Signs of Ovulation
1. Mittleschmerz
- Lower abdominal pain felt at the side of
ovary that released the ovum
2. Spinnbarkeit
- Cervical mucus showing a ferning pattern
when dried and viewed under the
microscope, mucus is also thin and
transparent, stretchable and abundant.
3. Higher basal body temperature
- Caused by a high level of progesterone
4. Peak level of Luteinizing Hormone (LH)
- to released the matured ovum
Menopause (Climacterium)
- The last menstruation which indicates the
end of a woman reproductive years
- Refers to the time in a woman’s life when she
undergoes a transition from the
reproductive stage to the non- reproductive
stage.
- Generally, occurs between ages of 45 to 55
and at time earlier in some women.
- Age + 35 = age of menopause
The OVUM
- The female sex gametes
- Has 2 protective covering
o Zona pellucida – inner layer
o Corona radiata – outer layer
- Lifespan – 24 hours / 1 day
- Immobile structure (moved by cilia)
The SPERMATOZOA
- The male gametes or sex cell
- Parts include:
o HEAD – contains the chromatin
materials
o NECK – or midpieces which
provides energy from movement
o TAIL – responsibility for the
motility
Types of sperm cells
1. GYNOSPERM
- Contains the X chromosomes
- Large oval heads and lesser in number
- Survive in acidic environment
2. ANDROSPERM
- Carriers the Y chromosomes
- Smaller heads but greater in number
- Thrive in alkaline environment
SIDE NOTES:
- MALE is XY chromosome
- FEMALE is XX chromosome
SEMEN
- The fluid release by a man during ejaculation
that contains the sperm cells and secretions
from the male reproductive tract
- The average amount of semen is 3-5 ml and
this contains about 300-500 million of sperm
cells
SIDE NOTES: based kay ma’am rose
- Average ejaculation is 2.5 ml
- Contains 50 – 200 million sperm cells
Fertilization
- This is the union of the egg cell and the
sperm cell in the fallopian tube.
- Zygote is the term used for a fertilized ovum
Implantation
- Also called NIDATION
- Burrowing of developing zygote into the
endometrial lining of the uterus that occurs
7-10 days after fertilization
- Chorionic villi appear on surface and secrete
human chorionic gonadotropin (HcG) which
inhibits ovulation during pregnancy by
stimulating continuous production of
estrogen and progesterone.
The DECIDUA
- Refers to the endometrium after
implantation
- 3 layers
o Decidua capsularis – enclose the
blastocyst
o Decidua vera – located under
decidua basalis
o Decidua basalis – layer involved
with implantation. It forms the
maternal side of the placenta
The MEMBRANES
1. Chorionic membrane
- Membrane not involves with implantation.
This is attached to the fetal surface of the
placenta that provides support to the
amniotic membrane.
- Describe as thick, opaque, and friable
EL JIREH D. ASAURO BSN 2D
 2. Amniotic membrane
- Directly encloses the fetus and amniotic
fluid
- This is continuous to the umbilical cord
Amniotic fluid
- The fluid found within the amniotic sac and
in which the fetus floats
- Also called liquor amnii
Characteristics of Amniotic fluid
1. Volume: 500ml – 1200 ml, average = 1000ml
- Oligohydramnios – amniotic fluid of less than
300ml
- Polyhydramnios – amniotic fluid of more
than 2000ml
2. Composition – 99% water and 1% solid
particles containing albumin, urea, uric acid,
creatinine, lecithine, sphyngomyelin, bilirubin,
vernix and lanugo.
Functions of amniotic fluid
1. Protects the fetus from trauma, blows and
pressure
2. Allows freedom of movement permitting
symmetrical growth and development of
musculoskeletal system
3. Maintain constant pressure
4. Acts as an excretion and secretion system
5. Sources of oral fluid for the fetus
6. Provides protection against certain infections
7. Aids in the diagnosis of maternal and fetal
complications
8. Aids in fetal descend during labor
UMBILICAL CORD
- It serves as the connection of the fetus and
the placenta
- Its main function is to carry nutrients and
oxygen via the umbilical vein and fetal waste
products back to the placenta via umbilical
arteries
- About 50 – 55 cm long and 2 cm in diameter
- Contains 2 arteries and 1 vein supported by a
mucoid material, Wharton’s jelly to prevent
kinking and knotting.
