NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

Signs of Pregnancy
1. Presumptive
Largely subjective in nature that suggest but
do not confirm a pregnancy is present.
2. Probable
Largely objective in nature that suggest but do
not confirm a pregnancy is present.
3. Positive
Positive Signs
Findings that definitely indicate a pregnancy is
present. Fetal outline on Audible Fetal Fetal movement
ultrasound Heart Sound felt by examiner
Presumptive Signs
Amenorrhea Frequent Melasma
urination
Breast Fatigue Striae
Changes gravidarum
Common Discomforts in Pregnancy
Nausea, Linea nigra Quickening
vomiting Discomforts Usual Causes Nursing
Intervention
Breast Tenderness Increased Encourage to wear
stimulation of a bra with a wide
breast tissue shoulder strap for
brought about by support and to
high estrogen level dress warmly to
avoid cold drafts.
Constipation Slower peristalsis; Increase the
weight of a growing amount of fiber in
uterus presses diet.
against the bowel Drink at least 8
glasses of water
per day.
Evacuate bowels
regularly.
Nausea and Sensitivity to high Eat a few dry
Probable Signs Vomiting level of HCG; crackers, toast, or a
Lowered maternal sourball before
Laboratory Ballottement Evidence of blood sugar caused getting out of bed
Tests: When lower uterine gestational by the needs of the Small frequent
Serum segment is tapped on a sac on developing embryo meals
; Lack of pyridoxine Avoid greasy &
Urine bimanual examination, ultrasound (vitamin B6 highly seasoned
the fetus can be felt to foods
rise against abdominal Delay meal until
wall. nausea passes &
make up missed
meals at other time
Chadwick’s Hegar’s sign Palpation of of the day
Sign Softening of the lower Fetal Try sipping a
Color uterine segment Outline carbonated
beverage, water, or
change of an herbal
the vagina noncaffeinated or
from pink to ginger tea.
violet Fatigue Increased Advise to increase
metabolic the amount of rest
Goodell’s Braxton Hicks requirements and sleep
Sign Contractions Muscle Cramps Decreased serum Advise to lie on
Softening of Periodic uterine calcium levels, back momentarily
the cervix tightening occurs increased serum and extend
phosphorus levels, involved leg,
and possible keeping the knee
interference with straight and
circulation dorsiflexing the foot
until the pain
disappears

SALVACION 1
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

Varicosities Weight of the Encourage to lie Braxton Hicks Uterus periodically Advise to change
distended uterus on the back with Contractions contracts and then position.
puts pressure on the legs raised relaxes again as Encourage to drink
the veins returning against the wall or early as the 8th to more water.
blood from the elevated on a 12th week of Encourage warm
lower extremities. footstool for 15 to pregnancy baths.
This causes 20 minutes twice a
pooling of blood day.
and distention of Encourage the
the vessels. use of elastic
support stockings.
Encourage
exercise
Hemorrhoids Pressure on the Encourage to
rectal veins from assume a knee-
the growing uterus chest position for
10-15mins daily.
Apply cold Terms Related To Pregnancy Status
compress to
external
GRAVIDA/GRA PARA/PA PRIMIGRA MULTIGRA
hemorrhoids.
Frequent urination Due to the pressure Advise NOT to
VIDITY RITY VIDA VIDA
of the growing restrict fluid intake.
uterus on the Educate that it is Number of Number Woman Woman
anterior bladder. normal during times a woman of births who is who has
pregnancy, is or has been where
provided there are pregnant been
pregnant pregnanci for the pregnant
no other
es have
signs/symptoms
reached
first time more than
indicative of UTI. once
Dyspnea Lung compression Advise to sleep age of
and shortness of with head and viability
breath result as the chest elevated (to (including
expanding uterus relieve nighttime live births
places pressure on dyspnea) & still
the diaphragm Caution to limit births)
activities during the
day (to prevent
exertional dyspnea)
Backache As pregnancy Advise to squat Nulligravida Primipara Multipara
advances, a lumbar rather than bend Woman who has Woman who has Woman who has
lordosis develops over to pick up never been and given birth to one given birth to
and postural objects. is not currently child past age of more than one
changes necessary Encourage to wear pregnant viability child past the
to maintain balance shoes with low to
age of viability
lead to backache moderate heels to
reduce the amount
of spinal curvature
necessary to Obstetric Scoring: GTPAL
maintain an upright
posture.
Encourage pelvic
Gravida – Present Pregnancy
rocking or tilting
exercises. Term - Number of full-term infants born (infants born at
Ankle Edema Caused by general Advise to rest in a 37 weeks or after)
fluid retention and left side-lying
reduced blood position. Preterm - Number of preterm infants born (infants
circulation in the Elevate legs at
lower extremities least 30mins twice born before 37 weeks)
because of uterine a day.
pressure. Avoid constrictive Abortion - Number of spontaneous miscarriages or
clothing that can therapeutic abortions
impede lower
extremity Living - Number of living children
circulation
Headache Pressure on Encourage to
cerebral arteries reduce any
Michaela / 27/ F
due to the possible causative
expanding blood situations, such as Michaela is currently pregnant with twins at 34 weeks
volume eye strain or of gestation. At home, she has 2 kids. 1 was delivered
tension.
at 38 weeks AOG, 1 was delivered at 36 weeks AOG.
Application of cold
towels on forehead. Michaela also mentioned she delivered a dead baby at
Prescribed 23 weeks AOG.
analgesics.

SALVACION 2
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

SCORING: Current Date: Oct. 6, 2022

G 4 P 2 ( TPAL) Take the remaining days of May 31 days – 25 = 6

G4P2T1P1A1L2 June 30 days

MICHAELA / 27 / F July 31 days

Michaela delivered twins at 34 weeks of gestation. At Aug 31 days

home she has 2 kids. 1 was delivered at 38 weeks
AOG, 1 was delivered at 36 weeks AOG. Michaela
also mentioned she delivered a dead baby at 23
weeks AOG.
G4 P3 T 1 P 3 A 1 L 4
FORMULA FOR ESTIMATED DATE OF DELIVERY
(EDD)
Naegele’s Rule
If the LMP falls between JAN-MARCH
+ 9 months + 7 days
If the LMP falls between April – Dec
-3mos + 7days + 1 year
Sept 30 days
Oct 6 ( current date)_____________________
134/7(constant) = 19 weeks, 1 day/7
Quality Antenatal care will
• Encourage women to seek skilled care at child
birth.
• Reduce stillbirths, childbirth complications and
newborn deaths
• Help women get care and counselling for HIV,
Malaria, TB and other conditions
Quality antenatal care should be available for all
women to ensure a positive pregnancy experience.

