Lecture Notes

Published on February 2017 | Categories: Documents | Downloads: 89 | Comments: 0 | Views: 1515
of 198
Download PDF   Embed   Report

Comments

Content


!"#$%!& ''' ()*+"#) !,+)$

+,-%* -.&)
!"#$%&" ' ()$&*+%#$,*) $* -.$"&),$/ 0%&1,)2 3
!"#$%&" 3 4)#*567,#.$"+ !.8*& 9 :"7,;"&/ '<
!"#$%&" = >).72"1,. 9 >)"1$?"1,. =@
!"#$%&" @ 0%&1,)2 ,) $?" 0*&5.7 A%"&6"&,%5 @'
!"#$%&" B 0%&1,)2 C.&" *D $?" 0*&5.7 0"E8*&) B=
!"#$%&" F G,2? H,1I 0"E8*&) FJ
!"#$%&" K 4)#*567,#.$"+ A&"2).)#/ LL
!"#$%&" L M"$.7 >11"115")$ 9 A&"2).)#/ .$ H,1I '<K
!"#$%&" J A&"2).)#/ .$ H,1I N3 '3J
!"#$%&" '< C*567,#.$,*)1 *D !.8*& 9 :"7,;"&/ '@<
!"#$%&" '' C*567,#.$,*)1 *D $?" A%"&6"&,%5 'BL
!"#$%&" '3 :,1*&+"&1 *D $?" M"5.7" 9 -.7" H"6&*+%#$,;" 'FL
O/1$"5
!"#$%&" '= ()D"&$,7,$/ 9 P")"$,#1 'J<
!
1
CSM Maternity Nursing
Lecture 1


I. Intro to Maternity Nursing
A. Role of the Perinatal Nurse
I. The Registered Nurse

c. Sccpe cf nur:ing prccIice ceIerminec Ly:
-Cc|if SIcIe Nur:ing FrccIice /cI-8FN
-CcmmuniIy :Icnccrc:
-Fc|icy cnc Frccecure cf fcci|iIy
-JC/HC-JcinI Ccmmi::icn cn /ccreciIcIicn
cf Hec|Ihccre CrgcnizcIicn:
-DepI. cf Hec|Ih Service:

L. Nur:e: he|c |egc||y re:pcn:iL|e fcr prccIicing
wiIhin :ccpe cf prccIice

c. Specic|Iy CrgcnizcIicn: AWHONN
-/::ccicIicn cf Wcmen´: Hec|Ih,
CL:IeIric:, cnc NecncIc| Nur:e:

c. CrienIcIicn Fericc/Specic|izcIicn
-LcLcr cnc De|ivery
-Nur:ery/Leve| ll N:y/NlCU
-Fc:IpcrIum/McIher-8cLy-¦ :ince 1ºº0´:
-Cccc:icnc| prcL|em: wiIh
ccmprehen:ive ccre-IerriIcric|
-Difference: in cpinicn: |ecc Ic pI
ccnfu:icn

II. Expanding roles in Perinatal Nurses

c. Nur:e FrccIiIicner:
-Definec Ly /N/ c:: prcvice
ccmprehen:ive hec|Ih c::e::menI:,
ceIermine cicgnc:e:
p|cn/pre:criLe IrecImenI
mcncge hec|Ihccre regimen:
fcr Ihe incivicuc|, fcmi|ie:, cnc Ihe
ccmmuniIy
-ln 1ºó0´:, :hcrIcge cf MD´: |ecc Ic
1
"
2
crecIicn cf Ihe FNF
-Mcy prcvice fcmi|y ccre cr :pecic|ize
-Icke pcrI in c cerIificcIe prcgrcm cr
Mc:Ier´: Degree prcgrcm
-Neec cI cerIificcIicn fcr Ihirc-pcrIy
reimLur:emenI
-Fe¢uire: cccumenIcIicn cf ccnIinuec
ecuccIicn cnc prccIice

L. C|inicc| Nur:e Specic|i:I:
-Definec Ly /N/: C|inicc| experI whc
prcvice: cirecI pI ccre :ervice:
--hec|Ih c::e::menI:
--hec|Ih prcmcIicn
--prevenIcIive inIervenIicn:
-MSN
-ExperIi:e in p|cnning, :upervi:ing, cnc
ce|ivery cf nur:ing ccre Ic fcmi|ie: in
chi|cLecring pericc
-Cc:e mcncger:
-Ccn:u|IcnI
-Fcmi|y cnc :Icff ecuccIcr
-CccrcincIicn cf ce|ivery cf nur:ing ccre
Ic fcmi|ie: re¢uiring inIen:ive nur:ing
:uppcrI
-Fe:ecrch ccIiviIie:/crIic|e:
-Mcy wcrk :pecificc||y wiIh high ri:k pI:
-IrcciIicnc||y wcrkec in hc:piIc|: LuI ncw
fcunc in nur:ing hcme:, :chcc|:, hcme
ccre :eIIing: cnc hc:pice.

c. CerIifiec Nur:e Micwife
-Definec Ly /CNM: incepencenI
mcncgemenI cf wcmen´: hec|Ih
ccre e:pecic||y F/I pregncncy,
chi|cLirIh, FF pericc, cnc ccre cf Ihe
newLcrn
-GrccucIe frcm c cerIificcIe cr MSN
prcgrcm
-/|:c prcvice fcmi|y p|cnning :ervice:,
cIher gynecc|cgicc| neec:, cnc peri/
pc:Imencpcu:c| ccre
-Cne cf Ihe c|ce:I prcfe::icn:
-1º25-Mcry 8reckenricge e:IcL|i:he:
2
#
3
FrcnIier Nur:ing Service:-fir:I Nur:e-
Micwife Ic prccIice in Ihe US
-/mericcn Cc||ege cf Nur:e Micwive:
wc: inccrpcrcIec in 1º55
-prcvice ccre Ic wcmen wiIh |cw
inccme:, unin:urec, cnc mincriIie: whc
ccn´I :eek cuI regu|cr hec|Ih ccre
-|cwer rcIe: cf ce:crecn :ecIicn: in
fcci|iIie: where CNM´: prccIice

c. CerIifiec Nur:e /ne:IheIi:I:
-Definec Ly //N/: prcvice
--pre-cne:IheIic c::e::menI
--ceve|cp cnc imp|emenI p|cn
cf ccre
--perfcrm generc|, regicnc|, |ccc|,
cnc :eccIive cne:Ihe:ic
--mcncge pI´: cirwcy/pu|mcncry
:IcIu:
--fcci|iIcIe emergence/reccvery frcm
cne:Ihe:ic
--prcvice fc||cw-up evc|ucIicn cnc ccre
--re:pcnc Ic emergency :iIucIicn:
Ic c::I wiIh /CLS, cirwcy, meciccIicn:
-Minimum 24 mcnIh prcgrcm:/MSN wiIh
--45 hr: prcfe::icnc| c:pecI:
--135 hr: cncIcmy/phy:ic|cgy/
pcIhcphy:ic|cgy
--45 hr: chemi:Iry
--º0 hr: cne:IheIic princip|e:
--45 hr: c|inicc|/|iIercIure review
--kncw|ecge cf cI |ec:I 450 cne:IheIic:
-80 7 prccIice in cn cne:Ihe:ic ccre Iecm
-20 7 prccIice incepencenI cI :c|c
prcvicer:

e. Nur:e Ccn:u|IcnI:
-experI: in c :pecific crec cf nur:ing
-fee fcr :ervice
-mcy ccI c: experI wiIne::e:
-u:ec Ly ccrpcrcIicn: F/I ceve|cping
prccucI:/e¢uipmenI
-ccn:u|I Ic IexI:, e|ecIrcnic mecic, cnc
periccicc|:
3
$
4
B. Legal and Ethical Issues
I. Litigious nature of this specialty

c. ¦ numLer cf mc|prccIice cc:e: invc|ving
chi|cLirIh i::ue:
-C8/Gyn cc:e: 2
nc
cn|y Ic :urgerie:

L. Minimum :Icnccrc cf ccre:
-ccre IhcI c rec:cncL|e, prucenI nur:e wcu|c
prcvice in Ihe :cme cr :imi|cr circum:Icnce:

c. FreccmincnI Ihecry cf LicLi|iIy-neg|igence
-4 e|emenI:
cuIy exi:I:
Lreech cf cuIy-:Icnccrc cf ccre vic|cIec
injury
ccnnecIicn LeIween vic|cIicn cf Ihe
:Icnccrc cnc Ihe injury

c. Mc|prccIice |cw:uiI: cre Lc:ec cn Ihe
c::umpIicn IhcI Ihe hec|Ih ccre prcvicer
fci|ec Ic meeI Ihe prcfe::icnc| :Icnccrc cf
ccre cnc re:u|Iec in injury

e. /||egec injury Ic feIu:, necncIe, cr mcIher

f. Fcmi|ie: expecIing c hec|Ihy chi|c-Lcc
cuIccme mecn: mi:Icke mu:I hcve Leen
mcce

g. /IIriLuIe prcL|em Ic cne cr mcre memLer:
cf Ihe hec|Ih ccre Iecm
-fre¢uenI uncvci|cLi|iIy cf phy:icicn
-Iime frcme Ic ccmmuniccIe mcy Le :hcrI

h. Ic :uppcrI experI cpinicn, neec evicence:
-hc:piIc| prccecure:
-nur:ing pc|icie:
-guice|ine: e:IcL|i:hec Ly prcfe::icnc|
crgcnizcIicn:
-:IcIe nur:e prccIice ccI:
-JC/HC

4
%
5
II. Informed Consent

c. Frcce:: Ly which c pI cecice: Ic hcve c
cerIcin mecicc| cr :urgicc| prccecure
-inc|uce: kncwing cnc uncer:Icncing
whcI hec|Ih ccre IrecImenI i: Leing
uncerIcken

L. Mcre Ihcn ju:I :igning c fcrm

c. Frcce:: Ly which Ihe phy:icicn, nur:e, cnc
pc::iL|y cIher hec|Ih ccre prcfe::icnc|: ccnvey
Ic pI Ihe infcrmcIicn fcr Ihem Ic cecice wheIher
cr ncI Ic prcceec wiIh Ihe ccur:e cf Ix

c. WiIhcuI prcper ccn:enI, prcvicer ccu|c Le Ihe
:uLjecI cf c |cw:uiI c||eging c::cu|I, LcIIery,
neg|igence , cr c ccmLincIicn cf ccIicn:

f. Iype: cf ccn:enI:
-expre::ec-crc| cr wriIIen
-imp|iec: nur:e :IcIe: here Ic crcw L|ccc
cnc Ihe pI exIenc: her crm
--mcy Le u:ec in emergency cc:e:
--when pI ccnIinue: Ic Icke Ix wiIhcuI
cLjecIicn
--curing :urgery, ccciIicnc| :urgery i:
inciccIec

g. lnfcrmec refu:c|
-ccn Icke p|cce cI iniIicIicn cf Ix cr cny Iime
cfIer :IcrI cf Ix
-refu:c| i: vc|ic even cfIer infcrmec ccn:enI i:
given
-refu:c| mu:I Le vc|unIcry, unccercec, cnc ncI
mcce uncer frcucu|enI circum:Icnce:
-pI mu:I refu:e Ix wiIh kncw|ecge cnc
uncer:Icncing cf Ihe refu:c|
-chcrI :hcu|c inc|uce :ignec refu:c| fcrm Ly pI
cnc nur:ing ncIe: :hcu|c inc|uce Iime
|efI, |efI wiIh whcm, ri:k: cnc
ccn:e¢uence: cf nc furIher Ix, cnc
whc wi|| Le ncIifiec

5
&
6
III. Common Legal Pitfalls

a. ¬1 c||egcIicn: LirIh cf neurc|cgicc||y-impcirec
infcnI

L. repcrIing/reccrcing errcr::
-inccmp|eIe iniIic| H & F
-fci|ure Ic cL:erve & Icke cpprcpricIe ccIicn
-fci|ure Ic ccmmuniccIe chcnge: in c pI´:
ccnciIicn in c Iime|y mcnner
-inccmp|eIe cnc/cr incce¢ucIe cccumenIcIicn
-fci|ure Ic u:e cr inIerpreI feIc| mcniIcring
cpprcpricIe|y
-incpprcpricIe piIccin mcniIcring/u:cge
-imprcper :pcnge/in:IrumenI ccunI

c. c|mc:I ¾ cf C8/Gyn´: hcve Leen :uec
-mc:I cc:e: wi|| ncI gc Iric| LuI Le :eII|ec
cuI cf ccurI

c. 307 hcve hcc 3 cr mcre |cw :uiI:

e. ri:ing cc:I: cf |icLi|iIy in:urcnce

f. ¦ cemcnc: fcr ccccunIcLi|iIy crecIec Ly
expcncing Ihe :ccpe cf prccIice:

g. cc:I ccnIcinmenI:
-:hcrIer hc:piIc| :Icy:
-u:e cf un|icen:ec c::I per:cnne|
-cecrec:e in hc:piIc| :Icff

h. chcnge: in Iechnc|cgy mecn neecec
ccnIinuec ecuccIicn: EFM

IV. Standards of Care

c. SIcnccrcizec prccecure:/pc|icie:

L. :upervi:icn cf un|icen:ec c::I. per:cnne|
KNCW ycur fcci|iIy´: Sccpe cf FrccIice



6
'
7

VI. Ethical Dilemmas Unique to Perinatal Nursing

c. feIc| re:ecrch-|cw: vcry Ly :IcIe

L. feIc| :urgery
-i.e.: Li|cIerc| hycrcnephrc:i:, ccngeniIc|
cicphrcgmcIic hernic
-whcI if mcIher refu:e: Ix

c. cLcrIicn-Fce v:. Wcce {1º73)
-mcrning-cfIer pi||
F|cn 8-|evcncrge:Ire|
-|cck cf e:Ircgen ¡ ncu:ec
-mecicc| cLcrIicn
US: mifepri:Icne + mi:cprc:Ic|
Frcnce: FU-48ó

c. crIificic| in:emincIicn
-/lH-hu:Lcnc´: :perm-prcL|em wiIh
mcIher
-/lD-ccncr :perm
-|egc| prcL|em:-ccncr re|in¢ui:he: righI:

e. :urrcgcIe chi|cLirIh
-Luying c chi|c-$$$$
-Lic|cgicc| mcIher mcy refu:e Ic give up
Ihe newLcrn

f. /FI-/::I. FeprccucIive Iechnc|cgy
-lVF-EI
-GlFI, ZlFI

g. emLrycnic :Iem ce|| re:ecrch/ccrc L|ccc
Lcnking









7
(


8
8
h. Ihe NecncIe
-icIrcgenic prccecure:
prc|cngec u:e cf venIi|cIcr:
C2 Ihercpy
-prcL|em: :hcu|c we :cve Ihe |ive: cf infcnI:
cn|y Ic hcve Ihem |ecc |ive: cf pcin,
ci:cLi|iIy, cnc ceprivcIicn°
-whc cecice: if mcjcr inIervenIicn i: u:ec
-whcI kinc cf ccre cc ycu give cr ceny Ihe
infcnI Ic c||cw him Ic cie wiIh cigniIy
cnc ccmfcrI

i. Ihe McIher
-u:e |ife :uppcrI in irrever:iL|e ccnciIicn:°

V. Nursing Role

c. CcmmuniccIicn
-inIerccIicn: LeIween MD´:, CNM´:, &
nur:e:
-wc: c c|ecr |ine cf ccmmuniccIicn u:ec
-wc: Ihe chcin cf ccmmcnc fc||cwec
-wc: Ihere infcrmec ccn:enI
-Ihe LeIIer Ihe ccmmuniccIicn LeIween
nur:e cnc pI, |e:: u:e cf |iIigcIicn
-ecr|ier ci:chcrge: hcme mecn mcre
ecuccIicnc| re:pcn:iLi|iIie: fcr Ihe
FN

L. U:e cf EFM
-fir:I inIrccucec cI Yc|e Univer:iIy in 1º58
-ln |c:I 25 yr: cf u:e, nc ¡ in rcIe cf CF
-i: pcrIic||y re:pcn:iL|e fcr ¦ in C/S rcIe
-crcincry pcrI cf lnIrcpcrIum ccre-
ccn:IcnI IhrecI cf |egc| ccIicn

C. Review of Conception/ Fetal Development
{Feview Lcck:)




01/13
)
1
Unccmp|iccIec LcLcr cnc De|ivery
Lecture 2 [2 doys}

l. Fhy:ic|cgicc| effecI: cf Ihe LirIh prcce::
A. Moterno| response
1. CV
c. During U/C-300-500 m| L|ccc frcm uIeru:
Ic vc:cu|cr :y:Iem
L. lncrec:e in ccrcicc cuIpuI
10-157 SIcge l
30-507 SIcge ll
c. 8|ccc pre::ure chcnge:
1. L|ccc f|cw in Ihe uIerine crIery
curing ccnIrccIicn: cnc i: recirecIec
Ic Ihe peripherc| ve::e|:
2. peripherc| re:i:Icnce cccur: wiIh cn
¦ in 8F cnc ¡ cf pu|:e
3. SIcge l- ¦ 30 mm Hg :y:Ic|ic
¦ 25 mm Hg cic:Ic|ic
4. SIcge ll- 8F furIher
5. Supine hypcIen:icn-ri:k fccIcr:
mu|IifeIc|, hycrcmnic:, cLe:iIy,
cehycrcIicn, hypcvc|emic
c. W8C´: 25-30,000 mm :eccnccry Ic :Ire::,
Ircumc
e. hemcIcpcieIic
1. ce:ire HgL cI |ec:I 11 g/c|
HcI 337 cr higher
2. ¦ p|c:mc fiLrincgen÷ ¡ L|ccc cccg
Iime÷ ¦ c|cIIing fccIcr: Ic prcIecI
cgcin:I hemcrrhcge LuI ¦ ri:k fcr
IhrcmLcph|eLiIi: {inf|cmmcIicn cf
vein in ccnjuncIicn wiIh fcrmcIicn
cf c thrombus {L|ccc c|cI cf c ve::e|
cr c ccviIy in Ihe hecrI)
!*
2
2. F|u|dsJe|ectro|ytes
c. Dicphcre:i:, ¦ in:en:iL|e wcIer |c:: Ihrcugh
re:pircIicn:, NFC :IcIu:, cnc ¦ Iemp
L. Vcicing mcy Le cifficu|I r/I cne:Ihe:ic cr
Fre::ure frcm pre:enIing pcrI-¡ :en:cIicn
cf c fu|| L|cccer
c. FrcIeinuric-
-¦ in cminc ccic: mcy exceec ccpcciIy
cf renc| IuLu|e: Ic cL:crL
-mcy Le renc| ccmcge ccu:ec Ly
vc:c:pc:m: cf IuLu|e:

3. GI
c. F|uic: cI Ic|ercIec r/I ¡ Gl mcIi|iIy cnc
cL:crpIicn wiIh ce|cy in :Icmcch
empIying
L. N & V wiIh cicrrhec in |cLcr

4. kesp|rotory
c. ¦ C2
ccn:umpIicn, ¦ in re:p. rcIe
L. hypervenIi|cIicn ÷re:pircIcry c|kc|c:i:
¦ in pH, hypcxic, hypcccpnic {¡CC
2
)
c. 2
nc
SIcge-C
2
ccn:umpIicn meIcLc|ic
ccicc:i: unccmpen:cIec Ly re:p. c|kc|c:i:

5. Muscu|orJske|eto|
c. FcIigue cf mu:c|e:/:Ircin
L. SepcrcIicn cf puLi: :ymphy:i:
-Mcy Le re|cIec Ic pregncncy cr
ce|ivery prcce::
[re|ox|n-po|ypept|de hormone-secreted
|n corpus |uteum dur|ng pregnoncy-con
re|ox the symphys|s, |nh|b|t uter|ne
controct|ons, ond so|tens the cerv|x}
c. 8reckccwn cf prcIein: mcy |ecc Ic
prcIeinuric-c|Lumnin in Ihe urine
!!
3
ó. Neuro|og|co|
c. Euphcric-Le|ieve iI cr ncIl
enccrphin:-¦ pcin Ihre:hc|c cnc prccuce
:eccIicn
L. ¦ cnxieIy
c. pcrIic| Ic IcIc| cmne:ic in 2
nc
:Icge

7. Integumentory
c. cicphcre:i:
L. ¦ IempercIure-mcy Le F/I Ic mcIernc|
effcrI: cr infecIicn
c. exccerLcIicn cf pruriIu:-
mcy Le re|cIec Ic cho|estos|s {crre:I cf
Ihe f|cw cf Li|e) in pregncncy

8. Feto| kesponse
1. CV
c. A in feIc| hecrI rcIe {FHF)
-mcIernc| hycrcIicn
N & V
¦ mcIernc| Iemp
in:en:iL|e wcIer |c::
-mcIernc| pc:iIicn
-meciccIicn: Ic mcIher
-p|ccenIc| i::ue:
pc:I ccIe:-cc|cificcIicn:
:mcker/¦ 8F-¡ p|ccenIc| :ize
ve|omentous |nsert|on {umLi|icc|
ccrc cIIcchec Ic Ihe
memLrcne c :hcrI ci:Icnce
frcm Ihe p|ccenIc
ccrc ccmpre::cn
-mcIernc| cnxieIy
!"
4
2. Fu|monory
c. Ihcrccic ccviIy :¢ueezec
-ncI c: much in C/S cc:e:
-prec|p|tous de||ver|es {:wifI prcgre::icn cf
2
nc
:Icge cf |cLcr mcrkec Ly rcpic
ce:cenI/expu|:icn cf Ihe feIu:)
-mcy neec exIrc :ucIicn
L. pc::ing cf mecon|um {1
:I
fece: cf
necncIe) mcy neec re:u:ciIcIicn effcrI

3. Cotecho|om|nes
c. epinephrine & ncrepinephrine-ccIive
om|nes {niIrcgen-ccnIcining crgcnic
ccmpcunc:)
-hcve effecI cn CV, neurc, meIcLc|ic
rcIe, Iemp., cnc :mccIh mu:c|e
L. chcnge F/I ¦ :Ire:: cf |cLcr
:peec c|ecrcnce cf f|uic

ll. E::enIic| CcmpcnenI: cf Ihe 8irIh Frcce::
A. Fossogewoy
1. moterno| pe|v|s
c. 4 Lcne:
-2 |nnom|note {ncme|e::) Lcne:
-mcce up cf 3 Lcne:
-i|ium-i|icc cre:I
-i:chium-i:chic| IuLerc:iIy
-:pine:-:hcrIe:I cicmeIer
-puLi:-:ymphy:i: puLi:
-Ihe :ccrum
-Ihe ccccyx
L. Fc|:e pe|vi:-Ihe upper pe|vi:
-pcrIicn cLcve Ihe in|eI




!#
5
c. Irue pe|vi:
-in|eI
-cicgcnc| ccnjugcIe-|cwer Lcrcer
cf :ymphy:i: puLi:-:ccrc|
prcmcnIcry
-u:uc||y 12.5 cm cr grecIer
-cL:IeIric ccnjugcIe- c|:c cc||ec
cnIericr/pc:Iericr cicmeIer
-mec:uremenI IhcI ceIermine:
wheIher pre:enIing pcrI ccn
engcge :upericr :IrciI
-u:uc||y 1.5-2 cm |e:: Ihcn
cicgcnc|
-micpe|vi:-ccviIy, micp|cne
-Ircn:ver:e cicmeIer-inIer:pincu:
cicmeIer-10.5 cm
-cuI|eI
-Ircn:ver:e cicmeIer-inIerIuLercu:
cicmeIer-> 8 cm

2. Fe|v|c shopes
c. gyneccic-rcunc
-507 cf wcmen
-mc:I fcvcrcL|e
-u:uc| mcce cf LirIh-vcginc|
L. cncrcic-hecrI :hcpec
-237 cf wcmen
-u:uc| mcce cf LirIh-ce:crecn
pc::iL|e fcrcep:-cifficu|I
c. cnIhrcpcic-cvc| :hcpec
-247 cf wcmen
-u:uc| mcce cf LirIh-vcginc|
:pcnIcnecu: cr c::I.
-mcy |ecc Ic CF pc:iIicn
c. p|cIype||cic-f|cI :hcpec
-37 cf wcmen
-ncI fcvcrcL|e fcr vcginc| ce|ivery
!$
6
8. Fossenger
1. Feto| sku||
c. mcce up cf ó Lcne:
-frcnIc|
-2 pcrieIc|
-2 Iempcrc|
-cccipiIc|
L. ncI fu:ec IcgeIher-c||cw fcr mc|cing,
cver|cpping cf Lcne: Ic pc:: Ihru pe|vi:
c. :uIure:-memLrcne:
-frcnIc|
-:cgiIIc|
-|cmLccicc|
-ccrcnc|
c. fcnIcne|:-where memLrcne: inIer:ecI
-cnIericr {bregmo)-cicmcnc-:hcpec-2cm
Ly 3 cm
-c|c:e: Ly 18 mcnIh:
-pc:Iericr-Iricng|e-:hcpec-1cm Ly 2 cm
-c|c:e: Ly 8-12 week:
e. |cncmcrk:
-menIum-chin
-:incipuI-Lrcw
-verIex-LeIween cnIericr/pc:Iericr
fcnIcne|
-cccipuI-LenecIh Ihe pc:Iericr fcnIcne|

2. Feto| Fresentot|on
c. feIc| pcrI enIering Ihe pe|vi: fir:I
-cephc|ic {hecc)-ºó7
-Lreech {LuIIcck)-37
-Ircn:ver:e {:hcu|cer)-17
L. fccIcr: IhcI inf|uence pre:enIcIicn
-feIc| |ie
-feIc| cIIiIuce
-exIen:icn/f|exicn cf feIc| hecc

!%
7
c. cicgnc:ec u:ing
-Lecpc|c´: mcneuver:
-verify wiIh u|Irc:cunc
c. exIernc| ver:icn-MD cIIempI: Ic mcnuc||y
rcIcIe Ihe feIu: inIc c cephc|ic
pre:enIcIicn
-ccne in L &D
-u|Irc:cunc Ic check feIc|/p|ccenIc|
pc:iIicn
-mcy u:e meciccIicn: Ic re|cx uIerine
mu:c|e
-fre¢uenI|y unccmfcrIcL|e fcr mcIher

3. Feto| L|e
c. re|cIicn:hip cf |cng cxi: {:pine) cf feIu:
Ic |cng cxi: {:pine) cf mcIher
L. primcry |ie::
-|cngiIucinc| {verIicc|)-cephc|ic, Lreech
-Ircn:ver:e {hcrizcnIc| cr cL|i¢ue)-:hcu|cer

4. Feto| Att|tude
c. re|cIicn:hip cf feIc| pcrI: Ic cne cncIher
L. generc| f|exicn
-Lcck i: rcuncec
-chin f|exec cnIc che:I
-Ihigh: f|exec cn Ihe cLccmen
-|eg: f|exec cI Ihe knee:
-crm: crc::ec cver Ihe Ihcrcx
-umLi|icc| ccrc |ie: LeIween crm:/|eg:
c. hecc f|exicn
-LipcrieIc| cicmeIer-º.25 cm
-:uLcccipiIcLregmcIic-º.5 cm
-cccipiIcfrcnIc|-12 cm
-cccipiIcmenIc|-13.5 cm



!&
8
5. Feto| pos|t|on
c. re|cIicn:hip cf pre:enIing feIc| pcrI Ic
4 ¢uccrcnI: cf mcIernc| pe|vi:
L. inciccIec u:ing c 3-|eIIer cLLrevicIicn
-1
:I
|eIIer-|cccIicn cf pcrI in pe|vi: {F cr L)
-2
nc
|eIIer-pre:enIing pcrI cf feIu: {C,S,M)
-3
rc
|eIIer-|cccIicn cf pre:enIing pcrI in
re|cIicn:hip Ic mcIernc| pe|vi: {/,F,I)

ó. Stot|on
c. re|cIicn:hip cf pre:enIing feIc| pcrI Ic cn
imcgincry |ine cI Ihe mcIernc| i:chic|
:pine:: 0 :IcIicn i: cI Ihe :pine:
L. negcIive :IcIicn:-higher in Ihe pe|vi:
c. pc:iIive :IcIicn:-|cwer in Ihe pe|vi:

C. Fowers
1. Fr|mory Fowers
c. invc|unIcry uIerine ccnIrccIicn:
-:IcrI cI funcu:-Ihickenec uIerine
mu:c|e |cyer cf upper uIerine
:egmenI
-upper :egmenI Ihicker :c mcre ccIive
-|cwer :egmenI hc: |e:: mu:c|e
-ccnIrccIicn: mcve ccwn mu:c|e
in wcve:
-c::e::ec Ly:
repcrI: frcm mcIher
FN pc|pcIing funcu:
mcniIcr
L. primcri|y re:pcn:iL|e fcr ci|cIicn cf
cx cnc ce:cenI cf feIu:
-crcwing upwcrc cf Ihe
mu:cu|cfiLrcu: ccmpcnenI:
cf Ihe cervix wiIh feIc| hecc ccmpre::icn
|ecc Ic ci|cIicn {cpening)
-fu|| ci|cIicn {10 cm) mcrk: Ihe enc cf
!'
9
Ihe fir:I :Icge cf |cLcr
c. effccemenI {Ihinning)
-cx u:uc||y 3 cm |cng, 1 cm Ihick
-Icken up Ly :hcrIening cf uIerine
mu:c|e Lunc|e:
-u:uc||y expre::ec in 7
c. uIerine ccnIrccIicn:
-3 phc:e:-incremenI, ccme, cecremenI
-invc|unIcry, rhyIhmic, inIermiIIenI
-fre¢uency-Leginning cf cne Ic Ihe
Leginning cf Ihe nexI
-regu|criIy-u:uc||y :IcrI irregu|cr Ihen
Leccme: mcre regu|cr c: |cLcr
prcgre::e:
-curcIicn-:IcrI Ic enc cf ccnIrccIicn
-inIen:iIy-mi|c, mccercIe, :Ircng cr
:IrengIh ccn Le mec:urec wiIh
inIernc| mcniIcr {lUFC) wiIh
re:Iing Icne u:uc||y 15-25 mm
e. Ferguson's re||ex
-pre:enIing feIc| pcrI recche: perinec|
f|ccr
-mechcnicc| :IreIching cf cervix cccur:
-:IreIch recepIcr: in vcginc Irigger
exogenous {crigincIing cuI:ice cn
crgcn) cxyIccin re|ec:e
-Irigger: mcIernc| urge Ic Lecr ccwn

2. Secondory Fowers
c. Lecring ccwn effcrI cI 10 cm
-ccnIrccIicn cf cicphrcgm cnc
cLccminc| mu:c|e: whi|e pu:hing
L. ¦ inIrccLccminc| pre::ure IhcI
ccmpre::e: uIeru: cn c|| :ice:
c. u:uc||y nc effecI cn ci|cIicn-impcrIcnI
F/I expu|:icn cf feIu: cnc p|ccenIc
c. LeIIer re:u|I: when cwciI mcIernc| neec
!(
10
Ic Lecr ccwn rcIher Ihcn :IcrI pu:hing
cI 10 cm
e. ceLcIe cver hcw Ic pu:h
-vc|:c|vc-c|c:ec g|cIIi:, prc|cngec pu:h
-cpen g|cIIi: pu:hing
-mini pu:he:
f. prc|cngec pu:hing effcrI: ccn |ecc Ic
feIc| hypcxic/ccicc:i: cnc :evere
mcIernc| perinec| |ccercIicn:

D. F|ocento
1. Structure
c. fcrmec cI imp|cnIcIicn
L. dec|duo {enccmeIrium curing
pregncncy) Lc:c|i:-wiIh Ihe chor|on
{exIrcemLrycnic memLrcne) fcrm: Ihe
p|ccenIc
c. ccIy|eccn-mc:: cf vi||i cn Ihe chcricnic
:urfcce cf Ihe p|ccenIc
-15-20 in numLer
c. :IrucIure i: ccmp|eIec Ly 12 week
e. Lreck: mcy cccur in p|ccenIc|
memLrcne c||cwing mixing cf mcIernc|
cnc feIc| L|ccc-Fh :en:iIizcIicn
f. pc:iIicn prcL|em:
-previc-imp|cnIec in |cwer uIerine
:egmenI-ccver: inIernc| cx c:
-cLrupIic-:epcrcIicn cf p|ccenIc frcm
uIerine wc||
-cccreIc-ccIy|eccn: invccec uIerine
mu:cu|cIure
-increIc-invc:icn inIc Ihe mycmeIrium
-percreIc-invc:icn Ic Ihe :erc:c cf Ihe
periIcneum ccvering cf Ihe uIeru:
con |eod to uter|ne rupture


!)
11
g. umLi|icc| ccrc in:erIicn prcL|em:
-LcII|eccre-in:erIicn inIc Ihe mcrgin cf Ihe
p|ccenIc-re:emL|e: c pccc|e
-ve|cmenIcu:-cIIcchec Ic memLrcne c
:hcrI ci:Icnce Ic p|ccenIc

2. Funct|on
c. encccrine g|cnc-prccuce: hcrmcne: Ic
mcinIcin pregncncy
-hCG-humcn chcricnic gcncccIrcpin
-Lc:i: fcr pregncncy Ie:I
-pre:erve: funcIicn cf ccrpu: |uIeum
-en:ure: ccnIinuec :upp|y cf
e:Ircgen/prcge:Iercne
-recche: mcx |eve| cI 50-70 ccy:
-hFL-humcn p|ccenIc| |ccIcgen
-:imi|cr Ic grcwIh hcrmcne
-:Iimu|cIe: mcIernc| meIcLc|i:m
-¦ re:i:Icnce Ic in:u|in cnc fcci|iIcIe:
g|ucc:e Ircn:pcrI ccrc::
p|ccenIc| memLrcne [GDM?}
-e:Ircgen {e:Iric|)
-:Iimu|cIe: uIerine grcwIh
-:Iimu|cIe: uIercp|ccenIc| L|ccc
f|cw
-prcge:Iercne
-mcinIcin: enccmeIrium
-cecrec:e: ccnIrccIi|iIy cf uIeru:
-:Iimu|cIe: ceve|cpmenI cf Lrec:I
c|vec|i cnc mcIernc|
meIcLc|i:m
L. meIcLc|ic funcIicn:
-re:pircIicn
-nuIriIicn
-excreIicn
-:Icrcge

"*
12


c. fccIcr: which ccu|c effecI funcIicn
-:mcking
-crug u:e
-pccr nuIriIicn
-¦ 8F
-mcIernc| pc:iIicn
-infecIicn
-Ircumc

E. Fsyche
1. Foctors |n||uenc|ng womon's reoct|on to
phys|co|Jemot|ono| cr|s|s o| |obor
c. ccccmp|i:hmenI cf Ic:k: cf pregncncy
L. u:uc| ccping mechcni:m: in re:pcn:e Ic
:Ire::
c. :uppcrI :y:Iem-e:p. pcrIner´:
ccmmiImenI
c. prepcrcIicn fcr chi|cLirIh
e. cu|Iurc|/re|igicu: inf|uence:
f. :ccic|/eccncmic re:pcn:iLi|iIy

2. Foctors ossoc|oted w|th b|rth exper|ence
c. mcIivcIicn fcr pregncncy
L. cIIenccnce cI chi|cLirIh c|c::e:
c. :en:e cf ccmpeIency/mc:Iery
c. :e|f-ccnficence/:e|f-e:Ieem
e. + re|cIicn:hip wiIh pcrIner
f. mcinIcining ccnIrc| curing |cLcr
g. :uppcrI curing Ihe ce|ivery
h. ncI Leing |efI c|cne
i. Iru:I in :Icff-mecicc| cnc nur:ing
j. pcin mcncgemenI
k. |engIh cf |cLcr prcce::-exhcu:Iicn, ¦
cnxieIy, ¦ fcr mecicc| inIervenIicn:

"!
13
F. Fos|t|on [moterno|}-See book

lll. LcLcr Fhy:ic|cgy
A. Lobor Onset Iheor|es
1. Oxytoc|n St|mu|ot|on Iheory
c. :IreIching cf cervicc| c: ccu:e: ¦ in
excgencu: cxyIccin
L. prccucec Ly pc:Iericr piIuiIcry
c. cxyIccin :Iimu|cIe: :mccIh uIerine mu:c|e
ccnIrccIicn:
c. ¦ re:pcn:e Ic cxyIccin c: necr: Ierm

2. Estrogen St|mu|ot|on Iheory
c. e:Ircgen :Iimu|cIe: :mccIh uIerine mu:c|e
Ic ccnIrccI
L. c: cpprccche: Ierm, ¦ e:Ircgen,
¡ prcge:Iercne {prcg. keep: e:Ircgen in
check)
c. prcmcIe: prc:Icg|cncin :ynIhe:i: {c|:c
:Iimu|cIe: mu:c|e)

3. Frogesterone W|thdrowo| Iheory
c. u:uc||y re|cxe: mu:c|e
L. cI Ierm-¡ in effecIivene::

4. Feto| Cort|so| Iheory
c. cI Ierm, feIu: prccuce: mcre ccrIi:c|
L. ccrIi:c|-{ccrencccrIiccc| hcrmcne)
-:|cw: prccucIicn cf prcge:Iercne
-:Iimu|cIe: prc:Icg|cncin precur:cr:

5. bter|ne D|stent|on Iheory
c. :IreIching uIerine mu:c|e: ccu:e:
irriIcLi|iIy |eccing Ic ccnIrccIicn:
L. :Iimu|cIe: prccucIicn cf prc:Icg|cncin:
""
14
ó. Frostog|ond|ns
c. :Iimu|cIe :mccIh mu:c|e Ic ccnIrccI
L. ccn hcve prccucIicn :Iimu|cIec Ly
vcricu: meIhcc:
-¦ :ynIhe:i: cf FGE2
in cmnicn
c. re:ecrch vcrie: wheIher ccncenIrcIicn
cf prc:Icg|cncin: ¦ in cmnicIic f|uic cnc
mcIernc| L|ccc ju:I Lefcre |cLcr cn:eI

8. S|gns o| Lobor
1. 8roxton-H|cks controct|ons
c. 4-ó week: Lefcre cn:eI cf |cLcr
L. uIerine mu:c|e wcrkcuI Lefcre |cLcr
c. mcy Le :Ircng cnc fre¢uenI LuI u:uc||y
cre irregu|cr in pcIIern

2. L|ghten|ng
c. feIc| ce:cenI inIc Ihe Irue pe|vi:
L. 2-3 week: in primigrcvicc:
c|c:er Ic cn:eI cf |cLcr in mu|Iipcrc:
c. ec:ier Ic LrecIhe, ¦ neec Ic vcic

3. Cerv|co| ond vog|no| chonges
c. cervix ripen: {:cfIen:) cnc mcy Legin Ic
ci|cIe cnc effcce
L. vcginc| mucu: ¦ wiIh mucu: p|ug Leing
re|ec:ec 1hr, 1ccy, cr even 1 week Lefcre
:IcrI cf |cLcr
c. cccc:icnc||y L|cccy :hcw ncIec wiIh
ccrk Lrcwn cr |ighI pink-Iingec mucu:
ncIec

4. Fers|stent |ow bock oche
c. F/I re|cxcIicn cf pe|vic jcinI cnc ce:cenI
cf feIu:
L. chcnge cf pc:iIicn, wcrm pcck:, cnc
wcrm :hcwer:/LcIh: he|p
"#
15
5. We|ght Loss
c. F/I Gl up:eI wiIh N & V cnc cicrrhec
L. u:uc||y :IcrI: 1-2 ccy: Lefcre cn:eI

ó. Nest|ng
c. hcve c Lur:I cf energy
L. hcve c neec Ic geI everyIhing in crcer
fcr crrivc| cf LcLy

C. Irue vs. Fo|se Lobor
Irue Fo|se
UIerine ccnIrccIicn:
regu|cr irregu|cr

c|c:e IcgeIher vcry

:Ircnger mi|cer

¦ wiIh wc|king ¡ wiIh wc|king

fe|I in |cw Lcck Ihen fe|I in Lcck cr pe|vi:
rccicIe: Ic cLccmen

ncI :Icppec Ly LcIh ¡ wiIh re|cxcIicn
cr f|uic Iechni¢ue:

Cervix
:cfIen:, effcce:, ci|cIe: nc :ignificcnI chcnge:

FeIu:
:IcrI: ce:cenI inIc pe|vi: nc chcnge in pc:iIicn

D. E||ocement, d||ot|on, ond stot|on
1. E||ocement
c. Ihinning cf cervix {:hcrIening frcm u:uc|
|engIh cf 2-3 cm)
L. cccumenIec eiIher in 7´: cr cm´:
"$
16

2. D||otot|on
c. cpening cf cervicc| c: frcm c|c:ec Ic
10 cm
L. cue Ic reIrccIicn cf cervix inIc Ihe |cwer
uIerine :egmenI F/I uIerine ccnIrccIicn:
cnc pre::ure frcm cmnicIic :cc cnc feIu:
c. LcIh ci|cIicn cnc effccemenI cre
mec:urec Ly fingerIip pc|pcIicn cr vi:uc|
in:pecIicn wiIh :Ieri|e :pecu|um

3. Stot|on
c. u:ing imcgincry |ine cI i:chic| :pine:,
ncIe |cccIicn cf pre:enIing feIc| pcrI
L. cccumenIec frcm -4 Ic +4
c. Lc||cIIcL|e-when pre:enIing pcrI i:
f|ccIing in cnc cuI cf Ihe pe|vi:

E. Stoges ond Fhoses o| Lobor
1. Frodromo| phose
c. :Ircng regu|cr ccnIrccIicn: wiIhcuI
cervicc| chcnge
L. |ecc: Ic exhcu:Iicn F/I incLi|iIy Ic :|eep
c. mcy neec crc|/lM meciccIicn fcr re:I

2. Stoge 1 [0-10 cm}-hos 3 phoses
c. Ecr|y/LcIenI phc:e-0-3 cm, 50-º07, -3Ic -1
-cL|e Ic wc|k cnc Ic|k
-cL|e Ic ecI |ighI mec|:
-mcy Le hcme fcr mc:I cf Ihi: phc:e
-invc|ve: mcre cx effccemenI cnc |e::
chcnge in feIc| pc:iIicn
-U/C´: mcy Le 2-10 minuIe: cpcrI
-U/C´: mi|c Ly pc|pcIicn
-|c:I: cn cvercge 8 hcur: fcr primip:
-mu|Iipcrc: mcy hcve cx ci|cIe Ic 3 cm
ccy: pricr Ic cn:eI cf |cLcr
"%
17
-FCM mcy cccur curing Ihi: Iime
L. /cIive phc:e-4cm-7cm, 80-1007, -2 Ic 0
-U/C´: every 3-5 minuIe:, mccercIe Ly
pc|pcIicn
-U/C´: |c:I cpprcx ó0 :ec
-mcy :IcrI Ic hcve ncu:ec/vcmiIing
-mcy c:k fcr enemc if impccIec Ic
:peec ce:cenI cf feIu:
-mcy c:k fcr pcin meciccIicn:
-prcvicer mcy cecice Ic /FCM Ic he|p
:peec |cLcr
-expecI cx Ic chcnge 1cm every 1-1.5 hr:
c. Ircn:iIicn phc:e-8-10 cm, 1007, -1 Ic +1
-U/C´: every 1-3 minuIe: wiIh ¦ inIen:iIy
-U/C´: |c:I 45-º0 :ec |cng
-u:ing LrecIhing Iechni¢ue: ncI Ic pu:h
Icc ecr|y
-mcy c:k fcr mcre pcin meciccIicn
-:hcrIe:I phc:e-u:uc||y 15 min-3 hcur: wiIh
ce|cy: F/I meciccIicn:/infecIicn:

3. Stoge 2-10 cm [push|ng} to de||very o| neonote
c. nu||ipcrc:-2 hcur: cn cvercge-nc epic.
3-4 hcur: wiIh epicurc|
L. mu|Iipcrc:-15 min-1 hcur wiIhcuI epic.
1-2 hcur: wiIh epicurc|

4. Stoge 3-b|rth o| neonote to expu|s|on o|
F|ocento
c. u:uc||y |c:I: 20 minuIe: Ic 1 hcur
L. if reIcinec, MD wi|| neec Ic mcnuc||y
remcve-ccn:icer pcin mec: fcr mcm

5. Stoge 4-kecovery
c. mcm-1-4 hcur:
L. LcLy-ó hcur:

"&
18

F. Mechon|sms o| Lobor [Cord|no| Movements}
1. Engogement ond Descent-occurs rJt:
c. pre::ure cf cmnicIic f|uic
L. uIerine pre::ure cn Ihe Lreech
c. ccnIrccIicn: cf cLccminc| mu:c|e:
c. exIen:icn/:IrcighIening cf feIu:

2. F|ex|on
c. ncIurc| cIIiIuce cf feIu:
L. feIc| hecc f|exe: c: iI meeI:
re:i:Icnce

3. Interno| kotot|on
c. Ic gc Ihru Ircn:ver:e cicmeIer
L. rcIcIe: Ic cccipuI cnIericr

4. Extens|on
c. re:i:Icnce cf pe|vic f|ccr wiIh vu|vc
cpening fcrwcrc cnc cnIericr
L. feIc| hecc Legin: Ic crcwn

5. Externo| kotot|on
c. :hcu|cer: rcIcIe Ic cnIercpc:Iericr
L. feIc| hecc rcIcIe: furIher Ic cne :ice

ó. Expu|s|on
c. cnIericr :hcu|cer :|ip: uncer
:ymphy:i: puLi:
L. pc:Iericr :hcu|cer cnc Lccy i: Ihen
ce|iverec






"'
19

G. Lobor Durot|on
1. Nu|||poros
c. 1
:I
:Icge-13 hcur: {1.2 cm/hr)
L. 2
nc
:Icge-5 minuIe:-2 hcur:
c. 3
rc
:Icge-10-20 minuIe:

2. Fr|m|Jmu|t|poros
c. 1
:I
:Icge-7 hcur: {1.5 cm/hr)
L. 2
nc
:Icge-5 minuIe: Ic 1 hcur
c. 3
rc
:Icge-5-20 minuIe:


lV. F|cn cf Ccre
A. Assessment-Doto Co||ect|on
1. prenoto| record
c. c::e:: cIIenccnce Ic FN cppI:
L. cny ccmp|iccIicn: cf pregncncy
c. cny high ri:k Lehcvicr:
c. cLncrmc| |cL/u|Irc:cunc repcrI:
1. L|ccc Iype/FH fccIcr
2. VDFL/FFF-:yphi|i: :creen
3. HL:/G-:urfcce cnIigen
4. C8C
5. FuLe||c immuniIy
ó. cu|Iure fcr G8S
7. urinc|y:i:
8. HlV Ie:I
e. primcry |cngucge

2. |n|t|o| |nterv|ew
c. c:k why :he ccme in
L. :IcIu: cf 8CW
c. cny U/C´:°
c. cny L|eecing°
e. + FM recenI|y°
f. cny cIher :ympIcm:°
"(
20

3. phys|co| exom
c. mcIernc| viIc| :ign:
L. FHF Irccing
c. pc|pcIe :IrengIh cf U/C´:
c. c::e:: feIc| pre:enIcIicn
e. c::e:: cervicc| ci|cIicn/effccemenI

4. |ob reportsJu|trosound resu|ts
c. C8C
L. FlH pcne|
c. F8S {:ure :Iep cr |cL crcw)
c. ck feIc| |ie//Fl wiIh u|Irc:cunc

5. expressed psychosoc|o| ond cu|turo|
|octorsJneeds
c. hi:Icry cf :exuc|/phy:icc| cLu:e
L. hi:Icry cf cepre::icn/:uicice cIIempI:
c. :ccic| :uppcrI
-fcmi|y necr Ly
-frienc: whc ccn piIch in
c. cu|Iurc|/re|igicu: neec:

ó. c||n|co| evo|uot|on o| |obor stotus
c. :ign ccn:enI fcrm:
L. C8C cnc urine Ie:I
c. if FCM, ck niIrczine pcper cr ferning
c. Lecpc|c´: mcneuver
e. vcginc| excm
f. u|Irc:cunc if neecec
g. hecc Ic Ice c::e::menI
h. ck fcr mec c||ergie:
i. c:k cLcuI c|c::e: Icken




")
21

8. Nurs|ng D|ognoses
1. Anx|ety kJI |obor ond b|rth|ng process
c. crienI pcrenI: Ic uniI
L. exp|cin ccmi::icn prcIccc|
c. c::e:: wcmcn´: kncw|ecge,
experience:, cnc expecIcIicn: cf
|cLcr
c. ci:cu:: prcgre:: cf |cLcr
e. invc|ve wcmcn cnc pcrIner in ccre
ceci:icn: curing |cLcr

