CORE Program Ridge of tissue formed by the labia majora and

minora
COmpetency-based, Recall and Enhancement

Hymen
Tough but elastic semicircle of tissue that covers the
vagina
Obstetric Nursing
Compiled by: JULIE VEE M. DECIN RN
MALE:

Scrotum

rugated skin-covered muscular pouch suspended from

the perineum

Anatomy and Physiology
Functions are to support the testes and help regulate
sperms temperature
FEMALE:
Vestibule
Flattened, smooth surface inside the labia where
Testes
openings to the bladder and vagina arise
Clitoris
Small, rounded organ of erectile tissue two ovoid glands, 2-3cm wide that lie in the scrotum

Skenes glands (Paraurethral glands)

Ducts open into the urethra
Penis
Bartholins Gland (Vulvovaginal glands)
Ducts open into the vagina
composed of 3 cylindrical masses of erectile tissue in the
penis shaf
Fourchette

Epididymis

located below the prostate gland

tightly coiled tube, approx. 20 f. long

conduct sperm from testes to the vas deferens Urethra

Vas Deferens hallow tube leading from the base of the

bladder that passes through the prostate gland

passageway of sperm from epididymis into the urethra

ends in the seminal vesicles and ejaculatory duct

Menstruation

Ejaculatory Duct
Termed as female reproductive cycle

connects seminal vesicles to urethra
Defined as the episodic uterine bleeding in response to
cyclic hormonal changes

Prostate Gland chestnut

Process that allows for conception and implantation of

sized gland that lies below the bladder new life

Cowpers Glands
Ultimate purpose is for fertilization or pregnancy.
Four Phases

Proliferative

Secretory Fetal Membranes

encloses fetus and amniotic fluid
Ischemic composed of 2 membranes

Menses
1. Chorionic Membrane

Embryonic and Fetal Structures
outermost fetal membrane

Decidua
Functions to provide support to amniotic membrane

the uterine cells of endometrium

2. Amniotic Membrane

has 3 separate areas:

forms beneath the chorionic membrane
a. decidua basalis

b. decidua capsularis supports and produces amniotic fluid

c. decidua vera

Chorionic Villi
Amniotic Fluid
medium in which the fetus and the cord float inside

tiny projections around the zygote, present as early as 12

the amniotic membrane

days afer fertilization Volume

increases from the 1st trimester until 38th week of pregnancy (800-1,200ml)
Composition

99% water and 1% solid UTERUS

contains albumin, urea, uric acid, creatine

Color Increase in size

clear and colorless to straw colored
about 4,000 g

Amniotic Fluid
slightly alkaline: pH 7.0 to 7.25
Hegars sign
Function:

Connects the fetus to the placenta softening of lower uterine segment

Blood Vessels:

2 arteries, 1 vein (AVA)

UTERINE BLOOD VESSELS & BLOOD FLOW

Length: Blood flow increases from 20 ml to 700-900 ml

50-55 cm long and 2 cm in diameter

of this blood supply goes to the placenta

Wartons Jelly:

Gelatinous substance found inside the cord

During contraction, uterine pressure increase at about 20-30
mmHg

Maternal Adaptations to Pregnancy

 Example: A pregnant woman who has had two pregnancies, 1 resulted to
abortion at 12 weeks and the other one is already 2 years old.
Psychologic / Emotional Adaptations
to Pregnancy Ans: G3P1

1st Trimester Acceptance of Pregnancy Example: A pregnant woman who has had two pregnancies, 1 resulted to
abortion at 25 weeks and the other one is already 2 years old.
2nd Trimester Acceptance of Fetus
Ans: G3P
3rd Trimester Acceptance of Mother Role

Example: A pregnant woman who has had two pregnancies, two resulted
to preterm infants, alive and well.
Prenatal Care
Ans: G3P2
Basic Terminologies

Pregnancy Classification
Basic Terminologies

Initial visit
Example: A woman who has had two previous pregnancies, has given
1. Complete History
birth to two term children and is again pregnant.
2. History of Past Pregnancies
Ans: G3P2
G No. of pregnancies, regardless of the outcome

T No. of full term infants born at 37 weeks or afer

P No. of preterm infants born before 37 weeks

Example: A woman who has had two miscarriages at 12 weeks and is
again pregnant. A No. of spontaneous or induced abortions
Ans: G3P L No. of living children
 M No. of multiple pregnancies

LIVE BIRTH An infant born showing signs of life

Manner of Counting

T individual counting STILLBIRTH An infant born without signs of life

EARLY NEONATAL
P individual counting Death of newborn within 7 days afer birth
DEATH
A individual counting LATE NEONATAL An infant who died between 7 to 29 days afer
DEATH birth
L individual counting LOW BIRTHWEIGHT A term infant with birth weight less than 2500
INFANTS grams
M 1 para = 1 multigestation LARGE FOR
A term infant with birth weight more than 4000
GESTATIONAL
grams
AGE / LGA
An infant born between 37 and 42 weeks
TERM INFANT
gestation

POST TERM INFANT An infant born afer 42 weeks gestation

PRETERM An infant born before 37 weeks gestation

INFANT

PARTURIENT A woman in labor

A woman who has just delivered (within six

PUERPERA
weeks afer delivery)
 How to get Expected Date of Delivery?
Done 14th 16th week

1. Nageles Rule 1st day of the last menstrual period
Ultrasound guided
Formula: - 3 (months) + 7 (days)

2. Quickening For primigravida: Add 22 weeks

Detects Neural Tube Defects

For multigravida: Add 24 weeks

3. Mc Donalds Rule

Chorionic Villi Sampling

fundic height in cm x 2 / 7 = AOG in months

Obtaining a tissue sample in the placenta

fundic height in cm x 8 / 7 = AOG in weeks

Done 10th 12th week

4. Bartholomews Rule

12 16 20 30 36 Ultrasound guided

Detects Chromosomal Abnormalities

Amniocentesis

Aspiration of amniotic fluid from the uterus

LEOPOLDS MANEUVER

1st Maneuver
 determines Presentation
determines whether fetal head or breech is in the fundus

2nd Maneuver Signs of Beginning Labor

determines Position

locates the fetal back

Prodromes to labor are:

3rd Maneuver Lightening the settling of fetal head into the

determines Engagement inlet of the true pelvis; may not occur in multiparas.

determines fetal part at the inlet and its mobility Show the release of the cervical plugs
consisting of mucous, blood streaked vaginal discharge.
4th Maneuver

determines Fetal Attitude Spontaneous Rupture of membrane sudden

gush of clear fluid from the vagina.
determines degree of fetal extension into the pelvis

Excess energy nesting instinct; feeling of

extremely energetic.
LABOR AND DELIVERY

THE LABOR PROCESS: Braxton Hicks contractions increased.

Alterations in hormonal balance of estrogen and progesterone Loss of 1-3 lbs from water loss resulting from
fluid shifs produced by changes in progesterone and
increase uterine contractility
estrogen levels.

Degeneration of the placenta, which no longer provides necessary Uterine contraction True labor contractions
elements to fetus starts at the back and sweep across the abdomen,
increasing in frequency and intensity.

Over distention of uterus creates stimulus triggering release of

oxytocin, which initiates contractions. DURATION OF LABOR:
 varies depending upon the individual
SIGNS OF LABOR:

average:
Differentiate true from false labor

primipara: up to 18 hours; some may be shorter, others longer Irregular contractions

multipara: up to 8 hours; some may be shorter, others longer Contractions may cause discomfort

Pain is confined in the abdomen only

The True Labor Contractions Pain usually radiates at the back then sweeps to the abdomen

Discomfort may be relieved by walking

Result in progressive cervical dilation and effacement.
Discomfort may not be relieved by walking

Occur at regular interval.

Contractions do not bring about appreciable changes in cervix

Interval between contraction decreases.

UTERINE CONTRACTIONS:

Intensity increases.
Contractions divided into three periods of intensity

increment increasing intensity

Located mainly in back and abdomen

acme peak or full intensity

Intensified by walking decrement decreasing intensity

Not affected by mild sedation.

 UTERINE CONTRACTIONS:
Contractions are monitored for frequency, duration and intensity
frequency: measured by timing contractions from the
beginning of one contraction to the beginning of the next
contraction
Forces acting to expel fetus; primarily by involuntary
uterine contractions, secondarily by voluntary
bearing down.Function of uterine contractions
are effacement and dilation.
& E. Person / Psychological Response
Response to contraction, perception and beliefs,

duration: beginning of contraction to beginning of

prenatal care and education, support
systems and communication skills.
decreasing intensity. Cannot be measured exactly by feeling with
the hand
EFFACEMENT AND DILATATION
Intensity: cannot be measured by feeling; must be
Effacement
measured by internal fetal monitoring device. Usually refers to
contraction at beginning of labor. Peaks at about 25 mmhg. At
the end of labor it may it may reach 50 to 75 mmHg thinning process by which cervical canal is
progressively shortened to complete
Contractions may be described as mild, moderate or obliteration. Progresses from a structure of 1 2
intense. cm long to almost complete obliteration.

Five Ps of Labor DILATATION

Passenger : the fetus

process by which external os enlarges from a
few millimeters to approximately 10 cm.
Passageways

Pelvis

Sof tissues lower uterine segment, cervix,

vagina, and introitus.

Powers
DURATION OF LABOR:
Length of labor depends on:

effectiveness of consistent cotnractions: Extension once fetal head reaches perineum, it extends
contractions must overcome resistance of the cervix to be born.

amount of resistance baby must overcome to

adapt to pelvis
Restitution afer delivery of head, it rotates back to to
stretching ability of sof tissues position prior to engagement.

preparation and relaxation of client. Fear and

anxiety can retard progress
External Rotation Shoulder engage and move similarly to
head.

Mechanisms of Labor
Expulsion entire infant emerges from mother.

Descent presenting part progresses through pelvis; level

os station

Stages of Labor

Flexion descending head meets pelvic floor; chin is

brought down to chest.
1. First stage of Labor - begins with first true labor contractions and ends with
complete dilatation of the cervix ( 10 cm dilatation)

Latent phase- 0-4 cm

Internal Rotation fetal head rotates from transverse
Active phase 4-7 cm
diameter to anteroposterior diameter to facilitate movement
through pelvis. Transitional 7-10 cm
2. Second Stage of Labor - begins with complete dilation and ends with birth of
Second Stage of Labor- from full dilatation to delivery of infant.

baby.

* 30-60 minutes for primigravida, 20 minutes for multipara; frequency is 2-

3. Third Stage of Labor - begins with delivery of baby and ends with delivery of 3 minutes lasting 60-90 seconds; strong intensity.
placenta.
*Nursing Care: Transfer to delivery room for 8-9cm dilation for
multigravidas and full dilation for primigravidas; Monitor V/S and FHR,
prepare perineal area, Encourage pushing with contractions, Immediate
4. Fourth Stage of Labor - lasts from delivery of placenta to postpartum newborn care.
condition( an hour afer delivery).

First Stage- onset of regular contraction to full dilatation

Third Stage- from delivery of infant to delivery of placenta.

Duration is 8-9 hours for primigravida and 5-6 hours for
multipara; Transition is 1 hour for primigravida and 10-15
minutes for multipara.
Frequency of contraction is every 2-4 minutes lasting for
45-90 seconds.
>5-30 minutes duration.
> Nursing Care: assess for placental separation, inspection of placenta,
monitor V/S, Initiate breastfeeding, administer Oxytoxic and antilactation
agents as ordered, sending cord blood to laboratory if the mother is O-
positive or Rh-negative, and allow bonding.

Nursing Care: Monitor V/S and FHR every 15 minutes,

Fourth Stage time from delivery of placenta to homeostasis.
Bed rest for ruptured membrane, Have her empty bladder, Pain
reliefs, Breathing techniques, maintain safety.

>Monitor V/S every 15 minutes, including fundal height, position, and

consistency.

>Assess for lochia, check perineum, perform peri care from front to back
weak, infrequent contractions usually present in
>Post partum care
the active stage of labor

signs of placental separation:

may occur due to the following:
Calkins sign

Sudden gush of blood from vagina

overstretched uterus due to multiple
Lengthening of the umbilical cord gestation

Displacement of the uterus upward occurs

(rise of the fundus) LGA

ASSESSMENT:

Hydramnios
evaluate placenta afer separation:

Schultze (most common): placenta is inverted on itself,

Lax uterus due to grand multiparity

and shiny fetal surface appears; 80% separate in center

Congenital abnormalities of uterus
Duncan: descends sideways, and the maternal surface
appears. Separates at edges rather than center

Management:

Labor Complications
Oxytocin infusion

Hypotonic Uterine Contractions
Amniotomy
 Labor Complications
Managed through:

Hypertonic Uterine Contractions

Oxytocin infusion
Too frequent but uncoordinated contractions
Amniotomy
Usually occur at latent stage
HYPERTONIC

Management: Too frequent but uncoordinated

Fluid and electrolytes infusion

Therapeutic rest
Seen in latent stage
Empty bladder

Side lying position

Managed through

Lets Compare! Fluids and electrolytes

HYPOTONIC
Rest
Weak, infrequent contractions
Empty bladder
Seen in active stage
Side lying position
 Labor Complications
Contractions can be so forceful that can lead to
premature separation of placenta
Contraction Rings

Types:
Predisposing Factors:
a. Constriction Ring

occurs at any point in the myometrium Multiparity, large pelvis, Small baby in good
position
b. Pathologic Retraction Ring (Bandls Ring)

occurs at any junction of the upper and

lower uterine segments Management:

Cause: Uncoordinated contractions

Tocolytics

Labor Complications
Management:
Uterine Inversion
Tocolytic

IV Morphine Sulfate or inhalation of amyl nirite

refers to the uterus turning inside out with
either birth of the uterus or delivery of placenta

Labor Complications
Causes:
Precipitate Labor

Pulling of umbilical cord
Labor that is completed fewer than 3 hours

Applying Pressure on uncontracted uterus

 Labor Complications
Cover the umbilicus with saline sterile
moistened cloth
Prolapsed Umbilical Cord

Administer Oxygen inhalation

a loop of the umbilical cord slips down in front
of the presenting fetal part

DISCLAIMER

Causes: In light of the rapid turnover of technology in the medical sciences, the compilation of
information, and the possibility of human error, AIM.ONE, and any other parties
involved in said compilation of information contained herein, disclaims all
Long cord, Polyhydramnios, Malposition and
responsibility for and accepts no liability for any inaccuracies, errors, omissions or
liabilities incurred as a consequence, directly or indirectly, of the use and application
of its contents. Any similarities with other materials are only a result of such
compilation

Malpresentation

My dear students,

May this handouts help you. I wish u well in the board exam. Please use this material
for a good cause. I appeal you dont duplicate, copy or reproduce it at any rate.

Thank you. God Bless!

Management:

Reduce pressure on the cord -maam Julie