The Royal Pentagon Review Specialist, Inc.

Maternity Nursing
Human Sexuality
a. Concepts
1. A persons sexuality encompasses the complex behaviors, attitudes and
emotions and preferences that is related to sexual self and eroticism
2. Sex is basic and dynamic aspect of life
3. During reproductive years, the nurse performs as resource person on human
sexuality
! " ## y.o. " age o$ repro%uctivity C&'
(. )e$initions relate% to sexuality
*en%er I%entity sense of feminity and masculinity developed !age 3 or 2 "# y.o.
Role I%entity attitudes, behaviours and attitudes that differentiate roles
Sex biologic male or female status. sometimes referred to as specific sexual behavior
such as sexual intercourse
Sexuality " behavior of being a girl or boy and is identity sub$ect to a lifelong dynamic
change
II. Sexual +natomy an% Physiology
a. ,emale Repro%uctive System
1. -xternal " .ulva/ Pu%en%a
a. Mons pu(is/ veneris mountain of venus, a pad of fatty tissues that lies
over the symphysis pubis covered by s%in and at puberty covered by pubic
hair that serves as a cushion or protection to the symphysis pubis
Stages o$ Pu(ic Hair )evelopment 0Tool 1se%2 Tanner3s Scale/ Sexual Maturity Rating4
Stage 1 &re adolescence
no pubic hair, fine body hair
Stage 2 'ccurs bet. 11 12 y.o
sparse, long, slightly pigmented and curly that develop along
labia
Stage 3 'ccurs bet. 12 13 y.o.
hairs become dar%er and curlier develops along pubis
symphysis
Stage # 13 1# y.o.
hair ssumes normal appearance of an adult but is not so thic%
and does not appear to the inner aspect of the upper thigh
Stage ( Sexual )aturity
assumes the normal appearance of an adult, appears at the
inner aspect of thigh
b. 5a(ia Ma6ora large lips latin, longitudinal fold from perenium to pubis
symphysis
c. 5a(ia Minora a%a *ymphae, soft and thin longitudinal fold created bet+een
labia ma$ora
Clitoris ,%ey-, pea shaped erectile tissue composed of sensitive
nerve endings. sight of sexual arousal in females
,ourchet tapers posteriorly of the labia ma$ora. Site for episotomy
1
" sensitive to manipulation, torn during pregnancy
d. .esti(ule almond shaped area that contains the hymen, vaginal orifice and
batholenes gland
1rinary Meatus small opening of urethra/ opening for urination
S7ene3s *lan% a%a &araurethral 0land, 2 small mucus secreting
glands for
lubrication
Hymen membranous tissue that covers the vaginal orifice
.aginal 8ri$ice external opening of the vagina
&artholene3s *lan% paravaginal gland, secretes al%aline
substance, neutrali1es acidity of the vagina
o )o%erleins &acillus responsible for vaginal acidity
o Parumculae Mysti$ormes healing of a hymen
e. Perenium muscular structure in bet+een lo+er vagina and anus
2. 2nternal
a. .agina female organ for ovulation, passage+ay of menstruation, 3 inches
4 15 cm long containing rugae
o 6ugae permits considerable stretching +ithouit tearing
during delivery 789
b. 1terus hollo+ muscular organ, varies in si1e, +eight and shape, organ of
menstruation
Si9e 2 1 x 2 x 3
Shape 2 pear shaped, pregnant " ovoid
:eight 2 1terine involution C&'
Non pregnant 2 !; " <; g
Preganant 2 ;;; g
#
th
stage o$ 5a(or 2 ;;; g
=
n%
wee7 a$ter o$ )elivery 2 !;; g
>
r%
wee7s a$ter %elivery 2 >;; g
! " < :ee7s a$ter %elivery2 !; " <; g
:hree &arts of ;terus
,un%us upper cylindrical layer
Corpus/ &o%y upper triangular layer
Cervix lo+er cylindrical layer
Isthmus lo+er uterine segment during pregnancy
)uscular 7omposition< 3 main )uscles ma%ing possible expansion in all direction
a. -n%ometrium muscle layer for menses
o =ines the non"pregnant uterus
o >olumes the non pregnant uterus
o )eci%ua slouching off of endometrium during menstruation
o -n%ometriosis
?ctopic ?ndometrium
7ommon site is ovaries
&roliferation of abnormal gro+th of lining of outer part
&ersistent dysmenorrhea, lo+ bac% pain
Dx ?xam< biopsy,laparoscopy
:x< =upron @luprolideA inhibits BSC D =C
:x< Dana1ol @DanacrineA D'7
1. 2nhibits ovulation
2
2. stop menstruation
(. Myometrium
o &o+er of labor
o Smooth muscles is considered to be =2>2*0 =20A:;6?
@muscles of delivery, capable of closingA of the body
o =argest portion of the uterus
c. Peremetrium
o &rotects the entire uterus
c. 8varies
2 female sex gland
almond shape
Bxn< 'vulation,production of 2 hormones@ estrogen and progesteroneA
%. ,allopian Tu(e
2 3 inches long that serves as a passage+ay of the sperm from the
uterus to the ampulla or the passage+ay of the mature ovum or fertili1ed
ovum from the ampulla to the uterus
# significant segments
o In$un%i(ulum most distal part, trumpet shape, has fimbrae
o +mpulla outer 3
rd
or 2
nd
half, site of fertili1ation, common site for
ectopic preg.
o Isthmus site for sterili1ation, site for 8:=
o Interstitial most dangerous site for ectopic pregnancy
(. Male Repro%uctive System
. -xternal
Penis
:he male organ of copulation and urination
7ontains of a body or shaft consisting of 3 cylindrical layers and erectile
tissues
o 2 corpora cavernosa
o 1 corpus spongiosum
At the tip is the most sensitive area comparable to clitoris E glans penis
Scrotum
&ouch hanging belo+ the pendulous penis, +ith medial septum deviding
into 2 sacs each containing testes
6eFuires 2 degrees celcius for continuous spermatogenesis
7ooling mechanism of testes
=. Internal
The Process o$ Spermatogenesis
Testes
@G55 coiled seminiferous tubulesA

epi%i%ymis
@site of maturation of sperm H mA

.as )e$erens
@conduit path+ay of spermA

Seminal .esicle
@secreted< $ructose form of glucose, nutritative value
3
Prostaglan%in< causes reverse contraction of uterusA

-6aculatory )uct
@conduit of semesnA

Prostate *lan%
@release al%aline substancesA

Cowpers *lan%
@release al%aline substanceA

1rethra
Cypothalamus 0*6C

A&0

,SH maturation of sperm
5H testosterone production
5ey%ig Cells releases testosterone
Male ? $emale Homologues
Male ,emale
&enile 0lans
&enile Shaft
:estes
&rostate
7o+pers 0lands
Scrotum
7litoris
7litoral shaft
'varies
S%enes gland
8artholins 0land
=abia )a$ora
III. &asic @nowle%ge on *enetics an% 8(stetrics
1. )N+ Deoxyribonucleic Acid carries genetic code
2. Chromosomes threadli%e structure of hereditary material %no+n as the D*A
3. *ormal amount of e$aculated sperm > " ! cc/ teaspoon
4. 'vum is capable of being fertili1ed +ithin =# " >< hours after ovulation.
!. Sperm #A " B= %ays via(ility
6. 6eproductive cells divide by the process of M-I8SIS @haploid numberA
Spermatogenesis process of maturation of sperm
8ogenesis process of maturation of ovum
o 35 +ee%s A'0 H million immature ovum
o ! birth 1 million immature oocytes
o ! puberty 355 #55 immature oocytes
o ! 13 y/o 355 #55 mature oocytes
o ! 23 y/o 145 245 mature ovum
o ! 33 y/o H5 1H5 mature ovum
o ! 3H y/o 2# 12# mature ovum
o !#H y/o # mature ovum
*ametogenesis process of formation of t+o haploid into diploid
B. +ge o$ repro%uctivity " ! " ## y/o chil%(earing age " =; " >! y/o
High ris7 CA ? D>! y.o. :ith Ris7 A " =;E >; " >!
