Bsn2 2 Cmca Lec Prelims 1

LECTURE\POWERPOINT
[TRANS] LESSON 1: FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING CARE
OUTLINE • In the MDGs, 8 anti-poverty targets had been set to be

I Four Phases of Health Care achieved by 2015 and the Philippines only made some
II National Health Goals progress.
III Trends in the Maternal Child Health Nursing • Poverty has not been ended.
A Ways in which Nurses have Adapted to these Changes • The development agenda called “Sustainable Development
IV Measuring Maternal and Child Health Goals” builds on the MDGs. The proposed framework has 17
A Birth Rate
goals with 169 targets.
B Fertility Rate
C Fetal Death Rate 1. No poverty
D Neonatal Death Rate 2. Zero hunger
i 5 Leading Cause of Infant Death 2018 3. Good health and well-being
E Perinatal Death Rate 4. Quality education
F Infant Mortality Rate 5. Gender equality
6. Clean water and sanitation
FOUR PHASES OF HEALTH CARE 7. Affordable and clean energy
• Maternal and child health nursing can be visualized within a 8. Decent work and economic growth
framework in which nurses uses nursing process, nursing 9. Industry, innovation and infrastructure
theory, and Quality & Safety Education for Nurses (QSEN) 10. Reduced inequalities
competencies to care for families during childbearing and 11. Sustainable cities and communities
childbearing years and through the four phases of health 12. Responsible consumption and production
care: 13. Climate action
o Health Promotion 14. Life below water
o Health Maintenance 15. Life on land
o Health Restoration 16. Peace, justice and strong institutions
o Health Rehabilitation 17. Partnerships for the goals
TRENDS IN THE MATERNAL CHILD HEALTH NURSING

• Constantly changing because of changes in social structure,
variations in family lifestyle, and changing patterns of illness
NATIONAL HEALTH GOALS

• The two main overarching national health goals are:
o To increase quality and years of healthy life
o To eliminate health disparities
MILLENIUM DEVELOPMENT GOALS

• United Nations spearheaded the formulation of the MDGs
with the corresponding targets and these goals are:
1. Eradicate extreme poverty and hunger;
2. Achieve universal primary education;
3. Promote gender equality and empower women;
4. Reduce child mortality;
5. Improve maternal health;
6. Combat HIV/AIDS, malaria, and other diseases;
7. Ensure environmental sustainability; and
8. Develop a global partnership for development
IBARRA. MARIANO. ONG. PECUNDO. RICO. 1

[TRANS] LESSON 1: FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING CARE
2. Pneumonia 2,628 1.5 11.7
3. Respiratory distress of 2,526 1.4 11.2
newborn
4. Congenital malformation of 1,572 0.9 7.0
the heart
5. Disorders related to short 1,487 0,8 6.6
gestation and low birth
weight, not elsewhere
classified
6. Congenital pneumonia 1,095 0,6 4.9
7. Neonatal aspiration 1,079 0.6 4.8
syndrome
8. Intrauterine hypoxia 950 0.5 4.2
9. Other congenital 941 0.5 4.2
malformation
10. Diarrhea and 900 0.5 4.0
WAYS IN WHICH NURSES HAVE ADAPTED TO THESE gastroenteritis of
CHANGES presumed infectious
• Client advocacy origins
• Participating in cost-containment measures,
• Focusing on health education, and • The five leading causes of infant death in 2018 were:
• Creating new nursing roles 1. Birth defects
2. Preterm birth and low birth weight
MEASURING MATERNAL AND CHILD HEALTH 3. Maternal pregnancy complications
• Measuring what constitutes the area of maternal and child 4. Sudden infant death syndrome (SIDS)
health is not as simple as defining whether patients are ill or 5. Injuries (e.g., suffocation)
well because individual patients and healthcare
practitioners can maintain different perspectives on illness PERINATAL DEATH RATE
and wellness. • The perinatal period is the time period beginning when a
• Statistics is used to determine the status of maternal and child fetus reaches 500g (about week 20 of pregnancy) and
health ending about 4 to 6 weeks after birth
• Perinatal death rate is the sum of the fetal and neonatal
BIRTH RATE death rates
• The total number of live births per 1,000 of a population in a
year INFANT MORTALITY RATE
• This is an Index of its general health because it measures the
FERTILITY RATE quality of pregnancy care, nutrition, and sanitation as well as
• It reflects what proportion of women who could have babies infant health
are having them • This rate is the traditional standard used to compare the
health care of a nation with that of previous years or of other
countries
FETAL DEATH RATE
• It reflects the status of health care
• Defined as the death in utero of a child (fetus) weighing 500g
or more, roughly the weight of a fetus of 20 weeks or more
pregnancy – including abortion
• Implication to the maternal & child health
o The mother that is pregnant has very poor health –
cannot sustain pregnancy
NEONATAL DEATH RATE

• Death within the first 28 days of life
o The neonatal death rate reflets not only the quality
of care available to women during pregnancy and
childbirth but also the quality of care available to
infants during the first month of life
o Once a baby is born, remember that the fetus is
totally dependent on the mother for 9 months
(food, respiration, blood circulation). After the
delivery, neonates will experience sudden change.
o The first 28 days of infants are crucial
• Implication to the maternal & child health
o Both mother and child is not taken care of
LEADING CAUSES OF INFANT DEATH

• The leading causes of infant mortality in the Philippines REFERENCES
Table No. 3 Infant Mortality: Ten (10) Leading Causes Notes from the discussion by Prof. Lualhati M. Floranda, DNM, RN
NO. AND RATE per 1000 LIVE BIRTHS AND PERCENTAGE
DISTRIBUTION Book Reference – Pillitteri, A. & Silbert-Flagg, J. Maternal & Child
Philippines, 2010 Health Nursing: Care of the Childbearing & Childbearing Family.
Cause Number Rate Percent (8th Edition)
1. Bacterial sepsis of newborn 3,608 2.0 16.1

LECTURE\POWERPOINT
[TRANS] LESSON 2: ANATOMY OF THE FEMALE PELVIS AND FETAL SKULL
OUTLINE
I Female Bony Pelvis
A Ilium
B Ischium
i Ischial spines
C Pubic Bones and the Symphysis Pubis
D Sacrum and Coccyx
E Pelvic Canal
II Size and shape of the pelvis
A Pelvic Inlet and Pelvic Outlet
i Pelvic Inlet
ii Pelvic Outlet
III True and False Pelvis ISCHIUM
IV Planes of the Pelvis
• Ischium – thick lower part of the pelvis, formed from 2 fused
A Plane of the Pelvic Cavity
B Plane of the Obstetric Outlet bones - one on either side
C Plane of the Anatomical Outlet
i Consequences of Walking Upright o When a woman is in labor, the descent of the fetal
ii Obstetric Pelvic Axis head as it moves down the birth canal is estimated
V Four Types of Female Pelvis in relation to the ischial spines, which are inward
VI Conjugate projection of the ischium on each side
VII Fetal skull
o If ischial spine is not yet protruding during the
A Fetal Skull Presentation
B Fetal Skull Circumferences internal examination (IE) then the fetus is not yet
C Moulding ready to be delivered
VIII Fetal Skull Bones
A Sutures ISCHIAL SPINES
B Fontanels
C Regions and Landmarks in the Fetal Skull • Ischial spines – smaller and rounder in shape in the woman’s
pelvis than in the man
o On Labor and Delivery Care, you will learn how to
FEMALE BONY PELVIS
feel for the ischial spines to help you estimate how
• Pelvis – hard ring of bone
far down the birth canal the baby’s head has
o Supports and protects the pelvic organs and the
progressed
contents of the abdominal cavity
▪ Pelvic organs include: vagina, cervix, uterus,
bladder, urethra, and rectum
PUBIC BONES AND THE SYMPHYSIS PUBIS
• Pubic bones on either side form the front part of the pelvis
• The two pubic bones meet in the middle at the pubic
symphysis
o Symphysis – a very strong bony joint
• Pubic symphysis – immediately below the hair covered pubic
mound that protects the woman’s external genitalia
o When examining the abdomen of a pregnant
woman, feeling the top of the pubic symphysis with
fingers is an important landmark
o Measuring the height of the uterus from the pubic
symphysis to the fundus (top of the uterus) or fundic
height will enable to estimate the gestational age
• Woman’s pelvis is adapted for child bearing of the fetus
o Wider and flatter shape than the male pelvis ▪ i.e. how many weeks of the pregnancy have
• Pelvis is composed of pairs of bones which are fused together passed, and whether the fetus is growing at the
so tightly that the joints are difficult to see normal rate
ILIUM
• The major portion of the pelvis is composed of 2 bones called
ilium – one on either side of the spinal column and curving
towards the front of the body
• Iliac crest – upper border of the ilium on that side
o Touched when place you hand on either hip

• A narrow pelvis can make it difficult for the baby to pass
through the pelvic canal
• A deficiency of important minerals like iodine in the diet
during childhood may result in abnormal development of the
pelvic bones.
o Stunting (being much shorter than average for age)
due to malnutrition and/or infectious diseases can
also result in a narrow pelvis
PELVIC INLET AND PELVIC OUTLET

• Shape of the pelvic canal can be distinguished between the
pelvic inlet and pelvic outlet
• Pelvic inlet – roughly circular space where the baby’s head
enters the pelvis
• Pelvic outlet – roughly circular space where the baby’s head
emerges from the pelvis
• Pelvic inlet and pelvic outlet are not the same size
• Gestational age of Week 40 is lower than Week 38 since
lightening occurred PELVIC INLET
• Pelvic inlet is formed by the pelvic brim
SACRUM AND COCCYX • Pelvic brim is rounded, except where the sacral promontory
• Sacrum – tapered, wedge-shaped bone at the back of the and the ischial spines project into it
pelvis, consisting of five fused vertebrae o A baby in a head-down position, looking down on
o Small bones that make up the spinal column or the pelvis from above, the baby must squeeze
backbone through the space.
• Coccyx – bottom of the sacrum, tail-like bony projection ▪ It is 13 cm wide (on average) and 12 cm long
• The upper border of the first vertebra in the sacrum sticks out, from top to bottom
and points towards the front of the body; this protuberance
is the sacral promontory – important landmark for labor and
delivery
PELVIC OUTLET
• Pelvic outlet is formed by the lower border of the pubic bones
at the front, and the lower border of the sacrum at the back
PELVIC CANAL • Ischial spines point into this space on both sides
• Pelvic Canal – roughly circular space enclosed by the pubic • Figure below shows the dimensions of the space that the
bones at the front, and the ischium on either side at the back; fetus must pass through as it emerges from the mother’s
bony passage through which the baby must pass pelvis.
o This canal has a curved shape because of the o As you look, imagine that you are the birth
difference in size between the anterior and attendant who is looking up the birth canal, waiting
posterior borders of the space created by the to see the fetal head emerging
pelvic bones
SIZE AND SHAPE OF THE PELVIS Table No.1 Sizes of Pelvic Inlet and Pelvic Outlet
• Size and shape of the pelvis is important for labor and delivery PELVIC INLET PELVIC OUTLET
• Well-built healthy women, who had a good diet during their Anterior Sagittal Plane – its
childhood growth period, usually have a broad pelvis that is apex at the lower border of
well adapted for childbirth the symphysis pubis
• Gynecoid Pelvis – round pelvic brim and short, blunt ischial 13 cm wide (on average)
spines and 12 cm from top to Anterior sagittal diameter
o Gives the least difficulty during childbirth, provided bottom from the lower b0rder of the
the fetus is a normal size and the birth canal has no symphysis pubis to the center
abnormal tissue growth causing an obstruction of the bituberous diameter:
• There is considerable variation in pelvis shapes, some of 6 – 7 cm
which create problems in labor and delivery

Posterior Sagittal Plane – its PLANE OF ANATOMICAL OUTLET
apex at the tip of the coccyx • Passes with the boundaries of anatomical outlet and consists
of 2 triangular planes with one base which is the bituberous
Posterior sagittal diameter diameter
from the tip of the sacrum to Table No.2 Sizes of Pelvic Outlet
the center of the bituberous PELVIC OUTLET
diameter: Anterior Sagittal Plane – its apex at the lower border of the
7.5-10cm symphysis pubis
TRUE AND FALSE PELVIS Anterior sagittal diameter from the lower border of the
• Four bones articulated at four joints symphysis pubis to the center of the bituberous diameter:
o False pelvis – above the pelvic brim and has no 6 – 7 cm
obstetric importance Posterior Sagittal Plane – its apex at the tip of the coccyx
o True pelvis – below the pelvic brim; bone defined
tunnel that the infant must traverse at birth Posterior sagittal diameter from the tip of the sacrum to the
center of the bituberous diameter:
7.5-10cm
CONSEQUENCES OF WALKING UPRIGHT

• When a woman stands erect:
o Pelvic inlet makes an angle of about 55 with
horizon
o Pelvic outlet makes an angle of 15 with horizon
▪ If the angle made by the inlet is greater than
55 this may make the descent of the fetal
head in the pelvis difficult
OBSTETRIC PELVIC AXIS

• This represents the path the presenting part follow for delivery
to occur:
o Upper part moves downward approximately in a
PLANES OF THE PELVIS straight line till the level of the ischial spine
• The planes of the of pelvis consist of: o Trajectory then changes to become a curvilinear
1. Plane of the pelvic inlet path directed forward and downward
2. Plane of the cavity: Plane of the greatest pelvic
dimensions
3. Plane of the mid pelvis: Plane of obstetric outlet
4. Plane of the anatomical outlet.
PLANE OF THE PELVIC CAVITY

• aka Plane of the greatest pelvic dimensions
• Passes bet. the middle of the posterior surface of the
symphysis pubis and the junction bet. 2nd and 3rd sacral
vertebrae
o Laterally, it passes to the center of the acetabulum
and the upper part of the greater sciatic notch
• A round plane with diameter of 12.5 cm FOUR TYPES OF FEMALE PELVIS
• Internal rotation of the head occurs when the biparietal • They differ in:
occupies this wide pelvic plane while the occiput is on the o Shape of the pelvic inlet
pelvic floor o Shape of the side-walls
o i.e., at the plane of the least pelvic dimensions o Character of the subpubic arch
• Four types do exist:
PLANE OF OBSTETRIC OUTLET 1. Gynecoid – 50%
• aka Plane of least pelvic dimensions ▪ Rounded
• Passes from the lower border of symphysis pubis anteriorly, to ▪ Trans. diameter slightly behind the center
the ischial spines laterally, to the tip of the sacrum posteriorly 2. Android – 20%
• It is the plane of the pelvic floor ▪ Heart shaped
• Head is considered engaged of the vault reaches it ▪ Trans. Diameter near the sacrum
• This is the plane where the pelvic axis turns forward 3. Anthropoid – 25%
▪ AP diameter > Trans

4. Platypelloid – 5% FETAL SKULL
▪ Wide trans. diameter • Fetal skull is the most difficult part of the baby to pass through
o The truth is that the majority of the pelvis are a the mother’s pelvic canal, due to the hard bony nature of
mixture of all the 4 types the skull
• Understanding the anatomy of the fetal skulls and its
diameter will help to recognize how a labor is progressing,
and whether the baby’s head is presenting correctly as it
comes down the birth canal
• This will give you a better understanding of whether a normal
vaginal delivery is likely, or if the mother needs referral
because the descent of the baby’s head is not making
sufficient progress
Table No.3 Types of Female Pelvis

GYNECOID ANDROID ANTHROPOID PLATYPELLOID
Female Male-like Ape-like Flat
50% 20% 25% 5%
Inlet Rounded Triangle AP-oval Trans-oval
Cavity Wide and Narrow and
Wide Wide
shallow deep
Subpubic Wide
Narrow <70 <90 >90
angle >90
Ischial Not Inward Not
Prominent
Spines prominent projection prominent
I.S.D Wide Reduced Reduced Wide
Walls Parallel Convergent Parallel Divergent
Sacrum Smooth Jutting
Table No.4 Ideal Obstetric Pelvis

