NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

MATERNAL AND CHILD NURSING a. 3 actual

b. 2 potential
FINALS ix. Drug study
x. Discharge plan
a. M – medication
CONTENTS b. E – exercise
c. T – Treatment
 Lesson 1: Health promotion and d. H – Health education
assessment before and during e. O – out patient Care
pregnancy f. D – discharge
 Lesson 2: Abdominal assessment
 Lesson 3: Diameter of the fetal skull THE INITIAL VISIT
 Lesson 4: Fetal Presentation
 Complete history and physical
 Lesson 5: Fetal Lie
assessment
 Lesson 6: Fetal Attitude
 Lesson 7: Fetal Position Obstetric History: PAST PREGNANCIES
 Lesson 8: Fetal Station
 Date
 Lesson 9: The Components of Labor
 Course of pregnancy
o Normal spontaneous delivery
o Cesarean section
LESSON 1: HEALTH PROMOTION AND
 Labor and postpartum
ASSESSMENT BEFORE AND DURING
PREGNANCY  Information about infant and neonatal
course
FOR CASE STUDY PRESENTATION
GTPAL
i. Introduction
ii. Biographical data  Gravida – # of pregnancy regardless of
a. Patient’s data the outcome
b. Genogram o Primi-gravida – 1st time mothers
iii. History of past and present o Multigravida – 2 or more times
a. Present: LMP, no. of pregnancy, of pregnancy
age of gestation, GTPAL o Null gravida – di pa nabuntis
iv. General assessment
a. Physical assessment – head to  Parity - # of pregnancy that is carried to
toes assessment the age of viability whether born dead
b. Gordon’s assessment or alive (>20 weeks)
i. Response of patient o Nilabas na
v. Anatomy and physiology
a. Physiological changes during  Term – # of pregnancy with full term
pregnancy (37-38 weeks gestational)
vi. Pathophysiology o Full term infants born
vii. Laboratory and diagnostic
examination
viii. Nursing care plan
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 NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

 Pre-term – # of pregnancy with pre  Fh (cm) x2 divide 7

term (20-37 weeks gestational)  Fundic height – from symphysis pubis to
o Pre term infants born fundus
o Incubator is needed
o Pre term babies lack brown fats

 Abortion – termination of pregnancy

before age of viability (<20-24 weeks of
gestation)
o Therapeutic abortion – legal
abortion (cord twisting)
o Illegal abortion
o Fetal demice

 Living - # of living children

o Living infants that is born

THE INITIAL VISIT

Present pregnancy:
Bartholomew’s rule – measurement of age of
Naegele’s rule – Estimated due date gestation by determining the position of the
 +9+7+1 fundus
 LMP – 1st day or last menstruation
 Ex: December 15 2021

+9 +7 +1

= September 22, 2022 (+7 or -7)

 To compute gestational week = add the

days of months divided by 7

Ex: sep 6, 2021

EDD: JUNE 13, 2021

Sept – 24

Oct - 31

Nov - 30

Dec - 31

Jan – 3 = 119 divided by 7 = 17

Mcdonald’s rule – Age Of Gestation = Fundic  Symphysis pubis – 12 weeks

height  Level of umbilicus – 20 weeks
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 NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

 Level of xiphoid process – 36 weeks

SCHEDULE OF PRENATAL VISIT

 To monitor VS, weight, FHT, Fundic

height and outline
o Once every 4 weeks: up to 32
weeks
o Every 2 weeks from 32 to 37
weeks
o Every week from 37 to 40 Anteroposterior diameter – from front to back
weeks until delivery
Ischial spine – matulis na buto ng pelvis
IF THERE ARE RISK FACTOR, CONCURRENT
PROBLEM OR DISORDERS, PRENATAL VISITS Tuberosity – “mabuto” or “bony”
WILL HAVE MORE FREQUENCY LANDMARKS

1. Symphysis pubis
LESSON 2: ABDOMINAL ASSESSMENT  kinakapa para makuha ang fundic
height
 From symphysis pubis to fundus

2. Tip of coccyx

 Tip of umbilical cord

2. Ischial spine
 To determine the status of the baby. if
the baby is floating, engage, or ready to
deliver.

ANTHEROPOSTERIOR DIAMETER

 Measures 110mm or 11 to 11.5cm

 Also called obstetric conjugate

TRANSVESE DIAMETER

 Measures 135mm or 13.5cm

Leopold’s maneuver – it is used to locate fetal
heart tone

Symphysis pubis – pantog area

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NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

OBLIQUE DIAMETER SACRAL PROMONTORY

 Measures 125mm or 12-12.5cm

 If the pelvis is not yet matured, the

mother might suffer when delivering
the baby. They might end up in a
cesarean section.

