Signs of Ovulation - The fluid release by a man during ejaculation

1. Mittleschmerz that contains the sperm cells and secretions

- Lower abdominal pain felt at the side of from the male reproductive tract
ovary that released the ovum - The average amount of semen is 3-5 ml and
2. Spinnbarkeit this contains about 300-500 million of sperm
- Cervical mucus showing a ferning pattern cells
when dried and viewed under the SIDE NOTES: based kay ma’am rose
microscope, mucus is also thin and - Average ejaculation is 2.5 ml
transparent, stretchable and abundant. - Contains 50 – 200 million sperm cells
3. Higher basal body temperature
- Caused by a high level of progesterone Fertilization
4. Peak level of Luteinizing Hormone (LH) - This is the union of the egg cell and the
- to released the matured ovum sperm cell in the fallopian tube.
- Zygote is the term used for a fertilized ovum
Menopause (Climacterium) Implantation
- The last menstruation which indicates the - Also called NIDATION
end of a woman reproductive years - Burrowing of developing zygote into the
- Refers to the time in a woman’s life when she endometrial lining of the uterus that occurs
undergoes a transition from the 7-10 days after fertilization
reproductive stage to the non- reproductive - Chorionic villi appear on surface and secrete
stage. human chorionic gonadotropin (HcG) which
- Generally, occurs between ages of 45 to 55 inhibits ovulation during pregnancy by
and at time earlier in some women. stimulating continuous production of
- Age + 35 = age of menopause estrogen and progesterone.

The OVUM
- The female sex gametes
- Has 2 protective covering
o Zona pellucida – inner layer
o Corona radiata – outer layer
- Lifespan – 24 hours / 1 day
- Immobile structure (moved by cilia)

