INTRODUCTION TO OBSTETRICS
Obstetrics- is the branch of medicine that
deals with the management of pregnancy,
parturition (labor and delivery) and puerperium
(the sixth weeks following childbirth)
SIGNIFICANT DEVELOPMENT IN
OBSTETRICS
PRIMITIVE PERIOD
 WOMAN IN LABOR GIVES BIRTH IN
SQUATTING POSITION OR SIT IN
SPECIAL BIRTH STOOL
 KILLING OF BABY IS PRACTICED
 CHILD IS NOT CONSIDERED A
PERSON WITH SOUL UNTIL HE
RECIEVES A NAME AND PRESENTED
TO SPIRIT
ANCIENT TIME (ANCIENT EGYPT)
 EGYPTIANS ARE CONSIDERED TO BE
THE FOUNDERS OF MEDICINE
 CHILDREN WERE VALUED HIGHLY
AND INFANTICIDE WAS NOT ALLOWED
BY THE LAW DURING THIS TIME
 PRACTICE OF MEDICINE WAS MORE
SOPHISTICATED – FORCEP, CS,
PODALIC VERSION WAS ALREADY
PRACTICED DURING THIS PERIOD.
ANCIENT INDIA
HIPPOCRATES WAS CONSIDERED THE
“FATHER OF MEDICINE”
SORANUS OF EPHESUS WAS CONSIDERD
THE ‘FATHER OF OBSTETRICS”
MIDDLE AGE
 LYING IN HOSPITAL ARE ALREADY
AVAILABLE
 MIDWIVES ARE CONSIDERED
ATTENDANTS OF NORMAL DELIVERY
 DOCTORS ATTEND COMPLICATED
DELIVERIES
 WET NURSING OR BREAST FEEDING
WAS PRACTICED
PRESENT TRENDS
 PRENATAL CARE ARE PRACTICE
 HUSBAND AND WIFE ARE
ENCOURAGED TO SHARE INCHILD-
BEARING EXPERIENCES
 ROOMING-IN AND MOTHER-BABY
FRIENDLY HOSPITAL STARTS
 Unang Akap or First Embrace practice.
 KMC or Kangaroo mother care
 Breast feeding practice intensified.
MATERNAL ADAPTATION TO
PREGNANCY
BIOCHEMICAL, PHYSIOLOGICAL AND
ANATOMIC CHANGES
A. ORGANIC CHANGES
UTERUS- HYPERTROPHY AND
DILATATION
1.NON- PREGNANT UTERUS- ALMOST
SOLID WITH 10ML CAVITY
PREGNANT UTERUS- BECOMES THIN-
WALLED AND ENLARGED TO
ACCOMMODATE FETUS, PLACENTA,
AMNIOTIC FLUID
2. TOTAL VOLUME OF UTERINE
CONTENTS AT TERM AVERAGES ABOUT 5
LITERS TO AS MUCH AS 10 LITERS OR
MORE WHICH IS 500-1000 TIMES ITS NON-
PREGNANT CAPACITY
3. NON- PREGNANT UTERUS WEIGHTS
ABOUT 70 GRAMS
TERM PREGNANCY -1100 GRAM
4.PREGNANCY-
HYPERTROPHY/ENLARGEMENT OF
MUSCLE FIBERS AND TO A LIMITED
DEGREE AND DUE TO ESTROGEN AND
PROGESTERONE.
5.UTERINE WALLS BECOME THICKER
DURING FEW MONTHS THEN BECOME
THIN AS 1.5 CM AT TERM THIS ALLOWS
MOVEMENT OF THE FETAL EXTREMITIES
AND FACILITATE PALPATION OF FETAL
PARTS ABDOMINALLY BY LEOPOLD’S
MANUEVER.
UTERINE SIZE, SHAPE, AND POSITION
SIZE
1. BY THE END OF THE 12TH WEEK
GESTATION, THE UTERUS HAS
GROWN TOO LARGE TO REMAIN
IN THE PELVIS, SO IT RISES UP TO
THE ABDOMINE CAVITY.
SHAPE- PEAR SHAPE-GLOBULAR to
OVOID FROM 1 WEEKS UNTIL TER
NOTE: INCREASE OF FUNDIC HEIGHT IS
AN IMPORTANT SIGN OF FETAL GROWTH
AND WELL BEING.
 12 WEEKS - FUNDUS CAN ALREADY BE
PALPATED AS IT RISES OUT OF THE PELVIC
CAVITY.
AT THE LEVEL OF SYMPHISIS PUBIS.
 16 WEEKS – HALFWAY BETWEEN SYMPHISIS
PUBIS AND UMBILICUS.
 2O WEEKS - AT THE LEVEL OF UMBILICUS.
