NCM 107

MATERNAL AND CHILD NURSING

PREPARED BY: MA. CARYL H. TADY, MAN, RN

 Menstruation
Menstrual Cycle: (female reproductive
cycle)

An episodic uterine bleeding in response

to cyclic hormonal changes.

A process that allows for conception and

implantation of a new life.

It brings the ovum to maturity.

 Physiology of
Menstruation
Four body structures involved:

1. Hypothalamus

2. Pituitary gland

3. Ovaries

4. Uterus
 Hypothalamus
The release of Luteinizing hormone-
releasing hormone (LHRH,
abbreviated GnRH) by the
hypothalamus initiates the menstrual
cycle.

Hypothalamus to anterior pituitary

gland (to release FSH & LH)
 Pituitary Gland
Under the influence of LHRH

Two hormones produced:

1. FSH - active early in the cycle and

responsible for maturation of ovum.

2. LH – most active at the midpoint of

the cycle and responsible for
ovulation, released of matured egg
and growth of uterine lining.
 Ovary
Under the influence of FSH and LH
(gonadotropic hormones, growth “trophy”,
gonads “ovaries”)

One ovum matures in one or the other

ovary and is discharged from it each month.

At this stage, small ovum is barely visible

to the naked eye ( printed period) with its
surrounding follicle membrane and fluid
(graafian follicle).
At maturity, visible on the surface of the
ovary as a clear water blister ( one-
quarter or one-half of an inch.

Following an upsurge of LH from the

pituitary, prostaglandins are released
and the graafian follicle ruptured, the
ovum is set free from the surface of the
ovary. This is termed as “ovulation.”
 Uterus

Stimulation from the hormones produced

by the ovaries causes specific monthly
effects on the uterus.
 Menstrual Cycle
1. Proliferative (first phase)

Immediately after a menstrual flow

( occurring the first 4 to 5 days of a
cycle, the endometrium, lining of the
uterus is very thin.

Proliferative, Estrogenic, follicular, or

Post menstrual phases.
2. Secretory (second phase)

After ovulation, the formation of progesterone

in the corpus luteum (under the direction of
LH) causes glands of uterine endometrium to
become corkscrew or twisted in appearance
and dilated with quantities of glycogen and
mucin, an elementary sugar and protein.

Progestational, Luteal, Premenstrual, or

secretory phase.
3. Ischemic ( third phase)

If fertilization does not occur, the corpus

luteum in the ovary begins to regress
after 8 to 10 days.

Production of progesterone and estrogen

decreases. With the withdrawal of
progesterone stimulation, the
endometrium begins to degenerate.
4. Menses ( final phase)

Products are discharged from the uterus as

the menstrual flow or menses;

a. Blood from the ruptured capillaries

b. Mucin from the glands

c. Fragments of endometrial tissue

d. The microscopic, atrophied, and unfertilized

ovum
Cycle of menstruation varies in length among women, but an
average is to have a period every 28 days. Regular cycles may range
from 21 to 40 days are considered normal. This has four phases:

1.) Follicular phase - first day of the period and ovulation wherein
estrogen level rises as an egg is to be released (before the release of
egg),

2.) Proliferative phase - concentrations of estradiol influences the

endometrial lining or uterine lining builds back up again

3.) Ovulation phase - the release of egg from the ovary (egg
release)

4.) Luteal phase – occurs after ovulation wherein the lining of the
uterus normally gets thicker to prepare for pregnancy (after egg
release).

Amount of menstrual discharge ranges from 10 to 35 ml. each

soaked normal-sized tampon or pads holds a teaspoon (5ml) of blood
which means that soaking seven normal sized pads or sanitary
products in a whole period is normal.
 DIAGNOSIS OF
PREGNANCY
• Situation:

• Mrs. Gomez visited the maternity clinic for the first-time

and she was accompanied by her husband. It has been 4
weeks since she missed her period and stated that she
experienced morning sickness, fatigue and breast
tenderness. She took a home pregnancy test and yielded a
positive result.
• She stated that she feels happy because she is finally
pregnant after 2 years of being married yet she also feels
anxious because it is her first pregnancy and
• What are the different signs of pregnancy does Mrs. Gomez
exhibits? What emotional changes does she shows?
• Confirmation of her pregnancy is most
important for both the mother and the
fetus. It is then when the woman can
begin receiving medical care for the
health and welfare of herself and the
baby.

• There are three different categories for

the signs of pregnancy. The categories
are Presumptive, Probable and
Positive.
 Presumptive
(SUBJECTIVE)
Symptoms
• These are signs of pregnancy the
woman is experiencing that makes her
suspicious that she may be pregnant.
They are subjective signs reported
by the woman and are not definite
that a baby is growing in the
uterus. When symptoms are taken as
single entities, it could easily indicate
other conditions.
Week
Description
Finding
1 Breast changes Tenderness, fullness, tingling; enlargement & darkening of areola
Nausea &
2 Vomiting Arising when fatigues

2 Amenorrhea Absence of menstruation

3 Frequent Sense of having to void more often than usual

Urination
12 Fatigue Generally feeling of tiredness
Uterine
12 Enlargement Can be palpated at the symphysis pubis

18 Quickening Fetal movement felt by woman

24 Linea Nigra Line of dark pigment forms on the abdomen
24 Melasma Dark pigment forms on face
Striae
24 Gravidarum Red streaks form on abdomen
 Probable
(OBJECTIVE)
Findings
• It is objective and so can be verified
by an examiner. Although they are
more reliable than

• presumptive symptoms, they still do

not positively diagnose a
pregnancy.
Week Finding Description

1 Maternal serum test Presence of HCG hormone

6 Chadwick’s sign Color change of vagina (pink-violet)

6 Goodell’s sign Softening of cervix

6 Hegar’s sign Softening of the lower uterine segment

Sonographic evidence of
6 Characteristic wing is evident
gestational sac
Fetus can be felt to rise against the
16 Ballottement
abdominal wall
20 Braxton Hicks Contractions Periodic uterine tightening
Fetal outline felt by
20 Fetal can be palpated through abdomen
examiner
 Positive Findings

• Positive signs of pregnancy are those

signs that are definitely confirmed
as a pregnancy.
Week Finding Description

Sonographic Evidence of fetal Fetus can be felt to rise against the

8
outline abdominal wall

10 -12 Fetal Heart Audible Periodic uterine tightening

Fetal can be palpated through

20 Fetal movement felt by examiner
abdomen
 Discomforts of
Pregnancy
• Nausea & • Ankle Edema • Numbness/
Vomiting • Varicose vein tingling of the
• Syncope fingers
• Headaches
• Urinary urgency • Hemorrhoids • and/or toes
& frequency • Palpitations
• Constipation
• Breast • Nosebleeds
• Flatulence
tenderness (epistaxis)
• Leg Cramps
• Nasal • Pelvic Pressure
Congestion • Shortness of
• Skin change
Breath
• Fatigue
• Insomnia
• Heartburn
• Leukorrhea
 Physiologic changes
in Pregnancy
• A.Reproductive System Changes

• 1) Uterus
Prepregnan
Uterine Term
cy
Weight 50- 70 gm 800-1,200 gm
Capacity 10 ml 5000 ml
Thickness 1- 2 cm .5 cm
Length 6.5 cm 32 cm
Depth 2.5 cm 22 cm
 Pattern of Uterine growth
(location of the fundus)
• 12 weeks – at the level of symphysis
pubis
• 16 weeks – halfway between symphysis
pubis and umbilicus
• 20 weeks – at the level of the umbilicus

• 24 weeks – two fingers above umbilicus

• 30 weeks – midway between umbilicus

and xiphoid process
• 36 weeks – at the level of xiphoid
process

• 40 weeks – two fingers below

umbilicus uterus sinks to a lower level
( at the level of 34 weeks)

• (lightening)
 Uterine Blood Flow

• Increases from 20 ml before pregnancy

to 700- 900 ml at the end of
pregnancy.

