MATERNAL/OB NOTES

Human Sexuality
A. Concepts
1. A persons 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. Durin reproductive years, the nurse performs as resource person on human sexuality.
B. Definitions elate! to sexuality"
!ender identity sense of femininity or masculinity
2"# yrs$3 yrs ender identity develops.
%ole identity attitudes, behaviors and attributes that differentiate roles
Sex bioloic male or female status. Sometimes referred to a specific sexual behavior such as sexual intercourse.
Sexuality " behavior of bein boy or irl, male or female man$ &oman. 'ntity life lon dynamic chane.
" developed at the moment of conception.
##. Sexual Anatomy an! $%ysiolo&y
A. 'emale Repo!ucti(e System
1. 'xternal value or pretender
a. Mons pu)is/(eneis " a pad of fatty tissues that lies over the symphysis pubis covered by s(in and at puberty
covered by pubic hair that serves as cushion or protection to the symphysis pubis.
Sta&es of $u)ic Hai De(elopment
)annerscale tool " used to determine sexual maturity ratin.
Stae 1 *re"adolescence. +o pubic hair. ,ine body hair only
Stae 2 -ccurs bet&een aes 11 and 12 sparse, lon, slihtly pimented . curly hair at pubis
symphysis
Stae 3 occurs bet&een aes 12 and 13 dar(er . curlier at labia
Stae # occurs bet&een aes 13 and 1#, hair assumes the normal appearance of an adult but is
not so thic( and does no appear to the inner aspect of the upper thih.
Stae / sexual maturity" normal adult" appear inner aspect of upper thih .
). La)ia Ma*oa " lare lips lonitudinal fold, extends symphisis pubis to perineum
c. La)ia Minoa 2 sensitive structures
clitoris" anterior, pea shaped erectile tissue &ith lots sensitive nerve endins siht of sexual arousal
0!ree("(ey1
fourchette" *osterior, tapers posteriorly of the labia minora" sensitive to manipulation, torn durin delivery.
Site episiotomy.
!. +esti)ule an almond shaped area that contains the hymen, vainal orifice and bartholenes lands.
1. 2rinary 3eatus small openin of urethra, serves for urination
2. S(enes lands$or paraurethral land mucus secretin subs for lubrication
3. hymen covers vainal orifice, membranous tissue
#. vainal orifice external openin of vaina
/. bartholenes lands" paravainal land or vulvo vainal land "2 small mucus secretin subs secrets
al(aline subs.
Al(aline neutrali4es acidity of vaina
*h of vaina " acidic
Doderleins bacillus responsible for acidity of vaina
5arumculae mystiformes"healin of torn hymen
e. $eineum , muscular structure loc lo&er vaina . anus
6nternal7
A. (a&ina female oran of copulation, passae&ay of mens . fetus, 3 #inches or 8 19 cm lon, dilated canal
%uae permits stretchin &ithout tearin
B. uteus- -ran of mens is a hollo&, thic( &alled muscular oran. 6t varies in si4e, shape and &eihts.
1
Si4e" 1x2x3
Shape7 nonprenant pear shaped $ prenant " ovoid
:eiht " nonprenant /9 ";9 (" prenant 1,999
*renant$ 6nvolution of uterus7
#
th
stae of labor " 1999
2 &ee(s after delivery " /99
3 &ee(s after delivery " 399
/"; &ee(s after delivery " returns to oriinal, state /9 ;9
T%ee pats of t%e uteus
1. fundus " upper cylindrical layer
2. corpus$body " upper trianular layer
3. cervix " lo&er cylindrical layer
< 6sthmus lo&er uterine sement durin prenancy
5ornua"=unction bet&een fundus . interstitial
Muscula compositions" there are three main muscle layers &hich ma(e expansion possible in every direction.
1. 'ndometrium" inside uterus, lines the nonprenant uterus. 3uscle layer for menstruation. Slouhs durin
menstruation.
Decidua" thic( layer.
'ndometriosis"proliferation of endometrial linin outside uterus. 5ommon site7 ovary.
S$sx7 dysmennorhea, lo& bac( pain.
Dx7 biopsy, laparoscopy
3eds7 1. Dana4ole 0Danocrene1 a. to stop mens b. inhibit ovulation
2. >upreulide 0>upron1 inhibit ,S?$>? production
2. 3yometrium larest part of the uterus, muscle layer for delivery process
6ts smooth muscles are considered to be the livin liature of the body.
" *o&er of labor, resp" contraction of the uterus
3. *erimetrium protects entire uterus
C. o(aies 2 female sex lands, almond shaped. 'xt" vestibule int ovaries
,unction7 1. ovulation
2. *roduction of hormones
!. 'allopian tu)es 2"3 inches lon that serves as a passae&ay of the sperm from the uterus to the ampulla or the
passae&ay of the mature ovum or fertili4ed ovum from the ampulla to the uterus.
. si&nificant se&ments
1. 6nfundibulum distal part of ,), trumpet or funnel shaped, s&ollen at ovulation
2. Ampulla outer 3
rd
or 2
nd
half, site of fertili4ation
3. 6sthmus site of sterili4ation bilateral tubal liation
#. 6nterstitial site of ectopic prenancy most danerous
B. Male Repo!ucti(e System
/. Extenal
penis the male oran of copulation and urination. 6t contains of a body of a shaft consistin 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 lands penis.
0 Cylin!ical Layes
2 corpora cavernosa
1 corpus sponiosum
Scotum a pouch hanin belo& the pendulous penis, &ith a medial septum dividin into t&o sacs, each of &hich contains
a testes.
" coolin mechanism of testes
" @ 2 derees 5 than body temp.
" >eydi cell release testosterone
2
1. #ntenal
T%e $ocess of Spemato&enesis , maturation of
sperm

Male an! 'emale %omolo&ues
Male 'emale
*enile lans 5litoral lans
*enile shaft 5litorial shaft
)estes ovaries
*rostate S(enes ands
5o&pers !lands AartholinBs lands
Scrotum >abia 3a=ora
'pididymis ; meters coiled
tubules site for maturation of sperm
Cas Deferens conduit for
spermato4oa or path&ay of sperm
Seminal vesicle secretes7
1.1 ,ructose lucose has
nutritional value.
2.1 *rostalandin causes reverse
contraction of uterus
Alan(D 5ant eraseD
?ypothalamus
!n%?
Ant *it
!land
,S? >,
,x7
Sperm
3aturation
,x7 ?ormones
for
)estosterone
*roduction
)estes E99 coiled 0F meter lon
at ae 13 on&ards1
0Seminiferous tubules1
'=aculatory duct conduit of semen
*rostate land" secrets al(aline substance
5o&pers land secrets al(aline substance
2rethra
3
###. Basic 2no3le!&e on 4enetics an! O)stetics
1. D+A carries enetic code
2. 5hromosomes threadli(e strands composed of hereditary material D+A
3. +ormal amount of e=aculated sperm 3 / cc., 1 tsp
#. -vum is capable of bein fertili4ed &ith in 2# 3; hrs after ovulation
/. Sperm is viable &ithin #8 G2 hrs, 2"3 days
;. %eproductive cells divides by the process of meiosis 0haploid1
Spermatoenesis maturation of sperm
-oenesis process " maturation of ovum
!ematoenesis formation of 2 haploid into diploid 23 H 23 I #; or diploid
G. Ae of %eproductivity 1/ ##yo
8. 3enstruation"
3enstrual 5ycle beinnin of mens to beinnin of next mens
Averae 3enstrual 5ycle 28 days
Averae 3enstrual *eriod " 3 / days
+ormal Alood loss /9cc or J cup
%elated terminoloies7
3enarche 1
st
mens
Dysmenorrhea painful mens
3etrorrhaia bleedin bet&een mens
3enorhaia excessive durin mens
Amenorrhea absence of mens
3enopause cessation of mens$ averae 7 /1 years old
E. ,unctions of 'stroen and *roestin
5 Esto&en K?ormone of the :omanL
*rimary function7 development secondary sexual characteristic female.
-thers7
1. inhibit production of ,S? 0 maturation of ovum1
2. hypertrophy of myometrium
3. Spinnbar(eit . ,ernin 0 billins method$ cervical1
#. development ductile structure of breast
/. increase osteoblast activities of lon bones
;. increase in heiht in female
G. causes early closure of epiphysis of lon bones
8. causes sodium retention
E. increase sexual desire
<$o&estin K ?ormone of the 3otherL
*rimary function7 prepares endometrium for implantation of fertili4ed ovum ma(in it thic( . tortous 0t&isted1
Secondary ,unction7 uterine contractility 0favors prenancy1
-thers7 1.inhibit prod of >? 0hormone for ovulation1
2.inhibit motility of !6)
3. mammary land development
#. increase permeability of (idney to lactose . dextrose causin 0H1 suar
/. causes mood s&ins in moms
;. increase AA)
/6. Menstual Cycle
# phases of 3enstrual 5ycle
1. *hases of 3enstrual 5ycle7
1. *roliferative
2. Secretory
3. 6schemic
#. 3enses
*arts of body responsible for mens7
1. hypothalamus
2. anterior pituitary land master cloc( of body
#
3. ovaries
#. uterus
6nitial phase 3
rd
day decreased estroen
13
th
day pea( estroen, decrease proesterone
1#
th
day 6ncrease estroen, increase proesterone
1/
th
day Decrease estroen, increase proesterone
6. -n the initial 3
rd
phase of menstruation , the estroen level is decreased, this level stimulates the hypothalamus
to release !n%? or ,S?%,
66. !n%?$,S?%, stimulates the anterior pituitary land to release ,S?
'unctions of 'SH7
1. Stimulate ovaries to release estroen
2. ,acilitate ro&th primary follicle to become raffian follicle 0secrets lare amt estroen . contains mature
ovum.1
666. *roliferative *hase proliferation of tissue or follicular phase, post mens phase. *re"ovularoty.
"phase of increase estroen.
,ollicular *hase causin irreularities of mens
*ostmenstrual *hase
*reovulatory *hase phase increase estroen
6C. 13
th
day of menstruation, estroen level is pea( &hile the proesterone level is do&n, these stimulates the
hypothalamus to release !n%, on >?%,
1.1 3ittelschmer4 sliht abdominal pain on > or %M of abdomen, mar(s ovulation day.
2.1 5hane in AA), mood s&in
C. !n%,$>?%, stimulates the ant pit land to release >?.
'unctions of LH7
1. 013
th
day"decreased proesterone1 >? stimulates ovaries to release proesterone
2. hormone for ovulation
C6. 1#
th
day estroen level is increased &hile the proesterone level is increased causin rupture of raffian follicle on
process of ovulation.
C66. 1/
th
day, after ovulation day, raafian follicle starts to deenerate yello&ish (no&n as corpus luteum 0secrets lare
amount of proesterone1
C666. Secretory phase"
>utheal *hase
*ostovulatory *hase 6ncreased proesterone
*remenstrual *hase
6N. 2#
th
day if no fertili4ation, corpus luteum deenerate 0 &hitish corpus albicans1
N. 28
th
day if no sperm in ovum endometrium beins to slouh off to bein mens
,ornix" &here sperm is deposited
Sperm" small head, lon tail, pearly &hite
*honones"vibration of head of sperm to determine location of ovum
Sperm should penetrate corona radiata and 4ona pellocida.
5apacitation" ability of sperm to release proteolytic en4yme to penetrate corona radiata and 4ona pellocida.
