Abortion- termination of pregnancy before *Considerations of when life begins varies

the fetus is capable of survival outside the from country to country. 

uterus. 
Quickening - first movement of the fetus
Sperm meets ovum =  Fertilization   inside the womb.
 fallopian tube → uterus → mitosis
 The zygote begins mitosis or divides What are the methods of abortion? 
itself  at exactly 3 days.  Dilatation  and curetage, auto toxic
 It attaches at the uterine lining.  medications 
 Blastocyst continues development
until end of 2nd week.  Legal implication 
 3 weeks to 8 weeks is now called an  Abortion allowed in the UK, US,
embryo.  Japan and other European countries. 
 During this time it takes a human  Philippines has not legalized
form.  abortion. 
 At approximately, 8 weeks the  
embryo is nowcalled a fetus. This is Under the Revised Penal Code of the
characterized by the beginning of brain Philippines:
activity (8-12 wk). It is called fetus until Article 255-259
time of birth. 
Article 255  
When does life begin? Infanticide - killing of a child that is less
than 3 days old 
Viability -  Means capacity for living and  
generally refers to a fetus that has reached a Article 256
certain gestational age and weight and is Intentional abortion — Any person who
capable of living outside the uterus. Most shall intentionally cause an abortion shall
recent is from 20 to 35 weeks and 500 g .  suffer: 
    
5 Possible Considerations When Life 3 types of Intentional Abortion
Begins  Violence
 Without violence and without
1. At the time of conception. *Roman consent
Catholics, Chinese, and Koreans argue that  Consent by the woman
life begins at conception, because the
blastocyst carries the genetic code. Penalties
2. When the brain begins to function, usually 1. The penalty of reclusion temporal, if he
at 8 to 12 weeks. *Woman feels that a baby shall use any violence upon the person of the
is alive during quickening, thus life has pregnant woman. 
begun.  2. The penalty of prision mayor if, without
3. at the time of quickening, 16 to 18 weeks. using violence, he shall act without the
4. At the time of viability, from 20 to 35 consent of the woman.
weeks. 3. The penalty of prision correccional in its
5. At the time of birth.   medium and maximum periods, if the
woman shall have consented.
Article 257  any abortive shall suffer arresto mayor and a
Unintentional abortion - By violence fine not exceeding 1,000 pesos.
without unintention. 

Penalty
The penalty of prision correccional in its PEDIA 
minimum and medium period shall be
imposed upon any person who shall cause an Requirements: 
    Case Study
abortion by violence, but unintentionally
    EBN
    
Article 258 Start of notes 
Abortion practiced by the woman herself *Half a million of mothers
of by her parents — The penalty of prision die fromcomplication 
correccional in its medium and maximum
periods shall be imposed upon a woman who 4 million babies die due to:
shall practice abortion upon herself or shall     -prematurity
    -infection
consent that any other person should do so.     -cord prolapse
    - asphyxia
Any woman who shall commit this offense
to conceal her dishonor, shall suffer the Maternal death causes: 
penalty of prision correccional in its 1. hypertensive disorders- leading
minimum and medium periods. cause 
2. post partum hemorrhage- second
If this crime be committed by the parents of leading cause 
3. abortive outcomes - Third leading
the pregnant woman or either of them, and cause 
they act with the consent of said woman for
the purpose of concealing her dishonor, the Causes of neonatal death:
offenders shall suffer the penalty of prision 1. preterm- First cause 
correccional in its medium and maximum 2. infection- 2nd 
periods. 3. Asphyxia- third cause 

Article 259 Maternal death is the death of a

 
Abortion practiced by a physician or
midwife and dispensing of abortives. —
The penalties provided in Article 256 shall
be imposed in its maximum period,
respectively, upon any physician or midwife
who, taking advantage of their scientific
knowledge or skill, shall cause an abortion
or assist in causing the same.
Any pharmacist who, without the proper
prescription from a physician, shall dispense
woman while pregnant or within 42 days
of termination of pregnancy, irrespective
of the duration and site of the
pregnancy, from any cause related to or
aggravated by the pregnancy or its
management but not from accidental or
incidental causes. 
*approx. 1, 484 maternal deaths - as of
2016
Top 3 region with highest number
of deaths 
1. CALABARZON / Region 4-A 
2. central visayas/  region 7
3. NCR

