THE BEGINNING OF PREGNANCY Zygote From fertilization to

implantation
Presumptive – felt by the mother (subjective) least Embryo From implantation to
indicative of pregnancy. 5-8 weeks
 Amenorrhea, nausea and vomiting, frequent Fetus From 5 weeks until
urination, fatigue (baby uses the sugar of the term
mother) Conceptus Developing embryo or
 Chloasma gravidarum - darkening of the
detus and placental
structures throughout
face
pregnancy
 Linea nigra – dark line on the abdomen
 Striae gravidarum
5 PRODUCTS OF CONCEPTION
Probable – felt by the examiner or the nurse.
1. Fetus,
 Abdominal enlargement
2. Placenta/pancake
 Hegar sign – softening of the lower portion
3. Umbillical cord/funis
of the uterus
4. Amiotic fluid
 Chadwich sign – darkening of vagina
5. Amiotic sac
 Ballotment – baby is bouncing occurs in 4th
B. Implantation
month
 Zygote migrates towards the body of uterus
 Goodle sign – softening of cervix
which taks 3 or 4 days
 Braxtonhic sign – painless palpable
 Cleavage or mitotic cell division begins: 24
contraction
hours
 Pregnancy test (male positive in pregnancy
Blastomeres
test indicates testicular cancer)
 Time zygote reaches body of uterus it
Positive
consists of 16-50 cells
 ultrasound, fetal hearbeat, fetal
 In initial cell division, 2 blastomeres until
movement/quickening (felt by the examiner)
after 3-4 days
Morula
Antepartum period – woman know that she is
 Blastomeres that will arrange in a ball-like
pregnant/nalaman. Longest period (9 months)
structure
Intrapartum – labor, delivery, removal of placenta
 Travels to uterus and stays for 3-4 days
Postpartum – 6 weeks following pregnancy
Blastocyst
 Multiplication of morula forming solid
Trimester
clump of cells
1st trimester – first 3 months
Trophoblast (fingerlike projections)
2nd trimester (4-6 months)
 Outer ring replacing zona pellucida
3rd trimester (7-9 mmonths)
EMBRYONIC AND FETAL STRUCTURES
After implantation, endometrium is termed
A. Fertilization
DECIDUA, which has 3 portions:
(conception/impregnation/fecundation)
1. Decidua basalis – lies directly under
 Union of ovum and spermatozoa
embryo
 Occurs in outer third of fallopian tube, the
2. Decidua capsularis – portion stretches and
ampullar region
encapsulate the surface of trphoblast
 Critical time span occurs about 72 hours
3. Decidua vera – remaining portion of uterine
 After ovulation, the ovum is extruded from
lining
graafian follicle, surrounded by a ring of
Chorionic Villi - finger like projections
mucopolysaccharide fluid (zona pellucida)
responsible for secretion of pregnancy hormones
and circle of cells (corona radiata)
human chorionic gonadotrophin (HCG) and human
Capacitation
placental lactogen (HPL), estrogen, progesterone
 Ejection of DNA of sperm to ovum
*At the time of implantation, there are 3 important
 Final process for fertilization
changes in the embryo that occurs simultaneously –
 Changes in plasma membrane of sperm head
formation of membranes
Factors affecting fertilization
1. Chorionic membrane – first membrane to
1. Maturity of sperm and ovum
be formed. Protects and support embryo
2. Ability of sperm to reach ovum
during growth and development
3. Ability of sperm to penetrate zona pellucida
2. Amniotic membrane – thin protective
Terms used to denote fetal growth membrane containing amniotic fluid. The
Ovum From ovulation to
fertilization
 space between membrane and embryo is
amniotic cavity.
Amnion – produces amniotic fluid. Usually 800 –
1200cc average amount of amniotic fluid
Polyhydramnios – more than 2,000 mL
Oligohydramnios – less than 300 Ml
Functions of Aminiotic fluid
1. Shields against [ressure or blow to mother’s
abdomen
2. Protects fetus against changes in
environment – temperature
3. Muscular development allowing fetus to
move freely
4. Protects umbilical cord from pressure,
protecting fetal oxygen supply
C. Placenta/pancake
 Provides nutrition and blood suppy and
oxygen supply.
 15-20 cm in diameter at the beginning of
pregnancy
 2-3 cm in thickness; weighs 500 grams at
term
 Covers half surface area of internal uterus
 Mature placenta has 16-30 separate
segments called cotyledons
2 Portions:
 Maternal portion – formed by deciduas
basalis and its circulation. Surface is red and
flesh like-presnce of cotyledon Looks rough,
uneven, and dirty (duncan)
 Fetal portion – made up of chorionic vili
and its circulation
 Give shiny and grayish apperance (shaltz)
Functions:
1 Serves as fetal lungs, kidneys and
gastrointestinal tract
2 Endocrine functions:
 HCG – first hormone produced
 Estrogen – contributes to mother’s
ammmary gland development in
preparation for lactation
 Progesterone – maintain
endometrian lining produced by
placenta staring 8 or 12th week
pregnancy.
