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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maturation of ovum Gematogenesis – formation of 2 haploid into diploid 23 + 23 = 46 or diploid 7. increase in height in female 7. increase osteoblast activities of long bones 6. Phases of Menstrual Cycle: 1. Normal amount of ejaculated sperm 3 – 5 cc.III. Age of Reproductivity – 15 – 44yo 8. Functions of Estrogen and Progestin * Estrogen “Hormone of the Woman” – Primary function: development secondary sexual characteristic female. inhibit production of FSH ( maturation of ovum) 2. development ductile structure of breast 5. causes early closure of epiphysis of long bones 8. Chromosomes – threadlike strands composed of hereditary material – DNA 3. 1 tsp 4. Proliferative 2. Menstrual Cycle 4 phases of Menstrual Cycle 1.inhibit motility of GIT 3. mammary gland development 4. DNA – carries genetic code 2. Secretory 3. Ovum is capable of being fertilized with in 24 – 36 hrs after ovulation 5. increase BBT 10. causes sodium retention 9. causes mood swings in moms 6. Spinnbarkeit & Ferning ( billings method/ cervical) 4.. hypothalamus 4 . hypertrophy of myometrium 3.inhibit prod of LH (hormone for ovulation) 2. Sperm is viable within 48 – 72 hrs. MenstruationMenstrual Cycle – beginning of mens to beginning of next mens Average Menstrual Cycle – 28 days Average Menstrual Period . Menses Parts of body responsible for mens: 1. Basic Knowledge on Genetics and Obstetrics 1. Others: 1. Ischemic 4. increase permeability of kidney to lactose & dextrose causing (+) sugar 5. 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. Reproductive cells divides by the process of meiosis (haploid) Spermatogenesis – maturation of sperm Oogenesis – process . 2-3 days 6.3 – 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.

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

Amniotic Fluid – bag of H2O. Before 24 weeks critical. slightly alkaline. Cytotrophoblast – inner layer or langhans layer – protects fetus against syphilis 24 wks/6 months – life span of langhans layer increase. Lifespan of zygote – from fertilization to 2 months b.3. Short cord: abruptio placenta or inverted uterus. Implantation/ Nidation.fertilized ovum. Long cord:cord coil or cord prolapse b. Common complication fetal limb defect. Umbilical Cord. 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. Amnion – inner most layer a. Ex missing digits/toes. 15 – 55cm. Fetus. with crystallized forming pattern. maintains temp 4. peak v/s) involuntary release of sexual tension with physiologic or psychologic release. Resolution – (v/s return to normal. wherein he cannot be restimulated for about 10-15 minutes A. immeasurable peak of sexual experience. Blastocyst – covering of blastocys that later becomes placenta & trophoblast d. slight pain 2. 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. Apposition 2. May last 2 – 10 sec. facilitates musculo-skeletal development 3. 4. Done early in pregnancy.FUNIS. cushions fetus against sudden blows or trauma 2. clear.occurs after fertilization 7 – 10 days. Fertilization B. Blastocyst – enlarging cells that forms a cavity that later becomes the embryo.if with fertilization – corpus luteum continues to function & become source of estrogen & progesterone while placenta is not developed. Invasion C. Orgasm – (involuntary spasm throughout body. Adhesion 3.2 months to birth. placenta previa – implantation at low side of uterus Signs of implantation: 1. whitish grey. 4 days free floating & multiplication c. 3 processes of Implantation 1. prevent cord compression 5. 20 – 21”. Zygote.most affected are is pelvic area. help in delivery process 6 . E. Stages of Fetal Growth and Development 3-4 days travel of zygote – mitotic cell division begins *Pre-embryonic Stage a. slight vaginal spotting . Chorionic Villi. odor mousy/musty.10 – 11th day. *Function of Amniotic Fluid: 1. might get infected syphilis F. C. genitals return to pre-excitement phase) Refractory Period – the only period present in males. Morula – mulberry-like ball with 16 – 50 cells. Synsitiotrophoblast – synsitial layer – responsible production of hormone 1.

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

for calcium Thymus – development of immunity Liver – lining of upper RT & GIT * Mesoderm – development of heart. nails. 16. mucus membrane or anus & mouth First trimester: 1st month Brain & heart development GIT& resp Tract – remains as single tube 1. FOCUS: weight of fetus Seventh Month – development of surfactant – lecithin 1. It serves as a protective barrier against some microorganisms – HIV. Fetal heart tone heard – Doppler – 10 – 12 weeks 4. Third trimester: Period of most rapid growth.20 weeks primi. placenta developed 2. 18. Sex organ formed 4. Buds of milk teeth appear 3. 2. 3. 4. Kidneys functional 2. Sex is distinguishable Second Trimester: FOCUS – length of fetus 1. 1.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 . CNS develops – dizziness of mom due to hypoglycemic effect Food of brain – glucose complex CHO – pregnant womans food (potato) Second Month 1. skin and senses.6. 3. 2.1st fetal movement. kidneys and repro organ * Ectoderm – development of brain. 18 – 20 weeks buds of permanent teeth appear Fifth Month lanugo covers body actively swallows amniotic fluid 19 – 25 cm fetus. All vital organs formed.18 wks – multi fetal heart tone heard with or without instrument Sixth Month eyelids open wrinkled skin vernix caseosa present 2. 3. Meconium is formed Third Month 1. Corpus luteum – source of estrogen & progesterone of infant – life span – end of 2nd month 3. hair. musculoskeletal system. 2. 1. Quickening. Fourth Month lanugo begins to appear fetal heart tone heard fetoscope. Fetal heart tone begins – heart is the oldest part of the body 2. Eighth Month lanugo begin to disappear sub Q fats deposit 8 . 5.

