You are on page 1of 37

MATERNAL/OB NOTES

Human Sexuality
A. Concepts
1. A persons sexuality encompasses the complex behaviors, attitudes emotions and preferences that are related to
sexual self and eroticism.
2. Sex basic and dynamic aspect of life
3. Durin reproductive years, the nurse performs as resource person on human sexuality.
B. Definitions elate! to sexuality"
#en!e i!entity sense of femininity or masculinity
2!" yrs#3 yrs ender identity develops.
Role i!entity attitudes, behaviors and attributes that differentiate roles
Sex bioloic male or female status. Sometimes referred to a specific sexual behavior such as sexual intercourse.
Sexuality ! behavior of bein boy or irl, male or female man# $oman. %ntity life lon dynamic chane.
! developed at the moment of conception.
$$. Sexual Anatomy an! %&ysiolo'y
A. (emale Repo!ucti)e System
1. %xternal value or pretender
a. Mons pu*is/)eneis ! a pad of fatty tissues that lies over the symphysis pubis covered by s&in and at puberty
covered by pubic hair that serves as cushion or protection to the symphysis pubis.
Sta'es of %u*ic Hai De)elopment
'annerscale tool ! used to determine sexual maturity ratin.
Stae 1 (re!adolescence. )o pubic hair. *ine body hair only
Stae 2 +ccurs bet$een aes 11 and 12 sparse, lon, slihtly pimented , curly hair at pubis
symphysis
Stae 3 occurs bet$een aes 12 and 13 dar&er , curlier at labia
Stae " occurs bet$een aes 13 and 1", hair assumes the normal appearance of an adult but is not so
thic& and does no appear to the inner aspect of the upper thih.
Stae - sexual maturity! normal adult! appear inner aspect of upper thih .
*. La*ia Ma+oa ! lare lips lonitudinal fold, extends symphisis pubis to perineum
c. La*ia Minoa 2 sensitive structures
clitois, anterior, pea shaped erectile tissue $ith lots sensitive nerve endins siht of sexual arousal ./ree&!&ey0
fouc&ette, (osterior, tapers posteriorly of the labia minora! sensitive to manipulation, torn durin delivery.
Site episiotomy.
!. -esti*ule an almond shaped area that contains the hymen, vainal orifice and bartholenes lands.
1. .inay Meatus small openin of urethra, serves for urination
2. S/enes 'lan!s/o paauet&al 'lan! mucus secretin subs for lubrication
3. &ymen covers vainal orifice, membranous tissue
". )a'inal oifice 0 external openin of vaina
-. bartholenes lands! paravainal land or vulvo vainal land !2 small mucus secretin subs secrets al&aline subs.
Al&aline neutrali1es acidity of vaina
(h of vaina ! acidic
Doderleins bacillus responsible for acidity of vaina
2arumculae mystiformes!healin of torn hymen
e. %eineum 0 muscular structure loc lo$er vaina , anus
3nternal4
A. )a'ina female oran of copulation, passae$ay of mens , fetus, 3 "inches or 5 16 cm lon, dilated canal
7uae permits stretchin $ithout tearin
B. uteus, +ran of mens is a hollo$, thic& $alled muscular oran. 3t varies in si1e, shape and $eihts.
Si1e! 1x2x3
Shape4 nonprenant pear shaped # prenant ! ovoid
1
8eiht ! nonprenant -6 !96 &! prenant 1,666
(renant# 3nvolution of uterus4
"
th
stae of labor ! 1666
2 $ee&s after delivery ! -66
3 $ee&s after delivery ! 366
-!9 $ee&s after delivery ! returns to oriinal, state -6 96
T&ee pats of t&e uteus
1. fundus ! upper cylindrical layer
2. corpus#body ! upper trianular layer
3. cervix ! lo$er cylindrical layer
: 3sthmus lo$er uterine sement durin prenancy
2ornua!;unction bet$een fundus , interstitial
Muscula compositions" there are three main muscle layers $hich ma&e expansion possible in every direction.
1. %ndometrium! inside uterus, lines the nonprenant uterus. <uscle layer for menstruation. Slouhs durin menstruation.
Decidua! thic& layer.
%ndometriosis!proliferation of endometrial linin outside uterus. 2ommon site4 ovary.
S#sx4 dysmennorhea, lo$ bac& pain.
Dx4 biopsy, laparoscopy
<eds4 1. Dana1ole .Danocrene0 a. to stop mens b. inhibit ovulation
2. =upreulide .=upron0 inhibit *S>#=> production
2. <yometrium larest part of the uterus, muscle layer for delivery process
3ts smooth muscles are considered to be the livin liature of the body.
! (o$er of labor, resp! contraction of the uterus
3. (erimetrium protects entire uterus
C. o)aies 2 female sex lands, almond shaped. %xt! vestibule int ovaries
*unction4 1. ovulation
2. (roduction of hormones
!. (allopian tu*es 2!3 inches lon that serves as a passae$ay of the sperm from the uterus to the ampulla or the passae$ay of the
mature ovum or fertili1ed ovum from the ampulla to the uterus.
1 si'nificant se'ments
1. 3nfundibulum distal part of *', trumpet or funnel shaped, s$ollen at ovulation
2. Ampulla outer 3
rd
or 2
nd
half, site of fertili1ation
3. 3sthmus site of sterili1ation bilateral tubal liation
". 3nterstitial site of ectopic prenancy most danerous
B. Male Repo!ucti)e System
2. Extenal
penis the male oran of copulation and urination. 3t contains of a body of a shaft consistin of 3 cylindrical layers
and erectile tissues. At its tip is the most sensitive area comparable to that of the clitoris in the female the lands
penis.
3 Cylin!ical Layes
2 corpora cavernosa
1 corpus sponiosum
Scotum a pouch hanin belo$ the pendulous penis, $ith a medial septum dividin into t$o sacs, each of $hich contains a testes.
! coolin mechanism of testes
! ? 2 derees 2 than body temp.
! =eydi cell release testosterone
2
4. $ntenal
T&e %ocess of Spemato'enesis 0 maturation of sperm

Male an! (emale &omolo'ues
Male (emale
(enile lans 2litoral lans
(enile shaft 2litorial shaft
'estes ovaries
(rostate S&enes ands
2o$pers /lands @artholinAs lands
Scrotum =abia <a;ora
%pididymis 9 meters coiled
tubules site for maturation of sperm
Bas Deferens conduit for
spermato1oa or path$ay of sperm
Seminal vesicle secretes4
1.0 *ructose lucose has
nutritional value.
2.0 (rostalandin causes reverse
contraction of uterus
@lan&C 2ant eraseC
>ypothalamus
/n7>
Ant (it
/land
*S> =*
*x4
Sperm
<aturation
*x4 >ormones
for
'estosterone
(roduction
'estes D66 coiled .E meter lon
at ae 13 on$ards0
.Seminiferous tubules0
%;aculatory duct conduit of semen
(rostate land! secrets al&aline substance
2o$pers land secrets al&aline substance
Frethra
3
$$$. Basic 5no6le!'e on #enetics an! O*stetics
1. D)A carries enetic code
2. 2hromosomes threadli&e strands composed of hereditary material D)A
3. )ormal amount of e;aculated sperm 3 - cc., 1 tsp
". +vum is capable of bein fertili1ed $ith in 2" 39 hrs after ovulation
-. Sperm is viable $ithin "5 G2 hrs, 2!3 days
9. 7eproductive cells divides by the process of meiosis .haploid0
Spermatoenesis maturation of sperm
+oenesis process ! maturation of ovum
/ematoenesis formation of 2 haploid into diploid 23 H 23 I "9 or diploid
G. Ae of 7eproductivity 1- ""yo
5. <enstruation!
<enstrual 2ycle beinnin of mens to beinnin of next mens
Averae <enstrual 2ycle 25 days
Averae <enstrual (eriod ! 3 - days
)ormal @lood loss -6cc or J cup
7elated terminoloies4
<enarche 1
st
mens
Dysmenorrhea painful mens
<etrorrhaia bleedin bet$een mens
<enorhaia excessive durin mens
Amenorrhea absence of mens
<enopause cessation of mens# averae 4 -1 years old
D. *unctions of %stroen and (roestin
7 Esto'en K>ormone of the 8omanL
(rimary function4 development secondary sexual characteristic female.
+thers4
1. inhibit production of *S> . maturation of ovum0
2. hypertrophy of myometrium
3. Spinnbar&eit , *ernin . billins method# cervical0
". development ductile structure of breast
-. increase osteoblast activities of lon bones
9. increase in heiht in female
G. causes early closure of epiphysis of lon bones
5. causes sodium retention
D. increase sexual desire
:%o'estin K >ormone of the <otherL
(rimary function4 prepares endometrium for implantation of fertili1ed ovum ma&in it thic& , tortous .t$isted0
Secondary *unction4 uterine contractility .favors prenancy0
+thers4 1.inhibit prod of => .hormone for ovulation0
2.inhibit motility of /3'
3. mammary land development
". increase permeability of &idney to lactose , dextrose causin .H0 suar
-. causes mood s$ins in moms
9. increase @@'
28. Menstual Cycle
" phases of <enstrual 2ycle
1. (hases of <enstrual 2ycle4
1. (roliferative
2. Secretory
3. 3schemic
". <enses
(arts of body responsible for mens4
1. hypothalamus
2. anterior pituitary land master cloc& of body
3. ovaries
"
". uterus
3nitial phase 3
rd
day decreased estroen
13
th
day pea& estroen, decrease proesterone
1"
th
day 3ncrease estroen, increase proesterone
1-
th
day Decrease estroen, increase proesterone
3. +n the initial 3
rd
phase of menstruation , the estroen level is decreased, this level stimulates the hypothalamus to release
/n7> or *S>7*
33. /n7>#*S>7* stimulates the anterior pituitary land to release *S>
(unctions of (SH4
1. Stimulate ovaries to release estroen
2. *acilitate ro$th primary follicle to become raffian follicle .secrets lare amt estroen , contains mature ovum.0
333. (roliferative (hase proliferation of tissue or follicular phase, post mens phase. (re!ovularoty.
!phase of increase estroen.
*ollicular (hase causin irreularities of mens
(ostmenstrual (hase
(reovulatory (hase phase increase estroen
3B. 13
th
day of menstruation, estroen level is pea& $hile the proesterone level is do$n, these stimulates the hypothalamus
to release /n7* on =>7*
1.0 <ittelschmer1 sliht abdominal pain on = or 7M of abdomen, mar&s ovulation day.
2.0 2hane in @@', mood s$in
B. /n7*#=>7* stimulates the ant pit land to release =>.
(unctions of LH4
1. .13
th
day!decreased proesterone0 => stimulates ovaries to release proesterone
2. hormone for ovulation
B3. 1"
th
day estroen level is increased $hile the proesterone level is increased causin rupture of raffian follicle on process of
ovulation.
B33. 1-
th
day, after ovulation day, raafian follicle starts to deenerate yello$ish &no$n as corpus luteum .secrets lare amount of
proesterone0
B333. Secretory phase!
=utheal (hase
(ostovulatory (hase3ncreased proesterone
(remenstrual (hase
3N. 2"
th
day if no fertili1ation, corpus luteum deenerate . $hitish corpus albicans0
N. 25
th
day if no sperm in ovum endometrium beins to slouh off to bein mens
2ornix! $here sperm is deposited
Sperm! small head, lon tail, pearly $hite
(honones!vibration of head of sperm to determine location of ovum
Sperm should penetrate corona radiata and 1ona pellocida.
