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Lecturer : Dr. Marie Therese Pacabis Date : February

Subject : MCN-OB Nursing Pages : 5

Lecture Coverage Summary IV. Anatomy and Physiology

I. Antenatal Care A. External Female Genitalia (Vulva)
A. Uniqueness of Obstetrics Nursing 1. Clitoris 8. Hymen
1. Physiologic 3. Two Clients 2. Vagina 9. Bartholin’s Glands
2. Time-framed 3. Fourchette 10. Perineum
4. Bulbocavernosus Muscles
5. Labia Majora and Minora
II. Women’s Health
6. Urethral Meatus
A. Reproductive Problems of Non-Pregnant 7. Skenes or Periurethral Glands
Women
B. Internal Reproductive Organs
1. Vaginal Infections
1. Fallopian Tube
2. Menstrual Disorders
2. Ovaries
3. Infertility
3. Uterus
4. Cancer in Women
4. Bladder

III. Legal Practice of MCN C. Pelvis

1. Basic Points 4. Pubic Arch
A. RA 9173: Philippine Nursing Law
2. Ilium 5. Sacral Promontory
1. Care of Pregnant Women
3. Ischial Spine 6. Sacrum
2. Labor and Delivery
3. IE and Suturing D. Pelvimetry
4. Care of Newborn 1. Definition
2. Diameters
B. RA 7600: Rooming In Act
1. Purpose E. Breasts

C. RA 10028: Expanded Breastfeeding Act

1. Breastfeeding Stations V. Reproductive Processes
2. Inclusion in the Curriculum A. Menstruation
D. RA 10354: Reproductive Health Law B. Ovulation
1. Purpose 3. Family Planning C. Fertilization
2. BEmONC D. Germ Layers

E. RA 1123: Universal Health Law

VI. The Fetus
1. PhilHealth
2. Costs A. Fetal Growth and Development
B. Fetal Circulation
F. Other Laws
1. RA 10192: CPD Units
2. RA 10968: Philippine Qualification VII. Pregnancy
Framework Law A. Signs and Symptoms of Pregnancy
3. AO 0025 - Series 2009 (UNANG YAKAP) B. Changes in Pregnancy
4. AO 0029 - Series 2008 (MNCHN) C. Psychological Aspect
5. AO 0012 - Series 2012 D. Fetal Health Evaluation
(Birthing Center Requirements)
G. Important Points to Remember
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I. Introduction to Obstetrics Nursing ■ Greyish secretions with foul odor
4. Chlamydia
A. Uniqueness of Obstetrics Nursing ■ Mostly asymptomatic
1. Physiologic ● The first sign of vaginal infection: itchiness
● Pregnancy is a normal physiologic function. ● Other signs: foul-smelling, colored secretions
● Risks:
2. Menstrual Disorders
○ Low (physiologic) - delivery via birth center
● Irregular menstruation - Normal is 28 days.
○ High (pathologic) - delivery via hospitals
● Dysfunctional bleeding - Hormonal imbalance.
2. Time-framed ● Dysmenorrhea
● The date of delivery can be predicted. ○ Primary. Caused by the initial menstrual
● How long does labor and delivery last? < 24 hrs cycle or malpositioning of the uterus.
● How long does puerperium last? 6-8 weeks ○ Secondary. Possible endometriosis.
● How long does pregnancy last?
3. Infertility
○ Average Days : 280 (260-290)
● The inability to have a child or get pregnant.
○ Average Weeks : 37-42
● Time frame: 1 year of trying
○ Average Months : 9 (Calendar: Naegel’s)
● Men are tested first. (Sperm count)
● Considerations in women:
10 (Lunar: Hae’s)
1. Ovaries 3. Endometrium
● “The longer the fetus stays inside the uterus,
2. Fallopian Tube 4. Cervical secretions
the better the fetus will be.”
● Assistive methods:
Formula:
1. Clomid (Clomiphene citrate) - ovulator
● Naegel’s: M-3 / D+7 / Y+1 or M+9 / D+7
2. In-vitro Fertilization - test tube, implantation
● Hae’s: Measures the length of the fetus.
3. Surrogacy
(1-5 Lunar mos): AOG is squared
○ Eg. If 3 mos. pregnant, the fetus is 9 cm.
(6-10 Lunar mos): AOG is multiplied by 5 4. Cancer in Women
○ Eg. If 10 mos. pregnant, the fetus is 50 cm. ● Breast: Mammogram and self-breast exam.