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

Assessment reveals: • Pallor.3 g. horseradish. Vomiting in preg – emesisgravida.saluyot.lateral expansion of lungs or side lying position.painful.) 4.small freq feeding. 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. avoid wearing knee high socks .) 3. protamine sulfate Avoid aspirin! Might aggravate bleeding.increase fibrinogen .if improperly administered. Z tract. F&E imbalance – primary med mgt – replace fluids. green leafy vegetable-alugbati. It affects toughly 20% of pregnant women. • 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 . give IM. Nausea afternoon . Varicosities – pressure of uterus .pregnant mom hyperfibrinogenemia . 10 . Respiratory system – common problem SOB due to enlarged uterus & increase O2 demand Position.Hgb Shdn't < 10. Gastrointestinal – 1st trimester change • Morning Sickness – nausea & vomiting due to increase HCG. 2. 3. malunggay.) 5. 3 times a day) empty stomach 1 hr before meals or 2 hrs after. constipation • Slowed capillary refill • Concave fingernails (late sign of progressive anemia) due to chronic physio hypoxia Nursing Care: • Nutritional instruction – kangkong. to relieve.5% pathologic anemia if lower Pathogenic Anemia . ampalaya • Parenteral Iron ( Imferon) – severe anemia. Eat dry crackers or dry CHO diet 30 minutes before arising bed. black stool.) 2. liver due to ferridin content.use support stockings.iron deficiency anemia is the most common hematological disorder. pressure on gravid uterus.increase clotting factor .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.) 6.) 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. Metabolic alkalosis. elevate legs above hip level.use elastic bandage – lower to upper Vulbar varicosities. . hematoma.

head of fish. 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. lobster. proper body mechanical increase salivation – ptyalsim – mgt mouthwash *Hemorrhoids – pressure of gravid uterus. over fatigue. increase fiber diet .exercise -mineral oil – excretion of fat soluble vitamins * Flatulence – avoid gas forming food – cabbage * Heartburn – or pyrosis – reflux of stomach content to esophagus . 11 . watermelon. . mango. 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. avoid 3 full meals. crab. cantaloupe.fruits – papaya. Moniliasis or candidiasis due to candida albecans. suha. sips of milk. Carcinogenic drug so don’t give at 1st trimester 1. 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. Increase fluid intake. Vit D for increased Ca absorption dorsiflexion B. Mgt. fungal infection. Except guava – has pectin that’s constipating – veg – petchy. mousy odor discharge ESTROGEN – hormone. brocolli. chills. treat dad also to prevent reinfection 2. apple with skin. 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. avoid fatty & spicy food. malungay. PROGESTERONE – hormone responsible for operculum PREGNANT – acidic to alkaline change to protect bacterial growth (vaginitis) Problems Related to the Change of Vaginal Environment: a. 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). resp for leucorrhea OPERCULUM – mucus plug to seal out bacteria.Monitor I&O constipation – progesterone resp for constipation. Dilis.small frequent feeding. Cheese. Ca & phosphorous imbalance(#1 cause while pregnant). yogurt. seafood-tahong (mussels). sardines with bones. no alcohol – has antibuse effect VAGINAL DOUCHE – IQ H2O : 1 tbsp white vinegar b. oversex. hot sitz bath for comfort 4. pineapple.

condifoma acuminata due to papilloma virus Mgt: cauterization 2. cotrimaxole. genshan violet. Breast Changes – increase hormones. Signs & Symptoms: Management – antifungal – Nistatin.there is calcium Presumptive Probable Breast changes Goodel's.7 days after mens –– supine with pillow at back quadrant B – upper outer – common site of cancer Test to determine breast cancer: 1.change of consistency of cervix Urinary freq Chadwick’s. Ballotment sign of myoma * + HCG – sign of H mole . colostrums at 3rd trimester Breast self exam.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. Empty bladder . 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 . color of areola & nipple pre colostrums present by 6 weeks. Skin Changes – brown pigmentation nose chin.blue violet discoloration of vagina Fatigue Hegar's.linea nigra. Abdominal Changes – striae gravidarium (stretch marks) due enlarging uterus-destruction of sub Q tissue – avoid scratching. canesten Gonorrhea -Thick purulent discharge Vaginal warts.Color – white cheese like patches adheres to walls of vagina. Brown pinkish line. umbilicus is protruding 3.symphisis pubis to umbilicus 4. C. Subjective Probable – signs observed by the members of health team. Positive Ultrasound evidence (sonogram) full bladder Fetal heart tone Fetal movement Fetal outline Fetal parts palpable VII. mammography – 35 to 49 yrs once every 1 to 2 yrs 50 yrs and above – 1 x a yr 6. Objective Positive Signs – undeniable signs confirmed by the use of instrument. B.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 . 7. cheeks – chloasma melasma due to increased melanocytes.trans vaginal ultrasound. Psychological Adaptation to Pregnancy (Emotional response of mom –Reva Rubin theory) 12 . use coconut oil.

