MATERNAL NURSING

(OB)
 MCN -
- Traditionally refers to care of women
during pregnancy Birth and postpartum
as well as the care of infants Children
and adolescents. Specifically tasked
complexities in health care has nurses to be
maternal and women’s health care
practitioners, nurse and midwives etc.
 OBSTETRICS – Science that deals
with childbirth
- it deals with duration
Pregnancy 38-42 weeks
Labor & Delivery 20 hours
Puerperium 6-8 weeks

- It deals with 2 clients

1. mother
2. fetus
 Menstrual Disorders
 Infertility
 Contraception/ Family Planning
Menopause
The best managed care principles value a
comprehensive approach that focus on:

*Prevention
ex: mammograms, SBE, cervicacancer,
screening, cervical vaccines, prenatal care,
smoking cessation programs, healthy lifestyle,
food choices etc.

*Early Intervention

*Continuity of Care
Vagina – connects external to
internal reproductive organ
- It is a tube with rugae, distensible
- Copulation and passage way
- 3-4 inches long
- Acidic, due to its normal flora
- Ph – 4-5- average

Internal Reproductive Organs

p.47 Fig. 3 - 1
 Ovary - Cortex, medulla ovulation
(4cm long) endocrine

 Uterus - Fundus menstruation

(3X2X1) Corpus gestation
Cervix

Fallofian - Infundiberlum
Tubes Ampulla Fertilization
4 inches Intramus Passageway
Interstitial
 UTERUS
- Pear shaped
- 3 Layers
1. endometrum
2. myometrum
3. perimetrium
- 50-60gms weight
- Antenor rectum
- Posterior to the bladder
- Ligaments
- Broad, Cardinal, uterosacral
- Ovarian cycle Follicular maturation
of follicles
Intral ovulation

- Endometrial Cycle
 Proliferative
Secretory
menstrual
 Monthly shedding of the uterine lining
 Ave onset =12years – menarche
 Ave duration =50-52 years- menopause
 Ave amount =50ml (30-80ml)
 Ave cycle =28 days
 Menstrual blood consists of endometrial
cells, blood, mucus unfertilized ovum
 Menorrhagia
 Dysmenorrhea
 Amenorrhea
 menopause
Organs Hormones Functions

Brain
Hypothalamus GnRH -stimulates the APG to
secrete gonodo- trophic
Hormones
Brain
APG FSH -Responsible for
maturation of Follicles
Ovary Estrogen -Responsible for
*development of ducts of
the breasts
*spinnbarkeit secretions
Organs Hormones Functions

Uterus Estrogen Responsible for

*proliferation of the
endometrial glands
*endometrium increases
in thickness
Contracts uterus
Brain
APG LH Responsible for the
rupture of the follicle
Ovary Progesteron -Responsible for
development of the Acini
cells of the breast
-thick mucus secretion
*relaxes the uterus
Organs Hormones Functions

Uterus ProgesteroResponsible for secretory

ne phase
*Endometrium becomes
more thickened, more
vascular and glandular
*Preparedness for
implantation
 Produced by the endometrium
 Technically not a hormone because they are
produced by tissues rather than special
glands
 Play a role in rupturing the grafian follicle
 Large amount of prostaglandins are found in
the menstrual blood
 Found to have a contracting effect on the
uterus
 Ovulation occurs 14 days in a 28 day cycle
 To get the approximate ovulation day,
subtact 14 from the cycle
 Ex. Cycle is d32 days – 14 = 18th day
WOMAN MAN

One ovum Millions of sperms

22 chromosomes Around 200-300M to

effect fertilization, but
only one to fertilized the
ovum
And X sex chromosome 22 chromosomes and Y
sex chromosome
24 hours viability 72 hours viability
Fertilization takes place in the ampulla
of the fallopian tube

Union of sperm and ovum forms a zygote

(46 chromosomes)

Zygote continues to form a MORUL

(16cells)
 Morula – BlastocysInner cell mass

Embryo ammion

Outer cell Mass

trophoblast

Chorionic Villi

Decidua Basalis

PLACENTA
 Implantation occurs 7 to 10 days after conception
 Organ of metabolic and nutrient exchange
between the embryonic and maternal
circulation – begins 3rd week of embryonic
development