 Human placental lactogen – growth
promoting and lactogenic (milk-
producing) properties by 6 weeks
 Protection againsta invading
microorganisms and chemical
substance
D. Umbilical cord
 Formed from amnion and chorion
 Provides circulatory pathway that
connects embryo to chorionic vili of
placenta
 Protected by whaton’s jelly – transparent
gelatinous white substance which
prevents pressure on veins and arteries
Veins and arteries
 21 inches in length
 2 cm in thickness
 2 arteries (carrying blood from fetus back to
placental vili)
 1 vein (carrying blood from placental vili to
fetus)
Functions:
 Transport O2
 Nutrients to fetus from placenta
 Return waste products from fetus to placenta
Organogenesis – first 3 months when organs begin
to grow
ORIGIN OF ORGAN SYSTEMS
FETAL GROWTH AND DEVELOPMENT
First lunar month
Germ layers differentiate by the 2nd week
1. Endoderm - gives rise to lining of GIT,
Respiratory Tract, tonsils, thyroid (for basal
metabolism, parathyroid (for calcium metabolism),
thymus gland (for development of immunity),
bladder and urethra
2. Mesoderm - forms into the supporting structures
of the body (connective tissues cartilages. muscles
and tendons); heart circulatory system, blood cells,
reproductive system, kidneys and ureters.
3. Ectoderm - responsible for the formation of the
nervous svsten skin, hair and nails and the mucous
membrane of the anus ands mouth
Stages of Human Prenatal Development
a. First 12 - 14 days = zygote
b. From 15th day up to 8th week = embryo
C. From 8th week up to the time of birth = fetus
DEVELOPMENT OF ORGAN SYSTEMS
A. Cardiovascular System
• 6th or 7th week- septum divides the heart into
chambers
• 10th-12th week- heartbeat may be heard with a
doppler o 11th week - ECG may be recorded on
fetus
• 16th day of life- single heart tubes form o 24th day
of life- heart beats
• 28th week - Sympathetic Nervous System matures
heart rate
B. Respiratory System
• 3rd week - Intrauterine life:
respiratory and digestive tracts
exists as a single tube
 4th week - septum begins to divide the
esophagus from the trachea. lung buds appear
on the trachea
• 7th week - diaphragm does not completely divide • Vernix caseosa - important for lubrication and for
the thoracic cavity from the abdomen keeping the skin from macerating in utero.
Respiratory Milestone J. Immune System
 28th week alveoli and capillaries begin to form • IgG - increases phagocytosis: provide immune
SURFACTANT -phospholipid substance formed protection to the fetus and newborn.
and excreted at about 24th week of pregnancy
COMPONENTS: MILESTONES OF FETAL GROWTH AND
• 35th week - production of lecithin o 2: 1 (Lecithin: DEVELOPMENT
Sphingomyelin) End of 4 Gestation Weeks
• Respiratory Distress- lack of surfactant • Length - 0.75 cm to 1 cm
C. Nervous System - Weight - 400 mg
 3rd Week - a neural plate is apparent forming th • The spinal cord is formed and fused at midpoint
CNS (brain and spinal cord) Trophoblasts embed in decidua
 8th week = brain waves can be detected by the Chorionic villi form
EEG • Foundation for nervous system, GUT, skin.
• All parts of the brain (cerebellum, cerebrum, bones and lungs are
medulla oblongata and pons) form in utero formed
• 24 weeks = ear is capable of responding to sound: • The rudimentary heart appears as a prominent
eyes exhibit pupillary reaction bulge on the anterior surface
• Meningocele or Anencephaly • Back is bent so the head almost touches the tip of
D. Endocrine System the tail
o Thyroid and parathyroid glands - play vital roles • Arms and legs are budlike structures
in • Rudimentary eyes, ears and nose appear
metabolic function and calcium balance
• Fetal Pancreas - produces insulin End of 8 Gestation Weeks
o Fetal Pancreas - produces insulin • Length - 2.5 cm
E. Digestive System o 4th week- digestive tract is • Weight - 20 g
separated from th respiratory tract • Organogenesis is complete
o 10 week - abdominal cavity has grown large • The heart, with a septum and valves, is beating
enough to accommodate all intestinal mass o 6th • Facial feature are definitely discernible
week- meconium forms in the intestine o GIT is • Primitive tail is regressing
sterile before birth - becausts Vit. K is synthesized • Head is disproportionately large, owing to brain
by the action of bacteria in the intestines. development
• Sucking and swallowing reflexes are not mature o • Abdomen appears lage due to rapid growth of fetal
Liver is active, functioning as a filter between the intestine
incoming blood and fetal • External genitalia is present, but sex is not
o Fetal stores such as iron and glycogen. o It is still distinguishable by simple observation
immature after birth, possibly
hypoglycemia and hyperbilirubinemia End of 12 Gestation Weeks
(2 lead to serious • Length - 7 to 8 cm
problems 24 hours after birth) • Weight - 45 grams.
