Maternal and Child Nursing

Maria Jessica de Guzman- Areja RN

Manuelito Cantos RN
Michael Emman Orbe RN
Luzviminda Porte RN, MAN
Team Lecturer
Maternal and Child Nursing or
Maternal Newborn Nursing

 Involves care of the woman and family

throughout pregnancy and childbirth and the
health promotion and illness care of the children
and families

 It refers to the relationship of mother and child

to one another and consideration of the entire
family, as well as the culture and socio-economic
environment, as framework of the clients.
 Nursing/
Maternal
Newborn
Nursing

 Promotion and maintenance

of optimum health of the
woman and the newborn
 PHILOSOPHY OF MCN
MATERNAL CHILD NURSING :
 Is family centered

 Is community centered

 Is research oriented

 Is based on nursing theory

 Protects the rights of all family members

 Uses a high degree of independent functioning

 Places importance on promotion of health

 Is based on the belief that pregnancy or childhood

illness are stressful because they are crises

 Is based on the belief that personal, cultural and

religious attitudes and beliefs influence the

meaning of illness and its impact on the family
 Is a challenging role for the nurse and is a major

factor in promoting high-level wellness in families

Principles to consider in
MCN

 The family is the basic unit of

society
 Families represent racial, ethnic,
cultural and socioeconomic
diversity
 Children grow both individually and
as part of a family
 PHASES OF HEALTH CARE IN
MCN
 Health promotion
- educating clients to be aware of
good health through teaching
and role modeling

 Health maintenance
- intervening to maintain health when risk
of illness is present

 Health rehabilitation
- preventing further complications from an
illness; bringing ill client back to optimal
state of wellness or helping the client
accept inevitable death
 Trends in Maternal and Child
Health Care

 Families are smaller in size than in

previous decades
 Single parents are increasing in number
 An increasing number of mothers work
outside the home
 Families are more mobile than previously
 Abuse is more common than ever before
 Families are more health conscious than
previously
 Anatomy and

Physiology
Female Reproductive System
A. The External Reproductive Organs
1. Mons pubis or mons veneris – is a pad of fat which
lies over the symphysis pubis which protects the
surrounding delicate tissues from trauma
2. Labia majora – a two folds of skin with fat
underneath; contain Bartholin’s glands ( believed to
secrete a yellowish mucus that acts as a lubricant
during sexual activity
3. Labia minora – two thin folds of delicate tissues that
forms the upper fold encircling the clitoris (called the
prepuce)
and unite posteriorly ( called the fourchette )
which is highly sensitive to manipulation and trauma t
why it is often torn during delivery.
4. Glans clitoris – small, erectile structure at the anterior
junction of the labia minora, which is comparable to the
penis and extremely sensitive to sexual manipulation
5. Vestibule – narrow space seen when the labia minora is
separated
6. Urethral meatus – external opening of the urethra;
slightly behind to the side are the openings of the Skene’s
glands
( often involved in infections of the external genitalia)
7. Vaginal orifice/introitus/vaginal opening- external
opening of the vagina, covered by a thin membrane ( called
hymen ) in virgins
8. Perineum – area from the lower border of the vaginal
orifice to the anus; contains the muscles which supports
the pelvic organs, the pudendal nerves which are important
during delivery under anesthesia
B. Internal Reproductive System
1. Vagina: a 3 – 6 inch long dilatable canal located between the bladder and the rectum;
contains rugae ( which permit considerable stretching without tearing; passageway for
menstrual discharges; receives penis during sexual intercourse ( organ of copulation ),
and forms part of birth canal
: vascular and acidic pH; Doderleins bacilli makes the vagina acidic
2. Uterus: a hollow pear shaped fibro muscular organ 3 inches long, 2 inches wide, 1
inch thick, weighing 50 Gms. in a non pre-pregnant state, hold in place by the ligaments
of the uterus
: Organ of menstruation
: Site of implantation and retainment and nourishment of the products
of conception
2.1 Ligaments of the uterus:
2.1.1 Broad ligaments: extend from the lateral margin of the uterus to the
pelvic sidewall

2.1.2 Round ligaments: Dense bands of connective tissue that extend from the
lateral uterine fundus to the upper portion of the labia majora

2.1.3 Uterosacral ligaments: dense bands of connective tissue that extend from the
inferior and posterior portion of the uterus and attach to the fascia over the
sacrum
2.2 Source of blood supply:
2.2.1 uterine ovaries
2.2.2 ovarian arteries
2.3 Parts of the uterus:
2.3.1 Fundus: uppermost convex portion
located between the insertions of the
fallopian tubes
:The most muscular area of the uterus; as such it
is thickest and most contractile portion
: Ideal site for implantation of the zygote
: Used as an obstetrical landmark during pregnancy through the
technique of physical examination by palpation of its height to
assess the uterine growth: during labor, being the mot contractile
area is palpated to assess the uterine contractions and labor
progress and during postpartum period, to assess for uterine involution

2.3.2 Cornua: areas of the uterus at which the fallopian tubes are attached

2.3.3 Corpus: the body of the uterus which makes up two-third of the said organ;
it houses the fetus during pregnancy

2.3.4 Isthmus: the upper third of the cervix which is very thin or areas between
corpus and cervix which forms part of the lower uterine segment
 2.3.5 Cervix: neck of the uterus; it measures 2.5cm long and 2.5
cm in diameter, it contains sebaceous glands that secretes a clear,
viscid and alkaline mucus
2.3.5.1 Parts of the cervix
2.3.5.1 Internal os – which opens to the corpus
2.3.5.2 Cervical canal – located between internal and
external os
2.3.5.3 External os – which opens to vagina

