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MALE REPRODUCTIVE SYSTEM Andrology: Study of male reproductive system Primary Reproductive Function: The production and transport

of sperm through out of the genital tract into the female genital tract The Penis 1. It is elongated and cylindrical, consisting of a body (shaft) and a coneshaped end (gland). It lies in front of the scrotum. 2. Extremely vascular (blood supplied by a parallel system of internal and external pudendal arteries and veins. Blood to the cavernous sinuses is provided by branches of the penile artery.) Blood spaces fill and become distended during sexual excitement resulting in penile distension and stiffening termed erection. 3 columns of erectile tissue: The penile shaft has 3 longitudinal columns of erectile tissue: 1. Corpora Cavernosa (2 columns): lateral columns located on either side and in front of the urethra. 2. Corpus Spongiosum (1 column): posterior column which contains the urethra. The tip is expanded to form the glans penis. The skin at the end of the penis is folded back on itself above the glans penis to form the prepuce (foreskin), a movable double fold. Blood Supply: It is comprised of a parallel system of internal and external pudendal arteries and veins. Blood to the cavernous sinuses is provided by two branches of the penile artery.

Nerve Supply: The penis is inverted by the pudendal nerve. Sympathetic Fibers and Parasympathetic Fibers.

Function: It carries the urethra, path way for both urine and semen (serves both urinary and reproductive systems.)

Primary Function: Deposits sperm in the female vaginal for fertilization of the ovum.

Mechanism: Parasympathetic fibers from third and fourth sacral nerves, stimulation of the parasympathetic causes contraction of ischiocavernous muscle which prevents the return of venous blood from the cavernous sinuses. The blood vessels engorge, the penis becomes elongated, thickened, and stiff, which is a phenomenon called erection. If stimulation is intense, there is rhythmic contraction of penile muscle resulting in forceful and sudden expulsion of semen, a phenomenon which is called ejaculation.

Special Concerns: 1. Impotence: is the inability of the male to perform sexual intercourse due to absence or lack of ability to initiate and/or maintain erection. Types: 1. primary: rare 2. Secondary impotence: maybe due to organic cause such as: endocrine: diabetes Oral intake: alcohol Drugs (barbiturates, some anti-hypertensive drugs) Psychogenic causes (stress, depression, fatigue – burn out, guilt) Situational impotence is when it occurs only in a particular conflict-or guilt-laden relationship.

Medical Treatment: Viagra, contra indicated on men who use nitric oxide donors? And nitrates in any form, in men with cardiovascular problems, and in those for whom sexual activity is inadvisable, not indicated for women.

Surgical treatment: Penile prosthesis: the implant of silicones into penile tissue restore erectile capability but has no impact on ejaculation, fertility, nor orgasm. Post-op problem: pain and edema are expected for 5 to 14 days and sexual activity may resume 6 to 8 weeks after surgery if there is no pain.

2. ejaculatory incompetence: a. premature ejaculation: may be a learned behavior from early hurried sexual experience or expression of interpersonal conflicts. The Scrotum Sac or pouch-like structure from root of penis suspended from the perineal region; formed of pigmented skin and has two compartments, one for each testis. 1. It is composed of skin and dartos muscles. 2. Sebaceous glands open directly onto scrotum secretions with distinct odor. 3. Contraction of dartos and cremasteric muscles shortens scrotum and draws it closer to the body, wrinkling its outer surface. 4. Degree of wrinkling a. Smooth in preterm, wrinkled in full term newborns b. Greatest wrinkling in young men and at cold temperature. c. Least wrinkling in older men and at warm temperature. 5. Nursing Implication: When education on testicular self-examination (TSE) emphasize that the best time for doing it is after a warm bath or shower when scrotum is soft and less wrinkled, one can palpate the testes.

Testicular Self-examination (TSE) a. Ideally performed monthly, after a warm shower or bath when scrotal skin is relaxed. b. Standing in front of a mirror, the man gently rolls each testicle between the thumb and fingers of both hands. c. Feel for the normal testes which are smooth, firm, and oval shaped. d. Most testicular cancers, the most common cancer in young men between 15 and 34, are found by men themselves or when doing TSE. Warning Signs that men should look for:

ICSH (interstitial cell-stimulating hormone) .5cm wide. Testicular functions: Secretion of male sex hormones (androgens) and site of spermatozoa production in the mature male. because the testes are sensitive to touch. Function of scrotum: The scrotum contains the testes and the epididymis. Nursing Implication: 1. the primary function of the scrotum is to protect the testes and the sperm by maintaining temperature lower than the body. the scrotum protects the testes from potential harm. 3cm thick). Spermatogenesis will not occur if the testes fail to descend because they will be subjected to body temperature. temperature. e. Dull ache in the lower abdomen or groin. To enhance spermatogenesis and have adequate number of viable sperm. it is cooler in the scrotum.a. oval male gonads suspended in the scrotum. Painless swelling. d. and pain. 1. Sudden collection of fluid in the scrotum. hypothalamus: Releasing factor is inhibiting Anterior Pituitary Gland (APG) b. weighing 10 to 15 g. Hard lump. Feeling of heaviness. Testes: Two small (4. c.5cm to 6cm long. Anterior Pituitary Gland: Secrets the gonadotropins (LH) – luteinizing hormone . b.Stimulates the testes . pain in a testicle or scrotum. Assessment of the male newborn should include palpating the scrotum to detect if the testes have descended from the abdominal cavity. avoid tight undergarment and pants and prolonged sitting. pressure. 2. Endocrine function: a. 2.

short-lived Dies in acid Gynosperm Carries X-sex chromosome slower bigger. 2. with cells (diploid) 44XY. 3. Sperm production: 1. it is believed to be healthy and higher fertile for only 24 hours (Silverstein 1980) . 2. 2. However. they continue to mature and acquire motility during their passage through the epididymis. Testosterone hormone production – is by the interstitial cells of leydig of the testes. made up of chromosomal materials. long-lived acid-resistant 1.c. Sperm Types: Androsperm Carries Y-sex chromosome Fast – moving Smaller. the tip is covered by a cap called acrosome which is rich in enzymes to dissolve the covering of the ovum (zona pellucida) in order to penetrate it. after puberty. Head – where the nucleus is compacted. the primitive germ cell. Most of the circulating testosterone is converted in the liver into 17ketosteriods. Body 3. Sperm Parts: 1. spermatogenesis is the process by which male spermatogonia develop into mature spermatozoa. Life span: Sperms can survive in the female reproductive tract for up to 72 hours. the primary spermatogonia. d. Testes – interstitial cells of leydig are the cells stimulated by LH to synthesize testosterone from cholesterol. which are secreted in the urine. are present at birth. stronger. Mobile tail – used to propel the sperm along the spermatozoa leaving the testes are not fully motile. which is the area for maturation of sperms and reservoir for mature sperms. weaker. spermatogenesis is continuous and is completed in 72 hours.

The x chromosome carry several genes other than those for sexual traits. The father is responsible for the Y sex chromosome. 3. seminal vesicles. 4. including the development of sperm (levels decrease as men age) 2. Testosterone: the male reproductive hormone. d. sperm remain in the epididymis for 12 to 26 days for maturation. 1. Testicular differentiation and testosterone production begin at 7 weeks of gestation. Together with FSH. 4. Females have two X chromosomes (XX). a. e. prostate gland and genital duct system. Responsible for production of sex drive and potency. testes. These other traits are called sex linked because they are controlled by the genes of X chromosome like hemophilia. Sex determination – the 2 chromosomes of the 23rd pair (either XX or XY) are called sex chromosome. b. the larger sex chromosome in the sperm. scrotum. Development of sperm in the testes takes approximately 70 days. Males have one X chromosome and one Y chromosome (XY). Increase in height. Deepening of the voice. c. chest. Gonadal development begins at 5 to 6 weeks gestations. the smaller sex chromosome on the sperm. . testosterone stimulates sperm production. Growth of penis. the Y chromosome carry only genes for maleness b. Growth of hair on face. blindness. Develops secondary sex characteristics: a. which determines the male sex of the offspring. axilla and pubis. d. Y. size and number of muscles and bone growth cessation. This action of testosterone continues through out life. for female c.3. X.

2. The right testicular vein joins the inferior vena cava.The Ducts: The Highly Intricate Duct Systems of the Testis 1. scrotum and attachments. Spermatic Chord a. c. . Tail: continuous with vas deferens. Lymphatic Vessels – lymphatic drainage is to the lymph nodes around the aorta. planning. There are up to three tubules in each lobule and between the tubules are interstitial cells which secret the male hormone testosterone. coma-shaped b. Located on the superior surface of the testes and travels down to the posterior aspect to the lower pole of the testis leading to the deferent duct (vas deferens) c. cordlike. Nerves – the nerve supple is from the tenth and eleventh thoracic nerve. Testicular blood vessels Testicular artery – branch of abdominal aorta. The tubule join to form a system of channels leading to the epididymis. Vas deferens – carries the sperm to the ejaculatory duct. Seminiferous tubules (seed-carrying tubules) a. d. ligated in bilateral vasectomy. c. e. but the left returns its blood to the left renal vein. supplies blood to the testis. Soft. Head: attached to the top of the testis d. Testicular vein – drains in the same manner as the ovarian veins. 3. b. Place of sperm production (spermatogenesis) b. Epididymis a. Strong House: for maturing spermatozoa.

secrete small amount of lubricating fluid. b. The subinfertility is the inability to achieve a pregnancy after one year of unprotected intercourse. 3. d. Secrete a viscous fluid. 2. Composed of columnar epithelium. d. b. appropriately timed coitus. 3 cm wide and 2 cm deep. Connected to urethra and ejaculatory ducts. Accessory Glands 1.e. a muscular layer and enclosed in a firm outer fibrous layer/capsule. Male factor account for 35% to 40% pf infertility. lubricating milky fluid which enters the urethra. Prostate Gland: It is located below the bladder surrounds the urethra at the base of the bladder between the rectum and the symphysis pubis. becomes part of the ejaculated. motile sperm. just below the prostate glands. c. Keep sperms alive and motile. c. a. Seminal vesicles: They are paired structures. or pouches situated posterior to the bladder. The male must produce adequate quantity of mature. c. Cowper’s glands: Located on each side of the urethra. Secrets a thin. 4cm long. Reproductive concerns: a. a. Infertility: inability to conceive after 1 year of unguarded. 5cm long and pyramid-shaped b. secrete small amount of lubricating fluid. Vas Deferens – joins ducts of seminal vesicles to become ejaculatory ducts – small muscular ducts that carry the spermatozoa and the seminal fluid to the urethra. . capable of surviving the hostile environment and the arduous trip to reach the egg cell. Contribute to nutrition and activation of sperms. just below the prostate gland.

Normal findings: 1. Viscosity: liquefy within 30 minutes (20-30 minutes) 3. 4. 2. urethral mucosa. Most common problem of the male reproductive system occurring in 50% of men over age 50.Special Concerns 1. and lymphatic systems. Leucocytes: fewer than 1 million/ml . bladder wall. Collect entire specimen/ejaculate obtained through masturbation in a clear/ dry container. Mild to moderate prostatic enlargement causing urethral compression resulting to urinary retention. pH: 7-8 2. Volume 2-6 ml. 2-3 specimens may be required over several months because spermatogenesis takes 2.5 months. Deliver to the laboratory with in 30 to 45 mins or up to 60 mins. d. Morphology: more than 50% mature and normal 5. Diagnosis: elevated acid phosphatase (distant metastasis) and alkaline phosphatase (bone metastasis) Semen Analysis: Procedure: 1. Usually an adenocarcinoma (growth related to the presence of androgens) b. Diagnosis: elevated prostate-specific antigen (PSA) normal less than 4ng/ml Prostatic Cancer: a. Abstain form coitus/ejaculation for 2 to 3 days or at least 48 hours before collecting specimen. external sphincter. 5. Motility: more than 40% (or 50%) moving 6. Benign Prostatic Hypertrophy (BPH) a. Keep the specimen at body temperature. Sperm count: more than 20 millions/ml 4. 3. Early sign: decreased force and amount caliber of urinary stream. Test may be repeated after 2-4 weeks because of the variability specimens. b. Spreads from prostate to the seminal vesicles. Cause: unknown c. and 75% of men over age of 75 c. d.

long periods of sitting (e. frequent sauna. car. With fat iii. Drug/ marijuana use and alcohol 4. Grows coarse hair after puberty that thins after menopause ii.g. Labia Minora: two thinner folds of delicate tissue within the labia majora. hairless . bike) 2. rounded. tight-fitting clothing 3. fatty pad over the symphysis pubis i. Two folds of the skin with sparse hair on either side at the vaginal opening ii. at a desk. Frequency of ejaculation 5.Factors to consider when cause of low sperm count seems idiopathic 1. Clothing that increase scrotal heat. Contains the bartholin’s glands iv. Mons Veneris/ Mons Pubis: soft. Function: protects the symphysis pubis b. THE VULVA: the external genitalia a. Activities that increase scrotal heat: frequent hot tub use. The Labia Majora: known as the bigger lips i. Sons of mother who took diethylstilbestrol (DES) while pregnant 6. Function: protects the labia minora and vaginal os c. Trauma/ surgery to the testes FEMALE REPRODUCTIVE SYSTEM EXTERNAL GENITALIA: 1.

ii. Posterior ends unite to form the fourchette iii. Site of Syphilitic chancre (in young women) and Leukoplakia (in mature women) e. Primary site of sexual arousal. which die in acidic environment. iii. i. Two small. infection (Bartholinitis) and abscess formation (Bartholin’s abscess) f. Openings of the Bartholin’s glands or Vulvoginal glands i. Measures less than 1 cm in width and 2 cm in length ii. pressure and temperature iii. Common site of gonococci infection and other sexually transmitted diseases. Secretes smegma iv. and orgasm. urinary meatus and vaginal os d. palpable glands that open onto the posterior urethral wall. Function: secretes mucus to lubricate the vestibule . Function: protects and obscures the vestibule. Anterior ends unite to form the prepuce ii. Sensitive to touch. Secrete alkaline mucus during coitus which makes vagina less acidic and more alkaline. v. thus secretion favors motility and viability of sperms particularly the Androsperms (carriers of the Ysex chromosomes). Openings of the skene’s ducts or paraurethral glands: 2 small. excitement. palpable glands situated between the vestibule on wither side of the vaginal orifice ii. Primary significance in obstetrics: serves as guide to female catheterization vi. Glans Clitoris: a small body of highly erogenous and sensitive tissue protected by prepuce i. Site of cysts (Bartholin’s cyst).i.

separates internal from external reproductive system i. INTERNAL GENITALIA A. h. ii. Imperforate hymen: congenital absence of the normal opening of the hymen which can be treated by surgical perforation iv. the constrictor of the urethra and the internal and external fascial coverings. Most of the support of the perineum is provided by: i. tampon insertion. Hymen: thin mucus membrane i. Length: 3-4 inches Posterior wall: 10 cm long Anterior wall: 7. musculomembranous structure that extends from the vulva to the uterus between the urinary bladder (anteriorly) and rectum (posteriorly). VAGINA: vascular.g. tubular. Perineum: is the area between the vagina and rectum which consists of fibromuscular tissue. Myrtiformes Caruncles are remnants of the hymen after childbirth iii. Can be stretched or torn during physical activity.5 cm long because the cervix projects at the right angle into its upper part . the shortness of the urethra predisposes the female to recurrent urinary tract infection. a. Urinary meatus: external opening of the urethra. vaginal examination or sexual intercourse. Pelvic diaphragms: this consist of the Levator ani muscles plus the coccygeous muscle posteriorly ii. Function: protects the opening of the vagina. Urogenital diaphragms: the urogenital diaphragm is compromised of the deep transverse perineal muscles.