2. Fo|n kJI |ncreos|ng |requency ond |ntens|ty o|
controct|ons
c. c::e:: |eve| cf pcin
L. enccurcge :uppcrI pecp|e Ic cic in
ccmfcrI mec:ure:
c. enccurcge u:e cf re|cxcIicn Iechni¢ue:
c. exp|cin when cnc why cnc|ge:ic: mcy Le
u:ec

3. k|sk |or o|tered pottern o| ur|nory e||m|not|on kJI
sensory |mpo|rment secondory to |obor
c. pc|pcIe Ihe L|cccer :upericr Ic :ymphy:i:
L. enccurcge fre¢uenI vcicing
c. c::i:I Ic 8FF cr u:e ccIheIer prn

4. k|sk |or ||u|d vo|ume de||c|t kJI ||u|d |ntoke
ond b|ood |oss dur|ng b|rth
c. mcniIcr f|uic |c::
L. ccmini:Ier crc|/pcrenIerc| f|uic prn
c. mcniIcr funcu: fcr firmne::
c. ccmini:Ier meciccIicn: Ic cic in
ccnIrccIicn cf uIeru:
e. pc::iL|e Iype cnc :creen/crc:: mcIch
if Ircn:fu:icn neecec

#*
22

5. Impo|red gos exchonge kJI moterno| 8F,
compress|on o| umb|||co| cord
c. keep mcIher cff her Lcck
L. mcinIcin cce¢ucIe hycrcIicn
c. cxygen vic mc:k if C2
Le|cw º07
c. :huI cff piIccin
e. pc::iL|e neec fcr cmnicinfu:icn

C. Intervent|ons-Fr|or|ty Sett|ng
1. V|to| s|gns
c. ncIify prcvicer if 8F cLcve 140/º0
L. ck Iemp ¢ 4 hr: if FCM

2. Feto| mon|tor|ng
c. c::e:: FHF cI |ec:I cnce hcur|y in
ecr|y phc:e:
L. mcy neec ccnIinucu: mcniIcring
c. ccn:icer inIernc| mcniIcring fcr pccr
Irccing, |cck cf prcgre::, cr meccnium

3. Hydrot|onJoxygenot|on
c. enccurcge pc f|uic: cr :IcrI lV if N & V
L. ck cxygen :cIurcIicn if cece|: ncIec

4. Com|ort meosures
c. LrecIhing/fccc| pcinI:/ci:IrccIicn:
-|cLcr sh a kes cre ncrmc|
L. hycrcIhercpy/mc::cge
c. ccIive |i:Iening F/I mcIernc| Lehcvicr:
-0-3 cm: cnIicipcIicn, exciIemenI
-4-7 cm: :ericu:ne::, inIrc:pecIicn
-8-10 cm: irriIcL|e, fcIigue, cmne:ic
c. u:e cf :uppcrI pecp|e



#!
23

5. Fo|n monogement
c. :hcwer:/wcrm cr ccc| pcck:
L. mc::cge
c. crc| meciccIicn:
c. lV cr lM meciccIicn:
e. Epicurc|:

ó. 2
nd
stoge |ntervent|ons
c. rccm preppec fcr ce|ivery
-wcrmer fcr necncIe
-ce|ee :ucIicn if meccnium pre:enI
-pc::iL|e neec fcr Feci
-keep up NFF/8LS :ki||:
L. c::I mcIher wiIh c vcrieIy cf pc:iIicn:
whi|e pu:hing
-:hcrI pu:he: ó-7 :eccnc:
-ccn:icer cpen-g|cIIi: pu:hing
-:¢ucIIing ccn cpen Ihe pe|vi: cn
ccciIicn ' inch
c. c::e:: neec fcr ccciIicn cxygen F/I FHF
Irccing
c. c::e:: mcIernc| VS cnc FHF Irccing: per
hc:piIc| pc|icie:
e. keep Frcvicer cwcre cf pI´: prcgre::
f. ccn:icer |e::ening epicurc| cc:e if
pu:hing effcrI |e:: Ihcn cce¢ucIe
g. prcvicer :hcu|c Le in LDF Lefcre hecc i:
crcwning Ic prcvice :uppcrI fcr perineum
h. c|ecn perineum if re¢ue:I: Ly prcvicer
i. cI ce|ivery, c::I pcrIner wiIh cuIIing cf
umLi|icc| ccrc





#"
24

7. 3
rd
ond 4
th
stoge |ntervent|ons
c. c::I prcvicer wiIh |iccccine/:uIure if
perinec|/vcginc| repcir i: neecec
-epi:icIcmie:: mecicn cr mecic|cIerc|
-|ccercIicn::
1
:I
cegree-:kin, :uperficic|
2
nc
cegree-mu:c|e: cf perineum
3
rc
cegree-Ic cnc| :phincIer mu:c|e
4
Ih
cegree-cnIericr recIc| wc||
L. funcc| ruL pc:I ce|ivery cf p|ccenIc
-wcIch fcr Irick|e/:purI cf L|ccc cnc
chcnge in uIerine :hcpe Ic herc|c
expu|:icn cf p|ccenIc
c. cL:erve fcr neec fcr piIccin/meIhergine
c. prcmcIe Lcncing/Lrec:Ifeecing even
curing repcir
e. ice pcck Ic peri/VS ¢ 15 min/pcin mec:
f. prepcre fcr pc::iL|e Irip Ic CF if p|ccenIc
i: reIcinec {¦ 1 hr)
g. immecicIe newLcrn ccre
-cry cff f|uic:, :kin Ic :kin, :ucIicn mucu:
-ck fcr 3-ve::e| ccrc
-ck phy:icc| c::e::menI/wI./|engIh
-/FG/F :ccre cnc infcnI lD Icg:

V. E|ecIrcnic FeIc| McniIcring-:ki||: |cL

Vl. Fe|cIec Fhcrmccc|cgy-meciccIicn ccmini:IrcIicn ccrc:




01/13


##
1
"#$%&'()$ $#* "#'(+,'()$
Lecture 3
I. Labor Pain
A. Data Collection and Assessment
-. "(/ 0$+)'#+ 123425+ %'6'% $#* 1755'#+ 0$)# %'6'%
898-9 (1$%' 25 120)#& (1$%'
8123425+ %'6'% )( :,'# +,'; 1$# 0$5+)1)0$+' )#
"<=>( :)+,27+ +,' #''* 24 0$)# 3'*(
?. @' $:$5' 24 17%+75$% *)44'5'#1'( )# 5'(02#(' +2
0$)#
8"()$# 0207%$+)2#( 3$; #2+ 'A,)B)+ 0$)# 25 $(/
425 0$)# 3'*)1$+)2#(
8C)(0$#)1 :23'# 3$; B' 6'5; (+2)1 7#+)% D7(+
B'425' +,' *'%)6'5; 24 +,' B$B;
8E)**%' F$(+'5# &5270( 3$; B' 6'5; 621$% )#
5'G7'(+)#& '$5%; 7(' 24 3'*)1$+)2#( 425 0$)#
H. "#A)'+; $#* 4'$5 24 +,' 7#/#2:# 3)&,+
,')&,+'# +,')5 %'6'% 24 0$)#
I. J5'6)27( 'A0'5)'#1'( :)+, 1,)%*B)5+, 25 2+,'5
0$)#47% 0521'*75'( 3$; %'$* +2 ,)&,'5 %'6'%( 24
12#1'5# $B27+ 0$)# 3$#$&'3'#+ #''*(
K. "++'#*$#1' +2 1,)%*B)5+, 1%$(('( 3$; $)* )# +,'
0$+)'#+>( $B)%)+; +2 120' +,527&, 12#+5$1+)2#(

B. First Stage
-. F$5%; 0,$('898H 13
$. #2#0,$53$12%2&)1$% 3'+,2*(
-. 421$% 02)#+(
?. 3$(($&'L127#+'505'((75'
H. ,;*52+,'5$0;L$523$+,'5$0;
I. 37()1
K. B5'$+,)#& +'1,#)G7'(
M. N5$#(17+$#'27( F%'1+5)1$% O'56'
P+)37%$+)2# 7#)+ QNFOPR
S. ,'$+L12%* 0$1/(
T. ,;0#2()(
U. 1,$#&)#& 02()+)2#(L:$%/L521/'5
#$
2

B. 0$)# 3'*)1$+)2#(
-. (,27%* B' *)(1275$&'* $( +,';
127%* (%2: +,' %$B25 0521'((
?. 7(7$%%; 25$%(V
0'5121'+ 6)12*)#L#2512
B'#$*5;% $1'+$3)#20,'#
H. 211$()2#$%%; WEV
3250,)#' :)+, 0,'#'5&$#
?. "1+)6' 0,$('8I8S 13
$. 3$; 7(' 3$#; 24 +,' ($3'
#2#83'*)1$+)2# 1,2)1'( $( $B26'
B. :,'# 0$)# )( 325' )#+'#('X 7(7$%%;
5'G7'(+( WY 3'*)1$+)2#( 425 4$(+
$1+)2#
84'#+$#;%
8#7B$)#
8(+$*2%
1. 3$; $%(2 5'G7'(+ $#* 5'1')6' $# '0)*75$%
$+ +,)( (+$&' )# %$B25

H. N5$#()+)2#$% 0,$('8T8-9 13
$. 3$; 5'G7'(+ '0)*75$%
B. 3$; :$#+ +2 B' 27+ 24 B'* $#* 07(, 2#
+2)%'+ +2 5'%)'6' B$1/$1,'
1. '#1275$&' 02()+)2# 1,$#&'( )4 02(()B%'
*. (,25+ $1+)#& WY #$512+)1( (+)%% 2/ B7+ ,$6'
O$51$# $6$)%$B%' 425 )#4$#+ 5'(7(1)+$+)2#

C. Second Stage
-. E$; 12#+)#7' 07(,)#& :)+, '0)*75$% 0730 2# )4
'4425+( $5' $44'1+)6'
?. E$; 5'1')6' %21$% $#'(+,'()$ 425 5'0$)5 24
0'5)#'$% %$1'5$+)2# 25 '0)()2+23;
H. W4 #2 '0)*75$% )( )# 0%$1'X 3$; 5'1')6' $
07*'#*$% B%21/ :,)1, 5'%)'6' 0$)# )# +,'
6$&)#$X 67%6$X $#* 0'5)#'$% 5'&)2#(
#%
3

D. Third Stage
-. W4 0%$1'#+$ )( 5'+$)#'*X 3$; 5'1')6' WY 0$)#
3'*)1$+)2#( 25 B' 326'* +2 Z[ 425 +:)%)&,+
(%''0
?. \25 %$1'5$+)2#L'0)()2+23; 5'0$)5(X 7(' 24 %21$%
$#'(+,'+)1( 25 07*'#*$% B%21/ Q%'(( 12332#R

II. Adverse Effects of Excessive Pain
A. Physiological effects
-. F44'1+ 2# 1'56)1$% 1,$#&'8325' )# 0$)#X %'((
$B%' +2 5'%$A $#* %'+ +,' %$B25 052&5'((
?. N'#()#& 70 $&$)#(+ +,' 0$)# %'$*( +2 37(1%'
$#* %)&$3'#+ (+5$)#( )# 2+,'5 0$5+( 24 +,' B2*;
H. E$; #2+ /''0 0520'5%; ,;*5$+'* $#* #275)(,'*
[LN +,' )#+'#()+; 24 +,' 0$)#
I. W#$B)%)+; +2 5'%$A B$1/ 37(1%'( $#* *2 *''0
B5'$+,)#& 3$; %'$* +2 *)44)17%+; 0%$1)#&
'0)*75$% 1$+,'+'5

B. Psychological effects
-. ]W 1$#>+ *2 )+^8)#'44'1+)6' 07(,)#& *7' +2 4'$5
24 0$)#
?. )#$B)%)+; +2 3$/' *'1)()2#( [LN 0$)#
H. 3$; B'123' ,2(+)%' +2 (+$44L4$3)%; [LN
)#$B)%)+; +2 120'


III. Factors Influencing Perception of Discomfort
A. Teens and Older Primigravidas
B. Cultures/ Religions
C. Previous experiences with pain
D. Support person
E. Preparatory classes
F. Fetal position-i.e.: OP presentation

#&
4
IV. Pertinent Nursing Diagnoses
A. Pain R/ T physiologic response to labor
-. $(('(( 0$+)'#+>( /#2:%'*&' 24 %$B25 $#*
5'%$A$+)2# +'1,#)G7'(
?. '#1275$&' (70025+ 0'20%' +2 $)* )# 123425+
3'$(75'(
H. +'$1, $%+'5#$+)6' #2#80,$53$12%2&)1$%
3'+,2*( 24 0$)# 5'%)'4
I. $(('(( #''* +2 62)*L*'4'1$+'
K. '#1275$&)#& 5'(+)#& B'+:''# _L`>(
M. /''0 0+. $#* 4$3)%; #2+)4)'* 24 %$B25 052&5'((
S. 244'5 02(()B%' 1,2)1'( 425 0$)# 3'*)1$+)2#( )4
$%% 2+,'5 3'+,2*( ,$6' B''# 7#(711'((47%

B. Other possible nursing diagnoses
-. W#'44'1+)6' $)5:$;
?. \%7)* 62%73' *'4)1)+
H. \'+$% 2A;&'#$+)2#
I. "#A)'+; [LN 0$)#
K. '+1. Q('' 2+,'5( )# B22/R

V. Pharmacological Pain Management
A. Considerations for the Pregnant Patient
-. a,$+ 3'*)1$+)2#( ;27 &)6' +,' 323 ;27 &)6'
+,' 4'+7(
?. E$+'5#$% 12#1'5#( +,$+ (,' :$(#>+
](+52#& '#27&,^ +2 3$/' )+ +,57 :)+,27+
0$)# 3'*(
H. O''* +2 +$0'5 *2($&' +2 +,' 0$+)'#+
I. W4 05'6)27( $B7('5 24 3'*)1$+)2#(X :)%% 0$)# 3'*
'6'# B' '44'1+)6'
K. `7%+75$% B'%)'4(





#'
5
B. Analgesics, sedatives, and adjuncts
-. P'*$+)6'( 3$; B' &)6'# )# '$5%; %$B25 +2 $)*
a)+, (%''0 $#* $#A)'+; B7+ 1$# %'$* +2 $
P%2:)#& 24 +,' %$B25 052&5'(( $#* #2+'*
5'(0)5$+25; *'05'(()2# )# +,' 0$+)'#+ $%2#& :)+,
6$(232+25 *'05'(()2# 24 B2+, 323 $#* 4'+7(.
?. "#$%&'()1(
$. 1$# B' (;(+'3)1 152(()#& +,' B%22*LB5$)#
B$55)'5 $( :'%% $( +,' 0%$1'#+$% B$55)'5
B. WY )( 05'4'55'* 26'5 WE *7' +2 5$0)* 2#('+
B7+ WE 3'*)1$+)2#( %$(+ %2#&'5
1. #$512+)1 123027#*(
8<'3'52%83'0'5)*)#'
8P7B%)3$b'84'#+$#;%
8P+$*2%8B7+250,$#2%
8O7B$)#8#$%B70,)#'
85'(0)5$+25; *'05'(()2#
8+$1,;LB5$*;1$5*)$
*. $#$%&'()1 02+'#+)$+25(
87(7$%%; $#+)'3'+)1( QJ,'#'5&$#X Y)(+$5)%R
8*'15'$(' $#A)'+; $#* $005','#()2#
8,'%0( 5'*71' +,' $327#+ 24 #$512+)1
#''*'* 425 5'%)'4

C. Anesthetics (Regional and General)
-. =21$% B%21/
$. 7(7$%%; 7('* 2# 0'5)#'$% 5'&)2#
B. -c %)*21$)#' 7('*
1. )#D'1+'* )#+2 (/)# $#* (7B17+$#'27(
*. '0)#'0,5)#' 3$; B' $**'* +2 )#+'#()4;
$#'(+,'+)1 $#* *'15'$(' B%''*)#&
?. J7*'#*$% B%21/
$. &2$% +2 $#'(+,'+)b' +,' 07*'#*$% #'56'
%21$+'* #'$5 +,' )(1,)$% (0)#'(
B. 3$; *'15'$(' $B)%)+; +2 B'$5 *2:# [LN
%$1/ 24 ('#($+)2#
1. *2'(#>+ 0526)*' 0$)# 5'%)'4 425 3$#7$%
#(
6
'A+5$1+)2# 24 0%$1'#+$ 25 7+'5)#'
'A0%25$+)2#
H. F0)*75$% B%21/LJ`F"
$. #''*( WY B2%7( B'425' )#('5+)2# [LN
3$+'5#$% ,;02+'#()2# *7' +2
6$(2*)%$+)2#
B. *2#' B; `[O" 25 E<
1. 0+. $:$/' 425 0521'*75'L*'%)6'5;
*. 0+. ()++)#& 70 425 0%$1'3'#+
'. $4+'5 )#('5+)2#X 3$; #''* 45'G7'#+
02()+)2# 1,$#&'( ()*' +2 ()*' +2
/''0 $#'(+,'+)1 %'6'% 'G7$%
4. 05'4'55'* B%21/ N-98P-
&. #''* \2%'; 1$+, )# B%$**'5 *7' +2
)#$B)%)+; +2 4''% :,'# +2 62)*
,. 02(()B)%)+; 24 (0)#$% ,'$*$1,' )4 #''*%'
0%$1'3'#+ )( #2+ 1255'1+
). ($+75$+'( 0$)# 5'1'0+25( B7+ #2+ 32+25
2#'
D. 3$; #''* +2 7(' F0,'*5)#'
Q$ 6$(205'((25R )4 3$+'5#$% @J ¡
/. 7(7$%%; $ %21$% $#'(+,'+)1 $%2#' 25
3)A'* :)+, $ #$512+)1 Q4'#+$#;%X '+1.R
%. 3$; )#15'$(' %$B25 +)3' $#* #''* 425
0)+21)# $7&3'#+$+)2#
3. $#+)'3'+)1(X $#+)0575)+)1(X $#* #$512+)1
$#+$&2#)(+( (,27%* B' ,$#*; +2 +5'$+
02(()B%' ()*' '44'1+( 24 '0)*75$%
#. $( :)+, $#; 3'*)1$+)2#X B' 05'0$5'* 425
02(()B%' ('6'5' $*6'5(' 5'$1+)2#( (71,
$( B52#1,2(0$(3(X (7**'# ¡ )# @JX
*;(0#'$X 25 12#67%()2#(815$(, 1$5+ (,27%*
B' $6$)%$B%' 2# 7#)+

I. P0)#$% B%21/
$. %21$% $#'(+,'+)1 )#+2 +,' =
H
X =
I
X 25 =
K

)#+'5(0$1'÷(7B$5$1,#2)* (0$1'
#)
7
B. 3'*)1$+)2# 3)A'( :)+, `P\8($+75$+'(
0$)# $#* 32+25 5'1'0+25(
1. 7('* 425 1'($5'$# ('1+)2#(
*. 5)(/ 24 (0)#$% ,'$*$1,' *7' +2 %'$/
24 `P\83$; #''* +2 5'3$)# (70)#' 02(+
*'%)6'5;X WY 3$)#+$)#'*X $#* 02(()B%'
B%22* 0$+1,
'. WY B2%7( &)6'# 05)25 +2 0521'*75' [LN
5)(/ 24 3$+'5#$% ,;02+'#()2#X ¡ `ZX
$#* 0%$1'#+$% 0'547()2#
'. 3$+'5#$% @JX 07%('X 5'(0. '4425+X $#* \C[
$5' $(('(('* '6'5; K 3)#7+'( 425 +,' 4)5(+
-K8H9 02(+ )#D'1+)2#

K. d'#'5$% $#'(+,'()$
$. :,)%' 5$5'%; 7('*X 3$; B' #''*'* 425 `LP
)4 7#$B%' +2 $11'(( 5'&)2#$% B%21/ 25 )#
'3'5&'#1; 1$('(
B. OJZX WYX 25$% (2*)73 1)+5$+' B'425' (+$5+
1. [O 3$; B' $(/'* +2 &)6' 15)12)* 05'((75'
+2 $)* $#'(+,'()2%2&)(+ )# +7B' 0%$1'3'#+
*. #253$%%; 5'126'5'* )# J"`_ Q5'126'5; 53R
(2 B2#*)#& :)+, )#4$#+ *'%$;'*
'. ,)&,'5 5)(/ 24 1230%)1$+)2#( 6(. 5'&)2#$%
B%21/(832+,'5 7#12#(1)27( *75)#& B)5+,
24 )#4$#+
4. $( :)+, $%% $#'(+,'()$( 7('* *75)#& `LPX
:'*&' (,27%* B' 0%$1'* 7#*'5 323>(
[ ,)0 +2 *)(0%$1' 7+'57( +2 +,' =
&. B'()*'( `LPX &'#'5$% $#'(+,'()$ 3$; B'
#''*'* *75)#& 3$#7$% 0%$1'#+$ 5'326$%
25 < e `




9-L-H
$*
1
Nur:ing in Ihe Ncrmc| Fuerperium {Ihe pericc cf 42 ccy: pc:I
chi|cLirIh cnc expu|:icn cf Ihe p|ccenIc)
Lecture 4

l. Fhy:ic|cgy cf Ihe puerperium
A. Alterations in the body systems as a result of the birth process
1. FeprccucIive :y:Iem
c. invc|uIicn cf uIeru:-reIurn Ic ncn-pregncnI
:IcIe-ccu:ec Ly ccnIrccIicn: cf uIerine
mu:c|e: {:ize cf c grcpefruiI cfIer 3
rc
:Icge)
L. wiIhin 12 hcur:, funcu: cI U/U
c. funcu: ce:cenc: 1-2 cm/24 hr:
c. uIeru: ncI pc|pcL|e cfIer Ihe º
Ih
FF ccy
e. ¡ in e:Ircgen/prcge:Iercne=cuIc|y:i:
f. :uLinvc|uIicn-fci|ure cf uIeru: Ic reIurn Ic
ncn-pregncnI :IcIe-u:uc||y invc|ve: reIcinec
FCC cr infecIicn
g. cuIer cecicuc :|cugh: cff c: |cchic, inner |cyer
Leccme: new enccmeIrium
h. cxyIccin re|ec:ec frcm piIuiIcry g|cnc he|p:
uIeru: Ic ccnIrccI-¦ wiIh 8F
i. cfIerLirIh pcin: ¦ in mu|Iipcrc:
j. p|ccenIc| :iIe regenercIicn ccmp|eIe cI ó wk:
k. chcnge in |cchic-ruLrc-1-3 ccy:-LrighI rec
:erc:c-3-10 ccy:-pink, Lrcwn
c|Lc-10 cy:-2 wk:-ye||cw, whiIe
|. cervix-Lrui:ec, :cfI, :wc||en-c|c:e: Ly 2 wk:
-exIernc| c:-cppecr: c: jcggec :|iI
m. vcginc-reIurn: Ic prepregncncy :IcIe Ly ó-8 wk:
n. perineum-hec|ing :IcrI Ly 2-3 wk:, ccmp|eIe
wiIhin 4-ó mcnIh:
-Fec
-Ecemc
-Ecchymc:i:
-Drcincge
-/pprcximcIicn
c. ó mcnIh: fcr reIurn cf pe|vic mu:cu|cIure

2. Ccrcicvc:cu|cr
c. CC remcin: e|evcIec fcr 2 week:-12 wk: Lefcre
¡ Ic prepregncncy vc|ue:
L. E8L 300-500 m|-vcginc| LirIh
500-1000m| -C/S

$!
2

c. L|ccc vc|ume increc:ec Ly:
-e|imincIicn cf uIercp|ccenIc| circu|cIicn
-|c:: cf p|ccenIc| encccrine funcIicn which
remcve: :Iimu|u: fcr vc:cci|cIcIicn
-mcLi|izcIicn cf exIrcvc:cu|cr wcIer :Icrec
c. ViIc| :ign::
-Iemp-¦ Ic 38
0
C
/
100
4
F F/I cehycrcIicn
-Fu|:e-¦ 1
:I
hr-reIurn Ic pre-preg. 8-10 wk:
-Fe:p-¡ Ly 8-10 wk:
-8F-mcy hcve crIhc:IcIic hypcIen:icn
e. HgL/HcI:
-1
:I
72 hr:-¦ |c:: cf p|c:mc vc|ume ccmpcrec Ic
F8C´:
-¦ in H & H Ly ccy 7
f. W8C´: mcy ¦ Ic 25-30,000/mm
3

g. Cccg fccIcr:-hypercccgu|cL|e :IcIe mcy |ecc
Ic pc::iL|e IhrcmLcemLc|i:m

3. Gc:IrcinIe:Iinc|
c. ¦ cppeIiIe
L. nc 8M fcr 2-4 ccy: pc:I ce|ivery
-enccurcge cmLu|cIicn
-hycrcIicn
-fiLer
-meciccIicn:, i.e.: :Icc| :cfIener:
c. Ix hemcrrhcic:-ice pcck:, Iuck:, crm
-nc pr mec: if 3
rc
-4
Ih
cegree |ccercIicn
c. Kege| exerci:e: Ic :IrengIhen pe|vic f|ccr

4. Fenc|
c. reIurn: Ic ncrmc| funcIicn 1 mcnIh cfIer LirIh
-L|cccer Icne reIurnec Ly 5-7 ccy:
L. ciure:i:-frcm f|uic reIenIicn, piIccin, eIc
c. exce::ive vcginc| L|eecing mcy Le ncIec if
L|cccer i: c||cwec Ic geI ci:Iencec wiIh urine

5. Mu:cu|c:ke|eIc|
c. jcinI: :IcLi|ize ó-8 week: pc:I LirIh
L. mcy hcve permcnenI increc:e in :hce :ize
c. mcy hcve :epcrcIicn cf :ymphy:i: puLi: cr
recIu: cLccmini:


$"
3

ó. lnIegumenIcry
c. ch|cc:mc {mc:k cf pregncncy) u:uc||y fcce:
Ly enc cf pregncncy
L. hyperpigmenIcIicn cf crec|ce cnc |inec nigrc
mcy ccnIinue
c. mcy ncIe perfu:e cicphcre:i: pc:I ce|ivery

7. Encccrine
c. Expu|:icn cf p|ccenIc=¡ in e:Ircgen, ccrIi:c|
prcge:Iercne, cnc hFL {hCS)
|humcn p|ccenIc| |ccIcgen/humcn chcricnic
:cmcIcmcmmcIrcpin]
-rever:e cicLeIcgenic effecI-|cwer 8S |eve|
L. if 8F-¦ prc|ccIin |eve|: fcr ó week:
if LcII|e-fec-¡
-u:uc||y mecn: |cIer cvu|cIicn in |ccIcIing
wcmen

8. F:ychc:ccic|
c. pcrenI´: cccepIcnce cf infcnI´: neec: cnc
cLi|iIie:
L. neec Ic |ecrn cue:, uncer:Icnc emcIicnc|
:IcIe:
c. Lcncing-prcximiIy, Icuch, vcice, inIerccIicn
c. icenIify infcnI c: cn incivicuc| yeI pcrI cf Ihe
whc|e fcmi|y
e. muIuc|iIy-infcnI´: Lehcvicr: :Iimu|cIe mcm´:
f. mcy fee| cIIrccIec Ic c|erI, re:pcn:ive infcnI
cnc repe||ec Ly irriIcL|e, ci:inIere:Iec infcnI
g. cIIcchmenI cccur: mcre recci|y wiIh Ihe
infcnI whc:e IempercmenI, :ccic| ccpcLi|iIie:,
cppecrcnce, cnc :ex fiI pcrenI´: expecIcIicn:
h. neec Ic c::e:: mcIher-infcnI ccmmuniccIicn
i. Lehcvicr:
-enIrcinmenI-mcving in Iime wiIh ccu|I :peech
-LicrhyIhmiciIy-:ccIhec Ly mcm´: hecrILecI
-reciprcciIy-re:pcnc: Ic cue:
-:ynchrcny-muIuc||y rewcrcing
-engrc::menI-inIere:I in LcLy Ly fcIher




$#
4

j. mcIernc| ccju:ImenI:
-Icking in-fir:I 24 hr:-fccu: cn :e|f cnc Lc:ic neec
DepencenI, pc::ive
-Icking hc|c-|c:I 10 ccy: Ic :everc| week:-fccu:
cn ccre cf LcLy cnc ccmpeIenI
mcIhering-cepencenI
-|eIIing gc-fccu: cn fcrwcrc mcvemenI cf
Ihe fcmi|y uniI
k. FF L|ue:- 707 cf wcmen-mccc :wing:, cnger,
cepre::icn, |eIccwn, fcIigue, in:cmnic,
H//´:, weepine:: (resolves in 10-14 days)
|. FF cepre::icn-7-307-mcre :evere :yncrcme
-cepre::icn, fee|ing cf fci|ure cverwhe|ming
gui|I, |cne|ine::

ll. Nur:ing Frcce::
A. Data collection/ Assessment
1. ViIc| :ign:
2. Funcu:
c. ck funcc| |cccIicn, Icne, |cchic
L. hcve pI empIy L|cccer Lefcre excm
3. 8|cccer
c. c::e:: fcr ci:IenIicn
L. mec:ure fir:I vcic: unIi| 500 m| {vcicec cuI)
c. ccIheIerize if neecec
4. Ferineum
c. if repcir ccne, c::e:: :iIe fcr inIccIne::, ecemc,
hemcIcmc:, recne::, cr crcincge {FEED/)
L. c::e:: fcr pre:ence cf hemcrrhcic:
5. 8rec:I:
c. ncIe if Lrec:I cre fi||ing-pc|pcIe
L. ncIe cny recne::, :crene::, crccking cf
nipp|e:

B. Nursing Diagnoses
1. Fi:k fcr f|uic vc|ume ceficiI
2. /|IercIicn in urincry e|imincIicn
3. Fcin
4. FcIigue
5. lneffecIive Lrec:I feecing
ó. SiIucIicnc| |cw :e|f-e:Ieem
7. /nxieIy cue Ic |cck cf kncw|ecge Lc:e
8. eIc.
$$
5

C. Interventions
1. ScfeIy
c. infcnI lD Lcnc:
L. crienIcIicn Ic uniI
c. :Icff picIure lD´:
c. mcve infcnI in criL
2. SIcnccrc preccuIicn:
c. wc:h hcnc: Lefcre hcnc|ing LcLy
L. chcnge |inen:
c. prcper hygiene
c. u:e cf :¢ueeze LcII|e fcr peri ccre
e. wiping frcnI Ic Lcck
f. Iecch pI cLcuI funcc| mc::cge
g. u:e cf pepperminI cr running wcIer Ic cic in
vcicing Ic prevenI urincry reIenIicn
h. u:e cf ice pcck: fcr Ihe fir:I 12 hcur: pc:I
repcir cf peri Ihen in:IrucI cn u:e cf :iIz LcIh
i. :¢ueeze LuIIcck: IcgeIher when :iIIing cr ri:ing
frcm c chcir Ic he|p keep repcir inIccI
j. wecr gccc :uppcrIive Lrc
k. u:e |cnc|in crm Ic prevenI crccking cf nipp|e:
|. wcrm pcck: Lefcre Lrec:I feecing, ccc| pcck:
pc:I
m. wc|k c: :ccn c: pc::iL|e-he|p: wiIh gc: pcin:
n. Icke pcin mec: prn
c. enccurcge ruLe||c vcccine if ncn-immune
pt should prevent getting pregnant for at least
4 weeks post vaccination
p. Iccp-FerIu::i:-
¢. rhcgcm given Ic Fh - mcm: whc hcc Fh+ LcLie:

lll. Ecr|y Di:chcrge
A. Candidates and criteria
1. NewLcrn:´ cnc McIher:´ Hec|Ih FrcIecIicn /cI cf 1ººó
c. 48 hcur: minimum pc:I vcginc| ce|ivery
L. ºó hcur: minimum pc:I C/S
c. pI cnc cccIcr mcy cgree cn ecr|ier D/C
2. McIernc| criIeric fcr ecr|y D/C
c. VSS
L. vcicing
c. HgL >10
c. nc L|eecing
e. in:IrucIicn: cn :e|f-ccre
$%
6


3. lnfcnI criIeric fcr ecr|y D/C
c. Ierm infcnI
L. VSS
c. ncrmc| phy:icc| c::e::menI
c. cI |ec:I 2 :ucce::fu| feecing:
e. cI |ec:I 1 vcic cnc 1 cefeccIicn
f. nc jcuncice
g. circ :iIe ck
h. newLcrn L|ccc/hecring :creening: ccne
i. fc||cw-up in 1 week
j. mcIernc|/infcnI Iecching ck|i:I ccmp|eIec

lV. Ccre cf Ihe Ce:crecn 8irIh FcIienI
A. Assessment / Interventions
1. VS every 15 min X 1hcur, 30 min X 1 hcur, Ihen per
hc:piIc| prcIccc|
2. mcniIcr l & C´:-neec UC cI |ec:I 30 m|/hr
3. c::e:: cLccminc| cre::ing fcr crcincge
4. c::e:: neec fcr pcin meciccIicn
5. c::e:: funcc| |cccIicn, Icne, cnc |cchic
{:Ii|| hcve 3 ci:IincI |cchic :Icge:)
ó. cmLu|cIe c:cp
7. c::e:: fcr pc::cge cf gc:-ccvcnce cieI c: Ic|ercIec
8. C & D8-mcy u:e in:pircmeIer

B. Nursing diagnoses
1. F|uic vc|ume ceficiI
2. Fcin
3. Fi:k fcr infecIicn
4. Fi:k fcr injury
5. /nxieIy F/I :urgery, feIc| we||-Leing
ó. SiIucIicnc| |cw :e|f-e:Ieem

C. Possible post-op complications
1. CV-hemcrrhcge, :hcck, cvI
2. Fu|m-emLc|u:, pnemcIhcrcx
3. Gl-pcrc|yIic i|eu:
4. GU-renc| fci|ure, hemcIuric, UIl, c|iguric
5. Feprcc-enccmeIriIi:, emLc|i
ó. Skin-wcunc infecIicn, cehi:cence


$&
7


V. Ccre cf Ihe LccIcIing Wcmcn
A. Physiology of Lactation
1. Femc|e Lrec:I hc: 15-20 |cLe: ccnIcining c|vec|i
{Ihe mi|k prccucing ce||:)
2. c|vec|i÷cucIu|e:÷|ccIifercu: cucI:÷nipp|e
3. ¡ e:Ircgen & prcge:Iercne pc:I ce|ivery=¦ prc|ccIin
|eve|: which remcin cLcve Lc:e|ine Ihru curcIicn cf
|ccIcIicn {highe:I |eve| i: cI ccy 10)
4. Frc|ccIin:
-highe:I |eve| cI ccy 10
-i: prccucec in re:pcn:e Ic infcnI´: :ucking
-prcmcIe: mi|k prccucIicn Ly :Iimu|cIing c|vec|cr ce||:

B. Other hormone changes/ reflexes
1. CxyIccin re:pcn:iL|e fcr |eI-ccwn ref|ex
nipp|e :Iimu|cIicn÷piIuiIcry prccuce: cxyIccin÷
mcke: ce||: crcunc Ihe c|vec|i ccnIrccI÷:enc: mi|k Ic
nipp|e
2. Nipp|e erecIicn ref|ex
infcnI crie: cr ruL: cgcin:I Ihe Lrec:I÷nipp|e Leccme:
erecI÷prcpu|:icn cf mi|k

C. Supply/ demand
1. Fir:I mi|k cc||ec cc|c:Irum
c. rich in immuncg|cLin:
L. higher ccncenIrcIicn cf prcIein cnc minerc|: Ic
mcIure mi|k LuI |e:: fcI
c. prcmcIe: grcwIh cf LccIcLcci||u: Lifice: in Gl
2. lf infcnI i: we|| ncuri:hec, wi|| :ee ó-8 weI cicper: cnc
3 :Icc|: in 24 hcur: cI ccy 5 cf Lrec:Ifeecing
3. lnccmp|eIe empIying ccn |ecc Ic ¡ mi|k :upp|y
4. wcIch fcr infcnI grcwIh :purI:
-10 ccy:
-3 week:
-ó week:
-3 mcnIh:
-4.5-ó mcnIh:

D. Maternal nutrition/ considerations
1. ccc ccciIicn 200-500 cc|crie:/cy whi|e Lrec:Ifeecing
2. crink 2-3 |iIer: cf f|uic cci|y
3. ccnIinue cn FN ViIcmin: cnc ircn c: cirecIec
$'
8
4. wcIch fcr engcrgemenI/p|uggec mi|k cucI:/
:cre nipp|e/mcni|ic| {yec:I) infecIicn:/mc:IiIi:

Vl. Ccre cf Ihe Wcmcn/NecncIe Fcrmu|c-fec
A. Formula types
1. ccmmercic| fcrmu|c: primcri|y ccw-mi|k Lc:ec LuI
:cy cnc cIher :pecic|Iy fcrmu|c: cvci|cL|e
2. mcy Le in pcwcerec, ccncenIrcIec, cr reccy Ic ecI

B. Common problems
1. pc:iIicning-neec Ic mcke :ure mi|k ccver: nipp|e crec
2. wcrming-never micrcwcve LcII|e
3. prcpping-ccn´I |ecve infcnI uncIIencec whi|e feecing

C. Nutritional requirements
1. fir:I ccy-cn|y give 7.5-15 m| fcrmu|c cI cne Iime
-Iheir eye: cre Ligger Ihcn Iheir :Icmcch:
2. u:uc||y feec every 2-4 hcur:
3. :cme infcnI: :wc||cw cir c: Ihey feec-Lurp Iheml
4. Ly 1 week cf cge, LcLie: wi|| Le crinking 700-º00 m|
in 24 hcur:
*bottle fed because-returning to work, +HIV, mastectomies,
adopted infant, maternal medications

Vll. CcnIrccepIicn EcuccIicn
A. Considerations for Choosing a Method
1. re:umpIicn cf :exuc| ccIiviIie: :hcu|c wciI 2-3 week:
Ic cecrec:e ri:k frcm infecIicn
2. Le:I Ic u:e ccnccm:/fccm cI Ihi: Iime
3. when ci:cu::ing ccnIrccepIicn wiIh ycur cccIcr,
-ccIicn
-:cfeIy
-effecIivene::
-ccnvenience
-cvci|cLi|iIy
-expen:e
-per:cnc| preference

B. Methods (failure rates listed within 1
st
year of use)
1. CciIu: inIerrupIu: {wiIhcrcwc|)
-ccIicn-prevenI: ferIi|izcIicn
-:cfeIy-nc prcIecIicn frcm SIl´:
-ccnvenience/cvci|cLi|iIy-gccc
-expen:e-N//
$(
9


2. FerIi|iIy cwcrene:: meIhcc:
-periccic cL:Iinence-nc :ex 4 ccy: Lefcre cnc 4 ccy:
cfIer cvu|cIicn
-rhyIhm-Lc:ec cn 3-4 cyc|e:-u:e :hcrIe:I cnc |cnge:I
-88I-:|. ¡ Iemp Lefcre cvu|cIicn {0.05
0
C) Ihen ¦
0.3-0.ó
0
C
-cervicc| mucu:-ck fcr chcnge:-cmI. cnc ccn:i:Iency
-:ympIcIhermc|-ccmLc cf 88I cnc cervicc| mucu:
-cvu|cIicn kiI:-ceIecI :urge in LH IhcI cccur: cpprcx.
12-24 hcur: Lefcre cvu|cIicn

3. 8crrier meIhcc:
c. spermicides
-ccIicn-phy:icc|/chemicc| Lcrrier Ic :perm
-:cfeIy-mcy prcvice :cme prcIecIicn frcm SIl´:
-ccnvenience-neec: Ic p|ccec Lefcre ccI
-cvci|cLi|iIy-gccc if IhcughI cf in ccvcnce
-expen:e-checp
L. condoms
-ccIicn-phy:icc| Lcrrier Ic :perm
-:cfeIy-prcIecI cgcin:I SIl´:/HlV if u:ec prcper|y
-effecIivene::-ccn ¡ fci|ure rcIe wiIh u:e
cf :permicice:
-vaginal sheath/ condom
c. diaphragm
-ccIicn-mechcnicc| Lcrrier Ic :perm
-:cfeIy-:ee ccnccm:, :mc|| cmI cf cc:e: wiIh
ISS-Icxic :hcck :yncrcme
-effecIivene::-neec: Ic Le fiIIec Ic wcmcn´:
cncIcmy, neec: Ic Le u:ec wiIh
:permicice
-ccnvenience-mcy Le p|ccec ó hcur: Lefcre
inIerccur:e LuI mu:I Le |efI in fcr ó hcur:
pc:I ccI, ccciIicnc| :permicice ecch Iime
-cvci|cLi|iIy-MD cppI
-expen:e-cffcrccL|e
c. cervical cap/ sponges
-cervicc| ccp neec: fiIIing
-mu:I ck pc:iIicn cf ccp Lefcre inIerccur:e
-fci|ure rcIe in pcrcu: wcmen-407
-:pcnge-mci:Ien wiIh wcIer Lefcre in:erIicn
-hcve :permicice
$)
10
-ri:k cf ISS if ncI remcvec cfIer 24 hcur:

4. Hcrmcne:
c. cver 30 cifferenI fcrmu|cIicn:
L. mcy hcve e:Ircgen/prcge:Iin cr cn|y prcg.
c. mcy Le crc|, :uLcermc| imp|cnIcIicn, lM,
vcginc|
c. prevenI pregncncy Ly :Icpping cvu|cIicn cr
prevenIicn cf imp|cnIcIicn
e. cc ncI prcIecI cgcin:I SIl´:
f. ncI reccmmencec fcr :cme wcmen
-h/c IhrcmLcemLc|ic
-:mcker
-h/c e:Ircgen cepencenI Iumcr:
-h/c C/D
-h/c impcirec |iver
-cver Ihe cge cf 35
-HIN
g. mini pill {prcge:Iin-cn|y)
-prcL|em: wiIh irregu|cr men:e:
h. injectable progestin-Depo Provera
-injecIec ¢ 11-13 week:-mcy neec cppI.
-¦ ri:k cf vencu: IhrcmLc:i:
i. implanted progestin-Nexplanon
-gccc fcr 3 yecr:
-imp|cnIec in crm
-nc SIl prcIecIicn
j. Emergency contraception
Plan B-levonorgestrel
-neec: Ic u:ec wiIhin 72 hcur: cf unprcIecIec
inIerccur:e
-prevenI: cvu|cIicn/imp|cnIcIicn
-º07 effecIive
-CIC-mu:I Le cI |ec:I 17 yecr: c|c Ic purchc:e
Ella-non-hormonal
-neec: Ic u:ec wiIhin 120 hcur:
-neec: Fx
-º07 effecIive
IUD insertion
-ºº7 effecIive if in:erIec wiIhin 5-7 ccy:




%*
11

5. lnIrcuIerine Device:
c. u:uc||y I-:hcpec
L. |cccec wiIh eiIher ccpper cr |evcncrge:Ire|
c. mcy Le u:ec fcr 5 yr {hcrmcne)-10 yr: {ccpper)
c. prevenI: ferIi|izcIicn
e. Mirena (hormone IUD)-he|p: Ic cimini:h men:e:
f. Copper “T”-gccc chcice fcr wcmen cver 35,
:mcker:, h/c C/D, HIN
g. ncI reccmmencec fcr wcmen wiIh:
-h/c FlD
-:u:pecIec pregncncy
-Ieen:
-h/c ci:IcrIec uIerine ccviIy
-h/ o multiple partners

ó. SIeri|izcIicn
c. femc|e:
- Li|cIerc| IuLc| |igcIicn
-:urgicc| prccecure
-expen:e u:uc||y higher Ihcn vc:ecIcmy
-e|ecIrccccgu|cIicn, |igcIicn, Lcncec,
cru:hec, cr p|uggec
-nc prcIecIicn cgcin:I SIl´:
-:hcu|c Le ccn:icerec permcnenI
-infcrmec ccn:enI neecec cI |ec:I 72
hcur: Lefcre prccecure
-eSSUFE
-ccne in c|inic cr CF
-u:e: wcIer Ic vi:uc|ize fc||cpicn IuLe
mecIu:
-cci| p|ccec cnc Ii::ue cc||ecI: cn cci|
crecIing c L|cckcge
-HSG perfcrmec cI 3 mcnIh: Ic e:IcL|i:h
c|c:ure
-Lcck-up 8C meIhcc u:ec curing Ihi:
pericc
L. mc|e:-vc:ecIcmie:
-ccne in c|inic: uncer |ccc| cne:IheIic
-vc: ceferen: cre |igcIec/ccuIerizec
-Icke: mu|Iip|e ejccu|cIicn: Ic c|ecr
remcining :perm frcm vc: ceferen:


%!
12

BIRTH CONTROL COMPARISONS
FAILURE
RATES
MECHANISM OF ACTION STD USER
method of
birth control
perfect
use
actual
use
prevents
fertilization
prevents
implantation
postpone
sex
protectioncontinuation
rates
No Method 85 85
Spermicides 18 29 ++++ + 42
Male Condoms 2 15 ++++ ++ 53
Female Condoms 5 21 ++++ ++ 49
Diaphragm 6 16 ++++ + 57
Cervical FemCap
w/o prior pregnancy
4 14 ++++ + 57
Sponge
w/o prior pregnancy
9 16 ++++ + 57
Sponge
w/ prior pregnancy
20 32 ++++ + 46
Ovulation Method 3 22 +++ + 51
Sympto-Thermal 2.5 16 +++ + 51
Standard Days
Method
5 12 +++ +
Calendar Method 5 13-20 +++ + 51
Lactation (LAM) 0.5 6 ++++
Withdrawal 4 27 ++++ + 43
Oral Contraceptives0.3 8 +++ + 68
Ortho Evra Patch 0.3 8 +++ + 68
Nuva Ring 0.3 8 +++ + 68
Shot (Depo-
Provera)
0.3 3 +++ + 56
Shot (Lunelle) 0.05 3 +++ + 59
IUD (ParaGard
Copper)
0.8 0.6 ++ ++ 80
IUD (Mirena) 0.1 0.1 ++ ++ 80
Abstinence 0 0 ++++ ++++ ++++
For added protection against pregnancy, you can use more than one method of
contraception at a time. For example, many clinicians recommend that when using
condoms, spermicides be used as well. If a woman is allergic to spermicides she can use
a natural method and a condom and for extra protection. Any of these combinations will
reduce the predicted failure rate
%"
1
Nur:ing Ccre cf Ihe Ncrmc| NewLcrn
!"#$%&" (

l. Ircn:iIicn Ic exIrcuIerine |ife
)* +",-.&/$0&1 #2/34", /$ 5.&$2
1. Deve|cpmenI cf Ihe Lung:
c. whi|e c feIu:, re:p. IrccI prccuce: feIc| |ung
f|uic IhcI expcnc: c|vec|i
L. c: Ierm cpprccche:, f|uic :IcrI: Ic mcve Ic Ihe
inIer:IiIic| :pcce:
c. :hifI cf f|uic he|p: Ic ¡ pu|mcncry re:i:Icnce Ic
L|ccc f|cw-pre:enI Lefcre LirIh cnc enhcncec
wiIh LrecIhing cf cir
c. mcIure |ung prccuce: :urfccIcnI-nc :urfccIcnI
|ecc: Ic c|vec|i cc||cp:ing wiIh exhc|cIicn
-:ufficienI :urfccIcnI Ly 34-3ó week:

2. lniIicIicn cf re:pircIcry effcrI
c. fir:I LrecIhe: re¢uire grecIer pre::ure Ic cpen
c|vec|i
L. 62"7.#/8-ccrcIic cnc ccrIic chemcrecepIcr:
re:pcnc Ic chcnge: in L|ccc chemi:Irie::
¡pH, ¡pC
2
, ¦pCC
2
-:Iimu|cIe re:pircIcry cIr.
in mecu||c
c. 92"&7/8-:kin :en:cr: re:pcnc Ic :uccen chcnge
in IempercIure-impu|:e: IhcI :Iimu|cIe re:p. cIr.
c. :"#2/3.#/8-che:I ccmpre::icn fcrce: f|uic cuI
inIc upper cirwcy:-expe||ec wiIh LirIh, pre::ure
re|ec:ec, ccu:e: cir inIc |ung:-c|:c he|pec wiIh
IccIi|e :Iimu|cIicn, |ighI:, nci:e:

3. Ncrmc| Fe:pircIcry EffcrI
c. cnce c|vec|i cpenec, :urfccIcnI he|p: Ic keep
Ihem cpen
L. circu|cIcry cnc |ymphcIic :y:Iem: cL:crL mcvec
feIc| |ung f|uic
c. ccmp|eIe cL:crpIicn cf f|uic Ly 24 hr:-ce|cyec
cL:crpIicn ncIec in C/S ce|iverie:
c. cfIer iniIic| Icchypnec, re:p. rcIe i: u:uc||y
LeIween 30-ó0 LrecIh:/min-mcy Le irregu|cr

