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 repro !ct"#"ty C$% &ef"n"t"ons re'ate to se(!a'"ty )en er I ent"ty sense of feminity and masculinity developed @age 3 or 2 ! y"o" *o'e I ent"ty attitudes, behaviours and attitudes that differentiate roles Se( biologic male or female status" sometimes referred to as specific sexual behavior such as sexual intercourse Se(!a'"ty behavior of being a girl or boy and is identity sub#ect to a lifelong dynamic change SEXUAL ANAT+MY AN& ,HYSI+L+)Y -EMALE *E,*+&UCTI.E SYSTEM E(terna' .!'#a/ ,! en a a. Mons p!0"s/ #ener"s mountain of venus, a pad of fatty tissues that lies over the symphysis pubis covered by s$in and at puberty covered by pubic hair that serves as a cushion or protection to the symphysis pubis Stages of ,!0"c Ha"r &e#e'op1ent 2Too' Use 3 Tanner4s Sca'e/ Se(!a' Mat!r"ty *at"ng5 Stage % &re adolescence no pubic hair, fine body hair Stage 2 'ccurs bet" %% %2 y"o sparse, long, slightly pigmented and curly that develop along labia Stage 3 'ccurs bet" %2 %3 y"o" hairs become dar$er and curlier develops along pubis symphysis Stage ! %3 %! y"o" hair ssumes normal appearance of an adult but is not so thic$ and does not appear to the inner aspect of the upper thigh Stage ( Sexual )aturity assumes the normal appearance of an adult, appears at the inner aspect of thigh b. La0"a Ma6ora large lips latin, longitudinal fold from perenium to pubis symphysis c. La0"a M"nora a$a *ymphae, soft and thin longitudinal fold created bet+een labia ma#ora C'"tor"s ,$ey-, pea shaped erectile tissue composed of sensitive nerve endings. sight of sexual arousal in females -o!rc7et tapers posteriorly of the labia ma#ora" Site for episotomy sensitive to manipulation, torn during pregnancy d. .est"0!'e almond shaped area that contains the hymen, vaginal orifice and batholenes gland Ur"nary Meat!s small opening of urethra/ opening for urination S8ene4s )'an a$a &araurethral 0land, 2 small mucus secreting glands for lubrication Hy1en membranous tissue that covers the vaginal orifice .ag"na' +r"f"ce external opening of the vagina $art7o'ene4s )'an paravaginal gland, secretes al$aline substance, neutrali1es acidity of the vagina o &o er'e"ns $ac"''!s responsible for vaginal acidity o ,ar!1c!'ae Myst"for1es healing of a hymen e. ,eren"!1 muscular structure in bet+een lo+er vagina and anus Interna' a. .ag"na female organ for ovulation, passage+ay of menstruation, 2 inches 3 %4 cm long containing rugae o *!gae permits considerable stretching +ithouit tearing during delivery 567 b. Uter!s hollo+ muscular organ, varies in si1e, +eight and shape, organ of menstruation S"9e 3 % x 2 x 3 S7ape 3 pear shaped, pregnant ovoid :e"g7t 3 Uter"ne "n#o'!t"on C$% Non pregnant 3 5; <; g ,reganant 3 1;;; g 4t7 stage of La0or 3 1;;; g =n >ee8 after of &e'"#ery 3 5;; g ?r >ee8s after e'"#ery 3 ?;; g 5 < :ee8s after e'"#ery3 5; <; g TH*EE ,A*TS +- UTE*US -!n !s upper cylindrical layer

 Corp!s/ $o y upper triangular layer Cer#"( lo+er cylindrical layer

@Ist71!s lo+er uterine segment during pregnancy M!sc!'ar Co1pos"t"on3 ? 1a"n M!sc'es 1a8"ng poss"0'e e(pans"on "n a'' "rect"on a. En o1etr"!1 muscle layer for menses o 8ines the non pregnant uterus o 9olumes the non pregnant uterus o &ec" !a slouching off of endometrium during menstruation o En o1etr"os"s :ctopic :ndometrium 5ommon site is ovaries &roliferation of abnormal gro+th of lining of outer part &ersistent dysmenorrhea, lo+ bac$ pain &( E(a13 0"opsyA'aparoscopy T(3 L!pron 2'!pro'" e5 "n7"0"ts -SH B LH T(3 &ana9o' 2&anacr"ne5 &+C %" ;nhibits ovulation 2" stop menstruation 0. Myo1etr"!1 o &o+er of labor o Smooth muscles is considered to be LI.IN) LI)ATU*E <muscles of delivery, capable of closing= of the body o 8argest portion of the uterus c. ,ere1etr"!1 o &rotects the entire uterus c. +#ar"es 2 female sex gland almond shape >xn? 'vulation,production of 2 hormones< estrogen and progesterone= . -a''op"an T!0e 2 3 inches long that serves as a passage+ay of the sperm from the uterus to the ampulla or the passage+ay of the mature ovum or fertili1ed ovum from the ampulla to the uterus ! significant segments o Inf!n "0!'!1 most distal part, trumpet shape, has fimbrae o A1p!''a outer 3rd or 2nd half, site of fertili1ation, common site for ectopic preg" o Ist71!s site for sterili1ation, site for 6@8 o Interst"t"a' most dangerous site for ectopic pregnancy MALE *E,*+&UCTI.E SYSTEM E(terna' ,en"s @he male organ of copulation and urination 5ontains of a body or shaft consisting of 3 cylindrical layers and erectile tissues o 2 corpora cavernosa o % corpus spongiosum At the tip is the most sensitive area comparable to clitoris A glans penis Scrot!1 &ouch hanging belo+ the pendulous penis, +ith medial septum deviding into 2 sacs each containing testes BeCuires 2 degrees celcius for continuous spermatogenesis 5ooling mechanism of testes Interna' @THE ,*+CESS +- S,E*MAT+)ENESIS TESTES <D44 coiled seminiferous tubules=
E,I&I&YMIS <site of maturation of sperm E m=

.AS &E-E*ENS <conduit path+ay of sperm=

SEMINAL .ESICLE <secreted? fr!ctose form of glucose, nutritative value. ,rostag'an "n? causes reverse contraction of uterus=

ECACULAT+*Y &UCT <conduit of semens=

,*+STATE )LAN& <release al$aline substances=

C+:,E*S )LAN& <release al$aline substance= U*ETH*A

Hypot7a'a1!s )N*H A,) 2Anter"or ,"t!"tary )'an 5 -SH maturation of sperm LH testosterone production Ley "g Ce''s releases testosterone

$ASIC DN+:LE&)E +N )ENETICS AN& +$STET*ICS &NA Deoxyribonucleic Acid carries genetic code CH*+M+S+MES threadli$e structure of hereditary material $no+n as the D*A *ormal amount of e#aculated sperm ? 5 cc/ 1 teaspoon 'vum is capable of being fertili1ed +ithin =4 ?< 7o!rs after ovulation" Sper1 4E F= ays #"a0"'"ty Beproductive cells divide by the process of MEI+SIS 27ap'o" n!10er5 S,E*MAT+)ENESIS process of maturation of sperm ++)ENESIS process of maturation of ovum o 34 +ee$s A'0 E million immature ovum o @ birth % million immature oocytes o @ puberty 344 !44 immature oocytes o @ %3 y/o 344 !44 mature oocytes o @ 23 y/o %34 234 mature ovum o @ 33 y/o E4 %E4 mature ovum o @ 3E y/o 2! %2! mature ovum o @!E y/o ! mature ovum

MALE B -EMALE H+M+L+)UES MALE -EMALE G&enile 0lans G5litoris G&enile Shaft G5litoral shaft G@estes G'varies G&rostate GS$enes gland G5o+pers G6artholins 0lands 0land GScrotum G8abia )a#ora

)AMET+)ENESIS process of formation of t+o haploid into diploid A)E +- *E,*+&UCTI.ITY 15 44 y/o CHIL&$EA*IN) A)E =; ?5 y/o HI)H *ISD G1E B H?5 y.o. :ITH *ISD 1E =;I ?; ?5 MENST*UATI+N Menstr!a' Cyc'e beginning of menstruation to the beginning of the next menstruation Average menstrual cycle =E ays Average menstrual period 5 ays *ormal blood loss 5; cc/ J c!p acco1pan"e 0y -I$*IN+LYSIS prevents clot formation Belated terminologies o Menarc7e %st menstruation o &ys1enorr7ea painful menstruation o Metrorr7ag"a bleeding in bet+een menstruation o Menorr7ag"a :xcessive bleeding during menstruation o A1enorr7ea absence of menstruation o Menopa!se cessation of menstruation <Average Age (% y"o"= Tof! has isoflavone estrogen of plant that mimics the estrogen +ith a +oman -!nct"ons of Estrogen an ,rogest"n EST*+)EN hormone of +oman o &rimary function Besponsible for the development of secondary characteristics in females inhibit production of >SF o 'ther function Fypertrophy of the myometrium Spinnbar$eit and >erning &attern <6illings )ethod= Ductile structure of the breast 'steoblastic bone activity <causes increased in height= :arly closure of the epiphysis of the bone Sodium retention ;ncreased sexual desire Besponsible for vaginal lubrication ,*+)ESTE*+NE Formone of the mother

o &rimary function prepares the endometrium for implantation ma$ing it thic$ and tortous
o o Secondary >unction inhibit uterine contractibility 'thers ;nhibit 8F <hormone of ovulation= production 0; motility &ermeability of $idneys to lactose and dextrose causing H % sugar in urine )ammary gland development 66@ )ood s+ings