The SPERMATOZOA
- The male gametes or sex cell
- Parts include:
o HEAD – contains the chromatin The DECIDUA
materials - Refers to the endometrium after
o NECK – or midpieces which provides implantation
energy from movement - 3 layers
o TAIL – responsibility for the motility o Decidua capsularis – enclose the
Types of sperm cells blastocyst
1. GYNOSPERM o Decidua vera – located under decidua
- Contains the X chromosomes basalis
- Large oval heads and lesser in number o Decidua basalis – layer involved with
- Survive in acidic environment implantation. It forms the maternal
2. ANDROSPERM side of the placenta
- Carriers the Y chromosomes The MEMBRANES
- Smaller heads but greater in number 1. Chorionic membrane
- Thrive in alkaline environment - Membrane not involves with implantation.
SIDE NOTES: This is attached to the fetal surface of the
- MALE is XY chromosome placenta that provides support to the
- FEMALE is XX chromosome amniotic membrane.
- Describe as thick, opaque, and friable
2. Amniotic membrane
SEMEN
EL JIREH D. ASAURO BSN 2D
 - Directly encloses the fetus and amniotic - Produces hormones to maintain pregnancy
fluid and assumes full responsibility for the
- This is continuous to the umbilical cord production of these hormones by the 12th
Amniotic fluid week of gestation
- The fluid found within the amniotic sac and - Larger particles cannot such as bacteria
in which the fetus floats cannot pass through placenta
- Also called liquor amnii - In addition to nutrients, drugs, antibodies
and viruses can pass through placenta
Characteristics of Amniotic fluid - In the 3rd trimester of maternal
1. Volume: 500ml – 1200 ml, average = 1000ml Immunoglobulin provides fetus, passive
- Oligohydramnios – amniotic fluid of less than immunity to certain disease for the first few
300ml months after birth
- Polyhydramnios – amniotic fluid of more - By week 8, genetic testing can be done
than 2000ml
2. Composition – 99% water and 1% solid - Passage of materials in either direction is
particles containing albumin, urea, uric acid, affected by:
creatinine, lecithine, sphyngomyelin, bilirubin, o Diffusion – CO2, and fetal waste
vernix and lanugo. products, O2 sodium, chloride and fat-
Functions of amniotic fluid soluble vitamins cross the placenta in
1. Protects the fetus from trauma, blows and this manner.
pressure o Facilitated diffusion – glucose, amino
2. Allows freedom of movement permitting acid, and minerals
symmetrical growth and development of o Pinocytosis – maternal
musculoskeletal system immunoglobulins that provide passive
3. Maintain constant pressure immunity to fetus cross the placenta
4. Acts as an excretion and secretion system through this mechanism
5. Sources of oral fluid for the fetus - 2 sides of the placenta
6. Provides protection against certain infections o MATERNAL SIDE – dirty side composed
7. Aids in the diagnosis of maternal and fetal of 15-20 cotyledons, when delivered
complications first it’s called DUNCAN MECHANISM
8. Aids in fetal descend during labor (20%)
o FETAL SIDE – appears smooth and
UMBILICAL CORD shiny, when delivered first, it is called
- It serves as the connection of the fetus and SCHULTZ MECHANISM (80%)
the placenta o MDFS
- Its main function is to carry nutrients and FUNCTION OF THE PLACENTA (REPEN)
oxygen via the umbilical vein and fetal waste - Respiratory system
products back to the placenta via umbilical - Endocrine system
arteries - Pulse or circulatory system
- About 50 – 55 cm long and 2 cm in diameter - Excretory function
- Contains 2 arteries and 1 vein supported by a - Nutrition
mucoid material, Wharton’s jelly to prevent
kinking and knotting. Fetal Growth and Development
- Organ systems are developed from 3 primary
PLACENTA germ layer
- Transient organ allowing passage of nutrients a. ECTODERM – outer layer, produces
and waste material between mother and skin, nails, nervous system and tooth
fetus enamel
- A discoid organ weighing 500 grams at term b. MESODERM – middle layer, produces
- Also act as an endocrine organ and as a sieve connective tissue, muscles, blood and
which allow smaller particles through and circulatory system
holds back larger molecules c. ENDODERM – inner layer, produces
linings of GIT and RT, endocrine glands
- Provides for exchange of nutrients and waste and auditory canal
products between fetus and mother
- Develops by the third month
EL JIREH D. ASAURO BSN 2D
Term used to denote Fetal Growth and Development mother’s. these blood cells are produces by
NAME PERIOD the liver now instead of the yolk sac
OVUM From ovulation to 8 weeks
fertilization - Eyes, ears, nose and mouth are recognizable
ZYGOTE From fertilization to o Fingers and toes are present
implantation o Gestational sac is visible by ultrasound
EMBRYO From implantation to o Capable of some movements but too
5 – 8 weeks faint to be feel by the mother
FETUS From 5 – 8 weeks until o Hands and feet are available
term o Heart with valves and septum
CONCEPTUS Developing embryo or o Ossification of bones begins
fetus and placental o Length is 2.5 cm
structures throughout 8 weeks
pregnancy - The unborn child, called a fetus at this stage.
The picture on the right is a fertilized egg, only thirty This about half an inch long. The tiny person
hours after conception. Magnified here, it is no larger is protected by the amniotic sac, filled with