• Three fourths of blood supply goes to

the placenta.
 Uterine Shape

• From pear shape before pregnancy to

spherical and later on to ovoid shape
in the last months of pregnancy.
• Can hold a 7-lb (3,175 g) fetus plus
1,000 ml amniotic fluid = 4000g
 Uterine Position
• After 12 weeks gestation, the uterus
loses its anteflexed position.
 Uterine Contractility

• Beginning on the first trimester, the

uterus undergo irregular contractions
called Braxton-Hick’s contractions.

• Late in pregnancy, contractions

become more intense and frequent
causing false labor.
 Isthmus
• During pregnancy, the isthmus softens and elongates up
to 25 mm. It will later form the lower uterine segment,
together with the cervix.
• Hegar’s sign – softening of the lower uterine segment
that begins as early as 6 weeks gestation.
• 2 weeks before the term (the 38th week) pregnancy,
lightening occur (primipara).(for multipara, not
predictable)
• 16th to 20th week of pregnancy, when the fetus is still
small in relation to the amount of amniotic fluid present,
ballotement may be demonstrated
• Braxton-hicks contraction – “practice contraction”
 2) CERVIX

• Leukorrhea

Estrogen stimulation results in increase mucus

production that leads to the formation of
Operculum, the mucus plug of the cervix that
protects against bacteria and infection.

The discharge of Operculum at term, called Show,

is an important sign of labor.
• Consistency

Goodell’s sign, is observable by 6 to 8 weeks

gestation.
 3) Vagina and Vulva
• Chadwick’s sign – vaginal mucosa change
in color from pinkish to purplish or dark-
bluish.
• Vaginal pH: 3.5 to 6, Acidic

4) Ovaries
• Upon conception, the major function of the
corpus luteum is to secrete progesterone
for the first 6- 12 weeks of gestation.
During pregnancy ovulation ceases
 5) Breasts
• Increased breast size due to alveolar tissue
growth, fat deposition and increased vascularity:
Nipples increase in size and become more erect

• Areolae become larger and more pigmented.

Montgomery tubercles become more prominent
and secrete a

• substance that lubricates the nipples.

• Colostrum, a thick, yellow breast fluid, is present

beginning in the second trimester and can
readily be expressed by the third trimester.
 B) Cardiovascular
Heart
• 1) Size and Position

• Muscles of the heart enlarge slightly because of

increased cardiac workload.

• The heart is pushed upward and toward the left as

the uterus elevates the diaphragm during the third
trimester.

• 2) Heart Sounds – Some heart sounds may be

altered that they may be considered abnormal in a
non pregnant state.
The following are normal during
pregnancy:
• a. Splitting 3rd sound is due to lowered
blood viscosity.
• b. Systolic murmurs in about 90% of
pregnant women
• c. Diastolic murmur in 20%
• d. Benign pericardial effusion on x-ray
Blood and Plasma Volume
• Total blood volume increases about 40
% to 50 % during pregnancy
• Plasma volume begins to increase at 6-
8 weeks of gestation and peaks at
4,700 to 5,200 mL at 32 weeks, the
concentration of hemoglobin and
erythrocytes decreases giving a
woman a pseudoanemia.
Cardiac Output
• Rises rapidly during the first trimester and
increases 30% to 50% by third trimester.

• Heart rate rises 10 to 20 beats per minute

by 32 weeks of gestation.
• Cardiac output is highest when the
woman is lying on her side and lower in
the sitting, standing, or supine position.
Peripheral Vascular Resistance
and BP
• PVR falls during pregnancy.

• BP remains stable during pregnancy

despite the increase in blood volume.
Diastolic pressure shows a decrease
(about 10 to 15 mm Hg) that is
greatest at 24 to 32 weeks of
gestation. Bp returns to usual levels by
term.
Supine Hypotension Syndrome
• Caused by the pressure of the gravid uterus to
the vena cava against the vertebrae,
obstructing blood flow from the
lower extremities.
• Can lead to fetal hypoxia

• The woman experiences lightheadedness,

faintness, palpitations.
• Left side lying position is the preferred position.
Blood Constitution
• Fibrinogen increases by 50%
(necessary for clotting), because of the
increase level of estrogen.

• Platelet count, Factors VII, VIII, IX, and

X are also increase.

• WBC increases
 C) Respiratory
System
Changes are caused by:
• Increased oxygen requirements

• Effect of progesterone and estrogen

• Mechanical effect of the enlarging uterus that

educes the space in the chest
• Hyperventilation is experienced in an effort to
blow off the extra carbon dioxide from the fetus.
• Nasal congestion occurs due to estrogen
stimulation.
 4) Urinary System
Urinary frequency is due to:
• First Trimester – uterus exerts pressures on the
bladder as it rises out of the pelvic cavity

• Second Trimester – pressures of the presenting part

on the bladder after lightening

• Increased blood flow to the kidney which increases

GFR and consequently, UO.

• Lactosuria – Lactose is secreted by the mammary

glands but since it is not yet used during
pregnancy, it normally spills in the urine.
The following are increased during
pregnancy:
• Increased UO as the mother must excrete her
metabolic waste products and those of the fetus
too. With increased volume of urine, specific
gravity decreases.

• GFR and renal plasma flow by 40 %

• Kidney increases slightly in size

• Greater loss of amino acids and water soluble

vitamins in the urine of pregnant woman.
 E) Gastrointestinal
System
1) Nausea and vomiting (First Trimester) :
• increased HCG and estrogen levels

• Decreased maternal glucose levels as glucose is

being utilized for fetal brain development.
• Effects of Progesterone:

2) Constipation – decreased GIT motility and longer

emptying time.

3) Pyrosis/ Heartburn – relaxation of cardiac sphincter

results in reflux of acidic gastric contents into the lower
esophagus which irritates the esophageal mucosa.
• 4) Generalized itching and increased
predisposition to gall stone formation
due to slowed bile movement from gall
bladder resulting to reabsorption of
bilirubin into maternal blood stream.
• Effects of Estrogen :
•Ptyalism- increased salivation
•Epulis – hypertrophy or swelling of
gums
 F) Integumentary
System
• Increased melanin production:
a) Melasma – Facial dicoloration
b) Linea Nigra – dark line from
umbilicus to symphysis pubis
• c) Darker areola
• Estrogen effects:
Palmar erythema – redness and itching
of the hands
• Vascular Spider Nevi – prominent
capillaries under the skin
• Activation of sweat and sebaceous glands
resulting in increased perspiration and oily
skin
• Striae Gravidarum- enlargement of the uterus
results in stretching and tearing of the elastic
fibers of the abdominal skin, that results to
striae.
• They appear pinkish during pregnancy and
turn silvery white after delivery.
• Pruritus or severe itching of the abdominal
skin is due to the stretching of the skin.
 G) Endocrine
• Thyroid Gland – slight enlargement of
thyroid gland due to increased
metabolic rate

• Pancreas – Elevated glucocorticoid

levels stimulate increase in insulin
production
• Parathyroid glands – enlargement of
parathyroid glands to meet the
increased need for Calcium to be
utilized for the development of fetal
• Adrenal gland – increased corticosteroid
production and aldosterone production promote
sodium reabsorption and water retention.

