Release of matured egg called OVULATION
Obstetrics Day 1
Ovarian Cycle – aka menstrual cycle
Estrogen = Female Hormone
= capacity to get pregnant
Bata pa = Estrogen is LOW
(Estrogen came from adrenal glands pag bata)
Puberty dapat UP TO GO(tataas)
With the bit of right hormones
Hypothalamus release GnRH (Gonadotrophin
releasing hormone)
=first structure to trigger to increase
estrogen
=but not directly release estrogen “trigger”
only
Gonad means Ovaries
Trophin means Growth
APG (anterior pituitary gland) release FSH (follicle
stimulating hormone) =para mag grow si gonads
(ovary)
Ovary has eggcells that surrounded by young
follicles called PRIMORDIAL YOUNG FOLLICLES
(ito ung inistimulate ni APG para mag release ng
estrogen)
Once na nagising na ang primordial young follicles
it will be called Graafian Follicles (nagmatured
na follicles) which release follicular Fluid that is
very rich in Estrogen
Proliferation Phase (nag proprolifirate ang
endometrial lining)
Ano nangyayari sa Proliferative phase:
● Kumakapal ang endometrial lining (once
estrogen is high) preparation for
pregnancy para may pagkakapitan ang
fertilized egg.
INCREASE ESTROGEN
APG will calm down kasi mataas na ang estrogen
APG now produce LH( luteinizing hormone)
The one that triggers to removed /embarks the
most mature egg.
Follicles are surrounding the eggs will now
embarks (aalis) sa ovary and maghihintay siya sa
Fallopian Tube (24-48 hours ONLY) ( mag eexpire
sila within 48 hours)
When an egg mabarks magiging yellow na ang
follicle at magkakaroon siya ng production ng
lutein na nag cacause ng yellow called Corpus
Luteum which contains Progesterone
Progesterone work: keep the endometrial lining
intact) (hindi siya mag shed off)
Corpus luteum 8 -1 0 days ang kanyang life.
Mataas ang progesterone within these days. After
10 days Corpus Letuem na yellow ay magiging
puti which we called Corpus Albicans (dahil wala
ng yellow wala ng ding lutein at pag wala ng lutein
wala ng progesterone
Dahil mababa na ang progesterone, mag sheshed
off na ang endometrial lining. Ito na ung tinatawag
natin na menstruation.
Once progesterone drops = menstruation
Menarche -First Menstraution (9-16 years old)
Thelarche – breast development
Coitarche – first sexual intercourse
But once kapag nabuntis ang nanay. Mag eextend
ang Corpus Luteum up to 16-20 weeks to wait for
the growing placenta.
After that, si placenta na ang mag mag cocontinue
ng hormonal na progesterone
Pano malalaman ng corpus Luteum na buntis? It
its because of the HCG hormone produces by the
placenta. Kaya mag eextend si corpus and
Progesterone need to be high all through out the
pregnancy (16-20 weeks corpus luteum and
Placenta the rest of pregnancy. Tinatangal lang
after manganak si progesterone.
FERTILIZATION or Conception or Impregnation
When an egg and sperm unit
Typically, one egg only fertilized from left or right
ovary.
Once egg and sperm unite and has separation
magiging twin un.
Or if dalawang cells ang naman ang na fertilize
zygotic twin un or paternal twin.
Subfertility = couples who try to conceived but
cannot
=we need time to consider
=unable to conceives of the couples without using
of the contraception for more than 12 months but
hindi makabuo.
Morulla – floating cell
Blastocyst – fluid filled center
Special cells – trophoblast (developing
Placenta release HcG) ( HcG ito ung na dedetect
para mag extend ang corpus luteum para sa
progesterone.)
-ready to implant
Primitive villi – placenta in the future
Embryo – implantation up to 5-8 weeks
Fetus – 8 weeks up to delivery
Neonate – newborn (birth up to 28 days)
Infant (1 month -1 year)

Sterility = permanent Fetal Growth and Development

Increasing chances of pregnancy Average: 40 weeks
Time : ovulation Lunar Month = 4 weeks = 10 lunar months
*Expiration of sperm 48-72 hours Term : 38-42 weeks
Frequency: every other day 39 weeks = complete brain development
Position: man-dominated
Pre and post coitus: FIRST LUNA MONTHS
no douche, no lubricant F – 4 weeks old
Woman will remain hips are elevated with I – implanted ( 8-10 days)
pillow x 20mins atleast R – Rudimentary heart (draft- not functioning
Diet: complex carbohydrates (brown rice, Fiber heart ) (no heart beat)
bread), moderate protein, low fat diet. S – Spinal Cord Formed – the spinal cord will fuse
Weight: both woman and man normal BMI (18- in the center
24.5) (if not success the baby will have neutral tube
Exercise: 30mins/day defect) (NTD)
Extra: hobbies like ballroom dancing, bowling, e.g. Spina Bifida, Meningocele,
zumba Meningomyelocele
need Folic Acid to prevent NTD
FETAL DEVELOPMENT T – 3 Germ layers (dito magmumula lahat ng
Stage of fetal development organs)
Mnemonics: Oh, ZuMBa Pa! Eh Foodtrip 3 Germ Layer:
Nanaman Ikaw! 1. Ectoderm ( outer layer ) –
Ovum – single cell E- Ears, eyes and Nose
Zygote – when there is fertilization occur ( Z - C – CNS
fertilization and Zygote) T – Sense of Touch and Taste
Mitosis -cell division (where 1 cell will O - Opening of the Body (mounth and
produce 2 daughter cell) Anus)
2. Mesoderm (middle ) O -Ordinary Stethoscope (mas maririnig pag 5
M -Muscles months)
E – Enamel of teeth U- Urine in AF (pwde na mag amniocentesis)
S – Skeletal (slightly yellow ang normal amiotic fluid)
0 – Organs (repro, circu, kidneys) R – Revel Gender
3. Endoderm ( inner ) (genital ang basehan) (testosterone for male –
4L s (LOOB) may humahaba na lawit– estrogen for female -
L- Lower Urinary tract including Bladder umuurong magiging clitoris)
and the urethra
Linings (pericardial and sac) FIVE LUNAR MONTHS
Lalamunang may T-T-T (throat, tonsil, 20 weeks of gestation
thymus and thyroid) F- Fetal Movement – quickineng
Lungs Primigravida -18-20 weeks
SECOND LUNAR MONTHS(8 weeks) Multigravida- as early as 16 weeks
S – Sac (probable signs of pregnancy) I – Immunoglobulin -IgG placenta
E – Extremities (kapag gatas IgA ang natratransfer)
C – Contraction of the Heart (positive signs of VE- Vernix Caseosa – white cheeselike substance
pregnancy) 2 purposes
(no heart sound) 1. to protect the skin of the baby
O -Organogenesis complete called Fetus 2. for heat
N - Noticeable face (pag nagiging term na ang bata naglalagasan na
D - Digestive Developing ng VE.
Pag sobra na sa term 42 weeks. Hindi na
THIRD LUNAR MONTHS (12 weeks) Maganda sa bata kaya pag lumabas meron na
T – toothbuds siyang DESQUAMATION of the skin.)
H -Hear heart sound (10-12 weeks *earliest) I delay ang pag alis ng vernix caseosa after
I – ihi (form) (amniotic fluid: clear) color from delivery because the baby need heat.
● maternal serum by osmosis and defusion)
● small amount : no to amniocentesis since SIX LUNAR MONTHS
small amout 24 weeks
Chorionic Villi Samplicg to detect Defect Mnemonics: 4s
S – Scalp hair developing (pilik mata, kilay)
R- reflex Babinski (bakinski ) Fanning of Toes S- Sound (dito na makaka appreciate ng sound ng
D- Doppler (the only instrument to hear the heart fetus)
sound) S- Surfactant (active production of surfactant)
(Produce by the lungs – prevents alveolar
FOURTH LUNAR MONTHS (air sacs) to collapse during
(2nd trimester, 16 weeks) exhale/expiration)
F -Fetoscope, Fine Downy Hair(lanugo) S- Survival ( 20-24 weeks – range age of viability )
Decrease ang lanugo kaoag lumabas si babay)( Reason for survivability
 -presence of surfactant
- > 500g grams
SEVEN LUNAR MONTHS
28 weeks of gestataion
S – scrotum (descend)
Kapag hindi nag descend ang testes-
undescened testes- crypto orchidism
Very common for Testicular Cancer
E -Eye delicate – mabubuhay si baby but
V – vessels in retina – forming dring this time
-high o2 concentration in preterm babywill
destroy the vessels which will result to
Blindness
E- Eye blinking Peak
N- Ninety % Survival
EIGHT LUNAR MONTHS
32 weeks of Gestation
E- extend when startled (Moro/Startle Reflex)
I- Iron stores (on the liver)
-reason: isang weakness ng breastfeed,
iron is low.pag labas at nag breastfeed
mababa ang iron. Gagamitin ng bata until
6 months ung na strore hangang makapag
solid food na si baby.
G- Grow faster
H- hermit face gone (mukang matanda)
T- Tips of Nails and Fingertips (basehan if preterm
pa si baby)
TEN LUNAR MONTHS
40 weeks of gestation
T – Term
E- Engaged – descend na si fetus. Pag nag
decend si fetus lumuluwag na ang lungs ng mother
called Lightening: effect to mother
N- Nearing birth
Kelangan manganak na si mother to 42 weeks
If > 42 weeks Post term na. not good because si
placenta hangang 42 weeks lang ang functioning
niya.
Function of Placenta
1. distribution of blood supply to baby (circulation)
2. oxygen (hindi pa nagreregulate ang breathing
sa loob)
3. nutrients
4. barriers against some harmful organism (virus
hindi na bloblock ng placenta nakakarating kay
baby)
May barrier ang baby sa syphilis si baby
sa first trimester dahil sa trophoblastic cells. Kaya
after 4 months (2nd trimester onwards) pwde ng
mahawaan si mother ng syphilis
5. it transfer ng IgG
6. Excretion
Normal Pregnancy
Maternal Physiologic Changes

