REPRODUCTIVE SYSTEM ● Corpus spongiosum – is the mass of spongy tissue which

surrounds urethra and involves in erection by allowing

MALE REPRODUCTIVE SYSTEM rushing of blood into it
- Consists of a number sex organs that are a part of the ● Corpus cavernosa – is one of a pair of sponge-like
human reproductive process. regions of erectile tissue which contains most of the
- Produces, stores and releases the male gametes, or blood in the penis during penile erection
sperm. Urethra – a tube within the penis that conveys semen out of the
o Gametes – a sex cell body during ejaculation
MALE REPRODUCTIVE ORGANS Glans – the rounded, highly sensitive head of the penis;
External Genital Organs homologous to clitoris

1. Penis Prepuce – a fold of skin, covering the head of the penis; gnacut
2. Scrotum sa circumcision

Internal Genital Organs Scrotum

1. Testis - A pouch of skin formed from the lower part of the

2. Epididymis abdominal wall.
3. Vas deferens - The scrotum keeps the testes at a temperature slightly
4. Accessory glands cooler than body temperature.
a. Seminal vesicles
b. Prostate gland
c. Bulbourethral glands

INTERNAL GENITAL ORGANS

Testis (plural: testes)

▪ The testes are the two-oval shaped male organs that

produce sperm and hormone testosterone.
o Where spermatogenesis happen
o Testosterone – primary male sex hormone

▪ Each testis is made of tightly coiled structures called

seminiferous tubules.
▪ Among tubules are cells that produce testosterone.
EXTERNAL GENITAL ORGANS

Penis

- Is the organ by which the sperm is introduced into the

female
- It contains spongy tissue that becomes turgid and erect
when filled with blood.

Epididymis

▪ The epididymis is a tightly coiled tubes against the testicles.

▪ It acts as maturation and storage place for sperm.

Erectile Tissues
 REVIEW:

● The main function of the male reproductive system is to

produce sperm cells and deliver them to the female
reproductive system
● It consists of external and internal genital organs which
are essential for the continuous reproduction of life

SPERM

Vas Deferens (Ductus Deferens) Function: to move and carry genetic information to the egg

▪ The vas deferens is a thin tube that starts from the Structure:
epididymis to the urethra in the penis.
● Head: the large head region of the sperm that contains
▪ They transport sperm from the epididymis in anticipation of
DNA; genetic composition
ejaculation (release of semen).
● Midpiece: the narrow middle part of the cell that
contains mitochondria (powerhouse); powerhouse of
the sperm cell; saan galing ang energy
● Tail: the wavelike motion of the flagellum propels the
sperm forward

ACCESSORY GLANDS – these glands produce nourishing fluids for

the sperms that enter the urethra.

Seminal Vesicles

▪ The seminal vesicles are sac-like structures attached to the

vas deferens at one side of the bladder.
▪ They produce a sticky yellowish fluid that contains fructose SPERMATOGENESIS
(sweet). - Is the formation of sperm cells
- It takes place in the seminiferous tubules
- Sperm formation
- Involve meiosis (cell duplication)
- Produces 4 haploid daughter cells
- Begins at puberty (13-14y.o.) and ends at death
- 50-500million per ejaculation

Prostate Gland

▪ The prostate gland surrounds the ejaculatory ducts at the

base of the urethra, just below the bladder.
▪ The prostate gland is responsible for making the production
of semen, a liquid mixture of sperm cells, prostate fluid and
seminal fluid.
o Produce some alkaline-like fluid at the time of
https://www.youtube.com/watch?v=krSMZDsjLuU
ejaculation
o Sperm cannot survive w/o alkaline fluid bc acidic envt
sa female na organ
EJACULATION
Bulbourethral Glands (Cowper’s gland)
- Is the discharge of semen from the penis
▪ The bulbourethral glands are two small glands located on - During orgasm, the semen is forcefully expelled from
the sides of the urethra just below the prostate gland. the body by strong muscular contractions of sperm
▪ These glands produce a clear, slippery fluid that empties ducts
directly into the urethra. o Orgasm – the physical and emotional
sensation experienced at the peak of sexual
excitation, accompanied in the male by
ejaculation

SEMEN

● 60% prostate gland

● 30% seminal vesicle
 ● 5% epididymis MAJOR ORGANS
● 5% bulbourethral gland
● 2-5cc (1 tsp) per ejaculation ● Cervix
● Vagina
SPERMATOZOA ● Ovaries (gonads)
● Uterine tubes (fallopian tubes)
● Produced by the testicles ● Uterus
● 40-80 million per cc of semen
● 300-500 million per ejaculation Cervix
● Mature after 64 days
▪ The lower portion or neck of the uterus.
▪ The cervix is lined with mucus, known as cervical mucus.
o Cervical mucus provides lubrication & sperm transport
during sexual intercourse
o During ovulation, secretion of cervical mucus increases
in response to estrogen (help production of mucus)
o But when an egg is ready for fertilization, the mucus
then becomes thin and slippery, offering a ‘friendly
environment’ to sperm; so that sperm can penetrate
▪ At the end of pregnancy,
▪ The cervix acts as the passage through which the baby exits
the uterus into the vagina.
▪ The cervical canal expands to roughly 50 times its normal
width for the passage of the baby during birth.

Vagina

▪ A muscular, ridged sheath connecting to the external

genitals to the uterus.
▪ Functions as a two-way street, accepting the penis and
sperm during intercourse.
Video: (Functional Anatomy of the Male Reproductive System) ▪ Serving as the avenue of birth through which the new baby
https://www.youtube.com/watch?v=k60M1h-DKVY enters the world.

REVIEW:

The pathway of the sperm in the male reproductive system are

the following: (in chronological order)

External genitalia

▪ Vulva – which runs from the pubic area downward to the

rectum.
o Labia majora or “greater lips” are the part around the
vagina containing two glands (Bartholin’s glands) which
helps lubrication during intercourse.
FEMALE REPRODUCTIVE SYSTEM o Labia minora or “lesser lips” are the thin hairless ridges
- Produce sex hormones at the entrance of the vagina, which joins behind and in
o Estrogen, progesterone front. In front they split to enclose the clitoris.
- Produce egg (ova) o The clitoris is a small pea-shaped structure. It plays an
- Support & protect developing embryo important part in sexual excitement in females.
- Give birth to new baby ▪ The urethral orifice or external urinary opening is below the
clitoris on the upper wall of the vagina and is the passage for
urine; where catheter is inserted.
▪ Opening of the vagina is separate from the urinary opening
and located below it.
▪ The hymen is a thin crescentic fold of tissue which partially
covers the opening of the vagina. Medically, it is no longer
considered to be a 100% proof of female virginity.

os (not an abbrev)
 Fallopian tubes (uterine tubes)

▪ Stretch from the uterus to the ovaries and measure about 8

to 13cm in length.
▪ The ends of the fallopian tubes lying next to the ovaries
feather into ends called fimbria.
▪ Millions of tiny hair-like cilia line the fimbria and interior of
the fallopian tubes.
▪ The cilia beat in waves hundreds of times a second catching
the egg at ovulation (rupture of mature egg) and moving it
through the tube to the uterine cavity.
▪ Fertilization typically occurs in the fallopian tube.
6oclock incision to anus

7oclock right media lateral

5oclock left media lateral

Incision facilitate the delivery

- Endometrium inner lining uterus asa mutubo ang ova;

implantation happens
- Myometrium middle mucontract
- Perimetrium outer

Uterus
Os “doughnut” ▪ Pear-shaped muscular organ in the female reproductive
tract.
Ovaries
▪ The fundus is the upper portion of the uterus where
▪ Also known as female gonads pregnancy occurs.
▪ They produce eggs (also called ova) every female is born ▪ The cervix is the lower portion of the uterus that connects
with a lifetime supply of eggs with the vagina and serves as a sphincter to keep the uterus
▪ They also produce hormones: estrogen (secondary closed during pregnancy until it is time to deliver a baby.
characteristics; create mucus) and progesterone ▪ The uterus expands considerably during the reproductive
(pregnancy) process.
▪ The organ grows to from 10 to 20 times its normal size
during pregnancy.
▪ The main body consists of a firm outer coat of muscle
(myometrium) and an inner lining of vascular, glandular
material (endometrium).
o The endometrium thickens during the menstrual cycle
to allow implantation of a fertilized egg.
o Pregnancy occurs when the fertilized egg implants
successfully into the endometrial lining.

Endometrium

▪ The endometrium is the innermost layer as a lining for the

uterus.
▪ During the menstrual cycle, the endometrium grows to a
thick, blood vessel-rich, glandular tissue layer.
▪ This represents an optimal environment for the
implantation of a blastocyst upon its arrival in the uterus.

