THE BEGINNING OF PREGNANCY Zygote From fertilization to

implantation
Presumptive – felt by the mother (subjective) least Embryo From implantation to
indicative of pregnancy. 5-8 weeks
 Amenorrhea, nausea and vomiting, frequent Fetus From 5 weeks until
urination, fatigue (baby uses the sugar of the term
mother) Conceptus Developing embryo or
 Chloasma gravidarum - darkening of the
detus and placental
structures throughout
face
pregnancy
 Linea nigra – dark line on the abdomen
 Striae gravidarum
5 PRODUCTS OF CONCEPTION
Probable – felt by the examiner or the nurse.
1. Fetus,
 Abdominal enlargement
2. Placenta/pancake
 Hegar sign – softening of the lower portion
3. Umbillical cord/funis
of the uterus
4. Amiotic fluid
 Chadwich sign – darkening of vagina
5. Amiotic sac
 Ballotment – baby is bouncing occurs in 4th
B. Implantation
month
 Zygote migrates towards the body of uterus
 Goodle sign – softening of cervix
which taks 3 or 4 days
 Braxtonhic sign – painless palpable
 Cleavage or mitotic cell division begins: 24
contraction
hours
 Pregnancy test (male positive in pregnancy
Blastomeres
test indicates testicular cancer)
 Time zygote reaches body of uterus it
Positive
consists of 16-50 cells
 ultrasound, fetal hearbeat, fetal
 In initial cell division, 2 blastomeres until
movement/quickening (felt by the examiner)
after 3-4 days
Morula
Antepartum period – woman know that she is
 Blastomeres that will arrange in a ball-like
pregnant/nalaman. Longest period (9 months)
structure
Intrapartum – labor, delivery, removal of placenta
 Travels to uterus and stays for 3-4 days
Postpartum – 6 weeks following pregnancy
Blastocyst
 Multiplication of morula forming solid
Trimester
clump of cells
1st trimester – first 3 months
Trophoblast (fingerlike projections)
2nd trimester (4-6 months)
 Outer ring replacing zona pellucida
3rd trimester (7-9 mmonths)
EMBRYONIC AND FETAL STRUCTURES
After implantation, endometrium is termed
A. Fertilization
DECIDUA, which has 3 portions:
(conception/impregnation/fecundation)
1. Decidua basalis – lies directly under
 Union of ovum and spermatozoa
embryo
 Occurs in outer third of fallopian tube, the
2. Decidua capsularis – portion stretches and
ampullar region
encapsulate the surface of trphoblast
 Critical time span occurs about 72 hours
3. Decidua vera – remaining portion of uterine
 After ovulation, the ovum is extruded from
lining
graafian follicle, surrounded by a ring of
Chorionic Villi - finger like projections
mucopolysaccharide fluid (zona pellucida)
responsible for secretion of pregnancy hormones
and circle of cells (corona radiata)
human chorionic gonadotrophin (HCG) and human
Capacitation
placental lactogen (HPL), estrogen, progesterone
 Ejection of DNA of sperm to ovum
*At the time of implantation, there are 3 important
 Final process for fertilization
changes in the embryo that occurs simultaneously –
 Changes in plasma membrane of sperm head
formation of membranes
Factors affecting fertilization
1. Chorionic membrane – first membrane to
1. Maturity of sperm and ovum
be formed. Protects and support embryo
2. Ability of sperm to reach ovum
during growth and development
3. Ability of sperm to penetrate zona pellucida
2. Amniotic membrane – thin protective
Terms used to denote fetal growth membrane containing amniotic fluid. The
Ovum From ovulation to
fertilization
 space between membrane and embryo is  Protected by whaton’s jelly – transparent
amniotic cavity. gelatinous white substance which
Amnion – produces amniotic fluid. Usually 800 – prevents pressure on veins and arteries
1200cc average amount of amniotic fluid Veins and arteries
Polyhydramnios – more than 2,000 mL  21 inches in length
Oligohydramnios – less than 300 Ml  2 cm in thickness
 2 arteries (carrying blood from fetus back to
Functions of Aminiotic fluid placental vili)
1. Shields against [ressure or blow to mother’s  1 vein (carrying blood from placental vili to
abdomen fetus)
2. Protects fetus against changes in Functions:
environment – temperature  Transport O2
3. Muscular development allowing fetus to  Nutrients to fetus from placenta
move freely  Return waste products from fetus to placenta
4. Protects umbilical cord from pressure, Organogenesis – first 3 months when organs begin
protecting fetal oxygen supply to grow
C. Placenta/pancake ORIGIN OF ORGAN SYSTEMS
 Provides nutrition and blood suppy and
oxygen supply. FETAL GROWTH AND DEVELOPMENT
 15-20 cm in diameter at the beginning of First lunar month
pregnancy Germ layers differentiate by the 2nd week
 2-3 cm in thickness; weighs 500 grams at 1. Endoderm - gives rise to lining of GIT,
term Respiratory Tract, tonsils, thyroid (for basal
 Covers half surface area of internal uterus metabolism, parathyroid (for calcium metabolism),
 Mature placenta has 16-30 separate thymus gland (for development of immunity),
segments called cotyledons bladder and urethra
2 Portions: 2. Mesoderm - forms into the supporting structures
 Maternal portion – formed by deciduas of the body (connective tissues cartilages. muscles
basalis and its circulation. Surface is red and and tendons); heart circulatory system, blood cells,
flesh like-presnce of cotyledon Looks rough, reproductive system, kidneys and ureters.
uneven, and dirty (duncan) 3. Ectoderm - responsible for the formation of the
 Fetal portion – made up of chorionic vili nervous svsten skin, hair and nails and the mucous
and its circulation membrane of the anus ands mouth
 Give shiny and grayish apperance (shaltz)
Functions: Stages of Human Prenatal Development
1 Serves as fetal lungs, kidneys and a. First 12 - 14 days = zygote
gastrointestinal tract b. From 15th day up to 8th week = embryo
2 Endocrine functions: C. From 8th week up to the time of birth = fetus
 HCG – first hormone produced
 Estrogen – contributes to mother’s DEVELOPMENT OF ORGAN SYSTEMS
ammmary gland development in A. Cardiovascular System
preparation for lactation • 6th or 7th week- septum divides the heart into
 Progesterone – maintain chambers
endometrian lining produced by • 10th-12th week- heartbeat may be heard with a
placenta staring 8 or 12th week doppler o 11th week - ECG may be recorded on
pregnancy. fetus
 Human placental lactogen – growth • 16th day of life- single heart tubes form o 24th day
