MATERNAL AND CHILD NURSING  Organ for copulation Penis

ANATOMY  Outlet for urine and semen

Female Reproductive: External  Regulates temperature of sperm Scrotum
Anus – not an organ for reproduction; pathway for feces  Protects the testes
Mons Pubis – composed of adipose tissue
 Responsible for making the testosterone, the Testes
primary male sex hormone
Prepuce – protects the clitoris (hood of clitoris)  Generates sperm
Clitoris – 2-3 cm; part that produces pleasure
Labia majora – 2 lips; bigger; Moist. Sits on either side of the INTERNAL MALE GENETALIA
opening. Epididymis – 20ft long; Housing the immature sperm
Labia minora – helps protects the vagina Vas deferens – Ejaculation
Vagina – birth canal; passage of menstruation; Prostate gland – aids in the fluid that is in the semen; provide a good
Urethral Orifice – passage of urine. environment for the survival of the sperm cell
CUVA – landmark for Catheter insertion Seminal Vesicle – aid in provide a good environment for the survival
 Clitoris of the sperm cell
 Urethral Orifice  Reservoir/ Storage of sperm cells Epididymis
 Vagina  Bring the sperm to maturity
 Anus  Carries sperm from epididymis to seminal Vas deferens
vesicles
 Collective name for external genitalia Vulva Pudendum  Structure severed during vasectomy
 Erectile tissue Clitoris  Produce a sugar-rich fluid (fructose) that Seminal Vesicles
 Center of sexual arousal and orgasm provides sperm with a source of energy
 Pad of adipose tissue at symphysis Mons Pubis  Helps with the sperms’ motility (ability to
pubis covered by hairs Mons Veneris move)
 Protects pubis bone  Walnut-sized structure that produces Prostate Glands
alkaline milky fluid
 Two spongy folds of skin covered by Labia Majora  Its fluid help nourish the sperm
hairs – one on either side of the  Pea-sized structures (located on the sides Bulbourethral Glands
vaginal opening of the urethra just below the prostate
 Cover and protect the genitals gland)
structures  Produce a clear, slippery fluid that serves
 Hairless folds of skin that cover the Labia Minora to lubricate the urethra
“VUBS” of the vestibule  Produce alkaline fluid that helps
counteract the acid secretion of the
 Organ of coitus Vagina urethra and ensure sage passage of
 Narrow muscular but elastic organ spermatozoa
about 4-5 inches long
 Serves as the birth canal Vagina SEMEN
 External opening of the urethra Urethral Orifice  Thick whitish secretion of the male reproductive organs
 Opening for passageway of urine  Contains spermatozoa and other secretions
 Network of muscles surrounding the Perineum Prostate 30%
vagina and anus Seminal Vesicles 60%
 Support the pelvic cavity Epididymis 5%
 Help keep organs in place Bulbourethral Glands 5%
 Outlet for feces; not part of the female Anus
reproductive organs Semen Analysis
 Measures the amount of semen a man produces and
Internal Reproductive Organs determines the number and quality if sperm in the semen
Cervix – lowest portion of the uterus; passageway of menstruation; sample.
passageway pf sperm to uterus, passageway of baby  Normal: 50-200 million/ml
Fallopian tube – site for fertilization Before:
 Fibrate – tries to catch the eggs to the ovary  Sexual abstinence 2-4 days prior to test
 Ampulla – meets the egg cell and sperm cell; where  No alcohol a few days before test
fertilization happen During:
 Isthmus – narrowest part  Proved clean, dry specimen jar
 Interstitial – distal; part of ovary  Avoid using lubricants
Uterus – pear shape organ that houses the fetus for 9 months; organ After:
which lining sheds of during menstruation; Site for implantation.
 Keep specimen at body temperature during transport
Ovaries – 2 ovaries; produces mature and discharge ova. Produces
 Make sure specimen is sent to the lab within 1hour
estrogen and progesterone.
Homologous Structures
 Almond shaped Ovaries
 Produce, mature and discharge ova
 Produce estrogen and progesterone Males Females
 Regulate the menstrual cycle Spermatozoa Ovum
 Hollow muscular, pear-shaped organ Uterus Glans Penis Glans Clitoris
 Site of implantation Scrotum Labia Majora
 Location where fetus develops Penis Vagina
 Structure the sheds its lining monthly Testes Ovaries
during menstruation
Vas Deferens Fallopian tube
 Lowermost portion of fetus Cervix
 Passage of menstrual flow from the uterus Prostate Glands Skene’s Glands
 Passage of sperm into the uterus Cowper’s Glands Bartholin’s Glands
 Also called oviducts Fallopian Tubes
 Site of fertilization HUMAN SEXUAL RESPONSE
 Passageway for the ovum to travel to 4 Stages of Physiological (Masters and Johnson 1966)
the uterus  Excitement Phase
 Area of heightened erotic sensitivity Grafenberg Spot  Plateau Phase
 Source of a small amount of fluid  Orgasm Phase
ejaculated at orgasm  Resolution Phase
1st: Excitement Phase
ANATOMY OF THE MALE REPRODUCTIVE ORGAN
 Parasympathetic stimulation
Penis – reproductive function; excretory function
o Arousal
Scrotum containing testicles – produces androgen and testosterone
o Erection
(sperm cells)
 HR, RR, BP, arterial dilation, venous constriction  Softens connective tissue
 Males - penis becomes partially erect, testicles drawn upward,
scrotum becomes tense and thicken  Hormone of women Estrogen
 Females – breast slightly increase in size clitoris becomes  Hormone of womanhood
swollen, (+) vaginal lubrication  Hormone of pregnancy Progesterone
 Occurs as the result of any erotic physical or mental situation  Stimulates production of milk Prolactin
