PREGNANCY

1st trimester
-organogenesis=CRITICAL=CATEGORY A DRUGS(SAFE)
-ambivalence: presence of two opposing feelings=normal
-GERM LAYERS:
ECTODERM-brain devt
MESODERM-heart & bv
ENDODERM-GI & other structures
2nd trimester
-easiest part of pregnancy=comfortable
-increase libido
-spoon position for sex
3rd trimester
-feeling of unattractiveness

SIGNS
PRESUMPTIVE PROBABLE POSITIVE
Breast changes HEGAR-thinning UTZ
Amenorrhea CHADWICK
Urinary changes GOODEL’S
Non preg- nose
N/v Pregnant-earlobe
Labor-soft as butter
Quickening
Chloasma/melasm HCG (HUMAN CHORIONIC
GONADOTROPIN)
a
POSITIVE PREGNANCY TEST

BRAXTON HICKS
BALOTTEMENT

LIGHTENINGENGAGEMENT
BRAXTON HICKS-painless irregular
BALLOTEMENT-Bouncing of fetus
MONTGOMERY’S TUBERCLE-

ADAPTATIONS IN PREGNANCY
CARDIOVASCULAR CHANGES
-increase in total CO
-palpitations
-edema (lower- N upper- abn)
-Varicose vein- tortous veinspoor circulation inc
pressure to lower extremities
 -HOMAN’S SIGN
=dorsiflexion of the foot ; pain in calf muscle = (+):DVT
=never massage
=elevate the legs: to increase venous return
DVT
Virchow’s Triad
Venous Stasis- Antiembolic stockings: before getting out of the bed
Venal wall damage
Vlood Coagulation

SIGNS OF PREGNANCY:

PRESUMPTIVE (SUBJECTIVE DATA)- Nararamdaman lang ni mommy

Observable
M ORNING SICKNESS
Presumptive
=>LINEA NEGRA
=>CHLOASMA
Increase HCG:from placenta [HCG=stimulates the stomach to produce more acids]

PROGESTERONE
=>STRIAE
=> 1st trimester=NORMAL
GRAVIDARUM
=>2nd Trimester=Hmole,Hyperemesis Gravidarum

MGMT:

Diet: Dry Crackers &

INCREASE Sodium Bicarb

AMENORRHEA:temporary =BF: 6months after giving birth

 =Non BF: 2-3 mo

Cause: Increase ESTROGEN=CONTRACTION

Increase PROGESTERONE=RELAXATION,MAINTAINS PREGNANCY

Breast enlargement: INCREASE ESTROGEN

Fatigue: decrease RBC: iron deficiency anemia
U rinary Frequency: normal:compression of urinary bladder

1st TRI: Present

2ND TRI: None-bc the fetus is going upward

If yes=H.mole

3RD TRI: Present

INCONTINENCE (N) =Kegel’s exercise

Dysuria(ABN)-UTI

Quickening- Felt by mother onset: 2 nd

trimester
-2nd TRIMESTER
1.Primigravida- 5months start
2.Multigravida-4th month
upper body
--Moro reflex present on babies
Leaning:brain

Ex. 5mo=UTZ: breech

3rd TRI: Lower body.legs ang igagalaw pag breech

PROBABLE-OBJECTIVE
CHADWICK’S: BLUISH CERVIX
  INCREASE PROGESTERONE: increase blood supply
 Vaginal Speculum
Fallopian Tube-
Ampulla(fertilization)

Goodell’s- Softening of cervix BTL-Isthmus

 INTERNAL EXAM

Hegar’s- Softening Uterus Lower -manipis-hegar’s

o Implantation/nidation
 Upper segment: Kakapal POSTERIOR
Endometrium

P OSITIVE PREGNANCY TEST

BRAXTON HICKS CONTRACTION: Lower abdomen; false labor

2nd Trimester
Estrogen (weak contraction)
Painless

Ballotement: Floating
POSITIVE (CONFIRMATORY)
(+) UTZ
1. TRANSABDOMINAL UTZ: FULL BLADDER
-Clear visualization
-offer fluids 1L before procedure
-4 glasses q 30 minutes
-2hrs prep
Position:*DORSAL RECUMBENT -Left side lying
VENA CAVA syndrome-bc of compressed vena cava
-tachycardia
-diziness
-Sudden drop of BP
2.TRANSVAGINAL UTZ: to rule out H.Mole
-Empty bladder
-on 2nd Trimester as early as 5months=gender of baby