4
A. Menstruation
Menstrual Cycle beginning of menstruation to the beginning of the next
menstruation
Average menstrual cycle =A %ays
Average menstrual period ! %ays
*ormal blood loss !; cc/ F cup accompanie% (y ,I&RIN85GSIS prevents
clot formation
6elated terminologies
o Menarche 1
st
menstruation
o )ysmenorrhea painful menstruation
o Metrorrhagia bleeding in bet+een menstruation
o Menorrhagia ?xcessive bleeding during menstruation
o +menorrhea absence of menstruation
o Menopause cessation of menstruation @Average Age" (1 y.o.A
To$u has isoflavone estrogen of plant that mimics the estrogen
+ith a +oman
H. ,unctions o$ -strogen an% Progestin
-STR8*-N hormone of +oman
o &rimary function
6esponsible for the development of secondary characteristics in
females
inhibit production of BSC
o 'ther function
Cypertrophy of the myometrium
Spinnbar%eit and Berning &attern @8illings )ethodA
Ductile structure of the breast
'steoblastic bone activity @causes increased in heightA
?arly closure of the epiphysis of the bone
Sodium retention
2ncreased sexual desire
6esponsible for vaginal lubrication
PR8*-ST-R8N- Cormone of the mother
o &rimary function prepares the endometrium for implantation ma%ing it
thic% and tortous
o Secondary Bunction inhibit uterine contractibility
o 'thers
2nhibit =C @hormone of ovulationA production
02 motility
&ermeability of %idneys to lactose and dextrose causing I 1 sugar
in urine
)ammary gland development
88:
)ood s+ings
;. Menstrual Cycle
# phases of menstrual cycle
. Proli$erative
=. Secretory
>. Ischemic
5
#. Menses
1. 'n the initial phase of menstruation, the estrogen level is , this level stimulates the
hypothalamus to release *nRH/ ,SHR,
2. 0n6C/ BSC6B stimulates the anterior pituitary gland to release ,SH
,SH ,unction
o Stimulate ovaries to release estrogen
o Bacilitate the gro+th of primary follicle to become
*R++,I+N ,855IC- structure that secretes large amount of
estrogen that contain mature ovum
3. &roliferative &hase @estrogenA
Bollicular &hase responsible for the variation and irregularity of mense
&ostmenstrual &eriod after menstruation
&reovulatory &hase happen before menstruation
4. 13
th
day of menstruation, estrogen level is P-+@ +hile progesterone is , these
stimulates the hypothalamus to release 0n6C/ =C6B
5. *nRH/ 5HR, stimulates the Anterior &ituitary 0land to release 5H
Bunctions of =C
o Stimulates the release of progesterone
o Cormone for ovulation
6. 1#
th
day estrogen level is +hile progesterone level is
S/S
o 6upture of the graafian follicle " '>;=A:2'*
o Mittelschsmer9 slight abdominal pain lo+er right
Fuadrant
7. 1(
th
day, after ovulation day, graafian follicle starts to degenerate, estrogen level ,
progesterone , causing degeneration of the graafian follicle becoming yello+insh
%no+n as C8RP1S 51T-1M secretes large amount of progesterone
8. Secretory &hase
=utheal &hase 0progesterone4
&ostovulatory phase
&remenstrual &hase
9. 2#
th
day Corpus +l(icans @+hitishA corpus luteum degenerates and becomes +hite
10. 24
th
day if no sperm united the ovum, the uterine begins to slough off to have the next
menstruation
*ote<
if there is no fertili1ation, corpus luteum continues functioning
'varian 7ycle from primary follicle corpus albicans
Stages<
o 1 ( days menses
o H 1# proliferative
o 1( 2H secretory
o 2J 24 ischemic
11. Stages of Cuman Sexual 6esponse
2nitial 6esponse<
>AS'7'*0?S:2'* constriction of blood vessels
)K':'*2A increased muscle tension
-xcitement Phase
muscle tension, moderate >S
6
erotic stimuli causing sexual tension, may last from minutes to hours
Plateu Phase
and sustained tension near orgasm
may last 35 sec 35 minutes
8rgasm
2nvoluntary release of sexual tension accompanied by physiologic and
psychologic release,
immeasurable pea% of experience 2 3 seconds
Resolution
6eturn to normal state
>S return to normal
R-,R+CT8RG P-RI8) only period present in male, +herein he cannot restimulated for
about 15 1( minutes
I.. :on%ers o$ ,ertili9ation
a. ,ertili9ation
1. Phonones song of sperm
2. Capacitation ability of sperm to release proteolytic en1yme and penetrate the
ovum
(. Stages o$ ,etal *rowth an% )evelopment
. Pre -m(ryonic Stage
I. Iygote fertili1ed ovum @3 # days travel, # days floatingAL from fertili1ation
II. Morula mulberry"li%ed ball containing 1H (5 cells
III. &lastocyst enlarging cell forming a cavity that later becomes the embryo covered by
thropoblast +hich later becomes the placenta and membrane
IV. Implantation J 15 days after fertili1ation
:hropoblast covering of blastocyst that become placenta
S/Sx of 2mplantation Slight pain, Slight >aginal Spotting
3 &rocesses
o +pposition
o +%hesion
o Invasion
=. -m(ryonic Stage
Iygote fertili1ation to 1# days
-m(ryo 1(
th
2 mos/ 4 +ee%s
,etus 2 mos to birth
c. )eci%ua thic%ened endometrium, latin +ord for ,falling off-
1. &asalis located directly under the fetus +here placenta developed
2. Caspularis encapsulates the fetus
3. .era remaining portion of and endometrium
d. Chorionic .illi 15 11 +ee%s
1. Chorionic .illi Sampling 0C.S4 removal of tissue from the fetal postion of the
developing placenta
Bor genetic screening
Betal limb defects, missing digits of toes
e. Cytothropho(last outer layer, 5+N*H+N3S 5+G-R, protect the fetus against syphilis
@2# +ee%s/ H monthsA
f. Synsitiotropho(last syncitial layer responsible for hormone production
1. +mnion inner most layer 2. Chorion
I. 1m(ilical cor% 0,unisA +hitish gray @(5 H5 cmA
7
Short abruptio placenta, uterine inversion
=ong cord prolapse, cord coil
3 vessels @A>AA Artery >ein Artery
:harton3s Jelly protects the umbilical cord
II. +mniotic $lui% bag of +ater clear color, musty/mousy odor
Mith crystalli1ed forming pattern, slightly al%aline
(55" 1555 cc *ormal
o 'ligohydramnios %idney malformation
o Cydramnios 02: , :?B/ :?A
Bunctions
o 7ushion the fetus against sudden blo+ or trauma
o )aintains temperature
o Bacilitate muscus%eletal development
o &revents cord compression
o Celps in development process
)iagnostic Test $or +mniotic ,lui% +mniocentesis
&urpose< obtain sample of amniotic fluid by inserting a needle hrough the abdomen into
the amniotic sac
Bluid is tested for<
0enetic screening
Determination of fetal maturity primarily by evaluating factors indicative of lung
maturity
Done +ith empty bladder
7omplication
L )ost common side effect < 2*B?7:2'*
L =ate < pre term labor
L ?arly < spontaneous abortion
2ndication for Amniocentesis<
L ?arly in &regnancy Advance )aternal Age
L =ater in &regnancy Diabetic )others
" do+n syndrome
" neural tube defect, spina befida
=/S ratio < 2<1 @=ecitin/ SpingomyelinA
Definitive test E &hosphatiglycerol< &0 I best Ans+er
0reenish )econium Stains @Betal DistressA
Kello+ish $aundice, hyperbilirubinemia
7loudy 2nfection
)ost 2mportant 7onsideration *eedle insertion site
Amnioscopy direct examination through intact fetal membrane via ultrasound
Bern :est a test determining if bag of +ater has rupture or not
*itra1ine &aper :est differentiate amniotic fluid and urine 8lue geen I rupture of bag
of C2'
2. Chorion outermost layer
a. Placenta ANA Secundines chorionic >illi and basalis
&anca%e in latin
(55 grams in +eight
1( 24 cotyledons
8
1( 25 cm in diameter and 2 3 cm in depth
Bunctions
o 6espiratory 52 7'2 exchange via simple diffusion
o 02: glucose transport via facilitated diffusion
o ?xcretory via 2 arteries, carries unoxygenated blood
then detoxify by maternal liver
o 7irculatory fetoplacental circulation by S?=?7:2>?
'S)'S2S
o ?ndocrine
C70 primary maintain corpus luteum/
secondary basis of pregnancy test
Cuman &lacental =actogen a%a
Somatomammothrophin
6esponsible for the development of
mammary gland
Diabetogenic ?ffect insulin antagonist
6elaxin softening of maternal $oints and bones
o Serves as protective barrier against some microorganism
7an pass< C2> 7)> 6ubella
&2*'7K:'S2S transport of virus
&regnancy 2HH 244 days/ 3J #2 +ee%s
,-T+5 ST+*-2 ,etal *rowth an% )evelopment
,irst Trimester 2 Perio% o$ organogenesis, most critical perio%
,irst Month
,HT, CNS )evelops, *IT an% Respi Tract remains as single tu(e
Differentiation of &rimary 0erm =ayer
?ndoderm
o :hyroid responsible for basal metabolism
o :hymus immunity
o =iver
o 02:
o =inings of ;pper 02 :ract
)esoderm
o Ceart
o )usculos%eletal
o 6eproductive 'rgan
o Nidney
?ctoderm
o 8rain
o 7*S
o S%in
o ( senses
o Cair, nails
o Anus
o )outh
Secon% Month
=ife span of corpus luteum ends
All vital organs are formed
9
&lacenta is developed
Sex organ is developed
)econium is present
Thir% Month
&lacenta is complete
Nidneys are functional
Betus begins to s+allo+ amniotic fluid
8uds of mil% appear
Sex is distinguishable
BC: audible via dopples ! 15 12 +ee%s
Terratogens any drug or irradiation, the exposure to +hich may cause damage to the fetus
)R1*S
o Streptomycin anti :8 @FuinineA damage to the 4th cranial nerve poor learning
and deafness/ ototoxic
o Tetracycline stoning the tooth enamel, inhibits long bone gro+th
o .itamin @ hemolysis, destruction of 687, $aundice, hyperbilirubenemia
o Io%i%es enlargement of thyroid and goiter
o Thali%omi%es anti"emetics Amelia or &ocomelia absence of distal part of
extremities
o Steroi%s cleft lip or palate and even abortion
o 5ithium congenital maformation
+5C8H85 =8M, fetal alcohol syndrome @ characteri1ed by microcephalyA
SM8@IN* =8M
C+,,-IN- =8M
C8CC+IN- =8M, abruptio placenta
T8RCH group of infections that can cross the placenta or ascend through the birth canal
and adversely effect fetal gro+th
o :oxoplasmosis cat lovers
o 'thers " Cepa A8, C2>, Syphillis
o 6ubella 7CD,
6ubella :iter * ! 1<15 or E immunity to rubella E notify doctor
6ubella vaccine after delivery for 3 mos. *o pregnancy for 3 mos.
o 7ytomegalo virus
o Cerpes Simplex virus
Secon% Trimester 2 continuous growth an% %evelopment 0$ocus lengh o$ $etus4
,ourth Month
=anugo begins to appear
8uds of permanent teeth appear
BC: audible via Betuscope ! 14 25 +ee%s
,i$th Month
9uic%ening < 1
st
fetal movement &rimi< 14 25, *ulli " 1H " 14
=anugo covers the body
BC: audible via stethoscope or +/out instrument
Actively s+allo+ amniotic fluid
Betus < 1G 2( cm
Sixth Month
S%in is red and +rin%led
>ernix caseosa covers the s%in
10
?yelids open
?xhibits startle reflex
>
r%
Trimester 2 perio% o$ most rapi% growth an% %evelopment ,ocus2 weight
Seventh Month
Surfactant development
)ale< the testes begins to descent into the scrotal sac
Bemale < clitoris is prominent and labia ma$ora are small doesnt cover the minora
-ight Month
Active moro reflex
=anugo begins to disappear
Sub F fats deposits, steady +eight gain, nails to fingers
Ninth Month
=anugos and vernix caseosa is evident in body fold
8irth position assumed
Amniotic fluid some+hat decrease
Sole of the foot has fe+ creases
Tenth Month
8one ossification in the fetal s%ull
>ernix caseosa is evident in body
PHGSI858*IC +)+PT+TI8N T8 PR-*N+NCG
Systemic Changes
. Car%iovascular System
blood volume 35 (5O
1(55 cc. additional (55 cc for multiple pregnancy
plasma volume
cardiac +or%load easy fatigability/ slight ventricular hypertrophy
?pistaxis due to hyperemia of nasal membrane
&alpitation due to S*S stimulation
Physiologic +nemia/ pseu%oanemia in pregnacy
o *ormal >alue
Cct < 32 #2O
Cgb< 15.( 1# g/dl
o 7riteria
1
st
D 3
rd
:rimester < Cct L 33O Cgb L 11 g/dl
2
nd
:rimester < Cct L 32O Cgb L 15.( g/dl
o &athologic Anemia
Iron )e$$iciency +nemia is the most common hematologic disorder. 2t
affects 25O of pregnant +omen
Assesment reveals<
&allor
Slo+ed capillary refill E *ormal E 2 3 sec
7oncave fingernails @late sign of progressive anemiaA clubbing
E chronic tissue hypoxia
constipation
*ursing care
*utritional instruction
o Source of iron
Nang%ong
11
=iver E best source due to B?662D2* 7ontent
6ed and lean meat
0reen =eafy >egetables
&arenteral 2ron @2mferonA
o P tract 2)
o incorrect causes hematoma
o best given 1 hour before meals @causes 02 irritationA
o )aybe given 2 hours after meal @results to poor
absorptionA
0iven +ith orange $uice to absorption
'ral 2ron Supplements @ferrous sulfate 5.3 g 3 x a dayA
)onitor for hemorrhage
Alert
2ron from red meat is better absorbed iron from other sources
2ron is better absorbed +hen ta%en +ith foods high in >itamin 7
such as orange $uice
Cigher iron inta%e is recommended since circulating blood
volume is increased and heme is reFuired from production of
687s
-%ema
o 2mpeded venous return due to the gravid uterus
o *ursing 2ntervention
?levate legs above the hips level
.aricosities
o Mear support stoc%ings
o ?levate legs
.ulvar .aricosities
o D/t pressure of gravid uterus
o Side lying +ith pillo+ under the hips
o )odified %nee chest position
Throm(ophle(itis
o &resence of thrombus in inflamed blood vessels
o I Comans Sign pain on the calf upon dorsiflexion
o )edical )anagement
Anticoagulant/ C?&A62*
Does not cross the placental barrier
)onitor A&::
Antidote< &6':A)2*? S;=BA:?