PARAMETER PARAMETER
Brim • Round or Oval
• Occiput – most appropriate part of the fetal skull to present
transversely
first in pelvic outlet since it small
• No undue projection of
• Sinciput – consist of the brow and the face
sacral promontory
o Some instances that brow, face and mentum
• AP diameter: 12 cm
present first
• Transverse diameter: 13
• The vault: From the orbital ridge to the nape of the neck
cm
(frontal, parietal, occipital bones).
• The plane of pelvic inlet
o It is compressible
not more than 55
• The face: root of the nose to junction of head and neck
Cavity • Shallow with straight side-
walls Table No.5 Transverse Diameters of the Fetal Skull
• No great projections of
BONE DIAMETER MEANING
ischial spines
Biparietal Diameter 9.5cm Bet. 2 parietal
• Smooth sacral curve
eminences
Outlet • Pubic arch rounded
Bitemporal Diameter 8.5cm Bet. 2 temporal
• Subpubic angle >80
eminences
• Intertuberous diameter
Bimastoid Diameter 7.5cm Bet. 2 mastoid
of at least 10cm
processes (Not
reducible nor
CONJUGATE destroyable even by
• Conjugate is measured by the obstetrician via ultrasound or destructive
pelvimetry procedures
1. True conjugate – 11 cm (purple)
Supra-subparietal 8.25cm – 9cm Asynclitic head
2. Obstetric conjugate – 10.5 cm (green)
3. Diagonal conjugate – 12 cm (blue)
FETAL SKULL PRESENTATION

Table No.6 Fetal Skull Presentation MOULDING

PARAMETER LENGTH PRESENTATION • Reshaping of the fetal skull:
1 – Suboccipito-bregmatic 9.5cm • Flexed vertex o Obliteration of the sutures
Nape of neck to center of o Overlapping of the bones of the vault:
bregma ▪ One parietal bone overlaps the other
2-Suboccipito-frontal 10.5cm • Partially ▪ Both overlap the occipital bone
Nape of neck to 2.5 cm. In deflexed vertex • It accounts for diminution of the biparietal diameter and
front of bregma • Diameter suboccipito-bregmatic diameters by 0.5-1cm or even more
distending the
vulva after
crowning
3-Occipito-frontal 11.5cm • Deflexed vertex
Root of nose to occipital • Diameter
protuberance distending the
vulva in face
presentation
4-Mento-vertical 13.75- • Brow
Point of chin to above 14cm
posterior fontanelle
5-Submento-bregmatic 9.5cm • Face
From below chin to center
of bregma
6-Submento-vertical 11.5cm • Face not fully
From below chin to in front extended FETAL SKULL BONES
of posterior fontanelle • Skull bones encase and protect the brain, which is very
delicate and subjected to pressure when the fetal head
FETAL SKULL CIRCUMFERENCES passes down the birth canal
• Suboccipito-bregmatic x Biparietal (28cm) – these are the • Correct presentation of the smallest diameter of the fetal skull
engaging diameters of well flexed vertex presentation to the largest of the mother’s bony pelvis is essential if delivery
• Occipito-frontal x Biparietal (33cm) – these are the engaging is to proceed normally.
diameters in deflexed vertex presentation (OP Position) o If the presenting diameter of the fetal skull is larger
• Mento-vertical x Biparietal (35.5cm) – this is the largest head than the maternal pelvic diameter, it needs very
circumference (Brow presentation) close attention for the baby to go through a normal
vaginal delivery
Table No.7 Engaging Diameters of Fetal Skull • Fetal skull bones are as follows
PRESENTATION DIAMETER IMAGE 1. (2) Frontal bone – forms the forehead. In the fetus,
Well-flexed Circle of 9.5cm the frontal bone is in two halves, which is fuse into a
Head The engaging diameter is the single bone after the age of eight years
suboccipito-bregmatic 2. (2) Parietal bones –lie on either side of the skull
diameter 3. Occipital bone – forms the back of the skull and part
Deflexed Oval of its base. Joins with the cervical vertebrae (neck
Head The longer occipito-frontal bones in the spinal column or backbone)
diameter of 11.5cm is 4. (2) Temporal bones – one on each side of the head,
exposed. closest to the ear
Greater Oval • Understanding the landmarks and measurements of the fetal
Deflexion of The longer mento-vertical skull will help you to recognize normal and abnormal
the Head diameter of 13.75-14cm is presentations of the fetus during antenatal examinations,
exposed labor and delivery
Full Extension Circle of 9.5cm
of the Head The engaging diameter is the
submento-vertical diameter
SUTURES
• Sutures – joints bet. the bones of the skull
o In the fetus, they can give a little under the pressure
a. Well-flexed head on the baby’s head as it passes down the birth
b. Partially flexed head canal
c. Deflexed head o During early childhood, these sutures harden and
d. Face presentation the skull bones can no longer move relative to one
e. Brow presentation another, as they can to a small extent in the fetus
and newborn

• Fetal sutures are as follows:
1. Lambdoid suture – forms the junction bet. the
occipital and the frontal
2. Sagittal suture – joins the two parietal bones
together
3. Coronal suture – joins the frontal bone to the two
parietal bone
4. Frontal suture – joins the two frontal bones together • Brow – area of skull which extend from the anterior fontanel
to the upper border of the eye
o A brow presentation is a significant risk for the
mother and the baby.
• Face – extends from the upper ridge of the eye to the nose
and chin (lower jaw)
o A face presentation is also a significant risk for the
mother and baby
FONTANELS
• Fontanel – space created by the joining of two or more
sutures
o Covered by thick membranes and the skin on the
baby’s head, protecting the brain underneath the
fontanel from contact with the outside world
o Identification of the 2 large fontanels on the top of Brow Face
the fetal skull helps you to locate the angle at which • Occiput – area bet. the base of the skull and posterior
the baby’s head is presenting during labor and fontanel
delivery
• Fetal fontanel are as follows:
1. Anterior fontanel – aka bregma, a diamond-shaped
space toward the front of the baby’s head, at the
junction of the sagittal, coronal and frontal sutures
▪ Very soft and you can feel the fetal heart beat
by placing your fingers gently on the fontanel
▪ Skin over the fontanel can be seen pulsing in a
new born or young baby
2. Posterior fontanel – aka lambda, a triangular-
shaped and is found toward the back of the fetal
skull. It is formed by the junction of the lambdoid
and sagittal sutures
REFERENCES
Notes from the discussion by Prof. Lualhati M. Floranda, DNM, RN
Manila Doctors Colleges of Nursing PowerPoint Presentation
REGIONS AND LANDMARKS IN THE FETAL SKULL

• Vertex – area midway bet. the anterior fontanel, 2 parietal
bones and the posterior fontanel
o Vertex presentation – occurs when this part of the
fetal skull is leading the way
▪ This is the normal and the safest presentation
for vaginal delivery

LECTURE\POWERPOINT
[TRANS] LESSON 3: PHYSIOLOGY OF MENSTRUATION
OUTLINE BODY STRUCTURES INVOLVE IN MENSTRUATION

I Menstruation • Four body structures are involved in the physiology of the
A Purpose of Menstruation menstrual cycle:
B Normal Characteristics of Menstruation 1. Hypothalamus
II Body Structures Involved in Menstruation 2. Anterior Pituitary Gland
A Hypothalamus
3. Ovaries
i What may Alter Menstruation
B Pituitary Gland 4. Uterus
C Ovary ▪ Cervix*
D Uterus • For a menstrual cycle to complete all four structures must
i Proliferative Phase contribute their part
ii Secretory Phase o Inactivity of any part results in an incomplete or
iii Ischemic Phase ineffective cycle
iv Menses Phase
E Cervix
III Cervical Mucus to Help Plan Coitus
A Fern Test
B Spinnbarkeit Test
IV Education for Menstruation
A Menstrual Disorders
B Menopause
V Summary of Menstrual Cycle
MENSTRUATION
• Menstrual cycle (female reproductive cycle) is episodic
uterine bleeding in response to cyclic hormonal changes
• Process that allows for conception and implantation of a new
life
• Length of menstrual cycles differs from woman to woman
• Average length is 28 days (from the beginning of one
menstrual flow to beginning of the next)
o It can be:
▪ As short as 23 days or
▪ As long as 35 days
• The length of the average menstrual flow (termed menses) is HYPOTHALAMUS
o 4-6 days, although women may have period as • Aka the master gland
▪ Short as 2 days or • Release of GnRH (Gonadotrophic Releasing Hormone) or
▪ As long as 7 days (MacKay, 2009) also called LHRH (Luteinizing Hormone-Releasing Hormone)
by the hypothalamus initiates the menstrual cycle
PURPOSE OF MENSTRUATION • When the level of estrogen (produce by the ovaries) rises,
1. To bring an ovum to maturity release of the hormone is repressed, and menstrual cycles do
2. Renew a uterine tissue bed that will be responsible for not occur
the ova’s growth should it be fertilized o The principle that birth control pills use to eliminate
menstrual flow
NORMAL CHARACTERISTICS OF MENSTRUATION • During childhood, hypothalamus is apparently so sensitive to
the small amount of estrogen produced by the adrenal
Table No.1 Characteristics of Normal Menstrual Cycles glands that release of the hormone is suppressed
CHARACTERISTICS DESCRIPTION • Beginning with puberty, hypothalamus becomes less
Beginning (Menarche) Average age at onset, 12.4 sensitive to estrogen feedback; this results in the initiation
years; average range 9-17 every month in females of the hormone GnRH
years o GnRH is transmitted from the hypothalamus to the
Interval bet. Cycles Average, 28 days; cycles of anterior pituitary gland and signals the gland to
23-25 days not unusual begin producing the gonadotropic hormones
Duration of Menstrual Flow Average flow, 2-7 days; Follicle-Stimulating Hormone (FSH) and Luteinizing
ranges of 1-9 days not Hormone (LH)
abnormal • Because production of GnRH is cyclic, menstrual periods is
Amount of Menstrual Flow Difficult to estimate; average also cycle.
30-80mL per menstrual
period; saturating pad or
tampon in less than an hour is
heavy bleeding
Color of Menstrual Flow Dark red; a combination of
blood, mucus, and
endometrial cells
Odor Similar to that of marigolds
WHAT MAY ALTER MENSTRUATION
1. Diseases of the hypothalamus that cause deficiency of
this releasing factor can result in delayed puberty
IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 1

o The secondary pituitary hormone, LH, continues to
2. Disease that causes early activation of GnRH can lead rise in amount and acts on the follicle cells of the
to abnormally early sexual development or precocious ovary
puberty • It influences the follicle cells to produce lutein, a bright-yellow
3. High levels of pituitary-based hormones (FSH or LH) can fluid
also inhibit the production of GnRH o Lutein is high in progesterone and contains some
estrogen, whereas the follicular fluid was high in
PITUITARY GLAND estrogen with some progesterone
• Under the influence of GnRH, the anterior lobe of the pituitary o This yellow fluid fills the empty follicle, which is then
gland (adenohypophysis) produces two hormones that act termed a corpus luteum (yellow body)
on the ovaries to further influence the menstrual cycle • Basal body temperature of a woman drops slightly (by 0.5 to
1. Follicle-Stimulating Hormone (FSH) – a hormone 1 F) just before the day of ovulation, because of the
that is active early in the cycle and is responsible for extremely low level of progesterone that is present at that
maturation of the ovum time
2. Luteinizing Hormone (LH) – a hormone that o It rises by 1 F on the day after ovulation, because of
becomes most active at the midpoint of the cycle the concentration of progesterone (which is
and is responsible for ovulation, or release of the thermogenic) that is present at that time.
mature egg cell from the ovary, and the growth of o The woman’s temperature remains at this level until
the uterine lining during the 2nd half of the menstrual approximately day 24 of the menstrual cycle, when
cycle the progesterone level again decreases
• FSH and LH are called gonadotropic hormones because they • If conception occurs, as the ovum proceeds down a
cause growth (trophy) in the gonads (ovaries). fallopian tube and the fertilized ovum implants on the
• Every month during the fertile period of a woman’s life (from endometrium of the uterus
menarche to menopause), one of the ovary’s primordial o Corpus luteum remains throughout the major
follicles is activated by FSH to begin to grow and mature portion of the pregnancy (approximately 16-20
o As it grows, its cells produce a clear fluid (follicular weeks)
fluid) that contains a high-degree of estrogen • If conception does not occur, the unfertilized ovum atrophies
(mainly estradiol) and some progesterone after 4 or 5 days, and the corpus luteum (called a “false”
• As the follicle reaches its maximum size, it is propelled toward corpus luteum) remains for only 8-10 days
the surface of the ovary o As the corpus luteum regresses, it is gradually
• At full maturity, it is visible on the surface of the ovary as a replaced by white fibrous tissue, and the resulting
clear water blister approximately 0.25 to 0.5 inches across structure is termed a corpus albicans (white body)
• At this stage of maturation, the small ovum (barely visible to
the naked eye, approximately the size of a printed period),
with its surrounding follicle membrane and fluid, is termed a
graafian follicle
OVARY
• By day 14, before the end of a menstrual cycle (the midpoint
of a typical 28-day cycle), the ovum has divided by mitotic
division into two separate bodies
1. Primary oocyte – contains the bulk of the cytoplasm
2. Secondary oocyte – contains so little cytoplasm
that it is not functional
• Structure also has accomplished its meiotic division, reducing
its no. of chromosomes to the haploid (having only one
member of a pair) number of 23
• After an upsurge of LH from the pituitary, prostaglandins are
released and the graafian follicle ruptures
• The ovum is set free from the surface of the ovary, a process
termed ovulation
• It is swept into open end of a fallopian tube
o Teach women that ovulation occurs on
approximately the 14th day before the onset of the
next cycle, not necessarily at a cycle’s midpoint
• After the ovum and the follicular fluid have been discharged
from the ovary, the cells of the follicle remain in the form of a
hollow, empty pit
o FSH has done its work at this point and now
decreases in amount

UTERUS
• Phases of menstrual cycle is as follows:

1. Proliferative Phase
2. Secretory Phase CERVIX
3. Ischemic Phase • The mucus of the uterine cervix, as well as the uterine body,
4. Menses Phase changes each month during the menstrual cycle
• During the first half of the cycle, when hormone secretion
PROLIFERATIVE PHASE from the ovary is low, cervical mucus is thick and scant
• First phase of menstrual cycle o Sperm survival in this type of mucus is poor
• Immediately after a menstrual flow (which occurs during the • At the time of ovulation, when the estrogen level is high,
first 4 or 5 days of a cycle) cervical mucus becomes thin and copious
• Endometrium – lining of the uterus very thin, approximately o Sperm penetration and survival at the time of
one cell layer in depth ovulation in this thin mucus are excellent
• As the ovary begins to produce estrogen (in the follicular • As progesterone becomes the major influencing hormone
fluid, under the direction of the pituitary FSH), the during the second half of the cycle, cervical mucus again
endometrium begins to proliferate becomes thick and sperm survival is again poor
• This growth is very rapid and increases the thickness of the
endometrium approximately eightfold CERVICAL MUCUS CHANGES TO HELP PLAN COITUS
SECRETORY PHASE FERN TEST

