4 process

Menstruation (28 days)

Phases:
1. MENSTRUAL: 1-6 days
a) 1-7 ( average: 5, Max: 9) - blood
b) Estrogen: low- kasi lumalabas ang dugo (on the 3rd day, it reacts and
stimulates the brain) anterior pituitary gland will stimulate. 13th day-
tataas na ang level ng estrogen
c) Progesterone: low
2. PROLIFERATIVE: 6-13 days / follicular phase (FSH)
a) Estrogen: stars to rise (uterus: mataas ang estrogen)
i. Peak: 13th day; spinnbarkheit test to check for fertility test.
b) FSH is already high ( Ovary )
3. SECRETORY (isesecrete na ang itlog): 13-25 days /Luteal Phase (LH)
a) Progesterone: starts to rise, expectedly your LH is already high.
(progesterone is release by corpus luteum (10-12 days))
b) LH: on the 14th day there will be ovulation
4. ISCHEMIC: 25-28 days
a) Corpus albicans
 ANAPHY OF MALE REPRO
Parts:
1. testis (seminiferous tubules)= production of the SPERM ( Spermatogenesis
a) Sperm
b) Semen(fluid)
2. COLLECTING DUCTS: transport and storage of Sperm from testis to epididymis
3. EPIDIDYMIS: maturation, ejaculation and transport
4. VAS DEFERENS (SPERM DUCT): process of ejaculation and transport. Received
mature sperm.
5. SEMINAL VESICLES: Store area of the semen(it will use as a medium to
transport sperm).
6. PROSTATE GLAND: located at the base of male genitalia. -secrete thin alkaline
solution to neutralize urine in the female system/ during sexual intercourse.
7. COWPERS GLAND: secretion of a substance that lubricates and to flush out urine.
PROTECTION OF THE DEATH OF THE SPERM AS IT GOES TO THE
URETHRA,
8. URETHRA: passageway of urine, and sperm/semen.
9. PENIS: intended for sexual intercourse copulation.

SPERM/SEMEN - 74 days.
Production of sperm on testis ( 300-500 million sperm) (3-5 ml of seminal fluid)
 SPERMATOGENESIS: development of sperm ( production = meiosis)
 Alkaline
 Nailabas outside the body - it can survive for about 7 days however the capability
to fertilized can live for 48 to 72 hours.
 SPERM TRANSPORT: sexual intercourse, masturbation

CHARACTERISTICS OF HEALTHY SPERM

1. COUNT: around 15 million to 300 million sperm has the capacity to cause
pregnancy.
<less than 20 million - medyo mahihirapan to cause pregnancy
2. MOTILITY: atleast 40% of sperm are moving
3. SHAPE/ MORPHOLOGY “STRUCTURE”
1. HEAD (ACROSOME - CAP): it releases HYALURONIC ACID
a) DNA: genetic make up
2. NECK : powerhouse “ mitochondria
3. TAIL: motility and transport

REPRODUCTIVE PROCESS
4 PROCESS
 FERTILIZATION : meeting union of the SPERM ( SPERMATOGENESIS) and
OVUM / CHROMOSOMES( CHON/ DNA strands). Site: Ampulla
 SPERM/ OVUM = MEIOSIS
 23 male + 23 Female = 46 chromosomes
 Pairs: 23
 22 pairs of AUTOSOMES
 1 pair of SEX CHROMOSOMES.
 XX(FEMALE)
 XY(MALE)
 DNA: carries genetic traits
 Gene (100,000 genes in each cell nuclei)
 Genotype: (inside) ‘blood type, major organs, muscles
 Phenotype: (outside) ‘eyes, skin, hair
 AUTOSOME: characteristics
 HOMOZYGUS: same
 HETEROZYGOUS: different
 SEX CHROMOSOME: gender
 Copulation (sex)
 CAPACITATION- the female egg is penetrated/ thee is a penetration that is
happening.
 FERTILIZATION- THE UNION = ZYGOTE (7-8 days travel period - 14 days
fertilization)
 OVUM
 LINING:
 Zona pellucida
 Corona radiata
 Cumulus oophorus
 ZYGOTE starts to travel. They will travel to the uterus. As they travel they
undergo mitosis.
 MITOSIS: cell, division, it will produce dagther cells.
 Blastomere: 8 DC
 Morula: 16 DC
 Primary blastocysts: 54 DC
 Mature blastocycst: 120 DC or more
PREGNANCY PERIOD
Pregnancy:
Prenatal
OBSTETRICAL HISTORY
 Gravida Para Term Preterm Abortion Living
 Gravida: number of pregnany, irregardless of the result or outcome
 Current pregnancy (undelivered
 Delivered (Alive or Still Birth
 Abortion
 Multiple gestation ( twin, triplets) “ counted as ONE
 PRIMIGRAVIDA ( first time to be pregnant)
 MULTIGRAVIDA (2 or more pregnancy)

