Maternal & Child

/Obstetrics
ADONIS N. CHAVEZ, RN, RM, MN
OBSTETRICS
FEMALE REPRODUCTIVE SYSTEM
 Labia Majora – with pubic hair
 Labia Minora – Without pubic hair
 Clitoris – 6 mm x 6 mm, extreme
excitement, clitoral orgasm
 Urinary meatus – passageway of urine
 Shortness of the urethra predisposes the female to
recurrent UTI.
 Skene’s Gland – paraurethral gland, with
secretions
 Bartholin’s Gland – vulvovaginal glands,
aids during sexual intercourse
 Hymen – thin mucous membrane
 Can be stretched or torn during physical activity,
tampon insertion, vaginal exam, or sexual
intercourse.
 Myrtiformes Caruncles: are remnants of the
hymen after childbirth
 Imperforate Hymen: congenital absence of
normal opening of the hymen which can be treated
by surgical perforation
 Perineum – space between anus
and vagina, site of EPISIOTOMY
Consists of fibromuscular tissue.
Most of the support of the perineum
is provided by:
1. Pelvic Diaphragms
2. Urogenital Diaphragms
 Vagina– Length: 3 to 4 inches
 Posterior wall: 10 cm. long
 Anterior wall: 7.5 cm. long
 Acidic with pH 4 to 6 – Doderlein’s Bacilli
 Vault – term for the upper end of the
vagina
 Rugae: transverse ridges of mucous
membranes lining the vagina which allow it
to stretch during sexual intercourse and
childbirth.
UTERUS
Weight: non-pregnant : 50 – 60 gms
Pregnant: 1000 gms or 1 kg
4 stages of Labor during delivery : 1000 gms
2 weeks pp : 500 gms
3 weeks pp: 300 gms.
5 – 6 weeks pp: 50 – 60- gms.
  Uterine Parts:
a. Fundus – convex upper part between the
insertion of the FT: most CONTRACTILE
portion of the uterus during labor.
b. Corpus or body – upper, larger, triangular
portion.
c. Cornua – the portion or point from where the
oviducts or FT emerge.
d. Isthmus – constricted area immediately above
the cervix; the lower uterine segment; distends
during pregnancy
e. Cervix – lower, smaller cylindrical portion with
internal os, cervical canal, and external os.
Shape : non-pregnant : pear-shape
Pregnant: Ovoid
Muscle Layers:
Endometrium – slough-off during
menstruation
Lining of a non-pregnant
Decidua – if pregnant
Myometrium – source of contraction/
“living ligature”
Largest portion of the uterus – muscle
layers
Perimetrium – outer covering
FALLOPIAN TUBE (Oviducts)
Length: 8 – 14 cm (average: 10 cm)
Tubal Parts:
a. Interstitium
b. Isthmus
c. Ampulla – widest portion (5 cm long)
d. infundibulum
Ampulla – fertilization takes place
Distal third portion of the fallopian tube
(ECTOPIC PREGNANCY HAPPENS)
Common site of EP
Where fertilization takes place
OVARIES
Two almond-shaped organs
Size: 2.5 to 5 cm length, 1.5 to 3 cm breadth,
0.6 to 1.5 cm thick
Weight: 6 to 10 g each
Ovulation: monthly expulsion of a mature
ovum from the Graafian Follicle into the pelvic
cavity.
Endocrine Function: Estrogen and
progesterone
Nerve Supply: from the Ovarian plexus
ACCESSORY ORGANS:THE
MAMMARY GLANDS (Breast)
Location: under the skin, over the
pectoralis major muscle
Size: varies depending on the amount of
adipose tissue rather than the amount of
glandular tissue
Function: Lactation, maternal Antibodies
(IgA). Source of pleasurable sexual
sensation.
Maternal Reflexes in Breastfeeding:
a. Prolactin Reflex (Milk-secretion reflex)
b. Letdown reflex – oxytocin-induced
c. Milk Ejection Reflex – influenced by
Oxytocin (PPG)
CHARACTERISTIC OF NORMAL
MENSTRUAL FLOW
MENARCHE (Beginning) Average age onset: 11-13 years
Average range: 9-17 years
INTERVAL between cycles Average: 28 days
Cycles of 25-35 days are not unusual
DURATION of menstrual flow Average flow: 2-7 days
Ranges: 1-9 days are NOT abnormal
AMOUNT of menstrual flow Difficult to estimate;
Average: 30-80mL per menstrual flow
Saturating a pad or tampoon in less
than an hour is considered HEAVY
BLEEDING
COLOR of menstrual flow Dark red; combination of blood,
mucus and endometrial cells
ODOR Similar to that of marigolds
MENSTRUAL CYCLE
Duration varies and is highly individualized but
the average cycle/mean cycle length is 28 days;
Normal range is 25 to 35 days per cycle;
Can be as short as 21 days or as long as 40
days.
Only one interval is fairly constant (almost
always 14 or 15 days): the time from ovulation
to the beginning of menses.

