PH Intensive Notes Maternal and Child Nursing 1

Abarquez, Amil, Auza, Son
1
MATERNAL AND CHILD NURSING Clitoris: For OB purposes: it serves as a
INTENSIVE REVIEW LECTURE landmark (female catheterization insertion)
September 3-4, 2022
● Note: You would know the catheter
is inserted when there is
DAY 1 spontaneous urine output. If none, it
went into the vaginal uterus
“Soar high, because for sure you will ● Note: You cannot reinsert catheter if
gain success.” - Si ma’am you mistakenly put it wrongly as the
___________________________________ vagina is non-sterile
OBSTETRICS Urinary meatus - located below the clitoris

and above the vagina
TOPIC 1: Anatomy of the Female Perineum - where episiotomy is performed,

Reproductive System prone to laceration
Topic Outline: Vaginal introitus / vaginal opening -

● Part 1: External Genitalia larger than the urinary meatus.
● Part 2: Internal Genitalia
Other external vaginal parts
Part 1: External Genitalia ● Hymen
● Vestibule
● Fourchette
Note: There are vaginal suppositories and

rectal suppository medications. Make sure
you know where to place it depending on
the medications.
Why is clitoris important? - Because this

structure allows for sexual arousement in
the woman. Most sensitive part of the
woman’s body: excitement, plateau,
orgasm, resolution (males have refractory
period)
Orgasm is reached in 2 sites: clitoris and

vagina
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
- Aids in the growing baby

(accommodates the growing baby)
Part 2: Internal Genitalia - Also the organ of menstruation
Uterus Fallopian Tube

- Largest organ of the female - Composed of the Right and Left
reproductive system Parts
- Board Exam: Sites of Uterus: Upper - Interstitial, isthmus, ampulla,
part of uterus fundus. Isthmus, is infundibulum, fimbriae
the lower uterine segment. Cervix is - Function: Organ of fertilization
just a PART of the uterus, not a
separate organ. Ovaries
- Internal Os: That opens into the - Organ producing hormones estrogen
body of the uterus and progesterone
- Cervical canal - connects the - Follicles mature and grow in this site
external to internal Os - Where ovulation occurs
Layers of Uterus Vagina

➔ Endometrium - inner layer - Organ of soft passageway of baby
➔ Myometrium - Muscular Layer and of menstruation
➔ Perimetrium - outer - Organ of copulation
- It is important to keep vaginal pH
Function of a Uterus: acidic, from the Douderllins bacilli. If
- Organ of implantation too alkaline, it can predispose to
Color Coding:
3
develop an infection like
trichomonas vaginalis.
Ligaments: structures that keep the

reproductive organs in place
Homologous reproductive organs:

- Structures such as testes and
ovaries that arise from the same
same undifferentiated embryonic
tissues in males and females
Other Sources may differ: Some say up to
8, others have 4-6 days.
Phases of the Menstrual Cycle:
TOPIC 2: The Menstrual Cycle and

Family Planning Methods
Menstrual Cycle
- From the 1st day of menstruation to
the 1st day of the next menstruation
Phase 1 Proliferative (Follicular)
How to get the menstrual cycle: - Endometrium begins to proliferate
- Plot the first day of menstruation - Rapid growth. Increases thickness
each month by eightfold
- Identify the number of days each - Increase continues for 1st half of the
month menstrual cycle - approximately day
- Total number of days for the specific 5-14
‘month subtract the date of the first - Termed also as estrogenic,
day then add the date of the first day follicular or postmenstrual phase
of the following month
Phase 2 Secretory/Luteal
Example: - Where ovulation happens.
- Increase in estrogen receptor
content
- Formation of progesterone in the
corpus luteum causes the glands of
Color Coding:
4
the uterine endometrium to become The endometrial cycle is simply the
twisted in appearance and dilated portion within the menstrual cycle.
with quantities of glycogen and
mucin Conditions Related to Menstruation
- Other terms: Progestational, - Dysmenorrhea
Luteal, Premenstrual, or Secretory - Amenorrhea
Phase - Metrorrhagia
- Menorrhagia/Hypermenorrhea
Ischemic Phase: - Hypomenorrhea
- If (-) fertilization, the corpus luteum - Polymenorrhea
in the ovary begins to regress after - Oligomenorrhea
8-10 days - Menopause
- Progesterone and estrogen
production regresses Dysmenorrhea
- Withdrawal of progesterone - Painful menstruation
stimulation causes the endometrium - Primary: The pain but the pain is
to degenerate. relieved by resting or analgesic
(normal). Pain caused by
Menses: prostaglandins in myometrium
- Capillaries rupture with minute - Secondary: Unrelieved by resting, or
hemorrhages, analgesic. Most likely pathologic in
- Endometrium sloughs off nature, and need to visit a
- Discharges from the uterus: blood gynecologist.
(from ruptured capillaries), mucin
(from glands), fragments of Amenorrhea
endometrial tissue and microscopic, - Primary: cannot menstruate
atrophied and unfertilized ovum. - Secondary: Cannot menstruate due
to underlying condition like
post-hysterectomy or pregnancy
Note there is a difference between
Uterine and Menstrual Cycle. Metrorrhagia:
Key Points: - Bleeding in between periods
The uterine cycle describes
changes that occur in the follicles of the Menorrhagia/Hyper
ovary. It includes the increase in the - Normally 80mL
endometrium in preparation for implantation - More than 80mL is Menorrhagia
and the shedding of the lining following lack
of implantation, termed menstruation. Hypomenorrhea
Menstrual cycles are counted from - Scanty menstruation
the first day of menstrual bleeding until the - Less than 20mL
last day before the next menstrual bleeding.
Polymenorrhea
Color Coding:
5
- Short menstrual interval RH Bill - 10354 (Responsible Parenthood
- Like in a month twice complete and Reproductive Health Act of 2012,)
menstrual cycle
Natural Family Planning - Responsible
Oligomenorrhea Parenthood
- Someone who menstruates once
every few months, or even once a 1. Calendar Method
year. Example:
Days 14— 17 - possible day of ovulation,
Ovulation therefore, + 5-3 days before and after
- The release of the mature ovum (unsafe period)
from the ovary
- Occurs 14 days before the onset of LMP: Jan.8
the next menstruation ● 14th day - Jan.21
● 17th day - Jan,24
Example:
JAN. ... 16,17,18,19.20 (21,22.23,24) 25,
26,27
JAN.16- 27 — UNSAFE DAYS, therefore

put X on those dates and ✓ before and
after that dates.
2. Billing Method/Cervical Secretion

Method
MC: Subtract 14 from her shortest menstrual cycle,

and subtract 14 from her longest menstrual cycle.
This is the duration of ovulation for the woman. For
those regular cycle
For an irregular cycle, subtract 18 on the shortest

day, and subtract 11 on the longest day. In the
example anytime between Day 10 to 34.
Important to be aware of this menstrual

cycle as stipulated by the Reproductive
Health Bill. As this is important in health
teaching for family Planning. Senses vaginal wetness (cervical
secretion: spinnbarkeit) to detect fertility
Menstrual Cycle is a form of natural (Billing’s method)
planning under the Calendar Method.
3. Basal Body Temperature
Color Coding:
6
6. Lactation Amenorrhea Method:
- During lactation for 6 months
post-pregnancy, the mother is sterile
- However, the mother needs to
EXCLUSIVELY breastfeed, with
30-40 minutes per feeding, with 6
times or more in a day, or every 2-3
BBT relies on the woman’s resting (morning hours.
before activity) body temperature, which
goes up higher at the time of ovulation. 7. Behavioral Method:
- Coitus interruptus or Withdrawal
Board: The moment the temperature Method
drops and suddenly rises, by 0.3-0.6 - Ejaculation takes place
centigrade, then this is the day the outside the vagina
woman is ovulating. - Very HIGH failure rate
- Men have premature
Progesterone is the hormone of ejaculation, which has sperm
pregnancy as it keeps endometrium thick
and relaxes the uterine muscle. Because of - Coitus Reservatus
this the temperature remains high. - The man will not reach
orgasm
4. The Symptothermal Method -
(multiple indicator method) combines any Artificial Methods of Family Planning

two or three methods. It combines the
cervical mucus and BBT methods. Barrier Method
- Condom
The woman takes her temperature daily, - Cervical Cap
noting the rise in temperature that marks - Diaphragm
ovulation. She also analyzes her cervical - IUD
mucus everyday and observes for other
signs of ovulation which include Purpose: Blocks the entrance of the Sperm
mittelschmerz (mid cycle abdominal
pain).The couple mustt abstain from Female Condom:
intercouse until 3 days after the election of
temperature or the 4th day after the peak of
mucus change, because these are the
woman’s fertile days.
5. Abstinence: No sex lmao

