NHCM 1 Notes - Mother and Child Health Nursing PDF

NHCM 1 - Mother and Child Health Nursing The uterus divided into three parts: 01. Body of the Uterus - the upper part is the Anatomy and Physiology of Female...

NHCM 1 - Mother and Child Health Nursing The uterus divided into three parts: 01. Body of the Uterus - the upper part is the Anatomy and Physiology of Female corpus, or body of the uterus. The fundus is Reproductive System Lesson 1 the part of the body or corpus above the area External Female Structures - the external female where the fallopian tubes enter the uterus. reproductive organs are called the Vulva. Length about 5 cm. Mons Pubis - is rounded, soft fullness of 02. Isthmus - a narrower transition zone. Is subcutaneous fatty tissue, prominence over between the corpus of the uterus and cervix. the symphysis pubis that forms the anterior During late pregnancy, the isthmus elongates border of the external reproductive organs. It and is known as the lower uterine segment. is covered with varying amounts of pubic hair. 03. Cervix 3 - the lowest position of the uterus Labia Majora - are two rounded, fleshy folds “neck”. The length of the cervix is about 2.5 of tissue that extend from the mons pubis to to 3 cm. The os, is the opening in the cervix the perineum. It protects the labia minora, that runs between the uterus and vagina. The urinary meatus and vaginal introitus. upper part of the cervix is marked by internal Labia Minora - located between the labia os and the lower cervix is marked by the majora, and is narrow. The lateral and anterior external os. aspects are usually pigmented. The inner Layers of the Uterus: surfaces are similar to vaginal mucosa, pink 01. Perimetrium - the outer peritoneal layer of serous and mois. Their rich vascularity. membrane that covers most of the uterus. Laterally, the Clitoris - the term clitoris comes from a perimetrium is continuous with the broad ligaments on Greek word meaning key. Erectile organ. It’s either side of the uterus. rich vascular, highly sensitive to temperature, 02. Myometrium - the middle layer of thick muscle. touch, and pressure sensation. Most of the muscle fibres are concentrated in the upper Vestibule - an oval-shaped area formed uterus, and their number diminishes progressively between the labia minora, clitoris, and toward the cervix. Types of Smooth Muscle Fibre: fourchette. It contains the external urethral Longitudinal fibres (outer layer) are found mostly meatus, vaginal introitus, and Bartholin's in the fundus and are designed to expel the fetus glands. efficiently toward the pelvic outlet during birth. Perineum - is the most posterior part of the Middle layer fibres contract after birth to compress external female reproductive organs. It the blood vessels that pass between them to limit blood extends from fourchette anteriorly to the anus loss. posteriorly. Composed of fibrous and Inner layer circular fibre form constrictions where muscular tissues that support pelvic structures. the fallopian tubes enter the uterus and surround the internal os. Circular fibres prevent reflux of menstrual blood and tissue into the fallopian tubes. Promote normal implantation of the fertilized ovum by controlling its entry into the uterus. And retain the fetus until the appropriate time of birth. 03. Endometrium - the inner layer of the uterus. It is responsive to the cyclic variations of estrogen and progesterone during the female reproductive cycle every month. Layers: Internal Female Structures: a. Compact layer 1. Vagina - an elastic fibro-muscular tube and b. Basal layer membranous tissue about 8 to 10 cm long. Lying c. Functional or Sponge layer is shed during between the bladder anteriorly and the rectum each menstrual period and after childbirth in posteriorly. The vagina connects the uterus above with the lochia. the vestibule below. The upper end is blind and called Functions: the vaginal vault. The vaginal lining has multiple Menstruation, the uterus sloughs off the folds, or rugae and muscle layer. These folds allow the endometrium. vagina to stretch considerably during childbirth. The Pregnancy, the uterus supports the fetus and allows reaction of the vagina is acidic, the pH is 4.5 that the fetus to grow. protects the vagina against infection. Labor and birth, the uterine muscles contract and Functions: the cervix dilates during labor to expel the fetus. a. to allow discharge of the menstrual flow. b. as the female organs of coitus. c. to allow passage of the fetus from the uterus. 2. Uterus - is a hollow, pear shaped muscular organ. The uterus measures about 7.5 X 5 X 2.5 cm and weighs about 50 – 60 gm. Its normal position is anteverted (rotated forward and slightly antiflexed (flexed forward). 1  forming the iliac fossa. The upper border of the ilium is called the iliac crest. ➔ Ischium is the thick lower part. It has a large prominence known as the ischial tuberosity on which the body rests while sitting. Behind and little above the tuberosity is an inward projection of the ischial spine. ➔ Pubis II. Sacrum - a wedge shaped bone consisting of five vertebrae. The anterior surface of the sacrum is concave. The upper border of the first sacral vertebra known as the sacral promontory 4. Fallopian tubes - the two tubes extended from the III. Coccyx - consists of four vertebrae forming a cornus of the uterus to the ovary. It runs in the upper small triangular bone. free border of the broad ligament. Length 8 to 14 cm average 10 cm. Menstrual Cycle Lesson 2 It's divided into 4 parts: Menstrual Cycle is defined as cyclic events that take place in a rhythmic fashion during the reproductive period of a woman's life. It starts at the age of 12-15 years, which marks the onset of puberty. The commencement menstrual cycle is called menarche. Menstruation (Period/Menses/Menstrual Bleeding) - is the periodic discharge of blood, mucus, and uterine cellular debris at cyclic intervals from menarche to I. Interstitial part runs into the uterine cavity, passing menopause. through the myometrium between the fundus and body Exception: of the uterus. About 1-2 cm in length. Pregnancy II. Isthmus is the narrow part of the tube adjacent to Lactation the uterus. Straight and cord-like, about 2-3 cm in Anovulation length. Pharmacological Interventions (e.g. III. Ampulla is the wider part about 5 cm in length. contraceptive pills) 4 Phases Of Menstrual Cycle: Fertilization occurs in the ampulla. 