Primordial young, but FSH’s high
Obstetric Nursing
OVARIAN CYCLE
Ovarian Cycle - a.k.a. menstrual cycle
• Boy → testosterone
• Girl → estrogen (produced by the adrenal
cortex)
At 16 weeks gestation: genitalia formation
1st Menstruation: Menarche (9 - 16 year old)
Decreased estrogen stimulates the hypothalamus
to release GnRH
GnRH: Gonadotropin releasing hormone
Gonad- [reproductive organ], -tropin [to grow/ growth]
→ for the gonads of the female to grow
When Anterior Pituitary Gland (APG) detects GnRH,
it will release Follicle Stimulating Hormone (FSH)
which turns Primordial follicle (immature) into
Graafian follicle (mature).
Graafian follicles will then release more estrogen
during the follicular/proliferative phase. Increased
estrogen thickens the endometrium for possible
implantation. FSH also induces the rupture of the
Graafian follicle to release the mature egg
(Ovulation).
APG also produces Luteinizing Hormone (LH) which
is responsible for the formation of Corpus Luteum.
The ruptured Graafian follicle will turn into CORPUS
(body) LUTEUM (yellow) → rich in lutein (rich in
progesterone). This occurs in the secretory phase.
If there’s no fertilization: Corpus Luteum (yellow) will
turn into Corpus Albicans (white, low progesterone)
after 8-10 days
If fertilization occurs: Corpus Luteum will remain for
16 weeks
Estrogen: Hormone for ovulation; increases
endometrial lining
Progesterone: Hormone of pregnancy; protects
endometrial lining from shedding off. PRO-GEST
(Gestation) = Pro-pregnancy
Normal amount of menses = 30-80 ml
Endometrium - site of implantation
Ampulla - site of fertilization
Ovary - production of estrogen and progesterone;
discharges ovum
“Bata pa, Estrogen is low
Puberty dapat up to go
With the bit of right hormones
Hypothalamus release GnRH
APG release FSH
Add some more stimulation, turns to Graafian
Then Estrogen will surge
Proliferative phase
[CHORUS]
APG now produce LH
An egg embarks, ovulation
Follicles become YELLOW, that’s CORPUS LUTEUM
contains Progesterone
Pag di na fertilize… MENSTRUATION (30-80 days)”
1st phase (Proliferative phase) - Follicular,
Estrogenic = Increase production of FSH and
Estrogen. Ends in ovulation (14 days: constant
value)
2nd phase (Secretory phase) - Luteal,
progestational
If pregnancy occurs = cycle will stop
3rd phase - Ischemic
If there’s no pregnancy = progesterone and
estrogen level will be decreased.
4th phase (1st day of the cycle) - Menstrual
bleeding - shedding of the endometrium,
sloughing
What determines the length of the cycle:
proliferative phase.
Fertilization
• An egg (24-48 hrs) and sperm (72 hrs) unites
• Conception or impregnation
• Subfertility: inability to conceive for more
than 2 months
• Sterility: permanent
Increasing Chances for fertilization
Time: Ovulation
1. Basal body temperature (BBT)
o Sudden drop 0.5℉ - 1℉ then sudden rise
1℉ caused by increased progesterone
2. Spinnbarkeit
o elasticity of the cervical mucus
3. Subtract 14 days from next expected
menstruation
4. Fern Test
o palm leaf pattern under the microscope
5. Mittelschmerz (Mid cycle pain)
o unilateral lower abdominal discomfort
(only one ovary ovulate at a time)
Frequency: every other day
Position: man-dominated
Pre Coitus: no douche, no lubricants
Post Coitus: woman elevate hips for 20 mins
Diet: Complex carbohydrates, moderate protein, January to February - 29 days
low fat February to March - 32 days
Weight: Normal BMI (18 - 24.5) March to April - 34 days
Exercise: 30 mins/day April to May - 30 days
Extra: Hobby (High stress = harder conception) May to June - 30 days
June to July - 35 days
Cervical Mucus: Fertile characteristic
Must be clear, elastic, thin, slippery, watery (egg 29 - 18 = 11th
white); caused by high levels of estrogen 35 - 11 = 24th

Sample Problem: Fertility period: July 20 up to August 2

1. 32 day regular cycle
LMP: July 5-July 10
When will be the first day of the next cycle?
Starting from July 5, count 32 days which will end
up on August 5 (last day). This means that the next
cycle will start on August 6
When will be the day of the ovulation?
14 days before the cycle ends is the ovulation.
32 - 14 = 18th day (July 22)
Fertility period: 3-4 days before and after the
ovulation due to the viability of the sperm
July 18 - 21 and 23 - 26
Stages of Fetal Development
[Oh, ZuMBa Pa! Eh, Foodtrip Nanaman Ikaw!]
O - Ovum
Z - Zygote
M - Morula
B - Blastocyst
P - Primitive villi: Chorionic villi → placenta
E - Embryo: 5 - 8 weeks when organs form
organogenesis
F - Fetus: 8 weeks to delivery
N - Neonate: from birth to 28 days
I - Infant: 1 month to 1 year

