OB WARD - DR - LR 7 FETAL CARDINAL MOVEMENTS

Engagement
Descent
SIGNS OF PREGNANCY
Flexion
1. Presumptive: 2. Probable:
Internal Rotation
- Amenorrhea - Ballottement
Extension
- Fatigue - Outline of Fetus
External Rotation
- Enlarged Breasts - Braxton Hick’s Contractions
Expulsion
- Increased Urination - Goodell’s (soft cervix)
- Quickening - Hegar’s (soft uterine)
4P’s
- Emesis/Nausea - Chadwick’s (bluish cervix)
POWER- uterine contraction and pushing effort
- Enlarged Uterus
PASSAGE- pelvis and birth canal
PASSENGER- fetus, cord, placenta, amniotic fluid, amniotic sac,
3. Positive
membranes, and blood
- Fetal Movement
PSYCHOLOGIC RESPONSE- attitude and behavior towards labor
- Heart Tones
- Delivery
G (gravida) - total number of pregnancies
- Ultrasound
T (term) - 37 weeks and above
- Visible Movement
P (preterm) - 36 weeks and below
A (abortion) - miscarriages 20 weeks and below
SIGNS OF LABOR
L (live) - living children
1. rupture of the bag of water
2. bloody show
FETAL MALPRESENTATION
3. painful, regular, uterine contractions
- Longitudinal
STAGES OF LABOR
- Transverse
1. DILATATION STAGE
Latent - mild short contractions 0-3cm CORD PROLAPSE
Active - true discomfort 4-7cm - causes distress to the fetus
Transition - urge to push 10cm - blocks oxygen and blood circulation
2. FETAL STAGE What to do?
Birth of infant C - call for help
Crowning- fetal head pushes against the perineum O - organize delivery
3. PLACENTAL DELIVERY R - relieve pressure (assume knee chest position) doggy
Schultz or Duncan D - deliver (immediately) CS most preferably
Signs of Placental Separation: *Add, cover with gauze with PNSS to prevent drying.
- lengthening of the cord
- sudden gush of blood FETAL DISTRESS
- Calkin’s Sign (shape shift of uterus) - decreased fetal movement or activity
- mild contractions What to do?
- presence of placenta - assume left side lying position (to promote optimal
4. RECOVERY STAGE oxygenation and blood flow to the baby thus alleviating fetal
Immediate Postpartum Assessment: distress)
Breast - check for breastfeeding difficulties - administer oxygen
Uterus - check for uterine atony (uterus not contracting) - carry out doctor’s order
Bladder - check for difficulty voiding/urinary retention
Bowels - check signs of constipation or bowel obstruction DYSTOCIA/DIFFICULT LABOR
Lochia - check odor, color, amount of lochia - Fetal Factors (size too big (macrosomia) and position)
Rubra (1-3), Serosa (4-10), Alba (10-14) - Uterine Factors (ineffective contractions, uterine shape,
Episiotomy - check signs of healing, swelling, or infection uterine rupture)
Homan’s Sign - check for Deep Vein Thrombosis DVT - Pelvic Factors (structure and size)
(Flex knee, Dorsiflex foot) - Psyche Factors (anxiety, fear, previous trauma, mindset,
Emotional Well-being – check for postpartum depression. coping mechanism)
Pain Score. Inquire about the mood and feelings
NSVD CESAREAN SECTION
Normal Blood Loss: 500cc Normal Blood Loss: 1000cc

Nursing Diagnoses: Nursing Diagnoses:

During Delivery
# Risk for Ineffective Childbearing Process related to maternal
exhaustion
# Ineffective Coping related to labor pain and stress
Post-Partum
# Ineffective Breastfeeding related to maternal fatigue
secondary to insufficient rest and sleep deprivation.
# Risk for infection related to perineal laceration secondary to
poor wound care and inadequate hygiene practices.
Post-CS
# Risk for Infection related to cesarean section surgery and
breach in skin integrity.
# Altered Comfort related to cesarean section surgery and
impaired mobility.
# Acute Pain related to cesarean delivery as evidenced by verbal
reports of pain, facial grimacing, guarding behavior, elevated
vital signs and restlessness.