 24 WEEKS - TWO FINGERS ABOVE UMBILICUS.
 28 WEEKS - MIDWAY BETWEEN UMBILICUS
AND XYPHOID PROCESS.
 32 WEEKS - TWO FINGER BELOW THE XIPHOID
PROCESS.
 36 WEEKS- TWO FINGERS BELOW UMBILICUS,
DROPS AT 3 WEEKS LEVEL
 40 WEEKS- TWO FINGERS BELOW UMBILICUS,
DROPS AT 3 WEEKS LEVEL BECAUSE OF
LIGHTENING.
ISTHMUS – NARROW PORTION OF THE
UTERUS THAT JOINS THE CONNECTIVE
TISSUE OF THE CERVIX TO THE MUSCLE
FIBERS OF THE BODY OF THE UTERUS.
HEGAR’S SIGN – REFERS TO THE
SOFTENING OF THE LOWER UTERINE
SEGMENT THE BEGINS AS EARLY AS 5
WEEKS GESTATION.
CERVIX COLOR
MATERNAL ADAPTATION TO
PREGNANCY
A. CARDIOVASCULAR SYSTEM
1. AT 3RD MONTH, THERE IS AN
INCREASE IN BLOOD VOLUME OF 30-50%
(AROUND 1500 ML) WHICH CONTRIBUTES
TO INCREASED CARDIAC WORKLOAD.
BLOOD VOLUME IS INCREASED TO MEET
THE DEVELOPMENT NEEDS OF THE
FETUS. THIS INCREASE FURTHER WITH
MULTIPLE PREGNANCIES.
2. MOTHER FEELS FATIGUE (LASSITUDE)
3. SLIGHTLY HYPERTROPHY OF
VENTRICLES
4. HEART RATE INCREASES 10-15 BEATS
PER MINUTE IN THE LETTER HALF OF
PREGNANCY
5. PALPITATION IS ALSO COMMON DUE
TO STIMULATION OF THE SYMPATHETIC
NERVOUS SYSTEM
6. BLOOD PRESSURE MAY DROP
SLIGHTLY IN SECOND TRIMESTER
7. SUPINE HYPOTENSION SYNDROME: IN
SUPINE POSITION WEIGHT OF ENLARGED
UTERUS OBSTRUCTS VENA CAVA, WHICH
DECREASES BLOOD RETURN TO HEART
THERFORE DECREASING CARDIAC
OUTPUT RESULTING TO HYPOTENSION,
LIGHT HEADEDNESS, FAINTNESS AND
PALPITATIONS.
8. WHITE BLOOD CELLS, FIBRINOGEN
AND OTHER CLOTTINGFACTORS
INCREASES.
9. PHYSIOLOGIC ANEMIA
a. occurs as a result of hemodilution of the
blood.
b. There is 45-50% increase in blood volume
expansion, of which about 75% is plasma and
25% is RBC.
c.Normal values in pregnancy
Hct. 32-42 %
Hgb. : 10.5-14 g/L
11. PATHOLOGIC ANEMIA
 IRON DEFICIENCY ANEMIA-MOST
COMMON HEMATOLOGIC DISORDER
AFFECTS ROUGHLY 20% OF
PREGNANT WOMEN
 ASSEESSMENT REVEALS: PALLOR,
SLOWED CAPILLARY REFIL, CONCAVE
FINGERNAILS (LATE SIGN OF
PROGRESSIVE ANEMIA) CAUSED BY
CHRONIC TISSUE HYPOXIA AND
CONSTIPATION
NURSING CARE
 Nutritional INSTRUCTION- INCREASED
IRON IN THE DIET
 PARENTERAL IRON THRU Z- TRACT
METHOD.IF NOT GIVEN PROPERLY
HEMATOMA FORMATION MAY OCCUR
 ORAL IRON SUPPLEMENTS (FERROUS
SULFATE 0.3G,3X A DAY) BEST GIVEN
1 HOUR BEFORE MEALS OR WITH
EMPTY STOMACH FOR BETTER
ABSORPTION, HOWEVER CAN LEAD
TO GIT IRRITATION, HENCE, GIVEN ON
FULL STOMACH BUT WITH VITAMIN C
TO ENHANCE ABSORPTION.
SIDE EFFECT: CONSTIPATION AND BLACK
TARRY STOOL.
 MONITOR FOR HEMORRHAGE
 IRON FROM REDIS BETTER
ABSORBED THAN IRON FROM OTHER
SOURCES
 IRON IS BETTER ABSORBED WHEN
TAKEN WITH FOODS RICH IN VITAMIN
C SUCH AS ORANGE JUICE
 HIGHER IRON INTAKE IS
RECOMMENDED SINCE CIRCULATING
BLOOD VOLUME IS INCREASED AND
IS REQUIRED FROM PRODUCTION OF
RBC’S.
