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

Blank! Can¶t erase!

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

Ischemic = 27 to 28th day 4. mammary gland development 4. Reproductive cells divides by the process of meiosis (haploid) Spermatogenesis ± maturation of sperm Oogenesis ± process . development ductile structure of breast 5. causes mood swings in moms 6. 1 tsp 4. Menstrual Cycle 4 phases of Menstrual Cycle 1. increase BBT 10. Menses = 1st to the 5th day . MenstruationMenstrual Cycle ± beginning of mens to beginning of next mens Average Menstrual Cycle ± 28 days Average Menstrual Period . Spinnbarkeit & Ferning ( billings method/ cervical) 4. Phases of Menstrual Cycle: 1. increase in height in female 7. Sperm is viable within 48 ± 72 hrs.inhibit prod of LH (hormone for ovulation) 2. Chromosomes ± threadlike strands composed of hereditary material ± DNA 3. hypertrophy of myometrium 3. 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. increase osteoblast activities of long bones 6. causes early closure of epiphysis of long bones 8.3 ± 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. increase permeability of kidney to lactose & dextrose causing (+) sugar 5. Proliferative = 6 to 14th day 2. 2-3 days 6. Ovum is capable of being fertilized with in 24 ± 36 hrs after ovulation 5.. 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. inhibit production of FSH ( maturation of ovum) 2. DNA ± carries genetic code 2. Others: 1. Age of Reproductivity ± 15 ± 44yo 8.inhibit motility of GIT 3. Basic Knowledge on Genetics and Obstetrics 1.maturation of ovum Gematogenesis ± formation of 2 haploid into diploid 23 + 23 = 46 or diploid 7. causes sodium retention 9. Secretory = 15 to 26th day 3.

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

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

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

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

18. 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. 4. C. Fourth Month lanugo begins to appear fetal heart tone heard fetoscope. 3. fetal alcohol withdrawal syndrome char by microcephaly Smoking ± low birth rate Caffeine ± low birth rate Cocaine ± low birth rate. 1.3. absence of extremities Steroids ± cleft lip or palate Lithium ± congenital malformation Alcohol ± lowered weight (vasoconstriction on mom). 2. E. 16. 2.any drug. Quickening. the exposure to such may cause damage to the fetus A. D. 3. 2. hyperbilirubenia or jaundice Iodides ± enlargement of thyroid or goiter Thalidomides ± Amelia or pocomelia. virus or irradiation. 3.18 wks ± multi fetal heart tone heard with or without instrument Sixth Month eyelids open wrinkled skin vernix caseosa present 1. 1.20 weeks primi. 4. inhibit growth of long bone Vitamin K ± hemolysis (destr of RBC). Drugs: Streptomycin ± anti TB & or Quinine (anti malaria) ± damage to 8th cranial nerve ± poor hearing & deafness Tetracycline ± staining tooth enamel. Third trimester: Period of most rapid growth. 2. 18 ± 20 weeks buds of permanent teeth appear Fifth Month lanugo covers body actively swallows amniotic fluid 19 ± 25 cm fetus. abruption placenta B. 3. 2. Terratogens. Fetal heart tone heard ± Doppler ± 10 ± 12 weeks Sex is distinguishable Second Trimester: FOCUS ± length of fetus 1.1st fetal movement. TORCH (Terratogenic) Infections ± viruses . 5.