Menstr!a' Cyc'e 4 p7ases of 1enstr!a' cyc'e 1.,ro'"ferat"#e =.Secretory ?.Isc7e1"c 4.Menses 1. 'n the initial phase of menstruation, the estrogen level is , this level stimulates the hypothalamus to release )n*H/ -SH*2. 0nBF/ >SFB> stimulates the anterior pituitary gland to release -SH -SH -!nct"on o Stimulate ovaries to release estrogen o >acilitate the gro+th of primary follicle to become )*AA-IAN -+LLICE structure that secretes large amount of estrogen that contain mature ovum 3. &roliferative &hase < estrogen= >ollicular &hase responsible for the variation and irregularity of mense &ostmenstrual &eriod after menstruation &reovulatory &hase happen before menstruation 4. %3th day of menstruation, estrogen level is ,EAD +hile progesterone is , these stimulates the hypothalamus to release 0nBF/ 8FB> 5. )n*H/ LH*- stimulates the Anterior &ituitary 0land to release LH >unctions of 8F o Stimulates the release of progesterone o Formone for ovulation th 6. %! day estrogen level is +hile progesterone level is S/S o Bupture of the graafian follicle '9I8A@;'* o M"tte'sc7s1er9 slight abdominal pain lo+er right Cuadrant 7. %(th day, after ovulation day, graafian follicle starts to degenerate, estrogen level , progesterone , causing degeneration of the graafian follicle becoming yello+insh $no+n as C+*,US LUTEUM secretes large amount of progesterone 3" Secretory &hase 8utheal &hase 2 progesterone5 &ostovulatory phase &remenstrual &hase 9. 2!th day Corp!s A'0"cans <+hitish= corpus luteum degenerates and becomes +hite 10. 23th day if no sperm united the ovum, the uterine begins to slough off to have the next menstruation Note3 if there is no fertili1ation, corpus luteum continues functioning 'varian 5ycle from primary follicle corpus albicans Stages3 o 1 5 ays 1enses o < 14 pro'"ferat"#e o 15 =< secretory o =F =E "sc7e1"c Stages of Fuman Sexual Besponse ;nitial Besponse? .AS+C+N)ESTI+N constriction of blood vessels MY+T+NIA increased muscle tension E(c"te1ent ,7ase muscle tension, moderate 9S erotic stimuli causing sexual tension, may last from minutes to hours ,'ate! ,7ase

 and sustained tension near orgasm

+rgas1 *eso'!t"on Beturn to normal state 9S return to normal ;nvoluntary release of sexual tension accompanied by physiologic and psychologic release, immeasurable pea$ of experience 2 3 seconds may last 34 sec 34 minutes

*E-*ACT+*Y ,E*I+& only period present in male, +herein he cannot restimulated for about %4 %( minutes :on ers of -ert"'"9at"on -ert"'"9at"on ,7onones song of sperm Capac"tat"on ability of sperm to release proteolytic en1yme and penetrate the ovum Stages of -eta' )ro>t7 an &e#e'op1ent ,re E10ryon"c Stage Kygote fertili1ed ovum <3 ! days travel, ! days floating=J from fertili1ation Mor!'a mulberry li$ed ball containing %E (4 cells $'astocyst enlarging cell forming a cavity that later becomes the embryo covered by thropoblast +hich later becomes the placenta and membrane I1p'antat"on K %4 days after fertili1ation @hropoblast covering of blastocyst that become placenta S/Sx of ;mplantation Slight pain, Slight 9aginal Spotting 3 &rocesses o Appos"t"on o A 7es"on o In#as"on E10ryon"c Stage Kygote fertili1ation to %! days E10ryo %(th 2 mos/ 3 +ee$s -et!s 2 mos to birth &ec" !a thic$ened endometrium, latin +ord for ,falling off$asa'"s located directly under the fetus +here placenta developed Casp!'ar"s encapsulates the fetus .era remaining portion of and endometrium C7or"on"c ."''" %4 %% +ee$s C7or"on"c ."''" Sa1p'"ng 2C.S5 removal of tissue from the fetal postion of the developing placenta >or genetic screening >etal limb defects, missing digits of toes Cytot7rop7o0'ast outer layer, LAN)HAN4S LAYE*, protect the fetus against syphilis <2! +ee$s/ E months= Syns"t"otrop7o0'ast syncitial layer responsible for hormone production A1n"on inner most layer 2" C7or"on U10"'"ca' cor 2-!n"s= +hitish gray <(4 E4 cm= Short abruptio placenta, uterine inversion 8ong cord prolapse, cord coil 3 vessels <A9A= Artery 9ein Artery :7arton4s Ce''y protects the umbilical cord A1n"ot"c f'!" bag of +ater clear color, musty/mousy odor Lith crystalli1ed forming pattern, slightly al$aline (44 %444 cc *ormal o 'ligohydramnios $idney malformation o Fydramnios 0;@ , @:>/ @:A >unctions o 5ushion the fetus against sudden blo+ or trauma o )aintains temperature o >acilitate muscus$eletal development o &revents cord compression o Felps in development process &"agnost"c Test for A1n"ot"c -'!" A1n"ocentes"s &urpose? obtain sample of amniotic fluid by inserting a needle hrough the abdomen into the amniotic sac

>luid is tested for? 0enetic screening Determination of fetal maturity primarily by evaluating factors indicative of lung maturity Done +ith empty bladder 5omplication J )ost common side effect ? ;*>:5@;'* J 8ate ? pre term labor J :arly ? spontaneous abortion ;ndication for Amniocentesis? J :arly in &regnancy Advance )aternal Age J 8ater in &regnancy Diabetic )others L o>n syn ro1e L ne!ra' t!0e efectA sp"na 0ef" a 8/S ratio ? 2?% <8ecitin/ Spingomyelin= Definitive test A &hosphatiglycerol? &0 H best Ans+er 0reenish )econium Stains <>etal Distress= Mello+ish #aundice, hyperbilirubinemia 5loudy ;nfection )ost ;mportant 5onsideration *eedle insertion site Amnioscopy direct examination through intact fetal membrane via ultrasound >ern @est a test determining if bag of +ater has rupture or not *itra1ine &aper @est differentiate amniotic fluid and urine 6lue geen H rupture of bag of F2' C7or"on outermost layer ,'acenta ANA Secundines chorionic 9illi and basalis &anca$e in latin (44 grams in +eight %( 23 cotyledons %( 24 cm in diameter and 2 3 cm in depth >unctions o Bespiratory 42 5'2 exchange via simple diffusion o 0;@ glucose transport via facilitated diffusion o :xcretory via 2 arteries, carries unoxygenated blood then detoxify by maternal liver o 5irculatory fetoplacental circulation by S:8:5@;9: 'S)'S;S o :ndocrine F50 primary maintain corpus luteum/ secondary basis of pregnancy test Fuman &lacental 8actogen a$a Somatomammothrophin Besponsible for the development of mammary gland Diabetogenic :ffect insulin antagonist Belaxin softening of maternal #oints and bones o Serves as protective barrier against some microorganism 5an pass? F;9 5)9 Bubella &;*'5M@'S;S transport of virus ,regnancy =<< =EE ays/ ?F 4= >ee8s -ETAL STA)E3 -eta' )ro>t7 an &e#e'op1ent -I*ST T*IMESTE* 3 ,er"o of organogenes"sA 1ost cr"t"ca' per"o -"rst Mont7 2-HTA CNS &e#e'opsA )IT an *esp" Tract re1a"ns as s"ng'e t!0e5 &"fferent"at"on of ,r"1ary )er1 Layer En o er1
o o o o o @hyroid responsible for basal metabolism @hymus immunity 8iver 0;@ 8inings of Ipper 0; @ract
Feart )usculos$eletal Beproductive 'rgan Nidney 6rain 5*S

Meso er1
o o o o

Ecto er1
o o

o o o o o

S$in ( senses Fair, nails Anus )outh

Secon Mont7 8ife span of corpus luteum ends All vital organs are formed &lacenta is developed Sex organ is developed )econium is present T7"r Mont7 &lacenta is complete Nidneys are functional >etus begins to s+allo+ amniotic fluid 6uds of mil$ appear Sex is distinguishable >F@ audible via dopples @ %4 %2 +ee$s TE**AT+)ENS any drug or irradiation, the exposure to +hich may cause damage to the fetus &*U)S o Strepto1yc"n anti @6 <Cuinine= damage to the 3th cranial nerve poor learning and deafness/ ototoxic o Tetracyc'"ne stoning the tooth enamel, inhibits long bone gro+th o ."ta1"n D hemolysis, destruction of B65, #aundice, hyperbilirubenemia o Io " es enlargement of thyroid and goiter o T7a'" o1" es anti emetics Amelia or &ocomelia absence of distal part of extremities o Stero" s cleft lip or palate and even abortion o L"t7"!1 congenital maformation ALC+H+L 86L, fetal alcohol syndrome < characteri1ed by microcephaly= SM+DIN) 86L CA--EINE 86L C+CCAINE 86L, abruptio placenta T+*CH group of infections that can cross the placenta or ascend through the birth canal and adversely effect fetal gro+th o To(op'as1os"s cat lovers o +t7ers Fepa A6, F;9, Syphillis o *!0e''a 5FD, Bubella @iter * @ %?%4 or A immunity to rubella A notify doctor Bubella vaccine after delivery for 3 mos" *o pregnancy for 3 mos" o Cyto1ega'o #"r!s o Herpes S"1p'e( #"r!s SEC+N& T*IMESTE* 3 cont"n!o!s gro>t7 an e#e'op1ent 2-+CUS LEN)H +- -ETUS5 -o!rt7 Mont7 8anugo begins to appear 6uds of permanent teeth appear >F@ audible via >etuscope @ %3 24 +ee$s -"ft7 Mont7 7uic$ening ? %st fetal movement &rimi? %3 24, *ulli %E %3 8anugo covers the body >F@ audible via stethoscope or +/out instrument Actively s+allo+ amniotic fluid >etus ? %D 2( cm S"(t7 Mont7 S$in is red and +rin$led 9ernix caseosa covers the s$in :yelids open :xhibits startle reflex ?*& T*IMESTE* 3 per"o of 1ost rap" gro>t7 an e#e'op1ent -+CUS3 :EI)HT Se#ent7 Mont7 Surfactant development )ale? the testes begins to descent into the scrotal sac >emale ? clitoris is prominent and labia ma#ora are small doesnt cover the minora E"g7t Mont7 Active moro reflex

 8anugo begins to disappear Sub C fats deposits, steady +eight gain, nails to fingers N"nt7 Mont7 8anugos and vernix caseosa is evident in body fold 6irth position assumed Amniotic fluid some+hat decrease Sole of the foot has fe+ creases Tent7 Mont7 6one ossification in the fetal s$ull 9ernix caseosa is evident in body ,HYSI+L+)IC A&A,TATI+N T+ ,*E)NANCY Syste1"c C7anges 1. Car "o#asc!'ar Syste1 blood volume 34 (4O %(44 cc. additional (44 cc for multiple pregnancy plasma volume cardiac +or$load easy fatigability/ slight ventricular hypertrophy :pistaxis due to hyperemia of nasal membrane &alpitation due to S*S stimulation ,7ys"o'og"c Ane1"a/ pse! oane1"a "n pregnacy o *ormal 9alue Fct ? 32 !2O Fgb? %4"( %! g/dl o 5riteria %st P 3rd @rimester ? Fct J 33O Fgb J %% g/dl 2nd @rimester ? Fct J 32O Fgb J %4"( g/dl o &athologic Anemia Iron &eff"c"ency Ane1"a is the most common hematologic disorder" ;t affects 24O of pregnant +omen Assesment reveals? &allor Slo+ed capillary refill A *ormal A 2 3 sec 5oncave fingernails <late sign of progressive anemia= clubbing A chronic tissue hypoxia constipation *ursing care *utritional instruction o Source of iron Nang$ong 8iver A best source due to >:BB;D;* 5ontent Bed and lean meat 0reen 8eafy 9egetables &arenteral ;ron <;mferon= o Q tract ;) o incorrect causes hematoma o best given % hour before meals <causes 0; irritation= o )aybe given 2 hours after meal <results to poor absorption= 0iven +ith orange #uice to absorption 'ral ;ron Supplements <ferrous sulfate 4"3 g 3 x a day= )onitor for hemorrhage Alert ;ron from red meat is better absorbed iron from other sources ;ron is better absorbed +hen ta$en +ith foods high in 9itamin 5 such as orange #uice Figher iron inta$e is recommended since circulating blood volume is increased and heme is reCuired from production of B65s E e1a o ;mpeded venous return due to the gravid uterus o *ursing ;ntervention :levate legs above the hips level .ar"cos"t"es o Lear support stoc$ings o :levate legs

