September.

20, 2021
HEALTH PROMOTION DURING PREGNANCY 6. IODINE – Mineral – Abnormal function of thyroid gland
o Pre-natal checkup should be minimum of 4 (Metabolism)
o Best Sources:
BEST SOURCE OF NUTRIENTS - Iodized salt
1. PROTEIN – Albumin, CHON - Seafoods
 FETUS – Prevents:
 High Biologic Value  Cretinism – Hypothyroidism in children.
- Egg – Egg white  Mineral Retardation
- Lean Meats – less or no fat
- Vegan – Tofu, soya (Pernicious anemia) 7. FOLATE/FOLIC ACID – Vit. B9 – Prevents neural tube
o Protein supplement/ shakes – Are contraindicated to defects.
pregnant women.  Spina Bifida: Myelomeningocele, meningocele, Arnold
char malformation
2. FLUIDS – Prevent Dehydration, Constipation, Decrease o Best Sources:
cramps - Dark, green vegetable
o Good Sources: - Iron + Folic Acid Supplement
- Water – 6 – 8 glasses/day; 3L/day
- Fruit Juices – Less promoted – Increased Glucose 8. VITAMIN A – Retinol – Prevention of:
(Diuretic Effect)  Night blindness (xeropthalmia)
- Milk – Promoted rich source of calcium – bone &  Anemia
teeth development.  Spontaneous preterm birth
o AVOID: Stimulants – Cola, Coffee, Tea  Teratogenic – Accutane – CI – 1st trimester
(Promotes IUGR, Intrauterine growth o Best Sources:
retardation, Increased risk of abortion) - Orange & Yellow foods
 4th month – supplement 10,000 IV, twice a week
3. IRON – Prevents Anemia
o Best Sources:
- LEAN MEATS (highest iron) SPECIAL NUTRITIONAL CASE
o Best and Cheap Sources:
- Dark green, leafy vegetable 1. TEENAGE PREGNANT – Priority body-image
- Prenatal – 180 tabs : Prone – unhealthy diet Practices
- Postpartum – 90 tabs Priority Assessment:
o Side effects of supplement: - Current Nutritional Status – BMI (Body Mass Index)
- Constipation, Dark, tarry stools 24 – hours diet recall
- Enhanced Absorption  First Prenatal Check-up – Best time for nutritional
- Vitamin C/Citrus Juices counselling
 2,300 calories everyday
4. CALCIUM – Mineral supplement – Bone & teeth
development fetus 2. PICA – Decreased nutrition (decreased iron)
o Best Source: Eating NON-FOOD SUBSTANCES
- Milk and Dairy Products Prone to:
: Non – Milk Drinkers – Sardines, Salmon, Bread, Beans - Iron deficiency Anemia
- Malnutrition
5. ZINC – Mineral (Natural sources or tab) Immunity, Most Common trigger: Anemia
Prevent DHN, Promotes wound healing
o Best Source: 3. COMMON PICA: Iron Supplementation
- Milk Pacophagia – Ice
- Milk Products Amylophagia – Starch
- Multivitamins Geophagia – Clay/Dirt
 FETUS – Prevents: Dwarfism & Hypogonadism
 Couvade Syndrome – (Father) – food craving, 4. COITUS – Sexual intercourse – Allowed
discomforts o General Reactions:
4. VEGAN – Vegetarians  1st Tri: Uncomfortable
Less Intake Of:  2nd Tri: Comfortable/more tolerable
- Vitamin B12 – Best Animal Protein  3rd Tri: Uncomfortable – fear of labor
- Protein Possible Contraindications:
Prone to: - Vaginal Bleeding/Spotting
- Anemia (Pernicious Anemia) - Threatened Abortion
- Fetus – Neurologic Deficits Cobalamin - Infection/Sepsis
Alternative Source:
- Vitamin B12 Supplement
- Soya milk COMMON DISCOMFORTS

