I.
ANATOMY AND PHYSIOLOGY
A. Female Reproductive System
1) Ovary – produces egg cells and female sex
hormones.
2) Uterine tube – conveys egg cell toward uterus;
site of fertilization; conveys developing embryo
to uterus.
3) Uterus – protects and sustains embryo during
pregnancy.
4) Vagina – conveys uterine secretions to outside
off body; receives erect penis during sexual
intercourse; provides open channel for offspring
during birth process.
5) Labia majora – enclose and protect other
external reproductive organs.
6) Labia minora – form margins of vestibule;
protect openings of vagina and urethra.
7) Clitoris – produces feelings of pleasure during
sexual stimulation due to abundant sensory
nerve endings in glans.
8) Vestibule – space between labia minora that
contains vaginal and urethral openings.
9) Vestibular glands – secrete fluid that moistens
and lubricates vestibule.
10) Urethral orifice – where foley catheter is
inserted.
11) Vaginal orifice – where the baby comes out;
penis comes in and out.
12) Anus – defecation
B. Male Reproductive System
1) Penis – is the male organ for sexual intercourse.
It has three parts: the root, shaft, and glans.
2) Scrotum – is the loose pouch-like sac of skin
that hangs behind the penis. It contains the
testicles has a protective function and acts as a
climate control system for the testes.
3) Testicles/Testes – are responsible for making
testosterone, the primary male sex hormone
(endocrine function), and for generating sperm
(exocrine function).
4) Epididymis – it functions in the transport and
storage of the sperm cells that are produced in
the testes.
5) Vas deferens – transports mature sperm to the
urethra in preparation for ejaculation.
6) Urethra – carries urine from the bladder to
outside of the body.
7) Seminal vesicle – produce a sugar-rich fluid
(fructose) that provides sperm with a source of
energy and helps with the sperm’s motility.
8) Prostate gland – contributes additional fluid to
the ejaculate. Prostate fluids also help to nourish
the sperm.
II. Human Sexuality
► It is multidimensional phenomenon that includes
feelings, attitudes, beliefs and actions.
► It encompasses and gives direction to a person’s
physical, emotional, social and intellectual
responses throughout life.
A. Terms Related to Sexuality
1) Biologic Sex/ Gender
 Used to denote chromosomal sexual
development male (XY) and female (XX).
2) Gender identity
 It is the individual’s persisting inner sense of
being male or female, masculine or
feminine.
 Its development was based on biologic sex
and sociocultural reinforcement, which
brings at birth with identification of the baby
as male or female.
3) Sexuality
 Includes all those aspects of the human
being that relate specifically to being a boy
or girl. Man or woman.
 As a function of total personality, it is
concerned with biological, psychological,
sociological, spiritual & cultural variables of
life.
4) Sexual orientation
 Whom you are attracted to.
 Types of Sexual Identity/ Orientation
a) Heterosexual – one who is sexually
attracted to one person of the opposite
sex.
b) Bisexual – one who is attracted to
persons of both sexes.
c) Homosexual – one who is sexually
attracted to persons of the same sex.
d) Transsexual – one’s belief that one is
not the sex of one’s physical body but of
the opposite sex.
5) Gender Role Behavior
 The way a person acts, female or male
including the expression of what is
perceived as gender appropriate behavior.
B. Human Sexual Response
► Feelings and attitudes about sex vary widely; the
sexual experience is UNIQUE to each
 individual. It is a combination of physiological  General muscle relaxation occurs, in men.
responses and emotional responses (thoughts  The inner 1/3 of the vagina gradually shrink
and feelings). and color returns to pre excitement phase.
► A cycle with four discrete stages.  HR and RR returns to normal
1) Excitement  For the male, a refractory period occurs
 It occurs with physical and psychological during which further orgasm is impossible.
stimulation that causes parasympathetic  For the female, there is multiple orgasm.
nerve stimulation (sight, sound, emotion or
thought) C. Human Sexual Response
 This leads to arterial dilation and venous 1) Teenage sex
constriction in the genital area; the blood 2) Premarital sex
supply in this area increases resulting in 3) STD
vasocongestion and increase muscular 4) HIV/AIDS
tension.
 In women, this vasocogestion result in:
 Increased size of clitoris
 Increased mucus in the vagina
 Vagina widens its diameter and length
 Nipples become erect
 Increased cardiac and respiratory rate
2) Plateau
 The plateau stage is reached just before the
orgasm. III. Menstrual Cycle
► It is the periodic uterine bleeding in response to
 In women:
cyclic hormonal changes.
 The clitoris is drawn forward and
► It is the process that allows for conception and
retracts under the clitoral prepuce;
implantation of a new life.
 Lower part of female vagina becomes
congested. Characteristics Description
 There is increased nipple engorgement. Beginning (menarche) Onset 12 or 13 y/o,
3) Orgasm average 9-17
 It occurs when stimulation proceeds through Interval between cycles 28 days, 23-35 days not
