-Acts as organ of copulation

MATERNAL AND CHILD HEALTH -Conveys sperm to the cervix

NURSING -Expands to serve as birth canal
Maternal and Child Health Nursing involves care of the --Wall contains many folds or rugae making it very
woman and family throughout pregnancy and child birth elastic
and the health promotion and illness care for the children Fornices – uterine end of the vagina; serve as a place
and families. for pooling of semen following coitus
Bulbocavernosus – circular muscle act as a voluntary
Primary Goal of MCN sphincter at the external opening to the vagina (target of
>The promotion and maintenance of optimal family Kegel’s exercise)
health to ensure cycles of optimal childbearing and child
rearing II. PUBERTAL DEVELOPMENT

ANATOMY & PHYSIOLOGY Puberty: the stage of life at which secondary sex
changes begins the development and maturation of
Ovaries reproductive organs which occurs in female 10-13 years
o Almond shaped old & male at 12-14 yrs old the hypothalamus serve as a
o Produce, mature and discharge ova gonad stat or regulation mechanism set to “turn on”
o Initiate and regulate menstrual cycle gonad functioning at this age
o 4 cm long, 2 cm in diameter, 1.5 cm thick
o Produce estrogen and progesterone Reproductive Development
Estrogen: promotes breast dev’t & pubic hair Readiness for child bearing
distribution prevents osteoporosis keeps cholesterol -begins during intrauterine life
levels reduced & so limits effects of atherosclerosis -full functioning initiated at puberty
-the hypothalamus releases the GRF which triggers the
Fallopian tubes. APG to form and release FSH and LH. (FSH & LH
Approximately 10 cm in length initiates production of androgen and estrogen --->2°
Conveys ova from ovaries to the uterus Sexual characteristics
Site of fertilization
Parts: interstitial Role of Androgen
isthmus – cut/sealed in BTL Androgenic hormones – are produced by the testes,
ampulla – site of fertilization ovaries and adrenal cortex which is responsible for:
infundibulum – most distal segment; covered with fimbria muscular development physical growth inc. sebaceous
gland secretions
Uterus -Hollow muscular pear shaped organ Testosterone –primary androgenic hormone
-uterine wall layers: endometrium; myometrium; Related terms
perimetrium a. Adrenarche – the development of pubic and axillary
-Organ of menstruation hair (due to androgen stimulation)
-receives the ova b. Thelarche – beginning of breast development
-Provide place for implantation & nourishment during c. Menarche – first menstruation period in girls (early 9
fetal growth y.o. or late 17 y.o.)
-Protects growing fetus d. Tanner Staging
-Expels fetus at maturity -It is a rating system for pubertal development
-Has 3 divisions: corpus – fundus , isthmus (most -It is the biologic marker of maturity
commonly cut during CS delivery) and cervix -It is based on the orderly progressive development of:
breasts and pubic hair in female’s genitalia and pubic
Uterine Wall hair in males
-Endometrial layer: formed by 2 layers of cells which are
as follows: Body Structures Involved
basal layer- closest to the uterine wall 1 Hypothalamus
glandular layer – inner layer influenced by 2 Anterior Pituitary Gland
estrogen and progesterone; thickens and shed 3 Ovary
off as menstrual flow 4 Uterus
-Myometrium – composed of 3 interwoven layers of 4. Menstrual Cycle
smooth muscle; fibers are arranged in longitudinal; -Female reproductive cycle wherein periodic uterine
transverse and oblique directions giving it extreme bleeding occurs in response to cyclic hormonal changes
strength -Allows for conception and implantation of a new life

Vagina
-Its purpose it to bring an ovum to maturity; renew a 5. Polymenorrhea - frequent menstruation occurring at
uterine bed that will be responsive to the growth of a intervals of less than 3 weeks
fertilized ovum Ovulation
Menstrual Phases 1 Occurs approximately the 14th day before the onset of
• First: 4-5 days after the menstrual flow; the next cycle (2 weeks before)
endometrium is very thin, but begins to proliferate 2 If cycle is 20 days – 14 days before the next cycle is
rapidly; thickness increase by 8 folds under the influence the 6th day, so ovulation is day 6
of increase in estrogenlevel also known as: proliferative; 3 If cycle is 44 days – 14 days, ovulation is day 30.
estrogenic; follicular and postmentrual phase 4 Slight drop in BT (0.5 – 1.0 °F) just before day of
• Secondary: after ovulation the corpus luteum produces ovulation due to low progesterone
progesterone which causes the endometrium become level then rises 1°F on the day following ovulation
twisted in appearance and dilated; capillaries increase in (spinnbarkheit; mittelschmerz)
amount (becomes rich, velvety and spongy in 5 If fertilization occurs, ovum proceeds down the
appearance also known as: secretory;progestational; fallopian tube and implants on the
luteal and premenstrual endometrium
Menopause
• Third: if no fertilization occurs; corpus luteum regresses o Mechanism- a transitional phase (period of 1 – 2
after 8 – 10 days causing decrease in progesterone and years) calledcl i macte ri c, heralds
estrogen level leading to endometrial degeneration; the onset of menopause.
capillaries rupture; endometrium sloughs off ; also o Monthly menstrual period is less frequent, irregular
known as: ischemic and with diminished amount.
o Period may be ovulatory or unovulatory - advised to
• Final phase: end of the menstrual cycle; the first day use Family planning method until
mark the beginning of a new cycle; discharges contains menses have
blood from ruptured capillaries, mucin from glands, been absent for 6 continuous months
fragments of endometrial tissue and atrophied ovum. o Menopause is has occurred if there had been no
period for one year.
Physiology of Menstruation Classical signs: Vasomotor changes due to hormonal
1. About day 14 an upsurge of LH occurs and the imbalance
graafian follicle ruptures and the ovum a. hot flushes
is released b. excessive sweating especially at night
2. After release of ovum and fluid filled follicle cells c. emotional changes
remain as an empty pit; FSH d. insomnia
decrease in Amount; LH increase continues to act on e. headache
follicle cells in ovary to produce f. palpitations
lutein which is high in progesterone ( yellow fluid) thus g. nervousness
the name corpus luteum or h. apprehension
yellow body i. depression
3. Corpus luteum persists for 16 – 20 weeks with j. tendency to gain weight more rapidly
pregnancy but with no fertilization ovum k. tendency to lose height because of osteoporosis
atropies in 4 – 5 days, corpus luteum remains for 8 -10 (dowager hump)
days regresses and replaced by white l. arthralgias and muscle pains
fibrous tissue, corpus albicans m. loss of skin elasticity and subcutaneous fat in labial
Characteristics of Normal Menstruation Period folds
1. Menarche – average onset 12 -13 years Artificial menopause / surgically induced menopause
2. Interval between cycles – average 28 days a. oophorectomy or irradiation of ovaries
3. Cycles 23 – 35 days b. panhysterectomy
4. Duration – average 2 – 7 days; range 1 – 9 days III. PROMOTE RESPONSIBLE
5. Amount – average 30 – 80 ml ; heavy bleeding PARENTHOOD – FAMILY PLANNING
saturates pad in <1hour A. Artificial Methods:
6. Color – dark red; with blood; mucus; and endometrial 1. physiologic method: oral contraceptives ; natural
cells methods
Associated Terms 2. mechanical methods
1. Amenorrhea - temporary cessation of menstrual flow 3. chemical methods
2. Oligomenorrhea - markedly diminished menstrual flow 4. surgical methods
3. Menorrhagia - excessive bleeding during regular Oral contraceptive
menstruation Action:
4. Metrorrhagia - bleeding at completely irregular
inhibits release of FSH no ovulation
intervals
Types:
Combined ; 1.
Sequential; Intrauterine Device - prevents implantation by
Mini pill non-specific cell
Side Effects: due to estrogen and progesterone inflammatory reaction
> nausea and vomiting inserted during menstruation (cervix is dilated)
> Headache and weight gain SE:
> breast tenderness increased menstrual flow
> dizziness spotting or uterine cramps
> breakthrough bleeding/spotting increased risk of infection
> chloasma Note: when pregnancy occurs, no need to remove IUD,
Contraindications: will not harm
a. Breastfeeding fetus 2.
b. Certain diseases: Diaphragm
o thromboembolism oa
o Diabetes Mellitus disc that fits over the cervix
o Liver disease of
o migraine; epilepsy; varicosities orms a barrier against the entrance of sperms
o CA; renal disease;recent hepatitis o initially inserted by the doctor
c. Women who smoke more than 2 packs of cigarette o
per day maybe washed with soap and water is reusable
d. Strong family Hx of heart attack o
Note: If taking pill is missed on schedule, take one as when used, must be kept in place because sperms
soon as remembered and remains viable for 6 hrs.
take next pill on schedule; if not done withdrawal in the vagina but must be removed within 24 hours (to
bleeding occurs. decrease risk of
B. Natural Methods: toxic shock syndrome)
a. Rhythm/Calendar/Ogino Knause Formula 3.
o Couple abstains on days that the woman is fertile Condom
o Menstrual cycles are observed and charted for 12 1 a rubber sheath where sperms are deposited
months 2 it lessens the chance of contracting STDs
Standard Formula: 3 most common complaint of users
first day of the beginning of one cycle to the first day of interrupts sexual act when to apply
the D. Chemical Methods
next cycle These are spermicidals (kills sperms) like jellies, creams,
shortest cycle = minus 18 foaming tablets,
longest cycle = minus 11 suppositories
Example: shortest cycle = 28 E. Surgical Method
longest cycle = 35 a.
