Ma’am Robite  Scrotum – support testes & regulate

Chapter 5 temperature
The nursing role in Reproductive & Sexual - ruggated
Health  Testes – two ovoid glands (2 – 3cm)
Gonad – a body organ that produces the cells necessary Leydig cells – produces
for reproduction testosterone
Mesonephric & paramesonephric Seminiferous tubules –
produces sperm
Mesonephric (4) increase testosterone made rep.  Cryptorchidism
After 10 days absence of testosterone  Can’t produce viable sperm
Female repro paramesonephric dominant  Prone to testicular cancer
 Testes remain in pelvic cavity
Pubertal Development  Testes descend in 34th – 38th weeks of
Puberty – stage of life at which secondary sex changes gestration
begin.  Penis
GnRH – (FHS & LH) Gonadotropin - Composed of three cylindrical
Hypothalamus – gonadostat or regulation mechanism masses of erective tissue.
Gonad – ovary - Outlet of both urinary and
Tropin – growth reproductive tracts.
8 – 11 vears range of puberty/menarche Internal structures
Epididymis – responsible for conducting sperm
Role of Androgen from testes to vas deference
Androgenic Hormones – responsible for muscular - Approximately 20 feet long
development, physical growth and increasein sebaccous - Tightly coile tube
glands - It take 12 – 20 days to travel the
epididymis
When level of testosterone increases: - Total of 65 – 75 days to reach full
maturity
 Aspermia – absence of sperm
 Obligospermia – fewer than 20 million
The role of Estogen: sperm/ml
 Increase influences the development of the Vas deferens (Ductus deferens)
uterus, fallopian tubes & vagina; typical Spermatic cord – no hollow tube surrounded by
Thelarche – occurs in 1 -2 years before menstruation arteries & veins and protected by a thick fibrous
 Beginning of breast development coating.
Seminal vesicles – 2 convoluted pouches that lie along
Secondary sex Characteristics the lower position of bladder & empty into urethra by
Pubertal changes in female ejaculatory ducts
 Growth spurt Prostate gland – chestnut – sized gland
 Increase in the transverse diameter of the  Like a doughnut
pelvis  Secrete thin alkaline fluid
 Breast developmet Bulbourethral glands/ cowper’s glands
 Growth of pubic hair  Supply more source of alkaline
 Onset of menstruation  Lie beside the prostate gland and empty by
 Growth of axillary hair short ducts.
 Vaginal secretions Semen
Menarche - 1st menstrual period Prostate – 60%
 9 – 17 years old Seminal vesicles – 30%
 Irregular for first two years Epididymis – 5%
Bulbourethral glands – 5%
Puberty changes in male: Urethra – hollow tube
 Increase in weight  About 8 inches (18 – 20cm) long
 Growth of testes
 Growth of face, axillary & pubic hair Female reproductive system
 Voice changes Gynecology – Study of female repro.
 Penile growth External Structure
 Increase in height 1. Mons Veneris
 Spermatogenesis (production of sperm)  Pad of adipose tissue located over symphys,
Andrology – the study of the male reproductive system pubis, the pubic joint.
 Protect junction of pubic joint from trauma.
Male External Structures 2. Labia Minora
  Spread two hairless folds of connective  Non – pregnant – 60grams
tissue  After pregnancy – 80grams
3. Labia Majora 3. Division of uterus
 Two folds of tissue fused anteriorly but 1. Body – upper part and forms the
separated posteriorly serves as protection bulk of the organ
for external genitalia 2. Isthmus – short segment between
4. Vestibule – flattened smooth surface inside the the body & curvix (non -preg. 1 -2
labia. mm)
3. Curvix – lonest portion of uterus – 2
5. Clitoris – small (approx. 1 – 2cm) 5cm long
Uterine wall layers
6. Bartholins glands – vulvo vaginal glands 1. Endometrium – inner layer of mucous mem.
Basal layer – remains stable & uninfluenced
7. Fourchette by hormones
Glandular layer – influence by estrogen &
8. Perinial body progesterone
2. Myometrium – middle layer of muscles
9. Hymen – tough but elastic semicircle of tissue fiber
Endo cervix
CBQ Ampullary – most common site of fertilization  Sercrete alkaline, lubricate surface to
Isthmus – site of tubal vagination reduce activity of upper vagina
 700 ml mucus/daily if 4 estrogen
Female internal structures  Mucus membrane that lines the cervix
1. The ovaries Operculum – protect placenta from infections
 3 x 2cm in diameter ; 1.5 cm thick  Mucous plugged during pregnancy
 Held suspended and in close contact with  Uterine contraction
ends of fallopian tube  Present regurgitation of menstrual blood
 Not covered by peritoneum into the fallopian tubes
 Maturation of oocytes  Prevent preterm birth
 Produce estrogen & progesterone  Prevent blood loss after giving birth
 Luitiate regular menstrual cycle MYOMA – tumors that arise from myometrium
 Composed of 3 interwoven layers of
The division of reproductive cells smooth muscles
 Contains approx. 2 million oocytes at birth 3. Perimetrium - after layer of connective
- 22 pairs of antosome tissue
- Mitosis Uterine supportive structures
- Meiosis (cell reduction division) Broad vigament – help steady the uterus
 Ovum – 22 autosome and Round vigaments – additional “slays” to further
an x steady the uterus
Sex chromosome  Cytocile – bladder herniate into anterior
 Spermatozoa – 22 vagina
autosome and an x or y sex - Prone to UTI
chromosome  Rectocele – rectum herniate to vaginal
Maturation of oocytes wall
In utero – 5 – 7 million ovum - Prone to constipation
7years – 500,000
22years – 300,000 Uterine deviations
Menopause – 0 1. Auteversion –

