MATERNAL/OB NOTES

Human Sexuality A. Concepts 1. A person’s sexuality encompasses the complex behaviors, attitudes emotions and preferences that are related to sexual self and eroticism. 2. Sex – basic and dynamic aspect of life 3. During reproductive years, the nurse performs as resource person on human sexuality. B. Definitions related to sexuality: Gender identity – sense of femininity or masculinity 2-4 yrs/3 yrs gender identity develops. Role identity – attitudes, behaviors and attributes that differentiate roles Sex – biologic male or female status. Sometimes referred to a specific sexual behavior such as sexual intercourse. Sexuality - behavior of being boy or girl, male or female man/ woman. Entity life long dynamic change. - developed at the moment of conception. II. Sexual Anatomy and Physiology A. Female Reproductive System 1. External value or pretender a. Mons pubis/veneris - a pad of fatty tissues that lies over the symphysis pubis covered by skin and at puberty covered by pubic hair that serves as cushion or protection to the symphysis pubis. Stages of Pubic Hair Development Tannerscale tool - used to determine sexual maturity rating. Stage 1 – Pre-adolescence. No pubic hair. Fine body hair only Stage 2 – Occurs between ages 11 and 12 – sparse, long, slightly pigmented & curly hair at pubis symphysis Stage 3 occurs between ages 12 and 13 – darker & curlier at labia Stage 4 – occurs between ages 13 and 14, hair assumes the normal appearance of an adult but is not so thick and does no appear to the inner aspect of the upper thigh. Stage 5 sexual maturity- normal adult- appear inner aspect of upper thigh . b. Labia Majora - large lips longitudinal fold, extends symphisis pubis to perineum c. Labia Minora – 2 sensitive structures clitoris- anterior, pea shaped erectile tissue with lots sensitive nerve endings sight of sexual arousal (Greek-key) fourchette- Posterior, tapers posteriorly of the labia minora- sensitive to manipulation, torn during delivery. Site – episiotomy. d. Vestibule – an almond shaped area that contains the hymen, vaginal orifice and bartholene’s glands. Urinary Meatus – small opening of urethra, serves for urination Skenes glands/or paraurethral gland – mucus secreting subs for lubrication hymen – covers vaginal orifice, membranous tissue vaginal orifice – external opening of vagina bartholene’s glands- paravaginal gland or vulvo vaginal gland -2 small mucus secreting subs – secrets alkaline subs. Alkaline – neutralizes acidity of vagina Ph of vagina - acidic Doderleins bacillus – responsible for acidity of vagina Carumculae mystiformes-healing of torn hymen e. Perineum – muscular structure – loc – lower vagina & anus Internal: A. vagina – female organ of copulation, passageway of mens & fetus, 3 – 4inches or 8 – 10 cm long, dilated canal Rugae – permits stretching without tearing B. uterus- Organ of mens is a hollow, thick walled muscular organ. It varies in size, shape and weights. Size- 1x2x3 Shape: nonpregnant pear shaped / pregnant - ovoid 1. 2. 3. 4. 5.

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Weight - nonpregnant – 50 -60 kg- pregnant – 1,000g Pregnant/ Involution of uterus: 4th stage of labor - 1000g 2 weeks after delivery - 500g 3 weeks after delivery - 300 g 5-6 weeks after delivery - returns to original, state 50 – 60 Three parts of the uterus 1. fundus - upper cylindrical layer 2. corpus/body - upper triangular layer 3. cervix - lower cylindrical layer * Isthmus lower uterine segment during pregnancy Cornua-junction between fundus & interstitial Muscular compositions: there are three main muscle layers which make expansion possible in every direction. 1. Endometrium- inside uterus, lines the nonpregnant uterus. Muscle layer for menstruation. Sloughs during menstruation. Decidua- thick layer. Endometriosis-proliferation of endometrial lining outside uterus. Common site: ovary. S/sx: dysmennorhea, low back pain. Dx: biopsy, laparoscopy Meds: 1. Danazole (Danocrene) a. to stop mens b. inhibit ovulation 2. Lupreulide (Lupron) –inhibit FSH/LH production 2. Myometrium – largest part of the uterus, muscle layer for delivery process • Its smooth muscles are considered to be the living ligature of the body. - Power of labor, resp- contraction of the uterus 3. Perimetrium – protects entire uterus C. ovaries – 2 female sex glands, almond shaped. Ext- vestibule int – ovaries Function: 1. ovulation 2. Production of hormones d. Fallopian tubes – 2-3 inches long that serves as a passageway of the sperm from the uterus to the ampulla or the passageway of the mature ovum or fertilized ovum from the ampulla to the uterus. 4 significant segments 1. Infundibulum – distal part of FT, trumpet or funnel shaped, swollen at ovulation 2. Ampulla – outer 3rd or 2nd half, site of fertilization 3. Isthmus – site of sterilization – bilateral tubal ligation 4. Interstitial – site of ectopic pregnancy – most dangerous B. Male Reproductive System 1. External penis – the male organ of copulation and urination. It contains of a body of a shaft consisting of 3 cylindrical layers and erectile tissues. At its tip is the most sensitive area comparable to that of the clitoris in the female – the glands penis. 3 Cylindrical Layers 2 corpora cavernosa 1 corpus spongiosum Scrotum – a pouch hanging below the pendulous penis, with a medial septum dividing into two sacs, each of which contains a testes. - cooling mechanism of testes < 2 degrees C than body temp. Leydig cell – release testosterone

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2. Internal The Process of Spermatogenesis – maturation of sperm

Blank! Can’t erase!

Testes – 900 coiled (½ meter long at age 13 onwards) (Seminiferous tubules)

Hypothalamus

Epididymis – 6 meters coiled tubules site for maturation of sperm

GnRH Ant Pit Gland
Vas Deferens – conduit for spermatozoa or pathway of sperm

FSH

LF

Seminal vesicle – secretes: 1.) Fructose – glucose has nutritional value. 2.) Prostaglandin – causes reverse contraction of uterus

Fx: Sperm Maturation

Fx: Hormones for Testosterone Production

Ejaculatory duct – conduit of semen

Prostate gland- secrets alkaline substance Cowpers gland secrets alkaline substance Urethra

Male and Female homologues Male Penile glans Penile shaft Testes Prostate Cowper’s Glands Scrotum Female Clitoral glans Clitorial shaft ovaries Skene’s gands Bartholin's glands Labia Majora

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increase sexual desire *Progestin “ Hormone of the Mother” Primary function: prepares endometrium for implantation of fertilized ovum making it thick & tortous (twisted) Secondary Function: uterine contractility (favors pregnancy) Others: 1. causes mood swings in moms 6. Reproductive cells divides by the process of meiosis (haploid) Spermatogenesis – maturation of sperm Oogenesis – process . Ischemic 4. Spinnbarkeit & Ferning ( billings method/ cervical) 4. increase osteoblast activities of long bones 6. Age of Reproductivity – 15 – 44yo 8. Sperm is viable within 48 – 72 hrs. Secretory 3. Ovum is capable of being fertilized with in 24 – 36 hrs after ovulation 5. Others: 1. inhibit production of FSH ( maturation of ovum) 2. hypothalamus 4 . MenstruationMenstrual Cycle – beginning of mens to beginning of next mens Average Menstrual Cycle – 28 days Average Menstrual Period . Chromosomes – threadlike strands composed of hereditary material – DNA 3.inhibit motility of GIT 3. increase in height in female 7. causes sodium retention 9. increase BBT 10.3 – 5 days Normal Blood loss – 50cc or ¼ cup Related terminologies: Menarche – 1st mens Dysmenorrhea – painful mens Metrorrhagia – bleeding between mens Menorhagia – excessive during mens Amenorrhea – absence of mens Menopause – cessation of mens/ average : 51 years old 9. mammary gland development 4. 2-3 days 6.maturation of ovum Gematogenesis – formation of 2 haploid into diploid 23 + 23 = 46 or diploid 7. Proliferative 2. Normal amount of ejaculated sperm 3 – 5 cc.. 1 tsp 4. Menstrual Cycle 4 phases of Menstrual Cycle 1.III. development ductile structure of breast 5.inhibit prod of LH (hormone for ovulation) 2. Functions of Estrogen and Progestin * Estrogen “Hormone of the Woman” – Primary function: development secondary sexual characteristic female. Phases of Menstrual Cycle: 1. DNA – carries genetic code 2. increase permeability of kidney to lactose & dextrose causing (+) sugar 5. hypertrophy of myometrium 3. Basic Knowledge on Genetics and Obstetrics 1. Menses Parts of body responsible for mens: 1. causes early closure of epiphysis of long bones 8.

post mens phase. 2. pearly white Phonones-vibration of head of sperm to determine location of ovum Sperm should penetrate corona radiata and zona pellocida.BP. Facilitate growth primary follicle to become graffian follicle (secrets large amt estrogen & contains mature ovum. Plateau Phase – (accelerated V/S) – increasing & sustained tension nearing orgasm. after ovulation day.where sperm is deposited Sperm. moderate increase in HR. 2.) III. GnRH/FSHRF – stimulates the anterior pituitary gland to release FSH Functions of FSH: 1. 15th day. Excitement Phase – (sign present in both sexes.small head. 24th day if no fertilization. RR. graafian follicle starts to degenerate yellowish known as corpus luteum (secrets large amount of progesterone) VIII. ovaries 4. corpus luteum degenerate ( whitish – corpus albicans) X. Pre-ovularoty. 13th day of menstruation. Capacitation. lasts minutes to hours. 28th day – if no sperm in ovum – endometrium begins to slough off to begin mens Cornix. Lasts 30 seconds – 3 minutes. On the initial 3rd phase of menstruation . increase progesterone 15th day – Decrease estrogen. the estrogen level is decreased. these stimulates the hypothalamus to release GnRF on LHRF 1. Stimulate ovaries to release estrogen 2. uterus Initial phase – 3rd day – decreased estrogen 13th day – peak estrogen.2. Secretory phaseLutheal Phase Postovulatory Premenstrual Phase V. Functions of LH: 1. long tail. anterior pituitary gland – master clock of body 3. -phase of increase estrogen. 5 . this level stimulates the hypothalamus to release GnRH or FSHRF II. Stages of Sexual Responses (EPOR) Initial responses: Vasocongestion – congestion of blood vessels Myotonia – increase muscle tension 1. (13th day-decreased progesterone) LH stimulates ovaries to release progesterone 2. VII.) Mittelschmerz – slight abdominal pain on L or RQ of abdomen. sex flush. nipple erection) – erotic stimuli cause increase sexual tension. 14th day estrogen level is increased while the progesterone level is increased causing rupture of graffian follicle on process of ovulation. PhaseIncreased progesterone IX. Proliferative Phase – proliferation of tissue or follicular phase. increase progesterone I. marks ovulation day. estrogen level is peak while the progesterone level is down.ability of sperm to release proteolytic enzyme to penetrate corona radiata and zona pellocida. decrease progesterone 14th day – Increase estrogen.) Change in BBT. Follicular Phase – causing irregularities of mens Postmenstrual Phase Preovulatory Phase – phase increase estrogen IV. mood swing GnRF/LHRF stimulates the ant pit gland to release LH. hormone for ovulation VI. 11.