(+) FHT
I.LEOPOLD- FETAL BACK
*CEPHALIC(BACK)-Lower abdomen
*Breech(back)-Upper abd
Sleeping baby:
Fetal HR: 120-160bpm Absence of fetal movt.
-FHT: 100bpm
>160=fetal distress (early)
 <120=fetal distress (late)
DOPPLER-3months
FETOSCOPE-4th month of pregnancy
STETHOSCOPE-5-9months
LUNG SOUNDS-diaphragm (high pitch sound)
HEART SOUNDS-bell (low pitch sound)

(+) FETAL MOVT

10-12 FM/hr
-Cardinal rule of 10
>12FM/hr-Hyperactive: fetal distress (early sx)
<10FM:Hypoactive: fetal distress(late sx)
TRANSIENT ORGANS
-Amniotic Fluid
-Umbilical cord
-Placenta

AMNIOTIC FLUID
OTHER NAME: Fetal urine
FUNCTIONS:
Protection & Cushion
Thermoregulation
Musculo skeletal devt
Nutrition
COLOR: Clear straw colored (PALE YELLOW)=Normal
->BLACK=Fetal demise(can cause septic shock)
->GREEN=Meconium
Breech presentation=Normal if meconium
->DARK YELLOW= Increase Bilirubin RBC
=RH incompatibility
->RED= Bleeding
=AP (Dark)
=P.P (Bright red)
*NITRAZINE PAPER-determine if acid or alkaline fluid
-BLUE: ALKALINE =AMNIOTIC FLUID(+)BOW
-YELLOW: ACID

VOLUME: 800-1,200mL
>1200mL=Polyhydramnios (GI problem=Cleft lip/palate)
<800mL=Oligohydramnios (renal problem)
=
AMNIOCENTESIS:Fetal lung maturation=Betamethasone(for lung
maturation)
L:S Ratio
1:2=immature lungs of fetus
2:1=mature lungs
AMNIOTIC SAC-Bag of water

UMBILICAL CORD
Dry 7-10 day and falls off
Other name: Funis/Nuchal Cord
FXN: passageway for o2 and nutrients
Blood vessels: 3 BV (AVA)
 Mas Malaki ang VEIN kaysa ARTERY
1A + 1V= Congenital heart defect
Length: 50-60cm
55cm=best size
Ultrasound to know the length
Special element: Wharton’s Jelly(obstruction)
Cord infections: 11 days:wet=Omphalitis=infection of UC

Fetal Circulation:
70% 30%
(O2placentaUmbilical vein) (bypass LIVER bc immature)
Ductus VenosusRight Inferior vena cava(100%)Right
atrium(30%)Left atrium(70%)L. VentricleAscending
A.aorta(brain) Head (70%)=CO2(UNOXYGENATED) Unoxy
bloodSuperior Vena cava(70%)RIGHT ATRIUM(MAG MIX SA O2 &
CO2)R.VENTRICLEP.Artery(bypass Lungs bc immature)Ductus
ArteriosusDescending Aorta(Extremity) (30%)=ACROCYANOSIS

Patent ductus arteriosus=closes immediately(PDA)

Foramen ovale(Partial closure upon exit)=1month NORMAL heart
murmurs(ASD)

PLACENTA
FXN:
Protection(UTEROPLACENTAL BARRIER)
Cannot protect from TORCH(Toxoplasmosis,Other infections,Rubella,Cytomegalo,Herpes)

Oxygenation
Nutrition: Glucose
UTERUS-Pear shaped,inverted avocado
FALLOPIAN TUBE-Funnel shape
Hormone production
HPL(Human Placental Lactogen)-DM
HCG
Estrogen/Progesterone (ovaries produce)

SHAPE: PANCAKE/ PIE SHAPED/DISC LIKE

SPECIAL ELEMENT: Cotyledons(20-25)
<20: Retained placental fragments
Tx: D & C
>25: Normal

DIAGNOSTIC PROCEDURES:

ACETIC ACID TEST

Assess PROTEINURIA=Pregnancy induced HPN
OB Bag
Procedure:
-2/3 Urine of test tube
-1/3 Acetic acid (Clear, Transparent & Colorless) + Heat for 1-2minutes
RESULTS:

Clear: (-) PROTEINURIA

Cloudy: (+) PROTEINURIA

PREGNANCY INDUCED HYPERTENSION

CAUSE:
PLACENTA: HCG (blood)=vasoconstriction
ONSET: 1ST trimester=H.MOLE
2ND trimester= 5th month/20 weeks=PIH

PIH=
Check systole of mother first = Basline

HPN= 30
15

TRIAD
MANIFESTATIONS

Proteinuria Edema= UPPER BODY= PIH

Lower edema=NORMAL
= elevate FEET
 CLASSIFICATION OF PIH:
MILD PRE-ECLAMPSIA SEVERE PRE-ECLAMPSIA ECLAMPSIA
140/90 140/90 to 160/100
PROTEINURIA +1, +2
PROTEINURIA +1, +2 PROTEINURIA +3, +4
=SEIZURE ->decrease
o2fetus=fetal
distress)

MEDICATIONS:
HYDRALAZINE- VASODILATOR (No fx on fetus) (No to phenytoin)
MgSO4:Anti-Convulsant
Check DTR
(+)Give
(-)don’t give
MgSO4 Toxicity (+2)=Normal:give
BP decreased=90/60 (+1) Decreased:continue
Urine Output (+3)=malapit na magseizure
(+4)=hyperactive malapit
decrease=<30ml/hr
na mag seizure
Respiratory rate (-1,-2,-3,-4) Don’t give
decrease=12cpm FATAL=RESPIRATORY DEPRESSION
Patellar reflex SHOULD MONITOR RR

absent=<+2 RR: 12 STOP

(INCREASE MG DECREASE
CA)
ANTIDOTE: Calcium
Gluconate
BENEDICT’S TEST
-Assessment for Glycosuria: Gestational DM Gestational DM=6th month
-OB BAG
PROCEDURE:
In a test tube
5mL = Benedict sol’n (blue in color) then heat for (1-2minutes)
8-10 drops of urine(dropper)
RESULTS:
BLUE = (-) NEGATIVE
GREEN= (+1)
YELLOW= (+2)
ORANGE=(+3)
RED= (+4) POSITIVE FOR GDM

ALPHA FETO PROTEIN-base product during pregnancy

-38-42mg/dL-Normal

<38: Down syndrome (duplication of chromosome 21)

>42: NTD (folic acid deficiency) GREEN LEAFY VEG rich in folic acid
-Maternal Blood exam assessment for Down syndrome/NTD
-on 2nd TRIMESTER: 4-5th month

COOMB’S TEST
-
Specimen: Blood
->Direct- Blood ni NB baby
->Indirect-mother’s blood
(+) RH Antibody
(-) RH Antibody
Problem:
Onset:
Occurrence:

RH INCOMPATIBILITY
-blood test
-Confirm RH incompatibility
-Rhesus (+,-)
Other name:
Hemolysis- destruction of RBC
Erythro: RBC
Blastosis: Destruction
Fetalis: Fetus
Problem: Hemolysis (of 2nd child)
Onset: 2nd child affected (1st child SAFE but at risk for autism)
Occurrence:
Mother (RH-) Fetus (RH+)
(If in womb no reaction bc uteroplacental barrier)
Mother releases RH antibody after first delivery

Treatment:
RHOGAM-prevent the formation of RH Antibody
Mother: 48-72hrs (2nd-3rd day)after deliver( INTRAMUSCULAR)
ABO Incompatibility
Immature placenta
Mother=O
Fetus A/B
BT for baby

Analgesia- loss of pain

Anesthesia- loss of sensation
-regional=Local
-epidural=epidural space
-spinal

FIRST STAGE OF LABOR(DILATION: PASSAGEWAY)

ONSET: TRUE LABOR CONTRACTION
TRUE LABOR
LOCATION: lumbosacral pain
WALKING: intensifies the pain
REGULARITY: regular
FREQUENCY: beginning to beginng: more frequent contraction
DURATION: start to ending: Increase in duration
INTERVAL:ending up to the beginning:decrease
DILATION: yes
EFFACEMENT: yes
PASSAGE OF SHOW: operculum