2apacitation! ability of sperm to release proteolytic en1yme to penetrate corona radiata and 1ona pellocida.
22. Sta'es of Sexual Responses .%(+70
$nitial esponses"
Basoconestion conestion of blood vessels
<yotonia increase muscle tension
1. %xcitement (hase .sin present in both sexes, moderate increase in >7, 77,@(, sex flush, nipple erection0 erotic stimuli
cause increase sexual tension, lasts minutes to hours.
2. (lateau (hase .accelerated B#S0 increasin , sustained tension nearin orasm. =asts 36 seconds 3 minutes.
3. +rasm .involuntary spasm throuhout body, pea& v#s0 involuntary release of sexual tension $ith physioloic or
psycholoic release, immeasurable pea& of sexual experience. <ay last 2 16 sec! most affected are is pelvic area.
". 7esolution .v#s return to normal, enitals return to pre!excitement phase0
-
Refactoy %eio! the only period present in males, $herein he cannot be restimulated for about 16!1- minutes
A. (etili9ation
B. Sta'es of (etal #o6t& an! De)elopment
3!" days travel of 1yote mitotic cell division beins
:(re!embryonic Stae
a. Oyote! fertili1ed ovum. =ifespan of 1yote from fertili1ation to 2 months
b. <orula mulberry!li&e ball $ith 19 -6 cells, " days free floatin , multiplication
c. @lastocyst enlarin cells that forms a cavity that later becomes the embryo. @lastocyst coverin of blastocys that later
becomes placenta , trophoblast
d. 3mplantation# )idation! occurs after fertili1ation G 16 days.
*etus! 2 months to birth.
placenta previa implantation at lo$ side of uterus
Sins of implantation4
1. sliht pain
2. sliht vainal spottin
! if $ith fertili1ation corpus luteum continues to function , become source of estroen , proesterone $hile
placenta is not developed.
3 pocesses of $mplantation
1. Apposition
2. Adhesion
3. 3nvasion
C. Dici!ua thic&ened endometrium . =atin fallin off0
: @asalis .base0 part of endometrium located under fetus $here placenta is delivered
: 2apsularies encapsulate the fetus
: Bera remainin portion of endometrium.
2. C&oionic -illi, 16 11
th
day, finer life pro;ections
3 vesselsI
A unoxyenated blood
B +2 blood
A unoxyenated blood
8hartons ;elly protects cord
2horionic villi samplin .2BS0 removal of tissue sample from the fetal portion of the developin placenta for enetic
screenin. Done early in prenancy. 2ommon complication fetal limb defect. %x missin diits#toes.
%. 2ytotrophoblast inner layer or lanhans layer protects fetus aainst syphilis 2" $&s#9 months life span of lanhans layer
increase. @efore 2" $ee&s critical, miht et infected syphilis
*. Synsitiotrophoblast synsitial layer responsible production of hormone
1. Amnion inner most layer
a. Fmbilical 2ord! *F)3S, $hitish rey, 1- --cm, 26 21L. Short cord4 abruptio placenta or inverted uterus.
=on cord4cord coil or cord prolapse
b. Amniotic *luid ba of >2+, clear, odor mousy#musty, $ith crystalli1ed formin pattern, slihtly al&aline.
7(unction of Amniotic (lui!"
1. cushions fetus aainst sudden blo$s or trauma
2. facilitates musculo!s&eletal development
3. maintains temp
". prevent cord compression
-. help in delivery process
normal amt of amniotic fluid -66 to 1666cc
polyhydramnios, hydramnios! /3' malformation '%*#'%A, increased amt of fluid
oliohydramnios! decrease amt of fluid &idney disease
9
Dia'nostic Tests fo Amniotic (lui!
A. Amniocentesis empty bladder before performin the procedure.
(urpose obtain a sample of amniotic fluid by insertin a needle throuh the abdomen into the amniotic sacP fluid is
tested for4
1. /enetic screenin! maternal serum alpha feto!protein test .<SA*(0 1
st
trimester
2. Determination of fetal maturity primarily by evaluatin factors indicative of lun maturity 3
rd
trimester
'estin time 39 $ee&s
decreased <SA*(I do$n syndrome
increase <SA*( I spina bifida or open neural tube defect
2ommon complication of amniocenthesis infection
Danerous complications spontaneous abortion
3
rd
trimester! pre term labor
3mportant factor to consider for amniocentesis! needle insertion site
Aspiration of yello$ish amniotic fluid ;aundice baby
/reenish meconium
A. Amnioscopy direct visuali1ation or exam to an intact fetal membrane.
@. *ern 'est! determine if amniotic fluid has ruptured or not .blue paper turns reen#rey ! H ruptured amniotic fluid0
2. )itra1ine (aper 'est diff amniotic fluid , urine.
(aper turns yello$! urine. (aper turns blue reen#ray!.H0 rupture of amn fluid.
1. C&oion $here placenta is developed
=ecithin Sphinomyelin =#S
7atio! 241 sinifies fetal lun maturity not capable for 7DS
Sha&e test amniotic H saline , sha&e
*oam test
(hosphatilyceroli4 (/H definitive test to determine fetal lun maturity
a. %lacenta .Secundines0 /ree& panca&e, combination of chorionic villi H deciduas basalis. Si1e4 -66 or E &
!1 inch thic& , 5L diameter
*unctions of (lacenta4
1. 7espiratory System beinnin of lun function after birth of baby. Simple diffusion
2. /3' transport center, lucose transport is facilitated, diffusion more rapid from hiher to lo$er. 3f mom hypolycemic,
fetus hypolycemic
3. %xcretory System! artery ! carries $aste products. =iver of mom detoxifies fetus.
". 2irculatin system achieved by selective osmosis
-. %ndocrine System produces hormones
>uman 2horionic /onadrophin maintains corpus luteum alive.
>uman placental =actoen or sommamommamotropin >ormone for mammary land development. >as a
diabetoenic effect serves as insulin antaonist
7elaxin >ormone! causes softenin ;oints , bones
estroen
proestin
9. 3t serves as a protective barrier aainst some microoranisms >3B,>@B
*etal Stae K *etal /ro$th and DevelopmentL
%ntire prenancy days 299 256 days 3G "2 $ee&s
Differentiation of (rimary /erm layers
G
: %ndoderm
1
st
$ee& endoderm primary erm layer
'hyroid for basal metabolism
(arathyroid ! for calcium
'hymus development of immunity
=iver linin of upper 7' , /3'
: <esoderm development of heart, musculos&eletal system, &idneys and repro oran
: %ctoderm development of brain, s&in and senses, hair, nails, mucus membrane or anus , mouth
(ist timeste"
1
st
month ! @rain , heart development
/3', resp 'ract remains as sinle tube
1. *etal heart tone beins heart is the oldest part of the body
2. 2)S develops di11iness of mom due to hypolycemic effect
*ood of brain lucose complex 2>+ prenant $omans food .potato0
Second <onth
1. All vital orans formed, placenta developed
2. 2orpus luteum source of estroen , proesterone of infant life span end of 2
nd
month
3. Sex oran formed
". <econium is formed
'hird <onth
1. Qidneys functional
2. @uds of mil& teeth appear
3. *etal heart tone heard Doppler 16 12 $ee&s
". Sex is distinuishable
Secon! Timeste" *+2FS lenth of fetus
*ourth <onth
1. lanuo beins to appear
2. fetal heart tone heard fetoscope, 15 26 $ee&s
3. buds of permanent teeth appear
*ifth <onth
1. lanuo covers body
2. actively s$allo$s amniotic fluid
3. 1D 2- cm fetus,
". Muic&enin! 1
st
fetal movement. 15! 26 $ee&s primi, 19! 15 $&s multi
-. fetal heart tone heard $ith or $ithout instrument
Sixth <onth
1. eyelids open
2. $rin&led s&in
3. vernix caseosa present
T&i! timeste" (eriod of most rapid ro$th. *+2FS4 $eiht of fetus
Seventh <onth development of surfactant lecithin
%ihth <onth
1. lanuo bein to disappear
2. sub M fats deposit
3. )ails extend to finers
)inth <onth
1. lanuo , vernix caseosa completely disappear
2. Amniotic fluid decreases
'enth <onth bone ossification of fetal s&ull
5
Teato'ens, any dru, virus or irradiation, the exposure to such may cause damae to the fetus
A. Drus4
Streptomycin anti '@ , or Muinine .anti malaria0 damae to 5
th
cranial nerve poor hearin , deafness
'etracycline stainin tooth enamel, inhibit ro$th of lon bone
Bitamin Q hemolysis .destr of 7@20, hyperbilirubenia or ;aundice
3odides enlarement of thyroid or oiter
'halidomides Amelia or pocomelia, absence of extremities
Steroids cleft lip or palate
=ithium conenital malformation
@. Alcohol lo$ered $eiht .vasoconstriction on mom0, fetal alcohol $ithdra$al syndrome char by microcephaly
2. Smo&in lo$ birth rate
D. 2affeine lo$ birth rate
%. 2ocaine lo$ birth rate, abruption placenta
TORCH :Teato'enic; $nfections viruses
2>A7A2'%73S'32S4 roup of infections caused by oranisms that can cross the placenta or ascend throuh birth canal and
adversely affect fetal ro$th and development. 'hese infections are often characteri1ed by vaue, influen1a li&e findins, rashes and
lesions, enlared lymph nodes, and ;aundice .hepatic involvement0. 3n some chases the infection may o unnoticed in the prenant
$oman yet have devastatin effects on the fetus. '+72>4 'oxoplasmosis, +ther, 7ubella, 2ytomealo virus, >erpes simples virus.
' toxoplasmosis mom ta&es care of cats. *eces of cat o to ra$ veetables or meat
+ others. >epa A or infectious heap oral# fecal .hand $ashin0
>epa @, >3B blood , body fluids
Syphilis
7 rubella /erman measles conenital heart disease .1
st
month0 normal rubella titer 1416
?1416 less immunity to rubella, after delivery, mom $ill be iven rubella vaccine. Dont et prenant for 3 months.
Baccine is terratoenic
2 cytomealo virus
> herpes simplex virus
-$. %&ysiolo'ical A!aptation of t&e Mot&e to %e'nancy
A. Systemic C&an'es
1. 2ardiovascular System increase blood volume of mom .plasma blood0 36 -6R I 1-66 cc of blood
! easy fatiability, increase heart $or&load, sliht hypertrophy of ventricles, epistaxis due to
hyperemia of nasal membrane palpitation,
(hysioloic Anemia pseudo anemia of prenant $omen
Nomal -alues
>ct 32 "2R
>b 16.- 1"#d=
Citeia
1
st
and 3
rd
trimester.! patholoic anemia if lo$er
>2' should not be 33R, >b should not be ? 11#d=
2
nd
trimester >ct should not ?32R
>b ShdnAt ? 16.-R patholoic anemia if lo$er
%at&o'enic Anemia
! iron deficiency anemia is the most common hematoloical disorder. 3t affects touhly 26R of prenant $omen.
! Assessment reveals4
(allor, constipation
D
Slo$ed capillary refill
2oncave finernails .late sin of proressive anemia0 due to chronic physio hypoxia
)ursin 2are4
)utritional instruction &an&on, liver due to ferridin content, reen leafy veetable!alubati,saluyot, malunay,
horseradish, ampalaya
(arenteral 3ron . 3mferon0 severe anemia, ive 3<, O tract! if improperly administered, hematoma.