*o aspirin
Mil7 5eg/ Plagmasia +l(a )olens
o Shiny +hite legs due to stretching of s%in D hyperfibrinogenemia
o *ursing intervention
7hec% dorsalis pedis pulse @compare bothA
*ever massage
Assess for Comans sign only once
=. Respiratory System
Shortness of 8reath d/t gravid uterus
*ursing intervention< Side"lying lateral expansion of the lungs
12
>. *astrointestinal System
Nausea an% vomiting
Morning Sic7ness
o Due to C70 levels
o 7rac%ers 35 min before arising
o A) 7arb diet 35 mins
o &) small freFuent meal
Constipation
o Due to &6'0?S:?6'*? E fluid reabsorption due to 02: motility
o *ursing intervention
Bluid
Biber
?xercise
,latulence
o Due to increased progesterone
o Avoid gas forming foods
Heart(urn 0pyrosis4
o 6eflux of stomach content into esophagus
o *ursing 2ntervention
Small freFuent meals
Sips of mil%
Avoid fatty and spicy foods
&roper body mechanics
o Maist +bove Acid
o Maist &elo+ 8ase
Hemorrhoi%s
o Due to gravid uterus
o Cot sit1 bath for comfort
Ptyalism
o salivation
o )outh+ashes to relieve
#. 1rinary System
*ormal E I 1 sugar due to &rogesterone via 8?*?D27:S :?S:
Birst :rimester " BreFuency
Second :rimester " normal
:hird :rimester " BreFuency
!. Muscolos7eletal
7alcium sources
o )il% " 7a & 1 pint/ day or 3 # servings/ day
o 7heese, Kogurt, Cead of Bish, Sardines, Anchovies, 8rocolli
5or%osis
o &ride of &regnacy
:a%%ling *ait
o A+%+ard gait +hile +al%ing due to relaxin
o &rone to accidental falls
Mear lo+ healed shoes
5eg Cramps
o 7a & 2mbalance during pregnancy
o =umbo"sacral nerves by pressure of gravid uterus during labor
13
o 'ver sex
o Dorsiflex the foot affected
o 3"# servings/ # cups/day sa mil%, sardines, dilis
+. 5ocal Chnages
.agina
o Cha%wic73s Sign " bluish discoloration
o 5eu7orrhea " +hitish gray, moderate in amount, mousy odor
Cervix
o *oo%el3s Sign " change in consistency of uterus
o 8perculum mucus plug to seal bacteria/ progesterone
1terus
o Hegar3s Sign " change in consistency
>agina 7had+ic%s
7ervix 0oodels
;terus Cegars
Problems related to the changes of Vaginal Environment
a. .aginitis K +.8C+)8
:richomonas >aginalis
o Blagellated protox1oan, =oves ala%aline environment
Signs and Symptoms
o 0reenish, cream, colored, frothy, irritably itchy, foul smelling vaginal discharge
o >aginal edema
)anagement
o Drug of choice< )?:6'*2DAP'=? @BlagylA
Antiproto1oan
7arcinogenic
*ot given in 1
st
trimester
vaginal douche as substitue
o 1 Ft Mater E 1 tbsp +hite vinegar
o :reat partner as +ell to prevent reinfection
o *o alcohol due to antabuse effect
b. Moniliasis K CH--S-
7andida Albicans
:ransvaginal transfer in fetus 'ral :rush
Signs and Symptoms
o Mhite 7heeseli%e patches that adheres to the +alls of the vagina
)anagement
o Antifungals
)ycostatin
7ontrima1ole 7anisten
0entian >iolet
. +(%ominal Changes
Striae 0ravidarum
o Due to destruction of the subcutaneous tissue by the enlarge uterus
=. S7in Changes
14
)elasma/ 7hloasma
o Mhite light bro+n pigmentation related to melanocytes
=inea *igra
o 8ro+n pin%ish line from symphysis pubis to umbilicus
>. &reast Changes
Due to hormonal changes
7hange in color and si1e of nipple and areola
&recolostrum H +ee%s
7olustrum 3
rd
trimester
Supine +ith pillo+ under the bac%
4. 8varies " rest perio%, no ovulation
!. Signs an% Symptoms o$ Pregnancy
Presumptive
S/sx felt and observed by the
mother but does not confirm
the diagnosis of pregnancy
Pro(a(le
Signs observed by
the members of the
health care team
Positive
;ndeniable signs confirmed
by the use of instrument
Birst
trimester
&reast changes
1rinary changes
,atigue
+menorrhea
Morning sic%ness
-nlarge uterus
*oodels sign
Chad+ic%s sign
Hegars sign
-levated 88:
Positive C70
1ltrasound ?vidence
Second
:rimester
Chloasma
5inea *igra
Increase S%in &igmentation
Striae gravidarum
'uic%ening
&allotement
-nlarge Abdomen
&raxton Cic%s
7ontraction

etal Ceart :one
etal movement
etal outline
etal parts palpable
C&' Cancer o$ the &reast Lua%rant &
)amography 3( and above 1/ year
8allotement bouncing of the fetus
may be present in uterine myoma
:ransvaginal ;ltrasound empty bladder
Abdoiminal ulrasound full bladder
Placenta *ra%ing System
0rade 5 immature
0rade 1 slightly mature
0rade 2 moderately mature
0rade 3 fully mature
Mhat is depositedQ calcium
.I. Psychological +%aptation to Pregnancy " Reva Ru(in
,irst Trimester
*o tangible s/sx
Beeling of surprise
Ambivalence
Denial of pregnancy maladaptation
Developmental :as%< Accept biological facts of pregnancy
15
Cealth :eaching< 8ody changes of pregnancy and *utrition
Secon% Trimester
:angible s/sx
)other identifies fetus as separate entity due to Fuic%ening
Bantasy
Developmental :as%< Accept gro+ing fetus as a baby to nurture
Cealth :eaching< 0ro+th and development of fetus
Thir% Trimester
)other has personally identifies +ith the appearance of the baby
Developmental :as%< &repare child birth and parenting the child
Cealth :eaching< responsible parenthood, prepare babys layette, =ama1e 7lass
Address )others fear let she hear the BC:
.II. Pre " Natal .isit
&asic Consi%eration
. ,reLuency o$ .isit
1 J
th
mos. once a month
4 G
th
mos. t+ice per month
15
th
month every +ee%
=. Personal )ata
Home &ase% Mother3s Recor%/ H&MR determines high ris% pregnancy
Pseu%ocyesis false pregnancy appearance of presumptive D probable signs
Coma%e Syn%rome psycosomatic disorder, father experience +hat the mother
goes through
>. )iagnosis o$ Pregnancy
;rine ?xam C70 #5 155
th
day. pea% H5 J5
th
day
?=2SA beta subunits of C70 is detected as early as J 15
th
day
62A beta subunits of C70 is detected as early as 4
th
day
Come &regnancy Nit
#. &aseline )ata
6oll 'ver :est test of pre"eclampsia by the use of 8&
Meight monitoring
*ormal Meight 0ain
1
st
:rimester E 1.( 3 lbs 1 lb/ mo
2
nd
:rimester E 15 12 lbs # lbs/mo
3
rd
:rimester E 15 12 lbs # lbs/mo
)inimum allo+able +eight gain 25 2( lbs
'ptimal +eight gain 2( 3( lbs
!. 8(stetrical )ata
a. *ravi%a no. of pregnancy
b. Para no. of viable pregnancy
16
.ia(ility the ability of the fetus to live outside the uterus at the earliest possible gestational age
1 abortion 1 3G
:C
Mee%, 1 miscarriage, 1 still birth, 1 2
nd
mo. preg
1 pregnancy 3
rd
mos. 0#&2 0# :1 &1 A1 =1
02&5 02 :5 &5 A1 =5
c. Important -stimates
1. *ageles 6ule
;se to determine expected date of delivery
Ran )ar IG months IJ days
Apr Dec "3 months IJ days I 1 year
=. Mc)onal%3s Rule
Determines age of gestation in +ee%s
Bundic Ceight x J/4 E A'0 in +ee%s
>. &artholomew3s Rule
Determines age of gestations
o 3 mos above pubis symphysis
o ( mos level of umbilicus
o G mos belo+ xiphoid process
o 15 mos level of 4
th
mos
#. Haases Rule
Determines the length of fetus in cm.
1
st
half sFuare each month
2
nd
half month x (
%. Tetanus Immuni9ation
::1 anytime or early during pregnancy
::2 1 month after ::1 3 years protection
::3 H months after ::2 ( years of protection
::# 1 year after ::3 15 years of protection
::( 1 year after ::# lifetime protection
!. Physical -xaminations
a. )anger Signs o$ Pregnancy
Chills D Bever
Cerebral Disturbances
+bdominal &ain epigastric pain auro of impending convulsion
&oardli%e Abdomen Abruptio placenta
&lurred >ission pre eclampsia
&leeding abortion/ ectopic pregnancy 1
st
trimester
C )ole/ 2ncompetent 7ervix 2
nd
trimester
&lacental Anomalies 3
rd
:rimester
&& S
S+elling
Scotoma spots in the eye
Sudden gush of fluid &6') premature rupture of membrane
17
6. Pelvic -xamination
&elvic examination or 2? empty bladder, precaution
1st visit 7had+ic%s, 0oodles sign, etc.
