OBSTETRICS NOTE

Proliferation Phase
 Bata pa Estrogen (Female Hormone) is: LOW (Adrenal Gland)
 Puberty dapat: Up to Go with the bit of right hormones.
 Hypothalamus release: Gonadotrophin Releasing Hormone (GnRH)
 Anterior Pituitary Gland releases Follicle-Stimulating Hormone (FSH)
 Primordial Follicle young, but FSH’s high
 Add some more stimulation, turns to Graafian Follicle – Growth – “follicular fluid.”
 Then Estrogen will surge: To thickens the endometrial lining.
 Follicular Phase
 Estrogenic Phase
Secretory Phase
 Anterior Pituitary Gland now produce Luteinizing Hormone
 An egg embarks, Ovulation (Eggs will wait on the fallopian tube)
 Follicles become YELLOW, that’s Corpus Luteum (8 – 10 days life) – after expiration it turns white called
Corpus Albicans
 Contains Progesterone (Hormone of Pregnancy) – to keep endometrial lining intact.
 Pag di na fertilize…Menstruation (Menarche 9 – 16 years old)

Fertilization – If and egg and sperm units

Subfertility – Inability of couples to conceive 12 months and beyond.
Sterility – Permanent inability to impregnate.
Increasing Chances:
 Time: Ovulation
o Ovulation Kit: Detects LH
o Basal Body Temp: Drops then rise .5°F to 1°F
o Cervical Mucus: Spinnbarkeit
o Fern Pattern
 Frequency: Every Other Day
 Position: Man-Dominated
 Pre and Post-Coitus:
o No Lubricants
o No Douche
o Woman remain hips are elevated for 20 minutes.
 Diet:
o Complex Carbohydrate
o Moderate Protein
o Low-Fat
 Weight: Normal BMI
 Exercise: 30 minutes per day
 Extra: Hobby (Bowling and Ballroom)

Fetal Development:
Stages of Fetal Development (Oh, ZuMBa Pa! Eh Foodtrip Nanaman Ikaw!)
 Ovum
 Zygote – Fertilization
 Morula – Mitosis
  Blastocyst – Ready to implant “Trophoblast” releases HCG.
 Primitive Villi Formation – Chorionic Villi – Magiging part ng “Placenta” (16 – 20 weeks full formation)
 Embryo – Implantation Happens – Organogenesis (5 – 8 weeks)
 Fetus – 8 Weeks to Delivery
 Neonate – 0 – 28 Days
 Infant – 1 Month – 1 Year

Fetal Growth and Development

Average Length of Pregnancy: 40 weeks – 10 Lunar Months (4 weeks = 1 Lunar Month) – 9 Calendar Months
 FIRST Lunar Month: 4 Weeks
o Four weeks old
o Implanted (8 – 10 days average)
o Rudimentary Heart (Without function)
o Spinal cord formed: Fusion – Take Folic Acid
 (To avoid Neural Tube Defect: Spina Bifida, Meningocele, and Myelomeningocele)
o Three germ layers: All organs will be formed here.
 Ectoderm (Outer)
 Ears, Eyes, Nose
 CNS
 Touch and Taste
 Openings
 Mesoderm (Middle)
 Muscles
 Enamel of teeth
 Skeletal
 Organs (Repro, Circu, Kidneys)
 Endoderm (Inside) – “LOOB” 4L’s
 Lower Urinary (Bladders, Urethra)
 Linings (Sac)
 Lalamunang may Tonsil, Thyroid, at Thymus
 Lungs
 SECOND Lunar Month: 8 Weeks
o Sac – 6 weeks of pregnancy (Probable sign of pregnancy) return in 8 weeks.
o Extremities
o Contraction of heart – Fetal Heart Activity (Positive sign of pregnancy = no sound yet)
o Organogenesis complete – FETUS
o Noticeable face
o Digestive developing
 THIRD Lunar Month: 12 Weeks
o Tooth buds
o Hear – The Heartbeat
o Ihi – Formed in the kidney.
 “Wala pang ihi sa amniotic Fluid
 Amniotic Fluid Functions:
o Cushion
o Thermoregulation
o Fluid to drink
o Facilitates fetal movement.