immeasurable peak of sexual experience. prevent cord compression 5. Fetus. cushions fetus against sudden blows or trauma 2.2 months to birth.fertilized ovum. Chorionic Villi.FUNIS. slightly alkaline. Implantation/ Nidation. finger life projections 3 vessels= A – unoxygenated blood V – O2 blood A – unoxygenated blood Wharton’s jelly – protects cord Chorionic villi sampling (CVS) – removal of tissue sample from the fetal portion of the developing placenta for genetic screening. Stages of Fetal Growth and Development 3-4 days travel of zygote – mitotic cell division begins *Pre-embryonic Stage a. Adhesion 3. Amniotic Fluid – bag of H2O.if with fertilization – corpus luteum continues to function & become source of estrogen & progesterone while placenta is not developed. might get infected syphilis F. 3 processes of Implantation 1. slight pain 2.occurs after fertilization 7 – 10 days. Apposition 2. Short cord: abruptio placenta or inverted uterus. C. *Function of Amniotic Fluid: 1. wherein he cannot be restimulated for about 10-15 minutes A. facilitates musculo-skeletal development 3. 20 – 21”. Orgasm – (involuntary spasm throughout body. Ex missing digits/toes. Zygote. 15 – 55cm. Synsitiotrophoblast – synsitial layer – responsible production of hormone 1. slight vaginal spotting . Long cord:cord coil or cord prolapse b. Invasion C. Cytotrophoblast – inner layer or langhans layer – protects fetus against syphilis 24 wks/6 months – life span of langhans layer increase. E. maintains temp 4. Dicidua – thickened endometrium ( Latin – falling off) * Basalis (base) part of endometrium located under fetus where placenta is delivered * Capsularies – encapsulate the fetus * Vera – remaining portion of endometrium.most affected are is pelvic area. help in delivery process 6 . odor mousy/musty.3. with crystallized forming pattern. 4 days free floating & multiplication c. Amnion – inner most layer a. Fertilization B. May last 2 – 10 sec. Resolution – (v/s return to normal. Umbilical Cord. placenta previa – implantation at low side of uterus Signs of implantation: 1. peak v/s) involuntary release of sexual tension with physiologic or psychologic release. Done early in pregnancy. Blastocyst – covering of blastocys that later becomes placenta & trophoblast d. whitish grey. 4. Lifespan of zygote – from fertilization to 2 months b. Before 24 weeks critical. Blastocyst – enlarging cells that forms a cavity that later becomes the embryo. Common complication fetal limb defect. Morula – mulberry-like ball with 16 – 50 cells.10 – 11th day. clear. genitals return to pre-excitement phase) Refractory Period – the only period present in males.

Has a diabetogenic effect – serves as insulin antagonist Relaxin Hormone. Amniocentesis empty bladder before performing the procedure. Paper turns blue green/gray-(+) rupture of amn fluid.normal amt of amniotic fluid – 500 to 1000cc polyhydramnios.maternal serum alpha feto-protein test (MSAFP) – 1st trimester 2. fetus hypoglycemic 3. Human placental Lactogen or sommamommamotropin Hormone – for mammary gland development.urine. Paper turns yellow. If mom hypoglycemic. hydramnios. Genetic screening. Determination of fetal maturity primarily by evaluating factors indicative of lung maturity – 3rd trimester Testing time – 36 weeks decreased MSAFP= down syndrome increase MSAFP = spina bifida or open neural tube defect Common complication of amniocenthesis – infection Dangerous complications – spontaneous abortion 3rd trimester.determine if amniotic fluid has ruptured or not (blue paper turns green/grey . increased amt of fluid oligohydramnios.decrease amt of fluid – kidney disease Diagnostic Tests for Amniotic Fluid A. Fern Test.pre term labor Important factor to consider for amniocentesis. B. Liver of mom detoxifies fetus.2:1 signifies fetal lung maturity not capable for RDS Shake test – amniotic + saline & shake Foam test Phosphatiglyceroli: PG+ definitive test to determine fetal lung maturity a. combination of chorionic villi + deciduas basalis. 1. diffusion more rapid from higher to lower.needle insertion site Aspiration of yellowish amniotic fluid – jaundice baby Greenish – meconium A. Size: 500g or ½ kg -1 inch thick & 8” diameter Functions of Placenta: 1.carries waste products. fluid is tested for: 1. Purpose – obtain a sample of amniotic fluid by inserting a needle through the abdomen into the amniotic sac. Respiratory System – beginning of lung function after birth of baby. GIT – transport center. Chorion – where placenta is developed Lecithin Sphingomyelin L/S Ratio. Excretory System. 4. Circulating system – achieved by selective osmosis 5. Nitrazine Paper Test – diff amniotic fluid & urine.artery . Amnioscopy – direct visualization or exam to an intact fetal membrane. glucose transport is facilitated. Placenta – (Secundines) Greek – pancake. Simple diffusion 2. Endocrine System – produces hormones • • • • • Human Chorionic Gonadrophin – maintains corpus luteum alive.GIT malformation TEF/TEA.causes softening joints & bones estrogen progestin 7 .+ ruptured amniotic fluid) C.

18 wks – multi fetal heart tone heard with or without instrument Sixth Month eyelids open wrinkled skin vernix caseosa present 2. placenta developed 2. Kidneys functional 2. Corpus luteum – source of estrogen & progesterone of infant – life span – end of 2nd month 3. 4. Sex organ formed 4. 18. All vital organs formed.for calcium Thymus – development of immunity Liver – lining of upper RT & GIT * Mesoderm – development of heart. Eighth Month lanugo begin to disappear sub Q fats deposit 8 . 16. 2.HBV Fetal Stage “ Fetal Growth and Development” Entire pregnancy days – 266 – 280 days 37 – 42 weeks Differentiation of Primary Germ layers * Endoderm 1st week endoderm – primary germ layer Thyroid – for basal metabolism Parathyroid . Meconium is formed Third Month 1. 3. kidneys and repro organ * Ectoderm – development of brain.20 weeks primi. 5. 18 – 20 weeks buds of permanent teeth appear Fifth Month lanugo covers body actively swallows amniotic fluid 19 – 25 cm fetus. CNS develops – dizziness of mom due to hypoglycemic effect Food of brain – glucose complex CHO – pregnant womans food (potato) Second Month 1. 3. 1. musculoskeletal system. It serves as a protective barrier against some microorganisms – HIV. 2. Quickening. mucus membrane or anus & mouth First trimester: 1st month Brain & heart development GIT& resp Tract – remains as single tube 1. 3. Fourth Month lanugo begins to appear fetal heart tone heard fetoscope.6. 2. Sex is distinguishable Second Trimester: FOCUS – length of fetus 1. 1. Fetal heart tone begins – heart is the oldest part of the body 2. Fetal heart tone heard – Doppler – 10 – 12 weeks 4.1st fetal movement. Buds of milk teeth appear 3. nails. Third trimester: Period of most rapid growth. hair. FOCUS: weight of fetus Seventh Month – development of surfactant – lecithin 1. skin and senses.

These infections are often characterized by vague. Vaccine is terratogenic C – cytomegalo virus H – herpes simplex virus VI. Cardiovascular System – increase blood volume of mom (plasma blood) 30 – 50% = 1500 cc of blood . and jaundice (hepatic involvement). TORCH: Toxoplasmosis. abruption placenta B. rashes and lesions. virus or irradiation.easy fatigability.. Hgb should not be < 11g/dL 2nd trimester – Hct should not <32% 9 . hyperbilirubenia or jaundice Iodides – enlargement of thyroid or goiter Thalidomides – Amelia or pocomelia. slight hypertrophy of ventricles. enlarged lymph nodes. inhibit growth of long bone Vitamin K – hemolysis (destr of RBC). D. Hepa A or infectious heap – oral/ fecal (hand washing) Hepa B. epistaxis – due to hyperemia of nasal membrane palpitation. 2. fetal alcohol withdrawal syndrome char by microcephaly Smoking – low birth rate Caffeine – low birth rate Cocaine – low birth rate. T – toxoplasmosis – mom takes care of cats. increase heart workload. Don’t get pregnant for 3 months. Nails extend to fingers Ninth Month lanugo & vernix caseosa completely disappear Amniotic fluid decreases Tenth Month – bone ossification of fetal skull Terratogens. the exposure to such may cause damage to the fetus A. C. Herpes simples virus. mom will be given rubella vaccine. after delivery. Physiologic Anemia – pseudo anemia of pregnant women Normal Values Hct 32 – 42% Hgb 10.3.pathologic anemia if lower HCT should not be 33%. Drugs: Streptomycin – anti TB & or Quinine (anti malaria) – damage to 8th cranial nerve – poor hearing & deafness Tetracycline – staining tooth enamel. HIV – blood & body fluids Syphilis R – rubella – German measles – congenital heart disease (1st month) normal rubella titer 1:10 <1:10 – less immunity to rubella.5 – 14g/dL Criteria 1st and 3rd trimester. Feces of cat go to raw vegetables or meat O – others. E. influenza like findings. Rubella. absence of extremities Steroids – cleft lip or palate Lithium – congenital malformation Alcohol – lowered weight (vasoconstriction on mom). TORCH (Terratogenic) Infections – viruses CHARACTERISTICS: group of infections caused by organisms that can cross the placenta or ascend through birth canal and adversely affect fetal growth and development. Systemic Changes 1. Physiological Adaptation of the Mother to Pregnancy A.any drug. Cytomegalo virus. 1. Other. In some chases the infection may go unnoticed in the pregnant woman yet have devastating effects on the fetus.

