MATERNAL AND CHILD NURSING (MCN)

★ Tip: Kung ano ang choice na imamanage both ang mother and baby, yung
ang piliin

1st Trimester:
● Organogenesis / critical
● Category A drugs (safe in pregnancy)
● Germ layers
○ Ectoderm - development of brain
○ Mesoderm - development of heart
○ Endoderm - development of gastrointestinal disorders
● Ambivalence - presence of two opposing feelings
● Nausea and Vomiting

2nd Trimester
● Most comfortable / easiest part
● the mother had already adopted to the pregnancy state
● Increase Libido - highest sexual urge best time for the pregnant mother to
have sex with partner

3rd Trimester
 ● Period of unattractiveness - nafefeel ni mother na di na siya maganda
● Decreased self esteem - talk to the husband
○ if walang husband - talk to relatives, other significant others, friends
● Preparation for the delivery, conditioning for labor and delivery
○ Tell them what to expect, ano mararamdaman - yung pain

SIGNS AND SYMPTOMS OF PREGNANCY

Presumptive Probable Positive

Subjective - from the Objective Confirm

patient herself
Hegar Ultrasound
Breast Changes - Thinning of uterus Transvaginal
Amenorrhea Chadwicks - NR: Mother should
Urinary Changes - Bluish / purplish empty bladder
Nausea and Vomiting vagina - Early pregnancy
Quickening Goodell’s Abdominal
- movement felt by - softening of cervix - NR: Ask mother to
the mother - 5th HCG (Human Chorionic drink 2-3 glasses of
month of pregnancy Gonadotropin) water
(20 weeks) - Responsible for (+) - Effective: Late
Chloasma / Melasma Pregnancy test pregnancy
- Mask of pregnancy Braxton Hicks Contraction
- Hanggang leeg lang - painless, irregular FHT - Fetal heart tone
- di aabot sa BREAST contractions - N: 120 - 160 bpm
Ballottement
- bouncing of the MFE - movement felt by
fetus examiner

● Presumptive - kapag maraming cases na pwede mag cause ng manifestation

● Chadwicks - naging Cyanotic ang vagina due to lack of circulation
○ Temporary - it will go back after delivery: Pinkish
● Goodell’s
Gaano kalambot:
○ Non-pregnant - as soft as Nose
○ Pregnant - as soft as Earlobe
○ During Labor - as soft as Butter (yung hindi naka ref)
● Pag naging painful, regular contractions - indicates true labor
● Ballottement
 ○ Insert 2 fingers inside the vagina, pipilitin abutin ang fetal presenting pa, if
bouncing, non-engaged pa siya, di pa naka lock sa maternal ischial spine
○ Balottable = non-engaged
○ Non-ballotable - engaged
● Transvaginal ultrasound - iinsert kasi yung probe sa vagina
● Abdominal - drink 2-3 water to distend stomach, tinulak yung uterus para mas
mabilis mag visualize
● Fetal heart tone
○ <120 - fetal bradycardia
○ >160 - fetal tachycardia
○ Assess fetus for signs of fetal distress

Signs and Symptoms of Pregnancy

● Lightening: Fetal head → pelvis (engagement)
● Braxton hicks: painless, irregular
● Ballottement - bouncing of fetus
● Montgomery’s tubercle - lubricates breast during breastfeeding

● Melasma / Chloasma - mask of pregnancy

● Linea Nigra / Negra → Blackish line
○ Seen sa midline ng abdomen
○ Seen during pregnancy
● Linea Alba → Withish
○ Linea nigra after pregnancy lightens to white

ADAPTATIONS IN PREGNANCY
● Cardiovascular Changes
○ Increase total cardiac volume
○ Palpitations - temporary
■ Gravidocardiac patient - if may cardiac problems
○ Edema
■ Located in the lower extremities / bipedal - NORMAL
● caused by decreased venous return

■ Upper body area / anasarca / facial / periorbital - ABNORMAL

● might be a sign of Pregnancy Induced Hypertension (PIH)
○ Varicose veins / Varicosities - overworked veins
■ Lahat ng organs na-na o-overwork lumalaki
■ Assess for Homan’s sign - dorsiflexion of the foot → (+) pain in the
calf muscle = BAD SIGN
🆇 Do not massage
✓ Elevate
○ Deep Vein Thrombosis
■ Virchow’s Triad
● Venous Stasis - main cause
○ Instruct to wear anti embolic stockings
● Venal wall damage
● V/blood coagulation