• Fern Test – when high levels of estrogen are present in the
• After ovulation, the formation of progesterone in the corpus
body, as they are just before ovulation, the cervical mucus
luteum (under the direction of LH) causes the glands of the
forms fernlike patterns caused by crystallization of sodium
uterine endometrium to become corkscrew or twisted in
chloride on mucus fibers when it is placed on a glass slide and
appearance and dilated w/ quantities of glycogen (an
allowed to dry
elementary sugar) and mucin (a protein)
o This pattern is known as arborization or ferning
• Capillaries of the endometrium increase in amount until the
lining takes on the appearance of rich, spongy velvet
• This second phase of the menstrual cycle is termed the
progestational, luteal, premenstrual, or secretory phase
ISCHEMIC PHASE
• If fertilization does not occur, the corpus luteum in the ovary
begins to regress after 8 to 10 days
• As it regresses, the production of progesterone and estrogen NON-FERTILE TRANSITIONAL FERTILE
decreases Only dots and Some fern A lot of ferning
• W/ the withdrawal of progesterone stimulation, the some lines appear patterns start to patterns appear
endometrium of the uterus begins to degenerate (at appear
approximately day 24 or day 25 of the cycle) • When progesterone is the dominant hormone, as it is just after
• Capillaries rupture, with minute hemorrhages, and the ovulation, when the luteal phase of the menstrual cycle is
endometrium sloughs off beginning, a fern pattern is no longer discernible
• Cervical mucus can be examined at midcycle to detect
MENSES PHASE whether ferning, which suggests a high estrogen surge, is
• Menses is composed of: present
1. Blood from the ruptured capillaries • Women who do not ovulate continue to show the fern
2. Mucin from the glands pattern throughout the menstrual cycle (i.e., progesterone
3. Fragments of endometrial tissue levels never become dominant), or they never demonstrate
4. Microscopic, atrophied, and unfertilized ovum it because their estrogen levels never rise
• A menstrual flow contains only approximately 30-80mL of
blood SPINNBARKEIT TEST
o It seems like more, it is because of the • At the height of estrogen secretion, cervical mucus not only
accompanying mucus and endometrial shreds becomes thin and watery but also can be stretched into long
• Iron loss in a typical menstrual flow is approximately 11mg strands
o This is enough loss that many women need to take • This stretchability is in contrast to its thick, viscous state when
a daily iron supplement to prevent iron depletion progesterone is the dominant hormone
during their menstruating years o A woman can do this herself by stretching a mucus
sample between thumb and finger, or it can be
tested in an examining room by smearing a cervical

mucus specimen on a slide and stretching the • Women who notice excessive vaginal dryness can be
mucus between the slide and coverslip advised to use a lubricating jelly such as KY Jelly prior to
sexual relations
• Other possibilities are application of estrogen cream or
insertion of a vaginal ring that dispenses low-dose estrogen
• Low-dose estrogen or testosterone can also prescribe to
increase sexual libido
• Practicing Kegel’s exercises can help strengthen bladder
supports and reduce urinary incontinence
• Osteoporosis – occurs in as many as 13% - 18% of women over
age 50
o To help prevent osteoporosis:
▪ Women should be sure to ingest 1200 mg
EDUCATION FOR MENSTRUATION calcium daily
• Myths about Menstruation ▪ 400-800 IU of Vitamin D
1. Women should not get a hair permanent during menses ▪ Program of weight-bearing exercises such as
2. They should not plant vegetables because the walking or low-impact aerobics
vegetables will die ▪ Calcitonin – a thyroid hormone that regulates
3. They should not ear sour foods because this cause body calcium, may be prescribed as a nasal
cramping spray
• Early preparation for menstruation to dispel these myths is
important to a girl’s concept of herself as a woman, because Table No.2 Teaching About Menstrual Health
it teaches her trust her body or to think of menstruation AREAS OF TEACHING POINTS
• Education regarding menstruation is equally important for CONCERN
boys so they can appreciate the cyclic process that a Exercise Moderate exercise during menses promotes a
woman’s reproductive system activates and can be active general sense of well-being. Sustained
participants in helping plan or prevent the conception of excessive exercise, such as professional athletes
children maintain, can cause amenorrhea
Sexual Not contraindicated during menses although
MENSTRUAL DISORDERS Relations the male should wear a condom to prevent
1. Dysmenorrhea – painful menstruation exposure to body fluid. Heightened or
2. Menorrhagia – abnormally heavy menstrual flows decreased sexual arousal may be noticed
3. Metrorrhagia – bleeding bet. menstrual periods during this time. Orgasm may increase the
4. Menstrual migraines amount of menstrual flow. It is improbable but
5. Premenstrual Dysphoric Syndrome not impossible for conception to occur from
coitus during menses
MENOPAUSE Activities of Nothing is contraindicated (many people
• Menopause – change of life; the cessation of menstrual Daily Life believe incorrectly that activities such as
cycles washing the hair or bathing are harmful)
• Perimenopausal – a term used to denote the period during Pain Relief Prostaglandin inhibitors such as ibuprofen
which menopausal changes occur (Motrin) are most effective for menstrual pain.
• Postmenopausal – describes the time of life following the final Applying local heat may also be helpful. If a
menses migraine headache occurs, specific drugs for
• The age range menopause occurs, approximately 40-55 this are now available, such as sumatriptan
years of age, mean age of 51.3 (Imitrex). Adolescents under age 18 should not
• The age at which menopause symptoms begin appears to take aspirin because of the association bet. this
be genetically influenced or at least is not associated with and Reye’s syndrome
age of menarche Rest More rest may be helpful if dysmenorrhea
• Women who smoke tend to have earlier menopause (Baram interferes with sleep at night
& Basson, 2007) Nutrition Many women need iron supplementation to
• Menopause can cause physiologic stress as ovaries are a replace iron lost in menses. Eating pickles or
woman’s chief source of estrogen cold food does not cause dysmenorrhea
• When ovaries begin to atrophy:
a. Reducing estrogen production SUMMARY OF MENSTRUAL CYCLE
b. Hot flashes
c. Vaginal dryness
d. Osteoporosis – lack of bone density (BMD)
occurs
o Urinary incontinence from lack of bladder support
can also occur
• Hot flashes can be accompanied by heart palpitations and
can occur up to 20-30 episodes a day
o Episodes commonly last for 3-5 minutes at a time
o An immediate aid in reducing this sudden
overheated feeling is to sip at a cold drink or use a
hand fan
• At one time, hormone replacement therapy (HR) was
prescribed extensively to decrease menopause symptoms
o It was believed that this therapy reduced
cardiovascular complications such as
atherosclerosis or heart attacks as well

1. Hypothalamus (master gland) releases GnRH

2. Under the influence of GnRH, the anterior pituitary gland
will secrete two hormones – FSH and LH
a. FSH is active in the first half of the cycle
b. LH is active in the second half of the cycle and
high in the midcycle
3. FSH develop follicle
a. If fertilization occur in the ovulation, LH will
maintain the follicle (corpus luteum)
developed by the FSH
b. If fertilization does not occur in the ovulation,
the ovum will atrophy and corpus luteum turns
to corpus albicans
4. Ovary will release two hormones – estrogen and
progesterone
a. Estrogen is active on the first half of the cycle
b. Progesterone is active on the second half of
the cycle
5. On the first four days of the menstrual cycle,
menstruation will start
a. If fertilization occur, the progesterone will stay
active to maintain the uterine lining thick
b. If fertilization does not occur, the progesterone
will slough off as well as the uterine lining
6. With the dropping of progesterone, menstruation will
occur
REFERENCES
Notes from the discussion by Prof. Lualhati M. Floranda, DMN, RN

LECTURE\POWERPOINT
[TRANS] LESSON 4: SEXUALITY & SEXUAL IDENTITY
OUTLINE • How appealing parents or other adult role models portray

I Normal Sexuality their gender roles may also influence how a child envisions
II Sexuality himself or herself
A Biologic Gender o Gender role is also culturally influenced
B Gender Identity ▪ Filipino cultural influence
C Gender Role
i Development of Gender Identity
D Factors Affecting Sexuality FACTORS AFFECTING SEXUALITY
III Stages of Sexuality 1. Developmental Considerations
A Infancy o Sexuality is the only distinguishing trait present at
B Preschool Period conception
C School-age Child o Gender, or sex, influences behavior throughout life
D Adolescent
E Young Adult
2. Culture
F Middle-age Adult
G Older Adult o Every culture has its own norms dictating duration of
IV Human Sexual Response Cycle sexual intercourse, methods of sexual stimulation
A Phases of the Sexual Response Cycle and sexual positions
i Normal Sexual Behavior o Some cultures promote childhood sexual play,
B Physiologic Changes Associated with the Sexual Response polygamy/monogamy, and puberty rites including
Cycle male circumcision
i Phase 1: Excitement
o Religious beliefs promote beliefs on
ii Phase 2: Plateau
iii Phase 3: Orgasmic premarital/extramarital coitus, homosexuality, and
iv Phase 4: Resolution decisions on circumcision (male and female)
C Controversies about Female Orgasm
D Influence of the Menstrual Cycle on Sexual Response 3. Religion
E Influence of Pregnancy on Sexual Response o Some view organized religion as having a generally
V Types of Sexual Orientation negative effect on expression of sexuality
VI Types of Sexual Expression
o Sexual expression other than male-female coitus
VII Disorders of Sexual Functioning
are considered unnatural by some
o Concept of virginity came to be synonymous with
NORMAL SEXUALITY purity, and sex became synonymous with sin
• Perception of being male or female and all those thoughts, o Double standards and rigid regulations exist in many
feelings, behaviors, connected with sexual gratification and religions
reproduction, including the attraction of one person to
another 4. Ethics
o Involves feelings of desire, behavior that brings o Health sexuality depends on freedom from guilt and
pleasure to oneself and one’s partner anxiety
▪ Devoid of guilt or anxiety and not compulsive o What one views bizarre, perverted or wrong may be
natural and right to another
SEXUALITY o If sexual expression is performed by consenting
• A multidimensional phenomenon that includes feelings, adults, is not harmful to them and is practiced in
attitudes, and actions privacy, it is not considered a deviant behavior
• Has both biologic and cultural components o Many accept sexual expression of various forms
• Encompasses and gives direction to a person’s physical
emotional, social and intellectual responses throughout life 5. Lifestyle
o Many are under considerable strain to perform and
BIOLOGIC GENDER function in workplace as well as at home
• Term used to denote a person’s chromosomal sex ▪ Stressors may be external (job, financial
o Male (XY) demands) or internal (competitive)
o Female (XX) o Although some couples view sexual activity as a
release from stressors of everyday life, most place
GENDER IDENTITY sex far from the top of the list of things to do
• Aka Sexual Identity is the inner sense a person has being male
or female, which may be the same as or different from 6. Health State
biologic gender o Chronic Pain
o Diabetes
GENDER ROLE o Cardiovascular diseases
• The male or female behavior a person exhibits, which, again, o Diseases of Joint and Mobility
may or may not be the same as biologic gender or gender o Surgery and Body Image
identity o Spinal Cord Injuries
o Mental Illness
DEVELOPMENT OF GENDER IDENTITY o Sexually Transmitted Disease
• Several theories exist regarding whether gender identity
7. Medications
arises from primarily a biologic or a psychosocial focus
o Some meds have side effects that affect sexual
o The amount of testosterone secreted in utero (a
functioning
process termed sex typing) may affect how gender
o Some people use illegal drugs because of their
develops)
reputed ability to heighten sexual experience, but
can have serious and even deadly side effects

[TRANS] LESSON 4: SEXUAL & SEXUAL IDENTITY
STAGES OF SEXUALITY OLDER ADULT

• Both male and female older adults continue to enjoy active
INFANCY sexual relationships
• From the day of birth, female and male babies are treated • Some men experience less erectile firmness or ejaculatory
differently by their parents force than when they were younger, but others discover that
• People generally bring girls dainty rattles and dresses with they are able to maintain an erection longer
ruffles • Older women may have less vaginal secretions because they
o They are treated more gently by parents and held have less estrogen after menopause
and rocked more than male babies
• Admonitions given babies can be different HUMAN SEXUAL RESPONSE CYCLE
o Girl – “Don’t cry, you don’t look pretty when you cry”
o Boy – “You’ve got to learn to be tougher than that if PHASES OF THE SEXUAL RESPONSE CYCLE
you’re going to make it in this world” 1. Phase 1: Excitement
2. Phase 2: Plateau
PRESCHOOL PERIOD 3. Phase 3: Orgasmic
• Children can distinguish bet. males and females as early as 2 4. Phase 4: Resolution
years of age
• By age 3 or 4 years, they can say what sex they are, and they
have absorbed cultural expectations of that sex role
o Boys – play rough-and-tumble games with other
boys
o Girls – play more quietly, although the two
frequently mix at this age
• Sex role modeling is reinforced
• They start insisting on what they want, like: what to wear,
color of their room, etc.
• Social contacts bet. the child and significant adults
contribute to sexual identification NORMAL SEXUAL BEHAVIOR
• A positive self-concept grows from parental love, effective • Sexual response is a true psychophysiological experience
relationships with other, success in play activities, and gaining • There is:
skills and self control o Arousal
o Experience
SCHOOL-AGE CHILD o Orgasm
• Early school-age children typically spend play time imitating
adult roles as a way of learning gender roles PHYSIOLOGIC CHANGES ASSOCIATED WITH THE SEXUAL
• They form strong impressions of what a female or male should
RESPONSE CYCLE
be
• Grade schools have become more attuned to unisex
activities PHASE 1: EXCITEMENT
• The excitement phase (aka arousal phase / initial excitement
ADOLESCENT phase) is the first stage of the human sexual response cycle
• At puberty, as the adolescent begins the process of • Occurs as the result of any erotic physical or mental
establishing a sense of identity, the problem of final gender stimulation, such as kissing, petting, or viewing erotic images,
role identification surfaces again that lead to sexual arousal
• Problem of final gender role identification surfaces again • During the excitement stage, the body prepares for coitus, or
• Most early adolescents maintain strong ties to their gender sexual intercourse
group Table No.1 Excitement Phase
o Boys with boys SIGNS PRESENT IN SIGNS PRESENTS IN SIGNS PRESENT IN
o Girls with girls BOTH SEXES MALES ONLY FEMALES ONLY
• The advent of menstruation may provide a common bond • Increased • Penile erection • Enlargement of
for girls at this stage muscle tension • Tensing, the clitoral
• Moderate thickening, and glands
YOUNG ADULT increase in elevation of the • Vaginal
• When young adults move away from home to attend college heart rate, scrotum lubrication
or establish their own home, the change in their eating respiration, and • Partial elevation • Widening and
patterns can increase or decrease their weight that lead to blood pressure and increase in lengthening of
changes in their body image • Sex flush (less size of testicles the vaginal
prevalent in barrel
MIDDLE-AGE ADULT men than in • Separation and
• For many women and men in midlife, sexuality has achieved women; flattening of the
a degree of stability present in 75% labia majora
• A sense of masculinity of femininity and comfortable patterns of women) • Reddening of
of behavior have been established • Nipple erection the labia
• During midlife, men may begin to experience changes in (60% of men minora and
sperm production erectile power, achievement of orgasm, and most of vaginal wall
and sex drive, although these changes usually do not women) • Breast
significantly alter reproductive or sexual functioning enlargement
• Although menopause alters reproductive functioning, it does and enlarge
not physically inhibit sexual functioning areolae

Table No.3 Orgasmic Phase

SIGNS PRESENT IN SIGNS PRESENTS IN SIGNS PRESENT IN
BOTH SEXES MALES ONLY FEMALES ONLY
• Involuntary • Rhythmic, • Approx. 5-12
spasms of expulsive contractions in
muscle groups contractions of the orgasmic
throughout the the penis at 0.8 platform at 0.8
body seconds interval seconds
• Diminished • Emission of interval
sensory seminal fluid into • Contractions of
awareness the prostatic the muscle of
• Involuntary urethra the pelvic floor
contraction of • Closing of the and uterine
PHASE 2: PLATEAU the anal internal bladder muscles
• The period during which sexual tension increases to levels sphincter sphincter • Varies pattern
nearing orgasm, may last from 30 seconds to 30 minutes • Peak heart rate • Orgasm may of orgasm
(110-180 bpm), occur w/o including minor
Table No.2 Plateau Phase respiratory rate ejaculation surges and
SIGNS PRESENT IN SIGNS PRESENTS IN SIGNS PRESENT IN (40/min or • Ejaculation of contractions,
BOTH SEXES MALES ONLY FEMALES ONLY greater) semen through multiple
• Increased • Increased in • Retraction of the penile orgasm, or
voluntary and penile the clitoris urethra and simple intense
involuntary circumference, under the hood expulsion from orgasms similar
myotonia at the coronal • Appearance of the urethral to that of the
• Abdominal, ridge, and the orgasmic meatus male
intercostal, deepening in platform,
anal, and facial color increased in the
muscle • 50% increase in size of the outer
contraction testicular size, 1/3 of the
• Accelerated and elevation vagina and the
heart rate and close to the labia minora
respiratory rate perineum • Slight increase
and blood • Appearance of in width and
pressure a few drops of depth of the
• Sex flush mucoid inner 2/3 of the
(appearance in secretions from vagina
some men late the • Farther
in the phase; bulbourethral reddening of
spread over the glands at tip of the labia
entire body in penis; may minora
women) contain sperm • Appearance of
few drops of
mucoid
secretion from
the Bartholin’s
gland to
lubricate the
inner labia
• Farther increase
in breast size
and areolar
enlargement
PHASE 4: RESOLUTION
• Occurs after orgasm and allows the muscle to relax, blood
pressure to drop and the body to slow down from its excited
state
Table No.4 Plateau Phase

