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REPRODUCTIVE DEVELOPMENT paramesonephric duct will turn to male or female

- discussed by Sir Francis A. Vasquez
• Obstetric Nursing – came from the word
“obstetric” means “midwife”.
• Midwife – took care of the client during the under
prandial period, inter prandial period, post-prandial
period.
GONADS
reproductive organ.
- How? – If between 7th or 8th of pregnancy if the
level of testosterone being produce by primitive
testes will became high the mesonephric duct will
turn into the male reproductive organs, whereas
paramesonephric duct will regress. (kase ang
paramesonephric duct will be the one to turn into the
female reproductive system)

• High testosterone level - Mesonephric duct  male

reproductive organs
- Paramesonephric duct  regression

• If testosterone level is not present by 10th week -

Gonadal tissues will become – ovaries – therefore,
paramesonephric duct will turn to – female
reproductive organs.
- The male & female reproductive organ - So, it is all about the testosterone but we can say
- Male gonad: Testis that this is already pre-determined.
- Female gonad: Ovaries

a) Sperm – produce by the testes carry the x and y

chromosomes
b) Ovaries – egg coming from the ovary they carry
xx chromosomes
(That determine of the gender/sex of the individual)

Testis – XY chromosome
Ovaries – XX chromosome

How does gender of individual develop?

When the woman gets pregnant of the 5th week of
intrauterine life, there is a presence of primitive
Gonadal Tissue that has two ducts:

TWO DUCTS:
1. Mesonephric Duct
2. Paramesonephric Duct
- These two ducts will be the one that will change so
that the baby will become male or female

What happened to the developing baby?

- The 7th and 8th week of pregnancy the baby/fetus
will producing or developing a primitive testis.
- Primitive Testes – capable of producing a small
amount of testosterone.

- The level of testosterone will be the one to

determine if mesonephric duct and

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REMEMBER:
- OVARIES – produce egg cells, Ovum produced by
the ovaries are carrying XX chromosomes.
- TESTES – produce sperm cells. Carry X or Y
chromosome.
• Therefore, if the xx chromosomes of the sperm
fertilize or if the sperm that is carrying an xx
chromosome fertilize the egg that always carrying the
xx chromosomes (pre-determined), so the paring and
the combination will be xx, therefore the gender of
the baby will be female
• But the sperm cell carrying a y chromosome and it
fertilized the egg cell that always carrying xx
chromosomes the combination will be xy, therefore
the gender baby will become boy.
• Therefore, if the combination of the chromosomes
will be x and y the primitive testes is expected to
increase in production testosterone. So, the
mesonephric duct will turn into male reproductive
organ whereas, the paramesonephric duct progresses.
RECAP:
- If the sperm that is carrying an xx chromosome
fertilize the egg that always carrying the xx
chromosomes (pre-determined). What will happen?
The level of the testosterone by the 10th week of
intrauterine life will not increase so therefore the
mesonephric duct will be the one that will regress,
and the paramesonephric duct will develop into the
female reproductive organs
PUBERTAL DEVELOPMENT
- Puberty will start at the age of 9 and end the age of
17, called pubertal period.
- Secondary sex changes begin:
NERIZA BA-AR BSN 2-YA-6
• Range: 9-17 years old
• Average:
9-12 (girls)
12-14 (boys)
• Growth spurt (A sudden increase) – is earlier in
girl and later in boys.
ROLE OF ANDROGEN HORMONE
- FEMALE: adrenal cortex and Ovaries
• Master clock is the hypothalamus
- Hypothalamus – will trigger the adrenal cortex to
start producing the hormones
- Ovaries – will produce estrogen and progesterone
- MALE: Adrenal Cortex and Testis
• Adrenal cortex – will start producing androgen and
will stimulate the testes to produce testosterone
(that’s why there will be an appearance of
characteristics of male and female secondary
characteristics
TANNER’S SEXUAL DEVELOPMENT
- FEMALE SECONDARY SEX
CHARACTERISTICS (IN ORDER)
1. Acceleration in linear growth (growth spurt)
(Could have Broadening of the hips)
2. Increase transverse diameter of the pelvis
3. Breast development (Thelarche)
4. Growth of pubic hair (Adrenarche)
5. Onset of menstruation (Menarche)
6. Growth of axillary hair (Adrenarche) *not
frequently asked so our code will be ABTAMOI
7. Ovulation
8. Increase in vaginal secretions
ABTAMOI
CBQ:
• Thelarche
• Adrenarche
• Menarche
• Ovulation
What is the earliest sign of female secondary sex
characteristics? Increase in height or Breast
development?
- Increase in height (accelerated in linear growth)
Among the following which is the female
secondary sign of sex characteristics? Adrenarche,
Thelarche, Menarche, Ovulation.
- Thelarche (breast development)
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Which one comes out first? pubic hair or axillary
hair?
- Pubic hair. Pubic hair before axillary hair.
MALE SECONDARY SEX
CHARACTERISTICS (IN ORDER)
1. Increase in weight.
2. Broadening of shoulders
3. Growth of testes.
4. Growth of face, axillary and pubic hair.
5. Voice changes- because of androgens
6. Penile growth
7. Increase in height (second to the last)
8. Spermatogenesis
NOTE: - If a 10-year-old masturbate there is no
sperm cell, seminal fluid pa lang kase ang production
ng sperm sa male last pa nangyayari 12–14-year-old.
- Size of penis matters in terms of survival of the
sperm
- Small penis has a compensatory mechanism which
is forceful expulsion
- Semen must reach the uterus via the cervix in 9
seconds and reach the fallopian tube in 5 minutes
How will the penis erect?
• Sexual stimulation – have blood rush, when the
male person sexually stimulated the penile arteries
dilate more blood rush towards the penis and penile
veins will constrict, the blood inside corpora
spongiosum will trapped and it will absorb by it that’s
why the penis will erect. (pinkish color)
• If sexual stimulation subside the penile vein will
dilate and blood goes out of corpus spongiosum so
mawawala ang erection.
• Parasympathetic stimulation

MALE REPRODUCTIVE ANATOMY GLANS PENIS

EXTERNAL STRUCTURES – highly sensitive area in males
- Female counterpart: Clitoris

PREPUCE (FORESKIN)
– covers the glans penis
- majority of Christian world are circumcised
- benefits of circumcision: hygiene

CORONA
– sit of sexual excitement

SCROTUM
- sperm cells are heat sensitive
- responsible for protecting the testes
- scrotal sac is 1F lower than the body temp (vice
versa)
- scrotal sac is not equally elevated (left sac is lower)

PENIS
– organ of copulation/coitus
- Female counterpart: Vagina
- Penis is not highly muscular but rather high in
ligaments (Corpora cavernosa & Corpus
spongiosum)
- covered by glands skin known as prepuce
POINTS TO REMEMBER
Why is it the testes are found inside the scrotal
sac? And scrotal sac is found outside the body?
• Because there are sperms inside the testes
• Sperm cells are heat sensitive (pag masyadong
mainit
namamatay sila)
What’s temperature diff. bet. the body temp. and
scrotal temp?
• 1 degree Fahrenheit
• The body temp is 1 degree Fahrenheit higher than
the scrotal temperature. (vice versa)

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How long is the average length of the penis fully TESTES

erect? - Spermatogenesis
• Around 4 to 5 inches  - Leydig’s cell nourishes the sperm with
• There is lesser than 4 in. or longer than 5 in. glucose/fructose
• Urethra – tip portion of the penis - produce male hormone  testosterone
Function: dual, passageway of urine and semen - Spermatogenesis occurs specifically at
Therefore, reproduction and elimination seminiferous tubules

How long is the male urethra? VAS DEFERENS/DUCTUS DEFERENS

• 5 to 9 in an average of 7 - the site of the male surgical sterilization
• dual function (elimination and reproduction) (vasectomy- ligate ligate then cut)
• Scrotal sac – does not equally level. (isa mababa, • sperm cells after maturation will die
left side) • they provide nurishment
• made up of protein
What are the structures connected to male • Vasectomy is permanent contraception
urethra? • After vasectomy still possible to make the wife
1. Urinary bladder pregnant because may natira sa vas deferens
2. Ejaculatory duct
3. Prostate gland Nursing Teaching Plan (After vasectomize)
4. Cowper’s gland - Do not forget that after vasectomy that you need to
wear condom if you are going to engage sexual
AVERAGE SIZE/LENGTH OF FULLY ERECT intercourse for at least 2 months
PENIS: - Sperm cells that located on your vas deferens are
- 4-5 inches capable of 64 days maturing causing pregnancy
- To quickly emptying the part needed to ejaculate
MALE URETHRA LENGTH: (35 to 45 ejaculation, there is no guarantee)
- 5-9 inches (average of 7 inches) - Surest method is you need to test your sperm count
- Male urethra has dual function (for urination and - 1st result – not sure even the sperm count is zero
ejaculation) - 2nd result – still zero
- 2 consecutive zero sperm count results
- Blood rush causes the penis to erect during sexual - Vasectomy cannot stop the erection and not
stimulation preventing spermatogenesis and can still ejaculate
(but seminal fluid only no sperm)
MALE INTERNAL REPRODUCTIVE ORGANS - Vasectomy cannot protect the husband from STD
1. Testes 4 STRUCTURES PRODUCING SEMINAL
2. Epididymis – on top of testes FLUID
3. Vas difference 1. Epididymis
4. Ampulla 2. Seminal vesicle
5. Seminal vesicle 3. Prostate gland
6. Ejaculatory duct – where the ampulla and seminal 4. Cowper’s gland
vesicle meet
connected to the urethra How many percent of the seminal fluid will
7. Urethra – structure connected to this is ejaculatory epididymis produce?
duct, • Epididymis – 5%
prostate gland, & bulbourethral gland (cowper’s • Cowper’s gland – 5%
gland) • Prostate gland – 60%
8. Corpora spongiosum – came from the word sponge • Seminal vesicle – 30%

EPIDIDYMIS * Prostate gland is the main producer of seminal

– storage of testes for growth and maturation of fluid
sperms (takes 64-75 days to mature)

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During anal intercourse why is it some males
ejaculate even without masturbating?
- Because of the vibration of the prostate gland
during anal sex
• Maturation of cells in epididymis – 64 to 70 days
(common answer 64 days more than 2 months)
• Sperm Cells travels from vas deferens to ampulla –
because of the 5% of the seminal fluid produce by the
epididymis
• Sperm route: Testes (produce) → epididymis
(mature/storage, 5% fluid) → vas deferens
(connecting struct.) → ampulla (dito naka pila mga
sperm) → seminal vesicle (already prod. 30%
seminal fluid kaya super lubricated na ung ejac. duct)
→ prostate 60% and cowpers 5% at the same time
produce total of 65% seminal fluid
• Sperm Cells are alkaline in nature because of the
fluids (able to survive the acidity of vaginal canal
bec. of alkaline)
• Vaginal canal is acidic
2 STRUCTURES THAT GIVES THE SPERM
ALKALINITY:
1) Cowper’s gland
2) Prostate gland
• During contraction of ejaculatory duct there is
forceful
ejaculation so that the sperm will not stay in the
acidic vaginal canal.
• Sperm cells will reach the cervix in 90 seconds and
reach fallopian tube in 5 minutes
• Testes- male sex gland
• Testosterone- male sex hormones
SPERM ANALYSIS RESULT
- mL of semen/ejaculation: 3-5 mL
- sperm count/mL – 20-150 million
- sperm count/ejaculation: 400 million
- Life span of sperm: 3-5 days/72 hours
- pH: 7-8
- Morphology: 30%
- Motility: 50%
- Viability: 50%
Oligospermia – less than 20 million sperms
Aspermia – 0 sperm count
Low sperm count – less than 20 million sperm 
number one cause of infertility
CLOMID – increases sperm production
- with doctor’s order
NERIZA BA-AR BSN 2-YA-6
- woman can also take clomid (stimulates ovulation)
2 TYPES OF SPERM (NORMAL)
MORPHOLOGY
1. Gynosperm – big head, small tail (contains more
alkaline; acid-resistant)
2. Androsperm – small head, long tail (fast moving;
mas madaling mamatay)
FEMALE REPRODUCTIVE EXTERNAL
STRUCTURES
• Mons pubis/ Mon veneris - protects the symphysis
pubis
• Labia Majora and labia minora
• Clitoris - sit of sexual excitement for female.
Homologous part of glans penis of the male.
• Vestibule – pear/boat-shaped space. 2 obvious
opening found in here: urethral meatus and vaginal
orifice (for vaginal opening)
• Female urethra – 2-3 inches;
Male- 5-9 average of 7.
That is why female is prone to UTI. Have single
function for elimination only passage of urine
• For correct catheterization we can see the clitoris
• Fourchette – where labia minora and majora meet
• Perineum- fourchette to anus
• Paraurethral gland (skene’s) – lubricates the
urethra
• Bartholin’s gland – lubricates the vagina
• Down the fourchette and perineum this is the site of
episiotomy.
• Episiotomy – the cutting of the perineum of the
woman to provide wider space to delivery and
prevent laceration.
HAS 2 TYPES: midline and mediolateral
episiotomy.
• Mediolateral episiotomy- is better than midline.
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• If you have laceration and there is total

communication bet. The vaginal canal and the
rectum that can lead to infection because of fecal
contamination

• When will the doctor perform the cut? During

contraction or between contraction? Is there an
anesthesia?
- No, because it has a natural anesthesia, the doctor
will cut during the peak of the uterine contraction,
because when there is strong uterine contraction
during the acme, because one contraction is
composed of three parts: relaxation, contraction,
relaxation
- There is a natural anesthesia during Acme
- Head of baby is putting pressure so nerve endings
will not be able to transmit pulses so patient is numb

A - Ovaries
B – Fallopian tube
C - Uterus
D – Vaginal canal
I-ncrement (start), A-cme (peak), D-ecrement (end)
UTERUS
• The doctor will not do the cut during the increment
and decrement. The doctor will do the cut during
acme because during this time the peak of the
uterine contraction, the head of the baby is already
pressuring the perineum of the woman. If the head of
the baby is pressuring the perinium of the woman the
nerve ending will not be able to transmit pain

SIZE:
3”x2”x1”
3 inch long
2 inch wide
1 inch thick

Weight: 50 grams
Shape: pear-shaped
Location: Suspended between urinary bladder and
rectum

INTERNAL STRUCTURES 4 POSITION:

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3. Aids in labor and delivery

4. Organ of menstruation

3 LAYERS OF UTERUS:
1. Perimetrium- outermost layer
2. Myometrium- middle, thickest layer, source of
origin of uterine contraction; thickest layer is found
in the fundus
3. Endometrium- inner most layer and the site of
implantation.
.
UTERUS IS COMPOSED OF 4 PARTS:
1. Fundus – upper most triangular portion
2. Corpus – the working you find the uterine cavity.
Body of uterus
3. Isthmus – lower segment/part
4. Cervix (collar) – mouth/opening of uterus.
• Anteflexion - fundus of uterus is leaning sharply
forward and it is abnormal because it can compress
to much of urinary bladder and other organs in front
of it.; cystocele; protrudes to bladder wall

• Anteverted/ anteversion (non-pregnant)- normal

position, fundus of uterus is leaning forward.