• High estrogen levels inhibit LH and FSH

production

• Increased secretion of growth hormone and

melanocyte stimulating hormone

• Posterior Pituitary gland secrete increasing

amounts of oxytocin and prolactin as pregnancy
nears term
 Estrogen VS
Progesterone
Estrogen effects:
• Hormone for Women

• Stimulates uterine growth

• Increases blood supply to uterine vessels

• Increases uterine contraction near term

• Aiding in the development of the glands and ductal

system in the breasts in preparation for lactation

• Causing hyperpigmentation, vascular changes in the

skin, increased salivary gland activity, and hyperemia of
gums and nasal mucous membranes
Progesterone effects:
• Hormone of Pregnancy

• Maintaining the endometrial layer for implantation of

the fertilized ovum
• Preventing spontaneous abortion by relaxing the
smooth muscles of the uterus
• Helping to prevent tissue rejection of the fetus

• Stimulating the development of lobes and lobules in

the breast in preparation for lactation.
• Facilitating the deposit of maternal fat stores, which
provide a reserve energy for pregnancy and lactation.
 H) Skeletal System
• Softening of joints and ligaments,
especially of symphysis and sacroiliac
joints is caused by relaxin and
estrogen causing a woman a waddling
gait.
• Leg cramps is caused by pressure of
gravid uterus on nerves and imbalance
of calcium in the body.
 PSYCHOLOGICAL
CHANGES
Uncertainty
FIRST  Early weeks - unsure - pregnant and tries to confirm it.
TRIMESTE  Observes her body for changes
R  Reaction uncertainty of pregnancy
 Eagerness: pregnant or not
 Ambivalence
 Conflicting feelings, or ambivalence, about being
pregnant.
Examine the meaning of the pregnancy in terms of
changes that must be made in their lives and what
they must give up as a result of the pregnancy.
 The Self as Primary Focus
 Because she has not gained weight to confirm a
growing, developing fetus, she probably says “I am
pregnant” rather than “I am going to have a baby”
 Physical changes and increase hormone levels may
cause emotional lability (unstable moods).
 Physical Evidence of Pregnancy
 Physical changes occur in expectant
mother that make the fetus “real”.
 Uterus grows rapidly and can be palpated
in the abdomen, weight
 increases, and breast changes are obvious.
(Quickening),which confirms that a life is
SECOND
developing within the uterus.
TRIMESTE 
Now she might say “I am going to have a
R
baby”.
The Fetus as Primary Focus
• The discomfort of the first trimester has
usually abated and her size does not alter
her activity.
• Now concern about producing healthy
 Narcissism’s and Introversion
•Increasingly concern about their ability to
protect and provide for the fetus.
•The primigravida wonders about the infant.
 Looks at baby pictures of herself and her
partner and wants to hear stories about
SECOND themselves as infants.
TRIMESTER  Multiparas interested in infant and
concerned with child’s acceptance by
sibling and grandparents.
Body Image
Rapid and profound changes take place in
the body during second trimester.
Changes in Sexuality
 Vulnerability
The sense of well-being and contentment that dominates
the second trimester gives way to increasing feelings or
vulnerability, particularly during the seventh month of
pregnancy.
THIRD
TRIMESTER Many mothers have fantasies or nightmares about harm
coming to the infant and become very cautious as a result.
Increasing Dependence
Dependent on partner in the last weeks of pregnancy.
o Need for love and attention from her partner-more
pronounced in late
 Preparation for Birth
 Feelings of vulnerability decreased as the
woman comes to terms with her
situation.
THIRD  Are concerned - ability to determine
TRIMESTER when they are in labor.
 During this trimester an expectant
mother may say “I am going to be a
mother” as she prepares for the infant.
 3 Developmental Tasks: by
Rubin
FIRST TRIMESTER: ACCEPTANCE OF PREGNANCY
• Phase I=
woman accepts the biological fact of pregnancy; able to state “ I am
pregnant” and incorporate the idea of a child into her body and self image
( fetus as unreal ).
SECOND TRIMESTER: ACCEPTANCE OF THE FETUS AS A SEPARATE
INDIVIDUAL
• Phase II=
Accept the growing fetus ask distinct from the self as a person to nurture;
can say” I am going to have a baby” at second trimester beginning of
mother- child relationship; becomes more introspective and enters a quiet
period.
THIRD TRIMESTER: ACCEPTANCE OF MOTHERHOOD
• Phase III=
Prepare realistically for birth and parenting of the child; expresses “ I am
going to be a mother “, defines the nature and characteristics of the child.
 Emotional Responses to
Pregnancy
• Ambivalence

• Grief

• Narcissism (self-centeredness)

• Introversion vs Extroversion

• Body image and boundary

• Stress

• Emotional lability

• Couvade syndrome
 Danger Signs of
Pregnancy
1. Abdominal pain

2. Spotting/Vaginal bleeding

3. Persistent Vomiting

4. Sudden gush of fluid from the vagina

5. Weight gain in a short period of time

6. Protein in the urine

7. Headache

8. Edema of face and hands

9. Fever

10. Absence of fetal movement

11. Absence of fetal heartbeat

12. Painful urination (dysuria)

13. Decreased urine output (oliguria)

14. Weight loss

 DISCOMFORTS OF
PREGNANCY AND
INTERVENTIONS
• Nausea & Vomiting
• •Varicose vein Leukorrhea

• Syncope • Headaches • Numbness/tingling

of the fingers
• Urinary urgency & • Hemorrhoids and/or toes
frequency
• Constipation • Palpitations
• Breast tenderness
• Flatulence • Nosebleeds
• Nasal Congestion (epistaxis)
• Leg Cramps
• Fatigue • Pelvic Pressure
• Shortness of Breath
• Heartburn • Skin changes
• Insomnia
• Ankle Edema
 HEALTH HISTORY
• Obstetric history involves the ability
to obtain an accurate and relevant
information regarding the patient’s
current and previous pregnancies.
Some of the questions are highly
personal, therefore good
communication skills and a respectful
approach are absolutely essential.
• Obstetric assessment is an
important component of
comprehensive obstetric care. It is a
tool used to evaluate the physical,
medical, psychosocial, familial and
environmental factors that affects the
condition of the mother, infant or both.
 PURPOSES
1. To gather essential information related to
maternal concerns.

2. To determine the history of pregnancies and

complications.

3. To educate mother in the entire process of

pregnancy.

4. To reassess mother’s level of understanding

about pregnancy.
 ASSESSMENT
1. patient’s baseline/ demographics

2. family history

3. past and present medical history

4. pertinent menstrual history

5. history of past pregnancies and complications

 TO DETERMINE
1. Pregnancy History

G – gravida, P – para, T – term, P – preterm, A –

abortion, L – live births

2. Complications

3. Allergies

4. Medications
 GENERAL
CONSIDERATIONS
In the conduct of an interview during obstetric history
taking, the following should be taken into consideration:
1. Provide privacy to the patient at all times.
2. Assess the level of understanding of the patient
3. Use the preferred language and terminologies that are
familiar to the patient.
4. Observe an appropriate distance in communicating to the
patient.
5. Ensure confidentiality on the information disclosed.

•
 OBSTETRICAL
HISTORY
Patient’s Baseline Data

are demographics that are collected

from the patients or informants that
contains the essential information
needed prior to the intervention. These
includes the characteristics of an
individual or population
Name:

Civil Status:

Age:

Birthdate:

Address:

Educational Attainment:

Occupation:

Chief Complaint:

Drug / Food Allergy:

Family History

contains the past information of a family

which traces their past medical, and
mental health conditions. These also
includes the behaviors and diseases that
are inherent to the family.
Past Medical History

is record of information about a person’s

health. This includes information about
allergies, illness, surgeries,
immunizations, and results of physical
examination and diagnostic tests. It may
also contain other pertinent information
like medication, diet, exercise program
and therapies.
Pertinent Menstrual History contains
the information regarding the start of the
monthly period, the amount of
discharges in a cycle and its
irregularities.

Menarche is the first occurrence of

menstruation which are usually painless
and occurs with warning. This occurs
between ages of 10 to 16 years old in
most girls but there are instances that it
occurs 10 years old below.
 History of Past
Pregnancies
Gravida – number of pregnancies regardless of duration, the
number
of times a woman has conceived and outcome
Para – number of pregnancies that has reached viable age
–birth after 20 weeks gestation, regardless if the infant is
born
or dead
Term – a delivery that is after 37 weeks
Preterm – delivery that is less 37 weeks
Abortion – spontaneous or elective – less than 20 weeks
Living – living children
 EXAMPLE
Ana is a first time mother. If she had twins, gravida
would be 1 and para would be 1 because it’s a single
pregnancy and a single delivery.

