MATERNAL/ OB NOTES fourchette- Posterior, tapers posteriorly of the labia minora- sensitive

to manipulation, torn during delivery.

Human Sexuality Site – episiotomy.
A. Concepts
1. A person’s sexuality encompasses the complex behaviors, attitudes d. Vestibule – an almond shaped area that contains the hymen, vaginal orifice
emotions and preferences that are related to sexual self and eroticism. and bartholene’s glands.
2. Sex – basic and dynamic aspect of life
3. During reproductive years, the nurse performs as resource person on 1. Urinary Meatus – small opening of urethra, serves for urination
human sexuality. 2. Skenes glands/or paraurethral gland – mucus secreting subs for
B. Definitions related to sexuality: lubrication
3. hymen – covers vaginal orifice, membranous tissue
Gender identity – sense of femininity or masculinity 4. vaginal orifice – external opening of vagina
2-4 yrs/3 yrs gender identity develops. 5. bartholene’s glands- paravaginal gland or vulvo vaginal gland -2
Role identity – attitudes, behaviors and attributes that differentiate roles small mucus secreting subs – secrets alkaline subs.
Alkaline – neutralizes acidity of vagina
Sex – biologic male or female status. Sometimes referred to a specific sexual Ph of vagina - acidic
behavior such as sexual intercourse. Doderleins bacillus – responsible for acidity of vagina
Carumculae mystiformes-healing of torn hymen
Sexuality - behavior of being boy or girl, male or female man/ woman. Entity e. Perineum – muscular structure – loc – lower vagina & anus
life long dynamic change. Internal:
- developed at the moment of conception. A. vagina – female organ of copulation, passageway of mens & fetus, 3 –
4inches or 8 – 10 cm long, dilated canal
II. Sexual Anatomy and Physiology Rugae – permits stretching without tearing
A. Female Reproductive System
1. External value or pretender B. uterus- Organ of mens is a hollow, thick walled muscular organ. It varies
a. Mons pubis/veneris - a pad of fatty tissues that lies over the symphysis in size, shape and weights.
pubis covered by skin and at puberty covered by pubic hair that serves as Size- 1x2x3
cushion or protection to the symphysis pubis. Shape: nonpregnant pear shaped / pregnant - ovoid
Weight - nonpregnant – 50 -60 kg- pregnant – 1,000g
Stages of Pubic Hair Development Pregnant/ Involution of uterus:
Tannerscale tool - used to determine sexual maturity rating. 4th stage of labor - 1000g
2 weeks after delivery - 500g
Stage 1 – Pre-adolescence. No pubic hair. Fine body hair only 3 weeks after delivery - 300 g
Stage 2 – Occurs between ages 11 and 12 – sparse, long, slightly pigmented & curly 5-6 weeks after delivery - returns to original, state 50 – 60
hair at pubis symphysis
Stage 3 -occurs between ages 12 and 13 – darker & curlier at labia Three parts of the uterus
Stage 4 – occurs between ages 13 and 14, hair assumes the normal appearance of an 1. fundus - upper cylindrical layer
adult but is not so thick and does no appear to the inner aspect of the upper thigh. 2. corpus/body - upper triangular layer
Stage 5- sexual maturity- normal adult- appear inner aspect of upper thigh . 3. cervix - lower cylindrical layer
* Isthmus lower uterine segment during pregnancy
b. Labia Majora - large lips longitudinal fold, extends symphisis pubis to Cornua-junction between fundus & interstitial
perineum Muscular compositions: there are three main muscle layers which make expansion
c. Labia Minora – 2 sensitive structures possible in every direction.
clitoris- anterior, pea shaped erectile tissue with lots sensitive nerve 1. Endometrium - inside uterus, lines the nonpregnant uterus. Muscle layer for
endings sight of sexual arousal (Greek-key) menstruation. Sloughs during menstruation.
Decidua- thick layer.
Endometriosis-proliferation of endometrial lining outside uterus. Common site: ovary. 2. Chromosomes – threadlike strands composed of hereditary material – DNA
S/sx: dysmennorhea, low back pain. 3. Normal amount of ejaculated sperm 3 – 5 cc., 1 tsp
Dx: biopsy, laparoscopy 4. Ovum is capable of being fertilized with in 24 – 36 hrs after ovulation
Meds: 1. Danazole (Danocrene) 5. Sperm is viable within 48 – 72 hrs, 2-3 days
a. to stop mens b. inhibit ovulation 6. Reproductive cells divides by the process of meiosis (haploid)
2. Lupreulide (Lupron) –inhibit FSH/LH production Spermatogenesis – maturation of sperm
Oogenesis – process - maturation of ovum
2. Myometrium – largest part of the uterus, muscle layer for delivery process Gematogenesis – formation of 2 haploid into diploid 23 + 23 = 46 or diploid
• Its smooth muscles are considered to be the living ligature of the 7. Age of Reproductivity – 15 – 44yo
body. 8. Menstruation-
- Power of labor, resp- contraction of the uterus Menstrual Cycle – beginning of mens to beginning of next mens
3. Perimetrium – protects entire uterus Average Menstrual Cycle – 28 days
Average Menstrual Period - 3 – 5 days
C. ovaries – 2 female sex glands, almond shaped. Ext- vestibule int – ovaries Normal Blood loss – 50cc or ¼ cup
Function: 1. ovulation Related terminologies:
2. Production of hormones Menarche – 1st mens
Dysmenorrhea – painful mens
d. Fallopian tubes – 2-3 inches long that serves as a passageway of the sperm from the Metrorrhagia – bleeding between mens
uterus to the ampulla or the passageway of the mature ovum or fertilized ovum from the Menorhagia – excessive during mens
ampulla to the uterus. Amenorrhea – absence of mens
Menopause – cessation of mens/ average : 51 years old
4 significant segments 9. Functions of Estrogen and Progestin
1. Infundibulum – distal part of FT, trumpet or funnel shaped, swollen at
ovulation * Estrogen “Hormone of the Woman” –
2. Ampulla – outer 3rd or 2nd half, site of fertilization Primary function: development secondary sexual characteristic female.
3. Isthmus – site of sterilization – bilateral tubal ligation Others:
4. Interstitial – site of ectopic pregnancy – most dangerous 1. inhibit production of FSH ( maturation of ovum)
2. hypertrophy of myometrium
B. Male Reproductive System 3. Spinnbarkeit & Ferning ( billings method/ cervical)
1. External 4. development ductile structure of breast
penis – the male organ of copulation and urination. It contains of a body of a shaft 5. increase osteoblast activities of long bones
consisting of 3 cylindrical layers and erectile tissues. At its tip is the most sensitive area 6. increase in height in female
comparable to that of the clitoris in the female – the glands penis. 7. causes early closure of epiphysis of long bones
8. causes sodium retention
3 Cylindrical Layers 9. increase sexual desire
2 corpora cavernosa
1 corpus spongiosum *Progestin “ Hormone of the Mother”
Primary function: prepares endometrium for implantation of fertilized ovum making it
Scrotum – a pouch hanging below the pendulous penis, with a medial septum dividing thick & tortous (twisted)
into two sacs, each of which contains a testes. Secondary Function: uterine contractility (favors pregnancy)
- cooling mechanism of testes Others: 1.inhibit prod of LH (hormone for ovulation)
- < 2 degrees C than body temp. 2.inhibit motility of GIT
- Leydig cell – release testosterone 3. mammary gland development
4. increase permeability of kidney to lactose & dextrose causing (+) sugar
III. Basic Knowledge on Genetics and Obstetrics 5. causes mood swings in moms
1. DNA – carries genetic code 6. increase BBT
10. Menstrual Cycle VII. 15th day, after ovulation day, graafian follicle starts to degenerate yellowish
4 phases of Menstrual Cycle known as corpus luteum (secrets large amount of progesterone)
1. Phases of Menstrual Cycle:
1. Proliferative VIII. Secretory phase-
2. Secretory Lutheal Phase
3. Ischemic Postovulatory PhaseIncreased progesterone
4. Menses Premenstrual Phase
Parts of body responsible for mens: IX. 24th day if no fertilization, corpus luteum degenerate ( whitish –
1. hypothalamus corpus albicans)
2. anterior pituitary gland – master clock of body X. 28th day – if no sperm in ovum – endometrium begins to slough off to begin
3. ovaries mens
4. uterus ✓ Cornix- where sperm is deposited
Initial phase – 3rd day – decreased estrogen ✓ Sperm- small head, long tail, pearly white
13th day – peak estrogen, decrease progesterone ✓ Phonones-vibration of head of sperm to determine location of ovum
14th day – Increase estrogen, increase progesterone ✓ Sperm should penetrate corona radiata and zona pellocida.
15th day – Decrease estrogen, increase progesterone ✓ Capacitation- ability of sperm to release proteolytic enzyme to
I. On the initial 3rd phase of menstruation , the estrogen level is decreased, this penetrate corona radiata and zona pellocida.
level stimulates the hypothalamus to release GnRH or FSHRF
II. GnRH/FSHRF – stimulates the anterior pituitary gland to release FSH 11. Stages of Sexual Responses (EPOR)
Functions of FSH:
1. Stimulate ovaries to release estrogen Initial responses:
2. Facilitate growth primary follicle to become graffian follicle (secrets Vasocongestion – congestion of blood vessels
large amt estrogen & contains mature ovum.) Myotonia – increase muscle tension
III. Proliferative Phase – proliferation of tissue or follicular phase, post mens
phase. Pre-ovularoty. 1. Excitement Phase – (sign present in both sexes, moderate increase in HR,
-phase of increase estrogen. RR,BP, sex flush, nipple erection) – erotic stimuli cause increase sexual
Follicular Phase – causing irregularities of mens tension, lasts minutes to hours.
Postmenstrual Phase 2. Plateau Phase – (accelerated V/S) – increasing & sustained tension nearing
Preovulatory Phase – phase increase estrogen orgasm. Lasts 30 seconds – 3 minutes.
3. Orgasm – (involuntary spasm throughout body, peak v/s) involuntary release
IV. 13th day of menstruation, estrogen level is peak while the progesterone of sexual tension with physiologic or psychologic release, immeasurable peak
level is down, these stimulates the hypothalamus to release GnRF on of sexual experience. May last 2 – 10 sec- most affected are is pelvic area.
LHRF 4. Resolution – (v/s return to normal, genitals return to pre-excitement phase)
1.) Mittelschmerz – slight abdominal pain on L or RQ of Refractory Period – the only period present in males, wherein he cannot be
abdomen, marks ovulation day. restimulated for about 10-15 minutes
2.) Change in BBT, mood swing
A. Fertilization
V. GnRF/LHRF stimulates the ant pit gland to release LH. B. Stages of Fetal Growth and Development
Functions of LH: 3-4 days travel of zygote – mitotic cell division begins
1. (13th day-decreased progesterone) LH stimulates ovaries to *Pre-embryonic Stage
release progesterone a. Zygote- fertilized ovum. Lifespan of zygote – from fertilization to 2 months
2. hormone for ovulation b. Morula – mulberry-like ball with 16 – 50 cells, 4 days free floating &
VI. 14th day estrogen level is increased while the progesterone level is increased multiplication
causing rupture of graffian follicle on process of ovulation. c. Blastocyst – enlarging cells that forms a cavity that later becomes the
embryo. Blastocyst – covering of blastocys that later becomes placenta &
trophoblast
 d. Implantation/ Nidation- occurs after fertilization 7 – 10 days.
Fetus- term starting 2 months to birth. ✓ normal amt of amniotic fluid – 500 to 1000cc
placenta previa – implantation at low side of uterus ✓ polyhydramnios, hydramnios- increased amt of amniotic fluid ndicates GIT
malformation particularly Tracheo Esophageal Fistula/TEA,
Signs of implantation: ✓ oligohydramnios- decrease amt of fluid –indicates kidney disease
1. slight pain
2. slight vaginal spotting Diagnostic Tests for Amniotic Fluid
- if with fertilization – corpus luteum continues to function & become A. Amniocentesis :empty bladder before performing the procedure.
source of estrogen & progesterone while placenta is not developed. Purpose – obtain a sample of amniotic fluid by inserting a needle through the
3 processes of Implantation abdomen into the amniotic sac; fluid is tested for:
1. Apposition 1. Genetic screening- maternal serum alpha feto-protein test (MSAFP) – 1st
2. Adhesion trimester
3. Invasion 2. Determination of fetal maturity primarily by evaluating factors indicative of lung
C. Dicidua – thickened endometrium ( Latin – falling off) maturity – 3rd trimester
* Basalis (base) part of endometrium located under fetus where placenta is -Testing time – 36 weeks
delivered Results:
* Capsularies – encapsulate the fetus ✓ decreased MSAFP= down syndrome
* Vera – remaining portion of endometrium. ✓ increase MSAFP = spina bifida or open neural tube defect
✓ Common complication of amniocenthesis – infection
D.Chorionic Villi- 10 – 11th day, finger life projections ✓ Dangerous complications – spontaneous abortion
3 vessels (AVA)- 2 arteries and 1 vein ✓ 3rd trimester- pre term labor
Artery – unoxygenated blood ✓ Important factor to consider for amniocentesis- needle insertion site
Vein – O2 blood ✓ Aspiration of yellowish amniotic fluid – jaundice baby
Aartery – unoxygenated blood ✓ Greenish – meconium

