Female Reproductive System
characteristics in females.
2. Fallopian Tubes
Internal Structures
1. Ovaries
● The ovaries are the ultimate
life-maker for the females.
● For its physical structure, it
has an estimated length of 4
cm and width of 2 cm and is
1.5 cm thick. It appears to be
shaped like an almond. It
looks pitted, like a raisin, but
is grayish white in color.
● It is located proximal to both
sides of the uterus at the
lower abdomen.
● For its function, the ovaries
produce, mature, and
discharge the egg cells or
ova.
● Ovarian function is for the
maturation and maintenance
of the secondary sex
● It also has three divisions: the
protective layer of epithelium,
the cortex, and the central
medulla.
● Manufactures estrogen and
progesterone.
● Role when pregnant, none
since they are relaxed and
dormant.
● The fallopian tubes serve as
the pathway of the egg cells
towards the uterus.
● It is a smooth, hollow tunnel
that is divided into four parts:
the interstitial, which is 1 cm
in length; the isthmus, which
is2 cm in length; the ampulla,
which is 5 cm in length; and
the infundibular, which is 2 cm
long and shaped like a funnel.
● The funnel has small hairs
called the fimbria that propel
the ovum into the fallopian
tube.
● The fallopian tube is lined
with mucous membrane, and
underneath is the connective
tissue and the muscle layer.
● The muscle layer is
responsible for the peristaltic
movements that propel the
ovum forward.
● The distal ends of the
fallopian tubes are open,
making a pathway for
conception to occur.
● Site of fertilization- in the
course of the outer half or
outer 3rd of the fallopian tube.
(ampulla)
 ● Responsible for transport of
mature ovum.
3. Uterus
● The uterus is described as a
hollow, muscular,
pear-shaped organ.
● It is located at the lower
pelvis, which is posterior to
the bladder and anterior to
the rectum.
● The uterus has an estimated
length of 5 to 7 cm and width
of 5 cm. it is 2.5 cm deep in
its widest part.
● For non-pregnant women, it is
approximately 50- 60g in
weight.
● Its function is to receive the
ovum from the fallopian tube
and provide a place for
implantation and
nourishment.
● It also gives protection for the
growing fetus.
● It is divided into three: the
body, the isthmus, and the
cervix. f
● The body forms the bulk of
the uterus, being the
uppermost part. This is also
the part that expands to
accommodate the growing
fetus.
● The isthmus is just a short
connection between the body
and the cervix. This is the
portion that is cut during a
cesarean section.
● Cervix- lies halfway above
the vagina, and the other half
extends into the vagina. It has
an internal and external
cervical os, which is the
opening into the cervical
canal.
● Myometrium, endometrium,
and perimetrium.
4. Fundus
- Intensity of contraction when labor
- Fundal pressure.
External Structures
1. Mons Veneris/ Pubis
● The mons veneris is a pad of
fat tissues over the symphysis
pubis.
● It has a covering of coarse,
curly hairs, the pubic hair.
● It protects the delicate tissues
and pubic bone from trauma.
2. Labia Minora
● The labia minora is a spread
of two connective tissue folds
that are pinkish in color.
● The internal surface is
composed of mucous
membrane and the external
surface is skin.
● Fourchette - torn when
delivery of the baby
● It contains sebaceous glands
all over the area.
3. Labia Majora
● Lateral to the labia minora are
two folds of fat tissue covered
by loose connective tissue
and epithelium, the labia
majora.
● Its function is to protect the
external genitalia and the
distal urethra and vagina from
trauma.
● It is covered in pubic hair that
serves as additional
 protection against harmful joining of the labia minora and
bacteria that may enter the majora.
structure. ● During episiotomy, this is the
4. Vestibule tissue that is cut to enlarge
● It is a smooth, flattened the vaginal opening.
surface inside the labia 9. Perineal Body
wherein the openings to the ● This is a muscular area that
urethra and the vagina arise. stretches easily during
5. Clitoris childbirth.
● The clitoris is a small, circular ● Most pregnancy exercises
organ of erectile tissue at the such as Kegel’s and squatting
front of the labia minora. are done to strengthen the
● The prepuce, a fold of skin, perineal body to allow easier
serves as its covering. expansion during childbirth
● This is the center for sexual and avoid tearing the tissue.
arousal and pleasure for 10. Hymen
females because it is highly ● This covers the opening of
sensitive to touch and the vagina.
temperature. ● It is tough, elastic, semicircle
6. Skene’s Glands tissue torn during the first
● Also called paraurethral sexual intercourse.
glands, they are found lateral
