OB Lesson 1 PDF

Obstetric Nursing MENSTRUATION AND OVULATION Why don't we get periods during pregnancy? And why do we get periods Estrogen Hypothalamus FSHRH APG when we’re not pregnant? If a woman has any problems with her menstruation and is currently...

Obstetric Nursing MENSTRUATION AND OVULATION Why don't we get periods during pregnancy? And why do we get periods Estrogen Hypothalamus FSHRH APG when we’re not pregnant? If a woman has any problems with her menstruation and is currently having her period for 9 months, if you are going to assess her, what structures are you going to evaluate? Estrogen Ovary FSH What are the structures that are involved in menstruation? A certain hormone will be significantly low, and it is Estrogen. Hypothalamus By negative feedback the structure Hypothalamus will be ✓ Hypothalamus secrets GnRH stimulated. ▪ GnRH has two types, Follicle-stimulating hormone As said earlier the Hypothalamus is capable of producing (FSH)/(FSH-RF) and Luteinizing hormone (LH)/(LH- GnRH, and one of the the two types of GnRH is FSHRH. RF). These are the two GnRH being produced by the With the production of FSHRH, APG will be stimulated. APG will Hypothalamus. now release its first hormone, FSH. The hormone FSH will mature and develop your primordial The Anterior Pituitary Gland follicle by stimulating the ovaries' first hormone which is ✓ APG is also capable of producing two hormones. Estrogen. ▪ Follicle-stimulating hormone (FSH) and Luteinizing With the increase of Estrogen the Endometrium will thicken. hormone (LH) Thickening of the endometrium is to start preparing the uterus for possible implantation just in case you had coitus and there Ovaries was fertilization. ✓ These release Estrogen and Progesterone. Estrogen will now mature from the Primordial follicle to the Graafian follicle. The uterus ✓ Does not produce any hormones, yung impact dito later ✓ FSH on, will be on the uterus in preparation actually either in ▪ The main role of this hormone is to stimulate one of menstruation or pregnancy. your primordial follicles inside the ovary. Ang target nya ay isang itlog sa ovary mo. These four structures are responsible for regulating your menstruation. ▪ It will stimulate the maturation of one of your primordial follicles. FOLLICULAR AND PROLIFERATIVE PHASE ▪ This will target your primordial follicles but of course, Negative Feedback Mechanism your immature oocytes, which can be located inside Someone said earlier na it was the mechanism called Negative the ovaries. Feedback on why a woman gets her period. This is when a certain ▪ Ovaries serve the oocytes as their house. Until they hormone decreases or bababa will in turn stimulate other are released in the process of ovulation. structures to produce their own hormone. This is actually the one ▪ Is it the hormone for ovulation? Not yet. Nag papa- that regulates when we talk about the menstrual cycle. mature lang sya hindi pa mag re-release. Menstrual Cycle ✓ Estrogen The Menstrual Cycle includes the first day to another first day. ▪ The major function of this hormone is endometrial The first day of my menstruation is in August and the first day of thickening. my menstruation is in September. From first drop to another first ▪ Estrogen will initiate thickening. drop. ✓ Average of 28 days, but not all women have 28 days ✓ Progesterone cycle. You can have 32, 35, 34, etc. ▪ Will also make the endometrial thick but it will maintain the thickness. Menstrual Period These are the days when a woman has her flow. What produces Estrogen? ▪ Start of the first day: August 23 The ovaries ▪ End of last day: August 28 What structure contains high levels of Estrogen? The Graafian Follicle. ✓ August 23 to August 28 is an average course of 3 to 5 days What stimulates FSH production? Decrease of Estrogen. If this is the case what will be my LMP here? Pag nag FSH ka na, mag i-increase ang Estrogen, what will Answer: August 23 (first day of my last menstruation) (unang araw ng happen to FSH? huling regla). Decrease of FSH. Rationale: Because FSH and Estrogen are inversely proportional. If On the 3rd day of the flow (August 25) FSH decreases, estrogen will increase and vice versa. This is in order to regulate your cycle and ovulation. If both of the hormones increase at the same time, ilang itlog ang gusto mo mag mature? Dapat isa lang. University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing Basal Body Temperature Pag proliferative and follicular phase, ano ang mataas na You cannot tell a woman she is ovulating when you see a hormone? straight line from the BBT graph. Advise the woman to go Estrogen to her doctor this might indicate some hormonal problems. Rationale: Pinakapal ng estrogen ung endometrial lining and There should be a sudden decrease and increase of BBT conversion of Primordial follicle to Graafian follicle due to FSH. during ovulation. This sudden change in temperature is triggered by low levels of progesterone. On the 13th day of the cycle (September 4) ✓ A decrease in the progesterone levels will result in a decrease in BTT. Progesterone LH ✓ This is because Progesterone is thermogenic in nature. Hypothalamus It affects BBT. ✓ This is why pag buntis ang isang woman mataas ang kanyang BBT dahil sa hormones. ✓ Progesterone = BBT. Ovulation A certain hormone will be significantly low, and this time it is your Progesterone. By negative feedback the structure Hypothalamus will be stimulated. As said earlier the Hypothalamus is capable of producing GnRH, and one of the the two types of GnRH is LH. With the production of LH, this is the only time a woman will have ovulation. What is the hormone of ovulation now? The LH What triggers LH production? The decrease of Progesterone This is why all hormonal preparations of family planning (injectables, implantable, and oral contraceptives) include high