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ROUTINE THE NURSE’S PRAYER ROUTINE Vision

MATERNAL AND CHILD HEALTH PRELIMINARIES – Dear Jesus, model and inspiration of the nursing profession, I know that when you PRELIMINARIES –
The school of choice of future healthcare professionals

Mission
NURSING CIRCLE TIME CIRCLE TIME
ascended into heaven you left the care of the sick to those of us whom you have blessed
To provide our clients with healthcare education of the highest order; our employees
with the holy vocation of nursing.
with a rewarding and fruitful working environment; our partners with mutually

Obstetric History and Examination Help me to be faithful to the calling so I can always do the things that you want me to do
in the way you want me to be.
beneficial relationships; and our stockholders with a viable sustainable enterprise
Core Values
L-LIBERTY TO LEARN
The exercise of academic freedom. The liberty to explore, to innovate, to advance the
Grant that my voice may be gentle, that my hands may have the softness and sympathy search for knowledge.
of your hands that my presence may bring something of the hope and consolation, which
your presence brought the sufferers of your day. I- INTEGRITY
Adherence to rules on acceptable conduct. Standing upright to uphold what is right.
GERALDINE I. BRITO RN, LPT, MAEM(CAR) I want to do all these things dear Lord, but I know that I am weak. I can do little
F-FORTITUDE
without your aid. Please give aid this day and every day of my life so I can always be,
CLINICAL INSTRUCTOR Strength of character. Courage in the face of adversity.
what I know you wantme to be... an angelin the sick room.
DAVAO DOCTORS COLLEGE Amen. E-EXCELLENCE
Performing to attain results of the highest order in everything we do.

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Introduction
ROUTINE ALMA MATER SONG (DDC Hymn)
By Henry Oh ROUTINE CHECKING OF ATTENDANCE
PRELIMINARIES – We live in this world but once
Face whatever challenge we can
PRELIMINARIES –
CIRCLE TIME In every chance we learn and grow
Let’s make each day a worthy day.
CIRCLE TIME • Maternal and Child Health refer to philo-mother
Oh, Dearest Alma Mater and child relationship to one another and
Thou has led us through the years
We dedicate ourselves to thee consideration of the entire family as well as the
For thou has offered us the best

Refrain:
culture and socio-economic environment as
Davao Doctors College
To you, we pledge our loyalty
framework of the patient.
Davao Doctors College
Through you, we serve humanity
Please turn ON your MIC AND
Beloved Alma Mater
Your memory will live.
CAMERA when your name is called
Reach out our hands to those in need to be recognized • It involves the care of the woman and family
(178) DDC HYMN - DDC Koro Harmonika Virtual Choir
To every man who’s weak and tired
Let’s show our love and share our time
throughout pregnancy and childbirth and the health
- YouTube
And lead the way to unity.

(Repeat Refrain)
promotion and illness care for the children and
families.

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Goal of MCH PRIMARY GOAL OF MCHN:

 Promotion and maintenance of optimal
• To ensure that every expectant and nursing mother family health
maintains good health, learns the art of child care,
has normal delivery and bears healthy child.

• That every child, wherever possible lives and grows

up in a family unit with love and security, in healthy
surroundings, receives adequate nourishment,
health supervision and efficient medical attention,
and is taught the elements of healthy living (Reyala,
2000).

• Promotion and maintenance of optimum health of

the women and newborn.

