NCM 107 MATERNAL AND CHILD HEALTH NURSING

Prelims: 1st Semester Reviewer

HUMAN REPRODUCTIVE SYSTEM

Reproductive Development responsible for the
development of the male
 The chromosomal sex or
external genitalia.
biologic sex is formed at
 If the embryo is XX, no
fertilization. Females have
hormones are released.
XX chromosomes, and the
 Mullerian ducts develop into
males have XY
oviducts, uterus, and upper
chromosomes.
vagina.
 During early fetal life,
 The Wolffian ducts disappears
primitive germ cells are
without stimulation.
formed in the 6th and 10th
 Puberty
week in the yolk sac.
 The stage of life at
 The gonads are the body
which secondary sex
organ that produce sex cells.
changes begin.
At the 5th week, primitive
 Both boys and girls
gonadal tissue is already
begin dramatic
formed.
development and
 The internal genitalia forms at
maturation of
around 13th week from the
reproductive organs at
Mullerian (female) and the
approximately 12 to 13
Wolffian (male) ducts.
years.
 If the embryo is XY, the
 The HYPOTHALAMUS serves
gonads secrete the following
as
hormones:
gonadostat or is set to “turn
 Mullerian duct inhibitor on” gonad functioning.
which cause the
 It is turned on to release
Mullerian duct to self-
initial trigger hormones when
destruct and disappear,
a girl has developed enough
a process called
body fat or has reached the
APOPTOSIS.
critical weight around 95 lbs
 Testosterone produced by the
or 43 kg.
Leydig cells which causes the
 Under the stimulation of the
Wolffian duct to develop into
hypothalamus, the pituitary
sperm transport system
glands release
epididymis, vas deferens, and
GONADOTROPIN hormones.
seminal vesicle.
 The first sign of pubescence
 The conversion of
in females is usually breast
testosterone to DHT
bud formation (thelarche).
(dihydrotestosterone) causes
Puberty ends with menarche
the development of the
which occurs approximately
prostate gland. DHT is also
two years after thelarche.

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 At puberty, it is covered by
the pubic hair (escutcheon)
that serves as cushion or
protection to the symphysis
pubis.
Labia Majora
 Large lips, longitudinal fold of
Anatomy and Physiology pigmented skin that extends
from the symphysis pubis to
the perineum.
 It functions to provide
covering and protection to the
external organs located under
it.
Labia Minora
 2 thin folds of connective
tissues that joins anteriorly to
form the prepuce and
posteriorly to form the
Female External Reproductive
fourchette, most highly
System
vascular, sensitive, and richly
Vulva supplied with sebaceous
glands.
 The collective term for the
female external genitalia Clitoris
Pudenda  A highly sensitive and erectile
tissue under the prepuce
 the term used to denote the
 The “seat of woman’s sexual
external genitalia of both
arousal and orgasm”
male and female
 Surrounded by many
Mons Pubis/Mons Veneris sebaceous glands that
produce a cheese like
 It is a mound of fatty tissues secretion called “smegma”
that lie over the symphysis
pubis covered by skin Vestibule
considered as an important
 The triangular space between
obstetrical landmark
the labia minora and where
 It is richly supplied with
the urethral meatus,
sebaceous glands
Bartholin’s gland and Skene’s
gland are located.

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Prelims: 1st Semester Reviewer

cm located in front of the

rectum and behind the
urinary bladder.
Bartholin’s Gland  The external opening of the
vagina is encircled by the
 a pair of glands also known as bulbocavernosus muscle that
“vulvovaginal gland or acts as the voluntary
paravaginal gland sphincter.
Skene’s Gland  Rugae are transverse folds of
skin in the vaginal wall.
 a pair of glands known as  Vaginal pH before puberty is
“paraurethral and minor 6.8 to 7.2; after puberty
vestibular gland” vaginal pH becomes acidic to
a pH of 4 to 5.
Vaginal Orifice or Introitus
Doderlein Bacilli
 the external opening of the
vagina located just below the  normally present in the
urethral meatus vaginal mucus to produce
lactic acid.
Grafenburg or the G spot
Uterus
 a very sensitive area located
at the inner anterior surface  A hollow, thick-walled
of the vagina muscular organ designed for
the implantation,
Urethral Meatus
containment, and
 the external opening of the nourishment of the
female urethra is located just developing fetus.
below the clitoris.  It varies in size, shape, and
weight.
Hymen  Its functions are mainly for
 is a thin circular membrane menstruation, pregnancy, and
made of elastic tissue labor\
situated at the vaginal  Size - 1” thick x2” wide x 3”
opening that separates the long
internal organs from the  Shape – non-pregnant: pear
external organs. shaped or inverted avocado;
pregnant: ovoid
 Position – anteflexed or
Vagina anteverted (bent or tipped
forward)
 A hollow membranous and  Weight – non pregnant: 50-
muscular canal about 8 to 12 60g

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 Pregnant – 1000 grams  Round Ligaments (2)

 Uterosacral (2)
Parts of the Uterus
 Anterior
 Corpus – the uppermost part  Posterior
that forms the bulk of the
Ovaries
uterus. It makes up 2/3 of the
organ, housing the growing  Two almond shaped female
fetus. sex glands for ovulation and
 Isthmus – the short segment production of two hormones
between the uterine body and progesterone and estrogen
the cervix.  The cortex of the ovary
 Cervix – considered the neck contains the developing
of the uterus composed of follicle and Graafian follicle.
elastic collagenous tissue and  Oogenesis, ovulation,
only 10% muscle fibers. hormone production
 How many egg cell can a
Muscle of Uterus
woman produce?
 Endometrium  By the time a woman is
 it lines the non- born, they have 1-2
pregnant uterus million eggs remaining,
 muscle layer for and by the time they
menstruation hit puberty, they have
 sloughs off during around 300,000 to
pregnancy 400,000 eggs. In a
 Myometrium woman's reproductive
 it’s smooth muscles are years, they will lose
considered to be roughly 1000 eggs but
 the “living ligature” of ovulate only one egg
the body each month.
 largest portion of the
Fallopian Tube
uterus
 the “power of labor”  The oviducts are a pair of
 muscle layer for tube-like structure originating
delivery process. from the cornua of the uterus.
 Perimetrium  Each tube is about 4 inches
 protects the entire long and ¼ inch in diameter.
uterus (parietal  Transport ovum from the
peritoneum) ovary to the uterus
 The site of fertilization
Uterine Ligaments
 Provides nourishment to the
 Cardinal Ligaments (2) ovum during its journey.
 Broad Ligaments (2)

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Prelims: 1st Semester Reviewer

of the pelvic bone. The pelvis

serves
Parts of the Fallopian Tube
 to both support and protect
 Interstitial/Intramural – the
thick walled located inside the  reproductive and the other
uterus pelvic organs.
 Isthmus – the narrowest  Three Parts:
portion of the fallopian tube  Ilium – the upper
 Ampulla – the middle portion lateral portion
and the widest part  Ischium – the lower
 Infundibulum – the most portion
distal portion. It has fingerlike  Pubis – anterior
projection called the portion of the bone
fimbriae.  The SYMPHYSIS PUBIS is
the junction of the innominate
Mammary Gland bone at the front of the
External Structures pelvis.
 For obstetrical purposes, the
 Nipple or Mammary papillae pelvis is further divided into
 Areola the false pelvis (superior half)
 Montgomery tubercles and the true pelvis (inferior
half).
Internal Structures
 The LINEA TERMINALIS
 Lobes Lactiferous ducts divides the true and the false
 Lobules Lactiferous sinus pelvis.
 Acini cells
Hormones that influence the
mammary glands
 Estrogen
 Progesterone
Human Placental Lactogen (HPL)
 Oxytocin Male External Reproductive
 Prolactin System
Penis
The Pelvis
 The male organ of copulation
 For a baby to be delivered and urination composed of
vaginally, he/she must be longitudinal erectile tissue:
able to pass through the ring corpora cavernosa and
corpora spongiosum.

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 NCM 107 MATERNAL AND CHILD HEALTH NURSING
Prelims: 1st Semester Reviewer

Parts of the Penis Prostate Gland

 Shaft or body  Walnut shaped body lying
 Glans penis inferior to the bladder
 Prepuce or foreskin surrounding the urethra and
 Urethral meatus the ejaculatory duct. It
secretes a thin milky alkaline
Scrotum
fluid that enhance the sperm
 The sac-like structure that survival (seminal fluid).
contains the testes that hangs
Cowper’s Gland
behind the penis. This has no
subcutaneous fat because the  Small glands located inferior
testes must be kept cool. to the prostate gland and
secretes an alkaline fluid
Epididymis
semen, bulbourethral gland.
 Long coiled tube
approximately 20 feet long
and at which the sperms The Sexual Response Cycle
travel for 12 to 20 days after
it leaves the testis.
Vas Deferens
 Forms the passageway of the
sperm cells. The contractile
power of the VD propels the
sperm to the urethra during
ejaculation.
Seminal Vesicle Excitement
 Pouch-like organs consist of  In response to sexual stimuli
saclike structure located next (whether psychological in the
to the VD lying posterior to form of sexual thoughts or
the bladder, anterior to the fantasies, or physical in the
rectum. form of physical stimulation),
Ejaculatory Duct the process of
VASOCONGESTION occurs.
 The 2 ejaculatory ducts pass  More blood flows into the
through the urethra and penis and the result will
connect the urethra carrying usually be that man will get
the secretion of the seminal an ERECTION.
vesicle.  How long it takes and what
the erection feels like will

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differ from man to man, and referred to as pre-cum,

for the same man over time which comes out of the
 Physical changes may tip of the penis.
include:  The testes move
 There are changes in further towards the
the scrotum and testes, body and increase in
which the testes size.
increase in size, and  There may be a sex
the scrotum elevates flush, muscle tension,
coming closer to the increase in heart rate
body. and rising blood
 The skin may become pressure.
flushed; men may
Orgasm
experience heightened
sensitivity in parts of  First Stage
their body like the  Contractions in the vas
nipples. deferens, seminal
 Some increase in heart vesicles, and the
rate, blood pressure prostate gland causes
and muscle tension. seminal fluid to collect
in a pool at the base of
Plateau
the penis, in the
 With continued sexual urethra. This collection
stimulation, this phase is usually felt as a
represents the time between “tickling” type
the initial arousal and sensation.
excitement up until orgasm.  Second Stage
For many men the plateau  Contractions of
phase is very short, but this is muscles occur in a
the phase that men can “throbbing” manner
extend as a way of controlling around the urethra and
premature ejaculation. propel ejaculate
 Physical changes may through the urethra
include: and out of the body.
 An increase in the size  These contractions
of the head of the (which occur in
penis, and the head different amounts) are
may also change in usually what is
color, becoming experienced as highly
purplish. pleasurable feelings of
 The Cowper’s gland release.
secretes fluid, often
Resolution

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Prelims: 1st Semester Reviewer

 The period immediately  It is a painful menstruation.

following an orgasm when the  It is thought that the uterus is
body begins to return to its prompted by certain
“normal” state. hormones to squeeze far
 This phase includes: harder than necessary to
 The loss of the erection dislodge its lining.
as the blood flows out  Treatment options include
of the penis, which painkillers.
happens in 2 stages
Characteristics of a Normal
over the period of a few
Menstrual Flow
minutes.
 The scrotum and testes Interval between cycles
return to normal size
 A general feeling of  Average is 28 days; cycles of
relaxation 23-35 days are not unusual.

Menstruation
Menstrual Cycle
 from the beginning of the Duration of menstrual flow
menstruation to the beginning  Average flow is 2-7 days;
of the next menstruation. ranges of 1-9 days are not
 The average menstrual abnormal.
cycle: 28 days
 Average menstrual period: Odor
5 days
 Similar to that of marigolds.
 Normal blood loss: 50cc or
¼ cup with fibrinolysin, which Parts of the Body Responsible
prevents clot formation. for Menstruation
Menarche  Hypothalamus
 Anterior Pituitary Gland as
 First menstruation. It occurs
master clock of the body
on the average of 11-14 y/o
 Uterus
Metrorrhagia  Ovaries

 Bleeding in between Phases of Endometrium

menstruation
Proliferative Phase
Amenorrhea
 Following the blood loss from
 Absence of menstruation the endometrium
 During this time the ovarian
Dysmenorrhea follicle is maturating, and

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secreting estrogen and this  The endometrium begins to

phase is completed by the slough off in preparation for
rupture of the follicle and the next menstruation
liberation of the egg.
Phases of the Menstrual Cycle
 About 14 days before the
next menstrual period begins. Menstrual Phase
Secretory Phase  The first stage of the
menstrual cycle that starts
 When the endometrium
when an egg from the
increases in thickness during
previous cycle is not fertilized.
this time the corpus luteum in
 Because pregnancy did not
an ovary is developing and
occur, estrogen and
secreting progesterone and
progesterone levels drop.
lasts about 15-26 days.
 The thickened lining of the
 Phases with elevated
uterus is no longer needed so
progesterone:
it sheds through the vagina.
 Secretory phase
During this period, a
 Luteinizing phase
combination of blood, mucus
 Postovulatory phase
and tissues from the uterus
 Premenstrual phase
are released.
Ischemic Phase  Symptoms
 Cramps
 If pregnancy has not
 Tender breasts
occurred, menstruation
 Bloating
beginning with the flow of
 Mood
menstrual fluid will occur by
 Swings
27-28 days
 Irritability
 On the 24th day, if no
 Headache
fertilization takes place,
 Fatigue
corpus luteum degenerates
 Low back pain
and becomes whitish known
as Corpus albicans. Follicular Phase
Menstruation  Starts on the first day of the
period and ends in ovulation.
 The period of uterine bleeding
 Starts when the
and
hypothalamus sends a signal
shedding of the endometrium
to the pituitary gland to
and last
release FOLLICLE
an average of 5 days
STIMULATING HORMONE
 On the 28th day, if no sperm
(FSH) to stimulate the
visited the ovum
ovaries to produce 5-20 small

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sacs called follicles. Each lining thick and ready for a

follicle contains an immature fertilized egg to implant.
egg. Only the healthiest egg  If one gets pregnant, the body
will mature, and the rest of will produce HUMAN
the follicles will be reabsorbed CHORIONIC
in the body. The maturing GONADOTROPIN (HCG) to
follicle sets off a surge in be detected by pregnancy
estrogen that thickens the test.
lining of the uterus to provide  If not pregnant, the corpus
nutrition to the embryo. luteum will shrink away and
be resorbed leading to
Ovulation Phase
decreased levels of estrogen
 Rising estrogen levels during and progesterone causing the
the follicular phase triggers shedding of the uterine lining
the pituitary gland to release during the period.
LUTEINIZING HORMONE,  During this phase, one may
which starts the process of experience symptoms of
ovulation. PREMENSTRUAL
 Ovulation is when the ovary SYNDROME:
releases mature egg. The egg  Bloating
travels down the fallopian  Breast tenderness
tube to the uterus to be  Mood changes
fertilized by sperm.  Headache
 The ovulation phase is the  Weight gain
only time during the  Changes in sexual
menstrual cycle when one can desire
get pregnant.  Food cravings
 Symptoms  Difficulty sleeping
 A slight rise in basal
Functions of Estrogen
body temperature and
thinner discharge that  “Hormone for Woman”
has the texture of egg  Responsible for Spinnbarkeit
white. and Ferning (cervical mucus
or Billing’s method).
Luteal Phase
 SPINNBARKEIT is a clear,
 After the follicle releases its slippery texture of an
egg, it changes into corpus uncooked egg white, typical
luteum. This structure of cervical mucus during
releases hormones mainly ovulation.
progesterone and some  “Hormone for Mother”
estrogen, keeping the uterine  Primary function to prepare
the endometrium for

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implantation of fertilized the woman’s reproductive

ovum making it thick and function gradually disappear.
tortuous (twisted)
 Secondary function is to
inhibit uterine contractility

MATERNAL AND CHILD HEALTH NURSING IN THE

PHILIPPINES
Teaching About Menstrual
Health
 Exercise
 Sexual relations
 Activities of daily life Refers to Philo
 Pain relief
 Rest  Mother and child relationship
 Nutrition to one another and
consideration of the entire
family as well as the culture
and socio-economic
Ferning
environment as framework of
 Test for the presence of the patient.
estrogen in the cervical  It involves the care of the
mucus. woman and family throughout
 Estrogen causes cervical pregnancy and childbirth and
mucus to dry on a slide in the health promotion and
fern-like pattern. illness care for the children
 In pregnancy testing the fern and families.
pattern does not appear.
Goal of Maternal and Child
Menopause Health Nursing
 Premature menopause occurs  To ensure that every
between the ages of 30 and expectant and nursing mother
40 which is mostly idiopathic maintains good health, learns
 Etiology for the menstrual the art of childcare, has
symptoms is lack of estrogen normal delivery and bears a
 The stage of female life when healthy child
there is physiologic cessation  That every child, wherever
of menses along with possible, lives and grows up
progressive ovarian failure in a family unit with love and
 CLIMACTERIC is the security, in healthy
transition period during which surroundings, receives

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Prelims: 1st Semester Reviewer

adequate nourishment, health Health. It entails the

supervision and efficient establishments of facilities
medical attention, and is that provide emergency
taught the elements of obstetric care for every
healthy living 125,000 population and which
 Promotion and maintenance are located strategically.
of optimum health of the  Improves the quality of
woman and the newborn prenatal and postnatal care
 Promotion, Prevention and  LGUs and NGOs and other
Rehabilitation of a pregnant stakeholders must advocate
woman. for health through resource
 At least 3 years recovery of generation and allocation for
the body of pregnant woman health services to be provided
to regain optimum health. for the mother and the
unborn.
Philosophy of Maternal and
Child Health Nursing
 Is community – centered
 Is research - centered
 Is based on nursing theory
Protects the rights of all
family members
 Uses a high degree of
independent functioning
Places importance on
promotion of health
 Personal, cultural and
Maternal Neonatal and Child
religious attitudes and beliefs
Health Nutrition Strategy
influence the meaning of
pregnancy for individuals and  It applies specific policies and
make each experience actions for local health
unique. systems to systematically
 Maternal – child nursing is address health risks that lead
family centered. to maternal and especially
 The father of the child is as neonatal deaths which
important as the mother. comprise half of the reported
infant mortalities.
Strategic Thrust (2005-2010)
 Every 7 seconds a woman or
 Launch and implement the newborn dies, or a baby is
Basic Emergency Obstetric lost to stillbirth. Most of these
Care strategy in coordination deaths are preventable with
with the Department of

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quality healthcare before, professional to include the following

during and after childbirth services:
Maternal Neonatal and Child  Administration of parenteral
Issues in The Philippines oxytocic drugs Administration
of dose of parenteral,
 According to the Field Health
anticonvulsant.
Service Information System
 Administration of
2022:
parenteral antibiotics
 Infant Mortality Rate in
 Administration of
the country is at 10.36
maternal steroids for
(target is 15 per 1,000
preterm labor
live births)
 Performance of
 Maternal Mortality Rate
assisted vaginal
is at 64.68 (target is 70
deliveries
per 100,000 live births)
 Removal of retained
 Adolescent Birth Rate is
placental products
at 24.36 (target is 37
 Manual removal of
per 1,000 females aged
retained placenta
15-19 years old)
 It also includes neonatal
interventions which include
the minimum: Newborn
resuscitation, Provision of
warmth, Referral, Blood
transfusion.
 Four essential newborn
care:
1. Thermoregulation –
cleaning and rubbing the
baby.
 Urgent action needed: teen 2. Skin to skin contact of the
pregnancies surge in newborn and the mother.
Philippines, law needed to 3. Proper timing of cord
curb crisis clamping.
 The mother is still a child 4. Initiation of breastfeeding.
herself  BEMONC facility shall consist
BEMONC (Basic Emergency of the core district hospital
Obstetrics and Newborn Care)  For geographically
isolated/disadvantaged
Lifesaving services for emergency areas/densely
maternal and newborn populated areas, the
conditions/complications being designated BEMONC
provided by a health facility or facilities are the

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following: Rural Health  To reach all pregnant

Unit, Barangay Health women, to give
Station, Lying - in sufficient care to
Clinics and Birthing ensure a healthy
Homes. pregnancy and the
 Accessibility within 1 birth of a full-term
hour from residence or healthy baby
referring facility within  Normal Patients - following
the Inter - local Health the initial evaluation, they will
Zones be given healthy instructions
 Shall operate within 24 and counselling. This will
hours with 6 signal include advice for prompt
obstetric function prenatal ca examination.
 Shall have access to  Patients With Mild
communication and Complications - a thorough
transportation facilities evaluation of the needs of
to mobilize referrals patients with mild
 Staff composition: 1 complications will determine
Medical Doctor, 1 the frequency of follow - up of
Registered Nurse, 1 these cases by the rural
Registered Midwife. health unit, city health clinic
or puericulture center
CEMONC (Comprehensive
 Patients With Potentially
Emergency Obstetrics and
Serious Complications -
Newborn Care)
these patients shall be
 Lifesaving services for referred to the most skilled
emergency maternal and source of medical and
newborn hospital care. As a first choice
conditions/complications as in they will be referred if at all
Basic Emergency Obstetric possible, for continuing care
and Newborn Care PLUS the or consultation. Second
provision of surgical delivery choice will be followed
and blood bank services and carefully by the rural health
other specialized obstetric unit, city health clinic or
interventions puericulture center
 All RHUs and BHS should have
Essential Health Services in a master list of pregnant
Health Care Facilities women in their respective
Antenatal Registration/Prenatal catchment center.
Care  The Home-Based Mother's
Record (HBMR) shall be used
 Objective: when rendering prenatal care

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as a guide in the identification early in

of risk factors, danger signs pregnancy as
and to be able to do possible
appropriate measures TT2 At least 4 weeks
 There should be at least 3 after TT1
prenatal visits following TT3 6 to 12 months
the prescribed timing: after TT2 or
during
 First prenatal visits
subsequent
should be made as
pregnancy
early in pregnancy as
TT4 1 to 5 years
possible, during the after TT3 or
first trimester during
 Second, during the subsequent
second trimester pregnancy
 Third and subsequent TT5 1 to 10 years
visits during the third after TT4 or
semester. during
 More frequent visits should be subsequent
done for those at risk or with pregnancy
complications.  The three booster dose shots
to complete the five doses
Tetanus Toxoid Immunization following the recommended
 Neonatal tetanus is one of the schedule provides full
public health concerns, that is protection.
why it is important for  The mother is then called as a
pregnant women and "Fully Immunized Mother"
childbearing age women to Micronutrient Supplementation
get a tetanus toxoid (TT)
immunization in order to  It is necessary to prevent
protect them from this deadly anemia, vitamin A deficiency
disease and other nutritional
 A series of 2 doses of TT disorders
vaccination must be received  VITAMIN A
by a woman one month  Dose: 10,000 IU
before delivery to protect the  Given a week starting
baby from neonatal tetanus. on the 4th month of
pregnancy
Tetanus Toxoid Immunization  Do not give it before
Schedule the 4th month of
pregnancy because it
TT1 On first contact
with medical might cause congenital
service or as problems in the baby

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Prelims: 1st Semester Reviewer

 IRON  Decide if the woman can

 Dose: 30-60mg/400ug safely deliver
tablet  Give supportive care
 Schedule: Daily throughout labor
 Monitor and manage labor
 Monitor closely after
 FOLIC ACID delivery
 Dose: 400ug tablet  Continue care for at least
 Schedule: Daily two hours postpartum
 Folic acid is  Inform, counsel, and teach
recommended for the woman
pregnant women to  Birth registration
help prevent neural  Importance of
tube defects, brain and breastfeeding
spinal cord  Newborn Screening
abnormalities in the  Schedule of postpartum
baby, and is said to visits:
decrease the risk of  1st visit - 1st week
premature birth. postpartum preferably
3- 5 days
Clean and Safe Delivery  2nd visit - 6 weeks
 Check for emergency signs postpartum
 Unconsciousness Home Delivery
 Vaginal
bleeding/severe vaginal  It is for normal pregnancies
bleeding Looks very ill attended by licensed health
 Severe headache with personnel.
visual disturbance  Trained hilots may be allowed
 Severe breathing to attend home deliveries
difficulty Fever and only in the following
severe vomiting circumstances:
 Make woman comfortable  Areas where there are
 Assess the woman in labor no health personnel on
 Last Menstrual Period maternal care
 Number of pregnancies  When, at the time of
 Start of labor pains delivery, such
 Age/height personnel are not
 Danger signs of available
pregnancy  Actively practicing but
 Determine the stage of untrained birth
labor attendants (hilot)
should be identified,

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trained, and supervised Home Delivery Kit

by some personnel of
 Home delivery kit must at
the nearest BHS/RHU
least contain two pairs of
trained on Maternal
clamps, a pair of scissors,
Care
antiseptic (may use 70%
 The following are qualified
Povidone iodine) soap and
for home delivery:
hand brush, clean towel/piece
 Full term
of cloth, flashlight,
 Less than 5
sphygmomanometer,
pregnancies
stethoscope.
 Cephalic in position
 Clean hands, clean
 Without existing
surface and clean cord
diseases such as
must be strictly
diabetes, bronchial
followed to prevent
asthma, heart disease,
infection
hypertension, goiter,
TB, severe anemia Guide For Home Delivery
 No history of
complications like  For registered patient: time
hemorrhage during when regular pains started,
previous deliveries whether bag of water
 No history of difficult ruptured or not, presence or
delivery and prolonged absence of vaginal
labor (more than 24 discharges, bleeding, etc.,
hours for primi and whether mother moved her
more than 12 hours for bowels and has urinated, fetal
multigravida) movement felt by the mother
 No previous Cesarian or not, unusual symptoms
section such as bleeding, headache,
 Imminent deliveries spots before eyes
(those who are about  For unregistered patient:
to deliver and can no get the same information as
longer reach the those registered patients and
nearest facility in time get medical and obstetric
for delivery) history
 No premature rupture Delivery In Health Facility
of membranes
 Adequate pelvis  At lying - in clinics, Birthing
 Abdominal Homes or within the
enlargement is BHS/RHUs
appropriate for age of  Normal pregnancies and with
gestation labor progressing normally

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Prelims: 1st Semester Reviewer

must be encouraged to Tone, Reflex Irritability, and

deliver in this facility. Color
 It is done at 1 minute
Delivery In Hospitals
of life and at 5 minutes
 Risk pregnancies should be of life Each sign is
advised to deliver in the evaluated according to
hospital are: the degree to which it
 Pregnancy more than 4 is present and given a
Previous CS score of O, 1, and 2.
 History of postpartum Scores of each sign is
hemorrhage added together to give
Anterpartum a total score (10 is
hemorrhage maximum)
 History of medical
illness such as heart
disease, goiter, goiter,
TB, diabetes, severe
anemia, hypertension,
bronchial asthma
 Hypertensive disorders of
pregnancy and eclampsia
 Cephalo - pelvic
disproportion
 Placenta previa and
abruptio placenta
Multifetal pregnancy
 Post term and preterm
pregnancies
 Previous uterine Newborn Screening
surgery such as  It is a public health program
myomectomy aimed at the early
Apgar Scoring (Activity, Pulse, identification of infants who
Grimace, Appearance, are affected by certain
Respiration) genetic/metabolic/infectious
conditions.
 Provides a valuable index for  Early identification and
evaluation of the infant at intervention can lead to
birth significant reduction of
 It is based on five signs morbidity, mortality, and
ranked in order of importance associated disabilities in an
as follows: Heart Rate, affected infant.
Respiratory Effort, Muscle

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Prelims: 1st Semester Reviewer

Significance Milk Code 1986 (EO 51)

 Most babies with metabolic  To contribute to the provision
disorders look "normal" at of safe and adequate nutrition
birth. By doing NBS, for infants by the protection
metabolic disorders may be and promotion of
detected even before clinical breastfeeding and by
signs and symptoms are ensuring the proper use
present. As a result of this, breastmilk substitutes and
treatment can be given early breastmilk supplements when
to prevent consequences of they are necessary, on the
untreated conditions basis of adequate information
and through appropriate
Timing
marketing and distribution
 Ideally done on the 48th to
Family Planning Counselling
72nd hours of life, but may
also be done after 24 hours  Proper counselling of couples
from birth on the importance of family
planning will help them be
Result
informed on the right choices
 A NEGATIVE screen means of family planning methods,
that the NBS is NORMAL proper spacing of birth and
 A POSITIVE screen - newborn addressing the right number
must be brought back to of children.
health practitioner  Birth spacing of 3 - 5 years’
interval will help completely
Support to Breastfeeding develop the health of a
 Motivate mothers to practice mother from previous
breastfeeding pregnancy and childbirth. The
 The Rooming - in and risk of complications
Breastfeeding Act of 1992 increases after the 2nd birth.
 Family is a very important

THE FAMILY
 To encourage, protect and unit in a social institution
support the practice of  Family consists of parents and
breastfeeding. It shall create children who interact with one
an environment where the another. Through this
basic physical, emotional, and socialization process, parents
psychological needs of are able to hand down
mothers and infants are socially accepted cultural
fulfilled practice that serves as initial
training for the young to

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become responsible citizen in joined together by bonds of

the future. sharing and emotional
 Refers to a group of people closeness and who identify
united by ties of marriage, themselves as being part of
blood or adoption. As a group, the family”.
the members of the family
Five Universal Characteristics
live together under one roof
and that they constitute a  A family is a social system
single housekeeping unit  A family performs certain
 It is a universal institution basic functions
that has the following  A family has structure
common characteristics:  A family has its own cultural
values and rules
 A family moves through
stages in its life cycle
Functions Of the Family
 Provision of physical
needs -food, shelter,
clothing, safety, and
healthcare
 Allocation of resources -
careful planning and use of
 Associate with one family money, material good,
another in their space and abilities
respective roles as  Division of Labor - assigning
husband and wife, the workload, including the
mother and father, son responsibility for household
and daughter or income and household
siblings management
 As the members of the  Socialization - guiding
family enjoy life towards acceptable standards
together playing of elimination, food intake,
different roles, they sexual drive, respect for
tend to create a others and their possession
common culture and sense of spirituality
 There have been significant
changes in the way people  Reproduction, recruitment
regard the family as a social and release - bearing or
institution. adopting children adding new
 Friedman defines it as: “Two members by marriage and
or more persons who are allowing members to leave

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Prelims: 1st Semester Reviewer

 Maintenance of order -  Bilateral Family – lineage in

interaction and which the relatives of the
communication opportunities, mother’s side and father’s
discipline, affection, sexual side are equally important for
expression emotional ties or transfer of
 Assistance with fitting property or wealth
into the larger society -
Based on Authority
community, schools, spiritual
center and organization  Patriarchal Family – the
 Maintenance of motivation father or male exerts the
and morale - recognition, most power/authority
affection, encouragement,  Matriarchal Family – the
family loyalty, help in meeting mother of female exerts the
crisis, philosophy of life, most power/authority
spirituality.  Equalitarian Family –
parents or members share
Family Structures
power and authority equally
 Different structures emanate  Matricentric Family – a
due to changing family nuclear family in which there
patterns and cultural is no continuing adult male
variations practiced by family functioning as a husband and
members in a given society father
Based on Internal Organization Based on Residence
 Conjugal Family - a nuclear  Patrilocal – married couple
family that may consist of a lives in the locality associated
married couple and their with the husband’s parents
children.  Matrilocal - married couple
 Nuclear Family – consists of lives in the locality associated
a pair of adults and their with the wife’s parents
socially recognized children.  Bilocal – married couple
 Extended Family – consist taking up residence with
of several generations of either husband’s or wife’s
people parents
 Neolocal – custom of a
Based on Family Descent
married couple living on their
 Patrilineal Family – own residence apart from
someone related to your their parents
relationship with your father  Avunculocal – married
 Matrilineal Family – couple takes up residence
someone related to your with or near husband’s or
relationship with your mother wife’s brother

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Prelims: 1st Semester Reviewer

Alternative Families
 Cohabitation – unmarried
individuals in a committed
Stages Of Family Development
partnership living together
with or without children. STAGE 1
 Gay/Lesbian – intimate
partners of the same sex may Single Young Adults Leave
live together or own a Home
property together.  Emotional change from
 Blended – couple having reliance on the family to
their own separate children acceptance of emotional and
that live in together financial responsibility for
 Communal – several people oneself; differentiation of self
live together often striving to in relation to family of origin.
be self-sufficient and  Accepting what our parents
minimize contact with outside believe or want us to do, nor
society. Members share we automatically respond
financial resources, work and negatively to their requests.
childcare responsibilities.  Developing intimate peer
 Foster – children live in relationships on a deeper
temporary arrangement with level and is financially
paid caregivers. These independent
children are meant to return
to their family of origin when STAGE 2:
condition permits or to
The New Couple Joins Their
otherwise be placed for
Families Through Marriage or
adoption
Living Together
Characteristics Of a Healthy
 Commitment to the new
Family
system which also involves
 Maintains a spiritual the formation of a marital
foundation system and realignment of
 Makes the family the top relationships with extended
priority families and friends including
 Asks and gives respect the spouses.
 Communicates and listens
 Values service to others
 Expects and offers
acceptance

STAGE 3

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Families With Young Children of exits from and entries into

the family system. Transition
 Accepting new members into
can be easy and enjoyable
the system
when children live by the
 Adjusting the marital system
values and expectations of
to make space for our
the parent
children, juggling childrearing,
financial and household tasks STAGE 6
 Realignment of relationships
Families In Later Life
with extended family as it
opens to include the  How we as individuals either
parenting and grand reflect on our lives with
parenting roles acceptance and a sense of
accomplishment or bitterness
STAGE 4
and regret
Families With Adolescents  The younger generation
needs to make room for
 Emotional transitions to
wisdom and experience of the
increase the flexibility of
elderly
family boundaries to include
 Other may experience dealing
children’s independence and
with the loss of a spouse,
grandparents’ frailties.
siblings and other peers
 Shifting of parent-child
 Preparation for our own death
relationship to permit
and the end of the generation
adolescents to move in and
out of the system.
 New focus on midlife marital
and career issues

FAMILY PLANNING
 Sandwich generation

Republic Act No. 10354

 Responsible Parenthood and
STAGE 5 Reproductive Health Act of
2012 Reproductive Health
Launching Children and Moving
Law A Philippine law that
On
provides universal access to
 Most emotionally difficult for methods on contraception,
parents to accept a multitude fertility control, sexual

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Prelims: 1st Semester Reviewer

education, and maternal care  A pregnancy test must be

in the Philippines. performed first to make sure
that the woman seeking for
Basic Principles birth control is not presently
Family Planning pregnant.
 Assess for the OB history of
 The voluntary and moral the client, any past sexually
management of all the transmitted diseases, the
processes of family life status of the past
including human pregnancies, and if they have
reproduction. used a family planning
 It must be moral so as not to method that did not turn out
allow doubt and anxiety in effective.
man’s conscience by the use  Assess subjectively the
of accepted scientific needs, preferences, desires,
methods, treatment for and feelings of the client
infertility, family life and sex regarding family planning.
education.  Assess the sexual practices of
 Because family planning deals the client, the frequency, the
with people’s sexuality, a number of their sexual
private setting should be partners, and if they have any
arranged whenever possible. allergies to latex.
 Feelings about contraception
must be explored in a Types of Family Planning
nonjudgmental way and the Natural Family Planning
variety of choices must be
summarized to allow selection  The natural family planning
of a method that fits the methods do not include any
unique circumstances of the chemical or foreign body
person or couple. introduction into the human
body.
Contraceptives  Most people who are very
 Contraceptives are products conscious of their religious
used to prevent pregnancy by beliefs are more inclined to
women and men. use the natural way of birth
 Each individual has their own control.
choice in what contraceptive  Some want to use natural
they want to use, so you must methods because it is more
assess their preference first cost effective.
before providing the best Periodic Abstinence
contraceptive for them.

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 This natural method involves experience localized lower

abstaining from sexual abdominal pain called
intercourse and is the most mittelschmerz which
effective natural birth control corresponds to the release
method with ideally 0% fail of the egg cell.
rate.  After ovulation, the mucus
 Abstention from sexual becomes thick, cloudy and
intercourse during fertile sticky again, then decreases
period of each cycle. or may be no mucus
 Usually depends on  The consistency of cervical
identification of fertile period mucus can be affected by
– usually 14 days before the medications such as
next menstrual period antihistamines that change
 The most effective way to mucus production throughout
avoid STIs. the body, and by spermicides,
 Most people find it difficult to sexual intercourse, vaginal
comply with abstinence, so infections, or the use of
only a few uses this method. douches.
 The fertile days of a woman
Cervical Mucus Method (Billings
according to this method is as
Method)
long as the cervical mucus is
 Requires a woman to examine copious and watery and a day
the mucus from her cervix to after it. Therefore, she must
determine her fertile period. avoid coitus during these
 The consistency and amount days.
of cervical mucus changes as
hormone levels vary during
the menstrual cycle.
 Just before ovulation, the
Calendar Method (The Rhythm
cervical mucus becomes thin,
Method)
watery, transparent and
copious.  Involves refraining from coitus
 During the peak of ovulation, during the days that the
the cervical mucus becomes woman is fertile.
wet, slippery, abundant, clear,  According to the menstrual
stretchable like “egg white” cycle, 3 or 4 days before and
(SPINNBARKEIT), stretched 3 or 4 days after ovulation,
to 2.5 cm and normally from 8 the woman is likely to
– 10 cm: wet days and signals conceive.
UNSAFE days.  A woman keeps a record of at
 During ovulation, some least 6 menstrual cycles and
women uses the record to determine

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Prelims: 1st Semester Reviewer

which days she is most likely  Body temperature decreases

to be fertile during an slightly just before ovulation
average menstrual cycle. and begins to rise for several
 But fertile periods can vary days afterward.
from cycle to cycle (irregular  Under the influence of
days) – exact time of progesterone, 24 – 48 hours
ovulation is hard to detect after ovulation, temperature
 According to the Ogino rises from 3 – 6 °C, remains
formula, the 1st unsafe days slightly elevated until next
(beginning of the fertile menstruation begins.
period) can be determined by  A woman takes her
subtracting 18 days from the temperature every morning
length of the shortest cycle before getting out of bed
 The last unsafe days using a basal thermometer.
(beginning of the  While this method is effective
postovulatory safe period) in determining the ovulation,
can be determined by the beginning of a woman’s
subtracting 11 days from the fertile period may occur 2
length of the longest cycle. days before ovulation.
 If the shortest cycle is 24  Since the sperm can live for
days and the longest is 30 up to 48 hours in a woman’s
days, application of the body, a woman who had
formula is as follows. unprotected sexual
intercourse before ovulation
may become pregnant if the
sperm, still alive when the
egg reaches the uterus.
 BBT may be ineffective if a
woman is sick or under stress
because lack of sleep and
 To avoid conception, the
illness can change a woman’s
couple would abstain during
body temperature.
the “fertile” period days 6
through 19 Lactation Amenorrhea Method
 If the woman has very regular
 Through exclusive
cycles of 28 days, compute
breastfeeding of the infant,
both with 28 days.
the woman is able to
Basal Body Temperature suppress ovulation through
the method of lactation
 The BBT method measures
amenorrhea method.
variations in body
 It is also best to advise the
temperature to determine
woman that after 3 months of
when ovulation has occurred.

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Prelims: 1st Semester Reviewer

exclusive breastfeeding, she  Shallow rubber dome fits over

must make plans of choosing cervix, blocking passage of
another method of sperm through cervix
contraception.  Efficiency increased by use of
 If the infant is not exclusively chemical barrier as lubricant
breastfed, this method would  Woman needs to be
not be an effective birth measured for diaphragm,
control method. refitted after childbirth or
weight gain/loss of 10 lbs.
Coitus Interruptus
 The withdrawal of the penis
from the vagina when
ejaculation is imminent;
effective when mechanical
devices are unavailable.
 Contraindicated when male is
not able to exert self – control
 Ineffective when premature
ejaculation occurs
 There is a psychological ill  The device needs to be left in
effect for both male and place 6 –24 hours after
female intercourse
 Woman needs to practice
Artificial Family Planning insertion and removal, and to
Condom be taught how to check for
holes in diaphragm.
 Thin stretchable rubber  Device must be stored in cool
sheath worn over the penis place
during intercourse
 Widely available without Cervical Cap
prescription  Cup shaped device that is
 Applied with room at tip to placed over cervical opening
accommodate ejaculate and held in place by suction
 Applied to erect penis before  Has 4 sizes that need to be
vaginal penetration and is fitted to the client
instructed to hold on to rim of  Women need to practice
condom as he withdraws from insertion and removal
the female to prevent spilling  Spermicidal increase
of the sperm. effectiveness when left in
Diaphragm place for 24 – 48 hours.
Contraceptive Sponge

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Prelims: 1st Semester Reviewer

 Small, soft insert, with  A distinct disadvantage is the

indentation on one side to fit increased risk of pelvic
over cervix infection (PID) with use of IUD
 Contains spermicide,
moistened with water and
inserted with indentation
snugly against cervix, which
may be left in place up to 24 Steroid Implants
hours  Approved in 1990 by FDA;
 No professional fitting biodegradable rods containing
required; may also protect sustained release, low dose
against STDs. progesterone.
 Should not be used by women  Inhibits LH release necessary
with history of toxic shock for ovulation
syndrome  Effective over 5 – year time
 Problems include cost, frame
difficulty in removal, and  It needs minor surgical
irritation. procedure for insertion and
Intrauterine Device removal
 Removal causes total
 Placement of plastic or reversibility of effect
noncreative device into  Injectable progestin
uterine cavity during
menstruation or after delivery Hormonal Control Therapy (Oral
 Mode of action thought to be Contraceptives, Birth Control
the creation of sterile Pills)
endometrial inflammation,  Ingestion of estrogen and
discourages implantation progesterone on a specific
(nidation) – does not affect schedule to prevent the
ovulation or conception. release of FSH and LH,
 The device is inserted during preventing ovulation and
or just after menstruation pregnancy
while cervix is still open  Usually taken starting on day
 It may cause cramping and 5 of the menstrual cycle
heavy bleeding during through day 25, then
menses for several months discontinued.
after insertion  Can cause additional tubal,
 The tail of IUD hangs into endometrial, and cervical
vagina through the cervix mucus changes
 The woman is taught to feel  Withdrawal bleeding occurs
for the tail before intercourse within 2 to 3 days
and after each menses

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 Contraindicated to patients egg by making mucus around

over 35 with history of a woman’s cervix thick and
hypertension, diabetes or sticky
vascular disorders and
Combine Pills
cigarette smoking.
 Women using OCP need to be  The pill works in several ways
sure to get sufficient amount to prevent pregnancy.
of vitamin B as metabolism of  The pill suppresses ovulation
this vitamin is affected. so that an egg is not released
 Minor side effects may from the ovaries, and
include weight gain, breast changes the cervical mucus,
changes, headache, nausea causing it to become thicker
and vaginal spotting. Vision and making it more difficult
changes must be reported for sperm to swim into the
immediately. womb.
 If the woman has skipped one  The pill also does not allow
day of taking the pill, she the lining of the womb to
must take it the moment she develop enough to receive
remembers it, then still follow and nurture a fertilized egg.
the regular use of the  This method of birth control
contraceptive. offers no protection against
 If the woman has missed sexually transmitted diseases.
taking the pill for more than
one day, she and her partner
must consider an alternative Advantages
contraception to avoid  It is 100% effective if taken
ovulation. regularly.
 Some birth control methods  Easy to use and does not
use hormones. They will have interfere with coitus.
either or both an estrogen  Reduce the risk of anemia
and a progestin or a progestin because menstrual bleeding
alone. You need a prescription is lessened.
for most hormonal birth  Reduce the risk of
control methods. inflammatory disease, cyst
 Both hormones prevent a and uterine cancer.
woman’s ovary from releasing
an egg during her cycle. Disadvantages
 They do this by affecting the
 Failure rate increase if taken
levels other hormones the
irregularly.
body makes.
 Minor side effects like
 Progestin help prevent sperm
dizziness, nausea vomiting,
from making their way to the
headache, weight gain, etc.

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 Increases the risk of heart  Abnormal uterine bleeding,

problems if women is already any malignancy of the genital
at risk. tract, suspected malignant
 May increase the risk of growth and breast cancer.
gallbladder disease and
cervical cancer.
Combined Injectable
Progesterone Only Pill
Contraceptives
 Also known as mini pill
 These contains progesterone
 It contains only progesterone,
and estrogen contraceptive
and it thickens the cervical
also similar to progesterone
mucus cavity.
only injectable.
 Mini pills are taken
 The injection is given once a
throughout the menstrual
month, 3 days early or 3 days
cycle, and these are not used
late.
widely because of its high
 Contraindicated in pregnancy,
failure rate.
women, having any other
Injectable Contraceptives problem like diabetes with
complications, vascular
Progestin Only Injectable
disorder, suspected
 Two preparations which are malignancy.
available.
Permanent Family Planning
 DMPA (Depo-medroxy
progesterone acetate) –  Bilateral Tubal Ligation in
injection every 3 months female is done by clamping or
 NET-EN (Norethiseterone blocking the isthmus of the
enanthate) –injection every fallopian tubes to prevent the
2 months passage of ova and is done
 These have similar after menstruation.
effectiveness, safety,  Females will still menstruate
characteristics, and eligibility but will not conceive
criteria  Bilateral Vasectomy in the
male to prevent the passage
Advantages
of sperm. Sperm will be
 It is easy to administer, highly absorbed by the cells after
effective and irreversible, do ligation.
not interfere with lactation  Males will be incapable of
and does not cause any effect fertilizing his partner after all
on the infant. viable sperm ejaculated from
vas deferens (6weeks or 10
Contraindication ejaculations)

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 A sperm count analysis will  Endometriosis –

determine sterility after 6 implantation of endometrium
weeks or 10 ejaculations or nodules that have spread
outside the uterus.
Infertility
 Infection Of the Cervix –
 Pregnancy has not occurred causing thickening of the
after at least 1 year of cervical mucus
engaging in unprotected  Infection Of the Vagina –
coitus acidotic secretion
 Inability to deliver a live infant
Fertility Testing
after 3 consecutive
pregnancies  Semen Analysis –
 Primary - no previous abstinence for 2-4 days
conceptions. before collection of specimen
 Secondary - had a previous check appearance, motility,
conception but unable at count average ejaculate: 2.5 –
present 5ml with 20 million/ml of
 Sterility - unable to conceive seminal fluid or 50
due to a known condition million/ejaculation
 Ovulation Monitoring – thru
Male Infertility Factors
BBT for at least 1 month or
 Inadequate Sperm Count – test strip (dip strip to
cryptorchidism (undescended midmorning urine)
testes), increased scrotal
Tubal Patency
heat, chronic infection
 Varicocele – varicosity of 1. Sonohysterography – fill
spermatic vein uterus with saline and check
 Obstruction (Adhesions) – for abnormalities using
infections like mumps transvaginal UTZ transducer
orchitis, epididymitis, 2. Hysterosalpingography –
gonorrhea scheduled immediately after
 Anomalies Of the Penis – menstrual flow; iodine based
hypospadias, epispadias radiopaque is introduced
 Erectile Dysfunction  medium is thick,
distending uterus and
Female Infertility Factors
tubes slightly causing
 Anovulation –
PCOS, momentary painful
Turner’s syndrome, uterine cramping
hypothyroidism, ovarian
Infertility Management
tumor, exposure to radiation,
stress  Abstain for 7-10 days to
 PID Tumors increase sperm count

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 NCM 107 MATERNAL AND CHILD HEALTH NURSING
Prelims: 1st Semester Reviewer

 Ligation of varicocele  if 2-3 zygotes are

 Treat infection according to achieved, selective
causative agent termination may be
 Administration of GnRH, recommended thru
clomiphene citrate (Clomid, intraabdominal
Serophene), human injection of KCl into
menopausal gonadotropins gestational sac to
 (Pergonal) to stimulate ensure success of
ovulation – multiple ova pregnancy
could mature
Gamete Intrafallopian
 Conjugated estrogen
(Premarin) for secretions that  Transfer – obtain sperm and
are scant and tenacious ova but instilled in a matter of
 Surgery – removal of tumor; hours in a patent fallopian
take estrogen for 3 months to tube
prevent adhesions from
reforming and insert IUD to Zygote Intrafallopian
prevent uterine sides from  Transfer – fertilization occurs
touching outside a woman’s body
Alternative Management before transferring to a
fallopian tube
 Artificial Insemination –
instillation of sperm from
husband or donor into female
either into the cervix
(intracervical insemination) or
into the uterus (intrauterine
insemination) to aid
conception
 woman records BBT,
assess cervical mucus
to predict her ovulation
 takes 6 months to
achieve conception
In Vitro Fertilization
 Mature oocyte/s is removed
by laparoscopy and fertilized
through exposure to sperm
under lab conditions outside a
woman’s body

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