NCMA219 OB LEC Preliminary 2022 (PDF)

Bachelor of Science in Nursing 2YB NCMA219 OB LEC: BSN 2ND YEAR 2ND SEMESTER PRELIM 2022 - 22 pairs of autosomes (homologous autosomes) – Coverage for Prelim:...

Bachelor of Science in Nursing 2YB NCMA219 OB LEC: BSN 2ND YEAR 2ND SEMESTER PRELIM 2022 - 22 pairs of autosomes (homologous autosomes) – Coverage for Prelim: homologous, they have the same pattern/ shape. Genetic Assessment and Counselling - 1 pair of sex chromosomes (No. 23) High Risk Pregnancy Terms: - Diagnostic Exams Phenotype – outward appearance of a person - RA 9262 Genotype – a person’s actual gene composition of person - Bleeding disorders (1st2nd3rd trimester) Genome – complete set of genes. Example: 46XX or 46XY - Gestational conditions (Hyperemesis gravidarum, (46 – no. Of chromosomes: XX – gender, 46XX – it has 46 PIH, Gravido Cardiac, GDM, Isoimmunization, chromosomes and it’s a female) Anemia) p-short arm defect – above part Problems During Labor and Delivery q-long arm defect – lower part - Problems with 4 P’s - Intrapartal complications Nature of Inheritance Postpartum Complications - Each cell, except for the sperm and ovum, contains 46 - Postpartal hemorrhage chromosomes (22 pair of autosomes and 1 pair of sex - Lacerations chromosomes). Spermatozoa and ova each carry only half of - Puerperal infection the chromosome number, or 23 chromosomes. For each - Emotional and Psychological Complications of chromosome in the sperm cell, there is a like chromosome of Puerperium similar size and shape and function (autosome, or homologous Male and Female Clients with General and Specific chromosome) in the ovum. Problems in Reproduction and Sexuality - A person’s phenotype refers to his or her outward appearance - Infertility, Alternatives to Childbirth or the expression of genes. A person’s genotype refers to his - Cystocele/ Rectocele or her actual gene composition. - Normal genome is abbreviated as 46XX or 46XY (designation GENETIC ASSESSMENT AND COUNSELLING of the total number of chromosomes plus a graphic description Discussed by Prof. Carmencita Pacis of the sex chromosomes present). Genetic disorders - Inherited or genetic disorders are disorders that can be passed Mendelian Inheritance: Dominant and Recessive patterns from one generation to the next. - By Gregor Mendel - Cytogenetics is the study of chromosomes by light microscopy - Dominant gene and non-dominant gene and the method by which chromosomal aberrations are - Kung may problema ka sa dominant gene then may problem identified. ka rin sa dominant inheritance, kung may problema ka naman Nature of inheritance sa non dominant gene then may problem ka rin sa recessive Mendelian inheritance inheritance. - Dominant pattern - A person who has two like genes for a trait—two healthy - Recessive patterns genes, for example (one from the mother and one from the - X-Linked father)—on two like chromosomes is said to be homozygous Inheritance of disease for that trait. If the genes differ - r (a healthy gene from the mother and an unhealthy gene from Inherited or Genetic Disorders the father, or vice versa), the person is said to be heterozygous - Disorders that can be passed from one generation to the next. for that trait. - Namamana - What are you going to inherit? Brown eyes, blue eyes, black Genetics hair. - Study of the way such disorders occur. - How this genetics or heredity disorders occur? Cytogenetics - The study of chromosomes by light microscopy and the method by which chromosomal aberrations are identified. - Used slide to visualize the chromosomes. Genes - Basic unit of heredity - Made up of DNA - DNA – they are intertwined with one another to be able to - The father inherited non dominant gene from his parents, and create chromosomes. his parents has both blue eyes = blue eye. The mother - DNA – basis of heredity; RNA – synthesizes protein for inherited one non dominant gene which is blue eyes from her cellular growth, supports DNA growth and heredity. one parent and one dominant gene which is brown eyes from - Human being composed of 46 chromosomes (23 pairs) one parent. J.A.K.E 1 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 - If the combination will be dominant brown and non-dominant Inheritance of Disease blue, brown will dominate. Autosomal dominant inheritance - Both non dominant and both dominant (same) – homozygous - “Autosomal" means that the gene in question is located on one - One dominant, one non dominant (different) – heterozygous of the numbered, or nonsex, chromosomes. "Dominant" means that a single copy of the disease-associated mutation is enough to cause the disease.” One Parent – one of the parents of a child with the disorder also will have the disorder Sex – the sex of the affected individual is unimportant in terms of inheritance History – there is usually a history of the disorder in other family members - Homozygous – healthy gene + healthy gene - Heterozygous – healthy gene + unhealthy gene - If the father is both dominant gene (BB) and mother is both non-dominant genes (bb). The father will dominate, and the combination is heterozygous. What type of heterozygous? Dominant. So the baby will be heterozygous dominant. - Autosomal – the first 22 chromosomes are autosomes almost the same pattern and shape. And no. 23 chromosome is the sex chromosome. - The father has one healthy non-dominant gene and one disease - If the father has dominant and non-dominant gene, and the dominant gene, while the mother has both healthy non- mother has both dominant gene, then the baby will be dominant gene. Therefore, 50% chances the baby will have homozygous dominant. (Kasi magkapareho ung nanay at tatay healthy gene (hh). And 50% chances the baby inherit the kaya naging homozygous, at both silang dominant, kaya dominant disease gene (hd & Dh). naging homozygous dominant) - If the father has non-dominant and the mother has dominant, then the baby will be heterozygous dominant. (magkaiba sila – non domi at domi, kaya tinawag heterozygous.) - If the father has non dominant and the mother also has non- dominant, and the baby is homozygous non- dominant/recessive. (magkapareho silang non-dominant kaya homozygous dapat.) - If the mother has both dominant gene and the father has one - The father has dominant disease gene and non-dominant dominant gene and one non-dominant gene, the child will healthy gene, and the mother also. Then 25% chances the baby become homozygous dominant 25%. And the heterozygous will get healthy (hh) but the 50% the baby will have disease dominant is 50%, then homozygous non-dominant is 25%, gene (hd & Dh) and when it’s both dominant disease (DD), the total of 100%. baby will be incompatible in life. Pwede syang mamatay sa - Each box has 25%. May dalawa syang heterozygous dominant uterus or during labor and delivery. kaya 50%. Pero yung homozygous dominant (orange) at homozygous non-dominant (green) ay iisa lang kaya naging 25% J.A.K.E 2 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 Disorders Huntington’s Disease - The father has one dominant healthy gene and one non- dominant disease gene while the mother has one dominant healthy gene and one non-dominant healthy gene. Therefore, 25% chances the baby will be healthy (HH), the 50% chances the baby will be a carrier of the disease but he’s not experiencing any sign and