CORE Program

COmpetency-based, Recall and Enhancement Testes

o two ovoid glands, 2-3cm wide that lie
in the scrotum
Obstetric Nursing Penis
Compiled by: JULIE VEE M. DECIN RN
o composed of 3 cylindrical masses of
erectile tissue in the penis shaft

Epididymis
• tightly coiled tube, approx. 20 ft. long
Anatomy and Physiology conduct sperm from testes to the vas deferens

FEMALE: Vas Deferens

Vestibule
• Flattened, smooth surface inside the labia where
openings to the bladder and vagina arise
Clitoris
• Small, rounded organ of erectile tissue
Skene’s glands (Paraurethral glands)
• Ducts open into the urethra
• passageway of sperm from epididymis into the urethra
ends in the seminal vesicles and ejaculatory
duct
Ejaculatory Duct
• connects seminal vesicles to urethra
Prostate Gland chestnut
• sized gland that lies below the bladder

Bartholin’s Gland (Vulvovaginal glands) Cowper’s Glands

• Ducts open into the vagina • located below the prostate gland

Fourchette Urethra
• Ridge of tissue formed by the labia majora and • hallow tube leading from the base of the
minora bladder that passes through the prostate gland

Hymen
Menstruation
• Tough but elastic semicircle of tissue that • Termed as female reproductive cycle
covers the vagina • Defined as the episodic uterine bleeding in response to cyclic
hormonal changes
• Process that allows for conception and implantation of new life
MALE: • Ultimate purpose is for fertilization or pregnancy.
Scrotum
o rugated skin-covered muscular pouch Four Phases
suspended from the perineum • Proliferative
o Functions are to support the testes and
help regulate sperm’s temperature
 • Secretory (800-1,200ml)
Composition
• Ischemic 99% water and 1% solid
contains albumin, urea, uric acid, creatine
Color
• Menses clear and colorless to straw colored

Amniotic Fluid
Embryonic and Fetal Structures slightly alkaline: pH – 7.0 to 7.25
Function:
Decidua Connects the fetus to the placenta
o the uterine cells of endometrium
o has 3 separate areas: Blood Vessels:
a. decidua basalis 2 arteries, 1 vein (AVA)
b. decidua capsularis
c. decidua vera Length:
50-55 cm long and 2 cm in diameter
Chorionic Villi
o tiny projections around the zygote, Warton’s Jelly:
present as early as 12 days after Gelatinous substance found inside the cord
fertilization

Maternal Adaptations to Pregnancy

Fetal Membranes
encloses fetus and amniotic fluid UTERUS
composed of 2 membranes
Increase in size
a. Chorionic Membrane  about 4,000 g
o outermost fetal membrane
 Functions to provide support to Hegar’s sign
amniotic membrane  softening of lower uterine segment

i.Amniotic Membrane
 forms beneath the chorionic
membrane
 supports and produces amniotic fluid
UTERINE BLOOD VESSELS & BLOOD FLOW
 Blood flow increases from 20 ml to 700-900 ml
 ¾ of this blood supply goes to the placenta
 During contraction, uterine pressure increase at about 20-30 mmHg

Amniotic Fluid
medium in which the fetus and the cord float inside
the amniotic membrane
Volume
increases from the 1st trimester until 38th week of pregnancy
 Psychologic / Emotional Adaptations T No. of full term infants born at 37 weeks or after
to Pregnancy P No. of preterm infants born before 37 weeks
A No. of spontaneous or induced abortions
1st Trimester Acceptance of Pregnancy L No. of living children
2nd Trimester Acceptance of Fetus M No. of multiple pregnancies
3rd Trimester Acceptance of Mother Role
Manner of Counting
T individual counting
Prenatal Care P individual counting
Basic Terminologies A individual counting
L individual counting
Pregnancy Classification M 1 para = 1 multigestation

