OBSTETRIC NURSING (NORMAL)  Most proximal

 Most dangerous
site for ectopic
pregnancy
REPRODUCTIVE SYSTEM:
b) Isthmus  Length: 2 cm
A. INTERNAL STRUCTURES:
 NARROWEST
1) OVARIES
 Site for Bilateral
 SHAPE: Almond-shaped
Tubal Ligation (BTL)
 COLOR: Grayish-white
c) Ampulla (Middle/  Length: 5 cm
 FUNCTIONS:
Outer third/  LONGEST
a) EXOCRINE function: secretes
Second half)  WIDEST
mucus
 MOST COMMON
1. Ovum production
site for ectopic
b) ENDOCRINE function:
pregnancy
secretes hormones
 Site of fertilization
1. Estrogen
 Hormone of the d) Infundibulum  Length: 2 cm
female’s secondary sex  Most distal
characteristics  Site of fimbriae
2. Progesterone ovarica
 Hormone of the
pregnant/mother 3) UTERUS
 3 LAYERS OF OVARY: CCC  Organ of reproduction &
a) Cover Protective menstruation
Layer/Epithelium/ Tunica  It is a floating organ which is
Albuginea needed ligaments
 Outermost layer  SHAPE:
 FUNCTION: Protect the a) Non-Pregnant: Pear-shaped/
ovaries inverted avocado
b) Cortex (Middle, functional b) Pregnant: ovoid-shaped
layer)  WEIGHT:
 Site of ovum maturation a) Non-Pregnant: 60 g (2 oz.)
IMMATURE OVUM  MATURE b) Pregnant: 1000 g
OVUM c) Postpartum: 80 g
 3 MAIN PARTS: CIC
GRAAFIAN
a) Corpus
FOLLICLE
 Center/Body of the uterus
PRIMORDIAL  High
 ABC:
FOLLICLE amounts of
1. An uppermost
ESTROGEN
portion of uterus
 Some
2. Body/Bulk of organ
progesterone
(2/3 of the uterus)
3. Contains the growing
c) Central Medulla
fetus
 Innermost layer
 SHAPE: Upper, triangular
 Location of the blood
portion
vessels, nerves,
 2 IMPORTANT PARTS:
lymphatics, smooth
1. Cornua
muscles
 Where the fallopian
tubes are attached
2) FALLOPIAN TUBE
2. Fundus
 ANOTHER TERM: Oviducts
 Force of uterine
 SHAPE: Funned-shaped
contractions
 4 PARTS: IIAI
 Use to measure
a) Interstitial  Length: 1 cm fundic height
(Intramural)  SHORTEST
 THICKEST
 (from symphysis  Lowest uterine segment
pubis to fundus)  “neck” of the uterus
 Needs to be  “floor” of the uterus
palpated  Lowest cylindrical portion
abdominally  3 MAIN LAYERS: PME
 D’ uppermost and a) Perimetrium (Parietal
cylindrical portion Peritoneum)
of the corpus  Outermost layer
 Used to measure  Attached at broad ligament
fundic return  FUNCTIONS:
 Site of placental 1. Protects the uterus
implantation (upper 2. Strengthens the uterus
posterior part) b) Myometrium (Living
 Placenta at Ligature)
Lower  Middle, largest, muscular
posterior part: layer
Placenta  The power of labor
previa  The muscles of delivery
 Classical c) Endometrium (Layer of
Cesarean Section: Menses)
VERTICAL CUT  Innermost layer
 Site of incision:  Highly vascular
FUNDUS  During NON-PREGNANT
 Performed State:
during 1. Endometrium sloughs
emergency off
cases (e.g. 2. occurrence of menses
abruptio  During PREGNANT State:
placenta) 1. No slough off
 No chance for 2. Forms into a DECIDUA
future NSVDs, (pregnant uterus)
or else,  After Delivery:
UTERINE 1. Forms into a LOCHIA
RUPTURE  In NON-PREGNANT: 2
happens. LAYERS of
b) Isthmus ENDOMENTRIUM
 Lower uterine segment BASAL  Stable
 Site for LTCS (Low LAYER  Uninfluenc
Transverse Cesarean (Stratum ed by
Section) basalis) hormonal
 MOST COMMON changes
Cesarean Section GLANDULA  Unstable
 Site of incision: R LAYER  Influenced
ISTHMUS (stratum by
 NAME of Incision: functionalis) hormonal
Pfannenstiel changes
incision (Bikini cut)  Sloughs off
 (+) Chance for during
NSVDs (called menses
VBAC – Vaginal  In PREGNANT: 3 LAYERS
Birth After of ENDOMENTRIUM
Cesarean Delivery) (Decidua)
 Performed during DECIDUA  BASE
elective cases BASALIS  Site of
c) Cervix implantatio
 n  for post-term labor (To
 Underlying induce labor)
the fetus  E.g. POMS
DECIDUA  Encapsulat a. Pitocin
CAPSULAR es/ b. Oxytocin
IS stretches c. Methergine
out (Methylergonovine
 Overlying maleate)
the fetus d. Syntocinon
DECIDUA  Remaining TOCOLYTICS  RELAXES uterus
VERA portion  For pre-term labor (to
 Becomes stop the labor)
LOCHIA  E.g. INMTR
after a. Indomethacin
delivery b. Nifedipine
 UTERINE BLOOD SUPPLY c. Magnesium Sulfate
Main Blood  Large (MgSO4)
Supply descending d. Terbutaline
abdominal e. Ritodrine
aorta
 Travels to  6 UTERINE LIGAMENTS
internal iliac CARDINAL/  MAIN ligament
artery TRANSVERSE-
Direct Blood  Uterine CERVICAL/
Supply arteries MACKENRODT
Supporting  Ovarian LIGAMENT
Blood Supply arteries BROAD/  Supports the sides of
PERITONEAL uterus
 UTERINE NERVE SUPPLY: LIGAMENT  Located in the
SAME (Sensory-Afferent; Motor- perimetrium
Efferent) ROUND  Connects the labia
EFFERENT  UPPER portion LIGAMENT majora to uterus
(MOTOR)  Supplied by the 5 UTEROSACRAL  Connects uterus to the
thoracic to 10 LIGAMENT sacrum
thoracic spine (T5- ANTERIOR  Connects uterus to
T10) LIGAMENT urinary bladder (bladder
AFFERENT  LOWER portion is anterior of uterus)
(SENSORY)  Supplied by the POSTERIOR  Connects uterus to
11th thoracic to 12 LIGAMENT rectum
thoracic spine
(T11-T12) 4) VAGINA
EPIDURAL ANESTHESIA:  Organ of copulation
 blocks T11-T12 ONLY  PARTS:
 Sensory ONLY a) Vaginal Wall
 (-) Pain response  Highly elastic (d/t the
 (+) Uterine contractions RUGAE)
 S/E: b) Vaginal Mucus
1. Maternal Hypotension  Acidic (d/t lactic acid)
 MANAGEMENT:  BACTERIA: Doderlein’s
a. Monitor BP bacillus
b. Fast drip IV, as  pH: 3.5-4.5
