32590736 Maternity Nursing Review

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. Defnitions related to sexuality
Gender dentity sense of feminity and masculinity developed !age 3 or 2 "# y.o.
!ole dentity attitudes, behaviours and attitudes that di$erentiate roles
"ex biologic male or female status. sometimes referred to as speci%c sexual behavior such as sexual
intercourse
"exuality " behavior of being a girl or boy and is identity sub&ect to a lifelong dynamic change
. "exual #nato$y and %&ysiology
a. 'e$ale !eproductive "yste$
1. (xternal – )ulva* %udenda
a. +ons pubis* veneris mountain of venus, a pad of fatty tissues that lies over the
symphysis pubis covered by s'in and at puberty covered by pubic hair that serves as a
cushion or protection to the symphysis pubis
"tages of %ubic ,air Develop$ent -.ool /sed0 .anner1s "cale* "exual +aturity !ating2
Stage 1 (re adolescence
• no pubic hair, %ne body hair
Stage 2 )ccurs bet. 11 12 y.o
• sparse, long, slightly pigmented and curly that develop along labia
Stage 3 )ccurs bet. 12 13 y.o.
• hairs become dar'er and curlier develops along pubis symphysis
Stage # 13 1# y.o.
• hair ssumes normal appearance of an adult but is not so thic' and does not
appear to the inner aspect of the upper thigh
Stage * Sexual +aturity
• assumes the normal appearance of an adult, appears at the inner aspect of
thigh
b. 3abia +a4ora large lips latin, longitudinal fold from perenium to pubis symphysis
c. 3abia +inora a'a ,ymphae, soft and thin longitudinal fold created bet-een labia ma&ora
• Clitoris .'ey/, pea shaped erectile tissue composed of sensitive nerve endings0
sight of sexual arousal in females
• 'ourc&et tapers posteriorly of the labia ma&ora. Site for episotomy
" sensitive to manipulation, torn during pregnancy
d. )estibule almond shaped area that contains the hymen, vaginal ori%ce and batholene’s
gland
• /rinary +eatus small opening of urethra1 opening for urination
• "5ene1s Gland a'a (araurethral 2land, 2 small mucus secreting glands for
lubrication
• ,y$en membranous tissue that covers the vaginal ori%ce
• )aginal 6rifce external opening of the vagina
• Bart&olene1s Gland paravaginal gland, secretes al'aline substance, neutrali3es
acidity of the vagina
o Doderleins Bacillus responsible for vaginal acidity
o %aru$culae +ystifor$es healing of a hymen
e. %ereniu$ muscular structure in bet-een lo-er vagina and anus
2. 4nternal
a. )agina female organ for ovulation, passage-ay of menstruation, 5 inches 6 17 cm long
containing rugae
o 8ugae permits considerable stretching -ithouit tearing during delivery
9:;
b. /terus hollo- muscular organ, varies in si3e, -eight and shape, organ of menstruation
"i7e 0 1 x 2 x 3
"&ape 0 pear shaped, pregnant " ovoid
8eig&t 0 /terine involution CBQ
9on pregnant 0 5: – ;: g
%reganant 0 1::: g
4
t&
stage of 3abor 0 1::: g
<
nd
=ee5 after of Delivery 0 5:: g
>
rd
=ee5s after delivery 0 >:: g
5 – ; 8ee5s after delivery0 5: – ;: g
<hree (arts of =terus
• 'undus upper cylindrical layer
• Corpus* Body upper triangular layer
• Cervix lo-er cylindrical layer
st&$us lo-er uterine segment during pregnancy
+uscular 9omposition> 3 main +uscles ma'ing possible expansion in all direction
a. (ndo$etriu$  muscle layer for menses
o ?ines the non"pregnant uterus
o @olumes the non pregnant uterus
o Decidua slouching o$ of endometrium during menstruation
o (ndo$etriosis
 Actopic Andometrium
 9ommon site is ovaries
 (roliferation of abnormal gro-th of lining of outer part
 (ersistent dysmenorrhea, lo- bac' pain
 Dx Axam> biopsy,laparoscopy
 <x> ?upron BluprolideC  inhibits DSE F ?E
 <x> Dana3ol BDanacrineC D)9
1. 4nhibits ovulation
2. stop menstruation
b. +yo$etriu$
o (o-er of labor
o Smooth muscles is considered to be ?4@4,2 ?42A<=8A Bmuscles of delivery,
capable of closingC of the body
o ?argest portion of the uterus
c. %ere$etriu$
o (rotects the entire uterus
c. 6varies
• 2 female sex gland
• almond shape
• Dxn> )vulation,production of 2 hormonesB estrogen and progesteroneC
d. 'allopian .ube
• 2 3 inches long that serves as a passage-ay of the sperm from the uterus to the
ampulla or the passage-ay of the mature ovum or fertili3ed ovum from the ampulla to
the uterus
• # signi%cant segments
o nfundibulu$ most distal part, trumpet shape, has %mbrae
o #$pulla outer 3
rd
or 2
nd
half, site of fertili3ation, common site for ectopic
preg.
o st&$us site for sterili3ation, site for :<?
o nterstitial most dangerous site for ectopic pregnancy
b. +ale !eproductive "yste$
1. (xternal
• %enis
• <he male organ of copulation and urination
• 9ontains of a body or shaft consisting of 3 cylindrical layers and erectile tissues
o 2 corpora cavernosa
o 1 corpus spongiosum
• At the tip is the most sensitive area comparable to clitoris G glans penis
• "crotu$
• (ouch hanging belo- the pendulous penis, -ith medial septum deviding into 2 sacs each
containing testes
• 8eHuires 2 degrees celcius for continuous spermatogenesis
• 9ooling mechanism of testes
<. nternal
.&e %rocess of "per$atogenesis
.estes
BI77 coiled seminiferous tubulesC
↓
epididy$is
Bsite of maturation of sperm J mC
↓
)as Deferens
Bconduit path-ay of spermC
↓
"e$inal )esicle
Bsecreted> fructose form of glucose, nutritative value
%rostaglandin> causes reverse contraction of uterusC
↓
(4aculatory Duct
Bconduit of semesnC
↓
%rostate Gland
Brelease al'aline substancesC
↓
Co=pers Gland
Brelease al'aline substanceC
↓
/ret&ra
Eypothalamus 2,8E
↓
A(2
↓
'", maturation of sperm
3, testosterone production
3eydig Cells releases testosterone
+ale ? fe$ale ,o$ologues
+ale 'e$ale
(enile 2lans
(enile Shaft
<estes
(rostate
9o-per’s 2lands
Scrotum
9litoris
9litoral shaft
)varies
S'ene’s gland
:artholin’s 2land
?abia +a&ora
. Basic @no=ledge on Genetics and 6bstetrics
1. D9# Deoxyribonucleic Acid carries genetic code
2. C&ro$oso$es threadli'e structure of hereditary material 'no-n as the D,A
3. ,ormal amount of e&aculated sperm > – 5 cc* 1 teaspoon
#. )vum is capable of being fertili3ed -ithin <4 – >; &ours after ovulation.
5. "per$ 4A – B< days viability
J. 8eproductive cells divide by the process of +(6"" Bhaploid numberC
• "per$atogenesis process of maturation of sperm
• 6ogenesis process of maturation of ovum
o 37 -ee's A)2 J million immature ovum
o ! birth 1 million immature oocytes
o ! puberty 377 #77 immature oocytes
o ! 13 y1o 377 #77 mature oocytes
o ! 23 y1o 167 267 mature ovum
o ! 33 y1o J7 1J7 mature ovum
o ! 3J y1o 2# 12# mature ovum
o !#J y1o # mature ovum
• Ga$etogenesis process of formation of t-o haploid into diploid
B. #ge of reproductivity – 15 – 44 y*o c&ildbearing age – <: – >5 y*o
,ig& ris5  C1A ? D>5 y.o. 8it& !is5  1A – <:E >: – >5
A. +enstruation
• +enstrual Cycle beginning of menstruation to the beginning of the next menstruation
• Average menstrual cycle <A days
• Average menstrual period 5 days
• ,ormal blood loss 5: cc* F cup acco$panied by 'B!963G"" prevents clot formation
• 8elated terminologies
o +enarc&e 1
st
menstruation
o Dys$enorr&ea painful menstruation
o +etrorr&agia bleeding in bet-een menstruation
o +enorr&agia Axcessive bleeding during menstruation
o #$enorr&ea absence of menstruation
o +enopause cessation of menstruation BAverage Age" *1 y.o.C
 .ofu has isoKavone estrogen of plant that mimics the estrogen -ith a -oman
H. 'unctions of (strogen and %rogestin
• (".!6G(9 hormone of -oman
o (rimary function
 8esponsible for the development of secondary characteristics in females
 inhibit production of DSE
o )ther function
 Eypertrophy of the myometrium
 Spinnbar'eit and Derning (attern B:illings +ethodC
 Ductile structure of the breast
 )steoblastic bone activity Bcauses increased in heightC
 Aarly closure of the epiphysis of the bone
 Sodium retention
 4ncreased sexual desire
 8esponsible for vaginal lubrication
• %!6G(".(!69( Eormone of the mother
o (rimary function prepares the endometrium for implantation ma'ing it thic' and tortous
o Secondary Dunction inhibit uterine contractibility
o )thers
 4nhibit ?E Bhormone of ovulationC production
 ↓ 24 motility
 ↑ (ermeability of 'idneys to lactose and dextrose causing L 1 sugar in urine
 +ammary gland development
 ↑ ::<
 +ood s-ings
1:. +enstrual Cycle
# phases of menstrual cycle
1.%roliferative
<."ecretory
>.sc&e$ic
4.+enses
1. )n the initial phase of menstruation, the estrogen level is ↓, this level stimulates the hypothalamus to
release Gn!,* '",!'