Shortest cycle: Tubal Ligation:
28 days – 18 = 10 Fallopian tubes are ligated to prevent passage of sperms
Longest cycle: Menstruation and ovulation continue
35 days – 11 = 24 b.
Fertile pd: Vasectomy:
10th to 24th day of cycle = No sexual intercourse Vas deferens is tied and cut blocking the passage of
b. Billings Method / Cervical Mucus sperms
o woman is fertile when cervical mucus is thin and Sperm production continues
watery; may be extended Sperms in the cut vas deferens remains viable for about
o Sexual Intercourse may be resumed after 3 – 4 days 6 months hence
c. Symptothermal Method / BBT couple
1 Requires daily observation and recording of body needs to observe a form of contraception this time to
temperature before rising in prevent pregnancy
the IV. BEGINNING OF PREGNANCY
morning or doing any activity to detect time of ovulation A.F e rti l i z ati on
2 Ovulation is indicated by a slight drop of temperature 1. Union of the ovum and spermatozoon
and then rises 2. Other terms: conception, impregnation or fecundation
3 Resume Sexual intercourse after 3 – 4 days 3. Normal amount of semen/ejaculation= 3-5 cc = 1 tsp.
4 Recommended observation of BBT is 6 menstrual 4. Number of sperms: 120-150 million/cc/ejaculation
cycle to establish pattern of 5. Mature ovum may be fertilized for 12 –24 hrs after
fluctuations ovulation
C. Mechanical Methods
6. Sperms are capable of fertilizing even for 3 – 4 days Polyhydramios = more than >1500 ml due to inability of
after ejaculation (life the fetus to swallow the fluid
span of sperms 72 hrs) as in
B.Im pl antati on trachoesophageal fistula.
General Considerations: Oligohydramnios = less than <500 ml due to the inability
o Once implantation has taken place, the uterine of the kidneys to add urine
endometrium is now termed as in
decidua congenital renal anomaly
o Occasionally, a small amount of vaginal bleeding F. Fetal Membranes
occurs with implantation due to •Chorion - together with the deciduas basalis gives rise
breakage of capillaries to the placenta, start to form at
o Immediately after fertilization, the fertilized ovum or 8th
zygote stays in the week of gestation; develops 15 – 20 cotyledons
fallopian tube for 3 days, during which time rapid cell •Purpose of Placenta: respiratory; exchange of nutrients
division (mitosis) is and oxygen
taking place. The developing cells now called •Renal system
blastomere and when about to •Gastrointestinal system
have 16 blastomere called morula. •Circulatory system
o Morula travels to uterus for another 3 – 4 days •Endocrine system: produces hormones (before 8th
o When there is already a cavity in the morula called week-corpus luteum produces these
blastocyt hormones) hCG keeps corpus luteum to continue
o finger like projections called trophoblast form around producing estrogen and progesterone
the blastocyst, which •HPL or human chorionic somatomammotropin which
implant on the uterus promotes growth of mammary
o Implantation is also called nidation, takes place about glands for
a week after fertlization lactation
C. Stages of human prenatal development •Protective barrier: inhibits passage of some bacteria
1. and large molecules
Cytotrophoblast – inner layer V. FETAL GROWTH AND DEVELOPMENT
2. First lunar month
Syncytiotrophoblast – the outer layer containing finger •Germ layers differentiate by the 2nd week
like projections called chorionic villi which 1. endoderm – gives rise to lining of GIT, Respiratory
differentiates into: Tract, tonsils, thyroid (for basal
oL metabolism),
angerhan’s layer – protective against Treponema parathyroid (for calcium metabolism), thymus gland (for
Pallidum, development of
present only during the second trimester immunity),
o bladder and urethra
Syncytial Layer – gives rise to the fetal membranes, 2. Mesoderm – forms into the supporting structures of
amnion and the body (connective tissues,
chorion cartilage, muscles and tendons); heart, circulatory
D. Fetal Membranes system, blood cells, reproductive
1. Amnion – gives rise to umbilical cord/funis – with 2 system, kidneys and ureters.
arteries and 1 vein supported by 3. Ectoderm – responsible for the formation of the
2. Wharton’s jelly nervous system, skin, hair and nails
3. Amniotic fluid: clear albuminous fluid, begins to form and the
at 11 – 15th week of gestation, chiefly mucous membrane of the anus and mouth
derived from maternal serum and fetal urine, urine is 1 month: 2nd week – fetal membranes
added by the 4th lunar month, near term is 16th day – heart forms ; 4th week – heart
clear, colorless, containing little white specks of vernix beats
caseosa, produced at rate of 500 ml/day. 2nd month: All vital organs and sex organs formed;
Known as BOW or Bag of Water placental fully developed;
E. Amniotic Fluid meconium formed (5th –8th wk)
Purposes of Amniotic Fluid 3rd month: Kidneys function - 12th wk- urine formed ;
Protection – shield against pressure and temperature Buds of milk teeth form ; begin
changes bone ossification ; allows amniotic fluid ; establishment
Can be used to diagnose congenital abnormalities of feto-placental exchange
intrauterine– amniocentesis 4th month: Lanugo appears; buds of permanent teeth
Aid in the descent of fetus during active labor form; heart beat heard by fetoscope
Implication:
5th month: Vernix appears; lanugo over entire body; e. Ultrasound – transducer on abdomen transmits sound
quickening; FHR audible with waves that show
stethoscope fetal image on screen
6th month: Attains proportions of full term but has a. Done as early as five weeks to confirm pregnancy,
wrinkled skin gestational age
7th month: 28 weeks – lower limit of prematurity; alveoli b. Multiple purposes – to determine position, number,
begins to form measurement of fetus(es)
8th month: 32 weeks – fetus viable; lanugo disappears, and other structures (placenta)
subcutaneous fat deposition begins c. Client must drink fluid prior to test to have full bladder
9th month: Lanugo continue to disappear; vernix to assist in clarity of
complete; amniotic volume decrease image
Focus of Fetal Development d. No known harmful effects for fetus or mother
First Trimester – period of organogenesis e. Noninvasive procedure
Second Trimester – period of continued fetal growth and VI. NORMAL ADAPTATIONS IN
development; rapid increase in PREGNANCY
length 1. Cardiovascular/ Circulatory changes:
Third Trimester – period of most rapid growth and a. Physiologic anemia of pregnancy
development because of the deposition -30-50% gradual increase in total cardiac volume (peak
of 6th month) causing drop in
subcutaneous fat Hemoglobin
Assessing Fetal Well-being and Hematocrit values (inc only in plasma volume)
Fetal Movement: Consequences of increased cardiac volume:
Quickening at 18 – 20 weeks , peaks at 29 -38 weeks 1. easy fatigability & shortness of breath due increase
Consistently felt until term cardiac workload
a. Cardiff Method: 2. slight hypertrophy of the heart
“Count to ten” - records time interval it takes for 10 3. systolic murmurs due to lowered blood viscosity
- fetal movements to be felt usually occurs 4. nosebleeds may occur due to congestion of
in 60minutes nasopharynx
b. Contraction Stress Test: b. Palpitations
Fetal Heart Rate (FHR) analyzed in conjunction with caused by the SNS stimulation during early part of
contractions pregnancy; increased pressure of
Nipple stimulation done to induce gentle contractions the uterus
***3 contractions with 40 sec duration or more must against the diaphragm during the second half of
be present pregnancy
in 10 minutes window c Edema of the lower extremities & varicosities
Normal Result no fetal decelerations with due to poor circulation caused by the pressure of the
contractions gravid uterus on the blood vessels
c. Non-stress Test: of the
Measures response of FHR to fetal movement (10- lower extremities
20mins.) d. Vaginal and rectal varicosities
with fetal movement FHR increase by 15 beats and - due to pressure on blood vessels of the genitalia
remain for 15 seconds then decrease to average rate Management: side lying hips elevated on pillow modified
(no increase means poor oxygen perfusion to fetus) knee chest position
d. Amniocentesis - done to determine fetal maturity: e. Predisposition to blood clot formation
Identify L/S ratio -due to increased level of circulating fibrinogen as a
16 wks – detect genetic disorder protection from bleeding
30 wks – assess implication: no
1. Prior to the procedure, bladder should be emptied; massage
ultrasonography is used 2. Gastrointestinal Changes
to avoid a. Morning sickness
trauma from the needle to the placenta, fetus 2 nausea and vomiting in the 1st trimester due to HCG
2. Complications include premature labor, infection, Rh or due to increased acidity or
isoimmunization emotional
3. Monitor fetus electronically after procedure, monitor factors
for uterine contractions 3 Management: dry toast 30 mins before get up in AM
4. Teach client to report decreased fetal movement, b. Hyperemesis gravidarum
contractions, or abdominal 4 excessive nausea & vomiting which persists beyond 3
discomfort months causing dehydration,
after procedure. starvation and acidosis
5 Management: hydration in 24 hrs; complete bed room c. Increased size of the parathyroid to meet need of
c. Constipation and Flatulence fetus for calcium
GI displacement slows peristalsis & gastric emptying d. Increased size and activity of adrenal cortex
time; inc progesterone increasing circulating cortisol,
d. Hemorrhoids aldosterone, and ADH which affect CHO and fat
1 due pressure of enlarged uterus metabolism causing
2 Management: cold compress with witch hazel and hyperglycemia.
Epsom salts e. Gradual increase in insulin production but there is
e. Heartburn decreased sensitivity to
1 due to increased progesterone and decreased gastric insulin during pregnancy
motility causing regurgitation 7. Weight Change
through gastric a. First Trimester 1.5 to 3 lbs normal weight gain
sphincter b. 2nd and 3rd trimester 10 – 11 lbs per trimester is
2 Management: pats off butter before meals recommended
avoid fried, fatty foods c. Total allowable weight gain during throughout
sips of milk at intervals pregnance is 20 – 25 lbs or 10 –
small, frequent meals taken slowly 12 kgs.
don’t bend on waist d. Pattern of weight gain is more important than the
take antacids (milk of magnesia) amount of weight gained.
3. Respiratory Changes 8. Emotional responses
a. Shortness of Breath a. 1st trimester: some degree of rejection, disbelief, even
due to inc. oxygen consumption and production of depression because of its future
carbon dioxide during the 1st implication -> give health teachings on body changes
Trimester; and allow for expression of feelings
and increased uterine size pushing the diaphragm b. 2nd trimester: fetus is perceived as a separate entity
crowding chest cavity and fantasizes
management: side lying position to promote lateral chest appearance
expansion c. 3rd trimester: best time to talk about layette, and infant
4. Urinary Changes feeding method. To
a. Urinary frequency allay fear of death let woman listen to the FHT.
felt during the 1st trimester due to the increase blood VII. COMMON EMOTIONAL RESPONSES
supply to the kidneys DURING PREGNANCY
and then on •Stress –decrease in responsibility taking is the reaction
the 3rd trimester due to pressure on the bladder. to the stress of pregnancy not the
b. Decreased renal threshold for sugar
pregnancy itself affects decision  making abilities
due to increased production of glucocorticoids which
•Couvade – syndrome – men experiencing
cause lactose and
nausea/vomiting, backache due to stress, anxiety
dextrose to spill
and empathy for partner
into the urine; and inc. progesterone
•Emotional labile – mood changes/swings occur
5. Musculoskeletal changes
frequently due to hormonal changes
a. Pride of Pregnancy
•Change in Sexual Desire – may increase or decrease
1d
needs correct interpretation… not
ue to need to change center of gravity result to lordotic
as a loss of interest in sexual partner
position
b. Waddling gait VIII. LOCAL CHANGES DURING
1 due to increased production of hormone relaxin, pelvic PREGNANCY
bones becomes more 1. Uterus – wt increase to about 1000 grams at full term
movable due to increase in fibrous and elastic
2 increasing incidence of falls tissues
c. Leg cramps a. Becomes ovoid in shape
1d b. Softening of lower uterine segment: Hegar’s sign seen
ue to pressure of gravid uterus, fatigue, muscle at 6th week
tenseness, low calcium and c. Operculum – mucus plug to seal out bacteria
phosphorus intake d. Goodell’s sign – cervix becomes vascular and
6. Endocrine Changes edematous giving it consistency
a. Addition of the placenta as an endocrine organ of the earlobe
producing HCG, HPL, estrogen 2. Vagina – increased vascularity occurs
and progesterone a. Chadwick’s sign – purplish discoloration of the vagina
b. Moderate enlargement of the thyroid due to increased b. Leukorrhea – increased amount of vaginal discharges
basal metabolic rate due to increased activity
of estrogen and of the epithelial cells. IX. SIGNS OF PREGNANCY
a. Must not be itchy, foul smelling, excessive, nor I.Pre gna ncy
green/yellow in color. 1 Prenatal care is important for prevention of infant and
b. Management: good hygiene maternal morbidity and
c. Under the influence of estrogen, vaginal epithelium & mortality
underlying tissues 2 Care is a cooperative action based on client’s
hypertrophic & enriched with glycogen understanding of treatment modalities
d. pH of vaginal secretions during pregnancy fall 3 Duration of normal pregnancy 266 – 280 days of 38 –
•Microorganisms that thrive in an alkaline environment: 42 weeks or 9 calendar months
a. Trichomonas – causes trichomonas vaginalis/vagnitis or 10 lunar months.
or trichomoniasis 4 Infant born < 38 weeks pre-term & 42 post term)
s/s: frothy, cream-colored, irritatingly itchy, foul smelling 5 Diagnosis: Urine examination – tests presence of HCG
discharges, (present from 40th –100th day,
vulvar peak 60 days) conduct test 6 weeks after LMP
edema 2. Prenatal Visit
Management : Flagyl 10 days p.o. or trichomonicidal History Taking:
cmpd personal data
suppositories obstetrical data
(e.g. Tricofuron, Vagisec, Devegan) gravida
Management: para
1. treat male partner also with Flagyl TPAL
2. avoid alcohol to prevent SE past pregnancies
3. dark brown urine expected present pregnancy: cc
4. Acidic vaginal douche (1 tbsp vinegar:1 qt water or 15 LMP
ml: 1000 ml) medical data: hx of diseases/illnesses
5. avoid intercourse to prevent reinfection 3. Danger Signals of Pregnancy
a.Candida Albicans - condition is called Moniliasis or 1. Vaginal bleeding (any amount)
Candidiasis 2. Swelling of face or fingers
6 it thrives in an environment rich in CHO and those on 3. Severe, continuous headache
steroid or 4. Dimness or blurring of vision
antibiotic 5. Flashes of light or dots before eyes
therapy 6. Pain in the abdomen
7 seen as oral thrush in the NB when transmitted during 7. Persistent vomiting
delivery 8. Chills and fever
8 s/s: white, patchy, cheese-like particles that adhere to 9. Sudden escape of fluids from the vagina
vaginal 10. Absence of FHT after they have been initially heard
walls, foul on 4th or 5th month
smelling discharges causing irritating itchiness 4.As se ss me nt
Management : a. Physical examination – review of systems
1. Mycostatin/Nystatin p.o. or vaginal suppositories b. Pelvic examination (ask client to void)
100,000 U BID x 15 c. IE –
days determine Hegar’s, Goodell’s, Chadwick’s
2. Gentian violet swab to vagina d. Ballotement – on 5th month
3. Acidic vaginal douche e. Pap Smear
4. Avoid intercourse f. Pelvic measurements (done after 6th month or 2 wks
3. Ovaries before EDC)
Inactive since ovulation does not take place during g. Leopold’s Manuever: to determine fetal presentation,
pregnancy. Placenta produces position, attitude, est.
Progesterone and Estrogen during pregnancy size and fetal parts
4. Abdominal Wall h. Vital signs
1 Striae Gravidarum – due to rupture and atrophy of i. Blood studies: CBC Hgb, Hct , blood typing, serological
connective tissue layers on the tests
growing abdomen j. Urinalysis: test for albumin, sugar & pyuria
2 Linea Nigra 5. Important Estimates:
3 Umbilicus is pushed out a. Age of Gestation:
4 Melasma or Chloasma – increased pigmentation due Nagele’s Rule: -3 calendar  months and +7 days
increased production of Ex. LMP= May 15, 2006 or 5-15-06
melanocytes by the pitutitary LMP:
5 Unduly activated sweat glands 51
5 there
Formula: is a gate that can be closed to ease pain felt.
-3+ 7 2 Information and breathing techniques help minimize
EDC: discomfort of labor
2 22 or February 22, 2007 experience
• 3 Discomfort can be lessened if abdomen is relaxed and
McDonald’s Rule: Ht fundus/4 (AOG wks) allows uterus to
1. Measure in cms the length from the symphysis to the rise freely against it during contractions
level of fundus Major Approaches to prepared childbirth
2. Lunar months: Fundal Height (cms) x 2/7 1 Teaching about anatomy, pregnancy, labor and
3. Weeks of pregnancy: Fundal height (cms) x 8/7 delivery, relaxation
Ex. Fundal Height = 14 cms techniques,
Lunar Month: 14cms x 2 = 28 / 7 = 4 months breathing exercises, hygiene, diet and comfort measures
Weeks Pregnant: 14 cms x 8 = 112 / 7 = 16 weeks Grant-Dick Read Method: Fear leads to tension and
AOG tension leads to
• pain
Bartholomew’s Rule: based on position of fundus in Lamaze Method: Psychoprophylactic method ; based on
abdominal S-R
cavity conditioning;
3rd month = above symphysis concentration on breathing is practiced
5th month = umbilical level f. Immunization: Tetanus Toxois (TT) =0.5 ml IM for all
9th month = below xiphoid process) pregnant women
b. Fetal Length: shall be
1 given in 2 doses- 4 wks interval with 2nd dose at
Haase’s Rule: 1st half of pregnancy – square number of least 3 wks
months before delivery
Example : 2 months = 2x2 = 4 cm = booster doses given during succeeding
2nd half of pregnancy – number of months multiplied pregnancies
by 5 regardless of interval.
Example: 7 months x 5 = 35 cm = 3 booster doses is equal to lifetime immunity
c. Fetal Weight: g. Clinic Visits for Pre-natal check-up
1 Johnson’s Rule: Fundic Ht – n x k ( k=155; n = 11 not 2 First 7 lunar months – every month
engaged/12 3 On 8th and 9th lunar month – every week
engaged) 4On 10th lunar month – every week until labor
Example for a not engaged fetus X. LABOR AND DELIVERY
Fundic Height given = 35 cms 1. THEORIES OF LABOR ONSET
n = 11 (standard for not engaged fetus) Uterine stretch theory
k= 155 gms. (9 standard) Oxytocin theory
Solution: 35 cms – 11 = 24 x 155 =3,720 g Progesterone Deprivation theory
5. Health Teachings Prostaglandin theory
a. Smoking – lead to LBW babies 2. FOUR P’S OF LABOR
b. Drinking – can cause respiratory depression in the NB a. Power - the uterine contraction
and fetal withdrawal b. Passenger – the fetus
syndrome if c. Passageway – the maternal pelvis
excessive; alcohol has empty calories d. Psyche – the mental and emotional aspect of the
c. Drugs – may be teratogenic hence contraindicated woman
unless prescribed by Doctor a. POWER -Uterine Contractions:
d. Sexual activity – allowed in moderation but not during a.1. Frequency – the beginning of one contraction to the
last 6 wks- high beginning of the next contraction
incidence of post a.2. Interval – pattern which increases in frequency and
partum infection noted. duration
♣ a.3. Duration – the beginning of one contraction to the
counseling is important on changes in desire and end of the same contraction
positions a.4. Intensity – strength of contraction, measured
 through a monitor or through touch of
contraindication: bleeding, ruptured BOW, incompetent a fingertip
cervix, deeply engaged presenting part on the fundus (mild, moderate or strong)
e. Prepared childbirth/Childbirth education b. PASSENGER -Fe t us
1 Based on Gate Control Theory: pain is controlled in the b.1. Fetal Skull:
spinal cord and
a. largest part of the fetus - most frequent presenting - widest AP diameter at outlet estimated on
part; least compressible vaginal/pelvic exam (Average:
Bones: sphenoid, ethmoid, temporal, frontal, occipital, 12.5 cm)
parietal >Obstetrical Conjugate
Suture lines: sagittal/ coronal, lamboidal - the distance from the inner border of the symphysis
b.2. Fontanels - membrane covered spaces at the pubis to the sacral
junction of the main suture lines prominence
anterior fontanel: larger, diamond shaped; closes at 12 – - most important pelvic measurement
18 months - shortest AP diameter of the inlet through which the
posterior fontanel: smaller, triangular shaped, closes at 2 head must pass
– 3 months - 1.5 to 2 cm or less than the diagonal conjugate
b.3. Fetal Lie – relationship of the cephalocaudal axis of >True Conjugate/Conjugate Vera
the fetus to the cephalocaudal - the distance between the anterior surface of the sacral
axis of the promontory and superior
mother. margin
Measurements: of the symphysis pubis
b.4. Fetal Attitude – fetal position - diameter of the pelvic inlet (10.5 -11 cm)
Pelvis is divided into 6 areas: Anterior, Posterior, >Bi-Ischial/ Tuberiischial Diameter
Transverse Left, - the distance between the ischial tuberosities
Transverse - narrowest diameter of the outlet
Right, Posterior Left, Posterior Right - transverse diameter of the outlet (Average: 11 cm)
Fetal landmarks: Occiput (O); mentum (M), sacrum (S), D.PSYCHE- the emotions of the mother
and scapula (Sc) Factors that may increase a woman’s chance of
b.5. Presentation –the part of the passenger that enters depression:
the pelvis is the presenting part 1 History of depression or substance abuse
a. Cephalic – Vertex (occiput) ; Brow (sinciput); Face 2 Family history of mental illness
(mentum) 3 Little support from family and friends
b. Breech – Complete (sacrum) ; Frank; Footling 4 Anxiety about the fetus
c. Shoulder 5 Problems with previous pregnancy or birth
b.6. Movement of Passenger upon birth or descent: 6 Marital or financial problems
d. Descent 7 Young age (of mother
e. Flexion Signs and Symptoms of Post-partum depression:
f. Internal Rotation 1 Feeling restless or irritable
g. Extension 2 Feeling sad, hopeless, and overwhelmed
h. External rotation/ restitution 3 Crying a lot
c. PASSAGEWAY – maternal pelvis 4 Having no energy or motivation
c.1. Divisions 5 Eating too little or too much
a. 6 Sleeping too little or too much
False Pelvis -supports the growing uterus during 7 Trouble focusing, remembering, or making decisions
pregnancy 8 Feeling worthless and guilty
-directs the fetus into the true pelvis near the end of 9 Loss of interest or pleasure in activities
gestation 10 Withdrawal from friends and family
b. 11 Having headaches, chest pains, heart palpitations
True Pelvis: the bony canal through which the fetus will (the heart beating fast
pass during delivery formed by the pubis and
in front, the iliac and ischia on the sides and the sacrum feeling like it is skipping beats), or hyperventilation (fast
and coccyx behind and shallow
c.2. Significant Pelvic Measurements breathing)
a. External – Suggestive only of pelvic size 3.PRELIMINARY/PRODROMAL SIGNS OF LABOR
> External Conjugate/ Baudelaocque’s Diameter a. Lightening
- the distance between the anterior aspect of the b. Increased activity level- “nesting behavior”
symphysis pubis and the c. Loss of weight ( 2-3 lbs)
depression d. Braxton Hick’s Contractions
below lumbar 5 (Average: 18 – 20 cm) e. Cervical Changes – effacement
b. Internal – the actual diameters of the pelvic inlet and - Goodell’s sign – ripening of the cervix
outlet f. Increase in back discomfort
> Diagonal Conjugate g. Bloody Show - pinkish vaginal discharge
- the distance between the sacral promontory and h. Rupture of Membranes– labor expect in 24 hours
inferior/lower margin of the i. Sudden burst of energy
symphysis pubis j. Diarrhea
k. Regular Contractions - phases: Types of Anesthesia:
increment,acme,decrement a. Paracervical block
- characteristics: intensity, frequency, interval, b. Peridural block: Epidural/caudal
duration c. Intradural: spinal/saddle block
False Labor Pains d. Pudendal block
True Labor Pains e. Local anethesia
o1 Remain irregular o Regional Anesthesia is mostly preferred because it
o2 Confined to abdomen does not enter
o3 No increase in duration, frequency, maternal circulation nor affect fetus
intensity o Xylocaine is used (NPO with IV infusion)
o4 Disappears on ambulation > allows to be awake and participate in process;
o5 No cervical changes > can increase incidence of maternal hypotension and
o6 Becomes regular and predictable fetal
o7 Radiates in girdle like fashion bradycardia
o8 Increase in duration, frequency, intensity 5.3. Analgesics:
o9 Continue regardless of activity 5.3.1 Narcotics (Demerol)
o10 Effacement and dilatation occurs op
o11 Signs of True labor roduces sedation/relaxation
Effacement od
Dilatation epresses NB’s respiration
1 Uterine Changes– upper and lower segments; og
physiologic retraction ring iven in active labor
2 Bandl’s pathologic retraction ring- a danger sign of o
impending rupture of the Special Considerations:
uterus if obstruction is not relieved Demerol is most commonly used
1. Nursing Interventions of Woman in Labor: Has sedative and antispasmodic effect
a. Assessment – history and physical assessment Dose is usually 25 –100 mg depends on body weight
a.1. Personal data Not given early in labor due to possible effect on
a.2. Obstetrical data contractions
1 determine EDC Not given too late (1 hr before delivery) can cause
2 obstetrical score respiratory depression in the newborn
3 amount/ character of show Given if cervical dilatation is 6 – 8 cms.
4 status of the BOW 5.3.2. Narcotic Antagonist: Narcan; Nalline
5 general physical examination 6. Nursing Care before administration of
6 Leopold’s Maneuver: presentation anesthesia/analgesia
7 Internal examination: 1.1.Assess pain status
effacement ; dilatation; station 1.2.Explain the action of drugs
b. Monitoring and Evaluating Progress of Labor 1.3.Check vital signs of mother and fetus
b.1. Blood pressure 1.4.Observe safety measures
b.2. Fetal Heart Tone Evaluate allergies
b.3. Observe for signs of fetal distress Provide siderails – have call bell ready
12 bradycardia NPO (anesthesia)
13 fetal thrashing Check time last medication was given
14 meconium stained amniotic fluid in non-breech 1.5.Nursing Care after administration of
presentation anesthesia/analgesia
b.4. Monitor and inform patient of progress of labor 1.6.Monitor: vital signs – BP and FHR (be alert for
b.5. Monitor progress – fetal bradycardia)
a) during labor check FHR 1.7.Record properly
b) manage fetal distress 1.8.Provide comfort measures
5. Analgesia/anesthesia during childbirth 1.9.Remember that the use ofF orce ps is needed in
5.1. Analgesia – relieves pain and its perception delivery of patient under
5.2. Anesthesia – produces local or general loss of anesthesia due
sensation ; to loss of coordination in bearing down during 2nd stage
- usually regional anesthesia (e.g. spinal) 1.10. Side effects:
o a. postspinal headaches – place flat on bed for 12 hrs
Relieve uterine and perineal pain and increase
o fluid intake
Usually safe for the fetus (potential for maternal b. common side effect is hypotension (xylocaine
hypotension) –vasodilator):
o Nursing Intervention:
turn to side a. Monitor discomfort/exhaustion/pain control – support
elevate legs client in choice of pain
administer vasopressor and oxygen as ordered control
Fetal bradycardia b. Relaxation techniques taught during pregnancy where
Decreased maternal respirations breathing is taught as a
(Observe for bulging of the perineum) relaxed
XI. STAGES OF LABOR response to contraction
1. Stages of Labor c. Low back pain – massage of sacral area
Stage d. Use different breathing techniques during the different
Characteristics phases of labor
First Stage e. Encourage rest between contractions
- the stage of true labor until the f. Keep couple informed of progress
complete cervical dilatation g. Administer analgesic : side effects-may prolong labor;
a. Latent Phase local/ block/ general
b. Active Phase 4. Nursing Care of Woman in the 3rd Stage of Labor
c. Transitional a. Principle Of Watchful Waiting
Phase b. Use Brandt Andrews Maneuver
Extent: c. Note Time Of Delivery (20 Minutes After Delivery Of
Primigravida – 3.3.-19.7 hrs The Baby)
Multigravida – 0.1 - 14.3 hrs d. Check Bp; Injects Oxytocin (Methergin 0.2 Mg/Ml Or
0-4 cms. cervical dilatation Syntocinon 10 U/Ml Im)
Interval: 15-20 mins interval e. Inspect Cotyledons For Completeness
Duration: 10-30 seconds f. Check Uterus For Contraction
5-7 cms. cervical dilatation g. Check Perineum For Lacerations -Give perineal care;
Interval: 3-5 mins apply perineal pads
Duration: 30-60 seconds h.
8-10 cms cervical dilatation Change gown
Interval: 2-3 mins. i.Place flat on bed
Duration: 50-90 seconds j.Keep warm – provide extra warm blanket
Second Stage k.
- begins with complete dilatation of the cervix until the Give initial nourishment – warm milk, tea
birth of the newborn l.Allow to rest/ sleep
Duration: 5. Nursing Care of Woman in Fourth Stage
Primigravida – 30 mins. - 2 hrs. a. Lactation: promote lactation by encouraging early
Multi-gravida- 20 mins – 1 hr. breastfeeding to stimulate
Contractions- 2-3 mins for 50-90 secs milk
Mother is exhausted and has urge to production
push *** Those mothers who cannot breastfeed:
Third Stage suppressing agents are given – estrogen- androgen
- from delivery of the newborn to preparations given
the delivery of the placenta first hours
Still with mild contractions until the post partum to prevent milk production. These drugs
placenta is expelled. tend to increase
Usually, placenta is expelled within 30 uterine
minutes. bleeding and retard involution. (e.g. diethylstilbestrol,
Fourth Stage Parlodel or
- the first hour after complete deladumone)
delivery until the woman becomes b. Rooming-in-concept
physically stable provides opportunity for developing positive family
Uterine cramping relationship
Rubra with small clots promotes maternal infant bonding
2. Principles of Postpartum Care releases maternal caretaking responses
a. Promote healing and the process of involution c. Assess vital signs, fundus and flow every 15 minutes.
b. Provide emotional support d. Hydration and elimination
c. Prevent postpartum complications e. May ambulate
d. Establish successful lactation Puerperium - the 6 weeks period following delivery
e. Promote responsible parenthood (FP) Involution- time period for the return of the reproductive
3. Nursing Care of the Woman in First & Second Stage organs to return to its
Labor prepregnant
state
8. Categories of Lacerations 4. Perineal Pain
8.1. First degree – involves vaginal mucous membrane Nursing Care:
and perineal skin 
8.2. Second degree – involves the perineal muscles, Place in Sim’s position – lessens strain on the suture line
vaginal mucous membrane 
and Expose to dry heat or warm Sitz bath
perineal skin 
8.3. Third degree – involves all in the 2nd degree Application of topical analgesics or oral analgesics as
lacerations and the external ordered
sphincter of 
the rectum Provide/ encourage perineal care
8.4. Fourth degree – involves all in 3rd degree 5. Sexual Activity
lacerations and the mucus 1 sexual stimulation may be decreased due to emotional
membrane of the factors and hormonal
rectum changes
XII. PROMOTING HEALING AND 2 it may be resumed if bleeding has stopped and
episiorrhaphy has healed by
INVOLUTION DURING POST-PARTUM the 3rd or
1. Vascular Changes
4th week
- Reabsorption of the 30-50% increase in cardiac volume
6. Menstruation
within 5 – 10 minutes after
1 Breastfeeding influences return of the menstrual flow.
the thirdstage of labor.
2 Breastfeeding – menses return in 3 – 4 months;
- WBC increases to 20,000 – 30,000/mm³
o some do not menstruate throughout lactation period
- Activation of the clotting factor
o ovulation is also possible with lactational amenorrhea
- All blood values are back to prenatal levels by 3rd or
3 Non-Breastfeeding Mothers – menstrual flow return
4th week
within 8 weeks
2. Location of the Fundus
7. Urinary Changes
- Uterine involution is measured by determining the level
o marked diuresis occurs within 12 hours postpartum to
of the fundus in relation to
eliminate excess tissue
the
fluids during pregnancy
umbilicus
o frequent urination in small amounts may be
- Nursing care:
experienced by some

o others have difficulty of urination
Assess condition and level of the fundus
Nursing Care:


Position in prone or knee chest
Explain cause of urinary changes
1 Occurrence of afterpains – it is an indication of uterine

contractions and are
Assist to promote voiding utilizing appropriate measures
normal. Usually
(encouraging
lasts up to 3 days after birth
voiding, let client listen to sound of flowing water, etc.)
Nursing Care:
8. Gastrointestinal Changes

- Change is more on the delay of bowel evacuation;
Explain to client cause of pain
constipation

- Cause:
Do not apply heat
decreased muscle tone

lack of food intake
Administer analgesics as prescribed
dehydration
3. Genital Changes/ Discharges
fear of pain
- Presence of Lochia: uterine discharges consisting of
-Nursing Care: encourage early ambulation
blood, decidua, WBC and some
increase fluids
bacteria
increase fibers in the diet
- Characteristics:
9. Vital Signs
pattern should not reverse –
o Temperature: may increase because of dehydration on
1-3 days – rubra - - - bright red with no or minimal clots
the first 24 hours pp.
4-9 days – serosa- - - thinner, serous sanguinous blood
o CR 50 – 70 beats/min (bradycardia) is common for 6 -
10- 3 to 6 wks pp – alba - - - whitish discharge
8 days pp.
same amount as menstrual flow, decreased if with
o RR – no change is expected
breastfeeding , increased
o Weight = 10 – 12 lbs is expected to be immediately
with activity
lost. This corresponds to the
with fleshy odor; never foul smelling
weight of the fetus, placenta, amniotic fluid and blood. Drugs – oral contraceptives, atropine, anticoagulants,
Diaphoresis will antimetabolites,
contribute to further weight loss cathartics,
10. Provision of Emotional Support tetracyclines.
Post-partum Psychological Phases Certain disease conditions – TB
1. Taking – in : First 1 – 2 days; mother focuses on because of close contact during feeding
herself and her experience (TB germs are not transmitted thru breast milk)
2. Taking – hold: mother starts to assume her role XIII. ASSOCIATED PROBLEMS
3. Letting go 1. Engorgement
Postpartum Blues – overwhelming sadness that cannot breast becomes full, tense and hot  with throbbing
be accounted for. Could be due pain
to expected to occur on the 3rd post partum day
hormonal changes, fatigue or feelings of inadequacy. accompanied by fever (milk fever)last 
Nursing Care: Encourage verbalization; crying is for 240 due to increased lymphatic and venous
therapeutic, explain that it is normal circulation
11. Establish Successful Lactation Nursing care:
Physiology of Lactation: o encourage breastfeeding
Estrogen & progesterone levels stimulates APG to o advise use of firm-supportive brassiere
produce  Prolactin acts on o (if not going to breastfeed – apply cold compress; no
acinar cells to massage; no breast
produce foremilk stored in collecting tubules -> infant pump; apply
sucking stimulates breast binder)
PPG to 2. Sore Nipples
produce oxytocin causes contraction of smooth Nursing care:
muscles of collecting tubules encourage to continue BF
milk  expose nipples to air for 10 – 15 minutes after feeding
ejected forward (milk ejection reflex or let down reflex (alternative) exposure to 20 watt bulb placed 12 – 18
hindmilk is produced inches away promotes
Implications of lactation: vasodilation
1 Breast milk will be produced postpartum and therefore promote healing
2 Lactation do not occur during pregnancy due to levels do not use plastic liners
of estrogen and progesterone use nipple shield
3 Lactation suppressing agents are to be given 3. Mastitis -
immediately after placental delivery to be inflammation of the breast
effective Signs & Symptoms: pain, swelling, redness, lumps in the
4 Oral contraceptives decrease milk supply and are breasts, milk becomes
contraindicated in lactating mothers scanty
5 Afterpains are felt more by breastfeeding mothers due Nursing Care:
to oxytocin production; have Ice compress
less lochia and rapid involution Supportive brassiere , empty breast with pump
12. Advantages of Breastfeeding Discontinue BF in affected breast
Mother: faster involution Apply warm dressing to increase drainage
less incidence of CA Administer antibiotics as prescribed
economical- time, effort, cost *** Postpartum Check-up: 6th week postpartum to
Infant: bonding with the mother assess involution
protection against common illness XIII. HIGH RISK PREGNANCY CONDITIONS
less incidence of GI diseases 1. Infections
always available 2. Bleeding / Hemorrhage/ PIH
13. Health Teachings 3. Diabetes Mellitus
a. Hygiene 4. Heart Disease
Wash breasts daily 5. Multiple Pregnancy
No soap; No Alcohol for cleaning 6. Blood Incompability
Handwashing 7. Dystocia
Insert clean OS squares/ absorbent cloth in brassiere for 8. Induced Labor
breast discharges 9. Instrumental Deliveries
b. Feeding Techniques
c. Nutrition: 3000 calories daily; 96 grams protein 1. INFECTIONS
d. Contraindications: 1.1.Syp hi l i s
Cause:
Treponema pallidum - a spirochete transmitted thru - An infection/inflammation of the lining of the uterus
sexual Signs & Symptoms: Abdominal tenderness
intercourse Uterus not contracted and
Treatment: painful to touch
2.4 – 4.8 million units of Penicillin (or 30 – 40 gms Dark brown
Erythrocin) Foul smelling lochia
x 10 days Management: Oxytocin administration
readily cross placenta thus prevent congenital syphilis Fowler’s position to drain out lochia
Untreated: Prevent pooling of discharges
Cause mid-trimester abortion 1.5.Thro mb o p hl e b it i s
Cause CNS lesions -infection of the lining of a blood vessel with formation of
Can cause death clots, usual an
1.2. TORCH test series extension of
TOxoplasmosis (protozoa) endometritis
avoid eating uncooked meat and handling cat Signs & Symptoms:
litter box o1
Others: Syphilis, Varicella/ Shingles Pain
Hepatitis B; Hepatitis A; AIDS o2 Stiffness and redness in the affected part of the leg
Rx – o3 Leg begins to swell below the lesion because venous
Zoster Immune Globulin ,Penicillin circulation
RUbella has been blocked
Effect: if contracted early, slows down cell o4 Skin is stretched to a point of shiny whiteness, called
division during organogenesis causing milk leg
congenital defects NB can carry and transmit of
the virus for about 12 – 24 months after birth Phlegmasia alba dolens
CYtomegalovirus o5 Positive Homan’s sign: calf pain on dorsi-flexing the
(CMV) (DNA virus) foot
Herpes type 2 Specific Management:
Group of maternal systemic infections that can cross the 1bed rest with affected leg elevated
placenta or by ascending 2a
infection(after rupture of membranes) to the fetus. nticoagulants (e.g. Dicumarol or Heparin) to prevent
Infection early in pregnancy may produce fetal formation or extension of a thrombus
deformities, whereas late infections Side effect of Anticoagulant: hematuria, increased lochia
may result in Considerations:
active systemic disease and/or CNS involvement 1 discontinue breastfeeding
causing severe neurological 2 monitor prothrombin time
impairment or 3 have Protamine Sulfate at bedside to counter act
death of newborn severe bleeding
Sources/ Cause: 4 analgesics are given but not ASPIRIN because it
1. Endogenous/primary sources - normal bacterial flora prevents
2. Exogenous sources - hospital personnel, excessive prothrombin formation
obstetric manipulations which may lead to hemorrhage
breaks in aseptic techniques, coitus late in pregnancy 2. HEMMORRHAGE/ BLEEDING
premature rupture of membranes Definition: blood loss more than 500 cc. ( normal blood
General symptoms: malaise, anorexia, fever, chills and loss 250- 350 cc)
headache *** Leading cause of maternal mortality associated with
Management: childbearing
Complete Bedrest 2.1. Early Post-partum hemorrhage – first 24 hrs after
Proper Nutrition delivery
Increased Fluid Intake 2.2. Late Postpartum Hemorrhage
Analgesics Early Post-partum hemorrhage
Antipyretics and antibiotics as ordered Late Postpartum Hemorrhage
1.3. Infection of the perineum Cause
Signs & Symptoms: pain, heat, feeling of pressure, Uterine Atony – uterus is not
inflammation of suture line with 1 –2 stitches sloughed well contracted, relaxed or boggy
off (most frequent cause)
temperature elevation Lacerations
Management: drain area & resuturing ; sitz bath & warm Hypofibrinogenemia
compress Clotting defect
1.4.End o me t ri ti s Retained Placental Fragments
Management o BP of 140/90 mmHg or increase of 30/15mmHg
Bleeding in Pregnancy o 2+ to 3+ proteinuria
blood transfusion o begins past 20th week
D & C (Dilatation and o slight generalized edema may be present, weight gain
Curettage of 1- 5
Predisposing factor: lbs/wk
Overdistension of the uterus (multiparity, large babies, c. Pre-eclampsia, severe
polyhydramnios, o BP of 150-160/100-110 mmHg
multiple pregnancies) o 4+ proteinuria (5 gm/L or more in 24 hrs
Cesarean Section o Headache and epigastric pain(aura to convulsions)
Placental accidents (previa or abruptio) o Oliguria of 400 ml or less in 24 hrs. (normal UO/day
Prolonged and difficult labor 1500 ml)
Management: Massage –first nursing action o Cerebral or visual disturbances
Ice compress d. Eclampsia - Obstetrical Emergency
Oxytocin administration o HPN
Empty bladder o Proteinuria
Bimanual compression to explore retained placental o Convulsions
fragments o Coma
Hysterectomy (last alternative) Immediate Intervention for Eclampsia:
2.3.He mat o ma a. Maintain IV line with large-bore needle
- Due to injury to blood vessels in the perineum during b. Monitor fluid balance
delivery c. Minimize stimuli
Incidence: Commnon in precipitate delivery and those d. Have airway and oxygen available
with perineal e. Give medications as ordered (e.g Magnesium sulfate,
varicosities Apresoline,
Treatment: Valium)
1 Ice Compress in first 24 hours f. Prepare for possible delivery of fetus
2 Oral Analgesics as prescribed g. Monitor fetal status
3 Site is incised and bleeding vessel ligated h. Type and cross match for blood
2.4. Pregnancy Induced Hypertension (PIH) i. Postpartum- monitor vital signs and watch for seizure
- A vascular disease of unknown cause Management for Eclampsia:
- Occurs anytime after the 24th wk of gestation up to 2 a. Digitalis (with Heart Failure)
wks PP Increase the force of contraction of the heart decrease
- Develops during pregnancy and resolves during heart
postpartum period rate
Predisposing Factors: Nursing Considerations: Check CR prior to
a. large fetus administration ( do
b. Older than 35, younger than 17 not give if
c. primigravida CR <60/min)
d. multiple pregnancy or H mole b. Potassium supplements – prevent arrhythmias
e. poor nutrition c. Barbiturates – sedation by CNS depression
f. Hx of DM, renal and vascular disease d. Analgesics; antihypertensives, antibiotics,
g. Morbid obesity or weight less than 100 lb anticonvulsants,
h. Family history sedatives
Diagnosis: e. Magnesium Sulfate – drug of choice
Roll – over test : Assess the probability of developing Action: CNS depressant ; Vasodilator
toxemia when done Antidote: Calcium Gluconate- given 10% IV to maintain
between the Cardiac and vascular tone
28th and 32nd week of pregnancy. Earliest sign of MgSO4 toxicity disappearance of knee
Procedure of Roll-over test: jerk/patellar reflex
1 Patient in lateral recumbent position for 15 minutes Method of delivery – preferably Vaginal but if not
until BP Stable possible CS
2 Rolls over to supine position Prognosis: the danger of convulsions is present until 48
3 BP taken at 1 minute and 5 minutes after roll over hrs
4 Interpretation: If diastolic pressure increases 20 mmHg postpartum
or more, f. Cathartic – cause shift of fluid from the extra cellular
patient is prone to Toxemia spaces into the
Types of Pregnancy Induced Hypertension (PIH): intestines from where the fluid can be excreted
a. Transient hypertension - without proteinuria or edema Dosage:
b. Pre-eclampsia, mild
10 gms initially –either by slow IV push over 5 – 10 Earliest sign of MgSO4 toxicity disappearance  of
minutes or knee jerk/patellar
deep IM, reflex
5 gms/buttock, then an IV drip of 1 gm per hour (1 Method of delivery – preferably Vaginal but if not
gm/100 ml possible CS
D10W), Prognosis: the danger of convulsions is present until 48
Check first the ff. before administration: hrs
1 Deep tendon reflexes are present postpartum
2 Respiratory rate = 12 / min f. Cathartic – cause shift of fluid from the extracellular
3 UO = at least 100 ml / 6 hrs. spaces into the
Nursing Intervention: intestines from where the fluid can be excreted
a. Dosage:
Advised bedrest, left lateral 10 gms initially –either by slow IV push over 5 – 10
bb minutes or
. deep IM,
. 5 gms/buttock, then an IV drip of 1 gm per hour (1
Encourage a well-balanced diet gm/100
c. ml D10W),
Weigh daily, keep daily log May administer if :
dd 4 Deep tendon reflexes are present
. 5 Respiratory rate = 12 / min
. 6 UO = at least 100 ml / 6 hrs.
Education on self – assessment 3. DIABETES MELLITUS
e. a.
Diversion Chronic hereditary disease characterized by marked
f. hyperglycemia
Family support b.
e.Post-delivery PIH Due to lack or absence of insulin
o with Disseminated Intravascular Coagulation – abnormalities in CHO, fat and protein
anticoagulant metabolism
therapy c.
o Monitor blood pressure for 48 hours Effects of pregnancy – may develop abnormalities in
Diagnosis:Roll – over test : Assess the probability of glucose tolerance decreased
developing toxemia when done renal threshold for sugar due to increased estrogen, inc.
between the 28th and 32nd week of pregnancy. production of
Procedure on Roll-over test: adenocorticoids, Anterior Pituitary hormones, and
5 Patient in lateral recumbent position for 15 minutes thyroxin which affect CHO
until BP Stable concentration in blood (hyperglycemia)
6 Rolls over to supine position d.
7 BP taken at 1 minute and 5 minutes after roll over Rate of insulin secretion is increased but sensitivity of
8 Interpretation: If diastolic pressure increases 20 mmHg the pregnant body to insulin
or more, patient is decreased
is prone to Toxemia Pregnancy Risks:
Management: 1
a. Digitalis (with Heart Failure) Toxemia
Increase the force of contraction of the heart  2I
decrease heart rate nfection
Nursing Considerations: Check CR prior to 3
administration ( do not give if Hemorrhage
CR <60/min) 4
b. Potassium supplements – prevent arrhythmias Polyhydramnios
c. Barbiturates – sedation by CNS depression 5
d. Analgesics; antihypertensives, antibiotics, Spontaneous abortion – because of vascular
anticonvulsants, sedatives complications
e. Magnesium Sulfate – drug of choice which affect placental circulation
Action: CNS depressant ; Vasodilator 6
Antidote: Calcium Gluconate- given 10% IV to maintain Acidosis – because of nausea and vomiting
Cardiac and 7
vascular tone Dystocia – due to large baby
Diagnosis : Glucose Tolerance Test (GTT) Apnea/cyanosis
Procedure for GTT: e.
NPO after midnight Hypotonia; hypothermia
2 ml of 50% glucose / 3 kg of pre-pregnant body weight ***Consequence of hypoglycemia: untreated hypos brain
given IV (oral glucose not damage  and even death
advisable due to decreased gastric motility and delayed ***Management: feed with glucose water earlier than
absorption of sugar during pregnancy) usual, or administer IV of glucose
Interpretation of Results: 4. HEART DISEASE
a. If less than 100 mg% = normal Classification:
b. If 100 – 120 mg% possible GDM Class I
c. If more than 120 mg% - overt gestational diabetes - no physical limitation
Management: Class II
a. - slight limitation of physical activity
Diet - highly individualized- adequate glucose intake - Ordinary activity causes fatigue, palpitation, dyspnea,
(1,800 – or angina
2200 calories) to prevent intrauterine growth retardation Class III
b. - moderate to marked limitation of physical activity; less
Insulin requirements – individualized; increased during than ordinary
2nd activity causes fatigue
and 3rd trimester because of more pronounced effect of Class IV
hormones -unable to carry on any activity without experiencing
c. discomfort
Method of Delivery – Cesarian Section Prognosis: Classes I & II – normal pregnancy & delivery
d. Classes III & IV – poor candidates
Postpartum Period – more difficult to control Blood Signs & Symptoms:
Glucose Heart murmur due to increased total cardiac volume
because of hormonal changes Cardiac output decreased nutritional and oxygen
Effect on Infant: requirements not
a. met
Typically longer and weighs more due to: excessive Incomplete emptying of the left side of the heart
supply of Pulmonary edema
glucose from the mother and HPN (moist cough in Gravidocardiacs danger
b. sign)
Increased production of growth hormone from maternal Congestion of liver and other organs due to inadequate
pituitary venous return increased venous
gland pressure fluid escapes through the walls of engorged
c. capillaries and cause edema and
Increased secretion of insulin from the fetal pancreas ascites CHF is a high probability due to increased CO
d. during pregnancy dyspnea,
Increased action of adrenocortical hormone that favor exhaustion, edema, pulse irregularities, chest pain on
the passage exertion and cyanosis of
of glucose from mother to fetus congenital anomalies are nailbeds are obvious
often Management: (depends on cardiac functional capacity)
seen a. Bed rest – especially after 30th week of gestation
e. b. Diet – gain enough (consider effect on cardiac
Cushingoid appearance (puffy, but limp and lethargic) workload)
f.Born premature more often – RDS common c. Medications: Digitalis, Iron preparations
g. d. Avoid lithotomy
Greater weight loss because of loss of extra fluid position to avoid increase in venous return, place in
h. semisitting
Prone to hypoglycemia (BG <30 mg%) position
Signs and symptoms of Diabetic Babies/ Hypoglemic e. Not allowed to bear down; Birth is via low forceps or
Infant: Cesarean section
a. f. Anesthetic choice – caudal anesthesia
Shrill, high pitched cry g. Ergotrate and other oxytoxics, scopolamine,
b. diethylstilbestrol and oral
Listlessness/jitteriness/tremors contraceptives –
c. h. contraindicated can cause fluid retention and
Lethargy/poor suck promote thromboembolism
d.
i. Most critical period: immediate postpartum period - Strong fundal push, attempts to deliver the placenta
when 30 – 50% increased before
blood volume signs of separation
j. is reabsorbed back in 5 – 10 minutes and the weak -Management: Hysterectomy
heart needs to adjust 8. INDUCED LABOR
5. MULTIPLE PREGNANCY - Stages of labor and birth occurs due to chemical or
Risks: Increased Blood Loss mechanical means which is
Small for Gestational Age Infants usually performed to save the mothe or fetusr from
Premature Birth complications which may cause death
Dystocia Indications:
Management: Maternal – toxemia
a. Monitor FHT, VS, weight Placental accidents
b. Cesarean Section Premature Rupture Of Membrane
c. Health Teaching on importance of regular pre-natal Fetal: DM – terminated at about 37 wks AOG if indicated
check-up visits Blood incompatibility
d. Educate regarding proper nutrition and exercise Excessive size
6. BLOOD INCOMPATIBILITY Postmaturity
- An antigen-antibody reaction which causes excessive Prerequisites to Induce Labor :
destruction of fetal red blood No Cephalo- Pelvic Dislocation
cells Fetus is already viable >32 weeks AOG
Mother Single fetus in longitudinal lie and is engaged
Fetus Ripe cervix – fully or partially effaced; Cervical Dilatation
Rh- negative at least 1=2 cm
Rh Positive (Father is homozygous Procedure for Induced labor:
or heterozygous Rh positive) 1. Oxytocin Administration; 10 IU of Pitocin in 1000 ml of
BloodType O D5W at a slow rate of 8
Either Type A or B (From father) gtts/min given initially no fetal distress in 30 minutes 
7. DYSTOCIA - broad term for abnormal or difficult labor  rate 16 -20 gts/min
and delivery 2. Amniotomy – done with Cervical Dilatation = 4 cm ;
Uterine Inertia – sluggishness of contractions Check FHR and quality of amniotic
Cause: fluidNursing Considerations:
Inappropriate use of analgesics Monitor uterine contractions potential for rupture
Pelvic bone contraction Monitor flow rate regularly
Poor fetal position Turn off IV with any abnormality in FHR or contractions
Overdistention – due to multiparity, multiple pregnancy, Watch out for complications: HPN, Antidiuresis
polyhydrmanios or excessively large baby Prostaglandin administration: Route: oral or IV (never IM
Management: Stimulation of labor by oxytocin causes irritation);
administration or amniotomy effect is slower than oxytocin
7.1. Precipitate Delivery 9. INSTRUMENTAL DELIVERIES
- labor and delivery that is completed in < 3 hours due to a. Forceps Delivery
multiparity or - Use of metal instruments to extract the fetus from the
followingoxytocin administration or amniotomy birth canal, when at +3 / +4 and sagittal
Effects: Extensive lacerations suture line is in an AP position in relation to the outlet
Abruptio placenta (e.g. Simpson, Elliot, Piper for breech
Hemorrhage due to sudden presentation)
Release of pressure shock Purposes:
7.2. Prolonged Labor - Usually occurs in primi gravida shorten second stage of labor because of fetal distress;
- Labor lasting more than 18 hrs and in multigravidas, maternal exhaustion;
more maternal disease – cardiac, pulmonary complication
than 12 hours ineffective pushing due to anesthesia
Effects: Maternal exhaustion prevent excessive pounding of fetal head against
Uterine atony perineum (low forceps for
Caput succedaneum prematures)
7.3. Uterine Inversion - fundus is forced through the poor uterine contraction or rigid perineum
cervix so that the uterus is Prerequisites:
turned inside out Pelvis adequate, no disproportion
- Insertion of placenta at the fundus, so that as fetus is Fetal head is deeply engaged
rapidly delivered, fundus is pulled down Cervix is completely dilated and effaced
Membranes have ruptured
Vertical presentation has been established f.Preoperative medication is usually only atropine
The rectum and bladder are empty sulfate.
Anesthesia is given for sufficient perineal No narcotics are given causes respiratory  depression
Relaxation and to prevent pain in the NB
Types: Postoperative Care
Low or Mid Forceps Delivery a.
Complications: Deep breathing, coughing exercises, turning from side to
Forceps marks – noticeable only for 24 – 48 hrs side
Bladder or rectal injury b.
Facial paralysis Ambulate after 12 hours
Ptosis c.
Seizures Monitor vital signs
Epilepsy d.Watch for signs of hemorrhage – inspect lochia; feel
Cerebral Palsy fundus (if
a. Cesarean Section – birth through a surgical incision boggy, massage
on the abdomen with proper abdominal splinting and give analgesics as
Indications: ordered)
o Cephalo-pelvic disproportion (CPD) e.
o Severe Toxemia Breastfeeding should be started 24 hrs after delivery
o Placental Accidents f. Most common complication: Pelvic thrombosis
o Fetal Distress 10. OTHER RISK FACTORS:
o Previous classic CS – done prior to onset of labor 10.1.Ag e :
pains; scheduled birth - Maternal and infant mortality rates tend to be high in
Types: age below 15
1. Low Segment – the method of choice. and older
Incision is made in the lower uterine segment, which is than 40 years
the thinnest and most Adolescent pregnancy
passive Advanced age
Part during active labor. Most common problems:
Advantages:Minimal blood loss Toxemia
Incision is easier to repair A precipitating factor in:
Lower incidence of post partum infection Placental accidents
No possibility of uterine rupture Iron-deficiency anemia
2. Lower vertical incision – recommended in: Toxemia
Bladder or lower uterine segment Uterine atony or inertia
Adhesions from Previous operations Varicosities; hemorrhoids
Anterior Placenta Previa Low birth weight babies
Transverse lie C Ch
Preoperative Care hr
a. ro
The patient is both a surgical and an OB patient om
b. mo
Check vital signs, uterine contractions, and FHR os
c. so
Physical examination; routine laboratory tests; blood om
typing and cross ma
matching al
d. lA
Abdomen is shaved from the level of the xiphoid process Ab
below the bn
nipple line, no
extending out to the flanks on both sides up to the upper or
thirds of the rm
thighs ma
e. al
Retention catheter is inserted to constant drainage to li
keep the bladder it
away from ti
the operative site ie
es Causes of Ectopic Pregnancy:
sl a. Pregnancy Induce Hypertension
li b. Previous tubal surgery
ik c. Congenital anomalies of the fallopian tubes
ke Signs & Symptoms:
eD 1
Do Severe, sharp, knife-like stabbing pain
ow 2
wn Rigid abdomen
n’ 3
’s Positive Cullen’s sign (bluish umbilicus)
s 4
S Excruciating pain on IE
Sy 5
yn Signs of shock
nd Management: Ruptured Ectopic Pregnancy is an
dr emergency requiring immediate
ro intervention
om Salpingostomy – if Fallopian tube can still be replaced
me and preserved,pregnancy
e/ is terminated
/T Saphingectomy – removal of FT and BT
Tr Nursing Interventions:
ri 1
is Help woman to combat shock
so 2
om Elevate foot of the bed
my 3
y2 Maintain body heat
21 4
1 (associated Prepare for surgery
with menopause) 5
10.2.Pari t y – first pregnancy is the period of high risk Monitor for shock preoperatively and postoperatively
Multiparity G5 and above and age is over 40 6
10.3. Birth Interval – 3 months from previous delivery or Provide emotional support and expression of grief
more than 5 years 7
10.4. Weight Administer Rhogam to Rh negative women
Pre-pregnant weight < 70 lbs or > 180 lbs 8
Weight gain < 10 lbs LBW babies Discharge teaching
Weight gain > 30 lbs = sign of toxemia; DM; H-mole; 3. Hydatidiform Mole (H-Mole)
polyhydramnios; -Degenerative anomaly of chorionic villi
multiple Signs & Symptoms:
pregnancy 1. Elevated hCG levels marked  nausea & vomiting
10.5. Height 2. Uterine size greater than expected for dates
Short stature < 4 feet, 10 inches = contracted pelvis or 3. No FHR
CPD 4. Minimal dark red/brown vaginal bleeding with passage
XIV. MATERNAL COMPLICATIONS of grapelike clusters
1. Spontaneous Abortion 5. No fetus by ultrasound
Termination of pregnancy spontaneously at any time 6. Increased nausea and vomiting and associated with
before the fetus has attained PIH
viability Management:
Assessment: 1. Curettage to completely remove all molar tissue that
1. Persistent uterine bleeding and cramplike pain can become malignant
2. Laboratory finding – negatively or weakly positive 2. Pregnancy is discouraged for 1 year
urine pregnancy test 3. hCG levels are monitored for 1 year (if continue to be
3. Obtain history, including last elevated, may require
menstrual period hysterectomy and chemotherapy)
2. Ectopic Pregnancy 4. Contraception discussed; IUD not used
- Any gestation outside the uterine cavity 4. Incompetent Cervical Os
One that dilates prematurely 2. Abdomen (uterus) is tender, painful, tense (couvelaire
Chief cause of habitual abortion ( 3 or more) uterus)
Causes: 3. Possible fetal distress
1 4. Contractions
Congenital Developmental Factors (Occurrence increased with maternal HPN and cocaine
2 abuse; sudden release of
Endocrine factors amniotic fluid; short cord; advanced age; multiparity;
3 direct trauma;
Trauma to the cervix hypofibroginemia)
Signs & Sypmtoms: Management:
1 Presence of show and uterine contractions a. Monitor maternal and fetal progress
2 Rupture of membranes, Painless cervical dilatation b. Blood loss seen may not match symptom
5. Incompetent Cervix c. Could have rapid fetal distress
6. Placenta Previa – the placenta is the presenting part d. Prepare for immediate delivery
1. First and second trimester spotting e. Monitor for post partal complications
2. Third trimester bleeding that is sudden, profuse, Predisposing Factors:
painless b. Disseminated intravascular coagulation
3. Ultrasonography – classified by degree of obstruction c. Pulmonary emboli
Management: d. Infection
1 e. Renal failure
Hospitalization, initially f. Transfusion hepatitis
2 Nursing Intervention:
Bedrest side-lying or Trendelenberg position for at least Bedrest
72 Vital signs, FHT
hrs. Monitor intake and output
3 Seizure precautions
Ultrasound to locate placenta Medications (Magnesium sulfate, Apresoline, Valium)
4 8. Uterine Rupture -occurs when the uterus undergoes
No vaginal, rectal exam unless delivery would not be a more straining than it is capable of
problem (if necessary must be done in OR sustaining
under sterile conditions) Cause: Scar from previous CS
5 Unwise use of oxytocins
Amniocentesis for lung maturity; monitor for changes in Overdistention
bleeding and fetal status Faulty presentation
6 Prolonged labor
Daily Hgb and Hct Signs & Sypmtoms:
7 Sudden severe pain
Two units of crossmatched blood available Hemorrhage and clinical signs of shock
8 Change in abdominal contour (two swelling on the
Monitor amount of blood loss abdomen due to retracted
9 uterus and the extrauterine fetus)
Send home if bleeding ceases and pregnancy is Management: Hysterectomy
maintained 9. Amniotic Fluid Embolism – (Obstetric Emergency)
10 – occurs when amniotic fluid is forced into an open
Limit activity maternal uterine flood sinus
11 through some defect in the membranes or after partial
No douching, enemas, coitus premature separation of the
12 placenta. Solid particles in the amniotic fluid enter
Monitor fetal movement maternal circulation and reach the
13 lungs as emboli
NST at least every 1 – 2 weeks Signs and symptoms: Dramatic
14 Sudden inability to breathe, sits up, grasps chest and
Monitor complications sharp chest pain
15 Turns pale then  bluish gray color
Delivery by cesarean if evidence of fetal maturity,
excessive
bleeding, active labor, other complications
7. Abruptio Placenta
Signs & Symptoms:
1. Painful vaginal bleeding