Interventions:
# Provide emotional support, reassurance, and
encouragement to the mother throughout the labor process.
# Provide guidance and support to the mother during the
pushing phase of labor, including coaching on effective
pushing techniques.
# Provide various pain relief measures, including non-
pharmacological techniques like relaxation techniques,
breathing exercises, and position changes.
Interventions:
# Provide non-pharmacological pain relief measures, such as
positioning, relaxation techniques, and cold or heat therapy.
# Encourage breastfeeding and providing support and guidance
for establishing and maintaining breastfeeding, taking into
consideration the mother's comfort and the baby's feeding cues.
# Encouraging the mother to ambulate and move around as
soon as possible to promote circulation, prevent blood clots,
and aid in the recovery process.

Diet: Diet:
-Diet As Tolerated (DAT) - NPO for 4-6 hours post operation
- Observe burp and flatulence (passing of gas) before giving any
Patient Education food. This is to ensure gastric motility. Because after undergoing
- First void: diaper a CS there is temporary disruption of in the normal functioning
- Second or if able to void in the CR. of the GI tract mainly because of the anesthesia which slowed
- Stimulate sucking reflex. down the GI motility. The burp and passing of gas indicate that
-Breastfeed the baby as soon as she arrives at the OB-ward. the patient’s GI is starting to function normally again.
- Give easily digestible food, like broth and porridge.
3 TYPES OF AMNIOTIC SAC - Diet as tolerated after the first defecation.
Intact
Ruptured DANGER SIGNS OF PREGNANCY
Leaking Abdominal Pain - miscarriage, ectopic pregnancy, abruptio
placenta, etc.
PHASES OF UTERINE CONTRACTION Vaginal Bleeding- miscarriage, ectopic pregnancy, abruptio
1. Increment (Building up) placenta, etc.
2. Acme (Strongest/Peak) Persistent vomiting- dehydration, hyperemesis gravidarum
3. Decrement (Decrease) Decreased fetal movement- fetal distress
*Contractions can last from 30-90s Swelling esp. the extremities- preeclampsia
Persistent Backpain- kidney infection or preterm labor
Rapid Weight Gain- gestational diabetes
Contraction before 37 Weeks- preterm labor
NEWBORN
Newborn Screening
- happens between 24-48 hours after birth
- purpose is to detect early signs of abnormalities in order to
give the newborn a chance to live a normal life.
- procedures are: anthropometric measures, hearing test,
blood sampling, and heart screening
APGAR
Appearance- color, physical abnormalities
Pulse- 120 to 180 bpm
Grimace- facial expression
Activity- cries and movements
Respiration- 30 to 60 cycles per minute
ANTHROPOMETRIC EXAMINATION
Importance:
- To identify early health risks such as nutritional deficiencies
and physical malformations.
Head Circumference - 35 to 37 centimeters
Length - 45 to 55 centimeters
Chest Circumference - 30 to 35 centimeters
Stomach - 30 to 35 centimeters
Weight - 2.5 to 4 kilograms
Macrosomia- large birth weight
IUGR or Small for Gestational Age- weight below the 10th
percentile of their gestational age
Hydrocephalus- large head, accumulation of CSF in the brain
Microcephaly- small head, undeveloped brain
Keep Vein Open (KVO)
- usually at 10 macro drops/min.
- the purpose of KVO is to maintain the patency of the IV line,
ensuring that the vein remains open and accessible for
potential future medication administration or fluid delivery.
Keep Set Sterile (KSS)
- procedure includes removing the cannula and wrapping the
needle with a micropore tape and hanging the IV tube in the
IV pole to keep sterility.
Heplock
- used to maintain venous access for future med. admin.
without continuous infusion of fluids or medications. It
involves flushing the intravenous (IV) line with a small
amount of saline solution and then sealing it with a
heparinized cap to prevent clotting and maintain patency.
JAUNDICE
- yellowing of the skin, mucous membranes, and whites of the
eyes.
1. Physiologic Jaundice
2. Pathologic Jaundice
a. Blood Incompatibility
- when the baby's blood type is incompatible with that of the
mother, such as Rh or ABO incompatibility, it can lead to
increased breakdown of red blood cells and subsequent
jaundice.
b. Infections
c. Bilirubin
- helps in bile production, liver metabolism, and hemoglobin
breakdown
PATHOPHYSIOLOGY
- It occurs when there is an excessive buildup of bilirubin, a
yellow pigment produced by the breakdown of red blood cells.
Bilirubin is normally processed by the liver and excreted from
the body, but when there is an issue with this process, it can
lead to jaundice.
Normal Bilirubin Level- 5 to 6 mg per dL (within 24 hours of life)
>15 mg/dl indicates Jaundice
DETECTION OF HYPERBILIRUBINEMIA/JAUNDICE
Bilirubin Test
This test measures the levels of bilirubin in the blood. Bilirubin
can be measured as total bilirubin, which includes both direct
(conjugated) and indirect (unconjugated) bilirubin. Elevated
levels of bilirubin can indicate jaundice.
PHOTOTHERAPY and/or SUNLIGHT THERAPY
- used to help break down bilirubin in the baby's body by
converting it into a water-soluble form that can be easily
excreted.
Soluset
- designed to deliver fluids, medications, or nutrients directly
