Module 2 | BSN 2 1st Semester

MATERNAL & CHILD NURSING

Care of Mother and Fetus During Antenatal Period
Lecturer: Mildred G. Glinoga, PhD, MAN, RN, RM

NSERT SPA FON

OUTLINE
● Growth of Pubic Hair
I. Unitive and Procreation A. Process of Human ● Onset of Menstruation
II. Pubertal Development Conception
● Growth of Axillary Hair
A. Secondary Sex B. Stages of Fetal
Characteristics Growth and ● Vaginal Secretions
III. Reproductive System Development ○ Clear: fertile
A. Female Reproductive VII. Fetal Circulation ○ White and Sticky: not fertile
System VIII. Signs of Pregnancy ○ Yellowish/Greenish: possible sign of STIs
B. Male Reproductive IX. Perinatal Exercises
System A. Tailor Sitting
MALE SECONDARY SEX CHARACETRISTICS
IV. Human Sexuality B. Squatting
V. Menstruation C. Kegel’s Exercise ● Increase in weight
A. Functions of Estrogen D. Abdominal Muscle ● Growth of testes
and Progestin Contractions ● Growth in face, axillary and pubic hair
B. Physiology of E. Pelvic Rocking ● Voice changes
Menstruation F. Pelvic Tilt
● Penile growth
C. Menstrual Cycle G. Sit-ups
VI. Fertilization, Implantation and H. Pelvic Floor Sitting ● Increase in height
Pregnancy I. Adductor Lengthening ● Spermatogenesis
SPACE FONT2

I. UNITIVE AND PROCREATION III. REPRODUCTIVE SYSTEM

● The 1983 Code of Canon Law 2 A. FEMALE REPRODUCTIVE SYSTEM
○ It highlights marriage not only as a natural institution but as a EXTERNAL REPRODUCTIVE SYSTEM
sacrament in the service of communion and holiness
● The Goods of Marriage ● Mons Veneris - protects pubic symphysis
○ Offspring - fruitfulness of union ● Labia Minora - hairless skinfold
○ Fidelity - loyalty and commitment ● Labia Majora - fatty skin fold; protects internal genitalia
○ Sacrament - two people united into one to guide their children ● Vestibule
accordingly ● Clitoris - erectile tissue; sensitive to touch and temperature
● 2 Essential Properties of Marriage ● Skene’s Gland
○ Unity ● Fourchette
○ Indissolubility ● Hymen
● Bartholin’s Gland- lubricates vulva
II. PUBERTAL DEVELOPMENT
● Puberty
○ Stage of life where secondary secondary characteristics begin INTERNAL REPRODUCTIVE SYSTEM
● Androgen ● Vaginal Canal - 3 to 6 inches; lined with epithelial cells
○ Hormone responsible for muscular development, physical growth ○ LEUKORRHEA - vaginal discharges
and increase in sebaceous gland secretion for both male & ○ Organ for copulation
female ○ Passageway of products of conception
● Estrogen ● Uterus
○ Hormone that influences the: ○ Body/Corpus - uppermost part that expands during pregnancy
■ Development of the uterus ○ Isthmus - passageway that is commonly cut during Cesarean
■ Fallopian tubes and vagine Section
■ Fat distribution and hair patterns ○ Cervix - lowest portion; passageway during delivery; the neck of
■ Breast development (thelarche) uterus
■ End of growth (closes the epiphyses of long bones) ○ Layers of Uterus:
■ Endometrium- important in menstrual function; influenced by
A. SECONDARY SEX CHARACTERISTICS estrogen & progesterone; site of implantation
FEMALE SECONDARY SEX CHARACETRISTICS ■ Myometrium - muscle layer of the uterus; construct tubal
junctions & prevent regurgitation of menstrual blood; consists
● Growth Spurt of smooth muscle ; stimulated when mother is in labor
● Increase in Transverse Pelvic Diameter ■ Perimetrium - add strength and support to the uterus
● Breast development

