NCM 107 MATERNAL AND CHILD
HEALTH
Ovaries NURSING
o Almond shaped
o Produce, mature and discharge ova
o Initiate and regulate menstrual cycle
o 4 cm long, 2 cm in diameter, 1.5 cm thick
o Produce estrogen and progesterone
Estrogen:
- promotes breast dev’t & pubic hair
distribution prevents osteoporosis keeps
cholesterol levels reduced & so limits
effects of atherosclerosis
Fallopian tubes.
- Approximately 10 cm in length Conveys
ova from ovaries to the uterus Site of
fertilization
Parts: interstitial
isthmus – cut/sealed in BTL
ampulla – site of fertilization
infundibulum – most distal segment; covered with
fimbria
Uterus
- Hollow muscular pear shaped organ
-uterine wall layers: endometrium;
myometrium; perimetrium
Organ of menstruation
-receives the ova
-Provide place for implantation &
nourishment during fetal growth
-Protects growing fetus
-Expels fetus at maturity
-Has 3 divisions: corpus – fundus , isthmus
(most commonly cut during CS delivery)
and cervix
Uterine Wall
-Endometrial layer: formed by 2 layers of
cells which are as follows:
basal layer-
- closest to the uterine wall
glandular layer
- inner layer influenced by
estrogen and progesterone; thickens and shed
off as menstrual flow
-Myometrium
- composed of 3 interwoven layers of
smooth muscle; fibers are arranged in
longitudinal; transverse and oblique
directions giving it extreme strength
Vagina
-Acts as organ of copulation
-Conveys sperm to the cervix
-Expands to serve as birth canal
--Wall contains many folds or rugae making it
very elastic
Fornices –
- uterine end of the vagina; serve as a place
for pooling of semen following coitus
Bulbocavernosus –
- circular muscle act as a voluntary
sphincter at the external opening to the vagina
(target of Kegel’s exercise)
II. PUBERTAL DEVELOPMENT
Puberty: the stage of life at which secondary sex
changes begins the development and maturation of
reproductive organs which occurs in female 10-13 years
old & male at 12-14 yrs old the hypothalamus serve as a
gonad stat or regulation mechanism set to “turn on”
gonad functioning at this age
Reproductive Development
✓ Readiness for child bearing
-begins during intrauterine life
-full functioning initiated at puberty
-the hypothalamus releases the GRF
which triggers the APG to form and
release FSH and LH. (FSH & LH
initiates production of androgen and
estrogen --->2°
Sexual characteristics
Role of Androgen
Androgenic hormones
- are produced by the testes, ovaries and
adrenal cortex which is responsible for:
muscular development physical growth inc.
sebaceous gland secretions
Testosterone
- primary androgenic hormone
Related terms
a. Adrenarche – the development of pubic and axillary
hair (due to androgen stimulation)
b. Thelarche – beginning of breast development
c. Menarche – first menstruation period in girls (early 9
y.o. or late 17 y.o.)
d. Tanner Staging
-It is a rating system for pubertal development
-It is the biologic marker of maturity
-It is based on the orderly progressive
development of: breasts and pubic hair in
female’s genitalia and pubic hair in males
Body Structures Involved
1 Hypothalamus
2 Anterior Pituitary Gland
3 Ovary
4 Uterus
4. Menstrual Cycle
-Female reproductive cycle wherein periodic uterine
bleeding occurs in response to cyclic hormonal changes
-Allows for conception and implantation of a new life
-Its purpose it to bring an ovum to maturity; renew a
uterine bed that will be responsive to the growth of a
fertilized ovum
Menstrual Phases
• First: 4-5 days after the menstrual flow; the
endometrium is very thin, but begins to proliferate
rapidly; thickness increase by 8 folds under the influence
of increase in estrogenlevel also known as: proliferative;
estrogenic; follicular and postmentrual phase
• Secondary: after ovulation the corpus luteum produces
progesterone which causes the endometrium become
twisted in appearance and dilated; capillaries increase in
amount (becomes rich, velvety and spongy in
appearance also known as: secretory;progestational;
luteal and premenstrual
• Third: if no fertilization occurs; corpus luteum regresses
after 8 – 10 days causing decrease in progesterone and
estrogen level leading to endometrial degeneration;
capillaries rupture; endometrium sloughs off ; also
known as: ischemic
• Final phase: end of the menstrual cycle; the first day
mark the beginning of a new cycle; discharges contains
blood from ruptured capillaries, mucin from glands,
fragments of endometrial tissue and atrophied ovum.
Physiology of Menstruation folds
1. About day 14 an upsurge of LH occurs and the Artificial menopause / surgically induced menopause
Graafian follicle ruptures and the ovum a. oophorectomy or irradiation of ovaries
is released b. panhysterectomy
2. After release of ovum and fluid filled follicle cells
remain as an empty pit; FSH
decrease in Amount; LH increase continues to act on