&osition < dorsal recumbent, lithotomy
&ap smear done 1st visit
7ytological exam determine presence of cancer cells.
6esult <
o 7lass 2 normal
o 7lass 22 A cytology +ithout evidence of malignancy
8 suggestive of inflammation
o 7lass 222 cytology suggestive of malignancy
o 7lass 2> cytology suggestive og malignancy
o 7lass > conclusive for malignancy
)ost common cancer report organ < cervical cancer
)ost common site for pap smear external 'S of cervix @sFuamocolumnar tissueA
7ommon site of cervical cancer. maternal speculum @openA
Stages o$ cervical cancer
o 5 carcinoma in situ
o 1 7a strictly confined to cervix
o 2 from cervix extends to the vagina
o 3 pelvic metastasis
o # affectation to bladder D rectum
B. 5eopol%s Maneuver
Purpose2 Done to determine the attitude, fetal presentation, lie, presenting part, degree of
descent an estimate of the si1e, and no. of fetuses
&rocedure
1. 1
st
maneuver
o place patient in supine position +ith %nees slightly flexed. &ut to+el under head and
right hip. Mith both hands palpate uppe#r abdomen and fundus. Assess si1e, shape,
movement and firmness of the part
o determine the presenting parts<
2. 2
nd
maneuver
o +ith both hands moving do+n, identify the bac% of the fetus +here the ball of the
stethoscope is placed to determine BC:.
o PR o$ mother 2 uterine sou$$lM " MHR
o $un%ic sou$$lM " ,HR
3. 3
rd
maneuver
o using the right hand, grasp the symphysis pubis part using the thumb and fingers.
o Assess +hether the presenting part is engaged in the pelvis.
o AlertT 2f the head is engaged it +ill not be movable
4. #
th
maneuver
o the examiner changes the position by facing the patients feet. Mith t+o hands, assess
the descent of the presenting part by locating the cephalic prominence or bro+.
o Mhen the bro+ is on the same side as the bac%, the head is extended. Mhen the bro+
is on the same side as the small parts, the head 4is flexed and vertex presenting.
+ttitu%e relationship of fetus to one another.
,ull ,lexion +hen the chin touches the chest
A. +ssessment o$ ,etal :ellK(eing
18
a. )aily $etal Movement Counting 0),MC4
Done starting 2J
th
+ee%
7onsideration
fetal sleep +a%e pattern
maternal food inta%e
drug"nicotine use
environmental stimuli
maternal dose
Car%i$$ count to ; metho% " one method currently available
o begin at the same time each day @usually in the morning after brea%fast A and
count each fetal movement, noting ho+ long it ta%es to count 15 fetal
movements @B)sA
o expected findings 15 movements in 1hrs or less
o +arning signs 15"12 movements in 1hr or less
more than 1hr to reach 15 movements
less than 15 movements in 12hrs
longer time to reach 15 B)s than on previous days.
movements are becoming +ea%er, less vigorous
movement alarm signal U3 B)s in 12hrs
o +arning signs should be reported to healthcare provider immediately. often
reFuire further testing. ?g. *on stress test @*S:A, biophysical profile @8&&A
(. Nonstress Test
o to determine the response of the fetal heart rate to the stress to activity.
o 2ndications pregnancies at ris% for
o placental insufficiency
o &ostmaturity
pregnancy induced hypertension @&2CA, diabetes
+arning signs noted during DB)7
maternal history of smo%ing, inadeFuate nutrition
o &rocedure <
Done +ithin 35mins +herein the mother is in semifo+lers position. external
monitor is applied to document fetal activity. mother activates the ,mar% button-
on the electronic monitor +hen she feels fetal movement. Attach external
noninvasive fetal monitors
tocotransducer over fundus to detect uterine contractions and fetal movements
@B)sA
ultrasound transducer over abdominal site +here most distinct fetal heart
sounds are detected
monitor until at least 2 B)s are detected in 25mins.
o if no B) after #5mins provide +omen +ith a light snac% or gently stimulate fetus through
abdomen
o 2f no B) after 1hr further testing may be indicated, such as a 7S:
o 6esult <
*oncreative *onstress *ot 0ood
6eactive 6esponse is 6eal 0ood
o 2nterpretation of results
6eactive result real good
baseline BC6 bet+een traction beteen 125 and 1H5 beats per min.
at least t+o accelerations of the BC6 of at least 1( beats per min., lasting
at least 1(secs in a 15 to 25 min period as a result of B)
19
good variability normal irregularity of cardiac rhythm representing a
balanced interaction bet+een the parasympathetic @V BC6A and
sympathetic @S BC6A nervous system. noted as an uneven line on the
rhythm strip
result indicates a healthy fetus +ith an intact nervous system
o Nonreactive result " not goo%
stated criteria for a reative result are not met
could be indicative of a compromised fetus reFuires further evaluation
+ith another *S:, biophysical profile, @8&&A or contraction stress test
@7S:A
H. Health Teachings
o do nutritional assessment
o daily food inta%e
o determine habit
o if V folic acid lead to spina bifida/open neural tube defect
o HI*H RIS@ M8TH-RS
pregnant teenagers poor compliance to health regimen
extremes in +t under+t eg. ?lite models over+t eg. D)/C&*
lo+ social economic status. 6efer to 'SMD
vegetarian mothers because V inta%e of vit 812 @7yanocobalaminA formation
of folic acid @cell D*A D 6*A formationA
types <
strict vegetarian prone to develop anemia
lacto vegetarian mil%
lacto"ovo vegetarian mil% D egg
a. Recommen%e% Nutrient ReLuirement that Increases )uring Pregnancy
Nutrients ReLuirements ,oo% sources
Calories
?ssential to supply energy for
metabolic rate
;tili1ation of nutrients
&rotein sparing so it can
be used for <
o gro+th of fetus
o development of
structures reFuires
for pregnancy
including placenta,
amniotic fluid, tissue
gro+th
355 calories/day above the
prepregnancy daily reFuirement
to maintain ideal body +eight
and meet energy reFuirement of
activity level
begin S in 2
nd
:rimester
use +t"gain pattern as an
indication of adeFuacy of
calories inta%e
failure to meet caloric
reFuirements can lead to
%etosis as fat D protein are
used for energy, %etosis has
been associated +ith fetal
damage.
*on pregnant< 2255 calories
&regnant< 2(55 calories
2255I(55 ! lactationE2J55 cal
7aloric S should reflect
foods of high nutrient value
such as protein, complex
carbohydrates @+hole grains,
vegetables, fruitsA
variety of foods representing
food sources for the nutrients
reFuired during pregnancy
no more than 35O fat
*a 3gms/day eat in
moderation
7C'* x #N 7al
7C' x #N 7al
Bats x GN 7al
Protein
?ssential for
fetal tissue gro+th
H5mg/day or an S of 15O above
daily reFuirements for age
group
&rotein S should reflect
=ean meat, poultry, fish
20
maternal tissue gro+th
including uterus and
breasts.
Development of essential
pregnancy structures
Bormation of 687 and
plasma proteins
2nadeFuate protein inta%e has
been associated +ith onset of
pregnancy induced
hypertension @&2CA
Adolescents have a higher
protein reFuirement than mature
+omen since adolescents must
supply protein for their o+n
gro+th as +ell as protein to
meet the pregnancy
reFuirement
?ggs, cheese, mil%
Dried beans, lentils, nuts
Mhole grains
>egetarians must ta%e note of
the amino acid content of
7C'* foods consumed to
ensure ingestion of sufficient
Fuantities of all amino acids
CalciumKPhosphorous
?ssential for
0ro+th and development
of fetal s%eleton and tooth
buds
)aintenance of
minerali1ation of maternal
bones and teeth
7urrent research is
demonstrating an
association bet+een
adeFuate calcium inta%e
and the prevention of
pregnancy induced
hypertension
7alcium S of
1255mg/day representing
an S of (5O above pre
pregnancy daily
reFuirement
1H55mg/day is
recommended for
adolescent
15mcg/day of vitamin D is
reFuired since it enhances
absorption of both calcium
and phosphorous
7alcium S should reflect
Dairy products, mil%, yogurt,
ice cream, cheese, egg yol%
Mhole grain, tofu
0reen leafy vegetables
7anned salmon D sardines
+ith bones
7a fortified foods such as
orange $uice
>itamin D sources fortified
mil%, margarine, egg yol%,
butter, liver, seafood
Iron
?ssential for
?xpansion of blood volume D
687 formation
?stablishment of fetal iron
stores for first fe+ months of life
*on &regnat<1(mg/day
&regnant < 35mg/day
" representing a doubling
of the prepregnant daily
reFuirement
8egin supplementation at
35mg/day in second
trimester, since diet alone is
unable to meet pregnancy
reFuirement
H5 125mg/day along +ith
copper and 1inc
supplementation for +omen
+ho have lo+ Cgb values
prior to pregnancy or +ho
have iron deficiency anemia
J5mg/day of vitamin 7
+hich enhances iron
absortion
o 2nadeFuate iron inta%e
results in maternal
effects anemia,
depletion of iron stores,
V energy and appetite,
2ron S should reflect
liver, red meat, fish, poultry,
eggs
enriched, +hole grain
cereals D breads
dar% green leafy
vegetables, legumes
nuts, dries fruits
vitamin 7 sources< citrus
fruits D $uices, stra+berries,
cantaloupe, tomatoes,
green peppers, broccoli or
cabbage, potatoes
iron form food sources is
more readily absorbed
+hen served +ith foods
high in vit 7
21
cardiac stress especially
during labor D birth
o fetal effects V availability
of oxygen thereby
affecting fetal gro+th
iron deficiency anemia is
the most common
nutritional disorder of
pregnancy
Iinc
?ssential for
the formation of en1ymes
maybe be important in the
prevention of congenital
malformation of the fetus
1( g/day representing an S of
3mg/day over prepregnant daily
reFuirement
Pinc S should reflect
liver, meats
shell fish
grains, legumes, nuts
,olic aci%s, $olacin, $olate
?ssential for
Bormation of 687 D
prevention of anemia
D*A synthesis D cell
formation. may play a role
in the prevention of neural
tube defects @spina bifidaA,
abortion, abruption
placenta
#55mcg/day representing an S
of more than 2x the daily
prepregnant reFuirement
355mcg/day supplement for
+omen +ith lo+ folate levels or
dietary deficiency
S should reflect
=iver. Nidney, lean bee%,
veal
Dar%, green leafy
vegetables, broccoli,
asparagus, articho%es,
legumes
Mhole grains, preanuts
Additional reFuirements
Minerals
2odine
)agnesium
selenium
1J(mcg/day
325mg/day
H(mcg/day
S reFuirements of pregnancy
can easily be met +ith a
balanced diet that meets the
reFuirement for calories and
includes food sources high in
the other nutrients needed
during pregnancy
>itamins
?