than the head of the pin. Still rapidly dividing, the amniotic fluid. Inside, the child swims and
developing embryo called zygote at this stage, floats moves gracefully. The arms and legs are
down from the fallopian tube and lengthened, and fingers can be seen. The toes
will develop in the next few days. Brain waves
can be measured.
10 weeks
- The heart is almost completely developed
and very much resembles that of a newborn
baby. An opening the atrium of the heart and
the presence of bypass valve divert much of
the blood away from the lungs, as the child’s
blood is oxygenated through the placenta.
Twenty tiny baby teeth are forming in the
gums
12 weeks (3 MONTHS)
- Vocal cords are complete, and the child can
does sometimes cry (silently). The brain is
fully formed and the child can feel pain. The
Fetal Growth and Development
fetus may even suck his thumb. The eyelids
4 weeks
now cover the eyes, and will remain shut
- All systems are rudiment form
until the seventh month. To protect the
- Heart chambers are formed and beating
delicate optical nerve fibers.
- Length: 0.4cm, weight: 0.4 gms
- the placenta is developed and functioning
5 weeks
- Fetus is palpable just above the symphysis
- Embryo is the size of a raisin. By day twenty-
pubis
one, the embryo’s tiny heart has begun
- Arms and legs ratio are proportional
beating. The neural tube enlarges into three
- Fingernails and toenails are present
parts, soon to become a very complex brain.
- Sucking and swallowing reflex are present
The placenta begins functioning. The spine
- Skin is pink
and spinal cord grow faster than the rest of
- Attains human shape
the body at this stage and give the
- Length: 6-7cm, weight: 19 grams
appearance of a tail. This disappears as the
child continue to grow
7 weeks
- Facial features are visible, including a mouth
The second trimester of the PREGNANCY
and tongue. The eyes have a retina and lens.
14 weeks
The major muscles system is developed. And
- Muscles lengthen and become organized.
the unborn child practices moving. The child
The mother will soon start feeling the first
has its own blood type, distinct from the
flutter of the unborn child kicking and moving
within
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16 weeks (4 month) – sex can be identified externally - iron transfer from mother to fetus
- Resembles a human face - skin slightly wrinkled, pink in color
- Multipara experience quickening - assumes delivery position
- FHT can be heard by fetoscope - fetus can turn the head to side
- Scalp hair and lanugo formation begins - more rounded appearance
- Length: 11.5 - 13.5cms, - nails extend to fingertip
- weight: 100 - 110 grams - length: 28 – 31 cms
20 weeks (5 month) – FHT can be heard by - weight: 1600 – 2100 grams
stethoscope
- quickening is felts by primipara 36 weeks (9 months) – testis descend to scrotum
- vernix caseosa and sebaceous glands are - body is round
present - sole creases on anterior 2/3 of feet
- fetus can hear sound from external - L/S ratio 2:1
environment - Lanugo almost absent
- meconium in the rectum - Skin is pink and smooth
- length: 16 – 18.5 cms - Length: 32 – 35 cms
- weight: 300 grams - Weight: 2200 – 2900 grams
24 weeks (6 months) – sweat glands, eyelashes and
eyebrows are present 40 weeks – decreasing vernix caseosa
- lanugo covers the entire body - Testes in scrotum
- skin is red and wrinkled - Lightening 2 weeks prior to delivery in
- body is well proportioned primiparas
- transfer of maternal antibodies to the fetus - Fingernails extend beyond fingertips
begins - All characteristics of newborn
- surfactant production begins - Length: 40 cms
- length: 23 cms, weight: 600-630 grams - weight: 3000 – 3600 grams
- seen here at 6 months, the unborn child is
covered with fine, downy hair called lanugo. PRENATAL CARE
Its tender skin is protected by a waxy - also called ANTENATAL care
substance called vernix. Some of this - refers to health care given to a woman and
substance may still be on the child’s skin at her family during pregnancy
birth which time it will be quickly absorbed. - the primary goal is to provide maximum
The child practices breathing by inhaling health to expectant mothers and their babies
amniotic fluid into developing lungs GRAVIDA
- refers to the number of pregnancies a
28 weeks (7 months) woman has had irregardless of the outcomes
- fingernails and toenails begin to grow of pregnancy
- eyes are opened and reactive to light NULLIGRAVIDA
- fetus is immature if born at this time but with - a woman has never been pregnant
higher chance of survival if give expert care MULTIGRAVIDA
- skin is red and covered with vernix caseosa - a woman who has had two or more
- length: 25-27cm, weight: 1100 grams pregnancies
PRIMIGRAVIDA
30 weeks - a woman pregnant for the first time
- for several months, the umbilical cord has PARA
been the baby’s lifeline to the mother. - the number of pregnancies that reached
Nourishment is transferred from the mother’s viability
blood, through the placenta. And into the - criteria of a viable infant
umbilical cord to the fetus. If the mothers o AOG – 20 weeks or more
ingest any toxic substances, such as drugs or o Weight – 500 grams or more
alcohol, the baby receives these as well. o Presence of a heart beat

