INTRODUCTION TO
SYSTEM
MATERNAL CARE NURSING
DRILLS
1. Which structure is the tissue that extends
from the clitoris to the posterior
fourchette?
• Vaginal postitude
2. Which three ligaments provide the uterus
with support
• broad, round, and uterosacral
ligaments
3. You are caring for a woman in labor. The
doctor is concerned that the uterus might
rupture. Which part of the uterus
requires closest assessment because it is
the thinnest part of the uterus?
• ower uterine segment
4. Which ovarian hormone predominates
during the proliferative phase of the
uterine cycle?
• Estrogen
5. What are the three layers of the corpus
or body of the uterus?
• Perimetrium, myometrium,
endometrium
•
ANATOMY OF MALE AND FEMALE
ANATOMY OF FEMALE REPRODUCTIVE
VAGINA
• Dyspareunia - persistent or recurrent
genital pain that occurs just before, during
or after sex.
o What to use if vagina is dry:
▪ Water based lubricant
▪ Sterile Water
• Rigid Hymen – thick hymen which may
interfere in menstrual flow
o Psuedo ammenorhia – it is when
you don’t get your menstrual
period
o Surgery done : Hymen perfusion
Execise Done After Birth To Help With Hymen:
1. Kegels Exercise (done after birth)
- will use same muscle (Pubococcygeal
Muscle) if you are holding your urine
- 4 contractions , 1 relaxation
Advantages:
- can prevent urinary infection
- increase blood supply which result to
faster healing of episiotomy
- restores vagina to non-pregnant state
PERINIAL AREA
-1-
 • Anal Sphincter – muscles form a ring
around the anus.
o If lacerated, person will lose
control of bowel.
• Episiotomy – done to prevent laceration
2. Prostaglandin Theory
3. PROGESTERONE Deprivation Theory –
prevents the uterus from contracting
4. Hollow organ stretched to its maximum
capacity > contract to expel its contents
o A mother should void every 2
hours

ENDOMETRIUM, PERIMTRIUM, MYOMETRIUM

ENDOMETRIUM
a. Functional Layer – the one prepared every
month for implantation
b. Basal layer

• RITGEN’S MANEUVER – perianal support

before head extension of the baby
• Episioraphy – Repair of episoitomy

STRUCTURES OF UTERUS

DECIDUA
- If women got pregnant functional layer will
thicken 4 times which will now be called decidua

Three types of Decidua:

(1)Decidua Basalis – placental attachment is
formed here
- Zona Basalis – post partum basalis

(2) Decidua Vera and (3) Decidua Capsularis – will

fuse to become one
Hormones:

1. Estrogen – thickens the myometrium

2. Progesterone – stimulate muscle
relaxation, prevents muscle from
contracting; hormone for pregnancy
o Uterus must not contract
o Drops when mother goes to labor
3. Oxytocin – stimulates contraction
4. Prostaglandin – biochemical agent by
FALLOPIAN TUBE
uterus that stimulates contractions

THEORIES OF LABOR

1. Oxytocin Theory

-2-
 b. LH – responsible for the development of
corpus leteum
• Luteinizing Hormone → Ovulation

Ovarian Cycle
1. Follicular Phase
a. pwede magbago ang phase nato
depends sa person
b. Can last to 25 to 35 days
2. Ovulation
3. Luteal
a. Isthmus - part that is ligated
a. Polymenorrhea – short intervals
- once ligated, hindi na uli
less than 25 days menstruation
makakabalik sa original function
b. Oligomenorrhea – more than 35
nya
days before getting menstruation
b. Ampulla – Usual site of Fertilization