01. Menstrual Phase - is the first stage of the IV. Infundibulum is funnel or trumpet shaped. menstrual cycle. It’s also when you get your Fimbriae are fingerlike processes, one of which is period. This phase starts when an egg from longer than the other and adherent to the ovary. The the previous cycle isn’t fertilized. Because fimbriae become swollen almost erectile at ovulation. Functions: pregnancy hasn’t taken place, levels of the a. Gamete transport (ovum pickup, ovum hormones estrogen and progesterone drop. transport, sperm transport). The thickened lining of your uterus, which b. Final maturation of gamete post ovulate would support a pregnancy, is no longer oocyte maturation, sperm capacitation. needed, so it sheds through your vagina. c. Fluid environment for early embryonic During your period, you release a development. combination of blood, mucus, and tissue from d. Transport of fertilized and unfertilized ovum your uterus. You may have period symptoms like these: to the uterus. Cramps V. Ovaries - oval solid structure, 1.5 cm in thickness, Tender Breasts 2.5 cm in width and 3.5 cm in length respectively. Each Bloating weighs about 4–8 gm. Ovary is located on each side of Mood Swings the uterus, below and behind the uterine tubes. Structure of the ovaries: Irritability ★ Cortex Headaches ★ Medulla Tiredness ★ Hilum Low Back Pain Functions: 02. Follicular Phase - the follicular phase starts a. Secrete estrogen & progesterone on the first day of your period (so there is b. Production of ova some overlap with the menstrual phase) and Bony pelvis is composed of 4 bones: ends when you ovulate. Only the healthiest I. Two Hip Bones - each or hip bone is egg will eventually mature. (On rare composed of three bones: occasions, a female may have two eggs ➔ Ilium is the flared out part. The greater part of mature.) The rest of the follicles will be its inner aspect is smooth and concave, reabsorbed into your body. The maturing follicle sets off a surge in estrogen that 2  thickens the lining of your uterus. This creates Education and good future a nutrient-rich environment for an embryo to Proper guidance, love, care, and support grow. The average follicular phase lasts for Financially stable about 16 days. It can range from 11 to 27 Population Growth - is one of the pressing social days, depending on your cycle. problems nowadays. Population growth in itself is not 03. Ovulation Phase - rising estrogen levels a problem. The problem is the resources needed by the during the follicular phase trigger your additional people that need public service, pituitary gland to release luteinizing hormone employment, housing, and food. (LH). This is what starts the process Family planning - aims to improve the quality of life of ovulation. Ovulation is when your ovary of families. releases a mature egg. The egg travels down ❖ Support Partnerships the fallopian tube toward the uterus to be ❖ Save The Environment fertilized by sperm. The ovulation phase is the ❖ End Hunger and Poverty time during your menstrual cycle when you ❖ Increase Education can get pregnant. You can tell that you’re ❖ Empower Women ovulating by symptoms like these: ❖ Improve Infant Health A slight rise in basal body ❖ Decreases HIV/AIDS temperature ❖ Improve Maternal Health Thicker discharge that has the texture Objectives Family Planning: of egg whites (WHO) "the use of a range of methods of a fertility Ovulation happens around day 14 if regulation to help individuals or couples attain certain you have a 28-day cycle right in the objectives: middle of your menstrual cycle. It a. Avoid unwanted birth lasts about 24 hours. After a day, the b. Bring about wanted birth egg will die or dissolve if it isn’t c. Produce a change in the no. of children born fertilized. d. Regulate the intervals between pregnancies 04. Luteal Phase - after the follicle releases its e. Control time at which birth occurs egg, it changes into the corpus luteum. This Scope Of Family Planning: structure releases hormones, mainly i. Proper spacing and limitation of births. progesterone and some estrogen. The rise in ii. Advice on sterility. hormones keeps your uterine lining thick and iii. Education for parenthood. ready for a fertilized egg to implant. If you do iv. Sex education. get pregnant, your body will produce human v. Screening for pathological conditions related to the chorionic gonadotropin (HCG). This is the reproductive system. hormone pregnancy tests detect. It helps vii. Genetic counselling. maintain the corpus luteum and keeps the Types of Family Planning Method: uterine lining thick. If you don’t get pregnant, 1. Natural Family Planning Method (Fertility the corpus luteum will shrink away and be Awareness Method) reabsorbed. This leads to decreased levels of Advantages of Natural Family Planning: estrogen and progesterone, which causes the Free from side effects of artificial substances onset of your period. The uterine lining will Develops discipline between two couples shed during your period. Increases body awareness between couples Free from medical risks of other methods Saves expense on medical services Adheres to religious or cultural standards Advantages: No harmful effects from hormone use occur. This may be the only method acceptable to couples. for cultural or religious reasons. NFP methods can also be used to achieve pregnancy. Disadvantages: This is most suitable for women with regular and predictable menstrual cycles. Complete Responsible Parenthood Lesson 3 abstinence is necessary during the fertile period. This method requires discipline and systematic charting. Responsible Parenthood - it is defined in the The method is not effective with improper use. To use Directional Plan of Department of Health on this method effectively, a woman or couple should be Population (DOH POPCOM) as the will and ability of trained by a medical professional or a qualified parents to respond to the needs and aspirations of the counselor. A relatively high failure rate has been family and children. A shared responsibility of the reported. This method does not protect against STDs. husband and wife to determine and achieve the desired Lactation and Amenorrhea Method - a number, spacing, and timing of their children modern, temporary family planning method. Parenthood is couple with bigger responsibilities like the following: This is a method used to space the birth of the Child's physical, emotional, social, spiritual, children through the mother's full and intellectual development breastfeeding term from 0-2 years of age. Can Growth and development as persons only be used for a short period (up to six Providing basic needs months postpartum) 3  Sympto-thermal Method - this combines the Vasectomy For Men - the tying or cutting of observation of changes in cervical secretions the vas deferens that prevents the passage of and basal body temperature. It also includes sperm cells during intercourse the feel of the opening of the cervix and its Tubal Ligation For Women - a surgical position. If a couple uses the Sympto-Thermal procedure done to block the fallopian tube Method perfectly, it is 99.4-99.6% effective in from the entry of sperm thus preventing the avoiding pregnancy. union of the sperm and egg. Basal Body Temperature (BBT) - this is How Does Conception Happen? used to measure the woman's temperature in 01. The typical female cycle is 28 days. Day 1 is the morning before doing any activity. If the when she starts her period. A woman typically temperature is at risk, the couples must ovulate around day 14. abstain from intercourse. 02. Ovulation is when a woman's ovary releases Abstinence - this method inhibits couples an egg for fertilization. If a sperm is available from having sexual contact during a woman's in the uterus, pregnancy can occur. fertile days. 03. Ovulation can vary based on a woman's cycle. Billings Ovulation Method (Cervical Mucus Some women have a longer cycle of around Method) - women who use this method 35 days between periods. observe the cervical mucus present in the Conception to Birth Lesson 4 vulva. If the mucus is clear, stretchy, slippery, What Happens During Conception? and wet, the woman is fertile. Couples who 1. Fertilization avoid pregnancy should refrain from having 2. Cells Begin To Divide sexual intercourse. 