NCM107 Transcribers: Castaneda, De Guzman, Nicolas, Soriano Page 1 of 10

 ○ Uterine Deviations: ● Dysmenorrhea
a. Anteversion- fundus is tipped forward; ideal ○ Painful menstruation – related to prostaglandin
deviation ● Metrorrhagia
b. Retroversion - fundus is tipped backwards ○ Bleeding in between menstruation (>300-500 mL of blood)
c. Anteflexion - body of the uterus is bent sharply ○ Possible cause: underlying problem in the reproductive system,
forward abnormal growth of tissues in the uterus
d. Retroflexion - body is bent sharply back just ● Menorrhagia
above the cervix ○ Excessive of heavy bleeding which can cause anemia
● Fallopian Tubes- convey the ovum from ovaries to the uterus; site ● Amenorrhea
of fertilization; divided into interstitial, isthmus, ampulla, and ○ Absence of menstruation
infundibulum. ● Menopause
○ Ampulla- common part where fertilization specifically occurs ○ Cessation of menstruation (average age is 51 years old)
● Ovaries
○ Produces, matures, and discharges egg cells A. FUNCTION OF ESTROGEN AND PROGESTIN
○ Produces estrogen and progesterone that initiates menstrual ESTROGEN – “Hormone of the Women”
cycles
● Primary Functions
B. MALE REPRODUCTIVE SYSTEM ○ Development of secondary sex characteristics in female
○ Inhibits production of Follicle Stimulating Hormone (FSH)
EXTERNAL REPRODUCTIVE SYSTEM
■ FSH is released by the pituitary gland for forced maturity of
● Scrotum - supports testes and helps regulate temperature of sperm the ova
● Testes - has Leydig’s cells (testosterone) & seminiferous gland ○ Responsible for hypertrophy of myometrium
● Penis ■ Steroids is secreted in both sexes by the adrenal cortex
■ In women, by the ovary (main source) and placenta
● Main Effects that occur at Puberty
IV. HUMAN SEXUALITY
● Sex ○ Breast growth
○ Refers to whether a person is maloe or female, whether a person ○ Fat deposition in the vulva
has penis or vagina ○ Bony pelvis growth and broadening
○ Commonly used as an abbreviation to refer to sexual intercourse ○ Vaginal epithelial changes
● Sexuality ○ General growth
○ Refers to the total expression of who you are as a human being ○ Produce cyclic changes in the uterine endothelium and
○ An integral part of human vaginal epithelium
○ Essential to the continued existence of humanity ■ Levels of estrogen decreases during menstruation
○ Responsible for the increased osteoblastic activity of long
● Human Sexuality Components
bones causing an increase in height
○ Human Development
○ Responsible for Spinnbarkeit and Ferning (Cervical Mucus
○ Sexual Health
or Billing’s Method)
○ Relationships and Emotions
■ Spinnbarkeit - clear, slippery texture of an uncooked egg
○ Sexal Behavior
whote, typical of cervical mucus during ovulation
○ Sexual Violence
■ Ferning - test for the presences of estrogen in the cervical
mucus ; estrogen causes cervical mucus to dry on a slide in a
V. MENSTRUATION
fern like pattern
● Definition: ■ Billing Method - a method of estimating ovulation time by
○ An episodic uterine bleeding changes in the mucus of the cervix that occurs during
○ A response to cyclic hormonal changes - hormones can menstrual cycle
decrease or decrease ○ Responsible for the development of ductile structure of the
○ Allows conception and implantation breast
○ Brings an ovum to maturity and renew uterine tissue bed due to ○ Responsible for early closure of epiphysis of long bones
production of different hormones ○ Responsible for increased sexual desire in female
○ Usually occur as early as 8-9 years – as late as age 17 ○ Responsible for increased vaginal lubrication
○ Length of the normal cycle is 28 days, but may still vary ■ In female, estrogen and bartholin’s gland
○ Length of menstrual flow: 4-6 days (average) ■ In male, prostate gland
○ Amount of mens excreted: 30-80 ml per menstrual period ○ Responsible for sodium retention therefore causing weight
(1ml=1gm) gain
■ Saturated napkin for 1 hour – heavy bleeding
PROGESTIN OR PROGESTERONE – “Hormone of the Mother”
RELATED TERMINOLOGIES
● A steroid hormone
● Menarche ● Known as the hormone of pregnancy
○ 1st menstruation ● Promotes development of placenta and mammary glands
○ occurs on the average of 11-14 years old (as early as 8, as late
● Responsible for increased basal body temperature
as 17)
● Responsible for mood swings of the woman

