OBSTETRICS

MEDSURG SEMESTER | PROFESSOR | CLASS SCHEDULE

LESSON 1: OBSTETRICS
masculinity

TOPIC OVERVIEW SEX ★​ Biologic male or

female status
A.​ OBSTETRICS
a.​ Human Sexuality
b.​ Female Reproductive System
c.​ Male Reproductive System B FEMALE REPRODUCTIVE SYSTEM
d.​ Menstruation
e.​ Menstrual Cycle
f.​ Terminologies
g.​ Pregnancy
h.​ Leopold’s Maneuveur
i.​ Pharmacological Drugs
j.​ Diagnostic Exams
k.​ Labor
l.​ Preliminary Signs of Labor
m.​ Stages of Labor
n.​ Hemorrhagic Disorders in
Pregnancy
o.​ Post-Partum Problems EXTERNAL GENITALIA

VULVA
A HUMAN SEXUALITY
★​ Collective term for external female genitalia

MONS PUBIS
★​ Also termed as Mons Veneris
★​ Encompasses
★​ Pad of adipose tissue that lies over symphysis
the complex
pubis covered by skin and at puberty covered
emotions,
by hair.
feelings,
preferences,
LABIA MAJORA
attitude and
★​ Large lips
SEXUALITY behaviors that
★​ Two folds of adipose tissue covered by loose
are related to
connective tissue and epithelium.
sexual self and
★​ Serves as protection for the external genitalia
eroticism.
and the dim! urethra and vagina.
★​ Behavior of
being a male or
female LABIA MINORA
★​ Two hairless folds of connective tissue
GENDER ★​ Sense of covered with mucous membrane and the
femininity or external surface with skin.

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CLITORIS INTERNAL GENITALIA

★​ Pea-shaped composed of erectile tissues and
sensitive nerve endings
★​ Site of sexual arousal and eroticism in females
FOURCHETTE
★​ Formed by the posterior joining of the labia
minora and majora
★​ Common site for episiotomy

VESTIBULE
★​ Almond-shaped structure containing urinary
meatus, Skene's gland, hymen, vaginal orifice
and Bartholin's RUGAE
★​ gland ★​ Thick folds of membranous stratified
epithelium which permits stretching without
URINARY MEATUS tearing.
★​ Urethral opening for urination

UTERUS
SKENE’S GLAND ★​ Hollow, muscular, pearshaped organ for
★​ Also called Paraurethral Gland containment and nourishment of the fetus
★​ Secretes small amount of mucous which ★​ Function for menstruation pregnancy and
functions as lubrication during sexual labor
intercourse or coitus ★​ Size (nonpregnant: 2.5 cm thick, 5 cm wide ,S7
cm long
BARTHOLIN’S GLAND ★​ Shape (nonpregnant): pear shape
★​ Also termed a Paravaginal Gland
★​ Shape (pregnant): ovoid
★​ Secretes alkaline substance responsible for
★​ Weight
neutralizing the acidity of the vagina to keep
-​ Non pregnant: 60 g
the sperm alive.
-​ Pregnant: 10000 g

VAGINAL ORIFICE
★​ External opening of the vagina UTERINE ATONY

Upper cylindrical layer

HYMEN
★​ Membranous issue that covers vaginal orifice
Portion that can be palpated at
FUNDUS the abdomen to determine the
PERINEUM amount of uterine growth
★​ Muscular structure In between vagina and occurring during pregnancy
anus

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Short segment between the body

and the cervix
ISTHMUS
Portion of the uterus that is most OVARIES
commonly cut when a fetus is ★​ 4cm long cm In diameter and approximately
a Cesarean section 1.5cm thick or almond shaped, grayish white,
female sex gonads producing progesterone
CORPUS Portion of the structure that
and estrogen.
upends to contain the growing
fetus ★​ Function:
-​ Produce, mature and discharge ova
Lower uterine segment (egg cells)
-​ Produce estrogen and progesterone
Lowest portion of the uterus
and inmate and regulate menstrual
CERVIX
cycle.
Approximately half of it lies
above the vagina and half
extends to the FALLOPIAN TUBE
vagina ★​ 10 cm long
★​ Conveys ova from Me ovaries to Me uterus
and provides a place for the fertilization of the
ovum by the sperm