symptoms (Hd – dh). And 25% of the baby will be disease state (dd) (hindi sya incompatible in Marfan Syndrome life kasi non-dominant yung may disease, mas malakas yung dominant kaysa non-dominant) - The father has both dominant healthy gene while the mother has one dominant healthy gene and one non-dominant disease gene. Therefore, 50% chances the baby will be healthy (HH) and the 50% chances the baby will be a carrier of the disease (dh) – not experiencing any sign and symptoms. So, no baby will experience a full-blown disease, they can be only a carrier Autosomal recessive inheritance that can pass on to the next generation. Because most of the - A genetic condition can occur when the child inherits one genes are healthy and dominant copy of a mutated (changed) gene from each parent. The parents of a child with an autosomal recessive condition usually do not have the condition. - The father has both dominant healthy gene while the mother has both non-dominant disease gene, therefore, 100% the baby will be a carrier of the disease (dh) (not experiencing any sign and symptoms. - Both parents of a child with the disorder are clinically free of the disorder. - The sex of the affected individual is unimportant in terms of inheritance. - The family history for the disorder is negative—that is, no one can identify anyone else who had it (a horizontal transmission pattern). - The father has one nondominant disease gene and one - A known common ancestor between the parents sometimes dominant healthy gene while the mother has both non- exists. This explains how both male and came to possess a like dominant disease gene, therefore 50% chances the baby will gene for the disorder. disease state (dd) (nakakaexperience sya ng disease pero hindi sya incompatible in life/ mamamatay) and 50% chances the baby will be a carrier (dh) (not experiencing s&s) J.A.K.E 3 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 - X-linked dominant inheritance occurs when a gene responsible for a trait or disorder is located on the X chromosome. - May problema sa x chromosome. It could be from ovum or sperm. Dominant Gene – All individuals with are affected. Affected – All female children of affected men are affected; all male children affected man are unaffected. Because the only sex chromosome affected is x. And male - The father has both nondominant disease while mother has is coming from y chromosome also nondominant disease. Therefore, 100% the baby will have Generations – It appears in every generation a disease (dd) (experiencing disease). Homozygous/Heterozygous – All children of homozygous affected women are affected. Fifty percent of  Dh / hd – will have a disease (nasa dominant yung disease) the children of heterozygous affected women are affected.  Hd / dh – carrier of the disease (no sign and symptoms kasi nasa - Kasi homozygous, parehas xx. Kaya affected. non-dominant gene yung disease nya)  DD – incompatible in life (both silang dominant kaya malala sya)  Dd – disease state (experiencing disease)  HH / hh – healthy Disorders Cystic Fibrosis - an inherited disorder that causes severe damage to the lungs, digestive system and other organs in the body. Sickle Cell Anemia - an inherited red blood cell disorder in which there aren't enough healthy red blood cells to carry oxygen throughout your body. - The father has both nondominant normal x and y, while the mother has dominant disease X and nondominant normal x. Therefore, 50% chance that the baby girl and boy will have a disease but the another 50% of the baby girl and boy will be normal.  Dominant disease X from the mother + nondominant normal x from the father = disease state – because the dominant X from the mother has disease and it will dominate the gene. The baby girl will have a disease.  The baby boy of the father will have the disease because the dominant of the mother has disease.  Non-dominant x of the mother + nondominant x of the father = a healthy baby girl  Non-dominant x of the mother + nondominant y of the father = a healthy baby boy X-linked Dominant inheritance - Some genes for disorders are located on, and therefore - The father has dominant disease X and nondominant normal transmitted only by, the female sex chromosome (the X y while the mother has both nondominant normal x. chromosome). If the affected gene is dominant, only one X Therefore, all the baby girls will have a disease and all the chromosome with the trait need be present for symptoms of boys will not have disease. the disorder to be manifested. - Father has dominant disease X + the mother has nondominant normal x = the baby girl will have disease. J.A.K.E 4 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 - Father has nondominant normal y + mother has nondominant normal x = the baby boy will be normal.  Blue – healthy; red - disease  Healthy x + healthy y = healthy boy  Healthy y + healthy x = healthy boy  Healthy x + healthy x = healthy girl  Disease x + healthy y = disease boy  Healthy x + disease y = disease boy  Disease x + disease x = disease girl  Disease y + disease y = disease boy - The father has nondominant normal x and y while the mother has dominant normal X and nondominant disease If the mother is affected, then 50% will have a disease and x. Therefore 50% of the children will have disease and 50% will be normal. (may isang affected sa babae at isang 50% of the children will have a disease. affected din sa lalaki, 50 50) Father has nondominant normal x + mother has dominant If the father is affected, then the baby GIRL will have 100% normal X = healthy girl disease and baby boy will be normal. (lahat ng babae Father has nondominant normal y + mother has dominant magkakasakit because X chromosome is only affected in X- normal X = healthy boy linked.) Father has nondominant normal x + mother has nondominant Disorders: disease x = the girl is carrier - Characterized by dermatological, Ocular, dental, and Father has nondominant normal y + mother has nondominant neurological Abnormalities. disease x = the boy is disease state. The X-linked Lissencephaly - (xx) – carrier lang sya kasi yung normal x na galing sa father, binabalance nya yung disease ng baby girl. Double-Cortex Syndrome Dalawang x kasi meron sya. Yung may disease na x, Incontinentia Pigmenti Type 1 nilalaban or binabalance ng healthy x, kaya wala syang s&s pero carrier sya. - (xy) – since ito wala syang another healthy x para ibalance yung problem ng baby boy, kaya naging disease state sya. - Interpretation: if both genes of the father is normal and the mother has one disease gene, then 50% chances the baby will be normal, 25% chances the baby will be a carrier, and the 25% chances the baby will be a disease state. (4 children) - The father has nondominant disease x and nondominant normal y while the mother has both dominant X. Therefore the 100% of baby girl will be a carrier and X-linked Recessive Inheritance 100% of baby boy is healthy. - X-linked recessive diseases most often occur in males. Males Father has nondominant disease x + mother has dominant have only one X chromosome healthy X = the baby girl will be a carrier Males – Only males in the family will have the disorder. Father has nondominant healthy y + mother has dominant History of Death – A history of girls dying at birth for healthy X = healthy baby boy unknown reason often