Written and Oral Assessment in MCHN Endocrine: Increased levels of estrogen and
progesterone maintain pregnancy and regulate
Menstrual Cycle metabolism.
The menstrual cycle is a monthly series of Skin: Hormonal changes cause
hormonal changes a woman’s body goes hyperpigmentation, stretch marks, and
through to prepare for pregnancy. It involves increased skin vascularity.
four phases, typically lasting around 28 days,
though it can range from 21 to 35 days: Components of Prenatal Visits
components of prenatal visits focus on
1. Menstrual Phase (Days 1-5): The monitoring maternal and fetal health and
uterine lining sheds, leading to providing education. Key components include:
menstruation. Estrogen and 1. Health History: Gathering personal,
progesterone levels drop. medical, obstetric, and family history
2. Follicular Phase (Days 1-13): to identify any risks.
Overlaps with menstruation initially. 2. Physical Examination: Includes
Follicle-stimulating hormone (FSH) checking weight, blood pressure, and
stimulates the development of ovarian general health status.
follicles, and estrogen thickens the 3. Fetal Assessment: Monitoring fetal
uterine lining. heart rate, growth, and position, often
3. Ovulation (Day 14): A surge in through palpation or ultrasound,
luteinizing hormone (LH) causes the Doppler.
release of a mature egg. This is the 4. Laboratory Tests: Screening for
most fertile period. conditions like anemia, infections,
4. Luteal Phase (Days 15-28): The gestational diabetes, and blood type
corpus luteum forms, producing compatibility. (blood type, Rh factor,
progesterone to maintain the uterine rubella immunity, etc.).
lining for pregnancy. If no pregnancy 5. Education and Counseling:
occurs, hormone levels drop, Discussing nutrition, exercise,
triggering menstruation. pregnancy symptoms, and preparation
for labor and delivery.
Normal Adaptations During Pregnancy
Pregnancy induces various physiological Leopold’s Maneuver
changes to support fetal development: A set of four systematic abdominal palpations
Cardiovascular: Increased blood volume and used to determine the position of the fetus in
cardiac output, with slight changes in heart the uterus, crucial for assessing fetal
rate and blood pressure. presentation, lie, and position before delivery.
Respiratory: Progesterone causes increased There are four maneuvers:
breathing rate to meet oxygen demands. 1. First Maneuver: Fundal Grip
Gastrointestinal: Slowed digestion leads to Purpose: To determine which fetal part (head
constipation and heartburn due to hormonal or buttocks) is located in the upper part of the
relaxation of smooth muscles. uterus (fundus).
Renal: Enhanced kidney function leads to Technique: The practitioner places both hands
frequent urination and fluid retention. on the mother’s abdomen, feeling the fundus.
Musculoskeletal: Hormones cause joint Findings: A round, firm, and moveable mass
flexibility and postural changes (like lordosis) suggests the fetal head. A softer, less-defined
for childbirth. mass suggests the fetal buttocks.
2. Second Maneuver: Lateral Grip
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Purpose: To identify the position of the fetal Serological Tests: Screen for infections such as
back and extremities. syphilis, rubella, and hepatitis B.
Technique: The practitioner places both hands 3. Urinalysis: Evaluates for urinary tract
on the sides of the abdomen. infections, protein levels, and glucose,
Findings: A smooth, firm surface on one side which can indicate gestational
suggests the fetal back. On the opposite side, diabetes.
small, irregular parts (limbs) can be felt. 4. Glucose Tolerance Test: Typically
3. Third Maneuver: Pawlik's Grip performed around 24-28 weeks to
(Pelvic Grip) screen for gestational diabetes.
Purpose: To assess which fetal part is lying 5. Non-Stress Test (NST): Assesses
above the pelvic inlet. fetal heart rate in response to
Technique: The practitioner uses the thumb movement, typically conducted in the
and fingers to grip the lower part of the third trimester to monitor fetal
abdomen, just above the pubic symphysis. well-being.
Findings: A hard, round mass indicates the 6. Amniocentesis: Optional procedure to
fetal head. A softer, irregular mass indicates test for genetic disorders and fetal lung
the buttocks. maturity, usually performed in
4. Fourth Maneuver: Pelvic Grip high-risk pregnancies.
Purpose: To determine the degree of
engagement of the fetal head in the maternal Normal Labor and Delivery
pelvis. Labor is divided into four stages:
Technique: The practitioner faces the 1. First Stage:
mother’s feet and places hands on both sides Latent Phase: Cervical dilation up to 3 cm,
of the lower abdomen, pressing gently to with irregular contractions.
assess how far the head has descended into the Active Phase: Dilation from 4 to 7 cm, with
pelvis. more frequent and intense contractions.
Findings: If the presenting part (usually the Transition Phase: Dilation from 8 to 10 cm,
head) is not engaged, it can be moved. If with strong contractions and increased
engaged, it will be fixed in the pelvis. discomfort.
2. Second Stage: Delivery of the baby.
Importance: Leopold's maneuvers are useful Involves pushing and the descent of
for determining the best course of action for the fetus through the birth canal,
labor and delivery, including whether a leading to delivery. This stage ends
cesarean section may be necessary if there are with the birth of the baby.
concerns about the fetal position or 3. Third Stage: Delivery of the placenta,
presentation. typically occurring within 5 to 30
minutes after the birth of the baby.
Diagnostic Tests in Pregnancy 4. Fourth stage: Postpartum recovery
1. Ultrasound: Confirm pregnancy, and monitoring.
monitors fetal growth and anatomy,
and determine gestational age and Signs of Normal Labor
position. Regular contractions that increase in intensity
2. Blood Tests: and frequency.
Complete Blood Count (CBC): Assesses Rupture of membranes (water breaking).
overall health and checks for anemia. Lower back pain or pelvic pressure.
Blood Type and Rh Factor: Determines blood
compatibility and potential Rh incompatibility. Assessment During Labor
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Monitoring maternal vital signs, fetal heart Activity, Respiration) and a physical
rate, and contraction patterns. examination.
Assessment of cervical dilation and 2. Thermoregulation: Maintaining body
effacement. temperature to prevent hypothermia
through skin-to-skin contact and
Pain Management warmers.
Options include breathing techniques, 3. Feeding: Supporting breastfeeding
relaxation methods, and pharmacological initiation and educating on formula
interventions (e.g., epidurals or analgesics). feeding if applicable.
4. Hygiene and Cord Care: Ensuring
Complications proper diaper hygiene and caring for
Normal labor is usually uncomplicated, but the umbilical cord stump.
monitoring is essential for any signs of distress 5. Immunizations: Administering
or abnormal progression. recommended vaccines, such as
hepatitis B.
Postpartum Care 6. Parental Education: Teaching safe
Focuses on the health and recovery of the sleep practices and recognizing signs
mother after childbirth, as well as the initial of illness.
care of the newborn: 7. Newborn screenings: For conditions
1. Maternal Assessment: Monitoring like hearing impairment and metabolic
vital signs, uterine involution, lochia disorders.
(vaginal discharge), and perineal 8. Follow-Up Care: Encouraging regular
healing. pediatric appointments for growth and
2. Emotional Support: Assessing for development monitoring.
postpartum depression and providing
guidance on emotional changes. Theories of Development
3. Newborn Care: Evaluating the Provide frameworks for understanding how
newborn’s health, including the Apgar children grow and change over time. Key
score, and supporting feeding theories include:
practices. 1. Erik Erikson's Psychosocial
4. Health Promotion: Encouraging Development Theory: Emphasizes
proper nutrition, hydration, and eight stages of psychosocial
discussing postpartum contraception development across the lifespan,
options. focusing on the conflicts that must be
5. Follow-Up Care: Scheduling resolved at each stage, such as trust vs.
necessary appointments for ongoing mistrust in infancy.
assessments and health management. 2. Jean Piaget's Cognitive
Development Theory: Describes four
Newborn Care stages of cognitive development,
Newborn care begins immediately after birth. highlighting how children acquire and
It encompasses essential practices to ensure process knowledge, from sensorimotor
the health and well-being of the infant in the (birth to 2 years) to formal operational
immediate postpartum period and beyond. Key (12 years and up).
components include: 3. Lawrence Kohlberg's Moral
1. Initial Assessment: Evaluating the Development Theory: Outlines three
newborn using the APGAR score levels of moral reasoning
(Appearance, Pulse, Grimace, (pre-conventional, conventional, and
post-conventional) that children
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progress through, emphasizing the
development of ethical understanding. 4. Social and Emotional Development
4. Albert Bandura's Social Learning 2 months: Begins to smile at people.
Theory: Focuses on learning through 6 months: Knows familiar faces and begins to
observation and imitation, know if someone is a stranger.
emphasizing the role of modeling in 12 months: Shows fear of strangers and has
behavior development. favorite things and people.
5. Lev Vygotsky's Sociocultural
Theory: Highlights the importance of 5. Cognitive Development
social interaction and cultural context 6 months: Looks around at things nearby.
in cognitive development, introducing 12 months: Explores things by shaking,
concepts like the Zone of Proximal banging, throwing, or dropping.
Development (ZPD).
Developmental Milestones
These are critical behaviors or skills that
children typically achieve by a certain age:
● Gross motor skills: Rolling over,
crawling, walking.
● Fine motor skills: Grasping objects,
drawing.
● Speech and language: Babbling,
saying words, forming sentences.
● Social and emotional: Smiling,
playing with others, showing empathy.
● Cognitive Development: curious at
things around and explores it by
shaking, banging, throwing, or
dropping.
1. Gross Motor Skills
2 months: Can lift head when lying on
stomach.
6 months: Sits with support; may roll over.
12 months: Stands and may take first steps.
2. Fine Motor Skills
3 months: Grasps objects placed in hand.
6 months: Transfers objects from one hand to
another.
12 months: Uses pincer grasp to pick up small
objects.
3. Language Development
2 months: Coos and makes gurgling sounds.
6 months: Babbles with different sounds.
12 months: Says “mama” or “dada” and
understands simple words.