○ Basically no sex
Color Coding:
7
- A string is present, the woman is
Male Condom: aware of its length: if it feels too
long, it may indicate that the IUD is
displaced.
Inhibits implantation through:
Cervical Cap/Cup
● Local inflammatory response

● Local production of prostaglandins
● Interference with enzymatic and
hormonal activity
● Increased motility of ovum in
fallopian tube
● It immobilizes sperms as they pass
Diaphragm through the uterus
- Only 6-8 hours
- No less than 6 hours, but no more
than 8 hours IUD Danger Signs (PAINS)
- Sperm can survive for around 8 P - Period late or skipped period
hours in vagina A - Abdominal pain (severe)
I - increased temperature, chills
Intrauterine Device N - Noticeable vaginal discharge; foul
smelling discharge
S - Spotting, bleeding, heavy periods, clots
Spermicides:
- Contraceptive Foam - most effective

- Contraceptive Jelly
Color Coding:
8
- Vaginally contraceptive film Situation: You decide to take your daily pill
- Sponge at 7pm. One day, upon looking at your pill
- Condom lubricated with spermicide pack, you realize that you forgot to take
yesterday’s pill. What should you do?
Answer: Take 2 pills, one from yesterday

and one due today. No need for a back-up
contraceptive method.
Implant: Norplant:
6 capsules of progestin are inserted

Oral Contraceptive Pill (OCP): subcutaneously in the woman'’s upper arm;
contraceptive effect lasts for up to 5 years
Danger Signs:
A - Abdominal pain (Severe)

C - Chest pain (severe with cough,
shortness of breath, or sharp pain on
breathing in)
H - Headaches (severe), dizziness,
weakness, numbness, especially if it occurs
on one side only.
E - Eye problems (vision loss or blurring),
speech problems)
S - Severe leg pain (calf or thigh)
Missed Pills
Sterilization
- Females: Bi-lateral Tubal Ligation
- Males: Vasectomy
- Series of sperm analysis is
done to check whether or not
completely sterile
Take into consideration this flowchart - After 16-20 ejaculation is the
will be situational in the board exam. first sperm analysis
Color Coding:
9
- 6-8 weeks 2nd sperm
Carl Balita:
analysis
- Per ejaculation - seminal fluid is
- 6 months - 3rd sperm
2.5mL containing 50-200million
analysis
spermatozoa per mL or 400million
- After nother 6 months - 4th
per ejaculation.
sperm analysis
- Fertilization occurs in the outer
- If zero at this time,
third (ampullary portion) of the
then it is completely
fallopian tube.
sterile.
- Hyaluronidase released by the
spermatozoa dissolves the layer of
cells protecting the ovum, which
How to help the patient decide on her
leads to penetration of ovum
method
- Upon fertilization, it makes zygote
1. Assess knowledge on family
- Only the father can determine the
planning
gender of the child - X carrying
2. Present patient the different
spermatozoon leads to XX
methods, advantage and differences
combination for female offspring;
3. Inquire on the patient’s decision and
Y-carrying spermatozoon leads to
act accordingly.
XY combination for male offspring.
The ovum carries X chromosome.
TOPIC 3: Fertilization Fertilization: Sperm Structure and

Function
How can a woman conceive a child? 1. The head contains the nucleus and
● Normal anatomy and physiology the enzyme-filled acrosome.
○ No hormonal balance a. Acrosome enzymes allow the
○ Regular ovulation sperm to penetrate the egg’s
● Detectable ovulation periods barriers.
● Partner should also be fertile, with 2. The neck encloses a centriole.
healthy structure of sperm (big head, a. The centriole will fuse with a
has a neck, long, motile tail) second centriole, contributed
by the egg, to form the
Factors that affect sperm motility: centrosome.
1. Sedentary lifestyle 3. The midpiece is packed with
2. Smoking mitochondria, which produces the
3. Alcoholism ATP necessary for movement.
4. Low resistance to infection 4. The tail has a flagellum that acts as
a propeller.
Fertilization:
Fertilization: generalized acrosomal
process
Color Coding:
10
1. Sperm makes contact with egg
2. Acrosome reacts with zona pellucida
3. Acrosome reacts with perivitelline
space
4. Plasma membranes of the sperm
and egg fuse
1. Process of Capacitation
a. There will be the removal of
the protective coating of the
sperm.
b. The sperm will go into the
acrosomal reaction - once
the sperm meets the ovum,
there is a rupture on the
head part, which releases an
enzyme (hyaluronidase).
This enzyme dissolves crown
of ovum
c. Fertilization occurs in the
fallopian tube, specifically,
the ampullar/outer third of
fallopian tube.
Board Exam: sometimes ampulla is not a

choice, rather, it is stated in the choices
as the “outer two-thirds of the fallopian
tube”. Take note of this keyword, this
means ampulla. Female: XX
Male: XY
Fertilization occurs within 24 hours.
44 autosomes - DNA, RNA
Color Coding:
11
Who is responsible of giving sex to the 4. Early blastocyst becomes a late
child? blastocyst as it exposed / outer layer
● Answer: Male (protoblast) adheres to the
endometrium
Which sex chromosom is the male
determinant: What cell is responsible for
● Answer: Y implantation?
Answer: Blastocyst
What carries the X / Y in males?
● Answer: Sperm What part of a cell, which is part of the
blastocyst that adheres to the
endometrial wall?
Implantation: Answer: Trophoblast
What is the most common site of

implantation?
Answer: Most common Implantation occurs
at the upper ⅔ and posterior fundal portion
of the uterus.
- Allowed on other sites isthmus,
anterior etc. but most common
What occurs when implantation occurs

in the cervix?
Answer: Placenta previa
When the zygote (fertilized egg) does not

reach the uterus, an ectopic pregnancy will Carl Balita:
occur. - It takes 3-4 days for the zygote to
journey to the uterus (where
Stages of Fertilization: implantation will take place) and
1. Mitosis: Rapid cell division occurs of during that journey, mitotic cell
the zygote. Produces two division happens.
blastomeres, then four, then eight. - Floating freely in the uterus for the
2. Eight blastomeres are still next 3-4 days, the morula (16 to
uncompacted, and gradually 50 cells with bumpy appearance
compacts as they descend to the resulting from mitotic division)
uterus and becomes one morula grows to become blastocyst with
3. Morula gets surrounded with early trophoblast cells (forming placenta
fluid and becomes a early- stage and membrane later in
blastocyst, free floating for 3-4 days. development).
Color Coding:
12
- Therefore, it takes 7 to 8 days
from fertilization to implantation.
- Most common Implantation
occurs at the upper ⅔ and
posterior fundal portion of the
uterus.
- On implantation, the structure is
called embryo, until 8-9 weeks
when it begins to be referred to as
a fetus.
- Implantation bleeding (mistaken
as menstrual period) results from Three decidual layers:
capillary rupture on implantation 1. Decidua basalis: future placenta
and usually happens a week 2. Decidua capsularis: “capsule” bag of
before the expected next water or amniotic cavity/ sac /
menstrual period. amniotic fluid
- Endometrium (the inner lining of 3. Decidua parietalis: remaining portion
the uterus) is termed decidua of the endometrium
What is the ideal site in the uterus for

implantation? Fetal Membranes:
Answer: Endometrium
What happens when implantation occurs

in the myometrium?
Answer: Placenta accreta
Placenta accreta is a serious pregnancy Chorion: develops from trophoblast,

condition that occurs when the contains chorionic villi on the surface
placenta grows too deeply into the Amnion: develops from the interior cells of
uterine wall. Typically, the placenta the trophoblast
detaches from the uterine wall after
childbirth. With placenta accreta, part or
Umbilical Cord (Short Review)
all of the placenta remains attached. This
can cause severe blood loss after - The main communicating system
delivery. between mother and baby via
placenta
- The presence of three blood vessels
AVA (Artery, Vein, Artery)
Decidua:
Color Coding:
13
- The vein carries oxygenated blood, the fluid if too much, this may indicate
and arteries carry the unoxygenated the baby may have esophageal atresia.
blood
- Vein has a larger hole, while artery is Placenta
smaller
- Wharton’s jelly -, it prevents the
kinking of the umbilical cord, despite
its length of 19-21inches or between
50 and 60 cm
- Has blood rushing to it,with
approximately 500 ml of blood flow
per minute left: fetal surface; right: maternal surface
● Formed by 12 weeks AOG