prescribed. c) Vaginal Opening
 DRUGS THAT AFFECTS THE  Circular, voluntary muscle
UTERUS: (bulbovacernosus muscle)
UTEROTONICS  CONTRACTS uterus
  EXERCISE: Kegel’s
Exercise OVULATION
 VAGINISMUS  14 days before the next menses
(psychological)  14 days before the end of menstrual
 MANAGEMENT: Muscle cycle
relaxant IM
 FUNCTION: LAST MENSTRUAL PERIOD (LMP)
a) Passageway of menses, the  1ST DAY of LAST menstrual period
penis, and the fetus.
4 ORGANS INVOLVED IN MENSTRUAL
CYCLE: HAOU
DIFFERENT CHANGES DURING 1) HYPOTHALAMUS
PREGNANCY  Ultimate initiator
PISKACEK’S Softening of the CORPUS  Releases GnRH (Gonadotropin-
SIGN Releasing hormone)
VON BRAUN Softening of the FUNDUS a) Follicles-Stimulating Hormone-
FERNWALD’S Releasing Hormone (FSHRH)
SIGN b) Luteinizing Hormone-Releasing
DICKINSON’S Focal softening of the Hormone (LHRH)
SIGN placental implantation site 2) ANTERIOR PITUITARY GLAND (APG)
(upper posterior part of the  Releases GONADOTROPINS:
fundus) a) Follicle-Stimulating Hormone
HEGAR’S Softening of the ISTHMUS (FSH)
SIGN b) Luteinizing Hormone (LH)
GOODELL’S Softening of the CERVIX 3) OVARIES
SIGN  Releases FEMALE hormones:
CHADWICK’S Bluish discoloration of the a) Estrogen
SIGN/ vagina b) Progesterone
JACQUEMIER’S 4) UTERUS
SIGN  Discharge menses
LADIN’S Increased  NOT INVOLVED in hormonal
SIGN vascularity/blood vessels release
of the vagina
OSIANDER’S Increased pulsations of HORMONES INVOLVED IN MENSTRUAL
SIGN vagina CYCLE: FELP
MONTGOMERY’S Breast changes  In menses: Decreased Estrogen +
SIGN Decreased Progesterone
MCDONALD’S Flexion of uterus FOLLICLE-  Stimulate to increase
SIGN STIMULATING ESTROGEN release
PALMER’S Rhythmic uterine HORMONE  FUNCTION:
SIGN contraction after bimanual ↓ a) Ovum maturation/
examination (Internal ↓ Development of
Examination) ESTROGEN ovum/Graafian
HARTMAN’S Fetal implantation Follicle
SIGN bleeding  FUNCTION:
a) Increase thickness
MENSTRUAL CYCLE (Ovarian Cycle) of endometrium
 From beginning of menstruation to the LUTEINIZING  Stimulate to increase
beginning of the next menstruation. HORMONE PROGESTERONE
 Episodic uterine bleeding (happens ↓ release
every cycle) ↓  FUNCTION:
 PURPOSES: PROGESTERONE a) Responsible for
1) Ovum maturation (for fertilization) ovulation/ Rupture
2) Tissue bed renewal (Endometrium of Graafian Follicle
renewal)  FUNCTION:
 a) Increase vascularity releas
of the endometrium es
(for blood supply) GON
ADOT
ROPI
4 PHASES OF MENSTRUAL CYCLE: PSIM NS
1) PRO  Proliferate (FSH)
LIFE : e) Ovum
RAT Increase matur
IVE in ation
PHA number occur
SE of s in
endometri ovarie
EST al cells s
RO  Thickenin (corte
GEN g of x
IC uterus layer)
PHA (↑Estroge f) Immat
SE n & ure
(↑Es ↑FSH) ovum
trog  Increase (Prim
en) of ordial
ESTROG Follicl
FOL EN e)
LIC  Increase turns
ULA of FSH to
R  Vary in matur
PHA length/du e
SE ration ovum
(↑FS  Day 6-14 (Graaf
H) (Ovulation ian
) Follicl
POS  In day 6: e)
T- a) ↓Estro g) Increa
ME gen ses
NST b) Need Estro
RUA s gen
L positiv levels
PHA e (13th
SE feedb day)
ack h) Increa
PRE (to se
- increa thickn
OVU se ess of
LAT Estro uterus
ORY gen) /endo
PHA c) Hypot metriu
SE halam m
us i) Suppr
initiat ess
es FSH
GnRH (to
(FSR stop
H) stimul
d) APG ating
 estrog minal
en) pain
j) Hypot upon
halam ovulat
us ion
initiat (Mitte
es lsch
GnRH merz
(LHR sign)
H)
k) APG
releas
es
GON
ADOT 2) SEC  Secretes
ROPI RET nourishin
NS ORY g
(LH) PHA substance
l) Ovula SE s
tion  Best time
occur PROGE for
s (14th STERO implantat
day) NIC ion (↑
 S/Sx of PHASE Progester
OVULATI (↑Proge one)
ON (For sterone) Incr
Fertile): eas
a) Spinn LUTEAL es
barke PHASE bloo
it (↑LH) d
(cervi sup
cal POST- ply
mucu OVULA at
s TORY uter
elastic PHASE us
ity) Nee
b) ↑ PRE- ded
Basal MENST MO
Body RUAL RE
Temp PHASE by
eratur the
e fetu
(after s
8  Happens
hours day 15-21
of  Fixed in
sleep length/du
then ration
take  Day 15:
tempe a. Ruptu
rature re of
) Graafi
c) Unilat an
eral Follicl
abdo e
b. Corpu steron
s e)
Luteu e. Relax
m is es
forme uterus
d 3) ISC  Ischemia:
(Yello HE ↓ blood
w MIC supply at
body) PHA uterus
1. ↑ SE  Happens
P day 22-28
ro  Day 22
g (Non-
e Pregnant)
st :
er a. Corpu
o s
n Luteu
e m
( degen
D erates
o after
m 8-10
in days
a b. Forms
nt into
) Corpu
2. H s
a Albica
s ns
s (Whit
o e
m body)
e c. Corpu
e s
st Albica
ro ns
g (↓Estr
e ogen
n +
c. Increa ↓Prog
ses estero
vascul ne)
arity d. Signal
of s
endo ische
metriu mia
m e. Decre
d. Suppr ase
ess blood
LH (to suppl
stop y at
stimul uterus
ating (↓O2
proge +
 ↓Nutri L duration)
ents) PHA  Occurren
f. Endo SE ce of
metria menses
l  (+)
sloug slough-off
h-off  Uterus is
occur at its
s thinnest
g. Menst (d/t
ruatio endometri
n al slough-
occur off)
s  Glandular
 Day 22 layer
(Pregnant slough-off
): (d/t
a. Corpu progester
s one
Luteu withdrawa
m l)
remai ↓Pro
ns for gest
2 eron
month e
s
(waiti  Day 1:
ng for a) ↓Estrogen
place +
nta to ↓Progeste
devel rone
op) a) Increase
b. Increa PROSTA
se of GLANDIN
Proge S
steron b) (+) uterine
e (↑ contractio
vascul ns &
arity) vasoconst
and riction
Increa c) (+) Pain
se of (e.g.
some dysmeno
estrog rrhea)
en  MANA
(↑thic GEM
kness ENT:
) 1. P
c. Thick O
ening SI
of TI
uterus O
4) ME  Happens NI
NST to day 1-5 N
RUA (5 days G:
 a.
1st