BEST ASSESSMENT OF DIET 1. NAUSEA & VOMITING – Morning Sickness

 24 Hour Diet Recall – intake for last 24 hour o Cause:
 Ask the mother to keep Nutritional Diary  Increased estrogen, Increased HCG (1st Trimester)

o Management:
PRENATAL CONCERNS  Eat dry crackers
 Small, frequent meals
1. EMPLOYMENT  Decreased fat (oily) food intake, Decreased spicy foods
o Allowed UNLESS high risk  Vitamin B6 supplement, it’s promoting GI Function
- (Before onset of labor/TERM)  AVOID: anti-emetic as possible
o Occupational Fatigue may lead to:  Metoclopramide – Hyperemesis Gravidarum
- Premature Rupture of Membrane (PROM)
- (+) ROM – (-) Labor 2. BACKACHE
o Cause:
2. EXERCISE – Light to Moderate  Shift in center of gravity
o Allowed Duration: o Management:
- 30 mins/day (light to moderate)  Squat -Do not bend down
- It depends on Individual characteristics  Support back with pillow
o Sample Exercise:  Pelvic TIH exercises
 KEGEL’S:  Lordosis – Pride of pregnancy
- Promotes/strengthens pelvic floor muscle  Scoliosis – Orthopedic braces
- Laceration during delivery
- No Kegel’s, if there is recurrent UTI 3. VARICOSITIES
- The pelvic should be empty before doing this type of o Cause:
exercise.  Increased pressure on lower vasculature – vessels –
 PELVIC TILT dilation
- Relives Back pain  Prolonged standing
- Complications: Best to abstains from exercises  Advanced age
 PANT-BLOW Exercise: Respiratory exercise – avoid o Management:
rapid delivery.  Elevate lower extremities
 Avoid prolonged sitting/standing
3. TRAVEL – Allowed  Obesity – Nutritional counselling
o TRAVEL:  Elastic stockings/compressors – stimulates circulation
 Automobile Travel (Seatbelt)
o Air Travel – expose fetus – high decibels
 Safe to travel up to 36 weeks (labor)
 DANGER SIGNS & SYMPTOMS OF PREGNANCY 8. FAST OR DIFFICULT BREATHING
 Cyanosis, abnormal breath sounds
1. SWELLING OF THE FACE, LEGS, HANDS o Possible Cause:
o Possible Cause:  COPD – Asthma, Bronchitis, Emphysema
 Pre-Eclampsia – Loss of albumin – edema  Cardiac Problem – Cyanosis
 Severe renal problem  Severe Anemia
 Covid-19
2. SEVERE HEADACHE
o Possible Cause: 9. SEVERE ABDOMINAL PAIN
 Pregnancy induced hypertension  Abdominal cramps
 Pre-eclampsia o Possible Cause:
 Eclampsia  Abortion
 DM – Severe hypoglycemia (Insulin)  Premature labor
 Insulin during pregnancy is allowed  Increased ectopic pregnancy
 Insulin towards labor is increased  Abruptio placenta

3. DIZZINESS & BLURRING OF VISION 10. VAGINAL DISCHARGE AND/OR GENITAL SORE
o Possible Cause:  LESIONS
 Pregnancy induced hypertension (PIH) o Possible Cause:
 Pre-eclampsia  Foul smelling – Puerperal Infection
 Eclampsia  Discharge + Itching – STD
 Lesion/Sore – STD – Herpes – Syphilis
4. VAGINAL SPOTTING/BLEEDING  Herpes – Painful
 Any form of bleeding – Pregnancy – Abnormal  Syphilis – Painless
o Possible Cause:
 Abortion 11.) PAINFUL URINATION
 Placenta previa  Dysuria
 Abruptio placenta  Frequent Urinary
 Laceration o Possible Cause:
 Ectopic/Molar pregnancy  UTI – abortion, premature labor (meds. Antibiotics)

