Ø 4-6mm

MATERNAL AND CHILD HEALTH: Ø 0.4g.

 Gametogenesis : Process in which germ 4 week Ø Noticeable limb buds
cells are produced (ovum and sperm). Ø Tubular heart is
 Meiosis : Cell division 46=23. XX beating
(FEMALE)-XY(MALE) Ø 3cm
 Menstrual cycle of 28 days, ovulation is at Ø 2gm
14th Ø Clearly resembles a
 Menstrual cycle of 34days, ovulation is at human being
20th day. 8 week Ø Eyelids begins to fuse
 Conception occurs outer one third of Ø Circulatory system
fallopian tube. through umbilical cord is
 Zygote –fertilized ovum well established
 Zygote changes through a process =
cleavage-morula-blastomere-blastocyst. Ø 8cm(3.2inch)
 Pre embryo-first 2 week Ø 45g
 Embryo-3 week to 8 week Ø Face well formed
 Fetus –until birth. 12 week Ø Limbs long and
 Embryonic membranes –amnion and slender
chorion formed at time of implantation. Ø Kidneys begins to
 Amniotic fluid volume -500 to 1000ml after form urine
20 weeks of gestation . it is alkaline. It is Ø 14cm
constantly replaced. Ø 200g
 Fetus swallow 400-500ml of amniotic fluid Ø Active movements
per day. present
 Amniotic fluid contains albumin, bilirubin Ø Fetal skin appears
,creatinine, fat enzymes,sphingomycin, 16week
transparent
epithelial cells , lecithin. Ø Skeletal ossification
 Couvades: Father may suffer physiological Ø Lanugo hair develops
symptoms with mother like nausea, Ø Sex of fetus can be
vomiting and fatigue. determined visually.
 Nulligravida : A women who has never been Ø 19cm
pregnant. Ø 465g
 Primigravida – pregnancy for first time Ø Lanugo covers entire
 Multigravida- In at least her 2nd pregnancy body
 Parity : number of births past 20 weeks Ø Skin less transparent
gestation. Ø Has nails on fingers,
 Obstertrical history –GTPAL method 20 week toes
G-Gravida Ø muscles well
T-Term birth (38-42weeks) developed
P- Preterm birth Ø Heart beat can be
A-Abortion detected by fetoscope
L-Living children. Ø Women can feel baby
FETAL DEVELOPMENT: more.
WEEKS CHANGES Ø 28cm
1st week Free floaty blastocyst Ø 780 gm
Ø 2mm crown to rump Ø Hair on head well
2-3 Ø Groove is formed 24week formed
week Ø Beginning of blood Ø Skin covering body is
circulation ,tubular heart reddish and wrinkled
Ø Reflex hand grasp
 Ø Vernix caseosa covers  It has 2 surfaces-maternal and fetal surfaces.
entire body  Placenta produce 4 hormones
1. Progesterone – decreases uterine
contractility
2. Estrogen or estriol- stimulate uterine
contraction
Ø 30cm 3. Human placental lactogen (HPL)
Ø 1200g 4. Human chorionic gonadotrophin(HCG)
Ø Limbs well flexed
Ø Brain develops rapidly
28 week
Ø Eyelids open and close
Ø Lungs still,
Physiologically immature
Ø Eyes reopen
Ø 38cm
Ø 2000g
Ø Bones are fully
developed, but are soft
and flexible.
32 week
Ø Lungs are not fully
mature Umbilical cord:
Ø Fetud begins storing  2 artery and one vein
iron , calcium and  It contains wharton’s jelly
phosphorous.  50-55cm length
Ø 42-48cm  Umbilical cord attaches to center of fetal
Ø 2500g side of placenta.
Ø Body and extremities Note : Battledone insertion: umbilical cord attaches
are filling out to edge of placenta.
Ø Fetus looks less
36 week
wrinkled
Ø Nails reach end of
finger tips
Ø Vernix continues to
cover most of body.
Ø 48-52cm
Ø 3000-3600g
Ø Skin is pinkish and
smooth
Ø Lanugo presentation
on upper arms and
40 week
shoulders
Ø Vernix caseosa Fetal circulation:
increases and folds of 1. Umbilical vein- carry oxygen and nutrients
skin to fetus
Ø Finger nails extends 2. Umbilical arteries-carry deoxygenated blood
beyond finger tips. and waste products from fetus
3. Ductus venosus- shunts umbilical vein to the
Placental development: inferior venacava , by passing liver and
 Begins at 3 week
organs of digestion.