▪ The endometrium is central, echogenic (detectable using

ultrasound scanners), and has an average thickness of 6.7
mm.
▪ During pregnancy, the blood vessels in the endometrium
further increase in size and number, forming the placenta
▪ Placenta supplies oxygen and nutrition to the embryo and
fetus. Placenta – inunlan (Bisaya)

Video (oogenesis vs. spermatogenesis):

https://www.youtube.com/watch?v=BeNIPmIzYFg

OOGENESIS

- Ovum formation
- 1 daughter cells become the ovum; 3 polar bodies die
- Begins before birth ends at menopause
- Completion: 13-50 years
- One ovum oocyte matures monthly
MENSTRUATION

Video (Menstrual Cycle):

https://www.youtube.com/watch?v=tOluxtc3Cpw&t=30s

Video (Understanding the Menstrual Cycle; How hormones

interplay during menstrual cycle):
https://www.youtube.com/watch?v=3Lt9I5LrWZw

Also involves CNS: Hypothalamus releases GNRH to stimulate 2

hormones responsible in menstrual cycle – FSH and LH which
also stimulates the production of progesterone (steroid sex
hormone; hormone to maintain pregnancy, prepares the
endometrium for pregnancy)

▪ Menarche (onset), menopause (termination) 1st day sa mens – count backward 14 para malaman ang
▪ 300,000-400,000 oocytes per ovary ovulation
o 1-2 mil oocytes at birth; but decreases every month
o Puberty/adult yrs 300k-400k
▪ Average cycle is 28 days, duration of 3-5 days HORMONES
▪ Menstrual flow contains 30-80ml of blood; beyond 80ml
(hemorrhage); expected blood loss during pregnancy Estrogen
(normal-500cc; CS-1000cc) - Inhibits production of FSH
▪ Structures involve hypothalamus, APG (Anterior pituitary - Causes hypertrophy of the myometrium
gland), ovaries, uterus (shedding of endometrial lining), - Stimulates growth of breasts ducts
vagina - Increases pH of cervical mucus causing it to become
▪ Hormones that regulate – FSH (follicle to mature) and LH thin and watery (Spinnbarkheit test – ex. Same sa
o Estrogen (secondary sex charx estrogen is involved) consistency of eggyolk if fertile ang babae; best envt for
o Progesterone the sperm to survive; estrogen-increases the pH of
▪ Mittelschmerz cervical mucus)
- the egg only lives for 24 hrs or less without fertilization - Proliferates the endometrium
- Midcycle pain (mittelschmerz) – during ovulation
period; lifespan sa egg/ovum 24hrs during ovulation; 5 Progesterone
days ang sperm if good envt; best time to get pregnant-
- Inhibits production of LH
day before ovulation
- Increases endometrial tortuosity (twisted uterus)
- There is release of matured follicle – as it ruptures, it
- Increases endometrial secretions
causes pain (midcycle pain)
- Inhibits uterine motility
- Facilitate transport of fertilized ovum through fallopian
tube
- Increases body temperature after ovulation
- responsible for pregnancy

Ovulation period 10-14th day

Luteal phase (corpeus luteum) after ovulation period

 ↓

THE MENSTRUAL CYCLE d. Menstrual Phase (1-5): an end and a beginning

THE FOUR LEVELS ↓

1. CNS Response – Hypothalamic – pituitary gland action Decrease in estrogen and progesterone
(release of FSH and LH)
2. Ovarian Response (2 phases) ↓
- Proliferative phase (1-14 days) Lining disintegrates and discharged from the body
- Secretory (15-22 days)
3. Endometrial Response (4 phases) ↓
- Menstrual phase (1-5 days)
- Proliferative (6-14 days) MENSTRUAL FLOW
- Secretory (15-26 days)
- Ischemic (27-28 days)
4. Cervical Mucus Response (Ovulatory) 15-23 days
- Before ovulation – Spinnbarkeit/Spinnbarkheit;
Mittelschmerz
- After ovulation

PHASES OF MENSTRUAL CYCLE

a. Proliferative/Preovulatory/Follicular Phase (6-14 days)

In a 28 days cycle → begins with the end of menstruation

Decrease levels of estrogen and progesterone

Hypothalamus senses the decrease, thus stimulates the APG to

secrete GnRH prompting the release of FSH which stimulates the Hormone increased after ovulation-progesterone
ovaries to produce follicles (10-20 days)
Luteal phase/DPO day post ovulation
↓

Follicles ripen but only one will mature which is known as the
Graafian follicle

b. Ovulatory Phase (14-15) – peak

Graafian follicle ruptures and releases the mature ovum near the
fallopian tube.
2 ova matures – both fertilized (Fraternal twins; 2 placenta)
1 fertilized ovum divides into 2 separate zygotes (identical twins; The 3 phases of the uterine cycle:
monozygotic; 1 placenta)
↓ MENSTRUAL: Shedding of the functional layer of the
Hypothalamus senses increase level of estrogen triggers the APG endometrium
to release LH which acts with FSH to cause ovulation and
enhance Corpus Luteum formation PROLIFERATIVE: Rebuilding of the functional layer of the
endometrium
↓
SECRETORY: Begins immediately after ovulation. Enrichment of
c. Secretory/Luteal Phase (16-28) the blood supply and glandular secretion of nutrients prepare
the endometrium to receive an embryo.
Corpus luteum secretes progesterone that maintains the
vascularity of the endometrium Both the menstrual and proliferative phases occur before
ovulation, and together they correspond to the follicular phases
↓
of the ovarian cycle. The secretory phase corresponds in time to
Decrease level of estrogen and increase progesterone (hormone the luteal phase of the ovarian cycle.
of pregnancy)

Cause glands in the endometrium to secrete nutrients to sustain

a fertilized ovum that is implanted in the uterine wall

If no implantation – hypothalamus signal the pituitary gland to

stop producing FSH and LH

Decrease in FSH and LH causes the Corpus luteum to decompose

in the ovary and nourishment of the endometrium stops
PREGNANCY

Stages of Pregnancy

1. Fertilization – the process in which a sperm penetrates outer

layer of the ovum
2. Implantation – when the blastocyst attaches the
endometrium (7-9 days after fertilization)
3. Pre-placental stage – when the endometrium becomes
highly vascular (week 2)
4. Placental and fetal development

Placenta- organ of exchange

Itsura if it is embedded in the endometrial lining (start of

pregnancy)

Ovum has protective layers ^

Amnion-
holds amniotic fluid

Chorion-outer covering of amnion/amniotic fluid

IMPLANTATION

▪ 50% of zygote never achieved implantation

IMPLANTATION PROCESS ▪ Small amount of vaginal spotting is occasionally present –
implantation bleeding-pgattach sa blastocyst sa
endometrial lining magcause ug bleeding (spotting)
▪ Endometrium turned to decidua:
o Decidua basalis
o Decidua capsularis
o Decidua parietalis/vera
▪ It has 3 processes:

Apposition → adhesion → invasion

Apposition- blastocyst magtouch sa endometrial lining

Adhesion- attachment

Invasion- establishment

Decidua – endometrial lining that forms the maternal side of the

placenta. AKA gravid endometrium (maternal side of placenta) PLACENTA
Placenta has 2 sides: fetal side-attaches to fetal circulation & 1. Respiratory system
maternal side-attached to maternal circulation 2. Renal system
Parts of decidua: 3. Gastrointestinal system
4. Endocrine system:
Decidua basalis – it is the part of decidua between blastocyst and Human chorionic gonadotropine (placental hormone)
myometrium. It forms the fetal part of placenta. Human placental lactogen
Estrogen } uterus (growth), breast (enlargement)
Decidua capsularis – it covers the blastocyst except embryonic Progesterone } uterus, breast
pole and separates it from uterine cavity. 5. Protective functions
Decidua parietalis – it is the rest of endometrium that lines the Placenta-organ for respiration
rest of uterine cavity

FETAL DEVELOPMENT
Blastocyst Implantation

Apposition – 1st connection between the blastocyst and the

endometrium

Adhesion – attachment/adherence to the endometrium

Invasion – establishment of the blastocyst in the endometrium

Umbilical cord

- 21 inches long
- 2 arteries and 1 vein (AVA)
o Carries oxygenated blood – vein
o Deoxygenated – artery
- Wharthon’s jelly
- Transport oxygen, nutrients, minerals, and waste
products

End part sa umbilical connected to placenta

Amniotic fluid

- 500-1000ml inside the amniotic sac (BOW; bag of

water) ruptures if term na
- Produced by the amniotic membrane
- Shields fetus from pressure or blow
- Protects fetus from sudden change in temperature
- Aids in muscular development
- Aids in descent (pagbaba sa baby)
- Protects umbilical cord from pressure
o Cushions baby inside the womb (amniotic
fluid)
o Amniotic fluid protects the umbilical cord by
providing cushion thus reducing risk of
compression
- Protects fetus from infection
Not earlier than 5 mos – to know the sex

FETAL CIRCULATION

Shunt (hole) fetal has 3 shunts; 1st is ang ductus venosus, 2nd is
foramen ovale; 3rd is ductus arteriosus (A shunt that
automatically closes when the umbilical cord is cut.); This hole
normally closes at birth stimulated by a decreasing amount of ● Increased blood volume 40% to 50%
prostaglandin. ● Total RBC volume 30% (18% no iron sup)
● Physiologic anemia – baba ang oxygen sa blood d/t
Foramen ovale - A fetal hole that allows the blood to pass
fetal demand
through between the two atria.
● Increased WBC (leukocytes); leukocytosis – normal
● CR & PR increased to 10-15 beats/min @ term
39wks/9mos
VIDEO: Understanding Fetal Circulation ● Supine hypotension – dec. BP d/t sudden change of
position
● Varicosities – bc ang pressure papunta sa lower
extremities + fetal weight

FOCUS OF FETAL DEVELOPMENT

First trimester 1-3 mos

- Organogenesis; mostly major organs

Second trimester 4-6 mos

- Period of continued growth and development

Integumentary System
Third trimester 7-9 mos

- Period of most rapid growth and development (Melanocyte) – ginasecrete sa placental hormone (HPL human
placental lactogen)

● Increased pigmentation
NORMAL ADAPTATION IN PREGNANCY ● Chloasma/melasma “mask of pregnancy”
● Striae gravidarum – stria means stretchmark
Reproductive System
● Linea nigra – dark purple/brownish vertical line that
Uterus appears on the abdomen
● Increased perspiration
- Uterine growth and enlargement
o Length – 6.5 cms to 32 cms
o Width – 4 cms to 24 cms
o Depth – 2.5 cms to 22 cms
o Weight – 50 gms to 1000 gms
o Volume – 1-2 ml to 1000 ml
- Braxton Hicks contraction “practiced contraction”,
“irregular contraction”; myometrium nagapractice ug
contract
- Becomes globular (4th month)
- Goodell’s sign (4th week) – sign of pregnancy, softening
of cervix
- Hegar’s sign (8th week) – softening of lower uterine
segment
- Chadwick’s sign (8th to 10th week) – discoloration of Gastrointestinal System
vagina; highly vascularized; dark blue to purplish red
● Morning sickness (N/V) – inc. progesterone
Ovaries – no ovulation ● Heartburn
Vagina – moderately acidic (pH 3.8 to 4.5) ● Constipation