- This position is also assumed in 1st trimester of

pregnancy, as the baby grows, the mother will
experience urinary frequency as the uterus is
pushing the bladder

The woman is 2 ½ mos pregnant is the uterus already

enlarging?
• Yes, and its position is anteverted and can compress
the bladder so discomfort of pregnancy experienced
by pregnant woman is urinary frequency and this will
disappear in 2nd trimester beginning 4th month
because the uterus assume the retroverted position

• Retroverted/ retroversion – normal position in

pregnant women, assumes position in 2nd trimester (4- • The thickest layer of the myometrium located in
6 months) the fundus.
• Retroflexion- protrudes to rectal wall; rectocele; - Because that is the site of uterine contraction.
can experience pain in defecation - The strongest uterine contraction.
- When the fundus contracts it gives the baby a
* Flexion - means abnormal downward push.
In the 3rd mos. of trimester, she experiences urinary - Uterine contraction in upper segment is the
frequency why? strongest because it pushes the baby out
• Because the baby is so big
• The uterine contraction in lower uterine segment
FUNCTIONS OF THE UTERUS are not that strong.
1. Site of implantation
2. Houses and nourishes the products of conception

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- If the uterine contraction here is strong, the baby 2. Intensity

cannot go out the baby will have a hard time going 3. Duration
out. 4. Frequency

SPECIFIC SITE OF IMPLANTAION:

- Endometrium ONLY
- The ideal site of implantation is Upper uterine
segment – posterior.
- Posterior because uterine arteries are located at the
posterior. Rich in nourishment, nutrient supply
and oxygen supply.
- REMEMBER: The site of implantation is the site of
placental development
DRUGS
OXYTOCIC DRUGS – stimulates contraction
Oxytocic drug increases BP
 Constricts blood vessel/vasoconstriction and
may lead to water intoxication which is
harmful
 More than 140/90 mmHg means you need
to hold the drug and notify the doctor

- Not in the lower because the site of implantation is 1. Syntocinon

the site of placental development. Ibig sabihin kung 2. Pitocin
saan nag plant dun din mag grow ang placenta. 3. Oxytocin – given via IM; given 1 minute after
– If the implantation happened in lower, called baby is out; it stimulates rhythmic uterine
Placenta Previa. The placenta obstructs the birth contraction
canal and lead to bleeding 4. Methergine – not given nowadays; sustained
uterine contraction  stimulates cervix to close,
o The implantation should only happen in give after the placenta is out
endometrium.  Given if there is postpartum uterine atony
- It should not reach in myometrium.
- If the implantation invaded the myometrium, in the * Syntocinon and Pitocin is given via IV
future the placenta is attach up to myometrium. incorporation
- After the baby goes out, the placenta goes out next.
The placenta separate itself from endometrium.
Meaning, the placenta is superficially implanted on
the endometrium. TOCOLYTIC DRUGS – relieve contraction
- smooth muscle relaxant; also bronchodilator
- If implantation goes deeper/ invasive, the - uterus is composed of smooth muscle
placenta is attached permanently on the (myometrium)
myometrium (because during delivery the baby goes
out and after that the placenta goes out next and it 1. Duvadilan
separates itself from endometrium meaning placenta 2. Dactil OB
is superficially implanted in the endometrium but if 3. Yuotpar
the implantation goes deeper invasive implantation 4. Bricanyl (brand name)
the placenta is attached permanently and it is called 5. Terbutaline (generic name)
Placenta Accreta 6. MgSO4
- If there’s Placenta Accreta, the placenta will not
go out, because the placenta becomes part of the ABRUPTIO PLACENTA
uterus. - premature and sudden separation of placenta from
- When the baby went out, but the placenta cannot uterus
detach itself from the uterus, the women bleed to - sudden and abrupt
death. - abdomen is board-like
MANAGEMENT: removal of uterus called - use Tocolytic drug (MgSO4)
hysterectomy
If a pre-term labor is cannot be stopped, used
UTERINE CONTRACTION Oxytocic drug
- Monitored by:
1. Interval

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- Drug contraindicated in Fetal distress  Oxytocic
(because it vasoconstricts)
3 STAGES OF UTERINE CONTRACTION
Increment
Acme
Decrement
Frequency  Increment to Increment
Duration  Increment to Decrement
Interval  Decrement to Increment
CERVIX
PARTS:
• Internal OS – during pregnancy it effaces
(thinning); thinning is measured by percentage
(100%)
• Cervical canal – during pregnancy turns into
operculum (thickened)
• External OS – during pregnancy it dilates
(widening/opening) Location: above vaginal canal;
dilation is measured by centimeters (10 cm)
NERIZA BA-AR BSN 2-YA-6
- During delivery we measure internal os by
percentage. What is the full cervical effacement?
100%, how about dilatation? Centimeters, what is the
full dilatation? 10 cm.
- During pregnancy, the level of estrogen is high. -
When the level of estrogen is high, it makes the
cervix soft. And softening of cervix is known as
GOODELL’S SIGN
Three probable signs of pregnancy can be found
in the vagina, cervix and isthmus:
1. Chadwick sign – purplish or bluish discoloration
of vaginal mucosa
2. Goodell’s sign – softening of cervix
3. Hegar’s sign – softening of cervix
- GS and HS are the same thanks to estrogen because
during pregnancy the level of estrogen increases
causes to increase vascularity (means temporary
capillaries are building up that increases fluid supply
that’s why it becomes soft) on the isthmus and cervix.
How soft is non pregnant cervix?
- as soft as tip of the noses
How soft is Early pregnancy cervix?
- Earlobe
How soft is late pregnancy cervix?
- lips
Why is there a need to cervix soften?
- To be able to allow the cervix to efface and dilates.
Kailangan lumambot para numipis ang internal os at
mag open ang external os
PAPANICOLAU SMEAR (PAP SMEAR)
- Females also produce smegma in vestibule that
builds up to the vaginal canal and smegma is prone to
cervical cancer in females during coitus
- Smegma is a combination of residual urine and
sweat
When should you check for a pap smear?
AGE: 21 years old (mandatory)
Or 1 YEAR after becoming sexually active
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• Uterosacral ligament/pelvic floor ligament –

PURPOSE: lower support
- To identify abnormal cervical cells
What ligament allows the uterus to assume the
- Doctor will smear in endocervical canal using retroverted position during pregnancy?
sterile cotton applicator • Round ligament. During 2nd trimester the round
ligament is contracting so fundus is going up
RESULTS (CLASS 5): retroverted position.
1. Absence of atypical cells • Cardinal ligament. It will not be called cardinal if
2. Presence of atypical cells but not suggestive of it is not important. Fundus and isthmus is not stable.
malignancy Middle part is usually stable and not becoming soft
3. Presence of atypical cells suggestive of so what is the ligament attached? Cardinal.
malignancy
4. Strongly suggestive of malignancy
5. Conclusive of malignancy

RESULTS (CLASS 4):

1. Absence of atypical cells
2. Presence of atypical cells but not suggestive of
malignancy
3. Presence of atypical cells suggestive of
malignancy
4. Conclusive of malignancy UTERINE BLOOD SUPPLY

PREPARATIONS:
- No sexual intercourse 3-5 days before pap smear
- No mechanical method of contraception (cervical
cap/diaphragm)  wearing will result in false
positive result
- No chemical method of contraception
- No vaginal deodorant/perfume
 Vaginal perfume acts as pheromones which
stimulates arousal
OPERCULUM
- Thickened cervical mucus
- When the cervical mucus thickened it acts as a seal
that protects the mother and the baby against the
ascending infection.
- Protection against microorganisms are acidity of
vaginal canal and operculum
- Dislodge during through labor (bloody show) UTERINE NERVE SUPPLY
SUPPORTING LIGAMENT STRUCTURE OF
UTERUS
• Broad Ligament – it keeps the fallopian tube and
uterus in place.
• Round ligament – upper support, pair of ligament
attached to the fundus.; assumes ante/retroverted
position
• Cardinal ligament – middle support (important, it
is vital), provides stabiltiy

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Uterus nerves
a) Afferent sensory – from thoracic #11 to #12
b) Efferent motor – from t5 to t10 CBQ: -
Epidural Anesthesia – stops pain of uterine
contraction at t11 and t12 without stopping uterine
contraction. For painless delivery.
• Because the motor nerves that will allow the motor
nerves to contract is t5 to t10, sensory from t11 to
t12.
• Kaya if woman receives epidural anesthesia the
woman will continue uterine contraction because
epidural anesthesia affects at t11 and t12 but not
affecting the nerves t5- t10 so she will continue
uterine contraction but not feeling the pain.
VAGINA
- Length – 3 to 4 inches
- Rugaeted – skin folds, stretching
- Function – organ of intercourse; passageway of
menstrual discharge; birth canal
- Environment - Acidic – douderlein bacillus this
produces lactic acid
- pH – 4 to 5
- During IE the fingers are inserted to vaginal canal
- Vagina can accommodate a bigger and longer size
of penis, because it has rugae
- During sexual intercourse the cervix moves little
upward and the rugae is stretched
FALLOPIAN TUBE
2. Isthmus – site of tubal ligation. The doc. Will fold
fallopian tube.
3. Ampulla – fertilization happens and common
site of ectopic pregnancy (pregnancy outside the
uterus) and meeting place/mating place, widest part.
4. Infundibulum
- If fallopian tubes is divided into 3 equal parts (4 if
including infundibulum) it is called:
ampulla- outer most third
isthmus- middle third
interstitial - inner most third (narrowest and goes to
3 layers of uterus)
- Fimbrae- farthest part of the infundibullum, to
catch the egg cell. When the follicle of the ovary
releases an egg cell the fimbrae catch the egg cell.
The egg cell will then go to ampulla to wait for the
arrival of the sperm.
* Most common site of fertilization for tubal
pregnancy: Ampulla
- Dangerous site: Interstitial

Lifespan of egg cell: 1 day (maximum of 2 days/48

hours)

- When woman is pregnant, estrogen increases but

progesterone increases more

ESTROGEN:
- enlarges uterus
- encourages contraction
- Pair of tubular organs
- Also called oviduct, because it is the passage way PROGESTERONE:
of ovum once it is fertilized - hormone of pregnancy
- Length 3-4 inches - prevents contraction
- Ciliated - provides nourishment

PARTS:
1. Interstitial – dangerous because of ectopic
pregnancy bec. it is narrowest and connected to the Braxton-Hicks contraction – contracting, painless,
uterus so bleeding is profuse irregular

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- Once fertilization occurred, fertilized egg stays in
fallopian tube for 3-4 days  estrogen is increasing
- Cilia will move inward and will take another 3-4
days of travelling to reach uterine cavity and implant
on endometrium
- So implantation will happen 7-10 days
QUESTIONS:
- Site of fertilization? Fallopian tube,
specific part? Ampulla
- Functions: site of sterilization and transports ovum
to the uterus.
- Pomeroy Procedure – cutting of fallopian tube
- Modified Pomeroy – no cutting the fallopian tube
- The doctor will do the tubal lateral ligation during
menstruation because it is a sign that the woman is
not pregnant.
- When is the best time will the woman undergo
tubal ligation?
– 1st day after the last menstrual period or during
mens. Choose the day closest to the day that the
woman is menstruating.
- For example, the woman had sex the sperms enter
vaginal canal → uterine cavity → 2 fallopian tubes
→ tapos wala pa ung egg cell dahil hindi pa siya nag
ovulate, eh ung life span ng sperm ay 72 hrs/3 days
maximum of 5 days so tatambay muna siya sa
ampulla → nag ovulate na ung egg cell → mature
NERIZA BA-AR BSN 2-YA-6
egg cell ika-catch sya ng fimbrae → it will enter
ampulla → there will be fertilization.
- Once its fertilized the egg it stays on the fallopian
tube for 3-4 days, during w/c the level of estrogen is
increasing and progesterone is increasing more
because the woman is already pregnant.
- When level of estrogen is increasing it encourages
contraction in the fallopian tube nag kakaroon ng
wave like motion.
- Inner portion of the fallopian tube is ciliated so as
the fallopian tube is contracting the cilia are moving
so the fertilized egg is also moving inward for
another 3-4 days if it moves outward, it will cause
high risk of ectopic pregnancy.
- After fertilization the implantation will happen 6 to
8 days or average of 7 days (1 week) and maximum
of 10 days
- 7 to 10 days implantation will occur in upper
segment in posterior uterus in the endometrium
- Pro (for) gesterone (gestation)- hormone of
preganancy, provides nourishment for the baby and
hormone that prevents contraction
- Estrogen- hormone that encourages contraction
and hormone that enlarges the uterus.
OVARIES
- Female gonad that produce estrogen and
progesterone
3 DIVISIONS:
1) Surface epithelium
2) Cortex – maturation of oocytes
3) Medulla
- During the pregnancy ovaries are not active because
placenta will be the one will provide the estrogen
and progesterone
BREAST MAMMARY GLANDS
- The breast lies in the pectoralis muscle
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- Cells responsible for producing the milk are the

acini cells that is found in the lobe that contains 15-
20 each breast.

