NCM 106 | THE NURSING ROLE IN CARING FOR FAMILIES DURING NORMAL

PREGNANCY,BIRTH, THE POST PARTUM AND NEW BORN PERIOD

ZSIDRICK JOHN P. ALIVIO, RN,MN,LPT,S02

STAGE OF FETAL DEVELOPMENT - The cells of the outer ring is called TROPHOBLAST –
- In just 38 weeks , a fertilized egg (ovum) matures from part that will form later as the placenta and the
single cell to a fully developed fetus ready to be born. membranes.
Although different cultures or religions debate the - The inner cell mass (Embryoblast cells) is the portion
point at which life begins. of the structure that will form the embryo.
- Fetal growth and development can be divided into - Implantation occurs 8-10 days after fertilization.
three time periods: - The blastocysts brushes against the rich uterine
i. Pre- embryonic ( first 2 weeks , beginning with endometrium ( in the second (secretory) phase of the
fertilization) menstrual cycle) called APPOSITION.
ii. Embryonic (weeks 3 through 8) - It attaches to the surface of the endometrium called
iii. Fetal (from week 8 through birth) ADHESION
- And settles down into its soft folds (INVASION)
TERMS USED TO DESCRIBE FETAL GROWTH

- The blastocysts is able to invade the endometrium

FERTILIZATION : THE BEGINNING OF PREGNANCY because as the trophoblast cells on the outside of the
- also referred to as conception and impregnantion, is structure touch the endometrium, they produce
ghe union of an ovum and spermatozoon proteolytic enzymes that dissolve the tissue they
- Occur in the outer third of fallopian tube, termed the touch.
“AMPULLAR PORTION” - As invasion continues, the structure establishes an
- Blastocyst- cluster of dividing cells made by fertilized effective communication network with the blood
egg. system of the endometrium.
- The touching or implantation point is usually high in
IMPLANTATION: FETAL DEVELOPMENT the uterus, on the posterior surface.
- Contact between growing structure and uterine - If the implantation is low in the uterus, the growing
endometrium. placenta may occlude the cervix and make birth of the
- Once fertilization is complete, the zygote migrates child difficult (Placenta previa)
over the next 3-4 days toward the body of the uterus,
aided by the currents initiated by muscular EMBRYONIC AND FETAL STRUCTURES
contractions of the FT. I. The Decidua or Uterine lining
- Mitotic cell division or cleavage begins (first II. Chorionic Villi
cleavage occurs about 24 hours continue with a rate III. The Placenta
every 22 hours)
- By the time the zygote reaches the body of the uterus - The Decidua –( the latin word for falling off) the
it consists of 16 to 50 cells. thickened endometrium in preparation of pregnancy.
- Termed MORULA because of its bumpy appearance. - Hcg- causes the uterine endometrium to continue
- Continue to multiply as it floats free in the uterine grow in thickness and vascularity.
cavity for 3 or 4 more days. - Different types of Decidua:
- Large cells tend to collect at the periphery of the ball. ✓ Basalis- endometrium lies directly to the embryo
Leaving a fluid space surrounding an inner cell mass or portion where the trophoblast cells are
termed BLASTOCYST establishing communication with maternal blood
- It attaches to the uterine endometrium. vessels

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 ✓ Capsularis- endometrium that streches or FETAL CIRCULATION

encapsulates the surface of gthe trophoblast.
✓ Vera- the remaining portion of the uterine lining. ➡ OXYGENATED BLOOD ENTERS TO THE UMBILICAL VEIN
- The Chorionic Villi- wispy projections of placental FROM THE PLACENTA
tissue that share the babys genetic makeup.
- 11th or 12th day after fertilization miniature ➡ THEN ENTERS TO DUCTUS VENOSUS
villi,resembling probing fingers reach the trophoblast
➡ AND PASSES THROUGH INFERIOR VENA CAVA
cells into uterine endometrium to form the
PLACENTA.
- ➡ ENTERS THE RIGHT ATRIUM
-it also provides oxygen and nutrients to the growing
baby and remove waste products from the baby’s ➡ THEN ENTERS TO THE FORAMEN OVALE
blood.
- Chronic Villi Central Core- loose connective tissue ➡ GOES TO LEFT ATRIUM
surrounded by a double layer of trophoblast cells. It
contains fetal capillaries. ➡ PASSES THROUGH THE LEFT VENTRICLE
- Cytotrophoblast or Langhan’s layer- Protect the
growing embryo from a certain infectious organism. ➡ THEN IT FLOWS TO ASCENDING AORTA TO SUPPLY 
- SYNCYTIOTROPHOBLAST or the syncytial layer- NOURISHMENT TO THE BRAIN AND UPPER EXTREMETIES
Outer of the two covering layers, Instrumental in the
➡ THEN ENTERS TO SUPERIOR VENA CAVA
production of various placental hormones ( early as 12
days gestation).
- ➡ GOES TO RIGHT ATRIUM
hPL ( human placental lactogen)
- Estrogen and progesterone ➡ ENTERS TO THE RIGHT VENTRICLE