 Weight – 400 to 600gms

 Diameter – 15 to 20 cm (8in)

 Average: 1 inch thick

Maternal Fetal

Cotyledons Membranes

 Chorion
 amnion
1. Respiratory
2. Nutritive
3. Excretory
4. Barrier – Bacteria, Virus
5. Endocrine
- HCG, HPL, Estrogen & Progesterone
 Functions:

 Acts as a cushion to protect against mechanical injury

 Maintains a constant temperature
 Acts as a nudge during labor

 Phis alkaline and contains L,S, bilirubin, vernix,

Lanugo, epithelial cells, albumin
 After 20 weeks, ranges between 700-
800ml

 Fetus contributes to volume of amniotic

fluid by excreting urine

 Fetus swallows up to 600ml every 24

hours and about 400ml flows out of fetal
lungs each day
 Umbilical veinLiver
Inferior Vena Cava
thru Ductus Venosus

 Right Atrium Foramen Ovale left ventricle

Aorta

 From the superior vena cava right atrium

right ventricle pulmonary artery
ductus Enterrosins Aorta
by passing the lungs
4 weeks – Heart begins to beat
 8 weeks – all body organs are formed
 8-12 weeks – FHB- heard by doppler
 16 weeks – Sex can be seen
 20 weeks – FHB – heard by stethoscope

- quickening
- baby has patterns of sleep,
sucking, kicking
- vernix and lanugo are present
24 weeks – Fetal respiratory movements
begin
28 weeks – Eyes begin to open and close

- Head hair, eyebrows and

eyelashes are present surfactant
is formed
32 weeks – Subcutaneous fat

- Fingernails and toenails

-Descend of testes begins
38 weeks – Term baby
 Uterus
 non-pregnant – 60gms pregnant -1000gms
capacity - 10ml
-5000cc
 Hypertrophy (Largely)
 Hyperpalasia (Limited)
 Stimulated by E and P
 Braxton Hicks – starting 4th month
* stimulates movement of blood thru the
spaces of the placenta
 Cervix

*Goodells
*Chadwicks
- higher glandular cell glands leading to
leukorrhea
 OVARIES

Cease to function

Corpus luteum covers 1/3 of ovary

and is maintained by HCG which
will persist and produce hormones
until placenta takes over
VAGINA

 Hypertrophy

Hyperplasia

Vascularization
Results in:

 Thickening of mucosa

 Loosened connective tissue

 Highervaginal secretions (thick, white,

acidic Ph 3.5 to 6.00)

 Chadwick’s SX
 BREASTS
Higher in size

Nipples erectile

Pigmented areola

Montgomary tubercles

Colostrum-may be present (yellowish, AB

rich)
 RESPIRATORY SYSTEM
Slight hypervilation
Slight increase in RR
Diaphragm is elevated due to
enlarging uterus
Breathing may become thoracic
than abdominal
Nasal stuffiness and congestion
Epistaxis may occur
 CARDIOVASCULAR SYSTEM

Heart is pushed upward and to the

left
Systolic murmur cab be heard in most
pregnant women
Blood Volume progressively higher to
about 40-50% above non-pregnant
level.
Cardiac output higher and peaks 20-
24 weeks
CARDIOVASCULAR SYSTEM

BP may decrease especially 2nd

trimester and returns to its
prepregnant level at term.

Uterine pressure on the vanal cava

when the woman is supine results
in supine hypotensive syndrome.
CARDIOVASCULAR SYSTEM

Total RBC volume higher by 18%-30%

Plasma volume increase is 50% but

HCT lower slightly, which causes
physiologic anemia of pregnancy

Higher WBC production

Fibrinogen higher by as much as 50%

 GASTROINTESTINAL SYSTEM
N and V (HCG effect)