Breasts – enlarged Respiratory System

Musculoskeletal System ● Increased RR

● Dyspnea – respiratory adaptation in pregnancy when
● Waddling gait – because shift of gravity is in the the gravid uterus put pressure on the vena cava; while
abdomen lying so dapat magtakilid sa left side
● Lordosis – same w/ waddling; + hormone ● Nasal stuffiness – inc. estrogen > produces mucus
progesterone, pelvic relaxation; Lumbar spinal ● Epistaxis – inc. both hormone for pregnancy
curve as the center of gravity gradually change d/t
gravid uterus. Urinary System

Circulatory System ● Urinary frequency

● Increased GFR 50% (glomerular filtration rate)
Endocrine System

● Increased metabolism of CHON and CHO

● Increased insulin production

Weight Gain

Weight distribution:

- Fetus – 7 lbs
- Placenta – 1lb
- Amniotic fluid – 1.5 lbs
- Uterus – 2 lbs
- Blood volume – 1 lb
- Breasts – 1.5-3 lbs
- Fluid – 2 lbs
- Fats – 4-6 lbs
- Total – 20-25 lbs

SIGNS OF PREGNANCY

First trimester

Presumptive signs: (subjective)

- Amenorrhea, morning sickness, breast changes,

fatigue, urinary frequency, enlarging of uterus

Probable signs: (objective)

- Chadwick’s sign, Goodells, Hegars, (+) HCG

Positive sign: (diagnostic)

- Doppler (10-12 wks) – lagay ng jelly to hear the fetal HR

- Ultrasound result (gest. sac 4-5 wks)

Second trimester

Presumptive signs:

- Quickening (20 wks) 1st movement, skin pigmentation,

chloasma, linea nigra, striae gravidarum

Probable signs:

- Enlarged abdomen, Braxton Hick’s, Ballotement

(internal exam; passive fetal movement)

Positive sign:

- FHT, fetal movements, USD

PRENATAL CARE Viable age 28 weeks (PH)

● Data gathering
o Demographic data (name, age, sex, status, bday..)
OBSTETRICAL ASSESSMENT
o Obstetrical data (LMP, EDC, AOG, GPA, TPAL)
o Medical health history (UTI, cardiac prob, HPN..) OBSTETRICAL DATA
o OB history
● Physical assessment ● Age of gestation (AOG)
● Pelvic examination o McDonald’s method
● Leopold’s maneuver o By weeks
● Fetal heart tone monitoring o Bartholomew’s rule
● Laboratory examinations o Johnson’s rule
● Gravida Para Abortion (GPA)
● Term Preterm Abortion Living (TPAL)
● Expected Date of Confinement (EDC)
Antepartal visits schedule:
- Nagele’s rule
Every 4 wks = 1st 28 wks AOG ● Obstetrical history

Every 2 wks = until 36 wks AOG

Every week = after 36 wks AOG McDonald’s method

- Measure the distance abdominally from the top of the

symphysis pubis to the top of the uterine fundus
OBSTETRICAL HISTORY

Terminologies:

● Gestation – the number of weeks of pregnancy since

the 1st day of the LMP
● Abortion – termination of pregnancy before 28 weeks
gestation
● Term – the normal duration of pregnancy (38 to 42 wks
gestation)
● Antepartum – time between conception & the onset of
labor
● Intrapartum – time from the onset of true labor until
the birth of the infant and placenta
● Postpartum – time from the delivery of placenta &
membranes until the woman’s body returns to a non-
pregnant condition
● Preterm or premature labor – labor after 20 wks but
before completion of 37 wks
● Post term labor – labor after 42 weeks
● Gravida – any pregnancy, regardless of duration,
including present pregnancy
● Nulligravida – a woman who has never been pregnant
● Multigravida – more than 1 pregnancy
● Para – birth after 28 wks gestation regardless the infant
is born alive or dead
● Nullipara – a woman who has had no births @ > 20 wks
gestation
● Primipara – a woman with 1 birth @ > 20 wks gestation,
regardless born alive or dead
● Multipara – who has had 2 or more births @ > 20 wks
gestation
● Stillbirth – an infant born dead after 20 wks gestation
 2. Very low birth weight = less than 1500g
3. Extremely low birth weight = less than 1000g

Haase’s rule (estimation of fetal length)

1-9 (no of months of pregnancy)

1&2 – multiply by their own num

3&4 – to the power of 2

5-9mos – multiply to 5

GPA

Gravida – any pregnancy, regardless of duration, including

present pregnancy.

Para – number of birth after 28 wks. gestation regardless the

infant is born alive or dead. delivered babies only

Abortion – termination of pregnancy before 28 weeks gestation

Ex. G2P1A0

TPAL

- A system used to describe obstetrical history

Bartholomew’s Rule T – term infants born (38-42 weeks)
- Estimates AOG by the relative position of the uterus in P – preterm infants born (after 20 weeks but before the
the abdominal cavity completion of 38 weeks = 37 & 6 days)

A – abortion either spontaneous natural cause or therapeutic

fertilized ovum in the fallopian tube or ectopic pregnancy
(termination of pregnancy before 28 weeks)

L – living children (number of currently living children)

Johnson’s rule

- Is used to estimate the weight of the fetus in grams

- Formula: FH (cm) – n x k = fetal weight in grams
(n=12 engaged, 11 not engaged, k=155)

Birth weight classification

1. Low birth weight = less than 2500g

 ● Sudden gush of fluid from vagina – RBOW

PELVIC EXAMINATION

- Performed either finger (index & middle) or instrument

● Internal examination (IE)

● Vaginal speculum
● Transvaginal ultrasound (TVS)
● Papanicolaou (Pap smear)
● Transabdominal ultrasound

Internal Examination (IE)

- Void before IE
- Position: Lithotomy where in the foot is placed on the
stirrup and the area to be examined is exposed
- Uses K-Y Jelly (lubricant) placed on top of glove

Guidelines what to examine:

Dilatation of cervix (1-10cm)

- Fully dilated cervix = 10cm (term)

Estimated Date of Confinement/Delivery (other term)
Effacement (%)
Nagele’s rule
- thinning of the cervix; 100% effaced – term

Bag of water (IRL)

- Intact, Ruptured, Leaking

Presentation (C, B)

- Fetal presentation
- Cephalic or Breech

Station (0, -, +)

- Engaged (stationed 0)
- Beyond station 0, above (-) -1, -2
- Below station 0, (+) +1, +2 about to give birth
PHYSICAL ASSESSMENT

Contraindication for walking upon admission: (wheelchair)

endorsed to ER

- RBOW ruptured bag of water

- Severe vaginal bleeding
- High BP
- Preterm labor
- Severely in pain
- With bearing down sensation
- With cardiac problems
- Fully dilated cervix
- Baby is engaged

Danger signs in pregnancy

● Nausea & vomiting if beyond 1st trimester –

hyperemesis gravidarum
● Vaginal bleeding – placenta previa (nauna si placenta
kesa kay fetus)
● Edema – PIH pregnancy induced hypertension
● Pallor – anemia; hypoxia
● Severe continuous headache – PIH
● Abdominal pain – abruptio placenta
● Blurring of vision – hypoxia
● Absence of FHT – FDIU fetal death in utero
● Chills and fever – infection
Vaginal Speculum
 - “vaginal spec”
- Uses an instrument “speculum”
- Done if ruptured na ang bag of water
- RBOW > mgstay na ang amniotic fluid in the vaginal area
- Doctor will check amniotic fluid’s color, consistency
- Lithotomy position

LEOPOLD’S MANEUVERS

With warm hands

1. Fundal grip – presentation

- Hand in fundus area
- Cephalic if buttocks/breech if ulo
2. Umbilical grip – position
- Located in the middle (umbilical area)
Transvaginal Ultrasound (TVS) - Vertical, horizontal
3. Pawlick’s grip – fetal descent/engagement
- TVS is recommended during early weeks of gestation (3 - Paw (kamay)
months) - If movable, not engaged
- Probe pinapasok sa vagina - If breech ang presentation and term na, possible
- Bladder empty or partly filled indication for CS
- Lie down on a table with knees bent - Fetal descent (+ or - position)
- Feet held in stirrups 4. Pelvic grip – attitude
- Dorsal recumbent - Lower portion of abdomen (pelvic region)

(Empty bladder, supine, knees bent)

Pap Smear

- Used to check for cervical cancer, malignancy in cervix

- In order to get a sample from cervical region, dilate the
cervix using the speculum

Transabdominal Ultrasound

- Probe/transducer pinapasok sa above the abdomen

- Full bladder 2 hours before the test
- Presence of fluid inside would facilitate the visualization
of the different organs
PREGNANCY

Stages of Pregnancy

5. Fertilization – the process in which a sperm penetrates outer

layer of the ovum
6. Implantation – when the blastocyst attaches the
endometrium (7-9 days after fertilization)
7. Pre-placental stage – when the endometrium becomes
highly vascular (week 2)
8. Placental and fetal development
Placenta- organ of exchange

Itsura if it is embedded in the endometrial lining (start of

pregnancy)

Ovum has protective layers ^

Amnion-
holds amniotic fluid

Chorion-outer covering of amnion/amniotic fluid

IMPLANTATION

▪ 50% of zygote never achieved implantation

IMPLANTATION PROCESS ▪ Small amount of vaginal spotting is occasionally present –
implantation bleeding-pgattach sa blastocyst sa
endometrial lining magcause ug bleeding (spotting)
▪ Endometrium turned to decidua:
o Decidua basalis
o Decidua capsularis
o Decidua parietalis/vera
▪ It has 3 processes:
Apposition → adhesion → invasion

Apposition- blastocyst magtouch sa endometrial lining

Adhesion- attachment

Invasion- establishment

Decidua – endometrial lining that forms the maternal side of the

placenta. AKA gravid endometrium (maternal side of placenta)

