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EXTERNAL GENITALIA:

A. MONS PUBIS
- Provides an adipose cushion over the
anterior symphysis pubis
- Protects the pelvic bones
B. LABIA MAJORA
- Positioned lateral top of the labia minor
- Covered by pubic hair
C. LABIA MINOR
- Consists of connective tissue, elastic fibers,
veins and sebaceous glands
- Protect the ext. genitalia and the distal
urethra and vagina
- Unite to form the fourchette, the vaginal
vestibule
D. CLITORIS
- 1-2 cm in size
- Located in the anterior position of the vulva
- Covered by a fold of skin called the prepuce
- Make up of erectile tissue, nerves and blood vessels
E. VAGINAL VESTIBULE
- Flattened smooth surface inside the labia
- Openings to the bladder (urethra) and the uterus (vagina), both arise
from the vestibule
- Consists of the vaginal orifice, the hymen, the fourchette, Skene’s and
Bartholin’s glands
• HYMEN
- Is a thin but tough, vascularization mucous membrane
- located at the vaginal orifice
• FOURCHETTE
- Is the ridge of tissue formed by the post. joining of the two
labia majora and labia minora
- sometimes cut during vaginal birth (episiotomy)
• SKENE’S GLANDS (PARAURETHRAL GLANDS)
- are located lateral to the urinary meatus on either side
- help lubricate the ext genitalia during intercourse
• BARTHOLIN’S GLANDS (VULVOVAGINAL GLANDS)
- Secrete mucus along with Skene’s glands during sexual
stimulation
- alkaline ph of Skene’s and Bartholin’s help improve sperm
survival in the vagina
F. PERINEAL. BODY / PERINEAL MUSCLE / PERINEUM
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- Post. to the fourchette

- Easily stretched during childbirth to allow enlargement of the vagina
G. URETHRAL MEATUS
- Located 1-2.5cm below the clitoris

INTERNAL GENITALIA:
A. UTERUS
Functions:
- To receive the ovum from the Fallopian tube
- To provide a place for the ovum to implant
- To offer nourishment and protection to the
growing fetus
- To expel the fetus when mature
4 Parts:
1. Body/corpus - uppermost portion
2. Fundus - between points of attachment of the
fallopian tubes
3. Isthmus - short segment between corpus and cervix
- cut during cesarean birth
4. Cervix - lowest part
- the junction of the canal at the isthmus is the internal cervical os
- the distal opening into the vagina is the external cervical os
B. UTERINE LAYERS
1. ENDOMETRIUM
- Inner mucous membrane layer that’s shed during menstruation
2. MYOMETRIUM
- 3 interwoven layers of smooth muscle, which are arranged in longitudinal, transverse, &
oblique directions - offers extreme strength to the uterus
3. PERIMETRIUM
- Outer layer that covers the body of the uterus and part of the cervix
- Adds strength and support
C. UTERINE NERVE SUPPLY
- Both afferent (sensory) & efferent (motor) nerves
D. UTERINE BLOOD SUPPLY
- Uterine arteries
- The uterus also receives blood from the ovarian arteries
E. UTERINE SUPPORT
BROAD LIGAMENTS - 2 fold of peritoneum that cover the front and back of the uterus and
extend to the pelvic sides
ROUND LIGAMENTS - 2 fibrous muscular cords that pass from the body of the uterus
near the attachments of the Fallopian tubes
F. VAGINA
- Vascularized musculomembranous tube that extends from the external genitalia to the
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uterus
- Functions as the organ of intercourse, channeling sperm to the cervix
- Expands with pregnancy to function as birth canal
- Act as uterine excretory duct for menses and other secretions
G. FALLOPIAN TUBES
- Each is about 10cm /12 cm long
4 layers:
1. Peritoneal
2. Subserous
3. Muscular- produces peristaltic motions that conduct the ova the length of the tube
4. Mucosal - act as lubricant to aid ova travel and also act as nourishment for the fertilized
egg; contains CHON, H2O, and salt

4 Portions:
1. Interstitial - proximal portion; 1 cm in length
2. Isthmus - next distal portion; 2 cm
- is the portion of the tube that is cut or sealed in tubal ligation
3. Ampulla - 3rd and longest portion of the tube; 5cm
- fertilization of an ovum takes place
4. Infundibular - 4th most distal of the tube
- 2 cm long and funnel shaped
- the rim of the funnel is covered by fimbriae (small hairs) that help guide the ova into the
tube

H. OVARIES
- 2 almond shaped glandular structures on
either side of the uterus, below and behind the
Fallopian tubes
- Produce mature and discharge ova

RELATED STRUCTURES:
FEMALE ACCESSORY GLANDS:

1. BREASTS /Mammary glands

- Divided by connective tissue into approx 20 lobes
- All the glands in each lobe produce milk by ACINI
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cells and deliver it to the nipple by lactiferous duct

- Nipple is surrounded by a darkly pigmented area of epithelium approx 4 cm - areola
- The areola appears rough due to many sebaceous glands called
MONTGOMERY’S tubercles
- Provide nourishment to the infant and transfer maternal antibodies during breastfeeding
- Enhance sexual pleasure
- Blood supply: thoracic branches of axillary, internal mammary and intercostal arteries

2. FEMALE PELVIS
- Supports and protects the reproductive organs
- Bones which compose the body pelvis: ILIUM,
ISCHIUM, PUBIS, SACRUM, COCCYX

FALSE
PELVIS
-

Supports the uterus during the late months

of pregnancy
- Directs the fetus into the true pelvis
TRUE PELVIS
Inlet - entrance to the true pelvis; upper ring of
the bone
Pelvic Cavity - space between the inlet and outlet
Outlet - inferior portion of the pelvis
For the fetus to be delivered vaginally, it must be able to pass through the ring of the pelvic
bone and the opening must be sufficient, otherwise the fetus may have to be delivered via
CS
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4 TYPES OF FEMALE PELVIS

1. GYNECOID
2. ANDROID
3. PLATYPELLOID
4. ANTHROPOID

EXTERNAL MALE GENITALIA

PENIS
- Has 3 layers of erectile tissue
2 corpora cavernous a
1 corpus spongiosum
- Glans is at the distal end of the penis
A retractable casing of skin or prep use protects
the glans at birth
- Deposits spermatozoon in the female
reproductive tract
- Contains sensory nerve endings that provide
sexual pleasure
- Serves as an outlet for the urinary tract
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- Penile artery supplies blood to the penis

2. SCROTUM
- Pouch-like structure made up of skin, fasciae
connective tissue, and smooth-muscle fibers
- House the testes, epididymis, and the lower
portion of the spermatic cord
- Protects the testes and spermatozoa from high
body temperature
3. TESTES
- Are 2 oval-shaped glandular organs inside the
scrotum
- Seminiferous tubules produces spermatozoa
- Leydig’s cells produce testosterone, the primary male sex hormone
- Sperm can’t survive at body temperature; the testes are
suspended outside the body where the temperature is
approximately 1oF lower than body temperature

FOLLICLE-STIMULATING HORMONE - Stimulates

production of sperm in the seminiferous tubules
LUTEINIZING HORMONE - Stimulates production of
testosterone in the interstitial cells
FSH & Testosterone - stimulates spermatogenesis

INTERNAL GENITALIA
1. EPIDIDYMIS
- Tightly curled, the length totals 6m
- Responsible for conducting sperm from the testis to the vas deferens or storing it
- Sperm are immobile as they pass through or stored here
- Takes at least 12-20 days for the sperm to travel the length of the epididymis and a total
of 64 days for them to reach maturity

