Week 1 NCMA219

Republic act 9262 - Anti violence against women and their children act of 2004
(March 08, 2004)

⁃ physical
rape, forcing the woman to sleep into the perpetrator’s room, forced to sleep
⁃ sexual
⁃ psychological
⁃ economic abuse
withdrawing any financial support, preventing the victim to engage in any
legitimate profession, occupation, business or activity, except in cases wherein
the other spouse objects on valid, serious, moral grounds.

you have the right to enjoy conjugal kineme, equal rights to a property
—————————————————————————————————————————
High risk
⁃ current/on going disorder that can lead to pregnancy related
complications
Left side heart failure
⁃ mitral stenosis, mitral insufficiency, aortic coarctation
Right side heart failure
⁃ pulmonary valve stenosis, atrial and ventricular septal defects

Assessment of woman with cardiac disease

⁃ cough due to edema (excess fluid in the lungs)
⁃ fatigue (due to insufficient oxygen)
⁃ tachycardia
⁃ increase respiratory rate (due to fluid accumulation in the lungs)
⁃ poor fht (due to poor tissue perfusion/poor utero-placental perfusion)
⁃ decrease amniotic fluid from intrauterine growth restriction
⁃ edema from poor venous return

RHD (rheumatic heart disease)

⁃ comes from continuous bacterial exposure of the heart (tonsillitis)
⁃ causes different types of heart valve defects
⁃ commonly causes mitral stenosis or narrowing of the valve between the
left chambers of the heart in women of child bearing age
⁃ can also cause abnormal leaking of blood through the valve between the
left chamber of the heart (condition called mitral regurgitation or pagbalik ng
dugo from one chamber to another)
Mitral stenosis
⁃ may develop breathing difficulty, swelling of the ankle and feet
(edema), irregular heartbeat (arrhythmia)

Effect of RHD on pregnancy

⁃ during pregnancy there is an increase in blood volume of 30% - 50%
resulting in increased pressure of the heart valves. For women with RHD this
increased pressure presents increase maternal and/or fetal risks
⁃ For women with more severe RHD, it could lead to the development of
much more serious symptoms such as pulmonary edema, atrial fibrillation or
clotting. These changes begin in the trimester but peak at 28-30weeks and are
sustained until term, meaning most women with valvular heart disease become more
symptomatic in the third trimester

Artificial Valve Prosthesis

⁃ advised not to get pregnant for fear of increased blood volume gained
during pregnancy would overwhelm the artificial valve
⁃ potential problem involves the use of oral anticoagulants that a woman
takes to prevent the formation of clots at valve site

Chronic hypertensive vascular disease

⁃ pregnant women with this disease comes with an elevate BP of 140/90mmHg
or above
⁃ usually associated with arteriosclerosis (blockage of blood vessels in
the heart) or renal disease, making it a problem of the older pregnant woman
⁃ places both woman and fetus at high risk as fetal wellbeing can be
compromised by poor placental perfusion during the pregnancy

Venous thromboembolic disease/ Deep Vein thrombosis (DVT)

⁃ May thrombus formation or blood clot na nabubuo sa malalaking veins ng
legs. Pag may thrombus formation, there is a possibility na ma dislodged. If
dislodged, it will travel to different blood vessels. (if nag travel sa heart
hanona? note that blood vessels of the heart are small) it can lead to death
⁃ incidence of DVT increase during pregnancy due to a combination of
stasis of blood in the lower extremities from uterine pressure and hyper-
coagulability. When pressure of the fetal head puts additional pressure to the
lower extremity vein, damage can occur to the walls of the vein.
⁃ When triad effects (stasis, vessel damage, hyper coagulation) stage is
set for thrombus formation
⁃ Likelihood of deep vein thrombosis (DVT) leading to pulmonary embolism
increases for women aged 30years or older because increased age is yet another risk
factor for thrombus formation

Symptoms of DVT
⁃ poor venous return from the pressure of the uterus leads to stasis in
the vein
⁃ thrombophlebitis (pain the the veins)
⁃ increased estrogen levels = increased blood coagulation

Some women are advised to take heparins or blood thinners, anticoagulants para
matunaw yung stasis or blood clots, para di mamuo. Women and advised not to wear
stockings (masisikip na stockings will put you at risk of venous stasis)

