CHARACTERISTICS OF PROGESTERONE  16-2- weeks placenta became fully  Hysterectomy - surgical removal of uterus.

 HIGH LEVEL OF PROGESTERONE: functional  HRT - Hormonal Replacement Therapy

1. Relaxes, quiet down the uterine   Atherosclerosis - thickening of the wall which is used to minimize the effect of
2. Thickening of the uterus  of the blood vessels in the heart menopause. 
3. No cramping or spontaneous abortion.   Arteriosclerosis - narrowing of the  Perimenopausal - irregular changes in cycle
4. Lassitude (feeling of laziness during blood vessels happens the menstrual cycle stops
menstruation)  Vaginismus - dryness of the vagina,  2 arteries and 1 vein in the umbilical cord of
5. Water retention tension in the muscle around the vagina the baby
6. Increase in body temperature  Completion Curettage - incomplete
7. Thermogenic abortion before 20 weeks. HUMAN PLACENTAL LACTOGEN
8. Negative feedback to hypothalamus and  Fractional Curettage / Diagnostic  Insulin inhibitor / anti insulin
pituitary  Curettage -  removes tissue from the  Normal amount of sugar can cause high
 LOW LEVEL OF PROGESTERONE: inside of the uterus due to heavy level of glucose during pregnancy
1. Uterine cramping prior to menstruation or bleeding  GDM (Gestation Diabetes Mellitus) if they
mittelschmerz (sci term for uterine  Umbilical cord - 53cm (21in) - in term 2 previously have a history of Diabetes
cramping) cm (½ in) Mellitus or when the mother is overweight.
2. Releases FHS, and LH, positive feedback to  Wharton’s jelly - gelatinous  Insulin subcutaneous regulators injections
hypothalamus and pituitary gland mucopolysaccharide prevents pressure are used for pregnant mothers since they
on the veins and arteries. can’t take meds.
3 Placental Hormones:  Amnion - have no nerve attached to it.
 HCG - Human Chorionic Gonadotropin  Graafian follicle / secondary oocyte -
 HPL - Human Placental Lactogen or HCS holds mature cells which are rich in
(Human Chorionic Somatomammotropin) estrogen and progesterone.
 Relaxin   Prostaglandin - chemical prone to pain
receptors which will tear the graafian
Stages of Ovum and Follicle: follicle to release egg cell during
 Primary Follicle  ovulation. It is also released during
 Graafian Follicle delivery.
 Corpus Luteum  Get the temperature during early
 Mature Corpus Luteum morning because there’s no activity
 Corpus Albicans yet.
 -ectomy - suffix used to describe a
surgically removal of something
 FERTILIZATION, IMPLANTATION,
EMBRYONIC, AND FETAL DEVELOPMENT
 Fertilization - also known as conception,
and impregnation.
 Implantation - 8-10 days after fertilization,
can also known as decidualization.
 On or after 42 weeks of gestation - with or
without signs of labor, the baby needed to
be delivered / the mother should undergo
labor.
Terms used to denote fetal growth:
 Ovum - ovulation to fertilization.
 Zygote - fertilization to implantation.
 Embryo - implantation to 5-8 weeks.
 Fetus - 5-8 weeks until term.
 Conceptus -  pregnancy tissue (fetal parts
and placental parts).
 Outer third of fallopian tube - ampullar
portion (most wide)
 Hyaluronidase - (proteolytic enzyme)
released by the spermatozoa and dissolves
the layer of cells protecting the ovum.
 Corona radiata - innermost layer of
follicular cells, adhering to the oocyte
before it leaves the ovarian follicle.
 Zona pellucida - supports communication
between oocytes and follicle cells during
oogenesis.  where trophoblast cells establish
Stages of fetal development:
 Day 1 - Fertilization - union of ovum and
spermatozoon.
 Day 2 - First cell division (zygote)
 Day 3 - Morula (mulberry/aratilis
shaped), when it enters the uterus it’s
called blastocyst.
 Day 4 - Blastocyst - will enter into the
uterus for implantation. Trophoblast
with yolk sac and its villi will connect to
the endometrium.
 Day 8-10 - Embryonic cells: ectoderm,
mesoderm, and endoderm.
 Upper portion of the uterus is the ideal
place for decidualization.
