BSN 2Q NCM 207
fourth trimester of pregnancy)
MATERNAL AND CHILD
NURSING
Framework for Maternal and Child
Nursing
Maternal and child health nursing can be
visualized within a framework in which
nurses, using nursing process, nursing
theory, and evidence-based practice, care
for families during childbearing and
childrearing years through four phases of
health care:
• Health Promotion
• Health Maintenance
• Health Restoration
• Health Rehabilitation
Goals and Philosophies of Maternal
and Child Health Nursing
GOALS
• Primary goal of Maternal and Child
health nursing care can be stated
simply as the promotion and
maintenance of optimal family health
to ensure cycles of optimal
childbearing and childrearing.
• The goals of maternal and child
health nursing care are necessarily
broad because the scope of practice
is so broad. The range of practice
includes
• Pre-conceptual health care
Care of women during three
trimesters of pregnancy and the
puerperium (the 6 weeks after
childbirth, sometimes termed the
• Care of children during the perinatal
period (6 weeks before conception
to 6 weeks after birth)
• Care of children from birth through
adolescence
• Care in settings as varied as the
birthing room, the pediatric intensive
care unit, and the home in all
settings and types of care, keeping
the family at the center of care
delivery is an essential goal.
PHILOSOPHIES
● Maternal and child health nursing is
family centered.
● Maternal and child health nursing is
community centered.
● Maternal and child health nursing is
research oriented.
● Both nursing theory and evidence-
based practice provide a foundation
for nursing care.
● A maternal and child health nurse
serves as an advocate to protect the
rights of all family members,
including the fetus.
● Maternal and child health nursing
includes a high degree of
independent nursing functions.
● Promoting health is an important
nursing role.
● Pregnancy or childhood illness can
be stressful and can alter family life
in both subtle and extensive ways.
● Personal, cultural, and religious
attitudes and beliefs influence the
meaning of illness and its impact on
the family.
 ● Maternal and child health nursing is
a challenging role for a nurse and is
a major factor in promoting high-
level wellness in families.
others, and health care providers in
providing patient care.
STANDARD VII: Research. The nurse uses
research findings in practice.

Maternal and Health Goals and

STANDARD VIII: Resource utilization. The
Standards nurse considers factors related to safety,
effectiveness, and cost in planning and
ASSOCIATION OF WOMEN’S
delivering patient care.
HEALTH, OBSTETRIC, AND
NEONATAL NURSES STANDARDS STANDARD IX: Practice environment. The
AND GUIDELINES nurse contributes to the environment of care
delivery within the practice settings.

STANDARD X: Accountability. The nurse is

STANDARDS OF PROFESSIONAL
PERFORMANCE
STANDARD I: Quality of care. The nurse
systematically evaluates the quality and
effectiveness of nursing practice.
professionally and legally accountable for
his/her practice. The professional registered
nurse may delegate to and supervise
qualified personnel who provide patient
care.

STANDARD II: Performance appraisal. The THEORIES RELATED TO

nurse evaluates his/her own nursing MATERNAL AND CHILD NURSING
practice in relation to professional practice THEORIST Major Concepts of
standards and relevant statutes and Theory
regulations
.
STANDARD III: Education. The nurse 1.Patricia
Nursing is a caring
acquires and maintains current knowledge Benner
relationship. Nurses
in nursing practice. grow from novice to
expert as they
STANDARD IV: Collegiality. The nurse practice in clinical
settings.
contributes to the professional development
of peers, colleagues, and others.

2.Dorothy A person comprises

STANDARD V: Ethics. The nurse’s subsystems that must
decisions and actions on behalf of patients Johnson
remain in balance for
are determined in an ethical manner. optimal functioning.
any actual or
STANDARD VI: Collaboration. The nurse potential threat to this
collaborates with the patient, significant system balance is a
 tertiary prevention.
nursing concern

Nursing is a process
of action, reaction,
3. Imogene King
interaction, and 7. Dorothea The focus of
transaction; needs Orem nursing is on the
are identified based individual; clients
on client’s social are assessed in
system, perceptions, terms of ability to
and health; the role of complete self-care.
the nurse is to help Care given may be
wholly
the client achieve
compensatory
goal attainment.
(client has no role);
The essence of partly
4. Madeleine
Leininger compensatory
nursing is care. to
(client participates
provide transcultural
in care); or
care, the nurse supportive-
focuses on the study educational (client
and analysis of performs own care).
different cultures with
respect to caring
behavior.

5. Florence The role of the nurse

8. Ida Jean
Nightingale is viewed as Orlando
changing or
structuring elements
of the environment The focus of the
such as ventilation, nurse is interaction
temperature, odors, with the client;
noise, and light to put effectiveness of
the client into the care depends on
best opportunity for the client’s behavior
and the nurse’s
recovery.
reaction to that
6. Betty Neuman
A person is an open behavior. The client
system that 9. Rosemarie should define his or
interacts with the Rizzo Parse her own needs.
environment;
nursing is aimed at
reducing stressors
Nursing is a human
through primary,
science. Health is a
secondary, and
lived experience.
 Man-living-health coping ability; full
10. Hildegard as a single unit adaptation includes
Peplau guides practice. physiologic
interdependence.

The promotion of
health is viewed as
the forward
Roles and Responsibilities of a
movement of the
Maternal Child Nurse
personality; this is
accomplished
1. Clinical Nurse Specialist
through an
2. Case Manager
interpersonal
process that 3. Women’s Health Nurse Practitioner
includes orientation, 4. Family Nurse Practitioner
identification, 5. Neonatal Nurse Practitioner
11. Martha exploitation, and 6. Pediatric Nurse Practitioner
Rogers resolution. 7. Nurse-Midwife

WHO’s 17 Sustainable Development

Goals (SDGS) To Transform our
world:
The purpose of
nursing is to move GOAL 1: NO POVERTY
the client toward
optimal health; the GOAL 2: ZERO HUNGER
nurse should view
GOAL 3: GOOD HEALTH AND WELL-
the client as whole BEING
and constantly
12. Sister changing and help GOAL 4: QUALITY EDUCATION
Callista Roy people to interact in
the best way GOAL 5: GENDER EQUALITY
possible with the
environment. GOAL 6: CLEAN WATER AND
SANITATION

GOAL 7: AFFORDABLE AND CLEAN

The role of the ENERGY
nurse is to aid
clients to adapt to GOAL 8: DECENT WORK AND
the change caused ECONOMIC GROWTH
by illness; levels of
adaptation depend GOAL 9: INDUSTRY, INNOVATION AND
on the degree of INFRASTRUCTURE
environmental
change and state of GOAL 10: REDUCED INEQUALITY

GOAL 11: SUSTAINABLE CITIES AND
COMMUNITIES
GOAL 12: RESPONSIBLE CONSUMPTION
AND PRODUCTION
GOAL 13: CLIMATE ACTION
GOAL 14: LIFE BELOW WATER
GOAL 15: LIFE ON LAND
GOAL 16: PEACE AND JUSTICE
STRONG INSTITUTIONS
GOAL 17: PARTNERSHIPS TO ACHIEVE
THE GOAL
Reproductive and Sexual Health
A. Concept of Unitive and
Procreative Health
A.1 Unitive and Procreative Health
The unitive meaning is a specific type of
physical union, the sexual union of a man
and woman in natural intercourse. This
type of sexual act is in harmony with and
ordered towards procreation.
Procreation focuses on the conceiving and
bearing of offspring.
Procreative health is the moral obligation of
parents to have the healthiest children
through all natural and artificial means
available.
Principles of Procreation
1. Sex is a search for sensual pleasure
and satisfaction, releasing physical
and psychic tensions.
2. Sex is a search for the completion of
the human person through an
intimate personal union of love
expressed by bodily union for the
achievement of a more complete
humanity.
3. Sex is a social necessity for
procreation of children and their
education in the family so as to
expand the human community and
guarantee its future beyond death.
4. Sex is a symbolic (sacramental)
mystery, somehow revealing the
cosmic order. In short, this
Christians principle is all about
pleasure, love, reproduction and the
sacramental meaning of sex.
A.2 Process of Human Reproduction
The process of reproduction in
humans usually relies on sexual
intercourse between a male and a female,
although there are exceptions to this.
Unlike many animals, humans mate
throughout the year. Humans have sexual
intercourse when sexual reproduction is
not possible for reasons such as the use of
birth control or female menopause.
Practices and behaviors surrounding
human reproduction vary widely across
cultures, but in every case, it involves
sperm, an ovum, a uterus and a baby.
 During meiosis, diploid cells divide
into sperm in males and ova in females.
During sexual intercourse, the male
ejaculates semen, containing hundreds of
millions of sperm into the vagina. If the
female is ovulating, a sperm may
encounter an ovum. When a sperm cell
penetrates the ovum’s barrier, its 23
chromosomes fuse with the ovum’s 23
chromosomes, forming the zygote.
The zygote divides and multiplies
many times. The growing embryo travels
to the uterus, where it remains, and about
40 weeks after fertilization, a baby is born.

INHERITANCE 1. Homozygous- the same alleles

- a cell is said to be
homozygous for a particular gene
HEREDITY - process in which traits
when identical allele of the gene are
are passed from parents to offspring
present on both homologous
chromosomes. The cell or organism
GENETICS - the study of heredity in question is called a homozygote.