:hiamine
6iboflavin
&yridoxine @8HA
812
*iacin
15mg/day
1.(mg/day
1.Hmg/day
2.2mg/day
2.2mcg/day
1Jmg/day
(. Sexual +ctivity
Principles o$ sex in Pregnancy
o Should be done in moderation
o Should be done in a private place
o :hat the mother should be placed in a comfortable position
o 2t must be avoided H +ee%s prior to ?DD
o Avoid blo+ing of air during cunnilingus
Contrain%ication in sex2
o vaginal spotting 1
st
tri
o incompetent cervix 2
nd
tri
o placenta previa, abruption placenta 3
rd
tri
o pre"term labor 6< prostaglandin oxytocin contraction
22
o &6') infection
Changes in sexual appetite %uring pregnancy2
o 1
st
tri " V
o 2
nd
tri " S
o 3
rd
tri " V
c. -xercise
strengthen muscle to be used during the delivery process
:al7ing best form of exercise
SLuatting strengthen perineum D Scirculation to the perineum @raise the buttoc%s before
head to prevent postural hypotensionA
Tailor sitting same purpose +ith sFuatting
@egel exercise strengthen pubococcygeal muscle
+(%ominal exercise muscle of the abdomen @ done as if blo+ing a candleA
Shoul%er circling exercise strengthen muscle of the chest
Pelvic roc7ing exercise or pelvic tilt relieve lo+ bac% pain D maintain good posture
@arching bac% for 3 secA
Principles o$ exercise
o must be done in moderation
o must be individuali1ed
%. Chil%(irth Preparation
8verall goal2 :o prepare patents physically D psychologically +hile promoting +ellness
behavior that can be used by parents D family thus, helping them achieved a satisfying D
en$oying childbirth experiences.
Psychological
o &ra%ley Metho% Dr. 6obert 8radley discoverer
advocated active participation of husband during labor D delivery to serve as
coach, based on ,imitation of nature-
Beatures<
dar%ened room
Fuiet D calm environment
relaxation techniFue
close eyes
o *rantly )ic7 Rea% Metho%
fear can lead to tension +hile tension can lead to pain. @brea% cycle by
removing the fear"by abdominal breathing exercises D relaxation techniFueA
Psychosexual
o @it9inger Metho% Dr. Shiella Nit1inger
pregnancy, labor D birth D the care of the ne+born is an important turning point
in a +omans life cycle. ,flo+ing +ith contractions rather than struggle +ith
contractions-
Psychoprophylaxis
o 5ama9e Dr. Berdinand =ama1e
&revention of pain thru mind D reFuires discipline, conditioning D concentration
+ith the husbands help.
Beatures<
conscious relaxation
23
cleansing breathe inhaling thru nose D exhaling thru mouth
effleurage gentle circular massage
over abdomen to relieve pain
imaging
)i$$erent metho%s o$ %elivery
o (irthing chain semi"fo+lers mother
o (athing (e% dorsal recumbent
o sLuatting position relieve on bac% pain D maintain good posture
o 5e(oyer3s metho%
features <
dar%ly lighted room
Fuiet D calm environment
room temp.
soft music
o &irth un%er water
IN. INTR+P+RT+5 N8T-S
+. +%mitting the la(oring Mother
&ersonal data
8aseline data
'bstetrical data
&hysical exams
&elvic exams
&. &asic 7nowle%ge in intrapartum
Theories o$ the 8nset o$ 5a(or
o 1terine Stretch Theory any hollo+ organ once stretched to its maximum potential
+ill al+ays contract D expel its content
o 8xytocin Theory released by &&0, contraction effect
o Prostaglan%in Theory stimulation by Arachidonic acid, causes contraction of uterus
o +ging Placenta #2+%s @lifespanA by 3H+%s placenta begins to degenerate causes
contraction
o Progesterone %eprivation theory " V level of progesterone +ill facilitate contraction of
the uterus
The # Ps o$ 5a(or
o Passenger fetus
fetal head
is the largest presenting part
W of its length
8ones H bones @sphenoid, temporal, ethmoidA Brontal, occipital D 2
parietal bones
Sutures/intermem(ranous spaces allo+s molding
Mol%ing the overlapping of the sutures of the s%ull to permit passage
of the head to the pelvis
o Sagittal (ones connect to parietal bones
o Cororontal (ones connect to parietal D frontal bones
o 5am(%oi%al (ones connect to parietal D occipital bones
,ontanels
o H fontanels only 2 palpable
anterior $ontanel/&regma
diamond in shape
24
3cm x #cm si1e
close 12"14 mos post delivery
S (cm hydrocephalus
posterior $ontanel/lam(%a
triangular in shape
1 x 1cm si1e
close 2"3mos post delivery
Measurements o$ $etal hea% 2
o transverse %iameter
&iKparietal " largest transverse diameter" G.2(cm
&iKtemporal " 4cm
&iKmastoi% " smallest transverse diameter " Jcm
o +P %iameter
Su(occipito(regmatic complete flexion
8ccipito$rontal partial flexion " 12cm
8ccipitotemporal largest A& diameter. hyperextended
@13.(cmA
Su(mento(rgmatic " face presentation. poor flexio
o Passageway vagina D pelvis
Pelvis
# main pelvic types
o gynecoi% round, +ide, deeper, most suitable for pregnancy
o an%roi% heart shape ,male pelvis- anterior pointed post part
shallo+
o +nthropoi% oval ,ape"li%e pelvis, A& +ider transverse narro+
o Platypelloi% flat transverse oval A& narro+ transverse +ider
c/s for delivery
&roblem <
o mother +ho encounter accident
o V #G-
o V 14y/o 6< pelvis not achieve its full pelvic gro+th
&ones o$ pelvis
#(ones
o = hips @2 innominate bonesA
3parts of 2 innominate bones
Ileum lateral/side of hips
o 2liac crest flaring superior border that
forms prominence of hips. common site
for bone marro+ aspiration
Ischium inferior portion
o 2schial tuberosities of the area +here +e
o Sit. basis in getting external measurement
of pelvis
Pu(is anterior portion
o Symphysis pubis $unction in bet+een
o sacrum posterior portion
Sacral prominence basis internal measurement of
pelvis
25
o coccyx " # small bones that compresses during vaginal
delivery
universal precaution in measurement of pelvis is to empty bladder first
2mportant )easurements
o )iagonal Con6ugate
measure bet+een Sacral promontory D inferior margin of
the symphysis pubis
)easurement 11.("12.( cm
8asis in getting the true con$ugate.
o True Con6ugate/Con6ugate .era
)easure bet+een the anterior surface of the sacral
promontory D superior margin of the symphysis pubis.
)easurement< 11.5 cm
Diagonal con$ugate< 1.( cm E true con$ugate.
o 8(stetrical Con6ugate
smallest A& diameter of the pelvis measuring 15cm or
more.
o Tu(eroischii )iameter
transverse diameter of the pelvic outlet.
Approx by a fist" 4cm D above.
o Power
the forces acting to expel the fetus D placenta
involuntary contractions
voluntary bearing do+n efforts
characteristics< +ave li%e
timing< freFuency, duration, intensity
myometrium po+er of labor
o Psyche/person
psychological stress exist +hen the mother is fighting the labor experience.
cultural interpretation preparation
past experience
support system
PreKeminent signs o$ la(or
o &reeminent Signs
lightening
settling of the presenting part into the pelvis brim @shooting pain
radiating to the legs, urinary freFuencyA
primi" early 2 +ee%s prior to ?DD
engagement settling of presenting part into pelvic inlet @not signs of
laborA
&raxton Hic7s Contractions painless irregular contractions
Increase +ctivity o$ the Mother *esting
2nstinct @mgt< save energyA
epinephrine production @hormone that S the activity of the motherA
Ripening o$ the cervix butter softness
)ecrease in weight 1.("3 lbs.
&loo%y show
pin%ish vaginal discharge @blood I leucorrhea I operculum E pin% in
colorA
26
Rupture o$ mem(ranes
chec% BC:
2? chec% for cord prolapse
after several hrs chec% temp.
o Premature Rupture o$ Mem(ranes 0PR8M4
contraction drop in intensity even though very painful
contraction drop in freFuency
uterus tense D/or contracting bet+een contractions
abdominal palpitations
Nursing Care2
administer analgesics @morphineA
attempt manual rotation for 6'& or ='&
bear do+n +ith contractions
adeFuate hydration
sedation as ordered
cesarean delivery may be reFuired, especially if fetal distress is noted
o Cor% Prolapse
a complication +hen the umbilical cord falls or is +ashed through the cervix
into the vagina.
)anger Signs2
&6')
&resenting part has not yet engaged
Betal distress
&rotruding cord from vagina cerebral palsy S ( mins., irreversible
brain damage mgt< 7S
Nursing Care
&ositioning %nee chest or trendelenberg, place +et sterile gau1e 6< to
ma%e it slippery
'bserve for fetal distress
&rovide emotional support
&repare for cesarean section
)i$$erence &etween True an% ,alse Contraction
:rue Balse
*o in intensity
&ain confined in the abdomen
&ain is relieved by +al%ing
*o cervical changes

:here is an in intensity
&ain begins ! the lo+er bac%
to abdomen
&ain is intensified by +al%ing
7ervical effacement @thinning of
the cervix, measured thru OA D
dilatation @+idening of the
cervix, measurement thru cmA
Xbest/ma$or sign of true labor
)uration o$ 5a(or
o Primipara 1# hrs but not more than 125 hrs
o Multipara 4 hrs but not more than 1# hrs
Nursing Interventions in -ach Stage o$ 5a(or
o ,irst Stage< onset of contractions to full dilatation D effacement of the cervix
o stage of effacement D dilatation
27
5atent Phase2
Assessment<
o Dilatations 5"3 cm
o BreFuency ("15 mins
o Duration 25"#5 mins
o 2ntensity mild
o )other is excited, apprehensive but can communicate
*ursing 7are<
o ?ncourage +al%ing < shortens 1
st
stage of labor
o ?ncourage to void F 2"3 hrs < full bladder inhibits uterine
contraction
o breathing @chest breathing techniFueA
+ctive Phase2
Assessment<
o Dilatations #"4 cm
o BreFuency F 3"( mins lasting for 35"H5 secs
o Duration 35"H5 secs
o 2ntensity moderate
Nursing Care2
o M edications have meds ready
o + ssessment include< v/s, cervical dilatation D effacement,
fetal monitor, etc
o ) ry lips oral care @ointmentA, dry linens
o 8reathing abdominal breathing
Transitional Phase2
+ssessment2
o Dilatations 4"15cm
o BreFuency F 2"3 mins contractions
o Duration #("G5 sec
o 2ntensity strong
o )ood of mother suddenly change accompanied by
hyperesthesia @hypersensitivity of mother to touchA of the s%in
Management
o sacral pressure, cold compress
Nursing care2
o T tires
o I inform of progress @to relieve emotional supportA
o R restless support her breathing techniFue
o - encourage D praise
o ) discomfort
o Pelvic -xams
-$$acement ? )ilatation
Station relationship of the presenting part to the ischial spine
o ( " "1 E the presenting part is above the ischial spine
o ?ngagement 15 E the presenting part is in line +ith the ischial
spine
o @"A fetus is floating
o @IA belo+ the ischial spine
Presentation
o the relationship of the long axis of the fetus to the long axis of
the mother.