3. Implantation 4. Fetal Development Conception The average length of time for prenatal development to complete is 38 weeks from the date of conception. During this time, a single-celled zygote develops in a series of stages into a full-term baby. Every normal human cell contains 46 chromosomes (23 pairs). The ovum however, 2. Artificial Family Planning Method has at some stage split, and therefore only Intrauterine Device (Iud) - a small plastic contains half the chromosomes of other cells sterile device inserted to the uterus that in the human body. prevents the implantation of a fertilized egg in A photo of a human ovum (egg) magnified many times: the uterus. It releases copper to stop you getting pregnant, and protects against pregnancy for between 5 and 10 years. Similarly, each human sperm only has 23 chromosomes: Diaphragm - a moulded, thin rubber cap that fits the uterine cervix and acts as a mechanical barrier. Fertilization (Conception) - occurs when a single sperm enters the ovum (egg) and the nuclei fuse. The two nuclei combine together to form a full 46 chromosome cells. Female Condom - a thin sheath made of latex that is inserted over an erect penis or cervix that acts a barrier to the transmission of sperm or egg cells. Combined Estrogen - progestin birth control pills and progestin only pills or implants prevent the pituitary gland's release of hormones that stimulate ovulation. 4 Within 38 hours, the cell division begins. Firstly into two then four, etc. Functions of the Placenta: 01. Respiratory Function (acts like a lung) 02. Digestive System 03. Kidney Function 04. Immunity - immune barrier to protect growing foetus. 05. Hormone Production and Growth Factors Stages of Implantation: ➔ Day 0: Fertilization occurs, forming a zygote. ➔ Day 1-5: The zygote undergoes cell division, becoming a morula and then a blastocyst. ➔ Day 6-7: The blastocyst hatches from its protective shell and begins to attach to the C. Amniotic Acid - is known as the embryonic period uterine lining (endometrium). finishes at the end of week 8 (week 6 since ➔ Day 8-9: The blastocyst embeds further into conception) and the fetal period begins. This period the endometrium, starting implantation. sees rapid growth of the foetus, and the further ➔ Day 10-12: Implantation is completed, and development of the organs and tissues that were the blastocyst starts forming connections with formed in the embryonic period. the maternal blood supply (ai search). a. Protects and cushions b. Maintains temperature c. Allows fetal movement d. Involved in lung development The fertilized egg, now a number of cells, makes its way to the uterus, so by the 10th day, it embeds itself in the protective walls of D. By week 12, its body is fully formed, including the uterus. ears, toes and fingers complete with fingernails. The A. At week 5, (3 weeks after conception) the embryo is external genitals appeared in week 9, and now, by the size of a grain of rice (about 2 mm long) and would week 12, have fully differentiated into male or female be visible to the naked eye. It has the beginnings of a genitals. The eyes have moved to the front of the face brain with 2 lobes and its spinal cord is starting to and the eyelids remain closed together. form. E. By 14 weeks the baby will be about 9-10 cm long. It B. At 6 weeks of 'pregnancy' (3-4 weeks after may suck its thumb now. Its body is now covered with conception) the embryo has a head with simple eyes a layer of fine hair called lanugo. By 16 weeks its face and ears. Its heart has 2 chambers and is beating. Small is becoming more human in appearance. buds are present that will form arms and legs later. F. By 24 weeks your baby's organs are fully formed. Placenta - a temporary organ that connects your baby The baby now has the face of a newborn baby, to your uterus during pregnancy. The placenta develops although the eyes are rather prominent because fat pads shortly after conception and attaches to the wall of are yet to build up in the baby's cheeks. The eyelids are your uterus. Your baby is connected to the placenta by fused until weeks 25 to 26 when they open. the umbilical cord. Together, the placenta and G. The baby is becoming plumper. By 30 weeks the toe umbilical cord act as your baby's lifeline while in the nails are present. uterus (ai search). H. 32 weeks the fingernails have developed. The eyes will be open when the baby is awake. The baby will 5 have settled into a downward position as there is no The exact causes of both identical and fraternal twins longer enough room left in the womb for it to move are not fully understood. However, there are some about freely. factors that may increase the risk of having twins: Twins - are two babies born at the same time. They can a) Age: Older mothers are more likely to have be either identical or fraternal. twins, especially fraternal twins. Identical Twins (Monozygotic Twins) b) Fertility treatments: Women who undergo Formed when a single fertilized egg fertility treatments are more likely to have splits into two embryos. They are twins. genetically identical. c) Genetics: Some women may have a genetic The process of splitting is not fully predisposition to having twins. understood, but it is thought to be What are the challenges of raising twins? due to an extra set of cell divisions. ❖ Double the work Identical twins are always the same ❖ Lack of sleep sex (boy-boy or girl-girl). ❖ Financial strain They are relatively rare, occurring in ❖ Social isolation about 1 in 250 births. Remember: Identical twins may have a higher 1. Sperm cells are released from the vagina and swim through the risk of certain genetic disorders. cervix and uterus to reach the egg in the Fallopian tube. 2. One sperm cell penetrates the egg and fertilizes it. Fraternal Twins (Dizygotic Twins) 3. The fertilized egg, called a zygote, begins to divide and develop Formed when two separate eggs are into a blastocyst. fertilized by two separate sperm. 4. The blastocyst implants in the wall of the uterus and begins to They are genetically different from develop into an embryo. each other, just like any other 5. The genetic material in the sperm and egg cells combines to siblings. form a single diploid nucleus containing 46 chromosomes. Fraternal twins can be either the 6. The zygote undergoes a process called mitosis, in which it same sex or different sexes. divides into two identical daughter cells. 7. The blastocyst consists of two parts: the inner cell mass, They are more common than which will develop into the embryo, and the outer trophoblast, identical twins, occurring in about 1 which will develop into the placenta. in 30 births. 