4. Fe:pircIcry Di:Ire::-&";"&," 0< $2" /50;"


%#
2

=* 6/&>.0;/,#%8/& $&/3,.$.03
1. cir inf|cIe: Ihe |ung:÷¡ pu|mcncry vc:cu|cr re:i:Icnce÷
¡ pu|mcncry crIery pre::ure÷¡ in pre::ure in Ihe F
cIrium÷¦ pu|mcncry L|ccc f|cw Ic L :ice cf hecrI÷
¦ Ihe pre::ure in Ihe L cIrium=funcIicnc| c|c:ing cf Ihe
fcrcmen cvc|e {funcIicnc||y c|c:ec-1-2 hr:,
cncIcmicc||y c|c:ec-30 mcnIh:

2. in uIerc, feIc| pC
2
i: 27 mm HG-cfIer LirIh, pC
2
A Ic
50 mm Hg in Ihe crIeric| L|ccc÷ccn:IricIure cf Ihe
cucIu: crIeric:u:-funcIicnc| c|c:ure in 10-24 hr:
-permcnenI c|c:ure in 3-4 week:

3. pu|mcncry L|ccc ve::e|: ci|cIe in re:pcn:e Ic C
2

feIc| |ung f|uic mcve: inIc Ihe inIer:IiIic| :pcce:
?/31 @
A
B>%#$%, >.8/$",C -%8703/&1 ;",,"8, #03,$&.#$D

4. c|cmping cf Ihe umLi|icc| ccrc c|c:e: Ihe umLi|icc|
crIerie:, umLi|icc| vein, cnc cucIu: venc:u: which
ccnverI inIc |igcmenI:-fiLrc:i: wiIhin 2 mcnIh:

ll. Neurc|cgicc| cccpIcIicn
)* 92"&70&"4%8/$.03
1. newLcrn´: cLi|iIy Ic prccuce hecI i: cfIen = Ic ccu|I:
LuI hcve c Iencency Icwcrc: rcpic hecI |c::

2. hecI |c:: frcm: Ihin :kin, |iII|e :uL C fcI, L|ccc ve::e|:
c|c:e Ic :urfcce, hecI ec:i|y Ircn:ferrec frcm inIernc|
Ic :kin

3. 3x Ihe Lccy :urfcce Ihcn ccu|I:=4x hecI |c::

4. f|exec pc:iIicn he|p: pre:erve hecI-prcL|em wiIh
premie: i: pccr mu:c|e Icne |ecc: Ic |e:: f|ex

5. ";/-0&/$.03-hecI |c:: Ihru weI :kin expc:ec Ic cir
-cry LcLy immecicIe|y cI LirIh

ó. #03>%#$.03-|c:: cf hecI frcm Lccy :urfcce Ic ccc|er
:urfcce in cirecI ccnIccI
-wcrm L|cnkeI, :kin-Ic-:kin ccnIccI


%$
3
7. #03;"#$.03-hecI Ircn:ferrec Ic ccc|er cmLienI cir
-keep cuI cf crcfI:, wrcp in L|cnkeI wiIh hcI cn hecc

8. &/>./$.03-Ircn:fer cf hecI Ic ccc|er cLjecI ncI in
cirecI ccnIccI wiIh infcnI
-keep criL: cwcy frcm cuIer winccw:

º. Ihermcgenei:
c. E03,2.;"&.34 $2"&704"3",., ?EF9D
-&.7/&.81 Ihru Lrcwn fcI { high|y vc:cu|cr fcI
fcunc cn|y in infcnI: wiIh cLunccnI :upp|y cf
L|ccc ve::e|:/nerve encing:, fcunc cI neck,
kicney:, ccrenc|:, :Iernum cnc inIrc:ccpu|cry
regicn)÷hecI prccucec Ly |ipic meIcLc|ic
ccIiviIy ÷ wcrm LcLy ?-&"$"&7 .3</3$, 8/#G
5&0H3 </$D
L. ,"#03>/&.81 Ihru increc:ec meIcLc|ic ccIiviIy in
|iver, Lrcin, cnc hecrI
c. ,2.;"&.34 Legin: when Ihermc| recepIcr: in :kin
ceIecI c crcp in Ihe :kin Iemp-rcre in necncIe:

10. cc|c :Ire::-
c. ¦ meIcLc|i:m = ¦ neec fcr C
2
cnc g|ucc:e
regcrc|e:: cf ge:IcIicnc| cge cr ccnciIicn
L. if prc|cngec-|ecc: Ic re:p. cifficu|Iy
c. C
2
ccn:umpIicn civerIec frcm mcinIcining
Lrcin/hecrI funcIicn Ic Ihermcgene:i:
c. cecrec:ec pu|mcncry perfu:icn mcy |ecc Ic cn
cpen cucIu: crIeric:u:
e. hypcg|ycemic
f. fcIIy ccic: re|ec:ec = meIcLc|ic ccicc:i:
g. fcIIy ccic: in L|ccc ccn inIerfere wiIh
Li|iruLin Ircn:pcrI = ri:k fcr jcuncice

=* +"<8"I",
1. Mcrc {:IcrI|e)
U:uc||y pre:enI fcr fir:I 3-4 mcnIh:

2. Fc|mcr, p|cnIcr grc:p
Finger:/Ice: cur| crcunc excminer´: finger:
pc|mcr |e::en: Ly 3-4 mcnIh:
p|cnIcr Ly 8 mcnIh:


%%
4
3. Icnic neck
fencing pc:iIicn
ccmp|eIe re:pcn:e gcne Ly 3-4 mcnIh:

4. Sucking cnc rccIing
hecc Iurn: Icwcrc: :Iimu|u: cnc :uck:

6* F"3,0&1 />/-$/$.03
1. Vi:icn
c. cI LirIh, mu:c|e: in eye crec cre immcIure
{Ircn:ienI :IrcLi:mu:)
L. c|ecre:I vi:icn wiIhin 10-20 inche:
c. :en:iIive Ic |ighI
c. cI 5 ccy: c|c, cIIrccIec Ic L|cck/whiIe pcIIern:
e. cL|e Ic :ee cc|cr: cI 2 mcnIh:
f. Iecr g|cnc: ceve|cpec Ly 2-8 week:
g. Ly ó mcnIh:, Iheir vi:uc| ccuiIy i: ½ cf ccu|I:
h. prefer pcIIern: Ic p|cin :urfcce:
i. eye cc|cr wi|| ncI Le :eI unIi| 3-12 mcnIh:

2. Hecring
c. |ike cn ccu|I´: cfIer crcining cf cmnicIic f|uic
L. |cuc :cunc: mcke LcLy hcve :IcrI|e ref|ex
c. cecrec:e mcIcr ccIiviIy in pre:ence cf |cw
fre¢uency :cunc: :uch c: c hecrILecI
c. hecring |c:: i: c ccmmcn mcjcr cLncrmc|iIy
1-3/1000 ncrmc| Ierm infcnI: hcve Li|cIerc|
hecring |c::

3. Icuch
c. re:pcn:e: Ic Icuch cn c|| pcrI: cf Ihe Lccy
L. fcce, hcnc:, :c|e: Leing mc:I :en:iIive

4. Ic:Ie
c. ccn ci:Iingui:h Ic:Ie:
L. prefer g|ucc:e wcIer Ic p|cin wcIer

5. Sme||
c. reccI Ic :Ircng cccr: Ly Iurning hecc cwcy
L. ccn cifferenIicIe Iheir mcIher´: Lrec:I mi|k Ly
:me||



%&
5
lll. HemcIc|cgicc| cccpIcIicn
)* E"03/$/8 >.<<"&"3#",
1. F8C´: cnc H & H
c. cI LirIh, |eve|: cre higher Ihcn ccu|I:
-HgL-14-24 g/c|
-HcI-44-ó47 if > ó57 = pc|ycyIhemic
-F8C-5.1-5.3/mm
3
-1
:I
24-48 hr: cf |ife
{necncIc| F8C´: hcve c |cwer :urvivc| rcIe
ccmpcrec Ic ccu|I:)÷phy:ic|cgicc| cnemic
c. ce|cy cf ccrc c|cmping :hifI: p|c:mc Ic
exIrcvc:cu|cr :pcce: wiIh ¦ |cL re:u|I:

2. LeukccyIe:
c. W8C º-30,000 per mm
3
i: ncrmc| cI LirIh
L. wi|| ri:e Ihen cec|ine Ic c |eve| cf 11,500
c. infecIicn ncI we|| Ic|ercIec in infcnI: wiIh
:ep:i: u:uc||y ccccmpcniec Ly c |c:: in W8C

3. F|cIe|eI:
c. 200,000-300,000/mm
3

L. fccIcr: ll, Vll, lX, cnc X cecrec:ec cue Ic |cck
cf ViIcmin K-ncI ccu|I |eve| unIi| < º mcnIh:

4. 8|ccc Grcup:
c. ccrc L|ccc :cmp|e Icken Ic ceIermine infcnI´:
L|ccc grcup cnc Fh :IcIu:
L. Fh neg mcm´: receive Fhcgcm if Fh + LcLy

5. 8|ccc Vc|ume
c. 80-85 m|/kg
L. cI LirIh, L|ccc vc|ume cpprcx. 300 m|
c. preIerm: hcve grecIer L|ccc vc|ume cue Ic
c grecIer p|c:mc vc|ume, ncI F8C mc::

ó. HecrI rcIe cnc 8F
c. HF cvercge: cI140 LecI:/min cI LirIh
L. ri:e: ju:I cfIer LirIh
c. fu|| Ierm infcnI: HF LeIween 120-1ó0 LI/min
c. FMl {pcinI cf mcximc| impu|:e) |efI che:I
{cpicc| pu|:e)
e. ½ cf hecrI murmur: hecrc cI LirIh ci:cppecr Ly
ó mcnIh:
f. 8F cvercge: 50-80/35-50 mm Hg

%'
6
lV. Mu:cu|c:ke|eIc| Sy:Iem
)* J"/> /3> %--"& 50>1
1. cI LirIh, mcre ccrIi|cge Ihcn Lcne

2. fcce |cck: :mc|| in re|cIicn:hip Ic :ku|| F/I mc|cing
{cver|cpping cf Ihe :ku|| Lcne:)

3. fcnIcne||e:
c. cnIericr c|c:e: cI 12-18 mcnIh:
L. pc:Iericr c|c:e: cI 8-12 week:
c. Lu|ging fcnIcne||e: mecn ¦ lCF
c. :unken fcnIcne||e: mecn cehycrcIicn

4. #&/3.0,$"30,.,-ccnIrccIec :ku|| cue Ic premcIure
c|c:ure cf Ihe crcnic| :uIure:-neec :urgery

5. CcpuI :ucceccneum
c. ecemc cf Ihe :cc|p
L. mcy crc:: :uIure |ine:
c. ci:cppecr: in 1-4 cy:

ó. Cephc|chemcIcmc
c. cc||ecIicn cf L|ccc LeIween Ihe :ku|| Lcne cnc
Ihe peric:Ieum-cce:n´I crc:: :uIure |ine:
L. mcy Le :pcnIcnecu: cr cue Ic vccuum cr
fcrcep: ce|ivery
c. re:c|ve: in 2-4 week:
c. mcy |ecc Ic jcuncice

7. neck/:hcu|cer:
c. :hcu|cer cy:Iccic÷ Lrcchic| p|exu: injury
-fx cf :ccpu|c cr c|cvic|e {c|cvic|e i: Ihe mc:I
ccmmcn|y fx Lcne curing ce|ivery prcce::)
-immcLi|ize in c :|ing

=* KI$&"7.$.",
1. crm:
c. ErL´: pc|:y-injury Ic Lrcchic| p|exu: = pcrc|y:i: cf
cffecIec crm/:hcu|cer
-f|cccic crm wiIh cL:ence Mcrc cn cffecIec :ice
-immcLi|ize crm LuI fc||cw exerci:e regimen



%(
7
2. hcnc:
c. pc|ycccIy|-exIrc finger:
L. :yncccIy|-fu:ec finger:
c. :imicn crec:e fcunc cn pc|m: {cnc :c|e: cf
feeI)÷fre¢uenI|y pre:enI in chi|cren wiIh Dcwn´:

3. hip:
c. ccn hcve ccngeniIc| hip cy:p|c:ic-hecc cf Ihe
femur :|ip: cuI cf Ihe cceIcLu|um
L. CrIc|cni´:/8cr|cw´: mcneuver-|i:Ien/fee| fcr c
c|ick
c. Lreech ce|iverie:-higher ri:k
c. mcy neec Ic ccuL|e cr Irip|e cicper

4. feeI
c. pc|y/:yncccIy|
L. c|uL fccI-pc:iIicnc| cr cc:Iec Ic he|p rcIcIe

6* )#$.;.$1 /3> :%,#8" 903"
1. :pcnIcnecu:, Ircn:ienI mcIcr funcIicn
-if f|cccic, F/C cny LirIh injurie:

2. Ircn:ienI Iremcr: ncrmc| LuI if per:i:IenI, mcy Le
pcIhc|cgicc|

3. wcIch fcr f|exicn cnc exIen:icn cf c|| exIremiIie:

V. Gc:IrcinIe:Iinc|
)* :0%$2L$2&0/$
1. muccu: memLrcne: cf mcuIh mci:I cnc pink if
cce¢ucIe|y hycrcIec

2. check fcr inIccIne:: cf hcrc cnc :cfI pc|cIe:

3. mcy finc Ep:Iein´: pecr|:-reIenIicn cy:I:-:mc|| whiIe
crec: cI gum mcrgin: cnc juncIicn cf pc|cIe:
-if crec very hcrc Ic Icuch, ¢ue:Iicn pc::iL|e IccIh
{mcre ccmmcn in :cme cu|Iure:)

4. mcy ncIe :ucking L|i:Ier: {cc||u:e:)

5. :ucking Lehcvicr i: inf|uencec Ly neurcmu:cu|cr
mcIuriIy, mcIernc| meciccIicn: cI LirIh, cnc Iype
cf iniIic| feecing
%)
8

ó. infcnI uncL|e Ic mcve fccc frcm |ip: Ic phcrynx-
neec Ic p|cce nipp|e ceep in:ice mcuIh

7. check fcr Icngue-Iiec-mcy neec frenu|um cuI

8. peri:Ic|Iic ccIiviIy cf e:cphcgu: i: uncccrcincIec cI
LirIh

=* F$07/#2
1. ccpcciIy vcrie: frcm 30-º0 m| cepencing cn :ize cf
infcnI

2. ccrcicc :phincIer i: immcIure-mcy hcve regurg

3. gc:Iric empIying Iime: vcry-effecIec Ly Iype cf
cf feecing, IempercIure cf fccc, vc|ume

4. ccn cecrec:e regurg Ly cvcicing cverfeecing,
Lurping cfIer ecIing, cnc infcnI pc:iIicning

6* M3$",$.3",
1. nc LccIeric in inIe:Iine: cI LirIh

2. u:uc||y hecr Lcwe| :cunc: cfIer 1 hcur cf |ife

3. cfIer LirIh, cir cnc LccIeric enIer Ihe crifice:

4. highe:I LccIeric| ccnIenI in |cwer inIe:Iine

5. ncrmc| cc|cn LccIeric e:IcL|i:hec in 1
:I
week
which he|p: :ynIhe:ize ViI. K, fc|cIe, cnc LicIin

N* N.4",$.;" K3O17",
1. fu|| Ierm newLcrn: ccpcL|e cf :wc||cwing, cige:Iing,
meIcLc|izing, cL:crLing prcIein: cnc :imp|e ccrL:, cnc
emu|:ifying fcI:

2. cige:Iive enzyme: nece::cry Ic cige:I :imp|e CHC,
prcIein:, cnc fcI: cre pre:enI Ly 3ó-38 week:

3. cmy|c:e-ncI prccucec unIi| 3 mcnIh:-:c|ivcry g|cnc:
ó mcnIh:-pcncrec:
-uncL|e Ic ccnverI :Icrch Ic mc|Ic:e
&*
9

4. |ipc:e-neecec fcr cige:Iicn cf fcI-neec: Ic Le
prccucec Ly pcncrec:

K* F$008 -/$$"&3,
1. meccnium-fir:I :Icc|:
c. fi||ec wiIh cmnicIic f|uic cnc iI: ccn:IiIuenI:,
inIe:Iinc| mucu: {Li|iruLin), cnc ce||:
L. greeni:h L|cck-mcy hcve cccu|I L|ccc
c. iniIic||y :Ieri|e Ihen ccnIcin: LccIeric
c. u:uc||y fu||y pc::ec in 24 hcur:

2. ¬ cf :Icc|: vcry-ecr|y feecing: = :ccner :Icc|

3. Ircn:iIicnc| :Icc|:-greeni:h Lrcwn÷ye||cwi:h Lrcwn
Ihick÷Ihin, wcIery

4. mi|k :Icc|:
c. Lrec:Ifec-ye||cw Ic gc|cen, pc:Iy, cnc cccr |ike
:cur mi|k
L. LcII|efec-ye||cw-|ighI Lrcwn, firmer, cccrcu:

Vl. HepcIic Sy:Iem
)* !.;"& <%3#$.03 /8$"&/$.03,
1. hepcIic :y:Iem re:pcn:iL|e fcr
c. mcinIencnce cf L|ccc :ugcr
L. ircn :Icrcge
c. crug meIcLc|i:m
c. Li|iruLin ccnjugcIicn
e. cccgu|cIicn

2. g|ucc:e
c. 1/3 cf :Icre: c: g|yccgen in |iver
L. neec ccn:IcnI :upp|y fcr Lrcin
c. L|ccc g|ucc:e |eve|: :IcLi|ize cI
50-ó0 mg/c| cfIer ce|ivery
c. Ly ccy 3, ó0-70 mg/c|
e. iniIicIicn cf feecing c::i:I in :IcLi|izing
newLcrn´: g|ucc:e |eve|:
f. newLcrn´: increc:ec energy neec: in
fir:I 24 hcur: cf |ife ccn rcpic|y cep|eIe
g|yccgen :Icre:


&!
10
g. ri:k fcr hypcg|ycemic
-LG/´:-exce:: in:u|in u:e: up g|ucc:e
-SG/´:, premie:-|cck cce¢ucIe Lrcwn fcI
cnc g|yccgen :Icre:
-IrcumcIic ce|iverie:
-c:phyxic
h. :/: cf hypcg|ycemic
-jiIIerine::
-re:pircIcry ci:Ire::
i. Ix cf hypcg|ycemic
-feecing:
-lV Ihercpy

3. ircn :Icrcge
c. feIc| |iver Legin: :Icring ircn in uIerc
L. prcpcrIicnc| Ic IcIc| Lccy HgL ccnIenI
cnc ge:IcIicn cge
c. cI LirIh, hcve encugh ircn :Icrec fcr 4-ó mcnIh:

4. cccgu|cIicn
c. cccg fccIcr: :ynIhe:izec in |iver÷ViI. K
L. Ircn:ienI L|ccc cccgu|cIicn ceficiency ccy: 2-5
c. ViI. K injecIicn he|p: prevenI c|cIIing prcL|em:
c. prencIc| ci|cIin/phencLcrL÷cLncrmc| c|cIIing

5. ccnjugcIicn cf Li|iruLin
c. Li|iruLin-ye||cw pigmenI cerivec frcm HgL
re|ec:ec wiIh Lreckccwn cf F8C´:/mycg|cLin
L. HgL i: ccnverIec Ic Li|iruLin in unccnjugcIec
fcrm ?303B"I#&"$/58" <0&7DB-0$"3$./8 $0I.3
c. unccnjugcIec Li|iruLin-in:c|uL|e, Lcunc Ic
circu|cIing c|Lumin-ccn permecIe Ic cIher
crec: {c|:c cc||ec incirecI Li|iruLin)
c. in Ihe |iver÷enzyme g|ucurcny| Ircn:ferc:e÷
ccnjugcIe: Li|iruLin {ncw cc||ec cirecI Li|i)
-:c|uL|e, excreIec frcm |iver ce||:÷Li|e
e. excreIec Ihru urine cnc fece:
f. IcIc| Li|i i: Ihe :um cf LcIh |eve|: cf ccnjugcIec
cnc unccnjugcIec Li|i
g. fccIcr: IhcI ¦ Li|i
-exce:: prccucIicn cf F8C´:
-F8C´: |ife :hcrIer-mcre Lreckccwn
-|iver immcIure
-pccr/ce|cyec feecing:-5&"/,$<"">.34 P/%3>.#"
&"
11
-IrcumcIic ce|ivery
-fcIIy ccic:-Linc wiIh c|Lumin in:Iecc cf Li|i

=* J1-"&5.8.&%5.3"7./L-21,.0804.#/8 P/%3>.#"
1. Cccur: 507 in fu|| Ierm:, 807 in premie:

2. incicence i: increc:ec in cerIcin ncIicnc|iIie:
c. /:icn:
L. NcIive /mericcn:
c. E:kimc:

3. necncIc| jcuncice i: ccn:icerec Lenign un|e:: ¦ |eve|:
|ecc Ic pcIhc|cgicc| ccnciIicn:

4. iI´: phy:ic|cgicc| jcuncice if:
c. infcnI i: we||
L. jcuncice cppecr: cfIer 24 hcur: cnc enc: Ly
Ihe enc cf ccy 7
c. :erum ccncenIrcIicn cf unccnjugcIec Li|i
-|e:: Ihcn 12 mg/c| in Ierm LcLy
-|e:: Ihcn 15 mg/c| in premie
c. c|mc:I exc|u:ive|y unccnjugcIec Li|i
-cirecI Li|i cce:n´I exceec 1-1.5 mg/c|
e. cci|y incremenI: in Li|i cce:n´I :urpc:: 5 mg/c|

5. Feec ecr|y Ic keep :erum Li|i |cw

ó. if hyperLi|iruLinemic i: ncI rever:ec, ccn |ecc Ic
G"&3.#$"&%,-precipiIcIicn cf Li|iruLin in neurcnc| ce||:
|eccing Ic cereLrc| pc|:y, epi|ep:y, cnc menIc|
reIcrccIicn

Vll. GeniIcurincry :y:Iem
)* )3/$071
1. cI Ierm, kicney: Icke up crec cf Ihe pc:Iericr cLc.
wc||

2. L|cccer c|c:e Ic cnIericr cLccminc| wc|| |ying in LcIh
Ihe cLccmen cnc Ihe pe|vi:

3. cI Ierm, hcve c fu|| ccmp|emenI cf funcIicning
nephrcn:


&#
12

=* Q0.>.34
1. L|cccer ccpcciIy- ó-44 mL: cI Ierm

2. fre¢uency cf vcicing vcrie: frcm 2-ó Iime:/24 hcur:
Ic 5-25 Iime: curing Ihe 3
rc
ccy

3. |imiIec ccpcLi|iIy Ic ccncenIrcIe urine
-cL|e Ic ccncenIrcIe urine Ly cge 3 mcnIh:

4. urine u:uc||y :Ircw-cc|crec cnc c|mc:I cccr|e::

5. mcy :ee pink :Icin: frcm p:euccmen:e: cr uric ccic
cry:Ic|:

ó. |c:: cf f|uic Ihru urine, fece:, |ung:, increc:ec
meIcLc|i:m, cnc |imiIec f|uic inIcke ccn re:u|I in
wI. |c:: cf 5-107 ncrmc||y

6* R8%.> /3> K8"#$&081$" =/8/3#"
1. 407 Lccy wI. i: exIrcce||u|cr f|uic: {ccu|I: cre 207)

2. newLcrn: inIcke cnc excreIe ó00-700 m| wcIer
=507 cf exIrcce||u|cr f|uic

3. GFF i: 30-507 cf cn ccu|I:

4. ¡ GFF = ¦ wc:Ie: cnc niIrcgencu: in :y:Iem

5. ¡ Nc recL:crpIicn = ¦ |eve|: cf Nc, phc:phcIe:, C|,
cnc crgcnic ccic:

N* S"3.$/8,
1. Femc|e:
c. in fu|| Ierm gir|:
-|cLic mcjcrc |crge cnc ccver |cLic mincrc
-mcy Le ccrk in pigmenI
-vcginc| cr hymenc| Icg: cre ccmmcn
-vernix mcy Le pre:enI LeIween |cLic
-mcy hcve muccu:y ci:chcrge
-mcy hcve fc|:e pericc {p:euccmen:e:)


L. in preIerm gir|:
&$
13
-c|iIcri: i: prcminenI
-|cLic mcjcrc cre :mc|| cnc wice|y :epcrcIec

2. Mc|e:
c. Ie:Ie: in :crcIum in º07 cf mc|e:
L. Ly yecr 1, incicence cf crypIcrchici:m i: < 17
c. IighI prepuce {fcre:kin) i: ccmmcn
c. :megmc mcy Le fcunc uncer fcre:kin
-Iecch Lcy: cI 3-4 yecr: c|c Ic reIrccI cnc c|ecn
uncer fcre:kin
e. evc|ucIe fcr hypc cr epi:pccic:
f. :crcIum mcre ceep|y pigmenIec cnc wiIh ceep
rugce in pc:I Ierm infcnI:
g. circumci:icn-per:cnc| ceci:icn
-mcy recuce UIl´:
-mcy recuce SIl´:
-mcy recuce peni|e C/
-ccne cn 8
Ih
ccy uncer Jewi:h fciIh
-ccmp|iccIicn:-hemcrrhcge, infecIicn

Vlll. lnIegumenIcry :y:Iem
)* Q"&3.I #/,"0,/
1. whiIe, chee:e-|ike :uL:Icnce

2. he|p: Ihe :kin reIcin mci:Iure

3. pre:enI mcre in premie:

=* !/3%40
1. fine, ccwny-|ike hcir

2. he|p: keep mci:Iure in :kin

3. :een |e:: in fu|| Ic pc:I Ierm infcnI:

6* N",T%/7/$.03
1. pee|ing cf Ihe :kin

2. :een mcre in pc:I ccIe infcnI:

N* =.&$27/&G,
1. Mcngc|icn :pcI:
c. L|ue-L|cck crec: cf pigmenIcIicn
L. mcre ccmmcn cn |cwer Lcck cnc LuIIcck:
&%
14
c. mcre ccmmcn in ccrk :kinnec ncIicnc|iIie:
c. mcy fcce cver mcnIh: cr Le permcnenI

2. Nevi-
c. 9"8/34."#$/$.# 3";.BF$0&G 5.$",
-cre pink cnc ec:i|y L|cnchec
-cppecr cn upper eye|ic:, nc:e, upper |ip,
|cwer cccipuI Lcne, cnc ncpe cf neck
-u:uc||y fcce LeIween 1-2 yecr:
L. E";%, ;/,#%80,%,- F$&/H5"&&1 7/&G
-mcy Le rci:ec cnc Le LrighI cr ccrk rec
-mcy |c:I Ihru chi|chccc
c. E";%, <8/77"%,B U0&$BH.3" ,$/.3
-rec Ic purp|e, ncne|evcIec
-vcrie: in :hcpe, :ize, cnc |cccIicn
-cc ncI L|cnch ncr fcce wiIh Iime
-if neurc|cgicc| prcL|em: exi:I-\ fcr SIurge-WeLer
:yncrcme

3. EryIhemc Icxicum
c. Ircn:ienI rc:h c|:c kncwn c: 'f|ec-LiIe rc:h"
L. IhcughI Ic Le c inf|cmmcIcry re:pcn:e
c. u:uc||y nc c|inicc| :ignificcnce cnc neec: nc Ix

lX. lmmune :y:Iem
)* E"03/$/8 #03,.>"&/$.03,
1. ce||: IhcI prcvice infcnI wiIh immuniIy cre pre:enI LuI
ncI ccIivcIec fcr Ihe fir:I :everc| mcnIh: cf |ife

2. fcr fir:I 3 mcnIh: cf |ife, pc::ive immuniIy frcm mcIher

3. immuncg|cLu|in:
c. lg/
-ccn´I crc:: p|ccenIc
-ncI prccucec in uIerc
-cc|c:Irum i: high in lg/
-:IcrI prccucing cLcuI 4 week: cf cge
L. lgG
-ccn crc:: p|ccenIc
-pc::ive immuniIy frcm mcm-pc::ec in 3
rc
A
-very ccIive cgcin:I LccIeric| Icxin:
c. lgM
-prccucec Ly feIu: in uIerc
-recch ccu|I |eve|: cI º mcnIh: c|c
&&
15
c. lg/, lgD, cnc lgE grccuc||y prccucec
e. cc|c:Irum cnc Lrec:I mi|k ccrry immuniIy

X. F:ychc:ccic| /ccpIcIicn
)* ="2/;.0&/8 ,$/$",
1. lnfcnI: ciffer in Iheir ccIiviIy |eve|:, feecing/:|eep
pcIIern:, cnc re:pcn:ivene::

2. 1
:I
pericc cf reccIiviIy-fir:I 30 minuIe: cf |ife
c. cwcke cnc c|erI
L. mcy hcve irregu|cr re:p. rcIe wiIh crcck|e:
c. grunIing, f|cring, reIrccIicn:
c. mcy hcve pericc: cf cpnec
e. :IcrI|e ec:i|y
f. cecrec:e in Lccy Iemp
g. increc:e in mcIcr funcIicn
h. mcy Le prc|cngec in Ierm infcnI: wiIh cLncrmc|
|cLcr cr LirIh Ircumc:

3. S|eep pericc-unre:pcn:ivene::-2-4 hcur:
c. HF ¡ 100-120
L. FF :|cw-irregu|cr

4. 2
nc
pericc cf reccIiviIy-4-ó hcur:
c. Icchyccrcic, Icchypnec
L. ¦ mu:c|e Icne, :kin cc|cr, mucu: prccucIicn
c. pc::cge cf meccnium

5. S|eep/wcke :IcIe:
c. 2 :|eep :IcIe:
-ceep :|eep
-|ighI :|eep-FEM
L. 4 wcke :IcIe:
-crcw:y
-¢uieI c|erI/wice cwcke
-:mi|e, vccc|ize, :ynchrcny Ic vcice:
-wcIch & re:pcnc Ic Iheir pcrenI:´ fcce:
-ccIive c|erI
-crying

ó. Furpc:efu| Lehcvicr:
c. wiIhcrcwc| Ly ¦ phy:icc| ci:Icnce
L. pu:h cwcy wiIh hcnc:/feeI
c. ¡ :en:iIiviIy Ly fc||ing c:|eep
&'
16
c. geI fu::y cr cry c: c :ignc|
e. Ierm infcnI: LeIIer cI :e|f-¢uieIing cLi|iIie:

Xl. Ccre cf Ihe NewLcrn
)* ),,",,7"3$
1. /::e:: viIc| :ign:, c::ign cpgcr :ccre:
c. Iemp-Icken cxi||cry
L. c::e:: cpicc| pu|:e
c. cu:cu|IcIe |ung: cnc :ucIicn if mci:I

2. Mec:uremenI:
c. weighI in pcunc: cnc grcm:
L. LengIh-u:uc||y 18-22 inche:
c. hecc circumference-u:uc||y 33-3ó cm

3. ChcrI if vcicing cr pc::ing meccnium

4. /cmini:Ier meciccIicn:
c. eryIhrcmycin cinImenI-CU
L. ViI. K lM
c. Hep. 8 vcccine-lM
c. H8lG lM-if neecec

5. /::e:: mcIher´: cLi|iIy Ic Lrec:I feec

ó. Fu|| hecc Ic Ice: c::e::menI cfIer Lcncing

7. Feview mcIernc| chcrI
c. ° infecIicn cI Iime cf ce|ivery
L. meciccIicn: given Ic mcIher
c. F/C h/c :uL:Icnce cLu:e

8. NewLcrn nuIriIicn
c. necncIe: neec 110 kcc|/kg/cy
L. cI 3 mcnIh:, 100 kcc|/kg/cy
c. wcnI Ic :ee ó-10 weI cicper:/cy

º. /::i:I wiIh circumci:icn if re¢ue:Iec
c. mincr :urgicc| prccecure-:Ieri|e Iech.
L. cfIer prccecure, infcnI Ic mcIher
c. Iecch pcrenI: ccre cf circ :iIe

10. Hcme ccre in:IrucIicn:
01/13
&(
1
Ihe High Fi:k NewLcrn
Lecture 6

l. Leve|: cf Ccre fcr Ihe High Fi:k NewLcrn
A. Assessment for need of NICU/ tertiary care center
1. mcIernc| Ircn:pcrI wiIh feIu: in uIerc preferrec
c. cecrec:e: necncIc| mcrLiciIy/mcrIc|iIy
L. mcIher cnc infcnI ncI :epcrcIec cI LirIh

2. if uncL|e Ic Ircn:pcrI Lefcre ce|ivery:
c. ncIify :upervi:cr cf neec fcr Ircn:fer Iecm
L. hcve emergency per:cnne| Ic :IcLi|ize LcLy

B. Transfer/ multidisciplinary approach
1. Ircn:fer Iecm ccn:i:I: cf:
c. MD´:
L. FN´:
c. FI´:

2. keep pcrenI: unccIec cn infcnI´: ccnciIicn
c. Iecch cLcuI e¢uipmenI he|ping LcLy
L. :IcrI ci:chcrge Iecching ecr|y

3. geI mcIher cnc infcnI IcgeIher /S/F

4. Ic|k cLcuI pc::iLi|iIy cf reIurn Ic primcry cenIer cf ccre
c. mcy Le frighIenec Ic mcve LcLy cgcin
L. mcy fee| in:ecure wiIh chcnge in :Icff

ll. Ihe FreIerm NecncIe
A. Risk Factors
1. Lefcre 37 week:, |cck :ufficienI crgcn mcIuriIy

2. |cck cce¢ucIe re:erve: cf Lcci|y nuIrienI:

3. |cw SES cf Ihe mcIher

4. expc:ure Ic envircnmenIc| ccnger:, l.E. Icxic chemicc|

5. pre-exi:Iing mcIernc| ccnciIicn:-hecrI ci:ec:e,
cicLeIe:, eIc

ó. mcIernc| cge cnc pcriIy

&)
2
7. mecicc| ccnciIicn: F/I Ihe pregncncy-GDM, FlH,
infecIicn

8. cL:IeIricc| ccmp|iccIicn:-ccrc prc|cp:e, cLrupIic
p|ccenIc

B. Physical characteristics and system alterations
1. Fe:pircIcry
c. cI 22 week: ge:IcIicn, :urfccIcnI Legin:
prccucIicn
L. 24-2ó week:-incce¢ucIe c|vec|cr :ize cnc
:urfccIcnI
c. 27-28 week:-c|vec|i :IcrI Ic cpen, :urfccIcnI
incce¢ucIe
c. 2º-30 week:-grcwIh cf c|vec|i cnc :urfccIcnI
|eve|
e. 34-3ó week:-mcIure c|vec|i, :urfccIcnI |eve|
cce¢ucIe
(surfactants-surface- active phospholipids
lecithin-increases after 24 weeks
sphingomyelin- constant amount
when L/ S ratio is 2:1=lungs mature)
f. ncIicecL|e cycnc:i:, reIrccIicn:, grunIing,
cecrec:ec Ii::ue perfu:icn
g. cpneic epi:cce:-15-20 ce::cIicn cf LrecIhing

2. CV
c. ¡ pu|mcncry crIeric|e mu:cu|cIure
L. ¡ pu|mcncry vc:cu|cr re:i:Icnce÷¦ L÷ F
c. :hunIing Ihru cucIu: crIeric:u:÷ inIc |ung:
c. ¡ 8F, ¡ ccp refi|| Iime, ¦ re:p. ci:Ire::

3. Ihermcregu|cIicn
c. |cck g|yccgen :Icre: in |iver-crecIec in 3
rc
/
L. ¡ Lrcwn fcI
c. |crger Lccy :urfcce
c. pc:Iure cf exIen:icn
e. |e:: cL|e Ic ¦ meIcLc|i:m fcr hecI

4. Gl
c. pccr gcg, :uck, :wc||cw-cccrcincIec cfIer
34 week:
L. inccmpeIenI ccrcicc :phincIer
c. :mc|| :Icmcch ccpcciIy
'*
3
c. ¡ Li|e ccic:, pcncrecIic |ipc:e = ¡ cL:crpIicn
cf nuIrienI:, mc|cL:crpIicn
e. nuIriIicnc| |c:: c::ccicIec wiIh vcmiIing/cicrrhec
f. wcrk cf :ucking = ¦ 8MF, ¦ C
2
u:cge
g. feecing inIc|ercnce

5. Fenc|
c. cI 35 week:, kicney: hcve |imiIec cLi|iIy Ic ci|uIe
cr ccncenIrcIe urine
L. ¡ GFF :eccnccry Ic renc| L|ccc f|cw
c. cI ri:k fcr ecemc {cverhycrcIicn) cr cehycrcIicn
c. ¡ Luffering = ccicc:i:
e. |cnger Ic excreIe crug: frcm Ihe :y:Iem

ó. HepcIic
c. ¡ g|yccgen :Icre: = hypcg|ycemic
L. ¡ ircn :Icre:
c. impcirec ccnjugcIicn cf Li|iruLin

7. lmmunc|cgic
c. ccn´I receive pc::ive immuniIy
L. lgG-ncI unIi| |c:I Irime:Ier

8. HemcIc|cgic
c. increc:ec ccpi||cry fricLi|iIy
L. Iencency Ic L|eec
c. L|ccc |c:: frcm fre¢uenI |cL wcrk
c. ¡ prccucIicn cf F8C´:

º. CNS
c. high ri:k cf Lrcin hemcrrhcge frcm Ihin, frcgi|e
ve::e| wc||:
L. up Ic 34 week:, Ihe germinc| mcIrix |ine: Ihe
venIric|e:
c. LirIh ccmcge Ic immcIure :IrucIure:
c. mcy hcve Leen expc:ec Ic recurrenI cncxic
epi:cce:

10. Fi:k cf infecIicn
c. Ihin, frcgi|e :kin
L. fricL|e L|ccc ve::e|:
c. ¡ :Icrcge cf immuncg|cLu|in:
c. incLi|iIy Ic mcke cnIiLccie:

'!
4
11. F|uic/e|ecIrc|yIe:
c. neec 80-150 kcc|/kg/cy-¦ Ihcn Ierm infcnI:
L. neec prcIein 3-4 g/kg/cy-Ierm 2-2.5g
c. neec ccciIicn ircn, cc|cium, K
c. u:uc||y geI :upp|emenIc| ViI. E {mu|Ii viIcmin)

C. Common complications of Preterm
1. FcIenI DucIu: /rIeric:u:
c. ncIicecL|e Ly Dcy 3
L. FDS imprcve:
c. L ÷ F
c. increc:e: pu|mcncry L|ccc f|cw
e. L venIricu|cr fci|ure
f. pu|mcncry ecemc
g. CHF
-S & S
ccnIinucu:/:y:Ic|ic murmur
Lcuncing pu|:e:
Icchyccrcic
Icchypnec
hepcIcmegc|y
-Ix
echcccrcicgrcm
re:IricI f|uic-give ciureIic:
inccmeIhccin-0.2 mg/kg
-:Iimu|cIe: c|c:ure cf cucIu:
:urgery

2. /pnec
c. ce::cIicn cf LrecIhing > 20 :eccnc:
L. u:uc||y cccur: < 3ó week: ge:IcIicn
c. F/I immcIure nervcu: :y:Iem
c. mcy Le F/I
Iemp in:IcLi|iIy
mcIernc| crug: in |cLcr
h/c mcIernc| crug cLu:e
infecIicn
meIcLc|ic ci:crcer:
c:phyxic
cLccminc| ci:IenIicn




'"
5

e. c::e::menI
-cL:erve LrecIhing pcIIern
-:Iimu|cIe-:|cp :c|e: cf feeI
-:ucIicn-u:e wiIh free-f|cw cxygen
wcIch fcr cu:ky, cycnc:i:, Lrccyccrcic
-prepcre fcr pc::iL|e inIuLcIicn
-Ihink pc::iL|e :epIic wcrkup
f. Ix
-cxygen per crcer-u:uc||y :IcrIec if FcC
2
<º27
wcrmec cnc humicifiec
nc:c| ccnnu|c, hccc, FFV, EI IuLe
Danger- excessive oxygen can lead to
retinopathy of prematurity or
bronchopulmonary dysplasia
-repcrI /8G chcnge:
-Ihecphy||ine-CNS :Iimu|cnI-:Iimu|cIe: re:p cIr
re|cxe: :mccIh mu:c|e cf Lrcnchic| cirwcy
cnc pu|mcncry L|ccc ve::e|:
-:urfccIcnI ccmini:IrcIicn
-ECMC NOT u:ec wiIh premie: cue Ic ri:k cf
inIrcvenIricu|cr hemcrrhcge

3. lnIrcvenIricu|cr Hemcrrhcge-mc:I ccmmcn Iype cf
inIrccrcnic| hemcrrhcge
c. mc:I :u:cepIiL|e-< 1500 gm:, < 34 week:
L. Iriggerec Ly
hypcxic
nc vencu: pre::ure chcnge:
¦ c:mc|criIy in L|ccc-cveru:e cf vc|ume
expcncer:
c. S &S
-hypcIcnic -hypcIen:icn
-|eIhcrgy -meIcLc|ic ccicc:i:
-Iemp in:IcLi|iIy -:eizure:
-ny:Icgmu: -|cw HcI
-Lu|ging fcnIcne||e: -cpnec
-cecereLrcIe pc:Iuring
c. Ix
-Ix Ihe :ympIcm:
-phencLcrL-:eccIive, ¡ :eizure ccIiviIy
-:eric| :pinc| Icp:
-VF :hunI
-mcin|y cL:ervcIicnc| cnc :uppcrIive ccre
'#
6

4. FeIincpcIhy cf FremcIuriIy {FCF)
c. cI ri:k cI < 3ó week:, < 1500 gm:
L. higher ri:k-<1000 gm:
c. cxygen Ien:icn: Icc high mcy |ecc Ic
vc:cccn:IricIicn
c. cI Ihe enc cf cxygen Ihercpy:
vc:cu|crizcIicn cf reIinc÷ccn:IricIicn cf ve::e|:÷
ci:inIegrcIicn cf ve::e|:÷new ve::e|:÷rupIure÷
reIinc| hemcrrhcge÷:ccr Ii::ue÷ceIcchmenI÷
L|incne::
e. c::e::menI
-cphc|mc:ccpe excm-4-ó week:
-:cme ccmcge mcy :pcnIcnecu:|y hec|
f. Ix
-|c:er phcIccccgu|cIicn
-ViI. E Ihercpy
-cecrec:e cmLienI |ighI
-circumferenIic| crycpexy

5. 8rcnchcpu|mcncry Dy:p|c:ic
c. ccu:ec Ly LcrcIrcumc: frcm pre::ure venIi|cIicn
cnc cxygen IcxiciIy
L. eIic|cgy i: mu|IifccIcric|
c. S & S
-Icchypnec -reIrccIicn:
-nc:c| f|cring -¦ wcrk Ic LrecIh
-Icchyccrcic
c. Ix
-cxygen -nuIriIicn
-f|uic re:IricIicn
-meciccIicn:: ciureIic:, :Iercic:, Lrcnchcci|cIcr:
e. key mcncgemenI i: Ihru prevenIicn
f. if unIrecIec-ccn |ecc Ic cecIh frcm ccrcic-
re:pircIcry fci|ure

ó. NecrcIizing EnIerccc|iIi:
c. inf|cmmcIcry ci:ec:e cf Gl mucc:c
L. ccu:e: unkncwn-up to 25-30% mortality rate
c. ccnIriLuIing fccIcr:
-c:phyxic -U/C -infecIicn
-FD/ -FDS -cnemic/i:chemic
-ccngeniIc| hecrI ci:ec:e
-ecr|y enIerc| feecing:
'$
7
c. Lrec:Ifec LcLie: hcve |cwer ri:k cf NEC
e. S & S
-hypcIcnic -cecrec:ec ccIiviIy
-recurrenI cpnec -pc||cr
-cecrec:ec perfu:icn -hypcIen:icn
-Iemp in:IcLi|iIy -cycnc:i:
-cLccminc| ci:IenIicn -cicrrhec
-vcmiIing L|ccc/Li|e
f. Dx
-x-rcy
-|cL repcrI:
-cLncrmc| e|ecIrc|yIe |eve|:
g. Ix
-mcin|y :uppcrIive
-nc feecing:-re:I Ihe guI-Irying prcLicIic:
-u:e cf IFN
-Ix cf infecIicn
-:urgicc| ci::ecIicn cf perfcrcIec/ceIericrcIec
crec

7. CIher neurc|cgicc| ccncern:
c. hecring-1:50 |c:: cf hecring
-¦ ri:k F/I ccngeniIc| viru:
-perincIc| c:phyxic
-LirIh Ircumc
-cerIcin meciccIicn:-genIcmycin
L. :peech impcirmenI:
c. cereLrc| pc|:y
c. hycrccephc|u:
e. :eizure ci:crcer:
f. |cwer lC´:
h. |ecrning ci:cLi|iIie:

D. Nursing Care
1. MeIhcc: cf feecing
c. cepenc cn ge:IcIicnc| cge, phy:icc| ccnciIicn,
neurc :IcIu:
L. nipple feeding-34 week: ck
-neec cccrcincIec :uck cnc :wc||cw
-neec: Ic hcve gcg ref|ex, FF < ó0, cnc :Ieccy
wI. gcin



'%
8
c. gavage-< 34 week: ge:IcIicn
-u:ec if infcnI hc:
pccr gcg/:wc||cw
neurc in:u|I
|c:ing wI. cue Ic energy expenciIure
c. TPN-cenIrc| cr peripherc| |ine:
e. lipids-peripherc|, nc fi|Ier
f. f|uic re¢uiremenI:
-80-100 m|/kg/cy-Dcy 1
-100-120 m|/kg/cy-Dcy 2
-150 m|/kg/cy-Dcy 3
-grccuc||y increc:e

2. /::e::menI:
c. viIc| :ign:-wcIch fcr Iemp fcr hecI |c::
L. urine-ck prcIein, g|ucc:e, SG
c. :IricI l & C
-wcIch fcr vcmiIing, cicrrhec
-wcIch lV :iIe fcr infi|IrcIicn
c. wcIch fcr gc:Iric re:icuc| ¦ 2 m|
e. gucicc :Icc|:
f. c::e:: fcr cLccminc| ci:IenIicn

3. Gcc|:
c. mcinIencnce cf re:pircIcry funcIicn
L. mcinIencnce cf neuIrc| Ihermc| envircnmenI
c. mcinIencnce cf f|uic/|yIe:
c. prevenIicn cf infecIicn
e. prevenIicn cf fcIigue
f. cce¢ucIe nuIriIicn
g. prcmcIicn cf cIIcchmenI
i. prcmcIicn cf :en:cry :Iimu|cIicn

lll. Dy:mcIure NecncIe:
A. Care of the Post Term Neonate
1. FrcL|em:
c. pc:I mcIuriIy :yncrcme
L. hypcg|ycemic-cep|eIec g|yccgen :Icre:
c. meccnium c:pircIicn-:Ire::
c. pc|ycyIhemic-¦ F8C prccucIicn F/I hypcxic
e. ccngeniIc| cncmc|ie:-unkncwn
f. :eizure ccIiviIy-F/I hypcxic
g. cc|c :Ire::-F/I |e:: :uL C fcI

'&
9
2. /::e::menI
c. pc:I mcIuriIy :yncrcme
-cry, crcck|ing :kin -mec :Icining
-|cng fingernci|: -prcfu:e :cc|p hcir
-wc:Iec cppecrcnce
L. meccnium c:pircIicn :yncrcme
-wcIch fcr mec :Icinec infcnI
-mcy ncI :hcw :ign: cf re:p. cepre::icn cI LirIh
-if mec migrcIe: Ic Ierminc| cirwcy:-Leccme:
meccnium c:pircIicn :yncrcme
mechanical obstruction
-if mec c:pircIec in uIerc÷chemicc| pneumcniIi:
c. per:i:IenI pu|mcncry HIN {FFHN)
-pu|mcncry crIery hyperIen:icn
-F Ic L :hunIing
-mcy neec ECMC {exIrcccrpcrec| memLrcne
cxygencIicn Ihercpy)
3. Ix
-Ix Ihe S & S-ECMC, inhc|ec niIric cxice, eIc