Health teaching: growth & development of fetus.# of viable pregnancy Viability – the ability of the fetus to live outside the uterus at the earliest possible gestational age. Diagnosis of Pregnancy 1.5 – 1lb/month) (4 lbs/month) (1 lb/wk) (4 lbs/ month) ( 1lb/wk) 4. Obstetrical Data: nullipara – no pregnancy a. age of viability .mom has personal identification on appearance of baby Development task: prepare of birth & parenting of child.# of pregnancy b. Gravida.5 – 3 lbs 10 – 12 lbs 10 – 12 lbs (. (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. surprise.First Trimester: No tanginal signs & sx. Third Trimester: . 5.best to get urine exam. Personal data – name. civil status. Para .) Elisa test – test for preg detects beta subunit of HCG as early as 7 – 10days 3. 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. religion.) Home preg kit – do it yourself Baseline Data: V/S esp. ambivalence. Developmental task is to accept biological facts of pregnancy Focus: bodily changes of preg. BP. Developmental task – accept growing fetus as baby to be nurtured. 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 . fantasy.20 – 24 wks Term 37 – 42 wks. Sex ( pseudocyesis or false pregnancy on men & women) Couvade syndrome – dad experiences what mom goes through – lihi) Address. monitor wt. denial – sign of maladaptation to pregnancy. age (high risk < 18 & >35 yrs old) record to determine high risk – HBMR. mom identifies fetus as a separate entity – due to presence of quickening. Most common fear – let mom listen to FHT to allay fear Lamaze classes VII. 6 weeks after LMP. Home base mom’s record. culture & beliefs with respect. 2. HT: responsible parenthood ‘baby’s Layette” – best time to do shopping. 60 – 70 day peak HCG. education background – level knowledge 3. Pre-Natal Visit: 1. non judgmental Occupation – financial condition or occupational hazards.) urine exam to detect HCG at 40 – 100th day. nutrition Second Trimester – tangible S&Sx.

3 months – above sym pub 5 months – level of umbilicus 9 months – below zyphoid 10 months – level of 8 months due to lightening 4. 04 +9 +7 10 / 32 / 04 . 2nd ½ of preg tetanus immunizations – prevents tetanus neonatum -mom with complete 3 doses DPT young age considered as TT1 & 2. 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. 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. Haases rule – to determine length of the fetus in cm. Nagele’s Rule – use to determine expected date of delivery Get LMP -3+ 7 +1 Apr-Dec M D Y LMP Jan 25.1 – 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. Important Estimates: GP GTPAL 4 2 4 11 1 1 GP GTPAL 6 4 6 2 2 15 1. Formula: 1st ½ of preg .1 add 1 month to month 11/31/04 EDD LMP – Jan Feb Mar +9 +7 no year 2. 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. square @ month 2nd ½ of preg. Bartholomew’s Rule – to determine age of gestation by proper location of fundus at abdominal cavity.

identify the back of the fetus ( to hear fetal heart sound) where the ball of the stethoscope is placed to determine FHT. fetal back & fetal heart tone . grasp the symphis pubis part using thumb and fingers. put towel under head and right hip. Examine teeth: sign of infection Danger signs of Pregnancy C . ectopic pre/2nd – H mole. Leopold’s Maneuver Purpose: is done to determine the attitude.use palm! Warm palm. fetal presentation lie. presenting part.cancer extends to vagina 3 – pelvis metastasis 4 – affection to bladder & rectum 7. Assess size.A. 15 . To determine degree of engagement. empty bladder 2. Assess whether the presenting part is engaged in the pelvis )Alert : if the head is engaged it will not be movable). Uterine soufflé – maternal H rate 3rd Maneuver: using the right hand. 2. movement and firmness of the part to determine presentation 2nd Maneuver: with both hands moving down. Prep mom: 1. (preeclampsia) Pelvic Examination – internal exam 1. abortion. 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.normal Class IIA – acytology but no evidence of malignancy B – suggestive of infl.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. 6. 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 .composed of squamous columnar tissue Result: Class I . universal precaution EXT OS of cervix – site for getting specimen Site for cervical cancer Pap Smear – cervical cancer .chills/ fever . with both hands palpate upper abdomen and fundus. and number of fetuses. incompetent cervix 3rd – placental anomalies S – sudden gush of fluid – PROM (premature rupture of membrane) prone to inf. position. shape. Get V/S(before 2nd maneuver) PR to diff fundic soufflé (FHR) & uterine soufflé. E – edema to upper ext. an estimate of the size. degree of descent.