levels of Progesterone. Mag t-trigger lang ung production ng LH pag mayron decrease levels of Progesterone. Without the decrease of Progesterone, LH will not be stimulated for ovulation. This is how When does ovulation happen? hormonal preparations work keeping your progesterone levels high. : Midway of BBT. (pag wala ung midway sa board exams next close answer will be ‘’when it increases’’). Rationale: Ovulation took place already when the BTT increased. OVULATION SYMPTOMS Nag o-ovulate lang ang woman pag nag increase ung BBT. Hindi Increase Libido pwede during decrease kasi wala pang ovulation. Increased in libido kaya malambing ang isang babae during ovulation. This is why when you want to get pregnant, couples Mittelschmerz Pain should have coitus during ovulation. Slight pain that is felt when the ovum was released either on the ✓ There are times when a woman feels beautiful, malambing, right or left lower quadrant (kung nasa right ovary or left ovary). sexy, and overall confident. This is due to her ovulation. ✓ This pain will be felt every time a woman gets her menstruation but it will fade afterwards. There is also nipple erectility When the ovum gets released from the ovaries the remaining capillaries Cervical mucus will rupture and that will cause Looks like a raw egg white. Clear, thin, watery, and elastic. vaginal spotting. This is called Spinnbarkeit and it could be stretched up to 12cm. When does ovulation happen? : 14 days before your next menstruation. Rationale: Kahit kaninong babae yan ang isasagot mo, dahil constant ✓ Estrogen is the hormone yan. Whatever your cycle maybe 14 days ang sagot. Pag ikaw ay nag responsible for Spinnbarkeit. ovulate, mag-foform ka ng corpus luteum inside the ovaries. And this ✓ When you put this mucus on a slide corpus luteum only has 14 days of lifespan. Kasi around 14th day under the microscope, you will nangyayare ang ovulation. observe a fern pattern. This means that a woman is ovulating. University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing LUTEAL AND SECRETORY PHASE Dysmenorrhea (masakit ang puson) occurs during the luteal phase. During this phase, certain hormones will be relased such as Premenstrual Syndrome prostagalndins. And this prostaglandin will cause vasouterine There are times when a woman feels sensitive, easily irritated, spasms, and with this makaka experience tayo ng Dysmenorrhea masungit, mataba, and bloated. This is due to her PNS during the luteal phase and before we get our menstruation. (Premenstrual Syndrome). This will occur during the Luteal Dysmenorrhea will continue throughout menstruation. Phase after ovulation. Premenstrual Syndrome happens during the increased Bakit mainet ang ulo mo? levels of progesterone. We become bloated because we gain Answer: Kasi mainet sa pakiramdam, masyado madaming progesterone. weight. Progesterone promotes fluid retention, kaya totoo pag Kaya. irritable ang babe during PMS. nasa luteal phase ka you feel bloated just before you get your Pag menstrual phase, ano ang status ng ating hormones? mens. Answer: Decrease in Hormones Rationale: Mababa ang hormones kaya nag-kakaroon ng shedding off Increased in Progesterone ng endometrium known as menstruations. After ovulation progesterone levels will increase. It will maintain endometrial thickening. Graafian Follice will turn into Corpus Luteum with progesterone, FROM CORPUS LUTEUM TO PLACENTA Not only does it promote thickening but also endometrial hypervascularity. Corpus Luteum and Placenta This is why we call progesterone a hormone of pregnancy. Blood After 12 weeks the Corpus luteum will die and the vessels are now dilated due to increased levels of progesterone, placenta will take over to maintain the 2nd and 3rd- so meaning to say if you had an egg that had ovulated and had trimester. During the 1st-trimester the placenta is only undergone fertilization, the site of the implantation will be developing. Nagiging functional lang ang placenta at an conducive to the growth of the baby since the location of the site average of 12 weeks, so dun pa lang sya capable of is full of nutrients and oxygen. Kasi dilated ung blood vessels ng producing estrogen and progesterone. Placenta will maintain uterus pag mataas ang progesterone. the high levels of estrogen and progesterone and thus, will Also promotes uterine relaxation (nag-papa relax). Promotes maintain the whole pregnancy from 2nd-trimester onwards. vasodilations thus relaxing the uterus. Kasi pag bumaba ang hormones baka magkaroon ng threaten abortion si mommy. In order to keep your 25th day of the cycle (September 16) pregnancy these hormones should be elevated. This is the Corpus luteum is only good for 14 days (pag hindi na- responsibility of the Corpus luteum in the 1st-trimester fertilization during ovulation). and the placenta in the 2nd and 3rd-trimester. ✓ 11 days na lang buhay ang Corpus luteum 25 - 14 =11 ▪ Corpus luteum will now start to degenerate. Unti-unti In short, pag ikaw ay buntis there is no way your hormones will go na syang masisira kasi hindi na buntis si woman. down, and since walang hormone na baba there will be no ▪ Estrogen and Progesterone will now decrease, bleeding or menstruation. and that is why on the 28th day of the cycle your corpus luteum will become corpus albicans. FSH is inversely proportional to Estrogen. ▪ Both hormones are very very low, without these LH is inversely proportional to Progesterone. hormones nothing will keep the uterus thick and Pag mataas ang FSH dapat mababa ang Estrogen and vice versa. Pag hypervascular. mataas ang LH dapat mababa ang Progesterone and vice versa. ▪ Endometrium will slog off and blood vessels will rupture and that will be the time you will have your The newer version of the book, it contains the Ovarian cycle and the next menstruation. Endometrial cycle. Pero kasi the book just