2. VAS DEFERENS
- Also called DUCTUS DEFERENS
- Carries sperm from the epididymis through the inguinal
canal into the abdominal cavity where it ends at the
seminar vesicles into the ejaculatory ducts
- Blood vessels and the vas deferens together are referred
as SPERMATIC CORD
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3. EJACULATORY DUCTS
- Located between the seminal vesicles and urethra
4. URETHRA
- Extends from the bladder through the penis to the external urethral opening
- Serves as excretory duct for urine and
semen

5. SEMINAL VESICLES
- Secrete a viscous portion of the semen
that aids in spermatozoa motility and
metabolism because the fluid is alkaline
and sperm are more motile in an alkaline
fluid
6. PROSTATE GLAND
- Located just below the bladder
- Homologous to Skene’s glands in females
- Secretes an alkaline fluid that enhances
spermatozoa motility and lubricates the
urethra during sexual activity
7. BULBOURETHRAL / COWPER’S GLANDS
- 2 pea sized glands that lie beside the prostate and empty into the urethra
- Secrete an alkaline fluid that neutralized acidic secretions in the female reproductive
tract, thus prolonging spermatozoa survival
- The alkaline fluid and sperm combination is a thick, whitish secretion termed SEMEN

-Also termed as MENSE / PERIOD

- Average length of menstrual flow is 2 - 7 days although some may have periods as short
as 1 day or as long as 9 - 10 days
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MENARCHE
- 1st menstruation period in girls
- May occur as early as 9 years and as late as age 17 and still be within normal limits
DIFFERENT MENSTRUAL CONCERNS
Amenorrhea
Dysmenorrhea
Metrorrhagia
Menorrhagia
Menopause

MENSTRUAL CYCLE
- Also termed FEMALE REPRODUCTIVE CYCLE
- Periodic uterine bleeding in response to cyclic hormonal changes
- Purpose is to bring an ovum to maturity and renew a uterine tissue bed that will be
responsive to its growth should it be fertilized
PHYSIOLOGY OF MENSTRUATION
4 STRUCTURES INVOLVED IN THE MENSTRUAL CYCLE:
1. HYPOTHALAMUS
- Releases LHRH / GnRH which initiates menstrual cycle
- Presence of estrogen represses the hormone
2. PITUITARY GLAND
- Under the influence of LHRH, the anterior lobe of the pituitary gland (adenohypophysis)
produces 2 hormones that act on the ovaries to further influence the menstrual cycle:
FSH - Responsible for maturation of the ovum
LH - becomes most active at the midpoint of the cycle and is responsible for ovulation
3. OVARIES
- Maturation of locates (4 million at present)
- Ovulation; every month, one of the follicles is
activated by FSH.
At maturity, it is visible on the surface of the
ovary as a clear water blister approximately 1/4
- 1/2 termed GRAAFIAN FOLLICLE
- The ovum is set free from the surface of the
ovary, a process termed OVULATION; ovulation
occurs on approximately 14th day before the
onset of the next cycle (subtract 14 days from
the
length of the menstrual cycle)
- The LH causes the ovary to produce
LUTEINIZING, a bright yellow fluid, instead of follicular fluid. This yellow fluid fills the
empty follicle, which is then termed CORPUS LUTEUM (yellow body)

SIGNS OF OVULATION:
• Mittleschmerz - slight discomfort in right / left iliac region
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• Spinnbarkeit - stretchable, clear vaginal / cervical secretions

• Change in body temperature 1 degree Fahrenheit the day following ovulation due to the
concentration of progesterone.
4. UTERUS
IST PHASE: PROLIFERATIVE /
FOLLICULAR / ESTROGENIC /
POSTMENSTRUAL
- Day 5-14 / 6-13
- Estrogen increases, leasing to
proliferation of endometrium and
myometrium in preparation of possible
implantation of a fertilized ovum
- Follicle secretes estradiol
- FSH stimulates Graafian follicle
- FSH production decreases before
ovulation (around day 14)
2ND PHASE: SECRETORY / LUTEAL /
PROGESTATIONAL /
PREMENSTRUAL
- Day 14 - 25
- The corpus luteum forms under the
influence of LH
- Estrogen and progesterone production
increase
- The endometrium is prepared for
implantation of fertilized ovum
- Increase vascular supply (capillaries)
3rd PHASE: ISCHEMIC PHASE
- Approximately 24 /25 day of the cycle
- Days 26 through 28
- Corpus luteum degenerates if conception
doesn’t occur
- Estrogen and progesterone levels decline
if conception doesn’t occur
- Arteries and capillaries constrict and
endometrium become anemiccapillaries
rupture with minute hemorrhages, and
the endometrium sloughs off
4TH PHASE: MENSTRUATED PHASE /
MENSE
- The end of menstrual cycle
- Comprise the 1st 5 days of the cycle
- The 1st day is used to mark the
beginning of a new menstrual cycle
- 30-80ml of blood / 50-150ml
- Estrogen and progesterone level decrease
- FSH levels rise, and steady levels of LH
influence the ovary to secret estrogen
- Usually lasts about 4-5 days, but 1-10
days maybe normal for some women

HORMONES INVOLVED:
1. GnRH (APG) - initiates the menstrual cycle
•

FSH
- stimulate development of primordial follicles
into Graafian follicles
• LH
- responsible for ovulation
2. ESTROGEN
- secondary sex characteristics
- Fertile cervical mucus
- Maintains the endometrium
- Stimulates uterine contraction
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3. PROGESTERONE
- Prepares the endometrium
- Relaxes the myometrium
- Increases basal body temperature
- Infertile mucus
- Maintains pregnancy
SEX
Act of copulation / “coitus
SEXUAL RESPONSE CYCLE - Elevation of the testes
4 Stages of Sexual Response: - Increase BP, HR, RR
1. EXCITEMENT PHASE 2. PLATEAU PHASE
- Physical and psychological stimulus - Reached first before orgasm
- Arterial dilatation and venous - Women: formation of orgasmic platform,
constriction in the genital area increased nipple engorgement
Physiological changes in woman: - Men: full distention of the penis
- clitoris increase in size 3. ORGASM PHASE
- Lubrication - Discharge of accumulated sexual tension
- Vagina widens - Shortest stage
- Breast nipples become erect 4. RESOLUTION STAGE
- Increase BP, HR, RR - External and internal organs return to
Physiological changes in men: their uncrossed state
- Erection - Generally takes 30 min
- Scrotal thickening
FERTILIZATION
CONCEPTION / IMPREGNATION /
FECUNDATION
- Union of ovum and spermatozoon
- Fertilized egg is called ZYGOTE
OVUM - from ovulation to fertilization
ZYGOTE - from fertilization to implantation
EMBRYO - from implantation to 5-8 weeks
FETUS - From 5-8 weeks until term
CONCEPTUS - developing embryo / fetus and
placental structures throughout pregnancy

 Functional life of a spermatozoa is about 48h,

possibly if 72h
- Ova about 24h possibly as long as 48h
- The ovum is surrounded by a ring of
mucopolysaccharide fluid (zona pellucida) and a
circle of cells (corona radiata) - serve as protection
from injury
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Fertilization usually occur in the outer 3rd of the Fallopian

tube, the ampullae portion
- Normally, an ejaculation of semen averages 2.5 ml of fluid
containing 50 - 200 million spermatozoa per milliliter or an
average of 400 million / ejaculation
- Spermatozoa deposited in the vagina during intercourse
generally reach the cervix within 90 sec and the other end of
the Fallopian tube within 5 min after deposition