After implantation, the endometrium will now

2. 29 day cycle
become decidua.
LMP: December 12-16
• Decidua Basalis - base of the implanted, in
When will be the first day of the next cycle?
contact with the blood vessels
Starting from December 12, count 29 days which
• Decidua Capsularis - encapsulates the
will end up on January 9 (last day). This means that
implanted vessels
the next cycle will start on Jan 10
• Decidua Vera/Parietalis - remaining portion
of the endometrium
When will be the day of the ovulation?
29 - 14 = 15th day (December 26)
Fetal Development:
Average length: in weeks
Fertility period: December 22 -25 and 27 - 30 • 19 weeks → abortus; unable to thrive
3. Irregular: Prerequisite (6 records of previous • 20 weeks → age of viability
cycle) • 38 - 42 weeks → term; (average: 40 weeks)
LMP: July 18 • > 42 weeks → post term (↓placental
January to February - 28 days function)
February to March - 30 days • Lunar months: 10 months (1 lunar months is
March to April - 29 days 4 weeks)
April to May - 32 days
May to June - 33 days
FIRST LUNAR MONTHS
June to July - 31 days
F - Four weeks old
I - Implanted (8-10 days)
Determine the shortest and longest cycle. R - Rudimentary heart (not real heart yet)
Shortest cycle: 28 days S - Spinal cord formed (fusion)
Longest cycle: 33 days § If defect occurs it might lead to:
28 -18 (constant) = 10th o Spina bifida
33 - 11 (constant) = 22nd o Meningocele
o Myomeningocele
When is the fertility period? § Give folic acid to prevent complication
10th day up to 22nd day = July 27 up to August 8 T - three germ layer [EME]
§ Ectoderm: outside
Ovulation is unknown o E → ears, eyes, nose
o C → CNS
LMP: July 10 - 14 o T → touch & taste
 o O → openings § ↑AFP = Open body defects
§ Mesoderm: middle § ↓AFP = Down syndrome
o M → muscles R - Reveal gender
o E → enamel of teeth
o S → skeletal FIFTH LUNAR MONTHS
o O → organs (reproductive, circulatory, F - Fetal movement “Quickening”
kidneys) • Primigravida: 18 - 20 weeks
§ Endoderm: inside; 4Ls • Multigravida: 16 weeks
o L → lower urinary (bladder, urethra) I - Immunoglobulin G
o L → linings VE - VErnix Caseosa: white cheese-like substance
o L → lalamunang may TTT (tonsil, thyroid, in skin
thymus) § Protect from amniotic
o L → lungs o Term: ↓ > 42 weeks AOG =
desquamation of skin
SECOND LUNAR MONTHS § Thermoregulation
S – Sac (earliest: 4-6 weeks): probable sign. Fetus
(earliest: 8 weeks) SIXTH LUNAR MONTHS
E – Extremities 4S
C - Contraction of heart: UTZ (positive sign) S - Scalp hair
O - Organogenesis complete (peak: 6-8 weeks) S - Sound
N - Noticeable face S - Surfactant: active production of surfactant
D - Digestive developing produced by LUNGS; prevent alveolar collapse
during expiration
THIRD LUNAR MONTHS S - Survival (20 - 24 weeks: age of viability)
T - Tooth buds § Surfactant
H - Hear (heart sounds) earliest: 10 - 12 weeks § Weight: > 500g
I - Ihi (kidney): Amniotic fluid water from mother’s 24 weeks: 550g
blood (osmosis + diffusion)
§ Amount: small (No to amniocentesis) SEVENTH LUNAR MONTHS
§ Invasive: sample of chorionic villi (1% risk) S - Scrotum (vs Cryptorchidism → Testicular CA)
§ Color: clear as H2O E - Eye delicate
R - Reflex (Babinski) “fanning” of toes V - Vessels in retina
D - Doppler E - Eye blinking peaks
N - Ninety (90) % survival
FOURTH LUNAR MONTHS If given increased oxygen concentration, it might
F - Fetoscope (16 - 20 weeks), fine downy hair lead to blindness
“lanugo” (term:↓, preterm:↑)
O - Ordinary stethoscope (5 months and beyond) EIGHTH LUNAR MONTHS
§ Doppler = 3 months E - Extends when started (startle/moro reflex)
§ Fetoscope = 4 months I - Iron stores (6 months): Breast Milk has low Iron
§ Stethoscope = 5 months G - Grows faster
U - Urine in amniotic fluid (AF: > 200 ml) H - Hermit face gone (old man face)
§ 🗸 Amniocentesis (20 ml) T - Tips of nails at fingertips
§ Color: Slightly yellow tinged
§ Abnormal: Strong yellow (↑ bilirubin → NINTH LUNAR MONTHS (early term)
destruction of RBC = blood incompatibility) N - Near term
I - Increased fats
Amniocentesis (0.5% risk) N - Nearly 100% survival
• Informed consent T - Turn around
• No NPO H - Head down (cephalic presentation)
• Empty bladder
• No 24 hour admission TENTH LUNAR MONTHS
• Monitor T - Term (38 - 42 weeks)
o Fetal heart E - Engaged (descent of fetus)
o Contractions • “Lightening” → effect to mother
o Bleeding N - Nearing birth
o Infection (fever, chills, pain)
• Ultrasound guided
Placenta
• Purpose:
1. Circulation
o L:S ratio (lung surfactant) = 2: 1
2. Oxygen
o AFP (Alpha Feto Protein) - Liver
3. Nutrition
 4. Ig Cause: Progesterone - Relaxin (pelvic joints)
5. Barrier (not all) Prevention: [4S]
Syphilis: blood only from 4 months • S - stand straight
6. Excretion • S - support pillow in the back
7. Hormones • S - squatting
• S - shoes are low-heeled
Maternal Physiologic Changes Management: Pelvic Rock