PLACENTA
- Transient organ allowing passage of nutrients
and waste material between mother and
fetus
- A discoid organ weighing 500 grams at term
- Also act as an endocrine organ and as a sieve
which allow smaller particles through and
holds back larger molecules
- Provides for exchange of nutrients and waste
products between fetus and mother
- Develops by the third month
- Produces hormones to maintain pregnancy
and assumes full responsibility for the
production of these hormones by the 12th
week of gestation
- Larger particles cannot such as bacteria
cannot pass through placenta
- In addition to nutrients, drugs, antibodies
and viruses can pass through placenta
- In the 3rd trimester of maternal
Immunoglobulin provides fetus, passive
immunity to certain disease for the first few
months after birth
- By week 8, genetic testing can be done
- Passage of materials in either direction is
affected by:
o Diffusion – CO2, and fetal waste
products, O2 sodium, chloride and
fat-soluble vitamins cross the
placenta in this manner.
o Facilitated diffusion – glucose,
amino acid, and minerals
o Pinocytosis – maternal
immunoglobulins that provide
passive immunity to fetus cross
the placenta through this
mechanism
- 2 sides of the placenta
o MATERNAL SIDE – dirty side
composed of 15-20 cotyledons,
when delivered first it’s called
DUNCAN MECHANISM (20%)
o FETAL SIDE – appears smooth and
shiny, when delivered first, it is
called SCHULTZ MECHANISM
(80%)
o MDFS
FUNCTION OF THE PLACENTA (REPEN)
- Respiratory system
- Endocrine system
- Pulse or circulatory system
- Excretory function
- Nutrition
Fetal Growth and Development
- Organ systems are developed from 3 primary
germ layer
a. ECTODERM – outer layer, produces
skin, nails, nervous system and tooth
enamel
b. MESODERM – middle layer, produces
connective tissue, muscles, blood and
circulatory system
EL JIREH D. ASAURO BSN 2D
 c. ENDODERM – inner layer, produces - Facial features are visible, including a mouth
linings of GIT and RT, endocrine glands and tongue. The eyes have a retina and lens.
and auditory canal The major muscles system is developed. And
the unborn child practices moving. The child
has its own blood type, distinct from the
Term used to denote Fetal Growth and Development mother’s. these blood cells are produces by
NAME PERIOD the liver now instead of the yolk sac
OVUM From ovulation to 8 weeks
fertilization - Eyes, ears, nose and mouth are recognizable
ZYGOTE From fertilization to o Fingers and toes are present
implantation o Gestational sac is visible by
EMBRYO From implantation to ultrasound
5 – 8 weeks o Capable of some movements but
FETUS From 5 – 8 weeks until too faint to be feel by the mother
term o Hands and feet are available
CONCEPTUS Developing embryo or o Heart with valves and septum
fetus and placental o Ossification of bones begins
structures throughout o Length is 2.5 cm
pregnancy 8 weeks
The picture on the right is a fertilized egg, only thirty - The unborn child, called a fetus at this stage.
hours after conception. Magnified here, it is no larger This about half an inch long. The tiny person
than the head of the pin. Still rapidly dividing, the is protected by the amniotic sac, filled with
developing embryo called zygote at this stage, floats amniotic fluid. Inside, the child swims and
down from the fallopian tube and moves gracefully. The arms and legs are
lengthened, and fingers can be seen. The toes
will develop in the next few days. Brain waves
can be measured.
10 weeks
- The heart is almost completely developed
and very much resembles that of a newborn
baby. An opening the atrium of the heart and
the presence of bypass valve divert much of
the blood away from the lungs, as the child’s
blood is oxygenated through the placenta.
Twenty tiny baby teeth are forming in the
gums
12 weeks (3 MONTHS)
- Vocal cords are complete, and the child can
does sometimes cry (silently). The brain is
Fetal Growth and Development
fully formed and the child can feel pain. The
4 weeks
fetus may even suck his thumb. The eyelids
- All systems are rudiment form
now cover the eyes, and will remain shut
- Heart chambers are formed and beating
until the seventh month. To protect the
- Length: 0.4cm, weight: 0.4 gms
delicate optical nerve fibers.
