Human Sexuality

Concepts
A persons sexuality encompasses
the complex behaviors, attitudes
and emotions and preferences that
is related to sexual self and
eroticism
Sex is basic and dynamic aspect of
life
During reproductive years, the
nurse performs as resource person
on human sexuality
15 44 y.o. age of reproductivity
CBQ
Definitions related to sexuality
Gender Identity
sense of
feminity and masculinity
developed @age 3 or 2 -4 y.o.
Role Identity attitudes,
behaviours and attitudes that
differentiate roles
Sex biologic male or female
status. sometimes referred to as
specific sexual behavior such as
sexual intercourse
Sexuality - behavior of being a girl
or boy and is identity subject to a
lifelong dynamic change
Sexual Anatomy and Physiology
Female Reproductive System
External Vulva/ Pudenda
Mons pubis/ veneris mountain of
venus, a pad of fatty tissues that
lies over the symphysis pubis
covered by skin and at puberty
covered by pubic hair that serves as
a cushion or protection to the
symphysis pubis
Stages of Pubic Hair Development
(Tool Used: Tanners Scale/ Sexual
Maturity Rating)
Stage 1 Pre adolescence
no pubic hair, fine body hair

Stage 2 Occurs bet. 11

12 y.o
sparse, long, slightly pigmented
and curly that develop along labia

Parumculae Mystiformes healing

of a hymen
Perenium muscular structure in
between lower vagina and anus

Stage 3 Occurs bet. 12 13 y.o.

hairs become darker and curlier
develops along pubis symphysis
Stage 4 13 14
y.o.
hair ssumes normal appearance of
an adult but is not so thick and does
not appear to the inner aspect of the
upper thigh
Stage 5 Sexual Maturity
assumes the normal appearance of
an adult, appears at the inner aspect
of thigh

Internal
Vagina female organ for
ovulation, passageway of
menstruation, inches 8 10 cm
long containing rugae
Rugae permits considerable
stretching withouit tearing during
delivery CBQ
Uterus hollow muscular organ,
varies in size, weight and shape,
organ of menstruation
Size : 1 x 2 x 3
Shape : pear shaped, pregnant ovoid
Weight :
Uterine involution
CBQ
Non pregnant
: 50 60 g
Preganant
: 1000 g
4th stage of Labor
: 1000 g
2nd week after of
Delivery
: 500 g
3rd weeks after
delivery
: 300 g
5 6 Weeks after
delivery: 50 60 g
Three Parts of Uterus
Fundus upper cylindrical layer
Corpus/ Body upper triangular
layer
Cervix lower cylindrical layer
Isthmus lower uterine segment
during pregnancy

Labia Majora large lips latin,

longitudinal fold from perenium to
pubis symphysis
Labia Minora aka Nymphae, soft
and thin longitudinal fold created
between labia majora
Clitoris key, pea shaped
erectile tissue composed of
sensitive nerve endings; sight of
sexual arousal in females
Fourchet tapers posteriorly of the
labia majora. Site for episotomy
- sensitive to manipulation, torn
during pregnancy
Vestibule almond shaped area
that contains the hymen, vaginal
orifice and batholenes gland
Urinary Meatus small opening of
urethra/ opening for urination
Skenes Gland aka Paraurethral
Gland, 2 small mucus secreting
glands for
lubrication
Hymen membranous tissue that
covers the vaginal orifice
Vaginal Orifice external opening
of the vagina
Bartholenes Gland paravaginal
gland, secretes alkaline substance,
neutralizes acidity of the vagina
Doderleins Bacillus responsible
for vaginal acidity

Muscular Composition: 3 main

Muscles making possible
expansion in all direction
Endometrium muscle layer for
menses
Lines the non-pregnant uterus
Volumes the non pregnant uterus
Decidua slouching off of
endometrium during menstruation
Endometriosis
Ectopic Endometrium
1

Common site is ovaries

Proliferation of abnormal growth of
lining of outer part
Persistent dysmenorrhea, low back
pain
Dx Exam: biopsy,laparoscopy
Tx: Lupron (luprolide) inhibits
FSH & LH
Tx: Danazol (Danacrine) DOC
Inhibits ovulation
stop menstruation
Myometrium
Power of labor
Smooth muscles is considered to be
LIVING LIGATURE (muscles of
delivery, capable of closing) of the
body
Largest portion of the uterus
Peremetrium
Protects the entire uterus
Ovaries
2 female sex gland
almond shape
Fxn: Ovulation,production of 2
hormones( estrogen and
progesterone)
Fallopian Tube
2 3 inches long that serves as a
passageway of the sperm from the
uterus to the ampulla or the
passageway of the mature ovum or
fertilized ovum from the ampulla to
the uterus
4 significant segments
Infundibulum most distal part,
trumpet shape, has fimbrae
Ampulla outer 3rd or 2nd half, site
of fertilization, common site for
ectopic preg.
Isthmus site for sterilization, site
for BTL
Interstitial most dangerous site
for ectopic pregnancy
Male Reproductive System
External
Penis
The male organ of copulation and
urination

Contains of a body or shaft

consisting of 3 cylindrical layers
and erectile tissues
2 corpora cavernosa
1 corpus spongiosum
At the tip is the most sensitive area
comparable to clitoris = glans penis
Scrotum
Pouch hanging below the
pendulous penis, with medial
septum deviding into 2 sacs each
containing testes
Requires 2 degrees celcius for
continuous spermatogenesis
Cooling mechanism of testes
Internal
The Process of Spermatogenesis
Testes
(900 coiled seminiferous tubules)

epididymis
(site of maturation of sperm 6 m)

Vas Deferens
(conduit pathway of sperm)

Seminal Vesicle
(secreted: fructose form of
glucose, nutritative value
Prostaglandin: causes reverse
contraction of uterus)

Ejaculatory Duct
(conduit of semesn)

Prostate Gland
(release alkaline substances)

Cowpers Gland
(release alkaline substance)

Urethra
Hypothalamus GNRH

APG

FSH maturation of sperm

LH testosterone production
Leydig Cells releases testosterone

Male & fem

Homologu
Male
Penile
Glans
Penile
Shaft
Testes
Prostate
Cowpers
Glands
Scrotum

Basic Knowledge on Genetics and

Obstetrics
DNA Deoxyribonucleic Acid
carries genetic code
Chromosomes threadlike
structure of hereditary material
known as the DNA
Normal amount of ejaculated
sperm 3 5 cc/ 1 teaspoon
Ovum is capable of being fertilized
within 24 36 hours after
ovulation.
Sperm 48 72 days viability
Reproductive cells divide by the
process of MEIOSIS (haploid
number)
Spermatogenesis process of
maturation of sperm
Oogenesis process of maturation
of ovum
30 weeks AOG 6 million
immature ovum
@ birth 1 million immature
oocytes
@ puberty 300 400 immature
oocytes
@ 13 y/o 300 400 mature
oocytes
@ 23 y/o 180 280 mature ovum
@ 33 y/o 60 160 mature ovum
@ 36 y/o 24 124 mature ovum
@46 y/o 4 mature ovum
2

Gametogenesis process of
formation of two haploid into
diploid
Age of reproductivity 15 44 y/o
childbearing age 20 35 y/o
High risk <18 & >35 y.o. With
Risk 18 20; 30 35
Menstruation
Menstrual Cycle beginning of
menstruation to the beginning of
the next menstruation
Average menstrual cycle 28 days
Average menstrual period 5 days
Normal blood loss 50 cc/ cup
accompanied by FIBRINOLYSIS
prevents clot formation
Related terminologies
Menarche 1st menstruation
Dysmenorrhea painful
menstruation
Metrorrhagia bleeding in between
menstruation
Menorrhagia Excessive bleeding
during menstruation
Amenorrhea absence of
menstruation
Menopause cessation of
menstruation (Average Age- 51
y.o.)
Tofu has isoflavone estrogen of
plant that mimics the estrogen with
a woman
Functions of Estrogen and
Progestin
ESTROGEN hormone of woman
Primary function
Responsible for the development of
secondary characteristics in
females
inhibit production of FSH
Other function
Hypertrophy of the myometrium
Spinnbarkeit and Ferning Pattern
(Billings Method)
Ductile structure of the breast
Osteoblastic bone activity (causes
increased in height)
Early closure of the epiphysis of
the bone
Sodium retention
Increased sexual desire

Responsible for vaginal lubrication

PROGESTERONE Hormone of
the mother
Primary function prepares the
endometrium for implantation
making it thick and tortous
Secondary Function inhibit
uterine contractibility
Others
Inhibit LH (hormone of ovulation)
production
GI motility
Permeability of kidneys to
lactose and dextrose causing + 1
sugar in urine
Mammary gland development
BBT
Mood swings
Menstrual Cycle
4 phases of menstrual cycle
Proliferative
Secretory
Ischemic
Menses
On the initial phase of
menstruation, the estrogen level is
, this level stimulates the
hypothalamus to release GnRH/
FSHRF
GnRH/ FSHRF stimulates the
anterior pituitary gland to release
FSH
FSH Function
Stimulate ovaries to release
estrogen
Facilitate the growth of primary
follicle to become
GRAAFIAN FOLLICE
structure that secretes large amount
of estrogen that contain mature
ovum
Proliferative Phase (estrogen)
Follicular Phase responsible for
the variation and irregularity of
mense
Postmenstrual Period after
menstruation