pressure on gravid uterus.) Bed rest Never massage Assess + Homan sign once only might dislodge thrombus Give anticoagulant to prevent additional clotting (thrombolytics will dilute) Monitor APTT antidote for Heparin toxicity.) 3. green leafy vegetable-alugbati. black stool. Nausea afternoon . Varicosities – pressure of uterus .) 6. Respiratory system – common problem SOB due to enlarged uterus & increase O2 demand Position. 10 . F&E imbalance – primary med mgt – replace fluids. .Assessment reveals: • Pallor.thrombus formation candidate outstanding sign – (+) Homan's sign – pain on cuff during dorsiflexion milk leg – skinny white legs due to stretching of skin caused by inflammation or phlagmasia albadolens Mgt: 1. malunggay. • Oral Iron supplements (ferrous sulfate 0.position – side lying with pillow under hips or modified knee chest position Thrombophlebitis – presence of thrombus at inflamed blood vessel . hematoma.increase fibrinogen .if improperly administered. 3. constipation • Slowed capillary refill • Concave fingernails (late sign of progressive anemia) due to chronic physio hypoxia Nursing Care: • Nutritional instruction – kangkong. 3 times a day) empty stomach 1 hr before meals or 2 hrs after.pregnant mom hyperfibrinogenemia .painful. constipation • Monitor for hemorrhage Alert: • Iron from red meats is better absorbed iron form other sources Iron is better absorbed when taken with foods high in Vit C such as orange juice Higher iron intake is recommended since circulating blood volume is increased and heme is required from production of RBCs • • Edema – lower extremities due venous return is constricted due to large belly. Z tract. ampalaya • Parenteral Iron ( Imferon) – severe anemia.lateral expansion of lungs or side lying position.use support stockings.3 g.use elastic bandage – lower to upper Vulbar varicosities. avoid wearing knee high socks .small freq feeding.increase clotting factor . Vomiting in preg – emesisgravida.saluyot. to relieve.iron deficiency anemia is the most common hematological disorder.) 4. 2.Hgb Shdn't < 10. Metabolic alkalosis. liver due to ferridin content. give IM. Eat dry crackers or dry CHO diet 30 minutes before arising bed. Gastrointestinal – 1st trimester change • Morning Sickness – nausea & vomiting due to increase HCG.) 2.5% pathologic anemia if lower Pathogenic Anemia . horseradish. elevate legs above hip level. protamine sulfate Avoid aspirin! Might aggravate bleeding. It affects toughly 20% of pregnant women.) 5.

pineapple. seafood-tahong (mussels). Musculoskeletal Lordosis – pride of pregnancy Waddling Gait – awkward walking due to relaxation – causes softening of joints & bones Prone to accidental falls – wear low heeled shoes Leg Cramps – causes: prolonged standing. Carcinogenic drug so don’t give at 1st trimester 1. increase fiber diet . chills. Cheese. hot sitz bath for comfort 4. suha. crab. brocolli. Mgt.fruits – papaya. treat dad also to prevent reinfection 2. fungal infection. sips of milk. Increase fluid intake. lobster. Ca & phosphorous imbalance(#1 cause while pregnant). head of fish. proper body mechanical increase salivation – ptyalsim – mgt mouthwash *Hemorrhoids – pressure of gravid uterus. malungay.exercise -mineral oil – excretion of fat soluble vitamins * Flatulence – avoid gas forming food – cabbage * Heartburn – or pyrosis – reflux of stomach content to esophagus . resp for leucorrhea OPERCULUM – mucus plug to seal out bacteria. cantaloupe. avoid 3 full meals. pressure of gravid uterus (labor cramps) at lumbo sacral nerve plexus Mgt: Increase Ca diet-milk(Inc Ca & Inc phosphorus)-1pint/day or 3-4 servings/day. sardines with bones. mousy odor discharge ESTROGEN – hormone. Local Changes Local change: Vagina: V – Chadwick’s sign – blue violet discoloration of vagina C – Goodel's sign – change of consistency of cervix I – Hegar's – change of consistency of isthmus (lower uterine segment) LEUKORRHEA – whitish gray. watermelon. Except guava – has pectin that’s constipating – veg – petchy. mango. no alcohol – has antibuse effect VAGINAL DOUCHE – IQ H2O : 1 tbsp white vinegar b. Moniliasis or candidiasis due to candida albecans. Vaginitits – trichomonas vaginalis due to alkaline environment of vagina of pregnant mom Flagellated protozoa – wants alkaline S&Sx: Greenish cream colored frothy irritatingly itchy with foul smelling odor with vaginal edema Mgt: FLAGYL – (metronidazole – antiprotozoa). . yogurt. over fatigue. oversex.small frequent feeding. Vit D for increased Ca absorption dorsiflexion B. apple with skin. Urinary System – frequency during 1st & 3rd trimester lateral expansion of lungs or side lying pos – mgt for nocturia Acetyace test – albumin in urine Benedicts test – sugar in urine 5. 11 . PROGESTERONE – hormone responsible for operculum PREGNANT – acidic to alkaline change to protect bacterial growth (vaginitis) Problems Related to the Change of Vaginal Environment: a. Dilis.Monitor I&O constipation – progesterone resp for constipation. avoid fatty & spicy food.

Psychological Adaptation to Pregnancy (Emotional response of mom –Reva Rubin theory) 12 . Brown pinkish line. umbilicus is protruding 3. genshan violet. Ballotment sign of myoma * + HCG – sign of H mole . B. C.blue violet discoloration of vagina Fatigue Hegar's. cheeks – chloasma melasma due to increased melanocytes. Objective Positive Signs – undeniable signs confirmed by the use of instrument.change of consistency of isthmus Amenorrhea Elevated BBT – due to increased progesterone Morning sickness Positive HCG or (+)preg test Enlarged uterus Ballottement – bouncing of fetus when lower uterine is tapped sharply Cloasma Enlarged abdomen Linea negra Braxton Hicks contractions – painless irregular contractions Increased skin pigmentation Striae gravidarium Quickening A. Breast Changes – increase hormones. Ovaries – rested during pregnancy Signs & symptoms of Pregnancy Presumptive – s/s felt and observed by the mother but does not confirm positive diagnosis of pregnancy .7 days after mens –– supine with pillow at back quadrant B – upper outer – common site of cancer Test to determine breast cancer: 1. Empty bladder .change of consistency of cervix Urinary freq Chadwick’s.Color – white cheese like patches adheres to walls of vagina.symphisis pubis to umbilicus 4. 7. mammography – 35 to 49 yrs once every 1 to 2 yrs 50 yrs and above – 1 x a yr 6. Abdominal Changes – striae gravidarium (stretch marks) due enlarging uterus-destruction of sub Q tissue – avoid scratching. Skin Changes – brown pigmentation nose chin. use coconut oil. cotrimaxole. Signs & Symptoms: Management – antifungal – Nistatin.trans vaginal ultrasound. canesten Gonorrhea -Thick purulent discharge Vaginal warts.condifoma acuminata due to papilloma virus Mgt: cauterization 2. color of areola & nipple pre colostrums present by 6 weeks. Subjective Probable – signs observed by the members of health team.there is calcium Presumptive Probable Breast changes Goodel's.ultrasound – full bladder placental grading – rating/grade o – immature 1 – slightly mature 2 – moderately mature 3 – placental maturity What is deposited in placenta which signify maturity . Positive Ultrasound evidence (sonogram) full bladder Fetal heart tone Fetal movement Fetal outline Fetal parts palpable VII. colostrums at 3rd trimester Breast self exam.linea nigra.

Developmental task – accept growing fetus as baby to be nurtured. Para . fantasy.5 – 1lb/month) (4 lbs/month) (1 lb/wk) (4 lbs/ month) ( 1lb/wk) 4.5 – 3 lbs 10 – 12 lbs 10 – 12 lbs (. BP. Most common fear – let mom listen to FHT to allay fear Lamaze classes VII. Gravida. (increase wt – 1st sign preeclampsia) Weight Monitoring First Trimester: Normal Weight gain Second trimester: normal weight gain Third trimester: normal weight gain Minimum wt gain – 20 – 25 lbs Optimal wt gain – 25 – 35 lbs 1. age (high risk < 18 & >35 yrs old) record to determine high risk – HBMR.# of pregnancy b.best to get urine exam.) urine exam to detect HCG at 40 – 100th day. education background – level knowledge 3. Health teaching: growth & development of fetus. Frequency of Visit: 1st 7 months – 1x a month 8 – 9 months – 2 x a month 10 – once a week post term 2 x a week 2. Third Trimester: .First Trimester: No tanginal signs & sx. ambivalence. denial – sign of maladaptation to pregnancy. Pre-Natal Visit: 1.) Elisa test – test for preg detects beta subunit of HCG as early as 7 – 10days 3. Developmental task is to accept biological facts of pregnancy Focus: bodily changes of preg. 2. religion. Sex ( pseudocyesis or false pregnancy on men & women) Couvade syndrome – dad experiences what mom goes through – lihi) Address. 60 – 70 day peak HCG. Diagnosis of Pregnancy 1. HT: responsible parenthood ‘baby’s Layette” – best time to do shopping. mom identifies fetus as a separate entity – due to presence of quickening. nutrition Second Trimester – tangible S&Sx. age of viability . Preterm -20 – 37 weeks abortion <20 weeks Sample Cases: 1 – abortion GTPAL 1 – 2nd mo 2 0 01 0 G–2 P–0 1 – 40th AOG 1 – 36th AOG 2 – misc 1 – twins 1 – 4th month GT P A L 612 2 4 35 AOG G6 P3 13 . surprise. culture & beliefs with respect. civil status. non judgmental Occupation – financial condition or occupational hazards. monitor wt. Home base mom’s record.# of viable pregnancy Viability – the ability of the fetus to live outside the uterus at the earliest possible gestational age.) Home preg kit – do it yourself Baseline Data: V/S esp.mom has personal identification on appearance of baby Development task: prepare of birth & parenting of child. 5. 6 weeks after LMP. Obstetrical Data: nullipara – no pregnancy a.20 – 24 wks Term 37 – 42 wks. Personal data – name.