B. Care of the SGA/ IUGR neonate
1. Ccu:e:
c. mcIernc|
-:mcker -hecrI ci:ec:e
-pccr nuIriIicn -FlH
-:uL:Icnce cLu:e -chrcnic HIN
-ccvcncec DM -Icxic chemicc|
-infecIicn expc:ure
-:mc|| :IcIure -<1ó, >40 yr: c|c
-|cck cf FN ccre -|cw SES
L. p|ccenIc|
-infcrcI:
-:ing|e umLi|icc| crIery
-cLncrmc| ccrc in:erIicn
-cc|cificcIicn:
c. feIc|
-mu|Iip|e ge:IcIicn
-ICFCH-Icxcp|c:mc:i:
cIher infecIicn:, i.e. hepcIiIi:
ruLe||c
cyIcmegc|cviru:
herpe: {Iype ll)


''
10
2. FrcL|em:
c. perincIc| c:phyxic
-c::ccicIec wiIh h/c
:mcker |cw SES
preec|cmp:ic mu|IifeIc| ge:IcIicn
infecIicn: DM
-wcIch fcr re:pircIcry cepre::icn cI LirIh
L. hypcg|ycemic
-higher meIcLc|ic rcIe
-F8S < 40 mg/c| in Ierm infcnI
<25 mg/c| in premie
-pccr feecer:, jiIIery, hypcIhermic
-wcIch fcr |eIhcrgy, f|cppy, :eizure:
c. hecI |c::
-|e:: mu:c|e cnc Lrcwn fcI mc::
-|iII|e cLi|iIy Ic ccnIrc| :kin ccpi||crie:
-neec Ic mcinIcin IhermcneuIrc|iIy
c. hypccc|cemic-F/I LirIh c:phyxic
e. pc|ycyIhemic-F/I ¦ F8C´: F/I :Ire::

3. Ix
c. mcinIcin c|ecr cirwcy
L. prevenI cc|c :Ire::
c. feecing per hc:piIc| prcIccc|
c. :IcLi|ize IempercIure
e. nur:ing :uppcrI :imi|cr Ic premie:

C. Care of the LGA Neonate
1. Ccu:e:
c. lDM/GDM
L. geneIic:
c. mu|Iip:
c. eIhnic grp:
e. cLe:iIy

2. FrcL|em:
c. CFD-¦ ri:k fcr C/S LirIh
L. LirIh Ircumc:-vccuum, fcrcep:, c:phyxic
:hcu|cer cy:Iccic:, fx c|cvic|e
c. hypcg|ycemic/pc|ycyIhemic

4. Ix-Ix Ihe S & S


'(
11
lV. Ccmmcn Fe:pircIcry Ccmp|iccIicn:
A. Respiratory Distress Syndrome{hyc|ine memLrcne ci:ec:e)
1. Lung ci:crcer u:uc||y cffecIing premie:
c. infcnI: <1500 gm: = 5ó7 ri:k cf FDS
L. ccu:ec Ly |cck cf :urfccIcnI

2. Ccu:e:
c. ¡ ri:k cf incicence/:everiIy
-/friccn-/mericcn:
-mcIernc| :Iercic Ihercpy
-:Ire::cr: :uch c: FlH
-FFCM
-lUGF
-mcIernc| crug u:e
L. ¦ ri:k cf incicence/:everiIy
-¡ in ge:IcIicn cge
-mcIernc| hypcIen:icn
-Ccucc:icn:
-mcIernc| cicLeIe:
-C/S LirIh wiIhcuI |cLcr
-:eccnc-Lcrn Iwin
-mc|e:
-perincIc| c:phyxic

3. FrcL|em:
c. |cck :ufficienI :urfccIcnI
L. weck re:pircIcry mu:c|e:
g. epiIhe|ic| ceLri: in cirwcy:
h. |ecc: Ic ¡ cxygencIicn, cycnc:i:, cnc re:p./
meIcLc|ic ccicc:i:
i. ccn |ecc Ic F Ic L :hunIing cnc cpening cf
fcrcmen cvc|e cnc cucIu: crIeric:u:

4. S & S
c. Icchypnec
L. grunIing/nc:c| f|cring
c. reIrccIicn:
c. hypcIen:icn
e. cycnc:i:
f. :e|f-|imiIing ci:ec:e
-u:uc||y cLcIe: in 72 hcur:
-ci:cppecrcnce ccincice: wiIh prccucIicn cf
:urfccIcnI in Iype 2 ce||: cf c|vec|i

')
12
5. Ix
c. :uppcrIive-cce¢ucIe venIi|cIicn/cxygencIicn
L. :urfccIcnI ccmini:IrcIicn
c. cxygen Ihercpy per crcer:
c. mcniIcring cf ccic/Lc:e Lc|cnce
e. prevenI cc|c :Ire::
f. cLx Ihercpy fcr infecIicn
g. prcper nuIriIicn cnc l & C´:
h. pc::iL|e neec fcr L|ccc Ircn:fu:icn F/I fre¢uenI
|cL wcrk

B. Transient Tachypnea of the Newborn
1. :imi|cr Ic FDS

2. F/I c:phyxic in uIerc-f|uic in |ung:

3. x-rcy :hcw: cver expcn:icn/hyperinf|cIicn cf |ung:

4. Ix-cxygen, ck fcr pc::iL|e ccicc:i:

5. u:uc||y imprcve: in 24-48 hr:, we|| in 2-5 ccy:

C. Meconium Aspiration-see post term neonate

V. NecncIe wiIh Sep:i:
A. Risk factors
1. mcIernc|
-|cw SES -pccr FN ccre
-pccr nuIriIicn -:uL:Icnce cLu:e

2. inIrcpcrIum
-FFCM -mcIernc| fever
-chcriccmnicniIi: -prc|cngec |cLcr
-premcIure |cLcr -mcIernc| UIl

3. necncIc|
-Iwin: -mc|e
-LirIh c:phyxic -mec c:pircIicn
-gc|ccIc:emic -cL:ence cf :p|een
-L8W/premie -prc|cngec hc:piIc|izcIicn




(*
13

B. Mode of transmission
1. verIicc|
c. in uIerc
L. cI LirIh
c. ICFCH

2. hcrizcnIc|
c. cfIer LirIh
L. envircnmenIc|, i.e. SIcph

C. Causes of susceptibility
1. |cck immuniIy

2. phcgccyIc:i: |e:: efficienI

3. cy:mcIuriIy

D. Causes of infection
1. Ecr|y cn:eI-wiIhin 24 hcur: cf LirIh
c. grcup 8 :Irep
L. Hcemcphi|u: inf|uenzc
c. Li:Ieric
c. E. Cc|i
e. SIrep. Fneumcnice
f. mcre ccmmcn wiIh FFCM, mcIernc| fever,
chcric, cnc premcIure |cLcr
g. higher mcrIc|iIy rcIe-10-257

2. /c¢uirec infecIicn:-:een cfIer 2 week: cf cge
c. mcy Le frcm LirIh ccnc| cr envircnmenI
L. SIcph cureu:
c. SIcph epicermici:
c. F:eccmcnc:
e. grcup 8 :Irep

3. Virc| infecIicn:
c. mcy ccu:e mi:ccrricge, :Ii||LirIh, inIrcuIerine
infecIicn:, cnc ccngeniIc| mc|fcrmcIicn:
L. mcy ccu:e chrcnic infecIicn wiIh :uLI|e
mcnife:IcIicn:
c. mcy neec i:c|cIicn frcm cIher necncIe:


(!
14

4. Fungc| infecIicn:
c. grecIe:I ccncern Ic immunc-ccmprcmi:ec
cr premcIure necncIe:
L. Ihru:h mcy Le pre:enI in cIherwi:e hec|Ihy kic:

E. Location of infection
1. SepIicemic i: infecIicn in Ihe L|ccc :y:Iem

2. Fneumcnic-mc:I ccmmcn fcrm cf necncIc| infecIicn
-cne cf Ihe |eccing ccu:e: cf perincIc| cecIh

3. 8ccIeric| meningiIi: cffecI 1 in 2500 |ive LirIh:

4. Gc:IrcenIeriIi: ncI c: ccmmcn

F. S & S
1. Fe:pircIcry
-cpnec -Icchypnec
-grunIing -nc:c| f|cring
-reIrccIicn: -cecrec:ec C
2
:cI

2. CV
-Lrccyccrcic -cecrec:ec CC
-Icchyccrcic -hypcIen:icn
-cecrec:ec perfu:icn

3. CNS
-Iemp in:IcLi|iIy -|eIhcrgy
-hypcIcnic -irriIcLi|iIy
-:eizure:

4. Gl
-vcmiIing -cLccminc| ci:IenIicn
-cicrrhec -re:icuc|: > 507

5. Skin
-jcuncice -pc||cr
-peIechice





("
15

G. Sepsis workup
1. |cL wcrk
-L|ccc {C8C wiIh ciff)
|ccking fcr ¡ neuIrcphi|:, ¦ Lcnc:{immcIure W8C)
-urine
-CSF
-gc:Iric c:pircIicn
-cu|Iure nc:e, IhrccI, :kin, umLi|icc| ccrc

2. che:I x-rcy

H. Tx
1. Ix Ihe :ympIcm:-i.e. cLx, C
2,
i:c|cIicn

2. /::e:: hcncwc:hing Iechni¢ue: cf Ihe :Icff

3. Enccurcge Lrec:Ifeecing-pc::ive immuniIy

Vl. Ihe NecncIe wiIh HyperLi|iruLinemic
A. Types
1. Fhy:ic|cgic jcuncice
c. cccur: in ó0-707 cf Ierm infcnI:, 807 preIerm
L. cri:e: 24 hcur: cfIer ce|ivery

2. FcIhc|cgic jcuncice
c. hyperLi|iruLinemic÷kernicIeru:
{Li|iruLin encephc|cpcIhy)
L. cppcrenI wiIhin 24 hcur: cf LirIh
c. :erum Li|i cf > 5mg/c| in ccrc L|ccc
c. :erum Li|i > 15mg/c| cI cny Iime

B. Causes
1. McIernc| fccIcr:
c. Fh//8C inccmpcIiLi|iIy
-feIc| cnIigen crc::e: p|ccenIc
-mcIernc| cnIiLccie: crc:: p|ccenIc
-ccu:e hemc|y:i: cf feIc| F8C´:
{eryIhrcL|c:Ic:i: feIc|i:÷hycrcp: feIc|i:)
L. infecIicn
c. cicLeIe:
c. cxyIccin in |cLcr
e. crug:

(#
16



2. FeIc|/newLcrn fccIcr:
c. premie:
L. hepcIic ce|| ccmcge
c. pc|ycyIhemic
c. inIe:Iinc| cL:IrucIicn
e. py|cric :Ienc:i:
f. Li|icry cIre:ic {cL:enI cr c|c:ec Li|e cucI:)
g. L|ccc :wc||cwec Ly feIu:

C. Nursing care
1. LcL wcrk
c. cirecI ccmL-ck fcr mcIernc| cnIiLccie: in
infcnI´: L|ccc
L. ck infcnI´: L|ccc Iype
c. :erum Li|i |eve|

2. Ix
c. ecr|y, fre¢uenI feecing:
L. phcIcIhercpy
c. exchcnge Ircn:fu:icn:
-if Fh inccmpcIiLi|iIy-u:e C neg L|ccc

Vll. Ihe NecncIe Lcrn Ic c cicLeIic mcIher
A. Problems
1. ccngeniIc| cncmc|ie:
-Le|ievec Ic Le ccu:ec Ly f|ucIucIicn in g|ucc:e &
epi:cce: cf keIcccicc:i:
-ccngeniIc| hecrI |e:icn:
cccrcIcIicn cf Ihe ccrIc
Ircn:pc:iIicn cf Ihe grecIer ve::e|
cIric|/venIricu|cr :epIc| cefecI:
-CNS
cnccephc|y
hycrccephc|y
encephc|cce|e
meningcmye|cce|e
-MS
ccucc| regre::icn :yncrcme-prcL|em: cf Ihe
|cwer exIremiIie:

2. mccrc:cmic/LirIh Ircumc
($
17
-exce::ive g|ucc:e in L|ccc = ¦ feIc| in:u|in prccucIicn
-en|crgemenI cf inIernc| crgcn excepI Lrcin
-high ri:k fcr fx cf c|cvic|e/:ccpu|c, cephc|chemcIcmc

3. FDS
-4-óX mcre |ike|y Ic ceve|cp Ihcn in ncrmc| infcnI:

4. hypcg|ycemic, hypccc|cemic, hypcmcgne:emic
-hypccc|cemic pre:enI in 507 cf lDM´:
-hypcmcgne:emic frcm mcIernc| renc| |c:: F/I DM

5. hyperLi|iruLinemic/pc|ycyIhemic
-exce:: F8C prccucIicn |ecc: Ic ¦ Li|i

B. Pathophysiology
1. Ncrmc||y:
mcIernc| L|ccc mcre c|kc|ine pH Ihcn CC
2
-rich feIc|
L|ccc÷exchcnge cf C
2
& CC
2
ccrc:: p|ccenIc

2. McIernc| ccicc:i::
¡ in gc: exchcnge

3. Gcc|:
McIernc| ccnIrc| cf 8S Ihru pregncncy wiIh FN ccre

C. Nursing care
1. FecicIric :Icff cI ce|ivery

2. lmp|emenI necncIc| g|ucc:e Ie:Iing per prcIccc|

3. lf F8S < 40 mg/c|, :upp|emenI wiIh fcrmu|c cr lV prn

4. Check :erum Li|iruLin cnc cc|cium |eve|:

ó. Fecuce ccver:e envircnmenIc| fccIcr:

Vlll. Ihe NecncIe Lcrn Ic c SuL:Icnce /Lu:ing McIher
A. Common characteristics
1. FeIc| c|cchc| :yncrcme
c. eye:
-epiccnIhc| fc|c: -:IrcLi:mu:
-pIc:i: -crccping |ic
-hypcp|c:Iic reIinc| ve::e|:

(%
18
L. mcuIh
-pccr :uck -c|efI |ip
-c|efI pc|cIe -:mc|| IeeIh
c. ecr:-cecfne::
c. :ke|eIcn
-fu:icn cf cervicc| verIeLrce
-re:IricIec Lcne grcwIh
e. hecrI
-cIric|/venIricu|cr :epIum cefecI:
-IeIrc|cgy cf Fc||cI
-pcIenI cucIu: crIeric:u:
f. kicney
-renc| hypcp|c:ic -hycrcnephrc:i:
-urcgeniIc| :inu:
g. |iver
-hepcIic fiLrc:i:
h. immune :y:Iem
-increc:e infecIicn: -cIiIi: mecic
-upper re:p. infecIicn: -immune ceficiencie:
i. Iumcr:-ncn:pecific necp|c:m:
j. :kin
-cLncrmc| pc|mcr -irregu|cr hcir

2. Ccccine
c. premcIuriIy/SG/
L. micrccephc|y/ceve|cpmenIc| ce|cy:
c. pccr feecer/cicrrhec
c. hyperccIiviIy/cifficu|I Ic ccn:c|e
e. ccngeniIc| cncmc|ie:

3. Hercin
c. L8W
L. SG/
c. necncIc| wiIhcrcwc| i::ue:

4. /mpheIcmine:
c. SG//L8W/premie
L. pccr wI. gcin
c. |eIhcrgy

5. IcLcccc
c. Fremie/L8W/lUGF
L. ri:k fcr SlDS
c. ri:k fcr LrcnchiIi:/pneumcnic
(&
19
c. ceve|cpmenIc| ce|cy:

ó. Mcrijucnc
c. pc::iL|e necncIc| Iremcr:
L. L8W

B. Nursing Care
1. Neec: mu|Iici:cip|incry cpprccch fcr LcIh necncIe
cnc pcrenI:

2. SuppcrIive ccre
c. f|uic cnc e|ecIrc|yIe Lc|cnce
L. nuIriIicn
c. infecIicn ccnIrc|
c. re:pircIcry ccre

3. CuieI, :ccIhing envircnmenI curing wiIhcrcwc| pericc

4. Fhcrmccc|cgicc| Ix-mcrphine, phencLcrL, ciczepcm,
pcregcric: {IincIure cf cpium), &
meIhcccne v: Luprencrphine {crIic|e)

lX. Hypcxic l:chemic Encephc|cpcIhy {HlE) in NewLcrn:÷/rIic|e




















01/13
('
1
Ncrmc| Fregncncy
Lecture 7

l. Fhy:ic|cgicc| Chcnge: curing Fregncncy
A. Reproductive system and breasts
1. UIeru:
c. increc:ec vc:cu|criIy/ci|cIicn cf L|ccc ve::e|:
-ó0 gm{2cz) Ic 1100 gm{2.2 |L)
L. hyperp|c:ic-new mu:c|e fiLer:/Ii::ue
c. hyperIrcphy-en|crgemenI cf pre-exi:Iing fiLer:
c. ceve|cpmenI cf Ihe cecicuc
e. grcwIh chcnge: F/I :Iimu|cIicn frcm high |eve|:
cf e:Ircgen/prcge:Iercne
f. :hcpe chcnge:
-7 week:-egg :ize
-10 week:-crcnge :ize
-12 week:-grcpefruiI :ize
-iniIic||y pecr :hcpec
-2
nc
Irime:Ier-g|cLu|cr
-Ierm-cvcic
g. pc:iIicn
-12 week:-cI cr cLcve Ihe :ymphy:i: puLi:
-1ó week:-LeIween SF cnc umLi|icu:
-20 week:-cI Ihe umLi|icu:
-3ó week:-c|mc:I Ic Ihe xiphcic prcce::
h. lightening
-nu||ipcrc:-2 week: Lefcre Ierm
-mu|Iipcrc:-when |cLcr :IcrI:
i. ballottement-pc|pcIe f|ccIing :IrucIure
j. c|Ierec cenIer cf grcviIy c: en|crging uIeru: Ii|I:
cgcin:I Ihe cnIericr cLccminc| wc||
k. 8rcxIcn-Hick: ccnIrccIicn:
-:IcrI crcunc 4 mcnIh:
-irregu|cr
-pcin|e::
-he|p Ic fcci|iIcIe L|ccc f|cw
|. uIercp|ccenIc| L|ccc f|cw
-uIerine L|ccc f|cw increc:e:
-mcre cxygen i: exIrccIec frcm Ihe L|ccc in Ihe
|cIIer pcrI cf Ihe pregncncy
-cI enc cf pregncncy, 1/ó cf IcIc| L|ccc vc|ume
wiIhin Ihe vc:cu|cr :y:Iem cf uIeru:
m. Hegar’s sign-ó week:-:cfIening cf |cwer uIerine
:egmenI
((
2
2. Cervix
c. Goodell’s sign-:cfIening cf cx-ó week:
L. Chadwick’s sign-L|ui:h cc:I-8 week:
c. fricLi|iIy increc:e:
c. operculum-mucu: p|ug-encccervicc| g|cnc:

3. Vcginc
c. increc:ec vc:cu|criIy
L. |eukcrrhec-Ihick whiIe vcginc| ci:chcrge
c. chcnge in pH |ecc: Ic higher ri:k fcr yec:I inf.

4. 8rec:I:
c. :IcrI Ic chcnge Ly week ó F/I hcrmcne :urge
L. increc:e in :en:iIiviIy, Lrec:I cnc nipp|e :ize
c. increc:e in fee|ing firm, hecvine::, nipp|e erecI
c. nipp|e: cnc crec|c Leccme mcre pigmenIec
e. ve::e|: LenecIh Ihe :kin ci|cIe-mcre vi:iL|e
f. striae gravidarum {:IreIch mcrk:) mcy cppecr
g. mcy |eck cc|c:Irum c: ecr|y c: 1ó week:

B. Cardiovascular system
1. HecrI
c. :|ighI hyperIrcphy F/I increc:e L|ccc f|cw
L. pc:iIicn chcnge F/I cicphrcgm pc:iIicn
c. Ircn:ienI murmur: mcy Le cu:cu|IcIec
c. ccrcicc cuIpuI
-increc:ec 30-507 Ly week 32
-cn|y 207 increc:e Ly week 40
-F/I increc:ec :Ircke vc|ume cnc hecrI rcIe
e. pu|:e rcIe increc:e: 10-15 LI/min

2. 8|ccc
c. increc:e in L|ccc vc|ume 40-507 {1500m|)
-p|c:mc-1000 m|
-F8C´:-450 m|
L. physiological anemia-hemcci|uIicn cf ce||:
-cnemic if HgL uncer 10g/c|, HcI uncer 357
c. increc:e in W8C´:
c. cccg Iime:
-circu|cIicn Iime cecrec:e: Ly week 32
necr ncrmc| cI Ierm
- in c|cIIing fccIcr: |ecc: Ic Iencency fcr
L|ccc Ic cccgu|cIe
- ri:k fcr IhrcmLc:i:-e:p. wiIh C/S
()
3

3. 8|ccc Fre::ure
c. 1
:I
Irime:Ier-nc chcnge in 8F
L. 2
nc
Irime:Ier-8F ¡ 5-10 mm Hg
c. 3
rc
Irime:Ier-8F reIurn: Ic 1
:I
Irime:Ier vc|ue:
c. supine hypotensive syndrome
-if Ihey |ie cn Iheir Lcck:
-cI 5 minuIe:, ref|ex Lrccyccrcic
-CC ¡ Ly hc|f
-wcmcn fee|: fcinI

C. Respiratory system
1. f|cring cf Ihe riL ccge

2. :hifI frcm cLccminc| Ic Ihcrccic LrecIhing

3. e|evcIec mcIernc| cxygen re¢uiremenI:
c. ccce|ercIicn in meIcLc|ic rcIe
L. Ihe neec Ic ccc Ic Ihe Ii::ue mc:: cf uIeru:
c. feIc| neec:

4. ¦ vc:cu|criIy cf Ihe upper re:p. IrccI
c. nc:c| cnc :inu: :Iuffine::-{e:Ircgen-incucec)
L. epistaxis {nc:eL|eec:)
c. chcnge: in Ihe vcice

5. pu|mcncry funcIicn
c. ceep LrecIhing-¡ cirwcy re:i:Icnce-Frcge:Iercne
L. ¦ Iicc| vc|ume
c. re:p rcIe ¦ 2 LrecIh:/min
c. ¦ cwcrene:: Ic LrecIh
e. :en:iIiviIy in mecu||c Ic CC
2
-¦ cepIh, rcIe

ó. Lc:c| meIcLc|ic rcIe
c. ¦ 15-207 Ly Ierm
L. ref|ecI: ¦ in cxygen cemcnc
c. mcy experience hecI inIc|ercnce F/I exce::
hecI frcm ¦ 8MF

7. ccic-Lc:e Lc|cnce
c. pregncncy i: c :IcIe cf re:p. c|kc|c:i:
ccmpen:cIec Ly mi|c meIcLc|ic ccicc:i:
L. fcci|iIcIe: mcIernc|-feIc| C
2
-CC
2
Ircn:fer
)*
4
D. Renal system
1. cncIcmic chcnge:
c. ¦ e:Ircgen cnc prcge:Iercne = ¦ uIeru: :ize cnc
L|ccc vc|ume
L. ci|cIicn: cf ureIer:, pe|vi:, renc| cc|yce:÷ |crge
cmI. cf urine
c. urine f|cw rcIe :|cwec÷:Ic:i:/:IcgncIicn÷
mecium fcr LccIeric
c. IuLu|cr recL:crpIicn impcirec÷g|ucc:e ¦ in urine
÷mcre c|kc|ine urine
e. urincry fre¢uency frcm ¦ in L|cccer :en:iIiviIy
cnc ccmpre::icn frcm uIeru:
f. 2
nc
Irime:Ier, L|cccer pu||ec up inIc Ihe
cLccmen
g. ureIhrc |engIhen:-pc::iL|e prcL|em wiIh ccIh

2. funcIicnc| chcnge:
c. ¦ in GFF
L. mc:I efficienI in L |cIerc|-¦ perfu:icn Ic kicney:

3. f|uic cnc e|ecIrc|yIe Lc|cnce
c. ¦ IuLu|cr recL:crpIicn Ic mcinIcin neecec Nc
|eve|
L. mcy Le cver:Ire::ec Ly exce::ive Nc inIcke
c. pcc|ing cf f|uic: in |eg: = |e:: L|ccc f|cw Ic
kicney:-LeIIer Ic e|evcIe |eg: Ihcn ciureIic:
c. :|ighI prcIein |eckcge +1 ck

E. Integumentary
1. hyperpigmenIcIicn
c. ccu:ec Ly :Iimu|cIicn cf cnIericr piIuiIcry
hcrmcne me|cncIrcpin
L. chloasma=Lrcwni:h fccic| pigmenIcIicn-
inIen:ifiec Ly :un
-u:uc||y fcce: cfIer pregncncy
c. ccrkening cf nipp|e, crec|c, vu|vc, Ihigh:
c. linea nigra=ccrk verIicc| |ine frcm :ymphy:i:
puLi: Ic funcu:
-:IcrI: c: linea alba-Lefcre pigmenIcIicn
-ncI pre:enI in c|| pregncnI wcmen
e. striae gravidarum-:IreIch mcrk:
-cn cLccmen, Lrec:I:, Ihigh:
-:epcrcIicn cf cc||cgen
-50-º07 cf wcmen wi|| hcve Ihi:
)!
5
2. cIher chcnge:
c. angiomas-vc:cu|cr :picer:
L. palmar erythema-L|cIche: cn hcnc:
c. pruriIu:
c. gum hyperIrcphy-L|eecing gum:
e. ccce|ercIec nci| grcwIh
f. hirsutism-exce::ive hcir grcwIh
g. ¦ L|ccc :upp|y = ¦ per:pircIicn

F. Musculoskeletal
1. ¦ |crcc:i:-cenIer cf grcviIy i: mcre fcrwcrc

2. re|cxin, cn cvcricn hcrmcne, he|p: wiIh re|cxcIicn cnc
increc:ec mcLi|iIy cf pe|vic jcinI:
-wccc|ing gciI

3. cic:Ic:i: recIi cLccmini:-per:i:IenI :epcrcIicn cf
mu:c|e: cf Ihe cLccminc| wc||

G. Neurologic system
1. ccmpre::icn cf pe|vic nerve: mcy ccu:e :en:cry
chcnge: in |eg:
-:cicIicc

2. ecemc cn peripherc| nerve:-carpal tunnel syndrome
c. Lurning, pcre:Ihe:ic
L. pcin in Ihe hcnc, rccicIing Ic Ihe e|Lcw

3. ¦ Ien:icn hecccche:

4. syncope ccmmcn in ecr|y pregncncy

H. Gastrointestinal
1. ¡ peri:Ic|:i:÷ccn:IipcIicn, N & V

2. L|eecing cf gum:/prcL|em: cf Ihe mcuIh
c. ccu:ec Ly ri:ing |eve| cf e:Ircgen
L. ptyalism-exce::ive :c|ivcIicn

3. 15-207 wi|| hcve prcL|em wiIh hicIc| hernic

4. ¦ e:Ircgen = ¡ :ecreIicn cf HC| ccic

5. ¦ prcge:Iercne = ¡ :Icmcch empIying Iime=hecrILurn
)"
6
ó. ¦ gc||L|cccer ci:IenIicn÷prc|cngec empIying Iime
cnc Ihickening cf Li|e÷ceve|cpmenI cf gc|| :Icne:

7. pruriIu: grcviccrum-mcy Le F/I cccumu|cIicn cf Li|e

8. chcnge in cppeIiIe/fccc ccn:umpIicn
c. chcnge in CHC, prcIein, fcI meIcLc|i:m
L. pica-crcving fcr ncn-fccc mcIeric|
c. mcrning :ickne::-u:uc||y enc: Ly 2
nc
Irime:Ier

I. Endocrine system
1. ¦ :ecreIicn: cf piIuiIcry hcrmcne::
c. IhyrcIrcpin
L. FSH/LH
c. prc|ccIin
c. vc:cpre::in {cnIiciurecIic hcrmcne)
e. cxyIccin

2. ¦ :ecreIicn: cf Ihyrcic hcrmcne::
c. Ihyrcxine
L. IriicccIhyrcnine

3. ¦ :ecreIicn cf pcrcIhyrcic hcrmcne:

4. ¦ :ecreIicn cf Ihe ccrenc| hcrmcne::
c. ccrIi:c|-r/I ¦ e:Ircgen-regu|cIe: CHC/prcI meIc.
L. /|cc:Iercne-prcIecIive re:pcn:e Ic Nc excreIicn

5. ¦ :ecreIicn cf in:u|in frcm Ihe pcncrec:

ll. Dicgnc:i: cf Fregncncy
A. Gravidity and Parity
1. grcvicc-wcmcn whc i: pregncnI
c. nu||igrcvicc-never Leen pregncnI
L. mu|Iigrcvicc-2 cr mcre pregncncie:
c. primigrcvicc:-fir:I pregncncy

2. pcriIy-numLer cf LirIh: cfIer 20 week: ge:IcIicn
c. cce:n´I mcIIer if Lcrn c|ive cr :Ii||Lcrn
L. nu||ipcrc-never ccmp|eIec c pregncncy
c. mu|Iipcrc-ccmp|eIec 2 cr mcre LirIh: cI
mcre Ihcn 20 week: ge:IcIicn
c. primipcrc-ccmp|eIec cne LirIh > 20 week:
e. ncI Ihe numLer cf feIu:e: Lcrn
)#
7
3. preIerm-Lefcre 37 week: ge:IcIicn

4. pc:IccIe:-cfIer 42 week cf ge:IcIicn

5. vicLi|iIy-ccpcciIy Ic |ive cuI:ice Ihe uIeru:
c. :cmewhere LeIween week 22-24
L. feIu: grecIer Ihcn 500 gm:

ó. 5-cigiI :y:Iem
c. grcvicc
L. Ierm-pcrc
c. preIerm
c. cLcrIicn:-:pcnIcnecu: cr IhercpeuIic
e. |iving chi|cren

B. Pregnancy tests
1. hCG-humcn chcricnic gcncccIrcpin
c. prccucIicn :IcrI: wiIh imp|cnIcIicn
L. fcunc in L|ccc ó ccy: cfIer ccncepIicn
c. in urine Ly ccy 2ó
c. |eve| ri:e: unIi| peck cI ccy ó0-70 in pregncncy
Ihen fc||:-|cwe:I |eve| cI 100-130 ccy:

2. ELlS/-enzyme |inkec immunc:crLenI c::cy:
c. cc|cr chcnge wiIh hCG Lcncing
L. re:u|I c: fc:I c: 5 minuIe:
c. ceIecI hCG in 7-º cfIer ccncepIicn

C. Nagele’s Rule
1. Fir:I ccy cf LMF÷:uLIrccI 3 mcnIh:÷ccc 1 week

D. Classic indicators
1. pre:umpIive
c. cmencrrhec-week 4
L. ¢uickening-week: 1ó-20
c. Lrec:I chcnge:-week: 3-4
c. N & V-week: 4-14
e. urincry fre¢uency-week: ó-12
f. fcIigue-week 12

2. prcLcL|e
c. Gcccwe||´: :ign-week 5
L. Chccwick´: :ign-week: ó-8
c. Hegcr´: :ign-week: ó-12
)$
8
c. + pregncncy Ie:I {:erum)-week: 4-12
e. + pregncncy Ie:I {urine)-week: ó-12
f. 8rcxIcn-Hick: ccnIrccIicn:-week 1ó
g. cLccminc| en|crgemenI
h. Lc||cIIemenI-week: 1ó-28
i. pc|pcL|e feIc| cuI|ine

3. pc:iIive
c. vi:uc|izcIicn cf feIu: cn U/S-week: 5-ó
L. feIc| hecrI Icne: Ly U/S-week ó
c. feIc| hecrI Icne: Ly Dcpp|er-week: 10-17
c. FHI Ly :IeIhc:ccpe-week: 17-1º
e. feIc| mcvemenI: pc|pcIec-week: 1º-22
f. vi:iLi|iIy-|cIe pregncncy

lll. Fir:I Irime:Ier
A. History taking
1. rec:cn: fcr :eeking ccre
c. mcy hcve cIher ccncern: Le:ice: Ihe preg.
L. u:e cpen encec ¢ue:Iicn:

2. currenI pregncncy
c. review :ign: cnc :ympIcm:
L. evc|ucIe hcw pI i: ccping

3. C8/Gyn hi:Icry
c. men:Iruc| hi:Icry
L. ccnIrccepIive hi:Icry
c. cny inferIi|iIy ccncern:
c. cny Gyn ccncern:
e. ck |c:I Fcp cnc cu|Iure: fcr SIl´:

4. mecicc| hi:Icry
c. pre-exi:Iing mecicc| ccnciIicn:/ccncern:
L. hi:Icry cf :urgicc| prccecure:

5. nuIriIicnc| hi:Icry
c. c::e:: fcr fccc c||ergie:
L. cny :pecic| cieIcry ccncern:

ó. hi:Icry cf crug u:e
c. pc:I cnc pre:enI u:e cf |egc| meciccIicn:
L. h/c i||egc| crug u:e

)%
9
7. fcmi|y hi:Icry

8. p:ychc:ccic| hi:Icry
c. :iIucIicnc| fccIcr:
L. cny previcu: ccre cf infcnI:
c. ccping mechcni:m:

º. hi:Icry cf phy:icc|/verLc| cLu:e
c. cLu:e mcy increc:e curing pregncncy
L. neec immecicIe c|inicc| inIervenIicn

B. Physical examination
1. viIc| :ign:

2. hecc Ic Ice c::e::menI

3. pe|vic excm wiIh vcginc|/cLccminc| U/S

4. review cf :y:Iem:
c. c::e:: ecch :ign/:ympIcm fcr cn:eI, chcrccIer,
cnc ccur:e
L. c::e:: fcr cggrcvcIing/c||evicIing fccIcr:

C. Laboratory tests
1. L|ccc wcrk up
c. C8C
L. L|ccc Iype cnc Fh fccIcr
c. ruLe||c IiIer
c. HlV :creen
e. HL:/G :creen
f. FFF/VDFL
g. Icy-Scch:
h. Sick|e-ce||
i. g|ucc:e Ic|ercnce Ie:I

2. urine :creen
c. urinc|y:i: wiIh cu|Iure
L. UD/F

3. pe|vic
c. Fcp :mecr
L. cu|Iure: fcr SIl´:

4. I8 :kin Ie:I
)&
10
5. :creening fcr feIc| chrcmc:cme cncmc|ie:
c. NI-nuchc| Ircn:|ucency {feIc| nuchc| fc|c)
L. :erum Ie:Iing fcr free LeIc hCG cnc F/FF-/
c. ¦ NI, ¦ free LeIc hCG, cnc ¡ F/FF-/ ccn
:ugge:I cneup|cicy

D. Priority patient education topics
1. :checu|e cf vi:iI:

2. rcIicnc|e fcr |cL:

3. Kege| exerci:e: fcr pe|vic f|ccr

4. review nuIriIicnc| neec:

5. ck Ic Ircve| cnc ccnIinue exerci:e c: ccmfcrIcL|e

ó. ck c|| u:e cf meciccIicn: wiIh ycur prcvicer-even CIC
c. wi|| :IcrI cn FN viIcmin: wiIh fc|ic ccic
L. ircn IcL: prn cnemic

7. immunizcIicn:
c. ck if ki||ec-DI, Hep 8, rcLie: {Iccp-cfIer 20 wk:)
L. nc ck if |ive-mec:|e:, MMF, C Fcx, mump:, pc|ic

8. c|cchc|, IcLcccc u:cge÷ FFCM, FIL, cLrupIicn

º. Iip: Ic he|p wiIh fcIigue, N & V

lV. Seccnc Irime:Ier
A. Ongoing care
1. phy:icc| excmincIicn
c. weighI-cpprcx. 1 |L per week pc:I 1
:I
Irime:Ier
L. 8F-wcIch fcr ¦ 140/º0 cr ¦ :y:Ic|ic 30>Lc:e|ine
¦ cic:Ic|ic 15>Lc:e|ine
c. cip urine fcr prcIein, g|ucc:e
c. cu:cu|IcIe FHI
e. c::e:: Lrec:I:/nipp|e:
f. review LirIh p|cn
g. c:k cLcuI ¢uickening-cpprcx 20 week:




)'
11
2. perIinenI |cLcrcIcry Ie:I:
c. Cucc Screen-ccne LeIween 15-20 week::
1. MS/FF
2. hCG
3. UE-unccnjugcIec e:Iric|
4. inhiLin-/
5. /::e::ing fcr pc::iL|e :pinc Licifc, Dcwn
:yncrcme, cr cIher chrcmc:cmc| cefecI:
L. fc||cw-up cn cny pricr Ie:I re:u|I:
c. cmniccenIe:i:

3. pcIenIic| ccmp|iccIicn:
c. L|eecing
L. cecrec:ec feIc| ccIiviIy
c. FlH/GHIN
-hecccche
-:we||ing cf fcce/finger:
-epigc:Iric pcin
-mu:cu|cr irriIcLi|iIy
-vi:uc| ci:IurLcnce
c. FFCM
-cmnicIic f|uic ci:chcrge
e. infecIicn:
-chi||:
-fever
-Lurning wiIh urincIicn

4. funcc| heighI
c. funcc| heighI {frcm :ymphy:i: puLi: Ic Icp cf
uIeru:) ¬ in cm = week: cf ge:IcIicn
{week: 18-3ó)
L. :IcL|e cr cecrec:ec funcc| heighI-° lUGF
c. exce::ive increc:e-mu|IifeIc| ge:IcIicn,
hycrcmnic:

5. ge:IcIicnc| cge
c. ceIerminec frcm LMF, ccnIrccepIive hi:Icry, cnc
pregncncy Ie:I re:u|I:
L. u:uc||y ccnfirmec wiIh U/S

ó. inIervenIicn: fcr ci:ccmfcrI:
c. c::e:: :kin chcnge:
L. hecccche:-re:I, hycrcIicn, cceIcmincphen
c. ccn:IipcIicn-hycrcIicn, exerci:e, prune juice
)(
12
c. vcricc:e vein:-e|evcIe |eg:, :uppcrI :Iccking:
e. fccc crcving:-ó :mc|| mec|:-keep 8S |eve| even
f. hecrILurn-:mc|| mec|:, :iI up cfIer ecIing, ¡ :picy
fccc:, cnIccic:
g. jcinI/|igcmenI pcin-:uppcrI gcrmenI:

7. ecuccIicn Icpic:
c. wcrning :ign:
L. c::e:: nuIriIicn :IcIu:
c. hygiene-F/I increc:e per:pircIicn
c. UIl prevenIicn-hycrcIicn, fre¢. Vcic:
e. Lrec:I :hie|c: fcr inverIec nipp|e:
-Icc much :Iimu|cIicn ccn |ecc Ic FIL
f. cenIc| ccre
g. F & F
h. ri:k fccIcr: cI wcrk-i.e. ccu:Iic cgenI:
i. Ircve|-if ncI high ri:k, ck
j. cvcic c|cchc|, cigcreIIe:
k. neec fcr :uppcrI gcrmenI:

V. Ihirc Irime:Ier
A. History and physical
1. vcginc| excm: mcy Legin in Ihe |c:I mcnIh

2. c::e:: fcr S & S cf FIL, FlH, GDM

B. Laboratory tests
1. Grcup 8eIc :Irep cu|Iure-35-37 week:

2. rhcgcm injecIicn-2ó-28 week: fcr Fh - mcm:

3. g|ucc:e Ic|ercnce Ie:I

4. mcy reIe:I fcr SIl´:

C. Interventions for discomforts (same as 2
nd
trimester)

D. Family adjustments
1. mcIernc| Ic:k:
c. cccepI Ihe ccncepI cf Leing pregncnI
L. mcy ci:|ike pregncncy LuI |cve chi|c
c. if hcppy cLcuI pregncncy-u:uc||y hcve
higher :e|f-e:Ieem, ccnficence
c. cec|ing wiIh rcpic mccc chcnge:
))
13
e. mcy hcve fee|ing: cf cmLivc|ence
f. prepcre fcr chi|cLirIh
g. prccIice cf mcIhering rc|e
h. mcy neec Ic wcrk cn ccmmuniccIicn wiIh
fcmi|y memLer:
i. wcrk cn re|cIicn:hip wiIh her mcIher
j. Iru:I cnc :hcre wiIh Ihe pcrIner
k. wcrk cn :exuc| re|cIicn:hip wiIh :pcu:e
|. 3 phc:e: cf ceve|cpmenIc| pcIIern
-cccepI Lic|cgicc| fccI-¨l cm pregncnI"
-cccepI: neec Ic nurIure feIu:-¨l cm gcing Ic
hcve c LcLy"
-prepcre: fcr rc|e cf pcrenI-¨l cm gcing Ic Le c
mcIher"

2. pcIernc| Ic:k:
c. cccepIcnce cf pregncncy
-mcy expre:: jcy cr ci:mcy
-unwcnIec v:. unp|cnnec
-cffcir:/LcIIery cf :pcu:e
L. couvades
-cL:ervcnce cf riIuc|: = Ircn:iIicn Ic fcIherhccc
-mcy hcve p:ychc:cmcIic :ympIcm: cf preg.
c. pcrIicipcIe in chi|cLirIh ecuccIicn
c. icenIify wiIh fcIher rc|e
-mcy Le inf|uencec Ly hcw Iheir fcIher wc:
e. recrcering per:cnc| re|cIicn:hip:
-mcy :ee feIc| c: c rivc|
-mcy fee| wife i: Icc cepencenI cn MD/CNM
f. cL:erver v:. expre::ive v:. in:IrumenIc|
g. e:IcL|i:h re|cIicn:hip wiIh feIu:
-ki:: cr ruL cLccmen
-Ic|k Ic feIu:
-c::i:I wiIh prepcring LcLy´: rccm

3. :iL|ing ccju:ImenI
c. fir:I cri:i: fcr c chi|c
L. mcy fee| rep|ccec
c. neec Ic prepcrec Ic Leccme Ihe Lig :i:Ier cr
LrcIher
c. :iL|ing c|c::e:



!**
14
4. grcncpcrenI re:pcn:e:
c. if cn|y in 30´: cr 40´:-mcy ncI Le c: inIere:Iec
L. mcy Le ncn-:uppcrIive-Iry Ic cecrec:e new
mcIher´: :e|f e:Ieem
c. mc:I :ee Ihe pregncncy c: c renewc| cf Iheir
ycuIh
c. ccnIinuiIy cf pc:I cnc pre:enI
e. mcy he|p Lricge c previcu: e:IrcngemenI
f. ncw hcve c|c::e: cn Leing c grcncpcrenI

5. cIher p:ychc:ccic| i::ue:
c. ccc|e:cenI mcIher:
-mc:I pregncncie: uninIencec-807
-407 wi|| enc in cLcrIicn-E/8: & S/8:
-higher rcIe: fcr Hi:pcnic:, /friccn-/mericcn:
-mc:I unmcrriec, |cw SES
-mcre |ike|y ncI Ic receive FN ccre
-FN neec: Ic enccurcge FN vi:iI:, nuIriIicnc|
guice|ine:, cnc :ccic| :ervice ccn:u|I
L. c|cer mcIher:
-mu|Iip:-pregncncy mcy Le :urpri:e-IhcughI
Ic hcve :IcrIec mencpcu:e
-mcy fee| :epcrcIec frcm ycunger mcm:
-nu||ip:-pregncncy i: c chc:en evenI
-mcy fee| i:c|cIec frcm c|cer frienc:
-u:uc||y :eek geneIic ccun:e|ing cnc FN ccre
-higher ri:k fcr ccver:e perincIc| cuIccme:

E. Education topics
1. prepcrcIicn fcr chi|cLirIh c|c::e:
c. prencIc| ycgc
L. Lcmcze
c. prencIc| Lrec:I feecing
c. ce:crecn infcrmcIicn

2. review wcrning :ign:

3. :ign: cnc :ympIcm: cf |cLcr

4. cIher pcIenIic| ccmp|iccIicn:
c. FlH
L. FIL/FFCM
c. L|eecing
c. ¡ FM
!*!
15
Vl. Cngcing :cfeIy i::ue:
A. Travel / exercise
1. u:e ccmmcn :en:e
c. nc prc|cngec u:e cf hcI IuL:
L. high ri:k fcr c|cI: in |eg: if ncI mcving crcunc
1. wc|k crcunc Ihe p|cne curing |cng Irip:
2. :Icp Ihe ccr every few hcur: fcr :IreIch

2. :hcu|c cvcic cir Ircve| cfIer Ihe 7
Ih
mcnIh

3. MV/-mc:I ccmmcn ccu:e cf feIc| cecIh-:ecILe|I:

4. ccnIinue wiIh ncn-weighI Lecring exerci:e:

B. Substance abuse
1. nc :uch Ihing c: c :cfe |eve| cf crug:

2. c|cchc|i:m-ri:k cf feIc| c|cchc| :yncrcme, cLcrIicn
-prcL|em wiIh u:ing cnIcLu:e-:u:pecIec IercIcgenic

3. :mcking-reIcrc: feIc| grcwIh cnc ceve|cpmenI
c. ¦ ri:k fcr FIL, FFCM, cLrupIicn
L. :eccnc-hcnc :mcke ju:I c: Lcc

4. ccffeine-:ince iI´: c :Iimu|cnI, Le:I Ic |imiI-300 mg/ccy
c. ri:k cf S/8
L. ri:k cf grcwIh re:IricIicn

C. Vaccinations-ok if not a live vaccine

D. Battering
1. mcy increc:e wiIh en|crgemenI cf cLccmen

2. mu:I Le repcrIec

3. hcck up pI. wiIh :ccic| :ervice:/wcmen´: :he|Ier:

E. Preventing Preterm labor

Vll. Mu|IifeIc| pregncncie:
A. Maternal concerns
1. L|ccc vc|ume ¦÷¦ :Ircin cn CV :y:Iem

2. ¦ cnemic
!*"
16

3. ¦ uIerine ci:IenIicn÷:epcrcIicn cf cLccminc| mu:c|e:

4. ¦ ri:k fcr p|ccenIc previc

5. ¦ fcr :epcrcIicn cf p|ccenIc

ó. |cck cf emcIicnc| prepcremenI
c. wi|| neec ccciIicnc| ecuccIicn cnc :uppcrI
L. pc::iL|e neec fcr :e|ecIive recucIicn

7. ¦ :Ircin cn fincnce:, :pcce, wcrk|ccc, cnc re|cIicn:hip:

B. Fetal concerns
1. ri:k cf premcIuriIy

2. FFCM

3. Iype: cf Iwin:
c. dizygotic-frcm 2 ferIi|izec cvc/2 :permcIczcc
1. 2 p|ccenIc:
2. 2 chcricn:
3. 2 cmnicn:
L. monozygotic-crigincIing frcm cne ferIi|izec cvum
1. dichorionic-diamniotic Iwin: {20-307)
-if civi:icn 3 ccy: cfIer ferIi|izcIicn
-mcy hcve :epcrcIe cr fu:ec p|ccenIc:
2. monochorionic-diamniotic
-if civi:icn 5 ccy: cfIer ferIi|izcIicn
3. monochorionic-monoamniotic
-if civi:icn 7-13 ccy: cfIer ferIi|izcIicn
-rcre:I
c. ¦ ri:k cf ccngeniIc| mc|fcrmcIicn:-in mcnczygcIic
Iwin:
c. Iwin Ic Iwin :hunIing
e. Iwc-ve::e| ccrc

4. ce|ivery ccmp|iccIicn:

Vlll. Cu|Iurc| vcricIicn: curing Ihe prencIc| pericc
A. Examples of cultural variations
1. Le|ief cf wheIher pregncncy i: :IcIe cf i||ne::/hec|Ih

2. Lehcvicrc| expecIcIicn: cf mcIher/prcvicer
!*#
17

3. cieIcry pre:cripIicn:/re:IricIicn:
c. wcrm v:. cc|c
L. |ike Ic |ike
c. picc

4. ccIiviIy re:IricIicn:

5. cvci|cLi|iIy cf ccvice/if ccvice i: :cughI cI c||

ó. ccn:icercIicn cf mcce:Iy/re|igicn
c. c|cIhing
L. cmu|eI:, Lecc:

7. pcin
c. ineviIcL|e, Ic Le encurec
L. ccn Le cvcicec ccmp|eIe|y
c. puni:hmenI fcr :in
c. ccn Le ccnIrc||ec

8. nc Iying cf kncI:-|ecc: Ic kncI in umLi|icc| ccrc

º. knife uncer Lec Ic cuI Ihe pcin

10. :pecific grcup:
c. Mexiccn:
-:Icic unIi| ju:I Lefcre ce|ivery
-cvcic ec|ip:e cf mccn-c|efI pc|cIe
-everyLccy pre:enI cI ce|ivery
L. Micc|e Ec:Iern
-cn|y femc|e cIIenccnI:
-FC8 u:uc||y ncI cI ce|ivery
c. /:icn
-prefer wcrm f|uic
-ncIurc| chi|cLirIh
-|cLcr in :i|ence
-mcy ecI curing |cLcr
-FC8 mcy cr mcy ncI Le pre:enI