LEAST NUMBER OF MATERNAL
DEATHS  (2016)
1. ARMM  ·      Labor complications
2017 (124 deaths) VS 2016 (121 deaths)
CAUSES OF MATERNAL
MORTALITY ( as of 2010)
1. complications related to
pregnancy (660)
2.  Hypertension complications (605)
3.  PPH  (298)
4. Aborted outcome  (156)
Factors affecting Risk for Maternal
death  Maternal Death
• Frequency and spacing of births
• Nutrition level (maternal
undernutrition)
• Stature and maternal age
• Appropriate medical and midwife
support
• Access to emergency and intensive
treatment if were necessary
• Lack of management capacity in the
health system
• No political will and lack of
management
• Majority of the deaths are preventable
• HIV infection increase threat
Main causes of maternal deaths
·      Hypertensive disorders of
pregnancy
·      Post-partum hemorrhage
·      Pregnancy with abortive outcomes
Main causes of neonatal deaths
·      Prematurity or Pre-term
·      Infection
·      Asphyxia
Maternal mortality rates in the
Philippines
·      Flat mortality rate/reduction
Main Causes of maternal mortality
·      Complications related to pregnancy
occurring in the course of labor, delivery
and puerperium
·      Hypertension complicating
pregnancy, childbirth and puerperium
·      Postpartum hemorrhage
·      Pregnancy with abortive outcome
 
Causes of Maternal Death
·      Hypertension
·      Postpartum hemorrhage
·      Abortion
 
Highest maternal mortality rate
1.Region IVA
2.Central Visayas
3.NCR
 
Recorded as least maternal date
1.ARMM
 
·      Death of a woman while pregnant
or within 42 days (period of puerperium)
of termination of pregnancy
·      Irrespective of the duration and site
of the pregnancy
·      Should be related by pregnancy, not
by accident or incidental causes.
Risk Factors
·      Frequency and spacing of births
·      Nutrition level (maternal
undernutrition)
·      Stature and maternal age
·      Appropriate medical and midwife
support
·      Access to emergency and intensive
treatment if were necessary
·      Lack of management capacity in the
health system
·      No political will and lack of
management
·      Majority of the deaths are
preventable
·      HIV infection increase threat
Main Problem
>Majority of these deaths and
disabilities are preventable, being
mainly due to insufficient care during
pregnancy and delivery.
Infant Mortality rates in the
Philippines
>  Infant – More than 28 days, less than
1 year
> There is the decrease in the under
five of child mortality
Different programs:
 Breastfeeding     -NMR (Neonatal Mortality Rate) -
 Unang Yakap Number ofdeath of children under 28
 Immunization days
 Newborn Screening   
    - Under 5 mortality rate- Number
Neonatal- 37% of death of children between birth and
Preterm – 28% exactly 5 year 
Pneumonia – 26%     
Asphyxia – 23% How do we measure? (Computation) 
Formula:
Infant death- occured Before reaching (# of maternal death/# of live
age 1 or <1 year old, but more than or birth) x (100,000)
equal29 days. 
  How do we assess? (Mortality
0-28 neonate  rates)  Assement for mortality 
29-1 infancy  - Very slow decline of MMR in past 20
1-3 toddler years
3-6 pre school  -Maternal deaths account for 14% of
6 to 12 School age  deaths among women of reproductive
12 to 20 Adolescent age
-Maternal death triggers other adverse
Top 3 regions with highest number consequences in families: orphans, loss
of infant deaths of family care provider
1. CALABARZON -17 infants die per 1,000 live births
2. NCR  within first 28 days of life
3. CENTRAL LUZON -Mostly within first week after birth
-Half die during the 1st 2 days
Least infant deaths  
 Predisposing factors for maternal
82,000 Filipino Children die annualy and neonatal death
Ph is one of the 42 countires that 1. Young age at marriage & first
account  90%  under the age of 5 years pregnancy
old death  2. Domestic violence and gender
inequality
Top 3 Leading causes: 3.Poor maternal health
    -Pneumonia 4. Poor hygiene during and after
    -bacterial sepsis  delivery
    -Respiratory Distress of the 5. Lack of/poor newborn care
Newborn     6. The three delays:
  1. Delay to seek medical care 
Maternal and Child Health  Failure to see the danger signs) 
Indicators:  Lack of money 
    - MMR (Maternal Mortality Rate)-  unwanted pregnancy 
number of maternal death per 1000 live  fear of being ill treated?
birth 2. Delay of reaching the facility
   Distance of home from facility
    - IMR (Infant Mortality Rate)- Number  lack of awareness of existing
of childre less than one year of age/ live services 
of birth x 1000   lack of community support 
   3. Delay of receiving appropriate and
adequate care at health facility 
 Lack of man pwoer 
 Less resources  c. Sepsis
 Shortage or lack of equipment  d. Hyperbilirubinemia