Anemia
⁃ puts a pregnant woman at high risk for complications
⁃ blood volume expands during pregnancy
⁃ . most women have pseudo anemia
⁃ 30% - 50% of our blood volume expands during pregnancy slightly ahead
of the rbc count, therefore patients have pseudo(fake) anemia (rbs and hemoglobin
will not expand right away)
⁃ pseudo anemia is normal and should not be confused with true types of
anemia that can occur as complications of pregnancy
⁃ true anemia is present when a woman’s hemoglobin( oxygen concentration
in the blood) is less than 11 */dL in the first or third trimester or hemoglobin
concentration is less than 10.5 g/dL (if not pregnant indicated levels are normal)

Iron deficiency anemia

⁃ iron is needed to help oxygen cling with the rbc
⁃ if you’re pregnant p, even if you’re not anemic the doctor will give
you iron supplements. supplements should be taken with vit C for better absorption
Folic acid anemia
⁃ folic acid helps with the spine and brain development of the fetus
⁃ can be due to poor nutritional intake
⁃ take supplements and food rich in folic acid
Sickle cell anemia
⁃ blood becomes sickle shaped
⁃ malformed rbc
 ⁃ looks depleted
⁃ blood transfusion to correct sickle cell anemia
Thalassemia
⁃ Problems in forming hemoglobin
⁃ turns to anoxia (poor tissue perfusion) due to pure oxygenation
⁃ body is not forming hemoglobin right away
⁃ needs blood transfusion depending on the severity of
Malaria
⁃ comes from anopheles mosquito which can infect the RBC
⁃ the protozoan infection from the mosquito will make the RBC stick to
the walls of the blood vessel resulting to clotting that eventually leads to
clogging/blocking. There will be poor perfusion to the placenta leading to death
⁃ medication is chloroquine to help treat malarian infection

RENAL AND URINARY DISORDERS IN PREGNANCY

UTI
⁃ risk of contracting UTI is much higher when pregnant
⁃ baby might have sepsis if not treated
⁃ hygiene and increase water intake
⁃ If infection is present when pregnant, antibiotic will be advised to
take
Chronic renal disease (renal failure)
⁃ kidney is not functioning = lose the ability to excrete toxins
⁃ chemo dialysis will still be continued as it is needed more during
pregnancy
⁃ diet is important

How to assess a woman with renal disease

⁃ will have elevated BP due to poor kidney function
⁃ Proteinuria (excess protein; protein in urine) = UTI
⁃ Lower back pain due to infection
⁃ Elevated serum creatinine and blood urea nitrogen (BUN) (these are
metabolized output of our body and if is not flushed out and still in the body
meaning, the kidney is not functioning properly), meaning kidney is not functioning
properly.
⁃ edema due to the inability of the kidney to evacuate the fluid
⁃ Laboratory (urinalysis, BUN, creatinine serum)
⁃ Medication (depends on the doctor’s prescription)
⁃ Hemodialysis as ordered

Respiratory disorders

Acute nasopharyngitis (common cold)

⁃ go to ob and ask for advise— whatever medication
Influenza
⁃ trangkaso
⁃ shots is recommended
Pneumonia
⁃ could be viral or bacterial
⁃ if bacterial, fever, cough and cold, runny nose, diff of breathing,
decrease o2sat; go to the doctoR
Severe acute respiratory syndrome
⁃ SARS, COVID,
Asthma
⁃ there will be increased pulmonary demand
⁃ after delivery, doctors cannot give u carboprost (contraindicated to
patients with asthma; for uterine contraction)
Tuberculosis
⁃ antibiotics will still be continued as needed or as ordered by the
doctor
⁃ after delivery medication will depend on whether the tb is active or
not
Chronic Obstructive Pulmonary Disease
⁃ sanay sila sa low oxygen drive because sanay yung baga nila na mababa
yung oxygen level kase sira gung alveoli ng lungs nil
⁃ should be referred to a pulmonologist for proper management
Cystic fibrosis
⁃ over secretion of fluids (in the lungs, pancreas)
⁃ if over secretion sa lungs, sobrang makapal plema nila

RHEUMATOID DISORDERS
rheumatoid arthritis
⁃ before pregnancy, a woman with this disease is usually taking folic
acid and methotrexate (a chemotherapeutic medication that can also help in
rheumatoid arthritis but is armful to the fetus). When pregnant, should consult the
doctor.
Systemic lupus erythematosus
⁃ lupus
⁃ body is producing not enough erythrocytes/rbc
⁃ consult physician and OB
Management
⁃ Corticosteroids (prevent inflammation)
⁃ NSAIDs (prevent inflammation)
⁃ Salicylates/heparis (prevent clotting)