  Maternal serum: Through osmosis and diffusion,
 Amount: Small amount
 Bawal pa mag amniocentesis (Chorionic Villi Sampling)
 Color: Clear as water
o Reflex – First reflex to appear = Babinski: Fanning of toes)
o Doppler – First instrument to use for fetal heart sound: 10 weeks to 12 weeks earliest.
 FOURTH Lunar Months: 16 Weeks
o Fetoscope (16 – 20 weeks), Fine Downy Hair (Lanugo) during term dapat konti nalang, pag post
almost absent na.
o Ordinary Stethoscope – Attempt to use (best to use in 5th month and beyond)
o Urine in Amniotic Fluid:
 Color: Slightly yellow tinged
 Strong yellow = Blood incompatibility
 Amount of AF: 200ml amniocentesis is possible (15 – 20ml extraction)
 Informed Consent
 Empty bladder
 UTZ
 No need admission
 Monitor: Contraction, bleeding, FHR, and Infection
o Reveal Gender
 FIVE Lunar Months: 20 Weeks
o Fetal Movement – Quickening (Felt by mother)
o Immunoglobulin G Transfer
o VErnix Caseosa – White cheese like substance in skin.
 Protection of the skin
 Thermoregulation (heat) – EINC: Bathing after 24 hours
 42 weeks: (+) Desquamation of skin
 SIXTH Lunar Months: 24 Weeks
o Scalp hair
o Sound
o Surfactant – Lungs: Prevents alveolar collapse during exhalation.
o Survival – Age of viability
 Presence of surfactant
 Weight > 500g
 SEVEN Lunar Months: 28 Weeks
o Scrotum descend; undescended: Cryptorchidism – prone to testicular cancer.
o Eye delicate – High O2 Administration could cause blindness.
o Vessels in retina
o Eye blinking peak
o Ninety Percent Survival
 EIGHT Lunar Months: 32 Weeks
o Extends when startled – Moro reflex (second reflex)
o Iron Stores – Used until 6 months of life.
o Grows Faster
o Hermit face gone
o Tips of nails at fingertips
  NINTH Lunar Months: 36 Weeks
o Near Term – Early Term: 37 – 38 weeks
o Increased Fats
o Nearly 100% Survival
o Turn Around
o Head Down
 TEN Lunar Months: 38 – 42 Weeks
o Term
o Engagement – Descend of fetus: Lightening – feeling of the mother.
o Nearing Birth – Up to 42 weeks; if >42 weeks: POST TERM: Decreased Placenta Functioning
 PLACENTA IMPORTANCE:
 Circulation
 Oxygen
 Nutrition
 Immunoglobulin
 Barrier (not all)
 Excretion
 Hormone production
Normal Pregnancy
Maternal Physiologic Changes
Sign and Symptoms
 Presumptive: Subjective Data
 Pains:
o Legs
 Normal: Cramps
 Cause: Low calcium, High Phosphorus
 Management: Dorsiflex the foot, extend the knee
 Prevent: Calcium supplements 1g/day
 Abnormal: Clot: DVT
 Cause: Uterine pressure
 Prevent:
 Ambulation
 Anti-embolism/elastic stocking (AM: Before getting out of the bed)
o If ambulated: Get her back in the bed and let the patient lie for 30
mins.
 Elevate
 Asses: Dorsiflex the food, extend the knee if pain is present (+) Homan’s Sign
 Management:
 Avoid H-A-M: Hot compress, Ambulation, Massage
 Call MD – Doppler – UTZ – Drug: Low molecular heparin – (if already an
embolus) Embolectomy
o Thrombophlebitis: Inflamed vein caused by clot
 S/X: Fever, chills, pain, redness, warmth
o Back
 Normal: Lower Back Pain
 Lordosis – “Pride of Pregnancy”
 Cause: Increased progesterone and relaxin
 Relaxes pelvic joints.
  Prevent:
 Stand Straight
 Support pillow when sitting
 Squatting
 Shoes “Low”
 Management: Pelvic Rock Exercise
 Abnormal: 4P’s
 Pre-term Labor
 Pain in urination: UTI
 Point pain: Vertebral rupture.