3. Two Clients ● Cervix: Vaccinations are now available.

● The mother and fetus (inside the mother). ● Uterus: Hysterectomy
● Ovaries
II. Women’s Health ○ The most dangerous.
○ Involves hormones therefore it can easily
A. Reproductive Problems of Non-Pregnant metastasize.
Women
1. Vaginal Infections III. Legal Practice of MCN
● Examples:
A. RA 9173: Philippine Nursing Law
1. Moniliasis - most common;
■ CA: Candida albicans 1. Care of Pregnant Women
■ SS: ● Practicing according to law.
→ Severe itching
2. Labor and Delivery
→ White patches in the vaginal area
● Requirements:
■ Tx: Clotrimazole
○ 3x Handles, 3x Assists, 3x Cord Care
2. Trichomoniasis
■ CA: Trichomonas vaginalis 3. IE and Suturing
■ SS: ● Nurses can only suture up to 2nd degree
→ Yellow-green secretions lacerations.
→ Foul odor 4. Care of Newborn
■ Tx: Metronidazole
3. Bacterial vaginosis
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B. RA 7600: Rooming In Act
1. Purpose F. Other Laws
● To facilitate breastfeeding. 1. RA 10192: CPD Units
● To minimize the possibility of switching babies. ● 15 units required to renew

C. RA 10028: Expanded Breastfeeding Act 2. RA 10968: Philippine Qualification Framework

Law (National Policy)
1. Breastfeeding Stations ● Levels of education are assigned:
● These are placed in public areas. ○ Level 6 - Post Basic
2. Inclusion in the Curriculum ○ Level 7 - Certifications for competence,
● Breastfeeding concepts are included in the trainings, master’s degree
curriculum of all medical degrees. ● Examples:
○ IVT (IV Training)
D. RA 10354: Reproductive Health Law ○ DOH-MCN Certification
○ FP-Certification BEmONC
1. Purpose
● Level 8 - Doctorate Degree
● Nurses and midwives can give life-saving drugs
when the mother is at risk (even without the 3. AO 0025 - Series 2009 (UNANG YAKAP)
physician’s orders). 4. AO 0029 - Series 2008 (MNCHN)
Maternal, Neonatal, and Child Health Nutrition
2. BEmONC
● Basic emergency obstetric and newborn care 5. AO 0012 - Series 2012
(BEmONC) (Birthing Center Requirements)
● A primary health care level initiative promoted a. It is a Newborn Screening Facility.
in low- and middle-income countries to reduce Hearing Test - referred
maternal and newborn mortality. b. Clinical Services:
❏ Prenatal and Postpartum Care
3. Family Planning ❏ NSVD for low risk
● Nurses and midwives can give oral pills and ❏ Detection of High Risk - referrals
insert IUDs to patients but they are required to ❏ Family Planning - natural and artificial
be trained and certified. except vasectomy, tubal ligation, D/C
c. Life-saving medications.
E. RA 1123: Universal Health Law d. Personnel should be:
❏ SBA
1. PhilHealth ❏ Trained in BEmONC and Newborn
● Provides insurance to all Filipinos. resuscitation
2. Costs ❏ MOA with OB-Gyn and Pedia
● Hospital delivery : Php 6,500 e. Human Waste Management
● Community : Php 8,000 ❑ DENR - Local government
○ According to DOH, the purpose of this is to
G. Important Points to Remember
decongest the hospitals.
1. All women are at risk at childbirth, no matter how
○ Low-risk births are encouraged to deliver in
complete the prenatal visits are.
community health clinics.
● Cesarean Section : Php 19,000 2. The main goal of prenatal care: a healthy
● Newborn Package - Screening and Hearing pregnancy for both the mother and fetus.
Tests : Php 1,750
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Millennium Development Goals (MDGs) 1. First degree - fourchette and skin
2. Second degree - 1st plus vaginal muscles
3. Third degree - 2nd plus anus
4. Fourth degree - 3rd plus rectal tissue
4. Bulbocavernosus Muscles
● Vaginal muscles in the perineal area.
5. Labia Majora and Minora
● The protectors of the vulva.
6. Urethral Meatus
● The catheter insertion site.
● Site of urination.
7. Skenes or Periurethral Glands
● Moistens and lubricates the vulva and vagina
IV. Anatomy and Physiology during intercourse.
A. External Female Genitalia (Vulva) 8. Hymen
● Covers the vaginal canal.
9. Bartholin’s Glands
● Glands that surround the vagina.
10. Perineum
● Area between fourchette and rectum.
● Site of episiotomy and deep lacerations.
● Main muscular support of vulva.