● Gastrointestinal Changes
○ Morning Sickness
■ Because of Hypoglycemia
✓ Provide simple carbohydrates → easily digested, easily converted to
glucose
■ Example: Dry crackers / toast

○ Hyperemesis Gravidarum
■ Excessive vomiting during pregnancy
✓ SFF - Small Frequent Feeding
- Increase in stretch - increase in contraction
- Konti ang kakainin - para konti ang stretch - konti ang contraction
para hindi suka ng suka

○ Constipation and Flatulence

■ Increase Fiber and Oral Fluid Intake (OFI) → enhances peristalsis
 ○ Hemorrhoids
- Bulging in the anus because of pressure in uterus increases
intraanal pressure
- Varicose veins pag nilagay sa pwet = hemorrhoids
■ Internal Hemorrhoids: asymptomatic
■ External hemorrhoids: painful
✓ Warm sitz bath + witch hazel (form of astringent / vesicant)
- Submerge yung hemorrhoids
- Astringent: dia-dry / dine dehydrate para hindi na lumaki pa

○ Heartburn
■ HCL reflux (chest pain)
✓ SFF - Small Frequent Feeding

● Respiratory Changes
○ SOB (Shortness of breath)
■ if DOB - abnormal na
○ Increase urinary frequency
○ Decrease urinary threshold

● Musculoskeletal changes
○ Lordosis - pride of pregnancy
■ kasi mukha silang proud
■ Disadvantage: Pressure sa back and legs
✓ Instruct to wear low-heel shoes with grip
○ Prone to Leg cramps

● Temperature
○ Increased temperature because of Increase BMR (Basal Metabolic Rate)
■ Need mabilis metabolism para mabilis maconvert ang glucose for
baby

● Endocrine Changes
○ Thyroid gland: moderate enlargement
■ sa Thyroid gland, may Calcitonin
■ Calcitonin → pinapasok ang calcium sa loob ng bone
■ may “in” pinapapasok
■ Hypocalcemia
 ○ Parathyroid gland: increase size
■ PTH (Parathormone) - function is kabaligtaran ng Calcitonin
■ Calcium from the bone to blood
■ Hypercalcemia

Normally ganyan function kapag hindi pregnant inversely proportional ang

function ng PTH and Calcitonin. Pero exception pagka-pregnant:

PTH (parathormone)
- Mother
- ginamit ang PTH para i-give up ang calcium, fetus through calcitonin siya
ang magbibigay ng calcium kay fetus
Calcitonin
- Fetus
- tatanggap ng calcium

○ Adrenal glands: Increase size and activity

● Skin
○ Chloasma / Melasma
○ Linea nigra - during pregnancy
○ Linea alba - after pregnancy
○ Striae Gravidarum
■ to prevent this, prescribe Cocoa butter - pinapababaw ang stretch
marks, enhances collagen matrix
● Uterus
○ Hegar's sign
● Cervix
○ Goodell's sign
● Vagina
○ Chadwick
○ Leukorrhea (vaginal secretion)
■ prevent vagina from drying
■ prevent UTI → which will put mother at risk for preterm labor
● together with vaginal pH
○ Vaginal pH
■ pH of vagina: 5.5 - 6.5
○ Weight Changes
■ 1st trimester
 ● 1.5 - 3 lbs
■ 2nd trimester
● 10 - 11 lbs
■ 3rd trimester
● 10 - 11 lbs
■ Whole pregnancy weight gain: 20 - 30 lbs
● Psychological task of the mother
○ 1st trimester: Accepting the pregnancy
■ Resolve ambivalence
○ 2nd trimester: Accepting the baby
■ mother fantasizes about the baby
○ 3rd trimester: Preparing for parenthood
■ Responsibilities
■ Asking about caring for the baby
● ex: breastfeeding

Stages of Fetal Development

Fertilization
- union of sperm cells and egg cells
- Site: Fallopian Tube: Ampulla
↓
Implantation
- Uterus, upper uterine segment
- Outside the uterus → ectopic pregnancy
- Inside the uterus but sa lower uterine segment → placenta previa

CONCEPTUS PERIOD

Ovum Ovulation → Fertilization

Zygote Fertilization → Implantation

★ Embryo Implantation → Eight weeks (8)

