Maternal and Child Nursing

(Normal Concepts)
Prepared by: Alvin John H. Gustilo, RN
I.

Human Sexuality
a. Concepts
1. A persons sexuality encompasses the complex behaviors, attitudes and
emotions and preferences that is related to sexual self and eroticism
2. Sex is basic and dynamic aspect of life
3. During reproductive years, the nurse performs as resource person on human
sexuality
________________________________________________

II.

b. Definitions related to sexuality

Gender Identity
Role Identity

Sex
Sexuality Sexual Anatomy and Physiology
a. Female Reproductive System
1. External Vulva/ Pudenda
a. Mons pubis/ veneris
Stages of Pubic Hair Development (Tool Used: Tanners Scale/ Sexual Maturity
Rating)
Stage 1 Pre adolescence
Stage 2 Occurs bet. 11 12 y.o
Stage 3 Occurs bet. 12 13 y.o.
Stage 4 13 14 y.o.
Stage 5 Sexual Maturity
b. Labia Majora
c. Labia Minora
Clitoris
Fourchet
d. Vestibule
Urinary Meatus
Skenes Gland
Hymen Vaginal Orifice
Bartholenes Gland
o Doderleins Bacillus

o Parumculae Mystiformes
e. Perenium
2. Internal
a. Vagina female organ for ovulation, passageway of menstruation,
__________________ long containing rugae
o Rugae
b. Uterus hollow muscular organ, varies in size, weight and shape, organ
of menstruation
Shape :
Weight :
Uterine involution
Non pregnant
:
Preganant
:
th
4 stage of Labor
:
2nd week after of Delivery :
3rd weeks after delivery
:
5 6 Weeks after delivery:
Parts of Uterus
Fundus
Corpus/ Body
Cervix
Isthmus

Muscular Composition: 3 main Muscles making possible expansion in all

direction
a. Endometrium
o Decidua
o Endometriosis
Ectopic Endometrium
Common site is ovaries
Proliferation of abnormal growth of lining of outer part
Persistent dysmenorrhea, low back pain
Dx Exam: biopsy,laparoscopy
Tx: Lupron (luprolide) inhibits FSH & LH
Tx: Danazol (Danacrine) DOC
Inhibits ovulation
stop menstruation
b. Myometrium
o Smooth muscles is considered to be ________________
(muscles of delivery, capable of closing) of the body
o Largest portion of the uterus
c. Peremetrium
c. Ovaries
2 female sex gland
Shape:__________________

Function:
d. Fallopian Tube
___________________ long that serves as a passageway of the
sperm from the uterus to the ampulla or the passageway of the
mature ovum or fertilized ovum from the ampulla to the uterus
4 significant segments
o ______________ most distal part, trumpet shape, has
fimbrae
o Ampulla
o ______________s site for sterilization, site for BTL
o Interstitial
b. Male Reproductive System
1. External
Penis
The male organ of _____________________
Contains of a body or shaft consisting of 3 cylindrical layers and
erectile tissues
o 2 ____________________
o 1 ____________________
At the tip is the most sensitive area comparable to clitoris =
________
Scrotum
Pouch hanging below the pendulous penis, with medial septum
deviding into 2 sacs each containing testes
Requires ________________ celcius for continuous spermatogenesis
Cooling mechanism of testes
2. Internal
The Process of Spermatogenesis

Male & female Homologues

Male
Female
Penile Glans
Penile Shaft
Testes
Prostate
Cowpers Glands
Scrotum
III.Basic Knowledge on Genetics and Obstetrics

1.
2.
3.
4.

DNA
Chromosomes
Normal amount of ejaculated sperm
Ovum is capable of being fertilized within _____________hours after
ovulation.

5.
6.

Sperm ___________ days viability

Reproductive cells divide by the process of ______________ (haploid
number)

_________________ process of maturation of sperm

_________________ process of maturation of ovum
o 30 weeks AOG 6 million immature ovum
o @ birth 1 million immature oocytes
o @ puberty 300 400 immature oocytes
o @ 13 y/o 300 400 mature oocytes
o @ 23 y/o 180 280 mature ovum
o @ 33 y/o 60 160 mature ovum
o @ 36 y/o 24 124 mature ovum
o @46 y/o 4 mature ovum
_______________ process of formation of two haploid into diploid
7.
Age of reproductivity ______________ childbearing age
_______________
High risk _____________ With Risk _____________
8.
Menstruation
Menstrual Cycle
Average menstrual cycle
Average menstrual period
Normal blood loss
Related terminologies
o _____________ 1st menstruation
o Dysmenorrhea
o _____________ bleeding in between menstruation
o Menorrhagia
o _____________ absence of menstruation
o Menopause
Tofu ________________ estrogen of plant that mimics the
estrogen with a woman
9.
Functions of Estrogen and Progestin
ESTROGEN _________________
o Primary function

o Other function
Hypertrophy of the myometrium
Spinnbarkeit and Ferning Pattern (Billings Method)

10.

Ductile structure of the breast

PROGESTERONE
o Primary function
o Secondary Function
o Others
Inhibit LH (hormone of ovulation) production
GI motility
Permeability of kidneys to lactose and dextrose causing + 1
sugar in urine
Menstrual Cycle
4 phases of menstrual cycle
1.
2.
3.
4.

1.
2.

3.

4.
5.

6.