1. Clitoris
● Used as a landmark for catheterization to
locate the urethra.
● The most sensitive part of the vulva.
2. Vagina
● The passageway of secretions and the baby.
● Organ of reproduction (copulation).
● Normal Flora: Doderlein's bacilli
● Common infections:
○ Moniliasis
○ Trichomoniasis
○ Bacterial infections (eg. STDs)
● Vaginal care:
1. Water, frequent flushing.
2. Use of guava leaves concoction.
3. Use of commercial vaginal wash products.
3. Fourchette
● The gap between the vagina and anus.
● This is assessed for lacerations.
● Nurses and midwives can only suture up to a
second (2nd) degree laceration.
● Types of Lacerations:

B. Internal Reproductive Organs
- Vagina is a part of the internal organ, but
the opening canal is external.
- The more reggae the more nulliparus. The
less the more multiparus.
1. Fallopian Tube
● Function: Fertilization and passage of zygote
● Divided into sections:
1. Infundibulum - attached to the fimbriae
which catches the ovum
2. Ampulla - most common site of fertilization
3. Isthmus - the site of tubal ligation
2. Ovaries
● Almond-shaped glands on each side of the
uterus
● Parts:
1. Cortex - outer; with Graafian follicles
- the most important part
*** Once a baby girl is born, the 2 million egg
cells at birth are reduced to 400,000. Upon
adulthood, it is reduced to 30,000 eggs.
2. Medulla - inner; contains blood vessels
● Exocrine: Ovulation
● Endocrine: Hormonal secretion
1. Estrogen
2. Progesterone
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3. Relaxin - softens the pelvic ligaments
3. Uterus
● Parts of the uterus:
1. Fundus - the round-shaped muscle
2. Corpus - the uterine body
a. Endometrium - the layer that changes
b. Myometrium - thickest layer, the part
that contracts to stop the bleeding
c. Perimetrium - outermost layer
3. Cervix
a. Internal os
b. External os
- Unique function of the uterus: organ of
menstruation and gestation
- Relation to bladder and rectum (post). If bladder,
and rectum is full, lesser space for the fetus.
Thus, they should be emptied before true labor.
● During the 1st trimester, the uterus is a pelvic
organ. This will cost frequent urination and
constipation due to the growing fetus.
● Uterine ligaments. Provide support for the
uterus.
4. Bladder
● It has to be empty during birth as it will block
the passage of the fetus.
C. Pelvis
1. Basic Points
● The hard passage in labor is the pelvis.
The soft passages are: cervix and vagina.
● There are four (4) bones in the pelvis.
1. Sacrum- back bone
2. Coccyx - moveable bones
3. Innominate bones (2) or Hip bones
A. Ilium - Biggest
B. Ischium - Lowermost
C. Pubic Arch - Front bone
● Types of Pelvis:
1. Gynecoid - round, possible NSVD
2. Anthropoid - oval, possible NSVD
3. Android - heart-shaped, male
4. Platypelloid - flat
2. Ilium: The biggest part of the pelvis (hip).
3. Ischial Spine: A landmark for delivery.
4. Pubic Arch
● A landmark for delivery.
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● Needs to be in an obtuse angle for the delivery
to be possible.
5. Sacral Promontory
● The last bone of the sacrum.
6. Sacrum
● There are five (5) sacral divisions.
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D. Pelvimetry
1. Definition V. Reproductive Processes
● The process of measuring the pelvis either by
A. Menstruation
X-Ray or internal exam (IE).
1. Definition
2. Diameters
● The periodic shedding of blood, mucus of
2.1 INLET
endometrial cells of the uterus. (Cyclical)
1. Diagonal Conjugate
● When does menstruation start and end?
🡆 11.5 cm or more
○ Menarche (starts 12 years old)
🡆 Lower margin of the symphysis pubis to
○ Menopause (starts 45-55 years old)
promontory of the sacrum.
● Amount: 30-80 mL (average 50 mL)
🡆 If less than 11.5, NSVD is not possible.
🡆 1.5 cm bigger than the OB conjugate.
ESTROGEN the hormone of women.
If lesser, NSVD is not possible.
PROGESTERONE the hormone of mothers.
2. Obstetrical Conjugate RELAXIN relaxes the uterine ligaments.
🡆 Shortest diameter - 10cm or more
🡆 If lower, there is an inlet contraction.
3. Anatomical Conjugate
2. Phases of Menstruation
🡆 11 cm or more 1. Follicular Phase
● Estrogen and FSH levels are higher.
2.2 MIDPELVIC MEASUREMENT
● Day 1-14 of menstruation.
The distance between the two (2) ischial spines.
● The basal body temperature drops prior to
1. Ischial Spine - 10 cm or more
ovulation (14th day) then increases.
2. Bispinous diameter
● Breasts are tender d/t estrogen surge.
2.3 OUTLET ● The estrogen suppresses the FSH, causing
1. X the LH to be secreted. LH causes
🡆x progesterone to be released, causing
estrogen to decline.
E. Breasts 2. Luteal Phase
● Lactiferous ducts - passage from the lobules to ● Progesterone and LH levels are higher.
the nipple. ● Progesterone and estrogen keep the uterine
● Acini Cells - milk producing decidua thick and secretory.
● Areola - pigmented area of the breast ● LH is the hormone of ovulation.
● Progesterone: ● Day 14-28 of menstruation.
○ Stimulates acini cells ● If no fertilization occurs, progesterone drops
○ Tenderness and breast enlargement followed by estrogen.
● Oxytocin ● Menstruation occurs.
○ Stimulates let down reflex. ● Once the hypothalamus detects that the
hormones are both too low, the GnRH is
triggered again (the cycle continues).
● This cycle can be interrupted by:
1. Pregnancy 3. Menopause
2. Lactation
3. Endometrial Cycle
● Proliferative: Day 6-14
● Secretory: Day 14-26
● Ischemic: Day 27-28
● Menstrual: Day 1-5
4. Cervical Mucus
● Before ovulation

