2.
Maternal and child health nursing is community
FRAMEWORK FOR MATERNAL AND CHILD HEALTH
NURSING
● Maternal and child health nursing can be
visualized within a framework in which nurses,
using the nursing process, nursing theory, and
evidence-based practice, care for families
during childbearing and childrearing years
through 4 phases of health care
○ Health promotion -educate to be
aware of good health
○ Health maintenance -intervene to
maintain health
○ Health restoration - prompt diagnosis
and treatment of illness
○ Health rehabilitation - prevent
further complications: bringing back an
optional state of wellness; to accept
death
GOALS AND PHILOSOPHIES OF MATERNAL AND
CHILD HEALTH NURSING
GOALS
● Primary goal of maternal and child health
nursing care can be stated simply as the
promotion and maintenance of optimal family
health to ensure cycles of optimal childbearing
and childrearing.
● Range of practice includes
○ Pre conceptual health care
○ Care of women during three trimesters
of pregnancy and the puerperium (the
six weeks after childbirth, sometimes
termed the fourth trimester of
pregnancy)
○ Care of children during the prenatal
period (6 weeks before conception to 6
weeks after birth)
○ Care of children from birth through
adolescence
○ Care in settings as varied as the birthing
room, the pediatric intensive care unit,
and the home
PHILOSOPHIES
1. Maternal and child health nursing is family
centered
centered
3. Maternal and child health nursing is
research-oriented
4. Both nursing theory and evidence-based
practice provide a foundation for nursing care
5. A maternal and child health nurse serves as an
advocate to protect the rights of all family
members, including the fetus
6. Maternal and child health nursing includes a
high degree of independent nursing functions
7. Promoting health is an important nursing role
8. Pregnancy or childhood illness can be stressful
and can alter family life in both subtle and
extensive ways
9. personal, cultural, and religious attitudes and
beliefs influence the meaning of illness and its
impact on the family
10. Maternal and child health nursing is a
challenging role for a nurse and is a major
factor in promoting high-level wellness in
families
MATERNAL AND CHILD HEALTH GOALS AND
STANDARDS
● Standard I: Quality of Care. The nurse
systematically evaluates the quality and
effectiveness of nursing practice
● Standard II: Performance Appraisal. The
nurse evaluates his/her own nursing practice in
relation to professional practice standards and
relevant statutes and regulations.
● Standard III: Education. The nurse acquires
and maintains current knowledge in nursing
practice.
● Standard IV: Collegiality. The nurse
contributes to the professional development of
peers, colleagues, and others.
● Standard V: Ethics. The nurse’s decisions and
actions on behalf of patients are determined in
an ethical manner.
● Standard VI: Collaboration. The nurse
collaborates with the patient, significant others,
and health care providers in providing patient
care.
● Standard VII: Research. The nurse uses
research findings in practice.
● Standard VIII: Resource Utilization. The
nurse considers factors related to safety,
effectiveness, and cost in planning and
delivering patient care
● Standard IX: Practice Environment. The nurse
contributes to the environment of care delivery
within the practice settings.
● Standard X: Accountability. The nurse is
professionally and legally accountable for
his/her practice. The professional registered
nurse may delegate to and supervise qualified
personnel who provide patient care.
THEORIES RELATED TO MATERNAL AND CHILD
NURSING
● Patricia Benner
○ Nursing is a caring relationship. Nures
grow from novice to expert as they
practice in clinical settings
● Dorothy Johnson
○ A person comprises subsystems that
must remain in balance for optimal
functioning. Any actual or potential
threat to this system balance is a
nursing concern
● Imogene King
○ Nursing is a process of action, reaction,
interaction, and transaction: needs are
identified based on the client’s social
system, perceptions, and health: the
role of the nurse us to help the client
achieve goal attainment.
● Madeleine Leininger
○ The essence of nursing is care. To
provide transcultural care, the nurse
focuses on the study and analysis of
different cultures with respect to caring
behavior
● Florence Nightingale
○ The role of the nurse is viewed as
changing or structuring elements of the
environment such as ventilation,
temperature, odor, noise, and light to
put the client into best opportunity for
recovery
● Betty Neuman
○ A person is an open system that
interacts with the environment: nursing
is aimed at reducing stressors through
primary, secondary, and tertiary
prevention
● Dorothea Orem
○ The focus of nursing is on the individual;
clients are assessed in terms of ability to
complete self-care. The care given may
be wholly compensatory (client
participates in care), or supportive
education (client performs own care).
● Ida Jean Orlando
○ The focus of the nurse is interaction
with the client; the effectiveness of care
depends on the client’s behavior and the
nurse’s reaction to that behavior. The
client should define his or her own
needs.
● Rosemarie Rizzo Parse
○ Nursing is a human science. Health is a
lived experience. Man-living-health as a
single unit guides practice
● Hildegard Peplau
○ The promotion of health is viewed as
the forward movement of personality;
this is accomplished through an
interpersonal process that includes
orientation, identification, exploitation,
and resolution
● Martha Rogers
○ The purpose of nursing is to move the
client toward optimal health: the nurse
should view the client as a whole and
constantly changing and help people to
interact in the best way possible with
the environment
● Sister Callista Roy
○ The role of the nurse is to aid clients to
adapt to the change caused by illness;
levels of adaption depend on the degree
of environmental change and state of
coping ability; full adaption includes
physiologic interdependence
ROLES AND RESPONSIBILITIES OF A MATERNAL
CHILD NURSE
1. Clinical nurse specialist
2. Case manager
3. Women’s health nurse practitioner
4. Family nurse practitioner
5. Neonatal nurse practitioner
6. Pediatric nurse practitioner
7. Nurse-midwife
THE 17 SUSTAINABLE DEVELOPMENT GOALS (SDGs)
TO TRANSFORM OUR WORLD
● GOAL 1: No poverty
● GOAL 2: Zero Hunger
● GOAL 3: Good health and well-being
 ● GOAL 4: Quality education
PROCESS OF HUMAN REPRODUCTION
● GOAL 5: Gender equality
● GOAL 6: Clean water and sanitation ● Practices and behaviors surrounding human
● GOAL 7: Affordable and clean energy reproduction vary widely across cultures, but in
● GOAL 8: Decent work and economic growth every case it involves sperm, an ovum, a uterus
and a baby
● GOAL 9: Industry, innovation, and infrastructure
● GOAL 10: Reduced inequality MEIOSIS
● GOAL 11: Sustainable cities and communities ● Mitosis
● GOAL 12: Responsible consumption and ○ Identical cell production
production ○ Can repair, grow and replace
● GOAL 13: Climate action ● Meosis
● GOAL 14: Life below water ○ Gametes = reproductive cells
● GOAL 15: Life on land ○ Sperm and egg cell
● GOAL 16: Peace and justice strong institutions ● Diploid cell
● GOAL 17: Partnerships to achieve the goal ○ Parent cell
● Zygote
REPRODUCTIVE AND SEXUAL HEALTH ○ Fertilized cell

● Sperm cell and Egg cells

CONCEPT OF UNITIVE AND PROCREATIVE HEALTH ○ 23 chromosomes which in turn they
● Unitive and Procreative Health have 46 pairs of chromosomes
○ Unitive - a specific type of physical
union, the sexual union of a man and
woman in natural intercourse. This type
of sexual act is in harmony with and
ordered toward procreation
○ Procreation - focuses on the
conceiving and bearing of offspring
○ Procreative health - the moral
obligation of parents to have the
healthiest children through all-natural
and artificial means available

PRINCIPLES OF PROCREATION
● Sex is a search for sensual pleasure and
satisfaction releasing physical and psychic
tensions
● Sex is a search for the completion of the human
person through an intimate personal union of
love expressed by the bodily union for the
achievement of a more complete humanity
● Sex is a social necessity for procreation of
children and their education in the family is so
as to expand the human community and
guarantee its future beyond death Note: every chromosome has a like pair, if the 23rd
● Sex is a symbolic (sacramental) mystery, pair is both XX=female and when it is XY=male
somehow revealing the cosmic order “in short,
this Christian principle is all about pleasure,
love, reproduction, and the sacramental
meaning of sex
 and chemicals - preganancy category
MECHANISM OF HEREDITY
drugs
● When a sperm cell penetrates the ovum;s
barrier, its 23 chromosomes fuse with the COMMON TEST FOR DETERMINATION OF GENETIC
ABNORMALITIES
ovum’s 23 chromosomes, forming a zygote

GOALS
● Enables individuals or couples to make informed
reproductive decisions
● Provides psychological support for decision
making
● Provides clients with information about the
defect in question
INHERITANCE
● Cmmunicationss to clients the risk for
● Genotype transmitting the defect in question to future
○ Complete set of inherited traits children
○ Set of genes - basic unit of heredity

GOALS
● Phenotype
○ How these traits are expressed e.g. blue ● Karyotyping - a visual display of the
eyes individual’s actual chromosome pattern
○ Observable characteristics
NORMAL

● Homozygous
○ Same alleles
● Heterozygous
○ Different versions of the trait
ABNORMAL