slight hypertrophy of ventricles. Other. Systemic Changes 1. Vaccine is terratogenic C ± cytomegalo virus H ± herpes simplex virus VI. Don¶t get pregnant for 3 months.. 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. y Oral Iron supplements (ferrous sulfate 0.5 ± 14g/dL Criteria 1st and 3rd trimester.iron deficiency anemia is the most common hematological disorder. green leafy vegetable-alugbati. and jaundice (hepatic involvement). These infections are often characterized by vague.saluyot. black stool. constipation y Slowed capillary refill y Concave fingernails (late sign of progressive anemia) due to chronic physio hypoxia Nursing Care: y Nutritional instruction ± kangkong. . 3 times a day) empty stomach 1 hr before meals or 2 hrs after.5% pathologic anemia if lower Pathogenic Anemia . liver due to ferridin content. give IM.Assessment reveals: y Pallor. Cytomegalo virus. horseradish. Physiologic Anemia ± pseudo anemia of pregnant women Normal Values Hct 32 ± 42% Hgb 10. T ± toxoplasmosis ± mom takes care of cats. Rubella. Hepa A or infectious heap ± oral/ fecal (hand washing) Hepa B. ampalaya y Parenteral Iron ( Imferon) ± severe anemia. epistaxis ± due to hyperemia of nasal membrane palpitation. constipation y Monitor for hemorrhage . Feces of cat go to raw vegetables or meat O ± others.3 g. Herpes simples virus. Hgb should not be < 11g/dL 2nd trimester ± Hct should not <32% Hgb Shdn't < 10.easy fatigability. TORCH: Toxoplasmosis. increase heart workload. In some chases the infection may go unnoticed in the pregnant woman yet have devastating effects on the fetus. rashes and lesions. Cardiovascular System ± increase blood volume of mom (plasma blood) 30 ± 50% = 1500 cc of blood . after delivery. influenza like findings. mom will be given rubella vaccine.CHARACTERISTICS: group of infections caused by organisms that can cross the placenta or ascend through birth canal and adversely affect fetal growth and development. hematoma.if improperly administered. It affects toughly 20% of pregnant women. Z tract.pathologic anemia if lower HCT should not be 33%. enlarged lymph nodes. malunggay. Physiological Adaptation of the Mother to Pregnancy A.

apple with skin. proper body mechanical increase salivation ± ptyalsim ± mgt mouthwash . increase fiber diet .) 2.) 4.painful.use support stockings. Increase fluid intake. avoid 3 full meals. cantaloupe. mango. watermelon. pressure on gravid uterus.) 6.small freq feeding.small frequent feeding.increase fibrinogen . y Gastrointestinal ± 1st trimester change Morning Sickness ± nausea & vomiting due to increase HCG.increase clotting factor . suha. avoid fatty & spicy food.pregnant mom hyperfibrinogenemia . Monitor I&O constipation ± progesterone resp for constipation. Eat dry crackers or dry CHO diet 30 minutes before arising bed. avoid wearing knee high socks .position ± side lying with pillow under hips or modified knee chest position Thrombophlebitis ± presence of thrombus at inflamed blood vessel .lateral expansion of lungs or side lying position.use elastic bandage ± lower to upper Vulbar varicosities. . Vomiting in preg ± emesisgravida. malungay.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.) 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. pineapple.exercise -mineral oil ± excretion of fat soluble vitamins * Flatulence ± avoid gas forming food ± cabbage * Heartburn ± or pyrosis ± reflux of stomach content to esophagus . Respiratory system ± common problem SOB due to enlarged uterus & increase O2 demand Position. 2.) 5. elevate legs above hip level.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.) 3. F&E imbalance ± primary med mgt ± replace fluids.fruits ± papaya. sips of milk. to relieve. Except guava ± has pectin that¶s constipating ± veg ± petchy. protamine sulfate Avoid aspirin! Might aggravate bleeding. 3. Metabolic alkalosis. Nausea afternoon . Varicosities ± pressure of uterus .

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. Moniliasis or candidiasis due to candida albecans. Signs & Symptoms: Management ± antifungal ± Nistatin. Carcinogenic drug so don¶t give at 1st trimester 1. genshan violet. PROGESTERONE ± hormone responsible for operculum PREGNANT ± acidic to alkaline change to protect bacterial growth (vaginitis) Problems Related to the Change of Vaginal Environment: a. treat dad also to prevent reinfection 2. Cheese. 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. head of fish. 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). yogurt. no alcohol ± has antibuse effect VAGINAL DOUCHE ± IQ H2O : 1 tbsp white vinegar b. Mgt. crab. Dilis.*Hemorrhoids ± pressure of gravid uterus. seafood-tahong (mussels). hot sitz bath for comfort 4. lobster. brocolli. Color ± white cheese like patches adheres to walls of vagina. resp for leucorrhea OPERCULUM ± mucus plug to seal out bacteria. 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. 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. over fatigue. canesten Gonorrhea -Thick purulent discharge Vaginal warts. sardines with bones. cotrimaxole. oversex. mousy odor discharge ESTROGEN ± hormone. chills. Ca & phosphorous imbalance(#1 cause while pregnant).condifoma acuminata due to papilloma virus Mgt: cauterization . Vit D for increased Ca absorption dorsiflexion B. fungal infection.

