Student No: 0221000**** Course: Competency Appraisal 1

Name: Tranquilo, Joshua E. Discussed by: Mrs. Carmelita Perez,RN,MAN

Section: BSN 4-YA-20
Course Unit 2:
MCHN
Maternal and Child Health Nursing

I. ANATOMY AND PHYSIOLOGY of REPRODUCTIVE SYSTEM

MALE REPRODUCTIVE SYSTEM

Penis
▪ Tubular structure located above the scrotum, composed of
shaft and glans.
▪ Half of it is an internal root and half is the external visible
shaft.
▪ Soft and flaccid (2.5 to 4 inches).
▪ Erection- blood vessels in the shaft become congested, penis
become hard and erect (5.5 to 7 inches)
Glans
➢ The distal end of the organ is bulging
sensitive ridge of tissue which has the
external urinary meatus at its tip.
Corona
➢ The proximal margin of the glans.
Prepuce
➢ Also called the foreskin.
➢ Loose skin attached to the shaft,
allowing for expansion during erection.
Frenulum
➢ Ventral fold of tissue attaches the
skin to the glans.
▪ Contains the urethra as well as 3
erectile bodies:
➢ 2 dorsal erectile tissues known
as the corpora cavernosa
➢ 1 midventral tissue known as
the corpus spongiosum
✓ Surrounds penile urethra
✓ Expands distally to form
the glans penis
 Erection

Sexual excitement → Nitric acid is released from the endothelium of blood

vessels → Result in engorgement or an increase in the blood flow to the
arteries of the penis →The Ischiocavernosus muscle at the penis base then
contracts → Trapping both venous and arterial blood in the 3 sections of
erectile tissue →Leading to distention and erection of the penis

SCROTUM
▪ loose pouch-like sac of skin that hangs behind
the penis
▪ rugated, skin covered muscular pouch
suspended from the perineum
▪ contains testes, epididymis, and the lower
portion of the spermatic cord
• Contains male gonads (testes) help
regulate the temperature of sperm
through contraction and relaxation and
moving closer to and further away from
the perineum
▪ the looseness of the scrotum is intentional to
provide expansion and contraction
▪ lowers T by 3C

❖ Cool Temperature
➢ Scrotum contracts and draws the
testes closer to the body for
warmth.
❖ Warm Temperature
➢ Scrotum becomes very loose and
allow the testes to hand further
away from the near of the body.
High temperature can cause delicate
sperm cell to die.
TESTES ✓ Each testis is encased by a protective white fibrous
▪ Two ovoid glands, 2 to 3 cm wide that lie in capsule and is composed of a number of lobules.
the scrotum (walnut size) ✓ Each lobule containing interstitial cells (Leydig’s Cell)
▪ Surrounded by 2 tunics: and seminiferous tubules.
• Tunica vaginalis
➢ Derived from the parietal • Seminiferous Tubules
peritoneum. -Produce spermatozoa
• Tunica albuginea • Leydig’s Cell
➢ Feel smooth and are freely -Responsible for producing of the male
movable within the scrotum. hormone testosterone.
➢ In most males, one testis is
slightly larger than the other
and is suspended slightly
lower in the scrotum than
the other (usually the left
one) for less possibility of
trauma to them
✓ Spermatozoa do not survive at the body
temperature
✓ It is suspended outside the body where the
temperature is approximately 1 F lower than
the body temperature and sperm survival is
ensured

Male Internal Structures:

Epididymis
▪ seminiferous tubule of each testis leads to a tightly coiled
tube, the epididymis
▪ Approximately 20 ft long
▪ Site of sperm maturation and storage
▪ Responsible for conducting sperm from the testis to the vas
deferens
▪ Contains smooth muscle to propel sperm during
ejaculation
▪ Sperm are immobile and incapable of fertilization as they
passed or are stored at the epididymis level
▪ It takes 12-20 days to travel the length of the epididymis
▪ A total of 64 days to reach maturity

Vas Deferens
▪ It carries sperm from epididymis through the inguinal canal
into the abdominal cavity where it ends at the seminal
vesicles and ejaculatory ducts. It is about 40cm long
▪ The vas deferens serves a transport function and the area of
the ampulla serves as a storage reservoir of sperm for
release at ejaculation.
▪ Sperm mature as they passed through the vas deferens
▪ It is believed that the vas deferens acts as reservoir for
sperm between ejaculation

Seminal Vesicles
▪ 2 convoluted pouches that lie along the lower portion of
posterior surface of the bladder and empty into the urethra
by way of ejaculatory ducts
▪ Secrete seminal fluid
▪ Sperm become increasingly motile
▪ because of viscous portion of the semen secreted by these
glands which serves as nutrients and more favorable pH

Ejaculatory ducts
▪ These are formed by the fusion of the vas deferens and the
seminal vesicles.
▪ The ejaculatory ducts empty into the urethra
▪ The ejaculatory ducts are part of the human male anatomy,
which cause the reflex action of ejaculation. Each male has
two of them.
▪ They begin at the vas deferens, pass through the prostate,
and empty into the urethra at the Colliculus seminalis.
During ejaculation, semen passes through the ducts and
exits the body via the penis.
Prostate Gland
▪ a chest-nut size gland that lies just below the bladder, the
urethra passes through the center of it, like the whole
donut
▪ When added to the secretion from the seminal vesicles and
the accompanying
▪ sperm from the epididymis, this alkaline fluid further
protects sperm from being immobilized by the naturally low
pH level of the urethra

Bulbourethral Glands
▪ 2 bulbourethral or Cowper’s gland lie beside the prostate
gland and by short ducts empty into the urethra
▪ Secrete an alkaline fluid that helps counteract the acid
secretions of the urethra and ensure the passage of
spermatozoa
▪ Produce small droplets of fluid during sexual activity that
neutralizes the acidity of the male urethra and aid in the
transport of sperm
▪ 5% semen

Urethra
▪ a hollow tube leading from the base of the bladder, which
after passing through the prostate gland continues to the
outside through the shaft and glans of the penis
3 sections:
▪ Prostatic
✓ Within the prostate
▪ Membranous
✓ Within the urogenital diaphragm
▪ Penile (spongy)
✓ Within the penis

Seminal Plasma Semen / seminal fluid

▪ The seminal vesicles, prostate gland and Cowper’s gland ▪ Thick, creamy white fluid with the
produce a liquid called a seminal plasma. consistency of mucus or egg whites
▪ Aids in the transport of sperm ▪ Normal amount is 2 mL – 6 mL per
▪ Provides energizing nutrients for the sperm ejaculation
▪ Contains form of sugar – fructose, mucous, salts, water, ▪ Fertile man will dispel 20-160 million
base buffers and coagulators to aid the sperm in their sperm per ejaculate.
journey.
Spermatozoon
▪ is made up of a head and a tail
✓ the head carries the male’s haploid number of
chromosomes (23)
✓ the part that enters the ovum at fertilization
▪ the tail specialize in motility
▪ sperm maybe stored in the male genital system for 42 days
▪ sperm can live only 2-3 days in the female genital tract once
ejaculated.
 FEMALE REPRODUCTIVE SYSTEM