GASTROINTESTINAL DISORDERS
appendicitis
⁃ when ruptures can lead to sepsis or peritonitis
⁃ when pregnant, operation will take place even if you’re pregnant
gastroesophageal reflux disease or hiatal hernia
⁃ GERD
⁃ gastric secretions umaakyat sa esophagus leading to heart burn🔥
⁃ antacids will be given to manage discomfort
Cholecystitis and cholelithiasis
⁃ gallstones
⁃ stones in gall bladder
⁃ right upper quadrant pain
⁃ management: removal is necessary if madami na or malaki na, if hindi pa
pregnancy will continue but after delivery gallstones will be removed
Pancreatitis
⁃ inflammation of the pancreas
⁃ treated using medication and diet
Inflammatory bowel disease
⁃ problems with intestine
⁃ antibiotics

NEUROLOGIC DISORDER
seizure disorder
⁃ epilepsy
⁃ know what is the trigger if there’s any
⁃ make sure that patient is safe physically during attacks
⁃ time the attack (patient can’t breathe during attack; there will be
deoxygenation in the brain)
⁃ usually last 30secs to 1min, if it goes beyond, patient should be
oxygenated with rescue breathing call ambulance
⁃ make sure the patient will be referred to a neurologist
⁃ kepra maintainance drug if pregnant dosage will be compromised
MUSCULOSKELETAL DISORDER
scoliosis
⁃ extra weight will cause pain
⁃ if scoliosis is severe, patient cannot go in labor and delivery due to
the cephalopelvic disproportion
⁃ referral to a spine doctor
⁃ braces should be worn
⁃ CS birth if severe
⁃ pain management

ENDOCRINE DISORDERS
hypothyroidism
⁃ decrease in secretion of thyroxine in the body
⁃ thyroxine enzyme secreted by thyroid which helps with metabolism,
ovulation, temp control
⁃ easily get tired
⁃ is overweight
⁃ dry skin
⁃ can’t tolerate cold environment
⁃ endocrinologist
⁃ given synthetic thyroxine
Hyperthyroidism
⁃ over secretion of thyroxine
⁃ increased heart rate
⁃ protruding eye balls (exophthalmus)
⁃ laging init na init
⁃ nervousness
⁃ palpitations
⁃ weight loss

CANCER
⁃ if diagnosed with cancer while pregnant will talk to physician. Next
step will depend on severity. If you want to go on chemotherapy, doctor will ask
but abortion will happen.
⁃ principle of double effect: getting chemotherapy while pregnant is
morally and legally accepted even if it will lead to abortion

MENTAL ILLNESS
⁃ mother needs to be referred to psych team

sa langhap👃🏻😃 mo’y nananabik 🫦🫦 makita 🤓🧐 ka lang 🫵🏻🫵🏻 ang langhap 👃🏻🤪😛mo bawat
parte 🫦🥵 malinamnam 🤤😛 diba 🤨❓‼️leeg 🥵 dibdib 🫦 hanggang hita 🤪 ulalayam 😫🖐🏻 kahit
pwet 🍑 katakam-takam 🤤🥵🫦🫦✨✨

————————————————————————————————————————————
BLEEDING DISORDERS
⁃ During pregnancy bleeding should not happen just mild spotting
⁃ end outcome: hypovolemic shock (no enough blood circulation to keep
heart working)
⁃ active bleeding > decrease intravasculqr volume > decrease blood return
to the heart > decrease cardiac output > lower blood pressure > body will try to
compensate (increase HR, vasoconstriction of peripheral vessels (to save the blood
for the vital organs)), increase RR > there will be cold, clammy skin due to the
lack of blood, decrease tissue perfusion, fluid shift from interstitial spaces to
intravascular spaces (all fluids will come in to compensate with the blood loss
resulting to dry skin) > Bp continues to drop > reduce renal perfusion > poor
brain/cerebral perfusion > lethargy, confusion > decrease UO > renal failure >
maternal and fetal death
Abortion
⁃ under 16weeks AOG
⁃ loss of pregnancy before viability (below 20weeks or less than 50g
types of abortion
spontaneous abortion
⁃ not induced,
⁃ nangyare nalang
a. threatened abortion
⁃ there is vaginal bleeding or spotting, usually starts with scant
bleeding, then progresses to a bright red bleeding but there is no cervical
dilation, if cramping or uterine cramping, feeling of having dysmenorrhea, the. you
are experiencing threatened abortion
⁃ there is still chance to continue pregnancy
⁃ management: ultrasound, Maternal serum beta-hCG and progesterone level
⁃ woman may be advised to limit sexual activity until bleeding has
ceased, note quantity color of bleeding, look for evidence of tissue passage which
will indicate progression beyond threatened abortion.
⁃ drainage with foul odor suggest infection
⁃ psychological support is very important
b. inevitable abortion
⁃ something that will happen and cannot be stopped
⁃ maybe because pumutok ang panubigan or nag dilate ang cervix
⁃ there will be cramping and active bleeding (bright red)
⁃ if products of conceptions will be evacuated immediately as it may lead
to further bleeding and infection
⁃ management: vacuum currettage, dilation and curettage
c. incomplete abortioni
⁃ some of the products are expelled naturally but some remains
⁃ fetus will be expelled out naturally but placenta and other products of
conception will be left in the uterus
d. complete abortion
⁃ opposite of incomplete abortion
⁃ entire products of conception are expelled
⁃ after passage of all products uterine bleeding and bleeding subsides
and cervix closes
⁃ management: no admitted intervention required (surgery, medication) if
there is active bleeding and infection
Ectopic Pregnancy
⁃ 1st trimester
H-mole
⁃ gestational thropoblastic disease
⁃ 3 to 6 months
Preterm labor
⁃ 2nd and 3rd trimester of pregnancy
Abruptio placenta
⁃ 3rd trimester
Premature rupture of membrane
⁃ may happen during 2nd and 3rd trimester