ENDING: Full cervical dilation

10cm:IE
1cm/hr

SUBPHASES OF CERVICAL STAGE

Dilation frequency Duration Intensity
LATENT 1-3 10mins 30sec Mild
ACTIVE 4-7 5mins 60sec moderate
TRANSITIONA 8-10 2-3mins 90sec severe
L
SECOND STAGE OF LABOR(expulsion stage:passenger)
ONSET: FULL CERVICAL DILATION
ENDING: DELIVERY OF FETUS
MECHANISM OF LABOR
1) ENGAGEMENT:Ischial spine
2) DESCENT: walk or squat
Do’s & Don’t’s during labor

No to shave; Clip
Position of comfort
Suction of newborn: No can cause hypoxia
Milking of cord: NO:can cause jaundice->Bilirubin
Complete bath: 6hrs after delivery
SILVER NITRATE ADMINISTRATION: NO;
Erythromycin;Crede’s to prevent opthalmia neonatorum

THIRD STAGE OF LABOR(placental stage)

ONSET: Delivery of fetus
ENDING: Delivery of placenta
S I G N S OF PLACENTAL SEPA
Calkin’s sign: Uterus becomes Firm & Globular shape
Lengthening of the cord:Brandt-Andrews
Sudden gush of blood
 *Placenta Must be delivered 5-30mins*
SCHULTZ DUNCAN
Clean: Fetal side Dirty:Maternal side
Center-corner Corner-center
Increase risk for Retained
placental fragments
Check Placenta: 20-30 cotyledons

FOURTH STAGE OF LABOR(Recovery/POSTPARTUM)

LOCHIA
RUBRA:
RED
0-3 DAYS
If 5 days=hemorrhage
NSD:500mL
CS:1000mL
Mgmt.: weigh pads
SEROSA
PINK-brown
4-7
ALBA
WHITE
:10days6wks

BF=immunoglobulin
IgA
IgG=placenta

E
Exclusive BF:
EO51
Extended BF up to 2y/o-4y/o

FOURTH STAGE
UTERUS-Must be firm and globular
-if uterus is not contracted:
Massage
Nipple stimulation
Oxytocin
*if the uterus is dislodged to the rt. Full
bladder:encourage the mother to
urinate/catheter
*re clean (retained placental fragments)
*well contracted uterus-> bleeding
(perineal laceration)
Bladder
Perineum
Lactating/rooming concept (EO51)

EINC (essential immediate NB care)

-thorogh drying
-properly timed cord clamping
-early skin to skin contact (unang yakap) (15-30mins)
bare stomach=NSD
Bare chest= CS
-early breast feeding

Breast feeding:
-COLOSTRUM: IgA
-15 to 3mins: each breast (that is alsao the breast that u will
start) facilitates proper breast emptying- must clean with warm
water only to prevent MASTITIS

Recovery and bonding

First 1-4 hrs after delivery
-most critical stage (dito lilitaw ang most critical
stage)
Considerations:
-fundus
-lochia
-empty bladder

Episiotomy and Peri care

-Ice pack= prevent bleeding
-sitz bath-healing
-witch hazel-hemorrhoids
-Use cotton underwear
*perineal lamp: 12-18in distance,prevents burns
-increase fiber and OFI-prevent constipation

Sore nipples-expose to air for 10-15min

No to soap and alcohol WATER ONLY
SEXUAL ACTIVITY:
No resume if:
There is vag bleeding
Episiotomy has not healed
-6weeks (involution)

MCN
FEMALE REPRO
(6mo earlier than males)
Completed in 3 yrs

Clitoris-organ of stimulation(sensitive)
Urethra-organ of stimulation(catheter)
*catheter inserted accidentally in vagina do not insert in urethra