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● Primary Function
○ Prepares the endometrium for the implantation of fertilized ovum VI. FERTILIZATION, IMPLANTATION AND PREGNANCY
● Secondary Functions HORMONAL REGULATION OF PREGNANCY
○ Inhibits uterine contractility
■ Once levels of progestin is decreased, we supplement more ● Estrogen
of the hormone to prevent miscarriage THUS, estrogen is ● Progesterone
decreased during pregnancy because it allows uterine ● Relaxin- softens the pelvic bone
contractitlity ● Human Chorionic Somatomammotropin (HCS)
○ Inhibits production of Luteinizing Hormone
■ That’s why we don't menstruate during pregnancy CONCEPTION
○ Decreased GIT mobility leading to constipation
● Conception happens when there are meet-ups of the egg and the
sperm cell.
B. PHYSIOLOGY OF MENSTRUATION
● It takes place at the ampulla of the fallopian tube (outer third).
● Hypothalamus
● It is the union of an ovum and spermatozoon.
○ Initiates menstruation by releasing Gonadotropin Releasing
● Also called as fertilization or impregnation
Hormone (Luteinizing Hormone Releasing Hormone)
● Pituitary Gland
IMPLANTATION
○ Known as the ‘master clock’
○ The anterior pituitary gland releases FSH and LH. ● It is the contact between the growing structure and uterine
■ FSH- responsible in ovum maturation endometrium.
■ LH- involved in ovulation and growth of the uterine lining ● Occurs eight to ten days after fertilization
● Ovaries
○ Contains primordial cell activated by the FSH to begin to grow A. PROCESS OF HUMAN CONCEPTION
and mature
PRE-EMBRYONIC STAGE
○ LH and prostaglandin cause the graafian follicle to rupture and
ovum is set free from the surface of ovary ● Zygote
● Cervix ○ Fertilized ovum
○ Opening after vagina during contractions ○ Travels 3 to 4 days to reach the uterus while mitotic cell division
● Uterus and sex differentiation begins
○ Implantation site ● Fertilization
○ Accommodates the fetus for nine months ○ 46 chromosomes
○ 22 pairs: for determining the trait of an individual
C. MENSTRUAL CYCLE ○ 1 pair of sex chromosomes: responsible for determining the
● Proliferative Phase (6 to 14 days of a cycle) sex of an individual
○ Happens immediately after menstrual flow ● Morula
○ Endometrium is approximately one cell layer in depth ○ Mulberry-like ball containing 16 to 50 cells; as it reaches the
○ Gradual increase in estrogen, rapid proliferation of endometrium uterus it continues to float and multiply for 4 days.
to eight- fold ● Blastocyst
● Secretory Phase (15 to 21 days) ○ Enlarging cell forming a cavity that later becomes the embryo
○ Occurs after ovulation ○ Trophoblast- covering of the blastocyst which will later become
○ Endometrium becomes a corkscrew or twisted in appearance placenta and membrane
and dilated with glycogen and mucin. ● Implantation or Nidation
○ Increase amount of capillaries that causes rich, spongy, velvet ○ Occurs 7 to 10 days after fertilization.
appearance of the lining ○ Site: Upper anterior or posterior of the uterus
○ Thickening of the uterine lining as a means of preparing a site for ○ 3 Processes of Implantation
implantation ■ Apposition- when blastocyst begins to BRUSH to the
○ Increase in progesterone and corpus luteum endometrial lining
● Ischemic Phase (22 to 28 days) ■ Adhesion- when blastocyst begins to ATTACH to the
○ Corpus luteum begins to regress after eight to ten days. endometrial lining
○ Decrease production of estrogen and progesterone ■ Invasion- when blastocyst begins to SETTLE DOWN the
○ Degeneration of uterine lining due to decrease progesterone endometrial lining
○ The capillaries rupture with minute hemorrhage. ● Embryonic/ Fetal Structures
○ Endothelium sloughs off. ○ Decidua- uterine lining during pregnancy; maternal part of the
○ Also called as ‘premenstrual phase’ placenta; supported by the progesterone
● Menses (1 to 5 days) ○ Chorionic Villi- probing fingers
○ Blood, mucin, endometrial tissues, and microscopic, unfertilized ○ Placenta- serves as a fetal lung, kidneys, and GIT; has
ovum are discharged from the uterus. circulatory and endocrine functions; provides oxygenation for
○ The only external marker of the menstrual cycle. survival

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 ■ Oligohydramnios: less than 500cc
EMBRYONIC STAGE ■ Polyhydramnios: More than 1500cc
● Functions of Amniotic Fluid
● Implanted ovum
○ Cushions the fetus against sudden trauma and blows
● Decidua ○ Maintains the temperature
○ Thickened endometrium ○ Facilitates musculoskeletal development and symmetrical growth
○ A Greek word that means “falling off” ○ Prevents cord compression
● Parts of Decidua ○ Helps in delivery process
○ Basalis- located directly under the fetus where placenta is ■ Diagnostic Test for Amniotic Fluid
developed ● Amniocentesis
○ Capsularis- part of the endometrium that encapsulates the fetus ○ obtains a sample of amniotic fluid by inserting needle
○ Vera- remaining portion of the endometrium through the abdomen into the amniotic sac
B. STAGES OF FETAL GROWTH AND DEVELOPMENT ○ Results determine fetal lung maturity and genetic
abnormalities
a. Genetic Screening - to determine genetic
abnormalities
b. Maternal Serum Alpha-Feto Protein Test
- If increased may indicate spina bifida
or open neural tube defects
- If decreased may indicate down
syndrome
● Amnioscopy- direct visualization through an intact fetal
membrane
● Fern test - determine if Bag of Water (BOW) has ruptured
or not
DEFINITION OF TERMS ● Nitrazine Paper Test - to differentiate urine: (acidic:yellow)
● Conceptus - refers to all the products of conception from amniotic fluid (alkaline:blue green/blue gray)
● Chorionic Villi - finger like projections develop by the 10th-11th day ● Determination of fetal maturity - evaluating factors if indicative of
of pregnancy lung maturity
● Cytotrophoblast - “Langhans Layer” ; outer layer which protects ● Surfactant - protein component of the lung enzyme that the alveoli
fetus against syphilis and capable of living until 24 weeks or 6 forms ; separate membranes of the lungs to allow expansion for
months breathing of fetus
○ Chorion
● Syncytiotrophoblast - inner layer which is responsible for
■ Outermost membrane of the fetus
production o f hormones
■ It is where placenta is developed
● HCG - found in maternal blood and urine as early as the first missed
■ Placenta/Secundinas - greek word which means
menstrual period
“pancake”; combination of chorionic villi and decidua basalis
● Human Placental Lactogen - promotes mammary gland growth;
■ Weight - 500g to 1000g
regulation of maternal glucose, protein & fats
■ Size - 1 inch thick and 8 inches diameter
● Umbilical Cord - function as circulatory pathway that connects the
■ Cotyledon - 15-28 cotyledons
embryo to the chorionic villi of the placenta
● Amniotic Membrane
PLACENTA
○ Amniotic Fluid - serves as protective mechanism for the fetus:
pressure, temperatur ● Respiratory System
○ Aids in muscular development of the fetus protects the umbilical ○ Exchange of O2 and CO2 through simple diffusion (from greater
cord from pressure to lower concentration)
● Gastrointestinal System
LAYERS OF AMNIOTIC MEMBRANE ○ Transports nutrients
■ Facilitated Diffusion - for glucose transport (from greater to
● Amnion
lower concentration but a more rapid rate)
○ Innermost membrane
■ Active Transport for amino acids
○ The umbilical cord and amniotic fluid are developed
● Excretory Systems
○ Umbilical cord or “funis” – 50-55 centimeters or 20-21 inches of
○ Waste secretions pass through the arteries
whitish gray cord which joins fetus to placenta
○ The mother’s liver detoxifies the waste products of the baby
○ 2 arteries and a vein which is protected by Wharton’s Jelly
● Circulatory Systems
○ Short cord - can lead to abruption of placenta and inversion of
○ Two arteries that carry oxygenated blood and a vein that carries
the uterus
oxygenated blood
○ Long Cord - can lead to cord coil or cord prolapse
○ Fetoplacental circulation through selective osmosis
● Amniotic Fluid or “Bag of Water”
○ clear , must or mousy odor with crystallized ferning pattern
○ Slightly alkaline
■ Normal amount: 500-1000cc