breakfast a. Daily Fetal Movement Counting (DFMC) –begin 27 weeks Mom. assess the descent of the presenting part by locating the cephalic prominence or brow. inadequate nutrition Procedure: Done within 30 minutes wherein the mother is in semi-fowler’s position (w/ fetal monitor).) more then 1 hour to reach 10 movements b. after breakfast) and count each fetal movement. Examples: nonstress test (NST). 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.) less then 10 movements in 12 hours(non-reactive.fetal distress) c.) warning signs noted during DFMC c. When the brow is on the same side as the back.) warning signs should be reported to healthcare provider immediately.Assessment of Fetal Well-BeingA.begin after meal . often require further testing.) maternal history of smoking. diabetes b. external monitor is applied to document fetal activity. such as a CST Result: Noncreative Nonstress Not Good Reactive Responsive is Real Good 16 .< 3 FMs in 12 hours 4. Attach external noninvasive fetal monitors 1. 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. tocotransducer over fundus to detect uterine contractions and fetal movements (FMs) 2. mother activates the “mark button” on the electronic monitor when she feels fetal movement. With two hands.4th Maneuver: the Examiner changes the position by facing the patient’s feet. less vigorous Movement alarm signals . Attitude – relationship of fetus to a part – or degree of flexion Full flexion – when the chin touches the chest 8. Cardiff count to 10 method – one method currently available (1) Begin at the same time each day (usually in the morning.) pregnancy induced hypertension (PIH). Nonstress test – to determine the response of the fetal heart rate to activity Indication – pregnancies at risk for placental insufficiency Postmaturity a. the head will be flexed and vertex presenting.) longer time to reach 10 FMs than on previous days d. To determine attitude – relationship of fetus to 1 another. biographical profile (BPP) B. the head is extended. ultrasound transducer over abdominal site where most distinct fetal heart sounds are detected 3.) movement are becoming weaker.

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

whole grains. meats . eggs . cantaloupe.inadequate iron intake results in maternal effects – anemia depletion of iron stores. 18 . 15mcg/day representing an increase of 3 mg/day over prepreganant daily requirements.) should be done in moderation 30 mg/day representing a doubling of the pregnant daily requirement . abortion.dark green leafy vegetables. legumes. milk.Magnesium . Taking it not needed – fat soluble vitamins. may play a role in the prevention of neutral tube defects (spina bifida).of maternal bones and teeth . 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.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.dark green leafy vegetables. decreased energy and appetite. whole grain cereals and breads . butter.Selenium Vitamins E Thiamine Riborlavin Pyridoxine ( B6) B12 Niacin 2.enriched.2 mg/day 2. Vit stored in body. fish. abruption placenta Additional Requirements Minerals . Folic Acid. . poultry. nuts Increases should reflect . Folate Essential for . kidney.iron from food sources is more readily absorbed when served with foods high in vit C Zinc increases should reflect .Whole grains.eggs. Hard to excrete.liver.70 mg/day of vitamin C which enhances iron absorption . seafood Zinc Essential for * the formation of enzymes * maybe important in the prevention of congenital malformation of the fetus. potatoes .Establishment of fetal iron stores for first few months of life the adolescent.liver. red meat.nuts.5 mg/day 1.DNA synthesis and cell formation. veal . 400 mcg/day representing an increase of more then 2 times the daily prepregnant requirement. Folacin. peanuts 175 mcg/day 320 mg/day 65 mcg/day 10 mg/day 1.fetal effects decreased availability of oxygen thereby affecting fetal growth * iron deficiency anemia is the most common nutritional disorder of pregnancy.Current research is : Demonstrating an association between adequate calcium intake and the prevention of pregnancy induce hypertension Iron Essential for . dried fruits . legumes.liver.Expansion of blood volume and red blood cells formation .6 mg/day 2.Sexual Activity a. legumes . egg yolk. since diet alone is unable to meet pregnancy requirement . margarine.vitamin C sources: citrus fruits & juices. broccoli or cabbage.formation of red blood cells and prevention of anemia .Begin supplementation at 30mg/day in second trimester.iodine .shell fish .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. broccoli. strawberries. lean beef. . liver. 300mcg/day supplement for women with low folate levels or dietary deficiency 4 servings of grains/day Iron increases should reflect . cardiac stress especially labor and birth . cheese .

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

5 cm. soft music. decrease progesterone will stimulate contractions & labor 5. disciple.) 2.) 5.) 3.) oxytocin theory – post pit gland releases oxytocin. Basic knowledge in Intrapartum.25cm .1. 4. The 4 P’s of labor 1. Fetal head – is the largest presenting part – common presenting part – ¼ of its length. address. imaging – sensate focus 5. 1. 1. Bones – 6 bones S – sphenoid F – frontal .close 2. will always contract & expel its content) – contraction action 2. 12 – 18 months after birth. At 36 wks degenerates (leading to contraction – onset labor).) theory of aging placenta – life span of placenta 42 wks. smallest AP occipitofrontal 12cm partial flexion occipitomental – 13.) Anterior fontanel – bregma.contraction 4. transverse diameter – 9.) 4. After delivery. Intrapartal Notes – inside ER A.2. age. Conscious relaxation 2. 1 Theories of the Onset of Labor 1.) 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: 1.5 cm hyper extension submentobragmatic-face presentation 20 . complete flexion.viable preg. Husband is coach Features: 1.sinciput E – ethmoid O – occuputal . IX. diamond shape. comfy room. Effleurage – gentle circular massage over abdominal to relieve pain 4. b.) 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.) prostaglandin theory – stimulation of arachidonic acid – prostaglandin. – 22 – 24 wks Physical Exams. 1 x 1 cm.Pelvic Exams B.) progesterone theory – before labor. conditioning & concentration. Lamaze: Dr.( > 5 cm – hydrocephalus). baby gets warm bath. etc Baseline Data: v/s esppecially BP.occiput T – temporal P – parietal 2 x Measurement fetal head: 1. exhale mouth 3. weight Obstetrical Data: gravida # preg. dark. Admitting the laboring Mother: Personal Data: name. 3 x 4 cm.) Posterior fontanel or lambda – triangular shape.biparietal – largest transverse . bimastoid 7cm smallest transverse Sutures – intermembranous spaces that allow molding.) Anteroposterior diameter suboccipitobregmatic 9.) uterine stretch theory ( any hallow organ stretched. Cleansing breathe – inhale nose. Birth under H20 – bathtub – labor & delivery – warm water. Closes – 2 – 3 months.bitemporal 8 cm 2. Passenger a. Hypothalamus produces oxytocin 3. Ferdinand Lamaze req.) sagittal suture – connects 2 parietal bones ( sagitna) 2. quiet.) coronal suture – connect parietal & frontal bone (crown) 3. b. para.

