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WARD CLASS

OB-GYNE WARD
NAEGELE’S RULE
Naegele’s rule is a standard way of calculating the due date for a pregnancy when
assuming a gestational age of 280 days at childbirth. The rule estimates the expected
date of delivery (EDD) by adding a year, subtracting three months, and adding seven
days to the origin of gestational age.
Formula:
Use the first day of last menstrual period
ADD 7 days
SUBTRACT 3 months
ADD 1 year
EXERCISES
Compute for EDC and AOG of the following LMP. Date of consultaion is September 5,
2018.
1. Feb. 14, 2018 5. May 28, 2018

2. January 10, 2018 6. June 20, 2018

3. March 15, 2018 7. July 27, 2018

4. April 17, 2018 8. August 17, 2018


OB SCORING
◦Obstetric score helps a person know about the
patients‘ obstetric history simply at a glance.
◦GRAVIDA- total number of pregnancies
◦PARA- previous pregnancy/deliveries which
reached the age of viability.
◦TERM >37 weeks <42 weeks
◦PRE TERM 20 weeks to 37 weeks
◦ABORTION <20 weeks
◦LIVING CHILDREN AT PRESENT
EXAMPLE
◦DETERMINE THE OB SCORE
◦1. 1ST pregnancy—39 weeks
◦ 2nd pregnancy---10 weeks
◦ 3rd pregnancy---40 weeks
◦ 4th pregnancy---35 weeks
◦ 5th pregnancy present
◦ Number of children 3
ANSWER

◦G5 P3 ( T2 P1 A1 L3)
EXAMPLE
◦1ST Pregnancy---39 weeks
◦2nd pregnancy– 35 weeks
◦3rd pregnancy present
◦Number of children 2
ANSWER

◦G3 P2 (T1 P1 A0 L2)


Exercises
◦ Beth is 39 weeks pregnant with her third baby. She has been pregnant 3 times. Her first
pregnancy resulted in a baby girl born at 39 weeks gestation. Her second pregnancy
resulted in a baby boy born at 38 weeks gestation. What is her GTPAL?

A. G 4 P2 ( T3 P 1 A 0 L 3)

B. G 3 P3 (T1 P0 A0 L2)

C. G3 P2 (T2 P0 A0 L2)
D. G4 P2 (T1 P1 A0 L2)
EXERCISES
◦ Ms. M. has had 3 pregnancies and is pregnant again. (At home,
she has full-term twins and a child born at 36 weeks.) She also has
had a fetus that spontaneously aborted at 10 weeks.
◦ A. G4 P2 (T1 P1 A1 L3)
◦ B. G3 P1 (T1 P1 A0 L2)
◦ C. G3 P0 (T1 P1 A0 L2)
◦ D. G4 P2 (T1 P0A0 L2)
QUIZ
1. Ms. T. has 7 living children who were full-term infants and also
had 2 spontaneous abortions at 12 and 15 weeks respectively.
2. Ms. S. has had three deliveries at term, one
preterm delivery, and two abortions. She has four
living children.