.!'#ar .ar"cos"t"es o D/t pressure of gravid uterus o Side lying +ith pillo+ under the hips o )odified $nee chest position T7ro10op7'e0"t"s o &resence of thrombus in inflamed blood vessels o H Fomans Sign pain on the calf upon dorsiflexion o )edical )anagement Anticoagulant/ F:&AB;* Does not cross the placental barrier )onitor A&@@ Antidote? &B'@A);*: SI8>A@: *o aspirin M"'8 Leg/ ,'ag1as"a A'0a &o'ens o Shiny +hite legs due to stretching of s$in P hyperfibrinogenemia o *ursing intervention 5hec$ dorsalis pedis pulse <compare both= *ever massage Assess for Fomans sign only once

=. *esp"ratory Syste1 Shortness of 6reath d/t gravid uterus *ursing intervention? Side lying lateral expansion of the lungs ?. )astro"ntest"na' Syste1 Na!sea an #o1"t"ng Morn"ng S"c8ness o Due to F50 levels o 5rac$ers 34 min before arising o A) 5arb diet 34 mins o &) small freCuent meal Const"pat"on o Due to &B'0:S@:B'*: A fluid reabsorption due to 0;@ motility o *ursing intervention

>luid >iber
:xercise -'at!'ence o Due to increased progesterone o Avoid gas forming foods Heart0!rn 2pyros"s5 o Beflux of stomach content into esophagus o *ursing ;ntervention Small freCuent meals Sips of mil$ Avoid fatty and spicy foods &roper body mechanics o Laist Above Acid o Laist $elo+ 6ase He1orr7o" s o Due to gravid uterus o Fot sit1 bath for comfort ,tya'"s1 o salivation o )outh+ashes to relieve 4. Ur"nary Syste1 *ormal A H % sugar due to &rogesterone via 6:*:D;5@S @:S@ >irst @rimester >reCuency Second @rimester normal @hird @rimester >reCuency 5. M!sco'os8e'eta' 5alcium sources o )il$ 5a & % pint/ day or 3 ! servings/ day o 5heese, Mogurt, Fead of >ish, Sardines, Anchovies, 6rocolli

Lor os"s o &ride of &regnacy :a '"ng )a"t o A+$+ard gait +hile +al$ing due to relaxin o &rone to accidental falls Lear lo+ healed shoes Leg Cra1ps o 5a & ;mbalance during pregnancy o 8umbo sacral nerves by pressure of gravid uterus during labor o 'ver sex o Dorsiflex the foot affected o 3 ! servings/ ! cups/day sa mil$, sardines, dilis A. Loca' C7nages .ag"na o C7a >"c84s S"gn bluish discoloration o Le!8orr7ea +hitish gray, moderate in amount, mousy odor Cer#"( o )oo e'4s S"gn change in consistency of uterus o +perc!'!1 mucus plug to seal bacteria/ progesterone Uter!s o Hegar4s S"gn change in consistency 9agina 5ervix Iterus 5had+ic$s 0oodels Fegars

Problems related to the changes of Vaginal Environment a. .ag"n"t"s L A.+CA&+ @richomonas 9aginalis o >lagellated protox1oan, 8oves ala$aline environment Signs and Symptoms o 0reenish, cream, colored, frothy, irritably itchy, foul smelling vaginal discharge o 9aginal edema )anagement o Drug of choice? ):@B'*;DAQ'8: <>lagyl= Antiproto1oan 5arcinogenic *ot given in %st trimester vaginal douche as substitue o % Ct Later A % tbsp +hite vinegar o @reat partner as +ell to prevent reinfection o *o alcohol due to antabuse effect 0. Mon"'"as"s L CHEESE 5andida Albicans @ransvaginal transfer in fetus 'ral @rush Signs and Symptoms o Lhite 5heeseli$e patches that adheres to the +alls of the vagina )anagement o Antifungals )ycostatin 5ontrima1ole 5anisten 0entian 9iolet 1. A0 o1"na' C7anges Striae 0ravidarum o Due to destruction of the subcutaneous tissue by the enlarge uterus =. S8"n C7anges )elasma/ 5hloasma o Lhite light bro+n pigmentation related to melanocytes 8inea *igra o 6ro+n pin$ish line from symphysis pubis to umbilicus ?. $reast C7anges Due to hormonal changes 5hange in color and si1e of nipple and areola &recolostrum E +ee$s 5olustrum 3rd trimester

Supine +ith pillo+ under the bac$

4. +#ar"es rest per"o A no o#!'at"on 5. Signs and Symptoms of Pregnancy

,*ESUM,TI.E S/sx felt and observed by the
>irst trimester mother but does not confirm the diagnosis of pregnancy $reast changes Urinary changes -atigue Amenorrhea Morning sic$ness Enlarge uterus Chloasma Linea *igra Increase S$in &igmentation Striae gravidarum %uic$ening

,*+$A$LE
Signs observed by the members of the health care team )oodels sign Chad+ic$s sign Hegars sign Elevated 66@ ,ositive F50 $allotement Enlarge Abdomen $raxton Fic$s 5ontraction

,+SITI.E Indeniable signs confirmed by the use of instrument

Ultrasound :vidence

Second @rimester

etal Feart @one etal movement etal outline etal parts palpable

C$% Cancer of t7e $reast M!a rant $ Ma1ograp7y ?5 an a0o#e %/ year $a''ote1ent bouncing of the fetus may be present in uterine myoma Trans#ag"na' U'traso!n empty bladder A0 o1"na' !'raso!n full bladder ,LACENTA )*A&IN) SYSTEM
0rade 4 immature 0rade % slightly mature 0rade 2 moderately mature 0rade 3 fully mature Lhat is depositedR ca'c"!1

.I. ,syc7o'og"ca' A aptat"on to ,regnancy *e#a *!0"n -"rst Tr"1ester *o tangible s/sx >eeling of surprise Ambivalence Denial of pregnancy maladaptation Developmental @as$? Accept biological facts of pregnancy Fealth @eaching? 6ody changes of pregnancy and *utrition Secon Tr"1ester @angible s/sx )other identifies fetus as separate entity due to Cuic$ening >antasy Developmental @as$? Accept gro+ing fetus as a baby to nurture Fealth @eaching? 0ro+th and development of fetus T7"r Tr"1ester )other has personally identifies +ith the appearance of the baby Developmental @as$? &repare child birth and parenting the child Fealth @eaching? responsible parenthood, prepare babys layette, 8ama1e 5lass Address )others fear let she hear the >F@ .II. ,re Nata' ."s"t $as"c Cons" erat"on 1. -reM!ency of ."s"t % Kth mos" once a month 3 Dth mos" t+ice per month %4th month every +ee$ =. ,ersona' &ata Ho1e $ase Mot7er4s *ecor / H$M* determines high ris$ pregnancy ,se! ocyes"s false pregnancy appearance of presumptive P probable signs Co1a e Syn ro1e psycosomatic disorder, father experience +hat the mother goes through ?. &"agnos"s of ,regnancy Irine :xam F50 !4 %44th day. pea$ E4 K4th day :8;SA beta subunits of F50 is detected as early as K %4th day

 B;A beta subunits of F50 is detected as early as 3th day

Fome &regnancy Nit 4. $ase'"ne &ata Boll 'ver @est test of pre eclampsia by the use of 6& Leight monitoring *ormal Leight 0ain %st @rimester A %"( 3 lbs % lb/ mo 2nd @rimester A %4 %2 lbs ! lbs/mo 3rd @rimester A %4 %2 lbs ! lbs/mo )inimum allo+able +eight gain 24 2( lbs 'ptimal +eight gain 2( 3( lbs 5. +0stetr"ca' &ata

a. )ra#" a no" of pregnancy b. ,ara no" of viable pregnancy

."a0"'"ty the ability of the fetus to live outside the uterus at the earliest possible gestational age % abortion % pregnancy 3rd mos" 02&4 02 @4 &4 A% 84 c. I1portant Est"1ates %" *ageles Bule Ise to determine expected date of delivery San )ar HD months HK days Apr Dec 3 months HK days H % year =. Mc&ona' 4s *!'e Determines age of gestation in +ee$s >undic Feight x K/3 A A'0 in +ee$s ?. $art7o'o1e>4s *!'e Determines age of gestations o 3 mos above pubis symphysis o ( mos level of umbilicus o D mos belo+ xiphoid process o %4 mos level of 3th mos 4. Haases *!'e Determines the length of fetus in cm" %st half sCuare each month 2nd half month x ( . Tetan!s I11!n"9at"on @@% anytime or early during pregnancy @@2 % month after @@% 3 years protection @@3 E months after @@2 ( years of protection @@! % year after @@3 %4 years of protection @@( % year after @@! lifetime protection 5. ,7ys"ca' E(a1"nat"ons a.&anger S"gns of ,regnancy Chills P >ever Cerebral Disturbances Abdominal &ain epigastric pain auro of impending convulsion $oardli$e Abdomen Abruptio placenta $lurred 9ission pre eclampsia $leeding abortion/ ectopic pregnancy %st trimester F )ole/ ;ncompetent 5ervix 2nd trimester &lacental Anomalies 3rd @rimester $& T S+elling Scotoma spots in the eye % 3D@F Lee$, % miscarriage, % still birth, % 2nd mo" preg 0!&2 0! @% &% A% 8%