Example: A woman who has had two previous pregnancies,

has given birth to two term children and is
again pregnant.
Ans: G3P2
An infant born between 37 and 42
TERM INFANT
weeks gestation
Example: A woman who has had two miscarriages at 12 weeks
POST TERM An infant born after 42 weeks
and is again pregnant.
INFANT gestation
Ans: G3P
PRETERM An infant born before 37 weeks
INFANT gestation
Example: A pregnant woman who has had two pregnancies, 1
resulted to abortion at 12 weeks and the other one is PARTURIENT A woman in labor
already 2 years old. A woman who has just delivered
Ans: G3P1 PUERPERA
(within six weeks after delivery)
Example: A pregnant woman who has had two pregnancies, 1
resulted to abortion at 25 weeks and the other one is
already 2 years old.
Ans: G3P

Example: A pregnant woman who has had two pregnancies,

two resulted to preterm infants, alive and well.
Ans: G3P2

Basic Terminologies
Initial visit
1. Complete History
2. History of Past Pregnancies
G No. of pregnancies, regardless of the outcome
 LIVE BIRTH An infant born showing signs of life 12 – 16 – 20 – 30 – 36

STILLBIRTH An infant born without signs of life

Amniocentesis
EARLY *Aspiration of amniotic fluid from the uterus
Death of newborn within 7 days after
NEONATAL *Done 14th – 16th week
birth
DEATH *Ultrasound – guided
LATE NEONATAL An infant who died between 7 to 29 *Detects Neural Tube Defects
DEATH days after birth
LOW
A term infant with birth weight less
BIRTHWEIGHT
than 2500 grams
INFANTS Chorionic Villi Sampling
LARGE FOR *Obtaining a tissue sample in the placenta
A term infant with birth weight more
GESTATIONAL *Done 10th – 12th week
than 4000 grams
AGE / LGA *Ultrasound – guided
*Detects Chromosomal Abnormalities

LEOPOLD’S MANEUVER

1st Maneuver
• determines Presentation
• determines whether fetal head or breech is in
the fundus

2nd Maneuver
 determines Position

How to get Expected Date of Delivery?  locates the fetal back

1. Nagele’s Rule 1st day of the last menstrual period 3rd Maneuver
Formula: - 3 (months) + 7 (days)
 determines Engagement
2. Quickening For primigravida: Add 22 weeks
For multigravida: Add 24 weeks  determines fetal part at the inlet and it’s
mobility
3. Mc Donald’s Rule
* fundic height in cm x 2 / 7 = AOG in months
* fundic height in cm x 8 / 7 = AOG in weeks 4th Maneuver