 Pahinga ineffective: Muscle strains
o Chest
 Normal: Heartburn/Pyrosis burning
 Cause:
 Sphincter is relaxed (caused by P-R: Prone to flatulence and constipation)
 Stomach is pushed upward. (By enlarge uterus
 Management:
 Small Frequent Feeding
 Sleep on the left side
 Support by “2” pillows – 2 hours to wait before lying down after eating.
 Avoid: KFC
o Kamatis
o Fried or Fatty food
o Citrus – Chili – Cola
 Medication:
o Magnesium Hydroxide
o H2 Blockers – “Tidine”
o Aluminum Hydroxide
o Head
 Normal: Mild, Occasional
 New-onset or New Type Management: Paracetamol
 Abnormal: Severe, Continuous
 Hypertension: S/X – Visual Changes

 Respiratory changes
o Stuffiness – Nasal Congestion
 Cause: Estrogen
o Shortness of Breath
 Cause: Enlarged Uterus
o Speedy Breaths – 18 – 20RR
 Cause: Enlarged Uterus
 Enlargement of breasts
o Blue Veins
o Readies Lactation – Hormones that prepares for milking: Progesterone and HPL
o Enlarge – Estrogen
o Areola Darkens
o Secretes colostrum – 16 Weeks – Hormones for production: Prolactin; Excretion: Oxytocin
o Tubercles Prominent – Montgomery
 Skin changes
o Striae Gravidarum – Stretch marks of pregnancy
 Only fades but will not disappear
 Cocoa butter lotion
o Kloasma (Chloasma) – Mask of pregnancy
 Face over the nose
 Only fades but will not disappear
o Increased pigmentation
o Nigra (Linea Nigra) - Vertical line mid-abdomen
 Urinary Frequency
o Increased GFR – Increased blood volume: 2nd trimester
 +1 Glucosuria
o High Hormones – Increased HCG, Decreased in 2nd trimester (Day 100th)
o Increased bladder pressure in 3rd trimester
 Morning sickness, Menstruation Cessation, Movement
o Quickening:
 Felt By: Mother.
 When: 5 months/20 weeks – Primigravida: 18 – 20 weeks, Multigravida: 16 weeks
 Peak: 28 – 38 weeks (Engagement, Decreased AF, Increased growth)
 Assess: Kick Count = 10 – 12 kicks per one hour (Average); if less than 10 – 12 per 2
hours (Abnormal)
o Morning Sickness:
 Cause: PHEG – Increased Progesterone, HCG, Estrogen, and Decreased Glucose
 Ba’t ka SAD – SAD – SAD?
 Small Frequent Feeding, Snack before bed
 Acupressure Band
 Dry toast/crackers
 Sour Ball
 Acupuncture
 Delay Breakfast
 Sips of carbonated beverage
 Avoid: (4s) Seasoned, Spicy, Sebo, Sudden Movements
 Doctor Notified: >1x, >12 weeks, <weight, <urine, Dehydration.
 Severe: Hyperemesis Gravidarum
 Risk for: Fluids and Electrolytes
o Menstruation Cessation: Amenorrhea
 Cause: Increased Estrogen
 Other Reasons:
 Anemia
 Anxiety
 Athletes
 Illness
 Infection
 Return:
 Breastfeeding: 3 – 6 months -> Lactational Amenorrhea Method
o Exclusive BF
o No Solid Food
o Never Menstruation
  Non-Breastfeeding: 2 – 3 months
 Palmar Erythema: Reddened and Itchiness
o Cause: Estrogen
 Tiredness:
o Cause:
 1st Trimester = Decreased Glucose
 2nd Trimester = Increased Blood Volume (Physiologic Anemia)
 3rd Trimester = Enlarged Uterus, Deprived Sleep
o Relax, Recommended Dietary Allowance Increase +300cal/day
o Enough Sleep
o Short Naps
o Take Break
 Fe: Iron Supplement: 2nd Trimester
 Pilli Teri Book: 27mg (15 – 30mg)
 WHO Recommendation: 30 – 60mg
 Total: 800mg – 1g
 Take with Vit C; Avoid Calcium and Magnesium
 Expect:
 GI Irritation: Take with snack/light meals preferably with Vit C
 Increase Constipation: Docusate Sodium
 Dark/Green Stool
 Folic Acid: 400mg/day
 Prevents NTD and Anemia
 Increased Salivation: Ptyalism
o Cause: Estrogen
o PICA: Eats inedible substances
 Eating psychiatric disorder
 Concerns:
 Lack of nutrition
 Fetus
 Vaginal changes, Varicosities
o Increased Secretion: white/colorless = Leukorrhea
 Cause: Estrogen
o Management:
 Perineal Hygiene (Front to Back)
 Cotton Underwear: Clean
 Varicosities:
o Cause: Uterine Pressure
 Prone to: Hemorrhoids, Pedal Edema, and Clot
o Management:
 Elevate Legs
 Elastic Stockings: Pantyhose, before going out of bed.