Sudden gush of fluid &B') premature rupture of membrane <. ,e'#"c E(a1"nat"on &elvic examination or ;: empty bladder, precaution %st visit 5had+ic$s, 0oodles sign, etc" &osition ? dorsal recumbent, lithotomy &ap smear done %st visit 5ytological exam determine presence of cancer cells" Besult ? o 5lass ; normal o 5lass ;; A cytology +ithout evidence of malignancy 6 suggestive of inflammation o 5lass ;;; cytology suggestive of malignancy o 5lass ;9 cytology suggestive og malignancy o 5lass 9 conclusive for malignancy )ost common cancer report organ ? cervical cancer )ost common site for pap smear external 'S of cervix <sCuamocolumnar tissue= 5ommon site of cervical cancer" maternal speculum <open= Stages of cer#"ca' cancer o 4 carcinoma in situ o % 5a strictly confined to cervix o 2 from cervix extends to the vagina o 3 pelvic metastasis o ! affectation to bladder P rectum F. Leopo' s Mane!#er ,!rpose3 Done to determine the attitude, fetal presentation, lie, presenting part, degree of descent an estimate of the si1e, and no" of fetuses &rocedure 1. 1st 1ane!#er o place patient in supine position +ith $nees slightly flexed" &ut to+el under head and right hip" Lith both hands palpate uppe!r abdomen and fundus" Assess si1e, shape, movement and firmness of the part o determine the presenting parts? 2. =n 1ane!#er
o +ith both hands moving do+n, identify the bac$ of the fetus +here the ball of the stethoscope is placed to determine >F@"

3.

o ,* of 1ot7er 3 !ter"ne so!ff'N MH* o f!n "c so!ff'N -H* ?r 1ane!#er

o o o o o using the right hand, grasp the symphysis pubis part using the thumb and fingers" Assess +hether the presenting part is engaged in the pelvis" AlertU ;f the head is engaged it +ill not be movable the examiner changes the position by facing the patients feet" Lith t+o hands, assess the descent of the presenting part by locating the cephalic prominence or bro+" Lhen the bro+ is on the same side as the bac$, the head is extended" Lhen the bro+ is on the same side as the small parts, the head 3is flexed and vertex presenting"

4. 4t7 1ane!#er

Att"t! e relationship of fetus to one another" -!'' -'e("on +hen the chin touches the chest

E. Assess1ent of -eta' :e''L0e"ng a.&a"'y feta' Mo#e1ent Co!nt"ng 2&-MC5 Done starting 2Kth +ee$ 5onsideration fetal sleep +a$e pattern maternal food inta$e drug nicotine use environmental stimuli maternal dose Car "ff co!nt to 1; 1et7o one method currently available o begin at the same time each day <usually in the morning after brea$fast = and count each fetal movement, noting ho+ long it ta$es to count %4 fetal movements <>)s= o expected findings %4 movements in %hrs or less o +arning signs %4 %2 movements in %hr or less
more than %hr to reach %4 movements less than %4 movements in %2hrs

longer time to reach %4 >)s than on previous days" movements are becoming +ea$er, less vigorous movement alarm signal V3 >)s in %2hrs

+arning signs should be reported to healthcare provider immediately. often reCuire further testing" :g" *on stress test <*S@=, biophysical profile <6&&= 0.Nonstress Test o to determine the response of the fetal heart rate to the stress to activity" o ;ndications pregnancies at ris$ for o
o o placental insufficiency &ostmaturity pregnancy induced hypertension <&;F=, diabetes +arning signs noted during D>)5 maternal history of smo$ing, inadeCuate nutrition Done +ithin 34mins +herein the mother is in semifo+lers position. external monitor is applied to document fetal activity. mother activates the ,mar$ button- on the electronic monitor +hen she feels fetal movement" Attach external noninvasive fetal monitors tocotransducer over fundus to detect uterine contractions and fetal movements <>)s= ultrasound transducer over abdominal site +here most distinct fetal heart sounds are detected monitor until at least 2 >)s are detected in 24mins"

&rocedure ?

o o o

if no >) after !4mins provide +omen +ith a light snac$ or gently stimulate fetus through abdomen ;f no >) after %hr further testing may be indicated, such as a 5S@ Besult ? *oncreative *onstress *ot 0ood Beactive Besponse is Beal 0ood ;nterpretation of results Beactive result real good

baseline >FB bet+een traction beteen %24 and %E4 beats per min" at least t+o accelerations of the >FB of at least %( beats per min", lasting at least %(secs in a %4 to 24 min period as a result of >) good variability normal irregularity of cardiac rhythm representing a balanced interaction bet+een the parasympathetic <W >FB= and sympathetic <T >FB= nervous system. noted as an uneven line on the rhythm strip result indicates a healthy fetus +ith an intact nervous system stated criteria for a reative result are not met could be indicative of a compromised fetus reCuires further evaluation +ith another *S@, biophysical profile, <6&&= or contraction stress test <5S@=

Nonreact"#e res!'t not goo

O. Hea't7 Teac7"ngs o do nutritional assessment o daily food inta$e o determine habit o if W folic acid lead to spina bifida/open neural tube defect o HI)H *ISD M+THE*S pregnant teenagers poor compliance to health regimen extremes in +t under+t eg" :lite models over+t eg" D)/F&* lo+ social economic status" Befer to 'SLD vegetarian mothers because W inta$e of vit 6%2 <5yanocobalamin= formation of folic acid <cell D*A P B*A formation= types ? strict vegetarian prone to develop anemia lacto vegetarian mil$ lacto ovo vegetarian mil$ P egg A. *EC+MMEN&E& NUT*IENT *E%UI*EMENT THAT INC*EASES &U*IN) ,*E)NANCY NUT*IENTS *E%UI*EMENTS -++& S+U*CES CAL+*IES :ssential to supply energy for 344 calories/day above the 5aloric T should reflect prepregnancy daily reCuirement to foods of high nutrient value such metabolic rate maintain ideal body +eight and as protein, complex carbohydrates Itili1ation of nutrients meet energy reCuirement of activity <+hole grains, vegetables, fruits= &rotein sparing so it can be level variety of foods representing food used for ? b egin T in 2nd @rimester sources for the nutrients reCuired o gro+th of fetus u se +t gain pattern as an during pregnancy o development of indication of adeCuacy of no more than 34O fat structures reCuires for calories inta$e pregnancy including failure to meet caloric *a 3gms/day eat in moderation placenta, amniotic fluid, reCuirements can lead to $etosis 5F'* x !N 5al tissue gro+th

as fat P protein are used for energy, $etosis has been associated +ith fetal damage" *on pregnant? 2244 calories &regnant? 2(44 calories 2244H(44 @ lactationA2K44 cal ,*+TEIN :ssential for fetal tissue gro+th maternal tissue gro+th including uterus and breasts" Development of essential pregnancy structures >ormation of B65 and plasma proteins ;nadeCuate protein inta$e has been associated +ith onset of pregnancy induced hypertension <&;F= CALCIUML,H+S,H+*+US :ssential for 0ro+th and development of fetal s$eleton and tooth buds )aintenance of minerali1ation of maternal bones and teeth 5urrent research is demonstrating an association bet+een adeCuate calcium inta$e and the prevention of pregnancy induced hypertension I*+N :ssential for :xpansion of blood volume P B65 formation :stablishment of fetal iron stores for first fe+ months of life E4mg/day or an T of %4O above daily reCuirements for age group Adolescents have a higher protein reCuirement than mature +omen since adolescents must supply protein for their o+n gro+th as +ell as protein to meet the pregnancy reCuirement

5F' x !N 5al >ats x DN 5al

&rotein T should reflect 8ean meat, poultry, fish :ggs, cheese, mil$ Dried beans, lentils, nuts Lhole grains 9egetarians must ta$e note of the amino acid content of 5F'* foods consumed to ensure ingestion of sufficient Cuantities of all amino acids

5alcium T of %244mg/day representing an T of (4O above pre pregnancy daily reCuirement %E44mg/day is recommended for adolescent %4mcg/day of vitamin D is reCuired since it enhances absorption of both calcium and phosphorous

5alcium T should reflect Dairy products, mil$, yogurt, ice cream, cheese, egg yol$ Lhole grain, tofu 0reen leafy vegetables 5anned salmon P sardines +ith bones 5a fortified foods such as orange #uice 9itamin D sources fortified mil$, margarine, egg yol$, butter, liver, seafood ;ron T should reflect liver, red meat, fish, poultry, eggs enriched, +hole grain cereals P breads dar$ green leafy vegetables, legumes nuts, dries fruits vitamin 5 sources? citrus fruits P #uices, stra+berries, cantaloupe, tomatoes, green peppers, broccoli or cabbage, potatoes iron form food sources is more readily absorbed +hen served +ith foods high in vit 5

*on &regnat?%(mg/day &regnant ? 34mg/day representing a doubling of the prepregnant daily reCuirement 6egin supplementation at 34mg/day in second trimester, since diet alone is unable to meet pregnancy reCuirement E4 %24mg/day along +ith copper and 1inc supplementation for +omen +ho have lo+ Fgb values prior to pregnancy or +ho have iron deficiency anemia K4mg/day of vitamin 5 +hich enhances iron absortion o ;nadeCuate iron inta$e results in maternal effects anemia, depletion of iron stores, W energy and appetite, cardiac stress especially during labor P birth o fetal effects W availability of oxygen thereby affecting fetal gro+th iron deficiency anemia is the most common nutritional disorder of pregnancy %( g/day representing an T of

KINC :ssential for

Qinc T should reflect

 the formation of en1ymes maybe be important in the prevention of congenital malformation of the fetus
-+LIC ACI&SA -+LACINA -+LATE

3mg/day over prepregnant daily reCuirement

liver, meats shell fish grains, legumes, nuts T should reflect 8iver" Nidney, lean bee$, veal Dar$, green leafy vegetables, broccoli, asparagus, articho$es, legumes Lhole grains, preanuts

:ssential for !44mcg/day representing an T of >ormation of B65 P prevention more than 2x the daily prepregnant reCuirement of anemia D*A synthesis P cell 344mcg/day supplement for formation. may play a role in +omen +ith lo+ folate levels or the prevention of neural tube defects <spina bifida=, abortion, dietary deficiency abruption placenta Additional reCuirements MINE*ALS %K(mcg/day Io "ne 324mg/day Magnes"!1 E(mcg/day se'en"!1 ."ta1"ns E %4mg/day T7"a1"ne %"(mg/day *"0of'a#"n %"Emg/day ,yr" o("ne 2$<5 2"2mg/day $1= 2"2mcg/day N"ac"n %Kmg/day 0. Se(!a' Act"#"ty ,r"nc"p'es of se( "n ,regnancy
o o o o o Should be done in moderation Should be done in a private place @hat the mother should be placed in a comfortable position ;t must be avoided E +ee$s prior to :DD Avoid blo+ing of air during cunnilingus

