MATERNAL/OB NOTES

Human Sexuality A. Concepts 1. A person¶s sexuality encompasses the complex behaviors, attitudes emotions and preferences that are related to sexual self and eroticism. 2. Sex ± basic and dynamic aspect of life 3. During reproductive years, the nurse performs as resource person on human sexuality. B. Definitions related to sexuality: Gender identity ± sense of femininity or masculinity 2-4 yrs/3 yrs gender identity develops. Role identity ± attitudes, behaviors and attributes that differentiate roles Sex ± biologic male or female status. Sometimes referred to a specific sexual behavior such as sexual intercourse. Sexuality - behavior of being boy or girl, male or female man/ woman. Entity life long dynamic change. - developed at the moment of conception. II. Sexual Anatomy and Physiology A. Female Reproductive System 1. External value or pretender a. Mons pubis/veneris - a pad of fatty tissues that lies over the symphysis pubis covered by skin and at puberty covered by pubic hair that serves as cushion or protection to the symphysis pubis. Stages of Pubic Hair Development Tannerscale tool - used to determine sexual maturity rating. Stage 1 ± Pre-adolescence. No pubic hair. Fine body hair only Stage 2 ± Occurs between ages 11 and 12 ± sparse, long, slightly pigmented & curly hair at pubis symphysis Stage 3 occurs between ages 12 and 13 ± darker & curlier at labia Stage 4 ± occurs between ages 13 and 14, hair assumes the normal appearance of an adult but is not so thick and does no appear to the inner aspect of the upper thigh. Stage 5 sexual maturity- normal adult- appear inner aspect of upper thigh . b. Labia Majora - large lips longitudinal fold, extends symphisis pubis to perineum c. Labia Minora ± 2 sensitive structures clitoris- anterior, pea shaped erectile tissue with lots sensitive nerve endings sight of sexual arousal (Greek-key) fourchette- Posterior, tapers posteriorly of the labia minora- sensitive to manipulation, torn during delivery. Site ± episiotomy. d. Vestibule ± an almond shaped area that contains the hymen, vaginal orifice and bartholene¶s glands. 1. 2. 3. 4. 5. Urinary Meatus ± small opening of urethra, serves for urination Skenes glands/or paraurethral gland ± mucus secreting subs for lubrication hymen ± covers vaginal orifice, membranous tissue vaginal orifice ± external opening of vagina bartholene¶s glands- paravaginal gland or vulvo vaginal gland -2 small mucus secreting subs ± secrets alkaline subs. Alkaline ± neutralizes acidity of vagina Ph of vagina - acidic Doderleins bacillus ± responsible for acidity of vagina

Carumculae mystiformes-healing of torn hymen e. Perineum ± muscular structure ± loc ± lower vagina & anus Internal: A. vagina ± female organ of copulation, passageway of mens & fetus, 3 ± 4inches or 8 ± 10 cm long, dilated canal Rugae ± permits stretching without tearing B. uterus- Organ of mens is a hollow, thick walled muscular organ. It varies in size, shape and weights. Size- 1x2x3 Shape: nonpregnant pear shaped / pregnant - ovoid Weight - nonpregnant ± 50 -60 kg- pregnant ± 1,000g Pregnant/ Involution of uterus: 4th stage of labor - 1000g 2 weeks after delivery - 500g 3 weeks after delivery - 300 g 5-6 weeks after delivery - returns to original, state 50 ± 60 Three parts of the uterus 1. fundus - upper cylindrical layer 2. corpus/body - upper triangular layer 3. cervix - lower cylindrical layer * Isthmus lower uterine segment during pregnancy Cornua-junction between fundus & interstitial Muscular compositions: there are three main muscle layers which make expansion possible in every direction. 1. Endometrium- inside uterus, lines the nonpregnant uterus. Muscle layer for menstruation. Sloughs during menstruation. Decidua- thick layer. Endometriosis-proliferation of endometrial lining outside uterus. Common site: ovary. S/sx: dysmennorhea, low back pain. Dx: biopsy, laparoscopy Meds: 1. Danazole (Danocrene) a. to stop mens b. inhibit ovulation 2. Lupreulide (Lupron) ±inhibit FSH/LH production 2. Myometrium ± largest part of the uterus, muscle layer for delivery process y Its smooth muscles are considered to be the living ligature of the body. - Power of labor, resp- contraction of the uterus 3. Perimetrium ± protects entire uterus C. ovaries ± 2 female sex glands, almond shaped. Ext- vestibule int ± ovaries Function: 1. ovulation 2. Production of hormones d. Fallopian tubes ± 2-3 inches long that serves as a passageway of the sperm from the uterus to the ampulla or the passageway of the mature ovum or fertilized ovum from the ampulla to the uterus. 4 significant segments 1. Infundibulum ± distal part of FT, trumpet or funnel shaped, swollen at ovulation 2. Ampulla ± outer 3rd or 2nd half, site of fertilization 3. Isthmus ± site of sterilization ± bilateral tubal ligation 4. Interstitial ± site of ectopic pregnancy ± most dangerous B. Male Reproductive System 1. External penis ± the male organ of copulation and urination. It contains of a body of a shaft consisting of 3 cylindrical layers and erectile tissues. At its tip is the most sensitive area comparable to that of the clitoris in the female ± the glands penis.

3 Cylindrical Layers 2 corpora cavernosa 1 corpus spongiosum Scrotum ± a pouch hanging below the pendulous penis, with a medial septum dividing into two sacs, each of which contains a testes. - cooling mechanism of testes < 2 degrees C than body temp. Leydig cell ± release testosterone

2. Internal The Process of Spermatogenesis ± maturation of sperm

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Testes ± 900 coiled (½ meter long at age 13 onwards) (Seminiferous tubules)

Hypothalamus

Epididymis ± 6 meters coiled tubules site for maturation of sperm

GnRH
Vas Deferens ± conduit for spermatozoa or pathway of sperm

Ant Pit Gland

FSH

LF

Seminal vesicle ± secretes: 1.) Fructose ± glucose has nutritional value. 2.) Prostaglandin ± causes reverse contraction of uterus

Fx: Sperm Maturation

Fx: Hormones for Testosterone Production

Ejaculatory duct ± conduit of semen

Prostate gland- secrets alkaline substance

Cowpers gland secrets alkaline substance Urethra

Male and Female homologues Male Penile glans Penile shaft Testes Prostate Cowper¶s Glands Scrotum Female Clitoral glans Clitorial shaft ovaries Skene¶s gands Bartholin's glands Labia Majora

causes early closure of epiphysis of long bones 8. increase osteoblast activities of long bones 6. causes sodium retention 9. Sperm is viable within 48 ± 72 hrs. increase in height in female 7. mammary gland development 4. Ovum is capable of being fertilized with in 24 ± 36 hrs after ovulation 5. Secretory = 15 to 26th day 3. Spinnbarkeit & Ferning ( billings method/ cervical) 4.maturation of ovum Gematogenesis ± formation of 2 haploid into diploid 23 + 23 = 46 or diploid 7. increase sexual desire *Progestin ³ Hormone of the Mother´ Primary function: prepares endometrium for implantation of fertilized ovum making it thick & tortous (twisted) Secondary Function: uterine contractility (favors pregnancy) Others: 1. Ischemic = 27 to 28th day 4. DNA ± carries genetic code 2. increase BBT 10. development ductile structure of breast 5. Phases of Menstrual Cycle: 1.inhibit prod of LH (hormone for ovulation) 2. Menstrual Cycle 4 phases of Menstrual Cycle 1. 1 tsp 4. Normal amount of ejaculated sperm 3 ± 5 cc. Functions of Estrogen and Progestin * Estrogen ³Hormone of the Woman´ ± Primary function: development secondary sexual characteristic female. Chromosomes ± threadlike strands composed of hereditary material ± DNA 3. Others: 1. causes mood swings in moms 6. inhibit production of FSH ( maturation of ovum) 2. increase permeability of kidney to lactose & dextrose causing (+) sugar 5. Menses = 1st to the 5th day . MenstruationMenstrual Cycle ± beginning of mens to beginning of next mens Average Menstrual Cycle ± 28 days Average Menstrual Period . Age of Reproductivity ± 15 ± 44yo 8.inhibit motility of GIT 3.3 ± 5 days Normal Blood loss ± 50cc or ¼ cup Related terminologies: Menarche ± 1st mens Dysmenorrhea ± painful mens Metrorrhagia ± bleeding between mens Menorhagia ± excessive during mens Amenorrhea ± absence of mens Menopause ± cessation of mens/ average : 51 years old 9.III. hypertrophy of myometrium 3. Reproductive cells divides by the process of meiosis (haploid) Spermatogenesis ± maturation of sperm Oogenesis ± process . Proliferative = 6 to 14th day 2. 2-3 days 6.. Basic Knowledge on Genetics and Obstetrics 1.

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

May last 2 ± 10 sec. Zygote.2 months to birth. Morula ± mulberry-like ball with 16 ± 50 cells. C. Adhesion 3. 3 processes of Implantation 1.most affected are is pelvic area. 4 days free floating & multiplication c. Plateau Phase ± (accelerated V/S) ± increasing & sustained tension nearing orgasm. Stages of Fetal Growth and Development 3-4 days travel of zygote ± mitotic cell division begins *Pre-embryonic Stage a. Lasts 30 seconds ± 3 minutes. Dicidua ± thickened endometrium ( Latin ± falling off) * Basalis (base) part of endometrium located under fetus where placenta is delivered * Capsularies ± encapsulate the fetus * Vera ± remaining portion of endometrium. Ex missing digits/toes.fertilized ovum. Blastocyst ± covering of blastocys that later becomes placenta & trophoblast d. Invasion C. Blastocyst ± enlarging cells that forms a cavity that later becomes the embryo. slight pain 2. lasts minutes to hours. Fetus. . wherein he cannot be restimulated for about 10-15 minutes A. Lifespan of zygote ± from fertilization to 2 months b. 2. immeasurable peak of sexual experience. Resolution ± (v/s return to normal. Common complication fetal limb defect. Orgasm ± (involuntary spasm throughout body. moderate increase in HR. Chorionic Villi.BP. 4. nipple erection) ± erotic stimuli cause increase sexual tension. Fertilization B.Vasocongestion ± congestion of blood vessels Myotonia ± increase muscle tension 1. 3. genitals return to pre-excitement phase) Refractory Period ± the only period present in males. slight vaginal spotting . Apposition 2. sex flush.if with fertilization ± corpus luteum continues to function & become source of estrogen & progesterone while placenta is not developed. Implantation/ Nidation.10 ± 11th day.occurs after fertilization 7 ± 10 days. peak v/s) involuntary release of sexual tension with physiologic or psychologic release. placenta previa ± implantation at low side of uterus Signs of implantation: 1. RR. Excitement Phase ± (sign present in both sexes. finger life projections 3 vessels= A ± unoxygenated blood V ± O2 blood A ± unoxygenated blood Wharton¶s jelly ± protects cord Chorionic villi sampling (CVS) ± removal of tissue sample from the fetal portion of the developing placenta for genetic screening. Done early in pregnancy.