Preovulatory Phase happen

before menstruation
13th day of menstruation, estrogen
level is PEAK while progesterone
is , these stimulates the
hypothalamus to release GnRH/
LHRF
GnRH/ LHRF stimulates the
Anterior Pituitary Gland to release
LH
Functions of LH
Stimulates the release of
progesterone
Hormone for ovulation
14th day estrogen level is while
progesterone level is
S/S
Rupture of the graafian follicle OVULATION
Mittelschsmerz slight abdominal
pain lower right quadrant
15th day, after ovulation day,
graafian follicle starts to
degenerate, estrogen level ,
progesterone , causing
degeneration of the graafian follicle
becoming yellowinsh known as
CORPUS LUTEUM secretes
large amount of progesterone
Secretory Phase
Lutheal Phase
(progesterone)
Postovulatory phase
Premenstrual Phase
24th day Corpus Albicans
(whitish) corpus luteum
degenerates and becomes white
28th day if no sperm united the
ovum, the uterine begins to slough
off to have the next menstruation
Note:
if there is no fertilization, corpus
luteum continues functioning
Ovarian Cycle from primary
follicle corpus albicans
Stages:
1 5 days menses
6 14 proliferative
15 26 secretory
27 28 ischemic
3

Stages of Human Sexual Response

Initial Response:
VASOCONGESTION
constriction of blood vessels
MYOTONIA increased muscle
tension
Excitement Phase
muscle tension, moderate VS
erotic stimuli causing sexual
tension, may last from minutes to
hours
Plateu Phase
and sustained tension near
orgasm
may last 30 sec 30 minutes
Orgasm
Involuntary release of sexual
tension accompanied by
physiologic and psychologic
release,
immeasurable peak of experience 2
3 seconds
Resolution
Return to normal state
VS return to normal
REFRACTORY PERIOD only
period present in male, wherein he
cannot restimulated for about 10
15 minutes
Wonders of Fertilization
Fertilization
Phonones song of sperm
Capacitation ability of sperm to
release proteolytic enzyme and
penetrate the ovum
Stages of Fetal Growth and
Development
Pre Embryonic Stage
Zygote fertilized ovum (3 4
days travel, 4 days floating)> from
fertilization
Morula mulberry-liked ball
containing 16 50 cells
Blastocyst enlarging cell
forming a cavity that later becomes
the embryo covered by thropoblast
which later becomes the placenta
and membrane

Implantation 7 10 days after

fertilization
Thropoblast covering of
blastocyst that become placenta
S/Sx of Implantation Slight
pain, Slight Vaginal Spotting
3 Processes
Apposition
Adhesion
Invasion
Embryonic Stage
Zygote fertilization to 14 days
Embryo 15th 2 mos/ 8 weeks
Fetus 2 mos to birth
Decidua thickened endometrium,
latin word for falling off
Basalis located directly under the
fetus where placenta developed
Caspularis encapsulates the fetus
Vera remaining portion of and
endometrium
Chorionic Villi 10 11 weeks
Chorionic Villi Sampling (CVS)
removal of tissue from the fetal
postion of the developing placenta
For genetic screening
Fetal limb defects, missing digits of
toes
Cytothrophoblast outer layer,
LANGHANS LAYER, protect the
fetus against syphilis (24 weeks/ 6
months)
Synsitiotrophoblast syncitial
layer responsible for hormone
production
Amnion inner most layer 2.
Chorion
Umbilical cord (Funis) whitish
gray (50 60 cm)
Short abruptio placenta, uterine
inversion
Long cord prolapse, cord coil
3 vessels (AVA) Artery Vein
Artery
Whartons Jelly protects the
umbilical cord
Amniotic fluid bag of water
clear color, musty/mousy odor
With crystallized forming pattern,
slightly alkaline
500- 1000 cc Normal

Oligohydramnios kidney
malformation
Hydramnios GIT , TEF/ TEA
Functions
Cushion the fetus against sudden
blow or trauma
Maintains temperature
Facilitate muscuskeletal
development
Prevents cord compression
Helps in development process
Diagnostic Test for Amniotic Fluid
Amniocentesis
Purpose: obtain sample of amniotic
fluid by inserting a needle hrough
the abdomen into the amniotic sac
Fluid is tested for:
Genetic screening
Determination of fetal maturity
primarily by evaluating factors
indicative of lung maturity
Done with empty bladder
Complication
> Most common side
effect : INFECTION
> Late : pre term labor
> Early : spontaneous
abortion
Indication for Amniocentesis:
> Early in Pregnancy
Advance Maternal Age
> Later in Pregnancy
Diabetic Mothers
- down syndrome
- neural tube defect, spina befida
L/S ratio : 2:1 (Lecitin/
Spingomyelin)
Definitive test = Phosphatiglycerol:
PG + best Answer
Greenish Meconium Stains (Fetal
Distress)
Yellowish jaundice,
hyperbilirubinemia
Cloudy Infection
Most Important Consideration
Needle insertion site
Amnioscopy direct examination
through intact fetal membrane via
ultrasound
4

Fern Test a test determining if

bag of water has rupture or not
Nitrazine Paper Test differentiate
amniotic fluid and urine Blue
geen + rupture of bag of H2O
Chorion outermost layer
Placenta AKA Secundines
chorionic Villi and basalis
Pancake in latin
500 grams in weight
15 28 cotyledons
15 20 cm in diameter and 2 3
cm in depth
Functions
Respiratory 02 CO2 exchange
via simple diffusion
GIT glucose transport via
facilitated diffusion
Excretory via 2 arteries, carries
unoxygenated blood then detoxify
by maternal liver
Circulatory fetoplacental
circulation by SELECTIVE
OSMOSIS
Endocrine
HCG primary maintain corpus
luteum/ secondary basis of
pregnancy test
Human Placental Lactogen aka
Somatomammothrophin
Responsible for the development of
mammary gland
Diabetogenic Effect insulin
antagonist
Relaxin softening of maternal
joints and bones
Serves as protective barrier against
some microorganism
Can pass: HIV CMV Rubella
PINOCYTOSIS transport of virus
Pregnancy 266 288 days/ 37
42 weeks
FETAL STAGE: Fetal Growth and
Development
First Trimester : Period of
organogenesis, most critical period
First Month

FHT, CNS Develops,

GIT and Respi Tract remains as
single tube
Differentiation of
Primary Germ Layer
Endoderm
Thyroid responsible for basal
metabolism
Thymus immunity
Liver
GIT
Linings of Upper GI Tract
Mesoderm
Heart
Musculoskeletal
Reproductive Organ
Kidney
Ectoderm
Brain
CNS
Skin
5 senses
Hair, nails
Anus
Mouth
Second Month
Life span of corpus luteum ends
All vital organs are formed
Placenta is developed
Sex organ is developed
Meconium is present
Third Month
Placenta is complete
Kidneys are functional
Fetus begins to swallow amniotic
fluid
Buds of milk appear
Sex is distinguishable
FHT audible via dopples @ 10 12
weeks
Terratogens any drug or
irradiation, the exposure to which
may cause damage to the fetus
DRUGS
Streptomycin anti TB
(quinine) damage to the 8th cranial
nerve poor learning and
deafness/ ototoxic
Tetracycline stoning the tooth
enamel, inhibits long bone growth

Vitamin K hemolysis, destruction

of RBC, jaundice,
hyperbilirubenemia
Iodides enlargement of thyroid
and goiter
Thalidomides anti-emetics
Amelia or Pocomelia absence of
distal part of extremities
Steroids cleft lip or palate and
even abortion
Lithium congenital maformation
ALCOHOL LBW, fetal alcohol
syndrome ( characterized by
microcephaly)
SMOKING LBW
CAFFEINE LBW
COCCAINE LBW, abruptio
placenta
TORCH group of infections that
can cross the placenta or ascend
through the birth canal and
adversely effect fetal growth
Toxoplasmosis cat lovers
Others - Hepa AB, HIV, Syphillis
Rubella CHD,
Rubella Titer N @ 1:10 or =
immunity to rubella = notify doctor
Rubella vaccine after delivery for 3
mos. No pregnancy for 3 mos.
Cytomegalo virus
Herpes Simplex virus
Second Trimester :
continuous growth and
development (focus lengh of
fetus)
Fourth Month
Lanugo begins to appear
Buds of permanent teeth appear
FHT audible via Fetuscope @ 18
20 weeks
Fifth Month
Quickening : 1st fetal movement
Primi: 18 20, Nulli - 16 - 18
Lanugo covers the body
FHT audible via stethoscope or
w/out instrument
Actively swallow amniotic fluid
Fetus : 19 25 cm
Sixth Month
Skin is red and wrinkled
5

Vernix caseosa covers the skin

Eyelids open
Exhibits startle reflex
3rd Trimester : period of most rapid
growth and development Focus:
weight
Seventh Month
Surfactant development
Male: the testes begins to descent
into the scrotal sac
Female : clitoris is prominent and
labia majora are small doesnt
cover the minora
Eight Month
Active moro reflex
Lanugo begins to disappear
Sub q fats deposits, steady weight
gain, nails to fingers
Ninth Month
Lanugos and vernix caseosa is
evident in body fold
Birth position assumed
Amniotic fluid somewhat decrease
Sole of the foot has few creases
Tenth Month
Bone ossification in the fetal skull
Vernix caseosa is evident in body
PHYSIOLOGIC ADAPTATION
TO PREGNANCY
Systemic Changes
Cardiovascular System
blood volume 30 50%
1500 cc; additional 500 cc for
multiple pregnancy
plasma volume
cardiac workload easy
fatigability/ slight ventricular
hypertrophy
Epistaxis due to hyperemia of nasal
membrane
Palpitation due to SNS stimulation
Physiologic Anemia/ pseudoanemia
in pregnacy
Normal Value
Hct : 32 42%
Hgb: 10.5 14 g/dl
Criteria
1st & 3rd Trimester : Hct > 33%
Hgb > 11 g/dl

