NCM107
SKL
I. INTRODUCTION
MENSTRUATION
What is MENSTRUATION?
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A menstrual cycle begins when you get your period
or menstruate.
This is when you shed the lining of your uterus.
This cycle is part of your reproductive system and
prepares your body for a possible pregnancy.
A typical cycle lasts between 24 and 38 days.
What are the four phases of the menstrual cycle?
What are the four phases of the menstrual cycle?
The rise and fall of your hormones trigger the steps in your
menstrual cycle. Your hormones cause the organs of your
reproductive tract to respond in certain ways. The specific
events that occur during your menstrual cycle are:
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The menses phase: This phase, which typically
lasts from day one to day five, is the time when the
lining of your uterus sheds through your vagina if
pregnancy hasn’t occurred. Most people bleed for
three to five days, but a period lasting only three days
to as many as seven days is usually not a cause for
worry.
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The follicular phase: This phase typically takes
place from days six to 14. During this time, the level
of the hormone estrogen rises, which causes the
lining of your uterus (the endometrium) to grow and
thicken. In addition, another hormone — folliclestimulating hormone (FSH) — causes follicles in
your ovaries to grow. During days 10 to 14, one of
the developing follicles will form a fully mature egg
(ovum).
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Ovulation: This phase occurs roughly at about day
14 in a 28-day menstrual cycle. A sudden increase in
another hormone — luteinizing hormone (LH) —
causes your ovary to release its egg. This event is
ovulation.
MENSTRUATION
The menstrual cycle is a term to describe the sequence of
events that occur in your body as it prepares for the possibility
of pregnancy each month. Your menstrual cycle is the time
from the first day of your menstrual period until the first day of
your next menstrual period. Every person’s cycle is slightly
different, but the process is the same.
How long is a normal menstrual cycle?
The average length of a menstrual cycle is 28 days. However,
a cycle can range in length from 21 days to about 35 days and
still be normal.
How many days between periods is normal?
The days between periods is your menstrual cycle length. The
average menstrual cycle lasts 28 days. However, cycles
lasting as little as 21 days or as long as 35 days can be normal.
How long does a normal period last?
Most people have their period (bleed) for between three and
seven days.
Is a three-day period normal?
A period is normal if it’s anywhere between three and seven
days. While on the shorter end of the range, some people
have a menstrual period for three days. This is OK.
PANAGLIMA, ALIYAH MAE C. BSN2-E
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Other signs you’re getting your period are:
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Mood changes.
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Trouble sleeping.
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Headache.
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Food cravings.
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Bloating.
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Breast tenderness.
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Acne
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The luteal phase: This phase lasts from about day
15 to day 28. Your egg leaves your ovary and
begins to travel through your fallopian tubes to your
uterus. The level of the hormone progesterone
rises to help prepare your uterine lining for
pregnancy. If the egg becomes fertilized by sperm
and attaches itself to your uterine wall
(implantation), you become pregnant. If pregnancy
doesn’t occur, estrogen and progesterone levels
drop and the thick lining of your uterus sheds during
your period.
How does your period change over time?
Your menstrual cycle can change from your teen years to your
40s or 50s. When you first get your period, it’s normal to have
longer cycles or a heavier period flow. It can take up to three
years for young people to have regular cycles after they begin
menstruating. A normal menstrual cycle is a cycle that:
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Occurs roughly every 21 to 35 days.
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Causes bleeding for between three and seven days.
Once you reach your 20s, your cycles become more
consistent and regular. Once your body begins transitioning to
menopause, your periods will change again and become more
irregular.
It’s also normal for your period to change during other life
events that affect your hormones, such as after childbirth or
when you’re lactating.
What is considered an irregular period?
Irregular menstruation describes anything that’s not a normal
menstrual period. Some examples of an irregular period are:
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Periods that occur less than 21 days or more than 35
days apart.
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Not having a period for three months (or 90 days).