Amniotic Fluid ± bag of H2O.maternal serum alpha feto-protein test (MSAFP) ± 1st trimester 2. hydramnios. odor mousy/musty.E. slightly alkaline. maintains temp 4.+ ruptured amniotic fluid) C. might get infected syphilis F. Synsitiotrophoblast ± synsitial layer ± responsible production of hormone 1. Genetic screening. fluid is tested for: 1. Paper turns blue green/gray-(+) rupture of amn fluid. Amnioscopy ± direct visualization or exam to an intact fetal membrane. with crystallized forming pattern. Determination of fetal maturity primarily by evaluating factors indicative of lung maturity ± 3rd trimester Testing time ± 36 weeks decreased MSAFP= down syndrome increase MSAFP = spina bifida or open neural tube defect Common complication of amniocenthesis ± infection Dangerous complications ± spontaneous abortion 3rd trimester. B.FUNIS. Paper turns yellow. Short cord: abruptio placenta or inverted uterus. *Function of Amniotic Fluid: 1. whitish grey. 1. help in delivery process normal amt of amniotic fluid ± 500 to 1000cc polyhydramnios. Long cord:cord coil or cord prolapse b. 20 ± 21´.urine. Fern Test.pre term labor Important factor to consider for amniocentesis. Amniocentesis empty bladder before performing the procedure.decrease amt of fluid ± kidney disease Diagnostic Tests for Amniotic Fluid A.2:1 signifies fetal lung maturity not capable for RDS Shake test ± amniotic + saline & shake Foam test Phosphatiglyceroli: PG+ definitive test to determine fetal lung maturity . Umbilical Cord. increased amt of fluid oligohydramnios. Purpose ± obtain a sample of amniotic fluid by inserting a needle through the abdomen into the amniotic sac. prevent cord compression 5. cushions fetus against sudden blows or trauma 2. facilitates musculo-skeletal development 3.determine if amniotic fluid has ruptured or not (blue paper turns green/grey .GIT malformation TEF/TEA. clear. Nitrazine Paper Test ± diff amniotic fluid & urine. Chorion ± where placenta is developed Lecithin Sphingomyelin L/S Ratio. Cytotrophoblast ± inner layer or langhans layer ± protects fetus against syphilis 24 wks/6 months ± life span of langhans layer increase. 15 ± 55cm.needle insertion site Aspiration of yellowish amniotic fluid ± jaundice baby Greenish ± meconium A. Amnion ± inner most layer a. Before 24 weeks critical.

diffusion more rapid from higher to lower. Has a diabetogenic effect ± serves as insulin antagonist Relaxin Hormone. Buds of milk teeth appear . nails. skin and senses. kidneys and repro organ * Ectoderm ± development of brain. Simple diffusion GIT ± transport center. Circulating system ± achieved by selective osmosis Endocrine System ± produces hormones y y y y y 6. CNS develops ± dizziness of mom due to hypoglycemic effect Food of brain ± glucose complex CHO ± pregnant womans food (potato) Second Month 1. Corpus luteum ± source of estrogen & progesterone of infant ± life span ± end of 2nd month 3.Placenta ± (Secundines) Greek ± pancake. musculoskeletal system. Respiratory System ± beginning of lung function after birth of baby.HBV Fetal Stage ³ Fetal Growth and Development´ Entire pregnancy days ± 266 ± 280 days 37 ± 42 weeks Differentiation of Primary Germ layers * Endoderm 1st week endoderm ± primary germ layer Thyroid ± for basal metabolism Parathyroid . 5. fetus hypoglycemic Excretory System.artery . Size: 500g or ½ kg -1 inch thick & 8´ diameter Functions of Placenta: a. hair. It serves as a protective barrier against some microorganisms ± HIV. placenta developed 2. 1. glucose transport is facilitated. mucus membrane or anus & mouth First trimester: 1st month . 4.carries waste products. If mom hypoglycemic. combination of chorionic villi + deciduas basalis.for calcium Thymus ± development of immunity Liver ± lining of upper RT & GIT * Mesoderm ± development of heart. All vital organs formed. Liver of mom detoxifies fetus. Human Chorionic Gonadrophin ± maintains corpus luteum alive. Fetal heart tone begins ± heart is the oldest part of the body 2. 2. Sex organ formed 4. Kidneys functional 2.causes softening joints & bones estrogen progestin 3.Brain & heart development GIT& resp Tract ± remains as single tube 1. Human placental Lactogen or sommamommamotropin Hormone ± for mammary gland development. Meconium is formed Third Month 1.

inhibit growth of long bone Vitamin K ± hemolysis (destr of RBC). 16. 2.3. D. Fetal heart tone heard ± Doppler ± 10 ± 12 weeks Sex is distinguishable Second Trimester: FOCUS ± length of fetus 1. Quickening. fetal alcohol withdrawal syndrome char by microcephaly Smoking ± low birth rate Caffeine ± low birth rate Cocaine ± low birth rate. 18.1st fetal movement. 1. Drugs: Streptomycin ± anti TB & or Quinine (anti malaria) ± damage to 8th cranial nerve ± poor hearing & deafness Tetracycline ± staining tooth enamel. 2. Terratogens. virus or irradiation. 2. 1. abruption placenta B. 3.20 weeks primi. 4.18 wks ± multi fetal heart tone heard with or without instrument Sixth Month eyelids open wrinkled skin vernix caseosa present 1. 3. FOCUS: weight of fetus Seventh Month ± development of surfactant ± lecithin Eighth Month lanugo begin to disappear sub Q fats deposit Nails extend to fingers Ninth Month lanugo & vernix caseosa completely disappear Amniotic fluid decreases Tenth Month ± bone ossification of fetal skull 1. TORCH (Terratogenic) Infections ± viruses . C.any drug. 5. Third trimester: Period of most rapid growth. the exposure to such may cause damage to the fetus A. 3. 2. 3. 2. Fourth Month lanugo begins to appear fetal heart tone heard fetoscope. 4. 18 ± 20 weeks buds of permanent teeth appear Fifth Month lanugo covers body actively swallows amniotic fluid 19 ± 25 cm fetus. absence of extremities Steroids ± cleft lip or palate Lithium ± congenital malformation Alcohol ± lowered weight (vasoconstriction on mom). E. hyperbilirubenia or jaundice Iodides ± enlargement of thyroid or goiter Thalidomides ± Amelia or pocomelia.

It affects toughly 20% of pregnant women. Physiologic Anemia ± pseudo anemia of pregnant women Normal Values Hct 32 ± 42% Hgb 10. after delivery. Z tract. and jaundice (hepatic involvement).iron deficiency anemia is the most common hematological disorder.Assessment reveals: y Pallor. y Oral Iron supplements (ferrous sulfate 0. Hgb should not be < 11g/dL 2nd trimester ± Hct should not <32% Hgb Shdn't < 10. HIV ± blood & body fluids Syphilis R ± rubella ± German measles ± congenital heart disease (1st month) normal rubella titer 1:10 <1:10 ± less immunity to rubella.saluyot. Don¶t get pregnant for 3 months. epistaxis ± due to hyperemia of nasal membrane palpitation. Systemic Changes 1. constipation y Monitor for hemorrhage . enlarged lymph nodes. Other. In some chases the infection may go unnoticed in the pregnant woman yet have devastating effects on the fetus. . T ± toxoplasmosis ± mom takes care of cats. Feces of cat go to raw vegetables or meat O ± others. Physiological Adaptation of the Mother to Pregnancy A. Cardiovascular System ± increase blood volume of mom (plasma blood) 30 ± 50% = 1500 cc of blood . green leafy vegetable-alugbati.5% pathologic anemia if lower Pathogenic Anemia . hematoma.easy fatigability.pathologic anemia if lower HCT should not be 33%. ampalaya y Parenteral Iron ( Imferon) ± severe anemia. rashes and lesions. Hepa A or infectious heap ± oral/ fecal (hand washing) Hepa B. constipation y Slowed capillary refill y Concave fingernails (late sign of progressive anemia) due to chronic physio hypoxia Nursing Care: y Nutritional instruction ± kangkong. black stool. give IM. slight hypertrophy of ventricles.5 ± 14g/dL Criteria 1st and 3rd trimester. malunggay. Rubella. horseradish. 3 times a day) empty stomach 1 hr before meals or 2 hrs after. mom will be given rubella vaccine. TORCH: Toxoplasmosis.CHARACTERISTICS: group of infections caused by organisms that can cross the placenta or ascend through birth canal and adversely affect fetal growth and development.3 g. increase heart workload. liver due to ferridin content. Cytomegalo virus. influenza like findings.. Herpes simples virus. Vaccine is terratogenic C ± cytomegalo virus H ± herpes simplex virus VI.if improperly administered. These infections are often characterized by vague.