 Upper portion of the uterus (2/3) is
contractile, while the lower portion
(1/3) is relaxed.
 Simultaneous contraction of the upper
and lower portion can cause fetal
distress.
 Human cell = 46 chromosomes, 22 pairs
(XX - female, XY - male)
 Aberration in the number of
chromosomes can result to abnormal
offspring or spontaneous abortion.
 Vaginal spotting occurs during
implantation due to ruptured
capillaries.  placental circulation, take precaution
 Desidua basalis - part of endometrium
that lies under the embryo. Portion
communication with maternal blood
vessels.
2 important hormones in pregnancy - estrogen
and progesterone.
PLACENTA
 Pancake in latin (400-600g. - 11lbs)
 Supplies the fetus oxygen and food and
transport waste products out of the fetal
system.
 Left lateral position - lifts the uterus away
from the inferior vena cava which prevents
SHS (Supine Hypertensive Syndrome).
 30 separate segments or cotyledons
(“square” shaped)
 Check the number of cotyledons that are in
the maternal side, if not then there’s still
some fragment left in the mother’s womb.
 2 sides of placenta: maternal side -
(connected to the mother) dirty side or
Duncan side, fetal side - (covered in
amnion) smooth and shiny side or the
Schultz side.
 Chorion on Schultz's side is used for skin
grafting.
 Duncan’s side was used as a formulation to
some beauty products.
 Almost all drugs may be able to cross
before taking medication.
 Teratogenic - may cause abortion or birth
defect. It can be drugs, radiation, viruses,
the environment, and many more.
 OHA (Oral Hypoglycemic Agent) - when
given to mother with GDM it may cross
placental circulation which can cause
hypoglycemia to the fetus.  collapse if there’s no surfactant.
 Umbilical Cord - has 2 arteries, 1 vein: AVA
(artery, vein, artery), arteries carries
deoxygenated blood, while veins carry
oxygenated blood, nutrients, hormones,
etc.
HORMONES
 Human Chorionic Gonadotropin - first
placental hormone, 1-2 weeks after birth it
is negative to the woman’s blood serum.
 Progesterone - “hormone that maintains
pregnancy”, prevents premature labor by
decreasing the contractility of the uterus.
 Estrogen - “hormone of women”,
stimulates uterine growth (thickening of
the uterus).
 Human Placental Lactogen - promoting
production of milk, mammary gland
growth, regulates maternal glucose.
 Relaxin - ready to soften the bones,
causes waddling gait of the mother
(walking like a duck).
 Amniotomy - artificial rupture of the
amniotic membrane using a tongue
depressor or fingers.
 Amniocentesis technique -  determine the
L/S ratio (2:1 normal ratio), primary test of
fetal maturity. Administer steroids if the
needed ratio is not met.
 24th week SURFACTANT - “lubricant of
the lungs”, secreted by the alveoli.
Alveoli will adhere together and
 
 24th week - the ear is capable of
responding to sound (perfect time to
play music to babies).
 Insulin does not cross the placenta
from the mother to the fetus, that is
why they are prone to DM/GDM.
ADDITIONAL TERMS
 Zygote - fertilized ovum.
 Morula - cleavage undergo 3-4 days of
cell division.
 Blastocyst - morula entering the
uterus.
 Decidua - endometrium after
implantation.
 Embryo - zygote implanted.
 Cryptorchidism - undescended testes
to infants.
 Pseudohermaphroditism - intersex
both mullerian and wolfian duct
developed.
 Fraternal or dizygotic - non identical
because there are 2 amnions, 2 chorion,
2 placenta.
 Identical or monozygotic twins - 2
amnions, 1 chorion, 1 placenta.
 4 STAGES OF LABOR
1. ) 1st Stage of Labor (Dilatation Stage /
Cervical Stage) - onset of first contraction to
full cervical dilation.
 RMLE - Right Mediolateral Episiotomy
(location of episiotomy)
 Show - bloody discharge
 SHS - Supine Hypotensive Syndrome.
Patient should be position in Left Lateral
Position to avoid putting pressure to the
patient’s vena cava
 LAMAZE - special breathing pattern
(pant and blow)
 Caput succedanum - edema is formed in
the baby’s scalp because of early pushing
of the baby out of uterine area.
 Monitor BP q15 minutes but if the
mother is having contractions, it is not
adviced to get the BP and FHT.