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Menstrual flow that’s much heavier or lighter than
usual.
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Period bleeding that lasts longer than seven days.
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Periods that are accompanied by severe pain,
cramping, nausea or vomiting.
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Bleeding or spotting that happens between periods.
At what age does menstruation typically begin?
People start menstruating at the average age of 12. However,
you can begin menstruating as early as 8 years old or as late
as 16 years old. Generally, most people menstruate within a
few years of growing breasts and pubic hair.
People stop menstruating at menopause, which occurs at
about the age of 51. At menopause, you stop producing eggs
(stop ovulating). You’ve reached menopause when you
haven’t gotten a period in one year.
What are symptoms of getting your period?
Some people experience symptoms of menstruation and
others don’t. The intensity of these symptoms can also vary.
The most common symptom is cramps. The cramping you feel
in your pelvic area is your uterus contracting to release its
lining.
TERMS TO BE REMEMBER IN MENSTRUATION:
1. Amenorrhea The absence of first menstrual period by age
15; secondary amenorrhea refers to a stretch of at least three
months without menstruation, whether from pregnancy or from
a medical condition.
2. Dysmenorrhea Painful periods.
3.Menarche The technical term for the first time you
menstruate.
4. Menopause The time in life after you have not had a period
for at least one year. The average age of menopause in the
United States is 52, although the range is quite large. Women
who have their ovaries surgically removed instantly go
into menopause.
5. Menorrhagia A condition in which your periods are
abnormally heavy or prolonged. The loss of so much blood
can lead to anemia, or iron-deficiency, and so should be
discussed with a physician.
6. Premenstrual Syndrome (PMS) A common condition that
appears up to 10 days before your period and continues into
the first few days of bleeding. Symptoms can be physical
(headache, fatigue, bloating) or emotional (anxiety,
PANAGLIMA, ALIYAH MAE C. BSN2-E
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irritability, insomnia), and can range from relatively mild to
fairly severe.
7. Ovulation The release of an egg from an ovary. After
ovulation the egg is available to be fertilized by sperm to
produce a pregnancy if no birth control methods are used.
8. Metrorrhagia – is abnormal bleeding between regular
menstrual periods.
RESPONSIBLE PARENTHOOD
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Is simply defined as the “will” and ability of parents to
respect and do the needs and aspirations of the
family and children.
It is the ability of the parent to detect the need,
happiness and desire of the children and helping
them to become responsible and reasonable
children.
The Responsible parenthood and Reproductive
Health Act of 2012 (Republic Act No. 10354) informally
known as the Reproductive Health Law or RH Law, is
a law in the Philippines, which guarantees universal
access to Methods on contraception, fertility control,
sexual education and maternal care.”
What is the purpose of Responsible Parenthood and
Reproductive Health Act?
The Responsible Parenthood and Reproductive Health Act of
2012, known as the RH Law, is a groundbreaking law that
guarantees universal and free access to nearly all modern
contraceptives for all citizens, including impoverished
communities, at government health centers
What are the responsibilities of the parents?
Your duties and rights as a parent
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to protect your child from harm.
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to provide your child with food, clothing and a place
to live.
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to financially support your child.
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to provide safety, supervision and control.
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to provide medical care.
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to provide an education.
What responsible parenthood includes?
It is a shared responsibility of the husband and the wife to
determine and achieve the desired number, spacing, and
timing of their children according to their own family life
aspirations, taking into account psychological preparedness,
health status, socio-cultural, and economic concerns.
Definition: Responsible Parenthood is the spirituality of the
family. From the very beginning of marriage, the spouses
embrace a new heart which makes them a gift for each other.
What are the 4 pillars of Responsible Parenthood?
These principles are based on the four (4) pillars of
1. Responsible Parenthood,
2. Respect for Life,
3. Birth Spacing, and
4. Informed Choice.
1.Parental Role- to provide physical, material, and
continuous guidance to the children in order for them to
become responsible members of the family and society.