the plateau stage to a point at which the usual
body suddenly discharges accumulated Duration 2-7 days, 1-9 days not
sexual tension. abnormal
 A vigorous contraction of muscles in the Amount Average 30-80 ml
pelvic area dissipates blood and fluid from Color Dark red, combination of
the area of congestion. blood, mucus &
endometrial cells.
 The average number of contractions in
women is from 8-15 at intervals of one in
A. Four Body Structures Involved in the Menstrual
every 0.8 sec
Cycle
 In men, muscle contraction surrounding the 1) Hypothalamus
seminal vessels and prostate project semen
 Secreted GnRH (Gonadotropin-releasing
into the proximal urethra.
hormone)
 These contractions are followed by 3-6 2) Anterior Pituitary Gland
propulsive ejaculatory contractions which
 Luteinizing Hormone (LH) – responsible
force semen into the penis.
for ovulation; releases mature egg cell from
4) Resolution
ovary.
 It is the period during which the external and
 Follicle-Stimulating Hormone (FSH) –
internal organs return to an unaroused state
maturation of ovum
– 30 minutes.
3) Ovaries
 More than 50% of the erection is lost.
 Estrogen – secondary sex characteristics
  Progesterone – thickens endometrium NURSING CARE DURING ANTEPARTAL
4) Uterus – flow of blood. PERIOD
I. Definition of Terms
B. Phase of Menstrual Cycle
1) Perinatal – the whole period of pregnancy and
1) Proliferative
child delivery.
 Produces estrogen in the follicular fluid
2) Antepartal – pregnancy up to onset of labor.
 Endometrium proliferates up to 8 folds 3) Intrapartal – onset of labor up to delivery.
 Termed as “estrogenic, follicular, 4) Prenatal – before delivery
postmenstrual” 5) Postnatal – after delivery
2) Secretory 6) Gravida – number of pregnancy
 Formation of progesterone in the corpus 7) Para – number of children in viable pregnancy
luteum (viable – 20 weeks)
 Endometrium corkscrew/ twisted
 Termed as “progestational, luteal, II. Fertilization & Implantation
premenstrual” A. Fertilization
3) Ischemic “Conception/Impregnation/Fecundation” – (The
 Decreased estrogen and progesterone Beginning or Pregnancy)
4) Menses ► Union of ovum and spermatozoa
 Products discharged during menstrual flow: ► Occurs in the outer 3rd of the fallopian tube
 Blood from the ruptured capillaries ► Spermatozoon functional life: 48-72 hours so the
 Mucin from the glands critical time span during which fertilization
 Fragments of endometrial tissue occur is about 72 hours.
► Ovum is capable of fertilization for only 24-48
Low levels of Estrogen hours.
Stimulates hypothalamus to signal Anterior Pituitary
► Spermatozoa move by means of flagella (tails)
Gland
and uterine contractions.
Release LHRH/GnRH
► Sperm reach the cervix for 90 seconds and 5
Release of FSH/LH
Growth (trophy) in the gonads (ovaries) minutes to the fallopian tube.
Ovum matures ► Capacitation
Graafian Follicle  Final process that sperm must undergo to be
ready for fertilization
 The sperm moves toward the ovum, consist
DAY 14 of changes in the plasma membrane of the
Before the end of the cycle, increase in LH from the sperm head which reveals the sperm binding
pituitary receptor side.
Release of Prostaglandins ► Zygote
Graafian follicle ruptures (Ovulation)
 Resulting structure of chromosomal material
FSH decreases, Increase in LH
of the ovum and spermatozoa fuse.
Corpus Luteum
If unfertilized, regression of corpus luteum after 8-  Fertilized ovum has 46 chromosomes.
10days  23 pairs (22 autosomes and sex
Menstrual Flow chromosomes)
 If an x-carrying spermatozoon enters the
ovum, the resulting child will have two x
chromosomes and will be female; and if Y,
will be male.
► Three Factors of Fertilization Occurrence
1) Maturation of both sperm and ovum
2) Ability of the sperm to reach the ovum.
3) Ability of the sperm to penetrate the cell
membrane of the ovum and achieve
fertilization.
 B. Implantation
► Once fertilization is complete, the zygote
migrates toward the body of the uterus, aided by
the currents initiated by the muscular
contractions of the fallopian tubes.
► Zygote reaches the uterus 3-4 days
► It occurs approximately 8-10 days after
fertilization.
C. Terms used to denote fetal growth
1) Ovum – from ovulation to fertilization
2) Zygote – from fertilization to implantation
3) Embryo – from implantation to 5-8 weeks
4) Fetus – from 5-8 weeks until term.
5) Conceptus – developing embryo or fetus and
placental structure throughout pregnancy.
III. Development of Fetus
A. Fertilization
► 3-5 cc – amount of sperm per ejaculation
► 50 – 130 M – number of sperm
► 12-24 hours after ovulation – ovum can be
fertilized
► 3-4 days – lifespan of sperm
► 90 seconds – time the sperm reaches the cervix
► Sperm carries 2 sex chromosomes, X and Y
which when united with female X determines
the sex of the child.
B. Stages of Fetal Development
1) Pre-Embryonic Stage
 First 2 weeks after fertilization (2 weeks
AOG)
 Development of Primary Germ Layers
a) Ectoderm – nervous system, skin,
glands.
b) Medoserm – skeleton, muscles, heart,
kidney, lymph cells, spleen.
c) Endoderm – respiratory system, GI
tract, bladder, liver, pancreas
 Product: zygote
2) Embryonic Stage