to the urethral meatus and Male Reproductive System
have ducts that open into the Internal Structures
urethra.
● The secretions from this
gland lubricate the external
genitalia during coitus.
7. Bartholin’s Gland
● Also called bulbovaginal
gland, this is another gland
responsible for the lubrication
of the external genitalia
during coitus.
● It has ducts that open into the
distal vagina.
● Both of these glands
secretions are alkaline to help 1. Epididymis
the sperm survive in the ● This is a tightly coiled tube
vagina. that is responsible for
8. Fourchette conducting the sperm from
● This is a ridge of tissue which the tubule to the vas
is formed by the posterior deferens.
 ● It has a length of
approximately 20 feet long.
● Some sperm are stored in the
epididymis, along with the
semen.
● The sperm takes an
estimated 12 to 20 days of
travel along the epididymis,
and a total of 64 days to
reach maturity.
2. Vas Deferens
● The function of the vas
deferens is to carry the sperm
through the inguinal canal
from the epididymis into the
abdominal cavity where it will
end at the seminal vesicles
and the ejaculatory duct.
● It is a hollow tube that is
protected by a thick fibrous
coating and surrounded by
arteries and veins.
3. Seminal Vesicles
● These are two convoluted
pouches along the lower
portion of the posterior
surface of the bladder.
● The seminal vesicles secrete
a liquid that is viscous and
alkaline and has high protein,
sugar, and prostaglandin
content, which makes the
sperm increasingly motile.
4. Ejaculatory Ducts
● These ducts pass through the
prostate gland to join the
seminal vesicles and the
urethra.
5. Prostate Gland
● This is a chestnut-sized gland
that is situated below the
bladder.
● It secretes a thin, alkaline
fluid that adds protection to
the sperm from being
immobilized by the low pH
level of the urethra.
● The urethra passes through
its center like a doughnut.
6. Bulbourethral Glands
● Also called as Cowper’s
gland, these glands also
secrete alkaline fluid to
counteract the acidic
environment in the urethra.
● These are twp glands located
at either side of the prostate
gland and seminal vesicles
and empty through the short
ducts towards the urethra.
● Semen is a product of 60%
from the prostate gland, 30%
from the seminal vesicles, 5%
from the epididymis, and 5%
from the bulbourethral glands.
7. Urethra
● This structure passes through
the prostate gland towards
the shaft and glans penis.
● It is a hollow tube from the
base of the bladder and lined
with mucous membrane.
● It has a length of
approximately 8 inches or 18
to 20 cm.
External Structures
1. Scrotum
● The scrotum is responsible
for the support of the testes
and it regulates the
temperature of the sperm.
● It is a rugated, muscular,
skin-covered pouch over the
perineum.
● To promote the production
and viability of the sperm, the
 scrotum contracts towards the protects the glans at birth. It is
body during very cold weather also the part that is surgically
and relaxes away from the removed during circumcision.
body during hot weather.
2. Testes
● In each scrotum lies two
----------------------------------------------------------
oval-shaped glands called the
Type of Pelvis
testes.
● These are 2 to 3 cm in width
and are encapsulated in a
protective, white fibrous
capsule.
● Several lobules are contained
in each testis, which also
contains Leydig’s cells that
produce testosterone and
seminiferous tubules that
produce spermatozoa.
● In most men, one testis is
slightly lower than the other to
prevent trauma and easily sit
or do any muscular activity.
3. Penis 1. Gynecoid
● The penis has three parts: - This is the most common type of
two are called the corpus pelvis in females and is generally
cavernosa, and the other is
the corpus spongiosum. considered to be the typical female
● These erectile tissues also pelvis. Its overall shape is round,
contain the urethra, making shallow, and open.
the penis an outlet for both
- most favorable pelvis type for a
urinary and reproductive
functions. vaginal birth. This is because the
● Erection of the penis is wide, open shape gives the baby
stimulated by the
plenty of room during delivery.
parasympathetic nerve
innervations, and the blood 2. Android.
supply for the penis is from - This type of pelvis bears more
the penile artery. resemblance to the male pelvis. It’s
● The glans, a sensitive,
bulging ridge of tissue, is narrower than the gynecoid pelvis
located at the distal part of and is shaped more like a heart or a
the penis. wedge.
● The prepuce, which is a
retractable casing of skin,
 - Longer sacrum and more narrow the immature can mature. Reproductive age
sub-pubic arch is 15-49 yrs old.