8. The placenta is a tissue that allows the embryo to exchange Fraternal twins can have different nutrients and waste products with the mother's bloodstream. health profiles based on their unique 9. The embryo develops into a fetus in the eighth week of genetic combinations. pregnancy. Semi-identical Twins Spermatozoa - male reproductive cells that are released into the A rare type of twin that is formed vagina during ejaculation. Oocyte - female reproductive cell that is released from the ovary when two sperm fertilize a single into the Fallopian tube. egg. Fertilization - the process by which a sperm cell penetrates and These twins are half identical and fertilizes an egg cell. half non-identical. They can be of Zygote - the fertilized egg cell contains a full set of 46 different sexes and have different chromosomes. genetic makeups. They have the Mitosis - the process by which a cell divides into two identical same genes from their mother and daughter cells. different genes from their father. Morula - a solid ball of cells that forms after the zygote undergoes several rounds of mitosis. They also have three sets of Blastocyst - a hollow ball of cells that forms after the morula chromosomes, instead of the usual undergoes further development. two. Implantation - the process by which the blastocyst attaches to Different ways that semi-identical twins the wall of the uterus. can form: Embryo - the developing organism from approximately two a. One possibility is that the weeks after fertilization until the eighth week of development. egg divides in two before Amniotic Sac - a fluid-filled sac that surrounds and protects the fertilization, and then each embryo. part is fertilized by a Fetus - the developing organism from the eighth week of different sperm. development until birth. Childbirth - the process of giving birth to a baby. b. Another possibility is that Conception the egg fuses with two The video starts with the release of approximately 300 sperm cells and then sheds million spermatozoa into the vagina. The sperm must one of the sperm's travel through the cervix, uterus, and Fallopian tubes to chromosomes. reach the egg. Only a few (200) sperm will make it to How can you tell the difference between identical and fraternal twins? the egg. The egg is surrounded by a zona pellucida, ✓ To do a DNA test. which is a tough outer layer. The sperm must break ✓ If the twins are the same sex, they are more likely to through this layer in order to fertilize the egg. be identical. Fertilization ✓ If the twins have different blood types, they are Once a sperm cell has penetrated the egg, the egg's definitely fraternal. shell changes to block the entry of other sperm. The What are the causes of twins? sperm's genetic material combines with the egg's 6 genetic material to form a zygote. The zygote then begins to divide and develop. Implantation The zygote travels down the Fallopian tube and implants in the wall of the uterus. The blastocyst breaks out of its shell and implants in the wall of the uterus. Here, it develops into an embryo surrounded and protected by the amniotic sac. 7 Embryonic Development ★ Ballottement - a technique where the fetus is The embryo develops rapidly during the first eight pushed gently in the uterus and felt to weeks of pregnancy. It develops a heart, lungs, brain, rebound, used as a sign of pregnancy. and other organs. The embryo is surrounded by the ★ Positive pregnancy tests (serum, urine) - amniotic sac, which is filled with amniotic fluid. The tests that detect the presence of human amniotic fluid helps to protect the embryo and keep it chorionic gonadotropin (HCG), a hormone warm. produced during pregnancy, in blood (serum) Fetal Development or urine. After the eighth week of pregnancy, the embryo is ★ Braxton Hicks ctx. - irregular, usually called a fetus. The fetus continues to grow and develop painless contractions that occur during throughout the rest of pregnancy. The fetus's bones and pregnancy as the uterus prepares for labor. muscles become stronger. The fetus's brain and Positive nervous system also continue to develop. ❖ Hearing fetal heart tones Childbirth ❖ visualization of the fetus Childbirth typically occurs between 37 and 42 weeks ❖ palpating fetal movement of pregnancy. During childbirth, the uterus contracts to ❖ visualizing fetal movements. push the baby out of the vagina. The baby's head is Physiologic changes: usually born first, followed by the body. After the baby 1. Integumentary System - these result from is born, the placenta is delivered. stretching of the skin and hormonal changes. a. Linea nigra: pigmentation down middle line Pregnancy Lesson 5 of abd. Pregnancy - it is the period from fertilization to birth. b. Chloasma: “mask of pregnancy" Signs and Symptoms Of Pregnancy: c. Straie: stretch marks of abd, breasts, thighs Presumptive Signs - subjective changes that are and buttocks. experienced and reported by the woman. Least reliable d. Sweating indicators of pregnancy. It includes: Amenorrhoea (absence of mens) Morning sickness Fatigue Breast changes Quickening (feels something in your 2. Gastrointestinal stomach/kabag) a) Digestive system slow due to progesterone Frequency of micturition b) Nausea and vomiting Skin changes c) Ptyalism (increase salivation) Probable Signs - objective findings that can be d) Heartburn (because the fetus is growing) documented by an examiner. Primarily related to e) Hemorrhoids (almuranas) physical changes in the reproductive system. They are: f) Prolonged gallbladder emptying time may a. Breast changes lead to gallstones b. Abdominal enlargement g) Bile salt buildup may lead to itching Positive Signs - attributed to the fetus. Detected and 3. Respiratory System documented by the examiner. A. increase respiratory rate (rising of the chest) ❖ Auscultation of fetal heart sound. B. increased oxygen consumption ❖ Fetal movement felt by the examiner. C. common are nasal stuffiness, nosebleeds due ❖ Visualization of the fetus. to increased vascular swelling to nose ★ Sonography 4. Endocrine - responsible for the glands ★ Radiology A) Normal pregnancy physiology shows Signs Of Pregnancy: lower lows and higher highs Presumptive B) Postprandial hyperglycemia ➔ amenorrhea to ensure sustained glucose levels for ➔ fatigue fetus ➔ nausea & vomiting C) Accelerated starvation ➔ breast changes early switch from glucose to lipids ➔ quickening for fuels ➔ urinary frequency D) Insulin resistance promotes hyperglycemia Probable resistance-reduced peripheral uptake ★ Goodell's Sign - softening of the cervix of glucose for a given dose of insulin during early pregnancy, typically noticeable E) Mild fasting hypoglycemia occurs with around the 4th to 6th week. elevated FFA, triglycerides, and cholesterol ★ Chadwick's Sign - a bluish-purple 5. Cardiovascular System discoloration of the cervix, vagina, and vulva a. Heart shifts up and to the left caused by increased blood flow, often seen in b. Hemoglobin stays the same (12-16 g/dL) early pregnancy. initially. ★ Hegar's Signs - a softening of the lower May drop down to 10 g/dL and still uterine segment, typically detectable by a be normal physiologic anemia. physician during a pelvic exam in early pregnancy. 8  Normal pregnancy Hgb is 10-14 g/dL ❖ Maternal role attainment later in pregnancy c. Decreased Hct (38-47%) Third Trimester Adaptations Normal pregnancy Hct is 32-42 later ★ Lack of knowledge and preparation for in pregnancy. maternal role d. Pulse rate may increase 10-15 beats. ★ Establishing a relationship with the fetus e. Weight of the uterus can cause supine ★ Fantasy during pregnancy hypotensive syndrome. Danger Signs of Pregnancy: 6. Skeletal Changes C - cramping, contractions (uterine) a) Increased lumbar fordosis (dli bako but breast R - rupture of membranes out ang posture) A - absence of fetal movement b) Relaxation of pelvic joints and ligaments due M - muscle irritability to progesterone and relaxing P - pain (epigastric, abdominal, uterine) Pregnancy: Physiologic Changes S - spotting or vaginal bleeding 1st Trimester: Weeks 1-12 U - urine frequency or oliguria Nausea/vomiting P - persistent vomiting Cravings/distaste Labor and Delivery Lesson 6 Constipation Labor Urinary frequency A physiological (normal) process which starts Increased heart & breathing rates when the mother begins to feel regular, Heartburn painful, rhythmical contractions of the uterus Breast tenderness, nipple changes (turns black (muscles of the womb tighten and relax). and widens) These contractions cause the cervix (neck of Weight changes the womb) to dilate (open) and efface Mood swings (shorten). Fatigue