Placenta ➡  ENTERS TO PULMONARY ARTERY WITH SOME BLOOD

- Arise from the trophoblast tissue GOING TO THE LUNGS TO SUPPLY OXYGEN AND  FOR
- Serves as the fetal lungs, kidneys, and GIT and as a NOURISHMENT
separate endocrine organ throughout pregnancy.
- 15 to 20 cm in diameter and 2 to 3 cm in-depth at ➡ THEN FLOWS TO DUCTUS ARTERIOSUS
term.
- Covers half of the uterus ➡ ENTERS TO DESCENDING AOTA AND SOME BLOOD GOING
- Formed when chorionic villi burrow into the TO THE LOWER EXTREMETIES

endometrium (decidua) ➡ THEN ENTERS  TO THE HYPOGASTRIC ARTERIES

- Fully developed by the third month
- Provides exchange of nutrients and wastes between ➡ THEN GOE BACK TO THE PLACENTA
mother and fetus
- Produces hormones to maintain pregnancy and
assumes full responsibility by 12 weeks
- Large particles will not pass through
- Nutrients, drugs, antibodies, and viruses can pass
through

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 Blood Circulation in the Fetus and Newborn
How does the fetal circulatory system work?
During pregnancy, the unborn baby (fetus) depends on
its mother for nourishment and oxygen. Since the fetus
doesn’t breathe air, his or her blood circulates differently
than it does after birth:
• The placenta is the organ that develops and
implants in the mother's womb (uterus)
during pregnancy. The unborn baby is
connected to the placenta by the umbilical
cord.  umbilical arteries. From there, blood flows
• All the necessary nutrition, oxygen, and life
support from the mother’s blood goes
through the placenta and to the baby
through blood vessels in the umbilical cord.
• Waste products and carbon dioxide from the
baby are sent back through the umbilical
cord blood vessels and placenta to the
mother's circulation to be eliminated.
While the baby is still in the uterus, his or her lungs are
not being used. The baby’s liver is not fully developed.
Circulating blood bypasses the lungs and liver by flowing
in different pathways and through special openings
called shunts.   region invaginates posteriorly, forming olfactory pits,
Blood ow in the unborn baby follows this pathway:
• Oxygen and nutrients from the mother's
blood are transferred across the placenta to
the fetus through the umbilical cord.
• This enriched blood flows through the
umbilical vein toward the baby’s liver. There it
moves through a shunt called the ductus
venosus.
• This allows some of the blood to go to the
liver. But most of this highly oxygenated
blood flows to a large vessel called the
inferior vena cava and then into the right
atrium of the heart.  various physiological organ systems and prepares the
Here is what happens inside the fetal heart:
• When oxygenated blood from the mother
enters the right side of the heart it flows into
the upper chamber (the right atrium). Most of
the blood flows across to the left atrium
through a shunt called the foramen ovale.
• From the left atrium, blood moves down into
the lower chamber of the heart (the left
ventricle). It's then pumped into the first part
of the large artery coming from the heart (the
ascending aorta).
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• From the aorta, the oxygen-rich blood is sent
to the brain and to the heart muscle
itself. Blood is also sent to the lower body.
• Blood returning to the heart from the fetal
body contains carbon dioxide and waste
products as it enters the right atrium. It flows
down into the right ventricle, where it
normally would be sent to the lungs to be
oxygenated. Instead, it bypasses the lungs
and flows through the ductus arteriosus into
the descending aorta, which connects to the
back into the placenta. There the carbon
dioxide and waste products are released into
the mother's circulatory system. Oxygen and
nutrients from the mother's blood are
transferred across the placenta. Then the
cycle starts again.  
RESPIRATORY SYSTEM
The development of the respiratory system in the fetus
begins at about 4 weeks and continues into childhood.
Ectodermal tissue in the anterior portion of the head
which ultimately fuse with endodermal tissue of the early
pharynx.
NERVOUS SYSTEM
The central nervous system of a growing fetus starts with
a simple structure called the 'neural groove' that folds in
to form the 'neural tube'. This then develops into the
spinal cord and brain. By day 28 after conception, the
neural tube should be closed and fused.
ENDOCRINE SYSTEM
The fetal endocrine system commences development
early in gestation and plays a modulating role on the
fetus for life after birth.
THE PROCESS WHEN THE ENDOCRINE ORGAN
MATURE IN INTRAUTERINE LIFE:
1. The fetal adrenal glands supply a precursor
for estrogen synthesis by the placenta.
2. The fetal pancreas produces the insulin
needed by the fetus
3. The thyroid and parathyroid glands play vital
roles in metabolic function and calcium
balance.