PRESUMPTIVE Abnormal: [4Ps]

• P - Preterm labor pain (PTL)
• P - Pain in the urination (UTI)
o 1st trimester: Abortion
• Subjective data (experienced by patient) o 2nd - 3rd trimester: Pre-term
• P - Point pain (vertebral rupture)
P – Pains (back, chest, legs, head) • P - Pahinga ineffective (muscle strain)
R – Respiratory changes
E – Enlargement of breast
CHEST
S – Skin changes
Normal: Heartburn/ Pyrosis
U – Urinary frequency
“burning”
M – Morning sickness,Menstruation cessation,
Causes:
Movement
• S - Sphincter relaxes (P - R)
P – Palmar erythema
🗸 Flatulence
T – Tiredness
I – Increased salivation 🗸 Constipation
V – Vaginal changes • S - Stomach is pushed upward (due to
E – Enlargement of breast enlarging uterus)
Management:
P - Pains: legs, back, chest, head • S - Small Frequent Feedings
• S - Sleep on Left side
PAINS • S - Support pillow (2)
LEGS 2 hours waiting time before lying down after meal
Normal: Cramps Avoid: [KFC] Kamatis, Fried/Fatty, Citrus
Cause: ↓ Calcium, ↑ Phosphorus Acceptable Drugs: [MaHAl]
Management: Dorsiflex foot, extend knees • Ma - Magnesium hydroxide
Prevention: Calcium supplement (1g/day) • H - H2 blockers (Cimetidine, Ranitidine)
• Al - Aluminum hydroxide
Abnormal:
Clots: Deep Vein Thrombosis HEAD
Cause: Uterine pressure → ↓ venous return Normal: Mild, Occasional
Prevention: Ambulation; anti-embolism/elastic • New onset/ new type
stockings (before getting out of bed). If ambulated Management: Paracetamol
→ go back to bed, wait for 30 mins. Length:
Pantyhose Abnormal: Severe
Assessment: Dorsiflex foot, if there’s pain in calf • Continuous
muscle = (+) HOMAN’S SIGN → (+) DVT • With visual changes (blurring, floaters)
Management: This could be due to HYPERTENSION
• Avoid H.A.M.
o H - hot compress R - Respiratory changes
o A - ambulation “Punta ko SSS”
o M - massage • Stuffiness - Nasal Congestion
• Call MD Cause: Estrogen
• Doppler UTZ • Shortness of Breath
• Drug → Low Molecular Heparin Cause: Enlarged Uterus
• Embolectomy (if there’s embolus) • Speedy breath
Cause: Enlarged Uterus
Thrombophlebitis: inflamed vein due to clot
S & Sx: Fever, pain, redness, warm E - Enlargement of breast
Management: Give moist heat • B - blue veins
• R - readies lactation
BACK o Progesterone
Normal: Lower Back Pain (LBP) o Human Placental Lactogen (HPL) a.k.a.
Lordosis (pride of pregnancy) → aggravates LBP Human Chorionic Somatomammotropin
 • E - enlarge → ↑estrogen (↓ Milk supply) • A - Avoid 4s (Seasoned, Spicy, Sebo, Sudden
• A - areola Movements)
• S - secretes colostrum (16 weeks AOG): 1st • D - Doctor notified: vomited more than once,
three (3) days of neonates > 12 weeks, < weight, < urine, DHN.
o Production of milk: prolactin Hyperemesis Gravidarum
o Milk ejection (OUT) O: oxytocin Complication: Fluid/ Electrolyte Imbalance
• T - tubercles prominent (montgomery
tubercles) Iron → aggravates nausea/ vomiting → given in
2nd tri (↑ blood volume)
S - Skin changes
• S - Striae Gravidarum → “Stretch marks” in Menstruation Cessation “Amenorrhea”
pregnancy. I. Primary: never had menarche
o Management: Cocoa-butter lotion II. Secondary: (+) menarche then 3 months up of
• K - Kloasma (Chloasma) → amenorrhea
hyperpigmentation in the face (Mask of Cause: ↑ estrogen & ↑ progesterone
pregnancy) Other reasons:
• I - Increased pigmentation • Anemia
• N - Nigra (Linea Nigra) → vertical black line in • Athlete
the mid abdomen • Anxiety
• Illness
U - Urinary frequency (1st & 3rd trimester) • Infection
• I - Increased GFR → ↑ blood volume
• H - High hormone → ↑Progesterone, ↑ Return: Breastfeeding (3 - 6 months); Non
Estrogen, ↑ HCG [1st tri: Keep ↑ two times breastfeeding (2 - 3 months)
every two days, 2nd tri: Start ↓ 100th day]
• I - Increased bladder pressure Natural family planning:
o Incontinence in pregnancy (“stress” Lactational Amenorrhea Method (LAM)
incontinence) • 100% breastfeeding
o Normal: + 1 Glycosuria acceptable due to • Never menstruated
↑GFR • No solid food