RISK FACTORS FOR GENETIC DISORDER

● Age
○ Risks increases with age - wear and tear
theory
● Race/Ethnic Background
○ Certain disorders occur more frequently
in some ethnic groups compared to
others - incest
● Family history of disease
○ Including those who hae died as part of
the family -undiagnosed chromosomal
disease or non compatible of life babies
● OB History of pregnancy issues
○ like exposure to teratogens such as
radiation, certain drugs viruses toxins
● Heterozygote screening
○ Is directed at detecting clinically normal
carriers of a disease- causing mutant
gene particularly in people of ethnic
groups with high frequency of the
mutant gene under investigation
● Maternal serum alpha-fetoprotein
(MSAFO)
○ Screen is done when an open neural
tube is suspected.
○ Alpha-fetoprotein - glycoprotein = fetal
liver, detectable in the maternal blood
during 13-32 weeks of pregnancy ( the
safest is 15 weeks)
○ If glycoprotein levels go beyond
10ng/ml -15ng/ml the fetus will be
suspected of neural tube disorder
○ If glycoprotein levels are low
-chromosomal disorder such as trisomy
21 (down syndrome)
● Triple screening
○ Analysis of 3 indicators from MSAFP,
ESTRIOL, and Human Chorionic
Gonadotropin
○ Estriol - a type of estrogen
○ HCG - a hormone produced by the
placenta
DIAGNOSTIC TEST
● Chorionic villi sampling - retrieval of
chorionic villi or chromosomal analysis. Done
in the 5th week of pregnancy (earliest), but
mostly done at the 8th to 10th week. The
results of this analysis are extremely accurate
but it cannot detect all inherited diseases
● Amniocentesis - the withdrawal of a sample
of amniotic fluid (2 to 5ml) transabdominally for
genetic analysis. It is usually done with
ultrasound visualization between 14 and 16
weeks
It is also used to analyze skin cells,
alpha-fetoprotein, or acetylcholinesterase. It carries
only a 0.5% risk of spontaneous abortion
● Sonography (Ultrasound) - is a diagnostic
tool that is used to examine structural disorders
of the internal organs, spine, and limbs. It uses
sound waves to create a “picture”
○ Transabdominal
■ Done through your abdomen
■ Lie on your back on an exam
table
■ Technician puts a little bit of gel
on the transducer. The gel helps
the transducer move more
smoothly and prevents air from
getting between the device and
your skin
■ Congenital anomaly scan (CAS)
done through transabdominal
ultrasound, this is done for a
more in-depth scan
○ Transvaginal
■ Also called an endovaginal
ultrasound, is a type of pelvic
ultrasound used to examine
female reproductive organs
■ Including the uterus, fallopian
tubes, ovaries, cervix, and
vagina.
■ Transvaginal means “ through
the vagina” this is an internal
examination
■ The very first ultrasound for the
first trimester is recommended
by doctors due to the fetus being
very small and difficult to get a
clear image using the
transabdominal ultrasound
 may enter maternal circulation
TRANSVAGINAL ULTRASOUND
after the procedure as a result of
oozing at the puncture site

PERCUTANEOUS UMBILICAL BLOOD SAMPLING

○ Fetoscopy
■ Involves the insertion into the
mother’s uterus of a fiberoptic
through a small incision in her
abdomen
■ It is used to inspect for fetal Genetic Disorders
anomalies or confirm an
ultrasound finding, it can also be
Chromosomal Inheritance Disorders
used to remove fetal skin cells
for DNA analysis and used to ● Chromosomal Inheritance Disorders
perform corrective surgery for ○ Autosomal Dominant Disorder (1 gene
congenital anomalies defective to cause the desease)
■ Dwarfism

FETOSCOPY

○ Autosomal Recessive Disorder (atleast 2

defective genes to cause the disease
○ Percutaneous Umbilical Blood Sampling
■ Cystic fibrosis
■ The removal of blood from the
umbilical vein. Blood studies
include karyotyping, complete
blood count (CBC), direct
Coomb’s test, and measurement
of blood gases
■ It uses a technique similar to
amniocentesis to obtain the
blood sample
■ An Rh-negative mother should
be given RhoGAM because blood
 ○ X-Linked Dominant Disorder
Autosoma Recessivel Disorder (ARD)
■ Sickle-cell disease
● Only 1,500 identified ARDs’
● Enzymatic Problems (Internal problems such as
organ issues, not visible on the outside)
● Disease will only occur if there is 2 defective
genes

Chromosomal Abnormality Disorders

● Numeric Abnormality
○ Klinefelter Syndrome - a disorder
where men are born with an extra X
(XXY) chromosome i.e. males with this
○ X-Linked Recessive Disorder
disorder will have female characteristics
■ Hemophilia
such as ( enlarged breast, reduced body
hair, and reduced muscle mass)

○ Turner Syndrome - a disorder that

affects females, where one of the X
chromosomes is meaning i.e from the
normal (XX) it has only one (X). this
○ Multifactorial Inheritance
disorder cause a variety of medical and
■ Cleft lip palate
developmental problems such as short
● Note: Most Asians are Rh+, it’s very seldom for
height, abnormal physic, undevelop
Asians to be RH-
ovaries and heart defect (Coarctation of
aorta)
Autosomal Dominant Disorder (ADD)
● 1 defective gene (Dominant) = disorder
● More than 3000 identified autosomal disorder
(e.g. dwarfism (very common) but only a few
can be seen, because if a baby has 2 or more
defective genes, meaning the baby is not
compatible of life (DD =X life)
● Structural Defects ( such undeveloped brain,
heart, etc.)
● Two types
○ Homozygous - 2 defective genes
○ Heterozygous - 1 healthy gene + 1
dominant defective gene
 ANATOMY AND PHYSIOLOGY OF THE MALE
● Structural Disorder REPRODUCTIVE SYSTEM
○ Translocation - a change in location. It
● Penis
often refers to genetics, when part of a
○ Is the male organ of copulation
chromosome is transferred to another
chromosome. Chromosomes are
structures that carry genes, our units of
heredity. When this type of translocation
occurs, it can cause flaws in
chromosomes

Nursing Process
● Assessment
○ Health History - should focus on
determining the couple’s risk for having
a baby with an inherited disorder:
■ Genetic history
■ Ethnic background
■ General medical history EXTERNAL STRUCTURES
■ Mother’s age ● The cylindrical shaft consists of the following:
○ Laboratory and Diagnostic studies ○ Corpora cavernosa
● Diagnosis ■ Two lateral column of erectile
○ Knowledge deficit tissue (corpora cavernosa)
○ Decisional Conflict ○ Corpus spongiosum
○ Anticipatory Grieving ■ A column of erectile tissue on
the underside of the penis
● Planning and outcome Identification (corpus spongiosum) that
○ The couple will receive education about encases the urethra
genetic problems that may affect their
children including risks for having a child
with a problem and treatment options
for the particular problem
○ The couple will receive emotional
support throughout the genetic
screening test
● Evaluation
○ The couple states that they received
adequate information about patterns of
inheritance, their risk in having a child
with an inherited disorder, information
concerning the disorder itself, and
information about treatments and
available resources
○ The couple demonstrates positive coping
skills and states that they are able to
make a reasonable choice about the
outcome of genetic testing and
counseling
 ERECT: TRANSVERSE VIEW

FLACCID: LATERAL VIEW

● The cylindrical shaft consists of the following:

○ Glans penis
■ Cone-shaped expansion of the
corpus spongiosum that is highly
sensitive to sexual stumulus
○ Prepuce or foreskin
■ A skin flap that cover the glans
FLACCID: TRANSVERSE VIEW
penis in uncercumcised men

ERECT: LATERAL VIEW

● Scrotum
○ A pouch hanging below the penis that
contains the testes. internally, the
medical septum divides the scrotum into
two sacs each of which contains a
testicle

● Ejaculatory duct
○ Is the canal formed by the union of the
vas deferens and the excretory duct of
the seminal vesicle. It enters the urethra
at the prostate gland

INTERNAL STRUCTURES
● Testes
○ Are two solid ovoid organs 4 to 5cm
long, divided into lobes containing
seminiferous tubules. The two functions
of the testes are the production of
testosterone and spermatogenesis
(production of sperm)
● Epididymis ● Urethra
○ Is a tubular sac located next to each ○ Is the passageway for urine and semen
testis that is a reservoir for sperm that extends from the bladder to the
storage and maturation. It can extend urethral meatus
10-20ft; 2-4 weeks of sperm maturation
● Vas deferens
○ Is a duct extending from the epididymis
to the ejaculatory duct which provides a
passageway for sperm. It extends to 16
inches long
○ This is also where “vasectomy” is done,
an elective surgical procedure for male
sterilization or permanent contraception.
During the procedure, the male vasa
deferentia are cut and tied or sealed so
as to prevent sperm from entering the
urethra and thereby prevent fertilization ● Seminal vesicles
of a female through sexual intercourse. ○ Located behind the bladder and in front
of the rectum, deliver secretions to the
urethra through the ejaculatory duct. It
 is 2 inches: and secretes alkaline fluid
and fructose or known as “semen”
MALE BREAST

● Prostate gland ● Male mammary tissue

○ Surround the base of the urethra and
the ejaculatory duct, secrets a clear fluid
with a slightly acid pH rich in acid
phosphatase, citric acid, zinc, and
proteolytic enzymes. It is shaped like a
walnut.
○ Remains dormant throughout life, but
the breasts are a site of sexual
excitation and arousal
○ Although rare (accounting for less than
1% of all breast cancers in the United
States), male breast cancer occur when
frequently enough to warrant routine
inspection of the breasts for dimpling,
discharge or nipple inversion

● Cowper’s gland
○ Also termed as Bulbourethal gland; 2
pea-sized structure that lies at the base
of the prostate gland and either side of
the membranous urethra. They produce SEMEN
a clear alkaline mucinous substance that ● A thick, whitish fluid ejaculated by the man
lubricates the urethra and coats its during orgasm
surface ● Contains spermatozoa (sperm) and
fructose-rich nutrients
● During ejaculation, semen receives
contributions of fluid from the seminal vesicles
and the prostate gland
● Alkaline (average pH 7.5) -because when the
semen will become acidic, this will kill the
sperm cells due to the vagina being acidic
● Average amount released during ejaculation is
2.5 to 3.5 ml

NEUROHORMONAL CONTROL OF THE MALE

REPRODUCTIVE SYSTEM
● Hypothalamus
○ Stimulates the pituitary gland to
produce Follicle Stimulation
Hormone (FSH) and Luteinizing
Hormone (LH)
 ○ FSH stimulates germ cells within the ● Spermatogenesis
testes to manufacture sperm -–to ○ “Sperm production”
stimulate for production and maturation ■ Occurs continually after puberty,
of egg cells (female repro) providing large numbers of
○ LH - stimulates the production of sperm for unlimited ejaculations
testosterone in the testes. Although LH during the mature life span.
stimulates the Leydig cells to produce ○ Spermatozoa - are released from the
testosterone from cholesterol, epithelial wall of the seminiferous
testosterone inhibits the secretion of LH tubules. Meiosis occurs during the
by the anterior pituitary gland process, and the number of
chromosomes in each cell is reduced by
one-half (Haploid number)
○ Spermatogenesis is a heat-sensitive
process; the 2’ to 3’ F difference
between scrotal and abdominal
temperatures allows spermatogenesis to
proceed in the cooler environment
○ The entire period of spermatogenesis
from terminal cell to mature sperm,
takes about 75 days
● Testosterone
○ One of the several androgens (and most
SPERM PRODUCTION DIAGRAM
potent) produced in the testes, is
responsible for the development of
secondary sex characteristics at puberty
○ Production occurs in the interstitial
Leydig cells in the seminiferous tubules.
Leydig cells are abundant in the
newborn and pubescent boy, and
testosterone is abundant during these
periods
○ Testosterone production slows after 40
years of age: by 80 years of age,
production is only about one-fifth of
peak level