Risk of Ligation of the Fallopian Tube

a. Ectopic Pregnancy

Progesterone - Hormones responsible to nurture

the fertilized egg

OVARY
• Primodial Ova (at birth) : 300,000 to
400,000
• By Age 7: reduced to ½ in number
• Number that reach maturation: around
400 (200/ovary)
• From Age 9 to 16 : menarche
o Malnutrition – can delay menarche
UTERUS CYCLE
• Turner’s Syndrome – genetic/44
chromosome
1. Menstrual - Shedding
o Will not have a fully develop
2. Proliferative
reproductive system
a. Estrogen – hormone in charge
• 35 Reproductive Years – normal years to
b. Thickening of uterus
empty ovary 7
3. Secretory phase – ready for implantation
a. Progesterone – responsible for
NOTE: 20 – 40 yrs old – New Age for High Risk
implantation
Pregnancies
4. Ischemic Phase
a. Degeneration
Hypothalamus → GnRH (Gonadotropin
hormone-releasing hormone) → AP
MENOPAUSAL
a. FSH - Follicle Simulating Hormone
1. Hormone Replacement Therapy
• Follicle Simulating Hormone → Primordial
- ERT (Estrogen Replacement Therapy)
Follicle → Graafian Follicle
Estrogen – ERT
-3-
 a. No estrogen DATE: 12/1/2023
b. Bone density scan – loss of calcium BIRTH CONTROL / FAMILY PLANNING
deposits.
o Preventive: 1. Natural Family Planning
→ Exercise – weight bearing Disadvantages:
exercise a. Only up to 96% safe
c. Loss of Height – manifestation of
osteoporosis 2. Artificial Method
a. CP – 99% sade
BREAST CANCER b. IUD – 98% safe
- also safe but have its effect on
- does not have life threatening effects
- but have adverse side effect

3. Permanent
- Vasectomy & Ligation

NATURAL FAMILY PLANNING

1. BEHAVIORAL METHOD
a. Abstinence or “Coitus Reservatus”–
the couple is the one deciding
b. Withdrawal Method or “Coitus
Interruptus”
• Disadvantages:
→ Cowper’s Gland – pea sized glands
present inferior to the prostate
gland in the male reproductive
system. It produced thick clear
BSE (Breast Self-Exam)
mucus prior to ejaculation
• done a week after menstruation → may result to pre-ejaculation
• use the index finger and thumb pregnancy (250,000 sperm – ready
1. Hands on side for ejaculation)
2. Hands above the head → Only 1 sperm is needed to result in
3. Hands on the waist and body leaning pregnancy
forward
• Palpation of lump or bump 2. CALENDAR METHOD
1. Circular a. Regular Cycle – same interval every cycle
2. Tail of spencer – from center to outer varies from 25 – 35 days
3. Longitudinal – from center → 9 days Rule / Ogino Knaus – 3 days
• Nipple for discharge – to check for pus or after the last of menstruation
any discharges → To get the Abstinence day –
• Orange-peel appearance • # of Cycle – 14 days = Ovulation
Date
o MAMOGRAM – • Ovulation Day (less 5 and add 3 to
→ done from age 40 to 50years old every the date) = Abstinence Dates
2 years
→ done 50 yrs after b. Irregular Cycle – does not have the same
days of cycle

-4-
 → For 6 months – have different number
of cycles
• For the shortest # of cycle deduct
18
• For the longest # of cycle add 11
→ Breastfeeding – at least 6 times during
the day and 2 time during the day
ARTIFICIAL FAMILY PLANNING

1. CHEMICAL METHODS
3. BILLING’S METHOD / CERVICAL MUCUS – use of spermicides
→ Estrogen > dilation cervix > releases
mucus – watery clear; spinnbarkeit – 5-10
cm or 6 -12 of stretch, ph 8 (UNSAFE)
→ Progesterone > closed cervix > sticky
and cloudy mucus – 3 cm stretch , pH 6
(SAFE)

2. LOCAL BARRIER METHODS

TYPES OF LOCAL BARRIER METHODS

a. Diaphragm
- can be used an older adolescent
- cannot be bough over the counter (need
4. TEMPERATURE METHOD / BBT (BASAL prescription
BODY TEMP) - Inserted up to 2 hours before coitus and
→ Core body temperature during rest remove 6 hours after coitus
→ Estrogen – Body temp drop (0.5 F drop) - Rechecking the Size of Diaphragm:
→ Progesterone – body temp rises • After pregnancy/any surgery that
Abstinence – From drop of temp to rise involves the vagina you can be
temp + 3 days = days of abstinence remeasured again after 6 weeks
• Weight gain of 15lbs or more
5. SYMPTO - THERMAL • Weight loss of 15lbs or more
- Combination of the Billing’s method and
temperature method
Ovulation Signs:
a. Increase Libido
b. mittelschmerz – pain in the lower
quadrant (an ovulation pain)
c. Breast – sensitive to touch because it is
stimulated