28
o spine relationship of the spine of the mother D the spine of the
fetus
o :+o :ypes
5ongitu%inal 5ie 0Parallel4/ .ertical
Cephalic +hen the fetus is completely flexed
o >ertex
o Bace
o 8ro+
o 7hin
&reech
o Complete (reech thigh rest on
abdomen +hile legs rest on thigh
o Incomplete (reech
,ran7 thigh resting on abdomen
+hile legs extend to the head
,ootling
@neeling
Transverse 5ie 0Perpen%icular4/Hori9ontal lie
Position relationship of the fetal presenting part
to specific Fuadrant of the mothers pelvis.
o R8+/58+
left occipito anterior
most common D favorable position
o R8T/58T left occipito transverse
o R8P/58P left occipito posterior
o 5/R" side of maternal pelvis
o Mi%%le presenting part
o R8P/R8T most common malposition
o R8P/58P most painful mgt< pelvis
sFuatting
o &reech sacro
place the stethoscope above the
umbilicus
o Chin mentum
o Shoul%er acromnio dorso
Monitoring the contractions ? $etal heart tone
spread the finger lightly over the fundus to monitor the contraction
Increment/Cresen%ro " beginning of contraction until it increases
+pex/+cne height of contraction
)ecrement/)ecresen%ro from height of contraction until it decreases
)uration beginning of contraction to the end of the same contraction
Interval from end of contraction to the beginning of the next
contraction
29
,reLuency from the beginning of 1 contraction to the beginning of
next contraction
2ntensity strength of contraction
if contract blood vessel constricts. the fetus +ill get the oxygen on the
placenta reserve +hich is capable of giving oxygen to the fetus up to
1min.
Duration of placenta to the fetus should not exceed 1min.
Significance During active phase, if S to 1min should notify the A)D
S 8&. V BC: < best time to get 8' D BC: $ust after a contraction
N1RSIN* C8NSI)-R+TI8N )1RIN* TH- ,IRST ST+*- 8, 5+&8R
8ath is necessary
)onitor >S especially 8&
o Same 8& E rest
o ?levated E notify the physician
*&'
o &revent aspiration chemical pneuminitis
?nema @per hospital policyA
o &urpose
7leanse the bo+el
&revent infection
o 12 14 inches normal length of tube
o 14 inches optimal length
o =ateral sims position
o 2f there is contraction clump the tube
o 2f there is resistance slo+ly remove
o 8efore and after administration< chec% BC: @125 1H5A and contractions
?ncourage mother to void
&erennial preparation @rule of JA
6est on left side lying position
o &revent supine vena cava syndrome or supine hypotension
2f membrane doesnt rupture amniotomy
,-T+5 TR+SHIN* " hyperactivity of fetus due to lac% of 'xygen
Bor &ain
o Systemic analgesic
)-M-R85 0Meperi%ine HCl4
*arcotic and antispasmonic
Dont give during latent phase
0iven ! H"4 cm dilated
:8, < Respiratory %epression
*arcan @*aloxone, nalorfan, nallineA
o Antidote for toxicity
o 2n$ected on the baby
-pi%ural +nesthesia
:8, < Hypotension
&rehydrate the client to prevent hypotension
2n case of Cypotension
o ?levate leg
o Bast Drip 2>
30
S-C8N) ST+*- 8, 5+&8R 0,-T+5 ST+*-4
7omplete dilatation and effacement to birth
7ro+ning occurs
&62)2 transfer to D6 ! 15 cm dilatation
);=:2 transfer to D6 ! J 4 cm dilatation
&osition in lithotomy both legs at the same time
&15*IN* 8, P-R-NI1M surest sign of delivery initiation
&A*: D 8='M 8reathing, fetal pushing should be done on an open glottis
Respiratory al7alosis
o Due to incorrect breathing
o Cyperventilation
o S/sx
66
=ightheadedness
:ingling sensation
7arpopedal spasm
7ircumoral numbness
-pisiotomy
&revent laceration
Miden the vaginal canal
Shortens the 2
nd
stage of labor
2 types
o M-)I+N
=ess bleeding
=ess pain
?asy repair
&ossible urethroanal fistula ma$or disadvantage
o M-)I85+T-R+5
)ore bleeding
)ore pain
Card to repair and slo+ healing
Ironing the Perenium prevent laceration
Mechanism o$ 5a(or 0-) ,IR- -R-4
-ngagement
)escent
,lexion
Internal Rotation
-xtension
-xternal Rotation
-xpulsion
P-5.IS
> Parts
o Inlet A& diameter narro+, transverse +ider
o Cavity bet+een inner and outer
o 8utlet A& diameter +ider, transverse narro+
5IN-+ T-RMIN+5-S
31
Nursing Care
M8)I,I-) RI*-N3S M+N-1.-R
o Done by supporting the perenium +ith a to+el during delivery
o Bacilitates complete flexion
o Avoids laceration
Birst intervention< Support the head and suction secretion
Do not mil% the cord, +ait for pulsation to stop before cutting
o )il%ing may cause too much blood going to the baby that may cause cardiac overload
Mhen there is still birth, let the mother see the baby to accept the finality of death
THIR) ST+*- 8, 5+&8R 0P5+C-NT+5 ST+*-4
3 15 minutes after child birth
1
st
sign Bundus rises C+5@IN3S SI*N
Signs o$ Placental Separation
o Bundus becomes globular and rises cal7in3s sign
o =engthening of the cord
o Sudden gush of blood
&R+NT " +N)R-:3S M+N-1.-R
o slo+ly pulling the cord and +ind at the clamp
o rapidly may cause uterine inversion
Types Placental )elivery
SH15TI @ShinyA
o Brom center to the edges
o &resenting fetal side
)1NC+N @)irtyA
o Borm edges to center
o &resenting the maternal side
Nursing Consi%erations %uring placental %elivery
7hec% placental completeness
o Should be (55 g
7hec% Bundus )assage if 8oggy
8& 7hec%
)ethergine, methylergonovine mallate @2)A
'xytocin @2>A if methergine is not present
7hec% perenium for lacerations
Assist in episioraphy
>aginoplasty/ >aginal =andscape >irgin again
,81RT ST+*- 8, 5+&8R 0Recovery Stage4
Birst 1 2 hours after delivery of placenta
)aternal observation body system stabili1e
o 1
st
hour F1( min 2
nd
hour " F 35 min
&lacement of fundus
o 2n bet+een umbilicus and pubis symphysis
o 7hec% bladder, assist in voiding, )ay lead to uterine atony hemorrhage
=ochia
&erineum
o 7hec% R--)+
32
R edness
- dema
- cchymosis
) ischarge
+ pproximation
o Bully saturated 35 #5 cc
o :eighing " cc O gram Common &oar% 'uestion
Nursing Consi%eration %uring Recovery
Blat on bed to prevent di11iness
2f +ith 7hills give blan%et due to dehydration
0ive nourishment @progression of mealA
o 7lear liFuids gatorade, ginger $uice, gelatins
o Bull liFuid mil%, ice cream
o Soft diet
o 6egular diet
7hec% >S/ &ain
&ychic State
&on%ing interaction bet+een mother and ne+born
o Strict 2# hours +ith mother
o &artial morning +ith mother, night nursery
C8MP5IC+TI8NS 8, 5+&8R
)ystocia
Difficult labor related to mechanical factor
&rimary cause is ;terine 2nertia
1terine Inertia
Sluggishness of contraction
:ypes
o Primary/ Hypertonic
2ntense contraction resulting to ineffective pushing
)anagement < Sedation
o Secon%ary/ Hypotonic
Slo+, irregular contraction resulting to ineffective pushing
)anagement < 'xytocin Augmentation
Prolonge% 5a(or
L 25 C for primi
L 1# C for multi
proper pushing should be encourage if inappropriate<
o may cause fetal distress
o caput succedaneum
o cephalhematoma
o maternal exhaustion
monitor contractions and BC:
Precipitate 5a(or
labor less than 3 hours
causes excessive laceration leading to profuse bleeding hypovolemic shoc%
s/sx of hypovolemic shoc% HGP8 T+CHG T+CHG
33
o HGP8tension
o T+CHGpnea
o T+CHGcardia
o 7old clammy s%in
o Management
)odified trendelenburg
Bast Drip 2>
Inversion o$ 1terus
Situation in +hich uterus is turn inside out due to<
o Short cord
o Currying of placental delivery
o 2neffective fundal push
7ause profuse bleeding hypovolemic
Hysterectomy
1terine Rupture
6upture of uterus
Cause% (y
o &revious classical 7S
o >ery large baby
o 2mproper use of oxytocin
S/sx
o Sudden pain
o &rofuse bleeding
&repare fore :AC8S'
Physiologic Retraction Ring boundary bet+een upper and lo+er uterine segment
&an%l3sPathologic Ring suprapubic depression sign of uterine rupture
+mniotic ,lui%/ Placental -m(olism
Anaphylactic syndrome of pregnancy
Situation in +hich placental fragment and amniotic fluid enters maternal circulation
S/Sx
o Dyspnea
o 7hest &ain
o Brothy Sputum
o ?nd Stage D27
&repare for 7&6, Suction and emergency etc
Trial 5a(or
Betal head measurement E measurement of pelvis
H hours labor allo+ance given to mother
monitor BC: and contractions
Preterm 5a(or
labor after 25 +ee%s and before 3J +ee%s
Tria% signs
o &remature conditions every 15 minuets
o ?ffacement of H5 45O
o Dilatation of 2 3 cm
Home Management
34
o 786
o Avoid Sex
o ?mpty bladder
o Drin% 3 # 0lasses of C2'
Bull bladder inhibit contraction
Hospital Management
o 2f 7ervix 7lose 0Criteria2 cervix is close% i$ it is = " > cm %ilate% only4
2 3 cm dilated, pregnancy can be saved
Tocolytic Therapy
Gutupar 0Rito%ine HCl4
o Side effect maternal 8& U G5/H5
o 7hec% 2mpt. &resence of crac%les
&rethine 0ter(utaline4 &ricanyl
o )8C
o Side effect< sustained tachycardia
o Antidote< propanolol/ inderal
Mg S8#
o I$ cervix is %ilate% 0 D #cm4
0ive steroid %examethasone
&romote surfactant maturation
2mmediately cut the cord after delivery to prevent $aundice/
hyperbilirubinemia
P8STP+RT+5 P-RI8)
Puerperium (
th
stage of labor, 1
st
H +ee%s post partum
7haracteri1e by involution
Involution " return to the normal stage of reproductive organ after pregnancy
Return to Normal Healing
Physiologic Changes
Systemic Changes
Car%iovascular System
o plasma volume
o sudden in blood volume
o elevated M87s up to 35, 555 mm3