 PARA: pregnancy delivered / Current Undelivered pregnancy ( Not included)

: Pregnancy viable ( included)
: Abortion ( Not Included)
: Multiple Gestation (Counted as one)
*Ang babae na buntis currently pero hindi pa siya nanganganak,
kasali sa gravida at hindi sa para.
SIGNS OF PREGNANCY
 Presumptive (Subjective)- felt by the mother “ SX”
 A - AMENORRHEA ( Estrogen, Progesterone)
 B - Breast changes (e)
 C - Chloasma (e)
 D - Dark lines “ linea nigra” (e)
 E- Enlarge uterus
 F - Fatigue “ lassitude” (physiologic anemia)
 G - Go to the bathroom regularly (compression of the bladder) 1st = 3rd
 H - has NAUSEA & VOMITING ( HCG - relax of Sphincter Stomach)
 Q - Quickening ( first fetal movement = PRIMI 5 months // MULTI 4
months)
 S - Stretch mark

 PROBABLE (objectve) - observe by the health worker

 C - chadwiks sign (bluish discoloration of the VAGINA/ CERVIX)
 G - Goodles sign (softening Cervix)
 H - Hegar’s sign (softening of the uterus)
 B - Balottement (bouncing of the baby in the BOW)
 B - Braxton Hicks - there is an irregular contraction
 E - Enlarge abdomen “BUMP”
 E - Elevated BBT (progesterone)
 P - Positive Pregnancy Test ( HCG)
 Delayed for 7- 10 days (blood)
 Delayed 10-14 days (urine)

 POSITIVE (Diagnostics) - test to confirm. *Weight gain

 FETAL HEART RATE - 120- 160 BPM
 FETAL MOVEMENT - 10- 12 MOVEENTS IN 1-2 HOURS
 FETAL STRUCTURE
 FETAL OUTLINES

 FETAL HEART RATE - 120- 160 BPM (leopolds maneuver)

 2-3 months ( DOPPLER)
 4-5 months (FETOSCOPE)
 5-6 months (STETHOSCOPE)
 LEOPOLDS MAEUVER
 Done 5-6 months (2nd tri)
 Dorsal Recumbent (relax abdominal muscles)
 Empty the bladder
 Handwashing, warm hands
 Expose only the part
 Provide privacy.
 Fetal movement
 1. Fundal grip - presentation. Anong part ng baby ang nakakapa natin
sa lower segment.
i. Cephallic: head of the baby - put the stet on the lower segment
ii. Breech : buttocks of the baby - put the stet on the upper segment
or umbilical area
iii. Shoulder of the baby -

2. Umbilical grip - BACK AND EXTREMETIES

3. Pawliks/ pallach grip - ENGAGEMENT
i. Movable : Non engage
ii. Immovable: engage
4. Pelvic grip - attitude
i. Flexion (nakayuko) - place the stet at the back
ii. Extension (neutral or chin uo) - either back or chest
iii. Hyperextension ( nakatangad) - place the stet at the chest

 FETAL MOVEMENT
 After meal of the mother to check the fetal movement.
 Check for fetal distress. Para malaman kun in good condition si baby o
hindi. Less than 10 and more than 12 (distress). kailangan dalhin sa
emergency, it is fatal.

 DISCOMFORTS OF PREGNANCY
1. FATIGUE - related to physiologic anemia, and poor oxygen in the
brain.
i. Common itervention: rest/ sleep for 6-8 hours, nap atleast
30 mins.
ii. Avoid with unnecessary activities
iii. Take supplements like iron & vitamin c for the absorption
of iron. ( Liver or organ meats, green leafy vegetables.

2. NAUSEA & VOMITING (1ST TRI)

i. MORNING SICKNESS/ hcg - relaxes the stomach sphinc
( progesterone/ estrogen)
ii. Watch out for FLUID &ELECTROLYTE imbalance
1. Small frequent feeding - 5-6 times
2. Take crackers or cookies with milk - early
3. Ice chips - late
4. Upright position when feeding the patient to prevent
regurtation
5. Avoid stress, smoking, alcohol, fatty and oily food, spicy
foods, and medication like aspirin.
3. BREAST CHANGES - There is an increasing amount of estrogen.
i. Estrogen prepares the breast for possible breast feeding.
ii. Breast contains ACINAR CELLS to produce milk.
iii. PROLACTIN is the hormone for milk production.
iv. PREGESTERONE prevents the milk from release
v. OCYTOCIN is to let down reflex or ejection of milk.
a) WASH BREAST WITH WARM WATER AND
MILD SOAP
b) USE BRA LIKE COTTON AND WIRELESS TO
PREVENT DISCOMFORT
c)