3 months – above sym pub 5 months – level of umbilicus 9 months – below zyphoid 10 months – level of 8 months due to lightening 4. Begin TT3 TT1 – any time during pregnancy TT2 – 4 wks after TT1 – 3 yrs protection TT3 – 6 months after TT2 – 5 yrs protection TT4 – 1 yr after TT3 – 10 yrs protection TT5 – yr after TT4 – lifetime protection 5.1 – 39th week 1 – miscarriage 1 – stillbirth 33 AOG (considered as para) 1 – preg 3rd wk 1 – 33 P 1 41st L 1 – abort A 1 – still 39 1 triplet 32 1 4th mon c. 04 +9 +7 10 / 32 / 04 . Physical Examination: 14 . McDonald’s Rule – to determine age of gestation IN WEEKS FUNDIC HT X 7/8=AOG in WK Fundic Ht X 7 = AOG in weeks 8 Fr sypmhisis pubis to fundus 24 X 7 =21 wks 8 3. Formula: 1st ½ of preg . Haases rule – to determine length of the fetus in cm. x @ month by 5 3mos x 3 = 9cm 4 mos x 4 = 16 cm 10 x 5 = 50 cm 1st ½ of preg 5 x 5 = 25 cm 6 x 5 = 30 cm 7 x 5 = 35 cm 8 x 5 = 40 cm 9 x 5 = 45 cm d. Bartholomew’s Rule – to determine age of gestation by proper location of fundus at abdominal cavity. 2nd ½ of preg tetanus immunizations – prevents tetanus neonatum -mom with complete 3 doses DPT young age considered as TT1 & 2. Important Estimates: GP GTPAL 4 2 4 11 1 1 GP GTPAL 6 4 6 2 2 15 1. Nagele’s Rule – use to determine expected date of delivery Get LMP -3+ 7 +1 Apr-Dec M D Y LMP Jan 25. square @ month 2nd ½ of preg.1 add 1 month to month 11/31/04 EDD LMP – Jan Feb Mar +9 +7 no year 2.

abortion. put towel under head and right hip.use palm! Warm palm. Get V/S(before 2nd maneuver) PR to diff fundic soufflé (FHR) & uterine soufflé. position.composed of squamous columnar tissue Result: Class I . with both hands palpate upper abdomen and fundus. Empty bladder Position of mom-supine with knee flex (dorsal recumbent – to relax abdominal muscles) Procedure: 1st maneuver: place patient in supine position with knees slightly flexed. Assess whether the presenting part is engaged in the pelvis )Alert : if the head is engaged it will not be movable). Prep mom: 1. 6.A. empty bladder 2. an estimate of the size. universal precaution EXT OS of cervix – site for getting specimen Site for cervical cancer Pap Smear – cervical cancer . Uterine soufflé – maternal H rate 3rd Maneuver: using the right hand.normal Class IIA – acytology but no evidence of malignancy B – suggestive of infl. presenting part. identify the back of the fetus ( to hear fetal heart sound) where the ball of the stethoscope is placed to determine FHT. movement and firmness of the part to determine presentation 2nd Maneuver: with both hands moving down. grasp the symphis pubis part using thumb and fingers. E – edema to upper ext. incompetent cervix 3rd – placental anomalies S – sudden gush of fluid – PROM (premature rupture of membrane) prone to inf. Examine teeth: sign of infection Danger signs of Pregnancy C . shape. Class III – cytology suggestive of malignancy Class IV – cytology strongly suggestive of malignancy Class V – cytology conclusive of malignancy Stages of Cervical Cancer Stage 0 – carcinoma insitu 1 – cancer confined to cervix 2 . fetal presentation lie. ectopic pre/2nd – H mole. Assess size. fetal back & fetal heart tone . 15 . 2.infection Cerebral disturbances ( headache – preeclampsia) A – abdominal pain ( epigastric pain – aura of impending convulsions B – boardlike abdomen – abruption placenta Increase BP – HPN Blurred vision – preeclampsia Bleeding – 1st trimester. To determine degree of engagement.cancer extends to vagina 3 – pelvis metastasis 4 – affection to bladder & rectum 7. degree of descent. (preeclampsia) Pelvic Examination – internal exam 1. Leopold’s Maneuver Purpose: is done to determine the attitude. and number of fetuses.chills/ fever .

Examples: nonstress test (NST). tocotransducer over fundus to detect uterine contractions and fetal movements (FMs) 2.) less then 10 movements in 12 hours(non-reactive.) movement are becoming weaker. often require further testing. the head is extended.) warning signs noted during DFMC c.) pregnancy induced hypertension (PIH). noting how long it takes to count 10 fetal movements (FMs) (2) Expected findings – 10 movements in 1 hour or less 3) Warning signs a. When the brow is on the same side as the small parts.) more then 1 hour to reach 10 movements b. Daily Fetal Movement Counting (DFMC) –begin 27 weeks Mom.) maternal history of smoking.) longer time to reach 10 FMs than on previous days d. the head will be flexed and vertex presenting. With two hands. such as a CST Result: Noncreative Nonstress Not Good Reactive Responsive is Real Good 16 . external monitor is applied to document fetal activity. mother activates the “mark button” on the electronic monitor when she feels fetal movement. less vigorous Movement alarm signals . When the brow is on the same side as the back. Attitude – relationship of fetus to a part – or degree of flexion Full flexion – when the chin touches the chest 8. ultrasound transducer over abdominal site where most distinct fetal heart sounds are detected 3. after breakfast) and count each fetal movement.fetal distress) c.begin after meal . biographical profile (BPP) B. inadequate nutrition Procedure: Done within 30 minutes wherein the mother is in semi-fowler’s position (w/ fetal monitor). Nonstress test – to determine the response of the fetal heart rate to activity Indication – pregnancies at risk for placental insufficiency Postmaturity a.breakfast a. monitor until at least 2 FMs are detected in 20 minutes • if no FM after 40 minutes provide woman with a light snack or gently stimulate fetus through abdomen • if no FM after 1 hour further testing may be indicated. assess the descent of the presenting part by locating the cephalic prominence or brow. diabetes b. To determine attitude – relationship of fetus to 1 another.) warning signs should be reported to healthcare provider immediately.< 3 FMs in 12 hours 4. Attach external noninvasive fetal monitors 1. Cardiff count to 10 method – one method currently available (1) Begin at the same time each day (usually in the morning.Assessment of Fetal Well-BeingA.4th Maneuver: the Examiner changes the position by facing the patient’s feet.

Good variability – normal irregularity of cardiac rhythm representing a balanced interaction between the parasympathetic (decreases FHR) and sympathetic (increase FHR) nervous system.dairy products : milk. milk .Begin increase in second trimester .utilization of nutrients activity level grains. fruits) . fat and protein are used for energy. lasting at least 15 seconds in a 10 to 20 minute period as a result of FM 3. Interpretation of results reactive result 1. (Decrease folic acid – spina bifida/open neural tube defect) How many Kcal CHO x4.Development of essential pregnancy structures .Development of structures intake. Nutrition – do nutritional assessment – daily food intake High risk moms: 1. amniotic fluid. Vegetarian mom – decrease CHON – needs Vit B12 – cyanocobalamin – formation of folic acid – needed for cell DNA & RBC formation. complex carbohydrates (whole . biophysical profile. yogurt.Lean meat. cheese.1200 mg/day representing an increase of 50% above prepregnancy daily requirement. Pregnant teenagers – low compliance to heath regimen. .Foods of high nutrient value such as .Formation of red blood cells and plasma proteins * Inadequate protein intake has been associated with onset of pregnancy induces hypertension (PIH) Calcium-Phosphorous Essential for .protein sparing so it can be used .Whole grains * vegetarians must take note of the amino acid content of CHON foods consumed to ensure ingestion of sufficient quantities of all amino acids Calcium increases of . Low socio – economic status 4. nuts . fish . ice cream. over wt – candidate for HPN.Eggs. Baseline FHR between 120 and 160 beats per minute 2.Use weight – gain pattern as an sources for the nutrients requiring . Health teachings a. At least two accelerations of the FHR of at least 15 beats per minute.Growth of fetus indication of adequacy of calorie during pregnancy .Fetal tissue growth . fats x 9 Recommended Nutrient Requirement that increases During Pregnancy Requirements Food Source Calories 300 calories/day above the prepregnancy Caloric increase should reflect Essential to supply energy for daily requirement to maintain ideal body .Dried beans. DM 3.Growth and development of fetal skeleton and tooth buds .Maternal tissue growth including uterus and breasts . 2.i.Maintenance of mineralization 60 mg/day or an increase of 10% above daily requirements for age group Adolescents have a higher protein requirement than mature women since adolescents must supply protein for their own growth as well as protein t meet the pregnancy requirement Protein increase should reflect . cheese.Variety of foods representing foods for . Requires further evaluation with another NST. noted as an uneven line on the rhythm strip. Nutrients Protein Essential for: . tofu . Nonreactive result 1. . Stated criteria for a reactive result are not met 2.Failure to meet caloric placenta. Extremes in wt – underweight.CHON x4. lentils.whole grains.1600 mg/day is recommended for Calcium increases should reflect: . vegetables. and requirements can lead to ketosis as tissue growth. ketosis has been associated with fetal damage. result indicates a healthy fetus with an intact nervous system ii.green leafy vegetables 17 .increased metabolic rate weight and meet energy requirement to protein. egg yolk . 4.No more than 30% fat required for pregnancy including . (BPP) or contraction stress test (CST) 9. Could be indicative of a compromised fetus. poultry.

broccoli. peanuts 175 mcg/day 320 mg/day 65 mcg/day 10 mg/day 1.formation of red blood cells and prevention of anemia .vitamin C sources: citrus fruits & juices. meats . potatoes .shell fish . dried fruits .Selenium Vitamins E Thiamine Riborlavin Pyridoxine ( B6) B12 Niacin 2. Hard to excrete. abruption placenta Additional Requirements Minerals .) should be done in moderation 30 mg/day representing a doubling of the pregnant daily requirement . 10 mcg/day of vitamin D is required since it enhances absorption of both calcium and phosphorous - canned salmon & sardines w/ bones Ca fortified foods such as orange juice Vitamin D sources: fortified milk. Taking it not needed – fat soluble vitamins.dark green leafy vegetables.liver.60 – 120 mg/day along with copper and zinc supplementation for women who have low hemoglobin values prior to pregnancy or who have iron deficiency anemia. 400 mcg/day representing an increase of more then 2 times the daily prepregnant requirement. legumes. decreased energy and appetite. Folate Essential for . cheese . seafood Zinc Essential for * the formation of enzymes * maybe important in the prevention of congenital malformation of the fetus. kidney.of maternal bones and teeth .liver. red meat. Folacin. legumes. strawberries.70 mg/day of vitamin C which enhances iron absorption .iron from food sources is more readily absorbed when served with foods high in vit C Zinc increases should reflect .liver. . broccoli or cabbage.Sexual Activity a. . veal . egg yolk. legumes . liver. 300mcg/day supplement for women with low folate levels or dietary deficiency 4 servings of grains/day Iron increases should reflect . eggs . may play a role in the prevention of neutral tube defects (spina bifida). Folic Acid.Current research is : Demonstrating an association between adequate calcium intake and the prevention of pregnancy induce hypertension Iron Essential for .inadequate iron intake results in maternal effects – anemia depletion of iron stores.fetal effects decreased availability of oxygen thereby affecting fetal growth * iron deficiency anemia is the most common nutritional disorder of pregnancy. cantaloupe. margarine. milk.iodine .Magnesium . nuts Increases should reflect . fish.Begin supplementation at 30mg/day in second trimester. 18 .DNA synthesis and cell formation.2 mg/day 2.6 mg/day 2.enriched. since diet alone is unable to meet pregnancy requirement . lean beef.Whole grains.2 mg day 17 mg/day Increased requirements of pregnancy can easily be met with a balanced diet that meets the requirement for calories and includes food sources high in the other nutrients needed during pregnancy.whole grains.eggs. whole grain cereals and breads .nuts. cardiac stress especially labor and birth . poultry. 15mcg/day representing an increase of 3 mg/day over prepreganant daily requirements. butter.dark green leafy vegetables.Expansion of blood volume and red blood cells formation . Vit stored in body.Establishment of fetal iron stores for first few months of life the adolescent.5 mg/day 1. abortion.