Internal structure 2. Retroversion –

1. Fallopian tube
 Fertilization occurs 3. Auteflexion –
 10cm ling in mature woman
2. Uterus 4. Retroflexion -
 Hollow, muscular, pear – shaped organ f(x)
1. Receive the ovim from fallopian tube Bicornuate uterus
2. Provide place for implantation and - Horn shape at junction of
nourishment fallopian tube
3. Turnish protection to a growing fetus
4. At maturity of fetus, expel it from The breasts
woman’s body - Around 20 lobules
  Milk glands – located in 20 lobes  Helps maintain pregnancy
- Acinal cells via lactiferousducts  Mother’s hormone
 nipples
 Gynecomastia – for males (bigger
boobs) supernumerary
Ampulla – reservoir of milk
Nipple – 20 openings
Let down reflex
 Process of the milk production
 Stimulated by sucking/manual stimulation

Sucking anterior pituitary glands

Pushing out constriction oxytocin
of milk of mammary gland
from nipples Hypothalamus

Areola – darkly pigmenteel

 21cm
Montgomery tubercles Ant.Pit gland
 Rough surface that contain sebaceous
glands

Menstruation FHS LH fallopian tubes ovulation

Menstrual cycle – episodic uterine bleeding in response

to cyclic hormonal changes 23 – 35 day (regular) Activate oocyte prostaglandin
Purpose: into maturity
1. Bring ovum to maturity
2. Renew uterine tissue bed that will neussary rapture release ovum
for ovals growth should be fertilized follicles create
- 28 days common cycle follicular fluids
release
Hypothalamus estrogen progesterone
 Release GnRH
Anterior pituitary glands primary & secondary
FSH – hormone active early in the cycle that oocyte
responsible for maturation of the ovum graafian follicle
LH – responsible for ovulation; stimulates (mature with fluid)
growth of uterine lining during the 2 nd half of menstrual Ovum to go mitosis
cycle 40 days from beginning & meiosis
of menstrual cycle
Common cause of menarche
 If a girl reaches certain pounds (95lbs/43kg) haploid
it iniates the release of growth hormones
which (yellow body)
Luten
Ovaries
Follicular iluid
 Contains high degree of estrogen and some
protesterone
Graafian follicle – mature ovum surrounded by follicular unfertilized(8yodays)
membrane and fluid
Curpos luteum
Hormone production ovaries (secretes
1. Estrogen progesterone) corpus albecars
 Woman’s hormone (white)
decrease
2. Progesterone progesterone
 Produce by corpus luteum fertilized egg
 Production continuesuntil LH diminisher in (16th – 20th)
the blood shed offs
  Cyclic changes of 3 separate factors of fertilization
1. Equal maturation of both sperm and ovum
2. Ability of the sperm to reach the ovum
3. Ability of the sperm to penetrate the zona
Stages pellucida and cell membrane and achieve
1. Proliferative stage fertilization
 Regenatation of functional layer Stage 1 (pre – embryonic stage)
2. Secretory stage – endometrium increases in size  Zygote undergoes cleavages (mitosis) as it is
& readies implantation; formation of transported to the uterine cavity in 72°
progesterone in the corpus luteum causes the  Cleavages create a ball of 16 – 50 cells called
glans of uterine endometrium to become cork morula, which divides in cells that