Excretory canal of the uterus through which uterine secretions and menstrual flow escape iii. The posterior vaginal fornix is the largest fornix because the vagina is attached to the uterus at a higher level at the back than in front. the vault forms a circular recess described as four arches or fornices.b. d. Vaginal reaction: acidic with pH 4-6 due to the presence of lactic acid formed by action of Lactobacilli (Döderlein's bacilli) on glycogen found in the squamous epithelium of the lining. The middle muscular layer is divided into: weak inner coat and strong outer coat of longitudinal fibers iii. Where the cervix projects into the vagina. The pelvis fascia surrounds the vagina forming a layer of connective tissue. Vaginal layers i. iii. the lateral fornices lie on wither side c. Soft birth canal during labor . Vault: the term for the upper end of the vagina i. Female organ of copulation ii. ii. The anterior vaginal fornix lies in front of the cervix. ii. Functions i. Beneath the epithelium lies a layer of vascular connective tissue. Rugae: transverse ridges of mucus membranes lining the vagina which allow it to stretch during sexual intercourse and childbirth. These are normal inhabitants of the vagina that cause vaginal acidity to protect against pathologic bacteria f. The inner lining is made of squamous epithelium. e.

Before puberty: from 2. pear-shaped organ.B. iii.5 cm ii. larger and triangular portion. Isthmus: constricted area immediately above the cervix. smaller.5 cm in depth. cylindrical portion with internal os. and rectum posteriorly. 2. It lies between the base of the bladder anteriorly. a. Endometrium: the inner mucosal layer which undergoes constant changes in response to estrogen (proliferative phase) and . iv. 3 uterine layers i. ii.5 cm long. v. Non-pregnant women: 60g ii. 5 cm wide. In adult nulliparous women: from 6-8 cm iii. Uterine weight i.5 cm. term: 1000g c. the lower uterine segment.5-3. cervical canal and external os. Corpus or body: upper. UTERUS: hollow muscular. It is 7. Cornua: the portion or point from where the oviducts or fallopian tubes emerge. Fundus: convex upper part between the positions of the fallopian tubes. Uterine length i. Cervix: lower. the most contractile portion of the uterus during labor. distends during pregnancy. Uterine parts i. Pregnant. covered partially by peritoneum or serosa. and with each wall 1. In multiparous women: from 9-10 cm b.25 cm thick. d. The lower third of the uterus is the cervix and measures 2.

As the body moves. It leans forward in a position known as. Perimetrium: is the outer serosal layer formed by the peritoneum. on the other hand. v. Broad ligaments: extend from the lateral margins of the uterus to the pelvic walls. during pregnancy. e. Retroflexion: the bending back of the body/corpus of the uterus toward the cervix. decidua. iii. It is continuous with the broad ligament son the sides of the uterus. ii. it becomes highly specialized and is termed. may cause the uterus to sag downwards when damaged. anteflexion iv. When a non-pregnant woman stands erect. the uterus lies in an almost horizontal position. thereby dividing the pelvic cavity into anterior and posterior compartments. g. resulting in a sharp angle at the point of bending b. responds to oxytoxic drugs. It leans forward on itself with the fundus resting on the bladder known as. Uterine function: i. Myometrium: is the middle muscular layer which serves as the living ligatures that control bleeding during the third stage of labor. The normal anteversion and anteflexion of the uterus prevents uterine prolapsed. Position: the uterus is a partially mobile organ. it freely moves along the antero-posterior plane. ii. The transverse cervical ligament. Retroversion: the turning backward of the entire uterus in relation to the pelvic area f. i. . anteversion iii.progesterone (secretory phase) during the menstrual cycle. Abnormalities in uterine position a. Uterine ligaments: the uterus is supported by the pelvic floor and maintained in position by several ligaments.

which supplies both the ovary and fallopian tubes before joining the uterine artery. under the bladder to the pubic bones. which consists of sympathetic (as the principal nerve supply) and parasympathetic nervous system. It passes down between the folds of the broad ligament to the ovaries. It passes in between the broad ligament and is inserted in each labia majora. Utero-sacral ligaments: pass backwards from the cervix to the sacrum and provide support for the uterus and cervix at the level of the ischial spines. and also tend to maintain the anteverted position of the uterus. They are also called transverse cervical ligaments or Mackenrodt’s ligaments. The ovarian artery is a branch of the abdominal aorta. Nerve supply: The pelvic autonomic system is the main nerve supply of the uterus. FALLOPIAN TUBES or OVIDUCTS: two muscular canals/tubes. h. Round ligaments: arise from the cornua of the uterus. Blood supply: derived principally from the two uterine and ovarian arteries. The uterine blood supply is increased in pregnancy and decreased in puerperium. Lymphatic drainage: abundant j. vi. infront and below the insertion of each fallopian tubes. Pubocervical ligaments: pass forward from the cervix. Cardinal ligaments: the chief uterine supports. The round ligaments have little value as a support but it helps the broad ligament keep the uterus in place. . The uterine artery arises at the level of the cervix and is a branch of the internal iliac artery. Ovarian ligaments: arise from the cornua of the uterus but behind the uterine tubes. iii. These ligaments fan out from the sides of the cervix to the side walls of the true pelvis. i.ii. C. iv. v.

c. b. Blood supply: uterine and ovarian arteries and drains . The ampulla: the passage widest portion with a length of 5 cm. ii. Site of normal fertilization. with a length of 1. f. Ducts through which an ova travels from the ovaries to the uterus. most commonly in the ampullary portion. Tubal function i.5 cm. The infundibulum: a funnel-shaped passage with fringed ends composed of fimbriae. The isthmus: a narrow portion immediately after the uterus which extends to a length of 2. The fimbria ovarica/ ovarian fimbria is an elongated fimbria that is connected to the ovary. The interstitium: a portion embodied within the uterine muscular wall. enveloped in the upper fold of the broad ligament. it is the site of fertilization (conception) iv. Length: 8-14 cm (average 10 cm) extending from the uterine cornua to a site near the ovaries. g. They are covered by peritoneal folds that drape down below as broad ligaments and extend at the sides to form the infundibulopelvic ligaments. Tubal parts: i.a. ii. iii. d.25 cm and a lumen diameter of 1mm. e. The lumen is lined by ciliated mucus membrane called. ciliated cubical epithelium. Tubal musculature: constantly contracts rhythmically at a rate that varies with hormonal changes of the ovarian cycles. which produces a current of lymph that facilitates movement of the ovum along the tube.

b. Tunica Albuginea: dense and dull-white protective layer ii. Location: situated in the uppermost portion of the pelvic cavity.5-3 breadth. Weight: 6-10 g each c. Completely surrounded by cortex .h. graafian follicles. No peritoneal covering for the ovaries. attached to the posterior surface or back of the broad ligament within the peritoneal cavity. Surface: smooth and dull-white in color through which glisten several small follicles.5-5 cm in length. Medulla: inner central part a.6-1. and degenerated follicles held together by ovarian stroma. i. iii. Lymphatic drainage: to the lumbar glands i. Nerve supply: from the ovarian plexus D. Covering: single layer of cuboidal epithelial cells called. Size: 2. e. It is more corrugated and markedly convoluted in older women. There are about 200. . Contains the ovarian follicles in different stages of development. ova. corpora lutea. Advantage of no covering: assists the mature ovum to erupt ii. Cortex: outer main functioning part a. d. Ovarian layers: i. degenerated corpora lutea (corpora albicantia).000 primordial follicles in the ovarian cortex at birth. OVARIES: two almond-shaped organs a.5 cm thick b. Disadvantage of no covering: easier spreading of malignant cells from cancer of the ovaries f. germinal epithelium. i.

Oogenesis It is the process of developing a mature ovum in the Graafian follicle. estrogen and progesterone. an area of compressed ovarian stroma. The sympathetic and parasympathetic nerves follow the ovarian artery across the infundibulo-pelvic ligament to reach the ovary. a. . Ovarian functions i. The very clear cells of the corona radiata are referred to as Zona Pellucida. Progesterone: hormone of pregnancy. The whole follicle is lined with Granulosa cells and contains follicular fluid. Around this lies the Theca. ii. encircled by a narrow perivitelline space. which radiates outward to form the Corona Radiata. while corpus luteum secretes estrogen and primarily progesterone. The outer coat of the follicle is the external limiting membrane. blood vessels and lymphatic vessels. Ovulation: monthly expulsion of a mature ovum from the graafian follicle into the pelvic cavity iii. The hilum where these vessels enter lies just where the ovary is attached to the broad ligament. Composed of loose connective tissues and contain nerves. Maturing follicles secrete estrogen. When the primordial follicles mature and become cystic. Endocrine function: secretion of female hormones. while adrenal cortex serves are an extrglandular site of production. Ovaries are the primary source of estrogen. called the mesovarium.b. The ovaries are insensitive unless they are distended and squeezed. they are termed as Graafian follicle. g. Estrogen: develops female secondary sex characteristics b. Mittelschmerz: mid-cyclic pain caused by irritation of the peritoneum by blood or fluid escaping along with the released ovum during ovulation. The Ovum is situated at the end of a graafian follicle. Its effects on the decidua allow pregnancy maintenance. The ovum is surrounded by clump of cells called Discus Proligerus.

. Lymphatic drainage: to the lumbar glands j. but the left return blood to the left renal vein. Size: varies depending on the amount of adipose tissue rather than on the amount of glandular tissue. Function: lactation or milk secretion for nourishment and maternal antibodies (IgA): source of pleasurable sexual sensation. Glandular tissues are arranged in about 15-25 lobes. b. adipose and glandular tissues. The breasts increase in size at puberty due to stimulation by female hormone estrogen. The right ovarian vein joins the inferior vena cava.h. Nerve supply: from the ovarian plexus E. Blood supply: blood flows through the ovarian arteries and veins. The size of the breast is not a significant factor in successful breast feeding. i. Composition: fibrous. Location: under the skin. which in turn are made up of a large bumber of alveoli with: i. the smooth muscle of the nipple causes erection of the nipple on contraction. Secreting cells (acinar cells) which produce milk. and ii. D. C. The areola: pigmented area of skin surrounding the nipple. Each lobe is made up of several lobules. ACCESSORY ORGANS The Mammary glands (breasts) A. a. Excretory ducts which lead from each lobe to opening in the nipple composed of erectile tissue and muscle fibers which have a sphincter-like action in controlling flow of milk. over the Pectoralis Major muscles B.

b. particularly the acini cells.E. This freeflowing of milk is called “letdown reflexes”. metastasis follows the vascular supply both medially and laterally. In cancer of the breast. c. The arterial. Early detection by monthly Self-Breast Examination (BSE) Mammography and Ultrasonography Reproductive concern: “Female Infertility” . or a lump. the act of sucking a lactating breast stimulates the flow of milk. as a result of high estrogen secretion by the placenta. Best surviving tips: i. It is also under the influence of oxytocin secreted by the posterior pituitary gland (PPG). High levels of estrogen and progesterone induce alveolar and duct growth as well as stimulating milk secretion. F. Cancer of Breast It is often signaled by a change in skin texture. venous. It is also affected by maternal emotions. ii. Milk ejection reflex: controls the expulsion of milk from the breast tubules. dimpling. i. Maternal reflexes in breast feeding: a. puckering. and lymphatic communicate medially with the internal mammary vessels and laterally with the axillary vessels. Prolaction reflex (milk secretion reflex): high prolactin level stimulates the alveoli. In pregnancy. milk secretion is not stimulated because of low prolaction. Letdown reflex (draught reflex): is oxytocin induced. Milk are then stored in the breast tubules. nipple discharge. ii.

pelvic mass. copious. b. Safety alert: assess allergy to iodine. Positive effect: Pregnancy is frequently achieved within the first 3 cycles following the test due to flushing of tubal debris. ii. acellular mucus with spinnbarkeit more than 8cm. and referred shoulders and chest pain caused by gas in the abdomen. there is increased risk of spontaneous abortion. iv. and unexplained/ unusual problems(20%) C. Post-coital test: evaluates cervical mucus to determine ability of sperms to travel within it. iii. and pelvic organs are directly visualized. irregardless of the outcome) D. Cervical specimen obtained 2 to 8 hours after coitus. may be abdominal or vaginal. Preparation/teaching: Abstinence from coitus for 48 hours. and spills into the peritoneal cavity. Woman may have discomfort/pain from organ displacement. c. Normal findings: 5 to 10 morphologically normal sperm with linear motility in thin. usually done under general anesthesia. Other cause of female infertility: failure to ovulate(40%). Hysterosalpingography/hysterogram: an x-ray of the uterus and the fallopian tube done 2 to 5 days after menses or first 10 days of the cycle. tubal or pelvic problems(40%). The single most important factor in female infertility is aging. coitus timed within 24 to 48 hours of ovulation. and the fallopian tubes. clear. a.A. Couples over 35 years old should seek help if conception has not occurred within 6 months. and decreased fertility due to endocrine changes that begin 10 to 15 years before menopause. Involves instillation of a radiopaque substance into the uterine cavity which fills the uterus. b. history of PID. b. The peritoneal cavity is distended with carbon dioxide gas. a. c. It may be abdominal or vaginal. a. increased incidence of pelvic or tubal problems. . Infertility may be primary (no conception ever) or secondary (there has been a pregnancy. Ultrasonography: use of sound waves to evaluate pelvic structures and monitor ovulation by identification of follicles and release of ova. May also be used to retrieve eggs for reproductive technology. A moderate discomfort/pain is referred from the peritoneum to the shoulder. Laparoscopy: uses an endoscope to view the pelvic organs. Evaluation of the female infertility: i. breaking of adhesions and induction of peristalsis by the instillation of dye. B. With increasing age.