How milk ejection happens?

- When the newborn baby sucks the nipple of mother,
it sends signal to the posterior pituitary gland to
release oxytocin.
- Lobes of the breast- are connected to the
- Once oxytocin release, it will cause the
lactiferous ducts; contains 15-20 lobes each breast
contraction of milk gland cells and acini cells will
- Lactiferous sinuses/Ampulla of the breast- dulo ng
release milk.
lactiferous duct, storage room for the milk
- Then, the milk flows into lactiferous ducts, it will be
- From: Lobes → lactiferous ducts → Lactiferous
stored in the lactiferous sinus.
sinuses/Ampulla → opening of lactiferous
- Because sucking action of the baby, the milk is
expressed in the nipple.
What hormone stimulates the breast to produce milk?
- Prolactin – it produces by the pituitary gland.
- Is there any advantage when posterior pituitary
(Anterior and posterior)
gland during breast feeding releases oxytocin
– the advantage will be contraction of the uterus
- Prolactin – from anterior pituitary gland; Oxytocin
during the post-partum period. Then, the uterus
– from Posterior pituitary gland.
remains firm and contracted, it stops or prevents
- Oxytocin causes uterine contraction.
post-partum bleeding.
- Prolactin stimulates acinar cells (found inside lobes
- The normal consistency of the uterus after delivery
that can produce milk)
must be firm and contracted. Because if the uterus is
relaxing, the woman bleeds.

SELF BREAST EXAM

How will the mother breast feed the baby after
- Done 5-7 days after menstruation
delivery?
PELVIS
- Because of the action of the prolactin and oxytocin.
- Supports and protects the reproductive and other
- Prolactin stimulates the production of milk by
pelvic organ
acini cells inside the lobes
- Bony ring structure
- Milk ejection reflex or let down reflex of the milk
- Inside the pelvic cavity there is female internal
we need oxytocin, coming from the posterior
reproductive system including the part of the renal
pituitary gland.
system, the bladder, and the digestive system, the
MAMMARY GLANDS & MILK EJECTION
rectum and the anus.
REFLEX
2 DIVISIONS:

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1. False pelvis – from symphysis pubis and up - Cannot support pregnancy and delivery
- supports the growing uterus (acts as funnel) 3 PARTS OF TRUE PELVIS
- Ilium
2. True Pelvis: from symphysis pubis and below
- serves as the birth canal

1. Inlet
2. Cavity
3. Outlet

4 TYPES OF PELVIS

- Ischial tuberosity- called sitting bones, the ones

carrying our body weight when we are sitting
- Ischial spine/ sipit-sipitan- katapat ng coccyx;
where station zero is located
1. GYNECOID
- True female pelvis because this is the most Anterior Posterior Lateral
rounded type of pelvis. Inlet Superior Sacral Ilium
- It can easily support pregnancy and delivery. Pubis prominence
- Rounded Cavity - - -
2. ANTHROPOID
Outlet Inferior Coccyx Ischial
- Can also support pregnancy and delivery.
pubis spines
3. ANDROID
- Male pelvis
– heart or triangular shape - If you get the distance from superior pubis to
sacral prominence it is anterior-posterior diameter
4. PLATYPELLOID of the inlet
- The anterior and posterior diameter is short.
- Flat pelvis

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- If you get the distance from inferior pubis to

coccyx it is anterior-posterior diameter of the • Ischial spines – landmark for the station zero.
outlet (Station zero is landmark of engagement – means
the head is already between the ischial spines naka
- If you get the distance between the 2 iliums, then sipit ang head kaya tinawag na sipit-sipitan)
transverse diameter
• If the fetus still inside of the uterus of mother, there
- If you get the measurement between the 2 ischial is amniotic fluid. The fetus bouncing in the amniotic
spines then, transverse diameter of outlet and inlet fluid.
kase may diameters ang pelvis
• Ballottement – the bouncing of the baby in the
DIAMETER OF PELVIS amniotic fluid.
Anterior- Transverse Oblique
Posterior
Inlet 11 cm 13 cm 12 cm
Cavity 12 cm 12 cm 12 cm
Outlet 13 cm 11 cm 12 cm

- All oblique and cavity are 12 cm

- Inlet- transverse is bigger and AP dia. is smaller
- Outlet- transverse is smaller and AP dia. is bigger
THE 6 MECHANISM OF LABOR & DELIVERY
The baby needs to rotate while passing the birth
canal. – 6 mechanism labor.
D-FIRE-ER-E

1) Decent
2) Flexion • Engagement is when the head of the baby reaches
3) Internal Rotation at least minimum of station zero or if the head of
4) Extension the baby is already reaching the two ischial spine.
5) External Rotation • Station zero- is the level of the ischial spine
6) Expulsion • Above station zero is negative 1, negative 2 etc.

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• Below station zero is positive 1, positive 2 etc.

• 1 station = 1 cm.

EXAMPLE:
1. The head is located at the negative 2 station, so
the baby is located 2 cm above ischial spine.

2. If the head is located at the positive 3 station the

baby is located 3 cm below ischial spine.

3. The head is located 2 cm above the ischial spine, FETAL SKULL

is the head already engage? Not yet but there is 3 MAIN BONES:
ballottement since the Station zero (-) Not Engaged 1) Frontal bones
(+) Engaged, head is not yet engage the baby can 2) Parietal bones
still bounce and the baby is floating 3) Occipital bones

4. When the head is already engaged in station zero it SUTURES:

is no longer floating w/out ballottement.
5. When the head goes down to positive 5 the head is
always engaged.
6. You performed IE upon inserting your finger you
are able to feel/palpate the ischial spine, but the head
is not yet there the head is located at the negative
station.
7. Upon inserting your finger, you feel the head
w/out feeling/ palpating ischial spine the head is
located at the positive station
- Cranial joints, like space
1) Frontal suture - between 2 frontal bones
2) Coronal suture - between 2 parietal and 2 frontal
3) Sagittal suture - between 2 parietal bones
4) Lambdoidal suture - between 2 parietal and 1
occipital
FONTANELLES
1) Anterior fontanelle – diamond space (closes
within 12-18 mos.)
2) Posterior fontanelle – triangular space (closes
within 2-3 mos.)  the one that closes first

8. Upon inserting your finger, you feel the head

along the ischial spine then that is station zero.

• Crowning – when the head reaches positive 4 and

5. The head of the baby is being encircle already by
the vaginal opening

FETAL SKULL-PELVIS RELATIONSHIP

- The fetal skull is the most important part of the
fetal body during the labor and delivery because:

• The most frequent presenting part. (Because the

most common fetal presentation is cephalic
presentation)
• Largest part of the fetal body. (Since it is the
largest that’s the part of the body that can have a
problem of not passing through the birth canal kase
malaki)
ATTITUDES:
• Least compressible. (When head passed birth canal
1) Flexion
the head is compressed and that is called molding)

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2) Extension • All babies that are in cephalic presentation will be

delivered normally? No, it depends.
4 REGIONS OF THE FETAL SKULL: • If the presenting part in the vagina is the face of the
1) Face - biggest baby, it is dangerous because as the uterus is
2) Brow/ sinciput - big contracting the uterus is pushing the baby down and
3) Vertex - small the head further extend is face that can cause
4) Occiput – smallest fracture of the cervical bone
FETAL LIE
EXAMPLE:
- If the head is:
• fully flexed the presenting part is occiput
• Partially flexed the presenting part is vertex
• Partially extended the presenting part is brow
• Fully extended the presenting part is face

Occiput and vertex - 2 ideal presenting part, kase

maliit sila
• Longitudinal lie - if the axis of uterus and baby is
parallel to each other.
Two types: Cephalic and breech

• Transverse lie

• In actual area presentation is the commonly used

term because it is direct.

MENSTRUATION
- periodic, cyclic discharge of blood from the uterus
- Uterus – organ of menstruation
- blood loss  30-80 cc (average of 60 cc)
- 60 cc  ¼ cup
- iron loss  12-29 mg
- If the woman is heavily having menstrual period,
pwede siya mamutla/ pallor.
FETAL PRESENTATION
MENSTRUAL PERIOD VS. MENSTRUAL
CYCLE
MENSTRUAL PERIOD:
- are the days that the woman is menstruating
- Average length of menstrual period: 3-5 days,
maximum of 7 days
MENSTRUAL CYCLE:
- Average of 28 days per cycle
- ranges from 23-35 days; maximum of 40 days
- starts from the first day of period to the next period
1) Cephalic – headfirst of regla (period to period)
2) Breech – buttocks first - occurs during puberty; 9-17 years old, average of
3) Transverse- shoulder first 12 years old

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- First onset of menstrual cycle is called menarche
* Menarche is not the first sign of female secondary
sex development, its thelarche (breast development)
1) Growth spurt
2) Broadening of Hips
3) Thelarche
4) Andrenarche
5) Menarche
6) Ovulation
7) Increased vaginal secretions
- Menstrual cycle can be regular or irregular
• Ovulation - the day that the one of the 2 ovaries of
the woman is releasing a mature egg cell.
• The woman is fertile when the one of her 2 ovaries
is releasing egg cell.
• If the woman is fertile and she had sex there is a
possibility that the egg will be fertilized by the sperm
and get pregnant.
• How are we going to compute for the day of
ovulation? - From the end of the cycle, minus 14.
- 28 – 14 = 14
- minus 14 is a constant value as this is the lifespan
of the corpus luteum
- she will be ovulating on day 14. - This is only done
by regular
• Hormone estrogen is high on the first half of the
cycle.
• Hormone progesterone is high on the second half
of the cycle.
• The length of the cycle affects the day of the cycle?
Yes
• The day of ovulation is based on the length of the
cycle
• If the length of the cycle is changing every month,
then the day of your ovulation every month is also
changing, then you are not regular.
- For the nurse to accurately determine the day of
ovulation, she must deduct 2 weeks from end of
cycle (best answer)
NERIZA BA-AR BSN 2-YA-6
- or add 14 days from beginning of the cycle ONLY if
the cycle is 28 DAYS, it its not, then this method can
no longer be used if the person is irregular
- Ovulation starts 2 weeks before the menstruation
(kasi if after the mens, nagvavariable ang days)
- The first half of cycle is where the days are variable
- 2nd half is 14 days fixed
- To know if the cycle of woman is regular or
irregular. The length of cycle is constant for 6
months of 28 days
- Irregular cycle cannot use calendar method as a
method of contraception because day of ovulation is
changing every month (we will have to deduct
longest cycle to shortest cycle and that’s how we will
get ovulation days)
FERTILE WINDOW
- These are the days the woman is considered fertile.
- If you want to get pregnant have sex during the
fertile window.
- If you don’t want to get pregnant have sex outside
the window
- Subtract 5 days from the day of ovulation (5 days
is the lifespan of sperm)
- Add 3 days from the day of ovulation (3 days –
lifespan of an egg cell, it is actually 1-2 days but they
make it 3 days)
5 days  lifespan of sperm cell
3 days  lifespan of egg cell
Example: 5 days of menstruation
- Days 1-5 = menstrual period is safe
- Deduct 5 days from the day of ovulation 14-5 = 9
- Add 3 days from the day of ovulation 14+3 =17
- Day 9-17 fertile window, the woman is considered
fertile
- The woman is considered safe to have sex if she
doesn’t want to get pregnant beyond the window so
less than 9 and above 17
- Specifically, the woman is safe to have sex from
day 1 to day 8 but days 1 to 5 have menstrual period.
Therefore, day 6- 8 and during menstrual period is
safe.
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- Day 18 – 28 is also safe 4) If you don’t want to get pregnant have sex more
- Day 9 – 17 fertile days, not safe than 5 days before ovulation: day 8 paatras.

RECAP:

5 days explanation:

28 Days Cycle Legend:

• Red - menstruation (safe) - It is considered safe to have sex during menstrual
• Green – safe days period but not all menstrual period are safe
• Orange - fertile window (not safe) depending if you are regular or irregular
• Violet- ovulation day - The shorter the menstrual cycle (shorter than 28
• Blue- sex days days), mas di nagiging safe
1) If the woman is a 28-day cycle, she will ovulate - So having sex during period is not always safe
on day 14, granted that the menstrual period of the - It is possible to ovulate while menstruating or pasok
woman is 1-5 days. sa fertile window
2) From the day of ovulation minus 5 (14-5 =9) &
from the day of ovulation plus 3 (14+3 =17) so days 21 DAY CYCLE
9-17 she is fertile. Menstruation ----- Ovulation ------- Menstruation
1-5 7 21
3) Therefore days 1-8 she is safe but if she wants to -5 +3
engage in sex beyond menstrual period, she is safe 1 day safe FW: 2-10 days 11-21 = safe
from days 6-8 and from day 18-28.
- Q: Is she ovulating at day 9? A: No, because day 14
is the ovulation day

1) Day 9 is 5 days before ovulation, means that if you

have sex on day 9 sperm enters the vagina →
cervix (w/in 90 sec) → uterine cavity → fallopian
tube (reached w/in 5 min) and;
2) Starting from day 9 the sperm is waiting in the
ampulla of the fallopian tube for the arrival of the
egg for 5 days (kase diba ang life span ng sperm is 3-
5 days so 5 days siyang mag hihintay sa ampulla) and
the egg will arrive on the 5th day at exactly day 14
(ovulation day) in the ampulla of the fallopian tube
therefore she will get pregnant even if the sex was 5
days ago.
3) Note the sperm lives for 3-5 days that is why you
have to subtract 5 and add 3 is derived from the life
span of the ovum/egg cell. It is only 1-2 days or
actually average of 24 hrs or 1 day, maximum of
48 hrs. or 2 days. Plus 3 kase they added 1 day.
Another Example: 4 days of menstruation
- Fertile window: 19-27
- Safe days: 1-18 and 28-38
- Ovulation day: 24
38 Days Cycle Legend:
• Red - menstruation (safe)
• Green – safe days
• Orange - fertile window (not safe)
• Violet- ovulation day
• For irregular there is computation but it is not
highly recommended because from the very
beginning the woman is irregular.
• To know if you are regular or not you have to:
- Monitor your menstrual cycle for at least 6 mos.
- For regulars your menstrual cycle should be fixed to
specific no. of days.