2nd Trimester
: Hct > 32% Hgb
> 10.5 g/dl
Pathologic Anemia
Iron Defficiency Anemia is the
most common hematologic
disorder. It affects 20% of pregnant
women
Assesment reveals:
Pallor
Slowed capillary refill = Normal =
2 3 sec
Concave fingernails (late sign of
progressive anemia) clubbing =
chronic tissue hypoxia
constipation
Nursing care
Nutritional instruction
Source of iron
Kangkong
Liver = best source due to
FERRIDIN Content
Red and lean meat
Green Leafy Vegetables
Parenteral Iron (Imferon)
Z tract IM
incorrect causes hematoma
best given 1 hour before meals
(causes GI irritation)
Maybe given 2 hours after meal
(results to poor absorption)
Given with orange juice to
absorption
Oral Iron Supplements (ferrous
sulfate 0.3 g 3 x a day)
Monitor for hemorrhage
Alert
Iron from red meat is better
absorbed iron from other sources
Iron is better absorbed when taken
with foods high in Vitamin C such
as orange juice
Higher iron intake is recommended
since circulating blood volume is
increased and heme is required
from production of RBCs
Edema
Impeded venous return due to the
gravid uterus
Nursing Intervention
Elevate legs above the hips level
Varicosities

Wear support stockings

Elevate legs
Vulvar Varicosities
D/t pressure of gravid uterus
Side lying with pillow under the
hips
Modified knee chest position
Thrombophlebitis
Presence of thrombus in inflamed
blood vessels
+ Homans Sign pain on the calf
upon dorsiflexion
Medical Management
Anticoagulant/ HEPARIN
Does not cross the placental barrier
Monitor APTT
Antidote: PROTAMINE SULFATE
No aspirin
Milk Leg/ Plagmasia Alba Dolens
Shiny white legs due to stretching
of skin & hyperfibrinogenemia
Nursing intervention
Check dorsalis pedis pulse
(compare both)
Never massage
Assess for Homans sign only once
Respiratory System
Shortness of Breath d/t gravid
uterus
Nursing intervention: Side-lying
lateral expansion of the lungs
Gastrointestinal System
Nausea and vomiting
Morning Sickness
Due to HCG levels
Crackers 30 min before arising
AM Carb diet 30 mins
PM small frequent meal
Constipation
Due to PROGESTERONE =
fluid reabsorption due to GIT
motility
Nursing intervention
Fluid
Fiber
Exercise
Flatulence
Due to increased progesterone
Avoid gas forming foods
6

Heartburn (pyrosis)
Reflux of stomach content into
esophagus
Nursing Intervention
Small frequent meals
Sips of milk
Avoid fatty and spicy foods
Proper body mechanics
Waist Above Acid
Waist Below Base
Hemorrhoids
Due to gravid uterus
Hot sitz bath for comfort
Ptyalism
salivation
Mouthwashes to relieve
Urinary System
Normal = + 1 sugar due to
Progesterone via BENEDICTS
TEST
First Trimester - Frequency
Second Trimester - normal
Third Trimester - Frequency
Muscoloskeletal
Calcium sources
Milk - Ca P 1 pint/ day or 3
4 servings/ day
Cheese, Yogurt, Head of Fish,
Sardines, Anchovies, Brocolli
Lordosis
Pride of Pregnacy
Waddling Gait
Awkward gait while walking due to
relaxin
Prone to accidental falls
Wear low healed shoes
Leg Cramps
Ca P Imbalance during pregnancy
Lumbo-sacral nerves by pressure of
gravid uterus during labor
Over sex
Dorsiflex the foot affected
3-4 servings/ 4 cups/day sa milk,
sardines, dilis
Local Chnages
Vagina
Chadwicks Sign bluish
discoloration

Leukorrhea whitish gray,

moderate in amount, mousy odor
Cervix
Goodels Sign change in
consistency of uterus
Operculum mucus plug to seal
bacteria/ progesterone
Uterus
Hegars Sign change in
consistency
Vagina
Cervix
Uterus

Chadwicks
Goodels
Hegars

Problems related to the changes of

Vaginal Environment
Vaginitis - AVOCADO
Trichomonas Vaginalis
Flagellated protoxzoan, Loves
alakaline environment
Signs and Symptoms
Greenish, cream, colored, frothy,
irritably itchy, foul smelling
vaginal discharge
Vaginal edema
Management
Drug of choice:
METRONIDAZOLE (Flagyl)
Antiprotozoan
Carcinogenic
Not given in 1st trimester
vaginal douche as substitue
1 qt Water = 1 tbsp white vinegar
Treat partner as well to prevent
reinfection
No alcohol due to antabuse effect
Moniliasis - CHEESE
Candida Albicans
Transvaginal transfer in fetus
Oral Trush
Signs and Symptoms
White Cheeselike patches that
adheres to the walls of the vagina
Management
Antifungals
Mycostatin
Contrimazole Canisten
Gentian Violet

Striae Gravidarum
Due to destruction of the
subcutaneous tissue by the enlarge
uterus
Skin Changes
Melasma/ Chloasma
White light brown pigmentation
related to melanocytes
Linea Nigra
Brown pinkish line from symphysis
pubis to umbilicus

Breast Changes
Due to hormonal changes
Change in color and size of nipple
and areola
Precolostrum 6 weeks
Colustrum 3rd trimester
Supine with pillow under the back
Ovaries rest period, no ovulation
Signs and Symptoms of Pregnancy
Presumptive Proba
S/sx felt and Signs
observed by observ
the mother
the
but does not memb
confirm the
the he
diagnosis of care t
pregnancy
First
Breast
Good
trimester changes
sign
Urinary
Chadw
changes
sign
Fatigue
Hegar
Amenorrhea sign
Morning
Eleva
sickness
BBT
Enlarge
Positi
uterus
HCG
Second
Chloasma
Ballot
Trimester Linea Nigra Enlarg
Increase
Abdo
Skin
Braxt
Pigmentation Hicks
Striae
Contr
gravidarum
Quickening

Abdominal Changes
7

CBQ Cancer of the Breast

quadrant B
Mamography 35 and above 1/
year
Ballotement bouncing of the
fetus
may be present in uterine
myoma
Transvaginal Ultrasound empty
bladder
Abdoiminal ulrasound full
bladder
Placenta Grading System
Grade 0 immature
Grade 1 slightly mature
Grade 2 moderately mature
Grade 3 fully mature
What is deposited? calcium
VI. Psychological Adaptation to
Pregnancy Reva Rubin
First Trimester
No tangible s/sx
Feeling of surprise
Ambivalence
Denial of pregnancy
maladaptation
Developmental Task: Accept
biological facts of pregnancy
Health Teaching: Body changes of
pregnancy and Nutrition
Second Trimester
Tangible s/sx
Mother identifies fetus as separate
entity due to quickening
Fantasy
Developmental Task: Accept
growing fetus as a baby to nurture
Health Teaching: Growth and
development of fetus
Third Trimester
Mother has personally identifies
with the appearance of the baby
Developmental Task: Prepare child
birth and parenting the child

Health Teaching: responsible

parenthood, prepare babys layette,
Lamaze Class
Address Mothers fear let she
hear the FHT

Optimal
weight gain 25 35 lbs
Obstetrical Data
Gravida no. of pregnancy
Para no. of viable pregnancy

VII. Pre Natal Visit

Basic Consideration
Frequency of Visit
1 7th mos. once a month
8 9th mos. twice per month
10th month every week
Personal Data
Home Based Mothers Record/
HBMR determines high risk
pregnancy
Pseudocyesis false pregnancy
appearance of presumptive &
probable signs
Comade Syndrome
psycosomatic disorder, father
experience what the mother goes
through
Diagnosis of Pregnancy
Urine Exam HCG 40 100th
day; peak 60 70th day
ELISA beta subunits of HCG is
detected as early as 7 10th day
RIA beta subunits of HCG is
detected as early as 8th day
Home Pregnancy Kit
Baseline Data
Roll Over Test test of preeclampsia by the use of BP
Weight monitoring
Normal Weight Gain
1st Trimester = 1.5 3 lbs 1 lb/
mo
2nd Trimester = 10 12 lbs 4
lbs/mo
3rd Trimester
= 10 12 lbs 4 lbs/mo
Minimum allowable
weight gain 20 25 lbs

Viability the ability of the fetus

to live outside the uterus at the
earliest possible gestational age
1 abortion
1 39TH Week, 1 miscarriage,
1 still birth, 1 2nd mo. preg
1 pregnancy 3rd mos.
G4P2 G4 T1 P1 A1 L1
G2P0 G2 T0 P0 A1 L0
Important Estimates
Nageles Rule
Use to determine expected date of
delivery
Jan Mar +9 months +7 days
Apr Dec -3 months +7 days +
1 year
McDonalds Rule
Determines age of gestation in
weeks
Fundic Height x 7/8 = AOG in
weeks
Bartholomews Rule
Determines age of gestations
3 mos above pubis symphysis
5 mos level of umbilicus
9 mos below xiphoid process
10 mos level of 8th mos
Haases Rule
Determines the length of fetus in
cm.
1st half square each month
2nd half month x 5
Tetanus Immunization
TT1 anytime or early during
pregnancy
TT2 1 month after TT1 3
years protection
8

TT3 6 months after TT2 5 years

of protection
TT4 1 year after TT3 10 years
of protection
TT5 1 year after TT4 lifetime
protection
Physical Examinations
Danger Signs of Pregnancy
Chills & Fever
Cerebral Disturbances
Abdominal Pain epigastric pain
auro of impending convulsion
Boardlike Abdomen Abruptio
placenta
Blurred Vission pre eclampsia
Bleeding abortion/ ectopic
pregnancy 1st trimester
H Mole/ Incompetent
Cervix 2nd trimester
Placental Anomalies
rd
3 Trimester
BP
Swelling
Scotoma spots in the eye
Sudden gush of fluid
PROM premature rupture of
membrane
Pelvic Examination
Pelvic examination or IE empty
bladder, precaution
1st visit Chadwicks, Goodles
sign, etc.
Position : dorsal recumbent,
lithotomy
Pap smear done 1st visit
Cytological exam determine
presence of cancer cells.
Result :
Class I normal
Class II A cytology without
evidence of malignancy
B suggestive of inflammation
Class III cytology suggestive of
malignancy
Class IV cytology suggestive og
malignancy
Class V conclusive for
malignancy