T reCuirements of pregnancy can easily be met +ith a balanced diet that meets the reCuirement for calories and includes food sources high in the other nutrients needed during pregnancy

Contra"n "cat"on "n se(3

o vaginal spotting %st tri o incompetent cervix 2nd tri o placenta previa, abruption placenta 3rd tri
o pre term labor B? prostaglandin oxytocin contraction o &B') infection

C7anges "n se(!a' appet"te !r"ng pregnancy3

o 1st tr" L P o =n tr" L Q o ?r tr" L P

c. E(erc"se strengthen muscle to be used during the delivery process :a'8"ng best form of exercise SM!att"ng strengthen perineum P Tcirculation to the perineum <raise the buttoc$s before head to prevent postural hypotension= Ta"'or s"tt"ng same purpose +ith sCuatting Dege' e(erc"se strengthen pubococcygeal muscle A0 o1"na' e(erc"se muscle of the abdomen < done as if blo+ing a candle= S7o!' er c"rc'"ng e(erc"se strengthen muscle of the chest ,e'#"c roc8"ng e(erc"se or pe'#"c t"'t relieve lo+ bac$ pain P maintain good posture <arching bac$ for 3 sec= ,r"nc"p'es of e(erc"se o must be done in moderation o must be individuali1ed . C7"' 0"rt7 ,reparat"on +#era'' goa'3 @o prepare patents physically P psychologically +hile promoting +ellness behavior that can be used by parents P family thus, helping them achieved a satisfying P en#oying childbirth experiences" ,syc7o'og"ca' o $ra 'ey Met7o Dr" Bobert 6radley discoverer advocated active participation of husband during labor P delivery to serve as coach, based on ,imitation of nature-

>eatures? dar$ened room Cuiet P calm environment relaxation techniCue close eyes o )rant'y &"c8 *ea Met7o fear can lead to tension +hile tension can lead to pain" <brea$ cycle by removing the fear by abdominal breathing exercises P relaxation techniCue= ,syc7ose(!a' o D"t9"nger Met7o Dr" Shiella Nit1inger pregnancy, labor P birth P the care of the ne+born is an important turning point in a +omans life cycle" ,flo+ing +ith contractions rather than struggle +ith contractions,syc7oprop7y'a("s o La1a9e Dr" >erdinand 8ama1e &revention of pain thru mind P reCuires discipline, conditioning P concentration +ith the husbands help" >eatures? conscious relaxation cleansing breathe inhaling thru nose P exhaling thru mouth effleurage gentle circular massage over abdomen to relieve pain imaging &"fferent 1et7o s of e'"#ery o 0"rt7"ng c7a"n semi fo+lers mother o 0at7"ng 0e dorsal recumbent o sM!att"ng position relieve on bac$ pain P maintain good posture o Le0oyer4s 1et7o features ? dar$ly lighted room Cuiet P calm environment room temp" soft music o $"rt7 !n er >ater

IX. INT*A,A*TAL N+TES A. A 1"tt"ng t7e 'a0or"ng Mot7er &ersonal data 6aseline data 'bstetrical data &hysical exams &elvic exams $. $as"c 8no>'e ge "n "ntrapart!1 T7eor"es of t7e +nset of La0or o Uter"ne Stretc7 T7eory any hollo+ organ once stretched to its maximum potential +ill al+ays contract P expel its content o +(ytoc"n T7eory released by &&0, contraction effect o ,rostag'an "n T7eory stimulation by Arachidonic acid, causes contraction of uterus o Ag"ng ,'acenta !2+$s <lifespan= by 3E+$s placenta begins to degenerate causes contraction o ,rogesterone epr"#at"on t7eory W level of progesterone +ill facilitate contraction of the uterus T7e 4 ,s of La0or o ,assenger fetus fetal head is the largest presenting part X of its length 6ones E bones <sphenoid, temporal, ethmoid= >rontal, occipital P 2 parietal bones S!t!res/"nter1e10rano!s spaces allo+s molding Mo' "ng the overlapping of the sutures of the s$ull to permit passage of the head to the pelvis o Sag"tta' 0ones connect to parietal bones o Cororonta' 0ones connect to parietal P frontal bones o La10 o" a' 0ones connect to parietal P occipital bones -ontane's

E fontanels only 2 palpable anter"or fontane'/$reg1a diamond in shape 3cm x !cm si1e close %2 %3 mos post delivery T (cm hydrocephalus poster"or fontane'/'a10 a triangular in shape % x %cm si1e close 2 3mos post delivery Meas!re1ents of feta' 7ea 3 o trans#erse "a1eter $"Lpar"eta' largest transverse diameter D"2(cm $"Lte1pora' 3cm $"L1asto" smallest transverse diameter Kcm o A, "a1eter S!0occ"p"to0reg1at"c complete flexion +cc"p"tofronta' partial flexion %2cm +cc"p"tote1pora' largest A& diameter. hyperextended <%3"(cm= S!01ento0rg1at"c face presentation. poor flexio ,assage>ay vagina P pelvis ,e'#"s ! main pelvic types o gyneco" round, +ide, deeper, most suitable for pregnancy o an ro" heart shape ,male pelvis- anterior pointed post part shallo+ o Ant7ropo" oval ,ape li$e pelvis, A& +ider transverse narro+ o ,'atype''o" flat transverse oval A& narro+ transverse +ider c/s for delivery &roblem ? o mother +ho encounter accident o W !Do W %3y/o B? pelvis not achieve its full pelvic gro+th $ones of pe'#"s 40ones o = 7"ps <2 innominate bones= 3parts of 2 innominate bones I'e!1 lateral/side of hips o ;liac crest flaring superior border that forms prominence of hips. common site for bone marro+ aspiration Isc7"!1 inferior portion o ;schial tuberosities of the area +here +e o Sit. basis in getting external measurement of pelvis ,!0"s anterior portion o Symphysis pubis #unction in bet+een o sacr!1 posterior portion Sacral prominence basis internal measurement of pelvis o 1 coccy( ! small bones that compresses during vaginal delivery universal precaution in measurement of pelvis is to empty bladder first ;mportant )easurements o &"agona' Con6!gate measure bet+een Sacral promontory P inferior margin of the symphysis pubis )easurement %%"( %2"( cm 6asis in getting the true con#ugate" o Tr!e Con6!gate/Con6!gate .era )easure bet+een the anterior surface of the sacral promontory P superior margin of the symphysis pubis" )easurement? %%"4 cm Diagonal con#ugate? %"( cm A true con#ugate" o +0stetr"ca' Con6!gate smallest A& diameter of the pelvis measuring %4cm or more" o

o o

T!0ero"sc7"" &"a1eter transverse diameter of the pelvic outlet" Approx by a fist 3cm P above"

,o>er the forces acting to expel the fetus P placenta involuntary contractions voluntary bearing do+n efforts characteristics? +ave li$e timing? freCuency, duration, intensity 1yo1etr"!1 po+er of labor o ,syc7e/person psychological stress exist +hen the mother is fighting the labor experience" cultural interpretation preparation past experience support system ,reLe1"nent s"gns of 'a0or o &reeminent Signs '"g7ten"ng settling of the presenting part into the pelvis brim <shooting pain radiating to the legs, urinary freCuency= primi early 2 +ee$s prior to :DD engagement settling of presenting part into pelvic inlet <not signs of labor= $ra(ton H"c8s Contract"ons painless irregular contractions Increase Act"#"ty of t7e Mot7er *esting ;nstinct <mgt? save energy= epinephrine production <hormone that T the activity of the mother= *"pen"ng of t7e cer#"( butter softness &ecrease "n >e"g7t %"( 3 lbs" $'oo y s7o> pin$ish vaginal discharge <blood H leucorrhea H operculum A pin$ in color= *!pt!re of 1e10ranes chec$ >F@ ;: chec$ for cord prolapse after several hrs chec$ temp" o ,re1at!re *!pt!re of Me10ranes 2,*+M5 contraction drop in intensity even though very painful contraction drop in freCuency uterus tense P/or contracting bet+een contractions abdominal palpitations N!rs"ng Care3 administer analgesics <morphine= attempt manual rotation for B'& or 8'& bear do+n +ith contractions adeCuate hydration sedation as ordered cesarean delivery may be reCuired, especially if fetal distress is noted o Cor ,ro'apse a complication +hen the umbilical cord falls or is +ashed through the cervix into the vagina" &anger S"gns3 &B') &resenting part has not yet engaged >etal distress &rotruding cord from vagina cerebral palsy T ( mins", irreversible brain damage mgt? 5S N!rs"ng Care &ositioning $nee chest or trendelenberg, place +et sterile gau1e B? to ma$e it slippery 'bserve for fetal distress &rovide emotional support &repare for cesarean section &I--E*ENCE $ET:EEN T*UE AN& -ALSE C+NT*ACTI+N T*UE -ALSE *o in intensity @here is an in intensity

&ain confined in the abdomen &ain is relieved by +al$ing *o cervical changes

&ain begins @ the lo+er bac$ to abdomen &ain is intensified by +al$ing 5ervical effacement <thinning of the cervix, measured thru O= P dilatation <+idening of the cervix, measurement thru cm= Gbest/ma#or sign of true labor

&!rat"on of La0or o ,r"1"para %! hrs but not more than %24 hrs o M!'t"para 3 hrs but not more than %! hrs N!rs"ng Inter#ent"ons "n Eac7 Stage of La0or o -"rst Stage? onset of contractions to full dilatation P effacement of the cervix o stage of effacement P dilatation Latent ,7ase3 Assessment? o Dilatations 4 3 cm o >reCuency ( %4 mins o Duration 24 !4 mins o ;ntensity mild o )other is excited, apprehensive but can communicate *ursing 5are? o :ncourage +al$ing ? shortens %st stage of labor o :ncourage to void C 2 3 hrs ? full bladder inhibits uterine contraction o breathing <chest breathing techniCue= Act"#e ,7ase3 Assessment? o Dilatations ! 3 cm o >reCuency C 3 ( mins lasting for 34 E4 secs o Duration 34 E4 secs o ;ntensity moderate N!rs"ng Care3 o M edications have meds ready o A ssessment include? v/s, cervical dilatation P effacement, fetal monitor, etc o & ry lips oral care <ointment=, dry linens o 6reathing abdominal breathing Trans"t"ona' ,7ase3 Assess1ent3 o Dilatations 3 %4cm o >reCuency C 2 3 mins contractions o Duration !( D4 sec o ;ntensity strong o )ood of mother suddenly change accompanied by hyperesthesia <hypersensitivity of mother to touch= of the s$in Manage1ent o sacral pressure, cold compress N!rs"ng care3 o T tires o I inform of progress <to relieve emotional support= o * restless support her breathing techniCue o E encourage P praise o & discomfort o ,e'#"c E(a1s Efface1ent B &"'atat"on Stat"on relationship of the presenting part to the ischial spine o ( % A the presenting part is above the ischial spine o :ngagement %4 A the presenting part is in line +ith the ischial spine o < = fetus is floating o <H= belo+ the ischial spine ,resentat"on o the relationship of the long axis of the fetus to the long axis of the mother" o spine relationship of the spine of the mother P the spine of the fetus