Histology of Umbilical Cord: ● Divided by either fetal or maternal
surfaces
Schultze - Fetal Surface: Shiny, glistening

and visible blood vessels. Grayish white in
color. (shiny schultze)
Duncan - Maternal Surface: Dirty, gritty,

has cotyledons 15-20 pieces (dirty duncan)
Natural Characteristics that promote safety
during pregnancy
Process Involved in Placental Exchange
Amniotic fluid
● Simple diffusion - for water,02 &
- Prevents cord compression
CO2, electrolytes like sodium &
- Cushions the fetus
chloride, anesthetic gasses & drugs.
- Creates equal pressure
● Facilitated transport — glucose,
galactose, and some oxygen
Vernix caseosa: secreted by sebaceous
● Active transport - amino acids, Ca,
glands of the baby for protection, cannot be
Fe, iodine, water soluble vitamins.
easily removed by water, but by oil
● Pinocytosis — controls larger
molecules such as globulins, viruses
Oligohydamnios may indicate a kidney
and antibodies
problem in the fetus, due to lack of fluid.
Ideal anesthesia/ sedation: Local or
Polyhydramnios may lead to
pudendal block: DOC - xylocaine
complications as the baby may swallow
Color Coding:
14
Note: Amino acids are building blocks of 1. In a woman having a 30 day cycle,
protein, which promotes growing (Grow). fertilization occurs on the 14th day of
Important to monitor weight gain in mothers. her cycle.
If no weight gain, this may limit the child. Answer: False - expected on 16th
Have it checked via food diary day (30-15 = (+1 ovulation) = 16)
How much protein is recommended for a 2. Spinnbarkeit is the most reliable sign
pregnant woman per day? of ovulation
Answer: 76 grams Answer: True - changes in the
cervical mucus can determine
Fetal Circulation Review: ovulation
3. Progesterone increases the BBT

during pregnancy
Answer: True
4. The sex of the fetus is determined at

the moment of fertilizations.
Answer: True - keyword:
determined; if “distinguishable,” this
becomes false as this concerns the
naked eye
5. Mitosis is a process of cell division

that occurs during the fertilization
Answer: False - mitosis is for
implantation; meiosis is for
fertilization.
6. Decidua is the specialized

myometrium of pregnancy
Answer: False - endometrium, not
myometrium.
7. Amnion is an outer fetal membrane.

Other Functions of the Placenta: Answer: True - amnion is outer,
1. Excretory system chorion is inner
2. Endocrine system
Practice Test (T/F) 8. There is only one sperm that can
Questions: fertilize an ovum in a normal
singleton pregnancy
Color Coding:
15
Answer: True - singleton pregnancy ● Estrogen
(only one sperm) ● Progesterone
● HPL / HC-Somatomammotropin
9. An enzyme hyaluronidase is
released during the process of Note: Because of the production of
capacitation estrogen and progesterone, the patient
Answer: False - not expected during experiences amenorrhea.
capacitation, but during acrosomal
reaction. Hormonal levels of HCG:
40 days pregnant- start of HCG secretion:
10. Pregnancy occurs during ovulation. nausea and vomiting may be seen
Answer: True - on the day of
ovulation, the pregnancy takes 60-70 days Peak HCG (about 400,000 -
place. 500,000 IU in 24 hours)
—---------------------- 70 days and beyond pregnant- HCG level

ideally subsides
Placenta - Cont.d
Endocrine Function: Estrogen:

The Trophoblast: ● Estrogen initiates the thickening of
During the implantation the trophoblast the endometrium; responsible for
differentiates itself into two layers: the maturation of ovum
● The syncytiotrophoblast (ST)
● The cytotrophoblast (CT) Progesterone
● Progesterone is responsible for the
1. Syncytiotrophoblast / Syncytial layer women’s secondary sex
● HCG characteristics
○ Responsible for positive ● Pregnancy hormone
pregnancy test ● Decreases peristaltic activity (effect:
○ Stimulates the corpus luteum constipation)
to produce the hormone
estrogen and progesterone Human Placental Lactogen (HPL) /
○ Vomiting HC-Somatomammotropin
○ However, with H. Mole may ● Breast Milk production as early as 4
produce a false positive months AOG
result. ● Milk ejection occurs postpartum
○ Peak of HCG 60-70 days, but
will normalize at 100 days
○ After 70 days, and HCG is 2. Cytotrophoblast (CT)
still high, then consider for H.
Mole
Color Coding:
16
Layer of the trophoblast that protects the Embryonic stage. This is because
mucus from spirochete syphilis, and organogenesis occurs here.
disappears by 20-24 weeks AOG
First half of pregnancy - there is protection Organ development stages:
1st month - Rapid development
development of 2 major organs (the heart
Stages of Fetal Development and the brain)
1. Ovum: starts from ovulation to - Major precipitating factors that leads
fertilization to neural tube defects? - Folic acid
2. Zygote: fertilization to implantation deficiency (highest risk during the
3. Embryonic: 2 weeks - 2 months/ 8 first month of pregnancy)
weeks, most critical stage as
organogenesis occurs here Possible Diseases if the baby is preterm:
4. Fetal Stage: 2 months until Hyaline Membrane Disease and/or
termination Respiratory Distress Syndrome
Primary Germ Layers and its Derivatives
Topic 4 - Physiological Changes in

Pregnancy
Systemic Changes:
Cardiovascular System:
● Greater workload of the heart

● Greater blood volume 30-50%
○ = Cellular—45%
○ = Plasma—55%
○ More of the blood volume is
contributed to the plasma
Favorite Board Exam Question: ● Easy fatigability
What is the layer that arises the nervous ● Palpitation
tissue? ● slight cardiomegaly/murmurs
- Ectoderm ● Hemodilution of pregnancy
○ Pseudo anemia in
Try to memorize the germ layers and pregnancy
anatomical developments that arise. ● results in MILD ANEMIA
Nursing Interventions: Promote rest, but

