MATERNAL HEALTH NURSING Vasoconstriction

Uterine contraction
MENSTRUATION
Dysmenorrhea
- Periodic uterine bleeding in - Mgt: warm compress, exercise and
response to hormonal analgesic ( ibuprofen – inhibits
changes prostaglandin pain reliver)
- 4 organs that involve in
menstruation occurs:
B. PROLIFERATIVE / estrogenic/
a.hypothalamus follicular/ post menstrual phase (6-14)
b. Anterior pituitary - Decrease estrogen will give signal to
HYPOTHALAMUS = GnRH
gland
C. C. Secretory/luteal/progesteronic
c. Ovaries premenstrual phase (15-21)
D. – increase estrogen LH --- corpus luteum
d. Uterus = increase progesterone = suppress LH
E. D. ischemic (22-28)
F. Not pregnant- corpus luteum de
generate-corpus albican

I. PREGNANCY Fertilization
implantation

SPERM CELLS
1. sperm count- 400
million /ejaculation 2.5-5ml
-20
million
per ml
(<20M =
OLIGOSP
ERMIA)
2. sperm motility 60%
90 seconds

cervix
 5 mins- uterus
APPHASES OF MENSTRATION  More important
A. A. MENSTRUAL PHASE 1-5 DAYS than sperm
- Decrease estrogen count
- Decrease progesterone PRODUCTION OF SPERM CELLS
- Increase prostaglandin
 1. miniferous tubules- - a. Ectoderm-outer
spermatogenesis, (integumentary/nervous system)
FSH
- b. mesoderm- middle (Musculo
2. Leydig cells- skeletal/cardio/renal)
responsible for
testosterone, H - c. entoderm- inner (lining of GI
and respiratory tract)
Scrotum -regulate temperature
2. CHORIONIC VILLI -originates
Alkaline
from trophoblast
Allow sperm survival
Fructose
TYPES OF HORMONES:
Protein a. HCG (Human Chorionic
Gonadotrophic
PRODUCTION
Hormone)
- Seminal vesicle Blood: 8-10 days
- Prostate gland after the vas Urine: 14 days
- Cowper’s gland False negative
- Epididymis a. Done too early
False positive
a. 99% prganat, 1%
H.mole
b. H-mole pregnancy:
no embryo

H.MOLE
- molar pregnancy
- also known as
Gestational trophoblast
DECIDUA disease
- pre cancer
- Endometrium after implantation
1. D. basalisbase/underneath s/s
embryo
Pregnancy test
2.D. capsularis- covers the
embryo - Increase HCG
- Excessive vomiting
3. D. Vera- remaining portion - Abdominal enlargement
ENDOMETRIUM - Brown/dark brown vaginal
bleeding
II.FETAL PARTS Diagnostic examination:
1.GERM LAYER ultrasound
- Reveal no FHT C. ESTROGEN: HORMONE OF
- Snow storm pattern – cluster of WOMEN
grape – like vesicle
Risk Factors: D. PROGESTERONE: HORMONE OF
PREGNANCY
1.Previous H. Mole
2. Low socioeconomic condition 3.UMBILICAL CORD
3. >35 y/0 - Lifeline
B. HPL (Human Placental Lactogen)
- AVA:
- Prepares breast for lactation Short cord= abruptio placenta
th
- 4 month of pregnancy = Nuchal cord-cord wraps around
Colostrum which is the the neck
lactogenesis
Mgt: clamp and cut
Regulates glucose metabolism
4.FETAL Membranes
GESTATIONAL DIABETES MELLITUS
5.AMNIOTIC FLUID
- RISK FACTORS OF GDM Diagnostic – amniocentesis 14t
week aog
1. Obesity
N amniotic fluid 800 – 1200 ml
2. Family history DM
Oligohydramnios below 300 ml
3. Previous GDM Polyhydramnios higher 1500 ml
MGT: esophageal
Diet 6. PLACENTA

Exercise  Fully develop at

12th weeks of
Insulin AOG
 Corpus Luteum:
- pregnant- increase (bec. of
placenta of 1st
present of HPL)
tri
- not pregnant/after delivery- 2 SIDES
decrease 1. Schultz –
fetal side
Diagnostic test:
2. Duncan –
FBS- fasting blood sugar 70-110mg maternal
side
Oral glucose Challenge test
FUNCTIONS: (organs)