crew  Blastocyst – inner cells from the embryo and
3. Ischemic stage the eminion
 Endometrium begin to degenerate the  Tropoldast
capillaries rupture with minute  Embryoldast
hemorrhages, & endometrium shoughs off
4. Fourth phase of cycle (menses) Implantation in the endometrium occurs between the
 It is the end of arbitrarily defined menstrual 8th – 10th day
cycle  Contact between the growing
Apposition – blastocyst brushes against the rich uterine
Fern test endometrium
Adhesion – attaches to the surface of the endometrium
Spinnbarkeit test Invasion – settle
Fetal membranes – start forming around the time of
Fetal development implantation
 Measured in the number of weeks after Decidua “falling off”
fertilization
 Average pregnancy lasts 280 days or 40 Chorionic villi
weeks from the date of the last menstrual  Form the placenta
period(LMP) 1. Central core
 Produce various placenta hormones such as
3 stages of dev. hCG, somatomammotropin human
1. Pre - embryonic stage Placental Lactogen (hPL), es & pro middle
 First 2 weeks, beginning with fertilization layer, the cytoprophoblast or Langhan’s
2. Embryonic stage layer – provide protection against syphyllis
 Weeks 3 through the eight week  After 20 weeks
3. Fetal stage  Placenta “pancake”
 Eight week until birth  Braxton Hicks Contractions
- Barely noticeable contractions
Fertilization Amniotic fluid
 Union of ovum & sperm in the outer third  Surrounds embryo
of the fallopian tube creating a zygote  Helps maintain constant body temp. for the
 The union restores the diploid number of fetus
the chromosomes  Permits eymimetric
 When ovum is extruded from a graafian f(x)
folliuleitis surrounded by mucopoly - Allows umbilical cord to be
succhavide fluid (zona pellucida) and a circle relatively free of compression
of corona radiata or circle of cells - Promotes
 An ejaculation of semen averages 2-5ml of
fluid containing 50 – 200m 1 million CBQ:
spermatozoon /ml Why is it the largest body part of a baby is the head?
(400m/8perm/ejaculation Ans. Organs increase in size cephaloccudal
 Sperm reach the cervix within 90 seconds manner
and the fallopian 5 minutes after deposition
Origin & Development of Organ Systems
Compacitation
 Is the process consists of changes in the Stem cells – totipotent, phevipotent, multipotent
plasma membrane of the sperm head, Zygote growth – cephalocaudal direction
which reveal the sperm – binding receptor
sites 3 unique shunts
  Ductus Venosus  Gon
 Foramen Ovale
 Ductus Arteriousus Live virus vaccines
 Herbs
Fetal Circulation  Alcohol
 Tobacco
oxy portal vein
Placenta brain liver Alcohol
en Behavioral changes – 1 drink/week
And the remainder will be shunted away to ductus Cognitives – 1-2 drinks/day
venosous Binge drinking – very harmful

Right atrium inferior VC All types of alcohol can be harmful during pregnancy
Shunts
Foramen ovale left atrium
Heart
SCV muscles aorta left ventricle
Brain

lungs
R atrium right ventricle
Ductus A
Placenta Aorta
Fetal hemoglobin
 More concentrated
 17.1g 100ml (newborn)
 11g/100 ml (adults)

Respiratory system
 3rd week
Exist as a single tube
 4th week
Septum divides esophagus