+ral 3ron supplements .ferrous sulfate 6.3 . 3 times a day0 empty stomach 1 hr before meals or 2 hrs after, blac& stool,
constipation
<onitor for hemorrhae
Alert4
3ron from red meats is better absorbed iron form other sources
3ron is better absorbed $hen ta&en $ith foods hih in Bit 2 such as orane ;uice
>iher iron inta&e is recommended since circulatin blood volume is increased and heme is reSuired from production of
7@2s
E!ema lo$er extremities due venous return is constricted due to lare belly, elevate les above hip level.
-aicosities pressure of uterus
! use support stoc&ins, avoid $earin &nee hih soc&s
! use elastic bandae lo$er to upper
!
-ul*a )aicosities! painful, pressure on ravid uterus, to relieve! position side lyin $ith pillo$ under hips or modified &nee chest
position
T&om*op&le*itis presence of thrombus at inflamed blood vessel
! prenant mom hyperfibrinoenemia
! increase fibrinoen
! increase clottin factor
! thrombus formation candidate
outstandin sin .H0 >omanAs sin pain on cuff durin dorsiflexion
mil& le s&inny $hite les due to stretchin of s&in caused by inflammation or phlamasia albadolens
<t4
1.0 @ed rest
2.0 )ever massae
3.0 Assess H >oman sin once only miht dislode thrombus
".0 /ive anticoaulant to prevent additional clottin .thrombolytics $ill dilute0
-.0 <onitor A('' antidote for >eparin toxicity, protamine sulfate
9.0 Avoid aspirinC <iht aravate bleedin.
2. 7espiratory system common problem S+@ due to enlared uterus , increase +2 demand
(osition! lateral expansion of luns or side lyin position.
3. /astrointestinal 1
st
trimester chane
Monin' Sic/ness nausea , vomitin due to increase >2/. %at dry crac&ers or dry 2>+ diet 36 minutes before arisin
bed. )ausea afternoon ! small freS feedin. Bomitin in pre emesisravida.
<etabolic al&alosis, *,% imbalance primary med mt replace fluids.
<onitor 3,+
constipation proesterone resp for constipation. 3ncrease fluid inta&e, increase fiber diet
! fruits papaya, pineapple, mano, $atermelon, cantaloupe, apple $ith s&in, suha.
%xcept uava has pectin thats constipatin ve petchy, malunay.
! exercise
!mineral oil excretion of fat soluble vitamins
16
7 (latulence avoid as formin food cabbae
: Heat*un or pyrosis reflux of stomach content to esophaus
! small freSuent feedin, avoid 3 full meals, avoid fatty , spicy food, sips of mil&, proper body mechanical
increase salivation ptyalsim mt mouth$ash
:Hemo&oi!s pressure of ravid uterus. <tP hot sit1 bath for comfort
". Frinary System freSuency durin 1
st
, 3
rd
trimester lateral expansion of luns or side lyin pos mt for nocturia
Acetyace test albumin in urine
@enedicts test suar in urine
-. <usculos&eletal
=ordosis pride of prenancy
8addlin /ait a$&$ard $al&in due to relaxation causes softenin of ;oints , bones
(rone to accidental falls $ear lo$ heeled shoes
=e 2ramps causes4 proloned standin, over fatiue, 2a , phosphorous imbalance.T1 cause $hile prenant0, chills, oversex,
pressure of ravid uterus .labor cramps0 at lumbo sacral nerve plexus
<t4 3ncrease 2a diet!mil&.3nc 2a , 3nc phosphorus0!1pint#day or 3!" servins#day. 2heese, yourt, head of fish,
Dilis, sardines $ith bones, brocolli, seafood!tahon .mussels0, lobster, crab.
Bit D for increased 2a absorption
dorsiflexion
B. Local C&an'es
=ocal chane4 Baina4
B 2had$ic&s sin blue violet discoloration of vaina
2 /oodelAs sin chane of consistency of cervix
3 >earAs chane of consistency of isthmus .lo$er uterine sement0
=%FQ+77>%A $hitish ray, mousy odor dischare
%S'7+/%) hormone, resp for leucorrhea
+(%72F=F< mucus plu to seal out bacteria.
(7+/%S'%7+)% hormone responsible for operculum
(7%/)A)' acidic to al&aline chane to protect bacterial ro$th .vainitis0
%o*lems Relate! to t&e C&an'e of -a'inal En)ionment"
a. -a'initits trichomonas vainalis due to al&aline environment of vaina of prenant mom
*laellated proto1oa $ants al&aline
S,Sx4
/reenish cream colored frothy irritatinly itchy $ith foul smellin odor $ith vainal edema
<t4
*=A/U= .metronida1ole antiproto1oa0. 2arcinoenic dru so dont ive at 1
st
trimester
1. treat dad also to prevent reinfection
2. no alcohol has antibuse effect
BA/3)A= D+F2>% 3M >2+ 4 1 tbsp $hite vinear
b. Moniliasis o can!i!iasis due to candida albecans, funal infection.
2olor $hite cheese li&e patches adheres to $alls of vaina.
Sins , Symptoms4
<anaement antifunal )istatin, enshan violet, cotrimaxole, canesten
/onorrhea !'hic& purulent dischare
Bainal $arts! condifoma acuminata due to papilloma virus
<t4 cauteri1ation
11
2. Abdominal 2hanes striae ravidarium .stretch mar&s0 due enlarin uterus!destruction of sub M tissue avoid scratchin,
use coconut oil, umbilicus is protrudin
3. S&in 2hanes bro$n pimentation nose chin, chee&s chloasma melasma due to increased melanocytes.
@ro$n pin&ish line! linea nira! symphisis pubis to umbilicus
". @reast 2hanes increase hormones, color of areola , nipple
pre colostrums present by 9 $ee&s, colostrums at 3
rd
trimester
@reast self exam! G days after mens supine $ith pillo$ at bac&
Suadrant @ upper outer common site of cancer
'est to determine breast cancer4
1. mammoraphy 3- to "D yrs once every 1 to 2 yrs
-6 yrs and above 1 x a yr
9. +varies rested durin prenancy
G. Sins , symptoms of (renancy
A. %esumpti)e s#s felt and observed by the mother but does not confirm positive dianosis of prenancy . Sub;ective
@. %o*a*le sins observed by the members of health team. +b;ective
2. %ositi)e Si'ns undeniable sins confirmed by the use of instrument.
@allotment sin of myoma
: H >2/ sin of > mole
! trans vainal ultrasound. %mpty bladder
! ultrasound full bladder
placental 'a!in' ratin#rade
o immature
1 slihtly mature
2 moderately mature
3 placental maturity
8hat is deposited in placenta $hich sinify maturity ! there is calcium
%esumpti)e %o*a*le %ositi)e
@reast chanes
Frinary freS
*atiue
Amenorrhea
<ornin sic&ness
%nlared uterus
2loasma
=inea nera
3ncreased s&in pimentation
Striae ravidarium
Muic&enin
/oodelAs! chane of consistency of cervix
2had$ic&s! blue violet discoloration of vaina
>earAs! chane of consistency of isthmus
%levated @@' due to increased proesterone
(ositive >2/ or .H0pre test
@allottement bouncin of fetus $hen lo$er uterine is tapped sharply
%nlared abdomen
@raxton >ic&s contractions painless irreular contractions
Fltrasound evidence
.sonoram0 full bladder
*etal heart tone
*etal movement
*etal outline
*etal parts palpable
B33. %syc&olo'ical A!aptation to %e'nancy .%motional response of mom 7eva 7ubin theory0
*irst 'rimester4 )o taninal sins , sx, surprise, ambivalence, denial sin of maladaptation to prenancy. Developmental tas& is to
accept bioloical facts of prenancy
*ocus4 bodily chanes of pre, nutrition
Second 'rimester tanible S,Sx. mom identifies fetus as a separate entity due to presence of Suic&enin, fantasy. Developmental
tas& accept ro$in fetus as baby to be nurtured.
>ealth teachin4 ro$th , development of fetus.
'hird 'rimester4 ! mom has personal identification on appearance of baby
12
Development tas&4 prepare of birth , parentin of child. >'4 responsible parenthood Vbabys =ayetteL best time to do
shoppin.
<ost common fear let mom listen to *>' to allay fear
=ama1e classes
-$$. %e,Natal -isit4
1. *reSuency of Bisit4 1
st
G months 1x a month
5 D months 2 x a month
16 once a $ee&
post term 2 x a $ee&
2. (ersonal data name, ae .hih ris& ? 15 , W3- yrs old0 record to determine hih ris& >@<7. >ome base moms record.
Sex . pseudocyesis or false prenancy on men , $omen0
2ouvade syndrome dad experiences $hat mom oes throuh lihi0
Address, civil status, reliion, culture , beliefs $ith respect, non ;udmental
+ccupation financial condition or occupational ha1ards, education bac&round level &no$lede
3. Dianosis of (renancy
1.0 urine exam to detect >2/ at "6 166
th
day. 96 G6 day pea& >2/. 9 $ee&s after =<(! best to et urine exam.
2.0 %lisa test test for pre detects beta subunit of >2/ as early as G 16days
3.0 >ome pre &it do it yourself
". @aseline Data4 B#S esp. @(, monitor $t. .increase $t 1
st
sin preeclampsia0
<ei'&t Monitoin'
*irst 'rimester4 )ormal 8eiht ain 1.- 3 lbs ..- 1lb#month0
Second trimester4 normal $eiht ain 16 12 lbs ." lbs#month0 .1 lb#$&0
'hird trimester4 normal $eiht ain 16 12 lbs ." lbs# month0 . 1lb#$&0
<inimum $t ain 26 2- lbs
+ptimal $t ain 2- 3- lbs
-. +bstetrical Data4
nullipara no prenancy
a. #a)i!a! T of prenancy
b. %aa ! T of viable prenancy
Biability the ability of the fetus to live outside the uterus at the earliest possible estational ae.
ae of viability ! 26 2" $&s
'erm 3G "2 $&s,
(reterm !26 3G $ee&s
abortion ?26 $ee&s
Sample 2ases4
1 abortion /'(A=
1 2
nd
mo 2 6 61 6
/ 2
( 6
1 "6
th
A+/ /' ( A =
1 39
th
A+/ 9 1 2 2 "
2 misc
1 t$ins 3- A+/
1 "
th
month /9 (3
1 3D
th
$ee&
1 miscarriae /( /'(A=
1 stillbirth 33 A+/ .considered as para0 " 2 " 11 1 1
1 pre 3
rd
$&
1 33 (
1 "1
st
=
1 abort A
1 still 3D /( /'(A=
1 triplet 32 9 " 9 2 2 1-
13
1 "
th
mon
c. 3mportant %stimates4
1. Na'ele=s Rule use to determine expected date of delivery
/et =<( !3H G H1 Apr!Dec =<( Xan *eb <ar
< D U HD HG no year
=<( Xan 2-, 6"
HD HG
16 # 32 # 6"
! 1
add 1 month to month
11#31#6" %DD
2. McDonal!=s Rule to determine ae of estation 3) 8%%QS
*F)D32 >' N G#5IA+/ in 8Q
*undic >t N G I A+/ in $ee&s
5
*r sypmhisis pubis to fundus 2" N G I21 $&s
5
3. Bat&olome6=s Rule to determine ae of estation by proper location of fundus at abdominal cavity.
3 months above sym pub
- months level of umbilicus
D months belo$ 1yphoid
16 months level of 5 months due to lihtenin
". Haases ule 0 to determine lenth of the fetus in cm.