Reproductive Development Pubertal Development

• Gonad is a body organ that produces sex cells • Puberty is the stage of life at which
• Mesonephric ducts develops in males secondary sex changes begin.
• Paramesonephric ducts develops in females • These changes are stimulated when the
• By week 7 or 8, in chromosomal males, this early hypothalamus synthesizes and releases
gonadal tissue differentiates into primitive testes gonadotropin-releasing hormone (GnRH),
and begins formation of testosterone. Under the which in turn triggers the anterior pituitary to
influence of testosterone, the mesonephric duct begin the release of follicle-stimulating
begins to develop into the male reproductive hormone (FSH) and luteinizing hormone
organs, and the paramesonephric duct regresses. (LH).
• If testosterone is not present by week 10, the • FSH and LH initiate the production of
gonadal tissue differentiates into ovaries, and androgen and estrogen, which in turn initiate
the paramesonephric duct develops into female secondary sex characteristics, the visible
reproductive organs signs of maturity.
Puberty - is the stage of life at which secondary sex changes begin.
Girls (estrogen) Boys (testosterone)
➢ Growth Spurt ➢ Increase in weight
➢ Increase in the transverse diameter of the ➢ Growth of testes
pelvis ➢ Growth of face, axillary & pubic hair
➢ Breast development ➢ Voice changes
➢ Growth of pubic hair ➢ Penile growth
➢ Onset of menstruation ➢ Increase in height
➢ Growth of axillary hair ➢ spermatogenesis
➢ Vaginal secretions
Mons Veneris / Pubis
• The mons veneris is a pad of adipose tissue located over
the symphysis pubis, the pubic bone joint.
• It is covered by a triangle of coarse, curly hairs.
• The purpose is to protect the junction of the pubic bone
from trauma.
• It contains many nerve ending that makes the mons
pubis sensitive to touch and pressure.

Labia Majora
• Consists of 2 rounded folds of fatty tissue. It is
analogous to the scrotum.
• The outer lips separates downward from the mons and
meet again below the vagina introitus.
• It contains multitude of sebaceous and sweat glands.
• It also serves as protection for the external genitalia and
the distal urethra and vagina.

Labia Minora
• Located posterior to the mons pubis veneris, spread 2
hairless folds of connective tissue.
• It has 2 smaller lips located within the labia majora.
• It appears thin pale pink in color.
• When stimulated, it turns to dark red or dark pink due to
presence of blood vessels, no hair; smooth in texture.

Clitoris
• It is a small rounded organ of erectile tissue at the
forward junction of the labia minora, covered by a fold
of skin called prepuce.
• The clitoris is sensitive to touch and temperature and is
the center for sexual arousal and orgasm in the female.
• The clitoris measures 5 – 6 mm. long and 6 – 8 mm.
across.
• It has very rich blood and nerve supplies

Vestibule
• It is a flattened smooth surface inside the labia.
• The openings of the bladder or the urethra, and the
uterus or the vagina, are both arise from the vestibule

Urethral meatus / urethral orifice

• although not a true part, it is considered as part of the
reproductive system because of its closeness and
relationship to the vulva
Vulvovaginal / Bartholin's gland

• pair of small, pea – sized glands located within the

substances of the labia majora
• they correspond to the bulbourethral or Cowper’s
gland in male
• the gland secretes a small amount of clear, viscid
mucus during sexual excitement

Paraurethral / skene’s gland

• a pair of small glands lying on each side of the urethra

• they produce a small amount of mucus and are
especially susceptible to gonorrheal infection
• it is homologous to male prostate

Vaginal orifice / introitus

• occupies the lower portion of the vestibule and varies
considerably in size and shape
• the vagina has an abundantly vascular supply

Hymen
• Is a tough but elastic semicircle of tissue that covers
the opening to the vagina in childhood.
• It is comprised mainly of connective tissue both
elastic and collagen. Both surfaces are covered by
stratified squamous epithelium.
• The hymen can be broken through strenous physical
activities or masturbation.
• It is often torn during the time of first sexual
intercourse.

Fourchette

• is the ridge of tissue formed by the posterior joining

of the labia minora and the labia major
• this structure is sometimes cut ( episiotomy ) during
childbirth to enlarge the vaginal opening

Perineum

• located just posterior to the fourchette

• This is a muscular area, that’s easily stretched during
childbirth to allow enlargement of the vagina and
passage of the fetal head.
• Many exercises (Kegel’s,squatting & tailor-sitting) are
aimed at making the perineal muscle more flexible to
allow easier expansion during birth without tearing of
this tissue.
 OVARY
• It is approximately 4 cm long by 2 cm in
diameter and approximately 1.5 cm thick
or the size and shape of an almond.
• Each ovary contains approximately
200,000 to 400,000 follicles during
female’s childbirth.
• It secretes hormones ESTROGEN and
PROGESTERONE which initiate and
regulate menstrual process.

Layers of ovaries:

Tunica albuginea - dense and dull white and

serves as protective layer.

Cortex – main functional part because it contains

ova, graafian follicles, corpora lutea, degenerated
corpora lutea (corpora albicantia).

Medulla – or central portion of the ovary is

composed of loose connective tissue.

Functions :
✓ ovulation
✓ hormone production
▪ These also a counterpart to the testes of male organ.
Fallopian Tubes
• A slender structure that extends from either side
of the uterus and end in a fringed fashion near
each ovary. Functions :
• It transports mature ovum from the ovary to the ✓ site of fertilization
uterus and to provide place for fertilization of the ✓ provide transport for the ovum from the ovary to
ovum. the uterus serve as a warm, moist, nourishing
• It takes about 3 days for an egg to travel the environment for the ovum or zygote
length, but unfertilized egg lives only 24 hours.
• If unfertilized it will die before it arrives in the

Parts of the Fallopian Tube

1. Interstital portion
✓ lies within the uterine wall
✓ approximately 1 cm in length
✓ lumen is 1 mm in the diameter
2. Isthmus
✓ next distal portion
✓ 2 cm in length
✓ this portion is cut and sealed in tubal ligation

3. Ampulla
✓ Longest portion
✓ 5 cm length
✓ Fertilization of ovum occurs
4. Infundibular
✓ Most distal segment
✓ 2 cm in length
✓ Funnel shape
✓ The rim of the funnel is covered by fimbriae or
small hairs that help to guide the ovum into the
fallopian tube .
 Uterus
 Pear-shaped approximately 3 inches long, located
between the urinary bladder and the rectum.
 Its primary purpose is to house and nurture a
pregnancy.
 It receives the ovum from the fallopian tube, to
provide a place for implantation and nourishment
during fetal growth and it furnish protection to a
growing fetus expel from the women’s body.

The uterus consists of three divisions:

1..The body or corpus – portion of the structure that
expands so greatly to contain the growing fetus.
• The portion of the uterus between the points of
attachment of the fallopian tube is called fundus.
• fundus is the portion that can be palpated to
measure uterine growth and the force of uterine
contraction during labor.

2. Isthmus – short segment between the body & cervix;

during pregnancy, this portion also enlarges greatly to aid
in accomodating the growing fetus.
• it is the portion of the uterus that is cut when a
fetus is delivered by CS

3. Cervix – lowest portion of the uterus

• cervical canal – central cavity
• internal cervical os – junction of the canal
at the isthmus
• external cervical os – distal opening to
the vagina

The cervical mucosa has 3 functions: Layers of uterus:

✓ provide lubrication for the vaginal • Perimetrium – a part of visceral peritoneum. the outermost
canal layer of the uterus. Adds strenght and support to the uterus.
✓ act as a bacteriostatic agent • Myometrium – bulk of uterus – three layers of muscle that
✓ provide an alkaline environment to contract under influence of oxytocin during labor. It prevents
shelter deposited sperm from the regurgitation of menstrual blood into the tubes and holds
acidic vagina. the internal os closed during pregnancy.
• Secretory cells of the cervix produce • Endometrium – highly vascular mucosa
about 20 – 60 ml of mucus / day. ✓ Stratum functionalis – shed during menstruation
• At time of ovulation, this mucus ✓ Stratum basalis – deeper, permanent layer, gives rise
becomes thinner and more alkaline. to new stratum functionalis
• Mucus provides for the energy needs
of the sperm, protects sperm from
environment of the vagina, and
protects them from phagocytes.
• At other times, mucus becomes thick
and can form a cervical plug which
impedes passage of pathogens.
Vagina
➢ Passageway for sperm and menstrual flow
➢ Receptacle for penis during intercourse
➢ Inferior portion of birth canal
➢ Capable of considerable distention (stretching)
➢ Mucosa is continuous with that of uterus and consists
of nonkeratinized stratified squamous epithelium.