promoting and lactogenic (milk- of life- heart beats
producing) properties by 6 weeks • 28th week - Sympathetic Nervous System matures
 Protection againsta invading heart rate
microorganisms and chemical B. Respiratory System
substance • 3rd week - Intrauterine life:
D. Umbilical cord respiratory and digestive tracts
 Formed from amnion and chorion exists as a single tube
 Provides circulatory pathway that  4th week - septum begins to divide the
connects embryo to chorionic vili of esophagus from the trachea. lung buds appear
placenta on the trachea
• 7th week - diaphragm does not completely divide • Vernix caseosa - important for lubrication and for
the thoracic cavity from the abdomen keeping the skin from macerating in utero.
Respiratory Milestone J. Immune System
 28th week alveoli and capillaries begin to form • IgG - increases phagocytosis: provide immune
SURFACTANT -phospholipid substance formed protection to the fetus and newborn.
and excreted at about 24th week of pregnancy
COMPONENTS: MILESTONES OF FETAL GROWTH AND
• 35th week - production of lecithin o 2: 1 (Lecithin: DEVELOPMENT
Sphingomyelin) End of 4 Gestation Weeks
• Respiratory Distress- lack of surfactant • Length - 0.75 cm to 1 cm
C. Nervous System - Weight - 400 mg
 3rd Week - a neural plate is apparent forming th • The spinal cord is formed and fused at midpoint
CNS (brain and spinal cord) Trophoblasts embed in decidua
 8th week = brain waves can be detected by the Chorionic villi form
EEG • Foundation for nervous system, GUT, skin.
• All parts of the brain (cerebellum, cerebrum, bones and lungs are
medulla oblongata and pons) form in utero formed
• 24 weeks = ear is capable of responding to sound: • The rudimentary heart appears as a prominent
eyes exhibit pupillary reaction bulge on the anterior surface
• Meningocele or Anencephaly • Back is bent so the head almost touches the tip of
D. Endocrine System the tail
o Thyroid and parathyroid glands - play vital roles • Arms and legs are budlike structures
in • Rudimentary eyes, ears and nose appear
metabolic function and calcium balance
• Fetal Pancreas - produces insulin End of 8 Gestation Weeks
o Fetal Pancreas - produces insulin • Length - 2.5 cm
E. Digestive System o 4th week- digestive tract is • Weight - 20 g
separated from th respiratory tract • Organogenesis is complete
o 10 week - abdominal cavity has grown large • The heart, with a septum and valves, is beating
enough to accommodate all intestinal mass o 6th • Facial feature are definitely discernible
week- meconium forms in the intestine o GIT is • Primitive tail is regressing
sterile before birth - becausts Vit. K is synthesized • Head is disproportionately large, owing to brain
by the action of bacteria in the intestines. development
• Sucking and swallowing reflexes are not mature o • Abdomen appears lage due to rapid growth of fetal
Liver is active, functioning as a filter between the intestine
incoming blood and fetal • External genitalia is present, but sex is not
o Fetal stores such as iron and glycogen. o It is still distinguishable by simple observation
immature after birth, possibly
hypoglycemia and hyperbilirubinemia End of 12 Gestation Weeks
(2 lead to serious • Length - 7 to 8 cm
problems 24 hours after birth) • Weight - 45 grams.
• Nail beds are forming on fingers and toes
Meconium – first stool of the newborn • Spontaneous movements are possible, but not felt
Vitamin k .1 is given to newborn for clotting by the mother
purposes preventing hemoraditc disease of newborn • Bone ossification centers are forming
• Tooth buds are present
F. Musculoskeletal System • Sex is distinguishable by outward appearance
(° 11° week - fetus can be seen moving • Placenta is complete
(quickening) but cannot be felt by the mother • Heart is audible by a Doppler
• 12* week- ossification of bone tissue begins • Kidney secretion has begun
G. Reproductive System
• 6th week - gonads (testes and ovaries) form, testes End of 16 Gestation Weeks
are • Length - 10 to 17 cm
H. Urinary System • Weight 55 - 120 grams
• 44 week - kidneys are present in the abdominal • Fetal heart sounds are audible by an ordinary
cavity stethoscope
1. Integumentary System • Sex can be determined by Ultrasound
• Lanugo - soft downy hairs • Lanugo is well formed
• Liver and pancreas are functioning •Length - 42 to 48 cm
• Nasal septum and palate close • Weight - 1800 to 2700 grams
• Fetus actively swallows amniotic fluid • Body stores of glycogen, iron, carbohydrate, and
• Urine is present in amniotic fluid calcium are augmented
• Additional amount of subcutaneous fats are
End of 20 Gestation Weeks deposited
• Length - 25 cm • Amount of lanugo begins to diminish
• Weight 223 grams • Amniotic fluids decreases
• Spontaneous fetal movements are felt by the • Sole of foot has 1 or 2 crisscross creases
mother
* Antibody production is possible End of 40 Gestation Weeks
Hair forms, extending to include eyebrows and hair • Length - 48 to 52 cm
on • Weight - 3000 grams
the head • Fetus kicks actively, hard enough to cause the
• Meconium is present in the upper intestine mother considerable discomfort
• Brown fat, a special fat that will aid in temperature • Creases on soles of feet cover at least 2/3 of the
regulation at birth, begins to form behind the surface
kidneys, sternum, and posterior back • Vernix caseosa fully formed
• Heart sounds are perceptible by auscultation • Fingernails extend over the fingertips
• Vernix caseosa appears
• Definite sleeping and activity patterns are THE DIAGNOSIS OF PREGNANCY
distinguishable (the fetus has devlop bio rhythms
that will guide sleep/wake patterns throughout life) Presumptive signs of pregnancy- are those tha are
least indicative of pregnancy
End of 24 Gestation Weeks • Amenorrhea
• Length - 28 to 36 cm • Nausea and Vomiting (morning sickness)
• Weight- 550 grams • Breast Changes
• Skin appears wrinkled • Frequent urination
• Meconium is present as far as the rectum • Quickening
• Active production of lung surfactant begins • Fatigue
• Eyebrow and fingernails are well defined • Changes in abdominal shape
• Pupils are capable of reacting to light • Linea nigra
• Hearing can be demonstrated by response to • Leukorrhea
sudden sound • Striae gravidarum