exists (females who had the affected - (Xx) – the dominant healthy X is overpowering the genes on both X chromosomes.) nondominant disease that’s why the baby girl is carrier. Unaffected – Sons of an unaffected man are unaffected. Parents – The parents of the affected children do not have the disorder. J.A.K.E 5 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 Imprinting - Refers to the differential expression of genetic material - allows researchers to identify whether chromosomal material comes from the male or female parent - ability of a gene to be expressed depends upon the sex of the parent who passed on the gene - Examples: Angelman Syndrome are expressed only from the maternal chromosome 15 Prader-Willi Chromosomal abnormalities (Cytogenic Disorders) - Happens when there is abnormality in the number or structure of chromosomes - Missing, additional or distorted chromosomes. Nondisjunction - If the father x is affected, then all the girls will be a carrier - Division of chromosomes is uneven; failure to separate while the boys is healthy. (xx – carrier lang si girl kasi - Failure to separate or disjoint yung another healthy x na galing sa mother nya ay - Abnormalities occur if the division is uneven binabalance yung problem ni girl.) - if spermatozoon or ovum with 24 or 22 chromosomes fuses - If the father both x and y is not affected but the mother x with a normal spermatozoon or ovum. The zygote will have is a carrier. Then the 1 boy will have a disease while the either 47 or 45 chromosomes, not the normal 46 girl is a carrier (xy – the mother x has carrier while the - 45 chromosomes are not compatible with life and could lead to father y is healthy therefore the boy will have a disease abortion. BECAUSE yung healthy na y ni tatay ay hindi nya kayang ibalance yung problem ni baby boy. – kapag both xx yan at isang x may disease, magiging carrier na sya, kasi yung healthy x lang Disorders Red-Green Color Blindness – the person cannot distinguish shades of red and green Hemophilia A Explanation: - (xx) 1 pair of chromosomes, during pre-embryonic development that contains chromosomes will divide and we call that meiosis. Meiosis is a process of cell division where in cell becomes haploid means it will divide into half. - Normal disjunction, 1 pair of chromosomes will split into one (x) right side (x) left side. - (x) Right side chromosome will split into another haploid (l) (l). During fertilization chromosomes coming from the male will pair here kaya magiging (ll) (ll) - (x) Left side, failure to disjoin so it will not separate kaya mag kasama pa din siya (ll) tapos empty ung isa (). During fertilization chromosomes coming from the male Patterns of Inheritance: Polygenic Traits will become (ll) → (lll), () → (l). Ung isa sobra ung isa Multi Factorial (Polygenic) Inheritance kulang we call that chromosomal aberration or - Many childhood disorders tend to have higher-than usual chromosomal abnormality. incidence Example: - occur from multiple gene combinations possibly combined o Patau's syndrome (trisomy 13) with environmental factors o edwards syndrome (trisomy 18) - Do not follow the mendelian laws o Trisomy 21: 47XX21+ or 47XY21+ - No set patters in Family History o Klinefelter syndrome: 47XXY - Example: o Turner syndrome: 45X0 For example, height is thought to be Polygenically - Klinefelter (47XXY) – it’s a boy and has one extra X. inherited, but a person's stature also is significantly Boy sya pero may isa syang female trait. (sobra ng affected by adequacy of diet while growing. Cleft lip with chromosome). Prone to osteoporosis and small scrotum or without cleft palate is probably an example of a - Turner (45X0) – lacking – it’s a girl but one chromosome polygenic trait with a threshold effect. Its incidence in the is missing kaya may 0 sa huli. Missing an x chromosome general population is about 1/1000. on 23rd pair (kulang ng chromosome J.A.K.E 6 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 Translocation abnormalities - A child gains additional chromosome through another route. - Example: Cancer: several forms of cancer are caused by acquired translocations. This has been described mainly in leukemia (acute myelogenous leukemia and chronic myelogenous leukemia). Translocations have also been described in solid malignancies such as ewing's sarcoma. Deletion Abnormalities - Part of a chromosome breaks during cell division resulting to normal number of chromosomes plus or minus an extra portion of a chromosome. - Changes the dna sequence by removing at least one nucleotide in a gene. Example: - Cri-du-chat syndrome – 46xy5q (lalaking may problema Isochromosomes sa long arm chromosome no.5) - results from chromosome accidentally dividing not by vertical separation but by horizontal one so a new chromosome with mismatched long and short arms - Turner Syndrome - mutation examples in humans are: Angelman Syndrome Canavan Disease Color Blindness Mosaicism Cri-Du-Chat Syndrome - abnormal condition that is present when the nondisjunction Cystic Fibrosis disorder occurs after fertilization of the ovum as the structure Down Syndrome begins mitotic division. Haemophilia - different cells in the body will have different chromosome Phenylketonuria counts - Symptoms of Cri-Du Chat syndrome: - Mosaic Down Syndrome A high-pitched cry resembling that of a cat Downward slanting eyes Extremely low birth weight Delayed growth of the child Abnormally shaped ears Intellectual impairment Webbing or fusing of fingers Skin tags in front of ear Delayed motor development Microcephaly Small jaw Genetic Counselling Wide set eyes 1) Provide concrete, accurate information about the process of inheritance and inherited disorders 2) Reassure people who are concerned that their child may inherit a particular disorder or that the disorder will not occur 3) Allow people who are affected by inherited disorders to make informed choice about future reproduction J.A.K.E 7 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 4) Offer support to people who are affected by genetic disorders Risk Factors 5) Offer support to people who are affected by genetic disorders. Demographic Factors - Timing: before first pregnancy to prevent future problem Age: < 18 and 35 > - Consideration: confidentiality of information that couple Optimal Age for Pregnancy: 20-30 years will share - Ideal age na to para magbuntis (pero mga teh kalma pasa muna Who should undergo counselling: board exam at maging RN HAHAHA) - Couple who has a child with congenital disorder or an - The women become at risk at the age of 20-30 because inborn error of metabolism they become at risk if she primigravida, meaning 1st time - Couple whose close relatives have a child with a genetic nya mabuntis. disorder - If the age of the woman who got pregnant is below 18 or - Any individual who is known balanced translocation above 35, they can lead to hypertension. – young, carrier primigravida & multipara with advanced maternal age. - Any individual who has an inborn error of metabolism or If u got pregnant at the young age, primigravida below 18 will chromosomal disorder produce new hormones and your blood vessels can act - A consanguineous (closely related) couple wrongly. - Any woman older than 35 years and any man older than - Vasoconstriction may arise especially if they are got 55 years