b.
2nd

2. E
X TERMS IN RELATION TO MENSTRUAL
E CYCLE:
R MENARCHE First occurrence of
CI menses
SE AMENORRHEA Absence of menses
: DYSMENORRHEA Painful menses
a. MENOPAUSE Stoppage of menses for
Re 12 months
METRORRHAGIA Bleeding between
b. menses
Re  (N) Duration of Menses = 3-8 days
HYPOMENORRHEA Menses less than 3 days
3. W POLYMENORRHEA Menses more than 8
A days
R  (N) Amount of Menses = 30-80 cc
M OLIGOMENORRHEA Menses less than 30 cc
C MENORRHAGIA Menses more than 80 cc
O
M NORMAL CHARACTERISTICS OF
P MENSTRUATION:
R
MENARCHE  NORMAL: 9-17 years
E
old
SS
 AVERAGE: 12 years
a.
old (6th grade)
Va
INTERVAL  NORMAL: 23-35
days
b.
 AVERAGE: 28 days
Ut
DURATION  NORMAL: 3-8 days
 AVERAGE: 8 days
4. M
E AMOUNT  NORMAL: 30-80 cc
DI  AVERAGE: ¼ cup
C ODOR  NORMAL: Marigold
A COLOR  NORMAL: dark-red
TI IRON LOSS  NORMAL: 11 mg
O
N STAGES OF FETAL GROWTH: OZEF
S: OVUM  Starts with Ovulation to
a. Fertilization
Pr ZYGOTE  Fertilization to Implantation
(2 weeks)
EMBRYO  3 to 8 weeks (2 months)
FETUS  9 weeks to birth
 b) GYNOSPERM (Female
sperm)
 Big head
 Short tail
 Carries X-
chromosome
 Less motile
 Less in number
 Longer lifespan
 Survives in an
acidic environment
 XY chromosome – MALE
STAGES OF FETAL DEVELOPMENT: PEF
 XX chromosome =
PRE-  Starts with fertilization to
FEMALE
EMBRYONIC implantation (2 weeks)
 The FATHER determines
 FERTILIZATION/
the GENDER of fetus
CONCEPTION/
PRE-EMBRYONIC PROCESS
IMPREGNATION/
a) OVUM
FECUNDATION (union of
b) ZYGOTE (Fertilized egg)
sperm & ovum)
c) Initiates first cell division
1) OVUM
(Blastomere)
 Female sex cell
d) Increase into 16-50 cells
 Carries X-chromosome
(Morula)
 LIFESPAN: 24-48 hours
e) Transforms blastocysts
 2 LAYERS:
(structure that implants)
a) Corona radiata
 2 LAYERS:
(Outer layer)
1. EMBRYOBLAST
b) Zona pellucida (Inner
(Embryo)
layer)
2. TROPHOBLAST
2) SPERM
(embryonic structures:
 Male sex cell
placenta, amniotic sac &
 Carries X or Y-
fluid, umbilical cord)
chromosome
f) Implantation occurs
 LIFESPAN: 48-72 hours
 3 PROCESSES:
 3 PARTS:
1. APPOSITION (floating
a) Head (Chromosome)
blastocysts)
b) Neck (Source of ATP)
2. ADHESION (attachment
c) Tail (Flagella – source
at endometrium)
of motility)
3. INVASION (settling in at
d) Vitamin C –
endometrium)
responsible for
g) Presence of Hartman’s Sign
sperm’s motility
(Implantation bleeding)
 2 TYPES:
h) Forms into an EMBRYO
a) ANDROSPERM (Male
(Embryonic Stage)
sperm)
i) Forms into FETUS
 Small head
EMBRYONIC  3 to 8 weeks
 Long tail  Most susceptible to teratogens
 Carries Y-  Organogenesis occurs
chromosome  MOST COMMON
 More motile TERATOGENS:
 More in number a) STEROIDS (leads to cleft
 Shorter lifespan lip/palate)
 Survives in an b) TETRACYCLINE (staining
alkalotic of teeth)
environment c) QUININE/STREPTOMYCIN
 (damage of CN VIII – (emesis gravidarum)
Vestibulocochlear/Acoustic  Emesis gravidarum
Nerve – causing is NORMAL in 1st
DEAFNESS) trimester
d) THALIDOMIDES/  Nausea & Vomiting
ANTIEMETICS increases at later
 Leads to AMELIA part of 1st trimester
(total absence of  ABN: Hyperemesis
extremities) gravidarum
 Leads to (Nausea & Vomiting
PHOCOMELIA occurring >1st
(absence of proximal trimester)
extremities with hands  FUNCTIONS:
or feet directly attached a. Takes care of
to torso) corpus luteum
for 2 months
b. Suppresses
mother’s immune
system (so as
not to reject the
 EMBRYONIC STRUCTURES: fetus -foreign
a) AMNIOTIC MEMBRANE body)
 Upon ROM: (-) pain of c. Mimics
mother (no nerve supply testosterone to
on amniotic membrane) develop the fetal
 2 LAYERS: male
1. CHORION reproductive
(transforms to organs
amniotic sac)  ESTROGEN:
2. AMNION (transforms a. Softening of the
to amniotic fluid) uterus
b) TROPHOBLAST b. Uterine growth
 Layer of the blastocyst c. Mammary gland
 2 LAYERS: development
1. CYTOTROPHOBLAS d. Increase the
T/ LANGHAN’S thickness of uterus
LAYER (protects fetus  PROGESTERONE:
from syphilis – a. Hormone of
Treponema pallidum) pregnancy
2. SYNCYTIOTROPHO- b. Mammary gland
BLAST/ SYNCYTIAL development
LAYER (produces c. Maintains
maternal hormones – endometrium via
estrogen, increasing
progesterone, HCG, vascularity
HPL, Relaxin) d. Decrease intestinal
 HCG (human chorionic motility (constipation
gonadotropin) during pregnancy)
 Present in first 100 e. Relaxes the uterus
days (1st trimester) (prevents pre-term
 NOTE: HIGHER in labor)
later part of the 1st  HPL (Human Placental
trimester. Lactogen)/ HCS (Human
 Culprit for NAUSEA Chorionic
& VOMITING Somatomammotropin)
 a. LACTOGENIC System
(mammary gland  Fetoplacental
development) circulation
b. Insulin antagonist  Via selective
(DIABETOGENIC) osmosis
 Increase glucose 6. Fetal Amino Acids
for (Proteins)
organogenesis of  Amino Acid
fetus Transport
c. Reason for GDM  Enters via active
 RELAXIN transport
a. SOFTENING OF 7. Virus (Rubella)
JOINTS during  Enters through
pregnancy (leads to PINOCYTOSIS
LORDOSIS – pride d) UMBILICAL CORD (Funis)
of pregnancy)  (N) LENGTH: 50-55 cm
c) PLACENTA (Secundines)  (N) THICKNESS: 2 cm
 WEIGHT: 400-600 gms.  Wharton’s Jelly
 AVERAGE: 500 gms (1 (cushions the cord)
lbs.)
 COMPARTMENT:
1. Cotyledons (O2
reserve)
 20-30 cotyledons