 2-8 weeks after fertilization (2 months
AOG)
 Period of rapid cell division
 Highly vulnerable to teratogens, virus,
radiation
 Product: embryo
3) Fetal Stage
 8 weeks to end of pregnancy
 Period of refinement and perfection
 Product: Fetus
C. Fetal Membrane & Amniotic Fluid
1) Fetal Membrane
 Has 2 Layers
a) Amnion – inner membrane produces the
amniotic fluid.
b) Chorion – outer membrane
2) Amniotic Fluid
 Forms within the amniotic cavity and
surrounds the embryo.
 Serves as a protective mechanism – cushion
fetus (“fetal shock absorber”) and keep
temperature constant.
 Contains fetal urine, lanugo from fetal skin.
 Fetus swallows amniotic fluid and urinates
in the fluid.
 Clear pale straw fluid in which the fetus
floats
 Volume
a) Normal Volume – 800-1200 mL
b) Polyhydramnios – excessive AF
c) Oligohydramnios – reduced AF
 Green-tinged – presence of meconium
 Functions of Amniotic Fluid
 Important protective mechanism for the
fetus.
 It shields against pressure or a blow to
the mother’s abdomen
 Protects the fetus from changes in
temperature
 Aids in muscular development because
it allows the fetus freedom to move.
 Protects the umbilical cord from
pressure, protecting fetal oxygenation.
D. Placenta
1) Development
 It is complete by 3rd month
 Formed by union of chronic villi (contains
blood vessels that are connected to the fetus)
& decidua basalis (the part which lies
directly under the embedded ovum).
 SCHULTZ – fetal surface and smooth.
 DUNCANS – maternal surface and is rough
 Umbilical cord is implanted in the center of
fetal surface
 Umbilical cord contains 2 Arteries & 1 Vein
 Umbilical cord is covered by Wharton’s
Jelly
2) Function
 Provides oxygen and removes carbon
dioxide from the fetal system
  Maintains fetal fluid and electrolytes, acid
and base balance
 Exchange takes place between mother and
fetus through Diffusion
 Placental function is dependent upon
maternal circulation
 Nutrients, drugs, antibiotics, and certain
viruses can cross the barrier
 Placental transfer of maternal
immunoglobulin gives the fetus passive C. 16 Weeks
immunity.
3) Hormone Production
 Human Chronic Gonadotropin (HCG)
 First hormone produced
 Detected in urine and plasma 8-100 days
AOG.
 Not present 1-2 weeks after birth
(indicator of placental delivery) D. 20 Weeks
 Estrogen (Hormone of Women)
 Second hormone produced
 Helps thickens endometrium
 Promotes development of mammary
gland
 Promotes uteroplacental blood flow.
 Progesterone (Hormone of Mothers)
 Maintains endometrium E. 24 Weeks
 Reduces uterine contractility
 Human Placental Lactogen (hPL)
 Produced by 6 weeks AOG
 Promotes development of mammary
gland.
4) Fetal Circulation
 Veins – carries unoxygenated blood
 Arteries – carry oxygenated blood.
 Circulation functions by a series of
bypasses:
a) Foramen Ovale – shunts blood from
right to left atria
b) Ductus Arteriosus – shunts blood from
pulmonary artery to aorta F. 28 Weeks
c) Ductus Venosus – bypasses fetal liver
 These bypass structures must close at birth
IV. Fetal Development
A. End of 1st Month
 Foundations of nervous and genitourinary
systems, skin, bones, and lungs form
 Buds of arms and legs start to form Rudiments
of eyes, ears, and nose appear. G. 32 Weeks
 Fetal length: 0.75 cm – 1 cm
 Weight: 400 mg
B. 6 Weeks
 The neural tube (brain, spinal cord, and other
neural tissue of the central nervous system) is
well formed.
 The digestive tract and sensory organs begin to
develop.
 Sex differentiation begins
 Fetal length: 2.5 cm
 Weight: 20g
 Sex differentiation is completed
 Heartbeat can be detected
 The nervous system is starting to function
 The reproductive organs and genitalia are now
fully developed.
 Fetal Length: 10-17cm
 Weight: 55-120g
 Lanugo covers the entire body
 Quickening occurs
 Heart sounds can be auscultated
 Can hear sounds
 Moves often
 Fetal Length: 25 cm
 Weight: 223g
 Vernix caseosa appears. (Vernix caseosa is a
white, creamy, naturally occurring biofilm
covering the skin of the fetus during the last
trimester of pregnancy. Vernix coating on the
neonatal skin protects the newborn skin and
facilitates extra-uterine adaptation of skin in the
first postnatal week if not washed away after
birth.)
 Finger and fingernails develop.
 Responds to sounds by moving or increasing the
pulse
 Fetal Length: 28-36cm
 Weight: 550g
 The likelihood of fetal survival in extrauterine
environment is good.
 Hearing is fully developed
 Changes position frequently
 Responds to stimuli, including sound, pain, and
light.
 Fetal length: 35-38cm
 Weight: 1,200g
  Continues to mature and develop reserves of  Determine the last normal menstrual period
body fat (LMP)
 Brain is developing rapidly at this time.  Consider first day of LMP
 Most internal systems are well developed, but  Consider the month in number terms.
the lungs may still be immature.
1. LMP is March 13-17, 2020.
 Fetal Length: 38-43cm
3 13
 Weight: 1,600g +9 +7
H. 36 Weeks = 12; 20
 Lungs are nearly fully developed December 20, 2020
 Reflexes are coordinated
 Can blink, close the eyes, turn the head, grasp 2. LMP is July 12 – 17, 2020
firmly. 7 12 2020
 Fetal Length: 42-48 cm -3 +7 +1
= 4; 19; 2021
 Weight: 1,800 to 2,700g (5 to 6 lb)
April 19, 2021