ambivalence. Positive Signs ± undeniable signs confirmed by the use of instrument. Ovaries ± rested during pregnancy 7. Subjective B. Empty bladder . Objective C. Psychological Adaptation to Pregnancy (Emotional response of mom ±Reva Rubin theory) First Trimester: No tanginal signs & sx. Abdominal Changes ± striae gravidarium (stretch marks) due enlarging uterus-destruction of sub Q tissue ± avoid scratching.7 days after mens ±± supine with pillow at back quadrant B ± upper outer ± common site of cancer Test to determine breast cancer: 1. umbilicus is protruding 3. cheeks ± chloasma melasma due to increased melanocytes.symphisis pubis to umbilicus 4.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 . denial ± sign of maladaptation to pregnancy. Developmental task is to accept biological facts of pregnancy Focus: bodily changes of preg. Breast Changes ± increase hormones. color of areola & nipple pre colostrums present by 6 weeks. Brown pinkish line.linea nigra. use coconut oil. surprise.there is calcium Presumptive Probable Breast changes Goodel's. colostrums at 3rd trimester Breast self exam. nutrition . mammography ± 35 to 49 yrs once every 1 to 2 yrs 50 yrs and above ± 1 x a yr 6.2. Skin Changes ± brown pigmentation nose chin. Probable ± signs observed by the members of health team.change of consistency of cervix Urinary freq Chadwick¶s.trans vaginal ultrasound. Presumptive ± s/s felt and observed by the mother but does not confirm positive diagnosis of pregnancy .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.blue violet discoloration of vagina Fatigue Hegar's. Ballotment sign of myoma * + HCG ± sign of H mole .

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

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. Bartholomew¶s Rule ± to determine age of gestation by proper location of fundus at abdominal cavity. Haases rule ± to determine length of the fetus in cm. 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.1 add 1 month to month 11/31/04 EDD 2. 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. Important Estimates: GP GTPAL 4 2 4 11 1 1 GP GTPAL 6 4 6 2 2 15 1. 3 months ± above sym pub 5 months ± level of umbilicus 9 months ± below zyphoid 10 months ± level of 8 months due to lightening 4. Formula: 1st ½ of preg .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. 04 +9 +7 10 / 32 / 04 . Begin TT3 TT1 ± any time during pregnancy TT2 ± 4 wks after TT1 ± 3 yrs protection . 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.

presenting part. 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 . and number of fetuses. position. ectopic pre/2nd ± H mole. (preeclampsia) Pelvic Examination ± internal exam 1. E ± edema to upper ext.composed of squamous columnar tissue Result: Class I . abortion. degree of descent. Examine teeth: sign of infection Danger signs of Pregnancy C . . Prep mom: 1. fetal presentation lie. Physical Examination: A.use palm! Warm palm.normal Class IIA ± acytology but no evidence of malignancy B ± suggestive of infl. Procedure: Empty bladder Position of mom-supine with knee flex (dorsal recumbent ± to relax abdominal muscles) 6. Leopold¶s Maneuver Purpose: is done to determine the attitude.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. empty bladder 2. an estimate of the size. universal precaution EXT OS of cervix ± site for getting specimen Site for cervical cancer Pap Smear ± cervical cancer . 2. incompetent cervix 3rd ± placental anomalies S ± sudden gush of fluid ± PROM (premature rupture of membrane) prone to inf. fetal back & fetal heart tone .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.chills/ fever .