 SUBSTANCES TO
AVOID:
1. No NICOTINE (it  (N) AVA:
crosses the placental a. 2 Arteries (carries
barrier) deoxygenated
2. No ALCOHOL (it blood)
crosses the placental b. Vein (carries
barrier) oxygenated blood)
 FUNCTIONS:  ABNORMALITIES:
1. Fetal Lung 1. Too Short Umbilical
 O2-CO2 Cord
Exchange (via  Leads to
simple ABRUPTIO
diffusion) PLACENTA
2. Fetal GIT  Leads to
 Glucose UTERINE
Transport (for INVERSION
organogenesis) 2. Too Long Umbilical
 Via facilitated Cord
diffusion  Leads to Cord
3. Fetal Endocrine Prolapse
System (fetal  Leads to Cord
hormones) Coil
 Estrogen is 3. 1 Artery & 1 Vein
passed to the Umbilical Cord
fetus  Check for
4. Fetal Kidneys cardiac/kidney
 Excretion of anomalies
waste products e) AMNIOTIC FLUID
5. Fetal Circulatory  (N) COLOR: CLEAR
 (BEST ANSWER)  Maternal
a. EARLY COLOR: Problem: GDM
Clear/ Transparent/ (Gestational
Colorless Diabetes
b. LATER COLOR: Mellitus)
Slight yellow  MANAGEMENT:
amber/ straw-  Amniocentesis
colored with flecks of  (3) DIAGNOSTIC
vernix caseosa TESTS:
 (N) VOLUME: 800-1200 a. FERN TEST
mL (Arborization test)
 (N) pH: 7.0-7.5 (Alkaline)  Swab-Dry Test
 (N) COMPOSITION:  (+) Fern Test:
a. 99 % water (+) Amniotic
b. 1% solid particles Fluid
 (ABN) COLOR OF  (-) Fern Test:
AMNIOTIC FLUID: (-) Amniotic
a. Greenish  Fluid/ (+) Urine
Meconium Staining b. NITRAZINE TEST
(sign of fetal  Using of
distress) phenolphthalei
b. Red/Pink  n and litmus
Bleeding paper
 (+) BLUE: (+)
Amniotic Fluid
 (+)
RED/YELLOW:
(-) Amniotic
c. Dark
Fluid/ (+) Urine
Yellow/Golden
c. AMNIOCENTESIS
Yellow 
Hyperbilirubinemia  Aspiration of
(Rh Incompatibility/ Amniotic Fluid under
ABO Incompatibility) UTZ
d. Gray/Cloudy   WHEN? 14-16
Infection weeks AOG (2nd
e. Dark Brown/ Tea- trimester)
colored/ Cola-
colored  Fetal  NOT PERFORMED
Death in 1st trimester
 (ABN) VOLUME OF (amniotic fluid is still
AMNIOTIC FLUID: in little amounts)
a. Oligohydramnios  INFORMED
 <300 mL CONSENT should
 Fetal Problem: be taken
Renal Agenesia (Amniocentesis is an
 MANAGEMENT: invasive procedure)
 Amniofusion  INDICATIONS of
b. Polyhydramnios ordering
 >2000 mL Amniocentesis
during:
 Fetal Problem:
1. 2nd Trimester:
Anencephaly/
ADVANCED
TEFA (Tracheo-
MATERNAL
esophageal
AGE: increased
Fistula & Atresia)
 chances of Down AOG
Syndrome  3 GERM LAYERS:
(damaged ovum) 1) ECTODERM(Outermost)
2. 3rd Trimester  Brain
GDM: Check for  CNS
fetal lung  Skin
maturity  5 senses
 PURPOSES:  Hair
1. Diagnose  Anus
chromosomal  Mouth
abnormalities  Nails
via AFP (alpha 2) MESODERM(Middle)
fetoprotein)  Heart
Level  Reproductive System
 (N) AFP: 2.5  Musculoskeletal System
MOM (Multiple of  Kidneys
Means) 3) ENDODERM/ENTODERM
 ↓ AFP: Down (Innermost)
Syndrome  Thyroid Gland
(Trisomy 21)  Thymus
 ↑ AFP: Neural  Liver
Tube Defects  GIT Lining
(Vitamin B9/Folic  ORGANOGENESIS: Embryo
Acid Deficiency) Stage
2. Check lung 1) NEUROLOGIC SYSTEM:
maturity via  Using of EEG at 8 weeks
SHAKE test 2) RESPIRATORY SYSTEM:
 (+) bubbles  Surfactant development
MATURE lungs at 6-7 months
 (-) Bubbles  Prevents lung collapse
IMMATURE 3) CARDIOVASCULAR
Lungs SYSTEM
 (N) L/S Ratio:  Using of ECG at 20
2:1 weeks
 (ABN) L/S Ratio:  FETAL HEART RATE:
1:1 a) 1st trimester:
MANAGEMENT of 160-170 bpm
IMMATURE lungs: b) 2nd-3rd trimester:
1. Steroids IM to 120-160 bpm
MOTHER  FETAL HEARTBEAT:
(Bethamethasone/ a) FETAL DOPPLER
Dexamethasone) by 12 weeks
 COMPLICATION: b) FETOSCOPE by 16
1. INFECTION weeks
 EARLY: c) STETHOSCOPE by
Spontaneous 20 weeks
Abortion  (N) Fetal O2 Saturation:
 LATER: Preterm 80%
Labor  To compensate:
 Most Important HEMOGLOBIN
Consideration: (17.1 g/dL)
Needle Insertion  HEMATOCRIT
Under UTZ (53%)
FETUS  9 weeks to birth  (N) ADULT O2
 FULL TERM: 37-42 weeks Saturation: 95-100%