6. LAM (LACTATIONAL AMENORRHEA

METHOD)
- breastfeeding method which would help
in preventing pregnancy
- Method can be used for at least 6 Steps of Putting Diaphragm:
months after pregnancy 1. Put jelly on the rim of tool
-5-
 2. Insert the diaphragm
3. Push the rim of the
Types of Hormonal Method:
After care for a Diaphragm:
1. Wash with warm water and mild
unperfumed soap
2. Dust with some cornstarch
3. Store in a cool, dry place
b. Cervical Cap
- has a snugly fit in the cervix, which
prevents sperm from entering the uterus
c. Condom – a thin, stretchable rubber
• Male Condom
• Female Condom
- 20% safe only
3. HORMONAL METHOD (Anovulatory
Menstruation) – prevent pregnancy by
inhibiting the hypothalamus and anterior
pituitary so that ovulation does not occur.
a. Injectable
- 3 months effectiveness
- 1 year to resume fertility
- Depo-Provera (Depo-
medroxyprogesterone)
(a) 3-months injectable
contraceptive pill
b. Implant
- 6 capsules of pregestin are inserted
subcutaneously in the upper woman’s
upper arm; after insertion not visible
to the eye
– 1 year effectiveness for latest
versions of Implant
- Return of Fertility
c. Oral Contraceptive Pills (OCP)
– is took everyday
– has many adverse effect
– can cause nausea or vomiting if
taken after meal
– taken at the first day of menstruation
• Combination Oral Contraceptive
– contain continuous doses of
estrogen and progesterone
- Taken every day at most
convenient time for the patient but
should be taken at a regular time
- If missed; can double dose at the
next day for the same time
• Triphasic Oral Contraceptive
-6-
 – there are 3 different
combinations of estrogen and
progestin taken during the
menstrual cycle
• Minipill
- progestin – only pill
- Less side effects
• “Morning after” pill
- Contain estrogen only
- Taken after unprotected
intercourse at midcycle
- form of Abortion
NOTE:
PERMANANENT FAMILY PLANNING
Surgical Method:
5. Ligation
- the doctor uses a device like a small
telescope called a laparoscope to look at
the pelvic organs and identify the fallopian
tubes so they can be blocked or cut.

CONTRAINDICCATIONS:
A. Undiagnosed vaginal bleeding
B. Thromboembolic disorders

ADVERSE EFFECTS:
A – Abdominal pain (severe
C – Chest pain (severe) or shortness of breath
H – Headaches (severe)
E – Eye problems (blurred vision or loss of
vision)
S – Sever leg pain ( calf or thigh) 6. Vasectomy
- Need to use condom 1 whole month
4. IUD (Intrauterine Devices) after the procedure
- Newly Inserted IUD – needs to be checked - 3 times to check Sperm Check after
weekly procedure
- when with swelling – must take antibiotic first a. 1st month
b. 2nd month
c. 1st yr after