3. LMP is May 1-5, 2020

5 1 2020
-3 +7 +1
= 2; 8; 2021
February 8, 2021

C. Estimating Gestational Age Based on LMP

 Procedure:
 Determine the LMP
 Determine the number of days from LMP to
the day of assessment
 Divide the total number of days by 7

V. Determination of Estimated Birth Date 1. January - 31 days

A. Definition of Terms 2. February - 28 days in a common year and 29 days
 EDC – estimated date of confinement in leap years
 EDB – estimated date of birth
3. March - 31 days
 EDD – estimated date of delivery
 Naegel’s Rule 4. April - 30 days
 Standard method used to predict the length 5. May - 31 days
of pregnancy.
6. June - 30 days
 January – March (+9 +7)
 April – December (-3 +7 +1) 7. July - 31 days
 Ovulation Age 8. August - 31 days
 Measurement of life of fetus from the time
9. September - 30 days
of ovulation or fertilization.
 Gestational Age (AOG) 10. October - 31 days
 Measurement of length of pregnancy from 11. November - 30 days
the first day of the last menstrual period
12. December - 31 days
(LMP).

B. Naegel’s Rule (Estimating Expected Date of

Delivery) 1. LMP: March 20—25, 2020
Visit: July 28, 2020
 (31.5 cm x 2) / 7 = 9 months
March: 11
April: 30 2. What is the estimated gestational age in weeks if
May: 31 the fundic height is 36 cm?
June: 30 (36 cm x 8) / 7 = 41 weeks and 1 day
July: 28 E. Bartholomew’s Rule
= 130/7  Estimates AOG by relative position of the uterus
18.57 (18 x 7 = 126) (130 – 126 = 4) in the abdominal cavity.
= 18 weeks and 4 days  3rd Lunar Month – fundus is palpable slightly
above the symphysis pubis.
2. LMP: April 15-20, 2020
Visit: July 12, 2020  5th Lunar Month – fundus is at the level of the
umbilicus
April: 15  9th Lunar Month – fundus is below the xyphoid
May: 31 process
June: 30
July: 12
= 88/7
12.57 (12 x 7 = 84) (88 – 84 = 4)
= 12 weeks and 4 days