• Nail beds are forming on fingers and toes
Meconium – first stool of the newborn • Spontaneous movements are possible, but not felt
Vitamin k .1 is given to newborn for clotting by the mother
purposes preventing hemoraditc disease of newborn • Bone ossification centers are forming
• Tooth buds are present
F. Musculoskeletal System • Sex is distinguishable by outward appearance
(° 11° week - fetus can be seen moving • Placenta is complete
(quickening) but cannot be felt by the mother • Heart is audible by a Doppler
• 12* week- ossification of bone tissue begins • Kidney secretion has begun
G. Reproductive System
• 6th week - gonads (testes and ovaries) form, testes End of 16 Gestation Weeks
are • Length - 10 to 17 cm
H. Urinary System • Weight 55 - 120 grams
• 44 week - kidneys are present in the abdominal • Fetal heart sounds are audible by an ordinary
cavity stethoscope
1. Integumentary System • Sex can be determined by Ultrasound
• Lanugo - soft downy hairs • Lanugo is well formed
• Liver and pancreas are functioning •Length - 42 to 48 cm
• Nasal septum and palate close • Weight - 1800 to 2700 grams
• Fetus actively swallows amniotic fluid • Body stores of glycogen, iron, carbohydrate, and
• Urine is present in amniotic fluid calcium are augmented
• Additional amount of subcutaneous fats are
End of 20 Gestation Weeks deposited
• Length - 25 cm • Amount of lanugo begins to diminish
• Weight 223 grams • Amniotic fluids decreases
• Spontaneous fetal movements are felt by the • Sole of foot has 1 or 2 crisscross creases
mother
* Antibody production is possible End of 40 Gestation Weeks
Hair forms, extending to include eyebrows and hair • Length - 48 to 52 cm
on • Weight - 3000 grams
the head • Fetus kicks actively, hard enough to cause the
• Meconium is present in the upper intestine mother considerable discomfort
• Brown fat, a special fat that will aid in temperature • Creases on soles of feet cover at least 2/3 of the
regulation at birth, begins to form behind the surface
kidneys, sternum, and posterior back • Vernix caseosa fully formed
• Heart sounds are perceptible by auscultation • Fingernails extend over the fingertips
• Vernix caseosa appears
• Definite sleeping and activity patterns are THE DIAGNOSIS OF PREGNANCY
distinguishable (the fetus has devlop bio rhythms
that will guide sleep/wake patterns throughout life) Presumptive signs of pregnancy- are those tha are
least indicative of pregnancy
End of 24 Gestation Weeks • Amenorrhea
• Length - 28 to 36 cm • Nausea and Vomiting (morning sickness)
• Weight- 550 grams • Breast Changes
• Skin appears wrinkled • Frequent urination
• Meconium is present as far as the rectum • Quickening
• Active production of lung surfactant begins • Fatigue
• Eyebrow and fingernails are well defined • Changes in abdominal shape
• Pupils are capable of reacting to light • Linea nigra
• Hearing can be demonstrated by response to • Leukorrhea
sudden sound • Striae gravidarum

End of 28 Gestation Weeks Probable signs of pregnancy- can be documented by

• Length - 35 to 38 cm th examiner. They are not positive or true diagnostic
• Weight 1200 grams findings
• Skin is red • Hegar's sign
• Pupillary membrane disappears from eyes and the • Goodell's sign
eyelids open • Chadwick's sign
• Lung alveoli begins to mature and surfactant can •Braxton Hick's contractions
be demonstrated in amniotic fluid • Ballottement
• Testes begins to descend into the scrotal sac from • HCG test (Pregnancy test)
the lower abdominal cavity
• Eyes are open Positive signs of pregnancy- they are only three
• The fetus has an excellent chance of survival positive signs of pregnancy:
Demonstration of fetal heart separate from the
The fetus has an excellent chance of survival mother's
End of 32 Gestation Weeks Fetal movements felt by the examiner
• Length - 38 to 43 cm • Visualization of fetus by ultrasound
• Weight - 1600 grams
• Subcutaneous fat begins to be deposited Responsibilities:
• Fetus is viable 1. Instruct the woman to drink glass of water and
•Fingernails grow to reach the end of the fingertips not to void before the procedure. Full bladder will
• Vigorous fetal movements ocours cause the uterus to be pushed upward out of the
pelvis
End of 36 Gestation Weeks
2. Tell the woman it is safe and painless procedure
and that there is no sensation at all from the UTZ
3. The abdomen will be covered w/ water soluble
gel because sound waves travel through liquid
medium. Reassure that conducting gel may feel cold
but it is not staining.