2nd: Plateau Stage
 Stimulates the “let-down” Oxytocin
reflex
 Period of sexual excitement prior to orgasm  Stimulates the “milk ejection”
 Further HR (100-175/min) reflex
 Further RR (up to 40/min) Basis for pregnancy test HCG
 May result in frustration for either partner if continued for too Structure that initiates the Posterior Pituitary Gland
long production of oxytocin
Commonly used to induce labor Oxytocin
 Males – Penis becomes fully erect, urinary bladder closes
Structure that initiates the Anterior Pituitary Gland
secretion of seminal fluid
production of prolactin
 Females – areola and labia further size, clitoris drawn forward,
Given to treat menopausal Estrogen
more vaginal lubrication, “orgasm platform is reached” signs and symptoms
3rd: Orgasm Phase Causes ↑ temperature Progesterone
 Shortest stage ovulation
 Associated with ejaculation
 Discharge of accumulated tension Presumptive Signs of Pregnancy: Subjective
 3-7 propulsive ejaculatory contractions 1. Nausea and vomiting
 Euphoric sensation 2. Urinary Frequency
 Males – waves of pleasure with each spurt of ejaculation, 1st and 3. Amenorrhea
2nd produce most amount of semen 4. Breast Enlargement
 Females – muscular spams are theorized to aid in fertilization 5. Quickening
4th: Resolution Phase 6. Increased Melanin production
 Return to unaroused state Probable Signs of Pregnancy: Objective
 Muscles relax, blood pressure drops and the body slows down 1. Positive Pregnancy Test
from its excited state 2. Ballottement – rebound sensation
 Generally, takes 30 minutes 3. Braxton Hick’s Contractions – irregular contractions that happen
only in the abdomen; can be relieved by rest; do not increase in
 Refractory period
duration, intensity, and frequency. (5th month)
 Males – refractory periods range from human to human, with
4. Chadwick’s sign – Bluish/ Purplish Discoloration (Vagina); due to
some males being immediate to as long as 12-24 hours
blood pooling in the area
 Females – further stimulation may cause a return to the plateau
5. Goodell’s Sign – softening of the Cervix
stage 6. Hegar’s Sign – lower uterine segment softens (Uterus)
PREGNANCY Positive Signs of Pregnancy
Hormones in Pregnancy (HHOPPE) 1. Ultrasound (UTZ)
Human Chorionic Gonadotropin 2. Positive FHT – 120-160 BPM
 Also known as HCG 3. Positive Fetal Outline (Quickening) – 10 kicks/hr
 1st hormone produced by chorionic villi PREGNANCY
 Hormone analyzed by pregnancy test  A – normal physiology process
 Maintains corpus luteum during early pregnancy  A – wellness state
 (+) ↑ levels in H -mole (Gestational Trophoblastic Disease)  Main responsibility of nurses:
 (+) ↑ levels in multiple pregnancies o Help mothers maintain wellness throughout pregnancy and
Human Placental Lactogen parenthood.
 Aids in breast growth to prepare for lactation Classification of Pregnancy:
 Regulates maternal glucose, protein and fat levels 1. Gravida – number of times the woman has been pregnant
 Antagonizes insulin a. Primigravida – first pregnancy
Oxytocin b. Multigravida – had multiple pregnancy
 Stimulate the labor onset (stimulates contractions) c. Nulligravida – no history of pregnancy
 Stimulates “let-down” reflex 2. Para – pregnancy that has reach the age of viability (20-24
 “Milk ejection” reflex weeks)
 Uterine contraction a. Nullipara – no history of pregnancy that has reach the age
 Produced by the Posterior pituitary gland of viability
Prolactin b. Primipara – first pregnancy that has reach the age of
 Stimulates the mammary glands to produce milk: “lactogenesis” viability
 “Milk Production” reflex c. Multipara – multiple pregnancy that has reach the age of
viability
 Suppressed by estrogen and progesterone
TPAL (M)
 Increased levels after delivery of placenta (2-3 days after birth)
 Term – count (38-42 weeks)
 Produces by the Anterior Pituitary Gland
 Preterm – younger than or before 38 weeks. (>37 weeks)
 ↑ levels with breastfeeding
 Abortion – history of abortion/ miscarriage
Progesterone
 Living – total of living children
 Hormone of mothers or motherhood
 Multiple pregnancy
 Hormone of pregnancy
PRE-NATAL ASSESSMENT (PRE-NATAL CARE)
 Develops the decidua
 Ensures the overall health of the woman and her baby
 Develops mammary glands
 Reduces maternal mortality, morbidity and complications
 ↓ Uterine excitability
 Lack of pre-natal care – associated with various maternal
 ↓ Gastric motility, relaxes esophageal sphincters
complications
 Causes ↑ temperature
PRE-NATAL VISITS
Estrogen
 Assess both maternal and fetal wellbeing.
 Hormone of women or womanhood
 Pregnant women receive information:
 Primary female sex hormone
o How to keep herself and her baby healthy
 ↑ Uterine growth
o How to prepare herself for the delivery
 ↑ Endometrial growth
o How to prepare her family for the coming of the baby
 Given to treat menopausal symptoms
 o Spider nevi – telangiectasis (spider veins)
TIME FRAME o Palmer erythema – reddish palm due to estrogen
 First Visit: stimulation
o As soon as the woman suspects that she is pregnant I. Back
 Subsequent Visits: o Exaggerated lumbar curve – lordosis (lumbar position)
o Every 4 weeks until the 28th weeks of pregnancy J. Rectum
o Every 2 weeks in between the 28th and 36th weeks of o The development of hemorrhoids due to straining/
pregnancy pressure of labor
o Every week until birth i. Diet
NAEGELE’S RULE ii. Prevent trauma, bleeding and further rupture
