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COACHING WITH THE ICONS: DOC PACABIS

Maternal and Child Nursing

Framework of MCN Nursing in the Philippines 1. Planning pregnancies – reproductive health and
family planning
2. Breastfeeding
3. Immunization

Antenatal Care
 Pregnancy – egg unites with sperm
(fertilization)
o latest in global (Geneva, Switzerland),
advocates redefines pregnancy as
beginning from implantation which is
 Antenatal Care: longest phase of maternity opposed by the church
nursing allowing pt. interaction for 9 mos. o longest phase in OB (fertilization): 280 days
o Universal Health Care Law: everybody – average (270-290 days); 40 wks. –
should pass the primary health care setting average (37-42 wks.); 9 calendar mos. –
at the community level except those who used for lay person; 10 lunar mos. – has
can afford consistent 7 days/wk. making it more
 Labor and Delivery Care: most critical area specific
and requires good clinical eye and where  but in new evidence based practice, the
maternal deaths occur best time to deliver a term baby is 38-39
o No labor should go beyond 24 hrs. wks.
 Postpartum Care: mildest care to provide for  Prenatal Care – significant in the outcome of
since RN is only assisting the mother to return pregnancy
to pre-gravid state and function o Any problems during pregnancy have not
o Discharge after 24 hrs. for NSD and 3 days been addressed for pt. w/o prenatal care
for CS. making them as high-risk pregnancy.
 Child Health// Child Care: for as long as the o DOH has an administrative order that
baby is in the delivery room, is normal until the discourages skilled birth attendants
postpartum area, until discharge (midwife and RN) not to deliver a
o Pediatric Nurse takes over for abnormal and primigravid (dystocia) and gravida 5 and
follow-up of a discharged neonate. above (atony d//t overstretched uterus) in
 Women’s Health (prev. Gynecology): least the community since you never know what
area of practice; RN assists the MD to expect.
o area of taking note and monitor the  Recommended Parity: 2-4
reproductive health of non-pregnant women  1st Trimester: Organogenesis – organs develop
o expanded to the inclusion of partner/ o Fetal Circulation
husband, infertility  Veins carry 02 and arteries carries
o Note: If there is a conflict b/n partners, the wastes products (opposite of adult
woman’s choice/ decision is the most circulation)
significant.  O2 passes from the placenta to fetus via
umbilical cord (AVA).
! TEST TAKING TIPS !  Temporary structures are in place that
closes at birth d/t mechanism of labor
 Master breastfeeding and immunizations
from pressure of contracting uterus or
(vaccines).
amniotic fluid.
 Use of partograph would be included but in the  Ductus venosus: placental vein →
future it will be replace with labor care guide. inferior vena cava bypassing portal
circulation
ADVOCACIES OF MCN
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 Foramen ovale: located between sutures which are prone to infection

two arteries since they come from animal intestines.
 Ductus arteriosus: pulmonary  Double arm: suture has 2 needles at
artery → aorta bypassing the lungs the edge (1 cutting for external skin
 2nd Trimester: Fetus begins to gain weight tissues, 1 round for internal tissue)
rapidly to week’s term  Poor suture = Hematoma
 3rd Trimester: Fetus tries to mature rapidly o Vaginal examinations
particularly the lungs  Not >5 internal examination
 There s/b 4 min. prenatal visits previously: throughout whole labor since it can
o 1st: 1x at 12 wks. cause injury to thee cervical canal,
o 2nd: 1x at 26 wks. rupture amniotic bag prematurely, and ⭐
o 3rd: 2x at 32 wks. and term risk for infection (lagging sagot pag
 However, in 2016, WHO decided to reinstate asa choice).
monthly prenatal visits (8x) for safer Do’s of IE Don’ts of IE
pregnancy and delivery.  Normal labor w/o  During contraction
previous bleeding  Abnormal labor
PHYSIOLOGIC CHANGES IN WOMEN DURING hx  Non-pregnancy and
PREGNANCY  If with certificate of pregnancy – check
 blood volume expands by 40%-50%: competence vaginal canal but
o anemia (N: 12; average: 11) → Iron no inserting of
supplementation fingers
 ↑ clotting factors (fibrinogen, prothrombin level,  Purpose:
clotting factor 7, 9, and 10)  To assess/ detect cervical dilatation
 ↑ progesterone and estrogen:  Determine presence or absence of
o Moodiness, weepy, anxiety, ambivalence bag of waters
 Determine station (locate ischial
Labor and Delivery Care spine)/ degree of descent of fetus
 Shortest phase or stage in OB (not more than
24 hrs.) 5 P’s THAT AFFECTS LABOR
 Complication in childbirth usually occur at this 1. Passage
point  Soft Passages: made up of tissues and
 Crucial competencies of the MCN: muscles (cervical canal and vaginal canal)
o Use of partograph  Major hard passage: refers to pelvis which
o Performing NSD cannot be cut or torn
 Episiotomy is now indicative and is only o 4 bones in the pelvis:
done if vaginal canal is tight because it  2 hip bones/ innominate bones –
is uncomfortable and requires 2-3 wks. ileum – thickest; ischium – 2nd and
of healing. lowermost part; pubis – front part
o Suturing lacerations  Left and right innominate joins at the
 only 1st and 2nd degree lacerations front forms symphysis pubis
(perineal muscles, bulbocavernosus  1 sacrum – back bone of pelvis where
muscles, and muscles surrounding everything is attached
the vaginal canal)  1 coccyx – attached to sacrum and the
 MD – 3rd and 4th degree (coccygeus only movable bone of the pelvis
muscles [goes far beyond sacrum to o False pelvis: above pelvic part
coccyx] which can create hematoma o True pelvis: below the inlet
and bleeding) o 3 cavities of the pelvis:
 Suture 1 cm above the laceration to  Inlet
catch the beginning of laceration using  OB conjugate: smallest diameter
polyglycolic suture materials  Diagonal conjugate: clinically
(absorbable) instead of chromic 2.0 significant which can be measured
(min: 11.5; average: 12.5 cm)