G1P1T2P0A0L2

Ruby is experiencing her fourth pregnancy. Her first

pregnancy ended in a spontaneous abortion at 8
weeks, and the second resulted in the live birth of twin
boys at 38 weeks, and the third resulted in the live
birth of a daughter at 34 weeks.

G4P2T2P1A1L3
 Types of Delivery
Natural Birth is a vaginal labor and delivery with
limited to no medical intervention that involve a
variety of choices

Vaginal Birth is the natural method of birth of

offspring through the vagina:

1. Spontaneous vaginal delivery is

a vaginal delivery that happens on its own,
without requiring doctors to use tools to help pull
the baby out. This occurs after a pregnant
woman goes through labor. Labor opens, or
dilates, her cervix to at least 10 centimeters.
 2. Assisted birth (also known as
an instrumental delivery) is when
forceps or a ventouse suction cup are
used to help deliver the baby.
Ventouse and forceps are safe and
only used when necessary for you and
your baby. Assisted delivery is less
common in women who've had a
spontaneous vaginal birth before
Partial Breech is when one of the baby's
knees is bent and his foot and bottom are
closest to the birth canal. The body of the
fetus is then rotated 180 degrees in the
reverse direction to deliver the other shoulder
and arm. If trunk rotation is unsuccessful.
Posterior shoulder is delivered first.

Complete Breech is when both of the

baby's knees are bent and his feet and
bottom are closest to the birth canal.
Abdominal Delivery is the delivery of a fetus by
surgical incision through the abdominal wall and uterus:

1. Primary Cesarean is a surgical procedure by

which a baby is delivered through an incision in the
mother’s abdomen, often performed because vaginal
delivery would put the baby or mother at risk

2. Vertical Cesarean Section is a

vertical incision on the uterus causes less bleeding
and better access to the fetus, but renders the
mother unable to attempt a vaginal delivery.
 3. Horizontal Cesarean Section is sometimes
called "the bikini cut” wherein an incision on the
skin of the abdomen 1–2 inches above the pubic
hairline is done.

4. Low Segment Transverse he doctor cuts

through the lower uterine segment of the uterus,
which typically doesn't involve the same tissue as
a classical C- section. This region of the
uterus has less muscular fiber, and is less easy
to tear or rupture with future labors.
Outcome of Delivery
Stillbirth is the delivery, after the 20th
week of pregnancy, of a baby who has
died. A baby is stillborn in about 1 in 200
pregnancies which is caused by
infections, birth defects and pregnancy
complications, like preeclampsia.

Multiple Birth occurs when two or more

child are delivered that can either be
twins, triplets and so forth.
Last Menstrual Period. By convention, the first gestational
week of pregnancies is marked by the first day of a
woman's last menstrual period (LMP). If her menstrual
periods are regular and ovulation occurs on day 14 of
her cycle, conception takes place about 2 weeks after
her LMP.

Expected Date of Delivery is an estimated date of when

your baby is due. Most pregnancies last around 40 weeks (or
38 weeks from conception), so typically the best way to
estimate your due date is to count 40 weeks, or 280 days,
from the first day of your last menstrual period (LMP).
Age of Gestation is the common term used
during pregnancy to describe how far along the
pregnancy is. It is measured in weeks, from the
duration of pregnancy which starts from the first
day of the Last Normal Menstrual Period
(L.N.M.P.) to the current date. The later months
of pregnancy known as the Expected Date of
Delivery (E.D.D.)

A normal pregnancy can range

from 38 to 42 weeks. Infants born
before 37 weeks are considered premature.
 COMPUTATION
Nagele’s Rule
Begin with the first day of the last LMP – add a
year, subtract three months, add seven days
Example:
LMP was May 12, 2013
Add year – 2013 +1 = 2014
Subtract three months – 5 – 3 = 2 (February)
Add seven days 12 + 7 = 19
Answer = February 19, 2014 estimated due date
 Prenatal History
include information on the mother's pregnancy,
such as prenatal exposure to illicit drugs, toxins, or
infections; maternal diabetes; acute maternal
illness; trauma; radiation exposure; prenatal care;
and fetal movements. Below are the common
questions asked during history taking:

When was your first prenatal visit?

How often?

Did you receive any teaching regarding prenatal

care?
Labor and Delivery? Food likes and dislikes:
Postpartum? Fluid Preferences:
Newborn? Sleeping habits:
By whom? Where? Usual bedtime:
Medications taken along No. of hours of sleep:
the course of pregnancy? Nap habits:
Was it prescribed? If unable to sleep, what
By whom? things you would do to
Medication for allergies? help you?
Appetite while pregnant: Discomfort that you felt:
Weight gain:
HEALTH TEACHINGS
1. Eating a healthy diet is especially important for pregnant women. Your baby needs
healthy food, not sugar and fat. Eat plenty of colorful fruits and vegetables, whole grains,
calcium-rich foods, and foods low in saturated fat.
2. Vitamin Intake. Make sure to get plenty of folic acid and calcium. You can get these and
other necessary vitamins and minerals from food and a standard multivitamin.
3. Stay Hydrated. A pregnant woman’s body needs more water than normal. Aim for eight
or more cups each day.
4. Proper prenatal care. Women should get regular prenatal care from a healthcare
professional. Mothers who don’t get regular prenatal care are much more likely to have a
child with low birth weight.
•

•
5. Don’t drink alcohol. Women should not drink alcohol before and
during their pregnancy and while breastfeeding. Drinking alcohol
increases the risk of having a baby with fetal alcohol spectrum
disorder (FASD). FASD can cause abnormal facial features, severe
learning disabilities, and behavioral issues.

6. Don’t smoke. Smoking is unhealthy for you and your unborn child. It
increases the risk of SIDS (sudden infant death syndrome), premature
births, miscarriages, and several other unhealthy outcomes.

7. Avoid certain foods. There are certain foods that women should
avoid eating while pregnant. Do not eat: raw or rare meats, liver,
sushi, raw eggs (also in mayonnaise), soft cheeses (feta, brie), and
unpasteurized milk. Raw and unpasteurized animal products can cause
food poisoning. Some fish, even when cooked, can be high in mercury.

8. Exercise daily. Daily exercise is great for most pregnant women.

Check with your doctor to find out how much physical activity would be
right for you.
9. Get plenty of sleep. Ample sleep (7 to 9 hours) is important for
you and your baby. Try to sleep on your left side to improve blood
flow to you and your child.

10. Reduce stress. Reducing stress is crucial for improving birth

outcomes. Pregnant women should avoid, as much as they can,
stressful situations. Recruit your loved ones to help you with this.

11. Get vaccinated. Pregnant women are susceptible to various

disease. Vaccines that are essential and appropriate for pregnant
women are highly encouraged.

12. Right timing. Choose the right time to become pregnant.

Readiness and preparation must be considered in getting
pregnant.
 LABORATORIES,
DIAGNOSTICS, SCREENING
PRENATAL VISITS

For a pregnant woman to be counted as provided with 4

prenatal

care, the schedule of prenatal care/visits should be at least:

• 1ST TRIMESTER – first 3 months (up to 12 weeks or 0-84

days)

• 2ND TRIMESTER – middle 3 months (13-27 weeks or 85-189

days)

• 3RD TRIMESTER - last 3 months (28 wks & more or 190

days & more)
 Urinalysis
A urinalysis is a test of your urine. A
urinalysis is used to detect and
manage a wide range of disorders,
such as urinary tract infections, pre-
eclampsia and gestational diabetes.

A urinary tract infection can make

urine look cloudy instead of clear.
Presence of protein in urine can be
a sign of pre-eclampsia.
• Unusual urinalysis results often
require more testing to uncover the
source of the problem.
 FECALYSIS
A stool analysis is a series of tests done on a stool
(feces) sample to help diagnose certain conditions
affecting the digestive tract. These conditions can
include infection (such as from parasites, viruses,
or bacteria), poor nutrient absorption among
pregnant women, or cancer.

The amount of stool to be sent depends on the

purpose for which the specimen is collected. Usually
about 2.5 cm (1 in.) of formed stool or 15 to 30 mL
of liquid stool is adequate.
 COMPLETE BLOOD COUNT
A complete blood count (CBC) is a blood test used to
evaluate your overall health and detect a wide range of
disorders, including anemia, infection and leukemia.

• A complete blood count test measures several

components and features of your blood, including:

• Red blood cells, which carry oxygen

• White blood cells, which fight infection

• Hemoglobin, the oxygen-carrying protein in red blood

cells

• Hematocrit, the proportion of red blood cells to the

fluid component, or plasma, in your blood

• Platelets, which help with blood clotting

 HUMAN IMMUNO
VIRUS
• During pregnancy, HIV can pass through the placenta
and infect the fetus.

• During labor and delivery, the baby may be exposed

to the virus in the mother’s blood and other fluids.
When a woman goes into labor, the amniotic sac
breaks (her water breaks). Once this occurs, the risk
of transmitting HIV to the baby increases. Most
babies who get HIV from their mothers become
infected around the time of delivery.

• Breastfeeding also can transmit the virus to the baby.

 BLOOD TYPING
• Blood typing is usually done during the first trimester (up to 12 weeks) or
the first prenatal visit. It is used to determine

• A pregnant woman's blood group, to establish whether she is A, B, AB, or

O, and whether she is Rh-positive or Rh-negative. A pregnant woman
should know her blood type.

• During pregnancy, problems can occur if you're Rh negative and the baby
you're carrying is Rh positive. Usually, your blood doesn't mix with your
baby's blood during pregnancy. However, a small amount of your baby's
blood could come in contact with your blood during delivery or if you
experience bleeding or abdominal trauma during pregnancy. If you're Rh
negative and your baby is Rh positive, your body might produce proteins
called Rh antibodies after exposure to the baby's red blood cells.
 Glucose Tolerance
Test
The glucose tolerance test, also known as the
oral glucose tolerance test, measures your body's
response to sugar (glucose). The glucose tolerance
test can be used to screen for type 2 diabetes.
More commonly, a modified version of the glucose
tolerance test is used to diagnose gestational
diabetes — a type of diabetes that develops
during pregnancy.

The glucose tolerance test identifies abnormalities in the way

your body handles glucose after a meal — often before your
fasting blood glucose level becomes abnormal.
 PREGNANCY TEST
• A pregnancy test measures a hormone in the
body called human chorionic gonadotropin
(HCG).

• HCG is a hormone produced during pregnancy. It

appears in the blood and urine of pregnant
women as early as 10 days after conception.

• HCG level should almost double every 48 hours

in the beginning of a pregnancy. HCG level that
does not rise appropriately may indicate a
problem with your pregnancy. Problems related
to an abnormally rising HCG level include
miscarriage and ectopic (tubal) pregnancy.
 Ultrasound
A prenatal or pregnancy ultrasound uses
sound waves to create a picture of your
baby on a screen. Pregnancy care
providers use it to check on the health of
your baby and detect certain pregnancy
complications. Most people have two
ultrasounds during pregnancy, but you
may have more if your provider feels it’s
medically necessary.
 IMMUNIZATION
• Generally, vaccines that contain killed (inactivated) viruses can
be given during pregnancy. Vaccines that contain live viruses
aren't recommended for pregnant women.

• Flu (influenza) shot. The flu shot is recommended for women

who are pregnant during flu season — typically November
through March. The flu shot is made from an inactivated virus,
so it's safe for both you and your baby. Avoid the influenza
nasal spray vaccine, which is made from a live virus.

• Tetanus toxoid, reduced diphtheria toxoid and acellular

pertussis (Tdap) vaccine. One dose of Tdap vaccine is
recommended during each pregnancy to protect your newborn
from whooping cough (pertussis), regardless of when you had
your last Tdap or tetanus-diphtheria (Td) vaccination. Ideally,
the vaccine should be given between 27 and 36 weeks of
pregnancy.
 TO AVOID
• Your health care provider will recommend
avoiding vaccines that contain live viruses
during pregnancy because they pose a
theoretical risk.
• Examples of vaccines to avoid during
pregnancy include:

• Chickenpox (varicella) vaccine

• Measles-mumps-rubella (MMR) vaccine
• Shingles (varicella-zoster) vaccine
General Health
Maintenance During
Pregnancy
 Schedule of Clinic
Visit
Should begin as soon as possible after
the first missed period. Subsequent clinic
visit for normal pregnancy are scheduled
as follows:

From first visit to 32 weeks – every 4

weeks

From 32 weeks to 36 weeks – every 2

weeks

From 36 weeks until delivery – every

 Exercises
Recommended exercise during
pregnancy:

1) Pelvic Rocking – relieves low

backache; strengthen the muscles of the
lower back
2) Squatting and Tailor Sitting –
stretch and strengthen perineal muscles;
improve circulation in the perineum
3) Rib Cage Lifting – relieves shortness
of breath
4) Calf Stretching – relieves leg
cramps
5) Shoulder Circling – relieve upper
backache and numbness of arms and
fingers
6) Abdominal Muscle Contractions –
strengthen abdominal muscles in
preparation for labor pushing
7) Modified Knee Chest – relieve
hemorrhoids, vulvar varicosities and low
backache
8) Leg Elevation – relieve swelling,
fatigue, varicosities of lower extremities

9) Leg Raising – relieve swelling,

fatigue, varicosities of lower extremities
10) Kegel exercise – strengthen
perineal muscles
 Clothing
Characteristic of good maternity clothes:

a) Light weight, non constrictive and loose fitting

b) Absorbent and washable because of increased

perspiration

c) Reasonably priced because they will be used only

during pregnancy.

d) Advise the woman to avoid using constricting

garters around the legs, abdomen and breasts.

e)Flat heeled shoes that provide good support are

recommended during pregnancy.
 Bathing
1) Encourage daily baths

2) Tub baths are discouraged

3) It is alright for the pregnant woman to

go swimming but Not diving

4) Bathing is contraindicated when there

is vaginal bleeding and after membranes
have ruptured
 Breast Care
1) Well fitted and larger sized brassiere is
recommended for the increased breast mass
and pendulous breast. Bras should provide
adequate support, with wide straps and deep
cups to prevent loss of breast tone.

2) If woman plans to breastfeed, nipple

rolling between thumb and forefinger and
drying of nipples with rough towel is
encouraged to help toughen the nipple.

3) Wash breast with water only.

 Immunizations
1) Immunizations with vaccines
containing live viruses is
contraindicated. Example of these
vaccines are: Measles (Rubella), Sabin
(Oral) poliomyelitis, Mumps

2) Hepa B vaccine is given only if risk

factors are present. Typhoid vaccine and
plague vaccine is given if there is
possibility of exposure or if the woman
will travel to endemic areas.
3) The immunization recommended to all pregnant
women in the Philippines is Tetanus Toxoid vaccine
given in the following schedule:

TT1 – anytime during pregnancy (usually on the

second trimester)

TT2 – One month after TT1

TT3 – six months after TT2

TT4 – one year after TT3

TT5 – one year after TT4

 Employment
1) Pregnant women can continue
working as long as their job does not
compromise the woman’s safety

2) Studies have shown that continued

employment during pregnancy resulted
in low birth weight infants
 Travel
There is usually no travel restrictions
during pregnancy but it is advised that
pregnant women avoid long trips on the
third trimester.

The best time to travel is on the second

trimester because the woman is most
comfortable at this time and there is
minimum danger of abortion and
preterm labor.
a) A 15 to 20- minute rest period every 2
hours on long rides to move about and
empty bladder

b ) Use of shoulder and lap belts should

be emphasized for safety

c ) The place should be pressurized,

exposure to low oxygen concentration at
high altitudes when traveling by non-
pressurized plane can cause fetal brain
damage
 Sexual Relations
1) Sexual desires continue during pregnancy but sexual
drive and responsiveness vary among women at different
stages of pregnancy:

First Trimester – decreased sexual desire due to

discomforts of pregnancy or due to preoccupation to the
changes occurring in her body.

Second Trimester – Increased sexual desire because the

woman has already adjusted to pregnancy and this is the
period when she is most comfortable.

Third Trimester – decreased sexual desire because of the

fear of hurting the fetus and the discomfort caused by
enlarged abdomen and deep penile penetration.
2) Contraindications to sexual
intercourse: Deeply presenting part,
rupture bag of water, vaginal spotting or
bleeding, incompetent cervical os

3) During the last 6 weeks of pregnancy,

coitus is discouraged by some physicians
because it has been related to increased
incidence of postpartal infection,
preterm labor, premature rupture of
membrane and bleeding
 Alcohol and Smoking

• Alcohol and smoking are contraindicated during

pregnancy

• Effects of alcohol are abortion and prematurity.

•Nicotine present in cigarettes causes

vasoconstriction resulting in decreased blood flow to
the placenta which in turn, diminishes oxygen supply
to the fetus. Fetal hypoxia leads to low birth weight.

•Smoking affects the appetite of the mother resulting

in decreased caloric intake which in turn leads to
limited maternal weight gain.
CARE OF THE FETUS
Stages of Fetal
Development
 Fertilization
• The union of the sperm and ova
Ovum – from ovulation to fertilization

Zygote – from fertilization to implantation

Blastocyst – 32 cell stage zygote

Embryo – from implantation to end of 7 weeks

Fetus – from 8 weeks until term

Conceptus – developing embryo or fetus and

placental structures throughout pregnancy
 Implantation
Hartman’s sign
- Vaginal bleeding on implantation
• IS THE UNION OF THE OVUM AND THE
SPERMATOZOA

OTHER TERMS:

• Conception, Impregnation, or Fecundation

• It occurs in the outer third of the fallopian tube

( ampullar portion )

• Functional life of spermatozoon is about 48 hours,

possibly as long as 72 hours

• Total critical time for fertilization is 72 hours ( 48

hours before ovulation plus 24 hours afterwards)
After ovulation, the ovum is extruded from the
graafian follicle, it is surrounded by a ring
mucopolysaccharide fluid (Zona pellucida)
and the circle of cells (Corona radiata)

These structures increase the bulk of the

ovum, facilitating its migration to the uterus.

FIMBRIAE – the fine, hairline stuctures that line

the openings of the fallopian tubes.
 Peristaltic action of the tube and and movement of the
tube cilia help propel the ovum along the length of the
tube.

Fertilization occurs after 24 hours or 48 hours the most.

Ovum atrophies and becomes non-functional after.

Amount of normal Semen:

2.5 ml ---- 50 to 200 Million/ml

Average of 400 Mil /ejaculation

During ovulation

There is a reduction in viscosity

( thickness) of the cervical mucus, making it
easier for the sperm to penetrate.

Sperm transport is so efficient close to

ovulation that spermatozoa deposited in the
vagina during intercourse generally reach
the cervix within 80 seconds and outer
fallopian tube within 5 minutes deposition.
 CAPACITATION
SPERMATOZOA:

Moves by means of flagella (tail)

CAPACITATION - The final process that

sperm must undergo to be ready for
fertilization.

Happens when sperm move toward the

ovum, consist of changes in the plasma
membrane of the sperm head, which reveals
the sperm binding receptor
All spermatozoa achieved capacitation reach
the ovum and cluster around the protective
layer of corona cells.

HYALURONIDASE – (proteolytic enzyme) is

released by sperm and acts to dissolve the
layer of cells protecting the ovum.

Only one spermatozoa is able to penetrate

the cell membrane of the ovum
• After penetration, the chromosomal material
of the ovum and spermatozoon fuse into
ZYGOTE
• 23 + 23 chromosomes ( sperm and ovum) =
46 . 22 autosomes + 1 sex chromosomes.

• X- carrying spermatozoon enters the ovum,

will have XX ( female child)
• Y- carrying spermatozoon enters the ovum,
will have XY ( male child)
 FACTORS TO ACHIEVE
FERTILIZATION
• Maturation of both sperm and ovum

• The ability of sperm to reach the ovum

• The ability of the sperm to reach zona pellucida

and cell membrane

ACCESSORY STRUCTURES TO SUPPORT INTRAUTERINE

LIFE:

Placenta, fetal membranes, amniotic fluid,

umbilical cord
 IMPLANTATION
The ZYGOTE migrates toward the body of the
uterus, aided by the contractions of the
fallopian tube (3 to 4 days)

CLEAVAGE (mitotic cell division) occurs.

First cleavage occurs at about 24 hours -------

continue to occur every 22 hours ------the time
the Zygote reaches the body of the uterus, it
consists of 16 to 50 cells --------- becomes
bumpy appearance is termed MORULA
( morus, meaning mulberry).
--- Morula continues to multiply as it floats
free in the uterine cavity for 3 to 4 days.
---------- Blastocyst, attaches to the
uterine endometrium------Trophoblast cells,
the cell in the outer ring ( will later form
placenta and membranes).

IMPLANTATION, contact between the

growing structure and uterine
endometrium, occurs approximately 8 to
10 days.
 Process of
Implantation
• Apposition – blastocyst brushes against
the uterine endometrium

• Adhesion – blastocyst attaches to the

surface of the endometrium

• Invasion – blastocyst settles down into

the endometrium’s soft fold
--- Morula continues to multiply as it
floats free in the uterine cavity for 3 to 4
days. ---------- Blastocyst, attaches to
the uterine endometrium------Trophoblast
cells, the cell in the outer ring ( will later
form placenta and membranes).

IMPLANTATION, contact between the

growing structure and uterine
endometrium, occurs approximately 8 to
10 days.
• The blastocyst is able to invade the
endometrium because as the
trophoblast cells on the outside of the
structure touch the endometrium, they
produce proteolytic enzyme that
dissolve the tissue they touch.
• The touching or implantation point is
usually high in the uterus, on the
posterior surface. If the point of
implantation is low, the growing
placenta may occlude the cervix and
make birth of the child difficult
( placenta previa)
 EMBRYONIC AND FETAL
STRUCTURES
After fertilization, the corpus luteum in
the ovary continues to function rather
than to atrophy because of the influence
of HCG secreted by the trophoblast cells.

The endometrium is now called

DESIDUA (means falling off)
• The placenta and membranes, which will serve
as the fetal lungs, kidneys, and digestive tract
in utero as well as help provide protection for
the fetus, begin growth in early pregnancy in
coordination with embryo growth.

PREPLACENTAL PHASE
• The endometrium is now typically termed the
decidua (the Latin word for “falling off”)
because it will be discarded after birth of the
child.
 DECIDUAS
DESIDUA part of the endometrium that lies directly
BASALIS under the embryo (or the portion where the
trophoblast cells are establishing
communication with maternal blood
vessels).

DECIDUA the portion of the endometrium that stretches or

CAPSULARI encapsulates the surface of the trophoblast
S

DESIDUA remaining portion of the uterine lining

VERA
 CHORIONIC VILLI
• As early as the 11th or 12th day after
fertilization, miniature villi, resembling probing
fingers and termed chorionic villi, reach out
from the trophoblast cells into the uterine
endometrium to begin formation of the
placenta. Chorionic villi have a central core
consisting of connective tissue and fetal
capillaries surrounded by a double layer of
cells, which produce various placental
hormones, such as hCG, somatomammotropin
(human placental lactogen [hPL]), estrogen,
and progesterone.
 PLACENTA
• a Fleshy, disk-like organ, 15- 20cm in
diameter, 2-3 cm in thickness, weighs
400 -600 grams @ term. It formed
through the union of the chorionic villi
(fetal) and decidua basalis (maternal)
on the 12th day.
 PLACENTAL
PRESENTATIONS:
 FUNCTIONS OF
PLACENTA
METABOLIC FUNCTIONS:
Respi- Gastro-
ratory Renal intestinal Skin Liver
System System System

Nutrition
Excretion & storage Detoxificat
Transfer of of wastes; – active ion of Transmi-
gases – Detoxified transport Transfer of some ssion of
diffusion in the Transport heat drugs & maternal
mother’s of chemicals antibodies
liver nutrients
ENDOCRINE GLAND
– Hormone production: HcG, hPL, progesterone, estrogens

• HcG

• - first placental hormone

- suppress maternal immunologic response so placental
tissue is not detected and rejected as foreign substance
- in male fetus, exerts an effect on the fetal testes to
begin production and maturation of Testosterone
• Progesterone

• - hormone that maintains pregnancy

- maintains the endometrial lining of the uterus during
pregnancy
- reduces the contractility of the uterus during
pregnancy, thus preventing premature Labor

• Estrogen

• - contributes to woman’s mammary gland development -

stimulates uterine growth
 PLACENTAL
DEVELOPMENT
• At time of implantation two (2) fetal membranes surround the developing
fetus

1. CHORION

2. AMNION

• PURPOSES:

• Encloses the fetus and the amniotic fluid

• Protects the fetus against ascending bacterial infection.

• Woman is prone to develop infection if integrity of the membranes are

destroyed.
CHORION / CHORIONIC MEMBRANE

- Develops from the trophoblast

- Originates from the portion of the chorionic villi

(Contains the chorionic villi → Burrows into decidua

basalis; Fetal side of the placenta (CHORION
FRONDOSUM – LEAFY CHORION)
Contains the major umbilical blood vessels CHORION
LAEVE (BALD CHORION)- Smooth membrane which
degenerates as embryo grows, chorionic villi atrophies &
decidua capsularis stretches

- Supports the amniotic membrane

AMNION / AMNIOTIC MEMBRANE

- Inner cell membrane develops from the interior

cells of the blastocyst; smooth glistening thin,

tough, and translucent membrane directly enclosing

the fetus and the amniotic fluid.

- Covering of the umbilical cord and the chorion on

the fetal surface of the placenta and umbilical cord

- Eventually comes in contact with the chorion

surrounding the fetus
** The amniotic membrane not only
offers support to amniotic fluid but also
actually produces the fluid. In addition, it
produces a phospholipid that initiates
the formation of prostaglandins, which
can cause uterine contractions and may
be the trigger that initiates labor
 AMNIOTIC
CAVITY
- Develops between the inner cell mass
& outer layer of cells (trophoblast) .
- Fetus floats & moves
- At full term, normally contains from
500ml to 1200ml of liquor amnii or “the
waters”. - Derives its fluid by diffusion
from maternal blood
 AMNIOTIC
FLUID
• Clear and colorless to straw, slightly yellowish color; non-
foul odor.
- 1st half of pregnancy – similar in composition to maternal
plasma with a lower protein concentration
- Fetus begins to urinate after the 10th week of pregnancy,
fetal urine contributes to the volume of amniotic fluid
Late in pregnancy – fetal urine excretion, absorbs amniotic
fluid thru GIT by swallowing fluid
• Responsible for absorbing nutrients & O2 from maternal
blood stream & disposing of fetal waste products (CO2)
• Increased weekly – 500 -1200 ml from first trimester

• Decreased on the 38th week until term

AMNIOTIC FLUID’S Composition:

- 98% water and 1-2 % organic & inorganic

- solid particles

- albumin, urea, uric acid, leukocytes, enzymes,

- creatinine, lecithin, sphingomyelin, CHON,

- lanugo, bilirubin, fructose, fat, epithelial cells,

- phospolipids and vernix caseosa.

Oligohydramnios Hydramnios
300 ml (fetal renal 2L (GIT & other malformations)
abnormalities)
Associated with poor fetal lung Fetus has a severe
development malformations malformation of the CNS or GIT
that results from compression that prevents normal ingestion
of fetal parts. of amniotic fluid
May occur because the kidneys
fail to develop, urine excretion
is blocked, or placental blood
flow is inadequate
AMNIOTIC FLUID’s Functions:
1. Protects the fetus from trauma, blows and pressure by
blunting & dispersing the forces.

2. Allows freedom of movement for symmetrical musculoskeletal

system growth and development; prevents from tangling with
the membrane.

3. Acts as an excretion and secretion system; source of oral fluid

& repository for waste.

4. Maintain a constant, even temperature.

6. Aids in diagnosis of maternal and fetal complications.

7. Aids fetal descent during labor by providing lubrication

in the birth canal.

8. During labor, if the membranes are intact, the amniotic

fluid protects the fetus from uterine

9. contractions.

10.It also aids in effacement and dilatation of the cervix

11.Prevents pressure on the cord.

AMNIOTIC FLUID Color’s indications:

Green tinged or meconium stained amniotic fluid

in non-breech presentation = fetal distress.
Golden = hemolytic disease such as Rh or ABO
incompatibility
Gray = infection.

YOLK SAC – 8-9 days after implantation

Membrane surrounding the blastocyst cavity

formed on either side of the developing
embryonic disk.
Functions:

Helps transfer maternal nutrients & O2

by diffusion through the chorion (embryo
while

uteroplacental circulation is being

established.

Forms early blood cells until hemopoeitic

activity begins in the liver
 UMBILICAL CORD
- Lifeline (circulatory pathway) linking the
embryo & the chorionic villi of the placenta
which extends from the umbilicus to the fetal
portion of the placenta

Function

1. Transport oxygen and nutrients to the fetus

from the placenta and to return waste products
from the fetus to the placenta
- length at term– 50-55cm,diameter– 2 cm (3⁄4
in), location – centrally
Contains:
*One vein
- carries blood, nourishment & oxygenated blood from the
placental villi to the fetus
*Two arteries
- The amino and the chorion does not have nerve supply and
blood vessels so the mother neither the fetus experience pain
when they rupture.
- Take waste products from fetus to placenta to be excreted by
the mother
- Return deoxygenated blood to placenta
* Wharton's jelly

Transparent, bluish white gelatinous substance

(mucopolysaccharide) – gives the cord body and
prevents compression of the blood vessels to
ensure continued nourishment of the embryo-
fetus.

A loose connective tissue containing a cushioning

material & prostaglandin vasoconstrictive effect –
carries blood, nourishment & oxygenated blood
from the placental villi to the fetus
ORIGIN AND
DEVELOPMENT OF
ORGAN SYSTEMS
 PRIMARY GERM LAYERS
Ectoderm = Outer layer Mesoderm = Middle Layer Endoderm = Inner Layer

Nervous system Bones and muscle Lining of digestive tract

including tissue, Lining of trachea,
brain, spinal cord and cartilage bronchi, and lungs
peripheral nervous Heart, blood and blood Liver, pancreas
system, pituitary gland, vessels Thyroid, parathyroid,
nerves, Lining of the Reproductive and thymus, urinary bladder,
mouth, nostrils, and excretory systems urethra, ear canal, and
anus, sensory Inner layer (connective tonsils
epithelium of the eye, tissue dermis) of skin
ear, and nose Epidermis Lymphatic system,
of skin, sweat glands, spleen, kidneys, adrenal
hair, nails Subcutaneous cortex, and lining
glands, mammary membranes (pericardial,
glands and tooth pleural, peritoneal).
enamel.
All organ systems are complete, at least in a
rudimentary form, at 8 weeks gestation (the
end of the embryonic period). During this
early time of organogenesis (organ
formation), the growing structure is most
vulnerable to invasion by teratogens (i.e.,
any factor that affects the fertilized ovum,
embryo, or fetus adversely, such as a
teratogenic medicine; an infection such as
toxoplasmosis; cigarette smoking; or
alcohol ingestion).
CARDIOVASCULAR SYSTEM

The cardiovascular system is one of the

first systems to become functional in
intrauterine life. Fetal circulation differs
from extrauterine circulation because
the fetus derives oxygen and excretes
carbon dioxide not from gas exchange in
the lungs but from exchange in the
placenta.
At the third week of intrauterine life, the
respiratory and digestive tracts exist as
a single tube. By the end of the fourth
week, a septum begins to divide the
esophagus from the trachea. At the
same time, lung buds appear on the
trachea.
RESPIRATORY SYSTEM
• Other important respiratory developmental milestones include:

• • Spontaneous respiratory practice movements begin as early as 3

months gestation and continue throughout pregnancy.
• Specific lung fluid with a low surface tension and low viscosity
forms in alveoli to aid in expansion of the alveoli at birth; it is
rapidly absorbed shortly after birth.