DOH programs for childcare  B.COMMON HEALTH PROBLEMS

1. Essential new born care THAT DEVELOP DURING INFANCY: 
2. new born screening  b.1. Colic
3. immunization program  b.2. Sudden infant death syndrome
4.Breastfeeding program/ infant feeding  b.3. Cleft palate
5. IMCI b.4. Imperforate anus
b.5. Intussusception
HIgher-risk newborn b.6. Hirchsprung's disease
------------------------------------------------- b.7. Failure to thrive
-------------- b.8. Otitis Media
QUIZ ON MONDAY (then everyday b.9. Meningitis
quizzes) b.10. Hydrocephalus
Different diseases and disorders in b.11. Febrile seizures
pediatric b.12. Spina bifida
------------------------------------------------- b.13. Trisomy 21
-------------- b.14. Autism/ADHD
Gestational age-  A measure of the  
age of a pregnancy which is taken from C.HEALTH PROBLEMS COMMON IN
the beginning of the woman's last TODDLERS
menstrual period (LMP), or the 1.     Burns
corresponding age of the gestation as 2.     Poisoning
estimated by a more accurate method if 3.     Child Abuse
available.  4.     Cerebral Palsy
 
Problems with gestational weight:  D.HEALTH PROBLEMS COMMON IN
SGA - Small for gestational age  PRESCHOOLER
LGA- Large for gestational age  1.     Leukemia
2.     Wilm’s Tumor (Nephroblastoma)
Acute condition  OF NEWBORN 3.     Asthma
RDS (Respiratory Distress Sydrome) 4.     Urinary Tract Infection (UTI)
MEConium AsPiratIon SyNdromE  
SEPSIS E. HEALTH PROBLEMS MOST
HYPERBILIRUBINEMIA COMMON IN SCHOOL AGED
CHILDREN
 A. Nursing Care of the High-Risk 1.     Diabetes Mellitus
Newborn to Maturity 2.     Rheumatic Fever
1. Problems related to Maturity 3.     Rheumatoid Arthritis
a. Prematurity 4.     Scabies
b. Postmaturity 5.     Pediculosis
6.     Impetigo
2. Problems related to gestational  
weight F.HEALTH PROBLEMS COMMON IN
a. Small for Gestational Age (SGA) ADOLESCENT
b. Large for Gestational Age (LGA) 1.     Amenorrhea
2.     Dysmenorrhea
3. Acute conditions of the neonates 3.     Accidents (trauma/injury)
such as: 4.     Scoliosis
a. Respiratory distress syndrome 5.     Bone Tumors
b. Meconium aspiration syndrome 6.     Obesity
7.     Anorexia Nervosa  abnormal amount of amniotic
8.     Substance abuse fluid 
9.     STD
10.  Suicide Ballard  Scoring- neuromuscular and
physical maturation of new borns
Newborn Regardless of the gestational 12 criterias: For physical maturation: (6)
age or birth weight, who has a and 6 for neuro
greater- than- average chance of     * Insert chart here later 
morbidity or mortality because of     neuromuscular: 
conditions or circumstances         1. posture 
superimposed on the normal course of         2. arm recoil 
events associated with birth and         3. square window 
adjustments to extrauterine life.         4. scarf sign
        5. popliteal angle
Preterm- 36Weeks-20Weeks         6. heel to ear
Full term-37-40 Weeks Physical 
Posterm - after 40-42 wks   skin
 Lanugo- 
preterm infants- weigh less than 5.5  breast 
pounds, 2.5 kgs  genitalia
 plantar surface 