4. A probe is then placed and moved back and forth
on the abdomen and a moving picture of the fetus is
seen on the screen
PSYCHOLOGICAL AND PHYSIOLOGICAL
CHANGES DURING PREGNANCY
PSYCHOLOGICAL TASKS OF PREGNANCY
First Trimester: Acceptance of pregnancy (*I am
pregnant"
• It is the first psychological task
• women and partner both spend time recovering
from shock of learning they are pregnant and
concentrate on what it feels like to be a pregnant
• a common reaction is ambivalence
• The doctor's confirmation of pregnancy often
helps the woman accept the fact that she is pregnant
• The unborn child is incorporated as part of the
woman's body image or as part of herself
* Second trimester: Acceptance of the fetus as a
separa individual ("I am going to have a baby")
• Women and partner move through emotions such
narcissism and introversion as they concentrate on
what it
feel like to be a parent
Quickening - it helps the woman realize that the
fetus is not just part of the body but a separate and
real individual to care for.
• She begins to fantasize about the child's sex and
appearance (she gives the fetus as identity)
• Role-playing is common
Third trimester: The woman prepares for the birth
of the baby and her role as a mother (" I am going to
be a mother")
• Woman begins to plan about the birth of the baby
• Select baby's layette, choose names for her baby,
make plans on how the baby will be fed, where the
baby will sleep at home etc
EMOTIONAL RESPONSES TO PREGNANCY
1. Ambivalence - refers to the simultaneous
negative or positiv response of the woman to
pregnancy
2. Grief - before a woman can take on mothering
role, she has to give up or alter her present role
3. Introversion or Narcissism (self-centeredness)
- during pregnancy, the woman may become
concerned for her welfare and the effects of
pregnancy on her health and lifestyle. She may be
preoccupied with her own thought and feelings.
4. Extroversion - women become more active,
appear healthier than ever before, and are more
outgoing. It tends to occur in women who are
finding unexpected fulfillment in pregnancy
5. Body image(the way your body appears to
yourself) and boundary (a zone of separation
perceive between yourself and objects or other
people)
6. Fear and anxiety - it is related to the woman's
concern about her own health and the health of her
baby.
7. Uncertainty - some women may still in doubt
that they are pregna despite a positive pregnancy
test and confirmation by a doctor
8. Couvade syndrome - men experience physical
symptoms such nausea, vomiting and backache to
the same degree or even more intensely than their
partners do. These symptoms are often the results of
anxiety and empathy for the pregnant woman.
9. Emotional liability - partly as a manifestation of
narcissism or
because of hormonal changes
10. Changes in sexual desire
- 1st tri - decrease libido because of nausea, fatigue,
and breast tenderness
- 2nd tri - libido and sexual enjoyment rises
markedly because blood flow to the pelvic area
increases to supply the placenta
- 3rd tri - it may remain high or decrease because of
difficulty finding a comfortable position and
increasing abdominal size
11. Changes in the expectant family preparing the
family for the birth of a new member.
Prenatal care is essential for ensuring the overall
health of newborns and their mothers, it is a major
strategy for helping to reduce the number of low-
birth weight babies born yearly.
Goals:
1. To ensure a healthy and uncomplicated
pregnancy and to deliver a healthy infant.
2. To identify and treat high risk conditions.
3. To assist patient in preparation for labor and
delivery and purperium.
4. To have adequate immunization against
contagious diseases.
5. To develop positive attitudes about sexuality,
womanhood and childbearing.
6. To provide pregnancy education for additional
health promotion.
COMPONENTS OF THE HEALTH HISTORY
1. History-taking
Demographic Data
(Name, age, address, civil status, telephone number,
religion, occupation, and
health insurance information)
Chief concern
- The reason the woman has come to the health care
setting, confirmation of pregnancy (date of LMP,
pregnancy test, elicit signs of early pregnancy and
danger signs of pregnancy)
Family profile- support person, marital status, loss
of loved one, financial; hardships, lack of support
system
Medical history (Past and Present)
- Existing
problems,
immunizations. alcohor mtake, orgaretie smoking,
ers allergies and reics;
History of family illness
Day history/social profile
- womanis utrimok inxercisono, dirinket.
medicationscreaturaneestynd drugs
(oral or IV), smoking, alcohol drinker, medications
(accutane) personal interactions
Gynecologic history
menarche, characteristics of menstruation,
discomforts associated with the monthly period,
actions taken to relieve such discomforts, previous
reproductive surgery, planning methods and sexual
history.
Obstetric history
# of past pregnancies, pregnancy outcome,
complications, labor time, method
delivery, complications of labor, pueperium, and
complications of puerperium
- GP TPALM
• Gravida- a woman who is or has been pregnant
• Primigravida- a woman who has been pregnant
for the first time
• Primipara- a woman who has given birth to one
child past age of viability
• Multigravida- a woman who has had two or more
pregnancies
• Multipara- A woman who has carried two or
more pregnancies to viability
• Nulligravida- a woman who has never been
pregnant and is not currentl pregnant
• Para- the number of pregnancies that reach
viability, regardless of whether the infants were
born alive or not (24 weeks)
o Age of viability- is the earliest age at which
fetuses could survive if they were born at that time,
generally accepted as 24 weeks, or fetuses weighing
more than 400 grams.