12.5 cm=true conjugate) 2.2 weeks prior to EDD * Engagement. Braxton Hicks Contractions – painless irregular contractions 3. intensity 4.nesting instinct. ape like pelvis. Timing: frequency.5 cm basis in getting true conjugate. Involuntary Contractions b. Cultural Interpretation b. 3. Anthropoid – oval.5 – 3 lbs 6. True conjugate/conjugate vera – measure between the anterior surface of the sacral promontory and superior margin of the symphysis pubis. will be used for delivery. Passageway Mom 1. wide. Measurement: 11.5 cm . 1.2. Ripening of the Cervix – butter soft 5. decreased body wt – 1. Measurement: 11. duration. transverse – wider b.shooting pain radiating to the legs .setting of presenting part into pelvic inlet 2. Pelvis 2 hip bones – 2 innominate bones 3 Parts of 2 Innominate Bones Ileum – lateral side of hips . AP diameter wider transverse narrow 4. Bloody Show – pinkish vaginal discharge – blood & leukorrhea 7. (DC – 11.do IE to check for cord prolapse 21 . Pelvis at 10 cm or more. Voluntary bearing down efforts c. Tuberoischi Diameter – transverse diameter of the pelvic outlet. Check FHT Premature Rupture of Membrane ( PROM) . Psyche/Person – psychological stress when the mother is fighting the labor experience a. Lightening – setting of presenting part into pelvic brim . Ischial tuberosity – approximated with use of fist – 8 cm & above. Increase Activity of the Mother. deeper most suitable (normal female pelvis) for pregnancy 2. Platypelloid – flat AP diameter – narrow. Gynecoid – round. Past Experience d.0 cm 3.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. Characteristics: wave like d.) Underwent pelvic dislocation Pelvis 4 main pelvic types 1. oval shape.) < 4’9” tall 2.urinary freq.anterior part pointed. Preparation c. Rupture of Membranes – rupture of water. Obstetrical conjugate – smallest AP diameter. Increase epinephrine 4. posterior part shallow 3. Diagonal Conjugate – measure between sacral promontory and inferior margin of the symphysis pubis. Android – heart shape “male pelvis”. Power – the force acting to expel the fetus and placenta – myometrium – powers of labor a.) < 18 years old 3. Support System Pre-eminent Signs of Labor S&Sx: .iliac crest – flaring superior border forming prominence of hips Ischium – inferior portion . Save energy.

Cover cord with sterile gauze with saline to prevent drying of cord so cord will remain slippery & prevent cord compression causing cerebral palsy. First Stage: onset of true contractions to full dilation and effacement of cervix. Count pulsation of cord for FHT 4. apprehensive.Contraction drop in intensity even though very painful Contraction drop in frequently Uterus tense and/or contracting between contractions Abdominal palpations Nursing Care.fundus 2. Unit used is cm. Nursing Interventions in Each Stage of Labor 2 segments of the uterus 1. Latent Phase: Assessment: Dilations: 0 – 3 cm mom – excited. Danger signs: PROM Presenting part has not yet engaged Fetal distress Protruding cord form vagina Nursing care: 1. 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. 2. Slip cord away from presenting part 3. upper uterine . Use % in unit of measurement Dilation – widening of cervix. Duration of Labor Primipara – 14 hrs & not more than 20 hrs Multipara – 8 hrs & not > 14 hrs Effacement – softening & thinning of cervix. lower uterine – isthmus 1. 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. especially if fetal distress is noted Cord Prolapse – a complication when the umbilical cord falls or is washed through the cervix into the vagina. can communicate Frequency: every 5 – 10 min Intensity mild Nursing Care: 22 .

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. cervical dilation and effacement. 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.1. Station – landmark used: ischial spine . c. Transverse Lie (Perpendicular) or Perpendicular lie. 3.2. Longitudinal Lie ( Parallel) cephalic Vertex – complete flexion Face Brow Poor Flexion Chin Breech Complete Breech – thigh breast on abdomen. Shoulder presentation.1 station = presenting part 1cm above ischial spine if (-) floating . etc. 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. Position – relationship of the fatal presenting part to specific quadrant of the mother’s pelvis.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.shorten 1st stage of labor 2. Variety: 23 . 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. double Kneeling b. Encourage walking . fetal monitor. Active Phase: Assessment: Encourage to void q 2 – 3 hrs – full bladder inhibit contractions Breathing – chest breathing Dilations 4 -8 cm Intensity: moderate Mom. breast lie on thigh Incomplete Breech – thigh rest on abdominal Frank – legs extend to head Footling – single.1.