Most common cancer report organ :

cervical cancer
Most common site for pap smear
external OS of cervix
(squamocolumnar tissue)
Common site of cervical cancer.
maternal speculum (open)
Stages of cervical cancer
0 carcinoma in situ
1 Ca strictly confined to cervix
2 from cervix extends to the
vagina
3 pelvic metastasis
4 affectation to bladder & rectum
Leopolds Maneuver
Purpose: Done to determine the
attitude, fetal presentation, lie,
presenting part, degree of descent
an estimate of the size, and no. of
fetuses
Procedure
1st maneuver
place patient in supine position
with knees slightly flexed. Put
towel under head and right hip.
With both hands palpate uppe4r
abdomen and fundus. Assess size,
shape, movement and firmness of
the part
determine the presenting parts:
2nd maneuver
with both hands moving down,
identify the back of the fetus where
the ball of the stethoscope is placed
to determine FHT.
PR of mother : uterine souffl
MHR
fundic souffl FHR
3rd maneuver
using the right hand, grasp the
symphysis pubis part using the
thumb and fingers.
Assess whether the presenting part
is engaged in the pelvis.
Alert! If the head is engaged it will
not be movable
4th maneuver
the examiner changes the position
by facing the patients feet. With
two hands, assess the descent of the

presenting part by locating the

cephalic prominence or brow.
When the brow is on the same side
as the back, the head is extended.
When the brow is on the same side
as the small parts, the head 8is
flexed and vertex presenting.
Attitude relationship of fetus to
one another.
Full Flexion when the chin
touches the chest
Assessment of Fetal Well-being
Daily fetal Movement Counting
(DFMC)
Done starting 27th week
Consideration
fetal sleep wake pattern
maternal food intake
drug-nicotine use
environmental stimuli
maternal dose
Cardiff count to 10 method one
method currently available
begin at the same time each day
(usually in the morning after
breakfast ) and count each fetal
movement, noting how long it
takes to count 10 fetal movements
(FMs)
expected findings 10 movements
in 1hrs or less
warning signs 10-12 movements
in 1hr or less
more than 1hr to reach 10
movements
less than 10 movements in 12hrs
longer time to reach 10 FMs than
on previous days.
movements are becoming weaker,
less vigorous
movement alarm signal <3 FMs in
12hrs
warning signs should be reported to
healthcare provider immediately;
often require further testing. Eg.
Non stress test (NST), biophysical
profile (BPP)
Nonstress Test
9

to determine the response of the

fetal heart rate to the stress to
activity.
Indications pregnancies at risk for
placental insufficiency
Postmaturity
pregnancy induced hypertension
(PIH), diabetes
warning signs noted during DFMC
maternal history of smoking,
inadequate nutrition
Procedure :
Done within 30mins wherein the
mother is in semifowlers position;
external monitor is applied to
document fetal activity; mother
activates the mark button on the
electronic monitor when she feels
fetal movement. Attach external
noninvasive fetal monitors
tocotransducer over fundus to
detect uterine contractions and fetal
movements (FMs)
ultrasound transducer over
abdominal site where most distinct
fetal heart sounds are detected
monitor until at least 2 FMs are
detected in 20mins.
if no FM after 40mins provide
women with a light snack or gently
stimulate fetus through abdomen
If no FM after 1hr further testing
may be indicated, such as a CST
Result :
Noncreative Nonstress Not Good
Reactive Response is Real Good
Interpretation of results
Reactive result real good
baseline FHR between traction
beteen 120 and 160 beats per min.
at least two accelerations of the
FHR of at least 15 beats per min.,
lasting at least 15secs in a 10 to 20
min period as a result of FM
good variability normal
irregularity of cardiac rhythm
representing a balanced interaction
between the parasympathetic (
FHR) and sympathetic ( FHR)
nervous system; noted as an uneven
line on the rhythm strip

result indicates a healthy fetus with

an intact nervous system
Nonreactive result not good
stated criteria for a reative result
are not met
could be indicative of a
compromised fetus requires further
evaluation with another NST,
biophysical profile, (BPP) or
contraction stress test (CST)
9. Health Teachings
do nutritional assessment
daily food intake
determine habit
if folic acid lead to spina
bifida/open neural tube defect
HIGH RISK MOTHERS
pregnant teenagers poor
compliance to health regimen
extremes in wt underwt eg.
Elite models overwt eg.
DM/HPN
low social economic status. Refer
to OSWD
vegetarian mothers because
intake of vit B12
(Cyanocobalamin) formation of
folic acid (cell DNA & RNA
formation)
types :
strict vegetarian prone to develop
anemia
lacto vegetarian milk
lacto-ovo vegetarian milk & egg
a. Recommended Nutrient
Requirement that Increases During
Pregnancy
Nutrients
Requirements
Calories
Essential to
300 calories/day
supply energy
above the
for
prepregnancy
daily requirement
metabolic
to maintain ideal
rate
body weight and
Utilization of
meet energy
nutrients
Protein sparing requirement of
activity level
so it can be
begin in 2nd
used for :

growth of fetus
development of
structures
requires for
pregnancy
including
placenta,
amniotic fluid,
tissue growth

Trimester
use wt-gain
pattern as an
indication of
adequacy of
calories intake
failure to meet
caloric
requirements can
lead to ketosis as
fat & protein are
used for energy,
ketosis has been
associated with
fetal damage.
Non pregnant:
2200 calories
Pregnant: 2500
calories
2200+500 @
lactation=2700
cal

Protein
Essential for
fetal tissue
growth
maternal tissue
growth
including
uterus and
breasts.
Development
of essential
pregnancy
structures
Formation of
RBC and
Foodplasma
sourcesproteins
Caloric
Inadequate
should
reflect
protein
intake
has been
high associated
nutrient with
valueonset
suchof
as
protein,
pregnancy
complex
induced
carbohydrates
hypertension
(whole
(PIH)
grains,

60mg/day or an
of 10% above
daily
requirements for
age group
Adolescents have
a higher protein
requirement than
mature women
since adolescents
must supply
protein for their
own growth as
well as protein to
meet the
pregnancy
requirement

10

CalciumPhosphorous
Essential for
Growth and
development of
fetal skeleton
and tooth buds
Maintenance of
mineralization
of maternal
bones and teeth
Current
research is
demonstrating
an association
between
adequate
calcium intake
and the
prevention of
pregnancy
induced
hypertension

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

Calcium of
1200mg/day
representing an
of 50% above
pre pregnancy
daily requirement
1600mg/day is
recommended for
adolescent
10mcg/day of
vitamin D is
required since it
enhances
absorption of both
calcium and
phosphorous

Non
Pregnat:15mg/day
Pregnant :
30mg/day
representing a
doubling of the
prepregnant daily
requirement
Begin
supplementation
at 30mg/day in
second trimester,
since diet alone is
unable to meet
pregnancy
requirement
60 120mg/day
along with copper
and zinc
supplementation
for women who
have low Hgb

Calcium
should reflect

products,
milk, yogurt,
ice cream,
cheese, egg
yolk

grain, tofu

vegetables

salmon &
sardines with
bones

foods such as
orange juice

sources
fortified milk,
margarine,
egg yolk,
butter, liver,
seafood
Zinc
Iron Essential for
should
thereflect
formation
liver,ofred
enzymes
meat,maybe
fish, be
poultry,
eggs in
important
enriched,
the prevention
whole
ofgrain
congenital
cereals
&
malformation
breads
of the fetus
dark Folic
greenacids,
leafyfolacin, folate
vegetables,
Essential for
legumes
Formation of
nuts,RBC
dries&
fruitsprevention of
vitamin
C
anemia
sources:
DNA synthesis
citrus&fruits
cell &
juices,
formation; may
strawberries,
play a role in
cantaloupe,
the prevention

values prior to
pregnancy or who
have iron
deficiency anemia
70mg/day of
vitamin C which
enhances iron
absortion
Inadequate iron
intake results in
maternal effects
anemia, depletion
of iron stores,
energy and
appetite, cardiac
stress especially
during labor &
birth
fetal effects
availability of
oxygen thereby
affecting fetal
growth
iron deficiency
anemia is the
most common
nutritional
disorder of
pregnancy
15 g/day
representing an
of 3mg/day
over prepregnant
daily requirement

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

tomatoes,
of neural tube
greendefects (spina
peppers,
bifida),
broccoli
abortion,
or
cabbage,
abruption
potatoes
placenta
iron form
Additional
food requirements
sources
is more
Minerals
readily
Iodine
absorbed
Magnesium
whenselenium
served
with foods
high in vit C

dietary deficiency

175mcg/day
320mg/day
65mcg/day

Vitamins
E
10mg/day
Thiamine
1.5mg/day
Riboflavin
1.6mg/day
Pyridoxine
2.2mg/day
(B6)
2.2mcg/day
17mg/day
Zinc B12
Niacin
should
reflect

b. Sexual Activity
Principles of sex in Pregnancy
Should be done in moderation
legumes, nuts
Should be done in a private place
That the mother should be placed
in a comfortable position
It must be avoided 6 weeks prior to
EDD
Avoid blowing of air during
reflect
Liver.cunnilingus
Contraindication
in sex:
Kidney,
lean
beek,vaginal
veal spotting 1st tri
cervix 2nd tri
Dark,incompetent
green
leafyplacenta previa, abruption placenta
3rd tri
vegetables,
pre-term labor R: prostaglandin
broccoli,
oxytocin contraction
asparagus,
PROM infection
artichokes,
11