SIGNS PRESENT IN BOTH SEXES SIGNS PRESENTS IN MALES
ONLY
• Reversal of • Refractory period during
vasocongestion in 10- which the body will not
30mins; disappearance of respond to sexual
PHASE 3: ORGASMIC all signs of myotonia w/in 5 stimulation; varies,
• This phase is the climax of the sexual response cycle. mins depending on age and
• Shortest of the phases and generally lasts only a few seconds • Genital and breast return other factors, from a few
to their pre-excitement moments to hours or days
states

• Sex flush disappears in
reverse order of INFLUENCE OF PREGNANCY ON SEXUAL RESPONSE
appearance • Pregnancy is another time in life when there is
• Heart rate, respiratory rate, vasocongestion of the lower pelvis because of the blood
blood pressure returns to supply needed by a rapidly growing fetus
normal • This causes some women to experience a first orgasm during
• Other reactions include their first pregnancy
sleepiness, relaxation, and • Following a pregnancy, many women experience increased
emotional outbursts such sexual interest because the new growth of blood vessels
as crying or laughing during pregnancy lasts for some time and continues to
facilitate pelvic vasocongestion
TYPES OF SEXUAL ORIENTATION

1. Heterosexuality
o Heterosexual is a person who finds sexual fulfillment
with a gender member of the opposite gender
2. Homosexuality
o Homosexual is a person who finds sexual fulfillment
with a member of his or her own sex
▪ Gay – homosexual men
▪ Lesbian – homosexual women
o More recent terms:
▪ MWM – “men who have sex with men”
▪ WWW – “women who have sex with women”
3. Bisexuality
o People are said to be bisexual if they achieve
sexual satisfaction from both homosexual and
heterosexual relationships
4. Transsexuality
o Transsexual or transgender person is an individual
who, although of one biologic gender, feels as if he
or she is of the opposite gender
o Such people may have sex change operations so
that they appear cosmetically as the gender they
feel that they are
5. Pansexual
o Attracted to people of any gender identity
CONTROVERSIES ABOUT FEMALE ORGASM 6. Asexual
• Freud deducted that there were two types of female o Not sexually attracted to other people
orgasms:
o Clitoral TYPES OF SEXUAL EXPRESSION
o Vaginal
• He believed that clitoral orgasms (originating from Table No.5 Sexual Expression
masturbation or other noncoital acts) represented sexual SEXUAL DEFINITION
immaturity and that only vaginal orgasms were authentic, EXPRESSION
mature form of sexual behavior in women
Sexual • Aka celibacy, a separation from
o Accordingly, he considered women to be neurotic
Abstinence sexual activity
if they could not achieve orgasm through
• Vowed state of certain religious orders
intercourse
Masturbation • Self-stimulation for erotic pleasure; it
• Masters (1998) showed that there is no physiologic difference
can also be a mutually enjoyable
bet. an orgasm achieved through intercourse and one
activity for sexual partners
achieved by direct stimulation of the clitoris
• Offers sexual release which may be
• In recent years, a subject of controversy regarding female
interpreted by the person as overall
sexuality has arisen: the existence or not of “the G Spot”
tension or anxiety relief
o First described in 1950 by the German physician
Autoerotic • Extreme practice of causing oxygen
Grafenberg, the G Spot, has been promoted as an
Asphyxia deficiency (usually by hanging) during
area of heightened erotic sensitivity
masturbation with the goal of
producing a feeling of extreme sexual
INFLUENCE OF THE MESTRUAL CYCLE ON SEXUAL RESPONSE excitement
• During the 2nd half of the menstrual cycle – the luteal phase –
Erotic • Use of visual materials such as
there is increased fluid retention and vasocongestion in a
Stimulation magazines or photographs for sexual
woman’s lower pelvis
arousal
o Because some vasocongestion is already present
Fetishism • Sexual arousal resulting from the use of
at the beginning of the excitement stage of the
certain objects or situations
sexual response, women appear to reach the
• Leather, rubber, shoes, and feet are
plateau stage more quickly and achieve orgasm
frequently perceived to have erotic
more readily during this time
qualities
o Women also may be more interested in initiating
Transvestism • Transvestite is an individual who
sexual relations at this time
dresses in the clothes of the opposite
sex; can be heterosexual,
homosexual, or bisexual
• Many are married

Voyeurism • Obtaining sexual arousal by looking at REFERENCES

another person’s body
• Almost all children and adolescents Notes from the discussion by Prof. Lualhati M. Floranda, DNM, RN
pass through a stage when voyeurism
is appealing; this passes w/ more Manila Doctors Colleges of Nursing PowerPoint Presentation
active sexual expression
Sadomasochism • Involves inflicting pain (sadism) or
receiving pain (masochism) to
achieve sexual satisfaction
• A practice generally considered to be
w/in the limits of normal sexual
expression as long as the pain involved
is minimal and the experience is
satisfying to both sexual partners
Table No.6 Other Sexual Expression

SEXUAL DEFINITION
EXPRESSION
Exhibitionism • Revealing one’s genitals in public
Bestiality • Sexual relations w/ animals
Pedophiles • Individuals who are interested in sexual
encounters w/ children
DISORDERS OF SEXUAL FUNCTIONING
Table No.7 Disorders of Sexual Functioning

SEXUAL DEFINITION
DISORDERS
Inhibited Sexual • Lessened interest in sexual relations is
Desire normal in some circumstances, such
as after the death of a family member,
a divorce, or a stressful job change
Failure to • Failure of a woman to achieve orgasm
Achieve can be a result of poor sexual
Orgasm technique, concentrating too hard on
achievement, or negative attitudes
toward sexual relationships
Erectile • Formerly referred to as impotence;
Dysfunction (ED) inability of a man to produce or
maintain an erection long enough for
vaginal penetration or partner
satisfaction
Premature • Ejaculation before penile-vaginal
Ejaculation contact
• Term also often used to mean
ejaculation before the sexual
partner’s satisfaction has been
achieved
Persistent Sexual • Excessive and unrelenting sexual
Arousal arousal in the absence of desire
Syndrome • May be triggered by medication or
(PSAS) psychological factors
Pain Disorders • Because the reproductive system has
a sensitive nerve supply, when pain
occurs in response to sexual activities,
it can be acute and severe and impair
a person’s ability to enjoy this segment
of their life
Vaginismus • Involuntary contraction of the muscle
at the outlet of the vagina when coitus
is attempted that prohibits penile
penetration
• May occur in women who have been
raped
Dyspareunia & • Pain during coitus
Vestibulitis • This can occur because of
endometriosis (abnormal placement
of endometrial tissue), vestibulitis
(inflammation of the vestibule),
vaginal infection, or hormonal
changes

LECTURE\POWERPOINT
[TRANS] LESSON 5: FAMILY PLANNING (REPRODUCTIVE LIFE PLANNING)
OUTLINE IDEAL CONTRACEPTIVE

I Reproductive Life Planning • An ideal contraceptive should be:
A Important Things to Consider 1. Safe
B Ideal Contraceptive 2. 100% effective
II Natural Family Planning and Fertility Awareness 3. Compatible with religious and cultural beliefs and
A Abstinence
personal preferences of both the user and sexual
B Calendar Method
C Basal Body Temperature partner
D Cervical Mucus Method 4. Free of side effects
E Symptothermal Method 5. Convenient to use and easily obtainable
F Ovulation Detection 6. Affordable and needing few instructions for
G Lactation Amenorrhea Method effective use
III Coitus Interruptus 7. Free of effects after discontinuation and on future
IV Postcoital Douching
pregnancies
A Effect on Sexual Enjoyment
V Hormonal Contraception
A Oral Route NATURAL FAMILY PLANNING AND FERTILITY AWARENESS
i Oral Contraceptives & Combination Oral • Aka periodic abstinence methods or fertility awareness
Contraceptives • Involves no introduction of chemical or foreign material into
ii Mini Pills the body or sustaining from sexual intercourse during a fertile
iii Effects on Pregnancy
period
B Transdermal Route
C Vaginal Insertion • The effectiveness of these methods varies greatly from 25%
D Implantation to 85%, depending mainly on the couple’s ability to refrain
E Injection from having sexual relations on fertile days
VI Intrauterine Devices • Fertility awareness involves detecting when a woman s fertile
A Mirena IUD Insertion so she can use periods of abstinence during that time
i Effect on Pregnancy
VII Barrier Methods
A Male Condom ABSTINENCE
B Female Condom • Or refraining from sexual relations
C Spermicide o Has a theoretical 0% failure rate and is also the most
D Diaphragm effective way to prevent STIs
E Cervical Cap
F Vaginal Sponge
VIII Terminal Methods
CALENDAR METHOD
A Male Sterilization • Also known as the rhythm method
B Female Sterilization o Based on the assumption that ovulation occurs 14
days (plus or minus 2 days) prior to the next menses
REPRODUCTIVE LIFE PLANNNING • Least reliable of the fertility awareness methods
• Avoid sexual intercourse during fertile period
• Reproductive Life Planning – includes all the decisions an
• With a calendar method:
individual or couple make about:
o Keep a record of the length of each menstrual
o whether and when to have children
cycle in order to determine when you are fertile
o how many children to have
o Use an ordinary calendar
o how they are spaced
o Circle day one of each cycle, which is the first day
of your period
IMPORTANT THINGS TO CONSIDER
o Count the total number of days in each cycle
• Important things to consider when doing reproductive
include the first day when you count
planning:
o Do this for at least 8-12 cycles
1. Personal values
▪ Don’t use the calendar method if all your
2. Ability to use a method correctly
cycles are shorter than 27 days
3. How the method will affect sexual enjoyment
o Chart your calendar pattern
4. Financial factors
• Example:
5. Status of a couple’s relationship
Table No.1 Sample Tracking of Menstrual Cycle
6. Prior experiences
FIRST DAY OF PERIOD NO. OF DAYS IN CYCLE
7. Future plans
Jan. 20 29
Feb. 18 29
Mar. 18 28
Apr. 16 29
May 12 26
Jun. 9 28
Jul. 9 30
Aug. 5 27
1. To predict the first fertile day in your current cycle

o Find the shortest cycle in your record
o Subtract 18 from the total no. of days
o Count that number of days from day one of your
current cycle, and mark that with an X
o Include day one when you count
o The day marked X is your first fertile day

▪ Predicting your first fertile day (based on Table CERVICAL MUCUS METHOD
no.1) • aka Billings method
▪ Shortest cycle is 26 days – 18 =8 • Based on the changes that occurs on the cervical mucus
▪ If day one was the 4th day of the month, the during the menstrual cycle
day you will mark X will be the 11th o Avoid intercourse when mucus is becoming more
▪ That’s the first day you’re likely to be fertile. So clear, elastic and slippery
on that day, you should start abstaining from ▪ First Half of the Cycle – estrogen level is high –
sex or start using a cervical cap. thin mucus – excellent survival for sperm
▪ Second Half of the Cycle – progesterone level
2. To predict the last fertile day in your current cycle is high – thick mucus – poor survival for sperm
o Find the longest cycle in your record • Monitoring cervical-mucus changes to predict when
o Subtract 11 days from the total no. of the days ovulation occurs
o Count that number of days from day one of your • As ovulation approaches, the cervical mucus thins and
current cycle, mark that day with an X becomes increasingly elastic and transparent
o Include day one when you count • Cervical Mucus – normally cloudy and tacky, it becomes
o The day marked X is the last fertile day clear and slippery (similar to egg whites) before ovulation
▪ Predicting you last fertile day (based on Table o It will also be stretchy bet. your fingers
no.1) (Spinnbarkeit).
▪ Longest day is 30 days – 11 = 19 o To use these changes for birth control, you must be
▪ If day one was the 4th day of the month, the religious in observing YOUR pattern changes
day you will mark X will be the 22nd
▪ That’s the last day you’re likely to be fertile
during your current cycle
▪ So you may start to have unprotected vaginal
intercourse after that day
Table No.2 Safe Times Using the Calendar Method

Sun Mon Tue Wed Thurs Fri Sat
[1 2 3 4 5 6 7
Safe Day Safe Day Safe Day Safe Day Safe Day Safe Day Safe Day
8 9 10] 11 12 13 14
Safe Day Safe Day Safe Day
15 16 17 18 19 20 21
SYMPTOTHERMAL METHOD
22 [23 24 25 26 27 28 • Combines the cervical mucus and BBT methods
Safe Day Safe Day Safe Day Safe Day Safe Day Safe Day
• Woman takes her temp. daily watching for the rise in temp.
29 30 1 2 3 4 5 that marks ovulation
Safe Day Safe Day Safe Day Safe Day Safe Day Safe Day Safe Day o Also analyzes her cervical mucus every day
Start of Period: Safe Days: [ ] Unsafe Days: observes for other signs of ovulation such as
mittelschmertz (midcycle abdominal pain)
• In this example, the 11th through 22nd are unsafe days • Couple must abstain from intercourse until 3 days after the
o All the others are safe days rise in temperature or the 4th day after the peak of mucus
• This method is ineffective if: change, because these are the woman’s fertile days
o Woman has an irregular menstrual cycle • Symptothermal method is more effective than either the BBT
o All cycles are shorter than 27 or the cervical mucus method alone (ideal failure rate, about
o Woman has no self-control 2%)
o Woman is lazy to take a monthly record of
menstrual cycle OVULATION DETECTION
• Use of an over-the-counter ovulation detection kit
BASAL BODY TEMPERATURE METHOD • These kits detect the midcycle surge of luteinizing hormone
• Just before the day of ovulation, a woman’s basal body (LH) that can be detected in urine 12-24hrs before ovulation
temperature (BBT), or temperature of her body at rest, falls • Such kits are 98% - 100% accurate in predicting ovulation
about 0.5 F • Although they are fairly expensive, use of such kit in place of
o At the time of ovulation, her BBT rises a full degree cervical mucus testing make this form of natural family
because of the influence of progesterone planning more attractive to many women
o This higher level is then maintained for the rest of • Combining it with assessment of cervical mucus is becoming
menstrual cycle the method of choice for many families using natural family
o This pattern is the basis of the BBT method of planning
contraception
• Body temp. measured immediately after awakening and
before any physical activity has been undertaken
o In women, ovulation causes an increase of 0.5-1 F
(0.25-0.5 C) in basal body temperature
o Monitoring of BBT is one way of estimating the day
of ovulation

LACTATION AMENORRHEA METHOD 1. Dysmenorrhea – because of lack of ovulation

• As long as a woman is breastfeeding an infant, there is some 2. Premenstrual Dysphoric Syndrome and Acne – because
natural suppression of ovulation of the increased progesterone levels
• Because women may ovulate, however, but not menstruate, 3. Iron deficiency Anemia – because of the reduced
a woman may still be fertile even if she has not had period amount of menstrual flow
since childbirth 4. Acute pelvic inflammatory disease (PID) and resulting
• If the infant is receiving a supplemental feeding or not tubal scarring
sucking well, the use of lactation as an effective birth control 5. Endometrial and ovarian cancer, ovarian cysts, and
method is questionable ectopic pregnancies
• As a rule, after 3 months of breastfeeding, the woman should 6. Fibrocystic breast disease
be advised to choose another method of contraception 7. Possibly osteoporosis, endometriosis, uterine myomata
(fibroid uterine tumors), and progression of rheumatoid
COITUS INTERRUPTUS arthritis
• aka withdrawal method 8. Colon cancer
• one of the oldest known methods of contraception • Because estrogen interferes with lipid metabolism, it may
• couple proceeds with coitus until the moment of ejaculation lower the concentration of low-density lipoproteins (LDL) and
o the man withdraws and spermatozoa are emitted increase the high-density lipoprotein (HDL) level
outside the vagina o COCs are packaged with 21 or 28 pills in a
• Ejaculation may occur before withdrawal is complete and, convenient dispenser
despite the care used, some spermatozoa may be deposited ▪ Generally recommended that the 1st pill be
in the vagina taken on a Sunday (1st Sunday after the
• Because there may be a few spermatozoa present in pre- beginning of a menstrual flow), although a
ejaculation fluid, fertilization may occur even if withdrawal woman may choose to begin on any day
seems controlled • Oral contraceptives side effects:
o For this reason, coitus interruptus is only about 75% 1. Nausea
effective 2. Weight gain
3. Headache
POSTCOITAL DOUCHING 4. Breast tenderness
• Douching following intercourse, no matter what solution is 5. Breakthrough bleeding
used, is ineffective as a contraceptive measure as sperm may 6. Monilial vaginal infections
be present in cervical mucus as quickly as 90 seconds after 7. Mild hypertension
ejaculation 8. Depression (due to hormonal change)
Table No.3 Absolute Contraindications to OCs

EFFECT ON SEXUAL ENJOYMENT
ABSOLUTE CONTRAINDICATION TO OCs
• More spontaneity in sexual relations is possible than with
methods that involve vaginal insertion products Breastfeeding High blood pressure
• The required days of abstinence may make a natural Family history of CVA or
Mental depression
planning method unsatisfactory and unenjoyable for a CAD
couple History of thromboembolic Migraine or other vascular
• Coitus interruptus may be unenjoyable because of the need disease type headaches
to withdraw before ejaculation History of liver disease Obesity
Undiagnosed vaginal
Pregnancy
HORMOMAL CONTRACEPTION bleeding
• Hormonal contraceptive are, as the name implies, hormones Age 40+ Seizure disorder
that cause such fluctuations in a normal menstrual cycle that Sickle cell or other
Breast or reproductive tract
ovulation does not occur hemoglobinopathies
• Hormonal contraceptives may be administered orally, Diabetes mellitus Smoking
transdermally, vaginally, by implantation or through injection Elevated cholesterol or Use of drug w/ interaction
triglycerides effect
ORAL ROUTE
MINI PILLS
ORAL CONTRACEPTIVE & COMBINATION ORAL • Oral contraceptives containing only progestins are popularly
CONTRACEPTVE called mini-pills
• Oral contraceptives – composed of varying amounts of • Progesterone content thicken cervical mucus and helps
synthetic estrogen with a small amount of synthetic (artificial) prevent sperm entry into the uterine cervix
progesterone (progestin) • Ovulation may occur but, bec. the endometrium does not
o OCs (Oral Contraceptives) develop fully, implantation will not take place
o COCs (Combination Oral Contraceptives) o Has advantages for the woman who cannot take
▪ Estrogen acts to suppress FSH and LH, thereby an estrogen- based pill because of the danger of
suppressing ovulation thrombophlebitis but who wants high-level
▪ Progesterone action complements that of contraception assurance (they are as effective as
estrogen by causing a decrease in the estrogen/progestin pills)
permeability of cervical mucus, thereby • They have the disadvantage of causing more breakthrough
limiting sperm motility and access to ova bleeding than combination pills
▪ Progesterone also interferes with tubal transport o They are taken every day, even through the
and endometrial proliferation to such degrees menstrual flow
that the possibility of implantation is ▪ Because it does not interfere with milk
significantly decreased production, they may be taken during
• Oral contraceptive have non-contraceptive benefits such as breastfeeding
decreased incidences of:

EFFECT ON PREGNANCY
• If a woman taking an estrogen/progestin (COCs) suspect
that she is pregnant, she should discontinue taking any more
pills she intends to continue the pregnancy
• High levels of estrogen or progesterone might be teratogenic
to a growing fetus, although the actual risk thought to be no
higher than normally occurs
• Use by adolescent
o Usually recommended that adolescent girls have
well-established menstrual cycles for at least 2yrs
before beginning COCs
o This reduces the chance that the estrogen content
will cause permanent suppression of pituitary- • To be folded on itself and inserted into vagina
regulating activity • Impregnated sex steroid is absorbed into systemic circulation
to prevent ovulation
TRANSDERMAL ROUTE
• Transdermal contraception – refers to patches that slowly but
continuously release a combination of estrogen and IMPLANTATION
progesterone • 5 subdermal implants, rods the size of pencil lead are
• Patches are applied each week for 3 weeks embedded just under the skin on the inside of the upper arm
• No patch is applied the 4th week • Implants are inserted w/ use of a local anesthetic, during the
o During the week on which the woman is patch free, menses or no later than day 7 of the menstrual cycle, to be
a menstrual flow will occur certain that the woman not pregnant at the time of insertion
o After the patch-free week, a new cycle of 3 weeks • Can be inserted immediately after an elective termination of
on/1 week off begins again pregnancy or 6 weeks after the birth of a baby
o Efficiency is equal to COCs • Failure rate is less than 1%
▪ May be less effective in women who weigh • At the end of 3-5 years, the implants are removed under
more than 90kg (198lbs) local anesthesia ( a quick minutes-only procedure)
• They have the same risk for thromboembolic symptoms as
COCs
• Patches may be applied to one of the ff. four areas:
1. Upper outer arm
2. Upper torso (front or back, excluding the breasts)
3. Abdomen
4. Buttocks
o Area of implants can be felt but not easily seen

• Disadvantage of the implant method is its costly and side
effects such as:
1. Weight gain
2. Irregular menstrual cycle such as spotting,
breakthrough bleeding, amenorrhea or prolonged
periods
3. Depression
• Should not be placed on:
4. Scarring at the insertion site
1. Any area where makeup, lotions or creams will be
5. Need for removal
applied
2. The waist where bending might loosen the patch
3. Or anywhere the skin is red or irritated or has an INJECTION
open lesion • Single intramuscular injection of medroxyprogesterone
acetate (Depo-Povera) a progesterone, give every 12 weeks
inhibits ovulation
VAGINAL INSERTION
• Alters the endometrium and changes the cervical mucus
• Vaginal Ring (NuvaRing) – a silicone ring that surrounds the
• Effectiveness rate of this method is almost 100%, making it an
cervix and continually releases a combination of estrogen
increasingly popular contraceptive method
and progesterone
• Inserted vaginally by the woman and left for 3 weeks then
removed for 1 week
o Menstrual bleeding occurs during the ring-free
week
• Hormones released are absorbed directly by the mucus
membrane of the vagina, thereby avoiding a “first pass” or
“hepatic pass” through liver, as happens w/ COCs
o This is an advantage for women w/ liver disease

INTRAUTERINE DEVICES EFFECT ON PREGNANCY

• Intrauterine device (IUD) – a small plastic object that is • If a woman with an IUD in place suspects that she is pregnant,
inserted into the uterus through the vagina she should alert her primary health care provider
• Triggers a spermicidal type reaction in the body, thereby • Although the IUD may be left in place during the pregnancy,
preventing fertilization it is usually removed vaginally to prevent the possibility of
• Also produces local inflammatory effect on the endometrium infection or spontaneous miscarriage during the pregnancy
• Best suited for multiparous women in single relationship • Woman should receive an early ultrasound to document
placement of the IUD
Table No.4 IUD Advantages and Disadvantages • This can also rule out ectopic pregnancy, which has an
ADVANTAGES DISADAVANTAGES increased incidence among IUD users who become
Effective for up to 5 years May cause cramping and pregnant with the IUD
w/o removal bleeding for 2st 3 to 6 months
Simplicity Woman must check for BARRIER METHODS
proper placement after • Forms of birth control that work by the placement of a
each menses chemical or other barrier bet. the cervix and advancing
Time taken Does not protect from STDs sperm so that sperm cannot enter the uterus or fallopian
Stays long Predispose to PID tubes and fertilize the ovum
Inexpensive • A major advantage of barrier methods is that they lack the
Reversible hormonal side effects associated w/ COCs
Motivation
MALE CONDOM
Table No.5 IUD Contraindications
ABSOLUTE RELATIVE Table No.7 Male Condoms’ Advantages and Disadvantages
Pregnancy Anemia ADVANTAGES DISADVANTAGES
PID Uterine distortions Availability Slip off or tear
Vaginal bleeding Menorrhagia Safe Interferes sensation
Carcinoma Unmotivated Inexpensive
Ectopic pregnancy h/o PID No supervision
No side effects
Compact & Disposable
Against STDs
• How to use male condoms:

1. Check expiration date
2. Avoid using oil-based lubricants; water-based
lubricants may be used
3. Erect penis must be withdrawn from the vagina
while holding the rim of the condom to prevent
leakage
4. Leave enough room at the tip to collect the sperm
5. Discard properly after use; single use only
6. Offers protection against pregnancy and STDs
7. Penis must be erected before placing the condom
MIRENA IUD INSERTION

• Mirena Intrauterine System, which releases levonorgestrel
gradually, may be left in place for up to 5 years
Table No.6 Side Effects & Complications

Unrolled condom w/
SIDE EFFECTS & COMPLICATIONS Correct use of a condom
reservoir tip
Bleeding Ectopic pregnancy
Pain Expulsion 12-20%
FEMALE CONDOM
PID Fertility after removal (70%)
• Made of polyurethane, has 2 rings and silicon
Uterine perforation Cancer & teratogenesis • High cost & acceptability are the major problems
Pregnancy Mortality 1/100000 • May be inserted up to 8hrs before intercourse
Spotting or uterine • Breastfeeding women can use condoms
Increased risk for PID
cramping • Insertion may be awkward
Heavier menstrual flow Dysmenorrhea

DIAPHRAGM
• Proper size should be used
• Held in position at least for 6hrs
• Used with spermicidal jelly
• Should be left in place for at least 6-8hrs after intercourse
Inserting Female Condoms
SPERMICIDES
• Chemical barrier preventing pregnancy by killing sperm or
neutralizing vaginal secretions
• Available in a variety of forms like:
1. Creams • Apply jelly to the rim and center of the diaphragm
2. Gels
3. Melting suppositories CERVICAL CAP
4. Foaming tablets • Similar to diaphragm, except it fits snugly over the cervix
5. Aerosol foams • Maybe left in place for 48hrs
6. Vaginal contraceptive film • Tends to be difficult for women to insert and remove
• Most common spermicidal agents:
o Nonoxynol-9
o Octoxynol-9
• Allergic response is possible
• Must be applied with each act of sexual intercourse;
interferes with spontaneity
• Safe for breastfeeding mothers
• May be irritating; messy
Table No.8 Spermicides Advantages and Disadvantages

ADVANTAGES DISADVANTAGES
Inexpensive Must be applied prior to
intercourse
Easy to obtain Considered messy by many
people
VAGINAL SPONGE
Minimally effective when
• Moistened with water prior to use to activate spermicide
used alone
• Saturated with nonoxynol-9 worn for 24hrs
• Must be left in place for 6hrs after intercourse
• Has a loop for easy removal
Applying spermicide agent

TERMINAL METHODS
• Male sterilization
• Female sterilization
MALE STERILIZATION
• Vasectomy
• Severs the vas deferens
• Simple procedure
• Does not interfere with erectile function
Table No.9 Sterilization Advantages and Disadvantages

ADVANTAGES DISADVANTAGES
Permanent form of birth
Nonreversible
control
No cost once procedure is Requires general anesthesia
completed for the woman
Vasectomy does not
produce immediately sterility
Semen sample must be clear
before stopping other REFERENCES
method
Does not protect against Notes from the discussion by Prof. Lualhati M. Floranda, DNM, RN
STDs
FEMALE STERILIZATION
• Tubal ligation
• Severs the fallopian tube
• Involves general anesthesia

LECTURE\POWERPOINT
[TRANS] LESSON 6: ROLE OF GENETICS
OUTLINE
I Genetic Disorders
A Gene Therapy
II Gregor Johann Mendel
III Introduction to Genetics
IV Mendelian Inheritance: Dominated Recessive Patterns
A Autosomal Dominant Disorders
i Punnett Square
B Autosomal Recessive Inheritance
C X-Linked Dominant Inheritance o New combinations of genes occur in sexual
D Y-Linked Inheritance reproduction due to fertilization from 2 parents
i Multifactorial (Polygenic) Inheritance • Cytogenetics – study of chromosomes by light microscopy
V Process of Determining the Sex of the Baby and the method by which chromosomal aberrations are
A Genetic Transmission identified
VI Genetic Counseling Table No.1 Genetics Term
TERM DESCRIPTION
GENETIC DISORDERS Gene Unit of heredity; a section of DNA sequence
• Inherited or genetic disorders – disorders that can be passed encoding a single protein
from one generation to the next Genome Entire set of genes in an organism
o Results from some disorder in gene or chromosome Alleles Two genes that occupy the same position on
structure and occur in 5% to 6% of newborns homologous chromosomes and that cover
• Genetic disorders may occur at the moment an ovum and the same trait
sperm fuse or even earlier, in the meiotic division phase of the Homozygous Having identical genes (one from each
gametes (ovum and sperm) parent) for a particular characteristic
• Some genetic abnormalities are so severe that normal fetal Heterozygous Having 2 different genes for a particular
growth cannot continue past that point characteristic
• Some do not affect life in utero, so the result of the disorder Dominant Allele of a gene that masks or suppresses the
becomes apparent only at the time of fetal testing or after expression of an alternate allele; trait appear
birth in the heterozygous condition
Recessive Allele that is masked by a dominant allele;
GENE THERAPY doe not appear in the heterozygous
• In the near future, it may be possible not only to identify condition, only in homozygous
aberrant genes for disorders this way but also to insert healthy Difference Between Dominant and Recessive Genes
genes in their place using stem cell implantation Dominant is always expressed when present. Recessive is only
• Gene replacement therapy – encouraging in the treatment expressed when no dominant genes are present.
of blood, spinal cord, and immunodeficiency syndromes Genotype Genetic makeup of an organisms; refers to his
• Women can arrange to have a newborn’s cord blood frozen or her actual gene composition
and banked to be available for bone marrow or other cell Phenotype Physical appearance of an organism
transplantation procedures in the future (genotype + environment); refers to his or her
o As stem cells from replacement therapy can be outward appearance or the expression of
obtained from menstrual blood, this also may be a genes
future contribution source
Genome Complete set of genes present (about 50,000
– 100,000)
GREGOR JOHANN MENDEL Normal genome is abbreviated as 46XX
• Known as the father of modern genetics (female) or 46XY (male) – designation of the
• Austrian Monk, born in Czech Republic in 1822 total no. of chromosomes plus a graphic
o Son of peasant farmer, studied Theology and was description of the sex chromosomes present
ordained priest Order St. Augustine Karyotype “general” form; number and appearance oof
o Went to the university of Vienna, where he studied chromosomes in the nucleus of a eukaryotic
botany and learned the Scientific Method cell
• Worked w/ pure lines of peas for 8yrs Complete set of chromosomes in a species or
o Prior to Mendel, heredity was regarded as a an individual organism
“blending” process and the offspring were a
“dilution” of the different parental characteristics
INTRODUCTION TO GENETICS
• Genetics – branch of biology that deals with heredity and
variation of organisms
• Chromosomes – carry the hereditary information (genes)
o Each individual consists of 46 of chromosome
▪ 23 (father) + 23 (mother)
o Chromosomes and genes occur in pairs
(homologous / non-homologous chromosome)
▪ Homologous Chromosome – same genes
▪ Non-homologous chromosome – different
genes

[TRANS] LESSON 6: ROLES OF GENETICS
MENDELIAN INHERITANCE: DOMINATED RECESSIVE A

PATTERNS Father
h = “healthy” gene
h D
• Principles of genetic inheritance of disease are the same as D = disease gene, dominant in this
those that govern genetic inheritance of other physical h hh hD example
Mother
characteristics, such as eye or hair color h hh hD hD = disease
o Homozygous – person who has 2 like genes for a
trait – two healthy genes, (one from the mother and B
one from the father) on two like chromosomes Father h = “healthy” gene
o Heterozygous – genes differ (a healthy gene from h D D = disease gene, dominant in this
the mother and an unhealthy gene from the father, h hh hD example
or vice versa) Mother hD or Dh = disease
D Dh DD DD = incompatible w/ life
• Assuming Mendelian Genetics, which is a simplified
explanatory tool: Figure 1. Autosomal dominant inheritance
o Recessive trait will only be expressed if the offspring
has two copies of the recessive allele that codes for
the trait (Recessive Homozygous, aa) • If a person who is heterozygous for an autosomal dominant
o Dominant trait will always be expressed in the trait (usual pattern) mates w/ a person who is free of the trait,
offspring if the dominant allele is present, even if the chances are even (50%) that a child born to the couple
there is only one copy of it (heterozygous or would have the disorder or would be disease and carrier fee
dominant homozygous, Aa or AA) (i.e., carrying no affected gene for the disorder)
▪ Many genes are dominant in their action over
others
▪ When paired w/ recessive genes, dominant
genes are always expressed in preference to
the recessive genes
• Homozygous dominant – individual w/ two homozygous
genes for a dominant trait (e.g., AA)
• Homozygous recessive – individual w/ two genes for a
recessive trait (e.g., aa)
Table No.2 Dominant and Recessive Traits

TRAIT DOMINANT RECESSIVE
Figure 2. Family genogram: Autosomal Dominant Inheritance
Hair color Dark hair Blonde or red hair
Hair Curly hair Straight hair
Hair Baldness
Hairline Widow’s peak Straight hairline
(V-shaped hairline)
Facial features Freckles, cleft chin
and dimples
Eye shape Almond-shaped eyes Round eyes
Earlobes Detached earlobes Attached earlobes
Handedness Right-handedness Left-handedness
Tongue ability Ability to roll Inability to roll
Eye sight Astigmatism Normal vision
Finger trait Webbed fingers
No. of fingers 6 fingers 5 fingers
Figure 3. This Punnett square shows potential gene combinations
Brown eyes Blue eyes
(genotypes) and resulting phenotypes of children from
However, eye color is controlled by more
parent genotypes w/ an autosomal dominant altered
than one gene and is thus a polygenetic
gene. Phenotypes are expressed (affected) when a
Eye color trait and cannot be explained by
male or female has one copy of the gene alteration
Mendelian genetic. People with green and
hazel eyes have a mix of alleles for brown
and blue eyes.
AUTOSOMAL RECESSIVE INHERITANCE
• In contrast to structural disorders, these tend to be
biochemical or enzymatic
AUTOSOMAL DOMINANT DISORDERS • Such diseases do not occur unless 2 genes for the disease are
• Although more than 3000 autosomal dominant disorders are
present (i.e., a homozygous recessive pattern)
known, only a few are commonly seen because the majority
of these are not compatible with life after birth
PUNNETT SQUARE
• Useful tool to do genetic crosses
• For a monohybrid cross, you need a square divided by 4
• Punnett square is used to predict the genotypes and
phenotypes of the offspring
25% 25%
25% 25%
Figure 4. Family genogram: Autosomal Recessive Inheritance

A A
Father h = “healthy” gene Father
H d d = disease gene, recessive in this x y
Ẋx = disease state
H HH Hd example Ẋ Ẋx Ẋy
Mother dd = disease Mother
Ẋy = disease state
d dH dd Hd or dH = carrier x xx xy
Figure 7. Sex-linked inheritance: Sex-linked Dominant
B
Father h = “healthy” gene B
H H d = disease gene, recessive in this Father
H HH HH example x y
Mother dd = disease
ẋx = carrier
X Xx Xy ẋy = disease state
d dH dH Hd or dH = carrier Mother
ẋ ẋx ẋy
C C
Father h = “healthy” gene Father
H H d = disease gene, recessive in this ẋ y xy = normal state
d dH dH example ẋx = carrier state
Mother dd = disease X Xẋ xy
d dH dH Mother ẋy = disease state
Hd or dH = carrier x Xẋ xy
Figure 8. Sex-linked inheritance: Sex-linked Recessive
D
Father h = “healthy” gene
d H d = disease gene, recessive in this
d dd dH example
Mother dd = disease
d dd dH Hd or dH = carrier
E
Father h = “healthy” gene
d d d = disease gene, recessive in this
d dd dd example
Mother dd = disease
d dd dd Hd or dH = carrier
Figure 5. Autosomal recessive inheritance Figure 9. Family Genogram: X-Linked Recessive Inheritance
Y-LINKED INHERITANCE
• Although genes responsible for features such as height and
tooth size are found on the Y chromosome, tall stature and
perhaps aggressive personality are the only consistent
phenotypic features associated w/ having an extra Y
chromosome (Karyotype 47XYY)
MULTIFACTORIAL (POLYGENIC) INHERITANCE

• Many childhood disorders such as heart disease, diabetes,
pyloric stenosis, cleft lip and palate, neural tube disorders,
hypertension, and menta illness tend to have a higher-than-
usual incidence in some families
• They appear to occur from multiple gene combinations
possibly combined w/ environmental factors
PROCESS OF DETERMINING THE SEX OF THE BABY

• Females (XX chromosomes) & Males (XY chromosomes)
• Therefore, all babies will automatically receive X
chromosomes from their mothers and either X or Y
Figure 6. This Punnett square shows potential gene combination chromosomes from their fathers
(genotypes) and resulting phenotypes of children from • Sex of the babies is determined after the process of receiving
parent genotypes w/ an autosomal recessive altered both chromosomes from the parents
gene. Phenotypes are expressed (affected) when a
male or female has two copies of the gene alteration GENETIC TRANSMISSION
• Default sex chromosome in a woman is known as the X
X-LINKED DOMINANT INHERITANCE chromosome
• Some genes for disorders are located on and therefore • On the other hand, the male sperm carries either an X
transmitted only by, the female sex chromosome (the X chromosome or Y chromosome
chromosome) • When the sperm and ovum combine, a baby’s sex depends
• Transmission is termed X-linked inheritance on the chromosomes received from the sperm
• If the affected gene is dominant, only X chromosome w/ trait o For example, the resident chromosome in a female
need be present for symptoms of the disorder to be is X; if a combining sperm also carries the X
manifested chromosome – the result would be a female child
(XX)
o Otherwise, if a Y chromosome is carried to the
ovum, most likely a male (XY) will be produced

Figure 10. The Process of Determining the Sex of the Baby

• However, to produce a male child a number of activities
must happen in 6-8 weeks after the transmission of the genes
o New XY embryo must produce ongoing high level
of testosterone, the male hormone
o If this does not happen, the XY embryo will retain
female characteristics to produce a female child
GENETIC COUNSELING
• Can result in making individua feel “well” or free of guilt for
the first time in their lives if they discover that the disorder, they
were worried about was not an inherited one but was rather
a chance occurrence
• Counseling results in informing individuals that they are
carriers of a trait that is responsible for a child’s condition
• Even when people understand that they have no control
over this, knowledge about passing a genetic disorder to a
child can cause guilt and self-blame
• Marriages and relationships can end unless both partners
receive adequate support
REFERENCES

LECTURE\POWERPOINT
[TRANS] LESSON 7: FERTLIZATION AND FETAL DEVELOPMENT
OUTLINE • Once the mature ovum is released fertilization must occur

I Terms Used to Denote Fetal Growth fairly quickly because an ovum is capable of fertilization for
II Fertilization only 24hrs (48hrs at the most)
A Sperm Capacitation o After that time, it atrophies and become
B Acrosomal Reaction nonfunctional
III Mitosis / Cleavage o Functional life of spermatozoon is about 48-72hrs,
IV Implantation
the total critical time span during which sexual
A Chorionic Villi
V Placenta relations must occur for fertilization to be successful
A Placental Function is about 72hrs (48hrs before ovulation + 24hrs
VI Umbilical Cord / Funis afterward)
VII Amniotic Fluid • As the ovum is extruded from the graafian follicle of an ovary
A Functions of Amniotic Fluid w/ ovulation, it is surrounded by:
VIII Stages of Uterine Development 1. A ring of mucopolysaccharide fluid (zona pellucida)
IX Embryonic Germ Layers
2. Circle of cells (corona radiata)
X Fetal Circulation
A Blood Circulation After Birth
XI Origin & Development of Organ Systems
XII Milestones of Fetal Growth and Development
XIII Assessment of Fetal Growth and Development
A Naegele’s Rule
B McDonald’s Rule
C Haase’s Rule
D Johnson’s Rule
E Bartholomew’s Rule • Ovum and these surrounding (which increase the bulk of the
XIV Assessing Fetal Well-Being ovum and serve as protective buffers against injury) are
A Fetal Movement propelled into a nearby fallopian tube by currents initiated by
i Cardiff Count to Ten the fimbriae
ii Sandovsky Methods o Fimbriae – fine, hairlike structure that line the
B Fetal Heart Rate
openings of the fallopian tube
C Rhythm Strip Testing
D Fetal ACTIVITY
E Ultrasound
i Transabdominal Ultrasound
ii Transvaginal Ultrasound
F Doppler Blood Flow Studies (Umbilical Velocimetry)
G Nonstress Stress
i Clinical Management
H Contraction Stress Test / Oxytocin Challenge Test
I Biophysical Profile
J Amniocentesis • Combination of peristaltic action of the tube and movements
i Nursing Care of the tube cilia help propel the ovum along the length of the
ii How to Prepare the Client for Amniocentesis
tube
iii Post Procedure
iv Discharge Instruction • Normally, an ejaculation of semen averages 2.5mL of fluid
v Danger Signs containing 50 to 200 million spermatozoa per mL, or an
K Amniotic Fluid Analysis average of 400 million sperm per ejaculation
i Information Obtained • At the time of ovulation, there is a reduction in the viscosity
L Maternal Serum Alpha Fetoprotein (thickness) of cervical mucus, which makes it easy for
M Chorionic Villus Sampling spermatozoa to penetrate it
N Percutaneous Umbilical Blood Sampling
• Sperm transport is so efficient close to ovulation that
spermatozoa deposited in the vagina generally reach the
TERMS USED TO DENOTE FETAL GROWTH cervix w/in 90 seconds and the outer end of a fallopian tube
w/in 5 minutes after deposition
Table No.1 Terms Used to Denote Fetal Growth o This is one reason why douching is not an effective
Name Time Period contraceptive measure
Ovum From ovulation to fertilization • The mechanism whereby spermatozoa are drawn toward an
Zygote From fertilization to implantation ovum is probably a species-specific reaction, similar to an
Embryo From implantation to 5-8 weeks antibody-antigen reaction
Fetus From 5-8 weeks until term
Conceptus Developing embryo or fetus and
placental structures throughout
pregnancy
FERTILZATION
• aka conception and impregnation
• union of an ovum and a spermatozoon • Spermatozoa move through the cervix and the body of the
• Occurs in the outer third of fallopian tube, the ampullar uterus and into the fallopian tubes, toward the waiting ovum
portion by the combination of movement by their flagella (tails) and
• Usually, one of a woman’s ova will reach maturity each uterine contractions
month • Sperm must undergo 2 processes before fertilization:
1. Sperm capacitation
2. Acrosomal reaction

[TRANS] LESSON 7: FERTILIZATION AND FETAL DEVELOPMENT
SPERM CAPACITATION MITOSIS/CLEAVAGE

• Capacitation is a final process that sperm must undergo to a. Zygote – the cell that results from fertilization of the ovum by
be ready for fertilization the spermatozoan
• This process, which happens as the sperm move toward the • This cell undergoes mitosis, which is the process of cell
ovum, consists of changes in the plasma membrane of the replication where each chromosome splits longitudinally to
sperm head, which reveal the sperm-binding receptor sites form a double-stranded structure
o Mitosis Phases:
▪ Interphase*
▪ Prophase
▪ Prometaphase*
▪ Metaphase
▪ Anaphase
▪ Telophase
b. Cleavage – series of mitotic cell division by the zygote
c. Blastomeres – daughter cells arising from the mitotic cell
division of the zygote (2-cell, 4-cell, 8-cell blastomeres)
ACROSOMAL REACTION
• Follows capacitation
• Acrosomal covering of the head od the sperm contains
hyaluronidase
d. Morula – solid ball of cells produced by 16 or so blastomeres,
• As millions of sperms surrounds the ovum, they deposit
called the “travelling” form because it is in this form when it
amounts of hyaluronidase in the corona radiata, (the outer
migrates through the fallopian tube and reaches the uterine
layer of the ovum), which allows the sperm head to
cavity about 3-4 days after ovulation
penetrate the ovum
e. Blastocyst – fluid-filled cavity that reaches the uterine cavity

• Over the next 3-4 days, differentiation the cells occurs
o This is the stage when there is already a cavity in the
• Block to Polyspermy – As soon as the sperm penetrates the morula called the blastocoel
zona pellucida, and makes contact w/ the membrane of the
ovum, a cellular change occurs in the ovum that inhibits
other sperms to penetrate
• This cellular change is mediated by the release of material
from the cortical granules, organelles, found just below the
surface
• The cavity enlarges and pushes the morula cells into an outer
layer cell called the trophoblast
• Fertilization – occurs when the male pronucleus unites w/ the

female pronucleus
• Thus, the chromosome diploid number (46) is restored and a
new cell, the Zygote, is created with a combination of
genetic materials which creates a unique individual different • Along with this is an inner cell mass attached to the side of
from the parents and anyone else the blastocyst
o The divisions and reorganizations have already
consumed energy stored available in the zygote,

such that it becomes necessary for the blastocyst to
embed or implant in the uterine wall PLACENTA
▪ This is necessary for it to obtain nourishment for • Dimension (Discoid) – 15-20cm in diameter and 2-3cm in
its further development thickness
▪ Zygote is now dependent on the uterine lining • Location – in the uterus, anteriorly or posteriorly near the
fundus
IMPLANTATION o Fetus is dependent on placenta, this is where fetus
• aka nidation gets their nourishment, oxygenation, circulation etc.
• Time – 6-9 days (ave. 7 days) after fertilization o If placenta is placed near the cervix, placenta is
• Site – upper fundal portion or upper 1/3 of the uterus; can be possible to be expel that can cause placenta
anterior or posterior previa
• Fetal side – covered w/ amnion
o Amnion – 0.02-0.5mm in thickness
o Amniotic Fluid – clear fluid that collects w/in the
amniotic cavity
• Maternal side – chorion; divided into irregular lobes, consists
of fibrous tissue w/ sparse vessels confined mainly to the base
o Ave. weight at term – 500gm
o Feto-placenta weight ratio at term – 6 : 1
• Abnormal implantation site – any implantation outside the

uterus can cause ectopic pregnancy
o Fallopian tube which lead to ectopic pregnancy,
lower uterine segment which causes placenta
previa
• Cotyledons – compartments of the placenta, with an

amount of 15-30
o During th 4-5th month a no. septa arise decidua and
project into intervillous space
o These compartments are only visible from the
maternal side of the septa as the decidual septa do
not project all the way to the chorionic plate
o Interconnectively bet. the villi are maintained
allowing for maximal infusion of blood by the spiral
arteries
• Nursing Responsibilities:
1. Check for the completenes of placenta when delivered
o If there is less than 15-30, the uterus will never
contract and the mother will bleed that can result
to death
2. Weigh the placenta
• At the time of implantation, the blastocyst is completely
buried in the endometrium (inner uterine lining)
o While the blastocyst is in the stage of implantation,
its outer layer, the trophoblast, is responsible for
actual implantation
CHORIONIC VILLI
• Once implantation is complete, the trophoblastic layer of
cells of the blastocyst begins to mature rapidly
• As early as the 11th or 12th day, miniature villi that resemble
probing fingers, termed chorionic villi, reach out from the
single layer of cells into the uterine endometrium to begin
formation of the placenta
• At term, almost 200 such villi will have formed • Placenta is formed by the union of the chorionic villi and
decidua basalis
• Decidua – the endometrium in pregnancy, thickens in
pregnancy w/ depth of 5-10cm
a. Decidua Basalis – portion of the decidua directly
beneath the site of implantation
b. Decidua Capsularis – portion overlying the developing
ovum, separates ovum from the rest of the uterine
cavity, most prominent by 2nd month
c. Decidua Vera/Parietalis – lines for the remainder of the
uterus

molecular structures too large cross this
manner).
Unfortunately, viruses can also cross in this
manner.
UMBILICAL CORD/FUNIS
• Umbilical cord – formed from the fetal membranes (amnion
and chorion) and provides a circulatory pathway that
connects the embryo to the chorionic villi of the placenta
• Its function is to transport O2 and nutrients to the fetus from
the placenta and0 to return waste products from the fetus to
the placenta
• Layers of the Decidua Basalis and Decidua Vera • Size – 53cm (21in) in length at term and about 2cm (3/4in)
a. Zona Compacta – uppermost/surface layer made up of thick
compact cells • The bulk of the cord is a gelatinous mucopolysaccharide
b. Zona Spongiosum – middle, spongy layer, w/ glands and called Wharton’s jelly which gives the cord body and
small blood vessels prevents pressure on the vein and arteries that pass through
c. Zona Basalis – lower most/basal layer, this layer remains it
after delivery/placenta separation • Outer surface is covered w/ amniotic membrane
• AVA – contains only 1 vein (carrying blood from the placental
villi to the fetus) but 2 arteries (carrying blood from the fetus
back to the placental villi
o No. of veins and arteries in the cord is always
assessed and recorded at birth bec. about 1-5% of
infants are born w/ a cord that contains only single
vein and artery
• Placental Maturity – 12 weeks or 3 months;

o Functions most effectively through 40-41 weeks
o May be dysfunctional beyond 42 weeks AMNIOTIC FLUID
• Clear, straw colored fluid in which fetus floats
PLACENTAL FUNCTION • Amount:
1. Transport mechanism bet. the embryo and the mother o Normal Amount – 500-1000mL at term
2. Transports O2, nutrients, and antibodies to the fetus by o Polyhydramnios – greater than 1000-1500mL
means of the umbilical vein (2000Ml)
3. Removes CO2 and metabolic wastes from the fetus by 2 o Oligohydramnios – less than 300-500mL
umbilical arteries • Reaction – neutral to alkaline (Ph 7 – 7.25)
4. Serves as a protective barrier against harmful effects of • Abnormal Colors:
certain drugs and microorganisms o Green-tinge – a non-breech presentation is a sign
5. Acts as a partial barrier bet. the mother and fetus to of fetal distress
prevent fetal and maternal blood from mixing o Golden-colored fluid – maybe found in hemolytic
6. Produces hormones essential for maintaining disease
pregnancy. (Hormones are: estrogen, progesterone, • Constantly being newly formed and reabsorbed by the
and human chorionic gonadotropin (HCG)) amniotic membrane so it never becomes stagnant
• Major method of absorption occurs bec. the fetus continually
Table No.2 Mechanisms by which Nutrients Cross the Placenta swallows the fluid
MECHANISM PARAMETER o In the fetal intestine, it is absorbed into the fetal
Diffusion From higher concentration to lower bloodstream
concentration. (e.g., O2, CO2, Na and Cl o From there, it goes to the umbilical arteries and to
cross the placenta by this method) the placenta, and it is exchanged across the
placenta
Facilitated From higher concentration to lower
Diffusion concentration by a carrier to move more
rapidly or easily than would occur if only FUNCTIONS OF AMNIOTIC FLUID
simple diffusion. (e.g., glucose is an 1. Serves as a protective cushion/shock absorber
example of a substance that crosses by 2. Separates fetus from membranes allowing symmetrical
this process) growth and development
Active Transport Requires the action of an enzyme to 3. Acts as medium of excretion
facilitate transport. (e.g., essential amino 4. Serves as fetal drink (if there is an abnormality in the
acid and water-soluble vitamins cross the deglutition center of the brain or if there is esophageal
placenta by this process. This ensures that atresia, the fetus could not swallow, amniotic fluid
a fetus will have adequate amino acid accumulates polyhydramnios)
concentrations for fetal growth 5. Serves as a specimen for periodic diagnostic exam to
Pinocytosis Absorption by the cellular membrane of determine fetal well-being or its absence
microdroplets of plasma and dissolved 6. Maintains fetal temperature
substances. (e.g., gamma globulin, 7. Equalizes uterine pressure and prevents marked
lipoproteins and phospholipids all have interference w/ placental circulation during labor

left by way of the foramen ovale, thus bypassing the
STAGES OF UTERINE DEVELOPMENT lungs
a. Ovum o Foramen ovale closes:
o From fertilization to 2 weeks ▪ w/ establishment of respiration (as early as 1-2
o The period of pre-differentiation of organs hours)
o When the ovum is exposed to teratogen, the “all or ▪ 1-2 days
none” law applies, meaning the ovum is damaged ▪ Anatomically 2-3 months
& is out in spontaneous abortion or it is not affected 5. From the left atrium → left ventricle → aorta → lower part
at all & continues to grow normally of the body
b. Embryo 6. From the hypogastric arteries (branches of the aorta),
o From 2 weeks to 2 months the right and left umbilical arteries receive
o Period of organ differentiation (organogenesis) unoxygenated blood directed back to placenta for
o MOST DANGEROUS PERIOD – a teratogen oxygenation
introduced at this stage may result in severe organ o Right and Left Arteries – closes w/ cord clamping &
malfunction & dysfunction later becomes umbilical ligaments
c. Fetus 7. Blood from the upper parts of the body enters the heart
o From 8 weeks to birth via superior vena cava
o Period of post differentiation of organs, when o Goes to right atrium → right ventricle → pulmonary
exposed to teratogens, a malformation is least likely artery
to occur 8. From pulmonary artery, some blood goes to the lungs
o If ever the fetus is affected, the effects will most o Most blood is shunted to the aorta via ductus
likely be alterations in size or function arteriosus
o Ductus arteriosus closes:
EMBRYONIC GERM LAYERS ▪ w/ establishment of respiration as early as 1-2
a. Ectoderm – outer layer; develops into: hours
o Nervous system ▪ 1-2 days
o Hair, nails, skin epidermis, sebaceous & sweat ▪ Anatomically 2-3 months
glands ▪ Becoming ligamentum arteriosum
o Salivary glands, mucous membranes of the mouth o If ductus arteriosus fails to close, it will become an
o Epithelium of nasal, oral passages acyanotic heart disease – patent ductus arteriosus
b. Mesoderm – middle layer, develops into: ▪ A murmur is an important sign to identify if fetus
o Dermis have PDA
o Cardiovascular system
o Reproductive system BLOOD CIRCULATION AFTER BIRTH
o Musculo-skeletal system • With the first breaths of air the baby takes at birth, the fetal
o Urogenital system, except the bladder circulation changes
c. Endoderm/Entoderm – inner layer, develops into: • A larger amount of blood is sent to the lungs to pick up
o Linings of GIT from the pharynx to rectum oxygen
o Liver, pancreas, thyroid, parathyroid • Because the ductus arteriosus (the normal connection bet.
o Respiratory system the aorta and the pulmonary valve) are no longer needed,
o Bladder, thymus (for immunity building) it begins to wither and close off.
• The circulation in the lungs increases and more blood flows
into the left atrium of the heart. This increased pressure causes
the foramen ovale to close and blood circulates normally
Table No.3 Summary of Fetal Circulation

SUMMARY OF FETAL CIRCULATION
1. Oxygenated blood enters the umbilical vein from the
placenta
2. Enters ductus venosus
3. Passes through inferior vena cava
4. Enters the right atrium
5. Enters the foramen ovale
6. Goes to the left atrium
7. Passes through left ventricle
8. Flows to ascending aorta to supply nourishment to the
FETAL CIRCULATION brain and upper extremities
1. Oxygenated blood enters from the placenta to the 9. Enters superior vena cava
umbilical vein 10. Goes to right atrium
o Umbilical vein closes at birth w/ cord clamping & 11. Enters the right ventricle
becomes ligamentum teres 12. Enters pulmonary artery w/ some blood going to the
2. From the umbilical vein, small amount of oxygenated lungs to supply oxygen and nourishment
blood will go to the liver to nourish 13. Flows to ductus arteriosus
o Not for the blood detoxification 14. Enters descending aorta (some blood going to the lower
3. Most of the blood from the umbilical vein goes to the extremities)
inferior vena cava via the ductus venosus 15. Enters hypogastric arteries
o Ductus venosus closes at birth w/ cord clamping &
16. Goes back to the placenta
becomes ligamentum venosum
4. From the inferior vena cava, it will go to the right auricle
o Since pressure in the right atrium is higher than the
pressure on the left atrium, blood is shunted to the

12 WEEKS
• Placental fully formed and functioning
o Kidneys develop; secrete urine
o Centers of ossification in most bone
o w/ sucking and swallowing
o sex distinguishable
o Fetal heart tone detected by ultrasound
• 12th Week of Gestation
o Toes and fingers already have nail beds
o Faint fetal movements are starting
o Early reflexes are present
ORIGIN & DEVELOPMENT OF ORGAN SYSTEMS o Tooth buds are forming
o Formation of bone ossification centers initiate
4 WEEKS o Genital is already recognizable through its
• All systems in the rudimentary form appearance
o Beginning formation of eyes, nose, GIT o Urine secretion begins but is not yet evident
o Heart chambers forms o Heartbeat could be detected by Doppler
o Heart beating (14 days)
o w/ arms and leg buds
o Spinal cord is formed and fused at the midpoint
o Head folds forward and is prominent
o Back is bent, which makes the head almost touch
the tail
o A prominent bulge appears which would later form
as the heart
o Lateral wings, the body, folds forward and fuse at
midline
o Arms and legs are budlike structures
o Eyes, ears, and nose are barely recognizable
16 WEEKS
• More human appearance
o Quickening – multigravida
o Meconium in bowels
o External genitalia obvious
o Scalp hair develops
o Formed eyes, nose, ears
o Fetal Heart Tone by fetoscope
o An ordinary stethoscope could detect the fetus’
8 WEEKS heart beat
• Head large in proportion to the body o Lanugo (hair) has started to form
o Neuromuscular development o Pancreas and liver are forming
o Some movements o Urine is present in the amniotic fluid
o Rapid brain development o Fetus starts to swallow the amniotic fluid
o External genitalia appear o Ultrasound could determine the sex of the fetus
o Organogenesis is achieved and complete
o Heart already developed septum and valves and is
beating rhythmically
o Arms and legs have developed
o Facial features are noticeable
o Genital starts to form but is not yet recognizable
o Fetal intestine is rapidly growing
o Results of an ultrasound would show a gestational
sac which confirms pregnancy

20 WEEKS 32 WEEKS
• With vernix caseosa and downy lanugo • Subcutaneous fats begin to deposit
o Quickening stronger, felt by primigravida o Skin is smooth and pink
o Fetal Heart Tone by stethoscope o More reflexed present
o Bones hardening o w/ iron and calcium storage
o good chance of survival if delivered
• 32nd Week of Gestation
o Subcutaneous fat is deposited
o Fetus responds to sounds outside the mother’s body
through movements
o Active Moro Reflex is present
o Iron stores are starting to develop
o Fingernails are starting to grow
24 WEEKS
• Body well proportioned
o Hearing established
o Eyebrows, eyelashes recognizable
o When born, may breathe, but usually doesn’t
• 24th Week of Gestation 36 WEEKS
o Lung surfactant begins to develop • Lecithin/sphingomyelin ratio 2:1
o Meconium is present at the rectum o Nails firm
o Eyebrows and eyelashes are distinguishable o w/ definite sleep/wake pattern
o Eyelids can now open o lanugo disappearing
o Pupils react to light o survival same as term
o Fetus has reached the age of viability, wherein they • 36th Week of Gestation
could survive externally if cared for in a modern o Depositions of iron, carbohydrate, calcium, and
intensive facility glycogen stores are in the body
o Additional subcutaneous fats are deposited
o One or two creases are present at the sole of the
foot
o Lanugo starts to diminish
o Some babies turn and assume a vertex presentation
28 WEEKS
• Viable, immature if born at this time
o Surfactant production begins
o Body is less wrinkled 40 WEEKS
o With iron storage • Full term w/ good muscle tone & reflexes
o Nails appear o Little lanugo
o Pupillary membranes have just disappeared from o If male, test in scrotum
the eyes o With other characteristics features of the new born
• 28th Week of Gestation • 40th Week of Gestation
o Surfactant is demonstrated in the amniotic fluid o Fetus now kicks very actively and hard enough to
o Alveoli are starting to mature cause discomfort
o Testes descend into the scrotal sac o The fetal hemoglobin is being converted to adult
o Retinal blood vessels start to form but are highly hemoglobin
susceptible to damage o Vernix caseosa is fully formed
o Fingernails extend to the fingertips
o Soles of the feet have creases that cover at least
2/3 of the surface

MILESTONES OF FETAL GROWTH AND DEVELOPMENT JOHNSON’S RULE

• Estimation of weight in grams
• Formula:
o Fundic Height in cm – N x K
▪ K = 155 (constant)
▪ N = 11 (if part id not yet engaged
▪ N = 12 (if part is already engaged)
o ex. 21 cm (not engaged)
▪ (21 – 11) x 155 = 1,550 grams
• Leopold’s Maneuver is necessary before doing the Johnson’s
Rule
BARTHOLOMEW’S RULE
ASSESSMENT OF FETAL GROWTH AND DEVELOPMENT • Estimation of AOG by the relative position of the uterus in the
abdominal cavity
NAEGELE’S RULE o 3rd lunar month – fundus is palpable slightly above
• Calculations of expected date of confinement (EDC) or the symphysis pubis
estimated date of delivery (EDD) o 5th lunar month – fundus is at the level of the
• Formula: umbilicus
o If patient LMP is Jan-Mar, then: o 9th lunar month – fundus is below the level of the
▪ +9, +7, +0 xiphoid process
o If patient LMP is Apr-Dec, then: • This determines the relative position of the uterus in the
▪ -3, +7, +1 abdominal cavity
ULTRASOUND
• Ultrasound – transducer on abdomen transmits sound waves
that show fetal image on screen
a. Done as early as 5 weeks to confirm pregnancy,
gestational age
b. Multiple purposes – to determine position, number,
measurement of fetus(es) and other structures
(placenta)
c. Client must drink fluid prior to test to have full bladder to
ASSESSING FETAL WELL-BEING
assist in clarity of image
d. No known harmful effects for fetus or mother
e. Non-invasive procedure
FETAL MOVEMENT
• Fetal movement that can be felt by the mother (quickening)
occurs at approximately 18-20 weeks of pregnancy
• Peaks in intensity at 28-38 weeks
• Fetal movement should be assessed when there is
quickening (at 24 months age of gestation onwards)
• Two schools of thought:
1. Cardiff Count to Ten
2. Sandovsky Method
CARDIFF COUNT TO TEN

• Normal Fetal Movement
o At least 1 movement every 5-6 minutes
o About 10-12 movements per hour
MCDONALD’S RULE • Instruction
• Estimation of age of gestation in months & weeks by fundic 1. Instruct the client to eat LIGHT MEAL 1 hour before
height measurement monitoring for fetal movement
• Formula: 2. Have short walk or massage abdomen as baby may be
o To determine AOG in months: asleep or is hungry
▪ Fundic Height in cm x 2/7 3. Ask mother to assume left lateral position
▪ ex. 21cm x 2 / 7 = 6 months 4. Clock must be at the bedside w/ pencil and paper
o To determine AOG in weeks: 5. Dominant hand of mother palpates most prominent part
▪ Fundic Height in cm x 8/7 of abdomen
▪ ex. 21 cm x 8 / 7 = 24 weeks 6. Note for any fetal movement
• Fundal Height Measurement – measure from the top of the 7. Mother notes for 10 fetal movements and notes the time
symphysis pubis to the top of the uterus in cm that the 10 fetal movements have been completed
o Should be completed in 1 hour
HAASE’S RULE o Approximately 5 movements in 30 minutes
• Estimation of fetal length ▪ Must get ay least one half of normal
• Rule: ▪ Therefore, at least 5 fetal movement per hour is
o During the first half of pregnancy (first 5 months), acceptable
square the number of the month
▪ ex. 3 x 3 = 9cm SANDOVSKY METHOD
o During the second half of pregnancy (6-9 months), • Same procedure as in Cardiff count to ten
multiply the month by 5 • Mother monitors fetal movement 3x a day
▪ ex. 6 x 5 = 30cm • These are done:

o After breakfast
o After lunch
o After dinner
• Normal – should appreciate 2-3 fetal movements in 1 hour
FETAL HEART RATE

• Fetal hearts beat at 120 to 160 bpm throughout pregnancy
• Types of Ultrasounds:
RHYTHM STRIP TESTING
o Transabdominal Ultrasound
• Means assessment of the fetal heart rate for whether a good
o Transvaginal Ultrasound
baseline rate and a degree of variability are present
• Procedure:
o Semi-fowler’s position
TRANSABDOMINAL ULTRASOUND
o Attach an external fetal heart rate monitor • Ask the client to FILL BLADDER
abdominally • Full bladder will push uterus to pelvic cavity for better
o Record the fetal heart rate for 20 minutes visualization at abdomen
• Ultrasound in First Trimester

