9.
Personal, cultural and religious attitudes and
Goals and Philosophies of Maternal and Child
Health Nursing
Goals _ factor in promoting high-level wellness in
● Primary goal of maternal and child health
nursing care can be stated simply as the
promotion and maintenance of optimal family
health to ensure cycles of optimal childbearing
and childrearing.
The goals of maternal and child health nursing care
are necessarily broad because the scope of practice
is so broad, the range of practice includes:
● Preconceptual health care
● Care of women during three trimesters of
pregnancy and the puerperium (the 6 weeks
after childbirth, sometimes termed the fourth
trimester of pregnancy)
● Care of children during the perinatal period (6
weeks before conception to 6 weeks after
birth)
● Care of children from birth through
adolescence
● Care in settings as varied as the birthing
room, the pediatric intensive care unit, and the
home in all settings ang types of care, keeping
the family at the center of care delivery is an
essential goal.
PHILOSOPHIES
1. Maternal and Child Health Nursing is family
centered
2. Maternal and Child Health Nursing is
community centered
3. Maternal and Child Health Nursing is research
oriented
4. Both nursing theory and evidence-based
practice provide a foundation for nursing care
5. A Maternal and Child Health Nurses serves as
an advocate to protect the rights of all family
members including the fetus
6. Maternal and Child Health Nursing includes a
high degree of independent nursing functions
7. Promoting health is an important nursing role
8. Pregnancy or childhood illness can be
stressful and can alter family life in both subtle
and extensive ways
beliefs influence the meaning of illness and its
impact on the family
10. Maternal and child health nursing is a
challenging role for a nurse and is a major
families.
Maternal and Child Health Goals and Standards
● Association of Women’s Health, obstetric and
neonatal nurses standards and guidelines
standards of professional performance
STANDARD 1: Quality of care _
➢ The nurses systematically evaluates the
quality and effectiveness of nursing practice
STANDARD 2: Performance Appraisal _
➢ The nurse evaluates his/her own nursing
practice in relation to professional practice
standards and relevant statutes and
regulations
STANDARD 3: Education _
➢ The nurse acquires and maintains current
knowledge in nursing practice
STANDARD 4: Collegiality _
➢ The nurse contributes to the professional
development in nursing practice
STANDARD 5: Ethics _
➢ The nurse’s decisions and actions on behalf of
patients are determined in an ethical manner
STANDARD 6: Collaboration _
➢ The nurse collaborates with the patient,
significant others and health care providers in
providing patient care
STANDARD 7: Research _
➢ The nurse uses research findings in practice
STANDARD 8: Resource Utilization _
➢ The nurse considers factors related to safety,
effectiveness and cost in planning and
delivering patient care
STANDARD 9: Practice Environment _
➢ The nurse contributes to the environment of
care delivery within the practice settings
STANDARD 10: Accountability _
➢ The nurse is professionally and legally
accountable for his/her practice. The
professional registered nurse may delegate to
and supervise qualified personnel who provide
patient care
 Framework for Maternal and Child Health
Nursing Care
● Maternal and Child Health Nursing can be
visualized within a framework in which nurses,
using nursing process, nursing theory and
evidence-based practice, care for families
during childbearing and childrearing years
through 4 phases of health care:
➢ Health Promotion
➢ Health Maintenance
➢ Health Restoration
➢ Health Rehabilitation
THEORIES RELATED TO MATERNAL AND
CHILD NURSING
Theorist and their Major Concepts of Theory
1. Patricia Benner
● Nursing is a caring relationship, nurses
grow from novice to expert as they
practice in clinical settings
2. Dorothy Johnson
● A person comprises subsystems that
must remain in balance for optimal
functioning, any actual or potential
threat to this system balance is a
nursing concern
3. Imogene King
● Nursing is a process of action,
reaction, interaction and transaction;
needs are identified based on client’s
social system, perceptions and health;
the role of the nurse is to help the
client achieve goal attainment
4. Madeleine Leininger
● The essence of nursing is acre to
provide transcultural care, the nurse
focuses on the study and analysis of
different cultures with respect to caring
behavior
5. Florence Nightingale
● The role of the nurse is viewed as
changing or structuring elements of the
environment such as ventilation,
temperature, odos, noise and light to
put the client into the best opportunity
for recovery
6. Betty Neuman _
● A person is an open system that
interacts with the environment; Nursing
is aimed at reducing stressors through
primary, secondary, and tertiary
prevention.
7. Dorothea Orem _
● The focus of nursing is on the
individual; clients are assessed in
terms of ability to complete self-care.
Care given may be wholly
compensatory (Client has no role);
partly compensatory (Client
participates in care); or
supportive-educational (Client
performs own care).
8. Ida Jean Orlando _
● The focus of the nurse is interaction
with the client; effectiveness of care
depends on the client’s behavior and
_ the nurse’s reaction to that behavior.
The client should define his or her own
needs.
9. Rosemarie Rizzo Parse _
_ ● Nursing is a human science. Health is
a lived experience. Man-living-health
as a single unit guides practice.
10. Hildegard Peplau _
● The promotion of health is viewed as
_ the forward movement of the
personality; this is accomplished
through an interpersonal process that
includes orientation, identification,
exploitation, and resolution.
11. Martha Rogers _
_ ● The purpose of nursing is to move the
client toward optimal health; the nurse
should view the client as whole and
constantly changing and help people
to interact in the best way possible
_ with the environment.
12. Sister Callista Roy _
● The role of the nurse is to aid clients to
adapt to the change caused by illness;
Levels of adaptation depend on the
degree of environmental change and
state of coping ability; Full adaptation
includes physiologic interdependence
Roles and Responsibilities of a Maternal Child
Nurse

1. Clinical Nurse Specialist

2. Case Manager
3. Women’s Health Nurse Practitioner
4. Family Nurse Practitioner
5. Neonatal Nurse Practitioner
6. Pediatric Nurse Practitioner
7. Nurse-Midwife

The 17 Sustainable Development Goals (SDGS)

to Transform Our World:

★ GOAL 1: No Poverty
★ GOAL 2: Zero Hunger
★ GOAL 3: Good Health and Well-being
★ GOAL 4: Quality Education
★ GOAL 5: Gender Equality
★ GOAL 6: Clean Water and Sanitation
★ GOAL 7: Affordable and Clean Energy
★ GOAL 8: Decent Work and Economic Growth
★ GOAL9: Industry, Innovation and
Infrastructure
★ GOAL 10: Reduced Inequality
★ GOAL 11: Sustainable Cities and
Communities
★ GOAL 12: Responsible Consumption and
Production
★ GOAL 13: Climate Action
★ GOAL 14: Life Below Water
★ GOAL 15: Life On Land
★ GOAL 16: Peace and Justice Strong
Institutions
★ GOAL 17: Partnerships to Achieve the Goal
 FETISHISM _
CONCEPT OF SEXUALITY
● sexual arousal by using certain objects or
inanimate objects
Sexual Orientation TRANSVESTISM _
● an individual who dresses to take on the role
➢ Concerns the direction of one’s romantic of the opposite sex
interest and erratic attractions towards same VOYEURISM _
sex, opposite sex or both. ● Sexual arousal by looking at another’s body,
Sexuality _ or watching other people who are nude, or
● refers to sexual behaviour in all sexual involved in sexual relationship.
organisms. A person’s sexuality encompasses
complex SADOMASOCHISM _
Asexuality _ ● a mutually gratifying sexual interaction
● is a general term or a self-designation for between consenting sex partners in which
people who lack sexual attraction or otherwise sexual arousal associated with infliction and
find sexual behaviour unappealing. recepient of pain or humiliation.
Auto sexuality _ ○ Sadist : inflicting pain or humiliation on
● or Autoerocitism is the secual stimulation of, others
or sexual desire towards one’s body. ○ Masochism : received pain/desire or
Human Sexuality _ need from pain
● refers to the expression of sexual sensation PEDOPHELIA _
and related intimacy between human beings, ● desire sexual pleasure from children
as well as the expression of identity through EXHIBITIONISM _
sex. ● Sexual arousal from exposing genitals to
Heterosexuality _ strangers usually men in a public place
● finds fulfillment with a member of his or her ZOOPHILIA _
own sex ● aroused by fantasies or actual sexual contact
Bisexuality _ with animals
● Achieve sexual satisfaction from both NECROPHILIA _
homosexual and heterosexual relation ships ● fantasies of or actual sexual contact with a
Transexuality _ dead person
● an individual who although of one biologic KLISMAPHILIA _
gender feels as if he or she should be the ● sexual arousal is derived from use of enemas
opposite gender. PROTTEURISM _
TYPES OF SEXUAL EXPRESSION ● sexual arousal by touching or rubbing other
people in sexual ways without their consent
➢ Celibacy SCATOLOGIA _
○ abstinence from sexual activity ● obscene phone callers and make sexual
➢ Masturbation suggestions or references. Uttering
○ self stimulation for erotic pleasure obscenities and sexual provocations to non
➢ Erotic stimulation consenting person
○ use of visual materials such as COPROPHILIA _
magazines or photos for sexual ● sexual arousal/gratification from feces, person
satisfaction may desire defecated on or to defecate a
partner
ATYPICAL SEXUAL VARIATIONS UROPHILIA _
● desire sexual excitement from urine as when
PARAPHILIA _ doing “Golden Showers”
● a diagnostic category used by the american
psychiatric association to describe a typical
patterns of sexual arousal or behaviour that
becomes problematic in the eyes of the
individual or society
 SEXUAL STIMUALTION AND RESPONSE
PATTERNS
A. PHYSICAL STIMULATION : usually consists
of touching the erogenous zones or the
excitement area of the human body.
B. PSYCHOLOGICAL STIMULATION
○ B.1. Visual : pictures of nudity and
romantic photo
○ B.2. Auditory : classical music
○ B.3. Olfactory : perfumes and
scented candles
SEXUAL RESPONSE CYCLES
★ DESIRE
★ EXCITEMENT PHASE
★ PLATEAU PHASE
★ ORGASMIC PHASE
★ RESOLUTION PHASE
PATTERNS OF SEXUAL RESPONSES
DESIRE
● it is a prelude to sexual excitement & sexual
activity. It occurs in the mind rather than the
body and may not progress to sexual
excitement without further physical or mental
simulation. It is communicated between
potential sexual partners either verbally or
through body language or behaviour
EXCITEMENT/AROUSAL
● is the body’s physical response to desire. A
person who manifests the physical indications
of excitement is termed to be “aroused” or
“excited”. It can be communicated between
partners verbally or through body language,
behavior, or any body changes
PLATEAU
● the highest moment of sexual excitement
before orgasm may be achieved, lost and
regained several times without the occurrence
of orgasm.
ORGASM
● occurs at the peak of the plateau phase. The
sexual tension that has been building
throughout the body isreleased, and the body
releases chemicals called “Endorphins”
which causes a sense of well being. This can
be achieved through mental stimulation and
fantasy alone, but more commonly is a result
of direct physical stimulation or sexual
intercourse.
RESOLUTION
● is a period following orgasm, during which
muscles relax and the body begins to return to
its pre-excitement state.
PRINCIPLES RELEVANT TO SEXUALITY
1. Human sexuality provies for reproduction of
human species.
2. Sexual fulfilments is a basic human need.
3. Sexuality pervades virtually every aspect of
life from birth to death.
4. All human cultures have sanctions, often legal
as well as moral, controlling expressions of
sexual drive.
5. Individuals have strong cultural, religious,
ethical convictions regarding the expression of
human sexuality.
6. Moral values concerning appropriate sexual
behaviors have undergone considerable
liberalizations in most western cultures in
recent years.
7. Successful gender identification in early
childhood is important for an individual’s
health and well being throughout life.
8. Actual or potential damage to the integrity of
an individual’s sex organ poses a
considerable threat to his self-esteem.
SEXUAL RELATIONSHIPS:
Premarital _
● is a period for two different people who do not
know each other, understand each other and
create bonds of love which are necessary to
live together before they make the decision to
marry.
Postmarital
● occurring, existing, or taking effect after the
end of marriage.
Extramarital
● a relationship outside of marriage where an
elicit romantic or sexual relationship or
passionate attachment occurs.
Non-traditional
● can be looked at in many different ways. They
can be non sexual. They can be in a
relationship where there’s a large disparity in
money or age.
FACTORS AFFECTING SEXUAL FUNCTIONING
1. Biological
➢ sexual differentiation, brain
mechanisms involved in sexual
responses, role of sex hormones,
sexual effects of drugs, sexually
transmitted diseases.
2. Social
➢ role of parents, social media
3. Moral
➢ beliefs or each culture regarding
sexual funcioning.
4. Psychological
➢ the impact of body image, sexual
abuse in childhood, and mental health
history, interpersonal problems
SEXUAL CONCERNS R/T PREGNANCY
_
PRINCIPLES OF PROCREATION
_ 1. Sex is a search for sensual pleasure and
satisfaction, releasing physical and psychic
tensions.
2. Sex is a search for the completion of the
_ human person through an intimate personal
union of love expressed by bodily union for
the achievement of a more complete
humanity.
3. Sex is a social necessity for procreation of
children and their education in the family so as
to expand the human community and
guarantee its future beyond death.
4. Sex is a symbolic (sacramental) mystery,
somehow revealin the cosmic order. In short,
this christian principle is all about pleasure,
love, reproduction and the sacramental
meaning of sex.
➢ Human Sexuality
➢ Nursing Implication
How can sexuality be integrated as part of a
total health care into the practice of nursing?
1. Learn about sexuality
2. Learn to know yourself
3. Use various techniques
4. Recognize that knowledge and attitude
change
5. Develop communication skills