Last menstrual period: First day of LMP iii. Advise the mother to lie down on her side
(-)3 months K. Extremities
(+)7days o Ankle swelling – due to weight
(+)1 year o Leg edema – due to weight
=Expected Date of Confinement o Waddling gait – weakness in hip girdle and upper
MCDONALD’S RULE thigh muscles
 Estimates duration of pregnancy (AOG) by measuring from
symphysis pubis to over the top of the uterine fundus (in cm) LEOPOLD’S MANEUVER
BARTHOLOMEW’S RULE o Christian Leopold
 Estimates AOG by the relative position of the uterus om the o To identify the position of the baby
abdominal cavity. o To be able to locate FHT
PHYSICAL ASSESSMENT o Beyond 24 weeks
Vital Sings: Preparation:
 Blood Pressure o Empty Bladder to avoid voiding
o no significant change o Warm the hands first before holding the mother’s abdomen – to
o Slight decrease in 2nd trimester but should go back to avoid stimulating contractions
normal on the 3rd trimester o Prevent uteroplacental insufficiency: put a pillow/ small towel in
o The leading cause of mortality in pregnancy is Pre- the right buttocks.
eclampsia/ Eclampsia 4 Leopold’s Maneuver:
o Warning sign: 140/90 mmHg 1st: Determine fetal part at the uterine fundus
o Gestational Hypertension can lead to Mild Pre-eclampsia  Examiner faces woman’s head
 Pulse Rate – Increases 10 beats per second  Palpate uterine fundus
o Increase in the cardiac workload  Head is round and hard
 Respiratory Rate – No significant change 2nd: Determine fetal back
o Shortness of breathing when the mother is close to labor  Examiner faces woman’s head
– limits or impedes the expansion of the lungs  Palpate with one hand on each side of abdomen
 Temperature – slightly elevated (due to progesterone)  Assess which side is spine, and extremities
o Progesterone has a thermogenic effect  The fetal back feels smooth, hard, and resistant
 Weight 3rd: Determine fetal engagement
o Average weight gain: 25-25 lbs.  Examiner faces woman’s head
o 1st-2nd trimester – mother’s weight increases  Palpate just above symphysis pubis
o 3rd trimester – baby’s weight  If the presenting part moves upward, it is not yet engaged
o 1st trimester – 1lbs/month 4th: Determine fetal attitude
o 2nd to 3rd trimester – 1lb/week  Examiner faces woman’s feet
HEAD-TO-TOE  Cross fingers downward on both sides of the uterus just
A. Hair – tends to grow faster; oily hair above the inguinal ligaments
o If dry hair – poor nutrition & hydration  Press downward and inward in the direction of the birth
B. Eyes canal
o Conjunctiva – pinkish DANGER SIGNS OF PREGNANCY
i. Low hemoglobin if not pinkish What to watch out for?
ii. Edema (severe abnormality) – PIH (Pregnancy  Vaginal bleeding
induced hypertension)  Persistent/ Severe Vomiting
C. Nose – congestion due to estrogen (normal) o Possible dehydration
o Increase fluid intake and eat more fruits and o Hyperemesis Gravidarum
vegetables o Fluid imbalance
D. Ears  Chills and fever
o Nasal congestion results in blockage of the eustachian  Fluid from vagina
tube – affects hearing o Specially if far from labor date
E. Mouth and teeth o Yellow – RH incompatibility (bilirubin problem)
o Gingivitis - Swollen gums o Black – uterus bleeding
o Epulis – any tumor like enlargement situated on the o Stained Red – bleeding
gingival or alveolar mucosa (due to estrogen)
 Abdominal or chest pain
o Cracking of the lips due to vitamin deficiency
 Pregnancy Induced Hypertension
o Dental caries (cavities)
o Proteinuria
o Avoid dental surgery – risk for infection
o Edema
F. Neck
o Hypertension (Warning sign: 140/90)
o Thyroid – slight enlargement due to increase basal
o Occurs 20th week AOG
metabolic rate (BMR)
G. Breast – enlargement
PSYCHOLOGICAL CHANGES
o Wider and darker areola
1ST Trimester:
o Prominent veins
 Accurate diagnosis of pregnancy
H. Skin
 Ambivalence of early pregnancy (mix/ roller coaster emotions)
o Linea Nigra – faint brown line from the umbilicus down
 Mother is self-centered, baby is part of her
to the symphysis pubis
 Task: Accepting the pregnancy
o Mask of pregnancy – chloasma
2nd Trimester:
o Striae Gravidarum – stretch marks
  Task: Accepting the baby  Negative Benedict’s Test: No color change (remains
 Demonstrates growing realization of baby as separate and blue).
needing person
 Fantasizes about unborn child
 50/50 chances of girl/ or boy
 Contributes the gender of the child: Father
3rd Trimester: (Nesting)
 Task: Preparing Parenthood BLOOD TEST/ COMPLETE BLOOD COUNT (CBC)
 Nesting – when mother prepares for the coming of the baby What When How Results Nursing
Consideration
 Desire to be finished with pregnancy
Hematocrit Initial Blood Mild Normal values:
 Anxiety and clinic extraction Anemia
 Couvade syndrome – psychological reaction when the father Hemoglobin visit is less Hb:
witnesses the stress of the mother, the father experiences the than 12-16mg/dl
discomforts/ effects of pregnancy. 11gm/dl
Detects
o Fathers – craves for food, nausea and vomiting. anemia (Hct 27-
Emotional Responses: 33%) Hct = 37-47%
 Grief – Mother has to give up herself/ the life before her
pregnancy Severe
 Narcissism – Feeling of self-absorption; Self-centered Anemia
 Introversion vs Extroversion – Has to take care of child and is Hb
cannot do what her past self can. less then
9gm/dl
 Body Image and Boundary – mother lacks care for herself.
(hct less
 Stress – being a parent is stressful; due to role acceptance than
 Emotional Lability – mood changes 27&)