@+o @ypes Long"t! "na' L"e 2,ara''e'5/ .ert"ca' Cep7a'"c +hen the fetus is completely flexed o 9ertex o >ace o 6ro+ o 5hin $reec7 o Co1p'ete 0reec7 thigh rest on abdomen +hile legs rest on thigh o Inco1p'ete 0reec7 -ran8 thigh resting on abdomen +hile legs extend to the head -oot'"ng Dnee'"ng Trans#erse L"e 2,erpen "c!'ar5/Hor"9onta' '"e ,os"t"on relationship of the fetal presenting part to specific Cuadrant of the mothers pelvis" o *+A/L+A left occipito anterior most common P favorable position o *+T/L+T left occipito transverse o *+,/L+, left occipito posterior

o L/* side of maternal pelvis o M" 'e presenting part o *+,/*+T most common malposition o *+,/L+, most painful mgt? pelvis sCuatting o $reec7 sacro
place the stethoscope above the umbilicus o C7"n mentum o S7o!' er acromnio dorso Mon"tor"ng t7e contract"ons B feta' 7eart tone spread the finger lightly over the fundus to monitor the contraction Incre1ent/Cresen ro beginning of contraction until it increases Ape(/Acne height of contraction &ecre1ent/&ecresen ro from height of contraction until it decreases &!rat"on beginning of contraction to the end of the same contraction Inter#a' from end of contraction to the beginning of the next contraction -reM!ency from the beginning of % contraction to the beginning of next contraction ;ntensity strength of contraction if contract blood vessel constricts. the fetus +ill get the oxygen on the placenta reserve +hich is capable of giving oxygen to the fetus up to %min" Duration of placenta to the fetus should not exceed %min" Significance During active phase, if T to %min should notify the A)D T 6&. W >F@ ? best time to get 6' P >F@ #ust after a contraction NU*SIN) C+NSI&E*ATI+N &U*IN) THE -I*ST STA)E +- LA$+* 6ath is necessary )onitor 9S especially 6& o Same 6& A rest o :levated A notify the physician *&' o &revent aspiration chemical pneuminitis :nema <per hospital policy= o &urpose 5leanse the bo+el &revent infection o %2 %3 inches normal length of tube o %3 inches optimal length

8ateral sims position

o ;f there is contraction clump the tube o ;f there is resistance slo+ly remove

o 6efore and after administration? chec$ >F@ <%24 %E4= and contractions :ncourage mother to void &erennial preparation <rule of K= Best on left side lying position o &revent supine vena cava syndrome or supine hypotension ;f membrane doesnt rupture amniotomy -ETAL T*ASHIN) hyperactivity of fetus due to lac$ of 'xygen >or &ain o Systemic analgesic &EME*+L 2Meper" "ne HC'5 *arcotic and antispasmonic Dont give during latent phase 0iven @ E 3 cm dilated :+- ? *esp"ratory epress"on *arcan <*aloxone, nalorfan, nalline= o Antidote for toxicity o ;n#ected on the baby Ep" !ra' Anest7es"a :+- ? Hypotens"on &rehydrate the client to prevent hypotension ;n case of Fypotension o :levate leg o >ast Drip ;9 SEC+N& STA)E +- LA$+* 2-ETAL STA)E5 5omplete dilatation and effacement to birth 5ro+ning occurs &B;); transfer to DB @ %4 cm dilatation )I8@; transfer to DB @ K 3 cm dilatation &osition in lithotomy both legs at the same time $UL)IN) +- ,E*ENIUM surest sign of delivery initiation &A*@ P 68'L 6reathing, fetal pushing should be done on an open glottis *esp"ratory a'8a'os"s o Due to incorrect breathing o Fyperventilation o S/sx BB 8ightheadedness @ingling sensation 5arpopedal spasm 5ircumoral numbness E,ISI+T+MY &revent laceration Liden the vaginal canal Shortens the 2nd stage of labor 2 types o ME&IAN 8ess bleeding 8ess pain :asy repair &ossible urethroanal fistula ma#or disadvantage o ME&I+LATE*AL )ore bleeding )ore pain Fard to repair and slo+ healing Iron"ng t7e ,eren"!1 prevent laceration MECHANISM +- LA$+* 2E& -I*E E*E5 Engagement &escent -lexion Internal *otation Extension External *otation

 Expulsion
,EL.IS ? ,arts

o In'et A& diameter narro+, transverse +ider o Ca#"ty bet+een inner and outer o +!t'et A& diameter +ider, transverse narro+
LINEA TE*MINALES N!rs"ng Care M+&I-IE& *I)EN4S MANEU.E* o Done by supporting the perenium +ith a to+el during delivery o >acilitates complete flexion o Avoids laceration >irst intervention? Support the head and suction secretion Do not mil$ the cord, +ait for pulsation to stop before cutting o )il$ing may cause too much blood going to the baby that may cause cardiac overload Lhen there is still birth, let the mother see the baby to accept the finality of death THI*& STA)E +- LA$+* 2,LACENTAL STA)E5 3 %4 minutes after child birth %st sign >undus rises CALDIN4S SI)N S"gns of ,'acenta' Separat"on o >undus becomes globular and rises ca'8"n4s s"gn o 8engthening of the cord o Sudden gush of blood $*ANT AN&*E:4S MANEU.E* o slo+ly pulling the cord and +ind at the clamp o rapidly may cause uterine inversion Types ,'acenta' &e'"#ery SHULTK <Shiny= o >rom center to the edges o &resenting fetal side &UNCAN <&irty= o >orm edges to center o &resenting the maternal side N!rs"ng Cons" erat"ons !r"ng p'acenta' e'"#ery 5hec$ placental completeness o Should be (44 g 5hec$ >undus )assage if 6oggy 6& 5hec$ )ethergine, methylergonovine mallate <;)= 'xytocin <;9= if methergine is not present 5hec$ perenium for lacerations Assist in episioraphy 9aginoplasty/ 9aginal 8andscape 9irgin again -+U*T STA)E +- LA$+* 2*eco#ery Stage5 >irst % 2 hours after delivery of placenta )aternal observation body system stabili1e o %st hour C%( min 2nd hour C 34 min &lacement of fundus o ;n bet+een umbilicus and pubis symphysis o 5hec$ bladder, assist in voiding, )ay lead to uterine atony hemorrhage 8ochia &erineum o 5hec$ *EE&A * edness E dema E cchymosis & ischarge A pproximation o >ully saturated 34 !4 cc o :e"g7"ng 1 cc R 1 gra1 Co11on $oar %!est"on N!rs"ng Cons" erat"on !r"ng *eco#ery >lat on bed to prevent di11iness ;f +ith 5hills give blan$et due to dehydration 0ive nourishment <progression of meal=

o 5lear liCuids gatorade, ginger #uice, gelatins o >ull liCuid mil$, ice cream o Soft diet o Begular diet 5hec$ 9S/ &ain &ychic State $on "ng interaction bet+een mother and ne+born o Strict 2! hours +ith mother o &artial morning +ith mother, night nursery

C+M,LICATI+NS +- LA$+* &ystoc"a Difficult labor related to mechanical factor &rimary cause is Iterine ;nertia Uter"ne Inert"a Sluggishness of contraction @ypes o ,r"1ary/ Hyperton"c ;ntense contraction resulting to ineffective pushing )anagement ? Sedation o Secon ary/ Hypoton"c Slo+, irregular contraction resulting to ineffective pushing )anagement ? 'xytocin Augmentation ,ro'onge La0or J 24 F for primi J %! F for multi proper pushing should be encourage if inappropriate? o may cause fetal distress o caput succedaneum o cephalhematoma o maternal exhaustion monitor contractions and >F@ ,rec"p"tate La0or labor less than 3 hours causes excessive laceration leading to profuse bleeding hypovolemic shoc$ s/sx of hypovolemic shoc$ HY,+ TACHY TACHY o HY,+tension o TACHYpnea o TACHYcardia o 5old clammy s$in o Manage1ent )odified trendelenburg >ast Drip ;9 In#ers"on of Uter!s Situation in +hich uterus is turn inside out due to? o Short cord o Furrying of placental delivery o ;neffective fundal push 5ause profuse bleeding hypovolemic Hysterecto1y Uter"ne *!pt!re Bupture of uterus Ca!se 0y o &revious classical 5S o 9ery large baby o ;mproper use of oxytocin S/s( o Sudden pain o &rofuse bleeding &repare fore @AF6S' ,7ys"o'og"c *etract"on *"ng boundary bet+een upper and lo+er uterine segment $an '4s,at7o'og"c *"ng suprapubic depression sign of uterine rupture A1n"ot"c -'!" / ,'acenta' E10o'"s1 Anaphylactic syndrome of pregnancy Situation in +hich placental fragment and amniotic fluid enters maternal circulation S/S(

o Dyspnea o 5hest &ain o >rothy Sputum o :nd Stage D;5 &repare for 5&B, Suction and emergency etc Tr"a' La0or >etal head measurement A measurement of pelvis E hours labor allo+ance given to mother monitor >F@ and contractions ,reter1 La0or labor after 24 +ee$s and before 3K +ee$s Tr"a s"gns
o o o &remature conditions every %4 minuets :ffacement of E4 34O Dilatation of 2 3 cm 56B Avoid Sex :mpty bladder Drin$ 3 ! 0lasses of F2' >ull bladder inhibit contraction

Ho1e Manage1ent
o o o o

Hosp"ta' Manage1ent o ;f 5ervix 5lose 2Cr"ter"a3 cer#"( "s c'ose "f "t "s = ? c1 "'ate on'y5 2 3 cm dilated, pregnancy can be saved Toco'yt"c T7erapy Y!t!par 2*"to "ne HC'5 o Side effect maternal 6& V D4/E4 o 5hec$ ;mpt" &resence of crac$les $ret7"ne 2ter0!ta'"ne5 $r"cany' o &+C o Side effect? sustained tachycardia o Antidote? propanolol/ inderal Mg S+4 o If cer#"( "s "'ate 2 H 4c15 0ive steroid e(a1et7asone
&romote surfactant maturation ;mmediately cut the cord after delivery to prevent #aundice/ hyperbilirubinemia

