32590736 maternity nursing review

8/11/2019 32590736 Maternity Nursing Review

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8eig&t 0 /terine involution CBQ9on pregnant 0 5: – ;: g%reganant 0 1::: g4t& stage of 3abor 0 1::: g<nd =ee after of Delivery 0 5:: g>rd =ees after delivery 0 >:: g5 – ; 8ees after delivery0 5: – ;: g

<hree (arts of =terus

• 'undus upper cylindrical layer• Corpus* Body upper triangular layer

• Cervix lo-er cylindrical layerst&$us lo-er uterine segment during pregnancy

+uscular 9omposition> 3 main +uscles ma'ing possible expansion in all directiona. (ndo$etriu$ muscle layer for menses

o ?ines the non"pregnant uteruso @olumes the non pregnant uterus

o Decidua slouching o$ of endometrium during menstruation

o (ndo$etriosis ctopic ndometrium 9ommon site is ovaries (roliferation of abnormal gro-th of lining of outer part (ersistent dysmenorrhea, lo- bac' pain

Dx xam> biopsy,laparoscopy <x> ?upron BluprolideC inhibits SE F ?E <x> Danaol BDanacrineC D)9

1. 4nhibits ovulation2. stop menstruation

b. +yo$etriu$o (o-er of laboro Smooth muscles is considered to be ?4@4 ?4A<=8 Bmuscles of delivery,

capable of closingC of the bodyo ?argest portion of the uterus

c. %ere$etriu$o (rotects the entire uterus

c. 6varies

• 2 female sex gland

• almond shape

•xn> )vulation,production of 2 hormonesB estrogen and progesteroneCd. 'allopian ube

• 2 3 inches long that serves as a passage-ay of the sperm from the uterus to theampulla or the passage-ay of the mature ovum or fertilied ovum from the ampulla tothe uterus

• # signi%cant segmentso nfundibulu$ most distal part, trumpet shape, has %mbraeo #$pulla outer 3rd or 2nd half, site of fertiliation, common site for ectopic

preg.o st&$us site for steriliation, site for :<?o nterstitial most dangerous site for ectopic pregnancy

b. +ale !eproductive "yste$

1. (xternal• %enis

• <he male organ of copulation and urination• 9ontains of a body or shaft consisting of 3 cylindrical layers and erectile tissues

o 2 corpora cavernosao 1 corpus spongiosum

• At the tip is the most sensitive area comparable to clitoris G glans penis

• "crotu$

• (ouch hanging belo- the pendulous penis, -ith medial septum deviding into 2 sacs each

containing testes

• 8eHuires 2 degrees celcius for continuous spermatogenesis

• 9ooling mechanism of testes<. nternal



&e %rocess of "per$atogenesis

estesBI77 coiled seminiferous tubulesC

↓

epididy$isBsite of maturation of sperm J mC

↓

)as DeferensBconduit path-ay of spermC

↓

"e$inal )esicleBsecreted> fructose form of glucose, nutritative value%rostaglandin> causes reverse contraction of uterusC

↓

(aculatory DuctBconduit of semesnC

↓

%rostate GlandBrelease al'aline substancesC

Co=pers GlandBrelease al'aline substanceC

↓

/ret&raEypothalamus 8E

A(

'", maturation of sperm3, testosterone production3eydig Cells releases testosterone

+ale ? fe$ale ,o$ologues+ale 'e$ale

(enile lans(enile Shaft

<estes(rostate

9o-per’s landsScrotum

9litoris9litoral shaft

)variesS'ene’s gland

:artholin’s land?abia +a&ora

. Basic @no=ledge on Genetics and 6bstetrics

1. D9# Deoxyribonucleic Acid carries genetic code2. C&ro$oso$es threadli'e structure of hereditary material 'no-n as the DA3. ormal amount of e&aculated sperm > – 5 cc* 1 teaspoon#. )vum is capable of being fertilied -ithin <4 – >; &ours after ovulation.5. "per$ 4A – < days viabilityJ. 8eproductive cells divide by the process of +(6"" Bhaploid numberC

• "per$atogenesis process of maturation of sperm

• 6ogenesis process of maturation of ovumo 37 -ee's A) J million immature ovumo ! birth 1 million immature oocyteso ! puberty 377 #77 immature oocyteso ! 13 yo 377 #77 mature oocyteso ! 23 yo 167 267 mature ovumo ! 33 yo J7 1J7 mature ovumo ! 3J yo 2# 12# mature ovumo !#J yo # mature ovum

• Ga$etogenesis process of formation of t-o haploid into diploid. #ge of reproductivity – 15 – 44 y*o c&ildbearing age – <: – >5 y*o

,ig& ris 1A ? >5 y.o. 8it& !is 1A – <:E >: – >5A. +enstruation

• +enstrual Cycle beginning of menstruation to the beginning of the next menstruation



• Average menstrual cycle <A days

• Average menstrual period 5 days

• ormal blood loss 5: cc* F cup acco$panied by 'B!963"" prevents clot formation

• 8elated terminologieso +enarc&e 1st menstruationo Dys$enorr&ea painful menstruationo +etrorr&agia bleeding in bet-een menstruationo +enorr&agia xcessive bleeding during menstruationo #$enorr&ea absence of menstruationo +enopause cessation of menstruation BAverage Age" *1 y.o.C

ofu has isoKavone estrogen of plant that mimics the estrogen -ith a -omanH. 'unctions of (strogen and %rogestin

• ("!6G(9 hormone of -omano (rimary function

8esponsible for the development of secondary characteristics in females inhibit production of SE

o )ther function Eypertrophy of the myometrium Spinnbar'eit and erning (attern B:illings +ethodC Ductile structure of the breast )steoblastic bone activity Bcauses increased in heightC arly closure of the epiphysis of the bone Sodium retention

4ncreased sexual desire 8esponsible for vaginal lubrication

• %!6G("(!69( Eormone of the mothero (rimary function prepares the endometrium for implantation ma'ing it thic' and tortouso Secondary unction inhibit uterine contractibilityo )thers

4nhibit ?E Bhormone of ovulationC production

↓ 4 motility

↑ (ermeability of 'idneys to lactose and dextrose causing L 1 sugar in urine +ammary gland development

↑ ::< +ood s-ings

1:. +enstrual Cycle

# phases of menstrual cycle1.%roliferative<."ecretory>.sc&e$ic4.+enses

1. )n the initial phase of menstruation, the estrogen level is , this level stimulates the hypothalamus torelease Gn!,* '",!'

2. n8E SE8 stimulates the anterior pituitary gland to release '",• '", 'unction

o Stimulate ovaries to release estrogeno acilitate the gro-th of primary follicle to become

G!##'#9 '633C( structure that secretes large amount of estrogen thatcontain mature ovum

3. (roliferative (hase B↑estrogenCollicular (hase responsible for the variation and irregularity of mense

(ostmenstrual (eriod after menstruation(reovulatory (hase happen before menstruation

#. 13th day of menstruation, estrogen level is %(#@ -hile progesterone is , these stimulates thehypothalamus to release n8E ?E8

*. Gn!,* 3,!' stimulates the Anterior (ituitary land to release 3,• unctions of ?E

o Stimulates the release of progesteroneo Eormone for ovulation

J. 1#th day estrogen level is -hile progesterone level is

• SSo 8upture of the graa%an follicle " )@=?A<4)o +ittelsc&s$er7 slight abdominal pain lo-er right Huadrant



M. 1*th day, after ovulation day, graa%an follicle starts to degenerate, estrogen level ↓, progesterone ↑,causing degeneration of the graa%an follicle becoming yello-insh 'no-n as C6!%/" 3/(/+ secreteslarge amount of progesterone

6. Secretory (hase?utheal (hase -

progesterone2(ostovulatory phase(remenstrual (hase

I. 2#th day Corpus #lbicans B-hitishC corpus luteum degenerates and becomes -hite

17. 26th day if no sperm united the ovum, the uterine begins to slough o$ to have the next menstruationote>

• if there is no fertiliation, corpus luteum continues functioning

• )varian 9ycle from primary follicle corpus albicans

• Stages>o 1 * days menseso J 1# proliferativeo 1* 2J secretoryo 2M 26 ischemic

11. Stages of Euman Sexual 8esponse4nitial 8esponse>@AS)9)S<4) constriction of blood vessels+N)<)4A increased muscle tension

• (xcite$ent %&ase

• ↑ muscle tension, moderate @S

• erotic stimuli causing ↑ sexual tension, may last from minutes to hours

• %lateu %&ase

• ↑ and sustained tension near orgasm

• may last 37 sec 37 minutes

• 6rgas$

• 4nvoluntary release of sexual tension accompanied by physiologic and psychologic release,

• immeasurable pea' of experience 2 3 seconds

• !esolution

• 8eturn to normal state

• @S return to normal

!('!#C6! %(!6D only period present in male, -herein he cannot restimulated for about 17 1* minutes

). 8onders of 'ertili7ationa. 'ertili7ation

1. %&onones song of sperm2. Capacitation ability of sperm to release proteolytic enyme and penetrate the ovum

b. "tages of 'etal Gro=t& and Develop$ent1. %re ($bryonic "tage

. Iygote fertilied ovum B3 # days travel, # days KoatingCO from fertiliation. +orula mulberry"li'ed ball containing 1J *7 cells. Blastocyst enlarging cell forming a cavity that later becomes the embryo covered by thropoblast -hich later

becomes the placenta and membrane). $plantation M 17 days after fertiliation

• <hropoblast covering of blastocyst that become placenta

• SSx of 4mplantation Slight pain, Slight @aginal Spotting

• 3 (rocesseso #ppositiono #d&esiono nvasion

<. ($bryonic "tageIygote fertiliation to 1# days($bryo 1*th 2 mos 6 -ee's'etus 2 mos to birth

c. Decidua thic'ened endometrium, latin -ord for falling o$/1. Basalis located directly under the fetus -here placenta developed2. Caspularis encapsulates the fetus3. )era remaining portion of and endometrium

d. C&orionic )illi 17 11 -ee's1. C&orionic )illi "a$pling -C)"2 removal of tissue from the fetal postion of the developing

placenta



• 8esponsible for the development of mammarygland

• Diabetogenic $ect insulin antagonist 8elaxin softening of maternal &oints and bones

o Serves as protective barrier against some microorganism 9an pass> E4@ 9+@ 8ubella (4)9N<)S4S transport of virus

(regnancy 2JJ 266 days 3M #2 -ee's

'(#3 "#G(0 'etal Gro=t& and Develop$ent

'irst ri$ester 0 %eriod of organogenesisL $ost critical period'irst +ont& ',L C9" DevelopsL G and !espi ract re$ains as single tube Di$erentiation of (rimary erm ?ayer

• ndodermo <hyroid responsible for basal metabolismo <hymus immunityo ?ivero 4<o ?inings of =pper 4 <ract

• +esodermo

Eearto +usculos'eletalo 8eproductive )rgano Qidney

• ctodermo :raino 9So S'ino * senseso Eair, nailso Anuso +outh

"econd +ont&• ?ife span of corpus luteum ends

• All vital organs are formed

• (lacenta is developed

• Sex organ is developed

• +econium is present&ird +ont&

• (lacenta is complete

• Qidneys are functional

• etus begins to s-allo- amniotic Kuid

• :uds of mil' appear

• Sex is distinguishable

• E< audible via dopples ! 17 12 -ee'serratogens any drug or irradiation, the exposure to -hich may cause damage to the fetus

• D!/G"o "trepto$ycin anti <: BHuinineC damage to the 6th cranial nerve poor learning and deafness

ototoxico etracycline stoning the tooth enamel, inhibits long bone gro-tho )ita$in @ hemolysis, destruction of 8:9, &aundice, hyperbilirubenemiao odides enlargement of thyroid and goitero &alido$ides anti"emetics Amelia or (ocomelia absence of distal part of extremitieso "teroids cleft lip or palate and even abortiono 3it&iu$ congenital maformation

• #3C6,63 ?:P, fetal alcohol syndrome B characteried by microcephalyC

• "+6@9G ?:P

• C#''(9( ?:P

• C6CC#9( ?:P, abruptio placenta

• 6!C, group of infections that can cross the placenta or ascend through the birth canal and adversely e$ectfetal gro-th

o <oxoplasmosis cat lovers



o )thers " Eepa A:, E4@, Syphilliso 8ubella 9ED,

8ubella <iter ! 1>17 or ↓ G immunity to rubella G notify doctor 8ubella vaccine after delivery for 3 mos. o pregnancy for 3 mos.

o 9ytomegalo viruso Eerpes Simplex virus

"econd ri$ester 0 continuous gro=t& and develop$ent -focus leng& of fetus2

'ourt& +ont&• ?anugo begins to appear

• :uds of permanent teeth appear

• E< audible via etuscope ! 16 27 -ee's'ift& +ont&

• ;uic'ening > 1st fetal movement (rimi> 16 27, ulli " 1J " 16

• ?anugo covers the body

• E< audible via stethoscope or -out instrument

• Actively s-allo- amniotic Kuid

• etus > 1I 2* cm"ixt& +ont&

• S'in is red and -rin'led

• @ernix caseosa covers the s'in

• yelids open

• xhibits startle reKex>rd ri$ester 0 period of $ost rapid gro=t& and develop$ent 'ocus0 =eig&t"event& +ont&

• Surfactant development

• +ale> the testes begins to descent into the scrotal sac

• emale > clitoris is prominent and labia ma&ora are small doesn’t cover the minora(ig&t +ont&

• Active moro reKex

• ?anugo begins to disappear

• Sub H fats deposits, steady -eight gain, nails to %ngers9int& +ont&

• ?anugos and vernix caseosa is evident in body fold

• :irth position assumed

• Amniotic Kuid some-hat decrease

• Sole of the foot has fe- creases

ent& +ont&• :one ossi%cation in the fetal s'ull

• @ernix caseosa is evident in body

%,"636GC #D#%#69 6 %!(G9#9C

"yste$ic C&anges1. Cardiovascular "yste$

• ↑ blood volume 37 *7R

• 1*77 cc0 additional *77 cc for multiple pregnancy

• ↑ plasma volume

• ↑ cardiac -or'load easy fatigability slight ventricular hypertrophy

• pistaxis due to hyperemia of nasal membrane

• (alpitation due to SS stimulation

• %&ysiologic #ne$ia* pseudoane$ia in pregnacyo

ormal @alueEct > 32 #2REgb> 17.* 1# gdl

o 9riteria1st F 3rd <rimester > Ect O 33R Egb O 11 gdl2nd <rimester > Ect O 32R Egb O 17.* gdl

o (athologic Anemia ron DeMciency #ne$ia is the most common hematologic disorder. 4t a$ects 27R

of pregnant -omen Assesment reveals>

• (allor

• Slo-ed capillary re%ll G ormal G 2 3 sec



• 9oncave %ngernails Blate sign of progressive anemiaC clubbing G chronictissue hypoxia

• constipation ursing care

• utritional instructiono Source of iron

Qang'ong ?iver G best source due to 884D4 9ontent 8ed and lean meat reen ?eafy @egetables

• (arenteral 4ron B4mferonCo tract 4+o incorrect causes hematomao best given 1 hour before meals Bcauses 4 irritationCo +aybe given 2 hours after meal Bresults to poor absorptionC

iven -ith orange &uice to ↑ absorption

• )ral 4ron Supplements Bferrous sulfate 7.3 g 3 x a dayC

• +onitor for hemorrhage Alert

• 4ron from red meat is better absorbed iron from other sources

• 4ron is better absorbed -hen ta'en -ith foods high in @itamin 9 such asorange &uice

• Eigher iron inta'e is recommended since circulating blood volume isincreased and heme is reHuired from production of 8:9s

• (de$ao 4mpeded venous return due to the gravid uteruso ursing 4ntervention

levate legs above the hips level

• )aricositieso Pear support stoc'ingso levate legs

• )ulvar )aricositieso Dt pressure of gravid uteruso Side lying -ith pillo- under the hipso +odi%ed 'nee chest position

• &ro$bop&lebitiso (resence of thrombus in inKamed blood vesselso L Eoman’s Sign pain on the calf upon dorsiKexiono +edical +anagement

Anticoagulant E(A84

• Does not cross the placental barrier

• +onitor A(<<

• Antidote> (8)<A+4 S=?A<

• o aspirin

• +il 3eg* %lag$asia #lba Dolenso Shiny -hite legs due to stretching of s'in F hyper%brinogenemiao ursing intervention

9hec' dorsalis pedis pulse Bcompare bothC ever massage Assess for Eoman’s sign only once

<. !espiratory "yste$• Shortness of :reath dt gravid uterus

• ursing intervention> Side"lying lateral expansion of the lungs

>. Gastrointestinal "yste$

• 9ausea and vo$iting

• +orning "icness

o Due to ↑ E9 levelso 9rac'ers 37 min before arisingo A+ 9arb diet 37 minso (+ small freHuent meal

• Constipation

o Due to (8)S<8) G ↑ Kuid reabsorption due to ↓ 4< motilityo ursing intervention



• ↑ luid

• ↑ iber

• xercise

• 'latulenceo Due to increased progesteroneo Avoid gas forming foods

• ,eartburn -pyrosis2o

8eKux of stomach content into esophaguso ursing 4ntervention

• Small freHuent meals

• Sips of mil'

• Avoid fatty and spicy foods

• (roper body mechanicso Paist #bove Acido Paist Belo- :ase

• ,e$orr&oidso Due to gravid uteruso Eot sit bath for comfort

• %tyalis$

o ↑ salivationo +outh-ashes to relieve

4. /rinary "yste$•

ormal G L 1 sugar due to (rogesterone via :D49<’S <S<• irst <rimester " reHuency

• Second <rimester " normal

• <hird <rimester " reHuency5. +uscoloseletal

• 9alcium sources

o +il' " ↑ 9a ↑ ( 1 pint day or 3 # servings dayo 9heese, Nogurt, Eead of ish, Sardines, Anchovies, :rocolli

• 3ordosiso (ride of (regnacy

• 8addling Gaito A-'-ard gait -hile -al'ing due to relaxino (rone to accidental falls

Pear lo- healed shoes

• 3eg Cra$pso 9a ( 4mbalance during pregnancyo ?umbo"sacral nerves by pressure of gravid uterus during laboro )ver sexo DorsiKex the foot a$ectedo 3"# servings # cupsday sa mil', sardines, dilis

1. 3ocal C&nages

• )aginao C&ad=ics "ign – bluish discolorationo 3euorr&ea – -hitish gray, moderate in amount, mousy odor

• Cervixo Goodels "ign – change in consistency of uteruso 6perculu$ mucus plug to seal bacteria progesterone

• /teruso

,egars "ign – change in consistency

@agina 9had-ic'’s9ervix oodel’s=terus Eegar’s

Problems related to the changes of Vaginal Environment a. )aginitis N #)6C#D6

• <richomonas @aginaliso lagellated protoxoan, ?oves ala'aline environment

• Signs and Symptomso reenish, cream, colored, frothy, irritably itchy, foul smelling vaginal dischargeo @aginal edema



• +anagemento Drug of choice> +<8)4DA)? BlagylC

Antiprotooan 9arcinogenic ot given in 1st trimester

• vaginal douche as substitueo 1 Ht Pater G 1 tbsp -hite vinegar

o <reat partner as -ell to prevent reinfectiono o alcohol due to antabuse e$ect

b. +oniliasis N C,(("(• 9andida Albicans

• <ransvaginal transfer in fetus )ral <rush

• Signs and Symptomso Phite 9heeseli'e patches that adheres to the -alls of the vagina

• +anagemento Antifungals

+ycostatin 9ontrimaole 9anisten entian @iolet

1. #bdo$inal C&anges• Striae ravidarum

o Due to destruction of the subcutaneous tissue by the enlarge uterus

<. "in C&anges• +elasma 9hloasma

o Phite light bro-n pigmentation related to ↑ melanocytes

• ?inea igrao :ro-n pin'ish line from symphysis pubis to umbilicus

>. Breast C&anges• Due to hormonal changes

• 9hange in color and sie of nipple and areola

• (recolostrum J -ee's

• 9olustrum 3rd trimester

• Supine -ith pillo- under the bac'

4. 6varies – rest periodL no ovulation

5. "igns and "y$pto$s of %regnancy

%resu$ptiveSsx felt and observed by the

mother but does not con%rm thediagnosis of pregnancy

%robableSigns observed by themembers of the health

care team

%ositive=ndeniable signs con%rmed by

the use of instrument

irst trimester Breast changes/rinary changes'atigue#menorrhea+orning sic'ness(nlarge uterus

Goodel’s signChad-ic'’s sign,egar’s sign(levated ::<%ositive E9

/ltrasound vidence

Second <rimester

Chloasma3inea igrancrease S'in (igmentation"triae gravidarumQuic'ening

Ballotement(nlarge AbdomenBraxton Eic's9ontraction

etal Eeart <one

etal movement etal outline etal parts palpable

CBQ Cancer of t&e Breast Ouadrant B+amography 3* and above 1 year:allotement bouncing of the fetus

may be present in uterine myoma <ransvaginal =ltrasound empty bladderAbdoiminal ulrasound full bladder

%lacenta Grading "yste$• rade 7 immature

• rade 1 slightly mature

• rade 2 moderately mature

• rade 3 fully mature



• Phat is depositedT calcium

). %syc&ological #daptation to %regnancy – !eva !ubin

'irst ri$ester• o tangible ssx

• eeling of surprise

• Ambivalence

• Denial of pregnancy maladaptation

• Developmental <as'> Accept biological facts of pregnancy

• Eealth <eaching> :ody changes of pregnancy and utrition

"econd ri$ester• <angible ssx

• +other identi%es fetus as separate entity due to Huic'ening

• antasy

• Developmental <as'> Accept gro-ing fetus as a baby to nurture

• Eealth <eaching> ro-th and development of fetus

&ird ri$ester

• +other has personally identi%es -ith the appearance of the baby

• Developmental <as'> (repare child birth and parenting the child

• Eealth <eaching> responsible parenthood, prepare baby’s layette, ?amae 9lass

• Address +other’s fear let she hear the E<

). %re – 9atal )isit

Basic Consideration1. 'reOuency of )isit

• 1 Mth mos. once a month

• 6 Ith mos. t-ice per month

• 17th month every -ee'<. %ersonal Data

• ,o$e Based +ot&ers !ecord* ,B+! determines high ris' pregnancy

• %seudocyesis

false pregnancy

appearance of presumptive F probable signs• Co$ade "yndro$e psycosomatic disorder, father experience -hat the mother goes through

>. Diagnosis of %regnancy• =rine xam E9 #7 177th day0 pea' J7 M7 th day

• ?4SA beta subunits of E9 is detected as early as M 17 th day

• 84A beta subunits of E9 is detected as early as 6 th day

• Eome (regnancy Qit4. Baseline Data

• 8oll )ver <est test of pre"eclampsia by the use of :(

• Peight monitoringormal Peight ain

1st <rimester G 1.* 3 lbs 1 lb mo2nd <rimester G 17 12 lbs # lbsmo3rd <rimester G 17 12 lbs # lbsmo

+inimum allo-able -eight gain 27 2* lbs)ptimal -eight gain 2* 3* lbs

5. 6bstetrical Data

a. Gravida no. of pregnancyb. %ara no. of viable pregnancy

)iability the ability of the fetus to live outside the uterus at the earliest possible gestational age

1 abortion 1 3I <E Pee', 1 miscarriage, 1 still birth, 1 2nd mo. preg1 pregnancy 3rd mos. #(2 # <1 (1 A1 ?1



2(7 2 <7 (7 A1 ?7

c. $portant (sti$ates1. agele’s 8ule

• =se to determine expected date of delivery

• Uan +ar LI months LM days

• Apr Dec "3 months LM days L 1 year

<. +cDonalds !ule

• Determines age of gestation in -ee's

• undic Eeight x M6 G A) in -ee's>. Bart&olo$e=s !ule

• Determines age of gestationso 3 mos above pubis symphysiso * mos level of umbilicuso I mos belo- xiphoid process

o 17 mos level of 6th mos

4. ,aases !ule

• Determines the length of fetus in cm.

• 1st half sHuare each month

• 2nd half month x *

d. etanus $$uni7ation• <<1 anytime or early during pregnancy

• <<2 1 month after <<1 3 years protection

• <<3 J months after <<2 * years of protection

• <<# 1 year after <<3 17 years of protection

• <<* 1 year after <<# lifetime protection

5. %&ysical (xa$inationsa.Danger "igns of %regnancy

Chills F everCerebral Disturbances#bdominal (ain epigastric pain auro of impending convulsionBoardli'e Abdomen Abruptio placentaBlurred @ission pre eclampsia

Bleeding abortion ectopic pregnancy 1st

trimester E +ole 4ncompetent 9ervix 2nd trimester (lacental Anomalies 3rd <rimester

B( V"-elling"cotoma spots in the eye"udden gush of Kuid (8)+ premature rupture of membrane

;. %elvic (xa$ination (elvic examination or 4 empty bladder, precaution 1st visit 9had-ic's, oodle’s sign, etc. (osition > dorsal recumbent, lithotomy (ap smear done 1st visit 9ytological exam determine presence of cancer cells. 8esult >

o 9lass 4 normalo 9lass 44 A cytology -ithout evidence of malignancy

: suggestive of inKammationo 9lass 444 cytology suggestive of malignancyo 9lass 4@ cytology suggestive og malignancyo 9lass @ conclusive for malignancy

+ost common cancer report organ > cervical cancer +ost common site for pap smear external )S of cervix BsHuamocolumnar tissueC 9ommon site of cervical cancer. maternal speculum BopenC "tages of cervical cancer

o 7 carcinoma in situo 1 9a strictly con%ned to cervixo 2 from cervix extends to the vagina



o 3 pelvic metastasiso # a$ectation to bladder F rectum

. 3eopolds +aneuver %urpose0 Done to determine the attitude, fetal presentation, lie, presenting part, degree of descent an estimate

of the sie, and no. of fetuses (rocedure

1. 1st maneuvero place patient in supine position -ith 'nees slightly Kexed. (ut to-el under head and right hip. Pith both

hands palpate uppe#r abdomen and fundus. Assess sie, shape, movement and %rmness of the parto determine the presenting parts>

2. 2nd maneuvero -ith both hands moving do-n, identify the bac' of the fetus -here the ball of the stethoscope is placed

to determine E<.o %! of $ot&er 0 uterine souP – +,!o fundic souP – ',!

3. 3rd maneuvero using the right hand, grasp the symphysis pubis part using the thumb and %ngers.o Assess -hether the presenting part is engaged in the pelvis.o AlertW 4f the head is engaged it -ill not be movable

#. #th maneuvero the examiner changes the position by facing the patient’s feet. Pith t-o hands, assess the descent of

the presenting part by locating the cephalic prominence or bro-.o Phen the bro- is on the same side as the bac', the head is extended. Phen the bro- is on the same

side as the small parts, the head 6is Kexed and vertex presenting.

#ttitude relationship of fetus to one another.

'ull 'lexion -hen the chin touches the chest

A. #ssess$ent of 'etal 8ellNbeing

a.Daily fetal +ove$ent Counting -D'+C2 Done starting 2Mth -ee' 9onsideration fetal sleep -a'e pattern maternal food inta'e drug"nicotine use environmental stimuli maternal dose

CardiR count to 1: $et&od – one method currently availableo begin at the same time each day Busually in the morning after brea'fast C and count each fetal

movement, noting ho- long it ta'es to count 17 fetal movements B+sCo expected %ndings 17 movements in 1hrs or lesso -arning signs 17"12 movements in 1hr or less

more than 1hr to reach 17 movements less than 17 movements in 12hrs longer time to reach 17 +s than on previous days. movements are becoming -ea'er, less vigorous movement alarm signal X3 +s in 12hrs

o -arning signs should be reported to healthcare provider immediately0 often reHuire furthertesting. g. on stress test BS<C, biophysical pro%le B:((C

b.9onstress esto to determine the response of the fetal heart rate to the stress to activity.o 4ndications pregnancies at ris' for

o placental insuYciencyo (ostmaturity

• pregnancy induced hypertension B(4EC, diabetes

• -arning signs noted during D+9

• maternal history of smo'ing, inadeHuate nutritiono (rocedure >

• Done -ithin 37mins -herein the mother is in semifo-lers position0 external monitor is appliedto document fetal activity0 mother activates the mar' button/ on the electronic monitor -henshe feels fetal movement. Attach external noninvasive fetal monitors

• tocotransducer over fundus to detect uterine contractions and fetal movements B+sC

• ultrasound transducer over abdominal site -here most distinct fetal heart sounds are detected

• monitor until at least 2 +s are detected in 27mins.



o if no + after #7mins provide -omen -ith a light snac' or gently stimulate fetus through abdomeno 4f no + after 1hr further testing may be indicated, such as a 9S<o 8esult >

• oncreative onstress ot ood

• 8eactive 8esponse is 8eal oodo 4nterpretation of results

• 8eactive result real good baseline E8 bet-een traction beteen 127 and 1J7 beats per min. at least t-o accelerations of the E8 of at least 1* beats per min., lasting at least 1*secs

in a 17 to 27 min period as a result of + good variability normal irregularity of cardiac rhythm representing a balanced

interaction bet-een the parasympathetic BZ E8C and sympathetic BV E8C nervoussystem0 noted as an uneven line on the rhythm strip

result indicates a healthy fetus -ith an intact nervous systemo 9onreactive result – not good

stated criteria for a reative result are not met

could be indicative of a compromised fetus reHuires further evaluation -ith another S<,

biophysical pro%le, B:((C or contraction stress test B9S<C

H. ,ealt& eac&ingso do nutritional assessmento daily food inta'eo determine habit

o if Z folic acid lead to spina bi%daopen neural tube defect

o ,G, !"@ +6,(!"

• pregnant teenagers poor compliance to health regimen

• extremes in -t under-t eg. lite models over-t eg. D+E(

• lo- social economic status. 8efer to )SPD

• vegetarian mothers because Z inta'e of vit :12 B9yanocobalaminC formation of folic acid BcellDA F 8A formationC

• types > strict vegetarian prone to develop anemia lacto vegetarian mil' lacto"ovo vegetarian mil' F egg

a. !eco$$ended 9utrient !eOuire$ent t&at ncreases During %regnancy9utrients !eOuire$ents 'ood sourcesCalories

ssential to supply energy for• V metabolic rate

• =tiliation of nutrients

• (rotein sparing so it can be usedfor >

o gro-th of fetus

o development of structures

reHuires for pregnancyincluding placenta,amniotic Kuid, tissuegro-th

377 caloriesday above theprepregnancy daily reHuirement tomaintain ideal body -eight and meetenergy reHuirement of activity levelbegin V in 2nd <rimesteruse -t"gain pattern as an

indication of adeHuacy of caloriesinta'e

failure to meet caloricreHuirements can lead to 'etosis asfat F protein are used for energy,'etosis has been associated -ithfetal damage.

on pregnant> 2277 calories(regnant> 2*77 calories

2277L*77 ! lactationG2M77 cal

9aloric V should reKectfoods of high nutrient value suchas protein, complex carbohydratesB-hole grains, vegetables, fruitsCvariety of foods representing foodsources for the nutrients reHuiredduring pregnancyno more than 37R fat

a 3gmsday eat in moderation9E) x #Q 9al9E) x #Q 9alats x IQ 9al

%roteinssential for

• fetal tissue gro-th

• maternal tissue gro-th includinguterus and breasts.

• Development of essentialpregnancy structures

• ormation of 8:9 and plasmaproteins

4nadeHuate protein inta'e has been

J7mgday or an V of 17R above dailyreHuirements for age group

Adolescents have a higher proteinreHuirement than mature -omen sinceadolescents must supply protein fortheir o-n gro-th as -ell as protein tomeet the pregnancy reHuirement

(rotein V should reKect?ean meat, poultry, %shggs, cheese, mil'Dried beans, lentils, nutsPhole grains

@egetarians must ta'e note of theamino acid content of 9E) foodsconsumed to ensure ingestion ofsuYcient Huantities of all amino acids



associated -ith onset of pregnancyinduced hypertension B(4ECCalciu$N%&osp&orousssential for

• ro-th and development of fetals'eleton and tooth buds

• +aintenance of mineraliation ofmaternal bones and teeth

• 9urrent research is demonstratingan association bet-een adeHuatecalcium inta'e and the preventionof pregnancy inducedhypertension

9alcium V of • 1277mgday representing an V of

*7R above pre pregnancy dailyreHuirement

• 1J77mgday is recommended for

adolescent• 17mcgday of vitamin D is reHuired

since it enhances absorption of bothcalcium and phosphorous

9alcium V should reKectDairy products, mil', yogurt, icecream, cheese, egg yol'Phole grain, tofureen leafy vegetables

9anned salmon F sardines -ithbones9a forti%ed foods such as orange &uice@itamin D sources forti%ed mil',margarine, egg yol', butter, liver,seafood

ronssential forxpansion of blood volume F 8:9formationstablishment of fetal iron storesfor %rst fe- months of life

on (regnat>1*mgday(regnant > 37mgday

- representing a doubling of theprepregnant dailyreHuirement

• :egin supplementation at37mgday in second trimester,since diet alone is unable to meet

pregnancy reHuirement• J7 127mgday along -ith copper

and inc supplementation for-omen -ho have lo- Egb valuesprior to pregnancy or -ho have ironde%ciency anemia

• M7mgday of vitamin 9 -hichenhances iron absortiono 4nadeHuate iron inta'e results

in maternal e$ects anemia,depletion of iron stores, Zenergy and appetite, cardiacstress especially during labor Fbirth

o fetal e$ects Z availability ofoxygen thereby a$ecting fetal

gro-th• iron de%ciency anemia is the most

common nutritional disorder ofpregnancy

4ron V should reKect• liver, red meat, %sh, poultry, eggs

• enriched, -hole grain cereals Fbreads

• dar' green leafy vegetables,legumes

• nuts, dries fruits

• vitamin 9 sources> citrus fruits F &uices, stra-berries, cantaloupe,tomatoes, green peppers, broccolior cabbage, potatoes

• iron form food sources is morereadily absorbed -hen served -ithfoods high in vit 9

Iincssential for

• the formation of enymes

• maybe be important in theprevention of congenitalmalformation of the fetus

1* gday representing an V of3mgday over prepregnant dailyreHuirement

inc V should reKectliver, meatsshell %shV grains, legumes, nuts

'olic acidsL folacinL folatessential for

• ormation of 8:9 F prevention ofanemia

• DA synthesis F cell formation0may play a role in the preventionof neural tube defects Bspinabi%daC, abortion, abruptionplacenta

#77mcgday representing an V ofmore than 2x the daily prepregnantreHuirement

377mcgday supplement for -omen-ith lo- folate levels or dietaryde%ciency

V should reKect• ?iver. Qidney, lean bee', veal

• Dar', green leafy vegetables,

broccoli, asparagus, articho'es,legumes

• Phole grains, preanuts

Additional reHuirements+inerals4odine+agnesiumselenium

1M*mcgday327mgdayJ*mcgday

V reHuirements of pregnancy caneasily be met -ith a balanced diet thatmeets the reHuirement for calories andincludes food sources high in the othernutrients needed during pregnancy

@itamins



<hiamine8iboKavin(yridoxine B:JC:12iacin

17mgday1.*mgday1.Jmgday2.2mgday2.2mcgday1Mmgday

b. "exual #ctivity

• %rinciples of sex in %regnancyo Should be done in moderationo Should be done in a private placeo <hat the mother should be placed in a comfortable positiono 4t must be avoided J -ee's prior to DDo Avoid blo-ing of air during cunnilingus

• Contraindication in sex0o vaginal spotting 1st trio incompetent cervix 2nd trio placenta previa, abruption placenta 3rd trio pre"term labor 8> prostaglandin oxytocin contractiono (8)+ infection

• C&anges in sexual appetite during pregnancy0o 1st tri " Zo 2nd tri " Vo

3rd

tri " Z

c. (xercise• strengthen muscle to be used during the delivery process

• 8aling best form of exercise

• "Ouatting strengthen perineum F Vcirculation to the perineum Braise the buttoc's before head to prevent

postural hypotensionC

• ailor sitting same purpose -ith sHuatting

• @egel exercise strengthen pubococcygeal muscle

• #bdo$inal exercise muscle of the abdomen B done as if blo-ing a candleC

• "&oulder circling exercise strengthen muscle of the chest

• %elvic rocing exercise or pelvic tilt relieve lo- bac' pain F maintain good posture Barching bac' for 3 secC• %rinciples of exercise

o must be done in moderationo must be individualied

d. C&ildbirt& %reparation• 6verall goal0 <o prepare patents physically F psychologically -hile promoting -ellness behavior that can be used

by parents F family thus, helping them achieved a satisfying F en&oying childbirth experiences.

• %syc&ologicalo Bradley +et&od Dr. 8obert :radley discoverer

advocated active participation of husband during labor F delivery to serve as coach, based onimitation of nature/

eatures>

• dar'ened room

• Huiet F calm environment• relaxation techniHue

• close eyeso Grantly Dic !ead +et&od

fear can lead to tension -hile tension can lead to pain. Bbrea' cycle by removing the fear"byabdominal breathing exercises F relaxation techniHueC

• %syc&osexualo @it7inger +et&od Dr. Shiella Qitinger

pregnancy, labor F birth F the care of the ne-born is an important turning point in a -oman’slife cycle. Ko-ing -ith contractions rather than struggle -ith contractions/

• %syc&oprop&ylaxiso 3a$a7e Dr. erdinand ?amae



(revention of pain thru mind F reHuires discipline, conditioning F concentration -ith thehusband’s help.

eatures>

• conscious relaxation

• cleansing breathe inhaling thru nose F exhaling thru mouth

• e[eurage gentle circular massage

• over abdomen to relieve pain

•imaging• DiRerent $et&ods of delivery

o birt&ing c&ain semi"fo-lers mothero bat&ing bed dorsal recumbento sOuatting position relieve on bac' pain F maintain good postureo 3eboyers $et&od

features >

• dar'ly lighted room

• Huiet F calm environment

• room temp.

• soft musico Birt& under =ater

S. 9!#%#!#3 96("#. #d$itting t&e laboring +ot&er

• (ersonal data

• :aseline data

• )bstetrical data

• (hysical exams

• (elvic examsB. Basic no=ledge in intrapartu$

• &eories of t&e 6nset of 3aboro /terine "tretc& &eory any hollo- organ once stretched to its maximum potential -ill al-ays

contract F expel its contento 6xytocin &eory released by ((, contraction e$ecto %rostaglandin &eory stimulation by Arachidonic acid, causes contraction of uteruso #ging %lacenta #2-'s BlifespanC by 3J-'s placenta begins to degenerate causes contractiono %rogesterone deprivation t&eory " Z level of progesterone -ill facilitate contraction of the uterus

• &e 4 %s of 3aboro %assenger fetus

fetal head

• is the largest presenting part• \ of its length

• :ones J bones Bsphenoid, temporal, ethmoidC rontal, occipital F 2 parietal bones

• "utures*inter$e$branous spaces allo-s molding

• +olding the overlapping of the sutures of the s'ull to permit passage of the head tothe pelvis

o "agittal bones connect to parietal boneso Cororontal bones connect to parietal F frontal boneso 3a$bdoidal bones connect to parietal F occipital bones

• 'ontanelso J fontanels only 2 palpable

anterior fontanel*Breg$a

• diamond in shape

• 3cm x #cm sie

• close 12"16 mos post delivery

• V *cm hydrocephalus posterior fontanel*la$bda

• triangular in shape

• 1 x 1cm sie

• close 2"3mos post delivery

• +easure$ents of fetal &ead 0o transverse dia$eter

BiNparietal " largest transverse diameter" I.2*cm BiNte$poral " 6cm BiN$astoid " smallest transverse diameter " Mcm

o #% dia$eter



"uboccipitobreg$atic complete Kexion 6ccipitofrontal partial Kexion " 12cm 6ccipitote$poral largest A( diameter0 hyperextended B13.*cmC "ub$entobrg$atic " face presentation0 poor Kexio

o %assage=ay vagina F pelvis %elvis

• # main pelvic typeso gynecoid round, -ide, deeper, most suitable for pregnancyo android heart shape male pelvis/ anterior pointed post part shallo-o #nt&ropoid oval ape"li'e pelvis A( -ider transverse narro-o %latypelloid Kat transverse oval A( narro- transverse -ider cs for

delivery• (roblem >

o mother -ho encounter accidento Z #’I/o Z 16yo 8> pelvis not achieve its full pelvic gro-th

Bones of pelvis

• 4boneso < &ips B2 innominate bonesC

3parts of 2 innominate bones

• leu$ lateralside of hipso 4liac crest Karing superior border that forms

prominence of hips0 common site for bone marro-

aspiration• sc&iu$ inferior portion

o 4schial tuberosities of the area -here -eo Sit0 basis in getting external measurement of

pelvis• %ubis anterior portion

o Symphysis pubis &unction in bet-eeno sacru$ posterior portion

Sacral prominence basis internal measurement of pelviso 1 coccyx " # small bones that compresses during vaginal delivery

• universal precaution in measurement of pelvis is to empty bladder %rst

• 4mportant +easurementso Diagonal Conugate

measure bet-een Sacral promontory F inferior margin of thesymphysis pubis

+easurement 11.*"12.* cm :asis in getting the true con&ugate.

o rue Conugate*Conugate )era +easure bet-een the anterior surface of the sacral promontory F

superior margin of the symphysis pubis. +easurement> 11.7 cm Diagonal con&ugate> 1.* cm G true con&ugate.

o 6bstetrical Conugate smallest A( diameter of the pelvis measuring 17cm or more.

o uberoisc&ii Dia$eter transverse diameter of the pelvic outlet. Approx by a %st" 6cm F above.

o %o=er the forces acting to expel the fetus F placenta

• involuntary contractions

• voluntary bearing do-n e$orts

• characteristics> -ave li'e

• timing> freHuency, duration, intensity $yo$etriu$ po-er of labor

o %syc&e*person psychological stress exist -hen the mother is %ghting the labor experience.

• cultural interpretation preparation

• past experience

• support system

• %reNe$inent signs of laboro (reeminent Signs

lig&tening



• settling of the presenting part into the pelvis brim Bshooting pain radiating to the legs,urinary freHuencyC

• primi" early 2 -ee's prior to DD

• engagement settling of presenting part into pelvic inlet Bnot signs of laborC Braxton ,ics Contractions painless irregular contractions ncrease #ctivity of t&e +ot&er esting

• 4nstinct Bmgt> save energyC

•epinephrine production Bhormone that V the activity of the motherC !ipening of t&e cervix butter softness

Decrease in =eig&t 1.*"3 lbs. Bloody s&o=

• pin'ish vaginal discharge Bblood L leucorrhea L operculum G pin' in colorC !upture of $e$branes

• chec' E<

• 4 chec' for cord prolapse

• after several hrs chec' temp.o %re$ature !upture of +e$branes -%!6+2

contraction drop in intensity even though very painful contraction drop in freHuency uterus tense For contracting bet-een contractions abdominal palpitations 9ursing Care0

• administer analgesics BmorphineC

• attempt manual rotation for 8)( or ?)(

• bear do-n -ith contractions

• adeHuate hydration

• sedation as ordered

• cesarean delivery may be reHuired, especially if fetal distress is notedo Cord %rolapse

a complication -hen the umbilical cord falls or is -ashed through the cervix into the vagina. Danger "igns0

• (8)+

• (resenting part has not yet engaged

• etal distress

• (rotruding cord from vagina cerebral palsy V * mins., irreversible brain damagemgt> 9S

9ursing Care

• (ositioning 'nee chest or trendelenberg, place -et sterile gaue 8> to ma'e itslippery

• )bserve for fetal distress

• (rovide emotional support

• (repare for cesarean section

• DiRerence Bet=een rue and 'alse Contraction

<rue alse

• o in intensity

• (ain con%ned in the abdomen

• (ain is relieved by -al'ing

• o cervical changes

•

• <here is an in intensity

• (ain begins ! the lo-er bac' toabdomen

• (ain is intensi%ed by -al'ing 9ervicale$acement Bthinning of the cervix,measured thru RC F dilatationB-idening of the cervix, measurementthru cmC ]bestma&or sign of true labor

• Duration of 3aboro %ri$ipara 1# hrs but not more than 127 hrso +ultipara 6 hrs but not more than 1# hrs

• 9ursing nterventions in (ac& "tage of 3aboro 'irst "tage> onset of contractions to full dilatation F e$acement of the cervixo stage of e$acement F dilatation

3atent %&ase0

• Assessment>o Dilatations 7"3 cmo reHuency *"17 minso Duration 27"#7 mins



o 4ntensity mildo +other is excited, apprehensive but can communicate

• ursing 9are>o ncourage -al'ing > shortens 1st stage of laboro ncourage to void H 2"3 hrs > full bladder inhibits uterine contractiono breathing Bchest breathing techniHueC

#ctive %&ase0

• Assessment>o Dilatations #"6 cmo reHuency H 3"* mins lasting for 37"J7 secso Duration 37"J7 secso 4ntensity moderate

• 9ursing Care0o + edications have meds readyo # ssessment include> vs, cervical dilatation F e$acement, fetal monitor, etco D ry lips oral care BointmentC, dry linenso :reathing abdominal breathing

ransitional %&ase0

• #ssess$ent0o Dilatations 6"17cmo reHuency H 2"3 mins contractionso Duration #*"I7 seco 4ntensity strongo +ood of mother suddenly change accompanied by hyperesthesia

Bhypersensitivity of mother to touchC of the s'in• +anage$ent

o sacral pressure, cold compress

• 9ursing care0o tireso inform of progress Bto relieve emotional supportCo ! restless support her breathing techniHueo ( encourage F praiseo D discomfort

o %elvic (xa$s (Race$ent ? Dilatation

• "tation relationship of the presenting part to the ischial spineo * " "1 G the presenting part is above the ischial spineo ngagement 17 G the presenting part is in line -ith the ischial spine

o B"C fetus is Koatingo BLC belo- the ischial spine

• %resentationo 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 F the spine of the fetus

o <-o <ypes 3ongitudinal 3ie -%arallel2* )ertical

• Cep&alic -hen the fetus is completely Kexedo @ertexo aceo :ro-o 9hin

• Breec&o Co$plete breec& thigh rest on abdomen -hile

legs rest on thigho nco$plete breec&

'ran thigh resting on abdomen -hilelegs extend to the head

'ootling @neeling

ransverse 3ie -%erpendicular2*,ori7ontal lie

• %osition relationship of the fetal presenting part tospeci%c Huadrant of the mother’s pelvis.

o !6#*36# left occipito anterior



• (rehydrate the client to prevent hypotension

• 4n case of Eypotensiono levate lego ast Drip 4@

"(C69D "#G( 6' 3#B6! -'(#3 "#G(2 9omplete dilatation and e$acement to birth 9ro-ning occurs (84+4 transfer to D8 ! 17 cm dilatation +=?<4 transfer to D8 ! M 6 cm dilatation (osition in lithotomy both legs at the same time B/3G9G 6' %(!(9/+ surest sign of delivery initiation (A< F :?)P :reathing, fetal pushing should be done on an open glottis !espiratory alalosis

o Due to incorrect breathingo Eyperventilationo Ssx

↑ 88 ?ightheadedness <ingling sensation 9arpopedal spasm 9ircumoral numbness

(pisioto$y (revent laceration Piden the vaginal canal Shortens the 2nd stage of labor 2 types

o +(D#9 ?ess bleeding ?ess pain asy repair (ossible urethroanal %stula ma&or disadvantage

o +(D63#(!#3 +ore bleeding +ore pain Eard to repair and slo- healing

roning t&e %ereniu$ prevent laceration

+ec&anis$ of 3abor -(D '!( (!(2 (ngagement Descent 'lexion nternal !otation (xtension (xternal !otation (xpulsion

%(3)" > %arts

o nlet A( diameter narro-, transverse -ider

o Cavity bet-een inner and outer

o 6utlet A( diameter -ider, transverse narro-

39(# (!+9#3("

9ursing Care

+6D'(D !G(9" +#9(/)(!o Done by supporting the perenium -ith a to-el during deliveryo acilitates complete Kexiono Avoids laceration

irst 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 Phen there is still birth, let the mother see the baby to accept the %nality of death



Dystocia DiYcult labor related to mechanical factor (rimary cause is =terine 4nertia

/terine nertia Sluggishness of contraction <ypes

o %ri$ary* ,ypertonic

4ntense contraction resulting to ine$ective pushing +anagement > Sedation

o "econdary* ,ypotonic Slo-, irregular contraction resulting to ine$ective pushing +anagement > )xytocin Augmentation

%rolonged 3abor O 27 E for primi O 1# E for multi proper pushing should be encourage if inappropriate>

o may cause fetal distresso caput succedaneumo cephalhematomao maternal exhaustion

monitor contractions and E<

%recipitate 3abor labor less than 3 hours causes excessive laceration leading to profuse bleeding hypovolemic shoc' ssx of hypovolemic shoc' ,%6 #C, #C,

o ,%6tensiono #C, pneao #C, cardiao 9old clammy s'ino +anage$ent

+odi%ed trendelenburg ast Drip 4@

nversion of /terus Situation in -hich uterus is turn inside out due to>

o Short cordo Eurrying of placental deliveryo 4ne$ective fundal push

9ause profuse bleeding hypovolemic ,ysterecto$y

/terine !upture 8upture of uterus Caused by

o (revious classical 9So @ery large babyo 4mproper use of oxytocin

"*sxo Sudden paino (rofuse bleeding

(repare fore <AE:S)%&ysiologic !etraction !ing boundary bet-een upper and lo-er uterine segment

Bandls%at&ologic !ing

suprapubic depression sign of uterine rupture

#$niotic 'luid* %lacental ($bolis$ Anaphylactic syndrome of pregnancy Situation in -hich placental fragment and amniotic Kuid enters maternal circulation "*"x

o Dyspneao 9hest (aino rothy Sputumo nd Stage D49

(repare for 9(8, Suction and emergency etc



rial 3abor etal head measurement G measurement of pelvis J hours labor allo-ance given to mother monitor E< and contractions

%reter$ 3abor labor after 27 -ee's and before 3M -ee's riad signs

o (remature conditions every 17 minuetso $acement of J7 67Ro Dilatation of 2 3 cm

,o$e +anage$ento 9:8o Avoid Sexo mpty bladdero Drin' 3 # lasses of E2)

ull bladder inhibit contraction ,ospital +anage$ent

o 4f 9ervix 9lose -Criteria0 cervix is closed if it is < – > c$ dilated only2

2 3 cm dilated, pregnancy can be saved ocolytic &erapy

• utupar -!itodine ,Cl2o Side e$ect maternal :( X I7J7o 9hec' 4mpt. (resence of crac'les

• Bret&ine -terbutaline2 Bricanylo D6Co Side e$ect> sustained tachycardiao Antidote> propanolol inderal

• +g "64o f cervix is dilated - 4c$2

ive steroid dexa$et&asone

• (romote surfactant maturation

• 4mmediately cut the cord after delivery to prevent &aundice hyperbilirubinemia

%6"%#!#3 %(!6D

%uerperiu$ *th stage of labor, 1st J -ee's post partum9haracterie by involution

nvolution " return to the normal stage of reproductive organ after pregnancy

!eturn to 9or$al ,ealing%&ysiologic C&anges"yste$ic C&anges

Cardiovascular "yste$

o ↑plasma volume

o sudden ↓ in blood volumeo elevated P:9’s up to 37, 777 mm3o hyper%brinogenemiao orthostatic hypertension can be possibleo early ambulation prevents thrombos formation

steps in ambulation

• lat

• Semifo-lers

• o-lers -ith dangling

• Pal' -ith assist

Genital racto 'undus

goes do-n 1 %nger breadth a day

17th day non palpable behind the symphysis pubis

"ubinvolution

• delayed healing of uterus containing Huarters or clots of blood

• may lead to puerperal sepsis

• +anage$ent 0 DF9o #fter %ains



(arly %ospartal ,e$orr&age

1. /terine #tony boggy fundus profuse bleeding interventions

o massage the uteruso cold compresso modi%ed trendelenburgo fast drip 4@o breastfeeding to release oxytocin

<. 3aceration -ell contracted uterus -ith profuse bleeding assess perenium for laceration degrees of laceration

o 1st degree vaginal s'in and mucus membraneo 2nd degree 1st degree L muscleso 3rd degree 2nd degree L external sphincter of rectumo #th degree 3rd degree L mucus membrane of rectum

>. ,e$ato$a bluish discoloration of sub; tissues of vagina or perenium candidates

o delivery of very large babieso pudendal bloc'o excessive manipulation due to excessive 4

interventiono cold compress 17 27 min then allo- 37 minutes rest period for 2# h

4. DC – disse$inated intravascular coagulation 9onsumption of pregnancy BothertermC ailure to coagulate :leeding in the eyes, ears, nose )oing blood Seen in cases -ith

o Abruptio placentao Still birth 4=D

+anage$ento :lood transfusion of cryoprecipitate or fresh froen plasmao hysterectomy

3ate %ostpartu$ ,e$orr&age

!etained placental frag$ents manual extraction of fragments is done uterine massage D?C except for cases of

o %lacenta #creta umusual attachment of the placenta to the myometriumo %lacenta ncreta deeper attachment of placemat to the myometriumo %lacenta %ercreta invasion of placenta to the perimetrium

9andidates of these disorders are

• rand multiparous

• (ost 9S All these reHuires hysterectomy

nfection "ources

o ndogenous from normal Kora of the bodyo xogenous from the health care team

+ost common Anaerobic Streptococci +anage$ent

o Supportive care

o ↑ luid inta'eo <S: if there is fever cold compress L paracetamol may also be given



o Analgesics iven on time to achieve maximum e$ect

o 9ulture and sensitivity

%erenial nfection Same s sx -ith infection 2 3 stitches are dislodges -ith purulent drainage

<x resuturing

(ndo$etritis 4nKammation of the endometrium en ssx of infection L abdominal tenderness +anage$ent

o Eigh fo-ler’s facilitates drainage F localie infectiono Administer oxytocin

'#+3 %3#999G +(,6D

Guiding %rinciples1. determine your o-n beliefs %rst2. never advise a permanent method of family planning3. informed concent#. the method is an individual decision

9atural +et&od accepted by the church

:illing’s 9ervical +ucus Spinnbar'eit

• clear -atery F stretchable

• 13th day longest due to estrogen

:asal :ody <emp in the morning before arising 13th 1#th day due to pea' of progesterone?A+ ?actational Amenorrhea +ethod

prolactin inhibits ovulation breastfeeding # J months no menstrual cycle bottle fed 2 3 months

Sympthothermal combination of :illings and ::< most e$ective method

"ocial +et&ods

Coitus nteruptus -ithdra-al least e$ective method

Coitus !eservatus sex -o e&aculation

Coitus interfe$ora bet-een femor

Calendar +et&od 1# days before menstrual cycle ovulation day BregularC " #, L # days unsafe period

6rigonause 'or$ula - irregular $enstrual cycle2 get the longest and shortest cycle subtract 16 to shortest 11 to the longest the di$erence is the unsafe period

%33" combined oral contraceptives preventovulation by inhibiting the anterior pituitary gland roduction of SE and ?E

-hich are essential for he maturation and rupture of a follicle. strogen inhibit SE -hich is responsible in the mturation of ovum. (rogesterone inhibit ?E -hich is responsible

for ovulation. contains estrogen that inhibits SE and progesterone that inhibit ?E II.IR e$ective 21 day feel on the *th day of mense start ta'ing 26 day 1st day of mense if forgotten, ta'e 2 tablets the follo-ing day adverse e$ect > brea'through bleeding if mother -ants to get pregnant



Contraindicated too reHuent =<4

C(!)C#3 C#% +ore durable than the diaphram 9ould stay on place for more than 2# hours o need to apply spermicides Contraindicated to abnormal papsmear

C,(+C#3"%(!+CD("

)A+S most e$ective Uellies 9reams <hese may cause toxic shoc' syndrome

"/!GC#3 +(,6D Bilateral tubal 3igation

o ! isthmuso 27R probability of reversal

)asecto$yo @as deferens is cuto +ore than 37 x or 7 sperm count or 2 x negative sperm count before it could be consider safe sex

,G, !"@ %!(G9#9C ,(+6!!,#GC D"6!D(!"

General $anage$ent 9:8 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 ri$ester Bleeding#bortion termination of labor before age of viability

"%69#9(6/"o AQA miscarriageo Causes

1. 9hromosomal aberrations due to advanced maternal age2. :lighted ovum3. germ plasm defect

o atures -ay of expelling defective babieso Classications 0

1. &reatened

• pregnancy is &eopardied by bleeding and cramping but the cervix is closed and can besaved.

<. nevitable• moderate bleeding, cramping, tissue protrudes from the cervix and the cervix is open.

o ypes 01. Co$plete

• all products of conception are expelled.

• +gt > emotional support2. nco$plete

• placenta and membranes retained.

• +gt > DF9 ,#B/#3

o 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix.o +anage$ent Bsuture of cervixC

1. +cDonald procedure• <emporary circlage



• Side e$ect infection

• +ay have SD<. "&irodar

• 9S delivery +""(D

o fetus dies0 product of conception remain in uterus # -ee's or longero signs of pregnancy cease

1. B"C pregnancy test2. Dar' bro-n3. Scanty bleeding

o +gt > induction of labor vacuum extraction

9D/C(Do <herapeutic abortion principle of 2 fold e$ect

1. Done -hen mother has class # heart disease

(ctopic %regnancy • occurs -hen gestation is location outside the uterine cavity

• 9ommon site > Ampulla or <ubal

• Dangerous site> 4nterstitial

/nruptured !uptured

• +issed period

• Abdominal pain -ithin 3" *-'s of missed

period Bmaybe generalied of one sidedC• Scant, dar' bro-n vaginal bleeding

• @ague discomfort

• sudden, sharp severe unilateral pain, 'nifeli'e

• shoulder pain Bindicative of intraperitonealbleeding that extends to diaphragm Fphrenic nerveC

• BLC 9ullen’s sign bluish tinged umbilicus

• syncopefainting

• ursing 9are >o vital signso administer 4@ Kuidso monitor for vaginal bleedingo monitor 4F)o prepare for culdocentesis to determineo hemoperitoneum

• +gt > non"surgical+ethotrexate

"(C69D !+("(! B3((D9G,ydatidifor$ +ole * Ubunc& of grapesV

• estational <rophoblastic Disease progressive degeneration of 9horionic @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 fertilied egg. <he nucleus of the sperm duplicates, producing adiploid number #Jxx. 4t gro-s and enlarges the uterus very rapidly.

• Cause > =n'no-n

• #ssess$ent 0o (arly signs

vesicles passed thru the vagina Eyperemesis gravidarum due to V E9 undal height @aginal bleeding Bscant or profuseC

o (arly in pregnancy high levels of E9

(re ecclampsia at about 12-'s @esicles loo' li'e a sno-storm/ on sonogram Anemia Abdominal cramping

o "erious late co$plications Eyperthyroidism (ulmonary embolus

• 9ursing care 0o prepare for DF9o do not give oxytocin drugs due to proneness to embolismo Eealth <eaching>



return for pelvic exams as scheduled for one year to monitor E9 and assess for enlargeduterus and rising titer could be indicative of choriocarcinoma

Avoid pregnancy for at least one year +ethotrexate therapy

nco$petent Cervix +anage$ent0• +cDonald procedure

o temporary circlage of incompetent cervix.o Delivery > S@Do S> infectiono Eealth teaching

observe for signs of infection signs of labor

• Shhirod'ar procedureo permanent procedure.o Delivery > caesarian section reHuired.

,!D !+("(! B3((D9G U%3#C(9#3 #96+#3("V

%lacenta %revia • it occurs -hen the placenta is improperly implanted in the lo-er uterine segment, sometime covering the cervical

os.• #ssess$ent

o

)utstanding sign > fran', bright red, painless bleedingo enlargement Busually has not occurredCo fetal distresso abnormal presentation

• 9ursing care 0o 4nitial mgt > () candidate for 9So :edresto prepare to induce labor if cervix is ripeo administer 4@o o 4, o Sex, o enema complication > Sudden fetal blood losso prepare +other for double set up D8 is converted to )8

#bruptio %lacenta • it is the premature separation of the placenta from the implantation site.

• 4t usually occurs after the t-entieth -ee' of pregnancy

• 9ause>o 9ocaine usero Severe (4Eo Accident

• Assessment>o )utstanding sign > dar' red F painful bleedingo concealed hemorrhage BretroplacentalCo couvelaire uterus Bcaused by bleeding into the myometriumC B"C contractiono rigid boardli'e abdomeno severe abdominal paino dropping coagulation factor Ba potential for D49Co sx > bleeding to any part of the body. +gt > for hysterectomy

• eneral ursing care >o infuse 4@, prepare to administer blood

• type and crossmatch

o monitor E8o insert oley cathetero measure bllod loss0 count padso report ss of D49o monitor vs for shoc'o strict 4F)

%lacental "uccenturiata 1 or 2 lobes connected to the placenta by a blood vessel%lacenta Bipartita placenta divided into 2 lobes

,%(!(9")( D"6!D(!



%regnancy nduced ,ypertensiono E( after 2#-'s resolved J-'s postpartum -hich cause pregnancy.o <ypes >

o estational E( E( -ithout edema F proteinuria. +gt > monitor :(

o (re"eclampsia triado sx > E( -ith edema, proteinuria or albuminuria BE(AC -hich cause is un'no-n or idiopathic but

multifactoral primis dt 1st exposure to chorionic villi multiple pregnancies due to V exposure to chorionic villi +others of lo- socio"economic status due to Z protein inta'e <eenagers dt lo- compliance to protein inta'e

o E??( syndrome hemolysis -ith elevated liver enymes F lo- platelet count

ransitional ,ypertension E( bet-een 27"2#-'sC&ronic or %reNexisting ,ypertension

o E( before the 27th -' not resolved J-'s postpartumo 3 types of pre"eclampsiao Sign of pre"eclampsia >

o O 37mmEg systolico O 1*mmEg diastolico

8oll over test 17"1*min side lying <hen supine <hen ta'e :(

o mild pre"ecclampsia 1#7I7mmEg, - L1 )2, L2 proteinuria arly signs > V -t, inability to -ear -edding ring due to

developing edema Signs present

• cerebral F visual disturbances, epigastric pain to liver edema and oliguria usuallyindicates an impending convulsion

• :efore convulsion > if you see sign of epigastric pain, 1` mgt is to place tonguedepressor and put the side rales up

• During convulsion > observe the +other for safety

• After convulsion turn to side to facilitate drainageo Severe pre"ecclampsia

1J7117, L3 or L#, proteinuria, visual disturbances

ursing care % promote bedrest %revent convulsions by nursing measures

• to V )2 demand F facilitate a excretion

• +anagement> Huiet F calm environment, minimal handling, avoid moving the bed

• Eeat Acetic Acid determine protein in the urine

• (repare the follo-ing at bedsideo tongue depressor, Suction machine F )2 tan'

( ensure high protein inta'e B1g'gdayC

• a in moderation # antihypertensive drug -ith hydraluine C 9S depressant -ith +g Sulfate for anti"convulsion

• +gt > evaluate for hypermagnesiumenimia ( evaluate physical parameters for +agnesium Sulfate toxicity >

• B :( Z

• / =rine output Z• ! 88 Z

• % (atellar reKex is absent

• Antidote > 9a gluconateo clampsia -ith seiure

V := sign of glumerular damage



Diabetes +ellitus o cause by absent F lac' of 4nsulino Action of 4nsulin is to facilitate transfer of glucose into the cello Dx test > *7gm 1hr lucose <olerance <est

o V 137 hyperglycemiao Z M7 hypoglycemiao 67"127 euglycemiao if O 137mgdl, the +other needs to undergo a 3hr <<

o +aternal $ects >o hypoglycemia during the 1st trimester development of the brain sinisipsip ng fetus yung glucose ng

nanay.o Eyperglycemia during the 2nd F 3rd trimester

E(? e$ect +gt > give insulin. )EA are teratogenic. 1st trimester " Z insulin, 2nd trimester " V insulin, post partum drop suddenly reHuent infectionseg. +oniliasis (olyhydramnios Dystocia

o etal $ects >o hypoglycemia during the 1st trimester and Eyperglycemia during the 2nd F 3rd trimester thru facilitated

di$usiono +acrosomia?A .#777gmso

4=8 due to prolonged D+o (reterm birth promote still birth

o e-born $ects >o Eyperinsulinism and Eypoglycemia

#7mgdl ormal > #*"**mgdl :orderline > #7mgdl Sx > V pitched shrill cry, tremors, &itteriness Dx test > heel stic' test to chec' glucose levels

o Eypocalcemia X Mmgdl 9alcemic tetany <x > 9a gluconate

,eart Diseaseo 9lassi%cation >

o 4 no limitationo 44 Slight limitation, ordinary activity causes fatigue

good prognosis can deliver vaginally +gt > sleep of 17hrsday, rest 37mins after meals

o 444 moderate limitation, less than ordinary activity causes discomfort poor prognosis. ood for vaginal delivery +gt > early hospitaliation by M"6mos

o 4@ mar'ed limitation of physical activity for even at rest there is fatigue poor prognosis. ood for vaginal delivery only -ith regional anesthesia. ?o- forceps delivery -hen unable to push F 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 reHuired, antibiotic therapy for preventionof sub acute bacterial endocarditis

9!#%#!#3 C6+%3C#69"

Cesarean Delivery• 4ndications

a. multiple gestationb. diabetesc. active herpes 44d. severe toxemiae. placental previaf. abruption placentag. prolapse of the cord



h. cephalo pelvic disproportion and primary indicationi. breech presentation

&. transverse lie• procedure 0

o classical vertical incision

o lo- segment bi'ini/, for aesthetic purposes. 9an have vaginal birth after cs

Genotype – genetic ma'e"up%&enotype – (hysical appearance@aryotype – pictorial analysis of individual chromosome for detecting chromosomal abnormalities#utoso$al Do$inant

• huntington’s chorea

• retinoblastoma

• achondroplasia

• polydactyl#utoso$al !ecessive

• sic'le cell

• 9ystic %brosis

• 9eliac

• (Q=

• alactosemiaSN 3ined !ecessive

• Eemophilia

• Duchenne’s muscular dystrophy

• 9olor blindnessS – 3ined Do$inant

• 8ic'ette’s

32590736 maternity nursing review

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