➢ Altered desire for sex

MECHANISM OF HEREDITY
➢ Breast may be painful to touch
➢ Increase amount and odor of vaginal
discharges
➢ Other concerns: dyspareunia
➢ Other forms of expression: kissing, hugging,
manual genital stimulation
RESPONSIBLE PARENTHOOD:

As defined in the directional plan of POPCOM,

is the will and ability of parents to respond to the
needs and aspirations of the family and children.
It is a shared responsibility of the husband and wife to
determine and achieve the desired number, spacing
& timing of their children according to their own family
life and aspirations, taking into account the
psychological preparedness, health status,
socio-cultural, and economic concerns.
 ○ Spina Bifida
INHERITANCE
○ Made in the baby’s liver amniotic fluid
Triple Screening _
1. GENOTYPE : complete set of inherited traits ● analysis of 3 indicators from MSAF, Estriol,
2. PHENOTYPE: how these traits are expressed HCG
ALLELES : are pair of genes (1 from ovum
Diagnostic Tests
and 1 from sperm)
A. Homozygous : the same alleles ➢ Diagnostic test
B. Heterozygous : different versions of the trait ○ confirmation of the diagnosis
➢ Clinical Diagnostic Test
○ Signs and symptoms being shown
CHROMOSOMAL INHERITANCE DISORDERS
➢ Laboratory Diagnostic Test
○ Blood, urine, stool
A. Autosomal Dominant disorder : dwarfism Chorionic villi sampling _
B. Autosomal Recessive disorder: cystic ● 5th wk. of pregnancy (earliest), but mostly
fibrosis done at 8th to 10th wk
C. X-Linked Dominant disorder : fragile x ● Prenatal test from a sample of tissue from the
syndrome placenta itself
D. X-Linked Recessive disorder : hemophilia ● To detect chromosomal diseases and genetic
E. Multifactorial Inheritance : cleft lip and disease
palate ● Invasive procedure
● Taking sample from the placenta itself
CHROMOSOMAL ABNORMALITY DISORDERS Amniocentesis _
● 2 to 5 ml done at 14 and 16 wks
● Test where part amniotic fluid is taken to
A. Numeric Abnormality : klinefelter syndrome detect birth defects
B. Structural disorder : translocations ● Invasive Procedure
● Not commonly done in the Philippines due to
risk in both mother and fetus
Risk Factors for Genetic Disorders Sonography _
● Ultrasound
Fetoscopy _
1. Age : mother and father ● an incision done to the mothers abdomen
2. Race ● Endoscopic process
3. Family history of Disease ● Surgical process to examine amniotic fluid
4. OB History of pregnancy issues: like ● 3 to 4 mm incision in the abdomen of the
exposure to teratogens such as radiation, mother
certain drugs, viruses, toxins and chemicals. ● Ballpen size wiring at the tip has camera
● Visualize the abdominal wall to see the
Screening Tests for Genetic disease itself
Traits and Disease _ Amniocentesis _

➢ To check for genetic disorders

➢ No signs and symptoms

Karyotyping _
● A visual display of the individual's actual
chromosome pattern.
● Cytogenetic test
Heterozygote screening _
Maternal Serum Alpha Fetoprotein _
● Check the protein found in the fetal
development - detect neural tube defects
○ anencephaly _ Chorionic villi sampling _
○ Patient do not have abdominal wall
 Nursing Processes

A. Assessment _
1. Health History - genetic history, ethinic
background, general medical history and
mother’s age
B. Nursing Diagnosis _
1. Knowledge Deficit
2. Decisional Conflict
3. Anticipatory Grieving
C. Planning _
1. The couple will receive education
2. The couple will receive emotional support
D. Implementation _
1. Provide education - information about genetic
problem; testing required;possible treatments;
and available resources
2. Provide emotional support- counseling;
healthcare facilities; assist in coping
E. Evaluation _

THE ANATOMY AND PHYSIOLOGY OF THE
REPRODUCTIVE SYSTEM
MALE REPRODUCTIVE ORGAN
➢ Transport the sperm
➢ Deliver the sperm to female
➢ Excrete the hormone testosterone
A. External Structures
1. Scrotum
● Skin sack hanging under the penis
● Provide proper temperature for the
viable sperm
2. Penis
● Organ of copulation
● Carry urine of the organ of the men
● 3 columns of erectile tissue
○ Corpus cavernosum
○ Corpus spongiosum
● Shaft body
● Glans penis
● Prefuse
● If not circumcised the penis, the
smegma cause bad smell it will be
trapped by the skin or the foreskin
● Penis serves as penetrative organ to
deliver sperm at females
● Nitric oxide release from endothelium
increase blood flow of the penis
● Erection : there is no bone in the
penis because of the blood trapped in
corpus cavernosum is when erection
occurs
B. Internal Structures
1. Testes
● Exocrine : produce sperm
● Endocrine : testosterone
● cryptorchidism : testes failure to
descend in the scrotum = cause
infertility sperm cannot live in the body
temperature
● Male gonads
● Start in abdominal cavity descend in
the scrotum in the last 2 months or 38
weeks
● If it's too cold it will attach near the
body : cremaster muscles keeping
the sperm warm
● If it's too hot it will go down to have air
and the temperature not too hot
2. Vas deferens _
● 12 inches cut during : vasectomy
● The passageway of sperm
● Enclosed by spermatic cord and end at
ejaculatory duct passes through
prostate gland (prevent mixing of
urine and sperm during sexual
excitement so urine will not kill the
sperm ) to merge with urethra
3. Epididymis _
_ ● Extend 10-20 ft; 2-4weeks sperm
maturation
_ ● Aspermia/Oligospermia
● Temporary storage site for immature
sperm
● 20 days travel
_ ● Complete maturation process at 64
days for the ability of the sperm to
swim
● Walls of epidymis contract during
sexual excitement
● absence of sperm : Aspermia
● Less than 20 million sperm :
oligospermia
4. Ejaculatory duct _
5. Urethra _
● Prostatic, membranous, penile urethra
● Part of urinary system and
reproductive
● Base of the bladder and tip of penis
○ Prostatic : surrounded from
prostate gland
○ Penile whole length of penis
○ membranous
C. Accessory Glands _
_
1. Seminal vesicles _
_ ● 2 inches: secrete alkaline fluid
and fructose, vitamin C,
prostaglandins
 ●60% of male discharge rich in
sugar and vitamin c
Spermatozoa
● Yellowish discharge
● Prostaglandine
● Produced by the testicles
2. Prostate gland _
● 40-80 million per cc of semen
● Walnut
● 300-500 million per ejaculation
● BPH - Benign prostatic
● 12-20 days travel
hyperplasia/Cystitis/Prostate
● Mature after 64 days
cancer
● Encircle prostatic urethra
● Enlarges and compresses the
urethra : Bladder Pain
Syndrome , systasis
● Prostate cancer
3. Cowper’s gland _
● 2 pea sized structure
● Bulbourethral
Secrete alkaline fluid combat
acidity of prostate
● Serve as lubricant during
sexual intercourse