3. LMP: June 4-8, 2020

Visit: October 1, 2020

June: 26
July: 31
August: 31
September: 30
October: 1
= 119/7
= 17 weeks
F. Haase’s Rule
 Determine the length of the fetus in centimeter.
D. Assessment of Fetal Growth and Development
 The length of the embryo in centimeter can be
 ESTIMATING FETAL GROWTH – Mc
calculated during the:
Donald’s Rule
 First 5 months of gestation by squaring the
 Explain the procedure
number of the months of pregnancy.
 Instruct the client to void  In the 6th to the 9th month, by multiplying the
 Measure the fundic height (FH) in cm. using the number of the month of pregnancy by 5.
McDonald’s rule
 Formula (Lunar Months): 1. A 4-month old fetus is approximately 16cm long.
 Multiply the fundic height by two then (42) = 16 cm
divide by seven 2. An 8-month old fetus is 40cm long.
8 x 5 = 40 cm
FH ( ¿ cm ) x 2
=gestational age∈lunar mos
7 VI. OB Classification
 Formula (Weeks) 1) Gravida – the number of pregnancy
 Multiply the fundic height by 8 then divide 2) Para – number of viable deliveries (20 weeks)
by seven 3) Full term – the number of full term infants born
(infants born at 37 weeks or after)
FH ( ¿ cm ) x 8 4) Preterm – the number of preterm infants born
=gestational age∈weeks
7 (infants born before 37 weeks)
5) Abortion – the number of spontaneous
1. What is the estimated gestational age in months if miscarriages or therapeutic abortions
the fundic height is 31.5 cm?
 6) Living – the number of living children
7) Multiple – the number of multiple pregnancies
1. A pregnant woman visited the clinic. History
reveals that she had 2 term infants, pre-term twins, D.
and a pregnancy at 19 weeks of gestation.
E.
G-5; T-2; P-2; A-1; L-4; M-1 F.
2. A woman visited the clinic. History reveals that she
had a baby born at 39 weeks of gestation, baby girl at
40 weeks of gestation, and another baby girl at 33
weeks of gestation.
G- 3; T-2; P-1; A-0; L-3; M-0
G.
3. A pregnant woman visited the clinic. She has the
following history, baby boy at 36 weeks of gestation,
baby girl at 39 weeks of gestation, triplets at 36 weeks
of gestation, and twins at 37 weeks of gestation.
G-5; T-3; P-4; A-0; L-7; M-2
H.
4. A pregnant woman visited the clinic. History
reveals that she had term twins, 1 pre-term, and 2
pregnancies at 23 weeks of gestation.
G-5; T-2; P-1; A-2; L-3; M-1
I.
VII. Assessment of Fetal Well-Being
A. Fetal Movement
 Can be felt by mother as quickening which J.
begins approximately 18-20 weeks of pregnancy
and peaks at 28-38 weeks.
 Healthy fetus moves at least 10x a day.
1) Sandovsky Method K.
 Mother lying in left recumbent position after
a meal and record how many fetal
movements she feels over the next hour;
normal is twice every 10 minute or average L.
of 10-12x/hr
2) Cardiff Method
 “count to ten”; the mother records the time M.
interval it takes for her to feel ten fetal
movements, usually occurs within 60 mins.
B. Fetal Heart Rate
 Can be heard and counted as early as the 10 th –
11th week of pregnancy by the use of ultrasonic
Doppler; normal is 120-160 beats/minute
C. Ultrasound VIII.
 Diagnose pregnancy as early as 6 weeks AOG A. Laboratory Tests
 Confirm presence, size, and location of placental
and amniotic fluid.
 Establish presentation and position of the fetus.
 Predict maturity by measurement of the
biparietal diameter.
Electrocardiography (ECG) – recorded as early as
11th week of pregnancy.
Magnetic Resonance Imaging (MRI)
Maternal Serum Alpha-Fetoprotein
 A substance produced by the fetal liver that is
present in amniotic fluid and maternal serum;
increase in maternal serum AF indicates open
spinal or abdominal defects and determine
chromosomal defects (down syndrome/ trisomy
21)
Triple Screening
 Analysis of three indicators (serum alpha
fetoprotein, unconjugated estriol and HCG).
Together, they increase the detection of trisomy
18 and 21. They are performed between 15 and
22 weeks and considered positive if all markers
are low.
Chronic Villi Sampling
 Biopsy and analysis of chorionic villi for
chromosomal analysis done at 10-12 weeks
AOG to determine the fetus’ chromosomal
condition.
Amniocentesis
 Aspiration of AF from the pregnant uterus for
examination at 14-16 weeks AOG; tests for fetal
maturity.
Amnioscopy
 Visual inspection of the AF through the cervix
and membranes with an amnioscope to detect
meconium staining.
Percutaneous Umbilical Blood Sampling
(Cordocentesis or Funicentesis)
 Aspiration of blood from umbilical vein for
analysis.
Fetoscopy
 Visualizing the fetus by inspection through a
fetoscope. Helps in assessing fetal well-being.
Biophysical Profile
 Combines 4-6 parameters into one assessment:
 Amniotic Fluid
 Placental grading and fetal heart activity
 Fetal breathing movements
 Fetal movement and fetal tone
Diagnostic Tests
  Detecting the presence of human chorionic
gonadotropin (HCG), a hormone created by the
