1.

Introduction to NCM 109

Reyes || February 14, 2022 SUBJECT
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name

OUTLINE MATERNAL MORTALITY: BY MAIN CAUSE

Number, Rate/1000 Livebirths & Percent Distribution
Legend: Philippines, 2017
Remember Previous Trans
(Exams)
Lecturer Book
Trans Comm 1. Obstetrical history – pregnancy history
2. Psychosocial risks - maternal behaviors
     3. Lifestyle - smoking, alcoholic, caffeine ingestion
4. Drugs - increases the chance of birth defects, premature
Heading 1 babies, underweight babies, and stillbirths.
A. Heading 2 5. Psychological status - intrapsychic disturbances; disturbed
state of mind
• The quick brown fox jumps over the lazy dog 6. Stress - can increase the chances of having a premature baby
o The quick brown fox jumps over the lazy dog (born before 37 weeks of pregnancy) or a low-birth weight baby
▪ The quick brown fox jumps over the lazy dog 7. Type of work - time ( > 10 hrs, lifting heavy objects, prolonged
• The quick brown fox jumps over the lazy dog standing at work, work-related stress, non-daytime shift disrupts
sleep)
1. Heading 3
Biophysical Risk
MATERNAL MORTALITY: A GLOBAL Factors in Pregnancy
TRAGEDY
- Annually, 585,000 women die of pregnancy-related Socio-Demographic Risk Factors in Pregnancy
complications. 1. Low income
2. Lack of Prenatal care
• 99% in developing countries 3. Age ( < 18 yrs. or > 35 yrs)
• 1% in developed countries 4. Parity (> 5 pregnancies)
5. Marital Status
MATERNAL DEATHS 6. Residence
20-25% deaths occur during pregnancy 7. Ethnicity
40-50% deaths occur during labor and delivery
25-40% deaths occur after childbirth (more during the first 7 days)
DANGER SIGNS of Pregnancy
- Although most danger signs of pregnancy occur toward
What is the maternal mortality in the Philippines? the end of pregnancy, women need to know about them
- 1 maternal death per 1,000 livebirths at the early stage. Nurses must emphasize that if one of
the danger signs occur, it should serve merely as a
What is maternal mortality ratio? signal of the possibility that something may happen.
Maternal mortality ratio is the number of women
DANGER SIGNS of Pregnancy
-

who die during pregnancy and childbirth, per ❖ Spotting or Vaginal bleeding
100,000 live births. ❖ Persistent vomiting
❖ Chills, headache and fever
❖ Clear fluid discharges from the vagina
- Maternal mortality ratio is the number of women who die ❖ Abdominal or chest pain
during pregnancy and childbirth, per 100,000 live births. ❖ Pregnancy induced hypertension
https://drive.google.com/file/d/1-w- ❖ Absence, Increase or decrease in fetal movements
HGmigOQe18auHk2wU54mgTHg_bdwv/view?usp=sharing ❖ Anasarca (generalized edema)
- National Safe Motherhood Program ❖ Dysuria (painful urination)
https://doh.gov.ph/national-safe-motherhood-program ❖ Visual changes, overwhelming tiredness
❖ Breathing problems, thoughts of hurting self/baby
- https://bit.ly/3uIovI4
(Proceed to chapter 2 – pages 21 to 30) TERATOGENS
- To reach maturity with optimal health, a FETUS needs
Risk factors in pregnancy: sound genes and a healthy intrauterine environment that
1. Genetic – family history protects the fetus from the influence of TERATOGENS.
- TERATOGENS are any factor (chemical or physical) that
2. Biophysical risks
adversely affect the fertilized ovum, embryo or fetus.
– originate from the mother or fetus
3. Nutritional status
– 20% of underweight or overweight pregnant mothers. 3 FACTORS that Influence the Amount of Damage
Caused by Teratogens
1. The strength of the teratogens
Example:
Prenatal Radiation Exposure
- Exposure to radiation in small amount can cause NO
damage but frequent and/or large doses of radiation can
cause serious fetal defects.
Page 1 of 3
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

Other Infections that are Teratogenic:

2. The teratogen’s affinity for a specific tissue. ❖ Rubeola (Measles)
Example: ❖ Mumps
Lead – attacks & disables the nervous system ❖ Varicella
Tetracyclines – when taken during pregnancy may affect tooth ❖ Poliomyelitis
and bone development in the unborn baby. ❖ Influenza
Taking tetracycline during the last half of pregnancy can cause ❖ Viral Hepatitis
permanent tooth discoloration later in the baby's life. ❖ Coxsackie virus

3. The timing of the teratogenic insult. Rubella

The time the teratogen was introduced to the body. - Also called German Measles
- If the teratogen is introduced before implantation, the zygote will - A communicable viral disease characterized by swollen
be destroyed glands caused by rubella virus
- If the teratogen is introduced during implantation the fetus is - Mother experience mild rashes and mild systemic
vulnerable to injuries. illnesses but the teratogenic effects on the fetus can be
- If the teratogen is introduced late pregnancy, there is less devastating.
potential for harm because is already formed. - Fetal damage that occurs like deafness, IUGR, dental &
facial clefts, cataracts, mental & motor challenges,
cardiac defects (commonly PDA & pulmonary stenosis),
Implantation thrombocytopenia purpura
- A woman should undergo Rubella immunization 3
TERATOGENIC MATERNAL INFECTIONS months before pregnancy
- Infections that involve either sexually transmitted or
systemic infections. Cytomegalovirus
- The organisms of these infections might be viral, - (CMV) is one of the Herpes virus, transmitted by droplet
bacterial or protozoan and that it crosses to the placenta. infection from one person to another.
- The woman may not experience serious symptoms on - If a woman with CMV infection during pregnancy & if the
the disease yet but might give serious injury to the fetus. virus crosses the placenta; the infant will be born with a
severe neurological challenge (hydrocephalus,
TORCH microcephaly, spasticity); eye damage (optic atrophy,
- TORCH Syndrome this refers to any of a group of choriorenitis); deafness or chronic liver disease
infections in newborns due to one of - The child’s skin may be covered with large petechiae
the TORCH infectious agents having crossed the (“Blueberry – muffin lesions”)
placenta during pregnancy. - No treatment for this infection exists.
- Prevention from exposure to droplets and thorough
The acronym TORCH refers to: hand washing before & after eating is important.
(T)oxoplasmosis - Herpes Simplex Virus is also called Genital Herpes
(O)ther Agents infection. It has systemic involvement.
(R)ubella (or German Measles) - The viruses spread into the blood stream (viremia) and
(C)ytomegalovirus crosses to the placenta to the fetus.
(H)erpes Simplex - If the infection occurs in the First trimester, severe
congenital anomalies or spontaneous miscarriages will
TORCH Screen occur.
- is group of blood tests to determine whether these infections - If the infection occurs in the 2nd and 3rd trimester, there
exist in either the pregnant woman (to identify the fetal risk is a high incidence of Premature birth.
factors) or the newborn (to detect if antibodies against the
common infectious teratogens are present) Herpes Simplex Virus
- Teratogenicity of Cigarettes
TOXOPLASMOSIS - A pregnant woman who is a cigarette smoker shows
- A protozoan infection caused by contact with uncooked meat or teratogenic effect on the fetus most commonly with
handling of animals like cats. growth retardation.
> A woman infected with this has no other symptoms - Other teratogenic of effects of cigarette smoking is low
except body malaise and a posterior cervical lymph- adenopathy birth weight in infants resulting from the vasoconstriction
and if it crosses to the placenta, will cause central nervous of the uterine vessels which is an effect of nicotine that
system damage to the fetus like hydrocephalus, microcephaly, limits the blood supply to the fetus.
intracerebral calcification and retinal deformities.
Pyrimethamine – an antiprotozoan agent is the drug of choice. Teratogenicity of Alcohol
- Pregnant women consuming large amount of alcohol
show high congenital deformities like: craniofacial
Toxoplasmosis methods of contact: deformity
1. Cleaning the cat's litter box when the cat has shed toxoplasma (short palpebral fissures, thin upper lip and upturned nose)
in its feces cognitive impairment as a result of the mother’s poor nutritional
2. Touching or ingesting anything that has come into contact with status.
cat feces that contain toxoplasma gondii - Women should completely abstain from alcohol during
3. Accidentally ingesting contaminated soil (e.g., Not washing the period of pregnancy.
hands after gardening or eating unwashed fruits or vegetables Is any amount of alcohol safe during pregnancy?
from a garden
4. Mother-to-child - There is no known safe amount of alcohol use during
pregnancy or while trying to get pregnant. There is also
Page 2 of 3
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
no safe time during pregnancy to drink. All types of
alcohol are equally harmful, including all wines and beer.

Teratogenicity of Drugs

Principles to be observed when taking drugs while pregnant:

1. Pregnant women should not take any drugs or food
supplement not specifically prescribed or approved
by the physician or nurse- midwife.
2. A woman on a childbearing age and has the ability to
get pregnant should not take drugs unless they are
prescribed by the physician

Environmental Teratogens
- Radiation has been proven to be a potent teratogen to
unborn children because of high proportion of rapidly
growing cells present.
-
Common examples of Chemical teratogens:
1. Metal and Chemical Hazards – carbon monoxide from
a motor vehicle exhaust.
2. Lead poisoning from paints and plastics

Page 3 of 3