UTERINE LAYERS

C MALE REPRODUCTIVE SYSTEM

Innermost layer
ENDOMETRIUM
Composed of 2 layers (basal
Iayer and glandular layer)

Muscle layer of the uterus

Constricts the tubal junctions

and preventing regurgitation of
MYOMETRIUM menstrual blood into the tubes

Contracts during the labor and

delivery processes

Outmost layer of the uterus

PERIMETRIUM Serves the purpose of adding

strength and support to the PENIS
structure ★​ Male organ for copulation and urination

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★​ Layers: PROSTATE GLAND

-​ 2 corpus cavernosa lateral column of ★​ Produces alkaline substance for the
erectile tissue protection of the sperm
-​ 1 corpus spongiosum located on the ★​ Reduces the acidity of the vagina
underside of the penis
COWPER’S GLAND
SCROTUM ★​ Also termed as bulbourethral gland.
★​ Pouch hanging below the penis ★​ Secretes lubricant Into the urethra to facilitate
★​ Contains the testes transport of sperm during ejaculation
★​ Temperature regulator of the testes

D MENSTRUATION
TESTES
★​ Two ovoid glands, 23 cm wide, that lie in the
★​ AVERAGE CYCLE: 28 days (23-35days)
scrotum.
★​ Duration of menstrual flow
-​ 4-6days (normal)
EXTERNAL GENITALIA
-​ 1-9 days (abnormal)

EPIDIDYMIS ★​ Normal blood loss: 30-80cc 1/4 cup

★​ Responsible for conducting sperm from the ★​ Interplay of 4 major organs:
testis to the vas deferens -​ Hypothalamus
★​ Site of maturation of the sperm -​ Anterior pituitary gland
-​ Ovaries
VAS DEFERENS -​ Uterus
★​ Carries sperm from the epididymis through
the inguinal canal into the abdominal cavity HYPOTHALAMUS
★​ Sperm matures as it passes the vas deferens. ★​ Produces GnRH or gonadotropin-releasing
hormone to stimulate the anterior pituitary
SEMINAL VESICLE gland for the release of hormones
★​ Secretes viscous portion of the semen
★​ Contains: ANTERIOR PITUITARY GLAND
-​ Fructose ★​ Also termed as adenohypophysis
-​ Protein ★​ Secretes Gonadotropins (Hormones that
-​ Prostaglandin stimulate the Gonads or Ovaries)
★​ Stimulates the ovaries to secrete estrogen
EJACULATORY DUCT and progesterone
★​ Conduit of semen and seminal vesicle to the
urethra. GONADOTROPINS
★​ Follicle Stimulating Hormone (FSH)

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★​ Hormone that is active early in the cycle and

proliferate as the over
is responsible for maturation of the primordial
ins to produce estrogen
follicle. Levels of estrogen will
★​ Luteinizing Hormone (LH) increase in this phase
-​ Hormone most active at the midpoint
Other terms: secretory
of the cycle and is responsible for
phase /Progestatlonal
ovulation
phase/ Premenstrual
phase
OVARY
★​ Release of the ovum (egg cell) Second phase of
menstrual cycle
UTERUS
★​ Stimulation from the hormones Remains constant:
★​ Develops stratum functionals in preparation Always 14 days In length
Production of corpus
for pregnancy - sheds of as menstruation if
luteum occurs
ovum not fertilized

LUTEAL PHASE Secretion of luteinizing

hormone (LH) peaks in
E MENSTRUAL CYCLE
mid phase

Cavity Is left inside the

Other terms: follicular follicle
phase/ estrogenic
phase / postmenstrual Stimulates change In
phase fluid In Graaflan follicle
(yellowish, milky white

6 to 14 days fluid high In

progesterone)
First phase of menstrual
cycle
PROLIFERATIVE PHASE
If fertilization does not
Always variable in
occur, the corpus
length
luteum in the ovary
begins to regress after 8
Immediately after the
ISCHEMIC PHASE to 10 days.
menstrual flow, the
endometrium is very
Production of
thin, approximately once
progesterone and
cell layer in depth
estrogen in this phase
also decreases
Endometrium begins to