 BEST SOURCES OF IRON :
LIVER,LEAN OR RED MEAT, LEGUMES
SUCH AS MONGGO AND GREEN
LEAFY VEGETABLES SUCH AS
KANGKONG, AMPALAYA, SPINACH
AND MALUNGAY
11. EDEMA OF THE LOWER EXTREMITIES
IS NORMAL BUT EDEMA IN THE UPPER
EXTREMITIES IS A SIGN OF PRE-
ECLAMPSIA
12.VARICOSITIES- CAN BE PREVENTED
THRU WEARING OF PANTYHOSE OR
SUPPORT STOCKINGS
13. THROMBOPHLEBITIS OR DEEP VEIN
THROMBOSIS ( DVT) – VENOUS
INFLAMMATION WITH THROMBUS
FORMATION.
SIGNS AND SYMPTOMS:
(+) HOMAN’S SIGN –PAIN ON CALF UPON
DORSIFLEXION
MILK LEG OR “PHLAGMASIA ALBA
DOLENS”-SHINY WHITE LEG BROUGHT
ABOUT BY STREGHING AND
INFLAMMATION OF SKIN.
NURSING INTERVENTIONS:
 COMPLETE BED REST
 NEVER MASSAGE THE AFFECTED
LEG TO PREVENT
THROMBOEMBOLISM.
 ASSESS THE PATIENT FOR
HOMAN’S SIGN ONCE ONLY.
 ANTICOAGULANT PREVENTS
ADDITIONAL THROBUS
 AVOID GIVING ASPIRIN BECAUSE
IT MAY AGGREVATE BLEEDING
PROBLEM (ANTIDOTE: PROTAMINE
SULFATE)
ENDOCRINE SYSTEM
ELEVATED HCG LEVELS WHICH REACH
PEAK AT THE THIRD MONTHS THEN
DROPS
ESTROGEN AND PROGESTERON
INCREASE AND CONTINUE TO BE
SECRETED FROM THE PLACENTA
DURING THE LAST 6 MONTHS OF
PREGNANCY
THYROID ACTIVITY IS INCREASED;
NORMAL PREGNANCY MAY EMULATE A
MILD HYPERTHYROID STATE.

RESPIRATORY SYSTEM
THE MOTHER EXPERIENCES SHORTNESS
OF BREATH BECAUSE OF ENLARGING
UTERUS AND THERE IS ALSO AN
INCREASED OXYGEN DEMAND; POSITION
THE MOTHER ON LEFT SIDE LYING TO
PROMOTE LATERAL EXPANSION OF THE
LUNGS
HYPERVENTILATION OCCURS DUE TO
THE MOTHER’S NEED TO BLOW-OFF
INCREASED CARBON DIOXIDE
TRANSFERRED TO HER FROM THE
FETUS.
NASAL CONGESTION OCCURS AS A
RESPONSE TO INCREASED ESTROGEN
LEVELS
GASTROINTESTINAL SYSTEM
1.MORNING SICKNESS-CHARACTERIZED
BY EARLY MORNING NAUSEA AND
VOMITING DUE TO INCREASED HCG AND
REDUCTION IN HYDROCHLORIC ACID
SECRETION THAT INTERFERE WITH
GASTRIC MOTILITY.
NURSING MANAGEMENT:
GETTING OUT OF BED SLOWLY AFTER
EATING CRACKERS
SMALL FREQUENT MEALS
AVOID SPICY OR GREASY FOODS
2. HYPEREMESIS GRAVIDARUM-
EXCESSIVE VOMITING DURING
PREGNANCY. MAY RESULT TO
METABOLIC ALKALOSIS
ACID: ALKALOSIS- OCCURS WITH LOSSES
FROM VOMITING OR HYPERVENTILATION
BASE: ACIDOSIS- OCCURS FROM FECAL
LOSSES (DIARRHEA)
4. HEARTBURN OR PYROSIS- REFLUX OF
STOMACH CONTENT TO THE
ESOPHAGUS.CAN BE PREVENTED BY
EATING SMALL FREQUENT MEALS,
AVOIDING FATTY AND SPICY FOODS,
PROPER BODY MECHANICS AND TAKING
SIPS OF MILK.
5. DECREASED EMPTYING OF
GALLBLADDER MAY PRECIPITATE
DEVELOPMENT OF GALLSTONES.
6. FOOD CRAVINGS MAY OCCUR UNSUAL
CRAVED (PICA) FOR EXAMPLE:
CLAY, DIRT, STARCH
7. PTYALISM- INCREASED SALIVATION
CAUSED BY ELEVATED ESTROGEN
LEVELS.