 Enlargement of Uterus/Abdomen
o Naegle’s Rule:
 Jan – March: +9 Months and +7 Days
 April – Dec: -3 Months, +7 Days, and +1 Year
o McDonald’s Rule:
 You need: Measuring tape
  1cm = 1 week – put 0 in symphysis pubis
 Accuracy: 20 – 32 or 34 weeks
o Bartholomew’s Rule: Landmarks
 Symphysis = 3 months/12 weeks
 Umbilicus = 5 months/20 weeks
 Xyphoid = 9 months/36 weeks
o Postpartum: Return of uterus to its pre-pregnancy state = Involution
 This has to achieve within 6 weeks
 Requirements to achieve involution:
 Contractions
 Ambulation
 Nutritional Status
 If not achieved in 6 week it’s called Subinvolution
 At the day of birth uterus should be at the level of umbilicus:
 Descend of 1 fingerbreadths is equal to 1cm per day
 Day 10: No longer palpable (BUT IT DOESN’T MEAN IT’S THE USUAL)
 If the question is where is the level of uterus after an hour of delivery:
 Between Symphysis and Umbilicus
 If tilted in one side it means the Bladder is full
 Management: Void/Catheter
o Perinatal: AOV = 20 – 24 weeks up to postpartum

 Probable: Objective Data

o Positive serum PT
 Hormone: HCG
 Created by: Chorionic Villi
 Accuracy: 95 – 98%
 Present: 1 – 2 Days after fertilization
 Declines: 100th day (2nd trimester)
 Absent: 1 – 2 weeks after delivery (Retained placental fragment)
 Types:
o Qualitative: Yes or No answer
o Quantitative: Numerical data on PT
o Reported urine PT: Accuracy: 97 – 99%
 Avoid late reading: False Positive
 Best done in first urine: False Negative
 Concentrated urine: False Negative
 Don’t take methadone/chlordiazepoxide: False Positive
 Expiration date: False Positive
o Outline felt by Nurse
 When: 3rd Trimester
 Why PROBABLE: Tumor with calcification
 Leopold’s Maneuver: Palpation
 Not painful
 Empty Bladder
 Warm Hands
 Provide Privacy
  Grip 1: Fundal Grip
 Where: Superior of fundus
 What: If head (round, hard, movable)/buttocks(round, soft, with mass)/back
(broad,hard)/small parts (small, scattered part)
 Why: Presentation – Fetal part in birth canal
 Grip 2: Umbilical Grip
 Where: One hand on one side of the uterus
 How: Palpate other side top to bottom
 What: Fetal back (broad, hard) = Point of Maximum Impulse
 Why: Position
 Best and Fastest: ROA/LOA; If ROP/LOP: It’s painful and prolonged
 Grip 3: Pawlick’s Grip
 Where: Above symphysis
 How: Grasp between thumb and fingers
 What: Movement, Consistency
 Why: Engagement – Descend of Fetus: 0 Station (Ischial Spine felt during I.E)
o Best Engagement Exam: Vaginal Exam
 -3 and -4 “Above Ischial Spine” is called Floating
 +3 and +4 “Below Ischial Spine” is called Crowning
o Amniotomy -> Artificial ROM – WOF: Cord Prolapse -> Cord Compression -
> Monitor: FHR Deceleration
 Grip 4: Pelvic Grip
 Where: Both sides of uterus 2 inch above inguinal ligaments
 How: Press downward and inward
 What: Degree of flexion/extension
 Why: Attitude
o BAllottement: “Balloter” to quake
 Bimanual Palpation
 One hand: (Vaginal Exam) Tap the cervix
 Other hand: Abdomen of the patient
 Bouncing of Baby: Against amniotic fluid (Passive Movements)
 When: 4 – 5 months
o Braxton Hicks, Bluish Vagina
 Braxton Hicks Contraction:
 Do not cause true labor
o True Labor:
 Contractions intensify
 Dilation of cervix
 Show: Mucus plug
 Painless to Painful: False Labor
 Placenta Perfusion
 Present throughout Pregnancy
 Practice/Preparation: “Rehearsal”
 Starts: 12 weeks, noticed in 2nd trimester; stronger in 3rd trimester.