Examples:

LMP: 09/ 25 /2022

-3 + 7 +1

6 / 32 / 2023

+1 -30______

7 / 2 / 2023

LMP: 09 /01 / 2022

-3 +7 +1

6 / 8 / 2023
Health Assessment During Prenatal Visit
LMP: 01/ 28 / 2022
Health History Review of Laboratory and
+9 +7_______ -Demographic Systems Diagnostic test
Data -CBC
10 / 35 / 2022 -Blood Type &
-Chief Concern
RH
+1 -31_______ -Family Profile -Maternal Alpha-
-History of Past -Feto Protein
11 / 4 / 2022 Illnesses -Screening test
-History of for Syphilis
LMP 03 / 18 / 2022 Family Illnesses -HBsAg &
-Day History / Rubella Titer
+9 +7 ______ -HIV Screening
Social Profile
Obstetric & -Urinalysis
12 / 25 / 2022 -OGTT
Gynecologic
-TB Screening
Calculating Age Of Gestation Using LMP History -Indirect
Coomb’s Test
LMP: May 25, 2022 Ultrasonography

SALVACION 3
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS
Health History
Demographic Data
Chief Concern
Family Profile
History of Past Illnesses
History of Family Illnesses
Day History/Social Profile
Obstetric & Gynecologic
History
Review of Systems
Head
Eyes
Ears
Nose
Mouth and pharynx
Neck
Breasts
Respiratory system
Cardiovascular system
Gastrointestinal system
Name, age, address,
telephone number, e-
mail address, religion,
and health insurance
Ask about: LMP, type of
pregnancy test used
(urine/serum), signs &
symptoms,
planned/unplanned
Ask about: support
system, living conditions
Past medical history
(hypertension, diabetes,
UTI, STD, etc.)
Illnesses that occur
frequently in the family
Information about a
woman’s current nutrition,
elimination, sleep,
recreation, and
interpersonal interactions
can be elicited best by
asking a woman to
describe a typical day of
her life
Menarche, menstrual
pattern, previous
pregnancies, operations,
birth experience (for
multigravida)
Headache? Head injury? Seizures?
Dizziness? Fainting?
Vision? Glasses needed? Diplopia
or double vision?
Infection? Discharge? Earache?
Hearing loss? Tinnitus? Vertigo?
Epistaxis (nose bleeds)?
Discharge? How many colds a
year? Allergies? Postnasal
drainage? Sinus pain?
Dentures? Condition of teeth?
Toothaches? Any bleeding of
gums? Hoarseness? Difficulty in
swallowing? Tonsillectomy? Last
dental exam?
Stiffness? Masses?
Lumps? Secretion? Pain?
Tenderness?
Cough? Wheezing? Asthma?
Shortness of breath? Pain?
Tuberculosis? Pneumonia? COVID-
19?
History of heart murmur? History of
heart disease? Hypertension? Any
pain? Palpitations? Anemia? History
of blood transfusion?
What was her prepregnancy
weight? Vomiting? Diarrhea?
Constipation? Change in bowel
habits? Rectal pruritus?
Hemorrhoids? Pain? Ulcer?
Genitourinary system
Extremities
Skin
Laboratory and Diagnostic Test
Complete Blood Count
(CBC)
Blood typing and Rh
factor
Maternal alpha-
fetoprotein (AFP)
Serologic test for syphilis
(VDRL or rapid plasma
reagin test)
HBsAg & Rubella Titer
HIV Screening
Gallbladder disease? Hepatitis?
Appendicitis?
Urinary tract infection? Hematuria?
Frequent urination? Sexually
transmitted infection? Pelvic
inflammatory disease? Hepatitis B?
HIV?
Varicose veins? Pain or stiffness of
joints? Any fractures or
dislocations?
Any rashes? Acne? Psoriasis?
Anemia, infection,
estimate clotting ability
Possibility of Rh
isoimmunization,
availability of blood
during labor and delivery
Elevated: neural tube or
abdominal defect;
Decreased:
chromosomal anomaly
If present, must be
treated early in
pregnancy before fetal
damage occurs
Determine whether a
woman is protected
against rubella; whether
newborn will have a
chance of developing
hepatitis B
Testing early in
pregnancy allows a
woman who is found to
be HIV antibody positive
the opportunity to begin
therapy with zidovudine
(AZT), which can
decrease the risk of her
infant acquiring the virus
SALVACION 4
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

Urinalysis Proteinuria, glycosuria,
pyuria
Oral Glucose Tolerance Rule out gestational
Test (OGTT) diabetes
Tuberculosis (TB) Screening early in
Screening pregnancy is important
because it increases the
risk of miscarriage;
change in the shape of
the lung tissue as the
growing uterus presses
on the lung may
reactivate old lesions
Indirect Coomb’s Test Determine if Rh
antibodies are present in
an Rh-negative woman
Ultrasonography Transvaginal /
Transabdominal
lies directly under the embryo (or the portion where the
trophoblast cells establish communication with
maternal blood vessels).
Decidua capsularis - portion of the endometrium that
stretches or encapsulates the surface of the
trophoblast.
Decidua vera - remaining portion of the uterine lining
Functions of the Placenta
-Provides oxygen, glucose and nutrients to the growing
fetus.
-Removes waste products and carbon dioxide from the
baby's blood.
-Enables the exchange of oxygen and nutrients
between the bloodstreams of the mother and the baby
without ever mixing them.

-Serves as the fetal lungs, kidneys, and digestive tract

in utero.

Fetal membranes
Chorionic membrane Amniotic membrane
- Outermost fetal membrane - Lines the chorionic
- Its purpose is to form the membrane and forms
sac that contains the beneath the chorion
amniotic fluid - Not only offers support to
amniotic fluid but also
actually produces the fluid
-Produces a phospholipid
Accessory Structures Needed for Support During
that initiates the formation of
Intrauterine Life prostaglandins, which can
cause uterine contractions
• Placenta - There is no nerve supply,
• Fetal membranes so when they spontaneously
• Amniotic Fluid rupture at term or are
artificially ruptured, neither
• Umbilical Cord
woman nor child
experiences any pain.
Placenta
-At birth, it can seen
Begins growth in early pregnancy in coordination with covering the fetal surface of
the placenta, giving that
embryo growth. surface its typically shiny
appearance
DECIDUA

Modified mucosal lining of the uterus (endometrium) Amniotic Fluid

that forms in preparation for pregnancy
Forms the maternal part of the placenta, remains for
the duration of the pregnancy, shed off during
childbirth
Participates in the exchanges of nutrition, gas, and
waste with the gestation. It also protects the pregnancy
from the maternal immune system.
Structures
Decidua basalis – part of the endometrium that
Importance:
Shields the fetus against pressure or a blow to the
mother’s abdomen
Protects the fetus from changes in temperature
Aids in muscular development
Protects the umbilical cord from pressure.
Oligohydramnios - reduction in the amount of
amniotic fluid (less than 300 mL in total,