D. Male Breasts _
➢ Head : primary nucleus genetic material=
SPERMATOGENESIS
acrosome hyalorace enzyme to break the
barrier of egg cell
➢ Tail : for fast movement reach in ova
➢ Body : Contains mitochondria supply energy
needed for the big swim

FEMALE REPRODUCTIVE ORGAN

● Produce egg
● Produce estrogen and progesterone
● Nurture and protect the developing baby for 9
months

➢ Formation of the sperm 3 parts head body and

tail
➢ Hypothalamus receive signal from GRH

Semen A. External Structures _

1. Mons veneris/ Mons pubis
● 60% : Prostate gland ● Shave half moon
● 30%: Seminal vesicle ● Leave with box
● 5% : Epididymis ● Fatty rounded area underlying
● 5% : Bulbourethral gland the symphysis pubis
● 3-5 cc : (1 tsp) per ejaculation ● 1 patient : 1 shaver
 ● Direction of strand of hair = ● Interstitial : fertilization happen but
direction of shaving did not grow in uterus - ectopic
2. Labia majora = adipose tissue protect pregnancy
and cover inner structures 5. Fimbriae : catch egg cell
3. Labia minora 6. Ovaries : 2 almond shaped glands
4. Clitoris: center of sexual arousal ● Cervical cancer : overuse and
5. Vaginal opening : 2 hands of the underuse cervix
doctor comes in episiotomy going into C. Accessory Glands _
the side - mayo scissors 1. Breast (mammary gland) : increase
6. Urethral meatus estrogen increase breast thelarche
7. Perineum 2. Skene or Paraurethral glands
8. Vestibules 3. Bartholin or Vulvovaginal gland
D. Pelvis _
● Estrogen widens the pelvis preparation
for pregnancy
● Included in the reproductive system
since included in childbirth
● Cephalopelvic disproportion : The
only indication for cs

B. Internal Structures _
1. Vagina : 3-4 inches long
● Vaginal canal : corrugated
● Cervical OS : During IE opening how
many cms until 10 cm mos dilated
internal and external
● Broad ligament : hold uterus in place
2. Uterus : “womb” : like the ballon as the baby
grows
● After delivery go back to non pregnant
state
● Estrogen : FHS, maturation of the egg
,develop secondary sexual
characteristics
● Progesterone : hormone of pregnancy
low progesterone baby goes out =
preterm delivery ➢ 70%: vaginal canal
3. Cervix ➢ Coccyx bone : curved giveaway of the baby
to come out
4. Fallopian tube : 4 inches ➢ Ischial spine : station in IE
4 parts
● Infundibulum : fingerlike
● Ampula : longest portion fertilization
takes place
● Bismuth
 ● Graffian follicle : provide maturation of
oocytes forms corpus luteum = maintain
implantation of embryo
● Ovum : produce new individual when fertilized

➢ Egg cell
➢ Hyaluronic acid: important of extracellular
➢ Rectum is full disrupt delivery of baby
part for signaling
➢ Zona : communication during oogenesis
interaction of ovulated eggs
➢ Corona radiata : provide vesicle protection of
cyte

MENSTRUATION

● 300,000-400,000 oocytes per ovary

● Menarche (onset) : as early as 10 years old -
18 yrs old
● Menopause (termination) : 50 - 65 years old
● Average cycle is 28 days, duration of 3
● 5 days
● Unovulatory state after menarche
OOGENESIS ● Menstrual flow contains 30-80 ml of blood
● Structures involve: hypothalamus, APG,
ovaries, uterus
● Hormones that regulate: FSH and LH

ESTROGEN _
● Inhibits production of FSH
● Causes hypertrophy of the myometrium : 2nd
layer of the uterus inner layer
● Stimulates growth of breasts ducts
● Increases ph of cervical mucus causing it to
become thin and watery (Spinnbarkeit test)
○ Elasticity of cervical mucus 8-10cm
ferning capacity
○ Produces mucus at ovulation time
● Development of oocyte ○ The mucoid being discharge by
● Primitive oogonia : undeveloped occur in external genitalia
follicle fetal stage ○ When stretched upto 8-10 cm and not
● Secondary : mitosis half chromosomes separated means ovulating girl
 ○The time to check ovulation time when
ready for delivery
● Proliferates the endometrium: Lining of the
uterus
PROGESTERONE _ oogenesis
● Inhibits production of LH
● Increases endometrial tortuosity: pregnancy
● Increases endometrial secretions
● Inhibits uterine motility
● Facilitate transport of fertilized ovum through
fallopian tube
● Increases body temperature after ovulation :
after menstruation
● Mittelschmerz : abdominal pain after
ovulation 24-48 hours , cramping sensation
THE MENSTRUAL CYCLE
➢ Ovaries
➢ Hypothalamus
➢ Uterus
➢ Pituitary gland
➢ Vagina (Exit)
A. The Four Level
1. CNS Response : Hypothalamic anterior
pituitary gland action FSH and LH
2. Ovarian Response : 2 Phases
● Proliferative phase : 1-14 days
● Secretory : 15-22 days
3. Endometrial Response : 4 phases
● Menstrual phase : 1-5 days
● Proliferative : 6-14 days
● Secretory : 15-26 days
● Ischemic : 27-28 days usually
● Sometimes reaches 31 days
4. Cervical Mucus Response : Ovulatory
● 15-23 days
● Before Ovulation :
Spinnbarkeit/Spinnbarkeit= stretched
8-10 cm
● After Ovulation : Mittelschmerz = 24
hrs cramping abdominal pain
PHASES OF MENSTRUAL CYCLE
A. Proliferative/Preovulatory/Follicular Phase
(6-14 days) _ ● an end and a beginning
● In a 28 days cycle begins with the end
of menstruation
● Levels of estrogen and progesterone
● Hypothalamus senses the decrease,
thus stimulates the APG to secrete
GnRH prompting the release of FSH
which stimulates the ovaries to
produce follicles (10-20)
● Follicles ripen but only one will mature
which is known as the Graafian
follicle : increase estrogen
● FHS : growth of primordial follicle
B. Ovulatory Phase (14 days of cycle -15)-
Peak _
● Graafian follicle ruptures and releases
the mature ovum near the fallopian
tube
○ 2 ova matures both fertilized :
Fraternal twins
○ 1 fertilized ovum divides into 2
separate zygotes : Identical
twins
● Hypothalamus senses increase level
of estrogen triggers the APG to
release LH which acts with FSH to
cause Ovulation and enhance
Corpus Luteum formation = if there
will be the union of ovum and sperm it
will become a bed of fertilized egg
● increased thickness ovum produce
_ progesterone hormone of pregnancy
and decrease level of estrogen
● Check spinnbarkeit test to check
temperature
C. Secretory/Luteal Phase (16-28) _
● Corpus luteum secretes progesterone
that maintains the vascularity of the
endometrium
● Decrease level of estrogen and
increase progesterone : hormone of
pregnancy
● Cause glands in the endometrium to
secrete nutrients to sustain a fertilized
ovum that is implanted in the uterine
wall - myometrium implantation
● If no implantation: Hypothalamus
signal the Pituitary gland to stop
producing FSH and LH
● Decrease in FSH and LH causes the
Corpus luteum to decompose in the
ovary and nourishment of the
endometrium stops
D. Menstrual Phase (1-5) _
● Decrease in estrogen and
progesterone
● Lining disintegrates and discharged
from the body necrotized
● Menstrual Flow
○ Dead egg cell ovum
○ Decomposed corpus luteum
○ Endometrial lining
➢ Obstetric nursing : specialize in obstetrics or
the branch of medicine that focuses on
women and fetus during pregnancy and
childbirth.
➢ Maternal and child care nursing : caring of
the whole family and caring for the women ,
duration of pregnancy
➢ Maternity nursing : care to client before
pregnancy, during and after delivery
 PREGNANCY ● Acrosome release hyaluronidase
enzyme to breakdown zona pellucida
● Not a certain occurrence there are 3
●  ormal amount of semen/eiaculation: 3.5 cc
N
● Number of sperm per cc of semen : 40 - 80 separate factors
● million ○ Equal maturation of the sperm
● Number of sperm per ejaculation : 300 - 500 and ovum
● million ○ Ability of sperm to travel
● Mature ovum is capable of being fertilized for ○ Ability of sperm to penetrate
12 to 24 hours after ovulation
the zona pellucida
● Sperm is capable of fertilizing for 3 to 4 days
after ejaculation ● Accessory to support fetal life
● Normal lifespan of sperm is 7 days ○ Placenta
● Sperm can reach ovum in 1 - 5 mins. ○ Fetal membrane
● Fallopian tube will contract due to estrogen ○ Amniotic fluid
● Sperm must remain in female genital tract 4 - ○ Umbilical cord
6 hours before they are capable of fertilizing 2. Implantation _
the ovum : asked by the ob to stay in the
● when the blastocyst attaches the
position after penetration
● Sperm have 22 autosomes and 1 X or Y sex endometrium (7 -9 days after
chromosomes fertilization)
● Ova contains 22 autosomes and 1 X sex ● Zygote undergoes cell division PMAT
chromosome ● morula 3 days
the enters the cavity and 3-4 days
STAGES OF PREGNANCY ○ Develops into a blastocyst
:transformation of fertilized
1. Fertilization _ ovum that would attach to
● the process in which a sperm uterine endometrium wall
○ floating and brushing against
penetrates the outer layer of the ovum.
● Conception / impregnation
rich endometrium wall -
● Union of sperm and ovum to form a
secretory phase : apposition
○ If fertilized attach at
zygote
● Penetrated outer layer of ovum
endometrium wall : adhesion
○ Settle in soft wall of the
● Development of women's embryo in
the ampulla endometrium continuously
● 24-48 hours completion
develop blastocyst turns into
● Mature ovum zona pellucida and
early - have hollow cavity :
surrounded plasma membrane invasion
● Occurs in the ovulation not earlier in
Early Blastocyst _
● Hollow cavity have cells show
the 72 hours not later than after 24
hours beginning of amniotic fluid : late
● Deposited near the cervix of the uterus
blastocyst
● Many of the sperm killed by the acidic
○ beginning of implantation
vagina borrowing process : functions
● 100,000 still survive in the fallopian
as gland HCG hormone corpus
tube by the current of the fimbriae, luteum will continue to produce
peristalsis and cilia 1-2 hour after estrogen and progesterone
intercourse gathered sperm decrease increase uterine wall
viscosity
 ● HCG will increase until 2 months
● HCG steadily decreases as placenta
will form it will replace the corpus
luteum to nourish developing fetus
also for estrogen and progesterone
● Single layer of cell : trophoblast
○ single flattened cell help to
form the placenta
● Inner cell mass : baby early
embryonic period come to a close
3. Pre-placental stage _
● when the endometrium becomes
highly vascular (week 2).
● To function fully
4. Placental and fetal development _

➢ Identical twin : 1 ovum matured and divided

into 2 separate zygote IMPLANTATION
➢ Fraternal twin : 2 matured ova
● 50% of zygote never achieve implantation
● Small amount of vaginal spotting is
occasionally present
● Endometrium grow in thickness and
vascularity turned to decidua:
○ decidua basalis : portion where
trophoblast establish communication
with maternal blood vessel
○ maternal side of placenta
○ decidua capsularis :endometrium
encapsulated portion of trophoblast
○ decidua vera: lines the remaining
area of uterus
● It has 3 processes:
○ apposition
○ adhesion
○ Invasion

UMBILICAL CORD
●  1 inches long
2
● 2 arteries and 1 vein = Ava cord dressing
● Wharton'sn's jelly: cover and protect the
umbilical cord
● Transport oxygen, nutrients, minerals, and
waste products
AMNIOTIC FLUID
● 500 - 1000 ml inside the amniotic sac
○ BOW : bag of water covered by
amniotic sac
● Produced by the amniotic membrane
● Shields fetus from pressure or blow : not
acceptable when child has cleft palate when
mother slips
● Protects fetus from sudden change in
temperature : temperatures like urine
● Aids in musculdevelopment
● Aids in descent during the labor and delivery :
slippery help fetus go down in the pelvical
cavity
● Protects umbilical cord from pressure : if baby
is small in the month of pregnancy or AGA
have problem in the delivery and the rupture
of water will make the cord float in fluid
○ cord will go down first it will have
pressure there will be a cut off oxygen
supply of the fetus
● Protects fetus from infection = ruptured bag of
water before due date administered
prophylaxis
● Once BOW is ruptured have interview what
color, is it green, does it have poop, what
time, it usually has blood smell , foul odor :
means infection know estimated amount
● Amniotic fluid : swallowed by the fetus
excreted by the fetal kidney turn into urine
and some if absorbed in the bloodstream it
will go into umbilical cord
● Amniocentesis : One of the diagnostic test
in which the sample of amniotic fluid is taken
for evidences of abnormalities
○ 2000 ml : hydramnios
○ More than 2000 ml : polyhydramnios
➢ limit fluid intake , properly
regulated IV fluid , fluid during
delivery if not ruptured BOW
water will be aspirated by the
fetus , diuretic : for urination
less amniotic fluid
○ Below 300 ml : oligohydramnios
➢ encourage patient for fluid
intake more than 8, IV fluid
increase by doctor
➢ mother will have difficulty to
expel the baby out
PLACENTA
● 15-20 cm : diameter of the placenta
● 2.5 cm : in thickness placenta
● 30 Cotyledons : segments of the placenta,
grapes which are flattened
● Highly vascular embryonic to maternal tissues
● At end of 8 weeks fully functional
● 2months development of placenta
● Arises from the trophoblast, single layer flat
cells
● Communicating from the mother to fetus from
the umbilical cord
● Provide nutrition and excrete waste

1. Respiratory system
● lungs of fetus does not function the 1st
cry of baby lungs is functioning of
lungs it will make the lungs inflamed :
fetal lung gas exchange take place
2. Renal system
● standing as the kidney of fetus, waste
product is excreted through placenta
and mothers kidney will filter
3. Gastrointestinal system
● stomach and intestine carry the
nutrients to the placenta to fetus
placental tissues : diffusion
4. Endocrine system – different hormones
● Human chorionic gonadotropin
○ orders corpus luteum to
produce progesterone and
estrogen
○ bases in pregnancy test will be
completely absent in urine after
1-2 weeks after delivery
○ it is not a positive sign when
shows big abdomen some
diseases may cause + of hcg
test
○ Testing of hcg after pregnancy
can confirm the delivery of
placental tissues is expensive
● Human placental lactogen
● hPL : human somatomammotropin
○ help to promote mammary
gland growth for lactation
● Estrogen : mammary development
stimulate uterine growth to
accommodate the fetus hormone of
woman increasing in Menstruation
● Progesterone : Hormone of
pregnancy maintain endometrium
lining during pregnancy - will cause
miscarriage if less. Contractility of
uterus to prevent premature
development
5. Protective functions
● Inhibit passage of bacteria and large
molecules bacteria not easily pass
through some drugs
● May cause some deformities
TERATOGENS : toxic substances
drugs, virus : german measles
interfere embryonic development ,
alcohol
● Pregnant women should not be
exposed to chickenpox and german
measles
● Radiation can cross placental barrier,
thalidomide: component of
medications , even paracetamols are
not advised will cross the barrier
DEVELOPMENT OF FETUS
● Major organs are formed first 8 weeks after
fertilization
● First 2 weeks after fertilization the stages of
human placental
○ Zygote : 1st 14 days
○ Embryo : 15 days to 8 weeks
○ Fetus : 8 weeks to birth
○ Newborn baby : delivered
○ 38-42 weeks : term
○ post term baby : 42 weeks
○ 28 weeks : age of viability
PHILIPPINES, other country is 21
weeks they have equipment to survive
the fetus
○ Preterm: 28-37 weeks
○ abortion : below 28 weeks
● Abortion : Less than 500 grams/ less than
300g fetus too immature to survive in
intrauterine environment
○ Septic abortion: when the quack
doctors will do something to remove
the baby inside catheter will be
considered as foreign object
○ Spontaneous abortion : not assisted
or induced abortion naturally
happened
○ Therapeutic abortion: done by
licensed physician to help mother
survive during course of pregnancy
ex. Cancer patient chemotherapy may
cause deformities
● 21 or 28 weeks : age of viability
● Three trimester: 1-3, 4-6, 6-9
● 10 lunar months: count per month with 4
weeks
● Age of gestation by weeks
● Calendar 9 months : 38 weeks = 266 days
● Pre Embryonic period: first 2 weeks after
preconception rapid cell differentiation
establishment of embryonic and germ layer,
cephalocaudal, proximal to distal 2 weeks
after the last menstruation
● Embryonic : 3rd week after fertilized zygote
travels the uterus undergoing mitotic cell
division 3 days after fertilization moral enters
uterine
● Fetal development: develop into
recognizable human being 8 weeks to birth
-Rapid growth -Can observe the
differentiation of arms fully identifies
tissues and body
systems -Umbilical cord can
see the 3 blood
vessels with 2
arteries 1 vein

-Covered by
wharton's jelly like
rubber band

-Enlarged head ,
eyes nose ears not
properly places

-All body organs are

-The fetus is having formed by 8 weeks
facial features
crude form -FHT by doppler
like tadpole

-Increase in fetal -Face is formed but

size it triple length by 10 weeks
body weight doubles recognizable as
human being
-Tail buds
-The liver is major
-Other organs site for rbc production
started to develop erythropoiesis
heart and liver
- -Urine production is
The heart is beating present
this time

-FHT is -9-12 weeks urine

recognizable production is
Limb buds : start to excreted
branch out
-Eyes at the proper
location already

-Prominent arms tail

buds not properly
formed
-For 2nd trimester -The growth fetus
already continues but
slows down
-Rapid growth and
coordinated -Maternal
movements of the awareness of fetal
limbs by 12-14 movement is felt
weeks external
reproductive -Quickening
organs distinguable
-The skin is now
-Ultrasound to covered with thick
know the sex of the cheesy substance
baby protect feral skin
from exposure of
-Eyes started to amniotic fluid for
blink and sucking thermoregulation
movement also : vernix
caseosa

-Ossification of -Lanugo formed

the skeleton bone except palm sole
formation in bone and lips
formation of fetus
-Fetal uterus and
-Bone of fetus testes start to
more than adult descend but still in
but will merge 300 abdominal wall
then 206

-Gain much weight

fht is heard by
stethoscope

-Skin appears pink

or reddish as blood
is visible in the
capillaries

-Rapid eye
movement

-Long fingernails

-Girl gender iis

difficult to
distinguish
-Lungs begins to
release ➢ 35 weeks –
surfactant ○there is a strong hand grip of baby if
decreases surface baby is too rowdy can hold the
tension of the umbilical cord have cord coil due to the
alveoli in the orientation
delivery ➢ 38 weeks –
○ full term delivery contractility of
-Erythropoiesis myometrium some cases reach 40
in the spleen but weeks the baby’s weight is 7.5 pound
stop in 28 weeks 3500g about 45-50 cm baby surviving
bone marrow well in outside environment
replaces the
function liver

-The ocular light

reflex: has
reflection in the
eyes of fetus

-The body is
leaned and
becomes
proportion position
eyes and ears

-Some
subcutaneous fats
to help the
thermoregulation
 FETAL CIRCULATION

● Foramen ovale : allow the blood from right

atrium to left atrium mix oxygenated and
deoxygenated blood
● Umbilical vein : transport blood from placenta
to fetus
● Umbilical arteries : fetus to placenta
● Ductus arteriosus : allows the blood in the
pulmonary artery to go directly to descending
aorta bypass circulation
● Ductus Venosus : inferior vena cava bypass
liver
● Placenta : get blood from the fetus FOCUS ON FETAL DEVELOPMENT
● Reproductive system undergo greatest
change
First Trimester _
● organogenesis
Second Trimester _
● period of continued growth and development
Third trimester _
● period of most rapid growth and development

NORMAL ADAPTATION IN PREGNANCY

Reproductive System

Uterus _
● Uterine growth and enlargement
○ Length : 6.5-32 cms
○ Width : 4-24 cms
○ Depth : 2.5-22 cms
○ Weight : 50-1000 gms
○ Volume : 1-2 ml to 1000 ml
● Braxton Hicks contraction:
○ estrogen lets the uterine
contract
○ Irregular painless contraction
○ Begin about 16 weeks or 4
months Age of Gestation
○ Contraction in abdomen
○ Becomes globular in shape as
the fetus enlarges
○ Becomes globular (4th month)
● stretch as fetus enlarges to
accommodate the growing fetus
 ● Under estrogen it will undergo
hyperplasia myometrium and fiber
cells : enlargement of organ and tissue
● Hypertrophy : uterus enlarge and
stretch the estrogen will enhance the
uterine contractility for labor
● Progesterone : relaxation effect of
smooth muscle until full term
Cervix _
● Goodell’s sign (4th week)
○ Stimulation from estrogen and
progestin cervical softening
● Hegar’s sign (8th week)
○ Softening of lower uterine segment
caused by pelvic congestion
● Chadwick’s sign (8th-10th week)
○ cause increase blood flow 8-10 cm
there will be engorgement increases
level of estrogen
○ earliest sign of pregnancy the
discoloration , bluish purple hue during
pregnancy, vulva and vagina
Ovaries _
● No ovulation/Leukorrhea
○ Leukorreha whitish vaginal discharge
increase during course of pregnancy to ➢ Spinnbarkeit test
increase the acidity in the vagina to
help control the growth of pathogens in
vaginal canal
● No ovulation produce progesterone
Vagina _
● more acidic (ph 3.5-6)
Breast _
● Enlarged
● Melanotropin, colostrum
● Melanotropin : anterior pituitary gland causes
nipple to become tender and more pronounce
and darken areola presence of colostrum at
the end of trimester with antibodies cause
natural immunity help the fetus in delivery
Musculoskeletal System

● Waddling walk : Relaxation of the pelvic joint

● Symphysis pubis may separate slightly
 Circulatory System

● Increased blood volume 40-50%

○ increase metabolic demands of the
new tissue
● Physiologic anemia/Pseudoanemia
○ hemodilution of hemoglobin level to
the blood volume
○ Pseudoanemia : Decreases rbc in the
plasma
➢ superior vena cava from upper part of body
● Heart is displaced upward
➢ inferior vena cava impede circulation in
○ placement of fetus
supine
● Increased cardiac output to 30%
● Supine hypotension/ Vena-caval Syndrome Integumentary System
○ Large uterus lies at the inferior vena
obstruct cardiac venous return
● Increased pigmentation
○ Advises lie down at left lateral position
○ Increased estrogen and progesterone
receive right atrium
● Chloasma/ melasma
○ Lying down compensate right atrium
○ mask of pregnancy appears after
needs to be loaded making the
pregnancy , some on the neck normal
mother breath comfortable
occurrence
○ Impered inferior vena cava in supine
● Striae gravidarum
position decreased circulation vena
○ stretch mark at the abdomen of
caval syndrome
mother, stretching of abdominal
○ inferior vena cava is squished in
muscles
supine position
● Linea negra
● CR & PR increased to 10-15 beats/min.
○ Found at the abdomen, darkened line
● Varicosities and edema
from umbilicus-pubis
○ lower extremities only
● Increased perspiration
○ Eyes and hands edema is indication of
● Palmar erythema
hypertension in pregnancy
○ Changes color in palmar surfaces

Gastrointestinal System

● Morning sickness
○ Due to estrogen, progesterone and
HCG
○ increase salivation due to hcg
● Heartburn/Pyrosis
○ due to relax sphincter between
stomach and esophagus cause reflux
● Constipation
○ receive medication increase
hemoglobin cause constipation but
main reason is due to the decreased
 motility brought about increase
estrogen and progesterone
○ Ferrous sulfate for delivery or other
medication

➢ Areola darken veins are prominent and

visualized

Respiratory System

➢ linea negra
● Increased RR
○ 5-10 cycles increased
● Dyspnea
○ diaphragm is displaced upward by 2
cm by fetus
○ Amount of air is increased estrogen
prompts hypertrophy and hyperplasia
of lungs
○ Progesterone relaxation of
bronchioles
● Increased tidal volume
● Increased vital lung capacity
○ maximum amount of air that can move
in and out of lungs is being forced
● Decreased residual volume
 Urinary System
Weight Gain

● Urinary frequency
● Weight distribution:
○ anatomical location of bladder and
○ Fetus : 7 lbs
uterus compressed by weight of
○ Placenta : 1 lb
growing fetus fetus is lying on bladder ,
○ Amniotic fluid : 1.5 lbs
increased progesterone induced
○ Uterus : 2 lbs
relaxation of urethra and sphincter the
○ Blood volume : 1 lb
descending part of fetus descends in
○ Breasts : 1.5-3 lbs
pelvis , liver pushed up
○ fluid : 2 lbs
○ Occurs in first and 2nd but more on
○ Fats : 4-6 lbs
3rd trimester
○ Total: 20-25 lbs
○ Experience UTI: relaxation of smooth
★ Pattern of weight gain is
muscles of bladder movement of
important
kidney being obstructed
★ Not abrupt but slow as the
● Increased GFR/Glycosuria
fetus enlarges
○ Asymptomatic bacteriuria (ASB)
★ Allowable gain = 20-25 pounds
○ GFR increased 50% this alternation
★ 20lbs = 10-12 kg
increase renal tubular reabsorption
kidneys inability of kidney to absorb
glucose can be GDM SIGNS OF PREGNANCY

First Trimester

Presumptive signs:
Endocrine System
Probable signs:
● Increased metabolism of CHON and CHO
● Increased insulin production
○ Lactogen diminished insulin
● APG enlarge, thyroid gland increase in size
and activity
○ Enlargement of thyroid not advised to
get pregnant : caused by increased
circulation or progesterone in thyroid
gland
_
● Amenorrhea
● morning sickness : persons who are having
tumor in the uterus
● breast change
● Fatigue
● urinary frequency
● enlargement of uterus
● Signs of pregnancy which are taking it as
single entity can be other conditions
● Can be seen to other disorders
_
● Chadwick’s sign: discoloration of vaginal
mucosa or thickening ,
● Goodell’s: softening of cervix 2nd trimester
Hegar's: softening of isthmus of uterus 6
weeks of pregnacy
● (+)HCG : can be seen in H Mole
(Hydatidiform mole) a rare complication of
pregnancy characterized by the abnormal
growth of trophoblasts, the cells that normally
develop into the placenta
 ● These can be documented by examiner not
more reliable than presumptive not a true PRENATAL CARE
diagnostic of pregnancy
Positive sign: _
● Ensure uncomplicated pregnancy to have a
● Ultrasound result
live baby
● Indication of pregnancy
● First pregnancy is not accepted in lying inn
Second Trimester and not have prenatal care in the same lying
inn

Presumptive signs: _ Data Gathering

● Quickening
● skin pigmentation
1. Demographic data _
● Chloasma
● Marital status
● linea negra
● Chief complaint
● striae gravidarum
2. Obstetrical data: _
A. LMP (Last Menstrual Period)
Probable signs: _
● 1st day of LMP
● Enlarged abdomen
● first day of last menstruation
● Braxton Hick’s : periodic tightening of
B. AOG (Age of Gestation)
abdominal muscles until 7 months, first felt by
i. By weeks
the mother
● LMP until date of
● Ballottement
assessment
Positive sign: _
● FHT
● fetal movements
● fetal X-ray

Third Trimester

Presumptive signs: _
● Quickening
● skin pigmentation
● Chloasma
● linea negra
● striae gravidarum
Probable signs: _
● Enlarged abdomen
● fetal outline ii. MC Donald’s Method (FH/4=
● Ballottement no. in months)
Positive sign: _ ● ex: 32 cms ÷ 4 = 8
● FHT months
● fetal movements iii. Bartholomew’s rule = 4
● visualization of fetus by USD landmarks
1. Level of symphysis
pubis : 12 weeks AOG
 2. In between symphysis
pubis to umbilicus : 16
weeks AOG
3. Level of umbilicus : 20
weeks AOG
4. Xiphoid process : 36
weeks AOG
★ 1 cm per week
C. TPAL Scoring
● TERM : 38-42 weeks
● PRETERM : 28-37 weeks
H. Past pregnancies :
● Methods of delivery
○ CS, NSVD,
Instrumentation
(forceps, vacuum)
● Place of delivery
○ Lying inn, hospital
I. Present Pregnancy
3. Medical Data _
● illness before, during pregnancy ,

● ABORTION: terminated before previous pregnancy illness after

28 weeks delivery
● LIVING
D. EDC (expected date of confinement)
i. Naegele's rule (-3 +7 +1)

E. EFW (estimated fetal weight) ➢ If the baby is about to be delivered it go

Johnson’s rule
i. FH - N x K (constant 155)
○ N= 11 not engaged
○ N= 12 engaged
F. GPA
● Gravidity: # of pregnancies
dead or alive
● Parity: # of pregnancy reached
age of viability 28 weeks
● Abortion in pregnancy:
aborted before 28 weeks
G. TPAL
● Term : 38-42 weeks AOG
● Preterm : 28-37 weeks
● Post term : 42 wells above
● Living : # of children alive
down in pelvic inlet or cavity
Sample Computation
1. Mrs. K, a mother of 7 children, visits a health
center for prenatal checkup. History is taken
she had her LMP on October 16, 2009. She
abrtion in 1996, 1999, 2002. She had a couple
of identical twins whom she delivered
prematurely in the year 2000 and 2004.
(use March 16, 2010 as the date of visit)
A. EDC
B. AOG in weeks
C. GPA
D. TPAL
Answers: _ ● Pregnancy increase progesterone
A. 7-23-10 gums become edematous : bleeding
during brushing and some open
lesions and other dental problems
pathway of pathogens enter
bloodstream to prevent infection
● Check for hair will lose some hair
B. 21 4/7 ● Striae gravidarum, edema eyelids :
HPN
1. Physical Exam _
2. Pelvic Exam _
● Empty the bladder in
abdominal examination to not
make patient uncomfortable so
that bladder is not bloated
C. G9 P5 A3 ● difficulty to asses completely
D. T3 P4 A3 L7 with full bladder
A. Internal examination (IE)
Calculate the estimated date of delivery using B. Vaginal Speculum
Naegel’s rule ● Placed in vaginal canal to open
and visualize
● Lynne is a 28 year old woman who comes to C. Transvaginal Ultrasound
the clinic with a history of amenorrhea and a ● Done in the abdomen
positive pregnancy test result. Her last ● It should be full bladder :
menstrual period began on May 31, 2021. She because tube connected to
bleeds for the usual amount of time and monitor inserted to vagina not
reports that the amount of blood loss was visualized properly to know
normal assuming that Lynne had a 28 days where is the bladder properly
cycle. Use the Naegele’s rule to calculate her rectum
estimated date of birth. D. Ballottement
● Fetus bounce back in the lower
Computation uterine segment when the
examiner will tap : 5 months
1. The mother has 4 living children and she is 38 E. Papanicolaou test (PAP smear)
weeks pregnant. The mother delivered the 1st Stages of Malignant cells:
child at 36 weeks, the 2nd at 37 weeks, the ● Stage 1 : confined to
rest at 40 weeks and 39 weeks. She had 2 the cervix
aboritons at 20 weeks. She also had a twin ● Stage 2: extend
pregnancy at 38 weeks but died after delivery. beyond the cervix
A. GPA : G8 P5 A2 rectum, bladder
B. TPAL: T4 P2 A2 L4 ● Stage 3 : extend to
pelvic wall
ASSESSMENT ● Stage 4 : beyond pelvic
● Cephalucaudal head to toes floor to other organs
● Teeth of the mother if she experienced
toothache the growing fetus take
calcium for bone development
 F. Pelvic Measurement- Pelvimetry
G. Leopold Maneuver
● Fundal grip
○ Fetal position
○ Where is the head
hands and feet
○ Facing towards the
face of mother from
fundus to going down
● Umbilical grip
○ fetal back & extremities
○ face the mothers
abdomen
○ push on the left palapte
on the right
○ push on the right
palpate on the left
➢ White line : chadwick's sign : purple hue
○ fetal back : Plain
discoloration, before discharges in the vagina
● Pawlik’s grip
in the ovulation
○ engagement : face
➢ Hegar's sign : softening of isthmus
mothers abdomen
➢ Godells : softening of cervix
palpate upper portion of
symphysis pubis to
check if baby is
engaged
○ Not moving : engage
○ Moving : not engage
● Pelvic grip
○ fetal attitude :
curvature check of
degree of flexion of
baby , face presentation
, vertex cephalic, looked
up mentum , flex head
brow being presented
○ Curvature of neck if
flexed vertex
○ Extended hollow portion
hands will curve
3. Vital signs _
● BP : 40-50% demand blood volume
● Compare BP before pregnancy
○ Slight increase is normal
● Increasing b4 pregnancy
○ Systolic and diastolic increase
HPN
● 100mmhg diastolic bp > refer to doctor
➢ Chadwick's sign External OS ● RR : increase 5-10 cycles
4. Blood studies _
● Blood typing, rh factor: test rh
incompatibility
● 1st pregnancy is safe in rh
incompatibility
● CBC: loss of 500 ml NVSD , 1000ml
if CS
● Blood loss in delivery
5. Urine exam (hpn and dm) _
● Know hypertensive through protein
and albumin + 3
● Determine glycosuria : glucose on
urine need further examination

➢ Is the baby's head extended?

DANGER SIGNS OF PREGNANCY:

● Not a disease but not an assurance she will

not experience any complications
A. Vaginal bleeding _
● No matter slight it is , it should be
reported
● Placenta previa : low implantation of
placenta it should be in endometrium
blocks the outlet, bigger baby
compressed blood cells of placenta ,
painless bleeding check up
● Abruptio placenta : premature
separation of placenta separated at 40
weeks degenerate considered by the
body as a foreign body expelled , not
 mature yet already separated , seek C. Sudden escape of fluid from the vagina
medical attention and painful ● PROM
● Premature labor : blood also will ○ Premature Rupture of
come out Membrane not yet reached to
● Threatened abortion : miscarriage term
mother ○ premature labor or contraction
uterine cavity no longer sealed
NURSING INTERVENTION baby is prone to infection and
baby is small of gestational age
● CBR w/o BRP = prolapse of the chord
● Emotional support if with first ● Ruptured bag of water
pregnancy ○ baby will go down cord will
● Defecate given with laxative descend first
A. Persistent vomiting _ ○ baby's head can compress the
● Not a positive sign of pregnancy 1-2x a umbilical cord impede the
day vomiting is normal circulation of fetus from the
● More than that can lead to dehydration umbilical cord
depletes nutritional supply to fetus : D. Abdominal or chest pain _
needs hospitalization to replace ● some think is normal like the bladder
electrolytes being expelled through iv being displaced
fluids ● Ectopic pregnancy : if baby at the
● Hyperemesis gravidarum : might be tube does not go down in the
due to persistent infection , systemic endometrium will lead to bleeding
infection ● Abruptio placenta : premature
● Persistent infection : cause separation of the placenta
persistent vomiting ● Uterine rupture
B. Chills and fever _ ● Pulmonary embolism: air should not
● Increase fluid intake , replace the loss enter in the blood vessels in IV
fluid , urinate remove hotness of the insertion traveling clot can cause chest
body pain
● Intrauterine infection E. Swelling of face and fingers _
● Dehydration ● Check for swelling if accompanied by
● Benign gastroenteritis edema at lower extremities
● Indication of PIH hypertension in
pregnancy
● Eyelids hpn
F. Rapid weight gain _
● Pattern is important not should be
abrupt not enbulked
G. Flashes of lights or dots before the eyes
● Check for face and finger and
extremities : HPN
H. Dimness or blurring of vision _
● Eclampsia
➢ Placenta disrupting external OS I. Severe headache _
➢ Compress blood vessels in placenta cause ● Cannot be relieved by pain
bleeding medications
J. Decrease urine output _ First and Third Trimester
● Glomerular filtration rate is altered
when there is glycosuria and dm 6. Fatigue _
● Frequent rest periods
DISCOMFORT IN PREGNANCY ● Regular exercise
● Avoid stimulants
First Trimester 7. Urinary frequency and urgency _
● enlarging fetus increase oral fluid
intake for dehydration
1. Nausea and vomiting _
● Increase oral fluid intake
● Eat dry crackers
● Limit fluid intake in the evening: alter
● Small frequent feeding
sleep pattern of mother
● Low fat meals
● Void at regular intervals: constipation
● Avoid fried foods
due to decrease motility of
● Avoid animetics = medication that will
gastrointestinal system and ferrous
stop nausea and vomiting medications
sulfate
are not allowed unless prescribed by
● Sleep on the side at night : left lateral
ob
position
2. Syncope _
● Wear perineal pads if necessary :
● Sit with feet elevated
change every 4 hours , panty liners
● Change position slowly
● Left lateral position = increase Second and Third Trimester
circulation

First through Third Trimesters 8. Heartburn _

● Small frequent feeding
● Sit upright for 30 minutes after meal =
3. Breasts tenderness _
avoid vomiting
● in preparation for lactation human
● Drink milk between meals
placental lactogen
● Avoid fatty and spicy foods = cause
● Use supportive bra with elastic strap
oily foods trigger heartburn
● Avoid soap in the nipples and areola
● Avoid antacids unless prescribed by
4. Increased Vaginal Discharges _
physician = given to patient who are
● increase estrogen and progesterone
having hyperacidity
● Proper cleaning and hygiene
● Content in milk prevent heartburn
● Wear cotton underwear : absorb
9. Ankle edema _
discharges
● indication of hpn check for puffy
● Avoid douching
eyelids - occur 2 weeks before delivery
● Consult physician if infection is
have to be cautious with headache ,
suspected
puffy eyelid edema on extremities :
● Take note of smell and odor: foul odor
HPN
: infection have to refer to OB
● Elevate legs at least twice a day
5. Nasal stuffiness _
● Wear support stockings
● Use humidifier : simple no medications
● Avoid one position for long periods of
and steamed
time : trigger occurrence of edema
● Avoid nasal sprays and antihistamines
: loosens stucked part at nose
 ● Avoid diuretics = medications eliminate ● Elevate and dorsiflex the feet while
fluid from the body no consultation resting
should be avoided ● Increase calcium intake : help in
○ potassium sparing diuretics : increase in blood flow , leg cramps in
retain the potassium needed occured in altered calcium and
for contraction of heart muscles phosphorus balance and the pressure
not should be given of the uterus on the nerve
10. Varicose veins _
● Wear support stockings RECOMMENDED EXERCISE
● Elevate feet when sitting
● Lying with feet and hips elevated 1. Tailor sitting : 15 mins per day while
● Move out while standing watching tv
● Avoid pressure on lower legs 2. Squatting : done in the third trimester month
● Avoid leg crossing of edc in october squating 15 mins per day
● Avoid standing or sitting long period of everyday help in stamina of mother to push
time during delivery
● Avoid constricting clothing 3. Pelvic Floor contraction (Kegel’s exercise)
11. Headaches _ : squeeze when you urinate when you like to
● Change position slowly stop squeeze muscles surrounding the
● Apply cool cloth at forehead vagina tighten perineum
● Eat small snack 4. Abdominal Muscle contraction: like
● Use pain relievers when prescribed blowing candle
12. Hemorrhoids _ 5. Pelvic Rocking : woman makes lumbar spine
● Warm sitz bath more flexible to stretch the spine hold position
● High fiber diet for 1 min sitted down
● Increase oral fluid intake
● Exercise
● Apply ointments/ suppositories as
prescribed
13. Constipation _
● High fiber diet
● Increase oral fluid intake
● Exercise
● Avoid laxatives
14. Shortness of breath _
● Rest periods
● Elevate head while sleeping= weight
on body on the lungs
● Avoid overexertion
15. Backache _
● Encourage rest
● Use body mechanics
● Wear low-heeled shoes
● Exercises
● Sleep on firm mattress
16. Leg Cramps _
● Exercise
 3. Progesterone Deprivation Theory _
● A decrease in progesterone causes
uterine changes- labor pains occur
● Progesterone hormone of pregnancy
decreases cause uterine changes so
labor begins , labor pain
4. Prostaglandin Theory _
● Prostaglandin stimulates myometrium
thus labor onset to contract
● To initiate contractions labor begins
5. Placental Aging Theory _
● Insufficient nutrients to reach the fetus,
no longer produce estrogen and
progesterone. Thus, labor begins
● Placental reach maximum function at
40 weeks or 42 weeks then expelled

Components of Labor (5P’s)

LABOR 1. Passageway _
● Mother’s pelvis, cervix and vagina
● A series of events when the product of 2. Passenger _
conception is expelled out from the woman’s ● Fetus and placenta
body 3. Power _
● Regular uterine contractions cause ● Uterine contraction, uterine muscles
progressive dilatation of the cervix and and mother’s ability to push
sufficient muscular force to allow the baby to ● Pushing method of mother
be pushed outside 4. Psyche _
● Usually begins when the fetus is sufficiently ● Mother’s psychological condition
mature 38 - 42 weeks 5. Position, maternal _
● Lithotomy , water delivery or standing

THEORY OF LABOR

1. Uterine Stretch Theory _

● Contraction of the uterus would
indicate labor begins
● Uterus is just like the balloon to
accommodate growing fetus

2. Oxytocin and Prostaglandin Theory _

● Works together to inhibit calcium
binding in muscle cells, raising calcium
thus activating contractions
● Oxytocin release apg help in
contraction during labor
Engagement _ Dilation _
● settling of the fetal presenting part into the ● Opening of the cervical os
ischial spine ● From 1-10 cms (fully dilated cervix)
Station _ ● Due to uterine contraction and amniotic fluid
● relationship of the fetal presenting part to the Effacement _
level of the ischial spine ● Thinning of the cervical canal
● Expressed in % (100% is a fully dilated cervix)

THE VAGINA

Vagina Canal _
● Has rugae and capable of stretching but can
be lacerated:
A. 1st degree : skin
B. 2nd degree : skin and muscles
C. 3rd degree : external sphincter of
rectum
D. 4th degree : mucus membrane of
rectum
Perineum _
● Site of episiotomy:
A. Median episiotomy
B. Right mediolateral
C. Left mediolateral

PASSENGER - fetus & placenta

● Fetal skull of the fetus is the largest part of the

body
● The least compressible of all parts
● The most frequent presenting part
 PRESENTATION

Body parts that will first contact the cervix

 METHODS TO DETERMINE FETAL POSITION

● Leopold’s maneuver
● IE/Vaginal Exam
● Auscultation of FHT
● Sonography (USD) .

_ Left Occiput Anterior (LOA) _

POSITION

Position of the fetal presenting part to the

specific quadrant of the mother’s pelvis

_ Right Occiput Anterior (ROA) _

FETAL LANDMARKS

● Occiput : Vertex/cephalic presentation (O)

● Mentum : chin/face presentation (M)
● Sacrum : in breech presentation (Sa)
● Acromion : Scapula/shoulder presentation
(A) .
FETAL POSITION - represented by 3-Letter
abbreviation
● 1st letter - L (left) or R (right)
● 2nd - fetal landmarks
● 3rd - A (anterior), P (posterior), T
(transverse)
_ Left Occiput Transverse (LOT) _ _ Right Occiput Posterior (ROP) _

_ Right Occiput Transverse (ROT) _

_ Direct Occiput Posterior (DIRECT OP) _

_Left Occiput Posterior (LOP) _ _ Direct Occiput Anterior (Direct OA) _

_ Right Sacrum Posterior (RSaP) _
DIFFERENCE BETWEEN FALSE AND TRUE
LABOR

FALSE LABOR .
1. Irregular interval contractions
2. Pain in the abdomen
3. Intensity remains the same
4. Intervals remain long
5. Walking gives relief
6. No bloody show
7. No cervical changes
8. Contractions stops with sedation
TRUE LABOR .
POWER 1. Regular interval of contraction
2. Starts at the back to abdomen
3. Contractions are intensified
A. Uterine Contraction _ 4. Intervals gradually shorten
5. Intensified by walking
6. With bloody show
7. Cervical dilation and effacement
8. Does not stop with sedation
STAGES OF LABOR

● First stage : Dilation stage

○ Latent phase
○ Active Phase
PRELIMINARY SIGNS OF LABOR
○ Transitional Phase
● Second Stage : Fetal expulsion stage
1. Lightening ● Third Stage : Placental Stage
2. Braxton Hicks contraction ● Fourth Stage :Recovery
3. Cervical changes
4. Bloody show
5. Loss of weight
6. Increase in activity level
SIGNS OF TRUE LABOR

● Uterine Contractions
● Effacement : shortening & thinning of the
cervical canal expressed in % (fully dilated
cervix is 100%)
● Dilatation : opening of the cervical os from
1cm-10cms (fully dilated cervix)
● Uterine changes:
○ upper uterine segment
○ lower uterine segment
● Physiological retraction ring
 NURSING CARE
DURING THE 1ST STAGE

1. Admission care
2. Date gathering
3. Assisting IE
4. Leopold’s maneuver
5. Fetal Heart Tone (FHT) monitoring
6. Uterine Contraction Monitoring
7. Promote change in position
8. Empty the bladder
9. Hygiene
10. Enema administration
11. Perineal preparation
12. Analgesic administration as ordered
13. Assist in the administration of regional
anesthesia
14. Start IVF as ordered
15. Assist in amniotomy
16. Watch out for SUBIRBA
17. Emotional support

WHEN TO POSITION PATIENT FOR DELIVERY

_ (SUBIRBA) _
S - Severe uterine contraction
U - Urge to defecate
B - Bearing down sensation
I - Increase bloody show
R - Ruptured Bag of Water
B - Bulging of the perineum
A - Anal Dilation
CARDINAL MOVEMENTS OR
MECHANISM OF LABOR
 2. Placental delivery _
● Schultz Delivery : fetal, shiny
● Duncan Delivery :maternal, dirty,
rough

NURSING CARE ON
THE SECOND STAGE
1. Lithotomy position
2. Perineal flushing
3. Drape aseptically
4. Teach breathing technique during uterine
relaxation
5. Teach pushing technique during uterine
contraction
6. Assist episiotomy
7. Do ritgen’s maneuver
8. Ease head out, wipe face and do initial
suctioning
9. Wait for external rotation
10. Pull head downward and upward to deliver the
shoulders
11. Deliver the body
12. Take note of time of delivery and sex od the
baby
13. Place baby on mother’s abdomen
14. Palpate for the pulsation of the cord
15. Clamp the cord near the vulva
16. Milk the cord towards the baby
17. Clamp 1 inch apart from initial clamping
18. Cut the cord
THIRD STAGE OF LABOR
(PLACENTAL STAGE)

➢ A healthy placenta after delivery. Notice the

1. Placental Separation _
shiny surface of the fetal side. The umbilical
A. Calkin’s sign : uterus becomes
cord is inserted in the center of the fetal
globular and firm
surface. The maternal side is rough and
B. Uterus rises above the abdomen
divided into segments (cotyledons).
C. Sudden gush of blood
D. Lengthening of the cord
 2. Temperature _
A. Dry the baby
B. Wrap with towel
C. Gooseneck lamp
D. Avoid unnecessary exposure
E. Place inside incubator
3. Proper identification _
A. Name bond
B. Foot prints
4. Care of the cord _
A. Milking the cord
B. Cord dress aseptically
5. Care of the eyes _
A. Crede’s prophylaxis (prevents
NURSING CARE ON ophthalmia neonatorum) - terramycin
THIRD STAGE 6. Vitamin K injection _
7. Newborn assessment _
1. Wait for signs of placental separation ★ APGAR scoring : done after 1 and 5
2. Do Brandt Andrew’s Maneuver mins of life
3. Do Crede’s Maneuver
4. Gently pull the placenta downward
5. Take note for the time of placental delivery
6. Check for type of placental delivery
7. Take BP
8. Check for completeness of cotyledons
9. Promote uterine contraction:
A. Massage the hypogastric area
B. Apply ice pack on the hypogastric area
C. Administer medication:
Oxytocin/Maleate
D. Empty the bladder ★ SCORE INTERPRETATION
10. Inspect perineum for lacerations ○ 0-4 : Poor; in serious danger
11. Assist in episiorrhaphy and needs resuscitation
12. Do perineal care ○ 5-6 : condition is guarded;
13. Apply contoured brief/adult diaper may need airway clearing and
14. Make patient comfortable oxygen
NEONATAL PERIOD ○ 7-10 : good; newborn is doing
well
1. Airway _ 8. Anthropometric measurements _
A. Wipe mouth and nose A. Birth weight : 2.5 - 3.5 kgs
B. Suction B. Length : 45 - 55 cms
C. Stimulate to cry C. Head Circumference : 32 - 35.5 cms
D. Oxygen administration D. Chest Circumference : 30 - 33 cms
E. Hook to respiratory machine E. Abdominal Circumference : 28 - 30
cms
9. Vital signs _
A. Heart Rate : 120 - 160 bpm
B. Respiratory : 40 - 60 bpm
C. Temp(rectal) : 36 - 37.6

C. Chest _
● Witch milk
D. Abdomen _
● Check the umbilical cord
● Gastroschisis : absence of
10. Head to toe assessment _ abdominal wall
A. Head _ E. Genitals _
● Moldings ● Should void within the 1st 24
● Fontanels hours
● Caput succedaneum ● Pseudomenses
● Cephalhematoma ● Testes should be descended
● Suture lines cryptorchidism: undescended
● Anencephaly testes
B. Face _ ● Preterm male has less rugae in
● Blink reflex the scrotum
● Strabismus ● Labia minora is prominent
● Ears should be even or above F. Extremities _
outer eye canthus ● Flexed
● Creases on the palm
○ Simian crease : only
one crease
● Polydactyly:extra toes or
fingers
● Syndactyly: webbing of fingers
● Amelia : absence of upper
extremities
● Tocophilia : absence of lower
extremities
● Clubfoot
G. Skin _
● Color
● Mongolian spots
● Vernix Caseosa
● Lanugo
● Milia
 PRINCIPLES OF PUERPERIUM
● Promotion of healing and prevention of illness
● Prevent postpartal complications
● Establish successful lactation
● Motivate use of family planning method
● Provide emotional and psychological support
POSTPARTUM ASSESSMENT
(AV BUBBLEHER)