//. Sta&es of Sexual Responses 0'*-%1
#nitial esponses"
Casoconestion conestion of blood vessels
3yotonia increase muscle tension
1. 'xcitement *hase 0sin present in both sexes, moderate increase in ?%, %%,A*, sex flush, nipple erection1 erotic
stimuli cause increase sexual tension, lasts minutes to hours.
2. *lateau *hase 0accelerated C$S1 increasin . sustained tension nearin orasm. >asts 39 seconds 3 minutes.
/
3. -rasm 0involuntary spasm throuhout body, pea( v$s1 involuntary release of sexual tension &ith physioloic or
psycholoic release, immeasurable pea( of sexual experience. 3ay last 2 19 sec" most affected are is pelvic area.
#. %esolution 0v$s return to normal, enitals return to pre"excitement phase1
Refactoy $eio! the only period present in males, &herein he cannot be restimulated for about 19"1/ minutes
A. 'etili7ation
B. Sta&es of 'etal 4o3t% an! De(elopment
3"# days travel of 4yote mitotic cell division beins
<*re"embryonic Stae
a. Oyote" fertili4ed ovum. >ifespan of 4yote from fertili4ation to 2 months
b. 3orula mulberry"li(e ball &ith 1; /9 cells, # days free floatin . multiplication
c. Alastocyst enlarin cells that forms a cavity that later becomes the embryo. Alastocyst coverin of blastocys
that later becomes placenta . trophoblast
d. 6mplantation$ +idation" occurs after fertili4ation G 19 days.
,etus" 2 months to birth.
placenta previa implantation at lo& side of uterus
Sins of implantation7
1. sliht pain
2. sliht vainal spottin
" if &ith fertili4ation corpus luteum continues to function . become source of estroen . proesterone
&hile placenta is not developed.
0 pocesses of #mplantation
1. Apposition
2. Adhesion
3. 6nvasion
C. Deci!ua thic(ened endometrium 0 >atin fallin off1
< Aasalis 0base1 part of endometrium located under fetus &here placenta is delivered
< 5apsularies encapsulate the fetus
< Cera remainin portion of endometrium.
5. C%oionic +illi- 19 11
th
day, finer life pro=ections
3 vesselsI
A unoxyenated blood
C -2 blood
A unoxyenated blood
:hartons =elly protects cord
5horionic villi samplin 05CS1 removal of tissue sample from the fetal portion of the developin placenta for
enetic screenin. Done early in prenancy. 5ommon complication fetal limb defect. 'x missin diits$toes.
'. 5ytotrophoblast inner layer or lanhans layer protects fetus aainst syphilis 2# &(s$; months life span of lanhans
layer increase. Aefore 2# &ee(s critical, miht et infected syphilis
,. Synsitiotrophoblast synsitial layer responsible production of hormone
1. Amnion inner most layer
a. 2mbilical 5ord" ,2+6S, &hitish rey, 1/ //cm, 29 21L. Short cord7 abruptio placenta or inverted
uterus.
>on cord7cord coil or cord prolapse
b. Amniotic ,luid ba of ?2-, clear, odor mousy$musty, &ith crystalli4ed formin pattern, slihtly
al(aline.
5'unction of Amniotic 'lui!"
1. cushions fetus aainst sudden blo&s or trauma
2. facilitates musculo"s(eletal development
3. maintains temp
;
#. prevent cord compression
/. help in delivery process
normal amt of amniotic fluid /99 to 1999cc
polyhydramnios, hydramnios" !6) malformation )',$)'A, increased amt of fluid
oliohydramnios" decrease amt of fluid (idney disease
Dia&nostic Tests fo Amniotic 'lui!
A. Amniocentesis empty bladder before performin the procedure.
*urpose obtain a sample of amniotic fluid by insertin a needle throuh the abdomen into the amniotic
sacP fluid is tested for7
1. !enetic screenin" maternal serum alpha feto"protein test 03SA,*1 1
st
trimester
2. Determination of fetal maturity primarily by evaluatin factors indicative of lun maturity 3
rd
trimester
)estin time 3; &ee(s
decreased 3SA,*I do&n syndrome
increase 3SA,* I spina bifida or open neural tube defect
5ommon complication of amniocenthesis infection
Danerous complications spontaneous abortion
3
rd
trimester" pre term labor
6mportant factor to consider for amniocentesis" needle insertion site
Aspiration of yello&ish amniotic fluid =aundice baby
!reenish meconium
A. Amnioscopy direct visuali4ation or exam to an intact fetal membrane.
A. ,ern )est" determine if amniotic fluid has ruptured or not 0blue paper turns reen$rey " H ruptured amniotic fluid1
5. +itra4ine *aper )est diff amniotic fluid . urine.
*aper turns yello&" urine. *aper turns blue reen$ray"0H1 rupture of amn fluid.
1. C%oion &here placenta is developed
>ecithin Sphinomyelin >$S
%atio" 271 sinifies fetal lun maturity not capable for %DS
Sha(e test amniotic H saline . sha(e
,oam test
*hosphatilyceroli7 *!H definitive test to determine fetal lun maturity
a. $lacenta 0Secundines1 !ree( panca(e, combination of chorionic villi H deciduas basalis. Si4e7 /99 or F (
"1 inch thic( . 8L diameter
,unctions of *lacenta7
1. %espiratory System beinnin of lun function after birth of baby. Simple diffusion
2. !6) transport center, lucose transport is facilitated, diffusion more rapid from hiher to lo&er. 6f mom
hypolycemic, fetus hypolycemic
3. 'xcretory System" artery " carries &aste products. >iver of mom detoxifies fetus.
#. 5irculatin system achieved by selective osmosis
/. 'ndocrine System produces hormones
?uman 5horionic !onadrophin maintains corpus luteum alive.
G
?uman placental >actoen or sommamommamotropin ?ormone for mammary land
development. ?as a diabetoenic effect serves as insulin antaonist
%elaxin ?ormone" causes softenin =oints . bones
estroen
proestin
;. 6t serves as a protective barrier aainst some microoranisms ?6C,?AC
,etal Stae K ,etal !ro&th and DevelopmentL
'ntire prenancy days 2;; 289 days 3G #2 &ee(s
Differentiation of *rimary !erm layers
< 'ndoderm
1
st
&ee( endoderm primary erm layer
)hyroid for basal metabolism
*arathyroid " for calcium
)hymus development of immunity
>iver linin of upper %) . !6)
< 3esoderm development of heart, musculos(eletal system, (idneys and repro oran
< 'ctoderm development of brain, s(in and senses, hair, nails, mucus membrane or anus . mouth
'ist timeste"
1
st
month " Arain . heart development
!6). resp )ract remains as sinle tube
1. ,etal heart tone beins heart is the oldest part of the body
2. 5+S develops di44iness of mom due to hypolycemic effect
,ood of brain lucose complex 5?- prenant &omans food 0potato1
Second 3onth
1. All vital orans formed, placenta developed
2. 5orpus luteum source of estroen . proesterone of infant life span end of 2
nd
month
3. Sex oran formed
#. 3econium is formed
)hird 3onth
1. Qidneys functional
2. Auds of mil( teeth appear
3. ,etal heart tone heard Doppler 19 12 &ee(s
#. Sex is distinuishable
Secon! Timeste" ,-52S lenth of fetus
,ourth 3onth
1. lanuo beins to appear
2. fetal heart tone heard fetoscope, 18 29 &ee(s
3. buds of permanent teeth appear
,ifth 3onth
1. lanuo covers body
2. actively s&allo&s amniotic fluid
3. 1E 2/ cm fetus,
#. Muic(enin" 1
st
fetal movement. 18" 29 &ee(s primi, 1;" 18 &(s multi
/. fetal heart tone heard &ith or &ithout instrument
Sixth 3onth
1. eyelids open
2. &rin(led s(in
3. vernix caseosa present
8
T%i! timeste" *eriod of most rapid ro&th. ,-52S7 &eiht of fetus
Seventh 3onth development of surfactant lecithin
'ihth 3onth
1. lanuo bein to disappear
2. sub M fats deposit
3. +ails extend to finers
+inth 3onth
1. lanuo . vernix caseosa completely disappear
2. Amniotic fluid decreases
)enth 3onth bone ossification of fetal s(ull
Teato&ens- any dru, virus or irradiation, the exposure to such may cause damae to the fetus
A. Drus7
Streptomycin anti )A . or Muinine 0anti malaria1 damae to 8
th
cranial nerve poor hearin .
deafness
)etracycline stainin tooth enamel, inhibit ro&th of lon bone
Citamin Q hemolysis 0destr of %A51, hyperbilirubenia or =aundice
6odides enlarement of thyroid or oiter
)halidomides Amelia or pocomelia, absence of extremities
Steroids cleft lip or palate
>ithium conenital malformation
A. Alcohol lo&ered &eiht 0vasoconstriction on mom1, fetal alcohol &ithdra&al syndrome char by
microcephaly
5. Smo(in lo& birth rate
D. 5affeine lo& birth rate
'. 5ocaine lo& birth rate, abruption placenta
TORCH 8Teato&enic9 #nfections viruses
5?A%A5)'%6S)65S7 roup of infections caused by oranisms that can cross the placenta or ascend throuh birth canal and
adversely affect fetal ro&th and development. )hese infections are often characteri4ed by vaue, influen4a li(e findins,
rashes and lesions, enlared lymph nodes, and =aundice 0hepatic involvement1. 6n some chases the infection may o
unnoticed in the prenant &oman yet have devastatin effects on the fetus. )-%5?7 )oxoplasmosis, -ther, %ubella,
5ytomealo virus, ?erpes simples virus.
) toxoplasmosis mom ta(es care of cats. ,eces of cat o to ra& veetables or meat
- others. ?epa A or infectious heap oral$ fecal 0hand &ashin1
?epa A, ?6C blood . body fluids
Syphilis
% rubella !erman measles conenital heart disease 01
st
month1 normal rubella titer 1719
@1719 less immunity to rubella, after delivery, mom &ill be iven rubella vaccine. Dont et prenant for 3
months. Caccine is teratoenic
5 cytomealo virus
? herpes simplex virus
#. $%ysiolo&ical A!aptation of t%e Mot%e to $e&nancy
A. Systemic C%an&es
1. Ca!io(ascula System increase blood volume of mom 0plasma blood1 39 /9R I 1/99 cc of blood
" easy fatiability, increase heart &or(load, sliht hypertrophy of ventricles, epistaxis
due to hyperemia of nasal membrane palpitation,
*hysioloic Anemia pseudo anemia of prenant &omen
Nomal +alues
E
?ct 32 #2R
?b 19./ 1#$d>
Citeia
1
st
and 3
rd
trimester." patholoic anemia if lo&er
?5) should not be 33R, ?b should not be @ 11$d>
2
nd
trimester ?ct should not @32R
?b ShdnBt @ 19./R patholoic anemia if lo&er
$at%o&enic Anemia
6ron deficiency anemia is the most common hematoloical disorder. 6t affects touhly 29R of prenant &omen.
Assessment reveals7
*allor, constipation
Slo&ed capillary refill
5oncave finernails 0late sin of proressive anemia1 due to chronic physio hypoxia
+ursin 5are7
+utritional instruction (an(on, liver due to ferridin content, reen leafy veetable"alubati,saluyot, malunay,
horseradish, ampalaya
*arenteral 6ron 0 6mferon1 severe anemia, ive 63, O tract" if improperly administered, hematoma.
-ral 6ron supplements 0ferrous sulfate 9.3 . 3 times a day1 empty stomach 1 hr before meals or 2 hrs after, blac(
stool, constipation
3onitor for hemorrhae
Alert7
6ron from red meats is better absorbed iron form other sources
6ron is better absorbed &hen ta(en &ith foods hih in Cit 5 such as orane =uice
?iher iron inta(e is recommended since circulatin blood volume is increased and heme is reSuired from
production of %A5s
E!ema lo&er extremities due venous return is constricted due to lare belly, elevate les above hip level.
+aicosities pressure of uterus
" use support stoc(ins, avoid &earin (nee hih soc(s
" use elastic bandae lo&er to upper
"
+ul)a (aicosities" painful, pressure on ravid uterus, to relieve" position side lyin &ith pillo& under hips or modified
(nee chest position
T%om)op%le)itis presence of thrombus at inflamed blood vessel
" prenant mom hyperfibrinoenemia
" increase fibrinoen
" increase clottin factor
" thrombus formation candidate
-utstandin sin 0H1 ?omanBs sin pain on cuff durin dorsiflexion
3il( le s(inny &hite les due to stretchin of s(in caused by inflammation or phlamasia albadolens
3t7
1.1 Aed rest
2.1 +ever massae
3.1 Assess H ?oman sin once only miht dislode thrombus
#.1 !ive anticoaulant to prevent additional clottin 0thrombolytics &ill dilute1
/.1 3onitor A*)) antidote for ?eparin toxicity, protamine sulfate
;.1 Avoid aspirinD 3iht aravate bleedin.
2. Respiatoy system common problem S-A due to enlared uterus . increase -2 demand
19
*osition" lateral expansion of luns or side lyin position.
3. 4astointestinal 1
st
trimester chane
Monin& Sic:ness nausea . vomitin due to increase ?5!. 'at dry crac(ers or dry 5?- diet 39 minutes before
arisin bed. +ausea afternoon " small freS feedin. Comitin in pre emesisravida.
3etabolic al(alosis, ,.' imbalance primary med mt replace fluids.
3onitor 6.-
constipation proesterone resp for constipation. 6ncrease fluid inta(e, increase fiber diet
" fruits papaya, pineapple, mano, &atermelon, cantaloupe, apple &ith s(in, suha.
'xcept uava has pectin thats constipatin ve petchy, malunay.
" exercise
"mineral oil excretion of fat soluble vitamins
5 'latulence avoid as formin food cabbae
< Heat)un or pyrosis reflux of stomach content to esophaus
" small freSuent feedin, avoid 3 full meals, avoid fatty . spicy food, sips of mil(, proper body mechanical
increase salivation ptyalsim mt mouth&ash
<Hemo%oi!s pressure of ravid uterus. 3tP hot sit4 bath for comfort
#. ;inay System freSuency durin 1
st
. 3
rd
trimester lateral expansion of luns or side lyin pos mt for nocturia
Acetyace test albumin in urine
Aenedicts test suar in urine
<. Musculos:eletal
>ordosis pride of prenancy
:addlin !ait a&(&ard &al(in due to relaxation causes softenin of =oints . bones
*rone to accidental falls &ear lo& heeled shoes
>e 5ramps causes7 proloned standin, over fatiue, 5a . phosphorous imbalance0T1 cause &hile prenant1, chills,
oversex, pressure of ravid uterus 0labor cramps1 at lumbo sacral nerve plexus
3t7
6ncrease 5a diet"mil(06nc 5a . 6nc phosphorus1"1pint$day or 3"# servins$day. 5heese, yourt, head of
fish, Dilis, sardines &ith bones, brocolli, seafood"tahon 0mussels1, lobster, crab.
Cit D for increased 5a absorption
dorsiflexion
B. Local C%an&es
>ocal chane7 Caina7
C 5had&ic(s sin blue violet discoloration of vaina
5 !oodelBs sin chane of consistency of cervix
6 ?earBs chane of consistency of isthmus 0lo&er uterine sement1
>'2Q-%%?'A &hitish ray, mousy odor dischare
'S)%-!'+ hormone, resp for leucorrhea
-*'%52>23 mucus plu to seal out bacteria.
*%-!'S)'%-+' hormone responsible for operculum
*%'!+A+) acidic to al(aline chane to protect bacterial ro&th 0vainitis1
$o)lems Relate! to t%e C%an&e of +a&inal En(ionment"
a. +a&initits trichomonas vainalis due to al(aline environment of vaina of prenant mom
,laellated proto4oa &ants al(aline
S.Sx7
!reenish cream colored frothy irritatinly itchy &ith foul smellin odor &ith vainal edema
11
3t7
,>A!U> 0metronida4ole antiproto4oa1. 5arcinoenic dru so dont ive at 1
st
trimester
1. treat dad also to prevent reinfection
2. no alcohol has antibuse effect
CA!6+A> D-25?' 6M ?2- 7 1 tbsp &hite vinear
b. Moniliasis o can!i!iasis due to candida albecans, funal infection.
5olor &hite cheese li(e patches adheres to &alls of vaina.
Sins . Symptoms7
3anaement antifunal +istatin, enshan violet, cotrimaxole, canesten
!onorrhea ")hic( purulent dischare
Cainal &arts" condifoma acuminata due to papilloma virus
3t7 cauteri4ation
2. Abdominal 5hanes striae ravidarium 0stretch mar(s1 due enlarin uterus"destruction of sub M tissue avoid
scratchin, use coconut oil, umbilicus is protrudin
3. S(in 5hanes bro&n pimentation nose chin, chee(s chloasma melasma due to increased melanocytes.
Aro&n pin(ish line" linea nira" symphisis pubis to umbilicus
#. Areast 5hanes increase hormones, color of areola . nipple
pre colostrums present by ; &ee(s, colostrums at 3
rd
trimester
Areast self exam" G days after mens supine &ith pillo& at bac(
Suadrant A upper outer common site of cancer
)est to determine breast cancer7
1. mammoraphy 3/ to #E yrs once every 1 to 2 yrs
/9 yrs and above 1 x a yr
;. -varies rested durin prenancy
G. Sins . symptoms of *renancy
A. $esumpti(e s$s felt and observed by the mother but does not confirm positive dianosis of prenancy .
Sub=ective
A. $o)a)le sins observed by the members of health team. -b=ective
5. $ositi(e Si&ns undeniable sins confirmed by the use of instrument.
Aallotment sin of myoma
< H ?5! sin of ? mole
" trans vainal ultrasound. 'mpty bladder
" ultrasound full bladder
placental &a!in& ratin$rade
o immature
1 slihtly mature
2 moderately mature
3 placental maturity
:hat is deposited in placenta &hich sinify maturity " there is calcium
$esumpti(e $o)a)le $ositi(e
Areast chanes
2rinary freS
,atiue
Amenorrhea
!oodelBs" chane of consistency of cervix
5had&ic(s" blue violet discoloration of vaina
?earBs" chane of consistency of isthmus
'levated AA) due to increased proesterone
2ltrasound evidence
0sonoram1 full bladder
,etal heart tone
12
3ornin sic(ness
'nlared uterus
5loasma
>inea nera
6ncreased s(in pimentation
Striae ravidarium
Muic(enin
*ositive ?5! or 0H1pre test
Aallottement bouncin of fetus &hen lo&er uterine is tapped
sharply
'nlared abdomen
Araxton ?ic(s contractions painless irreular contractions
,etal movement
,etal outline
,etal parts palpable
C6. $syc%olo&ical A!aptation to $e&nancy 0'motional response of mom %eva %ubin theory1
,irst )rimester7 +o taninal sins . sx, surprise, ambivalence, denial sin of maladaptation to prenancy. Developmental
tas( is to accept bioloical facts of prenancy
,ocus7 bodily chanes of pre, nutrition
Second )rimester tanible S.Sx. mom identifies fetus as a separate entity due to presence of Suic(enin, fantasy.
Developmental tas( accept ro&in fetus as baby to be nurtured.
?ealth teachin7 ro&th . development of fetus.
)hird )rimester7 " mom has personal identification on appearance of baby
Development tas(7 prepare of birth . parentin of child. ?)7 responsible parenthood Vbabys >ayetteL best time to
do shoppin.
3ost common fear let mom listen to ,?) to allay fear
>ama4e classes
+##. $e-Natal +isit"
1. ,reSuency of Cisit7 1
st
G months 1x a month
8 E months 2 x a month
19 once a &ee(
post term 2 x a &ee(
2. *ersonal data name, ae 0hih ris( @ 18 . W3/ yrs old1 record to determine hih ris( ?A3%. ?ome base moms
record. Sex 0 pseudocyesis or false prenancy on men . &omen1
5ouvade syndrome dad experiences &hat mom oes throuh lihi1
Address, civil status, reliion, culture . beliefs &ith respect, non =udmental
-ccupation financial condition or occupational ha4ards, education bac(round level (no&lede
3. Dianosis of *renancy
1.1 urine exam to detect ?5! at #9 199
th
day. ;9 G9 day pea( ?5!. ; &ee(s after >3*" best to et urine
exam.
2.1 'lisa test test for pre detects beta subunit of ?5! as early as G 19days
3.1 ?ome pre (it do it yourself
#. Aaseline Data7 C$S esp. A*, monitor &t. 0increase &t 1
st
sin preeclampsia1
=ei&%t Monitoin&
,irst )rimester7 +ormal :eiht ain 1./ 3 lbs 0./ 1lb$month1
Second trimester7 normal &eiht ain 19 12 lbs 0# lbs$month1 01 lb$&(1
)hird trimester7 normal &eiht ain 19 12 lbs 0# lbs$ month1 0 1lb$&(1
3inimum &t ain 29 2/ lbs
-ptimal &t ain 2/ 3/ lbs
/. -bstetrical Data7
nullipara no prenancy
a. 4a(i!a" T of prenancy
b. $aa " T of viable prenancy
Ciability the ability of the fetus to live outside the uterus at the earliest possible estational ae.
ae of viability " 29 2# &(s
)erm 3G #2 &(s,
13
*reterm "29 3G &ee(s
abortion @29 &ee(s
Sample 5ases7
1 abortion !)*A>
1 2
nd
mo 2 9 91 9
! 2
* 9
1 #9
th
A-! !) * A >
1 3;
th
A-! ; 1 2 2 #
2 misc
1 t&ins 3/ A-!
1 #
th
month !; *3
1 3E
th
&ee(
1 miscarriae !* !)*A>
1 stillbirth 33 A-! 0considered as para1 # 2 # 11 1 1
1 pre 3
rd
&(
1 33 *
1 #1
st
>
1 abort A
1 still 3E !* !)*A>
1 triplet 32 ; # ; 2 2 1/
1 #
th
mon
c. 6mportant 'stimates7
1. Na&ele>s Rule use to determine expected date of delivery
!et >3* "3H G H1 Apr"Dec >3* Xan ,eb 3ar
3 D U HE HG no year
>3* Xan 2/, 9#
HE HG
19 $ 32 $ 9#
" 1
add 1 month to month
11$31$9# 'DD
2. McDonal!>s Rule to determine ae of estation 6+ :''QS
,2+D65 ?) N G$8IA-! in :Q
,undic ?t N G I A-! in &ee(s
8
,r sypmhisis pubis to fundus 2# N G I21 &(s
8
3. Bat%olome3>s Rule to determine ae of estation by proper location of fundus at abdominal cavity.
3 months above sym pub
/ months level of umbilicus
E months belo& 4yphoid
19 months level of 8 months due to lihtenin
#. Haases ule , to determine lenth of the fetus in cm.
,ormula7 1
st
F of pre , sSuare Y month
2
nd
F of pre, x Y month by /
3mos x 3 I Ecm
# mos x # I 1; cm 19 x / I /9 cm 1
st
F of pre
/ x / I 2/ cm
; x / I 39 cm
1#
G x / I 3/ cm 2
nd
F of pre
8 x / I #9 cm
E x / I #/ cm
d. tetanus immuni4ations prevents tetanus neonatum
"mom &ith complete 3 doses D*) youn ae considered as ))1 . 2. Aein ))3
))1 any time durin prenancy
))2 # &(s after ))1 3 yrs protection
))3 ; months after ))2 / yrs protection
))# 1 yr after ))3 19 yrs protection
))/ yr after ))# lifetime protection
/. *hysical 'xamination7
A. 'xamine teeth7 sin of infection
Daner sins of *renancy
5 " chills$ fever " infection
5erebral disturbances 0 headache preeclampsia1
A abdominal pain 0 epiastric pain aura of impendin convulsions
A boardli(e abdomen abruption placenta
6ncrease A* ?*+
Alurred vision preeclampsia
Aleedin 1
st
trimester, abortion, ectopic pre$2
nd
? mole, incompetent cervix
3
rd
placental anomalies
S sudden ush of fluid *%-3 0premature rupture of membrane1 prone to inf.
' edema to upper ext. 0preeclampsia1
;. *elvic 'xamination internal exam
1. empty bladder
2. universal precaution
'N) -S of cervix site for ettin specimen
Site for cervical cancer
$ap Smea cervical cancer
" composed of sSuamous columnar tissue
%esult7
5lass 6 " normal
5lass 66A acytoloy but no evidence of malinancy
A suestive of infl.
5lass 666 cytoloy suestive of malinancy
5lass 6C cytoloy stronly suestive of malinancy
5lass C cytoloy conclusive of malinancy
Sta&es of Ce(ical Cance
Stae 9 carcinoma insitu
1 cancer confined to cervix
2 " cancer extends to vaina
3 pelvis metastasis
# affection to bladder . rectum
?. Leopol!>s Maneu(e
*urpose7 is done to determine the attitude, fetal presentation lie, presentin part, deree of descent, an estimate of
the si4e, and number of fetuses, position, fetal bac( . fetal heart tone
" use palmD :arm palm.
*rep mom7
1/
1. 'mpty bladder
2. *osition of mom"supine &ith (nee flex 0dorsal recumbent to relax abdominal muscles1
*rocedure7
/
st
maneu(e7 place patient in supine position &ith (nees slihtly flexedP put to&el under head and riht hipP &ith both hands
palpate upper abdomen and fundus. Assess si4e, shape, movement and firmness of the part to determine presentation
1
n!
Maneu(e" &ith both hands movin do&n, identify the bac( of the fetus 0 to hear fetal heart sound1 &here the ball of the
stethoscope is placed to determine ,?). !et C$S0before 2
nd
maneuver1 *% to diff fundic soufflZ 0,?%1 . uterine soufflZ.
2terine soufflZ maternal ? rate
0
!
Maneu(e7 usin the riht hand, rasp the symphis pubis part usin thumb and finers.
)o determine deree of enaement.
Assess &hether the presentin part is enaed in the pelvis 1Alert 7 if the head is enaed it &ill not be movable1.
.
t%
Maneu(e" the 'xaminer chanes the position by facin the patients feet. :ith t&o hands, assess the descent of the
presentin part by locatin the cephalic prominence or bro&. )o determine attitude relationship of fetus to 1 another.
:hen the bro& is on the same side as the bac(, the head is extended. :hen the bro& is on the same side as the small parts,
the head &ill be flexed and vertex presentin.
Attitude relationship of fetus to a part or deree of flexion
,ull flexion &hen the chin touches the chest
@.Assessment of 'etal =ell-Bein&-
A. Daily 'etal Mo(ement Countin& 8D'MC9 ,bein 2G &ee(s
3om" bein after meal " brea(fast
a. Ca!iff count to /6 met%o! one method currently available
011 Aein at the same time each day 0usually in the mornin, after brea(fast1 and count each fetal movement, notin ho&
lon it ta(es to count 19 fetal movements 0,3s1
021 'xpected findins 19 movements in 1 hour or less
31 :arnin sins
a.1 more then 1 hour to reach 19 movements
b.1 less then 19 movements in 12 hours0non"reactive" fetal distress1
c.1 loner time to reach 19 ,3s than on previous days
d.1 movement are becomin &ea(er, less viorous
3ovement alarm sinals " @ 3 ,3s in 12 hours
#.1 &arnin sins should be reported to healthcare provider immediatelyP often reSuire further testin. 'xamples7 nonstress
test 0+S)1, bioraphical profile 0A**1
A. Nonstess test to determine the response of the fetal heart rate to activity
6ndication prenancies at ris( for placental insufficiency
*ostmaturity
a.1 prenancy induced hypertension 0*6?1, diabetes
b.1 &arnin sins noted durin D,35
c.1 maternal history of smo(in, inadeSuate nutrition
$oce!ue"
Done &ithin 39 minutes &herein the mother is in semi"fo&lers position 0&$ fetal monitor1P external monitor is applied to
document fetal activityP mother activates the Kmar( buttonL on the electronic monitor &hen she feels fetal movement.
Attach external noninvasive fetal monitors
1. tocotans!uce over fundus to detect uterine contractions and fetal movements 0,3s1
2. ultasoun! tans!uce over abdominal site &here most distinct fetal heart sounds are detected
3. monitor until at least 2 ,3s are detected in 29 minutes
if no ,3 after #9 minutes provide &oman &ith a liht snac( or ently stimulate fetus throuh abdomen
if no ,3 after 1 hour further testin may be indicated, such as a 5S)
%esult7
1;
+oncreative
+onstress
+ot !ood
%eactive
%esponsive is
%eal !ood
#ntepetation of esults
i. eacti(e esult
1. Aaseline ,?% bet&een 129 and 1;9 beats per minute
2. At least t&o accelerations of the ,?% of at least 1/ beats per minute, lastin at least 1/ seconds in a 19 to
29 minute period as a result of ,3
3. !ood variability normal irreularity of cardiac rhythm representin a balanced interaction bet&een the
parasympathetic 0decreases ,?%1 and sympathetic 0increase ,?%1 nervous systemP noted as an uneven line
on the rhythm strip.
#. result indicates a healthy fetus &ith an intact nervous system
ii. Noneacti(e esult
1. Stated criteria for a reactive result are not met
2. 5ould be indicative of a compromised fetus.
%eSuires further evaluation &ith another +S), biophysical profile, 0A**1 or contraction stress test 05S)1
E. Healt% teac%in&s
a. Nutition do nutritional assessment daily food inta(e
?ih ris( moms7
1. *renant teenaers lo& compliance to heath reimen.
2. 'xtremes in &t under&eiht, over &t candidate for ?*+, D3
3. >o& socio economic status
#. Ceetarian mom decrease 5?-+ needs Cit A12 cyanocobalamin formation of folic acid needed for cell
D+A . %A5 formation. 0Decrease folic acid spina bifida$open neural tube defect1
?o& many Qcal 5?- x#,5?-+ x#, fats x E
Recommen!e! Nutient ReAuiement t%at inceases Duin& $e&nancy
Nutients ReAuiements 'oo! Souce
Caloies
'ssential to supply enery for
" increased metabolic rate
" utili4ation of nutrients
" protein sparin so it can be used for
" !ro&th of fetus
" Development of structures reSuired
for prenancy includin placenta,
amniotic fluid, and tissue ro&th.
399 calories$day above the
preprenancy daily reSuirement to
maintain ideal body &eiht and
meet enery reSuirement to activity
level
" Aein increase in second
trimester
" 2se &eiht ain pattern as
an indication of adeSuacy of
calorie inta(e.
" ,ailure to meet caloric
reSuirements can lead to
(etosis as fat and protein are
used for eneryP (etosis has
been associated &ith fetal
damae.
5aloric increase should reflect
" ,oods of hih nutrient value such as
protein, complex carbohydrates 0&hole
rains, veetables, fruits1
" Cariety of foods representin foods
sources for the nutrients reSuirin
durin prenancy
" +o more than 39R fat
$otein
'ssential for7
" ,etal tissue ro&th
" 3aternal tissue ro&th includin
uterus and breasts
" Development of essential prenancy
structures
;9 m$day or an increase of 19R
above daily reSuirements for ae
roup
Adolescents have a hiher protein
reSuirement than mature &omen
since adolescents must supply
*rotein increase should reflect
" >ean meat, poultry, fish
" 's, cheese, mil(
" Dried beans, lentils, nuts
" :hole rains
< veetarians must ta(e note of the amino
acid content of 5?-+ foods consumed to
1G
" ,ormation of red blood cells and
plasma proteins
< 6nadeSuate protein inta(e has been
associated &ith onset of prenancy
induces hypertension 0*6?1
protein for their o&n ro&th as
&ell as protein t meet the
prenancy reSuirement
ensure inestion of sufficient Suantities of
all amino acids
Calcium-$%osp%oous
'ssential for
" !ro&th and development of
fetal s(eleton and tooth buds
" 3aintenance of minerali4ation
of maternal bones and teeth
" 5urrent research is 7
Demonstratin an association bet&een
adeSuate calcium inta(e and the
prevention of prenancy induce
hypertension
5alcium increases of
" 1299 m$day representin an
increase of /9R above
preprenancy daily
reSuirement.
" 1;99 m$day is recommended
for the adolescent. 19 mc$day
of vitamin D is reSuired since
it enhances absorption of both
calcium and phosphorous
5alcium increases should reflect7
" dairy products 7 mil(, yourt, ice
cream, cheese, e yol(
" &hole rains, tofu
" reen leafy veetables
" canned salmon . sardines &$ bones
" 5a fortified foods such as orane =uice
" Citamin D sources7 fortified mil(,
mararine, e yol(, butter, liver,
seafood
#on
'ssential for
" 'xpansion of blood volume and red
blood cells formation
" 'stablishment of fetal iron stores
for first fe& months of life
39 m$day representin a doublin
of the prenant daily reSuirement
" Aein supplementation at 39"
m$day in second trimester,
since diet alone is unable to
meet prenancy reSuirement
" ;9 129 m$day alon &ith
copper and 4inc
supplementation for &omen
&ho have lo& hemolobin
values prior to prenancy or
&ho have iron deficiency
anemia.
" G9 m$day of vitamin 5 &hich
enhances iron absorption
" inadeSuate iron inta(e results
in maternal effects anemia
depletion of iron stores,
decreased enery and appetite,
cardiac stress especially labor
and birth
" fetal effects decreased
availability of oxyen thereby
affectin fetal ro&th
< iron deficiency anemia is the
most common nutritional disorder
of prenancy.
6ron increases should reflect
" liver, red meat, fish, poultry, es
" enriched, &hole rain cereals and
breads
" dar( reen leafy veetables,
leumes
" nuts, dried fruits
" vitamin 5 sources7 citrus fruits .
=uices, stra&berries, cantaloupe,
broccoli or cabbae, potatoes
" iron from food sources is more
readily absorbed &hen served
&ith foods hih in vit 5
Binc
'ssential for
< the formation of en4ymes
< maybe important in the prevention of
conenital malformation of the fetus.
1/mc$day representin an
increase of 3 m$day over
prepreanant daily reSuirements.
Oinc increases should reflect
" liver, meats
" shell fish
" es, mil(, cheese
" &hole rains, leumes, nuts
'olic Aci!C 'olacinC 'olate
'ssential for
" formation of red blood cells
and prevention of anemia
" D+A synthesis and cell
formationP may play a role in
the prevention of neutral tube
defects 0spina bifida1,
abortion, abruption placenta
#99 mc$day representin an
increase of more then 2 times the
daily preprenant reSuirement.
399mc$day supplement for
&omen &ith lo& folate levels or
dietary deficiency
# servins of rains$day
6ncreases should reflect
" liver, (idney, lean beef, veal
" dar( reen leafy veetables,
broccoli, leumes.
" :hole rains, peanuts
A!!itional ReAuiements
Mineals
6ncreased reSuirements of prenancy can
easily be met &ith a balanced diet that
18
" iodine
" 3anesium
" Selenium
1G/ mc$day
329 m$day
;/ mc$day
meets the reSuirement for calories and
includes food sources hih in the other
nutrients needed durin prenancy.
+itamins
'
)hiamine
%iborlavin
*yridoxine 0 A;1
A12
+iacin
19 m$day
1./ m$day
1.; m$day
2.2 m$day
2.2 m day
1G m$day
Cit stored in body. )a(in it not needed
fat soluble vitamins. ?ard to excrete.
1.Sexual Acti(ity
a.1 should be done in moderation
b.1 should be done in private place
c.1 mom placed in comfy pos, sidelyin or mom on top
d.1 avoided ; &ee(s prior to 'DD
e.1 avoid blo&in or air durin cunnilinus
f.1 chanes in sexual desire of mom durin pre" air embolism
5hanes in sexual desire7
a.1 1
st
tri decrease desire due to bodily chanes
b.1 2
nd
trimester increased desire due to increase estroen that enhances lubrication
c.1 3
rd
trimester decreased desire
5ontraindication in sex7
1. vainal spottin
1
st trimester
threatened abortion
2
nd
trimester placenta previa
2. incompetent cervix
3. preterm labor
#. premature rupture of membrane
3. Execise , to strenthen muscles used durin delivery process
" principles of exercise
1.1 Done in moderation. 2.1 3ust be individuali4ed
:al(in best exercise
SSuattin strenthen muscles of perineum. 6ncrease circulation to perineum. SSuat feet flat on floor
)ailor Sittin 1 le in front of other le 0 6ndian seat1
%aise buttoc(s 1
st
before head to prevent postural hypotension di44iness &hen chanin position
" shoulder circlin exercise" strenthen chest muscles
" pelvic roc(in$pelvic tilt" exercise relieves lo& bac( pain . maintain ood posture
" < arch bac( standin or (neelin. ,our extremities on floor
Qeel 'xercise strenthen pulococcyeal muscles
" as if hold urine, release 19x or muscle contraction
Abdominal 'xercise strenthens muscles of abdominal done as if blo&in candle
.. C%il!)it% $epaation"
-verall oal7 to prepare parents physically and psycholoically &hile promotin &ellness behavior that can be used by
parents and family thus, helpin them achieved a satisfyin and en=oyin childbirth experience.
a. *sychophysical
1. Ba!ley Met%o! Dr. %obert Aradley advocated active participation of husband at delivery process. Aased on imitation
of nature.
1E
,eatures7
1.1 dar(ened rm
2.1 Suiet environment
3.1 relaxation tech
#.1 closed eye . appearance of sleep
2. 4antly Dic: Rea! Met%o! fear leads to tension &hile tension leads to pain
b. *sychosexual
1. 2it7in&e met%o! pre, labor . birth . care of ne&born is an impt turnin pt in &omans life cycle
" flo& &ith contraction than strule &ith contraction
c. *sychoprophylaxis prevention of pain
1. Lama7e7 Dr. ,erdinand >ama4e
reS. disciple, conditionin . concentration. ?usband is coach
,eatures7
1. 5onscious relaxation
2. 5leansin breathe inhale nose, exhale mouth
3. 'ffleurae entle circular massae over abdominal to relieve pain
#. imain sensate focus
<. Diffeent Met%o!s of !eli(ey"
1.1 birthin chair bed convertible to chair semifo&lers
2.1 birthin bed dorsal recumbent pos
3.1 sSuattin relives lo& bac( pain durin labor pain
#.1 leboyers &arm, Suiet, dar(, comfy room. After delivery, baby ets &arm bath.
/.1 Airth under ?29 bathtub labor . delivery &arm &ater, soft music.
#D. #ntapatal Notes inside '%
A. Admittin the laborin 3other7
*ersonal Data7 name, ae, address, etc
Aaseline Data7 v$s esppecially A*, &eiht
-bstetrical Data7 ravida T pre, para" viable pre, 22 2# &(s
*hysical 'xams,*elvic 'xams
A. Aasic (no&lede in 6ntrapartum.
b. 1 T%eoies of t%e Onset of La)o
1.1 uterine stretch theory 0 any hallo& oran stretched, &ill al&ays contract . expel its content1 contraction action
2.1 oxytocin theory post pit land releases oxytocin. ?ypothalamus produces oxytocin
3.1 prostalandin theory stimulation of arachidonic acid prostalandin" contraction
#.1 proesterone theory before labor, decrease proesterone &ill stimulate contractions . labor
/.1 theory of ain placenta life span of placenta #2 &(s. At 3; &(s deenerates 0leadin to contraction onset
labor1.
b.2. )he . $>s of la)o
/. $assen&e
a. 'etal %ea! is the larest presentin part common presentin part J of its lenth.
Bones , ; bones S sphenoid , frontal " sinciput
' ethmoid - occuputal " occiput
) temporal * parietal 2 x
3easurement fetal head7
1. transverse diameter E.2/cm
" biparietal larest transverse
" bitemporal 8 cm
2. bimastoid Gcm smallest transverse
Sutues , intermembranous spaces that allo& moldin.
29
1.1 saittal suture connects 2 parietal bones 0 saitna1
2.1 coronal suture connect parietal . frontal bone 0cro&n1
3.1 lambdoidal suture connects occipital . parietal bone
Mol!in&s" the overlappin of the sutures of the s(ull to permit passae of the head to the pelvis
'ontanels"
1.1 Anterior fontanel brema, diamond shape, 3 x # cm,0 W / cm hydrocephalus1, 12 18 months after birth" close
2.1 *osterior fontanel or lambda trianular shape, 1 x 1 cm. 5loses 2 3 months.
#.1 Anteroposterior diameter "
suboccipitobrematic E./ cm, complete flexion, smallest A*
occipitofrontal 12cm partial flexion
occipitomental 13./ cm hyper extension submentobramatic"face presentation
2. $assa&e3ay
3om 1.1 @ #EL tall
2.1 @ 18 years old
3.1 2nder&ent pelvic dislocation
*elvis
# main pelvic types
1. !ynecoid round, &ide, deeper most suitable 0normal female pelvis1 for prenancy
2. Android heart shape Kmale pelvisL" anterior part pointed, posterior part shallo&
3. Anthropoid oval, ape li(e pelvis, oval shape, A* diameter &ider transverse narro&
#. *latypelloid flat A* diameter narro&, transverse &ider
). *elvis
2 hip bones 2 innominate bones
3 *arts of 2 6nnominate Aones
6leum lateral side of hips
" iliac crest flarin superior border formin prominence of hips
6schium inferior portion
" ischial tuberosity &here &e sit landmar( to et external measurement of pelvis
*ubes ant portion symphisis pubis =unction bet&een 2 pubis
1 sacrum post portion sacral prominence landmar( to et internal measurement of pelvis
1 coccyx / small bones compresses durin vainal delivery
#mpotant Measuements
1. Diaonal 5on=uate measure bet&een sacral promontory and inferior marin of the symphysis pubis.
3easurement7 11./ cm " 12./ cm basis in ettin true con=uate. 0D5 11./ cmItrue con=uate1
2. )rue con=uate$con=uate vera measure bet&een the anterior surface of the sacral promontory and superior
marin of the symphysis pubis. 3easurement7 11.9 cm
3. -bstetrical con=uate smallest A* diameter. *elvis at 19 cm or more.
)uberoischi Diameter transverse diameter of the pelvic outlet. 6schial tuberosity approximated &ith use of fist
8 cm . above.
0. $o3e , the force actin to expel the fetus and placenta myometrium po&ers of labor
a. 6nvoluntary 5ontractions
b. Coluntary bearin do&n efforts
c. 5haracteristics7 &ave li(e
d. )imin7 freSuency, duration, intensity
.. $syc%e/$eson , psycholoical stress &hen the mother is fihtin the labor experience
a. 5ultural 6nterpretation
b. *reparation
c. *ast 'xperience
d. Support System
21
$e-eminent Si&ns of La)o
S.Sx7
" shootin pain radiatin to the les
" urinary freS.
1. >ihtenin settin of presentin part into pelvic brim " 2 &ee(s prior to 'DD
< 'naement" settin of presentin part into pelvic inlet
2. Araxton ?ic(s 5ontractions painless irreular contractions
3. 6ncrease Activity of the 3other" nestin instinct. Save enery, &ill be used for delivery. 6ncrease epinephrine
#. %ipenin of the 5ervix butter soft
/. decreased body &t 1./ 3 lbs
;. Aloody Sho& pin(ish vainal dischare blood . leu(orrhea
G. %upture of 3embranes rupture of &ater. 5hec( ,?)
$ematue Ruptue of Mem)ane 8 $ROM9 - do 6' to chec( for cord prolapse
5ontraction drop in intensity even thouh very painful
5ontraction drop in freSuently
2terus tense and$or contractin bet&een contractions
Abdominal palpations
+ursin 5areP
Administer Analesics 03orphine1
Attempt manual rotation for %-* or >-* most common malposition
Aear do&n &ith contractions
AdeSuate hydration prepare for 5S
Sedation as ordered
5esarean delivery may be reSuired, especially if fetal distress is noted
Co! $olapse a complication &hen the umbilical cord falls or is &ashed throuh the cervix into the vaina.
Daner sins7
*%-3
*resentin part has not yet enaed
,etal distress
*rotrudin cord form vaina
+ursin care7
1. 5over cord &ith sterile au4e &ith saline to prevent dryin of cord so cord &ill remain slippery . prevent cord
compression causin cerebral palsy.
2. Slip cord a&ay from presentin part
3. 5ount pulsation of cord for ,?)
#. *rep mom for 5S
*ositionin trendelenber or (nee chest position
'motional support
*repare for 5esarean Section
Diffeence Bet3een Tue La)o an! 'alse La)o
,alse >abor )rue >abor
6rreular contractions
+o increase in intensity
*ain confined to
abdomen
*ain relived by &al(in
+o cervical chanes
5ontractions are reular
6ncreased intensity
*ain beins lo&er bac( radiates to abdomen
*ain intensified by &al(in
5ervical effacement . dilatation < ma=or sx
of true labor.
Duation of La)o
*rimipara 1# hrs . not more than 29 hrs
3ultipara 8 hrs . not W 1# hrs
Effacement softenin . thinnin of cervix. 2se R in unit of measurement
22
Dilation &idenin of cervix. 2nit used is cm.
Nusin& #nte(entions in Eac% Sta&e of La)o
2 sements of the uterus
1. upper uterine " fundus
2. lo&er uterine isthmus
1. 'ist Sta&e" onset of true contractions to full dilation and effacement of cervix.
>atent *hase7
Assessment7 Dilations7 9 3 cm mom excited, apprehensive, can communicate
,reSuency7 every / 19 min
6ntensity mild
+ursin 5are7
1. 'ncourae &al(in " shorten 1
st
stae of labor
2. 'ncourae to void S 2 3 hrs full bladder inhibit contractions
3. Areathin chest breathin
Active *hase7
Assessment7 Dilations # "8 cm 6ntensity7 moderate 3om" fears losin control of self
,reSuency S 3"/ min lastin for 39 ;9 seconds
+ursin 5are7
3 edications have meds ready
A ssessment include7 vital sins, cervical dilation and effacement, fetal monitor, etc.
D dry lips oral care 0ointment1
dry linens
A abdominal breathin
)ransitional *hase7 intensity7 stron 3om mood chanes &ith hyperesthesia
Assessment7 Dilations 8 19 cm
,reSuency S 2"3 min contractions
Durations #/ E9 seconds
?yperesthesia increase sensitivity to touch, pain all over
?ealth )eachin 7 teach7 sacral pressure on lo&er bac( to inhibit transmission of pain
(eep informed of proress
controlled chest breathin
+ursin 5are7
) ires
6 nform of proress
% estless support her breathin techniSue
' ncourae and praise
D iscomfort
$el(ic Exams
'ffacement
Dilation
a. Station , landmar( used7 ischial spine
" 1 station I presentin part 1cm above ischial spine if 0"1 floatin
" 2 station I presentin part 2 cm above ischial spine if 0"1 floatin
9 station I level at ischial spine enaement
H 1 station I belo& 1 cm ischial spine
H3 to H/ I cro&nin occurs at 2
nd
stae of labor
). $esentation/lie the relationship of the lon axis 0spine1 of the fetus to the lon axis of the mother
"spine of mom and spine of fetus
T3o types"
b.1. >onitudinal >ie 0 *arallel1
cephalic " Certex complete flexion
23
,ace
Aro& $oo 'lexion
5hin
Areech " 5omplete Areech thih breast on abdomen, breast lie on thih
6ncomplete Areech thih rest on abdominal
,ran( les extend to head
,ootlin sinle, double
Qneelin
b.2. )ransverse >ie 0*erpendicular1 or *erpendicular lie. Shoulder presentation.
c. $osition , relationship of the fatal presentin part to specific Suadrant of the mothers pelvis.
Cariety7
-ccipito >-A left occipito ant 0most common and favorable position1 side of maternal pelvis
>-* left occipito posterior
>-* most common mal position, most painful
%-* sSuattin pos on mom
%-)
%-A
Areech" use sacrum >SA left sacro anterior
" put stet above umbilicus >S), >S*, %SA, %S), %S*
S%oul!e/acomnio!oso
>ADA, >AD), >AD*, %ADA
C%in / Mento
>3A, >3), >3*, %3*, %3A, %3), %3*
Monitoin& t%e Contactions an! 'etal %eat Tone
Spread finers lihtly over fundus to monitor contractions
$ats of contactions7
6ncrement or crescendo beinnin of contractions until it increases
Acme or apex heiht of contraction
Decrement or decrescendo from heiht of contractions until it decreases
Duration beinnin of contractions to end of same contraction
6nterval end of 1 contraction to beinnin of next contraction
,reSuency beinnin of 1 contraction to beinnin of next contraction
6ntensity " strenth of contraction
5ontraction vasoconstriction
6ncrease A*, decrease ,?)
Aest time to et A* . ,?) =ust after a contraction or mid&ay of contractions
*lacental reserve ;9 sec o2 for fetus durin contractions
Duration of contractions shouldnt W;9 sec
+otify 3D
3om has headache chec( A*, if same A*, let mom rest. 6f A* increase , notify 3D "preeclampsia
Healt% teac%in&s
1.1 -( to sho&er
2.1+*- !6) stops function durin labor if &ith food" &ill cause aspiration
3.1'nema administer durin labor
a.1)o cleanse bo&el
b.1*revent infection
c.1Sims position$side lyin
12 18 inch ht enema tubin
5hec( ,?) after adm enema
2#
+ormal ,?)I 129"1;9
Sins of fetal distress"
1.1 @129 . W1;9
2.1 mecomium stain amnion fluid
3.1 fetal thrushin hyperactive fetus due to lac( -2
2. Secon! Sta&e7 fetal stae, complete dilation and effacement to birth.
G 8 multi brin to delivery room
19cm primi brin to delivery room
>ithotomy pos put les same time up
Aulin of perineum sure to come out
Areathin pantin 0 teach mom1
Assist doc in doin episiotomy" to prevent laceration, &iden vainal canal, shorten 2
nd
stae of labor.
'pisiotomy median less bleedin, less pain easy to repair, fast to heal, possible to reach rectum 0 urethroanal fistula1
3ediolateral more bleedin . pain, hard to repair, slo& to heal
"use local or pudendal anesthesia.
6ronin the perineum to prevent laceration
3odified %itens maneuver place to&el at perineum
1.1)o prevent laceration
2.1 :ill facilitate complete flexion . extension. 0Support head . remove secretion, chec( cord if coiled. *ull shoulder do&n
. up. 5hec( time, identification of baby.
Mec%anisms of la)o
1. 'naement "
2. Descent
3. ,lexion
#. 6nternal %otation
/. 'xtension
;. 'xternal rotation
G. 'xpulsion
T%ee pats of $el(is 1. 6nlet A* diameter narro&, transverse diameter &ider
2. 5avity
T3o Ma*o Di(isions of $el(is
1. )rue pelvis belo& the pelvic inlet
2. ,alse pelvis above the pelvic inletP supports uterus durin prenancy
Linea Teminales diaonal imainary line from the sacrum to the symphysis pubis that divides the false and true pelvis.
+ursin 5are7
)o prevent puerperal sepsis " @ #8 hours only vainal pac(
Aolus of *tocin can lead to hypotension.
3. T%i! Sta&e" )it% to expulsion of $lacenta -placental stae placenta has 1/ 28 cotyledons
*lacenta delivered from 3"19 minutes
Si&ns of placental sepaation
1. ,undus rises becomes firm . lobular K 5al(ins sinL
2. >enthenin of the cord
3. Sudden ush of blood
)ypes of placental delivery
S%ult7 KshinyL beins to separate from center to edes presentin the fetal side shiny
Dun:an KdirtyL bein to separate form edes to center presentin natural side beefy red or dirty
Slo&ly pull cord and &ind to clamp A%A+D) A+D%':S 3A+'2C'%
2/
?urryin of placental delivery &ill lead to inversion of uterus.
+s care for placenta7
#. 5hec( completeness of placenta.
/. 5hec( fundus 0if relaxed, massae uterus1
;. 5hec( bp
G. Administer metherine 63 03ethyleronovine 3aleate1 K'rotrate derivatives
8. 3onitor hpn 0or ive oxytocin 6C1
E. 5hec( perineum for lacerations
19. Assist 3D for episiorapy
11. ,lat on bed
12. 5hills"due dehydration. Alan(et, ive clear liSuid"tea, iner ale, clear elatin. >et mom sleep to reain
enery.
#. 'out% Sta&e" t%e fist /-1 %ous afte !eli(ey of placenta recovery stae. 3onitor v$s S 1/ for 1 hr. 2
nd
hr S 39
minutes.
5hec( placement of fundus at level of umbilicus.
6f fundus above umbilicus, deviation of fundus
1.1 'mpty bladder to prevent uterine atony
2.1 5hec( lochia
a. 3aternal -bservations body system stabili4es
b. *lacement of the ,undus
c. >ochia
d. *erineum
% " edness
'" dema
' " cchymosis
D ischares
A approximation of blood loss. 5ount pad . saturation
,ully soa(ed pad 7 39 #9 cc &eih pad. 1 ramI1cc
e. Aondin interaction bet&een mother and ne&born roomin in types
1.1 Straiht roomin in baby7 2#hrs &ith mom.
2.1 *artial roomin in7 baby in mornin , at niht nursery
Complications of La)o
Dystocia difficult labor related to7
3echanical factor due to uterine inertia sluishness of contraction
1.1 hypertonic or primary uterine inertia
" intense excessive contractions resultin to ineffective pushin
" 3D administer sedative valium,$dia4epam muscle relaxant
2.1 hypotonic secondary uterine inertia" slo& irreular contraction resultin to ineffective pushin. !ive oxytocin.
*roloned labor normal lenth of labor in primi 1# 29 hrs
3ulti 19 "1# hrs
W 1# hrs in multi . W 29 hrs in primi
" maternal effect exhaustion. ,etal effect fetal distress, caput succedaneum or cephal hematoma
" ns care7 monitor contractions and ,?%
$ecipitate La)o - labor of @ 3 hrs. extensive lacerations, profuse bleedin, hypovolemic shoc( if &ith bleedin.
'arliest sin7 tachycardia . restlessness
>ate sin7 hypotension
-utstandin +ursin dx7 fluid volume deficit
*ost of mom modified trendelenber
6C fast drip due fluid volume def
Sins of ?ypovolemic Shoc(7
?ypotension
2;
)achycardia
)achypnea
5old clammy s(in
6nversion of the uterus situation uterus is inside out.
3D &ill push uterus bac( inside or not hysterectomy.
,actors leadin to inversion of uterus
1.1 short cord
2.1 hurryin of placental delivery
3.1 ineffective fundal pressure
;teine Ruptue
5auses7 1.1
1.1*revious classical 5S
2.1>are baby
3.1 6mproper use of oxytocin 06C drip1
Sx7
a.1 sudden pain
b.1 profuse bleedin
c.1 hypovolemic shoc(
d.1 )A?AS-
*hysioloic retraction rin
" Aoundary bet upper$lo&er uterine sement
AA+D>S patholoic rin suprapubic depression
a.1 sin of impendin uterine rupture
Amniotic 'lui! Em)olism or placental embolism amniotic fluid or framents of placenta enters natural circulation
resultin to embolism
Sx7
dyspnea, chest pain . frothy sputum
prepare7 suctionin
end stae7 D65 disseminated intravascular coaopathy" bleedin to all portions of the body eyes, nose, etc.
Tial La)o measurement of head . pelvis falls on borderline. 3om iven ; hrs of labor
3ulti7 8 1#, primi 1# 29
$etem La)o , labor after 29 3G &ee(s1 0 abortion @29 &ee(s1
Sx7
1. premature contractions S 19 min
2. effacement of ;9 89R
3. dilation 2"3 cm
?ome 3t7
1. complete bed rest
2. avoid sex
3. empty bladder
#. drin( 3 "# lasses of &ater full bladder inhibits contractions
/. consult 3D if symptoms persist
?osp7
1. 6f cervix is closed 2 3 cm, dilation saved by administer )ocolytic aents" halts preterm
contractions.U2)-*A%" Uutopar ?cl1
1/9m incorporated /99cc Dextrose piybac(.
3onitor7 ,?) W 189 bpm
3aternal A* " @E9$;9
5rac(les notify 3D pulmo edema administer oral yutopar 39 minutes before d$c 6C
)ocolytic 0*hil1
)erbuthaline 0Aricanyl or Arethine1 sustained tachycardia
Antidote propranolol or inderal " beta"bloc(er
6f cervix is open 3D steroid dextameth4one 0betametha4one1 to facilitate surfactant maturation preventin %DS
2G
*reterm"cut cord ASA* to prevent =aundice or hyperbilirubenia.
D. $ostpatal $eio! /
th
stae of labor
after 2#hrs 7+ormal increase :A5 up to 39,999 cumm
*uerperium covers 1
st
; &(s post partum
6nvolution return of repro oran to its non prenant state.
?yperfibrinoenia
" prone to thrombus formation
" early ambulation
*rinciples underlyin puerperium
1. )o return to +ormal and ,acilitate healin
A. *hysioloic 5hanes
a.1. Systemic 5hanes
1. 5ardiovascular System
" the first fe& minutes after delivery is the most critical period in mothers because the increased in plasma volume return to
its normal state and thus addin to the &or(load of the heart. )his is critical especially to ravidocardiac mothers.