CAPACITATION
- Final process that sperm must undergo to be ready for
fertilization
- The sperm move toward the ovum
- Changes in the plasma membrane of the sperm head,
reveals the sperm - binding receptor sites

HYALURONIDASE
- Proteolytic enzyme
- Released by the spermatozoa and acts to dissolve the
layer of cells protecting the ovum
Normally, only one spermatozoon is able to penetrate the
cell membrane of the ovum. Once it penetrates the zona
pellucida, the cell membrane becomes impervious to other
spermatozoa.
After the spermatozoon penetrates the ovum, its nucleus is released into the ovum, its tail
degenerates and its head enlarges and fuses with the nucleus of the ovum. This fusion
provides the
fertilized ovum, called a zygote with 46 chromosomes. The spermatozoon and ovum each
carried 23 chromosomes (22 autosomal and 1 sex chromosome)
https://youtu.be/_5OvgQW6FG4
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3 SEPARATE FACTORS FOR FERTILIZATION TO OCCUR

A. Maturation of both sperm and ovum
B. Ability of sperm to reach the ovum
C. Ability of the sperm to penetrate the zona pellucida and cell membrane and achieve
fertilization
IMPLANTATION
- Occurs when the cellular wall of growing structure / zygote implants itself in the
endometrium of the anterior or posterior fundal region, 8-9 days after fertilization after the
corona and zona pellucida degenerates
- After fertilization. It takes 3-4 days for the zygote to reach to the body of the uterus (free
floating). During this time, mitosis cell division, or cleavage begins
- Day 2 - 1st cell division
- Day 3 - morul
a; bumpy appearance; consists of 16-50 cells; body of the uterus; floats free in the uterine
cavity for 3-4 days
- Day 4
- Blastocyst; large cells collect at the periphery of the ball, leaving a
fluid space surrounding an inner cell mass
- this structure attaches to the uterine endometrium
- the cells in the outer ring are known as trophoblasts which will
form into placenta and membranes
- the inner cell mass (enclosed within the trophoblast will form the
embryo)

After implantation, the endometrium is called the DECIDUA

- Once implanted, the zygote is called an EMBRYO
HTTPS://YOUTU.BE/YCXQDKMPJ6W
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STAGES OF FETAL DEVELOPMENT:

1. Pre-embryonic Period
- Begins with fertilization and last a about 3 weeks
- As the zygote passes through the Fallopian tube, it undergoes a series of mitosis divisions,
or cleavage
- Once formed, the zygote develops into morula and then blastocyts eventually becoming
attached to the endometriu
2. Embryonic Period
- Begins with the 4th week of gestation and ends with the 7th week (2wk - 8 was)
- Germ layers develop, giving rise to organ systems
- The embryo is highly vulnerable to injury from maternal drug use, certain maternal
infections and other factors
3. Fetal Period
- Begins with the 8th week of gestation and continues until birth (9 weeks/2months-birth)
- During this period, the embryo, now called a FETUS matures, enlarges and grows heavier
-The head is disproportionately larger when compared its body - lacks subcutaneous fat
EMBRYONIC AND FETAL STRUCTURES
A. DECIDUA
-refers to the endometrial lining during pregnancy
3 Separate layers:
DECIDUA BASALIS - lies directly under the embryo; its where trophoblasts connect to the
maternal blood vessels
DECIDUA CAPSULARIS - Stretches over or forms a capsule over the trophoblast; enlarges
as the embryo grows; eventually coming into contact & fusing at the opposite side of the
uterine wall
DECIDUA VERA/PARIETAL - remaining area of the endometrial lining
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ENDOCRINE FUNCTIONS OF THE DECIDUA

- Secretes PROLACTIN to promote lacatation
- Secretes RELAXIN, which relaxes the connective tissue of the symphysis pubis and pelvic
ligaments; also promotes cervical dilation
- Secretes PROSTAGLANDIN, important for mediating several physiologic functions
B. CHORIONIC VILLI
- Develops on the 11th / 12th day
- Miniature villi or probing fingers that reach out
from the single layer of cells into the uterine
endometrium
2 layers:
SYNCYTIOTROPHOBLAST / SYNCYTIAL LAYER
- Produces HCG, somatomammotropin (HPL),
estrogen and progesterone
- Outer layer
CYTOTROPHOBLAST / LANGHAN’S LAYER
- Inner layer
- Develops after fertilization - 12 days gestation
- Functions in early pregnancy by protecting the
growing embryo and fetus from certain infectious
organisms

C. PLACENTA
- Latin for pancake
- is formed by the union of chorionic villi and decidua basalis
- Contains 15 - 2-/30 subdivisions called COTYLEDONS
- Maturity: 12 weeks/3 months; functions most effectively through 40 - 41 weeks
- Weighs 400-600 gm; 1/6 of the weight of the baby; measures from 15-20cm in diameter
and 2-3cm in depth at term
2 parts:
Maternal side - has a rough surface
Fetal side - shiny and gray
MECHANISMS OF PLACENTA
A. SCHULTZ’ mechanism
- fetal side goes out first
- Most common; 80% of deliveries
B. DUNCAN’s mechanism
- 20%
FUNCTIONS OF THE PLACENTA
1. Respiration, circulation
- Umbilical vein - carries oxygenated blood
- 2 Umbilical arteries - carry deoxygenated blood
- Foramen ovale - septal opening between the atria of
the fetal heart
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- Ductus arteriosus - connects the pulmonary artery to the aorta, allowing blood to shunt
around the fetal lungs
- Ductus venous - carries oxygenated blood from the umbilical vein to the inferior vena cava
bypassing the liver

2. Nutrition
- supplies the fetus with CHO, H2O, fats, CHON, minerals and inorganic salts
3. Protection
- transfers passive immunity via maternal antibodies (IgG)
4. Excretion
- it carries end products of fetal metabolism to the maternal circulation for excretion
5. Endocrine function
- produces hormones
• HCG - first hormone produces
• Estrogen - hormone of women
- primarily Estriol
- contributes to the mother’s mammary gland development
- stimulates uterine growth to accommodate the developing fetus
• Progesterone - hormone of mothers
- necessary to maintain the endometrial lining of the uterus during pregnancy
- reduce the contractility of the uterine musculature during pregnancy, which prevents
premature labor
• HPL / Human Chorionic Somatomammotropin
- Growth promoting and lactogenic properties
- Regulates maternal glucose, CHON, and fat levels
D. UMBILICAL CORD
- Originates from the amnion and chorion
- Serves as the lifeline from the embryo to the placenta; provides circulatory pathway
- About 53 - 55 cm (21inch) in length at term
3 Parts:
1 vein
2 arteries
Wharton’s jelly - gelatinous substance that helps prevent kinking of the cord in uterus
(cord coiling / nuchal cord); gives the cord body and prevents pressure on the veins and
arteries
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E. FETAL MEMBRANES & AMNIOTIC FLUID

- The chorionic villi on the medial surface of the the trophoblast gradually thin and leave
the medial surface of the structure smooth
- The smooth chorion eventually becomes the chorionic membrane, the outermost fetal
membrane