• • The alveolar cells of the lungs forms and excretes a phospholipid

substance called surfactant approximately at the 24th week of
pregnancy. This decreases alveolar surface tension on expiration,
preventing alveolar collapse and improving the infant’s ability to
maintain respirations in the outside environment at birth.
NERVOUS SYSTEM
The nervous system begins to develop extremely early in
pregnancy.
All parts of the brain (cerebrum, cerebellum, pons, and medulla
oblongata) form in utero, although none are completely mature
at birth. Brain growth continues at high levels until 5 or 6 years
of age.
• Brain waves can be detected on an electroencephalogram
(EEG) by the eighth week.
• The eye and inner ear develop as projections of the original
neural tube.
• By 24 weeks, the ear can respond to sound, and the eyes
exhibit a pupillary reaction, indicating sight is present.
ENDOCRINE SYSTEM

The function of endocrine organs begins along with

neuro-system development.
• The fetal pancreas produces insulin needed by the
fetus (insulin is one of the few substances that does
not cross the placenta from the mother to the
fetus).
• The thyroid and parathyroid glands play vital roles
in fetal metabolic function and calcium balance.
• The fetal adrenal glands supply a precursor
necessary for estrogen synthesis by the placenta.
DIGESTIVE SYSTEM

The digestive tract separates from the

respiratory tract at about the fourth week of
intrauterine life and, after that, begins to
grow extremely rapidly. Initially solid, the
tract canalizes (hollows out) to become
patent. Later in the pregnancy, the
endothelial cells of the gastrointestinal tract
proliferate extensively, occluding the lumen
once more, and the tract must canalize again.
MUSCULOSKELETAL SYSTEM

During the first 2 weeks of fetal life,

cartilage prototypes provide position and
support to the fetus. Ossification of this
cartilage into bone begins at about the
12th week and continues all through
fetal life and into adulthood.
REPRODUCTIVE SYSTEM

A child’s sex is determined on

conception by a spermatozoon carrying
an X or a Y chromosome and can be
ascertained as early as 8 weeks by
chromosomal analysis or analysis of fetal
cells in the mother’s bloodstream. At
about the sixth week after implantation,
the gonads (i.e., ovaries or testes) form.
URINARY SYSTEM

Rudimentary kidneys are present as

early as the end of the fourth week of
intrauterine life, the presence of kidneys
does not appear to be essential for life
before birth because the placenta clears
the fetus of waste products. Urine,
however, is formed by the 12th week
and is excreted into the amniotic fluid by
the 16th week of gestation.
INTEGUMENTARY SYSTEM

In the earlier weeks of pregnancy, the

skin of fetus appears thin and almost
translucent. Approximately at the 36th
week of pregnancy, subcutaneous fat
begins to be deposited underneath. Soft
lanugo and vernix caseosa cover the
skin, both are still present at birth.
FETAL
DEVELOPMENT
(Estimating Fetal health,
growth etc.)
 FIRST LUNAR MONTH
(End of 4 week)

•Heart chambers formed, heart Begin to

beat as early as 14th day

•Cartilage formation
•Arm and leg buds present
•Primary lung buds appear
•Length is 4 to 5 mm ; weighs .4 gm
•Nervous system appears by the 3rd
week
 TWO LUNAR MONTHS
(End of 8 weeks)
•Head is large compare to trunk
•External genitalia,Testes and ovaries
are distinct but sex not yet distinguishable By
simple observation (8 wks)
•Amniotic fluid surrounds embryo
•Assumes a human form
•Gestational sac visible at UTZ
•Capable of some movements but

too faint to be felt by the mother

Length: 2.5 cm (1inch)/Weight :2gms
•Organogenesis is complete
•Meconeum is formed by 5th to 8th
week visible on UTZ
 THREE LUNAR MONTHS
(End of 12 week)
•Fingers and toes have nails
•Kidney begins to secrete urine, although
may not be evident in the Amniotic fluid
•Sucking reflex, Babinski reflex are present
• By 12 weeks fetus moves body parts,
swallows and practices inhaling and exhaling
but too faint to be felt by the examiner
•FHT audible by doptone/doppler
•Sex is distinguishable by outward
appearance •Tooth buds are present
•Ossification in most bones
 Four Lunar Months
(End of the 16 weeks)
•Sex can be identified at 14 weeks by UTZ (sex
differentiation) •Fetal heart tone heard by
fetoscope/Stethoscope
•Length : 10 to 17 cm
•Weight : 55-120 gms

•Lanugo (fine and downy hair on the back and arms of

the newborns,
Which apparently serves as insulation of body heat) is
well formed

•Amniocentecis is possible by 14-16 weeks (200 ml of

amniotic fluid is present)
 Liver and pancreas are functioning
•Fetus actively swallows amniotic fluid,
but uncoordinated
•Urine is present in the amniotic fluid
•Meconium in bowel
•Scalp hair develops
•Buds of permanent teeth form
 FIVE LUNAR MONTHS
(End of 20 weeks)
•Brown fat begin to form behind the kidneys, sternum,
and

posterior neck
•Spontaneous fetal movements can be sensed by the
mother
•Quickening (first fetal movement felt by the mother)
•Heart rate audible
•Bones hardening

•Length : 16-18.5 cm : weighs 300 gms

•Vernix and lanugo covers entire body with some scalp
hair visible
 SIX LUNAR MONTHS
(End of the 24 weeks)
•Skin is red and wrinkled with some
subcutaneous fat beneath
•Surfactant production begins
•Start of fetal vibility

•Length : 28 to 36 cm/ weight : 550 gms

•Passive transfer of antibodies from mother
to fetus (begins at 20th week)
•Meconium is present as far as the rectum
•Hearing can be demonstrated by response
to sudden sound
SEVEN LUNAR MONTHS
(End of 28 weeks)
•An infant born at this time moves his
extremities quite actively and cries weakly. If
given an expert care, the immature infant has a
high chance for survival

•Length : 35 to 38 cm/weight : 1, 200 gms

•Lung alveoli begin to mature, and surfactant
can be demonstrated in amniotic fluid
•Testes begin to descend into the scrotal sac
from the lower abdominal cavity
•Body less wrinkled
•Appearance of nails
 EIGHT LUNAR MONTHS
(End of the 32 weeks)
•Infants born at this time usually survive if
given proper care •Length : 38-43 cm/weight :
1,600 gms
•Subcutaneous fats are present (“Little old
man” appearance is lost) •Assumes delivery
position (vertex or breech)

•Responds by movement to sounds outside

the mother’s body •Active Moro reflex present
•Skin is pink and slightly wrinkled
•LS ratio in lungs now 1.2:1
 NINE LUNAR MONTHS
(End of 36 weeks)
•Body round, skin is pink and smooth
•L/S ratio is 2:1
•Lanugo begins to diminish
•Length is 42-48; weight 2200-2900gms
•Additional amounts of SQ fats are deposited
•Sole of the foot has only one or two crisscross
creases
•Most babies turn into a vertex or head-down
presentation during

this month
•Definite wake/sleep cycle
THANK YOU AND GOD
BLESS …..