The baby is born and the placenta (afterbirth) 2nd Trimester: Weeks 13-28 and membranes (bag around the fetus are ❖ Fetal movements completely expelled out of the mother's body. ❖ Body aches ❖ Skin darkening False Labor Symptoms True Labor Symptoms ❖ Swelling in extremities ❖ Breast/belly growth Discomfort is Over the fundus, with characterized as over the radiation of discomfort ❖ Braxton-Hicks lower abdomen and to the flow back and low 3rd Trimester: Weeks 29-40 groin areas. abdomen. ★ Stronger fetal kicking ★ Dyspnea (hard breathing) Without effect on Associated with ★ Difficulty sleeping dilation of the cervix effacement and dilation. ★ Colostrum leaks (first flow of the milk) (not associated with progressive dilation). Postpartum ➔ Lochia (blood: body fluid) Typically shorter in Increasingly intense and ➔ Fatigue duration. frequent. ➔ Breast soreness/leaking ➔ Postpartum depression risk Less intense. Regular and effective. Psychological Changes of Pregnancy: The woman's attitude toward the pregnancy depends on Relieved by administration of a the environment in which she is raised. sedative or ambulation. 01. Social influences - pregnancy is not an illness, now the family is included. Factors affecting labor (5 P’s): Use of birthing centres has increased. 01. Passenger (the fetus) - the fetus relationship to the Demedicalize childbirth. passageway is the major factor in the birthing process. 02. Cultural influences The relationship includes: How active a role she wants to take. a. fetal skull and size Certain beliefs and taboos may place b. number of fetuses restrictions on her behaviours and c. position of fetus activities. Fetal Lie - relationship of fetal spine to First Trimester Adaptations maternal spine; longitudinal (vertical) or Ambivalence (caught in between or uncertain) transverse (horizontal). Introversion or narcissism (focus on herself) Fetal Presentation - part of the fetus that Acceptance of pregnancy enters the pelvis first. Need extra emotional support from family Fetal Attitude - relationship of fetal body members (for the first 3 months) parts to each other; flexion (normal) or Second Trimester Adaptations extension (abnormal). ❖ Role assumption (e.g by clothes) Fetal Position - fetal direction in the pelvis. ❖ Self image and body image during pregnancy (e.g conscious of how you look) 9  Fetal Station - position of the baby's head relative to the lower bone of pelvis called the ischial spines. 02. Passageway (the pelvis and birth canal) The passage includes the bony pelvis, the soft tissues of the cervix, and the vagina. The maternal pelvis is the greatest determinant in the vaginal delivery of the fetus. During the first stage of labor, the cervix opens (dilates) and thins out (effaces) to allow the baby to move into the birth canal. Stages of Labor: The cervix must be 100 percent effaced and 1. 1st (Cervix Dilation) - also called Cervical Stage. 10 cm dilated before a vaginal delivery. It starts from the onset of true labor pain and ends up 03. Powers (the uterine contractions) - refers to the with full dilatation of the cervix. Average duration 12 involuntary Uterine Contractions (UCs) and voluntary hours in primigravidae (first time labor) and 6 hours pushing of the fetus. Contractions are a tightening and multiparae (multi labor). relaxing of the muscles in the abdomen and the back. Two phases: After each contraction there is a uterine relaxation that Latent Phase (0-3 cm cervical dilatation) allows blood flow to the uterus. Active Phase (4-10 cm cervical dilatation) UCs have two major goals: a. to dilate the cervix b. to push the fetus through the birth canal 04. Position (maternal postures and physical positions) - maternal position during labor and birth. It is called Lithotomy Position. 05. Psyche (the response of the mother) - the psychological state of the mother and her response. Mechanism of Labor: 1. Engagement 2. Descent 3. Flexion 4. Internal Rotation 2. 2nd (Baby Delivery) - often referred to as the 5. Extension “pushing stage,” when the mom pushes the baby 6. External Rotation outside to the world. It starts when the cervix is 7. Expulsion completely opened (dilation) and ends with the delivery of the baby. Contractions will last about 60 to 90 seconds every 2 to 5 minutes. When the baby's head is visible at the opening of the vagina, it is called the “crowning.” It is shorter than the first stage, and may take between 30 minutes to 3 hours for a woman's first pregnancy. (1 hour to 2 hours). Delivery is expulsion or extraction of a viable fetus out of the womb. it is not synonymous with labour, delivery can take place without labour as in elective cesarean section. 3. 3rd (Placenta Delivery) - begins after delivery of may be vaginal, either spontaneous or aided, baby and ends with delivery of placenta and the or it may be abdominal. umbilical cord is clamped. Once a baby is born, the womb (uterus) continues to contract, causing the placenta to separate from the wall of the uterus. Once the baby has been delivered, it may be left for two to three minutes before cutting the umbilical cord. The mother may experience some bleeding. This stage usually lasts just a few minutes up to a half hour. There are two ways: 10  Physiological Management (spontaneously with the mother's effort) Active Management 4. 4th (Postpartum) - begins an hour to four hours after delivery, and sometimes for about six weeks, or with the stabilization of the mother. The baby should be assessed and the mother should have regular assessments for uterine contraction, vaginal bleeding (the normal blood loss is about 500 mL), heart rate and blood pressure, and temperature, for the first 24 hours after birth. 11 Normal Labor Signs: c. an urge to vomit 1. Pre-labor (1-4 weeks before labor) d. the discharge of blood stained mucus, baby's head drops down and which is known as a ‘show.’ lightening feels e. breaking of the waters. Stage 2 (a few minutes to 3 hours) - the expulsion: increased back pain and cramps descent of head and pushing phase. Contractions abdominal pain increase in strength and the cervix is fully dilated; the joints feel looser infant is delivered. diarrhea a. nausea and vomiting cervix effacement and dilation b. increased pressure in the bottom region of (opening and thins out of cervix) the body 2. Early Labor (Hours before labor) c. longer contractions occurring within one to bloody show (vaginal discharge two minutes of each other d. the desire to push becomes thicker and pink) e. burning sensations in the vagina water breaks (rupture and break of Stage 3 (5 to 30 minutes) - placenta delivery. The the amniotic sac) placenta is expelled and other membranes, also known uterine contractions (UCs) (painful, as After Birth. regular, strong contraction) Episiotomy - a small cut made in the perineum to enlarge the Remember: vaginal opening. The period begins with the onset of regular uterine Crowning - when the top of your baby's head appears at the contractions (UCs) and lasts until the expulsion of the placenta; vaginal opening. we call the Intrapartum. Shoulder Delivery - the process of delivering your baby's Delivery is the birth of a baby itself. It can occur in two ways, shoulders one at a time. vaginally or by a cesarean delivery. Placenta Delivery - the process of delivering the placenta after Nursing Responsibilities During 1st Stage of Labor: your baby is born. a. vital signs Mucus Plug - a plug of mucus that seals the opening of the b. hydration and nutrition cervix