Chorion - outer wall of blastocyst

- covering of the fetus
- holds the sac of amniotic fluid
Amniotic / amniotic membrane - holds / lines
amniotic fluid
- inner fetal membrane
- forms beneath the chorion
- also produces the fluid (amniotic fluid)
Amniotic fluid - source is the fetal urine and
amnion secretions
Characteristics:
- clear / yellowish
- 800 - 1200 cc
- 7.2 pH
Functions of amniotic fluid:
- Provides buoyancy and temperature control
- Prevents heat loss
- Cushions the fetus
- Facilitates symmetrical fetal growth
- Provides a source of oral fluid
- Provides a repository for fetal waste
- Helps open the cervix during birth
Problems of Amniotic Fluid:
Oligohydramnios - lesser amount of amniotic fluid (300cc)
Polyhydramnios- excessive amount of fluid (3000-5000cc)
Embryonic Germ Layers:
- Ectoderm
- Endoderm
- Mesoderm
EMBRYONIC AND
FETAL STRUCTURES
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1. Cardiovascular System
- One of the 1st systems to become functional in intrauterine life
- Single heart tube forming as early as the 16th day of life, beating as early as the 24th day
- Heart beat may be heard with a Doppler as early as the
10th - 12th week of pregnancy; 16th - 20th week with a stethoscope
2. Respiratory System
- 3rd week, respiratory and digestive tracts exists as a single tube
- End of 4th week, a septum begins to divide the esophagus from the trachea. At the same,
lung buds appear on the trachea
- Spontaneous respiratory movements begins as early as 3 months
- SURFACTANT, a phospholipid substance is formed and excreted by the alveolar cells at
about 24th week. This decreases alveolar surface tension on expiration, preventing alveolar
collapse
Surfactant has 2 components:
- 35th weeks - lecithin and sphingomyelin
- Ratio: 2:1
- With fetal lung movements, surfactant mixes with amniotic fluid
3. Nervous System
- Develops during 3rd and 4th week of life
- Neural plate (thickened portion of ectoderm) is apparent by 3rd week of gestation
- Brain waves can be detected on EEG by the 8th week
- By 24th week, the ear is capable of responding to sound; the eye exhibit a pupillary
reaction, indicating sight is present
4. Endocrine System
- They mature in intrauterine life
5. Digestive System
- Separated from the respiratory tract at about 4th week
- MECONIUM forms in the intestines as early as the 16th week. It consists of cellular
wastes, bile, fats, mucoproteins, mucopolysaccharides, and portions of the vernix caseosa
- Meconium is black or dark green (obtaining its color from bile pigment and sticky
- Sucking and swallowing reflexes are not mature until the fetus is about 32 weeks or the
fetus weighs 1500 gm

6. Musculoskeletal System
- Quickening - 1st fetal movements perceived by the mother
16th week - multiparous
20th week - primipara
- Fetus can be seen to move on ultrasound as early as 11th
week
7. Reproductive System
- Child’s sex is determined at the moment of conception
- Can be determined as early as 8 weeks by chromosomal
analysis
- Gonads form at about 6th week
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- Testes first form into the scrotal sac late in intrauterine life at the 34th - 38th week
8. Urinary System
- Rudimentary kidneys are present as early as the end of the 4th week
- Urine is formed by the 12th week and is excreted into the amniotic fluid by the 16th week
of gestation
- At term, fetal urine is being excreted at the rate of 500 ml/ day
9. Immune System
- IgG maternal antibodies cross the placenta into the fetus primarily during the 3rd
trimester of pregnancy, giving a fetus temporarily passive immunity against diseases for
which the mother has antibodies
- The level of passive IgG immunoglobulins peaks at birth and then decreases over the next
9 months
10. Integumentary System
- Skin covered by soft downy hairs (lanugo), and a creamcheese like substances Vernix
Caseosa - secreted by sebaceous glands, important for lubrication, provide warmth, and
keeping skin from macerating.

Estimated Date of Delivery / EDC - Expected Date of Confinement

1. NAGELE’s Rule.
- Count back 3 calendar months from the 1st day of LMP then add 7 days.
- e.g. Oct 5 , ---> 10-3, 5+7
=. 7. 12
July 12
2. DATE OF QUICKENING
Primigravida:
- Date of quickening + 4 months and 20 days = EDC Multigravida:
- Date of quickening + 5 months and 4 days = EDC
First three months = +9 +7
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AGE OF GESTATION
1. MC DONALD’S rule
- uses fundal height to determine duration of pregnancy
- Measurement is made from the notch of the woman’s
symphysis pubis to over the top of the
uterine fundus as the woman lies supine
- Typically, the distance form the fundus to symphysis
pubis in centimeters is equal to the week of
gestation between 20th - 31st week
- FH x 8/7 = AOG
- Mc Donald’s rule becomes inaccurate during the 3rd
trimester of pregnancy

2. Bartholomew’s Rule of Fours

- Measures age of gestation by determining the position of the fundus in the abdominal
cavity
Normal length of pregnancy:

Days - 267 - 280

Weeks - 40 - 41 weeks
Lunar months - 10
Calendar months - 9
Trimesters - 3

ASSESSMENT FETAL WELL-BEING

1. FETAL MOVEMENT
- Also called quickening; described as light fluttering
- Typically follows a consistent pattern, usually on the average of at least 10x / day
- Ask the mother to lie in a left recumbent position after a meal and record how many fetal
movements she feels over the next hour (SANDOVSKY method); a fetus usually moves a
minimum of 2 x every 10 min or an average of 10
- 12 times an hour
- CARDIFF method - the time interval it takes for the mother to feel 10 fetal movements;
usually this occurs within 60 min
2. FETAL HEART SOUNDS / RATE
- Heart rate should be 120 - 160 beats/min throughout pregnancy
A. RHYTHM STRIP TESTING
- Assessment of the FHR in terms of baseline and long and short variability
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- BASELINE - refers to the average rate of the fetal heartbeat per minute
- SHORT-TERM VARIABILITY / BEAT-TO-BEAT VARIABILITY small changes in rate that
occur from second to second
- LONG-TERM VARIABILITY - the differences in heart rate that occur over the 20-minute
time period
- Rhythm strip requires the mother to remain in a fixed position for 20 minutes
B. NON-STRESS TEST (NST)
- Measures the response of the FHR to fetal movement
- The woman pushes a button attached to the monitor whenever she feels the fetus move
- Fetal movement typically results in an increase in FHR of about 15 beats/min
- This increase should be sustained for about 15 seconds and turn to baseline or average
when fetus quiets down
- Absence of an increase in FHR with movement is highly suggestive of fetal
hypoperfusion / fetal hypoxia
- Non-stress test is usually done for 10-20 minute (20-40)
- The test is REACTIVE if two accelerations of FHR (15 beats or more) lasting for 15 seconds
occur after movement within the chosen time period. NON-REACTIVE if no accelerations
occur with the fetal movements
C. STRESS TEST / CONTRACTION STRESS TEST / OXYTOCIN
CHALLENGE TEST (OCT)
- Method of evaluating fetal ability to withstand decrease O2 supply and the physiologic
stress of an oxytocin - induced contractions before true labor begins
- IV oxytocin is administered, usually starting at 0.5mU/min at 15-20 min intervals until
three high quality uterine contractions are obtained within 10 minutes
- Can be used at 32 - 34 week gestation
D. NIPPLE STIMULATION STRESS TEST (breast selfstimulation)
- Carries the risk of hyper stimulation or embarrassment because it can’t be controlled if
there’s hyper stimulation
- May require nipple rolling or application of warm washcloths to one nipple
- Induces contractions by activating sensory receptors in the areola, triggering the release
of oxytocin by the posterior pituitary gland
- Exhibits the same reactive pattern as the reactive NST result and the same pattern as the
abnormal OCT result
3. BIOPHYSICAL PROFILE
- Assesses several variable
Fetal breathing movements
Fetal body movements
Fetal muscle tone
Fetal amniotic fluid volume
Fetal heart rate reactivity
Placental grade
- Each variable is scored as 0 - 2, with 0 indicating abnormal finding and 2 indicating a
normal finding; some institutions use a scoring system of 0, 1 and 2; total score is then
calculated
- This profile is commonly referred to as the FETAL APGAR SCORE because scoring is
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similar to that of the Neonatal APGAR Score