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- Producing:
• Ex. Your cycle is 30-day cycle so dapat every - GnRH or Gonadotropic Releasing Hormone
following month 30 days pa din siya.
- Although naiba nung April ng 28 hindi pa din siya 2 TYPES OF GNRH:
considered as irregular, ask ur self if you are stressed 1) FSHRF or Follicle Stimulating Hormone
that time because it can alter mens. cycle. Releasing Factor
2) LHRF or Luteinizing Hormone Releasing Factor

2. Anterior pituitary gland

- Producing:
- FSH or Follicle Stimulating Hormone
- LH or Luteinizing Hormone
• For irregular, you must also monitor your menstrual
3. Ovaries
cycle at least 6 months.
Producing:
- You have to identify the month that has longest
- Estrogen- dominant on the 1st half of cycle
cycle and the shortest cycle.
- Progesterone- dominant on the 2nd half of cycle
- You have to deduct 11 days from the longest cycle
then,
4. Uterus
- Deduct 18 days from the shortest cycle.
- We cannot identify exactly the ovulation day but we
will know the fertile window.

Example for irregular:

a) (May) Longest cycle – 38 – 11 = 27 days ↑
4 DATES IN MENSTRUAL CYCLE
Considered as the cycle because it is the longest
1. ↓ 3rd day - the level of estrogen in the blood of
b) (Aug.) Shortest cycle – 21 – 18 = 3 days
the woman is very low.
- Days 1-5, she is menstruating at the beginning
menstrual cycle.
2. ↑ 13th day - the level of estrogen in the blood of
the woman is very high
- Day 5 still menstruating and day 3 ovulation day-
they are overlapping 3. ↓ 13th day - the level of progesterone in the blood
of the woman is very low.
4. ↑ 14th day - the level of progesterone in the blood
of the woman is very high.

38 Days Cycle for Irregular Legend:

• Red - menstruation (safe)
• Green – safe days
• Orange - fertile window (not safe)
• NO ovulation day
4 IMPORTANT STRUCTURES
- In menstrual cycle, there are different glands that
control/regulate menstrual cycle
- Hypothalamus gland starts the menstrual cycle and
the hypothalamus stimulates Anterior Pituitary
Gland and APG stimulates Ovaries and ovaries
affects Uterus

1. Hypothalamus

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FIRST HALF OF THE CYCLE – ESTROGEN
1) Particularly days 1-5, on the 3rd day of
menstrual period the level of estrogen in the blood
of the woman is already very low because she is
menstruating.
2) That low level of the estrogen of woman
stimulates the hypothalamus to start a new cycle.
3) Estrogen stimulate hypothalamus to release
FSHRF
4) FSHRF stimulates the APG to release FSH.
5) FSH stimulates the ovary to release estrogen.
Then,
6) Estrogen will affect the uterus.
- Once APG release, FSH – will develop egg cells. It
will cause the maturation of oocytes (1st effect).
(Oocyte – immature egg cells)
- (2nd effect of FSH) FSH stimulates ovaries to
release estrogen so once estrogens is released, it
converts the follicle of the ovary into graafian
follicle.
- Follicle is the compartment in the ovary where you
can find the egg cells and becomes graafian follicle.
Estrogen is the hormone that is very high in the
graafian follicle.
- The effect of the estrogen on the uterus is
thickening of myometrium and endometrium.
- Myometrium is also thickening – the uterus will
slightly enlarge during menstrual cycle because of the
hormone estrogen.
- If the woman gets pregnant the level of estrogen is
high that is why estrogen enlarges the uterus.
- Hindi sabay pinoproduce ng ovary ang estrogen and
progesterone. Isa isa lang.
- Estrogen partner niya si FSH. Progesterone is LH
NERIZA BA-AR BSN 2-YA-6
How ovaries produce progesterone?
- Estro is low on 3rd day and high on 13th day so on
the 13th day the level of estro is high and pro is low.
Since the 13th day the level of estrogen is already
very high, there will be a feedback effect.
- That high level of the estrogen will send signal to
the APG to temporarily stop producing FSH.
- Effect: If the FSH stop producing, then ovary will
no longer produce estrogen. (may stock na
sya ng estrogen sa graafian follicle)
SECOND HALF OF THE CYCLE –
PROGESTERONE
1) That’s why on the 13th day of the menstrual cycle
the level of progesterone is very low stimulating the
hypothalamus to release LHRF.
2) LFRH stimulates the APG to release LH.
3) LH stimulates the ovary to release progesterone.
Then,
4) Progesterone will affect the uterus.
- When the level of LH is high, LH triggers
ovulation.
- The high level of progesterone will convert graafian
follicle into corpus luteum. (Corpus luteum -
yellowish)
- Progesterone will stimulate uterus, there will be
increased vascularity on endometrium
- Increase vascularity – building up of temporary
capillary.
- Progesterone builds up temporary capillaries on
endometrium.
- The blood supply will be high when there’s a build-
up of temporary capillary.
- If the blood supply in endometrium will become
high, it increased supply of O2, H2O, Glucose,
Amino Acid.
- Progesterone made the endometrium highly
nourished.
PATHWAY OF WOMAN GETTING
PREGNANT
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1) Placental Aging/Degeneration Theory – the

placenta will start to degenerate as it reached 9
months and then it will cause progesterone levels to
decrease 2) Progesterone Deprivation Theory

- Therefore, the Braxton-Hicks contraction (painless

and irregular) starts to be painful and regular  it
will increase uterine contractionn.
- The reason why it is minus 14 is because the - Then the woman enters the labor.
lifespan of Corpus Luteum is 14 days
- Corpus luteum came from graafian follicle, GF PATHWAY OF MENSTRUATION
produce estrogen. CL combines estrogen with
progesterone. But progesterone is higher during
pregnancy.
- 2 hormones produced by CL is estrogen and
progesterone.
- Mat. oocyctes 13th ↑ Triggers ovulation Graafian
follicle Graafian follicle Corpus luteum Thickening
of myo and endo ↑vascularity on endo Corpus luteum
(2 weeks life span)
- Estrogen is high (encourage contraction) but
progesterone is higher (prevent contraction) and we
need these 2 hormones in pregnancy. - If she did not engage in sexual intercourse, or she
engaged in sexual intercourse but protected. There is
- The reason why the woman will not menstruate no fertilization.
when she gets pregnant because lifespan of CL after - If there is no fertilization, there is no pregnancy to
fertilization, extends from 2 weeks to 2 months. support. So, CL will not extend life span from 2
Since nag extend menstruation missed. weeks to 2months. So, within 2 weeks the corpus
- On the 2nd month, corpus luteum is luteum is degenerating.
aging/degenerating. - If the corpus luteum is degenerating, the level of
estrogen and progesterone will begin to decrease.
- On the 2nd month of pregnancy, the placenta will - If the estrogen and progesterone decrease, the
develop. And the placenta produces estrogen and uterine contraction will increase.
progesterone, but the progesterone is higher than - The temporary capillaries will begin to
estrogen. rupture/slough off – giving you menstrual
discharge.
- The lifespan of placenta (inunan) is 9 months.
- When the placenta reaches the 9th month of
pregnancy, placenta is considered aging (Placental
Aging/Degeneration Theory) TO SIMPLIFY:

- Progesterone – preventing contraction then, the

ability of the placenta to produce progesterone, will
begin to decrease (Progesterone Deprivation
Theory) Mnemonic: FEG – HAOU – LPC
Legend:
* Aging will decrease progesterone level that is •Yellow – hormones
preventing contraction and that decrease of • Green – structures
progesterone has a theory called Progesterone - If hormones contain “RF” releasing factor it came
Deprivation Theory from hypothalamus, if theres no “RF” from APG
- If the questions are about structures look at the
2 theories used: middle

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- If the question is about the hormones look at the

outside.

QUESTIONS:
1. What gland that starts menstrual cycle?
Hypothalamus
2. Hypothalamus stimulates? APG
3. APG stimulates? Ovary
4. Ovary affects? Uterus
5. Hormone high in the graafian follicle? Estrogen
6. Hormone high in the CL? Progesterone
7. What gland stimulate ovary to produce estrogen
and progesterone? APG
8. What hormone will stimulate the ovary to
produce estrogen? FSH
9. What hormone will stimulate the ovary to
produce progesterone coming from what gland? LEARNING OBJECTIVES
APG, under the regulation of hypothalamus gland After the discussion, learners should be able to:
10. What hormone will stimulate APG to produce 1. Assess the readiness for parenthood and the health
LH? LHRF coming from hypothalamus status of a pregnant woman and her family.
11. What day the level of estrogen is highest? 13th 2. Relate ovulation and ejaculation to the process of
12. What day the level of progesterone is lowest? human conception.
13th 3. Explain implantation and nourishment of the
13. What day the level of progesterone is highest? embryo before development of the placenta.
14th 4. Describe normal prenatal development from
14. What day the level of estrogen is lowest in the conception through birth.
blood of the woman? 3rd day because she is CONCEPTION
menstruating Ovum
15. What hormones trigger ovulation? LH - Female sex cell
16. Hormone that decreases GI motility  - mature gamete
Progesterone - released during ovulation
17. Hormone that leads to pyrosis (heartburn)  - Lifespan: 24 hours (maximum of 48 hours)
Progesterone
18. Hormone that causes epistaxis  Estrogen
19. What mineral if depleted during pregnancy causes
leg cramps  Calcium

Four parameters/tools to know accurately when a

woman is ovulating:
1) CYCLE REGULARITY – regular menstrual
cycle (21-35 days; maximum of 40 days; average of
28 days)
- Woman cannot use calendar method if she is
irregular

- Mitelschmerz
- Can feel slightest of pain

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- Slight discomfort associated with the
stretching of follicle
- One-sided, kung saan nagrerelease si ova
- Situated in lower abdomen
- German for middle pain – it occurs
midway through a menstrual cycle about 14
fays before your next menstrual period
- Doesn’t require medical attention
2) CHANGES IN CERVICAL MUCUS –
There are changes every month.
- It starts from white, dry, pasty cervical mucus to egg
white consistency and stretchy
• Usually start with dry wala tayong mga secretions
and eventually mag kakaroon ng konti-konti until the
secretions is stretchy and clear you can actually
compare to egg white.
• Spinnbarkeit - 6 cm before it breaks
- Needs to be stretchy, so that it can go farther or it
can transport the sperm to ova that is targeting to
meet. (makiki-ride sya).
3) HORMONAL CHANGES –
Estrogen and progesterone.
• There is slight increase because of the presence of
corpus luteum.
4) BODY TEMPERATURE CHANGES
- prior to ovulation there will be a temp. drop to a
low normal and then the following day it shoots up to
a very high normal and this will tell us that the
woman is actually ovulating.
• We have to use basal body thermometer when we
use this technique.
• The woman should check her temperature daily
upon arising (kapag bagong gising sya)
Ovulating - 14 days before the next cycle.
• Every good fertilization, start from a good
ovulation. And every good conception, starts from the
good fertilization.
• The ovum released by the ovary is then transported
through the tube by the muscular movement.
• Cilia- used to move the ova.
• Fallopian tube
- Infundibulum
- Ampulla – outer; meeting place; common site of
ectopic pregnancy
- Isthmus – inner
NERIZA BA-AR BSN 2-YA-6
- Interstitial – most dangerous site for ectopic
pregnancy
• This gamete once released is ready for fertilization
already and normally occur in the ampulla of the
fallopian tube, whether the ova is fertilized or not
tuloy pa din ang journey niya.
• The ovum proceeds to the uterus in approximately 4
days after it is released by the ovary.
TWO IMPORTANT LAYERS OF OVA
1) CORONA RADIATA - outer layer, granulosa or
follicular cells that formed around developing oocyte
in the ovary and remain until ovulation.
2) ZONA PELLUCIDA - transparent but thick,
composed of glycoprotein that surround the cell
plasma membrane.
Other parts of ova:
- Plasma membrane
- Cytoplasm
- Nucleus
Kapag nag karoon ng conception in a natural
interaction of many factors including the correct
timing in between the release of the mature ovum
during ovulation and ejaculation of enough healthy
motile sperm in woman vagina.
SPERM CELLS
Parts: Head, neck, and tail
Lifespan: 48-72 hours (3 days maximum of 5 days)
- Male is the one who determine the sex of the baby.
- Ave. male produce: 525B sperm cells over a
lifetime.
- Healthy adult men: 20M-150M with the max of
1.2B in a single ejaculation.
- Typically, volume of climax: 3-5ml/ejaculate. (3
quarters of the teaspoon – ¾)
- If it lowers down to 1.5 ml or 1/3 teaspoon – check
for a doctor
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- Pre ejaculation cannot be measured

- Pre ejaculation is usual among teens

TYPES:
a. Gynosperm
- large head – slow swimmer
- alkaline – low survival on vagina’s acidic environment
- carries Y chromosome – male

b. Androsperm
- small head
- acidic – can survive longer in vagina’s acidic environment
because it is already acidic
- Carries X chromosome – girl

-------
- First to reach ova doesn’t mean winning, it depends
REPRODUCTION on the penetration called capacitation
- First to release hyalase/hyaluronidase
- Intercourse more than a day after ovulation will
usually not result to fertilization
- After fertilization, we create 23 chromosomes of
ova and 23 chromosomes of sperm  joined
together diploid of 46 chromosomes

- Sexual activity involves the insertion of erected

penis into the vagina, both for sexual pleasure and
reproduction purposes.