Mammary glands
• Accessory organs of the female reproductive
system
• Modified sweat glands
• Function is to synthesize, secrete and eject milk
(lactation)

• Breasts are located anterior to the pectoral

muscle. In many women, breast tissue extends
well into the axilla.
• Each breast has 15-20 lobes made up of several
lobules. Lobules are made of milk-secreting cells
arranged in alveoli.
• All the glands in each lobe produce milk by acini
cells & deliver it to the nipple by lactiferous duct
• Milk production is stimulated mostly by prolactin
with some help from estrogen & progesterone.

Ampulla
• Portion of the duct just posterior to the nipples
serves as reservoir for milk before breastfeeding.
Nipples
• Composed of smooth muscle that is capable of
erection on manual or sucking stimulation.
• approximately 20 small openings through which
milk is secreted.

• On stimulation, it transmits sensations to the

posterior pituitary gland to release oxytocin.
• Oxytocin- acts to constrict milk gland cells and
push milk forward into the ducts that lead to the
nipple
Areola
• Darkly pigmented area surrounding the nipple.
• Rough surface owing many sebaceous gland,
called MONTGOMERY’S TUBERCLES.
• It contains the opening of sebaceous and sweat
glands (Montgomery glands) that secrete
lubricating substances for the nipple
 II. MENSTRUATION

It’s More than Just Your Period: When you think about your menstrual cycle, do you think of just your period? For some
of us, those few days of bleeding are the only thing we think about, since it’s easy to associate your cycle with the time of
the month when you may experience some other physical symptoms like headaches, bloating, and stomach upset.

Menstruation

• This is the monthly menstrual bleeding (also

called menstruation or menstrual period) that
you have from your early teen years until your
menstrual periods end around age 50
(menopause).

• About once a month, the uterus grows a new,

thickened lining (endometrium) that can hold a
fertilized egg.
• When there is no fertilized egg to start a
pregnancy, the uterus then sheds its lining.
• The menstrual cycle is measured from the first
day of menstrual bleeding, Day 1, up to Day 1
of your next menstrual bleeding.
• A teen's cycles tend to be long (up to 42 days),
growing shorter over several years.
• The average menstrual period is 5 days.
• The amount of blood loss every menstrual
period is 30 to 80 ml.
• The normal color of the menses is dark red that
contains mucus and endometrial cells.

NOTE: Although 28 days is often cited as the "regular"

cycle length, only 15% of women actually have such a
cycle.
 Organs Involved in Menstruation
• Hypothalamus- stimulates anterior pituitary • LH : a hormone that becomes most active at the
gland to begin production of gonadotropic midpoint of the cycle & is responsible for
hormones. ovulation or release of the mature egg cell from
• Pituitary gland- under the influence of LHRH, the the ovary, and growth of uterine lining.
anterior pituitary gland produces 2 hormones • Ovaries –one ovum matures in one or the other
that act on the ovaries to further influence ovary & is discharge from it each month.
menstruation. • Uterus – stimulation from the hormones
- FSH : a hormone that is active early in a cycle & produced by the ovaries causes specific monthly
is responsible for maturation of the ovum effects on the uterus

NOTE: NOTE:

- the release of GnRH or LHRH by the hypothalamus - FSH and LH are called gonadotropic hormones
initiates the menstrual cycle
because they cause growth (trophy) in the ovary.
- Disease in the hypothalamus decreases the
release of these hormones causes delayed
puberty

What Happens During the Cycle?

• So, what is actually happening inside your body

each month? It’s all about hormones. The
menstrual cycle can be divided into the following
parts: the ovarian cycle and the uterine cycle.

• The changes associated with the menstrual cycle

are brought on by fluctuations in hormones at
different times of the month.
Estrogens ( Hormone for Woman) Progesterone( Hormone of the Mother)

1. Stimulate the growth, development, and maintenance of female • Is secreted mainly by the corpus
reproductive structures, secondary sex characteristics and the luteum and works with
breast. estrogen to prepare the
2. They help regulate fluid and electrolyte balance. endometrium for implantation
3. They stimulate protein synthesis and mammary glands for
4. They lower blood cholesterol levels lactation.
5. Spinnbarkeit and ferning • Decrease GI motility
6. Thickening of the endometrium • Increase permeability of kidney
• Moderate levels of estrogen in the blood inhibit the release of to lactose & dextrose
GnRH, LH and FSH. • Responsible for the mood
• This is the basis for the birth control pill. swings of the mother
• Mammary gland development
NOTE: Hair growth at puberty regulated by androgens, and female skeletal • High levels of progesterone also
development is related to a low amount of androgens. Women under 50 inhibit GnRH, LH and FSH.
have a much lower risk of coronary artery disease than men do.

FSH Relaxin
• Release of estrogen from the Ovary
• facilitate the growth of primary follicle to become • Produced by the corpus luteum
graafian follicle • Inhibits uterine contractions which aids
implantation.
• During pregnancy, it is produced by the placenta, and
LH continues to relax uterine smooth muscle.
• Stimulates ovary to release progesterone • Also relaxes the pubic symphysis and helps dilate the
• Hormone for Ovulation uterine cervix for delivery.

THE MENSTRUAL CYCLE

• On the third day of the menstrual cycle, serum

estrogen level is at lowest which stimulates the • On the 13thday of menstrual cycle, there is now
hypothalamus to produce follicle stimulating a very low level of progesterone in the blood.
hormone releasing factor (FSHRF). This stimulates the hypothalamus to produce
Luteinizing Hormone releasing factor (LHRF).
• FSHRF is responsible for stimulating the anterior
pituitary gland (APG) to produce the FSH which • LFRH is responsible for stimulating the APG to
will act on one immature occyte inside a produce LH.
primordial follicle, stimulating its growth.
• The LH in turn, is responsible for stimulating the
• In view of the FSH, estrogen is now going to be ovary to produce progesterone. The increased
produced in an increasing amount inside the amounts of both estrogen and progesterone push
follicle, which is found in the ovary. Once the new mature ovum to the surface of the ovary
estrogen is present, the primordial follicle is now until the following day (14th) the GF ruptures
termed Graaffian follicle. The GF is the structure and releases the mature ovum.
therefore that contains high amounts of
estrogen. • Once ovulation has taken place, the GF which
contains increased amount of progesterone will
• Estrogen in the GF will cause the cells in the turn to Corpus Luteum which is yellow
uterus to proliferate (grow rapidly), increasing its appearance.
thickness to about eight fold. This is called
Proliferative/follicular phase.
KEY NOTES:

Ovarian Cycle Uterine Cycle

• The Follicular Phase: Days 1 through 13 • Proliferative Phase: Days 5 -14
In response to follicle stimulating hormone (FSH) The uterine lining increases rapidly in thickness, and
released from the pituitary gland in the brain, the uterine glands proliferate and grow.

ultimately one egg matures. Secretory Phase: Days 14 through 22

• Ovulation: Day 14
When an egg is not fertilized, the corpus luteum
At about day 14, in response to a surge of gradually disappears, estrogen and progesterone levels
luteinizing hormone, the egg is released from the drop, and the thickened uterine lining is shed. This is
ovary. menses (your period).
• Ischemic phase: Days 23 through 28
The egg travels through the fallopian tube toward
last part of the secretory phase with ischemia due to
• The Luteal Phase: Days 14 through 28
The remains of the follicle become the corpus blood deficiency, endometrium pales, and spiral
luteum which releases progesterone arteries constrict intermittently due to decreased
hormone secretion by the degenerating corpus luteum
Hormonal decrease results in stoppage of glandular
secretion, loss of interstitial fluid, and a shrinking of the
endometrium