  To compensate: mother to fetus
HEMOGLOBIN (12- intrauterine at 20-
16 g/dL) 24 weeks
 HEMATOCRIT (36-
46%) FETAL ASSESSMENT
4) GIT 1) DFMC (Daily Fetal Movement
 Sterile GIT (↓ Vitamin Counting)
K): risk for BLEEDING!  Quickening at 20 weeks
 LIVER (Active but  WHEN: AFTER MEALS
Immature)  POSITION: (L) side-lying
 Risk for  AVOID SUPINE POSITION!
hypoglycemia & (Compresses the vena cava)  ↓
hyperbilirubinemia Venous return  HYPOTENSION
5) URINARY SYSTEM SYNDROME!
 Urine formed at 16  If (R) side-lying:
weeks  Urinary bladder is located at the
 Urine excreted at 20 right side
weeks  It leads to URINARY
6) REPRODUCTIVE SYSTEM FREQUENCY
 Gender identification  (N) COUNTING:
via outward  10-12 movements/hour
appearance at 12  1-2 movements/minute
weeks  2 WAYS of DFMC:
 Gender identification a) SANDOVSKY METHOD
via UTZ at 16  Count the number of
weeks movements PER HOUR
 Testes descends at b) CARDIFF’S METHOD
28-38 weeks  Count the DURATION in
7) MUSCULOSKELETAL reaching 10 movements
SYSTEM 2) ULTRASOUND
 Quickening (fetal  2 WAYS of UTZ:
movement felt by the a) TRANSVAGINAL UTZ
mother) at 20 weeks  For EARLY PREGNANCY
 If PRIMIGRAVIDA: (1st trimester)
Quickening is felt by  MUST be EMPTY
18-20 weeks BLADDER!
 If MULTIGRAVIDA b) ABDOMINAL UTZ/PELVIC
Quickening is felt by UTZ
16-18 weeks  For LATER PREGNANCY
 Stretched out uterus (2nd-3rd trimester)
 Muscle memory/  MUST be FULL
experience of BLADDER! (it hastens the
pregnancies urinary frequency)
8) INTEGUMENTARY
SYSTEM  INDICATIONS OF UTZ during:
 Lanugo (white a) 1st TRIMESTER:
downy hair) at 20  Confirm PREGNANCY
weeks  Confirm IMPLANTATION
 Vernix Caseosa at SITE
24 weeks  Determine AOG
 Subcutaneous fats  Determine MULTIPLE
achieved by 8 FETUS
months b) 2nd TRIMESTER:
9) IMMUNE SYSTEM  Determine GENDER
 IgG passed by
  Determine PLACENTAL  If RESULTS are NON-REACTIVE:
LOCATION  To CONFIRM, use
c) 3rd TRIMESTER: CONTRACTION STRESS
1) Determine FETAL SIZE TEST IS DONE.
& POSITION
3) KLEINHAUER-BETKE’S TEST 6) CONTRACTION STRESS TEST/
 Differentiate maternal from fetal OXYTOCIN CHALLENGE TEST
blood  Check FHR in response to uterine
4) BPP/BPS (BIOPHYSICAL PROFILE/ contraction
BIOPHYSICAL PROFILE SCORING)  HOW:
 The FETAL APGAR  BEFORE: inject synthetic
 5 PARAMETERS: oxytocin
a) Fetal 2  NOW: Natural Way (Nipple
Breathing Stimulation)
b) Fetal 2  Look for DECELERATION (ABN)
Reactivity  RESULTS:
(Heart Rate) POSITIVE NEGATIVE
c) Fetal 2 (+) (-)
Movement DECELERATIO DECELERATIO
d) Fetal Tone 2 N N
e) Amniotic Fluid 2 FETAL FETAL WELL-
Index DISTRESS BEING
TOTAL 10  MANAGEMENT FOR (+)
 SCORES: CONTRACTION STRESS TEST:
7-10 FETAL WELL- a) STOP Oxytocin
BEING b) Turn to (L) Side-Lying
4-6 SUSPICIOUS Position
0-3 FETAL DISTRESS c) O2 Via Face Mask at 8-10
(Assess for LPM
DELIVERY)  3 TYPES OF DECELERATION:
5) NON-STRESS TEST (NST) a) EARLY DECELERATION
 Check for FHR in response to fetal  Due to HEAD
movement COMPRESSION
 Look for ACCELERATION (N)  Stimulation of Vagus
(Increase 15 bpm of FHR from Nerve (causing
baseline after fetal movement) Bradycardia)
 Performed in 20 minutes: b) VARIABLE DECELERATION
2-4 fetal movements (minimum of 2  Due to CORD
movements & 2 accelerations) COMRPESSION
 NOTE: NST is done after c) LATE DECELERATION
meals  Due to
 If 1 acceleration = REPEAT THE UTEROPLACENTAL
TEST INSUFFICIENCY
 EXAMPLE:  MNEMONIC: VEAL CHOP
 If baseline is 135 bpm: 135 + VARIABLE CORD
15 bpm (Normal Acceleration) COMPRESSI
= 150 bpm Acceleration EARLY ON
HEAD
after fetal movements COMPRESSI
 RESULTS: ON
REACTIVE NON- ACCELERATI OKAY!
REACTIVE ON
REAL/GOOD NOT GOOD LATE PLACENTAL
FETAL WELL- FETAL INSUFFICIEN
BEING DISTRESS CY
  FORMULA:
a) [1-5 months]2 = cm
1 month 1 cm
2 months 4 cm
3 months 9 cm
4 months 16 cm
5 months 25 cm