★ Fetus Eight weeks (8) → Full term

Membranes
● Chorion: outer
● Amnion: inner
 ○ Contains the amniotic Fluid - Normal value: 500 - 1,000 ml
■ <500 - Oligohydramnios
● Inom ng inom ng amniotic fluid di nakaka-ihi
● Possible Disorder of baby: Kidney Problems
■ >1,000 ml - Polyhydramnios
● Ihi ng ihi, hindi nakakainom
● Possible Disorder of baby: Esophageal Problems
○ Esophageal Atresia
○ TEF: Tracheoesophageal Fistulla
■ not well-developed ang esophagus and trachea
● Amniotic Fluid
○ Protection
○ Temperature regulation
○ Supports growth
○ Fetal Movement

● Umbilical cord
3 blood vessels:
○ AVA: 2 arteries, 1 vein → NORMAL
■ VAV: 2 veins, 1 artery → ABNORMAL: (+) Congenital Heart Defect
○ Wharton’s Jelly
■ Protective covering of umbilical cord

Antepartum Care
- Caregiver between concepcion
- Prenatal care

Inclusions:
- Fetal well being
- Maternal well being

Fetal Well being

● Auscultation
○ 3 months: Doppler
○ 4 months: Fetoscope
○ 5 months: Stethoscope ★
● Normal FHT: 120 - 160 bpm
● Fundic souffle
○ gush of blood sa umbilical cord, rinig fetal heart tone - sabog sound
 Non-stress Test (NST) Stress Test (ST)

- Normal hinahanap - Abnormal hinahanap

- Wait for the normal, walang pang - Invasive
titrigger ✓ Consent
✓ Acceleration ✓ Nipple Stimulation / exogenous
- Rule of 15 x 15 oxytocin
✓ 15 beats increase in a 15 seconds - “Oxytocin challenge test” - other
duration name of ST
✓ Deceleration
● Early - Head Compression
● Late - Uteroplacental insufficiency
● Variable - Cord Compression

Results:
✓ Reactive - Good result
ⓧ Non-reactive - Bad Result
➔ Proceed to Stress Test
Results:
✓ Positive - Bad Result
ⓧ Negative - Good
Nursing Responsibility
● Positive - notify physician
● Negative - go back to NST

*Invasive ang ST, marami pwede mangyari so pwede consent pwede ma rupture bag of
water etc.

Amniocentesis
- Amniotic fluid sample
- Evaluate fetal maturity and certain birth defects
- AFP (alpha fetoprotein)
● If Increased: (+) Neural Tube defects
● If Decreased (+) Down syndrome / Trisomy 21

Maternal Well Being

Diagnostic Procedures
● Ultrasound (UTZ)
Purpose:
➔ Diagnose pregnancy
➔ Confirm sex: @ 3 months
➔ Confirms growth and abnormalities
➔ Fetal maturity
Management:
- Transvaginal: empty bladder
- Abdominal: drink 2-3 glasses of water

Leopolds Maneuver
First Maneuver - Fundal Grip
- Determine the presentation
❖ Cephalic - ulo una
❖ Breech - buttocks
❖ Facial - mukha una
❖ Acromion / Transverse - shoulders ang una
❖ Footling - paa una

Second Maneuver - Umbilical Grip

- Determine fetal back
❖ andito ang PMI: point of maximum impulse → Most audible FHT

Third Maneuver - Pawliks Grip

- Engagement / station

Fourth Maneuver - Pelvic Grip

- Determine Fetal Lie / Attitude -
- Flex or Extended

★ Nursing Responsibilities for Leopold’s Maneuver: Empty bladder

 ● Clean Catch Urine / Mid Stream Urine
- A method of collecting urine sample
- Purpose: detects UTI
➢ First steam: Discard (contaminated kasi)
➢ Mid stream - Use (accurate results)

● Papanicolaou Smear / Pap Smear

Class I: Normal
Class II: Inflammation
- Punta sa hospital → Needs check up
- Bawal IE
Class III: Mild to moderate Dysplasia
- Bawal F word, no sex → can damage cervical lining
Class IV: Probably Malignant
- mahihirapan makarecover
Class V: Possibly Malignant
- slimmest change, smallest chance of surviving

Remember: 5 fingers na tinuro ni sir archie

Oh cancer,
Cancer has a
C- chemothrapy
U- upera / opera
R- radiation
E - emotional support

*if you lack this, you will surely DIE!!