What is the most critical part of the not complete bed rest.
pregnancy in regards to the growing baby? -
Color Coding:
17
Note: It is not normal that a woman has
increased blood pressure. Urinary Tract
● Frequency of urination (1st and 3rd
What is the intervention for varicosities? trimester)
- Elevate legs for 15 minutes at least ○ 2nd trimester - uterus will get
2x a day. out into the abdomen
● Emphasize importance of perineal
Respiratory System: care (wash from the front to back)
● Shortness of Breath ● Ureters: Become dilated and
○ Increased size of abdomen elongated due to mechanical
will compress diaphragm pressure
○ Position client on left-lateral ● GFR: Increases early in pregnancy
position or semi-fowler’s ● Glycosuria may be evident because
of decreased renal threshold for
Gastro-intestinal Tract glucose
● Nausea and Vomiting ● Protein in the urine should be
○ Dry biscuits upon waking in reported because it may be a sign of
the morning hypertensive disorder of pregnancy
● Constipation or renal problem
○ Progesterone is the cause
○ Inform to increase fluids Musculoskeletal
(except night time) ● Lordosis
○ Exercise should be done ○ Center of gravity is towards
such as walking or the front, affecting the
swimming. But no heavy curvature of the spine
lifting. ● Waddling Gait
○ Avoid laxative and/or enema ○ Due to wider base of support
as this can induce labor ● Leg Cramps
● Pyrosis/heartburn ○ Caused by calcium and
○ Eat small, frequent feedings phosphorus imbalance (need
as the stomach contents will to drink milk at least 1200
rise (acidic) mg/day)
○ Avoid lying down after eating, ○ Put legs on a flat surface:
rather walk or sit affected leg down on the
○ When picking something up, floor and dorsiflex the toes
bend to the knees and not to (DO NOT MASSAGE) as
the waist massaging will increase pain.
○ Medical management for
pyrosis: antiemetics Local Changes:
(nausea/vomiting) and Uterus:
antacids (pyrosis) - Hegars
Color Coding:
18
- Softening of the lower uterine
Nausea and
segment (Isthmus part) vomiting Ballottement -
- Goodells sinking/rebounding
- Softening of the cervix Amenorrhea of fetus
- Operculum-cervix
- Mucus plug over the cervix of ^ first three are Serum lab test
the body earliest signs of
pregnancy raw / Chadwick’s Sign
most exaggerated - Bluish or
Breast signs of pregnancy purplish
- Enlargement (2-3 weeks) discoloratio
- Colostrum n of vagina
Frequent urination
Vagina Cervical Softening:
Fatigue Goodell’s sign
● Chadwick’s sign
- Softening of
○ Bluish discoloration of the Vaginal and the cervix
vaginal wall cervical color
● Leukorrhea changes Changes in uterine
● Slightly alkaline consistency:
○ Moniliasis Quickening Hegar’s Signs
- Softening of
Breast and Skin the uterus
Skin
Changes:
● Chloasma Melasma - mother Braxton hicks
● Striae gravidarum is the only who is contractions
● Linea nigra aware of any - Painless
presence of skin irregular
Ovary changes, especially palpable
discoloration uterine
contraction
Linea nigra
Weight gain: Pregnancy tests
● 25-35lbs Striae gravidarum (positive)
● 1 lbs per month on first trimester
● 1lbs per week on the second or third ^ (melasma until
trimester striae) starts to
appear during 24
weeks of
pregnancy
Confirmation of Pregnancy Movement of the

baby felt only by
the mother
Presumptive Probable
Breast Changes Abdominal

enlargement Positive Sign
Color Coding:
19
● Officially diagnosed pregnancy S - Souffle, contraction & braxton hicks
(through lab tests), and data is (Painless contractions at 28 weeks)
objective and can be documented by
the nurse. Mnemonic: To arrange Hegar’s, Goodell’s and
● POSITIVE SIGNS Chadwicks signs, arrange the name in order (C,
○ Auscultation of Fetal Heart
G and H) and assign them to the reproductive
Sound (FHR)
system from external to internal (Vagina, Cervix,
○ Fetal movements felt by
Uterus). In this case, Vagina = Chadwick’s,
examiner usually after 20
Cervix = Goodell’s and Uterus = Hegar’s signs.
weeks
○ Visualization of Fetus by
Ultrasound (Movement)
Antepartum Assessment & Care:
Note: positive signs contain the word
“fetus” Objective:
● Antepartum care is to ensure that
Keyword “Active fetal movement” is a
pregnancy ends in the birth of a
positive sign. But “First fetal movement”
healthy infant without impairing the
is a presumptive sign as it is a sign of
health of the mother
quickening.
● Ideal frequency of visit for Prenatal
○ 1st-7th months - encourage
the client to visit a healthcare
Mnemonic:
provider every month. (7
Presumptive Signs: MACFLUQ
visits)
○ 8 month - every 2 weeks (2
M - Morning Sickness
visits)
A - Amenorrhea
○ 9th month - every week. (4
C - Changes in Breast
visits)
F - Fatigue
■ 13 visits in total
L - Lassitude ( lack of energy.)
U - Urinary Frequency
Q - Quickening (18th - 20th week)
3 phases of antepartum care:
1. Pre-consultation
Probable Sign: CHUPBOGS
2. Consultation
C - Chadwicks
3. Post consultation
H - Hegar
U - Uterine Enlargement (at 12 weeks felt
just above symphysis pubis)
Pre-consultation phase
P - Positive pregnancy test
● Rapport - history taking
B - Ballottement - sinking and rebound of
○ Personal history
fetus
○ Medical history
O - Outlining of fetal body
○ Family history
G - Goodells - Softening of the Cervix
○ Obstetric history
Color Coding:
20
■Menstrual history the abnormal growth of
(MIDAS) trophoblasts
● Menarche ■ Partial Mole
● Interval ■ Complete Mole
● Duration
● Amount ●
P = Parity
● Signs / ○ Number of pregnancies that
Symptoms reached >= 20 weeks or
■ Previous and present fetus >= 500 g
pregnancy ○ Number is not affected by
● Gravidity and multiples (e.g. twins)
Parity is ○ Counted once pregnancy is
questioned delivered
here T = Term
● AOG ● P = Preterm
● Antepartum assessment ● A = Abortion
○ VS ● L = Living
○ Leopold’s Maneuver
○ FHT Duration of Pregnancy:
○ Fundal height measurement - 266-280 days; Term 38-40 (42
○ Weight weeks)
○ PE - Above 42 weeks - Post-term
○ Fetal weight - Below 38 weeks - Pre-term
○ Fetal length - Below 20 weeks - Abortion
GPTPAL LMP - EDC / AOG

● G = Gravidity ● LMP (known) Naegel’s Rule ->
○ How many pregnancies subtract 3 months and days
○ Normal or abnormal ● If LMP is on the 1st 3 months of the
pregnancy should be year, add 9 months and 7 days
counted ● Example: January 8
○ Blighted ovum - A ○ LMP: 1-8 (Jan 8)
pregnancy where the embryo ○ + 9-7 (Add 9mos and 7 days)
is empty. Should still be
counted
○ Hydatidiform Mole - Bartholomew’s Rule
grapelike cluster filled with - For those who cannot remember
vesicles, and is considered their last menstrual period
as a molar pregnancy — also - Bartholomew’s rule of fourths
known as hydatidiform mole calculator calculates the estimated
— is a rare complication of AOG of a fetus depending on the
pregnancy characterized by height of the fundus.
Color Coding:
21
- If fundic is on umbilicus - then it is 5
months or 20 weeks Nipple Pinch Test for Breastfeeding:
- The fundus is not palpable below 3
months AOG.
- Allow patient to urinate prior to
procedure
Abnormal:
● Flat - the nipple stays flat
● Inverted - the nipple pulls
Intervention: Massage and/or pull out the
nipple
McDonald’s Rule
- You will measure the fundus
- From the base of the uterus, to the Formulas concerning the Fetus:
fundus
- Fundal height in cms x 2 / 7 Haase Rule:
= Age in months ● Length of the Fetus
- Fundal height in cms x 8 / 7 ● AOG (1-5 mos.) - square the age in
= Age in weeks mos.
- Quickening - Primi (20 ○ E.g if AOG is 3 mos then
weeks / 5th month) Multi 9cm
(16 weeks / 4th month) ● AOG (6-10mos) - multiple the age in
The Formula of Quickening: mos. By 5
- Least accurate ○ If AOG is 8 mos then the
- However, it can be used if there is fetus is 40cm
no other option.
- Inquire on when they experienced
quickening (primi 5th month, multi is Johnson’s Rule
5th month) then add following ● Considers the weight of the fetus in
months according to formula below. grams
- Primi (5th month) add 4 months and ● Formula: (fundal height in cm) - n
40 days xk
- Multi (4th Month) add 5 months and ○ K is constant, it is always 155
4 days
Color Coding:
22
○ N is 12 if the fetus is If the fundus area is rough and filled with
engaged; 11 if not yet ridges, then it is breech presentation.
engaged
● Example: A fundal height of 28cm,
and the fetus is not engaged
○ 28cm - 11(n) x 155(k)
○ 17 x 155 grams = 2635
grams
○ Term baby (normal: 2500
grams)
Note if baby is below 500g then the baby is

abortion, if baby is below 2500g then it is
preterm.
Third Maneuver (Lower Pole)
- Paulick Grip
Leopold’s Maneuver - Assess for Fetal Engagement
- Systematic way of identifying fetal
position Note: In general you need to read charts
and receive gravidity and para, and
First maneuver (Upper Pole) consider AOG. Because for women who are
- Fundal Grip primi the baby is engaged 2 weeks before
- Fetal Presentation labor, multi the baby is engaged on the day
of labor, or during labor.
- Example: If the mother is primi and
Second Maneuver (sides of maternal 28 weeks AOG, and engagement is
abdomen) felt then it could indicate that there is
- Umbilical grip a risk for premature delivery (primi is
- Fetal back 2 weeks before delivery with
engagement)
Fourth Maneuver (Presenting Part