ALLELES – are pair of genes 2. Heterozygous- different versions

1. GENOTYPE – complete set of
inherited traits. It is the genetic makeup
of an organism.
If an individual has two identical alleles
of a certain gene, the individual is
homozygous for the related character.
If an individual has two different alleles
of a certain gene, the individual is
heterozygous for the related character.
2. PHENOTYPE - how these traits are
expressed. It is the appearance of an
organism. Thus, genotype determines
phenotype.
of the trait
- a diploid organism is
heterozygous at a gene locus when
its cells contain two different alleles
(one wild-type allele and one mutant
allele of a gene. The cell of organism
is called a heterozygote.)
Risk Factors for Genetic Disorders
1. Age ( mother and father ) - risks
increases with age
2. Race /Ethnic Background -
certain disorders occur more
frequently in some ethnic groups
compared to others
a. Chinese people - down
syndrome
 3. Family history of Disease -
including those who have died as
part of the family
4. OB History of pregnancy issues:
like exposure to teratogens such
as radiation, certain drugs,
viruses, toxins and chemicals.
Common Tests for Determination of
Genetic Abnormalities
Goals:
a. Enables individuals or couples to
make informed reproductive
decisions
b. Provides psychological support
for decision making.
c. Provides clients with information
about the defect in question.
d. Communicates to clients the risk
of transmitting the defect in
question to future children.
Screening Tests for Genetic Traits
and Disease
1. Karyotyping – a visual display
of the individual’s actual
chromosome pattern.
2. Heterozygote screening - is
directed at detecting clinically
normal carriers of a disease-
causing mutant gene,
particularly in people of ethnic
groups with high frequency of
the mutant gene under
investigation.
3. Maternal Serum Alpha-
Fetoprotein (MSAFP) –
screen is done when an open
neural tube is suspected.
4. Triple Screening – analysis of
3 indicators from MSAFP,
Estriol, and Human Chorionic
Gonadotropin
Diagnostic Tests
1. Chorionic villi sampling – is the
retrieval of chorionic villi for
chromosomal analysis. Done in the
5th week of pregnancy (earliest), but
mostly done at 8th to 10th week.
Results of this analysis are
extremely accurate but it cannot
detect all inherited diseases.
2. Amniocentesis – is the
withdrawal of a sample of
amniotic fluid (2 to 5 ml)
transabdominally for genetic
 analysis. It is usually done with
ultrasound visualization between
14 and 16 weeks. It is also used
to analyze skin cells, alpha-
fetoprotein, or
acetylcholinesterase. It carries
only a .5% risk of spontaneous
abortion.

b. Transvaginal – also called an

endovaginal ultrasound, is a type of
pelvic ultrasound used by doctors to
examine female reproductive organs.
This includes the uterus, fallopian tubes,
ovaries, cervix and vagina.
“Transvaginal” means “through the
vagina”. This is an internal examination.

3. Sonography – is a diagnostic
tool that is used to assess a fetus
for general size. It can also be
used to examine structural
disorders of the internal organs,
spine, and limbs. It uses sound
waves to create a “picture”.

a. Transabdominal – is done 4. Fetoscopy – involves the

through your abdomen. You
lie onyour back on an exam
table. The technician puts a
little bit of gel on the
transducer. The gel helps the
transducer move more
smoothly and prevents air
from getting between the
device and your skin.
insertion into the mother’s uterus
of a fiberoptic fetoscope through
a small incision in her abdomen.
It is used to inspect for fetal
anomalies or confirm an
ultrasound finding, it can also be
used to remove fetal skin cells for
DNA analysis and used to
perform corrective surgery for
congenital anomalies.

5. Percutaneous Umbilical Blood
Sampling – is the removal of
blood from the umbilical vein.
Blood studies include
karyotyping, complete blood
count (CBC), direct Coomb’s test,
and measurement of blood
gases. It uses a technique
similar to amniocentesis to obtain
the blood sample. An Rh-
negative mother should be given
RhoGAM because blood may
enter maternal circulation after
the procedure as a result of
oozing at the puncture site.
GENETIC DISORDERS
1. Chromosomal Inheritance Disorders
● Autosomal Dominant disorder -
dwarfism
● Autosomal Recessive disorder –
cystic fibrosis
● X-Linked Dominant disorder – sickle-
cell disease.
● X-Linked Recessive disorder -
hemophilia
● Multifactorial Inheritance - cleft lip
and palate
2. Chromosomal Abnormality Disorders
● Numeric Abnormality- klinefelter
syndrome, Turner syndrome
● Structural disorder –
translocations
Utilization of the Nursing Process in the
Prevention of Genetic alteration and in
the care of clients seeking services
before and during conception
NURSING PROCESS
❖ Assessment
1. Health History – should focus
on determining the couple’s risk for
having a baby with an inherited disorder:
a. genetic history
b. ethnic background,
c. general medical history
d. mother’s age
2. Laboratory and diagnostic
studies
❖ Nursing Diagnoses
1. Knowledge Deficit
2. Decisional Conflict
3. Anticipatory Grieving
❖ Planning and outcome
identification
. 1. The couple will receive
education about genetic
problems that may affect
their children, including
risks for having a child with
a problem and treatment
options for the particular
problem.
2. The couple will receive
emotional support
throughout the genetic
screening tests.
❖ Implementation