divided the changes in the ovaries and in the uterus. Pero magkasabay lang itong Follicular at Bakit nag m-mens ang hindi buntis? Proliferative phase. And then itong Luteal phase kasabay lang ng : If you do not get pregnant, the Corpus luteum can only live for 14 Secretory phase. days. And since it will be only for 14 days, mamatay ito, babagsak, and then mag m-mens ang woman. The Corpus luteum plays a vital role in Ano ang meron kay ovary na wala kay endometrium? fertilization. : Ovulatory Phase Ano ang wala sa ovaries na meron kay endometrium? Bakit hindi nag m-mens ang isang buntis? : Menstrual Phase : You have a special hormone in pregnancy, and this hormone can only Since ibat-iba ang cyle ng mga babae, saang phase sila pare- be produced once you get pregnant. Hindi sya pwede sa non-preggy. parehas ng duration? The hormone is called Human Chorionic Gonadotropin (HCG). : Luteal Phase Rationale: HCG will prolong the life of the Corpus luteum and prevent Rationale: Whatever your cycle maybe 14 days ang sagot. Kasi 14 degeneration. HCG also maintains pregnancy by keeping the hormones days lang ang life span ng corpus luteum. very high. University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing What are the characteristics of the cervical mucus during ▪ Posterior Fundus = most implantation site in the ovulation? uterus. Answer: Thin, watery, and elastic. ✓ Corpus Rationale: Thin (manipis) is easily penetrated by the sperms, which it ▪ The main body of the uterus. makes a lot easier for pregnancy. Pero after ovulation this cervical ✓ Isthmus mucus will become thick (mucoid) caused by the increased levels of ▪ Has two parts, the Isthmus of the fallopian and the progesterone. Thus, it will be hard for the sperms to penetrate Isthmus of the uterus. and the chances of pregnancy decreases. Ma-ttrap agad ung mga ▪ Most contractile and the most passive part, lower sperms dun sa cervical mucus.That is why when you want to have sex uterine segment pag nag lalabor. with low chances of pregnancy, do it at the luteal phase. ▪ This is the part na ginugupit pag LTCS (low transverse cesarian section) si mommy. ▪ Pag CS, yung uterine insicion ang tinitignan. Pede FERTILIZATION magka iba ung cut sa tyan (sa labas) kesa sa uterine (sa loob). Paano nabubuntis ang isang babae? Of course, you have to do coitus, ▪ LTCS is the most common type of CS. This is preferably during the woman’s ovulation to make things easier. because a woman is still a candidate for normal delivery for her subsequent pregnancy. Malayo kasi ung cut sa fundus. ANATOMY OF THE UTERUS ▪ Pero kung nag fe-fetal distress, kailangan ng larger outlet, malaki si baby, unstable na si mommy, and Viginal Canal and Viginal Orifice need mabilis mailabas si baby, do the classical It serves as an opening, organ for copulation, also serves as part cesarian section. However malapit ito sa fundus, of the birth canal, and the passageway of the menses. so pag nag classical CS ako, hindi na ako pede for normal delivery. Cervix ▪ So if nag classical cut na si mommy, ang mga next Has 3 parts pregnancy sya is classical CS na. Dahil may ✓ External Cervical Os chances na mag rupture ang uterus. Kaya less ▪ Pinpoint opening pag hindi buntis pero it opens up chance mag normal delivery sa mga woman with to 10cm during cervical dilatation and labor. classical CS kaya sya less choice and preferred. ✓ Endocervical Canal Fallopian Tube ▪ Eto ung canal na nag e-efface pag nag lalabor Has 4 segments. Same size as a chicken intestine. ▪ Effacement is the thinning and shortening of ✓ Interstitial the canal, until finally wala nang canal na nag e- ▪ Most narrow or masikip na part. Most crucial site existing pag fully efface na. Dito na ung the best time for ectopic pregnancy. Hindi dahil kasi narrow ung to push. tube but it's because this part is hypervascular, kaya pag nag rupture ang ectopic, extensive ung ✓ Internal Cervical OS bleeding. ▪ Eto ung tinatahi natin para if ever mag dilate man ✓ Isthmus ung isang canal, mag efface man ung isang canal, ▪ Site for sterilization and BTL (bilateral tubal ligation) mame-maintain paren ang product sa loob kasi dito ✓ Ampulla mo sya sinara. Dito ginagawa ung cerclage ▪ Site where the ovum and the sperms unite. Site for procedure (temporarily sewing the cervix closed fertilization. with stitches). ✓ Infundibulum Fimbriae ▪ Dito ka lang pede mag tahi kasi pag nag tahi ka sa ▪ Catches the ovum during ovulation. external os, masisira lang ung tahi kasi nag di- dilate ung cervix. Ganun den sa endocervial Ovaries canal, bawal mag tahi dahil nag e-efface ang Houses the primordial follicles. cervix. Present na ung mga egg/itlog sa ovaries pag pinanganak ang ▪ In order to maintain pregnancy for an incompetent isang babae. Then, sa loob ng ovaries lalaki and mag ma-mature cervix, and you need to come up or do your cerclage ung mga itlog hangang ma-release sila. procedure, we do it in the internal cervical os. Produces estrogen and progesterone. ▪ Dito pede magka placenta previa, like partial and total previa. Since a placenta previa is the In the menstrual cycle, what produces estrogen and complete or partial covering of the internal os of the progesterone? cervix with the placenta. : Ovaries. Uterus In early pregnancy what produces estrogen and progesterone? Has 3 parts : Corpus Luteum. ✓ Fundus In late pregnancy what produces estrogen and progesterone? ▪ Most contracted part, that one that contracts, the : Placenta. upper uterine segment during labor. University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing LAYERS OF THE UTERUS The cell will undergo an acrosomal reaction, a formation of small perforations in the anterior head of the sperm. Endometrium And then parang mag dri-drill sya gamit ang ulo nya sa surface Layer for implantation and menstruation. ng egg to release an enzyme known as hyaluronidase. Most