Evaluation)
- Pelvic Grip
- Fetal Position: if baby is in a vertex
position, it is expected that the
mother might go in a vaginal delivery
due to the smallest AP cranial
If the fundus is soft, rounded and not diameter aligning with the birth canal
palatable, then it is cephalic presentation
Color Coding:
23
Consultation Phase: ● Triple Analyte Screening - identifying
● Establish Rapport birth defects and chromosomal
● Identify high risk pregnancy (History anomalies
Taking) ○ Levels of unconjugated
estriol
Laboratory Exam: (Explored on Day 2) ○ Levels of HCG
● CBC ○ Alpha fetoprotein (AFP)
● Maternal Serum Alpha Protein
● Glucose (1hr 50g glucose load test) Elevated maternal serum
● Blood type ABO alpha-fetoprotein (MSAFP)
● Rh factor ● Open Neural tube Defects
● Coomb’s Test ● Fetal Distress and Death
● Multiple Gestation
Infection: ● Maternal Diabetes Mellitus
● Rubella Titer ● Rh Isoimmunization
● Syphilis
Low levels of MSAFP and estriol, along
Vaginal and Cervical Smear with high levels of hCG
● Gonorrhea ● Down syndrome
● Chlamydia ● Maternal hypertensive
● Gram positive Streptococcus
● Hepatitis B surface antigen Decreased alpha fetoprotein (MSAFP)
● Tuberculosis ● Maternal Hypertensive state
Urine
● Glucose, ketones, albumin
● Cells: leukocytes, RBCs, bacteria
casts Procedures that concerns Assessment
● Specific gravity of Fetal Health:
Biophysical Assessment:
- Ultrasonography
Procedures that Concerns Assessment
of Fetal Health Indications of Ultrasonography:
● <10 fetal movement in 12 hours First Trimester:
● Lack of movement for 8 hours - Early dating and confirmation of
● Sudden increase in violent pregnancy
movements especially if followed by - Detection of IUD
reduced movement - Diagnosis of Ectopic pregnancy,
multiple gestation
Biochemical Assessment - Assessment of Placental Location
Second And Third Trimester:
Color Coding:
24
- Assessment of: ● Guided via ultrasound
- Placenta
- Fetal Body Structure
- Fetal Growth
- Fetal Position & Presentation
- Visualization of fetus, placenta
amniotic cavity during amniocentesis
- Diagnosis of Fetal Viability
- Biophysical Profile Score
Abdominal Ultrasound Electronic Fetal Monitoring (EFM)

- Allow patient to drink fluids for better
visualization
- During the 2nd or 3rd trimester, fluid
may not be as needed since
amniotic fluid has increased, but
also dependent on obstetricians
preference.
Transvaginal Ultrasound The indications of EFM included induction of

- Allow patient to urinate labor, concern about fetal heart rate,
prematurity, epidural, meconium stained
Chorionic Villus Sampling liquor, syntocinon, trial of scar,
● Catheter inserted through vagina malpresentation, associated medical
into uterus to sample villi of placenta problems, reduced fetal movements,
with the help of ultrasound Antepartum hemorrhage (APH), post
● Biopsy and chromosomal maturity, and unable to ascertain
analysis of chorionic villi reason.dd a little bit of body text
● More fetal cells, earlier in pregnancy ● External transducer - placed on the
(10-12 weeks AOG), can be done as outside of the womb
early as 8 weeks
Non Stress Test
Fetoscopy:
● Direct visualization of the fetus using
a fetoscope
Color Coding:
25
Mom is asked to click the button whenever
she feels that her baby moved - an arrow
will be indicated in the rhythm strip.
Normal:
● Reactive: Fetal heart tone will
increase in about 15 bpm for 15
seconds when movement is present.
● Monitor the mother and the baby
specifically.
Rhythm strip Abnormal:

● Non-reactive: no change in the
● Electrode is externally attached into fetal heart tone / less than 15
the skull of the baby to assess bpm/ 15 bpm in less than 15
well-being seconds when movement is
present
● Fetal distress/ fetal compromise:
Procedure: The use of External Electronic position the mother on her left
Fetal Monitor where a rhythm strip comes side to increase perfusion to the
out. baby
● Oxygenate the mother (no need for
Criterion for Measurement: Effect of fetal doctor’s order)
movement to Fetal Heart Rate ● Report the patient immediately to the
doctor
Normal finding: Presence of 2 or more ● Anticipate that possible termination
accelerations of FHR of 15 beats/min for 15 of pregnancy can occur, or wait until
sec or more occurring after fetal movements the term period of pregnancy is
in a period of 20 mins. Basically increased reached - this is determined through
FHR the contraction stress test
Note: Contraction Stress Test

- If the baby is not moving, the mother ● Criterion for Measurement: Effect
is given juice. of Uterine Contractions produced by
- In a 20 minute period of having the nipple stimulation on FHR
baseline data, it is expected to have ● Normal: No late decelerations with
3-4 movements of the baby. contractions (can continue
pregnancy, but under monitoring)
● Done ONLY if non-reactive result
Upper strip: fetal heart tone from non-stress test is seen, that is
Lower strip: contraction when contraction stress test is
recommended.
Color Coding:
26
2. Late Deceleration - Uteroplacental
Insufficiency
3. Variable - Cord Compression

a. The cord should not be
compressed for more than 5
minutes as it can cause
irreversible brain damage
Note: when uncompromised after a back-up

test shows compromise, then delivery is
expected.
Types of Deceleration
● Assesses if the baby can withstand Biophysical Scoring / Biophysical Profile
the stress of the labor 4 Basic Criterion:
● Simulates 3-4 contractions in a 20 ● Fetal breathing movement
minute period. ● Gross body movement
● Fetal tone
● Qualitative Amniotic Fluid
Fetal heart tones during contractions:
Types of deceleration Uses Ultrasonography
1. Early Deceleration - normal PRN:
response, brings head ● NST
compression to the baby due to ● Placental
vagal stimulation. What to expect:
1. Lie on back with belly exposed
2. Non-stress test measures baby’s
heart rate
3. Ultrasound measures baby’s
movements
Grading
Color Coding:
27
○ Alters proper metabolism of
nutrients, leads to mental
retardation
○ End product: acetaldehyde ->
it causes congenital
anomalies
● Clothing
○ Pregnant mothers should
wear loose and light (no
—------------------------------------------------------- restrictive clothing)
● Employment
DAY 2 ○ Mothers can work, as long as
there are periods of rest, and
Post Consultation Phase not exposed to heavy lifting
and chemical exposures.
Post consultation involves and emphasizes ● Bathing
on health teaching. ○ Avoid tub bathing, risk for slip
and injury
Possible Health Teaching Topics ○ Greater risk for infection
● Exercises
● Nutrition ○ Kegel’s
■
○ Tailor Sitting
■ Strengthen perineal
muscles
○ Pelvic Rock
○ Squatting
■ Increased lean
muscle mass
■ More calories burned
○ ■ Improved total body
● Smoking (AVOID duh) circulation
○ General effect: ■ Improved mood
vasoconstriction ■ Helps the fetus
○ Baby ends up being SGA descend
● Alcoholism (AVOID parin) ○ Sex
○ Empty calories, can lead to ■ can be done during
baby developing fetal alcohol pregnancy as long as
syndrome (baby is the mother is gentle
intoxicated and will show and comfortable
symptoms upon birth) ■ But if the mother is
spotting or if the
Color Coding:
28
uterus feels Note: According to BB Emer, we focus now
hardened, or if the on SDG, but good to know that ENC is first
mother doesn’t feel derived from the MDG.
comfortable anymore,
stop immediately. Note:
■ What is daks si papi and In December 2000, 189 heads of States or
ang otin ma touch sa
Governments jointly endorsed the Millenium
baby? :( Answer:
Makahibaw na nga
Declaration which committed signatories to
engaged si baby :> achieving, by 2015, 8 MDGs. The
Philippines is one of the signatories to his
Board exam: Pelvic rock exercise helps declaration.
relieve backache and maintain good ● Of the 8 goals, Goals 4 and 5 relate
posture. to reduction of child mortality and
improvement of maternal health
Objectives:
By the end of the lecturer, the learner
should:
1. Identify the problems and
interventions of maternal and
neonatal mortality
2. Enumerate immediate newborn care
evidence-based practices that save
lives
3. Demonstrate the Essential
Intrapartum Newborn Care Protocol
Essential Intrapartum Newborn Care

