NORMAL OB | ARCHIE ALVIZ | TRA HCG - Human Chorionic Gonadotropin

Transcribed By: John Patrick G. Guevarra, RN 2024 PT Test is PROBABLE, presence of HCG may be
Psalm 20:4 | May 24, 2024 due to H-MOLE and cause false (+)

Pregnancy has three periods… Braxton Hicks Contraction - painless, irregular contraction
Painful and regular contractions = TRUE LABOR
1st TRIMESTER
Organogenesis - organs of the fetus are being created. Ballotment - bouncing of the fetus = NOT ENGAGED
Most critical period of pregnancy, bc the fetus may be Assessment: Insertion of fingers and reach for fetal head,
affected by external factors. then tap fundus. If the head bounced, it is not engaged.

NO OTC drugs nor NON-Prescription drugs Positive; confirmatory

ONLY Category A Drug; safe in pregnancy (Ex. Ultrasound (UTZ)
Paracetamol; does not cross placental barrier)
Transvaginal - used during early pregnancy
Development of germ layer; NR: instruct mother to EMPTY BLADDER. Full bladder may
Ectoderm - Brain cause premature rupture of membrane
Mesoderm - Heart
Endoderm - GI Transabdominal - late pregnancy
NR: instruct mother drink 3-4 glasses of water to distend
Period of Ambivalence - presence of two opposing feelings; fundus for easier visualization
mixed emotions (normal)
Fetal Heart Tone (Normal: 120-160 bpm)
Most common in Primigravida, does not know what to WOF: bradycardia/tachycardia = FETAL DISTRESS
expect and only occurs in the 1st trimester. If still present
at 2nd-3rd, may develop Postpartum Depression Movement felt by the examiner is POSITIVE

2nd TRIMESTER S/SX OF PREGNANCY

Easiest part, bc mother has already adapted to the
pregnancy state. Lightening - descent of fetal head to maternal pelvis
(ENGAGEMENT)
Hormones are already balanced
Increased in LIBIDO; BEST TIME to have SEX Braxton Hicks
Ballottement
3rd TRIMESTER
Period of unattractiveness Montgomery’s Tubercle - lubricates the breast during
Low self-esteem breastfeeding, prevents nipple cracking/dryness
Mgt: know the mothers’s support system; husband, mother,
family, and friends. Melasma/ Chloasma “Mask of Pregnancy”
Best Support: HUSBAND
Linea Nigra - blackish-line in midline of abdomen, seen
S/SX OF PREGNANCY during pregnancy. Does not disappear, only lightens after
pregnancy = Linea Alba (whitish-line)
Presumptive; subjective
Only felt by the mother (BAUN QC) ADAPTATIONS OF PREGNANCY

B - Breast Changes CARDIOVASCULAR CHANGES

A - Amenorrhea Inc total cardiac volume > inc cardiac workload >
U - Urinary Changes palpitations; temporary, if persist, NOTIFY MD!
N - Nausea and vomiting
Edema - normal, depends on location.
Q - Quickening (mov’t felt at 5mos pregnancy) Normal: Lower extremities/bipedal (dec venous
C - Chloasma/Melasma (MASK OF PREG; discoloration of return)
face and neck) Abnormal: Upper extremities
ANASARCA/periorbital/facial = Pregnancy Induced HPN
Probable; objective
Seen by the nurse (HCG HCG BB) Varicose veins - tortuous veins d/t overworked veins
Homan’s Sign - dorsiflexion of foot part. If calf pain is
H - Hegar’s Sign (thinning of uterus) present = (+) Homan’s
C - Chadwick’s (blue/purple vagina) TEMPORARY DO NOT MASSAGE may lead dislodged BLOOD CLOT
G - Goodell’s (softening of cervix; easier passage of fetus) ELEVATE instead = VENOUS RETURN
Non-Pregnant - soft as nose
Pregnant - soft as earlobe Varicose vein prone to Deep Vein Thrombosis
During Labor - BUTTER-like soft
Virchow’s Triad (DVT) WEIGHT CHANGES
- Venous stasis 1st: 1.5-3lbs
- Venal wall damage 2nd: 10-11lbs
- Vlood coagulation 3rd: 10-11lbs
Mgt: use anti-embolic stockings Total Weight Gain: 25-35lbs

GASTROINTESTINAL CHANGES Psychological Task of Pregnancy

Morning sickness d/t hypoglycemia at morning 1st Tri: Accepting the pregnancy
2nd Tri: Accepting the baby (fantasizing the baby)
Hypoglycemia is caused by continuous consumption of 3rd Tri: Preparing for parenthood (responsibilities)
nutrients of baby from mother even night time
FETAL GROWTH & DEVELOPMENT
Mgt: Dry crackers/toast, simple CHO; carbohydrates Fertilization - union of sperm and egg cell in the AMPULLA
of fallopian tube
Hyperemesis gravidarum - excessive vomiting Implantation - upper uterine segment
Mgt: small frequent feedings Lower uterine segment = Placenta Previa
Outside uterus = Ectopic Pregnancy
Constipation and Flatulence - lack of peristalsis mov’t due
to compression of bowel Conceptus Period
Mgt: inc OFI + Fiber = enhanced peristalsis Ovum Ovulation > Fertilization
Zygote Fertilization > ImPLANTation
Hemorrhoids - dilated blood vessels at anal sphincter Embryo Implantation > Eight weeks
Internal (asymptomatic) Fetus 8 weeks > Full Term
External (painful)
MEMBRANES
Heartburn d/t HCL reflux > damaged esophageal linings > Chorion - outer membrane
Hoarseness of voice > Dysphagia (difficulty of swallowing) Amnion - inner membrane
Amniotic fluid: 500-1000mL
RESPIRATORY CHANGES Oligohydramnios: <500mL = renal problems
Shortness of breath Polyhydramnios: >1000mL = esophageal prob.
Mgt: left side-lying position, prevents compression of lungs (TEF: Tracheoesophageal Fistula/Esoph. Atresia)
and diaphragm
Amniotic Fluid
URINARY CHANGES - Protection
Increase urinary frequency, bc bladder is compressed by - Temperature regulation
uterus = Decrease urinary threshold - Support growth
- Fetal movement
MUSCULOSKELETAL CHANGES
Lordosis “Pride of Pregnancy” UMBILICAL CORD
Symptoms: Backache and leg cramps AVA: 2 arteries, 1 vein NORMAL
Mgt: low heel shoes with grip, to prevent slipping VAV: 2 veins, 1 artery ABNORMAL = Congenital Heart Prob.
Whartons Jelly - protective covering of cord
Increased Temperature > Inc Basal Metabolic Rate >
Glucose Production ANTEPARTUM CARE
Care given between conception to onset of labor
SKIN CHANGES
Melasma/Chloasma “Mask of Pregnancy” Inclusions:
FETAL WELL-BEING
Linea Nigra - black line discoloration on abdomen during
pregnancy FHT Monitoring: Auscultation
Linea Alba - white line after pregnancy 3mos - doppler
4mos - fetoscope
Striae Gravidarum 5mos - stethoscope
Mgt: use cocoa butter > enhances collagen matrix >
minimizes scarring

UTERINE CHANGES
Hegar’s sign - thinning of uterus
Goodell’s sign - softening of cervix
Chadwick’s sign - blue/purple vagina
NORMAL COLOR: PINK

Leukorrhea - WBC in vagina > prevent infection

Vaginal pH: 5.5 - 6.5 (slightly acidic)
Electronic Fetal Heart Monitoring: Stress/Non-Stress 4th Maneuver: Pelvic Grip
NST ST ATTITUDE/FETAL LIE
Normal contraction Abnormal Contraction Flexion = GOOD
Acceleration Invasive > CONSENT! Extension = BAD
Rule of 15x15: Trigger Contraction via:
15 beats inc Nipple Stimulation Clean Catch Urine - method of collecting urine sample
15 secs duration Oxytocin (Oxy Challenge Test) Purpose: Detects UTI (predisposes pregnant to preterm
Results: Deceleration: labor)
Reactive = GOOD Early - head compression
Non-Reactive = BAD Late - uteroplacental insuff. Stream of Urine:
Variable - cord compression 1st stream: Contaminated = DISCARD
Results: 2nd stream: Accurate = USE
Positive = BAD AKA: Midstream Urine
Mgt: NOTIFY MD!
Negative = GOOD Pap Smear - determines Cervical Cancer
Mgt: Non-Stress Test Class I: Normal
Class II: Inflammation (check-up, NO IE)
Amniocentesis - evaluate fetal maturity, and certain birth Class III: Mild-Moderate Dysplasia (NO SEX)
defects Class IV: Probably Malignant (HARD RECOVERY)
AlphaFeto Protein (AFP) Class V: Possibly Malignant (SLIM SURVIVAL)
Increased: Neural Tube Defects (NTDs) Ex. Spina Bifida
Decreased: Down’s Syndrome DISCOMFORTS OF PREGNANCY
Nausea and Vomiting
Fetoscope - direct visualization of the fetus Mgt: Dry Crackers/toast

MATERNAL WELL-BEING Breast Tenderness

Mgt: Supportive Brassiere
Diagnostic Procedures:
Ultrasonography/Ultrasound (UTZ) Ptyalism (Excessive Salivation)
Mgt: Mouthwash, gum, hard candies
Purpose:
Diagnose pregnancy Ankle Edema + Varicosities
Confirms sex Mgt: Elevate, prevent prolonged standing
Confirms growth and abnormalities
Fetal maturity Backache
Mgt: Low-heeled shoes with grip
Types:
Transvaginal - early pregnancy Constipation
EMPTY BLADDER > CONSENT! Mgt: Increase OFI + Fiber
Transabdominal - late pregnancy
FULL BLADDER > 3-4 glasses water Heartburn
Mgt: Small frequent feedings (SFF)
Leopold’s Maneuver
Palpation > EMPTY BLADDER Hemorrhoids
Mgt: Warm sitz bath + witch hazel
1st Maneuver: Fundal Grip
To check for PRESENTATION Shortness of Breath
(Cephalic, Breech, Footling, Transverse/Acromnion, Facial) Mgt: Pillows, left side-lying position

2nd Maneuver: Umbilical Grip HEALTH TEACHINGS

FETAL BACK > Point of Maximum Impulse (PMI) > FHT Nutrition
MOST AUDIBLE Well-balanced nutrition (Protein, vitamins, and minerals)
Add Calories:
3rd Maneuver: Pawliks Grip Pregnant +300 cal
ENGAGEMENT Breastfeeding +500 cal
-3 FLOATING (above ischial spine) BOTH +500 cal
-2
-1 Smoking is Avoided = low birth weight
0 ENGAGED (at level of ischial spine) Alcohol is Prohibited = prevent fetal withdrawal syndrome
+1
+2 Sexual Activity
+3 CROWNING (below ischial spine) 1st - dec
2nd - inc (libido)
3rd - dec
RULE OF 6 - Culkins Sign (Uterus becomes firm and globular)
6 weeks before delivery = NO SEX Soft boggy > uterus is not contracted >
6 weeks after delivery = YES SEX massage/oxytocin
6 weeks at normal involution (uterus go back to Oxytocin is given but still bleeding = RETAINED
non-pregnant state) = YES SEX PLACENTAL FRAGMENTS > Re-Clean
Well contracted uterus, but still bleeding = perineal
Employment laceration
No hazardous waste
Types of Placenta
Travel Schultze: SHINY
Every 2-3hrs Duncan: DIRTY/MEATY > inc risk retained placenta
Rest periods: 6-15mins Mgt: check for completeness of cotyledons: 20-30

LABOR & DELIVERY 4. Recovery and Bonding

Components of Labor (4Ps) 1st 1-4 hours after delivery

Passenger: fetus Most critical stage
Passageway: pelvis, cervix, vagina
CPD - Cephalopelvic Disproportion Considerations:
Power:
Primary - Uterine contraction (STRONGER) Assess fundus (firm and globular)
Secondary - bearing down
Psyche: overall status of mother (holistically ready) Assess Lochia
Rubra: Red 1-3days
TYPES OF LABOR Serosa: Pink > Brown 4-9 days
False True Alba: White, 10th day-6 weeks (involution)
Irregular Regular/Predictable
Confined in Abdomen Lower Back > abdomen Bladder: EMPTY
No inc freq/dura/int Inc freq,dura, short int.
Relieved by ambulation not relieved by ambu Perineum: Monitor s/sx of infection
Absent cervical changes with cervical changes
Blood Pressure: prone to bleeding = SHOCK
STAGES OF LABOR Normal blood loss:
NSD: 500mL
1. Dilatation and Effacement CS: 800-1000mL

Phases: PERINEAL CARE

Latent: 0-3cm, mother able to communicate (health Ice Pack: prevent bleeding via vasoconstriction (1st 24hrs)
teaching)
Active: 4-7cm, inc freq,duration, interval. Mother begins to Sitz Bath: promotes healing via vasodilation (after 24hrs)
lose self control. Focus: PAIN
Transition: 8-10cm fully dilated/effaced Witch Hazel: astringent = dehydrates hemorrhoids
Transfer mother LR > DR
Use Cotton Underwear
2. Expulsion Stage (DFIRE ERE)
Increase Fiber + OFI: prevent constipation > lessen
Mechanism of Labor pressure > prevents wound evisceration
D - Descent of fetal head > maternal pelvis (engagement)
F - Flexion; preparation of fetal head to pass cervix SEX
I - Internal If VAGINAL BLEEDING STOPPED
R - Rotation; actual passage of fetal head to cervix Episiotomy has HEALED (6 weeks; after involution)
E - Extension; expulsion of fetal head

E - External
R - Rotation; expulsion of fetal shoulder (if absent = CPD)
E - Expulsion; passage of whole fetus

3. Placental Stage (3 Signs of Placental

Separation)

- Lengthening of Umbilical Cord

- Sudden Gush of Blood