Oblited ovum pregnancy

 Has a sac yet no fetal pole

03 – 13 - 19 03 – 13 – 19
-3 + 7 -3 + 7
12 20 – 19 12 – 20 – 19

5 – 25 – 19 5 – 25 – 19
3 7 1 -3 +7
3 – 03 – 20 3 – 3 – 20

Chapter II
Prenatal care
Reasons for assessment
 Established baseline of present health
 Def. gestational age of fetus
 Monitor fetal development & maternal well
– being
 Identify women at risk for complications
 Minimize risk of possible complications by
anticipating and preventing problems
before they occur
 Provide education about pregnancy,
lactation and newborn care

Infections that causes illness at birth

 Syph
 5. Practicing gratitude
Ma’am Cercado (blue) 6. Listening To music that makes you feel
7. Telling the baby stories about your loved ones
Nurse major responsibility 8. Taking walks with your partner/friend
 Maintain state of wellness throughout the Depression
pregnancy and into early parenthood  Feeling of sadness marked by loss of
interest in usual things, feelings, guilt or low
Box 10.1 self north, disturbed sleep, low energy, &
Table 10 poor concentration and is common finding
Emotional responses that can cause concern in in late adolescents
pregnancy  Can cause as many as 15% moment to enter
 Grief pregnancy depressed; other grow
o A period of serious sorrow or mourning depressed
o Usually occurs after a specific &
sometimes traumatic event Narcissism
o A pregnant woman affected by grief Prenatal Narcissism
may have a different experience than  Online culture of over sharing pregnancy
someone who is working through especially in social media
mental issue. “having”
 Causes
o Miscarriage Cause of stress during pregnancy
 First thing in mind  Soon to be mother may be dealing with the
o Death of close relative, partner, child discomfort of pregnancy, like nausea,
o Unemployment constipation, being tired or having a
o Divorce/breakup backache
o Lack of shelter/ poverty  Her hormones are changing, which can
o Health complications of mother/child cause her mode to change. Mood swings
during pregnancy can make it harder to handle stress
 Effects of grief of pregnancy  She may be worried about what to expect
o Grief can affect pregnancy through its during labor and birth or how to take care
impact on hormone balance & of the baby
production  If she is working, she may have to manage
o Can cause an imbalance of serofonin job responsibilities and prepare her
production. It also raises the body’s employer for time away from her job
cortisol or stress hormone level  Couvade syndromes
o Grief can also worsen symptoms that o AKA sympathy pregnancy/pregnant dad
typically come with pregnancy. These syndrome as men with pregnant
include aches and pains, sleep issues partners begin to experience symptoms
and digestive problems. Combined with of pregnancy
a sudden loss o Symptoms of this conditions usually
 Potential risk of grief during pregnancy appear in the first trimester, around the
o Development delays third month of pregnancy they improve
 Stress during pregnancy can temporarily during the second trimester
cause this in most cases, and return to the third
 Intense grief cause by loosing trimester. Once the baby was born,
someone symptoms typically disappear.
o Future mental health issues  Symptoms
 Intense grief can cause ADAD, 1. Gl issues like nansea, stomach pain,
anxiety & impacts on cognitive diarrhea/corst
function 2. Heartburn
o Increase likelihood of stillbirth 3. Back pain, leg cramps
4. Changes in appetite, weight gain
5. Toothache
How to lope
6. Respiratory issues
Best way is to care for oneself reach out to
7. Issues with urination or genital discomfort
support network and practice regular self care
8. Symptoms of anxiety/depression
9. Restlessness, sleeplessness
Other methods
10. Decrease of libido
1. Seeing licensed therapist
2. Attending couples counseling with a partner
Assessing events that could contribute to difficulty
3. Talking with trusted friends
accepting a pregnancy
4. Taking a relaxing bath/nap
 1. Pregnancy is unintended pregnancy) since the only plasma
2. Learning the pregnancy in multiple, not a single volume increased
one Consequences:
3. Learning the fetus has develop abnormality  Easy fatigability and shortness of breath
4. Pregnancy is less than 1 year after a previous because of increase workload of heart
