucose levels
o Hypocalcemia
§ < 7mg/dl
§ Calcemic tetany
§ Tx : Ca gluconate
Heart Disease
o Classification :
o I – no limitation
o II – Slight limitation, ordinary activity causes fatigue
§ good prognosis can deliver vaginally
§ Mgt : sleep of 10hrs/day, rest 30mins after meals
o III – moderate limitation, less than ordinary activity causes discomfort
§ poor prognosis. Good for vaginal delivery
§ Mgt : early hospitalization by 7-8mos
o IV – marked limitation of physical activity for even at rest there is fatigue
§ poor prognosis. Good for vaginal delivery only with regional anesthesia.
§ Low forceps delivery when unable to push & to shorten the stage of labor
§ Mgt :
• therapeutic abortion, high semifowlers position, left side lying, no
valsalva maneuver - may trigger cardiac arrest, heparin therapy
required, antibiotic therapy for prevention of sub acute bacterial
endocarditis
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INTRAPARTAL COMPLICATIONS
Cesarean Delivery
• Indications
a. multiple gestation
b. diabetes
c. active herpes II
d. severe toxemia
e. placental previa
f. abruption placenta
g. prolapse of the cord
h. cephalo pelvic disproportion and primary indication
i. breech presentation
j. transverse lie
• procedure :
o classical – vertical incision
o low segment – “bikini”, for aesthetic purposes. Can have vaginal birth after c/s
Genotype – genetic make-up

Phenotype – Physical appearance
Karyotype – pictorial analysis of individual chromosome for detecting chromosomal abnormalities
Autosomal Dominant
• huntington’s chorea
• retinoblastoma
• achondroplasia
• polydactyl
Autosomal Recessive
• sickle cell
• Cystic fibrosis
• Celiac
• PKU
• Galactosemia
X- Linked Recessive
• Hemophilia
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• Duchenne’s muscular dystrophy

• Color blindness
X – Linked Dominant
• Rickette’s
OB NURSING BULLETS – PRACTICE WORKSHEETS
_______________________________________ responsible for a positive pregnancy test.

_________________________ caused by elevated estrogen and progesterone and also fatigue.
____________________ produced by posterior pituitary gland for uterine contractions.
______________________ aids in placental delivery if mother is anesthetized.
____________ uterus in 3rd stage of labor.
______________________________________ inversion of uterus and avultion of cord.
____________________________ comfort, dry clothing, perineal pads and linens.
________________________________ lochia, fundus, hematoma.
_______________ if servical mucus is clear and elastic (for contraception).
__________________________ for low sperm count.
_____________ for tubal occlusion.
__________________ tx of Clomid or Parlodel.
_________________ (-) spermicide pre-intercourse, can stay up to 24-48h, durable,
contraindicated if with abnormal pap smear.
_________________ doesn’t protect against STDs
_________________________ saturation of peripad within 15 minutes and with pain sensation.
________________________ inhibits uterine contraction with increased risk blood loss.
_______________________________ massage fundus if boggy, elevate legs from hips, IV line,
oxygen at 8-10 1/min, stay with patient.
_______________ void.
_______________ priority post rupture of membranes.
________________ beginning to beginning.
________________ growth of endometrial tissue outside the uterus; dx: lap and biopsy.
____________ menses stop, edema, weight gain, anovulation.
__________________drop 0.2 F pre ovulation, increase 0.4 F post ovulation.
____________________________ immediately after awakening and before arising.
_____________________ abdominal stretches.
__________ descending but not at aschial spine.
_________________________increase in bloody show, rectal pressure, rupture of membranes,
regular and long contractions.
______________________ at crowning.
^ _______________________ at 20 weeks or 5 months gestations.
^ ____________________________ most important to check 24 post-partum.
^ _____________________________ termination of first stage of labor.
^ _______________________ end of 3rd stage of labor.
^ _________________ 1.0 mg for full terms, 0.5 mg for pre-terms.
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^ _________________________ monthly.
^ ____________ for maternal-infant bonding.
^ ___________________________ maintain corpus luteum during 1st trimester.
^ ___________________ maintains acidic vaginal pH.
^ _____ no lifting activities post surgery.
^ ____________ 5-7 days post menstruation.
^ ______________ dx of breast CA; yearly for 40’s, biannual for 50yrs above.
^ ___________________ removal of breast/s, pectoral muscle, pectoral fascia, nodes.
^ _________ most important 2hrs post-partum.
^ ______________ done during menstrual days 1-4.
^ __________________ 24-28hrs pre-ovulation to 48hrs post ovulation.
^ ________ prevent ovulation.
^ ____________ stimulates oogenesis.
^ _____________ decrease in fundal height due to a change in shape of the abdomen a few
weeks before onset of labor.
^ _______________ for continuity of care.
^ ____________ loss of fetus before viability (20 weeks).
^ ______________________ with dilated cervix.
^ __________________ closed cervix, spotting and uterine cramping.
^ ___________________ consecutive abortions.
^ ______________________ complete bed rest, check vaginal bleeding and observe uterine
contractions.
^ __________ 14 days before menstruation (for a 28 day cycle); increased pH of cervical
secretions, (+) MITTLESCHMERZ; increase in BBT.
^ _____________ LH surge from anterior pituitary gland.
^ ________________ at 5th month or 20-24 weeks.
^ _____________________at 10th lunar month.
^ FHT- Doppler at 3 weeks, fetoscope at 18-20 weeks.
^ __________________ fundic ht in cm x 8/7 = aog.
________________ 1-7 mo once a month, 8th mo 2/month, 9th q wk.