4. CONSTIPATION - hormonal
i. Matigas ang tae kasi nagkarroon ng valsalva maneuver
( HYPOTENSION, BRADYCARDIA). CHANGES OF VITAL SIGNS.
1. INCREASE FLUID, FIBER AND AMBULATION

5.DIARRHEA - dehydration
i. ORESOL
ii. FLUIDS AND BRAT DIET. BANANA, RICE, APPLE AND
TOAST
INTRANATAL

 LABOR ( CHANGES)
 DELIVERY ( ACTUAL EXPULSION OF THE BABY
 Primi ( =1st time) = 14-20 hours
 PED PRIMI - NEED EFFACEMENT AND DILATION (NAG-
OOPEN ANG CERVIX NI MOTHER)
 More than 20 hours = DYSTOCIA - “oxytocin medication”
 M: exhaustion // F:fetal distress
 MULTI (2 OR MORE pregnancy) = 8-14 HOURS
 DEM SABAY ang DILATION AND EFFACEMENT
 Less than 3 hours ( precipitate) - “Tocolytic medication”
 M: laceration// F: fetal distress

 Cervical Dilation: surest sigh TRUE LABOR

 Bloody show: surest sigh of CD
 Internal examination every 4 hrs to prevent ascending infection
 Sterile technique ( handwashing, gloving and KJ)
 Do not IE(bleeding, discharge)
 TRUE
 W/ CERVICAL DILATION ( OPEN)
 BLOODY SHOW IS PRESENT
 Pain is radiating ( abdomen, lower back, thigh)
 Cotractions are aggravating
 Not relieved by rest and ambulation

 FALSE
 No cervical dilation (CLOSE)
 Discharges( Urine, Vaginal)
 Pain is confined in the abdomen
 Contractions are non-aggravating
 Pain relieved by rest and ambulation

LABOR AND DELIVERY THEORY

1. UTERINE STRETCH THEORY (HOLLOW ORGAN, EXPAND
STRETCHING CAN CAUSE CONTRACTIONS
2. OXYTOCIN THEORY: WHEN THE OXYTOCIN IS RELEASE FROM
THE PORTERIOR PITUITARY GLAND.
3. PROGESTERONE DEPRIVATION THEORY: UTERUS WILL STRAT
TO CONTRACT AND THIS IS WHAT YOU CALL LABOR
4. THEORY THE AGING PLACENTA: how placenta can release hormones;
if t is gradually dies hormones will decrease.\
i. THEY RELEASE ESTROGEN, PROGESTERONE, HCG AND
HPL
 5. PROSTAGLANDIN THEORY: the placenta, amnion, chorion deteriorate
releases ARAHIDONIC ACID (it stimulates the production of
PROSTAGLANDIN REACTION)

STAGES:
1. LABOR PROCESS - CONTRACTION WITH CD
i. PHASES:
1. LATENT : mild anxiety (concious, coherent, calm and
compose); 1-3cm
 Contractions: duration - 15 -20 secs
 Interval nd frequency - 5-15 mins
2. ACTIVE : moderate anxiety (in pain, selective attention span ;
4-7 cm
 Contractions: DURATION - 20-40 secs
 Interval and frequency - 3-5 mins
3. TRANSITION : severe anxiety( hysterical uncontrollable; 8-10
cm
 Contractions: DURATION - 40-60 secs
 Interval and Frequency - 1-3 mins
* DURATION IS HABA: START OF 1ST CONTRACTION TO THE END OF
THE SAME CONTRACTION
INTERVAL IS PAGITAN WHILE FREQUENCY IS DALAS NG CONTRACT
2. FETAL STAGE: FULL cervical dilation to complete delivery of the baby
i. MECHANISM OF LABOR : LEDFIRE ERE
3. PLACENTAL STAGE: complete delivery of the baby to the complete
delivery of the placenta.
i. 3 signs of placental separation
ii. 2 types placental delivery
iii. 2 techniques
4. RECOVERY
i. Keep the patient safe and stable

CARE DURING DELIVERY

STAGE 2 FETAL STAGE
 Full dilation - 10 cm
 Crowning
 Bulging of the perineum
 If there is contraction( we let the patient bear down
 Amniotomy- rupturing BOW
 Episiotomy - lacerate the perineum
 We let the head be delivered

 RITGEN’S MANEUVER - head and shoulder

  Once the head of the baby is delivered : suction “ promote airway”
 Check the neck “cord coil”
 Clamp and cut the cord
 We let the baby cry