B. Nursing care
1. :uppcrI cu|Iurc| Le|ief-cffer c|IerncIive:

2. enccurcge pcIienI: Ic pcrIicipcIe in mecicc|
ceci:icn:
!*$
18

lX. McIernc| NuIriIicn
A. Nutritional requirements
1. energy neec:-ccciIicnc| 300 kcc| grecIer Ihcn
pre-pregncncy

2. prcIein
c. neecec fcr grcwing feIu:
L. mi|k, mecI, egg:, chee:e-ccmp|eIe prcIein:
c. cn|y :|ighI|y higher neec Ihcn ncn-pregncncy

3. f|uic:
c. reccmmenc 8-10 g|c::e: {2-3 |iIer:)
L. ccffeincIec crink: ccn´I ccunI-ciureIic
c. mcy Le gccc Ic cvcic crIificic| :weeIener:
c. prcper hycrcIicn: he|p: prevenI hecccche:,
ccn:IipcIicn, cnc uIerine crcmping

4. minerc|: cnc viIcmin:
c. ircn
-neecec fcr feIu: cnc expcn:icn cf mcIernc|
F8C mc::
-pccr ircn inIcke/cL:crpIicn = ircn ceficiency
-if cicgnc:ec wiIh cnemic-exIrc ircn :upp|emenI:
cnc ircn-rich cieI
-ircn ceficiency ccn |ecc Ic:
-mcIernc|: ccrcicc fci|ure, FF infecIicn:,
pccr wcunc hec|ing, cecIh
-feIc|: FIL, |cw-LirIh weighI infcnI
-ceficiencie: mcre ccmmcn in Ieen mcm: cnc
/friccn-/mericcn:
L. cc|cium
-nc chcnge in DFl fcr cc|cium
-1000 mg cci|y if 1º yr: cr c|cer
-1300 mg cci|y if uncer 1º
-if |ccIc:e-inIc|ercnI, :eek: ncn-cciry :curce: cf
cc|cium
-mcy neec cieIcry :upp|emenI ccnIcining
ó00 mg cc|cium
-he|p: prevenI |eg crcmp: frcm imLc|cnce cf
cc|cium/phc:phcru: rcIic
c. :ccium
-:|ighI increc:e in neec
-e::enIic| fcr mcinIcining wcIer Lc|cnce
!*%
19
-re:IricIicn cn|y neecec in wcmen wiIh
HIN, renc| cr |iver fci|ure
c. zinc
-ceficiency c::ccicIec wiIh CNS mc|fcrmcIicn:
-neecec fcr prcIein meIcLc|i:m
-if pI cn high-cc:e ircn :upp|emenI:, neec:
ccciIicnc| zinc :upp|emenI
e. fcI-:c|uL|e viIcmin:-/, D, E, K
-chrcnic cvercc:e: ccn |ecc Ic Icxic |eve|:
-/ccuIcne-if u:ec fcr cy:Iic ccne, mcy ccu:e
mu|Iip|e LirIh cefecI:
-necncIc| hypccc|cemic ncIec in crec: where
mcIher´: :kin |cckec ccce:: Ic :un|ighI
-ViI. K.-fcr :ynIhe:i: cf prcIhrcmLin
f. wcIer-:c|uL|e viIcmin:-8, C
-recci|y excreIec in urine :c neec: fre¢uenI
inIcke
-Fc|ic ccic
-neec 507 mcre fc|ic ccic Ihcn ncn-
pregncncy
-400-800 mcg cci|y
-CDC-50-707 cf NID {neurc| IuLe cefecI)
& cncencephc|y ¡ wiIh cce¢ucIe fc|cIe

B. Weight gain
1. 1
:I
Irime:Ier-5 |L: {1-2 kg)
2
nc
-3
rc
Irime:Ier-1 |L/week {0.44 kg/week)

2. ncrmc| 8Ml-11.5-1ó kg {25-35 |L:)
uncerweighI-12.5-18 kg {28-40 |L:)
cverweighI-7-11.5 kg {15-25 |L:)
cLe:e-7 kg {S 15 |L:)

3. 1
:I
Irime:Ier-ceve|cpmenI cf feIc| Ii::ue:
2
nc
cnc 3
rc
Irime:Ier-grcwIh cf feIc| Ii::ue:

C. Cultural differences

D. Nutritional risk factors
1. VegeIcricn
2. Ficc
3. LccIc:e lnIc|ercnI
4. /ncrexic/8u|imic
01/13
!*&
1
FeIc| /::e::menI
Lecture 8

l. Ihe High Fi:k Fregncncy
A. Indications for fetal diagnostic testing
1. Licphy:icc|-ri:k fccIcr: IhcI crigincIe wiIhin Ihe mcIher
cr feIu:-cffecI Ihe ceve|cpmenI cr funcIicn cf eiIher
cr LcIh
c. geneIic:
-cefecIive gene:
-inheriIec ci:crcer:
-chrcmc:cmc| cncmc|ie:
-mu|Iip|e pregncncie:
-/8C inccmpcIiLi|iIy
L. nuIriIicnc| :IcIu:
-Ieen mcm:
-3 pregncncie: in |c:I 2 yecr:
-IcLcccc, c|cchc|, cr crug u:e
-incce¢ucIe cr exce::ive weighI gcin
-HcI |e:: Ihcn 337
c. mecicc| cr cL:IeIric
-chrcnic HIN
-FlH
-GDM cr lDDM
-h/c FIL
-/M/
-h/c :Ii||Lcrn, feIc| cecIh
-:ick|e ce||
-hecrI ci:ec:e
-HlV
-L|eecing prcL|em:

2. p:ychc:ccic|-ri:k: ccmpri:ec cf mcIernc| Lehcvicr:
cnc ccver:e |ife:Iy|e IhcI hcve c negcIive effecI cn
Ihe hec|Ih cf Ihe mcIher cnc/cr feIu:
c. :mcking
L. ccffeine
c. c|cchc|
c. crug:
e. p:ychc|cgic :IcIu:
-h/c phy:icc|/verLc| cLu:e
-incce¢ucIe :uppcrI :y:Iem:
-ncnccmp|icnce wiIh cu|Iurc| ncrm:
-:iIucIicnc| cri:e:
!*'
2
-un:cfe cu|Iurc|, eIhicc|, cr re|igicu: prccIice:
3. :cciccemcgrcphic-ri:k: cri:e frcm Ihe mcIher cnc her
fcmi|y cnc p|cce Ihe mcIher cnc feIu: cI ri:k
c. |cw inccme
L. |cck cf FN ccre
c. cge
c. pcriIy
e. mcriIc| :IcIu:
f. re:icence
g. eIhniciIy

4. envircnmenIc|-ri:k: inc|uce hczcrc: cf Ihe wcrkp|cce
cnc Ihe wcmcn´: generc| envircnmenI
c. infecIicn:
L. rccicIicn
c. chemicc|:
c. IhercpeuIic crug:
e. i||egc| crug:
f. incu:Iric| pc||uIcnI:
g. :mcke, :Ire::, cieI

B. Nursing Interventions
1. Ccmp|eIe FN inIerview wiIh hi:Icry

2. Cffer ccce:: Ic :ervice: fcr hec|Ih prcmcIicn

3. Di:cu:: rec:cn: fcr hec|Ih cieI cnc |ife:Iy|e prccIice:

4. Emphc:ize neec Ic keep FN vi:iI: cnc cc |cL wcrk

5. EcuccIe pcIienI/pcrIner Ic p|cy cn ccIive rc|e in
hec|Ih cf Ihe mcIher cnc feIu:

ll. FeIc| cicgnc:Iic Ie:I:
A. Biophysical Assessment
1. Dci|y feIc| mcvemenI ccunI
c. :imp|e, ncninvc:ive, ccne cI hcme
L. ccn Le cffecIec Ly feIc| :|eep cyc|e cr mcIernc|
crug u:e
c. pre:ence cf feIc| mcvemenI i: generc||y c :ign
cf gccc hec|Ih
c. < 10 mcvemenI: in 3 hcur:, C/LL MD
e. 2 hcur: cfIer c mec| cnc :Ii|| < 4, C/LL MD
f. fc||cw up wiIh NSI, CSI, cr Licphy:icc| prcfi|e
!*(
3

2. u|Irc:cunc
c. inciccIcr:
-ge:IcIicnc| cge
-mu|Iip|e ge:IcIicn:
-feIc| grcwIh pcIIern:
-feIc| ccngeniIc| cncmc|ie:
-p|ccenIc| pc:iIicn cnc mcIuriIy
-cffecI: cf ci:ec:e prcce:: cn Ihe feIu:
-c::e:: feIc| re:pcn:e: Ic inIrcuIerine envircn.
-c::i:I wiIh cmniccenIe:i:, CVS, feIc:ccpy, eIc.
L. ccIc
-ref|ecIicn: cf echce: IhcI cre prccucec when
:cunc wcve: cre ci:per:ec Ic cnc
cL:crLec Ly Ii::ue: Leing :ccnnec
-nc reccgnizcL|e ri:k: Ic mcIher cr LcLy
-fu|| L|cccer he|p: Ic |ifI: up Ihe uIeru:
-tr a nsv a gi n al pro b e
1. c||cw: fcr LeIIer vi:uc|izcIicn cf pe|vi:
2. gccc Ic u:e cn cLe:e pcIienI:
3. c||cw: pregncncy Ic Le ceIerminec
ecr|ier
4. we|| Ic|ercIec, nc fu|| L|cccer
5. he|p: ceIecI ecIcpic pregncncie:
ó. u:ec in ccjuncIicn wiIh cLccminc|
:ccn Ic F/C FIL in 2
nc
& 3
rc
Irime:Ier:
- a b d o mi n al sc a n
1. fu|| L|cccer he|p: mcve uIeru: up
2. mcy Le hcrc Ic u:e cn cLe:e pI:.
3. mcre u:efu| cfIer 1
:I
Irime:Ier
-feIc| hecrI ccIiviIy Ly ó-7 week Ly echc :ccnner
-ge:IcIicnc| cge
1. ge:IcIicnc| :cc cimen:icn:-8 week:
2. crcwn-rump |engIh-7-14 week:
3. LipcrieIc| cicmeIer {8FD)-12+ week:
4. femur |engIh-12+ week:
-cmnicIic f|uic vc|ume {/FV cr /Fl)
1. ck f|uic-fi||ec pcckeI: wiIhcuI feIc|
pcrI: cr ccrc
2. /Fl-cepIh cf f|uic in c|| 4 ¢ucc:
-< 5cm=c|igc
-5-1º cm=ncrmc|
-cver 20 cm=pc|y

!*)
4

3. cecrec:ec /FV-|crge:I pcckeI cf
f|uic i: <2 cm
4. increc:ec /FV-mu|Iip|e |crge
pcckeI: cf f|uic > 12 cm

3. MFl-mcgneIic re:cncnce imcging
c. ncninvc:ive, nc kncwn effecI cn feIu:
L. evc|ucIe feIc| grcwIh
c. evc|ucIe feIc| :IrucIure
c. evc|ucIe p|ccenIc| grcwIh, pc:iIicn
e. /FV
f. mcIernc| :IrucIure:
g. Licchemicc| :IcIu:
h. :cfI Ii::ue, meIcLc|ic, cr funcIicnc| mc|fcrmcIicn:

B. Biochemical Assessment
1. /mniccenIe:i:
c. Ircn:cLccminc| in:erIicn cf c neec|e inIc uIeru:
L. ccne cfIer week 14 when uIeru: i: in Ihe cLc.
c. inciccIicn: fcr:
-FN cicgnc:i: cf geneIic ci:crcer:
cc||ecIicn cf feIc| ce||: in f|uic
kcrycIype ccne
¦ /FF |eve|-pc::iL|e neurc| IuLe cefecI
-ccngeniIc| cncmc|ie:
-c::e::menI cf |ung mcIuriIy
L/S rcIic cf 2:1 cr +FG cr L8C >50,000 cI:/UL
-cx feIc| hemc|yIic ci:ec:e
c. ccmp|iccIicn:
-|e:: Ihcn 17 cf cc:e:
-FIL/mi:ccrricge
-infecIicn
-hemcrrhcge{Fh - mcm: geI Fhcgcm)
-cmnicIic f|uic emLc|i:m
-injury Ic feIu:/feIc| cecIh

2. FU8S-percuIcnecu: umLi|icc| L|ccc :cmp|ing
c. c|:c kncwn c: ccrcccenIe:i:
L. u:ec curing 2
nc
cr 3
rc
Irime:Ier
c. u:ec fcr L|ccc :cmp|ing cr Ircn:fu:icn
c. in:erI neec|e inIc feIc| ve::e| u:ing U/S
e. u:ec Ic cx feIc| L|ccc ci:crcer:, kcrycIype,
L|ccc Iype, cnc cccmL:
!!*
5
f. c::e:: FHF fcr 1 hcur cnc re:ccn in 1 hcur

3. CVS-chcricnic vi||u: :cmp|ing
c. ccne cI 10-12 week:
L. remcve :mc|| Ii::ue frcm feIc| pcrIicn cf p|ccenIc
c. inciccIive cf feIc| geneIic mckeup
c. u:e Ircn:cervicc| cr Ircn:cLccminc| cpprccch
e. ccmp|iccIicn:
-cLcrIicn -infecIicn -L|eecing
f. Fhcgcm given Ic Fh - mcm:
g. º07 cf prccecure: ccne cn wcmen > 35 yr: c|c
h. Leccu:e ccne ecr|y, ccn´I ceIecI neurc| IuLe
cefecI:

4. mcIernc| L|ccc :cmp|ing
c. Cc|ifcrnic FrencIc| Screening Frcgrcm
-:ee Lcck|eI fcr L|ccc Ie:I cnc U/S cfferec
L. CccmL:
-Ie:I fcr Fh inccmpcIiLi|iIy
-incirecI=cmI. cf Fh+ cnIiLccie: in mcm´: L|ccc
-cirecI=pre:ence cf cnIiLccy-cccIec Fh+ F8C:
in LcLy´: L|ccc
-ceIermine :everiIy cf feIc| cnemic frcm
hemc|y:i:

C. Electronic fetal monitoring
1. Ncn:Ire:: Ie:I-{NSI)
c. hec|Ihy feIu: wiIh inIccI CNS, º07 wi|| hcve FHF
ccce|ercIicn: wiIh grc:: Lccy mcvemenI:
L. L|unIec Ly hypcxic, ccicc:i:, crug:, feIc| :|eep
c. reccIive if:
-ncrmc| Lc:e|ine rcIe
-2 cr mcre ccce|ercIicn: {15X15) in 20 min.
-mccercIec vcricLi|iIy
c. ncnreccIive cr un:cIi:fccIcry
-neec furIher mcniIcring, ccn:icer CSI/8FF

2. ccnIrccIicn :Ire:: Ie:I-{CSI)
c. prcvice: c wcrning cf feIc| ccmprcmi:e ecr|ier
Ihcn NSI
L. U/C´: cecrec:e uIerine L|ccc f|cw/p|ccenIc|
perfu:icn-hypcxic Ic feIu:=cece|ercIicn in FHF
c. FHF i: mcniIcrec fcr cI |ec:I 15 minuIe:
c. nipp|e-:Iimu|cIec CSI
!!!
6
-mc::cge nipp|e unIi| ccnIrccIicn i: e|iciIec
-ce:ire 3 U/C´:/10 minuIe:/|c:Iing 40-ó0 :ec
e. cxyIccin-:Iimu|cIec CSI
-lV infu:icn cf cxyIccin Ic :IcrI U/C´:
-increc:ec in 0.5 mU/min incremenI:
f. negcIive re:u|I:
-nc |cIe cece|:
g. pc:iIive re:u|I:
-per:i:IenI cnc ccn:i:IenI |cIe cece|: wiIh mcre
Ihcn hc|f Ihe ccnIrccIicn:

3. feIc| cxygen :cIurcIicn
c. FSpC
2
mcy Le he|pfu| in cifferenIicIing feIc|
hypcxic
L. ccjuncI Ic EFM
c. ncrmc| FSpC
2
mcy prevenI unnece::cry
inIervenIicn: when c ncnrec::uring FHF pcIIern
i: icenIifiec
c. FCM i: neecec
e. :ignc| errcr if imprcper|y p|ccec, Icc hciry, cr
Icc much vernix
f. ncrmc| FSpC
2
curing |cLcr i: LeIween 30-707

D. Biophysical profile
1. ncninvc:ive cyncmic c::e::menI cf feIu:/envircnmenI

2. c::e::ing 5 vcricL|e:
c. feIc| LrecIhing mcvemenI:
-ncrmc| {2)-cne cr mcre epi:cce: in 30 min
|c:Iing > 30 :eccnc:
-cLncrmc| {0)-cL:enI cr nc epi:cce mcIching
re¢uiremenI cLcve
L. grc:: Lccy mcvemenI:
-ncrmc| {2)-3 cr mcre mcvemenI:/30 min
-cLncrmc| {0)-ncne cr |e:: Ihcn 3/30 min
c. feIc| Icne
-ncrmc| {2)-1 cr mcre ccIive exIen:icn wiIh
reIurn Ic f|exicn
-cLncrmc| {0)-:|cw exIen:icn wiIh reIurn
c. reccIive feIc| hecrI rcIe
-ncrmc| {2)-2 cr mcre ccce|: wiIh +FM/20 min
-cLncrmc| {0)-|e:: Ihcn re¢uiremenI
e. ¢uc|iIcIive cmnicIic f|uic vc|ume
-ncrmc| {2)-1 cr mcre pcckeI: cf f|uic > 1 cm in
!!"
7
2 perpencicu|cr p|cne:
-cLncrmc| {0)-pcckeI: cL:enI cr Le|cw neecec

3. :ccre
c. ncrmc| = 8-10 if /Fl ck
L. e¢uivccc| = ó
c. cLncrmc| = <4

E. Role of the Nurse in Fetal Assessment Testing
1. :uppcrI per:cn when Ihe wcmcn i: uncergcing excm:
:uch c: U/S, cmnic, FU8S, CVS, eIc

2. in :cme :eIIing:, Ihe FN wi|| perfcrm Ihe NSI, CSI,
8FF, cnc Lc:ic U/S

3. pcIienI Iecching
c. prepcrcIicn fcr prccecure
L. inIerpreIing Ihe fincing:
c. prcvicing p:ychc:ccic| :uppcrI FFN


F. Electronic FHR assessment
1. FHF Irccing-c::e::menI cnc inIerpreIcIicn
c. Lc:e|ine
-rcnge cf FHF in c 10 minuIe pericc in Ihe
cL:ence cf cr LeIween U/C´:
-110-1ó0 Lpm
L. vcricLi|iIy
-º87 cccurccy in precicIing feIc| we||-Leing
-re:u|I cf feIc| :ympcIheIic/pcrc:ympcIheIic
nervcu: :y:Iem:
-ccn Le cffecIec Ly feIc| :|eep cyc|e, mcIernc|
cnc|ge:ic:, premcIuriIy, ccngeniIc|
cncmc|ie:
-cecrec:e in vcricLi|iIy-pc::iL|e :ign cf feIc|
ci:Ire:: cr prcfcunc ccmprcmi:e
c. Lrccyccrcic
-FHF Le|cw 110 Lpm fcr 10 minuIe: cr mcre
-inciccIive cf feIc| hypcxic
c. Icchyccrcic
-FHF cver 1ó0 Lpm fcr 10 minuIe: cr mcre
-mcrkec Icchyccrcic > 180 Lpm
-premcIuriIy -mi|c hypcxic
-Iccc|yIic cgenI: -mcIernc| fever
!!#
8
-mcIernc| cnemic -feIc| ccIiviIy
e. chcnge: in FHF
-ccce|ercIicn:-u:uc||y c::cc. wiIh + FM
-cece|ercIicn:-ecr|y, |cIe, vcricL|e

2. nur:ing rc|e
c. reccrc infcrmcIicn cn :Irip if uncL|e Ic chcrI
L. vcginc| excm:
c. c::e:: if FCM
c. VS c::e::menI:
e. pc:iIicn chcnge: when neecec
f. cxygen vic mc:k
g. meciccIicn:
h. eme:i: ccnIrc|
i. c::e:: neec fcr inIernc| mcniIcr:

3. cece|ercIicn pcIIern:
c. ecr|y-rcre|y Le|cw 110 Lpm
-periccic cece|: F/I inIen:e feIc| hecc
ccmpre::icn
-unifcrm :hcpe, mirrcr imcge cf U/C
L. |cIe
-unifcrm-ref|ecI: :hcpe cf ccnIrccIicn
-cn:eI cfIer peck cf U/C
-repeIiIicu:
-ccu:e-uIercp|ccenIc| in:ufficiency
-hypcIen:icn -FlH
-hyperIcnic ccnIrccIicn:
-cLrupIic -pc:ImcIuriIy
-lUGF -DM
-ccIicn
-cxygen -pc:iIicn chcnge
-:Icp piIccin crip -lV hycrcIicn
-c::e:: cIher S & S
c. vcricL|e
-U cr V :hcpec
-wiIh cr wiIhcuI U/C
-F/I ccrc ccmpre::icn
-u:uc||y Ircn:ienI, chcngecL|e
-ccIicn
chcnge Ic :ice |ying cxygen
exIernc| feIc| mcnipu|cIicn SVE
knee-che:I pc:iIicn
cmnicinfu:icn if FCM
!!$
9
Pregnancy at Risk

lV. Di:crcer: Ccu:ing 8|eecing in Ecr|y Fregncncy
A. hemorrhage during pregnancy
1. emergenI :iIucIicn-ccmp|iccIe: 1 in 5 pregncncie:

2. curing Ihe fir:I hc|f-u:uc||y re:u|I cf S/8, ecIcpic, mc|cr
cr inccmpeIenI cx

3. curing Ihe :eccnc hc|f-u:uc||y p|ccenIc previc,
p|ccenIc cLrupIic

4. ri:k fcr mcIernc| ex:cnguincIicn wiIh 8-10 minuIe:
r/I uIerine L|ccc f|cw i: ó50 m|/min {157 cf CC)

B. spontaneous abortion
1. pregncncy IhcI enc: Lefcre 20 week:

2. cr feIc| weighI |e:: Ihcn 500 gm:

3. incicence-10-157 cf c|| pregncncie:

4. ecr|y-cccurring pricr Ic 12 week:
c. 507 ccu:cIicn frcm chrcmc:cmc| cLncrmc|iIie:
L. 807 cccur wiIhin Ihe fir:I 12 week:
c. cIher ccu:e:
-encccrine imLc|cnce {lDDM)
-immunc|cgicc| fccIcr: {cnIiphc:phc|ipic
cnIiLccie:)
-infecIicn: {ch|cmycic, LccIeruric)
-:y:Iemic ci:crcer: {|upu:)
-geneIic fccIcr:

5. |cIe-12-20 week:
c. u:uc||y r/I mcIernc| ccu:e:
-/M/
-pcriIy
-chrcnic infecIicn:
-premcIure ci|cIicn cf cx
-reprccucIive IrccI cncmc|ie:
-chrcnic ci:ec:e:
-incce¢ucIe nuIriIicn
-recrecIicnc| crug u:e/cLu:e

!!%
10
ó. Iype:
c. IhrecIenec-:pcIIing, c|c:ec cervix, crcmping
L. ineviIcL|e-cpen cervix, mcc-hecvy L|eecing,
mcc-:evere crcmping
c. inccmp|eIe-:cme FCC reIcinec
c. ccmp|eIe-c|| FCC remcvec
e. mi::ec-cecIh in uIerc wiIhcuI cLvicu: S & S
cicgnc:ec Ly U/S
f. recurrenI-3 cr mcre

7. c|inicc| mcnife:IcIicn:
c. increc:ing|y :evere c: ge:I. cge increc:e:
L. Lefcre ó week:-increc:ec f|cw |ike hecvy
men:e:
c. ó-12 week:-mccercIe ci:ccmfcrI, L|ccc |c::
c. 12 week:-:evere pcin

8. c::e::menI
c. check FN hi:Icry cnc hCG |eve|
L. U/S
c. C8C
c. L|ccc Iype cnc Fh fccIcr
e. c::e:: fcr infecIicn

º. p|cn cf ccre
c. re:I cnc :uppcrIive ccre
L. D & C
c. D & E
c. mcy neec prc:Icg|cncin:, lV, cr piIccin fcr
feIc| cemi:e

10. Iecching
c. repcrI hecvy cr LrighI rec L|eecing
L. :cme :ccnI ccrk ci:chcrge 1-2 week: pc:I
c. nc vcginc| in:erIicn: unIi| L|eecing :Icp:
c. Icke enIire ccur:e cf cLx if pre:criLec
e. grief ccun:e|ing if neecec
f. refer Ic :uppcrI grcup

C. induced abortion
1. e|ecIive-Ly re¢ue:I

2. IhercpeuIic-fcr mcIernc|/feIc| hec|Ih cr ci:ec:e

!!&
11
3. primcri|y ccne in 1
:I
Irime:Ier

4. c::e::menI
c. infcrmec ccn:enI
L. cpIicn: exp|crec
c. ci:cu:: ccnf|icI:/fecr:

5. prccecure
c. |cmincric Ihen vccuum c:pircIicn {D & E )
L. mcy u:e FG ge| Ic ripen cx
c. neec Ic mcniIcr Iemp. cnc L|eecing
c. mcy u:e FU48ó {Mifepri:Icne)
e. mcy u:e meIhcIrexcIe lM wiIh vcginc|
mi:cprc:Ic|

ó. ccmp|iccIicn:
c. infecIicn
L. reIcinec FCC
c. c|cI:
c. L|eecing

D. Ectopic pregnancy
1. ferIi|izec cvum cuI:ice Ihe uIeru:

2. ccccunI: fcr 27 cf c|| pregncncie:

3. º57 cccur in Ihe fc||cpicn IuLe:
c. 17 cvcry
L. 37 cLccminc| ccviIy
c. 17 cervix

4. re:pcn:iL|e fcr 107 cf c|| mcIernc| mcrIc|iIy &
|eccing ccu:e cf inferIi|iIy

5. c::e::menI
c. L|eecing
L. cu||, cc|icky pcin
c. Iencerne::
c. referrec :hcu|cer pcin r/I cicphrcgmcIic
irriIcIicn
e. :hcck if rupIurec
f. Cullen’s sign-ecchymcIic L|uene:: crcunc Ihe
umLi|icu: inciccIing hemcIcperiIcneum

!!'
12
ó. cicgnc:i:
c. c|inicc| picIure :cunc: |ike cIher infecIicn: cr
ci:ec:e:
L. neec Ic r/c cppenciciIi:, S/8, eIc.
c. \ LeIc hCG, C8C, cnc U/S
c. prcge:Iercne <25ng/mL=inIrcuIerine
prcge:Iercne <5ng/mL=cecc feIu:/ecIcpic

7. prccecure
c. unrupIurec-meIhcIrexcIe Ic ci::c|ve re:icuc|
Ii::ue
L. :c|pingc:Icmy
c. rupIurec-|cpcrcIcmy wiIh :c|pingecIcmy

8. p|cn
c. Iecching ccncerning pc::iL|e prccecure:
L. mcniIcr |cL:-C8C, hCG, L|ccc Iype, Fh
c. ccmini:IrcIicn cf lV f|uic:/L|ccc Ircn:fu:icn
c. fre¢uenI viIc| :ign:
e. ccmini:IrcIicn cf Fhcgcm FFN
f. pc:I-cp Iecching
g. :uppcrI grcup:/grief ccun:e|ing

F. Gestational trophoblastic disease
1. hyccIicifcrm mc|e, invc:ive mc|e, cnc
chcricccrcincmc

2. incicence: 1:1200, :|ighI|y higher in /:icn:

3. Iype: cf hyccIicifcrm mc|e::
c. complete-ferIi|izec egg whc:e nuc|eu: i: |c:I
-inIrcuIerine ccnIenI: re:emL|e Lunch cf whiIe
grcpe:-grcw cnc en|crge uIeru:
-nc feIu:, p|ccenIc, memLrcne:, cr f|uic
-cvc:cu|cr ve:ic|e:
-c::ccicIec wiIh choriocarcinoma
L. partial-2 :perm ferIi|izec ncrmc| cvum, re:u|I:
in cmLigucu: pcrI:, ccngeniIc| cncmc|ie:
-kcrycIype cf óº xxy, óº xxx, cr óº xy
-feIu: wiIh mu|Iip|e cncmc|ie:

4. eIic|cgy unkncwn

5. ri:k fccIcr:: c|cmic, Ieencger:, wcmen cver 40
!!(
13

ó. mcnife:IcIicn:
c. ecr|y pcrI cf pregncncy unccmp|iccIec
L. ccrk Lrcwn vcginc| ci:chcrge cr LrighI rec
c. higher Ihcn expecIec funcc| heighI {507)
c. c::ccicIec wiIh cnemic, hypereme:i:
grcviccrum, cLccminc| crcmp:
e. FlH-º-12 week:
f. 1ó week:-pc::cge cf ve:ic|e:

7. |cL:/Ie:I:
c. :eric| hCG
L. U/S

8. p|cn
c. :ucIicn cureIIcge cf Ii::ue
L. incucIicn wiIh piIccin/prc:Icg|cncin: NCI
reccmmencec r/I increc:e ri:k cf emLc|izcIicn
cf IrcphcL|c:Iic Ii::ue
c. Fhcgcm if neecec

º. nur:ing p|cn
c. ccre fcr grief/|c::
L. IhercpeuIic ccmmuniccIicn
c. reIurn fcr :eric| hCG prcIccc| fcr 1 yecr &
Lc:e|ine che:I x-rcy Ic ceIecI |ung meIc:Ic:i:
e. mcniIcr hCG cnc increc:ing funcc| heighI fcr
pc::iL|e chcricccrcincmc-chemc/meIhcIrexcIe

V. Di:crcer: Ccu:ing 8|eecing in LcIer Fregncncy
A. Placenta previa
1. imp|cnIcIicn cf p|ccenIc in |cwer uIerine :egmenI
necr cr cver inIernc| cervicc| c:

2. Iype:
c. IcIc|-c: IcIc||y ccverec when cervix ci|cIec
L. pcrIic|-inccmp|eIe
c. mcrginc|-ecge exIenc: Ic c: LuI mcy increc:e
curing ci|cIicn
c. |cw-|ying-imp|cnIec in |cwer uIerine :egmenI-
cce:n´I recch c:

3. incicence: 0.57 cf c|| LirIh:

!!)
14
4. c::ccicIec ri:k fccIcr:
c. previcu: p|ccenIc previc {12X ri:k)
L. previcu: C/S
c. incucec cLcrIicn
c. mu|IifeIc|
e. c|c:e|y :pccec pregncncie:
f. /M/
g. eIhnic-/friccn-/mericcn, /:icn:
h. :mcking
i. ccccine

5. mcnife:IcIicn:
c. 707 pcin|e:: L|eecing
L. 207 uIerine ccIiviIy

ó. cicgnc:i:
c. Ircn:cLccminc| u|Irc:cunc
L. re¢uire: C/S
c. ck NSI, 8FF, feIc| |ung mcIuriIy
c. Lec re:I FFN
e. cL:ervcIicn fcr FHF, vcginc| L|eecing, VS

7. p|cn
c. if Ierm cnc in |cLcr wiIh L|eecing-C/S
L. if Lefcre 3ó-37 week:-re:I/cL:ervcIicn
c. NSI, feIc| mcniIcring
c. mcniIcr L|eecing cnc viIc| :ign:
e. mcniIcr C8C
f. give 8eIcmeIhc:cne
g. nc vcginc| excm:
h. cc C/S |cIer if :IcL|e

B. Abruptio placenta
1. premcIure :epcrcIicn cf p|ccenIc, ceIcchmenI cf pcrI
cr c|| cf p|ccenIc frcm imp|cnIcIicn :iIe cfIer 20 week:
ge:IcIicn

2. :ignificcnI perincIc| mcrIc|iIy fcr LcIh feIu:/mcIher

3. ri:k fccIcr:
c. HIN
L. ccccine
c. L|unI Ircumc-LcIIering, MV/
c. :mcking
!"*
15
e. mc|nuIriIicn
f. ri:k cf recurrence :ignificcnI

4. c|c::ificcIicn
c. Grcce 1-mi|c :epcrcIicn-10-207
L. Grcce 2-mccercIe-20-507
c. Grcce 3-:evere->507

5. c|inicc|
c. :ignificcnI uIerine Iencerne::/pcin
L. vcginc| L|eecing
c. ccnIrccIicn:
c. mcy hcve nc L|eecing
e. hypcvc|emic :hcck
f. cccgu|cpcIhy
g. ccuve|cire uIeru:-F/I L|ccc Ircppec LeIween
p|ccenIc cnc uIerine wc||÷hy:IerecIcmy
h. DIC-disseminated intravascular coagulation
i. ccmp|iccIicn:-hemcrrhcge, :hcck, infecIicn
j. perincIc| mcrIc|iIy-hypcxic in uIerc, FIL, SG/,
neurc|cgicc| ceficiI:

ó. cicgnc:i:-U/S

7. p|cn
c. cepenc: cn ge:IcIicn cge, :IcIu:, cnc mcm
L. VS, feIc| mcniIcring, l & C, lV f|uic:, L|ccc ccmin.
c. LeIcmeIhc:cne if cpp|iccL|e
c. u:uc||y re¢uire: C/S-mcy hcve prcL|em: wiIh
unccnIrc||cL|e L|eecing

º. nur:ing ccre
c. |crge Lcre lV´:
L. fc|ey ccIheIer
c. wcIch fcr cecrec:e in urincry cuIpuI
c. L|ccc ccmini:IrcIicn FFN
e. mcniIcr FHF
f. mcniIcr fcr pcin
g. mcniIcr C8C, fiLrincgen, FI, FII
h. IhercpeuIic ccmmuniccIicn fcr cnxieIy, grief




!"!
16
Vl. Hypereme:i: Grcviccrum
A. Risk factors
1. |e:: Ihcn 20 yr: c|c, cLe:iIy, mu|IifeIc|, mc|cr

2. eIic|cgy-cL:cure, mu|IifccIcric|-mcy Le c::ccicIec wiIh
Ircn:ienI hyperIhyrcici:m cr e|evcIec |eve|: cf e:Ircgen

B. Priority nursing care
1. p|cn
c. ccmiI, p|cce lV, keep NFC
L. cieI-ccvcnce c: Ic|ercIec
c. meciccIicn:: ccccrcing Ic neec
-Zcfrcn-cnccn:eIrcn HC|
-Feg|cn-meIcc|cprcmice
-8enccry|-ciphenhycrcmine
-lncp:ine-crcpericc|
-ccrIicc:Iercic:
c. p:ych ccn:u|I FFN

2. nur:ing ccre
c. IhercpeuIic ccmmuniccIicn
L. l & C
c. cci|y weighI
c. re:I
e. cieI c: Ic|ercIec
f. :mc||, fre¢uenI mec|:
g. cecrec:e fcI: cnc prcIein if ncI Ic|ercIec
h. mcniIcr lV :iIe

Vll. HyperIen:ive ci:crcer: cf pregncncy
A. Background
1. HIN i: Ihe mc:I ccmmcn mecicc| ccmp|iccIicn cf
pregncncy-1-57

2. preec|cmp:ic ccmp|iccIe: 2-77 cf c|| pregncncie:
-147 in Iwin pregncncie:

3. wcmen wiIh chrcnic HIN cr renc| ci:ec:e=257 ri:k fcr
preec|cmp:ic

4. rcIe hc: ri:en :ince ecr|y 1ºº0´:

5. 2
nc
cn|y Ic emLc|i c: ccu:e cf mcIernc| mcrIc|iIy

!""
17
ó. preci:pc:e: mcIher fcr ec|cmp:ic, DlC, cLrupIic,
hepcIic fci|ure, /FDS, cereLrc| hemcrrhcge


7. mcIernc| cnc perincIc| mcrLiciIy cnc mcrIc|iIy cre
highe:I when ec|cmp:ic i: :een ecr|y in ge:IcIicn
{Lefcre week 28), mcm: cver Ihe cge cf 35,
mu|Iigrcvicc:, cnc chrcnic HIN cr renc| ci:ec:e

8. feIu: cI ri:k frcm cLrupIic p|ccenIce, FIL, lUGF, cnc
ccuIe hypcxic

B. Risk factors
1. chrcnic renc| ci:ec:e

2. chrcnic hyperIen:icn

3. fcmi|y h/c FlH

4. mu|IifeIc| ge:IcIicn

5. primigrcvicc

ó. mcIernc| cge <1º yr:, >35 yr:

7. cicLeIe:

8. Fh inccmpcIiLi|iIy

10. cLe:iIy

C. Classification/ assessment
1. 2 Lc:ic Iype:-chrcnic HIN cnc pregncncy-incucec
c. CHTN-preccIe: Ihe pregncncy cr HIN IhcI
ccnIinue: Leycnc 42 week: pc:IpcrIum
L. PIH/ GHTN-cn:eI cf HIN generc||y cfIer Ihe 20
Ih

week
mcy cccur incepencenI|y cr :imu|Icnecu:|y

2. preec|cmp:ic
c. pregncnI :pecific
L. HIN cfIer week 20
c. mu|Ii:y:Iem vc:cpc:Iic ci:ec:e-HIN wiIh
FrcIeinuric {1-2+)
!"#
18
c. chcrccIerizec mi|c cr :evere
e. ¦ 8F i: fir:I wcrning :ign-¦140/º0
f. pcIhc|cgic ecemc in fcce, hcnc:, cr cLccmen
cr weighI gcin >2 kg/week
g. urine cnc 8F check: neec 2 + re:u|I: Ic Le
c|c::ifiec preec|cmp:ic

3. :evere preec|cmp:ic
c. 8F ¦ 1ó0/110
L. > 3+ cr 4+ cn cip:Iick: 5g< 24 hr urine cc||ecIicn
c. c|iguric-<400-500 m|/cy
c. vi:uc| ci:IurLcnce:/hecccche:/c|Ierec LCC
e. hepcIic invc|vemenI
f. ¡ p|cIe|eI:-IhrcmLccyIcpenic
g. pu|mcncry/ccrcicc invc|vemenI
h. ceve|cpmenI cf HELLF :yncrcme
i. :evere feIc| grcwIh reIcrccIicn

4. ec|cmp:ic
c. cn:eI cf :eizure ccIiviIy in Ihe wcmcn cicgnc:ec
wiIh FlH wiIh nc neurc|cgic pcIhc|cgy
L. mcy Le iniIic| :ign pcIienI hc: FlH

5. HELLF-hemc|y:i:, e|evcIec |iver enzyme:, |cw FLI
c. vcricnI cf :evere preec|cmp:ic
L. cppecr: in 2-127 cf wcmen wiIh :evere
preec|cmp:ic
c. mcIernc| mcrIc|iIy-c: high c: 247
c. :een mcre fre¢uenI|y in c|cer wcmen,
Ccucc:icn:, cnc mu|Iipcrcu: wcmen
e. ó57 wi|| hcve c/c epigc:Iric/FUC pcin
f. 507 wi|| hcve N & V
g. ccn Le ncrmcIen:ive cnc wiIhcuI prcIeinuric
h. IhcughI Ic Le ccu:ec Ly crIeric| vc:c:pc:m:,
enccIhe|ic| ccmcge, cnc p|cIe|eI cggregcIicn

ó. chrcnic HIN
c. HIN Lefcre pregncncy cr cicgnc:ec Lefcre
week 20
L. c|:c ccn:icerec chrcnic if HIN |c:I: |cnger Ihcn
ó week: FF
c. ccn:icerec mi|c if cic:Ic|ic remcin: Le|cw 110
c. crug cf chcice: /|ccmeI {meIhy|ccpc)

!"$
19


7. chrcnic HIN wiIh :uperimpc:ec preec|cmp:ic
c. 8F wiIh ¦ :y:Ic|ic 30 mm Hg, cic:Ic|ic 15 mm Hg
L. wiIh prcIeinuric cnc generc|izec ecemc

8. Ircn:ienI HIN
c. ceve|cpmenI cf HIN curing pregncncy cr
in Ihe fir:I 24 hcur: pc:I pcrIum
L. nc cIher S & S cf preec|cmp:ic

D. Pathophysiology/ etiology
¦ 8F÷vc:c:pcm:
¡
¡ p|ccenIc| perfu:icn
¡
enccIhe|ic| ce|| ccIivcIicn
¡ ¡ ¡
vc:cccn:IricIicn ccIivcIicn cf inIrcvc:cu|cr
cccgu|cIicn f|uic
cc:ccce reci:IriLuIicn
¡
cecrec:ec crgcn perfu:icn

1. mi|c preec|cmp:ic÷:evere preec|cmp:ic÷HELLF÷
cr ec|cmp:ic

2. ref|ecI: c|IercIicn: in ncrmc| cccpIcIicn: cf pregncncy
c. increc:e L|ccc p|c:mc vc|ume
L. vc:cci|cIicn
c. cecrec:ec :y:Iemic vc:cu|cr re:i:Icnce
c. e|evcIec ccrcicc cuIpuI
e. cecrec:ec cc||cic c:mcIic pre::ure

3. mcin pcIhcgenic fccIcr i: ncI ¦ 8F LuI pccr perfu:icn
c: c re:u|I cf vc:c:pc:m

E. HELLP syndrome
1. i: c |cLcrcIcry, ncI c|inicc|, cicgnc:i:
c. p|cIe|eI: < 100,000/mm
3
L. ¦ |iver enzyme:
-/SI-c:pcrIcIe cmincIrcn:ferc:e ¦
-/LI-c|cnine cmincIrcn:ferc:e ¦
c. :cme evicence cf hemc|y:i:
!"%
20
-e|evcIec Li|i |eve| & Lurr ce||: cn :mecr
c. un|ike DlC, cccgu|cIicn pcne| ncrmc|



2. ccmp|iccIicn: repcrIec wiIh HELLF inc|uce:
c. renc| fci|ure
L. pu|mcncry ecemc
c. rupIurec |iver hemcIcmc
c. DlC
e. cLrupIic p|ccenIce

F. Nursing process
1. reccgnizec ri:k fccIcr:

2. hi:Icry
c. hecccche
L. epigc:Iric pcin
c. vi:uc| ci:IurLcnce:

3. c::e:: 8F, wI., ecemc, prcIeinuric, cnc DIF´:
c. ecemc cn c :cc|e cf 0-+4
L. DIF-pcIe||c cnc Licep, \ fcr c|cnu:

4. feIc| c::e::menI

5. uIerine IcniciIy

ó. vcginc| excm

7. |cL Ie:I:
c. C8C
L. c|cIIing fccIcr:
c. |iver enzyme:
c. chem pcne|: uric ccic, crecIinine, 8UN, F8S
e. Iype cnc :creen
f. urinc|y:i: cr 24 hr prcIeinuric

8. nur:ing cicgnc:e:
c. cnxieIy
L. c|Ierec Ii::ue perfu:icn
c. kncw|ecge ceficiI
c. ri:k fcr impcirec gc: exchcnge
e. ri:k fcr ¡ CC
!"&
21
f. ri:k cf injury Ic feIu: cr mcIher
g. ineffecIive ccping F/I pcwer|e::ne::

G. Pharmacology and related nursing interventions
1. mi|c FlH
c. re:I cI hcme, cn L :ice when pc::iL|e
L. Iecch mcm Ic c::e:: 8F, cip urine, feIc|
kick ccunI
c. pc::iL|e fre¢uenI NSI´:
c. mcy wcnI Ic enccurcge |cw Nc cieI

2. :evere FlH cr HELLF
c. immecicIe LirIh cr ccn:ervcIive mcncgemenI
L. |cL: c: cirecIec
c. wI., fc|ey, :IricI l & C, vcg. excm, cLc. pc|pcIicn
c. EFM
e. Lec re:I, ¢uieI, ccrk rccm, nc vi:iIcr:
f. pcccec :ice rci|:
g. :ucIicn e¢uipmenI cI Lec:ice
h. Icxemic Lcx in rccm-re:u:ciIcIicn mec:
i. ccnIinue Ic mcniIcr curing Ihe inIrc Ic
pc:IpcrIum

3. phcrmccc|cgy
c. mcgne:ium :u|fcIe
-he|p: prevenI cr IrecI ccnvu|:icn:
-inIerfere: wiIh cceIy|chc|ine cI :yncp:e:
-¡ neurcmu:cu|cr cnc CNS irriIcLi|iIy
-¡ ccrcicc ccncucIicn
-increc:e: L|ccc f|cw in uIeru: Ic prcIecI Ihe
feIu:
-increc:e: prc:Irccy|in: Ic prevenI uIerine
vc:cccn:IricIicn
-:eccnccry infu:icn
|cccing cc:e-4-ó gm: cver 20-30 min
mcinIencnce-1-3 gm:/hr
-mcg |eve| in 4-ó hr: {IhercpeuIic |eve| 4-8 mg/c|)
-fre¢uenI|y ck FF, UC, DIF´:
-hcve cc|cium g|uccncIe cI Lec:ice {cnIiccIe)
-IcxiciIy-ncu:ec, f|u:hing, ¡ ref|exe:, :|urrec
:peech, cnc mu:c|e weckne::
-mcy Le given lM fcr Ircn:pcrI yeI cL:crpIicn
rcIe i:n´I ccnIrc||ec, lM i: mcre pcinfu|
-ciure:i: wiIhin 24 hcur: i: cn + prcgnc:Iic :ign
!"'
22
-if ec|cmp:ic ceve|cp:-2-ó gm: MgSC
4
lV pu:h
cver 3-5 minuIe:
L. cmcLcrLiIc| :ccium-:eccIive
-250 mg :|cw pu:h cver 3-5 min
c. ciczepcm-cccc:icnc||y u:ec
-mcy ccu:e ph|eLiIi:, vencu: IhrcmLc:i:
-if given Icc rcpic|y-cpnec, ccrcicc cecIh
c. cnIihyperIen:ive:
-lV hycrc|czine {/pre:c|ine)
-|cLeIc|c| HC|, meIhy|ccpc, cr nifecipine

































01/13
!"(
1
Fregncncy cI Fi:k, FcrI 2
Lecture º

Vlll. McIernc|-feIc| L|ccc inccmpcIiLi|iIie:
[See H|gh k|sk Neonotes}

lX. DicLeIe: me||iIu:
A. C|oss|||cot|ons
1. Iype 1: pcncrecIic ce|| ce:IrucIicn-in:u|in ceficienI
prcne Ic keIcccicc:i: {ccicc:i: F/I exce::ive keIcne:)

2. Iype 2: in:u|in re:i:IcnI, re|cIive in:u|in ceficiency
mc:I prevc|enI fcrm cf DM, eIic|cgy unkncwn
c. ceve|cp: grccuc||y, mcy mi:: S & S
{pc|ycip:ic, pc|yuric, pc|yphcgic)
L. increc:e ri:k if cLe:e cr fcI crcunc cLccmen
c. cge, :ecenIcry |ife:Iy|e, HIN, previcu: GDM
c. run: in fcmi|ie:

3. Frege:IcIicnc|: Iype 1 cr 2 IhcI exi:I: Lefcre preg.

4. Ge:IcIicnc|: cny cegree cf g|ucc:e inIc|ercnce wiIh
cn:eI cr reccgniIicn curing pregncncy
c. mcy cr mcy ncI Le in:u|in cepencenI
L. :hcu|c Le rec|c::ifiec ó week: FF

8. Fothophys|o|ogy
1. Grcup cf meIcLc|ic ci:ec:e: chcrccIerizec Ly
hyperg|ycemic F/I cefecI: in in:u|in :ecreIicn, ccIicn,
cr LcIh

2. 8eIc ce||:÷in:u|in÷mcve: g|ucc:e inIc ccipc:e cnc
mu:c|e ce||: Ic Le u:ec fcr energy

3. ¡ cr ineffecIive in:u|in÷hyperg|ycemic÷
hyper:c:mc|criIy÷¦ inIrcce||u|cr f|uic inIc Ihe vc:cu|cr
:y:Iem÷ ¦ L|ccc vc|ume÷ exce:: UC wiIh g|yccuric

4. ce||: Lurn: prcIein:/fcI: fcr energy=keIcccicc:i:

5. weighI |c:: frcm Lreckccwn cf fcI cnc mu:c|e Ii::ue:

ó. ccmp|iccIicn:: reIincpcIhy, nephrcpcIhy, neurcpcIhy,
cnc premcIure cIherc:c|erc:i:
!")
2

