MATERNAL AND CHILD

HEALTH NURSING
Important Points to
Remember

Reproductive Health and

Fertility
Ovulation occurs on approximately the 14 th
day before the onset of the next cycle, not
necessarily at a cycles midpoint.
Calendar method involves calculating for
fertile days and safe days
Subtract 18 from the shortest cycle (first fertile
day)
Subtract 11 from the longest cycle (last fertile
day)
A record of six menstrual cycles must be
obtained.

Reproductive Health and

Fertility
Infertility is the inability to conceive or
sustain a pregnancy.
Subfertility exists when a pregnancy has
not occurred after at least 1 year of
unprotected coitus.
Primary- no previous conceptions
Secondary-there was a previous viable
pregnancy

Sterility is the inability to conceive due to

a known condition (ex. absence of uterus)

Reproductive Health and

Fertility
Huhner Test (Post Coital Test)
A fertility test that evaluates the
compatibility of sperm and cervical mucus.
Cervical mucus pH is generally from 7 to 8.5.
Mucus can be stretched to at least 3.15
inches (8cm) before breaking.
Test is done several hours after intercourse.
Date should be close to the next ovulation.
A drop of mucus should contain a dozen or
sperm that swim with strong forward motion
(good motility)

Reproductive Health and

Fertility
Tubal Patency
The Ability of the egg to move from
the ovary to the uterus.
Hysterosalpingography
Previous damage to tubes can cause
infertility.
Usual cause is Pelvic Inflammatory
Disease.

Pregnancy
Signs of Pregnancy
1. Presumptive (Subjective) Signs
Breast changes (fullness, enlargement,
color)
N&V
Amenorrhea
Urinary Frequency
Quickening (18-20 wks)
Skin Pigmentation (linea nigra, striae
gravidarum, chloasma)

Pregnancy
Signs of Pregnancy
2. Probable Signs

Serum HCG
Chadwicks sign
Goodells sign
Hegars sign
Ultrasound (gestational sac)
Ballottement
Braxton Hicks contractions (at least 12 th
wk)
Fetal outline felt by examiner

Pregnancy
Signs of Pregnancy
2. Positive signs
Ultrasound (fetal outline)
Fetal heart is audible
Fetal movement felt by examiner

Pregnancy
Circulatory System During Pregnancy
Increase in blood volume (30-50%)
Pseudoanemia (first trimester)
Increase in heart rate (10 beats)
BP decreases slightly (second trimester),
but rises again (third trimester)
Blood fibrinogen increases
Blood lipids increase by one third
Serum cholesterol level increase by 90100%

Pregnancy
Pregnancy Related Problems
Ectopic Pregnancy
Implantation occurs outside the uterus
Can cause bleeding in pregnancy
Most common site is the fallopian tube
(95%)
Tubal scarring due to PID
Common to women who smoke

Pregnancy
Pregnancy Related Problems
Hyperemesis Gravidarum
N & V past the 12th week of pregnancy
Severe N &V that dehydration, ketonuria
and significant weight loss occurs within
the first 12 wks of pregnancy
NPO
IVF with vitamin B
If no vomiting after the first 24 hrs of
NPO, small amounts of clear fluid may
be given

Pregnancy
Pregnancy Related Problems
Hyperemesis Gravidarum
N & V past the 12th week of pregnancy
Severe N &V that dehydration, ketonuria
and significant weight loss occurs within
the first 12 wks of pregnancy
NPO
IVF with vitamin B
If no vomiting after the first 24 hrs of
NPO, small amounts of clear fluid may
be given

Pregnancy
Pregnancy Related Problems
PIH
Cause is still unknown
Occurs in 5-7% of pregnancies
Multiple pregnancies
Primipara younger than 20 and older
than 40
Five or more pregnancies
Have underlying disease like heart
diseases or diabetes

Pregnancy
Pregnancy Related Problems
Gestational HPN
BP 140/90
Increase in systolic 30mmHg or
diastolic 15mmHg above prepregnancy
level
No proteinuria or edema
Returns to normal after birth

Pregnancy
Pregnancy Related Problems
Mild pre-eclampsia
BP 140/90
Increase in systolic 30mmHg or
diastolic 15mmHg above prepregnancy
level
Proteinuria 1-2+
Weight gain of 2lbs/wk (2nd trimester),
1lb/wk (3rd trimester)
Mild edema in upper extremities and
face

Pregnancy
Pregnancy Related Problems
Severe pre-eclampsia
BP 160/110
Proteinuria 3-4+
Oliguria (500ml or less in 24hrs)
Cerebral or visual disturbances
(headache, blurred vision)
Epigastric pain
thrombocytopenia

Pregnancy
Pregnancy Related Problems
Eclampsia
Seizure or coma accompanied by
symptoms of pre-eclampsia
Cerebral edema

Labor and Delivery

Fetal Presentation and Position
Attitude
The degree of flexion a fetus assumes
during labor
Good Attitude:
Complete flexion
Head is flexed (chin touching the sternum)
Arms flexed and folded into chest
Thighs flexed into abdomen
Calves are pressed against posterior
aspect of thighs

Labor and Delivery

Fetal Presentation and Position
Engagement
Settling of the presenting part of the
fetus into the pelvis
At the level of the ischial spines
Floating presenting part not yet
engaged
Dipping has not reached the ischial
spine yet

Labor and Delivery

Fetal Presentation and Position
Station
Relationship of the presenting part to
the level of the ischial spine
0 station at level with ischial spine
(engaged)
+3 - +4 station presenting part is at
the perineum (crowning)

Labor and Delivery

Fetal Presentation and Position
Lie
Relationship between the long axis of
the fetal body and the long axis of the
mothers body
Either horizontal (transverse) or vertical
(longitudinal)
Longitudinal Lie:
Cephalic
Breech

Labor and Delivery

Signs of Labor
Uterine Contractions
Begins irregularly but become regular
and predictable
Felt first in the lower back and sweep
around the abdomen in a wave
Continues regardless of womans
activity
Increases in duration, frequency, and
intensity
Achieves cervical dilation

Labor and Delivery

Signs of Labor
Show
Rupture of Membranes
Sudden gush or scanty, slow seeping of
clear fluid from the vagina
Can be advantageous
Risk for intrauterine infection and
prolapsed cord

Labor and Delivery

Stages of Labor
1. First Stage
a) Latent Phase

Contractions last 20-40 seconds

Cervix dilates from 0-3cm
Lasts 6hrs (nullipara) to 4.5hrs (multipara)

b) Active Phase

Dilation from 4-7cm

Contractions last 40-60 seconds every 3-5
mins
Lasts 3hrs (nullipara) to 2hrs (multipara)
Show and ROM may occur

Labor and Delivery

Stages of Labor
1. First Stage
a) Transition Phase

Contractions last 60-90 seconds every

2-3 mins
Cervix dilates from 8-10cm
Show and ROM
Full dilatation
N & V may sometimes be felt
Irresistible urge to push

Labor and Delivery

Stages of Labor
2. Second Stage
Period from full dilatation and cervical
effacement to birth of infant
Takes about 1 hour
Crowning

Labor and Delivery

Stages of Labor
3. Third Stage
Placental stage
From birth of infant to delivery of
placenta
Sudden gush of blood, lengthening of
umbilical cord (placental separation)

4. Fourth Stage
First 1 to 4 hrs after birth of the
placenta
Oxytocin is given

Congenital Heart
Disorders
1. Ventricular Septal Defect
Most common type of CHD (30%)
Opening is present between the two
ventricles
Left to right shunting of blood
Right ventricular hypertrophy and
increased pulmonary artery pressure
Postop be alert for arrhythmias

Congenital Heart
Disorders
2. Atrial Septal Defect
Abnormal communication between two
atria
More common in girls
Can be caused by patent foramen
ovale
Left to right movement of blood
Ventricular hypertrophy and increased
pulmonary artery pressure

Congenital Heart
Disorders
2. Atrial Septal Defect
Abnormal communication between two
atria
More common in girls
Can be caused by patent foramen
ovale
Left to right movement of blood
Ventricular hypertrophy and increased
pulmonary artery pressure

Congenital Heart
Disorders
3. Atrioventricular Canal Defect
Incomplete fusion of the endocardial
cushion
Low ASD and high VSD and distortion of
the mitral and tricuspid valves
May have left to right blood flow or
between all chambers of the heart
Common in children with trisomy 21
(50%)

Congenital Heart Disorders

4. Aortic Stenosis
Prevents blood from passing freely from
the left ventricle to the aorta
Increased pressure and hypertrophy of LV
LA pressure increase
Back pressure to pulmonary veins and
pulmonary edema
Decreased CO:
Faint pulses
Hypotension
Tachycardia
Inability to suck for long periods

Congenital Heart
Disorders
5. Tetralogy of Fallot
Four anomalies are present:

Pulmonary stenosis
VSD
Overriding aorta (dextroposition)
RV hypertrophy

Cyanosis
Polycythemia
Dyspnea