• T: The number of full-term infants born (infants
born at 37 weeks or after)
• P: The number of preterm infants born (infants
born before 37 weeks)
• A: The number of spontaneous or induced
abortions
• L: The number of living children
• M: Multiple pregnancies
Review of systems - to recall diseases that she
forgot to mention, it completes the subjective
information. It uses systematic approach, such as
head to toe, and explain what you'll be doing.
2. Physical Examination
Baseline height and weight - to get the baseline
data; to determine weight gained or lost
Vital signs - ex. A sudden ^ of BP and sudden
weight gain is a sign of HPN
pregnancy/ A sudden ^ of PR and R may suggest
bleeding v Assessment of systems - cephalocaudal
method
- General Appearance/ mental status: body posture,
appearance, way of speaking, hygiene, facial
expression
- Head/Scalp: symmetry, contour, hair, chloasma,
tenderness
- Eyes: edema of eyelids, poor vision
Nose: nasal congestion, swollen nasal membrane
Ears: fullness in the eustachian tube, fullness in the
ear
- Sinuses: tenderness
- Mouth/Teeth/Throat: cracked corners of mouth
(Vitamin A deficiency), herpes
- Neck: slight thyroid hypertrophy
- Lymph Nodes: no palpable
- Heart: no murmurs, palpitations, HR 70-80
- Lungs: diaphragmatic excursion
- Back: back pain
- Rectum: hemorrhoids
- Extremities/Skin: erythema, itchiness, jaundice,
pigmentations
LABORATORY TESTS
1. Blood tests
Hematocrit and hemoglobin level
• To detect anemia
• Done at initial clinic visit and repeated at 28-32
weeks
• Anemia during pregnancy is usually of the iron-
deficiency type.
• Normal hemoglobin level (12-16 mg/di)
• Normal hematocrit level (37-47%)
• Mild anemia is hgb less than 11 gm/dl (Hct 27-
33%)
• Severe anemia is hgb less than 9 gm/dI(Hct more
than 27%)
•Leukocyte count - to rule out leukemia and
possible infection
•Platelet count - to estimate clotting ability
•Blood type and Rh factor
• VDRL - to screen for maternal syphilis
2. Urinalvsis
- to detect proteinuria, glycosuria and pyuria
3. Tuberculosis screening
PPD (purified protein derivative)
PELVIC EXAMINATION
• External genitalia (signs of inflammation,
irritation or infection)
• Internal genitalia
1. Internal examination or Vaginal examination
Patient preparation:
a. Provide explanation
b. Let woman empty her bladder first
c. Provide good lightning
d. Place the woman in a lithotomy position with
buttocks extended slightly beyond examining table
e. Drape properly
Let support person stay at the head of the bed
g. Instruct woman not to:
- hold or squeeze your hands and that of her
husband hold her breath close eyes tightly clench
fist
- contract perineal muscles
h. After procedure, provide tissue to wipe perineum
of lubricant.
2. COMPUTATION OF THE EXPECTED
DATE OF DELIVERY
~ Nagele's rule
it is the standard method used to predict the length
of a pregnancy
- inquire for last menstrual period (LMP) and
calculate for expected date of delivery/confinement
(EDD/EDC)
Problems encountered with the use of LMP
1. Failure to record LMP
2. Menstrual cycle may be irregular and variable
3. Pregnancy may follow immediately without
menstruation in between gestation
4. Implantation bleeding may be mistaken as
menstruation
5. Ovulation that occurs after cessation of ovulation
inhibition method of contraception may be delayed
Inquire the last menstrual period
If LMP is from January to March
*Add 9(month) and 7 (day)
PROMOTING FETAL AND MATERNAL
HEALTH
1. Measurement of Fundic Height:
Purposes:
a. Check pregnancy is progressing at the expected
rate
b. Estimate AOG (McDonald's Rule)
Formula:
Height of fundus (cm) x 2/7 = gestation in lunar
month
Height in fundus (cm) × 8/7 = gestation in weeks
MEASURING FUNDIC HEIGHT
Place the zero line of the tape measure on the
anterior border of the symphysis pubis and stretch
tape over midline of abdomen to top of fundus.
The tape should be brought over the curve of the
fundus.