) should be done in private place c. Psychosexual 1. Four extremities on floor - Kegel Exercise – strengthen pulococcygeal muscles .b.) changes in sexual desire of mom during preg.) avoided 6 weeks prior to EDD e.) Must be individualized Walking – best exercise Squatting – strengthen muscles of perineum.) mom placed in comfy pos.) darkened rm 2.) Done in moderation.air embolism Changes in sexual desire: a. premature rupture of membrane 3. a. Psychoprophylaxis – prevention of pain 19 .) quiet environment 3. Kitzinger method – preg.) closed eye & appearance of sleep 2. release 10x or muscle contraction Abdominal Exercise – strengthens muscles of abdominal – done as if blowing candle 4.) 3rd trimester – decreased desire Contraindication in sex: 1.) relaxation tech 4. incompetent cervix 3. Grantly Dick Read Method – fear leads to tension while tension leads to pain b.exercise – relieves low back pain & maintain good posture * arch back – standing or kneeling. Squat – feet flat on floor Tailor Sitting – 1 leg in front of other leg ( Indian seat) Raise buttocks 1st before head to prevent postural hypotension – dizziness when changing position shoulder circling exercise.strengthen chest muscles pelvic rocking/pelvic tilt.) avoid blowing or air during cunnilingus f.) 2nd trimester – increased desire due to increase estrogen that enhances lubrication c. Childbirth Preparation: Overall goal: to prepare parents physically and psychologically while promoting wellness behavior that can be used by parents and family thus. 2. Robert Bradley – advocated active participation of husband at delivery process. preterm labor 4. Exercise – to strengthen muscles used during delivery process principles of exercise 1.) 1st tri – decrease desire – due to bodily changes b. Based on imitation of nature.flow with contraction than struggle with contraction c. labor & birth & care of newborn is an impt turning pt in woman’s life cycle . Psychophysical 1. Bradley Method – Dr.as if hold urine. sidelying or mom on top d. helping them achieved a satisfying and enjoying childbirth experience. Increase circulation to perineum. Features: 1. vaginal spotting 1st trimester – threatened abortion 2nd trimester– placenta previa 2.

) coronal suture – connect parietal & frontal bone (crown) 3. Husband is coach Features: 1. bimastoid 7cm smallest transverse Sutures – intermembranous spaces that allow molding. 3 x 4 cm.sinciput E – ethmoid O – occuputal .( > 5 cm – hydrocephalus). Bones – 6 bones S – sphenoid F – frontal . complete flexion. Birth under H20 – bathtub – labor & delivery – warm water. disciple.) 4. Closes – 2 – 3 months. 1 Theories of the Onset of Labor 1. quiet. Cleansing breathe – inhale nose.bitemporal 8 cm 2. soft music.) Posterior fontanel or lambda – triangular shape.) 2. 1.) uterine stretch theory ( any hallow organ stretched. conditioning & concentration.close 2. age. dark. Conscious relaxation 2. will always contract & expel its content) – contraction action 2. After delivery.) theory of aging placenta – life span of placenta 42 wks.) oxytocin theory – post pit gland releases oxytocin.2. decrease progesterone will stimulate contractions & labor 5. Fetal head – is the largest presenting part – common presenting part – ¼ of its length. The 4 P’s of labor 1. IX.) lambdoidal suture – connects occipital & parietal bone Moldings: the overlapping of the sutures of the skull to permit passage of the head to the pelvis Fontanels: 1.25cm . Admitting the laboring Mother: Personal Data: name. Lamaze: Dr. baby gets warm bath.) sagittal suture – connects 2 parietal bones ( sagitna) 2.viable preg.) 5.biparietal – largest transverse .) Anteroposterior diameter suboccipitobregmatic 9. b.) 3.) Different Methods of delivery: birthing chair – bed convertible to chair – semifowlers birthing bed – dorsal recumbent pos squatting – relives low back pain during labor pain leboyers – warm.) progesterone theory – before labor. imaging – sensate focus 5. address. – 22 – 24 wks Physical Exams. etc Baseline Data: v/s esppecially BP. diamond shape.) Anterior fontanel – bregma. 1 x 1 cm.5 cm hyper extension submentobragmatic-face presentation 20 . exhale mouth 3.5 cm. Effleurage – gentle circular massage over abdominal to relieve pain 4.contraction 4. Hypothalamus produces oxytocin 3. b.) prostaglandin theory – stimulation of arachidonic acid – prostaglandin.Pelvic Exams B. comfy room. weight Obstetrical Data: gravida # preg. 4. Passenger a. transverse diameter – 9. para.1.occiput T – temporal P – parietal 2 x Measurement fetal head: 1. At 36 wks degenerates (leading to contraction – onset labor). 1. Ferdinand Lamaze req. Basic knowledge in Intrapartum. Intrapartal Notes – inside ER A. 12 – 18 months after birth. smallest AP occipitofrontal 12cm partial flexion occipitomental – 13.

Pelvis at 10 cm or more. Involuntary Contractions b. intensity 4. Characteristics: wave like d. Passageway Mom 1.0 cm 3. wide. duration.) < 4’9” tall 2.ischial tuberosity where we sit – landmark to get external measurement of pelvis Pubes – ant portion – symphisis pubis junction between 2 pubis 1 sacrum – post portion – sacral prominence – landmark to get internal measurement of pelvis 1 coccyx – 5 small bones compresses during vaginal delivery Important Measurements 1. Increase Activity of the Mother. Ischial tuberosity – approximated with use of fist – 8 cm & above.nesting instinct. Tuberoischi Diameter – transverse diameter of the pelvic outlet. Gynecoid – round. transverse – wider b.) < 18 years old 3.anterior part pointed. Cultural Interpretation b. Psyche/Person – psychological stress when the mother is fighting the labor experience a.setting of presenting part into pelvic inlet 2.2 weeks prior to EDD * Engagement. Ripening of the Cervix – butter soft 5. (DC – 11. Anthropoid – oval. Power – the force acting to expel the fetus and placenta – myometrium – powers of labor a. Check FHT Premature Rupture of Membrane ( PROM) . Bloody Show – pinkish vaginal discharge – blood & leukorrhea 7. Timing: frequency. Past Experience d. Support System Pre-eminent Signs of Labor S&Sx: . Platypelloid – flat AP diameter – narrow.5 cm basis in getting true conjugate.5 cm . Diagonal Conjugate – measure between sacral promontory and inferior margin of the symphysis pubis.12. decreased body wt – 1. posterior part shallow 3. Save energy. Measurement: 11.5 – 3 lbs 6.shooting pain radiating to the legs . Preparation c.2. AP diameter wider transverse narrow 4.) Underwent pelvic dislocation Pelvis 4 main pelvic types 1.do IE to check for cord prolapse 21 . Android – heart shape “male pelvis”. deeper most suitable (normal female pelvis) for pregnancy 2. Rupture of Membranes – rupture of water.iliac crest – flaring superior border forming prominence of hips Ischium – inferior portion . oval shape. Braxton Hicks Contractions – painless irregular contractions 3. Increase epinephrine 4. True conjugate/conjugate vera – measure between the anterior surface of the sacral promontory and superior margin of the symphysis pubis. Voluntary bearing down efforts c. will be used for delivery. Pelvis 2 hip bones – 2 innominate bones 3 Parts of 2 Innominate Bones Ileum – lateral side of hips . Obstetrical conjugate – smallest AP diameter.5 cm=true conjugate) 2. Lightening – setting of presenting part into pelvic brim . ape like pelvis.urinary freq. 3. 1. Measurement: 11.

Unit used is cm. Slip cord away from presenting part 3. Administer Analgesics (Morphine) Attempt manual rotation for ROP or LOP – most common malposition Bear down with contractions Adequate hydration – prepare for CS Sedation as ordered Cesarean delivery may be required. Duration of Labor Primipara – 14 hrs & not more than 20 hrs Multipara – 8 hrs & not > 14 hrs Effacement – softening & thinning of cervix. Danger signs: PROM Presenting part has not yet engaged Fetal distress Protruding cord form vagina Nursing care: 1.Contraction drop in intensity even though very painful Contraction drop in frequently Uterus tense and/or contracting between contractions Abdominal palpations Nursing Care. Use % in unit of measurement Dilation – widening of cervix. especially if fetal distress is noted Cord Prolapse – a complication when the umbilical cord falls or is washed through the cervix into the vagina. First Stage: onset of true contractions to full dilation and effacement of cervix. lower uterine – isthmus 1.fundus 2. Cover cord with sterile gauze with saline to prevent drying of cord so cord will remain slippery & prevent cord compression causing cerebral palsy. Count pulsation of cord for FHT 4. Latent Phase: Assessment: Dilations: 0 – 3 cm mom – excited. Prep mom for CS Positioning – trendelenberg or knee chest position Emotional support Prepare for Cesarean Section Difference Between True Labor and False Labor False Labor True Labor Irregular contractions Contractions are regular No increase in intensity Increased intensity Pain – confined to Pain – begins lower back radiates to abdomen abdomen Pain – intensified by walking Pain – relived by walking Cervical effacement & dilatation * major sx No cervical changes of true labor. can communicate Frequency: every 5 – 10 min Intensity mild Nursing Care: 22 . upper uterine . Nursing Interventions in Each Stage of Labor 2 segments of the uterus 1. apprehensive. 2.