(Marieb, 2002)
MENSTRUAL CYCLE STAGES/PHASES
A. Menstrual/Bleeding Phase
- (days 1 to 4) may last for 3 to 5 days – the
terminal phase of the menstrual cycle
- menstrual period – the woman’s period of
absolute infertility
- menstrual blood is incoagulable –
liquefied by fibrinolytic activity
B. Follicular/Proliferative Phase
- days 5 to 14 ending in ovulation; lasts
about 9 days
- Regenerative phase is the first few
days of the reformation of the endometrium
- under the control of ESTROGEN
(principally the ESTRADIOL), there is
regrowth and thickening/proliferation of
the endometrium up to 8- 10 fold and off at
ovulation.
 - at the completion of the Proliferative
phase, the endometrium consists of 3 levels:
a. Basal layer
b. Functional layer
c. Cuboidal ciliated epithelium layer
- Ovulation: middle of the cycle:
monthly growth and release of a mature, non-
fertilized ovum from the ovary.
- Estrogen is high; progesterone is low
 How do you estimate ovulation time?????
C. Luteal/Secretory Phase
- 15 to 28 days; lasts about 14 days
- if fertilization occurs – implantation follows
average of 7 days.
- Corpus Luteum lives 10 – 14 days; later replaced
by placenta
- If fertilization does not occur – the yellow
body corpus luteum functions only for 7 to 8 days
after ovulation, then involutes to become a white
body, the corpus albicans which persists up to
10 to 12 days post-ovulation.
- Estrogen and Progesterone level drops causing
Ischemic or Premenstrual phase
 During which of the following periods is a
woman absolutely INFERTILE?
A. Days 1-4 of the menstrual cycle
B. Days 13-14 of the menstrual cycle
C. Days 9-14 of the mesntrual cycle
D. Days 24-28 of the cycle
MENSTRUAL CYCLE
EMBRYOLOGY
PREGNANCY
1st – critical period/organogenesis --- Drugs:
Category A drugs
GERM layers:
- ectoderm - brain
- mesoderm - heart
- endoderm – GI
- Period Ambivalence – presence of 2
opposing feelings.
2nd – mother adopted to
pregnancy/comfortable/easiest
- period of increase in Libido
3rd – period of unattractiveness/low self-
esteem/
 Signs & Symptoms of Pregnancy
Presumptive
- Subjective
- MACFLUQ
- Morning Sickness, N&V
- Amenorrhea
- Changes in Breast
- Fatigue
- Lassitude
- Urinary Frequency
- Quickening (18th – 20th
weeks / 5th month)
- Chloasma / Melasma –
mask of pregnancy
Probable Positive
Objective - Definitive sign of pregnancy
- CHUPBOGS - Fetal heartbeat – 10
- Chadwicks – bluish weeks by Doppler, 16
discoloration of vaginal weeks by fetoscope, 18 –
wall 20 weeks by Auscultation
- Hegar’s Sign – softening of - Fetal Movement – felt by
lower uterine segment examiner usually after 20
- Uterine Enlargement – at weeks
12 weeks gestation felt - Fetal Skeleton – by
just above SP Sonography or X-ray
- Positive Pregnancy test –
HCG
- Ballottement – sinking and
rebound of fetus
- Outlining of fetal body
- Goodells sign – softening
of the cervix
- Souffle, Contraction &
Braxton Hick’s
LEOPOLD’S MANEUVER
1ST – Fundal Grip – Presentation
2nd – Umbilical Grip – “Where is the fatal
back?” FHT (Fetal Back)
3rd – Pawlick’s Grip – “What is at the inlet
of the Pelvis?” by grasping the lower
portion of the abd (just above the SP)
4th – Pelvic Grip – “What is the fetal
Attitude (degrees of flexion/extension)?”
CARDIAC CLASSIFICATION IN
PREGNANCY
Class I Class II Class III Class IV
- Asymptomatic - Asymptomatic - Asymptomatic - Symptomatic
- No limitation at rest at rest with all activity
of activity - Symptomatic - Symptomatic and at rest
with HEAVY with - High risk for
PHYSICAL ORDINARY pregnancy
ACTIVITY ACTIVITY
- Slight - Able to handle
limitation of physical
activity demand of
pregnancy
- Considerable
limitation of
activity
PSYCHOLOGICAL TASKS OF
PREGNANCY
1st Tri Accepting the Pregnancy
2nd Tri Accepting the Baby
3rd Tri Preparing for Parenthood
PAP SMEAR – Cervical Cancer
 Class I – normal
 Class II – inflammation
 Class III – mild to moderate dysplasia
 Class IV – probably malignant
 Class V – Possibly malignant