Note: Leydig cells - are the primary source of

testosterone or androgens in males. This ● Semen
physiology allows them to play a crucial role in ○ 60% - Prostate gland
many vital physiological processes in males, ○ 30% - Seminal vesicle
including sperm production or spermatogenesis, ○ 5% - Epididymis
controlling sexual development, and ○ 5% - Bulbourethral gland
maintaining secondary sexual characteristics ○ 3-5cc (1tsp) per ejaculation
and behaviors. SPERM PATHWAY
● Spermatozoa
○ Produced by the testicles
○ 40-80 million per cc of semen
○ 300- 500 million per ejaculation
○ Mature after 64 days
patient to submit herself for a medical check-up
for prompt diagnosis of an illness, the following
phase of health care applies
a. Health restoration
7. Among all the 17 SDGs, MCN belongs to what
goal?
a. Good health and well-being

Evaluate the quality of Quality care

nursing practice

Evaluate one’s own Performance Appraisal

practice

Acquires and maintains Eduction

knowledge in practice

Work effectively with Collaboration

patient watchers and
other healthcare
providers

use s research finding in Research

practice

Consider factors and cost Resource Utilization

in delivering patient care

Nurses may delegate and Accountability

supervise qualified
QUIZ 2 personnel

1. Framework, Goals, & Standards of maternal &

QUIZ 3
child health nursing –all the following is true
except
1. This term refers to the substance which
a. MCN Uses evidence-based practice
can cause harm/ deformity/ abnormal
solely
development of the growing fetus if the
2. The range of practice in MCN starts with the
mother is exposed during pregnancy
care of women before and during the three
a. Teratogens
trimesters of pregnancy and ends after the birth
2. This refers to the visual display of the
of a child
individual’s actual chromosome pattern
a. False
wherein a sample is taken, stained, and
3. In this phase of health care, the nurse should
placed under a microscope
intervene practice of the patient to maintain
a. Karyotyping
health
3. A chorionic villi sampling is the retrieval
a. Maintenance
of chronic villi for chromosomal analysis.
4. The primary goal of MCN is the promotion and
It is mostly/ usually done at how many
maintenance of optimal family health to ensure
wells of pregnancy
a. True
a. 8 to 10 weeks
5. Which of the following is not included in the
4. This term refers to the different versions
roles and responsibilities of a maternal and
of a trait
child health nurse
a. Heterozygous
a. Medical doctor
5. As the age of the mother or father
6. A patient is experiencing cough and cold for 5
increases the risk of getting a child with
days already. When a nurse encourages a
genetic abnormality decreases
 a. False 2. All the following are external structures except
6. The following are necessary for human a. Testicle
reproduction except 3. Testosterone production slows after the age of
40
a. Penis
a. True
7. This term refers to the process of cell 4. The semen has an acidic pH
growth, repair, and replacement of a. False
worn-out ones 5. This is a cone-shaped expansion of the corpus
a. Mitosis spongiosum that is highly sensitive to sexual
8. A child has red hairt like her mother and stimulus
blue eyes like her father. This is due to a. Glans penis
6. This refers to the process of producing sperm
the complete set of inherited traits or
a. Spermatogenesis
set genes which are called? 7. A sperm cell is a thick, whitish fluid ejaculated
a. Genotype by the man during orgasm
9. This carries only a 0.5% risk of a. False
spontaneous abortion
a. Amniocentesis Secrete alkaline fluid and Seminal vesicles
10. The following are products of meiosis fructose
except for
a. Skin cells Passageway for urine Urethra
11. This focuses on the conceiving and Male organ of copulation Penis
bearing of offspring
a. Procreation Passageway for sperm Vas deferens
12. Humans get 2 copies of every gene from
Walnut-shaped that Prostate gland
parents and the 2 copies/ alleles should surround the base of the
always be identical urethra
a. False
13. Sex is a social necessity for the Storage of sperm Epsdidymis
procreation of children to expand the
Pea-sized lies at the base Bulbourethral gland
human community of the prostate
a. True
Canal formed by the Ejaculatory gland
union of vas deferens
Dwarfism Autosomal dominant and the excretory duct of
disorder seminal vesicle
Cystic fibrosis Autosomal recessive
disorder
FEMALE REPRODUCTIVE SYSTEM
Sickle-cell disease X-linked dominant
disorder
EXTERNAL STRUCTURES
Cleft lip Multifactorial inheritance ● Mons veneris / Mons pubis
○ is a mound of fatty tissue over the
Hemophilia X-linked recessive
symphysis pubis that cushions and
disorder
protects the bone
Klinefelter syndrome Numeric abnormality
● Labia majora
Turner syndrome Nurmeric abnormality ○ are the longitudinal fold of pigmented
skin extending from the mons pubis to
the perineum
QUIZ 4 ○ Cushion vaginal area
○ Pigmented
○ Serves as a cushion
1. This structure stimulates the pituitary gland to
produce FSH and LH
a. Hypothalamus
 VAGINA
● Vagina
○ Is the female organ of copulation and
also serves as the birth canal. It is a
tubular,
○ musculomembranous organ that lies
between the rectum and urethra, and
bladder
○ It is 3-4 inches long

● Labia minora
○ Are soft longitudinal skin folds between
the labia majora
● Clitoris
○ Is an erectile tissue located at the upper
end of the labia minora. It is the primary
site of sexual arousal
● Urethral meatus (urethral orifice) ● Uterus (womb)
○ Is a small opening of the urethra. It is ○ Located between the bladder and
located between the clitoris and the rectum and consist of regions the
vaginal orifice for the purpose of
fundus, body (corpus) and cervix
urination
○ Is hollow, musculoar organ with three
● Perimeum
○ Is the area of tissue between the anus muscle layers ( perimetrium,
and vagina; an episiotomy is performed myometrium, and endometrium)
here i.e. where doctors create an
incision during a mother's labor ● Menstruation is the sloughing away of spongy
● Vestibule layers of endometrium with bleeding from tourn
○ Is an almond-shaped area between the
vessels
labia minora containing the vaginal
introitus, hymen, Bartholin glands ● Environment for pregnancy: the meebryo and
● Hymen fetus develop in the uterus after fertilization
○ Is a membranous tissue ringing the ● Labor consists of powerful contractions of the
vaginal introitus muscular uterin wall that result in expulsion of
the fetus –which results to the delivery
● Uterine ligaments
○ Broad and round ligaments provide
upper support for the uterus
 ● Cervix
● Cardinal, pubocervical, and uterosacral ○ Is a cylinder-shaped neck of tissue that
ligaments are suspensory and provide middle connects the vagina and uterus. Located
support at the lower most portion of the uterus
● Pelvic muscular floor ligaments provide lower the cervix is comeposed primarily of
support fibromuscular tissue

● Fallopian tube (oviducts)

○ Extend from the upper out angles of the
uterus and end near the ovary. It is 4
inches long. These tubes serve as the
passageway fro the ovum to travel from
the uterus to the ovary
○ Has three segments
■ Infundibulum - an expanded
funnel near the ovary

ACCESSORY GLANDS

● Breast ( mammary gland)

● Ampulla - middle segment ○ Specialized sebaceous glands that
● Isthmus - a short segment between produce milk after childbirth (lactation)
ampulla and uterine wall

VAGINA
● Ovaries
○ Are 2 almond-shaped female sex glands ● Nipple
located on each side of the uterus. ○ Is a raised, pigmented area of the
○ The two functions are breast
■ ovulation - release of ovum
■ Secretion of hormones ● Areola
-estrogen and progesterone ○ Is a pigmented skin around the nipple
● Montgomery tubercles ● Physical changes in breast size and activity are
○ Are sebaceous glands of the areola at a minimum 5 to 7 days after menstruation
stops; this is the best time to detect pathologic
changes through breast self examination
● Bartholin or Vilvovaginal gland ( female
counter part of the cowpers glands)
○ Are mucus-secreting glands located on
either side of the vaginal orifice

● Glandular tissue
○ Parenchyma is composed of acini ( milk
producing) cells that cluster in groups of
15 to 20 to form the lobes of the breast

● Lactiferous ducts or sinuses

○ form passageways for the lobes to the
nipple ○ Skene or paraurethral glands
● Fibrous tissue ○ Are small mucus screting glands that
○ Also called cooper ligaments, provide open into the posterior wall of the
support to the mammary glands urinary meatus and lubricate the vagina
● Aduoise and fibrous tissue (stroma)
○ provide the relative size and consistency
of the breast

● Pelvis
○ A bony ring in the lower portion of the
● The breast change in size and nodularity in the
trunk. It consists of three parts (ilium,
response to cyclic ovarian hormonal changes,
ischium, and pubis) and four bones (
including
two innominate bones or hipbones,
○ Estrogen stimulation
sacrum, and coccyx)
■ Which produces tenderness
○ Pelvic bones are held together by four
○ Progesterone (Postovulation) which
joints (articulations) - symphysis pubis,
cause increased tenderness and breast
two sacroiliac, and sacrococcygeal.
enlardement
Fibrocartilage between these joints
provides mobility
 OOGENESIS
● The production or development of an ovum

● Types of pelvis
○ Gynecoid
■ The typical female pelvis with a
rounded inlet
○ Antherpoid
■ Is an “apelike” pelvis with an
oval inlet
○ Android
■ Normal male pelvis with a
heart-shaped inlet
○ Platypeloid
■ Is a flat, female type pelvis with
a transverse oval inlet

● Pelvimetry
○ (The process of measuring the internal Physiology of Menstrual Cycle
or external pelvis)
○ Is performed with radiography or by
internal examination
● Menarche ● Progesterone - inhibits the
○ Onset of menstruation production of
○ Typically occurs between 10 and 13 Luteinizing hormone
○ inhibits uterine motility
years of age
○ facilitate the transport of fertilized
● Menstrual cycle
ovum through fallopian tube
○ Monthly patter of ovulation and ○ increases body temperature after
menstruation ovulation
● Ovulation ○ Stops construction GnR
○ Discharge of a mature ovum from the
ovary ● Prostaglandins - regulate the reproductive
process by stimulating the contractility of the
○ Produces 300,000 to 400,000 oocytes
uterine and other smooth muscles.
per ovary in a lifetime
○ Average cycle is 28 days and a duration
of 3 to 5 days Sexual Response Cycle
● Mittelschmerz ● Phases of Menstrual Cycle
○ one-sided, lower abdominal pain ○ Proliferative/Preovulatory/Follicular
associated with ovulation. It occurs Phase (6-14 days)
midway through a menstrual cycle about
14 days before your next menstrual
period. It doesn’t require medical
attention.
● Menstruation -
○ periodic shedding of blood, mucus, and
epithelial cells from the uterus; average
blood loss is 50 ml (1⁄4 cup); the range
of 30 to 80 ml of blood.