2. 2n8E1 DSE8D stimulates the anterior pituitary gland to release '",
• '", 'unction
o Stimulate ovaries to release estrogen
o Dacilitate the gro-th of primary follicle to become
G!##'#9 '633C(  structure that secretes large amount of estrogen that
contain mature ovum
3. (roliferative (hase B↑estrogenC
Dollicular (hase responsible for the variation and irregularity of mense
(ostmenstrual (eriod after menstruation
(reovulatory (hase happen before menstruation
#. 13
th
day of menstruation, estrogen level is %(#@ -hile progesterone is ↓, these stimulates the
hypothalamus to release 2n8E1 ?E8D
*. Gn!,* 3,!' stimulates the Anterior (ituitary 2land to release 3,
• Dunctions of ?E
o Stimulates the release of progesterone
o Eormone for ovulation
J. 1#
th
day estrogen level is ↑ -hile progesterone level is ↑
• S1S
o 8upture of the graa%an follicle " )@=?A<4),
o +ittelsc&s$er7 slight abdominal pain lo-er right Huadrant
M. 1*
th
day, after ovulation day, graa%an follicle starts to degenerate, estrogen level ↓, progesterone ↑,
causing degeneration of the graa%an follicle becoming yello-insh 'no-n as C6!%/" 3/.(/+ secretes
large amount of progesterone
6. Secretory (hase
?utheal (hase -↑progesterone2
(ostovulatory phase
(remenstrual (hase
I. 2#
th
day Corpus #lbicans B-hitishC corpus luteum degenerates and becomes -hite
17. 26
th
day if no sperm united the ovum, the uterine begins to slough o$ to have the next menstruation
,ote>
• if there is no fertili3ation, corpus luteum continues functioning
• )varian 9ycle from primary follicle corpus albicans
• Stages>
o 1 * days menses
o J 1# proliferative
o 1* 2J secretory
o 2M 26 ischemic
11. Stages of Euman Sexual 8esponse
4nitial 8esponse>
@AS)9),2AS<4), constriction of blood vessels
+N)<),4A increased muscle tension
• (xcite$ent %&ase
• ↑ muscle tension, moderate @S
• erotic stimuli causing ↑ sexual tension, may last from minutes to hours
• %lateu %&ase
• ↑ and sustained tension near orgasm
• may last 37 sec 37 minutes
• 6rgas$
• 4nvoluntary release of sexual tension accompanied by physiologic and psychologic release,
• immeasurable pea' of experience 2 3 seconds
• !esolution
• 8eturn to normal state
• @S return to normal
!('!#C.6!G %(!6D only period present in male, -herein he cannot restimulated for about 17 1* minutes
). 8onders of 'ertili7ation
a. 'ertili7ation
1. %&onones song of sperm
2. Capacitation ability of sperm to release proteolytic en3yme and penetrate the ovum
b. "tages of 'etal Gro=t& and Develop$ent
1. %re ($bryonic "tage
. Iygote  fertili3ed ovum B3 # days travel, # days KoatingCO from fertili3ation
. +orula  mulberry"li'ed ball containing 1J *7 cells
. Blastocyst  enlarging cell forming a cavity that later becomes the embryo covered by thropoblast -hich later
becomes the placenta and membrane
). $plantation  M 17 days after fertili3ation
• <hropoblast covering of blastocyst that become placenta
• S1Sx of 4mplantation  Slight pain, Slight @aginal Spotting
• 3 (rocesses
o #pposition
o #d&esion
o nvasion
<. ($bryonic "tage
Iygote fertili3ation to 1# days
($bryo 1*
th
2 mos1 6 -ee's
'etus 2 mos to birth
c. Decidua thic'ened endometrium, latin -ord for .falling o$/
1. Basalis located directly under the fetus -here placenta developed
2. Caspularis encapsulates the fetus
3. )era remaining portion of and endometrium
d. C&orionic )illi 17 11 -ee's
1. C&orionic )illi "a$pling -C)"2 removal of tissue from the fetal postion of the developing
placenta
• Dor genetic screening
• Detal limb defects, missing digits of toes
e. Cytot&rop&oblast outer layer, 3#9G,#91" 3#G(!, protect the fetus against syphilis B2# -ee's1 J
monthsC
f. "ynsitiotrop&oblast syncitial layer responsible for hormone production
1. #$nion inner most layer 2. C&orion
. /$bilical cord -'unisC -hitish gray B*7 J7 cmC
• Short  abruptio placenta, uterine inversion
• ?ong  cord prolapse, cord coil
• 3 vessels BA@AC Artery @ein Artery
• 8&arton1s Jelly protects the umbilical cord
. #$niotic Kuid  bag of -ater  clear color, musty1mousy odor
• Pith crystalli3ed forming pattern, slightly al'aline
• *77" 1777 cc ,ormal
o )ligohydramnios 'idney malformation
o Eydramnios 24< , <AD1 <AA
• Dunctions
o 9ushion the fetus against sudden blo- or trauma
o +aintains temperature
o Dacilitate muscus'eletal development
o (revents cord compression
o Eelps in development process
Diagnostic .est for #$niotic 'luid  #$niocentesis
• (urpose> obtain sample of amniotic Kuid by inserting a needle hrough the abdomen into the amniotic sac
• Dluid is tested for>
• 2enetic screening
• Determination of fetal maturity primarily by evaluating factors indicative of lung maturity
• Done -ith empty bladder
• 9omplication
O +ost common side e$ect > 4,DA9<4),
O ?ate > pre term labor
O Aarly > spontaneous abortion
• 4ndication for Amniocentesis>
O Aarly in (regnancy Advance +aternal Age
O ?ater in (regnancy Diabetic +others
• ↑ " do-n syndrome
• ↓ " neural tube defect, spina be%da
• ?1S ratio > 2>1 B?ecitin1 SpingomyelinC
• De%nitive test G (hosphatiglycerol> (2 L  best Ans-er
• 2reenish +econium Stains BDetal DistressC
• Nello-ish &aundice, hyperbilirubinemia
• 9loudy 4nfection
• +ost 4mportant 9onsideration  ,eedle insertion site
• Amnioscopy direct examination through intact fetal membrane via ultrasound
• Dern <est a test determining if bag of -ater has rupture or not
• ,itra3ine (aper <est di$erentiate amniotic Kuid and urine :lue geen  L rupture of bag of E2)
2. C&orion outermost layer
a. %lacenta AQA Secundines  chorionic @illi and basalis
• (anca'e in latin
• *77 grams in -eight
• 1* 26 cotyledons
• 1* 27 cm in diameter and 2 3 cm in depth
• Dunctions
o 8espiratory  72 9)2 exchange via simple di$usion
o 24<  glucose transport via facilitated di$usion
o Axcretory  via 2 arteries, carries unoxygenated blood then detoxify
by maternal liver
o 9irculatory  fetoplacental circulation by SA?A9<4@A )S+)S4S
o Andocrine
 E92 primary maintain corpus luteum1 secondary basis of
pregnancy test
 Euman (lacental ?actogen a'a Somatomammothrophin
• 8esponsible for the development of mammary
gland
• Diabetogenic A$ect insulin antagonist
 8elaxin softening of maternal &oints and bones
o Serves as protective barrier against some microorganism
 9an pass> E4@ 9+@ 8ubella
 (4,)9N<)S4S transport of virus
(regnancy 2JJ 266 days1 3M #2 -ee's
'(.#3 ".#G(0 'etal Gro=t& and Develop$ent
'irst .ri$ester 0 %eriod of organogenesisL $ost critical period
'irst +ont&
',.L C9" DevelopsL G. and !espi .ract re$ains as single tube
Di$erentiation of (rimary 2erm ?ayer
• Andoderm
o <hyroid responsible for basal metabolism
o <hymus immunity
o ?iver
o 24<
o ?inings of =pper 24 <ract
• +esoderm
o Eeart
o +usculos'eletal
o 8eproductive )rgan
o Qidney
• Actoderm
o :rain
o 9,S
o S'in
o * senses
o Eair, nails
o Anus
o +outh
"econd +ont&
• ?ife span of corpus luteum ends
• All vital organs are formed
• (lacenta is developed
• Sex organ is developed
• +econium is present
.&ird +ont&
• (lacenta is complete
• Qidneys are functional
• Detus begins to s-allo- amniotic Kuid
• :uds of mil' appear
• Sex is distinguishable
• DE< audible via dopples ! 17 12 -ee's
.erratogens any drug or irradiation, the exposure to -hich may cause damage to the fetus
• D!/G"
o "trepto$ycin anti <: BHuinineC damage to the 6th cranial nerve  poor learning and deafness1
ototoxic
o .etracycline stoning the tooth enamel, inhibits long bone gro-th
o )ita$in @ hemolysis, destruction of 8:9, &aundice, hyperbilirubenemia
o odides enlargement of thyroid and goiter
o .&alido$ides anti"emetics  Amelia or (ocomelia  absence of distal part of extremities
o "teroids cleft lip or palate and even abortion
o 3it&iu$ congenital maformation
• #3C6,63 ?:P, fetal alcohol syndrome B characteri3ed by microcephalyC
• "+6@9G ?:P
• C#''(9( ?:P
• C6CC#9( ?:P, abruptio placenta
• .6!C, group of infections that can cross the placenta or ascend through the birth canal and adversely e$ect
fetal gro-th
o <oxoplasmosis cat lovers
o )thers " Eepa A:, E4@, Syphillis
o 8ubella 9ED,
 8ubella <iter , ! 1>17 or ↓ G immunity to rubella G notify doctor
 8ubella vaccine after delivery for 3 mos. ,o pregnancy for 3 mos.