PRENATAL ASSESSMENT: ULTRASOUND

LABORATORY AND DIAGNOSTIC TEST What When How Results Nursing
Consideration
FETAL DIAGNOSTIC TEST Sonography Between High Baby’s Abdominal full
– 18 weeks frequency growth and bladder supine
 Used to: transducer to 20 sound developmen position
o Identify or confirm the existence of risk factors emits high- weeks of waves are t are on
o Validate Pregnancy frequency gestation used to target
Transvaginal
o Observe progress of pregnancy – (start of pregnancy to create an
image of empty bladder
delivery) Identify lithotomy
the baby
o Identify genetic abnormalities and other various position
problems
o Identify optimum time for induction of labor it indicated. structures
(maternal/
fetal)
PREGNANCY TEST Gender:
What When How Results Nursing Females – Hamburger’s sign
Consideration Male – Turtle sign
Detects After a Follow 2 lines Result is not ELECTRONIC MONITORING
the missed instruction (+) conclusive Assessment Non-Stress Test Stress Test
presence period on test kit 1 line (-) further What is Response of FHR Responsible of FHR
of hCG evaluation is measured? to real movement. to uterine
advised contractions
Reactive: Normal  Negative:
URINE TEST/ URINALYSIS 2 or more (Normal)
What When How Results Nursing accelerations of  No late
Consideration 15 bpm lasting 15 decelerations
Acetic Acid During Do perineal Proteinuria Provide sterile Findings seconds or more with contractions
(Proteinuria) monthly care before container
prenatal collection in a 20
visits of urine Glucosuria Non-reactive Positive (Abnormal)
Benedict’s Proper urine (Abnormal)
Test collection
(Glucose) Discard the UTI technique
first flow of (technique) RHYTHM STRIP TESTING
urine What is Fetal Heart Rate
Clean-catch
midstream measured?
urine () Collect the Interpretations Baseline: 120-160bpm
midstream Short-term variability
clean-catch Long-term variability