RMP. LADP.) Ok to shower 2. RADA LSA – left sacro anterior LST.to prevent laceration. LADT.strength of contraction Contraction – vasoconstriction Increase BP. RSP Chin / Mento LMA. LSP. LMP. LMT. let mom rest. RMT. shorten 2nd stage of labor.put stet above umbilicus Shoulder/acromniodorso LADA. if same BP. 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 . RSA.) mecomium stain amnion fluid 3.)NPO – GIT stops function during labor if with food.)To cleanse bowel b.)Enema administer during labor a.Occipito – LOA left occipito ant (most common and favorable position)– side of maternal pelvis LOP – left occipito posterior LOP – most common mal position. 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. Second Stage: fetal stage. notify MD -preeclampsia Health teachings 1.) <120 & >160 2.)Sims position/side lying 12 – 18 inch – ht enema tubing Check FHT after adm enema Normal FHT= 120-160 Signs of fetal distress1. complete dilation and effacement to birth.will cause aspiration 3. RST. 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.) fetal thrushing – hyperactive fetus due to lack O2 2. most painful ROP – squatting pos on mom ROT ROA Breech. RMA.use sacrum . widen vaginal canal.)Prevent infection c. 24 . If BP increase .

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

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

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.Boundary bet upper/lower uterine segment BANDL’S pathologic ring – suprapubic depression a.)Large baby 3.) sudden pain b. avoid sex 3. empty bladder 4. dilation saved by administer Tocolytic agents. Mom given 6 hrs of labor Multi: 8 – 14. Trial Labor – measurement of head & pelvis falls on borderline.early ambulation 27 .)Previous classical CS 2. Postpartal Period 5th stage of labor after 24hrs :Normal increase WBC up to 30. nose.bleeding to all portions of the body – eyes. Monitor: FHT > 180 bpm Maternal BP . consult MD if symptoms persist Hosp: 1. complete bed rest 2. primi 14 – 20 Preterm Labor – labor after 20 – 37 weeks) ( abortion <20 weeks) Sx: 1.) profuse bleeding c. drink 3 -4 glasses of water – full bladder inhibits contractions 5.) Improper use of oxytocin (IV drip) Sx: a.<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 . premature contractions q 10 min 2.halts preterm contractions. dilation 2-3 cm Home Mgt: 1.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.1. etc.000 cumm Puerperium – covers 1st 6 wks post partum Involution – return of repro organ to its non pregnant state. If cervix is closed 2 – 3 cm.prone to thrombus formation .) hypovolemic shock d. chest pain & frothy sputum prepare: suctioning end stage: DIC disseminated intravascular coagopathy.Yutopar Hcl) 150mg incorporated 500cc Dextrose piggyback. X. Hyperfibrinogenia .) TAHBSO Physiologic retraction ring . effacement of 60 – 80% 3.

urinary retention with overflow 4. musty/mousy.) Care of newborn 2. position prone 2. limited amt 3.stimulate bladder 3. Mom is active. Nursing Care: . deciduas. Lochia-bld. c.redefines new roles may extend until child grows. III. 1. microorganism.D&C after. Perineal area – painful – episiotomy site – sims pos. This is critical especially to gravidocardiac mothers. birth pain: 1. Prevent complications 1. Cardiovascular System . Ruba – red 1st 3 days present. Genital tract a. wbc. hot sitz bath. Cervix – cervical opening b. 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. Mgt: 1. Physiologic Changes a. Provide Emotional Support – Reva Rubia Psychological Responses: a.urine collection . Uterus – return to normal 6 – 8 wks. mefenamic acid d.alternate warm & cold compress .Principles underlying puerperium 1. To return to Normal and Facilitate healing A. not compress sex. fear of bearing down 5. Alba – créme white 10 – 21 days very decreased amt dysuria . Hemorrhage – bleeding of > 500cc CS – 600 – 800 cc normal NSD 500 cc I. Serosa – pink to brown 4 – 9th day.inability to sleep & lack of appetite. activity is to tell child birth experiences. moderate amt 2. – let mom cry – therapeutic.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. Mom . cant make decisions. cold compress – to prevent bleeding 3. Complications: hypovolemic shock. Early postpartum hemorrhage– bleeding within 1st 24 hrs. can make decisions HT: 1. Taking hold phase – dependent to independent phase (4 to 7 days). Baggy or relaxed uterus & profuse bleeding – uterine atony. Letting go – interdependent phase – 7 days & above.) Insert family planting method common post partum blues/ baby blues present 4 – 5 days 50-80% moms – overwhelming feeling of depression characterized by crying. Systemic Changes 1.) massage uterus until contracted 28 . Urinary tract: Bladder – freq in urination after delivery. Nsd & Cs with lochia.1.when perineum has healed II.a medium for bacterial growth(puerperal sepsis). 2. Taking in phase – dependent phase (1st three days) mom – passive. Vaginal and Pelvic Floor c. cold compress for immediate pain after 24 hrs. Colon: Constipation – due NPO. despondence.proper hygiene b.