________________________ due to hormonal and physiological changes occurring.
__________ prone to infections.
____________________ focus is the infant.
_________________________ 4-5 days post-partum.
___________ cell that results from the fertilization of the ovum by the sperm.
__________ cell division of the fertilized ovum.
___________ rupture of the ovum from na graafian follicle.
___________ mulberry- like ball of cell that results from cleavage.
_____________ where zygote normally implants.
__________________ 7-10 days post fertilization.
___________________ cervix becomes thinner.
_______ carbohydrate intolerance induced by pregnancy.
85
____________________ morbidity common in newborn, infant may inherit a predisposing to DM,

higher perinatal death.
________________________ liberal exercise, acceptable diet at 30-35 kcal/kg of IDBW/day,
insulin as ordered, CBG monitoring.
_______________ 18.02 mg/dl = 1 mmol
____________________ doesn’t last for greater than 24 hours.
_______________________ anti-inflammatory.
_________________ structure of maternal pelvis.
_____________________ urine vs. amniotic fluid; yellow vs. blue.
______________ check temperature.
____________________ lined by endometrium.
____________ externally visible structure of the female reproductive system extending from the
symphysis pubis to the perineum.
________________ fertilization site.
_____________ site of sterilization.
______________ conduit for spermatozoa.
____________________________ seminal fluid.
_________________ synthesized testosterone.
_________________ increased activity of endometrial glands during luteal phase; increased basal
metabolism, increased placental growth, development of acinar cells in the breast.
________________ (+) hypertrophy during pregnancy.
_______________ best criterion for sperm quality.
________________________ introduction of radiopaque material into uterus and fallopian tubes
to assess for tubal patency.
______________________ brought about by th overstimulation by oxytocin.
________________ due to mechanical factors.
_____________________ where developing follicles and the graafian follicles are found.
__________________ forms the frenulum and prepuce on the clitoris.
_______________ formed by the labia minora tapering and extending posteriorly.
_______ thick folds of membranous stratified epithelium on the internal vaginal wall capable of
stretching during the birth process to accommodate delivery of fetus.
________________ location where squamocolumnar junction is, pap smear location.
_________________ largest portion of uterus.
________ upper triangular portion of uterus.
_______ testosterone production.
____________ secreted by graafian follicle associated with spinnbarkeit and ferning.
____________________ cystic fibrosis, tay sach’s disease, sickle-cell anemia.
________________________ detects trisomy 21, cystic fibrosis and tay sach’s.
______________ indication for chorionic villi sampling.
_____________ essential post-CVS or RH (-) mom; refrain from sex 48h post-CVS.
____________________ most important factor affecting amniocentesis.
_____________________ prevent implantation of the fertilized ovum; taken within 12h post-
intercourse, (+) slight nausea post-2d; not given to those with hx contraindications to OCPs.
_____________________ inhibit FSH and LH production.
86
___________ causes sodium retention.

____________ indication for IUD use.
_______________________ contraindication for IUD use.
_______________________ done 2-6 days after menses.
____________________ way in which an expectant father can explore his feelings.
________ should be administered within 72h; destroys fetal RBCs to prevent antibody formation.
_____________ tx for endometriosis.
_____________ safest antibiotic for pyelonephritis.
__________________ monitor contractions.
____________________- first sign is disappearance of knee-jerk reflex.
_______________ excessive menstrual flow.
______________________ spontaneous expulsion of device.
______ provides contraception by setting up a non-specific inflammatory cell raction in the
endometrium.
________________ occurs when LH is high.
_________ causes breakthrough bleeding.
_______________ best timed within 1-2 days of presumed ovulation.
__________________ are most often related to past infections.
__________________ inability to become pregnant after a year of trying.
__________________________ determine the number, motility and activity of sperm.
__________________ be alert for unusual uterine enlargement.
_______________________ sudden lower right or left abdominal pain radiating to the shoulders.
___________________ sudden knifelike, lower quadrant pain.
_______________________ causes most spontaneous abortions.
____________________ fetus is expelled but part of the placenta and membranes are not.
__________ umbilical cord.
__________ inner membrane that encloses the fluid medium for the embryo.
__________ 8th week to birth.
___________ uterus becomes an abdominal organ.
______________ first fetal movement felt by the mother.
_____________________ in 3rd trimester, 2nd trimester; height and length..
______________ chief source of estrogen and progesterone after the 1st 3 months.
_________________ has the highest oxygen content.
____________________ A-P diameter of pelvic inlet.
_______________ _________ 30-50% is normal.
_____________________ purplish discoloration of vaginal mucosa.
__________________________ result of increased plasma volume of the mother.
________________________ causes nausea and vomiting.
____________________ increase in melanotropin hormone causing dark nipples and linea nigra.
_____________________ routinely performed on expectant mother to predict whether the fetus
is at risk for acute haemolytic anemia.
_________________ caused by elevated estrogen.
____________________ adequate fluids and evaluation of lower extremities.
^ __________________ pre UTZ.
87
_________________________ clear, almost colorless, containing little white specks.

_____________________ when an external fetal monitor is being used.
__________________ FHT decreases just before acme due to head compression.
__________________ FHT decreases just after acme caused by uteroplacental insufficiency; may
lead to distress.
________________________ due to cord compression.
__________________________________ halfway between the symphysis pubis and the
umbilicus.
______________________ alleviates discomfort during contractions.
_____________ during crowning.
__________________ causes low back pain.
___________________________________ during contractions to increase comfort.
__________ during 2nd stage of labor because undigested food and fluid may cause nausea and
vomiting, limiting the choice of anesthesia.
___________________ help client retain/remain in control.
_______________________________ legs elevated simultaneously to prevent trauma to the
uterine ligaments.
____________ observe carefully for this during the indication of labor.
____________________ when fully dilated but (-) crowning.
___________ is done to prevent lacerations.
________________ 2 most important predisposing factors to its development is hemorrhage and
trauma during birth.
________________ stimulates secretion of milk from the mammary glands.
________________ promotes vasolidation, relieves haemorrhoids.
_______________ on demand; baby will soon develop a feeding schedule.
_____________________ after birth is caused by an increase in the pulmonary blood flow.
__________________ becomes the ligamentum anteriosum.
_____________ primary critical observation in APGAR scoring.
_____________________ to keep limit development of hyperbilirubinemia.
___________________________ associated with brachial plexus, cervical or humerus injuries.
____________________ lacks bacteria necessary in the synthesis of prothrombin.
___________________ measures protein metabolism.
________________________ in infants is caused by an underdeveloped cardiac sphincter.
________________ done to detect presence of neural tube defects.
________________ contraindication for oxytocin challenge test.
_________________________________ (+) CST
_______________________ emphasize importance of consistent care.
___________________ is 2-3 times greater in multiple gestation than in single gestation.
__________________________ is often times caused by multiple gestation.
_____________ observe for signs of PTL; antibiotic tx should be administered until urine is sterile-
--2 (-) C/S.
_______________________ causes abdominal pain associated with abruption placenta.
___________________________ causes bleeding following server abruption placenta.
88
_________________________ is most likely to occur in woman with pregnancy induced

hypertension.
__________________ painless vaginal bleeding.
_______________ are kept at minimum during PTL to prevent respiratory depression.
___________________ due to overstretching is commonly caused by multiple gestation.
__________________________________ may cause uterine atony.
______________________ rarely occurs as a compilation of uncomplicated gestational
hypertension
__________ BP elevation of 30/15 mmHg from baseline on 2 occasions 6 hours apart.
________________ subjective symptom of an impending seizure.
___________________________________________ objective sign of an imoending seizure.
________________ ends in 48h post-partum in a woman with eclampsia.
____________________ birth hazard associated with breech delivery.
____________________ cardiac acceleration in the last half of pregnancy; most compromised
during the 1st 48h after delivery; forceps delivery.
______________ balanced, to meet the increased dietary needs with insulin adjusted as
necessary.
__________________ funis with only two vessels.
________________________ irritability and nasal congestion.
_______________________ with low apgar score at 5 minutes post delivery.
_________________ microcephalic, craniofacial features, persistent diarrhea.
________________________ caused by high oxygen concentration administered in premature
infants.
_________ asymptomatic newborn, VDRL, test.
_________________ asymmetric gluteal folds
_____________ complication of breech delivery; flaccid arm with elbows extended; ROM exercises.
____________________ increased risk for intracranial hemorrhage and elevated ICP.
_________________________ appearance of jaundice during the 1st 24h.
__________________________ inability of the infant to concentrate urine and conserve water.
_________________________ most common preterm complication.
___________________________ tremors, periods of apnea, cyanosis and poor sucking.
___________________ due to increased somatotropin and increased glucose utilization.
____________________________ main blood supply of the uterus.
______________ is characterized by painful menstruation and backache.
________________ is brought about by overstretching of pireneal supporting tissues as a result of
childbirth.
___________________________________________________ common size of cervical CA
growth.
____________________ management for infertility.
______________________ pain and elevated temperature.
___________________ inhibits RNA synthesis bu binding DNA.
________________________________ evaluates potential response to hormone threrapy.
___________________________ surgical menopause.
____________________ is due to inability of the ovary to respond to gonadrotopic hormone.
89
____________________ via location of fundus.

_______________ 1st 5 months: month2 = aog; second half: month x % = aog
____________________ LMP minus 3m + 7d + 1y = EDC
^ ____________________ placenta.
90

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CLINICAL OBSTETRICS (PHYSIOLOGIC) ISABELA STATE UNIVERSITY – CITY OF ILAGAN

b. Definitions related to sexuality

II. Sexual Anatomy and Physiology

a. Female Reproductive System

Stage 1 – Pre adolescence

• Urinary Meatus – small opening of urethra/ opening for urination

Shape : pear shaped, pregnant - ovoid

Three Parts of Uterus

Muscular Composition: 3 main Muscles making possible expansion in all direction

b. Male Reproductive System

Male & female Homologues

Cowper’s Glands Bartholin’s Gland

III. Basic Knowledge on Genetics and Obstetrics

1. DNA – Deoxyribonucleic Acid – carries genetic code

o Metrorrhagia – bleeding in between menstruation

4 phases of menstrual cycle

IV. Wonders of Fertilization

1. Capacitation – ability of sperm to release proteolytic enzyme and penetrate

e. Cytothrophoblast – outer layer, LANGHAN’S LAYER, protect the fetus against

II. Amniotic fluid à bag of water à clear color, musty/mousy odor

Diagnostic Test for Amniotic Fluid à Amniocentesis

• Fluid is tested for:

2. Chorion – outermost layer

o GIT à glucose transport via facilitated diffusion

FETAL STAGE: Fetal Growth and Development

First Trimester : Period of organogenesis, most critical period

• Life span of corpus luteum ends

o Vitamin K – hemolysis, destruction of RBC, jaundice, hyperbilirubenemia

Second Trimester : continuous growth and development (focus à lengh of fetus)

PHYSIOLOGIC ADAPTATION TO PREGNANCY

• Physiologic Anemia/ pseudoanemia in pregnacy

Hgb: 10.5 – 14 g/dl

o incorrect causes hematoma

• Oral Iron Supplements (ferrous sulfate 0.3 g 3 x a day)

o Wear support stockings

• Milk Leg/ Plagmasia Alba Dolens

o Leukorrhea – whitish gray, moderate in amount, mousy odor

Problems related to the changes of Vaginal Environment

4. Ovaries – rest period, no ovulation

CBQ Cancer of the Breast à quadrant B

Placenta Grading System

VI. Psychological Adaptation to Pregnancy – Reva Rubin

VII. Pre – Natal Visit

- For high risk pregnancy a specialized schedule depending on clinical

Minimum allowable weight gain à 20 – 25 lbs

a. Gravida à no. of pregnancy

1 abortion 1 39TH Week, 1 miscarriage, 1 still birth, 1 2nd mo. preg

o 2 – from cervix extends to the vagina

8. Assessment of Fetal Well-being

a. Daily fetal Movement Counting (DFMC)

o HIGH RISK MOTHERS

a. Recommended Nutrient Requirement that Increases During Pregnancy

Non pregnant: 2200 calories

RBC formation - representing a doubling • liver, red meat, fish,

prevention of congenital • ↑ grains, legumes, nuts

Folic acids, folacin, folate

• selenium 65mcg/day requirement for calories and

o It must be avoided 6 weeks prior to EDD

§ advocated active participation of husband during labor & delivery to serve

IX. INTRAPARTAL NOTES