- Both of which will be culminating in an orgasm and

ejaculation.

- Irregardless of the position of the couple as long as

the penis enters the vagina during sexual intercourse.

- Ejaculation – ejecting semen into the body.

- When a couple executed sexual activity millions of

candidates sit off a long peroneus journey with a
single target is to reach the ova.
- Many sperm are loss in the vaginal introitus,
because of the ejaculation drips kase may nababawas
ng mga sperm.

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- Survivors continue their journey to the cervix going
to the uterus and the fallopian tube through the help
of the whip like movement of tails to swim upward.
- Only the viable sperms enter the cervix. Tapos ung
seminal fluid naiiwan na nag seseparate na sila.
- They meet in the ampulla of the fallopian tube.
- Remember that there is only one ova waiting to be
fertilized for every menstrual cycle.
- The first one to reach the finish line is not
guaranteed to win, the sperm has to undergo
capacitation – glycoprotein and seminal proteins that
are being removed from the acrosome of the sperm
head. And after that, same pa rin ung itsura ng sperm.
Pero pag Nawala na yon, this particular sperm have a
better fight or possibility of getting into or
penetrating the corona radiata (also release hyalase)
and zona pellucida covering the ovum.
- Body of sperm release Acrosin – it allows the
penetration of zona pellucida.
- Once the sperm is able to penetrate mag kakaroon
na ng fertilization
- Fertilization – this is when a sperm and egg cell
combine. (nagsasama sila) and their nuclei is fused
together at this time is the beginning of pregnancy.
- Fertilization is a number game we started millions
up to 1 sperm will survive. Usually, it takes 30
minutes to 2 hours and if the sperm did not encounter
an oocyte immediately, they can survive in the
uterine tubes for 3-5 days.
- Thus, fertilization can still occur if intercourse takes
place a few days before ovulation.
- Intercourse more than a day after ovulation will
therefore not usually result in fertilization.
- After fertilization occurs the 23 chromosomes of
sperm and 23 chromosomes of ova together restoring
the diploid 46.
- Fertilization is complete when cell division starts
from the entry of the sperm to the ova, we call it
fertilization then;
NERIZA BA-AR BSN 2-YA-6
- Cell will split to have – zygote; which happens from
day 0 to 14. Then, the cell continues to divide, 2
cells, 4 cells, 6 cells, this is what we called cleavage.
- By the time they reach the endometrium they
become morula or mulberry → hallow spear of cell
blastocyst. This is the preliminary stages in the
embryo beginning form
- Rapid cell division  Cleavage divides into two 
Monozygotic identical twins
- Accidentally two ova matures and both of them has
been fertilized  Dizygotic fraternal twins
- Trophoblast – outer layer of blastocyst
cells that formed the outer layer of blastocyst. They
are present 4 days post fertilization.
They provide nutrients to the embryo and develop
into large part of placenta. Located next to the
maternal endometrium and must exhibit invasive
properties that forms an effective maternal fetal
vascular relationship. Nag kakaroon ng vascular
relationship yung mother and fetus and this is what
we call chorionic villi.
- CHORIONIC VILLI – finger like projections by
10th to 11th day of pregnancy; for vascular relationship
for fetus, will be connected to umbilical cord and this
is the passage way of nutrients from the mother
- From the start of cell division up to the time it
reaches endometrium and the fetus is formed, the
process usually takes 2-8 weeks
- kumakapit sya doon sa endometrium and has same
genetic material as the fetus.
- While in the blastocyst cavity there is a formation of
the fetus
- Early blastocyst
- Late blastocyst – buries itself in the endometrium
and eventually become fetus.
- From the start of cell division up to the time that
reaches the endometrium, and the fetus is formed, the
process usually takes 2-8 weeks.
- During implantation it happens approximately
around the 10th day after fertilization.
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HUMAN CHORIONIC GONADOTROPIN
(HCG)
- available at 8-10 days after conception.
- Primary role is to keep the corpus luteum
functioning so that corpus luteum continues to
produce estrogen and progesterone until placenta is
fully developed tapos siya na ung mag poproduce ng
estrogen and progesterone.
- This is the stage of pregnancy where the embryo
adheres to the wall of the uterus. And stages of
prenatal development the conceptus is still called
blastocyst.
- It is by adhesion of the embryo in the uterus on
the upper or lower uterine segment that embryo
receives oxygen and nutrients from the mother in
order to be able to grow.
- Embryo receives oxygen and nutrients from the
mother.
* HCG is the earliest basis for pregnancy to be
tested on pregnancy test kit (urine)
- Corpus luteum deteriorates after 2 months and
placenta will replace
HUMAN PLACENTAL LACTOGEN/ HUMAN
CHORIONIC SOMATOMAMMOTROPIN
(HPL)
– produced by syncytiotrophoblast.
From about when the production HCG begins nag
dediminished siya which promotes fetal growth by
stimulating amino acid uptake and DNA synthesis.
- HPL both growths promoting hormone and
lactogenic hormone.
Lacto – milk producing. It is produced by the
placenta beginning as early as 6 weeks of pregnancy.
Increases to a peak level by the time fetus reaches
term. Promotes mammary gland growth in
preparation for lactation of the mother.
– serves important role of regulating maternal
glucose, protein, and fat level.
- So that adequete amount of nutrients will be given
to the growing fetus; diabetogenic effect or insulin
antagonist.
NERIZA BA-AR BSN 2-YA-6
- And that benefits the fetus because it increase the
availability of maternal glucose for fetal
consumption.
- It also antagonaist the cellular action of insulin
decreasing the use of insulin which predisposes
pregnant woman into developing glucose
intolerance. That can lead to gestational diabetes.
ORAL GLUCOSE TOLERANCE TEST (OGTT)
Oral Glucose Tolerance Test – papainumin ng liquid
sobrang tamis.
- Ordered by the doctor between 24th- 28th weeks of
pregnancy.
- If levels is low, it may result to abortion or
intrauterine growth
DECIDUA
- serves as maternal bed embracing the embryo
- has 3 layers
1) Decidua basalis/ serotina – the area of
endometrium between the implanted chorionic
vesicles and myometrium. Which becomes later the
maternal part of placenta.
2) Decidua Capsularis – surrounds the chorionic
sack.
3) Decidua Vera – makes the operculum of the
mucus plug. To prevent ascending infections.
Mucus plug released once there is already bloody
show. Synonymous to decidua parietalis which will
fused with the decidua capsularis by the 4th month
gestation.
CHORIONIC VILLI
- Finger like projections develop by 10th to 11th
day of pregnancy.
- Sprout from the chorion to provide maximal contact
area with maternal blood. They are an essential
element in pregnancy from a histomorphologic
perspective, and by definition, a product of
conception. Branches of the umbilical arteries carry
embryonic blood to the villi.
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- Used for testing
CHORIONIC VILLI SAMPLING (CVS)
• Removal of tissue sample from the fetal portion of
the developing placenta
- Used for genetic screening as it is done earlier in
pregnancy usually 9 – 12 weeks
- Prenatal test to detect birth defects
- During test small sample of the chorionic villi will
be aspirated from the placenta where it attaches the
wall of uterus.
- Most common complications: fetal limb defects
such as missing digits and toes.
THE BLASTOCYST
- Adhesion to uterus either to upper or lower uterine
segment
- Ideal: upper posterior
- Placenta (high in progesterone; low in estrogen)
- Blastocele (embryonic disc)
3 PRIMARY GERM LAYERS
1) Ectoderm – outermost layer of cell; embryo CNS
2) Mesoderm – middle layer; majority of major
organs
3) Entoderm – inner layer
NERIZA BA-AR BSN 2-YA-6
FAMILY PLANNING
- is the use of a range of methods of fertility
regulation in order to:
1. Avoid unwanted births/pregnancy
2. Bring about wanted births/pregnancy
3. Regulate the number of children born
4. Regulate intervals between pregnancies/ birth
spacing
5. Control time at which birth occurs
- Recommended number of children per couple:
2-3 children
- Interval between 2 pregnancies: 3-5 years
2 COMPONENTS
1. Planning pregnancy
2. Preventing pregnancy
SEXUAL REPRODUCTIVE HEALTH
- Good sexual and reproductive health is a state of
complete physical, mental and social well-being in
all matters relating to the reproductive system.
- It implies that people are able to have a satisfying
and safe sex life, the capability to reproduce, and
the freedom to decide if, when, and how often to
do so. – United Nations Population Fund
- To maintain one’s sexual and reproductive health,
people need access to accurate information and the
safe, effective, affordable and acceptable
contraception method of their choice.
- They must be informed and empowered to protect
themselves from sexually transmitted infections. And
when they decide to have children, women must have
access to services that can help them have a fit
pregnancy, safe delivery and healthy baby.
REPRODUCTIVE LIFE PLAN
A plan for whether, when and how to have children.
It includes personal goals, and states how to achieve
them. The plan is based on a person's priorities and
goals with regards to life and children
IF YOU DO NOT WANT TO HAVE CHILDREN,
YOU MIGHT ASK YOURSELF:
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• How do I plan to prevent pregnancy? Am I sure that
I or my partner will be able to use the method chosen
without any problems?
• What will I do if I or my partner becomes pregnant
by accident?
• What steps can I take to be as healthy as possible?
• What medical conditions (such as diabetes, obesity,
and high blood pressure) or other concerns (such as
smoking, drinking alcohol, and using drugs) do I
need to talk about with my doctor?
• Is it possible I could ever change my mind and want
to have children one day?
IF YOU DO WANT TO HAVE CHILDREN ONE
DAY:
• Am I ready to have a baby?
• How old do I want to be when I start and when I
stop having children?
• How many children do I want to have?
• How many years do I want between my children?
• What method do I plan to use to prevent pregnancy
until I’m ready to have children? Am I sure that I or
my partner will be able to use this method without
any problems?
• What, if anything, do I want to change about my
health, relationships, home, school, work, finances,
or other parts of my life to get ready to have
children?
• What steps can I take to be as healthy as possible,
even if I’m not ready to have children yet?
• What medical conditions (such as diabetes, obesity,
and high blood pressure) or other concerns (such as
smoking, drinking alcohol, and using drugs) do I
need to talk about with my doctor?
FAMILY PLANNING – DOH
The program is anchored on the following basic
principles.
• Responsible Parenthood which means that each
family has the right and duty to determine the desired
number of children they might have and when they
might have them. And beyond responsible
parenthood is Responsible Parenting which is the
proper upbringing and education of children so that
they grow up to be upright, productive and civic-
minded citizens.
• Respect for Life. The 1987 Constitution states that
the government protects the sanctity of life. Abortion
is NOT a FP method:
• Birth Spacing refers to interval between
pregnancies (which is ideally 3 years). It enables
NERIZA BA-AR BSN 2-YA-6
women to recover their health improves women's
potential to be more productive and to realize their
personal aspirations and allows more time to care for
children and spouse/husband, and;
• Informed Choice that is upholding and ensuring
the rights of couples to determine the number and
spacing of their children according to their life's
aspirations and reminding couples that planning size
of their families have a direct bearing on the quality
of their children's and their own lives.
NATURAL FAMILY PLANNING METHOD
- Abstinence
- Lactational Amenorrhea Method (LAM)
- Fertility Awareness Method (FAM)
 Calendar or Standard days method
 Two days method
 Cervical mucus test/Billing’s test
 Basal Body temp
 Symptothermal method
- Coitus interruptus  not included in natural family
planning as it has a high failure rate according to
DOH
ARTIFICIAL CONTRACEPTIONS
Hormonal - Oral, Injectable, Implant, Patch
Chemical - Spermicide
Mechanical - Cervical Cap, Diaphragm, IUD
Surgical - Bilateral Tubal Ligation and Vasectomy
PLANNING THE PREGNANCY
• Proper nutrition and exercise
• Lifestyle changes:
Remember:
• Smoking can cause SGA baby (Small for
Gestational Age)
• Alcohol can cause cognitive impaired- baby
• Medical History Taking and Check up is important
• Genetic counselling
PREVENTING PREGNANCY
- Contraceptive methods are used
- Always remember that there is always a possibility
for the method of contraception to fail thus
pregnancy may occur.
NATURAL METHODS
CONCEPT: No use of any chemical and mechanical
means of preventing pregnancy.
1. ABSTINENCE
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- refraining from vaginal sexual intercourse -

different from STRICT ABSTINENCE Advantages:
- acceptable, 100% effective, no cost
Disadvantages: - loss of self control- difficult to
maintain
LACTATION AMENORRHEA METHOD (LAM)
- Use of this method requires regular and fulltime 4. FAM-CMT
breast feeding (Exclusive) - aka Billing’s Test, Spinnbarkheit, Creighton’s
- Effective during the first 6 months post partum - Estrogen
- No ovulation and no menstruation - clear, elastic, watery, slippery, thin, abundant
- Not effective after 6 months If can be stretched by 5-10 cm without breaking,
- After 6 months, woman may ovulate but without woman is fertile.
menstruation (because she still continue 2-day method
breastfeeding the baby after the first 6 months)  If
woman is breastfeeding the baby in the first 6 months
of post partum, the level of estrogen remains high,
thus, hypothalamus will not release FSHRF  APG
will not produce FSH  no egg cells will mature
thus no ovulation

So how does the woman know if she is pregnant?

