Maternal Nursing
by

S. Mateo, RN, MD

- Contents  Anatomy of the female reproductive tract
 Physiology of Ovulation
 Menstruation/Puberty/Menopause
 Physiology of Pregnancy
 Pre-natal Care
 Fetal Presentation, Lie and Position
 Fetal Surveillance

FNCC in partnership with UV

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MATERNAL NURSING

Anatomy of the Female
Reproductive Tract
Must Know:
 parts of the internal & external



female reproductive organsblood supply to the uterus,
ovaries and tubes
ligaments of the uterus
course of the ureter
embryologic origin
homologous structures to male

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MATERNAL NURSING

External Female Genitalia Vulva/ Pudenda          Mons pubis Labia majora Labia minora Clitoris Hymen Vestibule Urethral opening Skene’s glands Bartholin’s glands Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 4 MATERNAL NURSING .

Internal Female Genitalia  Uterus  Fundus  cornu  isthmus  cervix  Ovaries  Fallopian tubes  Interstitial  isthmus  ampulla  infundibulum w/ the fimbriated end Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 5 MATERNAL NURSING .

Arterial Blood Supply  aorta --> common iliac--> internal iliac (hypogastric) --> anterior branch --> uterine a.---> medial to uterine isthmus then branches to two ( 2 cm lateral to endocervix crosses over the ureter)  ----->ascending branch anastomoses w/ ovarian a.----> descending branch supply the cervix and the vagina Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 6 MATERNAL NURSING .

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arises from the     aorta just below the renal vessels It courses in the retroperitoneal space.Arterial Blood Supply  Ovarian Artery. enters the infundibulo-pelvic ligament to the ovary. crosses anterior to the ureter. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 8 MATERNAL NURSING . and anastomosis with the ascending branch of the uterine artery.

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Ligaments  Broad ligament . draping the outstretched fallopian tubes  Round ligament .peritoneum covering the fundus and part of the body continuous laterally as the broad ligament.begins anterior to the interstitial portion of the tube extends laterally to the pelvic sidewalls to the deep inguinal ring to attach to the skin of the labium major Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 10 MATERNAL NURSING .

containing ovarian vessels Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 11 MATERNAL NURSING .part of the broad ligament attached to the fallopian tube  Infundibulo-pelvic or Suspensory lig of the ovary .arise from the pelvic side wall to the lateral aspect of the ovary.attaches the ovary to the broad ligament  Mesosalpinx .attaches the ovary to the uterus.Ligaments  Ovarian . posterior to the fallopian tube  Mesovarium .

Ligaments  Uterosacral . It is the main ligamentous support of the uterus. serves as the lateral border of the cul-de-sac  Cardinal or Mackenrodt’s .from the upper portion of the cervix it goes posteriorly to the third sacral vertebra. It is the condensation of the broad lig inferiorly.extends from the lateral portion of the cervix and vagina to the pelvic side walls. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 12 MATERNAL NURSING .

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descends anterior to the internal iliac artery. the ureter is about 1 to 2 cm. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 14 MATERNAL NURSING . and crosses inferior to the uterine artery.  At the level of the cardinal lig.Course of the Ureter  Ureter enters the pelvis at the bifurcation of the common iliac artery. lateral to the uterine cervix.

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 Mullerian ducts form the Fallopian tubes. and proximal part of the vagina. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 17 MATERNAL NURSING . uterus.Embryology  Mullerian or Paramesonephric duct forms the female reproductive tract  Fusion of the two Mullerian ducts in the midline form the uterine canal which later meets caudally with the urogenital sinus.

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ovary and its effect on the endometrium. pituitary. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 19 MATERNAL NURSING .Physiology of Ovulation and Menstruation  Must know: Know the different hormones and their respective actions involved in ovulation. and menstruation from the hypothalamus.

Physiology of Ovulation BRAIN Hormone Hypothalamus GnRH Anterior Pituitary FSH LH 1/hrfollicular 1/ 2-3h luteal granulosa cells theca cells Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 20 MATERNAL NURSING .

Physiology of Ovulation OVARY Hormone Granulosa cells Estrogen increase granulosa cells and Theca cells Androgens  Estrogen follicular maturation Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 21 MATERNAL NURSING .

Physiology of Ovulation OVARY Hormone Dominant follicle- Mature follicle (18 22 mm) - Ovulation -- Corpus luteum  Progesterone Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 22 MATERNAL NURSING .

Physiology of Menstruation Hormone Ovary Endometrium Estrogen Follicular phase Proliferative phase Progesterone Luteal phase Secretory phase Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 23 MATERNAL NURSING .

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the proper sequence of physiologic changes occurring in puberty Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 25 MATERNAL NURSING .Puberty  Must know: .

old 5. Thelarhe .     old 2.10 yrs. old 4. old Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 26 MATERNAL NURSING .breast dev’t .appearance of pubic hair . Pubarche .9 ½ yrs.13 1/2 yrs. Ovulation .Puberty  Events occurring in chronologic order:  1. Menarche .12 1/2 yrs. Growth spurt . old 3.12 yrs.

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Menstrual Disorders Must know:    Primary amenorrhea Secondary amenorrhea Dysfunctional Uterine Bleeding Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 28 MATERNAL NURSING .

Primary Amenorrhea  The absence of menarche by age 16 years of age in the presence of normal secondary characteristics or by 14 years of age when there is no visible secondary sexual characteristic development. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 29 MATERNAL NURSING .

 Most common cause of physiologic secondary amenorrhea is pregnancy Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 30 MATERNAL NURSING .Secondary Amenorrhea  Absence of menstruation for six months in a previously menstruating woman.

Dysfunctional Uterine Bleeding  Abnormal bleeding without an obvious anatomic or organic pathology.  Usually is anovulatory secondary to a persistent graafian follicle.  Estrogen is the predominant hormone leading to endometrial stimulation ---> endometrial hyperplasia. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 31 MATERNAL NURSING .

Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 32 MATERNAL NURSING . unopposed by progesterone leading to endometrial shedding and irregular bleeding.DUB  Bleeding is caused by slight withdrawal of estrogen.

Clomiphene Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 33 MATERNAL NURSING .DUB: Treatment  Medical:  Cyclic progesterone  Cyclic estrogen and progesterone  Ovulation induction eg.

DUB: Treatment  Surgical:  Fractional curettage  Endometrial ablation  Hysterectomy for recurrent DUB cases unresponsive to medical treatment Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 34 MATERNAL NURSING .

Menopause  Menopause is the absence of menstruation for 6 to 12 months occurring on the average at age 50 years. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 35 MATERNAL NURSING .  Climacterium is the phase preceding menopause characterized by irregular ovulation and menstruation with subjective symptoms.

Menopause  Is the result of the gradual decrease in secretion of ovarian estrogen due to progressive diminution in the number of functional ovarian follicles.  Adrenal and ovarian androstenedione is likewise aromatized to estrone. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 36 MATERNAL NURSING .  Ovarian stromal cells continue to secrete testosterone for a time which is aromatized to estradiol in fat and liver.

Menopause  As estrogen and progesterone production decreases. the negative feedback to the hypothalamus and pituitary is reduced leading to increased levels of FSH and LH. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 37 MATERNAL NURSING .

neck.Symptoms  Hot Flash .  May last for a few seconds to a few minutes. face. principally that of the head. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 38 MATERNAL NURSING . chest. back followed by profuse diaphoresis.Sensation of intense heat and flushing of the skin.  Diminish in severity and disappear in two years if untreated.

Physical Changes  Atrophy of the reproductive tract leading to Atrophic vaginitis and later dyspareunia and loss of libido. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 39 MATERNAL NURSING .  Amount of collagen in the dermis decreases leading to thinning of the skin and wrinkling.

long bones and femoral neck. inactivity and use of corticosteroids. Treatment: ERT Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 40 MATERNAL NURSING .Physical Changes  Bone . Exacerbated by smoking.resorption exceeds growth     leading to Osteoporosis (loss of bone density). Occurs more in White and Oriental women than in black. May be complicated by fractures of vertebra.

 This increases the incidence of Atherosclerosis and the risk of Myocardial Infarction in this age group.Menopause  Cholesterol .There is an increase in the level of low density lipoproteins and decrease in the level of high density lipoprotein. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 41 MATERNAL NURSING .

Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 42 MATERNAL NURSING . eg. Raloxifene (Evista). either cyclic or continuous  SERM .  HRT.selective estrogen receptor modifiers has beneficial effect on the bone and cholesterol but does not stimulate the breast and the endometrium.Treatment:  ERT can lead to stimulation of the endometrium and breast.combination of estrogen and progesterone.

it enters the endometrial cavity as a morula (12 -16 cell stage)  Six to seven days after fertilization. Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 43 MATERNAL NURSING .Fertilization and Implantation  Egg is released in the metaphase II stage  Completion of second meiotic division occurs with fertilization (ampulla of FT)  After 3 to 4 days in the tube. implantation occurs as a blastocyst.

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Embryo and Fetus  embryo .from fertilization to 8 weeks from ovulation ( 10 weeks by LMP) .from 8 weeks ovulatory age ( 10 weeks by LMP) to term differentiation and maturation of different organs occur Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 45 MATERNAL NURSING .major organ systems are formed  fetus .

Diagnosis of Pregnancy  Presumtive  Presumptive signs Sx’s      nausea/vomiting disturbance in urination fatigue perception of fetal movement breast tenderness      amenorrhea anatomical breast changes changes in vaginal mucosa(Chadw ick’s) skin pigmentation thermal signs Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 46 MATERNAL NURSING .

Probable Evidence of Pregnancy  enlargement of  Braxton Hick’s the abdomen  changes in the size. shape and consistency of the uterus  anatomical changes in the cervix contraction  ballotement  physical outlining of the fetus  positive results of endocrine test Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 47 MATERNAL NURSING .

Positive Evidence of Pregnancy  Identification of fetal heart tones  perception of active fetal movements by the examiner  recognition of the embryo or fetus by ultrasound or radiologic tests Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 48 MATERNAL NURSING .

capacity of 10ml to 5      liters stretching and marked hypertrophy of existing muscles formation of new muscles limited first 3 months .uterine enlargement due to estrogen more than 3 months enlargement due to effect of pressure of the expanding fetus Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 49 MATERNAL NURSING .Maternal Adaptations to Pregnancy  Uterus .

4 to 5 weeks  softening of the lower uterine segment ( Hegar’s sign) .6 weeks  Utero-placental blood flow 500ml/min Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 50 MATERNAL NURSING .bluish discoloration of the vagina and cervix  softening of the cervix .Uterus/ Vagina  Chadwick’ sign .

Ovaries  ovulation and maturation of new follicles suspended  corpus luteum of pregnancy is the main source of progesterone for the first 6 to 7 weeks age of gestation Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 51 MATERNAL NURSING .

2 pounds ( 1kg)  2nd trim -11 pounds ( 5 kg)  3rd trim .11 pounds ( 5 kg) Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 52 MATERNAL NURSING .Weight Gain  Total of 24 pounds (11 kg)  1st trim .

40 % increase in plasma volume .there is hemodilution leading to physiologic anemia of pregnancy Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 53 MATERNAL NURSING .20 -30 % increase in RBC mass .Blood Volume  Increase in blood volume marked during the second trimester  Due to .

6 to 7 mg of Fe required daily Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 54 MATERNAL NURSING .300 mg to fetus and placenta . .Iron Requirements  Total Fe requirement is 1.0 gm.500 mg to formation of new RBC’s  Second half of pregnancy .200 mg to obligatory loss .

Heart  Increase heart rate to 10 to 15 beats/min  heart displaced to the left and upward  Heart sounds: exaggerated splitting of the 1st heart sound  a loud third heart sound  Heart murmurs:  systolic murmur intensified on inspiration  Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 55 MATERNAL NURSING .

vital capacity  decrease .Pulmonary function  increase: . minute O2 uptake  mild increase inspiratory capacity  no change maximum breathing capacity. minute ventilatory volume.residual volume Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 56 MATERNAL NURSING .tidal volume.

Urinary Tract

 Increased GFR and RPF
 Glucosuria not necessarily

abnormal
 Proteinuria not occur normally
 Hydronephrosis and hydroureter

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MATERNAL NURSING

GIT

 decreased peristalsis leading to

pyrosis ( heartburn),
constipation
 Hemorrhoids
 predisposes to formation of gall

stones

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MATERNAL NURSING

Thyroid function

Test

Normal
pregnancy

Hyperthyroidism

BMR

Inc

Inc

Total T4

Inc

Inc

Thy binding
globulin

Inc

Not inc

Free T4

Not inc

Inc

Total T3

Inc

Inc

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Estimation of AOG  Naegle’s Rule – from LMP add 7 days. subtract 3 months  Quickening – 16 to 20 weeks  Height of Fundus    12 weeks – above symp pubis 16 weeks – halfway between sym pubis and xiphoid 20 weeks – level of umbilicus Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 61 MATERNAL NURSING .

FL +/.Estimation of AOG  Ultrasound . HC.2-3 weeks Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 62 MATERNAL NURSING . AC.First Trimester: CRL +/1 week .Second/Third Trim: BPD.

Initial Comprehensive
Evaluation

 History
 Physical Examination

 Leopold’s maneuver
 First maneuver: fundal grip
 Second maneuver: fetal back
 Third maneuver: presenting part
(Pawlick’s grip)
 Fourth maneuver: cephalic
prominence
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Prenatal Care

 Pap’s smear
 Pelvic Exam

 Laboratory
 Urinalysis
 CBC, typing
 HBSAg
 VDRL
 50 gms Glucose Challenge test

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Frequency of Visits

 First missed period
 Every 4 weeks until 28 weeks
 Every 2 weeks from 28 to 36

weeks
 Every weeks from 36 weeks
 WHO recommendation: 5
visits, minimum of 3 visits
with the 1st visit during the 1st
trimester
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8) 12.5 – 18 .High (15-25)7 – 11.5 – 16 .Low (<19.Normal (19.Obese (>29) < 7 Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 66 MATERNAL NURSING .Nutrition in Pregnancy Weight Gain  Pre-pregancy BMI Recommended Total Wt Gain in Kilogram .8-26)11.5 .

Recommended Dietary Allowance (1989)  Folate and Iodine supplementation  Safe level intake of Vit D and E  Proportionate intake of the basic food groups Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 67 MATERNAL NURSING .

1st trim 225 gms/day .Calories  Additional 300 kcal/day for the 2nd and 3rd trimesters  Proteins: 9 gms/day  Carbohydrates: .3rd trim 50 – 100gms/day – ave.150 gms/day .  Fats 15 – 25 g/day Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 68 MATERNAL NURSING .

Iron  Required to replace losses and for expansion of RBC mass  First trimester: no supplements needed  Second and Third trimesters: Supplementation needed Daily required of 68 mg dietary Fe .Ave. 41 mg / day Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 69 MATERNAL NURSING .

Lie.transverse .longitudinal . Attitude and Position  Fetal Attitude – relation of the fetal parts to one another  Fetal Lie – relation of the long axis of the fetus to the long axis of the mother . Presentation.oblique Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 70 MATERNAL NURSING .

Presentation  Part of the fetus lying over the pelvic inlet .cephalic 95% .shoulder rare Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 71 MATERNAL NURSING .breech 5% .

full flexion .shortest AP diameter: Suboccipitobregmatic – 9.Cephalic presentation  Vertex – occiput presentation .5 cm Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 72 MATERNAL NURSING .the occipital fontanel is presenting .

partially flexed head .5 cm Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 73 MATERNAL NURSING .occipitofrontal diameter – 12.bregma or anterior fontanel presenting .Cephalic Presentation  Sinciput – Military Attitude .

marked extension .5 cm Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 74 MATERNAL NURSING .occipitomental diameter – 13.chin presenting .submentobregmatic diameter – 9.5 cm (longest)  Face .brow is presenting - partially extended .Cephalic Presentation  Brow .

one or both thighs are extended.thighs are flexed on the fetal abdomen with the legs extended  Complete . one or two feet/knee and are below the breech Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 75 MATERNAL NURSING .Breech Presentation  Frank .thighs are flexed and the legs are flexed  Incomplete .

Breech Presentation  Shoulder presentation .prolapse of fetal hand together with the head or breech Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 76 MATERNAL NURSING .shoulder or an acromion is presenting in transverse lie  Compound presentation .

right or left Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 77 MATERNAL NURSING .Position  Position – the relation of a chosen portion of the presenting part of the fetus as to the right or left side of the maternal birth canal: .

posterior Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 78 MATERNAL NURSING . transverse or posterior portion of the maternal pelvis .anterior .Variability  Relation of a chosen portion of the presenting part of the fetus as to anterior.transverse .

Direction of the fetal back determines if dorsoanterior or dorsoposterior Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 79 MATERNAL NURSING . Points of reference O – Occiput M – Mentum S – Sacrum A – Acromion  In shoulder presentation the side of the mother towards which the acromion is directed determines if it is right or left.

Diagnosis of Presentation and Position  Leopold’s maneuver  Vaginal Examination  Sonography Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 80 MATERNAL NURSING .

Fetal Surveillance  Inspection  Palpation  Size and shape of growing uterus  Observe and feel gross fetal movements Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 81 MATERNAL NURSING .

first perceived at quickening .Fetal Surveillance  Fetal Movement .daily fetal movement count in high risk pregnancies advocated Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 82 MATERNAL NURSING .increases as pregnancy progresses .

Fetal Surveillance  Contraction Stress Test or Oxytocin Challenge Test .observe fetal heart pattern on Electronic Fetal Monitor Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 83 MATERNAL NURSING .three contractions (40-60 secs) in ten minutes .mimic uterine contractions of labor .

No decelerations  Positive .Persistent Late Decelerations (> half)  Suspicious . but < half  Hyperstimulation Excessive uterine contractions  Unsatisfactory No adequate contractions Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 84 MATERNAL NURSING .Oxytocin Challenge Test  Negative .Late Dec.

records FHR acceleration in response to Fetal Movement .Fetal Surveillance  Nonstress Testing .test of fetal condition .easier to perform Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 85 MATERNAL NURSING .

after fetal movement  Non-reactive Nonstress test .increase of FHR of 15 beats/min for longer than 15 secs.no increase in FHR Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 86 MATERNAL NURSING .Nonstress Test  Reactive Nonstress Test .

Fetal Tones .Fetal Movements .Fetal Surveillance  Biophysical Profile .Amniotic fluid Volume Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 87 MATERNAL NURSING .Fetal Heart Reactivity .Fetal Breathing .

30 secs FB in 30 min 2.flexion 1.Biophysical Profile Score 2   Fetal breathing – 1.3 or > gross BM 3. limb flexionextension. Fetal Tone – 1 3. Fetal Movements . Score 0 Less than 30 sec FB movements Two or < gross BM Limb in extension or semi-extension no or slow return to flexion Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 88 MATERNAL NURSING . 2.

AFV – 2 pockets 5. No or < 2 FH 4. Largest pocket < 1 of AF at least 1 cm cm each Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 89 MATERNAL NURSING .2 or > FH accelerations 5.Biophysical Profile 4. Fetal Heart accelerations Reactivity.

8/10 – decreased AF Chronic fetal asphyxia 6/8 – normal AF 4/8 0-2 Possible asphyxia Probable asphyxia Certain of fetal asphyxia Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 90 MATERNAL NURSING .Biophysical Profile 10/10 or 8/8 8/10 –normal AF Normal 6/8.

External intrapartum assessment  2 transducers  Involves the use of a fetal monitor  Uses the Doppler principle .uterine activity (contractions) Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 91 MATERNAL NURSING .fetal heart rate .

Electronic Fetal Monitoring  Serve as a screening test for severe asphyxia  Diagnose fetal distress  Decrease incidence of fetal morbidity and mortality Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 92 MATERNAL NURSING .

 Recognition of early asphyxia so that timely obstetric intervention can be instituted Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 93 MATERNAL NURSING .

Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 94 MATERNAL NURSING .

Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 95 MATERNAL NURSING .

Variability  Fluctuations in baseline FHR of 2 cycles/minute or greater  Fluctuations are irregular in amplitude and frequency  Normal: 6-25 bpm Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 96 MATERNAL NURSING .

Variability  Short-term variability .amplitude excursions .beat to beat fluctuations in FHR  Long-term variability .visually determined approximate amplitude range of the fluctuations Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 97 MATERNAL NURSING .

Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 98 MATERNAL NURSING .

at least 15 seconds. less than 2 minute duration in a 10 minute tracing  Prolonged acceleration: 2-10 minutes  If acceleration > 10 minutes.Acceleration  Abrupt increase in fetal heart rate of at least 15 bpm. already a baseline rate change Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 99 MATERNAL NURSING .

Deceleration  Early (type I)  Late (type II)  Variable (type III) Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 10 0 MATERNAL NURSING .

bradycardia Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 101 MATERNAL NURSING .Deceleration  Transient episode of slowing of the fetal heart rate below the baseline level of more than 15 bpm and lasting 15 seconds or more  If rate is below 110 bpm and duration is > 10 minutes.

acidemia or low Apgar scores Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 102 MATERNAL NURSING .Early deceleration  usually associated with head compression  generally seen in active labor between 4 and 7 cm dilatation  not associated with fetal hypoxia.

Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 103 MATERNAL NURSING .

Late Decelerations  smooth. gradual symmetrical decrease in FHR beginning at or after the peak of the contraction  return to baseline after the contraction has ended  usually but not invariably pathological Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 104 MATERNAL NURSING .

Late Deceleration  magnitude not more than 30-40 bpm  in milder cases. may be the result of direct myocardial depression Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 105 MATERNAL NURSING . can be a reflex to CNS hypoxia  in more severe cases.

Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 106 MATERNAL NURSING .

Variable Deceleration  Onset of deceleration varies with successive contractions  Due to umbilical cord compression  Reflex that reflects BP changes due to interruption of umbilical blood flow or changes in oxygenation Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 107 MATERNAL NURSING .

Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 108 MATERNAL NURSING .

Variable Deceleration    appearance of the dip is variable in duration. depth and shape from contraction to contraction usually abrupt in onset and cessation described as severe when the decelerations are below 70 bpm and longer than 60 seconds in duration Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 109 MATERNAL NURSING .

Other Intrapartum Fetal Assessment Techniques  Fetal scalp blood sampling  Scalp stimulation  Vibroacoustic stimulation  Fetal pulse oximetry  Intrapartum Doppler velocimetry Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 110 MATERNAL NURSING .

20 immediate delivery Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 111 MATERNAL NURSING .Fetal scalp blood sampling  pH of fetal scalp blood measured  Fetal acidosis  pH > 7.25 repeat testing  pH < 7.25 observe labor  pH 7.20-7.

Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 112 MATERNAL NURSING .

Color Flow Doppler  Uses Doppler Principle in measuring vessels supplying the fetus  Trophoblastic proliferation losses the muscular layer of vessels of the uterus  Leads to decrease in resistance to flow of blood Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 113 MATERNAL NURSING .

increase in resistance at 20 – 24 weeks . absent to reversed flow during diastole Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 114 MATERNAL NURSING .Color Flow Doppler  Normal Pregnancy .decrease in resistance at 20-24 weeks .decreased.good systolic and diastolic flow  Utero-Placental Insufficiency .

Color Flow Doppler  Resistance Index  Pulsality Index  Systolic/Diastolic Ratio Notes: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ FNCC in partnership with UV 115 MATERNAL NURSING .

__________________________ (Signature of Client) ____________ Date FNCC in partnership with UV 116 MATERNAL NURSING . __________________________ (Signature of Client) ____________ Date ---------------------------------------------FNCC Copy ACKNOWLEDGMENT OF RECEIPT I hereby acknowledge the receipt of this Student Handbook.ACKNOWLEDGMENT OF RECEIPT Student Copy ACKNOWLEDGMENT OF RECEIPT I hereby acknowledge the receipt of this Student Handbook.

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