MATERNAL

Male Reproductive Organ

4 parts of the Fallopian tube:
1. Infundibulum
2. Ampulla
3. Isthmus
4. Interstitial
Uterus Layer:
1. Endometrium
2. Myometrium
3. Perimetrium

Puberty
- Development of secondary sex characteristics
- Theory: weight of 95 lbs (43kg) → GnRH
Female:
• Menarche: 1st Menstruation flow
• Thelarche: Mammary Gland Duct
Male:
• Gynecomastia
• Adrenarche: closure of the epiphysis plate → halt growth

MENSTRUAL CYCLE
Characteristics:
1. Age of menarche - 12.4 yrs., 9-17 yo
2. Internal/cycle of flow - 28 days, 23-35 days
3. Duration of flow - 4-6 days, 2-9 days
4. Amount of flow - 30-80 mL, 11g of iron loss
5. Color and Odor - dark red, no clots, similar to marigold
Related Terms:
Menarche - 1st menstrual flow
Amenorrhea - absence
Dysmenorrhea - painful
Menopause - cessation of menstruation w/ average of 51 yrs old
Menorrhagia - heavy bleeding during menstruation, >80mL
Metrorrhagia - 2 times bleed between cycle

FEMALE REPRODUCTIVE CYCLE

Hypothalamus Gonadotropin Releasing Hormone
Anterior Pituitary Gland Follicle Stimulating Hormone
Luteinizing Hormone
Ovary Estrogen & Progesterone
Uterus ↓E&P

Hypothalamus APG Ovary Uterus

1-4 G FHS Follicular Phase 1.Menstruation
days -growth of follicles
6-14 n -one large Graafian 2.Proliferative
days Follicle → estrogen -proliferation of endometrial
lining.

14-26 R LH Luteal Phase 3.Secretory

days -release of ovum -thickest layer
“ovulation” -Corkscrew appearance

27-28 H Corpus luteum 4.Ichemic

days -progesterone -degeneration of endometrial
lining
*Mittelschmerz
-pain during ovulation

*Spinnbarkeit
-cervical mucus
stretches for at least
1 inch

FAMILY PLANNING
- DOH: 3-5 yrs birth spacing
- Desired # of children & use of safe & effective method.

SECCA:
• Safe
• Effective
• Convenient
• Compatible
• Available
1) Natural Methods
a. Abstinence -100%
b. Lactation Amenorrhea Method (LAM)
Infant is:
- <6 months of age
- Totally breast feed
- Menstruation has not returned
c. Coitus Interruptus
d. Calendar Method
e. Basal Body Temperature
- ↓0.5⁰F Day before
- ↑0.2⁰C/32⁰F during ovulation
f. Cervical Mucus Method
- Thin, transparent, spinnbarkeit property
g. Symphothermal Method
- BTT + CCM

2) Barrier Method
a. Spermicide
b. Condoms
• HIV: Latex Condom
• Latex Allergy: Natural Lamb Condom
c. Diaphragm vs. Cervical cap
-fits tightly -fits snugly
-24hrs -48hrs
Complication: Toxic Shock Syndrome
1. Unexplained High Fever
2. GI Disturbances
3. Muscle Pain

3) Hormonal Imbalance
a. Oral Contraceptives
1. Combination OC – mix of synthetic E & P

Rules:
• Take 1st pill during 1st day of cycle: 21 active pills, 7 placebo pills
• Fertile 1st 7 days, use other contraceptive methods
• 24hr interval, 2-3hrs window period
2. Progestin Only Pills
- Ovulation
- Thick cervical mucus, thin layer of endometrial lining
b. Transdermal Patches
- Arms, trunks, buttocks
- 3 patches
1 patch = 1wk
c. Subdermal Implant
- 3 yrs
d. IM Injection “Depo Provera”
- 3 months/12 weeks
e. IUD - creates local inflammation to precent implantation
Copper vs. Hormonal
-10yrs -5yrs
STAGES OF FETAL GROWTH & DEVELOPMENT “PozEF”
1. Pre-embryonic
• Ovum: Ovulation to fertilization aka fecundation, impregnation, conception
• Zygotic: Fertilization to implantation aka nidation
o 8-10 days
o Site: Upper posterior portion of uterus
2. Embryonic
• 3-8 weeks → organogenesis
3 germ layers:
1. Ectoderm - CNS
2. Mesoderm - Heart
3. Endoderm – GI

3. Fetal
• 9 weeks to birth
• Age of viability
- Earliest age of fetus to survive in the extrauterine life
- 20-24 weeks
- >500g - 600g

HORMONES DURING PREGNANCY

1. HCG - “1ST Hormone of Pregnancy”
• Fail-safe measure to ensure corpus luteum functioning
• ↓ maternal immunologic response
2. Progesterone – “Hormonal Pregnancy”
• Maintains endometrial lining
• Reduces contractility of smooth muscle
3. Estrogen “Hormone of Women”
• Development of secondary sex characteristics
- Breast: promote lactation
4. Human Placental Lactogen (HPC) /Somatomammotropin
• Growth-promoting
• Lactogen properties
• ↓ insulin sensitivity
5. Relaxin
• Relaxes and increase mobility of pelvis, joints, ligaments

Supporting Structures
1. Amniotic Membrane – supports the embryo
• Chorion – outer
• Amnion – inner
o Amniotic fluid function:
- Protection
- Thermoregulation
- Supports growth
- Facilitates fetal movement
o Normal weight: 500 – 1000 mL, 800 – 1200Ml
• <500mL → oligohydramnios → renal problems
• >1000mL → Polyhydramnios → TEF, EA
2. Umbilical Cord – support circulation
• Normal: AVA
• Abnormal: VAV
- Congenital Heart Defects
 3. Placenta – “Endocrine Organ of Pregnancy
- Produces hormones
- Exchange of waste, nutrients, gases
PHYSICL SIGNS & SYMPTOMS
Presumptive Probable Positive
• Subjective data • Objective data • Confirmatory
• Patient, mother • Nurse • Machine

• Breast Changes • Hegar’s sign • FHT

• Amenorrhea - Softening of the 3 months – doppler
• Urinary Changes uterus 4 months – fetoscope
• Nausea & Vomiting • Chadwick’s sign 5 months - stethoscope
• Quickening - Bluish, purplish, • Ultrasound
- Movement felt of discoloration of • MFE
the mother vagina - Movement felt by the
• Goodell’s sign Examiner
• Choalasma Nonpregnant - nose
- Mask of Pregnant - earlobe
pregnancy Labor - butter
• +HCG
• Ballottement
• Braxton Hicks’s

PSYCHOLOGICAL TASK
Trimester Task Maternal Changes
1 Accepting Pregnancy Organogenesis → Critical Period
• Ambivalence
- contradiction feelings Thalidomides
Epileptic Medications
Retinol Vit. A
ACE Inhibitors
ARBS
Third Element Lithium
Oral Contraceptives
Warfarin
Alcohol
Sulfonamide

Torch Infections
Toxoplasmosis
Others, STD
Rubella
Cytomegalovirus
Herpes
2 Accepting the baby Most comfortable, easiest
• Narcism ↑libido
- Appearance
• Introversion
- Focus on one-self &
body to protect the
child
3 Preparing for Childhood & Period of unattractiveness
Parenting ↓ self-esteem
• Nesting
- Overwhelming desire
to prepare home for
the arrival.
ANTEPARTUM CARE
- Care given from conception to onset of labor.
1. Maternal well-being assessment
❖ Ovulation: 14 days before the end of cycle

28 days cycle: 14th

30 days cycle: 16th
LMP: March 3 → March 31
28-day cycle → -14
Ovulation: March 17
❖ Estimated Date of Delivery
“Naegele’s Rule”
LMP: +7 Days
-3 months
+1yr

2. Fetal well-being assessment

ELECTRONIC FETAL HEART MONITORING

Nonstress Test Stress Test/Oxytocin Challenge
Test
Description Record FHR based on fetal Record FHR based on uterine
movements contraction
Result Acceleration “15 x 15” Deceleration:
15 bpm increase in 15 secs Early - Head compression
Late - Placental Insufficiency
Variable – Cord Compression

Interpretation Reactive √ Negative √

Nonreactive X Positive X

3. Age of Gestation
“Bartholomew’s Rule”
12th - symphysis pubis
16th - between symphysis pubis & umbilicus
20th - umbilicus
36th - xiphoid process
4. GTPALM
Gravidity - # of pregnancy
Parity - # of viable
Term - pregnancy beyond 37 weeks
Preterm - pregnancy between 20-37 weeks
Abortion - loss of pregnancy
Living
Multiple
 Amniocentesis - Punctures the sac to collect fluid
Alpha-protein
↑ neural defects
↓ down syndrome
Leopold’s maneuver - to determine fetal presentation, engagement & attitudes.

1st “Fundal Grip”

o To determine fetal presentation
2nd “Umbilical Grip”
o To identify fetal back → PMI
3rd “Pawlick’s Grip”
o Determine fetal engagement
-3
-2
-1
0
+1
+2
+3

4th “Pelvic Grip”

o For cephalic presentation only
o Identify fetal attitudes

Tetanus Toxoid Immunization:

TT Time Protection
1 ASAP -----
2 After 1 month 3 yrs., 80%
3 After 6 months 5 yrs., 90%
4 After 1 year 10 yrs., 99%
5 After 1 year Lifetime, 99%

PHYSIOLOGIC MATERNAL CHANGES

Cardiovascular
• ↑ blood volume → oxytocin
RBC → physiological anemia
• Palpitations
• Edema
N: Dipedal anemia - ↓ venous return
AN: Upper body & facial edema
• Varicosities
NI: elevate legs, avoid prolonged standing, use pantyhose or compression stocking
Gastrointestinal
• Nausea & Vomiting
Morning sickness
-mild N&V caused by hypoglycemia
NI: eat simple carbs – crackers
• Hyperemesis Gravidarum
 Persistent N&V caused by ↑ HCG
NI: small frequent feeding, antiemetic meds except thalidomides
• Constipation
NI: ↑ Oral fluid intake, ↑ fiber
• Heartburn
NI: Small frequent feeding, sitting upright for 30 mins.
• Hemorrhoids
NI: warm sitz bath, witchhazel
Respiratory
• Shortness of Breath
Urinary
• ↑ frequency
• ↓ renal threshold
Musculoskeletal
• Lordosis → ↑ lumbosacral curve → backache
NI: pelvic rock
• ↑ mobility → risk for injury
NI: wear low-heeled shoes with grip
Endocrine
• ↑ Thyroid Gland
↑ T3 T4
↑ Calcitonin → “calcium in” → hypoglycemia
• Parathyroid Gland
↑ Parathormone → “calcium out” → hyperglycemia

Weight gain:
1st 1.5 – 3 lbs
2 nd 10-11 lbs
3 rd 10-11 lbs
= 20 -25 lbs
Integumentary
• ↑ melanocyte – stimulating hormone
Mask of pregnancy: Choalasma
Midline abnormal discoloration: Linea nigra → “alba”
Stretchmark: Straie Gravidarum
NI: cocoa butter
• Palmar Erythema → ↑ Estrogen

RISK FACTORS IN PREGNANCY

1. 5th or more pregnancy
Uterine Prolapse
Uterine Atony
Placenta Previa
2. Previous CS
Uterine Rapture
3. Post partum Hemorrhage
o NSVD
Normal: <500 ml
Abnormal: >500 ml
o CS
Normal: <1000 ml
 Abnormal: >1000 ml
4. Maternal Age
<20 yo - LBWI, CPD
<35 yo - chromosomal abnormality

NURSING RESPONSIBILITY
1. Nutrition
Nonpregnant: 2,200 kcal
Pregnant: +300 kcal = 2,500
BF; +500 kcal = 2,700
2. Eliminate Alcohol & Smoking
Smoking: LBWI
Alcohol: Fetal Alcohol Syndrome
3. Sexual Activity
1st ↓ 6 weeks before labor X to sex
2nd ↑ 6 weeks after labor √ to sex
3rd ↓ 6 weeks Normal involution
4. Traveling
2-3 hrs, 10 -15 mins.