M

Introduction to the O
D
CARE OF MOTHER
U
DURING
z ANTENATAL L

PERIOD E

2
 z
UNITIVE and PROCREATION

The 1983 Code of Canon Law 2

▪ It highlight marriage not only as a natural institution but as a sacrament in the service of
communion and holiness.
▪ The Three Goods of Marriage
▪ Offspring
▪ Fidelity
▪ Sacrament
▪ The Two Essential Properties of Marriage
▪ Unity
▪ Indissolubility
In Sacred Scripture, especially in Gen 1–2, God wills man and woman to unite as one
flesh and to be fruitful and multiply.
Human
Sexuality
 SEX
- refers to whether a person is
male or female, whether a person
has a penis or vagina

- commonly used as an
abbreviation to refer to sexual
intercourse.
 Sexuality

• refers to the total expression of who

you are as a human being, your
femaleness or your maleness.
 Sexuality

✓An integral part of human

being. It begins before birth
and lasts until the end of life

✓Essential to the continued

existence of humanity
Human Sexuality
Components:

1. Human Development
2. Sexual Health
3. Relationships and
Emotions
4. Sexual behavior
5. Sexual violence
Pubertal
z Development

PUBERTY
- Stage of life where secondary sex characteristics
begin.

ANDROGEN
- Hormone responsible for muscular
development, physical growth and increase in
sebaceous gland secretions for both male &
female.
 Pubertal
z
Development

ESTROGEN

- Hormone that influences the development of

the uterus, fallopian tubes & vagina; fat
distribution & hair patterns; breast
development (thelarche); end to growth
(closes the epiphyses of long bones).
Secondary
z
Sex Characteristics

FEMALE
- Growth spurt
- Increase in transverse pelvic diameter
- Breast development
- Growth of pubic hair
- Onset of Menstruation
- Growth of axillary hair
- Vaginal secretions
Secondary
z
Sex Characteristics

MALE
- Increase in weight
- Growth of testes
- Growth in face, axillary & pubic hair

- Voice changes
- Penile growth
- Increase in height
- Spermatogenesis
OVERVIEW
z OF THE REPRODUCTIVE SYSTEM

MALE REPRODUCTIVE SYSTEM

Male Reproductive
z
System

• EXTERNAL
• Scrotum- support testes & helps regulate
temperature of sperm
• Testes- contains Leydig’s cells (testosterone) &
seminiferous gland (spermatozoa)
• Penis
Female
z
Reproductive System
 z
Female Reproductive System

▪ EXTERNAL

1. Mons Veneris – protect the symphysis pubis

2. Labia Minora- hairless skinfold
3. Labia Majora- fatty skin fold; protects
the internal genitalia
Female Reproductive System
4. Other external organs
- Vestibule
- Clitoris: erectile tissue; sensitive to
touch & temperature
z
- Skene’s glands
- fourchette
- hymen
- Bartholin’s gland: lubricates vulva
Female
z Reproductive System

▪ INTERNAL
1. Vaginal canal

- lined with epithelial cells;

- LEUKORRHEA
- Organ for copulation;
- passageway of products of conception
 Female
z
Reproductive System

2. Uterus
- Body/corpus: uppermost part; expands
during pregnancy

- Isthmus: commonly cut during cesarean birth

- Cervix: lowest portion; passageway during

delivery, the neck of the uterus.
Female Reproductive System
z

LAYERS OF THE UTERUS

a. Endometrium- important in menstrual function;
influenced by estrogen & progesterone;
site of implantation
b. Myometrium- muscle layer of the uterus;
constrict tubal junctions &prevent
regurgitation of menstrual blood
c. Perimetrium- add strength & support to the
uterus
z
Female
z
Reproductive System
▪ UTERINE DEVIATIONS
1. Anteversion- fundus is tipped forward
2. Retroversion- fundus is tipped back
3. Anteflexion- body of the uterus is bent
sharply forward at the junction with cervix
4. Retroflexion- body is bent sharply back just
above the cervix
z

Anteflexion Retroflexion
Female Reproductive System
z

Fallopian Tubes
- Convey the ovum from ovaries to the uterus;
site of fertilization; divided into interstitial,
isthmus, ampulla & infundibulum
Ovaries
z

❑ Produce, mature and discharge egg cells.