ACETIC ACID TEST FHR FLUCTUATIONS

1. Take 2/3 of test tube with urine Acceleration Early Late Variable
2. Heat urine until cloudy Decelerati Decelerati Deceleration
3. Add acetic acid 1-2 drops on on
Description ↑FHR above ↓FHR ↓FHR after ↓FHR that
a. Positive: cloudiness increases baseline concurrent onset of varies
with contractions
contractions
BENEDICT’S TEST
Cause Spontaneous Head Utero- Umbilical cord
1. Approximately 1ml of sample is placed into a clean test tube. fetal movement compression placental compressions
2. 2ml (10 drops) of Benedict’s reagent (CuSO4) is placed in the insufficiency
Clinical Fetal well- Reassuring Non- Non-reassuring
test tube. being, alertness pattern – not reassuring pattern
Significance
3. The solution is then heated in a boiling water bath for 3-5 associated pattern associated with
with fetal associated fetal hypoxemia
minutes. hypoxemia with fetal
4. Observe for color change in the solution of test tubes or hypoxemia
precipitate formation. Nursing None None Change Change
Interventions maternal maternal
Result: position position
 Positive Benedict’s Test: Reddish precipitate (within 3 Increase Increase rate of
rate of IVF IVF
minutes) O2 therapy O2 therapy
 Discontinue Discontinue o Greenish – meconium stained
oxytocin oxytocin
o Yellow – presence of bilirubin
o Black or bloody – fetal death or premature detachment of the
placenta
FETOSCOPY
 Utilizes a small camera or scope to examine and perform
procedures on the fetus during pregnancy
 Allows a visual assessment of any abnormalities during
AMNIOCENTHESIS pregnancy
What When How Results Nursing DOPLER ULTRASOUND
Consideration  Uses sound waves to check how blood flow through blood
Removal 14 A long, Identify Invasive vessels
of fluid weeks to G20 chromosomal procedure  Shows the rate of blood flow through arteries and veins.
from the 16 spinal abnormalities (consent)
amniotic weeks needle and certain NITRAZINE PAPER TEST
cavity by gestatio is genetic Early  Color changes depending on the pH of the fluid
needle n inserted problems pregnancy –  Blue- membranes have ruptured
puncture into the (down full bladder
mother’s syndrome,
uterus spinal bifida) Interpretation of Amnicator Color Change
Guided by Late in Intact Membranes Ruptured Membraned
ultrasound and into
the pregnancy – pH 5.0 – yellow pH 6.5 – blue green
(safe site) empty bladder
amniotic pH 5.5 – yellow pH 7.0 – blue green
sac to pH 6.0 – yellow pH 7.5 – blue black
aspirate Continuously
15-20ml monitor the INTRANATAL CARE
of fetus  Care given to the mother and baby at the time of delivery
amniotic
fluid PERINEAL AND ABDOMINAL EXERCISE
 Tailor sitting
CHORIONIC VILLUS SAMPLING (CVS)  Squatting
What When How Results Nursing
 Pelvic floor exercise
Considerati
on  Abdominal Muscle Contractions
Chorionic 8 Guided Identify Risk for limb  Pelvic rocking – twerking
villi sample weeks by chromosom reduction
is tested to 10 ultrasoun al syndrome MANAGING PAIN
for genetic weeks d, a abnormalitie Method Personality Concept
abnormaliti (12 needle is s some Lamaze Fernand Lamaze Relaxation methods
es weeks) inserted specific to deal with pain
gestati in the genetic Bradley Robert Bradley Parents working as
on uterus or problems, a team
a thin earlier than Dick Read – less Grantly Dick Read Fear and tension
tube is amniocente blood going to the (Labor is pleasant) were the cause of
threaded sis uterus and causing labor pains
through pain
the Leboyer – rub the Frederick Leboyer More sensitive and
cervix back, music gentle approach to
and a therapy birth
sample
of
placental
tissue is
removed
PREGNANCY COMPLICATIONS: INTRANATAL
MATERNAL SERUM ALPHA-FETOPROTEIN
TIME TYPE CAUSE ASSSESS
What When How Results Nursing
Threatened Unknown; Painless
Consideratio
miscarriage Chromosomal; spotting;
n
Uterine slight
AFP is 15 Using Neural tube Used in the
abnormalities cramping;
produce week aseptic defect second
cervix closed:
d by the s to technique trimester of
fetus is not
fetal liver 17 , obtain Chromosoma pregnancy expelled
and is week blood l defect Imminent Spotting;
excreted s specimen
(Inevitable) cramping;
through from
cervix is
the mother

1st
dilated; loss
placenta
of fetus is not
into the
avoidable
mother’s

Trimester
blood Complete All products
of conception
expelled
PERCUTANEOUS UMBILICAL BLOOD SAMPLING
Incomplete Fetus
 Cordocentesis expelled;
o Examinations of blood from the fetus to defect fetal placenta and
abnormalities membranes
 Between 18 to 22 weeks retained
AMNIOSCOPY Missed No apparent
 Study of amniotic fluid (Dark red loss of
 Amnioscope is inserted through the vagina and cervical canal bleeding) pregnancy;
fetus dies in
 Normal: Transparent, light fluid with or without case of vernix
utero and is
 Abnormal: not expelled
 Ectopic Implantation of Sharp LABOR
pregnancy zygote at site stabbing pain LABOR: PRELIMINARY SIGNS
other than in unilateral  Lightening – 9 months; below level of xiphoid process; relieves
uterus lower dyspnea
abdominal o Primigravida – delay in delivery
quadrant;
o Multigravida – abrupt delivery
scant; vaginal
spotting
Gestational Abnormal Excessive  Increased level of activity

2 Trimester
nd Trophoblastic proliferation and fundal height o Advise rest before labor, mother may be tired when labor
Disease degeneration of for gestation; happens.
(H-mole) trophoblastic marked  Braxton Hick’s Contractions – false labor contractions
tissue nausea and  Goodell’s Sign – softening of the cervix (preliminary sign)
vomiting; LABOR: TRUE SIGNS OF LABOR
absent FHTs;
 Regular Contractions – from abdomen to back, girdling sensation,
blood or
↑intensity, ↑duration, ↑frequency, painful
grapelike
vesicles  Blooding show – operculum; gush of blood
Premature Cervix dilates Painless  Rupture of membranes (ROM) – gush of fluids; leak/squirting of
cervical prematurely and bleeding; fluids;
dilatation pregnancy is early and o Observe aseptic technique
(incompetent lost at about 20 progressive
cervix) weeks effacement FALSE LABOR TRUE LABOR
and dilatation Contractions: Contractions:
leading to A – abdominal G – “girdling”
expulsion of S – short R – regular and rhythmic
fetus I – irregular I – increased FID (frequency,
Placenta Uterine factors; Painless; intensity, duration)

3 rd
previa low implantation bright-red Relief: Relief:
of placenta bleeding after Walking Unaffected
7th month Change of position
Abruptio Associated with Sharp.