5. SEVERE PALLOR 12.) CONVULSION/LOSS OF CONSCIOUSNESS

 Conjunctiva, Palms  Seizure, clonus
o Possible Cause: o Possible Cause:
 Severe Anemia  Eclampsia
 Epilepsy – convulsive disorder or lack of consciousness
6. FEVER AND CHILLS
 Mild – 38 Celsius (Progesterone) 13.) ABSENCE OF FETAL MOVEMENT/HEART BEAT
o Possible Cause:  (-) FHT, <10 kick (12 hour)
 Infection/Sepsis  (-) Fetal Kick
 Vaginal discharge – foul – smelling, purulent o Possible Cause:
 Vaginal itching – Present of STD  FDU – Fetal Death in Utero
 Respiratory s/sx  8 weeks – 20 weeks – missed abortion
 >20 weeks – still birth
7. SEVERE VOMITING  8 weeks – UTZ
 Persists up to 2nd – 3rd trimester  10 – 12 weeks – Boppler
o Possible Cause:  16 weeks - Fetoscope
 Hyperemesis gravidarum – 2nd – 3rd Trimester  Ketone – urine (danger sign) Pt. has diabetic ketoacidosis
 H-Mole – (HPN) 1st Trimester – Increased HCG
 SCREENING TESTS o BMI FORMULA
 Best done during prenatal checkup Pound/kg
o SCREENING TEST (LABORATORIES)
 CBG
 Capillary Blood Glucose test
 Fasting – 70-100 mg/dL
 Screening for Gestational DM
 Non-Fasting – up to 140mg/dL
 Hgb, Hct
 Screening For Anemia
 Hgb - <12 g/dl; 32-42 % - Low
 RPR
 Rapid Plasma Reagin – VDRL
 VDRL (venereal disease research laboratory) Screening
test for syphilis
 st
1 trimester, protection of the syphilis
 BSMP
 Blood Smear for Malarial Parasite
 Screening test for malaria
 Severe Anemia can cost death to the mother or baby
 HEPA B
 HBSAg – Hepa B surface Antigen (-)
 Reactive result – The patient is a carrier of Hepa B
 HBSAb – Hepa B Surface Antibody (+)
 The mother is Protected from Hepa B
 Range is greater than (>) 12 IU, less than (<) 5-12
Repeat
 URINALYSIS
 Screening for UTI, Kidney stone, other complication
 Urinalysis of pregnant – SPC gravity – 1.010 – 1.030
(color is clear to light yellow)
 (-) Albumin, RBC, Ketones, Bacteria
 (+) Albumin – Pre-Eclampsia
 (+) RBC – Nephrolithiasis, bleeding
 (+) Ketones – Diabetic ketoacidosis
 (+) Glucose – DM
 (+) Bacteria – (+) PUS, UTI, Puerperal infection
 (+) Crystals – kidney stone
 Calcium supplement – routine urinalysis
 Decrease Overload/fluid excess
 Increase dehydration

BMI SCREENING
 Ideally Done: 1st trimester (MOST ACCURATE)
o BMI RANGE: Height and Weight of the Pt.
 Underweight: Below 18
 Normal: 18 – 24.9
 Overweight: 25 – 29.9
 Obese: 30 & above
Septem. 21, 2021 MATERNAL VS (NORMAL)  Infection
BEST TAKEN OF:  Risk Factors for Urinary Retention in:
 In between contraction (interval)  Operative deliveries – CS
 Relaxation phase  Regional anesthesia
o Frequency:  Epidural (Risk for hypotension) – Painless Delivery
 Early latent – every 4 hours  Bladder Hypotonia
 Late latent – every 1 hour
 Active – 30 mins transitional 5-15 mins CAUTION!!
o If Prolonged Membrane Rupture:  Do not allow the woman to push unless delivery is
 Temperature taking 1-2 hours imminent – Dilatation – 10cm (+) uterine
 Tachycardia – presence of fever contraction
 PROM -12 Hour – infection  Possible effects:
 Cervical swelling
FLUIDS  Exhaustion
 Active – Gastric emptying is slower – *Ask the mother to PANT-BLOW, if not yet fully dilated and
vomiting/aspiration she is always pushing.
 NPO if: *PANT-BLOW – Hyperventilation, Respi. Alkalosis (breath
 Active – Transitional through brown paper bag or cupped hands)
 Offer ice chips, lip moisturizer
 IV Fluids: Is not routinely hooked FETAL HEART MONITORING
 DHN, Operative clients, Blood Replacement  Low risk: every 15 mins
 PNSS – Dextrose -has Hemolysis  High risk: every 5 mins