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- 1.5 bigger than OB conjugate  Complete extension/ face

measured through IE o Fetal Lie: relationship between the long
 Anatomical or True conjugate: (cephalocaudal) axis of the fetal body and
between the sacral promontory and the long (cephalocaudal) axis of the
the upper edge of the pubic woman’s body
symphysis (N: 11 cm)  Longitudinal: Cephalic or Breech
 Transverse
o Fetal Presentation: body part that will first
contact the cervix or be born first and is
determined by fetal lie and fetal attitude
1. Cephalic presentation: head is in
contact with cervix
 Vertex/ occiput
 Brow
 Face
 Mentum/ Chin
Type Lie Attitude
Vertex Longitudinal Good
Brow Longitudinal Moderate
 Midpelvis: Face Longitudinal Poor
 Anteroposterior diameter Mentum Longitudinal Very poor
 Outlet: ≥11 cm transverse diameter
o Nsg. Assessment: Assess pelvis in relation 2. Breech Presentation: feet or buttocks;
to the head of the baby (fetal head – hard, sacrum is landmark
biggest, and most difficult to deliver [1/4  Complete
of total length of fetus; N diameter: 9.5]  Frank
vs. pelvis)  Footling (Single or Double)
o Min. pelvic size: 10 cm found in OB Type Lie Attitude
conjugate and bispinous diameter Complete Longitudinal Good
(transverse diameter of midpelvis or Frank Longitudinal Moderate
distance of 2 ischial spines where we Footling Longitudinal Poor
determine station)
3. Shoulder Presentation: acromion
2. Passenger process (scapula is landmark), iliac
 Size of fetal head: 9.5 cm crest, hand, or elbow
o Suboccipitobregmatic (SOB): completely o Maternal Pelvis Quadrants: Right anterior,
flexed head, vertex/ occipital presentation Left anterior (best position), Right Posterior,
(9.5 cm) Left Posterior
o Submentobregmatic (SMB): fully extended
head, face presentation (9.5 cm) 5 PASSENGERS IN LABOR THAT CAN CAUSE
o Occipitofrontal Diameter: occipital DYSTOCIA
prominence to bridge of the nose (12 cm) 1. Fetus – Macrosomic, Malpresentation
o Occipitomental Diameter: widest 2. Placenta (accessory organ)– adherent placenta
anteroposterior diameter, posterior fontanel from AP
to chin (13.5 cm) o 2 parts:
 Fontanelle Spaces: compresses during birth to  Cotyledon – adhered to decidua basalis
aid in molding the fetal head found in maternal side
 Fetal Presentation and Position  Membranes
o Fetal Attitude: degree of flexion o Functions:
 Good attitude/ Complete flexion/ Vertex a. Respiratory
 Moderate flexion/ Military or Sinciput b. Nutritive
 Brow or partial extension
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c. Excretory Do not achieve cervical (+) effacement and

d. Immunologic – antibody transfer at 3rd dilation; absent cervical cervical dilation, bloody
trimester changes show, ruptured bag of
e. Barrier – closes organ from bacterial water
invasion except syphilis and viruses False Labor True Labor
(except COVID-19) irregular and painful but have rhythmic
do not cause cervical contractions
3. Amniotic fluid (accessory organ) – oligo and
dilation
poly
4. Membranes (accessory organ) – opposite of
4. Psyche
placenta found in fetal side
 Overall status of the mother (physical,
o 2 types:
emotional, and psychological)
 chorion – thicker membrane →
adherent membranes in decidua or 5. Position in labor
endometrium and is the most common
type of membrane retained during ESSENTIAL INTRAPARTAL NEWBORN CARE
placental expulsion 2 Phases
 amnion – thinner membrane  M: EIC (Essential Intrapartal Care)
5. Cord (accessory organ) – short cord → o 1st stage of labor:
abruptio; long cord → cord coil (N: as long as
a. Woman can move around (mobility of
baby’s length)
mother) so long as bag is intact – labor
is shorter as the baby descends faster
 Station
b. Woman can be given a light diet (sopas,
aroscaldo, goto, noodles) – gives
mother energy to push in labor
c. Pain relief
 Non-pharmacologic: Breathing
techniques
 Pharmacologic: Meperidine,
Demerol, Nifedipine, Nubaine
d. Use of partograph
e. (=) birth environment: provides
companion in labor – reduces pain and
provides emotional support shortening
labor
3. Power o 2nd stage of labor:
 primary power (uterine contraction – stronger a. No fundal push/ pressure; allow mother
power), secondary power (bearing down – use to do spontaneous ushing when
of abdominal muscles) contraction are there – can lead to
False Contractions True Contractions asphyxiation and trauma to newborn
(False Labor Pains) (True Labor Pains) and PP and ruptured uterus to mother
Begin and remain Begin irregularly but
b. Mother should assume most feasible
irregular – unpredictable become regular and
predictable
position (best position: upright squatting
Felt first abdominally and Felt first in lower back or semi-upright [elevate head and trunk,
remain confined to the and sweep around to the legs on lithotomy])
abdomen and groin abdomen in a wave – c. Episiotomy is never a routine, a choice
radiating pain and only done if indicated
rd
Often disappear with Continue no matter what o 3 stage of labor:
ambulation which relieves the woman’s level of a. Traditional/ Expected Mgt.
pain activity  Wait for signs of placental separation
Do not increase in Increase in duration, (Calkin’s, Lengthening of Cord,
duration, frequency or frequency and intensity – Gushing of blood)
intensity shortened interval

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 Expel placenta thru controlled cord