fears losing control of self Frequency q 3-5 min lasting for 30 – 60 seconds Nursing Care: M – edications – have meds ready A – ssessment include: vital signs. Shoulder presentation. c. breast lie on thigh Incomplete Breech – thigh rest on abdominal Frank – legs extend to head Footling – single. D – dry lips – oral care (ointment) dry linens B – abdominal breathing Transitional Phase: Assessment: Dilations 8 – 10 cm Frequency q 2-3 min contractions Durations 45 – 90 seconds intensity: strong Mom – mood changes with hyperesthesia Hyperesthesia – increase sensitivity to touch.2 station = presenting part 2 cm above ischial spine if (-) floating 0 station = level at ischial spine – engagement + 1 station = below 1 cm ischial spine +3 to +5 = crowning – occurs at 2nd stage of labor b. double Kneeling b. Variety: 23 . Position – relationship of the fatal presenting part to specific quadrant of the mother’s pelvis. etc. pain all over Health Teaching : teach: sacral pressure on lower back to inhibit transmission of pain keep informed of progress controlled chest breathing Nursing Care: T – ires I – nform of progress R – estless support her breathing technique E – ncourage and praise D – iscomfort Pelvic Exams Effacement Dilation a. 3. Transverse Lie (Perpendicular) or Perpendicular lie.1.shorten 1st stage of labor 2. Longitudinal Lie ( Parallel) cephalic Vertex – complete flexion Face Brow Poor Flexion Chin Breech Complete Breech – thigh breast on abdomen. Active Phase: Assessment: Encourage to void q 2 – 3 hrs – full bladder inhibit contractions Breathing – chest breathing Dilations 4 -8 cm Intensity: moderate Mom.1. Encourage walking .1 station = presenting part 1cm above ischial spine if (-) floating .2. fetal monitor. Presentation/lie – the relationship of the long axis (spine) of the fetus to the long axis of the mother -spine of mom and spine of fetus Two types: b. cervical dilation and effacement. Station – landmark used: ischial spine .

use sacrum .)To cleanse bowel b.to prevent laceration. If BP increase . RMA. RADA LSA – left sacro anterior LST. RSA. notify MD -preeclampsia Health teachings 1.put stet above umbilicus Shoulder/acromniodorso LADA. complete dilation and effacement to birth. Second Stage: fetal stage. 7 – 8 multi – bring to delivery room 10cm primi – bring to delivery room Lithotomy pos – put legs same time up Bulging of perineum – sure to come out Breathing – panting ( teach mom) Assist doc in doing episiotomy.) Ok to shower 2. RST. 24 .strength of contraction Contraction – vasoconstriction Increase BP. LADP. RMT. RMP. decrease FHT Best time to get BP & FHT just after a contraction or midway of contractions Placental reserve – 60 sec o2 for fetus during contractions Duration of contractions shouldn’t >60 sec Notify MD Mom has headache – check BP. LADT. let mom rest.will cause aspiration 3.)NPO – GIT stops function during labor if with food. RMP Monitoring the Contractions and Fetal heart Tone Spread fingers lightly over fundus – to monitor contractions Parts of contractions: Increment or crescendo – beginning of contractions until it increases Acme or apex – height of contraction Decrement or decrescendo – from height of contractions until it decreases Duration – beginning of contractions to end of same contraction Interval – end of 1 contraction to beginning of next contraction Frequency – beginning of 1 contraction to beginning of next contraction Intensity . shorten 2nd stage of labor.)Prevent infection c.)Sims position/side lying 12 – 18 inch – ht enema tubing Check FHT after adm enema Normal FHT= 120-160 Signs of fetal distress1. LMP. LMT. widen vaginal canal. RSP Chin / Mento LMA. if same BP.)Enema administer during labor a. most painful ROP – squatting pos on mom ROT ROA Breech.) <120 & >160 2.) fetal thrushing – hyperactive fetus due to lack O2 2.) mecomium stain amnion fluid 3.Occipito – LOA left occipito ant (most common and favorable position)– side of maternal pelvis LOP – left occipito posterior LOP – most common mal position. LSP.

Assist MD for episiorapy 11. Third Stage: birth to expulsion of Placenta -placental stage placenta has 15 – 28 cotyledons Placenta delivered from 3-10 minutes Signs of placental separation 1. Nsg care for placenta: 4. Inlet – AP diameter narrow. Flexion 4. Pull shoulder down & up. False pelvis – above the pelvic inlet. give clear liquid-tea. supports uterus during pregnancy Linea Terminales diagonal imaginary line from the sacrum to the symphysis pubis that divides the false and true pelvis. ginger ale. Administer methergine IM (Methylergonovine Maleate) “Ergotrate derivatives 8. Check fundus (if relaxed. Fourth Stage: the first 1-2 hours after delivery of placenta – recovery stage. Fundus rises – becomes firm & globular “ Calkins sign” 2. Extension 6. clear gelatin. Sudden gush of blood Types of placental delivery Shultz “shiny” – begins to separate from center to edges presenting the fetal side shiny Dunkan “dirty” – begin to separate form edges to center presenting natural side – beefy red or dirty Slowly pull cord and wind to clamp – BRANDT ANDREWS MANEUVER Hurrying of placental delivery will lead to inversion of uterus. Flat on bed 12. Check completeness of placenta. less pain easy to repair. transverse diameter wider 2. Chills-due dehydration. 5. Monitor v/s q 15 for 1 hr. identification of baby. 4. Let mom sleep to regain energy. Monitor hpn (or give oxytocin IV) 9. Descent 3. (Support head & remove secretion. Blanket. fast to heal. External rotation 7. 3. Internal Rotation 5.) Will facilitate complete flexion & extension.< 48 hours only – vaginal pack Bolus of Ptocin can lead to hypotension. 25 . possible to reach rectum ( urethroanal fistula) Mediolateral – more bleeding & pain. slow to heal -use local or pudendal anesthesia.Episiotomy – median – less bleeding. Mechanisms of labor 1.)To prevent laceration 2. Cavity Two Major Divisions of Pelvis 1. Ironing the perineum – to prevent laceration Modified Ritgens maneuver – place towel at perineum 1. True pelvis – below the pelvic inlet 2. Lengthening of the cord 3. Engagement 2. Check bp 7. Expulsion Three parts of Pelvis – 1. Check time. hard to repair. 2nd hr q 30 minutes. Check perineum for lacerations 10. Check placement of fundus at level of umbilicus. check cord if coiled. massage uterus) 6. Nursing Care: To prevent puerperal sepsis .

Maternal Observations – body system stabilizes b.maternal effect – exhaustion.) 26 . profuse bleeding. Earliest sign: tachycardia & restlessness Late sign: hypotension Outstanding Nursing dx: fluid volume deficit Post of mom – modified trendelenberg IV – fast drip due fluid volume def Signs of Hypovolemic Shock: Hypotension Tachycardia Tachypnea Cold clammy skin Inversion of the uterus – situation uterus is inside out. Bonding – interaction between mother and newborn – rooming in types 1.If fundus above umbilicus.) Check lochia a.intense excessive contractions resulting to ineffective pushing .) Empty bladder to prevent uterine atony 2. hypovolemic shock if with bleeding. Factors leading to inversion of uterus 1. extensive lacerations.) Straight rooming in baby: 24hrs with mom. at night nursery Complications of Labor Dystocia – difficult labor related to: Mechanical factor – due to uterine inertia – sluggishness of contraction 1. Lochia d. deviation of fundus 1. Fetal effect – fetal distress.) hypotonic – secondary uterine inertia.nsg care: monitor contractions and FHR Precipitate Labor . Give oxytocin.labor of < 3 hrs. Count pad & saturation Fully soaked pad : 30 – 40 cc weigh pad. Perineum – R . Prolonged labor – normal length of labor in primi 14 – 20 hrs Multi 10 -14 hrs > 14 hrs in multi & > 20 hrs in primi . Placement of the Fundus c./diazepam – muscle relaxant 2.edness E. 2. MD will push uterus back inside or not hysterectomy.) hurrying of placental delivery 3.MD administer sedative valium.dema E .) Partial rooming in: baby in morning .slow irregular contraction resulting to ineffective pushing. caput succedaneum or cephal hematoma .cchemosis D – ischarges A – approximation of blood loss. 1 gram=1cc e.) hypertonic or primary uterine inertia .) short cord 2.) ineffective fundal pressure Uterine Rupture Causes: 1.

prone to thrombus formation .<90/60 Crackles – notify MD – pulmo edema – administer oral yutopar 30 minutes before d/c IV Tocolytic (Phil) Terbuthaline (Bricanyl or Brethine) – sustained tachycardia Antidote – propranolol or inderal .Yutopar Hcl) 150mg incorporated 500cc Dextrose piggyback. nose. premature contractions q 10 min 2. effacement of 60 – 80% 3. avoid sex 3. Postpartal Period 5th stage of labor after 24hrs :Normal increase WBC up to 30.beta-blocker If cervix is open – MD – steroid dextamethzone (betamethazone) to facilitate surfactant maturation preventing RDS Preterm-cut cord ASAP to prevent jaundice or hyperbilirubenia.)Previous classical CS 2.) Improper use of oxytocin (IV drip) Sx: a.) sudden pain b. Mom given 6 hrs of labor Multi: 8 – 14. chest pain & frothy sputum prepare: suctioning end stage: DIC disseminated intravascular coagopathy. Hyperfibrinogenia .1.) profuse bleeding c.early ambulation 27 .Boundary bet upper/lower uterine segment BANDL’S pathologic ring – suprapubic depression a. primi 14 – 20 Preterm Labor – labor after 20 – 37 weeks) ( abortion <20 weeks) Sx: 1. empty bladder 4.bleeding to all portions of the body – eyes. If cervix is closed 2 – 3 cm. Monitor: FHT > 180 bpm Maternal BP . Trial Labor – measurement of head & pelvis falls on borderline. etc.000 cumm Puerperium – covers 1st 6 wks post partum Involution – return of repro organ to its non pregnant state.) TAHBSO Physiologic retraction ring . dilation saved by administer Tocolytic agents.) hypovolemic shock d. dilation 2-3 cm Home Mgt: 1. drink 3 -4 glasses of water – full bladder inhibits contractions 5. X.)Large baby 3. consult MD if symptoms persist Hosp: 1.YUTOPAR.) sign of impending uterine rupture Amniotic Fluid Embolism or placental embolism – amniotic fluid or fragments of placenta enters natural circulation resulting to embolism Sx: dyspnea.halts preterm contractions. complete bed rest 2.