✓ Wharton’s jelly – protects cord A. Amnioscopy – direct visualization or exam to an intact fetal membrane.
✓ Chorionic villi sampling (CVS) – removal of tissue sample from the fetal B. Fern Test- determine if amniotic fluid has ruptured or not (blue paper turns
portion of the developing placenta for genetic screening. Done early in green/grey - + ruptured amniotic fluid)
pregnancy. Common complication fetal limb defect. Ex missing digits/toes. C. Nitrazine Paper Test – diff amniotic fluid & urine.
- Paper turns yellow- urine. Paper turns blue green/gray-(+) rupture of amn fluid.
E. Cytotrophoblast – inner layer or langhans layer – protects fetus against syphilis 24
wks/6 months – life span of langhans layer increase. Before 24 weeks critical, might get 1. Chorion – where placenta is developed
infected syphilis ✓ lecithin Sphingomyelin L/S
F. Synsitiotrophoblast – synsitial layer – responsible production of hormone ✓ Ratio- 2:1 signifies fetal lung maturity not capable for RDS
1. Amnion – inner most layer respiratory distress syndrome
a. Umbilical Cord- FUNIS, whitish grey, 15 – 55cm, 20 – 21”.
Short cord: abruptio placenta or inverted uterus. a. Placenta – (Secundines) Greek – pancake, combination of chorionic villi +
Long cord:cord coil or cord prolapse deciduas basalis. Size: 500g or ½ kg
b. Amniotic Fluid – bag of H2O, clear, odor mousy/musty, with crystallized -1 inch thick & 8” diameter
forming pattern, slightly alkaline. Functions of Placenta:
*Function of Amniotic Fluid: 1. Respiratory System – beginning of lung function after birth of baby.
1. cushions fetus against sudden blows or trauma Simple diffusion
2. facilitates musculo-skeletal development 2. GIT – transport center, glucose transport is facilitated, diffusion more
3. maintains temp rapid from higher to lower. If mom hypoglycemic, fetus hypoglycemic
4. prevent cord compression 3. Excretory System- artery - carries waste products. Liver of mom
5. help in delivery process detoxifies fetus.
 4. Circulating system – achieved by selective osmosis Fourth Month
5. Endocrine System – produces hormones 1. lanugo begins to appear
• Human Chorionic Gonadrophin – maintains corpus luteum 2. fetal heart tone heard fetoscope, 18 – 20 weeks
alive. 3. buds of permanent teeth appear
• Human placental Lactogen or sommamommamotropin Fifth Month
Hormone – for mammary gland development. Has a 1. lanugo covers body
diabetogenic effect – serves as insulin antagonist 2. actively swallows amniotic fluid
• Relaxin Hormone- causes softening joints & bones 3. 19 – 25 cm fetus,
• estrogen 4. Quickening- 1st fetal movement. 18- 20 weeks primi
• progestin 16- 18 wks – multi
6. It serves as a protective barrier against some microorganisms – HIV,HBV 5. fetal heart tone heard with or without instrument
Sixth Month
Fetal Stage “ Fetal Growth and Development” 1. eyelids open
2. wrinkled skin
✓ Entire pregnancy days – 266 – 280 days 37 – 42 weeks 3. vernix caseosa present
✓ Differentiation of Primary Germ layers
* Endoderm Third trimester: Period of most rapid growth. FOCUS: weight of fetus
1st week endoderm – primary germ layer Seventh Month – development of surfactant – lecithin
Thyroid – for basal metabolism Eighth Month
Parathyroid - for calcium 1. lanugo begin to disappear
Thymus – development of immunity 2. sub Q fats deposit
Liver – lining of upper RT & GIT 3. Nails extend to fingers
* Mesoderm – development of heart, musculoskeletal system, kidneys and Ninth Month
repro organ 1. lanugo & vernix caseosa completely disappear
* Ectoderm – development of brain, skin and senses, hair, nails, mucus 2. Amniotic fluid decreases
membrane or anus & mouth Tenth Month – bone ossification of fetal skull

First trimester: Terratogens- any drug, virus or irradiation, the exposure to such may cause
1st month - Brain & heart development damage to the fetus
✓ GIT& resp Tract – remains as single tube
o Fetal heart tone begins – heart is the oldest part of the body A. Drugs:
o CNS develops – dizziness of mom due to hypoglycemic effect ✓ Streptomycin – anti TB & or Quinine (anti malaria) – damage to 8th cranial
✓ Food of brain – glucose ;complex CHO – pregnant womans food nerve – poor hearing & deafness
Second Month ✓ Tetracycline – staining tooth enamel, inhibit growth of long bone
1. All vital organs formed, placenta developed ✓ Vitamin K – hemolysis (destr of RBC), hyperbilirubenia or jaundice
2. Corpus luteum – source of estrogen & progesterone of infant – life span – ✓ Iodides – enlargement of thyroid or goiter
end of 2nd month ✓ Thalidomides – Amelia or pocomelia, absence of extremities
3. Sex organ formed
4. Meconium is formed Steroids – cleft lip or palate
Third Month Lithium – congenital malformation
1. Kidneys functional B. Alcohol – lowered weight (vasoconstriction on mom), fetal alcohol withdrawal
2. Buds of milk teeth appear syndrome char by microcephaly
3. Fetal heart tone heard – Doppler – 10 – 12 weeks C. Smoking – low birth rate
4. Sex is distinguishable D. Caffeine – low birth rate
E. Cocaine – low birth rate, abruption placenta
Second Trimester: FOCUS – length of fetus
TORCH (Terratogenic) Infections – viruses • Nutritional instruction – kangkong, liver due to ferridin content, green leafy
CHARACTERISTICS: group of infections caused by organisms that can cross the vegetable-alugbati,saluyot, malunggay, horseradish, ampalaya
placenta or ascend through birth canal and adversely affect fetal growth and • Parenteral Iron ( Imferon) – severe anemia, give IM, Z tract- if improperly
development. These infections are often characterized by vague, influenza like findings, administered, hematoma.
rashes and lesions, enlarged lymph nodes, and jaundice (hepatic involvement). In some • Oral Iron supplements (ferrous sulfate 0.3 g. 3 times a day) empty stomach 1
chases the infection may go unnoticed in the pregnant woman yet have devastating hr before meals or 2 hrs after, black stool, constipation
effects on the fetus. TORCH: Toxoplasmosis, Other, Rubella, Cytomegalo virus, • Monitor for hemorrhage
Herpes simples virus. Alert:
• Iron from red meats is better absorbed iron form other sources
T – toxoplasmosis – mom takes care of cats. Feces of cat go to raw vegetables or meat • Iron is better absorbed when taken with foods high in Vit C such as orange
O – others. Hepa A or infectious heap – oral/ fecal (hand washing) juice
Hepa B, HIV – blood & body fluids
• Higher iron intake is recommended since circulating blood volume is
Syphilis
increased and heme is required from production of RBCs
R – rubella – German measles – congenital heart disease (1st month) normal rubella titer
1:10
Edema – lower extremities due venous return is constricted due to large belly, elevate
<1:10 – less immunity to rubella, after delivery, mom will be given rubella
legs above hip level.
vaccine. Don’t get pregnant for 3 months. Vaccine is terratogenic
C – cytomegalo virus
Varicosities – pressure of uterus
H – herpes simplex virus
- use support stockings, avoid wearing knee high socks
- use elastic bandage – lower to upper
Physiological Adaptation of the Mother to Pregnancy
-
Vulbar varicosities- painful, pressure on gravid uterus, to relieve- position – side lying
A. Systemic Changes
with pillow under hips or modified knee chest position
1. Cardiovascular System – increase blood volume of mom (plasma blood) 30
– 50% = 1500 cc of blood
Thrombophlebitis – presence of thrombus at inflamed blood vessel
- easy fatigability, increase heart workload, slight hypertrophy of ventricles, epistaxis –
- pregnant mom hyperfibrinogenemia
due to hyperemia of nasal membrane palpitation,
- increase fibrinogen
- increase clotting factor
✓ Physiologic Anemia – pseudo anemia of pregnant women
- thrombus formation candidate
✓ Normal Values
o Hct 32 – 42% outstanding sign – (+) Homan's sign – pain on cuff during dorsiflexion
o Hgb 10.5 – 14g/dL
milk leg – skinny white legs due to stretching of skin caused by inflammation or
✓ Criteria
phlagmasia albadolens
o 1st and 3rd trimester.- pathologic anemia if lower
o HCT should not be 33%, Hgb should not be < 11g/dL
Mgt:
✓ 2nd trimester – Hct should not <32%
1.) Bed rest
• Hgb Shdn't < 10.5% pathologic anemia if lower 2.) Never massage
✓ Pathogenic Anemia 3.) Assess + Homan sign once only might dislodge thrombus
✓ iron deficiency anemia is the most common hematological disorder. It affects 4.) Give anticoagulant to prevent additional clotting (thrombolytics will dilute)
toughly 20% of pregnant women. 5.) Monitor APTT antidote for Heparin toxicity, protamine sulfate
✓ Assessment reveals: 6.) Avoid aspirin! Might aggravate bleeding.
• Pallor, constipation
• Slowed capillary refill 2. Respiratory system – common problem SOB due to enlarged uterus & increase
• Concave fingernails (late sign of progressive anemia) due to chronic O2 demand
physio hypoxia Position- lateral expansion of lungs or side lying position.
Nursing Care:
 3. Gastrointestinal – 1st trimester change I – Hegar's – change of consistency of isthmus (lower uterine segment)
Morning Sickness – nausea & vomiting due to increase HCG. Eat dry crackers or
dry CHO diet 30 minutes before arising bed. Nausea afternoon - small freq feeding. LEUKORRHEA – whitish gray, mousy odor discharge
Vomiting in preg – emesisgravida. ESTROGEN – hormone, resp for leucorrhea
Metabolic alkalosis, F&E imbalance – primary med mgt – replace OPERCULUM – mucus plug to seal out bacteria.
fluids. PROGESTERONE – hormone responsible for operculum
Monitor I&O PREGNANT – acidic to alkaline change to protect bacterial growth (vaginitis)
constipation – progesterone resp for constipation. Increase fluid intake, increase
fiber diet Problems Related to the Change of Vaginal Environment:
- fruits – papaya, pineapple, mango, watermelon, cantaloupe, apple a. Vaginitits – trichomonas vaginalis due to alkaline environment of vagina of
with skin, suha. pregnant mom
Except guava – has pectin that’s constipating – veg – petchy, Flagellated protozoa – wants alkaline
malungay. S&Sx: Greenish cream colored frothy irritatingly itchy with foul smelling
- exercise odor with vaginal edema
-mineral oil – excretion of fat soluble vitamins Mgt:
* Flatulence – avoid gas forming food – cabbage FLAGYL – (metronidazole – antiprotozoa). Carcinogenic drug so
* Heartburn – or pyrosis – reflux of stomach content to esophagus don’t give at 1st trimester
- small frequent feeding, avoid 3 full meals, avoid fatty & spicy food, 1. treat dad also to prevent reinfection
sips of milk, proper body mechanical 2. no alcohol – has antibuse effect
increase salivation – ptyalsim – mgt mouthwash VAGINAL DOUCHE – IQ H2O : 1 tbsp white vinegar
*Hemorrhoids – pressure of gravid uterus. Mgt; hot sitz bath for comfort b. Moniliasis or candidiasis due to candida albecans, fungal infection.

4. Urinary System – frequency during 1st & 3rd trimester lateral expansion of Signs & Symptoms:
lungs or side lying pos – mgt for nocturia Color – white cheese like patches adheres to walls of vagina.
Acetyace test – albumin in urine Management – antifungal – Nistatin, genshan violet, cotrimaxole, canesten
Benedicts test – sugar in urine Gonorrhea -Thick purulent discharge
Vaginal warts- condifoma acuminata due to papilloma virus
5. Musculoskeletal Mgt: cauterization
✓ Lordosis – pride of pregnancy
✓ Waddling Gait – awkward walking due to relaxation – causes softening of 3. Abdominal Changes
joints & bones a. striae gravidarium (stretch marks) due enlarging uterus-destruction of
▪ Prone to accidental falls – wear low heeled shoes sub Q tissue – avoid scratching, use coconut oil, umbilicus is
✓ Leg Cramps – causes: prolonged standing, over fatigue, Ca & phosphorous protruding
imbalance(#1 cause while pregnant), chills, oversex, pressure of gravid uterus 4. Skin Changes
(labor cramps) at lumbo sacral nerve plexus a. brown pigmentation nose chin, cheeks – chloasma melasma due to
Mgt: increased melanocytes.
• Increase Ca diet-milk(Inc Ca & Inc phosphorus)-1pint/day or 3-4 b. Brown pinkish line- linea nigra- symphisis pubis to umbilicus
servings/day. Cheese, yogurt, head of fish, Dilis, sardines with bones, 5. Breast Changes
brocolli, seafood-tahong (mussels), lobster, crab. a. increase hormones, color of areola & nipple
• Vit D for increased Ca absorption pre colostrums present by 6 weeks, colostrums at 3 rd
• dorsiflexion trimester
Breast self exam- 7 days after mens –– supine with pillow at back
B. Local Changes quadrant B – upper outer – common site of cancer
Local change: Vagina: Test to determine breast cancer:
V – Chadwick’s sign – blue violet discoloration of vagina 1. mammography – 35 to 49 yrs once every 1 to 2 yrs
C – Goodel's sign – change of consistency of cervix 50 yrs and above – 1 x a yr
 6. Ovaries – rested during pregnancy Second Trimester – tangible S&Sx. mom identifies fetus as a separate entity – due to
presence of quickening, fantasy. Developmental task – accept growing fetus as baby to
7. Signs & symptoms of Pregnancy be nurtured.
A. Presumptive – s/s felt and observed by the mother but does not confirm Health teaching: growth & development of fetus.
positive diagnosis of pregnancy . Subjective
B. Probable – signs observed by the members of health team. Objective Third Trimester: - mom has personal identification on appearance of baby
C. Positive Signs – undeniable signs confirmed by the use of instrument. Development task: prepare of birth & parenting of child. HT: responsible
parenthood ‘baby’s Layette” – best time to do shopping.
Ballotment sign of myoma Most common fear – let mom listen to FHT to allay fear
* + HCG – sign of H mole Lamaze classes
- trans vaginal ultrasound. Empty bladder
- ultrasound – full bladder VII. Pre-Natal Visit:
1. Frequency of Visit: 1st 7 months – 1x a month
placental grading – rating/grade 8 – 9 months – 2 x a month
o – immature 10 – once a week
1 – slightly mature post term 2 x a week
2 – moderately mature 2. Personal data – name, age (high risk < 18 & >35 yrs old) record to determine
3 – placental maturity high risk – HBMR. Home base mom’s record. Sex ( pseudocyesis or false
pregnancy on men & women)
What is deposited in placenta which signify maturity - there is calcium Couvade syndrome – dad experiences what mom goes through – lihi)
Address, civil status, religion, culture & beliefs with respect, non judgmental
Presumptive Probable Positive Occupation – financial condition or occupational hazards, education background –
Breast changes Goodel's- change of consistency of Ultrasound level knowledge
Urinary freq cervix evidence
Fatigue Chadwick’s- blue violet discoloration of (sonogram) full 3. Diagnosis of Pregnancy
Amenorrhea vagina bladder 1.) urine exam to detect HCG at 40 – 100th day. 60 – 70 day peak HCG.
Morning sickness Hegar's- change of consistency of 6 weeks after LMP- best to get urine exam.
Enlarged uterus isthmus Fetal heart tone 2.) Elisa test – test for preg detects beta subunit of HCG as early as 7 –
Elevated BBT – due to increased Fetal movement 10days
Cloasma progesterone Fetal outline 3.) Home preg kit – do it yourself
Linea negra Positive HCG or (+)preg test Fetal parts 4. Baseline Data: V/S esp. BP, monitor wt. (increase wt – 1st sign preeclampsia)
Increased skin palpable
pigmentation Ballottement – bouncing of fetus when Weight Monitoring
Striae gravidarium lower uterine is tapped sharply First Trimester: Normal Weight gain 1.5 – 3 lbs (.5 – 1lb/month)
Quickening Enlarged abdomen Second trimester: normal weight gain- 10 – 12 lbs (4 lbs/mo.) (1 lb/wk)
Braxton Hicks contractions – painless Third trimester: normal weight gain 10 – 12 lbs (4 lbs/ mo.) ( 1lb/wk)
irregular contractions Minimum wt gain – 20 – 25 lbs
Optimal wt gain – 25 – 35 lbs

VI. Psychological Adaptation to Pregnancy (Emotional response of mom – 5. Obstetrical Data:

Reva Rubin theory) nullipara – no pregnancy
First Trimester: No tanginal signs & sx, surprise, ambivalence, denial – sign of a. Gravida- # of pregnancy
maladaptation to pregnancy. Developmental task is to accept biological facts of b. Para - # of viable pregnancy
pregnancy Viability – the ability of the fetus to live outside the uterus at the earliest
Focus: bodily changes of preg, nutrition possible gestational age.
age of viability - 20 – 24 wks
 Term 37 – 42 wks,
Preterm -20 – 37 weeks Danger signs of Pregnancy
abortion <20 weeks C - chills/ fever - infection
Cerebral disturbances ( headache – preeclampsia)
c. Important Estimates: A – abdominal pain ( epigastric pain – aura of impending convulsions
B – boardlike abdomen – abruption placenta
1. Nagele’s Rule – use to determine expected date of delivery Increase BP – HPN
Get LMP (last menstrual period)= -3+ 7 +1 for Apr-Dec Blurred vision – preeclampsia
LMP – +9 +7 no year for Jan Feb Mar Bleeding – 1st trimester, abortion, ectopic pre/2nd – H mole, incompetent
cervix
LMP Jan 25, 04 3rd – placental anomalies
+9 +7 S – sudden gush of fluid – PROM (premature rupture of membrane) prone to inf.
10 / 32 / 04 E – edema to upper ext. (preeclampsia)
- 1
add 1 month to month 5. Pelvic Examination – internal exam (IE)
11/31/04 EDD (expected date of delivery) 1. empty bladder
2. universal precaution
2. McDonald’s Rule – to determine age of gestation IN WEEKS External OS of cervix – site for getting specimen
FUNDIC HT X 7/8=AOG in WK Site for cervical cancer
Pap Smear – cervical cancer
Fundic Ht X 7 = AOG in weeks - composed of squamous columnar tissue
8 Result:
Fr sypmhisis pubis to fundus 24 X 7 =21 wks Class I - normal
8 Class IIA – acytology but no evidence of malignancy
3. Bartholomew’s Rule – to determine age of gestation by proper location of B – suggestive of inflammation.
fundus at abdominal cavity. Class III – cytology suggestive of malignancy
Class IV – cytology strongly suggestive of malignancy
✓ 3 months – above sym pub Class V – cytology conclusive of malignancy
✓ 5 months – level of umbilicus
✓ 9 months – below zyphoid Stages of Cervical Cancer
✓ 10 months – level of 8 months due to lightening Stage 0 – carcinoma insitu
1 – cancer confined to cervix
d. tetanus immunizations – prevents tetanus neonatum 2 - cancer extends to vagina
-mom with complete 3 doses DPT young age considered as TT1 & 2. 3 – pelvis metastasis
Begin TT3 4 – affection to bladder & rectum
✓ TT1 – any time during pregnancy
✓ TT2 – 4 wks after TT1 – 3 yrs protection 7. Leopold’s Maneuver
✓ TT3 – 6 months after TT2 – 5 yrs protection Purpose: is done to determine the attitude, fetal presentation lie, presenting
✓ TT4 – 1 yr after TT3 – 10 yrs protection part, degree of descent, an estimate of the size, and number of fetuses, position, fetal
✓ TT5 – yr after TT4 – lifetime protection back & fetal heart tone
- use palm! Warm palm.
4. Physical Examination:
A. Examine teeth: sign of infection Prepare mom:
1. Empty bladder
2. Position of mom-supine with knee flex (dorsal recumbent – to relax
abdominal muscles)
Procedure: leopold’s maneuver
1st maneuver: place patient in supine position with knees slightly flexed; put towel Changes in sexual desire:
under head and right hip; with both hands palpate upper abdomen and fundus. Assess a.) 1st tri – decrease desire – due to bodily changes
size, shape, movement and firmness of the part to determine presentation b.) 2nd trimester – increased desire due to increase estrogen that enhances
lubrication
2nd Maneuver: with both hands moving down, identify the back of the fetus ( to hear c.) 3rd trimester – decreased desire
fetal heart sound) where the ball of the stethoscope is placed to determine FHT. Get
V/S(before 2nd maneuver) PR to diff fundic soufflé (FHR) & uterine soufflé. Contraindication in sex:
Uterine soufflé – maternal H rate 1. vaginal spotting
1st trimester – threatened abortion
3rd Maneuver: using the right hand, grasp the symphis pubis part using thumb and 2nd trimester– placenta previa
fingers. 2. incompetent cervix
To determine degree of engagement. 3. preterm labor
4. premature rupture of membrane
Assess whether the presenting part is engaged in the pelvis )Alert : if the head is
engaged it will not be movable). 2. Exercise – to strengthen muscles used during delivery process
- principles of exercise
4th Maneuver: the Examiner changes the position by facing the patient’s feet. With two 1.) Done in moderation. 2.) Must be individualized
hands, assess the descent of the presenting part by locating the cephalic prominence or ✓ Walking – best exercise
brow. To determine attitude – relationship of fetus to 1 another.
✓ Squatting – strengthen muscles of perineum. Increase circulation to perineum.
When the brow is on the same side as the back, the head is extended. When the brow is Squat – feet flat on floor
on the same side as the small parts, the head will be flexed and vertex presenting. ✓ Tailor Sitting – 1 leg in front of other leg ( Indian seat)
o Raise buttocks 1st before head to prevent postural hypotension –
Attitude – relationship of fetus to a part – or degree of flexion dizziness when changing position
Full flexion – when the chin touches the chest o shoulder circling exercise- strengthen chest muscles
✓ pelvic rocking/pelvic tilt- exercise – relieves low back pain & maintain good
posture
8. Health teachings ✓ * arch back – standing or kneeling. Four extremities on floor
a. Nutrition – do nutritional assessment – daily food intake ✓ Kegel Exercise – strengthen pulococcygeal muscles
High risk moms: o as if hold urine, release 10x or muscle contraction
1. Pregnant teenagers – low compliance to heath regimen. ✓ Abdominal Exercise – strengthens muscles of abdominal – done as if blowing
2. Extremes in wt – underweight, over wt – candidate for HPN, DM candle
3. Low socio – economic status
4. Vegetarian mom – decrease CHON – needs Vit B12 – cyanocobalamin – 4. Childbirth Preparation:
formation of folic acid – needed for cell DNA & RBC formation. (Decrease Overall goal: to prepare parents physically and psychologically while promoting
folic acid – spina bifida/open neural tube defect) wellness behavior that can be used by parents and family thus, helping them achieved a
How many Kcal CHO x4,CHON x4, fats x 9 satisfying and enjoying childbirth experience.

2.Sexual Activity a. Psychophysical

a.) should be done in moderation
b.) should be done in private place 1. Bradley Method – Dr. Robert Bradley – advocated active participation of
c.) mom placed in comfy pos, sidelying or mom on top husband at delivery process. Based on imitation of nature.
d.) avoided 6 weeks prior to EDD Features:
e.) avoid blowing or air during cunnilingus 1.) darkened rm
f.) changes in sexual desire of mom during preg- air embolism 2.) quiet environment
 3.) relaxation tech 5.) theory of aging placenta – life span of placenta 42 wks. At 36 wks
4.) closed eye & appearance of sleep degenerates (leading to contraction – onset labor).
2. Grantly Dick Read Method – fear leads to tension while tension leads to
pain b.2. The 4 P’s of labor

b. Psychosexual 1. Passenger
1. Kitzinger method – preg, labor & birth & care of newborn is an impt a. Fetal head – is the largest presenting part – common presenting part – ¼ of its
turning pt in woman’s life cycle length.
- flow with contraction than struggle with contraction Bones – 6 bones S – sphenoid F – frontal - sinciput
E – ethmoid O – occupital - occiput
c. Psychoprophylaxis – prevention of pain T – temporal P – parietal 2 x
1. Lamaze: Dr. Ferdinand Lamaze Measurement fetal head:
req. disciple, conditioning & concentration. Husband is coach 1. transverse diameter – 9.25cm
Features: - biparietal – largest transverse
1. Conscious relaxation - bitemporal 8 cm
2. Cleansing breathe – inhale nose, exhale mouth 2. bimastoid 7cm smallest transverse
3. Effleurage – gentle circular massage over abdominal to relieve pain
4. imaging – sensate focus Sutures – intermembranous spaces that allow molding.
1.) sagittal suture – connects 2 parietal bones ( sagitna)
5. Different Methods of delivery: 2.) coronal suture – connect parietal & frontal bone (crown)
1.) birthing chair – bed convertible to chair – semifowlers 3.) lambdoidal suture – connects occipital & parietal bone
2.) birthing bed – dorsal recumbent pos
3.) squatting – relives low back pain during labor pain Moldings: the overlapping of the sutures of the skull to permit passage of the head to
4.) leboyers – warm, quiet, dark, comfy room. After delivery, baby gets warm the pelvis
bath.
5.) Birth under H20 – bathtub – labor & delivery – warm water, soft music. Fontanels:
1.) Anterior fontanel -bregma,
IX. Intrapartal Notes – inside ER a. diamond shape, 3 x 4 cm,( > 5 cm – hydrocephalus),
A. Admitting the laboring Mother: b. closes 12 – 18 months after birth
Personal Data: name, age, address, etc 2.) Posterior fontanel or lambda –
Baseline Data: v/s esppecially BP, weight a. triangular shape, 1 x 1 cm.
Obstetrical Data: gravida # preg, para- viable preg, – 22 – 24 wks b. Closes – 2 – 3 mos.
Physical Exams,Pelvic Exams 4.) Anteroposterior diameter -
suboccipitobregmatic 9.5 cm, complete flexion, smallest AP
B. Basic knowledge in Intrapartum. occipitofrontal 12cm partial flexion
occipitomental – 13.5 cm hyper extension submentobragmatic-face
b. 1 Theories of the Onset of Labor presentation
1.) uterine stretch theory ( any hallow organ stretched, will always contract &
expel its content) – contraction action 2. Passageway
2.) oxytocin theory – post pit gland releases oxytocin. Hypothalamus produces Mom 1.) < 4’9” tall
oxytocin 2.) < 18 years old
3.) prostaglandin theory – stimulation of arachidonic acid – prostaglandin- 3.) Underwent pelvic dislocation
contraction Pelvis
4.) progesterone theory – before labor, decrease progesterone will stimulate 4 main pelvic types
contractions & labor 1. Gynecoid – round, wide, deeper most suitable (normal female pelvis) for
pregnancy
 2. Android – heart shape “male pelvis”- anterior part pointed, posterior part c. Past Experience
shallow d. Support System
3. Anthropoid – oval, ape like pelvis, oval shape, AP diameter wider
transverse narrow Pre-eminent Signs of Labor
4. Platypelloid – flat AP diameter – narrow, transverse – wider S&Sx:
- shooting pain radiating to the legs
b. Pelvis - urinary freq.
2 hip bones – 2 innominate bones 1. Lightening – setting of presenting part into pelvic brim - 2 weeks prior to
3 Parts of 2 Innominate Bones EDD
Ileum – lateral side of hips * Engagement- setting of presenting part into pelvic inlet
- iliac crest – flaring superior border forming prominence of 2. Braxton Hicks Contractions – painless irregular contractions
hips 3. Increase Activity of the Mother- nesting instinct. Save energy, will be used
Ischium – inferior portion for delivery. Increase epinephrine
- ischial tuberosity where we sit – landmark to get external 4. Ripening of the Cervix – butter soft
measurement of pelvis 5. decreased body wt – 1.5 – 3 lbs
Pubes – ant portion – symphisis pubis junction between 2 pubis 6. Bloody Show – pinkish vaginal discharge – blood & leukorrhea
1 sacrum – post portion – sacral prominence – landmark to get 7. Rupture of Membranes – rupture of water. Check FHT
internal measurement of pelvis
1 coccyx – 5 small bones compresses during vaginal delivery Premature Rupture of Membrane ( PROM) - do IE to check for cord prolapse
Contraction drop in intensity even though very painful
Important Measurements Contraction drop in frequently
Uterus tense and/or contracting between contractions
1. Diagonal Conjugate – measure between sacral promontory and inferior margin of Abdominal palpations
the symphysis pubis. Nursing Care;
Measurement: 11.5 cm - 12.5 cm basis in getting true conjugate. (DC – 11.5 Administer Analgesics (Morphine)
cm=true conjugate) Attempt manual rotation for ROP or LOP – most common malposition
Bear down with contractions
2. True conjugate/conjugate vera – measure between the anterior surface of the sacral Adequate hydration – prepare for CS
promontory and superior margin of the symphysis pubis. Measurement: 11.0 Sedation as ordered
cm Cesarean delivery may be required, especially if fetal distress is noted
Cord Prolapse – a complication when the umbilical cord falls or is washed through the
3. Obstetrical conjugate – smallest AP diameter. Pelvis at 10 cm or more. cervix into the vagina.
Danger signs:
Tuberoischi Diameter – transverse diameter of the pelvic outlet. Ischial tuberosity – PROM
approximated with use of fist – 8 cm & above. Presenting part has not yet engaged
Fetal distress
3. Power – the force acting to expel the fetus and placenta – myometrium – powers of Protruding cord form vagina
labor Nursing care:
a. Involuntary Contractions 1. Cover cord with sterile gauze with saline to prevent drying of cord so cord will
b. Voluntary bearing down efforts remain slippery & prevent cord compression causing cerebral palsy.
c. Characteristics: wave like 2. Slip cord away from presenting part
d. Timing: frequency, duration, intensity 3. Count pulsation of cord for FHT
4. Psyche/Person – psychological stress when the mother is fighting the labor 4. Prep mom for CS
experience Positioning – trendelenberg or knee chest position
a. Cultural Interpretation Emotional support
b. Preparation Prepare for Cesarean Section
 Frequency q 2-3 min contractions
Difference between True Labor and False Labor Durations 45 – 90 seconds
False Labor True Labor Hyperesthesia – increase sensitivity to touch, pain all over
Irregular contractions Contractions are regular Health Teaching :
No increase in intensity Increased intensity • teach: sacral pressure on lower back to inhibit transmission of pain
Pain – confined to abdomen Pain – begins lower back radiates to abdomen • keep informed of progress
Pain – relived by walking Pain – intensified by walking • controlled chest breathing
No cervical changes Cervical effacement & dilatation * major sx Nursing Care:
of true labor. T – ires
Duration of Labor I – nform of progress
Primipara – 14 hrs & not more than 20 hrs R – estless support her breathing technique
Multipara – 8 hrs & not > 14 hrs E – ncourage and praise
D – iscomfort
Effacement – softening & thinning of cervix. Use % in unit of measurement Pelvic Exams
Dilation – widening of cervix. Unit used is cm. Effacement
Dilation
2 segments of the uterus a. Station – landmark used: ischial spine
1. upper uterine - fundus - 1 station = presenting part 1cm above ischial spine if (-) floating
2. lower uterine – isthmus - 2 station = presenting part 2 cm above ischial spine if (-) floating
0 station = level at ischial spine – engagement
Nursing Interventions in Each Stage of Labor + 1 station = below 1 cm ischial spine
1. First Stage: onset of true contractions to full dilation and effacement of cervix. +3 to +5 = crowning – occurs at 2nd stage of labor
Latent Phase:
Assessment: Dilations: 0 – 3 cm mom – excited, apprehensive, can communicate b. Presentation/lie – the relationship of the long axis (spine) of the fetus to the long
Frequency: every 5 – 10 min axis of the mother
Intensity mild -spine of mom and spine of fetus
Nursing Care: Two types:
1. Encourage walking - shorten 1st stage of labor b.1. Longitudinal Lie ( Parallel)
2. Encourage to void q 2 – 3 hrs – full bladder inhibit contractions cephalic - Vertex – complete flexion
3. Breathing – chest breathing Face
Brow Poor Flexion
Active Phase: Chin
Assessment: Dilations 4 -8 cm Breech - Complete Breech – thigh breast on abdomen, breast lie on thigh
Intensity: moderate Mom- fears losing control of self Incomplete Breech – thigh rest on abdominal
Frequency q 3-5 min lasting for 30 – 60 seconds Frank – legs extend to head
Nursing Care: Footling – single, double
M – edications – have meds ready Kneeling
A – ssessment include: vital signs, cervical dilation and effacement, fetal
monitor, etc. b.2. Transverse Lie (Perpendicular) or Perpendicular lie. Shoulder presentation.
D – dry lips – oral care (ointment)
- dry linens c. Position – relationship of the fatal presenting part to specific quadrant of the
B – abdominal breathing mother’s pelvis.

Transitional Phase: Variety:

Assessment: intensity: strong Mom – mood changes with hyperesthesia Occipito – LOA left occipito anterior (most common and favorable position)– side of
Dilations 8 – 10 cm maternal pelvis
LOP – left occipito posterior
LOP – most common mal position, most painful Check FHT after adm enema
ROP – squatting pos on mom Normal FHT= 120-160
ROT
ROA Signs of fetal distress-
1.) <120 & >160
Breech- use sacrum LSA – left sacro anterior 2.) mecomium stain amnion fluid
- put stet above umbilicus LST, LSP, RSA, RST, RSP 3.) fetal thrushing – hyperactive fetus due to lack O2

Shoulder/acromniodorso 2. Second Stage: fetal stage, complete dilation and effacement to birth.
LADA, LADT, LADP, RADA
7 – 8 multi – bring to delivery room
chin / Mento 10cm primi – bring to delivery room
LMA, LMT, LMP, RMP, RMA, RMT, RMP Lithotomy position – put legs same time up
Bulging of perineum – sure to come out
Monitoring the Contractions and Fetal heart Tone Breathing – panting ( teach mom)
Spread fingers lightly over fundus – to monitor contractions Assist doc in doing episiotomy- to prevent laceration, widen vaginal canal, shorten 2 nd
stage of labor.
Episiotomy – median – less bleeding, less pain easy to repair, fast to heal, possible to
Parts of contractions: reach rectum ( urethroanal fistula)
Increment or crescendo – beginning of contractions until it increases Mediolateral – more bleeding & pain, hard to repair, slow to heal
Acme or apex – height of contraction -use local or pudendal anesthesia.
Decrement or decrescendo – from height of contractions until it decreases
Duration – beginning of contractions to end of same contraction Ironing the perineum – to prevent laceration
Interval – end of 1 contraction to beginning of next contraction Modified Ritgens maneuver – place towel at perineum
Frequency – beginning of 1 contraction to beginning of next contraction 1.)To prevent laceration
Intensity - strength of contraction 2.) Will facilitate complete flexion & extension. (Support head & remove secretion,
check cord if coiled. Pull shoulder down & up. Check time, identification of baby.
Contraction – vasoconstriction
Increase BP, decrease FHT Mechanisms of labor
Best time to get BP & FHT just after a contraction or midway of contractions 1. Engagement -
2. Descent
Placental reserve – 60 sec o2 for fetus during contractions 3. Flexion
Duration of contractions shouldn’t >60 sec 4. Internal Rotation
Notify MD 5. Extension
6. External rotation
Mom has headache – check BP, if same BP, let mom rest. If BP increase , notify MD - 7. Expulsion
preeclampsia
Health teachings Three parts of Pelvis – 1. Inlet – AP diameter narrow, transverse diameter wider
1.) Ok to shower 2. Cavity
2.)NPO – GIT stops function during labor if with food- will cause aspiration Two Major Divisions of Pelvis
3.)Enema administer during labor 1. True pelvis – below the pelvic inlet
a.)To cleanse bowel 2. False pelvis – above the pelvic inlet; supports uterus during pregnancy
b.)Prevent infection Linea Terminales diagonal imaginary line from the sacrum to the symphysis pubis that
c.)Sims position/side lying divides the false and true pelvis.
12 – 18 inch – ht enema tubing Nursing Care:
To prevent puerperal sepsis - < 48 hours only – vaginal pack E- dema
E - cchemosis
Bolus of Ptocin can lead to hypotension. D – ischarges
A – approximation of blood loss. Count pad &
3. Third Stage: birth to expulsion of Placenta -placental stage placenta has saturation
15 – 28 cotyledons
Placenta delivered from 3-10 minutes Fully soaked pad : 30 – 40 cc weigh pad. 1 gram=1cc
Signs of placental separation
1. Fundus rises – becomes firm & globular “ Calkins sign” e. Bonding – interaction between mother and newborn –
2. Lengthening of the cord rooming in types
3. Sudden gush of blood 1.) Straight rooming in baby: 24hrs with mom.
2.) Partial rooming in: baby in morning , at night nursery
Types of placental delivery
Shultz “shiny” – begins to separate from center to edges presenting the fetal side Complications of Labor
shiny Dystocia – difficult labor related to:
Dunkan “dirty” – begin to separate form edges to center presenting natural side – Mechanical factor – due to uterine inertia – sluggishness of contraction
beefy red or dirty 1.) hypertonic or primary uterine inertia
- intense excessive contractions resulting to ineffective pushing
Slowly pull cord and wind to clamp – BRANDT ANDREWS MANEUVER - MD administer sedative valium,/diazepam – muscle relaxant
Hurrying of placental delivery will lead to inversion of uterus. 2.) hypotonic – secondary uterine inertia- slow irregular contraction resulting to
ineffective pushing. Give oxytocin.
Nsg care for placenta:
1. Check completeness of placenta. Prolonged labor – normal length of labor in primi 14 – 20 hrs
2. Check fundus (if relaxed, massage uterus) Multi 10 -14 hrs
3. Check bp > 14 hrs in multi & > 20 hrs in primi
4. Administer methergine IM (Methylergonovine Maleate) “Ergotrate derivatives - maternal effect – exhaustion. Fetal effect – fetal distress, caput succedaneum
5. Monitor hypertension (or give oxytocin IV) or cephal hematoma
6. Check perineum for lacerations - nsg care: monitor contractions and FHR
7. Assist MD for episiorapy
8. Flat on bed Precipitate Labor - labor of < 3 hrs. extensive lacerations, profuse bleeding,
9. Chills-due dehydration. Blanket, give clear liquid-tea, ginger ale, clear gelatin. hypovolemic shock if with bleeding.
Let mom sleep to regain energy. Earliest sign: tachycardia & restlessness
Late sign: hypotension
4. Fourth Stage: the first 1-2 hours after delivery of placenta – recovery Outstanding Nursing dx: fluid volume deficit
stage. Monitor v/s q 15 for 1 hr. 2nd hr q 30 minutes. Post of mom – modified trendelenberg
Check placement of fundus at level of umbilicus. IV – fast drip due fluid volume def
If fundus above umbilicus, deviation of fundus Signs of Hypovolemic Shock:
1.) Empty bladder to prevent uterine atony Hypotension
2.) Check lochia Tachycardia
a. Maternal Observations – body system stabilizes Tachypnea
b. Placement of the Fundus Cold clammy skin
c. Lochia
d. Perineum – Inversion of the uterus – situation uterus is inside out.
R - edness MD will push uterus back inside or not hysterectomy.
Factors leading to inversion of uterus 1. If cervix is closed 2 – 3 cm, dilation saved by administer Tocolytic agents-
1.) short cord halts preterm contractions.YUTOPAR- Yutopar Hcl)
2.) hurrying of placental delivery 150mg incorporated 500cc Dextrose piggyback.
3.) ineffective fundal pressure Monitor: FHT > 180 bpm
Maternal BP - <90/60
Uterine Rupture Crackles – notify MD – pulmo edema – administer oral yutopar 30 minutes
Causes: 1.) before d/c IV
1.)Previous classical CS Tocolytic (Phil)
2.)Large baby Terbuthaline (Bricanyl or Brethine) – sustained tachycardia
3.) Improper use of oxytocin (IV drip) Antidote – propranolol or inderal - beta-blocker
Sx:
a.) sudden pain If cervix is open – MD – steroid dextamethzone (betamethazone) to facilitate
b.) profuse bleeding surfactant maturation preventing RDS
c.) hypovolemic shock Preterm-cut cord ASAP to prevent jaundice or hyperbilirubenia.
d.) TAHBSO
Physiologic retraction ring X. Postpartal Period 5th stage of labor
- Boundary bet upper/lower uterine segment after 24hrs :Normal increase WBC up to 30,000 cumm
BANDL’S pathologic ring – suprapubic depression
a.) sign of impending uterine rupture Puerperium – covers 1st 6 wks post partum
Involution – return of repro organ to its non pregnant state.
Amniotic Fluid Embolism or placental embolism – amniotic fluid or fragments of Hyperfibrinogenia
placenta enters natural circulation resulting to embolism - prone to thrombus formation
Sx: - early ambulation
dyspnea, chest pain & frothy sputum
prepare: suctioning Principles underlying puerperium
end stage: DIC disseminated intravascular coagopathy- bleeding to all portions of 1. To return to Normal and Facilitate healing
the body – eyes, nose, etc.
A. Physiologic Changes
Trial Labor – measurement of head & pelvis falls on borderline. Mom given 6 hrs of a.1. Systemic Changes
labor 1. Cardiovascular System
Multi: 8 – 14, primi 14 – 20 - the first few minutes after delivery is the most critical period in mothers because the
increased in plasma volume return to its normal state and thus adding to the workload
Preterm Labor – labor after 20 – 37 weeks) ( abortion <20 weeks) of the heart. This is critical especially to gravidocardiac mothers.
Sx:
1. premature contractions q 10 min 2. Genital tract
2. effacement of 60 – 80% a. Cervix – cervical opening
3. dilation 2-3 cm b. Vaginal and Pelvic Floor
Home Mgt: c. Uterus – return to normal 6 – 8 wks. Fundus goes down 1 finger breath/day until 10 th
1. complete bed rest day – no longer palpable due behind symphisis pubis
2. avoid sex 3 days after post partum: sub involuted uterus – delayed healing uterus with big clots of
3. empty bladder blood- a medium for bacterial growth- (puerperal sepsis)- D&C
4. drink 3 -4 glasses of water – full bladder inhibits contractions after, birth pain:
5. consult MD if symptoms persist 1. position prone
2. cold compress – to prevent bleeding
Hosp: 3. mefenamic acid
d. Lochia-bld, wbc, deciduas, microorganism. Nsd & Cs with lochia. 4.) IV fast drip/ oxytocin IV drip
1. Rubra – red 1st 3 days present, musty/mousy, moderate amt
2. Serosa – pink to brown 4 – 9th day, limited amt 1st degree laceration – affects vaginal skin & mucus membrane.
3. Alba – créme white 10 – 21 days very decreased amt 2nd degree – 1st degree + muscles of vagina
dysuria 3rd degree – 2nd degree + external sphincter of rectum
- urine collection 4th degree – 3rd degree + mucus membrane of rectum
- alternate warm & cold compress
- stimulate bladder Breast feeding – post pit gland will release oxytocin so uterus will contract.
Well contracted uterus + bleeding = laceration
3. Urinary tract:Bladder – freq in urination after delivery- urinary retention with - assess perineum for laceration
overflow - degree of laceration
4. Colon:Constipation – due NPO, fear of bearing down - mgt episiorapy
5. Perineal area – painful – episiotomy site – sims pos, cold compress for immediate
pain after 24 hrs, hot sitz bath, not compress DIC – Disseminated Intravascular Coagulopathy. Hypofibrinogen- failure to coagulate.
sex- when perineum has healed - bleeding to any part of body
- hysterectomy if with abruption placenta
II. Provide Emotional Support – Reva Rubia mgt: BT- cryoprecipitate or fresh frozen plasma
Psychological Responses:
a. Taking in phase – dependent phase (1st three days) mom – passive, cant make II. Late Postpartum hemorrhage – bleeding after 24 hrs – retained
decisions, activity is to tell child birth experiences. placental fragments
Nursing Care: - proper hygiene Mgt: D&C or manual extraction of fragments & massaging of uterus. D&C except
b. Taking hold phase – dependent to independent phase (4 to 7 days). Mom is placenta increta, percreta,
active, can make decisions
Health teachings: Acreta – attached placenta to myometrium.
1.) Care of newborn Increta – deeper attachment of placenta to myometrium
2.) Insert family planting method Percreta – invasion of placenta to perimetrium
common post partum blues/ baby blues present 4 – 5 days 50-80% moms –
overwhelming feeling of depression characterized by crying, despondence- Hematoma – bluish or purple discoloration of SQ tissue of vagina or perineum.
inability to sleep & lack of appetite. – let mom cry – therapeutic. - too much manipulation
- large baby
c. Letting go – interdependent phase – 7 days & above. Mom - redefines new - pudendal anesthesia
roles may extend until child grows. Mgt:
1.) cold compress every 30 mins. with rest period of 30 minutes for 24 hrs
III. Prevent complications 2.) shave
3.) incision on site, scraping & suturing
1. Hemorrhage – bleeding of > 500cc
CS – 600 – 800 cc normal Infection- sources of infection
NSD 500 cc 1.)endogenous – from within body
2.) exogenous – from outside
I. Early postpartum hemorrhage– bleeding within 1st 24 hrs. Baggy or 1.) anaerobic streptococci – most common - from members health team
relaxed uterus & profuse bleeding – uterine atony. Complications: 2.) unhealthy sexual practices
hypovolemic shock. General signs of inflammation:
Mgt: 1. Inflammation – calor (heat), rubor (red), dolor (pain) tumor(swelling)
1.) massage uterus until contracted 2. purulent discharges
2.) cold compress 3. fever
3.) modified trendelenberg
Gen mgt: 21 day pill- start 5th day of mens
1.) supportive care – CBR, hydration, TSB, cold compress, paracetamol, 28day pill- start 1st day of mens
VITC, culture & sensitivity – for antibiotic missed 1 pill – take 2 next day