2. Except guava ± has pectin that¶s constipating ± veg ± petchy. Eat dry crackers or dry CHO diet 30 minutes before arising bed.) 5. increase fiber diet .lateral expansion of lungs or side lying position. pineapple. Nausea afternoon .) 2. to relieve.pregnant mom hyperfibrinogenemia . cantaloupe. watermelon.fruits ± papaya. Respiratory system ± common problem SOB due to enlarged uterus & increase O2 demand Position. y Gastrointestinal ± 1st trimester change Morning Sickness ± nausea & vomiting due to increase HCG. apple with skin. Varicosities ± pressure of uterus . elevate legs above hip level. proper body mechanical increase salivation ± ptyalsim ± mgt mouthwash .painful.position ± side lying with pillow under hips or modified knee chest position Thrombophlebitis ± presence of thrombus at inflamed blood vessel .use elastic bandage ± lower to upper Vulbar varicosities. mango. avoid fatty & spicy food. 3.increase clotting factor . Metabolic alkalosis. protamine sulfate Avoid aspirin! Might aggravate bleeding. malungay.) Bed rest Never massage Assess + Homan sign once only might dislodge thrombus Give anticoagulant to prevent additional clotting (thrombolytics will dilute) Monitor APTT antidote for Heparin toxicity.) 3. . Monitor I&O constipation ± progesterone resp for constipation.) 4.use support stockings. avoid wearing knee high socks . pressure on gravid uterus. avoid 3 full meals.) 6.exercise -mineral oil ± excretion of fat soluble vitamins * Flatulence ± avoid gas forming food ± cabbage * Heartburn ± or pyrosis ± reflux of stomach content to esophagus . Increase fluid intake.small freq feeding. sips of milk.small frequent feeding.increase fibrinogen .thrombus formation candidate outstanding sign ± (+) Homan's sign ± pain on cuff during dorsiflexion milk leg ± skinny white legs due to stretching of skin caused by inflammation or phlagmasia albadolens Mgt: 1. F&E imbalance ± primary med mgt ± replace fluids. suha. Vomiting in preg ± emesisgravida.Alert: y y y Iron from red meats is better absorbed iron form other sources Iron is better absorbed when taken with foods high in Vit C such as orange juice Higher iron intake is recommended since circulating blood volume is increased and heme is required from production of RBCs Edema ± lower extremities due venous return is constricted due to large belly.

crab. Color ± white cheese like patches adheres to walls of vagina. Mgt. no alcohol ± has antibuse effect VAGINAL DOUCHE ± IQ H2O : 1 tbsp white vinegar b. Ca & phosphorous imbalance(#1 cause while pregnant). Cheese. hot sitz bath for comfort 4. Local Changes Local change: Vagina: V ± Chadwick¶s sign ± blue violet discoloration of vagina C ± Goodel's sign ± change of consistency of cervix I ± Hegar's ± change of consistency of isthmus (lower uterine segment) LEUKORRHEA ± whitish gray. Vaginitits ± trichomonas vaginalis due to alkaline environment of vagina of pregnant mom Flagellated protozoa ± wants alkaline S&Sx: Greenish cream colored frothy irritatingly itchy with foul smelling odor with vaginal edema Mgt: FLAGYL ± (metronidazole ± antiprotozoa). Moniliasis or candidiasis due to candida albecans. Vit D for increased Ca absorption dorsiflexion B. resp for leucorrhea OPERCULUM ± mucus plug to seal out bacteria. head of fish. over fatigue. treat dad also to prevent reinfection 2. sardines with bones. mousy odor discharge ESTROGEN ± hormone.condifoma acuminata due to papilloma virus Mgt: cauterization . fungal infection. lobster. seafood-tahong (mussels). oversex. genshan violet. yogurt.*Hemorrhoids ± pressure of gravid uterus. Signs & Symptoms: Management ± antifungal ± Nistatin. Dilis. canesten Gonorrhea -Thick purulent discharge Vaginal warts. brocolli. PROGESTERONE ± hormone responsible for operculum PREGNANT ± acidic to alkaline change to protect bacterial growth (vaginitis) Problems Related to the Change of Vaginal Environment: a. Urinary System ± frequency during 1st & 3rd trimester lateral expansion of lungs or side lying pos ± mgt for nocturia Acetyace test ± albumin in urine Benedicts test ± sugar in urine Musculoskeletal 5. pressure of gravid uterus (labor cramps) at lumbo sacral nerve plexus Mgt: Increase Ca diet-milk(Inc Ca & Inc phosphorus)-1pint/day or 3-4 servings/day. cotrimaxole. Lordosis ± pride of pregnancy Waddling Gait ± awkward walking due to relaxation ± causes softening of joints & bones Prone to accidental falls ± wear low heeled shoes Leg Cramps ± causes: prolonged standing. chills. Carcinogenic drug so don¶t give at 1st trimester 1.

Ovaries ± rested during pregnancy 7. Positive Signs ± undeniable signs confirmed by the use of instrument. Empty bladder .change of consistency of isthmus Amenorrhea Elevated BBT ± due to increased progesterone Morning sickness Positive HCG or (+)preg test Enlarged uterus Ballottement ± bouncing of fetus when lower uterine is Cloasma tapped sharply Linea negra Enlarged abdomen Increased skin Braxton Hicks contractions ± painless irregular contractions pigmentation Striae gravidarium Quickening Positive Ultrasound evidence (sonogram) full bladder Fetal heart tone Fetal movement Fetal outline Fetal parts palpable VII. Signs & symptoms of Pregnancy A. denial ± sign of maladaptation to pregnancy. Subjective B. nutrition . use coconut oil.blue violet discoloration of vagina Fatigue Hegar's.trans vaginal ultrasound. Ballotment sign of myoma * + HCG ± sign of H mole . surprise.symphisis pubis to umbilicus 4. Psychological Adaptation to Pregnancy (Emotional response of mom ±Reva Rubin theory) First Trimester: No tanginal signs & sx. umbilicus is protruding 3. color of areola & nipple pre colostrums present by 6 weeks.linea nigra. Abdominal Changes ± striae gravidarium (stretch marks) due enlarging uterus-destruction of sub Q tissue ± avoid scratching. mammography ± 35 to 49 yrs once every 1 to 2 yrs 50 yrs and above ± 1 x a yr 6. cheeks ± chloasma melasma due to increased melanocytes.7 days after mens ±± supine with pillow at back quadrant B ± upper outer ± common site of cancer Test to determine breast cancer: 1. Presumptive ± s/s felt and observed by the mother but does not confirm positive diagnosis of pregnancy . Breast Changes ± increase hormones. colostrums at 3rd trimester Breast self exam. Probable ± signs observed by the members of health team.2.change of consistency of cervix Urinary freq Chadwick¶s. ambivalence. Brown pinkish line. Developmental task is to accept biological facts of pregnancy Focus: bodily changes of preg.there is calcium Presumptive Probable Breast changes Goodel's. Objective C.ultrasound ± full bladder placental grading ± rating/grade o ± immature 1 ± slightly mature 2 ± moderately mature 3 ± placental maturity What is deposited in placenta which signify maturity . Skin Changes ± brown pigmentation nose chin.

culture & beliefs with respect. religion. Preterm -20 ± 37 weeks abortion <20 weeks Sample Cases: 1 ± abortion GTPAL 1 ± 2nd mo 2 0 01 0 G±2 P±0 1 ± 40th AOG 1 ± 36th AOG 2 ± misc 1 ± twins 1 ± 4th month GT P A L 612 2 4 35 AOG G6 P3 . Personal data ± name. Sex ( pseudocyesis or false pregnancy on men & women) Couvade syndrome ± dad experiences what mom goes through ± lihi) Address.# of pregnancy b. Pre-Natal Visit: 1.) urine exam to detect HCG at 40 ± 100th day.) Home preg kit ± do it yourself Baseline Data: V/S esp. monitor wt. Diagnosis of Pregnancy 1.best to get urine exam.# of viable pregnancy Viability ± the ability of the fetus to live outside the uterus at the earliest possible gestational age. mom identifies fetus as a separate entity ± due to presence of quickening. non judgmental Occupation ± financial condition or occupational hazards. HT: responsible parenthood µbaby¶s Layette´ ± best time to do shopping. (increase wt ± 1st sign preeclampsia) Weight Monitoring First Trimester: Normal Weight gain Second trimester: normal weight gain Third trimester: normal weight gain Minimum wt gain ± 20 ± 25 lbs Optimal wt gain ± 25 ± 35 lbs 1. age (high risk < 18 & >35 yrs old) record to determine high risk ± HBMR. Most common fear ± let mom listen to FHT to allay fear Lamaze classes VII. 6 weeks after LMP. education background ± level knowledge 3. Third Trimester: . Developmental task ± accept growing fetus as baby to be nurtured.5 ± 1lb/month) (4 lbs/month) (1 lb/wk) (4 lbs/ month) ( 1lb/wk) 4. Gravida.) Elisa test ± test for preg detects beta subunit of HCG as early as 7 ± 10days 3.mom has personal identification on appearance of baby Development task: prepare of birth & parenting of child. 60 ± 70 day peak HCG. civil status. Home base mom¶s record. BP. 2. age of viability .Second Trimester ± tangible S&Sx. fantasy. Obstetrical Data: nullipara ± no pregnancy a. Frequency of Visit: 1st 7 months ± 1x a month 8 ± 9 months ± 2 x a month 10 ± once a week post term 2 x a week 2. 5.20 ± 24 wks Term 37 ± 42 wks. Para . Health teaching: growth & development of fetus.5 ± 3 lbs 10 ± 12 lbs 10 ± 12 lbs (.

x @ month by 5 3mos x 3 = 9cm 4 mos x 4 = 16 cm 10 x 5 = 50 cm 1st ½ of preg 5 x 5 = 25 cm 6 x 5 = 30 cm 7 x 5 = 35 cm 8 x 5 = 40 cm 9 x 5 = 45 cm d. Bartholomew¶s Rule ± to determine age of gestation by proper location of fundus at abdominal cavity.1 ± 39th week 1 ± miscarriage 1 ± stillbirth 33 AOG (considered as para) 1 ± preg 3rd wk 1 ± 33 P 1 41st L 1 ± abort A 1 ± still 39 1 triplet 32 1 4th mon c. Haases rule ± to determine length of the fetus in cm. 2nd ½ of preg tetanus immunizations ± prevents tetanus neonatum -mom with complete 3 doses DPT young age considered as TT1 & 2. square @ month 2nd ½ of preg. Begin TT3 TT1 ± any time during pregnancy TT2 ± 4 wks after TT1 ± 3 yrs protection .1 add 1 month to month 11/31/04 EDD 2. Important Estimates: GP GTPAL 4 2 4 11 1 1 GP GTPAL 6 4 6 2 2 15 1. 04 +9 +7 10 / 32 / 04 . McDonald¶s Rule ± to determine age of gestation IN WEEKS FUNDIC HT X 7/8=AOG in WK Fundic Ht X 7 = AOG in weeks 8 Fr sypmhisis pubis to fundus 24 X 7 =21 wks 8 3. Formula: 1st ½ of preg . 3 months ± above sym pub 5 months ± level of umbilicus 9 months ± below zyphoid 10 months ± level of 8 months due to lightening 4. Nagele¶s Rule ± use to determine expected date of delivery Get LMP -3+ 7 +1 Apr-Dec LMP ± Jan Feb Mar M D Y +9 +7 no year LMP Jan 25.

use palm! Warm palm.composed of squamous columnar tissue Result: Class I . (preeclampsia) Pelvic Examination ± internal exam 1. presenting part. Leopold¶s Maneuver Purpose: is done to determine the attitude.normal Class IIA ± acytology but no evidence of malignancy B ± suggestive of infl. and number of fetuses.infection Cerebral disturbances ( headache ± preeclampsia) A ± abdominal pain ( epigastric pain ± aura of impending convulsions B ± boardlike abdomen ± abruption placenta Increase BP ± HPN Blurred vision ± preeclampsia Bleeding ± 1st trimester. ectopic pre/2nd ± H mole. an estimate of the size. incompetent cervix 3rd ± placental anomalies S ± sudden gush of fluid ± PROM (premature rupture of membrane) prone to inf.cancer extends to vagina 3 ± pelvis metastasis 4 ± affection to bladder & rectum 7.TT3 ± 6 months after TT2 ± 5 yrs protection TT4 ± 1 yr after TT3 ± 10 yrs protection TT5 ± yr after TT4 ± lifetime protection 5. Class III ± cytology suggestive of malignancy Class IV ± cytology strongly suggestive of malignancy Class V ± cytology conclusive of malignancy Stages of Cervical Cancer Stage 0 ± carcinoma insitu 1 ± cancer confined to cervix 2 .chills/ fever . degree of descent. Prep mom: 1. Physical Examination: A. 2. Examine teeth: sign of infection Danger signs of Pregnancy C . fetal presentation lie. E ± edema to upper ext. . fetal back & fetal heart tone . abortion. Procedure: Empty bladder Position of mom-supine with knee flex (dorsal recumbent ± to relax abdominal muscles) 6. universal precaution EXT OS of cervix ± site for getting specimen Site for cervical cancer Pap Smear ± cervical cancer . position. empty bladder 2.

movement and firmness of the part to determine presentation 2nd Maneuver: with both hands moving down.< 3 FMs in 12 hours 4. Nonstress test ± to determine the response of the fetal heart rate to activity Indication ± pregnancies at risk for placental insufficiency Postmaturity a. often require further testing. diabetes b. Attitude ± relationship of fetus to a part ± or degree of flexion Full flexion ± when the chin touches the chest 8. Cardiff count to 10 method ± one method currently available (1) Begin at the same time each day (usually in the morning.) warning signs should be reported to healthcare provider immediately. biographical profile (BPP) B. identify the back of the fetus ( to hear fetal heart sound) where the ball of the stethoscope is placed to determine FHT. Examples: nonstress test (NST). When the brow is on the same side as the small parts. the head is extended. Assess size. To determine degree of engagement.) more then 1 hour to reach 10 movements b. Get V/S(before 2nd maneuver) PR to diff fundic soufflé (FHR) & uterine soufflé. Assess whether the presenting part is engaged in the pelvis )Alert : if the head is engaged it will not be movable). 4th Maneuver: the Examiner changes the position by facing the patient¶s feet. with both hands palpate upper abdomen and fundus.) pregnancy induced hypertension (PIH).begin after meal .) maternal history of smoking. To determine attitude ± relationship of fetus to 1 another.Assessment of Fetal Well-BeingA. put towel under head and right hip.) less then 10 movements in 12 hours(non-reactive. Daily Fetal Movement Counting (DFMC) ±begin 27 weeks Mom. the head will be flexed and vertex presenting. With two hands. inadequate nutrition Procedure: .1st maneuver: place patient in supine position with knees slightly flexed.) longer time to reach 10 FMs than on previous days d. noting how long it takes to count 10 fetal movements (FMs) (2) Expected findings ± 10 movements in 1 hour or less 3) Warning signs a.) warning signs noted during DFMC c.) movement are becoming weaker. less vigorous Movement alarm signals . When the brow is on the same side as the back. grasp the symphis pubis part using thumb and fingers.breakfast a.fetal distress) c. after breakfast) and count each fetal movement. assess the descent of the presenting part by locating the cephalic prominence or brow. shape. Uterine soufflé ± maternal H rate 3rd Maneuver: using the right hand.

ultrasound transducer over abdominal site where most distinct fetal heart sounds are detected 3. At least two accelerations of the FHR of at least 15 beats per minute.Development of structures . Extremes in wt ± underweight. noted as an uneven line on the rhythm strip. over wt ± candidate for HPN. ii.No more than 30% fat . Requires further evaluation with another NST.CHON x4. lasting at least 15 seconds in a 10 to 20 minute period as a result of FM 3. Stated criteria for a reactive result are not met 2. Nonreactive result 1.Use weight ± gain pattern . Could be indicative of a compromised fetus.utilization of nutrients activity level . complex carbohydrates .Variety of foods representing foods . Good variability ± normal irregularity of cardiac rhythm representing a balanced interaction between the parasympathetic (decreases FHR) and sympathetic (increase FHR) nervous system. Pregnant teenagers ± low compliance to heath regimen. 2. vegetables. Low socio ± economic status 4. Nutrition ± do nutritional assessment ± daily food intake High risk moms: 1. (Decrease folic acid ± spina bifida/open neural tube defect) How many Kcal CHO x4. mother activates the ³mark button´ on the electronic monitor when she feels fetal movement. Baseline FHR between 120 and 160 beats per minute 2.protein sparing so it can be used . Health teachings a. Attach external noninvasive fetal monitors 1.Foods of high nutrient value such Essential to supply energy for to maintain ideal body weight as protein. biophysical profile. result indicates a healthy fetus with an intact nervous system i. such as a CST Result: Noncreative Nonstress Not Good Reactive Responsive is Real Good Interpretation of results reactive result 1. DM 3.Begin increase in second sources for the nutrients requiring for trimester during pregnancy . Vegetarian mom ± decrease CHON ± needs Vit B12 ± cyanocobalamin ± formation of folic acid ± needed for cell DNA & RBC formation. external monitor is applied to document fetal activity. fruits) .increased metabolic rate and meet energy requirement to (whole grains. monitor until at least 2 FMs are detected in 20 minutes y if no FM after 40 minutes provide woman with a light snack or gently stimulate fetus through abdomen y if no FM after 1 hour further testing may be indicated. (BPP) or contraction stress test (CST) 9.Growth of fetus .Done within 30 minutes wherein the mother is in semi-fowler¶s position (w/ fetal monitor). tocotransducer over fundus to detect uterine contractions and fetal movements (FMs) 2. fats x 9 Recommended Nutrient Requirement that increases During Pregnancy Nutrients Requirements Food Source 300 calories/day above the Caloric increase should reflect Calories prepregnancy daily requirement . 4.

Development of essential pregnancy structures . tofu .Failure to meet caloric requirements can lead to ketosis as fat and protein are used for energy.whole grains. nuts .vitamin C sources: citrus fruits & juices.Whole grains * vegetarians must take note of the amino acid content of CHON foods consumed to ensure ingestion of sufficient quantities of all amino acids Calcium increases of .nuts.Establishment of fetal iron stores for first few months of life 60 mg/day or an increase of 10% above daily requirements for age group Adolescents have a higher protein requirement than mature women since adolescents must supply protein for their own growth as well as protein t meet the pregnancy requirement Protein increase should reflect .Ca fortified foods such as orange juice .Expansion of blood volume and red blood cells formation .dark green leafy vegetables. Protein Essential for: .canned salmon & sardines w/ bones . egg yolk.liver. as an indication of adequacy of calorie intake. and tissue growth.Begin supplementation at 30.enriched.Maternal tissue growth including uterus and breasts .dairy products : milk.Eggs.Vitamin D sources: fortified milk.Maintenance of mineralization of maternal bones and teeth . butter. fish . lentils. poultry.green leafy vegetables . yogurt. 10 mcg/day of vitamin D is required since it enhances absorption of both calcium and phosphorous 30 mg/day representing a doubling of the pregnant daily requirement . potatoes . ice cream. egg yolk . cantaloupe.mg/day in second trimester. strawberries. since diet alone is unable to meet pregnancy requirement . liver.Current research is : Demonstrating an association between adequate calcium intake and the prevention of pregnancy induce hypertension Iron Essential for . margarine.Growth and development of fetal skeleton and tooth buds .Fetal tissue growth . seafood Iron increases should reflect . poultry. whole grain cereals and breads .60 ± 120 mg/day along with copper and zinc supplementation for women who have low hemoglobin values prior to pregnancy or who have iron deficiency anemia.1600 mg/day is recommended for the adolescent. . legumes . . eggs .required for pregnancy including placenta. fish. ketosis has been associated with fetal damage.Lean meat. red meat.70 mg/day of vitamin C which enhances iron absorption . dried fruits .1200 mg/day representing an increase of 50% above prepregnancy daily requirement.Dried beans.iron from food sources is more readily absorbed when served with foods high in vit C . broccoli or cabbage. cheese.inadequate iron intake results in maternal effects ± anemia depletion of iron Calcium increases should reflect: . cheese. . milk .Formation of red blood cells and plasma proteins * Inadequate protein intake has been associated with onset of pregnancy induces hypertension (PIH) Calcium-Phosphorous Essential for . amniotic fluid.

Folic Acid. Taking it not needed ± fat soluble vitamins.liver.) mom placed in comfy pos. .iodine . Folate Essential for . 15mcg/day representing an increase of 3 mg/day over prepreganant daily requirements. may play a role in the prevention of neutral tube defects (spina bifida).Magnesium .) 2nd trimester ± increased desire due to increase estrogen that enhances lubrication c. abortion.formation of red blood cells and prevention of anemia . 300mcg/day supplement for women with low folate levels or dietary deficiency 4 servings of grains/day 175 mcg/day 320 mg/day 65 mcg/day 10 mg/day 1.whole grains.6 mg/day 2. kidney. peanuts 400 mcg/day representing an increase of more then 2 times the daily prepregnant requirement. legumes.2 mg day 17 mg/day Increased requirements of pregnancy can easily be met with a balanced diet that meets the requirement for calories and includes food sources high in the other nutrients needed during pregnancy. veal . Folacin.Sexual Activity a.) avoid blowing or air during cunnilingus f.liver.) 3rd trimester ± decreased desire Contraindication in sex: 1. Zinc increases should reflect .) 1st tri ± decrease desire ± due to bodily changes b.eggs.5 mg/day 1.air embolism Changes in sexual desire: a. incompetent cervix .) should be done in moderation b. lean beef. nuts Increases should reflect . milk. Vit stored in body. cardiac stress especially labor and birth . meats . cheese .) avoided 6 weeks prior to EDD e.) changes in sexual desire of mom during preg.Whole grains. legumes.Selenium Vitamins E Thiamine Riborlavin Pyridoxine ( B6) B12 Niacin stores.Zinc Essential for * the formation of enzymes * maybe important in the prevention of congenital malformation of the fetus. broccoli.2 mg/day 2. 2. abruption placenta Additional Requirements Minerals . Hard to excrete.dark green leafy vegetables. vaginal spotting 1st trimester ± threatened abortion 2nd trimester± placenta previa 2. decreased energy and appetite.fetal effects decreased availability of oxygen thereby affecting fetal growth * iron deficiency anemia is the most common nutritional disorder of pregnancy.DNA synthesis and cell formation.shell fish .) should be done in private place c. sidelying or mom on top d.

Kitzinger method ± preg. labor & birth & care of newborn is an impt turning pt in woman¶s life cycle .as if hold urine. Ferdinand Lamaze req.) Done in moderation. Psychophysical 1. 2. imaging ± sensate focus 5.) darkened rm 2.) quiet environment 3. preterm labor 4. Lamaze: Dr.) birthing chair ± bed convertible to chair ± semifowlers . conditioning & concentration. Based on imitation of nature. Squatting ± strengthen muscles of perineum. a. Cleansing breathe ± inhale nose. Childbirth Preparation: Overall goal: to prepare parents physically and psychologically while promoting wellness behavior that can be used by parents and family thus.strengthen chest muscles pelvic rocking/pelvic tilt. Robert Bradley ± advocated active participation of husband at delivery process. Bradley Method ± Dr. disciple. exhale mouth 3. release 10x or muscle contraction Abdominal Exercise ± strengthens muscles of abdominal ± done as if blowing candle 4. Psychosexual 1. helping them achieved a satisfying and enjoying childbirth experience. Psychoprophylaxis ± prevention of pain 1. premature rupture of membrane Exercise ± to strengthen muscles used during delivery process principles of exercise 1.exercise ± relieves low back pain & maintain good posture * arch back ± standing or kneeling. Four extremities on floor Kegel Exercise ± strengthen pulococcygeal muscles . Squat ± feet flat on floor Tailor Sitting ± 1 leg in front of other leg ( Indian seat) Raise buttocks 1st before head to prevent postural hypotension ± dizziness when changing position - shoulder circling exercise. Husband is coach Features: 1. Conscious relaxation 2. Different Methods of delivery: 1.3.flow with contraction than struggle with contraction c.) relaxation tech 4. Features: 1. Grantly Dick Read Method ± fear leads to tension while tension leads to pain b. Increase circulation to perineum.) Must be individualized Walking ± best exercise 3. Effleurage ± gentle circular massage over abdominal to relieve pain 4.) closed eye & appearance of sleep 2.

3 x 4 cm. comfy room. Fetal head ± is the largest presenting part ± common presenting part ± ¼ of its length. 1. transverse diameter ± 9.) Anterior fontanel ± bregma. Passageway Mom 1. diamond shape. decrease progesterone will stimulate contractions & labor 5. dark.contraction 4.5 cm.biparietal ± largest transverse .) Posterior fontanel or lambda ± triangular shape. will always contract & expel its content) ± contraction action 2. Bones ± 6 bones S ± sphenoid F ± frontal .) 4.25cm . Birth under H20 ± bathtub ± labor & delivery ± warm water.( > 5 cm ± hydrocephalus). The 4 P¶s of labor 1. b. quiet. age.) prostaglandin theory ± stimulation of arachidonic acid ± prostaglandin.Pelvic Exams B.) oxytocin theory ± post pit gland releases oxytocin.) lambdoidal suture ± connects occipital & parietal bone Moldings: the overlapping of the sutures of the skull to permit passage of the head to the pelvis Fontanels: 1. Admitting the laboring Mother: Personal Data: name. Hypothalamus produces oxytocin 3.) coronal suture ± connect parietal & frontal bone (crown) 3. Passenger a.occiput T ± temporal P ± parietal 2 x Measurement fetal head: 1.) 5.) < 18 years old 3. 12 ± 18 months after birth. b.) progesterone theory ± before labor.sinciput E ± ethmoid O ± occuputal .) < 4¶9´ tall 2. soft music. Closes ± 2 ± 3 months.5 cm hyper extension submentobragmatic-face presentation 2.2. etc Baseline Data: v/s esppecially BP. At 36 wks degenerates (leading to contraction ± onset labor). address.) 3. baby gets warm bath.) theory of aging placenta ± life span of placenta 42 wks.bitemporal 8 cm 2. Basic knowledge in Intrapartum.2.) birthing bed ± dorsal recumbent pos squatting ± relives low back pain during labor pain leboyers ± warm. IX.) sagittal suture ± connects 2 parietal bones ( sagitna) 2. 4. Intrapartal Notes ± inside ER A. weight Obstetrical Data: gravida # preg. After delivery.) uterine stretch theory ( any hallow organ stretched. 1 x 1 cm. smallest AP occipitofrontal 12cm partial flexion occipitomental ± 13.close 2. bimastoid 7cm smallest transverse Sutures ± intermembranous spaces that allow molding. complete flexion.) Anteroposterior diameter suboccipitobregmatic 9. 1 Theories of the Onset of Labor 1. ± 22 ± 24 wks Physical Exams.) Underwent pelvic dislocation .viable preg. para.

Braxton Hicks Contractions ± painless irregular contractions 3. Involuntary Contractions b. Ischial tuberosity ± approximated with use of fist ± 8 cm & above. (DC ± 11. Support System Pre-eminent Signs of Labor S&Sx: . intensity 4.ischial tuberosity where we sit ± landmark to get external measurement of pelvis Pubes ± ant portion ± symphisis pubis junction between 2 pubis 1 sacrum ± post portion ± sacral prominence ± landmark to get internal measurement of pelvis 1 coccyx ± 5 small bones compresses during vaginal delivery Important Measurements 1. Rupture of Membranes ± rupture of water. Check FHT . duration.5 ± 3 lbs 6. Measurement: 11. Obstetrical conjugate ± smallest AP diameter. True conjugate/conjugate vera ± measure between the anterior surface of the sacral promontory and superior margin of the symphysis pubis. Increase epinephrine 4. Past Experience d. Lightening ± setting of presenting part into pelvic brim .2 weeks prior to EDD * Engagement. Characteristics: wave like d. will be used for delivery. Gynecoid ± round. Psyche/Person ± psychological stress when the mother is fighting the labor experience a. Android ± heart shape ³male pelvis´.0 cm 3. 3. Ripening of the Cervix ± butter soft 5.anterior part pointed.iliac crest ± flaring superior border forming prominence of hips Ischium ± inferior portion .12. Platypelloid ± flat AP diameter ± narrow.5 cm basis in getting true conjugate.5 cm . Preparation c.nesting instinct. Diagonal Conjugate ± measure between sacral promontory and inferior margin of the symphysis pubis. 1.5 cm=true conjugate) 2. Cultural Interpretation b. Tuberoischi Diameter ± transverse diameter of the pelvic outlet. oval shape. Pelvis 2 hip bones ± 2 innominate bones 3 Parts of 2 Innominate Bones Ileum ± lateral side of hips .urinary freq. wide. AP diameter wider transverse narrow 4. Timing: frequency. posterior part shallow 3. Bloody Show ± pinkish vaginal discharge ± blood & leukorrhea 7. transverse ± wider b.Pelvis 4 main pelvic types 1. Voluntary bearing down efforts c.shooting pain radiating to the legs . Save energy.setting of presenting part into pelvic inlet 2. Pelvis at 10 cm or more. decreased body wt ± 1. deeper most suitable (normal female pelvis) for pregnancy 2. Measurement: 11. Anthropoid ± oval. Power ± the force acting to expel the fetus and placenta ± myometrium ± powers of labor a. Increase Activity of the Mother. ape like pelvis.

Duration of Labor Primipara ± 14 hrs & not more than 20 hrs Multipara ± 8 hrs & not > 14 hrs Effacement ± softening & thinning of cervix. upper uterine . Use % in unit of measurement Dilation ± widening of cervix. Cover cord with sterile gauze with saline to prevent drying of cord so cord will remain slippery & prevent cord compression causing cerebral palsy.Premature Rupture of Membrane ( PROM) . Slip cord away from presenting part 3. Count pulsation of cord for FHT 4.do IE to check for cord prolapse Contraction drop in intensity even though very painful Contraction drop in frequently Uterus tense and/or contracting between contractions Abdominal palpations Nursing Care. 2. Nursing Interventions in Each Stage of Labor 2 segments of the uterus 1. Prep mom for CS Positioning ± trendelenberg or knee chest position Emotional support Prepare for Cesarean Section Difference Between True Labor and False Labor False Labor True Labor Irregular contractions Contractions are regular No increase in intensity Increased intensity Pain ± confined to abdomen Pain ± begins lower back radiates to abdomen Pain ± relived by walking Pain ± intensified by walking No cervical changes Cervical effacement & dilatation * major sx of true labor.fundus 2. Unit used is cm. Danger signs: PROM Presenting part has not yet engaged Fetal distress Protruding cord form vagina Nursing care: 1. Administer Analgesics (Morphine) Attempt manual rotation for ROP or LOP ± most common malposition Bear down with contractions Adequate hydration ± prepare for CS Sedation as ordered Cesarean delivery may be required. lower uterine ± isthmus . especially if fetal distress is noted Cord Prolapse ± a complication when the umbilical cord falls or is washed through the cervix into the vagina.

Station ± landmark used: ischial spine . Encourage to void q 2 ± 3 hrs ± full bladder inhibit contractions 3. Longitudinal Lie ( Parallel) cephalic Vertex ± complete flexion Face Brow Poor Flexion Chin .fears losing control of self Frequency q 3-5 min lasting for 30 ± 60 seconds Nursing Care: M ± edications ± have meds ready A ± ssessment include: vital signs. cervical dilation and effacement. First Stage: onset of true contractions to full dilation and effacement of cervix. Breathing ± chest breathing Active Phase: Assessment: Dilations 4 -8 cm Intensity: moderate Mom. Latent Phase: Assessment: Dilations: 0 ± 3 cm mom ± excited. Encourage walking .2 station = presenting part 2 cm above ischial spine if (-) floating 0 station = level at ischial spine ± engagement + 1 station = below 1 cm ischial spine +3 to +5 = crowning ± occurs at 2nd stage of labor b.shorten 1st stage of labor 2. D ± dry lips ± oral care (ointment) dry linens B ± abdominal breathing Transitional Phase: Assessment: Dilations 8 ± 10 cm Frequency q 2-3 min contractions Durations 45 ± 90 seconds intensity: strong Mom ± mood changes with hyperesthesia Hyperesthesia ± increase sensitivity to touch. fetal monitor. Presentation/lie ± the relationship of the long axis (spine) of the fetus to the long axis of the mother -spine of mom and spine of fetus Two types: b.1. etc. can communicate Frequency: every 5 ± 10 min Intensity mild Nursing Care: 1. pain all over Health Teaching : teach: sacral pressure on lower back to inhibit transmission of pain keep informed of progress controlled chest breathing Nursing Care: T ± ires I ± nform of progress R ± estless support her breathing technique E ± ncourage and praise D ± iscomfort Pelvic Exams Effacement Dilation a.1.1 station = presenting part 1cm above ischial spine if (-) floating . apprehensive.

RMA. Position ± relationship of the fatal presenting part to specific quadrant of the mother¶s pelvis.)Sims position/side lying 12 ± 18 inch ± ht enema tubing . double Kneeling b. LADT. LMP.use sacrum . LMT. If BP increase . breast lie on thigh Incomplete Breech ± thigh rest on abdominal Frank ± legs extend to head Footling ± single. RMP. RST. most painful ROP ± squatting pos on mom ROT ROA Breech. RMT. let mom rest. RSA.strength of contraction Contraction ± vasoconstriction Increase BP. c. if same BP.put stet above umbilicus Shoulder/acromniodorso LADA. Shoulder presentation. LSP.) Ok to shower 2.)To cleanse bowel b.)NPO ± GIT stops function during labor if with food.)Enema administer during labor a. RSP Chin / Mento LMA.)Prevent infection c. Variety: Occipito ± LOA left occipito ant (most common and favorable position)± side of maternal pelvis LOP ± left occipito posterior LOP ± most common mal position.Breech - Complete Breech ± thigh breast on abdomen. LADP. RMP Monitoring the Contractions and Fetal heart Tone Spread fingers lightly over fundus ± to monitor contractions Parts of contractions: Increment or crescendo ± beginning of contractions until it increases Acme or apex ± height of contraction Decrement or decrescendo ± from height of contractions until it decreases Duration ± beginning of contractions to end of same contraction Interval ± end of 1 contraction to beginning of next contraction Frequency ± beginning of 1 contraction to beginning of next contraction Intensity . notify MD -preeclampsia Health teachings 1. decrease FHT Best time to get BP & FHT just after a contraction or midway of contractions Placental reserve ± 60 sec o2 for fetus during contractions Duration of contractions shouldn¶t >60 sec Notify MD Mom has headache ± check BP.will cause aspiration 3.2. Transverse Lie (Perpendicular) or Perpendicular lie. RADA LSA ± left sacro anterior LST.

to prevent laceration. complete dilation and effacement to birth. hard to repair. Cavity Two Major Divisions of Pelvis 1. True pelvis ± below the pelvic inlet 2. Nursing Care: To prevent puerperal sepsis . Extension 6. placenta has 15 ± 28 cotyledons . check cord if coiled. Descent 3. Flexion 4. identification of baby. Fundus rises ± becomes firm & globular ³ Calkins sign´ 2. Pull shoulder down & up.) Will facilitate complete flexion & extension. 7 ± 8 multi ± bring to delivery room 10cm primi ± bring to delivery room Lithotomy pos ± put legs same time up Bulging of perineum ± sure to come out Breathing ± panting ( teach mom) Assist doc in doing episiotomy. Third Stage: birth to expulsion of Placenta -placental stage Placenta delivered from 3-10 minutes Signs of placental separation 1. Mechanisms of labor 1. Second Stage: fetal stage.)To prevent laceration 2. slow to heal -use local or pudendal anesthesia. transverse diameter wider 2. False pelvis ± above the pelvic inlet.) <120 & >160 2. (Support head & remove secretion. Engagement 2. Internal Rotation 5. supports uterus during pregnancy Linea Terminales diagonal imaginary line from the sacrum to the symphysis pubis that divides the false and true pelvis.< 48 hours only ± vaginal pack Bolus of Ptocin can lead to hypotension. External rotation 7. Expulsion Three parts of Pelvis ± 1. Inlet ± AP diameter narrow.Check FHT after adm enema Normal FHT= 120-160 Signs of fetal distress1.) mecomium stain amnion fluid 3. Ironing the perineum ± to prevent laceration Modified Ritgens maneuver ± place towel at perineum 1. possible to reach rectum ( urethroanal fistula) Mediolateral ± more bleeding & pain. Lengthening of the cord 3. Episiotomy ± median ± less bleeding. widen vaginal canal. shorten 2nd stage of labor. Check time. fast to heal. less pain easy to repair.) fetal thrushing ± hyperactive fetus due to lack O2 2.

) hypotonic ± secondary uterine inertia.) Straight rooming in baby: 24hrs with mom. Check perineum for lacerations 10. Placement of the Fundus c. 2nd hr q 30 minutes. Count pad & saturation 4.slow irregular contraction resulting to ineffective pushing. Let mom sleep to regain energy.) Partial rooming in: baby in morning .) Empty bladder to prevent uterine atony 2./diazepam ± muscle relaxant 2. Maternal Observations ± body system stabilizes b. deviation of fundus 1. Check completeness of placenta.) hypertonic or primary uterine inertia . Flat on bed 12. Check fundus (if relaxed. Perineum ± R . Sudden gush of blood Types of placental delivery Shultz ³shiny´ ± begins to separate from center to edges presenting the fetal side shiny Dunkan ³dirty´ ± begin to separate form edges to center presenting natural side ± beefy red or dirty Slowly pull cord and wind to clamp ± BRANDT ANDREWS MANEUVER Hurrying of placental delivery will lead to inversion of uterus. If fundus above umbilicus. Bonding ± interaction between mother and newborn ± rooming in types 1. Fully soaked pad : 30 ± 40 cc weigh pad. Monitor v/s q 15 for 1 hr.MD administer sedative valium. give clear liquid-tea.3. Assist MD for episiorapy 11. Administer methergine IM (Methylergonovine Maleate) ³Ergotrate derivatives 8. Check bp 7.) Check lochia a. 5. Check placement of fundus at level of umbilicus.cchemosis D ± ischarges A ± approximation of blood loss. clear gelatin. Lochia d.edness E. massage uterus) 6. Blanket. Monitor hpn (or give oxytocin IV) 9. . 1 gram=1cc e.intense excessive contractions resulting to ineffective pushing . 2. ginger ale. Give oxytocin. Chills-due dehydration. Nsg care for placenta: 4. at night nursery Complications of Labor Dystocia ± difficult labor related to: Mechanical factor ± due to uterine inertia ± sluggishness of contraction 1.dema E . Fourth Stage: the first 1-2 hours after delivery of placenta ± recovery stage.

Earliest sign: tachycardia & restlessness Late sign: hypotension Outstanding Nursing dx: fluid volume deficit Post of mom ± modified trendelenberg IV ± fast drip due fluid volume def Signs of Hypovolemic Shock: Hypotension Tachycardia Tachypnea Cold clammy skin Inversion of the uterus ± situation uterus is inside out. hypovolemic shock if with bleeding. Fetal effect ± fetal distress. Mom given 6 hrs of labor Multi: 8 ± 14.) profuse bleeding c.) hypovolemic shock d.Boundary bet upper/lower uterine segment BANDL¶S pathologic ring ± suprapubic depression a.Prolonged labor ± normal length of labor in primi 14 ± 20 hrs Multi 10 -14 hrs > 14 hrs in multi & > 20 hrs in primi .) sudden pain b.)Large baby 3.) Improper use of oxytocin (IV drip) Sx: a.) hurrying of placental delivery 3. premature contractions q 10 min .) TAHBSO Physiologic retraction ring .) short cord 2.maternal effect ± exhaustion. profuse bleeding. Trial Labor ± measurement of head & pelvis falls on borderline. primi 14 ± 20 Preterm Labor ± labor after 20 ± 37 weeks) ( abortion <20 weeks) Sx: 1.nsg care: monitor contractions and FHR Precipitate Labor .)Previous classical CS 2. chest pain & frothy sputum prepare: suctioning end stage: DIC disseminated intravascular coagopathy. nose. MD will push uterus back inside or not hysterectomy. etc.labor of < 3 hrs.) ineffective fundal pressure Uterine Rupture Causes: 1.) sign of impending uterine rupture Amniotic Fluid Embolism or placental embolism ± amniotic fluid or fragments of placenta enters natural circulation resulting to embolism Sx: dyspnea.) 1.bleeding to all portions of the body ± eyes. caput succedaneum or cephal hematoma . Factors leading to inversion of uterus 1. extensive lacerations.

dilation saved by administer Tocolytic agents. Cervix ± cervical opening b. If cervix is closed 2 ± 3 cm.Yutopar Hcl) 150mg incorporated 500cc Dextrose piggyback.early ambulation Principles underlying puerperium 1.1. dilation 2-3 cm Home Mgt: 1.the first few minutes after delivery is the most critical period in mothers because the increased in plasma volume return to its normal state and thus adding to the workload of the heart. Hyperfibrinogenia .000 cumm Puerperium ± covers 1st 6 wks post partum Involution ± return of repro organ to its non pregnant state. avoid sex 3. 2. Postpartal Period 5th stage of labor after 24hrs :Normal increase WBC up to 30. Uterus ± return to normal 6 ± 8 wks. drink 3 -4 glasses of water ± full bladder inhibits contractions 5. Fundus goes down 1 finger breath/day until 10th day ± no longer palpable due behind symphisis pubis 3 days after post partum: sub involuted uterus ± delayed healing uterus with big clots of blood. Physiologic Changes a. Genital tract a.<90/60 Crackles ± notify MD ± pulmo edema ± administer oral yutopar 30 minutes before d/c IV Tocolytic (Phil) Terbuthaline (Bricanyl or Brethine) ± sustained tachycardia Antidote ± propranolol or inderal . Systemic Changes 1.YUTOPAR.prone to thrombus formation . consult MD if symptoms persist Hosp: 1.(puerperal sepsis).halts preterm contractions.beta-blocker If cervix is open ± MD ± steroid dextamethzone (betamethazone) to facilitate surfactant maturation preventing RDS Preterm-cut cord ASAP to prevent jaundice or hyperbilirubenia. empty bladder 4. Monitor: FHT > 180 bpm Maternal BP . Vaginal and Pelvic Floor c.2. X. To return to Normal and Facilitate healing A. birth pain: 1.D&C after. position prone . effacement of 60 ± 80% 3. This is critical especially to gravidocardiac mothers. Cardiovascular System . complete bed rest 2.a medium for bacterial growth.

not compress sex. hot sitz bath. Taking hold phase ± dependent to independent phase (4 to 7 days).proper hygiene b. cant make decisions. Baggy or relaxed uterus & profuse bleeding ± uterine atony. Nsd & Cs with lochia. limited amt 3. moderate amt 2. 2nd degree ± 1st degree + muscles of vagina 3rd degree ± 2nd degree + external sphincter of rectum 4th degree ± 3rd degree + mucus membrane of rectum Breast feeding ± post pit gland will release oxytocin so uterus will contract.) Insert family planting method common post partum blues/ baby blues present 4 ± 5 days 50-80% moms ± overwhelming feeling of depression characterized by crying.) Care of newborn 2.) 3. .stimulate bladder 3. fear of bearing down 5. despondence. Perineal area ± painful ± episiotomy site ± sims pos. Complications: hypovolemic shock. Colon: Constipation ± due NPO. musty/mousy. Provide Emotional Support ± Reva Rubia Psychological Responses: a.alternate warm & cold compress . Mom . Hemorrhage ± bleeding of > 500cc CS ± 600 ± 800 cc normal NSD 500 cc Early postpartum hemorrhage± bleeding within 1st 24 hrs. Alba ± créme white 10 ± 21 days very decreased amt dysuria . Ruba ± red 1st 3 days present. c.) 4. Taking in phase ± dependent phase (1st three days) mom ± passive. 1.redefines new roles may extend until child grows.inability to sleep & lack of appetite. Serosa ± pink to brown 4 ± 9th day. Lochia-bld. microorganism. Letting go ± interdependent phase ± 7 days & above. Urinary tract: Bladder ± freq in urination after delivery. cold compress for immediate pain after 24 hrs. Mgt: 1. Nursing Care: .urinary retention with overflow 4. wbc.urine collection . cold compress ± to prevent bleeding 3. ± let mom cry ± therapeutic. Prevent complications 1. can make decisions HT: 1. deciduas. Mom is active.when perineum has healed II. III.2. mefenamic acid d. activity is to tell child birth experiences. massage uterus until contracted cold compress modified trendelenberg IV fast drip/ oxytocin IV drip I.) 1st degree laceration ± affects vaginal skin & mucus membrane.) 2.

paracetamol.cryoprecipitate or fresh frozen plasma II.) shave 3.) exogenous ± from outside 1.) anaerobic streptococci ± most common . saline.bleeding to any part of body .Well contracted uterus + bleeding = laceration .hysterectomy if with abruption placenta mgt: BT. Endometriosis ± inflammation of endometrial lining Sx: Abdominal tenderness. percreta. .) never advice a permanent method of planning 3.sources of infection 1. . Increta ± deeper attachment of placenta to myometrium Percreta ± invasion of placenta to perimetrium hysterectomy Hematoma ± bluish or purple discoloration of SQ tissue of vagina or perineum.) determine one¶s own beliefs 1st 2.failure to coagulate.mgt episiorapy DIC ± Disseminated Intravascular Coagulopathy. rubor (red).) supportive care ± CBR. cold compress. Motivate the use of Family Planning 1. VITC. culture & sensitivity ± for antibiotic prolonged use of antibiotic lead to fungal infection inflammation of perineum ± see general signs of inflammation 2 to 3 stitches dislocated with purulent discharge Mgt: Removal of sutures & drainage. Fowlers ± to facilitate drainage & localize infection oxytocin & antibiotic IV. Acreta ± attached placenta to myometrium.) method of choice is an individuals choice. D&C except placenta increta. Inflammation ± calor (heat). pos.large baby .from members health team 2. purulent discharges 3. Late Postpartum hemorrhage ± bleeding after 24 hrs ± retained placental fragments Mgt: D&C or manual extraction of fragments & massaging of uterus. between & resulting.) unhealthy sexual practices General signs of inflammation: 1.pudendal anesthesia Mgt: 1.)endogenous ± from within body 2. dolor (pain) tumor(swelling) 2.) cold compress every 30 minutes with rest period of 30 minutes for 24 hrs 2. hydration. scraping & suturing Infection.) incision on site. fever Gen mgt: 1.assess perineum for laceration . TSB.too much manipulation . Natural Method ± the only method accepted by the Catholic Church . Hypofibrinogen.degree of laceration .

-get short test & longest cycle from Jan ± Dec . coitus interfemora ± ³ipit´ 4.Billings / Cervical mucus± test spinnbarkeit & ferning (estrogen) . .menstruation will come out 4 ± 6 months bottle fed 2 ± 3 months disadvantage of lam ± might get pregnant Symptothermal ± combination of BBT & cervical.start 5th day of mens 28day pill.clear. she would wait for at least 3 months before attempting to conceive to provide time for the estrogen and progesterone levels to return to normal.monitor cycle for 1 year .headache E ± eye problems S ± severe leg cramps .start 1st day of mens missed 1 pill ± take 2 next day Physiologic MethodPills ± combined oral contraceptives prevent ovulation by inhibiting the anterior pituitary gland production of FSH and LH which are essential for the maturation and rupture of a follicle. Waiting time to become pregnant. Best method Social Method ± 1.least effective method 2.get before arising in bed LAM ± lactation amenorrheal method ± hormone that inhibits ovulation is prolactin. Consult OB-6mos.3 months.if a new oral contraceptive is prescribed the mother should continue taking the previously prescribed contraceptive and begin taking the new one on the first day of the next menses.18 8 Dec 33 -11 22 unsafe days 21 day pill. elastic ± long spinnbarkeit Basal Body Temperature 13th day temp goes down before ovulation ± no sex . coitus reservatus ± sex without ejaculation ± 3. stretchable. watery. breast feeding. .shortest ± 18 . calendar method OVULATION ±count minus 14 days before next mens (14 days before next mens) Origoknause formula ± .discontinue oral contraceptive if there is signs of severe headache as this is an indication of hypertension associated with increase incidence of CVA and subarachnoid hemorrhage. Alerts on Oral Contraceptive: -in case a mother who is taking an oral contraceptive for almost long time plans to have a baby.9% effective. Signs of hypertension Immediate Discontinuation A ± abdominal pain C ± chest pain H .) coitus interuptus/ withdrawal .longest ± 11 June 26 . 99.

If mom HPN ± stop pills STAT! Adverse effect: breakthrough bleeding Contraindicated: 1. gives highest protection against STD ± female condom Alerts: Disadvantage: . immediately take the forgotten tablet plus the tablet scheduled that day.parity or # of children.it gives higher protection in the prevention of STDs Diaphragm ± rubberized dome shaped material inserted to cervix preventing sperm to get to the uterus.others: P eriod late (pregnancy suspected) Abnormal spotting or bleeding A bdominal pain or pain with intercourse I nfection (abnormal vaginal discharge) N ot feeling well.right time to insert is after delivery or during menstruation primary indication for use of IUD . . . shorter or longer Uterine inflammation. it will shorten duration Norplant ± has 6 match sticks ± like capsules implanted subdermally containing progesterone. ectopic pregnancy Condom ± latex inserted to erected penis or lubricated vagina Adv. use another method for the rest of the cycle and the start again. If forgotten for two consecutive days.it lessen sexual satisfaction .) Monthly checkup 3.most common complications: excessive menstrual flow and expulsion of the device (common problem) . if 1 kid only don¶t use IUD HT: 1. fever.as soon as removed ± can become pregnant Mechanism and Chemical Barriers Intrauterine Device (IUD) Action: prevents implantation ± affects motility of sperm & ovum .) Thrombophlebitis or problems in clotting factors if forgotten for one day.) DM 5.5 yrs ± disadvantage if keloid skin .) extreme obesity 3. uterine perforation. REVERSABLE . or more days.) HPN 4.) chain smoker 2.) Check for string daily 2.) Regular pap smear Alerts. DMPA ± depoproveda ± has progesterone inhibits LH ± inhibits ovulation Depomedroxy progesterone acetate ± IM q 3 months .never massage injected site. chills S trings lost.prevents implantation .

creams S/effect: Toxic shock syndrome Alerts: Should be kept in place for about 6 ± 8 hours Cervical Cap ± most durable than diaphragm no need to apply spermicide C/I: abnormal pap smear Foams.) plasma germ defect Classifications: a. Jellies. safe XI. infection. HT: >30 ejaculations before safe sex O ± zero sperm count.) Complete ± all products of conception are expelled. Habitual ± 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix.) Avoid sex 3. jellies. circlage is removed. No mgt just emotional support! 2. Threatened ± pregnancy is jeopardized by bleeding and cramping but the cervix is closed Inevitable ± moderate bleeding.) chromosomal alterations 2. Hemorrhagic Disorders General Management 1. Barrier ex.) 5. NSD Sheridan ± permanent surgery cervix. tissue protrudes form the cervix (Cervical dilation) Types: 1.) Signs of Hypovolemic shock 6. b. Creams Surgical Method ± BTL . During delivery.) 2.) proper hygiene check for holes before use must stay in place 6 ± 8 hrs after sex must be refitted especially if without wt change 15 lbs spermicide ± chem.) Ultrasound to determine integrity of sac 5. Bilateral Tubal Ligation ± can be reversed 20% chance. Abortions ± termination of pregnancy before age of viability (before 20 weeks) Spontaneous Abortion.) CBR 2. cramping. Foam (most effective). product of conception remain in uterus 4 weeks or longer.) Assess for bleeding (per pad 30 ± 40cc) (wt ± 1gm =1cc) 4.) 4. HT: avoid lifting heavy objects Vasectomy ± cut vas deferense.) Incomplete ± Placental and membranes retained. Present 2nd trimester d.) Save discharges ± for histopathology ± to determine if product of conception has been expelled or not First Trimester Bleeding ± abortion or eptopic A.) blighted ovum 3. Missed ± fetus dies. CS c.) 3.Ht: 1. (-) preg test.miscarriage Cause: 1. High Risk Pregnancy 1. signs of pregnancy cease. Mgt: D&C Incompetent cervix ± abortion McDonalds procedure ± temporary circlage on cervix S/E. scanty dark brown bleeding .

Return for pelvic exams as scheduled for one year to monitoring HCG and assess for enlarged uterus and rising titer could indicative of choriocarcinoma b. vaginal bleeding that extends to diaphragm and phrenic nerve) + Cullen¶s Sign ± bluish tinged umbilicus ± signifies Nursing care: intra peritoneal bleeding Vital signs syncope (fainting) Administer IV fluids Mgt: Monitor for vaginal bleeding Surgery depending on side Monitor I & O Ovary: oophrectomy Uterus : hysterectomy Second trimester bleeding C. . producing a diploid number 46 XX. The nucleus of the sperm duplicates. This neoplasm is formed form the selling of the chronic villi and lost nucleus of the fertilized egg. Progressive degeneration of chorionic villi. dark brown.interstitial Unruptured Tubal rupture .candidate for CS Sx: frank . Placenta Previa ± it occurs when the placenta is improperly implanted in the lower uterine segment.missed period .abdominal pain within 3 -5 weeks of missed radiating to shoulder. C. Hydatidiform Mole ³bunch or grapes´ or gestational trophoblastic disease. ± with fertilization. severe pain.gestational anomaly of the placenta consisting of a bunch of clear vesicles. . sometimes covering the cervical os.scant.Mgt: induced labor with oxytocin or vacuum extraction 5. Double effect choose between lesser evil. Ectopic Pregnancy ± occurs when gestation is located outside the uterine cavity. Unilateral .) Induced Abortion ± therapeutic abortion to save life of mom. Abnormal lower implantation of placenta. Avoid pregnancy for at least one year Third Trimester Bleeding ³Placenta Anomalies´ D.sudden . Recurs. sharp. it grows & enlarges the uterus vary rapidly. Use: methotrexate to prevent choriocarcinoma Assessment: Early signs vesicles passed thru the vagina Hyperemesis gravidarium increase HCG Fundal height Vaginal bleeding( scant or profuse) Early in pregnancy High levels of HCG Preeclampsia at about 12 weeks Late signs hypertension before 20th week Vesicles look like a ³ snowstorm´ on sonogram Anemia Abdominal cramping Serious complications hyperthyroidism Pulmonary embolus Nursing care: Prepare D&C Do not give oxytoxic drugs Teachings: a. common site: tubal or ampular Dangerous site . period (maybe generalized or one sided) shoulder pain (indicative of intraperitoneal bleeding .

G.cord divides into small vessels before it enters the placenta Vasa Previa ± velamentous insertion of cord has implanted in cervical OS - F. painful bleeding. Hypertensive Disorders I. count pads Report s/sx of DIC Monitor v/s for shock Strict I&O Placenta succenturiata ± 1 or 2 more lobes connected to the placenta by a blood vessel may lead to retained placental fragments if vessel is cut. Assessment: Concealed bleeding (retroplacental) Couvelaire uterus (caused by bleeding into the myometrium)-inability of uterus to contract due to hemorrhage. Outstanding Sx: dark red. RN as witness MD explain to patient complication: sudden fetal blood loss Nursing Care NPO Bed rest Prepare to induce labor if cervix is ripe Administer IV E. Abruptio Placenta ± it is the premature separation of the placenta form the implantation site.HPN after 24 wks of pregnancy. I. board like or rigid uterus. H. solved 6 weeks post partum. J. K. prepare to administer blood Type and crossmatch Monitor FHR Insert Foley Measure blood loss. Severe abdominal pain Dropping coagulation factor (a potential for DIC) Complications: Sudden fetal blood loss -placenta previa & vasa previa Nursing Care: Infuse IV. It usually occurs after the twentieth week of pregnancy. 2. . Placenta Circumvalata ± fetal side of placenta covered by chorion Placenta Marginata ± fold side of chorion reaches just to the edge of placenta Battledore Placenta ± cord inserted marginally rather then centrally Placenta Bipartita ± placenta divides into 2 lobes Vilamentous Insertion of cord.Bright red Painless bleeding Dx: Ultrasound Avoid: sex. IE. enema ± may lead to sudden fetal blood loss Double set up: delivery room may be converted to OR Assessment: Engagement (usually has not occurred) Fetal distress Presentation ( usually abnormal) Surgeon ± in charge of sign consent. Pregnancy Induced Hypertension (PIH). L.

+2 2.) increase wt due to edema b.turning to side done AFTER seizure! Observe only! for safely.) common in multiple pre (twins) increase exposure to chorionic villi 3.) common to mom with low socioeconomic status due to decrease intake of CHON Nursing care: P ± romote bed rest to decrease O2 demand. epigastric pain due to liver edema and oliguria usually indicates an impending convulsion.HPN without edema & protenuria H without EP 2.absence of insufficient insulin (Islet of Langerhans of pancreas) Function: of insulin ± facilitates transport of glucose to cell Dx: 1 hr 50gr glucose tolerance test GTT Normal glucose ± 80 ± 120 mg/dl < 80 ± hypoclycemic ( euglycemia) > 120 . protenuria +3 .) protenuria +1 . Urine output decrease 3.+4 3.) dimly lit room .) idiopathic or unknown common in primi due to 1st exposure to chorionic villi 2. E ± ensure high protein intake ( 1g/kg/day) .Na ± in moderation A ± anti-hypertensive drug Hydralazine ( Apresoline) C ± convulsion.prepare the following at bedside . Provide safety. Cause of preeclampsia 1. water immersion will cause to urinate. P.) minimal handling ± planning procedure 3.) Severe preeclampsia Signs present: cerebral and visual disturbances. antidote ± Ca gluconate 3. Patella reflex absent ± 1st sigh Mg SO4 toxicity.prevent convulsions by nursing measures or seizure precaution 1.) HELLP syndrome ± hemolysis with elevated liver enzymes & low platelet count II.) BP 140/90 c. quiet calm environment 2.1. Three types of pre-eclampsia 1. Transissional Hypertension ± HPN between 20 ± 24 weeks III. BP decrease 2.Diabetes Mellitus .) Eclampsia ± with seizure! Increase BUN ± glomerular damage. Resp < 12 4. facilitate. prevent ± Mg So4 ± CNS depressant E ± valuate physical parameters for Magnesium sulfate Magnesium SO4 Toxicity: 1.tongue depressor .) Pre-eclampsia ± HPN with edema & protenuria or albuminuria HE P/A 3. Chronic or pre-existing Hypertension ±HPN before 20 weeks not solved 6 weeks post partum.) Gestational hypertension . sodium excretion.) Mild preeclampsia ± earliest sign of preeclampsia a.) avoid jarring bed P.hyperglycemia 3 degrees GTT of > 130 mg/dL . BP 160/110 .

) antibiotic therapy. Fetal effect 1.) Hypo or hyperglycemia ± 1st trimester hypo.to prevent sub acute bacterial endocarditis 2. 2nd ± 3rd trim ± hyperglycemic 2.) early hospitalization by 7 months Class IV. Post partum decrease 25% due placenta out.good progress for vaginal delivery Class III & IV. Ordinary activity causes fatigue & discomfort. marked limitation of physical activity. 50% increase insulin at 2nd ± 3rd trimester.) preterm birth to prevent stillbirth Newborn Effect : DM 1. administer dextrose 3.) Frequent infection. not CS! NOT lithotomy! High semi-fowlers during delivery. Heart disease Moms with RHD at childhood Class I ± no limit to physical activity Class II ± slight limitation of activity. Recommendation: Therapeutic abortion . Recommendation of class I & II 1.< 7mg% Sx: Calcemia tetany Trousseau sign Give calcium gluconate if decrease calcium Recommendation Therapeutic abortion If push through with pregnancy 1.moderate limitation of physical activity.) macrosomia ± large gestational age ± baby delivered > 400g or 4kg 3.) rest 30 minutes & after meal Class III .) hyper & hypoglycemia 2.moniliasis 3. decrease in insulin by 33% in 1st tri.) Dystocia-difficult birth due to abnormalities in fetus or mom.) hypocalcemia . Ordinary activity causes discomfort Recommendation: 1.poor prognosis. for vaginal delivery. It will shorten 2nd stage of labor.) Polyhydramnios 4.) sleep 10 hrs a day 2.) anticoagulant ± heparin doesn¶t cross placenta Class I & II. No valsalva maneuver Regional anesthesia! Low forcep delivery due to inability to push.maternal effect DM 1.) hypoglycemia normal glucose in newborn 45 ± 55 mg/dL hypoglycemic < 40 mg/dL Heel stick test ± get blood at heel Sx: Hypoglycemia high pitch shrill cry tremors.) Insulin requirement. 5. Even at rest there is fatigue & discomfort.) hyperinsulinism 2.

CPD primary indication i.sperm motility for impotency Factors: low sperm count 1. If >15 ± low sperm count Best criteria. Procedure: sex 2 hours before test mom ± remains supine 15 min after ejaculation Normal: cervical mucus must be stretchable 8 ± 10 cm with 15 ± 20 sperm. Cesarean Delivery Indications: a.XII.irreversible Impotency ± inability to have an erection 2 types of infertility 1. Breech presentation j. Once classical always classical b. Diabetes c. Intrapartal complications 1. Multiple gestation b. Placenta previa f. Low segment ± bikini line type ± aesthetic use VBAC ± vaginal birth after CS INFERTILITY .) .Sims Huhner test ± or post coital test. no more next preg test male 1st . Severe toxemia e.) chain smoker administer: clomid ( chomephine citrate) to induce spermatogenesis Mgt: GIFT= Gamete Intra Fallopian Transfer for low sperm count Implant sperm in ampula 1.) fundal pressure .use of IUD .sterile bottle container ( not plastic has chem.) primary ± no pregnancy at all 2.appendicitis (burst) & scarring = dx: hysterosalphingography ± used to determine tubal patency with use of radiopaque material Mgt: IVF ± invitrofertilization (test tube baby) England 1st test tube baby To shorten 2nd stage of labor! 1. Within a year of attempting it .need: sperm only .) Secondary ± 1st pregnancy.) occupation. Active herpes II d.inability to achieve pregnancy. Due to increase prolactin ± hyperprolactinemia Administer. antihyper prolactineuria Give mom clomid: action: to induce oogenesis or ovulation S/E: multiple pregnancy 2.Manageable STERILITY .more practical & less complicated .truck driver 2. Prolapse of the cord h. parlodel ( Bromocryptice Mesylate) Action. classical ± vertical insertion.) Tubal Occlusion ± tubal blockage ± Hx of PID that has scarred tubes . Transverse lie Procedure: a.) Mom: anovulation ± no ovulation. Abruptio placenta g.

) episiotomy 3.2.) forcep delivery .

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