- Breastmilk production is decreasing
- Since she still breastfeeds after 6 months, she will
not menstruate but ovulation occurs
- You cannot compute for fertile window
- Its ok for a breastfeeding mother in first 6 months to
take pills to prevent pregnancy (POP  progesterone
pills)
2. COITUS INTERRUPTUS
- Withdrawal of penis before ejaculation inside the
vagina
- Sperm may leak from the penis even before
ejaculation – pre-cum
- Effectiveness is only 84%
- No protection to STD/STI
- Self-control is the key
3. FERTILITY AWARENESS METHOD (FAM)
- The identification of the woman’s fertile and
unfertile phases during her menstrual cycle.
- Requires cooperation between the Female And
Male (FAM)
Advantages: Inexpensive, no side effects, no harmful
chemicals and gadgets
FAM CALENDAR
CALENDAR METHOD: Fertile Window
? = Regular or Irregular
? = Day of Ovulation
5. FAM-BBT
- Progesterone
- sudden rise in BBT during ovulation because of
sudden rise in progesterone (3 days elevated BBT) -
consistency is the key (same time, same route: oral)
After Ovulation – temperature slightly rises by 0.20C
to 0.50C (thermal shift)
6. FAM – SYMPTOTHERMAL
- Use of BBT and CMT
ARTIFICIAL METHOD (BARRIER)
- Refers to chemical, mechanical or the
combination of the two in preventing the sperm
cells from entering certain points/ parts of the female
reproductive canal.
1 SPERMICIDE
- Provides both physical and chemical barrier
- Ex. Nonoxyno 9 (N9)
- kill spermatozoa before reaching
- cervix
- make vaginal pH strongly acidic
- No.1 contraindication: allergy

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- No.1 side effect: allergy, ↑ incidence of birth defect,
unpleasant taste
- inserted into the vagina 10 minutes before
intercourse not more than 30 minutes
- wait 6-8 hours after coitus before douching
2. MALE CONDOM
- Collects semen during and after intercourse
- Protects the couple from some STIs, low cost,
- May break, cause allergy from latex, and may
decrease sensation during intercourse
3. FEMALE CONDOM
– or vaginal sheath is a thin tube that is made up of
polyurethane with flexible rings at both ends
A. it collects the sperm before, during and after
intercourse like the male condom
B. Advantages
- erection is not necessary to keep the condom in
place
- external ring can provide extra clitoral stimulation
- available without prescription
C. Disadvantages
- difficult to apply
NERIZA BA-AR BSN 2-YA-6
- makes noise
- can cause vaginal or penile irritation
- it may slip during vigorous intercourse
4. DIAPHRAGM AND CERVICAL CAP
– is a shallow dome-shaped latex rubber device
with flexible, circular wire rim that fits over the
cervix.
- this is only available upon prescription in wide
range of diameters between 50 and 90 mm and
requires fitting by a trained practitioner
B. It must be inserted before intercourse and
should remain for 6 hours after. A diaphragm
should not be left in place for 24 hours
4. ORAL PILLS
Action: inhibits ovulation by suppressing FSH and
LH
Types: combined (COC; Estrogen and Progesterone)
and mini (POP; Progesterone) Contraindications:
- pregnancy and lactation
- smoking - over 35 y/o
- hx of thromboembolic disease, DM
- hypertension, cardiac disease, liver problem
- cancer of the breast and reproductive tract
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Pills – inhibits ovulation because estrogen and

progesterone levels are high

Danger signs:
A – abdominal pain
C – chest pain and dyspnea
H – headache
E – eye problems
S – severe leg pain

Danger SIGNS Side effects:

J-Jaundice (Liver problem) W – weight gain
A – abdominal pain- (liver problem) I - increased cervical discharge
C – chest pain and dyspnea (heart problem) S – spotting
H – headache (severe)- HPN H – headache
E – eye problems - HPN
S – severe leg pain – (Thromboembolic disease) Rule before taking CP:
PPP  PE, Pelvic exam and Pap smear
DMPA
DMPA – Depot medroxy progesterone acetate
(150mg) - Depo provera
ACTION – INHIBITS OVULATION; THICKENS
CERVICAL MUCUS
Duration of Protection: 3 mos
Rule: Do not massage injection site.
EFFECT: NO MENSTRUATION
FERTILE WINDOW LUNELLE: with menstruation
Let’s relate menstrual cycle to contraception
MENSTRUATION:

HORMONAL IMPLANTS
– a small, flexible, plastic rod about the size of the
matchstick and is inserted under the skin under
local anesthesia.
CONTRACEPTIVE PILLS - insertion takes approximately 4 minutes
Effect: Suppressing ovulation A. Advantages:
Action: by keeping the levels of estrogen and - extremely effective birth control
progesterone in the blood of the woman high - no daily pills to remember and no interference to
Will the woman still menstruate? Yes sexual activity
When: Ater the 21st pill
B. Disadvantages:
Estrogen – 3rd, 13th - weight gain
Progesterone – 13th, 14th - irregular bleeding patterns to some women
Hypothalamus – initiator - no protection against STIs

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TRANSDERMAL PATCH
– available upon prescription and provides
continuous supply of estrogen and progestin.
- the patch is placed on the skin continuously for 3
weeks and remove for a week to allow menses to
occur
A. advantage:
- with high rates on compliance
B. Disadvantages:
- decrease effectiveness on women over 198 pounds
- with side effects such as headache and application
site reactions
- Ortho Evra
VAGINAL RING
– soft flexible ring, approximately 2 inches in
diameter that contains estrogen and progestin.
- it is placed in the vagina once a month and
removed after 21 days to allow menstruation
A. advantages:
- with high effectiveness
- low incidence of hormone-related symptoms
- easy to insert and discreet to use
B. disadvantages:
- woman may feel un comfortable with the ring
NERIZA BA-AR BSN 2-YA-6
- may cause increase vaginal discharge
INTRAUTERINE DEVICE (IUD)
– a small T-shaped device that is inserted into the
uterine cavity (copper or progestin-bearing)
- copper bearing device is effective for 4 to 10
years and acts as a contraceptive by damaging the
sperm in transit to the uterus
- progestin-bearing device is effective for 5 to 7
years and affects mucus and endometrial
development
- side effects include cramping and bleeding upon
insertion of the device and offers no protection for
STIs
-
prevents pregnancy by causing sterile inflammatory
reaction
- blocks the access of sperm cells to fallopian tube
- pap smear and pelvic exam must be done before
insertion
- contraindicated in: PID, pregnancy, multiple sex
partners, severe dysmenorrhea, cervical/ uterine
malignancy/ abnormalities
- inserted during menstruation
CBQ – most common problem: spontaneous
expulsion of the device (signs s/x spotting and uterine
cramping)
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CBQ – most common complaint: ↑ excessive

vaginal discharge and dysparenunia (painful sexual
intercourse)

- Use condom for the first 3 months after insertion -

Wait 3 months after removal before attempting
pregnancy
- Check every month then after 6 months and yearly

DANGER SIGNS:
P - -period is late/missed period
A – abdominal pain (severe)
I – increase temperature
N – noticeable vaginal discharge (foul smelling)
S – spotting, bleeding, heavy periods

STERILIZATION
– permanent method of birth control obtained via
surgical procedure.
- Passages of the ova and sperm cells are occluded to
render the person infertile.
WHO:
- with genetic abnormalities
- with medical conditions
- couple who reached the desired no. of children
- have no wish to have children
MALE STERILIZATION
– or vasectomy is the permanent sterilization in
male.
- it takes one month until ejaculations are free
from sperm
- vasectomy has no effect on the man’s ability to
achieve or maintain erection and there is no
interference in the production of testosterone

-CBQ – BTL (Bilateral Tubal Ligation): sterility is

immediate
-CBQ – Vasectomy – sterility is achieved after 2
negative sperm count results

FEMALE STERILIZATION
– by tubal ligation or tubal occlusion involves
blocking or ligating (tying) the fallopian tubes
- it may be done immediately after giving birth and
is effective until 3 months until scars are fully
healed

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- - If amniotic fluid is gold/yellow  hemolytic
FETAL MEMBRANES
1) Chorion – outermost membrane of the fetus
where later on going to be placenta
2) Amnion – innermost layer, divided into parts
where bag of water, amniotic fluid, and umbilical
cord develops
- connected to umbilical cord
AMNIOTIC FLUID
NERIZA BA-AR BSN 2-YA-6
VOLUME – 500-1200 ml (average of 1L)
Abnormalities in Amniotic fluid volume
- Oligohydramnios – less than 500 cc  possible
malformation of fetal kidney or PROM (premature
rupture of membrane)
- Polyhydramnios – more than 1500cc  indicate
GIT problem, trachea esophageal atresia/fistula
- Majority is water
- 99% water
- 1% solid particles – albumin, urea, uric acid,
lecithin, sphingomyelin, bilirubin, vernix caseosa
- Odor: mousy
- Appearance: clear and colorless or straw colored
- pH: 7-7.25 (alkaline)
- If amniotic fluid is green  meconium; meconium
or the first bowel movement should be 24 hours after
birth
- can also be sign of fetal distress (cephalic)
- breech position (magkcocontract si mommy maiipit
abdominal ni baby leading to pooping)  sign of
impending labor
disease/Rh or Abo incompatibilities
- gray amniotic fluid  infection
PURPOSE:
• Protects the baby from moving
• Controls the temperature
• Supports symmetrical growth
• Prevents adherence to the amnion
• Allows to move
• Source of oral fluid- kase iniinom ito ni baby dahil
sterile naman ito
• Acts as excretion- collection repository
DIAGNOSTIC TEST FOR AMNIOTIC FLUID
1) Amniocentesis
- Obtaining a sample of amniotic fluid by inserting
a needle through the abdomen.
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UMBILICAL CORD
Aka funis
FUNCTION:
• Transport oxygen and nutrients to fetus,
unoxygenated blood and water to placenta
• Returns waste products from the fetus to the
placenta

Blood vessels: 2 arteries1 vein (AVA)

Length: 50-55 cm
Insertion: center of the placenta
- Membrane (velamentous)
- Edge of the placenta (Battledore)
2) Amnioscopy ABNORMALITIES
- “oscopy” means visualization. 1) KNOTS
- Direct visualization through an invasive intact - lead to perinatal loss because this is the lifeline of
fetal membrane. the baby
- An exam employed to visualize the forebag of the - cause brain injury or HIE (Hypoxic-ischemic
amnionic sac and to look out for meconium staining. encephalopathy)
- kulang sa oxygen supply ang brain
- brain does not have oxygen stores kase meron syang
blood brain barrier.

3) Fern test
- Determines if bag of water ruptured or not
- refers to detection of a characteristic 'fern like'
pattern of vaginal secretions when a specimen is
allowed to dry on a glass slide and is viewed under a 2) CORD COIL
low-power microscope.

- Positive – has amniotic fluid (will show fern

pattern)
- can be single or double
- usually, we insert 2 fingers to the neck of the baby
4) Nitrazine paper test to cut it and clump it hindi na pwedeng hinataying
- yellow – acidic/urine tuluyan makalabas kase masasakal si baby.
- blue green/ blue gray – alkaline; amniotic fluid - Happens 15-35% of pregnancy (common
abnormality)