- Can detect CNS depression
4. ULTRASOUND
- Provides immediate results without potential harm to the fetus or the mother
- Non-invasive and painless
- Provides info about fetal presence, size, position, and presentation, placental location,
amniotic fluid and gestational maturity via biparietal measurements
- Evidence of normal fetal growth or possible defects or malformations, fetal death,
malpresentations, placental abnormalities, multiple gestation and hydra nips or
oligohydramnios
- It is helpful if the mother has a full bladder at the time of the procedure
- May also be done by an intravaginal technique
5. BIPARIETAL DIAMETER
- The widest transverse diameter of the fetal head; a side to side measurement obtained
using ultrasound
- Measurements can be made by 12-13 weeks of gestation
- Typically, if the biparietal diameter is 8.5 cm or more, the fetus will weigh more than 5.5
lb (2,500g)
6. DOPPLER UMBILICAL VELOCIMETRY
- Measures the velocity at which RBC in the uterine and fetal vessels are traveling
7. PLACENTAL GRADING
- Placentas can be graded by ultrasound as 0 (a placenta
12-24 weeks), 1 (30-32 weeks), 2 (36 weeks), 3 (38 weeks)
- Because fetal lungs are apt to be mature at 38 weeks; a grade 3 placenta suggests that
the fetus is mature
8. AMNIOTIC FLUID VOL. ASSESSMENT
- Amount of amniotic fluid present is an
important fetal assessment measure because a
portion of the fluid is formed by fetal kidney
output
9. ELECTROCARDIOGRAPHY
- May be recorded as early as the 11th week of
pregnancy
10. MRI
- Has the potential to replace or complement
ultrasound as a fetal assessment technique
- It may be most helpful in diagnosing complications such as ectopic pregnancy /
trophoblasts disease
11. MATERNAL SERUM ALPHA-FETOPROTEIN
- 2.5 Median of N
- Requires a blood sample obtained via venipuncture to evaluate the level of alpha
fetoprotein in the mother’s serum
- Fetal liver produces alpha fetoprotein
- This CHON crosses the placenta and appears in the mother’s serum
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- Alpha-fetoprotein begins to rise at 11 weeks gestation, then steadily increases until term
- Elevated maternal serum AFP (MSAFP) level suggest a neural tube defect or other neural
tube anomaly (open spinal/abdominal defect) - open body defects
- Decrease MSAFP levels are associated with Down Syndrome
- Definitive diagnosis requires ultrasound and amniocentesis
12. TRIPLE SCREENING
- Involves a blood sample that tests 3 parameters: Maternal serum for alpha fetoprotein,
unconjugated estriol, HCG
13. CHORIONIC VILLI SAMPLING (CVS)
- Involves removal and analysis of a small tissue specimen from the fetal portion of the
placenta to determine the genetic make-up of the fetus
- Done at 10-12 weeks of pregnancy
- COELOCENTESIS- is an alternative method to remove cells for fetal analysis; transvaginal
aspiration of fluid from the extra embryonic cavity
- Complications: carries the risk of spontaneous abortion, infection, hematoma, and
intrauterine death

14. AMNIOCENTESIS
- Refers to a needle insertion into the uterus trans
abdominally to aspirate amniotic fluid for analysis
- Can be performed as early as 12 - 13th week of
gestation, when uterus has moved into the
abdominal cavity
- Requires only 1 ml of fluid for analysis
- Is indicated for women aged 35 and older and
women with family history of chromosomal /
neural tube defects or inborn errors of metabolism
USED FOR ASSESSMENT, DX, AND
EVALUATION
- Amniotic fluid color
Normal - color water
Slightly yellow tinge - late in pregnancy
Strong yellow color - blood incompatibility
Green color - meconium staining
-Lecithin/Sphingomyelin ratio 2:1
- Phosphatidyl glycerol & desaturated phosphatidyl - choline (present only with mature
lung function)
- Bilirubin determination - analyzed if a blood incompatibility is suspected
- Chromosome analysis - few fetal skin cells are always present in amniotic fluid. These
cells many be cultured and stained for karyotyping
- Inborn errors of metabolism
- Alpha-fetoprotein
15. PERCUTANEOUS UMBILICAL BLOOD SAMPLING
(PUBS)
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- Also called CORDOCENTESIS / FUNICENTESIS