Changes in sexual appetite during

pregnancy:
1st tri -
2nd tri -
3rd tri -
c. Exercise
strengthen muscle to be used
during the delivery process
Walking best form of exercise
Squatting strengthen perineum &
circulation to the perineum (raise
the buttocks before head to prevent
postural hypotension)
Tailor sitting same purpose with
squatting
Kegel exercise strengthen
pubococcygeal muscle
Abdominal exercise muscle of
the abdomen ( done as if blowing a
candle)
Shoulder circling exercise
strengthen muscle of the chest
Pelvic rocking exercise or pelvic
tilt relieve low back pain &
maintain good posture (arching
back for 3 sec)
Principles of exercise
must be done in moderation
must be individualized
d. Childbirth Preparation
Overall goal: To prepare patents
physically & psychologically while
promoting wellness behavior that
can be used by parents & family
thus, helping them achieved a
satisfying & enjoying childbirth
experiences.
Psychological
Bradley Method Dr. Robert
Bradley discoverer
advocated active participation of
husband during labor & delivery to
serve as coach, based on imitation
of nature
Features:
darkened room
quiet & calm environment

relaxation technique
close eyes
Grantly Dick Read Method
fear can lead to tension while
tension can lead to pain. (break
cycle by removing the fear-by
abdominal breathing exercises &
relaxation technique)
Psychosexual
Kitzinger Method Dr. Shiella
Kitzinger
pregnancy, labor & birth & the care
of the newborn is an important
turning point in a womans life
cycle. flowing with contractions
rather than struggle with
contractions
Psychoprophylaxis
Lamaze Dr. Ferdinand Lamaze
Prevention of pain thru mind &
requires discipline, conditioning &
concentration with the husbands
help.
Features:
conscious relaxation
cleansing breathe inhaling thru
nose & exhaling thru mouth
effleurage gentle circular
massage
over abdomen to relieve pain
imaging
Different methods of delivery
birthing chain semi-fowlers
mother
bathing bed dorsal recumbent
squatting position relieve on back
pain & maintain good posture
Leboyers method
features :
darkly lighted room
quiet & calm environment
room temp.
soft music
Birth under water
IX. INTRAPARTAL NOTES
A. Admitting the laboring Mother
Personal data
Baseline data
Obstetrical data
Physical exams

Pelvic exams
B. Basic knowledge in intrapartum
Theories of the Onset of Labor
Uterine Stretch Theory any
hollow organ once stretched to its
maximum potential will always
contract & expel its content
Oxytocin Theory released by
PPG, contraction effect
Prostaglandin Theory stimulation
by Arachidonic acid, causes
contraction of uterus
Aging Placenta 42wks (lifespan)
by 36wks placenta begins to
degenerate causes contraction
Progesterone deprivation theory -
level of progesterone will facilitate
contraction of the uterus
The 4 Ps of Labor
Passenger fetus
fetal head
is the largest presenting part
of its length
Bones 6 bones (sphenoid,
temporal, ethmoid) Frontal,
occipital & 2 parietal bones
Sutures/intermembranous spaces
allows molding
Molding the overlapping of the
sutures of the skull to permit
passage of the head to the pelvis
Sagittal bones connect to parietal
bones
Cororontal bones connect to
parietal & frontal bones
Lambdoidal bones connect to
parietal & occipital bones
Fontanels
6 fontanels only 2 palpable
anterior fontanel/Bregma
diamond in shape
3cm x 4cm size
close 12-18 mos post delivery
5cm hydrocephalus
posterior fontanel/lambda
triangular in shape
1 x 1cm size
close 2-3mos post delivery
Measurements of fetal head :
transverse diameter
12

Bi-parietal - largest transverse

diameter- 9.25cm
Bi-temporal - 8cm
Bi-mastoid - smallest transverse
diameter - 7cm
AP diameter
Suboccipitobregmatic complete
flexion
Occipitofrontal partial flexion 12cm
Occipitotemporal largest AP
diameter; hyperextended (13.5cm)
Submentobrgmatic - face
presentation; poor flexio
Passageway vagina & pelvis
Pelvis
4 main pelvic types
gynecoid round, wide, deeper,
most suitable for pregnancy
android heart shape male pelvis
anterior pointed post part
shallow
Anthropoid oval ape-like pelvis
AP wider transverse narrow
Platypelloid flat transverse oval
AP narrow transverse wider c/s
for delivery
Problem :
mother who encounter accident
49
18y/o R: pelvis not achieve its
full pelvic growth
Bones of pelvis
4bones
2 hips (2 innominate bones)
3parts of 2 innominate bones
Ileum lateral/side of hips
Iliac crest flaring superior border
that forms prominence of hips;
common site for bone marrow
aspiration
Ischium inferior portion
Ischial tuberosities of the area
where we
Sit; basis in getting external
measurement of pelvis
Pubis anterior portion
Symphysis pubis junction in
between
sacrum posterior portion

Sacral prominence basis internal

measurement of pelvis
1 coccyx - 4 small bones that
compresses during vaginal delivery
universal precaution in
measurement of pelvis is to empty
bladder first
Important Measurements
Diagonal Conjugate
measure between Sacral
promontory & inferior margin of
the symphysis pubis
Measurement 11.5-12.5 cm
Basis in getting the true conjugate.
True Conjugate/Conjugate Vera
Measure between the anterior
surface of the sacral promontory &
superior margin of the symphysis
pubis.
Measurement: 11.0 cm
Diagonal conjugate: 1.5 cm = true
conjugate.
Obstetrical Conjugate
smallest AP diameter of the pelvis
measuring 10cm or more.
Tuberoischii Diameter
transverse diameter of the pelvic
outlet.
Approx by a fist- 8cm & above.
Power
the forces acting to expel the fetus
& placenta
involuntary contractions
voluntary bearing down efforts
characteristics: wave like
timing: frequency, duration,
intensity
myometrium power of labor
Psyche/person
psychological stress exist when the
mother is fighting the labor
experience.
cultural interpretation preparation
past experience
support system
Pre-eminent signs of labor
Preeminent Signs
lightening
settling of the presenting part into
the pelvis brim (shooting pain

radiating to the legs, urinary

frequency)
primi- early 2 weeks prior to EDD
engagement settling of presenting
part into pelvic inlet (not signs of
labor)
Braxton Hicks Contractions
painless irregular contractions
Increase Activity of the Mother
Nesting
Instinct (mgt: save energy)
epinephrine production (hormone
that the activity of the mother)
Ripening of the cervix butter
softness
Decrease in weight 1.5-3 lbs.
Bloody show
pinkish vaginal discharge (blood +
leucorrhea + operculum = pink in
color)
Rupture of membranes
check FHT
IE check for cord prolapse
after several hrs check temp.
Premature Rupture of Membranes
(PROM)
contraction drop in intensity even
though very painful
contraction drop in frequency
uterus tense &/or contracting
between contractions
abdominal palpitations
Nursing Care:
administer analgesics (morphine)
attempt manual rotation for ROP or
LOP
bear down with contractions
adequate hydration
sedation as ordered
cesarean delivery may be required,
especially if fetal distress is noted
Cord Prolapse
a complication when the umbilical
cord falls or is washed through the
cervix into the vagina.
Danger Signs:
PROM
Presenting part has not yet engaged
Fetal distress

13

Protruding cord from vagina

cerebral palsy 5 mins.,
irreversible brain damage mgt: CS
Nursing Care
Positioning knee chest or
trendelenberg, place wet sterile
gauze R: to make it slippery
Observe for fetal distress
Provide emotional support
Prepare for cesarean section
Difference Between True and False
Contraction
True
False
No in
There is an in
intensity
intensity
Pain
Pain begins @
confined
the lower
in the
back to
abdomen abdomen
Pain is
Pain is
relieved
intensified by
by
walking
walking
Cervical
No
effacement
cervical
(thinning of
changes
the cervix,
measured thru
%) &
dilatation
(widening of
the cervix,
measurement
thru cm)
*best/major
sign of true
labor
Duration of Labor
Primipara 14 hrs but not more
than 120 hrs
Multipara 8 hrs but not more than
14 hrs
Nursing Interventions in Each
Stage of Labor
First Stage: onset of contractions to
full dilatation & effacement of the
cervix
stage of effacement & dilatation
Latent Phase:
Assessment:

Dilatations 0-3 cm
Frequency 5-10 mins
Duration 20-40 mins
Intensity mild
Mother is excited, apprehensive but
can communicate
Nursing Care:
Encourage walking : shortens 1st
stage of labor
Encourage to void q 2-3 hrs : full
bladder inhibits uterine contraction
breathing (chest breathing
technique)
Active Phase:
Assessment:
Dilatations 4-8 cm
Frequency q 3-5 mins lasting for
30-60 secs
Duration 30-60 secs
Intensity moderate
Nursing Care:
M edications have meds ready
A ssessment include: v/s, cervical
dilatation & effacement, fetal
monitor, etc
D ry lips oral care (ointment),
dry linens
Breathing abdominal breathing
Transitional Phase:
Assessment:
Dilatations 8-10cm
Frequency q 2-3 mins contractions
Duration 45-90 sec
Intensity strong
Mood of mother suddenly change
accompanied by hyperesthesia
(hypersensitivity of mother to
touch) of the skin
Management
sacral pressure, cold compress
Nursing care:
T tires
I inform of progress (to relieve
emotional support)
R restless support her breathing
technique
E encourage & praise
D discomfort
Pelvic Exams
Effacement & Dilatation