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GRAVIDA
The decrease in these
★​ number of pregnancies that reach the age of
hormones makes the
viability regardless of the outcome of the
endometrium to
degenerate pregnancy.
★​ TPAL
Capillaries rupture with -​ T term (38 42 weeks)
minute hemorrhages -​ P preterm (<37 weeks)
and the endometrium
-​ A abortion (any terminated
sloughs off
pregnancy)

Low levels of Estrogen & -​ L living children

Progesterone
MENSTRUAL PHASE IMPLANTATION
Passage of menstrual ★​ Contact between the growing structure and
flow the uterine endometrium.
★​ Occurs approximately 8 to 10 days after
fertilization.
F TERMINOLOGIES

NULLIPAROUS
ZYGOTE ★​ Had been pregnant before but has never
★​ Product fertilization
given birth to a viable, or a live, infant
★​ < 2 weeks AOG

NULLIGRAVID
EMBRYO ★​ Had never been pregnant
★​ Intrauterine growth period from the time
following implantation until organogenesis is
complete G PREGNANCY
★​ 2 to < 8 weeks AOG

PRESUMPTIVE SIGNS
FETUS
★​ 8 weeks to birth
★​ Least indicative of pregnancy
★​ A Largely subjective as they are
VIABILITY
experienced by the woman but cannot be
★​ Fetus can be delivered and capable of living
documented by the examiner
outside the utero
★​ Period of viability: 24 weeks and above EXAMPLES:
(Pillitteri, 2010) ★​ Breast Changes
-​ Feeling of tenderness, fullness, or
tingling, enlargement and darkening
of areola

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★​ Nausea and Vomiting

PROBABLE SIGNS
-​ Increase In human chorionic
gonadotropin (HCG) levels ★​ Can be documented by the examiner
★​ Interventions: ★​ Still not confirmatory
-​ Provide do, unsalted Crackers
EXAMPLES:
-​ Ice Chips ★​ Laboratory Results
-​ Small, Frequent Feedings -​ Test of blood serum/urine reveal the
-​ Less fatty foods In diet presence of hormone
-​ Encourage ambulation

★​ Positive Pregnancy Test

★​ Amenorrhea -​ Indicator: hCG levels
-​ Absence of menstruation because of -​ This can be detected 1014 days after
hormonal changes the missed period.
-​ Peak level of hCG = 10 weeks Age of
★​ Changers In Urination Gestation or 2 months
-​ Urinary Frequency - 1st and 3rd
Trimester ★​ Abdominal Enlargement
-​ Frequency of urination occurs in early -​ Symmetrical and globular
pregnancy due to the pressure of the
growing uterus on the anterior ★​ Chadwick’s Sign
bladder. -​ Bluish purple discoloration of the
vagina due to Increase In vascularity
★​ Fatigue of the vagina
-​ General feeling of tiredness due to
increased metabolic requirements ★​ Goodell’s Sign
-​ Softening of the cervix 5 ready cervix
★​ Quickening for dilation and effacement
-​ Fetal movement by the woman.
-​ Approximately 18 to 20 weeks. ★​ Hegar’s Sign
-​ Softening of the uterine segment
★​ Skin Changes
-​ Melasma /chloasma mask of ★​ Ballotment
pregnancy -​ When the lower uterine segment is
-​ Linea nigra - darkening of skin from tapped on a bimanual examination,
symphysis pubis to umbilicus the fetus can be felt to rise against the
-​ Striae gravidarum silvery in color, due abdominal wall.
to distortion of the collagen of the -​ At 16th - 20th week
abdomen as the uterus enlarges.