o 9ytomegalo virus
o Eerpes Simplex virus
"econd .ri$ester 0 continuous gro=t& and develop$ent -focus  leng& of fetus2
'ourt& +ont&
• ?anugo begins to appear
• :uds of permanent teeth appear
• DE< audible via Detuscope ! 16 27 -ee's
'ift& +ont&
• ;uic'ening > 1
st
fetal movement (rimi> 16 27, ,ulli " 1J " 16
• ?anugo covers the body
• DE< audible via stethoscope or -1out instrument
• Actively s-allo- amniotic Kuid
• Detus > 1I 2* cm
"ixt& +ont&
• S'in is red and -rin'led
• @ernix caseosa covers the s'in
• Ayelids open
• Axhibits startle reKex
>
rd
.ri$ester 0 period of $ost rapid gro=t& and develop$ent 'ocus0 =eig&t
"event& +ont&
• Surfactant development
• +ale> the testes begins to descent into the scrotal sac
• Demale > clitoris is prominent and labia ma&ora are small doesn’t cover the minora
(ig&t +ont&
• Active moro reKex
• ?anugo begins to disappear
• Sub H fats deposits, steady -eight gain, nails to %ngers
9int& +ont&
• ?anugos and vernix caseosa is evident in body fold
• :irth position assumed
• Amniotic Kuid some-hat decrease
• Sole of the foot has fe- creases
.ent& +ont&
• :one ossi%cation in the fetal s'ull
• @ernix caseosa is evident in body
%,G"636GC #D#%.#.69 .6 %!(G9#9CG
"yste$ic C&anges
1. Cardiovascular "yste$
• ↑ blood volume 37 *7R
• 1*77 cc0 additional *77 cc for multiple pregnancy
• ↑ plasma volume
• ↑ cardiac -or'load easy fatigability1 slight ventricular hypertrophy
• Apistaxis due to hyperemia of nasal membrane
• (alpitation due to S,S stimulation
• %&ysiologic #ne$ia* pseudoane$ia in pregnacy
o ,ormal @alue
Ect > 32 #2R
Egb> 17.* 1# g1dl
o 9riteria
1
st
F 3
rd
<rimester > Ect O 33R Egb O 11 g1dl
2
nd
<rimester > Ect O 32R Egb O 17.* g1dl
o (athologic Anemia
 ron DeMciency #ne$ia is the most common hematologic disorder. 4t a$ects 27R
of pregnant -omen
 Assesment reveals>
• (allor
• Slo-ed capillary re%ll G ,ormal G 2 3 sec
• 9oncave %ngernails Blate sign of progressive anemiaC clubbing G chronic
tissue hypoxia
• constipation
 ,ursing care
• ,utritional instruction
o Source of iron
 Qang'ong
 ?iver G best source due to DA884D4, 9ontent
 8ed and lean meat
 2reen ?eafy @egetables
• (arenteral 4ron B4mferonC
o S tract 4+
o incorrect causes hematoma
o best given 1 hour before meals Bcauses 24 irritationC
o +aybe given 2 hours after meal Bresults to poor absorptionC
 2iven -ith orange &uice to ↑ absorption
• )ral 4ron Supplements Bferrous sulfate 7.3 g 3 x a dayC
• +onitor for hemorrhage
 Alert
• 4ron from red meat is better absorbed iron from other sources
• 4ron is better absorbed -hen ta'en -ith foods high in @itamin 9 such as
orange &uice
• Eigher iron inta'e is recommended since circulating blood volume is
increased and heme is reHuired from production of 8:9s
• (de$a
o 4mpeded venous return due to the gravid uterus
o ,ursing 4ntervention
 Alevate legs above the hips level
• )aricosities
o Pear support stoc'ings
o Alevate legs
• )ulvar )aricosities
o D1t pressure of gravid uterus
o Side lying -ith pillo- under the hips
o +odi%ed 'nee chest position
• .&ro$bop&lebitis
o (resence of thrombus in inKamed blood vessels
o L Eoman’s Sign pain on the calf upon dorsiKexion
o +edical +anagement
 Anticoagulant1 EA(A84,
• Does not cross the placental barrier
• +onitor A(<<
• Antidote> (8)<A+4,A S=?DA<A
• ,o aspirin
• +il5 3eg* %lag$asia #lba Dolens
o Shiny -hite legs due to stretching of s'in F hyper%brinogenemia
o ,ursing intervention
 9hec' dorsalis pedis pulse Bcompare bothC
 ,ever massage
 Assess for Eoman’s sign only once
<. !espiratory "yste$
• Shortness of :reath d1t gravid uterus
• ,ursing intervention> Side"lying lateral expansion of the lungs
>. Gastrointestinal "yste$
• 9ausea and vo$iting
• +orning "ic5ness
o Due to ↑ E92 levels
o 9rac'ers 37 min before arising
o A+ 9arb diet 37 mins
o (+ small freHuent meal
• Constipation
o Due to (8)2AS<A8),A G ↑ Kuid reabsorption due to ↓ 24< motility
o ,ursing intervention
• ↑ Dluid
• ↑ Diber
• Axercise
• 'latulence
o Due to increased progesterone
o Avoid gas forming foods
• ,eartburn -pyrosis2
o 8eKux of stomach content into esophagus
o ,ursing 4ntervention
• Small freHuent meals
• Sips of mil'
• Avoid fatty and spicy foods
• (roper body mechanics
o Paist #bove Acid
o Paist Belo- :ase
• ,e$orr&oids
o Due to gravid uterus
o Eot sit3 bath for comfort
• %tyalis$
o ↑ salivation
o +outh-ashes to relieve
4. /rinary "yste$
• ,ormal G L 1 sugar due to (rogesterone via :A,AD49<’S <AS<
• Dirst <rimester " DreHuency
• Second <rimester " normal
• <hird <rimester " DreHuency
5. +uscolos5eletal
• 9alcium sources
o +il' " ↑ 9a ↑ ( 1 pint1 day or 3 # servings1 day
o 9heese, Nogurt, Eead of Dish, Sardines, Anchovies, :rocolli
• 3ordosis
o (ride of (regnacy
• 8addling Gait
o A-'-ard gait -hile -al'ing due to relaxin
o (rone to accidental falls
 Pear lo- healed shoes
• 3eg Cra$ps
o 9a ( 4mbalance during pregnancy
o ?umbo"sacral nerves by pressure of gravid uterus during labor
o )ver sex
o DorsiKex the foot a$ected
o 3"# servings1 # cups1day sa mil', sardines, dilis
1. 3ocal C&nages
• )agina
o C&ad=ic51s "ign – bluish discoloration
o 3eu5orr&ea – -hitish gray, moderate in amount, mousy odor
• Cervix
o Goodel1s "ign – change in consistency of uterus
o 6perculu$ mucus plug to seal bacteria1 progesterone
• /terus
o ,egar1s "ign – change in consistency
@agina 9had-ic'’s
9ervix 2oodel’s
=terus Eegar’s
Problems related to the changes of Vaginal Environment
a. )aginitis N #)6C#D6
• <richomonas @aginalis
o Dlagellated protox3oan, ?oves ala'aline environment
• Signs and Symptoms
o 2reenish, cream, colored, frothy, irritably itchy, foul smelling vaginal discharge
o @aginal edema
• +anagement
o Drug of choice> +A<8),4DAS)?A BDlagylC
 Antiproto3oan
 9arcinogenic
 ,ot given in 1
st
trimester
• vaginal douche as substitue
o 1 Ht Pater G 1 tbsp -hite vinegar
o <reat partner as -ell to prevent reinfection
o ,o alcohol due to antabuse e$ect
b. +oniliasis N C,(("(
• 9andida Albicans
• <ransvaginal transfer in fetus )ral <rush
• Signs and Symptoms
o Phite 9heeseli'e patches that adheres to the -alls of the vagina
• +anagement
o Antifungals
 +ycostatin
 9ontrima3ole 9anisten
 2entian @iolet
1. #bdo$inal C&anges
• Striae 2ravidarum
o Due to destruction of the subcutaneous tissue by the enlarge uterus
<. "5in C&anges
• +elasma1 9hloasma
o Phite light bro-n pigmentation related to ↑ melanocytes
• ?inea ,igra
o :ro-n pin'ish line from symphysis pubis to umbilicus
>. Breast C&anges
• Due to hormonal changes
• 9hange in color and si3e of nipple and areola
• (recolostrum J -ee's
• 9olustrum 3
rd
trimester
• Supine -ith pillo- under the bac'
4. 6varies – rest periodL no ovulation
5. "igns and "y$pto$s of %regnancy
%resu$ptive
S1sx felt and observed by the
mother but does not con%rm the
diagnosis of pregnancy
%robable
Signs observed by the
members of the health
care team
%ositive
=ndeniable signs con%rmed by
the use of instrument
Dirst trimester Breast changes
/rinary changes
'atigue
#menorrhea
+orning sic'ness
(nlarge uterus
Goodel’s sign
Chad-ic'’s sign
,egar’s sign
(levated ::<
%ositive E92
/ltrasound Avidence
Second
<rimester
Chloasma
3inea ,igra
ncrease S'in (igmentation
"triae gravidarum
Quic'ening
Ballotement
(nlarge Abdomen
Braxton Eic's
9ontraction

etal Eeart <one
etal movement
etal outline
etal parts palpable
CBQ Cancer of t&e Breast  Ouadrant B
+amography 3* and above  11 year
:allotement  bouncing of the fetus
 may be present in uterine myoma
<ransvaginal =ltrasound empty bladder
Abdoiminal ulrasound full bladder
%lacenta Grading "yste$
• 2rade 7 immature
• 2rade 1 slightly mature
• 2rade 2 moderately mature
• 2rade 3 fully mature
• Phat is depositedT  calcium
). %syc&ological #daptation to %regnancy – !eva !ubin
'irst .ri$ester
• ,o tangible s1sx
• Deeling of surprise
• Ambivalence
• Denial of pregnancy  maladaptation
• Developmental <as'> Accept biological facts of pregnancy
• Eealth <eaching> :ody changes of pregnancy and ,utrition
"econd .ri$ester
• <angible s1sx
• +other identi%es fetus as separate entity due to Huic'ening
• Dantasy
• Developmental <as'> Accept gro-ing fetus as a baby to nurture
• Eealth <eaching> 2ro-th and development of fetus
.&ird .ri$ester
• +other has personally identi%es -ith the appearance of the baby
• Developmental <as'> (repare child birth and parenting the child
• Eealth <eaching> responsible parenthood, prepare baby’s layette, ?ama3e 9lass
• Address +other’s fear  let she hear the DE<
). %re – 9atal )isit
Basic Consideration
1. 'reOuency of )isit
• 1 M
th
mos.  once a month
• 6 I
th
mos.  t-ice per month
• 17
th
month  every -ee'
<. %ersonal Data
• ,o$e Based +ot&er1s !ecord* ,B+!  determines high ris' pregnancy
• %seudocyesis  false pregnancy  appearance of presumptive F probable signs
• Co$ade "yndro$e  psycosomatic disorder, father experience -hat the mother goes through
>. Diagnosis of %regnancy
• =rine Axam E92  #7 177
th
day0 pea' J7 M7
th
day
• A?4SA  beta subunits of E92 is detected as early as M 17
th
day
• 84A  beta subunits of E92 is detected as early as 6
th
day
• Eome (regnancy Qit
4. Baseline Data
• 8oll )ver <est  test of pre"eclampsia by the use of :(
• Peight monitoring
,ormal Peight 2ain
1
st
<rimester G 1.* 3 lbs  1 lb1 mo
2
nd
<rimester G 17 12 lbs  # lbs1mo
3
rd
<rimester G 17 12 lbs  # lbs1mo
+inimum allo-able -eight gain  27 2* lbs
)ptimal -eight gain  2* 3* lbs
5. 6bstetrical Data
a. Gravida  no. of pregnancy
b. %ara  no. of viable pregnancy
)iability  the ability of the fetus to live outside the uterus at the earliest possible gestational age
1 abortion 1 3I
<E
Pee', 1 miscarriage, 1 still birth, 1 2
nd
mo. preg
1 pregnancy 3
rd
mos. 2#(2 2# <1 (1 A1 ?1
22(7 22 <7 (7 A1 ?7
c. $portant (sti$ates
1. ,agele’s 8ule
• =se to determine expected date of delivery
• Uan +ar  LI months LM days
• Apr Dec  "3 months LM days L 1 year
<. +cDonald1s !ule
• Determines age of gestation in -ee's
• Dundic Eeight x M16 G A)2 in -ee's
>. Bart&olo$e=1s !ule
• Determines age of gestations
o 3 mos above pubis symphysis
o * mos level of umbilicus
o I mos belo- xiphoid process
o 17 mos level of 6
th
mos
4. ,aases !ule
• Determines the length of fetus in cm.
• 1
st
half  sHuare each month
• 2
nd
half  month x *
d. .etanus $$uni7ation
• <<1 anytime or early during pregnancy
• <<2 1 month after <<1  3 years protection
• <<3 J months after <<2 * years of protection
• <<# 1 year after <<3  17 years of protection
• <<* 1 year after <<#  lifetime protection
5. %&ysical (xa$inations
a.Danger "igns of %regnancy
Chills F Dever
Cerebral Disturbances
#bdominal (ain  epigastric pain  auro of impending convulsion
Boardli'e Abdomen  Abruptio placenta
Blurred @ission  pre eclampsia
Bleeding  abortion1 ectopic pregnancy 1
st
trimester
 E +ole1 4ncompetent 9ervix 2
nd
trimester
 (lacental Anomalies 3
rd
<rimester
B( V
"-elling
"cotoma spots in the eye
"udden gush of Kuid (8)+ premature rupture of membrane
;. %elvic (xa$ination
 (elvic examination or 4A empty bladder, precaution
 1st visit 9had-ic's, 2oodle’s sign, etc.