A = Appearance
V = Vital Signs
B = Breasts
U = Uterus
B = Bladder
B = Bowel
L = Lochia
E = Episiotomy/Episiorrhaphy
H = Homan’s sign
E = Emotion
R = Rhogam

APPEARANCE

● The head to toe assessment of the mother

VITAL SIGNS

Temperature _
● increase on the 1st 24 hrs : dehydration/effort
FOURTH STAGE - PUERPERIUM
in labor
● after 24 hours : infection
1. Puerperium / postpartum period / 4th ● after 3-4 days : milk production
trimester / recovery stage _ Pulse _
● 6 weeks period after childbirth ● decrease due to decrease cardiac output
2. Involution _ Blood pressure _
● Reproductive organs return to its non ● slightly decrease
pregnant state Respiratory rate _
3. Subinvolution _ ● no changes
● Failure of the reproductive organ to
return to its non pregnant state BREASTS
4. Exfoliation _
● Placental site heals by scaling off of ● drop in estrogen and progesterone
● lactating
dead tissues
● colostrum is present
5. Atony _ ● Let-down reflex
● Uterus does not have good muscle ● warm and tender
tone and consequently relaxes ● engorged
● milk is produced by the 3rd - 4th day
● veins are apparent

UTERUS
● size is reduce:
○ immediately after delivery : 1000
gms
○ after end of 1st week : 500 gms
○ after end of 1st week : 50 gms
● placental site is sealed off
● cervical os are narrowed
● painful during contraction
● contracted
BLADDER
● Voiding should occur 4-6 hours postpartum
(6-8 hrs.)
BOWEL
● becomes more active soon after birth
● peptide hormone relaxin,-high circulating
levels during pregnancy, depresses bowel
motility
● continued effects of of progesterone on the
smooth muscles-decreased bowel motility
● bowel movement typically delayed until 2nd or
3rd puerperal date
● bowel tone is slowed
● during labor ,restriction of food
● fear of tearing the stiches
BOWEL
● discharges of the uterus
○ Lochia rubra : 1-3 days bloody red in
color
○ Lochia serosa: 4-10 days, pink or
brown color
○ Lochia alba : creamy,yellowish color
pattern should not reverse
● increase in activity
● decrease in breastfeeding
● not offensive in odor
● without large clots
● present in CS
EPISIOTOMY
● midline or mediolateral
● lacerations :
○ 1st degree : skin , mucus membrane
○ 2nd degree: skin, mucus
membrane,fascia
○ 3rd degree: skin, mucus membrane,
muscles , rectal sphincter
○ 4th degree : involve all these
structures plus anal wall assessment
○ REEDA: Redness, Edema,
Ecchymosis, Discharges and
Approximation
HOMAN’S SIGN
● used in assessment of deep venous
thrombosis (DVT) in the leg
● varicosities and signs of thrombophlebitis
○ inflammatory process that causes
blood clot to form and block one or
more veins pedal pulses may be
obstructed by thrombophlebitis and
should be palpated with each
assessment
EMOTIONAL STATUS
● sense of elation immediately after birth.
● mother wanted to talk about her labor and
delivery
● exhausted, need rest and sleep to restore her
body to health
● normally during the 1st 24 hours : passive,
preoccupied with own needs talkative if
unable to sleep
● 1-2 days beginning to assume responsibility
 RH INCOMPATIBILITY

● possible when two specific circumstances

exist:
○ mother is Rh negative
○ fetus is Rh positive : the father is Rh
positive causes no harm to the mother,
but affects the fetus
● RhoGam Rh : immune globulin,unsensitized -
28/7A0G,72 hrs PP-IM
● Icterus Gravis: RBC are destroyed,fetal
bilirubin increases = kernicterus - bilirubin
encephalopathy
● Erythroblastosis fetalis
● Coombs test

RETROGRESSIVE CHANGES

Exhaustion _
● sleeplessness
● fetal movements
● after pains energy expenditures
● NPO
Weight Loss _
● diuresis
● diaphoresis
● return to prepregnancy weight at 6th week
Progressive Changes _
● Lactation
● Mammary Gland HEALTH TEACHING FOR BREASTFEEDING

PROGRESSIVE CHANGES 1. Hand washing before and after

2. Clean nipple with water
3. Expose nipple to air
LACTATION 4. Feed the baby in short frequent intervals and
lengthen gradually
5. Alternate the breasts
6. Proper positioning
7. Adequate maternal nutrition and increase OFI
8. Wear well-fitted bra
PROPER ATTACHMENT

● Chin of the baby touches mother's breast

● Baby grasp not only the nipple but also the
areola
● Lower lip turned outward
● Mouth wide open
 PROPER POSITIONING

● Head and lower body part must be aligned

● Baby is facing the mother
● Tummy to tummy

THE CROSS-OVER HOLD

BREASTFEEDING

THE CLUTCH or FOOTBALL HOLD
B : Best for baby, also best for mommy
R : Reduces the incidence of allergies
E : Economical - no waste
A :Antibodies to protect baby against infection
S : Sterile and pure; stool inoffensive
T : Temperature is always ideal
F : Fresh milk never goes off
E : Easy once establish
E : Eradicates feeding difficulties
D : Digested easily
I : Immediately available
N : Nutritionally optimal; No mixing required
G: Gastroenteritis greatly reduced

SIDE LYING or RECLINING POSITION

Different Burping technique

● Over the lap

● Tummy to tummy
● Over the shoulder
● Holding the baby supported with one hand

EMOTIONAL PHASES OF PUERPERIUM

1. Taking-in Phase .
● woman is passive and dependent
● prefers talking about pregnancy, labor
THE CRADLE HOLD
and delivery
● uncertain in caring for newborn
● energies are focused on bodily
concerns
● uninterrupted sleep is important
● additional nourishment is necessary
● happens 1-2 days after delivery
2. Taking-hold Phase . Causes:
● woman begin to initiate action ○ large babies
● interested in taking care of newborn ○ cesarean birth
● asserts independence ○ augmentation of labor
● mother focuses on regaining control ○ placental accidents
over her bodily functions bowel and ○ dystocia
bladder; strength and endurance B. Late postpartum hemorrhage _
● happens 2 to 4 days after delivery ● retained placental fragments
● ruptured uterus
3. Letting-go Phase . ● You pulled too hard on the cord :
● gives up old role inversion of uterus
● ready for her new role
● postpartum depression most NURSING INTERVENTIONS
commonly occur
NURSING DIAGNOSES 1. Monitor funds frequently
2. Massage the uterus
3. Apply ice pack in the abdomen
● Actual/potential Fluid volume deficit related to 4. Empty the bladder
excessive bleeding of birthing 5. Regulate IVF as ordered
process/postpartum atony 6. Administer oxytocic agents (Oxytocin/Maleate)
● Pain related to uterine cramping (afterpains) 7. Initiate breastfeeding
or perineal sutures or 8. Monitor VS and watch for indications of
● tissue damage related to childbirth hypovolemic shock
● Potential for impaired urinary elimination 9. Prepare and assist for repair of laceration,
related to perineal edema removal of fragments or evacuation of
● Urinary retention related to bladder edema hematoma
secondary to trauma during delivery 10. Emotional support
● Altered Pattern of Urinary Elimination related
to postpartum Diuresis
● Risk for Constipation related to loss of bowel 2. POSTPARTUM INFECTION
sensation after childbirth
● Acute pain /Alteration in comfort related to A. Infection of the perineum /
tissue damage secondary to birthing process ● pain, heat, feeling of pressure in the
perineum, inflammation,redness, 1-2
COMMON POSTPARTUM COMPLICATIONS sutures slough off, febrile
● remove the suture, drain and resuture
hot sitz or warm compress perilight
1. HEMORRHAGE B. Endometritis /
● infection of the uterine endometrium
● blood loss more than 500 cc ● abdominal tenderness
● uterine atony
A. Early postpartum hemorrhage _ ● dark brown foul smelling lochia
Lacerations: ● Management: oxytocin and fowler's
○ Cervix position
○ vagina C. Mastitis /
○ labia
○ perineum
Atony
○ relaxed or boggy uterus
 SOURCES OF INFECTION MEDICATIONS

1. Endogenous (primary) _ ● Methyldopa : can prevent the complications

● normal flora caused by hypertension (high blood pressure)
2. Exogenous source _ in pregnancy, and a related condition called
● hospital personnel excessive obstetric pre-eclampsia.
manipulation ● Methergine : medication is used after
● break in aseptic technique childbirth to help stop bleeding from the uterus
● coitus in late pregnancy ● Apresoline : Apresoline is used to reduce
● PROM very high blood pressure, especially during
late pregnancy
3. THROMBOPHLEBITIS ● Duvadilan : It is used in the treatment of
premature labor (when the uterus starts
contracting for birth too early than usual)
Signs and Symptoms: _ ● Dexamethasone : accelerates maturation of
● pain, stiffness, redness fetal lungs, decreases the number of neonates
● swelling with respiratory distress syndrome and
● fever and chills improves survival in preterm delivered
● (+) Homan's sign neonates.
Management _
● bed rest PROGRAMS
● elevate affected part
● analgesics ● Unang Yakap : December 9 ,2009
● anticoagulant ● E.O.51 of 1986 : The Milk Code
● elastic support to the affected part ● R.A.7600 rooming in and BF act of 1992
Avoid: _ ● R.A.10028 expanded BF program act of
● frequent mobilization 2009
● thrombolytic agents
● massage

POSTPARTUM DEPRESSION

● Many mothers experience a "let down" feeling

after giving birth related to the magnitude of
the birth experience and doubts about the
ability to cope effectively with the demands of
childbearing.
● This depression is mild and transient,
beginning 2 to 3 days after delivery and
resolving 1 to 2 weeks

HEALTH TEACHINGS

● Self Care
● Infant care
● Resumption of intercourse
● PP exercises
● Danger signs to be reported