❑ Produces estrogen & progesterone that

initiates menstrual cycle.

 HUMAN SEXUALITY
• Log in to your Canvas Acct. and click the
Discussion icon.
z

• Read the Direction carefully.

• Read the rubrics for you to be guided

accordingly.
• You are given 1 hr. to do the activity.
Knowledge on Genetics and
Obstetrics
Fundamental Concepts:

1. Each individual is a product of two traits, one coming

from the mother and the other from the father

2. Deoxyribonucliec Acid (DNA) - carries genetic

information

3. Chromosomes - thread-like strands composed of

hereditary materials called DNA

4. Genes- small segments of DNA

5. Normal amount of ejaculated sperm: 3-5 cc or 1 tsp

6. Ovum is capable of being fertilized
within 24-36 hours after ovulation

7. Sperm is viable within 48-72 hours or

2-3 days

8. Spermatogenesis- is the process of

maturation of sperm; end product is 4
sperms
9. Oogenesis - is the process of maturation
of ovum; a process by which cells
formed during fetal life develop into
primitive eggs known as oocytes

10. Gametogenesis – formation of 2 haploids

into diploids

11. Mitosis - the process of cell division

resulting in 46 chromosomes
12. Age of Reproductivity: 15-44 years old

13. High Risk pregnancy : below 18 and

above 35 years old

14. Ideal age for childbearing: 20-30 years

old

15. Phenotype – physical appearance

16. Karyotype – pictorial analysis of
individual chromosomes for the
purpose of detecting chromosomal
aberrations

17. Reproductive cells divide by the

process of meiosis (Haploid
number)
 z

▪ Have you seen a pregnant

woman?
▪ What did you observe with
them?
Physiology of
Menstruation
 MENSTRUATION
- An episodic uterine bleeding
- A response to cyclic hormonal changes
- Allows conception & implantation
- Brings an ovum to maturity & renew uterine tissue bed
- Usually occur as early as 8-9 yrs; late as age 17
- Length of the cycle: 28 days, but, may differ
- Length of menstrual flow: 4-6 days (average)
 RELATED TERMINOLOGIES

Menarache
• First menstruation; occurs on the average of
11-14 years old (as early as 8, as late as 17)

Dysmenorrhea
• Painful menstruation

Metrorrhagia
• Bleeding in between menstruation
RELATED TERMINOLOGIES
❖ Menorrhagia
- excessive or heavy bleeding which can
cause anemia

Amenorrhea
- absence of menstruation

Menopause
- cessation of menstruation; average age is
51
Functions of Estrogen and Progestin
 Estrogen - “Hormone of the Woman”

Primary Function:

A. Development of secondary sex characteristics in

female
B. Inhibits production of Follicle Stimulating Hormone
(FSH)
C. Responsible for hypertrophy of myometrium

• Steroids secreted in both sexes by the adrenal cortex

• In women, by the ovary (main source) and placenta
Estrogen:

Main effects occur at puberty:

Breast growth
Fat deposition in the vulva
Pubic and axillary hair growth
Bony pelvis growth and broadening
Vaginal epithelial changes
General growth
d. Produce cyclic changes in the uterine
endothelium and vaginal epithelium

e. Responsible for the increased osteoblastic

activity of long bones causing an increase in height
f. Responsible for Spinnbarkeit and ferning (Cervical mucus
or Billing’s method)

Spinnbarkeit - clear, slippery texture of an uncooked

egg white, typical of cervical mucus during ovulation

Ferning - test for the presence of estrogen in the

cervical mucus; estrogen causes cervical mucus to
dry on a slide in a fernlike pattern

Billing Method- a method of estimating ovulation time

by hanges in the mucus of the cervix that occurs
during the menstrual cycle

g. Responsible for the development of ductile structure of

the breast
h. Responsible for early closure of epiphysis of
long bones

i. Responsible for increased sexual desire in

female

j. Responsible for increased vaginal lubrication

k. Responsible for sodium retention therefore

causing weight gain
2. Progestin or Progesterone- “Hormone of
the Mother”
➢ A steroid hormone
➢ Known as the hormone of pregnancy
➢ Promotes development of placenta and mammary
glands
➢ Responsible for increased basal body temperature
➢ Responsible for mood swings of the woman
•