NINTH LUNAR MONTHS PreSUmptive Sign

36 weeks of gestation -mga SUmbong, Subjective data
N- near term Mnemonic: presumptive
I- Increased fats (subQ fats) P-Pains: back, chest, legs, head
N-Nearly 100% survival (surfactant not fully R- Respiratory Changes
develop kaya not totally 100%) E- Enlargement of Breast
T- Turn Around (umiikot na si baby) S- Skin Changes
H- head down U- Urinary Frequency
-Cephalic Presentation
M- Morning Sickness, Menstruation Cessation,
Movement
P- Palmar erythema
T- Tiredness
I- Increased Salivation
V- Vaginal Changes, Varicosities
E- Enlargement of the Uterus
Pains :Legs
Normal: Cramps
Cause: calcium is low
Mngt: Dorsiflex foot while the knee is extended
Prevention: Calcium Supplement 1g/day
(iba pa ung sa diet)
Abnormal Leg Pain : Clot (DVT)
Cause: Uterine Pressure (mabigat na ang
extremities, hindi na makaakyat ang circulation)
If the veins is inflamed because of DVT
=thrombophlebitis
Signs : Fever, redness, pain, heat
Prevention for clot:
● Ambulation
● Elevate the legs to prevent statis of the
blood in the lower extremity
● Application of Moist heat para gumanda
ang circulation
● Elastic Stocking (anti embolism stocking)
Important to remember when putting and using
elastic stocking
1. before getting out of the bed isuot
2. it should be panty-hose
If the patient already ambulate without using of
elastic stocking what will the nurse do?
*let her lie down on bed and stay in bed for
30mins.
Assessment of presence of blood clot/DVT
1. dorsiflex the foot while the knee is extended if
positive pain in the calf muscle it is called Positive
Homans sign meaning positive for blood clot.
If positive na for homan’s sign
Avoid H.A.M.
*do not put Hot compress
*do not Ambulate
*do not massage
Then C.D.E.
*Call the doctor for positive homans sign
*Doppler Utz (visualization) then doctor will give
Low Molecular heparin within 24-48hours
If maintenance – Heparin SubCu
*Embolectomy
Pain: Back
Normal: lower back pain
Lordosis – pride of pregnancy
Cause: P-R. (Progesterone and relaxin)
Relaxation of pelvic joints
Prevention: para di mag aggravate ang low back
pain
S- stand straight
S- support pillow when sitting
S- Squatting instead of bending
S- Shoes are low heeled
Management: P-R. Pelvic Rock Exercise
Abnormal: 4P’s
P- Pre term labor
P- Pain in Urination (UTI) bawal sa
pregnancy because if it happens in first
trimester it can cause miscarriage or
abortion or Pre term labor
P- Point Pain (specific na masakit sa likod
(possible vertebral fracture)
P- Pahinga ineffective
Pain: Chest Cause; Enlarge Uterus
Normal: Burning (heartburn/pyrosis)
Cause: S-S. Enlargement of the Breast
*Sphincter relax by progesterone and Normal
relaxin (sila ung nagpapakalma sa Mnemonics : BREAST
pregnancy) *Blue Veins appearance
*Stomach pushed upward: enlarging *Readiness lactation –
Uterus Preparation: progesterone + Human
Management:S-S-S avoid K.F.C Placental Lactogen (galing ito sa placenta)
*Small frequent feeding (ito ung nag reready sa mother para mag
*Sleep on left lactation
*Support pillow: 2pcs and @ hours waiting *Enlargement of Breast :
time before the pregnant woman can lie cause by Estrogen (phrone sa bloodclots)
down (hindi pwde saknila ang my history of
AVOID stroke, hypertension and Age more than
Kamatis 35 years old)
Fried/fatty food *Areola Darkens and Enlarged
Citrus *Secretes Colostrum as early as 16 weeks
First 3 Days pure colustrom after 3 days
Only drugs that is accepted to manage na ang true milk
heart burn. Ma.H.Al Hormones responsible for Production of Milk:
Magnesium Hydorxide Prolactin
H2 Blockers (ranitidine, Cimetidine) Hormones responsible for milk- ejection
Aluminum Hydroxide ( Maalox, Gaviscon) (nagpapaout): Oxytocin
*Tubercles Prominent (Montgomery) – (parang
Pain: Head dots dots)
Normal: mild, occasional
Management: Paracetamol (only doctor can Care of Breasts:
prescribe) Cleanse : water only
Abnormal: Severe, Continuous + Visual Changes Soap/alcohol can cause drying which
(blurring vision, Floaters) = S/Sx of Hypertension result to Cracks. Staphylococcus will enter
which will result to MASTITIS
#1 cause of mastitis = Nipple Cracks
Respiratory Changes
Normal Skin Changes: Normal
S- Stuffiness (nasal Congestion) *S – Striae Gravidarum – Stretch Marks
Cause: Estrogen Anong pwdeng ipahid
S-OB (short of breathing) *Cocoa Butter Lotion
Cause: Enlargement of uterus Strecth marks will just fade after delivery
S- Speedy Breaths not totally disappear
*K-Kloasma (Chloasma) -hyperpigmentation of the
face, nose : Mask of Pregnany
*Increased Pigmentation everywhere (kilikili-batok-
tuhod)
Hindi siya mawawala kahit gamitan ng
sabon because it is cause by hormones
*Nigra (Linia Nigra) Vertical line in the abdomens
Urinary Frequency( 1st and 3rd Trimester only)
Mnemonics: IHI
I- Increase GFR = dilates ureters. Nagreready for
increase blood volume
H- High Hormones : HCG will start to decline at
day 100 of pregnancy (2 trimester) kaya
nd
walang nag sususbside ang urine.
I: Increased Bladder Pressure because of enlarge
uterus
Acceptable changes in Urine
1. Urinary Frequency
2. +1 glucose (because of increase GFR)
makakapasok si glucose
Movement, Morning Sickness, Menstruation
Cessation
Movement
Quickening
Felt by: Mother
When: 20 weeks
Peak:28-38 weeks
Assess: Kick Count (any movement felt) + morning
after meal because increase glucose
=1 hour monitoring everyday
=10-12 acceptable range
=if below 10 extend another 1 hour. The
total should still 10-12 for 2 hours.
If not. Report to HCP
Morning Sickness (nausea and vomiting in
pregnancy)
-majority in pregnancy experience this
whole day
-highlighted in the morning
Cause: PHEG (3 hormones na tumaas)
*progesterone
*HcG
*Estrogen
*low glucose (phrone sa hypocglycemia
ang nanay sa first trimester) WHY? low
glucose kasi hindi na lang si mother ang
nag coconsume ng glucose
-mababa in the morning
*phrone sa hypocglycemia ang nanay sa
first trimester
Pang Address sa morning sickness
Mnemonic: BAT KA SAD-SAD-SAD
S-Small Frequent Feedings, Snack before bed
(kasi mababa in the morning)
A- Acupressure Band (wrist band)
D-Dry Toast/Crackers (skyflakes, magic flakes) –
upon waking up
-dry toast/crackers omposed of
1. glucose (dry crackers are easily
converted into glucose.
2. Baking Soda: NaHCo3(sodium
bicarbonate -alkaline – it fight the acidity in
the stomach of the mother
*do not give milk, juice, water. It should be
dry
*do not dip into milk.
S-Sour Ball when nausiated
A-Acupuncture to decrease the morning sickness
D-Delay breakfast if nauseated (lalo siya
masusuka)
S-Sips of Carbonated Beverage (if nauseated)
A- Avoid (4s) Seasoned, Spicy, Sebo, Sudden
movement
 can trigger nausea Sino ang unang magkaka mens.?
D- Doctor Notified: when to consider if the morning a. Breastfeeding = 3 months earliest up to 6
sickness is abnormal if more than >1x, 12 months
weeks in duration, < weight loss, <urine , b. non-bf = answer = as early as 2-3 months
Dehydration
*if severe and morning sickness AKA Lactational Amenorrhea Method = pwdeng type of
hyperemesis Gravidarum (sobrang natural contraception habang nag papa breastfeed
pagsusuka in pregnancy) but:
Concern: Fluid And Electrolyte Imbalance Requirement: 1. 100% breasfeeding
(dangerous for bothe mother and child) 2. Hindi pa nag iintroduce ng solid
food
Iron is given starting second Trimester because it 3. never pang nagka mens
aggravate the morning sickness and also ang peak
ng volume ng Blood Volume is on second tri Palmar Erythema (itchiness and redness of the
*iron decrease absorption if it was taken with palm)
calcium and magnesium rich foods Cause: Estrogen
*it increase absorption if taken with Vitamin C *Anti-histamine is not effective because hormones
ang problem not allergy.
Menstruation Cessation AKA Amenorrhea
i. primary amenorrhea- above16 years old still no Tiredness
menarche -1st trimester : mababa ang glucose
2. Secondary amenorrhea- with menarche, 3 -2nd trimester : increase ang blood volume
months cessation of menses *plasma ang unang nag
increase.
Increase estrogen ang reason kaya may menstrual *mukang mababa ang
Cycle RBC (not mababa) dahil
Increase progesterone (it keeps the endometrial mas mataas ang plasma
lining intact) (iRBC mas mababa kaya
Other cause: konti ang o2
1. Severe anemia At kapag mababa ang
2. athletes RBC meron siyang
3. anxiety Pseudo-anemia or
4. illness physiologic anemia.
5. Infection Dito lang acceptable ng anemia (pseudo
If buntis Increase Estrogen and Increase or physoligic anmeia) kaya tayo
progesterone kaya hindi nagkakaregla, nagbibigay ng iron.
*kelan ulit magkaka regla? Kapag bumagsak na -3rd trimester – enlarge uterus, deprivation
ang estrogen at progesterone. Because estrogen of sleep, mahirap ng maghanap ng best
at progesterone ng buntis ay galing sa Placenta. position.
Management: R-elax, RDA Management: Elevate the legs
Diet: additional 300 Elastic Stocking
cal/day
E- Enough Sleep Enlargement of Uterus/Abdomen
S- Short Naps AOG/EDD = LMP : Naegels Rule
T- Take breaks, 1st day of the last mens
*take Fe supplement: 15-30mg
Total 800mg-1g/day January to March : +9 +7
Take with vit C May to December: -3 +7 +1
Avoid Ca, Mg McDonald Rule
Expectation: GI irritate, Need measuring tape
aggravation of constipation (dark 1cm=1week
or greenish) 0=symphysis pubis
*best indicator if pt is taking iron: blood test Measure =fundus
(increase RBC) Ex. 32cm = 32 weeks
*take Folic Acid (vit b9)– prevents Accurary: 20-34weeks AOG
NTD and anemia Di pwdeng gamitin below 20 kasi wala pa sa
Total 400mcg symphysis pubis ang uterus
Increase Salivation (ptyalism) And di din pwde sa late dahil nag dedescend ang
Cause: Estrogen fetus
Bartholomew Rule
PICA: eating disorder – weird cravings Check for Uterus: Landmarks ang gagamitin
Eats unedible substances Symphysis = 3 months pregnancy or 12 weeks
Concern: 1. nutrition AOG
2. fetus Umbilicus =5 months pregnancy or 20 weeks AOG
Crayons, Paint = Lead Poisoning= affect the Brain Xyphoid = 9 months pregnancy or 36 weeks AOG
Note: between symphysis and umbilicus =
Vaginal Changes 4month
*Increased Vaginal Secretion: Leukorrhea (white Between Umbilicus and Xyphoid =
and odorless) if may color = infection 7months
Cause: Estrogen Return of the uterus to its pre pregnancy state
Management: Good perineal hygiene to prevent state is called involution
infection Kelan ang involution completes ;within 6 weeks
*front to back (cleaner to dirtier) Post partum = 6 weeks only
*underware made of cotton (for easy absorption Once hindi nakamit ang involution within 6 weeks
called subinvolution
Varicosities:
Cause: Uterine Pressure Factors that achieve involution
U.P. can also cause 1. Hemorrhoids 1. uterine contraction (the more nag papa
2. Edema :pedal breastfeed si mother, the faster ang involution
2. Ambulation Declines: 100 day
3. Nutrition Absent: 1-2 weeks after delivery
HCG test done if have retained placenta
Perinatal Period: Age of viability(20-24 weeks) or
once it reaches 500g up to 6 weeks Reported Urine PT
-possible pa din ang false positive result
How will you know once involution is achieved? Reason for false positive?
Nasa Umbilicus ang uterus after manganak Ano ang ituturo natin sa pt if gagawa sila ng urine
And then everyday it will descend 1 FB (finger PT
breath)/1cm per day. MNEMONIC: ABCDE
Day 10. Uterus is not palpable in symphysis pubis 1. Avoid late Reading
(6 weeks maximum) 2.Best done in the first urine
(hcg in the urine is concentrated)
NOTE: you can find the uterus after 1 hour delivery 3. concentrated urine dapat
midway between symphysis and umbilicus 4. Don’t take Methadone/Chlordiazepoxide
5. Expiration Date – false positive result
What if the uterus is tiled to side (left or right)?
It means full bladder Outline felt by the nurse
Management: let her void – straight catheter Why probable?
-possible may tumor with calcification
Best Done 3rd trimester
PROBABLE SIGNS OF PREGNANCY
-Objective Leopold’s Maneuver -Palpation
Mnemonic: PROBABLE -warm hand