significant when it comes to OB. This hyaluronidase will cause the thinning of the surface until magkaroon ng opening para maka-pasok si sperm. Myometrium Papasok na ung sperm leaving its tail and then fertilization will Powerful layer, most contractile layer. Eto ung nag ccontract pag begin. ikaw ay nag dedeliver. Perimetrium Holds the entire uterus. CHARACTERISTICS OF AN OVUM Most significant when it comes to OB. Ovum Has 23 chromosomes, and out of the 23, we only have 22 CHARACTERISTICS OF A SPERM autosomes and 1 sex chromosome. Ovum has only a Y (female) chromosome. Gametes is a reproductive cell of an animal. In female gametes are At birth a woman has 300 to 500 thousand immature called ovum or egg cells, and male gametes are called sperm, they oocytes and only 300 to 500 will reach maturity, while the divide under the process of meiosis. Each egg or sperm, has exactly rest will die in the process called atresia. 23 chromosomes making them a haploid cell (a haploid cell is the Has a lifespan of 48 hours (max). presence of a single set of chromosomes). How does the ovum move from the ovaries to the ampulla? The Sperm Infundibulum fimbriae of the uterus will catch the ovum from the Has 23 chromosomes, and out of the 23, we only have 22 ovaries to the ampulla by a peristaltic movement. This movement autosomes and 1 sex chromosome. is estrogen-induced. Sperm has an X (female) chromosome and Y (male) chromosome. The ciliary action also contributes to the movement of the ovum. Cilia Semen has 50-115 million per cc and 3 - 5 cc of semen. (are tiny hair-like structures that line the fimbriae) it beats rapidly in the Has a lifespan of 72 hours. direction of your uterus. This beating motion sweeps the egg into your Sperm is a continuous process hindi nauubos, unlike the fallopian tubes and then makikisabay by rolling along the waves, where eggs of a woman. it can be fertilized by the sperm at the ampulla So the males will determine the sex of the baby. Pag ikaw ay tumatanda pede mag decrease ung levels ng estrogen, There are many ways but not 100% reliable to ensure a baby boy. so pag nag decrease ung estrogen production, mag-kakaroon ng effect First is deep penetration. The vagina is very acidic and will likely kill sa movement, implantation, and fertilization. Ano mangyayare? the sperms. This is why we need to provide a more alkaline environment its either may infertility ka (hindi mabuntis) or na fertalize nga yung egg like the cervix by doing deep penetration. Second, do prolonged pero hindi na implant ng maayos at dumikit kahit saan, pede foreplay so the bodily glands will produce more alkaline substances. magkroon ng ectopic pregnancy. Lastly, do it during ovulation, since the pH of the vagina is more alkaline. Pag may nakapasok nang isang sperm, the egg will inhibit other sperms to penetrate.This is called a zona reaction. This reaction is when 1 Sperms are flagellated sperm survives or enters the ovum, the egg will lock itself preventing They can swim, have tails, they are very motile, and they can other applicants from penetrating. Ngayon if defective ang itlog, propel themselves. tapos pinayagan nya ung dalawang sperms pumasok, magiging Hmole (partial Hmole) ang egg. ✓ Contraction/spasm of the uterus will occur after the ejaculation of the male. This is because the semen contains prostaglandin. The uterus will contract ZYGOTE paakyat to aid the sperms to enter and swim to the A lot of changes that will happen, for being zygote it will ampulla. This is how the sperms can propel themselves undergo several development and several changes, so the towards the ampulla meaning of fern ovum you will have zygote ✓ This is why if you have threatened abortion or pre– Zygote have a 46 chromosomes term contractions, you should avoid sex as this can Yung ating zygote undergo changes a cell division process worsen your contractions. mitosis, somitogenesis meiosis the product will be HAPLOID (kalahati) Sperms have acrosome Diploid (double), from single zygote nagging 2 will become Located sa ulo nila. 4,8,16 to 50 tawag dito zygote union product This acrosome will undergo capacitation, Capacitation is Pag nag divide na siya sa cell called blastomeres. Local – the removal of the protective covering from the head called ATIS structure called morula (madami). When the cavity the acrosome. inside called blastocyst University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing All changes they occur inside the fallopian tube and inside the fallopian PLACENTA AND FETAL MEMBRANE tube it will take around 3-4days bago siya mag blastocyst. Meaning to AMNION say for fertilization 3 to 4 days doon pa lang siya magiging blastocyst. Inner layer Pag nag blastocyst siya doon pa lang siya papasok sa matris, inside the Give rise to umbilical cord (AVA) 2 arteries (deoxygenated) matris before the implantation it will take 8 to 9 days all in all average and 1 vein(oxygenated) is 14 days maximum. For fertilization to implantation it around 14days maximum, that a reason don’t expect after the fertilization the UMBILICAL CORD implantation happen, it take maximum of 14 days. Warton’s jelly: prevents knotting of CORD If blastocyst undergo this processes hindi siya basta mag implant lang Pag yung cord na buhol (knotted) what do you think what will we have 3 process happen to the baby? Connecting to placenta and baby Cord, Apposition – entrance of blastocyst if the cord is knotted compromised yung oxygen and Adhesion – attached endometrium nutrients. (ALARMING OR EMERGENCY) Invasion – immerse doon sa endometrium Length Bago siya totally ma implant sa uterus normal site (posterior fundus) - 20-25cm (normal) layer of uterus implant endometrium Short Cord - Risk of abruption placenta (kase nahihila yung attachment doon sa base) DESIDUA Long Cord - former endometrium (layer of implantation) - Risk