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Philosophy of MCN
Is community-centered
Is research-centered
Is based on nursing theory
Protects the rights of all family members
Uses a high degree of independent
functioning
Places importance on promotion of health
Is based on the belief that pregnancies or
childhood illness are stressful because they
are crises.
Is a challenging role for the nurse and is a major
factor in promoting high level wellness in families.
Pregnancy, labor and delivery and the puerperium
are part of the continuum of the total life cycle.
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Personal, cultural and religious attitudes
and beliefs influence the meaning of
pregnancy for individuals and make each
experience unique.
Maternal-child nursing is family centered. The
father of the child is as important as the
mother.
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Maternal Neonatal and Child Health and

Nutrition Strategy (MNCHN)
🞅 It applies specific policies and actions for local
health systems to systematically address health
risks that lead to maternal and especially neonatal
deaths which comprise half of the reported infant
mortalities.
BeMONC- Basic Emergency Obstetrics and 🞅 Performance of assisted vaginal deliveries
Newborn Care 🞅 Removal of retained placental products
🞅 Manual removal of retained placenta
It refers to lifesaving services for emergency maternal and
newborn conditions/complications being provided by a health
facility or professional to include the following services: It also includes neonatal interventions which include
at the minimum:
🞅Administration of parenteral oxytocic drugs. 🞅 Newborn resuscitation
🞅 Provision of warmth
🞅Administration of dose of parenteral anticonvulsants
🞅 Referral
🞅Administration of parenteral antibiotics
🞅 Blood transfusion
🞅Administration of maternal steroids for preterm labor

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🞅BeMONC facility shall consist of the core district
hospital.
🞅For geographically isolated/disadvantaged areas/
densely populated areas, the designated BeMONC
facilities are the following: Rural Health Unit,
Barangay Health Station, Lying-in Clinics and
Birthing Homes.
🞅Accessibility within 1 hour from residence or
referring facility within the ILHZ (Inter-local
Health Zones)
🞅 Shall operate within 24 hours with 6
signal obstetric function.
🞅 Shall have access to communication
and transportation facilities to mobilize
referrals.
🞅 Staff composition: (1) Medical Doctor,
(1) Registered Nurse, (1) Registered
Midwife.
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CeMONC- Comprehensive
Emergency Obstetrics and
Newborn Care facility
- Refers to lifesaving services for emergency
maternal and newborn conditions/complications
as in Basic Emergency Obstetric and Newborn
Care plus the provision of surgical delivery and
blood bank services and other specialized
obstetric interventions.
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Essential Health Services available in the Health
Care Facilities
A. Antenatal Registration/ Prenatal Care
OBJECTIVE: to reach all pregnant women, to give sufficient care
to ensure a healthy pregnancy and the birth of a full term healthy
baby.
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🞅Patients with potentially serious complications-
these patients shall be referred to the most skilled
🞅Normal Patients- following the initial evaluation source of medical and hospital care. As a first
they will be given healthy instructions and choice they will be referred if at all possible for
counseling. This will include advice for prompt continuing care or consultation. Second choice will
prenatal care examination. be followed carefully by the rural health unit, city
health clinic or puericulture center.
🞅Patients with mild complications- a thorough
evaluation of the needs of patients with mild
complications will determine the frequency of
follow-up of these cases by the rural health unit,
city health clinic or puericulture center
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🞅All RHUs and BHS should have a masterlist of
pregnant women in their respective catchment center.
🞅The Home Based Mother’s Record (HBMR) shall be
used when rendering prenatal care as a guide in in the
identification of risk factors, danger signs and to be able
to do appropriate measures.
🞅There should be atleast 3 prenatal visits following the
prescribed timing:
🞅First prenatal visits should be made as early in
pregnancy as possible, during the first trimester.
🞅Second during the second trimester
🞅Third and subsequent visits during the third trimester.
🞅More frequent visits should be done for those at risk
or with complications.
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Tetanus Toxoid Immunization
🞅 Neonatal tetanus is one of the public health concerns, that is
why it is important for pregnant women and child bearing age
women to get a tetanus toxoid immunization in order to protect
them from this deadly disease.
🞅 A seriesof 2 doses of TT vaccination must be received by
woman one month before delivery to protect baby from
neonatal tetanus.
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Micronutrient Supplementation Clean and Safe Delivery

A. Check for Emergency signs
🞅 It is necessary to prevent anemia, vitamin A deficiency and other nutritional
disorders. 🞅Unconsciousness

Vitamin A 🞅Vaginal bleeding

🞅 And the three booster dose shots to complete the five 🞅 Dose: 10,000 IU
🞅Severe abdominal bleeding
doses following the recommended schedule provides 🞅 Given a week starting on the 4th month of pregnancy.
🞅Looks very ill
full protection. The mother is then called as a “Fully 🞅 Do not give it before the 4th month of pregnancy because it might cause
Immunized Mother” (FIM). congenital problems in the baby. 🞅Severe headache with visual disturbance
Iron 🞅Severe breathing difficulty
🞅 Dose: 60mg/400 ug tablet
🞅Fever
🞅 Schedule: Daily
🞅Severe vomiting

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B. Made woman comfortable G. Inform, counsel and teach woman

D. Determine the stage of labor
C. Assess the woman in labor E. Decide of the woman can safely deliver 🞅Birth registration
🞅LMP 🞅Importance of breastfeeding
F. Give supportive care throughout labor
🞅Number of pregnancy 🞅Newborn screening
G. Monitor and manage labor
🞅Start of labor pains 🞅Schedule of postpartum visits. (1st visit: 1st week
H. Monitor closely after delivery
🞅Age/height postpartum preferably 3-5 days and 2nd visit: 6
I. Continue care for at least two hours postpartum weeks postpartum)
🞅Danger signs of pregnancy

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Home Delivery
The following are qualified for home delivery:
🞅Full term 🞅 No historyof difficult delivery and prolonged labor (more
It is for normal pregnancies attended by licensed health personnel. than 24 hours for primi and more than 12 hours for
Trained hilots may be allowed to attend home deliveries only in 🞅Less than 5 pregnancies multigravida)
the following circumstances: 🞅Cephalic position 🞅No previous cesarean section
🞅Areas where there are no health personnel on maternal care. 🞅 Without existingdiseases such as diabetes, bronchial 🞅Imminent deliveries (those who are about to deliver and can
🞅When, at the time of delivery, such personnel is not available. asthma, heart disease, hypertension, goiter, tuberculosis, no longer reach the nearest facility in time for delivery)
severe anemia.
🞅No premature rupture of membranes
🞅 No historyof complications like hemorrhage during
Actively practicing but untrained birth attendants (hilots) should 🞅Adequate pelvis
previous deliveries.
be identified, trained and supervised by a personnel of the nearest
🞅 Abdominal enlargement is appropriate for age of gestation.
BHS/RHU trained on Maternal Care.

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Home delivery kit must atleast contain two pairs
of clamps, a pair of scissors, antiseptic (may use
70% Povidone/Iodine) soap and hand brush,
clean towel/piece of cloth, flashlight,
sphygmomanometer, stethoscope.
Clean hands, clean surface and clean cord must
be strictly followed to prevent infection.
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Guide for home delivery:
Delivery in Healthy Facility
🞅For registered patient: time when regular pains 🞅At
lying-in clinics, Birthing Homes or within the
started, whether bag of water ruptured or not, presence BHSs/RHUs.
of absence of vaginal discharges, bleeding, etc.,
whether mother moved her bowels and has urinated,
fetal movement felt by the mother or not, unusual
🞅Normal pregnancies and with labor progressing
symptoms such as bleeding, headache, spots before
eyes. normally must be encourage to deliver in this
facility.
🞅 For unregistered patients: get same information as
for those registered patients and get medical and
obstetric history.
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Delivery in Hospitals Apgar Scoring

🞅Hypertensive disorders of pregnancy and
Eclampsia 🞅It provides a valuable index for evaluation of the
Risk pregnancies should be advised to deliver in the hospital
are the following: 🞅Cephalo-pelvic disproportion infant’s at birth. It is based on five signs ranked in
🞅Pregnancy more the 4 order of importance as follows: Heart Rate,
🞅Placenta previa and abruption placenta
Respiratory Effort, Muscle Tone, Reflex Irritability
🞅Previous CS
🞅Multifetal pregnancy and Color. In general, they made 1 minute of life and
🞅 History of postpartum hemorrhage 5 minutes. Each signs is evaluated according to the
🞅Post term and preterm pregnancies
🞅 History of medical illnesssuch as heart disease, goiter, degree to which it is present and is given a score of 0,
tuberculosis, diabetes, severe anemia, hypertension, 🞅Previous uterine surgery such as myomectomy. 1 and 2. The scores of each sign is added together to
bronchial asthma give a total scores (10 is the maximum).
🞅Antepartum hemorrhage

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Newborn Screening
🞅It is a public health program aimed at the early
identification of infants who are affected by certain
genetic/metabolic/infectious conditions. Early
identification and intervention can lead to significant
reduction of morbidity, mortality and associated
disabilities in affected infant
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Significance:
Procedure:
🞅 Most babies with metabolic disorders look “normal” at
birth. By doing NBS, metabolic disorders may be
🞅 A few drops are taken from the baby’s heel, blotted on a special
detected even before clinical signs and symptoms are
present. And as a result of this, treatment can be given absorbent filter card and then sent to the Newborn Screening
early to prevent consequences of untreated conditions. Center (NSC). The blood samples for Newborn Screening (NBS)
may be collected by any of the following: physician, nurse,
medical technologies or trained midwife. The procedure costs
Timing: P550. The DOH advisory Committee on Newborn Screening has
approved a maximum allowable fee of P50 for the collection of
🞅 It is ideally done on the 48th-72nd hours of life. However, the sample. Newborn Screening is now included in the Philhealth
it may also be done after 24 hours from birth. Newborn Care Package. It is widely available in hospitals, Lying-
ins, Rural Health Unit, Health Centers, and some private clinics. If
babies are delivered at home, babies may be brought to the nearest
institution offering newborn screening.
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🞅Results can be claimed from the health facility where
NBS was availed. Normal NBS results are available
by 7-14 working days from the time samples are
received at the NSC. Positive NBS results are relayed
to the parents immediately by the health facility. A
NEGATIVE SCREEN MEANS THAT THE NBS IS
NORMAL.
🞅 A positive screenmeans that the newborn must be
brought back to his/her health practitioner for further
testing. Babies with positive results maybe referred at
once to a specialist for confirmatory testing and
further management.
Disorders detected in Newborn
Screening
Phenylketonuria
🞅 it is the inability to metabolize the amino acid
phenylaline, which is a common component such a milk.
Excessive accumulation of phenylalanine in the blood
causes brain damage. The babies may look like “albino”
with musty odor of the skin, hair, sweat and urine. PKU is
treated with a special low-phenylalanine diet which the
amount of amino acid is carefully regulated.
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Congenital Hypothyroidism
🞅most common causes of mental retardation. Most
affected infants may look normal at birth, however,
they may have large fontanels and tongues, big
tummies and prolonged yellowish discoloration of the
skin and eyes. Infants are treated with thyroid
hormones and it continues throughout life. If the
disorder is not detected and hormone replacement is
not initiated within two weeks, the baby with CH may
suffer fro mental and growth retardation
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Galactosemia
🞅it is the absence of enzymes necessary for
conversion of the milk sugar galactose to glucose.
Affected infants present with difficulty in
feeding, vomiting and diarrhea, yellowish skin
and eyes, weakness, white eyes (cat’s eyes) and
bleeding after blood extraction. Accumulation of
excessive galactose in the body may cause liver
damage, brain damage and cataracts. Treatment
may include elimination of milk from the diet
and use of milk substitute.
Glucose 6 phosphate dehydrogenase deficiency
(G6PD deficiency)
🞅the body lacks the enzyme called G6PD that may
cause hemolytic anemia, when the body exposed to
oxidative substances found in certain drugs, foods
and chemicals. Children become pale, with yellow
skin and eye, tea colored urine and fast breathing. It
may lead to heart failure.
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Support to Breastfeeding
Motivate ,mothers to practice breastfeeding
A. The Rooming-in and Breastfeeding Act of 1992
🞅 To encourage, protect and support the practice of breastfeeding. It shall create an
environment where the basic physical, emotional and psychological needs of mothers
and infants are fulfilled.
B. Milk Code of 1986
🞅 The aim of this code is to contribute to the provision of safe and adequate nutrition for
infants by the protection and promotion of breastfeeding and by ensuring the proper
use of breast milk substitutes and breastmilk supplements when these are necessary,
on the basis of adequate information and through appropriate marketing and
distribution.
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Family Planning Counseling Key points APPROACH TO AN OBSTETRIC PATIENT