3) TENSION OF THE CORD

- means that the cord is short

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- there is low amount of Wharton’s jelly resulting to
still birth
- short cord means hindi galaw ng galaw si baby
- cause birth injuries or complication because it will
pull the placenta that will lead to Abruptio placenta
 early detachment
- The doctor will do emergency cesarian birth
- Baby will experience dangerous oxygen deprivation
and sustaining brain damage worst uterine inversion
THE PLACENTA
- Came from the Greek word pancake or after birth
- Inunan in tagalog
- From the combination of chorionic villi and decidua
basalis
Weight: 500 to 1000 grams at term
- has 15-20 cotyledons (maximum of 28)
(maghahanap ka kung may butas; pag may butas ibig
sabihin may naiwan foreign material si baby)
- Produces hormones: estrogen, progesterone, HPL,
HCG
HAS 2 SIDES:
1. Maternal  called Duncan; dirty looking
- at the periphery
2. Fetal  called Schultz; shiny
- center---
NERIZA BA-AR BSN 2-YA-6
TYPES OF INSERTION:
1) Battledore  insertion of umbilical cord is at the
edge
- kita maternal side
- there is cut blood vessel from chorionic villi 
there is bleeding
2) Velamentous  Center insertion
- Cotyledons are trapped inside
- Placenta has high amounts of collagen
- Actual placenta is -not allowed for manufacturing of
products  risk for HIV
FUNCTIONS
• Protective barrier against microorganisms
• Has respiratory functions means there is gas
exchange of O2 and CO2
• Serves as gastrointestinal system because it
transports nutrients
• Facilitated diffusion for glucose transport and
Active transport of amino acid
• Functions as excretory. It passes through arteries
and the mother’s liver will be the one to detoxify the
waste of the baby
• Circulatory system, arteries that carries the
oxygenated blood and arteries carries unoxygenated
blood.
Fetoplacental circulation through selective osmosis.
• Endocrine system. It has hormone production
called HCG. Primary purpose is to maintain corpus
luteum at first trimester of pregnancy. Secondary
function basis as pregnancy test.
• Stimulates testosterone production in the fetal
male testis and excessive levels indicate twin
pregnancy or complication such as hydatidiform
mole or chorionic carcinoma. Low HCG indicates
ectopic pregnancy and may lead to threatened or
missed abortion.
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• Relaxin is also produced to soften the bones kay
nakaka bend si baby.
• Produces estrogen formed in the ovary possibly in
adrenal cortes, testis, fetal placenta unit and has
various functions in both sexes acts female genitalia
to produce environment suitable for fertilization and
implantation as well as nutrition for an early embryo.
• Exclusively by the corpus luteum up to 6-7 weeks
and is produced by placenta as well between 7-9
weeks. And after 9 weeks corpus luteum
degenerates and the production of progesterone is
now the main responsibility of placenta. It prepares
the lining of the uterus to receive and sustain the
fertilized egg and permits pregnancy kaya tinawag na
female hormone
PLACENTA EXCHANGE ORGAN
1. Diffusion – CO2, O2, Na, Cl, fat-soluble vitamins
2. Facilitated Diffusion – glucose
3. Active Transport – amino acid, water-soluble
vitamins, iron, calcium, iodine
4. Pinocytosis – antibodies & movement of minute
particles
FETAL DEVELOPMENTAL MILESTONES
- From 8 to 40 weeks
- 3 STAGES:
1) Pre-embryonic development stage – 1st 2 weeks
after fertilization. (1-14 days)
2) Embryonic development stage – 2 weeks to 2
months/ week 3-8 (15th day – 2 mos.)
3) Fetal development stage – 2 months to birth
(week 8- birth)
NERIZA BA-AR BSN 2-YA-6
- Ovum – from ovulation until fertilization
- Zygote – from fertilization until implantation
- Embryo – from implantation until 5-8 weeks of life
– Fetus – from 5-8 weeks until term.
- Organogenesis – formation of organ, begins 1st 2
months of pregnancy. Self-medication is not allowed
during 1st trimester of pregnancy because possible
effect of organ development.
- Placenta appears 2nd month of pregnancy (8weeks)
- Ovulation age – life of fetus from ovulation →
Fertilization
- Gestational age (AOG) – Length of pregnancy (1st
day of LMP until birth)
- Both ovulation age and gestational age are reported
in lunar months (4 weeks) or measured by trimesters,
we have 3 mos. in a trimester
- Fetus grows in uterus in 9 ½ lunar months or 3 full
trimesters 38 weeks/ 266 days
- Lunar months – consist of 4 weeks - 10 months of
pregnancy = total of 40 weeks, 280 days
- Intrauterine life – in uterus
1ST TRIMESTER
The period of organogenesis.
- Most critical period for fetal groth and development
(kasi ito ung time na nag mamature, nag gogrow, nag
dedevelop ang organs, pag nagkaproblema sa time na
to, the baby will have congenital deformities)
- Organogenesis – formation of organ begins 1st 2
months of pregnancy.
- Self-medication is not allowed during 1st trimester
of pregnancy because possible effect of organ
development.
1ST MONTH (1-4 WEEKS)
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Length: 0.75-1 cm
Weight: 400 mg
- Heart functions as early as 16th day
- Development – nervous system; maternal
hypoglycemia
- First sign in the development of NS is
hypoglycemia because glucose is essential to the
development of nervous system.
- Rudimentary heart appears as a prominent bulge
on the anterior surface that is towards end of 1st
month (1-4 weeks)
- Arms and legs are buds like structure
- Spinal cord, nafoform na at fused in the midline -
Rudimentary eyes, nose, ears are already
discernible
2ND MONTH (5-8 WEEKS)
Length: 1 inch
Weight: 20 grams
- Sex differentiation starts
- External genitalia forming but sex is still not yet
distinguishable (ultrasound is not recommended this
early just to confirm pregnancy)
- if the sex differentiation starts in 2 months of
pregnancy, sex differentiation is completed in 4th
month of pregnancy.
- But the 4th month is not the best time that the
woman will undergo ultrasound to be able to identify
the gender of the baby, kase ang genetalia are still
small. So, pwede sya ma pagkalaman na yung
scrotum can be the labia then vice versa.
- The fetus assumes human form
- Presence of amniotic fluid
- FHR determination by Doppler.
- Vital organs are formed and developing.
- By the end of month, almost complete
organogenesis.
- The heart is now with septum and valves. Starting
to beat rhythmically.
- Genitals – already forming but it cannot distinguish
the gender yet.
- Abdomen – starting to bulge. Medyo lumalaki na
sya kasi nag gogrow na ung intestine sa loob.
- Ultrasound – presence of gestational sac.
Considered as diagnostic of pregnancy. (Positive sign
of pregnancy)
3RD MONTH (9-12 WEEKS)
Renal system is functional
NERIZA BA-AR BSN 2-YA-6
- Sucking reflex is present. (which is tamang tama
dahil the fetus swallows the amniotic fluid, therefore
kapag nilunok nya yung amniotic fluid the fluid will
go to the gastrointestinal system. And thru absorption
some of the fluid will be absorb could mix with the
blood and go to the kidney)
- Placenta is fully developed and functional
- Sex is distinguishable
- By the end of month, the fetal heart tone is already
audible, by doppler
- 9-12 weeks na ang baby so may buds na siya for
milk teeth, teeth starts to form, nail beds also forms
- Spontaneous movement ang galaw ni baby pero
faint
- IMPORTANT TO REMEMBER:
• Heart functions as early in 16th day
• Nervous development which is manifested by
hypoglycemia in the part of the mother because
glucose is unnecessary ingredient for the
development of the nervous system
• Sex differentiation starts in 2nd month of pregnancy
• Fetal heart rate determination in second month
• 3rd month renal system is functional
2ND TRIMESTER
- Second trimester focuses on the length of the fetus
4TH MONTH (13-16 WEEKS)
Length: 10-17 cm
Weight: 55-120 g
- FHT by fetoscope
- Sex differentiation is complete (pwede na makita
ung gender)
- Quickening for multipara (quickening – fetal
movement felt by the mother 16th weeks – multi
gravid mother; 5th month of pregnancy for
primigravida)
- IgG transport from mother to fetus
- Lanugo is well formed. (Lanugo start to disappear
in 8th month)
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- The liver and pancreas are functioning.
- Fetus actively swallows amniotic fluid.
- Urine is also present in amniotic fluid.
- Appearance of the buds for the permanent teeth in
the gums.
5TH MONTH (17-20 WEEKS)
- Age of viability on 20th week (generally accepted
20-24 weeks)  AOV is the earliest stage at which
fetus will be able to survive if they are born
- Weight: 500-600 g
- Survival depends on the maturity of fetal nervous
system. Maturity of lungs/ presence of lungs
surfactant.
- Vernix appears (disappear in 9 months)
- FHT by stethoscope
- Lanugo covers the body
- Swallow amniotic
- Spontaneous fetal movement (mafifeel na rin kahit
first time pregnant)  quickening for primigravida
- Fetal stool, already present in upper intestine
6TH MONTH (21-24 WEEKS)
Length: 28-36 cm
Weight: 550 g
- Surfactant production begins (Hearing can be
demonstrated by the fetus as he/she response to
sudden sound.)
- Hears external sound – good time to talk and play
to the baby
- Vernix caseosa
- Eyelids start to open
- Skin is red and wrinkled
- Focus on continues growth and development of
fetus.
- Pwede ng mapanganak, preterm, high risk.
- Lung surfactant – used to sweating agents to
prevent alveolar walls from sticking and allowing the
lungs to expand during extrauterine life.
 Corticosteroid (Dexamethasone,
Betamethasone)
- Fetal stool, already in rectum. Kaya kapag fetal
distress sya, pwede na magkaroon ng meconium
staining
NERIZA BA-AR BSN 2-YA-6
3RD TRIMESTER
Period of rapid growth and development.
- Focus of growth is weight gain and adipose
tissues. (kailangan ng adipose tissue para maging
cute sya HAHAHA JOKE, to regulate body
temperature once he is born)
7TH MONTH (25-28 WEEKS)
Length: 35-38 cm
Weight: 1200 g
- Continued growth and development
- Bone ossification
- Surfactant develops
- Male testes start to descend in the scrotal sac,
(dapat naka suspend sa scrotum ang testis)
- Female clitoris is prominent. (mas pansin na)
- Blood vessels and retina of the eyes are formed but
extremely thin. If retina of the eyes is extremely thin,
the fetus also extremely susceptible to damage kapag
nag administer ng high oxygen concentration.
- This is the good time for 3D ultrasound to
determine the gender of the fetus.
8TH MONTH (29-32 WEEKS)
Length: 38-43 cm
Weight: 1600 g
- Subcutaneous fat is present
- Iron transfer from mother to fetus (going to
provide iron in immediate extrauterine life)
- Lanugo starts to disappear – fine downy hairs.
Full term: no lanugo
- Nails extend to fingers.
- Still considered as premature when delivered. -
Response to movements by sounds inside the
mother’s body.
- Moro reflex/ startle reflex is present
9TH MONTH (33-36 WEEKS)
Length: 42-48 cm
Weight: 1.8-2.7 kg
- Testes descends in scrotum
- Lanugo and vernix caseosa disappear (vernix
caseosa – cheese like substance, nakabalot sa buong
katawan, cold protection)
- Amniotic fluid somewhat decreases
- Body stores of glycogen, sugar, iron,
carbohydrate, and calcium are already deposited in
the body.
- Additional subcutaneous fats are also deposited.
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- Most fetus starts to position in cephalic.
(pumupwesto na siya)
- Still considered as preterm when it delivered
10TH MONTH (37-40 WEEKS)
Length: 48-52 cm
Weight: 3kg / 7-7.5 lbs
- Bone ossification of fetal skull begins
- Full term; ready to be born
- Fetus kicks actively which causes discomfort of the
mother.
FETAL CIRCULATION
- The heart is the first system that is functional as
early as the 4th week of AOG.
- Normal at birth: 120-160 per minute,
- Heard at Doppler  10-12 weeks
- Heard by stethoscope/fetoscope  18-20 weeks
- May difference sa heart ng baby at adult kasi may
temporary structures ang baby, at a certain time mag
ko-closed or mawawala yan
TEMPORARY STRUCTURES
• PLACENTA – source of nutrients and gas
exchange. Connected to the mother
• FORAMEN OVALE – opening between the
right atrium and left atrium. In adult circulation
there is no opening between the two chambers
• DUCTUS VENOSUS – connection between the
umbilical veins and inferior vena cava to bypass
the immature fetal liver. (temporary bypass; vein to
vein connection)
• DUCTUS ARTERIOSUS – connection between
the pulmonary artery and aorta in order the blood
to bypass the lungs. (artery to artery) So that the
majority of the blood won’t go to the lungs because
the fetal lungs are still immature. Some of the blood
will still go to the liver and to the lungs in order to
provide nourishment. But the majority of the blood
will bypass them because those structures are still
immature.
• UMBILICAL CORD – AVA (in fetus, 2 arteries –
carries deoxygenated blood and 1 vein – carries
oxygenated blood) by this the baby will breathe.
NERIZA BA-AR BSN 2-YA-6
- Fetal circulation differs from uterine circulation
because fetus derives oxygen and excretes carbon
dioxide, not from gas exchange, but from the
exchange in the placenta.
- Fetal circulation differs from extra uterine
circulation because the fetus derives oxygen and
excretes carbon dioxide not from gas exchange in the
lungs but from the exchange in the placenta.
- Fetal circulation in the utero depends on the use of
shunts to pull blood away from the lungs. While
laboring the fetus expel the fluids in its body as well
as fluids in the lungs. That’s why we use surfactants
GENETICS
Inherited or Genetic Disorders – disorders that can
be passed from one generation to the next
Genetics – study of the way such disorders occur
Cytogenetics – is the study of chromosomes by light
microscopy and the method by which chromosomal
aberrations are identified
GENES
- Deoxyribonucleic acid (DNA)
- Chromosomes
- Human beings are composed of 46 chromosomes
(22 pairs of autosomes; homologous autosomes)
- 1 pair or sex chromosomes (No. 23)
Egg cells always carry XX chromosome
Sperm cells carry either XX or XY chromosome
XX – girl
XY – boy
HUMAN KARYOTYPE
Karyotype = appearance of chromosomes; an
individual’s complete set of chromosomes
X chromosome is bigger than Y chromosome
-
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Parent 2 (Mother) – inherited 1 non dominant gene

(blue eyed) and another dominant gene (brown eyes)

Homozygous – same trait/pattern (both non

dominant/dominant)
Heterozygous – different trait/pattern (1 dominant; 1
non dominant)

Phenotype - outward appearance of a person (face,

eyes, looks, etc)
Genotype - a person’s actual gene composition
Genome - complete set of genes.
Example 46XX or 46XY
P - short arm defect;
q - long arm defect

Example:
46XX5p- Cri-Du-Shat syndrome
46 pieces
Girl
Short arm defect
------
47XX21+ or 47XY21+ - Down’s syndrome
46 Chromosome
Homozygous – healthy gene + healthy gene
21st chromosome has additional 1 chromosome
Heterozygous – healthy gene + unhealthy gene
- Trisomy 21

46X-7q – Cystic fibrosis

MANDELIAN INHERITANCE: DOMINANT
AND RECESSIVE PATTERNS
BY GREGOR MENDEL
- discusses the dominant and recessive pattern
- dominant and non-dominant gene B = dominant
b = recessive
Bb = heterozygous

For example:
Parent 1 (Father) – inherited both non dominant
gene from his parents and his parents has blue eyes

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Interpretation
25% chances only that their child will be normal
50% chances whether its Dh or hD that their child
will have the disease
25% incompatible for life; the baby can die during
labor and delivery

Interpretation:
AUTOSOMAL RECESSIVE INHERITANCE
25% Homozygous dominant
- Non dominant gene naman may problem
50% Heterozygous dominant
- is a pattern of inheritance characteristic of some
25% Homozygous non dominant
genetic disorder
AUTOSOMAL DOMINANT INHERITANCE
- Autosomal means that the gene in question is
“Dominant” means that a single copy of the mutated
located on one of the numbered, or non sex
gene (from one parent) is enough to cause the
chromosomes
disorder.
- Recessive means that two copies of the mutated
gene (one from each parent) are required to cause the
disorder.