• Information obtained
1. Confirmation of Pregnancy
o Upper strip signifies heart rate, lower strip indicates o (+) cardiac movement
uterine activity o (+) yolk sac
o Arrow signal fetal movement o (+) fetal heart tone
• Baseline reading – average rate of the fetal heartbeat per
minute 2. Identification of Ectopic Pregnancy (any pregnancy
• Variability – refers to small changes in rate that occur if the outside the utero)
fetal parasympathetic and sympathetic nervous systems are o Fallopian tube (common site for ectopic
receiving adequate oxygen and nutrients pregnancy) is peristaltic
▪ Therefore, look at the uterus, if the uterus is
empty and positive (+) for pregnancy test, then
there is ectopic pregnancy
o Baseline fetal heart rate – 130-132 bpm

o This strip shows the fetal heart rate acceleration in
response to fetal movements, shown by arrows 3. Identification of Intrauterine Device (IUD) in place
• Categorized as: o Intrauterine device has 97% protection and 3 %
o Absent – none apparent failure rate
o Minimal – exteremely small fluctuations o If IUD is in place and pregnancy occurs, advice the
o Moderate – amplitude range of 6-25 bpm client to let the IUD stay in place
o Marked – amplitude range over 25 bpm ▪ IUD will attach to the fetal membrane
▪ If taken out, there is greater chance of
FETAL ACTIVITY spontaneous abortion
• Vigorous fetal activity – provides reassurance of fetal well-
being 4. Identification of the H-MOLE (Hydatidiform mole)
• Marked decrease or cessation in activity o Ultrasound characteristic of H-Mole
o May indicate possible fetal compromise ▪ Snow storm appearance
o May require immediate follow-up ▪ In a dark background there is a speck of white
• Assessment of fetal activity (from week 28 to week 38) – ▪ There are vesicles
noninvasive method of monitoring the fetus
ULTRASOUND
• Confirmation of pregnancy and fetal presentation
• Evaluation of fetal heartbeat and fetal respiration
• Identification of more than one embryo or fetus
• For examination of anatomical fetal structures
• Estimate gestational age, fetal weight, and growth
• Location of the placenta and amniotic fluid volume

o If the FHR remains nonreactive for longer than
30mins, the test is repeated after the woman eats or
the fetus is stimulated via acoustic stimulation, foot
massage or palpation
o If a reactive test is not obtained w/in 40mins,
additional testing such as ultrasound or immediate
birth is considered
• Fetal Acoustic Stimulation and Vibroacoustic Stimulation Test
o Acoustic (sound) and vibroacoustic stimulation
(sound + vibration)
o Involve the use of handheld battery-operated
TRANSVAGINAL ULTRASOUND
devices (usually a laryngeal stimulator) placed over
• Ask the client to void since the probe is directed to the uterus the mother’s abdomen near the fetal head
▪ This technique produces a low-frequency
vibration and a buzzing tone intended to
induce fetal movement along with associated
FHR acceleration
o Sound stimulus lasts for 2-5 seconds
DOPPLER BLOOD FLOW STUDIES: UMBILICAL VELOCIMETRY

• Non-invasive: Can be initiated at 16 – 18 weeks
• Can be scheduled at regular intervals for women at risk
• Measures blood flow changes in maternal and fetal • Example of a reactive NST. Acceleration of 15bpm lasting 15
circulation seconds w/ each fetal movement. Top of strip shows FHR,
o Checks the blood circulation, nutrients circulation, bottom of strip shows uterine activity tracing. Note that FHR
status of placenta increases (above the baseline) at least 15 bpm and remains
• Allows for assessment of placental function at that rate for at least 15 seconds before returning to the
former baseline
NONSTRESS TEST
• Used to assess fetal status using an electronic fetal monitor
• Based on the knowledge
o Well-oxygenated fetus has adequate oxygenation
o Intact central nervous system
• Example of nonreactive NST. No accelerations of FHR with

FM. Baseline FHR is 130 bpm. Tracing of uterine activity is on
the bottom of the strip.
CONTRACTION STRESS TEST / OXYTOCIN CHALLENGE TEST
Table No.4 Test Results of the NST

RESULTS DESCRIPTION
Reactive (Normal) Two or more fetal heart rate increases
in the testing period (usually 20 mins)
Nonreactive There is no change in the fetal heart
rate when the fetus moves. This may
indicate a problem that requires
further testing
Unsatisfactory Test Data cannot be interpreted or there • Test used to evaluate the ability of the fetus to withstand the
was inadequate fetal activity stress of uterine contractions as would occur during labor
• CST utilizes endogenously produced oxytocin by way of
CLINICAL MANAGEMENT nipple or breast stimulation
• If the NST is reactive in less than 30mins – test concluded & • OCT utilizes exogenous oxytocin (Pitocin), which is
rescheduled as indicated by the high-risk condition that is administered by way of I.V. Infiltration
present
• If it is nonreactive -test is extended for 30mins until results are Table No.5 Test Results of the CST
reactive & then the test is rescheduled as indicated RESULTS DESCRIPTION
o Estimated that 80%-90% of nonreactive NST are due Normal Normal test results are called negative
to fetal sleep states

Abnormal Test Abnormal test results are called NST ≥ 2 accelerations of 0 or 1
positive ≥bpm for ≥ 15sec in acceleration in
20min 20min
• Enables identification of fetal risk for asphyxia Amniotic fluid Single vertical pocket Largest single
• Fetal monitor is used volume >2cm vertical pocket
• Fetal heart rate response to contractions is noted ≤2cm
• Healthy fetus usually tolerates contractions
• If placental reserve is insufficient AMNIOCENTESIS
o Fetal hypoxia • Procedure used to obtain amniotic fluid
o Depression of the myocardium • Allows for testing of amniotic fluid
o Decrease in FHR • These tests can provide info about genetic disorders
• May be used in screening for the following:
o Down syndrome (trisomy 21)
o Trisomy 18 and neural tube defects (NTDs)
o Can provide info about fetal lung maturity
• Best done at 16-18 weeks AOG or during 2nd trimester
o Time when the baby is small and there is much
amniotic fluid
• Example of a positive CST. Repetitive late decelerations

occur w/ each contraction. Note that there is no
acceleration of FHR w/ 3 fetal movements. Baseline FHR is
120bpm. Uterine contractions (bottom half of the strip)
occurred 4x in 12mins.
Table No.6 CST

DIAGNOSTIC VALUE PARAMETER
Demonstrates reaction of FHR Negative test – stress of
to stress of uterine uterine contraction shows 3 NURSING CARE
contraction contractions of good quality 1. Assist the physician during amniocentesis
lasting 40 or more seconds in 2. Support the woman undergoing the procedure
10mins w/ evidence of late 3. Obtain informed consent
decelerations 4. Clarify the physician’s instructions or explanations
Positive test – stress of uterine 5. Obtain baseline vital signs
contraction shows repetitive 6. Obtain baseline fetal heart rate
persistent late deceleration 7. After procedure, review reportable side effects
w/ more than 50% of the 8. Assess vital signs and fetal heart rate
uterine contractions
Equivocal or suspicious – non HOW TO PREPARE THE CLIENT FOR AMNIOCENTESIS
persistent late decelerations 1. Explain what to do to the client
or decelerations associated 2. Get consent
w/ hyperstimulation o CONSENT IS NEEDED as this procedure is INVASIVE
3. Client must have IV Fluid
BIOPHYSICAL PROFILE o Plain normal saline solution
• For each normal finding, score of 2 is assigned o Side drip of tocolytic to relax the uterus
• Maximum score of 10 is possible 4. Ask client to void before the procedure so as not to
• For each abnormal finding, a score of 0 is assigned puncture bladder
• Combination of an ultrasound and a NST o Ultrasound-guided procedure
• Helps to identify healthy or compromised fetus o Needle should not puncture the placenta
• Indicated when there is risk of placental insufficiency and 5. Abdomen is prepared aseptically
when there is risk of fetal compromise 6. Specific site:
o Pocket of abdomen containing highest amount of
Table No.7 Criteria for Biophysical Profile Scoring amniotic fluid
COMPONENT NORMAL (2) ABNORMAL (0) o Done by obstetric sonologist
Fetal breathing ≥ 1 episode of rhythmic ≤ 30sec of 7. Needle inserted
movements lasting ≥ 30sec w/in breathing in o Local anesthesia
30min 30min o Abdominal wall through the uterus to amniotic sac
Gross body ≥ discrete body or limb ≤ 2 movements in
movements movements in 30min 30min POST PROCEDURE
(episodes of active 1. Check vital signs every 15mins
continuous movement 2. Check blood pressure
considered as single 3. Check fetal heart tone
movement) 4. Rest for 2-3hrs
Fetal tone ≥ 1 episode of No movements 5. Mother is then sent home
extension of fetal or
extremity w/ return to extension/flexion DISCHARGE INSTRUCTIONS
flexion, or opening or
closing of hand 1. Note for uterine tone
2. Note for fetal activity

3. Client may be: MATERNAL SERUM ALPHA FETOPROTEIN
o Hyperactive – in distress • Special kind of protein produced in the yolk sac of the liver of
o Hypoactive – in distress baby/fetus
4. Note for vaginal bleeding or spotting • Specimen is blood
5. Vaginal spotting is acceptable • Consent is needed
• Normal Value of MS AFP – 2.0-2.5 MOM (measurements of the
DANGER SIGNS mean)
1. Persistent uterine contraction o If MS AFP is higher than normal, THERE IS A NEURAL
2. Hyper/hypoactive TUBE DEFECT:
3. Vaginal spotting to bleeding ▪ Spina bifida
o Therefore, ask mother to come back if she observes ▪ Meningocele
any of the above signs ▪ Myelomeningocele
▪ Anencephaly
AMNIOTIC FLUID ANALYSIS o If MS AFP is lower than normal – there is Down’s

• Triple test assesses for: Syndrome
1. Appropriate levels of alpha-fetoprotein (AFP) ▪ Therefore, you must be able to know exact
2. Human Chorionic Gonadotrophin (hCG) AOG
3. Unconjugated estriol (UE3) • 15-20 weeks of AOG is the ideal time for MS AFP or during the
4. Down syndrome (Trisomy 21) 2nd trimester not on the 1st or 3rd trimester
5. Trisomy 18 o If early – high result
6. Neural Tube Defects (NTDs) ▪ Yolk sac and liver gives false elevated result
• Quadruple screen o If late – low result
o More sensitive accurate detector of Trisomy 21 ▪ Liver only gives false low result
o Will replace the triple screen in the near future
CHORIONIC VILLUS SAMPLING (CVS)
INFORMATION OBTAINED • Get part of chorionic villi from the placenta
1. Fetal Lung Capacity • Done at 9-12 weeks AOG
o Analyzed for lung surfactant • Approach is intravaginal
o L : S Ratio (Lecithin : Sphingomyelin Ratio) • UTZ guided
▪ Lecithin – specific component of lung • Can be performed bet. 10-12 weeks
surfactant • Performed for 1st trimester diagnostic studies
▪ Lecithin should be greater than Sphingomyelin
▪ Normal Ratio – 2L : 1S
Table No.7 Lecithin/Sphingomyelin (L/S) Ratio and

Phosphatidylglycerol (PG)
DIAGNOSTIC VALUE PARAMETER
Provides info to help An L/S ratio of 2:1 and
determine fetal lung maturity presence of PG correlate w/
35 weeks’ gestation
An L/S ratio lower than 2:1, an
absence of PG, or both, may Table No.8 Advantage and Disadvantage of CVS
indicate underinflation of ADVANTAGE DISADVANTAGE
lungs and an increased risk for Allows for early detection of Increased risk of injury to fetus
development of respiratory fetal disorders
distress syndrome Short waiting time for results Inability to detect neural tube
o If there is anticipated premature delivery, defects
amniocentesis is done to know if delivery is viable Potential for repeated
invasive procedures
2. Phosphatidyl Glycerol (PG) Risk of failure to obtain
o Usually appreciated at amniotic fluid at 34-36 placental tissue
weeks AOG Risk of contamination of
o Therefore, it is safe to deliver fetus if PG is present specimen
o There is decreased risk of respiratory distress Risk of leakage of amniotic
fluid
3. Polyhydramnios Risk of intrauterine infection
o Amniotic fluid greater than 2000Ml (teratogenic Risk of Rh alloimmunization
effect)
o Therefore, remove part of amniotic fluid

• A part of chorionic villi near maternal attachment will be
suctioned to the catheter for Karyotyping and Genetic
Analysis
• Purpose of this procedure is for detection of genetic
chromosomal problems
• Nursing Responsibility:
o Bleeding is common in CVS
o Instruct mother to observe Spotting to Bleeding
o Ask mother to come back if bleeding occurs
• Therefore, not much done; increase chance of abortion or
fetal loss
PERCUTANEOUS UMBILICAL BLOOD SAMPLING (PUBS)

• AKA Cordocentesis
• Get sample, UTZ guided
• Sonologist identifies umbilical vein
o Vein has larger lumen than the artery
• Catheter is inserted
• Approach is through the abdomen
• Information obtained:
1. For identification of blood incompatibilities
2. For exchange transfusion
3. For isoimmunization
o Needed in instances of an Rh+ baby and an Rh-
mother
REFERENCES

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LECTURE\POWERPOINT

OUTLINE • In the MDGs, 8 anti-poverty targets had been set to be

TRENDS IN THE MATERNAL CHILD HEALTH NURSING

NATIONAL HEALTH GOALS

MILLENIUM DEVELOPMENT GOALS

IBARRA. MARIANO. ONG. PECUNDO. RICO. 1

NEONATAL DEATH RATE

LEADING CAUSES OF INFANT DEATH

IBARRA. MARIANO. ONG. PECUNDO. RICO. 2

IBARRA. MARIANO. ONG. PECUNDO. RICO. 1

PELVIC INLET AND PELVIC OUTLET

IBARRA. MARIANO. ONG. PECUNDO. RICO. 2

CONSEQUENCES OF WALKING UPRIGHT

OBSTETRIC PELVIC AXIS

PLANE OF THE PELVIC CAVITY

IBARRA. MARIANO. ONG. PECUNDO. RICO. 3

Table No.3 Types of Female Pelvis

Table No.4 Ideal Obstetric Pelvis

IBARRA. MARIANO. ONG. PECUNDO. RICO. 4

Table No.6 Fetal Skull Presentation MOULDING

IBARRA. MARIANO. ONG. PECUNDO. RICO. 5

Notes from the discussion by Prof. Lualhati M. Floranda, DNM, RN

Manila Doctors Colleges of Nursing PowerPoint Presentation

REGIONS AND LANDMARKS IN THE FETAL SKULL

IBARRA. MARIANO. ONG. PECUNDO. RICO. 6

OUTLINE BODY STRUCTURES INVOLVE IN MENSTRUATION

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 1

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 2

• Phases of menstrual cycle is as follows:

SECRETORY PHASE FERN TEST

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 3

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 4

1. Hypothalamus (master gland) releases GnRH

Notes from the discussion by Prof. Lualhati M. Floranda, DMN, RN

Manila Doctors Colleges of Nursing PowerPoint Presentation

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 5

OUTLINE • How appealing parents or other adult role models portray

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 1

STAGES OF SEXUALITY OLDER ADULT

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 2

Table No.3 Orgasmic Phase

Table No.4 Plateau Phase

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 3

TYPES OF SEXUAL ORIENTATION

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 4

Voyeurism • Obtaining sexual arousal by looking at REFERENCES

Table No.6 Other Sexual Expression

DISORDERS OF SEXUAL FUNCTIONING

Table No.7 Disorders of Sexual Functioning

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 5

OUTLINE IDEAL CONTRACEPTIVE

1. To predict the first fertile day in your current cycle

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 1

Table No.2 Safe Times Using the Calendar Method

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 2

LACTATION AMENORRHEA METHOD 1. Dysmenorrhea – because of lack of ovulation

Table No.3 Absolute Contraindications to OCs

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 3

o Area of implants can be felt but not easily seen

IBARRA. MARIANO. ONG. PECUNDO. PERALTA. RICO. 4

INTRAUTERINE DEVICES EFFECT ON PREGNANCY

• How to use male condoms:

MIRENA IUD INSERTION