Primary Function:

- Prepares the endometrium for implantation of

fertilized ovum

Secondary Function:

- Inhibits uterine contractility

- Inhibits production of Luteinizing Hormone (LH)
- Decreased GIT motility leading to constipation
 Structures affecting menstruation

A. Hypothalamus
- release GnRH (Luteinizing Hormone-Releasing Hormone)

B. Pituitary Gland
1. FSH (Follicle Stimulating Hormone)- maturation of the ovum
2. LH (Luteinizing Hormone)- responsible for
ovulation & growth of uterine lining
 Structures Affecting Menstruation
3. Ovaries
- Contain primordial cell activated by the FSH to begin to grow &
mature.
- LH & prostaglandin causes the graafian follicle to rupture and ovum is set
free from the surface of ovary.
4. Cervix
5. Uterus – “menstrual cycle”
 Menstrual Cycle
1. Proliferative Phase (6-14 days of a cycle)
- happens immediately after menstrual flow
- endometrium is approximately one cell
layer in depth
- gradual increase in estrogen, rapid
proliferation of endometrium to eightfold
 DECREASE ESTROGEN

SIGNALS HYPOTHALAMUS TO
RELEASE GnHR

2 FSH RELEASE (APG)

STIMULATION
OF LH
GRAAFIAN
1
FOLLICLE

OVULATION
INCREASE
DECREASES
ESTROGEN FSH
LEVEL
 Menstrual Cycle
2. Secretory Phase (15-21 days)
- occurs after ovulation.
- endometrium become corkscrew or twisted in
appearance & dilated with glycogen & mucin.
- increase amount of capillaries that causes rich,
spongy velvet appearance of the lining.
 Menstrual Cycle

3. Ischemic Phase (22-28 days)

- Corpus luteum begins to regress after 8 to 10 days
- decrease production of estrogen & progesterone
- degeneration of uterine lining due to decrease progesterone.
- the capillaries rupture with minute hemorrhage
- endothelium sloughs off
 Menstrual Cycle
4. Menses (1-5 days)
- Blood, mucin,endometrial tissues & microscopic,
unfertilized ovum are discharged from the uterus
- the only external marker of the menstrual cycle
THE MENSTRUAL CYCLE
Process of Conception
 When does
conception take
place?
Hormonal Regulation of Pregnancy

a. Estrogen
b. Progesterone
c. Relaxin
d. Human Chorionic
Somatomammotropin (HCS)
Conception
-Also known as fertilization or impregnation
-Union of an ovum & spermatozoon
-Occurs in the outer third of the fallopian
tube
Implantation

Contact between the growing structure &

uterine endometrium

Occurs 8 to 10 days after fertilization

 The Process of Human Conception

1.Pre-Embryonic Phase

2.Embryonic Phase

3.Fetal
 B. Pre- embryonic Stage
1. Zygote- is the fertilized ovum
- it travels 3-4 days to reach the uterus while
mitotic cell division and sex differentiation begins

• Fertilization would result 46 chromosomes; 22 pairs of autosomes

responsible for determining the trait of an individual and 1 pair of sex
chromosomes responsible for the sex of an individual

2. Morula - is the mulberry like ball containing of 16-50

cells; as it reaches the uterus it continues to float
and multiply for 4 days
3 Processes ofisImplantation:
3. Blastocyst- the enlarging cell forming a cavity
that later becomes the embryo
a. Apposition – when
Trophoblast- blastocyst
covering begins to which
of the blastocyst
will BRUSH theplacenta
later become endometrial lining
and membrane
b. Adhesion – when blastocyst begins to
ATTACH to
Implantation orthe endometrial
Nidation - occurslining
7-10 days after
fertilization
c. Invasion - when blastocyst begins to
Site:
SETTLEUpper DOWN
anterior orthe
posterior of the uterus
endometrial
lining
 4. Embryo – implanted zygote