follicle cells in ovary to produce III. PROMOTE RESPONSIBLE
lutein which is high in progesterone (yellow fluid) thus PARENTHOOD – FAMILY PLANNING
the name corpus luteum or A. Artificial Methods:
yellow body 1. physiologic method: oral contraceptives; natural
3. Corpus luteum persists for 16 – 20 weeks with methods
pregnancy but with no fertilization ovum 2. mechanical methods
atropies in 4 – 5 days, corpus luteum remains for 8 -10 3. chemical methods
days regresses and replaced by white 4. surgical methods
fibrous tissue, corpus albicans Oral contraceptive
Action:
Characteristics of Normal Menstruation Period inhibits release of FSH no ovulation
1. Menarche – average onset 12 -13 years Type:
2. Interval between cycles – average 28 days Combined ;
3. Cycles 23 – 35 days Sequential;
4. Duration – average 2 – 7 days; range 1 – 9 days Mini pill
5. Amount – average 30 – 80 ml ; heavy bleeding
saturates pad in <1hour Side Effects: due to estrogen and progesterone
6. Color – dark red; with blood; mucus; and endometrial > nausea and vomiting
cells > Headache and weight gain
> breast tenderness
Associated Terms > dizziness
1. Amenorrhea - temporary cessation of menstrual flow > breakthrough bleeding/spotting
2. Oligomenorrhea - markedly diminished menstrual flow > chloasma
3. Menorrhagia - excessive bleeding during regular Contraindications:
menstruation a. Breastfeeding
4. Metrorrhagia - bleeding at completely irregular b. Certain diseases:
Intervals o thromboembolism
5. Polymenorrhea - frequent menstruation occurring at o Diabetes Mellitus
intervals of less than 3 weeks o Liver disease
o migraine; epilepsy; varicosities
Ovulation o CA; renal disease;recent hepatitis
1. Occurs approximately the 14th day before the onset of c. Women who smoke more than 2 packs of cigarette
next cycle (2 weeks before) per day
2. If cycle is 20 days – 14 days before the next cycle is d. Strong family Hx of heart attack
the 6th day, so ovulation is day 6 Note: If taking pill is missed on schedule, take one as
3. If cycle is 44 days – 14 days, ovulation is day 30. soon as remembered and
4. Slight drop in BT (0.5 – 1.0 °F) just before day of take next pill on schedule; if not done withdrawal
ovulation due to low progesterone bleeding occurs.
level then rises 1°F on the day following ovulation
(spinnbarkheit; mittelschmerz) B. Natural Methods:
5. If fertilization occurs, ovum proceeds down the a. Rhythm/Calendar/Ogino Knause Formula
fallopian tube and implants on the o Couple abstains on days that the woman is fertile
endometrium o Menstrual cycles are observed and charted for 12
months
Menopause Standard Formula:
o Mechanism- a transitional phase (period of 1 – 2 first day of the beginning of one cycle to the first day of
years) called i macte ri c, heralds the next cycle
shortest cycle = minus 18
the onset of menopause.
longest cycle = minus 11
o Monthly menstrual period is less frequent, irregular
and with diminished amount. Example: shortest cycle = 28
o Period may be ovulatory or unovulatory - advised to longest cycle = 35
use Family planning method until Shortest cycle:
menses have 28 days – 18 = 10
Longest cycle:
been absent for 6 continuous months
o Menopause is has occurred if there had been no 35 days – 11 = 24
period for one year.
Fertile pd:
Classical signs: Vasomotor changes due to hormonal 10th to 24th day of cycle = No sexual intercourse
imbalance b. Billings Method / Cervical Mucus
o woman is fertile when cervical mucus is thin and
a. hot flushes
b. excessive sweating especially at night watery; may be extended
c. emotional changes o Sexual Intercourse may be resumed after 3 – 4 days
d. insomnia c. Symptothermal Method / BBT
e. headache
f. palpitations 1. Requires daily observation and recording of body
g. nervousness temperature before rising in
h. apprehension the
i. depression morning or doing any activity to detect time of ovulation
j. tendency to gain weight more rapidly 2. Ovulation is indicated by a slight drop of temperature
k. tendency to lose height because of osteoporosis and then rises
(dowager hump) 3. Resume Sexual intercourse after 3 – 4 days
l. arthralgias and muscle pains 4. Recommended observation of BBT is 6 menstrual
m. loss of skin elasticity and subcutaneous fat in labial cycle to establish pattern of
fluctuations
C. Mechanical Methods
1. Intrauterine Device - prevents implantation by
non-specific cell
inflammatory reaction
inserted during menstruation (cervix is dilated)
SE:
increased menstrual flow
spotting or uterine cramps
increased risk of infection
Note: when pregnancy occurs, no need to remove IUD,
will not harm
fetus
2. Diaphragm
o disc that fits over the cervix of
forms a barrier against the entrance of sperms
o initially inserted by the doctor
o maybe washed with soap and water is
reusable
o when used, must be kept in place because