 Complete CD to the expulsion of the baby. P-50 mins; M- 20 mins

 DSCENT
 Downward movement to the birth canal, continues engagement,
STATION
 Fetal Head is in the ISCHIAL SPINE
 Score (- or negative- above the ischial spine
 THE BABY IS FLOATING - MOVABLE
 Score 0 - at the level
 SCORE (+) below the ischial spine
 The baby is engage - immovable

 FLEXION (PAGYUKO NG BATA)

 Head noduling towards the chest
 SOB present through the birth canal
 INTERNAL ROTATION
 Fetus from occipitotransverse position to accpitoanterior position to
continues descent
 45- 90 degreess ANTERIOR ROTATION
 EXTENSION ( CHIN UP)
 Begins after crowning and completes as head passess under the
symphysis pubis, occiput, anterion fontanel etc.
 Pass over the sacrum, coccyx over the perineum
 RESTITUTION (REST PERIOD)
 Realignment of the fetal head with the body after the head emerges.

3RD STAGE : PLACENTAL DELIVERY

Complete delivery of the baby to the complete delivery of the placenta
3 signs of placental separation
CALKIN’S SIGN ( globular, rounded, contract)
LENGTHENING OF THE CORD (funis)

2 types Placental delivery

Shultz delivery : shiny, fetal side, separate MIDDLE, posterior
Duncan Delivery: dirty, maternal, separate MARGIN, anterior

2 techniques
OLD: Brandt andrews MANEUVER
NEW: Controlled cord traction with counter traction.
4th stage: RECOVERY PERIOD
Stabilization of the vital signs
Fever on th first 24 hours is NORMAL: DEHYDRATION(inc oral and iv
fluids)
Fever after 24 hrs: indication of infection

Hypovolemic shock

POSPARTAL PERIOD: from the2 hrs after the delivery until 6 weeks
B - BREAST : the acinar cells produce milk while prolactine is the hormones
that helps in the production of the breast milk of the mother
4th month: COLOSTRUM starts to develop.
Oxytocin stimulates the ejection of milk “let down reflex”
2 common concerns
 Engorgement : poor emptying of the breast
milk. (4th day) transition milk: full fluid,
vitamins, minerals
Encourage BF, manual pump (let
the baby drink)
 Mastitis : the breast is infected. Avoid bf on the
area that is infected. (do not let the baby drink),
antibiotic, pain reliever, antipyretic.
st
U - UTERUS : 1 12 hrs at the level of umbilicus.

After 1 days : 1 FB below the umblicus

After 8 days : 8 FB below the umbilicus
After 10-12 days : NON PALPABLE

NEED TO MONITOR
It should be at the midline : normal
It is deviated to the SIDE: you need to empty the
bladder of the patient.
If the uterus is contracted and hard : prevent
bleeding
If it is soft, boggy, relax, non-contracted: the patient
is prone to develop bleeding “UTERINE ATONY”
B - BOWEL (tae) : 2-3 days constipated
Increase fluid intake, fiber, ambulation.
B - BLADDER (ihi) : hematuria - blood in the urine of the patient.
1st 24 hrs - injury
Hematuria after 24 hrs maybe an indication of infection
L - lochia : there is a changes in color ; decidua VERA(lining: BMC)
Lochia rubra (red) - blood (MAKIKITA TUWING 1-5 DAYS AFTER
DELIVERY
Lochia serosa (pinkish to brown) - cells (5-10 DAYS AFTER THE
DELIVERY
Lochia alba (white) - mucus (10DAYS - 6 WEEKS)
***RULE***
NOT FOUL SMELLY

E - EPISIOTOMY - GOAL OF NURSE - PROPERLY MONITOR FOR THE

GOOD WOUND HEALING

S - SEX
NSD = 2 WEEKS PWEDE NA SIYA MAKIPAG-SEX
C/S = 6 MONTHS

H - HOMA’S SIGN
Indication of deep vein thrombosis (clot formation)
Dorsiflex lower extremety. If there is pain in the calf muscles
**do not massage**

H - HEMORRHAGE
Bleeding 1st 24 hrs : UTERINE ATONY
Bleeding after 24 hrs : RETAINED PLACENTAL FRAGMENTS

E - EMOTIONS
Taking in= we focus on the emotions of the mother/ concern to herself
Taking hold= nakafocus sa baby
Letting go = parenthood

ESTIMATES OF PREGNANCY
1. NAEGELES: EDC
2. MITTENDORF: EDD
3. MCDONALDS: AOG (weeks/ months)
4. HAASES RULES: Length
5. BARTHOLOMEWS : landmarks