Ptayalism

Heart burn

Gastric emptying time is delayed leading

to bloating and constipation

hemorrhoids
URINARY TRACT
Higher urinary frequency due to growing
uterus

Glomerular Filtration Rate(GFR) higher by

as much as 50%

Glycosuria is common

Amino Acids and water soluble vitamins

are excreted in greater amounts
SKIN AND HAIR
Higher Pigmentation – areola, nipples,
vulva, perianal area, linea alba

Chloasma

Striae or stretch mark

Sweat and sebaceous glands are

hyperactive
MUSCULOSKELETAL SYSTEM

Sacroiliac, sacrococcygeal and

pubic joints of the pelvis relax –
(waddling gait)

Postural changes (lordosis)

CENTRAL NERVOUS SYSTEM
Sleep problems

Mood swings

Depression

PICA
Most metabolic functions
accelerate during pregnancy in
support to the additional demands
of the growing fetus, the mother’s
tissue replacement needs and in
preparation to labor and lactation.
 Normal =25-30 lbs.
=11-13 kg.

 Weight Gain Distribution

-5kg.(11lbs) -Fetus, placenta AF
- .9kg(2lbs) -uterus
-1.8kg(4lbs) -Blood volume
-1.4kg(3lbs) -Breasts
-2.3-4.5kg -Maternal stores
(5-10lbs.)
Braxton Hicks Nausea & Vomitin

FAB Ballotement

Chadwick’s Pregnancy Test

Skin Changes Amenorrhea

Breast enlargement UTZ visualization

Hegar’s nsx Breast tenderness

According to Reva Runin (1984) there are tasks that a
woman must accomplish to incorporate the
maternal role successfully into her being.

1. Ensuring a safe passage throughout pregnancy and

birth

*Participation in positive self care activities related

to diet, exercise and over-all well being
2. Seeking acceptance of infant by
others

3. Seeking acceptance of self in

maternal role to infant (binding in)

*mother acknowledges fetus as a

separate being w/in her – wit her
experience of quickening
4. Learning to give of oneself
* what must be given up to assume
new role
 Ambivalence
- conflicting feelings, considered normal

Introversion
- focusing on oneself-common during early
pregnancy

- woman becomes passive to her family and

friends
 Acceptance
- generally, wnd trimester feeling

Mood scrimp
- feels, great joy, cry, disbelief etc.
 Promotion
of the health and well being of a
woman and her partner before pregnancy.

GOAL:
Identify any areas such as health problems,
lifestyle habits or other concerns that might
unfavorably affect pregnancy.
GOAL:
Healthy mother for a healthy baby
Frequency.

1-7 months = monthly

8 months = 2x moth

9 months = weekly
TERMS:

Gravida - # of pregnancy regardless of outcome

Para - # of pregnancy that has reached viability

Multigravida- a woman who has never been pregnant

OB Scoring - GP (TPAL)
 Example:

Juanita is pregnant and visits you at the PNC.

She had one ectopic pregnancy at 8 weeks.
She has one baby born at 39 weeks and one
born at 32 weeks which is a set of twins.
What is her OB Score?

Answer: G4P2 TPAL

1113
 DATA –
- Age, G, P, AOG
- OB HX
- Medical Hx
 P.E.

- Vital signs

- Weight and Height

- Head to toes Assessment

*Head, Breast, Abdomen, Genitals,
Extremities, IE
*FH and Leopold’s Maneuver
 Laboratory Test

- Urine

- Blood

- Pap smear- negative, organisms, presence of

squamous cells or glandular cell-
may favor neoplastic cells.
 Weight – 25 lbs

 BP

 Urine testing for preotein, glucose and albumin

 FH measurement

F Movement

 FHR
- A procedure that is performed to
determine presentation, position and lie.

First Maneuver = To determine presentation

2nd Maneuver = To determine position

3rd Maneuver = To confirm presentation and

Engagement

4th Maneuver = To determine attitude

 Hygiene of Pregnancy

 Minor Discomforts

 Danger Signs

 Teratogens

 Exercises

 Nutrition
Nutrient NP Present Lactation
Calories 2,200 2,500 2,700
Protein 60 gms 80 gms 80 gms
Folate 400 mcg 600 mcg 500 mcg
Iron 18mg 27mg 9mg
Calcium 1000g 1000g 1000g