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★​ Braxton Hicks
the bed
-​ Periodic uterine tightening occurs.
starts 28 weeks and above LEOPOLD’S MANEUVER 1
★​ Determines whether fetal presentation is
cephalic or breech.
POSITIVE SIGNS ★​ Palpates uterine fundus
★​ Important Concepts:
★​ Fetal Heart Tone
-​ Palpate the superior surface of the
★​ Fetal movement felt by examiner
fundus and determine the
★​ Fetus seen through Ultrasound or xray
consistency, shape and mobility.
-​ Head: more Firm than breech; round
H LEOPOLD’S MANEUVEUR and had moved independently of the
body.
-​ Breech: less well defined; moves only
PURPOSE:
in conjunction with the body.
★​ To determine fetal position and presentation
★​ LM 1 determines the end presentation.
WHAT TO DO -​ Fetal presentation refers to the body
part that will first contact the cervix or
Let patient Doing so promotes comfort and
be bom first.
void before allows for more productive
performing palpation because fetal contour -​ Types of Presentation: Cephalic,
Leopolds will not be obscured distended breech, shoulder
Maneuver bladder
LEOPOLD’S MANEUVER 2
Position the Flexing the knees relaxes the
★​ Locates the fetal had
woman supine abdominal muscles. Using a
★​ Fetal back Is characterized by a smooth, hard,
with knees pillow or towel tilts the uterus off
resistant surface.
slightly flawed. the vena cava this preventing
Place a small supine hypotension ★​ However, the assessment findings reveal
pillow or rolled syndrome several angular nodulations, the areas
towel under palpated may be part of the knees and
one side elbows of the fetus
★​ Important concept:
Hand washing prevents the
Wash your spread of possible infection. -​ Fetal back= where fetal heart tone Is
hands using Using warm water aids in client most audible
WARM water comfort and prevents tightening
of abdominal muscles LEOPOLD’S MANEUVER 3
★​ Determines Me part of the fetus at the Inlet
In the first three maneuvers, the nurse faces the
and Its mobility.
head part of the bed. However, during the last
★​ Determines If the presenting part is engaged
maneuver, the nurse will be facing the foot part of
or not engaged.

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★​ If head Is not engaged: the presenting part

I PHARMACOLOGICAL DRUGS
moves upward or either sideward
★​ If head is engaged: head Is firmly settled Into
FREQUENTLY USED DRUGS THAT SHOULD NOT BE TAKEN
the pelvis DURING PREGNANCY

★​ Not advisable
LEOPOLD’S MANEUVER 4
★​ Causes premature
★​ Determines fetal attitude and degree of fetal
closure of the Ductus
extensions into the pelvis.
Arterlosus
★​ It should be done only If the fetus Is In a
★​ No supply to the
cephalic presentation. Information about the
lower half of the
infant’s anteroposterior position may also be
body of the fetus
gained from this final maneuver
★​ This drug also
causes decreased
Fetal Attitude
★​ This is the degree of flexion of the baby in urine output

utero resulting in
oligohydramnios.
★​ In the neonate born
TYPES OF ATTITUDE
after prenatal

★​ The head is sharply indomethacin

flexed, making the exposure, reported

ASPIRIN
parietal bones, or the complications have
OCCIPUT / Included:
space between the
VERTEX -​ Pulmonary
fontanels presenting part
(Full Flexion)
★​ Present the Hypertension

suboccipitobregmatic -​ Necrotizing

(smallest) diameter enterocolitis

-​ Intracranial
SINCIPUT ★​ Fetus is not as well flexed hemorrhage
(Military) ★​ Presents occipitofrontal -​ Cystic brain
diameter to inlet lesion
-​ Renal
★​ The widest diameter dysfunction
(occipitomental) is the
BROW presenting part. ★​ May cause:
(Partial NSAIDs
★​ As a rule, a fetus cannot -​ Hemorrhage
Extension) (Indomethacin)
enter the pelvis in this -​ Premature
presentation closure of

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-​ Be certain that labor contractions are

the ductus
not beginning and fetal heart rate
arteriosus
remains within normal limits
-​ Pulmonary
hypertension
ULTRASOUND
-​ Prolonged
★​ Measures the response of sound waves
gestation
against solid objects
and labor
★​ Purposes
-​ Intrauterine
-​ To diagnose pregnancy.
growth
-​ To establish sex of the fetus.
restriction
-​ To predict maturity of the fetus.
-​ Congenital
-​ To confirm the presence, size, and
salicylate
location of the placenta and amniotic
intoxication
fluid.
-​ Important
★​ Types:
concept
★​ Transabdominal Ultrasound
-​ Use
-​ Ask the client to drink plenty of water 1
low-dose
hour before the procedure.
aspirin.
-​ A full bladder will push the uterus to
-​ Stop taking
the pelvic cavity for better
about four
visualization at the abdomen.
weeks prior
★​ Transvaginal Ultrasound
to EDD.
-​ Ask the client to void.