• The ovarian cycle involves changes in the ovaries,

and can be further divided into three phases:
▪ The follicular phase is the time from the
first day of menstruation until ovulation,
when a mature egg is released from the
ovary. It’s called the follicular phase
because growth or maturation of the egg is
taking place inside the follicle, a small sac
where the egg matures.
▪ The luteal phase is the time from when the
egg is released (ovulation) until the first
day of menstruation, when you get your
period. It is named after the corpus luteum
(Latin for "yellow body"), and is a structure
that grows in the ovary where a mature
egg was released at ovulation.
▪ *increase in LH causes the follicles to begin
to produce lutein (bright yellow fluid)

▪ Ovulation occurs around day 14 of the

cycle, in response to a surge of
luteinizing hormone (LH) when the egg
is released from the ovary.
▪ After an upsurge of LH from the PG,
prostaglandins are released and the
graafian follicles ruptures. The ovum is
set free from the surface of the ovary,
this process is termed as ovulation.
 • The uterine cycle involves changes in the uterus. NOTES:
It occurs in tandem with the ovarian cycle, and is • Proliferative phase occurs during the first 4 or 5
divided into two phases: days of a cycle. As the ovary begins to produce
– The proliferative phase is the time after estrogen, the endometrium begins to proliferate.
menstruation and before the next • * ischemic – if fertilization does not occur, the
ovulation, when the lining of the uterus corpus luteum begins to regress after 8 – 10 days, as
grows and thickens. it regresses, the production of estrogen and
– The secretory phase is the time after progesterone decreases. w/o progesterone, the
ovulation. endometrium of the uterus begins to degenerate
(24 -25 days)

Let’s look at what’s happening during each of these phases and when they occur throughout the menstrual cycle. The

timing of these phases can vary depending on the number of days in each woman’s menstrual cycle. <3

The follicular phase is the time from the first day of menstruation until ovulation, when a mature egg is released from
the ovary.

Ovulation occurs around day 14 of the cycle, in response to a surge of luteinizing hormone (LH) when the egg is
released from the ovary.

The luteal phase is the time from when the egg is released (ovulation) until the first day of menstruation, when you
get your period.
 Time of ovulation What common symptoms are linked to the
menstrual cycle?
• Women often believe that ovulation occurs • For about a week before a period, many
midcycle. It actually occurs 12-16 days before the women have some premenstrual symptoms.
next period. So although a woman with a 28 day You may feel more tense or angry. You may
cycle may ovulate midcycle (between day 12 and gain water weight and feel bloated. Your
day 16), a woman with a 36 day cycle will ovulate breasts may feel tender. You may get acne.
between day 20 and day 24. You also may have less energy than usual. A
• An easy way to approximate the time of day or two before your period you may start
ovulation for women with regular cycles is to having pain (cramps) in your belly, back, or
subtract 16 from the number of days in the cycle legs. These symptoms go away during the
and then add 4. This will calculate the span of first days of a period.
days in which ovulation is most likely to occur. • When your ovary releases an egg in the
For example, a woman with a 22 day cycle is middle of your cycle, you may have pain in
most likely to ovulate between days 6 and 10 of your lower belly. You also might have red
her cycle (22-16 = 6 (+4 =10). spotting for less than a day. Both are normal

Ovulation and conception How can women take care of bleeding and
• Following ovulation, the egg’s life span can be up symptoms?
to 24 hours, but is usually between 6 and 12
hours. In contrast, the sperm generally survive • You can use pads or tampons to manage
for 3 days, but can live for up to 5 days if optimal bleeding. Whichever you use, be sure to
fertile cervical mucus is present change the pad or tampon at least every 4 to
• Women interested in charting their cycle should 6 hours during the day. Pads may be best at
consult someone experienced in the area of night.
fertility awareness and natural family planning. • Many women can improve their symptoms
Women under 35 who are experiencing difficulty by getting regular exercise and eating a
in conceiving should consult their doctor after 12 healthy diet.
months of trying. This time is reduced to 6
• It also may help to limit alcohol and caffeine.
months for those 35 and over.
Try to reduce stress.
• Therefore, pregnancy is possible 3 to 5 days
• A heating pad, hot water bottle, or warm
before ovulation and in the 24 hours following
bath also can help with cramps. You can take
ovulation.
an over-the-counter medicine such as
• By learning the various signs of ovulation women
ibuprofen or naproxen before and during
can calculate their fertile and non-fertile days for
your period to reduce pain and bleeding.
contraceptive purposes or to optimize the
chances of pregnancy.
Managing menstrual cramps
Signs & Symptoms of Ovulation: Why do I get cramps when I have my period?
• Mittlelschmerz – abdominal tenderness on • During your menstrual cycle, the lining of
left/right iliac regions, brought about by your uterus produces a hormone called
peritoneal irritation due to blood coming out prostaglandin. This hormone causes the
from the graafian follicle. uterus to contract, or tighten, which can
• Spinnbarkeit – vaginal secretion is clear & cause cramping. Women with severe cramps
transparent may have higher-than-normal levels of this
• Change in vaginal mucus hormone, or they may be more sensitive to
• Goodel’s sign - softening of the cervix it.
• Mood changes
• Breast tenderness
• Increased levels of Progesterone
• Change in basal body temperature
 Menstrual Problems

There are a range of problems that women may Menorrhagia (heavy bleeding)
experience with their menstrual cycle. Some of the • Because it is hard to accurately measure the
most commonly reported menstrual disorders are amount of menstrual fluid loss, defining an
amenorrhea (absence of periods), dysmenorrhea amount that constitutes heavy bleeding can
(painful menstruation), menorrhagia (heavy be difficult. The degree to which
bleeding), bleeding between periods and menstruation interferes with everyday
premenstrual syndrome functioning can provide a useful guide. Heavy
bleeding can be caused by a number of
factors including hormonal imbalances,
Amenorrhea (absence of periods) polyps or endometriosis.
• Amenorrhea, (outside of pregnancy), • The excessive amounts of blood lost can lead
usually occurs as a result of a hormonal to a woman becoming anemic. Treatment
disturbance. These disturbances can be may include oral contraceptives and other
caused by a wide range of factors hormonal drugs, the destruction of the
including weight gain or loss, over- endometrium using a variety of methods, or
exercising, emotional upsets (both good the use of the intra-uterine system (IUS) –
and bad), anxiety or stress, travel, “Mirena”.
dietary changes.
Bleeding between periods
Dysmenorrhea (painful menstruation) ( Metrorrhagia)
• While some women experience only mild ▪ Bleeding between periods or spotting can be
discomfort during menstruation, Period a symptom of a number of conditions
pain can consist of a cramping-type pain, including sexually transmitted infections,
caused by the contraction of the uterine gynecological cancer, endometriosis,
muscles, or a heavy dragging pain in the fibroids or a thyroid disorder.
pelvic region. Pain in the legs and back, ▪ It can also be a side effect of some
headaches, nausea and diarrhea are also contraceptives or medications. If a woman
common. experiences bleeding between periods she
should consult her doctor.
• Popular remedies for mild pain include
analgesics (painkillers), Premenstrual Syndrome
• Premenstrual syndrome refers to a
anti-prostaglandins (eg. Nurofen,
collection of symptoms that some women
Ponstan), herbal medicines, warm baths, experience before each period. Symptoms
heat packs, gentle exercise and rest. include physical responses like bloating,
headaches, tiredness and food cravings and
• Other women suffer from severe, psychological responses like irritability,
incapacitating pain. Period pain is more anger, depression and lowered self-esteem.
common in adolescents and women in Women who suffer from premenstrual
their 20s, but can also occur in older syndrome find exercise, dietary changes,
women. Women may get pain a few days yoga, relaxation techniques and herbal
before their period or during the first few remedies are helpful in relieving symptoms.
days of bleeding.
 ANTEPARTAL PERIOD

Process of Fertilization

• Fertilization ( Conception, Fecundation)

- is the union of an ovum and a
spermatozoon. This usually occurs in the outer
third of fallopian tube.