End of 28 Gestation Weeks Probable signs of pregnancy- can be documented by

• Length - 35 to 38 cm th examiner. They are not positive or true diagnostic
• Weight 1200 grams findings
• Skin is red • Hegar's sign
• Pupillary membrane disappears from eyes and the • Goodell's sign
eyelids open • Chadwick's sign
• Lung alveoli begins to mature and surfactant can •Braxton Hick's contractions
be demonstrated in amniotic fluid • Ballottement
• Testes begins to descend into the scrotal sac from • HCG test (Pregnancy test)
the lower abdominal cavity
• Eyes are open Positive signs of pregnancy- they are only three
• The fetus has an excellent chance of survival positive signs of pregnancy:
Demonstration of fetal heart separate from the
The fetus has an excellent chance of survival mother's
End of 32 Gestation Weeks Fetal movements felt by the examiner
• Length - 38 to 43 cm • Visualization of fetus by ultrasound
• Weight - 1600 grams
• Subcutaneous fat begins to be deposited Responsibilities:
• Fetus is viable 1. Instruct the woman to drink glass of water and
•Fingernails grow to reach the end of the fingertips not to void before the procedure. Full bladder will
• Vigorous fetal movements ocours cause the uterus to be pushed upward out of the
pelvis
End of 36 Gestation Weeks
2. Tell the woman it is safe and painless procedure 4. Extroversion - women become more active,
and that there is no sensation at all from the UTZ appear healthier than ever before, and are more
3. The abdomen will be covered w/ water soluble outgoing. It tends to occur in women who are
gel because sound waves travel through liquid finding unexpected fulfillment in pregnancy
medium. Reassure that conducting gel may feel cold 5. Body image(the way your body appears to
but it is not staining. yourself) and boundary (a zone of separation
4. A probe is then placed and moved back and forth perceive between yourself and objects or other
on the abdomen and a moving picture of the fetus is people)
seen on the screen 6. Fear and anxiety - it is related to the woman's
concern about her own health and the health of her
PSYCHOLOGICAL AND PHYSIOLOGICAL baby.
CHANGES DURING PREGNANCY 7. Uncertainty - some women may still in doubt
that they are pregna despite a positive pregnancy
PSYCHOLOGICAL TASKS OF PREGNANCY test and confirmation by a doctor
First Trimester: Acceptance of pregnancy (*I am 8. Couvade syndrome - men experience physical
pregnant" symptoms such nausea, vomiting and backache to
• It is the first psychological task the same degree or even more intensely than their
• women and partner both spend time recovering partners do. These symptoms are often the results of
from shock of learning they are pregnant and anxiety and empathy for the pregnant woman.
concentrate on what it feels like to be a pregnant 9. Emotional liability - partly as a manifestation of
• a common reaction is ambivalence narcissism or
• The doctor's confirmation of pregnancy often because of hormonal changes
helps the woman accept the fact that she is pregnant 10. Changes in sexual desire
• The unborn child is incorporated as part of the - 1st tri - decrease libido because of nausea, fatigue,
woman's body image or as part of herself and breast tenderness
- 2nd tri - libido and sexual enjoyment rises
* Second trimester: Acceptance of the fetus as a markedly because blood flow to the pelvic area
separa individual ("I am going to have a baby") increases to supply the placenta
• Women and partner move through emotions such - 3rd tri - it may remain high or decrease because of
narcissism and introversion as they concentrate on difficulty finding a comfortable position and
what it increasing abdominal size
feel like to be a parent 11. Changes in the expectant family preparing the
Quickening - it helps the woman realize that the family for the birth of a new member.
fetus is not just part of the body but a separate and
real individual to care for.
• She begins to fantasize about the child's sex and Prenatal care is essential for ensuring the overall
appearance (she gives the fetus as identity) health of newborns and their mothers, it is a major
• Role-playing is common strategy for helping to reduce the number of low-
birth weight babies born yearly.
Third trimester: The woman prepares for the birth
of the baby and her role as a mother (" I am going to Goals:
be a mother") 1. To ensure a healthy and uncomplicated
• Woman begins to plan about the birth of the baby pregnancy and to deliver a healthy infant.
• Select baby's layette, choose names for her baby, 2. To identify and treat high risk conditions.
make plans on how the baby will be fed, where the 3. To assist patient in preparation for labor and