Male:6-9in
Female:2-3 in

Vagina-copulation
Anus-excretion
DEVT:
THELARCHE-Breast budding
GYNECOID: Increased pelvic size-AP Diameter=Transverse
ADRENARCHE-Apperance of body hair
MENSTRUATION-Act of removing dead Endometrial cells
OVULATION
MALE REPRO
GLANS PENIS: Organ of stimulation
TESTES-Spermatogenesis
*48-72hrs alive sperm
*300 million
SCROTUM-Protection/regulation of temp
SHAFT-keeps penis erected
DEVT:
6mo later than females
-completed in 5 yrs
DARKENING,THINING,ENLARGEMENT OF SCROTUM
ENLARGEMENT OF THE TESTES
PENIS GROWS & ENLARGES
NOCTURNAL EMISSIONS/WET DREAMS
ABORTION- Expulsion of the fetus below the age of viability
20wks
Types:
THREATENED-No cervical dilation
->Tocolytics= halts uterine contraction
(mgSO4, **Terbutaline, Indomethacin, Nifedipine)
IMMINENT- with cervical dilation/inevitable abortion
COMPLETE- All products of conceptus is released
INCOMPLETE- Expulsion of each part only= retained fetal fragments
(Bleeding, septicemia, DIC: Disseminated intravascular coag, DFS:
dead fetus syndrome)
MISSED ABORTION-
INDUCED – Methotrexate & Cytotec used: never allowed in Philippines
THERAPEUTIC- Medical, planned, legal- Ectopic preg
MISSED- less than 20 weeks only. Early fetal uterine death w/o
expulsion “Still birth” (IUFD [INTRAUTERINE FETAL DEATH] - more than
20 weeks
RECURRENT/HABITUAL- 3 or more consecutive abortions
MGMT
CBR: 12-24hrs
Coitus is restricted for 2 wks vaginal rest
-save all pads, clots and tissues (measure
bleeding/blood:weigh pads)
D&C- re clean the uterus
HMOLE
Gestational Trophoblastic Disease
-blast: Immature
-cytes: mature
-clast: dying
-embryo dies
-no fetus, no amnio f, no BV
S/sx:
-high levels of HCG
-rapid increase in fundic ht
-no fetal HB
**passage of clear fluid filled grape sized vesicles - PS
MGMT
No pregnancy in 1 yr
D&C
Methotrexate-kills rapidly dividing cells
ECTOPIC PREGNANCY- Implantation outside the uterus
S/sx:
-severe sharp stabbing knifelike abd pain*** PS
-+cullen’s sign- disc on the periumbilical area- rupture
EMERGENCY
-s/sx of shock(hypo tachy tachy)
MGMT:
Combat shock
-elevating the foot of the bed= modified Trendelenburg
*to prevent further increase in ICP
-laparotomy- fiberoptic scope-microsurgery
-metothrexate

INCOMPETENT CERVIX
-Painless cervical dilation w/o contraction
-20th week AOG
S/Sx:
-cervical dilation
-prolapse of memb
-w/o contractions
Mgmt:
-Cervical cerclage
-shirodkar: suture is perma
-mcdo: temporary suture
-Vaginal rest (no sex no orgasm)
-ROM=prepare for delivery
HYPEREMESIS GRAVIDARUM
-severe N/V
-due to inc HCG
-risk: F & E imbalances
S/Sx:
Unremitting N/V
-initial undigested foods
-late- presence of bile
Wt loss
Tachycardia-comp mech
MGMT
NPO-if acute vom
IVF- prevent F & E imbalances
I & O
SFF – if no vomiting
Vit b6 <100mg dec n/v during early pregnancy
PLACENTA PREVIA
-Painless/ bright red bleeding
Types:
Total= completely covers cervical os
Partial=partially covers cervical os
Marginal=placental borderborder of cervical
Low lying= placenta located in the lower uterine segment
MGMT:
No IE
No SEX
Strict BR
FHR monitoring-fetal distress
Double set (DR & OR ready)
ABRUPTIO PLACENTA- Premature separation of the placenta
after 20 wks
-painful/ dark red bleeding
Types:
Concealed/covert: hidden bleeding= peritonitis= coveleire
uterus
Unconcealed/overt: obvious bleeding
MGMT:
No IE
NO sex
Strict BR
FHR monitoring
PIH/TOXEMIA
-gestational HPN
-chronic HPN
Types:
Pre-eclampsia: no seizures
Eclampsia: WOF: AURA-ABD CRAMPS “ Impending
seizure”

