Maternity

Nursing I
Paul Jhon A. Vergara, RN
FEMALE REPRODUCTIVE SYSTEM
PHYSIOLOGY OF HYPOTHALAMUS
MENSTRUATION
GnRH

ANTERIOR PITUITARY GLAND

FSH & LH

OVARIES

ESTROGEN &
PROGESTERONE

UTERUS
CONTRACEPTIVES
ABSTINENCE
RHYTHM (KNAUS-OGINO) METHOD

Diary of 6 menstrual cycles

SHORTEST CYCLE – 18 = FIRST FERTILE DAY

LONGEST CYCLE – 11 = LAST FERTILE DAY

RHYTHM (KNAUS-OGINO) METHOD

October 28
November 28
December 29
January 28 PIPCDC
February27
March 28

27 - 18 = 9
29 - 11 = 18
STANDARD DAYS METHOD

26 to 32 day cycle

Day 1 to Day 7 –
INFERTILE

Day 8 to Day 19 –
FERTILE

Day 20 onwards -
INFERTILE
 BASAL BODY TEMPERATURE

After waking in AM

Abstain for the next

3 days

Day before ovulation:  0.5°F Used with calendar

method
Time of ovulation:  1°F
CERVICAL MUCUS (BILLINGS) METHOD

Spinnbarkeit
LACTATION AMENORRHEA METHOD

EXCLUSIVE
Breastfeeding

6 months
COITUS INTERRUPTUS

BULAGA!!!
 ORAL CONTRACEPTIVES

Side Effects

• Nausea
• Weight gain
• Mild hypertension
• Headache
• Breakthrough bleeding

Contraindications
Combined Oral
• History of
Contraceptive Pill THROMBOEMBOLISM,
STROKE, HEART ATTACK
Progestin Only Pill
ORAL CONTRACEPTIVES

Missed Doses

• 1 pill – take it as
soon as you
remember
• 2 pills – 2 pills as
soon as you
remember and
2 pills again the
following day
• 3 pills – discard;
start a new pack
VAGINAL RINGS
SUBCUTANEOUS IMPLANTS

6 implants

LEVONORGESTREL

5 years
INJECTABLE CONTRACEPTIVES

medroxyprogesterone
(Depo-Provera)

Lunelle

 Calcium

Weight-bearing
exercise
INTRAUTERINE DEVICES

ParaGard
(copper) 8 years

Mirena (hormone)
5 years
BARRIER METHODS
TUBAL LIGATION
VASECTOMY

Sex can resume after

1 week

2 negative sperm
reports

10-20 ejaculations
FETAL DEVELOPMENT
& STRUCTURES
FERTILIZATION & IMPLANTATION

Fertilization: AMPULLA

Ovum: 24-36 hours

Sperm: 48-72 hours

Day 3: MORULA

Day 4: BLASTOCYST

Implantation: 8-10 days

THE PLACENTA & THE UMBILICAL CORD

O2, Nutrients
Umbilical CO2, Wastes
Vein

NO blood exchange

hCG
Umbilical Arteries
Estrogen
FROM THE
TO THE
FETUS
FETUS
Progesterone

hPL
AMNIOTIC FLUID

800 – 1,200 mL

Hydramnios:
>2,000 mL

Oligohydramnios:
<300 mL

pH 7.0 – 7.25
4 weeks –
8 weeks – ORGANOGENESIS

12th week –

16th week –

20 weeks –

24 weeks – SURFACTANT
OBSTETRICAL
ASSESSMENT
ESTIMATED DATE OF DELIVERY

Nägele’s
Rule:
• Count backward 3
calendar months
from the first day
of the last
menstrual period
• Then, add 7 days
and 1 year
ESTIMATED DATE OF DELIVERY

Exercise:

• LMP is April 1, 2010

• What is the EDD?

4 - 3=1 January
1+7=8 8
2010 + 1 = 2011 2011
 McDONALD’S RULE

Fundic height x ⅞ = AOG in weeks

Exercise:
• Fundic height is 20 cm
• What is the AOG? 17 weeks
and 3-4 days
_____
20 x 7 = 140
___ = 17.5
8 8
 NONSTRESS TESTING

REACTIVE - 2 accelerations of FHR (15 bpm or

more) lasting 15 secs
NONREACTIVE - no acceleration with movements
- low short-term FHR variability
(less than 6 bpm)
 CONTRACTION STRESS TEST
 NEGATIVE (Normal) – no FHR
decelerations w/ contractions
 POSITIVE (Abnormal) – 50%
or more of contractions cause
late decelerations

Early Decelerations
• Head compression

Late Decelerations
• Uteroplacental insufficiency

10 min: 3 contractions of Variable

at least 40 seconds each Decelerations
• Cord compression
ULTRASOUND

Full bladder

Place towel under

right buttock

Contact gel must be

at room temp
MATERNAL SERUM ALPHA-FETOPROTEIN

Normal Value:

• 0.5 – 2.0 or 2.5 MoM

Elevated serum level:

• Spina bifida
• Anencephaly

Low serum level:

• Chromosomal defects (e.g.

Down syndrome)
CHORIONIC VILLI SAMPLING
AMNIOCENTESIS

EMPTY bladder

Place folded towel

under RIGHT buttock

RhoGAM
AMNIOCENTESIS

Color

Bilirubin Level

Lecithin/Sphingomeyelin
(LS) Ratio
Phosphatidylglycerol (PG)
Test

Chromosome Analysis

Alpha-fetoprotein
PERCUTANEOUS UMBILICAL
BLOOD SAMPLING
LEOPOLD’S MANEUVERS
First Maneuver: Second Maneuver:
Fundal Grip Umbilical Grip

PRESENTATION POSITION

Third Maneuver: Fourth Maneuver:

Pawlik’s Grip Pelvic Grip

ENGAGEMENT ATTITUDE