5. Fetus

Zygote Morula Blastocyst Embryo Fetus

C. Embryonic/Fetal Structures
1. Decidua - thickened endometrium
Parts of Decidua:
a. Basalis- part of the endometrium which is located directly under the fetus
where placenta is developed
b. Capsularis - part of the endometrium that encapsulates the fetus
c. Vera- remaining portion of the endometrium

2. Chorionic Villi -probing fingers

3. Placenta- serves as a fetal lung, kidneys and GIT; has circulatory &
endocrine functions
Amniotic Membrane

TWO Layers

1.Amnion
2.Chorion
Layers of Amniotic Membrane
1. Amnion- innermost membrane
• the umbilical cord and amniotic fluid are developed
• Umbilical cord or ”Funis”- 50-55 centimeters or 20-
21 inches of whitish gray cord which joins fetus to placenta
• 2 arteries and a vein which is protected by Wharton’s jelly
• Short cord - can lead to abruption placenta and inversion of
the uterus
• Long cord - can lead to cord coil or cord prolapse
Amniotic Fluid or “Bag Water”- clear, musty or mousy
odor with crystallized ferning pattern; slightly
alkaline

Normal amount : 500-1000 cc

Oligohydramnios : less than 500 cc

Polyhydramnios : More than 1500 cc

Functions of Amniotic Fluid:

a. Cushions the fetus against sudden trauma and

blows
b. Maintains the temperature
c. Facilitates musculoskeletal development and
symmetrical growth
d. Prevents cord compression
e. Helps in delivery processes
 Diagnostic Tests for Amniotic Fluid

1. Amniocentesis - obtains a sample of amniotic fluid by inserting needle through the

abdomen into the amniotic sac
- results determine fetal lung maturity and genetic abnormalities

Genetic screening - to determine genetic abnormalities

Maternal Serum Alpha Feto-Protein Test

- measures the quantity of fetal serum proteins
- if increased may indicate spina bifida or open neural tube defects
- If decreased may indicate Down Syndrome
Determination of fetal maturity- evaluating factors
indicative of lung maturity

Surfactant - protein component of the lung enzyme that

the alveoli forms
Diagnostic Tests for Amniotic Fluid…

2. Amnioscopy - direct visualization through an intact fetal membrane

3. Fern Test - determine if Bag of Water (BOW) has ruptured or not

4. Nitrazine Paper Test- to differentiate urine

(acidic- yellow) from amniotic fluid
(alkaline-blue green/blue gray)
Membranes….

B. Chorion - outermost membrane of the fetus

- it is where the placenta developed

Placenta/ Secundines
- Greek word which means“Pancake;”
- Combination of chorionic villi and
decidua basalis

Weight : 500g-1000g
Size : 1 inch thick and 8 inches diameter
Cotyledons : 15-28 cotyledons
Functions of the Placenta:

1. Respiratory system- exchange of 02 and C02 through simple diffusion (from greater to
lower concentration)

2. Gastrointestinal system- transports nutrients

a. Facilitated Diffusion- for glucose transport (from greater to lower
concentration but a more rapid rate)
b. Active transport for amino acid
3. Excretory systems- waste secretions pass through the arteries; the mother’s liver
detoxifies the waste products of the baby

4. Circulatory systems- two arteries that carry unoxygenated blood and a vein that carries
oxygenated blood. Fetoplacental circulation through selective osmosis
5. Endocrine System

a. Human Chorionic Gonadotropin (HCG)

- produced by the placental syncytiotrophoblast
- primary function: maintains Corpus Luteum at 1st trimester
- secondary function: basis of pregnancy

b. Human Placental Lactogen (HPL) –

responsible for development of the mammary glands
c. Relaxin - softens bones and joints
 d. Estrogen – formed in the ovary
- acts on the female genitalia to produce an
environment suitable for fertilization,
implantation and nutrition of the early
embryo
e. Progesterone - prepares the lining (endometrium) of the
uterus to receive and sustain the fertilized egg
and so permits pregnancy
6. It serves as a protective barrier against some micro-organisms
FETAL CIRCULATION
1.Umbilical vein
2. Ductus venosus
3. Inferior vena cava
4. Right Atrium
5. Foramen Ovale
6. Left Atrium
7. Ductus Arteriosus
8. Aorta
9. Umbilical Arteries
 Fetal Circulation
• Fetal cardiovascular system begins to develop at the end of the
3rd week