 Fully formed and functioning at 3 months of
4. Foramen ovale-shunts blood from right atria
gestation to left atria , by passing ventricles and lungs.
 40 weeks-placenta have 15-20 cotyledons.
 5. Ductus arteriosus-shunts blood from
pulmonary artery to aorta, by passing lung
Pregnancy :
Fundal height :
 During the second and third trimesters
(weeks 18 to 30), fundal height in
centimeters approximately equals the fetus’
age in weeks ± 2 cm.
 At 16 weeks, the fundus can be located
halfway between the symphysis pubis and
the umbilicus.
 At 20 to 22 weeks, the fundus is at the
umbilicus, and at 36 weeks the fundus is at
the xiphoid process.
Pregnancy signs and symptoms:
1. Subjective /presumptive signs:
 Amenorrhea
 Nausea and vomiting
 Urinary frequency
 Breast tenderness
2. Objective /probable signs:
 Uterine enlargement
 hegar’s sign (softening and thinning of the
lower uterine segment that occurs at about
week 6
 goodell’s sign (softening of the cervix that
occurs due to increased vasularization at the
beginning of the second month). This
softening also causes easy flexion of uterus
against cervix(Mc Donald’s sign).
 chadwick’s sign (bluish or purple coloration
of the mucous membranes of the cervix,
vagina, and vulva due to increased
vasularization, that occurs at about week 6)
 ballottement (rebounding of the fetus against
the examiner’s fingers on palpation)
 braxton hicks contractions( irregular
contractions)
 positive pregnancy test for the presence of
human chorionic gonadotropin (hcg).
 Pigmentation of skin
 Abdominal stria etc
 Linea nigra: dark line pigmentation from
umbilicus to pubis.
 Chloasma : mask of pregnancy ,
pigmentation over forhead , cheek and nose.
 Montgomerys tubercle : over the areola of
breast ,darkening of the areolas, the skin
around the nipples. The bumps on areolas
(called Montgomery’s tubercles) may look
more prominent.
 Striae –reddish ,purple stretch mark around
abdomen called gravidarum, whitish stretch
mark called albicans.
 Recommended weight gain during
pregnancy =25-35Ib(pound)
.(1Ib=0.453592kg)
Tests during pregnancy:
Non stress test(NST):
 It is done last 8 week of pregnancy
 A reactive non stress test is a normal result.
 To be considered reactive, the baseline fetal
heart rate must be within normal range (120
to 160 beats/min) with good long-term
variability.
 In addition, two or more fetal heart rate
accelerations of at least 15 beats/min must
occur, each with a duration of at least 15
seconds, in a 20-minute interval.
 Non reactive test: accelerations are not
present.
Contraction stress test:
 Contraction stress test results may be
interpreted as negative (normal), positive
(abnormal), or equivocal.
 A negative test result indicates that no late
decelerations occurred in the fetal heart rate,
although the fetus was stressed by three
contractions of at least 40 seconds’ duration
in a 10-minute period.
Doppler blood flow (umbilical velocimetry):
 To interpret the wave forms
  (S)-Systolic peak
 D-End diastolic
 Normal systolic to diastolic ratio (S/D)=2.8
at 20 week and 2.2 at term.
 If ration is above 3.0 , it is abnormal , due to
decreased uteroplacental perfusion).
Bio physical profile:
5 variables:
1. Fetal breathing movement
2. Fetal body movement or limbs
3. Amniotic fluid volume
4. Reactive FHR
Each variable score 0,1,2 .
Maximum score is 10.
Oxytocin challenge test
(OCT): Contraction pattern of 3 contractions with
duration of at least 40 seconds in 10 minutes.
Premonitory signs of labor:
 Lightening occurs as fetus settles or
descends into pelvic inlet.
 Braxton Hicks contractions increased in
frequency and may become uncomfortable.
 Softening of cervix (ripening).
 Bloody show-pink tinged mucus
 Rupture of amniotic membranes
 Experience sudden burst of energy
 Some women experience diarrhea.