 Ultrasound is used to know the exact

measurement

DIAMETER OF PELVIC INLET

MEASUREMENT EXTENSION DIAMETER

Anterior- From the sacral 11.5cm
posterior promontory to
INTER-SPINE DIAMETER (true conjugate) superior margin or
pubis symphysis
 Measures 10cm
Diagonal From sacral 12.0cm
 Ischial spine to ischial spine conjugate promontory to
inferior margin of the
pubis symphysis
Obstetric From sacral 10.5cm
conjugate promontory to
nearest point on
posterior surface of
pubic symphysis
Transverse The widest distance 13.5cm
diameter across pelvic brim

Symphysis pubis – nakakapa pag full ang

bladder ng mommy, reason why emptying of
bladder is important before internal
examination

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 NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

b. Bregma – nape portion

c. Measures 9cm
 Kailangan nakayuko si baby upon delivery
3. Occipitomental
a. Mental/mentum – jaw or chin
b. Measures 13.5cm

 Kahit gaano kalaki si baby as long as kasya ang

kanyang ulo, mailalabas siya. And when the
baby’s head has the capacity to mold.
 Pag nacompress and ulo ng baby mas madaling
LESSON 3: DIAMETER OF THE FETAL SKULL
ilabas.
 Nananatiling may suture and head ng baby after
delivery because naggrow ang brain ng baby
until such time when the brain finally reached
its maturity

ANTERIOR AND POSTERIOR FONTANELS

 They are open until couple of month

after delivery to avoid increase
intracranial pressure.
Transverse diameter – the widest diameter

Gynecoid pelvis – ideal pelvis for women to give LESSON 4: FETAL PRESENTATION
birth
 Dealing with the first body part that will
 The widest portion of the fetal skull contact the cervix of the mother.
should fit the widest portion of women
pelvis in order to deliver the baby. CEPHALIC

Cephalo pelvis disproportion – indication for  Most common presentation in NSD

cesarean section  Caput succedaneum – when the head of
the baby is longer than usual. And
Sinciput – anterior part of the head
resulted when the head of the baby is
Occiput – posterior part of the head pressed for a long time.

THE DIFFERENT MEASUREMENTS

1. Occipitofrontal
a. From the bridge of the nose to
back of the head
b. 12cm
2. Suboccipitobregmatic
a. Sub – portion only of the head
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NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

1. Complete breech
2. Frank breech
a. The feet of the baby is on the
face of the baby
3. Footling breech
a. Foot of the baby is presenting
outside
4. Kneeling breech
a. knee of the baby is presenting
outside

 Vertex presentation – most common PWEDE BA IPAHILOT PAG SUHI?

presentation  when the baby is too young (7 months or
o Measures 9.5cm lower), the fetus is still too small so it could
o Has the possibility to bruised still move around.
but not as damaged as face  As per medicine, hilot is not advisable as
presentation because the head they can cause injury the baby.
could mold for the help of the  The head and foot cannot be presented all
sutures. at once because the head of the baby is
 Occipitomentum fetal presentation fitted in the pelvis of the baby.
(presentation C)
o Also called brow presentation MACROSOMIA
 Face presentation  Macro – big; somia - baby
o Face of the baby is more  Big baby
exposed to the bony  The might have DM during pregnancy
prominences of the pelvis  Microsomal baby can still be delivered
o The baby might get bruises but NSD when the mommy knows how to
COULD WEAR OFF push properly. And by the help of
BREECH episiotomy.

 Most of the time will delivered by HYDROCEPHALUS

cesarean section  Hydro – water; cephalus – brain
 Lower presentation of the baby is on  Water in the brain of the baby because
the cervix of the mother of the interruption or obstruction in the
pathway of water
 The pathway of water in the brain has
no obstruction
 Hydrocephalus is not yet visible when
the baby is still inside the uterus
because the circulation happens to be
controlled by the placenta and umbilical
cord.