● The ovaries produce mature gametes and ● Ovulatory/Secretory/Luteal/Progestational

secrete the following hormones: Phase(14-15 days) – Peak
○ Estrogen - contributes to the
characteristics of femaleness( female
bodybuilder, breast growth)
■ Increase Estrogen - Thin and
watery
■ Decrease Estrogen - Cervical
mucus will be thick
■ causes hypertrophy of the
myometrium
■ proliferates the endometrium
■ inhibits the production of
follicle-stimulating hormone ● Ischemic Phase ( 16-28 days)
(FSH)
■ increases pH of
cervical mucus causing it
to become
thin and watery (Spinnbarkeit
test)

● Progesterone -hormone of pregnancy

○ Production of Luteinizing
HormoneLH
○ quiets/ decreases the contractility of
the uterus
○ increases endometrial tortuosity
○ increases endometrial secretions
● Menstrual Phase (1-5 days) (an end and a ● Spinnbarkeit Test
beginning)

● Climacteric Period and Menopause

○ Climacteric - a transitional period
during which ovarian function and
hormonal production decline.
○ Menopause - refers to a woman’s last
menstrual period
■ the average age of menopause is
51.4 years.
○ However, it is important to note that
women may ovulate after menopause
and thus can become pregnant
● Endometrial cells - buo2 in blood
● Each ovary release eggs per month
(alternate)

4 Level Concept of Sexuality

1. CNS Response – Hypothalamic-pituitary gland ● SEXUALITY
action (FSH and LH) ○ Maleness and femaleness
2. Ovarian Response (2 phases) – Proliferative ○ Physical
phase ( 1-14 days); Secretory ( 15-22 days) ○ Emotional
3. Endometrial Response ( 4 phases) ○ Social
a. Menstrual phase ( 1- 5 days) ○ Ethical
● SEXUAL STIMULATION
b. Proliferative ( 6 – 14 days)
○ Physical
c. Secretory ( 15-26 days)
○ Psychological
d. Ischemic ( 27 – 28 days)
○ Visual
4. Cervical Mucus Response ( Ovulatory) 15-23
● SEXUAL RESPONSE
days
○ Erection/Foreplay
a. Before Ovulation –
○ Coitus (sex/sexual intercourse)
Spinnbarkeit/Spinnbarkheit;
○ Ejaculation/Orgasm
mittelschmerz
b. After Ovulation
Principles Relevant to Sexuality
● Different way to know if you are fertile 1. Human sexuality provides for the reproduction
○ Fern Test- Using Cervical Mucus of the human species.
2. Sexual fulfillment is a basic human need.
3. Sexuality pervades virtually every aspect of
life from birth to death.
4. All human cultures have sanctions, often legal
as well as moral, controlling expressions of
sexual drive.
5. Individuals have strong cultural, religious, and
ethical convictions regarding the expression of
human sexuality.
6. Moral values concerning appropriate sexual
behaviors have undergone considerable
liberalizations in most western cultures in
recent years.
7. Successful gender identification in early
childhood is important for an individual’s
health and well being throughout life.
8. Actual or potential damage to the integrity of
an individual’s sex organ poses a considerable
threat to his self-esteem.
Principles of Procreations
1. Sex is a search for sensual pleasure and
satisfaction, releasing physical and psychic
tensions.
2. Sex is a search for the completion of the
human person through an intimate personal
union of love expressed by the bodily union for
the achievement of more complete humanity.
3. Sex is a social necessity for the procreation of
children and their education in the family so as
to expand the human community and
guarantee its future beyond death.
4. Sex is a symbolic (sacramental) mystery,
somehow revealing the cosmic order. In short,
this Christian principle is all about pleasure,
love, reproduction, and the sacramental
meaning of sex.
Human Sexuality
1. The ways in which we experience and express
ourselves as sexual beings.
2. A person's sexuality encompasses the complex
of emotions, attitude preferences, and
behaviors r/t expression of sexual self and
eroticism.
3. Nurses commonly are resource people for
clients seeking information r/t human
sexuality and functioning during the
reproductive years.
4. Responsible sexuality involves a commitment
to a relationship, responsible reproductive
health care, and rational decisions about
childbearing.
Developmental Tasks of Sexual Identity
1. Gender Identity- is a person’s sense of his or
her masculinity or femininity
2. Gender Roles/ Sex Role Standards - are
composed of behaviors, attributes, and
attitudes an individual conveys about being
male or female.
3. Sexual Partner Preference - may be
HETEROSEXUAL ( opposite sex), HOMOSEXUAL
(same sex), or BISEXUAL ( both), person may
vary during a person’s lifetime and is probably
shaped by a complex interaction of several
factors
SEX
● Latin roots “cut of Divide” ○ SEX meanings:
○ Gender: Male or Female
○ Anatomic Structures: sexual organs
○ Physical activities/Sexual expression
● An individual chooses to give and receive
physical love and gratification.
One’s culture determines acceptable forms of
sexual expression; what’s considered normal
may vary greatly among cultures.
● Acceptable sexual activity includes the
elements of PRIVACY, CONSENT, and LACK OF
FORCE
Sexual Orientation
● Concerns the direction of one’s romantic
interests and erratic attractions towards the
same sex, other sex, or both.
1. HETEROSEXUALITY: finds fulfillment
with a member of the opposite gender.
2. HOMOSEXUALITY: finds sexual
fulfillment with a member of his or her
own sex.
3. BISEXUALITY: Bisexual- achieve sexual
satisfaction from both homosexual and
heterosexual relationships.
4. TRANSEXUALITY: an individual who
although of one biological gender feels
as if he or she should be of the
opposite gender.
● Types of Social Interaction
○ Celibacy - abstinence from sexual
activity
○ Masturbation - self-stimulation for
erotic pleasure
○ Erotic Stimulation - Use of visual
materials such as magazines or photos
Atypical Sexual Variations
● PARAPHILIA - a diagnostic category used by
the American Psychiatric Association to
describes typical patterns of sexual arousal or
behavior that become problematic in the eyes
of the individual or society.
1. FETISHISM-Sexual arousal by the use of certain ○ HR and BP begin to increase
objects or inanimate objects. ○ Generalized muscle tension increases
2. TRANSVESTISM- an individual who dresses to associated with muscle contractions.
take on the role of the
● PLATEAU PHASE
3. opposite sex
4. VOYEURISM- Sexual arousal by looking at ● Women:
another’s body; watching other people who ○ Decrease internal vaginal diameter
are nude, or involved in sexual relations. ○ Labia minora further swell and
5. SADOMASOCHISM- A mutually gratifying darken
sexual, interaction between consenting sex ○ Clitoris retracts
partners in which sexual arousal is associated
○ Nipple further engorged
with infliction and recipient of pain or
humiliation ○ Flushing
6. Sadist - inflicting pain or humiliation on others ○ Increase:HR, BP, muscle tension
7. Masochism - received the pain /desire or need ● Men:
for pain ○ Further penile enlargement, with color
8. PEDOPHILIA - desires sexual pleasure from changes
children ○ Preorgasmic emission may occur from
9. EXHIBITIONISM - sexual arousal from exposing
Cowper glands
genitals to strangers
10. usually men in a public place ○ Testes continue to elevate and
11. FROTTEURISM - sexual arousal by touching or rotate
rubbing other people in sexual ways without ○ Increases: HR, BP, RR,
their consent muscle tension
12. SCATOLOGIA - obscene phone callers and ● ORGASMIC PHASE
makes sexual suggestions or references.
● Women:
Uttering obscenities and sexual provocations
to a non-consenting person. ○ Strong muscular contractions outer
13. COPROPHILIA - sexual arousal/gratification ○ 1/3 of the vagina
from feces; the person may desire to be ○ Uterine muscles contracts
defecated on or to defecate a partner. ○ Flushing
14. UROPHILIA - desire sexual excitement from ○ Increase: RR,BP, HR
urine as when doing “GOLDEN SHOWERS”
● Men:
15. ZOOPHILIA- aroused by fantasies or actual
○ Rhythmic contractions expel semen
sexual contact with an animal.
16. NECROPHILIA- fantasies of or actual sexual ○ Testes at maximum elevation, size and
contact with a dead person. elevation
17. KLISMAPHILIA- sexual arousal is derived from ○ flushing
the use of enemas. ○ increase at its peak: RR, BP, HR
a. Enemas - medication for ○ General loss of voluntary control occurs
leisure
○ Refractory period begins
● RESOLUTION PHASE
Sexual Response Cycle ● Women:
● EXCITEMENT ○ Inner 2/3 of the vagina gradually shrinks
● Female: ○ Cervix dips into the seminal pool
○ Vaginal lubrication ○ Labia minora and majora return to
○ Engorged labia minora/ minor flatten normal state
○ Nipples become erect, breast size ○ Clitoris protrudes
increase ○ Flushing disappears
○ Flushing ○ Muscle relax quickly
○ Overall muscle tension increases ● Men:
● Male: ○ More than 50% of the erection is lost
○ penile erection ○ Testes descend and return to normal
○ Thick and congested scrotal skin size
○ Testes elevate to scrotal sac ○ Nipple erection subsides
○ Some nipple erection ○ Flushing disappears
○ Flushing ○ Normal:RR,HR,BP
 ○ General muscle relaxation occurs

● Sexual concerns r/t pregnancy

○ Altered desire for sex
○ Breasts may be painful to touch
○ Increase amount and odor of vaginal
discharge can be turned off to some
men
○ Other concerns: dyspareunia
○ Other forms of expression:
■ kissing/hugging/ manual genital
stimulation

Pregnancy
● Pregnancy - is the term used to describe the
period in which a fetus develops inside a
woman’s womb or uterus
○ usually lasts about 40 weeks, or just
over 9 months, as measured from the
last menstrual period to delivery.
○ Normal amount of semen/ejaculation:
3.5cc
○ Number of sperm per cc of semen – 40
– 80 million
○ Number of sperm per ejaculation – 300
–500 million
○ Mature ovum is capable of being
fertilized for 12 to 24 hours after
ovulation
○ Sperm is capable of fertilizing for 3 to 4
days after ejaculation
○ Normal lifespan of sperm is 7 days
○ Sperm can reach the ovum in 1 – 5
mins. -Fallopian tube will contract due to
estrogen
○ Sperm must remain in the female
genital tract 4 – 6 hours before they are
capable of fertilizing the ovum
○ Sperm have 22 autosomes and 1 X or Y
sex chromosomes
○ Ova contains 22 autosomes and 1 X sex
chromosomes