Positive Serum PT Grip 1: Fundal Grip

Reported Urine PT where: superior of fundus
Outline felt by the nurse what: if head or buttocks or tranverse (shoulder)
Ballottement Head = round, hard, moveable
Brackston Hicks Contruction, Bluish Vagina Buttocks =soft, round, moves with the
Lower Uterine Softening mass
Evident Sac (it form on 2nd month) Why: presentation in birth canal
Head = cephalic Presentation
Positive Serum PT Attitude: flexion and extension
Hormone: HcG *not all cephalic are good it depends on
Created By:Chorionic Villi the attitude
Accuracy: 95%-98% Well flexed : Vertex Presentation (favorite
Present: as early as 1-2 days after fertilization presentation)
Continue to increase and it doubles every Partial flexed : Sinciput Presentation
2 days Partial Extension: Brow Presentation
Fully Extension: Face Presentation Left occipito . .
Extreme Extended: Chin or Mentum Presentation And if nasa likod likod
Left Occipito Posterior
(CS na)
Pano mamalaman if pwet ng bata or face
*insert ang pinakamaliit na daliri
If pwet ng bata makakapa ng Meconium

3 types of breech
1. Frank Breech = Foot nasa Face
2. Complete Breech = naka cross legs
3. Footling – 2 types. Single and Double Footling
Shoulder Presentation (CS)
-ang Lie (higa): relationship of long axis of
the baby to the long axis of the mother
A. Left Occipito Posterior
1st Ang occipito nasa left ni mommy
2nd ang occipito nasa likod ni mommy
How to identify the Point of Maximum Impulse
1st Divide into 4 quadrants
2nd saan ang fetal back
3rd ilalagay ang doppler or stet kung saan ung fetal
back na malapit sa ulo.
So ang sagot kay baby A. is LLQ

2 types of lie
1. longitudinal Lie; pag nakatayo si mother,
nakatayo si baby
2. transverse Lie – opposite – nakatayo si mommy,
nakahiga si baby

Obstetrics Day 2 Check the picture:

Always check kung nasan ang occiput.
Grip 2: Umbilical Grip Baby A: ang occiput nasa Right n ani
Where: one hand on one side of the uterus mother, and Posterior
How: palpate other side top to bottom Baby C. Nasa anterior na ni mother ang
What: Fetal Back occiput
Why: Position Baby B: T=Transverse ang occiput
Position: Transverse na
Favorite Position: Cephalic: Vertex
Anong unang lalabas kapag Fastest: Occiput (ang landmark) Anterior (ni
vertex: Occiput nanay)
Partially flex: Sinciput Pag lumabas si baby: Nakadapa ang baby
Fetal back = andoon ang occiput
Occiput (back ng head)
Painful and Prolonged: Occiput Posterior
Ang basis ng positioning is the relationship of the
Why? Tumatama ang likod ni baby sa
presenting
pelvis ni
part to the mother (not to the nurse facing
Mommy
the
mother)
Landmarks:
If ung occiput nasa right ni mommy.
If breech: Sacrum
Right Occipito . .
(if the sacrum is on the left or right, if the
And if nasa anterior ni mommy
sacrum is
Right Occipito Anterior
on anterior or posterior of the mother)
If unf occiput naman nasa kanan ni mother
 Possible positions: How: kapain mo ang dalawang buto nan
Left Sacro anterior. aka usli sa gilid (land mark of station 0 -
Left Sacro posterior. ischial spine)
Right Sacro anterior. Station 0 = engagement
Right Sacro posterior. Above the ischial spine – ang station
If face: Mentum Below the ischial spine + ang station
(if the face is on the left or right, if the face
is -4
on anterior or posterior of the mother) Floating pa si baby
Possible positions: -3
Left Mento anterior. -2
Left Mento posterior.
Right Mento anterior. -1
Right Mento posterior.
0 Ischial Spine