 Cancer - CURE
 Chemotherapy
 Upera
 Radiation
 Emotional Support
 DANGER SIGNS OF PREGNANCY
SIGN POSSIBLE CAUSE
Swelling of face, finger, and legs HPN of pregnancy, and
thrombophlebitis (for legs swelling)

Headache – continuous and severe HPN of pregnancy

Abdominal / Chest pain Ectopic pregnancy, uterine rupture,
and pulmonary embolism

Vaginal bleeding Placental problems (previa, abruptio)

Vomiting, persistent Infection (also with fever and chills),
and hyperemesis gravidarum

Visual changes HPN of pregnancy

Escape of vaginal fluids PROM
COMPLICATIONS OF
PREGNANCY
DISCOMFORTS OF EARLY PREGNANCY:
1. Breast tenderness – inc E & P – Mgt:
Wear bra with wide shoulder straps for
support
2. Constipation – weight of the growing
uterus (presses against the bowel and
slows down peristalsis) – Mgt: inc fiber
and fluids
3. Palmar Eryhthema – increase estrogen
level – Mgt: Apply Calamine lotion
4. Nausea,Vomiting, Pyrosis – increase HCG
caused decrease gastric motility – Mgt;
increase CHO intake, eat dry crackers
before rising.
5. Fatigue – increase metabolic demand –
Mgt: rest, avoid strenuous activity
6. Hypotension – uterus pressing on vena
cava – Mgt: lie on the side(remove pressure
on vena cava), rise slowly, avoid extended
periods of standing.

7. Hemorrhoids – pressure on the rectal

veins by the growing uterus – Mgt: regular
bowel movement, rest in modified Sims
position, knee-chest position at the end of
the day (to reduce pressure on rectal veins)
8. Frequent Urination – pressure on the
growing uterus on the anterior bladder –
Mgt: decrease amount of caffeine, Normal

9. Muscle Cramps – decrease serum

calcium and increase serum phosphorous
levels causing interference in circulation –
Mgt: Lie on the back and extend legs
(keeping the knee straight while
dorsiflexing the foot)
10.Varicosities – pressure of the uterus on
the veins of lower extremities – Mgt: Sims,
on back with legs raised against wall or
elevated 15- 20 mins twice a day, elastic
support stockings, exercise and walk, take
Vit C
11. Leukorrhea – high estrogen level and
increase blood supply to vagina, epithelium,
and cervix – Mgt: bath daily, wear cotton
underwear, avoid wearing tight underwear
or pantyhose
12. Palpitations – circulatory adjustments to
increase blood volume –Mgt: gradual and
slow body movements
DISCOMFORTS OF MIDDLE TO LATE
PREGNANCY
1. Backache – Mgt: wear shoes with low
heels, walk with pelvis tilted forward,
apply local heat
2. Dyspnea – pressure of the expanding
uterus to the diaphragm – Mgt: sleep
upright, limit activities during the day
3. Ankle Edema – reduced blood circulation
in the lower extremities (uterine pressure
and general fluid retention) – Mgt: Left Side
Lying, sitting with legs elevated, avoid
wearing constrictive clothing
4. Headache – expanding blood volume
puts pressure on the cerebral arteries –
Mgt: rest with a cold towel on forehead
DISEASE AND COMPLICATIONS
DURING PREGNANCY
1ST Tri
- Hyperemesis Gravidarum
- GDM
- H-Mole – Gestational Throphoblastic
Dse.
- Abortion
ABORTION
1. Induced abortion (Legal / Illegal)
2. Spontaneous Abortion
Spontaneous Abortion
 Threatened Abortion – bright red vaginal
bleeding without cervical
dilatation/effacement.
◦ Bleeding will subside 24 – 48 hours
◦ Self – limiting (24-48 hours)
◦ Nsg. Resp: Monitor Maternal and Fetal well-
being; save all perineal pads or clots or clots
for evaluation; bed rest.
Immenent/Inevitable abortion – bright red
vaginal bleeding with cervical
dilatation/effacement.
◦ Nsg. Resp: CBR without TP
1. Complete Abortion – all products of
conception expelled.
 Monitor maternal well-being.
 Assess v/s of mother.
2. Incomplete Abortion – not all product
of conception expelled.
 DANGER: Hemorrhage
 Monitor signs of Hemorrhage (Hypo-tachy-tachy)
 D&C
 Missed Abortion – fetus dies in the
uterus.
◦ Nsg. Resp: Monitor signs of Infection/sepsis
◦ Prostaglandin (for cervical ripening)
◦ O2
◦ Oxytocin (for uterine contraction)
 Habitual Abortion – having abortion for 3
or more times (continues or consecutive)
◦ CAUSE: incompetent cervix (cervical
dilatation without uterine contraction or
pain) – Mgt: CERCLAGE – MacDonald
(temporary/NSVD) and Shirodkar Procedure
(permanent/CS)
 abdominal cerclage, the least common type, is
permanent and involves stitching at the very top of
the cervix, inside the abdomen.
 RH Incompatibility
 Rhesus Factor – blood
 ABO – Rh+ and Rh –
 Rhogam
 ECTOPIC PREGNANACY
◦ Implantation takes place outside the uterine cavity
◦ Common site: AMPULLA
UNRUPTURED RUPTURED
- Missed period - Severe knife – like pain
- Pain 3 – 5 weeks - Shoulder pain
- Vague discomfort - bleeding

◦ Mgt: Monitor maternal well – being

◦ If ruptured: monitor signs of
Hemorrhage (hypo-tachy-tachy)
◦ Salphigostomy/salphingectomy
DISEASE AND COMPLICATIONS
DURING PREGNANCY
2nd Tri
Incompetent Cervix –
- painless CD
- Bloody show
(pink-stained vaginal discharge);
1st symptom
- Increase pelvic pressure
- PROM and discharge of AF
3rd Tri
Placenta previa
◦ Low implantation of the placenta
◦ PAINLESS, bright red/brick red vaginal
bleeding
◦ Mgt: No Internal Examination, No sex, No
enema
◦ I/E – prepare for a double set-up (DR will be
converted to OR)
◦ Bed rest
 Abruptio Placenta
◦ Premature separation of the placenta
◦ Late deceleration
◦ Classical sign: PAINFUL, darkened vaginal bleeding
◦ Rigid abdomen, tense, board-like abdomen
 Intervention: O2 therapy
◦ Monitor signs of Hemorrhage (concealed
bleeding)
◦ Left side lying position
◦ Monitor for fetal distress
DYSTOCIA – a complication of labor and delivery
in which one or both of baby’s shoulder get
“stucked” behind the mother’s pelvic bone as the
baby descends into the birth canal.
Causes :
 Abnormalities of the POWERS – uterine
contractility and maternal expulsive effort
 Abnormalities involving the PASSENGER – the
fetus (presentation, position, or development)/
macrosomia – large fetus.
 Abnormalities of the PASSAGEWAY – the
pelvis.
 Mgt : CS delivery
PRECIPITATE LABOR – extremely rapid labor and
delivery.
Causes:
◦ Abnormal resistance of the soft parts of the birth canal.
◦ Abnormally strong uterine contractions
◦ Or rarely, absence of painful sensations and thus a lack of
awareness of vigorous labor.
According to Hughes (1972), precipitous labor
terminates in expulsion of the fetus in less than 3
hours.
Maternal effects:
◦ Hemorrhage from the placental implantation
Effects on Fetus & Neonates:
◦ Newborn may fall – leading to injury
◦ Newborn maybe need resuscitation.
Mgt : Oxytocin should be stopped immediately
CEPHALOPELVIC DISPROPORTION
 Obstructed labor resulting from disparity
between the dimension of the fetal head and
maternal pelvis such as preclude vaginal
delivery.
 Types of Pelvis :
◦ Gynecoid – suitable for delivery
◦ Android
◦ Anthropoid
◦ Platypelloid
PROLAPSE CORD
 Happens when the umbilical cord precedes the
fetus’ exit from the uterus
 It is an obstetric emergency during pregnancy or
labor that momentarily endangered the life of
fetus.
 Potential pre-disposing risk factors include:
◦ Premature rupture of amniotic sac
◦ Polyhydramnios - (having a large volume of amniotic
fluid). The cord may be forced out with the more
forceful gush of water.
◦ Large umbilical cord
◦ Fetal malpresentation (Breech)
◦ Multiparity
◦ Multiple gestation
PROLAPSE CORD
Mgt :
 Removing pressure from the cord – in
some cases, doctor may be able to move the
baby away from the cord so as not to cut off
oxygen supply to the baby. The mother may
also be asked to move into a portion that
removes pressure from the cord and
protects the baby.
 Rapid delivery – if the mother is ready to
deliver, the doctor may try to deliver the
baby very quickly using forceps or a vacuum
extractor.
CORD COIL
 Also known as “ Nucal Cord”
 Occurs when the umbilical cord becomes
wrapped around the fetal neck.
 Types :
◦ Type A – nuchal cord is wrapped around the
neck 360 degrees
◦ Type B – pattern is described as a hitch
which cannot be undone and ends up as a
true knot.
CORD COIL
At Risks :
 Baby with long cord
 Baby which is large for gestational age
greater risk for developing true knots
 Smoking
 Drug use
 Multiple pregnancies
 Hydramnios
Mgt :
 Immediate vaginal delivery
 CS Delivery (often the best approach)
MULTIPLE PREGNANCY
 A pregnancy with 2 or more fetuses.
 Names include the following :
◦ Twins – 2 fetuses
◦ Triplets – 3 fetuses
◦ Quadruplets – 4 fetuses
◦ Quintuplets – 5 fetuses
◦ Sextuplets – 6 fetuses
◦ Septuplets – 7 fetuses
MULTIPLE PREGNANCY
Causes:
 Heredity
 Race (woman of African descent)
 Number of prior pregnancy
 Delayed childbearing
 Infertility treatment – fertility drugs,
Assisted Reproductive Tech. (ART), In
Vitro Fertilization (IVF).
 IDENTICAL TWINS – result from a
single fertilized egg dividing into separate
halves and continued to develop into two
separate but identical babies. These twins are
genetically identical, with the same
chromosomes and similar physical
characteristics. They’re the same sex, blood
type, hair and eye color.
 FRATERNAL TWINS – comes from two
eggs that are fertilized by two separate sperms
and are no more alike than other siblings born
to the same parents. They may or may not be
the same sex. This type of twins is much
more common, and only this type is
affected by heredity, maternal age, race, and
number of prior pregnancies.
 SUPERTWINS – common term for triplets and
other higher-order multiple births such as
quadruplets/quintuplets. These babies can be
identical, fraternal or a combination of both. High-
order births are rare; triplets occur approximately
in 1 in 7,000 to 8,000 births, whereas quintuplets
are likely to be born only once in 47 million births.
Risks:
 Premature birth (before 37 weeks AOG)
 Numerous health challenges to babies – NICU
 Pre-eclampsia
 Gestational Diabetes Mellitus
 Placental problems
 Fetal growth problems
 Cerebral palsy (twins)
Mgt :
 Nutrition intake : increase calcium & Folic Acid,
increase Protein and Iron.
 CS Delivery
 Vaginal Delivery (optional)
Types of Breech Presentation:
Frank Breech – the buttocks are
presenting and the legs are up along the
fetal chest. The fetal feet are next to the
fetal face. This is the safest arrangement for
Breech Delivery.
Complete Breech – fetal thighs are
flexed along the fetal abdomen, but the fetal
shins and feet are tucked under the legs.
The buttocks are presenting first, but the
feet are very close. Sometimes during labor,
a Complete Breech will shift to an
Incomplete Breech if one or both of the
feet extend below the fetal buttocks.
Footling Breech – either one part
(“single footling”) or both (“double
footling”) is presenting. Also known as
Incomplete Breech.
Risks of Breech Presentation during Vaginal
Delivery:
 Fetal Mechanical Injury – fractures,
nerve damage, soft tissue injury
 Fetal Asphyxia – due to umbilical cord
prolapse and obstruction, and fetal head
entrapment.
Mgt :
 CS Delivery.
 Premature labor
 PROM
 PIH – toxemia of pregnancy – Mild Pre-Ec,
Severe Pre-Ec, Eclampsia
Naegele’s Rule
 Ask for LMP
 FORMULA?

 If forgot?
◦ Use FHM
 LMP (1st day of the LMP)
 Jan, Feb, March - +9 +7
 April – Dec - -3 +7 +1
 AOG
Abdominal Assessments
 FETAL PRESENTATION
◦ Part of the fetus in the lower pole of the
uterus overlying the pelvic brim
◦ Cephalic, vertex breech
 FETAL ATTITUDE
◦ Posture of the fetus
◦ Flexion, deflexion, extension
 FETAL LIE
◦ Relation of the long axis of the fetus to the
mother
◦ Normal: LONGITUDINAL LIE
 FETAL POSITION
◦ Relationship of the presenting part to the
mother’s pelvis
◦ Expressed by referring to the position of one
area of the presenting part
LEOPOLD’S MANEUVER
LEOPOLD’S MANEUVER
 Systematic method of observation and
palpation to determine fetal position
 Woman who emptied her bladder
should lie in supine position with her
knees flexed slightly so abdomen is
relaxed.
 Warm hands to avoid contraction of
abdominal muscles.
 Gentle but firm touch
 LEOPOLD’S MANEUVER
F-U-P-P
1. FUNDAL GRIP - HEAD is more firm, hard and round that moves independently
of the body
- BREECH is less well defined that moves only in conjunction
with the body
2. UMBILICAL GRIP “Where is the fetal back?”
- FETAL BACK is smooth, hard, resistant surface
- KNEES and ELBOWS of fetus feel with a number of angular
nodulation
3. PAWLICK’S GRIP “What is the inlet of the pelvis?” by grasping the lower portion of the
abdomen (just above the symphysis pubis)
NOT ENGAGED (not firmly settled in pelvis) if the presenting part
moves upward so and examiner’s hands can be pressed together.
4. PELVIC GRIP “What is the fetal attitude (degree of flexion??”
- Fingers on both sides of the uterus (2 inched above inguinal
ligaments) pressing down and inwards. The fingers of the hand
that do not meet obstruction above the ligament palpates the
fetal brow.
- GOOD ATTITUDE if brow corresponds to the side (2nd
maneuver) that contained the elbows and knees.
- POOR/BAD ATTITUDE – if examining fingers will meet an
obstruction on the same side as fetal back (hyperextended
head)
LEOPOLD’S MANEUVER
 NOTE:
◦ The first 3 maneuvers: the examiner is
FACING THE PREGNANT WOMAN.
◦ The 4th maneuver: the examiner is FACING
THE WOMAN’S FEET.
 True VS False LABOR
TRUE FALSE
CONTRACTION - Regular - Irregular
- Increasing frequency, - No change in frequency,
duration & intensity duration & intensity
- Shortening interval
DISCOMFORT - Radiates from back - Pain at abdomen
around the abdomen
ACTIVITY - Contraction does not - Contraction may lessen
decrease with rest or with activity or rest
activity like walking
CERVIX - Progressive effacement - Cervical changes does
and dilatation of cervix not occur
 THEORETICAL ASSERTIONS
DURING CHILDBIRTH
 DICK READ METHOD
ASSERTIONS ACTIONS COVERS
Tension (psychic and Prenatal courses and - Fetal development and
muscular) is aroused by training reduce fear; childbirth
fear and anticipation of educates; and boost self- - Pain relief methods
pain. confidence. - Muscle strengthening
exercises
Sympathetic stimulation - Breathing techniques
brought about by fear - Physical and emotional
causes contraction of the health for childbirth
circular muscle of the - Mother gets
cervix. empathetic
understanding from
partner, midwife, nurse,
and physician
 THEORETICAL ASSERTIONS
DURING CHILDBIRTH
 LAMAZE METHOD
 (Psychoprophylactic Childbirth)
ASSERTIONS ACTIONS COVERS
Pavlov Theory of Classical Woman is taught to - Practice of breathing
Conditioning where replace responses of techniques during
unfavorable responses are anxiety, fear, and loss of labor
replaced by favorable control with more useful - Controlled perception
conditioning responses. activity. - Relaxation of involved
muscles
High level of activity - Mouthing silently
excite higher brain words or songs with
centers to inhibit other rhythmical tapping of
stimuli as pain. fingers
- Supportive person
nearby in a calm
environment
 THEORETICAL ASSERTIONS
DURING CHILDBIRTH
 LEBOYER METHOD
ASSERTIONS ACTIONS COVERS
The contrast of Gentle controlled delivery - Relaxing the
intrauterine environment craniosacral axis by
and the external world supporting the head,
causes infant to suffer neck and sacrum
psychological shock at the - Restoring the body
time of delivery. heat loss
- Allowing infant to
breath spontaneously
- Delaying cutting of
cord to permit
placental blood flow
- Promoting bonding
between mother and
infant dyad by skin-to-
skin contact.
MECHANISMS OF LABOR /
CARDINAL MOVEMENTS
 ED FIRE ERE
◦ Engagement
◦ Descent
◦ Flexion
◦ Internal Rotation
◦ Extension
◦ External Rotation
◦ Expulsion
4 types of newborn heat loss
1. EVAPORATION – wet amniotic fluid on
skin = dry the baby / cover head
2. CONDUCTION – transfer of heat to a
cooler surface = pre-warm devices.
3. CONVECTION – loss of heat to cooler
air (drafts) = keep baby away from vents.
4. RADIATION – loss of heat to colder
environment = keep baby away from the
windows.
 Conduction: when the newborn is
placed naked on a cooler surface, such as
table, scale, cold bed. The transfer of heat
between two solid objects that are
touching, is influenced by the size of the
surface area in contact and the
temperature gradient between surfaces.
 Convection: when the newborn is
exposed to cool surrounding air or to a
draft from open doors, windows or fans,
the transfer of heat from the newborn to
air or liquid Newborn Thermoregulation :
A Self-Learning Package ©CMNRP June
2013 5 is affected by the newborn’s large
surface area, air flow (drafts, ventilation
systems, etc), and temperature gradient.
 Evaporation: when amniotic fluid
evaporates from the skin. Evaporative
losses may be insensible (from skin and
breathing) or sensible (sweating). Other
factors that contribute to evaporative loss
are the newborn’s surface area, vapor
pressure and air velocity. This is the
greatest source of heat loss at birth.
 Radiation: when the newborn is near cool
objects, walls, tables, cabinets, without
actually being in contact with them. The
transfer of heat between solid surfaces that
are not touching. Factors that affect heat
change due to radiation are temperature
gradient between the two surfaces, surface
area of the solid surfaces and distance
between solid surfaces. This is the greatest
source of heat loss after birth.
APGAR SCORING
EINC (UNANG YAKAP)
INFANT CARE AND FEEDING
 Infant Care and Feeding
◦ Sucking – Oxygen

Heart – pumping out blood (hemoglobin:

Carries oxygen)

- Endocardium – inner
- Myocardium – cardiac output (CO) – amount
of blood pump out by heart
- Pericardium – outermost layer
DISORDERS/CONDITIONS AFFECTING
INFANT CARE AND FEEDING
 GERD (GastroEsophageal Reflux Dse.)
◦ aka Chalasia
◦ PROBLEM: incompetent LES (lower
esophageal sphincter) / cardiac sphincter
◦ S/Sx:
 Forceful vomiting
 Heartburn
 Bitter taste in the mouth
 Dysphagia
 Odynophagia – painful swallowing
 Hoarseness – laryngeal affectation
 GERD (GastroEsophageal Reflux Dse.)
◦ Mgt:
 Low-fat (gastric irritants/hard to digest), High Fiber
diet
 SFF – Small frequent feeding
 Avoid: spicy foods, tobacco, caffeine, alcohol
 Medications: antacids
 Magnesium based – diarrhea
 Aluminum – constipation
 H2 blockers – “tidine”
 PPI (Proton Pump Inhibitors) – “prazole”

 Head of Bed Elevated – 6-8 inches during sleeping

 Pyloric stenosis – affect infant’s pylorus
 hypertrophic pyloric stenosis (HPS).
◦ Weight gain difficulties
◦ Sex: Boys (first born males)
◦ Race: White especially in European descent
◦ High risks: Maternal Smoking, Antibiotics
(baby after birth, mother – late in pregnancy)
◦ Developed when baby 2-8 weeks old
◦ 5 months – symptom become apparent
◦ SYMPTOMS:
 Projectile vomiting
 Abdominal pain
 Dehydration
 Hunger after feedings
 Irritability
 Small stools
 Wave-like stomach motion right after eating, just before
vomiting starts. Occasionally a mass like a sausage can be
felt in the stomach.
 Weight loss
Surgery called pyloromyotomy
 HIRSCHSPRUNG’S DISEASE
 Hirschsprung's (HIRSH-sproongz) disease
is a condition that affects the large
intestine (colon) and causes problems
with passing stool.
 The condition is present at birth
(congenital) as a result of missing nerve
cells in the muscles of the baby's colon.
 Typically, the most obvious sign is a newborn's failure
to have a bowel movement within 48 hours after
birth.
 Other signs and symptoms in newborns may include:
◦ Swollen belly
◦ Vomiting, including vomiting a green or brown substance
◦ Constipation or gas, which might make a newborn fussy
◦ Diarrhea
◦ Delayed passage of meconium — a newborn's first bowel
movement
 In older children, signs and symptoms can include:
◦ Swollen belly
◦ Chronic constipation
◦ Gas
◦ Failure to thrive
◦ Fatigue
 Causes: Unknown
 Risk Factors:
◦ Sibling has HD
◦ Male
◦ Other inherited conditions – down syndrome,
CHD
Complications:
 Children who have Hirschsprung's disease
are prone to a serious intestinal infection
called enterocolitis. Enterocolitis can be
life-threatening and requires immediate
treatment.
INTUSSUSCEPTION
 Spontaneous telescoping of one portion
of the intestine into another leading to
mechanical obstruction
Cause: Unknown
 Main symptoms: Severe, crampy
abdominal pain
 Check: Barium Enema
 Surgery: laparoscopy, incision then push
the intestine back to normal or remove
the segment.
Pointers to Study
 Maternal Infections
 Torch – infectious disease identified as causing serious
harm to the embryo-fetus
 Pysiologic changes during the post-partum period
 Care of the newborn
 Apgar Scoring
 Physical Assessment
 Child Development
 Mental Retardation
 Reflexes
 Breastfeeding
 Down’s Syndrome
Pointers to Study
 Leukemia
 Sickle Cell Anemia
 Hemophilia
 Cystic Fibrosis
 Intussusception
 Croup
 Otitis Media
 Family Planning
 Principles of Sterility (Surgical Asepsis)