pregnant underage (e.g., 18 years old) and that can cause - Couples of ethnic backgrounds in which specific illnesses hypertension. Lumiliit or nag ta-tighten yung muscle are known to occur. around the blood vessel and liliit din ung lumen at dahil Nursing Responsibilities dyan nagkakaroon ng poor circulation. - Explain what procedures to undergo - The compensatory mechanism of the heart to keep it - Explain how different genetic screening tests are done and circulating is to increase the pumping action of the heart. when offered (pag lumakas ung pumping action, ung palo ng blood - Support the couple during the wait for test results against the wall ng artery lalakas kaya nagkakaroon ng - Assist couples in values clarification, planning, and decision increase in the blood pressure) and possible na ma- making based on test results hypertension sya. Genetic Disorders Assessment - May hypertension na mangyayari kase the heart will be History pump more stronger para magkaroon ng sufficient supply Physical Assessment ng blood sa mother and the baby. Diagnostic Testing If the woman got pregnant above 35 there is two factors that Karyotyping may arise: Maternal Serum Screening - Arteriosclerosis – hardening of the walls of arteries bec. Chorionic Villi Sampling of aging. (kapag tumitigas yan, nagiging less elastic sya Amniocentesis kaya kailangan ng increase pumping action of the heart) Percutaneous Umbilical Blood Sampling - Atherosclerosis – fat deposition on the walls of arteries Fetal Imaging (wrong diet) Fetoscopy - The effect of the hypertension to the baby, there will be Preimplantation Diagnoses decrease oxygen and nourishment supply to the baby kaya ang mangyayari SGA. HIGH RISK PREGNANCIES & DIAGNOSTIC EXAMS Weight – Pre-pregnant weight Discussed by Prof. Francis Vasquez Normal Birth Weight: 2.5 kg – 3 kg ave. - 4kg max. 1) Risk Factors - SGA < 2.5 kg (microsomia) a) Demographic factors - 4 kg < LGA (macrosomia) b) Socioeconomic status - Within the average – AGA (Average for Gestational Age) c) Obstetric history - (3 – 4> the baby is LGA or Large for Gestational Age) d) Current OB status - LGA, pwedeng maka affect sa normal delivery ng baby e) Maternal medical history/ status possible that the mother will undergo cesarean section f) Habits/ habituation - SGA, maapektuhan ang brain and head development that 2) Diagnostic tests in high-risk pregnancy and determination could lead to Neurological Impairment. of Fetal status o Neurological Impairment = permanent/irreversible a) Ultrasonography o IQ level = low b) Non-stress test - Pag nakakita ka ng buntis na below 18 y/o, dapat mag c) Contraction stress test health teaching tayo sakanila para maprevent ung d) Oxytocin challenge test hypertension. (Ex: low fat diet, monitoring BP every day, e) Biophysical profile monitor the weight for edema) f) Amniocentesis Pre-pregnant weight: 90 lbs and 150lbs g) X-ray: Lateral Pelvimetry - Normal Weight Gain: 24-20lbs h) Serial estriol-determination - Mother weight is < 90 lbs = Anemia (SGA) i) Chorionic villi sampling - Mother weight 150lbs > = Diabetes – mataas ang glucose j) Percutaneous umbilical blood sampling (baby size – LGA, possible cesarean section) J.A.K.E 8 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 - The most important is pattern of weight gain. Kase every - Unprepared – maybe bcz of finances trimester may sinusunod na pattern yung mother for her 5) Out of wed lock weight and yun ang ina-assess natin tuwing check-up. - Possible problem is psychological security or financial Chinecheck natin kung may sudden weight gain si mother. security. Pattern of Weight Gain: - 1st Trimester – 0.8~1~1.2 lbs/month = (3-4 lbs) Obstetric history - 2nd Trimester – 0.8~1~1.2 lbs lb/week (12-13 lbs) 1) History of infertility or multiple gestation - 3rd Trimester – 1 lb/week (12-13 lbs) - History of infertility because possibility of marital - Ex: If the pre-pregnant weight 115 lbs what is her PWG? problems o 1st tri = 118 lbs (add mo lang yung 3 months sa 115 lbs) 2) Grand multiparity - Possible problem uterine atony that can lead to bleeding. o 4th months = 122 lbs (add 4weeks) 3) Previous abortion or ectopic pregnancy o 6th months = 130lbs o if the mother became 138 lbs in her 6th month it - Previous abortion that can lead to RH compatibility or means there is Sudden Weight Gain. blood compatibility - Sudden Weight Gain – edema/manas - Ectopic pregnancy may lead to bleeding, if this is repeated - If the fluid increase between the cells (interstitial) it will the remain fallopian tube can be damage. 4) Previous loses fetal death, still birth, neonatal death or result to edema. perinatal death - Sa paa ka unang titingin para icheck ung edema - Once na may edema ang mother ang first VS na kukunin 5) Previous operative OB: Cesarian, midforcep delivery mo sakanya is Blood Pressure. - Recommended interval of CS – 3-5 years 6) Previous uterine abnormality Edema based on Grade: 7) Previous abnormal labor - Grade 0 x 2 = 0 mm Preterm – born before 37 weeks - Grade 1 x 2 = 2 mm - Grade 2 x 2 = 4 mm Post term – 42 weeks > - Grade 3 x 2 = 6 mm Prolonged labor –24 hrs > because uterine contraction is - Grade 4 x 2 = 8 (pag pinindot mo yung pa ani mother weak, this called hypotonic uterine contractions. hindi mo na nakikita yung kuko mo sa point finger) Precipitate labor – 3 hrs < hypertonic - To estimate if the baby is growing normally inside the 8) Previous high-risk infant uterus of the woman: Use Bartolome’s rule, Johnson’s Low birth weight (LBW) rule etc. Macrosomia - Factors that may affect fundic height: 9) Previous hydatidiform mole 1) Size of the baby Current OB status 2) Number of fetuses 1) Late or no prenatal care 3) Amount of the amniotic fluid - Risk factors will not be identified or are identified too late 4) Size of the mother kaya the women already develop the problem. - Health teaching to prevent hypertension: 2) Maternal anemia o Low fat diet 3) Rh sensitization o Monitoring blood pressure - Blood incompatibility o Monitoring the weight, report other s&s Height: < 5 feet 4) Antepartal bleeding - Less than 5ft – small pelvis - Abortion - Small Pelvis could cause CPD or cephalopelvic disproportion 5) Pregnancy-induced hypertension (PIH) - CPD – the baby is not able to pass through vaginal delivery - SGA (need mag CS ni mother) 6) Multiple gestation - Recommended laboratory for CPD is x-ray pelvimetry 7) Premature or post mature labor - X-ray Pelvimetry – is used to assess the dimension of the 8) Polyhydraminios maternal pelvis. (ginagawa to para ma sure yung percentage - Excessive amniotic fluid, the uterus will become bigger kung kaya ang normal delivery ng baby) then the baby have big space to move. So, the cord can - Performed by 3rd trimester 2 weeks prior EDC coil around the neck. - Never perform on the 1st trimester. (1st Trimester = 9) Premature rupture of membranes (PROM) Organogenesis) - If the amniotic sac ruptures prematurely, the mother is prone to ascending infection. The m.o. can enter the Socioeconomic Status vagina, vagina canal, cervical canal, uterine cavity. 1) Inadequate finances 10) Inappropriate fetal size - Low socioeconomic status (money) - SGA or LGA 2) Overcrowding, poor standards of housing, poor hygiene. - Prone to communicable diseases Maternal Medical history/ status - Nakakahawang sakit 1) Cardiac or pulmonary disease 3) Nutritional deprivation - Ex: permanent cardiac damage, prone to congestive heart - Balance diet failure. The mother at risk of determination of pregnancy/ 4) Unplanned and unprepared pregnancy pwedeng ipaabort – therapeutic abortion J.A.K.E 9 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 - Pulmonary disease – ex. COVID, asthma, tuberculosis - To avoid hitting the bladder by the needle, void 2) Metabolic disease before the procedure. - DM, Thyroid - UTZ aided = to locate and prevent puncturing the 3) Chronic renal disease placenta (upper uterine segment) - Repeated UTI may lead to abortion - 3 most important purposes of amniocentesis: 4) Chronic hypertension a) To determine chromosomal defect 5) STI/ STD b) Neural tube defects - There are STD that can affect the baby or can transmuted c) Fetal lung maturity to the baby. Non-stress test 6) Hemoglobinopathies - Observation of FHR related to fetal movements 7) Malignancy - 30-32nd week 8) Major emotional/ mental disorders - Accelerate – when the baby is awake and moving. - Depression - Eat your breakfast before the test. (bcz food intake increases Habits/ habituation glucose in the blood of mother, it goes to the placenta and 1) Sad habit absorbed by the fetal blood. So, the glucose in the fetal blood 2) Smoking will eventually increase after the mother ate. The increase of - Vasoconstriction, the baby can become SGA glucose will wake up the baby) 3) Alcohol o 8:30am hospital (determine if the mother ate) then rest - Neurologic impairment = permanent/ irreversible – FAS muna and get VS (FHR 130bpm before the test) fetal alcohol syndrome o 9:00 am test – left lateral position (if the mother feel the - No amount of alcohol during pregnancy baby move, ring the bell para ma notify ung nurses/ 4) Drug abuse doctor) - Neurologic impairment o 9:15 am – fetal movement (u need to wait 10mins, gumagalaw galaw in 10mins, after 10 mins get FHR) Check yourself: - Normal result = reactive/ positive/ fetal heart rate acceleration. a) Is the present weight of a pregnancy woman of 144 lbs normal - Reactive: if there’s an increase of at least 15bpm at 5th month if her pre-pregnant weight is 125 lbs? Contraction stress test Ppwt: 125 lbs - To determines reaction of FHR to uterine contraction. 1st tri = 128 lbs + 8 = 136 lbs - 34-36 week 4th-5th mos = 8 weeks = 8 lbs - Possible of complication is rupture of bag of water. b) Mrtha is 3 mos pregnant. Her OB score is G5P3T2P2A1L4M1. o 8:30am – rest; then get VS & FHR Identify the risk factors based on her OB score. o 9:00 am – test; provide mother hospital gown, instruct the Grand multigravida mother to roll the nipples at least 10mins Preterm - Rolling of nipples will produce mild uterine contraction only. Abortion The FHR not affected. - During actual labor there are strong contraction, decreases Multiple gestation FHR. Can cause fetal heart rate deceleration. Diagnostic tests - Normal result of CST: negative (no fetal heart rate Ultrasonography decelerations) - Uses high frequency sound waves to detect intra-body - Less than 100 bpm – at risk of fetal distress = fetal hypoxia structures. Oxytocin challenge test - UTZ vs Amniocentesis - Rolls her nipple causes the posterior pituitary gland to release o UTZ visualization oxytocin. - Non-invasive - A drug is given = IV fluid - To measure the amount of amniotic fluid - Occurrences of premature and rupture of membrane are - To increase the visualization, increase fluid intake. (if happening oxytocin challenge test compared to contraction less than 20 weeks) stress test using nipple rolling. - If 20 weeks above, no need fluid intake except if the Biophysical profile doctor/ nurse suspects lack of amniotic fluid. Fetal breathing - Do not void Fetal movement - Semi-fowlers position or dorsal recumbent with Fetal tone pillow under one buttock. Para ma-displace ung Reactivity of FHR – kasama ang nonstress test uterus sa side, so that the uterus will not totally Amniotic fluid volume BPP compress the inferior vena cava. Kase kung compress - Score: yan the women may feel dizziness or hypotension. o 8-10 = normal, low risk for chronic asphyxia (supine hypotensive syndrome) o 4-6 = suspected chronic asphyxia o Amniocentesis – aspiration of amniotic fluid. 15-30 ml o 0-2 = strong suspicion of chronic asphyxia - Invasive procedure - Informed consent is required - Ste of puncture = mid lower abdomen – there’s tendency that the bladder maybe hit J.A.K.E 10 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 Biophysical - UTZ aided Normal score = 2 Abnormal = 0 - Cord blood is aspirated and tested. variable Greater than equal to 1 Danger signs of pregnancy Fetal Absence of 30 secs or episode of 30 secs or Bleeding – danger sign of preg breathing long of fetal breathing more of fetal breathing Sudden escape of fluid from the vagina (can lead to infection) movements movement in 30mins movement in 30mins Edema 3 or more discreet 2 or less discreet Sudden weight gain Gross fetal movement of the body movements of vbody Rapidly increasing size of abdomen (polyhydramnios, multiple movements or any limb in 30 mins or any limb in 30 mins pregnancy, LGA) Foul-smelling vaginal discharge 1 or more episode of Either slow extension Fever extensive and flexion with return to partial Headache, blurring of vision of metal limbs or flexion or movement Excessive vomiting Fetal tone trunk. Opening and of limb in full closing of hand is extension or absent REPUBLIC ACT 9262: ANTI-VIOLENCE AGAINST considered normal fatal movement WOMEN AND THEIR CHILDREN tone. Discussed by Prof. Melanie Cambel 2 or more episode of - Refers to any act or a series of acts committed by an intimate Less than 2 episodes partner. accelerations of 15 of acceleration of fetal - Intimate partner – part of household. Reactive bpm or more lasting heart rate or - Against a woman who is his wife, former wife. FHR for 15 secs or longer in acceleration of less - Against a woman with whom the person has or had sexual or 20mins; associated than 15 bpm in 20mins dating relationship with fetal movement - Against a woman with whom he has a common child 1 pocket or more of Either no pockets or a - Against her child whether legitimate or illegitimate within or Qualitative fluid measuring 1 cm pocket of 1 cm or less without the family abode. amniotic or more in two in two perpendicular volume perpendicular planes planes. Types of Abuse Physical violence Amniocentesis - the act that includes bodily or physical harm. - Aspiration of amniotic fluid. 