+1

+2
If shoulder(transverse): Acromion
+3 Crowning
(if the shoulder is on the left or right, if the
shoulder +4 Ang ulo nasa perinium
is on anterior or posterior of the mother) na ni mother
Possible positions:
Left acromion anterior.
Left acromion posterior. Grip 4: Pelvic Grip
Right acromion anterior. Where: Both sides of uterus 2” above inguinal
Right acromion posterior. ligament
How: press downward and inward
MNEMONICS: Sa MOA What: degree of flexion/extension
Sacrum Kinakapa mo if nakayoko or nakatingala
Mentum ang bata (the degree of flexion or
Occiput extension = ATTITUDE)
Acromion Why: to know the attitude
RECAP:
3rd Grip: Pawlick’s Grip
Using 1 hand
Where: Above Symphysis
How: grasp between thumb and fingers
What: movement and consistency
Movable: not engaged
Not movable/fixed: descend /engaged.
Consistency: we confirm if its soft or hard
we confirm the presentation A. Attitude: well flexed C. Attitude: Partially
Extend
the best way to determine the engagement Presentation: Vertex Presentation: Brow
is to B. Attitude: Partially flexed D. Attitude: Fully
VAGINAL EXAMINATION (I.E.) Extension
-check the station Presentation: Sinciput Presentation: Face
If engaged; kelangan naabot niya ang
station 0 Continuation. . PROBABLE SIGNS OF
PREGNANCY
Ano ang kakapain sa I.E.? BA- Ballottement - Passive movement (tayo
1st hanapin ang station 0 ang nag move sa kanya)
 When: 4-5 months – enough na ang
Amniotic fluid
Amniocentesis – 2nd trimester
What: Fetus bounce in amniotic fluid
agains a hand on the abdomen
How: lower uterine segment tapped
sharply in a bimanual exam
Balloter – meaning “to Quake”
-tayo ang mag sha-shake kay baby
How? By Bimanual Palpation
One hand: IE : tap the cervix
upward
Other hand: in the abdomen of the
pt
While tapping: the nurse will fell bouncing
of the baby against the amniotic fluid
WHY PROBABLE: possible ascites
B- Brackston Hicks Contraction and Bluish
Vagina (
Brackston’s Hicks Contraction
Normal: contractions that do not cause
True Labor
SIGNS OF TRUE LABOR
1. Cervical Dilatation
2. Show mucus plug (takid ng bote ng
bote ng champaign -cork) once na nag
loosen ang cervix(dilation) -maalis ang
mucus plug.
3. Contractions unrelieved by
rest/ambulation and intensify
MNEMONICS: Puro PP nakikita ko sa OB
P: Painless to Painful
P: Placenta Perfusion
Explanation:Ang mga Brackston hicks daw
ay Painless to painful, at first they will start
na hindi maramdaman ng patient pero nag
iintesify din siya. But, kahit may painful
contraction they do not cause true labor.
Before ang turo: painless ang Brackston
hicks sa umpisa lang ang painless lalo
kapag end ng pregnancy
Bakit may contractions?
This is to increase the perfusion papunta
sa placenta para dumami ang circulation
sa uterus.
Kelan nag uumpisa?
P: Present throughout the pregnancy starts at 12
weeks
P: Practice/Preparation “rehearsal” meaning nag
cocontract contract para ready na kapag totong
labor na.
Bluish Vagina
Normal color: Pink (hindi buntis)
Bat nagiiba ang kulay ng mga
buntis?
1. increase vascularity and blood
supply
-because of Estrogen
2.. Vagina – dito lumabas ang
baby,
3.. Violet/purplish/ bluish?
CHADWICKS’S SIGNS
-pronounce as/sound as chadVicks = “V” =
violet
L- Lower Uterine Softening
S- Sixth Week
S- Second Missed Period
-palpate the lower uterus for
S- Soft and Thin
S- Sign of HEGAR
CAUSE: Progesterone
-it causes softening together with relaxin for
relaxation
PART OF UTERUS:
Topmost part of the Uterus called Fundus
Body of The Uterus called Corpus
Last Lower part of The Uterus is called Isthmus.
*Isthmus ang nag sosoften sa HEGARS
SIGN
Cervix – opening of the uterus
-Nag sosoftening din during pregnancy
called GOODLES SIGN
Corpus nag sosoft din during pregnancy WHY?
Kapag nag eenlarge ang uterus and it is called
MCDONALDS SIGN
And all of this softening is all cause by the
hormone PROGESTERONE
E- Evident Sac
What: Characteristic ring in UTZ
When: 4-6 weeks (2nd month)
*if Nakita ito sa UTZ
pababalikin siya hangang
makita ang outline ng fetus or heart beat
ng baby
BUT WHY PROBABLE? Because there could be
or not be fetus that can be develop.
If ultrasound is done in ____ what is the reason?
1st Trimester: Confirm if shes really pregnant
Diagnose the pregnancy:
Diagnose means: twin ba si baby or
implanted na ba si baby? Or abortion na
ang nangyari?
2 Trimester: Dito ichecheck kung may kulang/
nd
deformity or
Abnormality.
Reveal Gender
Placenta (naka implant bas a
tamang pwesto)
Amniotic Fluid (N- 500-1000 or
800-1200.
OLIGO: <200
POLY:>2000ML
Anong problem kapag may
oligohydramios? KIDNEY
Anong problem kapag may
polygohydramios?
DM
Or hindi nakaka shwallow si baby
Purpose of Amniotic Fluid
1. Cushion meaning
Kapag nasuntok si mommy hindi
agad matataan ang placenta
Kapag ang zuzumba hindi
maxadong naalog alog si baby
2. Thermoregulation
Kapag nilalamig si mommy hindi
maxadong nilalamig si baby; Vice
versa sa heat
3. Fluid to Drink
4. Facilitate Fatal Movement
Kaya kapag may oligohydramious
(konti ang tubig)
May problem si baby sa Musculo
skeletal why? Hindi siya nakaka
pag exercise doon sa loob
ORGANOGENESIS PA LANG SI FIRST
TRI
-no gender, konti ang amniotic
fluid
Q: If tinanong ka sa board: pwde bang
makakita ng abnormalities sa UTZ?
A: Yes
Q: At what Trimester:
A: 2nd Trimester
3 Trimester/Labor :to confirm maturity of the fetus
rd
How to confirm the maturity of fetus:
1. I memeasure niya ang BPD bi-parietal
parameter (layo ng parietal bone
nyasusukatin ) if more >8.5cm means ok
na.
2. Head Circumferenc, if >34 cm it means
Malaki na. mature na si baby
3. Femur Length
4. Placenta titignan ang calcium sa
placenta (the more calcium the ore
mature) PLACENTAL GRADING =
determining the calcium in the Placenta
Side Notes:
Lecithin and Sphingomyelin Ratio:2x
amount of lecithin than Sphiingomyelin.
if marami si lecithin kesa kay
sphingomyelin it means enough na ang
surfactant.
Where ginagawa ang L:S Ratio?
Amniocentesis
Amniocentesis -mag pupuncture sa
abdomen then aspirate sample of amniotic
fluid 15-20ML (2nd trimester? Why mas
marami ang amniotic fluid sa 2nd trimester.
*marami ang ma dedetermine sa
amniocentesis hindi lang L:S ratio
Preparation before UTZ
1. Educate – para kumalma
No need NPO, No need Inform
Consent
Inform Consent only applicable sa:
1. Invasive
2. Giving Anesthesia
3. Injecting Dye
2. Full Bladder – to Stabilize the Uterus
Drink 1glass of water : 40ML every
15minutes for 90 minutes
*pigilan g pumuntang mag CR si
PT
3. Position: Supine with rolled towel in
Right buttocks
Bawal ang supine sa mother
dahil babagsak ang BP kaya
lagyan ng rolled water.
Bakit bawal?
Once naka supine naiipit ang
largest vein in the body (Vena
Cava) kapag naipit baba ang
pressure and it is called VENA
CAVA SYNDROME OR SUPINE
HYPOTENSION SYNDROME
Best position in OB is LEFT
LATERAL
 If OB resuscitation: naka tilt pa
din sa left.
4. UTZ Gel should be Warn
POSITIVE SIGN
MNEMONIC SIGNS: HOMES
H- Heartbeat of fetus heard by Examiner
O- Outline UTZ
M- movement felt by Examiner
S- Sekeleton in Xray
Heartbeat of fetus heard by Examiner
Rate: 120-160bpm (110-160 by perry)
Example: if 96bpm
Nurse should ReAssess by confirming the
maternal pulse (60-100)
How: kunin mo ulit ang fetal heart rate
while hawak mo ang pulse ni mommy.
Kapag sabay maternal pulse.
NST: Non-Stress Test – test for fetal well being
Data Needed:
1. Fetal heart rhythm
Kelangan nakalagay na ung strip sa
maternal abdomen. Hanapin ang fetal
back at ilagay ang transducer machine at
madiditect niya ang heart beat ng baby
and mereregister don sa strip
2. Fetal Movement
*ibibigay kay mommy at pipindutin niya
every time may fetal movement
3. Accelerations during Movement
-kelangan may increase ang
heart ,kelangan may acceleration
-it should be 15 seconds acceleration
and 15 beats ang inangat niya
- kelangan tumaas ang accelereation
habang gumagalaw siya (sabay ang
acceleration sa movement)
INTERPRET: “REACTIVE” NST – good
Non-reactive – abnormal
kapag patay ang bata, kapag gumalaw
pero walang acceleration, may acceration
pero not 15-15
CST: Contraction Stress Test
-para sa mga abnormal NST
-stress test of the baby to see if stress ba
siya kapag nag cocontract ang mother
Data Needed:
1. Fetal Heart Rhythm
2. Contraction- kamusta ba ang heart niya
kapag nag cocontact si mother.
*The more mas Malaki ang curve the more
mas malakas ang contraction
*The more mas mahaba ang contraction
the more mas mahaba ang curve
Q: What if the mother is not yet on labor?
And there is no contraction?
A: Nipple Stimulation by the Patient (just
instruct tha patient to roll the finger in her
nipples)
NOTE: bawal magbigay ng oxytocin dahil
once nag contract mahirap patigilan ang
contraction pwdeng mag lead sa labor
1:10:40
The contraction should be 1:10:40
Meaning: 1contraction that occur in 10
minutes for 40 seconds
3. Deceleration – Decrease ang Heart
Rhythm
If we see >50% late decelerations: BAD
CST – POSITIVE CST .
May drop in rhythm. After contractions
may decelerations = LATE
DECELERATION
Kaya pangit because ang normal dapat
after contractions may oxygenation.
Pangit, kasi nag drop after contraction,
walang proper oxygenation. Hindi niya
kayang mag oxygenate after contractions.
=PLACENTAL INSUFFICIENCY
EARLY DECELERATION
= Head Compression
= Normal
-Sabay ang oxygenation sa
contractions
VARIABLE DECELERATION
=party sumabay , partly hindi
=Cord Compression
=abnormal
 Calls baby from “it” to He/She
Third Trimester Task: Preparing for Parenthood
Emotion: Impatience
4 N’s
Nest-Building – bibili na ng items ni baby
Name Nappies Natal Prep
OB ABNORMALS
Variable = Cord Gestational Hypertension – Pregnancy-
Early = Head Induced Hypertension
Late = Placental Insufficiency Q: What do you consider a normal BP in