Discomforts of Pregnancy
1. Nausea and Vomiting
✓ Crackers / Toast

2. Breast Tenderness
✓ Supportive brassiere → not too tight not too loose

3. Ptyalism: Excessive Salivation

→ Prone to Halitosis (bad breath)
✓ Mouthwash, gum, hard candy
 4. Ankle edema / Varicosities
✓ Elevate, no prolonged standing

5. Backache
✓ Low heel shoes, with grip

6. Constipation
✓ High Fiber + OFI

7. Heartburn
✓ SFF

8. Hemorrhoids
✓ Warm sitz bath + Witch hazel

9. SOB
✓ Pillows, left side lying position → best position → to open the vena cava

Risk Factors in Pregnancy

● Grand Multiparity: 5 or more pregnancies
○ Uterus → wear and tear
● Previous CS: Uterine Rupture
○ Scarring in uterus
● Postpartum Hemorrhage
○ One most causes of death
Normal blood loss
➢ NSD: 500 ml
➢ CS: 800 - 1000 ml
● 3 consecutive abortion: habitual abortion
● Heart disease (Gravidocardiac)
○ Prone to cardiac arrest

Health Teachings
Nutrition: well balanced nutrition
✓ CHON (protein), CHO (carbs), vitamins, and minerals, Folic acid (helps with
organogenesis)
+ 500 calories: pregnant
+ 500 calories: breast feeding
Smoking
✓ Stop smoking, because it can cause low birth weight

Drinking
✓ Stop drinking, it can cause Fetal alcohol syndrome (the baby will be wasted, have
altered eating and sleeping patterns)

Sexual Activity
● First Trimester: Decrease because may pregnancy discomforts pa
● Second Trimester: Increase → best time because dito inc ang libido
● Third Trimester: Decrease → malaki na ang uterus, uncomfortable and at risk for
rupture of membranes

Rule of 666:
6 weeks before delivery - Ⓧ sex
6 weeks after delivery - ✓ sex
6 weeks - Normal involution - return of organs to non-pregnant state

Employment
● Yes to work but no hazardous waste
Ⓧ Farm, Salon
● ✓ Traveling
- Every 2-3 hours, rest for 15 - 20 mins

Labor and Delivery

Components of Labor (4Ps)
● Passenger: Fetus
● Passageway
○ Pelvis - main passageway
○ Cervix
○ Vagina

*Cephalopelvic Disproportion (CPD) / Fetopelvic disproportion (FPD) -

Hindi kasya ang fetal presenting part sa maternal pelvis / di kasya
passenger sa passageway

● Power
○ Primary Power: Uterine contraction
 ■ Stronger power
○ Secondary Power: Bearing down

“ You will only bear down if you have contractions, if wala contractions and
u bear down it’s just a waste of energy”

● Psyche
○ Overall status: Physical, psychological, emotional

Types of Labor
False Labor True Labor

- Irregular contractions - Regular and predictable

- Confined in the abdomen
- No increase in frequency, duration,
interval
- Relieved by ambulation
- Absent cervical changes (no
cervical dilation and effacement)
contractions
- Lower back → abdomen (the pain
is radiating)
- Increase in frequency, duration,
shortened interval (kakacontract
palang cocontract ulit)
- Not relieved by ambulation
- With cervical dilationa and
effacement
- Rupture of membranes
- Bloody show (mucus plug
expulsion)

STAGES OF LABOR AND DELIVERY

1. Stage of Dilation and Effacement

3 PHASES
● LATENT: 0-3 cm dilation
○ Mother is able to communicate
○ Conduct health teachings (give instructions) ★

● ACTIVE: 4-7 cm
○ Mother loses self control
○ start of true labor; increasing duration, frequency, shortened interval
❖ Duration - start of a contraction to the end of the same contraction
❖ Frequency: start of a contraction to the start of the contraction
 ❖ Interval: end of an contraction to the start of another contraction
♡ Remember: yung kilay mo gamitin mo pang tanda nito!