1. Provide education – information
about genetic problem; testing required;
possible treatments; and available
resources
2. Provide emotional support –
Counseling; healthcare facilities; assist
in coping
❖ Evaluation
1. The couple states that they
received adequate information
about patterns of inheritance,
their risk in having a child with an
inherited disorder, information
concerning the disorder itself,
and information about treatments
and available resources.
2. The couple demonstrates positive
coping skills and states that they
are able to make a reasonable
choice about the outcome of
genetic testing and counseling.
B. Female and Male Reproductive
System
b.1 Anatomy and Physiology of the
Female and Male Reproductive
Systems
Male Reproductive System
A. External Structures
1. Penis – is the male organ of
copulation. This cylindrical shaft
consists of the following:
a. Two lateral columns of erectile
tissue (corpora cavernosa)
b. A column of erectile tissue on
the underside of the penis
(corpus spongiosum) that
encases the urethra.
c. The glans penis, a cone-
shaped expansion of the corpus
spongiosum that is highly
sensitive to sexual stimulus.
d. The prepuce or foreskin, a skin
flap that covers the glans penis in
uncircumcised men.
2. Scrotum – is a pouch hanging below
the penis that contains the testes.
Internally, the medial septum divides the
scrotum into two sacs, each of which
contains a testicle.
B. Internal Structures
1. Testes – are two solid ovoid organs
4 to 5 cm long, divided into lobes
containing seminiferous tubules. The
two functions of the testes are
production of testosterone and
spermatogenesis.
2. Epididymis – is a tubular sac
located next to each testis that is a
reservoir for sperm storage and
maturation. It can extend 10-20 ft.; 2-4
weeks sperm maturation
3. Vas deferens – is a duct extending
from the epididymis to the ejaculatory
duct, which provides a passageway for
sperm. It extends to 16 inches long.
4. Ejaculatory duct – is the canal
formed by the union of the vas deferens
and the excretory duct of the seminal
vesicle. It enters the urethra at the
prostate gland.
5. Urethra – is the passageway for
urine and semen that extends from the
bladder to the urethral meatus.
C. Accessory Glands
1. Seminal vesicles – located behind
the bladder and in front of the rectum
deliver secretions to the urethra through
the ejaculatory ducts. It is 2 inches;
secrete alkaline fluid and fructose
2. Prostate gland – It surrounds the
base of the urethra and the ejaculatory
duct, secretes a clear fluid with a slightly
acid pH rich in acid phosphatase, citric
acid, zinc, and proteolytic enzymes. It is
shaped like a walnut.
3. Cowper’s gland – also termed as
Bulbourethral gland; 2 pea sized
structure that lies at the base of the
prostate gland and either side of the
membranous urethra. They produce a
clear, alkaline mucinous substance that
lubricates the urethra and coats its
surface.
D. Male Breasts
1. Male mammary tissue remains
dormant throughout life, but the breasts
are a site of sexual excitation and
arousal.
2. Although rare (accounting for less
than 1% of all breast cancers in the
United States), male breast cancer
occur frequently enough to warrant
routine inspection of the breasts for
dimpling, discharge, or nipple inversion.
E. Semen
1. Semen is a thick, whitish fluid
ejaculated by the man during orgasm. It
contains spermatozoa and fructose rich
nutrients. During ejaculation, semen
receives contributions of fluid from the
seminal vesicles and the prostate gland.
Neurohormonal control of the Male
Reproductive System
1. At puberty, the hypothalamus
stimulates the pituitary gland to produce
Follicle Stimulating Hormone (FSH) and
Luteinizing Hormone (LH).
- FSH stimulates germ cells within
the testes to manufacture sperm.
- LH stimulates the production of
testosterone in the testes.
Although LH stimulates the leydig
cells to produce testosterone
from cholesterol, testosterone
inhibits the secretion of LH by the
anterior pituitary gland.
2. Testosterone, one of the several
androgens (and the most potent)
produced in the testes, is responsible for
the development of secondary sex
characteristics at puberty.
a. Testosterone production occurs in the
interstitial Leydig cells in the
seminiferous tubules. Leydig cells are
abundant in the newborn and pubescent
boy, and testosterone is abundant
during these periods.
b. Testosterone production slows after
40 years of age; by 80 years of age,
production is only about one-fifth peak
level.
3. Spermatogenesis (sperm production)
occurs continually after puberty,
providing large numbers of sperm for
unlimited ejaculations during the mature
life span.
 a. Spermatozoa are released
from the epithelial wall of the
seminiferous tubules. Meiosis
occurs during the process, and
the number of chromosomes in
each cell is reduced by one-half
(haploid number).
b. Spermatogenesis is a heat
sensitive process; the 2̊ to 3̊ F
difference between scrotal and
abdominal temperatures allows
spermatogenesis to proceed in
the cooler environment.
c. The entire period of
spermatogenesis, from germinal
cell to mature sperm, takes about
75 days.
SEMEN
60% - Prostate gland
30 % - Seminal vesicle
5% - Epididymis
5% - Bulbourethral gland
3-5 cc (1 tsp) per ejaculation
SPERMATOZOA produced by
testicles
40 – 80 million per cc of semen
300 – 500 million per ejaculation
12-20 days travel mature after 64
days
Female Reproductive System
A. External Structures
1. Mons veneris/Mons pubis – is a
mound of fatty tissue over the
symphysis pubis that cushions and
protects the bone.
2. Labia majora – are longitudinal folds
of pigmented skin extending from the
mons pubis to the perineum.
3. Labia minora – are soft longitudinal
skin folds between the labia majora.
4. Clitoris – is an erectile tissue located
at the upper end of the labia minora. It is
the primary site of sexual arousal.
5. urethral meatus (urethral orifice) –
is a small opening of the urethra. It is
located between the clitoris and the
vaginal orifice for the purpose of
urination
6. perineum – is the area of tissue
between the anus and vagina; an
episiotomy is performed here.
7. vestibule – is an almond-shaped
area between the labia minora
containing the vaginal introitus, hymen,
and Bartholin glands.
9. vaginal introitus – is the external
opening of the vagina.
10. hymen – is a membranous tissue
ringing the vaginal introitus.
the
11. perineal body – is composed of
muscle
B. Internal Structures
1. Vagina – is the female organ of
copulation and also serves as the birth
canal. It is a tubular
musculomembranous organ that lies
between the rectum and the urethra and
bladder. It is 3-4 inches long.
2. Uterus ( “womb”) – is a hollow,
muscular organ with three muscle layers
(perimetrium, myometrium, and
endometrium). It is located between the
bladder and rectum, and consists of
regions the fundus, body (corpus), and
cervix.
a. Menstruation is the sloughing
away of spongy layers of
endometrium with bleeding from
torn vessels.
b. Environment for pregnancy;
the embryo and fetus develop in
the uterus after fertilization.
c. Labor consists of powerful
contractions of the muscular
uterine wall that result in
expulsion of the fetus.
3. Uterine ligaments – this includes:
a. Broad and round ligaments
provide upper support for the
uterus.
b. Cardinal, pubocervical, and
uterosacral ligaments are
suspensory and provide middle
support.
c. Pelvic muscular floor ligaments
provide lower support.
4. Fallopian tube (oviducts) – extend
from the upper outer angles of the
uterus and end near the ovary. It is 4
inches long. These tubes serve as the
passageway for the ovum to travel from
the ovary to the uterus and for the
sperm to travel from the uterus to the
ovary.
Has three segments:
a. Infundibulum – an expanded
funnel near the ovary
b. Ampulla – middle segment
c. Isthmus – a short segment
between ampulla and uterine wall
5. Ovaries – are 2 almond shaped
female sex glands located on each side
of the uterus.
The two functions are:
a. Ovulation (release of ovum)
b. Secretion of hormones
(estrogen and progesterone)
6. Cervix – is a cylinder-shaped neck of
tissue that connects the vagina and
uterus. Located at the lower most
portion of the uterus, the cervix is
composed primarily of fibromuscular
tissue.
C. Accessory glands
1. Breasts (mammary gland) – are
specialized sebaceous glands that
produce milk after childbirth (lactation).
a. Internal breast structures:
• Glandular tissue – parenchyma
is composed of acini (milk
producing) cells that cluster in
groups of 15 to 20 to form the
lobes of the breast. • Lactiferous
ducts or sinuses – form
passageways from the lobes to
the nipple.
 • Fibrous tissue – also called time to detect pathologic changes
Cooper ligaments, provide through breast self examination.
support to the mammary glands.
• Adipose and fibrous tissues
(stroma) provide the relative size
and consistency of the breast.

b. External breast structures;

2. Bartholin or Vulvovaginal gland

- are mucus-secreting glands located on
either side of the vaginal orifice.
4. Skene or Paraurethral glands
– are smallmucus secreting glands that
open into the posterior wall of the
urinary meatus and lubricate the vagina.
● Nipple - is raised, pigmented
area of the breast
● Areola - is a pigmented skin
around the nipple.
● Montgomery tubercles - area
sebaceous glands of the areola
c. The breasts change in size and
nodularity in response to cyclic ovarian
hormonal changes, including:
1. Estrogen stimulation which
produces tenderness
2. Progesterone (Postovulation)
which causes increases
tenderness and breast
enlargement
d. Physical changes in breast and size
and activity are at minimum 5 to 7 days
after menstruation stops; this is the best
 D. Android - is a normal male pelvis
with a heart shaped inlet