- It has a narrower shape that can

Menopause- permanent cessation of
make labor difficult because the menstruation. There are no more
baby might move more slowly functioning oocytes in the ovary.

through the birth canal.

Abnormal uterine bleeding patterns
- may require a C-section.
3. Anthropoid Oligomenorrhea
- Menses > 35 days
- An anthropoid pelvis is narrow and
deep. Its shape is similar to an Polymenorrhea
upright egg or oval. - Menses < 21 days
- Narrower than gynecoid amenorrhea - temporary cessation of flow

- may be able to have a vaginal birth, Menorrhagia

but their labor might last longer since - excessive bleeding.
the fetus body may be stuck. - Menstrual bleeding that lasts more
than 7 days.
4. Platypelloid
- Regular.
- The platypelloid pelvis is also called
a flat pelvis. This is the least Metrorrhagia
- bleeding completes an irregular
common type. It’s wide but shallow,
interval.
and it resembles an egg or oval lying - when your period lasts more than
on its side. seven days or you have spotting
between periods.
- Vaginal birth is difficult because the
baby may have trouble passing Menometrorrhagia
through the pelvic inlet. - Menstrual bleeding occurs at
- need to have a C-section. irregular intervals with excessive
bleeding.

---------------------------------------------------------- Emotional & behavioral signs &

symptoms
Menstrual cycle 1. tension/ anxiety
2. Depressed mood
300 thousand to 400 thousand - immature 3. Crying spells
oocyte are ovary are present at birth 4. Mood swings
5. Appetite changes
300 to 400 - can mature during an entire 6. Insomnia
reproduction cycle of a woman. only 10% of 7. Social withdrawal
8. Poor concentration
 9. Change in libido 4. If they produce estrogen, they will be
known as graafian follicles- source
Physical signs & symptoms of the hormones progesterone and
1. Joint or muscle pain estrogen during the second half of
2. Headache the ovulatory cycle.
3. Fatigue 5. If there is now estrogen in the
4. Weight gain related to fluid retention graafian follicle, what would happen
5. Abdominal bloating sa cells ng uterine endothelium will
6. Breast tenderness proliferate.
7. Acne 6. Proliferative phase - Estrogen in the
8. constipation/ diarrhea graafian follicle will cause the cells in
9. Alcohol intolerance the uterine endometrium to grow
rapidly in 8th folds.
Board exam question: 7. Post menstrual phase
What are the organs that are involved in - It comes from menstrual period
the menstrual cycle? 8. Ambulatory phase
1. Anterior pituitary
2. Hypothalamus Primordial follicles- consist of immature
3. Uterus oocytes surrounded by a single layer of
4. Ovaries squamous follicular cells.

2 hormones that is responsible for the Board exam question:

cycle Graafian follicle- structures contain high
1. LH amounts of estrogen
2. FSH

On the 3rd day of my menstrual cycle,

estrogen and progesterone levels are low.
Serum estrogen is decreased or low
1st half
- Decreased of estrogen - bodily
changes for structure
1. Hypothalamus detects low estrogen,
so hypo will produce follicle
stimulating hormone releasing factor.
2. FSH-RH stimulates pituitary glands
to produce FSH.
3. FSH stimulates the growth of
oocytes that are inside in primordial
follicles.
On the 13th day, progesterone - for
pregnancy.
1. Hypothalamus detects low,
progesterone hypo will produce
luteinizing hormone releasing factor.
2. LH-RH stimulates anterior pituitary
glands to produce LH.
3. LH stimulates the ovary to produce
progesterone.
- An increased amount of 2 hormones
will push the new ovum to the
surface of the ovary until the
following day on the 14th day of the
menstrual cycle.
- Graafian follicles will rupture to
release mature ovum. (ovulation)
Luteinizing hormone- ovulation
Ovulation:
- The release of the egg from the
ovary, mid-cycle. Estrogen peaks
just beforehand, and then drops
shortly afterwards.
The luteal phase:
- The time between ovulation and
before the start of menstruation,
when the body prepares for a
possible pregnancy. Progesterone is
produced, peaks, and then drops.
The secretory phase:
- The uterine lining produces
chemicals that will either help
support an early pregnancy or will
prepare the lining to break down and
shed if pregnancy doesn’t occur.
Corpus luteum
- contains high amounts of
progesterone
- High amount will yellow
- If pregnant, it will continuously
produce progesterone till the
placenta takes over for 8-12 weeks.
So the placenta now is the one
responsible for the hormones.
Progestational Phase
- High levels of progesterone
promotes pregnancy (increase
capillaries to supply nutrients and
abundant blood supply to fertilize
zygote
If there is no fertilization, yellow will turn to
white.
Corpus albicans
- Decreased - white in color
- Low amount of progesterone
3-4 days, the capillaries will rupture, it will
begin the menstrual period.
Effects of estrogen in the body
- Hormone of women
- FSH
- Causes hypertrophy of myometrium
- For breast
Effects of progesterone in pregnancy
- LH
- Increase endometrial secretion
- Inhibits uterine motility (pahinga)
- Facilitate transport of the fertilized
ovum in FT
- Decreased the renal threshold for
lactose and dextrose
- Inhibit the temperature after
ovulation (before ovulation, low temp
then it will increase a day after
ovulation)
Board exam question:
- Mittelschmerz is one-sided, lower
abdominal pain associated with
ovulation. It occurs midway through
a menstrual cycle — about 14 days
before your next menstrual period