(EINC)
Evidence based standards that are

recommended for adoption in the Philippine
Topic 5: hospitals with maternal and newborn care
ESSENTIAL INTRAPARTUM NEWBORN services and birthing facilities both in
CARE government and private sectors by the
(From Evidence to Practice) DOH, PHilHealth, and WHO
Millennium Development Goal: MDG Evidenced based practices- application of

ENC Targets: best research results when making decision
- Goal 4: Reduce Child Mortality about health care
- Goal 5: Improve Maternal Health
Color Coding:
29
Standards represent levels of practice
agreed in by the leaders in the specialty.
United Nations Summit (2000)

● Millennium Development Declaration
○ To reduce disease and
poverty by 2015 by achieving
the anti-poverty goals
The health of the woman and child plays a

role in all MDGs.
Of death among children under five

years of age and neonates in the world,
For the Philippines the target is to reduce 2000-03
the MMR from 209 to 52 deaths/100,000
live birth
Strategy to Address these Problems:
● DOH- conducted a study in 2009
among 51 largest hospitals in 9
regions in the Philippines to assess
the state of current birthing practice
● Results: performance and timing of
evidence-based interventions }
🤮
Resolution as introduced by Sec.
Francisco Duque
● Issued A0 2009-0025: Adoption of
ENC or Unang Yakap Protocol- to
20 child deaths for every 1,000 live births provide evidence-based. low cost,
(20/1,000) low technology package of
interventions
Color Coding:
30
Basic emergency Obstetric and Newborn

Care (BEmONC)
Comprehensive Emergency Obstetric

Newborn Care (CEmONC)
- If the mother and neonate cannot be
managed by BEmONC
- Will need referral to tertiary hospital
Maternal Newborn Child health and