M - Morning sickness, menstruation cessation,

P - Palmar erythema
movement
• Palm of hands
Movement “Quickening” • Redness
Felt by Mother → 20th week (Peak: 28-38th week) • Itchiness
Why > 38th week is not the peak? Cause: Estrogen
1. Larger
2. Engagement
3. Decrease Amniotic Fluid T - Tiredness
Assess: Kick count 1st trimester: due to ↓ glucose
Done by Mother → everyday for 1 hour 2nd trimester: due to ↑ blood volume (40 - 50%)
Average movement: 10 - 12 (1 hour) • ↑ plasma = ↓ RBC (false anemia): a.k.a.
If low, extend 1 hour = >10 - 12 pseudo anemia/ physiologic anemia
• ↓ RBC = ↓O2 transport
3rd trimester: enlarged uterus → deprived sleep
Morning Sickness (Nausea & Vomiting)
Cause: PHEG
R - Relax, RDA (Recommended Dietary
↑Progesterone
Allowance): +300 calories/ day
↑ HCG → starts to ↓ in 2nd tri
↑ Estrogen E - Enough sleep
↓ Glucose S - Short naps
T - Take breaks, Fe (Iron), Folic Acid
Management: “Wag ka na SAD, SAD, SAD” Folic Acid: prevent neural tube defects & anemia
• S - SFF, snacks before bed Total: 400mcg/day
• A - Acupressure band
• D - Dry toast/ crackers (in the morning, upon
waking up) → baking soda has sodium Iron: to ↑ Iron
bicarbonate (Alkaline) Supplement: 15 - 30 mg/day
• S - Sour ball Total: 800 mg - 1 g/day
• A - Acupuncture Increased absorption: take with vitamin C
• D - Delay breakfast Health teaching:
• S - Sips of Carbonated beverages (glucose) 1. GI irritation → take with snack
 2. Constipation → ↑ H2O, ↑ fiber, ↑ mobility; U - Umbilicus = 5 months
avoid laxative (might cause preterm labor) X - Xiphoid = 9 months
as well as enema & mineral oil. Give 38 - 40 weeks = ↓ because of engagement
docusate sodium
3. Dark/ green stool Postpartum
4. Avoid combining with calcium & • return of uterus to its non-pregnancy state:
magnesium (↓ absorption) INVOLUTION (6 weeks: aka postpartum
period)
I - Increased salivation “Ptyalism”
Cause: Estrogen Involution
• ↓ cm/day
PICA: eating inedible substances • at day 10: uterus no longer palpable
Concern for PICA: • If tilted to one side: full bladder (uterus
1. Nutrition can’t contract)→ void/catheter
2. Fetus C.A.N.
1. Contractions
V - Vaginal changes 2. Ambulation
↑ secretion, colorless, white → leukorrhea 3. Nutritions
Cause: ↑ estrogen Slow involution = Subinvolution (Abnormal)
Management:
Perineal hygiene Perinatal period: age of viability (20 - 24 weeks)
o Front to back until 6 weeks after delivery.
o Cotton & clean undies

If vaginal infection: PROBABLE

1st trimester → abortion
2nd - 3rd trimester → preterm labor
Labor → CS • Objective data

P - Positive serum PT
Vaginal & rectal swab at 35 weeks to detect
R - Reported urine PT
vaginal infections → may cause infected eyes:
O - Outline felt by nurse
ophthalmia neonatorum → blindness
BA - Ballotment
B - Braxton hicks, bluish vagina
V – Varicosities L - Lower uterine softening
Varicosed veins E - Evident sac
✓ hemorrhoids, clot, pedal edema
Cause: Uterine pressure P - Positive Serum PT
Management: Hormone: HCG
E – elevate legs Created by: Chorionic Villi
E – elastic stocking Accuracy: 95-98%
If lying down, sim’s position or side lying Present: 1-2 days after fertilization (at first trimester
= x2 after 2 days → can detect if child is growing)
E - Enlargement of uterus/ abdomen Declines: 100th week (2nd trimester)
LMP = AOG/EDD Absent: 1-2 days weeks after delivery (Diagnose
retained placenta)
• Naegel’s Rule
Jan - Mar: Use +9 months, +7 days R - Reported Urine PT
Apr - Dec: Use -3 months, +7 days, +1 year Accuracy: 97-99%
Can cause false positive
Sample:
01 - 28- 2023 Early as A.B.C.D.E.:
+9 +7 A - avoid late reading (late reading - false positive;
11 - 04 - 2023 early reading - false negative)
B - best done in first urine
• Mcdonald (M for measuring tape) C - concentrated urine
1 cm = 1 week D - don’t take Methadone (opioid) or
(fundal height) Chlordiazepoxide (anxiolytic) as it can cause false
positive
• Bartholomew (Landmarks) E - expiration date (expired PT can cause false
S - Symphysis = 3 months positive)
 Engagement:
O - Outline Felt by Nurse “Station” – vaginal exam
Why probable: tumors with calcification
When: 3rd trimester -4 → floating
-3
Leopold’s Maneuver -2
• Palpation -1 → 1cm above
• Preparation: no need informed consent, no 0 → engaged
fasting, empty bladder +1 → 1cm below ischial spine
+2
1. Grip 1 - FUNDAL GRIP +3
Where: Superior of fundus +4 → crowning
What:
• Head: hard, round, movable 4. Grip 4 - PELVIC GRIP
• Buttocks: soft, round, moves with mass • For cephalic
• Back: hard, broad
• Parts: small, moveable Where: both sides of uterus 2 inches above
Why: Presentation inguinal ligaments
Presentation: How: press downward and inward
• Cephalic - attitude (degree of flexion or What: degree of flexion/extension
extension) Why: attitude
o Vertex: fully flexed
o Sinciput: partial flexion BA - Ballottement
o Brow: partial extension B.B.B.
o Face: fully extended B - bimanual palpation (one hand tap the cervix,
• Breech other hand is on the abdomen)
o Frank: feet on the face B - bounce of baby (against the amniotic fluid
o Complete: crossed legs “passive movement”)
o Footling: feet/foot first B - “ballotter” → to quake
ü (2 types: single footling and
double footling) When: 4-5 months, 2nd trimester
Shoulder: What: Fetus bounce
Lie - relationship of maternal long axis to
the fetal long axis
I. Longitudinal Braxton Hicks “Puro PP” Bluish Vagina
II. Transverse
Braxton Hicks Contraction V - vascularity increase