sperms remains viable for 6 hrs. in the
vagina but must be removed within 24 hours (to
decrease risk of
toxic shock syndrome)
3. Condom
1. a rubber sheath where sperms are deposited
2 .it lessens the chance of contracting STDs
3. most common complaint of users
interrupts sexual act when to apply
D. Chemical Methods
These are spermicidals (kills sperms) like jellies, creams,
foaming tablets, suppositories
E. Surgical Method
a. Tubal Ligation:
- Fallopian tubes are ligated to prevent
passage of sperms Menstruation and
ovulation continue
b. Vasectomy:
- Vas deferens is tied and cut blocking the
passage of sperms Sperm production
continues Sperms in the cut vas
deferens remains viable for about 6
months hence couple needs to observe
a form of contraception this time to
prevent pregnancy
IV. BEGINNING OF PREGNANCY
A.Fertilization
1. Union of the ovum and spermatozoon
2. Other terms: conception, impregnation or fecundation
3. Normal amount of semen/ejaculation= 3-5 cc = 1 tsp.
4. Number of sperms: 120-150 million/cc/ejaculation
5. Mature ovum may be fertilized for 12 –24 hrs after
Ovulation
6. Sperms are capable of fertilizing even for 3 – 4 days
after ejaculation (life
span of sperms 72 hrs)
B.Implantation
General Considerations:
o Once implantation has taken place, the uterine
endometrium is now termed decidua
o Occasionally, a small amount of vaginal
bleeding occurs with implantation due to
breakage of capillaries
o Immediately after fertilization, the fertilized
ovum or zygote stays in the fallopian tube for 3
days, during which time rapid cell division
(mitosis) is taking place. The developing cells
now called blastomere and when about to have
16 blastomere called morula.
o Morula travels to uterus for another 3 – 4 days
o When there is already a cavity in the morula
called blastocyt
o finger like projections called trophoblast form
around the blastocyst, which implant on the
uterus
o Implantation is also called nidation, takes
place about a week after fertlization
C. Stages of human prenatal development
1. Cytotrophoblast – inner layer
2. Syncytiotrophoblast – the outer layer
containing finger like projections called chorionic
villi which differentiates into:
o angerhan’s layer – protective against
Treponema Pallidum, present only
during the second trimester
o Syncytial Layer – gives rise to the fetal
membranes, amnion and chorion
D. Fetal Membranes
1. Amnion – gives rise to umbilical cord/funis –
with 2 arteries and 1 vein supported by
2. Wharton’s jelly
3. Amniotic fluid: clear albuminous fluid, begins
to form at 11 – 15th week of gestation, chiefly
derived from maternal serum and fetal urine,
urine is added by the 4th lunar month, near term
is clear, colorless, containing little white specks
of vernix caseosa, produced at rate of 500
ml/day. Known as BOW or Bag of Water
E. Amniotic Fluid
Purposes of Amniotic Fluid
Protection – shield against pressure and
temperature changes. Can be used to diagnose
congenital abnormalities
intrauterine– amniocentesis Aid in the descent of
fetus during active labor
Implication:
F. Fetal Membranes
•Chorion - together with the deciduas basalis
gives rise to the placenta, start to form at 8th
week of gestation; develops 15 – 20 cotyledons
•Purpose of Placenta: respiratory; exchange of
nutrients and oxygen
•Renal system
•Gastrointestinal system
•Circulatory system
•Endocrine system: produces hormones (before
8th week-corpus luteum produces these
hormones) hCG keeps corpus luteum to
continue producing estrogen and progesterone
•HPL or human chorionic somatomammotropin
which promotes growth of mammary glands for
lactation
•Protective barrier: inhibits passage of some
bacteria and large molecules
V. FETAL GROWTH AND DEVELOPMENT
First lunar month
•Germ layers differentiate by the 2nd week
1. endoderm – gives rise to lining of GIT,
Respiratory Tract, tonsils, thyroid (for
basal metabolism), parathyroid (for
calcium metabolism), thymus gland (for
development of immunity), bladder and
urethra
2. Mesoderm – forms into the supporting
structures of the body (connective
tissues, cartilage, muscles and
tendons); heart, circulatory system,
blood cells, reproductive system,
kidneys and ureters.
3. Ectoderm – responsible for the
formation of the nervous system, skin,
hair and nails and the mucous
membrane of the anus and mouth
- 1 month: 2nd week – fetal membranes
- 16th day – heart forms ; 4th week – heart beats
- 2nd month: All vital organs and sex organs formed;
placental fully developed;
-meconium formed (5th –8th wk)
- 3rd month: Kidneys function - 12th wk- urine formed ;
Buds of milk teeth form ; begin bone ossification ; allows frequently due to hormonal changes
amniotic fluid ; establishment •Change in Sexual Desire – may increase or decrease
of feto-placental exchange needs correct interpretation… not
