CARE OF MOTHER, CHILD, ADOLESCENT

(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims

ESSENTIAL INTRAPARTUM AND NEWBORN CARE

ANTENATAL CORTICOSTEROIDS WOMAN ALREADY IN DR

Administer ANTENATAL STEROIDS to all patients  PREPARING FOR DELIVERY
who are at risk for preterm delivery ➢ Checked temperature in DR area, it should
➢ With preterm labor between 24-34 weeks be 25-28 degree Celsius; eliminate air draft
AOG ➢ Asked the woman if she is comfortable in
➢ Or with any of the following prior to term: the semi-upright position(the default position
1. Antepartal hemorrhage/bleeding in delivery table)
2. Hypertension ➢ Ensured the woman’s privacy
3. (preterm) Pre-labor rupture of ➢ Removed all jewelry then washed hands
membranes thoroughly observing the WHO 1-2-3-4-5
CARE DURING LABOR procedure
RECOMMENDED NOT RECOMMENDED ➢ Prepared a clean newborn resuscitation
a. Admission to labor when in a. Routine perineal area.
the active phase shaving on ➢ Check if functional and within easy reached.
b. Companion of choice to admission ➢ Arrange materials/supplies in a linear
provide continuous maternal b. Routine enema sequence:
support c. Routine NPO ➢ Gloves, dry linen, bonnet, oxytocin
c. Mobility and upright position d. Routine IVF injection, plastic clamp, scissors, 2
d. Allow food and drink e. Routine vaginal
kidney basins,
e. Use of WHO partograph to douching
➢ In a separate sequence, (to be use after the
monitor progress of labor f. Routine amniotomy
f. Limit IE to 5 or less g. Routine oxytocin first breastfeeding)
augmentation ➢ Eye ointment, Stethoscope to symbolize
PE, Vit. K, Hepatitis B and BCG vaccines
UPRIGHT POSITION DURING DELIVERY\ (plus cotton balls)
• More efficient uterine contractions ➢ Cleanse the perineum with antiseptic
• Improved fetal alignment solution
• Larger anterior-posterior and transverse
diameters of pelvic outlet → enhances fetal
movement through the maternal pelvis in
descent for birth
• Faster delivery
• Leads to less interventions : less
episiotomies

EINC CHECKLIST
IN ADVANCE:
 Prepare decontamination solution
➢ Mix 1part 5% chlorine bleach to 9 parts
water to make 0.5% chlorine solution
➢ Change chlorine solution at the beginning
of each day or whenever solution is very
contaminated or cloudy
PRIOR TO WOMAN’S TRANSFER TO THE DR
 Ensure that mother is in her position of choice ➢ Wash hands and put on 2 pairs of sterile
while in labor. gloves aseptically (if same worker handles
 Asked mother if she wishes to eat and drink or perineum and cord)
void.
 Communicate with the mother – informed her of
progress of labor, gave reassurance and
encouragement.
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims
AT THE TIME OF DELIVERY
➢ Encourage woman to push
➢ Drape mother’s abdomen in preparation for
drying the baby.
➢ Apply perineal support and control the
delivery of the head
➢ Call out time of birth and sex of baby.
➢ Inform the mother of outcome
FIRST 30 SECONDS
➢ Thoroughly dry baby for at least 30 seconds,
➢ starting from eyes face and head, going
down to the trunk and extremities while
performing a quick check for breathing.
1 TO 3 MINUTES
➢ Remove the wet cloth.
➢ Place baby in skin to skin contact on the
mother’s abdomen or chest.
➢ Cover baby with the dry cloth and the baby’s
head with a bonnet
➢ Exclude a second baby by palpating the
abdomen in preparation of giving oxytocin
➢ Use wet cloth to wipe the soiled gloves
➢ Dispose wet cloth properly.
➢ Give oxytocin within one minute of baby’s birth.
➢ Remove the first set of gloves and
decontaminate them properly (for at least 10
mins)
➢ Palpate umbilical cord to check for pulsations.
➢ After pulsation stopped, clamp cord using the
plastic clamp 2cm from the base
➢ Placed the instrument clamp 5cm from the base
➢ Cut near plastic clamp, not midway
Perform the remaining steps of the AMTSL:
➢ Wait for long contraction then apply controlled
cord traction and counter traction on the uterus,
continuing until placenta is delivered.
➢ Massage the uterus until it is firm
➢ Inspect the lower vagina and perineum for
lacerations/tears and repair if necessary
➢ Examine the placenta for completeness and
abnormalities.
➢ Clean the mother, flush perineum and apply
perineal pad/napkin/cloth.
➢ Check the baby’s color and breathing
➢ Check the if mother is comfortable and if the
uterus is well contracted.
➢ Dispose the placenta in a leak proof container or
plastic bag.
➢ Decontaminate instruments before cleaning,
decontaminate the 2nd pair of gloves before
disposal, decontamination should last for 10
minutes
➢ Advise mother to maintain skin to skin contact.
➢ Baby should be prone on mother’s chest / in
between the breasts with head turned to one
side.
15 TO 90 MINUTES
➢ Advised mother to observe for feeding cues
➢ Opening of mouth, tonguing, licking, rooting
➢ Wait for full breast feeding
➢ After a complete breastfeeding
➢ Administer eye ointment
➢ Physical assessment
➢ Vit. K adminstration
➢ Hepatitis B injection
➢ BCG inection
➢ Explain purpose after each intervention
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims

EYE PROPHYLAXIS APGAR SCORING SYSTEM

 Is a mandatory precaution against opthalmia
neonatorum
INDICATORS 2 1 0
 Ophthalmia neonatorum is the inflammation of Activity Active, Some flexion No
the eyes resulting from gonorrheal or chlamydial Spontaneous of extremities movement
infection contracted as the newborn passes (Flaccid,
through the mothers birth canal Limp)
Pulse >100 BPM < 100 BPM Absent
Ophthalmic Ointments Commonly Used: Grimace Pulls away, Facial No
• Erythromycin sneezes, grimace response
• Tetracyclin coughs with
stimulation
Appearance Completely Acrocyanosis Bluish-
CREDE’S PROPHYLAXIS pink gray or
 Always use a single tube package pale all
 To instill the ointment: over
➢ Open the NB eyes with your thumb and Respiration Good Slow, Absent
vigorous cry irregular
forefinger weak cry
➢ Place the medication in the lower conjunctiva
from inner to outer canthus INTERPRETATION
• Score of 7-10 is normal,
VITAMIN K ADMINISTRATION • 4-6 condition is guarded, needs further
 Vit K necessary for blood clotting, is synthesize clearing of airway,
by action of bacteria in the intestine. • 4 below needs resuscitation
 GIT sterile at birth.
• Done 1 min.after delivery and 5 mins after
 Vit K level are low in NB.
delivery
 Vit. K is routinely administered, IM

BCG VACCINE
 Bacille-Calmette-Guerin
 BCG is used in many countries with a high
prevalence of TB to prevent childhood
tuberculous
 Administered through ID

15 TO 90 MINUTES
 Advised delayed bathing of baby
 Advise breastfeeding per demand
 In the first hour, check baby’s breathing and
color, check mother’s vital signs and massage
uterus every 15 minutes
 In the second hour, check mother-baby every 3o
minutes to one hour
 Complete all the records.
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims
IV PRIMING
INTRAVENOUS THERAPY
• A treatment that infuses intravenous solutions,
medications, blood, or blood products directly
into a vein (Perry, Potter, & Ostendorf, 2014).
• Intravenous therapy is an effective and fast-
acting way to administer fluid or medication
treatment in an emergency situation, and for
patients who are unable to take medications
orally.
• Approximately 80% of all patients in the hospital
setting will receive intravenous therapy.
PURPOSES OF INTRAVENOUS (IV) THERAPY
1. To supply fluid when clients are unable to take in
an adequate volume of fluids by mouth
2. To provide salts and other electrolytes needed to
maintain electrolyte imbalance
3. To provide glucose (dextrose), the main fuel for
metabolism
4. To provide water-soluble vitamins and
medications
5. To establish a lifeline for rapidly needed
medications.
6. To administer blood or blood products.
7. To deliver nutrients and nutritional supplements
GUIDELINES RELATED TO INTRAVENOUS
THERAPY
A. A physician’s order is necessary to initiate IV
therapy. The physician’s order should
include:
➢ Type of solution to be infused
➢ Volume of solution to be infuse
➢ Rate of infusion
➢ Duration of infusion or the time over which
the infusion is to be completed
➢ Exact amount (dose) of any medications to
be added to a compatible solution either
hourly or 24-hour volume
➢ Physician’s signature
B. IV therapy is an invasive procedure, and
therefore significant complications can occur if
the wrong amount of IV fluids or the incorrect
medication is given.
C. Aseptic technique must be maintained
throughout all IV therapy procedures, including
initiation of IV therapy, preparing and maintaining
equipment, and discontinuing an IV system.
➢ Always perform hand hygiene before
handling all IV equipment.
➢ If an administration set or solution
becomes contaminated with a non-sterile
surface, it should be replaced with a new
one to prevent introducing bacteria or
other contaminants into the system
D. Complications may occur with IV therapy,
including but not limited to localized infection,
catheter-related bloodstream infection (CR-BSI),
fluid overload, and complications related to the
type and amount of solution or medication given
(Perry et al., 2014).
➢ For an infusing peripheral IV, the site
must be assessed every 2 hours and
p.r.n.
➢ A saline lock site must be assessed every
12 hours and p.r.n.
E. CDC (2011) recommends that PIVs be replaced
every 72 to 96 hours to prevent infection and
phlebitis in adults.
F. Most agencies require training to initiate IV
therapy, but the care and preparation of
equipment, and the maintenance of an IV system
can be completed each shift by the trained health
care provider
G. PIVs are prone to phlebitis and infection, and
should be removed (CDC, 2011) as follows:
➢ Every 72 to 96 hours and p.r.n.
➢ As soon as the patient is stable and no
longer requires IV fluid therapy
➢ As soon as the patient is stable following
insertion of a cannula in an area of flexion
➢ Immediately if tenderness, swelling,
redness, or purulent drainage occurs at
the insertion site
➢ When the administration set is changed
(IV tubing)
TYPES OF SOLUTIONS
The most common way to categorize IV fluids is
based on their tonicity:
1. ISOTONIC
• Isotonic IV solutions that have the same
concentration of solutes as blood plasma.
• does not cause any fluid shifts within
compartments
• Do not cause cells to shrink or swell.
• are useful to increase intravascular volume, and
are utilized to treat vomiting, diarrhea, shock, and
metabolic acidosis, and for resuscitation
purposes and the administration of blood and
blood products.
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims

• It is important to monitor patients receiving 22 G Blue Most chemo infusions; patients

isotonic solutions for fluid volume overload with small veins, elderly, or
(hypervolemia) pediatric patients
0.9% NaCl (Normal Saline Solution, 24 G Yellow Very fragile veins; elderly or
NSS) Purple pediatric G25 patients
Dextrose 5% in Water (D5W)
Lactated Ringer’s 5% Dextrose in
Water (D5LRS) STANDARD CATHETER
Ringer’s Solution 1. The catheter itself is composed of:
a) a tip for insertion into the vein,
2. HYPOTONIC b) wings for manual handling and
• have lesser concentration of solutes than securing the catheter with
plasma. They cause fluid shifts from the ECF into adhesives,
the ICF to achieve homeostasis, therefore, c) a valve to allow injection of drugs
causing cells to swell but my also deplete fluid with a syringe
witin vascular space d) an end which allows connection to
an intravenous infusion line, and
• Monitor for hypovolemia and hypotension related
capping in between uses.
to fluid shifting out of the vascular space,3%
2. The needle (partially retracted) which serves
sodium chloride (3% NaCl)
only as a guide wire for inserting the
0.45% Sodium Chloride (0.45% NaCl)
cannula.
0.33% Sodium Chloride (0.33% NaCl)
3. The protection cap which is removed before
0.225% Sodium Chloride (0.225% NaCl)
use.
2.5% Dextrose in Water (D2.5W)
ADMINISTRATION SET
3. HYPERTONIC
• Solutions have greater concentration of solutes
than plasma. They are also known as volume
expanders as they draw water out of the
intracellular space, increasing extracellular fluid
volume (causes cells to shrink)
• Hypertonic solutions may cause intravascular
fluid volume overload and pulmonary edema, and
they should not be used for an extended period
of time.
Do not use for patient dehydrated
5% sodium chloride (5% NaCl)
Dextrose 10% in Water (D10W)
Dextrose 20% in Water (D20W)
Dextrose 50% in Water (D50W)

RECOMMENDED IV GAUGES
SIZE COLOR RECOMMENDED USE
14 G Orange In massive trauma situations
16 G Gray Trauma, surgeries, or multiple
large-volume infusions.
18 G Green Blood transfusion, or large
volume infusions.
20 G Pink Multi-purpose IV; for
medications, hydration, and
routine therapies
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims

DROP FACTOR CONSTANTS All pediatric patients

All medication as described in the PDTM
Infusion rates below 60 ml/hr

IV PARTS

IV TUBING LABEL

IV FLUID TAG/LABEL

INFUSING IV FLUIDS BY GRAVITY OR AN

ELECTRONIC INFUSION PUMP (EID)
• A health care provider is responsible for
regulating and monitoring the amount of IV fluids
being infused. IV fluid rates are regulated in one
of two ways:
• Gravity. The health care provider regulates the
infusion rate by using a clamp on the IV tubing,
which can either speed up or slow down the flow
of IV fluids. An IV flow rate for gravity is calculated
in gtts/min.
• Electronic infusion device (EID) The infusion rate
is regulated by an electronic pump to deliver the
fluids at the correct rate and volume. All IV pumps
regulate the rate of fluids in ml/hr. An IV pump
(EID) is used for many types of patients,
solutions, and medications (Vancouver Coastal
Health, 2008).
• An IV pump must be used for:
All CVC devices
All opioid infusions (use a patient-
controlled analgesia)
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims

REGULATION FOR AN INFUSION BY GRAVITY

1. Observe and count the drips in the drip
chamber and regulate for 42 gtts/min (one full
minute). Alternatively, divide 42 by 4
(rounded down from 10.4 to 10 gtts/min) to
count for 15 seconds. The gtts/min should be
assessed regularly to ensure the IV is
infusing at the correct rate (e.g., every 1 to 2
hours, if the patient accidentally bumps the IV
tubing, or if a patient returns from another
department).
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims

ANTENATAL CARE : FERTILIZATION AND IMPLANTATION

FERTILIZATION
DEFINITION ➢ The egg is swept into the funnel-shaped end of
➢ The union of the sperm and the mature ovum in one of the fallopian tubes.
the outer third or half of the fallopian tube, the ➢ Mature ovum is capable of being fertilized for 12-
ampullar portion. 24 hours after ovulation
➢ Also referred to as conception, impregnation, ➢ At ovulation, the mucus in the cervix becomes
fecundation more fluid and more elastic, allowing sperm to
GENERAL CONSIDERATION enter the uterus rapidly.
➢ Normal amount of semen per ejaculation: ➢ Immediately after penetration of the ovum, the
averages 2.5ml- 1 tsp chromosomal material of the ovum and
➢ Number of sperms in an ejaculate: 50-200 spermatozoon fuse, resulting structure is called a
million/cc or 400 million per ejaculation zygote.
➢ Sperms are capable of being fertilizing even for ➢ The cell membrane changes composition,
3-4 days after ejaculation. becomes impervious to other spermatozoa.
➢ Sperms, once deposited in the vagina, will ➢ An exception to this, is gestational trophoblastic
generally reach the cervix 90 seconds and the disease in which multiple sperm enter an ovum,
outer end of fallopian tube within 5 minutes after leading to abnormal zygote formation.
deposition.
➢ Spermatozoa move by means of their flagella
(tails) to reach the fallopian tube.
➢ Sperm will undergo capacitation to be ready for
fertilization
➢ During capacitation, changes in the plasma
membrane of the sperm head, which reveals
sperm binding receptor sites
➢ All the sperm that achieve capacitation reach the 1 2
ovum and cluster around the protective layer of
corona cells, protective covering the ovum.
➢ All sperms release hyalurodinase and acts to
dissolve the cell layers protecting the ovum
➢ Only one spermatozoon is able to penetrate the
cell membrane of the ovum
It is believed that the reason an
ejaculation contains large number of
sperm is to provide enough enzymes to
dissolve the protective layer. Once the
ovum is penetrated the cells, it cannot be
penetrated anymore by other sperm 3 4
➢ During each normal menstrual cycle, one egg
(ovum) is usually released from one of the
ovaries.
➢ As the ovum is extruded from the graafian follicle
it is surrounded by a ring of mucopolysaccharide
fluid(the zona pellucida) and a circle of cells(zona
radiatea), serves as protective layer
➢ The egg is swept into the funnel-shaped end of
one of the fallopian tubes.
➢ Mature ovum is capable of being fertilized for 12-
24 hours after ovulation 5
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims

IMPLANTATION

➢ At ovulation, the mucus in the cervix becomes ➢ Trophoblast cells produce proteolytic
more fluid and more elastic, allowing sperm to enzyme that allows the blastocyst to burrow
enter the uterus rapidly. deeply into the endometrium and receive
➢ Immediately after penetration of the ovum, the nourishment.
chromosomal material of the ovum and ➢ Implantation point is usually high in the
spermatozoon fuse, resulting structure is uterus, on the posterior surface.
called a zygote. ➢ It is a very important step because as many as
➢ Immediately after fertilization, zygote 50% of zygote never achieve it
migrates toward the body of the uterus, takes 3 ➢ Small amount of vaginal spotting appears with
or 4 days. , aided by the currents initiated by the implantation because capillaries are ruptured by
muscular contractions of the fallopian tubes. the implanting trophoblasts cells.
➢ During which time rapid cell division (mitosis) or ➢ Once implanted the zygote is now an embryo.
cleavage is taking place.
➢ The first cleavage occurs at about 24 hours; EMBRYONIC AND FETAL STRUCTURES
cleavage divisions continue occur at a rate of Decidua
about one every 22 hours. ➢ The uterine endometrium instead of
➢ By the time it reaches the body of uterus, it sloughing off as in a normal menstruation,
consist of 16-50 cells. Because of its bumpy continue to grow in thickness and vascularity,
outward appearance, it is termed morula.(french the endometrium is now termed decidua.
word morus, which means mulberry) ➢ this is because stimulation of progesterone
➢ For 3-4 more days the morula floats free in the produce by the corpus luteum.
uterine cavity, morula continues to multiply. The endometrium is now termed the
➢ Large cells tend to collect at the periphery of the decidua (the Latin word for “falling off”),
ball, leaving a fluid space because it will be discarded after the birth
surrounding an inner cell of the child.
mass, at this stage the
structure is called
blastocyst .
➢ Trophoblast cells, form
around the blastocyst.
The outer ring or
trophoblast cells attaches
to uterine endometrium
and become the placenta
and membranes
➢ The inner cell mass,
embryoblast cells, is the
portion that will form the CHORIONIC VILLI
embryo ➢ Once implantation is achieved, the
➢ Contact between the trophoblastic layer of the cells begins to
growing structure and endometrium occurs mature rapidly, as early as the 11th to 12th
approximately 8-10 days after fertilization. day, miniature villi or probing “fingers” termed
➢ After the 3rd of 4th day of free floating, the chorionic villi reach out from the single layer
residue of zona corona and zona pellucida are of cells into the uterine endometrium to begin
shed formation of the placenta.
➢ blastocyst brushes against the rich uterine
endometrium.
➢ It attaches to the surface of the endometrium,
➢
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims
DIFFERENTIATION OF CHORIONIC VILLI
A. CENTRAL CORE of loose connective tissue
surrounded by a double layer of trophoblast cells
➢ Central core contains fetal capillaries which
produces hormones such as, hCG, Human
Placental Lactogen (HPL), estrogen and
progesterone
B. MIDDLE LAYER
➢ The middle layer, the Cytotrophoblast or
Langhans’ layer,
➢ Present as early as 12 days of gestation and
disappears between the 20th to 24 weeks
➢ Protect the growing embryo and fetus from
certain infectious organism such as the
spirochete of syphilis.
➢ Syphilis may cause fetal damage late in
pregnancy, when this layer is no longer
present.
C. OUTER LAYER
➢ Syncytial Layer: give rise to fetal
membranes
1. Amnion: inner membrane which gives
rise to:
▪ Umbilical Cord
▪ Amniotic Sac / Amniotic Fluid
2. Chorion
▪ Placenta
UMBILICAL CORD
Connecting link between fetus and placenta
➢ It is about 53 cm in length and about 2cm thick
➢ Functions:
1. transport O2 and nutrients to the fetus from
the placenta
2. to return waste products from the fetus to the
placenta
➢ There are no pain receptors in the umbilical
cord
➢ The rate of blood flow is rapid (350/ml at term)
➢ In about 20% of all births, a loop of cord is found
around the fetal neck
➢ Contains two arteries and one vein
➢ supported by mucoid material – Wharton’s jelly,
prevents pressure on the artery and vein.
➢ Umbilical vein
- carry blood from the placental villi to the
fetus
➢ Umbilical artery
- carry blood from fetus back to placenta
AMNIOTIC MEMBRANE
➢ the smooth, slippery membrane enclosing
the fluid-filled space that develops around the
embryo (the bag waters) wherein the fetus
floats
➢ Clear, albuminous fluid, in which the baby
floats
➢ Begins to form at 11-15 weeks of gestation
➢ Slightly Alkaline pH 7.2:
➢ can be tested when membranes rupture to
distinguish from urine
Serves as the following purposes
1. Protection: shields the fetus
2. against blows or pressure on the
3. Abdomen, sudden changes in temp.
4. Diagnosis: meconium stain means fetal
distress
5. Fetal descend: produce prostaglandin
6. Which can cause uterine contraction and’
Initiate labor.
➢ Near term amniotic fluid is clear , colorless
with little white specks of vernix caseosa
➢ Produce at rate of 800 to 1,200ml in 24h by
the 4th lunar month, urine is added is added
to the amount of amniotic fluid
➢ Derived from maternal serum and fetal urine.
➢ Amniotic fluid is constantly being newly
formed and reabsorbed
➢ The fetus continually swallows the fluid
→ fetal intestine → fetal bloodstream
→umbilical arteries exchange it across the
placenta
IMPLICATION
Polyhydramios:
▪ more than 1500ml of amniotic fluid stems from
inability of the fetus to swallow amniotic
fluid rapidly, as in tracheoesophageal fistula,
esophageal atresia
▪ Also tend to occur in woman with DM,
because hyperglycemia causes excessive fluid
shift into the amniotic cavity.
Tracheoesophageal Fistula
Esophageal Atresia
Anencephaly
CHORION
➢ Together with the decidua basalis, give rise
placenta which starts to form at 8 weeks
gestation
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims
Placenta (latin word for pancake)
➢ Grow from a few identifiable cells at the
beginning of pregnancy to an organs 15cm to
20cm in diameter and 2-3 cm in depth at term.
➢ It grows parallel that of that of the fetus
➢ It covers about half the surface area of the
internal uterus
➢ It serves as the fetal lungs, kidneys, and
gastrointestinal tract and a separate endocrine
organ throughout pregnancy
➢ Transient organ allowing passage of
nutrients and waste materials between mother
and fetus as well as oxygen
➢ In mature placenta, there are as many as 30
separate segments, called cotyledons
SCHULTZE MECHANISM : Fetal Side
▪ The placenta separates in the center and
folds in on itself as it descends into the lower
part of the uterus.
DUNCAN MECHANISM : Maternal Side
▪ Separation starts at the lower edge of the
placenta lateral border separates
PLACENTA CIRCULATION
➢ As early as the 12th day of pregnancy, maternal
blood begins to collect in the intervillous spaces
of the uterine endometrium surrounding the
chorionic vili.
➢ By the 3rd week, oxygen and nutrients diffuse
from the maternal blood through the cell layers of
the chorionic villi to the villi capillaries
➢ By then nutrients is transported to embryo
➢ The is no direct exchange of blood between
the embryo and the mother during pregnancy.
➢ Almost all drugs drugs are able to cross into the
fetal circulation
➢ Alcohol perfuses across the placenta
➢ Placental circulation, is most efficient when
mother lies on her left side.
PLACENTA : ENDOCRINE FUNCTION
Placenta produces important hormone, through out
pregnancy(before 8 weeks, corpus luteum is the
one producing producing this hormone.
1. Human Chorionic Gonadotropin
▪ The first hormone produce by the placenta
▪ Can be found in maternal blood and maternal
urine .
▪ This is the basis for pregnancy test. It is
present from 40th day through 100 day,
reaching its peak on the 60th day.
▪ The purpose is to act as a fail-safe
measure to ensure that the corpus leteum of
the ovary continues to produce estrogen and
progesterone
▪ HCG play a role in suppressing the
maternal immunologic response so that
placental tissue is not rejected
▪ At 8th week of pregnancy, the outer layer of
cells of developing placenta begins to
produce progesterone, at this point , the
corpus leteum is no longer needed, hcg level
begins to decrease.
2. Estrogen
▪ contributes to the mother’s mammary gland
development in preparation for lactation and
stimulates uterine growth to accommodate
the developing fetus.
▪ “hormone of women”
3. Progesterone
▪ “Hormone of mother”
▪ Necessary to maintain endometrial lining
▪ it is present in serum as the early 4th week
of pregnancy by corpus letuem
▪ At about 8th-12th week, placenta synthesis
begins , the level of progesterone rises
progressively during the remainder of
pregnancy
▪ It also reduce contractility of the uterine
musculature during pregnancy
high levels of estrogen and progesterone
during gestation also function to suppress the
secretion of prolactin from the anterior
pituitary gland, thereby delaying the onset of
lactation until after delivery of the placenta,
when the estrogen and progesterone levels
drops significantly .
4. Human Placental Lactogen or Hormone
Chorionic Somatomammotropin
▪ Is a hormone with both growth promoting and
lactogenic (milk producing property)
▪ also regulates maternal glucose,protein and
fat levels so the adequate amounts of these
nutrients are also available to the fetus,
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims

NURSING CARE DURING FETAL DEVELOPMENT

FETAL CIRCULATION FETAL CIRCULATION DIAGRAM

Major Differences in Fetal Circulation
• Exchange of gases takes place in the placenta ,
not in fetal lungs
• Because, little blood goes to the fetal lungs,
pressure in the left side of the heart is less than
the pressure in the right side of fetal heart
PRESENCE OF ACCESSORY ORGAN
1. FORAMEN OVALE
➢ allows blood to flow from
right atrium to left atrium,
bypassing lungs;
➢ closes functionally at birth
because of increased
pressure in left atrium;
anatomic closure may
take several weeks to
several months 1. Blood from placenta
2. DUCTUS VENOSUS 2. Umbilical vein
➢ connects umbilical vein 3. Ductus venosus/small amount of blood
and inferior vena cava; liver
bypassing portal 4. Fetal inferior vena cava
circulation; closes after 5. RA
birth 6. Foramen Ovale
3. DUCTUS 7. LA to LV
ARTERIOSUS 8. Aorta
➢ allows blood flow from 9. Some blood from head and upper
pulmonary artery to aorta, extremities return to the heart
bypassing fetal lungs; 10. RA
closes after delivery. 11. Tricuspid Valve
4. UMBILICAL VEIN 12. LV
➢ carries the most oxygenated blood 13. Pulmonary artery/little blood goes to the
5. UMBILICAL ARTERY lungs
➢ carries deoxygenated blood 14. Ductus arteriosus
15. Descending aorta
REVIEW OF ADULT CIRCULATION 16. Blood return to placenta
1. Unoxygenated blood from the different parts
of the body empty into the inferior and NEONATAL CIRCULATION
superior vena cava ➢ As soon as breathing has been initiated,
2. RA oxygenation now takes place in the lungs
3. Tricuspid valve ➢ The change from neonatal circulation therefore,
4. Pulmonary Artery is associated with lung expansion
5. Lungs (oxygenation) Since oxygenation is now in the lungs:
6. Oxygenated blood empty into Pulmonary Pressure on the left side of the heart is now
Vein higher on the right , resulting in:
7. LA • Closure of the foramen ovale
8. MITRAL VALVE • Change of the ductus arteriosus to
9. LV ligamentum arteriosus
10. Aorta to different parts of the body
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims

• The decrease pressure on the right side of • Circulatory system

the newborn’s heart changes the ductus • Blood cells
venosus to ligamentum venosum • Lymph vessels
• Since no more blood goes through the ENTODERM
umbilical and artery, these vessels will Lining of pericardial, pleura, and peritoneal
atrophy and degenerates cavities
FETAL GROWTH • Lining of the gastrointestinal tract
Stages of human prenatal development • Respiratory tract
a. Zygote: first 12-14 days • Tonsils
b. Embryo: 15th days-8th week • Parathyroid
c. Fetus: 8th week to time of birth • Thyroid
• Thymus
ZYGOTE GROWTH • Lower urinary system(bladder urethra
• From the beginning of fetal growth, development
proceeds in a cephalocaudal (head-to-tail) IMPLICATIONS: Knowing which structure arises
direction. from each germ layer is important, because
coexisting congenital defects found in newborn
usually arises from same germ layer
Example: heart and kidney defects are commonly
seen together