Gynecoid is the ideal one for delivering

the baby naturally.
D. Pelvis
1. The pelvis is a bony ring in the
lower portion of the trunk. It 4. Pelvimetry (the process of
consists of 3 parts measuring the internal or external
● ILIUM pelvis) is performed with radiography or
● ISCHIUM by internal examination
● PUBIS
and 4 bones Assessment of Pelvic Adequacy
● TWO INNOMINATE BONES OR ● Clinical Pelvimetry via ultrasound
HIPBONES can be performed to determine if
● SACRUM the pelvis is of adequate size to
● COCCYX allow for a normal vaginal
2. The pelvic bones are held delivery
together by 4 joints ● Manual measurement via
(ARTICULATIONS) examiner
● SYMPHYSIS PUBIS
● TWO SACROILIAC
OOGENESIS- the production or
● SARCOCOCCYGEAL
development of an ovum
3. Types of pelvis include the
following:
A. Gynecoid - is a typical female
pelvis with rounded inlet
B. Anthropoid - is an “apelike”
pelvis with an oval inlet
C. Platypeloid - is a flat, female
type pelvis with a transverse oval
inlet.
 ● The ovaries produce mature
gametes and secrete the
following hormones:
1. Estrogen contributes to the
characteristics to the characteristics of
femaleness (female body build, breast
growth), causes hypertrophy of the
myometrium, proliferates the
endometrium, inhibits production of
follicle stimulating hormone (FSH) and
increases pH of cervical mucus causing
it to become thin and watery
PHYSIOLOGY OF MENSTRUAL (Spinnbarkheit test)
CYCLE
2. Progesterone (hormone of
● Menarche (onset of pregnancy) quiets or decreases the
menstruation) typically occurs contractility of the uterus. It increases
between 10 and 13 years of age. endometrial tortuosity, increases
endometrial secretions, inhibits
● Menstrual Cycle is a monthly production of Luteinizing hormone,
pattern of ovulation and inhibits uterine motility, facilitate
menstruation. transport of fertilized ovum through
● Ovulation is the discharge of a fallopian tube and increases body
mature ovum from the ovary. temperature after ovulation.
Produces 300,000 to 400,000 3. Prostaglandins regulate the
oozytes per ovary in a lifetime. reproductive process by stimulating the
Average cycle is 28 days and a contractility of uterine and other smooth
duration of 3 to 5 days. muscles.
Mittelschmerz is one-sided, lower
andominal pain associated with
THE MENSTRUAL CYCLE
ovulation. It occurs midway
through a menstrual cycle – A. THE FOUR LEVELS
about 14 days before your next 1. CNS RESPONSE - Hypothalamic
menstrual period. It doesn’t pituitary gland action (FSH & LH)
require medical attention. 2. OVARIAN RESPONSE (2 phases
● Menstruation is the periodic - proliferative phase ( 1-14 days;
shedding of blood, mucus and secretory (15 - 22 days )
epithelial cells from the uterus; 3. ENDOMETRIAL RESPONSE ( 4
average blood loss is 50 ml. ( ¼ Phases)
cup); range of 30 to 80 ml of a. MENSTRUAL PHASE ( 1-5 days)
blood. b. PROLIFERATIVE (6 - 14 days)
 c. SECRETORY ( 15 - 26 days )
d. ISCHEMIC ( 27 - 28 days)
4. Cervical Mucus Response
(Ovulatory) 15-23 days
ii. Before Ovulation – ➢ Decrease level of estrogen and increase
Spinnbarkeit/Spinnbarkheit;
mittelschmerz
iii. After Ovulation
B. Phases of Menstrual Cycle
A. Proliferative/Preovulatory/
Follicular Phase (6-14 days)
➢ In a 28 days cycle begins with the end of
menstruation
➢ levels of estrogen and progesterone
➢ Hypothalamus senses the decrease, thus
stimulates the APG to secrete GnRH
prompting the release of FSH which
stimulates the ovaries to produce follicles
(10- 20)
➢ Follicles ripen but only one will mature
which is known as the Graafian follicle
B. Ovulatory Phase (14-15) – Peak
➢ Graafian follicle ruptures and releases the
mature ovum near the fallopian tube.
➢ 2 ova matures –both fertilized
(Fraternal twins)
➢ 1 fertilized ovum divides into 2
separate zygotes (identical twins)
➢ Hypothalamus senses increase level of
estrogen triggers the APG to
release LH which acts with FSH to
cause Ovulation and enhance Corpus
Luteum formation
C. Secretory / Luteal Phase ( 16-28 )
➢ Corpus luteum secretes Progesterone that
maintains the vascularity of the
endometrium
progesterone (hormone of pregnancy)
➢ Cause glands in the endometrium to
secrete nutrients to sustain a fertilized ovum
that is implanted in the uterine wall
➢ If no implantation – Hypothalamus signal
the Pituitary gland to stop producing FSH
and LH
➢ Decrease in FSH and LH causes the
Corpus luteum to decompose in the ovary
and nourishment of the
endometrium stops
D. Menstrual Phase ( 1-5 ) : an end
and a beginning
➢ Decrease in estrogen and progesterone
➢ Lining disintegrates and discharged from
the body
➢ MENSTRUAL FLOW
Climacteric period and Menopause
a. The climacteric is a transitional period
during which ovarian function and
hormonal production decline.
b. Menopause refers to a woman’s last
menstrual period; the average age of
menopause is 51.4 years. However, it is
important to note that women may
ovulate after menopause
Climacteric period and Menopause
● The climacteric is a transitional
period during which ovarian
 function and hormonal production
decline.
● Menopause refers to a woman’s
last menstrual period; the
average age of menopause is
51.4 years. However, it is
important to note that women
may ovulate after menopause
and thus can become pregnant.
The process of Conception
(Fertilization)
PREGNANCY is the term used to
describe the period in which a fetus
develops inside a woman’s womb or
uterus. Pregnancy usually lasts about
40 weeks, or just over 9 months, as
measured from the last menstrual period
to delivery.
● Normal amount of
semen/ejaculation: 3.5 cc
● Number of sperm per cc of
semen – 40 – 80 million
● Number of sperm per ejaculation
– 300 – 500 million
● Mature ovum is capable of being
fertilized for 12 to 24 hours after
ovulation
● Sperm is capable of fertilizing for
3 to 4 days after ejaculation
● Normal lifespan of sperm is 7
days
● Sperm can reach ovum in 1 – 5
mins.
● • Fallopian tube will contract due
to estrogen
● • Sperm must remain in female
genital tract 4 – 6 hours before
they are capable of fertilizing the
ovum
● Sperm have 22 autosomes and 1
X or Y sex chromosomes
● Ova contains 22 autosomes and
1 X sex chromosomes
Process of Pregnancy
1. Ovulation- the ovary releases an egg
2. Fertilization ( sperm meets egg)– the
process in which a sperm penetrates the
outer layer of the ovum.
3. Implantation - when the blastocyst
attaches to the endometrium (7 -9 days
after fertilization).
➢ 50% of zygote never achieve implantation
➢ Small amount of vaginal spotting is
occasionally present
➢ Endometrium turned to decidua:
o decidua basalis – part of the
endometrium in the pregnant human
female that participates with the chorion
in the formation of the placenta.
o decidua capsularis – part of the
decidua in the pregnant human female
that envelops the embryo.
o decidua vera – the altered
endometrium lining the main cavity of
the pregnant uterus Capacitation
Acrosome reaction Fertilization Cortical
and zona 2 nd meoitic metabolic cell
reaction division division ZYGOTE
ZYGOTE (day 1) CLEAVAGE (DAY 1-3)
2-Cell Division 4-Cell Division 8-Cell
Division MORULA (DAY 3-4) 16-50 cells
EARLY BLASTOCYST (Day 4-6) LATE
BLASTOCYST (6 th day) EMBRYO
other than at the site of attachment of
the chorionic sac.
It has 3 processes:
o Apposition – the condition of being development of tissues and organs from
side by side or close together the three primary germ layers of the
o Adhesion – reflects the behaviour of embryo occur as follows:
cells shortly after contact a. Ectoderm. The tissues and
o Invasion – the capacity of the organs that develop from the
trophoblast cells to invade into the ectoderm include the
endometrial stroma and inner third of centralnervous system;
the myometrium and is essential for the peripheral nervous system;
development of the definitive maternal- sensory epithelium of ear, nose,
fetal circulation and for pregnancy eye, sinus, mouth, and anal
success in humans canal; skin (epidermis), hair,
nails, sebaceous glands, sweat
glands, hair follicles; and
Human Development
mammary glands, pituitary gland,
• Late Blastocyst The cells begin to enamel of teeth and oral glands.
differentiate into: b. Mesoderm. The tissues and
● Inner Cell Mass (embryo) organs that develop from the
● Trophoblast Cells (attach to mesoderm include bone,
uterus) cartilage, skeleton; connective
• Trophoblast cells erode the tissue, smooth and striated
endometrium of the uterus so that the muscles; cardiovascular and
Blastocyst burrows into the uterine wall. lymphatic systems; blood and
Endometrium covers the embryo and lymph cells; kidneys and
the blood supply becomes established. reproductive organs;
subcutaneous tissues of the skin;
Stages of fetal Growth and serous membrane lining of the
Development: pericardial, pleural, and
peritoneal cavities; and spleen. c.
c. Endoderm. The tissues and
1. Pre-embryonic stage organs that develop from the
1.1 This stage encompasses the first 14 endoderm include respiratory
days after conception. tract epithelium, epithelial lining
1.2 When the zygote implants in the of gastrointestinal tract ( pharynx,
decidua, approximately 8 to 10 days tongue, tonsils, thyroid,
after fertilization, the structure is referred parathyroid, thymus), epithelial
to as an embryo. lining of urinary bladder and
1.3 After implantation, the embryo urethra, liver, and pancreas.
undergoes rapid growth and
differentiation. Establishment of 2. Embryonic stage
embryonic membranes and
2.1 This stage begins during the third
week after conception and continues
until the embryo reaches a length of 3
cm (1.2 inch) at about the eighth week.
At this time the embryo is referred to as
a fetus.
2.2 During this stage, differentiation of
tissues into organs and development of
main external features occur.
3. Fetal stage
3.1 The fetal stage begins 8 to 10 weeks
after conception and continues until the
end of the pregnancy.
3.2 At this time, the fetus is fully
developed structurally. The remainder of
the gestational period is devoted to
refinement of structures and
organization and perfection of function.
3.3 Fetal circulation differs from
extrauterine blood flow. The fetus
receives oxygen and excretes carbon
dioxide through the placenta. Fetal
lungs are fluid filled and do not function
for gas exchange. There are three
shunts in fetal circulation that must close
at birth: ductus arteriosus, ductus
venosus and the foramen ovale. There
are two umbilical arteries and one vein.
3.4 Usually by the 12th week of
gestation, external genitalia are
developed enough to be distinguishable
with ultrasonography.
3.5 In a female fetus, the ovary has
many primitive follicles and produces
small amounts of estrogen.
3.6 The gonads of men play a critical
role in forming the genital tract. The
testes produce androgenic hormones
that promote growth and differentiation
of male genitalia.
Embryonic and fetal support
structures:
1. The corpus luteum supplies most
of the estrogen and progesterone
in the first 2 gestational months
before the placenta is fully
developed. The persistence of
the corpus luteum in supplying
these hormones is essential for
sustaining the uterine
endometrium and preventing
menstruation.
2. Decidua. The endometrium (the
lining of the inside of the uterus)
becomes the decidua following
conception and implantation. The
portion directly under the
blastocyst, where the chorionic
villa intersect with the maternal
blood vessels is the decidua
basalis. The portion covering the
blastocyst called the decidua
capsularis and the portion lining
the rest of the uterus is the
decidua vera. It will protect and
nourish the developing embryo.
3. Placenta
3.1 The placenta begins to
function by the fourth week of
gestation; by the 14th week, it is
a complete, independently
functioning organ.
3.2 It transmits nutrients and
oxygen to the fetus and removes
waste and carbon dioxide by
diffusion.
3.3 The endocrine gland of b.4. Progesterone
pregnancy, the placenta, maintains uterine lining for
produces the following hormones: implantation.
a. Estrogen (primarily estriol) b.5. It relaxes uterine
a.1. It stimulates the smooth muscle.
growth of uterine muscle c. Human chorionic
(myometrium) and gonadotropin (HCG)
glandular epithelium c.1. HCG is secreted by
(endometrium), and trophoblast cells of the
induces the synthesis of blastocyst (the early
receptors for product of conception) and
progesterone. the placenta (after the
a.2. Estrogen stimulates second gestational
uterine growth and month). It is partly
uteroplacental blood flow. responsible for maintaining
a.3. Estrogen enhances the corpus luteum.
growth of all organs and c.2. HCG is detected in the
ensures nourishment of urine and plasma (by day
developing tissue. 8), and is the first indicator
a.4. It indicates placental of a positive pregnancy.
function, fetal maturity, c.3. HCG levels also may
and fetal well-being (levels be monitored later in
of maternal serum estriol) pregnancy to determine
b. Progesterone (hormone of fetal well-being.
pregnancy) d. Human placental lactogen
b.1. Progesterone (human chorionic
promotes thickening and somatomammotropin)
increased viscosity of d.1 Levels increase after
cervical mucus (the 20 weeks gestation.
mucous plug) to protect d.2. It is a growthlike
the fetus against invading substance that stimulates
bacteria. maternal metabolism.
b.2. Progesterone d.3. It facilitates glucose
decreases motility of transport across the
oviducts and uterus. placenta.
b.3. It stimulates growth of d.4. It also stimulates
glandular breast tissue breast development to
(acini cells) preparation for prepare for lactation.
lactation.

