OB (9-15-22) HISU
MENSTRUATION
⬇️ESTROGEN
…………………………
FSH-RH(Gh-Rh)
…………………………>
FSH
⬇️ESTROGEN
—thickening of
endometrium
PROLIFERATIVE PHASE
(6th-14th day)
⬇️PROGESTERONE
HYPOTHALAMUS
<—————————————>
APG
<—————————————>
SEQUENCE OF MENSTRUATION
MENSTRUAL— THINNEST ENDO
PROLIFIRATIVE —TICKEST ENDO
SECRETORY—OVULATION OCCURS
ISCHEMIC—PERIOD SOFT BY MENSTRUATION
NORMAL BLD LOSS
MENSTRUATION—30-50cc(80cc)
—1/4 cup
—4tbsp
—AVERAGE:5 DAYS
—50cc(1day)—-250cc(5days)
MEMORRHAGIA
—heavy menstruation
—COMPLICATION:ANEMIA
—MGT: DOUBLE DOSE IRON-during menstruation
SITE:
1)AMPULLA
—Wildest portion of fallopian tube
—site of FERTILIZATION
—common site of ECTOPIC PREGNANCY
LH
⬇️PROGESTERONE
—⬇️ bld flow
SECRETORY PHASE
(14th-25th Day)
28 DAY CYCLE
1)
2)
3)
4)
LH-RH
<…………………………
2)ISTHMUS
—site of BTL(immediate sterility)
3)UTERUS
—site of IMPLANTATION
SPERM +EGG==FERTILIZATION
\
/
MEOSIS—-divides into 2 haploid cells
SPERM—23chrom==22A + X or Y
EGG—23chrom==22A + x
ZYGOTE==46chrom==44 A + XY—MALE
==44A+ XX—FEMALE
120-150million /cc
SPERM+EGG==FERTILIZATION(ampulla)
ZYGOTE
BLASTOMERE
MORULA—implabtation (uterus)
BLASTOCYSTS—chorion
AMNION
—-amniotic sac
CVS(CHORIONIC VILLI SAMPLING)
—done early pregnancy(8-12weeks)
—Thin Catheter inserted intravaginal into the uterus
—PURPOSE:GENETIC SCREENING
—COMPLICATION:FETAL LIMB DEFECT(MISSING DIGITS)
POLYDACTYL(extra digit)
SYNDACTYL(webbing of fingers)
BP MONITORING OF PRENAL VISIT
⬇️BP(HPN)—1ST TRI=H-MOLE/MOLAR PREGNANCY
—2nd TRI-3rd TRI=PIH
PRE ECLAMPSIA
ECLAMPSIA
(-)seizure
(+)seizure
GOAL:PREVENT ONSET OF
GOAL:TO TREAT SEIZURE
SEIZURE
DOC: MgSO4
MgSO4 TOXICITY. (ANTIDOTE-CALCIUM GLUCONATE)
B—⬇️BP
U-⬇️urune output
R-⬇️RR
P-(-)patellar (-)knee jerk reflex
PIH
—start 5mons (20weeks)and may continue up to 48hrs post partum
P-PROTEINURIA
I-IDEMA(hands and face)
H-HPN
PLAN OF CARE
1)DIET
—⬆️PROTEIN—protein is excreted in urine
—⬇️SODIUM—to ⬇️water retention
—-⬇️RESTRICT FLUID INTAKE
2)(-)SEIZURE
—⬇️environmental stimuli
A)PRIVATE ROOM
B)DIM ROOM
C)NEAR THE FUNDUS
3)(+)SEIZURE
—-PRIORITY==SAFETY
4)(+)HPN
—DOC:ANTI-HPN(betablockers)
5)ONLY CURE—DELIVERY OF BABY VIA CS
⬇️RBC-due to physiologic anemia
-⬆️in 30-52% of plasma volume
-75% plasma (liquid portion of bld)
-25%-rbc
-dilute blood
MANIFESTATION
—IDA—>4F==FATIQUE,FAINTING +dyspnea/tachycardia,FORGETFULLNESS,FALLOR
MGT:
1) DIET—⬇️iron
2) IRON SUPPLEMENT
SIGN OF PREGNANCY
PRESUMPTIVE
B—BREAST
TENDERNESS
PROBABLE
H—HEGAR
SIGN(softening of
uterus)
POSITIVE
(+)FHB=DOPPLER(3mons)
=FETOSCOPE(4)
=STET(5)
A—AMENORRHEA
C—CHADWICK
SIGN(bluish
discoloration of vagina
G—GOODELS
SIGN(softening of
cervix)
(+)FHT—UTZ
U—URINARY FREQ.