2.4 Muscle layers of the uterus:

2.4.1 Peritmetrium: serosal outer layer of the uterus attached to
the broad
ligaments
2.4.2 Myometrium: muscular layer of the uterus; thickest at the
fundal area
2.4.3 Endometrium: inner layer/ mucosal layer of the uterus that
contains
numerous uterine glands that secrete a thin alkaline fluid to
keep the
uterine cavity moist.
3. Fallopian tubes: 4 inches long/ eight to 14 cm. muscular tubes that extend
laterally from the cornua of the uterus from each side of the fundus
3.1 Functions:
3.1.1 Responsible for transport of
mature ovum from ovary to
uterus
3.1.2 The site of fertilization
3.1.3 Provides nourishment to the
ovum during its journey
3.2 Parts of the fallopian tube
3.2.1 Interstitial/Intramural: thick walled, located
inside the uterus
3.2.2 Isthmus: the narrowest portion of the uterus and is
about 1 cm. long; the site for tubal ligation
3.2.3 Ampulla: the middle portion and the widest part; the site for
fertilization
3.2.4 Infundibulum: the most distal portion; it has a fingerlike projections
called fimbria. The longest fimbria, called fimbria ovarica is attached
to the ovary to guide the ovum to the oviduct during the ovulation
3.3 Layers of the fallopian tubes:
3.1 Mucosal layer: composed of secretory cells
that secretes alkaline mucus which lubricates the fallopian
tube and ciliated cells that move in sweeping motion to
assist in the transportation of the ovum from the ovary to
the uterus
3.2 Muscular layer: this layer is responsible for the peristaltic
movement of the fallopian tube, rhythmic contractions of
the fallopian tubes are strongest at the time of ovulation
and weakest during pregnancy
3.3 Peritoneal layer: the outermost layer attached to the
ligaments that keep the fallopian tube suspended in its
normal position
Fallopian Tube
4. Ovaries: are almond-shaped glandular organs located on either side of
the uterus
:are movable organs on palpation
4.1Function of the ovaries:
4.1.1 Oogenesis – ovaries are responsible
for development and maturation of
ovum
4.1.2 Ovulation: refers to the release of ovum
from the ovary
4.1.3 Hormone production: the ovaries the main
source of estrogen and progesterone in non-
pregnant women
4.2 Layers of the ovaries:
4.2.1 Tunica albuginea: the outermost protective layer
4.2.2 Cortex: the functional layer because it is the site of ovum
formation
and maturation
4.2.3 Medulla: this layer contains blood vessels, lymphatics,nerves and
muscle fibers.
Ovary
Female Reproductive System
THE PELVIS
 Structure of pelvis

A. Two hip bones (right and left

innominate: Sacrum, coccyx).
1. False pelvis – this is the part of the
pelvis situated above the pelvic
brim. It is formed by the upper
flared out portion of the iliac bones
and protects the abdominal organs.
- supportive structure for uterus
during last half of pregnancy.
2.True pelvis – Is the bony canal through
which the fetus must pass during birth.
It has a brim, a cavity and outlet.
- below brim; pelvic inlet, midplane,
pelvic outlet. Fetus passes through
during birth
Pelvic measurements
Pelvic measurements
A. Diagonal conjugate – 12.5 cm or greater
is adequate size, evaluated by examiner

B. Conjugate vera – 11 cm is adequate size;

can be measured by x-ray (not commonly
performed)
C. Obstetric conjugate – measured
by x –ray (not commonly
performed)

D. Tuber-ischial diameter – 9 -11

cm indicates adequate size;
evaluated by examiner.
PELVIS
Four Types:
1.Gynecoid Pelvis
2. Android Pelvis
3. Anthropoid Pelvis
4. Platypelloid Pelvis
1.Gynecoid Pelvis
 Inlet is round, circular

 Wide

 This is the typical FEMALE

PELVIS
 Most favorable for normal

spontaneous delivery or
ideal for childbirth
 The anteroposterior and

transverse diameters are

relatively equal, with
straight pelvic sidewalls.
 The ischial spines are not

usually prominent
 The pubic arch is wide
2. Android Pelvis
 Wide

 HEART-SHAPED

 This is the typical

MALE PELVIS
 It is characterized by

convergent sidewalls,
prominent ischial
spines, and narrow
pubic arch
 May result to forceps

delivery or CS
3. Anthropoid Pelvis
 Wide

 Narrow

 This is the typical APE

PELVIS
 It is characterized by

the anteroposterior
diameter being greater
than the transverse
diameter
4. Platypelloid Pelvis
 Opposite of Anthropoid

Pelvis
 Wide

 Narrow

 The pelvis is characterized

by the transverse diameter

being greater than the
anteroposterior diameter
with wide sidewalls
 Flattened gynecoid shape

of flat pelvis
 Menstrual Cycle
 It refers to female reproductive cycle
 It is a periodic uterine bleeding in response to cyclical
hormonal changes
 Menstruation is being ushered in by menarche (onset
of menstruation ) and ends with menopause
( permanent cessation of menstruation) age of onset
and termination vary widely depending on heredity,
racial background, nutrition and even climate.
 Normal menstrual period ( days when there is
menstrual flow) last for3 – 6 days; menstrual cycle
(from first day of menstruation to the first day of next
menstruation) may be anywhere from 25 – 35 days,
but accepted average length is 28 days
 Body structures
involved
 Hypothalamus
 Pituitary gland
 Ovaries
 Uterus
 Hormones which regulate cyclic
activities
 GNRH ( APG ) – initiates the menstrual cycle
A. FSH
- stimulate the development of primordial
follicles (immature follicles) into graafian
( mature follicles )
B. LH
- it stimulates ovulation and development of
corpus luteum ( source of progesterone )
- thickens the endometrial lining of the
uterus