7. meIcLc|ic fccIcr::
c. 1
:I
Irime:Ier-¦ e:Ircgen/prcge:Iercne=¦ in:u|in
prccucIicn=¦ peripherc| g|ucc:e uIi|izcIicn
L. ¦ Ii::ue g|yccgen :Icre:=¡ hepcIic g|ucc:e
prccucIicn {Ihi: ccn cffecI in:u|in neec:)
c. 2
nc
& 3
rc
Irime:Ier:-¦ |eve|: cf hFL, e:Ircgen,
prcge:Iercne, prc|ccIin, ccrIi:c|, cnc in:u|inc:e
= ¦ in:u|in re:i:Icnce {Ihey cre in:u|in cnIcgcni:I:)
{cnIcgcni:I:-ccunIerccI Ihe ccIicn cf cncIher)
{:ynergi:I:-enhcnce: Ihe ccIicn cf cncIher)
c. mcIernc| in:u|in re¢uiremenI: mcy ccuL|e cr
¢uccrup|e Ly 3ó week: cf pregncncy
{|ecve: cLunccnI :upp|y cf g|ucc:e fcr feIu:)

C. k|sk |octors
1. Le:I precicIcr cf pregncncy cuIccme=cegree cf
mcIernc| ccnIrc| cf g|ucc:e |eve|:

2. ¡ g|ycemic ccnIrc| in ecr|y pregncncy=S/8

3. ¡ g|ycemic ccnIrc| |cIe in pregncncy =
c. ¦ mccrc:cmic feIu: = ¦ ri:k LirIh Ircumc
L. ¦ ri:k fcr C/S
c. ¦ fcr FlH cr preec|cmp:ic
c. ¦ ri:k fcr pc|yhycrcmnic:÷cverci:IenIicn cf uIeru:
which ccn |ecc Ic FIL cr FFCM
e. infecIicn:
f. keIcccicc:i: {DK/)÷fcIIy ccic: mcve frcm fcI Ic
circu|cIicn÷cxicizec÷keIcne Lccie: inIc
circu|cIicn÷¦ L|ccc g|ucc:e cnc
keIcne:=c:mcIic ciure:i:=¡ f|uic:/e|ecIrc|yIe:,
vc|ume cep|eIicn, ce||u|cr cehycrcIicn=
mcIernc| cnc feIc| cecIh

4. feIc| ri:k:
c. :Ii||Lcrn-eIic|cgy unk, °chrcnic hypcxic
L. ccngeniIc| cncmc|ie: {ó-107 chcnce)
-ccrcicc mc:I ccmmcn
c. mccrc:cmic/LirIh Ircumc:
c. lUGF F/I vc:cu|cr ci:ec:e
e. FDS
!#*
3
f. hypccc|cemic, hypcg|ycemic,
hypcmcgne:emic, hyperLi|iruLinemic, cnc
pc|ycyIhemic

D. Nurs|ng Frocess
1. LcL wcrk
c. eug|ycemic=ó5-130 mg/c|
L. c::e::menI cf g|ycc:y|cIec hemcg|cLin /
1c

-he|p: c::e:: |eve| cf hemcg|cLin :cIurcIec
wiIh g|ucc:e ccu:ec Ly hyperg|ycemic
-gccc ccnIrc| 77
->10 7 = ¦ ri:k fcr feIc| cncmc|ie: {20-257)
c. urine :creen fcr UIl, prcIeinuric, crecIinine
c|ecrcnce
c. Ihyrcic funcIicn :creening

2. EcuccIe Ic Ie:I g|ucc:e cI hcme-cieIcry chcnge:

3. DieIcry mcncgemenI Lc:ec cn L|ccc :ugcr Ie:I:
-1
:I
Irime:Ier-2200 kcc|/cy
-2
nc
cnc 3
rc
Irime:Ier-2500 kcc|/cy
-40-457 CHC, 12-207 prcIein, 35-407 fcI:
-neec LecIime :ncck Ic mcinIcin 8S |eve| Ihru nighI

4. Exerci:e cfIer mec|: Ic prevenI crcp in 8S

5. ln:u|in Ihercpy
c. 1
:I
Irime:Ier, in:u|in cc:cge mcy cecrec:e
L. crc| cgenI: mcy Le vicL|e :c|uIicn
-G|yLurice {:u|fcny|urec) ¦ in:u|in :ecreIicn
-cce:n´I crc:: Ihe p|ccenIc
c. 2
nc
cnc 3
rc
Irime:Ier:÷¦ in:u|in re:i:Icnce = ¦
in:u|in cc:cge
c. Scme in:u|in ccn crc:: Ihe p|ccenIc
e. vcricu: regimen: fc||cwec
f. in:u|in pump mcy Le u:ec curing pregncncy
g. :ee Cc|ifcrnic DicLeIe: cnc Fregncncy Frcgrcm
-CD/FF
-SweeI Succe::

ó. FeIc| :urvei||cnce Ic mcniIcr we||-Leing
c. NSI´:, 8FF´:, U/S, kick ccunI:
L. MS/FF
c. FeIc| echcccrcicgrcm {18-22 week:)
!#!
4

7. Urine Ie:Iing cI hcme
c. Ie:I fir:I mcrning urine
L. recheck if mec| mi::ec, i||, cr 8S > 200mg/c|
c. :pi||ing :mc|| cmcunI: cf keIcne: ck
c. :pi||ing |crge cmcunI: cf keIcne:-C/LL MD

8. lnIrcpcrIum
c. fc||cw hc:piIc|´: F & F
L. wcIch fcr cehycrcIicn, hypc/hyperg|ycemic
c. mcin|ine u:uc||y D5LF wiIh in:u|in cn :eccnccry
infu:icn
c. :chec C/S in mcrning-hc|c /M in:u|in, NFC

º. Fc:IpcrIum
c. in:u|in neec: crcp crcmcIicc||y wiIh remcvc| cf
p|ccenIc
L. :everc| ccy: Lefcre CHC hcmec:Ic:i:
c. ccmp|iccIicn:
-preec|cmp:ic
-ec|cmp:ic
-hemcrrhcge
-infecIicn
c. Lrec:Ifeecing enccurcgec
-he|p: u:e up CHC in mi|k prccucIicn
-ri:k fcr hypcg|ycemic
-ri:k fcr mc:IiIi:
-mcy recuce infcnI: ri:k fcr DM
-mcy neec Ic recc|cu|cIe in:u|in cc:e
e. ci:cu:: ccnIrccepIive meIhcc:
-Lcrrier meIhcc :cfe:I
-CC´: hcve ri:k cf IhrcmLcemLc|ic/vc:cu|cr
ccmp|iccIicn:
-u:e cf lUD ri:k: infecIicn
-IuLc| |igcIicn if ccmp|eIec fcmi|y




E. Gestot|ono| D|obetes
1. 47 cf c|| pregncncie:/º07 cf cicLeIic pregncncie:

2. |e:: ccmmcn in Ccucc:icn:

!#"
5
3. ri:k fccIcr:
c. cLe:e
L. cver cge 30
c. fcmi|y hi:Icry
c. h/c mccrc:cmic infcnI
e. unexp|cinec :Ii||LirIh
f. mi:ccrricge
g. hcving cn infcnI wiIh ccngeniIc| cncmc|ie:

4. :creening
c. 1 hcur g|ucc|c-50 grcm crc| g|ucc:e |ccc
-ccn:icerec + if >140 mg/c|
L. 3-hcur g|ucc:e Ic|ercnce Ie:I
-fc:Iing g|ucc:e
-crink c 100 gm |cccing cc:e
-ck :erum cnc urine every hcur
-+GDM if 2 cr mcre cf Ihe re:u|I: cre e|evcIec
fc:Iing = º5
1 hcur = 180
2 hcur = 155
3 hcur = 140

X. Freexi:Iing ccrcicc ci:ec:e
A. Overv|ew
1. CV chcnge: IhcI cccur ncrmc||y wiIh pregncncy ccn
cffecI wcmen wiIh ccrcicc ci:ec:e
c. ¦ inIrcvc:cu|cr vc|ume
L. ¡ :y:Iemic vc:cu|cr re:i:Icnce
c. chcnge in CC
c. chcnge in inIrcvc:cu|cr vc|ume pc:IpcrIum

2. ccrcicc ci:ec:e ccmp|iccIe: 17 cf c|| pregncncie:
c. |eccing ccu:e cf ncn-C8 mcIernc| mcrIc|iIy
L. 4
Ih
rcnking ccu:e cf mcIernc| cecIh

3. :cme cf Ihe mcre ccmmcn ccrcicc ci:ec:e:
c. miIrc| :Ienc:i:
L. miIrc| vc|ve prc|cp:e
-u:e lncerc| if :ympIcmcIic, ie: che:I pcin
-u:e cLx if hcving regurgiIcIicn
c. ccngeniIc| hecrI cefecI:, i.e. :epIc| cefecI
c. peripcrum ccrcicmycpcIhy
-cy:funcIicn cf Ihe L venIric|e
-:een in |c:I mcnIh cf preg cr 1
:I
5 mcnIh: FF
!##
6
-mcrIc|iIy rcIe cf 25-50 7
-Ix-IrecI Ihe :ympIcm:

8. C|oss|||cot|ons
1. C|c:: l: /:ympIcmcIic cI ncrmc| |eve|: cf ccIiviIy
morto||ty = 1%
c. ccrrecIec IeIrc|cgy cf Fc||cI
L. pu|mcnic/Iricu:pic ci:ec:e
c. miIrc| :Ienc:i: {c|c:: l, ll)
c. :epIc| cefecI:

2. C|c:: ll: SympIcmcIic wiIh increc:ec ccIiviIy
morto||ty = 5-15%
c. miIrc| :Ienc:i: wiIh cIric| fiLri||cIicn
L. crIificic| hecrI vc|ve:
c. miIrc| :Ienc:i: {c|c:: lll, lV)
c. unccrrecIec IeIrc|cgy cf Fc||cI
e. ccrIic cccrcIcIicn {unccmp|iccIec)
f. ccrIic :Ienc:i:

3. C|c:: lll: SympIcmcIic wiIh crcincry ccIiviIy
morto||ty = 25-50%
c. ccrIic cccrcIcIicn {ccmp|iccIec)
L. mycccrcic| infcrcIicn
c. Mcrfcn´: :yncrcme
c. Irue ccrcicmycpcIhy
e. pu|mcncry HIN

4. C|c:: lV: SympIcmcIic cI re:I

C. Nurs|ng Frocess
1. mecicc| ccre i: mu|Iici:cip|incry

2. ecuccIec F/I S & S cf ccrcicc ceccmpen:cIicn
c. :uLjecIive
-increc:ing fcIigue
-cifficu|Iy LrecIhing
-fre¢uenI ccugh
-pc|piIcIicn:
-:we||ing cf fcce, feeI, |eg:, finger:
L. cLjecIive
-irregu|cr, weck, rcpic pu|:e, cver 100
-prcgre::ive, generc|izec ecemc
-crcck|e: cI Lc:e cf |ung:
!#$
7
-crIhcpnec
-Icchypnec, cver 25
-mci:I, fre¢uenI ccugh
-increc:ing fcIigue
-cycnc:i: cf |ip: cnc nci| Lec:

3. icenIify crec: IhcI mcy |ecc Ic :Ire::

4. icenIiIy ccping mechcni:m:

5. :uppcrI grcup:
ó. ccn:u|IcIicn wiIh cieIicicn

7. wcIch fcr S & S cf IhrcmLcemLc|i:m
c. recne::
L. :we||ing
c. Iencerne::
e. pcin

8. cvcic ccn:IipcIicn cnc :Ircining fcr 8M

º. repcrI cny S & S cf infecIicn

10. keep c|| FN cppI:.

11. mcy Le puI cn prcphy|ccIic cLx

12. |cL:/:Iucie:
c. C8C, chem pcne|
L. ECG
c. che:I x-rcy:
c. EFM

13. meciccIicn:
c. hepcrin fcr cnIicccgu|cIicn-cce:n´I crc::
p|ccenIc
L. ccumccin-ccnIrccinciccIec-IercIcgenic
c. cLx-¡ ri:k cf LccIeric| enccccrciIi:
c. ciureIic: Ic IrecI CHF
e. cigiIc|i: fcr crrhyIhmic: cnc hecrI fci|ure

14. inIrcpcrIum
c. :ice |ying cr :emi-fcw|er:
L. C2 vic mc:k
!#%
8
c. ciureIic: Ic ¡ f|uic reIenIicn
c. prcphy|ccIic cLx
e. enccurcge pcin mec: Ic cecrec:e :Ire::-Epic.
f. mcniIcr FHF cnc mcIernc|
g. mcy u:e vccuum Ic :hcrIen 2
nc
:Icge
h. nc riIccrine/IerLuIc|ine fcr Iccc|y:i:
-mcy ccu:e mycccrcic| i:chemic
i. nc meIhergine

15. pc:IpcrIum
c. 1
:I
24-48 hcur: mc:I impcrIcnI fcr hemccyncmic
:IcLi|iIy
L. Lec re:I, c::I. wiIh /DL´: c: neecec
c. prevenI ccn:IipcIicn
c. Lrec:Ifeecing mcy Le ccnIrcinciccIec in higher
c|c::ificcIicn: cf ci:ec:e

Xl. /nemic:
A. Iron de||c|ency onem|o
1. mc:I ccmmcn
c. < 11 g/c| in 1
:I
A
L. < 10.5 g/c| in 2
nc
A
c. < 11 g/c| in 3
rc
A

2. ircn fcr feIu: ccme: frcm mcIernc| :erum

3. crc| ircn :upp|emenI:-30-ó0mg/cy
c. c|inicc|-325 mg ferrcu: :u|fcIe IcL|eI:
L. meIcLc|izec LeIIer wiIh ViI. C

4. ri:k Ic feIu:
c. L8W
L. preIerm
c. ¦ perincIc| mcrIc|iIy-mcIernc| HLg < óg/c|


8. Fo||c oc|d de||c|ency onem|omego|ob|ost|c onem|o
1. increc:e: ri:k fcr neurc| IuLe cefecI, c|efI |ip/pc|cIe

2. reccmmencec cci|y inIcke 400 micrcgrcm/ccy

3. ¨enrichec fccc:" hcve ccciIicnc| fc|ic ccic

C. S|ck|e ce|| onem|o-rece::ive cuIc:cmc| ci:ec:e
!#&
9
1. cLncrmc| hemcg|cLin in Ihe L|ccc

2. rece::ive, hereciIcry, fcmi|ic| hemc|yIic
c. /friccn-/mericcn: {107 hcve IrciI)
L. MeciIerrcnecn cnce:Iry

3. cri:i:: fever, pcin in cLccmen, exIremiIie:
c. cIIcck: F/I vc:cu|cr ccc|u:icn, Ii::ue hypcxic,
ecemc, F8C ce:IrucIicn, cnc crgcn fci|ure
L. c::ccicIec wiIh jcuncice, ncrmcchrcmic
cnemic, reIicu|ccyIc:i:, + :ick|e ce|| Ie:I,
cnc cemcn:IrcIec cLncrmc| hemcg|cLin

4. mcIernc|/feIc| ri:k:
c. pye|cnephriIi:
L. Lcne infecIicn
c. hecrI ci:ec:e
c. FlH
e. feIc| |c:: cue Ic impcirec cxygen :upp|y

5. Ix:
c. fc|ic ccic-1mg/ccy
L. cLx c: neecec
c. C2 cnc lV´:
c. SCD´: pc:IpcrIum

Xll. McIernc| infecIicn:
Foges 352-357
KNCW: Iype cf crgcni:m, S/S, Ix, cnc imp|iccIicn: fcr pregncncy
cnc feIu:.:uch c::
I-toxop|osmos|s-reIincchcrciciIi:, ccnvu|:icn:, micrccephc|y
O-others-Hepot|t|s, HIV, syph|||s-infecIicn, S/8,
k-rube||o-DM, hecring |c::, g|cuccmc, encephc|iIi:
C-cytomego|ov|rus-º07 cf :urvivcr: hcve neurc|cgicc| prcL|em:
H-herpes s|mp|ex-hyper/hypcIhermic, jcuncice, :eizure:


Xlll. F:ychc:ccic| prcL|em: curing pregncncy
A. Freex|st|ng psych|otr|c |||ness-e||ect on pregnoncy
1. wcmen wiIh Lipc|cr ci:crcer, :chizcphrenic, cr
chrcnic cepre::icn mcy Le cn p:ychcIrcpic mec:
IhcI ccn crc:: Ihe p|ccenIc cr Le fcunc in Lrec:I
mi|k

!#'
10
2. neec Ic weigh Ihe LenefiI: cf Ihercpy Ic ri:k: Ic mcm
cnc feIu:

3. feIc| ri:k: Ic meciccIicn:
c. ccngeniIc| cncmc|ie:
L. Iremcr:
c. hyperIcniciIy
c. weckne::
e. pccr :ucking

8. Abuse-pp. 108, 352

C. Substonce obuse-pg. 302
1. Lcrrier: Ic Ix
c. |iII|e uncer:Icncing hcw crug effecI: feIu: cr
pregncncy
L. ce|cy :eeking FN ccre
c. :Iigmc, :hcme, gui|I
c. ccncec| cLu:e

2. |egc| ccn:icercIicn:
c. ri:k Ic unLcrn mcy = criminc| chcrge: Ic mcm
L. mcy Le crre:Iec, jci|ec, hcu:ec in p:ychicIric
hc:piIc| fcr re:I cf Ihe pregncncy
c. LcLy mcy Le give Ic chi|c prcIecIive :ervice:

3. ri:k:
c. S/8, preIerm LirIh, lUGF, necncIc| cccicIicn,
necncIc| neurcLehcvicrc| hcnciccp:, /lDS,
feIc| cnc mcIernc| cecIh
L. c|cchc|-F/S
c. ccccine-c. p|ccenIc, FIL, SG/, micrcencephc|y
c. hercin-FIL, FFCM, lUGF, ccnvu|:icn:
e. :peec-FIL, lUGF, ¡ hecc circumference, c|Ierec
:|eep pcIIern:
f. :mcking-SlDS, L8W, pecicIric c||ergie:, re:pircIcry
cy:funcIicn
g. ccffeine-lUGF, L8W

3. cc:e mcncgemenI
c. finc cuI cLcuI pI.´: envircnmenI, pc:I crug u:e,
currenI crug u:e, cnc :uppcrI :y:Iem:
L. crug Ie:Iing-L|ccc cnc urine
-c|cchc| ccn gc unceIecIec in urine
!#(
11
c. ccn Ie:I necncIe´: hcir cr meccnium Ic cnc|yze
pc:I crug u:cge
c. :creen fcr h/c phy:icc| cLu:e cr p:ychc:ccic|
prcL|em:
e. ceIermine neec fcr wcmen´: hec|Ih :ervice:,
:ccic| :ervice:, cnc ecuccIicn fcr fcmi|y
f. :uppcrI grcup:, i.e. //
g. c|cchc| wiIhcrcwc| Ix
-Lenzcciczepine: {p:ychcIrcpic-:eccIive)
-nuIriIicnc| fc||cw-up
-p:ychcIhercpy
h. meIhcccne {:ynIheIic cpicic) ccnIrcver:ic|
-impcirec L|ccc f|cw Ic p|ccenIc
-ceIrimenIc| feIc| effecI:
-:Ircnger wiIhcrcwc| :ympIcm: fcr necncIe
ccmpcrec Ic hercin




















01/13
!#)
1
Ccmp|iccIicn: cf LcLcr cnc De|ivery
Lecture 10

l. Dy:funcIicnc| LcLcr
A. Alterations in contraction patterns and quality
1. HyperIcnic UIerine Dy:funcIicn
c. u:uc||y in |cIenI phc:e, Lefcre 4 cm
L. ccu:e unkncwn, mcyLe F/I cnxieIy/fecr
c. c::e::menI
-pcin cuI cf prcpcrIicn Ic inIen:iIy cf U/C
-U/C´: ¦ in fre¢uency LuI uncccrcincIec
c. ri:k Ic mcm
-|c:: cf ccnIrc|
-exhcu:Iicn
e. ri:k Ic feIu:
-c:phyxic
-pc::cge cf meccnium
f. Ix
-cnc|ge:ic
-re:I fcr mcm
g. cfIer 4-ó hcur: re:I, u:uc||y cwcken in ncrmc|
|cLcr pcIIern

2. HypcIcnic UIerine Dy:funcIicn
c. ccu:e:
-pe|vic ccnIrccIure
-feIc| mc|pre:enIcIicn
-cverci:IenIicn cf uIeru:
-unkncwn
L. c::e::menI
-¡ in U/C fre¢uency cnc inIen:iIy
-curing Ihe ccIive phc:e cf :Icge 1
-uIeru: ec:i|y incenIcL|e LeIween U/C´:
c. ri:k Ic mcm
-infecIicn
-exhcu:Iicn
c. ri:k Ic feIu:
-infecIicn
-cecIh
e. Ix
-r/c CFD
-|cLcr cugmenIcIicn
-cmnicIcmy
-chcnge pc:iIicn, cmLu|cIicn, :hcwer
!$*
2

3. lncce¢ucIe expu|:ive effcrI {:eccnccry pcwer:)
c. ccu:e:
-regicnc| cne:Ihe:ic
-cnc|ge:ic
-exhcu:Iicn
-|cck cf urge Ic pu:h
L. ri:k Ic mcm
-:urgery {C/S)
c. ri:k Ic feIu:
-c:phyxic
c. Ix
-chcnge pc:iIicn
-cccching
-|cwer epicurc| :IrengIh cr D/C
-vccuum-c::I.
-C/S
***See Table 18-1 for a list of complications

B. Fetal malpositions and malpresentations
1. cncmc|ie:
c. cffecI re|cIicn:hip cf feIc| cncIcmy Ic Ihe
mcIernc| pe|vic ccpcciIy

2. CFD-cephc|cpe|vic ci:prcpcrIicn
c. F/I mccrc:cmic infcnI:
L. mcIernc| ccu:e:
-pe|vi: Icc :mc||
-pe|vi: cLncrmc||y :hcpec
-pe|vic cefcrmiIy

3. mc|pc:iIicn:
c. u:uc||y per:i:IenI CF {LCF cr FCF)
L. prc|cngec :eccnc :Icge
c. u:uc||y c/c :evere Lcck pcin
c. mcy Le cL|e Ic chcnge feIc| pc:iIicn
-knee che:I pc:iIicn
-:¢ucI:
-|unge:
-pe|vic rccking
-rc||ing :ice Ic :ice



!$!
3
4. mc|pre:enIcIicn
c. Lreech mc:I ccmmcn
-frcnk-Ihigh: f|exec, knee: exIencec
-ccmp|eIe-Ihigh: cnc knee: f|exec
-inccmp|eIe
cne fccI Le|cw Ihe LuIIcck cr
cne knee Le|cw Ihe LuIIcck
L. Lreech pre:enIcIicn: c::ccicIec wiIh:
-mu|IifeIc| ge:IcIicn:
-preIerm LirIh
-feIc| cnc mcIernc| cncmc|ie:
-hycrcmnic:
c. ri:k cf prc|cp:ec ccrc
c. mighI cIIempI vcginc| ce|ivery in mu|Iipcrc:
e. fcce/Lrcw pre:enIcIicn:
-unccmmcn
-c::ccicIec wiIh feIc| cncmc|ie: cr pe|vic
ccnIrccIure:
-mcy neec fcrcep ce|ivery
f. if exIernc| ver:icn fci|: Ic rcIcIe c Lreech cr
:hcu|cer pre:enIcIicn = C/S

C. Pelvic alterations
1. pe|vic cy:Iccic
c. ccnIrccIure: {fiLrc:i: cf ccnnecIive Ii::ue in :kin,
fc:cic, mu:c|e, cr c jcinI ccp:u|e) cf Ihe pe|vi:
L. cefcrmiIie: frcm MV/, Ircumc:
c. immcIure pe|vi: in Ieen:

2. :cfI Ii::ue cy:Iccic
c. p|ccenIc previc
L. |eicmycmc: {fiLrcic:)
c. fu|| L|cccer cr recIum
c. cervicc| ecemc
e. 8cnc|´: ring {pcIhc|cgic reIrccIicn ring) cI Ihe
juncIicn cf Ihe |cwer cnc upper uIerine :egmenI:

D. Psychological alterations
1. :Ire:: ccn :|cw cr :Icp ci|cIcIicn
-pcin cnc |cck cf :uppcrI ¦ :Ire:: |eve|
-ccnfinemenI in Lec mcy mcke pI fee| Ircppec

2. :Ire:: ccn increc:e pcin percepIicn

!$"
4
3. :Ire::-re|cIec hcrmcne: ccI cn :mccIh mu:c|e
c. LeIc-enccrphin:, epinephrine, ccrIi:c|, eIc
L. cecrec:e uIerine ccnIrccIi|iIy

E. Alterations in the length of labor
1. prc|cngec |cLcr: mcre fre¢uenI wiIh mcm: cver 40

2. cLncrmc| |cLcr pcIIern: ccn cccur Leccu:e cf:
c. CFD
L. ineffecIive U/C´:
c. pe|vic ccnIrccIure:
c. mc|pre:enIcIicn cf feIu:
e. cnc|ge:ic/cne:Ihe:ic
f. cnxieIy/:Ire::

3. precipiIcu: |cLcr/ce|ivery
c. |cLcr |e:: Ihcn 3 hcur: frcm :IcrI cf U/C´:
L. mcIernc| ccmp|iccIicn:
-uIerine rupIure
-|ccercIicn:
-cmnicIic f|uic emLc|i:m
-FF hemcrrhcge
c. ri:k Ic feIu:
-hypcxic
-inIrccrcnic| hemcrrhcge
-Lrui:ing cf hecc/fcce

pcIIern nu||ip: mu|Iip:
prc|cngec |cIenI phc:e >20 hr: >14 hr:

prcIrccIec ccIive phc:e ci|cIicn <1.2 cm/hr <1.5 cm/hr

:eccnccry crre:I: nc chcnge >2 hr: >2 hr:

prcIrccIec ce:cenI <1 cm/hr <2 cm/hr

crre:I cf ce:cenI >1 hr >1/2 hr

fci|ure cf ce:cenI Nc chcnge in :eccnc :Icge

precipiIcu: |cLcr >5 cm/hr 10 cm/hr



!$#
5
F. Related nursing interventions
1. :uppcrI mcIher cnc fcmi|y

2. mcniIcr mcIher/feIu:

3. piIccin cugmenIcIicn/vccuum/C/S

ll. Ccmp|iccIicn: cf Ihe |cLcr prcce::
A. Premature rupture of membranes (PROM)
1. FCM 1 hcur Lefcre cn:eI cf |cLcr

2. FFFCM-cccur: Lefcre 37 week: ge:IcIicn

3. ccu:e unkncwn-pc::iL|y F/I infecIicn
c. chcriccmnicniIi:
L. |ife IhrecIening Ic feIu: cnc mcm
-mcm-:ep:i:, cecIh
-feIu:-pneumcnic, :ep:i:, meningiIi:

4. ci:cu:: FCM prcIccc|
c. kick ccunI:/EFM L. ck G8S :IcIu:
c. ck /Fl c. r/c prc|cp:ec ccrc

B. Preterm labor- cervical change and U/ C’s between 20-37 wks
Preterm birth- completion of pregnancy before wk37-pg 347
1. ri:k fccIcr:
c. cemcgrcphic
-/friccn-/mericcn -<17 yr: c|c, >34 yr: c|c
-|cw SES -unmcrriec
-|cw |eve| cf ecuccIicn
L. mecicc| ri:k: preccIing pregncncy
-h/c FIL-Irip|e: Ihe ri:k -mu|Iip|e cLcrIicn:
-uIerine cncmc|ie: -pcriIy-0 cr >4
-|cw prepregncncy weighI
-cicLeIe: -HIN
c. mecicc| ri:k: wiIh pregncncy
-mu|Iip|e ge:IcIicn -infecIicn
-inccmpeIenI cervix -UIl´:
-:hcrI inIervc| LeIween pregncncie:
-L|eecing -cnemic
-p|ccenIc previc/cLrupIic
-feIc| cncmc|ie: -FFCM


!$$
6
c. Lehcvicrc|/envircnmenIc| ri:k:
-DES {cieIhy|:Ii|Le:Irc|) expc:ure
-:mcking -pccr nuIriIicn
-:uL:Icnce cLu:e -|cIe cn nc FN ccre
e. cIher ri:k:
-cnxieIy/:Ire:: -uIerine irriIcLi|iIy
-|cng wcrking hcur: -incLi|iIy Ic re:I

2. precicIing FIL
c. feIc| fiLrcnecIin-Licchemicc| mcrker
-g|yccprcIein:-fcunc in p|c:mc
-cppecr in cervicc| ccnc| ecr|y/|cIe in preg.
-cppecrcnce LeIween 24-34 week: ge:I. i:
cn inciccIcr fcr FIL
-negcIive precicIive vc|ue=º57
-pc:iIive precicIive vc|ue=25-407
-ec:ier Ic precicI whc wi|| ncI hcve FIL
-expen:e=$180-215
L. :c|ivcry e:Iric|-Licchemicc| mcrker
-fcrm cf e:Ircgen prccucec Ly feIu: cnc pre:enI
in p|c:mc Ly º week:
-|eve|: hcve Leen :hcwn Ic ¦ Lefcre FIL
-negcIive precicIive vc|ue=º87
-pc:iIive precicIive vc|ue=7-257
-expen:e=$º0 ecch Ie:I
c. encccervicc| |engIh
-|engIh: |e:: Ihcn 30 mm in :ing|eIcn mcy
precicI ri:k fcr FIL

3. ccu:e: cf FIL
c. unkncwn cnc IhcughI Ic Le mu|IifccIcric|
L. infecIicn mcjcr eIic|cgicc| fccIcr
c. 257 cre icIrcgenic-inIenIicnc||y ce|ivery cf feIu:
-F/I hec|Ih cf feIu:/mcm
c. 257 F/I FFCM fc||cwec Ly |cLcr
e. 507 icicpcIhic {ccnciIicn: wiIhcuI reccgnizcL|e
ccu:e) preIerm LirIh:


4. c::e::menI
c. ccnIrccIicn: <10 minuIe: cpcrI in fre¢uency
L. per:i:IenI crcmping
c. c|ecr, pink, cr Lrcwni:h ci:chcrge
c. pre::ure in vcginc cr |cw Lcck
!$%
7
e. cicrrhec
f. cervicc| effccemenI >807
g. 1 cm ci|cIec

5. pI. ecuccIicn
c. Lec re:I-nc :Iucie: hcve prcven iI: efficccy
-wI. |c::
-|c:: cf mu:c|e Icne
-cc|cium |c::
-fcIigue
-cepre::icn
-ccn:IipcIicn
L. ncIify MD cf chcnge: in S & S
c. hcme uIerine ccIiviIy mcniIcring
c. ci:cu:: |ife:Iy|e cccpIcIicn:-neec Ic ¡
-:exuc| ccIiviIy
-hecvy |ifIing
-|cng crive:
-:Icncing mcre Ihcn 507 cf Ihe Iime
-c|imLing :Icir:
-ncI :Icpping when Iirec

ó. phcrmccc|cgy
c. Iccc|yIic:
-mcgne:ium :u|fcIe
CNS cepre::cnI
ccn ccu:e re:pircIcry cepre::icn
f|u:hing, N & V, ¡ DIF´: cnc 8F
-IerLuIc|ine/riIccrine
LeIc-ccrenergic recepIcr :Iimu|cnI
he|p: wiIh hyperIcnic ccnIrccIicn:
Icchyccrcic, pc|piIcIicn:
feIc| Icchyccrcic
-nifecipine
cc|cium chcnne| L|ccker
hecccche, hypcIen:icn
-inccmeIhccin
prc:Icg|cncin inhiLiIcr
ri:k cf c|c:ure cf cucIu: crIeric:u:
ri:k cf NEC cr lVH




!$&
8
L. cnIencIc| g|uccccrIiccic:
-LeIcmeIhc:cne-12 mg lM X 2 cc:e: 24 hr: cpcrI
-cexcmeIhc:cne-ó mg lM 2 cc:e: 12 hr: cpcrI
:Iimu|cIe |ung mcIuriIy
prcmcIe re|ec:e cf enzyme Ic incuce
:urfccIcnI prccucIicn
ccn ccu:e mcIernc| infecIicn, pu|mcncry
ecemc
ccn wcr:en HIN cr GDM

lll. lnIrcpcrIum emergencie:
A. Placental abnormalities
1. ccherenI reIcinec p|ccenIc
c. p|ccenIc cccreIc
-ccIy|eccn: invccec uIerine mu:c|e
L. p|ccenIc increIc
-chcricnic vi||i invcce Ihe mycmeIrium
c. p|ccenIc percreIc
-invc:icn cf mycmeIrium Ic Ihe :erc:c cf Ihe
periIcneum ccvering cf uIeru:
-ccn |ecc Ic rupIure cf uIeru:

2. cLrupIic p|ccenIc

3. vc:c previc
-ve|cmenIcu: in:erIicn-ccrc cIIcchec Ic memLrcne:
-nc WhcrIcn´: je||y
-ve::e|: expc:e: Ic |ccercIicn
-high incicence cf feIc| mcrIc|iIy
-Dx wiIh U/S, pc|pcIicn cf ve::e|:

4. :uccenIuricIe
-ccce::cry |cLe: cf feIc| vi||i ceve|cpec
-ve::e|: :uppcrIec cn|y Ly memLrcne:
¦ ri:k cf reIcinec FCC
-feIc| L|ccc |c:: if ve::e| nickec

5. LcII|eccre
-in:erIicn cI cr necr p|ccenIc| mcrgin rcIher Ihcn
cenIer
-increc:ec ri:k cf feIc| hemcrrhcge



!$'
9
B. Prolapsed umbilical cord
1. umLi|icc| ccrc |ie: Le|cw Ihe pre:enIing pcrI

2. mcy Le cccu|I cnc cccur even wiIh inIccI 8CW

3. frcnk prc|cp:e cccur: wiIh SFCM-1 cuI cf 400 LirIh:

4. ccnIriLuIing fccIcr:
c. |cng ccrc->100 cm
L. mc|pre:enIcIicn
c. Ircn:ver:e |ie
c. unengcgec pre:enIing pcrI

5. ri:k Ic feIu:
c. hypcxic
L. CNS ccmcge
c. DecIh

ó. ccre mcncgemenI
c. hc|c pre:enIing pcrI cff ccrc
L. knee-che:I cr Irence|enLurg pc:iIicn
c. ce|ivery
-pc::iL|e fcrcep/vccuum if 10 cm
-u:uc||y :IcI C/S

C. Uterine rupture
1. ccu:e: cf rupIure
c. previcu: uIerine :ccr
-c|c::icc| C/S
-mycmecIcmy
L. uIerine Ircumc
c. ccngeniIc| uIerine cncmc|ie:
c. mu|Iipcrc:
e. inIen:e :pcnIcnecu: U/C´:
f. hyper:Iimu|cIicn cf uIerine mu:c|e
g. cverci:IenIec uIeru:
h. mc|pre:enIcIicn
i. exIernc|/inIernc| ver:icn
j. fcrcep:

2. c|c::ificcIicn:
c. ccmp|eIe
-exIenc: Ihrcugh Ihe enIire uIerine wc|| inIc
Ihe periIcnec| ccviIy/Lrccc |igcmenI
!$(
10
L. inccmp|eIe
-rupIure exIenc: Ic periIcneum LuI ncI inIc
Ihe periIcnec| ccviIy/Lrccc |igcmenI

3. S & S-mcy Le :i|enI cr crcmcIic
c. ncnrec::uring FHF
L. vcmiIing
c. fcinIing
c. ¦ uIerine Iencerne::
e. :uccen, :hcrp :hccIing pcin
f. hypcvc|emic :hcck
g. hypcIcnic U/C´:
h. |cck cf prcgre::
i. :hcu|cer pcin
j. pc|pcL|e feIc| pcrI:

4. prevenIicn
c. nc V8/C´: wiIh c|c::icc| uIerine :ccr
L. c::e:: wcmcn´: ri:k fccIcr:
c. prevenI hyper:Iimu|cIicn
c. u:e cf Iccc|yIic crug:

5. cc:e mcncgemenI
c. prepcre pI fcr :urgery-C/S, pc::iL|e hy:IerecIcmy
L. lV/cxygen
c. Iype cnc crc:: fcr pc::iL|e L|ccc Ircn:fu:icn
c. IhercpeuIic ccmmuniccIicn/:uppcrI
e. feIc| mcrIc|iIy>807
f. mcIernc| mcrIc|iIy-50-757

D. Uterine inversion
1. c|c::ificcIicn:
c. ccmp|eIe-prcIruce:
L. inccmp|eIe-:mccIh mc:: pc|pcIec Ihru cervix

2. ri:k fccIcr:
c. funcc| imp|cnIcIicn cf p|ccenIc
L. |eicmycmc:
c. vigcrcu: funcc| pre::ure
c. cLncrmc||y ccherenI p|ccenIc| Ii::ue

3. S & S
c. :hcck & pcin
L. hemcrrhcge {|c:: cf 800-1800 m|)
!$)
11
4. inIervenIicn:
c. mcnuc| rep|ccemenI
L. cxyIccin
c. neec fcr :urgery i: rcre

E. Amniotic fluid embolism
1. cmnicIic f|uic wiIh pcrIic|e: enIer: mcIernc| circu|cIicn
cnc cL:IrucI: pu|mcncry ve::e|:

2. ccu:ec Ly cpening in cmnicIic :cc cr mcIernc| uIerine
vein wiIh inIrcuIerine pre::ure fcrcing f|uic inIc vein

3. mcIernc| mcrIc|iIy=857/feIc| mcrIc|iIy=507

4. ri:k fccIcr:
c. mu|IipcriIy
L. Iumu|Iucu: |cLcr
c. cLrupIic p|ccenIc
c. cxyIccin incucIicn
e. feIc| mccrc:cmic
f. feIc| cecIh in uIerc
g. meccnium pc::cge

5. cc:e mcncgemenI
c. c::e:: fcr mcnife:IcIicn: cf FDS
-re:I|e::ne::
-cy:pnec
-cycnc:i:
-pu|mcncry ecemc
-re:pircIcry crre:I
L. c::e:: fcr :hcck
-hypcIen:icn
-Icchyccrcic
-ccrcicc crre:I
-hemcrrhcge
-uIerine cIcny
c. cxygencIe-10 L
c. inIuLcIe/Lcg wiIh 1007 cxygen
e. CFF-30 cegree cng|e cf uIeru:
f. lV´:
g. L|ccc Ircn:fu:icn/Ix cccgu|cIicn cefecI:
h. fc|ey ccIheIer
i. prepcre fcr pc::iL|e C/S
j. emcIicnc| :uppcrI/ccun:e|ing if cecIh cccur:
!%*
12

F. Trauma
1. |eccing ncncL:IeIric rec:cn fcr mcIernc| mcrIc|iIy

2. c|| femc|e vicIim: cf chi|cLecring cge Ic Le ccn:icerec
pregncnI unIi| prcven cIherwi:e

3. 707 F/I MV/´: {|cck cf :ecILe|I)-hecc injurie: cnc
:hcck

4. phy:ic|cgicc| cifference: wiIh pregncnI wcmen
experiencing Ircumc
c. phy:icc| cL:ervcIicn |e:: re|icL|e
L. CC ccn Ic|ercIe 1000m| L|ccc |c::
c. nc inciccIcr: unIi| L|ccc |c:: > 1500-2000 m|
c. c|inicc| :ign: ccn´I cppecr unIi| 307 cf |c::
cf circu|cIing vc|ume
e. mcIernc| pu|:e cver 100 Lpm=cLncrmc|

5. Iype: cf Ircumc
c. L|unI cLccminc| Ircumc
-MV/, LcIIering, fc||:, ex:cnguincIicn
-feIc| :ku|| fx cr lCH
-ck fcr cLrupIec p|ccenIc
-pe|vic fx ccn ccu:e injury Ic feIu:
-uIerine rupIure rcre
L. peneIrcIing cLccminc| Ircumc
-Lu||eI, :IcL wcunc
-cirecI feIc| injury frcm Lu||eI, re¢uire: :urgery
-feIc| injury frcm :IcL wcunc
-LeIIer chcnce: if injury cccur: in upper mcIernc|
cLccmen
c. Ihcrccic Ircumc-257 cf Ircumc cecIh:
-mcIernc| |ife IhrecIenec Ly pu|mcncry
ccnIu:icn
-ccn ccu:e pneumc/hemcIhcrcx

ó. feIc| cecIh F/I mcIernc| cecIh cr cLrupIec p|ccenIc
c. C/S neecec in mc:I cc:e:
L. if mcIernc| cecIh cccur:, C/S wiIhin 20 minuIe:

7. cIher ccu:e: cf Ircumc: Lurn:, c::cu|I:

8. ccmp|iccIe: 87 cf c|| pregncncie:
!%!
13

º. Ix: :uppcrIive ccre
c. /8C´:
L. cxygen 10-12 |iIer:
c. |crge Lcre lV´:-14-1ó gcuge
f. LF cr NS 3:1 rcIic- 3 m| fcr every 1 cm E8L cver
30-ó0 minuIe:
g. mcy give C negcIive if Iype unkncwn
h. |cIerc| pc:iIicning
i. c::e:: G|c:gcw ccmc :cc|e
j. fccu: cn cLccmen
k. in:erI NG IuLe
|. check fcr cLrupIec p|ccenIc
m. feIc| c::e::menI Ie:Iing-U/S
n. periIcnec| |cvcge-ck fcr L|ccc, if +, |cpcrcIcmy
-if -, LF infu:ec Ihru ccIh/f|uic ck fcr ce|| ccunI
c. Fh negcIive wcmen geI Fhcgcm

G. Shoulder dystocia
1. increc:e ri:k cf mcIernc|/feIc| mcrLiciIy/mcrIc|iIy

2. feIc| hecc i: Lcrn LuI cnIericr :hcu|cer ccn´I pc::
uncer puLic crch

3. feIcpe|vic ci:prcpcrIicn cr mcIernc| pe|vic
cLncrmc|iIie: mcy Le Ihe ccu:e

4. mcy u:e McFcLerI: mcneuver-|eg: f|exec, knee: cn
cLccmen

5. mcy u:e Gc:kin mcneuver-c||-fcur:-hcnc: cnc knee:

ó. mcy u:e MczzcnIi cr FuLin Iechni¢ue: Ic ce|iver
:hcu|cer
c. FN c::i:I: wiIh Ihe :uprcpuLic pre::ure
L. c::e:: newLcrn fcr fx cf c|cvic|e/humeru:
c. c::e:: mcm fcr hemcrrhcge

lV. CL:IeIricc| ln:IrumenIcIicn cnc Frccecure:
A. Amniotomy-AROM (artificial rupture of membranes)
1. mc:I fre¢uenI|y u:ec meIhcc cf |cLcr incucIicn

2. incuce: |cLcr when cervix i: fcvcrcL|e cr cugmenI:
c :|cwing |cLcr prcgre::
!%"
14

3. |cLcr u:uc||y Legin: 12 hcur: pc:I rupIure-if prc|cngec,
ccn |ecc Ic infecIicn-Ck Iemp ¢ 2 hcur:

4. ccn Le u:ec in ccmLincIicn wiIh cxyIccin

5. exp|cin Ic pI IhcI prccecure i: pcin|e:: LuI mighI fee|
increc:e in vcginc| pcin F/I mcvemenI cf feIu:

ó. pre:enIing feIc| pcrI mu:I Le engcgec in pe|vi: cnc
cpp|iec Ic cervix Ic prevenI ccrc prc|cp:e

7. c::e:: cc|cr, cccr, ccn:i:Iency cnc ¢ucnIiIy cf f|uic

B. Induction and augmentation of labor
1. chemicc| cgenI:
c. FG ge|-prc:Icg|cncin ge|
Cervici|/Frepici|/Frc:Iin E2-cincprc:Icne
-he|p: Ic ripen {:cfIen cnc Ihin) cervix
-mcy iniIicIe |cLcr wiIhcuI furIher meciccIicn:
-mcy Le u:ec Ic IermincIe pregncncy
-ccver:e reccIicn:
hecccche:, N & V, cicrrhec, fever
hypcIen:icn, hyper:Iimu|cIicn cf uIeru:
feIc| pc::cge cf meccnium
L. CyIcIec {mi:cprc:Ic|)-:ynIheIic prc:Icg|cncin E1
-ncI FD/ cpprcvec fcr cervicc| ripening
c. cxyIccin
-hcrmcne prccucec Ly pc:Iericr piIuiIcry g|cnc
-:Iimu|cIe: uIerine ccnIrccIicn:
-u:ec Ic incuce cr cugmenI |cLcr
-inciccIicn: fcr u:e
:u:pecIec feIc| jecpcrcy
cy:Iccic
pc:IccIe:
mcIernc| mecicc| prcL|em:
feIc| cemi:e
-ccnIrcinciccIicn: fcr u:e
CFD, ccrc prc|cp:e, Ircn:ver:e |ie
ncnrec::uring FHF
p|ccenIc previc cr vc:c previc
c|c::icc| uIerine inci:icn
ccIive geniIc| herpe:
invc:ive C/ cf Ihe cx
!%#
15
c. infu:icn ccne cn lV pump
e. wcIch fcr hyper:Iimu|cIicn
f. c::e:: feIc| we|| Leing cnc mcIernc| pcin |eve|

2. mechcnicc| meIhcc:
c. ci|cIcr:
L. cmnicIcmy

C. Version
1. exIernc|
c. cIIempI Ic rcIcIe feIu: frcm c mc|pre:enIcIicn
L. u:uc||y ccne cI cr cfIer 37 week:
c. U/S :ccnning Lefcre Ic ck feIu: cnc p|ccenIc
c. mcy u:e c Iccc|yIic cgenI |ike IerLuIc|ine
e. cLIcin infcrmec ccn:enI-u:uc||y ccne in L & D
cue Ic ri:k cf ccmp|iccIicn:
f. MD cr CNM give genI|e, ccn:IcnI pre::ure Ic
cLccmen Ic rcIcIe pre:enIing feIc| pcrI
g. Fh - mcm: mcy receive Fhcgcm cue Ic Ihe ri:k
cf feIcmcIernc| L|eecing

2. inIernc|
c. MD in:erI: hcnc inIc Ihe uIeru: cnc chcnge:
pc:iIicn cr pre:enIcIicn
L. mcy Le u:ec in mu|IifeIc| pregncncie: Ic rcIcIe
:eccnc feIu:
c. mcIernc|/feIc| injury pc::iL|e
c. FN rc|e Ic mcniIcr FHF cnc :uppcrI mcIher

D. Episiotomy
1. inci:icn in Ihe perineum Ic en|crge Ihe vcginc| cuI|eI

2. Iype:
c. mecicn-mic|ine
-mc:I ccmmcn|y u:ec
-effecIive, ec:i|y repcirec
-ccn pc::iL|y exIenc inIc recIum
L. mecic|cIerc|
-prevenI: 4
Ih
cegree |ccercIicn
-repcir mc:I cifficu|I
-mcre pcin Ic mcm



!%$
16
3. prc: ccn:
prevenI: Iecring |ccercIicn: ccn cccur
cecrec:e: :Icge 2 ¦ pcin/ci:ccmfcrI
en|crge: vcginc |cIerc| pc:iIicn ccn
ccnIrc| hecc

4. |e:: rcIe cf epi:icIcmie: wiIh CNM v:. MD

E. Forceps
1. u:e: pcirec curvec L|cce: Ic c::I. ce|ivery cf hecc

2. mcIernc| inciccIicn: fcr u:e
c. :eccnc :Icge crre:I
L. ccrcicc mcm:
c. pccr pu:hing effcrI/fcIigue/cne:Ihe:ic

3. feIc| inciccIicn: fcr u:e
c. ci:Ire::
L. cLncrmc| pre:enIcIicn-c:ync|iIic
c. ce|ivery cf hecc curing Lreech ce|ivery

4. ccnciIicn:
c. fu||y ci|cIec
L. empIy L|cccer
c. engcgec pre:enIing feIc| pcrI
c. verIex
e. FCM
f. Nc CFD

5. ccre mcncgemenI
c. c::e:: FHF Lefcre cnc cfIer ce|ivery
L. Feci MD cI ce|ivery
c. c::e:: mcIher fcr |ccercIicn:, urincry reIenIicn
c. c::e:: LcLy fcr fccic| Lrui:ing, cLrc:icn:, pc|:y

F. Vacuum
1. cIIcchmenI cf vccuum cup cnc u:e cf negcIive
pre::ure

2. inciccIicn:/ccnciIicn: Ihe :cme c: u:e cf fcrcep:

3. fc||cw hc:piIc|´: F & F F/I meIhcc, :ucIicn pre::ure,
curcIicn, cnc chcrIing

!%%
17
4. newLcrn:-ck fcr ccpuI, cephc|chemcIcmc, :cc|p
|ccercIicn

G. Surgical Birth
1. LirIh cf Ihe feIu: Ihru c Ircn:cLccminc| inci:icn in Ihe
uIeru:

2. Ierm ce:crecn frcm LcIin ¨ccecc"-Ic cuI

3. C/S rcIe-20-307-higher in wcmen cver Ihe cge cf 35

4. ¦ rcIe cf V8/C´: hcc |ecc Ic ¡ C/S´: LuI mighI /

5. purpc:e Ic pre:erve hec|Ih cr |ife cf mcm cr LcLy

ó. ¦ in C/S rcIe F/I
c. increc:ec EFM
L. epicurc| u:e
c. ¦ cf repecI C/S
e. /M/ mcm:
f. privcIe in:urcnce/privcIe hc:piIc|:
g. mcm: wiIh high SES

7. inciccIicn: fcr C/S
c. feIc| ci:Ire::/inIc|ercnce cf |cLcr
L. CFD/mc|pre:enIcIicn/mc|pc:iIicn
c. p|ccenIc| cLncrmc|iIie:
c. umLi|icc| ccrc prc|cp:e
e. cy:funcIicnc| |cLcr pcIIern/fir:I :Icge crre:I
f. mu|Iip|e ge:IcIicn
g. ccIive geniIc| herpe:
h. unccnIrc||ec HIN
i. FlH/preec|cmp:ic

8. Iype cf inci:icn:
c. :kin-verIicc| cr hcrizcnIc| {Ffcnnen:Iie|, Likini)
L. uIeru:-verIicc| {c|c::icc|), |cw verIicc|, cnc
hcrizcnIc| {|cw Ircn:ver:e)
-c|c::icc|-fc:Ier Ic perfcrm, i: perfcrmec in cIher
ccunIrie:, ccnIrcinciccIicn fcr V8/C
-Ircn:ver:e-ec:ier, |e:: L|ccc |c::, cecrec:e ri:k
fcr infecIicn:, |e:: |ike|y Ic rupIure, mcy
cIIempI V8/C wiIh nexI pregncncy

!%&
18
º. ri:k:/ccmp|iccIicn:
c. c:pircIicn
L. pu|mcncry emLc|i:m
c. wcunc infecIicn
c. wcunc cehi:cence
e. IhrcmLcph|eLiIi:
f. hemcrrhcge
g. UIl
h. injury Ic L|cccer cr Lcwe| cr feIu:
i. cne:Ihe:ic ccmp|iccIicn:
j. cecrec:ec :cIi:fccIicn wiIh Ihe LirIh prcce::
k. |c:: cf cLi|iIy Ic ccccmp|i:h vcginc| ce|iverie:
|. increc:e fincncic| expen:e
m. |cnger hc:piIc| :Icy
n. Lcncing cnc Lrec:Ifeecing mcy Le ce|cyec

10. Iype: cf cne:Ihe:ic
c. regicnc| L|cck:
-epicurc|-mc:I ccmmcn, fee| pre::ure, nc pcin
-:pinc|-nc pcin cr pre::ure
L. generc|
-higher ri:k cf ccmp|iccIicn:

11. pre/inIrc/pc:IcpercIive ccre-in the textbook


















01/13
!%'
1
Ccmp|iccIicn: cf Ihe Fuerperium
Lecture 11

1. Fc:IpcrIum Hemcrrhcge
A. Definition/ Risk factors
1. 500 m| cr mcre L|ccc |c:: cfIer c vcginc| ce|ivery

2. 1000m| cr mcre L|ccc |c:: cfIer c C/S ce|ivery

3. 107 chcnge in HcI frcm ccmi::icn Ic FF

4. cr neec fcr Ircn:fu:icn

5. ecr|y FF hemcrrhcge-in Ihe fir:I 24 hcur:
c. uIerine cIcny
-mcrkec hypcIcnic
-º07 cf FFH cc:e: F/I cIcny
-c::ccicIec wiIh
cverci:Iencec uIeru:
mcg. Su|fcIe
Ircumc
cne:Ihe:ic
infecIicn:
prc|cngec cxyIccin u:cge
rcpic/prc|cngec |cLcr
L. reIcinec p|ccenIc
c. p|ccenIc cccreIc
c. uIerine rupIure
e. uIerine inver:icn
f. |cwer geniIc| IrccI |ccercIicn:
-cervix, vcginc, perineum
1
:I
-4
Ih
cegree |ccercIicn cf perineum
-c::ccicIec wiIh
precipiIcu: ce|ivery
cpercIive LirIh
ccngeniIc| cncmc|ie:
ccnIrccIec pe|vi:
infecIicn
vcricc:iIie: {ci:Iencec, :wc||en vein:)





!%(
2

g. hemcIcmc:-cc||ecIicn cf L|ccc in ccnnecIive
Ii::ue
-vu|vcr-mc:I ccmmcn, vi:iL|e, pcinfu|
-vcginc|-c::cc. wiIh fcrcep:, epi:icIcmy
-:uLperiIcnec|-|ife IhrecIening-c::cc. wiIh
uIerine crIery Lrcnche:/ve::e|: in Ihe
Lrccc |igcmenI
-cervicc|-u:uc||y :hc||cw, min. L|eecing
h. infecIicn:
i. cccgu|cpcIhie:

ó. |cIe FF hemcrrhcge-cfIer 24 hr: Ic ó week: FF
c. :uLinvc|uIicn cf Ihe uIeru:
-ce|cyec reIurn cf Ihe en|crgec uIeru: Ic
ncrmc| :ize
-ccu:ec Ly infecIicn, reIcinec p|ccenIc
-S & S: prc|cngec |cchic, exce::ive L|eecing
pc|pcL|e Lcggy uIeru:, funcc|
heighI grecIer Ihcn expecIec
L. reIcinec FCC
c. enccmeIriIi:

7. ccrk L|ccc-prcLcL|y vencu:-vcrice:/:uperficic| |cc.