COMPLICATION OF GDM 1. LUNGS- provide

 oxygenated removes
deoxygenated 4. Alcohol
- can lead to fetal alcohol syndrome
2. GI system- provides
(cranio facial deformities)
nourishment.
5. Cigarette smoking
3. Endocrine gland- provides vasoconstriction- low blood supply
hormones
4. Renal kidney- removes small for gestational age preterm
waste product
CANNOT CROSS
5. Protects the fetus -it acts
as semipermeable 1. Bacteria
membrane 2. Insulin
3. Heparin
- CAN CROSS TO THE PLACENTA 4. Marijuana
1. Antibodies- IgG
- TT- tetanus toxoid at least 2 doses FETAL CIRCULATION
- Start at 5 months (protected for 1 1. Umbilical
yr) vein-
- TT of newborn -prevent tetanus oxygenated
neonatorum blood
2. Viruses can cross placenta 2. Umbilical
- HIV- mgt: antiretroviral therapy + arteries-
CS (no breastfeeding) unoxygenat
- Rubella- when mother is pregnant ed
check for rubella 3. Ductus
 MMR - no venosus-
pregnancy connects
for next 3 umbilical
month vein and
3. DRUGS- ‘teratogens” inferior vena
(harmful substances) cava
- Do not give 4. Ductus
arteriosus-
 COUMADIN (when connect
in need for anti- pulmonary
clotting give artery and
heparin) aorta
 Antibiotic- 5. Foramen
tetracycline Ovale-
(bone/tooth connects
formation) right atrium
 Antipsychotic to left
 atrium Increase plasma volume – 50 %
*BY PASSES the liver- Ductus
High RBC – 35 %
venosus
*By passes the lungs – Ductus Hemodilution –
arteriosus and Foramen Ovale pseudoanemia/physiologic anemia
Supine uterus lox BP lead to light
III. PHYSIOLOGIC CHANGES
headedness, dizziness
A. reproductive system MGT. L side lying
1. Vagina – pH low acid –
protection High PR,RR, temp, plasma, WBC,
X douching – irrigation – RBC Fibrinogen, Clotting factor
removing N flora – Doderlain
bacillus Low BP-SHS, Hgb – pseudoanemia
Leukorrhea – whitish vaginal
discharge C. Respiratory system
-hyperactive a. Increase PR
epithelial cell (lining) b. Decrease PCO2-
prevent respiratory
Chadwicks – bluish discoloration = bld acidosis
2. Cervix c. Hyperventilation:
Goodela sign – softening respiratory alkalosis
Operculum – nausea plug Mgt: brown
with seala cervix paper bag
3. Uterus d. shortness of breath
Hegars – softening of uterus (decrease lung
Braxton hicks contraction – capacity)
painless, irregular contraction e. epistaxis
fake labor (hormones) – nose
Ballottement – passive bleeding
movement of a floating fetus f. nasal congestion
4. Ovaries
No Ovulation D. GI SYSTEM
1. Mouth- Ph
Increase E and P decrease- acid +
suppresses FSH nd poor dental
suppresses LH – no hygiene (can
ovulation cause tooth
B. Cardiovascular system decay)
PR – high 1015 bpm 2. Gum bleeding-
BP – slightly low use soft bristles
SHS- supine hypotensive 3. Ptyalism-
syndrome excessive
salivation (mgt:
 hard candy) 6.Heart burn
4. Food cravings-
- can cause reflux bec. uterus
cause by
hormones compresses stomach
5. Morning - 2nd AND 3RD trimester
sickness- 1st
trimester Mgt:
(organogenesis)
 Upright position after
- low glucose
meals
Nausea and
 SFF
vomiting
 Avoid spicy food/fatty
Mgt:
- eat crackers or 7.constipation
toast upon arising
Mgt:
- SFF
- Avoid nauseating  Increase fluid intake (8-10
situation ex. glass)
Perfume  Increase fiber intake
 Exercise
HYPEREMESIS GRAVIDARUM  No to laxative (stimulate
uterine contraction)
- refers to excessive vomiting in
entire pregnancy 8. hemorrhoid + constipation
- the mother needs to hospitalize - Because of pressing the uterus to
the rectal vessel
COMPLICATION: Mgt:
- Dehydration- fluid electrolytes  Avoid constipation
imbalance
 Change position frequently
- Metabolic alkalosis
 Cold packs

MGT:
E.INTERGUMENATARY SYSTEM
 NPO for 24 hrs
- Melasma/chloasma- mask of
 Give IVF replacement
pregnancy
 Start diet- clear liquid
(after 24 hrs) Increase melanocyte
 SFF- small frequent feeding stimulating hormones
 Antiemetic -plasil
Mgt:
 Temporary  Frequent
urination in 1st
Avoid sun exposure and 3rd tri-
 Increase sweat gland (uterus
 Increase sebaceous gland compress the
bladder)
 Linea nigra
 In 2nd tri
 Striae gravidarum-
frequent
permanent
urination is not
 Breast size- increase 3lbs seen because
Montgomery’s tubercle uterus is
- Sebaceous gland around the floating
areola Complaints:
Prevent cracked nipple
 Wash with water Dysuria
only Burning
 Avoid soap Nocturia prone to UTI- cause
 Air dry/pat dry of E. coli
Flack pain