On the initial phase of menstruation, the estrogen level is ___, this level
stimulates the hypothalamus to release ______________
GnRH/ FSHRF stimulates the anterior pituitary gland to release FSH

FSH Function
o
Stimulate ovaries to release estrogen
o
Facilitate the growth of primary follicle to
become
GRAAFIAN FOLLICE structure that secretes large
amount of estrogen that contain mature
ovum
Proliferative Phase (estrogen)
______________ responsible for the variation and irregularity of mense
______________ after menstruation
______________ happen before menstruation
13th day of menstruation, estrogen level is PEAK while progesterone is ,
these stimulates the hypothalamus to release GnRH/ LHRF
GnRH/ LHRF stimulates the Anterior Pituitary Gland to release LH
Functions of LH
o Stimulates the release of progesterone
o Hormone for ovulation
th
14 day estrogen level is while progesterone level is
S/S
o Rupture of the graafian follicle - OVULATION
o ______________ slight abdominal pain lower
right quadrant

15th day, after ovulation day, graafian follicle starts to degenerate, estrogen
level , progesterone , causing degeneration of the graafian follicle becoming
yellowinsh known as ______________ secretes large amount of progesterone
8.
Secretory Phase
Lutheal Phase
(progesterone)
Postovulatory phase
Premenstrual Phase
9.
24th day ______________ (whitish) corpus luteum degenerates and
becomes white
10.
28th day if no sperm united the ovum, the uterine begins to
______________to have the next menstruation
Note:
if there is no fertilization, corpus luteum continues functioning
Ovarian Cycle from primary follicle corpus albicans
Stages:
o ______________ menses
o ______________ proliferative
o ______________ secretory
o ______________ ischemic
7.

11.

Stages of Human Sexual Response

Initial Response:
VASOCONGESTION ______________
MYOTONIA ______________
Excitement Phase
muscle tension, moderate VS
______________s
______________
and sustained tension near orgasm
may last ______________
Orgasm
Involuntary release of sexual tension accompanied by
physiologic and psychologic release,
immeasurable peak of experience ______________
______________
Return to normal state
VS return to normal
REFRACTORY PERIOD ______________

IV.

Wonders of Fertilization
a. Fertilization
1. Phonones ______________
2. Capacitation ______________

b. Stages of Fetal Growth and Development

1. Pre Embryonic Stage
a. ______________ fertilized ovum (3 4 days travel, 4 days
floating)> from fertilization
b. ______________ mulberry-liked ball containing 16 50 cells
c. ______________ enlarging cell forming a cavity that later
becomes the embryo covered by thropoblast which later becomes
the placenta and membrane
d. ______________ 7 10 days after fertilization
Thropoblast covering of blastocyst that become placenta
S/Sx of Implantation Slight pain, Slight Vaginal
Spotting
3 Processes
o Apposition
o Adhesion
o Invasion
2. Embryonic Stage
______________ fertilization to 14 days
______________ 15th 2 mos/ 8 weeks
______________us 2 mos to birth
______________ thickened endometrium, latin word for falling
off
Basalis located directly under the fetus where placenta
developed
______________s encapsulates the fetus
Vera remaining portion of and endometrium
Chorionic Villi 10 11 weeks
______________ removal of tissue from the fetal postion of the
developing placenta
For genetic screening
Fetal limb defects, missing digits of toes
Cytothrophoblast outer layer, ______________, protect the
fetus against syphilis (24 weeks/ 6 months)
______________ syncitial layer responsible for hormone
production
Amnion ______________
Chorion- ______________
Umbilical cord (Funis) whitish gray (50 60 cm)
Short abruptio placenta, uterine inversion
Long cord prolapse, cord coil
______________
______________ protects the umbilical cord
Amniotic fluid bag of water clear color, musty/mousy odor

With crystallized forming pattern, slightly alkaline

______________

Oligohydramnios kidney malformation

Hydramnios GIT
Functions:

Diagnostic Test for Amniotic Fluid ______________s

Purpose: obtain sample of amniotic fluid by inserting a needle through the abdomen
into the amniotic sac
Fluid is tested for:
Genetic screening
Determination of fetal maturity primarily by evaluating factors indicative of
lung maturity
Done with empty bladder
Complication
> Most common side effect : ______________
> Late : pre term labor
> Early : spontaneous abortion
Indication for Amniocentesis:
> Early in Pregnancy Advance Maternal Age
> Later in Pregnancy Diabetic Mothers
Used to detect: ______________
L/S ratio : 2:1 (Lecitin/ Spingomyelin)
Color of Fluid Aspirated
o Greenish ______________)
o Yellowish ______________
o Cloudy ______________
o Most Important Consideration Needle
______________

______________ direct examination through intact fetal membrane via ultrasound

______________ a test determining if bag of water has rupture or not
______________ differentiate amniotic fluid and urine
o Blue geen + rupture of bag of H2O
3. Chorion outermost layer
a. Placenta AKA Secundines chorionic Villi and basalis
______________s in weight
______________8 cotyledons
______________ in diameter and 2 3 cm in depth
Functions
o Respiratory 02 CO2 exchange via simple
diffusion
o GIT glucose transport via facilitated diffusion

o Excretory via 2 arteries, carries

unoxygenated blood then detoxify by
maternal liver
o Circulatory fetoplacental circulation by
SELECTIVE OSMOSIS
o Endocrine
HCG ______________
Human Placental Lactogen
______________
Responsible for the development of
mammary gland
Diabetogenic Effect
______________
Relaxin ______________
o Serves as protective barrier against some
microorganism
Can pass: ______________
PINOCYTOSIS transport of virus
Pregnancy ______________
PHYSIOLOGIC ADAPTATION TO PREGNANCY
(Pre-partum Concepts)
Systemic Changes
1. Cardiovascular System
blood volume 30 50%

Physiologic Anemia/ pseudoanemia in pregnacy

o Normal Value
Hct : ______________
Hgb: ______________
o Criteria
1st & 3rd Trimester : Hct > 33% Hgb > 11 g/dl
2nd Trimester
: Hct > 32% Hgb > 10.5 g/dl
o Pathologic Anemia
Iron Defficiency Anemia is the most common hematologic
disorder. It affects 20% of pregnant women
Assesment reveals:
Pallor
Slowed capillary refill = Normal = 2 3 sec
______________ (late sign of progressive anemia)
______________ = chronic tissue hypoxia
constipation