8. LrighI rec L|ccc-crIeric|-ceep |ccercIicn cf cx

B. Complication-Hypovolemic shock

C. Care management
1. if hypcIcnic uIeru:
c. mc::cge
L. expre:: c|cI:-1 gm=1m| (weigh pads)
c. c::e:: fcr Icchyccrcic, ¡ 8F, Icchypnec, pc|e
ccc| :kin, / in LCC, |eIhcrgy
c. |crge Lcre lV´:-LF 1000 m| wiIh 10-40 uniI: piIccin
-wcIch fcr wcIer inIcxiccIicn, N & V
e. empIy L|cccer cr p|cce Fc|ey ccIh
f. C
2
10-12L/min vic mc:k if cxygen :cIurcIicn |cw
g. MeIhergine 0.2 mg lM-prccuce: :u:Icinec U/C
-e|evcIe: 8F, N & V, hecccche
-mcy exccerLcIe ccrcicc ci:ec:e
h. if un:ucce::fu|-prc:Icg|cncin F
2c
{HemcLcIe)
given lM cr inIrcmycmeIric||y
!%)
3
-hecccche, N & V, cicrrhec, fever
-mcy cggrcvcIe c:IhmcIic:
i. herLc| remecie:
-wiIch hcze|
-mcIherwcrI-prcmcIe: U/C, vc:cccnIricIive
-L|ue cchc:h-cxyIccic
-neII|e-¦ cvci|cL|e ViI. K, ¦ HgL
-Shepcrc´: pur:e-prcmcIe: U/C
-rec rc:pLerry |ecve:-prcmcIe: U/C
j. fc||cw-up wiIh |cL:
-C8C
-cccg pcne|
-Iype cnc crc:: mcIch

2. L|eecing wiIh ccnIrccIec uIeru:
c. c::e:: fcr c|cI: in |cwer uIerine :egmenI
L. in:pecIicn cf vcginc, cervix, perineum
c. :uIure L|eecing |ccercIicn:
c. fcr hemcIcmc
-cc|c pcck:
-|igcIicn cf L|eecing ve::e|

3. uIerine inver:icn
c. repc:iIicn uIeru:
L. Ix :hcck
c. cxyIccin
c. Lrccc :pecIrum cLx
e. NG IuLe if ccncernec F/I pcrc|yIic i|eu:

4. :uLinvc|uIicn
c. cxyIccin/ergcncvine
L. D & C if p|ccenIc frcgmenI: reIcinec

D. Teaching
1. ncrmc| |cchic prcgre::icn

2. review fccIcr: c::ccicIec wiIh hemcrrhcge

3. check fcr L|cccer ci:IenIicn

4. in:pecI perineum/vcginc| pcc:

5. c::e:: funcu:

!&*
4
ó. if S & S chcnge, cc|| MD immecicIe|y

ll. IhrcmLcemLc|ic ci:crcer:
A. Classifications
1. :uperficic| vencu: IhrcmLc:i:
c. mc:I ccmmcn Iype FF
L. invc|ve: :uperficic| :cphcnecu: vein

2. ceep vein IhrcmLc:i:
c. mc:I ccmmcn Iype curing pregncncy
L. invc|ve: vein: frcm fccI Ic i|icfemcrc|

3. pu|mcncry emLc|i:m
c. L|ccc c|cI ci:|ccgec-ccrriec Ic pu|mcncry crIery
L. ccc|uce: ve::e|-cL:IrucI L|ccc f|cw Ic |ung:

B. Incidence/ etiology
1. :uperficic| vencu: IhrcmLc:i:-1 cuI cf 500-750 wcmen

2. cec|inec F/I ecr|y cmLu|cIicn

3. ccu:e:: vencu: :Ic:i:, hypercccgu|cIicn, & injury Ic
L|ccc ve::e|

4. ri:k fccIcr:: C/S, cLe:iIy, /M/ cver 35 yr:, h/c DVI, DM,
:mcker, vcricc:e vein:

C. Clinical manifestations
1. :uperficic|-pcin/Iencerne::/wcrmIh/recne::

2. ceep-uni|cIerc| |eg pcin/cc|f Iencerne::/:we||ing

3. pu|mcncry-cy:pnec/Icchypnec/cpprehen:icn/ccugh
Icchyccrcic/hemcpIy:i:/p|euriIic che:I pcin

D. Case management
1. cicgnc:ing
c. Hcmcn´: :ign-ccn Le fc|:e pc:iIive
L. Dcpp|er U/S {VUS)
c. vencgrcphy-|e:: ccmmcn-expc:e: mcm/feIu:
Ic rccicIicn
c. pu|mcncry crIericgrcm

2. cnc|ge:ic-cnIiinf|cmmcIcry cgenI {i. e. McIrin)
!&!
5

3. re:I, e|evcIicn, wcrm pcck:, e|c:Iic :Iccking: {IEDS)

4. DVI-Ix wiIh cnIicccgu|cnI:-lV hepcrin÷pc Wcrfcrin

5. FE-lV hepcrin Ihercpy, :uppcrIive ccre

ó. if Ccumccin crcerec-neec CC Ihercpy
-teratogenic to fetus

lll. lnfecIicn:
A. Risk Factors
-C/S -FFFCM
-prc|cngec |cLcr -mu|Iip|e vcginc| excm:
-pccr hec|Ih :IcIu: -FSE/lUFC
-C8 Ircumc -chcriccmnicniIi:
-pre-exi:Iing vcg. infecIicn -vccuum/fcrcep: ce|ivery
-mcnuc| remcvc| cf p|ccenIc -|cp:e in c:epIic Iechni¢ue

B. Classifications
1. puerperc| :ep:i:-cny infecIicn cf geniIc| ccnc| wiIhin
ó week: cf mi:ccrricge, cLcrIicn, cr LirIh

2. enccmeIriIi:-infecIicn cf Ihe |ining cf Ihe uIeru:
c. mc:I ccmmcn FF infecIicn
L. u:uc||y :IcrI: cI p|ccenIc| :iIe
c. higher incicence wiIh C/S
c. mc:I fre¢uenI cu|priI:: G8S, ch|cmycic

3. pcrcmeIriIi: {pe|vic ce||u|iIi:)
c. invc|ve: ccnnecIive Ii::ue cf Lrccc |igcmenI
L. if :precc: Ic periIcneum=periIcniIi:
c. mcy Le re:u|I cf pe|vic vein IhrcmLcph|eLiIi:

4. wcunc infecIicn
c. cfIen ceve|cp: cI hcme
L. C/S :iIe, epi:icIcmy, |ccercIicn :iIe
c. Lrccc-:pecIrum cLx mcy Le u:ec

5. UIl´:
c. cccur in 2-47 cf FF wcmen
L. ri:k fccIcr:: Fc|ey, epicurc|, fre¢. excm:, C/S
c. mc:I fre¢uenI cu|priI: E. cc|i

!&"
6
ó. mc:IiIi:
c. cffecI: 5-107, mc:I fir:I-Iime mcIher:
L. ceve|cp: uni|cIerc||y
c. u:uc||y SIcph cureu:, E. cc|i, SIrepIcccccu:
c. if crgcni:m i: Ccncicc÷crc| Ihru:h in LcLie:

C. Manifestations
1. fever, chi||:, ¦ pu|:e, fcIigue, |eIhcrgy, pcin, Iencerne::

2. prcfu:e fcu|-:me||ing |cchic, |eukccyIc:i:, ¦ :ec rcIe

3. wcunc :epcrcIicn, cehi:cence

4. cy:uric, fre¢uency, urgency

5. recne::, wcrmIh

D. Case management
1. cLx cpprcpricIe fcr crgcni:m-imprcve hycrcIicn

2. enccurcge prcper perinec| hygiene

3. re:I, cnc|ge:ic:, :uppcrIive ccre
c. wcrm L|cnkeI:
L. :iIz LcIh
c. Iuck: pcc:
c. ccc| ccmpre::e: Ic peri

4. ccnIinue Lrec:Ifeecing cr pumping Lrec:I:

5. reinfcrce gccc hcncwc:hing Iechni¢ue:

ó. ccn:icer l & D fcr wcunc if neecec

7. c::i:I wiIh /DL´: cr LcLy ccre

lV. F:ychicIric ci:crcer:
A. PP Blues
1. 50-807 cf wcmen experience Ihe LcLy L|ue:

2. emcIicnc||y |cLi|e, cry cfIen cnc fcr nc rec:cn

3. peck: ccy 5, u:uc||y enc: ccy 10

!&#
7
4. mi|c cepre::icn, fcIigue, pccr ccncenIrcIicn, H//

5. eIic|cgy unkncwn

ó. fee|ing cverwhe|mec wiIh pcrenIc| re:pcn:iLi|iIy

7. |eI-ccwn fee|ing, |cck ccnnecIicn cf mcm Ic feIu:

8. neec: Ic |ecrn ccping :IrcIegie:, :eek :uppcrI grp:

º. 5-307 cf Ihi: grcup wi|| experience FF cepre::icn

B. PP depression-PP Major Mood Disorder
1. inIen:e, pervc:ive :ccne::, :evere/|cLi|e mccc :wing:

2. :ympIcm: rcre|y ci:cppecr wiIhcuI he|p

3. fee| inIen:e fecr, cnger, cnxieIy, cnc ce:pcncency

4. fee|ing: cf gui|I/incce¢uccy fue| wcrry cf Leing
inccmpeIenI pcrenI

5. ccc fccc crcving:, Linge ecIing, :|eeping hecvi|y

ó. ci:Iingui:hing fecIure: irriIcLi|iIy

7. prcminenI fecIure: rejecIicn cf Ihe infcnI F/I
jec|cu:y

8. mcy hcve IhcughI: cLcuI hcrming Ihe LcLy/:e|f

º. wiIh Ix, grccuc||y imprcve: in ó mcnIh:

10. Ix
c. p:ychcIhercpy
L. cnIicepre::cnI:
c. cnxic|yIic cgenI:
c. e|ecIrcccnvu|:ive Ihercpy






!&$
8
C. PP depression with psychotic features (PP psychosis)
1. cepre::icn, ce|u:icn:, cnc IhcughI: cf hcrming
infcnI cr :e|f

2. cccur: in 1-2 cf 1000 LirIh:/up Ic 507 chcnce Ic
recccur wiIh :uL:e¢uenI LirIh:

3. Lehcvicr evicenI wiIhin 1-3 mcnIh: FF

4. iniIic| ccmp|cinI:: cgiIcIicn, fcIigue, in:cmnic,
re:I|e::ne::, emcIicnc||y |cLi|e-incLi|iIy Ic mcve cr wcrk

5. Ihen :u:picicu:ne::, ccnfu:icn, inccherence, irrcIicnc|
:IcIemenI:, cnc cL:e::ive ccncern: F/I infcnI´: hec|Ih

ó. ce|u:icn: in 507 cf cc:e:, hc||ucincIicn: in 257

7. :evere ce|u:icn:/hc||ucincIicn: wi|| ccmmcnc mcm Ic
ki|| infcnI cr hcve her Le|ieve Ihe LcLy i: pc::e::ec Ly
Ihe cevi|

8. nur:ing :Icff :hcu|c Le cn c|erI fcr mcIher: whc cre
cgiIcIec, cverccIive, ccnfu:ec, cr :u:picicu:

º. ccur:e cf :yncrcme :imi|cr Ic IhcI :een in pecp|e
wiIh mccc ci:crcer:

10. p:ychicIric emergency: cnIicepre::cnI: cnc |iIhium

11. mcIher mcy ncI Le cL|e Ic Lrec:Ifeec cn cerIcin
meciccIicn:

12. wi|| prcLcL|y neec p:ychicIric hc:piIc|izcIicn

13. u:e :creening Icc|:: FF cepre::icn-pp 851-853

14. fc||cw-up wiIh ccvcncec prccIice p:ychicIric FN
c. hcme vi:iI:
L. meeI wiIh menIc| hec|Ih Ihercpi:I
c. :uppcrI grcup:




!&%
9
V. Lc:: cnc Grief
A. Situational life crises
1. inferIi|iIy

2. premcIure |cLcr/LirIh

3. C/:ecIicn

4. |c:: cf ccnIrc| curing LirIh prcce::

5. LirIh cf c Lcy when expecIing c gir|/vi:c ver:c

ó. LirIh cf c hcnciccppec chi|c

7. mcIernc| cecIh-7-8 cuI cf 100,000 wcmen

8. feIc| cecIh-ó.8 cuI cf 1000 LirIh:

º. necncIc| cecIh-27,000 yecr|y

B. Phases of grief-(denial, anger, bargaining, depression,
acceptance)
1. ccuIe ci:Ire::
c. |c:: cf icenIiIy c: pcrenI
L. |c:: cf c crecm/hcpe
c. :IcIe cf :hcck/numLne::
c. ccnfu:icn, ci:Le|ief, cenic|
e. mcy hcve cuILur:I cf emcIicn cr |cck cffecI
f. neec Ic cccepI Ihe |c::
g. ncrmc| funcIicning impecec/hcrc Ic mcke
ceci:icn:
h. mcy neec he|p wiIh funerc| crrcngemenI:

2. inIen:e grief
c. |cne|ine::, empIine::, gui|I, yecrning, cnger
L. hcve Ic ccccmmcccIe Ihe chcnge: Ihe
|c:: hc: crecIec-i.e. Ihe nur:ery, c|cIhe:
c. hcve Ic reIurn Ic wcrk-pc::iL|y meeI
in:en:iIive ccwcrker:/fcmi|y
c. cifficu|Iy hcnc|ing |eckcge cf Lrec:I mi|k-c
remincer cf |c::
e. gui|I fee|ing: mcy inIen:ify if mcIher Ihink: :he
i: Leing puni:hec fcr c pricr Lcc ccI
f. re:pcn:e:: cnger, LiIIerne::, re:enImenI
!&&
10
g. fccu:ec cnger cn hec|Ih ccre Iecm fcr ncI
:cving Ihe infcnI´: |ife
h. phy:icc| :ympIcm:: H//, fcIigue, cizzine::,
Lcckcche:

3. recrgcnizcIicn
c. :ecrch fcr c mecning Ic Ihe Ircgecy
L. imprcvec funcIicn cI hcme cnc wcrk
c. :IcrI Ic enjcy :imp|e p|ec:ure: wiIhcuI gui|I
c. ree:IcL|i:hing re|cIicn:hip:
e. ¨LiIIer:weeI grief"-grief re:pcn:e cccurring wiIh
remincer: cf Ihe |c::
f. grief ccn c|:c Le Iriggerec Ly :uL:e¢uenI LirIh:

C. Communication and caring
1. ccIuc|ize Ihe |c::

2. prcvice Iime Ic grieve

3. inIerpreI ncrmc| fee|ing:/c||cw fcr incivicuc| cifference:

4. prcvice fcr Ihe cu|Iurc|/:piriIuc| neec: cf pcrenI:

5. c::i:I wiIh Iheir phy:icc| ccmfcrI

ó. cffer cpIicn:
c. :ee cnc hc|c Ihe LcLy
L. LcIh cnc cre:: Ihe LcLy
c. privccy
c. vi:iIcIicn fcr cIher fcmi|y/frienc:
e. re|igicu: riIuc|:
f. :pecic| memcric|:/picIure:










01/13
!&'
1
Di:crcer: cf Ihe Femc|e/Mc|e FeprccucIive Sy:Iem:
Lecture 12

l. 8rec:I Mc::e:
A. Screening for breast masses
1. 8rec:I :e|f excm:
c. Le:I if ccne 5-7 ccy: cfIer men:e: hc: :Icppec
L. if pericc: cre ncI regu|cr, chc:e Ihe :cme ccy
ecch mcnIh
c. whi|e cn Lcck, pc|pcIe ecch Lrec:I in c circu|cr
cr verIicc| mcIicn Ic ccver whc|e Lrec:I
c. u:e finger pcc: Ic ck fcr incenIcIicn:, chcnge in
ccnIcur/IexIure, |ump:
e. ccmpre:: nipp|e Ic ck fcr ci:chcrge
f. mcy c|:c cc whi|e :Icncing/in Ihe :hcwer
g. ncIe :ize cnc :hcpe u:uc||y e¢uc| LuI ncI c|wcy:
:ymmeIricc|
h. vcry wiIh wcmcn´: cge, nuIriIicnc| :IcIu:, cnc
hereciIy
i. ccnIcur :hcu|c Le :mccIh wiIhcuI puckering
cr cimp|ing
j. c::e:: nipp|e: fcr :hcpe, cirecIicn, rc:he:,
u|cercIicn:, cnc ci:chcrge
k. º07 cf Lr:I |ump: fcunc Ly wcmen
-20-257 wi|| Le mc|igncnI

2. Excm Ly c|inicicn
c. u:uc||y ccne wiIh yecr|y pe|vic excm
L. :hcu|c ncI Le cn pericc cI Iime cf excm
c. mcy re¢ue:I mcmmcgrcm fcr wcmen wiIh
cen:e Lrec:I Ii::ue cr pc|pcL|e chcnge:
-mcmmcgrcm:-/CS guice|ine:
cnnuc||y cge 40 cnc cver if hec|Ihy cnc wiIh nc
ri:k fccIcr:-:ccner if ri:k fccIcr: pre:enI

B. Benign Breast Disorders
1. FiLrcccencmc
c. cccur: in wcmen frcm puLerIy Ic mencpcu:e
L. ri:k fccIcr:
-nu||ipcriIy
-|cw pcriIy
-|cIer mencpcu:e
-e:Ircgen Ihercpy
-fcmi|y h/c cf Lr:I C/
c. mc::e: cre :c|ic cnc mcce cf ccnnecIive Ii::ue
c. ccu:e unkncwn
e. u:uc||y :c|iIcry |ump < 1cm Ic 15 cm: in cicmeIer
f. |ump mcy Le Iencer curing men:e:
g. cicgnc:ec Ly mcmmcgrcm, U/S, MFl
h. cce:n´I re:pcnc Ic chcnge: in cieI/hcrmcne:
i. mcy neec :urgicc| exci:icn if |ump :u:picicu: cr
:ympIcm: cre :evere
!&(
2

2. FiLrccy:Iic Lrec:I ccnciIicn
c. mc:I ccmmcn Lrec:I prcL|em-mc:I|y fcunc in upper,
inner ¢uccrcnI cf Lrec:I
L. chcrccIerizec Ly |umpine::, wiIh/wiIhcuI Iencerne::, cnc
mcy Le c::ccicIec wiIh chcnge: in men:IrucIicn
c. 707 ncnprc|ifercIive {Lenign grcwing ce||:)
c. cIher: cre prc|ifercIive |e:icn: wiIh cIypicc| hyperp|c:ic
{¦ ri:k cf Lr:I C/)
e. ¦ ri:k cf Lr:I C/ wiIh re|cIive hcving Lr:I C/
f. eIic|cgy-unkncwn-pc::iL|y F/I imLc|cnce cf hcrmcne:
g. u:uc||y in LcIh Lrec:I: LuI mcy Le :ingu|cr
h. S & S ceve|cp cne week Lefcre men:e:
-cu||, hecvy pcin
-:en:e cf fu||ne::
-increc:ing Iencerne::
i. cy:I: cre u:uc||y :cfI, we|| cifferenIicIec, mcvcL|e
j. ceeper cy:I: mcy ncI Le cifferenIicIec frcm ccrcincmc:
k. U/S Ic ceIermine if f|uic fi||ec-if :c-c:pircIe
|. if :c|ic, mcmmcgrcm fc||cwec Ly fine neec|e c:pircIicn
{FN/) cr ccre Licp:y
m. mcncgemenI
-cieIcry chcnge:-¡ ccffeine -¡ Nc inIcke
-ViI. 8, C, cnc E :upp|emenI: -u:e NS/lDS
-:cme re|ief wiIh ¡ :mcking/c|cchc| inIcke
-:uppcrIive Lrc -hecI pcck: Ic Lrec:I:

3. DucIu: ecIc:ic
c. inf|cmmcIicn cf cucI: Lehinc nipp|e
L. eIic|cgy-unkncwn
c. cccur: mc:I cfIen in perimencpcu:c| wcmen
c. chcrccIerizec Ly Ihick, :Iicky nipp|e ci:chcrge eiIher whiIe,
Lrcwn, green, cr purp|e in cc|cr
e. cIher S & S: Lurning pcin, iIching, pc|pcL|e mc::
Lehinc nipp|e
f. wcrkup: mcmmc, c:pircIicn, cu|Iure cf f|uic
g. Ix: :ympIcmcIic
-nc :Iimu|cIicn -gccc Lrec:I hygiene
-l & D if cL:ce:: ceve|cp: -cLx
-mcy neec cffecIec cucI exci:ec

4. lnIrccucIc| pcpi||cmc:
c. fcunc in wcmen 30-50 yecr: cf cge
L. rcre, Lenign |e:icn in Ihe Ierminc| nipp|e cucI:
-mcy Le Icc :mc|| Ic pc|pcIe {2-3 cm)
c. mcy ncIe nipp|e ci:chcrge-:erc:cnguincu:
c. cc f|uic Fcp :mecr cf nipp|e ci:chcrge
e. Ix: exci:icn




!&)
3
C. Breast cancer- Cancer.org (American Cancer Society)
1. FcIhcphy:ic|cgy
c. mc:I ccmmcn infi|IrcIing cucIc| ccrcincmc
-cLncrmc| ce||: grcw in Ihe epiIhe|ic| ce||: which
|ine Ihe mcmmcry cucI:
-neec: 5-º yecr: Ic Le pc|pcL|e
L. ncninvc:ive if :Icy: in cucI {cucIc| ccrcincmc in :iIu cr
DClS)
c. invc:ive if peneIrcIe: Ihe Ii::ue crcunc Ihe cucI
c. invc:icn cf |ymphcIic chcnne|:/|ymph cucI: ccrry
cLncrmc| ce||: Ic |ymph cnc Ic meIc:IcIic :iIe:
e. :Icging cf ci:ec:e mu:I inc|uce |ymph ncce excmincIicn,
e:pecic||y cxi||cry ncce:
f. meIc:IcIic :iIe: inc|uce Lcne, |ung:, Lrcin, |iver

2. EIic|cgy/ri:k fccIcr:/incicence
c. exccI ccu:e unc|ecr
L. ¦ ri:k wiIh ¦ cf wcmcn´: cge
c. cIher ri:k fccIcr:-fcmi|y hi:Icry
-previcu: h/c Lr:I C/ -fcmi|y hi:Icry
-h/c cvcricn, enccmeIric|, cc|cn, cr Ihyrcic C/
-ecr|y mencrche {Lefcre cge 12)
-|cIer mencpcu:e {cfIer cge 55)
-nu||ipcriIy -fir:I preg. < cge 3
-HFI -cLe:iIy
-h/c Lenign Lrec:I ci:ec:e wiIh hyperp|c:ic
-Ccucc:icn:
-/friccn-/mericcn: hcve c higher mcrIc|iIy rcIe cue Ic |cIe
cicgnc:i:
-:ecenIcry |ife:Iy|e -high SES
c. incicence
-in US, 1 cuI cf 8 wcmen wi|| ceve|cp Lr:I C/
-ri:k fccIcr: he|p icenIify |e:: Ihcn 307 cf wcmen
-57 cf Lr:I C/ cIIriLuIec Ic hereciIy
-¦ ri:k fcr wcmen wiIh cLncrmc| 8FC/1/8FC/2 gene:
-Ie:Iing expen:ive
-cfIen ncI ccverec Ly in:urcnce
-ceLcIe F/I prcphy|ccIic mc:IecIcmie:
cr Icmcfixen u:e
-¦ ri:k cf Lr:I C/ wiIh u:e cf HFI
-cccur: in men < 1 7

3. C|inicc| mcnife:IcIicn:
c. phy:icc|
-mc:I |ump: in upper cuIer ¢uccrcnI
-mcy fee| |ump cr Ihickening cf Lr:I
-hcrc cnc fixec, :cfI cnc :pcngy
-we||-cefinec cr irregu|cr Lcrcer:
-mcy ccu:e cimp|ing cue Ic fixec Ic :kin {crcnge pee|)
-mcy hcve nipp|e ci:chcrge-L|cccy cr c|ecr


!'*
4
L. p:ychc:ccic|
-cenic|
-grief cnc |c:: Lehcvicr:
c. mcmmcgrcm/U/S/MFl
c. nipp|e ci:chcrge excm-cu|Iure/:pecimen Ic |cL
e. cucIcgrcm-fine p|c:Iic IuLe p|ccec inIc cucI,
ccnIrc:I mecic injecIec, c::e:: cucI
f. FN/
g. Licp:y-c:pircIicn cr ccre-mcy u:e guice wire
h. Irip|e Ie:I-phy:icc| excm, mcmmcgrcm, FN/
-if cny Lenign-º87 cf |e:icn Leing Lenign
i. :Icging-INM-I=:ize, N=ncce:, M=meIc:Ic:e:
-SIcge 0-cucIc| ccrcincmc {in :iIu)-ecr|ie:I fcrm
-SIcge 1-2 cm Iumcr/hc:n´I :precc
-SIcge 2-Iumcr >2 cm-in cxi||cry ncce: cn :cme
:ice
-SIcge 3-Iumcr >5 cm-:precc Ic |ymph ncce:-
|ccc|izec :precc, nc cIher crgcn:
-SIcge 4-meIc:Ic:i: Ic ci:IcnI-Lcne:, |ung:, |iver
|ymph ncce: ncI |ccc|

4. Nur:ing cicgnc:e:
c. pcin F/I :urgicc| prccecure
L. ri:k fcr infecIicn
c. Lccy-imcge ci:IurLcnce F/I |c:: cf Lccy pcrI

5. McncgemenI
c. :urgery
-|umpecIcmy {Iy|ecIcmy, pcrIic| mc:IecIcmy)
-remcvc| cf Iumcr
-remcvc| cf :mc|| :urrcuncing crec
-:cmp|ing cf cxi||cry |ymph ncce
-cce:n´I effecI pecIcrc| mu:c|e
-mcy fc||cw-up wiIh ó-7 week: cf
rccicIicn
-mccifiec rccicc| mc:IecIcmy
-remcvc| cf enIire Lrec:I
-:cmp|e cf |ymph ncce:
-:pcre: pecIcrc| mu:c|e
-ri:k:: infecIicn:, hemcIcmc
|ymphccemc, |imiIcIicn cf
crm/:hcu|cer mcLi|iIy
-:enIine| |ymph ncce Licp:y {SLN8)
-rccicccIive Irccer/cye injecIec
-ccrriec Ly |ymph Ic :enIine| ncce
which i: fir:I ncce Ic receive
|ymph frcm Iumcr
-mc:I |ike|y Ic ccnIcin meIc:Ic:i: if
C/ hc: :precc
-if :enIine| ncce i: ccncercu:, mcre
ncce: cre exci:ec

!'!
5
-reccn:IrucIive :urgery
-gcc| i: cchievemenI cf :ymmeIry wiIh
pre:ervcIicn cf Lccy imcge
-3 Iype: cf cuIc|cgcu: f|cp reccn:I.
-|cIi::imu: ccr:i
-IF/M-Ircn:ver:e recIu:
cLccmini: myccuIcnecu:
-infericr g|uIeu: free
-mcniIcr :kin f|cp fcr ¡ ccp. refi||,
hemcIcmc, infecIicn, necrc:i:
-mcy c|:c receive Lrec:I expcncer:÷ imp|cnI:
L. ccjuvcnI Ihercpy-rccicIicn
-cfIer |umpecIcmy in ncn/micrcinvc:ive cc:e:
-cny invc:ive cucIc| ccrcincmc <1 cm cicmeIer
-inIer:IiIic| cr Lc||ccn LrcchyIhercpy
-inIrccpercIive rccicIicn
c. ccjuvcnI Ihercpy-crug Ihercpie:
-chemcIhercpy :IcrIec :ccn cfIer cx
-mc:I u:efu| in premencpcu:c| wcmen wiIh
Lr:I C/ wiIh + ncce:
-ccn increc:e Iime wiIhcuI C/
-mcy Le given c|cne cr wiIh HFI
-Icmcxifen cIIcche: Ic hcrmcne recepIcr
cn C/ ce||-ce|| uncL|e Ic grcw
-:ice effecI:-|eukcpenic, neuIrcpenic, cnemic,
IhrcmcLccyIcpenic, Gl prcL|em:, hcir |c::

ó. Di:chcrge p|cnning
-re:curce:
/CS Fecch fcr Feccvery prcgrcm
NCCN-NcIicnc| Ccmprehen:ive Ccncer NeIwcrk
/CS hcme pcge

ll. Sexuc||y Ircn:miIIec Di:ec:e:/lnfecIicn:
A. Infections associated with ulcers
1. Syphi|i:
c. ccu:ec Ly Irepcnemc pc||icum-:pirccheIe
L. Ircn:mi::icn Ihru cLrc:icn cf Ii::ue, ki::ing,
LiIing, crc|-geniIc| :ex
c. ccn crc:: Ihe p|ccenIc
c. 120,000 new cc:e: ecch yecr
e. higher rcIe: in ycung /friccn-/mericcn:
f. cIIriLuIec Ic u:e cf :ex fcr crug:/mcney
g. primcry-chcncre cppecr: ccy 5-º0 pc:I
infecIicn-ncnIencer, :hc||cw, incurcIec
h. :eccnccry-cccur: ó week:-8 mcnIh:
-wice :precc mccu|cpcpu|cr rc:h cn pc|m:/:c|e:
-fever, hecccche, mc|ci:e
-mcy hcve ccncy|cmcIc |cIc
i. IerIicry-neurc|cgic, CV, MS, cr mu|Iicrgcn :y:Iem
ccmp|iccIicn:
j. :creening:
!'"
6
-micrc:ccpic excm cf |e:icn:
-:erc|cgy-VDFL/FFF-mcy hcve fc|:e +
-MH/-IF-micrchemcgg|uIincIicn c::cy:
fcr cnIiLccy Ic I. pc||icum u:ec Ic ccnfirm + Ie:I:
-:ercccnver:icn Icke: ó-8 week: pc:I expc:ure
j. mcncgemenI:
-FCN G lM
-IrecI: primcry, :eccnccry, cnc ecr|y |cIenI
-if :yphi|i: c|cer Ihcn 1 yecr, week|y :hcI: fcr 3 wk:
-c|IerncIive:: ccxycyc|ine, IeIrccyc|ine
-ncI u:ec in pregncncy
- eryIhrcmycin-un|ike|y Ic cure feIc| infecIicn

2. GeniIc| herpe: :imp|ex
c. re:u|I: in pcinfu|, recccurring u|cer:
L. HSV-1-u:uc||y ncn:exuc||y Ircn:miIIec
-crc| |cLic| u|cer:
-gingivc:IcmcIiIi:
c. HSV-2-Ircn:miIIec curing crc|/geniIc| :ex
c. ncI c repcrIec ci:ec:e
e. 207 /mericcn: infecIec wiIh viru:-cver 50 mi||icn pecp|e
f. e:IimcIec 1 cuI cf 4 wcmen wi|| geI HSV-2
g. iniIic| infecIicn:
-fever, chi||:, mc|ci:e
-:evere cy:uric
-pcinfu| |e:icn:-mcy |c:I 2-3 week:
h. |e:icn: mcy prcgre:: frcm mccu|e÷pcpu|e÷
ve:ic|e÷pu:Iu|e÷u|cer IhcI cru:I:÷:ccr
i. ccn ccu:e cervicc| prcL|em:, puru|enI vcginc|
vcginc| ci:chcrge cnc urincry reIenIicn
j. recccurring epi:cce: ncI c: :evere
k. HSV-2 ccn hcve ccver:e effecI: cn mcm/feIu:
-viremic
-ccngeniIc| infecIicn
-ó07 infcnI mcrIc|iIy if infcnI ccnIrccI: HSV
|. c::ccicIicn LeIween cervicc| C/ cnc HSV-2
m. :creening:
-phy:icc| excm wiIh ccmp|eIe H & F
-virc| cu|Iure cf u|cer
n. mcncgemenI:
-chrcnic/recccurring -prcper hygiene
-:y:Iemic cnIivirc| meciccIicn:
-ccyc|cvir, vc|ccyc|cvir, fcmicic|cvir
-:iIz LcIh wiIh Lcking :ccc -crc| cnc|ge:ic:
-cieI rich in ViI. C, 8, zinc, cnc cc|cium
-ke|p pcwcer, :unf|cwer :eec ci|
-re|cxcIicn Iechni¢ue: -:uppcrI grcup:
-ccnccm: Ic prevenI Ircn:mi::icn Ic new pcrIner
-C/:ecIicn ce|ivery if primcry cuILreck
-ccun:e|ing Ic cec| wiIh :hcme, gui|I, cnger

3. Lymphcgrcnu|cmc venereum-CDC.gcv-|cck fcr FccI: SheeI:
!'#
7
4. Chcncrcic
5. Grcnu|cmc inguinc|e


B. Infections of Epithelial surfaces
1. Humcn pcpi||cmc viru:-HFV
c. 100+ HFV Iype:, 40 kncwn mucc:c| :ercIype:
L. º07 cf cc:e: c|ecrec Ly immune :y:Iem in 2 yecr:
c. if ncI c|ecrec, ccn |ecc Ic geniIc| wcrI:, wcrI: in Ihe IhrccI,
cervicc| ccncer
c. cge: cI ri:k fcr HFV
14-1ºyr: c|c÷2ó.87
20-24yr: c|c÷44.87
25-2ºyr: c|c÷27.47
e. mcy |cck |ike c ccu|if|cwer-mc::
f. rcre|y Ircn:miIIec Ic necncIe cI LirIh
g. :creening:
-S & S-cy:pcreunic, iIching, ci:chcrge, Lump:
-mcy neec Ic chcnge g|cve: LeIween vcginc|
cnc recIc| excm: Ic prevenI :precc
h. Dicgnc:i:
-cervicc| excm Ic inc|uce Fcp :mecr & HFV Ie:I
-pcp cn|y 30-ó07 :en:iIive
-HFV :creen i: º07 :en:iIive
-cervicc| :creening guice|ine:-:IcrI cI cge 21
{wheIher cr ncI :exuc||y ccIive)
-inIervc|:-every 2-3 yr: 21-2º if pcp neg
-every 3 yr: 30-ó5 if pcp/HFV neg
-cge 30-HFV neg-17 ri:k
{ºº7 cx C/ frcm HFV-|cw prcgre::icn-8.1 Ic 12.ó yr:)
-cge ó5 w/ 3 ccn:e¢uenIic| neg pcp: in |c:I 10 yr:
-:Icp neecing pcp:
-cc|pc:ccpy Ic view grcwIh wiIh Licp:y
i. neec Ic cifferenIicIe LeIween HFV &:
-mc||u:cum ccnIcgic:um-whiIe pcpu|e:
-ccncy|cmcIc |cIc-:eccnccry :yphi|i:
j. FrevenIicn-vcccine Gcrci:i|-:IcrI cI cge º-2ó
-ki||ec vcccine
-give pricr Ic :exuc| ceLuI cr ecr|y cfIer
-ncI given cfIer >5 pcrIner:
-:erie: cf 3 injecIicn:/ó mc
-$$$, uncffcrccL|e Ic unin:urec
-|ifeIime immuniIy LuI :Ii|| neec: pcp: :ince ncI c||
:Ircin: ccverec
k. Ix-nc IrecImenI ccn ercciccIe: HFV-cn|y :ympIcm:
-imi¢uimcc, pcccphy||in, pcccfi|cx-Icpicc|
-crycIhercpy

!'$
8


2. Gcncrrhec
c. ccu:ec Ly Nei::eric gcncrrhcece-LccIeric
L. ó00,000 ccnIrccI gcncrrhec ecch yecr
c. ri:ing incicence cf crug-re:i:Icnce
c. Ircn:mi::icn: crc|, geniIc|, cnc|
e. higher incicence in pecp|e uncer 20 yecr: c|c
f. higher incicence in /friccn-/mericcn:
g. wcmen mc:I cfIen c:ympIcmcIic
h. mcy pre:enI wiIh pcin/Lurning wiIh urincIicn,
vcginc| ci:chcrge, |cw Lcck pcin
h. men mcy c/c pcin wiIh urincIicn cnc ye||cwi:h
ci:chcrge frcm peni:
i. mcy Icke up Ic 3-10 ccy: Lefcre :ympIcm: pre:enI
j. :creening: cu|Iure: Icken frcm encccervix,
recIum, cnc pc::iL|y phcrynx
k. pecp|e cre fre¢uenI|y ccinfecIec-:hcu|c Le
Ie:Iec fcr cIher SIl´:
|. mcncgemenI: u:uc||y :ing|e cc:e cnIiLicIic:
cefIricxcne
m. 457 wcmen wi|| c|:c hcve ch|cmycic :c :hcu|c
hcve ccnccmiIcnI Ix

3. Ch|cmycic
c. ccu:ec Ly Ch|cmycic IrcchcmcIi:
L. mc:I ccmmcn/fc:I :preccing SIl in wcmen
c. unIrecIec |ecc: Ic FlD cnc ccuIe :c|pingiIi:
c. mcy ccu:ec u|cer: cn Ihe cervix increc:ing
ri:k Ic cc¢uire HlV
e. higher incicence in wcmen uncer cge 20
!'%
9
f. :exuc||y ccIive incivicuc|: S 25 yr: c|c-:creen fcr ch|cmycic
yecr|y
g. c|| pregncnI wcmen :hcu|c Le :creenec cI fir:I FN vi:iI
h. repecI cu|Iure: if wcmcn wc: previcu:|y + cr hc: mu|Iip|e
pcrIner:
i. mcy hcve :pcIIing, pc:IcciIc| L|eecing, cervicc|
ci:chcrge, cr cy:uric
j. cx Ihru cu|Iure
k. mcncgemenI-ccxycyc|ine cr cziIhrcmycin
|. if pregncnI-eryIhrcmycin/cmcxici||in
m. :ince u:uc||y c:ympIcmcIic, mu:I enccurcge
ccmp|eIicn cf c|| Ihe meciccIicn
n. wcmen Ix wiIh eryIhrcmycin neec Ic Le reIe:Iec
in 3 week: cue Ic pccr vc|iciIy cf Ix


4. FlD-Fe|vic lnf|cmmcIcry Di:ec:e
c. invc|ve: fc||cpicn IuLe: {:c|pingiIi:), uIeru:
{enccmeIriIi:), cnc pc::iL|y cvcrie:
cnc periIcnec| :urfcce:
L. ccu:ec Ly mu|Iip|e crgcni:m: cnc cccc:icnc||y
ccu:ec Ly mcre Ihcn cne
c. mc:I ccmmcn|y ccu:ec Ly C. IrcchcmcIi:
c. c|:c ccu:ec Ly gcncrrhec cnc cIher cercLic
cnc cncercLic LccIeric
e. micrccrgcni:m: :precc frcm vcginc Ic upper
geniIc| IrccI-u:uc||y cccurring cI Ihe enc
cf cr ju:I cfIer men:e:
f. curing men:e:, :precc :uppcrIec Ly cpen cx,
cecrec:e cervicc| mucu:, cnc L|ccc u:ec
c: c mecium fcr grcwIh
g. ecch yecr, 1 mi||icn wcmen wi|| experience
:ympIcmcIic FlD
h. ri:k fccIcr:: Ieen:, mu|Iip|e pcrIner:, new
pcrIner:, hi:Icry cf FlD, u:e cf lUD
i. |ecc: Ic: ri:k fcr ecIcpic pregncncy, inferIi|iIy,
chrcnic pe|vic pcin, cy:pcreunic,
pyc:c|pinx, cL:ce::e:, cche:icn:
j. S & S: cu||, crcmping, cr :evere pe|vic pcin,
L|eecing, ccnexc| Iencerne::, pcin
wiIh cervicc| mcvemenI {Chcnce|ier
:ign), Li|cIerc| pe|vic Iencerne::
k. :creening: gccc hi:Icry Icking Ic r/c cIher
ccu:e:, Iemp ¦38.3
0
C, cLncrmc|
cervicc|/vcginc| ci:chcrge, ¦ :ec rcIe,
|cL cccumenIcIicn cf ch|cmycic cr
gcncrrhec
|. neec Ic Iecch prevenIicn cf ccu:e: Ic he|p
prevenI ci:ec:e
m. neec Ic :creen c:ympIcmcIic wcmen wiIh
hi:Icry cf ri:ky Lehcvicr
n. Ix: u:uc||y Lrccc-:pecIrum cLx, u:e cnc|ge:ic:,
!'&
10
:emi-fcw|er: pc:iIicn whi|e re:Iing
c. enccurcge re:I, prcper nuIriIicn, cnc hycrcIicn
p. wi|| neec fc||cw-up |cL wcrk Ic ccnfirm cure
¢. Iecching Ic inc|uce u:e cf Lcrrier meIhcc:, nc
:exuc| re|cIicn: unIi| ccmp|eIicn cf mec:,
fc||cw-up pe|vic excm:, cnc cIher
ccnIrccepIive meIhcc: cIher Ihcn lUD´:

lll. Gynecc|cgic Di:crcer:
A. Postmenopausal bleeding-bleeding 12 months post menses
cessation
1. Fe|cIec fccIcr:
c. cIrcphic vcginiIi:-Ii::ue: mcre :en:iIive, L|eec
ec:i|y
L. pc|yp:-mc::e: in/cn Ihe cervix
c. enccmeIric| prcL|em:
-enccmeIric| hyperp|c:ic mcy Le c precur:cr Ic
enccmeIric| C/-neec c D & C Ic evc|ucIe
c. ¡ cvcricn funcIicn ÷ ¡ e:Ircgen/prcge:Iercne

2. McncgemenI
c. fcr vcginiIi:-u:e cf crecm: Ic prcIecI Ii::ue:
L. fcr pc|yp:-remcvc|
c. HFI

3. Di:cu::icn regcrcing HFI
c. mc:I :Iucie: :hcw ¦ ri:k fccIcr: cnc ccver:e
reccIicn: F/I cc:e cnc |engIh cf Ix
L. ccnIrcver:y F/I meIhcc cf ccmini:IrcIicn,
cc:e:, cnc efficccy
c. mu:I incivicuc|izec Ic pI´: S & S , |ife:Iy|e,
cnc mecicc| hi:Icry
-neec Ic cec| wiIh phi|c:cphy/Le|ief: regcrcing
exchcrmcne:
c. if EFI c|cne, 5-10X ri:k cf enccmeIric| C/
e. prcL|em wiIh cccing prcge:Iercne, L|eecing
f. new :Iucie: prcving IhcI HFI mcy |ecc Ic
¦ ri:k fcr Lr:I C/
g. :hcrI Ierm HFI {1-5 yecr:)-nc prcIecIicn:
cgcin:I c:Iecpcrc:i: cr CVD
-ri:k fccIcr: fcr c:Iecpcrc:i:
fcmi|y hi:Icry
:hcrI, Ihin
Eurcpecn cr /:icn ce:cenI
ecr|y mencpcu:e
:mcker, c|cchc| u:e
ccffeine u:e, |cw cc|cium inIcke
:ecenIcry |ife:Iy|e
u:e cf :Iercic:, :ynIhyrcic, ciureIic:
-ri:k fccIcr: fcr CVD
¦ LDL, ¡ HDL, ¦ IcIc| :erum chc|e:Ierc|
¦ ri:k cf cIherc:c|erc:i:
!''
11
Ml
emLc|i
IhrcmLc:e:
h. |cng Ierm-mcy u:e e:Ircgen c|cne cr in
ccmLincIicn wiIh prcge:Iercne cr
Ie:Ic:Iercne
-mcy Le ccnIinucu: cr cyc|ic