4. Bartholomew’s Rule  determines Fetal Attitude

  determines degree of fetal extension into the
pelvis
LABOR AND DELIVERY
THE LABOR PROCESS:
*Alterations in hormonal balance of estrogen and progesterone
increase uterine contractility
*Degeneration of the placenta, which no longer provides necessary
elements to fetus
*Over distention of uterus creates stimulus – triggering release of
oxytocin, which initiates contractions.
Signs of Beginning Labor
*Prodromes to labor are:
*Lightening – the settling of fetal head into the inlet
of the true pelvis; may not occur in
multiparas.
*Show – the release of the cervical plugs consisting
of mucous, blood streaked vaginal
discharge.
*Spontaneous Rupture of membrane – sudden gush
of clear fluid from the vagina.
*Excess energy – “nesting instinct”; feeling of
extremely energetic.
*Braxton Hick’s contractions increased.
*Loss of 1-3 lbs from water loss resulting from fluid
shifts produced by changes in progesterone
and estrogen levels.
*Uterine contraction – True labor contractions starts
at the back and sweep across the abdomen,
increasing in frequency and intensity.
DURATION OF LABOR:
*varies depending upon the individual
*average:
primipara: up to 18 hours; some may be shorter,
others longer
multipara: up to 8 hours; some may be shorter,
others longer
The True Labor Contractions
* Result in progressive cervical dilation and effacement.
*Occur at regular interval.
*Interval between contraction decreases.
*Intensity increases.
*Located mainly in back and abdomen
*Intensified by walking
*Not affected by mild sedation.
SIGNS OF LABOR:
Differentiate true from false labor
Irregular contractions
Contractions may cause discomfort
Pain is confined in the abdomen only
Pain usually radiates at the back then sweeps to the
abdomen
Discomfort may be relieved by walking
Discomfort may not be relieved by walking
Contractions do not bring about appreciable changes
in cervix
UTERINE CONTRACTIONS:
Contractions divided into three periods of intensity
*increment – increasing intensity
*acme – peak or full intensity
*decrement – decreasing intensity
UTERINE CONTRACTIONS:
Contractions are monitored for frequency, duration and intensity
*frequency: measured by timing contractions from the
beginning of one contraction to the beginning of the
next contraction
*duration: beginning of contraction to beginning of
decreasing intensity. Cannot be measured exactly
by feeling with the hand
*Intensity: cannot be measured by feeling; must be
measured by internal fetal monitoring device.
Usually refers to contraction at beginning of labor.
Peaks at about 25 mmhg. At the end of labor it may
it may reach 50 to 75 mmHg
*Contractions may be described as mild, moderate or
 intense.
Five “ P”s of Labor
*Passenger : the fetus
*Passageways
Pelvis DURATION OF LABOR:
Soft tissues – lower uterine segment, cervix, Length of labor depends on:
vagina, and introitus. *effectiveness of consistent cotnractions: contractions
*Powers must overcome resistance of the cervix
Forces acting to expel fetus; primarily by *amount of resistance baby must overcome to adapt to
involuntary uterine contractions, pelvis
secondarily by voluntary bearing *stretching ability of soft tissues
down.Function of uterine *preparation and relaxation of client. Fear and anxiety
contractions are effacement and can retard progress
dilation.
*& E. Person / Psychological Response
Response to contraction, perception Mechanisms of Labor
and beliefs, prenatal care and *Descent à presenting part progresses through pelvis; level
education, support systems and os station
communication skills.
*Flexion à descending head meets pelvic floor; chin is
EFFACEMENT AND DILATATION brought down to chest.
Effacement
o thinning process by
*Internal Rotation à fetal head rotates from transverse
which cervical canal
diameter to anteroposterior diameter to facilitate
is progressively
movement through pelvis.
shortened to
complete
*Extension à once fetal head reaches perineum, it extends
obliteration.
to be born.
Progresses from a
structure of 1 – 2 cm
long to almost *Restitution à after delivery of head, it rotates back to to
complete position prior to engagement.
obliteration.
DILATATION *External Rotation à Shoulder engage and move similarly to
o process by which head.
external os enlarges
from a few *Expulsion à entire infant emerges from mother.
millimeters to
approximately 10
cm. Stages of Labor

a. First stage of Labor - begins with first true labor

contractions and ends with complete dilatation of the
 cervix ( 10 cm dilatation) sending cord blood to laboratory if the mother is O-positive or
Latent phase- 0-4 cm Rh-negative, and allow bonding.
Active phase – 4-7 cm
Transitional – 7-10 cm *Fourth Stage –time from delivery of placenta to homeostasis.

2. Second Stage of Labor - begins with complete dilation and ends >Monitor V/S every 15 minutes, including fundal height,
with birth of baby. position, and consistency.
>Assess for lochia, check perineum, perform peri care
3. Third Stage of Labor - begins with delivery of baby and ends with from front to back
delivery of placenta. >Post partum care