during pregnancy. c. elimination Water Breaking - when the amniotic sac ruptures and releases amniotic fluid. d. assessment of contractions and FHR Placenta - the organ that connects the mother to the fetus and e. labor support provides nutrients and oxygen to the fetus. f. comfort measures / pain management C-section - a surgical procedure in which incisions are g. education made in a woman's abdomen and uterus to deliver a Nursing Responsibilities During 2nd Stage of Labor: baby. C-sections can be planned in advance or can a) Never leave the patient alone once she has become necessary during labor. Common indications for a c-section: been transferred to the delivery room. Dystocia: Prolonged or non-progressive labor, b) Encourage the patient to rest between which can occur when the baby's head is contractions and to push with contractions. unable to fit through the birth canal or its c) Position the patient's legs in the stirrups for body is in an unfavourable position. the lithotomy position. Placenta Previa: When the placenta partially d) Prepare the patient's perineum or completely blocks the cervical opening. e) Monitor the patient's blood pressure and the Fetal Distress: When the health of the baby is in imminent danger, usually from inadequate fetal heart beat every 5 minutes and after each blood flow through the placenta or umbilical contraction. cord. Complications During 2nd Stage of Labor: Multiple Births: When a woman is pregnant slow progress of labor with more than one baby. when the baby is in an unusual position Large Tumors of the Uterus: When a concern about the baby's condition woman has large tumors in her uterus. perineal year Genital Herpes or Other Infections: When a woman has genital herpes or other infections postpartum hemorrhage that could be passed to the baby during retained placenta childbirth. umbilical cord prolapse Medical Problems: When a woman has umbilical cord compression medical problems such as uncontrolled Nursing Interventions: diabetes or hypertension. A) Explain to women and labor partners what is How is a c-section performed? expected in the third stage of labor to enlist 1. Prepping for surgery: The woman will be given anaesthesia and a catheter will be inserted into her cooperation. bladder to drain urine. B) Have women maintain her position to 2. Making incisions: The doctor will make an incision facilitate delivery of the placenta. in the woman's abdomen, either a vertical incision from C) Ask the mother if she wishes to dispose of the just below the navel to the top of the pubic bone or a placenta in any specific manner to comply horizontal incision across and just above the pubic with certain cultural customs. bone. Remember: 3. Opening the uterus: The doctor will make a second 3 Stages of Labor: incision on the lower part of the uterus. 4. Delivering the baby: The doctor will rupture the Stage 1 (12 to 19 hours) - the latent phase and active amniotic sac and deliver the baby. phase. The cervix relaxes, causing it to dilate and thin 5. Delivering the placenta: The doctor will clamp and out. Longest stage. cut the umbilical cord, gently remove the placenta, and a. mild and irregular contractions b. pain in the lower back tightly suture the uterus and abdomen. 12 Preeclampsia and Eclampsia Group 1 Severe Agitation Unconsciousness Preeclampsia Altered Mental Status and Confusion A serious blood pressure condition that Most women will have these symptoms of preeclampsia develops during pregnancy. before the seizure: People with preeclampsia often have high ➔ Headaches blood pressure (hypertension) and high levels ➔ Nausea and Vomiting of protein in their urine (proteinuria). ➔ Stomach Pain Preeclampsia usually develops after the 20th ➔ Swelling of the Hands and Face week of pregnancy. Preeclampsia can also ➔ Vision Problems (loss of vision, blurred affect other organs in your body and cause vision, double vision, or missing areas in the kidney and liver damage, brain injury and visual field). other serious side effects. Eclampsia Causes: Preeclampsia Symptoms: The exact cause of eclampsia is not known. Factors Swelling in the Face and Body that may play a role include: Abdomen and Shoulder Pain Blood Vessel Problems Nausea and Vomiting Brain and Nervous System (Neurological) Low Urine Output Factors Presence of Protein in Urine Diet Hypertension (High Blood Pressure) Genes Vision Changes 1. Severe Preeclampsia: High blood pressure and Persistent and Severe Headache organ damage in preeclampsia can escalate into Sudden Weight Gain seizures. Shortness of Breath 2. Placental Problems: Poor blood flow to the Preeclampsia Causes: placenta may trigger systemic problems leading to 1. Placental Issues - problems with the development eclampsia. of blood vessels in the placenta can lead to poor blood 3. Immune System Responses: Abnormal immune flow, causing preeclampsia. reactions to pregnancy may contribute to inflammation 2. Immune System Responses - abnormal immune and seizures. responses to pregnancy may trigger inflammation, 4. Blood Vessel Abnormalities: Dysfunction in the contributing to preeclampsia. blood vessels can restrict blood flow, affecting the 3. Chronic Health Conditions brain and triggering seizures. 5. Genetic Factors: A family history of preeclampsia or eclampsia increases the risk. 6. Lack of Proper Prenatal Care: Not receiving adequate prenatal monitoring or treatment for preeclampsia can lead to eclampsia. Eclampsia Medical Interventions: 1. Magnesium Sulfate: This is the first-line treatment to prevent and control seizures. It helps to calm the 4. Multiple Pregnancies - carrying twins or triplets nervous system and prevent further convulsions. can increase the risk. 2. Antihypertensive Medications: Drugs like Preeclampsia Medical Intervention: labetalol, hydralazine, or nifedipine may be used to I. Monitoring: Frequent prenatal visits, including lower dangerously high blood pressure and reduce the blood pressure checks, urine tests, and ultrasound to risk of stroke. monitor the baby's growth. 3. Delivery: The only definitive treatment for II. Medications: eclampsia is delivering the baby, as the condition is a. Antihypertensives - to lower blood pressure. pregnancy-related. Depending on the severity of the b. Corticosteroids - to induce fetal lung maturity condition and gestational age, immediate delivery may and prepare for premature delivery. be necessary, often via cesarean section. c. Anticonvulsants - to prevent seizures. 4. Fluid Management: Careful management of fluids Magnesium sulfate is commonly used. is essential to prevent complications like pulmonary III. Bed Rest: In mild cases, bed rest may be advised to edema (fluid buildup in the lungs). help lower blood pressure and improve the blood flow 5. Oxygen Support: In severe cases, oxygen therapy to the placenta. may be required to improve oxygenation for both IV. Delivery: The only cure for preeclampsia, the mother and baby. timing of delivery depends on the severity of the 6. Postpartum Monitoring: After delivery, the mother conditions and how far along the severe case is, will continue to be monitored closely for any ongoing delivery may be necessary. symptoms or complications, as eclampsia can still Eclampsia - a severe and life-threatening complication occur postpartum. of preeclampsia. It is characterized by the onset of seizures or convulsions in a pregnant woman with Ectopic Pregnancy and Iron Deficiency preeclampsia. Eclampsia typically occurs after the 20th Anemia Group 2 week of pregnancy, during labor, or after childbirth. Ectopic (Tubal) Pregnancy - a condition in which a Eclampsia Symptoms: fertilized egg implants and grows outside the uterus, Seizures 13 most commonly in the fallopian tubes. It can also occur transport adequate oxygen, leading to various health in the ovaries, cervix, or abdominal cavity. issues. Ectopic Pregnancy Causes: 1. Fallopian Tube Damage: Scarring from Iron Deficiency Anemia Causes: conditions like pelvic inflammatory disease 01. Heavy Menstrual Periods - women who (PID) or previous surgeries can block the experience heavy menstrual bleeding are at egg’s passage. increased risk of iron deficiency anemia. 