Nutrition (MNCHN):
AO - 2008-0029
Essential Intrapartum and Newborn

Care:
● Rooming in and breastfeeding
● Breastfeeding and infant and infant
and young child feeding
● BreastfeedingBreastfeeding during
emergencies and disasters
● Newborn Screening and newborn
hearing screening
As seen from above, perinatal deaths are ● Postnatal and postpartum care
highest during labor and delivery. ● Birth spacing, family planning
● Health lifestyle
Causes of high Maternal and Neonatal ● Oral Health
Deaths:
● Lack of well equipped facilities EINC covers from Conception until 5 years
● Fragmented MCN programs of age
● NB most neglected
● Failure to integrate nutrition Be familiar with the following
● Lack of skilled health professionals. internationally organized MCN programs:
● EINC, EPI, IYCF, IMCI, MBFHI
Solution?
Every day, around 800 women die due to
Basic emergency Obstetric and Newborn pregnancy or childbirth related causes
Care (BEmONC) or Comprehensive (Maternal mortality fact sheet 2011. WHO)
Emergency Obstetric Newborn Care
(CEmONC) The causes of death are PREVENTABLE:
Color Coding:
31
1. Hemorrhage Objective 1: To detect diseases which
2. Pre-eclampsia may complicate pregnancy:
3. Infection
4. Unsafe abortions #3 Screen
5. Obstructed Labor ● Anemia
○ Iron & Folic acid deficiency
Terms: ○ Screen complete blood count
● Antepartum - time of pregnancy ● Pre-eclampsia
before labor ● Diabetes Mellitus
● Intrapartum - labor and delivery ● Syphilis
● Postpartum - from delivery to first six #2 Detect:
weeks ● PROM
● Preterm labor
Antepartum Care: #3 Prevent:
● At least 4 antenatal visits with a ● Ferrous and folic acid
skilled health provide supplementation
● Objectives: ● Tetanus toxoid immunization
○ To detect diseases which ● Corticosteroids for preterm labor
may complicate pregnancy #4 Treat:
○ To educate women on ● Ferrous sulfate for anemia
danger and emergency ssx ● Antihypertensive meds and
○ To prepare the woman and Magnesium sulfate for severe
her family for childbirth pre-eclampsia
● Should be properly distributed: ● REFER
○ 1st visit - pregnancy is
suspected (sexually active + #1 SCREEN
regular menses + missed Pre-Eclampsia
period) or in 3 months) ● Screening is during the first trimester
○ 2nd - on the next 3 months ● Checking of baseline v/s
(4th to 6th month) ● Routine CBC and Urinalysis
○ 3rd - on the third trimester ● 130 systole - suspect
(7th to 9th month) ● Protein (+1 and above) in urine and
○ 4th - at 40 weeks because albuminuria
you are about to give birth ○ 24 hr urine collection to
consider preeclampsia 20
Note: DO NOT wait for your scheduled visit weeks AOG and above
once danger signs occur. ○ If proteinuria or albuminuria
is present earlier than 20
According to EINC, how many antenatal weeks AOG, this is for
visits are needed? - 4 Visits with a skilled consideration of hydatidiform
health provider mole (h.mole)
Color Coding:
32
● Occurs in 20 weeks AOG until 2
● Death is from cerebral
weeks postpartum
hemorrhage, circulatory
collapse, or renal failure
Carl Balita: ● Obstetrical Emergency!
- Pregnancy Induced
Hypertension is a precursor to
Gestational Diabetes
Pre-eclampsia.
- Originally called toxemia
Women who do not begin pregnancy with
- There are three effects:
diabetes become diabetic during pregnancy
- High Blood pressure -
(approximately 2-3%)
Vascular Spasm (Vascular
effect)
● 4Fs of predisposing factors
- Edema (Interstitial effect)
○ Family history
- Proteinuria (Renal Effect)
○ Fat
○ Female
Mild Pre-eclampsia
○ Forty and above
● BP of 140/90 (Increase of 30/15)
○ History of abortion, still birth
● 1+ to 2+ proteinuria on random
and other factors that brings
● Weight gain of 2lbs per week (2nd
the baby at risk
trimester) and 1 lbs per week (3rd
trimester)
Screening tests for Gestational Diabetes:
● Slight edema in upper extremities
● Maybe managed at home
Oral Glucose Challenge Test:
● Mom is just a suspect, might be
Severe Pre-eclampsia
having diabetes
● BP 160/110
● 8 Hours fasting for FBS
● 3+ or 4+ proteinuria or random
● Administered at the first prenatal and
● Oliguria (less than 500mL/24hrs)
again at 24 to 28 wks of gestation or
● Cerebral or visual disturbances
high risk women
● Epigastric pain
● Given 50-g FIXED glucose load and
● Pulmonary edema
1 hour after, a blood sample is taken
● Peripheral Edema
for serum glucose level testing
● Hepatic dysfunction
● Suspect Diabetic: If FBS is more
● Needs to be managed in
than 90mg/dl, and at 1hr post
hospital
glucose loading the blood glucose is
more than 140 mg/dl
Eclampsia
● If value is equal to 140 or MORE she
● Hypertension
is then a suspect. - proceed to oral
● Proteinuria
glucose tolerance test
● CONVULSIONS
● Normal is 140mg/dl or below.
● COMA
Color Coding:
33
Oral Glucose Tolerance Test: Note: Venereal disease research laboratory
● For mothers who manifested at least for syphilis
2 risk factors of the 4Fs and for - Screening test for syphilis which
those who have a result of 140 g/dL measures substances (protein)
in the oral glucose challenge test called antibodies which the body
● Gold standard for diagnosing may produce if you have come in
diabetes contact with the bacteria that cause
● (but also dependent on the syphilis.
woman’s weight as assessed by
the physician) #2 DETECT
● 100g of oral glucose solution is used
(CB source) Preterm Labor and Rupture of Membrane
● Fasting for 6-8 hours (PROM)
● Normal Findings (4 blood ● Normal expected rupture of
extractions) membranes is during labor
○ FBS - 80-100mg/dl (maam ● AOG
80-120mg/dl)
○ 1hr - 180mg/dl (normal/ max Early rupture of membrane and premature
level: 195 mg/dl) rupture of membrane (separate)
○ 2hrs - 155mg/dl (normal/max ● Rupture of membrane, delivery and
level: 165 mg/dl) labor is imminent
○ 3hrs - 140mg/dl (normal/ max ● Delivery must be done in 24 hours
- 145mg/dl) ● When that bag of water ruptures
● Blood extractions: during the latent phase of labor, then
○ Before administering glucose that is an early rupture of
○ 1 hour after membranes.
○ 2 hours after ● EINC is not recommended for
○ 3 hours after artificial rupture of membranes.
- Among the four, if there are 2
more or more where the value is If you suspect water breaking, you need
equal or more than that, the to check the pH first! (Nitrazine paper
patient is (+) for gestational test or Litmus paper)
diabetes. ● Amniotic fluid is alkaline (Blue
Result)
Glycosylated Hemoglobin: ● Urine is acidic (Red)
● Measures control (Average glucose
level) over the past 4-6 weeks (2-3 What could mask the result for amniotic
months) - the time the normal RBCs fluid on a nitrazine paper test? - Blood
are picking up the glucose since it is alkaline
● Upper normal level is 6% of the
total hemoglobin Another diagnostic result for amniotic
fluid:
Color Coding:
34
- Positive ferning test (swabbing and - Check deep tendon
drying a sample on a slide and reflex
viewing it in the microscope. Positive - Check RR
ferning shows ferning of amniotic - Urine output (not be
fluid, which urine does not do.) less than 30mL per
hour)
Preterm labor signs: W VAC - Antidote - Calcium
- W - Water Rupture: Bag of water Gluconate
ruptures below 27 weeks (preterm - Check BP before and
pregnancy) after injecting
- V - Vaginal spotting pink, brown,
red (normally no bleeding) #4 TREATMENT
- A - Assessment by Physician :
Physician will assess, to ensure that Tetanus Toxoid
term pregnancy is met (tocolytics
etc)
- C - Contractions (in 10 minute
period) get faster or severe (true
labor)
- Mnemonic: (W(ater) VAC(uum) Because if
you are in preterm labor its like water is
being vacuumed out of ur vagina too early!!!.
W VAC
#3 PREVENT
Antenatal Corticosteroids
Pre-Eclampsia ● Administered to all patients who are
- Nifedipine at risk for preterm delivery
- Hydralazine ● With preterm labor between 24-34
- Magnesium Sulfate (Drug of Choice weeks AOG
for Preeclampsia) ● Or with any of the following prior to
- Serves as an anticonvulsant, term
muscle relaxant and ○ Antepartum hemorrhage/
anti-hypertensive bleeding
- Stock dose: 250mg/mL ○ Hypertension
- Availability: comes in a 20 ml ○ Premature rupture of
and 50 ml vial, Before: 20 ml membranes (PROM)
ampule (brownish in color)
- First dose is usually 5g to 6g Dose:
of injection by the physician ● Betamethasone 12mg IM q 24x2
- Nursing Consideration: doses or
Color Coding:
35
● Dexamethasone 6mg or 1.5mL IM q ● Beyond 20 weeks with pain like
12x4 doses abortion - preterm labor
● Even one dose is beneficial ● Note: there is no pain in placenta
● Must be readily available in the ER, previa, only blood. Pain felt in the
DR, OPD, and ward (OB ward) abruptio placenta occurs during
delivery.
Objective #2: Educate on Danger and Shortness of Breath

Emergency Signs and Symptoms ● Normal; compression of the
● Vaginal bleeding diaphragm
● Headache (Severe) ● Severe difficulty may be a sign of
● Blurring of vision infection
● Abdominal pain
● Severe difficulty of breathing Burning on urination
● Dangerous fever (T > 38 C, feeling ● Possible UTI
of weakness) ● Woman had contracted sexually
● Burning on urination transmitted infection
Preparing woman and family on

Vaginal Bleeding: childbirth
- Spotting, brown, red on first ● Counsel on:
trimester ○ Proper nutrition
- If before 20 weeks it is abortion or ○ Self-care during pregnancy
ectopic pregnancy ○ Breastfeeding and family
- Brownish color: indicative of h. Mole planning
- 2 bleeding episodes: preterm labor ● Birth plan
- 3rd trimester bleeding episodes;
placenta previa or abruptio placenta Sample Birth Plan:
Headache, Blurring of vision

● When headache is severely painful,
it should be reported
● Both of these symptoms can indicate
preeclampsia.
Abdominal Pain
● Crampy pain before 20 weeks AOG
- abortion
● On or before 12 weeks AOG of
sharp stabbing excruciating pain -
ectopic pregnancy
Color Coding:
36
Phases of Labor
● Latent
● Active
● Transition
Phase Duration Interval Cervical Intensity

Dilation
Latent 20-40 5-30 0-3cm Mild to

secs mins moderate
Active 40-60 3-5 4-7cm Moderate to

secs mins strong
Topic 6:
Intrapartum Care Transition 60-90 2-3mins 8-10cm strong
secs
Stages of Labor and Delivery
● First stage (dilatation phase) —
Assess through:
from start of true contractions to full
- Palpation
dilation and effacement
- Fetal monitoring
● Second stage — full dilation and
effacement to birth of the newborn
● Third Stage — placental stage
Frequency: To time the frequence: Start of
● Fourth Stage — first 2-4 hours after
contraction until the end of the same
deliver = immediate postpartum
contraction - Express in minutes
○ Golden Hour
First Stage: Cervical Effacement &

Dilation
- Dilation is the External OS Opens
and Dilates
- Effacement: Cervical canal becomes
short and thin.
Color Coding:
37
Frequency - Purple Line ○ No difference in APGAR
Blue line - duration score
Green line - interval (uterine relaxation) ○ Decreased need for
Vertical line - peak (acme): mild, moderate, cesarean section by 82%
severe ○ No difference in need for
labor augmentation
Prepare as this is a must to know:
● Duration + Interval = Frequency 2. Continuous maternal support
● Frequency - Interval = Duration ● Husband as main support system
● Frequency - Duration = Interval ● Can be further supported by other
members of the family and loved
In between contractions, the fetal heart tone ones
and BP should be done. ● Decreases need for pain
medications by 10%
Because during contractions there are ● Duration of labor is SHORTENED by
unusual VS so best to do it during in half an hour
between contractions: ● Increased spontaneous vaginal
- Mother in contraction has higher BP delivery
than normal ● Decreased instrumental vaginal
- Baby fetal tones will be lower in delivery
contraction as it is exhibiting early ● The 5 minute APGAR score below 7
decelerations. decreased
If increased contractions past 90 3. Upright position during first stage of

seconds the following can happen: labor
- Fetal Distress due to late ● First stage of labor shorter by
decelerations as there is 1 hour
uteroplacental insufficiency ● Need for epidural is
- If frequent contractions and diminished
prolonged, it can cause uterine ● No difference in the status of
rupture the baby
- Obstetric emergencies.
Recommended Practices During Labor