NURSING CARE: OFFER MOUTH WASH
8.SOFTENING OF THE GUMS WITH
ACCOMPANYING HYPERACIDITY OF ORAL
SECRETIONS RESULT IN NON-SPECIFIC
GINGIVITIS.
NURSING CARE: INCREASE VITAMIN C
INTAKE AND REGULAR ORAL HYGIENE
9. FLATULENCE- PRESENCE OF
EXCESSIVE AMOUNT OF GAS IN THE
STOMACH AND INTESTINES DUE TO
INCREASED PROGESTERONE. IT CAN BE
LESSENED BY AVOIDING INTAKE OF GAS-
FORMING FOODS LIKE ROOT CROPS,
BEANS
10. CONSTIPATION-A CONDITION IN
WHICH BOWEL MOVEMENT ARE
INFREQUENT OR INCOMPLETE CAUSED
BY HYPOPERISTALSIS, LACK OF FLUIDS,
POOR DIETARY HABITS, PRESSURE OF
THE ENLARGED UTERUS ON INTERNAL
ORGANS, EFFECTS OF PROGESTERONE
ON MUSCLE AND HEMORRHOIDS.
Management:
Increase oral fluid intake
Eat high fiber diet-oatmeal,papaya,pinya
Regular exercise
11. Hemorrhoids -a varicose condition of the
external hemorrhoidal veins causing painful
swelling at the anus. This is due to the gravid
uterus
Nursing intervention: 8. PROTEINURIA-EXCESS SERUM
PROTEIN IN THE URINE GIVING ITS
 Warm sitz bath FOAMY APPEARANCE; DETERMINED BY
 Sit on soft pillows HEAT AND ACETIC ACID TEST
 High fiber diet
RENAL SYSTEM
MUSCULOSKELETAL SYSTEM
PROXIMITY OF THE UTERUS AND
BLADDER IN EARLY AND LATE 1. LORDOSIS- “PRIDE OF PREGNANCY”
PREGNANCY CAUSES URINARY 2. SOFTENING OF ALL LIGAMENTS AND
FREQUENCY JOINTS, especially symphysis and
sacroiliac joints, caused by increased
a. 1ST TRIMESTER- FREQUENT hormonal action of estrogens and relaxin.
URINATION
WADDLING GAIT- awkward walking due to
b. 2nd TRIMESTER- NORMAL AS BLADDER relaxin hence, the mother is candidate for
IS ALREADY ADJUSTED. accidental falls.
c. 3rd TRIMESTER – INCREASE IN 3. LEG CRAMPS may occur from an
FREQUENCY OF URINATION DUE TO imbalance of calcium (hypocalcemia) in
PRESSURE OF THE GRAVID UTERUS ON the body and from pressure of the gravid
URINARY BLADDER. uterus on the nerves supplying the lower
extremities.
2. BLADDER TONE IS REDUCED BY
EFFECTS OF THE HORMONES ON INTEGUMENTARY SYSTEM
SMOOTH MUSCLES.
1. STRIAE GRAVIDARUM OR STRETCH
3. PRESSURE OF ENLARGING UTERUS MARKS- caused by enlarging uterus
AND THE PROGESTERONE EFFECT ON which causes destruction of connective
SMOOTH MUSCLES CAUSES DILATATION tissue resulting from separation of
OF THE URETERS. THE RIGHT SIDE underlying collagen which appears as
DILATES MORE THAN THE LEFT IN MOST irregular scars. Do not scratch instead
PATIENTS. apply oil or lotion.
2. PROTRUDING UMBILICUS
4. THE KIDNEYS INCREASE IN SIZE
3. LINEA NIGRA- used to be the linea alba
BECAUSE OF THE INCREASE IN RENAL
but changes to brownish-pinkish line
BLOOD FLOW. THIS REVERSES AFTER
running from symphysis pubis to the
THE FIRST TRIMESTER.
umbilicus due to increased melanin.
5. INCREASED URINARY OUTPUT
RESULTS IN LOWERED SPECIFIC
GRAVITY.
6. GLYCOSURIA- INCREASED EXCRETION
OF SUGAR CAUSED BY LOWERED RENAL
THRESHOLD; DETERMINED BY
BENEDICT’S TEST
7. NOCTURIA- IS THE NEED TO GET UP
DURING THE NIGHT IN ORDER TO
URINATE, THUS INTERRUPTING SLEEP,
MANAGED BY:
A. Decreased oral fluid intake at least two
hours before bedtime
B. Side lying or lateral position
 4. CHLOASMA-melanoderma or
MELASMA characterized by the
occurrence of extensive brown patches
of irregular shape and size on the skin
of the face and elsewhere; the
pigmented facial patches.it is also called
“MASK OF PREGNANCY” and are
associated most commonly with
pregnancy and use of oral
contraceptive.