into the patient's bloodstream through the IV route. It is
typically used for continuous or intermittent infusion of fluids
and medications, such as antibiotics, electrolyte solutions, or
other prescribed therapies.
Why is there a need to calculate IV fluids?
- to make sure that the patient is receiving the right amount of
medication or fluids and to prevent underdosing and overdosing
thus, promoting optimal recovery.
Nasogastric Tube/NGT Feeding
- Check patency using bulb syringe (observe for gargling sound)
- Flush with 5-10 cc water (kink while flushing)
PLACENTA PREVIA
- a condition of pregnancy in which the placenta is implanted
abnormally in the lower part of the uterus. It is the most
common cause of painless bleeding in the third trimester of
pregnancy.
Main Characteristics: Painless Vaginal Bleeding, bright red
Nursing Diagnoses:
 Risk for Deficient Fluid Volume related to Excessive
vaginal bleeding
 Risk for infection related to premature rupture of
membranes
 Risk for Decreased Cardiac Output related to Excessive
blood loss
 Ineffective Peripheral Tissue Perfusion related to
Hypovolemia
Interventions and Rationale:
1. Deficient Fluid Volume
 Position to client supine with hips elevated if ordered or
in a left side - lying position. - to ensure an adequate
blood supply to the client and fetus.
 Avoid Vaginal Examinations - Because of the risk of
provoking life-threatening hemorrhage, a digital
examination of the vagina is absolutely contraindicated
until placenta previa is excluded.
 Weigh Perineal Pads to estimate blood loss - before and
after use to calculate the difference.
2. Infection
 Administer antibiotics as prescribed
 Instruct the client in proper perineal care
 Prepare the client for amniocentesis - Amniocentesis is
the only invasive procedure used to confirm the
diagnosis of acute chorioamnionitis.
3. Decreased Cardiac Output
 Administer intravenous fluids as indicated - Initial fluid
resuscitation is performed with an isotonic crystalloid,
such as lactated ringer solution or normal saline.
 Elevate the client’s legs or position her in a left side -
lying position - The position of the client can be used to
improve circulation.
 Demonstrate and encourage the use of stress
management behaviors such as relaxation techniques
and deep breathing exercises.
4. Ineffective Peripheral Tissue Perfusion
 Avoid High Fowler’s position and pressure under the
knees or crossing of legs.
  Encourage the client to drink an adequate amount of
fluids regularly.
 Instruct the client in foot and leg exercises and let her
ambulate as soon as able.
ABRUPTIO PLACENTA
- occurs when the placenta appears to have been implanted
correctly but begins to separate suddenly, which results
in painful bleeding. The separation generally occurs late in
pregnancy, even as late as during the first or second stage
of labor. 
Characteristics: Bleeding accompanied by abdominal or low
back pain. Obvious dark red vaginal bleeding occurs
when blood leaks past the edge of the placenta. The client’s
uterus is tender and unusually firm or board-like. Frequent,
cramp-like uterine contractions often occur.
Nursing Diagnoses:
 Acute Pain related to placental separation.
 Risk for Excessive Blood Loss related to ongoing bleeding
secondary to placental separation.
 Risk for fetal injury related to premature delivery.
 Risk for infection related to vaginal bleeding.
Interventions and Rationale:
1. Assess for referred pain as appropriate.
- To help determine the possibility of underlying condition or
organ dysfunction requiring treatment.
2. Note client’s locus of control
- Individuals with external locus of control may take little or
development of complications.
3. Acknowledge the client’s description of pain and convey
acceptance of client’s response to pain.
-Pain is a subjective experience and cannot be felt by others.
4. Monitor skin color and temperature and vital signs.
- These are usually altered in acute pain.
5. Note when pain occurs.
- To medicate as appropriate.
6. Provide comfort measures, quiet environment, and calm
activities.
- To promote non pharmacological pain management.
7. Administer analgesics as indicated
- To maintain an acceptable level of pain.
8. Encourage adequate rest periods.
- To prevent fatigue.
TUBERCULOSIS
- caused by Mycobacterium Tuberculosis
- tubercle (round nodule/swelling)
Latent TB
- lives but does not grow in the body
- does not make a person sick or have symptoms
- cannot spread
- cannot advance to TB Disease
Active TB
- active and can grow in the body
- makes a person feel sick and have symptoms
- can spread from person to person
- can cause death if not treated
DENGUE
- transmitted to humans through the bite of infected
mosquitoes. (Vector borne)
- dengue fever usually starts with a fever, joint pain, rash and
nausea.
- damage to blood and lymph vessels and lead to dengue
hemorrhagic fever, which is marked by difficulty breathing,
bruising and bleeding from the nose, gums or under the skin.
- low platelets
- not allowed to eat dark foods may cause confusion by altering
the color of the vomitus, urine or stool.
DENGUE HEMORRHAGIC FEVER
- a severe and sometimes fatal form of the disease