GESTATIONAL DM
Factors: Insulin & Glucose
Problem: Hypergly
24-28 weeks should be screened for GDM should be
screened for GDM (increase HPL)-insulin antagonist/anti
insulin
DX:
OGTT-oral glucose tolerance test “CONFIRMATORY”
NPO After midnight
-2ml of 50% glucose
Results:
 <100mg=Normal
 100-120=possible GDM
  >120 overt GDM
 Wait for 30mins-3hrs OGTT
INFANTS OF Diabetic mother
-longer and weighs more
-macrosomic
-cushingoid appearance (puffy, lethargic)
---after delivery: NB is prone to hypoglycemia

HEMOLYTIC DSE OF THE NB

-RH incompatibility
-Erythroblastosis fetalis
(+) baby=antigen
(-)mother=antibody
*first pregnancy is not affected
Amniocentesis= increase bilirubin levels in AF
28weeks AOG=Rhogam
After delivery: coomb’s test
DIRECT- rh antigen-baby
INDIRECT- rh antibody-mother
-Rhogam within 48 to 72hrs after delivery
S/sx:
Baby pathologic jaundice, hemolytic anemia
Mother: increased bilirubin levels in the amniotic fluid
Physiologic jaundice- after 24hrs after delivery-Normal-
immature liver
Pathologic jaundice- First 24hrs= ABN
Destruction of RBC heme iron and bilirubin pag walang iron
PROM
S/sx:
-amniotic fluid gushing into vagina (nitrazine test)
PH: 7.0-7.5
-Maternal fever (risk for infection)
-Fetal Tachycardia=fetal distress
MGMT:
Minimize IE
Assess for s/sx of infection
Bed rest- not engaged-prevent cord prolapse
Cord prolapsed-naipit ng bata ang cord= Emergency
Ambulate-if engaged hasten delivery minimizes fetal
distress
CORD PROLAPSE
“E”
-Compression of the umbilical cord bet. The fetal presenting part and maternal
pelvis
-compromised fetal circulation
FHT= St variable deceleration-> cord compression
MGMT:
-FHR every 5-10mins
-Emergency CS
-Trendelenburg or genupectoral/kneechest
-O2= 10-12L/per minute
-Firm manual upward pressure
-wrap the cord with sterile gauze moisten with NSS
SHOULDER DYSTOCIA- anterior shoulder cant pass the maternal pelvis
-lack of External rotation

Etiology:
Macrosomia
Maternal Obesity
-post date pregnancy
S/sx:
Turtle sign-fetal head retraction

MGMT:
-no fundal push
-forceps delivery
-CS

UTERINE RUPTURE
COMPLETE UTERINE RUPTURE- endometrium-myometrium-perimetrium-
affected
-spillage of amniotic fluid
INC- endo myo only. Perometrium is still intact
Mgmt.:
Hysterectomy

PLACENTA ACCRETA-Attached (severely)

PLACENTA INCRETA- Inside (myometrium)
PLACENTA PERCRETA- perforate (all layers are affected)
Mgmt:
D&C
Hysterectomy
S/sx:
-placenta fails to separate
-profuse hemorrhage

CS
CLASSIC- vertical=tradional
TRANSVERSE/PFANNENSTIAL/BIKINI CUT- Low scarring

***sterility
Major: 800-100mL of blood loss
NSD: 500ml blood loss

-CPD,herpes, Previous CS, Heart dse, placenta previa,AP,Fetal

D,Macrosomia

UTERINE INVERSION
S/SX:
-Sit gasp for air DOB sharp chest pain
-Pale cyanoticpulmonary embo
-death

MGMT:
Emergency measures: IV O2 CPR
Provide intensive care in the ICU
Keep the family informed

LACERATIONS:
1st-vag & per, muc memb
2nd-plus perineal muscle
3rd-plus capsule of the rectal sphincter
4th-plus the walls of the rectum
MGMT:
-suture the lacerations
-vag packaging
-BT

MENSTRUAL D/O
AMENORRHEA-Cessation of menstruation
DYSMENORRHEA-MEDICAL TERM FOR MENS CRAMPS
PRIMARY-starts (normal)
SECONDARY-problem in the repro system
MENORRHAGIA- Longer 8-10days heavier than 80mL
METRORRHAGIA-Bleeding in between cycles
OLIGOMENORRHEA-light infrequent menstruation(35 days apart)
PMS(PRE MENSTRUAL SYNDROME) – Backache,bloating,irritability,
& headache
PREMENSTRUAL DYSPHORIC D/O- Severe form of PMS but with
psychological component
SEXUAL RESPONSE CYCLE
I. EXCITEMENT STAGE- Stimulation of genitals, starts to get big
II. PLATEAU-Full distentionof the penis and nipple
III. ORGASMIC- Pleasurable, tension d/c, climax (shortest)
IV. RESOLUTION (DRY)-return to unaroused state
 MENSTRUAL CYCLE
MENARCHE-9-13 y/o
NORMAL MENS:
INTERVAL: 28 DAYS
DURATION: 2-7 DAYS
COLOR: Dark red, RBC, With blood clot, mucus,
endometrial cells
ODOR: Marigold (fishy)
Menstrual cycle
GnRH
(Red Horse)