Recurrent Spontaneous Anortion

⁃ paulit ulit nalalaglagan
⁃ pwedeng inaataka ng katawan mo yung baby your body creates antibodies
(you are RH negative, baby is RH positive)

Ectopic pregnancy
⁃ pregnancy outside the uterus
⁃ can occur in the abdomen or cervix, 97% occurs in the fallopian tube
⁃ who are at risk?
scarring in fallopian due to infection (PID), Failed tubal ligation, IUDs,
⁃ clinical manifestations:
missed mens period, positive pregnancy test, abdominal pain, vaginal spotting
⁃ if occurred in fallopian, rupture of the tube may occur within 2 or 3
weeks of the missed period
⁃ symptoms: pain in lower quadrant, profuse abdominal hemorrhage,
radiating pain under the scapula (indicate bleeding into the abdomen caused by
phrenic nerve irritation, hypovolemic shock, some doesn’t have active vaginal
bleeding due to close cervix, low BL, hypothermic, tachycardic, pale,
⁃ determined by beta-hCG, transvaginal ultrasound,
⁃ if gestational sac cannot be visualized when beta p-hCG is present
⁃ visualization of intrauterine preg does not rule out an ectopic
pregnancy grape like
⁃ management: if nalaman ng maaga (1 week or 2, before rupture),
methrotrexate may be given to help remove ectopic pregnancy. If ruptured, control
bleeding to prevent hypovolemic shock
⁃ mngmnt: cardio stability, pain control, psycho support, Methotrexate ad

HYDATIDIFORM MOLE / MOLAR PREGNANCY / H-Mole

⁃ trophoblastic cyst
⁃ grape like cyst
⁃ abnormal proliferation of trophoblast cells; fertilization or division
defect then degeneration of the trophoblastic villi
⁃ embryo will not develop, will look like grapes instead of embryo >
fetus
Complete mole
⁃ All trophoblastic villi swell and became cystic
⁃ early termination of embryo development
⁃ chromosomal analysis: karyotype is a normal 46XX or 46XY
Partial mole

Assessment:
⁃ overgrowth of uterus
⁃ (+) pregnancy test
⁃ no fetus present on ultrasound
⁃ bleeding
⁃ gestational hypertension
causes:
⁃ low protein intake
⁃ older than 35
⁃ Asian heritage
⁃ blood group A women married to blood group O men
mngmnt:
⁃ methotrexate (attacks growing cells)
⁃ Dactinomycin (ordered once metastasis occurs)
⁃ suckingb& curattage

Intervention
⁃ observe bleeding & shock
⁃ monitor bp
⁃ encourage verbalization of feelings
⁃ give open & trusting environment

INCOMPETENT CERVIX
⁃ dilates prema
Cause
⁃ increase maternal age
⁃ congenital structural defects
⁃ trauma (ex. repeated D&Cs)
Assessment:
⁃ painless dilation
⁃ pink stained discharge
⁃ increase pelvic pressure > rupture of membrane > discharge of amniotic
fluid
⁃ contractions begin > labor

———————————————————————————————————————————
Problems with passenger

1. umbilical cord prolapse

⁃ cord slips down front of the presenting fetal part
⁃ lumabas cord tas nasa loob pa fetus
risk faxtors/cause:
⁃ rupture of membrane (check fhr
⁃
1. fetal maloresentation
2. fetal malposition
3. fetalsize

———————————————————————-
Problems with power