 eyes cartilage
 APGAR 
 Ballard  
 Ulrasound  APGAR Scoring should be done within 5
 Silverman-Anderson index- mins 
neonatal respiratory distress grading 7-10 = Good; Healthy
 sonographic estimation of 4-6 = Fair; Guarded; Close Observation
gestational age 0-3 = Poor; Serious; Needs resuscitation
 LMP 1 min
 Neurologic and physical findings  - Determines how well the baby
tolerated the
Etiology- root cause/ possible reasons  birthing process
 Low socio economic level 5 min
 Lack of prenatal care  - Well the baby is doing outside the
 Poor nutritional status womb of the
 multiple pregnancy  mother
 Low BMI  10 min
 Previous early birth  - If poor, repeat again after 10 min
* Do cpr if poor padin
 Race 
Silverman Anderson Index- Grading
 Abuse of substance 
respiratory distresss 
 age of mother younger than 18 *Insert chart here later 
and older than 35
 mental status of women  Characteristics of Premature Infant 
 first and beyond 4th pregnancy  Characteristics of a Preterm Infant
 Closely space pregnancy no 6 a. very small and appear scrawny
month allowance, but pregnant.  b. have a proportionately large head in
 Early induction of labor   relation to the body;
 Elective  caesarean birth  with scant hair
 spontaneous surgical abortion  c. Skin - bright pink, smooth, and shiny,
with small blood
vessels clearly visible underneath the
thin epidermis ACTIVITY: 
d. Fine lanugo - abundant over the body     Read advance of anemia in
but is sparse, fine, prematurity?
and fuzzy on the head     RDS
e. Ear cartilage - soft and pliable     *summarize them 
f. Skin - bright pink, smooth, and shiny,     etiology 
with small blood     signs and symptoms 
vessels clearly visible underneath the     nursing management
thin epidermis     complications
g. Soles and palms - minimum creases
h. Bones of the skull and the ribs - feel
soft
i. Eyes may be fused.
j. Sleeping for most of the time
k. Inactive and listless
l. Underdeveloped breast tissue
m. Male infants - few scrotal rugae,
testes are undescended;
n. Females - labia minora and clitoris are
prominent
o. Extremities - maintain an attitude of
extension and remain
in any position in which they are placed
p. Unable to maintain body temperature,
have limited ability
to excrete solutes in the urine, and have
increased
susceptibility to infection.
q. A pliable thorax, immature lung
tissue, and an immature
regulatory center
r. More susceptible to biochemical
alterations
s. Higher extracellular water content
t. Preterm infants exchange fully half
their extracellular fluid
volume every 24hours
u. Soft cranium - subject to
characteristic unintentional
deformation, or "preemie head," caused
by positioning
from one side to the other on a mattress
v. Head - looks disproportionately longer
from front to back, is
flattened on both sides, and lacks the
usual convexity
seen at the temporal and parietal areas.
w. Frequent repositioning of the infant
and positioning on a
gel mattress can reduce or minimize
cranial molding.