5. Excretion of wastes through the skin
causes diaphoresis

REPRODUCTIVE CHANGES
AMENORRHEA- occurs because the corpus
luteum persists and ovulation is inhibited by
high level of circulating estrogen and
progesterone.
Changes in the uterus are circulatory,
hormonal and related to fetal growth
a. CHADWICK’S SIGN –purplish
discoloration of the cervix and vaginal
mucosa.
LEUKORRHEA –whitish gray, moderate in
amount vaginal discharge
b. GOODELL’S SIGN – softening of the
cervix.
OPERCULUM- mucus plug to seal off
bacteria, hormone responsible is
progesterone
SIGN AND SYMPTOMS OF PREGNANCY
c. HEGAR’S SIGN- softening of the lower
uterine segment PRESUMPTIVE SIGN

d. Uterus enlarges in size SIGNS ANS SYMPTOMS ARE FELT AND

OBSERVED BY THE MOTHER BUT DOES
e. Changes in position of the uterus NOT CONFIRM THE DIAGNOSIS OF
PREGNANCY.
First trimester: uterus in pelvic cavity
Second and third trimester: uterus is in
abdominal cavity before lightening occurs.
3. OVARIES –pregnancy is the rest period for B- breast changes f 1st trimester
the ovaries.
U- urinary frequency i
4. BREAST CHANGES such as fullness,
tingling, soreness, and darkening of the areola F-fatigue r
and nipples occur along with an increase in A- amenorrhea s
hormonal levels.
M- morning sickness t Ultrasound-in general full bladder
E- enlarged uterus Transabdominal- supine and full bladder
Transvaginal- lithotomy and empty bladder
2ND TRIMESTER SIGNS AND SYMPTOMS
OF PREGNANCY
POSITIVE S/S 2ND TRIMESTER
PRESUMPTIVE
F-FETAL HEART TONE AUDIBLE
C-chloasma
F- FETAL MOVEMENT
L- linea nigra
F- FETAL OUTLINE
I- increased pigmentation
F- FETAL PARTS PALPABLE
S- striae gravidarum
Q- quickening
POSITIVE EVIDENCE OF PREGNANCY
hearing or pulsations assures diagnosis:
PROBABLE
a. by stethoscope by the 17th weeks of
Signs and symptoms observed by the mother pregnancy on the average and almost all
and the members of the health care team pregnancies by the 19th week AOG ranging
from 120 to 160 bpm which is distinct from the
FIRST TRIMESTER mother’s pulse.
G- Goodell’s sign b. A doppler can detect fetal heartbeat almost
C- Chadwick’s sign always by the 10th to 12th weeks AOG.

H-Hegar’s sign 2. Echocardiography can detect fetal heart

P-Positive HCG
2ND TRIMESTER PROBABLE S/S
B- Ballotment – floating or bounching back of
the fetus when the uterine segment is tapped
sharply; it may also be a sign of uterine
myoma
E – enlargemed abdomen
B- Braxton – hicks contraction- painless and
irregular contraction
always by the 10th to the 12th weeks AOG.
3. Ultrasonography can detect fetal heartbeat
as early as 5 weeks post LMP.
4. In the later months of pregnancy, other
sounds can be heard over the abdomen such
as:
a. Funic or umbilical souffle
b. Uterine souffle
c. Maternal pulse
d. Sounds resulting from fetal
movements
e. Gurgling sounds of gas in the intestine

POSITIVE SIGNS AND SYMPTOMS II. PSYCHOLOGICAL ADAPTATION

DURING PREGNANCY
Undeniable signs confirmed by the use of
instruments. 1ST TRIMESTER

FIRST TRIMESTER ESTABLISH AN ACCEPTANCE OF

PREGNANCY
1.No tangible signs and symptoms
2. Feeling of surprise, ambivalence
( existence of two opposing feelings),
emotional , money worries, body image
changes
3. denial: a sign of maladaptation to
pregnancy
DEVELOPMENTAL TASK:
To accept the biological facts of pregnancy” I
Am pregnant”
HEALTH TEACHING:
Bodily changes, personal hygiene and
nutrition
B. 2ND TRIMESTER: CONTINUATION OF
PREGNANCY
1. WITH TANGIBLE SIGNS AND
SYMPTOMS
2. ROLE IDENTIFICATION AND
HEIGHTENED SENSE OF TIME
3. MOTHER IDENTIFIES AS A
SEPARATE ENTITY DUE TO
QUECKENING
4. MOTHER BEGINS TO FANTASIZE
THE APPEARANCE OF THE BABY
5. CHANGE IN SEXUAL INTEREST;
FATHER EXAMINES HIS OWN
ABILITY TO PARENT.