2. Endometriosis: Growth of uterine-like tissue 02. Gastrointestinal Bleeding - bleeding in the outside the uterus can affect the fallopian stomach, intestines, or other parts of the tubes or surrounding organs. digestive tract can also lead to iron deficiency 3. Hormonal Factors: Hormonal imbalances anemia. This can be caused by conditions may impact egg movement and embryo such as ulcers, polyps, colon cancer, or regular development. use of aspirin or NSAIDs. 4. Previous Ectopic Pregnancy: A history of 03. Urinary Tract Bleeding - bleeding in the ectopic pregnancy raises the risk of urinary tract can also contribute to iron recurrence. deficiency anemia. 5. Assisted Reproductive Technologies (ART): 04. Injuries or Surgery - blood loss due to Treatments like IVF can slightly increase the injuries or surgeries can also cause iron risk. deficiency anemia. 6. Smoking: Alters tubal cell structure and 05. Frequent Blood Donation - regular blood function, increasing ectopic pregnancy risk. donation can deplete iron stores and increase 7. Intrauterine Device (IUD) Use: Although the risk of iron deficiency anemia. rare, an IUD can be associated with an Iron Deficiency Anemia Symptoms: increased risk of ectopic pregnancy. Extreme Fatigue Ectopic Pregnancy Symptoms: Weakness Abdominal Pain Pale Skin Vaginal Bleeding Shortness of Breath Shoulder Pain Chest Pain Gastrointestinal Symptoms (nausea, vomiting, or Headache diarrhea) Iron Deficiency Anemia Medical Intervention: Signs of Internal Bleeding I. Complete Blood Count (CBC): This test Delayed Menstrual Period measures the number of red blood cells, white Medical Intervention: blood cells, and platelets in the blood. Medication: II. Hemoglobin Levels: This test measures the Methotrexate - an injection that stops the amount of hemoglobin in the blood. growth of ectopic tissue, allowing the body to III. Serum Iron Levels: This test measures the reabsorb it. Most effective when diagnosed amount of iron in the blood. early, with no risk of rupture. IV. Ferritin Levels: This test measures the Surgery: amount of iron stored in the body. Laparoscopy - a minimally invasive V. Treatment: Treatment for iron deficiency procedure using small incisions and a anemia focuses on addressing the underlying laparoscope to remove the ectopic tissue or cause and replenishing iron stores. the affected fallopian tube, with shorter VI. Intravenous (IV) Iron: If oral iron recovery time. supplements are ineffective or not tolerated, Laparotomy - a more invasive surgery with a IV iron may be administered. larger incision, used in cases of severe internal VII. Iron Supplements: Oral iron supplements are bleeding, significant damage, or when the most common treatment. laparoscopy isn't feasible. VIII. Vitamin C Intake: Consuming foods rich in Expectant Management: vitamin C, such as citrus fruits, strawberries, Watchful Waiting - monitoring with blood and broccoli, can enhance iron absorption. tests and ultrasounds in specific cases where Antepartum Hemorrhage and Placenta Previa the ectopic pregnancy is small, asymptomatic, and shows no signs of complications. This is Group 3 less common. Antepartum Hemorrhage - another term of Supportive Care: antepartum which is an Antenatal the term that means Pain Management - to relieve discomfort. before birth. Antepartum Hemorrhage Causes: Counseling - emotional support to help 1. Hypertensive Disorders - these conditions, patients cope with the distress of the diagnosis such as gestational hypertension and and treatment preeclampsia, involve high blood pressure Iron Deficiency Anemia - a type of anemia where the during pregnancy and can lead to serious body does not have enough iron to produce sufficient complications for both the mother and baby. hemoglobin. 2. Gestational Diabetes - this is a form of Hemoglobin - a protein found in red blood cells that diabetes that develops during pregnancy, carries oxygen from the lungs to the body's tissues. characterized by high blood sugar levels that Without enough hemoglobin, the red blood cells cannot 14  can affect the health of both the mother and 06. Large Placenta - an unusually large placenta the fetus if not managed properly. can occupy more space in the uterus, which 3. Placental Problems - issues like placental may lead to abnormal positioning and increase abruption or placenta previa can cause the likelihood of placenta previa. bleeding during pregnancy, posing risks to Placenta Previa Symptoms: both maternal and fetal health. Painless Vaginal Bleeding 4. Preterm Labor - this refers to labor that Occasional Contractions begins before 37 weeks of pregnancy, which Placenta Previa Medical Interventions: can result in premature birth and associated I. Diagnosis and Monitoring - placenta previa complications for the newborn. is typically diagnosed during routine prenatal 5. Infections - during pregnancy, such as urinary ultrasound examinations, often in the second tract infections or sexually transmitted trimester infections, can lead to complications like II. Treatment Options - for placenta previa preterm labor or adverse effects on fetal depends on the severity of bleeding, the development. gestational age of the baby, and the overall 6. Maternal Age - (typically over 35) is health of both mother and baby. associated with increased risks of III. Cesarean Delivery - is generally the complications during pregnancy, including preferred method for delivering babies with higher rates of hypertensive disorders and placerita pravia. gestational diabetes. IV. Coping and Supports - a diagnosis of Antepartum Hemorrhage Symptoms: placenta previa can be stressful and Vaginal Bleeding anxiety-provoking for expectant mothers. Abdominal Pain Placental Abruption Group 4 Uterine Contractions Placental abruption (abruptio placentae) - occurs Dizziness or Weakness when the placenta partly or completely separates from Antepartum Hemorrhage Medical Interventions: the inner wall of the uterus before delivery. This can I. Monitoring: Close observation of the mother decrease or block the baby's supply of oxygen and and fetus, including vital signs and fetal heart nutrients and cause heavy bleeding in the mother. rate. Placental Abruption Symptoms: II. Ultrasound: To assess placental location and Vaginal bleeding identify potential causes of bleeding: Abdominal pain III. Stabilization: Administration of intravenous Uterine contractions fluids (IV) possibly blood products to manage Fetal distress blood loss. Placental Abruption Causes: IV. Medications: To manage symptoms and, if 1. Trauma and External Injuries needed, medications like tocolytics to delay 2. Hypertension and Preeclampsia preterm labor. 3. Uterine Conditions and Abnormalities V. Delivery: If the bleeding is severe or the fetus 4. Advanced Maternal Age (35 y/o) is at risk, early delivery may be considered. 