VEL CHP pregnancy?
a. hypertension
O – Outline of fetus in UTZ b. hypotension
When: as early as 8 Weeks c. neither
ME- Movement is felt by Examiner d. both
20 weeks – primi Answer: B.
16 weeks- multis Hypotension is normal but only in second
S- Skeleton in XRAY trimester to give way to the growing
When: Bone ossification start at 12 weeks placenta.
Mineral Needed: Calcium 1g: 2nd trimester Hypertension is bad in pregnancy
Vitamin needed: Vitamin D 600IM/Day Existing Hypersion before pregnancy is
If no vitamin D, choose Fat called Chronic or Essential Hypertension =
Vitamin C- Iron pathophysio Cardio-Vascular
Before routine and Xray during 3rd sem PIH- nabuntis-tumaas ang BP
(not done anymore) Cause: P.I.H.
To check if cephalopelvic disproportion -increase in blood volume by 40-
Avoid in 1st Trimester =peak of 50%
organogenesis -blood vessel damage arteries
-it can destroy organogenesis (distribute ng blood)
4 types of Pelvis Prone: weak blood vessels. Sino
1. gynecoid –female (pwde na magdeliver ung high tendency na may weak
ng NSD) vessels?
2. android – male pelvis (cannot deliver -Young and Old
normal) -poor nutrition
3. anthropoid - ape-like -poor socioeconomic
4. platypeloid- Rectangular
Blood Vessel Damage = Vasospasm
Psychological Changes in Pregnancy
=Increase Pressure =
First Trimester Task: Accept Pregnancy
Hypertension
-as a nurse kelailangan natin matulungan
para ma achieve to accept the pregnancy
Pathophysiology:
Emotion: Ambivalence – feeling both pleased and
Increase blood volume = Vessel
not pleased about the pregnancy
damage = Vasospasm = Increase BP
How to help: Ultrasound
(P.I.H.)
-kailangan nila makita ang baby, kailangan
Q: When do we screen PIH on
nila marinig ang heart bead to accept the
Pregnancy?
pregnancy
A:2nd trimester because doon ang peak
Second Trimester Task: Accepting the Baby
ng blood volume
-Narcissism
Assessment:
-introversion
1.140/90 and beyond
-more on “self” ang concern nila
2. systolic +30
Happens at: Quickening -helps them to
3. diastolic +15
accept
 Example: 80 + 30 = 100
50 + 15 = 65
*atleast 2x, 6 hours apart
= Hypertension in
Pregnancy
*masama dahil hindi Maganda ang circulations,
maxadon mabilis, pwdeng mainvolve ang mga
vitals organs dahil hindi sila nakka received ng
proper blood.
MNEMONIC: Lab-Ni_Haydee drug for
Hypertension in pregnancy
Medication: Labetalol (Beta Blockers)
Nifedipine (CCB)
Hydralazine (Apresoline)
-potent vasodilator (iv bolus) (it
should be the doctor who will give
this drug)
-possible bumagsak ni bp
-bantayan ang BP at PR
-if may hypotension di na makakarating
ang blood sa uterus, CONCERN: BABY
Bakit bawal ang ACE inhibitor
-it can cause fetal kidney damage
If nagkaroon ng Poor Circulation because of
Hypertension = the kidneys will affect first which
result to proteinuria (malalaki ang mga protein
dapat hindi lumalabas sa ihi) pero dahil affected
ang kidneys lalabas si protein which result to
Hypoalbuminemia (function: it gives oncoltic or
osmotic pressure) (it keeps the fluid in the B.V and
Cells) =kaya nagroon ng generalize edema = Pre-
Eclamsia
Send urinalysis to confirm the proteinuria.
Assess the face = kasi if kung may
generalize edema it means Nawala na ung
albumin. Possible na Pre-eclampsia na
Pre-Eclampsia = HTN + Proteinuria , Then edema
If with Seizure = Eclampsia (20% mortality
rate-namamatay)
If nagroon ng seizure magkakaroon ng
decrease o2 ng brain ni mother and decrease o2
ng fetus. Parehas na silang delikado.
PRE ECLAMPSIA
P- Proteinuria
R- Renal Involvement
E- Edema : generalized (buong katawan) including
Cerebral edema = Magkakaroon ng irritation na
mag cacause ng seizure
*kaya if merong proteinuria need I control
to control the seizure
E- Eliminate Brights/Noise =dim light only
Why dim? If dark = sudden turn on
of lights will cause seizure
If may nahulog because of dark,
ung noise pwde mag trigger ng
seizure
C- Convulsion has to prevented
L-Lower the BP
A-asess the vital signs HOURLY
If may sudden increase ng BP =
Seizure
Mild Pre-eclampsia = 140/90-
150/100
Severe: 160/110 and above
DTR: 2 (increase reflex is a sign of
impending seizure)
M-magnesium Sulfate (DOC) pre-
eclampsia
P-Protein Intake: Mild: Regular
(maintain)
Severe: Increase Protein
`S- Sodium: Moderate : salt diet (dapat
laging maataas ang aldosterone)
(hindi pwdeng magpa low salt diet
sa pregnancy dahil maactivate
ang RAAS which will result to inc
BP)
I-I and O.check every q1
Output always +30 ML dapat
Oliguria is present = signs of pre
eclampsia (dahil damage na si
kidney)
Prone to magnesium toxicity
A- Assess fetus
Magnesium sulfate
-reduces Edema
-CBS depressant
(respi center nasa brain ) pwdeng
ng mag Respiratory Arrest
-Muscle Relaxant
Cardiac arrest (muscle is made up
of muscle
But *narrow and Therapeutic index very
prone to Toxicity
Nursing Responsibility
1. Therapeutic Range 5-8mg/dL
Check every 6-8 hours
2. Urine Output = always +30ML
3. DTR: normal 2. hypo reflexia score 1or 0 means
MgSo4
toxicity
-ito din ung unang nawawala if meron Eclampsia
MgSo4 toxicity is DTR Most Severe Gestational Hypertensive
-mawawala na alng ang DTR kapag Disorder
umabot na ng 8-10mg/dL -decrease o2 ni mommy
-check every hour -decrease o2 ni fetus
4. RR 15-20mg/DL: always check every hour If it involves: Liver + Pancreas the will
>25 mg/dL it will result to cardiac arrest. complain will: epigastric pain and increase
bleeding
ANTIDOTE: CALCIUM GLUCONATE Responsibilities if nag Seizure na si patient
E- Ensure Safety; Airway
RECAP: C- Convulsant Drugs:
PREGNANCY-INDUCED HYPERTENSION Valium/Diazepam
PEAK NG BLOOD VOLUME SA 2nd TRIMESTER L- Left Side (drain secreation and
PERO DAPAT, BP HINDI MAG CLIMB best position for circulation)
UGAT NA-DAMAGE NG IBANG PATIENT, A- assess fetus
ABNORMAL YAN M- continue MgSo4
PREGNATS SHOULD NOT HAVE IT P- progress of 2nd labor – how to
know? If nagroon ng contractions
PRE-ECLAMPSIA and cercial dilatation
I WILL ASSESS PAG MANAS ANG FACE S- Sp02: 6-10lpm via facemask
EDEMATOUS SA START NG DAY I- instruct NPO (ready na ba for
PROTEIN MAY TRACES SA KANYANG IHI NSD or CS)
FROM HIGH BP, NAGMALFUNCTION ANG BP A: assess the mother for bleeding
-assess for abruptio
DIAGNOSTIC AND TREATEMENT placenta
PAG TUMAAS NG 140/90 ANG BP -Liiver
OR SYSTOLIC AY PLUS 30 -Every 15mins assess for
DIASTOLIC AY PLUS 15 bleeding
HIGH BP LIKE THIS CAN CAUSE PROTEINURIA BIRTH for Eclampsia
GENERALIZED EDEMA THIS IS CALLED -Decide in 12-24 hours (AOV
PREECLAMPSIA reached)
START GIVING MAGNESIUM SULFATE SO SHE Why prefer NSD than CS?
GET BETTER Why not CS?
PARA HINDI MAG SEIZURE GANG AFTER CS only if life treathening
MAGDELIVER -Contraindicated to severe hypertension
-Retained Lung Fluid because of
MAGNESIUM SULFATE prematurity
WHEN IN MAGSUL DTR IS SEEN -HPN under GA can cause Hypotension
COUNTING RR, AND HER PROTIEN +1 AND +2 HTN = hypertension
MILD, +3 AND +4 SEVERE HPN = hypotension
TIGNAN ANG OUTPUT, DAPAT PLUS 30 Bleeding for Pregnancy
ANG ROOM NYA AY DIM, AT HINID NOISY Normal or abnormal? Abnormal. Any
bleeding no matter how the aout is,
bleeding is abnormal
1st trimestral Bleeding
A. Abortion – loss of pregnancy before AOV (20-
24 weeks)(5-6 months)
Because kulang pa sa
1. surfactant
2. Weight less than 500g
Reason of abortion: DIM
1. Development – nagkaroon ng problema
sa organogenesis pweding
1. Teratogenicity- na expose si
mother
-like drugs ,virus (rubella),
chemicals, radiation, xray,
hyperglycemia
2. Chromosomal Aberration-
abnormal in
chromosome
2. Implantation – implantation abnormality,
decreased Progesterone
3. Maintenance- Infections, immunologic
Normal: increase production of
deoxycorticosterone (steroid)
immune suppressant kaya ang
mga buntis immune suppress.
Bakit kelangan immune
suppress ang pregnant women?
Dahil para hindi I reject ng
immune system ang mga
nakikitirang bata. Hindi naman
tlaga siya part ng cells ng body.
*Cannot give Live Attenuated
Vaccine like
MMR or Rubella because it can
cause actual disease to them.
How to confirm if we lose the pregnancy
Diagnostic Test: H-U-H
1. H – HcG appears in the blood 1-2 days
after fertilization and it will keep in
increasing up to day 100th. 2x every 2
days. 100 days decline.
*kapag hindi na nag increase ang HCG -
abortion
2. U- Ultrasound: no fetus, no implantation,
no heart activity
3. Hear the heartbeat- no heart beat
means loss the baby
3 months can use: Doppler
4 months can use: Fetoscope
5 months can use: Stethoscope
Management: to prevent bleeding and can build
infection
-both can lead to shock (life-threatening)
No involution na mangyayari if may tissue na
naiwan
(involution =babalik ang uterus into previous state)
1. Surgical Interventions
AOG: below 14 weeks and prepares
Equipments
Bone formation = 12 weeks of AOG
Ginagamitan ng surgical interventions ay
ung mga halos wala pang buto.
3 TYPES:
1. Dilatation and Curettage (DandC)
2. Dilataiton and Evacuation
3. Sunction Curettage
2. Medical Interventions
AOG: above 14 weeks prepares Drugs
Drugs to manage abortion: M-O-M
1. misoprostol (Cytotec)–
Prostaglandin (it cause ripening of
cervix) (can also initiate
contraction)
2. Oxytocin (pampacontract ng
uterus)
*hindi pwdeng gamitin kung hindi
ripe ang cervix
3. Mifepristone: {progesteron
antagonist)
-decrease progesterone, will
cause shed of the endometrial
lining.
Types of Abortion:
1. Threatened :50-50%
Assessment: C-B-C
Cramps, Bleeding, Closed Cervix
Diagnosis: H-U-H
*no CBR (complete bed rest) – it
can cause vaginal blood pooling
meaning naiipon lang ung dugo sa
vaginal canal)
Cause of abprtion: D-I-M (walang
activity) so its ok to have activity)
Avoid: S-2-S-2-T
S- Strenous activities for 2 days
S- Sex for 2 weeks
T- Tampon (do not Insert)
Why avoid coitus and
tampon? To prevent
infection