2. Estimate fetal weight:
- using the fundic height (Johnson's Rule)
Formula:
FH (cm) - n x K = fetal weight in gms
Where:
n = 12 if the fetal head is below the level of the
ischial spine (engaged)
= 11 if the presenting fetal part is above the
level of the ischial spine
= 1 is added to n for patients over 200 lbs
k = 155 (constant)
3. Fetal length: (Haase's Rule) in cm long
- First 5 months of pregnancy = square the number
of the month of
pregnancy
- From 6th months on multiply the number of the
month by 5
BARTOLOMEW'S RULE
GROWTH OF THE FUNDIC HEIGHT
• 12 weeks - level of symphysis pubis
•16 weeks - halfway between symphysis pubis and
umbilicus
• 20 weeks - level of umbilicus
• 24 weeks - two finger above umbilicus
• 28-30 weeks - midway between umbilicus and
xiphoid process
• 36 weeks - at the level of xiphoid process
• 40 weeks - two fingerbreadths below umbilicus,
drops at 34 weeks level because of LIGHTENING
3. LEOPOLD's MANEUVER
• is a systemic method of observation and palpation
to determine fetal presentation and position
Purposes:
a. Determine the position of the fetus
b. Determine the presentation of the fetus (head or
breech)
Nursing Care:
1. Prepare the client
a. Explain the procedure
b. Instruct to empty bladder
c. Placed on supine position with knees slightly
flexed
d. Wash hands using warm water
e. Observe the abdomen for longest diameter and
where fetal movement is apparent
2. Perform the maneuver
FIRST MANEUVER (Upper uterine segment or
the uterine fundus)
a. Face the woman's head
b. Palpate upper abdomen to detect what lies in the
fundus
c. Determine the height of the uterine fundus
- Place hands on either side of the fundal area so
that the fingers of both hands almost tough each
other (face the woman's head).
- Press gently and firmly with finger pads.
- A very hard round well defined shape which can
be moved backand forth (balloted) usually indicates
a fetal head
- A somewhat hard and roundish shape, which when
moved back and forth between the finger pads, also
moves the entire fetus usually indicates a fetal
breech.
SECOND MANEUVER:
• (Determines small parts and back of fetus along
the sides maternal abdomen)
a. Exmainer faces the woman's head
b. Palpate the sides of the abdomen to detect
location of the fetal back and fetal small part
c. Palpate fetus between two hands
- Back: hard, smooth, resistant plane
- Small parts: irregular, nodular with bony
prominence
• Assess on which side is the fetal back or spine and
which side has small parts or extremities
• Lateral Palpation of the Uterus: provides
information regarding the location of the fetal back
and the fetal small parts consisting of arms and legs.
• Hands should alternately apply pressure against
the opposite hand.
• Directing alternating pressure against each hand is
the technique:
Alternating hands using firm resistance while the
other hand gently and firmly applies pressure and
rotates in a circular fashion. This technique can be
used up and down the entire length of the uterus.
THIRD MANEUVER:
- Face the woman's head and spread your hands
widely apart
- Grasp the uterine contents just above the
symphysis pubis (firmly but gently)
- Hold presenting part between index finger and
thumb; Assess for cephalic versus Breech
Presentation
- Move the fetal presenting part gently back and
forth in your hand
- Fetal head will shift more easily back and forth
- Fetal breech will move the whole body
FOURTH MANEUVER
(pelvic palpation of the uterus - assess the
presenting part)
- Examiner faces woman's feet
- Place hands on either side of the lower abdomen
with finger pads at the lower uterine pole (bikini
line) and thumbs directed toward the umbilicus.
- Carefully move fingers of each hand towards each
other in a downward and inward manner using
gentle pressure.
-The nurse's thumbs should point towards the
woman's umbilicus.
- If one of your hands met an obstruction. Above
the ligament it is the fetal blow
- If the fetus is in poor attitude, it will meet an
obstruction on the same side of the fetal back
Summarization of the manuevers:
1st – superior surface of the fundus is palpated to
determine consistency, shape and mobility
2nd – both sides of uterus are palpated to determine Elevate legs and hips
the direction the fetal back is facing for intervals of 15-20
3rd – determine part of the fetus at the inlet and its mns 2x a day
mobility Avoid prolongs
4th – determines the fetal altitude and degree of fetal tanding and sitting
extension into the pelvis Avoid wearing
garters
Rest legs
4. Check Fetal Heart Rate:
Muscle cramps Change position
• Funic souffle frequently