B. Endometriosis
1. /::e::menI
c. Lenign ci:ec:e chcrccIerizec Ly imp|cnIcIicn
cf enccmeIric| Ii::ue cuI:ice Ihe uIeru:
L. imp|cnIec cn Ihe cvcrie:, cu|-ce-:cc, uIerine
|igcmenI:, recIcvcginc| :epIum, :igmcic
cc|cn, pe|vic periIcneum, cervix, cnc
inguinc| crec
c. enccmeIric| |e:icn: ccn Le fcunc in Ihe vcginc,
:urgicc| :ccr:, vu|vc, perineum, L|cccer,
cnc cIher :iIe: :uch c: Ihcrccic ccviIy,
gc||L|cccer cnc hecrI
c. Ii::ue re:pcnc: Ic hcrmcnc| :Iimu|cIicn
e. Ii::ue L|eec: curing cr cfIer men:e: ccu:ing
inf|cmmcIcry re:pcn:e Ly ccjccenI
crgcn:/Ii::ue:
f. ccn |ecc Ic :ccr: cnc cche:icn:
g. incicence
-107 in wcmen cf reprccucIive cge
-25-357 inferIi|e wcmen
-287 cf wcmen wiIh chrcnic pe|vic pcin
h. ecch yecr ccccunI fcr c|mc:I 50,000
hy:IerecIcmie:
i. mcy remcin c:ympIcmcIic cnc ci:cppecr
cfIer mencpcu:e
j. mcy wcr:en wiIh repecIec cyc|e:
k. fcunc ccrc:: c|| SES |eve|:
|. mc:I wice|y cccepIec ccu:e-reIrcgrcce
men:IrucIicn
-e:IimcIec Ic cccur in ºó7 cf wcmen whc
men:IrucIe
m. pc::iL|e rec:cn: why :cme wcmen ceve|cp Ihe
ccnciIicn
-incivicuc| immune :y:Iem fci|: Ic ce:Ircy Ii::ue
-cifference: in geneIic mcke-up
-envircnmenIc| chc||enge:
n. S & S
-pcin {cy:mencrrhec)-pc::iL|y pricr Ic men:e:
-|cwer cLccmen pcin -cy:pcreunic
-pcinfu| cefeccIicn -hypermencrrhec
-:ccrc| Lcck pcin -inferIi|iIy



!'(
12
2. McncgemenI
c. NS/lD:
L. :uppre::icn cf enccgencu: e:Ircgen prccucIicn
medically induced menopause
-GnFH cgcni:I:
{gcncccIrcpin-re|ec:ing hcrmcne)
i.e. Luprcn, Syncre|
¡piIuiIcry gcncccIrcpin :ecreIicn÷
¡FSH/LH :Iimu|cIicn cf cvcrie:÷
¡cvcricn funcIicn÷hcI f|c:he:, vcginc|
cryne::
|imiIec Ic ó mcnIh: F/I Lcne |c::
pcIenIic| IercIcgen
-cncrcgen cerivcIive:
Dcnccrine {ccnczc|)
:uppre:: FSH/LH :ecreIicn
prccuce: cncvu|cIicn
regre::icn cf enccmeIric| Ii::ue:
mcy prccuce mc:cu|inizing IrciI:
weighI gcin ecemc
ceepening cf vcice
ci|y :kin hir:uIi:m
¡ in Lr:I :ize
cIher :ice effecI:
H// hcI f|c:he:
vcginc| cryne:: ¡ |iLicc
in:cmnic fcIigue
cizzine:: ¡HDL: ¦ LDL:
ccnIrcinciccIec-h/c |iver ci:ec:e
u:e wiIh ccuIicn if h/c hecrI cr renc|
ci:ec:e
feIu:-p:eucchermcphrcciIi:m
c. mcy u:e CC´: wiIh |cw E Ic F rcIic
Ic :hrink enccmeIric| Ii::ue:
SE: N & V, L|eecing, ecemc
c. mifepri:Icne {FU-48ó) Leing u:ec wiIh :ucce::
e. :urgery-nc Ic ccn:icer cge, ce:ire fcr chi|cren,
|cccIicn cf ci:ec:e
-I/H-8SC
-|c:er :urgery Ic remcve cche:icn:/Ii::ue
f. 407 recccurrence-excepI in I/H-8SC cc:e:

C. Dysfunctional uterine bleeding- abnormal uterine bleeding
1. Wice vcrieIy cf men:Iruc| irregu|criIie:
c. mencrrhcgic
L. irregu|cr cyc|e:

2. Fc::iL|e ccu:e:
c. cncvu|cIicn-pc|ycy:Iic cvcry :yncrcme
L. pregncncy-re|cIec-S/8
c. geniIc| infecIicn:-ch|cmycic| cerviciIi:
c. necp|c:m:-C/ cf cx
!')
13
e. Ircumc-fcreign Lccy
f. :y:Iemic ci:ec:e:-DM
g. icIrcgenic-herLc| prepcrcIicn:-gin:eng

3. Severe L|eecing wiIh HgL ¡8g/100m|=hc:piIc|izcIicn
c. given lV ccng. e:Ircgen {Fremcrin)
L. pc::iL|e D & C
c. enccmeIric| Licp:y Ic r/c enccmeIric| C/

4. lncicence
c. Ieen:-207
L. wcmen uncer 50-507

5. McncgemenI
c. crc| ccng. e:Ircgen X 21 ccy: wiIh prcge:Iercne
{mecrcxyprcge:Iercne-Frcverc) cccec fcr Ihe
|c:I 7-10 ccy:
L. |cw cc:e CCF
c. cL|cIicn cf enccmeIrium
c. hy:IerecIcmy

D. Inflammations and Infections
1. VcginiIi:/Vu|viIi:
c. inf|cmmcIicn cf vcginc cnc/cr vu|vc
L. S & S
-irriIcIicn, mc|cccrcu: cLncrmc| ci:chcrge
-iIching, Lurning, urincry fre¢uency
-:pcIIing
c. ccu:e:
-infecIicn:
-|cck cf hcrmcne e:Ircgen
-irriIcnI:/c||ergie:
chemicc|: mecicine:
|cIex ccnccm: :permicice:
cicphrcgm/cervicc| ccp
:cenIec/cc|crec Ici|eI pcper
LuLL|e LcIh: ccuche:
|cuncry ceIergenI:
hcI IuL: hcr:eLcck ricing
wecring IighI gcrmenI:
ruLLing cn c Licyc|e :ecI
c. infecIicn:
-ccncicic:i:-yec:I
ccu:e:-cLx, pregncncy, DM, prcL|em:
immune :y:Iem
Ihick whiIe cccr|e:: ci:chcrge
in Ihe mcuIh-cc||ec Ihru:h
Ix-cnIifungc| cgenI:
-LccIeric| vcginc:i:-8V
ccu:ec Ly c vcrieIy cf LccIeric
inc|ucing gcrcnere||c
c::ccicIec wiIh FIL cnc LirIh
!(*
14
eIic|cgy unkncwn
hecvy grcy frcIhy mc|cccrcu: D/C
Ix-crc| meIrcnicczc|e-F|cgy|
cnIiprcIczcc|/cnIiLccIeric|
ccnIrcinciccIec in wcmen
whc Lrec:I feec
mcy cffecI Ihe CNS cnc
hemcIcpcieIic :y:Iem:
wiIh c|cchc|-ccn ccu:e cLccminc|
ci:Ire::, N & V, H//
-Irichcmcnic:i:-cncercLic prcIczccn
mcy Le c:ympIcmcIic cr hcve frcIhy
mu:Iy-:me||ing ci:chcrge
iIching cn cr crcunc Ihe vcginc
:pcIIing, urincry urgency
Ix-F|cgy|-treat both partners
:ince c SIl-:hcu|c :creen fcr cIher SIl:
e. cIrcphic vcginiIi:-irriIcIicn wiIhcuI ci:chcrge
-|cck cf e:Ircgen cue Ic chi|cLirIh, mencpcu:e,
Li|cIerc| ccphcrecIcmy, rccicIicn Ix
-e:Ircgen crecm: re:Icre |uLriccIicn cnc
cecrec:e :crene::/irriIcIicn

2. Icxic Shcck Syncrcme
c. c::e::menI
-primcri|y c ci:ec:e cf Ihe reprccucIive cge
-ccu:ec Ly S. cureu:÷prccuce: Icxin ISSI-1
-ri:k fccIcr:-reIcinec Icmpcn:, Lcrrier cevice: |efI in p|cce,
:urgery, recenI ce|ivery
-S & S-fever >102 F, 38.º C, hypcIen:icn,
wice:precc mccu|cr rc:h, cizzine::, N & V, cicrrhec
myc|gic, inf|cmec muccu: memLrcne:
-|cL Ie:I:-¦ 8UN, Cr, SGCI, SGFI, ¡ p|cIe|eI:
L. mcncgemenI
-mcin|y :uppcrIive
-cnIiLicIic:-|imiIec vc|ue
-neec Ic Iecch prevenIicn, recccurrence

E. Problems R/ T Pelvic Support Structures
1. UIerine Frc|cp:e
c. rcunc |igcmenI: hc|c uIeru: in cnIever:icn
uIerc:ccrc| |igcmenI: pu|| cx up cnc Lcck
L. 2 mcnIh: FF, |igcmenI: :hcu|c reIurn Ic ncrmc|
|engIh-1/3 cf wcmen, uIeru: remcin:
reIrcverIec
c. ccu:e:: ccngeniIc| cr cc¢uirec pe|vic
re|cxcIicn
-pregncncy
-perimencpcu:c| pericc
-pe|vic :urgery
-pe|vic rccicIicn

!(!
15
c. Ix: -pe::crie: -e:Ircgen crecm:
-cLccminc|/vcginc| hy:IerecIcmy
e. ecuccIicn: u:e cf Kege| exerci:e: Ic :IrengIhen
pe|vic f|ccr mu:c|e:

2. Cy:Icce|e
c. ccwnwcrc ci:p|ccemenI cf L|cccer-Lu|ge
in cnIericr vcginc| wc||
L. ccu:e:: geneIic:, cLe:iIy, chi|cLirIh, ccvcncec
cge
c. S & S: urincry inccnIinence, vcginc| fu||ne::
Lu|ge in vcginc| wc||
c. ccmp|eIe empIying cf L|cccer cifficu|I F/I Ihe
cy:Icce|e :cg: Le|cw Ihe L|cccer neck
e. Ix: vcginc| pe::cry cr :urgicc| repcir
cc|pcrrhcpy {cnIericr repcir)-:hcrIen:
pe|vic mu:c|e: Ic LeIIer :uppcrI L|cccer

3. FecIcce|e
c. hernicIicn cf cnIericr recIc| wc||
L. mcy |ecc Ic ccn:IipcIicn, hemcrrhcic:, fecc|
impccIicn, fee|ing cf vcginc|/recIc| fu||ne::
c. fcunc Ly recIc| excm cr Lcrium enemc
c. neec Ic prcmcIe Lcwe| e|imincIicn
e. :urgery-pc:Iericr cc|pcrrhcphy cr / & F repcir
f. fc||cw :urgery wiIh |cw re:icue cieI

F. Common Benign Neoplasms
1. Iype:/McncgemenI
c. cvcricn mc::e:
-70-807 Lenign
-S & S-c:ympIcmcIic
-mc:: mcy Le pc|pcIec cn pe|vic excm
-mcy hcve c fee|ing cf fu||ne::, crcmping
-ccn |ecc Ic cy:pcreunic, irregu|cr L|eecing
-mcy re:c|ve cn cwn
-u:e cf CC´:
-cicgnc:Iic |cpcrc:ccpy wiIh pc::iL|e
|cpcrcIcmy
L. uIerine mc::e:
-fiLrcic:-|eicmycmc:
-minimc| C/ ri:k
-S & S-fre¢uenI|y c:ympIcmcIic
-|cw cLccminc| pcin, fu||ne::, pre::ure
-mencrrhcgic, cy:mencrrhec
-meIrcrrhcgic {inIermen:Iruc| L|eecing)
-mcy :hrink wiIh mencpcu:e
-mycmecIcmy, D & C, hy:IerecIcmy




!("
16
2. IcIc| cLccminc| hy:IerecIcmy
c. remcvc| cf uIeru: cnc cervix Ihru cLccminc|
inci:icn
L. mcy inc|uce remcvc| cf fc||cpicn IuLe:/cvcrie:
8SC-Li|cIerc| :c|pingc-ccphcrecIcmy
castration in females
c. ó00,000+ cre ccne yecr|y
c. ¢ue:IicncL|e rec:cn: fcr :urgery
e. mcy wcnI Ic ccn:icer c|IerncIive:
L/VH-|cpcrc:ccpic c::i:Iec vcginc| hy:Ier.
f. pre-cp: |cL wcrk, ECG, che:I x-rcy, infcrmec
ccn:enI-mu:I uncer:Icnc mecn: :Ieri|iIy
g. lV, :hcve, cLccminc| prep, Fc|ey ccIh
h. pc:I-cp ccre :imi|cr Ic pc:I-cp C/:ecIicn
i. neec Ic cec| wiIh p:ychc:ccic| i::ue:


G. Reproductive cancers
1. EnccmeIric|
c. mc:I fre¢uenI|y cccurring reprccucIive ccncer
L. 5
Ih
mc:I ccmmcn cfIer :kin, |ung, Lrec:I, cnc cc|crecIc|
c. c:ympIcmcIic in ecr|y ceve|cpmenI
c. enccmeIric| ccncer: cre necr|y c||
ccencccrcincmc: {807)
-ccncer cf g|cncu|cr ce||:
e. S &S-pc:Imencpcu:c| L|eecing
f. ri:k fccIcr:: cLe:iIy, ccvcncec cge,
uncppc:ec EFI, nu||ipcriIy,
|cIe mencpcu:e >cge 52
Ccucc:icn:
g. fcunc Ly enccmeIric| Licp:y
h. Ie:I:: C8C, |iver funcIicn, renc| funcIicn, 8E,
CI, |iver cnc Lcne :ccn, C/-125
j. Ix: rccicIicn-inIrcccviIy {LrcchyIhercpy)
-exIernc| Lecm
chemc
:urgery-I/H/8SC

2. Cervicc|-
c. 3
rc
mc:I ccmmcn C/ cf reprccucIive IrccI
L. ri:k fccIcr:
-cge {50-55) -ecr|y chi|cLecring
-ncn-Ccucc:icn: -:mcking
-mu|Iip|e :exuc| pcrIner: -HFV÷Gardasil vaccine
c. Ie:Iing
-Fcp :mecr -cc|pc:ccpy
-punch Licp:y -ECC
c. :Icging:
SIcge 0-ccrcincmc in :iIu-:uperficic|
SIcge 1-invccec Ihe cervix wiIhcuI :preccing
SIcge 2-C/ hc: :precc LuI remcin: in pe|vi:
-5 yecr :urvivc| rcIe ó5-807
!(#
17
SIcge 3-C/ :precc Ic |cwer wc|| cf vcginc
-5 yecr :urvivc| rcIe c: |cw c: 20-407
SIcge 4-C/ :precc Ic ci:IcnI crgcn:
e. Ix:
SIcge 0-cryc:urgery, |c:er :urgery, LEEF/LEEIZ,
ccne Licp:y, hy:IerecIcmy
{|ccp e|ecIrc:urgicc| exci:icn prccecure)
SIcge 1-:imp|e hy:IerecIcmy
if ccncer i: mcre Ihcn 3mm-mcy wcnI
rccicc| hy:IerecIcmy wiIh remcvc| cf
|ymph ncce: in Ihe pe|vi:
SIcge 2-hy:IerecIcmy wiIh high-cc:e rccicIicn
cnc chemc
SIcge 3 & 4-IrecImenI cnc precicIive prcgnc:i:
vcrie: cn :everiIy cf :precc cnc re:pcn:e

3. Cvcricn-
c. mc:I cfIen cccur: in 5
Ih
ceccce {cge 45-ó5)
L. mc:I cccur cfIer mencpcu:e
c. ri:k fccIcr:
-ferIi|iIy crug: -ecr|y men:IrucIicn
-nu||ipcriIy -high fcI cieI
-:mcking -c|cchc|
-1
:I
chi|c cfIer cge 30
-h/c Lrec:I, cc|cn, cr enccmeIric| C/
-fcmi|y h/c Lrec:I cr cvcricn C/
c. ¡ ri:k
-u:e cf CC´: -h/c 8IL
-8SC
e. 5 yecr :urvivc| rcIe-º07 {SIcge 1), 107 {SIcge lV)
-ci:ccvery cf C/ ncI unIi| ccvcncec :Icge
f. S & S
-irregu|cr men:e: -FM Ien:icn
-mencrrhcgic -Lrec:I Iencerne::
-ecr|y mencpcu:e -cLccminc| ci:ccmfcrI
-cy:pep:ic -pe|vic pre::ure
-¦ cLccminc| girIh -urincry fre¢uency
g. in 757 cf cc:e:, C/ hcc meIc:Ic:izec Lefcre cx
-ó07 Leycnc Ihe pe|vi:
h. cx: Ircn:vcginc| U/S, |cpcrc:ccpy, |cpcrcIcmy
i. Ix:
-I/H/8SC -Icmcxifen -chemc -rccicIicn
j. C/ 125-c::ccicIec wiIh vcricu: epiIhe|ic| C/
mcy Le u:ec Ic c::e:: re:pcn:e Ic Ix
in wcmen wiIh kncwn cvcricn C/

4. Vu|vcr
c. º07 :¢ucmcu: ce|| ccrcincmc:
L. ccccunI: fcr 47 cf Gyn mc|igncncie:
c. mcre Ihcn 507 cf cc:e: cccur in
pc:Imencpcu:c| wcmen {cge ó5-70)
c. u:uc||y |ccc|izec, :|cw-grcwing, cnc mcrkec
!($
18
Ly |cIe meIc:Ic:i: Ic regicnc| |ymph ncce:
e. ri:k fccIcr:: HIN, cLe:iIy, DM
f. S & S: L|eecing, mc|cccrcu: D/C, pcin, pruriIu:
g. Ix: exci:icn, |c:er, rccicIicn, vu|vecIcmy

lV. Mc|e FeprccucIive Di:crcer:-
A. Testicular Cancer
1. Leccing ccu:e cf ccncer cecIh: in men 15-35 yr: c|c
c. high|y IrecIcL|e
L. u:uc||y curcL|e-cver º07 in c|| :Icge: ccmLinec
c. rcre|y Li|cIerc|
c. C/ mc:I ccmmcn|y cx-:c|ic Iumcr-cge 15-40
e. mc:I cfIen in Ccucc:icn:, rcre in /friccn-/mer.

2. FcIhcphy:ic|cgy
c. germinc|-:perm-prccucing ce||:-º57cf cc:e:
-2 Iype:
:emincmc:- {407)
-cccur in men |cIe 30´: Ic ecr|y 50´:
-|ccc|izec-grcw :|cw
-meIc:Ic:izec |cIer
-re:pcn:e we|| Ic rccicIicn
-5 yecr :urvivc| rcIe-º57 wiIh
:urgery cnc rccicIicn
ncn:emincmc:-ncI :en:iIive Ic rccicIicn
-cccur in men |cIe Ieen: Ic ecr|y 40´:
-neec :urgery cr chemc
-emLrycnc| ccrcincmc:
ccmmcn in men 1º-2ó yr: c|c
mcy :precc vic L|ccc:Irecm
-IercIcmc:
rcre|y cccur
cfIen mixec wiIh cIher Iumcr:
-chcricccrcincmc:
|eIhc|, fc:I :preccing
iniIic| cx cfIen in meIc:IcIic
:Icge
-257-IercIcccrcincmc:
L. :Ircmc|-hcrmcne prccucing
-inIer:IiIic| ce|| Iumcr:{cri:e frcm Leycig ce||:)
¦ cncrcgenic hcrmcne :ecreIicn:
rcre, u:uc||y Lenign
-cncrcL|c:Icmc:
rcre, u:uc||y Lenign
mcy :ecreIe e:Ircgen-feminizcIicn
gyneccmc:Iic






!(%
19
3. Ccu:e:
c. mcin|y unkncwn
L. mcy Le F/I crypIcrchici:m
-if ceve|cp: C/, 757 wi|| Le in Ihe unce:cencec
Ie:Ii: {c::cc. wiIh :emincmc:)
c. mcy Le F/I Ircumc, infecIicn

4. Ie:Iing
c. Iumcr mcrker :Iucy
-Lenign Iumcr: never e|evcIe mcrker prcIein:
-/FF cnc HCG-fcr ncn:emincmc
-in :emincmc:-¦ hCG/LDH LuI ncI /FF
if ¦ /FF, Ihink mixec Iumcr-ciff. Ix
-if Ix effecIive, mcrker: :hcu|c fc||
L. CI :ccn, U/S
c. Che:I x-rcy Ic r/c meIc:Ic:i:
c. |ymphcngicgrcphy Ic ck reIrcperiIcnec|
|ymph ncce:

5. Fhy:icc| excm
c. pc|pcIe fcr |ump
L. mcy :ee pcin|e:: en|crgemenI
c. hecvine::, crcgging :en:cIicn
c. cu|| cche in cLccmen, inguinc|

ó. Nur:ing cicgnc:i:
c. ri:k fcr :exuc| cy:funcIicn F/I ci:ec:e/:urgery
L. cy:funcIicnc|/cnIicipcIcry grieving
c. ci:IurLcnce cf Lccy imcge F/I cx cnc Ix
c. ccuIe/chrcnic pcin
e. cnxieIy F/I cx cf ccncer

7. McncgemenI
c. :perm Lcnking-Lefcre rccicIicn cnc chemc
L. chemc
c. rccicIicn-:emincmc:
-u:ec cfIer crchiecIcmy
-exIernc| Lecm Ihercpy
÷ncn:emincmc:-rccicc| |ymph ncce
ci::ecIicn :cve: :ympcIheIic gcng|ic
c. :Iem ce|| Ircn:p|cnIcIicn-u:ec wiIh chemc Ic
he|p prevenI infecIicn/cnemic
e. uni|cIerc| crchiecIcmy
f. rccicc| reIrcperiIcnec| |ymph ncce ci::ecIicn
-he|p: Ic :Icge Ihe ci:ec:e cnc recuce Iumcr

8. Fc:I-cp Iecching
c. wcIch fcr fever, chi||:, increc:ing Iencerne::,
pcin crcunc Ihe inci:icn, crcincge, cr
cehi:cence cf Ihe inci:icn
L. nc :Icir c|imLing cr hecvy |ifIing {>20 |L:)
c. re:ume ncrmc| ccIiviIie: 1 week cfIer ci:chcrge
!(&
20
c. neec: fc||cw-up :Iucie:/ISE

B. Other Reproductive Disorders
1. Hycrcce|e
c. cy:Iic mc:: wiIh :Ircw-cc|crec f|uic fcrming
crcunc Ihe Ie:Ii:
L. ci:crcer cf |ymphcIic crcincge cf :crcIum
c. nc Ix nece::cry un|e:: ccmprcmi:e: Ie:Ii:
circu|cIicn
c. c:pircIec cr :urgicc||y remcvec
e. mcy neec :urgicc| crcin cnc hc:piIc|izcIicn
f. cirecIec Ic wecr :crcIc| :uppcrI

2. SpermcIcce|e
c. :perm-ccnIcining cy:Iic mc:: cn Ihe epicicymu:
c|cng:ice Ihe Ie:Iic|e
L. u:uc||y :mc||/c:ympIcmcIic-nc inIervenIicn
c. mcy Le exci:ec Ihru :mc|| inci:icn in :crcIum

3. Vcriccce|e
c. c|u:Ier cf ci|cIec vein: pc:Iericr/cLcve Ie:Ii:
L. uni cr Li|cIerc|
c. u:uc||y c:ympIcmcIic-nc Ix
c. if pcinfu|-:urgicc||y remcvec
-inguinc| inci:icn
-mcy neec Ic e|evcIe :crcIum wiIh Icwe| when
in Lec Ic he|p wiIh crcincge
e. ccn ccu:e inferIi|iIy Ly ¦ :crcIc| IempercIure

4. ScrcIc| Ircumc
c. Icr:icn cf Ie:Ie:-Iwi:Iing cf :permcIic ccrc
-ccn:icerec c :urgicc| emergency
-S & S-pcin, N & V
L. ice, e|evcIe, cvcic hecvy |ifIing, :crcIc| :uppcrI
5. CrypIcrchici:m
c. unce:cencec Ie:Ii:
L. mcin|y c pecicIric prcL|em
-37 fu|| Ierm mc|e:
-207 mc|e premie:
c. 807 wi|| :pcnIcnecu:|y ce:cenc
c. crchiccpexy-:urgicc| p|ccemenI cf Ie:Ii:
inIc Ihe :crcIum

ó. Ccncer cf Ihe Feni:
c. |e:: Ihcn 17 cf mc|e mc|igncncie:
L. ccrcincmc i: c pcin|e::, wcrI|ike grcwIh/u|cer
c. :mc|| crec: mcy Le exci:ec cr curec wiIh rccicIicn
c. penecIcmy-pcrIic| {g|cn: cn|y) cr IcIc|
-wiIh IcIc|-neec c perinec| ureIhrcIcmy fcr urincry
crcincge


!('
21
7. Fhimc:i:
c. prepuce ccn:IricIec-ccn´I reIrccI cver g|cn:
L. Ix-circumci:icn

8. Fricpi:m
c. unccnIrc||ec, prc|cngec erecIicn
L. peni: remcin: |crge, hcrc, cnc Leccme: pcinfu|
c. ccu:e:
-neurc|cgicc| -vc:cu|cr -phcrmccc|cgicc|
c. urc|cgic emergency
e. neec Ic imprcve vencu: crcincge Ic ccrpcrc
ccvernc:c
f. Ix: Demerc|, wcrm enemc:, ccIheIer, c:pircIicn
cf ccrpcrc ccvernc:c

º. EpicicymiIi:
c. infecIicn cf Ihe epicicymi:-Ix wiIh cLx
L. mcy ccme frcm infecIicn cf Ihe prc:IcIe
c. men uncer 35 yr:, ch|cmycic IrcchcmcIi:
c. c/c pcin c|cng inguinc| ccnc| cnc vc: ceferen:
e. mcy hcve pcin cnc :we||ing cf Ihe :crcIum
f. if unIrecIec, pyuric cnc LccIeriuric mcy ceve|cp
g. cL:ce:: mcy fcrm nece::iIcIing cn crchiecIcmy

10. CrchiIi:
c. ccuIe Ie:Iicu|cr inf|cmmcIicn
L. re:u|I: frcm infecIicn cr Ircumc
c. ccu:ec Ly LccIeric frcm ureIhrc cr cIher
:curce:
c. mcy Le uni cr Li|cIerc|
e. ri:k fcr :Ieri|iIy F/I Ie:Iicu|cr cIrcphy
f. Ix: Lecre:I, :crcIc| e|evcIicn, ice, cnc|ge:ic:,
cnc cnIiLicIic:
g. mump: crchiIi:-207 cf mc|e: whc hcve mump:
cfIer puLerIy-given gcmmc g|cLu|in:
-chi|chccc vcccincIicn i: c gccc prevenIcIive
mec:ure

11. Frc:IcIiIi:
c. mcy Le LccIeric| cr cLccIeric| {mcre ccmmcn)
L. cLccIeric|-cfIer c virc| i||ne:: cr c::cc. wiIh SIl
-c|:c cc||ec prc:IcIccynic
c. LccIeric|-c::cc. wiIh ureIhriIi:
-ccmmcn Lcc guy:-E. cc|i, FrcIeu:, EnIercLccIer
cnc grcup D :IrepIccccci
-S & S-fever, chi||:, cy:uric, ureIhrc| ci:chcrge,
cnc Lcggy, Iencer prc:IcIe
c. ccn |ecc Ic inf|cmmcIicn cf Ihe L|cccer cnc
epicicymu:
e. :exuc| cy:funcIicn mcy cccur F/I pcin
f. Ix: cnIimicrcLic|:-Gecci||in, Ciprc
g. enccurcge :iIz LcIh: cnc ccmp|eIicn cf mec:
!((
22
h. u:e cnc|ge:ic: prn
i. if UIl ceve|cp:, mcy Le puI cn SepIrc
j. in:IrucIicn: cn ccIiviIie: Ic crcin prc:IcIe
-:exuc| ccIiviIie: -mc:IurLcIicn
-prc:IcIic mc::cge







01/13

!()
1
lnferIi|iIy cnc GeneIic:
Lecture 13

l. Ihe Ccup|e Experiencing lnferIi|iIy
A. Incidence
1. DefiniIicn: lncLi|iIy Ic ccnceive cnc ccrry c pregncncy
Ic vicLi|iIy cfIer cI |ec:I cne yecr cf regu|cr
:exuc| inIerccur:e wiIhcuI ccnIrccepIive u:e
c. Frimcry-never pregncnI
L. Seccnccry-hcc Leen pregncnI in Ihe pc:I

2. FrcL|em fcr 10-157 cf reprccucIive-cgec ccup|e:

3. Wcmen cver cge 35-217 chcnce cf inferIi|iIy

B. Risk Factors
1. Femc|e:
c. cLncrmc| exIernc| geniIc|:
L. cLncrmc| inIernc| reprccucIive :IrucIure:
c. cncvu|cIicn
-piIuiIcry/hypcIhc|cmu: hcrmcne ci:crcer:
-ccrenc| g|cnc ci:crcer:
c. cmencrrhec cfIer :Icpping CCF
e. ecr|y mencpcu:e
f. increc:ec prc|ccIin |eve|:
g. IuLc| mcIi|iIy recucec
h. inf|cmmcIicn wiIhin Ihe IuLe
i. IuLc| cche:icn:
j. enccmeIric|/mycmeIric| Iumcr:
k. /:hermcn´: :yncrcme-uIerine cche:icn:/:ccr:

2. Mc|e:
c. unce:cencec Ie:Ie:
L. hypc:pccic:
c. vcriccce|e
c. |cw Ie:Ic:Iercne |eve|:
e. Ie:Iicu|cr ccmcge-Ircumc, mump:
f. encccrine ci:crcer:
g. geneIic ci:crcer:
h. SIl´:
i. expc:ure Ic hczcrccu: :uL:Icnce:
j. chcnge in :perm
-:mcking, hercin, mcrijucnc, cmy| niIrcIe, LuIy|
niIrcIe, meIhc¢uc|cne
1
!)*
2

k. cecrec:e in :perm
-hypcpiIuiIcri:m
-chrcnic ci:ec:e
-gcncccIrcpic incce¢uccy
|. cL:IrucIicn cf Ihe vc: ceferen: cr epicicymi:
m. cecrec:ec |iLicc
n. impcIency

C. Components of Fertility
1. Sperm vicL|e in femc|e reprccucIive IrccI fcr up Ic
48+ hcur:
-ferIi|iIy pcIenIic|-24 hr:

2. Cvc vicL|e fcr cLcuI 24 hcur:
-cpIimum Iime fcr ferIi|izcIicn mcy Le cn|y 1-2 hcur:

3. 8|c:Iccy:I mu:I imp|cnI wiIhin 7-10 ccy: inIc Ihe
hcrmcnc||y prepcrec enccmeIrium

4. Wcmen ccccunI fcr 507 cf inferIi|iIy cc:e:
c. mc|e prcL|em:-357
L. unexp|cinec fccIcr:-157

5. /::e::menI cf femc|e inferIi|iIy
c. ccmp|eIe hi:Icry
-curcIicn cf inferIi|iIy
-pc:I cL:IeIricc| evenI:
-:exuc| hi:Icry
-review mecicc|/:urgicc| hi:Icry
-c::e:: expc:ure Ic hczcrccu: :uL:Icnce:
L. phy:icc| excm
-c::e:: encccrine :y:Iem: fcr cLncrmc|iIie:
-vi:uc|ize :eccnccry :ex chcrccIeri:Iic:
-Ie:I: Ic evc|ucIe uIeru: cnc fc||cpicn IuLe:
-Limcnuc| excm cf crgcn mcLi|iIy
-|cL Ie:I:
c. Ie:Iing
-HSG-hy:Ierc:c|pingcgrcm
-pc:IcciIc| Ie:I
Sim:-Huhner Ie:I-ck cervicc| mucu:
cL:Icin frcm inIerccur:e fcr2-3 ccy:
perfcrmec :everc| hcur: cfIer ejccu|cIicn
excmine cervicc| mucu:/:perm uncer
2
!)!
3
micrc:ccpe
-:perm immcLi|izcIicn cnIigen-cnIiLccy reccIicn
-c::e::menI cf cervicc| mucu:
:pinnLcrkeiI-Ihe fcrmcIicn cf Ihrecc Ly
mucu: frcm Ihe cervix when :precc cn
c g|c:: :|ice cnc crcwn cuI Ly c ccver
g|c::
-U/S cx cf fc||icu|cr cc||cp:e
-:erum c::cy cf p|c:mc prcge:Iercne
-hcrmcne cnc|y:i:
e:Ircgen, prcge:Iercne
FSH, LH
Ihyrcic
-Lc:c| Lccy IempercIure {88I)
Liphc:ic-¦ Iemp 12-14 ccy: Lefcre men:e:
ck Iemp Lefcre ri:ing
0.5-1.0
0
ri:e=:urge cf LH, prcge:Iercne
cvc re|ec:ec 24-3ó hr: Lefcre ¦ Iemp
inIerccur:e-3-4 ccy: pricr Ic 2-3 cfIer
-enccmeIric| Licp:y
-|cpcrc:ccpy
-U/S

ó. /::e::menI cf mc|e inferIi|iIy
c. H & F
L. :emen cnc|y:i:
-:perm cen:iIy-20-200 mi||icn ce||:/m|
-mcy vcry ccy Ic ccy-cc||ecI cver c mcnIh
-effecI: cf cervicc| mucu: cn :perm´: mcIi|iIy cnc
:urvivc|
-ck :perm´: cLi|iIy Ic peneIrcIe cn cvc

D. Infertility management
1. F:ychc:ccic|
c. mcy neec ccun:e|ing Ic cec| wiIh i::ue: cf |c::
cr incce¢uccy
L. cx cf inferIi|iIy mcy |ecc Ic prcL|em: wiIh
ccup|e´: per:cnc| re|cIicn:hip
c. ci:cu:: c|IerncIive:, i.e. cccpIicn

2. Ncnmecicc| Ihercpie:
c. wcIer :c|uL|e |uLriccnI:
L. chcnge Ic Lcxer :hcrI:
c. u:e cf ccnccm: if wcmcn hc: immunc|cgic
3
!)"
4
reccIicn Ic :perm-wi|| recuce cnIi:perm
cnIiLccy prccucIicn

3. Mecicc| Ihercpie:
c. cvu|cIcry :Iimu|cnI:
-C|cmic {c|cmiphene) :Iimu|cIe: Ihe cvcricn
fc||ic|e
-mu|IifeIc| rcIe:-|e:: Ihcn 107
-Fcr|cce| {LrcmccripIine) inhiLiI: re|ec:e cf
prc|ccIin {e|evcIec |eve|: cf prc|ccIin hcve
cn cmencrrhec effecI cn Ihe Lccy)
-8rcve||e, Mencpur {humcn mencpcu:c|
gcncccIrcpin)
exIreme|y pcIenI
re¢uire: cci|y mcniIcring
cci|y lM fcr 7-14 ccy:-fir:I hc|f cf
cyc|e
incicence cf mu|IifeIc| > 257
-HCG-mcy Le given Ic incuce cvu|cIicn:
cfIer cvcrie: :Iimu|cIec wiIh HMG
-GnFH {gcncccIrcpin-re|ec:ing hcrmcne)
u:ec wiIh hypcIhc|cmic-piIuiIcry
cy:funcIicn cr fci|ure Ic re:pcnc
Ic c|cmiphene
L. hcrmcne rep|ccemenI Ihercpy
-u:e ccnj. e:Ircgen cnc mecrcxyprcge:Iercne
c. mc|e Ix
-Ihyrcic/ccrenc| g|cnc ccrrecIicn
-cLx fcr SIl
-c|cmiphene-un:ure effecIivene::
-HCG-:Iimu|cIe: cncrcgen:-¦ :permcIcgene:i:

4. Surgicc| IrecImenI:
c. exci:e cvcricn Iumcr:
L. remcvc| cf cche:icn:
c. hy:Ierc:c|pingcgrcphy-mcy unL|cck IuLe:
c. if uIerine ccviIy Icc :mc|| Ic ccrry pregncncy,
nc mecicc| Ix cvci|cL|e-ecch :ucce::ive
pregncncy en|crge: uIeru:
e. mcy Le cL|e Ic reccn:IrucI uIeru: F/I LiccrnucIe
f. mycmecIcmy
g. chemc/IhermcccuIery Ic e|imincIe chrcnic
inf|cmmcIicn cnc infecIicn

4
!)#
5
5. FeprccucIive c|IerncIive:
c. c::i:Iec reprccucIive c|IerncIive
{higher ri:k fcr ecIcpic)
-lVF-EI-in viIrc ferIi|izcIicn-emLryc Ircn:fer
-GlFI-gcmeIe inIrcfc||cpicn Ircn:fer
*cfIer cvu|cIicn, cvc cnc :perm mcvec inIc IuLe
-ZlFI-zygcIe inIrcfc||cpicn Ircn:fer
-cvum Ircn:fer {cccyIe ccncIicn)
-emLryc cccpIicn
-inIrccyIcp|c:mic :perm injecIicn
-c::i:Iec hcIching
-IDl-IhercpeuIic ccncr in:emincIicn
L. preimp|cnIcIicn geneIic cicgnc:i:
-e|imincIe cefecI emLryc: Lefcre imp|cnIcIicn
c. :urrcgcIe mcIher:
-u:e :urrcgcIe´: cvc cnc hu:Lcnc´: :perm
-u:e mcIher´: cvc cnc hu:Lcnc´: :perm
c. cccpIicn

E. Nursing diagnoses
1. 8ccy imcge ci:IurLcnce

2. Deci:icnc| ccnf|icI

3. /|Ierec pcIIern: cf :exuc|iIy

4. Fi:k fcr :ccic| i:c|cIicn


ll. Ihe Fcmi|y Experiencing c GeneIic Di:crcer
A. Chromosomal abnormalities
1. Humcn Gencme FrcjecI-1ºº0-inIerncIicnc| effcrI Ic
mcp cnc :e¢uence Ihe geneIic mckeup cf
humcn:
c. ELSl-EIhicc|, Legc|, cnc Sccic| lmp|iccIicn:
Frcgrcm-:enIine| Ic prevenI ci:crimincIicn
cr u:e cf mcIeric| fcr eugenic purpc:e:
{:e|ecIive Lreecing)
L. iniIic| :e¢uencing ccmp|eIe 0ó/00
c. gcc|-Ic fcci|iIcIe :Iucy cf hereciIcry ci:ec:e:
cnc prcvice pcIenIic| fcr c|Iering gene:
Ic IrecI cnc/cr prevenI cccurrence


5
!)$
6
2. Chrcmc:cme:
c. kcrycIype-picIcric| cnc|y:i: cf chrcmc:cme:-
u:uc||y frcm peripherc| L|ccc LuI mcy
ccme frcm cny Lccy Ii::ue
L. cuIc:cmc| chrcmc:cme:-22 pcir:
ccnIrc| IrciI: cf Ihe Lccy
c. :ex chrcmc:cme:-pcir 23
ceIermine: :ex
ccnIrc|: :cme cIher IrciI:
XX-femc|e
XY-mc|e
c. ccmincnI gene-Iheir IrciI i: expre::ec cver
cncIher {AA or Aa)
e. rece::ive gene-cn|y expre::ec when cncIher
cncIher rece::ive i: pre:enI {aa)
f. Ierm:-c||e|e-gene IhcI ceIermine: c :pecific IrciI
ecch IrciI hc: c pcir cf c||e|e:
gencIype-geneIic mckeup cf cn incivicuc|
phencIype phencIype- -e ex xp pr re e: :: :i ic cn n c cf f g ge en ne e´ ´: : f fu un nc cI Ii ic cn n
e ei iI Ih he er r m me ec c: :u ur rc cL L| |e e c cr r c cL L: :e er rv ve ec c
hcmczygcu: hcmczygcu:- -h hc c: : i ic ce en nI Ii ic cc c| | c c| || |e e| |e e: : c cn n
e ec cc ch h c ch hr rc cm mc c: :c cm me e i in n I Ih he e : :c cm me e | |c cc cu u: :
heIrczygcu: heIrczygcu:- -2 2 c ci if ff fe er re en nI I c c| || |e e| |e e: : c cI I c c g gi iv ve en n
| |c cc cu u: :

3. /Lncrmc|iIie: in chrcmc:cmc| numLer: {cneup|cicy)
c. u:uc||y ccu:ec Ly ncnci:juncIicn
L. cccur: curing meic:i: when pcir fci|: Ic :epcrcIe
c. Iri:cmy-ccciIicnc| cuIc:cmc| chrcmc:cme
-21-Dcwn Syncrcme
-18-Ecwcrc: Syncrcme
-13-FcIcu Syncrcme
{18 & 13-pccr prcgnc:i:: ccrcicc &
re:pircIcry prcL|em:)
c. |cck cf cn cuIc:cmc| chrcmc:cme {45)=cecIh cf
emLryc
e. mc:cici:m-:cme ce||: hcve ncrmc| ¬, cIher:
mi::ing/hcving cn ccciIicnc| chrcmc:cme
f. :ex chrcmc:cme cLncrmc|iIie:
-45X-Iurner´:
juveni|e exIernc| geniIc|ic
unceve|cpec cvcrie:
:hcrI in :IcIure
weLLing cf Ihe neck
6
!)%
7
impcirec inIe||igence
mc:I cffecIec emLryc: S/8
-47XXY-K|inefe|Ier´:
pccr|y ceve|cpec :eccnccry :exuc|
chcrccIeri:Iic:
:mc|| Ie:Ie:-inferIi|e
Ic||, effemincIe
:uLncrmc| inIe||igence u:uc||y pre:enI

4. /Lncrmc|iIy cf chrcmc:cme :IrucIure
c. Ircn:|cccIicn-geneIic mcIeric| mcvec frcm
cne chrcmc:cme Ic cncIher-mcy
crecIe cn imLc|cnce cf mcIeric|:
nc prcL|em if c|| infcrmcIicn pre:enI
L. ccciIicn:/ce|eIicn:
gcmeIe prccucec hc: Icc mcny/Icc few
gene-effecI mcy Le mi|c÷:evere

B. Patterns of Inheritance
1. Mu|IifccIcric|
c. ccmLincIicn cf geneIic cnc cIher fccIcr: :uch
c: envircnmenI
i.e.: c|efI |ip/pc|cIe, neurc| IuLe cefecI:
L. mc|fcrmcIicn mcy Le mi|c Ic :evere cepencing
cn ¬ cf gene: cffecIec
c. Ienc Ic cccur in fcmi|ie:
c. :cme mc|fcrmcIicn: mcre ccmmcn in cne :ex
e. pc|ygenic, mu|IifccIcric| ci:ec:e:: ccrcncry
crIery ci:ec:e, cLe:iIy, HIN, p:ychicIric ci:crcer:

2. UnifccIcric|-Sing|e-gene ci:crcer:
c. cne gene ccnIrc|: c pcrIicu|cr IrciI, ci:crcer, cr
cefecI
L. ¬ cf unifccIcric| cLncrmc|iIie: exceec Ihe ¬ cf
chrcmc:cmc| cLncrmc|iIie:
-50-100,000 gene: in 23 chrcmc:cme:
c. cuIc:cmc| ccmincnI inheriIcnce
-cLncrmc| gene wiIh IrciI i: expre::ec even wiIh
c ncrmc| memLer cf Ihe pcir-nc ccrrier:
-muIcIicn cf Ihe gene-:pcnIcnecu:, permcnenI
chcnge
-cffecIec incivicuc| ccme: frcm c fcmi|y wiIh
genercIicn: cf Ihe ci:crcer-507 chcnce cf
hcve muIcnI c||e|e if pcrenI wc: cffecIec
7
!)&
8
8
-ex: Mcrfcn´:-ci:crcer cf ccnnecIive Ii::ue
cchcncrcp|c:ic-cwcrfi:m
pc|ycccIy|y-exIrc cigiI:
HunIingIcn ci:ec:e
c. cuIc:cmc| rece::ive inheriIcnce
-LcIh gene: in Ihe pcir ccrry Ihe cLncrmc|iIy
-heIerczygcu:-ccrrier: cf Ihe rece::ive IrciI
-ex: Icy-Scch:
:ick|e ce|| cnemic
cy:Iic fiLrc:i:
-pheny|keIcnuric
e. X-|inkec ccmincnI inheriIcnce
-cccur in mc|e: cnc heIerczygcu: femc|e:
-ex: Frcgi|e X :yncrcme-menIc| reIcrccIicn
f. X-|inkec rece::ive inheriIcnce
- -n nc c m mc c| |e e I Ic c m mc c| |e e I Ir rc cn n: :m mi i: :: :i ic cn n
- -5 50 07 7 c ch hc cn nc ce e I Ih hc cI I c cc cr rr ri ie er r m mc cI Ih he er r w wi i| || | p pc c: :: :
c cL Ln nc cr rm mc c| | g ge en ne e I Ic c e ec cc ch h : :c cn n w wh hc c
w wi i| || | L Le e c cf ff fe ec cI Ie ec c { {I Ih he er re ef fc cr re e, , 5 50 07 7 c cf f
m mc c| |e e: : w wi i| || | L Le e u un nc cf ff fe ec cI Ie ec c) )
- -5 50 07 7 c ch hc cn nc ce e I Ih hc cI I c cc cr rr ri ie er r m mc cI Ih he er r w wi i| || | p pc c: :: :
c cL Ln nc cr rm mc c| | g ge en ne e I Ic c e ec cc ch h c cc cu ug gh hI Ie er r
w wh hc c w wi i| || | L Le ec cc cm me e c cc cr rr ri ie er r: :
- -f fc cr r c cc cu ug gh hI Ie er r: : I Ic c L Le e c cf ff fe ec cI Ie ec c, , f fc cI Ih he er r m mu u: :I I
L Le e c cf ff fe ec cI Ie ec c c cn nc c m mc cI Ih he er r L Le e c c c cc cr rr ri ie er r
c cr r c cf ff fe ec cI Ie ec c c c: : w we e| || |
-ex: hemcphi|ic-cefecI in c|cIIing fccIcr Vlllc
Duchenne mu:cu|cr cy:Ircphy
C. Testing
1. FrencIc| Ie:Iing-:ee Lcck|eI
c. MS/FF
L. CVS/cmniccenIe:i:
c. L|ccc Ie:I: fcr:
-Icy-Scch: -Sick|e Ce|| /nemic
-Ihc|c::emic -Cy:Iic FiLrc:i:
c. U/S-feIc:ccpy

2. NewLcrn Ie:Iing-:ee Lcck|eI
c. FKU-menIc| reIcrccIicn
L. ccngeniIc| hypcIhyrcici:m-reIcrccIicn
c. gc|ccIc:emic-cehycrcIicn/:ep:i:
c. mcp|e :yrup urine ci:ec:e-neurc|cgic
e. hcmccy:Iinuric-neurc|cgic
f. ccngeniIc| ccrenc| hyperp|c:ic-e|ecIrc|yIe:
!)'


9
9
g. LicIinicc:e ceficiency-neurc|cgic

D. Clinical management
1. GeneIic ccun:e|ing
c. uncer:Icnc fccI: cLcuI Ihe ci:ec:e-ccu:e
cnc IrecImenI
L. uncer:Icnc hcw hereciIy ccnIriLuIe:
c. uncer:Icnc rcIe cf recurrence
c. cwcre cf cpIicn:
e. ccur:e cf ccIicn
f. u:e cf ccping mechcni:m:/:uppcrI :y:Iem:

2. Nur:ing rc|e:
c. icenIify ri:k fccIcr:
L. icenIify phy:icc|/ceve|cpmenIc| cLncrmc|iIie:
c. c::e:: neec fcr referrc|
c. prepcre fcr geneIic ccun:e|ing
e. ccrrecI mi:ccncepIicn:
f. cemcn:IrcIe :uppcrI cnc :en:iIiviIy
g. exp|cin Iypicc| cuIccme:







01/13
!)(

Sponsor Documents

Or use your account on DocShare.tips

Hide

Forgot your password?

Or register your new account on DocShare.tips

Hide

Lost your password? Please enter your email address. You will receive a link to create a new password.

Back to log-in

Close