Station relationship of the

presenting part to the ischial spine
5 - -1 = the presenting part is above
the ischial spine
Engagement 10 = the presenting
part is in line with the ischial spine
(-) fetus is floating
(+) below the ischial spine
Presentation
the relationship of the long axis of
the fetus to the long axis of the
mother.
spine relationship of the spine of
the mother & the spine of the fetus

Two Types
Longitudinal Lie (Parallel)/ Vertical
Cephalic when the fetus is
completely flexed
Vertex
Face
Brow
Chin
Breech
Complete breech thigh rest on
abdomen while legs rest on thigh
Incomplete breech
Frank thigh resting on abdomen
while legs extend to the head
Footling
Kneeling
Transverse Lie
(Perpendicular)/Horizontal lie
Position relationship of the fetal
presenting part to specific quadrant
of the mothers pelvis.
ROA/LOA
left occipito anterior
most common & favorable position
ROT/LOT left occipito transverse
ROP/LOP left occipito posterior
L/R- side of maternal pelvis
Middle presenting part
ROP/ROT most common
malposition
ROP/LOP most painful mgt:
pelvis squatting
14

Breech sacro
place the stethoscope above the
umbilicus
Chin mentum
Shoulder acromnio dorso
Monitoring the contractions & fetal
heart tone
spread the finger lightly over the
fundus to monitor the contraction
Increment/Cresendro - beginning of
contraction until it increases
Apex/Acne height of contraction
Decrement/Decresendro from
height of contraction until it
decreases
Duration beginning of
contraction to the end of the same
contraction
Interval from end of contraction
to the beginning of the next
contraction
Frequency from the beginning of
1 contraction to the beginning of
next contraction
Intensity strength of contraction
if contract blood vessel
constricts; the fetus will get the
oxygen on the placenta reserve
which is capable of giving oxygen
to the fetus up to 1min.
Duration of placenta to the fetus
should not exceed 1min.
Significance During active phase, if
to 1min should notify the AMD
BP; FHT : best time to get BO
& FHT just after a contraction
NURSING CONSIDERATION
DURING THE FIRST STAGE OF
LABOR
Bath is necessary
Monitor VS especially BP
Same BP = rest
Elevated = notify the physician
NPO
Prevent aspiration chemical
pneuminitis
Enema (per hospital policy)
Purpose
Cleanse the bowel

Prevent infection
12 18 inches normal length of
tube
18 inches optimal length
Lateral sims position
If there is contraction clump the
tube
If there is resistance slowly
remove
Before and after administration:
check FHT (120 160) and
contractions
Encourage mother to void
Perennial preparation (rule of 7)
Rest on left side lying position
Prevent supine vena cava syndrome
or supine hypotension
If membrane doesnt rupture
amniotomy
FETAL TRASHING hyperactivity of fetus due to lack of
Oxygen
For Pain
Systemic analgesic
DEMEROL (Meperidine HCl)
Narcotic and antispasmonic
Dont give during latent phase
Given @ 6-8 cm dilated
WOF : Respiratory depression
Narcan (Naloxone, nalorfan,
nalline)
Antidote for toxicity
Injected on the baby
Epidural Anesthesia
WOF : Hypotension
Prehydrate the client to prevent
hypotension
In case of Hypotension
Elevate leg
Fast Drip IV
SECOND STAGE OF LABOR
(FETAL STAGE)
Complete dilatation and effacement
to birth
Crowning occurs
PRIMI transfer to DR @ 10 cm
dilatation
MULTI transfer to DR @ 7 8
cm dilatation

Position in lithotomy both legs at

the same time
BULGING OF PERENIUM
surest sign of delivery initiation
PANT & BLOW Breathing, fetal
pushing should be done on an open
glottis
Respiratory alkalosis
Due to incorrect breathing
Hyperventilation
S/sx
RR
Lightheadedness
Tingling sensation
Carpopedal spasm
Circumoral numbness
Episiotomy
Prevent laceration
Widen the vaginal canal
Shortens the 2nd stage of labor
2 types
MEDIAN
Less bleeding
Less pain
Easy repair
Possible urethroanal fistula
major disadvantage
MEDIOLATERAL
More bleeding
More pain
Hard to repair and slow healing
Ironing the Perenium prevent
laceration
Mechanism of Labor (ED FIRE
ERE)
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
PELVIS
3 Parts
Inlet AP diameter narrow,
transverse wider
Cavity between inner and outer
15

Outlet AP diameter wider,

transverse narrow
LINEA TERMINALES
Nursing Care
MODIFIED RIGENS
MANEUVER
Done by supporting the perenium
with a towel during delivery
Facilitates complete flexion
Avoids laceration
First intervention: Support the head
and suction secretion
Do not milk the cord, wait for
pulsation to stop before cutting
Milking may cause too much blood
going to the baby that may cause
cardiac overload
When there is still birth, let the
mother see the baby to accept the
finality of death
THIRD STAGE OF LABOR
(PLACENTAL STAGE)
3 10 minutes after child birth
1st sign Fundus rises
CALKINS SIGN
Signs of Placental Separation
Fundus becomes globular and rises
calkins sign
Lengthening of the cord
Sudden gush of blood
BRANT ANDREWS
MANEUVER
slowly pulling the cord and wind at
the clamp
rapidly may cause uterine
inversion
Types Placental Delivery
SHULTZ (Shiny)
From center to the edges
Presenting fetal side
DUNCAN (Dirty)
Form edges to center
Presenting the maternal side
Nursing Considerations during
placental delivery
Check placental completeness

Should be 500 g
Check Fundus Massage if Boggy
BP Check
Methergine, methylergonovine
mallate (IM)
Oxytocin (IV) if methergine is not
present
Check perenium for lacerations
Assist in episioraphy
Vaginoplasty/ Vaginal Landscape
Virgin again
FOURT STAGE OF LABOR
(Recovery Stage)
First 1 2 hours after delivery of
placenta
Maternal observation body
system stabilize
1st hour q15 min 2nd hour - q 30
min
Placement of fundus
In between umbilicus and pubis
symphysis
Check bladder, assist in voiding,
May lead to uterine atony
hemorrhage
Lochia
Perineum
Check REEDA
R edness
E dema
E cchymosis
D ischarge
A pproximation
Fully saturated 30 40 cc
Weighing 1 cc = 1 gram Common
Board Question
Nursing Consideration during
Recovery
Flat on bed to prevent dizziness
If with Chills give blanket due
to dehydration
Give nourishment (progression of
meal)
Clear liquids gatorade, ginger
juice, gelatins
Full liquid milk, ice cream
Soft diet
Regular diet
Check VS/ Pain

Pychic State
Bonding interaction between
mother and newborn
Strict 24 hours with mother
Partial morning with mother,
night nursery
COMPLICATIONS OF LABOR
Dystocia
Difficult labor related to
mechanical factor
Primary cause is Uterine Inertia
Uterine Inertia
Sluggishness of contraction
Types
Primary/ Hypertonic
Intense contraction resulting to
ineffective pushing
Management : Sedation
Secondary/ Hypotonic
Slow, irregular contraction
resulting to ineffective pushing
Management : Oxytocin
Augmentation
Prolonged Labor
> 20 H for primi
> 14 H for multi
proper pushing should be
encourage if inappropriate:
may cause fetal distress
caput succedaneum
cephalhematoma
maternal exhaustion
monitor contractions and FHT
Precipitate Labor
labor less than 3 hours
causes excessive laceration leading
to profuse bleeding
hypovolemic shock
s/sx of hypovolemic shock HYPO
TACHY TACHY
HYPOtension
TACHYpnea
TACHYcardia
Cold clammy skin
Management
Modified trendelenburg
Fast Drip IV
16

Inversion of Uterus
Situation in which uterus is turn
inside out due to:
Short cord
Hurrying of placental delivery
Ineffective fundal push
Cause profuse bleeding
hypovolemic
Hysterectomy
Uterine Rupture
Rupture of uterus
Caused by
Previous classical CS
Very large baby
Improper use of oxytocin
S/sx
Sudden pain
Profuse bleeding
Prepare fore TAHBSO
Physiologic Retraction Ring
boundary between upper and lower
uterine segment
BandlsPathologic Ring
suprapubic depression sign of
uterine rupture
Amniotic Fluid/ Placental
Embolism
Anaphylactic syndrome of
pregnancy
Situation in which placental
fragment and amniotic fluid enters
maternal circulation
S/Sx
Dyspnea
Chest Pain
Frothy Sputum
End Stage DIC
Prepare for CPR, Suction and
emergency etc
Trial Labor
Fetal head measurement =
measurement of pelvis
6 hours labor allowance given to
mother
monitor FHT and contractions
Preterm Labor

labor after 20 weeks and before 37

weeks
Triad signs
Premature conditions every 10
minuets
Effacement of 60 80%
Dilatation of 2 3 cm
Home Management
CBR
Avoid Sex
Empty bladder
Drink 3 4 Glasses of H2O
Full bladder inhibit contraction
Hospital Management
If Cervix Close (Criteria: cervix is
closed if it is 2 3 cm dilated only)
2 3 cm dilated, pregnancy can be
saved
Tocolytic Therapy
Yutupar (Ritodine HCl)
Side effect maternal BP < 90/60
Check Impt. Presence of crackles
Brethine (terbutaline) Bricanyl
DOC
Side effect: sustained tachycardia
Antidote: propanolol/ inderal
Mg SO4
If cervix is dilated ( > 4cm)
Give steroid dexamethasone
Promote surfactant maturation
Immediately cut the cord after
delivery to prevent jaundice/
hyperbilirubinemia
POSTPARTAL PERIOD
Puerperium 5th stage of labor, 1st
6 weeks post partum
Characterize by
involution
Involution - return to the normal
stage of reproductive organ after
pregnancy
Return to Normal Healing
Physiologic Changes
Systemic Changes
Cardiovascular System
plasma volume
sudden in blood volume
elevated WBCs up to 30, 000 mm3

hyperfibrinogenemia
orthostatic hypertension can be
possible
early ambulation prevents
thrombos formation
steps in ambulation
Flat
Semifowlers
Fowlers with dangling
Walk with assist
Genital Tract
Fundus
goes down 1 finger breadth a day
10th day non palpable behind the
symphysis pubis
Subinvolution
delayed healing of uterus
containing quarters or clots of
blood
may lead to puerperal sepsis
Management : D&C
After Pains
After birth pains
Multiparous breastfeeding most
common to develop
Position = prone
Cold compress
Mefenamic acid
Lochia
Components
Blood
Deciduas
WBC
Microorg
3 types
Rubra 1 3 days, musty,
moderate amount
Serosa 4 10th day, pink or
brown
Alba 10 21th day, crme white,
amount
Urinary Tract
Urinary Frequency due to urinary
retention with overflow
Dysuria
Damage to trigone of the bladder
Urine collection for culture and
sensitivity
Stimulate navel to urinate
17