3. Ms. M. has had 3 pregnancies and is pregnant


again. (At home, she has full-term twins and a
child born at 36 weeks.) She also has had a fetus
that spontaneously aborted at 10 weeks
4. Ms. Z. has a 5-year old child who was full-term at birth. Since that
time she has had an infant who was stillborn at 38 weeks and a
spontaneous abortion that occurred at 13 weeks. She is currently 7
months pregnant.
Stages of Labor and Delivery
◦STAGE 1 DILATATION STAGE
◦ LATENT PHASE
◦ Frequency 15-30min. Duration every 15-30sec. Intensity mild,
Cervix 0-3cm, mood of the mother excited
◦ Management: hospital admission on physical assessment,
monitor fetal heart rate and uterine contraction, NPO
(prevent aspiration), void every 2 hours because full
bladder hinders fetal descend, encourage ambulation.
◦ACTIVE PHASE
Frequency every 3-5 min, duration 40-60sec. Intensity
moderate to strong, Cervix
4-7cm, mood of the mother irritable
Management: provide comfort measure ( back rub), administer
medication—epidural anesthesia which has a side effect of
Hypotension ( instruct patient Left side lying position. Update the
progress of labor (1cm/hr)
◦ TRANSITION PHASE
◦ Frequency 2-3min. Duration 60-90sec. Intensity very strong
◦ Cervix 8-10cm. Mother losses control, transfer to Delivery
room (cervix of multipara mother 8-10cm, primi para
mother fully dilated). Position– lithotomy (legs up/down
together, it prevent tension to ligament)
◦ Management– nurses shave the mother hair
EXERCISES
◦ IDENTIFY THE PHASE OF LABOR IN STAGE 1 LABOR AND DELIVERY
◦ 1. CERVIX 4-7 CM
◦ 2. FREQUENCY 2-3 MINS.
◦ 3. MOTHER IS IRRITABLE
◦ 4. MONITOR FETAL HEART RATE
◦ 5. INSTRUCT NPO AS PER DOCTORS ORDER
◦ 6. ADMINISTER MEDICATION (EPIDURAL ANESTHESIA) AS PER DOCTORS ORDER
◦ 7. TRANSFER TO DELIVERY ROOM
◦ 8. INTENSITY MILD
◦ 9. INSTRUCT MOTHER TO VOID EVERY 2 HOURS
EXERCISES
◦ 10. MOTHER LOSSES CONTROL
◦ 11. INTENSITY MODERATE TO STRONG
◦ 12. ENCOURAGE AMBULATION
◦ 13. PROVIDE COMFORT MEASURE
◦ 14. CERVIX 8-10CM
◦ 15. DURATION 4-60 SEC
◦ 16. UPDATE THE PROGRESS OF LABOR 1CM/HR
◦ 17 DURATION 60-90 SECS.
◦ 18. NURSES SHAVES THE PUBIC HAIR
◦ 19. MOTHER IS EXCITED
DIFFERENTIATION BETWEEN TRUE AND FALSE LABOR
CONTRACTIONS

◦ FALSE TRUE
◦ Begin and remain irregular begin irregulary but become regular and
predictable
◦ Felt fist abdominally and remained felt first in the lower back and sweep around
Confined to the abdomen and groin to the abdomen in a wave
Often disappear with ambulation continue no matter what the women’s
And sleep level of activity
Do not increase in duration, frequency increase in duration, frequency and intensity
Or intensity
Do not achieve cervical dilatation achieve cervical dilatation
SIGNS OF LABOR
◦ 1. LIGHTENING- in primiparas, lightening or descend of the fetal
presenting part into the pelvis, approximately 10-14 days before labor begins.
This changes a woman’s abdominal contour, because the uterus becomes
lower and more anterior. It gives a woman relief from diaphragmatic pressure
and shortness of breath that she has been experiencing and in this way
lightens her load. Lightening probably occurs early in primiparas because of
tight abdominal muscles. In multi paras, it is not dramatic and usually occurs
on the day of the labor or even after the labor has begun. As the fetus sinks
lower in the pelvis, the mother may experience shooting leg pains form the
increased pressure on the sciatic nerve, increased amounts of vaginal
discharge, urinary frequency from pressure of the bladder.
◦ INCREASE LEVEL OF ACTIVITY
◦ A woman may awaken on the morning full of energy, in contract of feeling
of chronic fatigue during the previous months. The increase in activity is
related to an increase in epinephrine release that is initiated in decrease in
progesterone produced by the placenta

BRAXTONS HICKS CONTRACTIONS--Before "true" labor begins, you may have


"false" labor pains. These are also known as Braxton Hicks contractions. They
are your body's way of getting ready for the real thing -- the day you give
birth -- but they are not a sign that labor has begun or is getting ready to
begin.
◦ Unlike true labor, Braxton Hicks contractions:

◦ Are usually not painful


◦ Don’t happen at regular intervals
◦ Don’t get closer together
◦ May stop with a change in activity or position
◦ Do not last longer as they go on
◦ Do not feel stronger over time
◦ Cervical ripening refers to the softening of the cervix typically like the earlobe (
Goodell’s sign )that typically begins prior to the onset of labor contractions
and is necessary for cervical dilation and the passage of the fetus.
Signs of true labor
◦ Uterine contraction - The tightening and shortening of the uterine muscles. During
labor, contractions accomplish two things: (1) they cause the cervix to thin and dilate
(open); and (2) they help the baby to descend into the birth canal.