- Is an invasive procedure during which a needle is inserted through the mother’s abdomen
and uterine wall into a vessel in the umbilical cord under direct ultrasound guidance
- Provides direct access to the fetal circulation to obtain fetal blood samples or to transfuse
the fetus in utero
- Access to the fetal circulation allows for direct drug administration
- Used when the fetus is at risk for congenital and chromosomal abnormalities, congenital
infection or
anemia
- Also used to assess acid balance of fetuses with intrauterine growth retardation
- Can be done any time after 16 weeks gestation
16. AMNIOSCOPY
- Visual inspection of the amniotic fluid through the cervix and membranes with an
amnioscopy (a small fetoscope)
- Use to detect meconium staining
- Risk for membrane rupture
17. FETOSCOPY
- Actual visualization of the fetus by inspection through a fetoscope
- Amniotic may occur; mother is placed on 10 day antibiotic therapy after the procedure
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DIAGNOSIS OF PREGNANCY
SIGNS AND SYMPTOMS OF PREGNANCY
PRESUMPTIVE
- Subjective evidence / could be signs of pregnancy
A. AMENORRHEA
- In about 80% of clients or
- Slight, painless spotting of unknown cause in early gestation (20%)
- Due to suppression of FSH
B. BREAST CHANGES (2 weeks)
- Enlargement and tenderness
- A feeling of fullness, tingling or tenderness in breasts because of increase stimulation of
breast tissue by the high estrogen in the body
- Breast size increases, because of hyperplasia of the mammary alveoli and fat deposits
- The areola darkens in color, and its diameter increases from 3.5 to 5 or 7.5cm (1.5 - 2-
3inch)
- Vascularity of the breast increases, blue veins may become prominent over the surface of
the breasts
- Sebaceous glands of the areola enlarge and become protruberant to keep the nipple
supple and help prevent from crackling and drying during the lactation
- By 16th week, colostrum, can be expelled from the nipples MGT: relieved by wearing a
well-fitting bra
C. NAUSEA, VOMITING / MORNING SICKNESS (2 weeks)
- Most prevalent during the 1st trimester, most common in early morning
- Systemic reaction to increase estrogen levels or decrease glucose levels
MGT: Dry toast / crackers before arising in the morning; avoid greasy / fatty foods; avoid
highly seasoned foods; eat small, frequent meals
D. URINARY FREQUENCY AND URGENCY (3 weeks)
- Caused by the pressure of the enlarging uterus on the bladder within the 1st trimester
before uterus rises out of the pelvis
MGT: Decrease fluid intake in the evening
Avoid caffeine and tea
Void as soon as the urge is felt
Teach how to perform Kegel’s exercise
Report signs of UTI at once
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POSITIVE
- Absolute evidence
A. FHR
Funic soufflé
Uterine soufflé
B. FETAL MOVEMENT
- When felt by the examiner, after the 16th week but usually about 5 months
C. ULTRASONOGRAPHY
- Maybe detected as early as the 6th week of gestation, although usually done at 16 - 18
weeks
D. ROENTGENOGRAPHY
- X-ray of fetal skeleton; usually done at 14th - 20th week
PHYSIOLOGIC CHANGES OF PREGNANCY
A. REPRODUCTIVE SYSTEM
- Uterine changes
- “Practice contractions” - Braxton Hick’s contractions
- Amenorrhea
- Cervical changes
- Vaginal changes
- Ovarian changes
- Changes in the breasts
B. INTEGUMENTARY SYSTEM
- Hyperactive sweat and sebaceous glands
- Hyperpigmentation
- Palmar erythema & increase angiomas
- Increase hair & nails growth
C. RESPIRATORY SYSTEM
- Increase vascularization of the respiratory tract caused by increased estrogen levels
- Shortening of diaphragm caused by the enlarging uterus
- Increase tidal volume causing slight hyperventilation
- Slight increase (2 bpm) in respiratory rate
D. METABOLIC
- Increase water retention caused by higher levels of steroids sex hormones
- Decrease serum CHON levels
- Increase intra-capillary pressure and permeability
- Increase levels of serum lipids, lipoproteins, and cholesterol
- Increase iron requirements
- Increase CHO needs
- Increase body temperature
Weight gain 25 - 30 lb (11.3 - 13.6 kg)
Allowable weight gain in pregnancy
1st trimester - 2-4 lb
2nd trimester - 11 - 13 lb
3rd trimester - 11 - 13 lb
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E. CARDIOVASCULAR
Heart
- Increase cardiac workload > increase cardiac output > left ventricular hypertrophy >
palpitations, increase heart rate
- Stroke vol >increase 10 - 30%
- Heart displaced up and the left, PMI shifts about 1.5 cm to the left
Blood
- Increase iron demand
- Increase water retention
- Decrease blood viscosity and increase blood flow
->pulmonic and apical systolic murmurs
- Increase progesterone > increase fibrinogen > increase clotting factor XII, IX, and X at
term
Blood Volume
- Circulating blood volume increase by 30-50% by water and Na retention approximately
1,500 cc Blood Pressure
- Brachial artery pressure highest when sitting; lowest when at lateral recumbent position
- 2nd & 3rd trimester - increase relaxin > vasodilation,
muscle relaxation and decrease muscle tone > decrease peripheral resistance > decrease BP
- Venous compression > increase venous stasis > pronicity to thrombosis
- BP is lowest on the 2nd trimester because of pseudoanemia
- Compression of iliac veins leads to.
- Supine hypotensive syndrome
- increase hydrostatic pressure in leg veins > varicose veins and dependent edema
F. GASTROINTESTINAL
- Stomach displaced upward > increase reflux of acids in the lower esophagus > heartburn
(pyrosis) and flatulence - related to increase HCG, progesterone
- Increase progesterone > decrease GI motility and emptying > tendency for N&V
- EPULIS OF PREGNANCY due to estrogen
- Thicker bile secretion due to progesterone
- PTYALISM due to increase level of estrogen
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G. URINARY SYSTEM
- Diuresis > pressure of enlarging uterus to bladder in 1st trimester
- Relieved when uterus rises out of the pelvis in 3-4 months but returns with LIGHTENING
(2 weeks before onset of labor)
H. SKELETAL SYSTEM
Postural Changes
- Lumbosacral curve increases accompanied by a compensatory curvature in the
cervicodorsal region
- Characteristic posture in pregnancy: Backward tilt of torso to balance the weight of the
enlarging abdomen > strain on back and thigh muscles and ligaments > back pains and
cramps later in pregnancy
- Waddling-Gait of Pregnancy - duck-like movement of pelvis when walking due to pelvic
instability caused by the enlarging abdomen and relaxation of sacro-iliac joint and
symphysis pubis
- Enlarging uterus > anterior abdominal wall stretching > umbilical stretched > DIATASIS
RECTI
I.ENDOCRINE SYSTEM
- The major endocrine gland during pregnancy is the
PLACENTA
- Increase BMR (up to 25% at term)
- Increase iodine metabolism from slight hyperplasia of the thyroid gland
- Slight parathyroidism
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- Production of PROLACTIN
- ESTROGEN & PROGESTERONE > GnRH suppression > decreases gonadotrophic
hormones > no ovulation
- Increase HCG > (+) pregnancy test > prolongs life of corpus luteum > continued
production of estrogen and progesterone > continued vascularity of endometrium > support
life of embedded embryo / fetus
- Increase HPL detectable as early as 3 weeks and found in the maternal blood by 6th week
> decrease ability of the mother to use insulin (anti-insulin effect) > increase maternal
serum glucose supply to support the fetus & placenta > may cause GESTATIONAL
DIABETES
- Increase maternal cortisol / steroids > also has anti-insulin effect > increase maternal
serum glucose supply to support the fetus and placenta > may contribute to development of
Gestational DM
- Increase OXYTOCIN (later part of pregnancy) > stimulates the milk let-down reflex for the
release of milk after delivery of the baby and stimulates labor contractions to occur at term
J. IMMUNOLOGIC SYSTEM
- Only maternal IgG cross placental barrier to provide the baby with antibodies in the early
neonatal period
- IgA is secreted in colostrum providing baby with additional gastrointestinal protection
during
breastfeeding
- Fetal immune system develops as early as the 7th week and antigen recognition by 12th
week
- Fetus develops all types of immunoglobulins by 12th week, except IgA with highest
amount at term before delivery
PSYCHOLOGICAL / EMOTIONAL RESPONSES TO PREGNANCY
1. AMBIVALENCE
- Refers to the interwoven feelings of wanting and not wanting that always exist at high
levels
- Normal response in both the woman and her partner
- Lack of knowledge of or preparation for parenthood and children may also contribute to
ambivalence
2. GRIEF
- Commonly occurs as a result of changes in the woman’s role
3. NARCISSISM
- Self-centeredness / egocentrism
- Generally an early reaction to pregnancy
- Occurs as the woman becomes focused on herself and the changes occurring in her body
4. INTROVERSION / EXTROVERSION
- Some pregnant women become introverted during pregnancy, focusing entirely on their
bodies and
themselves
- Other women become extroverted - may increase their participation in activities and
appear more outgoing, they may view their expanding abdomen with a sense of fulfillment
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5. STRESS REACTION
- For some women pregnancy can be a time of stress
- The woman and her partner may view the pregnancy as interfering with his or her ability
to accomplish daily tasks
- Adequate support systems can help alleviate some of this stress and aid in adapting to the
pregnancy
6. EMOTIONAL LABILITY
- Mood changes occur frequently
- May be the result of the woman’s introversion and narcissism
- Additionally, hormonal changes, specifically increase
estrogen and progesterone contribute to this lability - Feelings are easily hurt by remarks
that would have been laughed off before
7. COUVADE SYNDROME
- Partner may experience discomforts such as nausea & vomiting, fatigue or weight gain,
similar to or possibly more intense than those that the pregnant woman experiences
- The more he is involved or attuned to the changes of his partner’s pregnancy, the more
symptoms he may experience
- These discomforts are normal and temporary and become problematic only if the partner
becomes delusional or emotionally disruptive
8. CHANGES IN SEXUAL DESIRE
- During the 1st trimester, most women report a decrease in libido because of the nausea,
fatigue and breast tenderness
- During the 2nd trimester, as blood flow to the pelvic area increases to supply the
placenta, libido and sexual enjoyment rise markedly
- During the 3rd trimester, it may remain high or decrease because of the awkwardness of
finding a comfortable position and increasing abdominal size
9. BODY IMAGE & BOUNDARY
- The way your body appears to yourself
- A zone of separation you perceive between yourself and objects or other people
DEVELOPMENTAL / PSYCHOLOGICAL TASKS OF
PREGNANCY
FIRST TRIMESTER - Acceptance of the Pregnancy
- “I am pregnant”
- Pregnancy confirmation may leave some couples with disbelief, shock, or amazement
- The woman & her partner must learn to accept the reality of the pregnancy
- Some couples experience some degree of ambivalence
- Feeling the fetus move or seeing the fetus on an
ultrasound can help the couple achieve acceptance
SECOND TRIMESTER - Acceptance of the Baby
- “I’m Going to Have a Baby”
- The woman and her partner work to accept the baby
- Acceptance of the baby refers to acknowledgment that the fetus is a distinct individual,
separate from the mother
- Feeling the fetus move or hearing its heartbeat demonstrates that the fetus is an active
being
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- The woman and her partner begin active preparations for the baby
- A good way to measure the level of a woman’s acceptance of the coming baby is to
measure how well she follows prenatal instructions
THIRD TRIMESTER - Preparation for Parenthood
- “I’m going to be a Mother”
- The couple work on preparing to become parents
- The couple begin to demonstrate “nesting” behaviors such as preparing the baby’s room,
shopping for
necessary baby items, and discussing names
- The couple may attend childbirth education classes
- The couple may review relationships with their own parents and engage in role-playing
and fantasizing about being a parent
MATERNAL DISCOMFORTS ASSOCIATED WITH
PREGNANCY
FIRST TRIMESTER MGT:
1. Nausea & Vomiting - Avoid constipation
2. Breast enlargement and tenderness - Avoid prolonged standing
3. Urinary frequency and urgency - Avoid constrictive clothing
4. Nasal stuffiness, discharge, or - Topical ointments / anesthetic
obstruction - Sitz baths or apply warm soaks
5. Leukorrhea - Lie on her side with feet slightly elevated
6. Fatigue - Re-insert external hemorrhoids, by
SECOND TRIMESTER placing patient in side lying / knee-chest
1, Heartburn / pyrosis position, using a lubricant and using only
2. Constipation gentle pressure
3. Hemorrhoids
4. Backache
- commonly known as PILES
5. Leg Cramps
- Overdilation of veins under the mucous
6. Ankle Edema
membrane in the rectal / anal area or
7. Shortness of breath
both related to the weakness in the walls
8. Fainting spells / Hypotension
of the rectum
9. Varicose veins
- Maybe INTERNAL or EXTERNAL and
10. Braxton Hick’s contractions
straining related bowel movement may
- are normal throughout the entire
cause bleeding
pregnancy, maybe more pronounced in
- Pressure on the pelvic veins by the
the latter part of pregnancy
enlarging uterus, which interferes with
11. Headache
venous circulation
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DANGER SIGNS OF PREGNANCY