ORGANOGENESIS
CARDIOVASCULAR SYSTEM
➢ 1 of the first systems to become
functional in intrauterine
➢ 16th day of life- single heart tube (from the
FETAL GROWTH & DEVELOPMENT joining of simple blood cells and the walls of
FIRST LUNAR MONTH the yolk sac)
A. Germ Layers differentiates by the second ➢ 24th day- beating heart
week. Organ systems develop from the ➢ 6th or 7th week- septum is develop that divides
three primary germ layers: the heart into chambers
1. Ectoderm ➢ 7th wk- heart valves developed
2. Mesoderm ➢ Heart beat heard by doppler at 10th to 12th
3. Endoderm weeks of preg;
➢ Heart Rate is affected by fetal O2 level, body
ECTODERM activity, circulating blood vol
Central Nervous System (brain and spinal cord) FETAL HEMOGLOBIN
• Peripheral nervous system ➢ Different from adult
• Skin,hair ,nails ➢ Composition: 2 alpha and 2 gamma,
• Sebaceous gland ➢ in adult : 2 gamma and 2 beta
• Sense organs ➢ Greater affinity to O2
• Mucous membrane of anus,mouth and nose ➢ At birth, Hb – 17g/dl, adult 11g/dl
• Toothe enamel RESPIRATORY SYSTEM
• Mammary gland ➢ 3 wk of intrauterine life, respiratory and
rd
MESODERM digestive tracts exist as a single tube
Supporting Structures of the body (connective ➢ End of 4th wk, a septum begins to divide the
tissue, bones, cartilage, muscle, ligaments, & esophagus from the trachea, lung buds
tendons) appear on the trachea
• Upper portion of the urinary system ➢ 24th and 28th week, alveoli and capillaries
• Reproductive system form
• Heart
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims

➢ Spontaneous respiratory movements begin ENDOCRINE SYSTEM

at 3 months of preg
➢ Surfactant is formed and excreted by the
alveolar cells at 24th wk of pregnancy
SURFACTANT
• is a phospholipid substance
• It decrease alveolar surface tension on
expiration, preventing lung collapse and
improving the infant’s ability to maintain
respirations in the extrauterine life
• Has two components: lecithin (L) and
sphyngomyelin (S)
• 35 weeks L/S ratio is 2:1
• Amniocentesis: analysis of L/S ratio is the
primary test for lung maturity
• Lack of surfactant is associated with
development of respiratory distress
syndrome
• Any interference with blood supply to the
fetus(hypertension) enhances the
development of surfactant.
• RDS-disease of premature, they were
delivered before the lung develop lung
surfacted resulting to lung collapse
• Placental insufficiency is a type of stress
increasing steroid level in the fetus, increase
steroid level can hurry alveolar maturation
NERVOUS SYSTEM
➢ 3 and 4th weeks of life, there is an active
rd
➢ Fetal pancreas produces insulin needed by
the fetus
➢ Thyroid and parathyroid glands play vital
roles in metabolic function and calcium
balance
DIGESTIVE SYSTEM
➢ 4th week, the digestive tract separates from
the respiratory tract
➢ Solid tubes initially then canalizes to become
patent
➢ Endothelial cells proliferates and occluding
the lumen, then recanalization occurs--
>failure to do so, atresia or stenosis develops
➢ 6th weeks, Because of rapid intestinal growth,
the abdomen becomes too small to contain
the intestine.
➢ A portion of the intestine, guided by a vitelline
membrane (a part of a yolk sac)is pushed at
the base of umbilicus, where it remains until
about 10 weeks .
➢ When the abdominal cavity has grown large
enough to accommodate all of the intestinal
mass, intestine returns in abdominal cavity.
➢ If any intestinal coils remain outside the
abdomen in the base of the umbilical
cord, omphalocoele will result