Taking hold phase – dependent to independent phase (4 to 7 days). Fundus goes down 1 finger breath/day until 10th day – no longer palpable due behind symphisis pubis 3 days after post partum: sub involuted uterus – delayed healing uterus with big clots of blood.urinary retention with overflow 4. Lochia-bld. Complications: hypovolemic shock.) Insert family planting method common post partum blues/ baby blues present 4 – 5 days 50-80% moms – overwhelming feeling of depression characterized by crying. Mom . moderate amt 2.the first few minutes after delivery is the most critical period in mothers because the increased in plasma volume return to its normal state and thus adding to the workload of the heart. activity is to tell child birth experiences. Taking in phase – dependent phase (1st three days) mom – passive. deciduas.a medium for bacterial growth(puerperal sepsis). c. microorganism. Vaginal and Pelvic Floor c. 2. Ruba – red 1st 3 days present. Provide Emotional Support – Reva Rubia Psychological Responses: a.) Care of newborn 2. fear of bearing down 5.proper hygiene b. hot sitz bath. Prevent complications 1. wbc. Uterus – return to normal 6 – 8 wks. Cervix – cervical opening b.when perineum has healed II. III. Nursing Care: . Genital tract a.1. Letting go – interdependent phase – 7 days & above.Principles underlying puerperium 1. Urinary tract: Bladder – freq in urination after delivery.inability to sleep & lack of appetite.redefines new roles may extend until child grows. Early postpartum hemorrhage– bleeding within 1st 24 hrs. cold compress for immediate pain after 24 hrs. limited amt 3. despondence. Physiologic Changes a. Mgt: 1. This is critical especially to gravidocardiac mothers. cold compress – to prevent bleeding 3.alternate warm & cold compress . Baggy or relaxed uterus & profuse bleeding – uterine atony. Colon: Constipation – due NPO. position prone 2. Alba – créme white 10 – 21 days very decreased amt dysuria . not compress sex.urine collection . birth pain: 1. Nsd & Cs with lochia. – let mom cry – therapeutic.D&C after. mefenamic acid d. cant make decisions. Perineal area – painful – episiotomy site – sims pos. can make decisions HT: 1. Systemic Changes 1. To return to Normal and Facilitate healing A. Cardiovascular System . musty/mousy. Serosa – pink to brown 4 – 9th day.stimulate bladder 3.) massage uterus until contracted 28 . Mom is active. 1. Hemorrhage – bleeding of > 500cc CS – 600 – 800 cc normal NSD 500 cc I.

) exogenous – from outside 1.hysterectomy if with abruption placenta mgt: BT. percreta.cryoprecipitate or fresh frozen plasma II.)endogenous – from within body 2. Inflammation – calor (heat). hydration. 29 . fever Gen mgt: 1. 2nd degree – 1st degree + muscles of vagina 3rd degree – 2nd degree + external sphincter of rectum 4th degree – 3rd degree + mucus membrane of rectum Breast feeding – post pit gland will release oxytocin so uterus will contract.large baby .assess perineum for laceration .mgt episiorapy DIC – Disseminated Intravascular Coagulopathy.) IV fast drip/ oxytocin IV drip 1st degree laceration – affects vaginal skin & mucus membrane. Endometriosis – inflammation of endometrial lining Sx: Abdominal tenderness.from members health team 2.2. .) supportive care – CBR. between & resulting. Acreta – attached placenta to myometrium. paracetamol.) incision on site.) shave 3. culture & sensitivity – for antibiotic prolonged use of antibiotic lead to fungal infection inflammation of perineum – see general signs of inflammation 2 to 3 stitches dislocated with purulent discharge Mgt: Removal of sutures & drainage.) modified trendelenberg 4. TSB. dolor (pain) tumor(swelling) 2. pos. saline.) cold compress 3. Well contracted uterus + bleeding = laceration . Late Postpartum hemorrhage – bleeding after 24 hrs – retained placental fragments Mgt: D&C or manual extraction of fragments & massaging of uterus. Increta – deeper attachment of placenta to myometrium Percreta – invasion of placenta to perimetrium hysterectomy Hematoma – bluish or purple discoloration of SQ tissue of vagina or perineum.degree of laceration .sources of infection 1.) unhealthy sexual practices General signs of inflammation: 1.) anaerobic streptococci – most common .) cold compress every 30 minutes with rest period of 30 minutes for 24 hrs 2. scraping & suturing Infection. D&C except placenta increta.too much manipulation .bleeding to any part of body .pudendal anesthesia Mgt: 1. VITC. rubor (red). cold compress. . purulent discharges 3. Hypofibrinogen.failure to coagulate.

Fowlers – to facilitate drainage & localize infection oxytocin & antibiotic IV. watery.get before arising in bed LAM – lactation amenorrheal method – hormone that inhibits ovulation is prolactin. 99. elastic – long spinnbarkeit Basal Body Temperature 13th day temp goes down before ovulation – no sex .) never advice a permanent method of planning 3.3 months.18 8 Dec 33 -11 22 unsafe days 21 day pill. . Motivate the use of Family Planning 1. she would wait for at least 3 months before attempting to conceive to provide time for the estrogen and progesterone levels to return to normal.) determine one’s own beliefs 1st 2.start 1st day of mens missed 1 pill – take 2 next day Physiologic MethodPills – combined oral contraceptives prevent ovulation by inhibiting the anterior pituitary gland production of FSH and LH which are essential for the maturation and rupture of a follicle. Best method Social Method – 1.) coitus interuptus/ withdrawal .menstruation will come out 4 – 6 months bottle fed 2 – 3 months disadvantage of lam – might get pregnant Symptothermal – combination of BBT & cervical. coitus interfemora – “ipit” 4. coitus reservatus – sex without ejaculation – 3. Alerts on Oral Contraceptive: -in case a mother who is taking an oral contraceptive for almost long time plans to have a baby.discontinue oral contraceptive if there is signs of severe headache as this is an indication of hypertension associated with increase incidence of CVA and subarachnoid hemorrhage.monitor cycle for 1 year . Signs of hypertension Immediate Discontinuation A – abdominal pain C – chest pain 30 .shortest – 18 . breast feeding.start 5th day of mens 28day pill.if a new oral contraceptive is prescribed the mother should continue taking the previously prescribed contraceptive and begin taking the new one on the first day of the next menses. calendar method OVULATION –count minus 14 days before next mens (14 days before next mens) Origoknause formula – .9% effective. stretchable.) method of choice is an individuals choice. Waiting time to become pregnant.least effective method 2.longest – 11 June 26 . . Natural Method – the only method accepted by the Catholic Church Billings / Cervical mucus– test spinnbarkeit & ferning (estrogen) . Consult OB-6mos.-get short test & longest cycle from Jan – Dec .clear.

shorter or longer Uterine inflammation.) chain smoker 2.) Regular pap smear Alerts.headache E – eye problems S – severe leg cramps If mom HPN – stop pills STAT! Adverse effect: breakthrough bleeding Contraindicated: 1. If forgotten for two consecutive days. chills S trings lost.it lessen sexual satisfaction .) Check for string daily 2. it will shorten duration Norplant – has 6 match sticks – like capsules implanted subdermally containing progesterone.most common complications: excessive menstrual flow and expulsion of the device (common problem) .) Monthly checkup 3.never massage injected site.prevents implantation .) extreme obesity 3.) Thrombophlebitis or problems in clotting factors - if forgotten for one day. uterine perforation.parity or # of children. DMPA – depoproveda – has progesterone inhibits LH – inhibits ovulation Depomedroxy progesterone acetate – IM q 3 months . fever. or more days.it gives higher protection in the prevention of STDs Diaphragm – rubberized dome shaped material inserted to cervix preventing sperm to get to the uterus.right time to insert is after delivery or during menstruation primary indication for use of IUD . . if 1 kid only don’t use IUD HT: 1. immediately take the forgotten tablet plus the tablet scheduled that day.) HPN 4. gives highest protection against STD – female condom Alerts: Disadvantage: . ectopic pregnancy Condom – latex inserted to erected penis or lubricated vagina Adv.) proper hygiene 31 .H .5 yrs – disadvantage if keloid skin .as soon as removed – can become pregnant Mechanism and Chemical Barriers Intrauterine Device (IUD) Action: prevents implantation – affects motility of sperm & ovum . .others: P eriod late (pregnancy suspected) Abnormal spotting or bleeding A bdominal pain or pain with intercourse I nfection (abnormal vaginal discharge) N ot feeling well.) DM 5. use another method for the rest of the cycle and the start again. REVERSABLE Ht: 1.

) Avoid sex 3. circlage is removed. NSD Sheridan – permanent surgery cervix.) 4. cramping.) Save discharges – for histopathology – to determine if product of conception has been expelled or not First Trimester Bleeding – abortion or eptopic A. No mgt just emotional support! 2. creams S/effect: Toxic shock syndrome Alerts: Should be kept in place for about 6 – 8 hours Cervical Cap – most durable than diaphragm no need to apply spermicide C/I: abnormal pap smear Foams.) Assess for bleeding (per pad 30 – 40cc) (wt – 1gm =1cc) 4. Habitual – 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix. common site: tubal or ampular Dangerous site . Foam (most effective).) 5. HT: avoid lifting heavy objects Vasectomy – cut vas deferense. Bilateral Tubal Ligation – can be reversed 20% chance.) Incomplete – Placental and membranes retained. CS c. signs of pregnancy cease.) Signs of Hypovolemic shock 6.interstitial Unruptured Tubal rupture 32 . Hemorrhagic Disorders General Management 1. Ectopic Pregnancy – occurs when gestation is located outside the uterine cavity. Missed – fetus dies. HT: >30 ejaculations before safe sex O – zero sperm count. Creams Surgical Method – BTL .) Ultrasound to determine integrity of sac 5. Double effect choose between lesser evil. (-) preg test. safe XI. Mgt: D&C Incompetent cervix – abortion McDonalds procedure – temporary circlage on cervix S/E.) blighted ovum 3. C. jellies.) plasma germ defect Classifications: a. infection.) Complete – all products of conception are expelled. Threatened – pregnancy is jeopardized by bleeding and cramping but the cervix is closed b. product of conception remain in uterus 4 weeks or longer. scanty dark brown bleeding Mgt: induced labor with oxytocin or vacuum extraction 5.) CBR 2. Inevitable – moderate bleeding.) Induced Abortion – therapeutic abortion to save life of mom. Abortions – termination of pregnancy before age of viability (before 20 weeks) Spontaneous Abortion.miscarriage Cause: 1. Barrier ex.) 3. tissue protrudes form the cervix (Cervical dilation) Types: 1.) check for holes before use must stay in place 6 – 8 hrs after sex must be refitted especially if without wt change 15 lbs spermicide – chem. During delivery.2. Jellies. High Risk Pregnancy 1.) chromosomal alterations 2. Present 2nd trimester d.