The first 14th day of the menstrual period is
variable. Last 14th day of the cycle is fixed.
minus 14 lang lagi para malaman
ang ovulation. Before 14 days ng
mens
----------------------------------------------------------
● Sperm have 22 autosomes, 1
chromosomes (X/Y)
● 43 chromosomes, 46 chromosomes
● X chromosome (acidic environment),
Y chromosome (alkaline
environment)
● X X (baby girl) X Y (baby boy), to
determine the sex of the baby we
must look into the father’s. It is
determined during fertilization.
● Fertilization. Zygote stays in the
fallopian tube for three days during
which time rapid cell division of
mitosis takes in place. The
developing cells are now called
blastomyr.
● Finger like projections - trophoblast
Cytotrophoblast (inner layer)
Syncytiotrophoblast (outer layer)
containing fingerlike projections
called chorionic villi.
● Chorionic Villi (two layers):
1. Langhan’s layer - protects the
fetus against treponema pallidum.
(An agent that causes syphilis).
Present only during the second
trimester of pregnancy.
2. Syncytial layer - gives rise to the
fetal membranes.
● Syncytial layer: 1. Amnion and 2.
Chorion
1. Amnion: (Polyhydramnios) more
than 1500 ml.
- Gives rise to the umbilical
cord or Funis (2 arteries
(unoxygenated) and 1 vein
(oxygenated); supported by
Wharton’s jelly)
- clear, albuminous fluid, it
forms 11 to 15 weeks AOG.
Specific gravity is 1.007 -
1.025. It is neutral to slightly
alkaline. (pH is 7 to 7.25)
Near Term: colorless, clear,
containing white specks of
verix caseosa & other
particles. Produces at a rate
of 500 ml in 24 hours, the
fetus swallows equally (rapid
rate).
- In the 4th lunar month, urine
is added to the amniotic fluid.
(Amniotic Fluid) derived
mainly -> maternal serum
- Amniotic fluid
(Polyhydramnios) more than
1500 ml.)
- Fetus: inability to swallow the
amniotic fluid -> (Possible)
TEF/Tracheoesophageal
fistula
-> Oligohydramnios: less
than 500 ml
- Kidneys: inability to add urine
to the amniotic fluid (by 4th
lunar month; urine is added)
with the given situation it is
not applicable because the
kidney cannot produce. ->
congenital renal anomaly.
● Chorion: gives rise to to the
placenta, form by 8th weeks of AOG,
15-20 subdivisions (cotyledons) -
PLACENTA (uses below)
a. Respiratory System:
exchange of gasses takes
place in the placenta
 b. Acts as a renal system: 4. Reduce child mortality
waste products are excreted 5. Improve maternal health
through the placenta 6. Combat HIV/Aids/Malaria
(Mother’s liver -> not to and other diseases
excrete waste products 7. Ensure environmental
rather it must detoxify the sustainability
fetal waste products.) 8. Develop a global partnership
c. Gastro-intestinal: nutrients for development
passess at the placenta by - 4 & 5 is the most important part of
the process called diffusion maternal
(higher to lower - 2015 to 2030 Sustainable
concentration) Development Growth (8 to 17) SDG
d. Circulatory system: feto number 3 is the main focus
placental circulation ● August is the month for Family
(selective osmosis; lower to Planning
higher concentration) ● E.O no. 12: client is in there, do not
e. Endocrine System: by the 8th let it passed that the client will not be
week is placenta formed. able to avail any family planning
- It produces HCG method
(human chorionic ● GATHER METHODS (Family
gonadotropin Planning)
hormone) G - great clients (open, respectful
- HPL (human manner)
placental lactogen) / A - ask clients about themselves
human chorionic (family planning experiences)
somatomammotropin: T - tell clients about choices (what
it promotes the choices of FP methods and focus on
growth of mammary interest)
glands (which is H - help clients make informed and
necessary for voluntary choices
lactation) E - explain fully how to use the
- Estrogen and chosen method (give supplies and
Progesterone explain)
(hormone produced R - returned visits should be
by placenta) welcomed
f. Protective Barrier ● WHO medical eligibility criteria
● MDG ( 8 Million Developmental (categories)
Growth) (ErAPRICED) - A condition for which there is
1. Eradicate extreme poverty no restriction for the use of
and hunger the contraceptive method
2. Achieve universal primary (choose any prevention
education method that you want)
3. Promote gender equality and - A condition where the
empower women advantages of using the
 method generally outweigh
the theoretical or proven
risks. (1&2: use the method)
- A condition where the
theoretical or proven risks
usually outweigh the
advantages of using the
method (do not use)
- A condition which represents
an unacceptable health risk if
the contraceptive method is
used (generally, do not use)
Three type of Family Planning
1. Natural FP Methods (Fertility
Awareness Based & Lactation
Amenorrhea Method)
2. Artificial FP Methods (Barrier
Methods and Oral Contraceptives)
3. Permanent FP Methods (Bilateral
Tubal Ligation and Vasectomy)
ARTIFICIAL- CONTRACEPTIVES
● Standard days method (bracelet) is