Placenta has 2 sides: fetal side-attaches to fetal circulation & PLACENTA

maternal side-attached to maternal circulation
6. Respiratory system
Parts of decidua: 7. Renal system
Decidua basalis – it is the part of decidua between blastocyst and 8. Gastrointestinal system
myometrium. It forms the fetal part of placenta. 9. Endocrine system:
Human chorionic gonadotropine (placental hormone)
Decidua capsularis – it covers the blastocyst except embryonic Human placental lactogen
pole and separates it from uterine cavity. Estrogen } uterus (growth), breast (enlargement)
Progesterone } uterus, breast
Decidua parietalis – it is the rest of endometrium that lines the 10. Protective functions
rest of uterine cavity Placenta-organ for respiration

Blastocyst Implantation FETAL DEVELOPMENT

Apposition – 1st connection between the blastocyst and the
endometrium

Adhesion – attachment/adherence to the endometrium

Invasion – establishment of the blastocyst in the endometrium

Umbilical cord

- 21 inches long
- 2 arteries and 1 vein (AVA)
o Carries oxygenated blood – vein
o Deoxygenated – artery
- Wharthon’s jelly
- Transport oxygen, nutrients, minerals, and waste
products
End part sa umbilical connected to placenta

Amniotic fluid

- 500-1000ml inside the amniotic sac (BOW; bag of

water) ruptures if term na
- Produced by the amniotic membrane
- Shields fetus from pressure or blow
- Protects fetus from sudden change in temperature
- Aids in muscular development
- Aids in descent (pagbaba sa baby)
- Protects umbilical cord from pressure
o Cushions baby inside the womb (amniotic
fluid)
o Amniotic fluid protects the umbilical cord by
providing cushion thus reducing risk of
compression
- Protects fetus from infection
Not earlier than 5 mos – to know the sex

FETAL CIRCULATION

Shunt (hole) fetal has 3 shunts; 1st is ang ductus venosus, 2nd is
foramen ovale; 3rd is ductus arteriosus (A shunt that
automatically closes when the umbilical cord is cut.); This hole
normally closes at birth stimulated by a decreasing amount of ● Physiologic anemia – baba ang oxygen sa blood d/t
prostaglandin. fetal demand
● Increased WBC (leukocytes); leukocytosis – normal
Foramen ovale - A fetal hole that allows the blood to pass
● CR & PR increased to 10-15 beats/min @ term
through between the two atria.
39wks/9mos
● Supine hypotension – dec. BP d/t sudden change of
position
VIDEO: Understanding Fetal Circulation ● Varicosities – bc ang pressure papunta sa lower
extremities + fetal weight

FOCUS OF FETAL DEVELOPMENT

First trimester 1-3 mos

- Organogenesis; mostly major organs

Second trimester 4-6 mos
Integumentary System
- Period of continued growth and development
Third trimester 7-9 mos (Melanocyte) – ginasecrete sa placental
hormone (HPL human placental
- Period of most rapid growth and development lactogen)

● Increased pigmentation
NORMAL ADAPTATION IN PREGNANCY ● Chloasma/melasma “mask of
Reproductive System pregnancy”
● Striae gravidarum – stria means
Uterus stretchmark
● Linea nigra – dark
- Uterine growth and enlargement
purple/brownish vertical line that
o Length – 6.5 cms to 32 cms
appears on the abdomen
o Width – 4 cms to 24 cms
● Increased perspiration
o Depth – 2.5 cms to 22 cms
o Weight – 50 gms to 1000 gms
o Volume – 1-2 ml to 1000 ml Gastrointestinal System
- Braxton Hicks contraction “practiced contraction”,
● Morning sickness (N/V) – inc. progesterone
“irregular contraction”; myometrium nagapractice ug
● Heartburn
contract
● Constipation
- Becomes globular (4th month)
Respiratory System
- Goodell’s sign (4th week) – sign of pregnancy, softening
of cervix ● Increased RR
- Hegar’s sign (8th week) – softening of lower uterine ● Dyspnea – respiratory adaptation in pregnancy when
segment the gravid uterus put pressure on the vena cava; while
- Chadwick’s sign (8th to 10th week) – discoloration of lying so dapat magtakilid sa left side
vagina; highly vascularized; dark blue to purplish red ● Nasal stuffiness – inc. estrogen > produces mucus
Ovaries – no ovulation ● Epistaxis – inc. both hormone for pregnancy
Vagina – moderately acidic (pH 3.8 to 4.5) Urinary System

Breasts – enlarged ● Urinary frequency

● Increased GFR 50% (glomerular filtration rate)
Musculoskeletal System Endocrine System

● Waddling gait – because shift of gravity is in the ● Increased metabolism of CHON and CHO
abdomen ● Increased insulin production
● Lordosis – same w/ waddling; + hormone Weight Gain
progesterone, pelvic relaxation; Lumbar spinal
Weight distribution:
curve as the center of gravity gradually change d/t
gravid uterus. - Fetus – 7 lbs
Circulatory System - Placenta – 1lb
- Amniotic fluid – 1.5 lbs
● Increased blood volume 40% to 50%
- Uterus – 2 lbs
● Total RBC volume 30% (18% no iron sup)
- Blood volume – 1 lb
- Breasts – 1.5-3 lbs
 - Fluid – 2 lbs
- Fats – 4-6 lbs
- Total – 20-25 lbs

SIGNS OF PREGNANCY

First trimester

Presumptive signs: (subjective)

- Amenorrhea, morning sickness, breast changes,

fatigue, urinary frequency, enlarging of uterus
Probable signs: (objective)

- Chadwick’s sign, Goodells, Hegars, (+) HCG

Positive sign: (diagnostic)

- Doppler (10-12 wks) – lagay ng jelly to hear the fetal HR

- Ultrasound result (gest. sac 4-5 wks)
Second trimester

Presumptive signs:

- Quickening (20 wks) 1st movement, skin pigmentation,

chloasma, linea nigra, striae gravidarum
Probable signs:

- Enlarged abdomen, Braxton Hick’s, Ballotement

(internal exam; passive fetal movement)
Positive sign:

- FHT, fetal movements, USD

PRENATAL CARE Viable age 28 weeks (PH)

● Data gathering
o Demographic data (name, age, sex, status, bday..)
OBSTETRICAL ASSESSMENT
o Obstetrical data (LMP, EDC, AOG, GPA, TPAL)
o Medical health history (UTI, cardiac prob, HPN..) OBSTETRICAL DATA
o OB history
● Physical assessment ● Age of gestation (AOG)
● Pelvic examination o McDonald’s method
● Leopold’s maneuver o By weeks
● Fetal heart tone monitoring o Bartholomew’s rule
● Laboratory examinations o Johnson’s rule
● Gravida Para Abortion (GPA)
● Term Preterm Abortion Living (TPAL)
Antepartal visits schedule: ● Expected Date of Confinement (EDC)
- Nagele’s rule
Every 4 wks = 1st 28 wks AOG
● Obstetrical history
Every 2 wks = until 36 wks AOG

Every week = after 36 wks AOG McDonald’s method

- Measure the distance abdominally from the top of the

symphysis pubis to the top of the uterine fundus
OBSTETRICAL HISTORY

Terminologies:

● Gestation – the number of weeks of pregnancy since

the 1st day of the LMP
● Abortion – termination of pregnancy before 28 weeks
gestation
● Term – the normal duration of pregnancy (38 to 42 wks
gestation)
● Antepartum – time between conception & the onset of
labor
● Intrapartum – time from the onset of true labor until
the birth of the infant and placenta
● Postpartum – time from the delivery of placenta &
membranes until the woman’s body returns to a non-
pregnant condition
● Preterm or premature labor – labor after 20 wks but
before completion of 37 wks
● Post term labor – labor after 42 weeks
● Gravida – any pregnancy, regardless of duration,
including present pregnancy
● Nulligravida – a woman who has never been pregnant
● Multigravida – more than 1 pregnancy
● Para – birth after 28 wks gestation regardless the infant
is born alive or dead
● Nullipara – a woman who has had no births @ > 20 wks
gestation
● Primipara – a woman with 1 birth @ > 20 wks gestation,
regardless born alive or dead
● Multipara – who has had 2 or more births @ > 20 wks
gestation
● Stillbirth – an infant born dead after 20 wks gestation
 Gravida – any pregnancy, regardless of duration, including
present pregnancy.

Para – number of birth after 28 wks. gestation regardless the

infant is born alive or dead. delivered babies only

Abortion – termination of pregnancy before 28 weeks gestation

Ex. G2P1A0

TPAL

- A system used to describe obstetrical history

T – term infants born (38-42 weeks)
Bartholomew’s Rule
P – preterm infants born (after 20 weeks but before the
- Estimates AOG by the relative position of the uterus in completion of 38 weeks = 37 & 6 days)
the abdominal cavity
A – abortion either spontaneous natural cause or therapeutic
fertilized ovum in the fallopian tube or ectopic pregnancy
(termination of pregnancy before 28 weeks)

L – living children (number of currently living children)

Johnson’s rule

- Is used to estimate the weight of the fetus in grams

- Formula: FH (cm) – n x k = fetal weight in grams
(n=12 engaged, 11 not engaged, k=155)

Birth weight classification

4. Low birth weight = less than 2500g

5. Very low birth weight = less than 1500g
6. Extremely low birth weight = less than 1000g
Haase’s rule (estimation of fetal length)

1-9 (no of months of pregnancy)

1&2 – multiply by their own num

3&4 – to the power of 2

5-9mos – multiply to 5

GPA
Estimated Date of Confinement/Delivery (other term) Bag of water (IRL)

Nagele’s rule - Intact, Ruptured, Leaking

Presentation (C, B)

- Fetal presentation
- Cephalic or Breech
Station (0, -, +)

- Engaged (stationed 0)
- Beyond station 0, above (-) -1, -2
- Below station 0, (+) +1, +2 about to give birth

PHYSICAL ASSESSMENT

Contraindication for walking upon admission: (wheelchair)

endorsed to ER

- RBOW ruptured bag of water

- Severe vaginal bleeding
- High BP
- Preterm labor
- Severely in pain
- With bearing down sensation
- With cardiac problems
- Fully dilated cervix
- Baby is engaged
Danger signs in pregnancy