 (osition > dorsal recumbent, lithotomy
 (ap smear done 1st visit
 9ytological exam determine presence of cancer cells.
 8esult >
o 9lass 4 normal
o 9lass 44 A cytology -ithout evidence of malignancy
: suggestive of inKammation
o 9lass 444 cytology suggestive of malignancy
o 9lass 4@ cytology suggestive og malignancy
o 9lass @ conclusive for malignancy
 +ost common cancer report organ > cervical cancer
 +ost common site for pap smear external )S of cervix BsHuamocolumnar tissueC
 9ommon site of cervical cancer. maternal speculum BopenC
 "tages of cervical cancer
o 7 carcinoma in situ
o 1 9a strictly con%ned to cervix
o 2 from cervix extends to the vagina
o 3 pelvic metastasis
o # a$ectation to bladder F rectum
B. 3eopolds +aneuver
 %urpose0 Done to determine the attitude, fetal presentation, lie, presenting part, degree of descent an estimate
of the si3e, and no. of fetuses
 (rocedure
1. 1
st
maneuver
o place patient in supine position -ith 'nees slightly Kexed. (ut to-el under head and right hip. Pith both
hands palpate uppe#r abdomen and fundus. Assess si3e, shape, movement and %rmness of the part
o determine the presenting parts>
2. 2
nd
maneuver
o -ith both hands moving do-n, identify the bac' of the fetus -here the ball of the stethoscope is placed
to determine DE<.
o %! of $ot&er 0 uterine souPQ – +,!
o fundic souPQ – ',!
3. 3
rd
maneuver
o using the right hand, grasp the symphysis pubis part using the thumb and %ngers.
o Assess -hether the presenting part is engaged in the pelvis.
o AlertW 4f the head is engaged it -ill not be movable
#. #
th
maneuver
o the examiner changes the position by facing the patient’s feet. Pith t-o hands, assess the descent of
the presenting part by locating the cephalic prominence or bro-.
o Phen the bro- is on the same side as the bac', the head is extended. Phen the bro- is on the same
side as the small parts, the head 6is Kexed and vertex presenting.
 #ttitude relationship of fetus to one another.
 'ull 'lexion -hen the chin touches the chest
A. #ssess$ent of 'etal 8ellNbeing
a.Daily fetal +ove$ent Counting -D'+C2
 Done starting 2M
th
-ee'
 9onsideration
 fetal sleep -a'e pattern
 maternal food inta'e
 drug"nicotine use
 environmental stimuli
 maternal dose
 CardiR count to 1: $et&od – one method currently available
o begin at the same time each day Busually in the morning after brea'fast C and count each fetal
movement, noting ho- long it ta'es to count 17 fetal movements BD+sC
o expected %ndings 17 movements in 1hrs or less
o -arning signs 17"12 movements in 1hr or less
 more than 1hr to reach 17 movements
 less than 17 movements in 12hrs
 longer time to reach 17 D+s than on previous days.
 movements are becoming -ea'er, less vigorous
 movement alarm signal X3 D+s in 12hrs
o -arning signs should be reported to healthcare provider immediately0 often reHuire further
testing. Ag. ,on stress test B,S<C, biophysical pro%le B:((C
b.9onstress .est
o to determine the response of the fetal heart rate to the stress to activity.
o 4ndications pregnancies at ris' for
o placental insuYciency
o (ostmaturity
• pregnancy induced hypertension B(4EC, diabetes
• -arning signs noted during DD+9
• maternal history of smo'ing, inadeHuate nutrition
o (rocedure >
• Done -ithin 37mins -herein the mother is in semifo-lers position0 external monitor is applied
to document fetal activity0 mother activates the .mar' button/ on the electronic monitor -hen
she feels fetal movement. Attach external noninvasive fetal monitors
• tocotransducer over fundus to detect uterine contractions and fetal movements BD+sC
• ultrasound transducer over abdominal site -here most distinct fetal heart sounds are detected
• monitor until at least 2 D+s are detected in 27mins.
o if no D+ after #7mins provide -omen -ith a light snac' or gently stimulate fetus through abdomen
o 4f no D+ after 1hr further testing may be indicated, such as a 9S<
o 8esult >
• ,oncreative ,onstress ,ot 2ood
• 8eactive 8esponse is 8eal 2ood
o 4nterpretation of results
• 8eactive result real good
 baseline DE8 bet-een traction beteen 127 and 1J7 beats per min.
 at least t-o accelerations of the DE8 of at least 1* beats per min., lasting at least 1*secs
in a 17 to 27 min period as a result of D+
 good variability normal irregularity of cardiac rhythm representing a balanced
interaction bet-een the parasympathetic BZ DE8C and sympathetic BV DE8C nervous
system0 noted as an uneven line on the rhythm strip
 result indicates a healthy fetus -ith an intact nervous system
o 9onreactive result – not good
 stated criteria for a reative result are not met
 could be indicative of a compromised fetus reHuires further evaluation -ith another ,S<,
biophysical pro%le, B:((C or contraction stress test B9S<C
H. ,ealt& .eac&ings
o do nutritional assessment
o daily food inta'e
o determine habit
o if Z folic acid lead to spina bi%da1open neural tube defect
o ,G, !"@ +6.,(!"
• pregnant teenagers poor compliance to health regimen
• extremes in -t under-t eg. Alite models over-t eg. D+1E(,
• lo- social economic status. 8efer to )SPD
• vegetarian mothers because Z inta'e of vit :12 B9yanocobalaminC formation of folic acid Bcell
D,A F 8,A formationC
• types >
 strict vegetarian prone to develop anemia
 lacto vegetarian mil'
 lacto"ovo vegetarian mil' F egg
a. !eco$$ended 9utrient !eOuire$ent t&at ncreases During %regnancy
9utrients !eOuire$ents 'ood sources
Calories
Assential to supply energy for
• V metabolic rate
• =tili3ation of nutrients
• (rotein sparing so it can be used
for >
o gro-th of fetus
odevelopment of structures
reHuires for pregnancy
including placenta,
amniotic Kuid, tissue
gro-th
377 calories1day above the
prepregnancy daily reHuirement to
maintain ideal body -eight and meet
energy reHuirement of activity level
begin V in 2
nd
<rimester
use -t"gain pattern as an
indication of adeHuacy of calories
inta'e
failure to meet caloric
reHuirements can lead to 'etosis as
fat F protein are used for energy,
'etosis has been associated -ith
fetal damage.
,on pregnant> 2277 calories
(regnant> 2*77 calories
2277L*77 ! lactationG2M77 cal
9aloric V should reKect
foods of high nutrient value such
as protein, complex carbohydrates
B-hole grains, vegetables, fruitsC
variety of foods representing food
sources for the nutrients reHuired
during pregnancy
no more than 37R fat
,a 3gms1day eat in moderation
9E), x #Q 9al
9E) x #Q 9al
Dats x IQ 9al
%rotein
Assential for
• fetal tissue gro-th
• maternal tissue gro-th including
uterus and breasts.
• Development of essential
pregnancy structures
• Dormation of 8:9 and plasma
proteins
4nadeHuate protein inta'e has been
J7mg1day or an V of 17R above daily
reHuirements for age group
Adolescents have a higher protein
reHuirement than mature -omen since
adolescents must supply protein for
their o-n gro-th as -ell as protein to
meet the pregnancy reHuirement
(rotein V should reKect
?ean meat, poultry, %sh
Aggs, cheese, mil'
Dried beans, lentils, nuts
Phole grains
@egetarians must ta'e note of the
amino acid content of 9E), foods
consumed to ensure ingestion of
suYcient Huantities of all amino acids
associated -ith onset of pregnancy
induced hypertension B(4EC
Calciu$N%&osp&orous
Assential for
• 2ro-th and development of fetal
s'eleton and tooth buds
• +aintenance of minerali3ation of
maternal bones and teeth
• 9urrent research is demonstrating
an association bet-een adeHuate
calcium inta'e and the prevention
of pregnancy induced
hypertension
9alcium V of
• 1277mg1day representing an V of
*7R above pre pregnancy daily
reHuirement
• 1J77mg1day is recommended for
adolescent
• 17mcg1day of vitamin D is reHuired
since it enhances absorption of both
calcium and phosphorous
9alcium V should reKect
Dairy products, mil', yogurt, ice
cream, cheese, egg yol'
Phole grain, tofu
2reen leafy vegetables
9anned salmon F sardines -ith
bones
9a forti%ed foods such as orange
&uice
@itamin D sources forti%ed mil',
margarine, egg yol', butter, liver,
seafood
ron
Assential for
Axpansion of blood volume F 8:9
formation
Astablishment of fetal iron stores
for %rst fe- months of life
,on (regnat>1*mg1day
(regnant > 37mg1day
- representing a doubling of the
prepregnant daily
reHuirement
• :egin supplementation at
37mg1day in second trimester,
since diet alone is unable to meet
pregnancy reHuirement
• J7 127mg1day along -ith copper
and 3inc supplementation for
-omen -ho have lo- Egb values
prior to pregnancy or -ho have iron
de%ciency anemia
• M7mg1day of vitamin 9 -hich
enhances iron absortion
o 4nadeHuate iron inta'e results
in maternal e$ects anemia,
depletion of iron stores, Z
energy and appetite, cardiac
stress especially during labor F
birth
o fetal e$ects Z availability of
oxygen thereby a$ecting fetal
gro-th
• iron de%ciency anemia is the most
common nutritional disorder of
pregnancy
4ron V should reKect
• liver, red meat, %sh, poultry, eggs
• enriched, -hole grain cereals F
breads
• dar' green leafy vegetables,
legumes
• nuts, dries fruits
• vitamin 9 sources> citrus fruits F
&uices, stra-berries, cantaloupe,
tomatoes, green peppers, broccoli
or cabbage, potatoes
• iron form food sources is more
readily absorbed -hen served -ith
foods high in vit 9
Iinc
Assential for
• the formation of en3ymes
• maybe be important in the
prevention of congenital
malformation of the fetus
1* g1day representing an V of
3mg1day over prepregnant daily
reHuirement
Sinc V should reKect
liver, meats
shell %sh
V grains, legumes, nuts
'olic acidsL folacinL folate
Assential for
• Dormation of 8:9 F prevention of
anemia
• D,A synthesis F cell formation0
may play a role in the prevention
of neural tube defects Bspina
bi%daC, abortion, abruption
placenta
#77mcg1day representing an V of
more than 2x the daily prepregnant
reHuirement
377mcg1day supplement for -omen
-ith lo- folate levels or dietary
de%ciency
V should reKect
• ?iver. Qidney, lean bee', veal
• Dar', green leafy vegetables,
broccoli, asparagus, articho'es,
legumes
• Phole grains, preanuts
Additional reHuirements
+inerals
4odine
+agnesium
selenium
1M*mcg1day
327mg1day
J*mcg1day
V reHuirements of pregnancy can
easily be met -ith a balanced diet that
meets the reHuirement for calories and
includes food sources high in the other
nutrients needed during pregnancy
@itamins
A
<hiamine
8iboKavin
(yridoxine B:JC
:12
,iacin
17mg1day
1.*mg1day
1.Jmg1day
2.2mg1day
2.2mcg1day
1Mmg1day
b. "exual #ctivity
• %rinciples of sex in %regnancy
o Should be done in moderation
o Should be done in a private place
o <hat the mother should be placed in a comfortable position
o 4t must be avoided J -ee's prior to ADD
o Avoid blo-ing of air during cunnilingus
• Contraindication in sex0
o vaginal spotting 1
st
tri
o incompetent cervix 2
nd
tri
o placenta previa, abruption placenta 3
rd
tri
o pre"term labor 8> prostaglandin oxytocin contraction
o (8)+ infection
• C&anges in sexual appetite during pregnancy0
o 1
st
tri " Z
o 2
nd
tri " V
o 3
rd
tri " Z
c. (xercise
• strengthen muscle to be used during the delivery process
• 8al5ing best form of exercise
• "Ouatting strengthen perineum F Vcirculation to the perineum Braise the buttoc's before head to prevent
postural hypotensionC
• .ailor sitting same purpose -ith sHuatting
• @egel exercise strengthen pubococcygeal muscle
• #bdo$inal exercise muscle of the abdomen B done as if blo-ing a candleC
• "&oulder circling exercise strengthen muscle of the chest
• %elvic roc5ing exercise or pelvic tilt relieve lo- bac' pain F maintain good posture Barching bac' for 3 secC
• %rinciples of exercise
o must be done in moderation
o must be individuali3ed
d. C&ildbirt& %reparation
• 6verall goal0 <o prepare patents physically F psychologically -hile promoting -ellness behavior that can be used
by parents F family thus, helping them achieved a satisfying F en&oying childbirth experiences.