partnered with the calendar.
● Combined Oral Contraceptives:
have estrogen, 1 tablet every day
(28 tables, 21 tables are hormonal
pills. 22 to 28 are iron supplements)
- PU- 99.7% / TU- 92%
● Progestin-only-pills: uniform time
(first timer, no sexual intercourse for
7 days) (24 hrs protection)
- PU- 99.5% / TU- 99%
● Combined Injectable
contraceptives: it is injected
subdermally by lidocaine. 1 implant
and provides 3 yrs protection.
- PU- 99.7% / TU- 97%
● IUD intrauterine devices: cervix is
open and woman isn't pregnant
that’s why it is injected during
menstruation. (Abdominal cramping
is normal, but severe cramping
might be a sign that the wire was
removed) (it is for 10 years, it can be
removed during menstruation)
- PU- 99.4% / TU- 99.2%
● Using condom; advise partner/s or
ask if there are any allergies in latex,
may it either be the female/male.
MALE- PU- 98% / TU- 85%
FEMALE- PU- 95.7% / TU- 79%
● Cervical Cap: nilalagay sa cervix,
washable, 48 to 72 hours
- Reusable
- Longer protection
- PU- 74% / TU- 68%
● Diaphragm: dome shape, 24 hours
- Short term protection but
more effective because of
increase spermicide
- PU- 94% / TU- 84%
BOARD EXAM QUESTION:
What is the baseline data to look for a
patient when using cervical cap and
diaphragm? BODY WEIGHT
● Weight gain from 5 to 10 pounds
means resizing of cervix
● Toxic shock syndrome: when an
individual was not able to remove
the cervical cap or diaphragm within
the recommended time.
----------------------------------------------------------
2ND PART OF LECTURE
Permanent method for family planning
(irreversible)
1. Vasectomy
- PU- 99.9% / TU- 99.8%
- Male
 - Presence of seminal fluids but no
sperm
- Warm and cold compress to avoid
scrotal edema and hematoma
- Effective only for patient after 2 or
more ejaculation for 2 months or
after 2 consecutives 0 sperm count
2. Bilateral tubal ligation
- female
- PU- 99.5% / TU- 99.5%
- Cut fallopian tube (ampulla)
I.Fetal Development
- Uterine endothelium as decidua
(when implantation of zygote)
- 7 days after fertilization is
implantation.
- 1-14 days zygote
- 15 days- 8 weeks embryo
- 8 weeks - delivery fetus
- 37 weeks near term
- 32-36 weeks preterm
- More than 42 weeks post term
- 1st trimester (1-13 weeks) -
organogenesis
- 2nd trimester (13-26 weeks) - fetal
growth and fetal length increases
1st Lunar Month
● Germ layers differentiate with the
2nd week
a. Endoderm
- forms inner lining of the organs
- develops in the lining in the
GIT,respiratory tract, tonsils, thyroid
(metabolism), parathyroid (calcium
metabolism), thymus, development
of bladder and urethra.
b. Mesoderm
- develop into organs or middle.
- Supporters in the body. Connective
tissues, tendons, cartilages, and
muscles. Kidney, heart, circulatory
systems, ureters, and blood cells,
liver.
c. Ectoderm
- forms outer lining of organs or
exoskeleton
- Responsible for formation of nervous
system, integumentary, mucous
membrane of anus and mouth.
● Nervous system rapidly develop at
the third week
● Dizziness is the early signs of
pregnancy because as the fetal
rapidly develops, the glucose stored
at the mother is depleted thus
causing hypoglycemia.
● Fetal heartbeat forms as early as
16th day of life and can be heard in
5 month of pregnancy using a
stethoscope. 3-4 months doppler
2nd Lunar Month
● All vital organs are formed by the 8th
week
● Placenta fully develops
● Sex organs formed
- When is sex determined? At the time
of conception or fertilization
- Who determine the sex? Father
because mother has x
chromosomes.
3rd Lunar Month
● Kidneys able to function
● Buds of milk teeth form
● Bone ossification
● Swallows amniotic fluid
● Feto-placental circulation is
established by osmosis (lower to
higher)
● No direct exchange between fetal
and maternal blood
4th Lunar Month
 ● Lanugo (soft, feathery hair that can
grow all over the body)
● Buds of permanent teeth form
● Heartbeat audible with fetoscope
and doppler
5th Lunar Month
● Vernix caseosa (white, creamy,
naturally occurring biofilm covering
the skin of the fetus during the last
trimester of pregnancy)
● Lanugo covers the body
● Quickening (fetal movement felt by
mother)
● Audible fetal heartbeat by
stethoscope
6th Lunar Month
● Skin is markedly wrinkled
● Proportion of FULL-TERM
7th Lunar Month
● Alveoli begins to form (28th weeks
AOG is the lower limit of prematurity)
● Baby can cry and breathe out but
can die and be critical.
2. Gravida- number of pregnancy
3. Para- number of pregnancy delivered
4. Nullipara- never give birth
5. Multipara- two or more live births
6. Primipara- first time pregnancy
7. Primigravida- first time pregnancy
8. Multigravida- pregnant more than once
9. Stillbirth- miscarriage or death
Normal adaptation in pregnancy
● Circulatory and Cardiovascular
changes
1. end of the 1st trimester there is a
gradual of about 30% - 50% in the
total cardiac volume
2. reaching its peak during the 6th
months of AOG
3. drop in Hgb and Hct values
(physiologic anemia of
pregnancy)

