Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Prepared by:
Ma. Reina Rose D. Gulmatico, RN, MSN
Mons Pubis (Mons Veneris) – (Mount of Venus) is a pad of fat lying over the symphysis pubis;
covered with pubic hair from the time of puberty
Labia Majora (Greater lips) – are two folds of fat and areolar tissue, covered with skin and pubic hair
on the outer surface; arise in the mons veneris and merge into the perineum behind.
Labia Minora (Lesser lips) - two folds of the skin between the labia majora; anteriorly, they divide to
enclose the clitoris; posteriorly they fuse, forming the fourchette
Clitoris - rudimentary organ corresponding to the male penis; extremely sensitive and highly vascular
and plays a part in the orgasm of sexual intercourse
Vestibule - area enclosed by the labia minora in which encloses the openings of the urethra and the
vagina
Vaginal orifice- also known as the introitus of the vagina and occupies the posterior two-thirds of the
vestibule; partially closed by the hymen, a thin membrane that tears during sexual intercourse or
during birth of the first child
Skene’s Glands- either side of the meatus which are often involved in infections of external genitalia
Bartholins Glands - are two small glands which open on either side of the vaginal orifice and lie on the
posterior part of the labia majora. They secrete mucus which lubricates the vaginal opening.
Functions:
a passage that allows the escape of the menstrual flow
receives the penis and the ejected sperm during sexual intercourse and provides an exit for the fetus
during delivery
THE UTERUS
Structure
hollow, muscular, pear-shaped organ situated in the true pelvis
Functions
to shelter the fetus during pregnancy and following pregnancy it expels the uterine
contents
Fundus – domed upper wall between the insertions of the uterine tubes
Cornua – are the upper outer angles of the uterus where the uterine tubes join
Isthmus – narrow area between the cavity and the cervix that enlarges during pregnancy to form the
lower uterine segment
Cervix or Neck – protrudes into the vagina; supravaginal (upper half)- above the vagina
infravaginal portion (lower half)
Myometrium (muscle coat)- thick in the upper part of the uterus and is more sparse in the isthmus
an cervix.
Perimetrium
D. UTERINE TUBES
Functions
• The uterine tubes propels the ovum towards the uterus, receives the
spermatozoa as they travel upwards and provides a site for fertilization. It
supplies the fertilized ovum with the nutrition during its continued journey to the
uterus.
Structure
• Each tube is 10 cm long. The lumen of the tube provides an open pathway from
the outside to the peritoneal cavity. The uterine tube has four portions:
a) The interstitial portion – is 1.25 cm long and lies within the wall of the uterus. It’s lumen
is 1 mm wide.
b) The isthmus – is another narrow part which extends from 2.5 cm from the uterus.
c) The ampulla – is the wider portion where fertilization usually occurs.
d) The infundibulum – is the funnel shaped fringed end which is composed of many
processes known as fimbriae. One fimbriae is elongated to form the ovarian fimbria
which is attached to the ovary.
E. THE OVARIES
Functions
• The ovaries produce ova and the hormones estrogen and progesterone.
Structure
• The ovary is composed of the medulla and cortex, covered with germinal
epithelium.
Functions
• The primary function of the pelvic girdle is to allow movement of the body
especially walking and running. It permits the body to sit and kneel.
• The woman’s pelvis is adapted to child-bearing, and because of its increased
width and rounded brim, women are less speedy than men.
• The female pelvis, because of its characteristics, gives rise to no difficulties
during in childbirth, provided that the fetus is of normal size.
Pelvic Bones
•There are four pelvic bones:
1. two innominate (nameless) or hip bones – each innominate bone is
composed of three bones:
The ilium
The ischium
The pubic bone
2. one sacrum
3. one coccyx
False Pelvis
superior half formed by the ilia; offers landmarks for pelvic measurements; supports the
growing uterus during pregnancy; directs the fetus into the true pelvis near the end of gestation
True Pelvis- is the bony canal through which the fetus must pass during birth. It has a brim, a
cavity and an outlet.
inferior half formed by the pubes in front, the ilia and the ischia on the sides and the
sacrum and coccyx behind
1. Inlet
entranceway to the true pelvis; transverse diameter is wider than its anteroposterior (AP)
diameter
2. Outlet
inferior portion/ lower border of the true pelvis of the pelvis
3. Cavity
space between the inlet and the outlet
contains the bladder and the rectum, with the uterus between them in an ANTEFLEXED
position towards the bladder
Variation/Types of Pelvis
1. Gynecoid – “normal” female pelvis that is most ideal for childbirth because it is well
rounded forward and back
2. Anthropoid – transverse diameter is narrow, AP diameter is larger than normal
3. Platypelloid – inlet is oval, AP diameter is shallow
4. Android – “male” pelvis; inlet has a narrow shallow posterior portion and pointed anterior
portion.
MENSTRUAL CYCLE
A. KEY CONCEPTS
1. Hormones
•Estrogen
•Progesterone
•Follicle Stimulating Hormone (FSH)
•Luteinizing Hormone (LH)
2. Associated Terms
• Amenorrhea
• Menorrhagia
• Metrorrhagia
• Polymenorrhea
• Oligomenorrhea
STAGES OF FETAL DEVELOPMENT
I. FERTILIZATION
Site: fallopian tube
mature ovum + sperm = (zygote)
Gamete: sex cell
contains 23 chromosomes
Sperm: contains X and Y chromosomes (XY)
Ovum: contains X chromosomes (XX)
II. Implantation
occurs 7 days post fertilization
morulla mitosis
mass of
large cells
(fluid space)
Blastocysts Apposition
a. Trophoblast A. Adhesion
b. Erythroblast (endometrium)
B. Invasion
Post implantation:
uterine endothelium DECIDUA
Blastocysts
a. Trophoblast (outer)- PLACENTA
b. Erythroblast (inner)- EMBRYO
TROPHOBLAST
Langhan’s Syncytial
fetal membranes
Amnion Chorion
Fetal Development
A. Amniotic fluid
1. Protective function
Shields the fetus against blows or pressures on the mother’s abdomen
Protects the fetus against sudden changes in temperature
Protects the fetus from infection
2. Diagnostic function
Amniocentesis (chromosomal abnormalities)
B. Placenta
1. Provides oxygen to the fetus
2. Provisions of nutrients (diffusion through the placental tissues)
3. Feto-placental circulation (osmosis)
4. Excretion of waste products
5. Production of hormones
HCG
HPL
Estrogen
Progesterone
6. Protective – inhibits the passage of bacteria and large molecules to the fetus
Stages of human prenatal development:
First 12-14 days – zygote
1. Endoderm – develops into the lining of the GIT, respiratory tract, tonsils, thyroids,
parathyroid, thymus gland, bladder and urethra
2. Mesoderm – forms into the supporting structures of the body (connective tissues,
cartilage, bones, muscles and tendons); heart, circulatory system, reproductive
system, kidneys and ureters
3. Ectoderm – responsible for the formation of the nervous system; the skin, hair and nails;
and the mucous membrane of the mouth and anus
FETAL CIRCULATION
NURSING CARE DURING LABOR AND DELIVERY
Theories of labor
Uterine Stretch theory – any hollow body organ when stretched to capacity
contract and empty
2. Loss of weight – about 2-3 lbs. 1 to 2 days before labor onset due to decrease progesterone
resulting to decrease fluid retention
(REMEMBER: Only 5 minutes of umbilical cord compression can already lead to CNS
damage even death.)
7. Show
Sudden gush of blood (pinkish vaginal discharge)
*Nursing Implication:
Assess for the color of vaginal discharge
GREENISH- meconium stained
BRIGHT RED- vaginal bleeding
1. Uterine contractions
2. Effacement/ Dilatation
In primis, effacement occurs before dilatation (ED)
In multis, dilatation proceeds effacement (DE)
Generally confined to the abdomen First felt in the lower back and sweep around
to the abdomen in a girdle-like fashion
Often disappears if the woman ambulates Continue no matter what the woman’s level of
activity is
5 P’s of Labor
1. Passenger (Fetus)
2. Passageway (Pelvis)
Soft tissue (cervix, vagina): stretches and dilates under the force of contractions to
accommodate the passage of the fetus
3. Power
A. Uterine Contractions (involuntary): fingers should be spread lightly over the fundus
1. Frequency: from the BEGINNING of one contraction to the beginning of the
next contraction (A-C)
2. Interval: from the END of one contraction to the BEGINNING of the next
contraction (B-C)
3. Duration: from the BEGINNING of one contraction to the END of the
same contraction (A-B)
A B C
B. Voluntary Bearing Down Efforts: use of ABDOMINAL MUSCLES to help expel fetus
thru CONTRACTION OF LEVATOR ANI MUSCLES
4. Placenta
5. Psychological response
“A positive attitude during labor yields a positive outcome.”
A woman who is: relax, aware and participating in the birth process: shorter, less
intense labor
A woman who is: fearful has high levels of adrenaline which slows uterine contractions
STAGES OF LABOR
Phases:
Latent phase: 3-4 cm
Active phase: 4-8 cm
Transition phase: 8-10 cm
1. Latent Phase
Duration: 6 hours
Cervical dilatation: 3-4 cm
Uterine contractions: every 15-30 minutes; short duration; mild intensity
Women’s Attitude: excited with some degree of apprehension
Support Measures
1. Establish rapport
2. Breathing exercise
3. Encourage ambulation
4. Offer ice chips or fluids
5. Encourage voiding of the client
2. Active/Accelerated
Cervical dilation: 4-8 cm
Uterine Contractions: every 3-5 minutes; 30-60 seconds
duration; moderate intensity
Women’s Attitude: afraid of losing control of herself
Support Measures
1. Encourage breathing exercise
2. Provide a quiet environment
3. Provide reassurance, encouragement and support
4. Provide comfort (back massage, assisting positioning,
support with pillows
5. Provide ice chips for dry mouth
Nursing management/ Health Teaching During Stage 1
1. Ambulation
(+) Ambulation – during the LATENT PHASE
BUT
2. Diet
On NPO
Solid or liquid foods are to be avoided because:
Digestion is delayed during labor
A full stomach interferes with proper bearing down
May vomit resulting to ASPIRATION
3. Enema administration
NOT a routine procedure
Purposes:
A full bowel hinders the progress of labor
Expulsion of feces during second stage of labor- INFECTION of the
mother and baby
Full bowel predisposes to postpartum discomfort
Procedure:
Enema solution: soapsuds or Fleet enema
Optimal temperature of the solution: 105°F to 115°F (40.5 °C-46.1°C)
Patient on side-lying position
Contraindications:
Vaginal bleeding
Premature labor
Abnormal fetal presentation or position
Ruptured membranes
Crowning
4. Voiding
“Please empty my bladder”
5. Breathing Technique
DO NOT PUSH OR BEAR DOWN DURING CONTRACTIONS because it leads
to: unnecessary exhaustion AND cervical edema (due to repeated strong pounding
of the fetus against the pelvic floor); thus interfering with dilatation and prolonging
the length of labor
6. Position
“I need to lie on my side!”
Sim’s position
SINCE:
It favors anterior rotation of the fetal head
It promotes relaxation between contractions
It prevents Supine Hypotensive Syndrome/Vena Cava Syndrome
7. Monitoring
Contractions
Vital Signs (Temperature/ BP)
A. Temperature: sign of infection due to early RUPTURE OF
MEMBRANE
BECAUSE
Danger Signals
Signs of Fetal distress
Signs of Maternal Distress
Should be taken:
every hour - latent phase
every half hour - active phase
every 15 minutes – transition
Remember:
Pressure of the contraction applied to
A. Fetal buttock- ACCELERATION
B. Fetal head- DECELERATION
SHAPE: U, V , W
COMPARISON BETWEEN LATE AN VARIABLE DECELERATION
PARAMETERS LATE VARIABLE
DECELERATION DECELERATION
DESCRIPTION GRADUAL decrease ABRUPT decrease
9. Administration of Anesthetics
Anesthetic of choice: Xylocaine
NURSING CONSIDERATION:
On NPO with IV to prevent aspiration and dehydration
Types of anesthesia:
A. Paracervical – transvaginal injection into either side of the cervix
C. Low spinal
1. Epidural (caudal) - local anesthetic injected at the lumbar
level
2. Saddle block - injection into the 5th lumbar space
(+) Anesthesia: perineum, upper thighs and lower pelvis
Position: sitting or side-lying position with back aligned
NURSING IMPLICATIONS:
TYPE of delivery: Forceps delivery (due to loss of coordination in
second stage pushing)
Management:
Increase fluid intake
FLAT ON BED without pillows for the first 12 hrs after
delivery
3. TRANSITION PHASE
B. Characteristics:
1. changes in the mood and intensity of contraction
2. rupture of membrane
if (-) ROM: AMNIOTOMY
to prevent aspiration of fetus from amniotic fluid
CONSIDERATION:
“(-) AMNIOTOMY for STATION (-)”
to prevent cord compression
3. Prominent SHOW
Nursing management:
1. Breathing technique
Controlled chest (costal) breathing during contractions
3. Emotional Support
Nursing management
1. Positioning
LITHOTOMY
When positioning legs onto the stirrups, put them up at the same time
in order to prevent injury to the uterine ligaments
Position: woman’s legs are flexed apart with her knees on her
abdomen
Mc Robert’s Maneuver
SACRUM straightens
SYMPHYSIS PUBIS rotates
PELVIC INCLINATION decreased
Types of episiotomy
A. Median – from middle portion of the lower vaginal border
directed towards the anus
6. Handling of Newborn
Immediately after delivery
A. Infant Position:
1. head lower than the rest of the body to allow drainage of
secretions
7. Cutting of Cord
Cutting of the cord- until the pulsations have stopped because 50-100 ml. of
blood is still flowing from the placenta to the baby at this time
8. Initial Contact
After newborn care,
Show the baby to the mother, inform her of the sex and time of delivery