2. Grip 2 - UMBILICAL GRIP • Don’t cause true labor (cause: ↑ estrogen)

V - vagina
Where: one hand on one side of the uterus V - violet
P - painless to painful (if
How: palpate other side top to bottom
painful→ false labor)
What: fetal back P - placenta perfusion “Chadwick sign” - violetish
Why: position P - present throughout vagina
Occipitoanterior - fastest pregnancy
P - practice or preparation
If right occiput posterior (ROP) or left
(“rehearsal”)
occiput posterior (LOP) - painful and Starts: 12 weeks
prolonged Noticed in 2nd trimester until
3rd trimester

Landmarks: Sa.M.O.C
Sa - Sacrum (breech) TRUE LABOR:
M - Mentum (face) 1. Contraction intensifies
O - Occiput (vertex) 2. Cervical dilatation (open)
C - Cromion (shoulder) 3. Mucus plug release “show”

3. Grip 3 - PAWLICK’S GRIP L - Lower Uterine Softening

Where: above symphysis
How: group between thumb and fingers
What:
Movement (if movable, not engaged; if
fixed, engaged)
Consistency (confirm presentation)
Uterus sections:
1. Fundus - Mcdonald’s sign
2. Corpus - Hegar’s sign
3. Isthmus - Ladin’s sign
4. Cervix - Goodell’s sign
S - sixth week
S - second missed period H - Heartbeat of fetus heard by examiner
S - soft and thin O - Outline UTZ
S - sign of “Hegar” M - Movements felt by
E - Examiner
E - Evident Sac S - Skeleton in x-ray
What: Characteristic ring in UTZ
When: 4-6 weeks H - Heartbeat
Rate: 120-160/min
Preparation for UTZ: Point of maximum impact (PMI): fetal back (upper)
1. Education
Pain? No. Duration? Short. Non-stress Test (NST)
2. No informed consent 1. Fetal heart rhythm
Not NPO. Should be full bladder (for stable 2. Fetal movement “call bell”
uterus) → 1 glass water q 15 mins x 90 mins 3. Acceleration (katapat ng movement)
3. Position: supine with rolled towel under the “15 beats/15 sec”
right hip for dec pressure on vena cava
(vena cava syndrome or supine Reactive: ✓
hypotension) Non reactive: x
Best position: LEFT LATERAL (if right →
pressure on portal vein)
Contraction Stress Test (CST)
1. Fetal heart rhythm
Reason for UTZ: 2. Contractions
Ultrasound - “sound waves” that are not harmful 3. Decelerations (↓ FHT)
1. 1st trimester Early: head compression
• Confirm pregnancy or ”diagnose” Late: fetus cannot oxygenate or placental
pregnancy insufficiency
2. 2nd trimester
• Congenital anomalies, gender, placenta
>50% late deceleration → positive CST →
(16-20 weeks), amniotic fluid (500-100ml)
emergency CS
o Oligohydramnios: <200mL
o Polyhydramnios: >2000mL
O - Outline of fetus in UTZ
Amniotic fluid function: When: 8 weeks
a. Cushion
b. Thermoregulation M -Movement felt by E - Examiner
c. Fetal movement When: 5 months/ 20 weeks
d. Fluid to drink
S - Skeleton in x-ray
Poly: GIT disorder or fetal DM Avoided in 1st trimester (organogenesis)
Oligo: kidney disorder 3rd Trimester before delivery for Cephalopelvic
Disproportion (CPD)
Amniotic fluid index (API):
Ø Normal: 12-15cm When: Bone Ossification (Starts 12 weeks AOG)
Ø Oligo: <5cm Mineral needed: Calcium 1g/day
Ø Poly: >25cm Vitamin needed: Vitamin D 600 IU/day

3. 3rd trimester or labor Fat soluble vitamins: A, D, E, K.