formation of the nervous system and sense

organs.
➢ “Dizziness” is said to be the earliest sign of
pregnancy, because of the depletion of the
mother’s glucose stores which the embryo
needs for brain development.
➢ Neural plate by 3rd wk, develop into neural
tube→ CNS (brain and spinal cord), and
neural crest→ Peripheral Nervous System ➢ Gastroschisis will result if the original
➢ The eye and ear develop as projections of the midline fusion is incomplete.
original neural tubes.
➢ By 24 weeks, the ear is capable of
responding to sound, eyes exhibit pupillary
reaction.
➢ Lack of folic acid may result to spinal cord
disorders.
➢ Develop during the third and 4th week just like
the circulatory system
➢ Hypoglycemia is the cause of dizziness
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims
➢ Meconium is formed at 16th week,
consists of cellular waste, bile, fats,
mucoproteins, mucopolysaccharides and
portions of vernix caseosa.
➢ Meconium is a sticky in consistency,
appears black or dark green
➢ The gastro intestinal tract is sterile
before birth. Because the vitamin k is
synthesized by the action of bacteria in the
intestine, vitamin k levels are low in the
newborn.
MUSCULOSKELETAL SYSTEM
➢ 1 2 wks, cartilage provide support and
st
position
➢ 11th wk, fetus can be seen to move
➢ 20th week mother can feel the fetal
movement.
➢ Ossification begins about the 12th wk and
continue all through fetal life.
REPRODUCTIVE SYSTEM
➢ Child’s sex is determined at the concepcion
➢ 6th wk, gonad forms
➢ If testes form, testosterone is secreted,
influencing the development of male organ,
absence of testosterone female organ is
formed
➢ 34th to 38th week testes descend into the
scrotal sac.
URINARY SYSTEM
➢ Kidneys are present are present as
early as the end of 4th week, but they are
not essential before birth
➢ Urine is formed by the 12th wk and is
excreted into the amniotic fluid by the 16th
wk of gestation
➢ At term 500ml of urine per day is formed
INTEGUMENTARY SYSTEM
➢ Skin of fetus appears thin and almost
translucent until subcutaneous fat begins to
be deposited at about 36 wks
➢ Covered by downy hair and vernix
caseosa
MILESTONES OF FETAL GROWTH AND
DEVELOPMENT
End of 4th Gestational Week (base on gestatiotan;
week)
• Length: 0.75 to 1cm
• Weight: 400mg
• The spinal cord is formed and fused at the
midpoint
• Wings that will form the body are folded
forward to fuse at midline
• Head folds forward and becomes prominent
, representing about1/3 of the entire
structure
• The back is bent so that the head almost
touches the tip of the tail
• The heart appears as prominent bulge on
the anterior surface
• Arms and legs are budlike structure
• Eyes,ears and nose are discernible
End of 8th Week
• Length : 2:5 cm (1 in )
• Weight:20g
• Organogenesis is complete
• The heart, with septum and valves, is
beating rhythmically
• Facial features are definitely discernible
• Arms and legs have developed
• External genitalia are present, but sex is not
distinguishable by simple observation
• The primitive tail is regressing.
• Abdomen appears large because the fetal
intestine is growing rapidly.
End of 12th Gestational Week (FIRST
TRIMESTER)
• Length: 7-8 cm
• Weight: 45 g
• Nail beds are forming on fingers and toes
• Spontaneous movements are possible,
although they are usually too faint to be felt
by the mother.
• Bone ossification centers are forming
• Tooth buds are present
• Sex is distinguishable by outward
appearance
• Kidney secretion has begun, although urine
may not yet be evident in amniotic fluid.
• Heartbeat is audible through doppler
technology
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims
End of 16TH Gestational Week
• Length: 10 to 17 cm
• Weight: 55 to 120 g
• Fetal heart sound are audible with an
ordinary stethoscope
• Lanugo is well formed
• Liver and pancreas is well functioning
• Fetus actively swallows amniotic fluid,
demonstrating an intact but uncoordinated
swallowing reflex, urine is present in
amniotic fluid.
• Sex can be determined by ultrasonography
End of 20th Gestational Week
• Length: 25 cm
• Weight: 223 g
• Spontaneous fetal movements can be
sensed by the mother
• Antibody production is possible
• Hair forms, extending to include eyebrows
and hair on head
• Meconium is present in the upper intestine
• Brown fat, a special fat that will aid in
temperature regulation at birth, begins to be
formed behind the kidneys, strenum and
posterior neck
• Vernix caseosa, serves as protective
covering during intra uterine life begins to
form
End of 24th Week (SECOND TRIMESTER)
• Length 28 to 36 cm
• Weight: 550gms
• Passive antibody transfer from mother to
fetus probably begins as early as the 20 th
week of gestation
• Meconium is present as far as the rectum
• Active production of lung surfactant begins
• Eyebrow and eyelashes are well defined
• Eyelids, previously fused since the 12th
week, are now open.
• pupils are capable of reacting to light
• Hearing can be demonstrated by response
to sudden sound
End of 28th Gestational Week
• Length: 35 to 38 cm
• Weight: 1,200g
• Lung alveoli begin to mature, and surfactant
can be demonstrated in amniotic fluid
• Testes begin to descend into the scrotal sac
from the lower abdominal activity.
End of 32nd Gestational Week
• Length: 38 t0 43 cm
• Weight: 1,600 g
• Subcutaneous fat begins to be deposited
• Fetus responds by movement to sounds
outside the mother’s body
• Birth position may be assumed
• Iron stores , which provide iron for the time
during which the neonates ingest only milk
after birth, are beginning to be developed
• Fingernails grow to reach the end of
fingertips.
End of 36th Gestational Week
• Length: 42 to 48 cm
• Weight: 1800 to 2,700 g (5 to 6lb)
• Additional amounts of subcutaneous fat are
deposited.
• Sole of the foot has only one or two
crisscross creases, compared with the
crisscross pattern that will be evident at
term.
• Amount of lanugo begin to diminish
• Most babies turn into vertex during this
month
End of 40th Week (THIRD TRIMESTER)
• Length: 48 to 52 cm
• Weight: 3000g (7 to 7.5 lb)
• Fetus kicks actively, hard enough to cause
the mother considerable discomfort
• Vernix caseosa is fully formed.
• Fingernails extend over the finger tips.
• Creases on the sole of the feet cover at
least two third of the surface
CARE OF MOTHER, CHILD, ADOLESCENT
(WELL CLIENT)
RSPB | BSN2C (2023-2024) | Prelims

FOCUS OF DEVELOPMENT
A. FIRST TRIMESTER : Organogenesis
B. SECOND TRIMESTER : continues fetal
growth and development, rapid increase in
fetal length
C. THIRD TRIMESTER : most rapid growth and
development because of rapid deposition of
subcutaneous fats

Almost all organs are completely formed by

about 8 weeks after fertilization (which equals
10 weeks of pregnancy).
The exceptions are the brain and spinal cord,
which continue to mature throughout
pregnancy.
Most malformations occur during the period
when organs are forming. During this period,
the embryo is most vulnerable to the effects
of drugs, radiation, and viruses.
Therefore, a pregnant woman should not be
given any live-virus vaccinations or take any
drugs during this period unless they are
considered essential to protect her health