● Nausea & vomiting if beyond 1st trimester –

hyperemesis gravidarum
● Vaginal bleeding – placenta previa (nauna si placenta
kesa kay fetus)
● Edema – PIH pregnancy induced hypertension
● Pallor – anemia; hypoxia Vaginal Speculum
● Severe continuous headache – PIH
● Abdominal pain – abruptio placenta - “vaginal spec”
● Blurring of vision – hypoxia - Uses an instrument “speculum”
● Absence of FHT – FDIU fetal death in utero - Done if ruptured na ang bag of water
● Chills and fever – infection - RBOW > mgstay na ang amniotic fluid in the vaginal area
● Sudden gush of fluid from vagina – RBOW - Doctor will check amniotic fluid’s color, consistency
- Lithotomy position

PELVIC EXAMINATION

- Performed either finger (index & middle) or instrument

● Internal examination (IE)

● Vaginal speculum
● Transvaginal ultrasound (TVS)
● Papanicolaou (Pap smear)
● Transabdominal ultrasound

Internal Examination (IE)

- Void before IE
- Position: Lithotomy where in the foot is placed on the Transvaginal Ultrasound (TVS)
stirrup and the area to be examined is exposed
- Uses K-Y Jelly (lubricant) placed on top of glove - TVS is recommended during early weeks of gestation (3
Guidelines what to examine: months)
- Probe pinapasok sa vagina
Dilatation of cervix (1-10cm) - Bladder empty or partly filled
- Fully dilated cervix = 10cm (term) - Lie down on a table with knees bent
Effacement (%) - Feet held in stirrups
- Dorsal recumbent
- thinning of the cervix; 100% effaced – term
Pap Smear

- Used to check for cervical cancer, malignancy in cervix

- In order to get a sample from cervical region, dilate the
cervix using the speculum
DISCOMFORTS IN PREGNANCY

1st trimester

1. Nausea and vomiting – triggered by hormone progesterone

a. Eat dry crackers

b. small frequent feeding
c. low fat meals
d. avoid fried foods
e. avoid anti emetics because client is pregnant which may
cause teratogenic effect; usually prescribed for
hyperemesis gravidarum
Transabdominal Ultrasound 2. Syncope

- Probe/transducer pinapasok sa above the abdomen a. Sit with feet elevated

- Full bladder 2 hours before the test b. change position slowly
- Presence of fluid inside would facilitate the visualization c. left lateral position
of the different organs First-Third Trimesters

3. Breast tenderness
a. use supportive bra with elastic strap
b. avoid soap in the nipples and areola; plain water only
4. increased vaginal discharges (Leukorrhea)
a. Proper cleaning and hygiene (prone to infection)
b. wear cotton underwear
c. avoid douching (introduce solution to vaginal area ex.
soap sud soln)
d. consult physician if infection is suspected
5. Nasal stuffiness and epistaxis
a. use humidifier
b. avoid nasal sprays and anti histamines
LEOPOLD’S MANEUVERS
6. fatigue
With warm hands a. frequent rest periods
b. regular exercise
5. Fundal grip – presentation c. avoid stimulants (ex. energy drink, coffee)
- Hand in fundus area 7. urinary frequency and urgency
- Cephalic if buttocks/breech if ulo a. increase oral fluid intake
6. Umbilical grip – position b. limit fluid intake in the evening can disturb sleep if sge
- Located in the middle (umbilical area) ug void
- Vertical, horizontal c. void at regular intervals
7. Pawlick’s grip – fetal descent/engagement d. sleep on the side at night
- Paw (kamay) e. wear perineal pads if necessary
- If movable, not engaged Second and Third Trimester
- If breech ang presentation and term na, possible
indication for CS 8. Heartburn
- Fetal descent (+ or - position) a. Small frequent feeding
8. Pelvic grip – attitude b. Sit upright for 30 minutes after meal
- Lower portion of abdomen (pelvic region) c. Drink milk between meals help digest
(Empty bladder, supine, knees bent) d. Avoid fatty and spicy foods trigger acid reflux
e. Avoid antacids unless prescribed by physician (antacids-
lessen the acid in stomach; neutralize acidity)
9. Ankle edema
a. Elevate legs at least twice a day
b. Wear support stockings
 c. Avoid one position for long periods of time promote
good circulation
d. Avoid diuretics (drugs pamparelease ug fluids sa body)
10. Varicose veins
a. Wear support stockings
b. Elevate feet when sitting
c. Lying with feet and hips elevated
d. Move out while standing
e. Avoid pressure on lower legs
f. Avoid leg crossing destruct tissue perfusion
g. Avoid standing or sitting in long period of time
h. Avoid constricting clothing destruct blood flow
11. Headaches (inc. blood flow up to 50%, inc. BP)
a. Change position slowly
b. Apply cool cloth at forehead para magconstrict
c. Eat small snack
d. Use pain relievers when prescribed
12. Hemorrhoids (pressure of gravid uterus-anal dilatation
which causes hemorrhoids)
a. Warm sitz bath
b. High fiber diet
c. Increase oral fluid intake
d. Exercise
e. Apply ointment/suppositories as prescribed
13. Constipation
a. High fiber diet
b. Increase oral fluid intake
c. Exercise
d. Avoid laxatives
14. Shortness of breath
a. Rest periods
b. Elevate head while sleeping
c. Avoid overexertion
15. Backache
a. Encourage rest
b. Use body mechanics
c. Wear low-heeled shoes
d. Exercises
e. Sleep on firm mattress
16. Leg cramps
a. Exercise
b. Elevate and dorsiflex the feet while resting
c. Increase calcium intake

LABOR “nagbati”
Recommended exercises
- a series of events when the product of conception is
1. Tailor sitting
expelled out from the woman's body
2. Squatting
- regular uterine contractions cause progressive
3. pelvic floor contraction (Kegel’s exercise)
dilatation of the cervix and sufficient muscular force to
4. abdominal muscle contraction
allow the baby to be pushed outside
5. pelvic rocking
- usually begins when the fetus is sufficiently mature
- ovulation to implantation
Theories of Labor

1. Uterine stretch theory - a hollow organ when

stretched to capacity contract and empty
2. Oxytocin theory - production
of oxytocin from posterior pituitary gland---contraction
of the uterus
o If unable to contract, given synthetic oxytocin
via IM
3. Progesterone deprivation theory
- progesterone inhibit uterine motility. A decrease in
progesterone---uterine contraction
4. Prostaglandin theory - increase prostaglandin
synthesis---uterine contraction
 5.Theory of aging placenta - decrease in blood supply to
the placenta---uterine contraction
Components of Labor (4 Ps)

1. Passageway
● mother's pelvis, cervix, and vagina
2. Passenger
● fetus and placenta
3. Power
● uterine contraction, uterine muscles, and mother's
ability to push
4. Psyche
● mother's psychological condition
The shape of your pelvic cradle is an important component in
1. PASSAGEWAY determining the outcome of your birth experience. Here are the
Pelvis four basic types.

There are 4 basic types of female pelvises and these are classified
according to the shape of the brim or inlet.

● Gyne-round brim
Types of pelvis:

1. Gynecoid – round brim (the rim of the upper opening of

the pelvis); least amount of trauma, NSVD
2. Android – heart shaped brim, tall women with narrow
hips, may experience longer labors, need to squat and
move around
3. Anthropoid – oval brim, slightly narrow pelvic cavity,
outlet is large, other diameters may be reduced, baby
engages in the pelvis in an anterior position, labor
would be expected to be straightforward
4. Platypelloid – kidney-shaped brim and the pelvic cavity
is usually shallow and may be narrow in the antero-
posterior (front to back) diameter. The outlet is usually
roomy. During labor, the baby may have difficulty
entering the pelvis, but once in, there should be no
further difficulty.

Terminologies:

Lightening – nestling of the fetal presenting part into the pelvis;

dropping

Engagement – settling of the fetal presenting part into the ischial

spine

Station – relationship of the fetal presenting part to the level of

the ischial spine

o Known during IE
o Floating (-)
o Crowning (+)
 The Vagina

Vaginal canal

● has rugae and capable of stretching but can be

lacerated:
a. 1st degree - skin
b. 2nd degree - skin and muscles
c. 3rd degree - external sphincter of rectum
d. 4th degree - mucus membrane of rectum
Perineum

Site of episiotomy:

a. Median episiotomy
b. right mediolateral
c. left mediolateral

Cervix

Laceration-uneven cut

Midline 6oclock

Right 7

Left 5
Dilatation

● opening of the cervical os

● from 1 centimeter to 10 centimeters (fully dilated 2. PASSENGER
cervix) Fetus
● due to uterine contraction and amniotic fluid
(RBOW)
Effacement

● thinning of the cervical canal

● Expressed in % (100% is a fully dilated cervix)
Fetal attitude

● the degree of flexion that the fetus assume

● well-flexed attitude: vertex presentation, smallest
diameter presents 9.5cm
● no flexion or extension: military presentation,
occipitofrontal diameter presents 11cm
● partial extension: brow presentation, largest diameter
(occipitomental) presents 13.5 cm
● full extension: face presentation, submentobregmatic,
diameter presents 9.5 cm

GOOD ATTITUDE

● Suboccipitobregmatic
● Vertex presentation

MILITARY ATTITUDE

● Occipitofrontal

POOR ATTITUDE

● Occipitomentum
● brow presentation difficult labor because wide ang
diameter

POOR ATTITUDE
 ● full extension
● Submentobregmatic

TWIN PREGNANCY
FETAL LIE

● relationship of the long axis of the fetus the long

axis of the mother

PRESENTATION

● body parts that will first contact the cervix

1. vertical cephalic presentation
2. vertical breech presentation
a. Frank breech
b. footling breech (single/double)
c. Complete breech
3. transverse presentation
POSITION

● position of the fetal presenting part to the specific

quadrant of mother's pelvis

FETAL LANDMARKS

Occiput - vertex/ cephalic presentation (O)

Mentum - chin/ face presentation (M)

Sacrum - in breech presentation (Sa)