RULES OF PREGNANCY b) [6-9 months] x 5 = cm

1) NAEGELE’S RULE 6 months 30 cm
 Determine the EXPECTED DATE 7 months 35 cm
OF BIRTH/ EXPECTED DATE OF 8 months 40 cm
CONFINEMENT via LMP 9 months 45 cm
 NOTE: 10 months 50 cm
 NO LMP = NO NAEGELE’S
 LEAP YEAR = FEBRUARY 29
5) JOHNSON’S RULE
(every 4 years)
 Estimate the FETAL WEIGHT
LMP MONTH DAY YEAR  (N) WEIGHT: 2500-3500 gms
Jan-Mar +9 +7 +0  <2500 gms = SGA/LBW
Apr-Dec -3 +7 +1  >3500 gms = LGA
CONSTANTS
2) BARTHOLOMEW’S RULE K 155
 Determine AOG via FUNDIC N (UNENGAGE) 11
LOCATION
9 MONTHS Below Xiphoid (STATIONS: -1, -
Process (d/t 2, -3)
lightening) N (ENGAGE) 12
8 MONTHS Level of
XIPHOID (STATIONS: 0,
PROCESS +1, +2, +3)
7 MONTHS Midway
between  FORMULA:
Umbilicus and a) FH (in cm) – N(K) = grams
Xiphoid Process  EXAMPLE:
6 MONTHS 2 cm above a) GIVEN: 32 cm; Station 0
umbilicus  32 – 12 (155) =
5 MONTHS Level of  20 (155) = 3,100 gms
UMBILICUS (N)
4 MONTHS Between b) GIVEN: 34 cm; Station -2
Symphysis  34 – 11 (155) =
Pubis and  23 (155) = 3,565 gms
Umbilicus (ABN) (LGA)
3 MONTHS Level of
SYMPHYSIS
PUBIS
3) MCDONALD’S RULE
 Determine AOG via FUNDIC
HEIGHT (FH in cm)
 FORMULA:
a) FH (in cm) x 8/7 – AOG (in
weeks)
b) FH (in cm) x 2/7 – AOG (in
months)
4) HAASE’S RULE
 Estimate the FETAL HEIGHT
SIGNS OF PREGNANCY
A. PRESUMPTIVE SIGNS
 SUBJECTIVE (coming from
mother)
 BUFAMECLISQ
BREAST MONTGOMERY’S SIGN
CHANGES
URINARY  1ST TRIMESTER:
FREQUENCY  PRESENT
(+)
 D/T uterine
enlargement
 2ND TRIMESTER:
 NOT
PRESENT
(-)
 D/T bladder
has adjusted
 3RD TRIMESTER:
 PRESENT
(+)
 D/T Fetal
Presentation
FATIGUE/  D/T increased BMR
LASSITUDE (slight enlargement
of thyroid gland)
AMENORRHE  Increased Estrogen
A + Increased
Progesterone
MORNING  D/T Increased hCG
SICKNESS  MANGEMENT:
a) Eat dry crackers
before arising
ENLARGED ABDOMEN
CHLOASMA/  MASK of
MELASMA/ Pregnancy
MELANODER
MA
LINEA NIGRA
INCREASED  D/T Increased
SKIN Melanocytes
 PIGMENTATI BRAXTON-HICKS  Irregular painless
ON CONTRACTIONS contractions
STRIAE  “STRETCHMARKS” VON BRAUN Softening of the
GRAVIDARU  MANAGEMENT: FERWALD’S FUNDUS
M a) Calamine Lotion SIGN
b) Oatmeal OSIANDER’S Increased pulsations
QUICKENING SIGN of vagina
OPERCULUM  Serves as a
(MUCUS PLUG) SEAL at cervix
(to prevent
ascending
infection)
 During LABOR:
a) Mucus Plug
falls-off
(BLOODY
SHOW)