Trimester
Cervical changes: Cervical changes:
placenta hypertension; Stabbing none ↑effacement
short umbilical fundal pain; ↑dilatation
cord; cigarette dark-red
smoking bleeding; STAGES OF LABOR
board-like
1ST STAGE:
uterus for
From the onset of painful uterine contraction to full cervical dilatation
concealed
hemorrhage (10cm)
Preterm labor Associated with Persistent, Criterion Latent Active Transition
dehydration; low Contractions:
UTI; backache; Duration <40 seconds 40 – 60 60 – 90
chorioamnionitis vaginal seconds seconds
spotting; Intensity Mild and Moderate Strong
uterine short
cramping and Frequency Every 5 Every 3–5 Every 2–3
contraction minutes minutes minutes
Dilatation 0–3 cm 4–7 cm 8–10 cm

ECLAMPSIA 2ND STAGE:

Mild Pre- Severe Pre- Eclampsia  From full cervical dilatation (10cm) to the birth of the baby.
Eclampsia Eclampsia  Happens during labor: (Cardinal signs)
Blood ↑140/90 or 160/110
o Engagement
Pressure ↑30/15
o Descent
Proteinuria 1+ to 2+ 3+ to 4+
Slight Purify face Convulsions o Flexion
generalized and hands o Internal rotation
Edema
edema anasarca o Extension
↑weight Blurring of Temperature o External rotation
Signs and (≥1lb/week) vision, (39 - 40°C); o Expulsion
Symptoms 3rd trimester epigastric tonic-clonic 3RD STAGE:
pain, oliguria seizures;
 From the expulsion of the fetus to expulsion of the placenta
coma
o Globular shape of the abdomen
Bedrest (side- CBR, MgSO4
lying); as ordered, o Lengthening of the cord
Nursing
adequate high protein o Gush of blood
Actions
protein diet diet o Placenta:
PIH – occurs 20th week AOG  Check for cotyledons (20)
 Check for placenta intactness
MAGNESIUM SULFATE  Check for placenta detachment/ seperation
 Drug of choice 4TH STAGE:
 Antidote: Calcium Gluconate Expulsion of placenta to 4 hours after delivery.
 Therapeutic level: 5-8mg/100ml Mothers:
 8-10mg = DTR disappears  ↑ temperature after delivery (within 24 hours); after 24
 15-20mg = RR↓ hours – infection
 ≥20mg = possible cardiac arrest
Before administration: CARDINAL SIGNS OF LABOR
 (+) DTR  Engagement
 RR = ↑ 12 bpm  Descent
 Urine output = ↑ 25-30ml/hour  Flexion
 Internal rotation
 Extension
 External rotation
 Expulsion
o E-D-F-Ir-E-Er-E

UTERINE CONTRACTIONS
 Duration – beginning of the contraction to the end of the same of
the contraction
 Frequency – from beginning of a contraction to another
beginning of a contraction
 Intensity – mild, moderate, strong
 Interval – end of the last contraction to the beginning of the next
contraction
Effacement
 Shortening and thinning of the cervical canal
 Due to longitudinal traction from the contracting uterine fundus
 Effacement happens due to contraction 2. Problems with Presentation
o Operculum – mucus-like discharge a. Any presentation unfavorable for delivery
Dilatation b. Posterior presentation that does not rotate or cannot be
 Enlargement or widening/ expanding of the cervical canal rotated with ease
Cervix is not effaced or dilated → Cervix is 50% effaced and not c. Cesarean birth is the usual intervention
dilated → Cervix is 100% effaced and dilated to 3cm → Cervix
is fully dilated to 10cm

Undilated, uneffaced → Partly dilated, partly effaced

→ fully dilated, fully effaced

PROBLEMS WE ENCOUNTER DURING INTRANAL

INTRA-NATAL RISK
 Conditions during labor and delivery that may put the woman
into a serious situation
o Affects the passage, passenger, and powers
o Prompt immediate medical and nursing intervention
 Dystocia – any labor or delivery that is prolonged and
difficult
 Prolapse umbilical cord
 Precipitous Labor and Delivery
 Premature Rupture of Membranes
 Prolonged Pregnancy
 Fetal Distress
DYSTOCIA
Any labor or delivery that is prolonged and difficult. 3. Problems with Maternal Soft Tissue
5P’S a. Full bladder – uterus cannot contract well; slows down the
 Passage labor process
b. Emptying the bladder may allow labor to continue
 Passenger
i. Insert straight catheter if mother is already in labor
 Powers
4. Dysfunctional Uterine Contractions
 Placenta
a. Contractions may be too weak, too short, too far apart,
 Psych ineffectual
FREQUENT CAUSES: b. Progress of labor is affected
1. Cephalopelvic Disproportion – Disproportion between fetal c. Progressive dilatation, effacement, descent do not occur in
presentation (usually the head) and maternal pelvis the expected pattern
a. Gynecoid – moist ideal Classification:
b. Platypelloid
 Primary – inefficient pattern is present from beginning of
c. Android – heart shaped
labor
d. Anthropoid
 Secondary – efficient pattern that changes to inefficient or
stops

PROLAPSED UMBILICAL CORD

Displacement of the cord in a downward direction
Associated with: (spaces for cord to tangle)
 Breech presentation
 Unengaged presentation
 Premature labor – small baby
ASSESSMENT FINDINGS:
 Vaginal exam identifies cord prolapse into the vagina
NURSING INTERVENTIONS:
 Check fetal heart tones
 If fetal bradycardia” perform vaginal examination and check for
prolapsed cord
 If cord prolapsed into vagina, exert upward pressure against
presenting part to lift part off cord
 Get help to move mother into a position where gravity assists in
getting presenting part off cord
 Administer oxygen and prepare for immediate cesarean birth
 If cord protrudes outside vagina, cover with sterile saline  Breastfeeding
 Do not attempt to replace cord  Early ambulation
 Notify physician UTERUS
 Empty bladder
PRECIPITATE LABOR  One hand at the level of the umbilicus and the other hand
 Labor of <3 hours right above the symphysis pubis (uterine massage)
 ASSESSMENT FINDINGS: o Firm
o History of previous precipitous labor and delivery o Uncontracted – baggy
o Desire to push
 NURSING INTERVENTIONS:
o If you have to, deliver the baby yourself
o Assess the client’s affect and the ability to understand
directions, as well as other resources available (other
physicians, nurses, auxiliary personnel)
o Stay with the client at all times
o Do not prevent birth of baby
o Maintain sterile environment if possible
o Support baby’s head as it emerges