 Bluish Vagina: Chadwick’s Sign
 Vascularity: Caused by estrogen
 Vagina
  Violet
o Lower uterine softening:
 Fundus: Top most part of uterus
 Corpus: Body of uterus
 Isthmus: Lower segment of uterus
o Softening of Cervix: Goodle’s Sign
o Softening of Uterus: McDonald’s Sign
o Softening between Isthmus and Cervix: Ladin Sign
 Sixth week
 Second missed period
 Soft and thin
 Sign of “Hegar”
o Evident Sac
 What: Characteristic Ring in UTZ
 When: 4 – 6 weeks
 UTZ:
o 1st Trimester: Confirm/Diagnose
o 2nd Trimester: Congenital Anomaly Scan, Gender, Placenta Implantation,
Amniotic Fluid
o 3rd Trimester/Labor: Presentation, Position, Maturity
 Biparietal Diameter (>8.5cm)
 Head Circumference (>34cm)
 Femoral Length
 Placental Grading (Grade 3) – Calcium
o Preparation:
 Educate
 Pain? No
 Duration? Short
 Bladder: Full to stabilize uterus (1 glass every 15 mins x 90 mins)
 Position: “Supine” (BUT DON’T FORGET WE DO NOT PUT
PREGNANT TO SUPINE POSITION) so put rolled towel in the right
hip to prevent: Vena Cava Syndrome and Supine Hypotension
Syndrome.
 Amniotic Fluid:
o Average: 500 – 1000ml
o Oligohydramnios: <200ml – Kidney Defect
o Polyhydramnios: >2000ml – GIT and DM
 Positive:
o Heartbeat of fetus heard by examiner
 Rate: 120 – 160bpm
 Point of maximum impulse: Upper Fetal Back
 If less than 120bpm check whether you’re getting the maternal pulse via
pulsating the radial pulse while auscultating the abdomen.
 Non-Stress Test: Requirements
 Fetal Heart Rhythm (UTZ/CTG)
 Fetal Movements (UTZ/CTG)
 Acceleration with Fetal Movement (Increase HR at least for 15 beats in 15
seconds duration)
  REACTIVE
 Contraction Stress Test: 1 minute interval; not more than 1 min contraction
 Fetal Heart Rhythm (Pattern)
 Contraction: Nipple Stimulation = 1 occurrence every 10 mins lasting for 40 secs.