○ Estrogen increases
○ Abundant mucus (spinnbarkeit)
○ Excellent sperm penetration
● After ovulation
○ Progesterone increases
○ Thicker mucus to plug the cervix
(non-spinnbarkeit)
5. Organs Affecting Menstruation
● The hypothalamus releases the GnRH.
● GnRH acts on the Anterior Pituitary gland:
1. FSH - maturation of follicles
2. LH - rupture of graafian follicles->ovulation
● Ovary releases:
1. Estrogen - Proliferative phase,
- spinnbarkeit secretions
2. Progesterone - Secretory phase
● Breasts - Estrogen - Ducts
● Progesterone - Acini Cells (produces milk
through prolactin stimulation)
● If no fertilization after 2 weeks of ovulation:
○ Progesterone and estrogen decrease
B. Ovulation
● Release of the ovum from the ovary.
● Each ovary ALTERNATES every cycle from
nearche to menopause unless stimulated by
ovulatory pills. (eg. Clomid)
● Ovulation generally occurs every 14th day of an
average 28-day cycle.
Eg. 28 days = 14th day ovulation
32 days = 14th-18th day ovulation
● Twins and multiple gestations are mostly
caused by fertility pills or genetics.
● Calendar method:
Subtract 18 from the SHORTEST cycle.
Subtract 11 from the LONGEST cycle.
The resulting range is the most fertile period.
C. Fertilization
1. Stages of the Zygote
● A zygote is the product of the union of the egg
and sperm.
● Stages:
1. Zygote
2. Blastomere
3. Morula: 16-cell
- Divides at the coruna of the uterus.
- Results into trophoblast and embryoblast.
4. Blastocyst
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5. Implantation of zygote
2. Factors Affecting Fertilization
● An egg and sperm must meet.
● Ovum:
○ Only one ovum is needed.
○ The ovum needs to ripe.
○ Viable for 24 hours.
○ Only one (X) sex chromosome
○ Best time to get pregnant is 4-6 hours prior
to ovulation.
● Sperm:
○ Recommended: 20 million per mL
○ The sperm needs to be mature.
○ Viable for 72 hours.
○ Varying X and Y sex chromosome
D. Germ Layers
1. Duration
● Occurs between 7-10 days after fertilization.
2. Germ Layers (inner to outer)
● Ectoderm: CNS, sense organs, nails, skin
● Mesoderm: Cardiovascular organs
● Endoderm: GIT organs
3. Nomenclature
● Zygote: From fertilization to implantation
● Embryo: From implantation to 8 weeks
● Fetus: From 8 weeks to birth
VI. The Fetus
A. Fetal Growth and Development
1. First Trimester
● Fetal heartbeat is first observed.
(A positive sign of pregnancy.)
○ 6-7 weeks it is first heard
○ Methods:
■ Doppler
■ Stethoscope
■ Electronic Fetal Monitor
■ Ultrasound
● Organogenesis (1-12 weeks).
● Sucking and swallowing of amniotic fluid
begins.
● The fetus modifies the amount of AF by voiding
and swallowing.
● If there is failure in swallowing, it may result
in polyhydramnios.