1. Maturity
o Biparietal diameter
o Head circumference
Physiologic Changes in Pregnancy
o Femoral length
o Placenta (Ca deposit)
First Trimester: Accept Pregnancy
o ↑Ca = mature
• Emotion: AMBIVALENCE → feeling both
2. Position of baby
pleased & not pleased about the
3. Presentation
pregnancy.
• How to help: Ultrasound
POSITIVE
Second Trimester: Accept the baby
• “Uwian naaa” • Happens at Quickening, calls baby “it” to
he/she
H.O.M.E.S. • Emotion: NARCISSISM/ INTROVERSION
 Pre-eclampsia: HTN + Proteinuria then edema
Third Trimester: Preparing for Parenthood Eclampsia: seizure (↓O2 brain of mother, ↓O2 fetus,
• Emotion: IMPATIENCE ↑BP)
• Happens at Quickening, calls baby “it” to
he/she PRE - ECLAMPSIA
4N’s • HTN + Proteinuria and edema
N - Nest building
N - Name P - Proteinuria
N - Nappies R - Renal involvement
N - Natal Preparation E - Edema = generalized → cerebral edema →
cerebral irritation → SEIZURE
ABNORMALS E - Eliminate bright light/ noise → dim light
C - Convulsion prevention
L - Lower BP
GESTATIONAL HYPERTENSION A - Assess V/S every 1 hour
• Pregnancy - induced HTN (PIH) vs Chronic/ M - Magnesium Sulfate
Essential HTN (due to cardiovascular P - Protein intake:
problem) MILD → Regular CHON diet;
Hypotension - normal in 2nd trimester → placenta SEVERE → ↑ CHON
• ↑ blood volume: 40 - 50% (peak: 2nd S - Sodium intake: Moderate
trimester) → vessel damage: ↑ RAAS system → ↑ BP (Rebound HTN)
o Young age I - Input and Output [q1]: +30 ml (Normal)
o Old age Severe: Oliguria
o Nutrition A - Assess Fetus
o Poor socioeconomic
• Vessel damage would lead to vasospasm DOC: Magnesium Sulfate
→ ↑ BP (PIH) • Reduces edema
• CNS depressant - medulla oblongata and
“Peak ng blood volume sa 2nd trimester pons (respiratory center)
Pero dapat, BP di magclimb • Muscle relaxant - muscle of heart and
Ugat na damage ng ibang patient respiratory
Abnormal yan • Therapeutic range: 5-8 mg/dL (check 6-8
hrs)
Pag tumaas ng 140/90 ang BP • Urine output: Normal - 30 ml/hr
Or systolic ay plus 30 Decreased UO at risk for toxicity
Diastolic ay plus 15 • DTR: Normal - 2
High BP like this” • RR: 12 minimum
Decreased RR = cardiac arrest
• Antidote: Calcium gluconate
Assessment:
1. 140/ 90
2. Systolic + 30 ECLAMPSIA
3. Diastolic + 15 • Most severe gestational hypertension
disorder
• 20% mortality
At Least two (2) times, 6 hours apart BP checking
• Affected organ: pancreas and liver
• Epigastric pain (no more blood
Treatment: [Lab-Ni-Haydee] supply)
Lab - Labetalol (BB) • Liver (clotting) → check for signs of
Ni - Nifedipine (CCB) bleeding
Hyd - Hydralazine (Apresoline) → potent • Seizure → eclampsia
vasodilator
E - Ensure safety, airway
ACE inhibitors: [-pril] Fetal kidney damage C - Convulsive (anti) drugs: Diazepam, Valium IV
Monitor BP and PR L - Left side: drain secretions
A - Assess fetus
↑BP (2nd tri) → vessel damage → vasospasm → M - MgSO4
HTN → poor circulation → kidney → proteinuria → P - Progress of labor (contraction and cervical
hypoalbuminemia → generalized edema (pre- dilatation)
eclampsia) → cerebral edema → seizure S - SPO2: give 6-10 LPM O2 face mask
(eclampsia) I - Instruct NPO → NSD/CS
A - Assess bleeding q15 (detached placenta due
to seizure and liver involvement) Assessment:
C - Cramps
✓ NSD not CS. CS is c/i to severe HTN B - Bleeding
C - Closed cervix
BLEEDING IN PREGNANCY
Nursing Intervention:
First Trimestral Bleeding x Complete bed rest
• can cause vaginal blood pooling
a. ABORTION • not part of DIM
• Loss of pregnancy before age of viability (5-6 Avoid S.S.T.
months; 20-24 weeks) S - strenuous (2 days)
S - sex (2 weeks)
T - tampon
Causes:
D - Development (teratogenicity,
chromosomal aberration) Imminent
I - Implantation (implantation abnormality, ↓ • inevitable/”di na mapipigilan”
progesterone)
M - Maintenance (infections, immunologic) Assessment:
C - Cramps
↓ immune because of ↑ deoxycorticosterone in B - Bleeding
pregnancy = pregnants are O - Open cervix
immunosuppressed
Diagnostics:
Diagnostics: H - Hcg levels
H - Hcg levels U - Ultrasound
U - Ultrasound H - Heartbeat
H - Heartbeat
Management:
Management: S/M
• To prevent bleeding and infection
which can lead to shock (hypovolemic Nursing Intervention:
and septic shock) SAVE pads (clots, tissue)
I.Surgical • Assess bleeding
AOG: <14 weeks (bones at 12 weeks • Rule out H.mole (can cause
“start”) choriocarcinoma)
1. Dilatation and Curettage (D&C)
2. Dilatation and Evacuation (D&E) Complete
3. Suction Curettage (SC) Assessment:
All products of conception are expelled
Only fetus is expelled
• Dilatation (Hegar Dilator)
• Curettage Management:
• Suction Curettage Surgical (<14 weeks)
Medical (>14 weeks)

II. Medical Nursing Intervention:

• Drugs Clarify

M - Misoprostol (Cytotec) → prostaglandin Missed

(ripens cervix, contracts) • early pregnancy failure
O - Oxytocin → contracts (do not use if
cervix is not ripe) Assessment:
M - Mifepristone → ↓ progesterone 5s
S - silent symptoms
Types of Abortion: S - slight cramping
Threatened S - spotting
• “nagbabadya” S - stopped growing
• 50%-50% S - stopped heartbeat
Diagnostics: F - Fast fresh flow (bleeding) → 4 mos
H.U.H. F - Fluid filled vesicles (clear, grape-sized)
P - Peaked HCG
Management: P - Prune juice
S/M P - Pattern: snowflake

