OBSTETRIC NURSING
Prof. Kenneth Arzadon, RN
PART 1: NORMAL OBSTETRICS
ANATOMY and PHYSIOLOGY
FALLOPIAN TUBE
OVARY
UTERINE
ENDOMETRIUM
PHYSIOLOGY OF MENSES
ESTROGEN
Hypothalamus
Follicular Stimulating Hormone Anterior Pituitary Gland
↑ production of
follicular fluid
Thickens the endometrium
Luteinizing Hormone
Rupture of the Graafian Follicle
formation of corpus luteum
Maintains the thickness of the
endometrium
Ovum will atrophy NO FERTILIZATION CL will remain for 10 days
Pregnancy FERTILIZATION CL will remain for 16 weeks
PHASES OF THE MENSTRUAL CYCLE
1st Phase: Follicular, Estrogenic, __________
2nd Phase: Luteal, Progestational, __________
3rd Phase: Ischemic (decreased progesterone and estrogen)
4th Phase: Menstrual Bleeding
Onset of Menarche: 9 – 17 years old
Interval of Menses: 23 – 35 days
Duration of Bleeding: 2 – 9 days
Amount: __________________
Odor: Marigold
For women with regular menstrual cycle
Date of Last Menstrual Bleeding:
1. First day of the next menstrual bleeding –
2. Day of Ovulation –
3. Date of Ovulation –
4. Fertile period –
Date of Last Menstrual Bleeding:
1. First day of the next menstrual bleeding –
2. Day of Ovulation –
3. Date of Ovulation –
4. Fertile period –
For women with irregular menstrual cycle
Keep a record of 6 previous menstrual cycle
OVULATION: ____________________ the next menstrual bleeding
6-day window period (fertility): 5 days before ovulation and the day of ovulation
Signs and Symptoms of Ovulation:
✓ Increased body temperature (Cause: increased Progesterone)
✓ Mittelschmerz – unilateral lower abdominal discomfort
✓ (+) Spinnbarkeit – elasticity of the cervical mucus
✓ (+) Ferning – palm leaf patter under the microscope
✓ Cervical Mucus
STAGES OF FETAL DEVELOPMENT
OVUM → Fertilization (within ________)
ZYGOTE
BLASTOCYST → Implantation (within ___________)
DECIDUA:
Basalis – in contact with blood vessels
Capsularis – encapsulates the blastocyst
Vera – remaining portion of endometrium
EMBRYO (5 – 8 weeks) – Period of ORGANOGENESIS
FETUS (8 weeks to TERM)
Note: LECITHIN-SPHYNGOMYELIN RATIO – indicates _________________________
EMBYONIC FETAL STRUCTURES
Placenta – serves a fetal lungs, kidneys, and GIT
Endocrine functions:
- Estrogen and Progesterone
- Human Chorionic Gonadotrophin
Umbilical Cord – 2 arteries, 1 vein (AVA)
Amniotic Fluid
- Protects the fetus from temperature and pressure changes
- Aids in muscular development
- Ensures adequate oxygenation for the fetus
Normal Amount:
Oligohydramnios:
Polyhydramnios:
FETAL HEART STRUCTURES
GRAVITY AND PARITY
Gravity: Number of pregnancies regardless of outcome of duration
Parity: Number of deliveries that reach the age of viability subsequently delivered; dead or alive
Principle in identifying parity:
1. Multiple pregnancy -
2. Abortion -
3. Stillbirth -
Examples:
1. Patient A is pregnant for the first time and carries a twin
2. Patient B delivered to an alive monozygotic twin
3. Patient C is now pregnant. Her pregnancy three years ago ended in abortion
4. Patient D has delivered an alive baby girl. Her pregnancy three years ago ended in abortion
5. Patient E pregnancy three years ago ended in abortion. She aborts for the second time;
GTPALM Scoring
Gravity
Term (37 weeks and above)
Preterm (36 weeks and below)
Abortion (Less than 20 weeks)
Living
Multiple Pregnancy
Example:
Patient X is experiencing her fourth pregnancy. Her first pregnancy ended in a spontaneous abortion at 8
weeks, the second resulted in the live birth of twin boys at 38 weeks, and the third resulted in the live
birth of a daughter at 34 weeks.
OBSTETRICAL FORMULA AND COMPUTATIONS:
NAEGELE’S RULE
To estimate: ESTIMATED DATE OF CONFINEMENT
Pre-requisite: Last Menstrual Period
Jan – Mar:
Apr – Dec:
BARTHOLOMEW’S METHOD
Xiphoid process (36 weeks)
Umbilicus (20 weeks)
Symphysis pubis (12 weeks)
SIGNS AND SYMPTOMS OF PREGNANCY
PRESUMPTIVE
• Amenorrhea
• Nausea and vomiting
• Urinary Frequency
• Breast changes
• Uterine enlargement
• QUICKENING
• Melasma/Chloasma (face)
• Linea Nigra (Xiphoid process to Symphysis pubis)
• Striae Gravidarum (Lower abdomen)
PROBABLE
• Braxton Hicks contractions – painless contractions relieved by walking
• Ballottement – rebounding of the fetus
POSITIVE
• Fetal heart rate
• Fetal outline
• Fetal movement
COMMON DISCOMFORTS DURING PREGNANCY
Nausea and Vomiting
o Dry crackers / carbohydrates
o Small frequent feedings
o Avoid fried, fatty, and spicy foods
o Fluid in between meals
Heartburn (Pyrosis)
Manifestation: substernal chest pain
o Elevate head of bed 3 hours after meals
o Milk in between meals
Constipation
o Increase oral fluid intake
o High fiber diets
o STOOL SOFTENERS
Backache
o __________________ Exercise
o Sleep in a flat, firm surface
Lordosis (Pride of Pregnancy)
Waddling Gait (Duck walk)
Breast Tenderness
o Wearing a supportive bra
o Avoid using soap to prevent drying
Leg Varicosities and Pedal Edema
o Elevate the legs
o Anti-embolic stockings
o Avoid prolonged sitting and standing
o Avoid crossing the legs
Hemorrhoids
o Knee Chest position / Modified sim’s position
o Modified sim’s position
o Cold Compress
o Warm sitz bath
LEUKORRHEA (Whitish non-foul vaginal discharge)
o Use cotton underpants / perineal pads
NOTE:
Leg Cramps
o Increase CA in the diet
o Dorsiflexion of the foot
Urinary Frequency
o Increase fluid intake
o Wipe perineum front to back
SUPINE HYPOTENSIVE SYNDROME
Cause: vena cava compression
Manifestation: Dizziness while lying supine
Management: ________________________
ROUND LIGAMENT PAIN
- Stabbing or jabbing pain in the lower abdomen aggravated by movement
- Management: ___________________