Palpate bladder
Running water listening
Pull pubic hair - stimulate
cremasteric reflex

bleeding within 24 hours

postpartum

Colon
Constipation
Due to NPO
Bearing down may cause pain
Perenium
Pain relieved by sims position
Cold compress 1st 24 hours if there
is pain at episioraphy followed by
warm

1. Uterine Atony
boggy fundus
profuse bleeding
interventions
massage the uterus
cold compress
modified trendelenburg
fast drip IV
breastfeeding to release oxytocin

EMOTIONAL SUPPORT

2. Laceration
well contracted uterus with profuse
bleeding
assess perenium for laceration
degrees of laceration
1st degree vaginal skin and mucus
membrane
2nd degree 1st degree + muscles
3rd degree 2nd degree + external
sphincter of rectum
4th degree 3rd degree + mucus
membrane of rectum

Taking phase
1st 3 days
dependent phase
passive, cant make decision
tells about childbirth experience
focus on: Hygiene
Taking Hold
4 7th day
dependent to independent phase
active, decides actively
focus: care of newborn
health teaching : Family planning
Letting Go
Interdependent phase
Redefines goals, new roles as
parents
May extend till the child grows
Post Partum Blues
4th 5th days
overwhelming feeling of
depression, inability of sleep and
lack of appetite
50 80% incidence rate
cause by sudden hormaonal change
progesterone suddenly decreases
allow crying: therapeutic
may lead to postpartum psychosis/
depression
Postpartal Complications
Hemorrhage

Early Pospartal Hemorrhage

3. Hematoma
bluish discoloration of subQ tissues
of vagina or perenium
candidates
delivery of very large babies
pudendal block
excessive manipulation due to
excessive IE
intervention
cold compress 10 20 min then
allow 30 minutes rest period for 24
h
DIC disseminated intravascular
coagulation
Consumption of pregnancy
(otherterm)
Failure to coagulate
Bleeding in the eyes, ears, nose
Oozing blood
Seen in cases with
Abruptio placenta
Still birth / IUFD

Management
Blood transfusion of
cryoprecipitate or fresh frozen
plasma
hysterectomy
Late Postpartum Hemorrhage
Retained placental fragments
manual extraction of fragments is
done
uterine massage
D&C except for cases of
Placenta Acreta umusual
attachment of the placenta to the
myometrium
Placenta Increta deeper
attachment of placemat to the
myometrium
Placenta Percreta invasion of
placenta to the perimetrium
Candidates of these disorders are
Grand multiparous
Post CS
All these requires hysterectomy
Infection
Sources
Endogenous from normal flora of
the body
Exogenous from the health care
team
Most common Anaerobic
Streptococci
Management
Supportive care
Fluid intake
TSB if there is fever/ cold
compress + paracetamol may also
be given
Analgesics
Given on time to achieve maximum
effect
Culture and sensitivity
Perenial Infection
Same s/ sx with infection
2 3 stitches are dislodges
with purulent drainage
Tx resuturing
18

Endometritis
Inflammation of the endometrium
Gen s/sx of infection + abdominal
tenderness
Management
High fowlers facilitates drainage
& localize infection
Administer oxytocin
FAMILY PLANNING METHOD
Guiding Principles
determine your own beliefs first
never advise a permanent method
of family planning
informed concent
the method is an individual
decision
Natural Method accepted by the
church
Billings/ Cervical Mucus/
Spinnbarkeit
clear watery & stretchable
13th day longest due to estrogen
Basal Body Temp in the morning
before arising/ 13th 14th day due to
peak of progesterone
LAM Lactational Amenorrhea
Method
prolactin inhibits ovulation
breastfeeding 4 6 months no
menstrual cycle
bottle fed 2 3 months
Sympthothermal combination of
Billings and BBT most effective
method
Social Methods
Coitus Interuptus
withdrawal
least effective method
Coitus Reservatus
sex w/o ejaculation
Coitus interfemora
between femor
Calendar Method
14 days before menstrual cycle
ovulation day (regular)

- 4, + 4 days unsafe period

Origoknause Formula ( irregular
menstrual cycle)
get the longest and shortest cycle
subtract 18 to shortest
11 to the longest
the difference is the unsafe period
PILLS
combined oral contraceptives
preventovulation by inhibiting the
anterior pituitary gland roduction
of FSH and LH which are essential
for he maturation and rupture of a
follicle.
Estrogen inhibit FSH which is
responsible in the mturation of
ovum. Progesterone inhibit LH
which is responsible for ovulation.
contains estrogen that inhibits FSH
and progesterone that inhibit LH
99.9% effective
21 day feel on the 5th day of mense
start taking
28 day 1st day of mense
if forgotten, take 2 tablets the
following day
adverse effect : breakthrough
bleeding
if mother wants to get pregnant
wait 3 monts
another 3 months if unsuucessful
before consulting gyne
contraindications
chain smoking
Hypertension
DM
Extreme obesity
Thrombophlebitis
Side effects (ressembles
Hypertension)/ Immediate
Discontinuation
Abdominal paon
Chest pain
Headache
Eye problem
Severe leg cramp
Alerts on oral contraceptives :
In case a Mother who is taking an
oral contraceptive for almost a long
time and plans to have a baby, she

would wait for at least 3mos before

attempting to conceive to provide
time for estrogen and progesterone
levels to return to normal. If after
6months the mother did not get
pregnant, consult AMD.
If a new oral contraceptive is
prescribed, the mother should
continue taking the previously
prescribed contraceptive and begin
taking the new one on the first day
of the next menses.
Discontinue oral contraceptive if
there is signs of severe headache as
this are an indication of
hypertension associated with
increase incidence of CVA and
subarachnoid hemorrhage.
If forget to drink pill for 1 day, take
2 pills the next day. If forget to
drink pills for 2days, stop the pill
and wait for the next mens.
Adverse reaction : breakthrough
bleeding
DMPA Depoprovera
Contains progesterone
Depomedroxy progesterone
Acetate
IM q 3 months never massage the
site may decrease effectiveness
NORPLANT
6 match stick like capsules/ rod
contain progesterone
sub Q planted
good for 5 years
Mechanical Device
IUD
prevent implantation
alters mobility of sperm and ovum
99.7% effective
best inserted after delivery and
during menstruation
Common complication
EXCESSIVE MENSTRUAL
FLOW
Common problem EXPULSION
OF THE DEVICE
19

No protection against STD

Side effects include
Uterine infection
Uterine perforation
Ectopic pregnacy
Major indication for the use is
PARITY
HT: monthly check up and regular
pap smear
CONDOM
Made up of latex
Put in erected penis or lubricated
vagina
Prevents sperm to enter the uterus
FEMALE CONDOM higher
protection than that of male
DIAPRAGHM
Dome shaped rubberied material
inserted at the cervix to prevent
sperm getting inside the uterus
Reusable
HT : Proper hygiene
Check for holes
Must be refitted in case of weight
gain of 15 lbs - - board question
Kept in place for about 6-8 Hours
Board question
Contraindicated to
Frequent UTI
CERVICAL CAP
More durable than the diaphram
Could stay on place for more than
24 hours
No need to apply spermicides
Contraindicated to abnormal
papsmear
CHEMICAL
SPERMICIDES
FOAMS most effective
Jellies
Creams
These may cause toxic shock
syndrome
SURGICAL METHOD
Bilateral tubal Ligation
@ isthmus

20% probability of reversal

Vasectomy
Vas deferens is cut
More than 30 x or 0 sperm count or
2 x negative sperm count before it
could be consider safe sex

HIGH RISK PREGNANCY

HEMORRHAGIC DISORDERS
General management
CBR
Avoid sex
Prepare ultrasound determine the
sac integrity
Assess bleeding and approximation
Assess hypovolemia
Save discharge for histopathology
Determine whether the product of
labor has been expelled
First Trimester Bleeding
Abortion termination of labor
before age of viability
SPONTANEOUS
AKA miscarriage
Causes
Chromosomal aberrations due to
advanced maternal age
Blighted ovum
germ plasm defect
Natures way of expelling defective
babies
Classifications :
Threatened
pregnancy is jeopardized by
bleeding and cramping but the
cervix is closed and can be saved.
Inevitable
moderate bleeding, cramping,
tissue protrudes from the cervix
and the cervix is open.
Types :
Complete
all products of conception are
expelled.
Mgt : emotional support