Characterized by changes in the ovaries and uterus . Visualization is best when the procedure is done in early follicular stage of the cycle. The first day of the cycle is the day on which menstruation begins. B. THE MENSTRUAL CYCLE MENSTRUAL CYCLE Series of rhythmic reproductive cycle A. I. when no other causes of infertility are found. Usually done 6 to 8 months after hysterogram. From the onset of menstrual bleeding to the day before the next bleeding day.d.

normal range is 25 to 35 days per cycles. 2002). Follicle-stimulating Hormone (FSH) a.C. Duration varies and is highly individualized but the average cycle/mean cycle length is 28 days. fertilization and implantation II. Function of the cycle: preparation for the release of egg. Secreted by the APG in response to the stimulation of the hypothalamic follicle stimulating hormone releasing hormone releasing factor (FSHRF) triggered by low blood levels of estrogen during the first half of the menstrual cycle. F. can be as short at 21 days or as long as 40 days. A. . Estrogen is at its lowest by days 4 to 5 of the menstrual cycle. E. 1. Only one interval is fairly constant (almost always 14 or 15 days): the time from ovulation to the beginning of menses (Marieb. MENSTRUAL CYCLE HORMONAL CONTROL HYPOTHALAMIC HORMONES: secrete gonadotrophin-releasing (GnRF) or inhibiting factors (GnIF) that stimulate the pituitary gland to secrete or inhibit the secretion of corresponding gonadotrophins (Gn) ANTERIORPITUTARY (APG) HORMONES: Gonadotrophins (Gn) follicle stimulating hormone (FSH) and luteinizing hormone (LH) B. Influenced by normal hormonal variation mediated by hypothalamus and anterior pituitary gland (APG) via feedback mechanism (negative feedback) Recurring cyclically beginning at puberty with the first menstruation called menarche and ceasing at menopause D.

Estrogen a. C.b. Inhibits secretion of FSH (negative feedback) and stimulates secretion of LH (positive feedback) d. colorless e. Secreted by the APG in response to the stimulation of hypothalamic luteinizing hormone releasing factor (LHRF) triggered by low blood levels of progesterone c. Responsible for the development of secondary sex characteristics and assists in maturation of ovarian follicles c. . d. Stimulates the development of primordial follicles (immature follicles) into Graafian follicle (mature follicles). Progesterone is lowest on the 13th day of the menstrual cycle. Responsible for the proliferative phase of the menstrual cycle Responsible for fertile cervical mucus • Thin. the slight rise in BBT (day 14) that is preceded by a drop (day 13) is considered a significant sign of ovulation in the regular 28 day cycle. Also called interstitial-cell stimulating hormone b. secreted by placenta in pregnancy b. Luteinizing Hormone (LH) a. Because progesterone is responsible for rise in basal body temperature (BBT). OVARIAN HORMONES: ESTROGEN AND PROGESTERONE 1. adrenal cortex. FSH stimulates follicle cells to secrete estrogen 2. clear. Secreted by the ovaries.

lubricative • Produces fern-pattern when dry (positive ferning test) f. e.• Stringy. 2. stretchable • Slippery. causes fatigue.preparation for implantation. Helps maintain the endometrium by facilitating secretory phase of the mentrual cycle . antidiuretic action . secreted by the placenta as early as sixth week of pregnancy until parturition b. Progesterone a. In pregnancy: increases vascularity. and antagonizes insulin. • A drop in progesterone in late pregnancy before term may lead to premature labor. stimulates uterine muscles contraction. Inhibits secretion of LH (negative feedback) c. also called nidation d. Relaxes smooth muscles including the myometrial muscle of the uterus: • Progesterone is the hormone that maintains pregnancy by maintaining decidua. maintains the highly specialized endometrium called decidua.increases basal body temperature f. • A drop in progesterone in early pregnancy may lend to abortion. Has water – retaining. • Progesterone drop at term is one of the theories of labor onset when smooth muscle relaxant progesterone drops at term. Thermogenic . uterine muscles are easily stimulated to contract due to rising stimulants late in pregnancy particularly oxytocin and prostaglandin. Secreted by corpus luteum in non-pregnant state and in early part of pregnancy.

Increases fibrinogen level. A. Characterized by vaginal bleeding as the uterine endometrium is shed down to the basal layer along with blood from the capillaries and with the unfertilized ovum. non-stretchable • Produces non-fern-pattern when dry (negative ferning test) In pregnancy: maintains pregnancy. Affects menstrual cycle 2. occurs between 12 to 13 years. 2. Menstruation is periodic discharge of blood. . infertile. Menarche is the first menstruation. PROSTAGLANDIN: fatty acids recognized as hormone secreted by a lot of body organs including the endometrium of the uterus 1. irregular. thus increases blood coagulability h. 4. relaxes the uterus. Decreases hemoglobin and hematocrit levels i. the terminal phase of the menstrual cycle 1. human placental lactogen (HPL) and cortisol. Responsible for infertile cervical mucus: • Thick opaque • Sticky. and together with estrogen. Stimulates uterine muscles to contract III. cyclic and predictable intervals from menarche to menopause.g. D. 3. MENSTRUAL CYCLE STAGES/PHASES MENSTRUAL PHASE or menstruation/BLEEDING PRASE (day 1 to 4) may last for 3 to 5 days. mucus and cellular debris from the uterine mucosa and occurs at regular. antagonizes insulin j. The menstrual period is the woman's period of absolute infertility. usually anovulatory.

lowest most layer lying immediately above the myometrium. 7. Proliferative changes level off at ovulation. Under the control of ESTROGEN (principally ESTRADIOL there is regrowth and thickening/proliferation of the endometrium up to 8 to10 fold. .0 mg of iron loss for every day of the: cycle.5. c. Amount: 25 to 60 mL equivalent to about 0.4-1. covers the functional layer. middle layer. coagulated as it is shed. 3. 2. B. contains all the necessary rudimentary structures for building up new endometrium. contains' tubular glands. dips down to line the tubular glands Ovulation: present in the middle of the cycle: monthly growth and release of a mature.fertilized ovum from the ovary b. is promptly liquefied by fibrinolytic activity. Duration of menstruation: variable with usual duration of 3 to 5 days or up to 4 to 6 days. At the completion of the proliferative phase. Menstrual blood is incoagulable because the blood. never alters during the menstrual cycle Functional layer: 2. 1. Basal layer: 1 mm thick. FOLLICULAR or PROLIFERATIVE PHASE (days 5 to 14 ending in ovulation. the endometrium consists of three lavers: a. non . lasts about 9 days). Regenerative Phase is the first few days of the reformation or the endometrium. 6. constantly CHANGES according to the hormonal influences of the ovary Cuboidal ciliated epithelium layer: upper most layer.5 mm thick.

13 to 15 days or an average of 14 days prior to the next menstruation in regular cycles.4 to (1. In a 28-day cycle. lasts about 12 days) . ovulation occurs on the 16th day counting from the first day of bleeding. The most fertile time is 3 to 4 days before ovulation and 1 to 2 days after (Littleton & Engebretson.• Usually happens in the middle of the menstrual cycle. is likely to occur if the woman engages in unguarded coitus.5°C or 0. • Estrogen is high while progesterone is low • Ovulation signs • Breast tenderness • Slight rise in BBT (0. b. the period of absolute fertility. In a 30-day cycle. ovulation occurs on the 14th day counting from the first day of bleeding. 4. In a 28-day cycle. during these periods.8°F) during ovulation which is preceded by a slight drop (0. periods of fertility is from 9 to 17 days and in a 30-day cycle. d. c. LUTEAL or SECRETORY PHASE (15 to 28 days.3 to O. pregnancy. periods of fertility is from 11 to 19 days. • Positive Spinnbarkeit test (with stretchable mucus) • Mirrelschrnerz (left or right lower quadrant pain corresponding to the rupture of the Graafian follicle) • Positive Ferning test Estimating Ovulation Time: Substract 14 days from the menstrual cycle length: a.2°F) 24 to 36 hour before. C. The period when the woman is most fertile is during ovulation time. 2006).

1985) a. anxiety. Complex physical signs and behavioral symptoms that occur during the second half of the menstrual cycle and that resolve with the onset of menses PMS SYMPTOMS (Chihal. Pariser et al. hostility .5 mm thick). syncope b. Irritability. Neurologic: migrane. c. vertigo. SPECIAL CONCERNS: MENSTRUAL PROBLEMS/DISORDERS A. This causes a drop in levels of estrogen and progesterone causing endometrial ischemic or premenstrual phase. If fertilization does not occur. PREMENSTRUAL SYNDROME ("PMS" Syndrome) 1.1. 2. implantation follows 6 to 9 days or 7 to 10 days (average on 7 days) after fertilization. 1982. If fertilization occurs. tearfulness/crying spell. IV. depression. sleep disorders. Initiated by ovulation in response to a surge in LH that promotes the development of corpus luteum from the ruptured follicle. the yellow body corpus luteum functions only for about 7 to 8 days after ovulation then involutes to become a white body. The corpus luteum lives longer and secretes progesterone and estrogen in early pregnancy – later replaced by placenta b. The usual life span of the corpus luteum is two weeks or 10 to 14 days. the corpus albicans which persists up to 10 to 12 days after ovulation. softer with glands becoming more tortuous as the endometrial capillaries get distended with blood in preparation for reception/implantation and nourishment of the fertilized ovum.. Progesterone stimulates the already proliferated endometrium causing the functional layer to become thicker (3. Psychologic: lethargy. the yellow body that secretes high levels of progesterone and estrogen. 2. a. more spongy.

Schaumburg. Magnesium zinc (Abraham. hyperthyroidism may be first suspected when delayed sexual maturation and amenorrhea occur. bloating. 1984). particularly Vitamin B6. Mammary: swelling. Nursing Counseling a. dancing) c. Dermatologic: acne 3. coryza. • Vitamin E supplementation to decrease for cravings b. Urinary: oliguria. AMENORRHEA: absence of menstruation 1. Diet • Restrict food rich in sugar and salt • Restrict food containing methylxanthines like chocolate and coffee • Increased intake of complex carbohydrates and protein • Increased frequency of meals • Supplementation with B complex. Drug treatment as prescribed. . Respiratory: asthma. vomiting. Rest periods balanced with exercise d. it must first be ascertained that the client: • has passed the age at which menarche normally occurs • has not entered puberty by the expected time • has undergone complete pubertal development without the onset of menses. hoarseness d. Primary Amenorrhea: menarche has never occurred a. Related to thyroid gland abnormalities. retention g. breast fullness and tenderness f. Gastrointestinal: nausea. even in the absence of other signs and symptoms.c. Activity: aerobic exercises (fast walking jagging. b. 1982. constipation. In order to diagnostic primary amenorrhea. typically. B. craving for sweets and salary foods e.

May also be due to other endocrine dysfunction or problems of the hypothalamus. Secondary Amenorrhea: cessation of menses for more than 3 months after regular menstrual cycles have been established • Assess first the last menstrual period. Psychologic factors: has long been erroneously considered to be emotional in origin d.c. 2000) 1. absent when ovulation is suppressed (Kain & Hall. and cervical stenosis c. cystic fibrosis. PREGNANCY is the most frequent cause of secondary amenorrhea so the first diagnosis to be considered is pregnancy. 3) hormonal therapy (Oral Contraceptive Pills). Also related to acute uterine anteflexion. DYSMENORRHEA: painful menstruation. 4) non-steroidal anti- . malnutrition (anorexia nervosa is a factor to both primary and secondary amenorrhea). b. 2) distraction. thyroid or adrenal origin. pituitary gland. cyanotic congenital heart defect) 2. pituitary. Also related to stress. ovaries. heat application. Treatment: 1) rest. and uterus. inflamamatorv bowel disease. chronic illnesses associated with malnutrition or tissue hypoxygenation (DM. Found in those with higher prostaglandins (produced by endometrium) Symptomatic relief occurs when prostaglandin synthetase inhibitors are administered prior to a menstrual period or with the onset of menses. retroflexion. Primary Dysmenorrhea: occurs in the absence of any underlying anatomic abnormality a. exercise. usually corresponds to the secretory phase of the endometrium indicating that ovulation has occurred. obesity and hormonal imbalance due to problems of ovarian. • C.

may be caused by hormonal imbalance. IUD use. Congenital coagulopathy Von Willebrand disease should be considered in an adolescent whose first menstrual period is excessive and with a finding of prolonged bleeding time. 3. MENORRHAGIA: excessive. Pelvic inflammatory disease (PID). ectopic pregnancy. . and cancer of the cervix. the effect of estrogen on the endometrium is unopposed by progesterone. corpus carcinoma. uterine tumors OLIGOMENORRHEA: infrequent menses G. spontaneous abortion. Excessive menstrual bleeding is most often secondary to anovulatory cycles that normally occur in the first year postmenarche. erosion. endometriosis. D. and 5) analgesic especially prostaglandin inhibitors (Ibuprofen) 2. or endometritis. Without ovulation. 2. F. uterine tumors.inflammatory medication. pregnancy. aspirin). and endometriosis. a. METRORRHAGIA: abnormal bleeding between menses/periods or intercyclic bleeding 1. endocrine problems (endocrinopathies). profuse menstrual flow. resulting in continued endometrial proliferation or eventual massive shedding. May be related to infection (PID). this could be dysfunctional uterine bleeding (DUB) b. presence of a foreign body (lUD). complications of medications (anticoagulants. infection. Treatment of DUB is indicated only when blood loss is significant. blood dyscrasias (thrombocytopenia). A characteristic of the disease is that it is a defect in plateler adhesiveness and lower than normal levels of factor VIII. Secondary Dysmenorrhea: occurs when there is an underlying structural abnormality of the cervix or uterus (malpositions). uterine fibroids. E. MENOMETRORRHAGIA: excessive or prolonged menstrual bleeding which may lead to or cause hypovolemia and anemia 1. May be related to PID.