‘Kick’ counts measurement:
 The client should sit or lie quietly on her
side to perform kick counts.
 Lying flat on the back is not necessary to
perform this procedure, can cause
discomfort, and presents a risk of vena cava
(hypotensive) syndrome.
 The client is instructed to place her hands on
the largest part of the abdomen and
concentrate on the fetal movements.
 The client records the number of movements
felt during a specified time period.
 The client needs to notify the physician or
nurse-midwife if there are fewer than 10
kicks in a 12-hour period or as instructed by
the physician or nurse-midwife.
Fetal heart rate monitoring by Doppler:
 The nurse should simultaneously palpate the
maternal radial or carotid pulse and
auscultate the fetal heart rate (FHR) to
differentiate the two.
 If the fetal and maternal heart rates are
similar, the nurse may mistake the maternal
heart rate for the FHR.
 Noting whether the heart rate is more than
140 beats/min or placing the diaphragm of
the Doppler on the mother’s abdomen will
not ensure accuracy in obtaining the FHR.
 Leopold’s maneuver may help the examiner
locate the position of the fetus but will not
ensure a distinction between the two heart
rates.
Issues in pregnancy :
1. Pica :Pica cravings often lead to iron
deficiency anemia, resulting in a lowered
hemoglobin level
2. Heart burn management:
 Lying down is likely to lead to reflux of
stomach contents, especially immediately
following a meal.
 The client should be instructed to avoid
spices, along with salt, because spices will
trigger heartburn. Salt will produce edema.
 The client should be encouraged to eat
between-meal snacks and should be
instructed that to control heartburn, eating
smaller, more frequent portions is preferred
over eating three large meals.
 The client also should limit or avoid gas-
producing and fatty foods.
3. Varicose veins:
 Elevate legs frequently during day
 Wear supportive hose
 Avoid crossing legs while sitting.
 Varicose veins often develop in the lower
extremities during pregnancy.
 Any constricting clothing such as knee-high
hose impede venous return from the lower
legs and thus place the client at higher risk
for developing varicosities.
 Clients should be encouraged to wear panty
hose or support hose.
 Flat nonslip shoes with proper support are
important to assist the pregnant woman to
maintain proper posture and balance and
minimize the risk for falls.
 Pants with an elastic waistband are
comfortable and are not constricting.
 4. Hemorrhoids: of the membranes because of the risk of
 Increase exercise infection.
 Maintain fluid intake at 2-3 litre per day 2. Abruption placenta and placenta previae-
 Increase fiber in diet. bleeding from vagina and cervical lesions
Hemorrhoids management: 3. Hyperemesis gravidarum -persistent
 Avoiding constipation and straining during vomiting.
bowel movements; 4. Pre eclampsia-severe headache, blurring of
 Applying ice packs to reduce the vision or spots before eyes , hypertension.
hemorrhoidal swelling; 5. Premature labor-abdominal pain
 Gently replacing the hemorrhoids into the 6. Infection –oral temperature greater than 101
rectum; degree F or 38.3 degree C.
 Using stool softeners, ointments, or sprays 7. Pregnancy induced hypertension-swelling of
as prescribed; lower legs, hands and face.
 and assuming certain positions to relieve 8. Fetal death-absence of fetal movement
pressure on the hemorrhoids Notes :
 Fundus reaches level of umbilicus at
20th week
 Quickening -18 to 20 week in primipara and
16 th week in multipara
 FHR ia audible through fetoscope at 18-20th
Nagele’s (Expected date of confinement):
 Substract 3 months from 1st day of LMP and
add 7 days and change year.
 Eg: LMP=JUNE -10-2015
 EDD= JUNE 10-3 MONTHS+7 DAYS
 MARCH 10 +7 DAYS
 MARCH 17 &change year
 EDD=March 17 2016.
Nutritional requirement in pregnancy:
5. Leg cramps:  Calorie increase=300cal/day
 Do not use milk as only source of calcium
 Protein increase =60g/day
 Release cramp by dorsi flexion.
 Calcium increase =1200mg
 Iron =18mg+
6. Back ache:  Folic acid =400mg
 Some measures that will assist in relieving a
DIABETES IN PREGNANCY:
backache include maintaining good posture
s/s:
and body mechanics, resting and avoiding
 Hyperemesis
fatigue, wearing flat-heeled shoes, and
 Glycosurea
sleeping on a firm mattress.