- refers to a soft blowing murmur caused by blood No garters
rushing through the umbilical cord. Soak in warm water
- 140 bpm using heating pads
• Uterine souffle Pedal edema Avoid prolong
- refers to a soft blowing by blood rushing through standing or siting
the large vessels of the uterus. Comfortable shoes
- 80 bpm No round garters
Elevate in side lying
5. Provide Health Teachings position
Minor discomforts Interventions Backache Good posture
Nausea and vomiting - Take dry carbo Flat shoes
- Sensitivity to HCG (30 mns before Firm maternity girdle
- High getting up) Firm/comfortable bed
estrogen/progesterone - Refrain fatty Pelvis rocking
- Low maternal blood foods exercises
sugar - Small frequent Rest and avoid
- Gastric motility meals fatigue
- Increase fluids Pride of pregnancy
best tolerated Breat tenderness Wash breast with
before meals water only
- Sour ball candies Wear maternity
Heartburn/pyrosis - Eat small brassiere
frequent meals Palpitations Avoid sudden
- Sleep with two movement
pillows Rest
- Don’t life after Leukorrhea Daily path or perineal
eating care
- Aluminum Wear perineal pad
hydroxide Frequent urination Increased fluid to
- Maintain upright replace
position Perineal pad
- Refrain from Flush perineum after
indigestible gas voiding
froming Kegel exercise
fatty/spicy foods Normal
Constipation Increase fluid intake Nasal stuffiness Avoid allegerns and
6 g/day smoke-filled rooms
High fiber diet/iron Normal saline ¼ tsp
Walking salt in 1 cup of water
Stool Breathe steam from
softenoers/regular bm pot boiling water
Easy fatigability Enough rest and sleep Leg cramps/charley horse Push toe forward
in sim’s position while applying
Comfortable clothes pressure on the knee
and shoes to strengthen leg
8 hours of sleep One quart of milk a
Avoid standing long day
periods exercise
Eat well balaced diet
for energy
Leg varicosities Elastc stockings
DANGERS SIGNS OF PREGNANCY abortion
1. Vaginal Bleeding - should be reported no matter Sleep Lose REM due to
how slight; if discovered it after bowel movement, frequent walking
she may report spotting from hemmorhoids. Sims position
2. Persistent vomiting - once or twice daily is Work Avoid toxic
uncommon it may deplete the nutritional suppl Travel No restrictions during
available to the fetus and is danger to the early pregnancy
pregnancy. DHN; Mo uncoooked fruits,
veg, meet and purified
FETAL DISTRESS
water
3. Hyperemesis gravidarum- excessive vomiting Lap belt when driving
4. Chills and Fever - indicative of uterine infection,
benign gastroenteritis PROMOTING NUTRITIONAL HEALTH DURIN
5. Sudden Escape of Clear Fluid from the Vagina PREGNANCY
rupture of the membrane (PROM), threatened both • Nutritional Assessment
fetus and mother because the uterine activity is no . Taking a diet history
longer sealed against infection - 24 hour diet recall
6. Abdominal/Chest Pain - tubal (tvivpic) - Cultural and religious practices
pregnancy; placental separation, preterm labor, - Eating habits and preferences
appendicitis, ulcer and pancreatitis. Pulmonary 2. Laboratory assessment
embolus thrombophlebitis (Hemoglobin and
7. PIH (Pregnancy-Induced Hypertension)- rapid Hematocrit)
weight gain (2lbs/week), swelling of the face or 3. Weight and height measurement (BMI)
fingers, flashes of light or dots before the eyes, 4. General physical assessment
blurring of vision, severe headache, decreased urine 5. Provide nutritional instruction
output, swelling of hands (tightness of the ring); • Increased calorie intake for energy
face (difficulty opening the eyes; visual disturbance - Additional 300 calories or a total caloric intake of
headache (cerebral edema/acute hypertension) 2,500 calories is recommended
8. Increase or decrease fetal movement- fetus is - Inadequate intake of calorie lead to protein
responding to the need for oxygen breakdown
Assess the weight gained to determine if a woman's
HEALTH PROMOTION DURING PREGNANCY caloric intake is adecuate
SELF CARE NEEDS CONSIDERATIONS • Increased CHON intake
Bathing Leukorrhea -Should be increased to 60 g/day
Increaste sweating
- For growth and repair of maternal and fetal tissue
Breast care Wear firm bra with
- For production of breast milk
wide straps
Wash with tap water no • Increased major minerals and vitamins intake
soap to remove
colostrum *total iron needed is about 800-1000 mg
Place gause or breast About 500 mg is utilized for the expanding maternal
pads in bra blood volume;
Pendulous breast 300 mg is transferred to the fetus and placenta; 200
Dental care Gingibal tissue tends to mg is to replace natural losses in the skin, sweat and
hypertrophy hair.