● TRANSITION: 8-10 cm
○ Fully dilated / effaced
○ Transfer from labor room to delivery room

STATIONS
- 3 Floating (- 2 and 3) Fetus is said to be above the ischial spine
- 2
- 1
0 - engaged - at the level of the ischial spine
+ 1
+ 2 Crowning (+ 2 and 3) Below the level of ischial spine
+ 3

*Ischial Spine - anatomical landmark of pelvis

PRESENTATION
● Cephalic: head
● Breech: Buttocks
● Acromion / Transverse: Shoulders
● Footling: Foot
● Facial: Face
✓
POSITION
● Best: LOA and ROA
○ Anterior
● Backache: LOP and ROP
○ Posterior kasi nata-tamaan
ang spine ✓

2. Fetal Expulsion
 “DFIRE ERE”

● Descent: pag baba ng fetal head going to maternal pelvis

○ *engagement - not ballotable
● Flexion: preparation of the fetal head to pass cervix
○ pag flex ng ulo ng bata: yun yung magbubuka ng cervix
● Internal Rotation: actual passage of the fetus to the cervix
● Extension: expulsion of the fetal head
● External Rotation: expulsion of fetal shoulder
● Expulsion: fetal expulsion

Episiotomy and Episiorrhaphy

- otomy - cutting
- rhappy - repair with suture

Median
- Advantage: Faster healing
- Increase risk for anal laceration

Mediolateral
 - Slow healing
- decrease risk for anal lacertion
- mas favorable

Analgesia - loss of pain

Anesthesia - loss of sensation

❖ Regional Anesthesia: localized effect

❖ Spinal: humalo sa CSF, mas prolonged effect
➢ if may complication, since tingin na not everything will go into plan baka
mas mapahaba pa
❖ Epidural: short effect
➢ used with straight CS, if walang complication

3. Placental Expulsion

3 Signs of Placental Separation

● Lengthening of the Cord
● Sudden Gush of blood
● Culkin’s sign: uterus becomes firm and globular - well contracted

★ Mga tinatanong sa board exam:

○ Soft and boggy (+) Risk for bleeding
★ Massage and give oxytocin
○ uterus is dislodged to the right: (+) full bladder
★ Encourage to urinate (non-invasive muna before invasive)
 ★ Catheter
○ Oxytocin is given, there is till bleeding: (+) Retained placental
fragments
★ Re-clean the uterus
○ Uterus is well contracted, however there is still bleeding. uterus is
not the problem anymore there is (+) Perineal laceration
★Check perineum

2 Types of Placenta

● Schultz - shiny
● Duncan - dirty
○ meaty portion
○ Risky for retained placental fragments
★ check for cotyledons: 20 - 30 dapat ang makuha

4. Recovery and Bonding / Postpartum

- First 1-4 hours after delivery
- Most critical phase (rapid deterioration)
- Considerations
● Assess fundus (firm and globular, well contracted
● Lochia
○ Rubra: 0-3 days, reddish
○ Serosa: 4-9th day, pinkish -> brownish
○ Alba: 10th day – 6 weeks, whitish

● Bladder: empty bladder

● Perineum: episiorrhaphy (signs of infection – fever, pus, and foul odor
● Lactation
○ EO51 – Milk Code
○ RA 7600 – Breastfeeding Law
○ 2 hormones for lactation
■ Oxytocin – milk let down
■ Prolactin – milk production
■ 10-15 mins each breast
■ Clean with warm water only

❖ Latching
- Areola must be covered by the newborns mouth
- Lower lip (outward)
 ❖ Storage:
- Room temp – 1 day
- Refrigerator – 1 week
- Freezer – 1 month
- Deep freezer – 6 months

❖ Perineal Care
- Ice pack – (constriction → stop bleeding) first 24 hours
- Sitz bath (dilation → healing) after 24 hours
- Perineal lamp: 12 – 18 inches
- Witch hazel – astringent
- Use cotton underwear (absorbent)
- Increase fiber and OFI (prevent constipation)

❖ Health Teachings
- Hygiene: do not use soap or alcohol in cleaning the breast (warm water)
- Breast Engorgement: felt during the 3rd post-partum day
● Use firm fitting brassiere – not too tight not too loose
- Sore nipples: Normal
● Expose to air for 10-15 minutes (dry)
● Expose to 20-watt bulb (12-18 inches)
- Sexual Activity
● Vaginal bleeding has stopped (6 weeks)

ANTEPARTUM COMPLICATIONS
Abortion
- expulsion of the fetus below the age of viability (20 weeks)

Types:

● Threatened Abortion: Closed cervix, no cervical dilatation

○ Tocolytics: inhibit uterine contraction
○ M: MgSO4,
○ T: Terbutaline
○ I: Indomethacin
○ N: Nifedipine