● If the fetus fails to void, it may result in
oligohydramnios.
● Placenta is complete.
● Fetal circulation is established.
● The trophoblast develops and releases HCG,
the first pregnancy hormone.
● The chorionic villi (finger-like projections) of the
trophoblast attaches to the decidua of the
uterus and forms the placenta.
● The HCG sustains the corpus luteum of the
pregnancy (gives nutrients and maintains
pregnancy) in the absence of the placenta.
● HCG levels are at its highest in the 1st
trimester, causing vomiting.
● Once the placenta develops, the HCG levels
decrease > nausea and vomiting decreases.
● If vomiting persists after the first trimester,
Hyperemesis Gravidarum is confirmed and the
woman needs to be hospitalized.
Electrolyte depletion is bad for pregnancy.
2. 2nd Trimester
● Rapid weight gain 13-24 weeks.
● Fetal movement is first felt.
● Fetal Heart Rate (FHR) is established.
● FHR felt via auscultation.
● Vernix and Lanugo develop.
● Sex can be differentiated around 12-16 weeks.
3. 3rd Trimester
● Maturation of organs begins.
(Most important organ = lungs)
● Lung surfactants develop at 26 weeks.
● The baby does not breathe yet but oxygen is
delivered via the placenta.
● Testes descend in the scrotum.
38 weeks - the testes is in the scrotum
(Cryptorchidism results if descent does not
occur at birth)
● The “first cry” of the baby indicates the health of
the lungs.
B. Fetal Circulation
1. Umbilical Cord
● The (1) vein carries the oxygen.
● The (2) arteries carry the CO2.
● These are covered by the Wharton’s Jelly.
● Umbilical Cord is 50cm or 20 inches.
● If the baby keeps going in and out of the vagina
during the 2nd stage of delivery, the suspected
condition is a cord loop.
2. Temporary Structures
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● These structures close at birth.
● Ductus Arteriosus = pulmonary artery - aorta
○ By-passes the lungs (pulmonary circulation)
○ Usually closes the last / difficult to close.
○ PDA (Patent Ductus Arteriosus)
■ Medication: Indomethacin
■ If it persists throughout infancy, it needs
surgery, otherwise the baby will
become a “blue baby”.
● Ductus Venosus = umbilical vein - vena cava
○ By-passes the liver (portal circulation)
● Foramen Ovale = between the RV and LV
3. Supporting Structures
1. Corpus luteum - maintains the pregnancy until
the placenta takes over
2. Endometrium - decidua following conception
and implantation (maintains the thickness)
○ Types of Decidua:
1. Basalis - where the fetus lies
2. Capsularis - what covers, disappears
around the 3rd month of pregnancy as the
fetus begins to grow bigger
3. Vera - protects and nourishes the embryo
3. Placenta - Functions by 12th week AOG.
○ The endocrine organ of pregnancy.
○ If there is no pregnancy, the endocrine
organ is the ovary.
○ HCG
■ Secreted by trophoblasts in the
placenta
■ D
○
4. Amniotic Fluid
○ Contained within the amnion.
○ Two (2) membranes:
1. Chorion - outer 2. Amnion - inner
○ The main source of amniotic fluid is the
fetal urine.
○ Average: 1,000 mL (oligo/polyhydramnios)
○ pH: Alkaline, clear of specks of vernix and
lanugo
○ Functions:
1. Protects the fetus.
2. Controls temperature.
3. Supports symmetrical growth.
4. Allows the fetus to move freely.
4. Functions of the Placenta
1. Respiratory - it breathes for the fetus
2. Nutritive - provides nutrition for the fetus
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3. Immunologic - secretes antibodies for the fetus ● Fetal movement felt
Begins on the 3rd trimester in preparation for