8th Lunar Month 32 weeks

● CONSEQUENCES :
● Fetus is viable a. Easy fatigability and shortness of
● Lanugo begins to disappear breath- due to increase workload of
● Nails extend (ends of fingers) heart
● Subcutaneous fat deposition b. Slight hypertrophy of the heart-
9th Lunar Month cause displace to the left resorting to
the pulmonary artery
● Lanugo and Vernix disappear c. Systolic murmur - due to lower blood
● Amniotic fluid decreases viscosity
10th Lunar Month d. Nosebleeds may occur- due to mild
congestion nasal pairing as
● Characteristics of a normal newborn pregnancy progresses
4. Palpitations
Terminologies - sympathetic nervous system
1. Abortion- stimulation 1st half
 - pressure of the uterus against the - excessive nausea and vomiting
diaphragm 2nd half persisting 3 months and beyond
(result to dehydration, starvation and
5. Edema of lower extremities (may occur)
acidosis)
- Normal but Edema of upper ● Management :
extremities is not since it may be a a. D10NSS 3 liters in 24 hours (priority)
sign of toxemia or pregnancy
induced hypertension b. bed rest
- poor circulation
3. Constipation and Flatulence
● MANAGEMENT
- displacement of stomach and
- Raise the leg above hip level
intestines (slowing peristalsis and
6. Varicosities of the Lower Extremities gastric emptying)
- Due to the increase of hormone
● MANAGEMENT
progesterone
a. Use / wear support hose or elastic
● Management
stockings (promote venous flow)
a. increase fluids and roughage diet
b. Apply elastic bandage ( start at the
b. establish regular elimination pattern
distal end and toward the trunk) do
c. encourage exercise
not cover toes
d. No enemas or Laxatives
c. Avoid use of constricting garters (
e. No mineral oil
knee-high stockings)
4. Hemorrhoids
7. Varicosities of the Vulva and Rectum
(may occur) - due to pressure from enlarged
uterus
● MANAGEMENT
● Management
a. side-lying position or modified knee
a. Cold compress with Witch Hazel or
-chest ‘
Epsom salts
b. Do not massage since
tromboembolism (increase level of 5. Heartburn
fibrinogen or formation of blood
- during the last trimester
clots) may occur
- regurgitation of stomach contents
through the cardiac sphincter into
the esophagus
GASTROINTESTINAL CHANGES
● Management
1. Morning sickness - nausea and a. Pats of butter before meals
vomiting during the 1st trimester (d/t b. Avoid fried fatty and spicy foods
HCG) c. Sips of milk at frequent intervals
● Management : d. Small, frequent meals taken slowly
a. eat dry toast or crackers 30 minutes e. Bend at the knees , not at the waist
before arising on the morning f. Milk of magnesia
b. Dry, high CHO, low FAT and low
SPICES in the diet
2. Hyperemesis Gravidarum
RESPIRATORY CHANGES e. Most effective : press the knee pf the
affected leg and dorsiflex the foot
1. Shortness of Breath (SOB)
- increased O2 consumption and
production of carbon dioxide during
TEMPERATURE CHANGES
the 1st trimester
● Management - Slight increase in basal body
a. Lateral expansion of the chest temperature ( increase
Progesterone)

ENDOCRINE CHANGES
URINARY CHANGES
- Moderate enlargement of the
1. Urinary Frequency
Thyroid gland (hyperplasia of the
- only sign seen during the 1st
glandular tissues and increased
trimester , disappears during the 2nd
vascularity
trimester and reappears on the 3rd
- Increased size of the Parathyroid
trimester
(satisfy the need of Calcium by the
- 1st Trimester : due to increase
fetus)
blood supply to the kidneys ,and to
- Increased size and activity of the
the uterus rising out of the pelvic
adrenal cortex (increasing the
cavity
amount of cortisol , aldosterone and
- 3rd Trimester : pressure of enlarged
ADH = affect CHO and Fat
uterus
metabolism = Hyperglycemia
2. Decrease Renal Threshold (sugar)
- Glandular increase in insulin
- increase production of
production (during pregnancy
Glucocorticoid
decreased sensitivity to insulin)
- effect of increased Progesterone
WEIGHT CHANGES

- 1st Trimester : weight gain of 1.5 - 3

MUSCULOSKELETAL CHANGES
pounds = normal
- Change in the center of gravity “ - 2nd & 3rd Trimester : 10 to 11
LORDOTIC POSITION” pounds
- Accidental falls occur due to - Total allowable weight gain : 25 -
Increased production of relaxin 35 pounds
- Leg Cramps - REMEMBER : Pattern of weight gain
- pressure of the gravid uterus on the is more important that the amount
lower extremity weight gained
- Low CALCIUM, High
HOW MUCH WEIGHT SHOULD YOU GAIN
PHOSPHORUS
WHEN YOU’RE PREGNANT?
● Management
a. Frequent rest period with leg - BMI: Get the client’s weight in
elevated kilograms over height in meter
b. Warm and comfortable clothing squared.
c. Increase Calcium intake
d. NO MASSAGE can cause embolism