baby will sleep at home etc delivery and purperium.
4. To have adequate immunization against
EMOTIONAL RESPONSES TO PREGNANCY contagious diseases.
1. Ambivalence - refers to the simultaneous 5. To develop positive attitudes about sexuality,
negative or positiv response of the woman to womanhood and childbearing.
pregnancy 6. To provide pregnancy education for additional
2. Grief - before a woman can take on mothering health promotion.
role, she has to give up or alter her present role
3. Introversion or Narcissism (self-centeredness) COMPONENTS OF THE HEALTH HISTORY
- during pregnancy, the woman may become
concerned for her welfare and the effects of 1. History-taking
pregnancy on her health and lifestyle. She may be Demographic Data
preoccupied with her own thought and feelings.
(Name, age, address, civil status, telephone number, • A: The number of spontaneous or induced
religion, occupation, and abortions
health insurance information) • L: The number of living children
Chief concern • M: Multiple pregnancies
- The reason the woman has come to the health care
setting, confirmation of pregnancy (date of LMP, Review of systems - to recall diseases that she
pregnancy test, elicit signs of early pregnancy and forgot to mention, it completes the subjective
danger signs of pregnancy) information. It uses systematic approach, such as
Family profile- support person, marital status, loss head to toe, and explain what you'll be doing.
of loved one, financial; hardships, lack of support
system 2. Physical Examination
Medical history (Past and Present) Baseline height and weight - to get the baseline
- Existing data; to determine weight gained or lost
problems, Vital signs - ex. A sudden ^ of BP and sudden
immunizations. alcohor mtake, orgaretie smoking, weight gain is a sign of HPN
ers allergies and reics; pregnancy/ A sudden ^ of PR and R may suggest
History of family illness bleeding v Assessment of systems - cephalocaudal
Day history/social profile method
- womanis utrimok inxercisono, dirinket. - General Appearance/ mental status: body posture,
medicationscreaturaneestynd drugs appearance, way of speaking, hygiene, facial
(oral or IV), smoking, alcohol drinker, medications expression
(accutane) personal interactions - Head/Scalp: symmetry, contour, hair, chloasma,
Gynecologic history tenderness
menarche, characteristics of menstruation, - Eyes: edema of eyelids, poor vision
discomforts associated with the monthly period, Nose: nasal congestion, swollen nasal membrane
actions taken to relieve such discomforts, previous Ears: fullness in the eustachian tube, fullness in the
reproductive surgery, planning methods and sexual ear
history. - Sinuses: tenderness
- Mouth/Teeth/Throat: cracked corners of mouth
Obstetric history (Vitamin A deficiency), herpes
# of past pregnancies, pregnancy outcome, - Neck: slight thyroid hypertrophy
complications, labor time, method - Lymph Nodes: no palpable
delivery, complications of labor, pueperium, and - Heart: no murmurs, palpitations, HR 70-80
complications of puerperium - Lungs: diaphragmatic excursion
- GP TPALM - Back: back pain
• Gravida- a woman who is or has been pregnant - Rectum: hemorrhoids
• Primigravida- a woman who has been pregnant - Extremities/Skin: erythema, itchiness, jaundice,
for the first time pigmentations
• Primipara- a woman who has given birth to one
child past age of viability LABORATORY TESTS
• Multigravida- a woman who has had two or more 1. Blood tests
pregnancies Hematocrit and hemoglobin level
• Multipara- A woman who has carried two or • To detect anemia
more pregnancies to viability • Done at initial clinic visit and repeated at 28-32
• Nulligravida- a woman who has never been weeks
pregnant and is not currentl pregnant • Anemia during pregnancy is usually of the iron-
• Para- the number of pregnancies that reach deficiency type.
viability, regardless of whether the infants were • Normal hemoglobin level (12-16 mg/di)
born alive or not (24 weeks) • Normal hematocrit level (37-47%)
o Age of viability- is the earliest age at which • Mild anemia is hgb less than 11 gm/dl (Hct 27-
fetuses could survive if they were born at that time, 33%)
generally accepted as 24 weeks, or fetuses weighing • Severe anemia is hgb less than 9 gm/dI(Hct more
more than 400 grams. than 27%)
• T: The number of full-term infants born (infants •Leukocyte count - to rule out leukemia and
born at 37 weeks or after) possible infection
• P: The number of preterm infants born (infants •Platelet count - to estimate clotting ability
born before 37 weeks) •Blood type and Rh factor
• VDRL - to screen for maternal syphilis
2. Urinalvsis
- to detect proteinuria, glycosuria and pyuria
3. Tuberculosis screening
PPD (purified protein derivative)

