You are on page 1of 34

The Royal Pentagon Review Specialist, Inc.

Maternity Nursing
Human Sexuality
a. Concepts
. A persons sexuality encompasses the complex behaviors, attitudes and emotions and preferences that is
related to sexual self and eroticism
!. Sex is basic and dynamic aspect of life
". During reproductive years, the nurse performs as resource person on human sexuality
# $ %% y.o. $ age o& repro'uctivity C()
*. +e&initions relate' to sexuality
,en'er I'entity sense of feminity and masculinity developed @age 3 or 2 ! y"o"
Role I'entity attitudes, behaviours and attitudes that differentiate roles
Sex biologic male or female status" sometimes referred to as specific sexual behavior such as sexual intercourse
Sexuality behavior of being a girl or boy and is identity sub#ect to a lifelong dynamic change
II. Sexual -natomy an' Physiology
a. .emale Repro'uctive System
. /xternal $ 0ulva1 Pu'en'a
a" Mons pu*is1 veneris mountain of venus, a pad of fatty tissues that lies over the symphysis pubis
covered by s$in and at puberty covered by pubic hair that serves as a cushion or protection to the
symphysis pubis
Stages o& Pu*ic Hair +evelopment 2Tool 3se'4 Tanner5s Scale1 Sexual Maturity Rating6
Stage % &re adolescence
no pubic hair, fine body hair
Stage 2 'ccurs bet" %% %2 y"o
sparse, long, slightly pigmented and curly that develop along labia
Stage 3 'ccurs bet" %2 %3 y"o"
hairs become dar$er and curlier develops along pubis symphysis
Stage ! %3 %! y"o"
hair ssumes normal appearance of an adult but is not so thic$ and does not appear to the
inner aspect of the upper thigh
Stage ( Sexual )aturity
assumes the normal appearance of an adult, appears at the inner aspect of thigh
b" 7a*ia Ma8ora large lips latin, longitudinal fold from perenium to pubis symphysis
c" 7a*ia Minora a$a *ymphae, soft and thin longitudinal fold created bet+een labia ma#ora
Clitoris ,$ey-, pea shaped erectile tissue composed of sensitive nerve endings. sight of
sexual arousal in females
.ourchet tapers posteriorly of the labia ma#ora" Site for episotomy
sensitive to manipulation, torn during pregnancy
d" 0esti*ule almond shaped area that contains the hymen, vaginal orifice and batholenes gland
3rinary Meatus small opening of urethra/ opening for urination
S9ene5s ,lan' a$a &araurethral 0land, 2 small mucus secreting glands for
lubrication
Hymen membranous tissue that covers the vaginal orifice
0aginal :ri&ice external opening of the vagina
(artholene5s ,lan' paravaginal gland, secretes al$aline substance, neutrali1es acidity of the
vagina
o +o'erleins (acillus responsible for vaginal acidity
o Parumculae Mysti&ormes healing of a hymen
e" Perenium muscular structure in bet+een lo+er vagina and anus
!. 2nternal
a" 0agina female organ for ovulation, passage+ay of menstruation, 3 inches 4 %5 cm long containing
rugae
o 6ugae permits considerable stretching +ithouit tearing during delivery 789
b" 3terus hollo+ muscular organ, varies in si1e, +eight and shape, organ of menstruation
Si;e 4 % x 2 x 3
Shape 4 pear shaped, pregnant ovoid
<eight 4 3terine involution C()
Non pregnant 4 #= $ >= g
Preganant 4 === g
%
th
stage o& 7a*or 4 === g
!
n'
wee9 a&ter o& +elivery 4 #== g
"
r'
wee9s a&ter 'elivery 4 "== g
# $ > <ee9s a&ter 'elivery4 #= $ >= g
:hree &arts of ;terus
.un'us upper cylindrical layer
1
Corpus1 (o'y upper triangular layer
Cervix lo+er cylindrical layer
Isthmus lo+er uterine segment during pregnancy
)uscular 7omposition< 3 main )uscles ma$ing possible expansion in all direction
a" /n'ometrium muscle layer for menses
o =ines the nonpregnant uterus
o >olumes the non pregnant uterus
o +eci'ua slouching off of endometrium during menstruation
o /n'ometriosis
?ctopic ?ndometrium
7ommon site is ovaries
&roliferation of abnormal gro+th of lining of outer part
&ersistent dysmenorrhea, lo+ bac$ pain
Dx ?xam< biopsy,laparoscopy
:x< =upron @luprolideA inhibits BSC D =C
:x< Dana1ol @DanacrineA D'7
%" 2nhibits ovulation
2" stop menstruation
*. Myometrium
o &o+er of labor
o Smooth muscles is considered to be =2>2*0 =20A:;6? @muscles of delivery, capable
of closingA of the body
o =argest portion of the uterus
c. Peremetrium
o &rotects the entire uterus
c" :varies
2 female sex gland
almond shape
Bxn< 'vulation,production of 2 hormones@ estrogen and progesteroneA
'. .allopian Tu*e
2 3 inches long that serves as a passage+ay of the sperm from the uterus to the ampulla or the
passage+ay of the mature ovum or fertili1ed ovum from the ampulla to the uterus
! significant segments
o In&un'i*ulum most distal part, trumpet shape, has fimbrae
o -mpulla outer 3
rd
or 2
nd
half, site of fertili1ation, common site for ectopic preg"
o Isthmus site for sterili1ation, site for 8:=
o Interstitial most dangerous site for ectopic pregnancy
*. Male Repro'uctive System
. /xternal
Penis
:he male organ of copulation and urination
7ontains of a body or shaft consisting of 3 cylindrical layers and erectile tissues
o 2 corpora cavernosa
o % corpus spongiosum
At the tip is the most sensitive area comparable to clitoris E glans penis
Scrotum
&ouch hanging belo+ the pendulous penis, +ith medial septum deviding into 2 sacs each containing
testes
6eFuires 2 degrees celcius for continuous spermatogenesis
7ooling mechanism of testes
!. Internal
The Process o& Spermatogenesis
Testes
@G55 coiled seminiferous tubulesA

epi'i'ymis
@site of maturation of sperm H mA

0as +e&erens
@conduit path+ay of spermA

Seminal 0esicle
@secreted< &ructose form of glucose, nutritative value
Prostaglan'in< causes reverse contraction of uterusA

/8aculatory +uct
@conduit of semesnA
2

Prostate ,lan'
@release al$aline substancesA

Cowpers ,lan'
@release al$aline substanceA

3rethra
Cypothalamus 0*6C

A&0

.SH maturation of sperm
7H testosterone production
7ey'ig Cells releases testosterone
Male ? &emale Homologues
Male .emale
&enile 0lans
&enile Shaft
:estes
&rostate
7o+pers 0lands
Scrotum
7litoris
7litoral shaft
'varies
S$enes gland
8artholins 0land
=abia )a#ora
III. (asic @nowle'ge on ,enetics an' :*stetrics
. +N- Deoxyribonucleic Acid carries genetic code
!. Chromosomes threadli$e structure of hereditary material $no+n as the D*A
". *ormal amount of e#aculated sperm " $ # cc1 teaspoon
%. 'vum is capable of being fertili1ed +ithin !% $ "> hours after ovulation"
#. Sperm %A $ B! 'ays via*ility
>. 6eproductive cells divide by the process of M/I:SIS @haploid numberA
Spermatogenesis process of maturation of sperm
:ogenesis process of maturation of ovum
o 35 +ee$s A'0 H million immature ovum
o @ birth % million immature oocytes
o @ puberty 355 !55 immature oocytes
o @ %3 y/o 355 !55 mature oocytes
o @ 23 y/o %45 245 mature ovum
o @ 33 y/o H5 %H5 mature ovum
o @ 3H y/o 2! %2! mature ovum
o @!H y/o ! mature ovum
,ametogenesis process of formation of t+o haploid into diploid
B. -ge o& repro'uctivity $ # $ %% y1o chil'*earing age $ != $ "# y1o
High ris9 CA ? D"# y.o. <ith Ris9 A $ !=E "= $ "#
A. Menstruation
Menstrual Cycle beginning of menstruation to the beginning of the next menstruation
Average menstrual cycle !A 'ays
Average menstrual period # 'ays
*ormal blood loss #= cc1 F cup accompanie' *y .I(RIN:7GSIS prevents clot formation
6elated terminologies
o Menarche %
st
menstruation
o +ysmenorrhea painful menstruation
o Metrorrhagia bleeding in bet+een menstruation
o Menorrhagia ?xcessive bleeding during menstruation
o -menorrhea absence of menstruation
o Menopause cessation of menstruation @Average Age (% y"o"A
To&u has isoflavone estrogen of plant that mimics the estrogen +ith a +oman
H. .unctions o& /strogen an' Progestin
/STR:,/N hormone of +oman
o &rimary function
6esponsible for the development of secondary characteristics in females
inhibit production of BSC
o 'ther function
Cypertrophy of the myometrium
Spinnbar$eit and Berning &attern @8illings )ethodA
Ductile structure of the breast
'steoblastic bone activity @causes increased in heightA
?arly closure of the epiphysis of the bone
3
Sodium retention
2ncreased sexual desire
6esponsible for vaginal lubrication
PR:,/ST/R:N/ Cormone of the mother
o &rimary function prepares the endometrium for implantation ma$ing it thic$ and tortous
o Secondary Bunction inhibit uterine contractibility
o 'thers
2nhibit =C @hormone of ovulationA production
02 motility
&ermeability of $idneys to lactose and dextrose causing I % sugar in urine
)ammary gland development
88:
)ood s+ings
=. Menstrual Cycle
! phases of menstrual cycle
. Proli&erative
!. Secretory
". Ischemic
%. Menses
. 'n the initial phase of menstruation, the estrogen level is , this level stimulates the hypothalamus to release ,nRH1
.SHR.