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● Endocrine Systems ● Ductus Arteriosus
○ Human Chorionic Gonadotropin (HCG) ○ Carry oxygenated blood from pulmonary artery to aorta,
■ Produced by the placental syncytiotrophoblast bypassing fetal lungs
■ Primary function - maintains corpus luteum at 1st trimester ○ Becomes ligamentum arteriosum after birth
■ Secondary function- basis of pregnancy
○ Human Placental lactogen (HPL)
PRIMARY GERM LAYERS
■ Responsible for development of the mammary glands
○ Relaxin ● Endoderm
■ Softens bones and joints
○ Thyroid - for basal metabolism
○ Estrogen
○ Parathyroid - for calcium metabolism
■ Formed in the ovary
○ Liver
■ Acts on the female genitalia to produce an environment
○ Linings of upper respiratory tracts and GIT
suitable for fertilization, implantation and nutrition of the early
○ Thymus - for development of immunity
embryo
● Mesoderm
○ Progesterone
○ Heart
■ Prepares the lining (endometrium) of the uterus to receive
○ Musculoskeletal system
and sustain the fertilized egg and so permits pregnancy
○ Reproductive organs
■ It serves as a protective barrier against some
○ Kidneys
microorganisms
● Ectoderm
○ CNS (Brain and Spinal Cord)
VII. FETAL CIRCULATION
○ 5 senses
○ Skin
○ Hair
○ Nail
○ Mucus membrane of anus and mouth

VIII. SIGNS OF PREGNANCY

● Fetal cardiovascular system begins to develop at the end of the 3rd
week.
● 4th Month- the heart starts to beat
● The critical period of heart development is from day 20 to day 50
after fertilization.
● Placenta
○ Attached to the uterus; gas exchange during fetal life
● Foramen Ovale
○ Connects the left and right atrium so that blood can be supplies
to brain, heart and kidney, bypassing fetal lungs
● Umbilical Vein (1)
○ Brings oxygenated blood coming from the placenta to the heart
and liver
○ Becomes ligamentum teres after birth
● Umbilical Arteries (2)
○ Carry unoxygenated blood from the fetus (descending aorta) to
placenta
○ Become umbilical ligaments after birth
● Ductus Venosus
○ Carry oxygenated blood from umbilical vein to inferior vena cava,
bypassing fetal liver
○ Becomes ligamentum venosum after birth
● Presumptive Signs of Pregnancy (Subjective)
○ The signs are at least least indicative of pregnancy; they could
easily indicate other conditions
○ Signs lead a woman to believe that she is pregnant
■ Amenorrhea
■ Breast changes and tingling sensation
■ Chloasma and linea nigra
■ Melasma
■ Abdominal enlargement & striae gravidarum
■ Nausea & vomiting
■ Frequent urination
■ Fatigue
■ Quickening (sensation of fetal movement in the abdomen,
firstly felt by the patient at approx. 16 to 20 weeks.)
● Probable Signs of Pregnancy (Objective)
○ More reliable than the presumptive signs, but they are not
positive of true diagnostic findings
■ Hegar's Sign - softening of the lower uterine segment
■ Chadwick’s Signs - color changes of the vagina from pink to
violet
■ Goodell’s sign - softening the cervix, uterus, vagina during
pregnancy (4-6 weeks)
■ Ballottement - dropping and rebounding of the fetus in its
surrounding amniotic fluid in response to a sudden tap on the
uterus
■ Positive pregnancy test - you can be tested positive even if
you're not really pregnant (H.mole)
■ Braxton Hicks Contractions - more frequently felt after 28
weeks, usually disappear with walking or exercise
● Positive Signs of Pregnancy
○ Fetal heart tone can be detected as early as 9-10 weeks from
last menstrual period by doppler technology
○ Fetal Movement felt by the examiner after about 20 weeks
gestation