EMOTIONAL RESPONSES/ CHANGES
- 1st Trimester
● Fetus is an unidentified
concept with great future
implications but without
tangible evidence of its
existence.
● Rejection, disbelief, even
depression.
Answer: When providing health teaching
you have to emphasize the changes
happening in the body (to the mother).
- 2nd Trimester
● Perceived stress as a
separate entity.
- 3rd Trimester
● Personal identification with a
real baby
● Makes realistic plans for
childcare and responsibilities
● Best time to talk about diet
and infant feeding method of
the baby.
LOCAL CHANGES IN PREGNANCY
UTERUS
- Weight increases about 1000 grams.
- Change in shape from pear-like to
ovoid.
- Hegar’s sign (extreme softening,
seen on the 6th week of pregnancy)
- Operculum (seal out of bacteria)
- Goodell’s sign (cervix become more
vascular, as soft as the earlobe)
Note:
● Non pregnant - Uterus Weight: 70g
● Pregnant - Uterus Weight: 1100g
● Non pregnant - Cavity Volume: 10ml
● Pregnant - Cavity Volume: 5L
VAGINA
- Chadwick’s Sign: due to the
increase of vascularity
● a dark blue to purplish-red
congested appearance of the
vaginal mucosa.
 ● Estrogen (purpose from acidic to
alkaline) protects against bacterial
- Hegar’s Sign
infection.
● occurs during the first
trimester of pregnancy. Microorganism that thrives in an
● Softening of uterus at alkaline environment
junction with cervix (isthmus)
- Trichomonas vaginalis
- Goodell’s Sign
● Trichomonas vaginitis
● Softening and cyanosis of
or trichomoniasis
the cervix at or after 4 weeks.
● Frothy,
● Softening of cervix at 4th
cream-colored,
month
irritatingly itchy,
- Landin’s Sign
foul-smelling
● Softening of the uterus after
discharges.
6 weeks.
● Flagyl p.o or vaginal
- Osiander’s Sign
suppository (avoid
● Increase pulsation felt
taking alcohol)
through lateral fornices at 8th
week. *Ma’am having dark brown urine is a normal
- Piskacek’s Sign (minor) side effect, there is no need to
● Asymmetrical enlargement of discontinue the medication.
uterus if there is lateral
implantation. *Avoid sexual intercourse (if not
preventable, wear protective method)
Note:
- Candida albicans (fungus or
● Activity in the Epithelial Cell yeast)
INCREASES (increase estrogen) ● Moniliasis or
thus increasing the vaginal candidiasis
discharge, LEUKORRHEA ● Thrives in CHO rich
- Management: maintain environment
cleanliness/ hygiene ● Seen as oral thrush
● pH changes from acidic (+ of among newborns
Doderlein bacilli) to alkaline ● White patchy,
(increased estrogen) cheese-like particles
(adhere to vaginal
Question: What makes the pH of the
walls)
Vagina, Acidic?
● Irritatingly itchy and
Answer: Doderlein bacilli foul-smelling vaginal
discharge.
Question: What makes the pH of the
● Mycostatin / nystatin
Vagina, Alkaline?
p.o or suppository.
Answer: Presence of Estrogen
Question: What STD/STI does require a
mother to remove her child on the womb via
operation?
Answer: If the mother has genetal warts or SIGNS OF PREGNANCY
herpes, the child must be taken out of the
- PreSUmptive Signs
womb via cesarean section.
● Subjective, coming from the
How to make the Vagina acidic? mother.
- PrOBable Signs
● Vinegar and Water
● Objective, visible to the HCP
ABDOMINAL WALL - Positive Signs
● Confirmatory procedures.
- Striae gravidarum
● Pink or reddish streaks PRESUMPTIVE SIGNS

SKIN - Period is absent/ Amenorrhea

- Really tired/Fatigue
- Linea nigra - Enlargement of the Breast/ Uterus
● Brown line from umbilicus to - Sickness (morning sickness)
symphysis pubis - Urination (frequent and increases)
- Melasma or Chloasma - Movement is perceived
● Extra pigmentation on - Emesis (nausea and vomiting)
cheeks, across the nose
- Sweat glands are unduly activated. PRESUMPTIVE SIGNS
- Avoid excessive exposure to
- Positive pregnancy test/ HCG
sunlight.
- Return of Fetus when uterus pushed
BREAST with fingers
- Outline of fetus (palpation)/
- All changes are due to Estrogen Quickening
- Increase in size and feeling of - Braxton - Hicks contraction/
fullness, tingling sensation Ballotement
- Nipple are more erect - A feeling of softening of cervix
- Montgomery glands (bigger and (Goodell’s sign)
protuberant) - Bluish discoloration of the vagina
- Areola becomes darker and (Chadwick’s sign)
diameter increases. - Lower uterine segment softening
- Skin surrounding the areola turns (Hegar’s Sign)
dark - Enlargement of the Uterus/
- 4th month of AOG, colostrum is abdomen
formed - Elevation of BBT
OVARIES POSITIVE SIGNS
- No activity - Fetal heart tones
Question: What happened to the Ovaries - Evidence and detected Xray
during pregnancy? - The examiner felt fetal movement
- Ultrasound confirmation
Answer: No activity. Placenta is the one - Sees visible movement
producing estrogen and progesterone
during pregnancy.
PRENATAL VISIT
- WHO recommends at least 4
prenatal visit:
● 1st - on the 1st trimester or
before 4th month
● 2nd- between 5-6 months
● 3rd - on the the 8th month of
pregnancy
● 4th - after 8 months of
pregnancy
- CBC
- Ultrasound
- Dental consultation
- Immunization and Supplementation
- History Taking
TETANUS TOXOID
- Given in 5 doses, two standard
doses and three booster doses.
- You have to aspirate before you
administer.
- Dose 1: Mother only protected.
- Dose 2, 3, 4: Mother and current
pregnancy.
- Dose 5: All succeeding pregnancies
are protected.
VITAMIN A SUPPLEMENTATION
- Pregnant women should receive up
to 10,000 IU vitamin A daily or up to
25,000 IU vitamin A weekly as an
oral liquid, oil-based preparation of
retinyl palmitate or retinyl acetate.
- 48 to 72 hours interval
- If the mother is already taking
prenatal multivitamins, do not give
vitamin A supplement anymore.
IRON SUPPLEMENTATION
- The equivalent of 60 mg of
elemental iron is 300 mg ferrous
sulfate heptahydrate, 180 mg ferrous
fumarate or 500 mg of ferrous
gluconate. Folic acid should be
commenced as early as possible
(ideally before conception) to
prevent neural tube defects.
- Daily oral iron and folic acid
supplementation with 30 mg to 60
mg of elemental iron and 400 µg (0.4
mg) folic acid is recommended for
pregnant women to prevent maternal
anemia, puerperal sepsis, low birth
weight, and preterm birth.
- Early antenatal iron-folate
supplementation reduces iron
deficiency anemia, preterm birth,
early neonatal death, and low birth
weight among pregnant women.
WHO has recommended a 6-month
regimen of a daily supplement
containing 60 mg of elemental iron
along with 400 mcg of folic acid for
all pregnant women.
- Best time: 1st trimester of
pregnancy.
- Non breastfeeding: 1 tablet per day
for 30 days
- Breastfeeding: 1 tablet once a day
for 90 days.
----------------------------------------------------------
HISTORY OF PREGNANCY
- Para OR Parity is the number of
completed pregnancies beyond 20
weeks gestation (whether viable or
nonviable). The number of fetuses
delivered does not determine the
parity.
- Gravidity is the amount
pregnancies.
- Gravidity is defined as the number of
times that a woman has been
pregnant. Parity is defined as the
number of times that she has given
birth to a fetus with a gestational age
of 24 weeks or more, regardless of
whether the child was born alive or
was stillborn.
- Risk of pregnancy: 18 to 20 / 30 to
35 (greater)
https://patient.info/doctor/gravidity-and-parit
y-definitions-and-their-implications-in-risk-as
sessment#:~:text=Gravidity%20is%20define
d%20as%20the,born%20alive%20or%20wa
s%20stillborn.
MODIFIED WHO CLASSIFICATION OF
MATERNAL CARDIOVASCULAR RISK
https://www.cmqcc.org/system/files/Modi
fied%20World%20Health%20Organizatio
n%20%28WHO%29%20Classification%20
of%20Maternal%20Cardiovascular%20Ri
sk-%20Application.pdf
----------------------------------------------------------
Additional learnings:
of
Postpartum
● Check for the fundus and lochia
Lochia
- vaginal discharge you have after a
vaginal delivery.
- stale, musty odor like menstrual
discharge.
- 3 days after delivery it is dark red in
color. A few small blood clots, no
larger than a plum, are normal.
Note: check for the COAC (color, odor,
amount, consistency)
Color:
1. rubra - (red, red-brown) 1-4 days
2. serosa - (brown-pink, brown) 4-10
days
3. alba - (yellow, white). 10-28 days or
few months
Amount
1. Scant- less than 5cm or less than 2
inches
2. Light
3. Moderate
4. Large or heavy
5. Excessive- soaking saturation of pad
for 15 mins.
Fundus

- Normal is in the midline and at the
bottom of umbilicus-if lateral, empty
the bladder (located in the anterior of
uterus)
- Fundus descends 1 cm each day
- If it does not back to normal, prepare
for postpartum hemorrhage
- Must be firm- if mushy and boggy, it
does not contract and risk also of
hemorrhage
- Massage the fundus to hold the
uterus in place until it becomes firm
to expel clots and contract
- After 2 weeks, uterus should not be
palpable
- Oxytocin is given to contract the
uterus. (breastfeeding increases
oxytocin production)
QUIZ
1. What does the term involution
mean?
- After delivery of the placenta, the
uterus begins the process of
involution,by which the uterus
returns to a pre-pregnant size,
shape, and location; and the
placental site heals.
2. How does involution occur?
- This occurs through uterine
contractions, atrophy of the
uterine muscle, and a decrease in
the size of uterine cells.
3. _______________ women usually
do not experience discomfort related
to uterine contractions during the
postpartum period.
- Primiparous
4. Multiparous women or women who
are breastfeeding may experience
____________ during the first few
postpartum days.
- after pains
5. What are "afterpains"
- After pains are moderate to
severe cramp-like pains that are
related to the uterus working
harder to remain contracted
and/or to the increase of oxytocin
that is released in response to
infant suckling
6. When do after pains occur
- Afterpains occur within the first
few days and last 36 hours
7. How do you relieve after pains
- Empty bladder - Rationale: A
distended bladder can increase
after pains.Warm blanket to
abdomen. Analgesia (ibuprofen is
commonly used for postpartum
discomfort). Relaxation
techniques
8. The uterus needs to be in a
contracted state during the
postpartum period to decrease the
risk of postpartum
__________________
- hemorrhage

9. How does this decrease the risk of

postpartum hemorrhage?
- The contracted uterine muscle
compresses the open vessels at
the placental site and decreases
the amount of blood loss.