• %syc&ological
o Bradley +et&od Dr. 8obert :radley discoverer
 advocated active participation of husband during labor F delivery to serve as coach, based on
.imitation of nature/
 Deatures>
• dar'ened room
• Huiet F calm environment
• relaxation techniHue
• close eyes
o Grantly Dic5 !ead +et&od
 fear can lead to tension -hile tension can lead to pain. Bbrea' cycle by removing the fear"by
abdominal breathing exercises F relaxation techniHueC
• %syc&osexual
o @it7inger +et&od Dr. Shiella Qit3inger
 pregnancy, labor F birth F the care of the ne-born is an important turning point in a -oman’s
life cycle. .Ko-ing -ith contractions rather than struggle -ith contractions/
• %syc&oprop&ylaxis
o 3a$a7e Dr. Derdinand ?ama3e
 (revention of pain thru mind F reHuires discipline, conditioning F concentration -ith the
husband’s help.
 Deatures>
• conscious relaxation
• cleansing breathe inhaling thru nose F exhaling thru mouth
• e[eurage gentle circular massage
• over abdomen to relieve pain
• imaging
• DiRerent $et&ods of delivery
o birt&ing c&ain semi"fo-lers mother
o bat&ing bed dorsal recumbent
o sOuatting position relieve on bac' pain F maintain good posture
o 3eboyer1s $et&od
 features >
• dar'ly lighted room
• Huiet F calm environment
• room temp.
• soft music
o Birt& under =ater
S. 9.!#%#!.#3 96.("
#. #d$itting t&e laboring +ot&er
• (ersonal data
• :aseline data
• )bstetrical data
• (hysical exams
• (elvic exams
B. Basic 5no=ledge in intrapartu$
• .&eories of t&e 6nset of 3abor
o /terine "tretc& .&eory any hollo- organ once stretched to its maximum potential -ill al-ays
contract F expel its content
o 6xytocin .&eory released by ((2, contraction e$ect
o %rostaglandin .&eory stimulation by Arachidonic acid, causes contraction of uterus
o #ging %lacenta #2-'s BlifespanC by 3J-'s placenta begins to degenerate causes contraction
o %rogesterone deprivation t&eory " Z level of progesterone -ill facilitate contraction of the uterus
• .&e 4 %s of 3abor
o %assenger fetus
 fetal head
• is the largest presenting part
• \ of its length
• :ones J bones Bsphenoid, temporal, ethmoidC Drontal, occipital F 2 parietal bones
• "utures*inter$e$branous spaces allo-s molding
• +olding the overlapping of the sutures of the s'ull to permit passage of the head to
the pelvis
o "agittal bones connect to parietal bones
o Cororontal bones connect to parietal F frontal bones
o 3a$bdoidal bones connect to parietal F occipital bones
• 'ontanels
o J fontanels only 2 palpable
 anterior fontanel*Breg$a
• diamond in shape
• 3cm x #cm si3e
• close 12"16 mos post delivery
• V *cm hydrocephalus
 posterior fontanel*la$bda
• triangular in shape
• 1 x 1cm si3e
• close 2"3mos post delivery
• +easure$ents of fetal &ead 0
o transverse dia$eter
 BiNparietal " largest transverse diameter" I.2*cm
 BiNte$poral " 6cm
 BiN$astoid " smallest transverse diameter " Mcm
o #% dia$eter
 "uboccipitobreg$atic complete Kexion
 6ccipitofrontal partial Kexion " 12cm
 6ccipitote$poral largest A( diameter0 hyperextended B13.*cmC
 "ub$entobrg$atic " face presentation0 poor Kexio
o %assage=ay vagina F pelvis
 %elvis
• # main pelvic types
o gynecoid round, -ide, deeper, most suitable for pregnancy
o android heart shape .male pelvis/ anterior pointed post part shallo-
o #nt&ropoid oval .ape"li'e pelvis. A( -ider transverse narro-
o %latypelloid Kat transverse oval A( narro- transverse -ider c1s for
delivery
• (roblem >
o mother -ho encounter accident
o Z #’I/
o Z 16y1o 8> pelvis not achieve its full pelvic gro-th
 Bones of pelvis
• 4bones
o < &ips B2 innominate bonesC
 3parts of 2 innominate bones
• leu$ lateral1side of hips
o 4liac crest Karing superior border that forms
prominence of hips0 common site for bone marro-
aspiration
• sc&iu$ inferior portion
o 4schial tuberosities of the area -here -e
o Sit0 basis in getting external measurement of
pelvis
• %ubis anterior portion
o Symphysis pubis &unction in bet-een
o sacru$ posterior portion
 Sacral prominence basis internal measurement of pelvis
o 1 coccyx " # small bones that compresses during vaginal delivery
• universal precaution in measurement of pelvis is to empty bladder %rst
• 4mportant +easurements
o Diagonal Con4ugate
 measure bet-een Sacral promontory F inferior margin of the
symphysis pubis
 +easurement 11.*"12.* cm
 :asis in getting the true con&ugate.
o .rue Con4ugate*Con4ugate )era
 +easure bet-een the anterior surface of the sacral promontory F
superior margin of the symphysis pubis.
 +easurement> 11.7 cm
 Diagonal con&ugate> 1.* cm G true con&ugate.
o 6bstetrical Con4ugate
 smallest A( diameter of the pelvis measuring 17cm or more.
o .uberoisc&ii Dia$eter
 transverse diameter of the pelvic outlet.
 Approx by a %st" 6cm F above.
o %o=er
 the forces acting to expel the fetus F placenta
• involuntary contractions
• voluntary bearing do-n e$orts
• characteristics> -ave li'e
• timing> freHuency, duration, intensity
 $yo$etriu$ po-er of labor
o %syc&e*person
 psychological stress exist -hen the mother is %ghting the labor experience.
• cultural interpretation preparation
• past experience
• support system
• %reNe$inent signs of labor
o (reeminent Signs
 lig&tening
• settling of the presenting part into the pelvis brim Bshooting pain radiating to the legs,
urinary freHuencyC
• primi" early 2 -ee's prior to ADD
• engagement settling of presenting part into pelvic inlet Bnot signs of laborC
 Braxton ,ic5s Contractions painless irregular contractions
 ncrease #ctivity of t&e +ot&er ,esting
• 4nstinct Bmgt> save energyC
• epinephrine production Bhormone that V the activity of the motherC
 !ipening of t&e cervix butter softness
 Decrease in =eig&t 1.*"3 lbs.
 Bloody s&o=
• pin'ish vaginal discharge Bblood L leucorrhea L operculum G pin' in colorC
 !upture of $e$branes
• chec' DE<
• 4A chec' for cord prolapse
• after several hrs chec' temp.
o %re$ature !upture of +e$branes -%!6+2
 contraction drop in intensity even though very painful
 contraction drop in freHuency
 uterus tense F1or contracting bet-een contractions
 abdominal palpitations
 9ursing Care0
• administer analgesics BmorphineC
• attempt manual rotation for 8)( or ?)(
• bear do-n -ith contractions
• adeHuate hydration
• sedation as ordered
• cesarean delivery may be reHuired, especially if fetal distress is noted
o Cord %rolapse
 a complication -hen the umbilical cord falls or is -ashed through the cervix into the vagina.
 Danger "igns0
• (8)+
• (resenting part has not yet engaged
• Detal distress
• (rotruding cord from vagina cerebral palsy V * mins., irreversible brain damage
mgt> 9S
 9ursing Care
• (ositioning 'nee chest or trendelenberg, place -et sterile gau3e 8> to ma'e it
slippery
• )bserve for fetal distress
• (rovide emotional support
• (repare for cesarean section
• DiRerence Bet=een .rue and 'alse Contraction
<rue Dalse
• ,o in intensity
• (ain con%ned in the abdomen
• (ain is relieved by -al'ing
• ,o cervical changes
•
• <here is an in intensity
• (ain begins ! the lo-er bac' to
abdomen
• (ain is intensi%ed by -al'ing 9ervical
e$acement Bthinning of the cervix,
measured thru RC F dilatation
B-idening of the cervix, measurement
thru cmC ]best1ma&or sign of true labor
• Duration of 3abor
o %ri$ipara 1# hrs but not more than 127 hrs
o +ultipara 6 hrs but not more than 1# hrs
• 9ursing nterventions in (ac& "tage of 3abor
o 'irst "tage> onset of contractions to full dilatation F e$acement of the cervix
o stage of e$acement F dilatation
 3atent %&ase0
• Assessment>
o Dilatations 7"3 cm
o DreHuency *"17 mins
o Duration 27"#7 mins
o 4ntensity mild
o +other is excited, apprehensive but can communicate
• ,ursing 9are>
o Ancourage -al'ing > shortens 1
st
stage of labor
o Ancourage to void H 2"3 hrs > full bladder inhibits uterine contraction
o breathing Bchest breathing techniHueC
 #ctive %&ase0
• Assessment>
o Dilatations #"6 cm
o DreHuency H 3"* mins lasting for 37"J7 secs
o Duration 37"J7 secs
o 4ntensity moderate
• 9ursing Care0
o + edications have meds ready
o # ssessment include> v1s, cervical dilatation F e$acement, fetal monitor, etc
o D ry lips oral care BointmentC, dry linens
o :reathing abdominal breathing
 .ransitional %&ase0
• #ssess$ent0
o Dilatations 6"17cm
o DreHuency H 2"3 mins contractions
o Duration #*"I7 sec
o 4ntensity strong
o +ood of mother suddenly change accompanied by hyperesthesia
Bhypersensitivity of mother to touchC of the s'in
• +anage$ent
o sacral pressure, cold compress
• 9ursing care0
o . tires
o inform of progress Bto relieve emotional supportC
o ! restless support her breathing techniHue
o ( encourage F praise
o D discomfort
o %elvic (xa$s
 (Race$ent ? Dilatation
• "tation relationship of the presenting part to the ischial spine
o * " "1 G the presenting part is above the ischial spine
o Angagement 17 G the presenting part is in line -ith the ischial spine
o B"C fetus is Koating
o BLC belo- the ischial spine
• %resentation
o the relationship of the long axis of the fetus to the long axis of the mother.