Acromion - scapula/ shoulder presentation (A)

Fetal Position - represented by three letter abbreviation

1st letter – L (left), R (right), D (direct)

2nd letter – fetal landmarks

3rd letter – A (anterior), P (posterior), T (transverse)

Examples:
 NST/Non-Stress Test

▪ Determine the response of the FHR to fetal movements

▪ Reactive (Normal)
Placenta o = favorable result
o = FHT accelerate @15 bpm for 15 secs with FM
1. Placental separation o = indicates adequate oxygenation
▪ Non-reactive
a. Calkins sign/globular shaped (bc magdetach ang
o = unfavorable result
placenta) of the uterus; rising of the fundus
o = poor FHR response to activity
b. sudden gush of blood
▪ Done after 28 wks. (viable)
c. lengthening of the cord (Brandt-Andrews
CST/Contraction Stress Test
maneuver)
2. Placental delivery ▪ Determine how fetus responds to stress of contractions
▪ Negative (Normal)
1. Duncan delivery – Dirty
o 3 good contractions lasting 40 seconds in 10-minute
2. Schultze delivery – Shiny
interval with no late decelerations (fhr)
o Matolerate ng baby ang uterine contraction
3. POWER ▪ Positive (undesirable result)
o Persistent late decelerations (fhr) with more than 50%
Uterine Contraction of the contractions
o Di matolerate ang uterine contraction, so how much
more if during term na
▪ Done after 32 wks
▪ Serves as prevention, incase the baby cannot tolerate the
UTC or positive sa CST, so may possibility ma CS due to
decelerations or fetal hypoxia
120-160 normal fetal heart rate

Possible ma CS d/t decelerations (if positive sa CST)

Acme (peak)

Resting period magkuha ng BP

Maximum of 60-70s per contraction; normally 30-40s

DIFFERENCE BETWEEN FALSE AND TRUE LABOR

Reactive NST. Accelerations of 15 bpm lasting 15 seconds with
FALSE LABOR TRUE LABOR each fetal movement (FM). Top of strip shows FHR; bottom of
irregular interval regular interval of strip shows uterine activity tracing. Note that FHR increases
contractions contraction (above the baseline) at least 15 beats and remains at that rate
pain in the abdomen starts at the back to for at least 15 seconds before returning to the former baseline.
abdomen
intensity remains the contractions are per column = 1 minute
same intensified
Intervals remain long intervals gradually
shorten
walking gives relief intensified by walking
no bloody show with bloody show
no cervical changes cervical dilatation and
effacement
contractions stops with UTC does not stop
sedation with sedation
Nonreactive NST. There are no accelerations of FHR with FM.
Non-Stress Test & Contraction Stress Test Baseline FHR is 130 bpm. The tracing of uterine activity is on the
bottom of the strip.
 mucus plug → bloody show

Mucus plug – para di maka ascend ang bacteria towards the

Negative CST result (normal result). uterus, if labor ma expel na sya mixed with blood which is the
bloody show
Bottom part UTC

Deceleration – baba sa baseline (120) within normal limit

STAGES OF LABOR

1. First stage – Dilatation stage (true labor-10cm)

● Latent phase
● Active phase
● Transitional phase
2. Second stage – Fetal expulsion stage
3. Third stage – Placental stage
Positive CST (undesirable result). Repetitive late decelerations 4. Fourth stage – Recovery stage post partum
occur with each contraction. Note that there are no
accelerations of FHR with three fetal movements (FM). The
baseline FHR is 120 bpm. Uterine contractions (bottom half of First stage: DILATATION STAGE
strip) occurred four times in 12 minutes. o Starts on the onset of true labor up to full dilatation of
May difficulty ang baby, hypoxic or lack of oxygen may be, the cervix (10cm).
because nag lessen iya fhr o Phases of labor:
1. Latent phase
Types of Decelerations: 2. Active phase
3. Transitional phase
1. Early decel – occur before UTC (head compression) not
o Nursing responsibilities
alarming bc pwde mag somersault ang bata
2. Late decel – occur after UTC (utero-placental insufficiency)
alarming
Insufficient ang exchange sa oxygen, blood, nutrients from the
placenta
3. Variable decel – occur before or after UTC (umbilical cord
compression) alarming
Maimpede ang distribution of oxygen going to the fetus
Management of late and variable decel:

● Left lateral position – promote good tissue

perfusion
● O2 (for the baby bc of dec. FHR) depende sa
doctor’s order pero usually 3-4 L/ minute via nasal Latent naa pa sa labor room
canula
Active/transitional sa DR
● Fast drip 200cc IVF
● If not relieved: CS NPO – if not, unhygienic sya
Amazing normal labour & vaginal birth (video)
Arm artificial rupture membrane “amniotomy”
https://www.youtube.com/watch?v=jFdXx35VR-o
NURSING CARE DURING THE 1ST STAGE

1. Admission care
PRELIMINARY SIGNS OF LABOR 2. Data gathering – ob data
3. Assisting IE - debps
1. Lightening – mag descend na ang presenting part; magka
4. Leopold’s maneuver – para makabalo asa ibutang ang
light feeling si mother sa chest or in the vena cava
transducer
2. Loss of weight – kay ma discharge man ang water blood
5. Fetal Heart Tone (FHT) Monitoring (EFM)
3. Increase in activity level – kay mag sge na contract
6. Uterine Contraction Monitoring (EFM)
4. Braxton Hick’s contraction – irregular contractions
7. Promote change in position
5. Ripening of the cervix - magsoften for dilatation and
8. Empty the bladder - sometimes, di nagacontract kay full ang
effacement
bladder
6. Rupture of the membranes
9. Hygiene shaving (half moon)
7. Bloody show – na detach na mna nag placenta from the
10. Enema administration if 4cms na
uterine wall mag cause ug bloody discharges
11. Perineal preparation
12. Analgesic administration as ordered
13. Assist in the administration of regional anesthesia - 4cms
above, pwde na mag anesthesia
14. Start IVF as ordered
15. Assist in amniotomy – depends on the dilatation of the
cervix; amniotomy if transitional phase na
16. Watch out for SUBIRBA (imminent signs of delivery)
o Severe UTC
o Urge to defecate
o Bearing down sensation
o Increased bloody show
o RBOW
o Bulging of the perineum (nagdescent na ang fetal head)
o Anal dilatation DESCENT – head going to pelvic inlet d/t 4 forces (AF, UTC,
17. Emotional support pressure on fundus, fetal body extends)
Ultrasound sa fetal back

LEOPOLD’S MANEUVERS – systematic way to evaluate the

maternal abdomen

● With warm hands

● Empty bladder, supine, knees bent
1. Fundal grip – presentation
2. Umbilical – position FLEXION – chin flexes down to chest d/t resistance from soft ts.
3. Pawlick’s – fetal descent/engagement of pelvis
4. Pelvic – attitude
Good flexion, no extension sa neck, good attitude – most likely
maka pass through sa paasageway
Second stage: EXPULSION

o Begins from full dilatation of the cervix up to the

delivery of the fetus
o Mechanism of labor
o Perineal and vaginal laceration
o Nursing responsibilities

INTERNAL ROTATION – fetal head must rotate to fit the diameter

of the pelvic cavity (AP diameter)

9.5-11.5cm or lesser

MECHANISM OF LABOR

ENGAGEMENT

Engagement occurs when the largest diameter of the fetal head EXTENSION – brow and face out from vagina
fits into the largest diameter of the maternal pelvis.
Pwde na magsuction sa mouth and nose
As the fetal head engages, the head moves towards the pelvic
brim in either the left or right occipito-transverse position.

This allows the widest part of the fetal head to fit through the
widest part of the pelvic inlet.

External Rotation – shoulder rotate = head turns farther

Fetal head is facing sideways (restitution)

Facilitate the mechanism in order to assist the delivery of the
newborn

First, move the head down ward to deliver the first shoulder then
move upward to deliver the second shoulder

+3 or +5 ang station

Vernix caseosa (secretions)

Blanket top of baby

Wait sa pulsation to stop before clamp to prevent IVH

Push back ang ulo if nastuck ang shoulder; possible ma-CS; intraventricular hemorrhage/anemia
however, needs an expert to do that NURSING CARE ON 2ND STAGE

2nd stage full dilatation up to expulsion

1. Lithotomy position
2. Perineal flushing; final prep
3. Drape aseptically; Double it up w/ sterile drape
4. Teach breathing technique during uterine relaxation
5. Teach pushing technique during uterine contraction
6. Assist episiotomy; get the scalpel and mayo scissor together
with OS; Before that, serve lidocaine
7. Do ritgen’s maneuver- the doctor would the incision so offer
the OS para ipress sa may incision site in order not to
lacerate
8. Ease head out, wipe face
9. Assist for external rotation
10. Pull head downward and upward to deliver the shoulders;
pull head up facilitate 2nd shoulder
11. Deliver the body
12. Take note of time of delivery and sex of the baby
13. Place baby on mother’s abdomen; Una ang skin to skin bago
icut cord
14. Dry thoroughly the baby
15. Palpate for the pulsation of the cord; so that all oxygen will
go to the baby prevent IVH and anemia
16. Clamp the cord 1 inch from the base once pulsation stops
17. Milk the cord from the cord clamp up to 2 inches towards
the mother; Milk para pag clamp dili muspurt ang blood
18. Clamp 1 inch apart from initial clamping using forceps

Third stage: PLACENTAL STAGE

1. Placental Separation
a. Calkin's sign (2 signs u can notice on the fundus)
o (rising of the fundus, globular shape of the
abdomen kay magseparate na ang placenta,
magdescend na sya)
b. Sudden gush of blood kay ngseparate na placenta sa
uterine wall; sa placenta nay blood vessels → magcause
ug bloody discharges
Usually nasa fundal part/upper part ang implantation ng
c. Lengthening of the cord so u have to do a maneuver
placenta
during this sign; coil the cord to facilitate the delivery of
placenta (Brandt Andrew’s maneuver) complications - placenta previa wherein implantation happens sa
2. Placental delivery (2 presenting part) lower part; sometimes, it covers the full opening of cervix termed
a. Schultze delivery (fetal side) as complete placenta previa; partially covers –partial placenta
o shiny presenting part; part na naay umbilical cord previa; near margin of cervix – marginal placenta previa
b. Duncan Delivery (maternal side)
o walay umbilical cord; Dirty NURSING CARE ON 3RD STAGE

1. Perform Crede's maneuver: to facilitate the delivery of

placenta/assist episiorraphy (apply 2nd towel sterile one; 1st
one is below buttocks; 2nd sa hypogastric region)
o Apply pressure on hypogastric area
o Gentle traction of the cord
2. Do Brandt Andrew's Manuever
3. Gently pull the placenta downward; gently, do not force
otherwise, it can cause uterine inversion-mavacuum ug apil
ang uterus so ang inner part uterus kay mabaliktad; pwde
din maputol ang cord if iforce
4. Take note for the time of placental delivery
o Usually placenta will be out 5 mins after delivery; if
maabot 30 mins longer (dugay na); pwde maghatag
oxytocin med
5. Check for type of placental delivery: (Duncan or Schultz)
tanawon unsay nauna na part nigawas
6. Take BP
o kung ikaw ang assist (unsterile) – ikaw mukuha sa BP sa
mother kay naa may tambal like methergine (if given
after placenta out) makacause increased BP
o there are medications like carboprost (ginahatag sa
SPMC) para di maghypertensive or PIH ang patient
o tell doctor what is the BP; then they will give an IM
Can feel the warmth paglabas ng placenta
injection to trigger uterine contraction para dili mag
atony ang patient
7. Check for completeness of cotyledons; if may hollow
portions → naa pay retained placental fragments; doctor
would scrape right away (placental curette) otherwise, it will
cause bleeding
 o Suction (rubber bulb/machine) prevent aspiration kay
nay secretions sa mouth; sa unang yakap, wala na
ginapromote ang suctioning unless wala naghilak
paggawas and nagbula2 ang secretions sa mouth and
nose; as much as possible, wala na ginaperform if
unnecessary (ex. If baby is crying paggawas, sign na
walay nagblock sa airway)
o stimulate to cry by massaging slightly sa fetal back
o oxygen administration if naay difficulty of breathing
mostly by nasal cannula
o hook to respiratory machine if need i-resuscitate ang
baby (eg. ventilator)
8. Promote uterine contraction:
2. Temperature (prevent hypothermia)
o massage the hypogastric area
o dry the baby
o Apply ice pack on the hypogastric area; nagastock ug
o wrap with towel
ice sa ref sa DR intended for uterine atony cases
o goose neck lamp/droplight chrisel man crib? (murag
o Administer medication: Oxytocin/Maleate-methergine
radiant warmer) wherein nay light to provide warmth
o Empty the bladder uterine atony is caused by full
after skin to skin contact
bladder; perform straight catheterization
o avoid unnecessary exposure
9. Inspect perineum for lacerations lalo na if may episiotomy
o place inside incubator (preterm)/warmer
baka naglacerate kasi may incision
3. Proper identification
10. Assist in episiorrhapy (if episiotomy)/repair of lacerations (if
o name bond (pink-F or blue-M)
laceration)
o footprints (done by staff) wala na karun
11. Do perineal care
4. Care of the cord
o perineal flushing, cotton balls soaked w/ betadine
o milking the cord; sa unang yakap di na mag milk; wait
disinfect episiotomy site
ug pulsation to stop; didto na magmilk after pagapply
12. Apply contoured brief/adult diaper
sa 2nd clamp para di magspurt ang blood
13. Make patient comfortable
o cord dress aseptically; wala na karun
o straighten legs from lithotomy position sabay dapat
pagbaba para d mastrain ang perineal muscle (supine
position)
o change gowns
14. Monitor vital signs (ang assist) every 5 minutes

Fourth stage: RECOVERY PERIOD 2cms from base ang 1st clamp
● From the delivery of the placenta up to 2 hours post-partum 5. Care of the eyes
● Most critical period of the mother; pwde magbleed if o Terramycin ointment
unattended/lead to septic shock o Crede's prophylaxis (prevents ophthalmia neonatorum
● Continue skin to skin contact for at least 90 minutes; help in caused by neisseria gonorrhoeae)
uterine contractions prevent uterine atony; suckle (baby) 6. Vitamin K injection (IM; if nakaaspirate ug blood, change
help oxytocin release → trigger uterine contraction → needle, tanan)
prevent uterine atony 7. Newborn assessment
NURSING CARE ON 4TH STAGE o APGAR scoring- done after 1 and 5mins of life
1. Assess fundus magassess ng location, use side sa hand or 0 1 2
other books say: fingerpads of fingertips Skin color Blue/pale Acrocyan All pink
2. Check for bleeding (Appearance) osis
o Before idischarge sa DR, dapat done na ang postpartum Heart rate Absent <100 >100
assessment bc there is a tendency na magbleed or kung (Pulse)
naka epidural si mother ginadala sa PACU Post Reflexes No Grimace Cry
Anesthesia Care Unit sa OR sa 3rd floor sa SPH (Grimace) response
3. Check the bladder cause uterine atony if full
4. Check the perineum basig nay part wa narepair that can Muscle tone Absent/ Some Active
cause bleeding (Activity) limp flexion
5. Take vital signs every 5 minutes for 15 minutes, every 15 Breathing Absent Slow/ Good cry
minutes for 30 minutes, every 30 minutes for 1 hour. (Respiration) irregular
SCORE INTERPRETATION
o Si handle mag aftercare sa instruments, si assist
mgmonitor sa VS 0-4 = Poor; in serious danger and needs resuscitation like in the
o Magstay pa ang pt after 1 hr sa DR tracheal tube insertion
6. Promote rest
5-6 = condition is guarded; may need airway clearing and oxygen

NEONATAL PERIOD 7-10 = good; newborn is doing well; 8 (usual APGAR score)

1. Airway 8. Anthropometric measurements

o wipe mouth and nose to prevent aspiration o Birth weight = 2.5-3.5 kgs
o Length = 45-55 cms (tape measure)
 o Head circumference = 32-35.5 cms
o Chest circumference = 30-33 cms
o abdominal circumference = 28-30 cms
do not insert your hand sa tape kay maapil ug measure

9. Vital signs
o Heart rate = 110-160 bpm
o Respiratory = 30- 60 bpm
o Temp (rectal) = 36-37.6 (anal patency)

MOLDING OF FETAL SKULL

o Molding = adaptation of fetal head to the pelvic
cavity during birth mareshape
o To reduce head circumference para makapass
Pag measure, magstart sa feet to head sa length through sa passageway
Chest circum. – in line sa nipple

Head circum. Taas sa eyebrow

10. Head to toe assessment

a. Head
o Moldings temporary reshaping of the head
o fontanelles
o caput succedanum temporary cone head; a type of
swelling around the skull, which can give an infant
a “conehead” appearance. Usually, it forms after a
difficult delivery; typically disappear within a few
days
o cephalohematoma – hemorrhage of blood
between the skull and the periosteum of a
newborn
o suture lines – where the bony plates of the skull
join together
o anencephaly – absence of a large part of the brain
and the skull; cephalic disorder that results from a Caput cone head (temporary)
neural tube defect that occurs when the rostral Cephalohematoma (difficult to identify if thick hair ang baby)
(head) end of the neural tube fails to close, usually
between the 23rd and 26th day of conception upper c. Chest = witch milk F/M (may colostrum; bc of exposure
part ng spine unable to close/open ang brain of hormones present during pregnancy)
walang nakaclose na skull d. Abdomen = check the umbilical cord
b. Face o gastroschysis — absence of abdominal wall prone
o blink reflex – not present in newborns, present in to infection (difficult to manage)
about 50% of 5 month old babies. It is not 100% e. Genitals
present in babies until 1 year o should void within the 1st 24 hours
o nystagmus/strabismus o pseudomenses present for female neonates;
o nystagmus – involuntary, rapid and naexpose sa hormones during pregnancy –
repetitive movement of the eyes – either magkaroon ng spotting (small amount)
horizontal (side-to-side), vertical (up and o testes should be descended (cryptorchidism -
down), or rotary (circular) undescended testes)
o strabismus – disorder in which the 2 eyes o preterm male has less rugae in the scrotum medyo
do not line up in the same direction (and shiny
including the 2 variants cross-eye and o labia minora is prominent sa female neonates
walleye) f. Extremities
o ears should be even or above outer eye canthus o flexed
o creases on the palm (Simian crease - only one
crease)
o polydactyl - extra toes or fingers
o syndactyl — webbing of fingers
o amelia - absence of upper extremities
o tocophilia - absence of lower extremities
o clubfoot
g. Skin
o = color
o = mongolian spots
 o = vernix caseosa o size is reduced:
o = lanugo - immediately after delivery - 1000 gms
o = milia - after end of 1st week - 500 gms
- after 6 weeks - 50 gms (normal size)
o placental site (uterine wall) is sealed off wala nay bleeding
dapat
o cervical os are narrowed wala nay dilatation
o painful during contraction
o contracted magcontract parin para walay bleeding
dpat mgdisappear within 1 yr FUNDAL HEIGHT POST PARTUM

caseosa do not remove –

help in thermoregulation

Immediately right after the delivery of the baby the location of

the fundus is at middle of umbilicus and symphysis pubis

After 6-12 hours postpartum the location of the fundus is at the

level of the umbilicus

1 day after postpartum – 1 finger breadth below umbilicus –

POSTPARTUM
1finger or 1cm
PUERPERIUM term for postpartum
2 days after postpartum - 2 finger breadths or 2 cm below the
Normal Puerperium umbilicus

Definition 3days – 3 finger breadths below the umbilicus

1. The time from the delivery of the placenta through the 1 st 4 - 9 days – non palpable because naa sa pelvic bone na dapit
few weeks after the delivery
A – midline
2. 6 weeks in duration
3. By 6 weeks (1 and ½ month) after delivery, most of the 1 finger breadth below umbilicus
changes of pregnancy, labor, and delivery have resolved and
the body has reverted to the nonpregnant state.
Termination of labor → Involution (means return of uterus to
non-pregnant state-also all organs involved); sub-involution if di
magbalik (may infection, uterus is remains big, lot of discharges
di nagadiminish ang amount)