2. !enital tract
a. 5ervix cervical openin
b. Cainal and *elvic ,loor
c. 2terus return to normal ; 8 &(s. ,undus oes do&n 1 finer breath$day until 19
th
day no loner palpable due behind
symphisis pubis
3 days after post partum7 sub involuted uterus delayed healin uterus &ith bi clots of blood" a medium for bacterial
ro&th" 0puerperal sepsis1" D.5
after, birth pain7
1. position prone
2. cold compress to prevent bleedin
3. mefenamic acid
d. Loc%ia"bld, &bc, deciduas, microoranism. +sd . 5s &ith lochia.
1. %uba red 1
st
3 days present, musty$mousy, moderate amt
2. Serosa pin( to bro&n # E
th
day, limited amt
3. Alba crme &hite 19 21 days very decreased amt
dysuria
" urine collection
" alternate &arm . cold compress
" stimulate bladder
3. 2rinary tract7 Aladder freS in urination after delivery" urinary retention &ith overflo&
#. 5olon7 5onstipation due +*-, fear of bearin do&n
/. *erineal area painful episiotomy site sims pos, cold compress for immediate pain after 2# hrs, hot sit4 bath, not
compress
sex" &hen perineum has healed
##. $o(i!e Emotional Suppot %eva %ubia
*sycholoical %esponses7
a. )a(in in phase dependent phase 01
st
three days1 mom passive, cant ma(e decisions, activity is to tell child birth
experiences.
+ursin 5are7 " proper hyiene
b. )a(in hold phase dependent to independent phase 0# to G days1. 3om is active, can ma(e decisions
?)7
1.1 5are of ne&born
2.1 6nsert family plantin method
common post partum blues$ baby blues present # / days /9"89R moms over&helmin feelin of depression
characteri4ed by cryin, despondence" inability to sleep . lac( of appetite. let mom cry therapeutic.
28
c. >ettin o interdependent phase G days . above. 3om " redefines ne& roles may extend until child ro&s.
###. $e(ent complications
1. Hemo%a&e bleedin of W /99cc
5S ;99 899 cc normal
+SD /99 cc
6. 'arly postpartum hemorrhae bleedin &ithin 1
st
2# hrs. Aay or relaxed uterus . profuse bleedin uterine
atony. 5omplications7 hypovolemic shoc(.
3t7
1.1 massae uterus until contracted
2.1 cold compress
3.1 modified trendelenber
#.1 6C fast drip$ oxytocin 6C drip
1
st
deree laceration affects vainal s(in . mucus membrane.
2
nd
deree 1
st
deree H muscles of vaina
3
rd
deree 2
nd
deree H external sphincter of rectum
#
th
deree 3
rd
deree H mucus membrane of rectum
Areast feedin post pit land &ill release oxytocin so uterus &ill contract.
:ell contracted uterus H bleedin I laceration
" assess perineum for laceration
" deree of laceration
" mt episiorapy
D65 Disseminated 6ntravascular 5oaulopathy. ?ypofibrinoen" failure to coaulate.
" bleedin to any part of body
" hysterectomy if &ith abruption placenta
mt7 A)" cryoprecipitate or fresh fro4en plasma
66. Late $ostpatum %emo%a&e bleedin after 2# hrs retained placental framents
3t7 D.5 or manual extraction of framents . massain of uterus. D.5 except placenta increta, percreta,
Acreta attached placenta to myometrium.
6ncreta deeper attachment of placenta to myometrium hysterectomy
*ercreta invasion of placenta to perimetrium
?ematoma bluish or purple discoloration of SM tissue of vaina or perineum.
" too much manipulation
" lare baby
" pudendal anesthesia
3t7
1.1 cold compress every 39 minutes &ith rest period of 39 minutes for 2# hrs
2.1 shave
3.1 incision on site, scrapin . suturin
#nfection" sources of infection
1.1endoenous from &ithin body
2.1 exoenous from outside
1.1 anaerobic streptococci most common " from members health team
2.1 unhealthy sexual practices
!eneral sins of inflammation7
1. 6nflammation calor 0heat1, rubor 0red1, dolor 0pain1 tumor0s&ellin1
2. purulent dischares
2E
3. fever
!en mt7
1.1 supportive care 5A%, hydration, )SA, cold compress, paracetamol, C6)5, culture . sensitivity for antibiotic
proloned use of antibiotic lead to funal infection
inflammation of perineum see eneral sins of inflammation
2 to 3 stitches dislocated &ith purulent dischare
3t7
%emoval of sutures . drainae, saline, bet&een . resultin.
'ndometriosis inflammation of endometrial linin
Sx7
Abdominal tenderness, pos.
,o&lers to facilitate drainae . locali4e infection oxytocin . antibiotic
#+. Moti(ate t%e use of 'amily $lannin&
1.1 determine ones o&n beliefs 1
st
2.1 never advice a permanent method of plannin
3.1 method of choice is an individuals choice.
Natual Met%o! the only method accepted by the 5atholic 5hurch
Billin&s / Ce(ical mucus test spinnbar(eit . fernin 0estroen1
" clear, &atery, stretchable, elastic lon spinnbar(eit
Basal Bo!y Tempeatue 13
th
day temp oes do&n before ovulation no sex
" et before arisin in bed
LAM lactation amenorrheal method hormone that inhibits ovulation is prolactin.
breast feedin" menstruation &ill come out # ; months
bottle fed 2 3 months
disadvantae of lam miht et prenant
Symptot%emal , combination of AA) . cervical. Aest method
Social 3ethod 1.1 coitus interuptus$ &ithdra&al " least effective method
2. coitus reservatus sex &ithout e=aculation
3. coitus interfemora KipitL
#. calendar method
-C2>A)6-+ count minus 1# days before next mens 01# days before next mens1
-rio(nause formula
" monitor cycle for 1 year
" "et short test . lonest cycle from Xan Dec
" shortest 18
" lonest 11
Xune 2; Dec 33
" 18 "11
8 " 22 unsafe days
21 day pill" start /
th
day of mens
28day pill" start 1
st
day of mens
missed 1 pill ta(e 2 next day
*hysioloic 3ethod"
$ills combined oral contraceptives prevent ovulation by inhibitin the anterior pituitary land production of ,S? and >?
&hich are essential for the maturation and rupture of a follicle. EE.ER effective. :aitin time to become prenant" 3 months.
5onsult -A";mos.
39
Alerts on -ral 5ontraceptive7
"in case a mother &ho is ta(in an oral contraceptive for almost lon time plans to have a baby, she &ould &ait for at least 3
months before attemptin to conceive to provide time for the estroen and proesterone levels to return to normal.
" if a ne& oral contraceptive is prescribed the mother should continue ta(in the previously prescribed contraceptive and
bein ta(in the ne& one on the first day of the next menses.
" discontinue oral contraceptive if there is sins of severe headache as this is an indication of hypertension associated &ith
increase incidence of 5CA and subarachnoid hemorrhae.
Si&ns of %ypetension
6mmediate Discontinuation
A abdominal pain
5 chest pain
? " headache
' eye problems
S severe le cramps
6f mom ?*+ stop pills S)A)D
Adverse effect7 brea(throuh bleedin
5ontraindicated7
1.1 chain smo(er
2.1 extreme obesity
3.1 ?*+
#.1 D3
/.1 )hrombophlebitis or problems in clottin factors
" if forotten for one day, immediately ta(e the forotten tablet plus the tablet scheduled that day. 6f forotten for t&o
consecutive days, or more days, use another method for the rest of the cycle and the start aain.
D3*A depoproveda has proesterone inhibits >? inhibits ovulation
Depomedroxy proesterone acetate 63 S 3 months
" never massae in=ected site, it &ill shorten duration
+orplant has ; match stic(s li(e capsules implanted subdermally containin proesterone.
" / yrs disadvantae if (eloid s(in
" as soon as removed can become prenant
3echanism and 5hemical Aarriers
#ntauteine De(ice 8#;D9
Action7 prevents implantation affects motility of sperm . ovum
" riht time to insert is after delivery or durin menstruation
primary indication for use of 62D
" parity or T of children, if 1 (id only dont use 62D
?)7
1.1 5hec( for strin daily
2.1 3onthly chec(up
3.1 %eular pap smear
AlertsP
" prevents implantation
" most common complications7 excessive menstrual flo& and expulsion of the device 0common problem1
" others7
$ eriod late 0prenancy suspected1
Abnormal spottin or bleedin
A bdominal pain or pain &ith intercourse
# nfection 0abnormal vainal dischare1
N ot feelin &ell, fever, chills
S trins lost, shorter or loner
31
2terine inflammation, uterine perforation, ectopic prenancy
Con!om latex inserted to erected penis or lubricated vaina
AdvP ives hihest protection aainst S)D female condom
Alerts7
Disadvantae7
" it lessen sexual satisfaction
" it ives hiher protection in the prevention of S)Ds
Diap%a&m rubberi4ed dome shaped material inserted to cervix preventin sperm to et to the uterus. %'C'%SAA>'
?t7
1.1 proper hyiene
2.1 chec( for holes before use
3.1 must stay in place ; 8 hrs after sex
#.1 must be refitted especially if &ithout &t chane 1/ lbs
/.1 spermicide chem. Aarrier ex. ,oam 0most effective1, =ellies, creams
S$effect7 )oxic shoc( syndrome
Alerts7 Should be (ept in place for about ; 8 hours
Ce(ical Cap most durable than diaphram no need to apply spermicide
5$67 abnormal pap smear
'oamsC EelliesC Ceams
Surical 3ethod A)> , Ailateral )ubal >iation can be reversed 29R chance. ?)7 avoid liftin heavy ob=ects
+asectomy cut vas deferense.
?)7 W39 e=aculations before safe sex
- 4ero sperm count, safe
D#. Hi&% Ris: $e&nancy
/. Hemo%a&ic Diso!es
!eneral 3anaement
1.1 5A%
2.1 Avoid sex
3.1 Assess for bleedin 0per pad 39 #9cc1 0&t 1m I1cc1
#.1 2ltrasound to determine interity of sac
/.1 Sins of ?ypovolemic shoc(
;.1 Save dischares for histopatholoy to determine if product of conception has been expelled or not
'ist Timeste Blee!in& abortion or eptopic
A. Abortions termination of prenancy before ae of viability 0before 29 &ee(s1
Spontaneous A)otion- miscarriae
5ause7 1.1 chromosomal alterations
2.1 blihted ovum
3.1 plasma erm defect
5lassifications7
a. )hreatened prenancy is =eopardi4ed by bleedin and crampin but the cervix is closed
b. 6nevitable moderate bleedin, crampin, tissue protrudes form the cervix 05ervical dilation1
Types"
1.1 5omplete all products of conception are expelled. +o mt =ust emotional supportD
2.1 6ncomplete *lacental and membranes retained. 3t7 D.5
6ncompetent cervix abortion
3cDonalds procedure temporary circlae on cervix
S$'P infection. Durin delivery, circlae is removed. +SD
32
Sheridan permanent surery cervix. 5S
c. ?abitual 3 or more consecutive prenancies result in abortion usually related to incompetent cervix. *resent 2
nd
trimester
d. 3issed fetus diesP product of conception remain in uterus # &ee(s or lonerP sins of prenancy cease. 0"1 pre
test, scanty dar( bro&n bleedin
3t7 induced labor &ith oxytocin or vacuum extraction
/.1 6nduced Abortion therapeutic abortion to save life of mom. Double effect choose bet&een lesser evil.