,+ST,A*TAL ,E*I+& ,!erper"!1 (th stage of labor, %st E +ee$s post partum 5haracteri1e by involution In#o'!t"on return to the normal stage of reproductive organ after pregnancy *et!rn to Nor1a' Hea'"ng ,7ys"o'og"c C7anges Syste1"c C7anges Car "o#asc!'ar Syste1

o o
o o o o

plasma volume sudden in blood volume elevated L65s up to 34, 444 mm3 hyperfibrinogenemia orthostatic hypertension can be possible early ambulation prevents thrombos formation

steps in ambulation >lat Semifo+lers >o+lers +ith dangling Lal$ +ith assist

)en"ta' Tract o -!n !s goes do+n % finger breadth a day %4th day non palpable behind the symphysis pubis S!0"n#o'!t"on delayed healing of uterus containing Cuarters or clots of blood may lead to puerperal sepsis Manage1ent 3 DP5 o After ,a"ns
After birth pains )ultiparous breastfeeding most common to develop &osition A prone

5old compress )efenamic acid 5omponents 6lood Deciduas L65 )icroorg

Loc7"a

3 types

*!0ra % 3 days, musty, moderate amount Serosa ! %4th day, pin$ or bro+n A'0a %4 2%th day, crYme +hite, amount
Ur"nary Tract o Ur"nary -reM!ency due to urinary retention +ith overflo+ o &ys!r"a Damage to trigone of the bladder Irine collection for culture and sensitivity Stimulate navel to urinate &alpate bladder Bunning +ater listening &ull pubic hair stimulate cremasteric reflex Co'on o Const"pat"on Due to *&' 6earing do+n may cause pain ,eren"!1 o &ain relieved by sims position o 5old compress %st 2! hours if there is pain at episioraphy follo+ed by +arm EM+TI+NAL SU,,+*T 1. Ta8"ng p7ase %st 3 days dependent phase passive, cant ma$e decision tells about childbirth experience focus on? Fygiene =. Ta8"ng Ho' ! Kth day dependent to independent phase active, decides actively focus? care of ne+born health teaching ? >amily planning ?. Lett"ng )o ;nterdependent phase Bedefines goals, ne+ roles as parents )ay extend till the child gro+s ,ost ,art!1 $'!es

!th (th days over+helming feeling of depression, inability of sleep and lac$ of appetite (4 34O incidence rate cause by sudden hormaonal change progesterone suddenly decreases allo+ crying? therapeutic may lead to postpartum psychosis/ depression

,+ST,A*TAL C+M,LICATI+NS He1orr7age bleeding +ithin 2! hours postpartum EA*LY ,+S,A*TAL HEM+**HA)E 1. Uter"ne Atony boggy fundus profuse bleeding "nter#ent"ons
o o o o o massage the uterus cold compress modified trendelenburg fast drip ;9 breastfeeding to release oxytocin

=. Lacerat"on
+ell contracted uterus +ith profuse bleeding

assess perenium for laceration

egrees of 'acerat"on o %st degree vaginal s$in and mucus membrane o 2nd degree %st degree H muscles o 3rd degree 2nd degree H external sphincter of rectum o !th degree 3rd degree H mucus membrane of rectum ?. He1ato1a bluish discoloration of sub7 tissues of vagina or perenium candidates o delivery of very large babies o pudendal bloc$ o excessive manipulation due to excessive ;: "nter#ent"on o cold compress %4 24 min then allo+ 34 minutes rest period for 2! h 4. &IC "sse1"nate "ntra#asc!'ar coag!'at"on
5onsumption of pregnancy <otherterm= >ailure to coagulate 6leeding in the eyes, ears, nose 'o1ing blood Seen in cases +ith o Abruptio placenta o Still birth / ;I>D Manage1ent o 6lood transfusion of cryoprecipitate or fresh fro1en plasma o hysterectomy

LATE ,+ST,A*TUM HEM+**HA)E *eta"ne p'acenta' frag1ents

manual extraction of fragments is done uterine massage

&BC e(cept for cases of o ,'acenta Acreta umusual attachment of the placenta to the myometrium o ,'acenta Increta deeper attachment of placemat to the myometrium o ,'acenta ,ercreta invasion of placenta to the perimetrium
5andidates of these disorders are 0rand multiparous &ost 5S All these reCuires hysterectomy

Infect"on So!rces
o o :ndogenous from normal flora of the body :xogenous from the health care team )ost common Anaerobic Streptococci Supportive care >luid inta$e @S6 if there is fever/ cold compress H paracetamol may also be given Analgesics 0iven on time to achieve maximum effect 5ulture and sensitivity

Manage1ent
o

o
o

o
o

,eren"a' Infect"on
Same s/ sx +ith infection 2 3 stitches are dislodges +ith purulent drainage @x resuturing ;nflammation of the endometrium 0en s/sx of infection H abdominal tenderness Manage1ent o Figh fo+lers facilitates drainage P locali1e infection o Administer oxytocin

En o1etr"t"s

-AMILY ,LANNIN) METH+& )!" "ng ,r"nc"p'es

%" 2" 3" !" determine your o+n beliefs first never advise a permanent method of family planning informed concent the method is an individual decision

@NATU*AL METH+& accepted by the church $"''"ng4s/ Cer#"ca' M!c!s/ Sp"nn0ar8e"t clear +atery P stretchable %3th day longest due to estrogen $asa' $o y Te1p in the morning before arising/ %3th %!th day due to pea$ of progesterone

LAM Lactat"ona' A1enorr7ea Met7o prolactin inhibits ovulation breastfeeding ! E months no menstrual cycle bottle fed 2 3 months Sy1pt7ot7er1a' co10"nat"on of $"''"ngs an $$T most effective method @S+CIAL METH+&S Co"t!s Inter!pt!s +ithdra+al. least effective method Co"t!s *eser#at!s sex +/o e#aculation Co"t!s "nterfe1ora bet+een femor Ca'en ar Met7o
%! days before menstrual cycle ovulation day <regular= !, H ! days unsafe period get the longest and shortest cycle subtract %3 to shortest %% to the longest the difference is the unsafe period

+r"go8na!se -or1!'a 2 "rreg!'ar 1enstr!a' cyc'e5

,ILLS combined oral contraceptives preventovulation by inhibiting the anterior pituitary gland production of >SF and 8F +hich are essential for he maturation and rupture of a follicle" :strogen inhibit >SF +hich is responsible in the maturation of ovum" &rogesterone inhibit 8F +hich is responsible for ovulation" contains estrogen that inhibits >SF and progesterone that inhibit 8F DD"DO effective 2% day feel on the (th day of mense start ta$ing 23 day %st day of mense if forgotten, ta$e 2 tablets the follo+ing day adverse effect ? brea$through bleeding if mother +ants to get pregnant o +ait 3 monts o another 3 months if unsuucessful before consulting gyne contra"n "cat"ons o chain smo$ing o Fypertension o D) o :xtreme obesity o @hrombophlebitis S" e effects 2resse10'es Hypertens"on5/ I11e "ate &"scont"n!at"on o Abdominal pain o Chest pain o Headache o Eye problem o Severe leg cramp Alerts on oral contraceptives ? o ;n case a )other +ho is ta$ing an oral contraceptive for almost a long time and plans to have a baby, she +ould +ait for at least 3mos before attempting to conceive to provide time for estrogen and progesterone levels to return to normal" ;f after Emonths the mother did not get pregnant, consult A)D" o ;f a ne+ oral contraceptive is prescribed, the mother should continue ta$ing the previously prescribed contraceptive and begin ta$ing the ne+ one on the first day of the next menses" o Discontinue oral contraceptive if there is signs of severe headache as this are an indication of hypertension associated +ith increase incidence of 59A and subarachnoid hemorrhage" o ;f forget to drin$ pill for % day, ta$e 2 pills the next day" ;f forget to drin$ pills for 2days, stop the pill and +ait for the next mens" A #erse react"on 3 0rea8t7ro!g7 0'ee "ng &M,A &epopro#era 5ontains progesterone Depomedroxy progesterone Acetate ;) C 3 months never massage the site may decrease effectiveness N+*,LANT E match stic$ li$e capsules/ rod contain progesterone sub 7 planted good for ( years @MECHANICAL &E.ICE IU& prevent implantation

alters mobility of sperm and ovum DD"KO effective best inserted after delivery and during menstruation Co11on co1p'"cat"on :Z5:SS;9: ):*S@BIA8 >8'L Co11on pro0'e1 :Z&I8S;'* '> @F: D:9;5: *o protection against S@D S" e effects "nc'! e o Iterine infection o Iterine perforation o :ctopic pregnacy )a#or indication for the use is &AB;@M HT3 monthly chec$ up and regular pap smear C+N&+M )ade up of latex &ut in erected penis or lubricated vagina &revents sperm to enter the uterus >:)A8: 5'*D') higher protection than that of male &IA,*A)HM Dome shaped rubberied material inserted at the cervix to prevent sperm getting inside the uterus Beusable HT 3 &roper hygiene o 5hec$ for holes o )ust be refitted in case of +eight gain of %( lbs board Cuestion o Nept in place for about E 3 Fours 6oard Cuestion Contra"n "cate to o >reCuent I@; CE*.ICAL CA, )ore durable than the diaphram 5ould stay on place for more than 2! hours *o need to apply spermicides Contra"n "cate to abnormal papsmear @CHEMICAL S,E*MICI&ES >'A)S most effective Sellies 5reams @hese may cause toxic shoc$ syndrome @SU*)ICAL METH+& $"'atera' t!0a' L"gat"on o @ isthmus o 24O probability of reversal .asecto1y o 9as deferens is cut o )ore than 34 x or 4 sperm count or 2 x negative sperm count before it could be consider safe sex HI)H *ISD ,*E)NANCY HEM+**HA)IC &IS+*&E*S )enera' 1anage1ent
56B Avoid sex &repare ultrasound determine the sac integrity Assess bleeding and approximation Assess hypovolemia Save discharge for histopathology o Determine +hether the product of labor has been expelled

-"rst Tr"1ester $'ee "ng A0ort"on termination of labor before age of viability S,+NTANE+US o ANA miscarriage o Ca!ses
%" 5hromosomal aberrations due to advanced maternal age 2" 6lighted ovum 3" germ plasm defect *atures +ay of expelling defective babies