• Implantation or contact between the growing

structure and the uterine endometrium occurs
approximately 8 to 10 days after fertilization.
• Apposition – the blastocyst brushes against the
rich uterine endometrium
• Adhesion – it attaches to the surface of the
endometrium
• Invasion – the blastocyst settles down into its
soft folds.
• ***once the zygote implanted it is an EMBRYO.
SIGNS OF PREGNANCY
BIOPSYCHOSOCIAL ADAPTATION OF PREGNANCY 3. Chloasma – “mask of pregnancy” are brownish
patches of pigment of the face.
Reproductive System

1. UTERUS
• HEGAR’S SIGN – softening of the lower
uterine segments.
• GOODELL’S SIGN – softening of the cervix.

Metabolic Changes

1. Weight gain
• ave. wt gain is 24 – 28 lbs.
2. VAGINA (fetus – 3400gm; placenta – 450; amniotic
• Increased vascularity causes change of color fluid- 900; uterus – 1100; breast tissue –
from light pink to deep purple known as 1400; blood volume – 1800; maternal stores
CHADWICK’S SIGN – 1800 -3600).
3. BREAST 2. Iron requirements increase to 20 – 40 mg daily
• Tender and tingle in the early weeks of and during on the last half of pregnancy, iron is
pregnancy transferred to fetus and stored to fetal liver.
• increase size, larger nipple, more pigmented
Endocrine System
• colostrum present by 2nd trimester
➢ Adrenal glands - ↑level helps to reduce the
Integumentary System possibility of the woman’s body to rejecting the
1. Striae gravidarum – reddish slightly depressed foreign protein of the fetus.
streaks in the abdominal wall, breast and thighs. ➢ Help regulate glucose
metabolism
➢ Parathyroid glands - necessary for the
metabolism of calcium which is important for
fetal growth.
➢ Pancreas - ↑production of insulin. The maternal
glucose level is usually at a higher than normal
level.

Circulatory System
2. Linea Nigra – line of dark pigment extending
➢ HR ↑ by 10 bpm. Cardiac work increase on the
from the umbilicus down the midline to the
2nd trimester.
symphysis pubis.
➢ Palpitations in the early months are caused by
sympathetic NS stimulation.
➢ Heart murmurs are audible probably because
of the altered ♥ position.
➢ Consequences of increased cardiac volume are
easy fatigability/shortness of breath and
epistaxis.
➢ Edema on the lower extremities because of poor
circulation resulting from the pressure of the
 gravid uterus on the blood vessels of the lower - (never take sodium bicarbonate
extremities. because they promote fluid retention)

- Mgmt. for edema: raise leg above hip Respiratory System

level.
➢ Marked congestion or “stuffiness” of the
➢ Varicosities of the lower extremities can occur. nasopharynx, a response to increase estrogen
➢ Wear elastic stockings to promote varicose flows level.
thus preventing stasis on the lower extremities. ➢ Crowding of the chest cavity causes an acute
sensation of shortness of breath
Gastrointestinal
➢ Breathing is rapid than normal.
➢ Morning Sickness - ( nausea and vomiting during - Mgmt:
pregnancy) due to increased HCG, increased - lateral expansion of the chest to
production of gastric acid or it can be due to compensate for shortness of
emotional factor. breathing increases O2 supply and
• Mgmt: vital lung capacity.
- Small frequent meals. ➢ Urinary Frequency – seen during 1st and 3rd
- Eat dry toast crackers 30 minutes before trimester.
arising in the morning. - 1st tri due to increased blood supply in
• Hyperemesis gravidarum (excessive nausea the kidney.
and vomiting which persists beyond 3 - 3rd tri due to pressure of enlarged uterus
months may result in dehydration, starvation on the bladder.
and alkalosis.) ➢ Decreased renal threshold for sugar because of
- Mgmt: D10 NSS, 3000 cc in 24 hours and the increased production of glucocorticoids and
CBR. with the influence of progesterone.
➢ Constipation and flatulence – are due to Musculoskeletal
displacement of the stomach and intestines thus
slowing peristalsis and gastric emptying time; ➢ Because of the woman’s attempt to change on
may also to increases progesterone which gravity, she makes ambulation easier by standing
inhibits gastric motility. more straight and taller.
• Mgmt: ( LORDOSIS/ Pride of pregnancy)
- Increase fluid and roughage in the diet • Advise to use low heeled shoes after the first
- Avoid enema trimester
- Mineral oil should not be taken because
it interfere with the absorption of fat
soluble vitamins.
➢ Hemorrhoids – are due to pressure of enlarge
uterus on the intestine.
• Mgtm:
- cold compress with hazel salt.
➢ Heartburn - due to increased progesterone
which decreased gastric motility and thereby
causing reverse peristaltic waves which lead to
regurgitation of acid in stomach into the
esophagus, causing irritation. ➢ Leg cramps are caused by increase pressure of
• Mgmt: gravid uterus on the lower extremities and low
- Avoid fried and fatty foods calcium level in the body.
- Small frequent mean and taken slowly • Mgmt:
- Take antacid (milk of magnesia) - Frequent rest period w/ legs
elevated
 - Increase Ca intake • Fundic Height (cm) x 8/7 = AOG in weeks
➢ Bartholomew's Rule
Psychological Response
• Uterus is palpable over the symphysis pubis
➢ First Trimester: as a firm globular sphere at 12-14 weeks
• Mother is ambivalent • Reaches the umbilicus at 20-22 weeks
• Some degree of rejection and disbelief • Reaches the xiphoid process at 36 weeks,
• Implication: when giving health teachings, returns to 4cm below the xiphoid at 40
emphasize the body changes in pregnancy. weeks.
➢ Second Trimester:
• Mother accepts pregnancy
• Fantasized appearance of the baby
➢ Third Trimester:
• The best time to talk about infant feeding
method
• Fear of death is prominent that’s why its
better to let the mother listen to fetal heart
sound

Prenatal Visit

Definition if Terms:
➢ Johnson’s Rule
➢ Gestation - the number of weeks of pregnancy • Is used to calculate fetal weight in grams.
since the first day of the last menstrual period • Fundic height (cm) – N x K = fetal weight
➢ Abortion - birth that occurs before the end of 20 - K = 155 (constant)
weeks gestation - N = 12 if engaged (do Leopold’s to find
➢ Term - the normal duration of pregnancy (38-42 out)
weeks gestation) - N = 11 if not engaged
➢ Stillbirth - an infant born dead after 20 weeks
gestation Leopolds Maneuver
➢ Viable - capable of living, such as a fetus that has
Cardinal Rules in Leopold’s Maneuver
reached a stage of development, usually 20 to 24
weeks, which will permit it to live outside the ➢ Instruct woman to empty her bladder first.
uterus; dependent on level of technology ➢ Place woman in dorsal recumbent position,
➢ Gravida - any pregnancy, regardless of duration, supine with knees flexed to relax abdominal
including present pregnancy muscles. Place a small pillow under the head for
➢ Parity - the number of pregnancies in which the comfort.
fetus or fetuses have reached viability, whether ➢ Drape properly to maintain privacy.
the fetus is born alive or is stillborn after viability ➢ Explain procedure to gain patient’s cooperation.
is reached does not affect parity ➢ Warm hands first by rubbing them together
before placing them over the woman’s
Obstetric History
abdomen.
➢ Nagele’s Rule ➢ Use the palm for palpation not fingers.
• If LMP occurred between January and
March, +9 +7 +0
• If LMP occurred between April and
December, -3 +7 +1
➢ Mc Donald’s Rule
• Fundic Height (cm) x 2/7 = AOG (in lunar
months)
➢ First Maneuver – also known as Fundal Grip, ➢ Fourth Maneuver – also known as Pelvic Grip, to
determines what fetal part occupies the fundus. confirm the presenting part of the fetus and its
(cephalic, breech, transverse, etc. ) descent into the pelvis. “Is the fetal head
engaged or not.