SALVACION 5
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

or no pocket on ultrasound larger than 1 cm. End of 12 weeks

-Usually caused by a disturbance of the fetus’ kidney Length = 7-8cm Weight =45g
function
Nail beds forming
Polyhydramnios / Hydramnios
Some reflexes present (Babinski Reflex)
-excessive amniotic fluid (more than 2000 mL in total,
or pockets of fluid larger than 8 cm on ultrasound) Bone ossification centers begin to form

-usually caused by fetus’ inability to swallow Tooth buds present

(esophageal atresia or Sex distinguishable by outside appearance
anencephaly are the two most common reasons)
Urine secretion starts
Umbilical Cord
FHB audible by Doppler
Formed from the fetal membranes (amnion and
chorion)
End of 16 weeks
Provides a circulatory pathway that connects the
embryo to the chorionic villi of the placenta. Length = 10-17 cm Weight =55-120g

Its function is to transport oxygen and nutrients to the FHB audible by stethoscope
fetus from the placenta and to return waste products
Lanugo well formed
from the fetus to the placenta.
Liver and pancreas are functioning
Contains only one vein (carrying blood from the
placental villi to the fetus) but two arteries (carrying Demonstrates intact but uncoordinated swallowing
blood from the fetus back to the placental villi)
Urine present in amniotic fluid
Milestones of Fetal Growth and Development
Sex can be determined by UTZ
FIRST TRIMESTER – ORGANOGENESIS (4-12
WEEKS)) SECOND TRIMESTER

End of 4th week End of 20th gestational week

Length = .75 – 1 cm Weight =400mg
Spinal cord formed
Head folds forward and becomes
prominent
Back is bent; head almost touches tip of the tail
Rudimentary heart appears as bulge on anterior
surface
Length = 25 cm Weight = 223g
Spontaneous fetal movement can be felt
by the mother
Hair forms and even eyebrows
Meconium is present in upper intestine
Brown fat begins t form behind the kidneys, sternum
and posterior neck
Vernix caseosa begins to form and cover the skin

End of 8th week Passive antibody from mother to fetus occur

Length = 2.5 cm (1inch) Weight =20g Sleep and activity patterns are distinguishable

Organogenesis is complete
End of 24th week – AGE OF VIABILITY
Heart with septum and valve is beating
Length = 28- 36 cm Weight =550g
Developed arms and legs
Meconium is present as far as the rectum
Facial features discernible
Lung surfactants are actively produced
Fetal intestine is growing, abdomen bulges

UTZ shows gestational sac

SALVACION 6
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS
Hearing can be demonstrated by response to sudden
sound.
THIRD TRIMESTER
End of the 28th week
Length = 35-38cm Weight =1200g
Lung alveoli begins to mature
Testes in males begin to descend to scrotum
Blood vessels of retina are formed but susceptible to
damage from exposure to high oxygen concentration
End of the 32nd week
Length = 38-43cm Weight =1600g
Subcutaneous fat begins to deposit
Fetus responds by movement to sound outside
mother’s body
Active Moro reflex
Iron stores
Fingernails grow to the tip of fingers
End of 36th week
Length = 42-48cm Weight =1800-2700g
Stores glycogen, iron, carbohydrates, and calcium
Additional subcutaneous fats deposit
Sole of foot has 1 crisscross crease
Amount of lanugo diminishes
Rotates to vertex presentation
End of 40th week
Length = 48-52cm Weight =3000g
Fetus kicks actively
Fetal hemoglobin starts to convert to adult
hemoglobin
Vernix caseosa fully formed
Creases on the sole of foot covers at least 2/3 of the
surface
SGA- Small for gestational age – below 2500g
LGA – Large for gestational age – above 4000g
Assessing Fetal Well – Being
Fetal Movement
Quickening - Fetal movement that can be felt by the
mother at approximately 18 to 20 weeks of pregnancy.
Peaks in intensity at 28 to 38 weeks.
- A healthy fetus moves at least 10x every hour
-A fetus not receiving enough nutrients because of
placental insufficiency has greatly decreased
movements
Sandovsky method - lie in a left recumbent position
after a meal and record how many fetal movements
she feels over the next hour.
a fetus normally moves a minimum of twice every 10
minutes or an average of 10–12 times an hour. If less
than 10 movements occur within an hour, the woman
repeats the test for the next hour. She should call her
health care provider if she feels fewer than 10
movements (half the normal number) during the chosen
2 hours.
Fetal Heart Rate
Normal FHB: 120 to 160 beats per minute throughout
pregnancy
Can be heard and counted as early as the 10th to 12th
week of pregnancy by the use of a Doppler.
Nonstress Testing - measures the response of the
fetal heart rate to fetal movement
How to do the test:
Attach mother to a fetal monitor (CTG machine)
Instruct to push a button attached to the whenever she
feels the fetus move (This will create a dark mark on the
paper tracing )
When the fetus moves, the fetal heart rate should
increase about 15 beats per minute and remain
elevated for 15 seconds. It should decrease to its
average rate again as the fetus quiets
How to interpret the result:
Reactive - two accelerations of fetal heart rate (by 15
beats or more) lasting for 15 seconds occur
Nonreactive - no accelerations occur with the fetal
movements.
Contraction Stress Testing - fetal heart rate is
analyzed in conjunction with contractions.
How to do the test:
SALVACION 7
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

1. Attach mother to a fetal monitor (CTG machine) INTERPRETATION OF SCORE:

2. Instruct mother to roll a nipple between her finger
and thumb until uterine contractions begin.
3. Three contractions with a duration of 40 seconds or
longer must be present in a 10-minute window before
the test can be interpreted.
How to interpret the result:
Negative - no fetal heart rate decelerations are present
with contractions
Positive (abnormal) - 50% or more of contractions
cause a late deceleration (a dip in fetal heart rate that
occurs toward the end of a contraction and continues
after the contraction)
8–10 - fetus is considered to be doing well
6 - Considered suspicious
4 – fetus is probably in jeopardy
Chorionic Villi Sampling
involves taking a sample of tissue
from the placenta to test for
chromosomal abnormalities and
certain other genetic problems.
typically scheduled 10–12 weeks of pregnancy
Amniocentesis
aspiration of amniotic fluid from the
pregnant uterus for examination to check
for genetic or chromosomal conditions.

typically scheduled between the 14th and 16th weeks

of pregnancy.