SIGNS AND SYMPTOMS Diagnoses

- coughing for 3 or more weeks - Risk for bleeding related to possible impaired liver function.
- coughing up blood or mucus - Risk for Fluid Volume Deficit: Related to excessive fluid loss
- chest pain from fever, vomiting, and diarrhea.
- weight loss - Impaired Skin Integrity: Related to pruritus (itching), rash, and
- fatigue potential for bleeding manifestations.
- fever
Common Interventions
- night sweats
- Monitor VS
- chills - Fluid electrolyte management (IV as ordered)
- loss of appetite - Pain management (cold compress, providing comfort)
- Platelet/ thrombocytes replacement (thrombocytopenia
TESTS FOR TUBERCULOSIS <1,500 platelets/microliter of blood)
Sputum Culture
This test involves collecting a sample of sputum (mucus Warning Signs
coughed up from the lungs) and culturing it in a laboratory to  Abdominal pain or tenderness.
identify the presence of TB bacteria. This test can determine  Persistent vomiting.
if the person has an active TB infection and can also help  Clinical fluid accumulation.
determine the strain and drug susceptibility of the bacteria.  Mucosal bleed.
 Lethargy or restlessness.
 Liver enlargement > 2 cm.
Tuberculin Skin Test (TST)
 Laboratory finding of increasing HCT (hematocrit)
Also known as the Mantoux test, this test involves injecting a
concurrent with rapid decrease in platelet/thrombocytes count.
small amount of purified protein derivative (PPD) tuberculin
into the skin, usually on the forearm. After 48 to 72 hours, a Subjective Data DIET
healthcare provider will check the injection site for a raised, - “sakit ako tiyan” Dengue patients are very prone
red bump. The size of the bump is measured, and a larger - “labad akong ulo” to bleeding, so they should not
induration (hardened bump) typically indicates a positive - “sige kog suka ganiha” eat any red, brown, or black
result. However, a positive TST only indicates exposure to the - Painscore : 9/10 foods. The purpose is so that
TB bacteria, and further evaluation is needed to confirm when the patient is vomiting, the
active infection. Objective Data doctor can accurately identify
- pale the patient's stomach bleeding
- thin or not, avoiding the case of
- abnormal vital signs confusing the blood with the
- rashes
color of the food.
- febrile

Afebrile: not feverish (normal temp.)