15-30 ml - Inaattempt na saktan, nilalagay sa isang situation na nababalot - Invasive procedure ng takot. - Informed consent is required Sexual violence - Ste of puncture = mid lower abdomen – there’s tendency that - The act that is sexual in nature, committed against a woman or the bladder maybe hit her child. - To avoid hitting the bladder by the needle, void before the - Rape, sexual harassment, acts of lasciviousness, treating a procedure. woman or her child as a sex object, making demeaning and - UTZ aided = to locate and prevent puncturing the placenta sexually suggestive remarks, physically attacking the sexual (upper uterine segment) parts of the victim’s body, forcing her/him to watch obscene - 3 most important purposes of amniocentesis: chromosomal publications and indecent shows or forcing the woman or her defect, Neural tube defects, Fetal lung maturity child to do indecent acts and/or make films thereof, forcing the X-ray: Lateral Pelvimetry wife and mistress/lover to live in the conjugal home or sleep - Lateral pelvimetry together in the same room with the abuser. - X-ray pelvimetry is a radiological investigation that involves - Acts causing or attempting to cause the victim to engage in the measurement of different anthropometric dimensions of any sexual activity by force, threat of force, physical or other the pelvis. harm or threat of physical or other harm or coercion. Serial estriol-determination - Prostituting the woman or child. - Measure fetoplacental wellbeing. Psychological violence - Specimens: serum or 24hr urine - Acts or omissions causing or likely to cause mental or - Normal: 12-50 mg/day at term (there is good fetoplacental emotional suffering of the victim. circulation, the baby receiving adequate amount of o2 and - Such as but not limited to intimidation, harassment, stalking, nourishment) damage to property, public ridicule, or humiliation, repeated Chorionic villi sampling verbal abuse and marital infidelity. - 10-12th week of pregnancy - It includes causing or allowing the victim to witness the - Purpose: to determine chromosomal defect. physical, sexual, or psychological abuse of a member of the - Most common: down syndrome family to which the victim belongs, or to witness pornography - Once the catheter reaches the chorionic plate, mag aaspirate si in any form or to witness abusive injury to pets or to unlawful doc. So kapag naaspirate na, gagawin na nila ung sampling. or unwanted deprivation of the right to custody and/or Percutaneous umbilical blood sampling visitation of common children. - Kumukuha ng blood coming from umbilical cord - Performed during the 2nd & 3rd trimesters J.A.K.E 11 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 Economic abuse Anxious if her appointment is running late - Acts that make or attempt to make a woman financially Call and cancel appointments frequently dependent. Dress inappropriately for warm weather, wearing long-sleeved, - Withdrawal of financial support or preventing the victim from tight-necked blouses to cover up bruises engaging in any legitimate profession, occupation, business or activity, except in cases wherein the other spouse/partner Assessment objects on valid, serious and moral grounds as defined in Presence of bruises or lacerations on breasts, abdomen, or Article 73 of the Family Code. back she cannot explain during physical examination. - Deprivation or threat of deprivation of financial resources and Ask woman with bruises to account for them and determine the right to the use and enjoyment of the conjugal, community whether explanation correlates with the extent and placement or property owned in common. of bruises or laceration. - Destroying household property, Ultrasound may reveal minimal placental infarcts from blunt - Controlling the victims’ own money or properties or solely abdominal trauma. controlling the conjugal money or properties. Record fetal heart tones and fundal height. Protection Order Nursing interventions - An order issued under this act for the purpose of preventing Support any ability the woman had to make constructive further acts of violence against a woman or her child and decisions granting other necessary grief. Discuss how she can call the police any time and take her to - The relief granted under a protection order serve the purpose shelter of safeguarding the victim from further harm, minimizing any Help to file charges or obtain restraining order to keep the disruption in the victim’s daily life, and facilitating the abusive person from coming near the woman if necessary opportunity and ability of the victim to independently regain Be careful not to blame the victim control over her life. Help find a shelter where the woman will feel safe Barangay Protection Orders (BPO) Do not leave an abused woman without support system after - Refer to the protection order issued by the Punong Barangay the birth of her child ordering the perpetrator to desist from committing acts under Sec. 5 (a) and (b) of this Act. BLEEDING DISORDERS IN PREGNANCY - BPOs shall be effective for 15 days. Discussed by Prof. Francis Vasquez Temporary Protection Orders (TPO) - Bleeding anytime during pregnancy is a danger sign of - Refers to the protection order issued by the court on the date pregnancy except of bleeding show. (Because bleeding show of filing of the application after ex parte determination that is a true labor) such order should be issued. - First trimester bleeding: - A court may grant in a TPO any, some or all of the reliefs Abortion mentioned in this Act and shall be effective for 30 days. Ectopic pregnancy – common site: fallopian tube, pag Permanent Protection Order (PPO) pumutok sya, mag dudugo sya internally, pumupunta sa - Refers to protection order issued by the court after notice and abdominal cavity then ung amount ng blood na hearing. The court shall not deny the issuance of protection pumupunta sa brain ay magiging low na sya kaya ung order on the basis of the lapse of time between the act of oxygen supply ng brain ay low din (hypoxia) brain cells violence and the filing of the application. will die – brain damage. (extrauterine) - Second trimester bleeding: Intimate Partner Abuse Hydatidiform more (H-more)/ GTD - Abuse by a family member against another adult living in the - Molar pregnancy/ gestational trophoblastic disease household. (GTD) - Common injuries suffered by abused women: Incompetent cervical Os Burns Abortion – the termination of pregnancy before the period Lacerations of viability. (Viability – can survive outside the uterus. 20 Bruises weeks-5 months) Pag lagpas 20weeks/ 5mos, wala ng Head injuries abortion. - Abused women may: - Third trimester bleeding: Have unintended and unwanted pregnancy Placenta previa Desire pregnancy because she believes having a child will Abruptio placenta change the partner’s behavior - Pag snabe sayo ng pasyente “Nurse, buntis po ako, dinudugo Be grateful for the pregnancy ako”. Ang una mong tatanungin ay ilan buwan na syang buntis. Para alam mo kung anong trimester bleeding si mami. Behaviors of abused women Abortion May come for care late in pregnancy or not at all - Termination of pregnancy before the fetus reaches the period Purchase no maternity clothing of viability Decline laboratory tests if they involve additional - Generally, before the 20th week of gestation or anytime whent transportation or money the fetus weighs < 500 grams. Difficulty following recommended pregnancy nutrition J.A.K.E 12 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 Preterm 20 – 36 weeks Yutopar – progesterone (prevents) Full term 37-42 weeks Bricanyl/ terbutaline – as bronchodilator and smooth Post term more than 42 weeks muscle relaxant (anti asthmatic) Abortion less than 20 weeks MgSO4 The start of viability is 20th week o Threatened abortion - 2 main types: - Mahinang pagdudugo, maaring walang contraction or 1) Spontaneous – non-intentional / miscarriage mahinang contraction, hindi pa dilated ung cervix kaya - The termination of a pre-viable conception thru wala pang lumalabas na products of contraction at intact natural causes and without the aid of mechanical and pa ang bag of water nya at walang lagnat. medicinal agents. - There’s a chance to save the pregnancy. 