1. Admit only when the patient is in the
active phase.
● Active phase labor
○ 2-3 contractions in 10 mins *recommended positions as long as the bag
○ Cervix is 4 cm dilated is not yet ruptured
Color Coding:
38
4. Routine use of WHO partograph to
monitor progress of labor
● Monitor progress of labor, early
identification of progress of labor
● Prevents obstructed labor
Amniotomy
Parts of the Partograph

Alert line - line between green and yellow
Action line - line between yellow and pink
Green zone: normal (can avail BEMOC)

Yellow: intervention is necessary, ready
transport services
Pink: urgent referral Amniotomy: Instrument to rupture the back
of water.
5. Limit total number of IE to 5 or less
● Lowers infection incidence by 34% Intravenous Fluids:
Not Recommended!
Traditional EINC
* Routine perineal shaving on admission
* Routine enema Upon admission, Light snack or meal
* Routine NPO patient is hooked to and water
* Routine IVF an IVF
* Routine vaginal douching
* Routine amniotomy Advantages
● Ready access
* Routine oxytocin augmentation
for emergency
● Maintain
Perineal Shaving maternal
hydration
Disadvantages
- Interferes with
natural birthing
Color Coding:
39
- EINC does not recommend the use
process
- Restricts of artificial rupture of membranes
movement because:
- Not as effective - Risk for infection and killing
as allowing food of baby
and fluids - Risk for cord prolapse
- If rupture is needed, keep the
mother in complete bedrest
Care during Labor: SUMMARY to prevent prolapse and
infection.
- Not recommended Artificial
Recommended Not
Recommended Rupture of Membrane - Risk for
infection and killing of baby. Risk
1. Admit only 1. Routine factors also can cause prolapse of
when the perineal the cord. Keep mother in complete
patient is in shaving on bed rest once bag of water is
the active admission ruptured.
phase. 2. Routine
2. Continuous enema However, why is Artificial Rupture of
maternal 3. Routine Membranes indicated by physicians?
support NPO - Augments labor prior: Stimulates
3. Upright 4. Routine IVF uterine contraction.
position 5. Routine
during first vaginal
stage of douching Practices recommended during Labor
labor 6. Routine and Delivery
4. Routine use amniotomy ● Upright position during delivery
of WHO ● Selective episiotomy
partograph ● Use of prophylactic oxytocin
ro monitor ● Delayed cord clamping
progress of ● Controlled cord traction with
labor countertraction
5. Limit total ● Uterine massage after placental
number of delivery
IE to 5 or
less 1. Upright Positioning:
● More efficient uterine contractions

● Improved fetal alignment
EINC: ● Faster delivery
● Less Episiotomies
Color Coding:
40
while the other hand supports the perineum
2. Selective (non-routine episiotomy) to allow gradual extension of the head
4. Giving prophylactic oxytocin for

management of 3rd stage of labor.
- 10 Units Oxytocin
- Palpate the fundus, as only 1 minute
is given to assess the presence of
another baby
- If absence of another baby, then go
ahead means that 10U of oxytocin
can be given
- In EINC the oxytocin is given
1minute after checking the presence
of another. And in its absence, the
oxytocin is given to facilitate the
delivery of placenta.
- If no contraction it can lead to
uterine inversion.
5. Delayed cord clamping
Episiotomy:
- To promote opening and widening of
birth canal
- Prevent Laceration
3. Perineal support and controlled

delivery of the head
● Time-bound evidence practice:

WAIT for the cord pulsations to
STOP, occurs in about 1-3
minutes after delivery
● Feel the cord, and wait until
pulsation stops even though 3
* Ritgen’s maneuver - keep one hand on minutes have passed. (time bound
the head as it advances during contractions nursing intervention)
Color Coding:
41
● If the cord is pulsating, blood loss is
many enough for the baby to
develop anemia
6. Controlled cord traction with

countertraction in order to deliver
placenta. Brandt Andrews Maneuver
7. Uterine Massage After Placental

Delivery
- Wait for signs of placental separation Active Management of third Stage of

first Labor (Summary)
- Sudden gush of blood 1. Give oxytocin within 1 minute after
- Lengthening of cord delivery of the baby
- Rising of the fundus 2. CCT + countertraction on uterus
- Globular uterus 3. Uterine massage after placenta is
- Brandt Andrews maneuver: using delivered
the forcep, foil the umbilical cord
around it, gently pulling down and up Practices during Immediate Postpartum
while the other hand massages the
uterus. Recommended Not recommended
- Note: make sure the uterus is WELL
CONTRACTED while doing the Routine inspection Manual exploration of
maneuver, as doing this during of the birth canal for uterus
uterine relaxation will cause uterine lacerations
Routine use of ice
involution packs over the
Inspect placenta
hypogastrium
and completeness
Routine oral
Early resumption of methergine
feeding
Color Coding:
42
Massaging the
uterus
Prophylactic
antibiotics for
women with a 3 or
4" degree perineal
tear
Early postpartum
discharge
—-- END OF MCN LECTURE —--
Color Coding:

PH Intensive Notes Maternal and Child Nursing 1

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Abarquez, Amil, Auza, Son

OBSTETRICS Urinary meatus - located below the clitoris

TOPIC 1: Anatomy of the Female Perineum - where episiotomy is performed,

Topic Outline: Vaginal introitus / vaginal opening -

Note: There are vaginal suppositories and

Why is clitoris important? - Because this

Orgasm is reached in 2 sites: clitoris and

- Aids in the growing baby

Uterus Fallopian Tube

Layers of Uterus Vagina

Ligaments: structures that keep the

Homologous reproductive organs:

Phases of the Menstrual Cycle:

TOPIC 2: The Menstrual Cycle and

JAN.16- 27 — UNSAFE DAYS, therefore

2. Billing Method/Cervical Secretion

MC: Subtract 14 from her shortest menstrual cycle,

For an irregular cycle, subtract 18 on the shortest

Important to be aware of this menstrual

(multiple indicator method) combines any Artificial Methods of Family Planning

5. Abstinence: No sex lmao

Inhibits implantation through:

● Local inflammatory response

- Contraceptive Foam - most effective

Answer: Take 2 pills, one from yesterday

6 capsules of progestin are inserted

A - Abdominal pain (Severe)

TOPIC 3: Fertilization Fertilization: Sperm Structure and

Board Exam: sometimes ampulla is not a

What is the most common site of

What occurs when implantation occurs

When the zygote (fertilized egg) does not

What is the ideal site in the uterus for

What happens when implantation occurs

Placenta accreta is a serious pregnancy Chorion: develops from trophoblast,

● Formed by 12 weeks AOG

Schultze - Fetal Surface: Shiny, glistening

Duncan - Maternal Surface: Dirty, gritty,

3. Progesterone increases the BBT

4. The sex of the fetus is determined at

5. Mitosis is a process of cell division

6. Decidua is the specialized

7. Amnion is an outer fetal membrane.

—---------------------- 70 days and beyond pregnant- HCG level

Endocrine Function: Estrogen:

Primary Germ Layers and its Derivatives

Topic 4 - Physiological Changes in

● Greater workload of the heart

Nursing Interventions: Promote rest, but

Confirmation of Pregnancy Movement of the

Breast Changes Abdominal

GPTPAL LMP - EDC / AOG

Note if baby is below 500g then the baby is

Fourth Maneuver (Presenting Part

Second And Third Trimester:

Abdominal Ultrasound Electronic Fetal Monitoring (EFM)

Transvaginal Ultrasound The indications of EFM included induction of

Rhythm strip Abnormal:

Note: Contraction Stress Test

3. Variable - Cord Compression

Note: when uncompromised after a back-up

Essential Intrapartum Newborn Care

Evidence based standards that are