for cord prolapse 3 layers: - Pag pumutok ang panubigan (water bag) lalabas yung cord Desidua basalis- implants blastocyst mauna kay baby Desidua capsularis - encapsulate blastocyst - May possibility nuchal cord or cord coil Desidua vera – not coordinated AMNIOTIC FLUID Monozygotic – identical twins, quadruplet - To it gently but firmly (Leopolds) dapat may pressure - Pag monozygotic (isa) galing sa isa pag nag divide sila totally Very important: divided, separate sila kaya nagging twins 1. Cushion against abdominal pressure Fraternal twins – hindi sila mag kamuka, or hindi sila same ng - That’s a reason do not be afraid kasi procted siya ng amniotic sex fluid - Binibigyan sila ng clomiphene citrateto induce the ovulation to - Thermoregulation: kung mag karoon ng changes of body regulation, 2 egg are fertilized temp ng mommy mas matagal siya mag changes because of fluid unlike sa air mabilis lang siya mag change ng temp - Pag dry sa amniotic sac at nag kakaroon ng development ang IMPLANTATION kanyang katawan ano feel niyo “dikit dkit” unlike moist siya it penetrate sperm sa ovum by time to dissolved zona pellucida, pag nag promotes symmetrical development kakaroon ng cell division yung zona pellucida later on will be replace - If walang tubig sa tingen niyo mag move si baby? NO, unlike trophoblast cells (outer layer). Cover to egg zona pellucida pag may tubig kay baby Chorionic Villi – serve as temporary passage way of oxygen and - Fetal movement – muscle development nutrients coming from the mother to the baby. From the baby to mother carbon dioxide and waste products. Intrauterine not functioning, 2. Does not provide nutrients Maternal Liver – (detoxify) kaya siya ilalabas papunta kay mommy - Source of oral intake dadaan sa liver niya lilinisin ng liver bago ibalik kay baby, later on the placenta will take over. Meaning to say chorion + desidua basal will the 3. Cleanses / Lubricate Birth Canal placenta ibig sabihin pag ginawa yung - Can you deliver intake amniotic fluid or amniotic sac? NO, CVS (Chorionic villus sampling test) to check chromosomal cavity that’s a reason kung spontaneous delivery or transition phase, 8-10weeks gestational pero pag nasa transition phase siya at 9cm hindi pa pumutok Early pregnancy what will you do? Amniotomy, kasi need paputukin ang Will become placenta (10weeks) panubigan bago lumabas si baby - 800- 1000 or 1500L (maximum) normal value TROPHOBLAST - < 300 oligohydramnios Outer layer - > 1,500 polyhydramnios (over 2000ml) Give rise to placenta and fetal membrane Question: kelan ako makakakuha ng realiable amount of EMBRYOBLAST measurement sa isang buntis? Inner layer Give rise to fetus It’s okey AFI (amniotic fluid index) Depth of 4 quadrants, gaano siya kalalim sa quarants ni mother tapos add the total Example: 2.5,2.5, 3,3 = 11cm AFI 11cm – normal or normohydramnios - 5-9cm NORMAL DEPTH University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing 1st trimester RH incompatibility – 72 hrs after (give RhoGAM after placental - Amniotic fluid is LOW delivery) kasi hindi na-expose si mommy sa fetal blood sa - Not reliable to get AFI intrauterine, para hindi siya mag develop ng antibodies. 2nd trimester Emergency case: Vaginal Bleeding - 12 weeks and above - Give RhoGAM (ASAP) - Fetal kidney are matured - Produce of amniotic fluid is Fetal Kidney. Kasi yung kidney nag IMMUNITY produce ng IHI yung ihi na yan ayan yung amniotic fluid. IHI MMR: (mumps, measles and rubella) serve the amniotic or oral fluid intake of the baby, to regulate - Give 9 months the amount - Because if will the protection of the placenta Immunoglobulin (IgG)- protect the baby at the 1st 9 months Kung mag papaAFI si mother to determine the amount of fluid what is - Natural passive immunity, kasi antibodies na ibibigay. the early AOG possible? Earliest - 12 weeks in relation to the maturity of the kidney ENDOCRINE 1st trimester: mother feel dizzy; Oligohydramnios -production problem, (konti) problem to produce, - Organogenesis → Brain (need ng madaming glucose) kidney. Meron siya renal Anomalies - Most of the time mother suffering morning sickness. Polyhydramnios – consumptions problem - Ano ang kukunin niyang glucose to develop the brain, kung Problem sa swallowing – tracheoesophageal fistula/atresia ano yung nasa dugo ni mother pag kuha sa mother ng dugo - Narrowing trachea to esophagus, may problema sa swalling si naiwan si mommy ng walang sugar baby hirap siya uminom. - The mother suffer HYPOGLYCEMIA cause of dizziness Diabetes - hyperglycaemia: Polyuria, Polydipsia and Polyphagia - More urine because of polyuria 2nd trimester: gestational Diabetes Mellitus Multiple Pregnancy: more babies → more kidney → more urine - Fully develop na si placenta Fetal high drops: autoimmune disease where in the baby’s made up - Produce the estrogen and progesterone si corpus luteum pero only of water may special hormone ito called HPL (Human Placental Breech: increase gastric motility during birth (most common meconium Lactogen) but not alarming) - Pag buntis ka may mataas ka cortisol collectively insulin Cephalic: can be led pulmonary aspiration and also infections by fetus antagonist hormone. Pag ikaw nasa 2nd tri may placenta (most alarming) capable producing - Antagonist (kalaban) – Diabetogenic effect CHRION - Pag kumain ka ng rice maconvert yan sa glucose, pagmay - Outer layer glucose ka sa bloodstream mo sino mag rereact si pancreas(sasabihin ni pancreas daming glucose mag produce MATERNAL SIDE ako ng insuli) - Separation from the start edges - Insulin serve a KEY (opening the cell) cells insulin receptor - Dirty Duncan (Makikita yung panget side) site - Insulin antagonist do not accept glucose resulting to GDM FETAL SIDE (late in pregnancy) - Separation start to center - 2nd – 3rd trimesters; 24-28 weeks check for DM or screening - Shiny Schultz Cotyledons – 25-30 average STAGES OF INTRAUTERINE LIFE - Pag mag dedeliver ka ng placenta always check the Question for board exam: who among the following patient in a risk cotyledons baka may missing part gross congenital defect lahat sila nag take ng teratogen? - 1 weeks FETAL CIRCULATION - 6 weeks UMBILICAL CORD - 10 weeks Two Arteries (deoxygenated) - 12 weeks One Vein (oxygenated blood) OVUM FETAL CIRCULATORY CIRCUIT Pre-embryonic; fertilization to implantation (14days or 2 weeks) Ductus venosus - Fertilization up to 14days Ductus arteriosus Foramen ovale EMBRYO 14 days, 2weeks, 8 weeks PLACENTA Most critical kay baby (organogenesis) PROTECTIVE BARRIER don’t have mature placenta No mixing of maternal & fetal blood intrauterine - Kasi maternal blood and fetal blood meron in between them FETUS prevent mixing called placental barrier 8 week until birth Complete organogenesis University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing FETAL DEVELOPMENT LANUGO AND VERNIX CASEOS 3 layers of EMBRYO: Lanugo – kelan siya nag start 4 or 6 weeks - 16 weeks ECTODERM - Common entire body plus the appearance of 20 weeks Outer most layer Vernix – 20 weeks 5 sense By 22 weeks, a fine downy hair, including eyebrows and a waxy - Skin substance covers the body. The fetus is about 30 cm long and - Mouth has regular sleep pattern. - Ears Anti bacteria properties - Nose - Eyes QUICKENING Hair 20 week – prominent Nails 16 weeks – multi (sensitive, Madali niya madetect yung quickening) MESODERM EARS Body systems Kelan mo kakausapin si baby? Cardiovascular, Musculoskeletal, urinary 1st half (kidney and o 20 weeks ureters) - 16 weeks – ossification - 20 weeks above– able to hear, develop sense of hear ENDODERM Bladder, Urethra, Reproductive, Endocrine, Respiratory, GI LUNGS Lung surfactant - Lecithin and Sphingomyelins FETAL HEART - Allow alveoli/ air sac to open for gas exchanges 1st develop (2weeks of life) 24 weeks – develop 4 weeks heart start to beat but cannot be detected with 28 weeks – 1:1 ratio ultrasound 32 weeks – 1.2.:1 8 weeks detectable/ earliest 5 weeks detect 36 weeks – 2:1 complete matured lungs - Sino ang nag survive na baby 7 months or 8 months, pag 12 weeks – doppler (earliest 9 weeks) mga 7 month naka NICU in term of maturity 8 months 16 weeks – fetoscope (earliest 13) - 37 accept the doctor as a full term because of lung maturity. 18 weeks – ordinary stethoscope (earliest 17) PREGNANCY BRAIN CHN: foreseeable crisis Develop 3 weeks Fundamentals: Maturational crisis 8 weeks – neuromuscular movement (functional mas late siya sa You have to cope with physiological and psychosocial heart) changes So why is it a crisis? After 8 week, all body system are prevent, and the embryo is o Because it requires you coping in order for you to cope called a FETUS. Muscles move the nervous system develops, and effectively blood cell formation is about 10 weeks old and weight as much as an ordinary leuter. Family centered approach We are not just after the woman, because pregnancy involves KIDNEYS AND PLACENTA everybody in the family: It may affect the husband. There will Fully develop 12 weeks be sibling rivalry and even the grandparents are affected Produce HPL Couvade syndrome a condition where the husband feels the same discomfort as that of a woman. This is basically more of psychological SEX ORGAN (husband is preoccupied on the pregnancy of the wife) 6 weeks – Gonad Identical o Management: Psychiatric nursing (ex: “It seems 8 weeks – begins to differentiate that you are preoccupied with the pregnancy, would 10 weeks – well differentiated genitalia you like to talk about it? ““tell me how you feel right 12 weeks – distinguishable by appearance now” 20 weeks above – if want mo malaman yung sex ng baby PHYSIOLOGIC CHANGES TEETH Urinary frequency o Due to compression of Deciduous – 8 weeks organs inside the body Permanent – 12 weeks resulting from the growing 6 months – temporary (decidua bonds) uterus. 2 years – permanent ✓ Bakit pag ikaw ay buntis nag fe- BONES frequency urination ka? 16 weeks – earlies time as needed (w/1st fetal skeleton) ▪ check the anatomical position. Ang bladder 12 weeks – bone ossification w/x-ray- hematologic problem may nasa harapan, so kung a rise with bone marrow (RBC) bone marrow depression may laman ang bladder University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing at lumalaki ang matres mo sa gitna, anong ▪ Kapag MS ang patients, high blood volume> tataas ang nangyayari sa bladder mo? - nacocompress. So, BP nya. Kasi pag mataas ang blood pressure mas kaya naiihi ka. (Urinary frequency) maraming pressure ang dadaan sa ugat ✓ Bakit constipated? ▪ pag lumalaki ang tiyan mo, ang uterus ay lumalaki High Progesterone Level din - nacocompress din ang intestine at stomach, o Sa pregnant may kakaiba sa kanya: that decreases gastric motility. Because of that ▪ MATAAS ANG PROGESTERONE LEVEL NYA. mother will be constipated or pag medyo naka kain ▪ effect ng progesterone: vasodilation so ibig sabihin ka, may pyrosis ka (heartburn) (reflux of gastric yung blood vessels mo, kahit maraming blood contents) kasi nacompress. volume, maluwag yung dadaanang blood vessels. ✓ bakit naiihi, nadudumi pag nagdedeliver? Kaya wala dapat High blood pressure. ▪ pag baby ay bumababa nacocompress ang bladder ▪ madami mang VOLUME: MALABNAW (blood) at rectum. MALUWAG (blood vessel) kaya hindi kailangan ng malakas na pressure para sa blood flow. CARDIOVASCULAR High blood volume NEVER IN PREGNANCY THAT HYPERTENSION IS EXPECTED o The blood volume during pregnancy is elevated to meet the ✓ BP should be normal or slightly decreased (especially on fetal needs and demands of the baby. the 28th-32 weeks gestation) because this is the peak ▪ Isa sa pinaka significant change is tumataas ang blood level of your plasma volume. volume para mabigyan mo ng mas maraming dugo at oxygen and baby