o hyperfibrinogenemia
o orthostatic hypertension can be possible
o early ambulation prevents thrombos formation
steps in ambulation
Blat
Semifo+lers
Bo+lers +ith dangling
Mal% +ith assist
*enital Tract
o ,un%us
goes do+n 1 finger breadth a day
15
th
day non palpable behind the symphysis pubis
Su(involution
delayed healing of uterus containing Fuarters or clots of blood
35
may lead to puerperal sepsis
Management 2 DD7
o +$ter Pains
After birth pains
)ultiparous breastfeeding most common to develop
&osition E prone
7old compress
)efenamic acid
o 5ochia
7omponents
8lood
Deciduas
M87
)icroorg
3 types
Ru(ra 1 3 days, musty, moderate amount
Serosa # 15
th
day, pin% or bro+n
+l(a 15 21th day, crYme +hite, amount
1rinary Tract
o 1rinary ,reLuency due to urinary retention +ith overflo+
o )ysuria
Damage to trigone of the bladder
;rine collection for culture and sensitivity
Stimulate navel to urinate
&alpate bladder
6unning +ater listening
&ull pubic hair " stimulate cremasteric reflex
Colon
o Constipation
Due to *&'
8earing do+n may cause pain
Perenium
o &ain relieved by sims position
o 7old compress 1
st
2# hours if there is pain at episioraphy follo+ed by +arm
-M8TI8N+5 S1PP8RT
. Ta7ing phase
1
st
3 days
dependent phase
passive, cant ma%e decision
tells about childbirth experience
focus on< Cygiene
=. Ta7ing Hol%
# J
th
day
dependent to independent phase
active, decides actively
focus< care of ne+born
36
health teaching < Bamily planning
>. 5etting *o
2nterdependent phase
6edefines goals, ne+ roles as parents
)ay extend till the child gro+s
Post Partum &lues
#
th
(
th
days
over+helming feeling of depression, inability of sleep and lac% of appetite
(5 45O incidence rate
cause by sudden hormaonal change progesterone suddenly decreases
allo+ crying< therapeutic
may lead to postpartum psychosis/ depression
Postpartal Complications
Hemorrhage
bleeding +ithin 2# hours postpartum
-arly Pospartal Hemorrhage
. 1terine +tony
boggy fundus
profuse bleeding
interventions
o massage the uterus
o cold compress
o modified trendelenburg
o fast drip 2>
o breastfeeding to release oxytocin
=. 5aceration
+ell contracted uterus +ith profuse bleeding
assess perenium for laceration
%egrees o$ laceration
o 1
st
degree vaginal s%in and mucus membrane
o 2
nd
degree 1
st
degree I muscles
o 3
rd
degree 2
nd
degree I external sphincter of rectum
o #
th
degree 3
rd
degree I mucus membrane of rectum
>. Hematoma
bluish discoloration of sub9 tissues of vagina or perenium
candidates
o delivery of very large babies
o pudendal bloc%
o excessive manipulation due to excessive 2?
intervention
o cold compress 15 25 min then allo+ 35 minutes rest period for 2# h
#. )IC " %isseminate% intravascular coagulation
7onsumption of pregnancy @othertermA
37
Bailure to coagulate
8leeding in the eyes, ears, nose
'o1ing blood
Seen in cases +ith
o Abruptio placenta
o Still birth / 2;BD
Management
o 8lood transfusion of cryoprecipitate or fresh fro1en plasma
o hysterectomy
5ate Postpartum Hemorrhage
Retaine% placental $ragments
manual extraction of fragments is done
uterine massage
)?C except $or cases o$
o Placenta +creta umusual attachment of the placenta to the myometrium
o Placenta Increta deeper attachment of placemat to the myometrium
o Placenta Percreta invasion of placenta to the perimetrium
7andidates of these disorders are
0rand multiparous
&ost 7S
All these reFuires hysterectomy
In$ection
Sources
o ?ndogenous from normal flora of the body
o ?xogenous from the health care team
)ost common Anaerobic Streptococci
Management
o Supportive care
o Bluid inta%e
o :S8 if there is fever/ cold compress I paracetamol may also be given
o Analgesics
0iven on time to achieve maximum effect
o 7ulture and sensitivity
Perenial In$ection
Same s/ sx +ith infection
2 3 stitches are dislodges
+ith purulent drainage
:x resuturing
-n%ometritis
2nflammation of the endometrium
0en s/sx of infection I abdominal tenderness
Management
o Cigh fo+lers facilitates drainage D locali1e infection
o Administer oxytocin
,+MI5G P5+NNIN* M-TH8)
38
*ui%ing Principles
1. determine your o+n beliefs first
2. never advise a permanent method of family planning
3. informed concent
#. the method is an individual decision
Natural Metho% accepted by the church
8illings/ 7ervical )ucus/ Spinnbar%eit
clear +atery D stretchable
13
th
day longest due to estrogen
8asal 8ody :emp in the morning before arising/ 13
th
1#
th
day due to pea% of progesterone
=A) =actational Amenorrhea )ethod
prolactin inhibits ovulation
breastfeeding # H months no menstrual cycle
bottle fed 2 3 months
Sympthothermal combination of 8illings and 88: most effective method
Social Metho%s
Coitus Interuptus
+ithdra+al
least effective method
Coitus Reservatus
sex +/o e$aculation
Coitus inter$emora
bet+een femor
Calen%ar Metho%
1# days before menstrual cycle ovulation day @regularA
" #, I # days unsafe period
8rigo7nause ,ormula 0 irregular menstrual cycle4
get the longest and shortest cycle
subtract 14 to shortest
11 to the longest
the difference is the unsafe period
PI55S
combined oral contraceptives preventovulation by inhibiting the anterior pituitary gland
roduction of BSC and =C +hich are essential for he maturation and rupture of a follicle.
?strogen inhibit BSC +hich is responsible in the mturation of ovum. &rogesterone inhibit =C
+hich is responsible for ovulation.
contains estrogen that inhibits BSC and progesterone that inhibit =C
GG.GO effective
21 day feel on the (
th
day of mense start ta%ing
24 day 1
st
day of mense
if forgotten, ta%e 2 tablets the follo+ing day
adverse effect < brea%through bleeding
if mother +ants to get pregnant
o +ait 3 monts
o another 3 months if unsuucessful before consulting gyne
contrain%ications
o chain smo%ing
39
o Cypertension
o D)
o ?xtreme obesity
o :hrombophlebitis
Si%e e$$ects 0ressem(les Hypertension4/ Imme%iate )iscontinuation
o +bdominal paon
o Chest pain
o Headache
o -ye problem
o Severe leg cramp
Alerts on oral contraceptives <
o 2n case a )other +ho is ta%ing an oral contraceptive for almost a long time and plans
to have a baby, she +ould +ait for at least 3mos before attempting to conceive to
provide time for estrogen and progesterone levels to return to normal. 2f after Hmonths
the mother did not get pregnant, consult A)D.
o 2f a ne+ oral contraceptive is prescribed, the mother should continue ta%ing the
previously prescribed contraceptive and begin ta%ing the ne+ one on the first day of
the next menses.
o Discontinue oral contraceptive if there is signs of severe headache as this are an
indication of hypertension associated +ith increase incidence of 7>A and
subarachnoid hemorrhage.
o 2f forget to drin% pill for 1 day, ta%e 2 pills the next day. 2f forget to drin% pills for 2days,
stop the pill and +ait for the next mens.
+%verse reaction 2 (rea7through (lee%ing
)MP+ " )epoprovera
7ontains progesterone
Depomedroxy progesterone Acetate
2) F 3 months never massage the site may decrease effectiveness
N8RP5+NT
H match stic% li%e capsules/ rod
contain progesterone
sub 9 planted
good for ( years
Mechanical )evice
I1)
prevent implantation
alters mobility of sperm and ovum
GG.JO effective
best inserted after delivery and during menstruation
Common complication ?Z7?SS2>? )?*S:6;A= B='M
Common pro(lem ?Z&;=S2'* 'B :C? D?>27?
*o protection against S:D
Si%e e$$ects inclu%e
o ;terine infection
o ;terine perforation
o ?ctopic pregnacy
)a$or indication for the use is &A62:K
HT2 monthly chec% up and regular pap smear
40
C8N)8M
)ade up of latex
&ut in erected penis or lubricated vagina
&revents sperm to enter the uterus
B?)A=? 7'*D') higher protection than that of male
)I+PR+*HM
Dome shaped rubberied material inserted at the cervix to prevent sperm getting inside the
uterus
6eusable
HT 2 &roper hygiene
o 7hec% for holes
o )ust be refitted in case of +eight gain of 1( lbs " " board Fuestion
o Nept in place for about H"4 Cours 8oard Fuestion
Contrain%icate% to
o BreFuent ;:2
C-R.IC+5 C+P
)ore durable than the diaphram
7ould stay on place for more than 2# hours
*o need to apply spermicides
Contrain%icate% to abnormal papsmear
CH-MIC+5
SP-RMICI)-S
B'A)S most effective
Rellies
7reams
:hese may cause toxic shoc% syndrome
S1R*IC+5 M-TH8)
&ilateral tu(al 5igation
o ! isthmus
o 25O probability of reversal
.asectomy
o >as deferens is cut
o )ore than 35 x or 5 sperm count or 2 x negative sperm count before it could be
consider safe sex
HI*H RIS@ PR-*N+NCG
H-M8RRH+*IC )IS8R)-RS
*eneral management
786
Avoid sex
&repare ultrasound determine the sac integrity
Assess bleeding and approximation
41
Assess hypovolemia
Save discharge for histopathology
o Determine +hether the product of labor has been expelled
,irst Trimester &lee%ing
+(ortion termination of labor before age of viability
SP8NT+N-81S
o ANA miscarriage
o Causes
1. 7hromosomal aberrations due to advanced maternal age
2. 8lighted ovum
3. germ plasm defect
o *atures +ay of expelling defective babies
o Classi$ications 2
. Threatene%
pregnancy is $eopardi1ed by bleeding and cramping but the cervix is
closed and can be saved.