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

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

inadequate iron intake results in maternal effects ± anemia depletion of iron Calcium increases should reflect: . yogurt.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 .required for pregnancy including placenta. 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 .nuts. dried fruits . ketosis has been associated with fetal damage.Development of essential pregnancy structures . red meat.Maternal tissue growth including uterus and breasts .Failure to meet caloric requirements can lead to ketosis as fat and protein are used for energy.iron from food sources is more readily absorbed when served with foods high in vit C . . since diet alone is unable to meet pregnancy requirement . ice cream.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 .1200 mg/day representing an increase of 50% above prepregnancy daily requirement.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 .liver.Eggs. poultry.Maintenance of mineralization of maternal bones and teeth . potatoes .whole grains.green leafy vegetables .canned salmon & sardines w/ bones . milk . whole grain cereals and breads . . nuts . poultry. margarine.Begin supplementation at 30.mg/day in second trimester.1600 mg/day is recommended for the adolescent. broccoli or cabbage. lentils. Protein Essential for: . fish.vitamin C sources: citrus fruits & juices.Vitamin D sources: fortified milk.Growth and development of fetal skeleton and tooth buds . amniotic fluid.enriched. as an indication of adequacy of calorie intake.dark green leafy vegetables. . fish . butter. and tissue growth. liver.Ca fortified foods such as orange juice . egg yolk . tofu .Expansion of blood volume and red blood cells formation .Fetal tissue growth . eggs .dairy products : milk. cantaloupe. seafood Iron increases should reflect . strawberries. cheese.Dried beans.Current research is : Demonstrating an association between adequate calcium intake and the prevention of pregnancy induce hypertension Iron Essential for .Lean meat. egg yolk.70 mg/day of vitamin C which enhances iron absorption .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. legumes . cheese.

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

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

) uterine stretch theory ( any hallow organ stretched.close 2. complete flexion.) birthing bed ± dorsal recumbent pos squatting ± relives low back pain during labor pain leboyers ± warm. b.5 cm hyper extension submentobragmatic-face presentation 2.contraction 4.) Posterior fontanel or lambda ± triangular shape. Bones ± 6 bones S ± sphenoid F ± frontal .) sagittal suture ± connects 2 parietal bones ( sagitna) 2. Basic knowledge in Intrapartum. 1.Pelvic Exams B. ± 22 ± 24 wks Physical Exams. weight Obstetrical Data: gravida # preg. decrease progesterone will stimulate contractions & labor 5.) Anteroposterior diameter suboccipitobregmatic 9. Passageway Mom 1. The 4 P¶s of labor 1. age. Passenger a.2.) < 18 years old 3.) prostaglandin theory ± stimulation of arachidonic acid ± prostaglandin. etc Baseline Data: v/s esppecially BP.) oxytocin theory ± post pit gland releases oxytocin. Intrapartal Notes ± inside ER A. Hypothalamus produces oxytocin 3.) 4. address.bitemporal 8 cm 2. 1 x 1 cm. quiet.sinciput E ± ethmoid O ± occuputal .occiput T ± temporal P ± parietal 2 x Measurement fetal head: 1. smallest AP occipitofrontal 12cm partial flexion occipitomental ± 13. 1 Theories of the Onset of Labor 1. transverse diameter ± 9. b.) Anterior fontanel ± bregma. baby gets warm bath. 3 x 4 cm. At 36 wks degenerates (leading to contraction ± onset labor). dark. comfy room.) 5.5 cm. Fetal head ± is the largest presenting part ± common presenting part ± ¼ of its length.viable preg. soft music. Birth under H20 ± bathtub ± labor & delivery ± warm water. para. Admitting the laboring Mother: Personal Data: name. 12 ± 18 months after birth. IX.25cm .) Underwent pelvic dislocation . 4.) coronal suture ± connect parietal & frontal bone (crown) 3.) progesterone theory ± before labor.) theory of aging placenta ± life span of placenta 42 wks.( > 5 cm ± hydrocephalus).) 3.biparietal ± largest transverse .2.) < 4¶9´ tall 2. Closes ± 2 ± 3 months. diamond shape.) 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. After delivery. bimastoid 7cm smallest transverse Sutures ± intermembranous spaces that allow molding. will always contract & expel its content) ± contraction action 2.

