Professional Documents
Culture Documents
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
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
3
develop an infection like
trichomonas vaginalis.
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
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 -
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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.
Cervical Cap/Cup
Spermicides:
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?
Implant: Norplant:
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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.
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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.
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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)
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
Systemic Changes:
Cardiovascular System:
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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)
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
Fetoscopy:
● Direct visualization of the fetus using
a fetoscope
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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.
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
26
2. Late Deceleration - Uteroplacental
Insufficiency
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
29
Standards represent levels of practice
agreed in by the leaders in the specialty.
🤮
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
30
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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.
Abdominal Pain
● Crampy pain before 20 weeks AOG
- abortion
● On or before 12 weeks AOG of
sharp stabbing excruciating pain -
ectopic pregnancy
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
36
Phases of Labor
● Latent
● Active
● Transition
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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
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:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
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:
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
40
while the other hand supports the perineum
2. Selective (non-routine episiotomy) to allow gradual extension of the head
- 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.
Episiotomy:
- To promote opening and widening of
birth canal
- Prevent Laceration
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
41
● If the cord is pulsating, blood loss is
many enough for the baby to
develop anemia
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes
Abarquez, Amil, Auza, Son
42
Massaging the
uterus
Prophylactic
antibiotics for
women with a 3 or
4" degree perineal
tear
Early postpartum
discharge
Color Coding:
Blue - Appears in Board exam as mentioned by the reviewer
Aqua green - Carl Balita Notes