chronic villi of the placenta, in the uterine or
blood serum of the pregnant women.
 Accuracy: 95=98%
X. Physiologic Changes in Pregnancy
 Test are performed by radioimmunoassay (RIA),
A. Reproductive System:
enzyme-linked immunosorbent (ELISA), radio-
1) Uterus
receptor assay (RRA).
B. Home Pregnancy Test  Enlarges and thickens
 Accuracy: 97%  Increases in fibro elastic tissue
 Not accurate for those who take psychotic drugs  Change in shape from Pear-like to ovoid.
like antianxiety agents, also those with oral  Blood vessels increase in size
contraception. Oral contraception should be  Hegar’s Sign – lower segment softens
discontinued 5 days before the test. 2) Cervix
C. Roll-Over Test (ROT)  Vascular and edematous
 Performed to pregnant mother suspected to  Goodell’s Sign – softening of the cervix
develop Pregnancy Induced Hypertension (PIH) 3) Vagina
between 28th and 32nd weeks of gestation.  Chadwick’s Sign – bluish discoloration
 A comparison of blood pressure is made with  Leukorrhea – increase secretion/ discharges
the woman lying on her left side and on her B. Abdominal Wall:
back; an excessive increase in blood pressure ► Striae Gravidarum
when she rolls to the supine position indicated ► Melasma/ Chloasma/ Mask of Pregnancy
increased risk of toxemia. C. Breasts:
 To determine the onset of hypertension and ► Feeling of fullness
proteinuria. ► Hyperplasia
 Mother is positive if diastolic blood pressure ► Darkening of areola
increases to 20 mm/hg at 5-minute interval. ► Secretion of colostrum by 4th month
► Nipples erected
IX. Verifying Pregnancy D. Circulation:
► Circulation volume increases 30-50%
► Physiologic anemia and easily fatigability
► Increase cardiac output
► Decrease circulation to lower extremities,
edema, varicosities.
► Palpitation may occur
► Lightheaded—due to compression of inferior
vena cava (rolled towel under the woman’s right
hip.
E. Skin Color Changes (inc. Melanin Production)
► Striae Gravidarum
► Linea negra
► Melasma
► Vascular spiders on the thigh (varicose veins)
► Increased perspiration
F. Respiration
► Displaced diagphragm
► Lung expands laterally to compensate for
shortness of breath
G. Digestive System
► Stomach and intestines are displaced
► Slow stomach peristalsis
► Delayed stomach emptying
 ► Heartburn/Pyrosis – regurgitation of acidic
stomach contents through cardiac sphincter into
the esophagus.
► Management:
 Avoid fried and fatty foods
 Sips of milk at frequent intervals
 Small frequent meals taken slowly
 Bend at the knees not at waist
► Constipation/flatulence
► Nausea and vomiting – eat dry toast, dry cereal
before getting up out of bed.
► Hyperemesis gravidarum
► Hemorrhoids
► Appetite increases after first 3 months.
H. Urinary System
► Increases output
► Increases in frequency occur first 3 months
I. Musculoskeletal
► Lordotic positon – due to backache/fatigue
► Waddling gait/Duck walk – low heeled/flat
shoes
► Leg cramps due to:
 Pressure of the gravid uterus
 Low calcium, Fatigue/muscle tense
► Management
 Increase calcium intake
 Dorsiflex the foot and press the knees
 Frequent period of rest
 Do not massage
XI. Managing Discomforts of Pregnancy
First Trimester
► Nausea and vomiting (morning sickness)
► Palmar erythema – Calamine Lotion
► Urinary frequency – Kegel’s exercise
► Breast tenderness
► Fatigue
► Leukorrhea (increased vaginal discharge that is
white in color)
► Headache
A. Danger Signs in Pregnancy
► Vaginal bleeding, no matter how slight
► Swelling of the face and fingers
► Severe, continuous headache
► Flashes of light before the eyes
► Pain in the abdomen
► Persistent vomiting
► Chills and fever
► Sudden escape of fluid from the vagina
XII. Self-Care Needs
1) Bathing – daily tub or showers due to sweating
that tends to increase in pregnancy.
2) Breast care – wearing firm supportive bra with
wide straps to spread weight across the shoulder.
Wash breast with clear tap water (no soap) to
remove or minimize infections.
3) Dental Care – good tooth brushing habits.
4) Perineal Care – douching is contraindicated
due to force of the irrigation that can cause it to
enter the cervix and lead to infection; also alters
pH of vagina leading to increased risk of
bacterial growth.
5) Emotional – “Couvade Syndrome”
6) Dressing – avoid garters, and knee high
stocking that can impede lower extremity
circulation
7) Sexual Activity – no sexual restrictions
8) Exercise – important to prevent circulatory
stasis in lower extremities
9) Sleep
10) Employment
11) Travel
12) Nutrition – weight gain 9-11.5 kg (20-25 lbs)
Folic Acid Intake – to reduce incidence of
neural tube defects in newborn.
Iron Intake – WOF Constipation
13) Immunization
 Task – Accepting the Baby
► Woman and partner move thorough emotions
such as narcissism and introversions as they
concentrate on what it will feel like to be a
parent. Role playing and increased dreaming
are common.