Stages/ Process of Pregnancy

1. Fertilization - is the process in which a sperm
penetrates the outer layer of the ovum.
2. Implantation - when the blastocyst attaches to
the endometrium (7 -9 days after fertilization).
3. Pre-placental stage - when the endometrium
becomes highly vascular (week 2)
4. Placental and fetal development -A clearer picture of the process
 ■ - decidua vera – lines the rest
of the uterus
○ It has 3 processes:
1. Apposition
2. Adhesion
3. invasion

Human Development
● Late Blastocyst
○ The cells begin to differentiate into:
-Inner cell mass ( embryo)
-Trophoblast Cells ( attach to the uterus)
■ Trophoblast cells erode the
endometrium of the uterus so
that
■ The Blastocyst burrows into the
uterine wall
■ Endometrium covers the embryo
and the blood supply becomes
established

- Cell Division Process

● IMPLANTATION
○ 50% of zygotes never achieve
implantation
○ Small amount of vaginal spotting is
occasionally present (Implantation
breed)
○ Endometrium turned to decidua:
■ - decidua basalis - directly
under blastocyst
■ - decidua capsularis – covers
blastocyst
● Placenta
○ Respiratory system
○ Renal system 3. Gastrointestinal system
○ Endocrine system:
■ Human chorionic gonadotropin
(HCG)
■ Human placental lactogen
■ Estrogen
■ Progesterone
○ Protective functions
Note: 1st stool of the baby is called
“meconium”
● Umbilical Cord
○ 21 inches long
○ 2 arteries and 1 vein (AVA)
○ Wharton's jelly (makes the umbilical
cord flexible and “un-kinkable”)
○ Transport oxygen, nutrients, minerals,
and waste products
● Amniotic Fluid
○ 500 – 1000 ml inside the amniotic sac
(BOW=Bag of Water)
○ Produced by the amniotic membrane
○ Shields fetus from pressure or blow
○ Maternal and Child Health Nursing | 25
○ Protects fetus from sudden change in
temperature
○ Aids in muscular development
○ Aids in descent
○ Protects umbilical cord from pressure
○ Protects fetus from infection
->500 -1000ML= Normal volume or level of amniotic
fluid
- Urine of the baby adds to the amniotic fluid
volume
- Oligohydramnios = below normal levels of
amniotic fluid
- Polyhydramnios = above normal levels of
amniotic fluid
-> Fetal kidney need to be develop first before the
baby can swallow
->
Focus of Fetal Development
● Fetal Development
○ ZYGOTE - 1st 14 days ( week2)
○ EMBRYO - 3rd to 8th week
○ FETUS - 8th to birth
○ NEWBORN - Delivery; 1st 28 days
○ INFANT - more than the 1st 28 days
● First Trimester (1-3months) -
organogenesis; highest risk for the baby to
develop malformities caused by teratogens
● Second Trimester (4-6 months) - Period of
continued growth and development; Rapid
development
● Third Trimester (7-9 months) - Period of
most rapid growth and development

- BOW composed of 2 layers

- Amnion = Inner layer; produces the
amniotic fluid
- Chorion = Outer layer
 FETAL CIRCULATION

- Shunting = these are shortcuts; faster blood

circulation for the fetus for faster fetal
development
- First organs that will experience
shunting
- Heart
- Liver
- Kidney
- Formen Ovale = opening of 2 atria the right and

left opening ( blood goes through the left opening
first)
We have 3 structures where shunting is most present
-Ductus Venosus ( 1st Shunting)
-Foramen Ovale (2nd Shunting)
-Ductus Arteriosus ( 3rd Shunting)
What happens when the 3 structure mention above
doesn't close? - the baby will be at high risk of
congenital malformations, such as Congenital Heart
Disease (CHD)
F= FETAL
A= ADULT
Common Teratogens
● Teratology
○ Study of abnormal development in
embryos and the causes of congenital
malformations or birth defects
○ May be visible on the surface of the
body or internal to the viscera
○ Congenital malformations account for
approximately 20% of deaths in the
perinatal period
○ Approximately 3% of newborn infants
will have major malformations
○ Another 3% will have malformations
detected later in life.
● Nicotine
○ effect on fetal growth
○ intrauterine growth restriction
○ Heavy cigarette smokers: premature
delivery
○ constricts uterine blood vessels and
causes decreased uterine blood flow
thereby decreasing the supply of oxygen
and nutrients available to the embryo
○ compromises cell growth and may have
an adverse effect on mental
development.
● Alchohol
○ Common abuse by women of
childbearing age.
○ Demonstrate prenatal and postnatal
growth deficiency, mental retardation,
and other malformations subtle but
classical facial features associated with
fetal alcohol syndrome including short
palpebral fissures, maxillary hypoplasia,
a smooth philtrum, and congenital heart
disease
○ Moderate consumption (2 to 3 oz. of
hard liquor per day): fetal alcohol effects
○ Binge drinking: harmful effect on
embryonic brain developments at all
times of gestation.
● Tetracycline: Antibacterial
○ Highly teratogenic: inhibit rapidly
dividing cells
○ Should be avoided whenever possible
but are occasionally used in the third
trimester when they are urgently
needed to treat the mother.
● Retinoic Acid: Anti-acne

○ Type of antibiotic
○ Can cross the placental membrane
○ Deposited in the embryo in bones and
teeth
○ Exposure can result in yellow staining of
the primary or deciduous teeth and
diminished growth of the long bones
● Phenytoin: Anti-compulsive

○ Produce the Fetal Hydantoin Syndrome

consisting of intrauterine growth
retardation, microcephaly, mental
retardation, distal phalangeal
hypoplasia, and specific facial features.

● Antineoplastic Agents: anti-cancer

(Attacks fast-growing cells)

○ Vitamin A derivatives
○ Extremely teratogenic
○ Even at very low doses, oral medications
○ such as isotretinoin, used in the
treatment of acne, are potent
teratogens
○ Critical period of exposure: second to
the fifth week of gestation
○ Most common malformations:
craniofacial dysmorphisms, cleft palate,
thymic aplasia, and neural tube defects.
 ● Congenital Cytomegalovirus

● Tranquilizer Thalidomide: Hypnotic

Agents

○ One of the most famous and notorious

teratogens
○ Hypnotic agent - used widely in Europe
in 1959, after which an estimated 7000
infants were born with the thalidomide
syndrome or meromelia
○ Characteristic features: limb
abnormalities that span from the
absence of the limbs to rudimentary
limbs to abnormally shortened limbs
○ Also causes malformations of other
organs including the absence of the
internal and external ears,
hemangiomas, congenital heart disease,
and congenital urinary tract
malformations
○ The critical period of exposure appears
to be 24 to 36 days after fertilization.
● German Measles
○ Consists of the triad of cataracts, cardiac
malformation, and deafness
○ The earlier in the pregnancy that the
embryo is exposed to maternal rubella,
the greater the likelihood that it will be
affected
○ Most common viral infection of the fetus
○ Infection of the early embryo during the
first trimester most commonly results in
spontaneous termination
○ Exposure later in the pregnancy:
intrauterine growth retardation,
micromelia, chorioretinitis, blindness,
microcephaly, cerebral calcifications,
mental retardation, and
hepatosplenomegaly
● Ionizing Radiation
○ can injure the developing embryo due to
cell death or chromosome injury
○ severity of damage to the embryo
depends on the dose absorbed and the
stage of development at which the
exposure occurs
○ Study of survivors of the Japanese
atomic bombing demonstrated that
exposure at 10 to 18 weeks of
pregnancy is a period of greatest
sensitivity for the developing brain
○ There is no proof that human congenital
malformations have been caused by
diagnostic levels of radiation. However,
attempts are made to minimize
scattered radiation from diagnostic
procedures such as x-rays that are not
near the uterus
○ The standard dose of radiation
associated with a diagnostic x-ray
 produces a minuscule risk to the fetus.
However, all women of childbearing age
are asked if they are pregnant before
any exposure to radiation

● Maternal Medical Conditions

○ also produce teratogenic risks
○ Infants of diabetic mothers have an
increased incidence of congenital heart
disease, renal, gastrointestinal, and
central nervous system malformations
such as neural tube defects
○ Tight glycemic control during the third
to sixth-week post-conception is critical
○ Infants of mothers with phenylketonuria
who are not well controlled and have
high levels of phenylalanine have a
significant risk of mental retardation,
low birth weight, and congenital heart
disease

Pregnancy Risk Categories

Pregnancy

Normal Adaptation in Pregnancy

● Reproductive System
● Uterus
○ Uterine growth and enlargement
Lenght 6.5cms to 32cms

Width 4cms to 24cms

Depth 2.5 cms to 22 cms

Weight 50 gms to 1000gms

Volume ( Blood volume) 1-2ml ( Non-pregnant Lightening- the preparation for labor
state) to 1000ml Pre-term - 37 and below
(pregnancy) Full-term - 38 to 42 weeks
Post - term - above 42 weeks
○ Braxton Hicks contraction - practice
contractions ( Before labor begins, you
might have false labor contractions, also
known as Braxton Hicks contractions.
These irregular uterine contractions are
perfectly normal and might begin in
your second or third trimester. A
contraction is when your uterus tightens
and then relaxes. Contractions are your
body's way of getting ready for real
labor)
○ Becomes globular (4th month)

● Reproductive system:
● Uterus
○ Goodell’s signs ( 4th week) - softening
of the cervix
○ Hegar’s sign (8th week) - softening of
12 weeks ( first 3 months) - organogenesis the lower uterine segment
○ Chadwick’s sign ( 8th to 10th week) -
discoloration of the cervix, including the
vaginal walls; bluish/purplish in color
due to the dilation of the blood vessels
● Ovaries
○ No ovulation
● Vagina
○ More acidic (ph 3.5 to 6)
● Breast
○ Enlarged
○ Increased in Size
○ Darken Areola, nipple
○ Blue veins
○ Montgomery tubercle enlarge

12 weeks - symphysis pubis

16 weeks- in between the symphysis pubis and
umbilicus
36 weeks - xiphoid process: diaphragm compressed
Average growth of the uterus - 1cm per week or
4cm per month