(+)FETAL MOVEMENT
N—NAUSEA n
VOMITING
Q—QUICKENING
C—CHLOASMA(skin
pig.)
B—BRAXTON
HICKS(painless irreg
U.C)
B—
BALLOTMENT(passive
movement
URINALYSIS
—(+) PROTENURIA(indicates PIH)
—(+)ALBUMIN(indicates PIH)
—(+)GLUCOSURIA—indicate GDM(hpl)==MACROSOMIA
—SLIGHT GLUCOSURIA—NORMAL
—(+)HCG—(urine)—nausea vomit excreted sugar in the urine
—(+)PREGNANCY TEST—(hyperemesis gravidarum)excessive n/v==indicate HMOLE
BEST TIME FOR PREGNANCY TEST==2wks after the missed period
DISCOMFORTS
1NAUSEA AND VOMITTING(MORNING SICKNESS)—due to HCG
BEST ACTION:CRACKERS OR DRY TOAST IN AM
2)HEARTBURN(PYROSIS)
—due to GASTRIC REFLUX(⬆️hcl)due to ⬆️pressure of enlarging uterus
—BEST ACTION:SMALL FREQ.FEEDING
3)CONSTIPATION
—due to compression of the intestine by the enlarging uterus
—BEST ACTION:⬇️FIBER DIET
4)RISK FOR THROMBUS FORMATION
— due to venous stasis in the lower extremities due to compression of uterus
—BEST ACTION:ENCOURAGE AMBULATION EVERY 2HRS
5)LEG EDEMA(VARICOSITIES)
—due to backflow of bld to the heart
—due to compression of uterus
—BEST ACTION:LEG ELEVATION
6)SUPINE HYPOTENSION(DIZZINESS)
—due to compression of vena cava by the uterus
—BEST ACTION:LSL
7)URINARY FREQUENCY
—due to compression of the bladder by the enlarging uterus
—BEST GIVEN:KEGELS EXERCISE
8)LEG CRAMPS
—due to imbalance bet.calcium+phosphorus that causes ⬇️calcemia due to bone
development
—BEST ACTION:DORSIFLEXION
—PREVENT ⬆️calcium
SMOKING
ALCOHOL
PHYSIOLOGIC ANEMIA
PIH
HPN
MOTHER w/ CARDIAC PROB
==⬇️O2recieved by the baby
==MICROSOMIA
==SGA
==INTRAUTERINE GROWTH
RETARDATION
1ST SIGN OF SEIZURE==EPIGASTRIC PAIN
—due to ischemic—SGPT(lab result)
—ammonia in the brain—seizure
LABOR AND DELIVERY
—AFTER DELIVERY= normal=MOTHER CUDDLED THE BABY
STAGE1==START OF U.C — FULL CX. CONTRACTION
STAGE2==FULL CX.CONTRACTION—DELIVERY OF BABY
STAGE3==DELIVERY OF BABY—DELIVERY OF PLACENTA
STAGE4==PLACENTA—1-4HRS POST PARTIM
TRUE LABOR
—REGULAR U.C
—PAIN CONTROL BE RELIEVED BY WALKING
—PINKSHOW THAT PROGRESSES TO BLD SHOW
(PROGRESSIVE CX.DILATATION (most significant)
PHASE OF LABOR
L==0-3cm
A==4-7cm
T==8-10cm
==STAGE2.
]surrest sign of delivery
==CROWNING
==BULGING OF PERINIUM
FREQUENCY OF BP AND FHB MONITORING
DONE—IN BETWEEN CONTRACTION
L==(0-3cm)qHR
A==(4-7cm)q30mins
T==(8-9cm)q15mins
BREATHING TECHNIQUE
—improper breath technique
COMPLICATION:RESPIRATORY ALKALOSIS
—INSTRUCT:BREATH THRU PAPER BAG CUPPED HAND
L==CHEST BREATHING
A==ABD.BREATHING
T==PANT. BLOW
10cm ==PUSH DURUNG CONTRACTION
EFFECTS OF U.C
—increment==⬆️U.C⬇️FHB==due vaginal nerve stimulation—>parasympathetic—>⬇️HR
—acne -peak
—decrement-⬇️U.C
BACKPAIN DURUNG U.C(LABOR)
—INSTRUCT:SQUATTING—>facilitate fetal descend
LEOPOLDS MANUEVER
SIGNS OF PLACENTAL SEPARATION
G=GUSHING OF BLOOD
R=RISING OF THE FUNDUS
=ABD.BECOMES GLOBULAR
=CALKINS SIGN
L=LENGTHENING OF THE CORD