32 weeks (8 months) – the fetus sleeps 90-95% of the NULLIPARA

day, and sometimes experiences REM sleep, an - A woman who has never delivered a viable
indication of dreaming. infant/ fetus that reached the age of viability
- subcutaneous fats Is present
EL JIREH D. ASAURO BSN 2D
MULTIPARA - Obstetric history – includes
- A woman who has completed 2 or more a. History of past pregnancies
pregnancies that reached viability TPAL or FPAL
PRIMIPARA b. History of present pregnancy
- A woman who has completed one pregnancy o Inquire the LMP compute the EDC
that reached viability (Naegel’s Rule) and AOG
PRETERM INFANT NAEGEL’s rule
- Infant born before 38 weeks gestation 1-3 months: +9, +7
FULLTERM INFANT 4-12 months: -3, +7, +1
- Infant born between 38 – 42 weeks gestation
POST TERM INFANT GESTATION
- Infant born after 42 weeks gestation - Estimated date of confinement (EDC)
PARTURIENT WOMEN - Lasts approximately 280 days
- A woman who is in labor - Naegele’s rule for estimating EDC
PUEPERA - For Naegele’s rule to be accurate requires
- A woman who had just delivered an infant that the women have a regular 28 – day
(within six weeks after delivery) menstrual cycle
LIVEBIRTH - Add 7 days to the first day if the last
- Is recorded when the infant born shows menstrual period (LMP), subtract 3 months,
signs of life: breathing, spontaneous and then add 1 year to that date
movement of voluntary muscles and
heartbeat ASSESSMENT
STILLBIRTH - Vital signs
- An infant born without signs of life a. BP normal
LOW BIRTH WEIGHT/ Small for Gestational Age (SGA) b. PR increases about 10 beats/ min due to
- An infant with a birth weight below the 10th increased cardiac workload
percentile rank c. RR increased in depth, no change in rate
- A term infant is considered low birth weight d. Temperature- slight elevation early in
if the birth weight is less than 2500 grams pregnancy but drops to normal after 16 weeks
Large for Gestational Age (LGA)
- An infant with birth weight above the 90th PHYSICAL EXAMINATION
percentile rank - It is best to perform systematically,
- A term infant with a birth weight of more cephalocaudal approach
than 4000 grams - Abdominal examination or Leopold’s
Maneuver
History Taking
- Personal data PHYSICAL EXAMINATION PER VISIT
o Includes the name, age, civil status, - Weight
religion, occupation, weight and height - BP
- Menstrual History - Examination of conjunctiva & palms for pallor
o Includes the menarche, menstrual - Abdominal exam for fundic height, fetal
cycle, amount or menstrual flow and position, presentation & FHT.
the regularity of the menses - Exam for face, hands, lower extremities for
- Breast health edema
o Includes incidence of breast surgery, - Examination of the breasts
breast disorder and breastfeeding of - Examination of thyroid for enlargement and
previous infants goiter
- Contraceptives use ASSESSMENT OF FUNDIC HEIGHT
o The method of family planning used