one  Slight hypertrophy of the heart, causing it to be
5. Family has to relocate during pregnancy displaced to the left – resulting in torsion on the
(involves a need to find a new support people) great vessels (aorta & pulmonary artery)
6. The woman has a role reversal previously  Systolic murmur – due to lowered blood
supporting person become late on a viscority
dependent/ via verse  Nosebleed may occur – due to marked
7. The main family support person suffers a job congestion of the nasopharynx as pregnancy
loss progresses
8. Woman’s relationship ends because of partner Palpitations due to:
infidelity  Increased pressure
9. There is a major illness in self, partner or Edema of lower Ex. Because of poor circulation resulting
relative from pressure of the gravid uterus of the blood vessel of
10. There’s a loss of significant the lower EL.
11. Complications of pregnancy occur such as a Management:
sever hypertension - Raise leg above hip level
12. The woman has serious devaluing experiences Importants:
such as failure to school or work - Edema of the lower Ex. Is normal
during pregnancy it is not a sign of
Presumptive (subjective) symptoms toxemia
1. Amenorrhea Varicosities of vulva or rectum can occur because of
2. Chadwick’s sign poor circulation in the blood vessel of genitalia due to
3. Quickening the pressure of the gravid uterus.
4. & vomiting Management:
- Side lying with hip elevated with
Probable signs pillows and modified knee – chest
1. Enlarge abdomen position/fetal position
2. Braxton – hicks contractions  GI changes
3. Ballottement o Morning sickness – nausea and
Table 10.2 vomiting due to
 Increase chronic gonadotropin
Other probable cause  Increase acidity
Amenorrhea  Emotional factors
 Stress; vigorous exercise, menopause, Management:
endocrine problems, malnutrition - Eat dry toast or cracker 30 mins.
Frequent urination Before arising in the morning
 Infection, pelvic tumors - Give ice chips
Chadwick’s sign - Drink ginger
 Pelvic congestion  Hyperemesis gravidarum
Goodells sign - Excessive nausea and vomiting
 Pelvic congestion which persist beyond 3 months.
Hegar’s sign - May result in
 Pelvic congestion  Dehydration
FHR – can heard for 18th – 20th weeks via slet  Starvation
10 – 20 via Doppler  Acidosis
Ballottement Management:
 Tumors, cervical polyps - DIONSS 3000ml in 24hrs
Quickening - Complete bed rest
 18th – 20th week  Constipation flatulence
 Gas, pevistalsis - Due to displacement of stomach
and intestines; increase in
 Circulatory/cardiovascular changes progesterone
o Increase about 30% - 50% in the total Management:
cardiac volume reaching its peak during - Increase fluid and roughage in the
6th month diet
o This causes the decrease in Hgband Hct - Establish regular elimination time
values (physiologic anemia of - Increase exercises
 - Avoid harsh laxatives like dulcolax: Management:
or stool softeners  Frequent rest periods with leg elevated
- Mineral oil should not be taken  Wear warm, more comfortable clothing
because it interferes with  Increase calcium intake (calcium tablets and
absorption of fat – soluble vitamins diets)
 Hemorrhoids – due to pressure of enlarge  Do not massage
uterus  Press the knee of the affected leg and dorsiflex
Management: 4. Temperature
Cold compress with witch hazel or EPSOM salts  Slight inverse due to the increase in
 Heartburn – due to increase in progesterone, but the body adopts
progesterone which decreases gastric after the fourth mark
motility 5. Weight changes
Management:  1st tri. – 1.5 – 3lbs is normal
 Pats of butter before meals  2nd 3rd – 10 – 11lbs per tri
 Avoid fried, fatty foods Total allowance weight gain during the period of
 Tips of milk at frequent pregnancy is 20 – 25lbs (10-12kg)
intervals Pattern of weight gain is more important rather than
 Small frequent meals taken the amount of weight gain
slowly 6 equal feeding of the
day Uterus
 Bend at the knees, not at the  Weight increases to about 1000 grams at full
waist form due to the increase in the amount of
 Take antacids but never sodium fibrous and elastic tissue
bicarb because it promotes Hegar’s sign
fluid retention  Seen at about 6th week
Respiratory changes  Softening of the lower uterine segment
1. Shortness of breath Good ell’s sign
 Increase oxygen consumption  Cervix becomes more vascular and edematous,