Percutaneous Umbilical Blood Sampling /

Cordocentesis

Ultrasonography

Used to:

Diagnose pregnancy as early as 6 weeks’ gestation

Confirm the presence, size, and location of the

placenta and amniotic fluid

Establish that a fetus is growing and has no gross

anomalies, such as hydrocephalus, anencephaly, or aspiration of blood from the umbilical vein for analysis
spinal cord, heart, kidney, and bladder defects and to detect certain genetic disorders, blood
conditions and infections.
Establish sex of the fetus
usually done after week 18 of pregnancy
Establish the presentation and position of the fetus
Examples of genetic disorders that can be diagnosed
Predict maturity by measurement of the biparietal before birth include:
diameter of the head
Cystic fibrosis
Placental grading Duchenne muscular dystrophy
Hemophilia A
Amniotic Fluid Volume Assessment
Polycystic kidney disease
Biophysical Profile Scoring Sickle cell disease
Tay-Sachs disease
Thalassemia

Danger Signs of Pregnancy

Vaginal Bleeding

A woman should report vaginal bleeding, no matter

how slight, because some of the serious bleeding

SALVACION 8
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

complications of pregnancy begin with only slight Chorioamnionitis (bag of water is broken for a long
spotting. time before birth)

May indicate: COVID-19

Ectopic pregnancy Sudden Escape of Clear Fluid From the Vagina

Miscarriage When a gush of clear fluid is discharged suddenly from

the vagina, it means the membranes have ruptured
Placenta Previa and the uterine cavity is no longer sealed against
Abruptio Placenta infection.

Possible Cause Definition Signs/Symptoms Might lead to Cord Prolapse

of Bleeding Abdominal or Chest Pain
Ectopic Occurs when a Severe abdominal
Pregnancy fertilized egg or pelvic pain When to seek help:
implants and accompanied by
grows outside vaginal bleeding -pain, pressure, or a squeezing sensation in the center
the main cavity Extreme of the chest that lasts for more than a few minutes or
of the uterus lightheadedness or goes away and comes back
fainting
Shoulder pain -shortness of breath, which may be accompanied by
Miscarriage Spontaneous Vaginal spotting or chest discomfort
loss of a bleeding
pregnancy Pain or cramping -cold sweats
before the 24th in your abdomen or
-lightheadedness
week. lower back
Fluid or tissue -nausea
passing from vagina
Placenta The placenta Painless, bright red -discomfort or pain in the jaw, neck, stomach, back, or
Previa completely or vaginal bleeding in one or both arms
partially covers
the opening of -Abdominal pain that is localized, abrupt, constant, or
the uterus. severe, or pain that is associated with nausea and
Abruptio The placenta Vaginal vomiting, vaginal bleeding, or fever.
Placenta partly or bleeding(may or
completely may not be present) Severe headaches, blurred vision/visual
separates from Abdominal pain disturbances, severe belly pain, severe shortness
the inner wall of Back pain of breath
the uterus Uterine tenderness
before delivery. or rigidity Pregnancy-induced hypertension (PIH) refers to a
Uterine potentially severe and even fatal elevation of blood
contractions, often pressure that occurs during pregnancy.
coming one right
Increase or Decrease in Fetal Movement
after another
Because a fetus normally moves more or less the
Persistent Nausea and Vomiting same amount every day, an unusual increase or
decrease in movement suggests that a fetus is
Hyperemesis Gravidarum - severe responding to a need for oxygen

Persistent, frequent vomiting that continues past the Lecturer: Ms. Leanne Bonifacio
12th week of pregnancy

Can lead to dehydration, weight loss, and electrolyte

imbalances

Chills and Fever

May indicate an intrauterine infection that can cause

premature labor with and without intact membranes.

SALVACION 9
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

Health Education ❖ Clothing

❖ Self-care needs Recommend lightweight, nonconstrictive, adjustable,

Daily tub baths or showers are now recommended
(unless membranes rupture or vaginal bleeding is
present)
Should not soak for long periods in extremely hot water
or hot tubs as heat exposure for a lengthy time could
lead to hyperthermia in the fetus.
If there is difficulty in getting in and out of the bathroom,
sponge bathing may be done instead.
❖ Breast Care
Wear a firm, supportive bra with wide straps to spread
breast weight across the shoulders.
comfortable, and enhances the sense of well-being of
the patient.
Caution women to avoid tight-fitting items such as
garters, girdles with panty legs, and knee-high stockings
during pregnancy.
Suggest wearing shoes with a moderate to low heel to
minimize pelvic tilt and possible backache.
The shoes should be comfortable and well-fitting, easy
to apply, especially in the last trimester when it is difficult
to bend over to tie or buckle.
❖ NUTRITION

Use a larger bra halfway through pregnancy to

accommodate increasing breast size

Nursing bras are advisable since it can still be used

even after delivery.

When colostrum emerges from the breast (at about 16th

week of pregnancy), wash breasts daily with clear tap
water to remove the colostrum and reduce the risk of
infection.

Dry nipples well by patting them with a soft towel.

If colostrum secretion is profuse, gauze squares or

breast pads inside the bra may be applied (should be Avoid/Limit Allowed/Recommended
changed frequently to maintain dryness).
Foods or drinks w/ caffeine Vegetables: carrots, sweet
❖ Dental Care potatoes, pumpkin, spinach,
cooked greens, tomatoes and
red sweet peppers (for vitamin A
Stress the importance of brushing since gingival tissue and potassium)
tends to hypertrophy during pregnancy. Excess seafood Fruits: cantaloupe, honeydew,
mangoes, prunes, bananas,
Encourage to see their dentists regularly for routine apricots, oranges, and red or
examination and cleaning. pink grapefruit (for potassium)
Artificial sweeteners Proteins: beans and peas; nuts
and seeds; lean beef, lamb and
Encourage to snack on nutritious foods, such as fresh pork; salmon, trout, herring,
fruits and vegetables, to avoid sugar coming in contact sardines and pollock
with their teeth Weight Loss Diet Grains: ready-to-eat
cereals/cooked cereals (for iron
and folic acid)
If a woman has trouble avoiding sweet snacks such as
candy, suggest to eat those that dissolve easily rather Unpasteurized milk and foods Dairy: fat-free or low-fat yogurt,
than one that remains in the mouth for a long time. made with unpasteurized milk skim or 1% milk, soymilk (for
calcium, potassium, vitamins A
and D)
❖ Perineal Hygiene
❖ Weight gain during pregnancy
Douching is contraindicated during pregnancy.
A weight gain of 11.2 to 15.9 kg (25 to 35 lb) is
Feminine hygiene deodorant sprays should not be used recommended as an average weight gain in pregnancy.
due to increased chance of perineal irritation, cystitis,
Approximately 0.4 kg (1 lb) per month during the first
and urethritis.
trimester, 0.4 kg (1 lb) per week during the last two
Undesirable odors can be controlled with daily use of trimesters (a trimester pattern of 3-12-12)
soap and water.

SALVACION 10
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

Weight gain is Women whose membranes have ruptured or who have

considered excessive: vaginal spotting should be advised against coitus until
more than 3 kg (6.6 lb) a examined.
month during the
second and third Advise caution about male oral–female genital contact
trimesters; (accidental air embolism has been reported from this act
during pregnancy).
Weight gain is
considered less than Early in pregnancy, a woman may experience a
usual: less than 1 kg decreased desire for coitus resulting from the increased
(2.2 lb) per month estrogen level in her body.
during the second and As pelvic congestion increases from the additional
third trimesters. uterine blood supply, most women notice increased
clitoral sensation thus, orgasm for the first time during
pregnancy may occur.