● Imminent Abortion: Open cervix, with cervical dilatation

○ Also known as inevitable abortion

● Complete Abortion: All products of conceptus is expelled

 ● Incomplete Abortion: Each part only
○ Risk for bleeding;
○ disseminated intravascular coagulation (DIC)
○ dead fetus syndrome (DFS)

● Induced Abortion: Never allowed in the PH

● Therapeutic Abortion: Legal, Medical, Planned (ectopic pregnancy)

● Early Abortion: Early fetal uterine death without expulsion (<20 weeks)
○ IUFD: Intrauterine Fetal Death (>20 weeks)

● Recurrent: 3 consecutive pregnancies

○ Also known as habitual abortion

Management:

- CBR for 12 - 24 hours

- Coitus us restricted for 2 weeks
- Save all pads, clots and tissues (measure bleeding) – weighing pads
- D and C (dilatation and curettage)

Hydatidiform Mole/ H-mole

- AKA: Gestational Trophoblastic Disease
- embryo dies
- no fetus, no amniotic sac, no blood vessels
- Immature cells

Signs and Symptoms

● high levels of HCG
● rapid increase in fundic height
● no fetal heartbeat
★ passage of clear fluid filled grape sized vesicles (pathog)
● (+) pregnancy test but not considered pregnant

Management:
● No pregnancy within 1 year
● Sex is not inhibited
 ● D and C - we need to clean the uterus

Drug of Choice: Methotrexate

● Kills rapidly dividing cells
● Cannot give in normal pregnancy

Condition that has the most risk for uterine cancer? H. Mole

Ectopic Pregnancy
- implantation outside the uterus

Signs and Symptom

★ Severe sharp stabbing abdominal pain (Phatog)
○ Pain Assessment
➔ Provoking / Precipitating
➔ Quality
➔ Radiation
➔ Severity
➔ Time

● Spotting (streaks of blood)

● (+) Cullens Sign: discoloration in periumbilical area
○ Emergency! - means the ectopic pregnancy ay nag rupture
● Signs of shock (Hypo tachy tachy)

Management
● Combat shock; Positioning → Elevate foot of the bed (modified trendelenburg)
● To increase venous return, ↑ Cardiac output
● Surgery: Laparotomy
● Iaabort
● Drug of Choice: Methotrexate
○ Kills rapidly dividing cells → miscarriage
Insulin administration

Incompetent Cervix
- painless cervical dilatation without contraction

Signs and Symptoms

● Cervical dilatation
● Prolapse of membranes
● Without contractions

Management:
● Cervical Cerclage
Two types:
Mcdonalds - temporary → Used when the mother wants to deliver NSD
Shirodkar - permanent → CS
*difference: yung suture
● Vaginal rest
○ No sex, no orgasm
● Prepare for childbirth, if with rupture of membranes

Hyperemesis Gravidarum
- severe nausea and vomiting due to increase HCG
- common in primi mothers
➢ Risk: Electrolyte imbalances → Alkalosis
Signs and Symptoms
● Unremitting nausea and vomiting
○ Initial: undigested food
○ Late: presence of bile
● Weight loss
● Tachycardia → Compensatory mechanism

Management:
● NPO → if acute vomiting
● IVF
● I and O
● SFF →if no vomiting
● Vitamin B6
○ <100mg - to decrease nausea and vomiting during early pregnancy
○ if >100 mg - it has a teratogenic effect

Placenta Previa
★ Bright red, painless

Types
● Total - completely covers the internal os
● Partial - partially covers
● Marginal - placental border reaches the border of the cervix
● Low lying - low lying

Management
- No Internal Exam (IE)
- No Sex
- Strict bed rest
- FHR monitoring
● monitor for fetal distress
- Prepared for Double set up (DR → OR)

Abruptio Placenta
- Premature separation of the placenta after 20th week AOG
★ Dark red, Painful bleeding

Types
 ● Unconcealed / Overt - meron siyang obvious bleeding
● Concealed / Covert - hidden bleeding
○ dangerous
○ bleeding can extravasate to the perinium → Peritonitis
○ peritonitis caused by abruptio placenta → Couvelaire uterus

Management
- No IE
- No sex
- Strict bed rest
- FHR monitoring
● monitor for fetal distress
- Prepared for Double set up (both DR → OR)