A. Foods to Avoid
a) Food with caffeine Third Trimester:
b) Artificial sweeteners Task – preparing for the baby and end of pregnancy
c) Weight loss diet ► Woman and partner grow impatient with
pregnancy as they ready themselves for birth
B. Components of Prenatal Visit
a) Health history F. Emotional Responses
b) Chief concern 1) Self-concept related to body image.
c) Any exposure to disease 2) Mood swings related to biophysical and social
d) Ingestion of drugs changes.
e) Family & social profile 3) Ambivalence related to fear and anxiety.
f) Past medical history 4) Sexual concerns related to biophysical changes.
g) Gynecological History
h) OB history
i) Birthing Plan

C. Frequency of Prenatal Visit

► 1st and 2nd Trimester – once a month up to 32
weeks
► 32-36 Weeks – twice a month (every 2 weeks)
► 36-40 Weeks – four times a month (every week)
 80% of pregnant women in the Philippines
should have at least 5 prenatal visits (DOH
Goal)

D. Emotional and Psychological Adaptations to

Pregnancy
► Stressors:
a) Circumstance to pregnancy – Couvade
Syndrome
b) Meaning of Pregnancy to the couple
c) Responsibilities associated with parenthood
d) Resources available to family

E. Psychological Tasks of Pregnancy

First Trimester:
Task – Accepting the Pregnancy
► Woman and partner both spent time
recovering from shock of learning they are
pregnant and concentrate on what it feels like
to be pregnant. A common reaction is
ambivalence, or feeling both pleased and not
pleased at the pregnancy.

Second Trimester: