newborn Average birth length(BL): 50cm

measuring of the length (supine) until 2yrs

Expected upper body/lower body ratio (UB:LB): 1.7
3 to 4 mos Expected weight gain: 20g/day
4 mos Expected weight gain: doubled BW
1 yr Expected weight gain: tripled BW
Expected length increase: BL +50% increase
Start measuring head circumference until 3 yrs
13 months no teeth = delayed eruption
2 yrs start measuring of height (upright) from length (supine)
3 yrs Expected UB:LB : 1.3
Stop measuring head circumference
7 yrs Expected UB:LB : 1

GROWTH PARAMETERS
Weight acute episodes of ill health & nutritional status
Length/Height skeletal growth
UB:LB short limb dwarfism or bone disorders
Head Circumference brain growth
 routinely measured in the 1st 3 yrs
 supraorbital ridge to the most prominent
part of the occiput
Chest Circumference chest pathologies
 in the 1st 3 yrs
 mid-inspiration: xiphoid notch
OTHER GROWTH PARAMETERS
Mid-arm amount of body fat
circumference
Triceps skinfold
thickness
Skeletal maturation Bone age = sexual maturity than chronological age
Dental development
Mineralization PRIMARY: 2nd trimester to 3 years
PERMANENT: up to 25 years
Eruption begins with central incisors then laterally
 the truly atypical granular cells
VAGINA
UTERUS
1. Increased vascularity & hyperemia in the vulvar skin & muscles,
1. Enlargement softening of the underlying connective tissue
Stimulus - <12 weeks: estrogen & progesterone Chadwick Sign - violaceous vagina (& cervix)
- >12 weeks: mechanical distention - due to the increased vascularity
Effects  pear-shaped to ovoid (at the end of 12th wk) 2. Vaginal Wall Changes:
 dextrorotation (due to the rectosigmoid) a. Epithelial thickening
2. Contraction b. Connective Tissue Loosening
Braxton Hicks - increase in frequency during last 2 weeks of c. Smooth Muscle hypertrophy
Contractions pregnancy
Stimulus  Estrogen - makes it contract SUMMARY OF SIGNS DURING PHYSICAL EXAMINATION
 Progesterone - stops contractions in the GENITAL REGION
 Ca2+, PGE2, PGF2α Hegar Sign 4-6 softening of the isthmus,
 ANS Hey cougar = soft weeks replacing it to be the LUS
but to be replaced
3. Isthmus Softening
Hegar Sign - softening of the isthmus, replacing it to be Goodell Sign 4 weeks softening of cervix
the lower uterine segment Chadwick Sign 6 weeks cyanosis of the cervix & vagina
UTEROPLACENTAL BLOOD FLOW Beading -poor crystallization of mucus
 UPBF:  UPBF:
Beads are PRO- -due to progesterone
poor
o vasodilation o uterine contractions Ferning -arborization of ice-like crystals
 estrogen o vasoconstriction -indicative amniotic leakage
 progesterone  nicotine
 relaxin  catecholamines BREASTS
o vasodilation &  peripheral  1. Sensation
resistance  tenderness - during the early pregnancy
 NO  parasthesias
 PIGF
2. Appearance
 VEGF
 Enlarged - after the 2nd month
 estrogen
 Visible veins
CERVIX  Nipples
- larger
1. Increased vascularity & Edema
- deeply pigmented
2. Changes in collagen network - induced by estrogen & progesterone
- more erectile
3. Hypertrophy & hyperplasia of the cervical glands
3. Secretion of Colostrum
Goodell sign softening of cervix
Colostrum - during the 1st few months*
Chadwick Sign cyanosis of the ectocervix (& vagina) - thick, yellowish fluid
4. Gland proliferation - can be expressed by gentle massage
Eversion - extension of the proliferation columnar 4. Changes in the Areola:
endocervical glands onto the ectocervical a. Broadening and Deep Pigmentation
portion b. Appearance of glands of Montgomery
- causes the red velvety appearance glands of Montgomery - hypertrophic sebaceous glands
- vulnerable to bleeding even with minor - small elevation scattered through the
trauma areola
5. Mucus Secretion Gigantomastia - pathological enlargement of breasts
Mucus plug - produced by endocervical mucus cells - requires postpartum surgical
- obstructs the cervical canal soon after reduction
conception - may result into skin striae
- rich in immunoglobulins & cytokines, acting *Pre-pregnancy breasr size & volume of milk production do not
as a protection against infection correlate
- when expelled: bloody show
6. Mucus Consistency SKIN
Beading -poor crystallization on microscopical exam 1. Changes in the abdominal wall
Beads are PRO- poor -due to progesterone Striae gravidarum -
Ferning -arborization of ice-like crystals on Diastasis recti -
microscopical exam 2. Hyperpigmentation
-indicative amniotic leakage Linea nigra -
7. Others Chloasma - Melasma gravidarum
Basal Cells -prominent in size, shape, and staining quality
proliferation at -induced by estrogen 3. Vascular Changes
the SCJ Vascular spiders - Angioma
Arias-Stella -endocervical gland hyperplasia & Palmar erythema -
reaction hypersecretory appearance
4. Hair Changes
-in Pap test: makes it difficult to differentiate
 Telogen effluvinum -
METABOLIC CHANGES KIDNEYS
1. Weight Gain 1. Increase in Size
2. Increased Water Retention 2. Increase in GFR
Pitting edema Factors 1. Hypervolemia-induced hemodilution
3. PROTEIN METABOLISM - lowers protein concentration &
4. CARBOHYDRATE METABOLISM oncotic pressure of plasma entering
Mild fasting the glomerular microcirculation
hypoglycemia 2. Increase in RPF
Postprandial Effect  Urinary frequency
hyperglycemia  nocturia
Hyperinsulinemia 3. Increase in RPF
5. FAT METABOLISM (but declines during late pregnancy)
a. Increased Plasma concentrations of: 4. Reversal of Hemodilution & hypervolemia by the 2nd week
 Lipids postpartum
 Lipoproteins RENAL FUNCTION TESTS
 Apolipoproteins 5. Decline in serum creatinine levels
b. Maternal hyperlipidemia Normal range 0.7 to 0.5 mg/dL
 Increased insulin resistance & Estrogen stimulation
c. Maternal Fat Accumulation Pathologic > 0.9 mg/dL
 1st two trimesters 6. Increase in creatinine clearance
 Augmented lipid synthesis & food intake 7. Glucosuria – normal
d. Decline/Cease of Fat Storage 8. Hematuria
 3rd trimester 9. Proteinuria
 enhanced lipolytic activity
Factors  Gestational age corresponding with peak
 Decreased lipoprotein lipase activity
of GFR
Pathologic > 300 mg/dL
HEMATOLOGICAL CHANGES
1. Hypervolemia
GIT
functions 1. meets the metabolic demands of the
enlarged fetus & its greatly 1. Displacement of stomach, appendix, & intestines
hypertrophied vascular syste 2. Pyrosis (heart burn)
2. provides abundant nutrients and Cause Reflux acid secretion
elements to support the rapidly growing  Altered stomach position
placenta and fetus  Decreased tone of the lower esophageal
3. protects the mother and fetus against sphincter
effects of impaired venous return in the  Lowered intraesophageal pressure
supine and erect positions  Increased intragastric pressure
4. safeguards mother against parturition-  Low-wave speed & amplitude of the
associated blood loss Esophageal peristalsis
-1st trimester: accrues 3. Unchanged gastric emptying time (but prolonged during labor)
-midtrimester: rapidly expands 4. Hemorrhoids
-3rd trimester: slows down
-Plateau: last several weeks of pregnancy
Factors  multiples (twins) accrues more
dramatically
 relaxin
Events  Increase in blood volume:
- Increase in plasma volume & RBCs
but plasma volume > RBCs
 Decrease in Hct & Hgb
- Whole blood viscosity decreases
Differential -develops in H mole as well
 ESTROGEN PROGESTERONE
- Contractility of uterus - Relaxation of uterus
- Colostrum production - Beading of cervical mucus
- Hypervolemia - Increased lipid accumulation
- Epulis (hyperemia of gums) - Physiologic dyspnea PELVIC ADEQUACY
EDM IsSsS SB
- Decreased vascular resistance - Heartburn or pyosis
INLET 1. (+) Engagement
- Decreased HCl secretion in - Decreased tone of lower What is in? - biparietal diameter passed the linea terminalis
stomach esophagus - EDM
2. Diagonal Conjugate ≥12cm
- Intrahepatic cholestasis - Decreased GI motility
3. Müller-Hillis maneuver
- Pruritus gravidarum - Decreased gallbladder
- pushing of the fundus downward
- Hypertrophy of Anterior contractions
- head reaches ischial spine
Pituitary - Formation of gallstones
- Angioma or Spider Veins - Anti-mineralocorticoid effects, MIDPELVIS 1. Ischial spine Prominence
- mid isss - Interspinous diameter ≥10cm
- Palmar erythema so decreased Aldosterone adequate
- Increased TBG 2. Pelvic side walls Convergence
3. Sacral curvature
BOTH OUTLET 1. Subpubic arch >90°
- increased size of uterus before 12 weeks AOG SB (starbucks) 2. Bituberous diameter ≥8cm
outlet!
- Hyperpigmentation
- Carbohydrate metabolism patterns
PELVIC INLET
- Lipolysis
- Coagulation and fibrinolysis AP Diameter 1. True Conjugate >10 cm
- Vessel remodeling 2. Obstetric Conjugate 10 cm
- Vasodilatation = DC – 1.5
or
= DC – 2.0
3. Diagonal Conjugate 12 cm
Congenital T.O.R.C.H. - measured clinically
malformation Toxoplasmosis Transverse 13 cm
Other: SVP Diameter
Syphilis MIDPELVIS
Varicella
Interspinous >10 cm
Parvovirus
Diameter
Rubella
AP Diameter ≥11.5 cm
Cytomegalovirus
of the
Herpes
Midpelvis
PELVIC OUTLET
Subpubic arch
Bituberous
diameter
CANDIDIASIS AP Diameter
Whitish curdlike Nystatin
Candida albicans of the Pelvic
TRICHOMONIASIS Outlet
Trichomonas Frothy yellow Metronidazole Transverse
vaginalis Diameter of
Tinidazole the Pelvic
BACTERIAL VAGINOSIS Fishy
or Clindamycin Outlet
Neisseria gonorrhoea
mucopurulent Cefixime + Azithromycin
GONORRHEA

AP Diameter
of the Pelvic
Outlet
Week 10-11 Swallowing
 PARTURITION
Phase 1 Uterine Quiescence & Cervical Softening
 36 to 38 weeks Every 1
 early stage of cervical remodeling yet maintaining
structural integrity SAMPLEX BASED Learning
 Braxton Hicks contractions
- low-intensity 1. Obstetrical Score
- do not cause cervical dilatation
 actions of estrogen and progesterone via
Gravidity # of pregnancies

intracellular receptors Parity # of pregnancies reaching 20 weeks

not increased with multiples (twins…)
 myometrial-cell plasma membrane receptor-
Full 37 weeks (early term)
mediated increases in cyclic adenosine 39 weeks (full term)
monophosphate (cAMP) 41 weeks (late term)
 generation of cyclic guanosine monophosphate Premature
(cGMP) Abortion H mole, etc.
 other systems, including modification of Living
myometrial-cell ion channels
Phase 2 Activation/ Uterine Awakening 2. Trimesters
 Progesterone withdrawal 1st Trimester … 14 weeks
 Lightening
2nd Trimester … 28 weeks
 cervical ripening
3rd Trimester …42 weeks
Myometrial and cervical changes
Phase 3 Labor
3. Trimesters
1st STAGE Onset  bloody
of LABOR show
 effacement
 dilation
Latent Variable & sensitive
to extraneous factors
- sedation prolongs this phase
- myometrial stimulation
shortens it
Active
 ACCELERATION
 PHASE OF MAXIMUM SLOPE
 DECELERATION
2nd STAGE Fetal Descent & Delivery
rd
3 STAGE Placenta & Membranes
Delivery
1st hour Postpartum
Phase 4
Involution

CARDINAL MOVEMENTS OF LABOR (EDFIrE ErE)

Engagement - @ station 0
- nulliparas: 38 weeks
multiparas: onset of labor
Asynclitism
Descent onset of 2nd stage of ;anpr
Flexion suboccipitobregmatic diameter
Internal Rotation turning of head towards the symphysis pubis
LOT  LOA (45°)or OA (90°)
Extension *push only when at 10 cm dilation
External Rotation restitution
Expulsion

INTRAPARTUM FETAL HEART MONITORING

1st Stage of Labor check immediately after a contraction
(every 30 minutes)
2nd Stage of Labor every 15 minutes