 Ketonuria
 The back discomfort that occurs in a
 Increase RBS, Increase GTT
pregnant client is often caused by the
 Polydypsia, polyphagia,polyuria
exaggerated lumbar and cervicothoracic
 Rapid weight gain
curves resulting from a change in the center
 Previous large babies weighly 4000g or
of gravity because of the enlarged uterus.
more.
 Performing more exercises to strengthen the
Treatment :
back muscles could be harmful to a pregnant
 Regular insulin
client.
 Avoid oral hypoglycemic. They cross
Danger signs of pregnancy: placenta and are teratogenic
1. PROM –Premature rupture of membrane:
 Calorie 2200-2400kcal/day
Sudden gush of clear fluid from vagina.
 CHO-45% of calorie
Vaginal examinations should not be done
 Protein -20%
routinely on a client with premature rupture
 Fat -35%
Complications :
 Hydramnios
 Pre eclampsia
 Eclampsia
 Still birth
 Neonatal respiratory distress syndrome
 Hyper bilirubinemia
 Hypoglycemia
 Congenital anomalies
 PPH
 infection
Dietary modifications:
 The diet for a pregnant client with diabetes
mellitus is individualized to allow for
increased fetal and metabolic requirements,
with consideration of such factors as
prepregnancy weight and dietary habits,
overall health, ethnic background, lifestyle,
stage of pregnancy, knowledge of nutrition,
and insulin therapy.
 Diet and insulin needs change during the
pregnancy in direct correlation to hormonal
changes and energy needs.
 In the third trimester, insulin needs increase.
 Dietary management during diabetic
pregnancy must be based on blood, not
urine, glucose changes.
 Insulin needs decrease in the first trimester
because of increased insulin production by
the pancreas and increased peripheral
sensitivity to insulin.
PREGNANCY INDUCED
HYPERTENSION(PIH):
s/s:
 Edema, hypertension,proteinuria, convulsion
and coma
 Eclampsia –at point of convulsions.
Treatment :
 Antihypertensives –aldomet,apresoline
 Sedatives-phenobarbital (Avoid valium as it
is associated with increased risk of
aspiration if seizures occurs.
 Prevent convulsions:
 Administer magnesium sulphate(loading
dose 4-6g and maintain at 1-2g/hr).
 Obtain magnesium sulphate blood levels
every 4 hours
 If magnesium sulphate overdose ,administer
calcium gluconate
 Continue magnesium sulphate for 24 hours
after birth.
CARDIAC DISEASES IN PREGNANCY:
Assess for :
 Pedal edema, progressive generalized edema
 Exertional dyspnea
 Basilar rales
 Moist cough
 Tachy cardia,irregular pulse
 Increase fatigue
 Cyanosis of lips and nail beds
 Heart murmers
 Severe fungal infections.
Dietary modification:
 Constipation can cause the client to use
Valsalva’s maneuver. This maneuver can
cause blood to rush to the heart and overload
the cardiac system. Therefore, high-fiber
foods are important.
 A low-calorie diet is not recommended
during pregnancy and could be harmful to
the fetus.
 Diets low in fluid can cause a decrease in
blood volume, which could deprive the fetus
of nutrients, so adequate fluid intake and
high-fiber foods are important.
 Sodium should be restricted somewhat, as
prescribed by the physician, because excess
sodium will cause an overload to the
circulating blood volume and contribute to
cardiac complications.
AIDS in pregnancy:-treatment of AIDS-
zidovudin
HYPERTENSION IN PREGNANCY:
 TREATMENT –Methyl dopa(aldomet)
 Avoid diuretics
Dietary modification:
 No added salt diet
 High protein
 Maintain fluid intake .
Pre eclampsia in pregnancy:
 Severe preeclampsia can trigger
disseminated intravascular coagulation
(DIC) because of the widespread damage to
vascular integrity.
 Bleeding is an early sign of DIC and should
be reported to the health care provider if
noted on assessment
DIC(Disseminated Intravascular coagulation):
 Dead fetus syndrome is considered a risk
factor for DIC.
 Severe preeclampsia is considered a risk
factor for DIC; a mild case is not.
 Disseminated intravascular coagulation
(DIC) is a state of diffuse clotting in which
 clotting factors are consumed, leading to
widespread bleeding.
 Platelets are decreased because they are
consumed by the process, coagulation
studies show no clot formation (and are thus
normal to prolonged), and fibrin plugs may
clog the microvasculature diffusely, rather
than in an isolated area.
 The presence of petechiae, oozing from
injection sites, and hematuria are signs
associated with DIC.
CESEAREAN DELIVERY:
 Indications : breech presentation, pre term,
fetal distress, dysfunctional labor, CPD,
prolapsed cord, abruption placenta, placenta
previa, active herpes, transverse lie, previous
LSCS.
 Complication: maternal infection,
hemorrhage, blood clots, injury to bladder,
preterm birth, TTN(Transient Tachypnea of
the Newborn).
 Abdominal exercises should not start
immediately following abdominal surgery,
and the client should wait at least 3 to 4
weeks postoperatively to allow for healing
of the incision.
Oxytocin use in labor:
 A normal fetal heart rate is 120 to 160
beats/min. Bradycardia or late or variable
decelerations indicate fetal distress and the
need to discontinue the oxytocin.
 The goal of labor augmentation is to achieve
three good-quality contractions (appropriate
intensity and duration) in a 10-minute
period.
 The uterus should return to resting tone
between contractions, and there should be no
evidence of fetal distress.
Contraction monitoring by external monitor:’
 Variable decelerations occur if the
umbilical cord becomes compressed, thus
reducing blood flow between the placenta
and the fetus.
 Early decelerations result from pressure
on the fetal head during a contraction.
 Late decelerations are an ominous pattern in
labor because they suggest uteroplacental
insufficiency during a contraction.
 Short-term variability refers to the beat-to-
beat range in the fetal heart rate.
Use of magnesium sulfate to stop preterm labor:
 Magnesium sulfate is a central nervous
system (CNS) depressant and the client
could experience adverse effects that
includes depressed respiratory rate (below
12 breaths/min), severe hypotension, and
absent deep tendon reflexes (DTRs).
Placenta previae:
 The placenta is implanted in the lower
uterine segment, which does not contain the
same intertwining musculature as the fundus
of the uterus, this site is more prone to
bleeding.
 Placenta implanted near or over the maternal
cervical Os.
 Complete or central
 Incomplete or partial
 Marginal or low implantation
 Signs and symptoms:
 Painless unexplained uterine bleeding after
20th week, each succeeding vaginal bleed
greater than previous.
  Painless, bright red vaginal bleeding in the
second or third trimester of pregnancy is a
sign of placenta previa.
 The client will have a soft, relaxed,
nontender uterus, and the fundal height may
be more than expected for gestational age.
Management:
 Don’t perform vaginal examination or rectal
examination or enemas.
 Do sonogram
 Double set up vaginal examination in OT
 Cesarean section
 Arrange for blood transfusion
 Count perineal pad (1gm weight=1ml)
 Administer IVF. UTERINE RUPTURE:
Abruptio placentae  Excessive fundal pressure, forceps delivery,
 Abruptio placentae is associated with violent bearing-down efforts, tumultuous
conditions characterized by poor labor, and shoulder dystocia can place a
uteroplacental circulation, such as client at risk for traumatic uterine rupture.
hypertension, smoking, and alcohol or Schultz presentation : Schultz presentation is the
cocaine abuse. expulsion of the placenta with the fetal side
 The condition also is associated with presenting first .
physical and mechanical factors, such as fetal or maternal compromise: Signs of a fetal or
overdistention of the uterus, which occurs maternal compromise include a persistent,
with multiple gestation or polyhydramnios. nonreassuring fetal heart rate, fetal acidosis, and the
 In addition, a short umbilical cord, physical passage of meconium
trauma, and increased maternal age and LABOUR MANAGEMENT:
parity are risk factors.  Length -6-18 hrs in primi
 In abruptio placentae, severe abdominal pain  3-10hrs in multi
is present. 4 stages:
 Uterine tenderness accompanies placental
abruption, especially with a central
abruption and trapped blood behind the
placenta.
 The abdomen will feel hard and board-like
on palpation as the blood penetrates the
myometrium and causes uterine irritability.
 Observation of the fetal monitor often
reveals increased uterine resting tone,
caused by failure of the uterus to relax in an
attempt to constrict blood vessels and
control bleeding.

First stage:
3 phases:
1. Latent phase:
 True labor until 4cm cervical dilation.
 Contraction range from every 15-30minutes
and last 15-30seconds.
 2. Active phase
 4-7cm
 Contractions are every 3-5minute and last
about 60seconds
3. Transition phase.
 8-10cm dilatation
 Contractions every 2-3minute and last 45-90
seconds.
Second stage:
 Begins with complete cervix dilation and
end with birth of baby.
 Length: 0.5-2hours in primi and 10-
60minutes in multigravida.
Third stage :
Station : Relationship of fetal presenting part to
 Begins with birth of baby and ends with
level of ischial spines.
birth of placenta.
 Above spines:-3,-2,-1
 Length 5-30minutes.
 At spines: 0
Fourth stage:
 Below spines: +1,+2,+3.
 Begins from birth of placenta and ends 1-
 On perineum :+4.
4hours after birth.
Fetal presentation:
Mechanism of labor:
 Cephalic : Any part of fetal head.
1. Engagement : point when bi parietal
 Occiput, vertex
diameter of fetal head passes pelvic inlet.
 Brow
2. Descent : down ward movement of fetal
 Face (mentrum or chin).
head into birth canal.
 Breech :
3. Flexion: flexion of fetal chin down onto fetal
 Buttocks and or feet (sacrum)
chest.
 Complete –buttocks and feet present
4. Internal rotation : rotation of fetal head to
 Footling –one or both feet present.
pass through ischial spines.
 Frank-buttocks only present.
5. Extension : as fetal head passess under
 Position : Relationship of fetal presenting
symphysis pubis ,fetal head extends.
part to maternal pelvis.
6. External rotation: Rotation of fetal head to
 LOA,ROA,LSPetc.
allow shoulders to pass through ischial
 Show : Vaginal discharge of mucus,fluid
spines.
and increasing amount of blood.
 Effacement : Shortening,thinning of cervix
 Membranes : SROM(spontaneous rupture of
(0% to 100%).
membrane), AROM(Artificial rupture of
 Dilation : Opening of cervix(0-10cm)
membrane).
 Lightening : Settling of fetal presenting part
 Contractions : Tightening of uterine muscle
into pelvic inlet.
during labor process.
 Contra indications:
 Grand multiparity
 Placental abnormalities
 Previous uterine surgeries
 Fetal distress
 Pre term fetus
 Positive CST
 Abnormal fetal presentation. Presenting part
above inlet
 CPD etc.
Nursing management;
 Trace uterine contractions and FHR atleast
20 minutes
 Discontinue oxytocin if frequency is less
than 2 minutes or duration is more than 90
Laboratory values changes in labor : seconds or fetal distress noted.
 WBC reaches 25,000/mm3 in labor Post episiotomy assessment:
 Increase in plasma fibrinogen and decrease
in blood coagulation time. REEDA:
Anesthesia in labor: R-E-E-D-A
1. Epidural block: Redness-Edema-Echymosis-Drainage-
 Cause hypotension Approximation of skin edges.
 Relieves pain from contraction and numbs NEW BORN:
vagina and perineum  Caput succeedaenum: Localized swelling
 Assess BP, maintain side lying position over the presenting part. It does cross suture
 Administer IV fluids lines.
 Provide support during block.  Cephalohematoma : It is a collection of
2. Spinal anesthesia: blood between skull bone and periosteum. It
 Place rolled blanket under right hip to does not cross suture lines.
displace uterus from venecava  Posterior fontanelle: Triangle shape , non
 IV fluid pulsating , 1-2 cm , closes 8-12 weeks.
 Relieves pain from contractions , numbs  Anterior fontanelle: Open ,soft, pulsating ,
vagina, perineum and lower extremities. diamond shape, 2-4cm long, 2-3cm wide,
 Cause hypotension and post partum closes at 18 month. Depression od fontanelle
headache. indicate dehydration and bulging indicate
3. Pudendal block: increased ICP.
 Relieves perineal discomfort and numbs area  Permanent eye color establish in new born at
for episiotomy 3-12 months.
4. Local anesthesia:  Polydactyl –more than 5 digits on an
 Numbs perineum for episiotomy and repair. extremity
INDUCTION OF LABOR: By IV oxytocin.  Syndactyly-fusing of 2 or more digits
Disadvantages:  Acrocyanosis –cyanosis of hands and feet
 Hypertonic labor that occurs just after birth.
 Fetal distress  Milia –clogged sebaceous glands over nose.
 Alteration in BP  Vernix caseosa- white cheese like substance
 Rupture of uterus. present in skin creases.
Indication for induction of labour are following:  Lanugo –fine downy hair
 Post maturity  Telangiectatic nevi- flat , reddish marks,
 PROM may be present on eye lids , between eyes
 PIH and on nape of neck.
 DM  Erythema neonatrum toxicum-maculo
 Fetal demise popular rash may be present over body
  New born Hb level=15-20gm/dl.
Abortion:
 Spontaneous termination of pregnancy
before 20th week of gestation
 Spontaneous abortion –occurs naturally
during 2nd or 3rd
 Habitual –spontaneous loss of 3 or more
pregnancies
 Complete –all related tissues and fetus are
expelled
 Incomplete –some but not all of the parts of
conception are expelled.
 Threatened –bleeding or cramping , but no
cervical dilation or ROM, possible loss of
the pregnancy.
 Missed –fetus dies, but the products of
conception are refained in uterus (increases
risk of DIC(Disseminated Intravascular
coagulation)
 Inevitable –bleeding and cramping with
cervical dilation .loss of pregnancy.
Threatened abortion management:
 The client is advised to curtail sexual
activities until bleeding has ceased, and for 2
weeks following the last evidence of
bleeding or as recommended by the
physician or other health care provider
 The client is instructed to count the number
of perineal pads used daily and to note the
quantity and color of blood on the pad.
 The client also should watch for the
evidence of the passage of tissue.
 Strict bed rest throughout the remainder of
the pregnancy is not required
HYDATIDIFORM MOLE:
Developmental anomaly of placenta that result in
changing chorionic villi into a mass of clear
vesicles. Edematous grape like cluster may be
benign or may develop into a
choriocarcinoma(cancer).
Signs and symptoms:
 Bright red or dark brown vaginal bleeding
(12th week)
 Hyper emesis
 Fundal height is greater than expected for
date
 Increase HCG levels
 In ultrasound –snow storm appearance
 No FHR
 s/s of PIH, before 20 th week (increase in
BP, edema, proteinurea)
management :
 uterine evacuation
 induced abortion
ECTOPIC PREGNANCY:
It results from implantation of fertilized ovum
outside the uterus , generally in the fallopian tube.
s/s:
 sharp, localized pain in lower
abdomen,caused by expansion and possible
rupture of the tube
 syncope, shoulder pain
 irregular vaginal bleeding
 abdominal rigidity and distension
 shock (increase heart rate and decrease in
BP)
 palpable mass in cul-de –sac
 decrease HCG level.
Management :
  pain relief Treatment :
 manage shock: administer oxygen, IVF, do  Left lateral position
cross matching for BT if ordered.  IVF
 Laparotomy

SUPINE HYPO TENSION IN PREGNANCY:

Symptoms:
 Decreased blood pressure, dizziness, pallor,
cool clammy skin.
Cause :
 When a pregnant mother lies on her back
,occlusion of venecava by heavy uterus.
Management :’
 Turning mother to left side ,starting oxygen
7-10L/mt.
INCOMPETENT CERVIX:
 It is the premature dilation of cervix.
 Treated with shirodkar –Barter or Mc
Donald procedure.
 Occurs due to cervical trauma.
s/s :
 Vaginal bleeding 18-28week
 Painless,spontaneous,3rd trimester abortion
or premature labor
 Fetal membranes visible through cervix.
HYPEREMESIS :
It is pernicious vomiting in pregnancy.
s/s:
 Intractable vomiting at any time.
 Weight loss of 25% or more
 Ketosis ,ketonuria
 Dehydration –poor skin turgor, dry tongue.
 Epigastric pain
 Drowsiness and confusion
 Unco-ordinated movements, jerking
 Jaundice, coma.
HYDRAMNIOS :
-excess amniotic fluid greater than 2000ml
Predisposing factors:
-DM, PIH,ABO,Rh Incompatibility
-multiple pregnancy
PREMATURE LABOR:
20-37WEEKS