Educate the need to use new positions for intercourse:

❖ Exercise
Moderate exercise is healthy during pregnancy (brisk
walking, general gardening)
Extreme exercise has been associated with lower birth
weight
The average, well-nourished women should exercise
during pregnancy a minimum of 3 times weekly for 30
consecutive minutes (Rojas, Wood, & Blakemore, 2007)
5 minutes of warm-up exercises, an active “stimulus”
phase of 20 minutes, and then 5 minutes of cool-down
exercises
Walking is the best exercise during pregnancy
Sports: A woman can continue any sport she
participated in before pregnancy unless it was one that
involved body contact.
❖ Sexual Activity
Most common myths:
Coitus on the expected date of her period will initiate
labor.
side-by-side position or a woman in a superior position
may be more comfortable.
Caution women with a non-monogamous sexual partner
that the partner needs to use a condom to prevent
transmission of a sexually transmitted infection during
pregnancy.
❖ Sleep
Pregnant women need an increased amount of sleep or
at least need rest to build new body cells during
pregnancy.
If a woman has trouble falling asleep, drinking a glass
of warm milk may help. Relaxation exercises also may
be effective.
Sleeping with two pillows or on a couch with an armrest
may be helpful (when pyrosis or dyspnea is present)
Encourage to avoid resting on her back, as supine
hypotension syndrome (faintness, diaphoresis, and
hypotension from the pressure of the expanding uterus
on the inferior vena cava) can develop in this position.
❖ Travel

Orgasm will initiate preterm labor, but participating in Early in a normal pregnancy, there are no restrictions.
sexual relations without orgasm will not. If susceptible to motion sickness, advise not to take any
Coitus during the fertile days of a cycle will cause a medication for this unless it is specifically prescribed or
second pregnancy or twins. approved by her physician.

Coitus might cause rupture of the membranes.
❖ Situations when sexual relations during a
pregnancy are contraindicated:
Women with a history of spontaneous miscarriage may
be advised to avoid coitus during the time of the
pregnancy when a previous miscarriage occurred.
Late in pregnancy, travel plans should take into
consideration the possibility of early labor.
Regardless of the month of pregnancy, be certain she
knows the location of a nearby health care facility should
an unexpected complication occur while she is
travelling.

SALVACION 11
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

Preferably every hour, but at least every 2 hours, the months of life to achieve optimum growth and
pregnant woman should get out of the car and walk a development.
short distance.
Extended breastfeeding up to two years and beyond.
May drive automobiles as long as they fit comfortably
behind the steering wheel; seat belt should be worn. -Breastfeeding shall be continued as frequent and on
demand for up to two years of age and beyond.
Traveling by plane: not contraindicated during
pregnancy as long as the plane has a well-pressurized
cabin.

Some airlines do not permit women who are more than

7 months pregnant to board; others require written
permission from a woman’s primary care provider.
Advise to investigate these restrictions by calling the
airline or a travel agency before making such travel
plans.

❖ Immunization

Maternal and Neonatal Tetanus (MNT) has been among

the most common life threatening consequences of
unclean deliveries and umbilical cord care practices,
and are indicators of inequity in access to immunization
and other maternal, newborn, and child health services.
Neonatal tetanus is a painful disease that killed 34,000
newborns in 2015 worldwide. However, while the
neonatal mortality is still high, MNT deaths can be
prevented through hygienic practices in delivery and
cord care, and by immunizing women and children with
tetanus vaccine.

❖ Common questions re: breastfeeding

Can HIV be transmitted through breast milk?

Yes. Breastfeeding contributes to the risk of perinatal

HIV infection. (CDC)

Is it safe for a mother infected with hepatitis B virus (HBV) to

❖ Breastfeeding
breastfeed her infant?
Antenatal breastfeeding education equips the mother-
Yes. The risk of HBV mother-to-child transmission
to-be with information and skills necessary for
through breastfeeding is negligible if infants born to
breastfeeding and promotes their confidence level,
HBV-positive mothers receive the HBIG/HBV vaccine at
knowledge, and skills.
birth.
Early Initiation of Breastfeeding
Can you breastfeed if you have Cancer?
- Infants shall be initiated to breastfeed within one
Cancer is not a contraindication for breastfeeding but
hour after birth.
mothers with cancer who are taking cancer
Exclusive Breastfeeding for the first six months chemotherapy medications cannot breastfeed their
babies.
-Infants shall be exclusively breastfeed for the first six

SALVACION 12
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS
Can you breastfeed if you have untreated and active
tuberculosis infections?
No. They may breastfeed after their infection is cured or
brought under control so that it does not spread to the
infant.
Can you breastfeed if your infant is diagnosed with
Galactosemia?
No. Galactosemia is clearly an absolute
contraindication to breast-feeding. Breast milk is a rich
source of lactose, and the very survival of infants with
galactosemia is dependent on their receiving a non-
lactose-containing formula.
The Psychological tasks of pregnancy
First Trimester: Accepting the Pregnancy
Woman and partner both spend time recovering from shock
of learning they are pregnant and concentrate on what it feels
like to be pregnant. A common reaction is ambivalence, or
feeling both pleased and not pleased about the pregnancy.
Second Trimester: Accepting the Baby
Woman and partner move through emotions. Role playing
and increased dreaming are common.
Third Trimester Task: Preparing for the baby and end of
pregnancy
Woman and partner prepare clothing and sleeping
arrangements for the baby. They might also grow impatient
with pregnancy as they ready themselves for birth.
NCM 107: Components of Labor
LECTURER: MS. ARGIE J. CAJIPO, RN, MAN
Labor
is the series of events by which uterine contractions and
abdominal pressure expel a fetus and placenta from a
woman’s body.
Regular contractions cause progressive dilatation
(enlargement or widening of the cervical canal) and
create sufficient muscular force to allow a baby to be
pushed from the birth canal (or vagina). It is a time of
change, both an ending and a beginning, for a woman,
a fetus, and her family.
Theories why Labor Begin
Labor normally begins between 37 and 42 weeks of
pregnancy, when a fetus is sufficiently mature to adapt
to extrauterine life, yet not too large to cause
mechanical difficulty with birth.
PRETERM BIRTH - labor begins before a fetus is
mature
POST TERM BIRTH - labor is delayed until the fetus
and the placenta have both passed beyond the optimal
point for birth.
Although in animals it has been shown that
progesterone withdrawal is the trigger that stimulates
labor, the association that converts the random,
painless Braxton Hicks contractions of pregnancy into
strong, coordinated, productive labor contractions in
women is still largely undocumented (Bernal & Norwitz,
2012).
DIFFERENT THEORIES
(Uterine Stretch Theory) Uterine muscle stretching,
which results in release of prostaglandins
(Oxytocin Theory)
Pressure on the cervix, which stimulates the release
of oxytocin from the posterior pituitary
Oxytocin stimulation, which works together with
prostaglandins to initiate contractions
(Progesterone withdrawal theory) Change in the ratio of
estrogen to progesterone (increasing estrogen in
relation to progesterone, which is interpreted as
progesterone withdrawal)
(Aging Placenta Theory) Placental age, which triggers
contractions at a set point
(Fetal Cortisol Theory) Rising fetal cortisol levels,
which reduces progesterone formation and increases
prostaglandin formation
(Prostaglandin Initiation Theory) Fetal membrane
production of prostaglandin, which stimulates
contractions (Impey & Child, 2012).
Does coitus help induce labor?
Semen contains prostaglandins, which can be helpful in
softening also known as “ripening” of the cervix, if a
cervix is ready to ripen, semen prostaglandins could
possibly stimulate the beginning of contractions.
SIGNS OF LABOR
Preliminary Signs of Labor
1. LIGTHENING
In primiparas, lightening, or descent of the fetal presenting
part into the pelvis, occurs approximately 10 to 14 days before
labor begins. This fetal descent changes a woman’s
abdominal contour, because it positions the uterus lower and
more anterior in the abdomen.
SALVACION 13
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