Increase Activity of the Mother. Android ± heart shape ³male pelvis´. Obstetrical conjugate ± smallest AP diameter. Pelvis at 10 cm or more. deeper most suitable (normal female pelvis) for pregnancy 2. Psyche/Person ± psychological stress when the mother is fighting the labor experience a. Ripening of the Cervix ± butter soft 5.0 cm 3. transverse ± wider b.2 weeks prior to EDD * Engagement.anterior part pointed. Tuberoischi Diameter ± transverse diameter of the pelvic outlet. Gynecoid ± round. Past Experience d. 3.5 cm . oval shape. wide. Power ± the force acting to expel the fetus and placenta ± myometrium ± powers of labor a.iliac crest ± flaring superior border forming prominence of hips Ischium ± inferior portion . Involuntary Contractions b. Measurement: 11. (DC ± 11. Bloody Show ± pinkish vaginal discharge ± blood & leukorrhea 7. Pelvis 2 hip bones ± 2 innominate bones 3 Parts of 2 Innominate Bones Ileum ± lateral side of hips . Diagonal Conjugate ± measure between sacral promontory and inferior margin of the symphysis pubis.5 cm basis in getting true conjugate.5 cm=true conjugate) 2. True conjugate/conjugate vera ± measure between the anterior surface of the sacral promontory and superior margin of the symphysis pubis. posterior part shallow 3.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. duration.shooting pain radiating to the legs . decreased body wt ± 1. Rupture of Membranes ± rupture of water. Support System Pre-eminent Signs of Labor S&Sx: .Pelvis 4 main pelvic types 1. intensity 4. Characteristics: wave like d. Braxton Hicks Contractions ± painless irregular contractions 3.12.setting of presenting part into pelvic inlet 2.5 ± 3 lbs 6.urinary freq. Increase epinephrine 4. 1. will be used for delivery. Timing: frequency. Check FHT . Save energy. Measurement: 11. Cultural Interpretation b. Lightening ± setting of presenting part into pelvic brim . Anthropoid ± oval. Platypelloid ± flat AP diameter ± narrow. AP diameter wider transverse narrow 4.nesting instinct. Preparation c. Voluntary bearing down efforts c. ape like pelvis. Ischial tuberosity ± approximated with use of fist ± 8 cm & above.

upper uterine . 2.fundus 2. Danger signs: PROM Presenting part has not yet engaged Fetal distress Protruding cord form vagina Nursing care: 1. Slip cord away from presenting part 3. Unit used is cm. Use % in unit of measurement Dilation ± widening of cervix. especially if fetal distress is noted Cord Prolapse ± a complication when the umbilical cord falls or is washed through the cervix into the vagina. lower uterine ± isthmus . 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.Premature Rupture of Membrane ( PROM) . Nursing Interventions in Each Stage of Labor 2 segments of the uterus 1. Count pulsation of cord for FHT 4. Cover cord with sterile gauze with saline to prevent drying of cord so cord will remain slippery & prevent cord compression causing cerebral palsy. 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.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. Duration of Labor Primipara ± 14 hrs & not more than 20 hrs Multipara ± 8 hrs & not > 14 hrs Effacement ± softening & thinning of cervix.

Station ± landmark used: ischial spine .1 station = presenting part 1cm above ischial spine if (-) floating . Encourage to void q 2 ± 3 hrs ± full bladder inhibit contractions 3. First Stage: onset of true contractions to full dilation and effacement of cervix.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. Breathing ± chest breathing Active Phase: Assessment: Dilations 4 -8 cm Intensity: moderate Mom. apprehensive. Latent Phase: Assessment: Dilations: 0 ± 3 cm mom ± excited. Encourage walking .shorten 1st stage of labor 2. 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. 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. can communicate Frequency: every 5 ± 10 min Intensity mild Nursing Care: 1. cervical dilation and effacement. fetal monitor. Longitudinal Lie ( Parallel) cephalic Vertex ± complete flexion Face Brow Poor Flexion Chin .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.1. etc. 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.

If BP increase . LADP. RSA. RMP.use sacrum . RST. 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.put stet above umbilicus Shoulder/acromniodorso LADA.strength of contraction Contraction ± vasoconstriction Increase BP.Breech - Complete Breech ± thigh breast on abdomen. RMT. Shoulder presentation.)Enema administer during labor a. LMT. Transverse Lie (Perpendicular) or Perpendicular lie.)To cleanse bowel b. LSP. 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 .)Prevent infection c. c.)NPO ± GIT stops function during labor if with food. let mom rest. LADT. LMP. 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 .will cause aspiration 3. Variety: Occipito ± LOA left occipito ant (most common and favorable position)± side of maternal pelvis LOP ± left occipito posterior LOP ± most common mal position. double Kneeling b. most painful ROP ± squatting pos on mom ROT ROA Breech.) Ok to shower 2.2. notify MD -preeclampsia Health teachings 1. if same BP. RSP Chin / Mento LMA. RMA. RADA LSA ± left sacro anterior LST. breast lie on thigh Incomplete Breech ± thigh rest on abdominal Frank ± legs extend to head Footling ± single.

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

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

Prolonged labor ± normal length of labor in primi 14 ± 20 hrs Multi 10 -14 hrs > 14 hrs in multi & > 20 hrs in primi . hypovolemic shock if with bleeding. 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 d.) hurrying of placental delivery 3. etc. Fetal effect ± fetal distress. Factors leading to inversion of uterus 1. chest pain & frothy sputum prepare: suctioning end stage: DIC disseminated intravascular coagopathy. premature contractions q 10 min . profuse bleeding.bleeding to all portions of the body ± eyes.)Large baby 3.labor of < 3 hrs. primi 14 ± 20 Preterm Labor ± labor after 20 ± 37 weeks) ( abortion <20 weeks) Sx: 1.) profuse bleeding c.) TAHBSO Physiologic retraction ring . nose.) 1.)Previous classical CS 2.) short cord 2.maternal effect ± exhaustion.) sudden pain b. Mom given 6 hrs of labor Multi: 8 ± 14.) 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. MD will push uterus back inside or not hysterectomy.) Improper use of oxytocin (IV drip) Sx: a. caput succedaneum or cephal hematoma .Boundary bet upper/lower uterine segment BANDL¶S pathologic ring ± suprapubic depression a.nsg care: monitor contractions and FHR Precipitate Labor . extensive lacerations.) ineffective fundal pressure Uterine Rupture Causes: 1. Trial Labor ± measurement of head & pelvis falls on borderline.

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. Postpartal Period 5th stage of labor after 24hrs :Normal increase WBC up to 30. Physiologic Changes a.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.2. consult MD if symptoms persist Hosp: 1. This is critical especially to gravidocardiac mothers. birth pain: 1.000 cumm Puerperium ± covers 1st 6 wks post partum Involution ± return of repro organ to its non pregnant state. Cardiovascular System .halts preterm contractions. position prone .D&C after. Monitor: FHT > 180 bpm Maternal BP . Cervix ± cervical opening b.early ambulation Principles underlying puerperium 1. dilation 2-3 cm Home Mgt: 1. Vaginal and Pelvic Floor c. Uterus ± return to normal 6 ± 8 wks.<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 . Hyperfibrinogenia . 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.1. drink 3 -4 glasses of water ± full bladder inhibits contractions 5. Systemic Changes 1. complete bed rest 2.prone to thrombus formation .(puerperal sepsis). To return to Normal and Facilitate healing A. empty bladder 4.YUTOPAR.a medium for bacterial growth.Yutopar Hcl) 150mg incorporated 500cc Dextrose piggyback. X. effacement of 60 ± 80% 3. avoid sex 3. 2. If cervix is closed 2 ± 3 cm. dilation saved by administer Tocolytic agents. Genital tract a.

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

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

watery.monitor cycle for 1 year .-get short test & longest cycle from Jan ± Dec .shortest ± 18 . Best method Social Method ± 1. 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.Billings / Cervical mucus± test spinnbarkeit & ferning (estrogen) . elastic ± long spinnbarkeit Basal Body Temperature 13th day temp goes down before ovulation ± no sex .9% effective. 99.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.headache E ± eye problems S ± severe leg cramps . Consult OB-6mos. stretchable.18 8 Dec 33 -11 22 unsafe days 21 day pill.) coitus interuptus/ withdrawal .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. coitus interfemora ± ³ipit´ 4.3 months.get before arising in bed LAM ± lactation amenorrheal method ± hormone that inhibits ovulation is prolactin.start 5th day of mens 28day pill. Waiting time to become pregnant. calendar method OVULATION ±count minus 14 days before next mens (14 days before next mens) Origoknause formula ± .clear.longest ± 11 June 26 . breast feeding. .least effective method 2. Alerts on Oral Contraceptive: -in case a mother who is taking an oral contraceptive for almost long time plans to have a baby.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. coitus reservatus ± sex without ejaculation ± 3. . Signs of hypertension Immediate Discontinuation A ± abdominal pain C ± chest pain H .menstruation will come out 4 ± 6 months bottle fed 2 ± 3 months disadvantage of lam ± might get pregnant Symptothermal ± combination of BBT & cervical.