) exogenous – from outside 1. paracetamol.degree of laceration .sources of infection 1. Acreta – attached placenta to myometrium.) cold compress 3.) anaerobic streptococci – most common .pudendal anesthesia Mgt: 1. fever Gen mgt: 1.large baby .too much manipulation .mgt episiorapy DIC – Disseminated Intravascular Coagulopathy. . VITC.) incision on site. 29 .) shave 3. Endometriosis – inflammation of endometrial lining Sx: Abdominal tenderness. Late Postpartum hemorrhage – bleeding after 24 hrs – retained placental fragments Mgt: D&C or manual extraction of fragments & massaging of uterus.) cold compress every 30 minutes with rest period of 30 minutes for 24 hrs 2. cold compress. dolor (pain) tumor(swelling) 2.) supportive care – CBR. 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. Hypofibrinogen. saline. . pos.) modified trendelenberg 4.) unhealthy sexual practices General signs of inflammation: 1. D&C except placenta increta.failure to coagulate. 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. Inflammation – calor (heat). Well contracted uterus + bleeding = laceration . TSB.2.cryoprecipitate or fresh frozen plasma II. rubor (red). between & resulting. 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.)endogenous – from within body 2. hydration.bleeding to any part of body . percreta.hysterectomy if with abruption placenta mgt: BT.from members health team 2. purulent discharges 3. scraping & suturing Infection.assess perineum for laceration .) IV fast drip/ oxytocin IV drip 1st degree laceration – affects vaginal skin & mucus membrane.

) method of choice is an individuals choice.9% effective. .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. Motivate the use of Family Planning 1.Fowlers – to facilitate drainage & localize infection oxytocin & antibiotic IV.-get short test & longest cycle from Jan – Dec . Signs of hypertension Immediate Discontinuation A – abdominal pain C – chest pain 30 .longest – 11 June 26 .) never advice a permanent method of planning 3.start 5th day of mens 28day pill.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.menstruation will come out 4 – 6 months bottle fed 2 – 3 months disadvantage of lam – might get pregnant Symptothermal – combination of BBT & cervical. calendar method OVULATION –count minus 14 days before next mens (14 days before next mens) Origoknause formula – .) determine one’s own beliefs 1st 2.least effective method 2. watery. Natural Method – the only method accepted by the Catholic Church Billings / Cervical mucus– test spinnbarkeit & ferning (estrogen) .) coitus interuptus/ withdrawal .monitor cycle for 1 year .clear.3 months.18 8 Dec 33 -11 22 unsafe days 21 day pill. breast feeding. elastic – long spinnbarkeit Basal Body Temperature 13th day temp goes down before ovulation – no sex . 99. coitus interfemora – “ipit” 4. Consult OB-6mos.get before arising in bed LAM – lactation amenorrheal method – hormone that inhibits ovulation is prolactin.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.shortest – 18 . stretchable. Best method Social Method – 1. . coitus reservatus – sex without ejaculation – 3. Waiting time to become pregnant. Alerts on Oral Contraceptive: -in case a mother who is taking an oral contraceptive for almost long time plans to have a baby. 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.

DMPA – depoproveda – has progesterone inhibits LH – inhibits ovulation Depomedroxy progesterone acetate – IM q 3 months .H . shorter or longer Uterine inflammation.prevents implantation . immediately take the forgotten tablet plus the tablet scheduled that day. or more days.parity or # of children. If forgotten for two consecutive days.it lessen sexual satisfaction .it gives higher protection in the prevention of STDs Diaphragm – rubberized dome shaped material inserted to cervix preventing sperm to get to the uterus. . fever. . it will shorten duration Norplant – has 6 match sticks – like capsules implanted subdermally containing progesterone.) Regular pap smear Alerts.headache E – eye problems S – severe leg cramps If mom HPN – stop pills STAT! Adverse effect: breakthrough bleeding Contraindicated: 1.most common complications: excessive menstrual flow and expulsion of the device (common problem) .) DM 5.) HPN 4. uterine perforation.right time to insert is after delivery or during menstruation primary indication for use of IUD .) Monthly checkup 3.) chain smoker 2. REVERSABLE Ht: 1. ectopic pregnancy Condom – latex inserted to erected penis or lubricated vagina Adv.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.as soon as removed – can become pregnant Mechanism and Chemical Barriers Intrauterine Device (IUD) Action: prevents implantation – affects motility of sperm & ovum . chills S trings lost. if 1 kid only don’t use IUD HT: 1.) proper hygiene 31 . use another method for the rest of the cycle and the start again.never massage injected site. gives highest protection against STD – female condom Alerts: Disadvantage: .) extreme obesity 3.5 yrs – disadvantage if keloid skin .) Check for string daily 2.) Thrombophlebitis or problems in clotting factors - if forgotten for one day.