Tooth decay Take with ascorbic acid in the form of fruit juices to
East freash fruits, veg enhance iron utilization and absorption
to avoid sugar - Ex. Pork liver (best source), soy beans, peanuts,
Perineal hygiene Increased vaginal green leafy vegetables, iron-fortified foods, egg
discharge
yolk
No douching
Dressing Maternity dress
No garters, high Common side effects of iron:
stokings 1 Constipation - advise woman to increase fluid
Moderate heels only and fiber in the diet
Sexual activity No coitus on expected 2. Dark stools - reassure woman that this is normal
date of period effect of iron pigments
Coitus may rupture 3. Nausea/gastric irritation - take iron after meal
membrane
With history of CALCIUM AND PHOSPHOROUS
• Recommended amount is 1,200-1,500 mg/day
FUNCTIONS:
- Formation of fetal bones and teeth
- Production of breast milk
- Blood coagulation, neuromuscular ability and
muscle contractility
-If a woman cannot drink milk or eat milk products,
she can be prescribed a daily calcium supplement
- Example : milk, cheese, leafy green vegetables
**food sources of CHON and calcium are good
source of phosphorous
IODINE
• RDA is 175 ug
• For the formation of thyroxine
• lodine deficiency- goiter (woman),
hypothyroidism in a fetus, thyroid enlargement in
fetus
• Seafood is he best source
ZINC
• For nucleic acid and protein metabolism
(important in early gestation)
• RDA 15mg (pregnant) and 19mg (lactating)
• Ex. Meat, liver, eggs and seafood
SODIUM
• Major electrolyte that acts to maintain fluid in the
body
• Sodium should neither be restricted nor used
excessively
• Most processed and prepared foods are high in
sodium
FLUORIDE
• Aid in the formation of teeth
• Large amount causes brown-stained teeth
VITAMIN K
• Antihemorrhagic, formation of clotting factors
VII, IX, and X in liver
• RDA 65 mg (pregnant and lactating)
• Ex. Liver, green leafy vegetables, egg yolk, soy
beans, tomatoes
VITAMIN A
• Normal vision with main influence on the retina
Maintenance of skin and mucous membrane by
aiding glycoprotein synthesis and tissues
differentiation
• Help promote bone and teeth growth
• RDA 800ug (pregnant) 1300ug (Lactating)
• Ex. Fish liver oil, egg yolk, yellow and green
fruits and vegetables
VITAMIN D
• Promotes calcium absorption
• Bone and teeth development
• Deficiency of Vit. D is associated with tooth
enamel hypoplasia
• RDA 10ug (pregnant) or 12ug (lactating)
• Milk, liver, egg yolk, fortified milk, exposure to
UV light
VITAMIN E
• Antioxidant
• Prevents hemolysis of RBC
• RDA 10ug (pregnant) or 12ug (lactating)
•Ex. Vegetable fats, nuts, green leafy veg., egg
yolk, milk
VITAMIN B1 OR THIAMINE
For CHO metabolism by being involved in the
release of energy from cells
•For normal nerve function
•Promotes appetite
•RDA 1.5 mg (pregnant) 1.6 mg (lactating)
•Nuts, egg yolk, legumes, meat
VITAMIN B2 OR RIBOFLAVIN
For CHO metabolism
Healthy skin
Converts tryptophan to niacin
It is also involved in the released of energy from
cells
RDA 1.6 mg (pregnant) 1.8 mg (lactating)
Cheese, milk, eggs, green leafy vegetables
VITAMIN B6 OR PYRIDOXINE
• It is important in CHON, CHO and lipid
metabolism
• It is also involved in the synthesis of heme
compound
• RDA 2.2mg (pregnant) 2.1 mg (lactating)
•Ex. Meat, liver, whole grains, green leafy
vegetables
VITAMIN B12 OR CYANOCOBLAMINE
•Maturation of RBC
•Prevents megaloblastic anemia
•Normal nerve and GIT function
•Essential for DNA synthesis and cell division
•RDA 2.2 mg (pregnant) 2.6 mg (lactating)
•Red meat, milk, nuts, legumes, egg, green leafy
veg
FOLIC ACID
• Maturation of RBC
• Prevents megaloblastic anemia
• For normal cell division and DNA synthesis
Prevents neural tube defect
• RDA0.4 mg or 400 ug (pregnant) 280 ug
(lactating)
• Dark green leafy veg., whole grain, legumes,
citrus fruits, liver
NIACIN
• Promotes iron absorption
• For tissue integrity, resistance against infection
and promotes healing assisting in pro-collagen
formation
• Antioxidants by reducing free radicals
RDA 70 mg (pregnant) 95 mg (lactating)
• Citrus fruits, tomatoes

VITAMIN C OR ASCORBIC ACID

• Important in the release of energy from cells
• Promote iron absorption
RDA 7 mcg (Pregnant) 20 mcg (lactating)

FOODS TO AVOID IN PREGNANCY

1. Foods with caffeine
- It is CNS stimulant capable of increasing heart
rate, urine production in the kidney and secretion of
acid in the stomach.
- It causes mood swings thus it may interfere with
rest and sleep; filling and satisfying without being
nutritious
- found in coffee, tea, cocoa and soft drinks
- A daily intake of caffeine of two or three cups of
coffee has not been associated with low birth
weight, but excessive intake of caffeine should be
limited.
2. Artificial sweetener
- Use of saccharides is not recommended because is
eliminated slowly from the fetal blood stream
3. Weight loss diets
- May lead to fetal ketoacidosis, poor growth, and
possibly neurologic defects
4. Alcoholic beverages
- Increases the risk for mental retardation, behavior
and learning disorders and fetal alcohol syndrome
(FAS)
- Women who drinks 3 to 5 drinks per day