 DIGESTIVE SYSTEM
At 5 weeks of pregnancy, a layer of cells on the
underside of your developing embryo rolls into a long
tube that will become the digestive tract. Between 5 and
7 weeks, the tube solidifies until sometime between 8
and 10 weeks, when cells inside the tract create small
spaces that expand to open up the tube again.
The third layer of cells forms the digestive system. Your
baby's intestines start to develop as early as week ve
of pregnancy. During the third month of foetal
development, the foetus' stomach cells start to secrete
fluid. Waste that forms from the foetus goes through the
placenta and into mother's blood.
MUSCULOSKELETAL SYSTEM
immunity against diseases for which the mother has
antibodies.
The level of these acquired passive IgG immunoglobulins
peaks at birth and then decreases over the next 8
months while the infants begins to to build up his own
stores of IgG as well as IgA and IgM. Because the
passive immunity receive by the newborn has already
declined substantially by about 2 months, immunization
against diphtheria, tetanus, pertussis, poliomyelitis and
haemuphilus influenzae is typical begun at this time.
DETERMINATION OF ESTIMATED BIRTH DATE
The clinically most appropriate unit of measure in
gestational age is weeks of gestation completed. 

The development of bone and muscle begins at the Two methods used:
fourth gestational week, when the paraxial mesoderm
differentiates into somites; the latter gives rise to 1. Menstrual age / Gestational age- measure
sclerotomes and dermomyotomes. Sclerotomes form the from LMP ( last menstrual period)
vertebra and the ribs, whereas myotomes form the 2. Ovulation age /Fertilization age- measure
majority of the muscular system. from the date of ovulation or fertilization.

The clinical parameters that can be used to measure

REPRODUCTIVE SYSTEM that duration of pregnancy are the following:

A child’s sex is determined at the moment of conception 1. Last Menstrual Period- this involved
by a spermatozoon carrying X or a Y chromosome and calculating the span of time from the last
can be ascertained as early as 8 weeks by chromosomal menstrual period up to the present. 
analysis. At about 6th week of life, the gonads ( ovaries or 2. Basal Body temperature record or single
testes) form. If the testes form, testosterone is created, coitus- precise onset of pregnancy can be
apparently influencing the sexually neutral genital duct dated.
to form other male organs. And in the absence of 3. Quickening- noted at 20 weeks in primis and
testosterone secretion, female organs will form. 16 weeks in multigravida.
4. Assessment of fundic height- measuring
URINARY SYTEM fundic height to estimate  the AOG, EDC and
fetal growth rate. Measure fundic height from
Kidneys are present as early as the end of the 4th week, top of symphesis pubis to the top of the
they do not appear to be essential for life before birth, fundus with the bladder empty.
because the placenta clears the fetus of waste products.
Urine is formed by the 12th week and excreted into the
amniotic fluid by the 16th week of gestation. At term , the The normal limit of EDB is 38 weeks to 42 weeks. 
fetal urine is being excreted at the rare of 500ml/day.
The complex structure of the kidneys is gradually 1.  Nagele’s rule - is the standard method used
develop during intrauterine life and continues for moths to predict the length of a pregnancy.
afterward. • TO GET THE EDD (Expected Date of
Delivery)
IMMUNE SYSTEM • Add 7 days to the first day of LMP, count
back 3 months add one year.
The immunoglobulin G ( IgG) maternal antibodies cross • If the woman cannot remember her LMP, ask
the placenta into the fetus primarily during the third her when she first felt the fetus move.
trimester of pregnancy, giving a fetus temporary passive

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 1.To get the EDC for primigravida, add 22 Ø Ultrasound - to confirm the
weeks to the date of quickening. presence, size and location of the placenta and amniotic
2. To get EDC for multigravida, add 24 weeks to fluid
the date of quickening.
2. McDonald rule  - to calculate AOG • To establish that fetus is growing and has no
• Fundic height (cm ) x 2/7= AOG in lunar gross anomalies such as hydrocephalus,
months anencephalus, or spinal cord, heart, kidneys
• Fundic height ( cm) x 8/7= AOG in weeks and bladder defects.
3. BARTOLOMEW’S RULE- is used to calculate • To establish sex if a penis is revealed
AOG • To establish presentation and position of the
• Height of fundus is used to determine AOG. fetus
Fundic height is determined by palpation and • To predict majority by measurement of the
by relating to the different landmarks in the biparietal diameter of the head.
abdomen: umbilicus, symphysis pubis,
xiphoid process. Ø Electrocardiography – fetal ECG’s may be recorded as
= 12 weeks- level of umbilicus early as the 11th weeks of pregnancy.
= 16 weeks halfway between umbilicus and symphysis
pubis Ø MRI – long term use, to replace or complement
= 20 weeks – level of umbilicus ultrasonography as a fetal assessment.
= 24 weeks- 2 fingers above umbilicus
= 30 weeks - halfway between umbilicus and xiphoid Maternal serum alpha-fetoprotein – a substance
process produced by the fetal liver that is present in amniotic
= 34 weeks- just below xiphoid process fluid and maternal serum.
= 36 weeks- level of xiphoid process
= 40 weeks – at 34 weeks level due to lightening Ø Triple screening – analysis of three indicators, MSAFP,
unconjugated estriol and hCG.
Assessment of Fetal Growth
Ø Chorionic villi sampling – is biopsy and chromosomal
ØHealth history analysis of chronic villi.

1. Assess the nutritional intake of the mother,
personal habit such as cigarette smoking,
recreational drug use and exercise, bec this
can influence the fetal growth.
2. Assess for any accident or partner’s abuse
helps reveal whether the fetus could have
suffered trauma.
Ø Amniocentesis – is the aspiration of amniotic fluid from
the pregnant uterus for examination 
Ø Percutaneous umbilical blood – is an aspiration of
blood from the umbilical vein for analysis.
Assessing fetal well-being

Estimating fetal growth

Ø Amnioscopy – is a visual inspection of the amniotic
fluid through the cervix and membrane with an
1. Using MCDONALD’s RULE to determine and amnioscope it use to detect meconium staining that it
record the milestone measurement. carries some risk of membrane rupture.

Assessing fetal well-being Ø Fetoscopy – is visualize  by inspection through a

fetoscope for assessing fetal well being.
Ø Fetal movement- begins approximately 18 to 29
weeks of pregnancy and peaks at 28 to 38 weeks with Ø Biophysical profile – combine the 5 parameters like
consistency of at least 10 times a day fetal activity, fetal breathing movement, fetal body
movement, fetal tone and amniotic fluid volume.
Ø Fetal heart rate- fetal heart sound can be heard and
counted as early as the 10th to 11th weeks of pregnancy
by the use of ultrasonic Doppler technique.

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 NCM 106 | THE NURSING ROLE IN CARING FOR FAMILIES DURING NORMAL
PREGNANCY,BIRTH, THE POST PARTUM AND NEW BORN PERIOD
ZSIDRICK JOHN P. ALIVIO, RN,MN,LPT,S02

- Complication of pregnancy occur, such as severe

hypertension.
- The woman has a series of devaluating experiences
such as failure in school or work

EMOTIONAL RESPONSES THAT CAN CAUSE

CONCERN IN PREGNANCY
- GRIEF- a positive process grief related to the new role
- NARCISSISM-self-love based on self-image or ego
- INTROVERSION VS. EXTROVERSION- introversion
DIFFERENT PSYCHOLOGICAL INFLUENCES WITH ( turning inward),extroversion (turning outward)
THE CHANGES OF PREGNANCY - BODY IMAGE AND BOUNDARY- – feel negative
- Social Influences- the society view about pregnancy toward body,
- Cultural Influences- cultural acceptance - especially during third trimester.
- Family influences- family perpecstive - STRESS- stress related to role confusion and changes
- Individual differences- personal view about pregnancy - DEPRESSION- feeling of sadness marked by loss of
- Partner’s adaptation- role changes and acceptance interest
- COUVADE SYNDROME-involves a father experiencing
PSYCHOLOGICAL CHANGE DESCRIPTION some of the behavior of his wife at
- near the time of childbirth, including her birth pains,
postpartum seclusion, food restrictions, and sex
taboos
- EMOTIONAL LABILITY- mood changes frequently
partly as a symptom of narcissism (sensitive with
remarks)
- CHANGES IN SEXUAL DESIRE- 1st trimester
(decreased libido) 2nd trimester (libido and sexual
enjoyment arise) 3rd trimester (libido may remain high)
- CHANGES IN EXPECTANT FAMILY- changes in family
PSYCHOLOGICAL TASKS OF THE MOTHER role
1. Ensuring safe passage through pregnancy, labor, and
birth.
2. Seeking acceptance of this child by others.
3. Seeking commitment and acceptance of self as
mother
to the infant (bonding-in)
4. Learning to give of herself on behalf of her child.

CONTRIBUTORY EVENT IN DIFFICULTY ACCEPTING

THE PREGNANCY
- Pregnancy is unwanted
- Learning the pregnancy is a multiple
- Learning the fetus has a developmental abnormality.
- Pregnancy is less than 1 year after previous one.
- Family has to relocate during pregnancy
- The woman has role reversal.
- The main family support person suffer job loss
- There is a major illness in self.partner and relatives
- There is loss of a significant others

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 PHYSIOLOGIC
CHANGES OF
PREGNANCY
Physiologic changes
that occur during
pregnancy are the
basis for the signs
and symptoms used
to confirm a
pregnancy.

Endocrine System
Changes

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