Membranes and Amniotic Fluid
1. Two membranes form to protect
and support the embryo.
a. Chorion, the outside embryonic
membrane
b. Amnion, the innermost
membrane.
2. Amniotic Fluid is contained within
the amnion. Fluid volume
normally ranges from 500 to 1000
ml. The functions of the amniotic
fluid are as follows:
a. Protects the embryo and fetus.
b. Controls temperature.
c. Supports symmetrical growth
d. Prevents adherence to amnion
e. Allows the embryo or fetus to
move within the amniotic cavity
Umbilical Cord
1. At term, it is 30 to 90 cm long and
2 cm in diameter.
2. It contains two arteries and one
vein.
3. Two arteries carry blood from the
fetus to the placenta.
4. One vein returns blood and
nutrients to the fetus.
5. The umbilical cord is normally
inserted at the center of the
placenta.
6. The cord also contains a clear,
jelly-like substance called
Wharton jelly, which is a
connective tissue that prevents
compression of the blood
vessels.
Multiple Pregnancy
1. Approximately 2% of births in the
United States are multiple. Most
involve twins; triplets occur in 1 to
7,600 pregnancies. Multiple births
higher than triplets are rare, but
the incidence is rising due to the
increasing use of gonadotropins
to treat women with ovulatory
failure.
2. Dizygotic (fraternal) multiple
pregnancy involves two or more
ova fertilized by separate sperm.
Fetuses have separate
placentas, amnions, and chorions
(although the placenta may fuse
to resemble a single one) and
may be the same or different
sexes.
3. Monozygotic (identical) multiple
pregnancy develops from a single
fertilized ovum. Fetuses share a
common placenta and chorion
but have separate amnions; they
are the same sex and have the
same genotype.
FETAL DEVELOPMENT
ZYGOTE (1ST 14 DAYS)
EMBRYO (3RD TO 8TH WEEK)
FETUS (8TH WEEK TO BIRTH)
FOCUS OF FETAL DEVELOPMENT
● First Trimester - organogenesis
● Second Trimester - Period of
continued growth and
development
● Third Trimester - Period of most
rapid growth and development
Four weeks (1 month)
● The embryo is 4 to 5 mm in
length.
● Triphoblasts embed in decidua.
● Chorionic villi form.
 ● Foundations for nervous system,
genitourinary system, skin,
bones, and lungs are formed.
● Buds of arms and legs begin to
form.
● Rudiments of eyes, ears, and
nose appear.
Five to Eight weeks (2 months)
● The fetus is 27 to 31 mm in
length and weighs 2 to 4 grams.
● Fetus is markedly bent.
● Head is disproportionately large
as a result of brain development.
● Sex differentiation begins.
● Centers of bone begin to ossify.
Nine to Twelve weeks (3 months)
● The fetus average length is 50 to
87 mm and weight is 45 grams.
● Fingers and toes are distinct.
● Placenta is complete.
● Rudimentary kidneys secrete
urine.
● Fetal circulation is complete.
● External genitalia show definite
characteristics.
Thirteen to Sixteen weeks (4 months)
● The fetus is 94 to 140 mm in
length and weighs 97 to 200
grams.
● Head is erect.
● Lower limbs are well developed.
● Coordinated limb movements are
present.
● Heartbeat is present.
● Lanugo develops.
● Nasal septum and palate close.
● Fingerprints are set.
Seventeen to Twenty weeks (5
months)
● The fetus is 150 to 190 mm in
length and weighs approximately
260 to 460 grams.
● Lanugo covers entire body.
● Fetal movements are felt by
woman.
● Eyebrows and scalp hair are
present.
● Heart sounds are perceptible by
auscultation.
● Vernix caseosa covers skin.
Twenty-One to Twenty-Five weeks (6
months and 1 week old)
● The fetus is about 200 to 240 mm
in length and weighs 495 to 910
grams.
● Skin appears wrinkled and pink to
red.
● Rapid eye movement begins.
● Eyebrows and fingernails
develop.
● Sustained weight gain occurs.
Twenty-Six to Twenty-Nine weeks (7
months and 1 week old)
● The fetus is 250 to 275 mm in
length and weighs about 910 to
1,500 grams.
● Skin is red.
● Rhythmic breathing movements
occur.
● Pupillary membrane disappears
from eyes.
● The fetus often survives if born
prematurely.
Thirty to thirty-Four weeks (8 months
and 2 weeks old)
● The fetus is 280 to 320 mm in
length and weighs 1,700 to 2,500
grams.
● Toenails become visible.
● Eyelids open.
● Steady weight gain occurs.
● Vigorous fetal movement occurs.
Thirty-Five to Thirty-Seven weeks (9
months and 1 week old)
 ● The fetus average length is 330
to 360 mm; weight is about 2,700
to 3,400 grams.
● Face and body have a loose
wrinkled appearance because of
subcutaneous fat deposit.
● Body is usually plump.
● Lanugo disappears.
● Nails reach fingertip edge.
● Amniotic fluid decreases.
Thirty-Eight weeks (Full Term)38-42
weeks
● The average fetus is 360 mm in
length and weighs 3,400 to 3,600
grams.
● Skin is smooth.
● Chest is prominent.
● Eyes are uniformly slate colored.
● Bones of skull are ossified and
nearly together at sutures.
● Testes are in scrotum.
b.6. Common Teratogens and their
effects
Teratology is the study of abnormal
development in embryos and the causes
of congenital malformations or birth
defects. These anatomical or structural
abnormalities are present at birth
although they may not be diagnosed
until later in life. They may be visible on
the surface of the body or internal to the
viscera. Congenital malformations
account for approximately 20% of
deaths in the perinatal period.
Approximately 3% of newborn infants
will have major malformations and
another 3% will have malformations
detected later in life.
Nicotine does not produce congenital
malformations but nicotine does have a
effect on fetal growth. Maternal smoking
is a wellestablished cause of intrauterine
growth restriction. Heavy cigarette
smokers were also more likely to have a
premature delivery. Nicotine constricts
uterine blood vessels and causes
decreased uterine blood flow thereby
decreasing the supply of oxygen and
nutrients available to the embryo. This
compromises cell growth and may have
an adverse effect on mental
development.
Alcohol is a common drug abused by
women of childbearing age. Infants born
to alcoholic mothers demonstrate
prenatal and postnatal growth
deficiency, mental retardation, and other
malformations. There are subtle but
classical facial features associated with
fetal alcohol syndrome including short
palpebral fissures, maxillary hypoplasia,
a smooth philtrum, and congenital heart
disease. Even moderate alcohol
consumption consisting of 2 to 3 oz. of
hard liquor per day may produce the
fetal alcohol effects. Binge drinking also
likely has a harmful effect on embryonic
brain developments at all times of
gestation.
Tetracycline, the type of antibiotic, can
cross the placental membrane and is
deposited in the embryo in bones and
teeth. Tetracycline exposure can result
in yellow staining of the primary or
deciduous teeth and diminished growth
of the long bones. Tetracycline
exposure after birth has similar effects.
Anticonvulsant agents such as
phenytoin produce the fetal hydantoin
syndrome consisting of intrauterine
growth retardation, microcephaly,
mental retardation, distal phalangeal
hypoplasia, and specific facial features.
Anti-neoplastic or chemotherapeutic
agents are highly teratogenic as these
agents inhibit rapidly dividing cells.
These medications should be avoided
whenever possible but are occasionally
used in the third trimester when they are
urgently needed to treat the mother.
Retinoic acid or vitamin A derivatives
are extremely teratogenic in humans.
Even at very low doses, oral
medications such as isotretinoin, used in
the treatment of acne, are potent
teratogens. The critical period of
exposure appears to be from the second
to the fifth week of gestation. The most
common malformations include
craniofacial dysmorphisms, cleft palate,
thymic aplasia, and neural tube defects.
The tranquilizer thalidomide is one of
the most famous and notorious
teratogens. This hypnotic agent was
used widely in Europe in 1959, after
which an estimated 7000 infants were
born with the thalidomide syndrome or
meromelia. The characteristic features
of this syndrome include limb
abnormalities that span from absence of
the limbs to rudimentary limbs to
abnormally shortened limbs.
Additionally, thalidomide also causes
malformations of other organs including
absence of the internal and external
ears, hemangiomas, congenital heart
disease, and congenital urinary tract
malformations. The critical period of
exposure appears to be 24 to 36 days
after fertilization.
Infectious agents can also cause a
variety of birth defects and mental
retardation when they cross the
placenta and enter the fetal blood
stream. Congenital rubella or German
measles consists of the triad of
cataracts, cardiac malformation, and
deafness. The earlier in the pregnancy
that the embyro is exposed to maternal
rubella, the greater the likelihood that it
will be affected. Most infants exposed
during the first four to five weeks after
fertilization will have stigmata of this
exposure. Exposure to rubella during
the second and third trimester results in
a much lower frequency of
malformation, but continues to pose a
risk of mental retardation and hearing
loss.
Congenital cytomegalovirus infection
is the most common viral infection of the
fetus. Infection of the early embryo
during the first trimester most commonly
results in spontaneous termination.
Exposure later in the pregnancy results
in intrauterine growth retardation,
micromelia, chorioretinitis, blindness,
microcephaly, cerebral calcifications,
mental retardation, and
hepatosplenomegaly.
Ionizing radiation can injure the
developing embryo due to cell death or
chromosome injury. The severity of
damage to the embryo depends on the
dose absorbed and the stage of
development at which the exposure
occurs. Study of survivors of the
Japanese atomic bombing
demonstrated that exposure at 10 to 18
weeks of pregnancy is a period of
greatest sensitivity for the developing
brain. There is no proof that human
congenital malformations have been
caused by diagnostic levels of radiation.
However, attempts are made to
minimize scattered radiation from
diagnostic procedures such as x-rays
that are not near the uterus. The
standard dose of radiation associated
with a diagnostic x-ray produces a
minuscule risk to the fetus. However, all
women of childbearing age are asked if
they are pregnant before any exposure environmental and genetic factors.
to radiation. Development of the malformation is
dependent upon passing a threshold
Maternal medical conditions can also that is the sum of a combination of many
produce teratogenic risks. Infants of of these factors. Traits that demonstrate
diabetic mothers have an increased this mode of inheritance include cleft lip,
incidence of congenital heart disease, cleft palate, neural tube defects, pyloric
renal, gastrointestinal, and central stenosis, and congenital dislocation of
nervous system malformations such as the hip.
neural tube defects. Tight glycemic
control during the third to sixth week CALLAO
post-conception is critical. Infants of
mothers with phenylketonuria who are
not well controlled and have high levels derived from any such activity depends
of phenylalanine have a significant risk upon the person and the circumstance.
of mental retardation, low birth weight, Example: Pornography
and congenital heart disease.
C.4 PATTERNS OF SEXUAL
RESPONSES
Mechanical forces can also act as
teratogens. Malformations of the uterus
may restrict fetal movements and be
associated with congenital dislocation of 1. Sexual Response Cycle is
the hip and clubfoot. Oligohydramnios composed of FIVE DISTINCT
can have similar results and PHASES:
mechanically induce abnormalities of
the fetal limbs. These abnormalities a. First phase is DESIRE– it is a
would be classified as deformations or prelude to sexual excitement and
abnormal forms, shapes, or positions of sexual activity – it occurs in the
body parts caused by physical mind rather than the body and
constraints. may not progress to sexual
excitement without further
Amniotic bands are fibrous rings and physical or mental stimulation. It
cause intrauterine amputations or is communicated between
malformations of the limbs as well. potential sexual partners either
These abnormalities would be classified verbally or through body
as disruptions or defects from language and behaviour.
interference with a normally developing Example: Flirting
organ system usually occurring later in
gestation. Most common congenital b. Second phase is
malformations have familial distributions EXCITEMENT (Arousal) – is the
consistent with multifactorial inheritance. body’s physical response to
desire. A person who manifests
Multifactorial inheritance may be the physical indications of
presented by a model in which liability to excitement is termed to be
a disorder is a continuous variable that “aroused” or “excited”. It can
is dependent on a combination of be communicated between
partners verbally, through body
 language, through behaviour, or
through any body changes.
c. Third phase is PLATEAU–
the highest moment of sexual
excitement before orgasm, may
be achieved, lost, and regained
several times without the
occurrence of orgasm. It can be
communicated between partners
verbally, through body language,
through behaviour or through any
of the following physiological
changes.
d. Fourth phase is ORGASM –
occurs at the peak of the plateau
phase. The sexual tension that
has been building throughout the
body is released, and the body
releases chemicals called
“endorphins”, which cause a
sense of well-being. Orgasm can
be achieved through mental
stimulation and fantasy alone, but
more commonly is a result of
direct physical stimulation or
sexual intercourse.
e. Fifth phase is RESOLUTION
– is the period following orgasm,
during which muscles relax and
the body begins to return to its
pre-excitement state.
2. Male responses
Excitement phase
● Penile erection begins
● Scrotal skin becomes congested
and thick
● Testes elevate into the scrotal
sac
● Some nipple erection occur
● Flushing may occur
● Heart rate and blood pressure
begin to increase
● Generalized muscle tension
increases, with a tendency
toward involuntary muscle
contractions.
Plateau Phase
● The penis further enlarges,
sometimes undergoing color
changes corresponding to
reddening of the female labia
● Pre orgasmic emission may
occur from Cowper glands
● The testes continue to be
elevated, enlarge, and rotate
(approximately 30 degrees)
● Heart rate, blood pressure, and
respiratory rate continue to
increase
● Muscle tension increases
Orgasmic phase
● Rhythmic contractions expel
semen from the epididymis
through the vas deferens,
seminal vesicles, prostate gland,
urethra, and urethral meatus
● Testes are at maximum
elevation, size and rotation
● Flushing reaches its peak
● Heart and respiratory rates also
peak
● A general loss of voluntary
control occurs
● A refractory period begins as the
final contractions of the urethral
walls occur
Resolution phase
● More than 50% of the erection is
lost rapidly in the first phase of
 resolution, with the penis
gradually returning to its
unstimulated size during the
second phase
● The scrotum gradually loses its
congested and thick status
● The testes descend and return to
normal size
● Nipple erection subsides
● Flushing disappears
● Heart rate, blood pressure, and
respiratory rate return to normal
● General muscle relaxation occurs
1. Female responses
Excitement phase
● Vaginal lubrication increases
● The inner two thirds of the vagina
begins to lengthen and distend,
the outer one third undergoes
slight thickening, and the body of
the uterus is pulled upward. The
vaginal walls become congested
with blood and darken in color,
and the clitoris increases in
diameter, possibly with slightly
increased occur in the labia
majora, labia minora,tumescence
of the glans clitoris
● The labia minora become
engorged with blood and incease
in size
● The labia majora flatten
somewhat and retract away from
the middle of the vulva
● The nipples become erect and
breast size increases
● Flushing occurs in approximately
75% of women
● Overall muscle tension increases
Plateau phase
● The walls of the outer one third of
the vagina become further
engorged with blood, decreasing
the internal vaginal diameter
● The labia minora become further
engorged with blood and darken
and swell
● The clitoris retracts and is
covered by the clitoral hood; the
clitoral body decreases in size by
about 50%
● The nipples become further
engorged
● Flushing may spread to the
abdomen, thighs, and back
● Muscle tension increases.
Breathing becomes deeper; heart
rate and blood pressure increase
markedly as tension rises toward
orgasm
Orgasmic phase
● Strong muscular contractions
occur in the outer one third of the
vagina, and the inner two thirds
expands
● The uterine muscles contract
● No observable changes occur in
the labia majora, labia minora,
clitoris, or breasts
● Flushing reaches a peak heart
rate of color intensity and
distribution
● Possibly strong muscular
contractions, both voluntary and
involuntary, may occur in many
parts of the body, including the
rectal sphincter muscle
● Respiratory rate may reach a
peak of two to three times
normal, heart rate may double,
and blood pressure may increase
as much as one third above
normal
Resolution phase
● Blood engorging the walls of the
outer one-third of the vagina
disperses rapidly
 ● The inner two thirds of the vagina
gradually shrinks, and color
returns to pre-excitement shade
● The uterus descends, and the
cervix dips into the seminal pool
● The labia minora and majora
return to unstimulated thickness
and close toward the midline
● The clitoris protrudes from under
the clitoral hood, and eventually
returns to prestimulated size
● Flushing disappears
● Muscles relax quickly
● Heart rate and blood pressure
return to normal
Differences in Male and Female
sexual response
1. Women have three identifiable
sexual response patterns.
a. Rapid progression to
plateau phase with some
peaks and valleys, and
one intense orgasm,
followed by rapid
resolution; resembles the
male pattern
b. Steady progression to
plateau phase, followed by
an intense orgasm and
possibly subsequent
orgasms, with slower
resolution
c. Slower progression to
plateau phase, followed by
minor surges toward
orgasm, causing
prolonged pleasurable
feelings without definitive
orgasm
2. Men have one basic sexual
response pattern – excitement
progresses steadily to plateau
stage, with one intense orgasm,
followed by resolution.
3. In general, women experience
orgasms in a wider range of
duration and intensity than do
men.
4. Female orgasmic contractions
last twice as long as the man’s
contractions; however, the
strength of the contractions is not
as markedly concentrated in the
first few pulsations.
Sexual concerns related to
pregnancy
1. During pregnancy, the woman’s
desire for sex may be altered
owing to fatigue, nausea, and
other discomforts of pregnancy.
2. Breasts may be painful to touch,
especially during the first
trimester.
3. Some men may find the normal
increase in the amount and odor
of vaginal discharge during
pregnancy a “turn off”; others do
not.
4. Other sexual concerns during
pregnancy include dyspareunia
and male erectile dysfunction.
5. Some women and couples need
“permission” to be sexually active
during pregnancy, along with
reassurance that female orgasm
will not harm the fetus.
6. For a couple who cannot have or
who choose not to have
intercourse during pregnancy,
kissing, hugging, and oral or
manual genital stimulation can be
satisfying expressions of
closeness and intimacy.
Sexual orientation and expression
1. Sexual orientation refers to a
person’s preference for
heterosexual, homosexual, or
bisexual relationships.
 Preference may vary during a
person’s lifetime and is probably
shaped by a complex interaction
of several factors including
prenatal hormone environment,
early parental interactions, social
mores and values, family
dynamics, and imitation of the
most valued parent.