How to determine cervix dilation:
 position the patient in dorsal recumbent
position
 place a rubber protector under the buttocks
 put lubricant in your first 2 fingers and
insert it in the vaginal orifice.
 10cm - fully dilated cervix, ready for labor.
Intensity of the contraction
- determined using hand/palpation
 Mild - minimally tense, hard as the nose
 Moderate - feels firm, hard as the chin
 Strong - wooden board, hard as the
forehead
Phases of Contraction:
 Increment (crescendo) - increase
intensity of contraction
 Acme (apex) - peak height of
contraction
 Decrement (decrescendo) - decreasing
contraction
3 Phases of first stage of Labor:
 Latent (0-7cm dilation), contraction:
mild (20-40 sec)
 Active (4-7 cm dilation), contraction:
moderate (40-6- sec)
 Transition (8-10 cm dilation),
contraction: strong (60-70 sec)
 Dorsal recumbent - position of the
mother in labor room
 Lithotomy - position in delivery room
2. ) 2nd Stage of Labor (Delivery Stage /
Expulsion Stage) - from full cervical
dilation up to the delivery of the baby
 Offer psychological support. Do not
leave the mother alone.
 Assist/couch: caution to bear down
when needed
 When to transfer to delivery room?
 Primigravida - cervix is 10 cm
dilated w/ buldging
 Multigravida - cervix is 8-9 cm
dilated
 Do EINC (Essential Intrapartum and
Newborn Care):
 Immediate drying
 Skin-to-skin contact
 Proper cord clamping & cutting
 Non separation of the baby to mother
and breast feeding initiation
Unang yakap, Yakap ng ina, Yakap ng
buhay
 Oil bathing
 Eye care or crede prophylaxis
 Initial temperature (rectum) : heat loss
thru evaporation, convection,
conduction, and radiation
 Cord care
 Anthropometric measurement :
weight, height/length, HC, CC, AC
 Immunization
 Dressing and taking vital signs of the
baby (except BP)
 1-2 minutes - call out the time of birth
 Dry the baby (30 sec), stimulate
breathing
 Place the baby on the mother’s
stomach (for skin-to-skin contact
 Place bonnet and linen
 Administer vaccine:
 Vitamin k - 0.1 ml, IM: vastus
lateralis, and rectus femoris. To
prevent anemia and for blood
clotting.
 Hepatitis B - 0.5ml, IM: right vastus
lateralis. To prevent hepa b.
 BCG - 0.05ml, ID: Deltoid. To
prevent TB.
3. ) 3rd Stage of Labor (Placental Stage) -
from delivery of the baby up to the delivery of
the placenta
 5-30 minutes - for primigravida
 5-10 minutes - for multigravida
 Watchful waiting - watch and wait for
the signs of placental separation
especially if the uterus is relaxed as
these actions should be caused uterine
inversion.
 Inject oxytocin after placental delivery
 Commonly used drugs: methergine -
methylegronovine maleate, ergotrate
- ethylergonovine maleate (increases
uterine monitor activity by direct
stimulation target: uterine
masculature)
4. ) 4th Stage of Labor (Recovery Stage) -
fundus is firm, it should be at/or just above
umbilicus (1-2 finger breaths) and midline.
 If fundus is boggy (or relaxed), do
fundal massage but do not over
massage as it can tire uterine muscle
 LOCHIA - vaginal discharge: Red
(Rubra), Pink (Serosa), and White
(Alba).
 A full bladder displaces the uterus, a
factor of uterine atony.
LABOR
 Labor - 30-42 weeks of pregnancy, when
fetus is sufficiently mature enough to
adopt extrauterine life yet not too large to
cause mechanical difficulty during birth.
 Preterm - labor before maturation of
the fetus (20-30 weeks)
 Posterm - 42 weeks (optimal) labor is
delayed until fetus is delivered.
Theories of Labor:
1. Uterine Myometrial Irritability / Uterine
Stretch Theory
- uterine muscle stretches which
results to release of prostaglandin and
induces contraction and labor.
2. Oxytocin theory
- pressure on the cervix by the
presenting part stimulates release of
oxytocin in which cause uterine contraction.
3. Low progesterone theory
- low progesterone causing uterine
cramp. When progesterone decreases,
estrogen increases during pregnancy in
which starts labor.