F.MUSCULOSKELETAL SYSTEM
SIGNS OF PREGNANCY
- Backache (pride of pregnancy)-
lordosis because of increase uterus I. PRESUMPTIVE
size in 3rd tri
 Subjective
Mgt: mother- weak
evidence
Proper posture  Ex amenorrhea
Low heeled shoes
Pelvic rocking exercise II. PROBABLE-
objectives – stronger
evidence
- Leg cramps
Increase activity, decrease Ca III. POSITIVE – absolute
100% evidence
Mgt:
 FHT
Dorsiflexion
 Fetal movement
Rest period  Ultrasound
Increase Ca (milk/ milk
production) + VIT. D PRENATAL CHECK UP

1-7 months-
G. RENAL SYSTEM every month
 8 months- very 2
 weeks Theories of labor onset
 9 months -every 1.placental Aging theory –
1 week placenta agent – low effectiveness
postterm = high risk 40 wk – 42
postterm
OB SCORE
no 02 , no nutrients, hypoglycemia
 G- gravida- pregnancy
2. progesterone deprivation theory
 P-Para- deliveries w/c reached
low prog – high uterine
viability 24 weeks (NLE-
20weeks) contraction
 T- Term- 37 weeks and above 3. oxytocin theory – fetus big –
cervix (receptor) – post PG =
 P-Preterm- < 37 weeks Oxytocin = UC
 A-Abortion - <20-24 week 4. Prstaglandin theory = amnion/
 L- Living children @ present Chorion – prostaglandin – UC
 M – multiple preg - twins
PREGNANCY: 5. Uterine structures theory –
 NULLI-0 uterus (hallo organ) – stretched
 PRIMI- 1 max capacity
 MULTI- 2 and more LABOR and DELIVERY \
4 P’s
EDC- LMP= last menstrual period
1. Power –
JAN- MARCH = +9 +7 uterine
contraction
APRIL – DEC= -3 +7 +1 2. Passages -
pelvis
FETAL DEVELOPMENT
3. Passenger –
fetus
TASK OF PREGNANCY
4. Psyche
- (1-3) 1st trimester- acceptance of - Emotional and psychological
pregnancy preparation- Lamaze metho
 Ambivalence - Psychoprophylactic- breathing
 Couvade syndrome exercise and guided imagery
- (4-6) 2nd trimester- acceptance of
fetus/baby I.POWER
- Uterine contraction – stage 1 –
- (7-9) 3rd trimester- preparation to
stage 2 U.C + push intraabdominal
parenthood
pressure
  OXYTOCIN (nipple TYPES OF PELVIS
stimulation)
1. Gynecoid
 D5LR 1L + oxytocin
2. Android-
ischial spine
II. PASSAGEWAY- pelvis prominent
3. Platypelloid
4 bones 4. Anthropoid
1. 2 innominate
2. (fused) bones
 Ilium- III.PASSANGER- FETUS- HEAD ¼
bewang Sutures:
 Pubis -
anterior  junction of bone
 Ischium - types:
inferior coronal
3. Sacrum - sagittal allows molding
posterior lambdoid

4. Coccyx – Fontanels
below
 landmark
sacrum
 intersection of
5. suture
1. anterior-
2. posterior
DIAMETERS OF THE HEAD:
OB PURPOSES
anterioposterior
DIVIDED INTO:
1. suboccipitobregmatic- 9.5cm
- False pelvis
2. occipitofrontal- 12cm
- True pelvic
3. occipitomental-13.5
a. Pelvic inlet-
Diagonal conjugate *TRANSVERSE DIAMETER-
-Landmark: sacrum biparietal parameter
and pubis

b. Mild pelvis
CHARACTERISTER OF PASSANGER
- ischial spine
A. ATTITUDE- degree of
c. pelvic outlet
flexion relationship of the
-land mark: ischial
tuberosity fetal parts to one another
 1.vertex (presentation) Relationship of the presenting part
to the ischial spine
 full flexion
 chin to chest Mid pelvis
 occupies the smallest space
 suboccipitobregmatic
 NSD

2. sinciput

 Military attitude

 Moderate flexion
 Chin up
 Occipitofrontal -12cm
 NSD

3.Face C. LIE (FETAL LIE)

 Complete extension
 Relationship of
 Poor flexion
fetal long axis to
 Poor flexion maternal long
 Occipitomental – 13.5cm axis
 CS a. Longitudinal-
 * contracted (small) pelvis- vertical
inlet <12cm  Cephalic
 Breech
 Types of
breech
a. Complete
b. Frank
c. Footling
 MGT:
external
manual
version
a. MD
b. Ultrasound
guided
c. Tocolytic
B. STATION (relax
uterus)
 b. Transverse-
horizontal
 Shoulder-
acromion
process
 Mgt: CS
D. POSITION
- Relationship of the reference point
to maternal guardant
Fetus part mother
1. Occiput (O) 1. R anterior (pubis)
2.Sacrum(S) 2. L
3. R
posterior sacrum
4. L