C'ass"f"cat"ons 3 1. T7reatene

pregnancy is #eopardi1ed by bleeding and cramping but the cervix is closed and can be saved" =. Ine#"ta0'e moderate bleeding, cramping, tissue protrudes from the cervix and the cervix is open" o Types 3 1. Co1p'ete all products of conception are expelled" )gt ? emotional support 2. Inco1p'ete placenta and membranes retained" )gt ? DP5 HA$ITUAL o 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix" o Manage1ent <suture of cervix= 1. Mc&ona' proce !re @emporary circlage Side effect infection )ay have *SD =. S7"ro 8ar 5S delivery MISSE& o fetus dies. product of conception remain in uterus ! +ee$s or longer o s"gns of pregnancy cease %" < = pregnancy test 2" Dar$ bro+n 3" Scanty bleeding o )gt ? induction of labor/ vacuum extraction

IN&UCE& o @herapeutic abortion principle of 2 fold effect %" Done +hen mother has class ! heart disease ECT+,IC ,*E)NANCY occurs +hen gestation is location outside the uterine cavity 5ommon site ? Ampulla or @ubal Dangerous site? ;nterstitial UN*U,TU*E& *U,TU*E& )issed period sudden, sharp severe unilateral pain, $nife li$e Abdominal pain +ithin 3 (+$s of shoulder pain <indicative of intraperitoneal missed period <maybe generali1ed of one sided= bleeding that extends to diaphragm P phrenic nerve= Scant, dar$ bro+n vaginal bleeding <H= 5ullens sign bluish tinged umbilicus 9ague discomfort syncope/fainting *ursing 5are ?
o o o o o o vital signs administer ;9 fluids monitor for vaginal bleeding monitor ;P' prepare for culdocentesis to determine hemoperitoneum

)gt ? non surgical )ethotrexate

SEC+N& T*IMESTE* $LEE&IN) Hy at" "for1 Mo'e / S0!nc7 of grapesT

0estational @rophoblastic Disease progressive degeneration of 5horionic 9illi gestational anomaly of the placenta consisting of a bunch of clear vesicles" @his neoplasm is formed from the s+elling of the chronic villi and lost nucleus of the fertili1ed egg" @he nucleus of the sperm duplicates, producing a diploid number !Exx" ;t gro+s and enlarges the uterus very rapidly"

Ca!se ? In$no+n
Assess1ent 3 o Ear'y s"gns
vesicles passed thru the vagina Fyperemesis gravidarum due to T F50 >undal height 9aginal bleeding <scant or profuse=

Ear'y "n pregnancy

high levels of F50 &re ecclampsia at about %2+$s 9esicles loo$ li$e a ,sno+storm- on sonogram Anemia Abdominal cramping Fyperthyroidism &ulmonary embolus

Ser"o!s 'ate co1p'"cat"ons

N!rs"ng care 3 o prepare for DP5 o do not give oxytocin drugs due to proneness to embolism o Fealth @eaching?
return for pelvic exams as scheduled for one year to monitor F50 and assess for enlarged uterus and rising titer could be indicative of choriocarcinoma Avoid pregnancy for at least one year )ethotrexate therapy

Inco1petent Cer#"( Manage1ent3

)cDonald procedure o temporary circlage of incompetent cervix" o Delivery ? *S9D o S:? infection o Fealth teaching observe for signs of infection signs of labor Shhirod$ar procedure o permanent procedure" o Delivery ? caesarian section reCuired"

THI*& T*IMESTE* $LEE&IN) S,LACENTAL AN+MALIEST ,'acenta ,re#"a it occurs +hen the placenta is improperly implanted in the lo+er uterine segment, sometime covering the cervical os" Assess1ent o 'utstanding sign ? fran$, bright red, painless bleeding o enlargement <usually has not occurred= o fetal distress o abnormal presentation N!rs"ng care 3 o ;nitial mgt ? *&' candidate for 5S o 6edrest o prepare to induce labor if cervix is ripe o administer ;9 o *o ;:, *o Sex, *o enema complication ? Sudden fetal blood loss o prepare )other for double set up DB is converted to 'B A0r!pt"o ,'acenta it is the premature separation of the placenta from the implantation site" ;t usually occurs after the t+entieth +ee$ of pregnancy 5ause? o 5ocaine user o Severe &;F o Accident Assessment? o 'utstanding sign ? dar$ red P painful bleeding o concealed hemorrhage <retroplacental= o couvelaire uterus <caused by bleeding into the myometrium= < = contraction o rigid boardli$e abdomen o severe abdominal pain o dropping coagulation factor <a potential for D;5= o sx ? bleeding to any part of the body" )gt ? for hysterectomy 0eneral *ursing care ? o infuse ;9, prepare to administer blood type and crossmatch o monitor >FB o insert >oley catheter o measure bllod loss. count pads o report s/s of D;5 o monitor v/s for shoc$ o strict ;P'

,'acenta' S!ccent!r"ata % or 2 lobes connected to the placenta by a blood vessel ,'acenta $"part"ta placenta divided into 2 lobes HY,E*TENSI.E &IS+*&E* ,regnancy In !ce Hypertens"on o F&* after 2!+$s resolved E+$s postpartum +hich cause pregnancy" o @ypes ? o 0estational F&* F&* +ithout edema P proteinuria" )gt ? monitor 6& o &re eclampsia triad o sx ? F&* +ith edema, proteinuria or albuminuria <F:&/A= +hich cause is un$no+n or idiopathic but multifactoral primis d/t %st exposure to chorionic villi multiple pregnancies due to T exposure to chorionic villi )others of lo+ socio economic status due to W protein inta$e @eenagers d/t lo+ compliance to protein inta$e o F:88& syndrome hemolysis +ith elevated liver en1ymes P lo+ platelet count Trans"t"ona' Hypertens"on F&* bet+een 24 2!+$s C7ron"c or ,reLe("st"ng Hypertens"on o F&* before the 24th +$ not resolved E+$s postpartum o 3 types of pre eclampsia o S"gn of preLec'a1ps"a 3 o J 34mmFg systolic o J %(mmFg diastolic o Boll over test %4 %(min side lying @hen supine @hen ta$e 6& o 1"' preLecc'a1ps"a %!4/D4mmFg, +/ H% '2, H2 proteinuria :arly signs ? T +t, inability to +ear +edding ring due to developing edema Signs present cerebral P visual disturbances, epigastric pain to liver edema and oliguria usually indicates an impending convulsion 6efore convulsion ? if you see sign of epigastric pain, %[ mgt is to place tongue depressor and put the side rales up During convulsion ? observe the )other for safety After convulsion turn to side to facilitate drainage o Se#ere preLecc'a1ps"a %E4/%%4, H3 or H!, proteinuria, visual disturbances *ursing care , promote bedrest ,revent convulsions by nursing measures to T '2 demand P facilitate *a excretion )anagement? Cuiet P calm environment, minimal handling, avoid moving the bed Heat Acet"c Ac" determine protein in the urine &repare the follo+ing at bedside o tongue depressor, Suction machine P '2 tan$ E ensure high protein inta$e <%g/$g/day= *a in moderation A antihypertensive drug +ith hydralu1ine C 5*S depressant +ith )g Sulfate for anti convulsion )gt ? evaluate for hypermagnesiumenimia E evaluate physical parameters for )agnesium Sulfate toxicity ? $ 6& W U Irine output W * BB W , &atellar reflex is absent Antidote ? 5a gluconate o :clampsia +ith sei1ure T 6I* sign of glumerular damage &"a0etes Me''"t!s

o o

cause by absent P lac$ of ;nsulin Dx test ? (4gm %hr 0lucose @olerance @est o T %34 hyperglycemia o W K4 hypoglycemia o 34 %24 euglycemia o if J %34mg/dl, the )other needs to undergo a 3hr 0@@ )aternal :ffects ? o hypoglycemia during the %st trimester development of the brain sinisipsip ng fetus yung glucose ng nanay" o Fyperglycemia during the 2nd P 3rd trimester F&8 effect )gt ? give insulin" 'FA are teratogenic" %st trimester W insulin, 2nd trimester T insulin, post partum drop suddenly >reCuent infections eg" )oniliasis &olyhydramnios Dystocia >etal :ffects ? o hypoglycemia during the %st trimester and Fyperglycemia during the 2nd P 3rd trimester thru facilitated diffusion o )acrosomia/80A "!444gms o ;I0B due to prolonged D) o &reterm birth promote still birth *e+born :ffects ? o Fyperinsulinism and Fypoglycemia !4mg/dl *ormal ? !( ((mg/dl 6orderline ? !4mg/dl Sx ? T pitched shrill cry, tremors, #itteriness Dx test ? heel stic$ test to chec$ glucose levels o Fypocalcemia V Kmg/dl 5alcemic tetany @x ? 5a gluconate

o Action of ;nsulin is to facilitate transfer of glucose into the cell

Heart &"sease
o 5lassification ? o ; no limitation o ;; Slight limitation, ordinary activity causes fatigue good prognosis can deliver vaginally )gt ? sleep of %4hrs/day, rest 34mins after meals o ;;; moderate limitation, less than ordinary activity causes discomfort poor prognosis" 0ood for vaginal delivery )gt ? early hospitali1ation by K 3mos o ;9 mar$ed limitation of physical activity for even at rest there is fatigue poor prognosis" 0ood for vaginal delivery only +ith regional anesthesia" 8o+ forceps delivery +hen unable to push P to shorten the stage of labor )gt ? therapeutic abortion, high semi fo+lers position, left side lying, no valsalva maneuver may trigger cardiac arrest, heparin therapy reCuired, antibiotic therapy for prevention of sub acute bacterial endocarditis

INT*A,A*TAL C+M,LICATI+NS Cesarean &e'"#ery ;ndications a" multiple gestation b" diabetes c" active herpes ;; d" severe toxemia e" placental previa f" abruption placenta g" prolapse of the cord h" cephalo pelvic disproportion and primary indication i" breech presentation #" transverse lie proce !re 3 o classical vertical incision o lo+ segment ,bi$ini-, for aesthetic purposes" 5an have vaginal birth after c/s )enotype genetic ma$e up ,7enotype &hysical appearance Daryotype pictorial analysis of individual chromosome for detecting chromosomal abnormalities A!toso1a' &o1"nant huntingtons chorea retinoblastoma achondroplasia polydactyl A!toso1a' *ecess"#e sic$le cell 5ystic fibrosis 5eliac &NI 0alactosemia XL L"n8e *ecess"#e Femophilia

 Duchennes muscular dystrophy 5olor blindness X L"n8e &o1"nant Bic$ettes