◦ Show- When the mucus plug dislodges from your cervix it's called the show, or a
bloody show. The jelly-like plug is often blood-tinged or streaked with old, brownish
blood when it comes away.

Rupture of membranes (ROM) or amniorrhexis is a term used during pregnancy to


describe a rupture of the amniotic sac. Normally, it occurs spontaneously at full term
either during or at the beginning of labor. Rupture of the membranes is known
colloquially as "breaking the water" or as one's "water breaking".
exercises
◦ Celeste Bailey didn’t recognize for over an hour that she
was in labor. A true sign of labor is:

◦ A. sudden increase in energy from epinephrine release


◦ B. nagging but constant pain in the lower back
◦ C. urinary urgency from increases bladder pressure
◦ D. show or release of cervical mucus plug
Exercises

◦ Determine if true or false labor


◦ 1. Begin irregularly but become regular and predictable
◦ 2. Achieve cervical dilatation
◦ 3. Often disappear with ambulation and sleep
◦ 4. Begin and remain irregular
◦ 5. increase in duration, intensity and frequency
◦ 6. Continue no matter what the women’s level of activity
◦ 7. Felt in lower back and sweep around to the abdomen in a wave
◦Stage II EXPULSION STAGE
◦ FULL DILATATION—delivery of the fetus
◦ Ritgen’s maneuver- supports the perineum, it
prevents laceration
◦ Episiotomy– enlarge vaginal opening, it prevent
laceration
◦ Types: mediolateral / (common)
◦ Midline I
MECHANISM OF LABOR
◦ HAPPENING PASSIVELY BECAUSE OF UTERINE CONTRACTION
◦ BABY GOES INLET
◦ ENGAGEMENT
◦ DSECEND
◦ FLEXION
◦ INTERNAL ROTATION

BABY GOES OUTLET


EXTENSION
EXTERNAL ROTATION
EXPULSION
◦STAGE III PLACENTAL STAGE

◦ SIGNS OF PLACENTAL SEPARATION

◦ Sudden gush of blood


◦ Lengthening of the cord
◦ Uterus become firm and globular
◦ Raises at the level of umbilicus
◦ TYPES OF PLACENTAL SEPARATION

◦ SCHULTZ (SHINNY) – SEPARATION BEGINS FROM THE CENTER

◦ DUNCAN ( DIRTY )- SEPARATION BEGIN WITH THE EDGES


NURSING INTERVENTION
◦ PLACENTAL DELIVERED

◦ 1. Check the completeness of cotyledons ( segment of placental )


◦ 2. Maintain uterus well contracted by:
◦ Massage
◦ Apply ice pack
◦ Initiate breastfeeding– release of oxytocin
◦ Administer methergin (s/e increase BP, nurse should check first the BP of the
patient)
3. Assist in the repair of laceration
◦ STAGE 4 POST PARTUM HAPPENS 4-6 HOURS AFTER
DELIEVRY UP TO 4-6 WEEKS AFTER DELIVERY
◦ RECOVERY PHASE
◦ NURSING INTERVENTION
◦ 1. ASSES VITAL SIGN EVERY 15 MINS. FOR ONE HOUR THEN EVERY 30 MINS FOR ONE
HOUR
◦ 2. ASSES FUNDAL HEIGHT POSITION AND ITS TONE
◦ 3. MONITOR AMOUNT OF LOCHIA, THE CONTENTS, ODOR AND COLOR
◦ 4. ASSES THE PERINEUM
◦ 5. PALPATE THE BLADDER, ENCOURAGE THE MOTHER TO VOID
◦ 6. MASSAGE THE FUNDUS IF BOOGY, STOP MASSAGING THE
UTERUS IF FIRM
◦ 7. ECOURAGE AND ASSIST WITH BREASTFEEDING AS SOON AS
POSSIBLE
◦ 8. MONITOR HEMOGLOBIN AND HEMATOCRIT LEVEL

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