5. Substance Abuse (e.g., tobacco, illicit drugs, Placenta Previa - a problem of pregnancy in which the alcohol) placenta grows in the lowest part of the womb (uterus) 6. Blood Clotting Disorders (e.g., thrombophilia) and covers all part of the opening to the cervix, 7. Multiple Gestations (e.g., twins or triplet) Placenta previa can cause severe bleeding in the Placental Abruption Medical Intervention: mother before, during or after the delivery. Once the placenta has separated from the uterus, it Placenta Previa Causes: can’t be reconnected or repaired. A healthcare provider 01. Previous Cesarean Section - having had a will recommend treatment based on: cesarean delivery in the past increases the The severity of the abruption. likelihood of placenta previa due to scarring How long the pregnancy is/gestational age of and changes in the uterine structure. the fetus. 02. Previous Placenta Previa - women who have Signs of distress from the fetus. experienced placenta previa in previous Amount of blood you’ve lost. pregnancies are at a higher risk of having it If the fetus isn’t close to term: recur in subsequent pregnancies. a. If it’s too soon for the fetus to be born and 03. Multiple Pregnancies - carrying multiple your abruption is mild, your healthcare fetuses can lead to an increased risk of provider will monitor you closely. You may placenta previa as the uterus is more stretched go home to rest, or you may stay in the and may alter placental positioning. hospital. Your provider may give you 04. Advanced Maternal Age - women over the corticosteroids to help the fetus’s lungs age of 35 are at a greater risk for placenta mature. They’ll continue to monitor you. previa, potentially due to changes in uterine b. If the abruption is severe and the health of you and placental development. or the fetus is at risk, immediate delivery may 05. Uterine Scarring - scarring from previous be necessary even if the fetus isn’t close to surgeries or conditions affecting the uterus can term (37 weeks of pregnancy). interfere with normal placental implantation, If the fetus is near term: increasing the risk of placenta previa. 15  a. If the abruption is mild and the fetal heart rate Fluids that go into your vein through a tube called an is normal, your provider may allow your “IV” (Intravenous). pregnancy to continue to term. They may give Medicines to help stop your nausea and vomiting. you corticosteroids to mature the fetus’s lungs If this treatment doesn’t work, your doctor can feed and monitor you closely for changes. you through a tube (nasogastric tube) that goes in b. If the abruption is severe, delivery may need your nose and down into your stomach or through a to happen immediately. If you or the fetus is vein. in danger at any time, the baby will be Can Hyperemesis Gravidarum be prevented? delivered (typically via emergency C Section). Doctors strongly recommend that all women who might get pregnant or who are pregnant take vitamins. Hyperemesis Gravidarum and Intrauterine The vitamin should contain at least 400 micrograms of Growth Retardation Group 5 Folic Acid. Taking vitamins before pregnancy and in Hyperemesis Gravidarum early pregnancy might help prevent nausea and A condition causing severe nausea and vomiting. frequent vomiting in pregnant women, much Intrauterine Growth Retardation (IUGR) worse than typical morning sickness. Baby grows slower than expected during Unlike morning sickness, which can occur pregnancy. Can lead to complications before any time of day, hyperemesis gravidarum is and after birth. more intense and persistent. Intrauterine Growth Retardation Causes: Babies born to women who have hyperemesis 1. Maternal Factors: gravidarum throughout their pregnancy are Chronic Diseases: Conditions like slightly more likely to be smaller than hypertension, diabetes, and kidney disease can average. affect fetal growth. Hyperemesis Gravidarum Causes: Nutritional Deficiencies: Poor maternal Hormonal Changes nutrition or inadequate caloric intake can Genetic Factors impair fetal development. Multiple Pregnancy Substance Abuse: Smoking, alcohol Gastrointestinal Issues consumption, and illicit drug use can hinder Immune System Response fetal growth. Pre-existing Conditions Infections: Maternal infections such as Psychological Factors Toxoplasmosis, Cytomegalovirus, and Rubella Hyperemesis Gravidarum Symptoms: can adversely impact fetal growth. Symptoms usually start in the first 2-3 months and 2. Placental Factors: often improve by mid-pregnancy, though some women Placental Insufficiency: If the placenta is not remain sick later. functioning properly, it may not deliver ➔ Daily vomiting, often multiple times a day. enough nutrients and oxygen to the fetus. ➔ Severe nausea. Placental Abruption: Premature separation ➔ Weight loss. of the placenta from the uterine wall can lead ➔ Dehydration (dark urine, urinating less, to IUGR. dizziness). Placenta Previa: A condition where the ➔ Inability to keep food or liquids down. placenta covers the cervix, potentially ➔ Extreme tiredness and fainting. affecting blood flow to the fetus. Is there anything I can do on my own to feel better? 3. Fetal Factors: 1. Eat when you’re hungry or even before you’re Chromosomal Abnormalities: Genetic hungry. disorders like Down syndrome can be 2. Snack often and have small meals. Choose associated with IUGR. high-protein or carbohydrate foods like Congenital Anomalies: Structural crackers, bread, pretzels, nuts, and low-fat abnormalities in the fetus can impede growth. yogurt. Avoid spicy, greasy, or acidic foods. Multiple Gestation: Twins or higher-order 3. Drink cold, clear fluids like sports drinks or multiples often experience restricted growth ginger ale, and avoid coffee. Drink between due to competition for resources. meals instead of with them. 4. Uterine Factors: 4. Suck on popsicles or ginger-flavoured Uterine Abnormalities: Structural issues lollipops. with the uterus can impact fetal growth. 5. Brush your teeth right after eating. Fibroids: Uterine fibroids can potentially 6. Avoid lying down right after eating. restrict fetal growth if they interfere with 7. Take your vitamins at bedtime with a snack, blood flow or space. not in the morning. Intrauterine Growth Retardation Symptoms: 8. Stay away from things that upset your ❖ Small for Gestational Age (SGA) stomach, like stuffy rooms, strong smells, hot ❖ Reduced Fetal Movements (may indicate places, or loud noises. distress or growth issues) 9. Have someone else prepare your meals. ❖ Low Amniotic Fluid 10. Wear acupressure bands on your wrists to help ❖ Abnormal Doppler Ultrasound Findings with nausea. Intrauterine Growth Retardation Medical Intervention: How is Hyperemesis Gravidarum treated? 01. Monitoring and Diagnosis 16  - Ultrasound: Checks fetal growth, amniotic b. Gestational diabetes may increase your fluid, and placenta function. chance of having a cesarian section, also - Doppler Studies: Assess blood flow in the called a C- section, because your baby may be umbilical artery and other vessels to monitor large. A C-section is a major surgery. fetal and placental health. c. Over time, having too much glucose in your - Non-stress Test (NST) and Biophysical blood can cause health problems such as Profile (BPP): Monitor fetal heart rate and diabetic retinopathy, heart disease, kidney movements. disease, and nerve damage. 02. Management Different Forms of Gestational Diabetes: - Manage Underlying Conditions: Treating 1. Class A1 - is used to d