4. Theory of Aging Placenta
- (40-42 weeks max), when
placenta matures it can result to more
pressure in uterus in which diminished blood
supply and will result to contraction.
5. Estrogen Fetal Hormone & Prostaglandin
Theory
- hormones have stimulating effect
4 P’s of Labor
1. Passage - woman’s pelvis
2. Passenger - the fetus
3. Power - uterine factors
4. Psyche - woman’s psychological state
How to determine CPD:
 Ultrasound
 Weight of the fetus
 Fundal height
 Ultrasound
 Leopold’s Maneuver
 Sugar in urine - +1 normal due to the
presence of prolactin (anti insulin agent)
 Protein in urine - pre eclampsia can lead to
hypertesion
 Amniocentesis - technique used to
Medical terms:
 GDM - Gestation Diabetes Mellitus
 CBC - Complete Blood Count
 OHA - Oral Hypoglycemic Agent
 TVUTz - Transvaginal Ultrasound
 TAUTz - Transabdominal Ultrasound
 BPD - Biparietal Diameter
 BPP - Biophysical Profile
 BPS - Biophysical Scoring
 FHR - Fetal Heart Rate
 FHT - Fetal Heart Tone
 CPD -Cephalopelvid Disproportion
 CS - Cesarean Section
 NSD - Normal Spontaneous Delivery
 AFD - Alpha-fetoprotein
 NDT - Neural Tube Defect
 CVS - Chorionic Villi Sampling
 PUBS - Percutaneous Umbilical Blood
Sampling
 POSTPARTUM ASSESSMENT UTERUS EPISIOTOMY
Assess BUBBLE SHEB:  REEDA - Redness, Edema, Ecchymosis  Episiorrhaphy - surgical repair
 Breast (bruise), Discharge, and Approximation  Assess for REEDA & Hemorrhoids
 Uterus of the skin.  Cold or ice pack for vasoconstriction effect
 Bowel  Involution - uterus should go back to its reduce edema & relieve pain
 Bladder pre pregnancy state  Warm compress, 20 inches from perineum
 Lochia  Normal finding: firm to touch for 20 mins, 3x a day
 Episiotomy  Autolysis - reduction of weight of the  Sitz bath, 2x a day or more, 38-42 c temp
 Skin cells during involution
 Homan’s Sign SKIN
 Emotional Status BOWEL  Diaphoresis - excessive sweating (1st 5
 Bonding  Auscultate 4 quadrants (LUQ, RUQ, days)
LLQ, and RLQ) - normal findings: there  Chloasma (pigmentation in the face) & linea
 Puerperium - from delivery of the placenta should be a sound in which indicates negra (mark across abdomen) fades
up to 6 weeks of birth. bowel movement  Striae gravidarum - stretch marks, become
 Breastfeed every 2 hours or every demand  Inspect signs of distention silver streaks
 A newborn can only hold an amount similar  Mother is expected to defecate after
to a “squeeze of calamansi” 3-8 hours. HOMAN’S SIGN
 Do not overfeed the baby or the baby will  Pain in calf in dorsiflexion might indicate
vomit BLADDER thrombophlebitis or positive homan’s sign.
 Void within 6-8 hours after delivery
BREAST  Assess: frequency, burning, or urgency EMOTIONAL STATUS
 Palpate for engorgement for possible UTI  Assess for postpartum blues (ask the ptx
 Inspect the nipple  Bladder can hamper in the way during “how are you feeling today?”)
 Colostrum - first letdown of the breast delivery that is why it is important to  Real cause: unknown
milk. Rich in antibodies that is why it is insert catheter  Normal finding: the mother should be
yellowish in color happy about the baby.
 Sucking stimulates the release of oxytocin LOCHIA
in which induces lactation (produces milk  Vaginal flow delivery consisting of the BONDING
200-300 ml) blood (Rubra, Serosa, and Alba)  “Claiming” - who looks or acts like the baby
 Burp the baby after the baby in order to  Inspect: type, quantity, amount, and  “Identification” - giving name to the baby
prevent discomfort/stomachache odor  Delay crede’s prophylaxis, allow eye-to-
 Babies are nose breathers, it is important eye, touching, stroking, and cuddling.
to free the nose when breast feeding