-4th month: Lanugo appears; buds of permanent teeth as a loss of interest in sexual partner
form; heart beat heard by fetoscope VIII. LOCAL CHANGES DURING
PREGNANCY
Focus of Fetal Development 1. Uterus – with increase to about 1000 grams at full
- First Trimester – period of term due to an increase in fibrous and elastic
organogenesis tissues
- Second Trimester – period of continued a. Becomes ovoid in shape
fetal growth and development; rapid b. Softening of lower uterine segment: Hegar’s
increase in length sign seen at 6th week
- Third Trimester – period of most rapid c. Operculum – mucus plug to seal out bacteria
growth and development because of the d. Goodell’s sign – cervix becomes vascular and
deposition of edematous giving it consistency of the earlobe
subcutaneous fat 2. Vagina – increased vascularity occurs
Assessing Fetal Well-being a. Chadwick’s sign – purplish discoloration of the
Fetal Movement: vagina
- Quickening at 18 – 20 weeks , peaks at b. Leukorrhea – increased amount of vaginal
29 -38 weeks Consistently felt until term discharges due to increased activity
a. Cardiff Method: a. Trichomonas – causes trichomonas vaginalis/vagnitis
“Count to ten” - records time interval it takes for 10 or trichomoniasis
- fetal movements to be felt usually occurs 4. Abdominal Wall
in 60minutes 1 Striae Gravidarum – due to rupture and
b. Contraction Stress Test: atrophy of connective tissue layers on the
Fetal Heart Rate (FHR) analyzed in conjunction with growing abdomen
contractions 2 Linea Nigra
Nipple stimulation done to induce gentle contractions 3 Umbilicus is pushed out
***3 contractions with 40 sec duration or more must 4 Melasma or Chloasma – increased
be present pigmentation due increased production of
in 10 minutes window melanocytes by the pitutitary
Normal Result no fetal decelerations with 5 Unduly activated sweat glands
contractions d. Ballotement – on 5th month
c. Non-stress Test: e. Pap Smear
Measures response of FHR to fetal movement (10- f. Pelvic measurements (done after 6th month or 2 wks
20mins.) before EDC)
with fetal movement FHR increase by 15 beats and
remain for 15 seconds then decrease to average rate a. Age of Gestation:
(no increase means poor oxygen perfusion to fetus) Nagele’s Rule: -3 calendar months and +7 days
d. Amniocentesis - done to determine fetal maturity:
Identify L/S ratio 2. FOUR P’S OF LABOR
16 wks – detect genetic disorder a. Power - the uterine contraction
30 wks – assess b. Passenger – the fetus
c. Passageway – the maternal pelvis
1. Prior to the procedure, bladder should be emptied; d. Psyche – the mental and emotional aspect of the
ultrasonography is used woman
to avoid
trauma from the needle to the placenta, fetus a. POWER -Uterine Contractions:
2. Complications include premature labor, infection, Rh a.1. Frequency – the beginning of one contraction to the
isoimmunization beginning of the next contraction
3. Monitor fetus electronically after procedure, monitor a.2. Interval – pattern which increases in frequency and
for uterine contractions duration
4. Teach client to report decreased fetal movement, a.3. Duration – the beginning of one contraction to the
contractions, or abdominal end of the same contraction
discomfort a.4. Intensity – strength of contraction, measured
after procedure. through a monitor or through touch of
a fingertip
a. Ultrasound – transducer on abdomen transmits sound on the fundus (mild, moderate or strong)
waves that show b. PASSENGER -Fe t us
fetal image on screen b.1. Fetal Skull:
b. Done as early as five weeks to confirm pregnancy,
gestational age Fetal Lie – relationship of the cephalocaudal axis of
c. Multiple purposes – to determine position, number, the fetus to the cephalocaudal axis of the mother.
measurement of fetus(es)
and other structures (placenta) PASSAGEWAY – maternal pelvis
d. Client must drink fluid prior to test to have full bladder
to assist in clarity of 3.PRELIMINARY/PRODROMAL SIGNS OF LABOR
image a. Lightening
e. No known harmful effects for fetus or mother b. Increased activity level- “nesting behavior”
f. Noninvasive procedure c. Loss of weight ( 2-3 lbs)
d. Braxton Hick’s Contractions
e. Cervical Changes – effacement
VII. COMMON EMOTIONAL RESPONSES - Goodell’s sign – ripening of the cervix
DURING PREGNANCY f. Increase in back discomfort
•Stress –decrease in responsibility taking is the reaction g. Bloody Show - pinkish vaginal discharge
to the stress of pregnancy not the h. Rupture of Membranes– labor expect in 24 hours
pregnancy itself affects decision making abilities i. Sudden burst of energy
•Couvade – syndrome – men experiencing j. Diarrhea
nausea/vomiting, backache due to stress, anxiety k. Regular Contractions - phases:
and empathy for partner increment,acme,decrement
•Emotional labile – mood changes/swings occur
- characteristics: intensity, frequency, interval,
Duration