• 4th month – the heart starts to beat

• The critical period of heart development is from day 20 to day

50 after fertilization

• Placenta – attached to the uterus; gas exchange during fetal life

• Foramen ovale – connects the left and right atrium so that blood
can be supplied to brain, heart and kidney, bypassing fetal lungs
Umbilical vein (1) – brings oxygenated blood coming from the placenta to the heart
and liver; becomes ligamentum teres after birth

Umbilical arteries (2) – carry unoxygenated blood from the fetus (descending aorta) to
placenta; become umbilical ligaments after birth

Ductus venosus – carry oxygenated blood from umbilical vein to inferior vena cava,
bypassing fetal liver; becomes ligamentum venosum after birth

Ductus arteriosus – carry oxygenated blood from pulmonary artery to aorta, bypassing
fetal lungs; becomes ligamentum ateriosum after birth
 ACTIVITY 2

Divide the class into 5 groups

1. Discuss the Fetal Circulation ( First 2 groups).

2. Discuss the different milestones of fetal
development within the group ( Next 3 groups).
 FETAL CIRCULATION

Oxygenated blood enters the

umbilical vein from the
placenta

Enters the right atrium

Enters the foramen ovale

Enters the foramen ovale

Flows to ascending aorta to

supply nourishment to the
brain and upper extremities

Enters the superior vena

cava and goes to right
atrium
MILESTONES OF FETAL DEV’T
 Fetal Growth and Development
First Trimester - Period of Organogenesis
- the most critical period in fetal growth and
development

1. First Month
Fetal heart tone (FHT) begins
CNS develops
On the second week, differentiation of the
Primary Germ Layers occurs:

A. Endoderm

a. Thyroid - for basal metabolism

b. Parathyroid - for calcium metabolism
c. Liver
d. Linings of upper respiratory tract and GIT
e. Thymus - for development of immunity
B. Mesoderm
a. Heart
b. Musculoskeletal system
c. Reproductive organ
d. Kidneys

C. Ectoderm
a. CNS (brain and spinal cord)
b. 5 Senses
c. Skin
d. Hair
e. Nail
f. Mucus membrane of anus and mouth
2. Second Month

a. All vital organs are formed or

developed
b. Placenta is developed
c. Sex organs are formed
d. Corpus luteum will last until the end of
the 2nd month
3. Third Month

a. Kidneys are functional

b. Fetus begins to swallow amniotic fluid
c. Fetoplacental circulation is achieved by
the process of selective osmosis
d. Sex is distinguishable
e. FHT is audible by Doppler, specifically
10-12 weeks
f. Placenta is complete
Second Trimester:
- continuous growth and
development
- the focus of growth is on
the length of the fetus

1. Fourth Month
a. Lanugo begins to appear
b. Buds of permanent teeth appear
c. FHT is audible by Fetoscope,
specifically 18-20 weeks
2. Fifth Month
a. Lanugo covers the body
b. Quickening - first
fetal movement

Primigravida : 18-20 weeks

Multigravida : 16-18 weeks

c. FHT is audible by stethoscope

d. Fetus Length - 19-25cm
3. Sixth Month
a. Vernix Caseosa- a white,
cheese like substance that
serves for lubrication
b. Eyelids open
c. Skin is red and wrinkled
C. Third Trimester:
- the period of most rapid
growth and development
- The focus of growth is
on weight gaining
1. Seventh Month
a. Surfactant develops
b. In males, testes
descends to scrotum
c. In females, clitoris is
prominent, labia
majora are small and
do not cover labia
minora
 ESTIMATING EDD
• Expected Date of Delivery
1. Nagele’s Rule- count backward 3 calendar months from the first day of the
last menstrual period and add 7 days and 1 year.
e.g:
first day of LMP- March 23,2022
December (3months back).
-3 + 7
Therefore, EDD is on December 30, 2022
• LMP- Jan. 10. 2022
• AGE OF GESTATION : NO. OF WEEKS OF PREGNANCY
• JAN. 21
• FEB. 28
• MAR.31
• APR.30
• MAY 31
• JUN. 30
• JUL 31
• AUG. 31
• SEPT. 5
• 238/7 = 34 WEEKS AOG
ESTIMATING EDC
2. Wahl Rule
Add 10 days to the LMP, subtract 3 months and add 1 year.

