FRAMEWORK FOR MATERNAL AND CHILD HEALTH
NURSING
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Maternal and child health nursing can be
visualized within a framework in which nurses,
using the nursing process, nursing theory, and
evidence-based practice, care for families
during childbearing and childrearing years
through 4 phases of health care
○ Health promotion -educate to be
aware of good health
○ Health maintenance -intervene to
maintain health
○ Health restoration - prompt diagnosis
and treatment of illness
○ Health rehabilitation - prevent
further complications: bringing back an
optional state of wellness; to accept
death
GOALS AND PHILOSOPHIES OF MATERNAL AND
CHILD HEALTH NURSING
2. Maternal and child health nursing is community
centered
3. Maternal and child health nursing is
research-oriented
4. Both nursing theory and evidence-based
practice provide a foundation for nursing care
5. A maternal and child health nurse serves as an
advocate to protect the rights of all family
members, including the fetus
6. Maternal and child health nursing includes a
high degree of independent nursing functions
7. Promoting health is an important nursing role
8. Pregnancy or childhood illness can be stressful
and can alter family life in both subtle and
extensive ways
9. personal, cultural, and religious attitudes and
beliefs influence the meaning of illness and its
impact on the family
10. Maternal and child health nursing is a
challenging role for a nurse and is a major
factor in promoting high-level wellness in
families
MATERNAL AND CHILD HEALTH GOALS AND
STANDARDS
GOALS
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Primary goal of maternal and child health
nursing care can be stated simply as the
promotion and maintenance of optimal family
health to ensure cycles of optimal childbearing
and childrearing.
Range of practice includes
○ Pre conceptual health care
○ Care of women during three trimesters
of pregnancy and the puerperium (the
six weeks after childbirth, sometimes
termed
the fourth trimester of
pregnancy)
○ Care of children during the prenatal
period (6 weeks before conception to 6
weeks after birth)
○ Care of children from birth through
adolescence
○ Care in settings as varied as the birthing
room, the pediatric intensive care unit,
and the home
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PHILOSOPHIES
1. Maternal and child health nursing is family
centered
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Standard I: Quality of Care. The nurse
systematically evaluates the quality and
effectiveness of nursing practice
Standard II: Performance Appraisal. The
nurse evaluates his/her own nursing practice in
relation to professional practice standards and
relevant statutes and regulations.
Standard III: Education. The nurse acquires
and maintains current knowledge in nursing
practice.
Standard
IV:
Collegiality. The nurse
contributes to the professional development of
peers, colleagues, and others.
Standard V: Ethics. The nurse’s decisions and
actions on behalf of patients are determined in
an ethical manner.
Standard VI: Collaboration. The nurse
collaborates with the patient, significant others,
and health care providers in providing patient
care.
Standard VII: Research. The nurse uses
research findings in practice.
Standard VIII: Resource Utilization. The
nurse considers factors related to safety,
effectiveness, and cost in planning and
delivering patient care
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Standard IX: Practice Environment. The nurse
contributes to the environment of care delivery
within the practice settings.
Standard X: Accountability. The nurse is
professionally and legally accountable for
his/her practice. The professional registered
nurse may delegate to and supervise qualified
personnel who provide patient care.
THEORIES RELATED TO MATERNAL AND CHILD
NURSING
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Patricia Benner
○ Nursing is a caring relationship. Nures
grow from novice to expert as they
practice in clinical settings
Dorothy Johnson
○ A person comprises subsystems that
must remain in balance for optimal
functioning. Any actual or potential
threat to this system balance is a
nursing concern
Imogene King
○ Nursing is a process of action, reaction,
interaction, and transaction: needs are
identified based on the client’s social
system, perceptions, and health: the
role of the nurse us to help the client
achieve goal attainment.
Madeleine Leininger
○ The essence of nursing is care. To
provide transcultural care, the nurse
focuses on the study and analysis of
different cultures with respect to caring
behavior
Florence Nightingale
○ The role of the nurse is viewed as
changing or structuring elements of the
environment
such
as
ventilation,
temperature, odor, noise, and light to
put the client into best opportunity for
recovery
Betty Neuman
○ A person is an open system that
interacts with the environment: nursing
is aimed at reducing stressors through
primary,
secondary,
and
tertiary
prevention
Dorothea Orem
○ The focus of nursing is on the individual;
clients are assessed in terms of ability to
complete self-care. The care given may
be
wholly
compensatory
(client
participates in care), or supportive
education (client performs own care).
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Ida Jean Orlando
○ The focus of the nurse is interaction
with the client; the effectiveness of care
depends on the client’s behavior and the
nurse’s reaction to that behavior. The
client should define his or her own
needs.
Rosemarie Rizzo Parse
○ Nursing is a human science. Health is a
lived experience. Man-living-health as a
single unit guides practice
Hildegard Peplau
○ The promotion of health is viewed as
the forward movement of personality;
this is accomplished through an
interpersonal process that includes
orientation, identification, exploitation,
and resolution
Martha Rogers
○ The purpose of nursing is to move the
client toward optimal health: the nurse
should view the client as a whole and
constantly changing and help people to
interact in the best way possible with
the environment
Sister Callista Roy
○ The role of the nurse is to aid clients to
adapt to the change caused by illness;
levels of adaption depend on the degree
of environmental change and state of
coping ability; full adaption includes
physiologic interdependence
ROLES AND RESPONSIBILITIES OF A MATERNAL
CHILD NURSE
1.
2.
3.
4.
5.
6.
7.
Clinical nurse specialist
Case manager
Women’s health nurse practitioner
Family nurse practitioner
Neonatal nurse practitioner
Pediatric nurse practitioner
Nurse-midwife
THE 17 SUSTAINABLE DEVELOPMENT GOALS (SDGs)
TO TRANSFORM OUR WORLD
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GOAL 1: No poverty
GOAL 2: Zero Hunger
GOAL 3: Good health and well-being
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GOAL 4: Quality education
GOAL 5: Gender equality
GOAL 6: Clean water and sanitation
GOAL 7: Affordable and clean energy
GOAL 8: Decent work and economic growth
GOAL 9: Industry, innovation, and infrastructure
GOAL 10: Reduced inequality
GOAL 11: Sustainable cities and communities
GOAL 12: Responsible consumption and
production
GOAL 13: Climate action
GOAL 14: Life below water
GOAL 15: Life on land
GOAL 16: Peace and justice strong institutions
GOAL 17: Partnerships to achieve the goal
PROCESS OF HUMAN REPRODUCTION
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MEIOSIS
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REPRODUCTIVE AND SEXUAL HEALTH
CONCEPT OF UNITIVE AND PROCREATIVE HEALTH
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Unitive and Procreative Health
○ Unitive - a specific type of physical
union, the sexual union of a man and
woman in natural intercourse. This type
of sexual act is in harmony with and
ordered toward procreation
○ Procreation
- focuses on the
conceiving and bearing of offspring
○ Procreative health - the moral
obligation of parents to have the
healthiest children through all-natural
and artificial means available
Practices and behaviors surrounding human
reproduction vary widely across cultures, but in
every case it involves sperm, an ovum, a uterus
and a baby
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Mitosis
○ Identical cell production
○ Can repair, grow and replace
Meosis
○ Gametes = reproductive cells
○ Sperm and egg cell
Diploid cell
○ Parent cell
Zygote
○ Fertilized cell
Sperm cell and Egg cells
○ 23 chromosomes which in turn they
have 46 pairs of chromosomes
PRINCIPLES OF PROCREATION
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Sex is a search for sensual pleasure and
satisfaction releasing physical and psychic
tensions
Sex is a search for the completion of the human
person through an intimate personal union of
love expressed by the bodily union for the
achievement of a more complete humanity
Sex is a social necessity for procreation of
children and their education in the family is so
as to expand the human community and
guarantee its future beyond death
Sex is a symbolic (sacramental) mystery,
somehow revealing the cosmic order “in short,
this Christian principle is all about pleasure,
love, reproduction, and the sacramental
meaning of sex
Note: every chromosome has a like pair, if the 23rd
pair is both XX=female and when it is XY=male
and chemicals
drugs
MECHANISM OF HEREDITY
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When a sperm cell penetrates the ovum;s
barrier, its 23 chromosomes fuse with the
ovum’s 23 chromosomes, forming a zygote
- preganancy category
COMMON TEST FOR DETERMINATION OF GENETIC
ABNORMALITIES
GOALS
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INHERITANCE
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Genotype
○ Complete set of inherited traits
○ Set of genes - basic unit of heredity
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Phenotype
○ How these traits are expressed e.g. blue
eyes
○ Observable characteristics
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Enables individuals or couples to make informed
reproductive decisions
Provides psychological support for decision
making
Provides clients with information about the
defect in question
Cmmunicationss to clients the risk for
transmitting the defect in question to future
children
GOALS
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Karyotyping - a visual display of
individual’s actual chromosome pattern
NORMAL
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Homozygous
○ Same alleles
Heterozygous
○ Different versions of the trait
RISK FACTORS FOR GENETIC DISORDER
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Age
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Risks increases with age - wear and tear
theory
Race/Ethnic Background
○ Certain disorders occur more frequently
in some ethnic groups compared to
others - incest
Family history of disease
○ Including those who hae died as part of
the family -undiagnosed chromosomal
disease or non compatible of life babies
OB History of pregnancy issues
○ like exposure to teratogens such as
radiation, certain drugs viruses toxins
ABNORMAL
the
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Heterozygote screening
○ Is directed at detecting clinically normal
carriers of a disease- causing mutant
gene particularly in people of ethnic
groups with high frequency of the
mutant gene under investigation
Maternal
serum
alpha-fetoprotein
(MSAFO)
○ Screen is done when an open neural
tube is suspected.
○ Alpha-fetoprotein - glycoprotein = fetal
liver, detectable in the maternal blood
during 13-32 weeks of pregnancy ( the
safest is 15 weeks)
○ If glycoprotein levels go beyond
10ng/ml -15ng/ml the fetus will be
suspected of neural tube disorder
○ If
glycoprotein
levels
are
low
-chromosomal disorder such as trisomy
21 (down syndrome)
Triple screening
○ Analysis of 3 indicators from MSAFP,
ESTRIOL,
and
Human
Chorionic
Gonadotropin
○ Estriol - a type of estrogen
○ HCG - a hormone produced by the
placenta
DIAGNOSTIC TEST
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Chorionic villi sampling - retrieval of
chorionic villi or chromosomal analysis. Done
in the 5th week of pregnancy (earliest), but
mostly done at the 8th to 10th week. The
results of this analysis are extremely accurate
but it cannot detect all inherited diseases
Amniocentesis - the withdrawal of a sample
of amniotic fluid (2 to 5ml) transabdominally for
genetic analysis. It is usually done with
ultrasound visualization between 14 and 16
weeks
It is also used to analyze skin cells,
alpha-fetoprotein, or acetylcholinesterase. It carries
only a 0.5% risk of spontaneous abortion
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Sonography (Ultrasound) - is a diagnostic
tool that is used to examine structural disorders
of the internal organs, spine, and limbs. It uses
sound waves to create a “picture”
○ Transabdominal
■ Done through your abdomen
■ Lie on your back on an exam
table
■ Technician puts a little bit of gel
on the transducer. The gel helps
the transducer move more
smoothly and prevents air from
getting between the device and
your skin
■ Congenital anomaly scan (CAS)
done through transabdominal
ultrasound, this is done for a
more in-depth scan
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Transvaginal
■ Also called an endovaginal
ultrasound, is a type of pelvic
ultrasound used to examine
female reproductive organs
■ Including the uterus, fallopian
tubes, ovaries, cervix, and
vagina.
■ Transvaginal means “ through
the vagina” this is an internal
examination
■ The very first ultrasound for the
first trimester is recommended
by doctors due to the fetus being
very small and difficult to get a
clear
image
using
the
transabdominal ultrasound
may enter maternal circulation
after the procedure as a result of
oozing at the puncture site
TRANSVAGINAL ULTRASOUND
PERCUTANEOUS UMBILICAL BLOOD SAMPLING
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Fetoscopy
■ Involves the insertion into the
mother’s uterus of a fiberoptic
through a small incision in her
abdomen
■ It is used to inspect for fetal
anomalies
or
confirm
an
ultrasound finding, it can also be
used to remove fetal skin cells
for DNA analysis and used to
perform corrective surgery for
congenital anomalies
Genetic Disorders
Chromosomal Inheritance Disorders
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Chromosomal Inheritance Disorders
○ Autosomal Dominant Disorder (1 gene
defective to cause the desease)
■ Dwarfism
FETOSCOPY
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Percutaneous Umbilical Blood Sampling
■ The removal of blood from the
umbilical vein. Blood studies
include karyotyping, complete
blood
count (CBC), direct
Coomb’s test, and measurement
of blood gases
■ It uses a technique similar to
amniocentesis to obtain the
blood sample
■ An Rh-negative mother should
be given RhoGAM because blood
Autosomal Recessive Disorder (atleast 2
defective genes to cause the disease
■ Cystic fibrosis
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X-Linked Dominant Disorder
■ Sickle-cell disease
Autosoma Recessivel Disorder (ARD)
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Only 1,500 identified ARDs’
Enzymatic Problems (Internal problems such as
organ issues, not visible on the outside)
Disease will only occur if there is 2 defective
genes
Chromosomal Abnormality Disorders
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X-Linked Recessive Disorder
■ Hemophilia
Numeric Abnormality
○ Klinefelter Syndrome - a disorder
where men are born with an extra X
(XXY) chromosome i.e. males with this
disorder will have female characteristics
such as ( enlarged breast, reduced body
hair, and reduced muscle mass)
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Multifactorial Inheritance
■ Cleft lip palate
Note: Most Asians are Rh+, it’s very seldom for
Asians to be RH○
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Autosomal Dominant Disorder (ADD)
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1 defective gene (Dominant) = disorder
More than 3000 identified autosomal disorder
(e.g. dwarfism (very common) but only a few
can be seen, because if a baby has 2 or more
defective genes, meaning the baby is not
compatible of life (DD =X life)
Structural Defects ( such undeveloped brain,
heart, etc.)
Two types
○ Homozygous - 2 defective genes
○ Heterozygous - 1 healthy gene + 1
dominant defective gene
Turner Syndrome - a disorder that
affects females, where one of the X
chromosomes is meaning i.e from the
normal (XX) it has only one (X). this
disorder cause a variety of medical and
developmental problems such as short
height, abnormal physic, undevelop
ovaries and heart defect (Coarctation of
aorta)
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Structural Disorder
○ Translocation - a change in location. It
often refers to genetics, when part of a
chromosome is transferred to another
chromosome.
Chromosomes
are
structures that carry genes, our units of
heredity. When this type of translocation
occurs, it can cause flaws in
chromosomes
ANATOMY AND PHYSIOLOGY OF THE MALE
REPRODUCTIVE SYSTEM
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Penis
○ Is the male organ of copulation
Nursing Process
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Assessment
○ Health History - should focus on
determining the couple’s risk for having
a baby with an inherited disorder:
■ Genetic history
■ Ethnic background
■ General medical history
■ Mother’s age
○ Laboratory and Diagnostic studies
Diagnosis
○ Knowledge deficit
○ Decisional Conflict
○ Anticipatory Grieving
Planning and outcome Identification
○ The couple will receive education about
genetic problems that may affect their
children including risks for having a child
with a problem and treatment options
for the particular problem
○ The couple will receive emotional
support
throughout
the
genetic
screening test
Evaluation
○ The couple states that they received
adequate information about patterns of
inheritance, their risk in having a child
with an inherited disorder, information
concerning the disorder itself, and
information about treatments and
available resources
○ The couple demonstrates positive coping
skills and states that they are able to
make a reasonable choice about the
outcome of genetic testing and
counseling
EXTERNAL STRUCTURES
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The cylindrical shaft consists of the following:
○ Corpora cavernosa
■ Two lateral column of erectile
tissue (corpora cavernosa)
○ Corpus spongiosum
■ A column of erectile tissue on
the underside of the penis
(corpus
spongiosum)
that
encases the urethra
ERECT: TRANSVERSE VIEW
FLACCID: LATERAL VIEW
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FLACCID: TRANSVERSE VIEW
ERECT: LATERAL VIEW
The cylindrical shaft consists of the following:
○ Glans penis
■ Cone-shaped expansion of the
corpus spongiosum that is highly
sensitive to sexual stumulus
○ Prepuce or foreskin
■ A skin flap that cover the glans
penis in uncercumcised men
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Scrotum
○ A pouch hanging below the penis that
contains the testes. internally, the
medical septum divides the scrotum into
two sacs each of which contains a
testicle
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Ejaculatory duct
○ Is the canal formed by the union of the
vas deferens and the excretory duct of
the seminal vesicle. It enters the urethra
at the prostate gland
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Urethra
○ Is the passageway for urine and semen
that extends from the bladder to the
urethral meatus
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Seminal vesicles
○ Located behind the bladder and in front
of the rectum, deliver secretions to the
urethra through the ejaculatory duct. It
INTERNAL STRUCTURES
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Testes
○ Are two solid ovoid organs 4 to 5cm
long, divided into lobes containing
seminiferous tubules. The two functions
of the testes are the production of
testosterone
and
spermatogenesis
(production of sperm)
Epididymis
○ Is a tubular sac located next to each
testis that is a reservoir for sperm
storage and maturation. It can extend
10-20ft; 2-4 weeks of sperm maturation
Vas deferens
○ Is a duct extending from the epididymis
to the ejaculatory duct which provides a
passageway for sperm. It extends to 16
inches long
○ This is also where “vasectomy” is done,
an elective surgical procedure for male
sterilization or permanent contraception.
During the procedure, the male vasa
deferentia are cut and tied or sealed so
as to prevent sperm from entering the
urethra and thereby prevent fertilization
of a female through sexual intercourse.
is 2 inches: and secretes alkaline fluid
and fructose or known as “semen”
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Prostate gland
○ Surround the base of the urethra and
the ejaculatory duct, secrets a clear fluid
with a slightly acid pH rich in acid
phosphatase, citric acid, zinc, and
proteolytic enzymes. It is shaped like a
walnut.
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Cowper’s gland
○ Also termed as Bulbourethal gland; 2
pea-sized structure that lies at the base
of the prostate gland and either side of
the membranous urethra. They produce
a clear alkaline mucinous substance that
lubricates the urethra and coats its
surface
MALE BREAST
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Male mammary tissue
○ Remains dormant throughout life, but
the breasts are a site of sexual
excitation and arousal
○ Although rare (accounting for less than
1% of all breast cancers in the United
States), male breast cancer occur when
frequently enough to warrant routine
inspection of the breasts for dimpling,
discharge or nipple inversion
SEMEN
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A thick, whitish fluid ejaculated by the man
during orgasm
Contains
spermatozoa
(sperm)
and
fructose-rich nutrients
During
ejaculation,
semen
receives
contributions of fluid from the seminal vesicles
and the prostate gland
Alkaline (average pH 7.5) -because when the
semen will become acidic, this will kill the
sperm cells due to the vagina being acidic
Average amount released during ejaculation is
2.5 to 3.5 ml
NEUROHORMONAL CONTROL OF THE MALE
REPRODUCTIVE SYSTEM
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Hypothalamus
○ Stimulates the pituitary gland to
produce
Follicle
Stimulation
Hormone (FSH) and Luteinizing
Hormone (LH)
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FSH stimulates germ cells within the
testes to manufacture sperm -–to
stimulate for production and maturation
of egg cells (female repro)
LH - stimulates the production of
testosterone in the testes. Although LH
stimulates the Leydig cells to produce
testosterone
from
cholesterol,
testosterone inhibits the secretion of LH
by the anterior pituitary gland
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Testosterone
○ One of the several androgens (and most
potent) produced in the testes, is
responsible for the development of
secondary sex characteristics at puberty
○ Production occurs in the interstitial
Leydig cells in the seminiferous tubules.
Leydig cells are abundant in the
newborn and pubescent boy, and
testosterone is abundant during these
periods
○ Testosterone production slows after 40
years of age: by 80 years of age,
production is only about one-fifth of
peak level
Note: Leydig cells - are the primary source of
testosterone or androgens in males. This
physiology allows them to play a crucial role in
many vital physiological processes in males,
including sperm production or spermatogenesis,
controlling
sexual
development,
and
maintaining secondary sexual characteristics
and behaviors.
Spermatogenesis
○ “Sperm production”
■ Occurs continually after puberty,
providing large numbers of
sperm for unlimited ejaculations
during the mature life span.
○ Spermatozoa - are released from the
epithelial wall of the seminiferous
tubules. Meiosis occurs during the
process,
and
the
number
of
chromosomes in each cell is reduced by
one-half (Haploid number)
○ Spermatogenesis is a heat-sensitive
process; the 2’ to 3’ F difference
between
scrotal
and
abdominal
temperatures allows spermatogenesis to
proceed in the cooler environment
○ The entire period of spermatogenesis
from terminal cell to mature sperm,
takes about 75 days
SPERM PRODUCTION DIAGRAM
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Semen
○ 60% - Prostate gland
○ 30% - Seminal vesicle
○ 5% - Epididymis
○ 5% - Bulbourethral gland
○ 3-5cc (1tsp) per ejaculation
SPERM PATHWAY
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Spermatozoa
○ Produced by the testicles
○ 40-80 million per cc of semen
○ 300- 500 million per ejaculation
○ Mature after 64 days
QUIZ 2
1. Framework, Goals, & Standards of maternal &
child health nursing –all the following is true
except
a. MCN Uses evidence-based practice
solely
2. The range of practice in MCN starts with the
care of women before and during the three
trimesters of pregnancy and ends after the birth
of a child
a. False
3. In this phase of health care, the nurse should
intervene practice of the patient to maintain
health
a. Maintenance
4. The primary goal of MCN is the promotion and
maintenance of optimal family health to ensure
a. True
5. Which of the following is not included in the
roles and responsibilities of a maternal and
child health nurse
a. Medical doctor
6. A patient is experiencing cough and cold for 5
days already. When a nurse encourages a
patient to submit herself for a medical check-up
for prompt diagnosis of an illness, the following
phase of health care applies
a. Health restoration
7. Among all the 17 SDGs, MCN belongs to what
goal?
a. Good health and well-being
Evaluate the quality of
nursing practice
Quality care
Evaluate one’s own
practice
Performance Appraisal
Acquires and maintains
knowledge in practice
Eduction
Work effectively with
patient watchers and
other healthcare
providers
Collaboration
use s research finding in
practice
Research
Consider factors and cost
in delivering patient care
Resource Utilization
Nurses may delegate and
supervise qualified
personnel
Accountability
QUIZ 3
1. This term refers to the substance which
can cause harm/ deformity/ abnormal
development of the growing fetus if the
mother is exposed during pregnancy
a. Teratogens
2. This refers to the visual display of the
individual’s actual chromosome pattern
wherein a sample is taken, stained, and
placed under a microscope
a. Karyotyping
3. A chorionic villi sampling is the retrieval
of chronic villi for chromosomal analysis.
It is mostly/ usually done at how many
wells of pregnancy
a. 8 to 10 weeks
4. This term refers to the different versions
of a trait
a. Heterozygous
5. As the age of the mother or father
increases the risk of getting a child with
genetic abnormality decreases
a. False
6. The following are necessary for human
reproduction except
a. Penis
7. This term refers to the process of cell
growth, repair, and replacement of
worn-out ones
a. Mitosis
8. A child has red hairt like her mother and
blue eyes like her father. This is due to
the complete set of inherited traits or
set genes which are called?
a. Genotype
9. This carries only a 0.5% risk of
spontaneous abortion
a. Amniocentesis
10. The following are products of meiosis
except for
a. Skin cells
11. This focuses on the conceiving and
bearing of offspring
a. Procreation
12. Humans get 2 copies of every gene from
parents and the 2 copies/ alleles should
always be identical
a. False
13. Sex is a social necessity for the
procreation of children to expand the
human community
a. True
Dwarfism
Autosomal dominant
disorder
Cystic fibrosis
Autosomal recessive
disorder
Sickle-cell disease
2. All the following are external structures except
a. Testicle
3. Testosterone production slows after the age of
40
a. True
4. The semen has an acidic pH
a. False
5. This is a cone-shaped expansion of the corpus
spongiosum that is highly sensitive to sexual
stimulus
a. Glans penis
6. This refers to the process of producing sperm
a. Spermatogenesis
7. A sperm cell is a thick, whitish fluid ejaculated
by the man during orgasm
a. False
Secrete alkaline fluid and
fructose
Seminal vesicles
Passageway for urine
Urethra
Male organ of copulation
Penis
Passageway for sperm
Vas deferens
Walnut-shaped that
surround the base of the
urethra
Prostate gland
Storage of sperm
Epsdidymis
Pea-sized lies at the base
of the prostate
Bulbourethral gland
Canal formed by the
union of vas deferens
and the excretory duct of
seminal vesicle
Ejaculatory gland
FEMALE REPRODUCTIVE SYSTEM
X-linked dominant
disorder
Cleft lip
Multifactorial inheritance
Hemophilia
X-linked recessive
disorder
Klinefelter syndrome
Numeric abnormality
Turner syndrome
Nurmeric abnormality
QUIZ 4
1. This structure stimulates the pituitary gland to
produce FSH and LH
a. Hypothalamus
EXTERNAL STRUCTURES
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Mons veneris / Mons pubis
○ is a mound of fatty tissue over the
symphysis pubis that cushions and
protects the bone
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Labia majora
○ are the longitudinal fold of pigmented
skin extending from the mons pubis to
the perineum
○ Cushion vaginal area
○ Pigmented
○ Serves as a cushion
VAGINA
●
●
●
●
●
●
●
Labia minora
○ Are soft longitudinal skin folds between
the labia majora
Clitoris
○ Is an erectile tissue located at the upper
end of the labia minora. It is the primary
site of sexual arousal
Urethral meatus (urethral orifice)
○ Is a small opening of the urethra. It is
located between the clitoris and the
vaginal orifice for the purpose of
urination
Perimeum
○ Is the area of tissue between the anus
and vagina; an episiotomy is performed
here i.e. where doctors create an
incision during a mother's labor
Vestibule
○ Is an almond-shaped area between the
labia minora containing the vaginal
introitus, hymen, Bartholin glands
Hymen
○ Is a membranous tissue ringing the
vaginal introitus
Vagina
○ Is the female organ of copulation
also serves as the birth canal. It
tubular,
○ musculomembranous organ that
between the rectum and urethra,
bladder
○ It is 3-4 inches long
and
is a
lies
and
●
Uterus (womb)
○ Located between the bladder and
rectum and consist of regions the
fundus, body (corpus) and cervix
○ Is hollow, musculoar organ with three
muscle
layers
(
perimetrium,
myometrium, and endometrium)
●
Menstruation is the sloughing away of spongy
layers of endometrium with bleeding from tourn
vessels
Environment for pregnancy: the meebryo and
fetus develop in the uterus after fertilization
Labor consists of powerful contractions of the
muscular uterin wall that result in expulsion of
the fetus –which results to the delivery
Uterine ligaments
○ Broad and round ligaments provide
upper support for the uterus
●
●
●
●
●
●
●
Cardinal,
pubocervical,
and
uterosacral
ligaments are suspensory and provide middle
support
Pelvic muscular floor ligaments provide lower
support
Cervix
○ Is a cylinder-shaped neck of tissue that
connects the vagina and uterus. Located
at the lower most portion of the uterus
the cervix is comeposed primarily of
fibromuscular tissue
Fallopian tube (oviducts)
○ Extend from the upper out angles of the
uterus and end near the ovary. It is 4
inches long. These tubes serve as the
passageway fro the ovum to travel from
the uterus to the ovary
○ Has three segments
■ Infundibulum - an expanded
funnel near the ovary
ACCESSORY GLANDS
●
●
●
Ampulla - middle segment
Isthmus - a short segment between
ampulla and uterine wall
Ovaries
○ Are 2 almond-shaped female sex glands
located on each side of the uterus.
○ The two functions are
■ ovulation - release of ovum
■ Secretion
of
hormones
-estrogen and progesterone
●
Breast ( mammary gland)
○ Specialized sebaceous glands that
produce milk after childbirth (lactation)
VAGINA
●
Nipple
○ Is a raised, pigmented area of the
breast
●
Areola
○ Is a pigmented skin around the nipple
●
Montgomery tubercles
○ Are sebaceous glands of the areola
●
●
●
Glandular tissue
○ Parenchyma is composed of acini ( milk
producing) cells that cluster in groups of
15 to 20 to form the lobes of the breast
●
Lactiferous ducts or sinuses
○ form passageways for the lobes to the
nipple
Fibrous tissue
○ Also called cooper ligaments, provide
support to the mammary glands
Aduoise and fibrous tissue (stroma)
○ provide the relative size and consistency
of the breast
●
●
○
○
●
●
The breast change in size and nodularity in the
response to cyclic ovarian hormonal changes,
including
○ Estrogen stimulation
■ Which produces tenderness
○ Progesterone (Postovulation) which
cause increased tenderness and breast
enlardement
Physical changes in breast size and activity are
at a minimum 5 to 7 days after menstruation
stops; this is the best time to detect pathologic
changes through breast self examination
Bartholin or Vilvovaginal gland ( female
counter part of the cowpers glands)
○ Are mucus-secreting glands located on
either side of the vaginal orifice
Skene or paraurethral glands
Are small mucus screting glands that
open into the posterior wall of the
urinary meatus and lubricate the vagina
Pelvis
○ A bony ring in the lower portion of the
trunk. It consists of three parts (ilium,
ischium, and pubis) and four bones (
two innominate bones or hipbones,
sacrum, and coccyx)
○ Pelvic bones are held together by four
joints (articulations) - symphysis pubis,
two sacroiliac, and sacrococcygeal.
Fibrocartilage between these joints
provides mobility
OOGENESIS
●
●
Types of pelvis
○ Gynecoid
■ The typical female pelvis with a
rounded inlet
○ Antherpoid
■ Is an “apelike” pelvis with an
oval inlet
○ Android
■ Normal male pelvis with a
heart-shaped inlet
○ Platypeloid
■ Is a flat, female type pelvis with
a transverse oval inlet
●
Pelvimetry
○ (The process of measuring the internal
or external pelvis)
○ Is performed with radiography or by
internal examination
The production or development of an ovum
Physiology of Menstrual Cycle
●
●
●
●
●
●
●
Menarche
○ Onset of menstruation
○ Typically occurs between 10 and 13
years of age
Menstrual cycle
○ Monthly patter of ovulation and
menstruation
Ovulation
○ Discharge of a mature ovum from the
ovary
○ Produces 300,000 to 400,000 oocytes
per ovary in a lifetime
○ Average cycle is 28 days and a duration
of 3 to 5 days
Mittelschmerz
○ one-sided,
lower
abdominal pain
associated with ovulation. It occurs
midway through a menstrual cycle about
14 days before your next menstrual
period. It doesn’t require medical
attention.
Menstruation ○ periodic shedding of blood, mucus, and
epithelial cells from the uterus; average
blood loss is 50 ml (1⁄4 cup); the range
of 30 to 80 ml of blood.
●
Progesterone inhibits
the
production
of
Luteinizing hormone
○ inhibits uterine motility
○ facilitate the transport of fertilized
ovum through fallopian tube
○ increases body temperature after
ovulation
○ Stops construction GnR
●
Prostaglandins - regulate the reproductive
process by stimulating the contractility of the
uterine and other smooth muscles.
●
Phases of Menstrual Cycle
○ Proliferative/Preovulatory/Follicular
Phase (6-14 days)
The ovaries produce mature gametes and
secrete the following hormones:
○ Estrogen
contributes
to
the
characteristics of femaleness( female
bodybuilder, breast growth)
■ Increase Estrogen - Thin and
watery
■ Decrease Estrogen - Cervical
mucus will be thick
■ causes hypertrophy of
the
myometrium
■ proliferates the endometrium
■ inhibits the production of
follicle-stimulating
hormone
(FSH)
■ increases
pH
of
cervical
mucus causing it
to
become
thin and watery (Spinnbarkeit
test)
●
Ovulatory/Secretory/Luteal/Progestational
Phase(14-15 days) – Peak
●
Ischemic Phase ( 16-28 days)
Progesterone -hormone of pregnancy
○ Production
of
Luteinizing
HormoneLH
○ quiets/ decreases the contractility of
the uterus
○ increases endometrial tortuosity
○ increases endometrial secretions
Sexual Response Cycle
●
Menstrual Phase (1-5 days) (an end and a
beginning)
●
Spinnbarkeit Test
●
Climacteric Period and Menopause
○ Climacteric - a transitional period
during which ovarian function and
hormonal production decline.
○ Menopause - refers to a woman’s last
menstrual period
■ the average age of menopause is
51.4 years.
○ However, it is important to note that
women may ovulate after menopause
and thus can become pregnant
Endometrial cells - buo2 in blood
Each ovary release eggs per
month
(alternate)
●
●
Concept of Sexuality
4 Level
1. CNS Response – Hypothalamic-pituitary gland
action (FSH and LH)
2. Ovarian Response (2 phases) – Proliferative
phase ( 1-14 days); Secretory ( 15-22 days)
3. Endometrial Response ( 4 phases)
a. Menstrual phase ( 1- 5 days)
b. Proliferative ( 6 – 14 days)
c. Secretory ( 15-26 days)
d. Ischemic ( 27 – 28 days)
4. Cervical Mucus Response ( Ovulatory) 15-23
days
a. Before Ovulation
–
Spinnbarkeit/Spinnbarkheit;
mittelschmerz
b. After Ovulation
●
Different way to know if you are fertile
○ Fern Test- Using Cervical Mucus
●
●
●
SEXUALITY
○ Maleness and femaleness
○ Physical
○ Emotional
○ Social
○ Ethical
SEXUAL STIMULATION
○ Physical
○ Psychological
○ Visual
SEXUAL RESPONSE
○ Erection/Foreplay
○ Coitus (sex/sexual intercourse)
○ Ejaculation/Orgasm
Principles Relevant to Sexuality
1. Human sexuality provides for the reproduction
of the human species.
2. Sexual fulfillment is a basic human need.
3. Sexuality pervades virtually every aspect of
life from birth to death.
4. All human cultures have sanctions, often legal
as well as moral, controlling expressions of
sexual drive.
5. Individuals have strong cultural, religious, and
ethical convictions regarding the expression of
human sexuality.
6. Moral values concerning appropriate sexual
behaviors
have undergone considerable
liberalizations in most western cultures in
recent years.
7. Successful gender identification in early
childhood is important for an individual’s
health and well being throughout life.
8. Actual or potential damage to the integrity of
an individual’s sex organ poses a considerable
threat to his self-esteem.
3. Sexual Partner Preference - may be
HETEROSEXUAL ( opposite sex), HOMOSEXUAL
(same sex), or BISEXUAL ( both), person may
vary during a person’s lifetime and is probably
shaped by a complex interaction of several
factors
SEX
●
Principles of Procreations
1. Sex is a search for sensual pleasure and
satisfaction, releasing physical and psychic
tensions.
2. Sex is a search for the completion of the
human person through an intimate personal
union of love expressed by the bodily union for
the achievement of more complete humanity.
3. Sex is a social necessity for the procreation of
children and their education in the family so as
to expand the human community and
guarantee its future beyond death.
4. Sex is a symbolic (sacramental) mystery,
somehow revealing the cosmic order. In short,
this Christian principle is all about pleasure,
love, reproduction, and the sacramental
meaning of sex.
●
●
Sexual Orientation
●
Human Sexuality
1. The ways in which we experience and express
ourselves as sexual beings.
2. A person's sexuality encompasses the complex
of emotions, attitude preferences, and
behaviors r/t expression of sexual self and
eroticism.
3. Nurses commonly are resource people for
clients seeking information r/t human
sexuality
and
functioning
during
the
reproductive years.
4. Responsible sexuality involves a commitment
to a relationship, responsible reproductive
health care, and rational decisions about
childbearing.
●
Developmental Tasks of Sexual Identity
1. Gender Identity- is a person’s sense of his or
her masculinity or femininity
2. Gender Roles/ Sex Role Standards - are
composed of behaviors, attributes, and
attitudes an individual conveys about being
male or female.
Latin roots “cut of Divide” ○ SEX meanings:
○ Gender: Male or Female
○ Anatomic Structures: sexual organs
○ Physical activities/Sexual expression
An individual chooses to give and receive
physical love and gratification.
One’s culture determines acceptable forms of
sexual expression; what’s considered normal
may vary greatly among cultures.
Acceptable sexual activity includes the
elements of PRIVACY, CONSENT, and LACK OF
FORCE
Concerns the direction of one’s romantic
interests and erratic attractions towards the
same sex, other sex, or both.
1. HETEROSEXUALITY: finds fulfillment
with a member of the opposite gender.
2. HOMOSEXUALITY:
finds
sexual
fulfillment with a member of his or her
own sex.
3. BISEXUALITY: Bisexual- achieve sexual
satisfaction from both homosexual and
heterosexual relationships.
4. TRANSEXUALITY: an individual who
although of one biological gender feels
as if he or she should be of the
opposite gender.
Types of Social Interaction
○ Celibacy - abstinence from sexual
activity
○
Masturbation erotic pleasure
self-stimulation
for
○
Erotic Stimulation - Use of visual
materials such as magazines or photos
Atypical Sexual Variations
●
PARAPHILIA - a diagnostic category used by
the American Psychiatric Association to
describes typical patterns of sexual arousal or
behavior that become problematic in the eyes
of the individual or society.
1. FETISHISM-Sexual arousal by the use of certain
objects or inanimate objects.
2. TRANSVESTISM- an individual who dresses to
take on the role of the
3. opposite sex
4. VOYEURISM- Sexual arousal by looking at
another’s body; watching other people who
are nude, or involved in sexual relations.
5. SADOMASOCHISM- A mutually gratifying
sexual, interaction between consenting sex
partners in which sexual arousal is associated
with infliction and recipient of pain or
humiliation
6. Sadist - inflicting pain or humiliation on others
7. Masochism - received the pain /desire or need
for pain
8. PEDOPHILIA - desires sexual pleasure from
children
9. EXHIBITIONISM - sexual arousal from exposing
genitals to strangers
10. usually men in a public place
11. FROTTEURISM - sexual arousal by touching or
rubbing other people in sexual ways without
their consent
12. SCATOLOGIA - obscene phone callers and
makes sexual suggestions or references.
Uttering obscenities and sexual provocations
to a non-consenting person.
13. COPROPHILIA - sexual arousal/gratification
from feces; the person may desire to be
defecated on or to defecate a partner.
14. UROPHILIA - desire sexual excitement from
urine as when doing “GOLDEN SHOWERS”
15. ZOOPHILIA- aroused by fantasies or actual
sexual contact with an animal.
16. NECROPHILIA- fantasies of or actual sexual
contact with a dead person.
17. KLISMAPHILIA- sexual arousal is derived from
the use of enemas.
a. Enemas
medication
for
leisure
Sexual Response Cycle
●
●
●
EXCITEMENT
Female:
○ Vaginal lubrication
○ Engorged labia minora/ minor flatten
○ Nipples become erect, breast size
increase
○ Flushing
○ Overall muscle tension increases
Male:
○ penile erection
○ Thick and congested scrotal skin
○ Testes elevate to scrotal sac
○ Some nipple erection
○ Flushing
HR and BP begin to increase
Generalized muscle tension increases
associated with muscle contractions.
PLATEAU PHASE
Women:
○ Decrease internal vaginal diameter
○ Labia minora further swell and
darken
○ Clitoris retracts
○ Nipple further engorged
○ Flushing
○ Increase:HR, BP, muscle tension
Men:
○ Further penile enlargement, with color
changes
○ Preorgasmic emission may occur from
Cowper glands
○ Testes continue
to
elevate and
rotate
○ Increases:
HR,
BP,
RR,
muscle tension
ORGASMIC PHASE
Women:
○ Strong muscular contractions outer
○ 1/3 of the vagina
○ Uterine muscles contracts
○ Flushing
○ Increase: RR,BP, HR
Men:
○ Rhythmic contractions expel semen
○ Testes at maximum elevation, size and
elevation
○ flushing
○ increase at its peak: RR, BP, HR
○ General loss of voluntary control occurs
○ Refractory period begins
RESOLUTION PHASE
Women:
○ Inner 2/3 of the vagina gradually shrinks
○ Cervix dips into the seminal pool
○ Labia minora and majora return to
normal state
○ Clitoris protrudes
○ Flushing disappears
○ Muscle relax quickly
Men:
○ More than 50% of the erection is lost
○ Testes descend and return to normal
size
○ Nipple erection subsides
○ Flushing disappears
○ Normal:RR,HR,BP
○
○
●
●
●
●
●
●
●
●
●
○
●
General muscle relaxation occurs
Sexual concerns r/t pregnancy
○ Altered desire for sex
○ Breasts may be painful to touch
○ Increase amount and odor of vaginal
discharge can be turned off to some
men
○ Other concerns: dyspareunia
○ Other forms of expression:
■ kissing/hugging/ manual genital
stimulation
Pregnancy
●
Pregnancy - is the term used to describe the
period in which a fetus develops inside a
woman’s womb or uterus
○ usually lasts about 40 weeks, or just
over 9 months, as measured from the
last menstrual period to delivery.
○ Normal amount of semen/ejaculation:
3.5cc
○ Number of sperm per cc of semen – 40
– 80 million
○ Number of sperm per ejaculation – 300
–500 million
○ Mature ovum is capable of being
fertilized for 12 to 24 hours after
ovulation
○ Sperm is capable of fertilizing for 3 to 4
days after ejaculation
○ Normal lifespan of sperm is 7 days
○ Sperm can reach the ovum in 1 – 5
mins. -Fallopian tube will contract due to
estrogen
○ Sperm must remain in the female
genital tract 4 – 6 hours before they are
capable of fertilizing the ovum
○ Sperm have 22 autosomes and 1 X or Y
sex chromosomes
○ Ova contains 22 autosomes and 1 X sex
chromosomes
Stages/ Process of Pregnancy
1. Fertilization - is the process in which a sperm
penetrates the outer layer of the ovum.
2. Implantation - when the blastocyst attaches to
the endometrium (7 -9 days after fertilization).
3. Pre-placental stage - when the endometrium
becomes highly vascular (week 2)
4. Placental and fetal development
-A clearer picture of the process
■
○
It has
1.
2.
3.
- decidua vera – lines the rest
of the uterus
3 processes:
Apposition
Adhesion
invasion
Human Development
●
-
●
Cell Division Process
IMPLANTATION
○ 50%
of zygotes never achieve
implantation
○ Small amount of vaginal spotting is
occasionally
present
(Implantation
breed)
○ Endometrium turned to decidua:
■ - decidua basalis - directly
under blastocyst
■ - decidua capsularis – covers
blastocyst
Late Blastocyst
○ The cells begin to differentiate into:
-Inner cell mass ( embryo)
-Trophoblast Cells ( attach to the uterus)
■ Trophoblast cells erode the
endometrium of the uterus so
that
■ The Blastocyst burrows into the
uterine wall
■ Endometrium covers the embryo
and the blood supply becomes
established
●
●
●
Placenta
○ Respiratory system
○ Renal system 3. Gastrointestinal system
○ Endocrine system:
■ Human chorionic gonadotropin
(HCG)
■ Human placental lactogen
■ Estrogen
■ Progesterone
○ Protective functions
Note: 1st stool of the baby is called
“meconium”
Umbilical Cord
○ 21 inches long
○ 2 arteries and 1 vein (AVA)
○ Wharton's jelly (makes the umbilical
cord flexible and “un-kinkable”)
○ Transport oxygen, nutrients, minerals,
and waste products
Amniotic Fluid
○ 500 – 1000 ml inside the amniotic sac
(BOW=Bag of Water)
○ Produced by the amniotic membrane
○ Shields fetus from pressure or blow
○ Maternal and Child Health Nursing | 25
○ Protects fetus from sudden change in
temperature
○ Aids in muscular development
○ Aids in descent
○ Protects umbilical cord from pressure
○ Protects fetus from infection
->500 -1000ML= Normal volume or level of amniotic
fluid
- Urine of the baby adds to the amniotic fluid
volume
- Oligohydramnios = below normal levels of
amniotic fluid
- Polyhydramnios = above normal levels of
amniotic fluid
-> Fetal kidney need to be develop first before the
baby can swallow
->
Focus of Fetal Development
●
●
●
●
-
BOW composed of 2 layers
- Amnion = Inner layer; produces the
amniotic fluid
- Chorion = Outer layer
Fetal Development
○ ZYGOTE - 1st 14 days ( week2)
○ EMBRYO - 3rd to 8th week
○ FETUS - 8th to birth
○ NEWBORN - Delivery; 1st 28 days
○ INFANT - more than the 1st 28 days
First
Trimester
(1-3months)
organogenesis; highest risk for the baby to
develop malformities caused by teratogens
Second Trimester (4-6 months) - Period of
continued growth and development; Rapid
development
Third Trimester (7-9 months) - Period of
most rapid growth and development
FETAL CIRCULATION
-
Shunting = these are shortcuts; faster blood
circulation for the fetus for faster fetal
development
- First organs that will experience
shunting
- Heart
- Liver
- Kidney
- Formen Ovale = opening of 2 atria the right and
We have 3 structures where shunting is most present
-Ductus Venosus ( 1st Shunting)
-Foramen Ovale (2nd Shunting)
-Ductus Arteriosus ( 3rd Shunting)
What happens when the 3 structure mention above
doesn't close? - the baby will be at high risk of
congenital malformations, such as Congenital Heart
Disease (CHD)
Congenital malformations account for
approximately 20% of deaths in the
perinatal period
○ Approximately 3% of newborn infants
will have major malformations
○ Another 3% will have malformations
detected later in life.
Nicotine
○ effect on fetal growth
○ intrauterine growth restriction
○ Heavy cigarette smokers: premature
delivery
○ constricts uterine blood vessels and
causes decreased uterine blood flow
thereby decreasing the supply of oxygen
and nutrients available to the embryo
○ compromises cell growth and may have
an
adverse
effect
on
mental
development.
Alchohol
○
left opening ( blood goes through the left opening
first)
●
●
○
○
F= FETAL
A= ADULT
Common Teratogens
●
Teratology
○ Study of abnormal development in
embryos and the causes of congenital
malformations or birth defects
○ May be visible on the surface of the
body or internal to the viscera
○
○
Common
abuse
by
women
of
childbearing age.
Demonstrate prenatal and postnatal
growth deficiency, mental retardation,
and other malformations subtle but
classical facial features associated with
fetal alcohol syndrome including short
palpebral fissures, maxillary hypoplasia,
a smooth philtrum, and congenital heart
disease
Moderate consumption (2 to 3 oz. of
hard liquor per day): fetal alcohol effects
Binge drinking: harmful effect on
embryonic brain developments at all
times of gestation.
●
Tetracycline: Antibacterial
Highly teratogenic: inhibit rapidly
dividing cells
○ Should be avoided whenever possible
but are occasionally used in the third
trimester when they are urgently
needed to treat the mother.
Retinoic Acid: Anti-acne
○
●
Type of antibiotic
Can cross the placental membrane
Deposited in the embryo in bones and
teeth
○ Exposure can result in yellow staining of
the primary or deciduous teeth and
diminished growth of the long bones
Phenytoin: Anti-compulsive
○
○
○
●
○
●
Produce the Fetal Hydantoin Syndrome
consisting
of
intrauterine
growth
retardation,
microcephaly,
mental
retardation,
distal
phalangeal
hypoplasia, and specific facial features.
Antineoplastic
Agents:
(Attacks fast-growing cells)
anti-cancer
○
○
○
○
○
○
Vitamin A derivatives
Extremely teratogenic
Even at very low doses, oral medications
such as isotretinoin, used in the
treatment
of
acne,
are
potent
teratogens
Critical period of exposure: second to
the fifth week of gestation
Most
common
malformations:
craniofacial dysmorphisms, cleft palate,
thymic aplasia, and neural tube defects.
●
●
Tranquilizer
Agents
○
○
○
○
○
●
Thalidomide:
Hypnotic
One of the most famous and notorious
teratogens
Hypnotic agent - used widely in Europe
in 1959, after which an estimated 7000
infants were born with the thalidomide
syndrome or meromelia
Characteristic
features:
limb
abnormalities that span from the
absence of the limbs to rudimentary
limbs to abnormally shortened limbs
Also causes malformations of other
organs including the absence of the
internal
and
external
ears,
hemangiomas, congenital heart disease,
and
congenital
urinary
tract
malformations
The critical period of exposure appears
to be 24 to 36 days after fertilization.
German Measles
○
○
Congenital Cytomegalovirus
Consists of the triad of cataracts, cardiac
malformation, and deafness
The earlier in the pregnancy that the
embryo is exposed to maternal rubella,
the greater the likelihood that it will be
affected
○
○
○
●
Most common viral infection of the fetus
Infection of the early embryo during the
first trimester most commonly results in
spontaneous termination
Exposure later in the pregnancy:
intrauterine
growth
retardation,
micromelia, chorioretinitis, blindness,
microcephaly, cerebral calcifications,
mental
retardation,
and
hepatosplenomegaly
Ionizing Radiation
○ can injure the developing embryo due to
cell death or chromosome injury
○ severity of damage to the embryo
depends on the dose absorbed and the
stage of development at which the
exposure occurs
○ Study of survivors of the Japanese
atomic bombing demonstrated that
exposure at 10 to 18 weeks of
pregnancy is a period of greatest
sensitivity for the developing brain
○ There is no proof that human congenital
malformations have been caused by
diagnostic levels of radiation. However,
attempts are made to minimize
scattered radiation from diagnostic
procedures such as x-rays that are not
near the uterus
○ The standard dose of radiation
associated with a diagnostic x-ray
produces a minuscule risk to the fetus.
However, all women of childbearing age
are asked if they are pregnant before
any exposure to radiation
●
Maternal Medical Conditions
○ also produce teratogenic risks
○ Infants of diabetic mothers have an
increased incidence of congenital heart
disease, renal, gastrointestinal, and
central nervous system malformations
such as neural tube defects
○ Tight glycemic control during the third
to sixth-week post-conception is critical
○ Infants of mothers with phenylketonuria
who are not well controlled and have
high levels of phenylalanine have a
significant risk of mental retardation,
low birth weight, and congenital heart
disease
Pregnancy Risk Categories
Pregnancy
Normal Adaptation in Pregnancy
●
●
Reproductive System
Uterus
○ Uterine growth and enlargement
Lenght
6.5cms to 32cms
Width
4cms to 24cms
Depth
2.5 cms to 22 cms
Weight
50 gms to 1000gms
Volume ( Blood volume)
○
○
1-2ml ( Non-pregnant
state) to 1000ml
(pregnancy)
Lightening- the preparation for labor
Pre-term - 37 and below
Full-term - 38 to 42 weeks
Post - term - above 42 weeks
Braxton Hicks contraction - practice
contractions ( Before labor begins, you
might have false labor contractions, also
known as Braxton Hicks contractions.
These irregular uterine contractions are
perfectly normal and might begin in
your second or third trimester. A
contraction is when your uterus tightens
and then relaxes. Contractions are your
body's way of getting ready for real
labor)
Becomes globular (4th month)
●
●
12 weeks ( first 3 months) - organogenesis
●
●
●
12 weeks - symphysis pubis
16 weeks- in between the symphysis pubis and
umbilicus
36 weeks - xiphoid process: diaphragm compressed
Average growth of the uterus - 1cm per week or
4cm per month
Reproductive system:
Uterus
○ Goodell’s signs ( 4th week) - softening
of the cervix
○ Hegar’s sign (8th week) - softening of
the lower uterine segment
○ Chadwick’s sign ( 8th to 10th week) discoloration of the cervix, including the
vaginal walls; bluish/purplish in color
due to the dilation of the blood vessels
Ovaries
○ No ovulation
Vagina
○ More acidic (ph 3.5 to 6)
Breast
○ Enlarged
○ Increased in Size
○ Darken Areola, nipple
○ Blue veins
○ Montgomery tubercle enlarge
due to the increased production
of melanocytes
chloasma/melasma
■ mask of pregnancy
Striae gravidarum
■ due to the stretching of the
abdominal skin (stretch marks)
Linea nigra
■ Drakens due to pregnancy
Increased perspiration
■ The mother sweats more due to
the increased activity of the body
and increase metabolism
■
Note: Lactation amenorrhea - prevents
periods due to lactation
Musculoskeletal System
○ Waddling walk
○ Symphysis pubis may separate slightly
○
●
○
○
○
○
Striae Gravidarum
-
With a growing baby, the mother will appear
lordotic (Pride of pregnancy)
Linea Nigra
●
Circulatory system
○ Increased blood volume 40% to 50%
○ Physiologic anemia
■ brought about by the rapid
increase of blood plasma
○ Heart is displaced upward
○ Increased cardiac output to 30%
○ Supine hypertension
○ Increased WBC
○ CR &PR increased to 10-15 beat/min.
○ Vaaricosities and edema
A - Supine
B - Side-lying position
●
Integumentary System
○ Increased pigmentation
Telangiectasis
●
Gastrointestinal System
○ Morning Sickness
■ HCG levels go up
Hyperemesis
gravidarum
excessive
vomiting
during
pregnancy
○ Heartburn
○ Constipation
Respiratory System
○ Increased RR
○ Dyspnea
○ Increased Tidal Volume
○ Increased vital lung capacity
○ Decreased residual Volume
Urinary
○ Urinary frequency
■ Due to getting compressed
○ Increased GFR
■ Capacity of the kidney to filter
■
●
●
Signs of Pregnancy
●
●
●
Presumptive sings
○ Subjective; presuming that the patient is
pregnacy, such as mornign sickness
Probable signs
○ Objective cues; these signs are
measurable
Positive signs
○ Confirmatory signs
Signs of Pregnancy (First Trimester)
●
●
●
Presumptive signs
○ Amenorrhea, morning sickness, breast
changes, fatigue, urinary frequency,
enlargement of uterus
Probable sings
○ Chadwick’s signs, Goodell’s, Hegar’s,
Increase of HCG (+) HGT
Positive sign
○ Ultrasound result
Signs of Pregnancy (Second Trimester)
●
●
●
Endocrine System
○ Increased metabolism of CHON and
CHO
■ Due to both the mother and
baby needing more nutrients
○ Increased insulin
■ 2nd trimester - insulin resistance
●
●
Presumptive signs
○ quickening , skin pigmentation, cloasma,
linea negra, striae gravidarum
Probable signs
○ Enlarged abdomen, Braxton Hick’s,
Ballottement
Positive signs
○ FHT, Fetal movements, Fetal X-ray
Weight Gain
Weight distribution
Fetus
7 lbs
Placenta
1 lbs
Amniotic fluid
1.5 lbs
uteus
2 lbs
Blood volme
1 lb
Breast
1.5 - 3lbs
Fluid
2 lbs
Fats
4 - 6 lbs
Total of 20 -25 lbs
Prenatal Care
●
●
●
●
●
●
Data gathering
Physical Assessment
Pelvic Examination
Leopold’s maneuver
Fetal Heart tone monitoring
Laboratory Examinations
○
Obstetrical Data
●
●
Last Menstrual period (LMP)
○ 1st day of last menstrual period
Age of Gestation (AOG)
○ By weeks (based on the LMP)
REMEMBER:
STEP 1 - Get the date of LMP ( Last menstrual
period) and DOF (Date of assessment)
STEP 2 - Note the number of days of the month of
the DOF and subtract it to the LMP
STEP 3 - Starting with the LMP write teh consecutive
months with there respective days in the month and
stop when you reach the month of the date of
assessment then sum it all up
STEP 4 - Divide the sum total of Step 3 with 7 and
note dont use calculator in this step due to
inaccuracies ( now if there will be a remainder that is
your days in the weeK)
○
Bartholomew’s rule ( relative position
of the uterus in abdominal cavity)
4 Landmarks
- Symphysis pubis
- In between the symphysis pubis and the
umbilicus
- Level of umbilicus
- Xiphoid process
Bathomeus rule = determining the AOG by basin on
the relative position of the uterus in the abdominal
cavity
Note: Not accurate during the 3rd trimester (because
the 36cm is higher than the 40 cm)
●
Gravida Para Abortion (GPA)
○ Pregnancy
Mc Donald’s Method ( FH/ 4 = in
months)
REMEMBER: Start from the symphysis pubis going
upwards to the fundus ( FH = Fundic Height)
G ( Gravida) = Number of Pregnancies
P ( Parity) = number of pregnancies that reached its
term or age of viability ( above 20 weeks “ in the
books” or the in the philippines 28 weeks and above)
A (Abortion) = number of pregnancies that did not
reach age of viability ( less than 20 (books) or 28
weeks(philippines))
●
Term Preterm Abortion Living (TPAL)
○ Person
●
Estimated Fetal Weight (EFW)
○ Aka. Johson’s Rule
○ FH - N x K (K is a constant 155)
○ N = 11 ( Not engaged)
○ N = 12 ( Engaged)
T = term - babies that are 38 -42 weeks of age
P = preterm - babies below 28 -37 weeks
A = abortion - babies that didn't reach the age of
viability ( 27 weeks or below)
L = Living - these are babies that are living
●
Expected Date of Confinement (EDC)
○ Aka Expected Date of Delivery (EDD)
○ Naegel’s rule (-3 +7 +1)
REMEMBER:
- Johnson’s rule =EFW
- K is always 155
- N depends if Engaged (11) or Not Engage
(11)
- And always read the situation if what unit of
measurement should be used for the final
answer
●
REMEMBER:
- The format -3 (month) +7 (day) +1 (year)
- By using the LMP subtract the given with -3
+7 +1 while following the format.
Sample Computation
EDC
AOG in weeks
○
○
GPA
TPAL
○
Physical Assessment of Pregnancy
●
Observe for danger signs of pregnancy:
○ Avaginal bleeding
■ Placenta previa - high risk
condition, where in the placenta
inplants it-self below and covers
the cervix ( high risk for
bleeding)
■ Abruptio placenta - premature
separation of the placenta
■ Premature Labor
■ Threatened
abortion
increase vaginal discharges
● Notes: Spotting is normal
during labor or near the
date of delivery but not
normal during pre-term
(would
indicate
the
opening of the cervix)
○ Persistent vomiting
■ Hyperemesis gravidarum Excessive
vomiting
during
pregnancy (only in the first
trimester)
■ Persistent
infection
consistent vomiting may be
cause by infections
○
○
○
○
○
Chills and fever
■ Infection
■ Dehydration
■ Gastroenteritis due to low
immune system response
Sudden escape of fluid from the
vagina - e.g. BOW rupture
■ Note: Operculum = mucus plug
protects
the
baby
from
infections, and if ever the mucus
plug breaks down there will be
massive bleeding
■ Note: Umbilical Cord Prolapse
= is the condition where, when
the BOW ruptures and the
umbilical cord drops out the
patient's
vagina
and
is
recommended for the patient to
be CBR
Abdominal or chest pain
■ Ectopic pregnancy - wrong
implantation of the baby ( like
when the baby is implanted in
the uterus and so on )
■ Abrutio placenta - premature
seperation of the placenta
■ Uterine rupture - can be cause
by prolonged labor where
contractions are continuous
■ Pulmonary embolism - (chest
pain) blood clot that formed in
the artery of the lung
Swelling of face and fingers
■ Edema - this normal during
pregnancy
■ But when swelling is found in the
finger and face this is S/S of
pregnancy induced hypertension
or PIH (Preeclampsia)
Rapid weight gain
■ Should not exceed 9 -11 kilos or
20 -25 lbs
Flashes of lights or dots before the
eyes
■ One of the signs of severe
preeclampsia
Dimness or blurring of vision
■ One of the signs of severe
preeclampsia
Severe headache
■ One of the signs of severe
preeclampsia
Decrease urine output
■ One of the signs of sever
preeclampsia
Note: if ever the patient goes thorugh siezures
and displaying the above mention severe
preeclampsia symptoms, the patient is now
experiencing emclampsia
○
-
VAGINAL SPECULUM
-
Pelvic Examination
●
●
●
●
-
Internal examination - should not be executed
by untrained staff
Vaginal speculum
Transvaginal ultrasound
Papnicolau (pap smear)
What happens?
- The nurse will document the whole IE
- DEBPS
- D = DILATION (opening of
the cervix)
- E = EFFACEMENT ( thinness
100%, thin as paper = fully
effeaced)
- B = BAG OF WATER ( intact,
leaking, or ruptured)
- P = PRESENTATION ( part
of thebaby in the cervix,
cephalic, breach)
- S = STATION ( how far down
is the baby’s head)
- First the OB will lubricate his/her
gloves
- second , the OB will inster 2 of her
fingers (Index and Mid finger) around
and will stretch it till it reaches
1-10cm depends on the patients
cervical dilation
-
-
A tool that is used for properly observing or
visualization of the pelvic organs such the
cervix ( such as checking the condition of the
BOW if ever ruptured that is +pooling where
there would be water on the speculum, if not
that is - pooling)
Multiple sizes S M L
Cutobrush (pap smear brush) = use to get a
sample to be sent to the lab
Nursing Procedure 10.1
(Leopold’s Maneuvers)
●
●
●
●
Leopold’s maneuvers
○ Are a noninvasive method of assessing
fetal
presentation,
position,
and
attitude. This technique can also be
used to locate the fetal back before
applying the fetal monitor
Equipment
○ Warm, clean hands
Procedure
Fundal Grip
○ Determine presentation
○ Stan beside the patient. Facing her.
place both hands on the uterine fundus
and palpate the contents of the fundus.
If the buttocks are in the fundus
indicating a vertex presentation ( which
is true 96% of the time), you will feel a
soft, irregular object that does not move
easily however, if the head is in the
fundus indicating a breech presentation,
you will palpate smooth, hard, round,
mobile object
vast majority of cases, you will feel a
hard round fetal head. If the part moves
easily. It is unengaged. If part is not
movable, engagement probably has
occurred. If the breach is present, you
will feel a soft, irregular object.
FUNDAL GRIP
PALWICK’S GRIP
REMEMBER: If irregular/somewhat round, soft, and
immovable - buttocks of baby. If round, hard,
moveable - head of baby.
- Head comes in contact w cervix: Cephalic
- Any other part (buttocks or foot): Breech
●
Umbilical Grip
○ Place both hands on the maternal
abdomen, one on each side. Use one
hand to support the abdomen while you
palpate the opposite side with the other
hand. Repeat the procedure so that
both sides of the abdomen
UMBILICAL GRIP
REMEMBER: To palpate the fetal position, locating
the fetal back.
- If irregular in shape you’re palpating the
front side of the baby
- If a rounded shape is felt that is the fetal
back
Doppler, Stethoscope, EFM (External Fetal Monitor)
will be positioned where the fetal back is located.
Giving the point of maximum volume, where fetal
heart tone is properly auscultated. N: 120-160 bpm.
●
Pawlick’s Grip
○ Place one hand over the symphysis
pubis and attempt to grasp the part that
is presenting to the pelvis between your
thumb and fingers of one hand. In the
REMEMBER: Palpating for the fetal presentation and
engagement. Engaged - immovable; Unengaged moveable. If engaged proceed to station 0, not
moveable.
●
Pelvic Grip
○ Begin the last step by turning to face
the woman’s feet. Using the finger pads
of the first three fingers of each hand,
palpate in a downward motion in the
direction of the symphysis pubis. If a
hard bony prominence is felt on the side
opposite the fetal back, you have
located the fetal brow, and the fetus is
in an attitude of flexion. If the bony
prominence is found on the same side
as the fetal back, you are palpating the
occiput, and the fetus is in an attitude of
extension.
PELVIC GRIP
REMEMBER: Palpate for fetal attitude or the degree
of flexion of fetal head. N: Good attitude (Flexed
head) AbN: Poor attitude (Head is extended).
Maneuvers are done 24 weeks and above, no high
risks, and without preterm labor. Usually done during
the second trimester.
○
Compared to the 3 grips, Pelvic Grip is done with the
hands facing the feet of the mother.
DISCOMFORTS IN PREGNANCY
●
●
●
First trimester
○ Nausea and vomiting
a. Eat dry crackers
b. Small frequent feeding
c. Low fat meals
d. Avoid fried foods
e. Avoid antiemetics
○ Syncope
a. Sit with feet elevated
b. Change position slowly
c. Left lateral position
First through Third Trimesters
○ Breasts tenderness
a. Use supportive bra with elastic
strap
b. Avoid soap in the nipples and
areola
○ Increased vaginal discharges
a. Proper cleaning and hygiene
b. Wear cotton underwear
c. Avoid douching
d. Consult physician if infection is
suspected
○ Nasal Stuffiness
a. Use humidifier
b. Avoid
nasal
sprays
and
antihistamines
○ Fatigue
a. Frequent rest periods
b. Regular exercise
c. Avoid stimulants
○ Urinary frequency and urgency
a. Increase oral fluid intake
b. Limit fluid intake in the evening
c. Void at regular intervals
d. Sleep on the right side at night
Second and Third Trimester
○ Heartburn
a. Small frequent feeding
b. Sit upright for 30 minutes after
meal
c. Drink milk between meals
d. Avoid fatty and spicy foods
○
○
○
○
○
○
○
e. Avoid antacids unless prescribed
by physician
Ankle Edema
a. Elevate legs at least twice a day
b. Wear support stockings
c. Avoid one position for long
periods of time
d. Avoid diuretics
Varicose Veins
a. Wear support stockings
b. Elevate feet when sitting
c. Lying with feet and hips elevated
d. Move out while standing
e. Avoid pressure on lower legs
f. Avoid leg crossing
g. Avoid standing or sitting in long
period of time
h. Avoid constricting clothing
Headaches
a. Change position slowly
b. Apply cool cloth at forehead
c. Eat small snack
Hemorrhoids
a. Warm sitz bath
b. High fiber diet
c. Increase oral fluid intake
d. Exercise
e. Apply ointments/suppositories as
prescribed
Constipation
a. High fiber diet
b. Increase oral fluid intake
c. Exercise
d. Avoid laxatives
Shortness of Breath
a. Rest periods
b. Elevate head while sleeping
c. Avoid overexertion
Backache
a. Encourage rest
b. Use body mechanics
c. Wear low-heeled shoes
d. Exercises
e. Sleeps on firm mattress
Leg Cramps
a. Exercise
b. Elevate and dorsiflex the feet
while resting
c. Increase calcium intake
Recommended Exercise
●
●
●
●
●
Tailor sitting
○ Like an meditation sitting position
Squatting
Pelvic Floor contraction (Kegel’s Exercise)
○ Can be done while sitting down
○ Contract 3 secs, Relax 3 secs then
Repeat
Abdominal Muscle contraction
○ Done by lying to stretch the abdomen
Pelvic Rocking
○ Kneel on with your hands on the floor
and rock the pelvis upward, downward,
and side to side “ ma imagine ninyo?
Myurag otso otso ba”
Labor and Delivery
●
●
Labor
- A series of events when the product of
conception is expelled out from the
woman’s body.
➢ Product of conception: Fetus and
Placenta
- Regular uterine contractions cause
progressive dilatation of the cervix and
sufficient muscular force to allow the
baby to be pushed outside.
➢ Uterine contraction is when the
uterus contracts or compress to
let push the baby out
➢ Dilatation - Opening of the cervix
- Usually begins when the fetus is
sufficiently mature (Term/ 38 - 42
weeks)
Theories of Labor
1. Uterine Stretch Theory
- contraction of the uterus would
indicate labor begins.
➢ The body detects how big
the uterus is to proceed
on contracting the uterus
➢ Brain
interprets
“oy
sobraan na ka stretch
ang uterus, term na guro
ni. Start na dapat sa
contraction”
○
○
○
➢ The twins are prone to
premature labor because
of this theory
➢ No specific measurement
but the body and brain
detects how big the
uterus is
Oxytocin
&
prostaglandin
hormones
responsible
for
contractions
Progesterone - relax the uterus
Progesterone and Oxytocin have
opposite/inverse relationship
2. Oxytocin and Prostaglandin Theory
- Works together to inhibit calcium
binding in muscle cells, raising
intracellular
calcium
thus
activating contractions.
➢ Inhibit
the
calcium
binding (action on the
smooth muscle)
➢ If
mataas
ang
intracellular calcium it will
activate contraction
➢ Oxytocin - to induce
contraction
3. Progesterone Deprivation Theory
- a decrease in progesterone
causes uterine changes – labor
pains occur.
➢ When
the
baby
matures/lumalapit na sa
term the placenta also
matures (gr 1 placenta,
gr 2 placenta, gr 3
placenta[mature] )
4. Placental Aging Theory
- insufficient nutrients to reach the
fetus,no longer produce estriol
and progesterone. Thus, labor
begins.
➢ When placenta matures it
will not produce estriol
○ Estriol - type of estrogen
➢ “hala nagdecrease na ang
atung
progesteron,
kailangan na natu mag
increase ug oxytocin and
prostaglandin” - body
●
COMPONENTS OF LABOR (4P’s)
1. Passageway
- mother’s pelvis, cervix, and
vagina
- “Kung
saan
dadaan
si
passenger”
- Cervix will dilate and effacement
(open & thin)
- Vagina
will
stretch
to
accommodate the baby
The Pelvic
○
Passageway
2. Passenger
- fetus and placenta
3. Power
- uterine
contraction,
uterine
muscles, and mother’s ability to
push (Teamwork)
- Contraction is not enough to
deliver the baby it should be
together with mother’s ability to
push
- Normal Spontaneous Vaginal
Delivery
- Assisted delivery:
1) Vacuum delivery
2) Forceps
delivery
(obstetric forcep)
- Caput Succedaneum - “mutaas
ang ulo sa baby upon delivery
due sa pagpush sa mother”
➢ Mawala after how many
days
➢ Bonnets can help to
shape the baby's head
True Pelvis
False Pelvis
- Ischial Spine
4. Psyche
- mother’s psychological condition
- Mind over Matter
- Mindset of the mother to deliver
or have the baby
- It will affect delivering her baby
- Common to teenage pregnancy
➢ As a nurse provide
comfort and support to
the mother
Human Pelvis
➢ Internal Examination (IE) - the doctors will
insert finger to the vagina through the cervix of
the mother to measure the fetus inside and the
size of the uterus and situation of the pelvic
➢ Cephalopelvic Disproportion - a condition which
the baby’s head didn’t coincide on the mothers
vagina (baby is too big)
●
●
Engage - Station 0
Above the ischial spine is minus (-)
- Floating ( -3 or -4)
- The baby is still moving
- Not engage
●
Below the ischial spine is plus (+)
- The baby is about to be deliver
●
Crowning
- +3 or +4
Stations of Presentation - Fetal Head
Positions During Descent
Gynecoid - Round
Platypelloid - Transerve Oval
Anthropoid - Vertical Oval/Upright egg
Android - heart shape/wedge shape
1. LIGHTENING
○ Nestling of the fetal presenting part into
the pelvis
➢ Baby’s head(/whatever part of
whatever will go first) is settling
on the false pelvis
➢ Baby is ready to go out
2. ENGAGEMENT
○ settling of the fetal presenting part into
the ischial spine
➢ Head of the baby is engage on
the ischial spine (true pelvis)
3. STATION
○ relationship of the fetal presenting part
to the level of the ischial spine
Anterior View
Fetal Descent Stations (Birth
Presentation
Anterior cut-away view
Cervix
●
➢ Internal and External Os - when the mother is
pregnant it will stretch and your cervix will
shorten
Assessment of the Cervix: Internal Examination (IE)
● DILATATION
○ opening of the cervical o
○ from 1 cm – 10 cms (fully dilated
cervix)
○ due to uterine contraction and amniotic
fluid
●
Perineum
- site of episiotomy:
a. Median episiotomy - middle
b. Right mediolateral - middle to
right
c. Left mediolateral - middle to left
➢ Episiotomy - surgical incision performed by the
doctor
- To prevent spontaneous laceration
- “Isabay ang cut sa pagpush sa mother”
EFFACEMENT (1st to happen)
○ thinning of the cervical canal
○ expressed in % (100% is a fully dilated
cervix)
○ Ripening of the cervix - Papahinugin,
soft cervix mean thin cervix
★ DEBPS - Internal Examination
Vagina
●
Vaginal Canal - has rugae and capable of
stretching but can be lacerated:
a. 1st degree – skin
b. 2nd degree – skin and muscles
c. 3rd degree – external sphincter of
rectum
d. 4th degree – mucus membrane of
rectum
Fetal Skull
Membrane Spaces
○
Anteroposterior Diameter
Suture - soft bone that did not fuse
together
➢ Frontal Suture - front of the baby
Fontanelles
The Fontanelles
Fetal Attitude
-
●
●
●
●
●
●
It should be soft
“ hubon” in bisaya
Posterior Fontanelle - triangle shape
- Will close/harden 2 - 3 months of the
baby
Anterior Fontanelle
- Will close/harden 12 - 18 months
- To allow brain development
Sunken - baby is dehydrated
Bulging - Complications of the baby
Degree of flexion that the fetus assume
Good Attitude - Suboccipitobregmatic
(Vertex Presentation)
-
Good attitude should be “well flexed”
Sub - baba
Occiput
Fetal Lie
-
Relationship of the long axis of the fetus to the
long axis of the mother (base on the vertebra)
Military Attitude - Occipitofrontal
-
Neutral (not flex - not extend)
First to come out is the back of the
head and forehead of the baby
Vertical lie - Head or Butt or Foot
Transverse Lie - Shoulder or arm
nakatakilid ang baby sa transverse line
-
●
Poor Attitude - Partial Extension
Occipitomentum
Brow Presentation
Poor Attitude - Full Extension
Submentobregmatic
Face Presentation
/
Baby’s position during pre term is not
the final position for the baby
Full term, Lightening or has been
settle to the pelvis that is the final
position
Presentation - Body parts that will first
contact the cervix
1. Vertical Cephalic Presentation
Cephalic - Head of the baby first come out
2. Vertical Breech Presentation
BREECH-TRANSVERSE
PRESENTATION
TRANSVERSETRANSVERSE
PRESENTATION
3. Transverse Presentation
Fetal Position
-
Position of the fetal presenting part to the
specific quadrant of mother’s pelvis
Division of Pelvis
○
○
○
Shoulder presentation
Arm Presentation
ElbowPresentation
Fetal Landmarks
●
●
●
●
CEPHALIC – CEPHALIC
PRESENTATION
BREECH-BREECH
PRESENTATION
CEPHALIC-BREECH
PRESENTATION
CEPHALIC-TRANSVERSE
PRESENTATION
Occiput – vertex/cephalic presentation (O)
Mentum- chin/ face presentation (M)
Sacrum - in breech presentation (Sa)
Acromion – scapula/shoulder presentation (A)
FETAL POSITION –represented by 3-letter abbreviation
➢ 1st letter - L (left) or R (right) , D (neither left
or right)
➢ 2nd - fetal landmarks
➢ 3rd - A (anterior), P (posterior) T (transverse)
Left Occiput Anterior
Right Occiput Posterior
Right Occiput Anterior
Direct Occiput Posterior
Left Occiput Transverse
Direct Occiput Anterior
Right Occiput Transverse
Right Sacrum Posterior
Left Occiput Posterior
Fetal lie has 2 classification:
1. Vertical
2. Transverse
➢ After delivery the nurse will give
medication, Oxytocin 10 units IM
➢ Main purpose of contraction during
delivery is to expel the fetus and
placenta
➢ Main purpose of contraction after
delivery is to shut off the bleeders
Placenta
1. Placental Separation
a. Calkin sign/ globular sign of the fundus
b. The fundus rising in the abdomen
c. Sudden gush of blood
- When placenta is separated all
the blood vessels will be
separated that results gushing of
blood
- Normal occurrence
- Stop when the placenta is
separated
- Blood loss:
○ NSDV = 500ml
○ Cesarean
section
=
1000ml
d. Lengthening of the cord
- Umbilical cord is connected to
the forcep
- When placenta is removed to
where it is connected, it will
results to slowly going back to
the vaginal area
○ When the mother is giving birth she is in
a Lithotomy position
○ When there is resistance, do not push
through.
Wait until there is no
resistance
○ 5 - 30 minutes after delivery placenta is
ready to pull
A. Uterine Contraction
Palpate the Fundus
0mm Hg - no contraction
○ Intensity - Strength of uterine contraction
○ Increment - Increasing intensity
○ Decrement - Decreasing intensity
○ Acme - Peak of contraction
- Mild, Moderate or Strong
➢ Cheeks (mild), Nose (moderate)
or Forehead (strong)
○ Duration - Beginning of the one contraction to
the end of the same contraction (seconds)
○ Frequency - Beginning of one contraction to the
beginning of another contraction
○ Interval (resting) - end of the one contraction to
the beginning of another contraction (minutes)
2. Placental Delivery
a. Duncan delivery - Dirty side [Maternal
Side (hugaw tan’awon)]
b. Schultz delivery - Shiny (fetal side)
-
When summarizing, get the lowest and highest
(duration)
When summarizing, get those time that there is
no contraction (Interval)
Summarizing: With (Intensity) uterine
contractions + Lasting for (Duration) + every
(Interval)
Electro Fetal Monitor (EFM)
False Labor
●
●
●
●
●
●
●
●
Irregular interval contractions
Pain in the abdomen
Intensity remains the same
Intervals remain long
Walking gives relief
No bloody show
No cervical changes
Contractions stops with sedation
True Labor
Toco - monitoring of the
contraction
- Place it on top of fundus
uterine
●
●
●
●
●
●
●
●
Regular interval of contraction
Starts at the back to abdomen
Contractions are intensified
Intervals gradually shorten
Intensified by walking
With bloody show
Cervical dilatation and effacement
Does not stop with sedation
PRELIMINARY SIGNS OF LABOR
Ultrasound Transducer - Monitor the
fetal heart tone
- Place it on the fetal back
- Put ultrasound transducer gel to
detect waves and remove air
bubbles
Event Marker - Movement of the baby
- Inform mother to press one
everytime the baby moves
1.
2.
3.
4.
5.
6.
7.
Lightening
Loss of Weight
Increase in activity level
Braxton Hick’s contraction
Ripening of the cervix (soft)
Rupture of the membranes (bag of water)
Bloody show
Stages of Labor
★ First stage - Dilatation stage (true)
- Latent Phase
- Active Phase
- Transitional Phase
★ Second Stage – Fetal expulsion stage
- Dilated cervix = 10 cm
★ Third Stage – Placental Stage
★ Fourth Stage - Recovery
Base on the picture:
➢ 139 - Fetal Heart Tone
➢ 10 - value of uterine contraction
➢ Green line indicates normal range of
FHT
First Stage of Labor
●
●
●
●
●
●
●
Latent - “wala pa”
Active - “hapit na manganak”
Transitional - “transfer to DR, position for
delivery”
BOW - Bag Of Water
IBOW - Intact Bag Of Water
RBOW - Rupture Bag of Water (spontaneous)
ARM - Artificial Rupture of Membrane
(Intentionally)
NURSING CARE DURING THE 1ST STAGE
1. Admission care
2. Data gathering
3. Assisting IE
- Place patient Lithotomy Position
- Do Perineal Flushing
- Give Gloves and Gel to the MD
- DEBPS
4. Leopold’s maneuver
5. Fetal Heart Tone (FHT) Monitoring
6. Uterine Contraction Monitoring
7. Promote change in position
8. Empty the bladder
9. Hygiene
10. Enema administration
11. Perineal preparation
12. Analgesic administration as ordered
➢ Sedation - to relax the mother
13. Assist in the administration of
anesthesia
➢ Epidural - painless delivery
14. Start IVF as ordered
15. Assist in amniotomy
16. Watch out for SUBIRBA
17. Emotional support
When to position a patient for delivery? (impending
delivery)
○ S – Strong uterine contraction
○ U – Urge to defecate (8 - 10cm)
○ B – Bearing down sensation
○ I - Increase bloody show
○ R – Ruptured Bag of Water
○ B – Bulging of the perineum(area between
vagina and anus)
○ A – Anal dilation
CARDINAL MOVEMENTS OR MECHANISMS OF LABOR
-
DFIRE ERE
Descent
regional
Flexion
Expulsion
Expulsion
Internal
Rotation
Extension Beginning (rotation complete)
Extension
Extension Complete
Extension
Rotation
External Rotation (Restitution)
External Rotation
External Rotation (Shoulder rotation)
NURSING CARE ON SECOND STAGE
1. Lithotomy position
2. Perineal flushing
3. Drape aseptically
4. Teach breathing technique during uterine
relaxation
5. Teach pushing technique during uterine
contraction
6. Assist episiotomy
7. Do Ritgen’s maneuver
- To prevent further laceration
- Putting pressure on the perineum
8. Ease head out, wipe face and do initial
suctioning
9. Wait for external rotation
10. Pull head downward and upward to deliver the
shoulders
11. Deliver the body
12. Take note of time of delivery and sex of the
baby
- “BABY OUT! 6:03PM BABY GIRL!
13. Place baby on mother’s abdomen
14. Palpate for the pulsation of the cord, if
pulsations stops…
15. Clamp the cord 1 inch using plastic clamp from
baby’s abdomen
16. Milk the cord at least 2 cm towards the vulva,
then …
17. Clamp with a forcep, then…
18. Cut the cord between the 2 clamps but should
be near the plastic clamp.
Manual support of perineum:
Assist in the external rotation
1. Manual support of perineum with straight
fingers, support against the perineum
Initial Suctioning of Mouth and Nose
2. Manual support of perineum with bended
fingers, collecting the tissue when support
Deliver the shoulder
3. Manual support of perineum with thumb and
index fingers the three other fingers supports
the chin (modified Ritgen’s maneuver)
Head is Visible
Easing the head out
Deliver the body
Clamping and Cutting the Umbilical
Cord
Thorough suctioning of the newborn
Schultz
Deliver the placenta
○
Duncan
NURSING CARE ON THIRD STAGE
1. Wait for signs of placental separation
2. Do Brandt Andrew’s Maneuver
- Coiling the cord while applying traction
to facilitate the delivery of the placenta
3. Do Crede’s maneuver
- Applying counter traction
- Applying pressure on the hypogastric
area to prevent the uterus from coming
out.
Count Cotyledons - 15 to 20 or 25
counts
THIRD STAGE OF LABOR (PLACENTAL STAGE)
1. Placental Separation
a. Calkin’s sign-uterus becomes globular
and firm
b. Uterus rises above the abdomen
c. Sudden gush of blood
d. Lengthening of the cord
2. Placental delivery
● Schultz delivery – fetal, shiny
● Duncan Delivery – maternal, dirty, rough
4. Gently pull the placenta downward
5. Take not for the time of placental delivery
➢ “PLACENTA OUT! 7:03PM”
6. Check for type of placental delivery:
7. Take BP
8. Check for completeness of cotyledons
9. Promote uterine contraction:
- massage the hypogastric area
- Apply ice pack on the hypogastric area
-
Administer medication:
Oxytocin/Maleate
- Empty the bladder
10. Inspect perineum for laceration
11. Assist in episiorrhaphy
12. Do perineal care
13. Apply contoured brief/adult diaper
14. Make patient comfortable
NURSING CARE ON FOURTH STAGE
1.
2.
3.
4.
5.
6.
Assess fundus
Check for bleeding
Check the bladder
Check the perineum
Take vital signs every 15 minutes
Promote rest