 Deceleration (Decrease HR)
o Early Deceleration – During Contraction: Head Compression
o WE DO NOT WANT TO SEE 50% LATE DECELERATIONS
o POSITIVE = MORE THAN 50% L.D; NEGATIVE = LESS THAN 50% L.D
o Outline UTZ
 When: 8 Weeks AOG
 When will we consider the meconium stain (Green A.F) as normal? Breech, Post-
term, and “Episodes of Hypoxia”
o Movements felt by Examiner
 CHECK FIFTH LUNAR MONTH
 Primigravida: 18 – 20 weeks
 Multigravida: 16 weeks
 GENERAL: 20 weeks
o Skeleton in X-Ray: Avoid Radiation
 When: Bone Ossification starts 12 weeks AOG (End of 1st trimester)
 Mineral needed: Calcium 1g/day
 Vitamin D: 600 IU/day – Fat Soluble
 Duration of Pregnancy
o EDB OR EDD VS EDC
 280 days (263 – 294 days)
 40 weeks (38 – 42 weeks)
 9 Calendar Months
 10 Lunar Months from time of ovulation
 Psychological Changes of Pregnancy
o First Trimester: Accept Pregnancy
 Emotion: Ambivalence – feeling both pleased and not pleased about the pregnancy
“mood swing”
 How to help: Ultrasound
o Second Trimester: Accepting the Baby
 Emotion: Narcissism or Introversion
 Happens at: Quickening
 Calls baby from “it” to: He/She
o Third Trimester: Preparing for Parenthood
 Emotion: Impatience
 Nest-Building
 Name
 Nappies
 Natal Prep
Abnormal Pregnancy
Gestation Hypertension
 Pregnancy Induced Hypertension (PIH): Hypotension can only be considered normal (only at 2nd
trimester)
o Hypertension is never normal in pregnancy.
o Why: increased blood volume 40 – 50%
 o After pregnancy BP should return to normal
 Peak ng Blood Volume: 2nd trimester
 Pero dapat, BP: Di mag climb
 Ugat na-damage ng ibang patient abnormal yan
 Pregnant should not have it.
o Assessment:
 Systolic +30; Diastolic +15 indicates Hypertension in pregnancy
 Taken twice and should be at least 6 hours apart.
o Diagnostic and Treatment:
 Pag tumaas ng 140/90 ang BP
 Or systolic ay +30
 Diastolic ay +15
 Prescription:
 Avoid – ACE inhibitors “pril”it causes fetal kidney damage
 Labetatol – Beta Blocker
 Nifedipine
 Hydralazine – Potent Vasodilator
 Nursing Consideration:
 Monitor BP and RR
o High BP = Poor Circulation – Affected Kidneys – Causes Proteinuria – Oncotic/Osmotic Pressure
– Hypoalbuminemia – Generalized Edema
o If there is hypertension in pregnancy check the urinalysis, because there is an affected kidney
and proteinuria check it may indicates: PRE-ECLAMPSIA
 Pre-Eclampsia
o Assessment:
 I will assess pag manas ang: Face
 Edematous sa: Start ng day
 Protein traces sa kanyang ihi
 From high BP, nagmalfunction: Kidney
o Check For:
 Proteinuria: Mild = +1, +2; Severe = +3, +4
 Renal Involvement
 Edema – Generalized: Mild = +1, +2;
 Severe = +3, +4 – Cerebral Edema – Cerebral Irritation = Seizure
o Prevent Via:
 Eliminate bright lights/noise: Private – Dim Lights
 Convulsion should be prevented
 Lower the BP: Lab-Ni-Haydee
 Assess V/S Hourly: 160/110 and higher = Severe
 Deep Tendon Reflex: Hyperreflexia (Severe)
o Normal: 2
 Magnesium sulfate to prevent seizure
 Protein Intake – Mild: Regular Protein; Severe: Increased Protein
 Sodium Intake – Moderate (Limit but not restrict)
 I and O – Always +30ml hourly: Oliguria is a sign of severe pre-eclampsia = prone to
magnesium sulfate toxicity
 Assess the Fetal Well-being
o Drug of Choice:
  Magnesium Sulfate:
 Reduces Edema
 CNS Depressant
 Muscle Relaxant
 Therapeutic Range:
o 5-8mg/dl – check 6 – 8 hours
 Urine Output:
o 30ml/hr
 DTR : Normal – 2
 RR: cut-off 12 consult, below 12 STOP
 > 25 mg/dl = Cardiac Arrest
 Antidote: Calcium Gluconate
 Eclampsia: Most Severe Gestational Hypertensive Disorders 20% Mortality Rate
o Ensure safety – Padded side-rails, lowest position bed.
o Convulsion Drugs – IV Diazepam or Valium
o Left Side – Drain the secretions (Best position for pregnancy)
o Assess Fetus
o Magnesium Sulfate
o Progress of Labor
o Spo2: Give 6 – 10lpm via facemask.
o Instruct NPO: Deliver the baby.
o Assess Bleeding: HTN can detach placenta.