○ Note: Lactation amenorrhea - prevents
periods due to lactation
● Musculoskeletal System
○ Waddling walk
○ Symphysis pubis may separate slightly
■ due to the increased production
of melanocytes
○ chloasma/melasma
■ mask of pregnancy
○ Striae gravidarum
■ due to the stretching of the
abdominal skin (stretch marks)
○ Linea nigra
■ Drakens due to pregnancy
○ Increased perspiration
■ The mother sweats more due to
the increased activity of the body
and increase metabolism

Striae Gravidarum

- With a growing baby, the mother will appear

lordotic (Pride of pregnancy)
Linea Nigra
● Circulatory system
○ Increased blood volume 40% to 50%
○ Physiologic anemia
■ brought about by the rapid
increase of blood plasma
○ Heart is displaced upward
○ Increased cardiac output to 30%
○ Supine hypertension
○ Increased WBC
○ CR &PR increased to 10-15 beat/min.
○ Vaaricosities and edema Telangiectasis

A - Supine
B - Side-lying position
● Gastrointestinal System
● Integumentary System ○ Morning Sickness
○ Increased pigmentation ■ HCG levels go up
 ■ Hyperemesis gravidarum -
Signs of Pregnancy
excessive vomiting during
pregnancy ● Presumptive sings
○ Heartburn ○ Subjective; presuming that the patient is
○ Constipation pregnacy, such as mornign sickness
● Respiratory System ● Probable signs
○ Increased RR ○ Objective cues; these signs are
○ Dyspnea measurable
○ Increased Tidal Volume ● Positive signs
○ Increased vital lung capacity ○ Confirmatory signs
○ Decreased residual Volume Signs of Pregnancy (First Trimester)
● Urinary ● Presumptive signs
○ Urinary frequency ○ Amenorrhea, morning sickness, breast
■ Due to getting compressed changes, fatigue, urinary frequency,
○ Increased GFR enlargement of uterus
■ Capacity of the kidney to filter ● Probable sings
○ Chadwick’s signs, Goodell’s, Hegar’s,
Increase of HCG (+) HGT
● Positive sign
○ Ultrasound result
Signs of Pregnancy (Second Trimester)
● Presumptive signs
○ quickening , skin pigmentation, cloasma,
linea negra, striae gravidarum
● Probable signs
● Endocrine System
○ Enlarged abdomen, Braxton Hick’s,
○ Increased metabolism of CHON and
Ballottement
CHO
● Positive signs
■ Due to both the mother and
○ FHT, Fetal movements, Fetal X-ray
baby needing more nutrients
○ Increased insulin
■ 2nd trimester - insulin resistance

● Weight Gain
Weight distribution

Fetus 7 lbs

Placenta 1 lbs

Amniotic fluid 1.5 lbs

uteus 2 lbs

Blood volme 1 lb
Prenatal Care
Breast 1.5 - 3lbs
● Data gathering
Fluid 2 lbs ● Physical Assessment
● Pelvic Examination
Fats 4 - 6 lbs
● Leopold’s maneuver
Total of 20 -25 lbs ● Fetal Heart tone monitoring
● Laboratory Examinations

Obstetrical Data
● Last Menstrual period (LMP)
○ 1st day of last menstrual period
● Age of Gestation (AOG)
○ By weeks (based on the LMP)
REMEMBER:
STEP 1 - Get the date of LMP ( Last menstrual
period) and DOF (Date of assessment)
STEP 2 - Note the number of days of the month of
the DOF and subtract it to the LMP
STEP 3 - Starting with the LMP write teh consecutive
months with there respective days in the month and
stop when you reach the month of the date of
assessment then sum it all up
STEP 4 - Divide the sum total of Step 3 with 7 and
note dont use calculator in this step due to
inaccuracies ( now if there will be a remainder that is
your days in the weeK)
○ Mc Donald’s Method ( FH/ 4 = in
months)
REMEMBER: Start from the symphysis pubis going
upwards to the fundus ( FH = Fundic Height)
○ Bartholomew’s rule ( relative position
of the uterus in abdominal cavity)
4 Landmarks
- Symphysis pubis
- In between the symphysis pubis and the
umbilicus
- Level of umbilicus
- Xiphoid process
Bathomeus rule = determining the AOG by basin on
the relative position of the uterus in the abdominal
cavity
Note: Not accurate during the 3rd trimester (because
the 36cm is higher than the 40 cm)
● Gravida Para Abortion (GPA)
○ Pregnancy
G ( Gravida) = Number of Pregnancies
P ( Parity) = number of pregnancies that reached its
term or age of viability ( above 20 weeks “ in the
books” or the in the philippines 28 weeks and above)
A (Abortion) = number of pregnancies that did not
reach age of viability ( less than 20 (books) or 28
weeks(philippines))
 ● Term Preterm Abortion Living (TPAL)
○ Person ● Estimated Fetal Weight (EFW)
○ Aka. Johson’s Rule
○ FH - N x K (K is a constant 155)
○ N = 11 ( Not engaged)
○ N = 12 ( Engaged)

T = term - babies that are 38 -42 weeks of age

P = preterm - babies below 28 -37 weeks
A = abortion - babies that didn't reach the age of
viability ( 27 weeks or below)
L = Living - these are babies that are living

REMEMBER:
● Expected Date of Confinement (EDC) - Johnson’s rule =EFW
○ Aka Expected Date of Delivery (EDD) - K is always 155
○ Naegel’s rule (-3 +7 +1) - N depends if Engaged (11) or Not Engage
(11)
- And always read the situation if what unit of
measurement should be used for the final
answer

● Sample Computation

EDC
REMEMBER:
- The format -3 (month) +7 (day) +1 (year)
- By using the LMP subtract the given with -3
+7 +1 while following the format.

AOG in weeks
GPA
TPAL
Physical Assessment of Pregnancy
● Observe for danger signs of pregnancy:
○ Avaginal bleeding
■ Placenta previa - high risk
condition, where in the placenta
inplants it-self below and covers
the cervix ( high risk for
bleeding)
■ Abruptio placenta - premature
separation of the placenta
■ Premature Labor
■ Threatened abortion
increase vaginal discharges
● Notes: Spotting is normal
during labor or near the
date of delivery but not
normal during pre-term
(would indicate the
opening of the cervix)
○ Persistent vomiting
■ Hyperemesis gravidarum -
Excessive vomiting during
pregnancy (only in the first
trimester)
■ Persistent infection
consistent vomiting may be
cause by infections
○ Chills and fever
■ Infection
■ Dehydration
■ Gastroenteritis - due to low
immune system response
○ Sudden escape of fluid from the
vagina - e.g. BOW rupture
■ Note: Operculum = mucus plug
protects the baby from
infections, and if ever the mucus
plug breaks down there will be
massive bleeding
■ Note: Umbilical Cord Prolapse
= is the condition where, when
the BOW ruptures and the
umbilical cord drops out the
patient's vagina and is
recommended for the patient to
be CBR
○ Abdominal or chest pain
■ Ectopic pregnancy - wrong
implantation of the baby ( like
when the baby is implanted in
the uterus and so on )
■ Abrutio placenta - premature
seperation of the placenta
■ Uterine rupture - can be cause
by prolonged labor where
contractions are continuous
■ Pulmonary embolism - (chest
pain) blood clot that formed in
the artery of the lung
○ Swelling of face and fingers
■ Edema - this normal during
pregnancy
- ■ But when swelling is found in the
finger and face this is S/S of
pregnancy induced hypertension
or PIH (Preeclampsia)
○ Rapid weight gain
■ Should not exceed 9 -11 kilos or
20 -25 lbs
○ Flashes of lights or dots before the
eyes
■ One of the signs of severe
preeclampsia
○ Dimness or blurring of vision
■ One of the signs of severe
- preeclampsia
○ Severe headache
■ One of the signs of severe
preeclampsia
 ○ Decrease urine output
■ One of the signs of sever
preeclampsia
- Note: if ever the patient goes thorugh siezures
and displaying the above mention severe
preeclampsia symptoms, the patient is now
experiencing emclampsia
Pelvic Examination
● Internal examination - should not be executed
by untrained staff
● Vaginal speculum
● Transvaginal ultrasound
● Papnicolau (pap smear)
- What happens?
- The nurse will document the whole IE
- DEBPS
- D = DILATION (opening of
the cervix)
- E = EFFACEMENT ( thinness
100%, thin as paper = fully
effeaced)
- B = BAG OF WATER ( intact,
leaking, or ruptured)
- P = PRESENTATION ( part
of thebaby in the cervix,
cephalic, breach)
- S = STATION ( how far down
is the baby’s head)
- First the OB will lubricate his/her
gloves
- second , the OB will inster 2 of her
fingers (Index and Mid finger) around
and will stretch it till it reaches
1-10cm depends on the patients
cervical dilation
VAGINAL SPECULUM
- A tool that is used for properly observing or
visualization of the pelvic organs such the
cervix ( such as checking the condition of the
BOW if ever ruptured that is +pooling where
there would be water on the speculum, if not
that is - pooling)
- Multiple sizes S M L
- Cutobrush (pap smear brush) = use to get a
sample to be sent to the lab
Nursing Procedure 10.1
(Leopold’s Maneuvers)
● Leopold’s maneuvers
○ Are a noninvasive method of assessing
fetal presentation, position, and
attitude. This technique can also be
used to locate the fetal back before
applying the fetal monitor
● Equipment
○ Warm, clean hands
● Procedure
● Fundal Grip
○ Determine presentation
○ Stan beside the patient. Facing her.
place both hands on the uterine fundus
and palpate the contents of the fundus.
If the buttocks are in the fundus
indicating a vertex presentation ( which
is true 96% of the time), you will feel a
soft, irregular object that does not move
easily however, if the head is in the
fundus indicating a breech presentation,
 you will palpate smooth, hard, round, vast majority of cases, you will feel a
mobile object hard round fetal head. If the part moves
easily. It is unengaged. If part is not
FUNDAL GRIP
movable, engagement probably has
occurred. If the breach is present, you
will feel a soft, irregular object.
PALWICK’S GRIP

REMEMBER: If irregular/somewhat round, soft, and

immovable - buttocks of baby. If round, hard,
moveable - head of baby.
- Head comes in contact w cervix: Cephalic
- Any other part (buttocks or foot): Breech
REMEMBER: Palpating for the fetal presentation and
● Umbilical Grip engagement. Engaged - immovable; Unengaged -
○ Place both hands on the maternal moveable. If engaged proceed to station 0, not
abdomen, one on each side. Use one moveable.
hand to support the abdomen while you
palpate the opposite side with the other ● Pelvic Grip
hand. Repeat the procedure so that ○ Begin the last step by turning to face
both sides of the abdomen the woman’s feet. Using the finger pads
of the first three fingers of each hand,
UMBILICAL GRIP
palpate in a downward motion in the
direction of the symphysis pubis. If a
hard bony prominence is felt on the side
opposite the fetal back, you have
located the fetal brow, and the fetus is
in an attitude of flexion. If the bony
prominence is found on the same side
as the fetal back, you are palpating the
occiput, and the fetus is in an attitude of
extension.
PELVIC GRIP
REMEMBER: To palpate the fetal position, locating
the fetal back.
- If irregular in shape you’re palpating the
front side of the baby
- If a rounded shape is felt that is the fetal
back
Doppler, Stethoscope, EFM (External Fetal Monitor)
will be positioned where the fetal back is located.
Giving the point of maximum volume, where fetal
heart tone is properly auscultated. N: 120-160 bpm.