once we confirm that we loss the pregnancy 2. Imminent: Inevitable

Assessment; C-B-O
 Cramp, Bleeding, Open Cervix NSG: Clarify
Diagnosis: H-U-H -kasi akala nila hindi natuluyang
Management: S or M na abortion. Wala ng pregnancy
Surgical = <14 weeks wala lang kamalay malay
Medical = > 14 weeks
NSG: health teaching 6. Recurrent Pregnancy Loss: Habitual
Save pads, clots and tissue Abortion
-to assess how much is the Assessment: 3 consecutive abortion
bleeding (spontaneous abortion) (hindi pwde ung
-to rule out kung naglabas siya ng sinadya or induced abortion)
clear fluid filled grapelike vesicles Dinisdicourage ang habitual
(to rule out if fetus ba or H.Mole) abortion kasi nagiging habit na
H.Mole -Cancerous niya maglaglag
-choriocarcinoma SIDE NOTE: Incompetent cervix: 2nd
3. Complete trimester not a cause of Habitual abortion.
Assessment: all products of pregnancy Dahil ang incompetent cervix ay pagdating
are expelled. ng 2nd tri kusang bumubukas ang cervix.
How to know if its complete? Causes:A-B-C-D-E
Dapat meron tong talong to: A- Autoimmune – the mother
1. fetus rejects the fetus)
2. Membrane B-Blood Flow Resist will result to
3. Placenta failed pregnancy
No S/M management: C-Chorioamnionitis
Since wala ng lamang ang D-Defective Sperm/Ova
kanyang uterus Bleeding will: E- Endocrine Factors
Slows in 2 hours NSG: Support-Emotional
Stops in Day
NSG: Health teaching B: Ectopic Pregnancy – implantation outside the
-report Heavy Bleeding uterine cavity
Ecto=outside
4. Incomplete Normal: Embryo should implant in uterine
Assessment: Not all producsts of cavity
conception are expelled, typically ang 95% of ectopic pregnancy are found in
nilalabas lang is fetus.Madalas maiwan Fallopian tube or Tubal Pregnancy
ung membrane and placenta -The problem is Hindi nkaka
Management: S/M stretch so hindi kaya mag sustain
NSG: Clarify ng pregtancy = delikado is rupture
- She understand the meaning of Abdominal Pregnancy: umaabot ng Term
incomplete abortion. Dahil kadalasana (dahil maluwang ang peritoneum
nag alam nila hindi na abort. “muntik =Laparotomy
lang”. but the reality is aborted na hindi =die within 24 hours
lang nailabas lahat. *Uterus ang perfect for
implantation
5. Missed – Early Pregnancy Failure Classic Triad of Ectopic Pregnancy: A-V-P
Assessment: 5s 1. A- Amenorrhea
S- Silent symptoms (walang 2. P- Pain
kamalay malay) 3. V- Vaginal Bleeding
S- Slight Craming -Ectopic Pregancy 2% cases
S- Slight Bleeding -1st to rule our ectopic if we receive the
S- Stopped Growing Uterus patient with this 3 sign and symptoms
S- Stop Heart Beat -mas delikado kasi ang rupture ectopic
Management: S/M pregnancy than abortion, mas mabilis
ikamaya ang rupture.
 -if hindi siya ictpic pwdeng abortion
Diagnostic: Ultrasound- if she relly pregnant ?
saan ang pregnancy?
What do you expect sa mga nag va-vaginal
Bleeding:
-konti ang vaginal bleeding dahil once nag
rupture the bleed will be in peritonium.
Makikitaan na natin si patient ng
1. Signs of shocks
2. Peritonitis (Rigid Board like abdomen)
SIDE NOTE: ANY BLEEDING IN PREGNANCY
IS ABNORMAL
Management: S-M-L- (share mo lang)
S- Spontaneously End = ma rereabsorb
siya siya sa katawan (some of them)
Anong gagawing agad ng doctor if
Nakita agad ang ectopic? Bibigyan
siya ng anti-cancer drugs:
methotrexate
M- Methotrexate (para hindi na matulog
ang pagbubuntis ni mommy.
If ruptured – EMERGENCY
L- Laparotomy( need tignan and repair if
kung ano ung na rupture)
2nd Trimestral Bleeding
Hydatidiform Mole -Gestational Tropoblastic
Disease (GTD)
Start 16-weeks/4months
H.Mole is the proliferation of trophoblast
cells in pregnancy, no fetus developed
Cause: Normal 46 chromosome come from 23
each parent
H.mole: 46 xx and result from
androgenesis, both sets of chromosome
are parental
Chromosomal ovum are either absent or
inactive
Explanation:
In H.Mole : 46 xx father chromosome
because in mother chromosome its either
inactive or absent
Kaya ang lumitaw mga clear fluid filled
vesicles
Assessment: 3Fs and 4Ps of HMOLE
F- Fundic height is larger than a usual
pregnancy
*inform the doctor if may malaking
discrepancy sa fundic height
F- Fast Fresh Flow which begin on Four
months /16 weeks of pregnancy
F- Fluid Filled Clear Vesicles (grape sizes)
ang lumabas sa vagina -DEFINITIVE
P- Peak always ang HcG (ang normal
dapat bumababa at 100th sa may H.Mole
tumaatas diretso)
P- Prune-Juice (dark in color)(bleeding)
P- Snowflake Pattern without fetus
P- PIH appears in 1st Trimester instead of
@nd trimester
Management:
S: Suction Curettage
WOF: Bleeding
Teaching: Heto Naman PaPaPan-CN (H2 NM1
PPPC)
HCG- Check the Serum
baseline(monitoring every
2 weeks, Until
Normal, then
Monthly for
1 year
P-P-P -Prevent-Pregnancy-Pills
C- Choriocarcinoma – invasive malignant
carcinoma
Cervical Insufficiency – Premature Cervical
Dilatation Incompetent Cervix
-kusang bumubukas pag tungtong ng 2nd
trimester
-start ang bleeding 20 weeks onwards
Cause: A-B-C-D
A- advance maternal age -makunat na ang
cervix
B- Biopsy (removal sample sa cervix)(if
lagging nakukuhnan ng sample tissue will
result to weakening of cervix
C-Cervical Trauma (DandC)
D-Defect sa Cervix
Assessment: P-P-P-P-P
Steps:
P- painless dilatation
P- Pink Show (mucus Plug)
P- Pressure
P- Premature ruptured of membrane
P-progress to labor
Diagnosis: Ultrasound
Management: Cerclage /Suture
2 types: differences are the material and
technique.
1. McDonald- Nylon
2. Shirodkar- Marcelene Tape
12 weeks after UTZ doon nila ilalagay ung
cerclage at once na ang pregnancy ay
okay
 Removed at 37 weeks/ NSD
delivery (before term)
Pero kapag CS -sabay na sa
delivery
3rd Trimestral Bleeding
P- Placenta Previa
A- Abruptio Placenta
P- Preterm Labors
A- Accreta Spectrum
Placenta Previa – low implantation of the placenta
Why may bleeding?
Dahil sa pwesto niya
Normal ang placenta sa upper
Bleeding Cause at 3rd trimester because:
A- Advancing Uterus (ung low laying
placenta naiiwan kaya may naiiwan at
napupunit at naseseparate or na
dedetached
B- Braxton Hicks Contraction
-hindi kinakaya ng isang low lying
placenta ang bracktons hicks
contraction dahil palakas ng
palakas ang contraction at
malakas during third trimester
C- D- Cervical Dilatation. Kapag nag
didilate ung part ng placenta na
seseparate or nag didilate
Previa = Preview (nasa unahan)
P- Painless (nas abungad) agad
tumatagas ang bleed)
SIDE NOTE: Abruptio nasa
tamang lugar pero nag de-
detached siya ng wala sa oras.
Dahil nasa taas. Nagkakaroon ng
concealment of blood. Kapag may
concealment nag pepenetrate sa
muscle layer called myometrium.
Naiirritate ngayong ang
myometrium dahil sa presence of
blood and magcacause ito ng
Tender or Pain.
R- Red (fresh)
E- Evaluated to Ultrasound (NO I.E)
-visualization sa abdominal
V- Vital Signs are monitored baka may
presence na siya ng shock
I- I.E. is not allowed. (pwdeng masundot
o matusok ang placenta, at possible
magkaroon ng massive hemorrhage
A- Assess Fetus FHR (dahil fetus gets the
blood from the placenta)
Management:
Under 30% NSD, above 30% CS (% ng
pagkababa ng placenta)
Vaginal Exam (IE) – IE can only done with
this 3D’s
1. D- Doctor – ang gagawa, kaya siya mag
IE kasi magdedeliver na siya. NOT
ASSESS
2. D- Delivery
3. Double Set-UP (ready for NSD and
Ready and CS room)
Abruptio Placenta- premature separation of a
normally situated placenta.
Kelan ba na seseparate dapat ang
placenta?
*After the delivery
Reason/Cause:
A- Advanced Age (mas common)
B- Brown or Dark ang bleed
R- Rigid and Uterus kapag tinouch
U- Uterus is Tender bec of concealment
of blood
Sharp Pain
P- Premature Separation
T- Tension, Trauma, HTN.
I- Intavascular Coagulation (DIC)
-very common complication of
Abruptio placenta (extreme
clotting) prone to embolism (life
threatening) and bleeding.
O- Occult / Concealed Bleeding
N- No IE, RE(Rectal Exam),
Abdominal Exam
Mas delikado kesa sa placenta
preview dahil hindi nakikita ang
bleeding
Upper ang Pain
Obstetrics Day 3
Third Trimester
P – Previa
A – Abruptio
P – Preterm Labor
A- Accreta Spectrum
Preterm Labor and Birth
- < 37 weeks
- AOG (20-24 weeks to 36weeks 6/7
days)
< 20 weeks = abortion/abortus
21-36 weeks 6/7 days = preterm
 37-38 weeks = early term
38-42 weeks = Term
>42 weeks = Post term
Respiratory Distress Syndrome = #1 concern for
preterm
-not enough ang surfactant
PTL CAUSES: DD AT TITI
D- Dehydration
D- Drugs (stimulant)
A- Amnionitis – infected amniotic fluid
T- Twins, Triplets – Multi Gestational
Pregnancy
Term weight – 2500g-3500g
T- Tension (high BP)
I- Illness
T- Trauma, Violence, Accidence
I- Infection =mortal na kaaway sa
pregnancy
If it happens in 1st trimester = can
cause abortion, organogenesis,
malformation
If it happens in after 1st trimester
= can trigger pre-term labor
UTI – infection cause of PTL
(highly link ang UTI sa
pagtritrigger PTL)
Management: Stop Labor if NO Blood + Water
is 50% “Red”
-NO Bleeding
-NO Rupture of Bag of Water
-Not more than 50% ang Progress ang Labor
How to know if 50% na =check cervix (I.E)
for dilatation and effacement
Dilatation 1-10cm = if more than 5 di na
pwdeng patigilin, dapat below 5cm
Short/Thin (Effacement) – minimeasure
though percentage = fully efface cervix
(100%), dapat wala pang 50% para pwde
pang patigilin.
Red Alert – dapat wala pang Fetal Distress
Two drugs that nurses has to prepare if preterm
ang patient
1. Tocolytics – stop the uterine
contractions
Toco – Contraction
Lytics – Dissolve
Mnemonics : MINT
M- Magnesium Sulfate -muscle relaxant,
uterus
have muscle, kaya titigil ang
contraction.
I- Indomethacin =CCB
N- Nifedipine =CCB
CCB = responsibility in contracting
muscles, block niya ang calcium
para mabawasan ang contractions
T- Terbutaline (number 1 tocolytics)-
bronchodilator
(beta 2 agonist) not only sa heart
pero may effect sa lungs (may
effect sa bronchioles). Uterine
relaxant.
QUESTION: ung patient 38 weeks naglalabor,
naka magnesium sulfate, ung BP mataas . which
of the following assessment of the nurse that
magnesium sulfate is to be effective.
a. tumigil ang contraction
b. bumaba ang BP
C. walang seizure
2. Corticosteroids
Dexamethasone. Betamethasone.
Route: IM
Doses: 2doses-12mg- 24 hours
apart
Question: Bakit binibigyan si mother ng
Dexa/Beta?
*Increase fetal lung production of
SURFACTANT para kahit hindi napigilan
ang labor(lalabas si baby), meron ng
enough na surfactant
Note: if pinanganak na si “newborn” at
meron pa din siyang Respiratory Distress
Syndrome (RDS)
Hindi na Dexa/Beta ang ibibigay.
Surfactant na Direct kay newborn
Route: ETT direct sa lungs ni baby
IF DI NA MAPIPIGILAN: CS or NSD?
-dahil ang mga preterm mahina pa ang
kanilang fetal head, hindi kaya ang
pressure pag dumaan sa birth canal ni
mommy.
-To prevent fetal heal pressure that causes
subdural/intraventricular hemorrhage
 N-NPO – ready to any surgery
Placenta Accreta Spectrum (PAS) G-Give IVF = 2 large bore catheter (why 2-para
-morbidly adherent placenta (sobrang mabilis ang
kapit) fuild replacement, and para meron pa din if
-deeply implanted mag infuse ng blood)
Give 02 = 6-12 LPM facemask