CS c. product of conception remain in uterus 4 weeks or longer. tissue protrudes form the cervix (Cervical dilation) Types: 1. signs of pregnancy cease.) 5. Hemorrhagic Disorders General Management 1. Missed – fetus dies. Abortions – termination of pregnancy before age of viability (before 20 weeks) Spontaneous Abortion.) Complete – all products of conception are expelled.miscarriage Cause: 1. During delivery. 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.) Signs of Hypovolemic shock 6.) 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. common site: tubal or ampular Dangerous site . Barrier ex.) Save discharges – for histopathology – to determine if product of conception has been expelled or not First Trimester Bleeding – abortion or eptopic A. Creams Surgical Method – BTL . Inevitable – moderate bleeding. Habitual – 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix. Bilateral Tubal Ligation – can be reversed 20% chance. HT: >30 ejaculations before safe sex O – zero sperm count.) Induced Abortion – therapeutic abortion to save life of mom.) chromosomal alterations 2. HT: avoid lifting heavy objects Vasectomy – cut vas deferense. circlage is removed.interstitial Unruptured Tubal rupture 32 . Mgt: D&C Incompetent cervix – abortion McDonalds procedure – temporary circlage on cervix S/E. Foam (most effective).) plasma germ defect Classifications: a.) 4. (-) preg test.2.) blighted ovum 3. NSD Sheridan – permanent surgery cervix.) Incomplete – Placental and membranes retained. High Risk Pregnancy 1. jellies. cramping. Present 2nd trimester d.) CBR 2. Double effect choose between lesser evil. Ectopic Pregnancy – occurs when gestation is located outside the uterine cavity. scanty dark brown bleeding Mgt: induced labor with oxytocin or vacuum extraction 5.) Assess for bleeding (per pad 30 – 40cc) (wt – 1gm =1cc) 4. safe XI. No mgt just emotional support! 2.) Ultrasound to determine integrity of sac 5. Jellies.) 3. C. infection. Threatened – pregnancy is jeopardized by bleeding and cramping but the cervix is closed b.) Avoid sex 3.

Avoid pregnancy for at least one year Third Trimester Bleeding “Placenta Anomalies” D. vaginal bleeding Nursing care: Vital signs Administer IV fluids Monitor for vaginal bleeding Monitor I & O sudden . it grows & enlarges the uterus vary rapidly. . dark brown. Abnormal lower implantation of placenta. 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. 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. sometimes covering the cervical os. . severe pain. Progressive degeneration of chorionic villi. This neoplasm is formed form the selling of the chronic villi and lost nucleus of the fertilized egg. sharp. Recurs. Unilateral radiating to shoulder.gestational anomaly of the placenta consisting of a bunch of clear vesicles. RN as witness 33 . – with fertilization. Placenta Previa – it occurs when the placenta is improperly implanted in the lower uterine segment. 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. Hydatidiform Mole “bunch or grapes” or gestational trophoblastic disease.candidate for CS Sx: frank Bright red Painless bleeding Dx: Ultrasound Avoid: sex. The nucleus of the sperm duplicates. producing a diploid number 46 XX. IE. 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.

Outstanding Sx: dark red. I.+2 2.) protenuria +1 . K.HPN after 24 wks of pregnancy. solved 6 weeks post partum.) increase wt due to edema b.) Mild preeclampsia – earliest sign of preeclampsia a. Three types of pre-eclampsia 1.) HELLP syndrome – hemolysis with elevated liver enzymes & low platelet count II.) Pre-eclampsia – HPN with edema & protenuria or albuminuria HE P/A 3. Pregnancy Induced Hypertension (PIH). L. 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. 2. 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. J. I.) Severe preeclampsia 34 . Transissional Hypertension – HPN between 20 – 24 weeks III.) BP 140/90 c. Severe abdominal pain Dropping coagulation factor (a potential for DIC) Complications: Sudden fetal blood loss -placenta previa & vasa previa Nursing Care: Infuse IV.) Gestational hypertension . prepare to administer blood Type and crossmatch Monitor FHR Insert Foley Measure blood loss. 1. Abruptio Placenta – it is the premature separation of the placenta form the implantation site. painful bleeding. H.HPN without edema & protenuria H without EP 2. board like or rigid uterus. G. Chronic or pre-existing Hypertension –HPN before 20 weeks not solved 6 weeks post partum.- 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. It usually occurs after the twentieth week of pregnancy. Assessment: Concealed bleeding (retroplacental) Couvelaire uterus (caused by bleeding into the myometrium)-inability of uterus to contract due to hemorrhage.cord divides into small vessels before it enters the placenta Vasa Previa – velamentous insertion of cord has implanted in cervical OS Hypertensive Disorders F.

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

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

) Tubal Occlusion – tubal blockage – Hx of PID that has scarred tubes .) fundal pressure 2.more practical & less complicated . 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.test male 1st .use of IUD .sterile bottle container ( not plastic has chem. antihyper prolactineuria Give mom clomid: action: to induce oogenesis or ovulation S/E: multiple pregnancy 2.sperm motility for impotency Factors: low sperm count 1.) episiotomy 3.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.truck driver 2. parlodel ( Bromocryptice Mesylate) Action.) forcep delivery 37 .Sims Huhner test – or post coital test.) chain smoker administer: clomid ( chomephine citrate) to induce spermatogenesis Mgt: GIFT= Gamete Intra Fallopian Transfer for low sperm count Implant sperm in ampula 1.) .) occupation. Due to increase prolactin – hyperprolactinemia Administer. If >15 – low sperm count Best criteria.need: sperm only .) Mom: anovulation – no ovulation.

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