2) Induced – intentional - No IE (because frequent IE may increase uterine - Therapeutic abortion/ legal abortion – to save the life contraction) of mother during pregnancy. - Bed rest (because activity can increase contraction) - Non-therapeutic abortion/ criminal abortion – to get - Tocolytic drug rid of the unwanted pregnancy. - Possible loss of products of pregnancy. - The baby has down syndrome, is she qualified to undergo - Sight and symptoms: abortion if during the test her baby has down syndrome Vaginal spotting already. – No, bcz her pregnancy is not at risk. Mild uterine cramping Tenderness over uterus Different types of Spontaneous abortion Persistent low back ache with feeling of pelvic Abdominal Cervical Tissue pressure Types Bleeding Fever cramps dilation passage Cervix is closed or slightly dilated Close/ Stimulates mild labor para kang manganganak. None to None Threatened Slight not None mild dilated (+) BOW - Management: Complete bed rest (CBR) Inevitable/ Mild to Mild to None Restriction of activities Dilated None imminent moderate strong (-) BOW Pad counts – u also need to inspect the pad. Titingnan Close or natin kung may tissue. Absent to Absent to All went Complete slight None slight slight out Avoidance of strenuous exercise, fatigue and dilated None or Placenta excitement Slight Tocolytic, sedative drugs – pampakalma (lalo na Incomplete uterus is Dilated or fetus None moderate relax remain kung ang cause ng abortion ay emotional and psychological stress. None None No IE None None None o Inevitable/ imminent Missed If more Some - Lumakas ang bleeding kase lumakas ang contraction at (IUFD) than 6wks Slight Open parts of Present – slight to POC nagopen ang cervix, nag rupture na ung bag of water. mild - We cannot save the pregnancy. It - Nasa loob pa ung products of concentration. Palabas plng Habitual / depends - Mapupunta yan sa complete or incomplete. recurrent on the - Pregnancy cannot survive, signalized by the rupture of the condition membranes in the presence of cervical dilation. Moderate Septic to heavy Strong Dilated Ruptured Present - If the admitting diagnosis is incomplete abortion at lahat o Threatened abortion – the one that differs to the rest because ng abortion, dapat magiging complete abortion na sa final the only type of spontaneous abortion wherein there’s still diagnosis. chance to save the pregnancy. (Tocolytic drug) - Signs and symptoms: o Inevitable, complete, incomplete, missed, habitual, and More profuse bleeding septic abortion – there’s no chance to save the pregnancy. Cervix is dilated (Oxytocic drug – to remove all products of conception POC) if Membranes ruptured some products remain inside the uterus, the uterus will relax Painful uterine contraction and it will bleed. And this can lead to infection. - Management: o 2 groups of drugs: Analgesics 1) Oxytocic – promoting contraction Vaginal discharge should be kepts for inspection Syntocinon – given IV incorporation Oxytoxic drugs to promote uterine contraction Pitocin – given IV incorporation Dilation and curettage – after this, Coomb’s test para Oxytocin – IM macheck ung rh incompatibility. Within 3 days, kung Methergine – IM negative result, bibigyan ng rhogam. 2) Tocolytic – preventing contraction Emotional support Duvadilan – progesterone (prevents) - Imminent abortion – products of conception are passed Dactyl OB – progesterone (prevents) within 2 hours. J.A.K.E 13 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 - Signs and symptoms: Etiology Copious vaginal bleeding Defective products of conception (ovum or germ plasm) Passage of blood clots Insufficient progesterone production – pagmababa ung Severe cramp like abdominal pain progesterone during pregnancy, humihilab hilab malakas ung Uterine contraction uterus. - Management: Acute maternal infections Immediate hospitalization Uterine anomalies – cancer, tumor Possible blood transfusion Trauma – nalaglag sa hagdan, nabangga etc. Dilation and curettage Rh incompatibility – may lead to fetal death Oxytoxin at 0.5 ml every half hour x6 doses Endocrine disorders o Complete abortion Abnormal implantation - All products of conception came out already. Drugs o Incomplete abortion Radiation - If the POC remain inside, the uterus will relax and bleed. Environmental hazards - Pag naiwan ung placenta, the doctor can do dilatation and Incompetent cervix curettage. - Part of the conceptus is expelled, but the membranes or Ectopic Pregnancy placenta is retained in the uterus - An ectopic pregnancy is one in which implantation occurs - Signs and symptoms: outside the uterine cavity. (extrauterine) The implantation may Fetus usually expelled occur on the surface of the ovary or in the cervix. Placenta and membranes are retained - For u to be able to find out the possible cause of bleeding of Pain may or may not be present the pregnant woman, u need to ask “u are how many months - Management: pregnant.” Immediate hospitalization PID – Pelvic Inflammatory Disease Blood transfusion PRN - Salpingitis – inflammation of fallopian tube. Nagkakaroon ng Dilatation and curettage infection sa fallopian tube during the healing process, Monitoring of BP and PR for shock nagkakaroon ng scar formation sa lumen kaya nagde-decrease Anti-hemorrhagic drug ang lumen and the fertilize egg cannot pass through kasi Emotional and psychological counseling sumikip. - Salphingo – fallopian tube; itis – inflammation - Sperm cells can pass through, pero pag nafertilize na ung egg, fertilize egg cannot go inside the uterus. IUD – Intra uterine Device - Used for contraception may slow the transport of the zygote and lead to an increased incidence of tubal or ovarian implantation. - She is still positive in Pregnancy test 4 types of ectopic pregnancy o Missed abortion - IUFD – intrauterine fetal death/ demise – namatay ung baby inside the uterus. - 4-6 weeks can a dead baby stay inside the uterus without causing a bleeding and contraction. - How will the mother notice that her baby is dead – no fetal movement - Pag more than 6 weeks sya – may cramping - Management: dilatation and curettage. o Habitual/ recurrent abortion - 3 > consecutive – sunod sunod na abortion - Miscarriage – kusang nalalaglag - Mahina ang kapit ng baby (tocolytic – pampawala ng hilab) - Kailangan ng emotional and psychological counseling o Septic abortion - After/ Post incomplete abortion/ missed abortion J.A.K.E 14 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 Tubal Pregnancy - If this manages late, the women can still survive but she’s - Most common in coma. - Ampulla – common, widest tube (middle – Isthmus, side of - If it is extrauterine, the doctors will be ready to schedule tubal ligation) the client to undergo surgery. - Interstitial – narrowest that connected to the uterus Ovarian Pregnancy (dangerous). Kaya pwede rin mag rupture ung uterus. Malakas - Lumabas ng fimbriae, at ung pinaka malapit ay ovary. ang bleeding. Magkakaroon ng abdominal pain. - Vaginal spotting/ bleeding – interstitial - Pag nagrupture ung ovary, magkakaroon ng internal bleeding. - Abdominal bleeding/ Internal bleeding – ampulla Abdominal pregnancy - Easier to manage: ampullary - Most dangerous pregnancy (internal bleeding) - Implanted in ampulla: the embryo will grow; the ampulla will - The fertilize egg implanted in any on the organs found in the stretch. The woman will feel unusual pain. That’s why, abdominal cavity. ultrasound is very important for the 1st trimester pregnancy to Cervical pregnancy confirm intrauterine pregnancy, para malaman kung nasa - Rare pregnancy inside or outside ng uterus. - Cervical canal – outside uterine cavity - To expect the rupture of fallopian tube – bago matapos ang 1st - Hindi ni-raraspa kase ung cervix is easily friable – it bleeds trimester (10th and 12th week of pregnancy) easily. 