If mom HPN ± stop pills STAT! Adverse effect: breakthrough bleeding Contraindicated: 1. use another method for the rest of the cycle and the start again. gives highest protection against STD ± female condom Alerts: Disadvantage: . uterine perforation. chills S trings lost. If forgotten for two consecutive days.) chain smoker 2.right time to insert is after delivery or during menstruation primary indication for use of IUD .) Monthly checkup 3.5 yrs ± disadvantage if keloid skin .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. .) HPN 4. shorter or longer Uterine inflammation.most common complications: excessive menstrual flow and expulsion of the device (common problem) . DMPA ± depoproveda ± has progesterone inhibits LH ± inhibits ovulation Depomedroxy progesterone acetate ± IM q 3 months .it gives higher protection in the prevention of STDs Diaphragm ± rubberized dome shaped material inserted to cervix preventing sperm to get to the uterus.) Check for string daily 2.never massage injected site.as soon as removed ± can become pregnant Mechanism and Chemical Barriers Intrauterine Device (IUD) Action: prevents implantation ± affects motility of sperm & ovum . fever.prevents implantation .it lessen sexual satisfaction .) extreme obesity 3. immediately take the forgotten tablet plus the tablet scheduled that day. or more days.) Regular pap smear Alerts. it will shorten duration Norplant ± has 6 match sticks ± like capsules implanted subdermally containing progesterone.) Thrombophlebitis or problems in clotting factors if forgotten for one day. if 1 kid only don¶t use IUD HT: 1.) DM 5. ectopic pregnancy Condom ± latex inserted to erected penis or lubricated vagina Adv. . REVERSABLE .parity or # of children.

Bilateral Tubal Ligation ± can be reversed 20% chance.) 3.) 5. HT: >30 ejaculations before safe sex O ± zero sperm count.) Save discharges ± for histopathology ± to determine if product of conception has been expelled or not First Trimester Bleeding ± abortion or eptopic A. High Risk Pregnancy 1. Threatened ± pregnancy is jeopardized by bleeding and cramping but the cervix is closed Inevitable ± moderate bleeding. Foam (most effective). scanty dark brown bleeding .) 2. Present 2nd trimester d. product of conception remain in uterus 4 weeks or longer. Barrier ex. cramping. Hemorrhagic Disorders General Management 1. Missed ± fetus dies. HT: avoid lifting heavy objects Vasectomy ± cut vas deferense. Creams Surgical Method ± BTL . b. NSD Sheridan ± permanent surgery cervix. Mgt: D&C Incompetent cervix ± abortion McDonalds procedure ± temporary circlage on cervix S/E. (-) preg test. infection.) Complete ± all products of conception are expelled. safe XI. No mgt just emotional support! 2. tissue protrudes form the cervix (Cervical dilation) Types: 1.) 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.) Incomplete ± Placental and membranes retained.) Avoid sex 3. Habitual ± 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix.miscarriage Cause: 1. Jellies.) blighted ovum 3.) 4. 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. circlage is removed.) Assess for bleeding (per pad 30 ± 40cc) (wt ± 1gm =1cc) 4. During delivery. Abortions ± termination of pregnancy before age of viability (before 20 weeks) Spontaneous Abortion.) chromosomal alterations 2.) plasma germ defect Classifications: a.) Ultrasound to determine integrity of sac 5.) CBR 2. jellies. signs of pregnancy cease. CS c.Ht: 1.) Signs of Hypovolemic shock 6.