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 ○ Visualization of the fetus by the ultrasound ● Ovaries
● Pregnancy: Normal Physical Changes ○ Pregnancy is the rest period for the ovaries from producing eggs
○ Uterus (A woman has 400,000 eggs in total.)
■ Normal Size = 2x3 inches ● Breast changes
■ Increases dramatically in size and weight ○ Fullness, tingling soreness and darkening of the areola and
nipples occur due to increase in hormonal level

■ Braxton Hicks Contractions
● Rhythmic painless contractions of the uterus..
● Begin by the end of the pregnancy
■ Hegar’ Sign
● Softening of the lower uterine segment of the cervix
● Occurs about 6th week of pregnancy
○ Cervix
■ Glandular tissue increases in number and becomes
hyperactive
■ Mucous plug is formed and acts as barrier to prevent
ascending infection
■ Increased blood flow to cervix leads to softening (Goodell’s
sign)
○ Ovaries
■ Ovum production ceases (due to high estrogen and
progesterone which inhibits FSH and LH from pituitary
stimulation)
■ Corpus luteum persist and secretes progesterone until weeks
6-8 until the placenta is developed
○ Breasts
■ Changes are brought about by estrogen and progesterone
■ Increase tenderness, feeling of fullness or tingling
■ Superficial veins are prominent
■ Increased pigmentation and increase in diameter of areola
and nipple
■ Montgomery’s tubercules (sebaceous glands of the areola)
enlarge and become protuberant due to increased estrogen
and progesterone
■ Colostrum produced by week 12
● The antibody-rich forerunner of the mature breast milk
● Precolustrum can be expelled by the 16th week
REPRODUCTIVE CHANGES
● Amenorrhea occurs because the corpus luteum persists.
○ Ovulutation inhibited by the high levels of estrogen and
progesterone
● Uterine changes (due to circulatory, hormonal and related fetal
growth):
○ Chadwick’s sign- purplish hue to the cervix and vaginal
mucosa
■ Leukorrhea- whitish, gray, moderate in amount with a musty
or mousy odor discharge
○ Goodell's sign- softening of the cervix
■ Operculum - mucus plug to seal off bacteria, hormone
responsible is progesterone
○ Hegar's Sign - softening of the lower uterine segment
○ Uterus enlarges in size
○ Changes in position of the uterus
■ 1st TrImester: uterus in pelvic cavity
■ 2nd and 3rd Trimester: uterus is in abdominal cavity before
lightening occurs
RESPIRATORY SYSTEM
● Shortness of breath because of enlarged uterus and increase
oxygen demand
○ Management: Position mother on the left lateral side-lying to
promote expansion of the lungs
● Hyperventilation occurs due to the mother’s need to blow-off
increased carbon dioxide transferred to her from the fetus
● Nasal congestion occurs as a response to increased estrogen
levels
CARDIOVASCULAR SYSTEM
● Blood volume increases about 40-45%
● By weeks 20-24, cardiac output increases 30-50% over
pre-pregnant levels; remains elevated for the duration of the
pregnancy
○ CARDIAC OUTPUT = Heart Rate x Stroke Volume
● Pulse rate increases .
● BP decreases slightly by 2nd trimester
○ RBCs, hemoglobin (NORMAL: 12-16 for female; 14-16 for
male) and plasma levels increase
● Hematocrit levels of 32% to 44% considered normal.
● Leukocyte production increases
● Pressure of enlarging uterus on vena cava can interfere with blood
return to the heart
○ Can cause dizziness, pallor, clamminess and lowered BP
(supine hypotensive syndrome/ vena caval syndrome/ aortocaval
compression)
● Supine Hypotensive Syndrome/ Vena Caval Syndrome
○ Weight of enlarged uterus obstructs vena cava, which decreases
blood return to heart therefore decreasing cardiac output
resulting to hypotension, lightheadedness, faintness and
palpitations
○ Corrected by having the woman lie on her side (left lateral
position)
● Lateral Position
○ Rationale: It helps relieve pressure on the sacrum and heels in
person who sit for much of the day or who are confined to bed
and rest in the fowler’s/supine positions.
○ Area of Support: the head, across the chest and in between the
thigh
● Heart rate increases 10-15 beats per min. in the latter half of
pregnancy.
● Palpitation is common.
● Physiologic Anemia (slight difference to the normal)
○ due to hemodilution of the blood
○ 45-50% increase in blood volume expansion, of which about
75% is plasma and 25% is RBC
● Pathologic Anemia
○ Iron Deficiency Anemia
■ Most common hematologic disorder
■ Affects roughly 20% of pregnant women
■ Assessment: pallor, concave fingernails(late sign of
progressive anemia) caused by chronic tissue hypoxia,
listlessness