● Pawlick’s Grip REMEMBER: Palpate for fetal attitude or the degree

○ Place one hand over the symphysis of flexion of fetal head. N: Good attitude (Flexed
pubis and attempt to grasp the part that head) AbN: Poor attitude (Head is extended).
is presenting to the pelvis between your
thumb and fingers of one hand. In the Maneuvers are done 24 weeks and above, no high

risks, and without preterm labor. Usually done during
the second trimester.
Compared to the 3 grips, Pelvic Grip is done with the
hands facing the feet of the mother.
DISCOMFORTS IN PREGNANCY
● First trimester
○ Nausea and vomiting
a. Eat dry crackers
b. Small frequent feeding
c. Low fat meals
d. Avoid fried foods
e. Avoid antiemetics
○ Syncope
a. Sit with feet elevated
b. Change position slowly
c. Left lateral position
● First through Third Trimesters
○ Breasts tenderness
a. Use supportive bra with elastic
strap
b. Avoid soap in the nipples and
areola
○ Increased vaginal discharges
a. Proper cleaning and hygiene
b. Wear cotton underwear
c. Avoid douching
d. Consult physician if infection is
suspected
○ Nasal Stuffiness
a. Use humidifier
b. Avoid nasal sprays and
antihistamines
○ Fatigue
a. Frequent rest periods
b. Regular exercise
c. Avoid stimulants
○ Urinary frequency and urgency
a. Increase oral fluid intake
b. Limit fluid intake in the evening
c. Void at regular intervals
d. Sleep on the right side at night
● Second and Third Trimester
○ Heartburn
a. Small frequent feeding
b. Sit upright for 30 minutes after
meal
c. Drink milk between meals
d. Avoid fatty and spicy foods
e. Avoid antacids unless prescribed
by physician
○ Ankle Edema
a. Elevate legs at least twice a day
b. Wear support stockings
c. Avoid one position for long
periods of time
d. Avoid diuretics
○ Varicose Veins
a. Wear support stockings
b. Elevate feet when sitting
c. Lying with feet and hips elevated
d. Move out while standing
e. Avoid pressure on lower legs
f. Avoid leg crossing
g. Avoid standing or sitting in long
period of time
h. Avoid constricting clothing
○ Headaches
a. Change position slowly
b. Apply cool cloth at forehead
c. Eat small snack
○ Hemorrhoids
a. Warm sitz bath
b. High fiber diet
c. Increase oral fluid intake
d. Exercise
e. Apply ointments/suppositories as
prescribed
○ Constipation
a. High fiber diet
b. Increase oral fluid intake
c. Exercise
d. Avoid laxatives
○ Shortness of Breath
a. Rest periods
b. Elevate head while sleeping
c. Avoid overexertion
○ Backache
a. Encourage rest
b. Use body mechanics
c. Wear low-heeled shoes
d. Exercises
e. Sleeps on firm mattress
○ Leg Cramps
a. Exercise
b. Elevate and dorsiflex the feet
while resting
c. Increase calcium intake
 ➢ The twins are prone to
premature labor because
Recommended Exercise
of this theory
● Tailor sitting ➢ No specific measurement
○ Like an meditation sitting position but the body and brain
● Squatting detects how big the
● Pelvic Floor contraction (Kegel’s Exercise) uterus is
○ Can be done while sitting down ○ Oxytocin & prostaglandin -
○ Contract 3 secs, Relax 3 secs then hormones responsible for
Repeat contractions
● Abdominal Muscle contraction ○ Progesterone - relax the uterus
○ Done by lying to stretch the abdomen ○ Progesterone and Oxytocin have
● Pelvic Rocking opposite/inverse relationship
○ Kneel on with your hands on the floor
and rock the pelvis upward, downward, 2. Oxytocin and Prostaglandin Theory
and side to side “ ma imagine ninyo? - Works together to inhibit calcium
Myurag otso otso ba” binding in muscle cells, raising
intracellular calcium thus
Labor and Delivery activating contractions.
➢ Inhibit the calcium
● Labor binding (action on the
- A series of events when the product of smooth muscle)
conception is expelled out from the ➢ If mataas ang
woman’s body. intracellular calcium it will
➢ Product of conception: Fetus and activate contraction
Placenta ➢ Oxytocin - to induce
- Regular uterine contractions cause contraction
progressive dilatation of the cervix and
sufficient muscular force to allow the 3. Progesterone Deprivation Theory
baby to be pushed outside. - a decrease in progesterone
➢ Uterine contraction is when the causes uterine changes – labor
uterus contracts or compress to pains occur.
let push the baby out ➢ When the baby
➢ Dilatation - Opening of the cervix matures/lumalapit na sa
- Usually begins when the fetus is term the placenta also
sufficiently mature (Term/ 38 - 42 matures (gr 1 placenta,
weeks) gr 2 placenta, gr 3
placenta[mature] )
● Theories of Labor
1. Uterine Stretch Theory 4. Placental Aging Theory
- contraction of the uterus would - insufficient nutrients to reach the
indicate labor begins. fetus,no longer produce estriol
➢ The body detects how big and progesterone. Thus, labor
the uterus is to proceed begins.
on contracting the uterus ➢ When placenta matures it
➢ Brain interprets “oy will not produce estriol
sobraan na ka stretch ○ Estriol - type of estrogen
ang uterus, term na guro ➢ “hala nagdecrease na ang
ni. Start na dapat sa atung progesteron,
contraction” kailangan na natu mag
increase ug oxytocin and
prostaglandin” - body
● COMPONENTS OF LABOR (4P’s)
The Pelvic
1. Passageway
- mother’s pelvis, cervix, and ○ Passageway
vagina
- “Kung saan dadaan si
passenger”
- Cervix will dilate and effacement
(open & thin)
- Vagina will stretch to
accommodate the baby

2. Passenger
- fetus and placenta

3. Power
- uterine contraction, uterine
muscles, and mother’s ability to
push (Teamwork)
- Contraction is not enough to
deliver the baby it should be
together with mother’s ability to
push
- Normal Spontaneous Vaginal
True Pelvis False Pelvis
Delivery
- Assisted delivery:
1) Vacuum delivery
2) Forceps delivery
(obstetric forcep)
- Caput Succedaneum - “mutaas
ang ulo sa baby upon delivery
due sa pagpush sa mother”
➢ Mawala after how many
days
➢ Bonnets can help to
shape the baby's head
- Ischial Spine
4. Psyche
- mother’s psychological condition
- Mind over Matter
- Mindset of the mother to deliver
or have the baby
- It will affect delivering her baby
- Common to teenage pregnancy
➢ As a nurse provide
comfort and support to
the mother

Human Pelvis
➢ Internal Examination (IE) - the doctors will ● Engage - Station 0
insert finger to the vagina through the cervix of ● Above the ischial spine is minus (-)
the mother to measure the fetus inside and the - Floating ( -3 or -4)
size of the uterus and situation of the pelvic - The baby is still moving
- Not engage
➢ Cephalopelvic Disproportion - a condition which
● Below the ischial spine is plus (+)
the baby’s head didn’t coincide on the mothers - The baby is about to be deliver
vagina (baby is too big)
● Crowning
- +3 or +4

Stations of Presentation - Fetal Head

Positions During Descent

Gynecoid - Round
Platypelloid - Transerve Oval
Anthropoid - Vertical Oval/Upright egg
Android - heart shape/wedge shape

1. LIGHTENING
○ Nestling of the fetal presenting part into Anterior View
the pelvis
➢ Baby’s head(/whatever part of Fetal Descent Stations (Birth
whatever will go first) is settling Presentation
on the false pelvis
➢ Baby is ready to go out

2. ENGAGEMENT
○ settling of the fetal presenting part into
the ischial spine
➢ Head of the baby is engage on
the ischial spine (true pelvis)
3. STATION
○ relationship of the fetal presenting part
to the level of the ischial spine
 Anterior cut-away view

Cervix

➢ Internal and External Os - when the mother is
pregnant it will stretch and your cervix will
shorten
Assessment of the Cervix: Internal Examination (IE)
● DILATATION
○ opening of the cervical o
○ from 1 cm – 10 cms (fully dilated
cervix)
○ due to uterine contraction and amniotic
fluid
● Perineum
- site of episiotomy:
a. Median episiotomy - middle
b. Right mediolateral - middle to
right
c. Left mediolateral - middle to left
➢ Episiotomy - surgical incision performed by the
doctor
- To prevent spontaneous laceration
- “Isabay ang cut sa pagpush sa mother”

● EFFACEMENT (1st to happen)

○ thinning of the cervical canal
○ expressed in % (100% is a fully dilated
cervix)
○ Ripening of the cervix - Papahinugin,
soft cervix mean thin cervix

★ DEBPS - Internal Examination

Vagina
Fetal Skull

● Vaginal Canal - has rugae and capable of

stretching but can be lacerated:
a. 1st degree – skin
b. 2nd degree – skin and muscles
c. 3rd degree – external sphincter of
rectum
d. 4th degree – mucus membrane of
rectum
 Membrane Spaces Anteroposterior Diameter

○ Suture - soft bone that did not fuse

together

➢ Frontal Suture - front of the baby

- Fontanelles

The Fontanelles

Fetal Attitude
- Degree of flexion that the fetus assume

● It should be soft
● “ hubon” in bisaya
● Posterior Fontanelle - triangle shape Good Attitude - Suboccipitobregmatic
- Will close/harden 2 - 3 months of the (Vertex Presentation)
baby
● Anterior Fontanelle - Good attitude should be “well flexed”
- Will close/harden 12 - 18 months - Sub - baba
- To allow brain development - Occiput