DEVELOPMENTAL TASK:
TO ACCEPT THE GROWING FETUS AS A
BABY TO BE NURTURED “ I AM GOING TO
HAVE A BABY”.
HEALTH TEACHING:
GROWTH AND DEVELOPMENT OF THE
FETUS.
C. 3RD TRIMESTER: PREPARATION FOR
SEPARATION OF THE BABY
1. Mother has a personal identification of
the appearance of the baby
2. Mother has fears due to enlarged
abdomen. Allow her to hear the FHT
3. Labor and delivery are on the mother’s
mind; safe passage for herself and the
newborn
4. Nesting behaviors: busy days and
restless nights
5. Father prepares for birth and his
involvement.
DEVELOPMENTAL TASK:
To prepare for birth and parenting of the child.
“I AM GOING TO BE A MOTHER”
HEALTH TEACHING:
Responsible parenting; best time to prepare
for baby’s layette, shopping and buying baby’s
clothes, Lamaze classes may also be offered
DEFINITION OF TERMS:
1. Labor – a low risk throughout,
spontaneous in onset with the fetus
presenting by vertex culminating in the mother
and infant in good condition following birth
(WHO, 1977).
A process by the products of conception is
expected through the birth canal after the 28th
weeks of frequency (Cunningham).
Precipitate labor – labor which lasts for three
hours or less.
2. First stage of labor – the period from
the onset of true labor contraction until full
cervical dilatation and effacement is achieved.
3. Uterine contraction – hardening of the
uterus caused by the contraction of the
uterine muscle.
4. Latent phase of labor – or preparatory
phase begins at the onset of regularly
perceive uterine contraction and ends when
rapid cervical dilatation begins.
5. Active phase of labor – cervical
dilatation occurs more rapidly going from 4cm
to 7cm and a period of maximum stage
cervical dilatation proceed at its most rapid
phase.
6. Transitional phase – maximum
dilatation of 8cm to 10cm occurs contraction
reach their peak of intensity occurring every
2cm to 3cm duration
7. Cervical dilatation – is the process of
enlargement of the os uteri from a tightly
closed aperture to opening large enough to
permit passage of the fetal head.
8. Cervical effacement – refers to the
inclusion of the cervical canal into the lower
uterine segment.
9. Multiple os – terms used a parous
woman effacement and dilatation that may
occur simultaneously and small canal may be
felt in early labor.
10.Cephalic presentation – the head is the
body part that first contacts the cervix
11.Floating – is when the head is still movable
above the pelvic inlet on palpation.
12.Fixation – is the descent of the fetal head
to the inlet to a level that it can no longer be
moved.
13.Moulding – is the changes in shape of the
fetal skull produced by the forces of
uterus contraction pressing the vertex against
the not yet dilated cervix.
14.Descent – refers to the downward
movement of the fetus in the birth canal
brought about the forces of uterine
contractions.
15.Rupture of membrane or bag of water – is
signified by gush or steady tickle of clear fluid
from the vagina.
16.Retraction ring or bandl’s ring – an
indention across the women’s abdomen
where the upper and lower segment of the
uterus join.
CHANGES DURING THE LAST WEEK OF
PREGNANCY
1. Mood swing is common and surge of
energy may be experienced.
2. Two to three weeks before the onset
of labor the lower uterine segment extends
and allows the fetal head to sink lower and it
may engage in the pelvis.
3. Walking may become more difficult for
some women at the end of pregnancy
because the symphysis pubis is more mobile
and relaxation of the sacroiliac joints may give
rise to backache.
CARE AND MANAGEMENT OF ANTENATAL
WOMAN
Ante natal period- refers to the nursing care
given to the mother from fertilization to the
beginning of true contractions.
A. Personal data
1. Name, age, address
2. Sex
a. Pseudocyesis or false pregnancy-father of
mother can experience presumptive or
probable signs of pregnancy however there is
no FHT.
b. Couvade syndrome- psychosomatic
reaction wherein the father experiences what
the mother goes through during pregnancy.
3. Civil status
a. unwed mothers are considered high risk
patients.
b. home-based mother’s record (HBMR) to
determine high risk pregnancy.
4. Religion- to determine cultural diversity
5. Occupation-to determine occupational
hazards
6. education-to determine level of knowledge
B. DIAGNOSIS OF PREGNANCY
1. Amenorrhea
2. Urine pregnancy test-may be positive
within days of the first missed
menstrual period.
a. Human Chorionic gonadotropin (HCG)
 present at 41-100th day of pregnancy
b. HCG peaks at 60-70th day
c. 6th week after LMP best time to do the test
3. Fetal heart tones can be detected as early
as 8 weeks from the last menstrual period
(LMP) by Doppler.