1. Severe, persistent vomiting
2. Vaginal bleeding
3. Sudden escape of fluid from the vagina
4. Chills and fever
5. Epigastric / Abdominal or Chest pain
6. Swelling of finger / face
7. Vision disturbances
8. Seizures / muscular irritability
9. Frequent, severe headaches
10. Decrease urine output
11. Rapid weight gain
12. Increase or decrease fetal movements

Childhood & parenthood education

METHODS FOR PAIN MANAGEMENT
1. BRADLEY (HUSBAND-COACHED) METHOD
- Originated by Robert Bradley
- Focuses on muscle-toning exercises during pregnancy combined with the limitation or
elimination of foods containing preservatives, animal fat, or large amounts of salts
- Incorporates abdominal breathing and ambulating during labor
2. KITZINGER METHOD / PSYCHOSEXUAL METHOD
- Encourages the woman to go with the contractions of labor and delivery rather than right
against them by incorporating progressive relaxation and breathing
- Developed by Shiela Kitzinger
3. DICK - READ METHOD
- Developed by Grantly Dick-Read
- Emphasizes the use of abdominal breathing with contractions to relax the body and
reduce pain
4. LAMAZE METHOD / PSYCHOPROPHYLACTIC METHOD
- Preventing pain of labor by use of the mind (psyche)
- Breathing exercises remain the focus of Lamaze class
5. DISTRACTION
- Involves diversion of attention from discomfort during early labor
6. TENS - Transcutaneous Electrical Nerve Stimulation
- Stimulation of large diameter neural fiber through electric currents to alter pain
perception
- May be effective in reducing the extreme back pain that some women have during
contractions
7. HYPNOSIS
- Involves an altered state of consciousness allowing perception and motor control to be
influenced by
suggestion
8. ACUPUNCTURE & ACUPRESSURE
- Stimulation of key trigger points with needles, causes the releases of endorphins of
affected organs, which reduce perception of pain
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- Acupressure is finger pressure / massage at the same trigger points

- Holding and squeezing the hand of a woman in labor may trigger the points during labor
9. YOGA
- Uses a series of deep-breathing exercises, body stretching postures, and meditation to
promote relaxation, slow the respiratory rate, lower BP, improve physical fitness, reduce
stress and allay anxiety
- Releases endorphins
10. ANALGESICS
11. ANESTHETICS
- General / Regional
BIRTH SETTINGS
1. HOSPITAL BIRTH
- Has the advantage of having ready supplies and expert personnel if the mother or fetus or
newborn should have a complication
- Birthing rooms, an important aspect is that the support person and often other family
members can stay with the woman for the entire process
- Birthing chairs > advantage of maintaining the woman in Semi-Fowler’s position, a
position that acts with gravity and appears to speed the secondary stage of labor
2. BIRTHING CENTERS
- May be found in maternity facilities located in a hospital or separate institution close to a
hospital
- Provide a warm, homelike environment
- Not appropriate for high risk deliveries
- Most care is provided by nurse-midwives
3. HOME BIRTHS
- May be considered controversial because of inadequate medical back-up
- Usual mode of birth in developing countries
4. SIBLINGS / CHILDREN PRESENT AT BIRTH
- Fosters the integration of the newborn into the family
ALTERNATIVE BIRTHING EXPERIENCE
1. LEBOYER METHOD
- Controversial birthing method
- Focuses on a soothing, tender approach to handling the neonate immediately after
delivery
- Lights are dimmed
- Noise is diminished
- Neonate is gently placed in a warm bath after the umbilical cord has been clamped
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During a normal pregnancy, return appointments are usually scheduled:

• Every 4 weeks through the 32nd week
• Every 2 weeks through the 36th week
• Every week until birth
Purposes of Prenatal Care:
- Establish a baseline of present health
- Determine gestation age of the fetus
- Monitor fetal development
- Identify the woman at risk for complications
- Minimize the risk of possible complications by anticipating and preventing problems
before they occur
- Provide time for education about
pregnancy and possible dangers

BATHING
- During pregnancy, sweating tends to
increase because the woman excretes
waste products for herself and the
fetus. She also has increase vaginal
discharges
- For these reasons, today, daily baths
or showers are recommended
- If membrane ruptures or vaginal
36 | P a g e

bleeding is present, tub baths are contraindicated because there would be danger of
contamination of uterine contents
BREAST CARE
- Proper breast support promotes comfort, retains breast shape, and prevents back strain
- Washing the breast with clear water and no soap is recommended
- Gauze / breast pads may be needed if the woman’s secretions of colostrum is significant