SIGNS AND SYMPTOMS ✓ In preparation for labor and delivery. Bakit? ✓ Congested ▪ there will be blood loss ✓ Nasal stuffiness ✓ NSD (normal spontaneous delivery) ▪ normal blood loss: 350-500ml ✓ Easy gum bleeding ✓ Cesarean ✓ Epistaxis ▪ normal blood loss 1,000 ml ✓ Palmar Erythema ✓ Chadwick’s sign High plasma level o Fluid component of blood Progesterone level leads to vasodilation ▪ Anong component ng blood ang talagang tumataas Ano ang ineexpect ngayon sa nanay? significantly? ✓ congested sya. Feeling ng nanay sinisipon sya palagi ▪ the fluid component- plasma (it doesn’t mean na hindi (meron syang nasal stuffiness kasi congested ang nasal tataas ang RBC, WBC at platelets mo. Tataas din lahat blood vessels) yan. Pero ang pinaka madaming taas would be the ✓ pag sya nag toothbrush madali syang magbleed (easy plasma. (Which is the fluid component) gum bleeding) ▪ dahil mataas ang plasma mo, anong klaseng dugo ang ✓ kapag sya ay nag linis ng ilong, there is easy epistaxis ineexpect mo? - diluted blood, but it doesn’t mean that dahil congested ang blood vessels sa ilong. mother is anemic. Because mataas ang RBC, Pero dahil ✓ PALMAR ERYTHEMA (mamula mula) sa sobrang plasma mo, it is hemodiluted. Ito yung ✓ and the vagina will also turn bluish/purplish discoloration tinatawag na: of vagina because of vasodilation (CHADWICK’S SIGN) ▪ PSEUDOANEMIA or false anemia Hypertrophy ✓ Hindi ka talaga anemic (physiologic anemia) ✓ Increased pulse rate of 5-10bpm during pregnancy is normal Blood values acceptable: ✓ Easy fatigability is expected ✓ Hgb: should never be below 11g/dl ✓ Hct: should never be below 32% ✓ A portion High blood pressure will be accommodated by the ▪ Kaya baseline CBC ay pinapagawa lagi to rule out heart. Syempre dalawa yan, yung isa si progesterone kung pathologic anemia or meron lang sya pseudo anemia ipapadilate nya yung blood vessel mo kaya congested ka. Acceptable: kung and Hgb mo ay 11 at Hct ay 32%, acceptable pa yan. Ngayon naman the remaining portion will be (Physiologic anemia ka lang) accommodated by the heart. Lower than 11 Hgb and 32% Hct (anemic talaga si mommy) ✓ Si heart mag iincrease ang workload nya. At dahil nag dito na kailangan bigyan ng mga iron supplement as early as increase ang workload nya, magpapump sya harder. first trimester. ✓ Thus, the pulse rate will increase. Gaano ka increase? - 5- 10 bpm of pulse rate (normal yun pag buntis ka. Because Management: of the added workload given by the increase of plasma for Iron supplements at second trimester up to third trimester you.) (6months/180 days) ✓ Pag naoverwork ang muscle ano mangyayari? ✓ Sa CHN normally binibigyan si mother ng iron ▪ mag hypertrophy. Expected ang slight supplements kung normal ang CBC baseline nya during hypertrophy of the heart. So medyo malaki ang first trimester/first visit, bibigyan sya at second trimester puso ng isang buntis. up to third trimester (6months/180 days) ✓ At dahil sa nagpump ng nagpump, ano ang mangyayari? ▪ there will be easy fatigability. These are the High Blood Pressure manifestations made by the increased plasma ✓ With the increase of plasma do you expect high blood volume. (Slight hypertrophy of the heart, and easy pressure? fatigability) ▪ No, kasi high blood pressure is not normal in pregnancy. University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing Sample questions: ugat, pero ugat yon. Hemorrhoids are also blood veins that dilates because of poor circulation) Which of the following is not expected physiological changes ✓ How will you relieve edema? in pregnancy? ▪ Elevate the leg above feet level to promote venous ▪ Increased blood pressure return. Not unless, you have cardiac problems If the patient is a gravidocardiac patient (may sakit sa puso). ✓ (Sa MS, hindi pwede mag taas ng paa ang isang may sakit sa Kailan ang most critical period na magkaka cardiac arrest ang puso. Bakit? px na ito? ▪ Dahil ang circulation pupunta sa body, tatataas ang ▪ Third trimester (because this is the peak level of workload ng heart at mahihirapan syang tumibok) plasma level increase) (the higher the level of ✓ Is it okay na imassage ang buntis at nanganak? volume, the higher the workload, the more ▪ The answer is NO, because increase of fibrinogen exhausted the heart will be.) level makes them prone to clot formation. (Kung What if kasama sa choice ang Immediate post-partum? What imamassage ang may clot: the clot will dislodge) is the priority? (what will happen pag na dislodge ang clot? - ▪ Immediate post-partum dahil pag buntis ka, may embolism) helper ang heart (ito yung pag dilate ng blood ✓ The best way to prevent clot formation during pregnancy and vessel para hindi magkaroon ng highblood postpartum pressure) ▪ you will tell the mother to, ambulate. (Walk every ▪ however, during immediate post-partum ano ang 2-3 hours to promote circulation) ineexpect mo? ✓ Postpartum px: encourage early gradual ambulation. - there will be an abrupt decrease in progesterone, ✓ Ambulation benefits: improves gastric motility (sa buntis at nanganak prevents constipation) (babagsak yan). Pag bumagsak yan, saan mapupunta lahat ng blood volume na nakaretain sa blood vessel mo nung buntis ka? Elevated WBC: - lahat yan sasama sa general circulation (kasi ✓ This is due to initial recognition of the body to the growing zygote as foreign body kailangan mag normalize na pagka panganak mo) ▪ saan dadaan lahat? o Normal ba sa isang buntis na ang WBC ay slightly - sa heart mo. ending ang heart mo exhausted, elevated? cardiac arrest follows. And that is the reason why ▪ yes, especially in the first trimester that the WBC is immediate post-partum will be the most correct slightly elevated. answer. (because of sudden decrease in o Bakit? progesterone level making all this volume go to ▪ Remember That baby is initially a foreign body. (If general circulation, entering the