MCDONALD’S Flexion of uterus

SIGN

B. PROBABLE SIGNS C. POSITIVE SIGNS

 OBJECTIVE (taken by nurse)  CONFIRMATORY: UTZ
 GCHELLPPBEBVOOM  FETAL HOMS
GOODELL’S Softening of the FETAL HEART RATE/TONE
SIGN CERVIX FETAL OUTLINE
CHADWICK’S Bluish discoloration FETAL MOVEMENT
SIGN/ of the vagina FETAL SKELETON
JACQUEMIERE’S
SIGN PRENATAL VISIT
HEGAR’S SIGN Softening of the  0-7 MONTHS = ONCE A MONTH
ISTHMUS  8 MONTHS = Every 2 weeks/Twice a
ENLARGED UTERUS month
LADIN’S SIGN Increased  9 MONTHS = Every week until delivery
vascularity/blood PSYCHOLOGICAL TASKS
vessels of the vagina A. 1ST TRIMESTER: ACCEPT
LEUKORRHEA  INCREASED PREGNANCY
vaginal discharge  Mothers felt:
PISCASEK’S Softening of the a) AMBIVALENCE
SIGN CORPUS b) SURPRISE
POSITIVE PREGNANCY TEST c) DENIAL
BALLOTTEMENT  UPWARD cervix  HEALTH TEACHING:
/ REBOUND SIGN tap a) Nutrition
 (+) rebounds b) Body Changes during
upon internal Pregnancy
examination B. 2ND TRIMESTER: ACCEPT BABY VIA
 WHY QUICKENING
PROBABLE?  Mothers felt:
 It may be a a) FANTASIES
tumor rather b) DREAMING
than the fetal c) NARCISSISTIC
head  HEALTH TEACHING:
ELEVATED BBT  D/T increased a) Fetal Growth &
(BASAL BODY PROGESTERON Development
TEMPERATURE) E
 C. 3RD TRIMESTER: ACCEPT (+300 kcal/day)
PARENTHOOD/ MOTHERHOOD LACTATING 2700 kcal/day
 Mothers felt:
a) UNPRETTY (+500 kcal/day)
b) UGLY  6-8 GLASSES of WATER per day
c) AWKWARD  No MINERAL OILS for
d) IMPATIENT CONSTIPATION (it inhibits the
 HEALTH TEACHING: absorption of the fat-soluble
a) Responsible Parenthood vitamins – ADEK vitamins)

OB SCORING LABOR
GRAVIDA (G) Number of pregnancies A. PAIN MANAGEMENT DURING
(alive or dead) LABOR
PARA (P) Number of viable 1) BRADLEY METHOD (by: Dr.
pregnancies (fetus can Robert Bradley)
already survive OUTSIDE  COACH: Partner
uterus/ extrauterine life) 2) DICK-READ METHOD (by: Dr.
 WHEN VIABLE? Grantly Dick-Read)
 >20 WEEKS  Reduce FEAR
3) PSYCHOSEXUAL METHOD (by:
TPAL: Dr. Sheila Kitzinger)
 “Just go with the flow”
a) TERM: 37-42 WEEKS 4) LAMAZE METHOD (by: Dr.
 If TWINS: COUNTS Ferdinand Lamaze)
AS ONE in term  4 ACTIVITIES:
b) PRETERM: >20 a) CLEANSING BREATH
WEEKS b) CONSCIOUS
c) ABORTION: <20 RELAXATION
WEEKS  ONLY ABDOMEN
d) LIVING: ALIVE contracts
 If TWINS: COUNTS  The rest of body relaxes
AS TWO in term c) EFFLUERAGE
 Light stroking of
abdomen
d) GUIDED IMAGERY
B. 4 STAGES OF LABOR
STAGE 1: FOCUS: CERVIX
CERVICA 2 PROCESSES:
L PERIOD a) EFFACEMENT
(thinning of cervix)
NUTRITION  Measured from 0-
A. WEIGHT GAIN DURING PREGNANCY 100%
 Minimum: 20-25 lbs. b) DILATATION (opening
 Optimum: 25-35 lbs. (single of cervix)
fetus)  Measured from 0-10
 MULTIPLE FETUS: 40- cm
45 lbs.
(lbs.) TRIMESTER MONTH WEEK For PRIMIGRAVIDA:
1ST 4 lbs 1.3 lbs 0.3 lbs  Effacement FIRST,
2ND 12 lbs 4 lbs 1 lb Dilatation LAST
3RD
12 lbs 4 lbs 1 lb  Number of hours of
B. CALORIC NEEDS labor: 20 hours
PRE-PREGNANT 2,200 Kcal/day For MULTIGRAVIDA:
PREGNANT 2500 kcal/day  Dilatation FIRST,
Effacement LAST
  Number of hours of INTENSITY MILD MDOERAT STRONG
labor: 14 hours E
DILATATION 0-3 cm 4-7 cm 8-10 cm
MANAGEMENT: MOOD Excited Irritable Loses Control
a) AMBULATION
b) LET THE MOTHER ACTIVITY Ambulation Comfort 2 legs UP
VOID EVERY 2 Measures
HOURS Void every
c) DELIVERY ROOM 2 hours Analgesics
 PRIMI: 10 cm FHT Every Every 30 Every 15
 MULTI: 7-8 cm MONITORIN HOUR MINUTES MINUTES
G
TERMS:
a) FREQUENCY
 From beginning STAGE 2: FOCUS: FETUS
of contraction to FETUS
beginning of PERIOD CARDINAL MOVEMENTS (ED
next contraction FIRE ERE):
 RATE of a) ENGAGEMENT
contraction b) DESCENT
b) INTENSITY c) FLEXION
 Strength of d) INTERNAL ROTATION
contraction e) EXTENSION
c) DURATION  Expulsion of fetal
 From beginning head ONLY
of contraction to  Check for cord
end of the same coil/ nuchal cord
contraction  Ritgen’s
 LENGTH of Maneuver is
contraction performed
d) INTERVAL (supporting of
 From the end of perineum to
contraction to prevent laceration)
beginning of f) EXTERNAL ROTATION
next contraction g) EXPULSION

STAGE 3: FOCUS: PLACENTA

PLACENTA
L PERIOD 2 TYPES OF PLACENTA
1) SCHULTZ MECHANISM
 SHINY
 FETAL SIDE
 CENTRAL
DETACHMENT
2) DUNCAN MECHANISM
 DIRTY
 MATERNAL SIDE
 3 PHASES (LAT) OF 1ST  MARGINAL
STAGE OF LABOR ATTACHMENT
3 PHASES  LATENT ACTIVE TRANSITION
AL
FREQUENC 8-15 3-5 2-3
Y minutes minutes minutes
DURATION 20-40 40-60 60-90
seconds seconds seconds 3 SIGNS OF PLACENTAL
 SEPARATION
1) GLOBULAR ABDOMEN
(CULKIN’S SIGN)
 1ST SIGN of
placental
separation
2) SUDDEN GUSH OF
BLOOD
3) LENGTHENING OF THE POSTPARTUM STAGE
CORD A. RETURN OF MENSES
 BEST SIGN of  BOTTLEFEEDING MOTHERS:
placental return of menses after 6-8
separation weeks
 BREASTFEEDING MOTHERS:
MANAGEMENT: return of menses after 3-6
1) WEIGH PLACENTA months
 NORMAL: 400- B. LOCHIA
600 gms. 1st stage RUBRA First 3
2) CHECK NUMBER OF (Red) days
COTYLEDONS 2nd stage SEROSA 4th-7th day
 NORMAL: 20-30 (Pink to
Cotyledons brown)
3) CHECK FOR PERINEAL 3 stage
rd
ALBA 8th-14th day
LACERATION (Whitish)
C. REVA RUBIN’S THEORY
4 DEGREES OF PERINEAL 1st TAKING FOCUS: SELF
LACERATION: stage IN (Passive)
1) 1st degree: 2nd TAKING FOCUS: BABY
 Vaginal skin + stage HOLD (Active)
mucous 3rd LETTING FOCUS:
membranes stage GO FAMILY
2) 2nd degree: (Interdependent)
 1st degree +
vaginal muscles
3) 3rd degree:
 2nd degree + rectal
external sphincter
4) 4th degree:
 3rd degree + rectal
mucous
membrane