Lightening gives a woman relief from the diaphragmatic 1. As soft as the nose tip: non-pregnant cervix
pressure and shortness of breath that she has been
experiencing and, in this way, “lightens” her load. 2. As soft as the earlobe: pregnant cervix “ Goodell’s sign”

In multiparas, it is not as dramatic and usually occurs on the 3. As soft as whipped butter: cervix ripe for labor
day of labor or even after labor has begun. As the fetus sinks
lower into the pelvis, a woman may experience shooting leg
pains from the increased pressure on her sciatic nerve,
increased amounts of vaginal discharge, and urinary
frequency from pressure on her bladder.

Lightening heralded by the following signs:

1. Relief of dyspnea

2. Relief of abdominal tightness

3. Increased frequency of voiding

4. Increased varicosities and pedal edema

5. Shooting pain down the legs/leg cramps

2. INCREASE LEVEL OF ACTIVITY
A woman may awaken on the morning of labor full of energy,
in contrast to the feeling of chronic fatigue she felt during the
previous month.
This increase in activity is related to an increase in epinephrine
release initiated by a decrease in progesterone produced by
the placenta. This additional epinephrine prepares a woman’s
body for the work of labor ahead.
This increased maternal activity supports the mother’s nesting
behavior.
Nesting behavior is a psychological sign of approaching labor.
The woman is busy preparing for the arrival of the baby:
sewing diapers, buying stuff (crib, layette, mittens, bonnets),
decorating a spare room for the baby and the like.
3. SLIGHT LOSS OF WEIGHT
As progesterone level falls, body fluid is more easily excreted
from the body. This increase in urine production can lead to a
weight loss between 1 and 3 pounds.
4. BRAXTON HICKS CONTRACTIONS
In the last week or days before labor begins, a woman usually
notices extremely strong Braxton Hicks contractions (3-4
weeks before labor).
These are false labor contractions. They are confined to the
abdomen, are painless, irregular, and relieved by walking.
For relief of discomfort: Encourage the woman to walks as it
relieves Braxton Hicks contractions
Signs of True labor
1. UTERINE CONTRACTIONS
The surest sign that labor has begun is productive uterine
contractions. Because contractions are involuntary and come
without warning, their intensity can be frightening in early
labor.
Helping a woman appreciate that she can predict when her
next one will occur and therefore can control the degree of
discomfort she feels by using breathing exercises offers her a
sense of well-being.
2.SHOW
As the cervix softens and ripens, the mucus plug that filled the
cervical canal during pregnancy (operculum) is expelled.
The exposed cervical capillaries seep blood as a result of
pressure exerted by the fetus. This blood, mixed with mucus,
takes on a pink tinged and is referred to as “show” or “bloody
show.”
Within 24 to 48 hours from expulsion of bloody show, labor
usually starts (Littletton & Engebretson, 2006).
3. RUPTURE OF THE MEMBRANES or BAG OF WATERS
(BOW)
Labor may begin with rupture of the membranes, experienced
either as a sudden gush or as scanty, slow seeping of clear
fluid from the vagina. Some women may worry if their labor
begins with rupture of the membranes, because they have
heard that labor will then be “dry” and that this will cause it to
be difficult and long.

5. RIPENING OF THE CERVIX

Ripening of the cervix is an internal sign seen only on pelvic

examination.

CERVICAL CONSISTENCIES:

SALVACION 14
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

Actually, amniotic fluid continues to be produced until 3. In case of a ruptured BOW, promptly report to the
delivery of the membranes after the birth of a fetus, so healthcare provider or transport to a healthcare facility.
no labor is ever “dry.”
4. The cervix is open and increasingly dilates and
Early rupture of the membranes can be advantageous effaces.
as it can cause the fetal head to settle snugly into the
pelvis, shortening labor.

RUPTURE OF THE BOW

1. Preterm rupture of the BOW ( PROM): when the bag

ruptures before 37 weeks gestation

2. Premature rupture of the BOW (PROM): when the

bags ruptures before labor

3. Early rupture of the BOW (EROM): when the bag

ruptures during the early first stage of labor, usually
before the active phase Components of Labor
The most common time for the BOW to rupture is the A successful labor depends on four integrated
early second stage or labor, when the cervix is fully concepts:
dilated.
1.Passage

A woman’s pelvis (the passage) is of adequate size and

MEMBRANES AND LIQOUR (AMNIOTIC FLUID)
The state of the membranes and color of amniotic fluid
is assess at every vaginal examination and recorded
immediately below the FHR recordings.
Four ways of recording membranes and liquor:
INTACT membranes
Ruptured membranes, CLEAR liquid
Ruptured membranes, MECONIUM-stained
liquid
Ruptured membranes, BlOOD-stained fluid
contour.
2. Passenger
The passenger (the fetus) is of appropriate size and in
an advantageous position and presentation.
3. POWER
I The powers of labor (uterine factors) are adequate. (The
C powers of labor are strongly influenced by the woman’s
M position during labor.)
B 4. PSYCHE

A woman’s psychological outlook is preserved, so that

afterward labor can be viewed as a positive experience.

PASSAGE

The passage refers to the route a fetus must travel from

the uterus through the cervix and vagina to the external
CAUTION:
perineum. Because the cervix and vagina are contained
The spontaneous rupture of the BOW is always an inside the pelvis, a fetus must also pass through the
indication for hospitalization. In institutional settings, the bony pelvic ring.
FIRST NURSING ACTION after the rupture of the BOW
BONY PELVIS
is to check the fetal heart tones.
False Pelvis
The expectant mother should be counseled that the
moment premonitory signs are noted, she should: Above linea terminalis
1. Refrain from engaging long trips is the expanded portion of the cavity situated above and
in front of the pelvic brim.
2. Have someone with her always in the home
True Pelvis

SALVACION 15
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

Below linea terminalis; the part most important to birth

Pelvic side walls: good

side walls are straight and
nor convergent (as seen
in gynecoid pelvis)

Sacrum: A good
sacrum is deep and well-
curved, as in the ideal
female pelvis the
GYNECOID pelvis.