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NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

NSD because the baby is still floating

and not engaged.
ANENCEPHALY
LESSON 6: FETAL ATTITUDE
 The baby has no skull.
 When the mother is exposed to viral  We are after the degree of flexion of
infections. the fetus
o Flexion – payuko
o Extenson – pataas
LESSON 5: FETAL LIE
 We are after the longitudinal axis.
 The relationship between the long axis
of the fetal body and the long axis of
the woman’s body.
 From head to toe (cephalocaudal)

SUBOCCIPITO BREGMATIC ATTITUDE

 Smallest antero-posterior diameter

 Most ideal attitude when delivering a
baby

 When the head is not on the pubis

symphysis we can’t use suction.
Assisted suction and forceps are only
used in vertex presentation
 When the stomach keeps contracting
and the cervix is not opening, it should
be cesarean section.
 But when the cervix is fully dilated or
10cm open, the doctor can manipulate
the baby. But still not applicable for
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 NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

MILITARY ATTITUDE

 Sinciput presentation
 Have wide diameter

LOA

 The best position for the delivery of the

 Occipitomental presentation baby
 Mentum – jawline to chin  There’s a big possibility that there will
be no complication thru the delivery of
the baby
Transverse attitude – straight ang face

Extension – nakatingala baby

Flexion – nakayuko baby

LESSON 7: FETAL POSITION

 After with the relationship of the
presenting part to the specific woman’s
quadrant to the specific quadrant of a
woman’s pelvis
 When doing leopold’s maneuver, fetal
heart back is being checked. Because
there is where we’ll check for fetal
heart tome.

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NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

LESSON 8: FETAL STATION

Internal OS

 Internal opening between the cervix

and the uterus

External OS

 External opening between the cervix

and vagina

Presentation B

 beginning effacement
 2cm cervical dilation

 Ischial spine is the landmark for fetal Presentation C

station
 Around 100% effaced
 When in negative numbers – the baby is
 Fully effaced – wala ng makapa na
still floating
cervix
 When in 0 – the baby is already
engaged. Presentation D
 When in positive numbers - the baby is
already crowning  Fully dilated
 10cm cervical dilation

IMPORTANCE OF SIDE LYING POSITION

CERVICAL EFFACEMENT
 For proper oxygenation
 This is in combination between uterine  Can reduce risk of supine hypotension
contraction and thinning of the cervix
 Shortening and thinning of the cervix in
relation to true contraction AFTER UTERINE CONTRACTION
 Normal length of cervix – 8 inches or LIE ON BACK SIDE LYING
2cm Frequent uterine Less frequently
 Braxton hicks – there’s no significant contraction contraction
Lower intensity Greater intensity
changes in cervix
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NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

LESSON 9: THE COMPONENTS OF b. Transverse diameter – widest

presentation (occipitomentum
LABOR
diameter)
 Passage – the route of the fetus 5. Extension
 Passenger – the fetus 6. Crowning
o SGA and LGA – small or large a. hindi masyadong sinasama sa
gestational age mechanism of labor pero
o Macrosomia – when the nangyayari
mommy is diabetic the baby i. Prepping – 5 mins or
might be macrosomic less
o Presentation of the baby ii. Sterile draping – 10
 Power – related to uterine contraction mins or less
o The quality, the force, and 7. External rotation
frequency of uterine a. for the shoulder to be
contraction presented easier
 Psyche – mother’s attitude towards the i. One shoulder first
labor 8. Expulsion
a. Pag nakalabas na buong
katawan doon lang magbbaby
out.
THE MECHANISM OF LABOR
STAGES OF LABOR
 Involves number of different positions
1. STAGE OF TRUE LABOR TO FULL
1. Engagement CERVICAL DILATION
2. Descent o False contraction – sumasakit
a. downward movement of the lang pero nawawala rin pag
fetal head within the pelvic inlet pinapahinga
3. Flexion o True contraction – may
a. bending of the head of the baby progress sa labor and would
i. Mas madali mailalabas contribute to cervical dilation
ang baby since mas
maliit ang size ng head 3 phases in 1st stage
ng baby kesa sa pelvis a. Latent
ni mommy. b. Active
ii. Flexion is important for c. Transition
the fetus to present his
smallest diameter PHASES LATENT NURSING
iii. Suboccipitobregmatic – INTERVENTION
flexion and the smallest
dilation Closed in  Assessment
presentation
3cm  Turuan ang
4. Internal rotation tamang pag-ir
a. from smallest to widest effacement Thinning of  Wala pa
cervix masyadong
50% efface
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NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

duration 6-8 hrs complain Duration 1-2hrs supportive care

Intensity Mild and the  Voiding dahil Intensity Strong and  Observe
contraction mahihirapan si regular perineum for
is irregular baby na mag contraction bulging
Uterine 5-30 mins descent sa pelvis Uterine 2-3 mins  NPO
contraction interval that since puno yung contraction around 40-  IVF running
last within 10 bladder 60 seconds  Position in
to 30  Monitor VS/ FHT Show Copius and lithotomy
seconds  Oral hygiene bloody position
show Discharge –  NPO – bawal mucous
scant brown painumin as they Station +2 to +3
or pinkish are risk for
vaginal aspiration
discharge  consent 2. STAGE OF FULL CERVICAL DILATION TO
station Primipara – 0 DELIVERY OF THE BABY
Multipara – 0 PHASES ACTIVE NURSING
to 2 INTERVENTION
Dilation Complete 10  Continue
PHASES ACTIVE NURSING cm checking of
INTERVENTION Effacement 100% FHT
Dilation 4-7cm  anticipate the Duration 20-25 minutes  The baby
needs of the Uterine Strong with 2-3 would be
Effacement 100%
mother contraction mins interval transfer to
Duration 3-4hrs NICU
 FHT q15min and last in 60 to
Intensity Moderate
 BP 130min 90 seconds
and the
 Observe for Show Membranes
contraction
hyperventilation (amniotic sac)
is regular
– give brown may rupture
Uterine 3 to 5 mins
bag Station
contraction interval and
last within  Administer
30-45 analgesic thru
IV Artificial rupture of membrane – using the
seconds
 Position in side instrument called amniotome
Show Scan to
moderate lying to avoid
bloody vena cave
mucous syndrome or 3. STAGE OF DELIVERY OF THE BABY TO
supine EXPULSION OF THE PLACENTA
Station 0 to +1
hypotension  Once the baby and placenta are
out
PHASES TRANSITION NURSING 3 phases:
INTERVENTION
1. Stage of placental separation
Dilation 8-10cm  Continuous with
Effacement 100% efface physical and

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NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

a. Products of conception is  Yung umbilical cord hinihili pababa

needed to remove to avid while yung placenta tinutulak
hemorrhage pataas
b. Retroplacental hemorrhage  The most common placental
i. Retro – side na delivery
nakadikit sa mother  Gentle pulling
ii. Healing of uterus takes  Kailangan medyo contracted and
around 3 to 4 months uterus to avoid bleeding
iii. Gitna muna ng placenta
ang humihiwalay before
and edges 2. Crede’s maneuver
iv. Nakaclamp ang
umbilical cord para
makabuo ng clots that
would help in healing.
v. Oxytocin –
vi. Methargin – would
cause decrease in blood
pressure of the mother
2. Descent of the placenta
 Hihilahin umbilical cord pababa
a. Changes that indicates that the
then ipipinch yung fundus
placenta is de-attaching to the
uterus of the mother MECHANISMS OF PLACENTAL SEPARATION
i. Calkin’s sign – the
2 SIDE OF PLACENTA
placenta is becoming
globular 1. Schultze – part na nakaharap sa baby
ii. Lengthening of the cord a. Shiny part and coated with
iii. Sudden gush of blood membrane
b. Fetal side
METHODS OF PLACENTAL DELIVERY

1. Brandt-andrews maneuver

2. Duncan mechanism
a. Mother side
b. Dirthy shultze

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 NCM 107: MATERNAL AND CHILD NURSING OPONDA, CGA.

c. Pinapasukan ng nutrient Nursing intervention

pupunta sa baby
 Continue monitor v/s (q15, q30, q1)

REVE RUBIN’S POSTPARTUM PHASE:

3 STAGES:

1. Taking in phase
a. 1 to 3 days
b. Mommy is dependent to HCP
c. Pre-occupied with self needs
d. Hindi madalas hawakan ang
baby
 Do not immediately dispose the
2. Taking hold phase
placenta to count if the
a. 4-7 days
cotylidones are complete (15 to
b. Assume responsibility for the
20)
baby
 Pag may naiwang portion sa
c. Postpartum hues that sooner
uterus it might cause bleeding
might result to postpartum
or also called retained placental
depression
fragments
3. Letting go phase
 Pag may naiwang portion, hindi
a. 8 to 10 days
magcocontract kaya nakadilate
b. Mother is already independent
lang mga vessels.
c. Assume totals responsibility to
the baby

PAG MALAMBOT UTERUS:

3. Cold compress
4. Massage
5. Encourage breastfeeding
6. Oxytocin or methargin

3. STAGE OF EXPULSION OF THE

PLACENTA TO MATERNAL
HOMEOSTATIC STABILIZATION

Other term:

 Stage of vigilance
 Recovery stage
 Puerperium

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