ADVERSE EFFECTS:
P – period late or skipped
A – Abdominal pain
I – Increased temperature, chills
N – Noticeable vaginal discharge; foul smelling
discharge
S – Spotting, bleeding, heavy periods, clots
PREGNANCY
-7-
- Fertilization – Union of 2 ovum and implantation
- 23 (female: x chromosome) + 23 (male: x or y
chromosome) = 46 (44 automes ; 2 chromosems)
- MEN: deretime the gender of the nany (XX:
male; XX: female)
Formation of the gende starts of the baby starts
to develop at 2nd month and ends at 3rd month
- Xygote – Formend from the union off egg and
sperm
- Genotype – genetic makeup
- Phenotype – physical trait implantation
- The location of the Placenta will determine who
is older in a twin
- quickening – mother feels first fetal movement
can start up to 4 – 5 mos (for multipara as early as
___ weeks)
• Ideal movement of a baby in an
hour: 10 counts
• More than 10: pwede may fetal
distress
--- dexamethasone or betamethasone (steroids) –
helps to develop baby surfactant;
IMPLANTATION/NIDATION
- will take 6 – 8 days or at least 1 week after
fertilization to form the egg
Stages of Implantation
a. Zygote > Mitosis > (2 cells stage; divided into 2
but still intact) Blastomere > Morula > Blastocyst
> Endometrium
Morulo
• Parabiosis – twin to twin transfusion (e.g.
shared cord but transfusion of wastes
result to death
• Monozygotic Twins – Zygote is split into
two; Consist of one placenta; may result
to death of one child
• Dizygotic Twins – Has 2 separate placenta
Blastocyst
• Trophoblast – outer layer of the Blastocyst
• Corion – will help develop the placenta
• Amrion – Develon into amniotic sac and
amniotic Fluid
• Embryoblasts- the fetus; Inner portion of
the blastocyst
PLACENTA
-
• Combination of the chorion and decidua
basalis because chorion attaches at DN
• 16 to 20 cotyledon makes up a complete
placenta
• development starts at the 3rd week and
become fully developed at 3 months
• Attaches to the mid upper segment then
spread to the side
• most common position (posterior part)
• HCG continues to double in number every
2 days; it reaches its peak until 3rd month
or until placenta is formed > it will drop
after 3 month and it will be sustained at a
low level
• Ectopic – HCG does not increase
• Abortion – suddenly drops
• Hydatidiform mole (H mole) – HCG
continues to increase after 3rd month
• Umbilical arteries carry the waste
products
• Clients with end stage kidney disease can
still get pregnant, given that they will
receive peritoneal dialysis
• Clients who received kidney transplant can
still get pregnant as long as the patient
will take steroids
• Placenta life span: 38 – 40 weeks
• Purpose: nourishment of the baby
• Folic Acid – important in the maturation of
RBCs (macrosize RBCs: Folic Acid
Deficiency)
• Iron – carrying oxygen (microsize RBCs:
Iron Defiency
DEVELOPMENT OF PLACENTA
Chorion → Chorionic villi → Enzymes (open to
maternal vessel) → Open → Lacunae (Blood Lake
– where blood stays temporarily) > Multiplication
> Cotyledon
CHARACTERISTICS OF MATURE PLACENTA
a. Diameter – 15 to 20 cm (6 -10 inches)
-8-
 b. Thickness - 2.5 to 3cm
c. Weight – 400 to 600 grams (1 to 1.5
lbs)
d. 15 to 20 cotyledons (segments)
separated by fenestrated septa
sklajd
PLACENTAL DEGENERATION
→ Is a phenomenon where numerous cystic
spaces are formed within the placenta which is
often accompanied by placental enlargement.
→ It can occur in a first trimester pregnancy loss.
• IGG –
• IGF –
Human Placenta Lactogens –
AMNIOTIC FLUID
• 98% water 2% salt
• Continuously produced by amnion + fetal
urine
• Average amount at term : 1000ml
• Hydramnios: >2000 ml (fetus unable to
swallow has to do with connection of
trachea to )
• Oligohydramnios: <400 ml ( fetal kidney
problem)
• Draws the sound of the fetal heartbeat of
the fetus to be able to heartbeat of the
fetus
• Using doppler FHT can be heard as early
as 3 months
• Using a Stethoscope : as early as 4 – 5
months
Amniocentesis
• The aspiration of amniotic fluid from the
amniotic sac for examination s
• genetic testing done to determine the AFP