Normal Fetal heart rate is 120- 160 beats per
minute and it is irregular.
4. Fetal movements (quickening) are first felt
by primiparous mother at 18-20 weeks.
5. ultrasound-will visualize a gestational sac at
5-6 weeks and a fetal pole with movement
and cardiac activity by 7-8 weeks. Ultrasound
can estimate fetal age accurately if completed
before 24 weeks.
6. Estimated date of delivery. The mean
duration of pregnancy is 40 weeks from
LMP.EDD can be calculated by Nagele’s rule:
add 7 days to the first day of the LMP, then
subtract 3 months.
BASELINE DATA
ROLL – OVER TEST – IS PERFORMED TO
DIAGNOSE PRE- ECLAMPSIA USING THE
BLOOD PRESSURE
THE MOTHER IS PLACED ON SIDE LYING
POSITION FOR ABOUT 10-15 MINUTES
THEN PLACED IN SUPINE.
NEXT, THE BP IS TAKEN.
IF THE SYSTOLIC PRESSURE IS GREATER
THAN 30 MMHG AND THE DIASTOLIC
PRESSURE IS ABOVE 15 MMHG, A SIGN
TO SUPPORT DIAGNOSIS OF PRE-
ECLAMPSIA
INCREASE IN WEIGHT
IS THE FIRST SIGN OF PRE- ECLAMPSIA
BUT PATTERN OF WEIGHT GAIN IS MORE
IMPORTANT.
MINIMUM WEIGHT GAIN: 20-25 LBS.
OPTIMUM WEIGHT GAIN: 25-35 LBS.
IDEAL WEIGHT GAIN
PER TRIMESTER PER MONTH
First: 1.5 – 3 lbs. 1 lb/ mos.
Second:10-12 lbs. 4 lbs./mos.
Third: 10-12 lbs. 4 lbs./ mos.
total gain: 20- 25 lbs
Multifetal pregnancy: 35-40 for twins, 50 for
triplets.
GYNECOLOGIC AND OBSTETRIC
HISTORY
1. GRAVIDITY- is the total number of
pregnancies.
2. PARITY- is the total number of viable
pregnancies; expressed as the
number of Term pregnancies, Preterm
pregnancies, Abortion and Live
birth(TPAL)
3. VIABILITY- the ability of the fetus to
live outside the uterus at the earliest
possible gestational age; 20-24 th
weeks or 5-6 months
4. GTPAL SCORE
GRAVIDA: number of pregnancies
Term: born between 37-42 weeks
Preterm: born more than 20 weeks but less
than 37 weeks.
Abortion: number of pregnancies ending in
therapeutic or spontaneous abortion.
Live: living children.
GENERAL RULE IN GETTING GTPAL
=Multiple gestations (twins, triplets, etc.) is
counted as one in the number of pregnancy
(Gravida) and is counted as one in the
number of viable pregnancy (Para)
=Stillbirth/Intrauterine Fetal Death
(IUFD)/Fetal Demise is counted as one viable
pregnancy
 -If it falls between 37 to 42 weeks it is
counted under term pregnancy
-If it falls less than 37 weeks but more than
20 weeks it is counted in preterm pregnancy.
=If the product of conception was delivered
before the age of viability (20-24 weeks) it is
considered under abortion
Mrs. Palaypay is pregnant again at 3 months
AOG. She told the nurse that she gave birth to
her 1st child at 38 weeks AOG her second
baby was aborted at 15 weeks, her 3rd was
still birth delivered at 35 weeks AOG.
Determine her OB score.
Gravida-pregnancy more than 20 weeks AOG
G-4
Term-38weeks and above T-1
Preterm-less than 37 weeks P-1
Abortion-less than 20 weeks A- 1
Living- alive L- 1
4-1-1-1-1
A prenatal visit was made by Mrs. Duterte
whose OB history revealed a baby boy
delivered by 39 weeks AOG, her second
pregnancy resulted to a miscarriage, her 3rd
pregnancy was a twin delivered at 35th weeks
AOG and she is pregnant at 3rd month. What
is her OB score?
G4 P2 GTPAL = 4-1-1-1-3
5. The character and length of previous
labors.
6. Type of delivery, complications, infant
status, and birth weight are recorded.
7. Assess prior cesarean sections and
determine type of C-section(low transverse or
classical), and determine reason it was
performed.
F. Medical and surgical history and prior
hospitalizations are documented.
G. Medications and allergies are recorded
H. Family history of medical illnesses,
hereditary illness, or multiple gestation is
sought.
Social history. Cigarettes, alcohol, or illicit
drug use.
J. Review of systems. Abdominal pain,
constipation, headaches, vaginal bleeding,
dysuria or urinary frequency, or hemorrhoids.