DENTAL CARE
- Dental check-up early in pregnancy and routine examination and cleaning are
encouraged
- Nausea and vomiting, heartburn, and hypermedia of gums may lead to poor oral hygiene
and dental carries
- The fetus receives calcium and phosphorus from the pregnant patient’s diet, not form her
teeth
- Nutritious snacks, such as fresh fruits and vegetables, are recommended to avoid
excessive contact of sugar with teeth
PERINEAL HYGIENE
- Douching is contraindicated
- The force of the irrigating fluid could possibly enter the cervix and lead to infection
DRESSING / CLOTHING
- Clothes should be non-constrictive (impede lower extremity circulation)
- Low to mid heeled shoes are recommended to prevent backache and poor balance
- Comfort is the key
SEXUAL ACTIVITY
- Sexual behavior is usually unrestricted in complication free pregnancies
- Discouraged on the 36th week, it causes premature labor
IMMUNIZATIONS
- Immunizations with attenuated live viruses (mumps) shouldn’t be given during pregnancy
because of their teratogenic effect on the developing embryo
- Vaccinations with killed viruses (DPT) may be given
PRECAUTIONS
- Work site should be checked for potential environmental hazards, such as pesticides,
anesthetic gas, and heavy metals such as lead and mercury
- Work duties may have to be altered to avoid excessive
physical strain; rest periods need to be scheduled to avoid fatigue
- When riding in a care, seat belts should be worn low, under the abdomen
- If a long trip is planned, the woman should get out of the car every hour to walk around
- Airplane travel is permissible in places with well-pressurized cabins; some airlines have
restrictions for over 7 months pregnant
TERATOGENS
- Any factor, chemical or physical that adversely affects the fertilized ovum, embryo, or
fetus
- If the insult occurs when the main body systems are being formed (2nd - 8th week), the
fetus is vulnerable to injury
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- During the last trimester, the potential for harm decreases because all the organs of the
fetus are formed and merely maturing
MATERNAL INFECTIONS
-Collectively termed TORCH
• Toxoplasmosis
- A protozoan infection
- Spread most commonly through contact with cat stool or litter; also contracted by eating
undercooked meat
- Causes CNS damage, hydrocephalus, microcephalic, intracerebral calcification and retinal
deformities
- Therapy: Sulfonamides
• Rubella / German Measles
- Causes deafness, mental & motor retardation, cataracts, cardiac defects, retarded
intrauterine growth
(SGA), thrombocytopenia purpura, dental & facial clefts
- Frequency of defects is about 80% if infection occurs in the 1st 12 weeks of pregnancy,
54% at 13-14 weeks, 25% after
- 30% chance of spontaneous abortion/ stillbirth if the infection occurs in the 1st trimester
• Cytomegalovirus
- Causes severe brain damage, eye damage, deafness or chronic liver disease
- Can cause infection of the NB during birth from genital secretions or postpartum from
exposure to CMV- infected breast milk
- No treatment or vaccine
• Herpes simplex (genital herpes infection)
- If the infection takes place in the 1st trimester, severe congenital anomalies or
spontaneous abortion may occur
- If the infection occurs during the 2nd or 3rd trimester, there is a high incidence of
premature birth, intrauterine growth retardation, and continuing infection of the newborn
at birth
- TORCH screen still provides a quick way to assess the potential risk of teratogenic
infection in pregnant women and newborns
Other Viral Diseases:
SYPHILIS
- Treponema Pallidum, can extensively damage the fetus after the 16th - 18th week
- If left untreated beyond the 18th week of gestation, deafness, cognitive impairment,
osteochrondritis, and fetal death
- Benzathine Penicillin is often use safely during pregnancy
LYME DISEASE
- Caused by a spirochete (Borrelia Burgdorgeri)
- Is spread by the bite of a deer tick
- Infection in pregnancy results in spontaneous abortion or severe congenital anomalies
VACCINES
- Live virus vaccines, such as measles, mumps, rubella, and polio
- May transmit virus infection to the fetus
MEDICATIONS
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- The woman should not take any drug not specifically prescribed / approved by her
physician
- Prescription meds are categorized as A, B, C, D and X
- Category D drugs are those that have clear health risks for the fetus
- Category X are those that have been shown to cause birth defects and should never be
taken during pregnancy
- OTC meds also pose a risk to the fetus
- ASPIRIN and other drugs containing salicylate aren’t recommended during pregnancy
- HERBAL remedies aren’t recommended because their effects on pregnancy and the fetus
are unknown
SUBTANCE ABUSE
- Increases the risk of gross structural fetal defects
- Risk is greatest in the 1st trimester, during organogenesis
- NICOTINE causes:
Vasoconstriction
Alters maternal & fetal heart rate

PROTEIN
- Requirement exceeds pregnancy needs by 10g/day (from
46-50g to 60g daily)
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- For expansion of blood volume

- For tissue growth
- For adequate amino acid intake for fetal development
FATS
- 20-35% of woman’s daily calorie intake
- Linoleic acid, an essential fatty acid is necessary for new cell growth is not manufactured
in the body; found in vegetable oils, such as corn, olive, peanut and safflower oils
VITAMINS
- Intake of all vitamins should be increase
- Necessary for tissue synthesis & energy production
- FOLIC ACID is particularly importantly (.4 - 1mg)
Promotes fetal growth and prevents anemia
Low levels of folic acid have been associated with premature separation of placenta,
spontaneous abortion, and neural tube defects
MINERALS
- Necessary for new cell building in the fetus
- CALCIUM & PHOSPHORUS - tooth formation
- Pregnant women need to ingest a diet high in calcium and Vit D
- Recommended calcium for pregnancy is 1200 - 1500 mg
- Calcium supplement if the woman is unable to drink milk or eat milk products
- Most foods high in protein also are high in phosphorus
- IODINE - essential for the formation of thyroxine, for the proper functioning of the thyroid
gland
• Hypothyroidism may lead to cognitive impairment
• RDA for iodine is 175mcg daily during pregnancy
- IRON - high Hgb level is necessary to oxygenate the blood during intrauterine life
• After 20 weeks of pregnancy, the fetus begins to store iron in the liver to last through the
first 3 months of life, when intake will consist mainly of milk, typically low in iron
• In addition, the woman needs iron to build an increase RBC volume for herself and to
replace iron lost in blood during delivery
RDA for iron is 30 mg/day
• Iron absorption increases in an acid environment. Thus, taking iron with orange juice is
recommended
• Oral iron compounds turn stools black and tend to cause constipation
FLOURIDE
• Aids in the formation of sound teeth
- SODIUM
• Maintain fluid balance in the body
• She should continue to season foods as usual during pregnancy unless she is
hypertensive / has heart disease
- ZINC
• Necessary for synthesis of DNA and RNA
• Deficiency has been associated with preterm birth
• RDA for zinc is 15mg/day
- FLUID needs
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• Extra amounts of water are needed during pregnant or promote kidney function because
the woman must excrete waste produces for two
• 2 glasses of fluid daily over and above a daily quart of milk are recommended
FIBER
- Broccoli and asparagus, are a natural way of preventing constipation, because the bulk of
the fiber in the intestine aids evacuation
- Also has the advantage of lowering cholesterol levels and may remove carcinogenic
contaminants from the intestines
FOODS TO AVOID DURING PREGNANCY
- Foods with caffeine > has been associated with low birth weight
- Artificial sweeteners > use of saccharine is not recommended during pregnancy because it
is eliminated slowly from the fetal bloodstream
- Weight loss diets are contraindicated during pregnancy because they may lead to fetal
keto acidosis and neurologic defects
COMMON PROBLEMS AFFECTING NUTRITION
- Nausa & vomiting
- Cravings
- Pica
• An abnormal craving for non-food substances
• Is a symptom that often accompanies iron deficiency
- Pyrosis
- Hypercholesterolemia
• Increasing progesterone levels causes elevation of cholesterol
• This can lead to an increase risk for gallstone formation (cholelithiasis) and
cardiovascular disease