Avoid pregnancy for at least one year Third Trimester Bleeding ³Placenta Anomalies´ D.Mgt: induced labor with oxytocin or vacuum extraction 5. ± with fertilization. severe pain.scant.missed period . C. Abnormal lower implantation of placenta.) Induced Abortion ± therapeutic abortion to save life of mom.interstitial Unruptured Tubal rupture . 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. sharp. 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. sometimes covering the cervical os. it grows & enlarges the uterus vary rapidly. . Hydatidiform Mole ³bunch or grapes´ or gestational trophoblastic disease. . producing a diploid number 46 XX.sudden . The nucleus of the sperm duplicates. Progressive degeneration of chorionic villi.abdominal pain within 3 -5 weeks of missed radiating to shoulder. Ectopic Pregnancy ± occurs when gestation is located outside the uterine cavity.candidate for CS Sx: frank . This neoplasm is formed form the selling of the chronic villi and lost nucleus of the fertilized egg. dark brown. Double effect choose between lesser evil. Unilateral . Placenta Previa ± it occurs when the placenta is improperly implanted in the lower uterine segment. Recurs.gestational anomaly of the placenta consisting of a bunch of clear vesicles. common site: tubal or ampular Dangerous site . period (maybe generalized or one sided) shoulder pain (indicative of intraperitoneal 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.

It usually occurs after the twentieth week of pregnancy. 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. 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. IE. prepare to administer blood Type and crossmatch Monitor FHR Insert Foley Measure blood loss. K. L. 2. 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. G. H. Hypertensive Disorders I. 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. Outstanding Sx: dark red. solved 6 weeks post partum. Assessment: Concealed bleeding (retroplacental) Couvelaire uterus (caused by bleeding into the myometrium)-inability of uterus to contract due to hemorrhage.HPN after 24 wks of pregnancy. painful bleeding. J. board like or rigid uterus.Bright red Painless bleeding Dx: Ultrasound Avoid: sex. I. Abruptio Placenta ± it is the premature separation of the placenta form the implantation site.cord divides into small vessels before it enters the placenta Vasa Previa ± velamentous insertion of cord has implanted in cervical OS - F. Pregnancy Induced Hypertension (PIH). Severe abdominal pain Dropping coagulation factor (a potential for DIC) Complications: Sudden fetal blood loss -placenta previa & vasa previa Nursing Care: Infuse IV. .

) avoid jarring bed P. Resp < 12 4.turning to side done AFTER seizure! Observe only! for safely.) Mild preeclampsia ± earliest sign of preeclampsia a. prevent ± Mg So4 ± CNS depressant E ± valuate physical parameters for Magnesium sulfate Magnesium SO4 Toxicity: 1.tongue depressor . Three types of pre-eclampsia 1. Chronic or pre-existing Hypertension ±HPN before 20 weeks not solved 6 weeks post partum.Diabetes Mellitus .) minimal handling ± planning procedure 3.prevent convulsions by nursing measures or seizure precaution 1.) Severe preeclampsia Signs present: cerebral and visual disturbances. Transissional Hypertension ± HPN between 20 ± 24 weeks III.) common to mom with low socioeconomic status due to decrease intake of CHON Nursing care: P ± romote bed rest to decrease O2 demand.) protenuria +1 . E ± ensure high protein intake ( 1g/kg/day) .HPN without edema & protenuria H without EP 2. Patella reflex absent ± 1st sigh Mg SO4 toxicity. Urine output decrease 3.) Gestational hypertension .) dimly lit room . epigastric pain due to liver edema and oliguria usually indicates an impending convulsion.) HELLP syndrome ± hemolysis with elevated liver enzymes & low platelet count II.) Pre-eclampsia ± HPN with edema & protenuria or albuminuria HE P/A 3. quiet calm environment 2. BP decrease 2.) increase wt due to edema b. water immersion will cause to urinate.prepare the following at bedside . sodium excretion.+2 2.) common in multiple pre (twins) increase exposure to chorionic villi 3.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 .hyperglycemia 3 degrees GTT of > 130 mg/dL . BP 160/110 .Na ± in moderation A ± anti-hypertensive drug Hydralazine ( Apresoline) C ± convulsion. Cause of preeclampsia 1. P. Provide safety. protenuria +3 . antidote ± Ca gluconate 3.) BP 140/90 c.) Eclampsia ± with seizure! Increase BUN ± glomerular damage. facilitate.) idiopathic or unknown common in primi due to 1st exposure to chorionic villi 2.+4 3.1.

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

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

) forcep delivery .2.) episiotomy 3.

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