*ormula4 1
st
E of pre , sSuare Y month
2
nd
E of pre, x Y month by -
3mos x 3 I Dcm
" mos x " I 19 cm 16 x - I -6 cm 1
st
E of pre
- x - I 2- cm
9 x - I 36 cm
G x - I 3- cm 2
nd
E of pre
5 x - I "6 cm
D x - I "- cm
d. tetanus immuni1ations prevents tetanus neonatum
!mom $ith complete 3 doses D(' youn ae considered as ''1 , 2. @ein ''3
''1 any time durin prenancy
''2 " $&s after ''1 3 yrs protection
''3 9 months after ''2 - yrs protection
''" 1 yr after ''3 16 yrs protection
''- yr after ''" lifetime protection
-. (hysical %xamination4
A. %xamine teeth4 sin of infection
Daner sins of (renancy
2 ! chills# fever ! infection
2erebral disturbances . headache preeclampsia0
A abdominal pain . epiastric pain aura of impendin convulsions
@ boardli&e abdomen abruption placenta
3ncrease @( >()
@lurred vision preeclampsia
@leedin 1
st
trimester, abortion, ectopic pre#2
nd
> mole, incompetent cervix
1"
3
rd
placental anomalies
S sudden ush of fluid (7+< .premature rupture of membrane0 prone to inf.
% edema to upper ext. .preeclampsia0
9. (elvic %xamination internal exam
1. empty bladder
2. universal precaution
%N' +S of cervix site for ettin specimen
Site for cervical cancer
%ap Smea cervical cancer
! composed of sSuamous columnar tissue
7esult4
2lass 3 ! normal
2lass 33A acytoloy but no evidence of malinancy
@ suestive of infl.
2lass 333 cytoloy suestive of malinancy
2lass 3B cytoloy stronly suestive of malinancy
2lass B cytoloy conclusive of malinancy
Sta'es of Ce)ical Cance
Stae 6 carcinoma insitu
1 cancer confined to cervix
2 ! cancer extends to vaina
3 pelvis metastasis
" affection to bladder , rectum
>. Leopol!=s Maneu)e
(urpose4 is done to determine the attitude, fetal presentation lie, presentin part, deree of descent, an estimate of the si1e,
and number of fetuses, position, fetal bac& , fetal heart tone
! use palmC 8arm palm.
(rep mom4
1. %mpty bladder
2. (osition of mom!supine $ith &nee flex .dorsal recumbent to relax abdominal muscles0
(rocedure4
2
st
maneu)e4 place patient in supine position $ith &nees slihtly flexedP put to$el under head and riht hipP $ith both hands palpate
upper abdomen and fundus. Assess si1e, shape, movement and firmness of the part to determine presentation
4
n!
Maneu)e" $ith both hands movin do$n, identify the bac& of the fetus . to hear fetal heart sound0 $here the ball of the
stethoscope is placed to determine *>'. /et B#S.before 2
nd
maneuver0 (7 to diff fundic soufflZ .*>70 , uterine soufflZ.
Fterine soufflZ maternal > rate
3
!
Maneu)e4 usin the riht hand, rasp the symphis pubis part usin thumb and finers.
'o determine deree of enaement.
Assess $hether the presentin part is enaed in the pelvis 0Alert 4 if the head is enaed it $ill not be movable0.
1
t&
Maneu)e" the %xaminer chanes the position by facin the patients feet. 8ith t$o hands, assess the descent of the presentin
part by locatin the cephalic prominence or bro$. 'o determine attitude relationship of fetus to 1 another.
8hen the bro$ is on the same side as the bac&, the head is extended. 8hen the bro$ is on the same side as the small parts, the head
$ill be flexed and vertex presentin.
Attitude relationship of fetus to a part or deree of flexion
*ull flexion $hen the chin touches the chest
1-
?.Assessment of (etal <ell,Bein',
A. Daily (etal Mo)ement Countin' :D(MC; 0bein 2G $ee&s
<om! bein after meal ! brea&fast
a. Ca!iff count to 28 met&o! one method currently available
.10 @ein at the same time each day .usually in the mornin, after brea&fast0 and count each fetal movement, notin ho$ lon it ta&es
to count 16 fetal movements .*<s0
.20 %xpected findins 16 movements in 1 hour or less
30 8arnin sins
a.0 more then 1 hour to reach 16 movements
b.0 less then 16 movements in 12 hours.non!reactive! fetal distress0
c.0 loner time to reach 16 *<s than on previous days
d.0 movement are becomin $ea&er, less viorous
<ovement alarm sinals ! ? 3 *<s in 12 hours
".0 $arnin sins should be reported to healthcare provider immediatelyP often reSuire further testin. %xamples4 nonstress test .)S'0,
bioraphical profile .@((0
@. Nonstess test to determine the response of the fetal heart rate to activity
3ndication prenancies at ris& for placental insufficiency
(ostmaturity
a.0 prenancy induced hypertension .(3>0, diabetes
b.0 $arnin sins noted durin D*<2
c.0 maternal history of smo&in, inadeSuate nutrition
%oce!ue"
Done $ithin 36 minutes $herein the mother is in semi!fo$lers position .$# fetal monitor0P external monitor is applied to document
fetal activityP mother activates the Kmar& buttonL on the electronic monitor $hen she feels fetal movement.
Attach external noninvasive fetal monitors
1. tocotans!uce over fundus to detect uterine contractions and fetal movements .*<s0
2. ultasoun! tans!uce over abdominal site $here most distinct fetal heart sounds are detected
3. monitor until at least 2 *<s are detected in 26 minutes
if no *< after "6 minutes provide $oman $ith a liht snac& or ently stimulate fetus throuh abdomen
if no *< after 1 hour further testin may be indicated, such as a 2S'
7esult4
)oncreative
)onstress
)ot /ood
7eactive
7esponsive is
7eal /ood
$ntepetation of esults
i. eacti)e esult
1. @aseline *>7 bet$een 126 and 196 beats per minute
2. At least t$o accelerations of the *>7 of at least 1- beats per minute, lastin at least 1- seconds in a 16 to 26 minute
period as a result of *<
3. /ood variability normal irreularity of cardiac rhythm representin a balanced interaction bet$een the
parasympathetic .decreases *>70 and sympathetic .increase *>70 nervous systemP noted as an uneven line on the
rhythm strip.
". result indicates a healthy fetus $ith an intact nervous system
ii. Noneacti)e esult
19
1. Stated criteria for a reactive result are not met
2. 2ould be indicative of a compromised fetus.
7eSuires further evaluation $ith another )S', biophysical profile, .@((0 or contraction stress test .2S'0
D. Healt& teac&in's
a. Nutition do nutritional assessment daily food inta&e
>ih ris& moms4
1. (renant teenaers lo$ compliance to heath reimen.
2. %xtremes in $t under$eiht, over $t candidate for >(), D<
3. =o$ socio economic status
". Beetarian mom decrease 2>+) needs Bit @12 cyanocobalamin formation of folic acid needed for cell D)A ,
7@2 formation. .Decrease folic acid spina bifida#open neural tube defect0
>o$ many Qcal 2>+ x",2>+) x", fats x D
Recommen!e! Nutient Re@uiement t&at inceases Duin' %e'nancy
Nutients Re@uiements (oo! Souce
Caloies
%ssential to supply enery for
! increased metabolic rate
! utili1ation of nutrients
! protein sparin so it can be used for
! /ro$th of fetus
! Development of structures reSuired
for prenancy includin placenta,
amniotic fluid, and tissue ro$th.
366 calories#day above the
preprenancy daily reSuirement to
maintain ideal body $eiht and meet
enery reSuirement to activity level
! @ein increase in second
trimester
! Fse $eiht ain pattern as an
indication of adeSuacy of calorie
inta&e.
! *ailure to meet caloric
reSuirements can lead to &etosis
as fat and protein are used for
eneryP &etosis has been
associated $ith fetal damae.
2aloric increase should reflect
! *oods of hih nutrient value such as
protein, complex carbohydrates .$hole
rains, veetables, fruits0
! Bariety of foods representin foods
sources for the nutrients reSuirin durin
prenancy
! )o more than 36R fat
%otein
%ssential for4
! *etal tissue ro$th
! <aternal tissue ro$th includin
uterus and breasts
! Development of essential prenancy
structures
! *ormation of red blood cells and
plasma proteins
: 3nadeSuate protein inta&e has been
associated $ith onset of prenancy induces
hypertension .(3>0
96 m#day or an increase of 16R
above daily reSuirements for ae
roup
Adolescents have a hiher protein
reSuirement than mature $omen since
adolescents must supply protein for
their o$n ro$th as $ell as protein t
meet the prenancy reSuirement
(rotein increase should reflect
! =ean meat, poultry, fish
! %s, cheese, mil&
! Dried beans, lentils, nuts
! 8hole rains
: veetarians must ta&e note of the amino acid
content of 2>+) foods consumed to ensure
inestion of sufficient Suantities of all amino
acids
Calcium,%&osp&oous
%ssential for
! /ro$th and development of fetal
s&eleton and tooth buds
! <aintenance of minerali1ation of
maternal bones and teeth
! 2urrent research is 4
Demonstratin an association bet$een
adeSuate calcium inta&e and the prevention
of prenancy induce hypertension
2alcium increases of
! 1266 m#day representin an
increase of -6R above
preprenancy daily reSuirement.
! 1966 m#day is recommended for
the adolescent. 16 mc#day of
vitamin D is reSuired since it
enhances absorption of both
calcium and phosphorous
2alcium increases should reflect4
! dairy products 4 mil&, yourt, ice cream,
cheese, e yol&
! $hole rains, tofu
! reen leafy veetables
! canned salmon , sardines $# bones
! 2a fortified foods such as orane ;uice
! Bitamin D sources4 fortified mil&,
mararine, e yol&, butter, liver,
seafood
$on
%ssential for
! %xpansion of blood volume and red
blood cells formation
36 m#day representin a doublin of
the prenant daily reSuirement
! @ein supplementation at 36!
m#day in second trimester, since
3ron increases should reflect
! liver, red meat, fish, poultry, es
! enriched, $hole rain cereals and
breads
1G
! %stablishment of fetal iron stores for
first fe$ months of life
diet alone is unable to meet
prenancy reSuirement
! 96 126 m#day alon $ith
copper and 1inc supplementation
for $omen $ho have lo$
hemolobin values prior to
prenancy or $ho have iron
deficiency anemia.
! G6 m#day of vitamin 2 $hich
enhances iron absorption
! inadeSuate iron inta&e results in
maternal effects anemia
depletion of iron stores, decreased
enery and appetite, cardiac stress
especially labor and birth
! fetal effects decreased availability
of oxyen thereby affectin fetal
ro$th
: iron deficiency anemia is the most
common nutritional disorder of
prenancy.
! dar& reen leafy veetables, leumes
! nuts, dried fruits
! vitamin 2 sources4 citrus fruits ,
;uices, stra$berries, cantaloupe,
broccoli or cabbae, potatoes
! iron from food sources is more
readily absorbed $hen served $ith
foods hih in vit 2
Ainc
%ssential for
: the formation of en1ymes
: maybe important in the prevention of
conenital malformation of the fetus.
1-mc#day representin an increase of
3 m#day over prepreanant daily
reSuirements.