AMNIOTOMY MANAGEMENT OF SECOND STAGE OF LABOR

 Baby should be TERM  Fetal delivery
 Risk for Prolapsed Cord/Cord Prolapse  Start: Full cervical dilatation (10cm)
 FHT monitoring
 Infection – Should be closely monitor the Temperature CARDINAL MOVEMENT OF LABOR: (CEPHALIC)
 Amniocentesis – inject and get the fluid from inside, o EDFIRE ERE
can be done in early pregnancy E – Engagement – ischial spine
- Aspiration of amniotic fluid D – Descent
- Fetal Distress – FHT F – Flexion
- Premature Labor – Monitor for s/sx of labor I – Internal
- Bleeding (use of needle) R – Rotation
- Infection E – Extension
 Artificial rupture of membranes
 Protects fetus – ascending infection E – External
 Presumed benefits: R – Rotation
 More active labor E – Expulsion
 Early detection of meconium staining
 Application of electrodes – fetal head – FHT SIGNS OF IMPENDING FETAL DELIVERY
 Current Guideline:  IE: 10cm
 Not advised -unnecessary procedure  Urge to bear down: Increased
 Uterine Contractions: Strong - every 2-3mins
PROMOTE BLADDER FUNCTION  Perineum: Bulging Perineum
 Full bladder – prevents fetal descent  Fetal Head: Visible - Crowning
 Avoid Bladder Distention:  BOW (Bag of Water): Usually Ruptures
 Encouraging voiding every 2 hours  Rectal Pressure: Increased
 Not able to ambulate – insert straight catheter *Lesion/Scars/Warts – Impede normal labor and delivery.
 Urine Retention:
 On anesthesia
 MONITORING THE 2nd STAGE
 Important Assessment: WHEN THE BABY’S HEAD IS OUT
 FHT – normal is 120-160 (During contraction –  WIPE – Clean gauze – cleanse mouth and nose (no routine
decreased FHT is normal, early deceleration) suctioning)
 Uterine contraction – Intensity, duration, frequency,  WAIT – External Rotation (1-2 mins. Post fetal head
interval delivery)
 Vital signs  As the baby’s head is delivered, support it with you hands.
 Mood and Behavior It will naturally turn to one side.
 Faster shoulder deliver – We have to apply downward
DURATION OF FETAL DELIVERY: Suprapubic pressure.
 Nulliparous – 1st time – viability, nabuntis pero hindi
umabot ng term IF SHOULDER DYSTOCIA
 NULL – 50 mins  DEFINITION:
 MULTI – 20 mins  Shoulder – lodged in mother’s pelvis – prolonged, difficult
 BEST POSITION: Lithotomy – legs in stirrups labor
*Simultaneously put both legs on stirrups to  Classic signs:
avoids damage to the ligament  TURTLE-NECK SIGN
 Management:
AVOID:  McRobert’s Position: The mother’s legs are pulled up
 Massaging or stretching perineum (promotes against the abdomen. -Dislodges shoulder
laceration)
 Applying fundal pressure to help delivery the baby THIRD STAGE OF LABOR: PLACENTAL DELIVERY
(Uterine rupture, Uterine Inversion)
HEMORRHAGE MOST IMPORTANT ASSESSMENT!!!
*1-5 mins post fetal delivery
DURING FETAL DELIVERY *Wait for signs of placental separation: (-) signs
 Implement the 3 CLEANS (sterile) separation - Do not Deliver placenta
 Clean Cord  Calkin’s sign – firm & globular fundus/rising of the fundus.
 Clean Hands Sudden gush of blood
 Clean Surface  Lengthening of the cord (most sensitive)
 WEAR – Double Gloves
 When the birth opening is STRETCHING: TYPES OF PLACENTAL DELIVERY
 Perform Ritgen’s Maneuver  SHULTZE
 Apply forward pressure on the chin, while the other  Placenta detaches at the center FIRST
hand applies pressure on occiput  Shiny
 Ritgen’s Maneuver – To facilitate fetal head Extension  Fetal side first
 Episiotomy  DUNCAN
 Incision – Fourchette  Beefy red appearance
Purpose:  Placenta detaches at the edges FIRST
 Shortens second stage of Labor  Dirty
 Median – Faster Healing, Less bleeding  Maternal signs
 Risk: Laceration
 Medio – Lateral: Less Prone to Laceration (Risk delayed FACILITATE DELIVERY OF THE PLACENTA
healing, more bleeding)  Perform brand + Andrews Maneuver
 Slow pulling and winding to clamp counter traction.
ENSURE CONTROLLED DELIVERY OF THE HEAD
 First Hand – Supports fetal head ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR
 Second Hand – Supports the perineum (AMSTL)
*If there is rapid Fetal Head Delivery – Instruct mother to:  Give Oxytocin 10 “u” IM – give after DELIVERY (1minute)
 Stop Pushing *Prevent postpartum hemorrhage or bleeding.
 Breath rapidly with mouth open (Hyperventilation) *Uterine hyperstimulation – tetanic contraction
*Water intoxication – confusion, pt. can experience *PERIPAD: capacity is 30-40cc
seizure
 Deliver the placenta by controlled CORD TRACTION – CAUSES OF POSTPARTUM HEMORRHAGE
BRAND ANDREWS
*Check that the placenta and membranes are complete  EARLY POSTPARTUM HEMORRHAGE
*Put the placenta into a container for disposal.  Within 24 hours
*Placenta should have AVA, 2 arteries 1 vein 15-28  DIC: Disseminated Intravascular Coagulation
cotilidons, if kulang meron cardiac anomaly *Decreased fibrinogen – fibrinolysis
 Uterine massage every 15 minutes for the 1st 2 hours – *Abruptio Placenta
to stimulate the oxytocin  LACERATION: Perineal, cervical (+) bleeding Fundus, Firm,
contracted
4th STAGE: POST PARTUM RECOVERY  ATONY: (-) uterine contraction (relaxed state) (+) bleeding
*Puerperium: post-partum – 6weeks postpartum. fundus, Soft, boggy
 VS MONITORING *ATONY
 1st hour – every 15 mins. - Oxytocin
 2nd hour – every 30 mins. - Uterine Massage (soft)
*Report abnormal V/S promptly. - Breastfeeding – to stimulate oxytocin, uterine contraction,
 FUNDUS – Uterus CRAMPS is normal because of the oxytocin
 IMMEDIATE POST-PARTUM: Should be; Firm
(contracted), Midline at the level of umbilicus.  LATE POSTPARTUM HEMORRHAGE
(Normal)  24 hours
 IF DISPLACED/DEVIATED: Suspect bladder distention  RETAINED PLACENTA: (secumdines) FUNDUS: not
*First – ask the mother to urinate. delivered within 30 minutes, soft & boggy
 EMPTY BLADDER TO AVOID: Prevent ATONY – not  PUDENDAL ANESTHESIA: D&C
contracting – soft (MASSAGE) – boggy  OVERMANIPULATION: manual manipulation of the uterus,
– Increased bleeding can cause late postpartum can lead to possible uterine
*ATONY is the first postpartum hemorrhage inversion.
 SOFT and BOGGY: Massage  MACROSOMIA: gestational DM mothers, uterine over
 ABOVE THE UMBILICUS: Distended bladder -Void stretching – atony
 MULTIFETAL PREGNANCY: twin pregnancy, uterine over
LOCHIA stretching
 Rubra: Reddish – 3-4 days: blood, membranes, decidua
– endometrium, cervical mucus CHECK PERINEUM
 Serosa: Brownish/Pinkish – 4-10 days: WBC, RBC’s, R – REDNESS:
wound discharges. E – ECCHYMOSIS:
 Alba: Whitish/Yellowish – 10-28 days (6weeks): Turbid E – EDEMA:
(medyo cloudy), white blood cells, decidual D – DISCHARGES: Foul smelling
cells, WBC, epithelium *EPISIOTOMY: severe pain, persistent pain (client is
*Report if the LOCHIA: experiencing bleeding)
 Foul-smelling
 Increase amount – soak pad COMMON PHYSIOLOGIC CHANGES – POSTPARTUM
 Large clots  Normal expected
 Return to the previous color/Persistence of Lochia  Increased:
discharges (rubra,serosa,rubra – heavy bleeding is the  Sweating: Diaphoresis
pt.)  Urination: Diuresis
 Temperature: Slight/Mild r-t DHN
ESTIMATION OF BLOOD LOSS
 Best: Perineal pad count – 1 gram -1cc blood loss STANDARD POST-PARTUM CHECK-UP
 NSVD normal: Changed every 4-6 hours, less than 500  1st check-up: Within 24 hours
cc  2nd check-up: within 3-10 days (postpartum) 7 days – 1
 CS normal: 500-1,000 cc week
 *Infection
POST-PARTUM CARE  Sever perineal pain
 IMPORTANT TIMELINES: *FUNDUS: Tender, soft, boggy
 Within 24 hours: immediate
 Within 1 week (2-3days) preferably ABNORMALITIES IN LOCHIAL FLOW - fleshy
 4-6 weeks  Foul-smelling - Sepsis
 Heavy flow – Retained Placenta/Uterine Subinvolution
WITHIN 24 HOURS POST-DELIVERY  Return to previous color: Red-brown-red (Pt. heavy
 Rapid assessment and management bleeding), Retained Placenta/Uterine
 Focuses in immediate needs Subinvolution
o EMERGENCY S/SX: Notify MD ASAP!  Passage of large clots – size of a coin – Golf ball size,
 Dyspnea – shortness of breathing or difficulty of Retained Placenta/Uterine Subinvolution
breathing.
 Cyanosis – Blueish, Central or Peripheral RUBIN’S PROCESS OF MATERNAL ADAPTATION
 Heavy Bleeding – Profuse, V/S – Hypotension, o TAKING-IN PHASE
Increased RR, Increased HR  1-2 days after delivery
 High Fever – hyperthermia, infection  ATTITUDE: Passive & Dependent
 Severe Abdominal Pain – Sign of Internal Bleeding,  FOCUS: Self- Bodily Concerns
tender - abdomen  May review the birthing experience frequently
 Convulsion  ACTION:
*If (+) for any EMERGENCY: "Mother the mother”
 Lying-in/RHU: Refer to the nearest hospital  Rest periods
 Hospital: Refer to M.D  Additional nourishment as needed
*SUPPLEMENTATION:  FOCUS: Self-care of the mother
 Vitamin A: Retinol, Single Dose: 200,000 IV within 1 *Normal P/Partum Changes
month post-delivery. *FP
 Iron Tablets: Daily, 90 tabs
o TAKING-HOLD PHASE
OTHER SERVICES  2-4 days after delivery
 Family Planning:  ATTITUDE: Increasing interest in newborn – Increased
*Natural: LAM (Lactation Amenorrhea) responsibility.
*Modern: IUD (Temporary but long-term, 10 years)  FOCUS: Regaining body control, Mastery of NB care
*BTL – Permanent  ACTION: Best time teaching
*Hormonal – Progesterone only Pills (POP)  More in depth self-care:
Does not affect the breastmilk  TEACH: Infant care skills
Estrogen – decreased milk production  MODEL: Attachment Behavior
 Tetanus Toxoid: as appropriate, if fully immunize hindi  PROVIDE (+) Reinforcement
na bigyan.
 RPR (if not done): Syphilis o LETTING-GO PHASE
 Occurs after mother returns to home
WITHIN 1 WEEK OF POST-DELIVERY  FOCUS: Family Reorganization
PHYSICAL EXAMINATION: Be alert for! Danger Sign  ATTITUDE: Assumes Full Responsibility
 Vaginal bleeding (Lochia flow)
*Dark red - abnormal POST-PARTUM “BLUES” – Normal sadness
 Foul smelling discharge  Onset: 2-3 days postpartum – as late as 10 days
*Puerperal Infection  Duration: 2-3 days
 Abnormal vital signs  Characteristics: Mood swings, Tearful (extra dramatic)
*Increased, Decreased  Management: Continuous self-care and NB care, No
 Pallor management required (Because, it’s normal)
*Anemia
 Dysuria and/or fever
  ACTIONS:  *They return to pre-pregnant state* (Process of
 Reassure that it may take weeks to develop comfort INVOLUTION, tru peripheral/puerperium
with new roles period)
 Watch for s/sx of postpartum depression/psychosis  DEFINITION
- Period between placental delivery up to 4-6 weeks
POSTPARTUM PSYCHOLOGICAL PROBLEMS postpartum (4th stage)/