PREMATURE RUPTURE OF MEMBRANES

 Loss of amniotic fluid prior to term, unconnected with labor
 Assessment findings:
o A report from mother/family the discharge of fluid
o pH of vaginal fluid: 7 to 7.5 pH alkaline (amniotic fluid)
 Nursing Interventions:
o Monitor maternal/ fetal vital assigns on continuous basis
o Observe for signs of infection and for signs of onset of
LOCHIA
labor
o If signs of infection, administer antibiotics as ordered and  Occurs in 3 stages
prepare for immediate delivery  Classified according to its appearance and content
o If no maternal infection, induction of labor may be delayed  Total amount of lochia varies by person
o Observed and record color, odor, amount of amniotic fluid Lochia Color Duration Composition
Rubra Red 1 to 3 days Blood,
o Examine mother for signs for prolapse cord
decidua
o Provide explanations of procedures and findings and mucus
support mother/ family Serosa Pink/Brown 3 to 10 days Blood, mucus,
o Prepare mother/ family for early birth, if indicated leukocytes
Alba White 10 to 14 days Mucus, high
PROLONGED LABOR leukocyte
 Pregnancy lasting beyond the end of the 42 weeks count
ASSESSMENT FINDINGS:
o Measurements of fetal gestational age for fetal maturity AMOUNT
o Check also for biophysical profile Scant Bloody only on tissue when
o Assist with amnio-infusion, if ordered to increase cushion for wiped or less than 1-inch stain
on peripad within 1 hour
cord.
Light Less than 4-inch stain on
NURSING INTERVENTIONS:
peripad within 1 hour
o Perform continual monitoring of maternal/fetal vital signs
Moderate Less than 6-inch on peripad
o Support mother through all testing and labor within 1 hour
o Assisting with amnio-infusion, if ordered to increase cushion for Heavy Saturated peripad within 1 hour
cord.
UTERINE ATONY
FETAL DISTRESS  A uterus that lacks tone (not contracting).
Baby experiences oxygen deprivation  Assessed using Uterine Massage.
Contributing factors: CERVIX
 Cord compression Begins contracting back down to its previous size.
 Placental abnormalities
 Pre-existing maternal conditions
ASSESSMENT FINDINGS:
 Decelerations in FHR
 Meconium-stained amniotic fluid
NURSING INTERVENTIONS:
 Check FHR
 Conduct vaginal exam
 Place mother on left side, administer oxygen, check for
prolapsed cord, notify physician
 Support mother and family
 Prepare for emergency birth if indicated