Incomplete
placenta and membranes retained.
Mgt : D&C
HABITUAL
3 or more consecutive pregnancies
result in abortion usually related to
incompetent cervix.
Management (suture of cervix)
McDonald procedure
Temporary circlage
Side effect infection
May have NSD
Shirodkar
CS delivery
MISSED
fetus dies; product of conception
remain in uterus 4 weeks or longer
signs of pregnancy cease
(-) pregnancy test
Dark brown
Scanty bleeding
Mgt : induction of labor/ vacuum
extraction
INDUCED
Therapeutic abortion principle
of 2 fold effect
Done when mother has class 4
heart disease

Ectopic Pregnancy
occurs when gestation is location
outside the uterine cavity
Common site : Ampulla or Tubal
Dangerous site: Interstitial
Unruptured Ruptured
Missed
sudden, sharp
period
severe unilatera
Abdominal pain, knife like
pain within shoulder pain
3- 5wks of (indicative of
missed
intraperitoneal
period
bleeding that
(maybe
extends to
generalized diaphragm &
of one
phrenic nerve)
sided)
(+) Cullens
Scant, dark sign bluish
brown
tinged umbilicu
vaginal
syncope/fainting
bleeding
20

Vague
discomfort
Nursing Care :
vital signs
administer IV fluids
monitor for vaginal bleeding
monitor I&O
prepare for culdocentesis to
determine
hemoperitoneum
Mgt : non-surgical
Methotrexate
SECOND TRIMESTER
BLEEDING
Hydatidiform Mole / bunch of
grapes
Gestational Trophoblastic Disease
progressive degeneration of
Chorionic Villi
gestational anomaly of the placenta
consisting of a bunch of clear
vesicles. This neoplasm is formed
from the swelling of the chronic
villi and lost nucleus of the
fertilized egg. The nucleus of the
sperm duplicates, producing a
diploid number 46xx. It grows and
enlarges the uterus very rapidly.
Cause : Unknown
Assessment :
Early signs
vesicles passed thru the vagina
Hyperemesis gravidarum due to
HCG
Fundal height
Vaginal bleeding (scant or profuse)
Early in pregnancy
high levels of HCG
Pre ecclampsia at about 12wks
Vesicles look like a snowstorm
on sonogram
Anemia
Abdominal cramping
Serious late complications
Hyperthyroidism
Pulmonary embolus
Nursing care :
prepare for D&C
do not give oxytocin drugs due to
proneness to embolism

Health Teaching:
return for pelvic exams as
scheduled for one year to monitor
HCG and assess for enlarged uterus
and rising titer could be indicative
of choriocarcinoma
Avoid pregnancy for at least one
year
Methotrexate therapy
Incompetent Cervix Management:
McDonald procedure
temporary circlage of incompetent
cervix.
Delivery : NSVD
SE: infection
Health teaching
observe for signs of infection
signs of labor
Shhirodkar procedure
permanent procedure.
Delivery : caesarian section
required.
THIRD TRIMESTER BLEEDING
PLACENTAL ANOMALIES
Placenta Previa
it occurs when the placenta is
improperly implanted in the lower
uterine segment, sometime
covering the cervical os.
Assessment
Outstanding sign : frank, bright red,
painless bleeding
enlargement (usually has not
occurred)
fetal distress
abnormal presentation
Nursing care :
Initial mgt : NPO candidate for
CS
Bedrest
prepare to induce labor if cervix is
ripe
administer IV
No IE, No Sex, No enema
complication : Sudden fetal blood
loss
prepare Mother for double set up
DR is converted to OR

Abruptio Placenta
it is the premature separation of the
placenta from the implantation site.
It usually occurs after the twentieth
week of pregnancy
Cause:
Cocaine user
Severe PIH
Accident
Assessment:
Outstanding sign : dark red &
painful bleeding
concealed hemorrhage
(retroplacental)
couvelaire uterus (caused by
bleeding into the myometrium) (-)
contraction
rigid boardlike abdomen
severe abdominal pain
dropping coagulation factor (a
potential for DIC)
sx : bleeding to any part of the
body. Mgt : for hysterectomy
General Nursing care :
infuse IV, prepare to administer
blood
type and crossmatch
monitor FHR
insert Foley catheter
measure bllod loss; count pads
report s/s of DIC
monitor v/s for shock
strict I&O
Placental Succenturiata 1 or 2
lobes connected to the placenta by
a blood vessel
Placenta Bipartita placenta
divided into 2 lobes
HYPERTENSIVE DISORDER
Pregnancy Induced Hypertension
HPN after 24wks resolved 6wks
postpartum which cause pregnancy.
Types :
Gestational HPN
HPN without edema & proteinuria.
21

Mgt : monitor BP
Pre-eclampsia triad
sx : HPN with edema, proteinuria
or albuminuria (HEP/A) which
cause is unknown or idiopathic but
multifactoral
primis d/t 1st exposure to chorionic
villi
multiple pregnancies due to
exposure to chorionic villi
Mothers of low socio-economic
status due to protein intake
Teenagers d/t low compliance to
protein intake
HELLP syndrome hemolysis with
elevated liver enzymes & low
platelet count
Transitional Hypertension HPN
between 20-24wks
Chronic or Pre-existing
Hypertension
HPN before the 20th wk not
resolved 6wks postpartum
3 types of pre-eclampsia
Sign of pre-eclampsia :
> 30mmHg systolic
> 15mmHg diastolic
Roll over test
10-15min side lying
Then supine
Then take BP
mild pre-ecclampsia
140/90mmHg, w/ +1 O2, +2
proteinuria Early signs : wt,
inability to wear wedding ring due
to developing edema
Signs present
cerebral & visual disturbances,
epigastric pain to liver edema and
oliguria usually indicates an
impending convulsion
Before convulsion : if you see sign
of epigastric pain, 1 mgt is to place
tongue depressor and put the side
rales up
During convulsion : observe the
Mother for safety
After convulsion turn to side to
facilitate drainage
Severe pre-ecclampsia

160/110, +3 or +4, proteinuria,

visual disturbances
Nursing care
P promote bedrest
Prevent convulsions by nursing
measures
to O2 demand & facilitate Na
excretion
Management: quiet & calm
environment, minimal handling,
avoid moving the bed
Heat Acetic Acid determine
protein in the urine
Prepare the following at bedside
tongue depressor, Suction machine
& O2 tank
E ensure high protein intake
(1g/kg/day)
Na in moderation
A antihypertensive drug with
hydraluzine
C CNS depressant with Mg
Sulfate for anti-convulsion
Mgt : evaluate for
hypermagnesiumenimia
E evaluate physical parameters
for Magnesium Sulfate toxicity :
B BP
U Urine output
R RR
P Patellar reflex is absent
Antidote : Ca gluconate
Eclampsia with seizure
BUN sign of glumerular
damage

22

Borderline : 40mg/dl
Sx : pitched shrill cry, tremors,
jitteriness
Dx test : heel stick test to check
glucose levels
Hypocalcemia
< 7mg/dl
Calcemic tetany
Tx : Ca gluconate
Diabetes Mellitus
cause by absent & lack of Insulin
Action of Insulin is to facilitate
transfer of glucose into the cell
Dx test : 50gm 1hr Glucose
Tolerance Test
130 hyperglycemia
70 hypoglycemia
80-120 euglycemia
if > 130mg/dl, the Mother needs to
undergo a 3hr GTT
Maternal Effects :
hypoglycemia during the 1st
trimester development of the brain
sinisipsip ng fetus yung glucose
ng nanay.
Hyperglycemia during the 2nd &
3rd trimester
HPL effect Mgt : give insulin.
OHA are teratogenic.
1st trimester - insulin, 2nd
trimester - insulin, post partum
drop suddenly
Frequent infections eg.
Moniliasis
Polyhydramnios
Dystocia
Fetal Effects :
hypoglycemia during the 1st
trimester and Hyperglycemia
during the 2nd & 3rd trimester thru
facilitated diffusion
Macrosomia/LGA .4000gms
IUGR due to prolonged DM
Preterm birth promote still birth
Newborn Effects :
Hyperinsulinism and
Hypoglycemia
40mg/dl
Normal : 45-55mg/dl

Heart Disease
Classification :
I no limitation
II Slight limitation, ordinary
activity causes fatigue
good prognosis can deliver
vaginally
Mgt : sleep of 10hrs/day, rest
30mins after meals
III moderate limitation, less than
ordinary activity causes discomfort
poor prognosis. Good for vaginal
delivery
Mgt : early hospitalization by 78mos
IV marked limitation of physical
activity for even at rest there is
fatigue
poor prognosis. Good for vaginal
delivery only with regional
anesthesia.
Low forceps delivery when unable
to push & to shorten the stage of
labor
Mgt :
therapeutic abortion, high semifowlers position, left side lying, no
valsalva maneuver - may trigger
cardiac arrest, heparin therapy
required, antibiotic therapy for
prevention of sub acute bacterial
endocarditis

c. active herpes II
d. severe toxemia
e. placental previa
f. abruption placenta
g. prolapse of the cord
h. cephalo pelvic disproportion and
primary indication
i. breech presentation
j. transverse lie
procedure :
classical vertical incision
low segment bikini, for
aesthetic purposes. Can have
vaginal birth after c/s
Genotype genetic make-up
Phenotype Physical appearance
Karyotype pictorial analysis of
individual chromosome for
detecting chromosomal
abnormalities
Autosomal Dominant
huntingtons chorea
retinoblastoma
achondroplasia
polydactyl
Autosomal Recessive
sickle cell
Cystic fibrosis
Celiac
PKU
Galactosemia
X- Linked Recessive
Hemophilia
Duchennes muscular dystrophy
Color blindness
X Linked Dominant
Rickettes

INTRAPARTAL
COMPLICATIONS
Cesarean Delivery
Indications
a. multiple gestation
b. diabetes
23