ESTIMATION OF GESTATIONAL AGE
1.NAEGELE’S RULE- USED TO
DETERMINE THE EXPECTED DATE OF
DELIVERY BY DETERMINING THE LMP OF
THE MOTHER.
2.MC DONALD’S RULE – USED TO
DETERMINE THE AGE OF GESTATION.
Formula:
Length of fundus in cm x 8/7 = AOG in weeks
or
Length of fundus in cm x 2/7 = AOG in months
3. BARTHOLOMEW’S RULE
TO DETERMINE AGE OF GESTATION BY
FUNDIC LOCATION.
a. 3 MONTHS – JUST ABOVE THE
SYMPHYSIS PUBIS.
b. 4 MONTHS – MIDWAY BETWEEN
SYMPHYSIS PUBIS AND UMBILICUS
c. 5 MONTHS – AT THE LEVEL OF THE
UMBILICUS
d. 9 MONTHS – JUST BELOW THE
XYPHOID PROCESS
e. 10 MONTHS – LEVEL AT 8 MONTHS DUE
TO LIGHTENING.
HAASE’S RULE
To determine the length of the fetus in
centimeter.
 a. First half of pregnancy (1-5 months):
Month2
b. Second half of pregnancy (6-10
months): Month x 5
After 20 weeks, there is a correlation between
the number of weeks of gestation and the
number of centimeters from the pubic
symphysis to the top of the fundus.
Uterine size that exceeds the gestational
dating by 3 or more weeks suggests multiple
gestation, molar pregnancy, or (most
commonly) an inaccurate date for LMP.
Ultrasonography will confirm inaccurate dating
or intrauterine growth failure.
LEOPOLD’S MANEUVERS
Done to determine the attitude, fetal
presentation, lie, presenting part, degree of
descent, estimate of fetal size, fetal back,
FHT, number of fetuses and position.
Difficult to perform on obese women and
women who have hydramnios.
Help determine the position and presentation
of the fetus, which in conjunction with correct
assessment of the shape of the maternal
pelvis can indicate whether or not the delivery
is going to be complicated, or whether or not a
cesarean section is necessary.
FIRST MANEUVER
 While facing the woman, palpate the
woman’s upper abdomen with both
hands. Assess size, shape, movement
and firmness of the part.
 Determine presentation
 BREECH: softer, symmetric, has
bony prominences and moves with the
trunk (buttocks part).
 CEPHALIC hard, firm and round and
moves independently of the trunks.
SECOND MANEUVER
With both hands moving down, identify the
fetal back where the ball of the stethoscope is
placed to determine Fetal Heart tone (FHT)
Assess pulse rate:
 Uterine soufflé: corresponds with
maternal heart rate
 Funic souffle: corresponds with fetal
heart rate
THIRD MANEAUVER
Using the dominant hand, grasp the
symphysis pubis with thumb and fingers.
 Assess whether the presenting part is
engaged in the pelvis
 Floating/ movable presenting part:
unengaged
 Immovable presenting part: engaged
FOURTH MANEUVER
The examiner changes the position by
facing the patient’s feet with two hands,
assess the descent of the presenting part by
locating cephalic prominence or brow. the
side where there is the resistance to the
descent of the fingers toward the pubis is
greatest is where the brow is located.
 Assess fetal attitude (relationship of
the fetus to one another:
 if the head of the fetus is well flexed, it
should be on the opposite side from
the fetal back.
 If the fetal head is extended though,
the occiput is instead is felt and is
located on the same side as the back.
IV. HEALTH TEACHINGS ABOUT
PREGNANCY
A. FREQUENCY OF PRE-NATAL VISITS

MONTTMONTH FREQUENCY
1-7 ONCE A MONTH
8-9 TWICE A MONTH
10 EVERY WEEK
POST-TERM TWICE A WEEK

DANGER SIGNS OF PREGNANCY

SWELLING OR EDEMA OF THE UPPER
EXTREMITIES- PREECLAMPSIA
CHILLS AND FEVER –SIGNS OF
INFECTION
CEREBRAL DISTURBANCES “HEADACHE”
SIGN OF PREECLAMPSIA
3. ABDOMINAL PAIN- “EPIGASTRIC PAIN”
IS AN AURA OF AN IMPENDING
CONVULSION.
4. Board like abdomen – abruptio placenta
Blurred vision – preeclampsia
Bp increase- hypertension
Bleeding
a. First trimester- abortion, ectopic
pregnancy
b. Second trimester- hydatidiform mole,
incompetent cervix
c. Third trimester- abruptio placenta,
placenta previa
5. Sudden gush of fluid- premature rupture of
membranes (PROM) predispose the mother
and fetus to infection