traction Postpartum Care
 Inject oxytocin  6-8 wks.
 Massage uterus gently  Immediate and Routine Care
b. Active Mgt. o Immediate care: first 2-4 hrs. (4th stage of
 Inject oxytocin as soon as baby is labor)
out so long as no other baby to o Routine care: w/n 24 hrs. - 10th day (1st 4-6
follow – hasten contraction and wks.)
separation of placenta from decidua  Complication (one of the most critical period)
 Expel placenta from uterus thru can set immediately after delivery.
controlled cord traction  Follow-up care is necessary to ensure healthy
 Massage uterus in a circular gentle transition to non-pregnancy state
manner
 B: ENC (Essential Newborn Care) – time NEWBORN
framed procedure RN performs in newborn  Pathologic jaundice: w/n first few hrs. of life
a. Drying in 30 secs. – prevent hypothermia indicative of hemolytic disease or severe
and stimulate cry, prevention of infection infection (chorioamnionitis)
(good bacteria from mother’s skin is  Physiologic jaundice: >24 hrs.
transferred to baby protecting the baby)
b. Skin-to-skin contact – continuation of Child Health
prevention of hypothermia, binding,  Includes care of the newborn to adolescent
c. Wait for cord pulsation (1-3 mins.) to stop  MCN – immediate neonatal care (EINC)
before cutting – to add more blood to fetus  Includes breastfeeding
(80-100 mL) preventing anemia and o breastfeeding and family planning are all
intraventricular rupture of meningeal included and started during the pre-natal
membranes of brain preventing brain care.
bleeding
d. Do not separate woman to baby for 90 mins Women’s Health
– to initiate breastfeeding w/n 24 hrs., REPRODUCTIVE PROBLEMS OF THE NON-
binding, prevent hypoglycemia (SIDS) PREGNANT WOMEN
e. Crede’s prophylaxis, Injection of Vit. K and 1. Vaginal infections
Hep. B, Anthropometric measures (wt., CC,  vagina has the best environment making it
HC, temp. [36-37C; <35C → radiant attractive for MO and it is a haven of MO
warmer, Kangaroo care, embrace by  Doderlein’s bacilli: built in defense of vagina
mother, incubator – prevent hypoglycemia] providing acidity since MO does not thrive in
acidic environment
MECHANISMS (EDFIERE ERE)
 Engagement Cause Sign Treatme
 Descent – fetal presenting part goes down to nt
the maternal pelvis Moniliasis Candida  Whitish Clotrima
 Flexion – preparation of the fetal head to pass - most albicans cheese- zole
the cervix common (fungus) like (Oral,
substan Vaginal
 Internal Rotation – actual passage of the fetal
ce b/n Supposit
head to the cervix by rotating to pass labia ory)
 Extension – expulsion of the fetal head as the majora
pressure is released and the head extends; and
head lag is normal minora
 Restitution  Most
 External Rotation – expulsion of the fetal itchy
(discomf
shoulder by rotating and twisting horizontally
ort)
 Expulsion – expulsion of the fetus as a whole
AMBAG, ALINE O.
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Trichomoni Trichomo  Foul- Metronid

asis nas smelling azole 3. Infertility
vaginalis  Greenis (Flagyl)  Normal average parity currently: 1-2
(protozo h-foamy  Unable to become after 12 mos. after trying
a) foul (regular intercourse)
secretio  Caused by:
n o Menstrual disorders
Bacterial Gardner  Charact o Endometriosis: painful disorder where
vaginosis ella eristic endometrial tissues grow outside uterus
- quite vaginalis odor but possibly d/t menstrual reflux
common not as  involves ovaries, fallopian tubes, and
next to much tissue lining the pelvis
moniliasis trichom  Treatment: Sunugin yung areas na
oniasis meron endometrial tissues
 Gray o Polycystic Ovarian Syndrome (PCOS):
secretio Antibioti common among obese or overweight
n c women
Chlamydia Chlamydi No  develop follicles (fluid inside ovarian
a characteristi follicles) that fail to release eggs
trachoma c unless a  Treatment: Pills
tis vaginal
(bacteria smear is 4. Cancer in women
) performed  rising d/t nutrition, stress, aging, etc.
(asymptom  Most common cancers for women:
atic) o Breast – no. 1 cancer in women and one of
the cancer that can recur but reversible
2. Menstrual Disorders  risk increases with age
 may be attributed to nutrition, temperature,  ≥ 40 y/o esp. with high familial
and stress tendency, req. mammogram
 vaginal bleeding outside of menstruation at  ≥ 50 y/o for regular women
times called abnormal uterine bleeding (AUB)  Commonly occurs in women with dense
consists of: breast
o Irregular menstruation: can identify period  Lump in the breast and persistent
but can bleed in b/n or no bleeding at all throbbing pain in breast is usually a
o Dysfunctional bleeding: menstrual period sign of breast cancer.
cannot be identified anymore (2-3 pads/day  If negative for first 3 years of
→ anemia) mammography, you can skip and make
 Treatment: it every other year and if negative again,
1. Medical drugs make it every after 5 yrs.
 Oral pill (estrogen and progesterone)  Mgt:
symptomatic – menstruation is  Self-breast exam – presumptive,
controlled by hormones  Annual PE (palpation of breast and
 Groden’s Method: used to regulate yearly mammogram for >40 y/o – a
menstruation by giving pills for 3 diagnostic sign)
mos. and withdraw after to see if o Cervix – most preventable thru vaccination
ovaries has regained its motility to (HPV vaccine as early as high school 2x
produce egg then repeated until but 3x for immunocompromised and at risk)
woman can have menstruation on  Caused: Human Papilloma Virus
their own (HPV) – transmitted thru intercourse
2. Surgical  Regular assessment for sexually active
 D & C (for dysfunctional bleeding) or women thru pap smear done using
endometrial ablation removes thin laboratory machines or acetic acid
layer of endometrium
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cervical assessment (viner is painted as long as they are certified to do so while

in the cervix and monitored for changes preparing the mother for transfer to hospital.
then refer to hospital) done in  Roles of RN in FP:
community. 1. Motivation
o Uterus – begins with myomas, cancer of 2. Counseling
the endometrium seen thru UTZ 3. Provision of Service – dispense pills, insert
o Ovaries – worst because it can be seen on IUD, pelvic exam, inject implant (no. 1
late stages preference of women globally)
 Mgt: Assessment and early detection
5. RA 11223 – Universal Health Law
Legal Bases of MCN Practice  PhilHealth is the financial component
1. RA 9173 – Philippine Nursing Law o Hospital delivery – P6,500.00
o Care of the Pregnant women o Community – P8,000.00
o Labor and Delivery o CS – P19,000.00
o IE and suturing o Newborn-Package – Screening and Hearing
o Care of newborn Tests – P1,750.00
 nursing bill approved by congress recently  Health is equitable to all Filipinos and no
o Important point of the bill: Advanced Filipinos should suffer and should not be able to
Practice Nursing (APN) access any health services just because they
o 4 Classification (Abroad): cannot pay.
1. Certified Nurse Midwives  ALL FILIPINOS are members of PhilHealth
2. Nurse Anesthetist – simple anesthetic
procedures 6. RA 11210 – Expanded Maternity Leave
3. Nurse Practitioner – independently  originally 60 days but was extended for 105
practicing profession days
4. Certified nurse specialist – ex. Nurse in
pedia, oncology, headache 7. RA 9288 – Newborn Screening Act
 APN in MCN  Done 24 to 48 hrs. (72 hrs. max) after birth –
o Primarily can prepare her to be an some abnormalities cannot be detected before
independent practitioner with a birthing 24 hrs.
clinic  PhilHealth covered – P550.00 – for 6 original
diseases
2. RA 7600 – Rooming In Act o Not covered – P950.00 – additional 28
 Mother and baby dyad wherein mother and diseases
baby are not separated but will initiate o Total: P1,500.00
breastfeeding.  Process of collection of a few drops of blood
from heel into filter paper
3. RA 10028 – Expanded Breastfeeding Act  Enables early detection and management of
 Instituted breastfeeding stations among several congenital disorders
companies with 100 female employees and  May lead to mental retardation and or death if
integrated breastfeeding course in the allied untreated
medicine profession  Early diagnosis, initiation of treatment and
appropriate long term care help ensure normal
4. RA 10354 – Responsible Parenthood and growth and development of the affected child.
Reproductive Health (2012)  6 Basic Disorders:
 heart of practice of MCN o Congenital Hypothyroidism, Congenital
 defined BEmONC, CEmOC FP, and everything Adrenal Hyperplasia, Galactosemia, G6PD
about reproductive health that can improve the Deficiency, Phenylketonuria, Maple Syrup
practice of RN and midwives Urine Disease
 Provision: RN and midwives can give life-  28 Disorders:
saving drugs (Mg SO4, Antibiotics, Steroids, o Current panel of 6 disorders, Cystic
Uterotonics) in the absence of the physician for Fibrosis, Biotinidase Disease, Organic Acid