and production of CO 2 during resembling the consistency of an earlobe
the first trimester increased Opeculurs (?)
uterine size causes diaphragm  Mucous plugs found in the cervix produced to
to be pushed or displaced, thus seal bacteria
crouding the chest cavity Vagina
Management:  pH of vagina changes from normally acidic to
Lateral expansion of chest to alkaline are to increase of estrogen
compensate for shortness of breath increases Chadnicki sign
blood supply and vital lung capacity  change in color from light pink to evap purple or
violet due to increase in vascularity of the
Urinary changes vagina
1. Urinary frequency Leukorrhea
 Early in pregnancy – due to increased  increase in the amount of vaginal discharge due
blood supply to the kidneys and uterus to the increase of estrogen
 Last trimester – due to the pressuer of management: take shower bath 2x daily
the enlarged uterus to the bladder,
especially with lightening II bacteria which can thrive in an alkaline environment
Musculo skeletal changes 1. trichomonas vaginatis
1. Pregnant moment makes ambulation easier by o protozoan or flagellate that causes the
standing move straight and fallen resulting in a condition called trichomonas vaginitis
lordoric position(private of pregnancy)\ or trichomoniasis
2. Pelvic bones become more supple and movable, S/Sx: froth, cream – colored, irritating, itchy, foul –
due to increased production of the hormone smelling dischanges: vulval edema and hyperemia due
relaxing resulting to incidence of accidental falls to irritation from dischanges
due to robbly gamit. Management:
Management: - flogyl for to days P.O. or vaginal
Use low heeled shoes after the first trimester suppositories of trichononicidal compounds
3. Leg cramps (vagiseu or devecan) inserted at bed time
 Caused of fatigue  considuntins
 Increased pressure of gravid uterus on o flagyl carcinogemic, in the 1st tri
the lower extremities o trends also with flagyl
 Muscles tenseness o avoid taking alcohol during the entire
 Low calcium intake treatment
 o dark brown urine is a minor side effect Leopard’s Manuever
 acidic vaginal douche Preparation:
o 17 white vinegar, 1 quart of water or 1. Instruct woman to empty her bladder first
1ml venigar in 1L or water 2. Place woman in dasal recumbent position,
o Avoid inter course to prevent supine with knees flexul/ relax abdominal
reinfection muscles, place a small pillow under the head for
2. Candida albicars comfort
- A fungus or yeast that causes the condition 3. Drape property to maintain privacy
called moniliasis or candidiasis 4. Explain procedure to the client
- Seen as oral thrush in the newborn when 5. Use the palm for palpation not the fingers
transmitted during delivery through the 6. Harms hand by rubbery together (cold hands
birth canal of the infected mother could stimulate uterine contractions)
S/Sx: white patchey cheese – like particles
that adhere to the vaginal walls First maneuver:
: irritatingly, itchy and foul – smelling FUNDAL GRIP
vaginal dischange - Determine fetal part lying in the fundus
Management: - Determine presentation
- Mycostatin (Nystation P.O. or vaginal  Using both hands, feel far the fetal part lying in
suppositories/pevaries 100,000v) BID for 15 the fundus
days  Head is more firm, hard and round that moves
- Gentian violet swab for vaginal in dependently of the body
- Manage 1 control diabetes  Breech is less well defined that moves only in
- Avoid intercourse conjunction with the body
- Perform acidic vaginal douche
Second maneuver:
 Abdominal wall UMBILICAL GRIP
o Umbilicus is pushed out striae - Identify location of fetal back
gravidarum – pink or reddish - Determine position
streaks due to the increase in  One hand is used to study the uterus
uterine size causing the rupture and  Or one side of the abdomen while the other
atrophy of connective tissue layers hand moves slightly on a circular motion from
Skin top to the lower segment of the uterus to feel
 Linea nigra for the fetal back and small fetal parts.
o Brown line running from umbilicus  Use gentle but deep pressure
to the symphysis pubis  Fetal back is smooth, hard and resistant surface
 Melisma or chloasma  Knees and elbows of fetus feel with a number of
o Mask of pregnancy extra angular modulation.
pigmentation on cheeks and across