Oinc increases should reflect
! liver, meats
! shell fish
! es, mil&, cheese
! $hole rains, leumes, nuts
(olic Aci!B (olacinB (olate
%ssential for
! formation of red blood cells and
prevention of anemia
! D)A synthesis and cell
formationP may play a role in the
prevention of neutral tube defects
.spina bifida0, abortion,
abruption placenta
"66 mc#day representin an increase
of more then 2 times the daily
preprenant reSuirement. 366mc#day
supplement for $omen $ith lo$ folate
levels or dietary deficiency
" servins of rains#day
3ncreases should reflect
! liver, &idney, lean beef, veal
! dar& reen leafy veetables, broccoli,
leumes.
! 8hole rains, peanuts
A!!itional Re@uiements
Mineals
! iodine
! <anesium
! Selenium
1G- mc#day
326 m#day
9- mc#day
3ncreased reSuirements of prenancy can
easily be met $ith a balanced diet that meets
the reSuirement for calories and includes food
sources hih in the other nutrients needed
durin prenancy.
-itamins
%
'hiamine
7iborlavin
(yridoxine . @90
@12
)iacin
16 m#day
1.- m#day
1.9 m#day
2.2 m#day
2.2 m day
1G m#day
Bit stored in body. 'a&in it not needed fat
soluble vitamins. >ard to excrete.
4.Sexual Acti)ity
a.0 should be done in moderation
b.0 should be done in private place
c.0 mom placed in comfy pos, sidelyin or mom on top
d.0 avoided 9 $ee&s prior to %DD
e.0 avoid blo$in or air durin cunnilinus
f.0 chanes in sexual desire of mom durin pre! air embolism
2hanes in sexual desire4
a.0 1
st
tri decrease desire due to bodily chanes
b.0 2
nd
trimester increased desire due to increase estroen that enhances lubrication
c.0 3
rd
trimester decreased desire
15
2ontraindication in sex4
1. vainal spottin
1
st trimester
threatened abortion
2
nd
trimester placenta previa
2. incompetent cervix
3. preterm labor
". premature rupture of membrane
3. Execise 0 to strenthen muscles used durin delivery process
! principles of exercise
1.0 Done in moderation. 2.0 <ust be individuali1ed
8al&in best exercise
SSuattin strenthen muscles of perineum. 3ncrease circulation to perineum. SSuat feet flat on floor
'ailor Sittin 1 le in front of other le . 3ndian seat0
7aise buttoc&s 1
st
before head to prevent postural hypotension di11iness $hen chanin position
! shoulder circlin exercise! strenthen chest muscles
! pelvic roc&in#pelvic tilt! exercise relieves lo$ bac& pain , maintain ood posture
! : arch bac& standin or &neelin. *our extremities on floor
Qeel %xercise strenthen pulococcyeal muscles
! as if hold urine, release 16x or muscle contraction
Abdominal %xercise strenthens muscles of abdominal done as if blo$in candle
1. C&il!*it& %epaation"
+verall oal4 to prepare parents physically and psycholoically $hile promotin $ellness behavior that can be used by parents and
family thus, helpin them achieved a satisfyin and en;oyin childbirth experience.
a. (sychophysical
1. Ba!ley Met&o! Dr. 7obert @radley advocated active participation of husband at delivery process. @ased on imitation of
nature.
*eatures4
1.0 dar&ened rm
2.0 Suiet environment
3.0 relaxation tech
".0 closed eye , appearance of sleep
2. #antly Dic/ Rea! Met&o! fear leads to tension $hile tension leads to pain
b. (sychosexual
1. 5it9in'e met&o! pre, labor , birth , care of ne$born is an impt turnin pt in $omans life cycle
! flo$ $ith contraction than strule $ith contraction
c. (sychoprophylaxis prevention of pain
1. Lama9e4 Dr. *erdinand =ama1e
reS. disciple, conditionin , concentration. >usband is coach
*eatures4
1. 2onscious relaxation
2. 2leansin breathe inhale nose, exhale mouth
3. %ffleurae entle circular massae over abdominal to relieve pain
". imain sensate focus
C. Diffeent Met&o!s of !eli)ey"
1.0 birthin chair bed convertible to chair semifo$lers
1D
2.0 birthin bed dorsal recumbent pos
3.0 sSuattin relives lo$ bac& pain durin labor pain
".0 leboyers $arm, Suiet, dar&, comfy room. After delivery, baby ets $arm bath.
-.0 @irth under >26 bathtub labor , delivery $arm $ater, soft music.
$D. $ntapatal Notes inside %7
A. Admittin the laborin <other4
(ersonal Data4 name, ae, address, etc
@aseline Data4 v#s esppecially @(, $eiht
+bstetrical Data4 ravida T pre, para! viable pre, 22 2" $&s
(hysical %xams,(elvic %xams
@. @asic &no$lede in 3ntrapartum.
b. 1 T&eoies of t&e Onset of La*o
1.0 uterine stretch theory . any hallo$ oran stretched, $ill al$ays contract , expel its content0 contraction action
2.0 oxytocin theory post pit land releases oxytocin. >ypothalamus produces oxytocin
3.0 prostalandin theory stimulation of arachidonic acid prostalandin! contraction
".0 proesterone theory before labor, decrease proesterone $ill stimulate contractions , labor
-.0 theory of ain placenta life span of placenta "2 $&s. At 39 $&s deenerates .leadin to contraction onset labor0.
b.2. 'he 1 %=s of la*o
2. %assen'e
a. (etal &ea! is the larest presentin part common presentin part J of its lenth.
Bones 0 9 bones S sphenoid * frontal ! sinciput
% ethmoid + occuputal ! occiput
' temporal ( parietal 2 x
<easurement fetal head4
1. transverse diameter D.2-cm
! biparietal larest transverse
! bitemporal 5 cm
2. bimastoid Gcm smallest transverse
Sutues 0 intermembranous spaces that allo$ moldin.
1.0 saittal suture connects 2 parietal bones . saitna0
2.0 coronal suture connect parietal , frontal bone .cro$n0
3.0 lambdoidal suture connects occipital , parietal bone
Mol!in's" the overlappin of the sutures of the s&ull to permit passae of the head to the pelvis
(ontanels"
1.0 Anterior fontanel brema, diamond shape, 3 x " cm,. W - cm hydrocephalus0, 12 15 months after birth! close
2.0 (osterior fontanel or lambda trianular shape, 1 x 1 cm. 2loses 2 3 months.
".0 Anteroposterior diameter !
suboccipitobrematic D.- cm, complete flexion, smallest A(
occipitofrontal 12cm partial flexion
occipitomental 13.- cm hyper extension submentobramatic!face presentation
2. %assa'e6ay
<om 1.0 ? "DL tall
2.0 ? 15 years old
3.0 Fnder$ent pelvic dislocation
(elvis
" main pelvic types
1. /ynecoid round, $ide, deeper most suitable .normal female pelvis0 for prenancy
2. Android heart shape Kmale pelvisL! anterior part pointed, posterior part shallo$
3. Anthropoid oval, ape li&e pelvis, oval shape, A( diameter $ider transverse narro$
". (latypelloid flat A( diameter narro$, transverse $ider
*. (elvis
26
2 hip bones 2 innominate bones
3 (arts of 2 3nnominate @ones
3leum lateral side of hips
! iliac crest flarin superior border formin prominence of hips
3schium inferior portion
! ischial tuberosity $here $e sit landmar& to et external measurement of pelvis
(ubes ant portion symphisis pubis ;unction bet$een 2 pubis
1 sacrum post portion sacral prominence landmar& to et internal measurement of pelvis
1 coccyx - small bones compresses durin vainal delivery
$mpotant Measuements
1. Diaonal 2on;uate measure bet$een sacral promontory and inferior marin of the symphysis pubis.
<easurement4 11.- cm ! 12.- cm basis in ettin true con;uate. .D2 11.- cmItrue con;uate0
2. 'rue con;uate#con;uate vera measure bet$een the anterior surface of the sacral promontory and superior marin of the
symphysis pubis. <easurement4 11.6 cm
3. +bstetrical con;uate smallest A( diameter. (elvis at 16 cm or more.
'uberoischi Diameter transverse diameter of the pelvic outlet. 3schial tuberosity approximated $ith use of fist 5 cm ,
above.
3. %o6e 0 the force actin to expel the fetus and placenta myometrium po$ers of labor
a. 3nvoluntary 2ontractions
b. Boluntary bearin do$n efforts
c. 2haracteristics4 $ave li&e
d. 'imin4 freSuency, duration, intensity
1. %syc&e/%eson 0 psycholoical stress $hen the mother is fihtin the labor experience
a. 2ultural 3nterpretation
b. (reparation
c. (ast %xperience
d. Support System
%e,eminent Si'ns of La*o
S,Sx4
! shootin pain radiatin to the les
! urinary freS.
1. =ihtenin settin of presentin part into pelvic brim ! 2 $ee&s prior to %DD
: %naement! settin of presentin part into pelvic inlet
2. @raxton >ic&s 2ontractions painless irreular contractions
3. 3ncrease Activity of the <other! nestin instinct. Save enery, $ill be used for delivery. 3ncrease epinephrine
". 7ipenin of the 2ervix butter soft
-. decreased body $t 1.- 3 lbs
9. @loody Sho$ pin&ish vainal dischare blood , leu&orrhea
G. 7upture of <embranes rupture of $ater. 2hec& *>'
%ematue Ruptue of Mem*ane : %ROM; , do 3% to chec& for cord prolapse
2ontraction drop in intensity even thouh very painful
2ontraction drop in freSuently
Fterus tense and#or contractin bet$een contractions
Abdominal palpations
)ursin 2areP
Administer Analesics .<orphine0
Attempt manual rotation for 7+( or =+( most common malposition
@ear do$n $ith contractions
AdeSuate hydration prepare for 2S
Sedation as ordered
2esarean delivery may be reSuired, especially if fetal distress is noted
21
Co! %olapse a complication $hen the umbilical cord falls or is $ashed throuh the cervix into the vaina.
Daner sins4
(7+<
(resentin part has not yet enaed
*etal distress
(rotrudin cord form vaina
)ursin care4
1. 2over cord $ith sterile au1e $ith saline to prevent dryin of cord so cord $ill remain slippery , prevent cord compression
causin cerebral palsy.
2. Slip cord a$ay from presentin part
3. 2ount pulsation of cord for *>'
". (rep mom for 2S
(ositionin trendelenber or &nee chest position
%motional support
(repare for 2esarean Section
Diffeence Bet6een Tue La*o an! (alse La*o
*alse =abor 'rue =abor
3rreular contractions
)o increase in intensity
(ain confined to
abdomen
(ain relived by $al&in
)o cervical chanes
2ontractions are reular
3ncreased intensity
(ain beins lo$er bac& radiates to abdomen
(ain intensified by $al&in
2ervical effacement , dilatation : ma;or sx
of true labor.
Duation of La*o
(rimipara 1" hrs , not more than 26 hrs
<ultipara 5 hrs , not W 1" hrs
Effacement softenin , thinnin of cervix. Fse R in unit of measurement
Dilation $idenin of cervix. Fnit used is cm.
Nusin' $nte)entions in Eac& Sta'e of La*o
2 sements of the uterus
1. upper uterine ! fundus
2. lo$er uterine isthmus
1. (ist Sta'e" onset of true contractions to full dilation and effacement of cervix.
=atent (hase4
Assessment4 Dilations4 6 3 cm mom excited, apprehensive, can communicate
*reSuency4 every - 16 min
3ntensity mild
)ursin 2are4
1. %ncourae $al&in ! shorten 1
st
stae of labor
2. %ncourae to void S 2 3 hrs full bladder inhibit contractions
3. @reathin chest breathin
Active (hase4
Assessment4 Dilations " !5 cm 3ntensity4 moderate <om! fears losin control of self
*reSuency S 3!- min lastin for 36 96 seconds
)ursin 2are4
< edications have meds ready
A ssessment include4 vital sins, cervical dilation and effacement, fetal monitor, etc.
D dry lips oral care .ointment0
22
dry linens
@ abdominal breathin
'ransitional (hase4 intensity4 stron <om mood chanes $ith hyperesthesia
Assessment4 Dilations 5 16 cm
*reSuency S 2!3 min contractions
Durations "- D6 seconds
>yperesthesia increase sensitivity to touch, pain all over
>ealth 'eachin 4 teach4 sacral pressure on lo$er bac& to inhibit transmission of pain
&eep informed of proress
controlled chest breathin
)ursin 2are4
' ires
3 nform of proress
7 estless support her breathin techniSue
% ncourae and praise
D iscomfort
%el)ic Exams
%ffacement
Dilation
a. Station 0 landmar& used4 ischial spine
! 1 station I presentin part 1cm above ischial spine if .!0 floatin
! 2 station I presentin part 2 cm above ischial spine if .!0 floatin
6 station I level at ischial spine enaement
H 1 station I belo$ 1 cm ischial spine
H3 to H- I cro$nin occurs at 2
nd
stae of labor
*. %esentation/lie the relationship of the lon axis .spine0 of the fetus to the lon axis of the mother
!spine of mom and spine of fetus
T6o types"
b.1. =onitudinal =ie . (arallel0
cephalic ! Bertex complete flexion
*ace
@ro$ %oo (lexion
2hin
@reech ! 2omplete @reech thih breast on abdomen, breast lie on thih
3ncomplete @reech thih rest on abdominal
*ran& les extend to head
*ootlin sinle, double
Qneelin
b.2. 'ransverse =ie .(erpendicular0 or (erpendicular lie. Shoulder presentation.
c. %osition 0 relationship of the fatal presentin part to specific Suadrant of the mothers pelvis.
Bariety4
+ccipito =+A left occipito ant .most common and favorable position0 side of maternal pelvis
=+( left occipito posterior
=+( most common mal position, most painful
7+( sSuattin pos on mom
7+'
7+A
@reech! use sacrum =SA left sacro anterior
! put stet above umbilicus =S', =S(, 7SA, 7S', 7S(
S&oul!e/acomnio!oso
=ADA, =AD', =AD(, 7ADA
23
C&in / Mento
=<A, =<', =<(, 7<(, 7<A, 7<', 7<(
Monitoin' t&e Contactions an! (etal &eat Tone
Spread finers lihtly over fundus to monitor contractions
%ats of contactions4
3ncrement or crescendo beinnin of contractions until it increases
Acme or apex heiht of contraction
Decrement or decrescendo from heiht of contractions until it decreases
Duration beinnin of contractions to end of same contraction
3nterval end of 1 contraction to beinnin of next contraction
*reSuency beinnin of 1 contraction to beinnin of next contraction
3ntensity ! strenth of contraction
2ontraction vasoconstriction
3ncrease @(, decrease *>'
@est time to et @( , *>' ;ust after a contraction or mid$ay of contractions
(lacental reserve 96 sec o2 for fetus durin contractions
Duration of contractions shouldnt W96 sec
)otify <D
<om has headache chec& @(, if same @(, let mom rest. 3f @( increase , notify <D !preeclampsia
Healt& teac&in's
1.0 +& to sho$er
2.0)(+ /3' stops function durin labor if $ith food! $ill cause aspiration
3.0%nema administer durin labor
a.0'o cleanse bo$el
b.0(revent infection
c.0Sims position#side lyin
12 15 inch ht enema tubin
2hec& *>' after adm enema
)ormal *>'I 126!196
Sins of fetal distress!
1.0 ?126 , W196
2.0 mecomium stain amnion fluid
3.0 fetal thrushin hyperactive fetus due to lac& +2
2. Secon! Sta'e4 fetal stae, complete dilation and effacement to birth.
G 5 multi brin to delivery room
16cm primi brin to delivery room
=ithotomy pos put les same time up
@ulin of perineum sure to come out
@reathin pantin . teach mom0
Assist doc in doin episiotomy! to prevent laceration, $iden vainal canal, shorten 2
nd
stae of labor.
%pisiotomy median less bleedin, less pain easy to repair, fast to heal, possible to reach rectum . urethroanal fistula0
<ediolateral more bleedin , pain, hard to repair, slo$ to heal
!use local or pudendal anesthesia.
3ronin the perineum to prevent laceration
<odified 7itens maneuver place to$el at perineum
1.0'o prevent laceration
2.0 8ill facilitate complete flexion , extension. .Support head , remove secretion, chec& cord if coiled. (ull shoulder do$n , up.
2hec& time, identification of baby.
Mec&anisms of la*o
1. %naement !
2"
2. Descent
3. *lexion
". 3nternal 7otation
-. %xtension
9. %xternal rotation
G. %xpulsion
T&ee pats of %el)is 1. 3nlet A( diameter narro$, transverse diameter $ider
2. 2avity
T6o Ma+o Di)isions of %el)is
1. 'rue pelvis belo$ the pelvic inlet
2. *alse pelvis above the pelvic inletP supports uterus durin prenancy
Linea Teminales diaonal imainary line from the sacrum to the symphysis pubis that divides the false and true pelvis.
)ursin 2are4
'o prevent puerperal sepsis ! ? "5 hours only vainal pac&
@olus of (tocin can lead to hypotension.
3. T&i! Sta'e" *it& to expulsion of %lacenta ,placental stae placenta has 1- 25 cotyledons
(lacenta delivered from 3!16 minutes
Si'ns of placental sepaation
1. *undus rises becomes firm , lobular K 2al&ins sinL
2. =enthenin of the cord
3. Sudden ush of blood
'ypes of placental delivery
S&ult9 KshinyL beins to separate from center to edes presentin the fetal side shiny
Dun/an KdirtyL bein to separate form edes to center presentin natural side beefy red or dirty
Slo$ly pull cord and $ind to clamp @7A)D' A)D7%8S <A)%FB%7
>urryin of placental delivery $ill lead to inversion of uterus.
)s care for placenta4
". 2hec& completeness of placenta.
-. 2hec& fundus .if relaxed, massae uterus0
9. 2hec& bp
G. Administer metherine 3< .<ethyleronovine <aleate0 K%rotrate derivatives
5. <onitor hpn .or ive oxytocin 3B0
D. 2hec& perineum for lacerations
16. Assist <D for episiorapy
11. *lat on bed
12. 2hills!due dehydration. @lan&et, ive clear liSuid!tea, iner ale, clear elatin. =et mom sleep to reain enery.
". (out& Sta'e" t&e fist 2,4 &ous afte !eli)ey of placenta recovery stae. <onitor v#s S 1- for 1 hr. 2
nd
hr S 36 minutes.
2hec& placement of fundus at level of umbilicus.
3f fundus above umbilicus, deviation of fundus
1.0 %mpty bladder to prevent uterine atony
2.0 2hec& lochia
a. <aternal +bservations body system stabili1es
b. (lacement of the *undus
c. =ochia
d. (erineum
7 ! edness
%! dema
% ! cchemosis
2-
D ischares
A approximation of blood loss. 2ount pad , saturation
*ully soa&ed pad 4 36 "6 cc $eih pad. 1 ramI1cc
e. @ondin interaction bet$een mother and ne$born roomin in types
1.0 Straiht roomin in baby4 2"hrs $ith mom.
2.0 (artial roomin in4 baby in mornin , at niht nursery
Complications of La*o
Dystocia difficult labor related to4
<echanical factor due to uterine inertia sluishness of contraction
1.0 hypertonic or primary uterine inertia
! intense excessive contractions resultin to ineffective pushin
! <D administer sedative valium,#dia1epam muscle relaxant
2.0 hypotonic secondary uterine inertia! slo$ irreular contraction resultin to ineffective pushin. /ive oxytocin.
(roloned labor normal lenth of labor in primi 1" 26 hrs
<ulti 16 !1" hrs
W 1" hrs in multi , W 26 hrs in primi
! maternal effect exhaustion. *etal effect fetal distress, caput succedaneum or cephal hematoma
! ns care4 monitor contractions and *>7
%ecipitate La*o , labor of ? 3 hrs. extensive lacerations, profuse bleedin, hypovolemic shoc& if $ith bleedin.
%arliest sin4 tachycardia , restlessness
=ate sin4 hypotension
+utstandin )ursin dx4 fluid volume deficit
(ost of mom modified trendelenber
3B fast drip due fluid volume def
Sins of >ypovolemic Shoc&4
>ypotension
'achycardia
'achypnea
2old clammy s&in
3nversion of the uterus situation uterus is inside out.
<D $ill push uterus bac& inside or not hysterectomy.
*actors leadin to inversion of uterus
1.0 short cord
2.0 hurryin of placental delivery
3.0 ineffective fundal pressure
.teine Ruptue
2auses4 1.0
1.0(revious classical 2S
2.0=are baby
3.0 3mproper use of oxytocin .3B drip0
Sx4
a.0 sudden pain
b.0 profuse bleedin
c.0 hypovolemic shoc&
d.0 'A>@S+
(hysioloic retraction rin
! @oundary bet upper#lo$er uterine sement
@A)D=S patholoic rin suprapubic depression
a.0 sin of impendin uterine rupture
29
Amniotic (lui! Em*olism or placental embolism amniotic fluid or framents of placenta enters natural circulation resultin to
embolism
Sx4
dyspnea, chest pain , frothy sputum
prepare4 suctionin
end stae4 D32 disseminated intravascular coaopathy! bleedin to all portions of the body eyes, nose, etc.
Tial La*o measurement of head , pelvis falls on borderline. <om iven 9 hrs of labor
<ulti4 5 1", primi 1" 26
%etem La*o 0 labor after 26 3G $ee&s0 . abortion ?26 $ee&s0
Sx4
1. premature contractions S 16 min
2. effacement of 96 56R
3. dilation 2!3 cm
>ome <t4
1. complete bed rest
2. avoid sex
3. empty bladder
". drin& 3 !" lasses of $ater full bladder inhibits contractions
-. consult <D if symptoms persist
>osp4
1. 3f cervix is closed 2 3 cm, dilation saved by administer 'ocolytic aents! halts preterm contractions.UF'+(A7!
Uutopar >cl0
1-6m incorporated -66cc Dextrose piybac&.
<onitor4 *>' W 156 bpm
<aternal @( ! ?D6#96
2rac&les notify <D pulmo edema administer oral yutopar 36 minutes before d#c 3B
'ocolytic .(hil0
'erbuthaline .@ricanyl or @rethine0 sustained tachycardia
Antidote propranolol or inderal ! beta!bloc&er
3f cervix is open <D steroid dextameth1one .betametha1one0 to facilitate surfactant maturation preventin 7DS
(reterm!cut cord ASA( to prevent ;aundice or hyperbilirubenia.
D. %ostpatal %eio! -
th
stae of labor
after 2"hrs 4)ormal increase 8@2 up to 36,666 cumm
(uerperium covers 1
st
9 $&s post partum
3nvolution return of repro oran to its non prenant state.
>yperfibrinoenia
! prone to thrombus formation
! early ambulation
(rinciples underlyin puerperium
1. 'o return to )ormal and *acilitate healin
A. (hysioloic 2hanes
a.1. Systemic 2hanes
1. 2ardiovascular System
! the first fe$ minutes after delivery is the most critical period in mothers because the increased in plasma volume return to its normal
state and thus addin to the $or&load of the heart. 'his is critical especially to ravidocardiac mothers.
2. /enital tract
a. 2ervix cervical openin
2G
b. Bainal and (elvic *loor
c. Fterus return to normal 9 5 $&s. *undus oes do$n 1 finer breath#day until 16
th
day no loner palpable due behind symphisis
pubis
3 days after post partum4 sub involuted uterus delayed healin uterus $ith bi clots of blood! a medium for bacterial ro$th!
.puerperal sepsis0! D,2
after, birth pain4
1. position prone
2. cold compress to prevent bleedin
3. mefenamic acid
d. Loc&ia!bld, $bc, deciduas, microoranism. )sd , 2s $ith lochia.
1. 7uba red 1
st
3 days present, musty#mousy, moderate amt
2. Serosa pin& to bro$n " D
th
day, limited amt
3. Alba crme $hite 16 21 days very decreased amt
dysuria
! urine collection
! alternate $arm , cold compress
! stimulate bladder
3. Frinary tract4 @ladder freS in urination after delivery! urinary retention $ith overflo$
". 2olon4 2onstipation due )(+, fear of bearin do$n
-. (erineal area painful episiotomy site sims pos, cold compress for immediate pain after 2" hrs, hot sit1 bath, not compress
sex! $hen perineum has healed
$$. %o)i!e Emotional Suppot 7eva 7ubia
(sycholoical 7esponses4
a. 'a&in in phase dependent phase .1
st
three days0 mom passive, cant ma&e decisions, activity is to tell child birth
experiences.
)ursin 2are4 ! proper hyiene
b. 'a&in hold phase dependent to independent phase ." to G days0. <om is active, can ma&e decisions
>'4
1.0 2are of ne$born
2.0 3nsert family plantin method
common post partum blues# baby blues present " - days -6!56R moms over$helmin feelin of depression characteri1ed by
cryin, despondence! inability to sleep , lac& of appetite. let mom cry therapeutic.
c. =ettin o interdependent phase G days , above. <om ! redefines ne$ roles may extend until child ro$s.
$$$. %e)ent complications
1. Hemo&a'e bleedin of W -66cc
2S 966 566 cc normal
)SD -66 cc
3. %arly postpartum hemorrhae bleedin $ithin 1
st
2" hrs. @ay or relaxed uterus , profuse bleedin uterine atony.
2omplications4 hypovolemic shoc&.
<t4
1.0 massae uterus until contracted
2.0 cold compress
3.0 modified trendelenber
".0 3B fast drip# oxytocin 3B drip
1
st
deree laceration affects vainal s&in , mucus membrane.
2
nd
deree 1
st
deree H muscles of vaina
3
rd
deree 2
nd
deree H external sphincter of rectum
"
th
deree 3
rd
deree H mucus membrane of rectum
@reast feedin post pit land $ill release oxytocin so uterus $ill contract.
25
8ell contracted uterus H bleedin I laceration
! assess perineum for laceration
! deree of laceration
! mt episiorapy
D32 Disseminated 3ntravascular 2oaulopathy. >ypofibrinoen! failure to coaulate.
! bleedin to any part of body
! hysterectomy if $ith abruption placenta
mt4 @'! cryoprecipitate or fresh fro1en plasma
33. Late %ostpatum &emo&a'e bleedin after 2" hrs retained placental framents
<t4 D,2 or manual extraction of framents , massain of uterus. D,2 except placenta increta, percreta,
Acreta attached placenta to myometrium.
3ncreta deeper attachment of placenta to myometrium hysterectomy
(ercreta invasion of placenta to perimetrium
>ematoma bluish or purple discoloration of SM tissue of vaina or perineum.
! too much manipulation
! lare baby
! pudendal anesthesia
<t4
1.0 cold compress every 36 minutes $ith rest period of 36 minutes for 2" hrs
2.0 shave
3.0 incision on site, scrapin , suturin
$nfection! sources of infection
1.0endoenous from $ithin body
2.0 exoenous from outside
1.0 anaerobic streptococci most common ! from members health team
2.0 unhealthy sexual practices
/eneral sins of inflammation4
1. 3nflammation calor .heat0, rubor .red0, dolor .pain0 tumor.s$ellin0
2. purulent dischares
3. fever
/en mt4
1.0 supportive care 2@7, hydration, 'S@, cold compress, paracetamol, B3'2, culture , sensitivity for antibiotic
proloned use of antibiotic lead to funal infection
inflammation of perineum see eneral sins of inflammation
2 to 3 stitches dislocated $ith purulent dischare
<t4
7emoval of sutures , drainae, saline, bet$een , resultin.
%ndometriosis inflammation of endometrial linin
Sx4
Abdominal tenderness, pos.
*o$lers to facilitate drainae , locali1e infection oxytocin , antibiotic
$-. Moti)ate t&e use of (amily %lannin'
1.0 determine ones o$n beliefs 1
st
2.0 never advice a permanent method of plannin
3.0 method of choice is an individuals choice.
Natual Met&o! the only method accepted by the 2atholic 2hurch
Billin's / Ce)ical mucus test spinnbar&eit , fernin .estroen0
! clear, $atery, stretchable, elastic lon spinnbar&eit
Basal Bo!y Tempeatue 13
th
day temp oes do$n before ovulation no sex
! et before arisin in bed
LAM lactation amenorrheal method hormone that inhibits ovulation is prolactin.
2D
breast feedin! menstruation $ill come out " 9 months
bottle fed 2 3 months
disadvantae of lam miht et prenant
Symptot&emal 0 combination of @@' , cervical. @est method
Social <ethod 1.0 coitus interuptus# $ithdra$al ! least effective method
2. coitus reservatus sex $ithout e;aculation
3. coitus interfemora KipitL
". calendar method
+BF=A'3+) count minus 1" days before next mens .1" days before next mens0
+rio&nause formula
! monitor cycle for 1 year
! !et short test , lonest cycle from Xan Dec
! shortest 15
! lonest 11
Xune 29 Dec 33
! 15 !11
5 ! 22 unsafe days
21 day pill! start -
th
day of mens
25day pill! start 1
st
day of mens
missed 1 pill ta&e 2 next day
(hysioloic <ethod!
%ills combined oral contraceptives prevent ovulation by inhibitin the anterior pituitary land production of *S> and => $hich are
essential for the maturation and rupture of a follicle. DD.DR effective. 8aitin time to become prenant! 3 months. 2onsult +@!9mos.
Alerts on +ral 2ontraceptive4
!in case a mother $ho is ta&in an oral contraceptive for almost lon time plans to have a baby, she $ould $ait for at least 3 months
before attemptin to conceive to provide time for the estroen and proesterone levels to return to normal.
! if a ne$ oral contraceptive is prescribed the mother should continue ta&in the previously prescribed contraceptive and bein ta&in
the ne$ one on the first day of the next menses.
! discontinue oral contraceptive if there is sins of severe headache as this is an indication of hypertension associated $ith increase
incidence of 2BA and subarachnoid hemorrhae.
Si'ns of &ypetension
3mmediate Discontinuation
A abdominal pain
2 chest pain
> ! headache
% eye problems
S severe le cramps
3f mom >() stop pills S'A'C
Adverse effect4 brea&throuh bleedin
2ontraindicated4
1.0 chain smo&er
2.0 extreme obesity
3.0 >()
".0 D<
-.0 'hrombophlebitis or problems in clottin factors
! if forotten for one day, immediately ta&e the forotten tablet plus the tablet scheduled that day. 3f forotten for t$o
consecutive days, or more days, use another method for the rest of the cycle and the start aain.
D<(A depoproveda has proesterone inhibits => inhibits ovulation
36
Depomedroxy proesterone acetate 3< S 3 months
! never massae in;ected site, it $ill shorten duration
)orplant has 9 match stic&s li&e capsules implanted subdermally containin proesterone.
! - yrs disadvantae if &eloid s&in
! as soon as removed can become prenant
<echanism and 2hemical @arriers
$ntauteine De)ice :$.D;
Action4 prevents implantation affects motility of sperm , ovum
! riht time to insert is after delivery or durin menstruation
primary indication for use of 3FD
! parity or T of children, if 1 &id only dont use 3FD
>'4
1.0 2hec& for strin daily
2.0 <onthly chec&up
3.0 7eular pap smear
AlertsP
! prevents implantation
! most common complications4 excessive menstrual flo$ and expulsion of the device .common problem0
! others4
% eriod late .prenancy suspected0
Abnormal spottin or bleedin
A bdominal pain or pain $ith intercourse
$ nfection .abnormal vainal dischare0
N ot feelin $ell, fever, chills
S trins lost, shorter or loner
Fterine inflammation, uterine perforation, ectopic prenancy
Con!om latex inserted to erected penis or lubricated vaina
AdvP ives hihest protection aainst S'D female condom
Alerts4
Disadvantae4
! it lessen sexual satisfaction
! it ives hiher protection in the prevention of S'Ds
Diap&a'm rubberi1ed dome shaped material inserted to cervix preventin sperm to et to the uterus. 7%B%7SA@=%
>t4
1.0 proper hyiene
2.0 chec& for holes before use
3.0 must stay in place 9 5 hrs after sex
".0 must be refitted especially if $ithout $t chane 1- lbs
-.0 spermicide chem. @arrier ex. *oam .most effective0, ;ellies, creams
S#effect4 'oxic shoc& syndrome
Alerts4 Should be &ept in place for about 9 5 hours
Ce)ical Cap most durable than diaphram no need to apply spermicide
2#34 abnormal pap smear
(oamsB EelliesB Ceams
Surical <ethod @'= , @ilateral 'ubal =iation can be reversed 26R chance. >'4 avoid liftin heavy ob;ects
-asectomy cut vas deferense.
>'4 W36 e;aculations before safe sex
+ 1ero sperm count, safe
31
D$. Hi'& Ris/ %e'nancy
2. Hemo&a'ic Diso!es
/eneral <anaement
1.0 2@7
2.0 Avoid sex
3.0 Assess for bleedin .per pad 36 "6cc0 .$t 1m I1cc0
".0 Fltrasound to determine interity of sac
-.0 Sins of >ypovolemic shoc&
9.0 Save dischares for histopatholoy to determine if product of conception has been expelled or not
(ist Timeste Blee!in' abortion or eptopic
A. Abortions termination of prenancy before ae of viability .before 26 $ee&s0
Spontaneous A*otion, miscarriae
2ause4 1.0 chromosomal alterations
2.0 blihted ovum
3.0 plasma erm defect
2lassifications4
a. 'hreatened prenancy is ;eopardi1ed by bleedin and crampin but the cervix is closed
b. 3nevitable moderate bleedin, crampin, tissue protrudes form the cervix .2ervical dilation0
Types"
1.0 2omplete all products of conception are expelled. )o mt ;ust emotional supportC
2.0 3ncomplete (lacental and membranes retained. <t4 D,2
3ncompetent cervix abortion
<cDonalds procedure temporary circlae on cervix
S#%P infection. Durin delivery, circlae is removed. )SD
Sheridan permanent surery cervix. 2S
c. >abitual 3 or more consecutive prenancies result in abortion usually related to incompetent cervix. (resent 2
nd
trimester
d. <issed fetus diesP product of conception remain in uterus " $ee&s or lonerP sins of prenancy cease. .!0 pre test, scanty
dar& bro$n bleedin
<t4 induced labor $ith oxytocin or vacuum extraction
-.0 3nduced Abortion therapeutic abortion to save life of mom. Double effect choose bet$een lesser evil.