Toxemia / Pregnancy Induced Hypertension (PIH)

- Gestational Hypertension

If fluid goes to transcellular (3rd space) = Edema

1. Na goes H20 follows
2. ↑ Fluid = Pressure
● Hydrostatic pressure - pushing
● Osmotic pressure- pulling
○ Albumin - most abundant protein (CHON)

Proteinuria → naiihi ang albumin – hihina osmotic pressure = edema → ↑ inc fluid →
HPN

PIH TRIAD SYMPTOM

● P - Proteinuria
● I - Edema
● H - Hypertension

Diet: Low Na (sodium) diet

Pre-eclampsia - no seizure
Eclampsia - with seizure
 Mild
Preeclampsia Severe Preeclampsia Eclampsia

BP 140/90 q 6hrs 160 / 110 above even TRIAD

at bed rest - HPN
- Edema
- Proteinuria
Edema Face, neck and Pitting edema; sacrum,
(+) Seizure:
ankles face, upper extremities
Aura: Epigastric /
★ BLURRING OF
abdominal cramps -
VISION
before seizure
Proteinuria 300 mg/dL in a 24 5 g in 24 hours urine
hour urine sample Grand mal seizure
(generalized)

Management ✓ Bed rest ✓ Complete bed rest ✓ DOC: Magnesium

✓ Left side lying ✓ Left side lying Sulfate (MgSO4)
✓ Moderate ✓ High protein ✓ Hydralazine (AntiHPN)
(CHON) ✓ Diazepam,
protein (CHON)
✓ DOC: MgSO4 Phenobarbital, Phenytoin
✓ Moderate ✓ Supporting drug:
sodium Hydralazine (Anti
✓ Drug of Choice: HPN)
Magnesium
sulfate (MgSO4)

Monitor for MgSO4 Toxicity “BURP”

● BP - <90/60 mmHg
● UO - <30 ml/hr
● RR - <12 cpm (Respiratory depression)
● Patellar reflex - <+2 (hypoflexion)

➔ Presence of this: Don’t give or stop giving

★ Give Antidote: Calcium Gluconate
 Gestational Diabetes Mellitus (GDM)
Factors: Insulin and Glucose
Problem: Hyperglycemia / ↑ Blood glucose
★ 24 - 28 weeks - mothers should be screened for GDM
➢ During this period the human placental lactogen (HPL) is increased
➢ Human Placental Lactogen (HPL) - placental hormone
○ Effect: Anti-insulin

Insulin – pinapapasok ang glucose sa loob ng cell, pag nabuntis at 24 - 28 weeks

mataas ang HPL, nawawalan ng function ang insulin = ↑ hyperglycemia

Diagnostic
● OGTT - oral glucose tolerance test
Results: 70 - 110 / 80 - 120 mg/dL
❖ If <100 mg/dL = normal
❖ 100 - 120 mg/dL= possible GDM
❖ >120 mg/dL = overrated GDM

Infants of Diabetic Mother

● Longer and weigh more
● Macrosomic
● Paglabas ni baby → Hypoglycemia:
○ Cushingoid appearance → puffy but lethargic

Management:
● Adjust insulin dosage

Hemolytic Disease of the newborn

- AKA Erythroblastosis fetalis / Rh Incompatibility
- lytic = destruction of blood (hemo), immature RBC, that causes the disease of
the newborn, the cause is Rh Incompatibility

Madalas na : (-) negative si mother

(-) Mother, (-) Father = (-) Baby

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

First pregnancy, the baby is not affected kasi wala pang antibody si mother sa first
antigen (which is si fetus)
Succeeding pregnancy - the baby is affected

Diagnosed:
➢ During pregnancy → Amniocentesis: ↑ Bilirubin levels in the amniotic fluid
● if inc nga yan, as early as 28 weeks AOG → Administer Rhogam

➢ After delivery → Coombs test

● Direct: measures Rh antigen in the baby
● Indirect: measures Rh antibody in the maternal circulation
→ Give Rhogam within 48 - 72 hours after delivery

*If may history ka na ng Rh, regardless kung ano ng results automatic na every
pregnancy, will be given Rhogam

Signs and Symptoms

➢ Baby:
● Pathologic jaundice
● Hemolytic anemia

●
➢ Mother
● ↑ Bilirubin levels in the amniotic fluid
○ Kasi diba si baby inom ihi sa amniotic fluid sumasama sa pag ihi
niya yung bilirubin kaya increased kay mother

INTRAPARTUM COMPLICATIONS

Premature Rupture of Membranes (PROM)

- Amniotic fluid gushing into the vagina
★ Nitrazine Test - know the acidity or alkalinity of a fluid
○ (+) Amniotic Fluid = 7.0 - 7.5
 ● Maternal fever
○ Risk infection: fever
● Fetal Tachycardia
○ Fetal distress

Management
● Minimize IE
● Assess for signs and symptoms of infection
● Bed rest → if not engaged, to prevent cord prolapse (pinaka mapanganib na
complication)
● Ambulate → if engaged, hasten labor and delivery

Cord Prolapse
- Emergency!
- Compression of the cord between the fetal presenting part and maternal pelvis
- Biggest problem: Compromised fetal circulation → No oxygen

Management
● Monitor FHR q 5-10 mins
● Emergency CS → di na pwede NSD nakaharang na ang umbilical cord
● Best Position
★ Trendelenburg / Knee Chest (Genupectoral)
→ depende sa presentation ng tanong
Ex:
history of head injury → trendelenburg
obese → knee chest
● Oxygen: 10 - 12 liters per minute
● Last resort: Firm manual upward pressure
● Pag Lumabas sa vagina ang cord:
○ Wrap with sterile gauze soaked in NSS (isotonic) to prevent dryness of the
cord

Shoulder Dystocia
- Anterior shoulder of the baby can’t pass the maternal pelvis
- Lack of external rotation

Etiology
● Macrosomia
 ● Maternal obesity
○ mas marami fats, mas mahina ang uterine contraction, di sapat for
external rotation
● Post date pregnancy

Signs and Symptoms

● Turtle Sign: Fetal retraction against the mother’s cervix

Management
● CS
● No fundal push
○ can cause shoulder dislocation

CAESARIAN BIRTH TYPES:

1. Classic or vertical
2. Transverse or Pfannenstial

Factors leading to CS
1. CPD
2. Herpes
3. Previous cs
4. Hypertension or heart disease
5. Placenta previa
6. Abruption placenta
7. Transverse lie
8. Fetal distress
9. macrosomia

POSTPARTUM COMPLICATIONS

SUBINVOLUTION
- Delayed return of uterus to its prepregnant state.
CAUSES:
➔ Retained placental fragments

MANIFESTATIONS:
● Prolonged lochial discharge
● Excessive bleeding
MANAGEMENT:
● Massage uterus
● Facilitate voiding
● Prepare for D and C

THROMBOPHLEBITIS and THROMBOSIS

- Clot formations inside the vessel wall

EMBOLUS may travel to:

a. Brain
b. Heart
c. Lungs Manifestations: Virchow’s triad Homan’s sign

Management:
1. Elevate
2. Do not massage
3. No ambulation

Extra Notes
IQ: Remember 20 -25 then add 15 to 25 tapos copy mo lang sa kabila
● 55 - 70 - mild (moron)
● 40 - 55 - moderate (imbecile)
● 25 - 40- severe (idiot)
● 20 - 25 - profound

Pag Analgesic late binigay

→ increase contraction = head compression —> early deceleration

Unang Yakap
● NSD → place baby on bare stomach
● CS → Bare chest

Apgar score assessment check ng

● 1 minute - status of newborn
● 5 minutes - adjustment to life
Assess uterine contraction during labor, palpate just below the xiphoid process of the
sternum

Measures to prevent transfer of gonorrhea or Chlamydia to the infant’s eye from the
mother
- applying erythromycin ointment
- Crede's Prophylaxis → prevents ophthalmia neonatorum (eye infection of the
baby kapag daan sa vagina of mother with STD)

Moro Reflex
- newborn responds to sudden noises or jarring movement by throwing out the
arms and drawing up the legs

According to DOH, infants can’t be overfed so most babies should be fed on demand.

Better source of irons for infants

→ Iron-fortified cereals

Breast Milk is rich in contents EXCEPT IRON

After breastfeeding @ 6 months
1. Cereal
2. fruits
3. vegetables
4. meat
5. table foods
Extra notes:

12 months - infants can stand alone

tricycle - 3 years old

kelan nakaktayo ang bata gamit ang isang paa - 4 years old

kelan nakakalundag ng isang paa? 7 years old

15 makakaakyat ng hagdan