prolonged use of antibiotic lead to fungal infection Physiologic Method-

inflammation of perineum – see general signs of inflammation
2 to 3 stitches dislocated with purulent discharge Pills – combined oral contraceptives prevent ovulation by inhibiting the anterior
Mgt: pituitary gland production of FSH and LH which are essential for the maturation and
Removal of sutures & drainage, saline, between & resulting. rupture of a follicle. 99.9% effective. Waiting time to become pregnant- 3 months.
Endometriosis – inflammation of endometrial lining Consult OB-6mos.
Sx:
Abdominal tenderness, pos. Alerts on Oral Contraceptive:
Fowlers – to facilitate drainage & localize infection oxytocin & antibiotic -in case a mother who is taking an oral contraceptive for almost long time plans to have
a baby, she would wait for at least 3 months before attempting to conceive to provide
IV. Motivate the use of Family Planning time for the estrogen and progesterone levels to return to normal.
1.) determine one’s own beliefs 1st - if a new oral contraceptive is prescribed the mother should continue taking the
2.) never advice a permanent method of planning previously prescribed contraceptive and begin taking the new one on the first day of the
3.) method of choice is an individuals choice. next menses.
Natural Method – the only method accepted by the Catholic Church - discontinue oral contraceptive if there is signs of severe headache as this is an
Billings / Cervical mucus– test spinnbarkeit & ferning (estrogen) indication of hypertension associated with increase incidence of CVA and
- clear, watery, stretchable, elastic – long spinnbarkeit subarachnoid hemorrhage.
Basal Body Temperature 13th day temp goes down before ovulation – no sex
- get before arising in bed Signs of hypertension
Immediate Discontinuation
LAM – lactation amenorrheal method – hormone that inhibits ovulation is prolactin. A – abdominal pain
breast feeding- menstruation will come out 4 – 6 months C – chest pain
bottle fed 2 – 3 months H - headache
disadvantage of lam – might get pregnant E – eye problems
S – severe leg cramps
Symptothermal – combination of BBT & cervical. Best method If mom HPN – stop pills STAT!
Adverse effect: breakthrough bleeding
Social Method – 1.) coitus interuptus/ withdrawal - least effective method Contraindicated:
2. coitus reservatus – sex without ejaculation – 1.) chain smoker
3. coitus interfemora – “ipit” 2.) extreme obesity
4. calendar method 3.) HPN
4.) DM
OVULATION –count minus 14 days before next mens (14 days before next mens) 5.) Thrombophlebitis or problems in clotting factors
Origoknause formula –
- monitor cycle for 1 year - if forgotten for one day, immediately take the forgotten tablet plus the tablet
- -get short test & longest cycle from Jan – Dec scheduled that day. If forgotten for two consecutive days, or more days, use
- shortest – 18 another method for the rest of the cycle and the start again.
- longest – 11
June 26 Dec 33 DMPA – depoproveda – has progesterone inhibits LH – inhibits ovulation
- 18 -11 Depomedroxy progesterone acetate – IM q 3 months
8 - 22 unsafe days - never massage injected site, it will shorten duration
Norplant – has 6 match sticks – like capsules implanted subdermally containing Cervical Cap – most durable than diaphragm no need to apply spermicide
progesterone. C/I: abnormal pap smear
- 5 yrs – disadvantage if keloid skin
- as soon as removed – can become pregnant Foams, Jellies, Creams
Surgical Method – BTL , Bilateral Tubal Ligation – can be reversed 20% chance. HT:
Mechanism and Chemical Barriers avoid lifting heavy objects
Intrauterine Device (IUD) Vasectomy – cut vas deferense.
Action: prevents implantation – affects motility of sperm & ovum HT: >30 ejaculations before safe sex
- right time to insert is after delivery or during menstruation O – zero sperm count, safe
primary indication for use of IUD
- parity or # of children, if 1 kid only don’t use IUD XI. High Risk Pregnancy
Health teachings: 1. Hemorrhagic Disorders
1.) Check for string daily General Management
2.) Monthly checkup 1.) CBR
3.) Regular pap smear 2.) Avoid sex
Alerts; 3.) Assess for bleeding (per pad 30 – 40cc) (wt – 1gm =1cc)
- prevents implantation 4.) Ultrasound to determine integrity of sac
- most common complications: excessive menstrual flow and expulsion of the 5.) Signs of Hypovolemic shock
device (common problem) 6.) Save discharges – for histopathology – to determine if product of conception
- others: has been expelled or not
P eriod late (pregnancy suspected)
Abnormal spotting or bleeding First Trimester Bleeding – abortion or eptopic
A bdominal pain or pain with intercourse A. Abortions – termination of pregnancy before age of viability (before 20 weeks)
I nfection (abnormal vaginal discharge) Spontaneous Abortion- miscarriage
N ot feeling well, fever, chills Cause: 1.) chromosomal alterations
S trings lost, shorter or longer 2.) blighted ovum
Uterine inflammation, uterine perforation, ectopic pregnancy 3.) plasma germ defect
Condom – latex inserted to erected penis or lubricated vagina Classifications:
Adv; gives highest protection against STD – female condom a. Threatened – pregnancy is jeopardized by bleeding and cramping but the
cervix is closed
Alerts: Disadvantage: b. Inevitable – moderate bleeding, cramping, tissue protrudes form the cervix
- it lessen sexual satisfaction (Cervical dilation)
- it gives higher protection in the prevention of STDs Types:
1.) Complete – all products of conception are expelled. No mgt just
Diaphragm – rubberized dome shaped material inserted to cervix preventing sperm to emotional support!
get to the uterus. REVERSABLE 2.) Incomplete – Placental and membranes retained. Mgt: D&C
Incompetent cervix – abortion
Health teachings: McDonalds procedure – temporary circlage on cervix
1.) proper hygiene S/E; infection. During delivery, circlage is removed. NSD
2.) check for holes before use Sheridan – permanent surgery cervix. CS
3.) must stay in place 6 – 8 hrs after sex
4.) must be refitted especially if without wt change 15 lbs c. Habitual – 3 or more consecutive pregnancies result in abortion usually related
5.) spermicide – chem. Barrier ex. Foam (most effective), jellies, creams to incompetent cervix. Present 2nd trimester
S/effect: Toxic shock syndrome d. Missed – fetus dies; product of conception remain in uterus 4 weeks or longer;
signs of pregnancy cease. (-) preg test, scanty dark brown bleeding
Alerts: Should be kept in place for about 6 – 8 hours Mgt: induced labor with oxytocin or vacuum extraction
 5.) Induced Abortion – therapeutic abortion to save life of mom. Double effect Prepare D&C
choose between lesser evil. Do not give oxytoxic drugs
Teachings:
A. Ectopic Pregnancy – occurs when gestation is located outside the uterine a. Return for pelvic exams as scheduled for one year to monitoring
cavity. common site: tubal or ampular HCG and assess for enlarged uterus and rising titer could indicative
Dangerous site – interstitial of choriocarcinoma
b. Avoid pregnancy for at least one year
Unruptured Tubal rupture
- missed period - sudden , sharp, severe pain. Third Trimester Bleeding “Placenta Anomalies”
- abdominal pain within 3 -5 weeks Unilateral radiating to shoulder.
of missed period (maybe shoulder pain (indicative of D. Placenta Previa – it occurs when the placenta is improperly implanted in the
generalized or one sided) intraperitoneal bleeding that extends to lower uterine segment, sometimes covering the cervical os. Abnormal lower
- scant, dark brown, vaginal diaphragm and phrenic nerve) implantation of placenta.
bleeding + Cullen’s Sign – bluish tinged - candidate for CS
umbilicus – signifies intra peritoneal Sx: frank Bright red, Painless bleeding
Nursing care: bleeding Dx:
Vital signs syncope (fainting) Ultrasound
Administer IV fluids Mgt: Avoid: sex, IE, enema – may lead to sudden fetal blood loss
Monitor for vaginal bleeding Surgery depending on side Double set up: delivery room may be converted to OR
Monitor I & O Ovary: oophrectomy
Uterus : hysterectomy Assessment:
Engagement (usually has not occurred)
Second trimester bleeding Fetal distress
Presentation ( usually abnormal)
C. Hydatidiform Mole “bunch or grapes” or gestational trophoblastic disease. – with Surgeon – in charge of sign consent,
fertilization. Progressive degeneration of chorionic villi. Recurs. - MD explain to patient
- gestational anomaly of the placenta consisting of a bunch of clear vesicles. This complication: sudden fetal blood loss
neoplasm is formed form the selling of the chronic villi and lost nucleus of the fertilized Nursing Care
egg. The nucleus of the sperm duplicates, producing a diploid number 46 XX, it grows NPO
& enlarges the uterus vary rapidly. Bed rest
Use: methotrexate to prevent choriocarcinoma Prepare to induce labor if cervix is ripe
Assessment: Administer IV
Early signs - vesicles passed thru the vagina
Hyperemesis gravidarium increase HCG E. Abruptio Placenta – it is the premature separation of the placenta form the
Fundal height implantation site. It usually occurs after the twentieth week of pregnancy.
Vaginal bleeding( scant or profuse) Outstanding Sx: dark red, painful bleeding, board like or rigid uterus.
Early in pregnancy Assessment:
High levels of HCG
• Concealed bleeding (retroplacental)
Preeclampsia at about 12 weeks
• Couvelaire uterus (caused by bleeding into the myometrium)-inability of
Late signs hypertension before 20th week
uterus to contract due to hemorrhage.
Vesicles look like a “ snowstorm” on sonogram
• Severe abdominal pain
Anemia
Abdominal cramping • Dropping coagulation factor (a potential for DIC)
Serious complications hyperthyroidism Complications: Sudden fetal blood loss
Pulmonary embolus -placenta previa & vasa previa
Nursing care: Nursing Care:
✓ Infuse IV, prepare to administer blood
 ✓ Type and crossmatch P- prevent convulsions by nursing measures or seizure precaution
✓ Monitor FHR 1.) dimly lit room . quiet calm environment
✓ Insert Foley 2.) minimal handling – planning procedure
✓ Measure blood loss; count pads 3.) avoid jarring bed
✓ Report s/sx of DIC P- prepare the following at bedside
✓ Monitor v/s for shock - tongue depressor
✓ Strict I&O - turning to side done AFTER seizure! Observe only! for safely.
F. Placenta succenturiata – 1 or 2 more lobes connected to the placenta by a E – ensure high protein intake ( 1g/kg/day)
blood vessel may lead to retained placental fragments if vessel is cut. - Na – in moderation
G. Placenta Circumvalata – fetal side of placenta covered by chorion A – anti-hypertensive drug Hydralazine ( Apresoline)
H. Placenta Marginata – fold side of chorion reaches just to the edge of placenta C – convulsion, prevent – Mg So4 – CNS depressant
I. Battledore Placenta – cord inserted marginally rather then centrally E – valuate physical parameters for Magnesium sulfate
J. Placenta Bipartita – placenta divides into 2 lobes Magnesium SO4 Toxicity:
K. Vilamentous Insertion of cord- cord divides into small vessels before it enters 1. BP decrease
the placenta 2. Urine output decrease
L. Vasa Previa – velamentous insertion of cord has implanted in cervical OS 3. Resp < 12
4. Patella reflex absent – 1st sigh Mg SO4 toxicity. antidote – Ca
2. Hypertensive Disorders gluconate

I. Pregnancy Induced Hypertension (PIH)- HPN after 24 wks of pregnancy, solved 6 3.Diabetes Mellitus - absence of insufficient insulin (Islet of Langerhans of pancreas)
weeks post partum. Function: of insulin – facilitates transport of glucose to cell
Dx: 1 hr 50gr glucose tolerance test GTT
1.) Gestational hypertension - HPN without edema & protenuria H without EP Normal glucose – 80 – 120 mg/dl < 80 – hypoclycemic
2.) Pre-eclampsia – HPN with edema & protenuria or albuminuria HE P/A ( euglycemia) > 120 - hyperglycemia
3.) HELLP syndrome – hemolysis with elevated liver enzymes & low platelet 3 degrees GTT of > 130 mg/dL
count maternal effect DM
II. Transissional Hypertension – HPN between 20 – 24 weeks 1.) Hypo or hyperglycemia – 1st trimester hypo, 2nd – 3rd trim –
III. Chronic or pre-existing Hypertension –HPN before 20 weeks not solved 6 weeks hyperglycemic
post partum. 2.) Frequent infection- moniliasis
Three types of pre-eclampsia 3.) Polyhydramnios
1.) Mild preeclampsia – earliest sign of preeclampsia 4.) Dystocia-difficult birth due to abnormalities in fetus or mom.
a.) increase wt due to edema 5.) Insulin requirement, decrease in insulin by 33% in 1 st tri; 50%
b.) BP 140/90 increase insulin at 2nd – 3rd trimester.
c.) protenuria +1 - +2 Post partum decrease 25% due placenta out.
2.) Severe preeclampsia Fetal effect
Signs present: cerebral and visual disturbances, epigastric pain due to liver edema and 1.) hyper & hypoglycemia
oliguria usually indicates an impending convulsion. BP 160/110 , protenuria +3 - +4 2.) macrosomia – large gestational age – baby delivered > 400g or 4kg
3.) Eclampsia – with seizure! Increase BUN – glomerular damage. Provide safety. 3.) preterm birth to prevent stillbirth
Cause of preeclampsia
1.) idiopathic or unknown common in primi due to 1 st exposure to chorionic villi Newborn Effect : DM
2.) common in multiple pre (twins) increase exposure to chorionic villi 1.) hyperinsulinism
3.) common to mom with low socioeconomic status due to decrease intake of 2.) hypoglycemia
CHON normal glucose in newborn 45 – 55 mg/dL
Nursing care: hypoglycemic < 40 mg/dL
P – romote bed rest to decrease O2 demand, facilitate, sodium excretion, water Heel stick test – get blood at heel
immersion will cause to urinate. Sx:
 Hypoglycemia high pitch shrill cry tremors, administer dextrose Procedure:
3.) hypocalcemia - < 7mg% a. classical – vertical insertion. Once classical always classical
Sx: b. Low segment – bikini line type – aesthetic use
Calcemia tetany
Trousseau sign VBAC – vaginal birth after CS
Give calcium gluconate if decrease calcium INFERTILITY - inability to achieve pregnancy. Within a year of attempting it
- Manageable
Recommendation STERILITY - irreversible
Therapeutic abortion Impotency – inability to have an erection
If push through with pregnancy 2 types of infertility
1.) antibiotic therapy- to prevent sub acute bacterial endocarditis 1.) primary – no pregnancy at all
2.) anticoagulant – heparin doesn’t cross placenta 2.) Secondary – 1st pregnancy, no more next preg
Class I & II- good progress for vaginal delivery test male 1st
Class III & IV- poor prognosis, for vaginal delivery, not CS! - more practical & less complicated
NOT lithotomy! High semi-fowlers during delivery. No valsalva maneuver - need: sperm only
Regional anesthesia! - sterile bottle container ( not plastic has chem.)
Low forcep delivery due to inability to push. It will shorten 2 nd stage of labor. - Sims Huhner test – or post coital test. Procedure: sex 2 hours before
test
Heart disease mom – remains supine 15 min after ejaculation
Moms with RHD at childhood Normal: cervical mucus must be stretchable 8 – 10 cm with 15 – 20 sperm. If >15 – low
Class I – no limit to physical activity sperm count
Class II – slight limitation of activity. Ordinary activity causes fatigue & discomfort. Best criteria- sperm motility for impotency
Recommendation of class I & II Factors: low sperm count
1.) sleep 10 hrs a day 1.) occupation- truck driver
2.) rest 30 minutes & after meal 2.) chain smoker
Class III - moderate limitation of physical activity. Ordinary activity causes discomfort administer: clomid ( chomephine citrate) to induce spermatogenesis
Recommendation: Mgt: GIFT= Gamete Intra Fallopian Transfer for low sperm count
1.) early hospitalization by 7 months Implant sperm in ampula
Class IV. marked limitation of physical activity. Even at rest there is fatigue &
discomfort. 1.) Mom: anovulation – no ovulation. Due to increase prolactin – hyperprolactinemia
Recommendation: Therapeutic abortion Administer; parlodel ( Bromocryptice Mesylate)
Action; antihyper prolactineuria
XII. Intrapartal complications Give mom clomid: action: to induce oogenesis or ovulation
1. Cesarean Delivery S/E: multiple pregnancy
Indications:
a. Multiple gestation 2.) Tubal Occlusion – tubal blockage – Hx of PID that has scarred tubes
b. Diabetes - use of IUD
c. Active herpes II - appendicitis (burst) & scarring
d. Severe toxemia = dx: hysterosalphingography – used to determine tubal patency with use of
e. Placenta previa radiopaque material
f. Abruptio placenta Mgt: IVF – invitrofertilization (test tube baby)
g. Prolapse of the cord England 1st test tube baby
h. CPD primary indication To shorten 2nd stage of labor!
i. Breech presentation 1.) fundal pressure
j. Transverse lie 2.) episiotomy
3.) forcep delivery
RLM®