o spine relationship of the spine of the mother F the spine of the fetus
o <-o <ypes
 3ongitudinal 3ie -%arallel2* )ertical
• Cep&alic -hen the fetus is completely Kexed
o @ertex
o Dace
o :ro-
o 9hin
• Breec&
o Co$plete breec& thigh rest on abdomen -hile
legs rest on thigh
o nco$plete breec&
 'ran5 thigh resting on abdomen -hile
legs extend to the head
 'ootling
 @neeling
 .ransverse 3ie -%erpendicular2*,ori7ontal lie
• %osition relationship of the fetal presenting part to
speci%c Huadrant of the mother’s pelvis.
o !6#*36#
 left occipito anterior
 most common F favorable position
o !6.*36. left occipito transverse
o !6%*36% left occipito posterior
o 3*!" side of maternal pelvis
o +iddle presenting part
o !6%*!6. most common malposition
o !6%*36% most painful mgt> pelvis sHuatting
o Breec& sacro
 place the stethoscope above the
umbilicus
o C&in mentum
o "&oulder acromnio dorso
 +onitoring t&e contractions ? fetal &eart tone
• spread the %nger lightly over the fundus to monitor the contraction
• ncre$ent*Cresendro " beginning of contraction until it increases
• #pex*#cne height of contraction
• Decre$ent*Decresendro from height of contraction until it decreases
• Duration beginning of contraction to the end of the same contraction
• nterval from end of contraction to the beginning of the next contraction
• 'reOuency from the beginning of 1 contraction to the beginning of next contraction
• 4ntensity strength of contraction
• if contract blood vessel constricts0 the fetus -ill get the oxygen on the placenta
reserve -hich is capable of giving oxygen to the fetus up to 1min.
• Duration of placenta to the fetus should not exceed 1min.
• Signi%cance During active phase, if V to 1min should notify the A+D
• V :(0 Z DE< > best time to get :) F DE< &ust after a contraction
9/!"9G C69"D(!#.69 D/!9G .,( '!". ".#G( 6' 3#B6!
 :ath is necessary
 +onitor @S especially :(
o Same :( G rest
o Alevated G notify the physician
 ,()
o (revent aspiration  chemical pneuminitis
 Anema Bper hospital policyC
o (urpose
 9leanse the bo-el
 (revent infection
o 12 16 inches normal length of tube
o 16 inches optimal length
o ?ateral sims position
o 4f there is contraction  clump the tube
o 4f there is resistance  slo-ly remove
o :efore and after administration> chec' DE< B127 1J7C and contractions
 Ancourage mother to void
 (erennial preparation Brule of MC
 8est on left side lying position
o (revent supine vena cava syndrome or supine hypotension
 4f membrane doesn’t rupture  amniotomy
 '(.#3 .!#",9G " hyperactivity of fetus due to lac' of )xygen
 Dor (ain
o Systemic analgesic
 D(+(!63 -+eperidine ,Cl2
• ,arcotic and antispasmonic
• Don’t give during latent phase
• 2iven ! J"6 cm dilated
• 86' > !espiratory depression
• ,arcan B,aloxone, nalorfan, nallineC
o Antidote for toxicity
o 4n&ected on the baby
 (pidural #nest&esia
• 86' > ,ypotension
• (rehydrate the client to prevent hypotension
• 4n case of Eypotension
o Alevate leg
o Dast Drip 4@
"(C69D ".#G( 6' 3#B6! -'(.#3 ".#G(2
 9omplete dilatation and e$acement to birth
 9ro-ning occurs
 (84+4 transfer to D8 ! 17 cm dilatation
 +=?<4 transfer to D8 ! M 6 cm dilatation
 (osition in lithotomy both legs at the same time
 B/3G9G 6' %(!(9/+  surest sign of delivery initiation
 (A,< F :?)P :reathing, fetal pushing should be done on an open glottis
 !espiratory al5alosis
o Due to incorrect breathing
o Eyperventilation
o S1sx
 ↑ 88
 ?ightheadedness
 <ingling sensation
 9arpopedal spasm
 9ircumoral numbness
(pisioto$y
 (revent laceration
 Piden the vaginal canal
 Shortens the 2
nd
stage of labor
 2 types
o +(D#9
 ?ess bleeding
 ?ess pain
 Aasy repair
 (ossible urethroanal %stula  ma&or disadvantage
o +(D63#.(!#3
 +ore bleeding
 +ore pain
 Eard to repair and slo- healing
 roning t&e %ereniu$  prevent laceration
+ec&anis$ of 3abor -(D '!( (!(2
 (ngagement
 Descent
 'lexion
 nternal !otation
 (xtension
 (xternal !otation
 (xpulsion
%(3)"
 > %arts
o nlet A( diameter narro-, transverse -ider
o Cavity bet-een inner and outer
o 6utlet A( diameter -ider, transverse narro-
 39(# .(!+9#3("
9ursing Care
 +6D'(D !G(91" +#9(/)(!
o Done by supporting the perenium -ith a to-el during delivery
o Dacilitates complete Kexion
o Avoids laceration
 Dirst intervention> Support the head and suction secretion
 Do not mil' the cord, -ait for pulsation to stop before cutting
o +il'ing may cause too much blood going to the baby that may cause cardiac overload
 Phen there is still birth, let the mother see the baby to accept the %nality of death
.,!D ".#G( 6' 3#B6! -%3#C(9.#3 ".#G(2
 3 17 minutes after child birth
 1
st
sign  Dundus rises  C#3@91" "G9
 "igns of %lacental "eparation
o Dundus becomes globular and rises  cal5in1s sign
o ?engthening of the cord
o Sudden gush of blood
 B!#9. – #9D!(81" +#9(/)(!
o slo-ly pulling the cord and -ind at the clamp
o rapidly  may cause uterine inversion
.ypes %lacental Delivery
 ",/3.I B"hinyC
o Drom center to the edges
o (resenting fetal side
 D/9C#9 BDirtyC
o Dorm edges to center
o (resenting the maternal side
9ursing Considerations during placental delivery
 9hec' placental completeness
o Should be *77 g
 9hec' Dundus +assage if :oggy
 :( 9hec'
 +ethergine, methylergonovine mallate B4+C
 )xytocin B4@C if methergine is not present
 9hec' perenium for lacerations
 Assist in episioraphy
 @aginoplasty1 @aginal ?andscape @irgin again
'6/!. ".#G( 6' 3#B6! -!ecovery "tage2
 Dirst 1 2 hours after delivery of placenta
 +aternal observation body system stabili3e
o 1
st
hour H1* min 2
nd
hour " H 37 min
 (lacement of fundus
o 4n bet-een umbilicus and pubis symphysis
o 9hec' bladder, assist in voiding, +ay lead to uterine atony  hemorrhage
 ?ochia
 (erineum
o 9hec' !((D#
 ! edness
 ( dema
 ( cchymosis
 D ischarge
 # pproximation
o Dully saturated 37 #7 cc
o 8eig&ing – 1 cc T 1 gra$ Co$$on Board Question
9ursing Consideration during !ecovery
 Dlat on bed to prevent di33iness
 4f -ith 9hills  give blan'et due to dehydration
 2ive nourishment Bprogression of mealC
o 9lear liHuids gatorade, ginger &uice, gelatins
o Dull liHuid mil', ice cream
o Soft diet
o 8egular diet
 9hec' @S* (ain
 (ychic State
 Bonding interaction bet-een mother and ne-born
o Strict 2# hours -ith mother
o (artial morning -ith mother, night nursery
C6+%3C#.69" 6' 3#B6!
Dystocia
 DiYcult labor related to mechanical factor
 (rimary cause is =terine 4nertia
/terine nertia
 Sluggishness of contraction
 <ypes
o %ri$ary* ,ypertonic
 4ntense contraction resulting to ine$ective pushing
 +anagement > Sedation
o "econdary* ,ypotonic
 Slo-, irregular contraction resulting to ine$ective pushing
 +anagement > )xytocin Augmentation
%rolonged 3abor
 O 27 E for primi
 O 1# E for multi
 proper pushing should be encourage if inappropriate>
o may cause fetal distress
o caput succedaneum
o cephalhematoma
o maternal exhaustion
 monitor contractions and DE<
%recipitate 3abor
 labor less than 3 hours
 causes excessive laceration leading to profuse bleeding  hypovolemic shoc'
 s1sx of hypovolemic shoc' ,G%6 .#C,G .#C,G
o ,G%6tension
o .#C,Gpnea
o .#C,Gcardia
o 9old clammy s'in
o +anage$ent
 +odi%ed trendelenburg
 Dast Drip 4@
nversion of /terus
 Situation in -hich uterus is turn inside out due to>
o Short cord
o Eurrying of placental delivery
o 4ne$ective fundal push
 9ause profuse bleeding  hypovolemic
 ,ysterecto$y
/terine !upture
 8upture of uterus
 Caused by
o (revious classical 9S
o @ery large baby
o 4mproper use of oxytocin
 "*sx
o Sudden pain
o (rofuse bleeding
 (repare fore <AE:S)
%&ysiologic !etraction !ing  boundary bet-een upper and lo-er uterine segment
Bandl1s%at&ologic !ing  suprapubic depression sign of uterine rupture
#$niotic 'luid* %lacental ($bolis$
 Anaphylactic syndrome of pregnancy
 Situation in -hich placental fragment and amniotic Kuid enters maternal circulation
 "*"x
o Dyspnea
o 9hest (ain
o Drothy Sputum
o And Stage D49
 (repare for 9(8, Suction and emergency etc
.rial 3abor
 Detal head measurement G measurement of pelvis
 J hours labor allo-ance given to mother
 monitor DE< and contractions
%reter$ 3abor
 labor after 27 -ee's and before 3M -ee's
 .riad signs
o (remature conditions every 17 minuets
o A$acement of J7 67R
o Dilatation of 2 3 cm
 ,o$e +anage$ent
o 9:8
o Avoid Sex
o Ampty bladder
o Drin' 3 # 2lasses of E2)
 Dull bladder inhibit contraction
 ,ospital +anage$ent
o 4f 9ervix 9lose -Criteria0 cervix is closed if it is < – > c$ dilated only2
 2 3 cm dilated, pregnancy can be saved
 .ocolytic .&erapy
• Gutupar -!itodine ,Cl2
o Side e$ect maternal :( X I71J7
o 9hec' 4mpt. (resence of crac'les
• Bret&ine -terbutaline2 Bricanyl
o D6C
o Side e$ect> sustained tachycardia
o Antidote> propanolol1 inderal
• +g "64
o f cervix is dilated - D 4c$2
 2ive steroid dexa$et&asone
• (romote surfactant maturation
• 4mmediately cut the cord after delivery to prevent &aundice1 hyperbilirubinemia
%6".%#!.#3 %(!6D
%uerperiu$ *
th
stage of labor, 1
st
J -ee's post partum
9haracteri3e by involution
nvolution " return to the normal stage of reproductive organ after pregnancy
!eturn to 9or$al ,ealing
%&ysiologic C&anges
"yste$ic C&anges
 Cardiovascular "yste$
o ↑plasma volume
o sudden ↓ in blood volume
o elevated P:9’s up to 37, 777 mm3
o hyper%brinogenemia
o orthostatic hypertension can be possible
o early ambulation prevents thrombos formation
 steps in ambulation
• Dlat
• Semifo-lers
• Do-lers -ith dangling
• Pal' -ith assist
 Genital .ract
o 'undus
 goes do-n 1 %nger breadth a day
 17
th
day non palpable behind the symphysis pubis
 "ubinvolution
• delayed healing of uterus containing Huarters or clots of blood
• may lead to puerperal sepsis
• +anage$ent 0 DF9
o #fter %ains
 After birth pains
 +ultiparous breastfeeding most common to develop
 (osition G prone
 9old compress
 +efenamic acid
o 3oc&ia
 9omponents
• :lood
• Deciduas
• P:9
• +icroorg
 3 types
• !ubra 1 3 days, musty, moderate amount
• "erosa # 17
th
day, pin' or bro-n
• #lba 17 21th day, cr^me -hite, ↓ amount
 /rinary .ract
o /rinary 'reOuency due to urinary retention -ith overKo-
o Dysuria
 Damage to trigone of the bladder
 =rine collection for culture and sensitivity
 Stimulate navel to urinate
 (alpate bladder
 8unning -ater listening
 (ull pubic hair " stimulate cremasteric reKex
 Colon
o Constipation
 Due to ,()
 :earing do-n may cause pain
 %ereniu$
o (ain relieved by sim’s position
o 9old compress 1
st
2# hours if there is pain at episioraphy follo-ed by -arm
(+6.69#3 "/%%6!.