Febrile: feverish (high temp.)
PREGNANCY INDUCED DIABETES
MELLITUS
- during pregnancy, your body makes more hormones and
goes through other changes, such as weight gain. These
changes cause your body's cells to use insulin less effectively,
a condition called insulin resistance. Insulin resistance
increases your body's need for insulin
- Gestational diabetes occurs when your body can't make
enough insulin during your pregnancy.
Insulin is a hormone made by your pancreas that acts like a
key to let blood sugar into the cells in your body for use as
energy.
- Gestational diabetes is a type of diabetes that is first seen in
a pregnant woman who did not have diabetes before she was
pregnant.
Treatment
-The treatment always includes special meal plans
- scheduled physical activity
- daily blood glucose testing
- insulin injections.
PREECLAMPSIA
-higher than 140/90 mmHg
-the placenta not developing properly due to a problem with the
blood vessels supplying it.
-You're at high risk for preeclampsia If:
 You've had preeclampsia in a previous pregnancy. ...
 You're pregnant with multiples (twins, triplets or more).
 You have high blood pressure, diabetes, kidney disease
or an autoimmune disease like lupus or
antiphospholipid syndrome.
Diagnosis
-Risk for Maternal Injury: Related to seizures, elevated blood
pressure, and potential complications of preeclampsia or
eclampsia.
- Risk for Fetal Injury: Related to placental insufficiency, poor
fetal growth, and potential complications of preeclampsia or
eclampsia.
Treatment
Antihypertensive drugs to lower blood pressure. Anticonvulsant
medication, such as magnesium sulfate, to prevent seizures.
Corticosteroids to promote development of your baby's lungs
before delivery

Diagnosis
ECLAMPSIA
-high bp 140/90 and above
Knowledge Deficit: Related to lack of understanding about -presence of convulsion or seizures
GDM, its management, and potential complications.
Risk for Impaired Fetal Development: Related to maternal Treatment
hyperglycemia and potential complications of GDM - Magnesium sulfate (a type of mineral) may be given to treat
active seizures and prevent future seizures
Nursing intervention - magnesium sulfate may be administered intramuscularly into
Education and Self-Management each buttock using undiluted 50% Magnesium Sulfate Injection
Glycemic Control
Maternal and Fetal Monitoring
Emotional Support and Counseling
Collaboration and Referral

DIET
- high in fiber
- complex carbohydrates
- avoid sugary foods
- balanced meals