3 signs of rupture 1) Kehr’s sign Paano ung ectopic pregnancy na walang scar formation: - When the fallopian ruptures, the women experience: sharp - Yung estrogen di masyado tumaas. Mahina ang wave like abdominal stabbing pain in the sight of tubal pregnancy movement ng fallopian tube. Pwedeng d na sya gumalaw (para syang sinaksak) at nag i-stay na sa ampulla. - Right lower quadrant Kapag sumobrang taas ung estrogen mo, kaya ung movement - Sharp stabbing pain beginning from the site of the ectopic ng fertilize egg ay magiging mabilis at baka magkaroon ng pregnancy that radiates in the same side shoulder – implantation sa lower uterine segment – placenta previa. unilateral pain kasi same side shoulder. What surgical to be done to remove ectopic pregnancy? - Example: ectopic pregnancy nya nasa right fallopian tube - Exploratory Laparotomy or ExplorLap or E-Lap – the – sharp stabbing pain will start in the right lower quadrant doctor will explore the severity of the damage. The doctor radiating on the same side shoulder – right shoulder. will locate the ectopic pregnancy 2) Cullen’s sign - Followed by Ectomy – removal of the fallopian tube - Purplish or bluish discoloration of the periumbilical area. o (Right fallopian tube) Salpingectomy - Several mins of kehr’s sign, around the umbilical area, a o (Left ovary) oophorectomy semi-circular discoloration and that discoloration is - Cervical pregnancy: the doctor will administer a drug to a colored bluish/ purplish. It means there is internal pregnant woman. An anti-cancer drug, to kill the fertilize bleeding. egg in the cervical canal – Methotrexate. 3) Sign and symptoms of shock Example: When the fallopian tubes ruptures, the woman - The pregnant women will experience sign and symptoms bleeds, the blood accumulates in the abdominal cavity, of shock. Hypovolemic shock – low amount of blood bcz amniotic fluid will also accumulate in the abdominal cavity, the blood is escaping from the fallopian tube to the making the abdomen bigger than usual, para syang 4-5months, abdominal cavity. when u touch the abdomen of the woman, it is firm because of - S/S of shock: the accumulation of blood and amniotic fluid. o BP decreases Ectopic Pregnancy will be detectable but not preventable o heart rate will increase because there is blood loss, the heart will pump faster to be able to circulate the Hydatidiform Mole (H-mole) blood and to give oxygen to the vital parts organs to - Molar Pregnancy or GTD (Gestational Trophoblastic Disease) the body. - Trophoblast has the abnormality o Respiratory Rate increases, to get more oxygen - Tagalog: Kiyawa or Kayawa (the woman feels that she is o Temperature decreases, the pregnant woman has cold pregnant, but it is not, ang laman ay kiyawa) clammy skin. - Trophoblast – egg and sperm cell met then it fertilizes → - she needs to keep warm become zygote → zygote will become a partially divided cell - When the pregnant woman continues to experience shock, – cleavage → 16 overlapping cells is the marulla → it will continues to bleed – low supply of oxygen to the brain → become blastocyst, marami na syang cells but the cells move the woman will experience hypoxia → that will affect the along the side and there will be space inside → outside the level of consciousness → lethargic → obtunded → blastocyst, finger like projections structures appear is the stuporous → coma. trophoblast → Inside the trophoblast there is chorionic villi is - If the woman experiencing internal bleeding, blood loss producing human chorionic gonadotropin (HCG) and this is and massive blood loss will not be operated soon, the the hormone serving as a basis for pregnancy test. Normal level of consciousness are decreasing, from conscious to amount: 50,000 – 400,000 units coma. The women can die bcs when the CNS shutdown - the fingerlike projection of trophoblast is the one to attach on then the heart fails to pump. the endometrium for the implantation. J.A.K.E 15 of 59  CARE OF MOTHER AND CHILD AT RISK OR PROBLEMS – OB LECTURE: BSN2ND YEAR 2ND SEM PRELIM 2022 - Once blastocysts enter the trophoblast, implantation occurred What will the doctor do, if the woman develops H-mole? in upper uterine segment posterior Evacuate the H-mole - Once the implantation occurred on the upper uterine segment, Dilatation and Curettage the endometrium is now called decidua of pregnancy. Suction curettage – kailangan masimot kase if the woman gets - 3 types of decidua: pregnant again, the next pregnancy will not trigger another H- 1) Basalis – under the site of implantation. mole development. 2) Capsularis – covering the ovum. After evacuating, it is advised that she must avoid pregnancy 3) Parietalis or vera – lining the rest of the uterine cavity. at least 1 year. - Placenta is developed with union of decidua basalis plus If she experiences H-mole again. She will develop chorionic villi. choriocarcinoma – cancer in uterus (Drug: methotrexate) - The trophoblast contains chorionic villi and becomes part of If the uterus is growing faster, it could be: the placenta. And the blastocyst become the baby. - H-mole - Polyhydramnios Predisposing factors of H-mole - LGA 1) Poverty - Multiple pregnancy 2) Low socio-economic status – poor - Nursing Intervention: Do leopold’s maneuver to check if 3) Protein Deficiency there is a baby - When the level of progesterone increases during the menstrual cycle the high level of progesterone will cause Incompetent cervix / Premature Cervical Dilatation/ increase vascularity on the endometrium. There will be premature dilatation cervical os increase blood supply then the supply of nourishment will - Pag sinabing incompetent walang kakayahan be high. Tataas ung water, glucose, oxygen and amino - The cervix cannot remain close during pregnancy acid supply – protein. - Kegel’s exercise can help your cervix close during pregnancy. - Protein is the building block of tissues. (e.g. meat and - The cervix is small, but it places an important role in fish) other sources na nakukuha lang nila is sa munggo or pregnancy – is to remain close while caring the weight of the egg kase mura. baby and amniotic fluid. - When implantation happens, since the trophoblast is not - Cause of incompetent Cervix: getting good amount of amino acids, the blastocyst will LGA die. When blastocyst dies it should be detach but the Multiple pregnancy trophoblastic cells continue to proliferate, ang Poly hydramnios mangyayare mag poproduce ng vesicle. The muscle is weak - Vesicles – fluid filled, size of vesicle will increase and if - In 2nd trimester bleeding if there’s incompetent cervix: this continues to increase the uterus of the woman will The cervix begins to dilate grow bigger. That’s why the woman thinks that she’s Possibility spotting pregnant. (Pregnancy test – positive)