1. .a5ing p&ase
• 1
st
3 days
• dependent phase
• passive, can’t ma'e decision
• tells about childbirth experience
• focus on> Eygiene
<. .a5ing ,old
• # M
th
day
• dependent to independent phase
• active, decides actively
• focus> care of ne-born
• health teaching > Damily planning
>. 3etting Go
• 4nterdependent phase
• 8ede%nes goals, ne- roles as parents
• +ay extend till the child gro-s
%ost %artu$ Blues
• #
th
*
th
days
• over-helming feeling of depression, inability of sleep and lac' of appetite
• *7 67R incidence rate
• cause by sudden hormaonal change progesterone suddenly decreases
• allo- crying> therapeutic
• may lead to postpartum psychosis1 depression
%ostpartal Co$plications
,e$orr&age
 bleeding -ithin 2# hours postpartum
(arly %ospartal ,e$orr&age
1. /terine #tony
 boggy fundus
 profuse bleeding
 interventions
o massage the uterus
o cold compress
o modi%ed trendelenburg
o fast drip 4@
o breastfeeding to release oxytocin
<. 3aceration
 -ell contracted uterus -ith profuse bleeding
 assess perenium for laceration
 degrees of laceration
o 1
st
degree vaginal s'in and mucus membrane
o 2
nd
degree 1
st
degree L muscles
o 3
rd
degree 2
nd
degree L external sphincter of rectum
o #
th
degree 3
rd
degree L mucus membrane of rectum
>. ,e$ato$a
 bluish discoloration of sub; tissues of vagina or perenium
 candidates
o delivery of very large babies
o pudendal bloc'
o excessive manipulation due to excessive 4A
 intervention
o cold compress 17 27 min then allo- 37 minutes rest period for 2# h
4. DC – disse$inated intravascular coagulation
 9onsumption of pregnancy BothertermC
 Dailure to coagulate
 :leeding in the eyes, ears, nose
 )o3ing blood
 Seen in cases -ith
o Abruptio placenta
o Still birth 1 4=DD
 +anage$ent
o :lood transfusion of cryoprecipitate or fresh fro3en plasma
o hysterectomy
3ate %ostpartu$ ,e$orr&age
!etained placental frag$ents
 manual extraction of fragments is done
 uterine massage
 D?C except for cases of
o %lacenta #creta umusual attachment of the placenta to the myometrium
o %lacenta ncreta deeper attachment of placemat to the myometrium
o %lacenta %ercreta invasion of placenta to the perimetrium
 9andidates of these disorders are
• 2rand multiparous
• (ost 9S
 All these reHuires hysterectomy
nfection
 "ources
o Andogenous from normal Kora of the body
o Axogenous from the health care team
 +ost common Anaerobic Streptococci
 +anage$ent
o Supportive care
o ↑ Dluid inta'e
o <S: if there is fever1 cold compress L paracetamol may also be given
o Analgesics
 2iven on time to achieve maximum e$ect
o 9ulture and sensitivity
%erenial nfection
 Same s1 sx -ith infection
 2 3 stitches are dislodges
 -ith purulent drainage
 <x resuturing
(ndo$etritis
 4nKammation of the endometrium
 2en s1sx of infection L abdominal tenderness
 +anage$ent
o Eigh fo-ler’s facilitates drainage F locali3e infection
o Administer oxytocin
'#+3G %3#999G +(.,6D
Guiding %rinciples
1. determine your o-n beliefs %rst
2. never advise a permanent method of family planning
3. informed concent
#. the method is an individual decision
9atural +et&od accepted by the church
:illing’s1 9ervical +ucus1 Spinnbar'eit
• clear -atery F stretchable
• 13
th
day longest due to estrogen
:asal :ody <emp in the morning before arising1 13
th
1#
th
day due to pea' of progesterone
?A+ ?actational Amenorrhea +ethod
 prolactin inhibits ovulation
 breastfeeding # J months no menstrual cycle
 bottle fed 2 3 months
Sympthothermal combination of :illings and ::< most e$ective method
"ocial +et&ods
Coitus nteruptus
 -ithdra-al
 least e$ective method
Coitus !eservatus
 sex -1o e&aculation
Coitus interfe$ora
 bet-een femor
Calendar +et&od
 1# days before menstrual cycle ovulation day BregularC
 " #, L # days unsafe period
6rigo5nause 'or$ula - irregular $enstrual cycle2
 get the longest and shortest cycle
 subtract 16 to shortest
 11 to the longest
 the di$erence is the unsafe period
%33"
 combined oral contraceptives preventovulation by inhibiting the anterior pituitary gland roduction of DSE and ?E
-hich are essential for he maturation and rupture of a follicle.
 Astrogen inhibit DSE -hich is responsible in the mturation of ovum. (rogesterone inhibit ?E -hich is responsible
for ovulation.
 contains estrogen that inhibits DSE and progesterone that inhibit ?E
 II.IR e$ective
 21 day feel on the *
th
day of mense start ta'ing
 26 day 1
st
day of mense
 if forgotten, ta'e 2 tablets the follo-ing day
 adverse e$ect > brea'through bleeding
 if mother -ants to get pregnant
o -ait 3 monts
o another 3 months if unsuucessful before consulting gyne
 contraindications
o chain smo'ing
o Eypertension
o D+
o Axtreme obesity
o <hrombophlebitis
 "ide eRects -resse$bles ,ypertension2* $$ediate Discontinuation
o #bdominal paon
o Chest pain
o ,eadache
o (ye problem
o "evere leg cramp
 Alerts on oral contraceptives >
o 4n case a +other -ho is ta'ing an oral contraceptive for almost a long time and plans to have a baby,
she -ould -ait for at least 3mos before attempting to conceive to provide time for estrogen and
progesterone levels to return to normal. 4f after Jmonths the mother did not get pregnant, consult A+D.
o 4f a ne- oral contraceptive is prescribed, the mother should continue ta'ing the previously prescribed
contraceptive and begin ta'ing the ne- one on the %rst day of the next menses.
o Discontinue oral contraceptive if there is signs of severe headache as this are an indication of
hypertension associated -ith increase incidence of 9@A and subarachnoid hemorrhage.
o 4f forget to drin' pill for 1 day, ta'e 2 pills the next day. 4f forget to drin' pills for 2days, stop the pill and
-ait for the next mens.
 #dverse reaction 0 brea5t&roug& bleeding
D+%# – Depoprovera
 9ontains progesterone
 Depomedroxy progesterone Acetate
 4+ H 3 months never massage the site  may decrease e$ectiveness
96!%3#9.
 J match stic' li'e capsules1 rod
 contain progesterone
 sub ; planted
 good for * years
+ec&anical Device
/D
 prevent implantation
 alters mobility of sperm and ovum
 II.MR e$ective
 best inserted after delivery and during menstruation
 Co$$on co$plication A_9ASS4@A +A,S<8=A? D?)P
 Co$$on proble$ A_(=?S4), )D <EA DA@49A
 ,o protection against S<D
 "ide eRects include
o =terine infection
o =terine perforation
o Actopic pregnacy
 +a&or indication for the use is (A84<N
 ,.0 monthly chec' up and regular pap smear
C69D6+
 +ade up of latex
 (ut in erected penis or lubricated vagina
 (revents sperm to enter the uterus
 DA+A?A 9),D)+ higher protection than that of male
D#%!#G,+
 Dome shaped rubberied material inserted at the cervix to prevent sperm getting inside the uterus
 8eusable
 ,. 0 (roper hygiene
o 9hec' for holes
o +ust be re%tted in case of -eight gain of 1* lbs " " board Huestion
o Qept in place for about J"6 Eours :oard Huestion
 Contraindicated to
o DreHuent =<4
C(!)C#3 C#%
 +ore durable than the diaphram
 9ould stay on place for more than 2# hours
 ,o need to apply spermicides
 Contraindicated to abnormal papsmear
C,(+C#3
"%(!+CD("
 D)A+S most e$ective
 Uellies
 9reams
 <hese may cause toxic shoc' syndrome
"/!GC#3 +(.,6D
 Bilateral tubal 3igation
o ! isthmus
o 27R probability of reversal
 )asecto$y
o @as deferens is cut
o +ore than 37 x or 7 sperm count or 2 x negative sperm count before it could be consider safe sex
,G, !"@ %!(G9#9CG
,(+6!!,#GC D"6!D(!"
General $anage$ent
 9:8
 Avoid sex
 (repare ultrasound determine the sac integrity
 Assess bleeding and approximation
 Assess hypovolemia
 Save discharge for histopathology
o Determine -hether the product of labor has been expelled
'irst .ri$ester Bleeding
#bortion termination of labor before age of viability
 "%69.#9(6/"
o AQA miscarriage
o Causes
1. 9hromosomal aberrations due to advanced maternal age
2. :lighted ovum
3. germ plasm defect
o ,atures -ay of expelling defective babies
o Classifcations 0
1. .&reatened
• pregnancy is &eopardi3ed by bleeding and cramping but the cervix is closed and can be
saved.
<. nevitable
• moderate bleeding, cramping, tissue protrudes from the cervix and the cervix is open.
o .ypes 0
1. Co$plete
• all products of conception are expelled.
• +gt > emotional support
2. nco$plete
• placenta and membranes retained.
• +gt > DF9
 ,#B./#3
o 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix.
o +anage$ent Bsuture of cervixC
1. +cDonald procedure
• <emporary circlage
• Side e$ect infection
• +ay have ,SD
<. "&irod5ar
• 9S delivery
 +""(D
o fetus dies0 product of conception remain in uterus # -ee's or longer
o signs of pregnancy cease
1. B"C pregnancy test
2. Dar' bro-n
3. Scanty bleeding
o +gt > induction of labor1 vacuum extraction
 9D/C(D
o <herapeutic abortion  principle of 2 fold e$ect
1. Done -hen mother has class # heart disease
(ctopic %regnancy
• occurs -hen gestation is location outside the uterine cavity
• 9ommon site > Ampulla or <ubal
• Dangerous site> 4nterstitial
/nruptured !uptured
• +issed period
• Abdominal pain -ithin 3" *-'s of missed
period Bmaybe generali3ed of one sidedC
• Scant, dar' bro-n vaginal bleeding
• @ague discomfort
• sudden, sharp severe unilateral pain, 'nife
li'e
• shoulder pain Bindicative of intraperitoneal
bleeding that extends to diaphragm F
phrenic nerveC
• BLC 9ullen’s sign bluish tinged umbilicus
• syncope1fainting
• ,ursing 9are >
o vital signs
o administer 4@ Kuids
o monitor for vaginal bleeding
o monitor 4F)
o prepare for culdocentesis to determine
o hemoperitoneum
• +gt > non"surgical +ethotrexate
"(C69D .!+(".(! B3((D9G
,ydatidifor$ +ole * Ubunc& of grapesV
• 2estational <rophoblastic Disease progressive degeneration of 9horionic @illi
• gestational anomaly of the placenta consisting of a bunch of clear vesicles. <his neoplasm is formed from the
s-elling of the chronic villi and lost nucleus of the fertili3ed egg. <he nucleus of the sperm duplicates, producing a
diploid number #Jxx. 4t gro-s and enlarges the uterus very rapidly.
• Cause > =n'no-n
• #ssess$ent 0
o (arly signs
 vesicles passed thru the vagina
 Eyperemesis gravidarum due to V E92
 Dundal height
 @aginal bleeding Bscant or profuseC
o (arly in pregnancy
 high levels of E92
 (re ecclampsia at about 12-'s
 @esicles loo' li'e a .sno-storm/ on sonogram
 Anemia
 Abdominal cramping
o "erious late co$plications
 Eyperthyroidism
 (ulmonary embolus
• 9ursing care 0
o prepare for DF9
o do not give oxytocin drugs due to proneness to embolism
o Eealth <eaching>
 return for pelvic exams as scheduled for one year to monitor E92 and assess for enlarged
uterus and rising titer could be indicative of choriocarcinoma
 Avoid pregnancy for at least one year
 +ethotrexate therapy
nco$petent Cervix +anage$ent0
• +cDonald procedure
o temporary circlage of incompetent cervix.
o Delivery > ,S@D
o SA> infection
o Eealth teaching
 observe for signs of infection
 signs of labor
• Shhirod'ar procedure
o permanent procedure.
o Delivery > caesarian section reHuired.
.,!D .!+(".(! B3((D9G U%3#C(9.#3 #96+#3("V
%lacenta %revia
• it occurs -hen the placenta is improperly implanted in the lo-er uterine segment, sometime covering the cervical
os.
• #ssess$ent
o )utstanding sign > fran', bright red, painless bleeding
o enlargement Busually has not occurredC
o fetal distress
o abnormal presentation
• 9ursing care 0
o 4nitial mgt > ,() candidate for 9S
o :edrest
o prepare to induce labor if cervix is ripe
o administer 4@
o ,o 4A, ,o Sex, ,o enema complication > Sudden fetal blood loss
o prepare +other for double set up D8 is converted to )8
#bruptio %lacenta
• it is the premature separation of the placenta from the implantation site.
• 4t usually occurs after the t-entieth -ee' of pregnancy
• 9ause>
o 9ocaine user
o Severe (4E
o Accident
• Assessment>
o )utstanding sign > dar' red F painful bleeding
o concealed hemorrhage BretroplacentalC
o couvelaire uterus Bcaused by bleeding into the myometriumC B"C contraction
o rigid boardli'e abdomen
o severe abdominal pain
o dropping coagulation factor Ba potential for D49C
o sx > bleeding to any part of the body. +gt > for hysterectomy
• 2eneral ,ursing care >
o infuse 4@, prepare to administer blood
• type and crossmatch
o monitor DE8
o insert Doley catheter
o measure bllod loss0 count pads
o report s1s of D49
o monitor v1s for shoc'
o strict 4F)
%lacental "uccenturiata 1 or 2 lobes connected to the placenta by a blood vessel
%lacenta Bipartita placenta divided into 2 lobes
,G%(!.(9")( D"6!D(!
%regnancy nduced ,ypertension
o E(, after 2#-'s resolved J-'s postpartum -hich cause pregnancy.
o <ypes >
o 2estational E(,
 E(, -ithout edema F proteinuria.
 +gt > monitor :(
o (re"eclampsia triad
o sx > E(, -ith edema, proteinuria or albuminuria BEA(1AC -hich cause is un'no-n or idiopathic but
multifactoral
 primis d1t 1st exposure to chorionic villi
 multiple pregnancies due to V exposure to chorionic villi
 +others of lo- socio"economic status due to Z protein inta'e
 <eenagers d1t lo- compliance to protein inta'e
o EA??( syndrome hemolysis -ith elevated liver en3ymes F lo- platelet count
.ransitional ,ypertension E(, bet-een 27"2#-'s
C&ronic or %reNexisting ,ypertension
o E(, before the 27th -' not resolved J-'s postpartum
o 3 types of pre"eclampsia
o Sign of pre"eclampsia >
o O 37mmEg systolic
o O 1*mmEg diastolic
o 8oll over test
 17"1*min side lying
 <hen supine
 <hen ta'e :(
o mild pre"ecclampsia
 1#71I7mmEg, -1 L1 )2, L2 proteinuria Aarly signs > V -t, inability to -ear -edding ring due to
developing edema
 Signs present
• cerebral F visual disturbances, epigastric pain to liver edema and oliguria usually
indicates an impending convulsion
• :efore convulsion > if you see sign of epigastric pain, 1` mgt is to place tongue
depressor and put the side rales up
• During convulsion > observe the +other for safety
• After convulsion turn to side to facilitate drainage
o Severe pre"ecclampsia
 1J71117, L3 or L#, proteinuria, visual disturbances
 ,ursing care
 % promote bedrest
 %revent convulsions by nursing measures
• to V )2 demand F facilitate ,a excretion
• +anagement> Huiet F calm environment, minimal handling, avoid moving the bed
• Eeat Acetic Acid determine protein in the urine
• (repare the follo-ing at bedside
o tongue depressor, Suction machine F )2 tan'
 ( ensure high protein inta'e B1g1'g1dayC
• ,a in moderation
 # antihypertensive drug -ith hydralu3ine
 C 9,S depressant -ith +g Sulfate for anti"convulsion
• +gt > evaluate for hypermagnesiumenimia
 ( evaluate physical parameters for +agnesium Sulfate toxicity >
• B :( Z
• / =rine output Z
• ! 88 Z
• % (atellar reKex is absent
• Antidote > 9a gluconate
o Aclampsia -ith sei3ure
 V :=, sign of glumerular damage
Diabetes +ellitus
o cause by absent F lac' of 4nsulin
o Action of 4nsulin is to facilitate transfer of glucose into the cell
o Dx test > *7gm 1hr 2lucose <olerance <est
o V 137 hyperglycemia
o Z M7 hypoglycemia
o 67"127 euglycemia
o if O 137mg1dl, the +other needs to undergo a 3hr 2<<
o +aternal A$ects >
o hypoglycemia during the 1st trimester development of the brain sinisipsip ng fetus yung glucose ng
nanay.
o Eyperglycemia during the 2nd F 3rd trimester
 E(? e$ect +gt > give insulin. )EA are teratogenic.
 1st trimester " Z insulin, 2nd trimester " V insulin, post partum drop suddenly
 DreHuent infections eg. +oniliasis
 (olyhydramnios
 Dystocia
o Detal A$ects >
o hypoglycemia during the 1st trimester and Eyperglycemia during the 2nd F 3rd trimester thru facilitated
di$usion
o +acrosomia1?2A .#777gms
o 4=28 due to prolonged D+
o (reterm birth promote still birth
o ,e-born A$ects >
o Eyperinsulinism and Eypoglycemia
 #7mg1dl
 ,ormal > #*"**mg1dl
 :orderline > #7mg1dl
 Sx > V pitched shrill cry, tremors, &itteriness
 Dx test > heel stic' test to chec' glucose levels
o Eypocalcemia
 X Mmg1dl
 9alcemic tetany
 <x > 9a gluconate
,eart Disease
o 9lassi%cation >
o 4 no limitation
o 44 Slight limitation, ordinary activity causes fatigue
 good prognosis can deliver vaginally
 +gt > sleep of 17hrs1day, rest 37mins after meals
o 444 moderate limitation, less than ordinary activity causes discomfort
 poor prognosis. 2ood for vaginal delivery
 +gt > early hospitali3ation by M"6mos
o 4@ mar'ed limitation of physical activity for even at rest there is fatigue
 poor prognosis. 2ood for vaginal delivery only -ith regional anesthesia.
 ?o- forceps delivery -hen unable to push F to shorten the stage of labor
 +gt >
• therapeutic abortion, high semi" fo-lers position, left side lying, no valsalva maneuver
" may trigger cardiac arrest, heparin therapy reHuired, antibiotic therapy for prevention
of sub acute bacterial endocarditis
9.!#%#!.#3 C6+%3C#.69"
Cesarean Delivery
• 4ndications
a. multiple gestation
b. diabetes
c. active herpes 44
d. severe toxemia
e. placental previa
f. abruption placenta
g. prolapse of the cord
h. cephalo pelvic disproportion and primary indication
i. breech presentation
&. transverse lie
• procedure 0
o classical vertical incision
o lo- segment .bi'ini/, for aesthetic purposes. 9an have vaginal birth after c1s
Genotype – genetic ma'e"up
%&enotype – (hysical appearance
@aryotype – pictorial analysis of individual chromosome for detecting chromosomal abnormalities
#utoso$al Do$inant
• huntington’s chorea
• retinoblastoma
• achondroplasia
• polydactyl
#utoso$al !ecessive
• sic'le cell
• 9ystic %brosis
• 9eliac
• (Q=
• 2alactosemia
SN 3in5ed !ecessive
• Eemophilia
• Duchenne’s muscular dystrophy
• 9olor blindness
S – 3in5ed Do$inant
• 8ic'ette’s