Excessive menstrual flow. problems and related concerns. . Absence of menarche at age 17 3. POLYMENORRHEA: too frequent menses HYPOMENORRHEA: abnormally short menstrual cycle HYPERMENORRHEA: abnormally long menstrual cycle NURSING IMPLEMENTATION: MENSTRUAL ABNORMALITIES/DISORDER V. External heat to lower abdomen 5. Leg lifts 4. I. depression.anxiety. VI. nausea. intermenstrual or post-menopausal bleeding 2. anxieties. Severe pre-menstrual tension syndrome (PMS) . Treatment as ordered: antiemetics and prostaglandin inhibitors C. Menopause is to the climacteric as menarche is to puberty (Olds et aI. Psychological support: initial-encourage verbalization of fears. provide and protect privacy. A.H. Hot drinks 6. Prompt referral for evaluation and diagnosis if with: 1. headache.. MENOPAUSE DESCRIPTION: transitional phase for women marking the end of their reproductive abilities. Mild sedatives 3. 1988). abdominal bloating B. J. A. Promote relief of discomfort of dysmenorrheal 1. Rest 2. irritahility.

not completed until 2 years since the last period. Ovulation ceases 1 to 2 years prior to menopause with individual variation. dizzy spells. f.1. can be from 35 to 60 years with an average of 53 years. Atrophic changes in the vaginal vulva and urethra and in the trigonal area of the bladder • The vaginal atrophy may result in discomfort during intercourse. sexual activity and interest may improve as the need for contraception disappears. b. Change of life or climacteric period 2. . weakness. Occurs between 45 to 50 years in 50% of women. sweating. The breasts become pendulous and decrease in size and firmness. B. 3. CHARACTERISTICS 1. Presence of physical symptoms due to a drop in estrogen: a.dyspareunia . Hot flashes: • A cluster of symptoms due to vasomotor disturbances related to hormonal changes and cessation of menses • Characterized by heat arising on the chest and spreading to the neck and face (caused by vasodilation). g. Gradual cessation of menstruation: first menstruation becomes irregular and then it ceases altogether 2. occasional chills .but may be overcome with a lubricating gel or saliva. Sleep disturbances d. Emotional changes as mood swings or emotional lability c. palpitations. Sexual drive may not be diminished. Tendency to obesity not because of a change in adipose deposits but rather due to increased caloric intake e. the most common vaginal lubricant.

Fertilization is the union of mature egg cell (ovum) and sperm cell happening in the ampulla (outer third) of the fallopian tube resulting in a fertilized ovum known as the zygote. and impregnation. Increased calcium and phosphorus intake for osteoporosis prevention d. . Vitamins B complex and E hot flashes and other symptoms c. Estrogen replacement if there is no history of cancer in the family although this treatrr. It is also termed conception. FERTILIZATION AND FETAL DEVELOPMENT FERTILIZATION A. Long-range physical changes may include osteoporosis associated with: • low estrogen and androgen levels • lack of physical exercise • low dietary intake of calcium. Treatment: For relief of symptoms of menopause. • Short-term. Support system to provide emotional support I. treatments include: a. fecundation.h. B.ent is controversial • • 3. The movement of the sperms caused by flagellar action is believed to maintain the sperms in suspension and to facilitate transport. Hormonal vagina creams/Lubricants (K-Y jelly) for painful coitus or dyspareunia b. C. low dose estrogenic therapy for troublesome vasomotor disturbances (hot flashes) Sustained high-dose estrogen therapy has been reported to predispose women to reproductive tract cancer.

This cellular change is mediated by release of materials from the cortical granules.D.. A. organelles found just below the egg surface (Class. Acrosomal Reaction: follows capacitation. the acrosomal covering of the head of the sperm contains hyaluronidase. Sperms must be in the genital tract 4 to 6 hours before they are able to fertilize an egg. The sperm must undergo 2 processes before fertilization: 1. Sperm Capacitation: the process by which the sperm become hyper mobile and there is a breakdown of the plasma membrane and exposes the acrosomal membrane/covering of the sperm head allowing the sperm to bind with the zona pellucid of the ovum (Speroff et al. . So as millions of sperms surrounds the ovum. It is during this period when the enzyme needed to dissolve the cement substance (hyaluronic acid that holds together the cells’ covering the ovum is activated. a time of 4 to 6 hours seems more reasonable. but on average. 1999). 1984) Fertilization occurs when the male pronucleus unites with the female pronucleus. This enzyme is called hyaluronidase. often only within 5 minutes. This cell undergoes mitosis which is the process of cell replication where each chromosome splits longitudinally to form a double-stranded structure. F. CLEAVAGE: series of mitotic cell division by the zygote B. E. which allows the sperm head to penetrate the ovum (Olds et al. II. thus the chromosome diploid number 46 is restored and a new cell the zygote is created with a new combination of genetic material which creates unique individual different from the parents and anyone else CLEAVAGE/MITOSIS H. 1985).. 2. As soon as the sperm penetrates the zona pellucid and makes contact with the vitelline membrane of the ovum. they deposit minute amounts of hyaluronidase in the corona radiata. ZYsGOTE: the cell that results from fertilization of the ovum by a spermatozoan. G. Each sperm reaches the site of fertilization in the ampulla of the fallopian tube shortly after ejaculation. a cellular change occurs in the (ovum that inhibits other sperms to penetrate. the outer layer of the ovum.

The divisions and the reorganization have already consumed energy stores available in the zygote. TIME: 6 to 9 days (average is 7 days) after fertilization SITE: upper fundal portion or upper one-third of the uterus. of the zygote (2-cell. such that it becomes necessary for the blastocyst to embed or implant in the uterine wall. A. its outer layer the trophoblast.cells arising from the mitotic cell division. This is necessary for it to obtain nourishment for its further development. and when it enters the uterine cavity. the reorganization of the morula follows forming a blastocyst. IMPLANTATION D. DIMENSION 1. C. III. IV. BLASTOMERES: daughter . a differentiation of cells as to their specific potencies occurs.C. The cavity enlarges and pushes the morula cells into an outer layer of cells called the trophoblast. Along with this is an inner cell mass attached to one side of the blastocyst. At the time of implantation. is responsible for actual implantation (nidation): THE PLACENTA D. MacDonald & Gant. 2. called the 'travelling' form because it is in this form when it migrates through the fallopian tube (oviduct) and reaches the uterine cavity about 3 to 4 days after ovulation (Cunningham. can be anterior (towards the mother's front) or posterior (towards the mother's back). Discoid: 15 to 20 cm in diameter and 2 to 3 cm in thickness Location: in the uterus. anteriorly or posteriorly near the fundus . 4-cell. Abnormal implantation sites are the fallopian tubes which leads to ectopic pregnancy and the lower uterine segment which causes placenta previa. B-cell blastomeres) MORULA: solid ball of cells produced by 16 or so blastomeres. 1989) BLASTOCYST: a fluid-filled cavity that reaches the uterine cavity Over the next 3 to 4 days of development. this is the Stage when there is already a cavity in the morula called the blastocoele. A. the blastocyst is completely buried in the endometriun. Also called Nidation B. E. While the blastocyst is the stage of implantation.

3.5 mm in thickness.02 to 0. at term . a sac that engulfs the growing fetus. Decidua Basalis: portion of decidua directly beneath the site of implantation. Decidua Capsularis: the portion overlying the developing ovum. Decidua: The endometrium in pregnancy. Zona Basalis: lowest most/ basal layer • The zona basalis and zona spongiosum together form the functional layer (zona functionales). under the imbedded ovum 2.500 gm 6. Initially. Layers of Decidua Basalis and Decidua Vera Zona Compacta: uppermost/ surface layer made up of compact cells a. the decidua capsularis and decidua vera are separated by a space because the gestational sac does not fill the entire uterine cavity. thickens in pregnancy with depth of 5 to 10 mm. Fetal Side: covered with amnion. Implanrauon is up to the level of spongiosum. Placenta is formed by the union of the chorionic villi and decidua basalis. beneath it the feral vessels course with the arteries passing over the veins. consists of fibrous tissue with sparse vessels confined mainly to the base 5.6:1 B. with glands and small blood vessels b. 4. Zona Spongiosum: middle. Amniotic fluid: clear fluid that collects within the amniotic cavity. separates ovum from the rest of the uterine cavity: most prominent by 2nd month 3.Feto-placental weight ratio. Amnion: 0. by the fourth month. Maternal Side: divided into irregular lobes. Decidua Vera/ Desidua Parietalis: lines the remainder of the uterus. spongy layer. 4. 1. .Average weight at term . • The zona basalis remains after delivery/ placental separation. the growing sac fills the uterine cavity. c.

D. 2. Excretory with the amniotic fluid as the medium of excretion 3. This layer is usually absent whenever the decidua is defective. is where invading trophoblast meets the decidua. nicorine. Decidual Aging: Nitabuch's layer. SOME PLACENTA/CORD ABNORMALTIES Placenta succenturiata One or small accessory lobes are developed in the membranes. depressants and stimulants. carbon dioxide. Respiratory organ of the fetus 4. and . water and electrolytes move from greater to lesser concentration • Facilities transport: glucose • Active transport: amino acid. may be dysfunctional beyond 42 weeks. Fluid/gas transport • Diffusion: oxygen. antibiotics. of clinical significance because retention in the uterus after placenta expulsion may result in maternal hemorrhage. PLACE TAL MATURITY: 12 weeks or 3 months. PLACENTAL FUNCTIONS: Varied 1. The placenta acts as a protective barriers to some substances and organisms like heparin and bacteria:ineffective for virus. Nutritive: transports nutrients and water soluble vitamins of fetus a. calcium. alcohol.5. gamma globulin albumin • Leakage allows fetal and maternal blood to mix slightly because of placenta defects. calcification. C. functions most effectively through 40 to 41 weeks. a zone of fibrinoid degeneration. iron • Pinocytosis: fat. Placenta infarcts Fibrinoid degeneration of the trophoblast. normally there is no mixture of fetal and maternal blood.

and human placental lactogen (HPL). progesterone. Human chorionic gonadotropin (HCG) • Secreted as early as 8 to 10 days after fertilization.U/24 hours c. b. Estrogen and progesterone's major source or production after the first 2 months. human chorionic gunadotropin (HCG). when marked. 00 I. detected in serum as early as the time of implantation by the most sensitive pregnancy test.Placenta bipartita Placenta tripartita Battledore placenta Velamentous insertion of cord / Placenta velamentosa Cord loops Cords torsion Cords knots ischemic infarction. of diverse origin. Human chorionic somatomammotropin (HCS) or Human Placental Lactogen (HPL) • Secreted by third week after ovulation . also called chorionic somatomammotropin (HCS) a. serves as basis for pregnancy tests • The hormone found elevated in excessive vomiting • Normal value: 400. The radioimmunoassay (RIA). and detected in urine a day after expected mense by a pregnancy test • Functions: prolongs the life of the corpus luteum. usually the neck (nuchal cord) Twisting of the cord resulting from fetal movements. Endocrine: secretes hormones estrogen. may affect fetal circulation False knots: result from kinking of the vessels to accommodate to the length of the cord True knots: result from active movement of the fetus 5. most common placental lesion Placenta with 2 complete or almost complete lobes Placenta with 3 complete or almost complete lobes insertion of the cord at the placental margin Umbilical vessels separate in the membranes at a distance from the placenta margin which they reach surrounded only by a fold of amnion When cord coils around portions of the fetus.

amniotic epithelium maternal serum and in later part (10th week). gelatinous substance a. PARTS: 1. VI. Clear. Influences somatic cellular growth of the fetus. One left umbilical vein: carries oxygenated blood to the 2. THE AMNIOTIC FLUID A. b. The cord extends from the fetal surface of the placenta to the fetal umbilicus D. Wharton’s jelly. Wharton’s Jelly: Specialized connective tissue. constantly being replaced so there is no "dry labor" in premature rupture of the bag of water . an extension of the amnion: surrounds the umbilical cord to prevent cord compression The blood volume in the cord also helps prevent cord compression C. FUNCTION: to transport oxygen and nutrients to the fetus and to return metabolic wastes including carbon dioxide from the fetus to the placenta. resembles the growth hormone The fetus principal diabetogenic factor as it is the major insulin antagonist.• • • V. straw-colored fluid in which the fetus floats B. fetal urine. Two umbilical arteries (left & right): carry deoxygenated blood from fetus to placenta 3. 1 inch across at term B. A. ORIGIN: both fetal and maternal. or glucose sparing hormone Prepares the breasts of the mother for lactation THE UMBILICAL CORD/FUNIS LENGTH: 55 cm.

F. AMOUNT: . Maintains fetal temperature 7.000 ml at term. 5. E.500 mL. amniotic fluid accumulates (polyhydramnios).25) ABNORMAL COLORS: green-tinge in a. oligohydramnios . AMNIOTIC FLUID FUNCTIONS 1. STAGES Of INTRAUTERINE DEVELOPMENT A. THE OVUM 1. Serves as a protective cushion/shock absorber 2. Serves as fetal drink (If there is an abnormality in the deglutition center of the brain or if there is esophageal atresia that the fetus could not swallow. Separates fetus from membranes allowing symmetrical growth and free movement 3.C.500 to 1.amount less than 300 to 500 mL. polyhydramnios excessive amount of amniotic fluid. non-breech presentation is a sign of fetal distress.000 to 1. Equalizes uterine pressure and prevents marked interference with placental circulation during labor VII. 2. golden-colored fluid may be found in hemolytic disease. D. From fertilization to 2 weeks The period of pre-differentiation of organs . greater than 1. Serves as a specimen for periodic diagnostic exams to determine fetal wellbeing or its absence 6. Acts as a medium of excretion 4. REACTION: neutral to alkaline (pH 7 to 7.

nails: skin epidermis. The period of post-differentiation of organs 3. B. Most Dangerous Period: A teratogen introduced at this stage may result in severe organ malformation and dysfunction.3. Salivary glands. Hair. C. the ‘ all or none' law applies. THE EMBRYONIC GERM LAYERS ECTODERM: the outer layer. the effects will most likely be alteration in size or function. . meaning the ovum is damaged and is out in spontaneous abortion or it is not affected at all and continues to grow normally. Nervous system 2. Epithelium of nasal oral passages MESODERM: the middle layer. Cardiovascular system B. THE FETUS 1. sebaceous and sweat glands 3. develops into: 1. 3. A. mucous membrane of mouth 4. When exposed to a teratogen. From 2 weeks to 2 months 2. If ever the fetus is affected. THE EMBRYO 1. When the' ovum is exposed to a teratogen. develops into: 1. The period of organ differentiation (organogenesis). Dermis 2. From 8 weeks to birth 2. a malformation is least likely to occur. VIII.

GUT Heart chambers formed. Reproductive system 4. ENDODERM/ENTODERM: the inner layer. heart beating (14 days) With arm and leg buds Head Large in proportion to the body Neuromuscular development some movements Rapid brain development External genitalia appear Placenta fully formed and functioning Kidneys develop: secrete urine Centers of ossification in most bones With sucking and swallowing Sex distinguishable FHT detected by ultrasound (1012 weeks) More human appearance Quickening-multigravida Meconium in bowels External genitalia obvious Scalp hair develops Formed eyes. except the bladder C. ears FHT by Doppler With vernix caseosa and downy Age 4 weeks 8 Weeks 12 Weeks 16 Weeks 20 Weeks .3. thyroid. INTRAUTERINE GROWTH AND DEVELOPMENT Development All systems in the rudimentary form Beginning formation of eyes. Urogenital system. parathyroid 3. thymus (for immunity building) IX. nose. pancreas. Bladder. Liver. develops into: 1. thyroid. nose. Musculo-skeletal system 5. Linings of gastrointestinal tract from pharynx to rectum 2. Respiratory tract 4.

24 Weeks 28 Weeks 32 Weeks 36 Weeks 40 Weeks lanugo Quickening stronger.. but usually doesn’t Viable. . immature if born at this time Surfactant production begins Body is less wrinkled With iron storage Nails appear Pupillary membrane has just disappeared from the eyes Subcutaneous fats begin to deposit Skin is smooth and pink More reflexes present With iron and calcium storage Good chance of survival if delivered Lecithin/sphyngoinyelin ratio 2:1 (L/S) Nails firm With definite sleep/wake pattern Lanugo disappearing Survival same as term Full term with good muscle tone and reflexes Little lanugo If male. eyelashes recognizable When born. felt by Primigravida FHT audible using stethoscope Bones hardening Body well-proportioned Skin red and wrinkled Hearing established Eyebrows. may breathe. 1998) Drugs Anticholinergic drugs Antithyroid drugs (Prophylthiouracil. testes in scrotum The age at time of EDC With other characteristic features Of the newborn Drugs with ProvenTerarogenic Effects (Modified from Koren et al. Teratogenic Effects Neonatal meconium ileus Fetal & neonatal goiter.

necrotizing enterocolitis Growth retardation. III. the fetus is 40 weeks old. Calendar months – 9 C. other genitourinary defects in male or female offspring Neonatal hypoglycemia CNS & limb malformations Constriction of ductus arteriosus. also called prenatal period. GNS defects Neonatal withdrawal syndrome when given in late pregnancy Teeth staining/defects. benzodiazepines) Tetracycline Thalidomide Warfarin (Coumadin) hypothyroidism CNS malformation. does not pass through placental barriers. Lunar months – 10 It is best to express gestational age or length of pregnancy in weeks. At expected date of confinement (EDC). I. Trimesters – 3 E. ANTEPARTAL PERIOD The period of pregnancy or the period before labor is the antepartal period.methimazole) Cyclophosphamide Diethylstilbestrol Hypoglycemic drugs Methotrexate NSAIDs Phenytoin Psychoactive drugs (barbiturates. II. opiods. TRIMESTERS OF PREGNANCY .267 to 280 B. Days . LENGTH Of PREGNANCY A. bone defects Limb defects/ shortening. The woman in this period is called the gravida. internal organ defects Skeleton & CNS defects ‘Heparin’ is the anticoagulant of choice in pregnancy. Weeks – 40 D. secondary cancer Vaginal cancer.

7. Chadwick’s sign : bluish or purplish discoloration of the cervix. virus. more pronounced at 8 months. 13th weeks – rising from pelvic cavity. 8. Fundic height changes : 12th weeks – level of symphysis pubis. Ballottment : Rebounding of fetal head against examining fingers by 4 to 5 months. ( No formation of new muscle fibers in pregnancy. there is increased mucus production which make up the mucus plug (week 7 ). c. Goodell’s sign – softening of the cervix. 6.it also prevents bacterial contamination of the uterine cavityIncreased vascularity causes to be soft : Goodell’s sign. 3. drugs. With edema and hyperplasia of the mucous lining. PHYSIOLOGIC ADAPTATIONS IN PREGNANCY A. C.more elastic. easy compressibility of the uterus. ( non-pregnant ) to 1000g. SECOND TRIMESTER: most comfortable for the mother. UTERUS 1. 30th weeks –at xiphoid process level. Hegar’s sign – softening of lower uterine segment called the isthmus.painless. Uterine shape changes from GLOBULAR to OVAL. New fibroelastic tissues are formed. 20th to 22th weeks at level of umbilicus. teratogens like alcohol. and radiation are highly damaging. Increased vascularity to the pelvic region (estrogen effect)results : a. b. As it seals the cervix. this makes up stonger uterine walls.A. B.abdominal. iron and calcium. Secondary amenorrhea : due to the persistent of the corpus luteum. Weight increases from 60g.thicker. CERVIX – shorter. IV. 2. 4. . FIRST TRIMESTER: period of rapid organogenesis. Braxton –Hicks Contractions – Intermittent irregular. and false labor contractions felt as abdominal muscle tightening by albout 4 months. 14th – weeks an abdominal content. 5. with continued growth of the fetus. UTERUS SIZE – is increased due to hyperthrophy of the existing muscles and connective tissues. THIRD TRIMESTER: with rapid deposition of fats. (full term). the period of most rapid fetal growth B.may be palpable just above the symphysis pubis.

Hematologic – Hemoglobin and hematocrit may drop by 10% in the second and third trimester may result to pseudoanemia/physiologic anemia. watery. Increased vascularity results to bluish discoloration: Chadwick’s sign. in the second and third trimesters. Edema of the lower extremities is common in the last 6 weeks of pregnancy because of the pressure on the pelvic girdle.progesterone.Increased in size. Circulatory system – cardiac rate increased by 10 to 15 bpm/min. E. Perineum . treatment –dental hygiene. Increased vascularity resulys in soft and swollen gum/gingivitis.Pancreas and Adrenal Cortex all as increases its works activities. Endocrine – Placenta secretes Human Chorionic Gonadotropin.Eustachean tube blockage causing temporary deafness or difficulty of hearing.non-pruritic vaginal secreations increases as estrogen levels increases. Prominence of superficial veins. light yellow.thickened vagina mucosa results in Leukorrhea : Whitish. Breast – Increased size and firmness. non-foul smelling. an added protection from bacterial invasion. Parathyroid Gland. Fibrinogen level increases by 50% due to progesterone effect hence results in increased tendency to clotting – high risk for thrombophlebitis. No tooth loss in preagnancy. increased vasularization – changes into deeper color. I. Homan’s sign – if positive is a danger sign of deep vein thrombosis.nasal stuffiness. Gastrointestinal system – increased acidity of saliva. Ovaries – Ovum production ceases. K. provides increase vaginal acidity.hoarseness. D. Cardiac output increases by 20 to 30% in the first and second trimesters to meet increase tissues demand. The rest – APG. Lungs – tendency to hyperventilate due to mother’s need to blow off carbon dioxide transferred from fetus.Nose – Increased vascularity ( estrogen effect) results most common in epistaxis. Colostrum ( 4 to 5 months ) : thin. Tingling sensation in the nipples in 4 weeks . and HPL ( human placental lactogen ) / HCS ( human chorionic somatomammotropin ). mucoid. Posterior ituitary Gland. Vascularity increases ( estrogen effect) : causing dilatation of pelvic veins resulting in pelvic veins varicosities and leg varicosities. Thyroid Gland – there are increased 25% metabolic rate activity but return to normal level at 6th week postpartum. Placenta is the major endocrine organ in pregnancy. Darkening of the areola and skin around it. alveoli duct and alveoli system.estrogen. G. high protein secretions. and direct effect of progesterone on respiratory center. there is also breast tenderness. Cardiac sphincter relaxed C. Enlargement of the areola. Corpus luteum takes over hormonal production task in early pregnancy. J. .Vagina . F. Respiratory . H. Diaphragm – rises by 1 inch at 36 to 38 weeks due to the growing fetus resulting in dyspnea which relieved by lightening.

Linea negra -_dark line from symphisis pubis upward to xyphoid process due to increased estrogen. Mood swings or emotional labiliry 4.nose and neck. Focusing on the self B. Renal system – Freqency of voiding – increased in the first and third trimester because of uterine pressure on the urinary bladder. Striae Gravidarum – stretch marks. Slow motility results in slow digestion ( progesterone effect). Stress on ligaments and muscles of the mid and lower spine results in backache. EMOTIONAL/PSYCHOSOCIAL ADAPTATIONS IN PREGNANCY V. career. FIRST TRIMESTER 1. Most comfortable stage C. silvery streak. Ambivalence about pregnancy child. evaluates marriage. Acceptance of the baby as distinct from self.L. N. results in esophageal reflux leading to heartburn or pyrosis felt behind the sternum.progesterone and relaxin relaxes the ligaments and joints. Normal denial to confirmation of pregnancy 2. ‘ Mask of pregnancy due to increased melamocytestimulating hormones of pregnancy. and parenting 3. enhanced by quickening which is "my baby is alive" to the layman 2. Palmar erythema – reddened palm and vascular spider nevi ( facial) from increased vascularity due to elevated estrogen. Musculo-skeletal – increased estrogen. THIRD TRIMESTER . and pressure of the gravid uterus on nerve supplying the lower extremities. A. in-laws 4. Introspective. M. Lordosis from shift in the center of gravity during pregnancy results in backache and fatigue. Cramps – (legs ) result from calcium and phosphorous imbalance. With fantasy and daydreaming 3. SECOND TRIMESTER 1. Diaphoresis – increased activity of the sweat and sebaceous glands due to increased metabolic rate. Integumentary system –Chloasma – dark patches on the checks.

In the third trimester the is also recommended woman to attend prenatal classes. PSYCHOLOGIC TASKS OF PREGNANCY: Related to the psychosocial adaptations in pregnancy are the psychologic tasks of pregnancy: 1. and death 2. 2. SIGNS OF PREGNANCY The changes in the various body systems give rise to the signs of pregnancy grouped into presumptive. The nurse should validate normalcy of her feelings and reactions in order to provide psychological support. In addition. Acceptance of pregnancy as a reality and incorporation of the fetus into the body image Preparation for physical separation from fetus (birth) Attainment of maternal role E. V. NURSING IMPLEMENTATION The pregnancy woman should be encouraged to verbalize and express feelings. PRESUMPTIVE SIGNS: subjective. pain. probable. concerns. mutilation. and positive signs. role playing D. Fear/anxiety/dreams about labor. Nausea and vomiting: are the most common forms of discomfort 2. A. Preparation for birth: nesting behavior. and discomforts. 3. . Amenorrhea: first sign at 2 weeks from fertilization because of persistence of corpus luteum. may be noticed by the woman but are not conclusive proof of pregnancy 1. Anxiety related to responsibilities 3. health teachings related to prevention and management of common discomforts of pregnancy should be provided.1.

abdominal contractions.s sign: softening of the cervix 3. 2000). darkening and enlargement of areola. 8. as noticed or observed by healthcare provider but still not conclusive for pregnancy 1. C. 9. striae gravidarum. 5. 6. diaphoresis Quickening: usually felt stronger at 20 weeks Leukorrhea: whitish-mucoid vaginal discharge due to estrogen 4. Chadwick's sign: bluish discoloration of cervix. relieved by walking 6. Urinary frequency: is the most disturbing sign especially in the thid trimester Fatigue: estrogen-induced in early pregnancy Breast changes: tingling of nipples (4 weeks). Positive pregnancy test: due to presence and rising HCG in maternal blood and urine 8. Hegar's sign: softening of lower uterus (isthmus) ~ compressibility of the uterus 4. POSITIVE SIGNS: objective. conclusive for pregnancy . Weight increase B.3. 7. Braxton-Hicks contractions: painless. Uterine enlargement causing abdominal enlargement 2. Goodell'. linea nigra. enlargement of breasts. increased number of milk-secreting cells Skin changes: chloasma. Ballottement: rebound of fetus against examining fingers 7. emanate from the fetus. Radioimmunoassay (RIA): test for the beta subunit of HCG ~ accurate as to be diagnostic of pregnancy (Kain & Hall. vagina and perineum 5. PROBABLE SIGNS: objective.

fatigue • Have adequate rest and sleep (8 hrs. • Practice frequent flushing: front to back. • Drink adequate fluids between meals. cloudy urine. FHT 2. • Regular exercise (best is walking) is recommended. • Avoid gas-forming food. • Report any burning sensation. Frequency of • Increase fluids to replace losses except at urination bedtime to present nocturia. dysuria. • Avoid highly spicy. • Avoid fatty. highly seasoned foods. • Practice regular voiding. Flatulence • Eat small frequent meals. Fetal outline (ultrasound) 3. Fetal skeleton (X-ray. not before 16 weeks) DISCOMFORTS OFPREGNANCY AND RELIEF MEASURES Discomfort Relief Measures Morning sickness • Eat dry crackers (carbohydrates) or toast. • Take aluminum-bearing antacids (Amphogel) as ordered. • Report increasing fatigue with regular activities-a danger sign of heart disease Constipation • Increase fluid intake (6 to 8 glasses of water per day). . • Practice good body mechanics (posture). • Avoid taking sodium bicarbonate. fatty foods. or tea-colored urine. • Remain upright 3 to 4 hours after eating.1. • Eat small frequent meals. in the morning 30 minutes before getting up. • Increase roughage in the diet (daily fruits and vegetables). Heartburn • Bend at the knees and NOT at the waist when picking things from the floor. average night sleep) • Avoid prolonged standing. avoid overeating. • Observe daily/regular bowel movement. Fetal parts (examiner's palpation) 4.

. nd • Avoid supine position in 2 to 3rd trimesters. • Wear supportive panty hose. • Assume left-lateral: position/elevation of legs frequently to promote venous return. • Arise from a bed from a lateral position and gradually. • Avoid sudden changes in position. • Frequent elevation of legs and hips is advised. • Maintain good posture. • Avoid prolonged standing and sitting. calciumphosphorus imbalance is the recognized most important cause of leg cramps. • Promote com for : sitz bath. • Report increasing dyspnea with minimal activity or dyspnea prior to 36 weeks (with normal pressure on the diaphragm). • Elevate head by several pillows in sleep. • Avoid constricting bra and other tight clothes. • Wear flat shoes. • Avoid constipation and other forms of straining. this hyperextends the involved muscle causing relief. • Wear maternity girdle in selected situation. • Avoid staying in one position for a long time.Hemorrhoids Faintness/supine hypotensive syndrome / vena caval syndrome Leg cramps Varicose veins Backache Pedal edema Shortness of breath • Drink warm water in the morning. • Pelvic rock exercise and tailor sitting are advised. • Use supportive mattress. • No round/constricting garters. • Avoid prolonged standing. • Dorsiflex the foot while extending the leg. avoid knee-high stockings. warm compresses • Reinsert hemorrhoids.as recommended. • Assume frequent left lateral positions in bed. • Avoid fatigue. avoid supine position. upon physician's recommendation. • Maintain good posture. • No round garters around the abdominal and legs. • Report swelling of hands and face. • Include adequate calcium in the diet. • Avoid prolonged standing.

Twice a month (every 2 weeks) from 32 to 36 weeks 3. Compare the first with the second diastolic reading . Place mother on left-side lying position (left lateral recumbent. A.VII. To serve as basis for comparison with information gathered on subsequent visits b. Check BP again. PRENATAL MANAGEMENT FIRST VISIT: as soon as the mother missed a menstrual period when pregnancy is suspected. PROCEDURE A. Once a month up to first 32 weeks 2. Check BP until stable. LLR). Four times a month (every week) from 36 to 40 weeks In the presence of danger signals of pregnancy. CONDUCT OF INITIAL VISIT 1. Baseline Data Collection a. Wait 5 minutes F. Check BP right away E. To screen for high-risk factors ROLL-OVER TEST I. C. may take 10 to 15 minutes C. SCHEDULE OF VISITS 1. Roll to supine D. B. the mother should be instructed to report promptly for evaluation. B.

INTERPRETATION A. deeper) because of progesterone's influence on the respiratory center. Menstrual history-menarche (onset. b. . Family History to detect illnesses or conditions Current Problems .past illnesses and surgical procedures. regularity. Prevention: Elevated BP reading may indicate pregnancyinduced hypertension (PIH). Negative Result – An increase in the diastolic pressure of values less than 20 mm of mercury 2. Initial and Subsequent Visits BP: Tends to be hypotensive with supine position: vena caval syndrome.II.activities of daily living. danger signs a. Obstetrical History a. duration. methods of Past menstrual period (PMP): menstrual period before the last Medical and Surgical History . 3. 5. • • 6. woman at risk B. contraception. character Last menstrual period (LMP). Positive Result – an increase in the diastolic pressure of values greater than 20 mm of mercury.. sexual history. current drugs used 4. Maximum increase under normal conditions: 24/min at rest. discomforts. • • CR: Plus 10 to 15 BPM RR: May tend to be rapid and deep (16/min. not to reach 38ºC. c. Vital signs • Temperature: slight rise because of increased progesterone and increased activity of the thyroid gland. frequency.

Weight is therefore a measure of health of a pregnant mother. Urine testing for albumin and sugar • • Sugar . Weight is checked in every visit. b. • • • • • • • Total weight gain: 20 to 25 lb. per month which is 3 to 4 lb. plus subsequent mobility .. • c.first fetal movement. upper limit: 25 to 35 lb.ideally not more than 1+ Albumin – negative d. with average of 24 lb.• The roll-over test can be done in the first trimester for early detection of developing pregnancy-induced hypertension by 20 to 24 weeks..5 to 1 lb. Fetal growth and development assessment • • • • Fundal height. total Second trimester: 0. The patterns of weight gain are more important than the amount of weight gain Normal weight gain patterns contribute to health of mother and fetus Failure to gain weight is ominous sign. Third trimester: 0. per week or about 10 to 12 lb. • Requires emptying of the bladder for accurate results Fetal heart tones/fetal heart rate Abdominal palpitation . First trimester: 1 lb. per week or about 8 to 11 lb.Leopold's maneuver Quickening .9 to 1 lb.

7.with two or more pregnancies Nulligravida . Therefore. Obstetrical History a. a primigravida had one pregnancy Multigravida . Preceding pregnancies and perinatal outcome • 4-Point System: Past pregnancies and perinatal outcomes (FPAL) F: number of full term births P: number of premature births A: number of abortions L: number of currently living children 5-Point System: the total number of pregnancies (G) is the first number (GFPAL) G: total number of pregnancies F: number of full term births P: number of premature births A: number of abortions L: number of currently living children b. Parity: number of pregnancies carried to period of viability whether born dead or alive at birth (twins considered as one parity) • Primipara: a woman who has once delivered a fetus or fetuses who reached the stage of viability.woman who is not pregnant now and has never been pregnant.pregnant for the first time. the completion of . Gravida: number of pregnancies regardless of duration and outcomes. c. including the present pregnancy • • • • Gravida 1 (G) .

2008 5 • 3 + 20 7 2008 + 1 _________________________ 2 27 2009 Measures of AGE of Gestation ( AOG ) 1. . AOG in weeks : FH in cm x 8 / 7 . 4. It also means. 2. EDC/EDD: expected data of confinement/ expected date of delivery • Naegele's Rule Formula: Add 7 days to the first day of the last menstrual period (LMP): subtract 3 calendar months then add 1 year Given LMP: May 20. Identification of FHT : 7 – 8 weeks by Doppler ultrasound. Ultrasonography : measures biparietal diameter. McDonald’s Rule : requires fundic height measurement in cm. Date of Quickening : at 20 weeks 6.measures age of gestation by determining the position of the fundus in the abdominal cavity. 5.pregnancy beyond the period of abortion means one parity. LMP : last menstrual period. 3. • Multipara: a woman who has completed two or more pregnancies to the stage of viability 8. therefore. that an abortion is not included in the counting. Estimates in Pregnancy a. A BPD of 9. AOG in months : FH in cm x 2 /7 . Fundic height – Bartholomew’s Rule of Fours. usually attained at 36 weeks of gestation.5cm = mature fetus.

VDRL ( Syphilis ).9. adequacy of breasts for breast feeding. Important concern of physical examinations : Breasts – look for breasts changes. Pelvic Lab Tests : collection of pelvic cultures ( pap’s smear. Danger sign : Homan’s sign ( pain in the calf upon dorsiflexion of the toes. Physical preparations specific to the procedure 3. . In all the necessary testing. b. Provision of support to patient and spouse. any abnormal signs. a. B. Human Immunodeficiency virus ( HIV). Rh factor determination. Leopold’s maneuvers : systematic abdominal palpitation to estimate fetal size. Laboratory Test : Blood studies : complete blood count ( CBC ) Blood typing. d. varicosities. Complete Physical examination : include internal examination and bimanual examinations. Urine Test . Rubella antibody titer determination. pedal edema. encouraging verbalization of concerns 4. Goodell’s and Hegar’s sign. Providing an explanation of the procedure 2. c. culture for gonorrhea . Determine gestational age of the fetus: estimate date of confinement. a sign of thrombophlebitis ). Internal examination ( IE ): detect early signs of pregnancy. Abdomen – Fundic height.Urinalysis . locate fetal back and parts and determine fetal position and presentation. Define the health status of the mother and fetus. prepare the client through the following steps : 1. Chadwick’s sign. Do Pap’s smear on the first visit. Documentation as necessary VIII. MAJOR GOALS OF COMPREHENSIVE PRENATAL ASSESSMENT AND EVALUATION: A. Hepatitis screening. Extremities – discomforts : leg cramps. Monitoring of patient and fetus after procedure 5. and Chlamydia ) .

Pre-pregnant and current nutritional status b. Mother's knowledge of nutritional needs and the daily recommended allowances e. interference with nutrient absorption. adolescent mother primigravidity low pre-pregnant weight obesity . Dietary habits: junk. regularity of meals. starch. empty-caloric foods. dirt. chalk). a psychobehaviora disorder (Rainville.g. Always start with diet history when it comes to giving nutritional instruction to the mother. Physical findings indicative of poor nutritional status such as: • anemia. and anemia c. clay. peer pressure. and/or substances of little nutritional value. cultural and religious restrictions· Pica: persistent ingestion of inedible substances (e. 2. NUTRITION 1. underweight/overweight states • dull hair • dry/scaly skin • pale/dull mucus membrane/conjunctiva f. adequacy of food/available finances. D. 1998). Initiate a nursing care-plan for continuing maternity care of both mother and fetus. Effects are displacement of nutritious foods.C. Nutritional Profile should include the following: a. Factors/conditions requiring special attention such as • • • • young. Detect early any high-risk condition. d. HYGIENE OF PREGNANCY A. IX.

500. Calories • • • • Non-pregnant requirement: 1. Carbohydrates: sufficient intake is necessary for added energy needs. and K. poultry. E. Protein: body-building food: additional 30 g/day to ensure 74 to 76 g/day. may need vitamin B 12 supplement successive pregnancies. Avoid too much fat to prevent vomiting and heartburn. f. avoid 'empty' calories like soft drinks. Fats: high-energy foods for absorption of vitamins A. Nutrient Needs should include the following: a.800 to 2. D. c.100 .2. supplementary in pregnancy 30 to 60mg/day . Essential Minerals and Vitamins • Iron: Most important mineral that must be taken in supplementary amount • 18 mg/day in non-pregnant state. fish. meat.• • • • • low socioeconomic status/economic deprivation pre-pregnant debilitating conditions vegetarians -lack essential protein and minerals. 3.200 Kcal/day Additional caloric requirement per day 300 Kcal/day Usual daily caloric need in pregnancy: 2.800 Kcal/day Avoid 'empty' calories like soft drinks. never less than 1. short interval between pregnancies education . and eggs. d. b. Fiber: taken from fruits and vegetables to prevent constipation e.not so much what they know (may receive nutritional teaching) but how much they earn (spells adequate finances) to buy essential foods. Rich food sources include: milk.

Sources: liver (best source) and other red meats, green leafy vegetables, egg yolk, cereals, dried fruits, and nuts

• •

Needed to increase maternal RBC mass and for fetal liver storage in the third trimester. Intake of iron-fortified multi-vitamins to ensure essential levels • • best absorbed in acidic medium: take between meals and with vitamin C-rich juice may cause constipation; so there is also a need for increased fluid intake, fibers/roughage; regular ambulation • will darken stools: explain this to the patient; can be used in evaluating compliance

Calcium • • • • Needed for maternal calcium and phosphorous metabolism and fetal bone and skeletal growth 1,200 mg/day, equivalent to 1 quart of milk a day (4 glasses) Sources: milk and milk products and broccoli (which carries the same amount of calcium as milk) Sodium: most abundant cation in extracellular fluid • • • Needed in pregnancy for tissue growth and development Contained in most kinds of foods Should not be restricted without serious indications

Folic Acid

• • • •

Needed to meet increased metabolic demands in pregnancy and for production of blood products Deficiency may cause fetal anomalies/neural defect and bleeding complications Sources: liver, dark green leafy vegetables

Vitamins: water-soluble vitamins (C and B) and fat-soluble vitamins (A, D, E, and K) Major Food Sources: •

Vitamin C: citrus fruits and vegetables like broccoli, bell peppers, and tomatoes Vitamin B Group: legumes, beans, nuts, whole grain. oatmeal, pork, beef, fish, liver, organ meats, eggs, and green leafy vegetables

• • • •

Vitamin A: milk and dairy products; dark green and dark yellow fruits and vegetables; eggs and liver Vitamin D: milk and foods fortified with vitamin D; egg yolk; fish Vitamin E: nuts, seeds, wheat germ, whole grain products, green leaf" vegetables, vegetable oils Vitamin K: meats, liver, cheese, tomatoes, peas, and egg yolk

4. Daily Food Needs/Servings Food Milk and milk products Meat and meat products Cereals/grain products Fruit/fruit juices Vegetables/ vegetable juices Number of Serving I quart a day (4 glasses/day) 3-4 servings 4-5 servings 3-4 servings (one serving of vitamin C-rich fruit/ juice included) 3-4 servings (included is 1 serving of dark green or yellow vegetable)

Fluid

4-6 glasses of water plus other fluids to equal 8 (8-10) cups/day

B. BATH 1. Daily bath if desired. 2. Avoid soaps on nipples: with drying effect. 3. Towel-dry breasts: increases integrity/toughness of nipples.
4.

Tub bath: may cause injuries from accidental slipping as pregnant women have difficulty maintaining balance. a. Usually contraindicated except when there is care in getting into and out of bathtub; nonskid rubber mat on bathtub floor helps to prevent falls. Douching: not needed to manage vaginal discharge (Leukorrhea is estrogen-induced.); daily bath will suffice

5.

C. CLOTHING 1. Loose, comfortable clothes, of cotton material for more comfort 2. No constrictions around breasts, abdomen, legs; no round garters 3. Flat-heeled shoes for comfort and balance 4. Support panty hose for varicosities (avoid knee-length stockings) 5. Supportive, cotton-lined brassiere 6. Maternity girdle as necessary D. SLEEP AND REST 1. Assess activities to identify need for rest and sleep. 2. Average number of hours of sleep is 8 hours; may need I to 2 hours of afternoon nap. In the second half of pregnancy, advise to avoid the supine position in bed. 3. Plan rest time during the day.

2. Can be practiced in pregnancy. the danger of abortion is not great. F. the threat of premature labor is at a minimum 4. Cleansing Breathing: deep relaxed breath. Squatting/Tailor-sitting: strengthens perineal muscles. Journeys close to term are discouraged. Best time to travel is during the second trimester because: a. TRAVELING 1. airlines will require a medical certificate indicating fitness to travel by air. makes pelvic joints more pliable . get to stand and walk about for few minutes at last once in every 2 hours (If task requires prolong standing. 3. used in labor to signal the beginning of uterine contractions 2. Purposes: a. the pregnant woman is most comfortable b. like a sigh. Seatbelts are needed. c. increases flexibility of the lower back b. Long distance travel by land needs stop-over’s so pregnant women can get out of the car and walk. improves posture and appearance . E. relieves backache. At work.in late pregnancy 3. Traveling by air requires pressurized planes: in late pregnancy. strengthens the abdominal muscles c. Pelvic Rock: The most important exercise for comfort during pregnancy.4. there should be time to walk about and sit at interval). EXERCISES 1. shifts center of gravity back to uterine spine d.

e. vaginal and pelvic floor muscles. diminishing blood flow to uterus. Regular exercises are needed.4. Not necessary to limit maternal exercises provided they are: • Usual. can carry women through most of the first stage. pushing should be in the second stage of labor EXCEPT during CROW ING. Abdominal Breathing: utilizes the diaphragm primarily and not the chest muscles. helpful during the first half of labor. fetus. b. This implies the possibility of fetal distress in severe exercise. 5. this can be done every hour. no new exercises should be started in pregnancy. . and. Avoid excessive and strenuous exercises. Panting: best for crowning period and actual delivery of the baby leaving the work to be accomplished by. the uterus. Do not cause maternal fatigue. Evidences support that women who are used to aerobic exercises before pregnancy should continue them during pregnancy provided fatigue is avoided. c. Exercise in standing position (not supine) to prevent pressure on the inferior vena and against the diaphragm. d. when used together with total relaxation. 6. In uterine prolapse. 7. • Excessive exercises cause increased blood flow to muscles and bones. Kegel: improves the tone of pubococcygeal. perineal. Only by panting can the mother be kept from pushing in the transition phase of labor. placenta and therefore. • • With no risk for maternal and fetal injury. Literature reports that regular exercise in pregnant women results to lower CS rate and length of hospitalization. customary. Nursing Considerations Related to Exercises in Pregnancy a. cystocele and rectocele.

Generally no contraindications except in the presence of: a. c. Changes in normal sexual response are related to the physiologic changes of pregnancy (Alteneder & Hartzell. exercise moderation and hygiene. avoid fatigue. pregnant women. bleeding d. b. The traditional man on top position is uncomfortable for many couples. or adaptation to pregnancy. nausea. First Trimester: less interest in sex due to fatigue. In healthy. sexual intercourse usually does no harm. c. history of abortion. Like any other activity. 2.• Excessive exercises can cause increased body temperature. deeply engaged head in late pregnancy e. 1997): a. Third Trimester. Second Trimester: interest in sex may increase as this trimester is the most comfortable period. near term: less interest due to the discomforts brought about by positional difficulty and abdominal size. G. premature rupture of membranes b. b. MARITAL RELATIONS/COITUS 1. elevated temperature is theoretically teratogenic. premature labor c. Couple may need counseling regarding more comfortable positions. Suggested positions: side lying and the woman-on-top position. a. incompetent cervix 3. .

CARE OF THE TEETH Regular examination of the teeth and gums should be part of the prenatal general physical examination. 1. Because of estrogen effect on vascularity. Safety and rest are the two most important considerations in deciding whether or not the pregnant woman should continue working. The concept that dental caries are aggravated by pregnancy. Instruct on the use of soft-bristled toothbrush and gentle brushing. and work conditions do not pose hazards TO the health of mother and fetus. the gums of pregnant women are painful and swollen. Whether standing or sitting at work. work area. There is no tooth loss secondary to pregnancy.is not supported by literature. 4. . Premature labor or abortions probably should minimize physical work. Dental carries require prompt management in pregnancy.H. but major dental surgeries should be postponed for the postpartal period. I. 1. the pregnant woman should be advised to stop and walk about every few hours to improve circulation of blood. 2. 3. Adequate periods of rest should be provided during the workday. EMPLOYMENT The pregnant woman may continue working provided the work. 2. Women with previous complications that are likely to be repetitive like SGA.

. Alcohol is the leading known teratogen in the Western world. Alcohol ingestion by pregnant women is likely to cause fetal abnormalities. S-A-D HABITS OF PREGNANCY Smoking. Alcohol. Prenatal tobacco exposure causes learning and attention problems in children but less consistently than does alcohol exposure (Streissguth et aI.. cause reduced placental perfusion. Effects of tobacco use (Lieberman et aI. Causes of adverse effects of smoking • • • • • 2. Nicotine.. The use of over five cigarettes per day in pregnancy doubles a woman's risk of delivering a low-birth infant (Lieberman et al. The increase of carbon monoxide causes functional inactivation of maternal and fetal hemoglobin.II. b. a vasoconstrictor. 1997) a. Smokers have decreased plasma volume Smokers have reduced appetite. Pregnant women should not smoke. Resulting to decreased caloric intake.. Women who smoke in pregnancy have smaller infants (SG/\) than those women who do not. 1994). 1994): • • • • • • Increased risk of SGA Prematurity Infant mortality Spontaneous abortion Placenta previa/abruption placenta Premature rupture of membranes 1.

Effects of chronic alcoholism: fetal alcohol syndrome (FAS). tea. colas.. it is best that pregnant women abstain from alcohol ingestion. Drugs prescribed in pregnancy should have benefits or advantages outweighing the risks. 3. Caffeine: reduce intake of coffee." as this can cause problems that persist into the child's teenage years and beyond (Streissguth et al.. attention. and learning deficits (streissguth. Drugs should only be taken by pregnant women when prescribed by their physicians. Intake of illicit drugs in the first trimester can cause the most adverse fetal malformations because: • placental barrier is not yet fully developed. Sampson. Prenatal alcohol is the leading cause of mental retardation. wide nasal bridge.a. motor. and cocoa to 300 mg of caffeine per day or no more than 2 to 3 servings per day (US FDA). characterized by: • retardation/delays: cognitive. 4. 1997) mental retardation: associated with microcephaly. and seizure disorders (Littleton & Engebretson. . 2006). Barr. Including the so-called "social drinking. 1977). 1997) • • • • • b. Heavy use of alcohol (2 or more drinks/day) has 10% risk of producing FAS. thin upper lip cardiovascular defects limb defects impaired fine and gross motor function Since modern science has not determined what level of alcohol is safe for pregnancy women. placenta is mature by 10 to 12 weeks of gestation. & Bookstein. surpassing down syndrome (Streissguth et al. The best recommendation: no medication is taken during pregnancy unless absolutely necessary and prescribed. a. craniofacial defects (FAS facies): flat mid face.

1996). • d. or neonatal abstinence syndrome giving rise to a group of signs that include: • • • • Sneezing Irritability vomiting and diarrhea seizures c. a gram of ginger is effective and safe. General rule for natural herbs must be approved and supervised by health care provider. and loss of life or death (mortality). 2006). but 20 times the stomach settling dose can trigger menstruation (Littleton & Engebretson. The most common harmful effect of heroin on the neonates is withdrawal (Richardson et al. Herbs. or disability (morbidity).. damage. being natural. I. b. DEMOGRAPHIC FACTORS . Illegal drugs carry the risk of acquiring HIV and other STDs because women may trade sex for drugs and may provide sexual favors for money needed to acquire drugs (Henderson et a!. injury.• rapid organogenesis takes place during this period and could therefore be altered. HIGH-RISK PREGNANCY A high-risk pregnancy is one in which the mother or fetus has a significant increased chance of harm. RISK FACTORS A. The so-called "hard" drugs may cause growth retardation and drug withdrawal which is associated with increased neonatal mortality. Herbal Supplements. For vomiting or morning sickness. are not always safe because of lack of consistent potency in the active ingredient. 1994)..

5. 9. Weight: Overweight or underweight before pregnancy 2. birth injury on malformation 3. macrosomic (LGA). C. 2.1. 6. Previous uterine or cervical abnormality 7. Overcrowding. Previous hydatidiform mole . or postmature labor prolonged labor Previous high-risk infant: low-birth-weight (LBW). neonatal or perinatal deaths Previous operative OB: cesarean section. with neurologic deficit. Age: Under 16 or over 35 years old. 3. Nutritional deprivation 4. Previous abortion or ectopic pregnancy 4. mid forceps delivery Previous abnormal labor: premature labor. Severe social problems 5. History of infertility or multiple gestation Grandmultiparity Previous loses: feral death. stillbirth. especially among adolescents • At the root of these problems are poverty and low educational status. OBSTETRIC HISTORY 1. poor standards of housing. Unplanned and unprepared pregnancy. Inadequate finances 2. Height: less than 5 feet SOCIOECONOMIC STATUS: There are many interrelated socioeconomic factors that place a fetus at greater risk including: 1. Studies have shown that the optimal age for childbearing is between 20 and 30 years. 8. poor hygiene 3. B.

Malignancy 11.D. Venereal and other infectious diseases 7. MATERNAL MEDICAL HISTORY/STATUS 1. Polyhydramnios 9. Antepartal bleeding: placenta previa and abrutio placenta 5. mental retardation F. Hemoglobinopathies 9. Pregnancy. Maternal anemia 3. bacteriurea 5. Metabolic disease: diabetes. adrenal 4. Seizure disorder 10. HABITS/HABITUATION 1. Drug use/abuse . Chronic renal disease: repeated UTI. PROM Fetus inappropriately large or small. Chronic hypertension 6. Endocrine disorders: pituitary. abnormality in presentation E. induced hypertension 6. Rh sensitization 4. Multiple gestation 7. Cardiac or pulmonary disease 2. Premature or postmarure labor 8. abnormality in tests for fetal well-being. Major emotional disorders. Smoking during pregnancy 2. thyroid disease 3. 10. Regular alcohol intake 3. Late or no prenatal care 2. Major congenital anomalies of the reproductive tract 8. CURRENT OB STATUS 1.

Detects placental location (placenta previa) or placental abnormality (H-mole) An important aid in high-risk procedures like the amniocentesis d. 2. To detect the fetus's: • Viability. Description A non-invasive diagnosis procedure utilizing high-frequency sound waves to detect intrabody structures.II. PREGNANCY-INDUCED HYPERTENSION 1. Purposes a. DIAGNOSTIC TESTS IN HIGH-RISK PREGNANCY/PRENATAL DETERMINATION Of FETAL STATUS A. edema and proteinuria appearing after the 20th . growth • Number (multiple pregnancy) • Position. In early pregnancy: to confirm pregnancy b. Description: a disorder characterized by three symptoms of hypertension. ULTRASONOGRAPHY 1. COMPLICATIONS OF PREGNANCY A. III.5 cm = mature fetus c. presentation • Abnormalities (structural) • Heart tones (FHT) • Age of gestation by determining the biparietal diameter of the fetal head • • Most accurate at 12 to 24 weeks Biparietal diameter of 9.

Incidence: 7% to 10% of all pregnancies. The reduced blood flow to tissues results in tissue ischemia and altered organ functioning affecting mostly the kidneys. fluid shift from intravascular compartment to interstitial spaces causing edema Angiotensin release leads to further vasospasm and hypertension. Assessment Finding Assessment findings result from generalized vasospasm and arteriolar vasoconstriction which cause increased peripheral resistance. Kidneys • Renal vasospasm and decreased perfusion cause glomerular lesions and membrane damage resulting in disturbed functions. chronic hypertension. polyhydramnios. Etiologic Factors a. hypoproteinemia. Real Cause. decreased blood flow to tissues and hypertension. and renal disease b. multiple pregnancy. low calories Coexisting conditions: diabetes mellitus. c. altered a/g ratio. a. brain and uterus. one of the major causes or maternal and fetal/neonatal mortality 3. Brain . • Proteinuria. • b.to 24th week of pregnancy and disappearing 6 weeks after delivery 2. unknown 4. 5. Nulliparity with extremes of age: 17 years old and below or 35 years old and above Severe nutritional deficiency: low protein diet. altered blood osmolarity.

Types: Preeclampsia (mild and severe) and eclampsia Nursing Plan and Implementation a. • • Supplemental iron of 30 to 60 mg per day in the second and third trimester and continued UP to 2 to 3 months postpartum in lactating mothers Increased caloric intake by 10% in pregnancy Sodium restriction in pregnancy is harmful as it can decrease circulating volume and may result in fluid and electrolyte imbalance and elimination of vital nutrients. 7. Prevention: Health Teachings • Well-balanced diet high in protein to increase blood osmolarity and prevent fluid shift to interstitial spaces. • • • • Adequate rest and sleep in left lateral (Sim's) position Regular prenatal care with prompt reporting of danger signals such as: • • visual disturbances severe. Uterus • Decreased placental perfusion causes SGA (small for gestational age babies) Generalized vasoconstriction and arteriospasm precipitates abruption placenta • 6.• Cerebral arteriospasm and edema cause cerebral hypoxia and CNS irritability manifested in: • visual disturbances: double vision. blurring and dimness of vision hyperreflexia/hyperirritability convulsion coma • • • c. persistent headache and dizziness digital and periorbital edema • .

severe facial puffiness. diastolic rise greater than 110 mm Hg or more on two readings taken 6 hours apart after bed rest 3+ to 4+ or 5g/day or more generalized. retain fluid in the intravascular compartment and reduce edema • Frequent monitoring : the room of the mother should be near the nurses' station • maternal and fetal VS Mild Preeclampsia 140/90 or systolic increase of 30 mm Hg or more above the baseline. diastolic rise 15 mm Hg or more Severe Preeclampsia 160/110 or systolic increase at or above the 160 or more than 50 mm Hg over the baseline. no total restriction of sodium • to replace protein losses. confined to face (periorbital) and .• • • irritability epigastric pain Monitoring own blood pressure during the periods between visits. b. severe Signs hypertension Proteinuria Edema 1 + 1 g/day Generalized. Treatments and Nursing Care • Maintain bedrest in left lateral recumbent (LLR): • to promote increase in tissue perfusion and induce diuresis to reduce risk of supine hypotension syndrome (SHS) • • Provide high protein diet with moderate sodium.

Severe headache and epigastric pain may mean oncoming convulsion. output above 500 mL in 24 hours Absent Hypernatremia Eclampsia is associated with convulsions and coma. .fingers Weekly weight gain greater than 1 Ib. The first nursing action if the client complains of severe headache or epigastric is to CHECK BLOOD PRESSURE.due to edema or liver capsule Cerebral disturbances: • Severe frontal headache • Increased irritability • Blurring of vision • Hyperreflexia • Severe dizziness • Halo vision. The first objective sign of a convulsion is ROLLlNG OF THE EYEBALLS. output 400 mL or less in 4 hours Present Hypoproteinemia Hemoconcentration Oliguria IUGD (Intra-uterine growth retardation Others Absent./week or more Epigastric pain . blind sports • Persistent vomiting • Disorientation Present./week swelling of face Excessive weight gain 5 Ib.

MgSO can depress the respiratory enter and smooth muscles for respiration. (it means the first dose (or previous dose) did not depress the CNS to toxic levels.particularly the deep tendon reflex (DTR) as this is the first to get lost with CNS depression secondary to drug magnesium sulfate toxicity. Z-track After: Monitor BP. diuresis is a good sign Daily weight/edema-daily weighing is to evaluate degree and distribution of edema Reflexes . and FHT . RR. give DEEP 1M. 1. signs of abruptio placenta • • • • Administer drugs as ordered. onset or progress of labor. DTR. Check antidote: 10% calcium gluconate. Check knee jerk reflex or the deep tendon reflex (DTR) before giving the second dose of the drug: if it is present or if the result is more than 1+.oliguria is a grave sign. requires doctor's order • • • • During: Divide the dose of the drug into the two buttocks. Check blood pressure. I&O. Magnesium Sulfate prevents convulsion Care before administration • Check RR: 12 to 14 min.• I & O . Procaine Hydrochloride can be mixed with magnesium sulfate to make it less irritating or painful. or more before giving the first dose of the drug.

5. IV fluids. Diazepam (Valium): Monitor BP 4. room should be near the nurses' station as the client needs frequent monitoring Monitor for signs of impending convulsion • • Severe headache – frontal Severe epigastric pain Sharp cry Fixed. Maintain a patent airway (this should be first priority): lateral position. catheterization set. provide oxygen as ordered. unresponsive eyes Facial twitching Hyperreflexia Administer anticonvulsant as ordered: MAGNESIUM SULFATE Have ready emergency items: airway. • • Never leave a convulsing patient alone. • . emergency drugs • • • • • • • • Provide care during convulsions. gentle suctioning. do not apply leather restraints (for this may cause fracture of long bones).2. restrict visitors. now considered inappropriate as it further decreases circulating volume resulting in decreased renal. cerebral and uteri ne perfusion 3. Promote safety/prevent injury (second priority): provide bedrails (right on admission). Blood volume expanders • Prevent convulsion • Reduce environmental stimuli: place the patient in a semi-darkened and quiet room. Hydralazine (Apresoline): Monitor BP Diuretics: Rare.

record. a postpartum cardiac patient) Monitor. cervical closure (McDonald surgery and Shirodkar-Barter surgery) may be employed. report type of convulsion: duration. but if there is no vacant single room available.• Reduce environmental stimuli: keep the patient alone in a quiet and dim room if possible. • • Types of Spontaneous Abortion: Clinical Signs and Symptoms Types Bleeding Abdominal Cramps May or may not Inevitable Complete Moderate Small to negative Incomplete Severe (bleeds Severe the most) be present Moderate Open Moderate Close or partially open Open with tissue in Missed None to severe None No incoaguloparhy FHT with Habitual: 3 or more consecutiv ultrasound May represent signs of any of the above. resultant coma or bowel or bladder evacuation. the patient can be with another patient who also needs quiet and restricted visitors (i. Continue strict monitoring for 48 hours after delivery because convulsions may still occur in the post-partum. cervix None None Complete placenta with fetus Fetal or. incomplete placental tissue None No No No No Cervical Dilation None Tissue Passage None Fever No Threatened Slight . progress.e. usually detected in the threatened phase..

. pads or tissues for correct diagnosis. Institute measures to treat shock as necessary: Replace blood. Prepare for surgery. Provide psychological support  Be non-judgmental  Encourage verbalization of fears.e Septic Mild to severe Severe Close or Possibly. I & O. Yes open with foul or without discharge tissue Nursing Care for Clients with Abortion THREATENED ABORTION • • • • INEVITABLE ABORTION • • • • • Advise on complete bedrest for 24 to 48 hours Teach to save all blood clots passed and perineal pads used Advise prompt reporting to the hospital if bleeding persists or increases Prevention of abortion: Avoid coitus or orgasm especially around normal time of menstrual period. change in status and signs of infection and refer any deviation. blood loss. Save or monitor clots. and concerns. and fluids as ordered. frustrations. Monitor VS. plasma.

calm and non-judgmental reassuring ways. 1.  Coombs' test result is negative (No isoimmunization yet – No antibodies formed yet) • Observe client for 48 to 72 hours: provide psychological and physical supported care. Reduce anxiety. severe anemia Environmental hazards • . B. offer your presence.second leading cause • • • • • c. thyroid dysfunction. reassure crying is healthy. Prevent isoimmunization: administer RhoGAM as ordered if:  Mother is Rh negative: abortus is Rh positive.decreased progesterone production increased temperature as in febrile conditions Systemic diseases in the mother . ABORTION Termination of pregnancy before the age of viability usually before 20 to 24 weeks Causes of Spontaneous Abortion a.DM. Defective ovum/congenital defects – the most common cause Unknown causes . b.most common cause of habitual abortion • • • hormonal . Maternal factors viral infection malnutrition trauma (physical and mental) congenital defects of the reproductive tract incompetent cervix .  Allow the patient to cry.

clotting time. Blood. Surgery: dilatation/suction curettage b. Spontaneous . Uterine/abdominal cramps c. b. • e. cerclage operation/cervical closure for incompetent cervix: • McDonald surgery: temporary closure of the cervix. d. cold clammy skin. Rh factor. Types of Abortion a. and hypotension b. tachypnea. delivery by cesarean section. ECTOPIC PREGNANCY This is a condition where pregnancy develops outside of the uterine cavity. 4. restlessness. air hunger. Shirodkar-Barter surgery: permanent suturing of the cervix. Antibiotics: specially for septic type c. Habitual abortion: determine etiology. Treatment a. platelet C.with medical or mechanical intervention 3. tachycardia. . oliguria. Signs of Abortion a. Blood tests: BT. fluid replacement d. plasma. Vaginal bleeding or spotting. Coombs' test serum fibrinogen.• Rh incompatibility 2. requires stitch removal set at the time of labor. treatment of underlying causes.without medical or mechanical intervention Induced . mild to severe Passage of tissues or products of conception Signs related to blood loss/shock: pallor.

1. Predisposing Factors
a. b.

Fallopian tube narrowing or constriction PID: pelvic inflammatory disease salpingitis, endometriosis

c. Puerperal and postpartal sepsis d. Surgery of the fallopian tubes
e.

Congenital anomalies of the fallopian tubes IUD usage: intrauterine device prevents pregnancy by preventing normal implantation

f. Adhesions, spasm, rumors
g.

2. Types (dependent on the site of implantation)
a.

Tubal: MOST COMMON: TYPE; found in 90 to 95% of cases ~ tubal rupture occurs before 12 weeks

b. Cervical c. Abdominal d. Ovarian 3. Assessment Findings
a.

Amenorrhea or abnormal menstrual period/spotting - most common sign Early signs of pregnancy: tubal rupture signs - sudden, acute low abdominal pain radiating to the shoulder – Kehr’s sign (referred shoulder pain) or neck pain

b.

c. Nausea and vomiting
d.

Bluish navel (Cullen's sign) because of blood in the peritoneal cavity Rectal pressure because of blood in the cul-de-sac Positive pregnancy test in many women (50%) Sign of shock/circulatory collapse

e. f.

g. Sharp localized pain when cervix is touched
h.

4. Laboratory Findings a. Low hemoglobin in and hematocrit
b.

Low HCG (normal value at its peak: 400, 000 I.O./24 hours

c. Elevated WBC 5. Diagnosis
a.

Pelvic ultrasonography - no embryonic sac in the uterine cavity Culdocentesis - aspiration of non-clotting blood from the cul-de-sac of Douglas (positive tubal rupture) Laparoscopy - not common; requires direct visualization Serial testing of HCG beta-subunit – offers 100% accurate result

b.

c. d.

6. Treatment
a. b.

Surgical removal of ruptured tube: SALPINGECTOMY Management of profound shock if ruptured: blood replacement

c. Antibiotics 7. Complications a. Hemorrhage b. Infection
c.

Rh sensitization. RhoGAM prevents isoimmunization: given to Rh negative mother with Rh position ectopic pregnancy with a negative Coombs’ test

8.

Nursing Implimentation a. Carry out an ongoing assessment for shock. b. Implement promptly shock treatment

c. Infuse D5LRS for plasma administration, blood transfusion or drug administration ( use isotonic saline to flush tube first before BT ) as ordered. d. Position on modified Trendelenburg. e. Monitor VS, bleedeing, I & O. f. Provide physical and psychological support – pre-operative and post-operative. Anticipate grief. Anticipate possible guilt responses. Anticipate fear related to potential disturbances in childbearing capacity in the future. HYDATIDIFORM MOLE – This is a benign neoplasm of the chorion. The chorion fails to develop into a full term placenta, and instead degenerates and become fluid-filled vesicles. . 1. Incidence : common in the orient and in people of low socioeconomic 2.Cause : unknown 3. Risk Factor : Increased or decreased maternal age ; Low socioeconomic status ; low protein diet ; History of abortion and clomiphene / Clomid therapy. 4. Assessment Findings a. Brownish or reddish, intermittent or profuse vaginal bleeding by 12 weeks. b. Expulsion, spontaneous, of molar cyst usually occurs between the 16th to 18th weeks of pregnancy. c. Rapid uterine enlargement inconsistent with the age of gestation. d. Symtoms of PIH before 20 weeks. e. Excessive nausea and vomiting because of excessive HCG ( 1 to 2 Million IU/L/24 hrs. ) f. Positive pregnancy test. g. No fetal signs – heart tones, parts, movements.

status.

d.V. : 400. Uterine perforation d. plasma. fluid . c. Infection 9. Abdominal pain. Diagnosis a. blood loss. Triad signs : Big uterus . Maintain fluid and electrolyte balance. 5. Nursing Implementation a. Chest X – ray to detect early lung metastasis. f. Vaginal bleeding : brownish and intermittent. plasma. Complications a. 8. may progress to cancer of the chorion : choriocarcinoma.h. e. Flat plate of the abdomen done after 15 weeks. c.no fetal skeleton. 7. Passage of vesicles – first sign that aids diagnosis b. Monitor VS. Hysterectomy if above 45 yrs old and no future pregnancy is desired or with increased chorionic gonadotropin levels after D & C. Treatment a. “ Serum Beta HCG” . molar tissue passage.000 IU/L/24 hrs. Choriocarcinoma : most dreaded complication. HCG greater than 1 million ( N. . c. 6. because signs of pregnancy can mask early signs of choriocarcinoma. no fetal parts. b. Advise bedrest b. Ultrasound – no fetal sac. b. HCG titer monitoring for one year. d. Medical replacement : blood. Chemotherapy for malignancy : Methotrexate is the drug of choice.I & O. ) c. Hemorrhage . Evacuation by D & C or hysterectomy if no spontaneous evacuation. Prognosis : 80% remission after D & C . most serious during the early treatment phase. and blood volume through replacements as ordered. no pregnancy for one year ( Use contraception ).

Partial – Placenta partly covers the internal os. Complete or Total : Placenta totally covers the internal os 4. Types/ Degree of Placenta Previa I. e. 2. Prepare for discharge : emphasize the need for follow – up HCG determination for one year: Reinforce instructions on NO PREGNANCY FOR ONE YEAR. Intermitent Pain if it happens in labor secondary . does not cover the internal os. c. hysterotomy or hysterectomy as indicated. painless vaginal bleeding ( fresh ) . Disturbances in self – esteem for carrying an abnormal pregnancy. b. in the third trimester/ 7th month. Risk Factors : a. 4. PLACENTA PREVIA – Premature separation of abnormally low implanted placenta.d. b. 3. Decreased vascularityin the upper uterine segment as in scarring and tumors. give instructions relted to contraceptions. Marginal : may be considered a low-lying type – Placenta lies over the margins of internal os. c. Multiple pregnancy. Incidence . Multiparity : the single most important factor. Prepare for D & C. intermittent hardening if in labor. f. 2. 1. Most common cause of bleeding in the third trimester . bright red. Provide psychological support : anticipate – Fear related to potential development of cancer. 3. occurs in 1:150 to 200 pregnancy. Increased age above 35 years d. Uterus soft/flaccid . Low –lying – Placenta at the lower third of the uterus . Assessment Findings a.

d. B leeding may be slight or profuse which may come after an activity. Term gestation 2. only one set-up is to be prepared. OBSTRUCTION OF BIRTH CANAL. in suspected placenta previa in the following conditions. DELIVERY . Vaginal delivery if birth canal is not obstructed. In previa. 7. and not in distress: Bleeding is not severe. prepared for I. 2. Double setup ( one set for vaginal delivery and another for classical CS . And/ or the fetus is distressed. ultrasonography give 95% accurate result .detects site of placenta. Cesarean section if placenta placement prevents vaginal birth. c. Mother and fetus are stable. Future pregnancies will then be terminated by another CS because the presence of a classical scar is contraindication to vaginal delivery . 5. HEMORRHAGE. it is the leading cause of uterine rupture. If conditions for watchful waiting are absent . 1.to uterine contractions d. Complications . Diagnosis . 1. Treatment a.E. conservative if : the mother is not in labor. 8. Watchful waiting : expectant management . 6. an emergency CLASSICAL cesarean section set-up. Mother in labor and progressing well 3. Coitus or internal examination. Fetus is premature. CLASSICAL CS is indicated as the LOWER uterine segment is occupied by the placenta. If the woman is not in labor or in shock. b. stable. PREMATURITY. Nursing Implimentation . Amniotomy : artificial rupture of the bag of water causes the fetal head to descend causing mechanical pressure at placenta site controlling bleeding.

the lower uterine segment. e. onset/progress of labor. VS. Also termed accidental hemorrhage and ablation placenta. Institute shock measures as necessary. DO NOT PERFORM AN I. Sudden uterine decompression as in multiple pregnancy and polyhydramnios. Prepare client for diagnostic ultrasonography. Incidence : second leading cause of bleeding in the third trimester.Advance age d. 2. Initially. renal disease b. occurs in 1:300 pregnancies. b. Careful assessment.Maternal hypertension : PIH. h. d. f. Predisposing factors a.a. g. is not as contractile as the upper fundal portion. Maintain bedrest – left lateral recumbent with a head pillow. the site of placental detachment. ABRUPTIO PLACENTA – A complication of late pregnancy or labor characterized by premature partial or complete separation of a normally implanted placenta.Trauma. 1. Prepare for conservative management. FHT. c..E. . Observe for bleeding after delivery . Provide psychological and physical comfort.Short umbilical cord f. double set-up or a classical cesarean section. c. bleeding. bleeding in previa is rarely life-threatening but may become profuse with internal examination. fibrin defects.Multiparity e. or vaginal examination.

or central type . Assessment Findings a…Painful vaginal bleeding in the third trimester b. Clotting studies – reveal DIC. d. SIGNS OF SHOCK NOT PROPORTIONAL TO THE AMOUNT OF EXTERNAL BLEEDING. External bleeding not evident. Hemorrhagic shock .covert. the classic type – Placenta separate at the center causing blood to accumulate behind the placenta. and painful abdomen c. or external bleeding type – Placenta separates at the margins. small fibrin clots in circulation. Hypofibrinogenemia : decrease normal fibrinogen results in absence of normal blood coagulation. Bleeding is external. Diagnosis a.3. TYPE II – Marginal. overt . 6. 5. clotting defects. Ultrasound – detect the retroplacental bleeding c. If in labor : titanic contractions with the absence of altering contraction and relaxation of the uterus. Maybe complete or incomplete depending on the degree of detachment. Complications a. Rigid. Enlarge uterus due to concealed bleeding. Signs of shock not proportional to the degree of external bleeding ( Classic type ). usually proportional to the amount of internal bleeding. The thromboplastin from retroplacental clot enters maternal circulation and consumes maternal free fibrinogen resulting in : DIC ( dessiminated intravascular coagulation ). Clinical diagnosis –signs and symptoms b. boardlike. 4. Types of Abruptio Placenta TYPE I – Concealed.

plasma. Prepare for emergency birth either per vagina or CS g. Uterine pain. e. Administer intravenous fluid. Prematurity. oliguria/anuria. Careful monitoring : Maternal VS. Nursing Implementation a. Bleeding ( not proportional to degree of shock ) c. d. or blood as ordered. Hypofibrinogenemia causing postpartal hemorrhage. Prematurity. c. f. neonatal distress causing neonatal morbidity and mortality. hypertension c. fetal distress/demise (IUFD ) 7. Infection h. Renal failure e. Prepare for diagnostic examinations –explain results. I & O measurements.b. Left lateral recumbent ( LLR) b. Couvelaire uterus : Bleeding behind the placenta may cause some of the blood to enter the uterine musculature causing the uterine muscles not to contract well once the placent is delivered. Disseminated intravascular coagulation ( DIC ) d. FHT. and inform/explain results. – Poorly contracting uterus ( Couvelaire Uterus ) causing post partum hemorrhage. Observe for ASSOCIATED PROBLEMS AFTER DELIVERY. Maintain bedrest . Provide psychological support – prepare for all examinations. Labor onset/progress. . Hypofibrinogenemia d. Disseminated intravascular coagulation ( DIC ) resulting in hemorrhage and possibly CVA. explain what is happening. CVA –cerebrovascular accident from : DIC .