2. Emotional Adjustment- to be emotionally prepared and
adjusted to cope up with challenges in life.
3. Family Relationship- to perform each role and create a
harmonious relationship.
4. Knowledge in child rearing- educated parents are better
prepared to face the challenges or parenthood.
What are the responsibilities of the parents?
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to protect your child from harm.
PANAGLIMA, ALIYAH MAE C. BSN2-E
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NCM107
SKL
I. INTRODUCTION
COMPUTATION OF EDD, LMP, AOG
Age Of Gestation- refers to the length of time a fetus has
been developing inside the mother's uterus. It is calculated in
weeks and days, starting from the first day of the mother's last
menstrual period (LMP).
The EDC, also known as the estimated due date (EDD), is the
projected date when a pregnant woman is expected to give
birth. Accurately estimating the EDC helps healthcare
professionals monitor the progress of pregnancy and plan
appropriate care.
COMPUTATION OF LAST MENSTRUAL PERIOD,
EXPECTED DATE OF DELIVERY, AND AGE OF
GESTATION
Naegele's Rule
Naegele's Rule is a standard method for estimating the EDC
based on the mother's LMP.
Follow these steps:
1. Determine the first day of the LMP.
2. Add 7 days.
3. Subtract 3 months.
4. Add 1 year.
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18TH week
+ 22
AOG = 40 weeks
EX:
18
+ 24
42 weeks
FUNDAL HEIGHT
OBJECTIVES
The objective of this review was to assess the effects of
routine use of symphysis‐fundal height measurements (tape
measurement of the distance from the pubic symphysis to the
uterine fundus) during antenatal care on pregnancy outcome.
What is fundal height?
Fundal height is a vertical (up and down) measurement of your
belly. It’s the distance from the pubic bone to the top of your
womb (uterus).
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The distance (in centimeters) from the portion of the
uterus above the insertion of the fallopian tubes to
the symphysis pubis. The symphysis pubis is a
joint of cartilage that sits in between the pubic bones
Antepartum: The standard fundal height at 20 weeks
gestation is at the maternal umbilicus. Thereafter,
measurement from
the pubic symphysis to the top of the fundus (in centimeters)
should equal the number of weeks of gestation.
Fundal
height measurement
is
an
important
tool in providing quality prenatal care. Defined as the distance
between the top of the pubic bone and the top of the uterus, it
is a measure of uterine growth to monitor baby's
development, estimate gestational age, and confirm due date.
McDonald's Rule
McDonald's Rule estimates AOG using fundal height (the
distance between the pubic bone and the top of the uterus).
Here's the steps:
1. Measure fundal height in centimeters (cm).
2. Divide the fundal height by 4.
Example: If the fundal height is 24 cm:
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24 cm ÷ 4 = 6 (AOG in months)
AOG- to obtain AOG, count the weeks from LMP up to the
date of clinic visit
1.LMP= APRIL 3 (SUBTRACT 30 -3 = 27)
APRIL 27
MAY 31
JUNE 30
JULY 18
2. DIVIDE 106 with 7 DAYS =
106
AOG= 15 weeks & 1/7
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If the woman cannot remember her LMP, ask when
she 1st felt the fetus move (18th week)
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To get EDC for primigravida, add 22 weeks to the
date of quickening
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To get EDC for multigravida, add 24 weeks to the
date of quickening
PANAGLIMA, ALIYAH MAE C. BSN2-E
A fundal height that measures smaller or larger than
expected — or increases more or less quickly than expected
— could indicate:
➢ Slow fetal growth (intrauterine growth restriction)
➢ A multiple pregnancy
➢ A significantly larger than average baby (fetal
macrosomia)
➢ Too little amniotic fluid (oligohydramnios)
➢ Too much amniotic fluid (polyhydramnios)
Purpose of Fundal Height
Fundal height is used to assess fetal growth and
development. Beginning in the second trimester, fundal height
should generally match the number of weeks of your
pregnancy. For example, if you were 26 weeks pregnant, your
physician would expect your fundal height to measure
approximately 26 centimeters.