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Disorders, Fatty Acid Oxidation Disorders, o Every woman has access to Emergency
Amino Acid Disorders, Urea Cycle Obstetric and Newborn Care (EmONC)
Disorders, Hemoglobin Disorders o Family planning services to help women
space their pregnancies
8. RA 10192 – CPD across professions  MNCHN Service Delivery Network
 Ensures life-long learning – 45 CPD points
 Future: CPD Law is undergoing changes
following the Philippine Qualification Framework
wherein CPD units that are taken should be in
line with chosen specialty.

9. RA 10968 – Philippine Qualification

Framework Law
 National policy
 Levels of education are assigned aligned with
10 ASEAN countries
o Level 6 – Post Basic
o Level 7 – Certifications for competence,
trainings, master’s degree  Integrated RMNCAHN (Reproductive
 Example: IVT, DOH-MCN Certification, Maternal, Neonatal, Child, and Adolescent
FP-Certification BEMONC Health Nutrition)
o Level 8 – Expertise, doctorate degree o Filipino women and men achieve their
desired family size and fulfill the
Other Legal Bases reproductive health and rights for all through
DOH – Administrative Orders: not a law but universal access to quality family planning
administratively adopted by DOH that controls the information and services.
provision of services rendered to Filipinos o Every pregnancy is wanted planned,
supported, and adequately managed
1. AO 0025 -Series 2009 – ENC (First Embrace, throughout its course.
Unang Yakap) o Every newborn infant and child are provided
 Revolutionized the care of newborn in the first with age-appropriate essential health and
few hours of life. nutrition care packages.
o Adolescents informed and guided on health
2. AO 0029 – Series 2008 – MNCHN (Maternal,
matters particularly RH and nutrition
Neonatal, and Child Health Nutrition)
services (adolescent have erratic diet).
 Intermediate Goals:
o Every adult has access to correct and
o Every pregnancy is wanted, planned, and
adequate information and guidance on RH
supported
services including FP and protection from
 Recommended interval for every
VAWC
pregnancy is 3-5 yrs. So that the uterus
and health of the woman to recover
3. AO 0012 – Series 2012 – Birthing Center
o Every pregnancy is adequately managed
Requirements for SBA
 Pre-natal visits  It is an NB Screening Facility
o Every delivery is facility-based and o Hearing Test - referred
managed by skilled health professional  Clinical Services:
 X home birth and hilot o Prenatal, Postpartum Care
o Every mother and newborn pair secures
o NSVD for low risk
proper postnatal care
o Detection for High risk – referral
 Current tools to avert maternal death and
o FP – natural and artificial except Vasectomy,
disability:
o A skilled health care professional attends Tubal Ligation, and D & C
o Life-saving medications
every childbirth
 Personnel
AMBAG, ALINE O.
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o SBA 2. Main Goal of PNC: Healthy pregnancy for

o Trained in BEMONC and Newborn mother and child
resuscitation
o MOA with OB-Gyne and Pedia – referral Philippine Picture of Maternal Health - MMR
 Human Waste Management 2000 (209) → 2006 (162) → 2012 (221) → 20115
o DENR – Local government checks (127) → 2017 (121) → 2023 (114)

4. Executive Order 141 MDGs (2000 – 2015)

 Addresses root cause of rising number of 1. Poverty and Hunger (Malnutrition) –
teenage pregnancy and mobilizing government breastfeeding lessens malnutrition
agencies to implement strategies through: 2. Primary Education
1. Reproductive Health Education as early 3. Gender Sensitivity and Empowering women
as elementary and high school 4. Decrease Child Mortality
2. Look for teenage pregnant women 5. Improve Maternal Health – MMR by 52
3. Functionality of Violence Against Women 6. Minimize HIV (alarmingly increasing in DOH),
& Children at Barangay Level – commonly Malaria, etc.
occurs as a result of rape, incest or non- 7. Environmental Care
consensual sexual activities 8. Global Competitiveness
 Teenage Pregnancy
o Defined as “children giving birth to children” STATUS OF MATERNAL HEALTH
o Teenage mothers are classified:  Everyday in 202, ≈ 810 women died from
preventable causes r/t pregnancy and childbirth.
1. 10-14 years old – early; more
 Between 2000-2020, the MMR dropped by ≈
complications
34% worldwide.
2. 15-19 years old – late teenage
 95% of all maternal deaths occur in low & lower
pregnancy
middle-income countries.
 Attended by MD and referred to social worker
as a potential act against VAWC
WHAT ARE PREGNANT WOMEN DYING FROM?
 Risks of Teenage Moms
 28% - Pre-existing medical conditions
o Anemia
exacerbated by pregnancy (such ass diabetes,
o Pregnancy related HTN (Pre-eclampsia)
malaria, HIV, obesity)
o Childbirth related complications (i.e.,  27% - severe bleeding
dystocia)  14% - pregnancy-induced high blood pressure
o Mental health – poorer; prone to postpartum  11% - infections (mostly after childbirth)
depression  9% - obstructed labor (dystocia) and other
 Risk for Babies direct causes
o Preterm – since uterus is not yet fully  8% - abortion complications (illegal in PH)
matured  3% - blood clots
o Low birth weight
o Severe neonatal complications NEONATAL HEALTH: SCOPE OF THE
PROBLEM
OB  Prematurity – 27%
 Childbirth  Asphyxia – 26%
 Unique from other medical sciences d/t to the  Infection (Sepsis + Pneumonia) – 10%
following factors:  Congenital Anomalies – 9%
o Physiologic  Neonatal Tetanus – 2%
o Time frame  Diarrhea – 2%
o 2 clients (mother, fetus)
BARRIERS THAT LIMIT ACCESS TO QUALITY
POINTS TO REMEMBER: HEALTH CARE: THE 3 DELAYS
1. All women are at risk at childbirth, no matter Delay in Delay in Delay in
how complete the PNC visits deciding to identifying and receiving
seek care reaching the appropriate
AMBAG, ALINE O.
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appropriate care o ↓ under 5 mortality to at least as low as 25