POST-PARTUM PERIOD
Puerperium
 The period of about six (6) weeks after birth
Involution VAGINA
 The return of the uterus to its pre-pregnancy state  Designed to stretch and accommodate a baby.
FACTORS THAT PROMOTE INVOLUTION  The tissue will usually shrink back down to its pre-
 Uncomplicated labor and birth pregnancy state.
 Complete expulsion of amniotic membranes and placenta
 PERINEUM TAKING IN TAKING HOLD LETTING GO
 Suffers a lot of stress and changes during pregnancy and First 1-2 days 3 days – 2 weeks Varied time frame
childbirth Time of reflection Assumes mothering Gives up old roles
CHANGES OF THE VITAL SIGNS: AFTER DELIVERY role
BP May be increased Passive, dependent Strong interest in Bonding process is
PR Slower than normal caring for baby facilitated and
RR Remains within the normal parenting skills
range enhanced.
Temperature Slightly increased Seeks attentions, Makes own Nursing alert:
** Changes reflect the internal adjustments that occur as a woman’s talkative decisions, initiates Post-partum blues
action (overwhelming
body returns to its pre-pregnant state**
Little interest in Nursing Alert: Best sadness) may
caring for baby time for health develop
GENERAL APPEARANCE
Nursing Alert: not a teaching
 Progesterone and Estrogen – (↓) Decrease good time for health
 Prolactin – (↑) milk let-down reflex teaching
 Oxytocin – (↑) milk production; contractions to prevent bleeding
URINARY CHANGES POST-NATAL RISK:
 Hydronephrosis – trauma and edema to the bladder POSTPARTUM HEMORRHAGE
 Diuresis – 12 hours after the woman has delivered  >500ml blood loss
 Void 6 to 8 hours after delivery MAJOR CAUSES:
 Bladder distention  Uterine atony
 Laceration
CIRCULATORY CHANGES  Retained placental fragments
 Blood loss is expected but should not go beyond 500ml - normal  Placenta accrete – problem with the separation of the placenta
delivery; 1000ml – Cesarean ASSESSMENT FINDINGS:
 Hematocrit usually returns to pre-pregnancy value within 4-6  Boggy uterus
weeks  Lacerations
 WBC count increases  Dark red blood, with clots
GASTROINTESTINAL CHANGES  Hemorrhage immediately after delivery with atony or lacerations
 Bowel is sluggish after birth  With retained placental fragments, delay of up to 2 weeks
 Lingering effected of progesterone  With severe blood loss, signs of shock
 Decreased abdominal and intestinal muscle tone  Full bladder
 Bowel movement may not happen for 2-3 days SUBINVOLUTION
 Urine – delayed few hours Failure of the uterus to revert to pre-pregnant state
 Feces delayed for 2-3 days ASSESSMENT FINDINGS:
INTEGUMENTARY CHANGES  Uterus remains enlarged
 Striae Gravidarum – permanent; stays even after delivery  Fundus higher in the abdomen than anticipated
 (+) Homan’s sign – (checks for thrombophlebitis) Dorsiflex the  Lochia does not progress from rubra to serosa to alba
ankle while observing for pain in the calf area and popliteal area  If caused by infection, possible leukorrhea and backache
EPISIOTOMY NURSING INTERVENTIONS:
Check for:  Teach client usual pattern of uterine involution
 Redness in the area  Teach client to recognize unusual bleeding patterns
 Ecchymosis/ bruising (purplish color)  Instruct client to report abnormal bleeding
 Edema (swelling) of the perineum PUERPERAL INFECTION
 Discharge from the episiotomy  Any infection of the reproductive tract associated with giving
 Approximation of the skin edges – intact incision birth
o If not approximate – can affect wound healing  Usually occurring within 10 days of the birth
Let the patient know: ASSESSMENT FINDINGS:
 After delivery the soft tissue in and wound the perineum may be  Fever
swollen and bruised  Abdominal, perineal or pelvic pain
 Initial healing – within 2-3 weeks  Foul-smelling vaginal discharge
o Sitz bath may help.  Nursing sensation with urination
o Kegel’s exercise  Chills, malaise
 Complete healing may take 4 to 6 months  Rapid pulse and respirations
PROGRESSIVE CHANGES  Elevated WBC count; positive culture/sensitivity report for
LACTATION causative organism
Enlargement of breast NURSING INTERVENTIONS:
 Transitional fullness usually lasts about 24 hours  Forcing fluids – to flush the organism causing infection (3L)
 Soft enough for the baby to nurse  Administer antibiotics and other medications as ordered.
 No pain but a sense of fullness to the breast will occur )3-5  Treat symptoms as they arise
day post-delivery)  Encourage high-calorie and high-protein diet – promotes and
 Fullness is normal and will resolve helps tissue repair
Engorgement of breast  Position client in semi to high-fowlers – stops/ impedes organism
 Overfilling and swelling of the breast and/ or areola transportation.
 Painful, warm to the touch, skin will appear shiny and taut  Support mother if isolated from the baby
 Can occur at any time THROMBOPHLEBITIS
 Breastfeeding is key Formation of a thrombus when a vein wall is inflamed.
Lactation May result from:
 If not lactating, menses may resume in 4-6 weeks  Injuries – trauma
 If lactating, menses less predictable, may resume in 12-24  Infection – that sticks in the vein wall and multiplies
weeks  Normal increase in circulating clotting factors in the pregnancy
PSYCHOLOGICAL CHANGES and newly delivered woman (abnormal increase)
Taking In – mother thinks of herself, first ASSESSMENT FINDINGS:
Taking Hold – new role as a mother  Pain – LEG: Pain, redness, edema in the affected area
Letting Go – varies from woman to woman; letting go of old functions  Elevated temperature and chills
and old roles.  Peripheral pulse may be decreased
 Positive Homan’s Signs
 If in deep pain, leg may be cool and pale
NURSING INTERVENTIONS
 Maintain bed rest with leg elevated on pillow
 Apply moist heat as ordered – dilation
 Administer analgesics as ordered
 Provide bed cradle to keep sheets off leg]
 Do not massage the leg – may dislodge the clot - embolism
 Administer anticoagulants therapy as ordered and observe
clients for signs of bleeding
 Apple elastic support hose if ordered
 Allow clients to express fears and reactions to conditions
 Observe client for signs of pulmonary embolism
 Continue to bring baby to mother for feeding and interactions

MASTITIS
Causative organism: Hemolytic Staphylococcus Aureus
ASSESSMENT FINDINGS:
 Redness, tenderness or hardened area in the breast
 Maternal chills, malaise
 Elevated vital signs – ↑Temperature
NURSING INTERVENTIONS
 Teach/ stress importance of hand washing
 Administer antibiotic as ordered
 Apply ice if ordered between feelings
 Advice mother to use breast cells –
 Empty breast regularly

URINARY SYSTEM DISORDERS

URINARY TRACT INFECTION
POSSIBLE CAUSES
 Bacteria, coupled with bladder trauma
 Break in technique during catheterization
ASSESSMENT FINDINGS
 Pain
 Fever
 Burning, urgency, frequency pm urination
 Increased WBC count and hematuria
 Urine culture positive for causative organism
NURSING INTERVENTIONS
 Check status of bladder frequency in postpartum client
 Use nursing measure to encourage client to void
 Let client listen to water flowing to stimulate voiding.
 Squatting or sitting down.
 Force fluids; may need minimum of 3 liters/day
 Catheterize client if ordered, using sterile technique
 Administer medication as ordered
 Monitor status or progress through continuing lab test
 Support mother with explanations of interventions
 No need for baby to be separated from mother

URINARY RETENTION
ASSESSMENT FINDINGS:
 Distention of the bladder
 Monitor I and O
NURSING INTERVENTION
 Encourage to void
 Catheterization