E.g: LMP- April 3, 2022

3+10=13
January (move 3 months backward since April)
2021+1=2022

Therefore, EDC is on January 13, 2022

ACTIVITY 3
Berta went to the hospital to find out if she’s
pregnant. It was ascertain by the physician
that she is pregnant. According to the
history, her last menstruation started on Jan
1, 2021 and since then, she never had her
period.

• When is her expected date of confinement?

Use Nagele’s Rule & Wahl Rule.
SIGNS OF
PREGNANCY
 PSYCHOLOGICAL TASKS OF
PREGNANCY

• FIRST TRIMESTER
• Accepting the Pregnancy

• SECOND TRIMESTER
• Accepting the Baby

• THIRD TRIMESTER
• Preparing for Parenthood
 EMOTIONAL RESPONSES TO PREGNANCY
•Ambivalence
•Grief
•Narcissism
•Introversion vs Extroversion
•Body Image and Boundary
•Stress
•Couvade Syndrome
1.Presumptive
2.Probable
3.Positive
PRESUMPTIVE SIGNS
• Subjective signs of pregnancy:
• the signs are least indicative of pregnancy; they could easily indicate other conditions.
signs lead a woman to believe that she is pregnant
▪ Amenorrhea.
▪ Breast changes and tangling sensation.
▪ Chlosma and linea nigra.
▪ Abdominal enlargement & striae gravidarum.
▪ Nausea & vomiting.
▪ Frequent urination.
▪ Fatigue
▪ QUICKENING :sensations of fetal movement in the abdomen. Firstly felt by the
patient at approximately 16 to 20 weeks.
 PROBABLE SIGNS ( OBJECTIVE)
• They are more reliable than the presumptive signs, but they still are
not positive or true diagnostic findings.

▪ Hegar’s sign (softening of the lower uterine segment). 6-8 weeks

▪ Goodell’s sign (softening of the cervix ,uterus, and vagina during
pregnancy.). 4-6 weeks
▪ Ballottement. dropping and rebounding of the fetus in its
surrounding amniotic fluid in response to a sudden tap on
the uterus
▪ Positive pregnancy test.
▪ Braxton hicks contractions. more frequently felt after
28 weeks. They usually disappear with walking or
exercise.
• Chadwick’s sign---bluish discoloration of
the cervix, vagina and labia during
pregnancy as a result of increased
vascular congestion.
• Osiander`s sign (pulsation of fornices)
• The uterus changes from a
pear shape to a globe shape.

• Enlargement and softening of

the uterus
 POSITIVE SIGNS OF PREGNANCY:

▪ Fetal heart tones can be detected as early as

9 to 10 weeks from the last menstrual period
(LMP) by Doppler technology

▪ Fetal movement felt by the examiner. after

about 20 weeks' gestation

▪ Visualization of the fetus by the ultrasound.

 Signs and Symptoms of Pregnancy

Presumptive Probable Positive

signs and symptoms are felt Signs and symptoms Undeniable signs
and observed by the mother observed by the mother and confirmed by the use of
but does not confirm the the members of the Health instruments
diagnosis of pregnancy care team

First Breast changes Goodell’s Ultrasound- in

Trimester Urinary Frequency Chadwick’s general: full
Fatigue Hegar’s bladder
Amenorrhea Elevated BBT Transabdominal- supine
Morning sickness Positive HCG (also infers and full
Enlarged uterus presence of H- bladder
Mole Transvaginal-
lithotomy and
empty
bladder
 Signs and Symptoms of Pregnancy…

Presumptive Probable Positive

2nd
Trimes
Chloasma Ballottement- floating FHT audible
or bouncing back of
ter Linea nigra the fetus when the Fetal movement
Increased uterine segment is Fetal outline
tapped sharply; it may
pigmentation also be a sign of
Fetal parts
Striae gravidarum uterine myoma palpable
Quickening Enlarged abdomen
Braxton-Hick’s
contraction - painless
and irregular
contraction