the nose due to increase production Third maneuver:
of melanocytes by pituitary glands PAWLIK’S GRIP
- Determine engagement of presenting part
Breasts  Using thumb and finger, grasp the lower portion
- All changes are due to the increase in of the abdomen above symphysis pubis, press
estrogen in slightly and make gentle movements from
- Increase in size side to side
- Feeling of fullness and tingling sensation  The presenting part is not engaged
- Areola becomes darker and increases in  It is movable
diameter  It is engaged if it is not movable
- Skin surrounding areola are dark
Fourth maneuver
For mothers who inted to breast pud advise: PELVIC GRIP
1. Nipple rolling on the 3rd tri - Determine the degree of flexion
2. Dry nipples with rough towel to help toughen  Facing foot part of the woman, palpate fetal
nipples head pressing downward about 2 inches above
3. Do not use soap or alcohol in cleaning nipples the inguilar ligaments.
Colostrum – a thin watery, high protein fluid formal at  Use both hands
the fourth month
- Buy nursing bra Sign indicating possible complications of pregnancy
- Advise to wear bra with larger straps & 1. Vaginal bleeding
bigger than usual size
 - Nonan should refer bleeding no matter how - All patient aged 25 years and under should
slight, sore of serias bleeding complications have a repeat gonorrhea and dilamydiatest
of pregnancy begin with only slight spotting at 35 – 37 weeks regardless of prior
Ex. infection status
Trauma, vaginal infections, placenta privea, Serum antibody titus for rubella, hepatitis (HBsAG),
implantation, polyps or nodules, abrupt hepatitis C, varicella (chicken fox)
placenta - Vaccines can be given after giving birth
2. Persistent Vomiting - Hepatitis (HBsAG) can be repeated after 36
- Persistent frequent vomiting is not normal weeks
nor is vomiting that continues past the 12 th
week of pregnancy AIV Screening
3. Chills an fever or pain or urination - CDC recommends that all pregnant woman
C & F – beniga gastroenteritis can be tested early part of their pregnancy
P on U – UTI - High risk should be re – tested in the 3 rd
4. Sudden escaped of fluid from the vagina trimester
- Gush of clear fluid is dischanged suddenly
from the vagina High risk criteria includes:
- Seddun escaped of clear fluid from the - Woman who have used or are using
vagina when a gush of clear fluid is intravenous drugs
dischanged suddenly from the vagina, it - Have
means the membranes have ruptures & - Have had sexual partner who are infected
mothers & fetus are non both threntened or at risk because they are bisexual or
because the uterine cavity is no longer intravenous drug users
sealed against infection. - Received BT between 1997 and 1985
5. Abdominal or chest pain
- Sign of tubal (ectopic pregnancy) 508 and 1hr glucose loading or tolerance test/ glucose
pregnancy, separation of placenta, preterm challenge test
labor or may be unrelated to the pregnancy - Done to pregnant women at the end of 1 st
like appendicitis, ulcer or pancreatitis tri (12weeks)
6. Gestational hypertusion - Woman who has a history of unexplained
- Refers to patertially severe and even fetal fetal loss
elevation of BP that occur during pregnancy - Has a family history of diabetes
usually after 20 weeks of pregnancy. - Has had babies who are large for
Symptoms: gestational age (LGA)
- Rapid weight gain (2lbs/week) 2nd tri - Has glycosuria
- Swelling of face and fingers - This test is done at 24th – 28th week of
- Flash of high or spot before the eyes pregnancy if the woman is not high risk
- Dimness or blurring vision
- Severe continuous headache Tuberculosis surveying (monitor test)
- Decreased urine output
- RUQ pain not related to fetal position
- BP increased upper more than Ultrasonography
140/90mmHg  7 – 11 weeks of pregnancy – can confirm
Increased in 30mmHg systolic inusual BP means pregnancy if the woman is not sure of LPM
15mmHg diastolic high blood  11 – 13 weeks – assess increased risk of
down syndrome
CBC – complete blood count  16 – 20 weeks – verify healthy fetal
Hemoglobin – determine the presence of aremia structure and gender
WBC count – determine infection  Under 8 weeks of gestation
Platelet count – estimate clothing ability  Presence of a gestationalsea
kicking fetus, not a moving
Serologic test
- For syphislic
[(VDRL) - rapid plasma reagin test]

Blood typing – may be made available if the woman has

bleeding early in pregnancy.

Cultures for gonorrhea & dilamydia

- Should be colheutul for each patient at the
initial pelvic exam
 - Pulse, BP, temperature, urine, IV fluids and
drugs

NORMAL LABOR AND DELIVERY

Labor
(red) - Uterine conditions and abdominal pressure
INTRAPARTUM expel fetus and placenta from the uterus
There are 5 factors affecting labor - Mechanical and physiological process of
1. Passage expulsion of fetus, placenta, amniotic fluid
2. Passenger & amniotic sac.
3. Power - Process of expressing all the products of
4. Maternal position conception
5. Psychological preparation Delivery
- Is the actual event of birth
4 stages of labor and birth
1. Beginning of true labor contractions – full Labor and Delivery
cervical dilatation - Ending of pregnancy where one/more
2. Full cervical dilatations – delivery of the baby babies leaves a human uterus by passing
3. Delivery of the baby – placental stage through the vagina.
4. Delivery of placenta – 2 – 4 hours or crucial and Labor
cervical stage - Represents a time of change as it is both an
ending and a beginning for the woman, her
9/10 birth deliveries were attended by health fetus and her family
professionals (physicians, nurses, midwives) Labor and Birth
- Are unique events, requiring a woman to
DOH descriptions of maternal health 15 – 49 employ all psychological and physical
coping method she has available
Partograph
3 forms THEORIES OF LABOR ON SET
1. Classic  Uterine muscles stretch with fetal
2. Modified growth and increasing amniotic
3. Simplified fluid, results to irritability and
 A tool advocated by WHO to be used by the entraction to empty the contents of
nurse – midwife the uterus.
 Use to assess progress of labor & identify
where intervention is necessary OXYTOLIN THEORY
- Pressure of the fetal head on the cervix in
Meconium stained amiotic fluid – sign of respiratory late pregnancy stimulates the posterior
distress pituitary gland to secrete oxytocin which
Shoulder distosia – causes uterine contractions
Yellow meconium – sign of infection LOW PROGESTERONE THEORY/ OROGESTERONE
Contractions in 10 minutes – 2-3/3-4 contractions DEPRIVATION THEORY/ PROGESTERONE WITH PRAWAL
Placental delivery – 5 – 30 minutes only if move THEORY
something is wrong - Changes in the ratio of estrogen to
progesterone occurs
2 types of placental delivery - Labor is said to start when progesterone
1. Separation - dettached from uterus decreases
- Sudden gush of blood ESTROGEN, FETAL HORMONE, FETAL PORTISOL
- Firming of fundus THEORIES
- Rising of fundus - Rising of fetal cortisol levels reduces
- Lightening of cord progesterone formation and increases
- Appearance of placenta prostaglandin formation
- All have stimulating effect on uterine
Components of partograph musculator causing uterine contractility
1. Progress of labor PROSTAGLANDIN THEORY
- Monitoring uses parameters cervical - Fetal membrane begin to produce
dilation, descent of fetal head and uterine prostaglandins, which stimulate
contractions contractions
2. Fetal conditions THEORY OF AGING PLACENTA
- FHT, amniotic fluid and liquor and mulding - Placenta reaches a set age, which triggers
of the fetal skull (fetal heart tone) contractions, as the placenta matures, it is
3. Maternal condition
 believed that the resultant diminished
blood supply to the area causes contraction

COMMON SIGNS OF LABOR

LIGHTENING
-descents, dipping or dropping of presenting
part to the true pelvis
ONSET:
Primigravida: lightening occurs early, 2 weeks before
labor
Multigravida: occurs either a day before labor or on the
day

SIGN OF LIGHTENING
- Relief dyspnea
- Relief abdominal tightness
- Increased frequency of urination,
varicosities, pedal eduma because pressure
on bladder and pelvic girdle
- Shooting pains down the legs because of
the pressure on sciatic nerve
- Increased amount of vaginal discharged