PELVIC EXAMINATION
• External genitalia (signs of inflammation,
irritation or infection)
• Internal genitalia

1. Internal examination or Vaginal examination

Patient preparation:
a. Provide explanation
b. Let woman empty her bladder first
c. Provide good lightning
d. Place the woman in a lithotomy position with PROMOTING FETAL AND MATERNAL
buttocks extended slightly beyond examining table HEALTH
e. Drape properly
Let support person stay at the head of the bed 1. Measurement of Fundic Height:
g. Instruct woman not to: Purposes:
- hold or squeeze your hands and that of her a. Check pregnancy is progressing at the expected
husband hold her breath close eyes tightly clench rate
fist b. Estimate AOG (McDonald's Rule)
- contract perineal muscles
h. After procedure, provide tissue to wipe perineum Formula:
of lubricant. Height of fundus (cm) x 2/7 = gestation in lunar
month
2. COMPUTATION OF THE EXPECTED Height in fundus (cm) × 8/7 = gestation in weeks
DATE OF DELIVERY
~ Nagele's rule MEASURING FUNDIC HEIGHT
it is the standard method used to predict the length Place the zero line of the tape measure on the
of a pregnancy anterior border of the symphysis pubis and stretch
- inquire for last menstrual period (LMP) and tape over midline of abdomen to top of fundus.
calculate for expected date of delivery/confinement The tape should be brought over the curve of the
(EDD/EDC) fundus.

Problems encountered with the use of LMP 2. Estimate fetal weight:

1. Failure to record LMP - using the fundic height (Johnson's Rule)
2. Menstrual cycle may be irregular and variable Formula:
3. Pregnancy may follow immediately without FH (cm) - n x K = fetal weight in gms
menstruation in between gestation Where:
4. Implantation bleeding may be mistaken as n = 12 if the fetal head is below the level of the
menstruation ischial spine (engaged)
5. Ovulation that occurs after cessation of ovulation = 11 if the presenting fetal part is above the
inhibition method of contraception may be delayed level of the ischial spine
Inquire the last menstrual period = 1 is added to n for patients over 200 lbs
If LMP is from January to March k = 155 (constant)
*Add 9(month) and 7 (day)
3. Fetal length: (Haase's Rule) in cm long
- First 5 months of pregnancy = square the number
of the month of
pregnancy
- From 6th months on multiply the number of the
month by 5

BARTOLOMEW'S RULE
GROWTH OF THE FUNDIC HEIGHT
• 12 weeks - level of symphysis pubis
•16 weeks - halfway between symphysis pubis and • (Determines small parts and back of fetus along
umbilicus the sides maternal abdomen)
• 20 weeks - level of umbilicus a. Exmainer faces the woman's head
• 24 weeks - two finger above umbilicus b. Palpate the sides of the abdomen to detect
• 28-30 weeks - midway between umbilicus and location of the fetal back and fetal small part
xiphoid process c. Palpate fetus between two hands
• 36 weeks - at the level of xiphoid process - Back: hard, smooth, resistant plane
• 40 weeks - two fingerbreadths below umbilicus, - Small parts: irregular, nodular with bony
drops at 34 weeks level because of LIGHTENING prominence

• Assess on which side is the fetal back or spine and

which side has small parts or extremities
• Lateral Palpation of the Uterus: provides
information regarding the location of the fetal back
and the fetal small parts consisting of arms and legs.
• Hands should alternately apply pressure against
the opposite hand.
• Directing alternating pressure against each hand is
the technique:
Alternating hands using firm resistance while the
3. LEOPOLD's MANEUVER other hand gently and firmly applies pressure and
• is a systemic method of observation and palpation rotates in a circular fashion. This technique can be
to determine fetal presentation and position used up and down the entire length of the uterus.

Purposes: THIRD MANEUVER:

a. Determine the position of the fetus - Face the woman's head and spread your hands
b. Determine the presentation of the fetus (head or widely apart
breech) - Grasp the uterine contents just above the
Nursing Care: symphysis pubis (firmly but gently)
1. Prepare the client - Hold presenting part between index finger and
a. Explain the procedure thumb; Assess for cephalic versus Breech
b. Instruct to empty bladder Presentation
c. Placed on supine position with knees slightly - Move the fetal presenting part gently back and
flexed forth in your hand
d. Wash hands using warm water - Fetal head will shift more easily back and forth
e. Observe the abdomen for longest diameter and - Fetal breech will move the whole body
where fetal movement is apparent
2. Perform the maneuver FOURTH MANEUVER
(pelvic palpation of the uterus - assess the
FIRST MANEUVER (Upper uterine segment or presenting part)
the uterine fundus) - Examiner faces woman's feet
a. Face the woman's head - Place hands on either side of the lower abdomen
b. Palpate upper abdomen to detect what lies in the with finger pads at the lower uterine pole (bikini
fundus line) and thumbs directed toward the umbilicus.
c. Determine the height of the uterine fundus - Carefully move fingers of each hand towards each
- Place hands on either side of the fundal area so other in a downward and inward manner using
that the fingers of both hands almost tough each gentle pressure.
other (face the woman's head). -The nurse's thumbs should point towards the
- Press gently and firmly with finger pads. woman's umbilicus.
- A very hard round well defined shape which can - If one of your hands met an obstruction. Above
be moved backand forth (balloted) usually indicates the ligament it is the fetal blow
a fetal head - If the fetus is in poor attitude, it will meet an
- A somewhat hard and roundish shape, which when obstruction on the same side of the fetal back
moved back and forth between the finger pads, also
moves the entire fetus usually indicates a fetal Summarization of the manuevers:
breech. 1st – superior surface of the fundus is palpated to
determine consistency, shape and mobility
SECOND MANEUVER:
2nd – both sides of uterus are palpated to determine Elevate legs and hips
the direction the fetal back is facing for intervals of 15-20
3rd – determine part of the fetus at the inlet and its mns 2x a day
mobility Avoid prolongs
4th – determines the fetal altitude and degree of fetal tanding and sitting
extension into the pelvis Avoid wearing
garters
Rest legs
4. Check Fetal Heart Rate:
Muscle cramps Change position
• Funic souffle frequently
- refers to a soft blowing murmur caused by blood No garters
rushing through the umbilical cord. Soak in warm water
- 140 bpm using heating pads
• Uterine souffle Pedal edema Avoid prolong
- refers to a soft blowing by blood rushing through standing or siting
the large vessels of the uterus. Comfortable shoes
- 80 bpm No round garters
Elevate in side lying
5. Provide Health Teachings position
Minor discomforts Interventions Backache Good posture
Nausea and vomiting - Take dry carbo Flat shoes
- Sensitivity to HCG (30 mns before Firm maternity girdle
- High getting up) Firm/comfortable bed
estrogen/progesterone - Refrain fatty Pelvis rocking
- Low maternal blood foods exercises
sugar - Small frequent Rest and avoid
- Gastric motility meals fatigue
- Increase fluids Pride of pregnancy
best tolerated Breat tenderness Wash breast with
before meals water only
- Sour ball candies Wear maternity
Heartburn/pyrosis - Eat small brassiere
frequent meals Palpitations Avoid sudden
- Sleep with two movement
pillows Rest
- Don’t life after Leukorrhea Daily path or perineal
eating care
- Aluminum Wear perineal pad
hydroxide Frequent urination Increased fluid to
- Maintain upright replace
position Perineal pad
- Refrain from Flush perineum after
indigestible gas voiding
froming Kegel exercise
fatty/spicy foods Normal
Constipation Increase fluid intake Nasal stuffiness Avoid allegerns and
6 g/day smoke-filled rooms
High fiber diet/iron Normal saline ¼ tsp
Walking salt in 1 cup of water
Stool Breathe steam from
softenoers/regular bm pot boiling water
Easy fatigability Enough rest and sleep Leg cramps/charley horse Push toe forward
in sim’s position while applying
Comfortable clothes pressure on the knee
and shoes to strengthen leg
8 hours of sleep One quart of milk a
Avoid standing long day
periods exercise
Eat well balaced diet
for energy
Leg varicosities Elastc stockings
DANGERS SIGNS OF PREGNANCY abortion
1. Vaginal Bleeding - should be reported no matter Sleep Lose REM due to
how slight; if discovered it after bowel movement, frequent walking
she may report spotting from hemmorhoids. Sims position
2. Persistent vomiting - once or twice daily is Work Avoid toxic
uncommon it may deplete the nutritional suppl Travel No restrictions during
available to the fetus and is danger to the early pregnancy
pregnancy. DHN; Mo uncoooked fruits,
veg, meet and purified
FETAL DISTRESS
water
3. Hyperemesis gravidarum- excessive vomiting Lap belt when driving
4. Chills and Fever - indicative of uterine infection,
benign gastroenteritis PROMOTING NUTRITIONAL HEALTH DURIN
5. Sudden Escape of Clear Fluid from the Vagina PREGNANCY
rupture of the membrane (PROM), threatened both • Nutritional Assessment
fetus and mother because the uterine activity is no . Taking a diet history
longer sealed against infection - 24 hour diet recall
6. Abdominal/Chest Pain - tubal (tvivpic) - Cultural and religious practices
pregnancy; placental separation, preterm labor, - Eating habits and preferences
appendicitis, ulcer and pancreatitis. Pulmonary 2. Laboratory assessment
embolus thrombophlebitis (Hemoglobin and
7. PIH (Pregnancy-Induced Hypertension)- rapid Hematocrit)
weight gain (2lbs/week), swelling of the face or 3. Weight and height measurement (BMI)
fingers, flashes of light or dots before the eyes, 4. General physical assessment
blurring of vision, severe headache, decreased urine 5. Provide nutritional instruction
output, swelling of hands (tightness of the ring); • Increased calorie intake for energy