TAROJA

CALLAO ● LIGHTENING- nestling of the

CALO fetal presenting part into the
TAROJA pelvis
● ENGAGEMENT- settling of the
fetal presenting part into the
COMPONENTS OF LABOR
ischial spine
1. Passageway - mother’s pelvis, ● STATION- relationship of the
cervix, and vagina fetal presenting part to the level
2. Passenger - fetus and placenta of the ischial spine
3. Power - uterine contraction,
uterine muscles, and mother’s
ability to push
4. Psyche - mother’s psychological
condition
DILATATION
● opening of the cervial os
● from 1 cm – 10 cms (fully dilated
cervix)
● due to uterine contraction and
amniotic fluid
EFFACEMENT
● thinning of the cervical canal
● expressed in % (100% is a fully
dilated cervix)

THE VAGINA
Vaginal Canal FETAL ATTITUDE
● has rugae and capable of ● the degree of flexion that the
stretching but can be lacerated: fetus assume
A. 1st degree – skin
B. 2nd degree – skin and
muscles
C. 3rd degree – external
sphincter of rectum
D. 4th degree – mucus
membrane of rectum
Perineum
site of episiotomy:
a. Median episiotomy FETAL LIE - Relationship of the long
b. Right mediolateral axis of the fetus to the long axis of the
c. Left mediolateral mother
PRESENTATION - Body parts that will
first contact the cervix

1. Vertical cephalic presentation

2. Vertical breech presentation

Position

Position of the fetal presenting part to

the specific quadrant of mother’s pelvis

Division of Pelvis

Anterior
Posterior

The Placenta

THE PLACENTA
1. Placental Separation
a. Calkin sign/ globular sign of
the fundus
b. The fundus rising in the
abdomen
c. Sudden gush of blood
d. Lenghtening of the cord
2. Placental Delivery
a. Duncan delivery
b. Schultz delivery

III POWER

A. Uterine Contraction
Characteristic of contraction: PRELIMINARY SIGNS OF LABOR
1. Duration – from the beginning 1. Lightening
of the first contraction until 2. Loss of Weight
the end of that same 3. Increase in activity level
contraction 4. Braxton Hick’s contraction
2. Interval – from the end of the
5. Ripening of the cervix
first contraction until the
beginning of the next 6. Rupture of the membranes
contraction 7. Bloody show
3. Intensity – it is the strength of
a contraction STAGES OF LABOR
4. Frequency – from the First stage – Dilatation stage
beginning of the first Latent Phase
contraction until the beginning
Active Phase
of the next contraction
Transitional Phase
Second Stage FIRST STAGE
– Fetal expulsion stageOFLABOR
INCREMENT – when the contractions gets CRITERIA LATENT ACTIVE TRANSITIONAL
Third Stage
0-3–cms
stronger and more painful Placental Stage4-7 cms
Dilatation 8-10 cms
ACME – when the contraction reaches its peak IntensityFourth Stage
mild- Recovery moderate strong
DECREMENT – when the contraction slowly Duration 15-30 secs 30-60 secs 60-90 secs
fades Interval 15-30 mins 3-5 mins 2-3 mins
Length 8-12 hrs 2-3 hrs 1 hr
Emotion excited fear irritable
DIFFERENCE BETWEEN FALSE AND TRUE LABOR
Diet DAT-soft NPO NPO
BOW IBOW RBOW ARM
FALSE LABOR
TRUE
LABOR
Irregular interval contractions
Regular interval of
contraction
Pain in the abdomen
Starts at the back to
abdomen
Intensity remains the same
Contractions are intensified NURSING CARE DURING THE 1ST STAGE
Intervals remain long 1. Admission care
Intervals gradually 2. Data gathering
shorten 3. Assissting IE
Walking gives relief 4. Leopold’s manuever
Intensified by walking 5. Fetal Heart Tone (FHT)
No bLOody show Monitoring
With bloody show 6. Uterine Contraction Monitoring
No cervical changes
Cervical dilatation and 7. Promote change in position
effacement 8. Empty the bladder
Contractions stops with sedation 9. Hygiene
Does not stop with 10. Enema administration ( Fleet
sedation enema )
11. Perineal preparation
 12. Analgesic administration as 10. Pull head downward and upward
ordered to deliver the shoulders
13. Assist in the administration of 11. Deliver the body
regional anesthesia 12. Take note of time of delivery and
14. Start IVF as ordered sex of the baby
15. Assist in amniotomy ( Allis Forcep 13. Place baby on mother’s abdomen
or Amniotome ) 14. Palpate for the pulsation of the
16. Watch out for SUBIRBA cord, if pulsations stops…
17. Emotional support 15. Clamp the cord 1 inch using
plastic clamp from baby’s
When to position patient for Delivery? abdomen
16. Milk the cord at least 2 cms
towards the vulva, then …
S – Severe uterine contraction
17. Clamp with a forcep, then…
U – Urge to defecate
18. Cut the cord between the 2
B – Bearing down sensation
clamps but should be near the
I - Increase bloody show
plastic clamp.
R – Ruptured Bag of Water
B – Bulging of the perineum
A – Anal dilatioN THIRDSTAGE OF LABOR
(PLACENTAL STAGE)
CARDINAL MOVEMENTS OR 1. Placental Separation
a. Calkin’s sign-uterus
MECHANISMS OF LABOR becomes globular and firm
1. Engagement/ Descent b. Uterus rises
2. Flexion above the abdomen
3. Internal Rotation c. Sudden gush of
4. Extension blood
5. External Rotation d. Lenghtening of the
6. Expulsion cord
2. Placental delivery
Schultz delivery – fetal,
NURSING CARE ON SECOND STAGE shiny
1. Litothomy position Duncan Delivery –
2. Perineal flushing maternal, dirty, rough
3. Drape aseptically
4. Teach breathing technique during
uterine relaxation
NURSING CARE ON THIRD STAGE
1. Wait for signs of placental
5. Teach pushing technique during
separation
uterine contraction
2. Do Brandt Andrew’s Manuever
6. Assist episiotomy
(coiling of the cord to facilitate
7. Do Ritgen’s maneuver ( applying
delivery of placenta)
pressure on the perineum to
3. Do Crede’s manuever( pressure
prevent further bleeding and
applied on abdomen to facilitate
laceration)
delivery of placenta)
8. Ease head out, wipe face and do
4. Gently pull the placenta
initial suctioning
downward
9. Wait for external rotation
 5. Take not for the time of placental
delivery
6. Check for type of placental
delivery:
7. Take BP (baseline for Methergine
administration)
8. Check for completeness of
cotyledons
9. Promote uterine contraction:
massage the
hypogastric area
Apply ice pack on the
hypogastric area
Administer medication:
Oxytocin/Maleate(Methergine)
Empty the bladder
10. Inspect perineum for lacerations
11. Assist in episiorrhapy( surgical
repair of episiotomy)
12. Do perineal care
13. Apply contoured brief/adult
diaper
14. Make patient comfortable
NURSING CARE ON FOURTH STAGE
1. Assess fundus
2. Check for bleeding
3. Check the bladder
4. Check the perineum
5. Take vital signs every 15 minutes
6. Promote rest
CALO (P7-12)
a.3. In a healthy fetus, fetal movement
causes an accelerated heart rate; in this
case, the test is reactive.
a.4. Among the various assessment
protocols, the most common involves
two FHR accelerations within a 10-
minute period, with each acceleration
increasing the heart rate by at least 15
beats Per minute and lasting at least 15
seconds.
a.5. The fetus typically is monitored for
at least 40 minutes (To account for a
normal sleep period); the entire tracing
is then evaluated.
a.6. Abnormal or nonreactive NST
results require further evaluation that
same day.
a.7. Even with a reactive NST,follow-up
is indicated if the FHR falls outside the
range of 120 to 160 beats per minute or
if decelerations (early,late,or variable)
are detected.
b. CST. (CONTRACTION STRESS
TEST)
b.1 The test would not be performed
until about 38+ weeks and only if there
were other indications of a problem like
the biophysical profile or MSAFP.
Delivery of the compromised fetus
would be the goal of such testing to
protect its welfare. There are two ways
to do this: nipple stimulation and
intravenous oxytocin drip.
b.2. Perfusion through the spinal
arteries of the uterus decreases during
contractions. Recordings of the heart
rate of the fetus with limited reserve
show late decelerations in response to
the stress of contractions ( a positive
CST finding ). The healthy fetus
responds to the stress of contractions
with a normal heart rate and no
decelerations apparent on the fetal
monitoring strip (a negative CST result).
b.3. During fetal testing, contractions
may occur spontaneously; most often,
however, stimulation will be necessary.
This is done either by breast stimulation
(e.g. nipple rolling or application of moist
hot pads) to trigger prolactin release or
by low-dose intravenous oxytocin
infusion (oxytocin challenge test) OCT.
b.4. Three contractions within 10
minutes, ideally lasting 40 to 60
seconds.
b.5. During the OCT, oxytocin may
precipitate labor.
Other Procedures:
1. Fetal activity determination
also referred to as “kick
counts”, are assessed by
the mother, and a marker
is placed on the monitor
strip. Fetal heart rate in
relation to fetal movement
is evaluated. There should
be a slight rise in fetal
heart rate immediately
before movement. The
heart rate should remain
within normal limits. These
are usually done when the
mother reports a sampling
decrease, or absence, of
fetal movement.
2. Routine Maternal
urinalysis and serum
assays help monitor fetal
status. For example,
serum human chorionic
gonadotropin indicates a
viable fetus, and serum
estriol and human
placental lactogen reflect
fetal homeostasis.
3. Triple screening includes
MSAFP, human chorionic
gonadotropin and
unconjugated estriol.
Together they increase the
detection of trisomy 18
and trisomy 21. They are
performed between 15 and
22 weeks and are
considered positive if all
three markers are low.
Further testing for
karyotyping is usually
offered.
4. CVS is a first-trimester (10 to 12
weeks) alternative to amniocentesis for
prenatal diagnosis of genetic
abnormalities. This procedure is
accomplished by needle aspiration of a
sample of chorionic villi, either by the
trancervical or transabdominal route.
5. Amniocentesis can determine fetal
maturity, and detect certain birth defects
(eg. Down syndrome or spina bifida)
hemolytic disease of the newborn and
sex and chromosomal abnormalities.
6. Percutaneous umbilical blood
(PUBS) also called
cordocentesis, may be performed in
the second or third trimesters to
investigate or treat conditions requiring
direct access to the fetal vascular
system.
7. Fetoscopy enables direct fetal
visualization through a fetoscope, a
fiberoptic optical instrument, inserted
through the abdominal and uterine walls
to identify fetal developmental
abnormalities. The fetoscope can
retrieve tissue and blood samples to
detect hemophilia or other disorders and
may be used for some types of fetal
surgery.
 PREGNANCY – normal female
physiologic process
1. Definition of terms:
a. Gravida – A woman who is
pregnant.
b. Para – The number of pregnancies
in which the fetus or fetuses have
reached viability, not the number of
fetuses delivered. Whether the fetus is
born alive or is stillborn after viability is
reached does no affect parity.
c. Primipara – A woman who has
completed one pregnancy with a fetus
or fetuses who have reached the age of
fetal viability.
d. Primigravida – A woman who is
pregnant for the first time.
e. Multipara – A woman who has
completed teo or more pregnancies to
the stage of fetal viability.
f. Multigravida – A woman who
has had 2 or more pregnancies.
g. Nullipara – A woman who has
not completed a pregnancy with a
fetus or fetuses who have reached
the stage of fetal viability
h. Parturient – A woman in labor.
i. Gravidity - Pregnancy
NORMAL ADAPTATION IN
PREGNANCY
REPRODUCTIVE SYSTEM:
Uterus – uterine growth and
enlargement
length – 6.5 cms to 32 cms
width - 4 cms to 24 cms
depth – 2.5 cms to 22 cms
weight – 50 gms to 1000 gms
volume – 1–2 ml to 1000 ml
- Braxton Hicks contraction (4th month)
– painless contraction
- becomes globular (4th month)
- Hegar’s sign (8th week)- softening of
the lower uterine segment
- Piscacek sign – enlargement and
softening of the uterus
Cervix - Goodell’s sign (4th week) –
softening of the cervix
Vagina - Chadwick’s sign (8th to 10th
week)- blue-purple coloration due to
increase vascularization
- more acidic (ph 3.5 to 6)
Ovaries - no ovulation
Breasts - enlarged
- Colostrum may leak or be expressed
from the breast during the last 3 months
of pregnancy
MUSCULOSKELETAL SYSTEM
● waddling walk
● symphysis pubis may separate
slightly
CIRCULATORY SYSTEM
● increased blood volume 40% to
50%
● physiologic anemia
● heart is displaced upward
● increased cardiac output to 30%
● supine hypotension
● increased WBC
 ● CR & PR increased to 10 -15 placenta – 1 lb
beats/min.
● varicosities and edema amniotic fluid – 1.5 lbs