the delivery.
4. Excretory - where the waste products of the
fetus go
5. Barrier - protects the fetus from harmful
organisms;
🡆 It CANNOT block viruses because viruses B. Changes in Pregnancy
are too small and can pass through
1. Uterus
🡆 Get the woman vaccinated.
● With 60-1,000 gms
🡆 Get the Rubella virus vaccine. (MMR)
● Capacity
🡆 The only bacteria it cannot block is
N: 1-10 mL, Preg: 5,000 mL
Congenital Syphilis.
● Stretching of muscle
6. Endocrine hormones ● Braxton Hicks (4th month)
a. Estrogen ● Uterine growth - predictable
🡆 Stimulates the growth of uterus Evidently from the 2nd-3rd trimester.
🡆 Fetal maturity, fetal well-being ● Landmarks:
b. Progesterone ○ Xiphoid process - 36th week
🡆 Thickens the cervical mucus ○ Just below the XP - 32nd and 40th weeks
🡆 Decreased motility of uterus (relaxes) It drops due to Lightening.
🡆 Growth of breasts This is followed by engagement of the fetal
c. HCG (Human Chorionic Gonadotropin) head.
🡆 Secreted by Trophoblasts in the placenta ○ Between navel and XP - 28th week
🡆 Detected in the urine / blood (plasma) ○ Navel - 20th week
🡆 By day 8, the first indicator of a positive (Pregnancy is viable.)
pregnancy. ○ Between navel and SP - 16th week
d. HPL ○ Symphysis pubis - 12th week / 3 mos
🡆 Prepares nreast for lactation.
🡆 Milk production. 2. Cervix
🡆 increases after 20 weeks ● Stimulated by estrogen. Becomes vascular,
🡆 Nutrition of the fetus edematous, and darker.
● Mucus plug (operculum)
● Soft cervix
VII. Pregnancy ● Hegar’s - Goodell’s bluish discoloration
● All maternal body systems are altered by 3. Ovaries
pregnancy. These are normal, temporary, and ● Dormant
inevitable.
● Pregnancy is a state of wellness, not an illness. 4. Vagina
● Increased vascularization - Chadwick’s
● Vaginal discharge - thick and acidic
A. Signs and Symptoms of Pregnancy
5. Breast
1. Presumptive ● Increased size
● Skin changes (linea nigra) ● Colostrum present in 3rd trimester
2. Probable 6. Respiratory Changes
● Felt fetal parts ● Shortness of breath d/t displaced diaphragm
● Chadwick’s, Goodell’s, etc. from the growing fetus
● Positive pregnancy Test ● Nasal stuffiness and epistaxis
3. Positive ○ d/t edema and vascular congestion caused
● FHT detected by increase in estrogen.
● UTZ visualization ● Respiratory Rate increased
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7. Cardiovascular Changes ● Folic acid: taken 3 mos before pregnancy
● Most significant change. ● Protein: growth
● Increased fibrinogen (clotting factors). ● Calcium: bones and teeth
The blood coming out from the vagina should
be clotted during birth.
Risk for DVT and Pulmonary Embolism
● Heart is displaced to left, forward
● Uterus enlarges, pressure on blood vessels
C. Psychological Aspects
increases and slows circulation
● Pressure on vena cava causes supine 1. First Trimester
hypotension ● Ambivalence, Fear, and Anxiety
● Blood volume increases 30-50% ● “I am pregnant.”
○ RBC increases
2. Second Trimester
○ Hematocrit decreases - causing physiologic
● Focuses on the fetus.
anemia of pregnancy
● Concerned about body changes.
● BP decreases slightly in the 2nd trimester, then
● “I am going to have a baby.”
returns to normal on the 3rd trimester
(It is not normal to have HIGH BP in 3. Third Trimester
pregnancy, watch out for Pre-eclampsia) ● Prepares for birth.
● Fibrinogen levels increase as much as 40% ● “I am going to be a mother.”
- Blood clots occur more rapidly
- Prone to thrombophlebitis / DVT
D. Supporting Structures of Pregnancy