5 weeks
- the placenta is developed and functioning
- Embryo is the size of a raisin. By day twenty-
- Fetus is palpable just above the symphysis
one, the embryo’s tiny heart has begun
pubis
beating. The neural tube enlarges into three
- Arms and legs ratio are proportional
parts, soon to become a very complex brain.
- Fingernails and toenails are present
The placenta begins functioning. The spine
- Sucking and swallowing reflex are present
and spinal cord grow faster than the rest of
- Skin is pink
the body at this stage and give the
- Attains human shape
appearance of a tail. This disappears as the
- Length: 6-7cm, weight: 19 grams
child continue to grow
-
7 weeks
The second trimester of the PREGNANCY
EL JIREH D. ASAURO BSN 2D
14 weeks
- Muscles lengthen and become organized.
The mother will soon start feeling the first
flutter of the unborn child kicking and moving
within
16 weeks (4 month) – sex can be identified externally
- Resembles a human face
- Multipara experience quickening
- FHT can be heard by fetoscope
- Scalp hair and lanugo formation begins
- Length: 11.5 - 13.5cms,
- weight: 100 - 110 grams
20 weeks (5 month) – FHT can be heard by
stethoscope
- quickening is felts by primipara
- vernix caseosa and sebaceous glands are
present
- fetus can hear sound from external
environment
- meconium in the rectum
- length: 16 – 18.5 cms
- weight: 300 grams
24 weeks (6 months) – sweat glands, eyelashes and
eyebrows are present
- lanugo covers the entire body
- skin is red and wrinkled
- body is well proportioned
- transfer of maternal antibodies to the fetus
begins
- surfactant production begins
- length: 23 cms, weight: 600-630 grams
- seen here at 6 months, the unborn child is
covered with fine, downy hair called lanugo.
Its tender skin is protected by a waxy
substance called vernix. Some of this
substance may still be on the child’s skin at
birth which time it will be quickly absorbed.
The child practices breathing by inhaling
amniotic fluid into developing lungs
28 weeks (7 months)
- fingernails and toenails begin to grow
- eyes are opened and reactive to light
- fetus is immature if born at this time but with
higher chance of survival if give expert care
- skin is red and covered with vernix caseosa
- length: 25-27cm, weight: 1100 grams
30 weeks
- for several months, the umbilical cord has
been the baby’s lifeline to the mother.
Nourishment is transferred from the mother’s
blood, through the placenta. And into the
umbilical cord to the fetus. If the mothers
ingest any toxic substances, such as drugs or
alcohol, the baby receives these as well.
32 weeks (8 months) – the fetus sleeps 90-95% of the
day, and sometimes experiences REM sleep, an
indication of dreaming.
- subcutaneous fats Is present
- iron transfer from mother to fetus
- skin slightly wrinkled, pink in color
- assumes delivery position
- fetus can turn the head to side
- more rounded appearance
- nails extend to fingertip
- length: 28 – 31 cms
- weight: 1600 – 2100 grams
36 weeks (9 months) – testis descend to scrotum
- body is round
- sole creases on anterior 2/3 of feet
- L/S ratio 2:1
- Lanugo almost absent
- Skin is pink and smooth
- Length: 32 – 35 cms
- Weight: 2200 – 2900 grams
40 weeks – decreasing vernix caseosa
- Testes in scrotum
- Lightening 2 weeks prior to delivery in
primiparas
- Fingernails extend beyond fingertips
- All characteristics of newborn
- Length: 40 cms
- weight: 3000 – 3600 grams
PRENATAL CARE
- also called ANTENATAL care
- refers to health care given to a woman and
her family during pregnancy
- the primary goal is to provide maximum
health to expectant mothers and their babies
GRAVIDA
- refers to the number of pregnancies a
woman has had irregardless of the outcomes
of pregnancy
NULLIGRAVIDA
- a woman has never been pregnant
MULTIGRAVIDA
- a woman who has had two or more
pregnancies
PRIMIGRAVIDA
- a woman pregnant for the first time
PARA
- the number of pregnancies that reached
viability
- criteria of a viable infant
o AOG – 20 weeks or more
o Weight – 500 grams or more
o Presence of a heart beat
NULLIPARA
- A woman who has never delivered a viable
infant/ fetus that reached the age of viability
EL JIREH D. ASAURO BSN 2D
MULTIPARA
- A woman who has completed 2 or more
pregnancies that reached viability
PRIMIPARA
- A woman who has completed one pregnancy
that reached viability
PRETERM INFANT
- Infant born before 38 weeks gestation
FULLTERM INFANT
- Infant born between 38 – 42 weeks gestation
POST TERM INFANT
- Infant born after 42 weeks gestation
PARTURIENT WOMEN
- A woman who is in labor
PUEPERA
- A woman who had just delivered an infant
(within six weeks after delivery)
LIVEBIRTH
- Is recorded when the infant born shows
signs of life: breathing, spontaneous
movement of voluntary muscles and
heartbeat
STILLBIRTH
- An infant born without signs of life
LOW BIRTH WEIGHT/ Small for Gestational Age (SGA)
- An infant with a birth weight below the 10th
percentile rank
- A term infant is considered low birth weight
if the birth weight is less than 2500 grams
Large for Gestational Age (LGA)
- An infant with birth weight above the 90th
percentile rank
- A term infant with a birth weight of more
than 4000 grams
History Taking
- Personal data
o Includes the name, age, civil
status, religion, occupation,
weight and height
- Menstrual History
o Includes the menarche, menstrual
cycle, amount or menstrual flow
and the regularity of the menses
- Breast health
o Includes incidence of breast
surgery, breast disorder and
breastfeeding of previous infants
- Contraceptives use
o The method of family planning
used
- Medical History
o This may include childhood
disease, drug allergies, past
surgeries, existing medical
conditions, family history,
immunization, intake of alcohol
and cigarette smoking
- Obstetric history – includes
a. History of past pregnancies
TPAL or FPAL
b. History of present pregnancy
o Inquire the LMP compute the EDC
(Naegel’s Rule) and AOG
NAEGEL’s rule
1-3 months: +9, +7
4-12 months: -3, +7, +1
GESTATION
- Estimated date of confinement (EDC)
- Lasts approximately 280 days
- Naegele’s rule for estimating EDC
- For Naegele’s rule to be accurate requires
that the women have a regular 28 – day
menstrual cycle
- Add 7 days to the first day if the last
menstrual period (LMP), subtract 3 months,
and then add 1 year to that date
ASSESSMENT
- Vital signs
a. BP normal
b. PR increases about 10 beats/ min due to
increased cardiac workload
c. RR increased in depth, no change in rate
d. Temperature- slight elevation early in
pregnancy but drops to normal after 16 weeks
PHYSICAL EXAMINATION
- It is best to perform systematically,
cephalocaudal approach
- Abdominal examination or Leopold’s
Maneuver
PHYSICAL EXAMINATION PER VISIT
- Weight
- BP
- Examination of conjunctiva & palms for pallor
- Abdominal exam for fundic height, fetal
position, presentation & FHT.
- Exam for face, hands, lower extremities for
edema
- Examination of the breasts
- Examination of thyroid for enlargement and
goiter
EL JIREH D. ASAURO BSN 2D
ASSESSMENT OF FUNDIC HEIGHT

MEASURING FUNDAL HEIGTH

- Place the zero line of the tape measure on
the anterior border of the symphysis pubis
and stretch tape over midline of abdomen to
top of fundus
- The tape should be brought over the curve of
the fundus
- The height of the fundus in centimeters
equals the number of weeks gestation plus
or minus 2
- After 32 weeks the relationship is less
accurate
- Perform Leopold’s Maneuver

The important estimates

- Mc Donald’s Rule – used to calculate AOG
Formula:
FH (CM) x 2/7 = AOG in lunar months
FH (CM) x 8/7 – AOG in weeks
Examples:
FH = 35 cms
FH = 14 cms

EL JIREH D. ASAURO BSN 2D