1. Maintain infection-free environment instruct proper way of

cleaning perineum front to back; clean water; change of
perineal pads;
2. Promote healing hot sitz bath, underwear dapat di synthetic
cotton, lifestyle, nutrition Lochia
3. Watch for bleeding because pwede mag ka uterine atony;
If CS lochia is still present, because it is the discharges of the
also at risk for infection
uterus.
4. Encourage early ambulation promote good circulation and
healing o discharges of the uterus
5. Provide comfort and rest - Lochia rubra
6. Provide emotional support child rearing period - Lochia serosa
7. Establish successful lactation - Lochia alba
o pattern should not reverse
o increase in activity
PHYSIOLOGIC CHANGES IN POST PARTAL PERIOD
o decrease in breastfeeding – magrelease ug oxytocin mag
1. Reproductive Changes contract ang uterus magdecrease ang bleeding
Uterus o not offensive in odor – no infection
o without large clots – if with clots may retained placental o positive bowel sounds
fragments o difficult bowel evacuation - lalo nap ag may episiotomy or
o present in CS laceration – encourage hifiber diet
Integumentary system

o linea negra and chloasma barely detectable in 6th week

3. Vital Signs
Temperature

o increase on the 1st 24 hrs - dehydration bc of NPO

- after 24 hours - infection up to 40C
- after 3-4 days - milk production up to 39?
Pulse
Check amount; if magdispose sa napkin
o decrease due to decrease cardiac output
Vagina Blood pressure

o soft, swollen o slightly decrease

o hymen is permanently torn Respiratory rate
Perineum middle between vulva and anal cavity where
o no changes
episiotomy is performed

o edematous
4. Retrogressive changes
o with laceration or episiorrhaphy
Exhaustion
o labia minora and majora remains a trophic
Abdomen o sleeplessness
o fetal movements
o soft and flobby
o labor pains
o striae gravidarum lightens
o energy expenditures – bearing down process
o linea negra disappears in 6th week
o NPO
Breasts
Weight Loss
o drop in estrogen and progesterone
o Diuresis -
o lactating
o diaphoresis extreme sweating – especially at night
o colustrum is present
o return to prepregnant weight at 6th week
o Let-down reflex excretion of milk from the mammary gland
o warm and tender
o engorged 5. Progressive changes
o milk is produced by the 3rd-4th day postpartum Lactation 3rd-4th day postpartum
o veins are apparent bc enlarged ang breast
THE MAMMARY GLAND

2. Systemic Changes
Hormonal

o after 1 week — prepregnant state – estrogen and

progesterone mag normalize na di na inrceased
Urinary system

o voiding maybe difficult immediately after birth; instruct to

lean forward during urination para di matamaan ang
lacerated part or episorrhaphy part
o urinary retention – mahadlok mangihi kay hapdos
o no output after 12 hours — give diuretic to promote
urination
o voiding time should be after 4-6 hours post-partum PHYSIOLOGY OF MILK PRODUCTION AND EJECTION
Circulatory system Placental delivery Suckling
↓ ↓
o decrease blood volume
Decrease estrogen & Stimulate PPG
o return to normal at 1st—2nd week
progesterone (posterior pituitary
o blood loss: ↓ gland)
- NSVD - 300-500 ml Stimulates APG ↓
- CS - 500-1000 ml bc abdominal incision man (5 layers of (anterior pituitary OXYTOCIN
abdomen are involved) gland) ↓
Gastrointestinal system ↓ Collecting tubules
PROLACTIN ↓
o hungry and thirsty bc NPO si mother sa labor and delivery ↓ Milk ejection
o slow passage of stool di pa dyun mubalik ang peristaltic Acinar cells LET DOWN REFLEX
movement
 (part sa mammary
gland)
↓
Milk Production
↓
Collecting tubules

HEALTH TEACHINGS FOR BREAST FEEDING

1. Hand washing before and after

2. Clean nipple with water
3. Expose nipple to air
4. Feed the baby in short frequent intervals and lengthen
gradually
5. Alternate the breasts
6. Proper positioning
7. Adequate maternal nutrition and increase OFI
8. Wear well-fitted bra – para di mag sag ang breast ang di
painful
PROPER ATTACHMENT

a. Baby grasp not only the nipple but also the areola
b. Lower lip turned outward
c. Chin of the baby touches mother's breast
PROPER POSITIONING

a. Head and lower body part must be aligned

b. Baby is facing the mother
c. Tummy to tummy
Football grip
POST PARTUM ASSESSMENT (AV BUBBLEHER)

A = Appearance

V = Vital Signs

B = Breasts

U = Uterus

B = Bladder

B = Bowel

L = Lochia

E = Episiotomy/Episiorrhaphy

H = Homan's sign dorsiflex legs (if nay pain sa calf positive >
thrombophlebitis)

E = Emotion

R = Rhogam prevent sensitization

RH + ang baby tas - si mother pwede magcause ug anemia,

tagaan ug rhogam para maprevent ang sensitization, ma
suppress ang antibodies para di magka anemia si baby, etc.
complications

EMOTIONAL PHASES OF PUERPERIUM

1. Taking-in Phase
o woman is passive and dependent
o prefers talking about pregnancy, labor and delivery
o uncertain in caring for newborn
2. Taking-hold Phase diri magperform nsg intervention
o woman begin to initiate action
o interested in taking care of newborn
o asserts independence
3. Letting-go Phase
o gives up old role
o ready for her new role
 RHOGAM o coitus in late pregnancy
o PROM – premature rupture of membrane – mag ascend
Use in obstetrics
ang infection
● Rh-negative pregnant patient may be exposed to RBC’s 3. Thrombophlebitis
from her Rh-positive fetus ▪ signs and symptoms:
● Can happen during the normal course of pregnancy or - pain, stiffness, redness
● After procedures or abdominal trauma - Swelling
● Given at 28 weeks - fever and chills
● And within 72 hrs of delivery - (+) Homan's sign
- Milk leg - a painful swelling of the leg caused by
inflammation and clotting in the veins
COMMON POST PARTUM COMPLICATIONS ▪ Management
- bed rest
I. Hemorrhage = blood loss more than 500 cc
- elevate affected part
a. Early post-partum hemorrhage
- analgesics
▪ uterine atony — relaxed or boggy uterus
- anticoagulant
- large babies – macrosomic babies
▪ Avoid:
- cesarean birth
- frequent mobilization – para di mag dislodge ang
- placental accidents (abruptio/previa)
clot kay basi maadto heart
- dystocia
- massage clot may travel to heart > disruption of
▪ lacerations - cervix
flow > cardiac arrest
- vagina
- thrombolytic agents
- labia
- perineum
b. Late postpartum hemorrhage FAMILY PLANNING METHODS
▪ retained placental fragments
▪ hematoma - accumulation of blood within the vessels 1. Natural Methods:
NURSING INTERVENTIONS a. Fertility Awareness Method (FAB)
b. Lactation Amenorrhea Method (LAM)
1. Monitor fundus frequently c. Billing's Method
2. Massage the uterus d. Basal Body Temperature (BBT)
3. Apply ice pack in the abdomen e. Symptothermal Method
4. Empty the bladder 2. Artificial Family Planning Methods:
5. Regulate IVF as ordered a. Intrauterine Device (IUD)
6. Administer oxytocic agents (Oxytocin/Maleate) b. Oral Contraceptive Pills
7. Initiate breastfeeding – para marelease ang oxytocin c. Depo Provera Injectables
8. Monitor VS and watch for indications of hypovolemic shock d. Implant
– altered vital signs e. Condom
9. Prepare and assist for repair of laceration, removal of f. cervical cap
fragments or evacuation of hematoma g. spermicidal gel
10. Emotional support 3. Surgical Contraceptive methods
a. Tubal ligation
b. Vasectomy
II. Post Partum Infection
a. Infection of the perineum
▪ pain, heat, feeling of pressure in the perineum, LEGAL IMPLICATIONS OF MATERNAL & NEWBORN HEALTH
inflammation, redness, 1-2 sutures slough off, febrile
▪ remove the suture, drain and resuture RA 10028
▪ hot sitz or warm compress
EXPANDED BREASTFEEDING PROMOTION ACT OF 1996
▪ perilight – heat provide healing
b. Endometritis - infection of the lining of the uterus ▪ Lactation station
▪ abdominal tenderness ▪ Deductible expenses
▪ uterine atony ▪ Lactation period for breastfeeding employees
▪ dark brown foul-smelling lochia ▪ Milk banks/storage
▪ Management: oxytocin and fowler's position -flow of ▪ Inclusion of breastfeeding in the curriculum
blood going to the endometrium RA 9288
c. Mastitis - is the inflammation of breast tissue.
NEWBORN SCREENING ACT

Objectives. - The objectives of the National Newborn Screening

SOURCES OF INFECTION
System are:
1. Endogenous (primary)
1) To ensure that every newborn has access to newborn
o normal flora
screening for certain heritable conditions that can result in
2. Exogenous source
mental retardation, serious health complications or death if left
o hospital personnel
undetected and untreated;
o excessive obstetric manipulation – use of vacuum
o break in aseptic technique – laceration, incision, EO 51
episiotomy
MILK CODE OF THE PHILIPPINES
Ensures adequate and safe nutrition for infants through
promotion of breastfeeding and the regulation of promotion,
distribution, selling, advertising, product public relations, and
information services artificial milk formulas and other covered
products.

EO 2009-0025

ESSENTIAL NEWBORN CARE

(UNANG YAKAP CAMPAIGN OF THE DOH)

▪ Immediate drying of the newborn

▪ Uninterrupted skin to skin contact
▪ Proper cord clamping and cutting
▪ Non-separation of the newborn from the mother for
breastfeeding initiation and rooming-in