➢ Second Maneuver – also known Lateral or

Umbilical Grip, to determine which maternal ➢ Important points:
side does the fetal back is located. Fetal backs is • Why should you position the patient in a
the best location to auscultate heart sounds. supine position?
- To prevent SHS (Supine Hypotensive
Syndrome). A drop in blood pressure
that occurs when a person esp. a
pregnant woman in the last trimester lies
on her back.

Fetal Assessment

ALPHA-FETOPROTEIN (AFP)/TRIPLE SCREENING

➢ This test involves measurement of AFP, estriol and

HCG in maternal serum at 15-20 weeks of gestation
to screen for fetal structural & chromosomal
abnormalities.
➢ Third Maneuver – also known as Pawlik’s Grip, ➢ A low estriol, elevated HCG, and low AFP finding is
to evaluate presenting part into the pelvis and often associated with Trisomy 21 (Down syndrome).
engagement.
AMNIOCENTESIS

➢ Amnion for sac and kentesis for puncture. Scheduled

between the 14th and 16th week.
➢ Amniocentesis is the removal of fluid from the
amniotic cavity by needle puncture. An ultrasound is
performed first to determine the safe site where the
needle can be inserted.
➢ During the procedure, the fetus is continuously
monitored by ultrasound to ensure its wellbeing.
➢ Complications includes hemorrhage from the
penetration of the placenta, infection of the amniotic
fluid and puncture of the fetus.
 BIOPHYSICAL PROFILE

NURSING CARE DURING AMNIOCENTESIS: ➢ Is a noninvasive method of assessing the general

wellbeing of the fetus and the fetal assessment.
• Assist client to empty her bladder before the
➢ BPP may be used as early as 26-28 weeks for the
procedure.
surveillance of high risk pregnancy.
• Place in supine position and drape properly.
➢ The test requires the use of an ultrasound and
• Put rolled towel under right hip to tip body the electronic fetal monitor and the observation
to the left and remove pressure of uterus on time takes about 30 minutes.
vena cava. ➢ Five parameters are evaluated:
• Instruct not to take a deep breath and hold it • Fetal breathing movements
while needle is being inserted as it will shift
• Fetal movement
the uterus and needle may hit placenta or
• Fetal tone
fetus.
• Amniotic Fluid Index
• Inform patient that it is not painful because
• Reactive FHT from nonstress test (NST)
anesthesia will be applied at the insertion
➢ Biophysical Scoring System
site. She may experience pressure sensation
• Normal score – 2
during the insertion of the needle.
• Abnormal score = 0
• Monitor FHT before, during and in 30
➢ At least one episode of 30secs. Of sustained
minutes after the test.
breathing movement w/in 30mins.
• Instruct patient to observe for:
➢ At least 3 episodes of fetal limb or trunk
- Infection
movement w/in 30mins. Observation.
- Uterine cramping
➢ Must extend and then flex extremities or spine at
- Vaginal bleeding
least once in 30 mins.
CHRIONIC VILLI SAMPLING (CVS) ➢ 2 or more heart accelerations at least 15
beats/min.
➢ Is a transcervical or transabdominal insertion of
a needle into the fetal portion of the placenta, at NONSTRESS TEST (NST)
the area of the chorion frondosum.
➢ Is an assessment of fetal well-being that analyses
➢ CVS is performed at 8-12 weeks gestation under
the response of the fetal heart to fetal
ultrasound guidance to ensure that the fetus is
movement.
unharmed.
➢ The baby’s heart rate should accelerate, by 15
➢ Chorionic villi cells are examined to detect
beats for at least 15 seconds, twice in a twenty-
chromosome abnormalities such as Down
minute period. This is called a reactive NST and is
syndrome and genetic disorders such as cystic
a good sign that the fetus is healthy.
fibrosis.
➢ A reactive NST indicates intrauterine survival for ➢ Persistent vomiting
one week. The doctor may order a CST if the NST ➢ Chills and fever (chills and fever may indicate
is nonreactive. The usual preparation is to feed intrauterine infection)
the mother with food or fluids before the test to ➢ Sudden escape of fluid from the vagina (may
stimulate fetal movements. indicate rupture of membranes that may result
to cord prolapse)
CONTRACTION STRESS TEST (CST)
HEALTH TEACHINGS
➢ Assess the ability of the fetus to withstand the
stress of uterine contraction done during labor. A. NUTRITION
➢ CST is a means of evaluating the respiratory
High risk moms:
function of the placenta.
➢ Testing is initiated when 3 contractions in every • Pregnant teenagers – low compliance to
10 minutes are attained. The test takes about 60- heath regimen.
90 minutes to perform. • Extremes in wt – underweight, over wt –
➢ CONTRAINDICATIONS TO CST: candidate for HPN, DM
• Premature rupture of the membrane • Low socio-economic status
• Placenta previa • Vegetarian mom – decrease CHON – needs
• Third trimester bleeding Vit B12 – cyanocobalamin – formation of
• Previous CS folic acid – needed for cell DNA & RBC
• Multiple gestation formation. (Decrease folic acid – spina
• Incompetent cervix bifida/open neural tube defect).
• Hydramnios
Recommended Nutrient Requirement that increases
• Risk for preterm delivery
During Pregnancy
➢ INTERPRETATION OF RESULTS OF CST:
• Positive: there is persistent late Calories Protein Calcium -
decelerations w/ more than half the Phosphorus
contractions; maybe associated w/ minimal • Essential to • Essential • Essential for
or absent variability. A positive CST means supply energy for fetal growth and
that the fetus is no longer receiving adequate • Protein for tissue development
oxygen and needs to be delivered. the fetal growth of fetal
• Negative: There is no late deceleration in a growth • 60 mg/day skeleton and
10-minute period and this means that it is • 300 tooth bud.
calories/day • 1,200
safe for the fetus to remain in utero for the
(A total of 2,500 mg/day
next 7 days.
calories is
DANGER SIGNS OF PREGNANCY recommended to
meet the
➢ Vaginal bleeding no matter how slight (first increased needs
trimester – threatened abortion ; second during pregnancy
trimester – H-mole ; third trimester – placenta to sustain an
previa) elevated
➢ Swelling of the face or fingers metabolic rate
➢ Severe continuous headache (caused by high BP, from increased
Pregnancy induced hypertension - severe and workload and
from the extra
even fatal hypertension)
wt. Eg. Carrot
➢ Dimness or blurring of vision
sticks, cheese
➢ Flashes of light or dots before the eyes (Calcium) Vit. D is
➢ Pain in the abdomen (Abdominal pain may necessary for
indicate ectopic pregnancy, separation of the calcium to be
placenta, preterm labor, appendicitis, ulcer)
absorbed in GIT • Walking – best exercise
to enter bones) • Squatting - strengthen muscles of perineum.
Iron Folic Acid, Zinc Increase circulation to perineum. Squat –
Folacin, Folate feet flat on floor.
• Essential for • Essential Essential for: • Tailor Sitting – 1 leg in front of other leg (
expansion of for • The Indian seat).
blood volume formation formation of
• Raise buttocks 1st before head to prevent
and red blood of red enzymes
postural hypotension – dizziness when
cells blood cells • Maybe
formation and important in changing position
• 30 mg/day prevention the • Shoulder circling exercise- strengthen chest
(Needed to build of anemia prevention of muscles
high level of hgb. congenital • Pelvic rocking/pelvic tilt- exercise – relieves
Necessary to malformation low back pain & maintain good posture
oxygenate the of the fetus. • Arch back – standing or kneeling. Four
blood during (15 mg. is extremities on floor
intrauterine life. recommended. • Kegel Exercise – strengthen pubococcygeal
Eg. Organ meats, Zinc deficiency
muscles - as if hold urine, release 10x or
green leafy veg. may be
muscle contraction
bread, dried associated w/
fruits). preterm birth). • Abdominal Exercise – strengthens muscles
B. SEXUAL ACTIVITY of abdominal – done as if blowing candle.
• Should be done in moderation
• Should be done in private place
• Mom placed in comfy position, side lying or
mom on top
• Avoided 6 weeks prior to EDD
• Avoid blowing or air during cunnilingus
• Changes in sexual desire of mom during preg.
• Changes in sexual desire:
- 1st trimester – decrease desire – due to
bodily changes
- 2nd trimester – increased desire due to
increase estrogen that enhances
lubrication
- 3rd trimester – decreased desire
- Contraindication in sex:
▪ Vaginal Spotting
o 1st trimester – threatened
abortion
o 2nd trimester – placenta previa
▪ Incompetent cervix
▪ Preterm labor
▪ Premature rupture of membrane
C. EXERCISE
• Exercise - to strengthen muscles used during
delivery process
• Principles of exercise
1. Done in moderation
2. Must be individualized
 THEORIES OF ONSET OF LABOR lungs, heart and stomach, which enables
these organs to function easily.
Uterine Stretch Theory
• The symphysis pubis widens and the pelvic
➢ The idea is based on the concept that any hollow floor softens and becomes more relaxed,
body organ when stretched to its capacity will allowing further descent of the uterus into
inevitably contract to expel its contents. In return, the pelvis.
the pressure increases causing physiologic changes 2. Frequency of Micturition
(uterine contractions) that initiate labor. • The descent of the fetal head increases
pressure within the pelvis. This limits the
Oxytocin Theory
capacity of the bladder, which can cause
➢ Pressure on the cervix stimulates the release irritation.
oxytocin from the maternal posterior pituitary gland. • The laxity of the pelvic floor muscles gives
As pregnancy advances, the uterus becomes more rise to poor sphincter control causing a
sensitive to oxytocin. Presence of this hormone degree of stress incontinence. This pressure
causes the initiation of contraction of the smooth results in the congestion of circulation to the
muscles of the body (uterus is composed of smooth lower limbs. Additionally, the relaxation of
muscles). the pelvic joint may give rise to backache.
• Bloody Show - a discharge from the
Progesterone Deprivation Theory
vagina of mucus, and this is sometimes
➢ It is believed that presence of this hormone inhibits tinged with blood.
uterine motility. As pregnancy advances, changes in • Braxton Hicks Contraction
the relative effects estrogen and progesterone • Uterine contraction
encourage the onset of labor. • Cervical Dilation and effacement
➢ A marked increase in estrogen level is noted in
The Ps of Labor
relation to progesterone, making the latter hormone
less effective in controlling rhythmic uterine ➢ Woman/Fetus
contractions. • Power of Labor (uterine factors) are adequate
• Passageway (pelvis) – is of adequate size and
PROSTAGLANDIN THEORY
contour.
➢ In the latter part of pregnancy, fetal membranes and • Passenger (the fetus) – is of appropriate size and
uterine decidua increase prostaglandin levels. in an advantageous position and presentation.
➢ This hormone is secreted from the lower area of the • Position
fetal membrane. • Psyche (or psychological state) – which may
➢ A decrease in progesterone amount also elevates the either encourage or inhibit labor. This can be
prostaglandin level. Synthesis of prostaglandin, in based on the pregnant person’s past life
return, causes uterine contraction thus, labor is experiences as well as present psychological
initiated. state.
THEORY OF AGING PLACENTA ➢ Providers/Support Persons
• Patience
➢ Advance placental age decreases blood supply to • Persistence
the uterus. This event triggers uterine contractions, • Practice/Pain Relief
thereby, starting the labor. • Psyche
PREMONITORY SIGNS OF LABOR FIRST STAGE
1. Lightening ➢ Begins with the onset of true labor contractions and
• Two to three weeks before labor, the lower ends with full or complete cervical dilation.
uterine segment expands allowing the fetal
head to sink deep. The descent of the head
and the body of the baby gives space to the
 True VS False Labor Nursing Management

True Labor False Labor ➢ Hospital Admission:

Contractions occur at Contraction are irregular • Get history of the patient, Asses if BOW is still
regular intervals intact. If it is ruptured as claimed by the patient,
Intensity gradually Intensity remains the perform: NITRAZINE PAPER TEST
increases same • Blue-green to deep blue: alkaline – amniotic
Discomfort is in the back Pain is confined on the fluid.
and abdomen abdomen
▪ FERN TEST – (+) ferning test: amniotic fluid
Cervix dilates No cervical dilation
(The more common use of the fern test is in
Discomfort is not Discomfort relieved by
pregnant patients when there is a concern
stopped by sedation sedation
that amniotic fluid may be leaking.)
▪ COLOR:
Latent Phase , Active Phase and Transition Phase - Yellow-stained – blood incompatibility
- Green-stained – meconium staining –
Latent Phase Active Phase Transition
o breech: normal
Phase
o vertex: fetal anoxia
• Contractions • contraction • contraction
➢ Physical Examination:
are mild and s grow s reach
short lasting stronger their peak • Maternal V/S
to 20 – 40 lasting 40- duration:60 • Temp : ruptured membranes: q 2 hours
sec. 60 sec. -90 sec. ▪ Intact membranes : q 4hrs * respect time of
• 0-3 cm • 4-7 cms (Pag more contractions
cervical cervical than 60-90 • BP,PR & RR: latent phase -q hour or PRN
dilatation dilatation sec. ang ▪ active phase – q 30 mins.
• interval : 5- • interval: 3- contract, • Internal Examination (IE)
10mins 5 mins hindi na • Leopold’s Maneuver
• Causes of • increase normal)
➢ Monitoring and Evaluating:
prolonged vaginal • Dilatation:
• Uterine Contractions: frequency of contractions,
latent secretions 8-10 cms
• duration/length of contractions, intervals
phase: “non- • bloody interval: 2-
ripe” cervix 3 min. intensity.
show and
analgesia spontaneou • At 9 cms ▪ mild: tense uterus but can be indented
given too s rupture of there is a ▪ moderate : firm uterus, difficult to indent
early membranes slight ▪ strong : board-like, cannot indent w/ fingers
cephalopelvi may occur slowing of • FETAL ASSESSMENT: FHT / Fetal Electronic
c • Nullipara – dilatation Monitoring: Normal: 120 – 160bpm
disproportio 3hrs. • at 10 cm • Fetal distress: Fetal bradycardia - < 100 bpm
n Multipara – - irresistibl • Fetal tachycardia - > 180 bpm
• Nullipara – 6 2 hrs e urge to • Fetal trashing-hyperactivity – meconium stained
hours push.
▪ Should not be taken during contractions
Multipara –
▪ Taken q 15 and immediately after rupture of
4.5 hours
membranes.
➢ Health Teachings & Preparations:
1. Ambulation : latent phase shortens the first
➢ Remember to: stage of labor.
• Provide privacy • C/I: Medications, Ruptured membranes ,
• Provide reassurance Intravenous infusions.
• Establish rapport 2. Breathing Technique:
• Inform patient of labor progress
• Check for show/rupture bow
 • Abdominal breathing - panting during • Sacral pressure
contractions (reduce tension and prevent • Proper bearing-down technique
hyperventilation). • Emotional support
• Note: Not to push or bear down during
SECOND STAGE
contractions (maternal exhaustion/cervical
edema) ➢ As the fetal head touches the internal side of the
perineum, the perineum begins to bulge and appears
Elimination:
tense.
• Encourage to void q 2-3 hours by offering a ➢ As the fetal head pushes against the perineum, the
bedpan. vaginal introitus opens and the fetal scalp appears at
• Urinary stasis can lead to UTI the opening of the vagina.
• Full bladder may be traumatized during ➢ ED FIRE ERE (Mechanism of labor)
delivery (Full bladder retards fetal descent) • Engagement – fetal head is “engaged” when the
3. Perineal shaving and preparation: widest part of their head (measured from ear tip
• Done aseptically to ear tip across the head) has passed into the
• Use #7 method always from front to back pelvic inlet
4. Pain Relief: administer analgesic as ordered • Descent - is the movement fetal head through
(Demerol – Meperidine HCL) the bony part of the pelvis and reaches the depth
• Give only when cervix is already 5-8 cms of the pelvic cavity
dilated (25-100 mg/ml) • Flexion – fetal head pushes against pelvic tissue,
• Antidote: Narcan or Nalline (narcotic aligning their head with their chin toward their
antagonist) chest
5. Anesthesia: Regional: low spinal • Internal Rotation – infant rotates head and body
• Usually xylocaine given at 5th lumbar space from side to side front to back to navigate the
• Post-spinal headache due to leakage of CSF changing diameters of the pelvis.
(keep patient flat on bed for 13 hrs.) • Extension - the head passes through the pelvis
• Patient kept on NPO with IVF of glucose. (to at the nape of the neck, a rest occurs as the neck
prevent aspiration and aid in proper uterine is under the pubic arch.
muscle function) • External Rotation – the infant will rotate from
• Watch out for hypotension face-down to 90 degrees to face towards
6. Positioning: downward
Assume Sim’s position • Expulsion – once the shoulders are born, the rest
of the baby is born easily and smoothly because
of its smaller size

• It favors rotation of the head

• Promotes relaxation between contractions
• Prevent supine hypotension syndrome
• Transfer of patient to DR:
▪ Primipara: when fully dilated
▪ Multipara: when 7-9 cm dilated

Note: During Transition Phase provide comfort measures

by:
 Nursing Management • Ease the head out and immediately wipe the
nose and mouth of secretions to ensure a
➢ Prepare the place of birth
patent airway
➢ Positioning for birth
➢ Promoting effective second-stage pushing • Note:
➢ Should push with contractions and rest ( As soon as the head of a fetus is prominent
between them at the vaginal opening, place a sterile towel
➢ Holding breath during contraction can cause over the rectum and press forward on the
temporarily impede blood return to the heart. fetal chin while the other hand is pressed
These could interfere with the blood supply to downward on the occiput. Immediately after
Perineal Cleaning birth of the baby’s head, suction out the
infant’s mouth with a bulb syringe).
➢ Always clean from the vagina outward
➢ Include a wide area (vulva, upper thighs, pubis
and anus)
➢ Sponge away any fecal materials may be
expelled from the rectum
Episiotomy

➢ Pudendal block is given (lidocaine)

➢ Prevent prolonged stretching of muscles
(vaginal prolapse)
➢ Spare the infant’s head from prolonged
pressure (brain damage)
➢ May shorten the last portion of the second
stage of labor
➢ Median episiotomy – heal more easily / less
blood loss / less postpartal discomfort
• Mediolateral Episiotomy – less prone to
rectal mucosal tears ➢ Insert finger in the vagina to check for nuchal
cord
➢ As the head rotates:
• Deliver the anterior shoulder - downward
push
• And then deliver the posterior shoulder -
upward lift
• Place the newborn on the mother’s
abdomen
• Show the baby to the mother, inform the sex
and time of delivery and has the baby to the
circulating nurse.
• Take note of the time when the whole body
of the infant is born.
➢ Cutting and clamping the cord:
• Delay cutting until pulsation ceases and
maintaining the infant at a uterine level
Birth allows as much as 100ml of blood to pass
from the placenta into the fetus.
➢ ED FIRE ERE • Late clamping of the cord can cause over
➢ Ritgen’s Maneuver infusion with placental blood.
• To support the perineum and prevent • Wait until pulsation stops within 1-3 mins.
laceration
 THIRD STAGE • 4th degree laceration – plus mucous
membrane of the rectum
Placenta Stage

➢ Begins with the birth of the infant and ends with

the delivery of the placenta.
➢ Signs of placental separation:
• Lengthening of the umbilical cord
• Sudden gush of vaginal blood
• Change of the size of the uterus
• Firm contraction of the uterus
• Appearance of the placenta at the vaginal
opening .

Types of Placenta

➢ SCHULTZE
• Placenta separate first at its center and lastly
to its edges, it tends to fold on itself like an
umbrella.
• Fetal surface (“shiny”)
• 80% of placental separation
➢ DUNCAN
• Separates first at its edges, it slides along the
uterine surface.
• Maternal surface (“dirty”)
• Raw, red and irregular

Nursing Management

➢ DO NOT HURRY the delivery of the placenta

➢ Care during and after perineal repair:
➢ Timing of placental delivery
• Administration of xylocaine/lidocaine
➢ Care after placental delivery
• Episiorrapy
• Inspection of the placenta for the
• Vaginal packing is sometimes inserted to prevent
completeness of cotyledons
bleeding but must be removed after 24 hours.
• Determine the degree of uterine contraction
• Estimation of blood loss. (any amount exceeding
by palpating the uterus
500cc is considered hemorrhage).
➢ Note : Pull the clamped cord gently and slowly while
winding it around the clamp, then deliver the FOURTH STAGE
placenta by rotating it so that no placental fragments
are left inside the uterus Recovery Stage
➢ Inspection of the perineum for lacerations: ➢ First 2 hours postpartum -most critical stage
• 1st degree laceration – vaginal mucous ➢ Monitor for signs for hemorrhage and other
membrane and skin of perineum complications
• 2nd degree laceration – plus the levator and
muscle Nursing Management
• 3rd degree laceration – plus the external ➢ Assess:
sphincter of the rectum • Fundus- checked q 15min for 1 hr and q 30mins
• for 4 hrs
• Lochia - should be moderate in amount
 • Bladder- full bladder is evidenced by shifting of
the uterus to the right
Note: (Rooming-in Concept: the mother and the
• Perineum - normally tender, discolored and
baby stay
edematous
• Inspected q 8 hours for 3 days
• BP & HR - monitored closely
▪ q 15 min for 1st hour
▪ q 20 min until stable N
• Note: (Rooming-in Concept: the mother and the
baby stay in the same room in the hospital to
promote bonding and encourage breastfeeding)

Stage Primigravida Multigravida

First Stage 12 ½ hours 8 hours
Second Stage 80 minutes 30 minutes
Third Stage 10 minutes 10 minutes
Total 14 hours 8 hours

Created by: Tranquilo, Joshua E.

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