● Sunken - baby is dehydrated

● Bulging - Complications of the baby
 Fetal Lie
- Relationship of the long axis of the fetus to the
long axis of the mother (base on the vertebra)

Military Attitude - Occipitofrontal

- Neutral (not flex - not extend)

- First to come out is the back of the
head and forehead of the baby

Vertical lie - Head or Butt or Foot

Transverse Lie - Shoulder or arm /
nakatakilid ang baby sa transverse line

- Baby’s position during pre term is not

the final position for the baby
- Full term, Lightening or has been
settle to the pelvis that is the final
position

● Presentation - Body parts that will first

contact the cervix

Poor Attitude - Partial Extension 1. Vertical Cephalic Presentation

Occipitomentum
Brow Presentation Cephalic - Head of the baby first come out

Poor Attitude - Full Extension

Submentobregmatic
Face Presentation
 2. Vertical Breech Presentation

TRANSVERSE-
BREECH-TRANSVERSE TRANSVERSE
PRESENTATION PRESENTATION

3. Transverse Presentation

Fetal Position
- Position of the fetal presenting part to the
specific quadrant of mother’s pelvis

Division of Pelvis

○ Shoulder presentation
○ Arm Presentation
○ ElbowPresentation

Fetal Landmarks
● Occiput – vertex/cephalic presentation (O)
● Mentum- chin/ face presentation (M)
● Sacrum - in breech presentation (Sa)
● Acromion – scapula/shoulder presentation (A)

FETAL POSITION –represented by 3-letter abbreviation

➢ 1st letter - L (left) or R (right) , D (neither left
CEPHALIC-BREECH
CEPHALIC – CEPHALIC or right)
PRESENTATION
PRESENTATION ➢ 2nd - fetal landmarks
➢ 3rd - A (anterior), P (posterior) T (transverse)

BREECH-BREECH CEPHALIC-TRANSVERSE
PRESENTATION PRESENTATION Left Occiput Anterior
 Right Occiput Posterior
Right Occiput Anterior

Direct Occiput Posterior

Left Occiput Transverse

Direct Occiput Anterior

Right Occiput Transverse

Right Sacrum Posterior

Left Occiput Posterior

Fetal lie has 2 classification:
1. Vertical
2. Transverse

Placenta
1. Placental Separation
a. Calkin sign/ globular sign of the fundus
b. The fundus rising in the abdomen
c. Sudden gush of blood
- When placenta is separated all
the blood vessels will be
separated that results gushing of
blood
- Normal occurrence
- Stop when the placenta is
separated
- Blood loss:
○ NSDV = 500ml
○ Cesarean section =
1000ml
d. Lengthening of the cord
- Umbilical cord is connected to
the forcep
- When placenta is removed to
where it is connected, it will
results to slowly going back to
the vaginal area
○ When the mother is giving birth she is in
a Lithotomy position
○ When there is resistance, do not push
through. Wait until there is no
resistance
○ 5 - 30 minutes after delivery placenta is
ready to pull
2. Placental Delivery
a. Duncan delivery - Dirty side [Maternal
Side (hugaw tan’awon)]
b. Schultz delivery - Shiny (fetal side)
➢ After delivery the nurse will give
medication, Oxytocin 10 units IM
➢ Main purpose of contraction during
delivery is to expel the fetus and
placenta
➢ Main purpose of contraction after
delivery is to shut off the bleeders
A. Uterine Contraction
Palpate the Fundus
0mm Hg - no contraction
○ Intensity - Strength of uterine contraction
○ Increment - Increasing intensity
○ Decrement - Decreasing intensity
○ Acme - Peak of contraction
- Mild, Moderate or Strong
➢ Cheeks (mild), Nose (moderate)
or Forehead (strong)
○ Duration - Beginning of the one contraction to
the end of the same contraction (seconds)
○ Frequency - Beginning of one contraction to the
beginning of another contraction
○ Interval (resting) - end of the one contraction to
the beginning of another contraction (minutes)
- When summarizing, get the lowest and highest
(duration)
- When summarizing, get those time that there is
no contraction (Interval)
- Summarizing: With (Intensity) uterine
contractions + Lasting for (Duration) + every
(Interval)
 Electro Fetal Monitor (EFM)
Toco - monitoring of the uterine
contraction
- Place it on top of fundus
Ultrasound Transducer - Monitor the
fetal heart tone
- Place it on the fetal back
- Put ultrasound transducer gel to
detect waves and remove air
bubbles
Stages of Labor
Event Marker - Movement of the baby
- Inform mother to press one
everytime the baby moves
Base on the picture:
➢ 139 - Fetal Heart Tone
➢ 10 - value of uterine contraction
➢ Green line indicates normal range of
FHT
False Labor
● Irregular interval contractions
● Pain in the abdomen
● Intensity remains the same
● Intervals remain long
● Walking gives relief
● No bloody show
● No cervical changes
● Contractions stops with sedation
True Labor
● Regular interval of contraction
● Starts at the back to abdomen
● Contractions are intensified
● Intervals gradually shorten
● Intensified by walking
● With bloody show
● Cervical dilatation and effacement
● Does not stop with sedation
PRELIMINARY SIGNS OF LABOR
1. Lightening
2. Loss of Weight
3. Increase in activity level
4. Braxton Hick’s contraction
5. Ripening of the cervix (soft)
6. Rupture of the membranes (bag of water)
7. Bloody show
★ First stage - Dilatation stage (true)
- Latent Phase
- Active Phase
- Transitional Phase
★ Second Stage – Fetal expulsion stage
- Dilated cervix = 10 cm
★ Third Stage – Placental Stage
★ Fourth Stage - Recovery
 First Stage of Labor

When to position a patient for delivery? (impending

● Latent - “wala pa” delivery)
● Active - “hapit na manganak”
○ S – Strong uterine contraction
● Transitional - “transfer to DR, position for
delivery” ○ U – Urge to defecate (8 - 10cm)
● BOW - Bag Of Water ○ B – Bearing down sensation
● IBOW - Intact Bag Of Water ○ I - Increase bloody show
● RBOW - Rupture Bag of Water (spontaneous) ○ R – Ruptured Bag of Water
● ARM - Artificial Rupture of Membrane ○ B – Bulging of the perineum(area between
(Intentionally)
vagina and anus)
○ A – Anal dilation
NURSING CARE DURING THE 1ST STAGE
1. Admission care
2. Data gathering
3. Assisting IE
- Place patient Lithotomy Position
- Do Perineal Flushing
- Give Gloves and Gel to the MD
- DEBPS
4. Leopold’s maneuver
5. Fetal Heart Tone (FHT) Monitoring
6. Uterine Contraction Monitoring
CARDINAL MOVEMENTS OR MECHANISMS OF LABOR
7. Promote change in position
8. Empty the bladder - DFIRE ERE
9. Hygiene Descent
10. Enema administration
11. Perineal preparation
12. Analgesic administration as ordered
➢ Sedation - to relax the mother

13. Assist in the administration of regional

anesthesia
➢ Epidural - painless delivery

14. Start IVF as ordered

15. Assist in amniotomy
16. Watch out for SUBIRBA
17. Emotional support
 Flexion Expulsion

Expulsion
Internal
Rotation NURSING CARE ON SECOND STAGE
1. Lithotomy position
2. Perineal flushing
3. Drape aseptically
4. Teach breathing technique during uterine
relaxation
5. Teach pushing technique during uterine
contraction
Extension Beginning (rotation complete) 6. Assist episiotomy
7. Do Ritgen’s maneuver
- To prevent further laceration
Extension
- Putting pressure on the perineum
8. Ease head out, wipe face and do initial
suctioning
9. Wait for external rotation
10. Pull head downward and upward to deliver the
shoulders
11. Deliver the body
12. Take note of time of delivery and sex of the
Extension Complete
baby
- “BABY OUT! 6:03PM BABY GIRL!
Extension 13. Place baby on mother’s abdomen
Rotation 14. Palpate for the pulsation of the cord, if
pulsations stops…
15. Clamp the cord 1 inch using plastic clamp from
baby’s abdomen
16. Milk the cord at least 2 cm towards the vulva,
then …
17. Clamp with a forcep, then…
External Rotation (Restitution) 18. Cut the cord between the 2 clamps but should
be near the plastic clamp.

External Rotation

External Rotation (Shoulder rotation)

Manual support of perineum:
Assist in the external rotation

1. Manual support of perineum with straight

fingers, support against the perineum

Initial Suctioning of Mouth and Nose

2. Manual support of perineum with bended

fingers, collecting the tissue when support

Deliver the shoulder

3. Manual support of perineum with thumb and

index fingers the three other fingers supports
the chin (modified Ritgen’s maneuver)

Head is Visible
Deliver the body

Easing the head out

 Clamping and Cutting the Umbilical
Cord

Thorough suctioning of the newborn

Schultz Duncan

NURSING CARE ON THIRD STAGE

Deliver the placenta 1. Wait for signs of placental separation
2. Do Brandt Andrew’s Maneuver
- Coiling the cord while applying traction
to facilitate the delivery of the placenta
3. Do Crede’s maneuver
- Applying counter traction
- Applying pressure on the hypogastric
area to prevent the uterus from coming
out.

○ Count Cotyledons - 15 to 20 or 25
counts

THIRD STAGE OF LABOR (PLACENTAL STAGE)

1. Placental Separation
a. Calkin’s sign-uterus becomes globular
and firm
4. Gently pull the placenta downward
b. Uterus rises above the abdomen
5. Take not for the time of placental delivery
c. Sudden gush of blood
➢ “PLACENTA OUT! 7:03PM”
d. Lengthening of the cord
6. Check for type of placental delivery:
7. Take BP
2. Placental delivery
8. Check for completeness of cotyledons
● Schultz delivery – fetal, shiny
9. Promote uterine contraction:
● Duncan Delivery – maternal, dirty, rough
- massage the hypogastric area
- Apply ice pack on the hypogastric area
 - Administer medication:
Oxytocin/Maleate
- Empty the bladder
10. Inspect perineum for laceration
11. Assist in episiorrhaphy
12. Do perineal care
13. Apply contoured brief/adult diaper
14. Make patient comfortable

NURSING CARE ON FOURTH STAGE

1. Assess fundus
2. Check for bleeding
3. Check the bladder
4. Check the perineum
5. Take vital signs every 15 minutes
6. Promote rest