- How to prevent? Homan’s sign, exercise
● Heart Rate increases by 10-15 bpm 1. Amniotic Fluid
● Protects the fetus.
8. GIT
● Allows and even temperature.
● Nausea and vomiting - HCG
● Allows symmetrical growth of the fetus.
● Gums become soft and bleed - estrogen
● Must be clear, with specks of lanugo and
● Heartburn - d/t decreased gastric acidity and
vernix. Does NOT smell foul.
smooth muscle relaxation
● If it is greenish (meconium stain), the baby
● Bloating and constipation - decreases intestinal
could be in distress.
motility
● If yellow with foul odor, it could be
9. Urinary Changes chorioamnionitis or infection (from premature
● Urine output increases rupture of membranes).
● Urinary stasis increases UTI
2. Placenta
● Urinary frequency increases
● Produces HCG and HPL.
10. Metabolic Changes
3. Umbilical Cord
● Metabolism increases by 20%
● 2 Arteries (carbon dioxide), 1 Vein (oxygen)
● Average weight gain 25-35 lbs
● Increased water retention.
Water is retained to support the increasing E. Fetal Health Evaluation
blood volume and serves as source of nutrients
for the fetus 1. Fetal Heart Rate (FHR)
● Doppler - 10 to 12 weeks
11. Endocrine Changes ● Stethoscope - 20 weeks
● Ovaries are dormant. ● Normal FHR: 120-160 bpm
● Pancreas increase production of insulin.
2. Ultrasound (UTZ)
12. Nutrition in Pregnancy ● Recommendation: One UTZ at least before 24
● Calories: +300 RDA per day in pregnancy weeks (6 mos) AOG.
+500 RDA / day in lactating women ● First trimester
Average per day is 2,500 so add 300/500. ○ Assess gestational age
● Iron
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○ Assess congenital anomalies ● If high, Neural Tube Defects.
○ Fetal growth evaluation ● If low, Trisomy defect.
○ Diagnosis of multiple gestation
8. Biophysical Profile (BPP)
● Second trimester
● A commonly used fetal health evaluation tool.
○ Same as first trimester
● The APGAR version of a fetus.
○ Include assessment of placental location
● Parameters:
● Third trimester
1. FHR
○ Determining fetal position
2. Respiratory breathing movements
○ Estimation of fetal size
3. Fetal movement
3. Fetal Movement 4. Fetal tone - flexion
● Generally felt at 20 weeks 5. Amniotic Fluid Volume
● Used during 3rd trimester ● Normal = 7-10
● Ask the woman to monitor the fetal movement High Risk = 3 or less
daily at home.
○ Count the number of fetal movements.
○ 10 is a good number.
○ Determine the pattern of movement of fetus
○ Count approximately the same time each
day. Babies move at different times of the
day.
○ Count 20 mins after eating
○ If the baby ceases to move within a day,
immediately seek consultation.
4. Non-Stress Test (NST)
● Increased FHR with fetal movement.
● This indicates adequate oxygenation.
● This is termed REACTIVE. It means that the
fetal movement causes acceleration of FHR.
● Criteria:
2 accelerations within 10 mins.
Increases by 15 bpm and lasts 15 seconds.
5. Contraction Stress Test (CST)
● Use of oxytocin.
● Usually performed 38 weeks AOG
● Normal: NEGATIVE CST. No late
decelerations noted. The healthy fetus
responds to contractions.
● Types of Decelerations:
1. Early - head descent
2. Late - utero-placental insufficiency
🡆 Lack of O2 exchange between the baby
and the placenta.
🡆 Oxygenate the mother.
3. Variable - cord compression
🡆 Immediate emergency CS delivery.
🡆 This is to relieve the cord compression.
6. Amniocentesis
● Done early to detect fetal abnormalities.
● Done late to detect lung maturity.
7. Maternal Alpha Feto Protein Test (AFP)