To measure the fundal height, which is measured
in centimeters, you will take a tape measure and extend it
from the symphysis pubis to the fundus of the uterus.
To measure:
Lay the patient down on their back.
NOTE: monitor the mother for supine hypotension because
she is at risk for this, especially if she is late into her
pregnancy. This occurs when the baby and other structures in
the uterus compress the great vessels of the heart in the
supine position (back position). This leads to the blood
pressure to drop. Therefore, monitor the patient for reports of
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place her on the left side. This should help alleviate signs and
symptoms.
Use a measuring tape and start at the symphysis pubis
and extend it up to the top of the uterus.
When interpreting the measurement you want the gestational
age of the baby to match the location of the fundus or its
measurement. After 20-36 weeks the measurement of the
fundus from the symphysis pubis will actually start to match
the fundal height measurement reading. plus or minus 2 cm.
feeling dizzy, lightheaded, nauseous etc. If this occurs
immediately
Important key points to remember about fundal height
measurement:
Fundal Height during Pregnancy
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The fundus will be found above the symphysis
pubis at 12 weeks.
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The fundus will be found at the belly
button (umbilicus) at 20 weeks.
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If the fundus is found in the midway point between
the symphysis pubis and belly button the patient is
about 16 weeks. So, if you have a test question that
says: the fundus is found within the symphysis pubis
and belly button, how far along is the patient?
Answer: About 12-20 weeks
*Finger breaths under the umbilicus can suggest the
gestational age quickly. Each finger is assumed to be a
cm in size, so 20 weeks (minus finger breadths below the
umbilicus) gives an assumed gestational age quickly.
FETAL HEART TONE
Fetal heart rate monitoring measures the heart rate and
rhythm of your baby (fetus). This lets your healthcare provider
see how your baby is doing.
Your healthcare provider may do fetal heart monitoring during
late pregnancy and labor. The average fetal heart rate is
between 110 and 160 beats per minute. It can vary by 5 to
25 beats per minute. The fetal heart rate may change as your
baby responds to conditions in your uterus. An abnormal fetal
heart rate may mean that your baby is not getting enough
oxygen or that there are other problems.
As mentioned above, after about 20-36 weeks the fundal
height measurement should almost match the gestational
age give or take 2 cm. Example: If your patient is 26 weeks,
what do you expect the fundal height measurement to be?
Anywhere to 24 to 28 cm
The fundus at 36 weeks should be at the xiphoid process.
Around 37-40 weeks (around delivery) the fundal height
actually decreases and slightly moves down about 4 cm
from the xiphoid process as the baby drops into the pelvis
for birth.
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Pubic spymphisis: 12 weeks gestation
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Umbilicus: 20 weeks gestation
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Xiphoid process of sternum: 36 weeks
gestation
After 36 weeks gestation the uterus regresses to a fundal eight
between 32-36 cm.
PANAGLIMA, ALIYAH MAE C. BSN2-E
External fetal heart monitoring
This method uses a device to listen to and record your baby’s
heartbeat through your belly (abdomen). One type of monitor
is a Doppler ultrasound device. It’s often used during prenatal
visits to count the baby’s heart rate. It may also be used to
check the fetal heart rate during labor.
STEPS ON HOW TO GET THE FHT
1. Depending on the type of procedure, you may be asked to
undress from the waist down. Or you may need to remove all
of your clothes and wear a hospital gown.
2. You will lie on your back on an exam table.
3. The healthcare provider will put a clear gel on your
abdomen.
4. The provider will press the transducer against your skin.
The provider will move it around until he or she finds the fetal
heartbeat. 5. You will be able to hear the sound of the fetal
heart rate with Doppler or an electronic monitor.
6. For continuous electronic monitoring, the provider will
connect the transducer to the monitor with a cable. A wide
elastic belt will be put around you to hold the transducer in
place.
7. The provider will record the fetal heart rate. With continuous
monitoring, the fetal heart pattern will be displayed on a
computer screen and printed on paper.
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NCM107
SKL
I. INTRODUCTION
LEOPOLDS MANEUVER
The Leopolds' Maneuver is a common and systematic way
to determine the position of a fetus inside the woman's uterus.
The maneuver is preferably performed after 24 weeks
gestation when fetal outline can be already palpated. The
Actual position can only be determined by ultrasound
performed by a competent technician or professional.
They are also used to estimate term fetal weight. The
maneuvers consist of four distinct actions, each helping to
determine the position of the fetus.
This method of abdominal palpation is of low cost, easy to
perform, and non-invasive. It is used to determine the position,
presentation, and engagement of the fetus in utero.
Leopold’s Maneuver is preferably performed after 24 weeks
gestation when fetal outline can be already palpated.
Preparation:
1. Instruct woman to empty her bladder first.
2. Place woman in dorsal recumbent position, supine with
knees flexed to relax abdominal muscles. Place a small pillow
under the head for comfort.
3. Drape properly to maintain privacy.
4. Explain procedure to the patient.
5. Warms hands by rubbing together. (Cold hands can
stimulate uterine contractions).
6. Use the palm for palpation not the fingers.
Fetal presentation refers to the fetal anatomic part
proceeding first into the pelvic inlet. When the fetal head is
approaching the pelvic inlet, it is referred to as a cephalic
presentation. The commonest presentation is the vertex of
the fetal head.
Clinical Significance
Clinical examination was relatively sensitive in multiparous
women and those with lower body mass indices. The
specificity of clinical examination increased significantly as
gestational age increased, and body mass index decreased.
When abdominal palpation was evaluated as a screening tool
for identifying malpresentation, it was found that false-positive
diagnoses were a more frequent error because of the low
prevalence of malpresentation in low-risk populations.
Leopold maneuvers have been reported to be difficult in
obese pregnant women and pregnancies complicated with
polyhydramnios, fibroids, or anterior placental location. In
clinical practice, the use of repeated procedure by a second
examiner, pelvic examination, and rescheduling a return visit
with a sequential abdominal examination can serve to improve
the accuracy of abdominal palpation findings.
Normally, the position of a fetus is facing rearward (toward the
woman’s back) with the face and body angled to one side and
the neck flexed, and presentation is head first. An abnormal
position is facing forward, and abnormal presentations
include face, brow, breech, and shoulder.
Fetal position : a position (as of a sleeping person) in which
the body lies curled up on one side with the arms and legs
drawn up and the head bowed forward and which is assumed
in some forms of psychic regression
PANAGLIMA, ALIYAH MAE C. BSN2-E
Leopold maneuvers can help mothers to perceive and
visualize fetuses. Thus abdominal palpations can develop the
maternal-fetal relationship, which plays an important role in a
child's psychological, cognitive, and social development.
Enhancing Healthcare Team Outcomes
All healthcare providers should be competent with the
methods to perform abdominal palpation of a gravid uterus
and the significance of the findings. The findings observed
should be documented and can be used to guide further
obstetric management. Identifying pregnancies complicated
by malpresentation and referral to appropriate facilities may
lead to improved outcomes for both neonate and mother.
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Offering an external cephalic version (ECV) for breech
presentation can contribute to the safe lowering of the primary
cesarean delivery rate. Training for existing or new staff who
are moving to midwifery-obstetric care is necessary as
experienced clinicians can be effective in using abdominal
palpation as a screening tool for fetal malpresentation,
particularly in settings where ultrasound may not be readily
available
PANAGLIMA, ALIYAH MAE C. BSN2-E
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