Hydatidiform Mole “bunch or grapes” or gestational trophoblastic disease. Unilateral radiating to shoulder. IE. Abnormal lower implantation of placenta. . dark brown. The nucleus of the sperm duplicates. sharp. it grows & enlarges the uterus vary rapidly. sometimes covering the cervical os. producing a diploid number 46 XX. vaginal bleeding Nursing care: Vital signs Administer IV fluids Monitor for vaginal bleeding Monitor I & O sudden . RN as witness 33 . This neoplasm is formed form the selling of the chronic villi and lost nucleus of the fertilized egg. Placenta Previa – it occurs when the placenta is improperly implanted in the lower uterine segment. severe pain. Use: methotrexate to prevent choriocarcinoma Assessment: Early signs vesicles passed thru the vagina Hyperemesis gravidarium increase HCG Fundal height Vaginal bleeding( scant or profuse) Early in pregnancy High levels of HCG Preeclampsia at about 12 weeks Late signs hypertension before 20th week Vesicles look like a “ snowstorm” on sonogram Anemia Abdominal cramping Serious complications hyperthyroidism Pulmonary embolus Nursing care: Prepare D&C Do not give oxytoxic drugs Teachings: a.- missed period abdominal pain within 3 -5 weeks of missed period (maybe generalized or one sided) scant. enema – may lead to sudden fetal blood loss Double set up: delivery room may be converted to OR Assessment: Engagement (usually has not occurred) Fetal distress Presentation ( usually abnormal) Surgeon – in charge of sign consent.candidate for CS Sx: frank Bright red Painless bleeding Dx: Ultrasound Avoid: sex. Return for pelvic exams as scheduled for one year to monitoring HCG and assess for enlarged uterus and rising titer could indicative of choriocarcinoma b.gestational anomaly of the placenta consisting of a bunch of clear vesicles. shoulder pain (indicative of intraperitoneal bleeding that extends to diaphragm and phrenic nerve) + Cullen’s Sign – bluish tinged umbilicus – signifies intra peritoneal bleeding syncope (fainting) Mgt: Surgery depending on side Ovary: oophrectomy Uterus : hysterectomy - Second trimester bleeding C. Recurs. – with fertilization. Avoid pregnancy for at least one year Third Trimester Bleeding “Placenta Anomalies” D. Progressive degeneration of chorionic villi. .

L. Three types of pre-eclampsia 1. prepare to administer blood Type and crossmatch Monitor FHR Insert Foley Measure blood loss. J.HPN after 24 wks of pregnancy.+2 2. K.) Gestational hypertension .cord divides into small vessels before it enters the placenta Vasa Previa – velamentous insertion of cord has implanted in cervical OS Hypertensive Disorders F. I. Chronic or pre-existing Hypertension –HPN before 20 weeks not solved 6 weeks post partum.) Mild preeclampsia – earliest sign of preeclampsia a.) increase wt due to edema b. Outstanding Sx: dark red. H. Assessment: Concealed bleeding (retroplacental) Couvelaire uterus (caused by bleeding into the myometrium)-inability of uterus to contract due to hemorrhage. count pads Report s/sx of DIC Monitor v/s for shock Strict I&O Placenta succenturiata – 1 or 2 more lobes connected to the placenta by a blood vessel may lead to retained placental fragments if vessel is cut. It usually occurs after the twentieth week of pregnancy. G.) BP 140/90 c.- MD explain to patient complication: sudden fetal blood loss Nursing Care NPO Bed rest Prepare to induce labor if cervix is ripe Administer IV E. solved 6 weeks post partum. 2.) HELLP syndrome – hemolysis with elevated liver enzymes & low platelet count II. board like or rigid uterus. Transissional Hypertension – HPN between 20 – 24 weeks III. painful bleeding. Pregnancy Induced Hypertension (PIH). Placenta Circumvalata – fetal side of placenta covered by chorion Placenta Marginata – fold side of chorion reaches just to the edge of placenta Battledore Placenta – cord inserted marginally rather then centrally Placenta Bipartita – placenta divides into 2 lobes Vilamentous Insertion of cord.HPN without edema & protenuria H without EP 2.) Pre-eclampsia – HPN with edema & protenuria or albuminuria HE P/A 3.) Severe preeclampsia 34 . Abruptio Placenta – it is the premature separation of the placenta form the implantation site. 1. I.) protenuria +1 . Severe abdominal pain Dropping coagulation factor (a potential for DIC) Complications: Sudden fetal blood loss -placenta previa & vasa previa Nursing Care: Infuse IV.

BP 160/110 .) hyper & hypoglycemia 2. water immersion will cause to urinate. Resp < 12 4.) common to mom with low socioeconomic status due to decrease intake of CHON Nursing care: P – romote bed rest to decrease O2 demand. epigastric pain due to liver edema and oliguria usually indicates an impending convulsion.) Eclampsia – with seizure! Increase BUN – glomerular damage.) hypoglycemia normal glucose in newborn 45 – 55 mg/dL hypoglycemic < 40 mg/dL Heel stick test – get blood at heel Sx: Hypoglycemia high pitch shrill cry tremors.) minimal handling – planning procedure 3.) preterm birth to prevent stillbirth Newborn Effect : DM 1. sodium excretion. 50% increase insulin at 2nd – 3rd trimester.tongue depressor . facilitate. Provide safety. Patella reflex absent – 1st sigh Mg SO4 toxicity.Diabetes Mellitus .) Insulin requirement.absence of insufficient insulin (Islet of Langerhans of pancreas) Function: of insulin – facilitates transport of glucose to cell Dx: 1 hr 50gr glucose tolerance test GTT Normal glucose – 80 – 120 mg/dl < 80 – hypoclycemic ( euglycemia) > 120 .) common in multiple pre (twins) increase exposure to chorionic villi 3.hyperglycemia 3 degrees GTT of > 130 mg/dL maternal effect DM 1.) idiopathic or unknown common in primi due to 1st exposure to chorionic villi 2.) avoid jarring bed P.+4 3. 5. Urine output decrease 3. administer dextrose 35 . prevent – Mg So4 – CNS depressant E – valuate physical parameters for Magnesium sulfate Magnesium SO4 Toxicity: 1. 2nd – 3rd trim – hyperglycemic 2.) Polyhydramnios 4. Post partum decrease 25% due placenta out.) Frequent infection.) dimly lit room . BP decrease 2. decrease in insulin by 33% in 1st tri. protenuria +3 .) macrosomia – large gestational age – baby delivered > 400g or 4kg 3.) hyperinsulinism 2. quiet calm environment 2. Cause of preeclampsia 1.prepare the following at bedside .) Hypo or hyperglycemia – 1st trimester hypo. E – ensure high protein intake ( 1g/kg/day) .moniliasis 3.turning to side done AFTER seizure! Observe only! for safely.Signs present: cerebral and visual disturbances.) Dystocia-difficult birth due to abnormalities in fetus or mom.prevent convulsions by nursing measures or seizure precaution 1. Fetal effect 1.Na – in moderation A – anti-hypertensive drug Hydralazine ( Apresoline) C – convulsion. antidote – Ca gluconate 3. P.

Once classical always classical b.poor prognosis. Intrapartal complications 1. Even at rest there is fatigue & discomfort. for vaginal delivery.3. No valsalva maneuver Regional anesthesia! Low forcep delivery due to inability to push.) hypocalcemia .irreversible Impotency – inability to have an erection 2 types of infertility 1. Low segment – bikini line type – aesthetic use VBAC – vaginal birth after CS INFERTILITY . Ordinary activity causes fatigue & discomfort. Within a year of attempting it .Manageable STERILITY .inability to achieve pregnancy. Prolapse of the cord h.) early hospitalization by 7 months Class IV. Transverse lie Procedure: a.) sleep 10 hrs a day 2.) primary – no pregnancy at all 2.moderate limitation of physical activity.) Secondary – 1st pregnancy. Cesarean Delivery Indications: a.good progress for vaginal delivery Class III & IV. not CS! NOT lithotomy! High semi-fowlers during delivery. Abruptio placenta g.) antibiotic therapy. Breech presentation j. Diabetes c. Multiple gestation b. Active herpes II d.to prevent sub acute bacterial endocarditis 2. Placenta previa f. It will shorten 2nd stage of labor. Recommendation of class I & II 1.) rest 30 minutes & after meal Class III .) anticoagulant – heparin doesn’t cross placenta Class I & II. Ordinary activity causes discomfort Recommendation: 1. Severe toxemia e. Heart disease Moms with RHD at childhood Class I – no limit to physical activity Class II – slight limitation of activity. Recommendation: Therapeutic abortion XII. classical – vertical insertion. marked limitation of physical activity. no more next preg 36 . CPD primary indication i.< 7mg% Sx: Calcemia tetany Trousseau sign Give calcium gluconate if decrease calcium Recommendation Therapeutic abortion If push through with pregnancy 1.

) fundal pressure 2.Sims Huhner test – or post coital test.) episiotomy 3.) chain smoker administer: clomid ( chomephine citrate) to induce spermatogenesis Mgt: GIFT= Gamete Intra Fallopian Transfer for low sperm count Implant sperm in ampula 1.more practical & less complicated .truck driver 2.) forcep delivery 37 .use of IUD .sperm motility for impotency Factors: low sperm count 1.) . Procedure: sex 2 hours before test mom – remains supine 15 min after ejaculation Normal: cervical mucus must be stretchable 8 – 10 cm with 15 – 20 sperm. Due to increase prolactin – hyperprolactinemia Administer. parlodel ( Bromocryptice Mesylate) Action.test male 1st .appendicitis (burst) & scarring = dx: hysterosalphingography – used to determine tubal patency with use of radiopaque material Mgt: IVF – invitrofertilization (test tube baby) England 1st test tube baby To shorten 2nd stage of labor! 1. antihyper prolactineuria Give mom clomid: action: to induce oogenesis or ovulation S/E: multiple pregnancy 2.) occupation.) Mom: anovulation – no ovulation.need: sperm only .) Tubal Occlusion – tubal blockage – Hx of PID that has scarred tubes .sterile bottle container ( not plastic has chem. If >15 – low sperm count Best criteria.

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