5. Ectopic $e&nancy occurs &hen estation is located outside the uterine cavity. common site7 tubal or ampular
Danerous site " interstitial
2nruptured )ubal rupture
" missed period
" abdominal pain &ithin 3 "/ &ee(s of missed period
0maybe enerali4ed or one sided1
" scant, dar( bro&n, vainal bleedin

+ursin care7
Cital sins
Administer 6C fluids
3onitor for vainal bleedin
3onitor 6 . -
" sudden , sharp, severe pain . 2nilateral radiatin to
shoulder.
shoulder pain 0indicative of intraperitoneal bleedin that
extends to diaphram and phrenic nerve1
H 5ullens Sin bluish tined umbilicus sinifies intra
peritoneal bleedin
syncope 0faintin1
3t7
Surery dependin on side
-vary7 oophrectomy
2terus 7 hysterectomy

Secon! timeste )lee!in&
5. Hy!ati!ifom Mole Kbunch or rapesL or estational trophoblastic disease. &ith fertili4ation. *roressive deeneration
of chorionic villi. %ecurs.
" estational anomaly of the placenta consistin of a bunch of clear vesicles. )his neoplasm is formed form the sellin of the
chronic villi and lost nucleus of the fertili4ed e. )he nucleus of the sperm duplicates, producin a diploid number #; NN, it
ro&s . enlares the uterus vary rapidly.
2se7 methotrexate to prevent choriocarcinoma
Assessment7
'arly sins " vesicles passed thru the vaina
?yperemesis ravidarium increase ?5!
,undal heiht
Cainal bleedin0 scant or profuse1
'arly in prenancy
?ih levels of ?5!
*reeclampsia at about 12 &ee(s
>ate sins hypertension before 29
th
&ee(
Cesicles loo( li(e a K sno&stormL on sonoram
Anemia
Abdominal crampin
Serious complications hyperthyroidism
*ulmonary embolus
+ursin care7
*repare D.5
Do not ive oxytoxic drus
)eachins7
a. %eturn for pelvic exams as scheduled for one year to monitorin ?5! and assess for enlared uterus and
risin titer could indicative of choriocarcinoma
b. Avoid prenancy for at least one year
33
T%i! Timeste Blee!in& F$lacenta AnomaliesG
D. $lacenta $e(ia it occurs &hen the placenta is improperly implanted in the lo&er uterine sement, sometimes
coverin the cervical os. Abnormal lo&er implantation of placenta.
" candidate for 5S
Sx7 fran(
Ariht red
*ainless bleedin
Dx7
2ltrasound
Avoid7 sex, 6', enema may lead to sudden fetal blood loss
Double set up7 delivery room may be converted to -%
Assessment7
'naement 0usually has not occurred1
,etal distress
*resentation 0 usually abnormal1
Sureon in chare of sin consent, %+ as &itness
" 3D explain to patient
complication7 sudden fetal blood loss
+ursin 5are
+*-
Aed rest
*repare to induce labor if cervix is ripe
Administer 6C
'. A)uptio $lacenta it is the premature separation of the placenta form the implantation site. 6t usually occurs after
the t&entieth &ee( of prenancy.
-utstandin Sx7 dar( red, painful bleedin, board li(e or riid uterus.
Assessment7
5oncealed bleedin 0retroplacental1
5ouvelaire uterus 0caused by bleedin into the myometrium1"inability of uterus to contract due to
hemorrhae.
Severe abdominal pain
Droppin coaulation factor 0a potential for D651
5omplications7
Sudden fetal blood loss
"placenta previa . vasa previa
+ursin 5are7
6nfuse 6C, prepare to administer blood
)ype and crossmatch
3onitor ,?%
6nsert ,oley
3easure blood lossP count pads
%eport s$sx of D65
3onitor v$s for shoc(
Strict 6.-
,. *lacenta succenturiata 1 or 2 more lobes connected to the placenta by a blood vessel may lead to retained placental
framents if vessel is cut.
!. *lacenta 5ircumvalata fetal side of placenta covered by chorion
?. *lacenta 3arinata fold side of chorion reaches =ust to the ede of placenta
6. Aattledore *lacenta cord inserted marinally rather then centrally
X. *lacenta Aipartita placenta divides into 2 lobes
Q. Cilamentous 6nsertion of cord" cord divides into small vessels before it enters the placenta
>. Casa *revia velamentous insertion of cord has implanted in cervical -S
3#
1. Hypetensi(e Diso!es
6. $e&nancy #n!uce! Hypetension 8$#H1" ?*+ after 2# &(s of prenancy, solved ; &ee(s post partum.
1.1 !estational hypertension " ?*+ &ithout edema . protenuria ? &ithout '*
2.1 *re"eclampsia ?*+ &ith edema . protenuria or albuminuria ?' *$A
3.1 ?'>>* syndrome hemolysis &ith elevated liver en4ymes . lo& platelet count
##. Tansissional Hypetension , ?*+ bet&een 29 2# &ee(s
###. 5hronic or pre"existin ?ypertension ?*+ before 29 &ee(s not solved ; &ee(s post partum.
)hree types of pre"eclampsia
1.1 Mil! peeclampsia earliest sin of preeclampsia
a.1 increase &t due to edema
b.1 A* 1#9$E9
c.1 protenuria H1 " H2
2.1 Se(ee peeclampsia
Sins present7 cerebral and visual disturbances, epiastric pain due to liver edema and oliuria usually indicates an
impendin convulsion. A* 1;9$119 , protenuria H3 " H#
3.1 Eclampsia &ith sei4ureD 6ncrease A2+ lomerular damae. *rovide safety.
5ause of preeclampsia
1.1 idiopathic or un(no&n common in primi due to 1
st
exposure to chorionic villi
2.1 common in multiple pre 0t&ins1 increase exposure to chorionic villi
3.1 common to mom &ith lo& socioeconomic status due to decrease inta(e of 5?-+
Nusin& cae"
* romote bed rest to decrease -2 demand, facilitate, sodium excretion, &ater immersion &ill cause to urinate.
*" prevent convulsions by nursin measures or sei4ure precaution
1.1 dimly lit room . Suiet calm environment
2.1 minimal handlin plannin procedure
3.1 avoid =arrin bed
*" prepare the follo&in at bedside
" tonue depressor
" turnin to side done A,)'% sei4ureD -bserve onlyD for safely.
' ensure hih protein inta(e 0 1$($day1
" +a in moderation
A anti"hypertensive dru ?ydrala4ine 0 Apresoline1
5 convulsion, prevent 3 So# 5+S depressant
' valuate physical parameters for 3anesium sulfate
3anesium S-# )oxicity7
1. A* decrease
2. 2rine output decrease
3. %esp @ 12
#. *atella reflex absent 1
st
sih 3 S-# toxicity. antidote 5a luconate
0.Dia)etes Mellitus - absence of insufficient insulin 06slet of >anerhans of pancreas1
,unction7 of insulin facilitates transport of lucose to cell
Dx7 1 hr /9r lucose tolerance test !))
+ormal lucose 89 129 m$dl @ 89 hypoclycemic
0 eulycemia1 W 129 " hyperlycemia
3 derees !)) of W 139 m$d>
maternal effect D3
1.1 ?ypo or hyperlycemia 1
st
trimester hypo, 2
nd
3
rd
trim hyperlycemic
3/
2.1 ,reSuent infection" moniliasis
3.1 *olyhydramnios
#.1 Dystocia"difficult birth due to abnormalities in fetus or mom.
/.1 6nsulin reSuirement, decrease in insulin by 33R in 1
st
triP /9R increase insulin at 2nd 3
rd
trimester.
*ost partum decrease 2/R due placenta out.
,etal effect
1.1 hyper . hypolycemia
2.1 macrosomia lare estational ae baby delivered W #99 or #(
3.1 preterm birth to prevent stillbirth
+e&born 'ffect 7 D3
1.1 hyperinsulinism
2.1 hypolycemia
normal lucose in ne&born #/ // m$d>
hypolycemic @ #9 m$d>
?eel stic( test et blood at heel
Sx7
?ypolycemia hih pitch shrill cry tremors, administer dextrose
3.1 hypocalcemia " @ GmR
Sx7
5alcemia tetany
)rousseau sin
!ive calcium luconate if decrease calcium
%ecommendation
)herapeutic abortion
6f push throuh &ith prenancy
1.1 antibiotic therapy" to prevent sub acute bacterial endocarditis
2.1 anticoaulant heparin doesnt cross placenta
5lass 6 . 66" ood proress for vainal delivery
5lass 666 . 6C" poor pronosis, for vainal delivery, not 5SD
+-) lithotomyD ?ih semi"fo&lers durin delivery. +o valsalva maneuver
%eional anesthesiaD
>o& forcep delivery due to inability to push. 6t &ill shorten 2
nd
stae of labor.
Heat !isease
3oms &ith %?D at childhood
5lass 6 no limit to physical activity
5lass 66 sliht limitation of activity. -rdinary activity causes fatiue . discomfort.
%ecommendation of class 6 . 66
1.1 sleep 19 hrs a day
2.1 rest 39 minutes . after meal
5lass 666 " moderate limitation of physical activity. -rdinary activity causes discomfort
%ecommendation7
1.1 early hospitali4ation by G months
5lass 6C. mar(ed limitation of physical activity. 'ven at rest there is fatiue . discomfort.
%ecommendation7 )herapeutic abortion
D##. #ntapatal complications
1. Cesaean Deli(ey 6ndications7
a. 3ultiple estation
3;
b. Diabetes
c. Active herpes 66
d. Severe toxemia
e. *lacenta previa
f. Abruptio placenta
. *rolapse of the cord
h. 5*D primary indication
i. Areech presentation
=. )ransverse lie
*rocedure7
a. classical vertical insertion. -nce classical al&ays classical
b. >o& sement bi(ini line type aesthetic use
CAA5 vainal birth after 5S
#N'ERT#L#TH " inability to achieve prenancy. :ithin a year of attemptin it
" 3anaeable
S)'%6>6)U " irreversible
6mpotency inability to have an erection
1 types of infetility
1.1 primary no prenancy at all
2.1 Secondary 1
st
prenancy, no more next pre
test male 1
st

" more practical . less complicated
" need7 sperm only
" sterile bottle container 0 not plastic has chem.1
" Sims ?uhner test or post coital test. *rocedure7 sex 2 hours before test
mom remains supine 1/ min after e=aculation
+ormal7 cervical mucus must be stretchable 8 19 cm &ith 1/ 29 sperm. 6f W1/ lo& sperm count
Aest criteria" sperm motility for impotency
,actors7 lo& sperm count
1.1 occupation" truc( driver
2.1 chain smo(er
administer7 clomid 0 chomephine citrate1 to induce spermatoenesis
3t7 !6,)I !amete 6ntra ,allopian )ransfer for lo& sperm count
6mplant sperm in ampula
1.1 3om7 ano(ulation no ovulation. Due to increase prolactin hyperprolactinemia
AdministerP parlodel 0 Aromocryptice 3esylate1
ActionP antihyper prolactineuria
!ive mom clomid7 action7 to induce ooenesis or ovulation
S$'7 multiple prenancy
2.1 Tu)al Occlusion tubal bloc(ae ?x of *6D that has scarred tubes
" use of 62D
" appendicitis 0burst1 . scarrin
I dx7 hysterosalphinoraphy used to determine tubal patency &ith use of radiopaSue material
3t7 6C, invitrofertili4ation 0test tube baby1
'nland 1
st
test tube baby
)o shorten 2
nd
stae of laborD
1.1 fundal pressure
2.1 episiotomy
3G
3.1 forcep delivery
38