STAGE 4: HAPPENS AFTER FIRST 4

RECOVERY HOURS AFTER DELIVERY
PERIOD
CHECK THE FF. EVERY 15
MINUTES:
1) VITAL SIGNS
2) FUNDUS
 (N): FIRM &
CONTRACTED
 (ABN): SOFT &
BOGGY (Sign of
bleeding)
 a) Smokers (can cause
tissue adhesion d/t
dryness)
b) Intrauterine Uterine
Device
c) Pelvic Inflammatory
Disease
 MOST COMMON
Causative agent:
GONORRHEA
 DIAGNOSTIC TESTS:
a) B-hCG + Transvaginal
UTZ
OBSTETRIC NURSING (ABNORMAL)

 2 TYPES OF EP:
a) Unruptured Ectopic
Pregnancy (<12 weeks AOG)
SUDDEN PREGNANCY COMPLICATIONS
 S/Sx: BUNP
A. 1ST TRIMESTER
1. Brief amenorrhea
1) ABORTION (termination of pregnancy
2. Unilateral abdominal
before the age of viability)
pain
 2 CLASSIFICATIONS:
3. Nausea & Vomiting
a) SPONTANEOUS ABORTION
4. (+) Pregnancy test
 Due to natural causes
 MANAGEMENT:
b) INDUCED ABORTION
1. Use abortifacient
 Deliberate termination of
 Mifepristone (RU 486)
pregnancy
2. To prevent
 TYPES OF SPONTANEOUS
choriocarcinoma:
ABORTION
NEEDS prophylaxis!
a) MISSED ABORTION
 Methotrexate (Anti-folic acid
 Fetus died within 1 month
drug) + Leucovorin (Active
 Retention after death
folic acid)
 (-) FHR
 Dactinomycin
 CLOSED Cervix
b) Ruptured Ectopic Pregnancy
b) INEVITABLE ABORTION
(>12 weeks AOG)
 (+) FHR
 S/Sx: SSHBR
 OPEN Cervix
1. Scanty, dark-brown,
c) THREATENED ABORTION
vaginal bleeding
 (+) FHR
2. Sudden, sharp, severe,
 CLOSED Cervix
stabbing, knife-like
 Slight Bleeding
abdominal pain
d) SEPTIC ABORTION
radiating to neck
 d/t infection
(Kehr’s Sign) and
e) HABITUAL ABORTION
shoulder
 More than 3 consecutive
3. Hemoperitoneum
abortions
(increase bleeding in
 d/t incompetent cervix
abdomen)
(cervix opens prematurely)
4. Bluish discoloration of
2) ECTOPIC PREGNANCY (implantation
umbilicus (Cullen’s Sign)
outside the uterus)
5. Rigid board-like
 MOST COMMON SITE: Fallopian
abdomen
Tubes (Ampulla)
 MANAGEMENT:
 MOST DANGEROUS SITE:
1. Blood transfusion +
Interstitial/Intramural
IVF
 CAUSES:
 2. Laparoscopy (to NSVD
visualize abdomen) 2) HYDATIDIFORM MOLE (H-mole,
 To repair/remove Molar Pregnancy, Gestational
the affected Trophoblastic Disease)
fallopian tube  Abnormal proliferation &
3. Salpingectomy degeneration of trophoblasts
(removal)  CAUSES: UNKNOWN
4. Salpingotomy (assisting  S/Sx:
incision) a) LGA (classic sign)
5. Salpingostomy b) Increased hCG (1-2 million IU)
(artificial opening)  (N) hCG: 300,000-400,000
IU
c) Hyperemesis gravidarum
d) Dark-brown, prune juice-like
vaginal bleeding
e) Grape-like vesicles (hallmark
sign)
 MANAGEMENT:
a) D&C
b) NO PREGNANCY for 1 year
c) hCG monitoring for 1 year
d) NO OXYTOCIN (to prevent
B. 2nd TRIMESTER pulmonary embolism)
1) INCOMPETENT CERVIX/ e) PREVENT complication:
PREMATURE CERVICAL Choriocarcinoma
DILATATION (the cervix opens  Methotrexate (Anti-folic acid
prematurely) drug) + Leucovorin (Active
 CAUSES: TFC folic acid)
a) Trauma from Forceps Delivery  Dactinomycin
b) Forced Dilatation & Curettage C. 3rd TRIMESTER
(D&C) PLACENTA PREVIA ABRUPTIO
c) Congenitally Short cervix PLACENTA
 1st sign: OPEN Cervix
 MANAGEMENT: DESCRIPTION
a) Cerclage (suture cervix) Low-lying placenta Premature
 Performed on 12-14 weeks separation of
AOG placenta
 The earlier, the better
Premature Premature
CRITERIA for Cerclage
separation of separation of
NO VAGINAL BLEEDING
ABNORMALLY NORMALLY
NO UTERINE
implanted placenta implanted placenta
CONTRACTIONS
HALLMARK SIGN
INTACT MEMBRANES
CERVIX NOT DILATED Painless, bright-red Painful, dark-red
BEYOND 3 cm vaginal bleeding vaginal bleeding
 2 TYPES OF CERCLAGE: DIAGNOSTIC TEST
McDonald’s Shirodkar- UTZ (to locate the UTZ (to locate the
Cerclage Barter placenta) retroplacental clot)
Cerclage MODE OF DELVIERY
TEMPORAR PERMANEN DOUBLE SET-UP Emergency C/S
Y suture T suture
Removed at C/S Delivery  1st Set-up: NSVD
37-38  2nd Set-up: C/S
weeks AOG delivery