Normal Amniotic Fluid

800 to 1000 cc
POLYHYDRAMNIOS
>1000cc
OLIGIHYDRAMNIOS
<800cc
DRUGS
TOCOLYTICS
- Medications used to inhibit or suppress premature labor
contractions. They are prescribed to delay the onset of labor
and allow for further gestation and fetal development. While
tocolytics help in preventing preterm birth, they do not
completely eliminate the risk.
LIDOCAINE
- can be used for local infiltration, where it is injected into a
specific area, such as the perineum, to numb the area and
provide pain relief during episiotomy or other procedures.
MAGNESIUM SULFATE
- administered IM on the upper outer quadrant of the
buttocks or the dorsogluteal site usually at 3ml.
- check BP before administering
- used to prevent or stop seizures of eclamptic patients
caused by sudden kick of blood pressure.
- always have calcium gluconate ready for emergency uses if
dosage was unseemly too high which can cause cardiac arrest
(hypotensive to zero heart activity).
CALCIUM GLUCONATE
- antidote for magnesium sulfate
CORTICOSTEROIDS
- In the context of preterm labor, corticosteroids may be
administered to the mother if preterm birth is anticipated
within a certain gestational age range. The administration of
corticosteroids aims to promote fetal lung maturation and
reduce the risk of respiratory distress syndrome in the
newborn.
PARACETAMOL
- also known as acetaminophen, is a commonly used
medication for pain relief and fever reduction. It belongs to
the class of drugs known as analgesics and antipyretics.
Paracetamol works by inhibiting the production of certain
chemicals in the body that contribute to pain and fever.
MEFENAMIC ACID
- It is primarily indicated for the management of mild to
moderate pain, such as menstrual pain (dysmenorrhea),
musculoskeletal pain, and dental pain.
OXYTOCIN
- used to ripen cervix, triggers the milk let-down reflex
*Always check physician’s order and expiration date before,
during, and after administration.
FUNDAL HEIGHT
- distance from the pubic bone to the top of the uterus
measured in cm
- after 24 weeks of gestation, fundal height matches with the
weeks of gestation
- 27 cm = 27 weeks pregnant, and soon
LEOPOLD’S MANEUVER
- ask the mother to empty bladder before the maneuver, place
woman dorsal recumbent position, supine, small pillow under
the head for comfort, knees slightly flexed, maintain privacy,
explain procedure, warm hands, palpate with whole palms not
only fingers
- preferably performed after 24 weeks of gestation when fetal
outline can already be palpated
First Maneuver (What lies at the fundus?)
- palpate woman’s fundus
- fetal head: hard, firm, round, moves independently of the
trunk
- buttocks: softer, symmetric, has small bony prominences,
moves with the trunk
Second Maneuver (Where is the fetal back?)
- palpate each side of the abdomen with gentle but deep
pressure using the tips of the hand
- fetal back: firm smooth, hard, resistant surface
- fetal extremities: feel like small irregularities and protrusions
Third Maneuver (What is in the inlet or lower abdomen?)
- grasp the lower portion of the abdomen just above the
symphysis pubis with the thumb & finger if the right hand
(Pawlick’s Grip)
Fourth Maneuver (What is the attitude?)
- determine the degree of flexion of the fetal head
- the fingers of both hands are moved gently down the sides of
the uterus towards the symphysis pubis.
- Good Attitude (nagduko): the brow corresponds to the side
that contained the elbows and knees.
- Poor Attitude (naghangad): the examiner finger will meet an
obstruction on the same side as fetal back.
EDC COMPUTATION
- April to December (4th - 12th month) LMP -3 +7 +1
- January to March (13th – 15th month) LMP -3 +7
AOG COMPUTATION
- Number of weeks from LMP to the Current Date.
- February always 28 days
Left Occiput Anterior (LOA)
- most common fetal position
Intrauterine Growth Restriction (IUGR)
- a condition in which a baby in the womb fails to grow at the
expected rate
Daily Fetal Movement (DFM) or Quickening
- an indicator of the baby's well-being and can provide
reassurance to expectant parents.
Tocolysis
- Delayed delivery
Cephalopelvic Disproportion
- the baby's head is too large or the mother's pelvis is too
small or misshapen, making it difficult or impossible for the
baby to pass through the birth canal during labor
Artificial Rupture of Membranes (AROM)/Amniotomy
- a medical procedure in which the healthcare provider
intentionally breaks the amniotic sac (bag of waters)
surrounding the baby during labor usually with an Allis
Forceps.
Cardiotocograph (CTG)
- two sensors are placed on the mother's abdomen. One
sensor, called the tocodynamometer, measures the
frequency and duration of uterine contractions. The other
sensor, known as the ultrasound transducer, detects and
records the fetal heart rate.
Prothrombin Time (PT)
- the time it takes for the blood to clot.
Artificial Rupture of Membranes (AROM)/Amniotomy
- a medical procedure in which the healthcare provider
intentionally breaks the amniotic sac (bag of waters)
surrounding the baby during labor usually with an Allis
Forceps.
Intrauterine Fetal Death (IUFD)
- symptoms can be absence of fetal movement, heartbeat,
and vaginal bleeding and fluid leakage.
Cardiotocograph (CTG)
- two sensors are placed on the mother's abdomen. One
sensor, called the tocodynamometer, measures the
frequency and duration of uterine contractions. The other
sensor, known as the ultrasound transducer, detects and
records the fetal heart rate.
Melena
- black, tarry stools. It is often an indication of bleeding in the
upper gastrointestinal tract, usually in the stomach or the first
part of the small intestine. The black color of the stool is a
result of digestion and breakdown of blood as it passes
through the digestive system.
Cyanosis
- low oxygenation (bluish extremities)
Meconium & Meconium Staining
- first stool of the baby
- can cause fetal distress and meconium aspiration syndrome
which obstructs the newborn’s airway.