2. Ectopic %e'nancy occurs $hen estation is located outside the uterine cavity. common site4 tubal or ampular
Danerous site ! interstitial
Fnruptured 'ubal rupture
! missed period
! abdominal pain $ithin 3 !- $ee&s of missed period
.maybe enerali1ed or one sided0
! scant, dar& bro$n, vainal bleedin

)ursin care4
Bital sins
Administer 3B fluids
<onitor for vainal bleedin
<onitor 3 , +
! sudden , sharp, severe pain . Fnilateral radiatin to
shoulder.
shoulder pain .indicative of intraperitoneal bleedin that extends
to diaphram and phrenic nerve0
H 2ullens Sin bluish tined umbilicus sinifies intra
peritoneal bleedin
syncope .faintin0
<t4
Surery dependin on side
+vary4 oophrectomy
Fterus 4 hysterectomy

Secon! timeste *lee!in'
2. Hy!ati!ifom Mole Kbunch or rapesL or estational trophoblastic disease. $ith fertili1ation. (roressive deeneration of
chorionic villi. 7ecurs.
32
! estational anomaly of the placenta consistin of a bunch of clear vesicles. 'his neoplasm is formed form the sellin of the chronic
villi and lost nucleus of the fertili1ed e. 'he nucleus of the sperm duplicates, producin a diploid number "9 NN, it ro$s ,
enlares the uterus vary rapidly.
Fse4 methotrexate to prevent choriocarcinoma
Assessment4
%arly sins ! vesicles passed thru the vaina
>yperemesis ravidarium increase >2/
*undal heiht
Bainal bleedin. scant or profuse0
%arly in prenancy
>ih levels of >2/
(reeclampsia at about 12 $ee&s
=ate sins hypertension before 26
th
$ee&
Besicles loo& li&e a K sno$stormL on sonoram
Anemia
Abdominal crampin
Serious complications hyperthyroidism
(ulmonary embolus
)ursin care4
(repare D,2
Do not ive oxytoxic drus
'eachins4
a. 7eturn for pelvic exams as scheduled for one year to monitorin >2/ and assess for enlared uterus and risin titer
could indicative of choriocarcinoma
b. Avoid prenancy for at least one year
T&i! Timeste Blee!in' F%lacenta AnomaliesG
D. %lacenta %e)ia it occurs $hen the placenta is improperly implanted in the lo$er uterine sement, sometimes coverin the
cervical os. Abnormal lo$er implantation of placenta.
! candidate for 2S
Sx4 fran&
@riht red
(ainless bleedin
Dx4
Fltrasound
Avoid4 sex, 3%, enema may lead to sudden fetal blood loss
Double set up4 delivery room may be converted to +7
Assessment4
%naement .usually has not occurred0
*etal distress
(resentation . usually abnormal0
Sureon in chare of sin consent, 7) as $itness
! <D explain to patient
complication4 sudden fetal blood loss
)ursin 2are
)(+
@ed rest
(repare to induce labor if cervix is ripe
Administer 3B
%. A*uptio %lacenta it is the premature separation of the placenta form the implantation site. 3t usually occurs after the
t$entieth $ee& of prenancy.
+utstandin Sx4 dar& red, painful bleedin, board li&e or riid uterus.
Assessment4
2oncealed bleedin .retroplacental0
2ouvelaire uterus .caused by bleedin into the myometrium0!inability of uterus to contract due to hemorrhae.
Severe abdominal pain
Droppin coaulation factor .a potential for D320
33
2omplications4
Sudden fetal blood loss
!placenta previa , vasa previa
)ursin 2are4
3nfuse 3B, prepare to administer blood
'ype and crossmatch
<onitor *>7
3nsert *oley
<easure blood lossP count pads
7eport s#sx of D32
<onitor v#s for shoc&
Strict 3,+
*. (lacenta succenturiata 1 or 2 more lobes connected to the placenta by a blood vessel may lead to retained placental
framents if vessel is cut.
/. (lacenta 2ircumvalata fetal side of placenta covered by chorion
>. (lacenta <arinata fold side of chorion reaches ;ust to the ede of placenta
3. @attledore (lacenta cord inserted marinally rather then centrally
X. (lacenta @ipartita placenta divides into 2 lobes
Q. Bilamentous 3nsertion of cord! cord divides into small vessels before it enters the placenta
=. Basa (revia velamentous insertion of cord has implanted in cervical +S
4. Hypetensi)e Diso!es
3. %e'nancy $n!uce! Hypetension :%$H0! >() after 2" $&s of prenancy, solved 9 $ee&s post partum.
1.0 /estational hypertension ! >() $ithout edema , protenuria > $ithout %(
2.0 (re!eclampsia >() $ith edema , protenuria or albuminuria >% (#A
3.0 >%==( syndrome hemolysis $ith elevated liver en1ymes , lo$ platelet count
$$. Tansissional Hypetension 0 >() bet$een 26 2" $ee&s
$$$. 2hronic or pre!existin >ypertension >() before 26 $ee&s not solved 9 $ee&s post partum.
'hree types of pre!eclampsia
1.0 Mil! peeclampsia earliest sin of preeclampsia
a.0 increase $t due to edema
b.0 @( 1"6#D6
c.0 protenuria H1 ! H2
2.0 Se)ee peeclampsia
Sins present4 cerebral and visual disturbances, epiastric pain due to liver edema and oliuria usually indicates an impendin
convulsion. @( 196#116 , protenuria H3 ! H"
3.0 Eclampsia $ith sei1ureC 3ncrease @F) lomerular damae. (rovide safety.
2ause of preeclampsia
1.0 idiopathic or un&no$n common in primi due to 1
st
exposure to chorionic villi
2.0 common in multiple pre .t$ins0 increase exposure to chorionic villi
3.0 common to mom $ith lo$ socioeconomic status due to decrease inta&e of 2>+)
Nusin' cae"
( romote bed rest to decrease +2 demand, facilitate, sodium excretion, $ater immersion $ill cause to urinate.
(! prevent convulsions by nursin measures or sei1ure precaution
1.0 dimly lit room . Suiet calm environment
2.0 minimal handlin plannin procedure
3.0 avoid ;arrin bed
(! prepare the follo$in at bedside
! tonue depressor
! turnin to side done A*'%7 sei1ureC +bserve onlyC for safely.
3"
% ensure hih protein inta&e . 1#&#day0
! )a in moderation
A anti!hypertensive dru >ydrala1ine . Apresoline0
2 convulsion, prevent < So" 2)S depressant
% valuate physical parameters for <anesium sulfate
<anesium S+" 'oxicity4
1. @( decrease
2. Frine output decrease
3. 7esp ? 12
". (atella reflex absent 1
st
sih < S+" toxicity. antidote 2a luconate
3.Dia*etes Mellitus , absence of insufficient insulin .3slet of =anerhans of pancreas0
*unction4 of insulin facilitates transport of lucose to cell
Dx4 1 hr -6r lucose tolerance test /''
)ormal lucose 56 126 m#dl ? 56 hypoclycemic
. eulycemia0 W 126 ! hyperlycemia
3 derees /'' of W 136 m#d=
maternal effect D<
1.0 >ypo or hyperlycemia 1
st
trimester hypo, 2
nd
3
rd
trim hyperlycemic
2.0 *reSuent infection! moniliasis
3.0 (olyhydramnios
".0 Dystocia!difficult birth due to abnormalities in fetus or mom.
-.0 3nsulin reSuirement, decrease in insulin by 33R in 1
st
triP -6R increase insulin at 2nd 3
rd
trimester.
(ost partum decrease 2-R due placenta out.
*etal effect
1.0 hyper , hypolycemia
2.0 macrosomia lare estational ae baby delivered W "66 or "&
3.0 preterm birth to prevent stillbirth
)e$born %ffect 4 D<
1.0 hyperinsulinism
2.0 hypolycemia
normal lucose in ne$born "- -- m#d=
hypolycemic ? "6 m#d=
>eel stic& test et blood at heel
Sx4
>ypolycemia hih pitch shrill cry tremors, administer dextrose
3.0 hypocalcemia ! ? GmR
Sx4
2alcemia tetany
'rousseau sin
/ive calcium luconate if decrease calcium
7ecommendation
'herapeutic abortion
3f push throuh $ith prenancy
1.0 antibiotic therapy! to prevent sub acute bacterial endocarditis
2.0 anticoaulant heparin doesnt cross placenta
2lass 3 , 33! ood proress for vainal delivery
2lass 333 , 3B! poor pronosis, for vainal delivery, not 2SC
)+' lithotomyC >ih semi!fo$lers durin delivery. )o valsalva maneuver
7eional anesthesiaC
=o$ forcep delivery due to inability to push. 3t $ill shorten 2
nd
stae of labor.
Heat !isease
<oms $ith 7>D at childhood
2lass 3 no limit to physical activity
3-
2lass 33 sliht limitation of activity. +rdinary activity causes fatiue , discomfort.
7ecommendation of class 3 , 33
1.0 sleep 16 hrs a day
2.0 rest 36 minutes , after meal
2lass 333 ! moderate limitation of physical activity. +rdinary activity causes discomfort
7ecommendation4
1.0 early hospitali1ation by G months
2lass 3B. mar&ed limitation of physical activity. %ven at rest there is fatiue , discomfort.
7ecommendation4 'herapeutic abortion
D$$. $ntapatal complications
1. Cesaean Deli)ey 3ndications4
a. <ultiple estation
b. Diabetes
c. Active herpes 33
d. Severe toxemia
e. (lacenta previa
f. Abruptio placenta
. (rolapse of the cord
h. 2(D primary indication
i. @reech presentation
;. 'ransverse lie
(rocedure4
a. classical vertical insertion. +nce classical al$ays classical
b. =o$ sement bi&ini line type aesthetic use
B@A2 vainal birth after 2S
$N(ERT$L$TH ! inability to achieve prenancy. 8ithin a year of attemptin it
! <anaeable
S'%73=3'U ! irreversible
3mpotency inability to have an erection
4 types of infetility
1.0 primary no prenancy at all
2.0 Secondary 1
st
prenancy, no more next pre
test male 1
st

! more practical , less complicated
! need4 sperm only
! sterile bottle container . not plastic has chem.0
! Sims >uhner test or post coital test. (rocedure4 sex 2 hours before test
mom remains supine 1- min after e;aculation
)ormal4 cervical mucus must be stretchable 5 16 cm $ith 1- 26 sperm. 3f W1- lo$ sperm count
@est criteria! sperm motility for impotency
*actors4 lo$ sperm count
1.0 occupation! truc& driver
2.0 chain smo&er
administer4 clomid . chomephine citrate0 to induce spermatoenesis
<t4 /3*'I /amete 3ntra *allopian 'ransfer for lo$ sperm count
3mplant sperm in ampula
1.0 <om4 ano)ulation no ovulation. Due to increase prolactin hyperprolactinemia
AdministerP parlodel . @romocryptice <esylate0
ActionP antihyper prolactineuria
/ive mom clomid4 action4 to induce ooenesis or ovulation
S#%4 multiple prenancy
2.0 Tu*al Occlusion tubal bloc&ae >x of (3D that has scarred tubes
39
! use of 3FD
! appendicitis .burst0 , scarrin
I dx4 hysterosalphinoraphy used to determine tubal patency $ith use of radiopaSue material
<t4 3B* invitrofertili1ation .test tube baby0
%nland 1
st
test tube baby
'o shorten 2
nd
stae of laborC
1.0 fundal pressure
2.0 episiotomy
3.0 forcep delivery
3G

You might also like