🞅Proper counseling of couples on the importance of family
planning will help them inform on the right choices of ■ Introduce yourself using the full name .

family planning methods, proper spacing of birth and

addressing the right number of children. Birth spacing of
three to five years interval will help completely develop
the health of a mother from previous pregnancy and
childbirth. The risk of complications increases after the
second birth.
■ Explain what would you like to do and gain her consent. INVESTIGATIONS
■ Ensure the patient is comfortable and warm.
EXAMINATION
■ Do not do vaginal or breast exam. alone.
■ All information's are confidential.

HISTORY

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HISTORY Personal History- 1 Terminology

■ History taking is an ART : ■ N→ Name

Gravida x, para a+ b
- Logical sequence ■ A→ Age x = total number of pregnancies including this one
- Avoid inadvertent omission of important details.
■ S→ sex XXXXXXXXXXXXX
■ O → Occupation a = number of births beyond 24 weeks
- Guide examination.
■ M→ Marital status
■ Since pregnancy is a “normal” occurrence, the usual ■ R→ Residency (Address) b= number of pregnancies terminated befor 24 weeks
format of the clinical history should be modified. ■ H→ Special Habits
■ History of past pregnancy may alter the outcome of ■ G→ Gravidity
current pregnancy. ■ P→ Parity

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CHIEF COMPLAINTS- 2
 The husband reported that they have been planning to have a baby since they lost
Chief complaint with
duration in chronological order
in patient own words
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their firstborn on Angela’s 7th month of pregnancy due to stillbirth, 3 years ago.
According to Angela, it was devastating for both of them since it should have been
1. AMENORRHOEA:
the first grandchild in their family. She was blaming herself at that time because Expressed in weeks, Calculated from LMP
she was thinking she was not being careful during her pregnancy and continued
Diagnosis of pregnancy confirmed???
to work in their store. Her husband said “Cge man gud sad sya karga karga ug
bug-at ato Ma’am kay gabaligya mi ug mga softdrink ba. Sa tanaw nako mao
gyud to dahilan sa pagkawala sa bata”. Angela then said “Guol bitaw ko ato HISTORY OF DATING
ma’am kay nabasol jud ko ato sa ako pamilya kay nag tuga-tuga daw ghapun ■ Naegele̕ s ILLNESS-
PRESENT rule (EDD= LMP +9M+7D)
ko ug trabaho.. Wala man gud lain masugo.” When asked further details about
For accurate estimation:
the stillbirth, Angela said “Naipit man daw sad ang tubo sa pusod ma’am ingun 3
pa si Doc, giingnan bitaw nako ako bana, ginabasol ghapun ko”. The copy of - Menses – regular, average length, sure
documentation from the previous pregnancy was handed over to the nurse and it
- No recent use of COC pills.
revealed that in her ultrasound, no FHT was detected after complaints of no fetal
movement felt at 8th month. She delivered via NSVD after induction of labor.
■ Obstetric calendar (wheel)
■ First trimester ultrasound scan
■ Later ultrasound scan
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HISTORY OF PRESENT ILLNESS- 3

2. SYMPTOMS RELATED TO PREGNANCY: 4. PAIN ABDOMEN: 5. BACKACHE:

■ NAUSEA & VOMITING
■ FREQUENCY OF MICTURATION
HISTORY OF
■ CONSTIPATION
■
PRESENT ILLNESS-
HEAVINESS IN THE BREAST
■
3
RISE OF TEMPERATURE
3. ANKLE EDEMA:
PRESSURE DUE TO GRAVID UTERUS
? HTN, ??? Protein Urea
LABOUR PAIN
ABRUPTIO PLACENTAE
PRE-ECLAMPSIA TOXEMIA
DEGENERATION OF MYOMA
ACUTE URINARY RETENSION
TORSION OF OVARIAN CYST
ACUTE CHOLECYSTITIS
Increase in body weight
HISTORY OF
Hyperextension of the spine
Laxity of joints in pelvis and spine
PRESENT ILLNESS-
6. VAGINAL 3
BLEEDING:
- Implantation Hemorrhage,
- Early pregnancy : Abortion, Ectopic Pregnancy, V.mole,
- Late pregnancy: Placenta Previa, Abruptio Placenta, Vasa previa

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7. Decreased FETAL MOVEMENT: 10/ 12 hrs

9. VAGINAL DISCHARGE: Pregnant female for ( weeks) as her LNMP ( / / ) and EDD ( / / ) and
PRIMI: 18 weeks ■

RUPTURE OF MEMBRANE pregnancy is confirmed by pregnancy test since( / / )

MULTI: 16 weeks
PHYSIOLOGICAL LEUCORRHOEA
HISTORY OF HISTORY OF
CANDIDIASIS
■
HISTORY OF
Analysis of the complaint ( onset, course duration)

PRESENTENLARGEMENT
ILLNESS- PRESENT ILLNESS- PRESENT ILLNESS-
■ History of current pregnancy
8. Excessive OF THE ABDOMEN: CERVICITIS ➔ details of the 1 ,2 & 3 trimester
st nd rd

3
Multiple pregnancy , 3 3
➔ admission and examination
Hydramnios, 10. HISTORY OF TT/ IRON+ CA SUPPLIMENT ➔ Investigations : lab tests & U/S scans pattern
accidental hemorrhage, ➔ the expected management
Macrocosmia,
➔ System review
Miscalculation.

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Past obstetric history-5 Past medical/ surgical H-6

Menstrual & gynecological history- 4
- Some medical conditions may have impact on the course of
Gravidity, Parity the pregnancy or the pregnancy may have an impact on the
■ Cycle :
Outcomes
-1st day of LNMP ( was it conform to the usual in terms of :medical condition examples
timing, volume, and appearance) □ Gestational age: abortion, preterm, term
- Regularity □ Delivery ■ Heart disease Kidney disease
- Length ■
□ Date ■ Hypertension ■ UTI
- OCP use. ■ Dm
□ Mode
■ Autoimmune disease
■ Surgical procedures
■ Epilepsy ■ Psychiatric disorders
■ Hx of infertility □ Place ■ Thyroid disease ■ Hepatitis
■ Sexually transmitted diseases ■ B asthma
□ Infant : sex ,weight, wellbeing ■ Venereal diseases
■ Uterine anomalies ■ Any previous surgery. ■ Blood transfusion
□ Complications

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OBSTETRIC HISTORY Key points

■ 7 Drug history and allergy. ■ Wash your hands

■ 8Social Hx → Cigarette smoking, illegal drug use, domestic ■ Introduce yourself using the full name .
violence, psychiatric illness specially in postnatal period. Explain what would you like to do and gain her consent. patient
OBESTETRIC PHYSICAL EXAM
■
■ 9 Family Hx to empty the bladder .
- Hereditary illness → DM., Hpt., thalassemia, sickle cell
■
disease, hemophilia
-Congenital defects eg. neural tube defects, Down ■ Do not do vaginal or breast exam. alone.
syndrome Ensure the patient is comfortable and warm.
■
-Twins

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Key points EXAMINATION

■ General ■ Specific
■ For abdominal exam: Uncover the patient’s abdomen
■ General of the general
from the xiphi sternum to the pubic hairline, .
□ Abdominal ( ???)
Abdominal wall relaxation is maximized by (arms ■ Local of the general
along side and hips slightly flexed) □ Breast □ Pelvic
□ Chest
■ Advise the mother to indicate if she should feel weak
□ Abdominal
or nauseous.
□ Heart

■ All information's are confidential. □ Back

□ Lower limbs

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General exam General exam Blood pressure

■ GENERAL PHYSICAL EXAMINATION : VITAL SIGNS :
■ Blood pressure: seated, semi-recombent.
APPEARANCE, HEIGHT, WEIGHT ,Body Mass Index
MODE, MEMORY, INTELEGENCE, PULSE each visit.
ORINTATION (TIME ,PLACE AND PERSONS) BLOOD PRESSURE HTN : BP > 140/90 mm Hg on 2 separate
GAIT RESPIRATORY RATE occasions 6 H apart and less than 7 days using 5th
DECUBETUS , chloasma
TEMPERATURE Korotkoff sounds .
Head, eyes, ears, nose & throat → no changes
Thyroid → diffuse enlargement ■ BREAST EXAMINATION < 20 wks Chronic HTN .
■ PALLOR, ICTERUS, LYMPH NODES, CYANOSIS, ■ Chest ,heart
CLUBBING, OEDEMA, DEHYDRATION > 20 wks Gestational HTN.
■ Ophthalmoscopy ➔hypertensive /diabetic women PET.

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Abdominal exam Abdominal exam : Specific palpation

■ Semi-recumbent position.
■ Cover legs with sheet.
* Fundal height → Palpate before 20 wks( fundal level) +
■ Inspection:  2-Palpation:

- Shape of uterus .  Superficial palpation: → Measure after 20 wks (Symphysis-fundal height)

- Any asymmetry. ■ Lie Temp

* Leopold's maneuvers
erature, Tenderness,
- Look for fetal movements. ■ Presentation
Gardening. 1. Fundal grip
- Look for scars ■ Engagement
 Specific palpation:
- Hernia orifices. ■ Fetal back 2. Lateral grip

- Cutaneous signs of pregnancy → linea nigra,

■ Liquor 3. First pelvic grip. PAWLIK’S GRIP
striae gravidarum, striae albicans, umbilicus flat or ■ Contractions
4. Second pelvic grip :
everted, superficial veins

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Symphysis-fundal height
Symphysis-fundal height MEASUREMENT

■ A), First maneuver. One or both hands are placed over fundus and the fetal part
identified.
■ (B), Second maneuver. The palmar surface of one hand is used to locate the back of
the fetus and the other hand to feel the irregularities, such as hands and feet.
■ (C), Third maneuver. Thumb and third finger are used to grasp presenting part over
the pubic symphysis.
■ (D) , Fourth maneuver. Both hands are used to outline the fetal head .

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Abdominal exam :Vaginal examination Vaginal examination

➔ Vulva and perineum:
3 Ascultation of fetal heart ➔
PRE-REQUISITS:
*Site: anterior fetal shoulder . ■ Hyper pigmentation
Contraindications :
*Time: ■ EXPLANATION
■ Look for abnormalities ➔ Varicose veins/ hemorrhoids,
■ Placenta praevia.
- 12 wks by sonicade ( US Doppler device) ■ EMPTY BLADDER
Warts or herpes
- 24 wks by Pinard steoscope ■ DORSAL POSITION ■ Prelabour rupture of

* Duration: rate ,rhythm over 1 min. ➔ Cx : Softer, pigmented with ➔ thick ,  yellowish
■ FULL ASEPSIS membranes
mucous secretions
■ Equipment are present
4-Percussion ➔polyhydramnious ➔ballotment & fluid ➔ Uterus : enlarged
thrill

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Pelvic assessment

■ Check ischial spines if prominent or not

■ Diagonal conjugate ➔distance from lower border of the

symphysis pubis to the sacral promontery (pelvic inlet)

■ Shape of the sacrum

■ Side walls of the pelvis

■ Distance between the two sacral promonteries

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