- Medical History
o This may include childhood disease,
drug allergies, past surgeries, existing
medical conditions, family history,
immunization, intake of alcohol and
cigarette smoking
EL JIREH D. ASAURO BSN 2D
 be small or not growing properly, the baby is
MEASURING FUNDAL HEIGTH less active than normal, too little or too much
- Place the zero line of the tape measure on amniotic fluid
the anterior border of the symphysis pubis
and stretch tape over midline of abdomen to Contraction test
top of fundus - A contraction stress test evaluates the ability
- The tape should be brought over the curve of of the baby(fetus) to tolerate low oxygen
the fundus levels that normally occur during contraction
- The height of the fundus in centimeters when you are in labor. It excludes external
equals the number of weeks gestation plus fetal heart monitoring (nonstress test). The
or minus 2 test is done when you are 34 or more weeks
- After 32 weeks the relationship is less pregnant.
accurate
- Perform Leopold’s Maneuver - For a contraction stress test, the hormone
oxytocin is given to you intravenously (IV)for
The important estimates cause labor contractions. Alternatively, you
- Mc Donald’s Rule – used to calculate AOG may massage your nipples to prompt your
Formula: baby to release oxytocin. If your baby’s heart
FH (CM) x 2/7 = AOG in lunar months rate slows down (decelerate) in a certain
FH (CM) x 8/7 – AOG in weeks pattern instead of speeding up (accelerate)
Examples: after a contraction, your baby may not be
FH = 35 cms able to tolerate the stress of a normal labor
FH = 14 cms - A contraction stress test is often done if a
baby’s heart rate is abnormal during external
Urine test for protein and glucose fetal heart monitoring (nonstress test)
- Protein may indicate pre- eclampsia
- Glucose may indicate gestational diabetes Estrial levels
- The placenta produces Estrial from
Fetal heart beat/ tone androstenedione that is produced by the fetal
- You may never hear it with a stethoscope adrenal gland
- 16-20 weeks with DeLee stethoscope - Level of estrogen in mom’s blood is a
- 12-14 weeks with Doppler measure of viability of the fetus
- 5-6 weeks with ultrasound
Goal of Care
Subsequent Laboratory Tests 1. Establish a diagnosis of pregnancy
- Amniocentesis at 11-17 weeks for women 2. Gather initial data
>35 3. Identify high-risk factors
- Serum AFP at 15-18 weeks 4. Propose realistic and necessary interventions
- Targeted (Level II) ultrasound for women at 5. Promote optimal health for the mother an
high risk at 16-20 weeks baby
- Hbg/Hct at 28 weeks (1-hour post 50 g oral 6. Provide needed information in preparation for
load) childbearing
- Rhogam to all Rh-Negative women at 28
weeks Health teaching
- Exercise
Non-stress test (NST) o Done to strengthen the muscles used
- A nonstress test is a simple, painless for labor and delivery
procedure in which your practitioner or a o It includes
technician monitors your baby’s heartbeat –  Pelvic rocking – to relieve low
first while the baby is resting, and then while backache and to strengthen
he’s moving – to evaluate his condition muscles of the lower back
- The test is typically given if your gone beyond  Squatting and tailor sitting –
your due date, or in the month leading up to stretch and strengthen perineal
your due date if you’re having a high-risk muscles
pregnancy (diabetes, high blood pressure,
gestational hypertension, the baby appears to
EL JIREH D. ASAURO BSN 2D
Pelvic Ricking Health teaching
- Relieve backache during pregnancy and labor - Clothing
- Can be done on hands and knees, sitting, o Characteristics of a good clothing
standing, lying down  Light weight, non-constrictive.
Loose fitting
Squatting  Absorbent and washable
- Stretches the perineal muscles  Flat heeled shoes
- Done everyday for picking up toys, etc. for 15 - Bathing
mins o Daily bath should be advised
o Swimming is acceptable but no diving
Health teaching o Contraindicated when there is vaginal
- Rib cage lifting – to relieve shortness of bleeding
breath o Bath tub should be use with extra care
- Calf stretching – to relieve leg cramps - Breast care
- Shoulder circling – to relieve upper backache o Wash with water only
o Use brassier appropriate to the size of
Prenatal exercises the breast
- Tailor sitting o Proper exercise of the nipple should be
o Strengthen thighs and stretches advised
perineal muscles without occluding - Employment
blood supply to the lower leg. o Avoid exhaustion, discomfort,
o Should be done at least 15 mins. Qd strenuous exercise, extreme
temperature, smoking areas, ladder
Abdominal muscle contraction climbing, lifting heavy objects,
- Helps strengthen the abdominal muscles and overtime, prolonged standing, crossing
relieves constipation the legs while sitting
- Helps in pushing during labor - Travel
- Try blowing a candle o No travel restricted but avoid long trips
on the third trimester
Leg elevation o Allow 15-20 minutes rest periods every
- To relieve swelling, fatigue and varicosities 2 hours of travel
Leg raising - Sexual teaching
- Strengthen abdominal muscles o No restriction except for the following
circumstances:
Kegel’s exercise or pelvic floor contractions  Rupture of the BOW
- Helps to strengthen perineal muscles  Spotting or bleeding
- It reduces pain during postpartum and  Incompetent cervical os
promotes healing - Alcohol and smoking
o Avoid all forms of alcohol
OTHER RECOMMENDED EXECERCISE
o Avoid smoking
1. Calf stretching
- Danger signs of pregnancy
- Relieves leg cramps
o It should be reported at once
2. Shoulder circling
 Vaginal bleeding in any amount
- Relieves pain of the upper back, finger and
 Persistent vomiting
arms
 Child and fever
3. Modified knee chest
 Sudden escape of
- Relieves hemorrhoids, vulvar varicosities and
fluid from the vagina
backache
 Visual disturbance
4. Leg elevation
 Dysuria
- Relieves swelling, fatigue, varicosities of
 Abdominal pain
lower extremities
 Severe or continuous bleeding
5. Leg raising
 Swelling of hands and face
- Strengthens abdominal muscles
 Absence of fetal movement

EL JIREH D. ASAURO BSN 2D

 o regular bowel habit
Minor discomforts o exercise regularly
- Nausea and vomiting o avoid gas forming food
- Nursing care: - leg and ankle edema
o Eat dry toast crackers before rising - nursing care:
o Eat small/frequent meals o leg elevation
o Get out of bed slowly o avoid constricting and tight clothing.
o Avoid odorous, spicy, greasy food Prolong standing
- Frequent urination o avoid salty food
- Nursing care: - backache
o Assess for any burning, pain on - nursing care:
urination, blood in urine o pelvic rocking
o Fluid intake should not be restricted, o low heeled shoes
fluids is necessary to allow blood o use proper mattress
volume to double o frequent rest
o Kegel’s exercises - muscles cramps
- Fatigue - nursing care:
- Nursing care: o dorsiflexion
o Take 8 hours of sleep/ frequent rest o leg elevation
period - hypertension
o Avoid standing for long period of time - nursing care:
o Eat well balanced diet o rising slowly
- Breast tenderness and nipple irritation o position in left lateral/ side lying
o Wash with water - hemorrhoids
o Wear supportive maternity brassiere o varicosities of the rectal veins
- Leukorrhea o pressure of veins from the bulk of the
- Nursing care: growing fetus
o Daily bath/ hygiene, perineal care - Nursing care
o Avoid tight underpants, panty hose o Daily bowel movement
o Assess for color, odor and o Rest on modified sim’s position
characteristics of discharge, vulvar o Stool softener
itching o Hazel or cold compress to external
o no douching – contraindicated because hemorrhoids
fluid could be forced into uterine cervix o Hot sitz bath
- nasal stuffiness - Heart palpitation
- nursing care: o Bouning palpitation when changing
o avoid allergen/ smoke filled area position
o normal saline nose drop o Circulatory adjustment to
o steam inhalation accommodate blood supply during
- heart burn pregnancy
- nursing care: - Nursing care
o eat small/frequent meal o Gradual slow movement
o bend at knees when picking objects
o antacids Health teaching on fetal exposure to Teratogens
o avoid greasy, spicy, highly seasoned - Teratogens
foods o Any factors, chemical or physical that
- constipation adversely affects the fertilized ovum,
- nursing care embryo, or fetus.
o increase fluid, fiber intake o Fetus is extremely vulnerable to
o regular bowel habit environmental injury
o moderate exercise - Effects of teratogen on a fetus
o avoid coffee/ apple o Radiation to treat cancer
o laxative  Can cause fetal defect or death
- flatulence o Timing of teratogenic insult
- nursing care:
EL JIREH D. ASAURO BSN 2D
  Teratogens introduce before b. Fetus maintains growth and development
implantation pattern appropriate to gestational age
- Teratogenic maternal infections c. No complication of pregnancy is evident
o Viral, bacterial or protozoan organism d. Pregnant women and family have
- Teratogenic maternal exposure received adequate educational
o Potentially teratogenic vaccines instructions
 Live vaccines contraindicated
during pregnancy Pregnancy signs
 Transmit viral infection to a fetus Presumptive signs
 Eg. Measles, human - Amenorrhea
papillomavirus (HPV), mumps, - Nausea and vomiting
rubella, poliomyelitis - Increased size and increased feeling of
o Teratogenic drugs fullness in the breasts
 Any drugs or herbal supplement - Pronounced nipples
o Teratogenicity of alcohol - Urinary frequency
 High incidence of congenital - Quickening: first perception of fetal
craniofacial deformity movement; may occur as early as the 14th to
o Teratogenicity of tobacco 16th week of gestation
 Growth restriction - Fatigue
 High risk for stillbirth, sudden - Discoloration and thickening of vaginal
infant death syndrome mucosa
o Teratogenic maternal stress
 Anxiety produces physiologic SKIN CHANGES
changes causing vasoconstriction - Chloasma (darkening of the face)
of uterine vessels that could - Spider telangectasias (red, star-shaped marks
interfere blood and nutrients - Stretch marks
supply to fetus - Linea nigra
o Infections that cause illness at birth - Darkening of nipples
 Eg. Gonorrhea, candidiasis,
chlamydia, streptococcus and Probable signs
hepa B infection - Uterine enlargement
- Proper nutrition - Hegar’s sign – softening and thinning of the
o Recommended weight gain lower uterine segment that occurs about 6
o 11.2 kg to 15.9 kg (25-35 lbs) weeks
o Different nutrients needed by a - Goodell’s sign – softening of the cervix that
occurs at the beginning of the second month
pregnant woman
- Chadwick’s sign – bluish coloration of the
mucous membrane of cervix, vagina, and
Maternal assessment
vulva that occurs about week 6
- BP
- Ballotment – rebounding of the fetus against
- Weight
the examiner’s fingers on palpation
- Fundic height
- Braxton hicks’ contraction
- Nutrition and appetite
o Positive pregnancy test measuring for
- Discomforts of pregnancy
- Other concerns human chorionic gonadotropin (HcG)

Fetal assessment Pregnancy tests are very reliable

- FHR - Turn positive at about the first missed period
- Abdominal palpation (4 weeks after the LMP or 14 days after
- Fetal movement conception)
- Vaginal exam – performed in late pregnancy
Positive signs
Health teaching - Fetal heart rate by doppler at 8 to 12 weeks
- According to the need of the client and by fetoscope at 20 weeks of gestation
a. Maternal/fetal assessment data remain - Active fetal movements palpable by
within acceptable limits examiners
- Outline of fetus via radiography or ultrasound
EL JIREH D. ASAURO BSN 2D
 - Hyperventilation – in an effort to blow off
extra CO2 coming from the fetus
- Estrogen causes nasal stuffiness that requires
Danger signs of pregnancy no medication
1. Swelling of face, fingers, and legs - Increased O2 requirement
- Hypertension of pregnancy, and - Displacement diaphragm
thrombophlebitis (forlegs swelling)
2. Headache continuous and severe Urinary system
- Hypertension of pregnancy - Urinary frequency
3. Abdominal / chest pain - Increased in bladder capacity (effect of
- Ectopic pregnancy, uterine rupture, and progesterone)
pulmonary metabolism - Nocturia – accumulate water during the day
4. Vaginal bleeding in the form of dependent edema but
- Placental problems (previa, abruptio, mobilized and excreted via kidney at night
premature separation)
5. Persistent vomiting Gastrointestinal tract
- Infection (also with fever and chills) and - Nausea and vomiting
hyperemesis - Pika/pica – craving for foods
6. Visual changes - Hemorrhoids – due to mechanical pressure,
- Hypertension of pregnancy slowed intestinal movement and constipation
7. Escape of vaginal fluids
- Premature rupture of membrane Integumentary system
- Increased melanin production (melasma)
Physiologic changes - Striae gravidarum
Uterus - Diastasis
- Increase in size - Vascular spider (small, fiery-red, branching
- Loses its spear shape and becomes spherical spots)
- Rises out of the pelvic cavity - Palmar erythema
- Growth of fundic height
- Increase in uterine blood flow Endocrine gland
- Become soft - Placenta
- Undergoes contraction o Increased amount of estrogen,
Istmus progesterone, HcG, human placental
- Hegar’s sign lactogen, relaxin and prostaglandins
- Expands - Anterior pituitary produces prolactin
Cervix - Posterior pituitary produces oxytocin causes
- From pinkish to purplish in color contraction of the breast (let-down-reflex)
- Increase mucus secretion (mucus plug)
- Goodel’s sign Clinical management of normal labor
Vagina - Review of prenatal records
- Purplish discoloration - Time of onset and frequency of uterine
- Decreased pH 3-4 (more glycogen is contraction
converted into lactic acid by Doderlein Bacilli) - History of leakage of amniotic fluids
Breast - Fundal height
- Increase in size - Fetal presentation, position and engagement
- Tingling sensation - Estimated fetal weight
- Darkerning of skin around areola - Status of the membrane
- Erectile nipples - Cervical dilatation, effacement
- Colostrum can be expressed from its early 4 - Station of the presenting part
months - Maternal vital signs
Ovaries - Hemogram including blood group, Rh type,
- Rise from being in pelvic organs antibody screen
- No Graafian follicle is developed - Urine dipstick for protein glucose
- Preparation of the patient for delivery
Respiratory System

EL JIREH D. ASAURO BSN 2D

 3. Strong – rigid board like fundus that is almost
impossible to indent with fingertips
III. Frequency is measured from the beginning of
contraction to the beginning of the next
Theories of labor onset contraction
1. Uterine stretch theory IV. Duration – refers to the length of contraction.
- Any hollow organ when stretch to capacity Measured from the beginning to the end
will necessarily contract and empty because same contraction
of the pressure on nerve endings and
increased irritability of the uterine Prodromal signs of labor
masculature 1. Lightening
2. Oxytocin stimulation - The settling of the presenting part to the
- Because labor is considered as stressful pelvic brim or inlet which occurs 2-3 weeks
event, the hypophysis is stimulated to initiate before labor onset
production of oxytocin, by the posterior - Signs includes
pituitary gland which stimulates uterine a. Relief of dyspnea
contraction b. Relief of abdominal tightness
3. Progesterone deprivation theory c. Increase frequency of voiding
- Progesterone inhibits uterine motility, a d. Shooting pain down to the legs
decrease in the amount of the hormone e. Increased lordosis
results in uterine contraction f. Increased vaginal discharge
4. Prostaglandin theory 2. Increased level of activity
- The relative progesterone deprivation and - Known as the nesting behavior
estrogen predominance set off the - The adrenal gland secretes large amount of
production of cortical steroids which acts on epinephrine or adrenalin about 2 weeks
lipid precursors to release arachidonic acid, before labor onset resulting to highly
and in turn increase the synthesis of energetic and active
prostaglandin which stimulates uterine 3. Softening of the cervix (butter soft)
contraction. 4. Increased Braxton-hicks contraction
5. Theory of the aging placenta - Usually happens 2-3 weeks before labor
- The decrease nutrients and blood supply in 5. Presence of show
the aging placenta causes uterine contraction - A mucus mixed with small amount of blood
from the torn capillaries of the cervix giving it
The labor phenomena a pink tint.
- Labor 6. Rupture of the membrane (BOW)
o A series of physiological and - May be seen as a sudden gush or scanty clear
mechanical processes by which all amniotic fluid from the vagina
products of conception are expelled - Note the color and instruct the women to go
from the birth canal to the hospital
- Eutocia - Things to remember:
o Refers to the normal labor that usually a. Labor is inevitable with the next 24 hours
occurs within 38-42 weeks b. If labor does not occur within the next 24
hours, induction of labor is done
Uterine Contraction
I. Phases of uterine contraction Lie
1. Increment or crescendo – the time when - Relationship of the spine of the fetus to the
contraction is starting is building up this is the spine of the mother
longest phase Longitudinal or vertical
2. Acme or apex – the peak of contraction - Fetal spine is parallel to the mother's spine
3. Decrement or decrescendo – the time when - Fetus is either cephalic or breech
muscles start to relax presentation
II. Intensity Transverse or horizontal
1. Mild – slightly tense fundus, easy to indent - Fetal spine is at right angle, or perpendicular,
with fingertips to the mother's spine
2. Moderate – firm fundus, difficult to indent - Presenting part is the shoulder
with fingertips - Delivery by caesarian section
EL JIREH D. ASAURO BSN 2D
Oblique True labor
- Fetal spine is at a right angle from a true - Uterine contractions increase in intensity,
horizontal lie frequency and duration
- Delivery is by caesarian section if - Ambulation increases contraction
uncorrectable - Discomfort radiates to the lower back or
lumbosacral area
Presentation - Contraction persists even if women is sedated
- Presenting part: portion of the fetus that - Progressive cervical dilatation
enters the pelvis first - Presence of show

Cephalic
- The most common presentation
- The head presents first
Breech
- Buttocks present first
- Delivery by caesarian section may be
required, although it is often possible to
deliver vaginally
Shoulder
- Fetus is in a transverse lie, or the arm, back,
abdomen, or side could present Prolonged labor
- If the fetus does not spontaneously rotate or - Labor which is completed 18 hours in primi or
it is not possible to turn the fetus gradually, a more than 12 hours in multigravida
caesarean section may be performed Precipitate delivery
- Labor which is completed in less than 3 hours
Position
- Relationship of the presenting part to one of Mechanism of labor
the quadrants of the mother's pelvis ENGAGEMENT
- LOA is the most favorable and common fetal - Mechanisms by which the fetus nestles on
position as it meets less resistance as it the pelvis
descends because during the process it - Also termed lightening or dropping
meets the soft tissues of the abdomen
- LOP and ROP makes labor longer and harder Cardinal movement of labor
as the head must make a 180-degree turn DESCENT
pressing against the bony sacrum in the - The process that the fetal head undergoes as
process it begins its journey through the pelvis
- A continuous process from the time of
Station engagement until birth, and is assessed by
- The measurement of the progress of descent the measurement called station
in centimeters above or below the midplane FLEXION
from the presenting part to the ischial - Process of the fetal head's nodding forward
- spine Station 0: at ischial spine toward the fetal chest
- Minus station: above ischial spine INTERNAL ROTATION
- Plus station: below ischial spine - Internal rotation of the fetus; most commonly
from the occiput transverse position,
False labor assumed at engagement into the pelvis, to
- No increase in intensity, duration, and the occiput anterior position while
frequency of uterine contractions continuously descending
- Contraction disappears with ambulation EXTENSION
- Discomfort remains in the abdomens - Enables the head to emerge when the fetus is
- Contraction stops when women is sedated in a cephalic position
- Absence of cervical dilatation - Begins after the head crowns Is complete
- Absence of show when the head passes under the symphysis
pubis and occiput, and the anterior fontanel,
EL JIREH D. ASAURO BSN 2D
 brow, face, and chin pass over the sacrum
and coccyx and are over the perineum
RESTITUTION
- Realignment of the fetal head with the body
after the head emerges.

Responsibilities During Labor

CARE DURING FIRST STAGE
- Performing on going assessment of maternal
and fetal conditions
- Informing the attending physician of the
progress of labor and timely referral of
abnormal conditions
- Providing nursing care (physical and
psychological) to the mother
- Providing physical care to the fetus

LATENT PHASE
- women feel comfortable walking and sitting
at this time
- Establish rapport
- Encourage verbalization fear and anxiety
regarding labor
- Promote comfort and relief measures as
needed

ACTIVE PHASE
- Coach woman on breathing pattern and
relaxation techniques
- Inform the mother on the progress of labor
- Discourage the mother from bearing down
- She must stay in bed if BOW has already
ruptured
- Provide relief measures: back rub, empty
bladder etc....

TRANSITION PHASE
- Reassure woman that although this is the
most difficult period of labor, this is the
shortest.
- Reinforce breathing and relaxation
techniques
- Discourage bearing down if cervix is not yet
fully dilated for it may lead to cervical
lacerations and edema which can prolong
labor
- Some women experience nausea and
vomiting. let the woman lie on her side to
prevent aspiration
- Some may fall asleep between contraction
due to fatigue, awaken her at the beginning
of the next contraction

EL JIREH D. ASAURO BSN 2D