Postpartum Hemorrhage (PPH)

-greatest danger is in the first 24 hours
because of the grossly denuded and
unprotected uterine area left after
detachment of the placenta
*Dapat ang placenta hangang endometrial lang.
-normal na ang bleeding after delivery
-NSD: 500mL/24hr (limit)
-CS: 1000mL/24hours (limit)
-pag sobra PPH
1. Primary Hemorrhage
-first 24 hours nangyari
-heavy bleeding cause by: Uterine
Atony(walang contractions sa uterus)
Tandaan lang ang lalim based sa Alphabetical
-first 24 hours kailangan masara
Order! A.I.P.
ung pinagtangalan ng placenta kasi may
mga blood vessels doon.
Accreta – attached in myometrium
How can we close them:
Increta – invades myometrium
Contractions
Percreta – penetrates Myometrium
*kaya kapag hindi nag cocontrac
(dangerous) kasi mag blebleed.
Note: 3rd stage of labor: normally nag seseparate
-primary reason of primary bleeding is a
ang placenta within average of 5-10minutes.
uterous does not contract and it is called
Maximum 30minutes (if more than 30 minutes
UTERINE ATONY and the bleeding is
refer to the doctor=possible accreta spectrum)
heavy.
=ano gagawin ni doc = ipapasok ang
2. secondary
kamay at babakbakin niya manually ang
-after 24 hours
placenta (manual removal of placenta)
-ang cause is gusto mag contract ng
Management of Accreta: MANUAL REMOVAL
uterus pero may natira,
Management of Increta/Percreta:
CAUSE is Retained placental fragment.
HYSTERECTOMY
*One of our responsibilities as a nurse is to
look what causes her bleeding
BLEEDING
Emergency Interventions
4T’s of PPH(4 reason of PPH)
(life-threatening)
1. Tone: number 1 cause of bleeding
*Pano malalaman if may problema sa
B- Bleeding assessment; BT-Ready
tone? TONE mnemonics.
Ob patient – 20-40% goes to uterus to
T = touch it should be firm
sustain the pregnancy.
(fundus)
L- Left lateral
If Soft, flabby, boggy
E- Evaluate Mother: Vital signs every 5-15mins
Management: stimulate by
E- Evaluate fetus:
massage (gentle)
D- Do not IE especially 3rd Trimester
*if vigorous lalong mang
I- Input and Output = best to determine if enough
rerelax ang uterus
ba ang
O = 1. Oxytocin – uteratonic drug
circulating na blood volume.
to
 contract the uterus
2. Methergine:
Nursing responsibilities –
check the BP, it can cause
hypertension
3. Misoprostol(Cytotec) can
also
initiate contractions
Route: Intra Rectal
4.Carboprost
If hindi pa din nag sstop ang
bleeding: hysterectomy na dahil
mamatay ang patient sa bleeding
N – No ice
E – Excision of Uterus (Last
Option)
2. Trauma = patak patak ang bleeding.
Different Causes of Traumas
L – Laceration – check the vagina, check
the perenium and cervix
(common side of
laceration)
4 Degress of Laceration:
(dipende s alala at lalim and
involve)
Kapag skin lang ang na lacerate
hindi pa kasama = skin nick lang
yon
1. 1st Degree – Perineal Skin
2. 2nd Degree- Perineal Body
3. 3rd Degree- External Sphincter
4. 4th degree – Rectal Membrane
(ang butas sa vagina at rectum
connected na)
How to prevent laceration:
1. Coaching – proper coaching,
kapag lumabas na ang head,
kelangan kalmado na ang pag ere.
2. Perineal Support – nurse will
give perineal support
Hangang 2nd degree ang pwdeng
tahiin ng mga nurses with training
3-4 degree = sa OR ginagawa
H- Hematoma
Palatandaan na may hematoma:
P – Pain unrelieved by
ibuprofen
P – Pressure in
P – Perineum and may
P – Purple Discoloration
I- Inversion of Uterus
Happen during
1. Delivery of the baby : excessive
fundal pressure
2. Delivery of Placenta:
mismanagement of 3rd stage
Placental Delivery (nasobrahan sa
hila ng placenta)
Inside Out (kakabatak ng
palcenta)
Notice in Vagina (ang uterus)
Vaginal Bleeding that is Heavy
R- Rupture of the Uterus
R- Retracted ang
U -Uterus
P – Prolonged Labor at ginamitan
ng instruments like Forceps and
vaccum, Past CS
T- Tearing Sensation (complain of
mother)
U- Usually causes fetal Death
(walang blood supply)
R- Rare but possible
E- Extra Uterine Fetus (fetal part
ourside the uterus)
3. Tissue
T- Tissue of Placenta (retained inside)
I- Infection
S- six to Ten days to discover if small
S- seen in the ultrasound or HCG level
U- Uterus not fully contracted
if sabi sa board na wala talagang
contraction ang sagot UTERINE
ATONY
E- Expel the Tissue
4. Thrombin
C- Clotting Problem is diagnose by LAB
TEST
While waiting for blood result
L- Look around (tignan ang dugo sa floor,
kelly pad
etc, and kailangan if kanina pa
ung dugo clotted na kasi kapg
hindi may clotting problem)
O- O2 (6-10lpm), IVF (Crystalloid pang
replace ng
 fluid ng electrolytes- ito ang
choice)
ang Colloid kasi Malapot (may
content na albumin-it keep ng
oncotic pressure)
T- transfuse cryoprecipitate or Fresh
Frozen
Plasma

ABNORMALS in Pregnancy
A =Absent / diminished fetal movement (hindi ko
na
nararamdaman ang baby ko)
B= Bleeding- no matter the amount is
N= Nasty Urination, Pain is reported (if UTI-It can
cause
miscarriage or pre term labor)
Normal: increase frequency, +1 Glycosuria
O- Ocular Changes – Floater cause by
Hypertension
R- Risk in Health (close monitoring/observation,
mas
madalas ang prenatal check-up)
M- Mornal Sickness Sever – Hyperemesis
Gravidarum (more
than 1 time and more than 12 weeks)
A- Abdominal Pains –should reported, possible
pre-term
labor, Cramping abortion, Rupture ectopic
pregnancy, Abruptio Placenta
L- Loss of Weigh in Pregnancy- Weight Gain kasi
dapat
Normal BMI – 25-35lbs (11-15.9kg)
1st trimester: target wt gain is 1kg (buong
trimester)
2nd trimester-3rd trimester: 1lb per week
except in
2nd trimester pwedeng 1-2lbs.
If nag exceed possible preeclampsia
(generalized
edema)
babawasan if overweight