Nursing Intervention: PIH - 1st trimester (N is 2nd)

Clarify
Management:
Recurrent Pregnancy Loss Surgical
• habitual abortion • Suction curettage
• WOF bleeding
Assessment:
3 consecutive spontaneous abortions Teaching:
HeTo NaMan PaPaPanCn (H2NM1PPPC)
Causes: H - HCG level
A.B.C.D.E. 2 - weekly
N - Normal
A - Autoimmune
M - Monthly
B - Blood flow resistance uterus
1 - 1 year
C - Chorioamnionitis
PPP - Prevent Pregnancy (take) Pills
D - Defective sperm
C - Choriocarcinoma
E - Endocrine factors

☆ incompetent cervix CERVICAL INSUFFICIENCY

• premature cervical ripening
• sudden cervix dilatation
• 2nd trimester
Cause:
b. ECTOPIC PREGNANCY A.B.C.D.
• implantation outside the uterus cavity A - Advanced age
• Infundibulum, abdominal pregnancy B - Biopsy
• 95% tubal pregnancy C - Cervical trauma
D - Defect (structural)
Assessment:
Classic Triad:
5Ps
1. A - Amenorrhea
P - Painless dilatation
2. P - Pain (lower abdomen, unilateral)
P - Pink show (bleeding)
3. V - Vaginal bleeding (scanty)
P - Pressure
P - Premature ROM
Management: P - Progress of labor
1. Spontaneous end, reabsorbed
2. Methotrexate
Management:
Cerclage
If ruptured, EMERGENCY! • Mcdonald (nylon suture) or Shirodkar
• Laparotomy (Mersilene tape)
• WOF shock (hypo-tachy-tachy) • 12 wks after UTZ
• Peritonitis (rigid board-like abdomen) • Removed 37 weeks/delivery

P.A.P.A.
Third Trimestral
Second Bleeding
Trimestral Bleeding P - Previa
A - Abruptio
P - Preterm
A - Accreta spectrum
HYDATIDIFORM MOLE
• Gestational Trophoblastic Disease (GTD)
• proliferation of trophoblasts PLACENTA PREVIA “Red”
• cause: 46xx and result from androgenesis, P - painless
both sets of chromosomes R - red
E - evaluated through UTZ
V - vital signs (check)
Assessment: I - IE not allowed (can cause massive bleeding)
3Fs and 3Ps of H-mole
F - Fundic height larger
A - assess fetus causes subdural/intraventricular hemorrhage
(brain)
Management:
Under 30% - NSD M.I.N.T. Dexamethasone,
Above 30% - CS M - Magnesium sulfate Betamethasone
(muscle relaxant) IM → mothers
Vaginal exam (IE) only if 3Ds: I - Indomethacin (CCB) • ↑fetal lung
D - Doctor N - Nifedipine (CCB) surfactant
D - delivery T - Terbutaline (direct • 2 doses, 12mg,
D - double set up (ready for shock) relaxant B2 agonist) → 24hrs apart
#1
ABRUPTIO PLACENTA
• premature separation of a normally PLACENTA ACCRETA SPECTRUM (PAS)
situated placenta • morbidly adherent placenta
Placental “ABRUPTION” • Placenta detachment post delivery: 5-15
A - advanced age minutes (max: 30 minutes)
B - brown/dark bleeding >30 minutes → REPORT TO MD
R - rigid
U - uterus tender (sharp pain on fundal area)
Accreta: attached to myometrium
P - premature separation
Increta: invade myometrium
T - trauma, tension (↑HTN), cocaine,
Percreta: penetrate myometrium
methamphetamine → cause HTN
I - intravascular coagulation (DIC): ↑clotting
(embolism), ↑bleeding Accreta management:
O - occult/concealed Manual removal
N - No IE, RE, abdominal exam
Increta and Percreta management:
PRETERM LABOR AND BIRTH Hysterectomy
• <37 weeks
• Respiratory Distress Syndrome (RDS) no1 Bleeding
problem Emergency interventions:
B - bleeding assessed (BT ready)
Cause: L - left lateral
D.D. at T.I.T.I. E - evaluate mother VS q 5-15 minutes
D - dehydration (IVF) but NPO E - evaluate fetus
D - drugs D - do not IE if 3rd trimester
I - Intake and output q 1 hour
N - NPO
A - amnionitis (infected amniotic fluid)
G - give IVF (fast drip) → crystalloids - LR, NS
T - twins, triplets
• give O2 (6-10 LPM facemask)

T - trauma
POSTPARTUM HEMORRHAGE
I - illness
• greatest danger is in the first 24 hrs because
T - tension (↑)
of the grossly denuded and unprotected
I - infection (UTI)
uterine area left under detachment of the
placenta
Stop labor if NO • contractions: needed to close the blood
Blood + water is 50% “red” vessels from the denuded area
• Blood - No bleeding • NSD = 500 mL/24 hrs
• Water - No leakage CS = 1000 mL
• Red - No distress If exceeded, PPH
• progress:
Dilatation: <5cm – open
I. Primary
Effacement: <50% – short/thin
within 24hrs → uterine atony
II. Secondary
Tocolytics (Toco - contraction; lytic - break down) after 24hrs → retained placenta
+ corticosteroid
Cause:
If preterm labor and birth cannot be stopped, CS 4Ts of PPH
or NSD? CS. To prevent fetal head pressure which 1. Tone
T - touch fundus → gentle massage
 O - oxytocin → methergine (↑BP) → N - Nasty urination
misoprostol, carboprost O - Ocular changes (blurring) → HTN
N - no ice R - Risks in health
E - enter vagina (bimanual compression) or M - Multiple gestation (twins/triplets) → ↑risk
OR (hysterectomy) A - Abdominal pains
L - Loss of weight/leak of bag of water
2. Trauma S - Severe N/V
L - Lacerations
H - Hematoma REFRESHER
I - Inversion of uterus Gravity and Parity
R - Rupture of uterus Gravity: Number of pregnancies regardless of
outcome of duration
Lacerations
I. Perineal skin Parity: Number of deliveries that reach the age of
• RN trained
viability (20 weeks) delivered; dead or alive
II. Perineal body
• RN trained
III. External sphincter Principle in identifying parity:
IV. Rectal membrane 1. Multiple pregnancy
If twins = counted as one
2. Abortion = Do not count! Since it is the
Hematoma
termination of pregnancy before age of viability
P - Pain (unrelieved by ibuprofen or NSAIDs)
(20 weeks)
P - Pressure
3. Stillbirth = Counted since it is more than 20 weeks
P - Perineum
P - Purple discoloration
Examples:
1. Patient A is pregnant for the first time and carries
Inversion of uterus a twin = G1P0
• mismanaged 3rd stage of labor
• uterine prolapse
2. Patient B delivered to an alive monozygotic twin
= G1P1
I - inside out
N - noticed in vagina
3. Patient C is now pregnant. Her pregnancy three
V - vaginal bleeding
years ago ended in abortion = G2P0
Rupture of uterus
R - retracted 4. Patient D has delivered an alive baby girl. Her
U - uterus pregnancy three years ago ended in abortion =
P - prolonged labor, past CS G2P1
T - tearing sensation
U - usually causes fetal death 5. Patient E pregnancy three years ago ended in
R - rare but possible abortion. She aborts for the second time; = G2P0
E - extrauterine fetus
WOF shock and peritonitis G-TPALM Scoring
Term (37 weeks and above)
3. Tissue Preterm (36 weeks and below)
T - tissue of placenta If twins = counted as 2
I - infection Abortion (Less than 20 weeks)
S - six to ten days if small Living
S - seen in TZ, HCG level Multiple Pregnancy
U - uterus is not fully contracted If twins = counted as one
E - expel the tissue
Example:
4. Thrombin Patient X is experiencing her fourth pregnancy. Her
C - clotting problem first pregnancy ended in a spontaneous abortion
L - look around at 8 weeks, the second resulted in the live birth of
O - O2, IVF (LR/NS) twin boys at 38 weeks, and the third resulted in the
T - transfuse (cryoprecipitate/FFP) live birth of a daughter at 34 weeks.

“ABNORMALS” in Pregnancy G4 T2 P1 A1 L3 M1
A - Absent/↓ fetal movement G4P2
B - Bleeding
PREGNANCY AND VACCINATION • Mother Rh(-), Baby Rh(-)
Safe Vaccine: = Do not give Rhogam
Tetanus vaccine • Mother Rh(+), Baby Rh(+)
Hepa B/A = Do not give Rhogam
Influenza (inactive) + pneumococcal and • Mother Rh(-), Baby Rh(+)
meningococcal = Give Rhogam
Rabies - only given as needed (Rubella is • Mother Rh(-), Father Rh(+)
contraindicated in pregnancy) = Give Rhogam
Diphtheria (DPT/Tdap) • Mother Rh(+), Father Rh(-)
= Do not give Rhogam
Covid 19 vaccine - safe to be given only after the • Mother Rh(-), Coombs(-), Baby Rh (-)
1st trimester = Do not give Rhogam
• Mother Rh(-), Coombs(+), Baby Rh(-)
Contraindicated vaccine: = Do not give Rhogam
• Mother Rh(-), Coombs(+), Baby Rh(+)
Varicella
Rubella = Give Rhogam
Anti Measles vaccine 1
Anti Measles vaccine 2
All live attenuated vaccine

RH ISOIMMUNIZATION / SENSITIZATION
PHYSIOLOGY:

Mother (Rh-) + Father (Rh+) = Baby (Rh+)

Baby has antigen D
If placental separation occurs, the blood/antigen
of the baby will enter the body of the mother. The
antibody of the mother will be programmed to
attack the antigen. The 1st baby will be safe,
however, the 2nd baby, which has the same
antigen, will be attacked. It will lead to
erythroblastosis ritalin (RBC death) then
Hyperbilirubinemia (Jaundice)

Q: Is the 1st baby always safe?

A: No. Any invasive procedures like amniocentesis
can cause accidental puncture/trauma of the
umbilical cord/placenta which will lead to the
mixing of maternal and fetal blood.

THERAPEUTIC MANAGEMENT:
RHOGAM / Rh Immunoglobulin
1. It can weaken the existing antibodies
produced by the 1st baby to protect the
2nd baby
2. It can prevent formation of new antibodies
to protect the succeeding pregnancies

When to give Rhogam?

1. Within 72 hours after delivery
2. Every after invasive procedure
3. Every succeeding pregnancies

Coombs’s test: test to determine the presence of

antibodies
2 Types:
1. Direct coombs’ test - use RBC
2. Indirect coombs’ test - use plasma

Example: