MCHN II.

Menstrual Cycle
• Ovaries, Oogenesis
Lecturer: Alexander D. Arucan, RN, RM, LPT, MAN, PhD • Hormone production
Nov. 12, 2022 • Estrogen
NP2: Care of the Mother & Child at Risk/Healthy (OB, • Progesterone
Pedia, Funda, PALMER) • Ovulation
(100 items) • 14th day of a 28-day cycle (FEB)
9/19/22 • 14 days before the 1st day of the
TEST-TAKING STRATEGIES last menstrual period
• Naegele’s Rule
Keywords (encircle, box)
Assessment vs Implementation
Physical vs Psychosocial NSG DX ESTROGEN PROGESTERONE
Maslow’s Hierarchy of Needs Hormone of the WOMAN Hormone of
ABC PREGNANCY/MOTHER
Need to evaluate your answer FIRST
Safety of the patient Primary function: Primary function:
SMART Secondary Sexual Prepares the endometrium
Characteristics to THICKEN
LAW OF PRIORITIZATION • Adolescent (12-18
1. Physical vs Psychosocial patient years old
2. Unstable vs stable patient • “Growth Spurt” -
3. Unexpected vs Expected patient sudden increase /
4. Acute vs Chronic patient change in the size of
5. TRIAGE (Life Threatening Situations) the body
• “Emergent”cy vs Urgent Increase in the
- RED size of the breast
Widening of the
hips
I. Sexual Anatomy & Appearance of
axillary and pubic
Physiology hair
Menstruation
A. Internal (The Body)
• Cervix Thelarche (IW)
• Fundus • Boobs,
• Fallopian tube balakang
• Ovaries Adrenarche (A)
B. External (The Face) / Vulva • buhol
• Pubic Hair Menarche (M)
• Mons Pubic • babae
• Protection
• Labia Majora Inhibits: eFSH Inhibits: LH & Uterine
• Protection Contraction
• Clitoris (Male: Penis)
• Sensitive to touch & temperature Family Planning: Cervical Family Planning: Basal
• Urethra Mucus Method / Billing’s Body Temperature
• Opening for urethral catheter Method / Spinbarkeit • decreased due to
• Skene’s Gland (Male: Prostate Gland) progesterone having
(Egg White) - FERTILE thermogenic e ects
• Lubrication
• Clear • 3 days increase after
• Vagina
• Slippery ovulation
• Bartholin’s Gland (Male: Couper’s • Stretchable • Mood swings
Gland) • Constipation
• Secretes uid that lubricate the
vagina Encrease Estrogen
(Weight Gain)
NOTE 1

• Alkaline - sperm NOTE 2

• Acidic - vagina
Pincer grasp, creep & crawl, mama-dada - 9 months
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 TERMINOLOGIES

1. Menarche - 1st menstruation

• Average: 11-14 years old
2. Amenorrhea - absence of menstruation
3. Dysmenorrhea - “painful”
• O er: Warm food & drinks
4. Menopause - matanda; cessation / stop of
menstruation
• Average: 50 y/o or 51 y/o
5. Menorrhagia - excessive bleeding
6. Metrorrhagia - bleeding in between menstruation

NOTE 3

HyPOthalamUs
GnRH - Gonadotropin Releasing Hormone
H”A”Y - anterior
Pituitary Gland - FSH, LH
Ovaries - Estrogen, Progesterone
Uterus

• Oral Conceptive Pill

- Contains Increased E & P
• When woman is pregnant, there is an
increased Estrogen & Progesterone
• What is the role of menstrual cycle?
a. Implantation
• W
• Organ of Implantation
• Menstrual organ (Endometrium “slough
o ”
• Bahay bata/Body
b. Ovulation
• OHO
• Ovaries, Hypothalamus, Ovulation
• Hormone fot ovulation: LH
c. Pregnancy
d. Menstruation

VIABILITY OF REPRODUCTIVE CELLS:

Sperm: 48-72 hours, 2-3 days
Ovaries: 24-36 hours, 1-1.5 days
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 MENSTRUAL CYCLE
- From the beginning of one menstruation to the beginning of next menstruation

“Magkakatunong”

ollicular phase uteal phase

Graa an

F ol
ollicle

ollicular stimulating
Hormone (FSH)
Corpus

L u
uteum

uteinizing Hormone
(LH)

High in EStrogen High in PROgesterone

FOLLICULAR PHASE 14TH DAY LUTEAL PHASE

O
Menstruation Proliferative Secretory Ischemic
Post menstruation Post ovulation Pre-menstruation
Pre-ovulation

V
1 average 5 6 “proliferate” 13/14 15 “secrete” 25 15 “Ischemia” 25
5 days Increase in Estrogen Increased Progesterone
50 cc • “Endometrium starts
to thicken” “NO”
U •
•
•
No oxygen
No blood supply
No fertilization occurs

L —> necrosis (death)

occurs in corpus
luteum
• Estrogen and Progesterone decrease on the
3rd day of menstruation A
T
Decreased E & P (because you secrete blood, Increased E, Decreased P
hormones, electrolytes) |
| Hypothalamus
Hypothalamus |
|
GnRH
|
I GnRH
|
Anterior Pituitary Gland

O
Anterior Pituitary Gland |
| LH
FSH |
| Ovaries
Ovaries
|
Increased E, Decreased P
N |
Increased E & P
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III. Human Conception & DAY Division Ampulla (Fallopian tube)

Fetal Development 4 16 Morulla: mullberry mass;

blastocysts
A. Sexual Responses • blastocyst —> embryo
• EXcitement: longest period: foreplay • Trophoblast —> placenta
- S/S: Sympathetic Nervous System - 8th day - Implantation on FUNDUS
- Increase except GIT & GUT • AKA fecundation / conception
- Dilation, dry mouth
• PLateu C. Embryonic Stage
• ORgasm: shortest period: female has • Zygote: 1st human cell
longer orgasm • Fertilization —> 2 weeks
• REsolution / REsting phase • Embryo: 2 weeks —> 8th week
- Refractory period: males cannot be • Implanted ovum
stimulated for the next 15-30 minutes • 1st 8th weeks - organogenesis
- S/S: Parasympathetic Nervous System (most sensitive)
- Increase GIT & GUT • Fetus: 8th week —> term (37 - 42 weeks)
- Constrict, increased salivation • pLacenta takes over = serves as
LUNGS of fetus
B. Pre-embryonic Stage
• Corpus luteum —> placenta
• “4 DAYS FLOATING”
• Ampulla (Fallopian tube) - where egg cell D. Germ Layers
and sperm cell meet —> travel to uterus
• MESoderm “May puso sa ibabaw ng titi”
• Heart
TITI MU ay mAPULA SAYA-SAYA • Musculoskeletal
kaya ang • Reproductive organ
• Kidneys
intersTITIal IsthMUs Ampulla inFUNdibulum • Ears
• Endoderm “TAY”
Closest to Site of Outer third Most distal
• Thyroid
uterus sterilization part
• Thymus
Most #2 Second Closest to the • Tract (GI, Respi)
proximal half ovaries • A”tay” - Liver
site • Tonsils
• Ectoderm “External”
Diameter: FP: Site of Oh its so FUN • Skin
1mm Bilateral fertilization over here! • Nails
Tubal (Ovaries) • Hair
Ligation • CNS
Most Common
dangerous site of
site of ectopic
ectopic pregnancy
pregnancy (implantati
on outside
uterus)

CELL DIVISION
DAY Division Ampulla (Fallopian tube)

1 1 Fertilization: union of sperm cell

and egg cell (aka impregnation) E. Fetal Growth & Development
2 2 Mitosis: 46 chromosomes
• Doppler - as early as 8 weeks
(23-23) • Lanugo - ne downy hair
XY - boy (father determines sex ➡ Appears on the 4th month
of baby) ➡ 4 x 5 = after 20 weeks (preterm) -
XX - girl there is abundant lanugo
Male sperm - triangular shape, • Fetoscope - “ fthoscope”
longer tail ➡ used on the 5th month
Female egg - rounded, shorter ➡ Quickening “fetal kick”
tail • Primigravida: 18-20 weeks
• Multigravida: 16-18 weeks
3 4 Blastomeres • Ver”six” Caseosa
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 ➡ Vernix caseosa: White cheesy • Diagnostic Procedure:
substance a) Amniocentesis - aspiration of
➡ Appears on the 6th month the amniotic uid from the
• On the 7th month, the testes descends amniotic sac
on the scrotum • Safety: empty the bladder
➡ Failure of testes to descend on • 16-18 weeks
scrotum = cryptorchidism • L:S ratio (Lecithin:
• orchidopexy / Orchiopexy - Sphingomyelin)
surgical repair • Determines the lung maturity
• Subcuteightnous Fat • Baby can already go out /
➡ Subcutaneous Fat mother can give birth on the
➡ Insulator 36th week (9 months)
➡ Eighth month • 2:1 ratio = determination of
• 2nd month - sex of baby is lung maturity through the
distinguishable alveoli compound
• 3rd month - sex of baby is already • If 1:2 = lung is immature —>
distinguishable by means of assessing RDS
the outward appearance - Nsg Management:
• 4th month - sex of baby is Bethametasone (steroids,
distinguishable by means of using teratogenic)
ultrasound • Don’t give too much
because it may lead to
cleft lip / palate
• Repair lip before
palate to save sucking
(lip) and speech
(palate)
b) Alpha Feto Protein (MSAFP
“maternal serum AFP”)
• Decreased AFP - down
syndrome / trisomy 21
• 21st chromosome has extra 1
• Increased AFP - Neural Tube
F. Structures of Pregnancy Defect (Spina Bi da)
1. Amniotic Fluid “swimming pool”
• Clear
NOTE 4
• Provides nourishment (alkaline)
• pH paper - blue to red (BRa) • To prevent NTD: Increase Folic Acid Diet (dark
• Controls body temperature green leafy vegetables) - vit. B9
• Provides elimination for urine and • Popeye (Spinach), Malunggay (horse
feces radish), Kangkong (Swamp Cabbage)
• Feces - meconium (blackish • BEST SOURCE: SPINACH
greenish) • TRN (vit b1, b2, b3)
• Less than 500 cc - oligohydramnios
• Spina Bi da
• More than 500 cc - polyhydramnios • Occulta
• Cystica
Oligohydramnios Polyhydramnios • Meningocele
• Myelomeningocele “Kuba” (cover with
Problem in urination Problem in drinking wet sterile gauze to prevent drying
which can lead to infection from cele
Possible for kidney Possible for rupture)
malformation tracheoesophageal atresia
(TEA) or stula (TEF)
2. Umbilical Cord: average 50 cm
Atresia - absence of • Short: abruptio placenta
connection • Longer: cord prolapsed
Fistula - with connection • Fetal Circulation (AVA)
• If 2-vessel cord: Kidney
4 Cs of TEA malformation or Cardiac disorder/
Cyanosis anomaly
Coughing • Oxygenated circulation -
Choking Umbilical vein —> carries
Continuous Drooling oxygenated blood to the baby
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 NOTE 5 9/20/22
3. Placenta
First structure to enter the fetal circulation: Ductus a) Lungs (Di usion)
Venosus “malinis” • CO2 <—> O2
• Bypasses the liVer to Vena Cava (inferior) • Higher concentration to lower
concentration
Ductus Arteriosus b) Immunologic function: IgG
• Aorta c) Endocrine Function
• Pulmonary Artery i. HCG
• Connection between Aorta & pulmonary artery = • Increased:
Ductus Arteriosus • (+) urine testing / (+)
pregnancy test
Foramen Ovale • (+) nausea & vomiting / (+)
• Opening emesis gravidarum
• (+) H-mole
• Decreased:
• MissED abortion (closed
cervix)
• Ectopic pregnancy
• ThreatenED abortion
(closed cervix)

Months 2 3 4

Weeks 8 12 16
Peak Starts to Lowest
decrease
Ductus Venosus, Ductus Arteriosus, Foramen
Ovale:
• How to initiate crying? ii. HPL (Human Placental Lactogen)
1. Sole (foot slapping) • AKA Sommatotropin
2. Suctioning • Insulin anTAGOnist - hides
3. Unang Yakap (Immediate Drying) the insulin
• Insulin: mode of
Expected Cry: Loud & Lusty Cry transportation of Glucose
Unexpected Cry: • Glucose: source of
• High Pitched Cry (earliest sign; language of energy of fetus
the child) • E ect to the mother when
• Universal language of children: Play HPL hides insulin:
• High ICP (stable with bulging fontanelle) hyperglycemia
• Hypoglycemic • Glucose is highest on the
3rd trimester —> baby
STUDY: needs more glucose for
• Tetralogy Of Fallot energy which is why HPL
• Acyanotic & Cyanotic Conditions usually increases in the
3rd trimester.
• Glucose is the only x that
NOTE 6 bypasses in the placental
barrier.
IgE - for allergy • Nsg Management: O er
inSulin (Subcutaneous - 45
degrees)
NOTE 7 • SAFETY: DO NOT give OHA
because this is teratogenic.
When baby is delivered, the baby will be
hypoglycemic because placenta (umbilical cord) is cut • Do not give Coumadin
which is the passage for glucose that is the source of (teratogenic)
energy of the baby. This will be indicated by a high • Anything taken orally is
pitched cry. Initiate breastfeeding then. teratogenic
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 PROM
Prolapsed
CORD
PROLAPSED
CORD COIL/
STRANGULAT
IV. Maternal Adaptation to
Rupture of the
Membrane
(Lumusot ang
cord)
ION
Nuchal of the
Pregnancy
A. Diagnosis of Pregnancy
(Pumutok ang cord
panubigan) (Nasakal ang 1. PreSumptive “hindi lahat ng SAGING ay
bata) nakakabuntis”
• Subjective, Symptoms (Covert)
“Life BEST ANSWER: Answer based • Observed by the patient
Threatening” Position on choices:
• BANQUS “banana cues”
Uncoil the cord.
Position the
Increased FHT mother: Cut the cord “BANQUS”
(normal: 120-160 trendelenburg / after pulsations
bpm) Knee-chest (1-3 minutes) B reast Changes
Fetal distress Or: Cover with Cord Clamping:
wet sterile gauze 2cm and 5cm A menorrhea
from the base. N ausea & Vomiting “emesis gravidarum”
Cut in the
middle. Q uickening “fetal kick”

Silver 25 U rinary Frequency

Intervention Unang Yakap S kin Changes
based on the EO: 2009: 0025
2. PrObable
choices:
Monitor the
FHT Silver 925 • Objective, Overt (Signs)
• Observed by the Health Care
First Action: Provider
Assess the • Mnemonic: Curriculum Vitae, G-
amniotic uid Cash, Hu U?
(because mother
might just want to
urinate) PROBABLE SIGNS

urriculum itae
NOTE 8 C hadwick’s V agina (Blue)
Independent nursing interventions FIRST before
oodell”s ash
dependent intervention.

“IMAGERY” - imagine the situation

G C ervix

egar’s terus
“PATIENT FIRST BEFORE THE EQUIPMENT.”

KEYWORD: Priority nsg management

H CG U rine Testing
(usually as early
• Answer: Monitor as the 8th day)

aBdomen enlargement

B
allotement “fetal bounced”

raxton Hick’s Contraction

• Painless, irregular
contractions
• “False Sign”

3. Positive
• (+) Ultrasound (Full Bladder)
• (+) FHT (120-160 bpm)
• Low pitched sound
• (+) Fetal Outline / Sonogram
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 LEOPOLD’S MANEUVER NOTE 9

1 Presentation DARK PIGMENTATION - is due to melanocytes

• Cephalic • Dark Areola
• Breech • Chloasma
• Melasma
2 FHT (120-160 bpm) • Linea Nigra
• Fetal back

3 Engagement INCREASED PERSPIRATION, SALIVATION, BREAST

ENGORGEMENT - because of“E”ncreased Estrogen &
4 Attitude Progesterone
• Flexion
• Extension EMESIS GRAVIDARUM
• Due to increased HCG
Position: Dorsal Recumbent • Metabolic Alkalosis
• Increased pH
• Increased HCO3
B. Physiological Changes During Pregnancy
(Expected) Decreased pH - acidosis

CHANGES NSG MANAGEMENT LORDOSIS

• Hormone responsible: Relaxin
Nasal Congestion / • NO OTC Drugs
Stu ness • Humidify the air
NOTE 10
Emesis • O er dry crackers
Gravidarum / • 6 small frequent feedings HgB HCT (%) Total
Nausea & Vomiting
/ Morning Sickness Do not o er: Female 12 (+3) (x3)
• Increased HCG • Hot Spicy Food
• Ca eine Male 14

Ptyalism Increased • O er bubblegum Normal Values:

Salivation • Mouthwash • RBC 4,600,000
• WBC 5-10,000
Chloasma / Melasma • Platelets 150-450,000
• Dark pigmentation of the face
• “Mask” of pregnancy

Breast Wear supportive bra

NOTE 11
Engorgement
Post lobectomy position - una ected
Erected nipple Post pneumonectomy position - a ected
Lobes in the right lung: 3
Darkened areola COAL: Cane On A ected Leg

Colostrum Venous return - amount of blood going back to the

• 16th week heart
• IgA - IgAtas
• IgG - placenta In tetralogy of fallot, child squats to reduce venous
return to the heart.
Linea Nigra

Protruding umbilicus

Striae gravidarum

Lower extremity edema

Palmar erythema

Increased Perspiration

Lordosis Pelvic rocking

• Inward curvature
of the spine
• “Pride of
Pregnancy”
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 EXPECTED OF THE PREGNANT MOTHER EXPECTED OF THE PREGNANT MOTHER

Increased RBC, WBC, Platelets to prevent shock GRAVID UTERUS

• RBC —> palmar erythema • There is di culty of breathing / shortness of breath
• WBC — teratogenic, TORCH to prevent risk for due to gravid uterus compressing the diaphragm
infection • Normal 1st - 3rd trimester
• Platelets to prevent bleeding • Relieved on the 3rd trimester due to lightening /
• Abortion engagement / baby dropped
• Eclampsia • Because urinary bladder is compressed, there is
• H-mole increased urinary frequency
• Incontinent Uterus • Hyperventilation because she needs to blow o own
• Placenta Previa CO2 and fetus’s CO2
• Postpartum Bleeding • Nsg Management: Give brown paper bag
• Expected in the rst 24 hours of Post partum • Respiratory Alkalosis
• Expected Blood loss in NSD : 500 cc • Increased pH
• Expected blood loss in CS: 1000 cc • Decreased pCO2
• Heart is displaced to the left
Physiological anemia • Palpitations (+10-15 bpm) without headache is
• Pseudo anemia “false anemia expected
• Too much plasma • To prevent SUPINE HYPOTENSION / VENA CAVA
Decreased SYNDROME, position LEFT SIDE-LYING POSITION
• Hemoglobin • Stomach is pushed upwards / compressed, acidic
• Hematocrit (%) contents / environment goes to the esophagus
Nsg Management: • There is heart burn (Pyrosis) ( re)
• O er Vit. C • Nausea, vomiting, emesis gravidarum
• For better absorption • Nsg Management:
• O er vit rst before FeSO4 • Antacids with doctor’s order (antagonists of acid)
• O er oral FeSO4 • Pushes liver to the side
• O er straw because it causes staining • Increased bile salts —> blood —> itchiness
• To prevent gastric irritation • Nsg management:
• Give with empty stomach BEFORE meals • O er calamine lotion
• Because of Iron De ciency • Frequent assessment
• IM, Z-track Method to seal the drug • Pushes small intestine to the side
• Aspirate rst before administration • Causes constipation due to increased
• DO NOT MASSAGE progesterone
SIDE EFFECTS OF IRON: • Nsg management:
• Black tarry stool • Increase uids and ber/rough diet/ bulk diet
• Constipation • 2-3L of uid per day
• Urinary bladder is pushed down
• There is increased urinary frequency
• 3rd trimester: due to lightening
• Nsg Management:
• Kegel’s Exercise - strengthens pubococcygeal
muscle
• Hemorrhoids because of gravid uterus going down
• Nsg Management:
• Hot sitz bath
• Increase uids & ber
• Edema on the lower Extremities
• Nsg Management:
• Elevate the legs to increase venous return
• Varicose Veins
• Nsg Management:
• O er panty hose stocking upon arising before
getting out of the bed to prevent DVT

SAFETY:
• Wear a at non-skidding shoes

NOTE: It’s okay to increase uid even if there’s edema

on the lower extremities due to increased urinary
frequency.
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 EXPECTED OF THE PREGNANT MOTHER C. DANGER SIGNS OF PREGNANCY
(Unexpected)
Expected Weight Gain:
• Minimum: 20-25 lbs
UNEXPECTED OF THE PREGNANT MOTHER
• Optimum: 25-35 lbs
• Speci c weight gain: • Headache
• 1st trimester: 1 lbs/month = 3 lbs • Blurring of vision
• organogensis • Rolling of the eye balls
• 2nd trimester: 1 lbs/week = 12 lbs • Epistaxis - nose bleeding
• Height gain • Nsg Management:
• 3rd trimester: 1 lbs/week = 12 lbs • Press nasal bone (10-15 mins for clotting time)
• weight gain • Lean forward to prevent aspiration
• Hyperemesis Gravidarum
Expected Caloric Intake: • Edema on the upper extremities
• Non-pregnancy: 2200 kcal/day • Increased Blood Pressure - Hypertension
• During Pregnancy: 2500 kcal/day
• 140/90
• Preg-nan-cy = add 300 to nonpregnancy caloric • Increased Temperature = Infection
intake
• Increased WBC accompanied by Increased
• Lactating: 2700 kcal/day temperature = NOT NORMAL
• Add 500 to nonpregnancy caloric intake • Breast Mastitis
EXPECTED BP OF MOTHER ENTIRE PREGNANCY: • In ammation —> infection
• Epigastric pain
1st trimester: ——— ——— 3rd trimester: • Due to in ammation of liver
normal or \ / normal or • Aura of an impending convulsion
same as pregnancy \/ same as 1T BP • Board-like abdomen
• Placenta Previa
2nd trimester: decreased due to: • Abruptio Placenta
Peripheral • Premature Rupture of the Membrane
Resistance • Any type of bleeding
Circulation • Proteinuria
• Cord Prolapsed

Pregnancy Induced Hypertension

NOTE 12 • 20th week
• Toxemia
Pneumonia - in ammation of the lungs
• Cause: unknown
• Same with Acute Glomerulonephritis
Beaten by a bee: scrape it
Proteinuria/Albuminuria
Beaten by a dog: wash it

You have seen an 8th month old infant with sunken

fontanel due to dehydration, what is your nursing
management?
Idema (Edema) Hypertension: 140/90
a. Monitor the weight
b. Monitor I&O PIH NSG Management:
c. Monitor depressed fontanel • For proteinuria:
d. Monitor skin turgor • Increase protein intake
• Limit intake: 1g/kg/day
Insensible uid loss - perspiration, loss of CO2, O2, • CHN: Heat Acetic Acid Test
etc. • Specimen: urine
• Heat the urine of pregnant mother with acetic
acid (vinegar) to detect proteins
• For Edema:
• Monitor weight to check for edema always
• For hypertension:
• Monitor BP
• DOC: Apresoline

CHN Management for HPN:

AFTER MINS CRITERIA

5 mins Relaxed
Calmed

30 mins Smoking
Drinking Alcohol
Cold/Hot drinks/food
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V. ANTEPARTUM MONTH Formula In cm
• Before

x
1 1

2
• From the time of fertilization —> TRUE site of
labor and deliver 2 4
• CHN (PH): Pregnancy Visit
• 1st trimester: Once or as early as 3 9
pregnancy
4 16
• 2nd trimester: Once
• 3rd trimester: Once 5 25
• On the 8th month: every 2 weeks
6 30

5x
A. EDD/EDC/EGA (Estimated Date of Delivery/
Estimated Date of Con nement/ Estimated 7 35
Gestational Age)
8 40
1. Naegel’s Rule (1st day of the last 9 45
Menstrual Period)
• Jan - March: +9 +7 10 50
• April - December: -3 +7 +1 year
Example:
• LMP: Sept. 19 - 24, 2022
9 19 22
-3 +7 +1

6 26 23
• Compute the :
1. Feb 14, 2023
2. Nov 1-5, 2022
3. Dec 25-30, 2022
4. April 29 - May 1, 2023
5. Nov 12-17, 2022

2. McDonald’s Rule
• Length of fundus (cm) x 8/7 = # of
weeks
• Length of fundus (cm) x 2/7 = # of
months

3. Bartholomew’s Rule
• 12 weeks (10 ngers + 2 arms) -
fundus is at the level of the
symphysis pubis
• 20 weeks - at the level of the
umbilicus
• 9 months - at the level of the
xyphoid process
• 8 or 10 months = at least 2 nger
breadths below the xyphoid process
• Due to lightening

4. Haase’s Rule
• Height of the fetus
• (1-5 months)2
• (6-10 months) x 5
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 VI. INTRAPARTUM STAGES OF LABOR & DELIVERY
• From TRUE signs of labor & delivery —> 1st 2 1st stage C ervical Stage
hours of postpartum • Dilation (cm)
• “Within” • E acement (%)
• PRIDE
“TRUE” • In PRImigravidas, Dilation
occurs before E acement
T aas Duration Intensity, & Frequency 2nd stage xpulsion of the fetus
E
R egular Contraction 3rd stage lacental Stage
upture of Membrane (Show) P

U nrelieved pain through walking

• Pain radiates from lower back to NOTE 14
abdomen
MgSO4 TOXICITY
E acement (+) & Dilation (+)
- Cervix BP
- E acement: Thinning (%) Urine output
- Dilation: Widening (cm) Respiratory rate
Patellar re ex is absent (1st sign)
• Station: the relationship of the presenting part
ANTIDOTE: Calcium Gluconate
MOSA to the level of ischial spine
Mentum - “chin”
Occiput - “head” NOTE 15
Sacrum - “buttocks”
Acronium - “shoulders” OXYTOCIN uterine stimulant
• Administer via piggyback
• Don’t give during transitional phase - may lead to
Before baby passes to the “Pekpek,” it passes
placental trauma
to the “FECPEC” • Give only after delivery of the placenta to release
loating placental fragments that lead to bleeding
F
• -4, -3, -2, -1
Side E ects:
E ngagement • Stimulates sympathetic nervous system + headache
• 0 = “water intoxication”
• Same level with the ischial spine
Nsg Management:
C rowning Stop administration of oxytocin
• +1, +2, +3, +4 Left (turn the mother to this position)
assageway of the fetus / menstruation Oxygen (administer)
P Physician (notify)
E ntrance & Exit of the penis
Exit of the baby Safety:
• Watch out for uterine contraction lasting 60-90
C opulation seconds every 2-3 mins

• BULGING OF THE PERINEUM - surest sign that

the baby is about to be delivered
• Delivery - act of giving birth
• Parturient - woman who is in labor
• Labor - coordinated sequences of involuntary
uterine contractions

NOTE 13

Vagina - acidic
Increased gylcogen
|
(Dorderlein’s bacillus)
|
Lactic acid (decreased pH)
|
Less infection
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 1ST STAGE: CERVICAL STAGE
Dilation Duration Frequency Intensity Breathing Nsg Management
APGAR
(Saunder’s)

1 L atent 0-3 cm 20-40 s Q 5-10 min Mild Chest • Health Teaching

• Therapeutic
Communication

2 A ctive 4-7 cm 40-60 s Q 3-5 min Moderate Abdominal Meds at the bedside
• TOcolytics
• It’s Not My Time Yet

Indomethacin
Nifedepine
MgSO4
• Anti-convuksant
• Muscle relaxant
Terbutaline
Yutopar

3 T ransitional 8-10 cm 60-80 / 90 s Q 2-3 min Severe Panting

2ND STAGE: EXPULSION OF THE FETUS

Labor & Delivery less than 3 hours: Labor Transfer to the DR/OR
Precipitate Labor & Delivery (Cervix)

Primi 14 - 20 hours FULL Dilation

Multi 8 - 14 hours 8 - 10 cm

MECHANISMS / CARDINAL MOVEMENT OF LABOR & DELIVERY

E ngagement Level 0

D escent

F lexion (Chin - Chest) Vertex

I nternal R otation

E xtension

E xternal R otation

E xpulsion “Baby out”

• Ritgen’s Maneuver - facilitate expulsion of fetus

3RD STAGE: PLACENTAL STAGE 3RD STAGE: PLACENTAL STAGE

15-28 cotyledons • Brandt Andrew’s Maneuver - Facilitate the

expulsion of the placenta

D
uncan
• Signs & symptoms of placental separation - are
irty UBC on your Final Coaching? “Expected”

ulo (edge) Contraction of U terus (Calkin’s Sign)

Ma er side Sudden gush of B lood

Lengthening of C ord

S
chultz

hiny F irm

enter (center) C ontracted

Fetu CHN Management:

Active, Management, Third, Stage, Labor
• Umbrella
VII. POSTPARTUM
• Involution: from pregnancy to nonpregnancy /
prepregnancy state
• Up to 6 weeks
• “Subinvolution” = “Failure” to return

L aceration Episiotomy
• Opening
• Done by the doctor

A tony Absence of uterine

contraction
• Give oxytocin /
methergine

R etained placental Surgical Management:

fragments Dilatation & Curettage

R upture of membranes SM: TAHBSO

I nversion of the uterus SM: Histerectomy

(removal of the uterus)

NOTE 16

2 TYPES OF EPISIOTOMY:
1. Medio-lateral
• To the side
2. Median
• Middle; to the anus

Repair of Laceration: Episiorrhapy

• RN can perform with proper training
• RA 9173

DEGREE OF LACERATION

1 (perineal) S kin

2 (perineal) T issue

3 A nus

4 R ectum
VIII. HIGH RISK PREGNANCY C. H. Mole

TRIMESTER BLEEDING/Shock - #1 HYATIDIFORM MOLE “ubas-ubasan”

complication
trop oblastic disorder
• Nsg Management: Complete Bed Rest without
bathroom privileges CG (+ pregnancy test)

H
1st A bortion before 20 weeks yperemesis gravidarum
E ctopic pregnancy
F T (fetal heart tone) is absent
2nd H -mole
I ncompetent cervix
Fundic eight
3rd PP Placenta Previa
Met otrexate
AP Abruptio Placenta
Monitor CG for 1 year

A. Abortion
• 2 Types of Abortion: D. Incompetent Cervix
1. Spontaneous • 2 types of sutures:
• Threatened - cervix is closed 1. McDonald’s
• Complete - all of the products of 2. Shirokar
conception are expelled • Permanent suture
• CS
• Either close or open cervix
• Incomplete - some of the products
of conception are expelled E. Placenta Previa
• Open cervix
• Missed - retained after death PLACENTA PREVIA “PPPI”
• Closed cervix
• Habitual - 2 or more abortion P lacenta
• Incompetent cervix
• Septic - possible with infection P revia
2. Induced
• Therapeutic P ainless
• Illegal ula-pula (Bright red)

I mplantation
B. Ectopic pregnancy - implantation outside
the uterus (common site: ampulla) Nsg Management: “Bawal tusok” because it may lead
to bleeding
SIGNS & SYMPTOMS OF ECTOPIC
PREGNANCY “ruptured” F. Abruptio Placenta
harp-like pain

S
ABRUPTIO PLACENTA “PDAS”
houlder pain
P lacenta
poSitive pregnancy test
D ark
cullen Sign - bluish discoloration of boarD-like abdomen
the umbilicus
A bruptio
yncope - fainting
S eparation (painful)
alphingoectomy - removal of the
fallopian tube Nsg Management: “Bawal tusok” because it may lead
to bleeding