uterus – 2 lbs
INTEGUMENTARY SYSTEM
blood volume – 1 lb
● increased pigmentation
● chloasma/melasma breasts – 1.5 – 3 lbs
● striae gravidarum
● linea negra fluid – 2 lbs
● increased perspiration
fats – 4 -6 lbs
total : 20 – 25lbs
GASTROINTESTINAL SYSTEM
● morning sickness
● heartburn
● constipation

RESPIRATORY SYSTEM SIGNS OF PREGNANCY

● Increased RR FIRST TRIMESTER

● dyspnea
● increased tidal volume
● increased vital lung capacity
● decreased residual volume
URINARY
Presumptive signs: (subjective)
● amenorrhea, morning sickness,
breast changes, fatigue, urinary
frequency, enlarging of uterus,
Quickening

● urinary frequency Probable signs: (objective)

● increased GFR (Glomerular
filtration rate) -glucose spillage ● Chadwick’s sign, Goodells,
in urine Hegars, (+)HCG,

ENDOCRINE SYSTEM Positive sign:

● increased metabolism of CHON ● ultrasound result, fetal

and CHO movement,FHB
● increased insulin production

SECOND TRIMESTER
WEIGHT GAIN Presumptive signs:
● weight distribution: ● quickening, skin pigmentation,
fetus – 7 lbs chloasma, linea negra, striae
gravidarum
Probable signs:
● enlarged abdomen, Braxton
Hick’s, Ballotement ( feeling the
rebound of the fetus following a
quick digital tap on the wall of the
uterus)
Positive sign:
FHT, fetal movements, fetal X ray
PRENATAL CARE
1. Health history
a. Current pregnancy history – should
include first day of the LMP, cramping or
bleeding, results of the pregnancy test,
and discomfort (e.g. nausea, vomiting,
headache, urinary frequency, and
fatigue).
b. History of previous pregnancies –
should include gravida, para, number of
abortions, number of living children,
prenatal education, ceasarean births,
length of labor, stillbirths, preterm
labors, gestational age, and birth weight.
c. Gynecologic history – should
include previous infections, previous
surgery, age of menarche and
menstrual cycle, and sexual, menstrual,
and contraception history.
d. Current medical history- should
include weight, blood type and
Rh,medications presently taking (ie,
prescription and OTC), habits (smoking,
alcohol, caffeine or drugs), allergies,
potential teratogenic effects on this
pregnancy (infections, medications,
radiographs, or toxins in home or
workplace), medical conditions
( diabetes, hypertension, cardiovascular,
renal, or congenital), and
immunizations.
e. Medical history – should include
childhood diseases, medical diseases
and treatment, sexually transmitted
diseases, surgeries, bleeding disorders
or previous blood transfusions,
emotional problems, and accidents.
f. Family medical history – should
include medical disorders (eg, cancer,
heart disease, or diabetes), multiple
births, and genetic or congenital
disorders.
g. Occupational history – should
include type of work and health hazard
h. History of the baby’s father –
should include age, health problems,
habits, blood type and Rh, genetic or
congenital disorders, occupation, and
attitude toward the pregnancy.
i. Personal information – should
include racial, cultural, and religious
practices; exercise; housing and living
conditions; income; support system; use
of health care system; and work.
j. Nutritional assessment should
include:
● Review of dietary intake of iron
and iron supplements
● 24 hour diet recall
● Comparison of prepregnancy
weight with weight gained during
the pregnancy:
● During the course of the
pregnancy, a total weight gain of
24 to 30 lbs.
● A normal pattern of weight gain is
1.5 lb. in the first 10 weeks(2 ½
mos.); 9 lbs. at 20 weeks (5mos);
 19lbs. By 30weeks(7 ½ mos); ● persistent infection
27.5 lbs by 40 weeks (9 mos)
● Nondietary factors affecting c. Chills and fever
weight gain include increased
blood pressure and excess fluid ● infection
retention. ● dehydration

OBSTETRICAL DATA
1. Last Menstrual Period (LMP) -1st
day of last menstruation
2. Age of Gestation (AOG)
- by weeks(based on LMP)
- Mc Donald’s Method (FH/4=in
months)
- Bartholomew’s rule(relative
position of the uterus in abdominal
cavity)
3. Gravida Para Abortion (GPA) -
Pregnancy
4. Term Preterm Abortion Living
(TPAL) - person
5. Expected Date of Confinement
(EDC)
- Naegel’s rule (-3+7+1)
6. Estimated Fetal Weight (EFW) –
FH-NxK (constant 155)
N= 11(not engaged)
N= 12 (engaged)

PHYSICAL ASSESSMENT
observe for danger signs of pregnancy:
a. Vaginal bleeding-
● Placenta previa
● Abruptio placenta
● Premature labor
● Threatened abortion
b. Persistent vomiting
● hyperemesis gravidarum