J DIAGNOSTIC EXAMS BIOPHYSICAL SCORE

★​ Combines five parameters which are as
AMNIOCENTESIS follows
★​ Withdrawal of amniotic fluid through the -​ Fetal reactivity
abdominal wall for analysis , -​ Fetal breathing movement
★​ Best done at 1416 weeks age of gestation or -​ Fetal tone
during 2nd trimester -​ Amniotic fluid volume
★​ Important considerations: ★​ Fetal heart activity
★​ Void before the procedure: -​ May be done as often as daily during
-​ Reduces bladder size and prevents -​ Fetal score of 8l0= fetus is doing well
accidental puncturing during the -​ Fetal score of 6 = considered to be
procedure suspicious
★​ Let the patient stay and observe for 30 -​ Fetal score of 4 = this so°ws a fetus in
minutes after the procedure jeopardy
★​ Instruments used:

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-​ Sonogram ★​ Done PA to 10 weeks

-​ Criteria for score is 2 ★​ Post procedure: Instruct to report chills or fever
★​ Nonstress Test suggestive of InfectIon or threatened
-​ Criteria for a score of 2 miscarriage.
-​ Fetal heart reactivity: two or more
fetal heart rate accelerations of least ALPHA-FETOPROTEIN
15 beats/mln above baseline and of ★​ MAlphafetoprotein is a glycoprotein produced
-​ 15 seconds in duration with fetal by the fetal liver that reaches a peak In
movement over a 20 minute time maternal serum between the 13th and 32nd
period. week of pregnancy,
★​ Results:
NONSTRESS TEST -​ Elevated: Neural tube defect
★​ Measures the response of fetal heart rate In -​ Decreased: Fetal chromosomal
relation to fetal movements Disorder (eg. Down syndrome)
★​ Uses Cardlotocograph (CTG) Traclng
★​ Noninvasive
K LABOR

CONTRACTION STRESS TEST

FETAL SIGN
★​ Measures response of fetal heart rate to
★​ The baby feels that it is already capable of
uterine contractions
living outside the Otero
★​ Stimulation of contractions through: (1) Nipple
stimulation or (2) Oxytocin Challenge
OXYTOCIN THEORY OF PARTURITION
★​ Best done when the mother is at thirtyeight
★​ Receptors for oxytocin in the uterus increase
(38) weeks Age of Gestation
as term approaches.
★​ Done when NST is NONREACTIVE.
★​ Results:
PROGESTERONE WITHDRAWAL THEORY
-​ Negative (Normal): No late ★​ Level of progesterone assayed in preterm and
decelerations with contractions term pregnancy
-​ Positive (Abnormal): Late ★​ Preterm: Progesterone level is still high
decelerations ★​ Approaching Term: Level of progesterone
-​ Safety consideration: Observe women decreases causing contraction of uterus
for 30 minutes to see that
contractions are quite not beginning. PROSTAGLANDIN THEORY
★​ Prostaglandin stimulates uterine contraction
CHRONIC VILI SAMPLING
★​ It is a diagnostic technique that Involves the
retrieval and analysis of chorionic vllll from the
growing placenta for chromosomes or DNA
analysis

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L PRELIMINARY SIGNS OF LABOR Intensity is increasing No change on intensity

Ambulation Ambulation stop the

LIGHTENING
intensifies uterine contraction
★​ Primigravida= 2 weeks poor to labor
contraction in true
★​ Multigravida= at time of labor
labor

BRAXTON HICKS CONTRACTION Sedation has no Sedation stop false

★​ Starting at 28 weeks AOG (or last week/ days effect labor
before labor begins), Bratton Hicks
contractions are strong UTERINE CONTRACTION
★​ The surest sign that labor has begun is
productive uterine contractions.
INCREASE IN LEVEL OF ACTIVITY
★​ Increase In activity is related to an Increase in
epinephrine release initiated by a decrease In BLOODY SHOW
★​ As the cervix soften and ripens, the mucus
progesterone produced by the placenta
plug that filled the cervical canal during
pregnancy (operculum) is expelled
SLIGHT LOSS OF WEIGHT
★​ As progesterone level falls, body fluid Is more
cally excreted from the body RUPTURE OF MEMBRANES
★​ A sudden gush or a scanty, slow seeping of
★​ This Increase In urine production can lead to a
clear fluid from the vagina
weight loss between 1 and 3 pounds

CERVICAL DILATION
RIPENING OF THE CERVIX
★​ Internal sign seen only on pelvic examination
★​ GoodeII’s sign = cervix feels softer than M STAGES OF LABOR
normal to palpation (buttersoft")

FIRST STAGE
★​ Starts from true contraction to full cervical
SIGN OF TRUE LABOR dilatation (10cm)

TRUE LABOR FALSELABOR

Start at lumbar or Confined to ★​ Begins at the

back hypogastric area onset of uterine
contractions.
Regular interval Irregular interval
★​ Contraction
LATENT
Progressive cervical No cervical dilation quality: Mild
dilation and and effacement ★​ Duration: 20 to
effacement 40 seconds,

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every s to 10 ★​ Important Concepts:

minutes -​ Do not encourage pushing if the
★​ Cervical cervix Is not fully dilated and If there
effacement Is no presence of contraction.
occurs -​ Main purpose of pushing: to shorten
★​ Cervical dilation: the Second Stage of Labor
0 to 3 cm. -​ Ask client to pant-breathe if there is
★​ Nullipara: 6 an urge to push
hours
★​ Multipara: 4.5
MECHANISMS OF LABOR
hours
★​ Engagement
★​ Descent
★​ Contraction
★​ Flexion
Quality:
★​ Internal Rotation
Moderate,
★​ Extension
stronger
★​ External Rotation (Restitution)
★​ Cervical Dilation:
ACTIVE ★​ Expulsion
4-7cm
★​ Duration: 40-60
ESSENTIAL INTRAPARTUM AND NEWBORN CARE
seconds, every
★​ Properly timed cord clamping (when
3-5 minutes
pulsation stops or after 2 minutes)
★​ Immediate drying of baby (prevent

★​ Contractlon hypothermia)

quality: ★​ Nonseparation of mother and baby

Strongest ★​ Early breastfeeding (within 60 minutes

★​ Cervical dilation: postpartum)

TRANSITIONAL
8 to 10 cm
★​ Duration: 60-90
THIRD STAGE
seconds, every
★​ Starts from the delivery of the baby to the
2-3 minutes
delivery of placenta
★​ Lasts for five (5) to ten (10) minutes
★​ Maximum waiting time is thirty (30) minutes
SECOND STAGE ★​ Beyond 30 minutes is already abnormal
★​ Starts from full cervical dilatation (10 cm)
up to delivery of the fetus
★​ Primigravida: 1-4 hours
★​ Multigravida: 20-45 minutes

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SIGNS OF PLACENTAL EXPULSION

★​ Thus, the most detrimental or difficult stage
★​ Calkin’s Sign (Uterus becomes firm and
of labor in gravidocardiac patients.
globular)
★​ Lengthening of the Cord
★​ Sudden Gush of Blood POSTPARTUM ASSESSMENT
★​ Breast
TWO TYPES OF PLACENTA ★​ Uterus
SHULTZ (SHINY) ★​ Bladder
★​ Shiny and glistening from the fetal ★​ Bowels
membranes ★​ Lochia
★​ Placenta separates first at its center and last ★​ Homans sign: pain upon dorsiflexion (possible
at*ls edges deep vein thrombosis)
★​ Less chances of bleeding ★​ Episiotomy

DUNCAN
★​ Raw, red, and irregular A N HEMORRHAGIC DISORDERS IN PREGNANCY

★​ Placenta separates first at its edges

★​ Associated with more bleeding and ABORTION / MISCARRIAGE
hemorrhage of the placenta ★​ Any interruption of a pregnancy before a fetus
★​ Nursing Responsibilities: is viable.
-​ Assess the appearance and ★​ Viable Fetus fetus of more than 24 weeks of
completeness of the cotyledons gestation or one that weighs at least 500 g.
(1620). If not complete, reclean the ★​ Two Types of Abortion:
uterus to prevent bleeding. -​ Spontaneous Abortion
-​ Measure the placenta diameter. -​ Induced Abortion
-​ Weigh the placenta. TYPES OF SPONTANEOUS ABORTION
-​ Measure the umbilical cord.
-​ Expect pursuance of blood vessels. THREATENED Presence of vaginal bleeding; no
-​ 2 arteries and 1 vein (AVA) ABORTION cervical dilation and effacement

FOURTH STAGE INEVITABLE / Presence of vaginal bleeding;

★​ First 1-4 hours after delivery of the placenta IMMINENT cervical effacement and dilation
ABORTION
★​ Priority: Achieve homeostasis and
minimize bleeding risks. COMPLETE All products of conception have
★​ All water retained previously will be ABORTION passed in the vagina
reabsorbed into the circulation leading to:
★​ Increased in Cardiac Output INCOMPLETE Some products of conception
ABORTION have passed the vagina
★​ Increase in Oxygen Consumption

HABITUAL Occurence of three or more

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★​ First symptoms may either be a show "

ABORTION pregnancies that end in
(pinkstained vaginal discharge) or increased
miscarriage of the fetus
pelvic pressure

INDUCED ABORTION PLACENTA PREVIA

★​ Also termed as elective termination of ★​ Placenta is implanted abnormally in the
pregnancy uterus.
★​ A procedure pert e end a pregnancy before ★​ Most common cause of painless bleeding in
fetal viability the third trimester of pregnancy
★​ Types of Induced Abortion:
-​ Therapeutic Abortion ABRUPTIO PLACENTA
-​ Illegal ★​ Early separation of the placenta prior to
delivery of the fetus

ECTOPIC PREGNANCY ★​ Abnormal separation occurs on the second

★​ Implantation occurs outside the uterine cavity stage of labor
★​ Most common site: Ampulla of Fallopian tube
★​ Most common predisposing factor: Pelvic PRETERM RUPTURE OF MEMBRANES
Inflammatory Disease (PID) ★​ Rupture of fetal membranes with loss of

★​ Other actors include: amniotic fluid during pregnancy before 37

-​ Previous Surgery weeks

-​ Presence of Intrauterine Device

-​ History of previous ectopic PREMATURE LABOR
★​ Labor that occurs before the end of week 3/ of
pregnancies
gestation
★​ Responsible for almost twothirds of all infant
HYDRATIDIFORM MOLE
★​ Also termed as H.Mole/ Gestational deaths in the neonatal period

Trophoblastic Disease/ Molar Pregnancy villi ★​ Preventable

★​ Abnormal proliferation and then degeneration

of the trophoblastic villi POST-TERM PREGNANCY
★​ Pregnancy that exceeds 42 weeks long
★​ Vesiclelike structure is formed instead of
★​ Also termed as Postmature/Postdate
placenta
★​ Post term pregnancy occurs in 3% to 12% of all
pregnancies
PREMATURE CERVICAL DILATION
★​ Previously termed as Incompetent cervix
★​ Refers to a cervix that dilates prematurely and PRECIPITATE LABOR
★​ Occur when uterine contractions are so strong
therefore cannot hold a fetus until term
that a woman gives birth with only a few,
★​ Most common cause of habitual abortion
rapidly occurring contractions
★​ Habitual abortion: 3 or more consecutive
★​ Labor that lasts for less than 3 hours
abortions

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★​ Precipitate dilatation
amnions and
★​ Cervical dilatation that occurs at a rate of
two umbilical
5cm or more per hour in a primipara or 10cm
cords
or more per hour in a multipara
★​ Always of the
★​ Dangers of Precipitate Labor
same sex
-​ Noninstitutionalized delivery
-​ Exposes baby to sepsis ★​ Fraternal twins
-​ Exposes mother to laceration ★​ 2 ova and 2
-​ Head of baby thumps to pelvis sperms
resulting to hemorrhage ★​ 2 placentas, z
-​ Intracerebral hemorrhage of the head umbilical cords,
DIZYGOTIC
of baby as the baby's head bumps ★​ 2 amnions, 2
the mothers bony prominences chorions
★​ May be of the
BREECH DELIVERY same or
★​ Either the buttocks or the feet are the first
different sex
body parts that will contact the cervix
★​ Occur In approximately 3% of births and are
affected by the fetal attitude PREGNANCY INDUCED HYPERTENSION
★​ Types: ★​ It is a condition in which vasospasm occurs

-​ Complete during pregnancy in both small and large

-​ Frank arteries

-​ Footling ★​ Unknown cause

★​ Classic Signs of PIH:

MULTIPLE PREGNANCIES -​ Hypertension after 20th week AOG

★​ Multiple Gestation: a complication of -​ Protelnurla: (>250 mg/dl)
pregnancy because a woman's body must -​ Edema
adjust to the effects of more than one fetus -​ Vision changes
★​ Occurs in 2% to 3% of all births ★​ General Classifications:
★​ 2 Types -​ Gestational Hypertension
-​ Monozygotic -​ Mild Preeclampsia
-​ Dizygotic -​ Severe Preeclampsia
-​ Eclampsla

★​ Identical twins
ECLAMPSIA
★​ 1 ovum and 1
★​ Most severe classification of PlH
MONOZYGOTIC sperm
★​ Grandmal seizure or coma occurs
★​ One placenta,
★​ Accompanied by signs and symptoms of
one chorion, two
preeclampsia

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HELLP SYNDROME
★​ Severely compromised
★​ Hemolysis, Elevated Liver enzymes, Low
★​ Woman is unable to
Platelet (HELLP)
CLASS IV carry out any physical
★​ Occurs in 4% to 12% of patients with PlH
activity without
★​ Maternal mortality rate of 24%
experiencing discomfort
★​ Infant mortality rate of 35%

LACTATION AMENORRHEA
★​ 3 Requirements: PUERPERIUM
★​ Exclusively breastfeeding/lactating ★​ This refers to the 6 week period after
★​ No menstruation: some suppression of childbirth
ovulation ★​ Main priority: Achieve involution
★​ "Involution is the return of reproductive
★​ Within 6 months postpartum
organs to prepregnancy state (Normal:
lcm/fingerbreadth per day)
GESTATIONAL DIABETES MELLITUS ★​ Progressive: Production of milk for lactation,
★​ A condition of abnormal glucose metabolism restoration of the normal menstrual cycle,
that arises during pregnancy and beginning of a parenting role
★​ Cause: unknown; Human Placental Lactogen
(HPL)
LOCHIA
HEART DISEASE (GRAVIDOCARDIA) RUBRA
★​ Day 1 to day 3
FOUR CLASSIFICATIONS
★​ Bright red in color with only small particles
of dead and mucus
★​ Uncompromised
CLASS I ★​ Ordinary Physical activity
SEROSA
causes no discomfort
★​ Day 3 to day 10
★​ Slightly compromised ★​ Pinkish or brownish in color
★​ Ordinary physical activity ★​ Composed of blood, mums, and invading
CLASS II causes excessive fatigue, leukocytes
palpitation, and dyspnea
ALBA
or angina pain
★​ Day 10 until 3rd week up to 6th week
postpartum
★​ Markedly compromised
★​ White In color
★​ During less than ordinary
activity, woman
CLASS III
experience, excessive
fatigue, palpitations,
dyspnea, or angina pain

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THROMBOPHLEBITIS
O POSTPARTUM PROBLEMS
★​ Most common sites are the vessels of the
lower extremities
MATERNAL HEMORRHAGE
★​ (+) for Homans Sign
★​ Early postpartum hemorrhage
-​ Upon lying supine with legs extended.
★​ Occurs within the first 24 hours after delivery
Ask the patient to dorsiflex the foot
★​ Most common cause: Uterine stony
-​ Stretching of Me blood vessels CBUSES
★​ Laceration is the second most common cause
pain on calf muscles (gastrocnemius
★​ Inherent clotting disorders occur:
muscle)
-​ Thrombocytopenia
★​ Management:
-​ Leucopenia
-​ Antiblotlcs
★​ Late postpartum hemorrhage: occurs after
-​ Anticoagulant: Heparin
first twentyfour hours of delivery
★​ Common causes:
-​ Primary cause (Retained Placental
Fragment/s)
-​ Secondary Cause (Hematoma)

INFECTION
★​ Endogenous infection
★​ Normal flora causes infection and may travel
up to the uterus
★​ PerinealInfection
-​ On site of episiotomy
-​ Antibiotic therapy
★​ Surgical Management
-​ Remove suture
-​ Drain pus
-​ Position in semi-filers position

ENDOMETRITIS
★​ Infection of the lining of the uterus
★​ Maternal fever >38C
★​ Foul smelling vaginal discharge
★​ Uterine or abdominal tenderness
★​ Management for Endometrids
-​ Antibiiotics
-​ Position: Semifowlers position

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