Nursing care
Nutritional instruction
o Source of iron
Kangkong
Liver = ______________
Red and lean meat
Green Leafy Vegetables
Parenteral Iron (Imferon)
o Z tract IM
o incorrect causes hematoma
o best given 1 hour before meals (causes GI
irritation)
o Maybe given 2 hours after meal (results to poor
absorption)
Given with orange juice to absorption
Oral Iron Supplements (ferrous sulfate 0.3 g 3 x a day)=
______________
Monitor for hemorrhage
Alert
Iron from red meat is better absorbed iron from other
sources
Iron is better absorbed when taken with foods high in
______________ such as orange juice
Higher iron intake is recommended since circulating blood
volume is increased and heme is required from production
of RBCs

Edema
o Impeded venous return due to the gravid uterus
o Nursing Intervention
______________Elevate legs above the hips level
Varicosities
o Wear support stockings
o ______________s
Vulvar Varicosities
o D/t pressure of gravid uterus
o Side lying with pillow under the hips
o ______________position
Thrombophlebitis
o Presence of thrombus in inflamed blood vessels
o ______________ pain on the calf upon dorsiflexion
o Medical Management
Anticoagulant/ HEPARIN
Does not cross the placental barrier

Monitor APTT______________
PROTAMINE SULFATE
No aspirin
Milk Leg/ Plagmasia Alba Dolens
o Shiny white legs due to stretching of skin & hyperfibrinogenemia
o Nursing intervention
Check dorsalis pedis pulse (compare both)
Never massage
Assess for ______________

2. Respiratory System
Shortness of Breath d/t gravid uterus
Nursing intervention: Side-lying lateral expansion of the lungs
3. Gastrointestinal System
Nausea and vomiting
Morning Sickness
o Due to HCG levels
o Crackers 30 min before arising
o AM Carb diet 30 mins
o PM small frequent meal
Constipation
o Due to ______________ = fluid reabsorption due to GIT motility
o Nursing intervention
Fluid
Fiber
Exercise
Flatulence
o Due to increased progesterone
o ______________
Heartburn (pyrosis)
o Reflux of stomach content into esophagus
o Nursing Intervention
Small frequent meals
Sips of milk
Avoid fatty and spicy foods
Proper body mechanics
o Waist Above ______________
o Waist Below ______________
Hemorrhoids
o Due to gravid uterus
o ______________

Ptyalism
o salivation
o Mouthwashes to relieve
4. Urinary System
Normal = + 1 sugar due to Progesterone via ______________
First Trimester - Frequency
Second Trimester - normal
Third Trimester - Frequency
5. Muscoloskeletal
Calcium sources
o Milk - ______________y
o Cheese, Yogurt, Head of Fish, Sardines, Anchovies, Brocolli
Lordosis
o ______________
Waddling Gait
o Awkward gait while walking due to relaxin
o Prone to accidental falls
Wear low healed shoes
Leg Cramps
o ______________during pregnancy
o Lumbo-sacral nerves by pressure of gravid uterus during labor
o Over sex
o ______________ the foot affected
o ______________s
Local Chnages

Vagina
o
o

______________Sign bluish discoloration

Leukorrhea ______________

Cervix
o ______________ change in consistency of uterus
o Operculum ______________
Uterus
o ______________ change in consistency

1. Abdominal Changes
______________
o Due to destruction of the subcutaneous tissue by the enlarge uterus
2. Skin Changes
______________a

White light brown pigmentation related to melanocytes

______________
Brown pinkish line from symphysis pubis to umbilicus

3. Breast Changes
Due to hormonal changes
Change in color and size of nipple and areola
Precolostrum ______________
Colustrum ______________
______________
4. Ovaries rest period, no ovulation
5. Signs and Symptoms of Pregnancy
Presumptive
Probable
S/sx felt and observed by the Signs observed by
mother but does not confirm the members of the
the diagnosis of pregnancy health care team
First
trimester

Second
Trimester

Goodels sign
Chadwicks sign
Hegars sign
Elevated BBT
Positive HCG
Chloasma
Linea Nigra
Increase Skin Pigmentation
Striae gravidarum
Quickening

Placenta Grading System

Grade 0 ______________
Grade 1 ______________
Grade 2 ______________
Grade 3 ______________
What is deposited? ______________
VI. Psychological Adaptation to Pregnancy
First Trimester
No tangible s/sx
Feeling of surprise
Ambivalence
Denial of pregnancy maladaptation
Developmental Task: ______________

Positive
Undeniable signs confirmed
by the use of instrument
Ultrasound Evidence

Health Teaching: Body changes of pregnancy and Nutrition

Second Trimester
Tangible s/sx
Mother identifies fetus as separate entity due to quickening
Fantasy
Developmental Task: ______________
Health Teaching: Growth and development of fetus
Third Trimester
Mother has personally identifies with the appearance of the baby
Developmental Task: ______________
Health Teaching: responsible parenthood, prepare babys layette, Lamaze Class
Address Mothers fear let she hear the FHT
VII. Pre Natal Visit
Basic Consideration
1. Frequency of Visit
______________
______________
______________
2. Personal Data
______________ determines high risk pregnancy
______________ false pregnancy appearance of presumptive &
probable signs
______________ psycosomatic disorder, father experience what the mother
goes through
3. Diagnosis of Pregnancy
Urine Exam HCG 40 100th day; peak 60 70th day
ELISA beta subunits of HCG is detected as early as 7 10th day
RIA beta subunits of HCG is detected as early as 8th day
Home Pregnancy Kit
4. Baseline Data
Roll Over Test test of pre-eclampsia by the use of BP
Weight monitoring
Normal Weight Gain
1st Trimester = ______________
2nd Trimester = ______________
3rd Trimester = ______________
Minimum allowable weight gain ______________
Optimal weight gain ______________

5. Obstetrical Data
a. Gravida no. of pregnancy
b. Para no. of viable pregnancy
GTPALM
Viability ______________
c. Important Estimates
1. Nageles Rule
Use to determine expected date of delivery
______________
______________
2. McDonalds Rule
Determines age of gestation in weeks
______________
3. Bartholomews Rule
Determines age of gestations
o ______________ above pubis symphysis
o ______________ level of umbilicus
o ______________ below xiphoid process
o ______________ level of 8th mos
4. Haases Rule
Determines the length of fetus in cm.
1st half ______________
2nd half ______________5
d. Tetanus Immunization
TT1 ______________
TT2 ______________
TT3 ______________
TT4 ______________
TT5 ______________
5.
a.

Physical Examinations
Danger Signs of Pregnancy
Chills & Fever
Cerebral Disturbances
Abdominal Pain epigastric pain auro of impending convulsion

Boardlike Abdomen Abruptio placenta

Blurred Vission pre eclampsia
Bleeding
BP
Swelling
Scotoma ______________
Sudden gush of fluid ______________
6.

Pelvic Examination
Pelvic examination or IE ______________
1st visit Chadwicks, Goodles sign, etc.
Position : ______________
Pap smear done 1st visit
Cytological exam determine presence of cancer cells.
Result :
o Class I normal
o Class II A ______________y
B suggestive of inflammation
o Class III cytology suggestive of malignancy
o Class IV ______________
o Class V conclusive for malignancy
Most common cancer report organ : ______________r
Most common site for pap smear ______________
Common site of cervical cancer. maternal speculum (open)
Stages of cervical cancer
o 0 carcinoma in situ
o 1 Ca strictly confined to cervix
o 2 from cervix extends to the vagina
o 3 pelvic metastasis
o 4 affectation to bladder & rectum

7.

Leopolds Maneuver
Purpose: ______________
Procedure
1. 1st maneuver
o place patient in supine position with knees slightly flexed. Put towel under head
and right hip. With both hands palpate uppe4r abdomen and fundus. Assess size,
shape, movement and firmness of the part
o determine the presenting parts
2. 2nd maneuver
o with both hands moving down, identify the back of the fetus where the ball of the
stethoscope is placed to determine FHT.
o PR of mother : ______________ MHR
o ______________ FHR

3. 3rd maneuver
o using the right hand, grasp the symphysis pubis part using the thumb and fingers.
o Assess whether the presenting part is engaged in the pelvis.
o Alert! ______________
4. 4th maneuver
o the examiner changes the position by facing the patients feet. With two hands,
assess the descent of the presenting part by locating the cephalic prominence or
brow.
o When the brow is on the same side as the back, the head is extended. When the
brow is on the same side as the small parts, the head is flexed and vertex
presenting.
______________ relationship of fetus to one another.
______________ when the chin touches the chest
8.

Assessment of Fetal Well-being

a. Daily fetal Movement Counting (DFMC)
Done starting ______________
Consideration
fetal sleep wake pattern
maternal food intake
drug-nicotine use
environmental stimuli
maternal dose
______________ one method currently available
o begin at the same time each day (usually in the morning after breakfast )
and count each fetal movement, noting how long it takes to count 10 fetal
movements (FMs)
o expected findings 10 movements in 1hrs or less
o warning signs more than 10-12 movements in 1hr or less
more than 1hr to reach 10 movements
less than 10 movements in 12hrs
longer time to reach 10 FMs than on previous days.
movements are becoming weaker, less vigorous
movement alarm signal <3 FMs in 12hrs
o warning signs should be reported to healthcare provider immediately;
often require further testing. Eg. Non stress test (NST), biophysical profile
(BPP)
b. Nonstress Test
o to determine the response of the fetal heart rate to the stress to activity.
o Indications pregnancies at risk for
o placental insufficiency
o Postmaturity

o
o
o

pregnancy induced hypertension (PIH), diabetes

warning signs noted during DFMC
maternal history of smoking, inadequate nutrition
Procedure :
Done within 30mins wherein the mother is in semifowlers position;
external monitor is applied to document fetal activity; mother activates the
mark button on the electronic monitor when she feels fetal movement.
Attach external noninvasive fetal monitors
tocotransducer over fundus to detect uterine contractions and fetal
movements (FMs)
ultrasound transducer over abdominal site where most distinct fetal heart
sounds are detected
monitor until at least ______________.
if no FM after 40mins provide women with a light snack or gently stimulate fetus
through abdomen
If no FM after 1hr further testing may be indicated
Result :
Noncreative Nonstress ______________
Reactive Response is ______________
Interpretation of results
Reactive result real good
baseline FHR between traction beteen 120 and 160 beats per min.
at least two accelerations of the FHR of at least 15 beats per min.,
lasting at least 15secs in a 10 to 20 min period as a result of FM
good variability normal irregularity of cardiac rhythm representing
a balanced interaction between the parasympathetic ( FHR) and
sympathetic ( FHR) nervous system; noted as an uneven line on the
rhythm strip
result indicates a healthy fetus with an intact nervous system
o Nonreactive result not good
stated criteria for a reative result are not met
could be indicative of a compromised fetus requires further
evaluation with another NST, biophysical profile, (BPP) or
contraction stress test (CST)

9. Health Teachings
o do nutritional assessment
o daily food intake
o determine habit
o if folic acid ______________
o HIGH RISK MOTHERS
pregnant teenagers poor compliance to health regimen
extremes in wt underwt eg. Elite models overwt eg. DM/HPN

low social economic status. Refer to OSWD

vegetarian mothers because intake of vit B12 (Cyanocobalamin)
formation of folic acid (cell DNA & RNA formation)
types :
strict vegetarian prone to develop anemia
lacto vegetarian milk
lacto-ovo vegetarian milk & egg

a. Recommended Nutrient Requirement that Increases During Pregnancy

Nutrients
Requirements
Food sources
Calories
Essential to supply energy for
Caloric should reflect
foods of high nutrient value
metabolic rate
such as protein, complex
Utilization of nutrients
carbohydrates (whole grains,
Protein sparing so it can be
vegetables, fruits)
used for :
variety of foods
growth of fetus
representing food sources for
o development of
the nutrients required during
structures requires for
pregnancy
pregnancy including
no more than 30% fat
placenta, amniotic fluid,
tissue growth
Na 3gms/day eat in
moderation
CHON ______________
Non pregnant: ______________ CHO ______________
Pregnant: ______________
Fats ______________
lactation=______________
Protein
Essential for
Protein should reflect
Lean meat, poultry, fish
fetal tissue growth
Eggs, cheese, milk
maternal tissue growth
D
ried beans, lentils, nuts
including uterus and breasts.
Whole grains
Development of essential
pregnancy structures
Vegetarians must take note of
Formation of RBC and
the amino acid content of
plasma proteins
CHON foods consumed to
ensure ingestion of sufficient
Inadequate protein intake has
quantities of all amino acids
been associated with onset of
pregnancy induced hypertension
(PIH)
Calcium-Phosphorous
Essential for
Calcium of
Growth and development of 1200mg/day representing an

fetal skeleton and tooth buds

Maintenance of

mineralization of maternal
bones and teeth
Current research is

demonstrating an association
between adequate calcium
intake and the prevention of
pregnancy induced
hypertension

Iron
Essential for
Expansion of blood volume &
RBC formation
Establishment of fetal iron
stores for first few months of life

of 50% above pre pregnancy

daily requirement
1600mg/day is recommended
for adolescent
10mcg/day of vitamin D is
required since it enhances
absorption of both calcium
and phosphorous

Iron should reflect

liver, red meat, fish,
poultry, eggs
enriched, whole grain
cereals & breads
dark green leafy vegetables,
legumes
nuts, dries fruits
vitamin C sources: citrus
fruits & juices,
strawberries, cantaloupe,
tomatoes, green peppers,
broccoli or cabbage,
potatoes
iron form food sources is
more readily absorbed
when served with foods
high in vit C

Zinc
Essential for
the formation of enzymes
maybe be important in the
prevention of congenital
malformation of the fetus
Folic acids, folacin, folate
Essential for
Formation of RBC &
prevention of anemia
DNA synthesis & cell
formation; may play a role in
the prevention of neural tube
defects (spina bifida),
abortion, abruption placenta
Additional requirements
Minerals
Iodine
Magnesium
selenium

Vitamins
E
Thiamine
Riboflavin
Pyridoxine (B6)
B12
Niacin

Zinc should reflect

liver, meats
s hell fish
grains, legumes, nuts

400mcg/day representing an of
more than 2x the daily
prepregnant requirement
300mcg/day supplement for
women with low folate levels or
dietary deficiency

requirements of pregnancy
can easily be met with a
balanced diet that meets the
requirement for calories and
includes food sources high in
the other nutrients needed
during pregnancy
10mg/day
1.5mg/day
1.6mg/day
2.2mg/day
2.2mcg/day
17mg/day

b. Sexual Activity
Principles of sex in Pregnancy
o Should be done in moderation
o Should be done in a private place
o That the mother should be placed in a comfortable position
o It must be avoided ______________
o Avoid blowing of air during cunnilingus
Contraindication in sex:
o vaginal spotting ______________
o incompetent cervix ______________
o placenta previa, abruption placenta ______________
o pre-term labor : ______________
o PROM ______________

 Changes in sexual appetite during pregnancy:

o 1st tri - ______________
o 2nd tri - ______________
o 3rd tri - ______________
c. Exercise
strengthen muscle to be used during the delivery process
______________ best form of exercise
Squatting ______________
Tailor sitting same purpose with squatting
______________ strengthen pubococcygeal muscle
Abdominal exercise muscle of the abdomen ( done as if blowing a candle)
Shoulder circling exercise strengthen muscle of the chest
______________ relieve low back pain & maintain good posture (arching back for 3 sec)
Principles of exercise
o must be done in moderation
o must be individualized
d. Childbirth Preparation
Overall goal: To prepare patents physically & psychologically while promoting wellness
behavior that can be used by parents & family thus, helping them achieved a satisfying &
enjoying childbirth experiences.

Psychological
o ______________ Dr. Robert Bradley discoverer
advocated active participation of husband during labor & delivery to serve
as coach, based on imitation of nature
Features:
darkened room
quiet & calm environment
relaxation technique
close eyes
o ______________
fear can lead to tension while tension can lead to pain. (break cycle by
removing the fear-by abdominal breathing exercises & relaxation
technique)
Psychosexual
o ______________ Dr. Shiella Kitzinger
pregnancy, labor & birth & the care of the newborn is an important turning
point in a womans life cycle. flowing with contractions rather than
struggle with contractions
Psychoprophylaxis

o ______________ Dr. Ferdinand Lamaze

Prevention of pain thru mind & requires discipline, conditioning &
concentration with the husbands help.
Features:
conscious relaxation
cleansing breathe inhaling thru nose & exhaling thru mouth
effleurage gentle circular massage
over abdomen to relieve pain
imaging
Different methods of delivery
o birthing chain ______________
o bathing bed ______________
o squatting ______________
o Leboyers method
features :
darkly lighted room
quiet & calm environment
room temp.
soft music
o Birth under water

IX. INTRAPARTAL NOTES

A. Admitting the laboring Mother
Personal data
Baseline data
Obstetrical data
Physical exams
Pelvic exams
B. Basic knowledge in intrapartum
Theories of the Onset of Labor
o Uterine Stretch Theory ______________
o Oxytocin Theory ______________
o Prostaglandin Theory ______________
o Aging Placenta ______________
o Progesterone deprivation theory - ______________
The Ps of Labor
o Passenger fetus
fetal head
is the largest presenting part
of its length
Bones 6 bones (sphenoid, temporal, ethmoid) Frontal, occipital
& 2 parietal bones

______________ allows molding

______________ the overlapping of the sutures of the skull to
permit passage of the head to the pelvis
o ______________ connect to parietal bones
o ______________ connect to parietal & frontal bones
o ______________ connect to parietal & occipital bones
Fontanels
o 6 fontanels only 2 palpable
anterior fontanel/Bregma
diamond in shape
3cm x 4cm size
close 12-18 mos post delivery
5cm hydrocephalus
posterior fontanel/lambda
triangular in shape
1 x 1cm size
close 2-3mos post delivery
Measurements of fetal head :
o transverse diameter
______________- largest transverse diameter9.25cm
______________- 8cm
______________- smallest transverse diameter 7cm
o AP diameter
______________ complete flexion
______________ partial flexion - 12cm
______________ largest AP diameter;
hyperextended (13.5cm)
______________ - face presentation; poor flexio
o Passageway vagina & pelvis
Pelvis
4 main pelvic types
o ______________ round, wide, deeper, most suitable for
pregnancy
o ______________ heart shape male pelvis anterior
pointed post part shallow
o ______________ oval ape-like pelvis AP wider
transverse ______________Platypelloid flat transverse
oval AP narrow transverse wider c/s for delivery
Problem :
o mother who encounter accident
o 49

o Power

o 18y/o R: pelvis not achieve its full pelvic growth

Bones of pelvis
4bones
o 2 hips (2 innominate bones)
3parts of 2 innominate bones
______________ lateral/side of hips
o Iliac crest flaring superior border
that forms prominence of hips;
common site for bone marrow
aspiration
______________m inferior portion
o Ischial tuberosities of the area where
we
o Sit; basis in getting external
measurement of pelvis
______________ anterior portion
o Symphysis pubis junction in
between
o ______________ posterior portion
Sacral prominence basis internal measurement of
pelvis
o ______________- 4 small bones that compresses during
vaginal delivery
universal precaution in measurement of pelvis is to empty bladder
first
Important Measurements
o ______________
measure between Sacral promontory & inferior
margin of the symphysis pubis
Measurement ______________
Basis in getting the true conjugate.
o ______________
Measure between the anterior surface of the sacral
promontory & superior margin of the symphysis
pubis.
Measurement: ______________
Diagonal conjugate: 1.5 cm = true conjugate.
o ______________
smallest AP diameter of the pelvis measuring 10cm
or more.
o ______________
transverse diameter of the pelvic outlet.
Approx by a fist- 8cm & above.

the forces acting to expel the fetus & placenta

involuntary contractions
voluntary bearing down efforts
characteristics: wave like
timing: frequency, duration, intensity
______________ power of labor
o Psyche/person
psychological stress exist when the mother is fighting the labor
experience.
cultural interpretation preparation
past experience
support system
Pre-eminent signs of labor
o Preeminent Signs
______________
settling of the presenting part into the pelvis brim (shooting pain
radiating to the legs, urinary frequency)
primi- early 2 weeks prior to EDD
engagement settling of presenting part into pelvic inlet (not signs
of labor)
______________ painless irregular contractions
______________ Nesting
Instinct (mgt: save energy)
epinephrine production (hormone that the activity of the mother)
______________x butter softness
______________ 1.5-3 lbs.
Bloody show
pinkish vaginal discharge (blood + leucorrhea + operculum = pink
in color)
Rupture of membranes
check ______________
IE check for cord prolapse
after several hrs check temp.
o Premature Rupture of Membranes (PROM)
contraction drop in intensity even though very painful
contraction drop in frequency
uterus tense &/or contracting between contractions
abdominal palpitations
Nursing Care:
administer analgesics (morphine)
bear down with contractions
adequate hydration

sedation as ordered
cesarean delivery may be required, especially if fetal distress is
noted
o Cord Prolapse
a complication when the umbilical cord falls or is washed through the
cervix into the vagina.
Danger Signs:
PROM
Presenting part has not yet engaged
Fetal distress
Protruding cord from vagina cerebral palsy 5 mins.,
irreversible brain damage mgt: CS
Nursing Care
Positioning ______________, place wet sterile gauze R: to make
it slippery
Observe for fetal distress
Provide emotional support
Prepare for cesarean section

Difference Between True and False Contraction

False
True
No in intensity
Pain confined in the abdomen
Pain is relieved by walking
No cervical changes

Duration of Labor
o Primipara ______________
o Multipara ______________
Nursing Interventions in Each Stage of Labor
o First Stage: ______________
o stage of effacement & dilatation
Latent Phase:
Assessment:
o Dilatations ______________
o Frequency ______________
o Duration ______________
o Intensity mild
o Mother is excited, apprehensive but can communicate
Nursing Care:
o Encourage walking : shortens 1st stage of labor

o Encourage to void q ______________3 hrs : full bladder

inhibits uterine contraction
o breathing (chest breathing technique)
Active Phase:
Assessment:
o Dilatations ______________8 cm
o Frequency q 3-5 mins lasting for 30-60 secs
o Duration ______________
o Intensity moderate
Nursing Care:
o M edications have meds ready
o A ssessment include: v/s, cervical dilatation &
effacement, fetal monitor, etc
o D ry lips oral care (ointment), dry linens
o Breathing ______________
Transitional Phase:
Assessment:
o Dilatations ______________
o Frequency ______________
o Duration ______________
o Intensity strong
o Mood of mother suddenly change accompanied by
hyperesthesia (hypersensitivity of mother to touch) of the
skin
Management
o sacral pressure, cold compress
Nursing care:
o T ______________
o I ______________
o R ______________
o E ______________
o D ______________
o Pelvic Exams
Effacement & Dilatation
Station relationship of the presenting part to the ischial spine
o 5 - -1 = the presenting part is above the ischial spine
o Engagement 10 = ______________
o (-)______________
o (+)______________
Presentation
o the relationship of the long axis of the fetus to the long axis
of the mother.

o spine relationship of the spine of the mother & the spine of

the fetus
o Two Types
Longitudinal Lie (Parallel)/ Vertical
______________ when the fetus is
completely flexed
o Vertex
o Face
o Brow
o Chin
______________
o Complete breech thigh rest on
abdomen while legs rest on thigh
o Incomplete breech
Frank thigh resting on
abdomen while legs extend to
the head
Footling
Kneeling
Transverse Lie (Perpendicular)/Horizontal lie
Position relationship of the fetal
presenting part to specific quadrant of the
mothers pelvis.
o ______________
left occipito anterior
most common & favorable
position
o ______________ left occipito
transverse
o ROP/LOP left occipito posterior
o L/R- side of maternal pelvis
o Middle presenting part
o ROP/ROT most common
malposition
o ______________ most painful
mgt: pelvis squatting
o Breech sacro
place the stethoscope above
the umbilicus
o ______________ mentum
o Shoulder acromnio dorso

Monitoring the contractions & fetal heart tone

spread the finger lightly over the fundus to monitor the contraction
______________- beginning of contraction until it increases
______________ height of contraction
Decrement/Decresendro from height of contraction until it
decreases
______________ beginning of contraction to the end of the same
contraction
Interval from end of contraction to the beginning of the next
contraction
______________ from the beginning of 1 contraction to the
beginning of next contraction
Intensity strength of contraction
if contract blood vessel constricts; the fetus will get the oxygen
on the placenta reserve which is capable of giving oxygen to the
fetus up to 1min.
Duration of placenta to the fetus should not exceed 1min.
Significance During active phase, if to 1min should notify the
AMD
BP; FHT : best time to get BO & FHT just after a contraction

NURSING CONSIDERATION DURING THE FIRST STAGE OF LABOR

Bath is necessary
Monitor VS especially BP
o Same BP = rest
o Elevated = notify the physician
NPO
o Prevent aspiration chemical pneuminitis
Enema (per hospital policy)
o Purpose
Cleanse the bowel
Prevent infection
o 12 18 inches normal length of tube
o 18 inches optimal length
o Lateral sims position
o If there is contraction clump the tube
o If there is resistance slowly remove
o Before and after administration: check FHT (120 160) and contractions
Encourage mother to void
Rest on left side lying position
o Prevent supine vena cava syndrome or supine hypotension
If membrane doesnt rupture amniotomy

 FETAL TRASHING - hyperactivity of fetus due to lack of Oxygen

For Pain
o Systemic analgesic
DEMEROL (Meperidine HCl)
Narcotic and antispasmonic
Dont give during latent phase
Given @ 6-8 cm dilated
WOF : Respiratory depression
Narcan (Naloxone, nalorfan, nalline)
o Antidote for toxicity
o Injected on the baby
Epidural Anesthesia
WOF : Hypotension
Prehydrate the client to prevent hypotension
In case of Hypotension
o Elevate leg
o Fast Drip IV

SECOND STAGE OF LABOR (FETAL STAGE)

Complete dilatation and effacement to birth
Crowning occurs
PRIMI transfer to DR @ ______________
MULTI transfer to DR @ ______________
Position in lithotomy both legs at the same time
______________ surest sign of delivery initiation
PANT & BLOW Breathing, fetal pushing should be done on an open glottis
Respiratory alkalosis
o Due to incorrect breathing
o Hyperventilation
o S/sx
RR
Lightheadedness
Tingling sensation
Carpopedal spasm
Circumoral numbness

Episiotomy
Prevent laceration
Widen the vaginal canal
Shortens the 2nd stage of labor

 2 types
o ______________
Less bleeding
Less pain
Easy repair
Possible ______________a major disadvantage
o ______________
More bleeding
More pain
Hard to repair and slow healing
Ironing the Perenium prevent laceration
Mechanism of Labor (ED FIRE ERE)
E______________
D______________
F______________
I______________
E______________
E______________
E______________

PELVIS
3 Parts
o Inlet ______________
o Cavity between inner and outer
o Outlet ______________
Nursing Care
MODIFIED RIGENS MANEUVER
o Done by supporting the perenium with a towel during delivery
o Facilitates complete flexion
o Avoids laceration
First intervention: ______________
Do not milk the cord, wait for pulsation to stop before cutting
o Milking may cause too much blood going to the baby that may cause cardiac
overload
When there is still birth, let the mother see the baby to accept the finality of death
THIRD STAGE OF LABOR (PLACENTAL STAGE)
3 10 minutes after child birth

 1st sign Fundus rises ______________

Signs of Placental Separation
o Fundus becomes globular and rises ______________
o Lengthening of the cord
o Sudden gush of blood
BRANT ANDREWS MANEUVER
o slowly pulling the cord and wind at the clamp
o rapidly ______________
Types Placental Delivery
SHULTZ ______________
o From center to the edges
o Presenting fetal side
DUNCAN ______________
o Form edges to center
o Presenting the maternal side
Nursing Considerations during placental delivery
Check placental completeness
o Should be 500 g
Check Fundus ______________
BP Check
Methergine, methylergonovine mallate (IM)
Oxytocin (IV) if methergine is not present
Check perenium for lacerations
Assist in episioraphy
Vaginoplasty/ Vaginal Landscape
FOURT STAGE OF LABOR (Recovery Stage)
First ______________hours after delivery of placenta
Maternal observation body system stabilize
o 1st hour q15 min 2nd hour - q 30 min
Placement of fundus
o In between umbilicus and pubis symphysis
o Check bladder, assist in voiding, May lead to ______________ hemorrhage
Lochia
Perineum
o Check REEDA
R ______________
E ______________
E ______________
D ______________
A ______________

o Fully saturated ______________

o Weighing ______________n

Nursing Consideration during Recovery

Flat on bed to prevent dizziness
If with Chills give blanket due to dehydration
Give nourishment (progression of meal)
o Clear liquids gatorade, ginger juice, gelatins
o Full liquid milk, ice cream
o Soft diet
o Regular diet
Check VS/ Pain
Pychic State
______________ interaction between mother and newborn
o Strict 24 hours with mother
o Partial morning with mother, night nursery

POSTPARTAL PERIOD
Puerperium ______________
Involution - ______________
Return to Normal Healing
Physiologic Changes
Systemic Changes
Cardiovascular System
o plasma volume
o sudden in blood volume
o elevated WBCs up to 30, 000 mm3
o hyperfibrinogenemia
o orthostatic hypertension can be possible
o early ambulation prevents thrombos formation
steps in ambulation
Flat
Semifowlers
Fowlers with dangling
Walk with assist
Genital Tract

o Fundus
goes down 1 finger breadth a day
______________ non palpable behind the symphysis pubis
Subinvolution
delayed healing of uterus containing quarters or clots of blood
may lead to puerperal sepsis
Management : D&C
o After Pains
After birth pains
Multiparous breastfeeding most common to develop
Position = prone
Cold compress
Mefenamic acid
o Lochia
Components
Blood
Deciduas
WBC
Microorg
3 types
______________ 1 3 days, musty, moderate amount
Serosa ______________
______________ 10 21th day, crme white, amount
Urinary Tract
o Urinary Frequency ______________
o Dysuria
Damage to trigone of the bladder
Urine collection for culture and sensitivity
Stimulate navel to urinate
Palpate bladder
Running water listening
Pull pubic hair - stimulate cremasteric reflex
Colon
o Constipation
Due to ______________
Bearing down may cause pain
Perenium
o Pain relieved by sims position
o Cold compress ______________if there is pain at episioraphy followed by warm

EMOTIONAL SUPPORT
1. ______________
1st 3 days
dependent phase
passive, cant make decision
tells about childbirth experience
focus on: Hygiene
2. ______________
4 7th day
dependent to independent phase
active, decides actively
focus: care of newborn
health teaching : Family planning
3. ______________
Interdependent phase
Redefines goals, new roles as parents
May extend till the child grows

Post Partum Blues

4th 5th days
overwhelming feeling of ______________
50 80% incidence rate
cause by sudden hormaonal change progesterone suddenly decreases
allow crying: therapeutic
may lead to postpartum psychosis/ depression
FAMILY PLANNING METHOD
Guiding Principles
1. determine your own beliefs first
2. never advise a permanent method of family planning
3. informed concent
4. the method is an individual decision
Natural Method ______________
Billings/ Cervical Mucus/ Spinnbarkeit
clear watery & stretchable
______________ longest due to estrogen

Basal Body Temp in the morning before arising/ 13th 14th day due to peak of
______________
LAM Lactational Amenorrhea Method
prolactin inhibits ovulation
breastfeeding ______________
bottle fed 2 3 months
Sympthothermal combination of Billings and BBT most effective method

Social Methods
Coitus Interuptus
______________
least effective method
Coitus Reservatus
______________
Coitus interfemora
______________
Calendar Method
14 days before menstrual cycle ovulation day (regular)
______________days unsafe period
Origoknause Formula ( irregular menstrual cycle)
get the longest and shortest cycle
subtract 18 to shortest
11 to the longest
the difference is the unsafe period

PILLS
combined oral contraceptives preventovulation by inhibiting the anterior pituitary gland
roduction of FSH and LH which are essential for he maturation and rupture of a follicle.
Estrogen inhibit FSH which is responsible in the mturation of ovum. Progesterone inhibit
LH which is responsible for ovulation.
contains estrogen that inhibits FSH and progesterone that inhibit LH
______________effective
21 day feel on the 5th day of mense start taking
28 day 1st day of mense
if forgotten, take 2 tablets the following day
adverse effect : ______________g
if mother wants to get pregnant
o wait 3 monts
o another 3 months if unsuucessful before consulting gyne
contraindications

o chain smoking
o Hypertension
o DM
o Extreme obesity
o Thrombophlebitis
Side effects (ressembles Hypertension)/ Immediate Discontinuation
o Abdominal paon
o Chest pain
o Headache
o Eye problem
o Severe leg cramp
Alerts on oral contraceptives :
o In case a Mother who is taking an oral contraceptive for almost a long time and
plans to have a baby, she would wait for at least 3mos before attempting to
conceive to provide time for estrogen and progesterone levels to return to normal.
If after 6months the mother did not get pregnant, consult AMD.
o If a new oral contraceptive is prescribed, the mother should continue taking the
previously prescribed contraceptive and begin taking the new one on the first day
of the next menses.
o Discontinue oral contraceptive if there is signs of severe headache as this are an
indication of hypertension associated with increase incidence of CVA and
subarachnoid hemorrhage.
o If forget to drink pill for 1 day, take 2 pills the next day. If forget to drink pills for
2days, stop the pill and wait for the next mens.
Adverse reaction : breakthrough bleeding

DMPA Depoprovera
Contains progesterone
Depomedroxy progesterone Acetate
IM q 3 months ______________ may decrease effectiveness
NORPLANT
6 match stick like capsules/ rod
contain progesterone
sub Q planted
good for ______________
Mechanical Device
IUD
prevent implantation
alters mobility of sperm and ovum

99.7% effective
best inserted after delivery and during menstruation
Common complication ______________
Common problem EXPULSION OF THE DEVICE
No protection against STD
Side effects include
o Uterine infection
o Uterine perforation
o Ectopic pregnacy
Major indication for the use is PARITY
HT: ______________

CONDOM
Made up of latex
Put in ______________ penis or lubricated vagina
Prevents sperm to enter the uterus
FEMALE CONDOM ______________e
DIAPRAGHM
Dome shaped rubberied material inserted at the cervix to prevent sperm getting inside the
uterus
Reusable
HT : Proper hygiene
o Check for holes
o Must be refitted in case of weight gain of 15 lbs - - board question
o Kept in place for about ______________Hours Board question
Contraindicated to
o ______________
CERVICAL CAP
More durable than the diaphram
Could stay on place for more than ______________ hours
No need to apply spermicides
Contraindicated to abnormal papsmear
CHEMICAL
SPERMICIDES
FOAMS most effective
Jellies
Creams
These may cause ______________

SURGICAL METHOD
Bilateral tubal Ligation
o @ isthmus
o ______________ probability of reversal
Vasectomy
o Vas deferens is cut
o More than ______________sperm count before it could be consider safe sex

Trust in the Lord with all your Heart and lean not on your own understanding,. Acknowledge
Him in all your ways and he shall make your path straight.
Proverbs 3:5-6