.1. Analgesia – relieves pain and its perception

5.2. Anesthesia – produces local or general loss of
sensation ;
- usually regional anesthesia (e.g. spinal)

Demerol is most commonly used

Has sedative and antispasmodic effect

XIII. ASSOCIATED PROBLEMS

1. Engorgement
breast becomes full, tense and hot with throbbing
pain expected to occur on the 3rd post partum day
accompanied by fever (milk fever)last
for 240 due to increased lymphatic and venous
circulation
Nursing care:
o encourage breastfeeding
o advise use of firm-supportive brassiere
o (if not going to breastfeed – apply cold
compress; no massage; no breast pump; apply
breast binder)
2. Sore Nipples
Nursing care:
encourage to continue BF
expose nipples to air for 10 – 15 minutes after feeding
(alternative) exposure to 20 watt bulb placed 12 – 18
inches away promotes
vasodilation
and therefore promote healing
do not use plastic liners
use nipple shield
3. Mastitis -
inflammation of the breast
Signs & Symptoms: pain, swelling, redness, lumps in the
breasts, milk becomes
scanty
Nursing Care:
Ice compress
Supportive brassiere , empty breast with pump
Discontinue BF in affected breast
Apply warm dressing to increase drainage
Administer antibiotics as prescribed
*** Postpartum Check-up: 6th week postpartum to
assess involution

Method of delivery – preferably Vaginal but if not

possible CS
Prognosis: the danger of convulsions is present until 48
hrs postpartum
f. Cathartic – cause shift of fluid from the extra cellular
spaces into the
intestines from where the fluid can be excreted
Dosage:

DYSTOCIA - broad term for abnormal or difficult labor

and delivery
Uterine Inertia – sluggishness of contractions
Cause:
Inappropriate use of analgesics
Pelvic bone contraction
Poor fetal position
Overdistention – due to multiparity, multiple pregnancy,
polyhydrmanios or excessively large baby
Management: Stimulation of labor by oxytocin
administration or amniotomy