facility per 1,000 LB
 Failure to  Distance  Lack of
recognize from a health Goal 4: Quality Education
danger woman’s care  Obtaining a quality education is the foundation
signs home to providers to improving people’s lives and sustainable
 Lack of health  Shortage development (i.e., scholarship).
money facility/ of supplies
 Unplanne provider  Lack of Goal 5: Gender Equality
d/  Lack of/ equipment  Gender equality is not only a fundamental
unwanted poor  Lack of human right, but a necessary foundation for a
pregnanc condition of competenc peaceful, prosperous and sustainable world.
y roads e of health
 Lack of  Lack of care Goal 6: Clean Water and Sanitation
companio emergency providers  Clean, accessible water for all is an essential
n in going transportati  Weak part of the world we want to live in. It is a basic
to health on referral need.
facility  Lack of system
 No awareness Goal 7: Affordable and Clean Energy
person to of existing  Energy is central to nearly every major
take care services challenge and opportunity.
of  Lack of
children/ community Goal 8: Decent Work and Economic Growth
home support  Sustainable economic growth will require
 Fear of societies to create the conditions that allow
being ill- people to have quality jobs (i.e., TESDA
treated in programs).
health
facility Goal 9: Industry, Innovation, and Infrastructure
 Investments in infrastructure are crucial to
SUSTAINABLE DEVELOPMENT GOALS achieving sustainable development (i.e.,
Goal 1: No Poverty hospital buildings, schools, clinics, health
 Economic growth must be inclusive to provide centers).
sustainable jobs and promote equality.
Goal 10: Reduced Inequalities
Goal 2: Zero Hunger  To reduce inequalities, policies should be
 The food and agriculture sector offers key universal in principle, paying attention to the
solutions for development, and is central for needs of disadvantaged and marginalized
hunger and poverty eradication. populations.

Goal 3: Good Health and Well-Being Goal 11: Sustainable Cities and Communities
 Ensuring healthy lives and promoting the well-  There needs to be a future in which cities
being for all at all ages is essential to provide opportunities for all, with access to
sustainable development. Making the health basic services, energy, housing, transportation
care accessible, acceptable, and affordable. and more.
 Target: To reduce maternal mortality
o Less than 70/100,000 LB Goal 12: Responsible Consumption and
o No country should have an MMR Production
>140/100,00  Sustainable consumption and production is
 Target: End all preventable deaths under 5 about promoting resource and energy
years of age efficiency, sustainable infrastructure, and
o ↓ NMR to at least as low as 12 per 1,000 LB providing access to basic services, green and
decent jobs and a better quality of life for all.
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1. Progress of Labor
Goal 13: Climate Action  Cervical dilatation
 Climate change is a global challenge that  Contraction pattern
affects everyone, everywhere.
2. Maternal and Fetal Well Being
Goal 14: Life Below Water  Maternal VS and the time voided
 Careful management of this essential global  FHR and amniotic fluid
resource is a key feature of a sustainable future
(i.e., clean water bodies).

Goal 15: Life on Land

 Sustainably manage forests, combat
desertification, halt and reverse land
degradation, halt biodiversity loss (legal mining
and legal logging).

Goal 16: Peace, Justice and Strong Institutions

 Access to justice for all, and building effective,
accountable institutions at all levels.
 If symbol X (cervical dilatation) is on the alert
Goal 17: Partnerships line going to green area, labor is satisfactory.
 Revitalize the global partnership for sustainable  But once it passes thru alert line, midwife
development for early success and progress. should contact transport services and ask
the woman to move around and void for
The Partograph head to descend.
 A record of all of the observations made on a
woman in labor, the central feature of which is CONDITIONS THAT DO NOT NEED THE USE OF
the graphic recording of the dilatation of the PARTOGRAPH
cervix as assessed by vaginal examination.  Antepartum hemorrhage
 Personal Information:  Severe pre-eclampsia and eclampsia
o Name  Fetal distress
o Gravida  Previous cesarean section
o Parity  Multiple pregnancy
o Registration/ Hospital Number  Very premature baby
o Date of Admission  Obvious obstructed labor
*** These are common cases requiring abdominal
o Time of Admission
delivery, no more time to monitor.
o Time when the membranes/ BOW rupture
was written at the top of the graph Fetal Heart Rate
 This is recorded hourly to monitor the condition
Normal (Expected)
of the fetus.
Alert/ Caution
Liquour (Liquour Amni)
Progress of Labor  Amniotic fluid is observed and recorded at each
vaginal examination as follows:
o Absent (“A”)
o Blood-stained (“B”) – consider AP or PP
Maternal and Fetal Condition o Clear (“C”)
o Meconium stained (“M”) – indicates
distress
o If the membranes are not rupture (“I”) for
intact
PARTS OF PARTOGRAPH

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Cervical Dilatation  Encourage upright position and walking if

 This is the most important observation to woman wishes
monitor progress of labour  Monitor intensively. If referral long, reassess in
 Is assessed at every vaginal examination and 2 hrs. and refer if no progress
marked with a (X). Plotting begins on the
partograph at 4cm. IF PARTOGRAPH PASSES ACTION LINE,
REFER URGENTLY TOO AN EMOC FACILITY
Hours UNLESS IMMINENT DELIVERY
 Refers to the time elapsed since the onset of  Assist the delivery
the active phase of labour o Ensure the bladder is empty
o Position the woman comfortably where she
Time will deliver
 The actual time of day is recorded here o When delivery is imminent, wash hands,
open delivery kit ready oxytocin 10 IU and
Contractions put on gloves just before delivery
 Are recorded every hour; palpate the number of o Deliver the baby
contractions in 10 minutes and their duration in o Give oxytocin 10 IU IM
seconds. o WOF vaginal bleeding
 If woman is admitted in LATENT PHASE of
Oxytocin, Drugs, and IV Fluids
labor (<4cm dilated) – record only other findings
 These are recorded in the space provided.
(BP, FHT, etc.)
 If she remains in latent phase for next 8 hrs.
BP, PR, and Temperature
(labor is prolonged), transfer her to hospital.
 Monitor every 4 hrs. and record the findings
(more frequently If indicated).
Recording the Findings in the Partograph
 Start by labeling the record with pertinent pt.
Urine
identifying information.
 The amount is recorded every time urine is
passed.
PLOTTING THE PROGRESS OF LABOR
 The woman is encouraged to pass urine every
 Begin by plotting the cervical dilatation on the
2 hrs. in labour because a distended bladder
alert line.
can retire the descend of fetus and each
 Plot only the cervical dilatation using the symbol
specimen is tested for CHON (pre-eclampsia)
“X”
and Ketones (DHN).
o Connect the “X”s to demonstrate the pattern
of labor
APPROPRIATE USE OF THE PARTOGRAPH IS
 Start when woman is in ACTIVE LABOR (4cm
EXPECTED TO:
or more) and is contracting adequately (3-4
 Reduce the incidence of prolonged labour
contractions in 10 minutes)
 Reduce the proportion of labours requiring
 Perform internal examination every 4 hrs. or
augmentation
more often if necessary, and plot each findings
 Reduce the rate of emergency Caesarean
each time
section
o Do not forget to write the time each
 Reduce the intrapartum stillbirth rate – able to
arrest the descent of the baby right at the time observation was made

IF PARTOGRAPH PASSES ALERT LINE Identifying Deviations of Labor Patterns from

 Reassess woman and consider criteria for Normal Findings
referral  Progress of labor is normal if plotting stays on
 Alert transport services or to the left of the alert line (green part).
 Empty bladder  Plotting that passes the alert line (yellow part)
 Ensure adequate hydration but omit solid foods more so if it reaches or passes the action line
for possibility of anesthetics (red part) indicates abnormal progress of
labor.

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o The older the woman is, the older the egg is

LABOR CARE GUIDE (2018) resulting to congenital anomalies in elderly
 new tool in monitoring labor introduced by WHO gravida (>35 y/o pregnancy).
but has not yet been adopted by DOOH d/t o Reproductive Age: 18-35 years old
training of SSBA was not done d/t COVID-19
 more sp. and includes quality of fetal heart rate MENSTRUATION
 begins at Menarche (average: 12 y/o) and
Reproductive Processes persists until Menopause (begins at 45 y/o
OVULATION and ends at 55 y/o) or permanent cessation of
 occurs 14 days before the next period menses (missing 1 yr./12 mos. of menses)
o Formula: 14 days – cycle of menstruation  caused by hormones and is an interrelation of 3
(days) organs:
 Normally alternates between two ovaries and o Brain: master organ is pituitary gland but
can be felt thru pain in either left or right side the first structure in the brain to initiate
called Mittelschmerz Sign menstruation is hypothalamus
 Is not present in the early yrs. of menarche and o Ovary: ovum only waits for 24 hrs. for
later yrs. of menopause fertilization and will die thereafter
 Eggs ovulated by a woman is as old as  Sperm + Ovum → fertilization →
herself. Blastocysts → implantation ready
o Uterus

 Phases of Menstrual Cycle:

1. Ovarian Phase FERTILIZATION
 Follicular Stage: FSH, Estrogen  only one that can be done artificially (test tube
 Luteal Stage: LH, Progesterone or petri dish)
2. Uterine Phase/Cycle  egg + sperm
 Proliferative Stage: Estrogen
 Secretory Stage: Progesterone IMPLANTATION/ NIDATION
 Menstrual Stage

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 contact between the growing structure and the C. Suturing all lacerations – not all only 1 st and 2nd
uterine endometrium, occurs approximately 7 to degree, 3rd and 4th are sutured by MD
10 days after fertilization D. Handling normal deliveries +
 1 – 7 – menstrual wk.
8 – 14 – pre-ovulatory pd. (↑ estrogen and
progesterone) and on the 14th day ovulation and 2. A type of vaginal infection characterized by foul
fertilization happens greyish discharge is:
15 – 21 – fertilized egg → blastomere (3-4 days A. Bacterial vaginosis
after fertilization going to fallopian tube) → B. Trichomoniasis – creamy to greenish, foamy
morula (16-cell cycle) → blastocysts (2 cavity C. Moniliasis
fertilized egg [zygote] and has the necessary D. Chlamydia
germ layers allowing it to safely implant in upper
uterus) 3. Which among these statements is not true about
22 – 28 – pregnancy infertility? (-)
A. Defined as inability to become pregnant within
PREGNANCY 12 months of unprotected regular sexual activity –
 begins as egg unites with sperm (fertilization) s/b after
B. Maybe caused by irregular or menstrual
Pregnancy Induced Hypertension disorders +
 Gestational HTN: HTN + edema, (-) proteinuria C. Caused by vaginal/pelvic infections +
 Pre-eclampsia: HTN (140/90, generalized D. Maybe initiated by endometriosis + endometrial
edema, proteinuria +1 to +2) cells outside of uterus can block fallopian tube X
o Severe Pre-eclampsia: >100 diastolic allowing passage of fertilized ovum or sperm cell
 Eclampsia: seizure + HTN
o Occurs after fetus is viable (any HTN that 4. The best diagnostic procedure to detect breast
occurs before age of viability is considered cancer is:
as Chronic HTN) → Mgt: Emergency CS A. Monthly self-breast exam – not a very good
w/n 5-7 mins. to prevent asphyxia detection strategy but a good way for woman to be
aware of her body and be alert to any changes in
SIDE EFFECTS breast
 Stroke B. Regular mammogram especially for women
 Blindness (reversible after 1-2 mos.) aged 40-50 years above
 CHF C. Mammotome biopsy – done thru a machine that
 Ruptured liver capsule sucks tissue and is done if tissues are non-
 Small placenta → SGA cancerous or just a cysts
 Renal failure D. Breast ultrasound – partner of mammography
 Thrombus formation → Embolus → Pulmonary but sometimes cannot identify tumor
embolism
 Pulmonary edema 5. These are characteristics of a woman with
 HELLP Syndrome (Hemolysis Elevated Liver normal menstruation except which? (-)
Enzymes Low Platelet Count) A. Her ovaries generally alternate each month in
release of egg +
 Place woman with pre-eclampsia in a dim, B. She can more or less predict her next period + if
quiet environment that will prevent seizure regular but in the question it is indicated normal
specifically the observation room (far away from C. It is expected that menstruation occurs from
station – busy area). pubarche to 45 years in a woman – s/b menarche
to menopause
Exam Questions D. It can last from 2-7 days +
1. In labor and delivery care, the nurse must be
competent in all the areas. Which one is an 6. The most important and shortest diameter of the
exception? (-) pelvis of the woman considered in assessment is:
A. Performing vaginal examinations + A. Anatomical conjugate
B. Use of partograph +
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B. Distance between the 2 ischial spines – D. Survival is possible of the fetus is born now –
bispinous diameter Age of viability: 20 wks. is passed
C. OB conjugate – 1st one to be measured
D. Diagonal conjugate – 1.5 bigger than the OB 12. What change in the urinary system predisposes
conjugate a pregnant woman to UTI?
A. Decreased bladder capacity – more of urine
7. A temporary structure of the fetal circulation that stasis rather than frequency
can create problems in the baby if it does not close B. Increased blood volume – more on anemia
at birth is: C. Pressure on the bladder by an enlarging uterus
A. Foramen ovale – applicable on 1st or last trimester
B. Ductus vanosus D. Stasis of the urine in the bladder and ureter due
C. Ductus arteriosus – PDA (machinery like to hormone. – d/t progesterone which relaxes
murmur) → DOC: Indomethacin uterus, bladder, and ureters (prone to stasis →
D. Hypogastric arteries attract MO → infection) balancing contracting effect
of estrogen aside from oxytocin, prostaglandin, and
8. In which sequence would the structures/organs seminal fluid
work to effect menstruation?
A. Pituitary → ovary → endometrium Note: Progesterone Withdrawal theory: ↓
B. Hypothalamus → ovary → uterus progesterone and persistence of estrogen →
C. Ovary → endometrium → hypothalamus release of prostaglandin, ↓ oxytocin → contraction
D. Hypothalamus → pituitary → ovary → uterus – → cervix dilates → pre-term labor, abortion, labor
Brain, Ovary, Uterus (BOU)
13. What assessment data would the nurse expect
9. A major hormone of the woman that is to obtain from a woman who is 14 weeks pregnant?
responsible mainly for development of breast ducts, A. Counting the FHR with a fetoscope - >20 wks.
and initiates the release of LH when it decreases in B. Auscultation of the FHR with a doppler – 10-12
the blood? wks.
A. Progesterone – go to acini cells C. Uterus just below the navel – s/b 2
B. Estrogen fingerbreadths above symphysis pubis
C. FSH D. Fetal movements as reported by the mother –
D. Prolactin – hormone from APG felt once fetus is viable

10. Thrombus formation is an expected occurrence 14. Performing IE is a competency of the nurse
in pregnancy, which maternal change is responsible assigned in the Labor room. What are the purposes
for this? of doing this?
A. Expanded blood volume + 40%-50% 1. Determine of the BOW is intact +
B. Increase clotting factors → Be active unless with 2. To evaluate the capacity of the pelvis +
signs of abnormality 3. Determine the station of the presenting part +
C. Effects of increase hormones + estrogen and 4. To age the pregnancy and by estimating the size
progesterone of the fetal head -
D. Encouraging rest in between periods during the A. 1, 2, 3
day – done but not all the time B. 2, 3, 4
C. 1, 3 & 4
11. The nurse is conducting mother’s class at the D. 4 only
PNC. She answers a question re: the significance
of 24 weeks AOG. Her answer is: 15. A nurse assesses the pregnant mother for signs
A. At this time, the fetus is most sensitive to of pre-eclampsia. This would be her expected
teratogens – during 1st trimester (organogenesis) complaints:
B. Fetal lung maturity is complete – surfactant A. Vaginal bleeding with discomfort – no spotting
begins to develop at 24-26 wks. B. Persistent on severe abdominal pain – not
C. The fetus weighs 2.5lbs and is about 14 inches – characteristic of pre-eclampsia alone, present in
not significant ectopic pregnancy

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C. Flashing lights, spots before the eyes, labor in the event for bleeding and 3 bags
continuous headache – severe pre-eclampsia [1,500 mL] for CS and detect the possibility
D. Edema of feet and legs that occur in the of hemolytic disease), Hep. B, ELISA (HIV),
afternoon – physiologic edema RPR (sister of VDRL; test for syphilis), TB
tests (skin and sputum); if with hx/ with DM:
16. Upon history, the mother tells the nurse that she oral glucose challenge test) but normally
has hypothyroidism or thyroid problem. The nurse done at 24-28 wks. (6-7 mos.)
knows that this existing medical condition can lead o urine tests (bacteria, proteinuria, ketones,
to: sugar – is not alarming because pregnancy
A. Increased risk of pre-eclampsia is diabetogenic)
B. Increased incidence of spontaneous abortion,
congenital anomalies in the fetus – give iodine and 19. In an MCN class, the teacher is explaining the
folic acid inter play of hormones in reproductive process. The
C. Increased risk for operative delivery – more risky luteal phase of the ovarian cycle is synonymous
for mother and baby unless there is cephalopelvic with one – phase of the uterine cycle?
disproportion and fetal distress A. Ovulatory phase
D. Maternal risk for cardiac decompensation and B. Proliferative phase – Follicular Phase, Estrogen
increased death rate C. Secretory phase - Progesterone
D. Menstrual phase
17. Which statement by a woman would show that
further teaching on fertility awareness is needed? 20. A woman on her 26 weeks AOG (fetus is viable)
(-) visits the PNC. She complains of weakness and
A. “Egg (24 hrs.) live a lot shorter than sperms (48- light headedness when lying on the examination
72 hrs.)” + table. What would be the primary nursing action?
B. “There will be a slight increase in temperature A. Assess the woman’s BP
before ovulation up to menstrual flow” – s/b after B. Ask the woman to take deep breaths
C. “Ovulation usually happens 14 days before my C. Turn the woman on her side – left side to relive
next period” + pressure of the uterus on the bigger vessels
D. “Wet, clean cervical secretions mean I am fertile” D. Lower the head of the exam table
+ occurs as estrogen acts on the body
21. Discussing the reproductive processes in a
18. What are the common laboratory tests done to woman, implantation in a regular cycle usually
a pregnant mother initially in her first visit? occurs on:
1. Urine test for sugar and ketones – not priority A. The first week of the cycle
2. Blood test for CBC, Hgb, Hct count + B. Second week of the cycle
3. RPR to test for sexually transmitted disease + C. Third week of the cycle
4. Oral glucose test to determine DM – done at 2 nd D. Last week of the cycle
and 3rd Trimester
A. 1 & 2 22. As a safety protocol of the WHO the DOH has
B. 2 & 3 adopted the following measures discussed with the
C. 3 & 4 mother on her first prenatal visit:
D. 1 & 4 1. Prepare Birth Plan with emergency
preparedness measures + checked at every visit
ASSESSMENT and then changes if the mother has change of
1. Get data and history: age, Naegele’s rule, OB plans (flexible)
scoring, GPTPAL, histories of disease and prev. 2. Encourage all pregnant women to deliver in a
pregnancy Health Facility +
2. Physical Exam: head-to-toe, Leopold’s 3. The mother is given a choice as to her place of
maneuver, fundic height delivery – s/b at health care facility attended by
3. Looking at lab exams and results including UTZ SBA
if mandated: 4. Discuss who will be her companion in labor, who
o blood tests (Routine: Hgb, blood type will take care of her older kids at home, etc. +
(assess type for 1 blood donor [500 mL] for A. 1, 2, 3
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B. 2, 3, & 4 B. 28 cm and the FHB can be assessed thru

C. 1, 2 & 4 stethoscope
D. 1 only C. Just above the xyphoid and FHR are regular
D. Above the umbilicus, the FHR audible by
23. Adolescent pregnancy has been increasing as stethoscope
per report of the POPCOM. The initial responsibility
in teaching the pregnant adolescent is: 28. When taking the heath history of the pregnant
A. Informing her the benefits of BF mother, the nurse recognizes that she would be at
B. Advising her to watch for danger signs risk for developing PIH if she is:
C. Emphasizing the importance of consistent A. 34 – 35 years old – ideal
regular PNC – teenage pregnant mothers do not B. Overweight, primigravida
seek check-ups; s/b reinforced with actual written C. Had six pregnancies – has no bearing
date in appointment card D. Has been on contraceptives within 3 months of
D. Teaching her about Family Planning conception – has no bearing

24. Which important fetal milestone occurs 29. These conditions are expected to occur in
generally on the 5th month of pregnancy? teenage pregnancy:
A. Organogenesis is completed 1. Placenta previa – caused by diminished blood
B. Fetal circulation is established supply to area of attachment from thinning of
C. Fetal movements are felt by the mother decidua; common in multigravida, malpresentation,
D. FHR is heard thru DOPPLER D&C
2. Cephalopelvic disposition +
25. Which among these statements is /are true of 3. Chromosomal abnormalities of the baby –
the placenta? common in elderly
1. It becomes functional as soon as the fertilization 4. Preeclampsia +
takes place A. 1 & 2
2. It protects the fetus from any trauma B. 3 & 4
3. It protects the fetus from bacterial organisms C. 2 & 4
4. It acts as the lungs of the fetus inside the uterus D. 1 & 4
A. 1 & 2
B. 3 & 4 30. Theoretically, the following hormones increase
C. 1 & 3 to initiate onset of labor except the secretion of
D. 2 & 4 which
hormone?
26. The nurse performs Leopold’s Maneuver on Ms. A. Relaxin – relaxes lumbosacral part for easy
Tuazon. She notes the following findings: a soft, stretch in labor
firm B. Fetal corticosteroids – produced by fetus to aid
mass on the fundus (buttocks); several knots and in contraction
protrusions on the left side (fetal back on right side) C. Progesterone – Progesterone withdrawal theory
of the mother; round movable mass above the D. Oxytocin
pubic area. She concludes that the position is:
A. LOA, longitudinal lie – best position Situation: A 26-year-old primigravida is admitted in
B. LSA, transverse lie labor at 8AM. Fetal position: ROP, CX-6cm, BOW
C. ROA, longitudinal lie – most presentations are (-) ruptured.
95% cephalic and anterior 31. With a BOW (-), what would the nurse instruct
D. RSA, longitudinal lie the mother?
A. She can eat anything for as long as it is a light
27. A primigravida, unsure of her LMP is told by the diet +
community health provider that she appears to be B. She must stay on bed, left side lying
about 7 months pregnant. The nurse confirms this C. She can move around anytime she pleases +
and explains to the mother that this is because the shortens labor
fundus is: D. She needs O2 inhalation, 3-5 liters/min to
A. 18 cm, and the baby just started to move ensure the baby’s safety – not at this point and is
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given based on HR >160 (early sign of fetal distress B. Basic Emergency Maternal and Newborn Care
in increasing HR; late sign is decreasing HR → C. Essential Intrapartum and Newborn Care
Delivery); dependent fxn D. Maternal, Neonatal, child Health and Nutrition

32. An ROP (occiput is at the back part of the 37. Routine suctioning of the newborn was a norm
pelvis) position would let the nurse inform the because it was believed that it was necessary to
woman that: stimulate him to breathe. These are now the
A. She will have the urge to push until she is fully evidence of ill effects of suctioning:
dilated 1. Associated with mucosal trauma
B. She can expect to have more back discomfort in 2. Associated with risk for infection
labor and have possibly a longer second stage – 3. Associated with apnea, bradycardia
takes more time to get to symphysis pubis (internal 4. It delays achieving normal oxygen saturation in
rotation) and is thereby more painful the newborn
C. The position of the baby’s head is occipital and A. 1 & 2
will have a spontaneous birth B. 2 & 3
D. An operative delivery may be needed to deliver C. 3 & 4
the baby D. 1, 2, 3, & 4

33. Midpelvic capacity (N: >10 cm because 38. Postpartum bleeding is still one of the causes of
passenger measures 9.5 cm) of the pelvis may be maternal mortality .AMTSL has been promoted to
measured by: effectively intervene in preventing bleeding. These
A. Subtracting 1.5-2cm from the diagonal conjugate are the components of AMTSL EXCEPT:
– OB conjugate A. Administration of uterotonic agents
B. Clinical measurement of the side wall B. Controlled traction to expel the cord
convergence C. Uterine massage prior to placental expulsion to
C. Clinical measurement of the ischial spines thru hasten separation of the placenta
IE D. Uterine massage after delivery of placenta to
D. Measurement of the sub pubic angle effect contraction

34. In the second stage of labor, expulsion of the

fetus from the birth canal depends on which
important factor?
A. Full dilatation of the cervix – cervix is already
fully dilated
B. Maternal bearing down – important to assist
labor
C. Uterine contraction
D. Adequate pelvic capacity

35. As the head descends and crowns, supporting

the perineum will facilitate:
A. Flexion of the head
B. External rotation of the head
C. Extension of the head – assisted thru Ritdgen’s
Maneuver
D. Expulsion of the baby

36. The Philippine policies mandating the safe and

quality care on mothers and their newborn across
all
Birthing Facilities in the country is embodied in
which program?
A. Maternal and child care services
AMBAG, ALINE O.