face (difficulty opening the eyes; visual disturbance - Additional 300 calories or a total caloric intake of
headache (cerebral edema/acute hypertension) 2,500 calories is recommended
8. Increase or decrease fetal movement- fetus is - Inadequate intake of calorie lead to protein
responding to the need for oxygen breakdown
Assess the weight gained to determine if a woman's
HEALTH PROMOTION DURING PREGNANCY caloric intake is adecuate
SELF CARE NEEDS CONSIDERATIONS • Increased CHON intake
Bathing Leukorrhea -Should be increased to 60 g/day
Increaste sweating
- For growth and repair of maternal and fetal tissue
Breast care Wear firm bra with
- For production of breast milk
wide straps
Wash with tap water no • Increased major minerals and vitamins intake
soap to remove
colostrum *total iron needed is about 800-1000 mg
Place gause or breast About 500 mg is utilized for the expanding maternal
pads in bra blood volume;
Pendulous breast 300 mg is transferred to the fetus and placenta; 200
Dental care Gingibal tissue tends to mg is to replace natural losses in the skin, sweat and
hypertrophy hair.
Tooth decay Take with ascorbic acid in the form of fruit juices to
East freash fruits, veg enhance iron utilization and absorption
to avoid sugar - Ex. Pork liver (best source), soy beans, peanuts,
Perineal hygiene Increased vaginal green leafy vegetables, iron-fortified foods, egg
discharge
yolk
No douching
Dressing Maternity dress
No garters, high Common side effects of iron:
stokings 1 Constipation - advise woman to increase fluid
Moderate heels only and fiber in the diet
Sexual activity No coitus on expected 2. Dark stools - reassure woman that this is normal
date of period effect of iron pigments
Coitus may rupture 3. Nausea/gastric irritation - take iron after meal
membrane
With history of CALCIUM AND PHOSPHOROUS
• Recommended amount is 1,200-1,500 mg/day • Antioxidant
FUNCTIONS: • Prevents hemolysis of RBC
- Formation of fetal bones and teeth • RDA 10ug (pregnant) or 12ug (lactating)
- Production of breast milk •Ex. Vegetable fats, nuts, green leafy veg., egg
- Blood coagulation, neuromuscular ability and yolk, milk
muscle contractility
-If a woman cannot drink milk or eat milk products, VITAMIN B1 OR THIAMINE
she can be prescribed a daily calcium supplement For CHO metabolism by being involved in the
- Example : milk, cheese, leafy green vegetables release of energy from cells
**food sources of CHON and calcium are good •For normal nerve function
source of phosphorous •Promotes appetite
•RDA 1.5 mg (pregnant) 1.6 mg (lactating)
IODINE •Nuts, egg yolk, legumes, meat
• RDA is 175 ug
• For the formation of thyroxine VITAMIN B2 OR RIBOFLAVIN
• lodine deficiency- goiter (woman), For CHO metabolism
hypothyroidism in a fetus, thyroid enlargement in Healthy skin
fetus Converts tryptophan to niacin
• Seafood is he best source It is also involved in the released of energy from
ZINC cells
• For nucleic acid and protein metabolism RDA 1.6 mg (pregnant) 1.8 mg (lactating)
(important in early gestation) Cheese, milk, eggs, green leafy vegetables
• RDA 15mg (pregnant) and 19mg (lactating)
• Ex. Meat, liver, eggs and seafood VITAMIN B6 OR PYRIDOXINE
SODIUM • It is important in CHON, CHO and lipid
• Major electrolyte that acts to maintain fluid in the metabolism
body • It is also involved in the synthesis of heme
• Sodium should neither be restricted nor used compound
excessively • RDA 2.2mg (pregnant) 2.1 mg (lactating)
• Most processed and prepared foods are high in •Ex. Meat, liver, whole grains, green leafy
sodium vegetables
FLUORIDE
• Aid in the formation of teeth VITAMIN B12 OR CYANOCOBLAMINE
• Large amount causes brown-stained teeth •Maturation of RBC
VITAMIN K •Prevents megaloblastic anemia
• Antihemorrhagic, formation of clotting factors •Normal nerve and GIT function
VII, IX, and X in liver •Essential for DNA synthesis and cell division
• RDA 65 mg (pregnant and lactating) •RDA 2.2 mg (pregnant) 2.6 mg (lactating)
• Ex. Liver, green leafy vegetables, egg yolk, soy •Red meat, milk, nuts, legumes, egg, green leafy
beans, tomatoes veg
VITAMIN A
• Normal vision with main influence on the retina FOLIC ACID
Maintenance of skin and mucous membrane by • Maturation of RBC
aiding glycoprotein synthesis and tissues • Prevents megaloblastic anemia
differentiation • For normal cell division and DNA synthesis
• Help promote bone and teeth growth Prevents neural tube defect
• RDA 800ug (pregnant) 1300ug (Lactating) • RDA0.4 mg or 400 ug (pregnant) 280 ug
• Ex. Fish liver oil, egg yolk, yellow and green (lactating)
fruits and vegetables • Dark green leafy veg., whole grain, legumes,
VITAMIN D citrus fruits, liver
• Promotes calcium absorption
• Bone and teeth development NIACIN
• Deficiency of Vit. D is associated with tooth • Promotes iron absorption
enamel hypoplasia • For tissue integrity, resistance against infection
• RDA 10ug (pregnant) or 12ug (lactating) and promotes healing assisting in pro-collagen
• Milk, liver, egg yolk, fortified milk, exposure to formation
UV light • Antioxidants by reducing free radicals
VITAMIN E RDA 70 mg (pregnant) 95 mg (lactating)
• Citrus fruits, tomatoes

VITAMIN C OR ASCORBIC ACID

• Important in the release of energy from cells
• Promote iron absorption
RDA 7 mcg (Pregnant) 20 mcg (lactating)

FOODS TO AVOID IN PREGNANCY

1. Foods with caffeine
- It is CNS stimulant capable of increasing heart
rate, urine production in the kidney and secretion of
acid in the stomach.
- It causes mood swings thus it may interfere with
rest and sleep; filling and satisfying without being
nutritious
- found in coffee, tea, cocoa and soft drinks
- A daily intake of caffeine of two or three cups of
coffee has not been associated with low birth
weight, but excessive intake of caffeine should be
limited.
2. Artificial sweetener
- Use of saccharides is not recommended because is
eliminated slowly from the fetal blood stream
3. Weight loss diets
- May lead to fetal ketoacidosis, poor growth, and
possibly neurologic defects
4. Alcoholic beverages
- Increases the risk for mental retardation, behavior
and learning disorders and fetal alcohol syndrome
(FAS)
- Women who drinks 3 to 5 drinks per day