4. Fourth Stage of Labor - lasts from delivery of placenta to signs of placental separation:
postpartum condition( an hour after delivery). Calkin’s sign
Sudden gush of blood from vagina
*First Stage- onset of regular contraction to full dilatation Lengthening of the umbilical cord
Displacement of the uterus upward occurs
*Duration is 8-9 hours for primigravida and 5-6 hours for (rise of the fundus)
multipara; Transition is 1 hour for primigravida and ASSESSMENT:
10-15 minutes for multipara. *evaluate placenta after separation:
*Frequency of contraction is every 2-4 minutes lasting for *Schultze (most common): placenta is inverted on itself, and
45-90 seconds. shiny fetal surface appears; 80% separate in center
*Nursing Care: Monitor V/S and FHR every 15 minutes, Bed *Duncan: descends sideways, and the maternal surface
rest for ruptured membrane, Have her empty appears. Separates at edges rather than center
bladder, Pain reliefs, Breathing techniques, maintain
safety.
Labor Complications
*Second Stage of Labor- from full dilatation to delivery of infant. Hypotonic Uterine Contractions
o weak, infrequent
* 30-60 minutes for primigravida, 20 minutes for contractions usually
multipara; frequency is 2-3 minutes lasting 60-90 present in the active
seconds; strong intensity. stage of labor
*Nursing Care: Transfer to delivery room for 8-9cm o may occur due to the
dilation for multigravidas and full dilation for following:
primigravidas; Monitor V/S and FHR, prepare perineal o overstr
area, Encourage pushing with contractions, Immediate etched
newborn care. uterus
due to
multipl
*Third Stage- from delivery of infant to delivery of placenta. e
gestati
>5-30 minutes duration. on
> Nursing Care: assess for placental separation, o LGA
inspection of placenta, monitor V/S, Initiate breastfeeding, o Hydra
administer Oxytoxic and antilactation agents as ordered,
 mnios o Seen in latent stage
o Lax o Managed through
uterus *Fluids and electrolytes
due to *Rest
grand *Empty bladder
multip *Side lying position
arity
o Conge
nital
abnor Labor Complications
malitie Contraction Rings
s of Types:
uterus a. Constriction Ring
– occurs at any point in the myometrium
Management: b. Pathologic Retraction Ring (Bandl’s Ring)
o Oxytocin infusion – occurs at any junction of the upper and
o Amniotomy lower uterine
segments

Labor Complications Cause: Uncoordinated contractions

Hypertonic Uterine Contractions
o Too frequent but uncoordinated Management:
contractions Tocolytic
o Usually occur at latent stage IV Morphine Sulfate or inhalation of amyl nirite

Management:
o Fluid and electrolytes infusion Labor Complications
o Therapeutic rest Precipitate Labor
o Empty bladder  Labor that is
o Side lying position completed
fewer than 3
hours
Let’s Compare!  Contractions
HYPOTONIC can be so
o Weak, infrequent contractions forceful that
can lead to
o Seen in active stage
premature
o Managed through:
separation of
*Oxytocin infusion
placenta
*Amniotomy
Predisposing Factors:
 Multiparity,
HYPERTONIC large pelvis,
o Too frequent but uncoordinated
 Small baby in
good position

Management:
 Tocolytics Management:
 Reduce
Labor Complications pressure on
Uterine Inversion the cord
 refers to the  Cover the
uterus turning umbilicus
inside out with saline
with either sterile
birth of the moistened
uterus or cloth
delivery of  Administer
placenta Oxygen
inhalation
Causes:
 Pulling of
umbilical cord DISCLAIMER
 Applying
Pressure on In light of the rapid turnover of technology in the medical sciences, the compilation of
uncontracted information, and the possibility of human error, AIM.ONE, and any other parties
uterus involved in said compilation of information contained herein, disclaims all
responsibility for and accepts no liability for any inaccuracies, errors, omissions or
Labor Complications liabilities incurred as a consequence, directly or indirectly, of the use and application
Prolapsed Umbilical Cord of its contents. Any similarities with other materials are only a result of such
 a loop of the compilation
umbilical cord
slips down in
front of
the
presenting
fetal part My dear students,

Causes: May this handouts help you. I wish u well in the board exam. Please use this material
 Long cord, for a good cause. I appeal you don’t duplicate, copy or reproduce it at any rate.
Polyhydramni
Thank you. God Bless!
os,
Malposition
and
 Malpresentati -ma’am JulieJ
on