!. 0n6C/ BSC6B stimulates the anterior pituitary gland to release .SH
.SH .unction
o Stimulate ovaries to release estrogen
o Bacilitate the gro+th of primary follicle to become
,R--.I-N .:77IC/ structure that secretes large amount of estrogen that contain mature
ovum
". &roliferative &hase @estrogenA
Bollicular &hase responsible for the variation and irregularity of mense
&ostmenstrual &eriod after menstruation
&reovulatory &hase happen before menstruation
%. %3
th
day of menstruation, estrogen level is P/-@ +hile progesterone is , these stimulates the hypothalamus to release
0n6C/ =C6B
#. ,nRH1 7HR. stimulates the Anterior &ituitary 0land to release 7H
Bunctions of =C
o Stimulates the release of progesterone
o Cormone for ovulation
>. %!
th
day estrogen level is +hile progesterone level is
S/S
o 6upture of the graafian follicle '>;=A:2'*
o Mittelschsmer; slight abdominal pain lo+er right Fuadrant
B. %(
th
day, after ovulation day, graafian follicle starts to degenerate, estrogen level , progesterone , causing degeneration
of the graafian follicle becoming yello+insh $no+n as C:RP3S 73T/3M secretes large amount of progesterone
A. Secretory &hase
=utheal &hase 2progesterone6
&ostovulatory phase
&remenstrual &hase
H. 2!
th
day Corpus -l*icans @+hitishA corpus luteum degenerates and becomes +hite
=. 24
th
day if no sperm united the ovum, the uterine begins to slough off to have the next menstruation
*ote<
if there is no fertili1ation, corpus luteum continues functioning
'varian 7ycle from primary follicle corpus albicans
Stages<
o % ( days menses
o H %! proliferative
o %( 2H secretory
o 2J 24 ischemic
. Stages of Cuman Sexual 6esponse
2nitial 6esponse<
>AS'7'*0?S:2'* constriction of blood vessels
)K':'*2A increased muscle tension
/xcitement Phase
muscle tension, moderate >S
erotic stimuli causing sexual tension, may last from minutes to hours
Plateu Phase
and sustained tension near orgasm
4
may last 35 sec 35 minutes
:rgasm
2nvoluntary release of sexual tension accompanied by physiologic and psychologic release,
immeasurable pea$ of experience 2 3 seconds
Resolution
6eturn to normal state
>S return to normal
R/.R-CT:RG P/RI:+ only period present in male, +herein he cannot restimulated for about %5 %( minutes
I0. <on'ers o& .ertili;ation
a. .ertili;ation
. Phonones song of sperm
!. Capacitation ability of sperm to release proteolytic en1yme and penetrate the ovum
*. Stages o& .etal ,rowth an' +evelopment
. Pre /m*ryonic Stage
2" Iygote fertili1ed ovum @3 ! days travel, ! days floatingAL from fertili1ation
22" Morula mulberryli$ed ball containing %H (5 cells
222" (lastocyst enlarging cell forming a cavity that later becomes the embryo covered by thropoblast +hich later becomes the
placenta and membrane
2>" Implantation J %5 days after fertili1ation
:hropoblast covering of blastocyst that become placenta
S/Sx of 2mplantation Slight pain, Slight >aginal Spotting
3 &rocesses
o -pposition
o -'hesion
o Invasion
!. /m*ryonic Stage
Iygote fertili1ation to %! days
/m*ryo %(
th
2 mos/ 4 +ee$s
.etus 2 mos to birth
c" +eci'ua thic$ened endometrium, latin +ord for ,falling off-
. (asalis located directly under the fetus +here placenta developed
!. Caspularis encapsulates the fetus
". 0era remaining portion of and endometrium
d" Chorionic 0illi %5 %% +ee$s
. Chorionic 0illi Sampling 2C0S6 removal of tissue from the fetal postion of the developing placenta
Bor genetic screening
Betal limb defects, missing digits of toes
e" Cytothropho*last outer layer, 7-N,H-N5S 7-G/R, protect the fetus against syphilis @2! +ee$s/ H monthsA
f" Synsitiotropho*last syncitial layer responsible for hormone production
. -mnion inner most layer 2" Chorion
2" 3m*ilical cor' 2.unisA +hitish gray @(5 H5 cmA
Short abruptio placenta, uterine inversion
=ong cord prolapse, cord coil
3 vessels @A>AA Artery >ein Artery
<harton5s Jelly protects the umbilical cord
22" -mniotic &lui' bag of +ater clear color, musty/mousy odor
Mith crystalli1ed forming pattern, slightly al$aline
(55 %555 cc *ormal
o 'ligohydramnios $idney malformation
o Cydramnios 02: , :?B/ :?A
Bunctions
o 7ushion the fetus against sudden blo+ or trauma
o )aintains temperature
o Bacilitate muscus$eletal development
o &revents cord compression
o Celps in development process
+iagnostic Test &or -mniotic .lui' -mniocentesis
&urpose< obtain sample of amniotic fluid by inserting a needle hrough the abdomen into the amniotic sac
Bluid is tested for<
0enetic screening
Determination of fetal maturity primarily by evaluating factors indicative of lung maturity
Done +ith empty bladder
7omplication
L )ost common side effect < 2*B?7:2'*
L =ate < pre term labor
L ?arly < spontaneous abortion
2ndication for Amniocentesis<
L ?arly in &regnancy Advance )aternal Age
5
L =ater in &regnancy Diabetic )others
do+n syndrome
neural tube defect, spina befida
=/S ratio < 2<% @=ecitin/ SpingomyelinA
Definitive test E &hosphatiglycerol< &0 I best Ans+er
0reenish )econium Stains @Betal DistressA
Kello+ish #aundice, hyperbilirubinemia
7loudy 2nfection
)ost 2mportant 7onsideration *eedle insertion site
Amnioscopy direct examination through intact fetal membrane via ultrasound
Bern :est a test determining if bag of +ater has rupture or not
*itra1ine &aper :est differentiate amniotic fluid and urine 8lue geen I rupture of bag of C2'
!. Chorion outermost layer
a" Placenta ANA Secundines chorionic >illi and basalis
&anca$e in latin
(55 grams in +eight
%( 24 cotyledons
%( 25 cm in diameter and 2 3 cm in depth
Bunctions
o 6espiratory 52 7'2 exchange via simple diffusion
o 02: glucose transport via facilitated diffusion
o ?xcretory via 2 arteries, carries unoxygenated blood then detoxify by
maternal liver
o 7irculatory fetoplacental circulation by S?=?7:2>? 'S)'S2S
o ?ndocrine
C70 primary maintain corpus luteum/ secondary basis of
pregnancy test
Cuman &lacental =actogen a$a Somatomammothrophin
6esponsible for the development of mammary gland
Diabetogenic ?ffect insulin antagonist
6elaxin softening of maternal #oints and bones
o Serves as protective barrier against some microorganism
7an pass< C2> 7)> 6ubella
&2*'7K:'S2S transport of virus
&regnancy 2HH 244 days/ 3J !2 +ee$s
./T-7 ST-,/4 .etal ,rowth an' +evelopment
.irst Trimester 4 Perio' o& organogenesis, most critical perio'
.irst Month
.HT, CNS +evelops, ,IT an' Respi Tract remains as single tu*e
Differentiation of &rimary 0erm =ayer
?ndoderm
o :hyroid responsible for basal metabolism
o :hymus immunity
o =iver
o 02:
o =inings of ;pper 02 :ract
)esoderm
o Ceart
o )usculos$eletal
o 6eproductive 'rgan
o Nidney
?ctoderm
o 8rain
o 7*S
o S$in
o ( senses
o Cair, nails
o Anus
o )outh
Secon' Month
=ife span of corpus luteum ends
All vital organs are formed
&lacenta is developed
Sex organ is developed
)econium is present
Thir' Month
6
&lacenta is complete
Nidneys are functional
Betus begins to s+allo+ amniotic fluid
8uds of mil$ appear
Sex is distinguishable
BC: audible via dopples @ %5 %2 +ee$s
Terratogens any drug or irradiation, the exposure to +hich may cause damage to the fetus
+R3,S
o Streptomycin anti :8 @FuinineA damage to the 4th cranial nerve poor learning and deafness/ ototoxic
o Tetracycline stoning the tooth enamel, inhibits long bone gro+th
o 0itamin @ hemolysis, destruction of 687, #aundice, hyperbilirubenemia
o Io'i'es enlargement of thyroid and goiter
o Thali'omi'es antiemetics Amelia or &ocomelia absence of distal part of extremities
o Steroi's cleft lip or palate and even abortion
o 7ithium congenital maformation
-7C:H:7 =8M, fetal alcohol syndrome @ characteri1ed by microcephalyA
SM:@IN, =8M
C-../IN/ =8M
C:CC-IN/ =8M, abruptio placenta
T:RCH group of infections that can cross the placenta or ascend through the birth canal and adversely effect fetal gro+th
o :oxoplasmosis cat lovers
o 'thers Cepa A8, C2>, Syphillis
o 6ubella 7CD,
6ubella :iter * @ %<%5 or E immunity to rubella E notify doctor
6ubella vaccine after delivery for 3 mos" *o pregnancy for 3 mos"
o 7ytomegalo virus
o Cerpes Simplex virus
Secon' Trimester 4 continuous growth an' 'evelopment 2&ocus lengh o& &etus6
.ourth Month
=anugo begins to appear
8uds of permanent teeth appear
BC: audible via Betuscope @ %4 25 +ee$s
.i&th Month
9uic$ening < %
st
fetal movement &rimi< %4 25, *ulli %H %4
=anugo covers the body
BC: audible via stethoscope or +/out instrument
Actively s+allo+ amniotic fluid
Betus < %G 2( cm
Sixth Month
S$in is red and +rin$led
>ernix caseosa covers the s$in
?yelids open
?xhibits startle reflex
"
r'
Trimester 4 perio' o& most rapi' growth an' 'evelopment .ocus4 weight
Seventh Month
Surfactant development
)ale< the testes begins to descent into the scrotal sac
Bemale < clitoris is prominent and labia ma#ora are small doesnt cover the minora
/ight Month
Active moro reflex
=anugo begins to disappear
Sub F fats deposits, steady +eight gain, nails to fingers
Ninth Month
=anugos and vernix caseosa is evident in body fold
8irth position assumed
Amniotic fluid some+hat decrease
Sole of the foot has fe+ creases
Tenth Month
8one ossification in the fetal s$ull
>ernix caseosa is evident in body
PHGSI:7:,IC -+-PT-TI:N T: PR/,N-NCG
Systemic Changes
. Car'iovascular System
blood volume 35 (5O
%(55 cc. additional (55 cc for multiple pregnancy
plasma volume
7
cardiac +or$load easy fatigability/ slight ventricular hypertrophy
?pistaxis due to hyperemia of nasal membrane
&alpitation due to S*S stimulation
Physiologic -nemia1 pseu'oanemia in pregnacy
o *ormal >alue
Cct < 32 !2O
Cgb< %5"( %! g/dl
o 7riteria
%
st
D 3
rd
:rimester < Cct L 33O Cgb L %% g/dl
2
nd
:rimester < Cct L 32O Cgb L %5"( g/dl
o &athologic Anemia
Iron +e&&iciency -nemia is the most common hematologic disorder" 2t affects 25O of pregnant
+omen
Assesment reveals<
&allor
Slo+ed capillary refill E *ormal E 2 3 sec
7oncave fingernails @late sign of progressive anemiaA clubbing E chronic tissue
hypoxia
constipation
*ursing care
*utritional instruction
o Source of iron
Nang$ong
=iver E best source due to B?662D2* 7ontent
6ed and lean meat
0reen =eafy >egetables
&arenteral 2ron @2mferonA
o P tract 2)
o incorrect causes hematoma
o best given % hour before meals @causes 02 irritationA
o )aybe given 2 hours after meal @results to poor absorptionA
0iven +ith orange #uice to absorption
'ral 2ron Supplements @ferrous sulfate 5"3 g 3 x a dayA
)onitor for hemorrhage
Alert
2ron from red meat is better absorbed iron from other sources
2ron is better absorbed +hen ta$en +ith foods high in >itamin 7 such as orange #uice
Cigher iron inta$e is recommended since circulating blood volume is increased and
heme is reFuired from production of 687s
/'ema
o 2mpeded venous return due to the gravid uterus
o *ursing 2ntervention
?levate legs above the hips level
0aricosities
o Mear support stoc$ings
o ?levate legs
0ulvar 0aricosities
o D/t pressure of gravid uterus
o Side lying +ith pillo+ under the hips
o )odified $nee chest position
Throm*ophle*itis
o &resence of thrombus in inflamed blood vessels
o I Comans Sign pain on the calf upon dorsiflexion
o )edical )anagement
Anticoagulant/ C?&A62*
Does not cross the placental barrier
)onitor A&::
Antidote< &6':A)2*? S;=BA:?
*o aspirin
Mil9 7eg1 Plagmasia -l*a +olens
o Shiny +hite legs due to stretching of s$in D hyperfibrinogenemia
o *ursing intervention
7hec$ dorsalis pedis pulse @compare bothA
*ever massage
Assess for Comans sign only once
!. Respiratory System
Shortness of 8reath d/t gravid uterus
*ursing intervention< Sidelying lateral expansion of the lungs
8
". ,astrointestinal System
Nausea an' vomiting
Morning Sic9ness
o Due to C70 levels
o 7rac$ers 35 min before arising
o A) 7arb diet 35 mins
o &) small freFuent meal
Constipation
o Due to &6'0?S:?6'*? E fluid reabsorption due to 02: motility
o *ursing intervention
Bluid
Biber
?xercise
.latulence
o Due to increased progesterone
o Avoid gas forming foods
Heart*urn 2pyrosis6
o 6eflux of stomach content into esophagus
o *ursing 2ntervention
Small freFuent meals
Sips of mil$
Avoid fatty and spicy foods
&roper body mechanics
o Maist -bove Acid
o Maist (elo+ 8ase
Hemorrhoi's
o Due to gravid uterus
o Cot sit1 bath for comfort
Ptyalism
o salivation
o )outh+ashes to relieve
%. 3rinary System
*ormal E I % sugar due to &rogesterone via 8?*?D27:S :?S:
Birst :rimester BreFuency
Second :rimester normal
:hird :rimester BreFuency
#. Muscolos9eletal
7alcium sources
o )il$ 7a & % pint/ day or 3 ! servings/ day
o 7heese, Kogurt, Cead of Bish, Sardines, Anchovies, 8rocolli
7or'osis
o &ride of &regnacy
<a''ling ,ait
o A+$+ard gait +hile +al$ing due to relaxin
o &rone to accidental falls
Mear lo+ healed shoes
7eg Cramps
o 7a & 2mbalance during pregnancy
o =umbosacral nerves by pressure of gravid uterus during labor
o 'ver sex
o Dorsiflex the foot affected
o 3! servings/ ! cups/day sa mil$, sardines, dilis
. 7ocal Changes
0agina
o Cha'wic95s Sign $ bluish discoloration
o 7eu9orrhea $ +hitish gray, moderate in amount, mousy odor
Cervix
o ,oo'el5s Sign $ change in consistency of uterus
o :perculum mucus plug to seal bacteria/ progesterone
3terus
o Hegar5s Sign $ change in consistency
>agina 7had+ic$s
7ervix 0oodels
;terus Cegars
9
Problems related to the changes of Vaginal Environment
a. 0aginitis K -0:C-+:
:richomonas >aginalis
o Blagellated protox1oan, =oves ala$aline environment
Signs and Symptoms
o 0reenish, cream, colored, frothy, irritably itchy, foul smelling vaginal discharge
o >aginal edema
)anagement
o Drug of choice< )?:6'*2DAP'=? @BlagylA
Antiproto1oan
7arcinogenic
*ot given in %
st
trimester
vaginal douche as substitue
o % Ft Mater E % tbsp +hite vinegar
o :reat partner as +ell to prevent reinfection
o *o alcohol due to antabuse effect
*. Moniliasis K CH//S/
7andida Albicans
:ransvaginal transfer in fetus 'ral :rush
Signs and Symptoms
o Mhite 7heeseli$e patches that adheres to the +alls of the vagina
)anagement
o Antifungals
)ycostatin
7ontrima1ole 7anisten
0entian >iolet
. -*'ominal Changes
Striae 0ravidarum
o Due to destruction of the subcutaneous tissue by the enlarge uterus
!. S9in Changes
)elasma/ 7hloasma
o Mhite light bro+n pigmentation related to melanocytes
=inea *igra
o 8ro+n pin$ish line from symphysis pubis to umbilicus
". (reast Changes
Due to hormonal changes
7hange in color and si1e of nipple and areola
&recolostrum H +ee$s
7olustrum 3
rd
trimester
Supine +ith pillo+ under the bac$
%. :varies $ rest perio', no ovulation
#. Signs an' Symptoms o& Pregnancy
Presumptive
S/sx felt and observed by the mother
but does not confirm the diagnosis of
pregnancy
Pro*a*le
Signs observed by the
members of the health
care team
Positive
;ndeniable signs confirmed by the use
of instrument
Birst trimester (reast changes
3rinary changes
.atigue
-menorrhea
Morning sic$ness
/nlarge uterus
,oodels sign
Chad+ic$s sign
Hegars sign
/levated 88:
Positive C70
3ltrasound ?vidence
Second
:rimester
Chloasma
7inea *igra
Increase S$in &igmentation
Striae gravidarum
)uic$ening
(allotement
/nlarge Abdomen
(raxton Cic$s 7ontraction

etal Ceart :one
etal movement
etal outline
etal parts palpable
C() Cancer o& the (reast Lua'rant (
)amography 3( and above %/ year
8allotement bouncing of the fetus
may be present in uterine myoma
:ransvaginal ;ltrasound empty bladder
Abdoiminal ulrasound full bladder
Placenta ,ra'ing System
0rade 5 immature
0rade % slightly mature
10
0rade 2 moderately mature
0rade 3 fully mature
Mhat is depositedQ calcium
0I. Psychological -'aptation to Pregnancy $ Reva Ru*in
.irst Trimester
*o tangible s/sx
Beeling of surprise
Ambivalence
Denial of pregnancy maladaptation
Developmental :as$< Accept biological facts of pregnancy
Cealth :eaching< 8ody changes of pregnancy and *utrition
Secon' Trimester
:angible s/sx
)other identifies fetus as separate entity due to Fuic$ening
Bantasy
Developmental :as$< Accept gro+ing fetus as a baby to nurture
Cealth :eaching< 0ro+th and development of fetus
Thir' Trimester
)other has personally identifies +ith the appearance of the baby
Developmental :as$< &repare child birth and parenting the child
Cealth :eaching< responsible parenthood, prepare babys layette, =ama1e 7lass
Address )others fear let she hear the BC:
0II. Pre $ Natal 0isit
(asic Consi'eration
. .reLuency o& 0isit
% J
th
mos" once a month
4 G
th
mos" t+ice per month
%5
th
month every +ee$
!. Personal +ata
Home (ase' Mother5s Recor'1 H(MR determines high ris$ pregnancy
Pseu'ocyesis false pregnancy appearance of presumptive D probable signs
Coma'e Syn'rome psycosomatic disorder, father experience +hat the mother goes through
". +iagnosis o& Pregnancy
;rine ?xam C70 !5 %55
th
day. pea$ H5 J5
th
day
?=2SA beta subunits of C70 is detected as early as J %5
th
day
62A beta subunits of C70 is detected as early as 4
th
day
Come &regnancy Nit
%. (aseline +ata
6oll 'ver :est test of preeclampsia by the use of 8&
Meight monitoring
*ormal Meight 0ain
%
st
:rimester E %"( 3 lbs % lb/ mo
2
nd
:rimester E %5 %2 lbs ! lbs/mo
3
rd
:rimester E %5 %2 lbs ! lbs/mo
)inimum allo+able +eight gain 25 2( lbs
'ptimal +eight gain 2( 3( lbs
#. :*stetrical +ata
a" ,ravi'a no" of pregnancy
b" Para no" of viable pregnancy
0ia*ility the ability of the fetus to live outside the uterus at the earliest possible gestational age
% abortion % 3G
:C
Mee$, % miscarriage, % still birth, % 2
nd
mo" preg
% pregnancy 3
rd
mos" 0!&2 0! :% &% A% =%
02&5 02 :5 &5 A% =5
c. Important /stimates
. *ageles 6ule
11
;se to determine expected date of delivery
Ran )ar IG months IJ days
Apr Dec 3 months IJ days I % year
!. Mc+onal'5s Rule
Determines age of gestation in +ee$s
Bundic Ceight x J/4 E A'0 in +ee$s
". (artholomew5s Rule
Determines age of gestations
o 3 mos above pubis symphysis
o ( mos level of umbilicus
o G mos belo+ xiphoid process
o %5 mos level of 4
th
mos
%. Haases Rule
Determines the length of fetus in cm"
%
st
half sFuare each month
2
nd
half month x (
'. Tetanus Immuni;ation
::% anytime or early during pregnancy
::2 % month after ::% 3 years protection
::3 H months after ::2 ( years of protection
::! % year after ::3 %5 years of protection
::( % year after ::! lifetime protection
#. Physical /xaminations
a. +anger Signs o& Pregnancy
Chills D Bever
Cerebral Disturbances
-bdominal &ain epigastric pain auro of impending convulsion
(oardli$e Abdomen Abruptio placenta
(lurred >ission pre eclampsia
(leeding abortion/ ectopic pregnancy %
st
trimester
C )ole/ 2ncompetent 7ervix 2
nd
trimester
&lacental Anomalies 3
rd
:rimester
(&
S+elling
Scotoma spots in the eye
Sudden gush of fluid &6') premature rupture of membrane
>. Pelvic /xamination
&elvic examination or 2? empty bladder, precaution
%st visit 7had+ic$s, 0oodles sign, etc"
&osition < dorsal recumbent, lithotomy
&ap smear done %st visit
7ytological exam determine presence of cancer cells"
6esult <
o 7lass 2 normal
o 7lass 22 A cytology +ithout evidence of malignancy
8 suggestive of inflammation
o 7lass 222 cytology suggestive of malignancy
o 7lass 2> cytology suggestive og malignancy
o 7lass > conclusive for malignancy
)ost common cancer report organ < cervical cancer
)ost common site for pap smear external 'S of cervix @sFuamocolumnar tissueA
7ommon site of cervical cancer" maternal speculum @openA
Stages o& cervical cancer
o 5 carcinoma in situ
o % 7a strictly confined to cervix
o 2 from cervix extends to the vagina
o 3 pelvic metastasis
o ! affectation to bladder D rectum
B. 7eopol's Maneuver
Purpose4 Done to determine the attitude, fetal presentation, lie, presenting part, degree of descent an estimate of the si1e, and
no" of fetuses
&rocedure
%" %
st
maneuver
o place patient in supine position +ith $nees slightly flexed" &ut to+el under head and right hip" Mith both hands palpate
uppe!r abdomen and fundus" Assess si1e, shape, movement and firmness of the part
12
o determine the presenting parts<
2" 2
nd
maneuver
o +ith both hands moving do+n, identify the bac$ of the fetus +here the ball of the stethoscope is placed to determine
BC:"
o PR o& mother 4 uterine sou&&lM $ MHR
o &un'ic sou&&lM $ .HR
3" 3
rd
maneuver
o using the right hand, grasp the symphysis pubis part using the thumb and fingers"
o Assess +hether the presenting part is engaged in the pelvis"
o AlertS 2f the head is engaged it +ill not be movable
!" !
th
maneuver
o the examiner changes the position by facing the patients feet" Mith t+o hands, assess the descent of the presenting
part by locating the cephalic prominence or bro+"
o Mhen the bro+ is on the same side as the bac$, the head is extended" Mhen the bro+ is on the same side as the small
parts, the head 4is flexed and vertex presenting"
-ttitu'e relationship of fetus to one another"
.ull .lexion +hen the chin touches the chest
A. -ssessment o& .etal <ellK*eing
a. +aily &etal Movement Counting 2+.MC6
Done starting 2J
th
+ee$
7onsideration
fetal sleep +a$e pattern
maternal food inta$e
drugnicotine use
environmental stimuli
maternal dose
Car'i&& count to = metho' $ one method currently available
o begin at the same time each day @usually in the morning after brea$fast A and count each fetal movement,
noting ho+ long it ta$es to count %5 fetal movements @B)sA
o expected findings %5 movements in %hrs or less
o +arning signs %5%2 movements in %hr or less
more than %hr to reach %5 movements
less than %5 movements in %2hrs
longer time to reach %5 B)s than on previous days"
movements are becoming +ea$er, less vigorous
movement alarm signal T3 B)s in %2hrs
o +arning signs should be reported to healthcare provider immediately. often reFuire further testing" ?g" *on
stress test @*S:A, biophysical profile @8&&A
*. Nonstress Test
o to determine the response of the fetal heart rate to the stress to activity"
o 2ndications pregnancies at ris$ for
o placental insufficiency
o &ostmaturity
pregnancy induced hypertension @&2CA, diabetes
+arning signs noted during DB)7
maternal history of smo$ing, inadeFuate nutrition
o &rocedure <
Done +ithin 35mins +herein the mother is in semifo+lers position. external monitor is applied to document
fetal activity. mother activates the ,mar$ button- on the electronic monitor +hen she feels fetal movement"
Attach external noninvasive fetal monitors
tocotransducer over fundus to detect uterine contractions and fetal movements @B)sA
ultrasound transducer over abdominal site +here most distinct fetal heart sounds are detected
monitor until at least 2 B)s are detected in 25mins"
o if no B) after !5mins provide +omen +ith a light snac$ or gently stimulate fetus through abdomen
o 2f no B) after %hr further testing may be indicated, such as a 7S:
o 6esult <
*oncreative *onstress *ot 0ood
6eactive 6esponse is 6eal 0ood
o 2nterpretation of results
6eactive result real good
baseline BC6 bet+een traction beteen %25 and %H5 beats per min"
at least t+o accelerations of the BC6 of at least %( beats per min", lasting at least %(secs in a %5 to
25 min period as a result of B)
good variability normal irregularity of cardiac rhythm representing a balanced interaction bet+een
the parasympathetic @U BC6A and sympathetic @V BC6A nervous system. noted as an uneven line on
the rhythm strip
result indicates a healthy fetus +ith an intact nervous system
o Nonreactive result $ not goo'
13
stated criteria for a reative result are not met
could be indicative of a compromised fetus reFuires further evaluation +ith another *S:, biophysical
profile, @8&&A or contraction stress test @7S:A
H. Health Teachings
o do nutritional assessment
o daily food inta$e
o determine habit
o if U folic acid lead to spina bifida/open neural tube defect
o HI,H RIS@ M:TH/RS
pregnant teenagers poor compliance to health regimen
extremes in +t under+t eg" ?lite models over+t eg" D)/C&*
lo+ social economic status" 6efer to 'SMD
vegetarian mothers because U inta$e of vit 8%2 @7yanocobalaminA formation of folic acid @cell D*A D 6*A
formationA
types <
strict vegetarian prone to develop anemia
lacto vegetarian mil$
lactoovo vegetarian mil$ D egg
a. Recommen'e' Nutrient ReLuirement that Increases +uring Pregnancy
Nutrients ReLuirements .oo' sources
Calories
?ssential to supply energy for
metabolic rate
;tili1ation of nutrients
&rotein sparing so it can be used for <
o gro+th of fetus
o development of structures
reFuires for pregnancy
including placenta, amniotic
fluid, tissue gro+th
355 calories/day above the prepregnancy
daily reFuirement to maintain ideal body
+eight and meet energy reFuirement of
activity level
begin in 2
nd
:rimester
use +tgain pattern as an indication of
adeFuacy of calories inta$e
failure to meet caloric reFuirements can
lead to $etosis as fat D protein are used
for energy, $etosis has been associated
+ith fetal damage"
*on pregnant< 2255 calories
&regnant< 2(55 calories
2255I(55 @ lactationE2J55 cal
7aloric should reflect
foods of high nutrient value such as
protein, complex carbohydrates @+hole
grains, vegetables, fruitsA
variety of foods representing food sources
for the nutrients reFuired during pregnancy
no more than 35O fat
*a 3gms/day eat in moderation
7C'* x !N 7al
7C' x !N 7al
Bats x GN 7al
Protein
?ssential for
fetal tissue gro+th
maternal tissue gro+th including uterus
and breasts"
Development of essential pregnancy
structures
Bormation of 687 and plasma proteins
2nadeFuate protein inta$e has been
associated +ith onset of pregnancy induced
hypertension @&2CA
H5mg/day or an of %5O above daily
reFuirements for age group
Adolescents have a higher protein
reFuirement than mature +omen since
adolescents must supply protein for their
o+n gro+th as +ell as protein to meet the
pregnancy reFuirement
&rotein should reflect
=ean meat, poultry, fish
?ggs, cheese, mil$
Dried beans, lentils, nuts
Mhole grains
>egetarians must ta$e note of the amino
acid content of 7C'* foods consumed to
ensure ingestion of sufficient Fuantities of all
amino acids
CalciumKPhosphorous
?ssential for
0ro+th and development of fetal
s$eleton and tooth buds
)aintenance of minerali1ation of
maternal bones and teeth
7urrent research is demonstrating an
association bet+een adeFuate calcium
inta$e and the prevention of pregnancy
induced hypertension
7alcium of
%255mg/day representing an of (5O
above pre pregnancy daily reFuirement
%H55mg/day is recommended for
adolescent
%5mcg/day of vitamin D is reFuired since
it enhances absorption of both calcium
and phosphorous
7alcium should reflect
Dairy products, mil$, yogurt, ice cream,
cheese, egg yol$
Mhole grain, tofu
0reen leafy vegetables
7anned salmon D sardines +ith bones
7a fortified foods such as orange #uice
>itamin D sources fortified mil$, margarine,
egg yol$, butter, liver, seafood
Iron
?ssential for
?xpansion of blood volume D 687
formation
?stablishment of fetal iron stores for first
fe+ months of life
*on &regnat<%(mg/day
&regnant < 35mg/day
representing a doubling of the
prepregnant daily reFuirement
8egin supplementation at 35mg/day in
second trimester, since diet alone is
unable to meet pregnancy reFuirement
H5 %25mg/day along +ith copper and
1inc supplementation for +omen +ho
have lo+ Cgb values prior to pregnancy
2ron should reflect
liver, red meat, fish, poultry, eggs
enriched, +hole grain cereals D breads
dar$ green leafy vegetables, legumes
nuts, dries fruits
vitamin 7 sources< citrus fruits D #uices,
stra+berries, cantaloupe, tomatoes,
green peppers, broccoli or cabbage,
potatoes
14
or +ho have iron deficiency anemia
J5mg/day of vitamin 7 +hich enhances
iron absortion
o 2nadeFuate iron inta$e results in
maternal effects anemia, depletion
of iron stores, U energy and
appetite, cardiac stress especially
during labor D birth
o fetal effects availability of oxygen
thereby affecting fetal gro+th
iron deficiency anemia is the most
common nutritional disorder of
pregnancy
iron form food sources is more readily
absorbed +hen served +ith foods high
in vit 7
Iinc
?ssential for
the formation of en1ymes
maybe be important in the prevention
of congenital malformation of the fetus
%( g/day representing an of 3mg/day
over prepregnant daily reFuirement
Pinc should reflect
liver, meats
shell fish
grains, legumes, nuts
.olic aci's, &olacin, &olate
?ssential for
Bormation of 687 D prevention of
anemia
D*A synthesis D cell formation. may
play a role in the prevention of neural
tube defects @spina bifidaA, abortion,
abruption placenta
!55mcg/day representing an of more
than 2x the daily prepregnant reFuirement
355mcg/day supplement for +omen +ith lo+
folate levels or dietary deficiency
should reflect
=iver" Nidney, lean bee$, veal
Dar$, green leafy vegetables, broccoli,
asparagus, articho$es, legumes
Mhole grains, preanuts
Additional reFuirements
Minerals
2odine
)agnesium
selenium
%J(mcg/day
325mg/day
H(mcg/day
reFuirements of pregnancy can easily be
met +ith a balanced diet that meets the
reFuirement for calories and includes food
sources high in the other nutrients needed
during pregnancy
>itamins
?
:hiamine
6iboflavin
&yridoxine @8HA
8%2
*iacin
%5mg/day
%"(mg/day
%"Hmg/day
2"2mg/day
2"2mcg/day
%Jmg/day
*. Sexual -ctivity
Principles o& sex in Pregnancy
o Should be done in moderation
o Should be done in a private place
o :hat the mother should be placed in a comfortable position
o 2t must be avoided H +ee$s prior to ?DD
o Avoid blo+ing of air during cunnilingus
Contrain'ication in sex4
o vaginal spotting %
st
tri
o incompetent cervix 2
nd
tri
o placenta previa, abruption placenta 3
rd
tri
o preterm labor 6< prostaglandin oxytocin contraction
o &6') infection
Changes in sexual appetite 'uring pregnancy4
o %
st
tri
o 2
nd
tri
o 3
rd
tri
c. /xercise
strengthen muscle to be used during the delivery process
<al9ing best form of exercise
SLuatting strengthen perineum D Vcirculation to the perineum @raise the buttoc$s before head to prevent postural hypotensionA
Tailor sitting same purpose +ith sFuatting
@egel exercise strengthen pubococcygeal muscle
-*'ominal exercise muscle of the abdomen @ done as if blo+ing a candleA
Shoul'er circling exercise strengthen muscle of the chest
15
Pelvic roc9ing exercise or pelvic tilt relieve lo+ bac$ pain D maintain good posture @arching bac$ for 3 secA
Principles o& exercise
o must be done in moderation
o must be individuali1ed
'. Chil'*irth Preparation
:verall goal4 :o prepare patents physically D psychologically +hile promoting +ellness behavior that can be used by parents D
family thus, helping them achieved a satisfying D en#oying childbirth experiences"
Psychological
o (ra'ley Metho' Dr" 6obert 8radley discoverer
advocated active participation of husband during labor D delivery to serve as coach, based on ,imitation of
nature-
Beatures<
dar$ened room
Fuiet D calm environment
relaxation techniFue
close eyes
o ,rantly +ic9 Rea' Metho'
fear can lead to tension +hile tension can lead to pain" @brea$ cycle by removing the fearby abdominal
breathing exercises D relaxation techniFueA
Psychosexual
o @it;inger Metho' Dr" Shiella Nit1inger
pregnancy, labor D birth D the care of the ne+born is an important turning point in a +omans life cycle"
,flo+ing +ith contractions rather than struggle +ith contractions-
Psychoprophylaxis
o 7ama;e Dr" Berdinand =ama1e
&revention of pain thru mind D reFuires discipline, conditioning D concentration +ith the husbands help"
Beatures<
conscious relaxation
cleansing breathe inhaling thru nose D exhaling thru mouth
effleurage gentle circular massage
over abdomen to relieve pain
imaging
+i&&erent metho's o& 'elivery
o *irthing chain semifo+lers mother
o *athing *e' dorsal recumbent
o sLuatting position relieve on bac$ pain D maintain good posture
o 7e*oyer5s metho'
features <
dar$ly lighted room
Fuiet D calm environment
room temp"
soft music
o (irth un'er water
IN. INTR-P-RT-7 N:T/S
-. -'mitting the la*oring Mother
&ersonal data
8aseline data
'bstetrical data
&hysical exams
&elvic exams
(. (asic 9nowle'ge in intrapartum
Theories o& the :nset o& 7a*or
o 3terine Stretch Theory any hollo+ organ once stretched to its maximum potential +ill al+ays contract D expel its
content
o :xytocin Theory released by &&0, contraction effect
o Prostaglan'in Theory stimulation by Arachidonic acid, causes contraction of uterus
o -ging Placenta !2+$s @lifespanA by 3H+$s placenta begins to degenerate causes contraction
o Progesterone 'eprivation theory U level of progesterone +ill facilitate contraction of the uterus
The % Ps o& 7a*or
o Passenger fetus
fetal head
is the largest presenting part
W of its length
8ones H bones @sphenoid, temporal, ethmoidA Brontal, occipital D 2 parietal bones
Sutures1intermem*ranous spaces allo+s molding
Mol'ing the overlapping of the sutures of the s$ull to permit passage of the head to the pelvis
16
o Sagittal *ones connect to parietal bones
o Cororontal *ones connect to parietal D frontal bones
o 7am*'oi'al *ones connect to parietal D occipital bones
.ontanels
o H fontanels only 2 palpable
anterior &ontanel1(regma
diamond in shape
3cm x !cm si1e
close %2%4 mos post delivery
(cm hydrocephalus
posterior &ontanel1lam*'a
triangular in shape
% x %cm si1e
close 23mos post delivery
Measurements o& &etal hea' 4
o transverse 'iameter
(iKparietal largest transverse diameter G"2(cm
(iKtemporal 4cm
(iKmastoi' smallest transverse diameter Jcm
o -P 'iameter
Su*occipito*regmatic complete flexion
:ccipito&rontal partial flexion %2cm
:ccipitotemporal largest A& diameter. hyperextended @%3"(cmA
Su*mento*rgmatic face presentation. poor flexio
o Passageway vagina D pelvis
Pelvis
! main pelvic types
o gynecoi' round, +ide, deeper, most suitable for pregnancy
o an'roi' heart shape ,male pelvis- anterior pointed post part shallo+
o -nthropoi' oval ,apeli$e pelvis, A& +ider transverse narro+
o Platypelloi' flat transverse oval A& narro+ transverse +ider c/s for delivery
&roblem <
o mother +ho encounter accident
o !G-
o %4y/o 6< pelvis not achieve its full pelvic gro+th
(ones o& pelvis
%*ones
o ! hips @2 innominate bonesA
3parts of 2 innominate bones
Ileum lateral/side of hips
o 2liac crest flaring superior border that forms prominence
of hips. common site for bone marro+ aspiration
Ischium inferior portion
o 2schial tuberosities of the area +here +e
o Sit. basis in getting external measurement of pelvis
Pu*is anterior portion
o Symphysis pubis #unction in bet+een
o sacrum posterior portion
Sacral prominence basis internal measurement of pelvis
o coccyx ! small bones that compresses during vaginal delivery
universal precaution in measurement of pelvis is to empty bladder first
2mportant )easurements
o +iagonal Con8ugate
measure bet+een Sacral promontory D inferior margin of the symphysis pubis
)easurement %%"(%2"( cm
8asis in getting the true con#ugate"
o True Con8ugate1Con8ugate 0era
)easure bet+een the anterior surface of the sacral promontory D superior
margin of the symphysis pubis"
)easurement< %%"5 cm
Diagonal con#ugate< %"( cm E true con#ugate"
o :*stetrical Con8ugate
smallest A& diameter of the pelvis measuring %5cm or more"
o Tu*eroischii +iameter
transverse diameter of the pelvic outlet"
Approx by a fist 4cm D above"
o Power
the forces acting to expel the fetus D placenta
involuntary contractions
17
voluntary bearing do+n efforts
characteristics< +ave li$e
timing< freFuency, duration, intensity
myometrium po+er of labor
o Psyche1person
psychological stress exist +hen the mother is fighting the labor experience"
cultural interpretation preparation
past experience
support system
PreKeminent signs o& la*or
o &reeminent Signs
lightening
settling of the presenting part into the pelvis brim @shooting pain radiating to the legs, urinary
freFuencyA
primi early 2 +ee$s prior to ?DD
engagement settling of presenting part into pelvic inlet @not signs of laborA
(raxton Hic9s Contractions painless irregular contractions
Increase -ctivity o& the Mother *esting
2nstinct @mgt< save energyA
epinephrine production @hormone that V the activity of the motherA
Ripening o& the cervix butter softness
+ecrease in weight %"(3 lbs"
(loo'y show
pin$ish vaginal discharge @blood I leucorrhea I operculum E pin$ in colorA
Rupture o& mem*ranes
chec$ BC:
2? chec$ for cord prolapse
after several hrs chec$ temp"
o Premature Rupture o& Mem*ranes 2PR:M6
contraction drop in intensity even though very painful
contraction drop in freFuency
uterus tense D/or contracting bet+een contractions
abdominal palpitations
Nursing Care4
administer analgesics @morphineA
attempt manual rotation for 6'& or ='&
bear do+n +ith contractions
adeFuate hydration
sedation as ordered
cesarean delivery may be reFuired, especially if fetal distress is noted
o Cor' Prolapse
a complication +hen the umbilical cord falls or is +ashed through the cervix into the vagina"
+anger Signs4
&6')
&resenting part has not yet engaged
Betal distress
&rotruding cord from vagina cerebral palsy V ( mins", irreversible brain damage mgt< 7S
Nursing Care
&ositioning $nee chest or trendelenberg, place +et sterile gau1e 6< to ma$e it slippery
'bserve for fetal distress
&rovide emotional support
&repare for cesarean section
+i&&erence (etween True an' .alse Contraction
:rue Balse
*o in intensity
&ain confined in the abdomen
&ain is relieved by +al$ing
*o cervical changes

:here is an in intensity
&ain begins @ the lo+er bac$ to abdomen
&ain is intensified by +al$ing 7ervical
effacement @thinning of the cervix,
measured thru OA D dilatation @+idening of
the cervix, measurement thru cmA
Xbest/ma#or sign of true labor
+uration o& 7a*or
o Primipara %! hrs but not more than %25 hrs
o Multipara 4 hrs but not more than %! hrs
Nursing Interventions in /ach Stage o& 7a*or
o .irst Stage< onset of contractions to full dilatation D effacement of the cervix
o stage of effacement D dilatation
18
7atent Phase4
Assessment<
o Dilatations 53 cm
o BreFuency (%5 mins
o Duration 25!5 mins
o 2ntensity mild
o )other is excited, apprehensive but can communicate
*ursing 7are<
o ?ncourage +al$ing < shortens %
st
stage of labor
o ?ncourage to void F 23 hrs < full bladder inhibits uterine contraction
o breathing @chest breathing techniFueA
-ctive Phase4
Assessment<
o Dilatations !4 cm
o BreFuency F 3( mins lasting for 35H5 secs
o Duration 35H5 secs
o 2ntensity moderate
Nursing Care4
o M edications have meds ready
o - ssessment include< v/s, cervical dilatation D effacement, fetal monitor, etc
o + ry lips oral care @ointmentA, dry linens
o 8reathing abdominal breathing
Transitional Phase4
-ssessment4
o Dilatations 4%5cm
o BreFuency F 23 mins contractions
o Duration !(G5 sec
o 2ntensity strong
o )ood of mother suddenly change accompanied by hyperesthesia @hypersensitivity of
mother to touchA of the s$in
Management
o sacral pressure, cold compress
Nursing care4
o T tires
o I inform of progress @to relieve emotional supportA
o R restless support her breathing techniFue
o / encourage D praise
o + discomfort
o Pelvic /xams
/&&acement ? +ilatation
Station relationship of the presenting part to the ischial spine
o ( % E the presenting part is above the ischial spine
o ?ngagement %5 E the presenting part is in line +ith the ischial spine
o @A fetus is floating
o @IA belo+ the ischial spine
Presentation
o the relationship of the long axis of the fetus to the long axis of the mother"
o spine relationship of the spine of the mother D the spine of the fetus
o :+o :ypes
7ongitu'inal 7ie 2Parallel61 0ertical
Cephalic +hen the fetus is completely flexed
o >ertex
o Bace
o 8ro+
o 7hin
(reech
o Complete *reech thigh rest on abdomen +hile legs rest
on thigh
o Incomplete *reech
.ran9 thigh resting on abdomen +hile legs
extend to the head
.ootling
@neeling
Transverse 7ie 2Perpen'icular61Hori;ontal lie
Position relationship of the fetal presenting part to specific
Fuadrant of the mothers pelvis"
o R:-17:-
19
left occipito anterior
most common D favorable position
o R:T17:T left occipito transverse
o R:P17:P left occipito posterior
o 71R side of maternal pelvis
o Mi''le presenting part
o R:P1R:T most common malposition
o R:P17:P most painful mgt< pelvis sFuatting
o (reech sacro
place the stethoscope above the umbilicus
o Chin mentum
o Shoul'er acromnio dorso
Monitoring the contractions ? &etal heart tone
spread the finger lightly over the fundus to monitor the contraction
Increment1Cresen'ro beginning of contraction until it increases
-pex1-cne height of contraction
+ecrement1+ecresen'ro from height of contraction until it decreases
+uration beginning of contraction to the end of the same contraction
Interval from end of contraction to the beginning of the next contraction
.reLuency from the beginning of % contraction to the beginning of next contraction
2ntensity strength of contraction
if contract blood vessel constricts. the fetus +ill get the oxygen on the placenta reserve +hich is
capable of giving oxygen to the fetus up to %min"
Duration of placenta to the fetus should not exceed %min"
Significance During active phase, if V to %min should notify the A)D
V 8&. U BC: < best time to get 8' D BC: #ust after a contraction
N3RSIN, C:NSI+/R-TI:N +3RIN, TH/ .IRST ST-,/ :. 7-(:R
8ath is necessary
)onitor >S especially 8&
o Same 8& E rest
o ?levated E notify the physician
*&'
o &revent aspiration chemical pneuminitis
?nema @per hospital policyA
o &urpose
7leanse the bo+el
&revent infection
o %2 %4 inches normal length of tube
o %4 inches optimal length
o =ateral sims position
o 2f there is contraction clump the tube
o 2f there is resistance slo+ly remove
o 8efore and after administration< chec$ BC: @%25 %H5A and contractions
?ncourage mother to void
&erennial preparation @rule of JA
6est on left side lying position
o &revent supine vena cava syndrome or supine hypotension
2f membrane doesnt rupture amniotomy
./T-7 TR-SHIN, hyperactivity of fetus due to lac$ of 'xygen
Bor &ain
o Systemic analgesic
+/M/R:7 2Meperi'ine HCl6
*arcotic and antispasmonic
Dont give during latent phase
0iven @ H4 cm dilated
<:. < Respiratory 'epression
*arcan @*aloxone, nalorfan, nallineA
o Antidote for toxicity
o 2n#ected on the baby
/pi'ural -nesthesia
<:. < Hypotension
&rehydrate the client to prevent hypotension
2n case of Cypotension
o ?levate leg
o Bast Drip 2>
20
S/C:N+ ST-,/ :. 7-(:R 2./T-7 ST-,/6
7omplete dilatation and effacement to birth
7ro+ning occurs
&62)2 transfer to D6 @ %5 cm dilatation
);=:2 transfer to D6 @ J 4 cm dilatation
&osition in lithotomy both legs at the same time
(37,IN, :. P/R/NI3M surest sign of delivery initiation
&A*: D 8='M 8reathing, fetal pushing should be done on an open glottis
Respiratory al9alosis
o Due to incorrect breathing
o Cyperventilation
o S/sx
66
=ightheadedness
:ingling sensation
7arpopedal spasm
7ircumoral numbness
/pisiotomy
&revent laceration
Miden the vaginal canal
Shortens the 2
nd
stage of labor
2 types
o M/+I-N
=ess bleeding
=ess pain
?asy repair
&ossible urethroanal fistula ma#or disadvantage
o M/+I:7-T/R-7
)ore bleeding
)ore pain
Card to repair and slo+ healing
Ironing the Perenium prevent laceration
Mechanism o& 7a*or 2/+ .IR/ /R/6
/ngagement
+escent
.lexion
Internal Rotation
/xtension
/xternal Rotation
/xpulsion
P/70IS
" Parts
o Inlet A& diameter narro+, transverse +ider
o Cavity bet+een inner and outer
o :utlet A& diameter +ider, transverse narro+
7IN/- T/RMIN-7/S
Nursing Care
M:+I.I/+ RI,/N5S M-N/30/R
o Done by supporting the perenium +ith a to+el during delivery
o Bacilitates complete flexion
o Avoids laceration
Birst intervention< Support the head and suction secretion
Do not mil$ the cord, +ait for pulsation to stop before cutting
o )il$ing may cause too much blood going to the baby that may cause cardiac overload
Mhen there is still birth, let the mother see the baby to accept the finality of death
THIR+ ST-,/ :. 7-(:R 2P7-C/NT-7 ST-,/6
3 %5 minutes after child birth
%
st
sign Bundus rises C-7@IN5S SI,N
Signs o& Placental Separation
o Bundus becomes globular and rises cal9in5s sign
o =engthening of the cord
o Sudden gush of blood
(R-NT $ -N+R/<5S M-N/30/R
o slo+ly pulling the cord and +ind at the clamp
21
o rapidly may cause uterine inversion
Types Placental +elivery
SH37TI @ShinyA
o Brom center to the edges
o &resenting fetal side
+3NC-N @+irtyA
o Borm edges to center
o &resenting the maternal side
Nursing Consi'erations 'uring placental 'elivery
7hec$ placental completeness
o Should be (55 g
7hec$ Bundus )assage if 8oggy
8& 7hec$
)ethergine, methylergonovine mallate @2)A
'xytocin @2>A if methergine is not present
7hec$ perenium for lacerations
Assist in episioraphy
>aginoplasty/ >aginal =andscape >irgin again
.:3RT ST-,/ :. 7-(:R 2Recovery Stage6
Birst % 2 hours after delivery of placenta
)aternal observation body system stabili1e
o %
st
hour F%( min 2
nd
hour F 35 min
&lacement of fundus
o 2n bet+een umbilicus and pubis symphysis
o 7hec$ bladder, assist in voiding, )ay lead to uterine atony hemorrhage
=ochia
&erineum
o 7hec$ R//+-
R edness
/ dema
/ cchymosis
+ ischarge
- pproximation
o Bully saturated 35 !5 cc
o <eighing $ cc O gram Common (oar' )uestion
Nursing Consi'eration 'uring Recovery
Blat on bed to prevent di11iness
2f +ith 7hills give blan$et due to dehydration
0ive nourishment @progression of mealA
o 7lear liFuids gatorade, ginger #uice, gelatins
o Bull liFuid mil$, ice cream
o Soft diet
o 6egular diet
7hec$ >S1 &ain
&ychic State
(on'ing interaction bet+een mother and ne+born
o Strict 2! hours +ith mother
o &artial morning +ith mother, night nursery
C:MP7IC-TI:NS :. 7-(:R
+ystocia
Difficult labor related to mechanical factor
&rimary cause is ;terine 2nertia
3terine Inertia
Sluggishness of contraction
:ypes
o Primary1 Hypertonic
2ntense contraction resulting to ineffective pushing
)anagement < Sedation
o Secon'ary1 Hypotonic
Slo+, irregular contraction resulting to ineffective pushing
)anagement < 'xytocin Augmentation
Prolonge' 7a*or
L 25 C for primi
L %! C for multi
22
proper pushing should be encourage if inappropriate<
o may cause fetal distress
o caput succedaneum
o cephalhematoma
o maternal exhaustion
monitor contractions and BC:
Precipitate 7a*or
labor less than 3 hours
causes excessive laceration leading to profuse bleeding hypovolemic shoc$
s/sx of hypovolemic shoc$ HGP: T-CHG T-CHG
o HGP:tension
o T-CHGpnea
o T-CHGcardia
o 7old clammy s$in
o Management
)odified trendelenburg
Bast Drip 2>
Inversion o& 3terus
Situation in +hich uterus is turn inside out due to<
o Short cord
o Currying of placental delivery
o 2neffective fundal push
7ause profuse bleeding hypovolemic
Hysterectomy
3terine Rupture
6upture of uterus
Cause' *y
o &revious classical 7S
o >ery large baby
o 2mproper use of oxytocin
S1sx
o Sudden pain
o &rofuse bleeding
&repare fore :AC8S'
Physiologic Retraction Ring boundary bet+een upper and lo+er uterine segment
(an'l5sPathologic Ring suprapubic depression sign of uterine rupture
-mniotic .lui'1 Placental /m*olism
Anaphylactic syndrome of pregnancy
Situation in +hich placental fragment and amniotic fluid enters maternal circulation
S1Sx
o Dyspnea
o 7hest &ain
o Brothy Sputum
o ?nd Stage D27
&repare for 7&6, Suction and emergency etc
Trial 7a*or
Betal head measurement E measurement of pelvis
H hours labor allo+ance given to mother
monitor BC: and contractions
Preterm 7a*or
labor after 25 +ee$s and before 3J +ee$s
Tria' signs
o &remature conditions every %5 minuets
o ?ffacement of H5 45O
o Dilatation of 2 3 cm
Home Management
o 786
o Avoid Sex
o ?mpty bladder
o Drin$ 3 ! 0lasses of C2'
Bull bladder inhibit contraction
Hospital Management
o 2f 7ervix 7lose 2Criteria4 cervix is close' i& it is ! $ " cm 'ilate' only6
2 3 cm dilated, pregnancy can be saved
Tocolytic Therapy
23
Gutupar 2Rito'ine HCl6
o Side effect maternal 8& T G5/H5
o 7hec$ 2mpt" &resence of crac$les
(rethine 2ter*utaline6 (ricanyl
o +:C
o Side effect< sustained tachycardia
o Antidote< propanolol/ inderal
Mg S:%
o I& cervix is 'ilate' 2 D %cm6
0ive steroid 'examethasone
&romote surfactant maturation
2mmediately cut the cord after delivery to prevent #aundice/ hyperbilirubinemia
P:STP-RT-7 P/RI:+
Puerperium (
th
stage of labor, %
st
H +ee$s post partum
7haracteri1e by involution
Involution return to the normal stage of reproductive organ after pregnancy
Return to Normal Healing
Physiologic Changes
Systemic Changes
Car'iovascular System
o plasma volume
o sudden in blood volume
o elevated M87s up to 35, 555 mm3
o hyperfibrinogenemia
o orthostatic hypertension can be possible
o early ambulation prevents thrombos formation
steps in ambulation
Blat
Semifo+lers
Bo+lers +ith dangling
Mal$ +ith assist
,enital Tract
o .un'us
goes do+n % finger breadth a day
%5
th
day non palpable behind the symphysis pubis
Su*involution
delayed healing of uterus containing Fuarters or clots of blood
may lead to puerperal sepsis
Management 4 DD7
o -&ter Pains
After birth pains
)ultiparous breastfeeding most common to develop
&osition E prone
7old compress
)efenamic acid
o 7ochia
7omponents
8lood
Deciduas
M87
)icroorg
3 types
Ru*ra % 3 days, musty, moderate amount
Serosa ! %5
th
day, pin$ or bro+n
-l*a %5 2%th day, crYme +hite, amount
3rinary Tract
o 3rinary .reLuency due to urinary retention +ith overflo+
o +ysuria
Damage to trigone of the bladder
;rine collection for culture and sensitivity
Stimulate navel to urinate
&alpate bladder
6unning +ater listening
&ull pubic hair stimulate cremasteric reflex
24
Colon
o Constipation
Due to *&'
8earing do+n may cause pain
Perenium
o &ain relieved by sims position
o 7old compress %
st
2! hours if there is pain at episioraphy follo+ed by +arm
/M:TI:N-7 S3PP:RT
. Ta9ing phase
%
st
3 days
dependent phase
passive, cant ma$e decision
tells about childbirth experience
focus on< Cygiene
!. Ta9ing Hol'
! J
th
day
dependent to independent phase
active, decides actively
focus< care of ne+born
health teaching < Bamily planning
". 7etting ,o
2nterdependent phase
6edefines goals, ne+ roles as parents
)ay extend till the child gro+s
Post Partum (lues
!
th
(
th
days
over+helming feeling of depression, inability of sleep and lac$ of appetite
(5 45O incidence rate
cause by sudden hormaonal change progesterone suddenly decreases
allo+ crying< therapeutic
may lead to postpartum psychosis/ depression
Postpartal Complications
Hemorrhage
bleeding +ithin 2! hours postpartum
/arly Pospartal Hemorrhage
. 3terine -tony
boggy fundus
profuse bleeding
interventions
o massage the uterus
o cold compress
o modified trendelenburg
o fast drip 2>
o breastfeeding to release oxytocin
!. 7aceration
+ell contracted uterus +ith profuse bleeding
assess perenium for laceration
'egrees o& laceration
o %
st
degree vaginal s$in and mucus membrane
o 2
nd
degree %
st
degree I muscles
o 3
rd
degree 2
nd
degree I external sphincter of rectum
o !
th
degree 3
rd
degree I mucus membrane of rectum
". Hematoma
bluish discoloration of sub9 tissues of vagina or perenium
candidates
o delivery of very large babies
o pudendal bloc$
o excessive manipulation due to excessive 2?
intervention
o cold compress %5 25 min then allo+ 35 minutes rest period for 2! h
%. +IC $ 'isseminate' intravascular coagulation
25
7onsumption of pregnancy @othertermA
Bailure to coagulate
8leeding in the eyes, ears, nose
'o1ing blood
Seen in cases +ith
o Abruptio placenta
o Still birth / 2;BD
Management
o 8lood transfusion of cryoprecipitate or fresh fro1en plasma
o hysterectomy
7ate Postpartum Hemorrhage
Retaine' placental &ragments
manual extraction of fragments is done
uterine massage
+?C except &or cases o&
o Placenta -creta umusual attachment of the placenta to the myometrium
o Placenta Increta deeper attachment of placemat to the myometrium
o Placenta Percreta invasion of placenta to the perimetrium
7andidates of these disorders are
0rand multiparous
&ost 7S
All these reFuires hysterectomy
In&ection
Sources
o ?ndogenous from normal flora of the body
o ?xogenous from the health care team
)ost common Anaerobic Streptococci
Management
o Supportive care
o Bluid inta$e
o :S8 if there is fever/ cold compress I paracetamol may also be given
o Analgesics
0iven on time to achieve maximum effect
o 7ulture and sensitivity
Perenial In&ection
Same s/ sx +ith infection
2 3 stitches are dislodges
+ith purulent drainage
:x resuturing
/n'ometritis
2nflammation of the endometrium
0en s/sx of infection I abdominal tenderness
Management
o Cigh fo+lers facilitates drainage D locali1e infection
o Administer oxytocin
.-MI7G P7-NNIN, M/TH:+
,ui'ing Principles
%" determine your o+n beliefs first
2" never advise a permanent method of family planning
3" informed concent
!" the method is an individual decision
Natural Metho' accepted by the church
8illings/ 7ervical )ucus/ Spinnbar$eit
clear +atery D stretchable
%3
th
day longest due to estrogen
8asal 8ody :emp in the morning before arising/ %3
th
%!
th
day due to pea$ of progesterone
=A) =actational Amenorrhea )ethod
prolactin inhibits ovulation
breastfeeding ! H months no menstrual cycle
bottle fed 2 3 months
Sympthothermal combination of 8illings and 88: most effective method
26
Social Metho's
Coitus Interuptus
+ithdra+al
least effective method
Coitus Reservatus
sex +/o e#aculation
Coitus inter&emora
bet+een femor
Calen'ar Metho'
%! days before menstrual cycle ovulation day @regularA
!, I ! days unsafe period
:rigo9nause .ormula 2 irregular menstrual cycle6
get the longest and shortest cycle
subtract %4 to shortest
%% to the longest
the difference is the unsafe period
PI77S
combined oral contraceptives preventovulation by inhibiting the anterior pituitary gland roduction of BSC and =C +hich are
essential for he maturation and rupture of a follicle"
?strogen inhibit BSC +hich is responsible in the mturation of ovum" &rogesterone inhibit =C +hich is responsible for ovulation"
contains estrogen that inhibits BSC and progesterone that inhibit =C
GG"GO effective
2% day feel on the (
th
day of mense start ta$ing
24 day %
st
day of mense
if forgotten, ta$e 2 tablets the follo+ing day
adverse effect < brea$through bleeding
if mother +ants to get pregnant
o +ait 3 monts
o another 3 months if unsuucessful before consulting gyne
contrain'ications
o chain smo$ing
o Cypertension
o D)
o ?xtreme obesity
o :hrombophlebitis
Si'e e&&ects 2ressem*les Hypertension61 Imme'iate +iscontinuation
o -bdominal paon
o Chest pain
o Headache
o /ye problem
o Severe leg cramp
Alerts on oral contraceptives <
o 2n case a )other +ho is ta$ing an oral contraceptive for almost a long time and plans to have a baby, she +ould +ait for
at least 3mos before attempting to conceive to provide time for estrogen and progesterone levels to return to normal" 2f
after Hmonths the mother did not get pregnant, consult A)D"
o 2f a ne+ oral contraceptive is prescribed, the mother should continue ta$ing the previously prescribed contraceptive and
begin ta$ing the ne+ one on the first day of the next menses"
o Discontinue oral contraceptive if there is signs of severe headache as this are an indication of hypertension associated
+ith increase incidence of 7>A and subarachnoid hemorrhage"
o 2f forget to drin$ pill for % day, ta$e 2 pills the next day" 2f forget to drin$ pills for 2days, stop the pill and +ait for the next
mens"
-'verse reaction 4 *rea9through *lee'ing
+MP- $ +epoprovera
7ontains progesterone
Depomedroxy progesterone Acetate
2) F 3 months never massage the site may decrease effectiveness
N:RP7-NT
H match stic$ li$e capsules/ rod
contain progesterone
sub 9 planted
good for ( years
Mechanical +evice
I3+
prevent implantation
alters mobility of sperm and ovum
GG"JO effective
27
best inserted after delivery and during menstruation
Common complication ?Z7?SS2>? )?*S:6;A= B='M
Common pro*lem ?Z&;=S2'* 'B :C? D?>27?
*o protection against S:D
Si'e e&&ects inclu'e
o ;terine infection
o ;terine perforation
o ?ctopic pregnacy
)a#or indication for the use is &A62:K
HT4 monthly chec$ up and regular pap smear
C:N+:M
)ade up of latex
&ut in erected penis or lubricated vagina
&revents sperm to enter the uterus
B?)A=? 7'*D') higher protection than that of male
+I-PR-,HM
Dome shaped rubberied material inserted at the cervix to prevent sperm getting inside the uterus
6eusable
HT 4 &roper hygiene
o 7hec$ for holes
o )ust be refitted in case of +eight gain of %( lbs board Fuestion
o Nept in place for about H4 Cours 8oard Fuestion
Contrain'icate' to
o BreFuent ;:2
C/R0IC-7 C-P
)ore durable than the diaphram
7ould stay on place for more than 2! hours
*o need to apply spermicides
Contrain'icate' to abnormal papsmear
CH/MIC-7
SP/RMICI+/S
B'A)S most effective
Rellies
7reams
:hese may cause toxic shoc$ syndrome
S3R,IC-7 M/TH:+
(ilateral tu*al 7igation
o @ isthmus
o 25O probability of reversal
0asectomy
o >as deferens is cut
o )ore than 35 x or 5 sperm count or 2 x negative sperm count before it could be consider safe sex
HI,H RIS@ PR/,N-NCG
H/M:RRH-,IC +IS:R+/RS
,eneral management
786
Avoid sex
&repare ultrasound determine the sac integrity
Assess bleeding and approximation
Assess hypovolemia
Save discharge for histopathology
o Determine +hether the product of labor has been expelled
.irst Trimester (lee'ing
-*ortion termination of labor before age of viability
SP:NT-N/:3S
o ANA miscarriage
o Causes
%" 7hromosomal aberrations due to advanced maternal age
2" 8lighted ovum
3" germ plasm defect
28
o *atures +ay of expelling defective babies
o Classi&ications 4
. Threatene'
pregnancy is #eopardi1ed by bleeding and cramping but the cervix is closed and can be saved"
!. Inevita*le
moderate bleeding, cramping, tissue protrudes from the cervix and the cervix is open"
o Types 4
. Complete
all products of conception are expelled"
)gt < emotional support
2" Incomplete
placenta and membranes retained"
)gt < DD7
H-(IT3-7
o 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix"
o Management @suture of cervixA
. Mc+onal' proce'ure
:emporary circlage
Side effect infection
)ay have *SD
!. Shiro'9ar
7S delivery
MISS/+
o fetus dies. product of conception remain in uterus ! +ee$s or longer
o signs o& pregnancy cease
%" @A pregnancy test
2" Dar$ bro+n
3" Scanty bleeding
o )gt < induction of labor/ vacuum extraction
IN+3C/+
o :herapeutic abortion principle of 2 fold effect
%" Done +hen mother has class ! heart disease
/ctopic Pregnancy
occurs +hen gestation is location outside the uterine cavity
7ommon site < Ampulla or :ubal
Dangerous site< 2nterstitial
3nrupture' Rupture'
)issed period
Abdominal pain +ithin 3 (+$s of missed period
@maybe generali1ed of one sidedA
Scant, dar$ bro+n vaginal bleeding
>ague discomfort
sudden, sharp severe unilateral pain, $nife li$e
shoulder pain @indicative of intraperitoneal
bleeding that extends to diaphragm D phrenic
nerveA
@IA 7ullens sign bluish tinged umbilicus
syncope/fainting
*ursing 7are <
o vital signs
o administer 2> fluids
o monitor for vaginal bleeding
o monitor 2D'
o prepare for culdocentesis to determine
o hemoperitoneum
)gt < nonsurgical )ethotrexate
S/C:N+ TRIM/ST/R (7//+IN,
Hy'ati'i&orm Mole 1 P*unch o& grapesQ
0estational :rophoblastic Disease progressive degeneration of 7horionic >illi
gestational anomaly of the placenta consisting of a bunch of clear vesicles" :his neoplasm is formed from the s+elling of the
chronic villi and lost nucleus of the fertili1ed egg" :he nucleus of the sperm duplicates, producing a diploid number !Hxx" 2t gro+s
and enlarges the uterus very rapidly"
Cause < ;n$no+n
-ssessment 4
o /arly signs
vesicles passed thru the vagina
Cyperemesis gravidarum due to C70
Bundal height
>aginal bleeding @scant or profuseA
o /arly in pregnancy
high levels of C70
29
&re ecclampsia at about %2+$s
>esicles loo$ li$e a ,sno+storm- on sonogram
Anemia
Abdominal cramping
o Serious late complications
Cyperthyroidism
&ulmonary embolus
Nursing care 4
o prepare for DD7
o do not give oxytocin drugs due to proneness to embolism
o Cealth :eaching<
return for pelvic exams as scheduled for one year to monitor C70 and assess for enlarged uterus and rising
titer could be indicative of choriocarcinoma
Avoid pregnancy for at least one year
)ethotrexate therapy
Incompetent Cervix Management4
)cDonald procedure
o temporary circlage of incompetent cervix"
o Delivery < *S>D
o S?< infection
o Cealth teaching
observe for signs of infection
signs of labor
Shhirod$ar procedure
o permanent procedure"
o Delivery < caesarian section reFuired"
THIR+ TRIM/ST/R (7//+IN, PP7-C/NT-7 -N:M-7I/SQ
Placenta Previa
it occurs +hen the placenta is improperly implanted in the lo+er uterine segment, sometime covering the cervical os"
-ssessment
o 'utstanding sign < fran$, bright red, painless bleeding
o enlargement @usually has not occurredA
o fetal distress
o abnormal presentation
Nursing care 4
o 2nitial mgt < *&' candidate for 7S
o 8edrest
o prepare to induce labor if cervix is ripe
o administer 2>
o *o 2?, *o Sex, *o enema complication < Sudden fetal blood loss
o prepare )other for double set up D6 is converted to '6
-*ruptio Placenta
it is the premature separation of the placenta from the implantation site"
2t usually occurs after the t+entieth +ee$ of pregnancy
7ause<
o 7ocaine user
o Severe &2C
o Accident
Assessment<
o 'utstanding sign < dar$ red D painful bleeding
o concealed hemorrhage @retroplacentalA
o couvelaire uterus @caused by bleeding into the myometriumA @A contraction
o rigid boardli$e abdomen
o severe abdominal pain
o dropping coagulation factor @a potential for D27A
o sx < bleeding to any part of the body" )gt < for hysterectomy
0eneral *ursing care <
o infuse 2>, prepare to administer blood
type and crossmatch
o monitor BC6
o insert Boley catheter
o measure bllod loss. count pads
o report s/s of D27
o monitor v/s for shoc$
o strict 2D'
30
Placental Succenturiata % or 2 lobes connected to the placenta by a blood vessel
Placenta (ipartita placenta divided into 2 lobes
HGP/RT/NSI0/ +IS:R+/R
Pregnancy In'uce' Hypertension
o C&* after 2!+$s resolved H+$s postpartum +hich cause pregnancy"
o :ypes <
o 0estational C&*
C&* +ithout edema D proteinuria"
)gt < monitor 8&
o &reeclampsia triad
o sx < C&* +ith edema, proteinuria or albuminuria @C?&/AA +hich cause is un$no+n or idiopathic but multifactoral
primis d/t %st exposure to chorionic villi
multiple pregnancies due to V exposure to chorionic villi
)others of lo+ socioeconomic status due to U protein inta$e
:eenagers d/t lo+ compliance to protein inta$e
o C?==& syndrome hemolysis +ith elevated liver en1ymes D lo+ platelet count
Transitional Hypertension C&* bet+een 252!+$s
Chronic or PreKexisting Hypertension
o C&* before the 25th +$ not resolved H+$s postpartum
o 3 types of preeclampsia
o Sign of preeclampsia <
o L 35mmCg systolic
o L %(mmCg diastolic
o 6oll over test
%5%(min side lying
:hen supine
:hen ta$e 8&
o mild preecclampsia
%!5/G5mmCg, +/ I% '2, I2 proteinuria ?arly signs < V +t, inability to +ear +edding ring due to developing
edema
Signs present
cerebral D visual disturbances, epigastric pain to liver edema and oliguria usually indicates an
impending convulsion
8efore convulsion < if you see sign of epigastric pain, %[ mgt is to place tongue depressor and put
the side rales up
During convulsion < observe the )other for safety
After convulsion turn to side to facilitate drainage
o Severe preecclampsia
%H5/%%5, I3 or I!, proteinuria, visual disturbances
*ursing care
P promote bedrest
Prevent convulsions by nursing measures
to V '2 demand D facilitate *a excretion
)anagement< Fuiet D calm environment, minimal handling, avoid moving the bed
Ceat Acetic Acid determine protein in the urine
&repare the follo+ing at bedside
o tongue depressor, Suction machine D '2 tan$
/ ensure high protein inta$e @%g/$g/dayA
*a in moderation
- antihypertensive drug +ith hydralu1ine
C 7*S depressant +ith )g Sulfate for anticonvulsion
)gt < evaluate for hypermagnesiumenimia
/ evaluate physical parameters for )agnesium Sulfate toxicity <
( 8& U
3 ;rine output U
R 66 U
P &atellar reflex is absent
Antidote < 7a gluconate
o ?clampsia +ith sei1ure
V 8;* sign of glumerular damage
31
+ia*etes Mellitus
o cause by absent D lac$ of 2nsulin
o Action of 2nsulin is to facilitate transfer of glucose into the cell
32
o Dx test < (5gm %hr 0lucose :olerance :est
o V %35 hyperglycemia
o U J5 hypoglycemia
o 45%25 euglycemia
o if L %35mg/dl, the )other needs to undergo a 3hr 0::
o )aternal ?ffects <
o hypoglycemia during the %st trimester development of the brain sinisipsip ng fetus yung glucose ng nanay"
o Cyperglycemia during the 2nd D 3rd trimester
C&= effect )gt < give insulin" 'CA are teratogenic"
%st trimester U insulin, 2nd trimester V insulin, post partum drop suddenly
BreFuent infections eg" )oniliasis
&olyhydramnios
Dystocia
o Betal ?ffects <
o hypoglycemia during the %st trimester and Cyperglycemia during the 2nd D 3rd trimester thru facilitated diffusion
o )acrosomia/=0A "!555gms
o 2;06 due to prolonged D)
o &reterm birth promote still birth
o *e+born ?ffects <
o Cyperinsulinism and Cypoglycemia
!5mg/dl
*ormal < !(((mg/dl
8orderline < !5mg/dl
Sx < V pitched shrill cry, tremors, #itteriness
Dx test < heel stic$ test to chec$ glucose levels
o Cypocalcemia
T Jmg/dl
7alcemic tetany
:x < 7a gluconate
Heart +isease
o 7lassification <
o 2 no limitation
o 22 Slight limitation, ordinary activity causes fatigue
good prognosis can deliver vaginally
)gt < sleep of %5hrs/day, rest 35mins after meals
o 222 moderate limitation, less than ordinary activity causes discomfort
poor prognosis" 0ood for vaginal delivery
)gt < early hospitali1ation by J4mos
o 2> mar$ed limitation of physical activity for even at rest there is fatigue
poor prognosis" 0ood for vaginal delivery only +ith regional anesthesia"
=o+ forceps delivery +hen unable to push D to shorten the stage of labor
)gt <
therapeutic abortion, high semi fo+lers position, left side lying, no valsalva maneuver may trigger
cardiac arrest, heparin therapy reFuired, antibiotic therapy for prevention of sub acute bacterial
endocarditis
INTR-P-RT-7 C:MP7IC-TI:NS
Cesarean +elivery
2ndications
a" multiple gestation
b" diabetes
c" active herpes 22
d" severe toxemia
e" placental previa
f" abruption placenta
g" prolapse of the cord
h" cephalo pelvic disproportion and primary indication
i" breech presentation
#" transverse lie
proce'ure 4
o classical vertical incision
o lo+ segment ,bi$ini-, for aesthetic purposes" 7an have vaginal birth after c/s
,enotype $ genetic ma$eup
Phenotype $ &hysical appearance
@aryotype $ pictorial analysis of individual chromosome for detecting chromosomal abnormalities
-utosomal +ominant
huntingtons chorea
33
retinoblastoma
achondroplasia
polydactyl
-utosomal Recessive
sic$le cell
7ystic fibrosis
7eliac
&N;
0alactosemia
NK 7in9e' Recessive
Cemophilia
Duchennes muscular dystrophy
7olor blindness
N $ 7in9e' +ominant
6ic$ettes
34

You might also like