=. Inevita(le
moderate bleeding, cramping, tissue protrudes from the cervix and the
cervix is open.
o Types 2
. Complete
all products of conception are expelled.
)gt < emotional support
2. Incomplete
placenta and membranes retained.
)gt < DD7
H+&IT1+5
o 3 or more consecutive pregnancies result in abortion usually related to incompetent
cervix.
o Management @suture of cervixA
. Mc)onal% proce%ure
:emporary circlage
Side effect infection
)ay have *SD
=. Shiro%7ar
7S delivery
MISS-)
o fetus dies. product of conception remain in uterus # +ee%s or longer
o signs o$ pregnancy cease
1. @"A pregnancy test
2. Dar% bro+n
3. Scanty bleeding
o )gt < induction of labor/ vacuum extraction
IN)1C-)
o :herapeutic abortion principle of 2 fold effect
1. Done +hen mother has class # heart disease
-ctopic Pregnancy
occurs +hen gestation is location outside the uterine cavity
7ommon site < Ampulla or :ubal
42
Dangerous site< 2nterstitial
1nrupture% Rupture%
)issed period
Abdominal pain +ithin 3" (+%s of
missed period @maybe
generali1ed of one sidedA
Scant, dar% bro+n vaginal
bleeding
>ague discomfort
sudden, sharp severe unilateral
pain, %nife li%e
shoulder pain @indicative of
intraperitoneal bleeding that
extends to diaphragm D phrenic
nerveA
@IA 7ullens sign bluish tinged
umbilicus
syncope/fainting
*ursing 7are <
o vital signs
o administer 2> fluids
o monitor for vaginal bleeding
o monitor 2D'
o prepare for culdocentesis to determine
o hemoperitoneum
)gt < non"surgical )ethotrexate
S-C8N) TRIM-ST-R &5--)IN*
Hy%ati%i$orm Mole / P(unch o$ grapesQ
0estational :rophoblastic Disease progressive degeneration of 7horionic >illi
gestational anomaly of the placenta consisting of a bunch of clear vesicles. :his neoplasm is
formed from the s+elling of the chronic villi and lost nucleus of the fertili1ed egg. :he nucleus
of the sperm duplicates, producing a diploid number #Hxx. 2t gro+s and enlarges the uterus
very rapidly.
Cause < ;n%no+n
+ssessment 2
o -arly signs
vesicles passed thru the vagina
Cyperemesis gravidarum due to S C70
Bundal height
>aginal bleeding @scant or profuseA
o -arly in pregnancy
high levels of C70
&re ecclampsia at about 12+%s
>esicles loo% li%e a ,sno+storm- on sonogram
Anemia
Abdominal cramping
o Serious late complications
Cyperthyroidism
&ulmonary embolus
Nursing care 2
o prepare for DD7
o do not give oxytocin drugs due to proneness to embolism
o Cealth :eaching<
return for pelvic exams as scheduled for one year to monitor C70 and assess
for enlarged uterus and rising titer could be indicative of choriocarcinoma
43
Avoid pregnancy for at least one year
)ethotrexate therapy
Incompetent Cervix Management2
)cDonald procedure
o temporary circlage of incompetent cervix.
o Delivery < *S>D
o S?< infection
o Cealth teaching
observe for signs of infection
signs of labor
Shhirod%ar procedure
o permanent procedure.
o Delivery < caesarian section reFuired.
THIR) TRIM-ST-R &5--)IN* PP5+C-NT+5 +N8M+5I-SQ
Placenta Previa
it occurs +hen the placenta is improperly implanted in the lo+er uterine segment, sometime
covering the cervical os.
+ssessment
o 'utstanding sign < fran%, bright red, painless bleeding
o enlargement @usually has not occurredA
o fetal distress
o abnormal presentation
Nursing care 2
o 2nitial mgt < *&' candidate for 7S
o 8edrest
o prepare to induce labor if cervix is ripe
o administer 2>
o *o 2?, *o Sex, *o enema complication < Sudden fetal blood loss
o prepare )other for double set up D6 is converted to '6
+(ruptio Placenta
it is the premature separation of the placenta from the implantation site.
2t usually occurs after the t+entieth +ee% of pregnancy
7ause<
o 7ocaine user
o Severe &2C
o Accident
Assessment<
o 'utstanding sign < dar% red D painful bleeding
o concealed hemorrhage @retroplacentalA
o couvelaire uterus @caused by bleeding into the myometriumA @"A contraction
o rigid boardli%e abdomen
o severe abdominal pain
o dropping coagulation factor @a potential for D27A
o sx < bleeding to any part of the body. )gt < for hysterectomy
0eneral *ursing care <
o infuse 2>, prepare to administer blood
44
type and crossmatch
o monitor BC6
o insert Boley catheter
o measure bllod loss. count pads
o report s/s of D27
o monitor v/s for shoc%
o strict 2D'
Placental Succenturiata 1 or 2 lobes connected to the placenta by a blood vessel
Placenta &ipartita placenta divided into 2 lobes
HGP-RT-NSI.- )IS8R)-R
Pregnancy In%uce% Hypertension
o C&* after 2#+%s resolved H+%s postpartum +hich cause pregnancy.
o :ypes <
o 0estational C&*
C&* +ithout edema D proteinuria.
)gt < monitor 8&
o &re"eclampsia triad
o sx < C&* +ith edema, proteinuria or albuminuria @C?&/AA +hich cause is un%no+n or
idiopathic but multifactoral
primis d/t 1st exposure to chorionic villi
multiple pregnancies due to S exposure to chorionic villi
)others of lo+ socio"economic status due to V protein inta%e
:eenagers d/t lo+ compliance to protein inta%e
o C?==& syndrome hemolysis +ith elevated liver en1ymes D lo+ platelet count
Transitional Hypertension C&* bet+een 25"2#+%s
Chronic or PreKexisting Hypertension
o C&* before the 25th +% not resolved H+%s postpartum
o 3 types of pre"eclampsia
o Sign of pre"eclampsia <
o L 35mmCg systolic
o L 1(mmCg diastolic
o 6oll over test
15"1(min side lying
:hen supine
:hen ta%e 8&
o mild pre"ecclampsia
1#5/G5mmCg, +/ I1 '2, I2 proteinuria ?arly signs < S +t, inability to +ear
+edding ring due to developing edema
Signs present
cerebral D visual disturbances, epigastric pain to liver edema and
oliguria usually indicates an impending convulsion
8efore convulsion < if you see sign of epigastric pain, 1[ mgt is to place
tongue depressor and put the side rales up
During convulsion < observe the )other for safety
After convulsion turn to side to facilitate drainage
o Severe pre"ecclampsia
45
1H5/115, I3 or I#, proteinuria, visual disturbances
*ursing care
P promote bedrest
Prevent convulsions by nursing measures
to S '2 demand D facilitate *a excretion
)anagement< Fuiet D calm environment, minimal handling, avoid
moving the bed
Ceat Acetic Acid determine protein in the urine
&repare the follo+ing at bedside
o tongue depressor, Suction machine D '2 tan%
- ensure high protein inta%e @1g/%g/dayA
*a in moderation
+ antihypertensive drug +ith hydralu1ine
C 7*S depressant +ith )g Sulfate for anti"convulsion
)gt < evaluate for hypermagnesiumenimia
- evaluate physical parameters for )agnesium Sulfate toxicity <
& 8& V
1 ;rine output V
R 66 V
P &atellar reflex is absent
Antidote < 7a gluconate
o ?clampsia +ith sei1ure
S 8;* sign of glumerular damage
46
)ia(etes Mellitus
o cause by absent D lac% of 2nsulin
o Action of 2nsulin is to facilitate transfer of glucose into the cell
o Dx test < (5gm 1hr 0lucose :olerance :est
o S 135 hyperglycemia
47
o V J5 hypoglycemia
o 45"125 euglycemia
o if L 135mg/dl, the )other needs to undergo a 3hr 0::
o )aternal ?ffects <
o hypoglycemia during the 1st trimester development of the brain sinisipsip ng fetus
yung glucose ng nanay.
o Cyperglycemia during the 2nd D 3rd trimester
C&= effect )gt < give insulin. 'CA are teratogenic.
1st trimester " V insulin, 2nd trimester " S insulin, post partum drop suddenly
BreFuent infections eg. )oniliasis
&olyhydramnios
Dystocia
o Betal ?ffects <
o hypoglycemia during the 1st trimester and Cyperglycemia during the 2nd D 3rd
trimester thru facilitated diffusion
o )acrosomia/=0A .#555gms
o 2;06 due to prolonged D)
o &reterm birth promote still birth
o *e+born ?ffects <
o Cyperinsulinism and Cypoglycemia
#5mg/dl
*ormal < #("((mg/dl
8orderline < #5mg/dl
Sx < S pitched shrill cry, tremors, $itteriness
Dx test < heel stic% test to chec% glucose levels
o Cypocalcemia
U Jmg/dl
7alcemic tetany
:x < 7a gluconate
Heart )isease
o 7lassification <
o 2 no limitation
o 22 Slight limitation, ordinary activity causes fatigue
good prognosis can deliver vaginally
)gt < sleep of 15hrs/day, rest 35mins after meals
o 222 moderate limitation, less than ordinary activity causes discomfort
poor prognosis. 0ood for vaginal delivery
)gt < early hospitali1ation by J"4mos
o 2> mar%ed limitation of physical activity for even at rest there is fatigue
poor prognosis. 0ood for vaginal delivery only +ith regional anesthesia.
=o+ forceps delivery +hen unable to push D to shorten the stage of labor
)gt <
therapeutic abortion, high semi" fo+lers position, left side lying, no
valsalva maneuver " may trigger cardiac arrest, heparin therapy
reFuired, antibiotic therapy for prevention of sub acute bacterial
endocarditis
INTR+P+RT+5 C8MP5IC+TI8NS
48
Cesarean )elivery
2ndications
a. multiple gestation
b. diabetes
c. active herpes 22
d. severe toxemia
e. placental previa
f. abruption placenta
g. prolapse of the cord
h. cephalo pelvic disproportion and primary indication
i. breech presentation
$. transverse lie
proce%ure 2
o classical vertical incision
o lo+ segment ,bi%ini-, for aesthetic purposes. 7an have vaginal birth after c/s
*enotype " genetic ma%e"up
Phenotype " &hysical appearance
@aryotype " pictorial analysis of individual chromosome for detecting chromosomal abnormalities
+utosomal )ominant
huntingtons chorea
retinoblastoma
achondroplasia
polydactyl
+utosomal Recessive
sic%le cell
7ystic fibrosis
7eliac
&N;
0alactosemia
NK 5in7e% Recessive
Cemophilia
Duchennes muscular dystrophy
7olor blindness
N " 5in7e% )ominant
6ic%ettes
49