o POSTPARTUM DEPRESSION PUEPERIAL PHYSIOLOGIC CHANGES

 Onset: Within 6 weeks from delivery
 Duration: Persistent >14days (2weeks)
 Characteristics: 1.) Anhedonia – lacks interest in
pleasurable activities. 2.) Anxious, 3.)
Hopeless, 4.) Self-Care Deficit
 Management: Psychotherapy, Anti-Depressants
 DEPRESSION – SUICIDE
- IDEATION – Have Idea to killing herself (Sometimes I
don’t feel like living anymore)
- Thoughts – (I think of killing myself)
- Threats - (I will kill myself with time/Tomorrow)
- Attempt
- Normal/expected.
 UTERINE INVOLUTION: Pelvic Region
 9-10 days: Fundus non-palpable
 2 weeks: Descended into true pelvis
 3 weeks: Endometrium (restored)
 4 weeks: pre-pregnant stage
 Rate of Involution: 1 finger breath/day
- Immediately: at the level of umbilicus
- 1 day: 1 finger breath below
- 2 days: 2 finger breaths below
- 3 – 8 days finger breath below
- 9 days: non-palpable

o POSTPARTUM PSYCHOSIS VAGINAL DISCHARGE/LOCHIA

- Hallucination  1-3 days: Rubra
- Illusion  4-10 days: Serosa
- Delusion  10 days – 6 weeks: Alba
 Onset: Within 3 weeks *Pinaka Mayaman sa WBC – Alba*
 Duration: Persistent > 1 month
 Characteristics: Psychosis – Loss of reality, (H,I,D) Self- REPORT TO MD IF:
Neglect-Poor Hygiene  HEAVY lochia flow
 Management: In-Patient admission, Anti-Psychotics  RETURN to previous color
 Hallucination – false sensory perception  Passage of LARGE CLOTS
- Visual – eyes  FOUL-SMELLING discharge
- Auditory – hearing
- Gustatory – taste URINARY TRACT
- Tactile – touch  2-5 days: Diuresis
- Olfactory – smell  2-8 weeks: Kidney & Ureter: Return to pre-pregnant stage
*Altered sensory perception*  4-6 weeks: Return to normal function
 Illusion – false interpretation
*Altered sensory perception* BREAST: Engorge – Prolactin (Increase milk
 Delusion – False belief with no basis in reality production)/Progesterone
- Grandiose – Famous or popular (tingin nya sa sarili  3-5 days: Engorgement, Milk Leakage
nya)  6 months: Amenorrhea – If mother is breastfeeding
- Persecutory – Someone will hurt him/her mothers
- Ideas of reference – Outside activity are connected to -Wear supportive bra
oneself. -Warm compress
*Altered thought process* -Avoid strong soap to avoid irritation/dryness

PUERPERIUM – 6 weeks following pregnancy RETURN OF OBULATION: Fertile

 Pelvic organ – uterus, fallopian tube, cervix, ovaries.  2 weeks: Abortion
 4 weeks: Pre-Term
 6 weeks: Term