 Birth for Eclampsia:
o Decide in 12 – 24 hours (AOV Reached)
o Preferred Delivery: NSD
o Why not CS?
 Contraindicated to severe HTN
 Retained Lung Fluid = CS babies
 HPN under GA
 Bleeding in Pregnancy:
 Any bleeding in pregnancy no matter how small the amount is we always need to: REFER
st
o 1 Trimestral Bleeding:
 A. Abortion: Loss of pregnancy before reaching AOV
 Causes:
o Developmental Problem: Teratogenicity, Chromosomal Aberration
o Implantation: Implantation Abnormality, Decreased Progesterone
o Maintenance: Infections, Immunologic
 Increased Deoxycorticosterone
 Decreased Immune System
 Diagnostic:
o HCG Level: Decreased
 1st trimester: Doubles x 48H
o Ultrasound
o Heartbeat: Diminished
 Surgical Intervention: For below 14 weeks AOG
o Dilatation and Curettage
o Dilatation and Evacuation
o Suction Curettage
  Medical Management: For above 14 weeks AOG
o Misoprostol – Prostaglandin (E2)
 Ripens Cervix
 Uterine Contraction
o Oxytocin – Contraction (Should not be administered if cervix is not yet
ripe)
o Mifepristone – Progesterone Antagonist
 Types of Abortion:
 Threatened 50-50%
o Assessment:
 Cramp
 Bleeding
 Closed Cervix
o Nursing Consideration:
 AVOID:
 Strenuous Exercise – 2 Days
 Sex – 2 Weeks
 Tampon
 Imminent Inevitable
o Assessment:
 Cramp
 Bleeding
 Open Cervix
o Diagnostic:
 H.U.H
o Management:
 Surgical or Medical
o Nursing Consideration:
 Save: Pads, Clot, and Tissue
 Rule out H-Mole – Assess Bleeding – Choriocarcinoma
 Complete
o Assessment:
 All products of conception are expelled.
 Fetus
 Placenta
 Membrane/Sac
 No Medical and Surgical Management:
 Bleeding slows in 2 hours and stops in days.
 Nursing Consideration:
 Report heavy bleeding
 Incomplete
o Assessment:
 Not all productions of conception are expelled.
o Management: Medical or Surgical
o Nursing Consideration: Clarify
  Missed: Early Pregnancy Failure
o Assessment:
 Silent Symptoms
 Slight Cramping
 Spotting
 Stopped growing
 Stopped heartbeat
o Diagnostic: H.U.H
o Management: Surgical and Medical
o Nursing Consideration: Clarify
 Recurrent Pregnancy Loss: Habitual Abortion
o Assessment: 3 consecutives spontaneous
o Causes:
 Autoimmune
 Blood flow resistance to uterus
 Chorioamnionitis
 Defective Sperm/Egg
 Endocrine Factors
o Nursing Consideration: Clarify
 B. Ectopic Pregnancy: Implantation outside the uterine
 Types of Ectopic:
o Cervix Pregnancy
o Ovary Pregnancy
o Abdominal Pregnancy – Abdominal organs
o Tubal Pregnancy – Fallopian Tube (MOST COMMON: 95%)
 WOF:
o Shock
o Peritonitis
 Classic Triad:
o Amenorrhea
o Pain (Sharp, Unilateral)
o Vaginal Bleeding (Scanty)
 Diagnostic: Ultrasound
 Management:
o Spontaneously end -> reabsorbed
o Methotrexate
 If ruptured – EMERGENCY!!
o Laparoscopy
nd
o 2 Trimestral Bleeding
 Hydatidiform Mole (Gestational Trophoblastic Disease)
 Cause: 46 chromosome – Androgenesis (Father’s 23/23 chromosome)
o Mother’s Chromosome: inactive/absent
 Assessment:
o Fundic Height is Larger
o Fast Fresh flow: Four months/16 weeks
o Fluid filled clear vesicles/grape like
o Peaked HCG
o Prune-juice bleeding
 o Pattern: Snowflake pattern without fetal growth
o PIH: 1st trimester
 Management:
o Suction Curettage
o WOF: Heavy Bleeding
 Teaching:
o HCG Level: Check
o 2 Weeks: Return
o Normal: Check during biweekly return
o Monthly: Bantayan
o 1: up to 1 year monthly check up
o P – P – P = Prevent pregnancy, use pills
o Choriocarcinoma (5:53)
 Cervical Insufficiency: Premature cervical dilation/Incompetent cervix
 Cause:
o Age (Advanced)
o Biopsy
o Cervical trauma
o Defect
 Assessment:
o Painless Dilatation
o Pink Show (Mucus Plug)
o Pressure (Contraction)
o Premature Rupture of membrane
o Progress of Labor
 Diagnostic:
o Ultrasound
 Management:
o Cerclage – Suture of the cervix
 McDonald (Nylon) /Shirodkar (Mersilene Tape)
 12 weeks after UTZ
 NSD: Removed 37 weeks before term
 CS: During Delivery
o 3rd Trimestral Bleeding:
 Previa: Low implantation of placenta
 Bleeding Cause:
o Advancing Uterus: 3rd Trimester
o Braxton Hicks: 3rd Trimester
o Cervical Dilatation: Bright Red Bleeding
 Painless
 Assessment:
o Painless
o Red Bleeding
o Evaluate: UTZ (Abdominal)
o Vital Sign is assessed for shock
o I.E is not allowed – Massive Hemorrhage
o Assess fetus
 Management:
 o Under 30% - NSD, Above 30% CS
o Vaginal Exam (IE) Only if 3D’s
 Doctor
 During Delivery
 Double Setup
 Abruptio: Premature separation of a normally situated placenta.
 Normal: 3rd Labor Stage Separation
 Cause:
o Advanced Age
o Brown/Dark Bleeding
o Rigid upon palpation
o Uterus “tender”: Sharp, upper pain
o Premature Separation
o Trauma, Tension: HTN, Pre-Eclampsia,
o Intravascular Coagulation (DIC): Increased clotting -> embolism
o Occult/Hidden/Concealed
o No I.E, No Rectal Exam, No Abdominal Exam
 Diagnostic:
o Ultrasound
 Preterm Labor: Less than 37 weeks
 Cause:
o Dehydration
o Drugs
o Amnionitis
o Twins, Triplets
o Trauma
o Illness
o Tension
o Infection – UTI (Most Common)
 Stop Labor if NO
o Blood + Water is 50% “Red”
 Drugs:
o Tocolytics: Stop Contraction
 Magnesium Sulfate
 Indomethacin
 Nifedipine – Calcium channel blocker
 Terbutaline – Beta 2 Agonist (Direct uterine relaxation)
o Corticosteroid
 IM: Betamethasone and Dexamethasone
 To Increase surfactant
 2 doses, 12mg and 24 hours apart
o Preferred Delivery: CS to prevent fetal head pressure that cause
subdural/intraventricular hemorrhage
 Accreta Spectrum: Morbidly adherent placenta/deeply implanted.
 Separation of placenta: 5 – 15 minutes (Maximum: 30 mins) more than = report
 Types:
o Accreta: Attached to myometrium
 Manual Removal
o Increta: Invades myometrium
 OR: Hysterectomy
o Percreta: Penetrates myometrium
 OR: Hysterectomy
o Emergency Interventions:
 Bleeding Assessed: BT – Ready
 Left Lateral
 Evaluate Mother: VS q5 – 15 mins
 Eval Fetus: FHR
 Do not IE: 3rd Trimester
 I and O: Every 1 hour
 NPO
 Give O2: 6 – 10lpm, IVF – Crystalloid: LR, NSS = 2 Large bore
catheter
o Abnormals in Pregnancy:
 Absent/Decreased Fetal Movement
 Bleeding
 Nasty Urination
 Ocular Changes
 Risk in Health
 Multiple Gestation
 Abdominal Pains
 Leak Bag of Water (Preterm): Infection
 Loss of Weight:
o 1st Tri: 1kg total
o 2nd Tri: 1lb – 2lb/week
o 3rd Tri: 1lb/week
 Severe Nausea and Vomiting