AT THE PELVIC INLET Coccyx: The mobility of the coccyx is detected by

palpating it and attempting to move it to and from.
Diagonal conjugate – is the distance from the lower
border of the symphysis pubis to the sacral promontory 2 PELVIC MEASUREMENTS
which makes it an anteroposterior diameter of the pelvic
1. DIAGONAL CONJUGATE
inlet.
The anteroposterior diameter of the inlet
A diagonal conjugate measurement of greater than
11.5cm assures a pelvic inlet of adequate size for 2.TRANSVERSE DIAMETER of the outlet
vaginal delivery of a normal-sized fetus.
In most instances, if a disproportion between fetus and
Obstetric conjugate (OC) – is the smallest pelvis occurs, the pelvis is the structure at fault. If the
anteroposterior diameter of the pelvic inlet. fetus is the cause of the disproportion, it is often
because the fetal head is presented to the birth canal at
If the diagonal conjugate measurement is known, the
less than its narrowest diameter, not because the fetal
obstetric conjugate can be indirectly measured by
head is too large.
subtracting 1.5 to 2 cm from the diagonal conjugate.

AT THE PELVIC OUTLET 4 Basic Pelvic Shapes

Ischial spines – are blunt and somewhat widely

separated, as in the gynecoid (circular) platypelloid (flat)
pelves.

Bi-ischial diameter – smallest transverse diameter

It can be estimated using the attendant’s knuckles or

clenched fist placed across the perineum at the level of
tuberosities. With a fist size of at least 8 cm. the
knuckles usually do not touch the left and right
tuberosities simultaneously, indicating a diameter of
8cm or greater.

Gynecoid

Most common pelvic shape (50% of women)

Best for vaginal delivery

Oval-shaped inlet (wider form side to side than from the

back

Parallel sides, dull ischial pines, and a pubic arch that is

90 degrees or wider.

SALVACION 16
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS
ANTHROPOID
Oval inlet but is wider from front to back than from the
side to side
Sidewalls are parallel or flare outward.
Back part is roomy enough to fit the back of the fetus
head (25% of women)
Often results in occiput posterior birth
ANDROID
Male type pelvis (20% of women)
Small inlet that is somewhat heart-shaped
Sidewalls converge, the ischial spines are prominent,
and the pubic arch is narrow
Birth might occur, but more likely it will not progress to
a vaginal birth
PLATYPELLOID
Oval-shaped inlet that is compressd from front to back.
Results in a fetus that tranverses the pelvis with its head
in a transverse or sideways position.
Occurs in 5% if women
NOT CONDUCIVE to a vaginal birth
MEASURING THE DIAGONAL CONJUGATE
The diagonal conjugate measures 12.5 cm to 13 cm.
The diagonal conjugate is 1.5cm – 2cm greater than the
obstetric conjugate
FORMULA:
DC – 1.5 to 2 cm = Obstetric conjugate
EXAMPLE
PROBLEM: Given a diagonal conjugate measurement
of 12 cm, what is the obstetric conjugate?
SOLUTION: 12 cm 12cm
- 1.5 cm - 2cm
10.5 cm 10cm
ANSWER: The obstetric conjugate is about 10cm-10.5
cm
Passenger
The passenger is the fetus. The body part of the fetus
that has the widest diameter is the head, so this is the
part least likely to be able to pass through the pelvic
ring. Whether a fetal skull can pass depends on both its
structure (bones, fontanelles, and suture lines) and its
alignment with the pelvis.
Structure of the Fetal Skull
The cranium, the uppermost portion of the skull, is
composed of eight bones. The four superior bones—the
frontal (actually two fused bones), the two parietal, and
the occipital—are the bones that are important in
childbirth. The other four bones of the skull (sphenoid,
ethmoid, and two temporal bones) lie at the base of the
cranium so are of little significance in childbirth because
they are never presenting parts. The chin, referred to by
its Latin name mentum, can be a presenting part.
The bones of the skull meet at suture lines. The sagittal
suture joins the two parietal bones of the skull. The
coronal suture is the line of juncture of the frontal bones
and the two parietal bones. The lambdoid suture is the
line of juncture of the occipital bone and the two parietal
bones. The suture lines are important in birth because,
as membranous interspaces, they allow the cranial
bones to move and overlap, molding or diminishing the
size of the skull so that it can pass through the birth
canal more readily.
Significant membrane-covered spaces called the
fontanelles are found at the junction of the main suture
lines. The anterior fontanelle (sometimes referred to as
the bregma) lies at the junction of the coronal and
sagittal sutures. Because the frontal bone consists of
two fused bones, four bones (counting the two parietal
bones) are actually involved at this junction so the
anterior fontanelle is diamond shaped. Its
anteroposterior diameter measures approximately 3 to
4 cm; its trans-verse diameter, 2 to 3 cm. It closes when
the infant is 12 to 18 months of age.
The posterior fontanelle lies at the junction of the
lambdoidal and sagittal sutures. Because three bones—
the two parietal bones and the occipital bone—are
involved at this junction, the posterior fontanelle is
SALVACION 17
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

triangular shaped. It is smaller than the anterior transverse diameter of the outlet, arrest of progress may
fontanelle, measuring approximately 2 cm across its occur.
widest part. Because of its small size, it closes when an
infant is about 2 months of age.

Fontanelle spaces compress during birth to aid in

molding of the fetal head. Their presence can be
assessed manually through the cervix after the cervix
has dilated during labor.

Palpating for them during a pelvic examination helps to

establish the position of the fetal head and whether it is
in a favorable position for birth.

Molding
is a change in the shape of the fetal skull produced by
the force of uterine contractions pressing the vertex of
the head against the not-yet-dilated cervix. Because the
bones of the fetal skull are not yet completely ossified
and therefore do not form a rigid structure, pressure
causes them to overlap and molds the head into a
narrower and longer shape, a shape that facilitates
passage through the rigid pelvis.

Molding is commonly seen in infants just after birth.

Diameters of the Fetal Skull
The shape of a fetal skull causes it to be wider in its
anteroposterior diameter than in its transverse
diameter. To best fit through the birth canal, a fetus must
present the smaller diameter (the transverse diameter)
to the smaller diameter of the maternal pelvis;
otherwise, progress can be halted and birth may not be
accomplished.
CAPUT SUCCEDANEUM - is the swelling or edema of
the scalp in a newborn that appear as a lump on the
head after childbirth.
CAUSE: from external pressures on the baby’s head
during delivery.
PRIMARY SYMPTOMS: swollen, puffy area of the head
under the skin of the scalp

The diameter of the anteroposterior fetal skull depends Molding is recorded immediately beneath the state of
on where the measurement is taken. The narrowest amniotic fluid or liquor.
diameter (approximately 9.5 cm) is from the inferior
aspect of the occiput to the center of the anterior
fontanelle (the suboccipitobregmatic diameter).