• Alpha feto – High value might be indicate
of neural rube defects; low value might be
indictive of down syndrome
• To check the maturity of the fetal orangs
o Respiratory Syndrome-
• Abdominal Ultrasound - to know where to
puncture need visualization first (Full
bladder)
• TVS utz – (empty bladder)
• Can result to pre-mature labor kasi hindi
nag heal agad nag leak into the vagina
o 7 months below – pregnancy loss
o 7 months above – premature labor
Characteristics:
a. Clear straw colored
Functions:
a. Cushions feteus against mechanical injury
b. Controls the fetus temperature (25 – 28
degree Celcioous)
c. Permits symmetrical fetal development
d. Prevents adherence of the amnion to the
fetus
e. Allows freedom of movement → change
in position of fetus → musculoskeletal
development
f. Source of oral fluid for fetus
g. Excretion-collection of wastes
UMBILICAL CORD
• Normal: As long as the baby
• Short Cord: Causes Abruptio
After Fertilization: Stages of Development
1. Pre embryonic 1st 14 days after
fertilization
2. Embryonic – day 15 until the 8th week or
until the embryo reaches a crown to rump
length of 3cm; organogenesis ( most
susceptible to teratogens)
3. Fetal – end of 8th week to end of
pregnancy
PREGNANCY
-9-
PHYSICAL CHANGES IN PREGNANCY
1. Hair Growth
• Increased Estrogen
• After 3 months
2. Face
• Chloasma – mask pregnancy
• Freckles may develop
3. Melasma
• Darkening of the armpit and other
parts of the body beside the face
4. Gums
• Hypertrophy – pamamaga of the
gums
• Reddish color of the gums
• Prone to gum infection
• Mx:
5. Thyroid Glands
• Hypertrophied due to estrogen
• Increased metabolism
• Incre
6. Breast
• Darker Nipples
• Increased of Brease Size
• Montgomery Gland Prominent –
activated while pregnancy
7. Heart Rate
• Increased heart rate (normal 10
beats more in resting position)
8. Blood Pressure
• BP Vasodilation → Lower BP = 2md
Trimester
• 100/60 mmhg
• Estrogen causes vasodilation
• Increased → Pregnancy Induce
Hypertension
• Gestational Hypertension – No
signs and symptoms except high
value of BP
• Pre-eclampsia
• 20 -24 weeks – watch out for BP
value
• BP returns to normal in the 3rd
Trimester
i. 120/80 mmhg/
9. LINEA NEGRA
• Darkening of the
10. DIASTASIS RECTUS ABDOMINIS SEPARATE
• Pag stretch of the abdomen
11. Stretch Mark – ISTEA GRAVIDARU
12. Lordosis – an exaggerated curvature of the
lumbar spine
• Waddling Gait – unstable
movement ; duck like walk
• One inch wedge shape heel or
Rubber Shoes is recommended
13. Backache
• Tailor Squat is recommended
• Pelvic Rock exercise is
recommended
14. Carpal Tunnel Syndrome
15. Edema
• Seen in Feet
• Poor venous return
• Elevate Leg
16. Varicosity
• Wear support stockings/anti
emboli stockings
17. Leukorrhea
• Increase vaginal discharge
• Mucus plus or “opercular”
• Show of labor
• Indicate that cervix is dilated –
starting the labor
• Ce
Gravida – number of times women got pregnant
12/9/2023
SYSTEMIC CHANGES IN PREGNANCY
NORMAL DISCOMFORTS
1. Skin
• Chloasma – face
• Melamsa Face
2. Cardio Vascular System
• Increased blood volume → up to
50% increased (3rd trimester) and
30% increased (2nd trimester)
because of increased fetal demans
• Easy fatigability shortness of
breath, palpation
3. EXERCISE
• Can do whatever exercise that she
as long as it is not dangerous
• Jumping, skip and bounce
- 10 -
 • Cannot lay down flat on back
because it may suppress the vena
cava
• If wala experience in exercising
walking is enough for the pregnant
women.
• Pelvic Rocking Exercise – relieves
back ache
• Tailor Sitting Position
Exercise Program Example:x
• 10-15 min warmup
• 30-40 min active
• 10-15

4. Respiratory Function
• Shallow Breathing is not done
• Increased carbon dioxide level →
effect of progesterone and fetal
waste
• Prone to hyperventilation = deep
breathing
• If hyperventilated = blow through a
brown bag or cupped hand
5. Gastrointestinal
• smooth muscle relaxation (
Progesterone) → decreased
peristalsis
• heartburn or PYROSIS
• Constipation and gas
• Morning Sickness = psychological,
hormonal, hypoglycemia
6.
7.
8.

- 11 -