|
Follicular phaseGrafiaan follicleFSH Estrogen: Thickens
(pulutan:FiSH)

|OVULATION|
LUTEAL PHASECORPUS LUTEUMLHProgesteronePrevents contraction
(pulutan: lutong hipon)

|
MENSTRUATION
FOLLICULAR PHASE/PROLIFERATIVE PHASE
*DECREASE IN ESTROGEN= Sloughing off the
endometrium thinning of the lining to be eliminated
LUTEINIZING PHASE/SECRETORY PHASE
*DECREASE PROGESTERONE= Initiates
contraction=elimination of menstruation
COLOR: Dark red, RBC, With blood clot, mucus,
endometrial cells
GNrH is stimulated to produce increase in estrogen that
will cause the endometrial lining to thicken, and to
increase the progesterone level to prevent contraction.
FOLLICULAR phase increases estrogen level to thicken the
endometrial lining while LUTEINIZING PHASE means
increasing progesterone level to prevent contraction of the
uterus .
*MENSTRUATION*
For menstruation to occur there would be a decrease in
estrogen that would cause sloughing off the endometrium
and decrease in progesterone to
*FERTILIZATION*
the matured cell grafiaan follicle, ovum moves out In the
fallopian tube specifically in the ampulla where fertilization
occurs, if the egg has been fertilized the ovum will move
into the thickened uterus and to be implanted . Corpus
Luteum is the first placenta staying for 14 days to support
the pregnancy
 DECREASE ESTROGEN

Grafian follicle matures= Ovum

Then the OVUM goes to the
AMPULLA (for fertilization) then to
uterus for implantation. Ang
STIMULATES THE endometrium dapat kumapal na
HYPOTHALAMUS ginawa ng estrogen

PITUITARY GLA

ANTERIOR
-ALL HORMONE

POSTERIOR
OXYTOCIN
ADH

SENDS SIGNAL TO
ANTERIOR PITUITARY GLAND
TO
FOLLICLE LUTENIZING
STIMULATING HORMONE
HORMONE
RELEASE

INCREASE LUTEIN

INCREASE FOLLICULAR FLUID

(from grafian follicle) CORPUS LUTEUM
HIGH LEVEL “PROGESTERONE”
Contains OF

Follicle
PREGNANCY
Stays for 16 weeks to sustain pregancy
OVULATION or and keep endometrium thick.
After 16 weeks PLACENTA will take over
(FOLLICULAR RUPTURE) for production of progesterone to
maintain Pregnancy.
Why rupture?:bc of INCREASE fluid!
Corpus Luteum will stay for 10 days. If not fertilized.

14 days before  INCREASE OF “TEMPERATURE”

 THICKENNING/PROLIFERATION OF
PROGESTERONE HORMONE

ENDOMETRIUM”
Why? for PREPARATION of PREGNANCY

Waiting
OVUM
for

2nd LUTEAL/PROGESTATIONAL/SECRETORY PHASE

FSH Stops 1 st
FOLLICULAR/ESTROGENIC/PROLIFERATIVE PHASE

“What happens to corpus luteum if

not fertilized”
1st FOLLICULAR/ESTROGENIC/PROLIFERATIVE
No FERTILIZATION= PHASE
OVUM will be released from the Increase estrogen 5-14 days
2nd LUTEAL/PROGESTATIONAL/SECRETORY PHASE
body in the form of white menses Increase progesterone 15-24 day
called CORPUS ALBICANS(unfertilized
3RD ISCHEMIC PHASE
ovum) Decrease estrogen and progesterone 25-28 after this
duduguin kana

4TH MENSES
1-4 days of Bleeding