The occipitofrontal diameter, measured from the

occipital prominence to the bridge of the nose, is
approximately 12 cm. The occipitomental diameter
which is the widest anteroposterior diameter
(approximately 13.5 cm), is measured from the posterior
fontanelle to the chin.

If a fetus presents the anteroposterior diameter of the

skull (a measurement wider than the biparietal
diameter) to the anteroposterior diameter of the inlet,
engagement, or the settling of the fetal head into the
pelvis, may not occur. If the fetus does not rotate so the
anteroposterior diameter of the skull is presented to the
Four ways of recording molding

SALVACION 18
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

Engagement
refers to the settling of the presenting part of a fetus far
enough into the pelvis to be at the level of the ischial
spines, a midpoint of the pelvis.

Descent to this point means that the widest part of the

Fetal Presentation and Position
Attitude
describes the degree of flexion a fetus assumes during
labor or the relation of the fetal parts to each other
A fetus in good attitude is in complete flexion: the spinal
column is bowed forward, the head is flexed forward so
much that the chin touches the sternum, the arms are
flexed and folded on the chest, the thighs are flexed
onto the abdomen, and the calves are pressed against
the posterior aspect of the thighs.
fetus (the biparietal diameter in a cephalic presentation;
the intertrochanteric diameter in a breech presentation)
has passed through the pelvis inlet or the pelvic inlet
has been proved adequate for birth.
The degree of engagement is assessed by vaginal and
cervical examination. A presenting part that is not
engaged is said to be “floating.” One that is descending
but has not yet reached the ischial spines is said to be
“dipping.”

A fetus is in moderate flexion if the chin is not touching

the chest but is in an alert or “military position”. This
position causes the next-widest anteroposterior
diameter, the occipital frontal diameter, to present to the
birth canal. A fair number of fetuses assume a military
position during the early part of labor. This does not
usually interfere with labor, because later mechanisms
of labor (descent and flexion) force the fetal head to fully
flex.

A fetus in partial extension presents the “brow” of the

head to the birth canal. If a fetus is in complete
extension, the back is arched, and the neck is extended,
presenting the occipitomental diameter of the head to
the birth canal. Station
This unusual position presents too wide a skull diameter refers to the relationship of the presenting part of a
to the birth canal for normal birth. Such a position may fetus to the level of the ischial spines.
occur if there is less than the normal amount of amniotic
At a 3 or 4 station, the presenting part is at the perineum
fluid present (olighydramnios), which does not allow a
and can be seen if the vulva is separated (i.e., it is
fetus adequate movement. It also may reflect a
crowning).
neurologic abnormality in the fetus causing spasticity.
MINUS STATIONS (-): Presenting part above the levels
of the ischial spines

Station -1 : 1cm above the level of the ischial spines

Station -2 : 2 cm above the level of the ischial spines

Station -3 : 3 cm above the ischial spines

PLUS STATIONS (+) : Presenting part below the ischial

spines

Station +1: 1 cm below the level of the ischial spines

Station +2: 2 cm below the ischial spines

Station +3: 3 cm below the level of the ischial spines

SALVACION 19
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

In station +3, the presenting part can be seen at the

perineum (Cunningham et al., 2001).

2. Breech presentation - means that either the buttocks

Lie - is the relationship between the long or the feet are the first body parts that will contact the
(cephalocaudal) axis of the fetal body and the long cervix.
(cephalocaudal) axis of a woman’s body; in other words,
Three types of breech presentation
whether the fetus is lying in a horizontal (transverse) or
a vertical (longitudinal)position. 1. Complete
Longitudinal lies are further classified as cephalic, which 2. Frank
means the head will be the first part to contact the
cervix, or breech, with the breech, or buttocks, as the 3. Footling
first portion to contact the cervix.

Types of Fetal Presentation

Fetal presentation denotes the body part that will first
contact the cervix or be born first. This is determined by
a combination of fetal lie and the degree of fetal flexion
(attitude).

1.Cephalic presentation - is the most frequent type of

presentation

With this type of presentation, the fetal head is the body

part that will first contact the cervix.

4 TYPES OF CEPHALIC PRESENTATION

1. Vertex - is the ideal presenting part because the skull

bones are capable of effectively molding to
accommodate the cervix.

2. Brow - moderately extended head, with the brow

EXTERNAL CEPHALIC VERSION
presenting
Performed after 36 or 37 weeks of pregnancy
3. Face - sharply extended fetal neck that the occiput
and back come in contact and the face is nearest the Non-surgical method
birth canal
Medicine is given to relax the uterus
4. Mentum - During labor, the area of the fetal skull that
contacts the cervix often becomes edematous from the Ultrasound is done before & after the ECV to check
continued pressure against it. This edema is called a baby’s heart beat and position
caput succedaneum. In the newborn, the point of
Success rate is 40% to 50%
presentation can be analyzed from the location of the
caput. Procedure usually lasts for a few minutes

SALVACION 20
NCM 107: PRENATAL CARE: CARE FOR THE MOTHER & CARE FOR THE FETUS

ECV can be uncomfortable and painful at times Prolong labor

3.Shoulder Presentation (Transverse Lie) Obstructed labor

a fetus lies horizontally in the pelvis so that the longest Rupture of uterus
fetal axis is perpendicular to that of the mother. The
Hemorrhage & Shock
presenting part is usually one of the shoulders
(acromion process), an iliac crest, a hand, or an elbow. Maternal death

FETAL

Cord prolapse

Hand prolapse

Intrauterine Demise (IUD)

Fetal distress

Still birth

TREATMENT

CS should be performed in persistent transverse lie

Internal podalic version in delivery of the second twin

External cephalic version may be tried in selected cases

before labor or early in labor

In advanced labor or in case of ruptured membranes CS

CAUSES OF TRANSVERSE LIE
is safer even in case of fetal death.
relaxed abdominal walls from grand multiparity, which
allow the unsupported uterus to fall forward.

pelvic contraction, in which the horizontal space is

greater than the vertical space.

Placenta previa - in which the placenta is located low in

the uterus, obscuring some of the vertical space

With a transverse lie, the usual contour of the abdomen

at term is distorted or is fuller side to side rather than top
to bottom.

If an infant is preterm and smaller than usual, an attempt

to turn the fetus to a horizontal lie may be made.

POSITION

1. Dorsoanterior – which is common (60%). The flexor

surface of the fetus is better adapted to the convexity of
the maternal spine.

2. Dorsoposterior

3. Dorsosuperior

4. Dorso-inferior

DANGER OF TRANSVERSE LIE

MATERAL

SALVACION 21