Legend:
h = healthy gene
D = disease gene, dominant Legend:
hD = disease H= healthy gene
d= disease gene, recessive
Interpretation: dd= disease (not incompatible since non dominant
50% chance that their child will be normal and 50% lang pareho)
Hd or dH- carrier (since the dominant hormone is
chance that will inherit dominant disease gene
healthy but non dominant is a disease  the child
will not experience the signs and symptoms of the
disease; he has the trait but not experience the
problem itself)

Interpretation
25% - healthy
50% - carrier
25% - disease

Legend:
h= healthy gene
D= disease gene, dominant
hD or Dh= disease
DD= incompatible with life

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dd= disease
Hd or dH- carrier

Interpretation:
50% disease
50% carrier

--
Legend-:
H= healthy gene
d= disease gene, recessive
dd= disease
Hd or dH- carrier

Interpretation: Legend:
50% - healthy H= healthy gene
50% - carrier (will not experience full blown disease; d= disease gene, recessive
will only pass to next generation) dd= disease
Hd or dH- carrier

Interpretation:
All of their children will experience disease
100% disease
X-LINKED DOMINANT INHERITANCE
1. All individuals are affected.
2. All female children of affected men are affected;
all male children of affected men are unaffected
(because sex chromosome of the sperm that is
affected is the only one that is carrying the X not the
Legend: Y, and male will be coming from the Y chromosome)
H= healthy gene 3. It appears in every generation.
d= disease gene, recessive 4. All children of homozygous affected women are
dd= disease affected (XX). Fifty percent of the children of
Hd or dH – carrier heterozygous affected women are affected.

Interpretation: X-linked dominant inheritance occurs when a gene

100% carrier responsible for a trait or disorder is located on the X
chromosome.

Legend:
Xx – disease state
H= healthy gene
Xy – disease state
d= disease gene, recessive
Dominant X of the mother has the disease

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Baby girl will have the disease
Baby boy of the father will also have the disease
because the dominant problem is from the dominant
X of the mother.
Father have the disease
All male child will not be affected
Legend:
xX- disease state
xy- normal
X-LINKED RECESSIVE INHERITANCE
1. Only males in the family will have the disorder.
2. A history of girls dying at birth for unknown
reason often exists (females who had the affected
genes on both X chromosomes)
3. Sons of an affected man are unaffected.
4. The parents of the affected children do not have the
disorder
NERIZA BA-AR BSN 2-YA-6
- Father has both heterozygous non dominant gene
but they are both healthy
- Mother has one x chromosome non dominant is
disease and other x chromosome is dominant but
healthy
Legend:
xx- carrier
xy- disease state
How come xx is a carrier and xy is a disease state?
- because the female has another x, the normal x gene
coming from the father is balancing the disease state
of the gene x from the mother
- Since its x-linked and there is no other x that will
try to balance the problem, the male child will have
the disease
Interpretation:
- If both gene of the father are normal and one
recessive gene of the mother has abnormality
- 50% children will be normal
- 25% will be a carrier
- 25% the male child has the disease
- If we are talking about 4 children
- if 2 children:
50% of males will have the disease
50% of girls will be carrier
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Legend:
xy- normal
Xx- carrier
Xy- disease

Genes that are healthy are overpowering the recessive

disease gene  The child will only be carrier

--

CHROMOSOMAL ABNORMALITIES --- Individual with Trisomy 21 (Down syndrome)

Cytogenic Disorders - happens when there is
abnormality in the number or structure of
chromosomes -missing, additional or distorted
chromosomes

Meiosis - type of cell division which the number of

chromosomes in the cell is reduced to haploid (half)
number for reproduction.
1. NONDISJUNCTION
- division is uneven
- failure to separate; failure to disjunction during
meiosis
EXAMPLE:
Trisomy 21: 47XX21+ or 47XY21+
Klinefelter Syndrome: 47XXY  excess of one (it
boy but there is an extra X chromosome; excess
female trait)---
Turner Syndrome: 45X0 (it is a girl because there is
an X but it is lacking another X chromosome)

a) Karyotype (G banding)

Additional X chromosome leading to mal

hypogonadism

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2. DELETION ABNORMALITIES
part of a chromosome breaks during cell division
resulting to normal number of chromosomes plus or
minus an extra portion of a chromosome.
Example: Cri-du-chat syndrome: 46XY5q-
(has a long arm problem on 5th chromosome)
NERIZA BA-AR BSN 2-YA-6
GENETIC COUNSELLING
1. Provide concrete, accurate information about the
process of inheritance and inherited disorders.
2. Allow people who are affected by the inherited
disorders to make informed choices about future
reproduction.
3. Offer support to people who are affected by
genetic disorders.
Timing: before the first pregnancy
Consideration: Confidentiality of information Who:
1. A couple who has a child with congenital disorder
or an inborn error of metabolism.
2. A couple whose close relatives have a child with a
genetic disorder.
3. A consanguineous couple.  very related couple-
4. Any woman older than 35 or man older than 55
when got married.
• History taking
• Genogram
• Physical Assessment
• Diagnostic Testing
• Karyotyping – picture of chromosome
• Choronic Villi Sampling – will get sample f-
rom placenta
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• Maternal Serum Alpha Feto Protein – - 2 visits for the 3rd trimester
special protein coming from the liver of the - Total of 4 visits
baby (normal alpha feto protein in the blood
of the mother is 38-45 ng/dl (<38 ng is SCREENING ON THE FIRST PRENATAL
chromosomal disorder) VISIT
• Fetal Imaging 1.Health history
• Fetoscopy 2.Complete physical examination (Pelvic
PERINATAL CARE examination)
- aka pre-pregnancy care or antenatal care 3.Blood and urine specimen for laboratory analysis
- Medical care that you do during pregnancy 4.Manual pelvic measurement to determine pelvic
- Develop a plan for their reproductive life adequacy
- Health care you get while you are pregnant
- Essential for ensuring the overall health of
newborns and their mothers and a major strategy or
helping mothers to reduce complications of
pregnancy
- The early part of pregnancy is organogenesis kaya
dapat alagaan at ingatan maigi si nanay and baby.
- Nurses develop a plan for are productive life.
PURPOSE OF PRENATAL CARE
• Identify women at risk & minimize possible
complications. (iba-iba ang situation ng mga nanay
kaya gusto natin malaman ito ng maaga at kung risk
sila sa work)
• Educate women about important steps they can take
INITIAL INTERVIEW
to protect their infant and ensure a healthy pregnancy.
- Includes both present and past history. (we have to
(ano ba yung mga dapat i-participate ng nanay to
develop baseline data for future use)
ensure that she is physically healthy)
- Interviewing is best accomplished in a private, quiet
• Establish a baseline of present health.
setting.
(kasalukuyang kalusugan niya, may maintenance ba
- Caution woman that a first visit may be lengthy
siya para maiba ng doc. ung gamot na hindi pwede sa
because of all the things that need to be
buntis etc)
accomplished.
• Determine the gestational age of the fetus.
- Be certain to ask how a woman wants the nurse to
• Monitor fetal development and maternal well-being
address her and make certain she also knows the
• Provide education about pregnancy, lactation, and
name and the role of the nurse.
newborn care (ituturo natin ung mga dapat nilang
- First time that the client visits the doctor’s office.
malaman para maging aware sila na common lang un
(to gain the trust and confidence of the client)
kapag nagbubuntis, breastfeeding, paano alagaan si
COMPONENTS OF HEALTH HISTORY
baby)
a) Demographic data
HEALTH ASSESSMENT DURING THE FIRST
- This are the common information’s (name, age,
PRENATAL VISIT
address, religion)
First visit  happens as soon as they suspect they are
- Age is important. (Teenage pregnancy)
pregnant
- Address – we wanted to know if the client is living
FREQUENCY OF CONSULTATION:
in congested place.
- Once a month/every 4 weeks  From 1-7th month
- Religion – Jehovah does not want blood transfusion
(4-28th week)
do recommend iron sucrose
- Place of employment – baka may hazardous sa
- Every 2 weeks  36th week and then every week
work place niya or mabigat work niya
until birth
- Ethnicity – baka may cultural beliefs siya
* DOH recommends (specially this pandemic):
- 1 visit each for the first and second trimester

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- We have to know from the very start so that we can
prepare. (para alam natin kung ano dapat ang action
natin at manners natin kay mommy)
b) Chief Concern
- Document the date of LMP (first day of last mens
period)
- Signs of early pregnancy (nausea and vomiting,
breast changes, easy fatiguability, at ano mga
ginagawa niya to relieve this)
- Discomfort of pregnancy (constipation)
- Danger signs (red alert, any sign of bleeding even it
is small amount she needs to report it; abdominal
pain needs to be specified; continues headache also)
c) Family profile (anong meron sa family, past
medical history genetic conditions)
d) History of past illnesses (ano ung mga naging
sakit niya dati)
e) History of family illnesses (may mga sakit kase
na genetic)
f) Day history/ social profile (lifestyle, alcoholic,
smoker)
g) Gynecologic history – menstrual history,
perennial and breast self-examination. (ask menarche,
cycle, regular or irregular, interval, duration, amount
of menstrual flow, discomforts)
h) Past surgery (past caesarian section, surgical
procedure sa ovary, previous abdominal surgery and
etc)
i) Reproductive planning – is this wanted pregnancy
or unplanned
j) Sexual history – when exactly she got sexually
active? Isa lang ba partner niya or marami?
k) Stress incontinence – naiihi ba siya kapag nauubo
etc
• Multiple pregnancy – twins are counted as one
PHYSICAL EXAMINATION
- Baseline height/ weight and vital sign measurement
- Assessment of body systems (general appearance,
mental status)
- Assessment of the heart, lungs, back, rectum,
extremities, and skin.
DETERMINATION OF ESTIMATED DATE OF
DELIVERY (EDD)
- Estimated Date of Delivery (EDD)
- Estimated Date of Birth (EDB)
- Estimated Date of Confinement (EDC)
1. NAEGELE’S RULE
Formula: 1. For the first three months of the year,
add 12 to the numerical value then subtract 3 months
and add 7 days to the first day of the LMP January: 1
+ 12 = 13
February: 2 + 12 = 14
March: 3 + 12 = 15
Formula 2. For the month of April to December,
subtract 3 months and add 7 days of the last
menstrual period (LMP)and add 1 year.

l) Obstetric history
– GPTPALM
• Gravida – number of pregnancies regardless of
outcome
• Parity – number of pregnancies that reach the age
of Viability (20 weeks) live or still birth?
• Term – the fetus already reaches 37 weeks and 2, MC DONALD’S RULE
above. -helps in estimating fetal gestational age using
• Preterm – the fetus delivered before 37 weeks and fundic height.
after viability. (Between 20-36 weeks)
• Abortion – miscarriages, therapeutic and non-
therapeutic, spontaneous miscarriages should be lost
before age of viability. Less than 500gms.
• Living – living children, nag kaka difference lang
sa mga may twins

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Formula 1 (Computing in lunar months):
multiply the fundic height by 2, then divide by 7.
= FH (in cm.) x 2 /7 = Gestational age in lunar
months
Formula 2 (Computing in weeks)
multiply the fundic height by 8, then divide by 7.
= FH (in cm.) x 8 / 7 = Gestational age in weeks
BARTHOLOMEW’S RULE
- Measures the AOG by determining the position of
the uterus in the abdominal cavity.
- 12 weeks – palpable just above the symphysis
pubis.
- 20th or 22nd weeks – palpable at the level of the
umbilicus.
- 36th week – touches the xiphoid process.
- 38th week – 2 weeks before term for primigravida
the fetal head settles into the pelvis and the uterus
returns to the height it was at 36 weeks.
LEOPOLD’S MANEUVER
- Are systematic abdominal palpation to determine
the position and presentation of the fetus.
- They are done at about 32 weeks and over.
-Factors that affect reliability of findings:
NERIZA BA-AR BSN 2-YA-6
a) Obesity
b) Polyhydramnios – increase amount of amniotic
fluid.
c) Anterior placental location
1) Fundal grip – palpate upper portion of abdomen
(buttocks – globular but soft and ballotable; head –
globular but hard and mass); to know if its cephalic
or breech
2) Umbilical grip – side to side (looking for fetal
back to auscultate – flat; toes and fingers – if other
side is irregular shape); fetal back is the best position
for fetal heart tone auscultation
3) Pawlik’s grip – at symphysis pubis (which part
of the fetal body occupies the pelvic inlet; engage or
not engage; ballottement); if buttocks ang na fefeel sa
fundal grip, it should be head that we feel on Pawlik’s
grip
4) Pelvic grip – determine the fetal attitude and
degree of fetal extension/ flexion (we maneuver the
baby to be in cephalic presentation)
ROLE OF THE NURSE IN PRENATAL CARE
1.Established baseline data relevant to a woman’s
health and identify health promotion strategies.
2. Teaching women and their families about safe
pregnancy lifestyle.
3. Obtained a detailed health and sexual history
including screening for the risk of teratogen exposure
as well as any concern about the woman pregnancy
4. Urging the client to continue prenatal care is
important because lack of prenatal care is associated
with pregnancy complications.
5. Be certain to reserve sufficient time during
prenatal visit, so care can be thorough and there is
enough time to set realistic goals and expected
outcomes with both a woman and her partner
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FETAL GROWTH & DEVELOPMENT

TERATOGENS – any drug, virus, irradiation, or any
harmful substances the exposure to which may cause
damage to the fetus.

• Streptomycin/Quinine – damage to the 8th cranial

nerve
• Tetracycline – staining the tooth enamel and inhibit
the growth of long bones.
• Vitamin K – leads to hemolysis or destruction of
RBC and hyperbilirubinemia.
• Iodines – enlargement of thyroid gland or goiter
• Thalidomides – Amelia (absence of extremities) or
Phocomelia
• Steroids – cleft lip, cleft palate, and abortion
• Lithium – congenital malformation, Epstein’s
anomaly
• Dilantin – fetal hydantoin syndrome, IUGR
(Intrauterine Growth Restriction), craniofacial
dysmorphism, microcephaly, nail hypoplasia, heart
defects
• Isotretinoin (Accutane) - congenital deafness,
microtia, CNS defects, CHO
• Alcohol – low birth weight, Fetal Alcohol
Withdrawal Syndrome characterized by microcephaly
• Smoking - low birth weight
• Caffeine – low birth weight
• Cocaine – low birth weight and abruption placenta

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