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 ■ Management ■ Small frequent meals
● Increased iron in diet ■ Take antacids
● Oral iron supplements (ferrous sulfate 0.3g, 3x a day): best ■ Taking baking soda in a glass of water is contraindicated
given before meals or with an empty stomach for better because pf the possibility of retention of sodium and
absorption, however can lead to GI irritation, hence given subsequent edema
on full stomach ■ Avoid fried, spicy and fatty foods
■ Best sources of iron: liver, lean or red meat, legumes like ■ Avoid citrus juices
monggo, green leafy vegetables such as kangkong, ● Food cravings may occur:
ampalaya, spinach, and malunggay ○ Only significant if substances craved is unusual (pica)
■ Iron Preparation ■ Examples: clay, starch, dirt
● Iron is better absorbed when taken with foods rich in ● Ptyalism
Vitamin C such as orange juice ○ Increased salivation caused by elevated estrogen levels
■ Side Effects: constipation, black, tarry stools (monitor for ■ Nursing Care - offer mouthwash
hemorrhage) ● Flatulence
■ Normal Values in Pregnancy ○ Presence of excessive amount of gas in the stomach and
● Hct: 32-42% intestines due to increased progesterone
● Hgb: 10.5- 14 g/dL ■ Prevention - voiding intake of gas-forming foods (ex. root
● Criteria: HCT and HGB should NOT: crops, beans)
○ 1st and 2nd trimester ● Constipation
■ Hct < 33% ○ A condition in which bowel movements are infrequent or
■ Hgb< 11 g/dL incomplete
○ 3rd trimester ■ Causes:
■ Hct < 32% ● Hypoperistalsis
■ Hgb< 10.5 g/dL ● Lack of habits
● Venous Congestion ● Poor dietary habits
○ Can develop into varicosities ● Pressure of the enlarged uterus on internal organs
○ Most commonly noted in the legs, vulva, and rectum ● Effects of progesterone on muscle and hemorrhoids
○ Management: Let the mother lie flat in bed with the feet ■ Management
elevated. ● Increase oral fluids intake
● Edema ● Eat high-fiber foods (oatmeal, papaya, pineapple, grapes,
○ When found on extremities or face, it necessitates further apple, watermelon, cantaloupe)
assessment for signs of pregnancy- induced hypertension. ● Regular exercise
● Hemorrhoids
GASTROINTESTINAL SYSTEM
○ A varicose condition of the external hemorrhoidal veins causing
● Morning Sickness - characterized by early morning nausea and painful swellings at the anus
vomiting due to increased HCG and reduction in hydrochloric acid ■ Causes - due to gravid uterine
secretion that interferes with gastric motility ■ Nursing Interventions
○ Management ● Warm sitz bath
■ 1st Trimester: ● Sit on soft pillows
● Getting out of bed slowly after eating a few crackers ● HIgh fiber diet
● Eating frequent, small meals (afternoon nausea) ● Increased fluid intake
● Avoiding spicy or greasy foods RENAL SYSTEM
○ Hyperemesis Gravidarum - excessive vomiting during
● Glycosuria
pregnancy
○ Increased excretion of sugar caused by lowered renal threshold.
○ Emesis Gravidarum - vomiting during pregnancy
○ Determined by Benedict’s test.
○ Heartburn of Pyrosis - reflux of stomach content to the
● Nocturia
esophagus
○ The need to get up during the night in order to urinate, thus
○ Prevention
interrupting sleep.
■ Eating small frequent meals
○ Management
■ Avoiding fatty and spicy goods
■ Decreased oral fluid intake at least two hours before bedtime
■ Proper body mechanics
■ Side-lying or lateral position
■ Taking sips of milk
● Heartburn
SKIN (INTEGUMENTARY) AND HAIR
○ Causes
■ Progesterone hormone relaxes the cardiac sphincter of the ● Pigmentation of areolae, nipples, vulva, and linea nigra increases.
stomach and allows reflex or bubbling back of gastric ● Facial chloasma or melasma gravidarum
contents into the esophagus ○ A butterfly- shaped area of pigmentation over the face (mask of
■ The pressure of the growing uterus on the stomach from pregnancy)
about 30-40 weeks ● Usually fades after birth
○ Management ● Striae or stretch marks may develop on the abdomen, breasts, and
■ Avoid lying flat thighs.
■ Sleeping with more pillows and lying on the right side

NCM107 Maternal & Child Nursing | Care of Mother During Antenatal Period Page 7 of 10
● Striae Gravidarum/ Stretch Marks NUTRITION AND METABOLIC CHANGES
○ Caused by enlarging uterus which causes destruction of
● All pregnant woman should be encouraged to eat a
connective tissue resulting from separation of underlying
well-balanced diet
collagen which appears as irregular scars
○ Do not scratch, instead apply lotion or oil.
● Folic acid
○ Prevent neural tube defects (NTD’s)
● Linea Nigra
○ Prenatal multivitamin
○ Brownish- pinkish line running from symphysis pubis to the
● Nutritional recommendations by pregnant women are based
umbilicus due to increased melanin
upon the pre-pregnancy body mass index (BMI)
● Protruding Umbilicus
○ A weight gain of 12.5 to 18kg (28-40 lbs) for underweight
women (BMI<19.8)
MUSCULOSKELETAL SYSTEM
○ 7 to 11.5kg (15-25 lbs) for overweight women (BMI>26)
● Lordosis ○ 11.5 to 16kg (25-35 lbs) for women of average wight (BMI 19.8
○ Accentuation of the lumbar curvature of the spine to 26.0)
○ Known as “Pride of Pregnancy” ● Conduct nutritional assessment and emphasize knowledge on
● Softening of all ligaments and joints (especially symphysis and the food guide pyramid especially on the following high risk
sacroiliac joints) caused by increased hormonal action of estrogen mothers:
and relaxin ○ Pregnant teenagers - low compliance to health regimen
○ Wedding Gait- awkward walking due to relaxin hence, the ○ Extremes in weight
mother is candidate for falls ■ Underweight - malnourished
○ Management: Prevent falls through wearing of low heeled or flat ■ Overweight - pre-eclampsia, DM
shoes. ○ Mothers with low socioeconomic status - refer to Social
● Leg Cramps Worker
○ May occur from an imbalance of calcium (hypocalcemia) in the ● 4 Types of Vegetarian Mothers
body and from pressure of the gravid uterus on nerves supplying ○ Strict Vegetarian- no meat, fish, eggs and dairy; rigid
the lower extremities. personality; most prone to anemia
○ Management ○ Lactovegetarian- eats dairy products and vegetables
■ Put the affected leg in a flat surface then do dorsiflexion ○ Ovo- vegetarian- eats eggs and vegetables
■ Milk consumption: 1 pint or 4 cups/ day or 3-4 servings ○ Lacto- ovovegetarian- eats eggs, milk, and vegetables; least
■ Calcium- rich foods: anchovies, sardines (specifically the prone to anemia
head of the fish), seafoods, mussels, cheese, yogurts, ● Calories
broccoli, and dairy products ○ Non-pregnant: 2, 200
● Backache ○ Pregnant: +300= 2, 500
○ Causes ○ Lactation: +500= 2, 700
■ May be due to muscular fatigue and strain that accompany ● Physical Activity
poor body balance ○ 30 minutes- most days
■ It may be due to increased lordosis during pregnancy in an ○ 60 minutes- to prevent weight gain
effort to balance the body. ○ 60 to 90 minutes- to sustain weight loss
■ The pregnancy hormones sometimes soften the ligaments to
such a degree that some support is needed. IX. PERINATAL EXERCISES
○ Management
PURPOSES
■ Exercise
■ Sit with knee slightly higher than hips. ● Help prevent the need for caesarian section
■ The pregnant woman is reassured that once birth has ● Help strengthen pelvic and abdominal muscles
occurred, the ligaments will return to their pre-pregnant ● Help reduce discomfort
strength. ● Help hasten recovery
● Exercises should be done in moderation and must be individualized.
ENDOCRINE SYSTEM

● Elevated HCG levels which reaches peak at third month then drops
● Estrogen and Progesterone increases and continue to be secreted
from the placenta during the last 6 months of pregnancy
○ Progesterone acts to inhibit uterine contractions
○ Increase in both hormones leads to sodium and water retention
and muscle relaxation which leads to fatigue
● Thyroid activity is increased ; normal pregnancy may emulate a mild
hyperthyroid state
● Estriol labels increased ; sometimes used as an indicator of fetal
well-being
GUIDELINES FOR EXERCISES DURING PREGNANCY
● Maintain adequate fluid intake.
● Warm up slowly, use stretching exercises but avoid over stretching
to prevent injury to ligaments.
● Avoid jerking or bouncing exercises.
● Be careful of loose throw rugs that could slip and cause injury.
● Exercises on a regular basis (three times per week).
● After the first trimester, avoid exercises that require supine position.

NCM107 Maternal & Child Nursing | Care of Mother During Antenatal Period Page 8 of 10
CONTRAINDICATIONS
● Vaginal bleeding
● Severe anemia
● History of preterm labor
● Extreme over or underweight
● Hypertension, heart, lung, thyroid diseases
PRE- EXERCISE POINTERS
● Always let breath flow freely. Let the abdomen and ribcage expand
and compress naturally as you inhale and exhale.
● Warm up with gentle stretching before exercise program- increase
blood flow to muscles and loosen them up.
● When you finish, take time to relax fully; lie in a comfortable position
on the floor for 10 minutes with eyes closed; let breathing slow
down.
● As strength improves, add one repetition of each exercise until
you’re up to 10; also, try holding positions from 3 to 5 counts.
● Do each exercise slowly and thoroughly. Allow rest between each
exercise.
A. TAILOR SITTING
● It strengthens the thigh and stretches the perineal muscles.
● Done at least 15 min/ day
● Sit on the floor with thighs apart, knees bent, legs parallel to each
other, one ankle should not be on top of the other, push knees
gently towards the floor until you feel the perineum stretch. Use this
when watching TV, reading, or entertaining friends.
B. SQUATTING
● Helps to stretch muscle of the pelvic floor
● Done at least 15 min/day
● When lifting something from the floor; bend knees rather than the
back; do not squat on tiptoes but keep flat on the floor; incorporate
this into daily activities
C. PELVIC FLOOR CONTRACTIONS (KEGEL’S EXERCISE)
● It is designed to strengthen pubococcygeus muscle.
● It may lead to increased sexual enjoyment.
● Each is a separate exercise and should be done 3 times a day.
● Squeeze the muscle surrounding the vagina as if stopping the flow
of urine, hold for 3 seconds then relax. (10 times)
● Contract and relax the muscles surrounding the vagina as rapidly as
possible (10 to 25 times)
● Imagine that you are sitting in the bathtub of water and squeeze
muscles as if sucking water into vagina. Hold for 3 seconds then
relax. (10 times)
D. ABDOMINAL MUSCLE CONTRACTIONS
● Strengthen the abdominal muscles
● Help prevent constipation
● May be done as often as she wishes
● Tighten abdominal muscles, then relax and repeat as often as you
can; can be done on lying or standing position along with pelvic floor
contractions.
E. PELVIC ROCKING
● Helps to relieve backache during pregnancy and early labor
● Makes the lumbar spine more flexible
● Can be done on a variety of positions
● The woman arches her back, trying to lengthen or stretch her spine.
She holds the position for 1 minute, and then hollows her back.
● Do this at the end of the day (5x)
NCM107 Maternal & Child Nursing | Care of Mother During Antenatal Period
F. PELVIC TILT
● Pelvic Tilt- Supine
○ Do daily and after delivery
○ Position: Backlying, knees bent
○ Exercise: Press small of back against floor by tightening
abdominal muscles and buttocks muscles
G. SIT UPS
● Sit- Ups- Modified
○ Purpose: Strengthen abdominal muscles. Good muscle tone is
important for maintaining good posture, for effective pushing,
and for early return of figure postpartum
○ Position: Backlying, knees bent, low back flat (pelvic tilt).
○ Exercise: Lift head and shoulders off floor, reaching hands
towards knees (lift trunk to about 45 degree angle). Slowly return
to the starting position; do not drop back.
● Oblique (Diagonal)
○ Purpose: Strengthen oblique abdominal muscles
○ Positon: Backlying, knees bent, low back flat
○ Exercise: As above, but reach up and across to the outside of
the opposite knee.
H. GLUTEAL/PELVIC FLOOR SETTING
● Position: Backlying, legs straight, ankles crossed, arms at sides
● Exercise: Pinch buttocks, squeeze pelvic floor muscles, squeeze
thighs together, raise head off floor
I. ADDUCTOR LENGTHENING
● Position: Sit on floor with legs straight and slightly apart. Roll knees
outward.
● Exercise: Slowly lean body forward towards the floor with arms
stretched out in front of you. Your knees may bend slightly. Do not
jerk or bounce. Hold forward for 3 to 5 seconds.
SPECIFIC ACTIVITIES
JOGGING
● Wear good shoes; supportive bra
● Keep pelvic floor muscles strong with Kegel Exercises
● Jog at a slower pace, shorter distances, less frequently
○ Remember: Increased weight and laxity of ligaments means
more strain on the lower body (lower spine, hip joints, knees,
ankles and feet). Do not overexert yourself.
BICYCLING AND SWIMMING
● Excellent activities with reasonable limitations, Don’t push yourself!
TENNIS, BASKETBALL AND “SUDDEN STOP AND START”
ACTIVITIES
● More awkward as bulk increases
● Listen to your body and slow down when necessary
SKATING, HORSEBACK RIDING
● Danger of falling! Advise against. Consult your obstetrician or nurse
practitioner as needed.
WALKING
● Most highly recommended for the pregnant woman
● Ideal alternative to more strenuous exercise
● Walk uphill, downhill at different speeds
Page 9 of 10
 PATIENT TEACHING
● Consult your obstetrician or nurse practitioner early in your
pregnancy
● In general, you can continue your pre-pregnant routine of exercising
● Stop when something hurt, ir when you become fatigued
● Know your limits and avoid exercising to the point of exhaustion
● It is generally advised that you not begin any new sport or activity
during pregnancy
● You may want to taper off your sports participation during the last
few months, but you may still continue to exercise regularly
● Avoid exercising in a very hot or humid weather or high altitudes if
you're not used to it

REFERENCES
● Lecture powerpoint

NOTES

NCM107 Maternal & Child Nursing | Care of Mother During Antenatal Period Page 10 of 10