heart to normalize there is a foreign body the immune system will try your blood circulation but unfortunately, heart is to fight. That is why WBC is elevated) weak, therefore, exhaustion is possible) ▪ later on, the baby will be recognized as part of the body and not a foreign body. Transient systolic murmur o Decrease in viscosity due to vasodilation causes transient -------------------------------------------------------------------------------------- systolic murmur What is the best position for a pregnant kung kailangan mong mag lie down? ✓ kapag mataas ang plasma level and blood ay o Left side lying. Because with left through gravity mare relieve hemodiluted (malabnaw) at madami (increased yung vena cava mo from compression (the point of entry of volume). Madami pero malabnaw pero maluwag ang blood going to the heart from the lungs is via the superior and dadaanan (blood vessels). inferior venacava) (kung sarado sya dahil nacompress ng ✓ Mabilis ba dumaan pag ganun? malaking tyan. Less blood will enter the heart, less will be ▪ Yes, mabilis lang. That is the reason why the oxygenated inside the lungs thus cardiac output will be less decrease in viscosity you will expect transient >> less supply to the baby >> fetal hypoxia.) systolic murmur. o Transient lang (paminsan Minsan lang) kasi kapag persistent GASTRO INTESTINAL CHANGES na ang murmur (suspect for cardiac problem) Morning sickness: has 3 major predisposing factors o Palpitation: ▪ can happen anytime and not only in the morning. ▪ sometimes expected is slight lang, kapag persistent and worsening hindi na ito normal. BOARD EXAM: a patient complains of morning sickness. Which of the following is the right intervention? (If general question ▪ Why? - because of the interaction of the or walang time na sinabi sympathetic and parasympathetic nervous system ▪ Give dried crackers/ toasted bread / any dry bread during pregnancy. (Thus, slight palpitation) (upon waking up in the morning) Edema/varicose/hemorrhoids: If morning sickness happens in the afternoon/evening what will be the answer? o Accumulation of fluid due to obstruction of the blood vessels ▪ Provide small frequent feeding ✓ anong cause nito? ▪ obstruction of circulation. Dahil malaki ang tyan mo If yuyuko may pupulutin paano gagawin? naiipit ang blood vessels going to the periphery and ▪ bend from your knees not from yours waist what will happen will be hemostasis and because of pagkatapos kumain hihiga ka ba? hemostasis magkakaroon ng edema. Leading to ▪ No, because by gravity there could be reflux of varicose veins dahil obstructed and blood flow. gastric contents. ▪ Hemorrhoids are also the result of obstructed blood ▪ avoid spicy/ oily foods as well flow going to the anal veins. (Minsan akala hindi University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing o Hormonal (HcG)- could be the predisposing factor for morning ✓ Oral Glucose Tolerance test is done to identify GDM (3hrs sickness usually) o Emotional stress o Transient hyperthyroidism Urinary Tract Infection ▪ because of the demand of the baby, natitrigger ang ✓ is prone during pregnancy because of: thyroid gland so most of the time meron kang ▪ frequency urination with poor hygiene transient hypothyroidism. (Binibigyan si mother ng ▪ glucose is present in urine medication for hyperthyroidism which is the PTU ▪ Urine stasis para icounter act ang hyperthyroidism) ▪ magfflow si urine from the kidneys via ureters papuntang bladder, papuntang urethra at palabas Hyperemesis Gravidarum ng urinary meatus. Kaso lumalaki ang matres, o If beyond first trimester nag susuka pa si mother nacocompress and ureters, so ang ihi ay obstructed (Hyperemesis Gravidarum) leading to Urine Stasis which is a factor for microbial ▪ have problem with fluid and electrolytes imbalance: growth thus UTI dehydration) ▪ females have short urethra and close proximity with Management: the meatus o do not force fluid; give IV fluids ▪ kaya dapat pag nag linis ka, from cleanest to dirtiest; harap papuntang likod Constipation Management: o expected at 2nd and third trimester when your ▪ increase fluid/ antibiotic (amoxicillin) internal organs are compressed by the fetus. Management: MUSCULOSKELETAL CHANGES o exercise/ambulate (best management) to promote Lordosis gastric motility ✓ exaggerated inward curve of the spine that typically o increase fluid affects the lower back o high fiber diet ▪ pag malaki ang tyan mo you have to maintain balance. You will assume a straighter and taller Heartburn posture. (liliyad) ✓ expected at 2nd and third trimester when your internal ✓ presence of back pain organs are compressed by the fetus. ▪ most of the time ang problema is back pain Management: Management ✓ is the same as the morning sickness ▪ sacral massage/ pelvic rock/ proper posture ✓ wobbling gait prone to accident/fall Hemorrhoids Management ✓ obstruction of blood flow in anal area ▪ wear flat shoes, stay away from injury will you encourage hemorrhoidectomy during pregnancy? ✓ Relaxin ▪ No, because anal sphincter will be damaged thus ▪ will make the pelvic bones more movable incontinent bowel leading to infection (infection is ✓ Leg cramps teratogenic in nature) Never dapat magkaroon ng infection ang isang buntis because most of the time ▪ due to muscle fatigue and hypocalcemia it is teratogenic. Management ▪ hemorrhoidectomy can be done after delivery ▪ drink milk (10-12 glasses of fluids a day; 6-8 non- caffeinated; 3-4 glasses should be milk), increase THIRD TRIMESTER CHANGES calcium (anchovies and seafoods) rest to prevent Ptyalism muscle fatigue ✓ increase salivation during third trimester of pregnancy; ▪ straighten the leg, dorsiflex mapait ito; ✓ the cause is unknown WEIGHT GAIN DURING PREGNANCY Management: normal ✓ give sweet chewing cany/hard candies/ frequent ▪ 25-35 lbs. all throughout the pregnancy mouthwash COMPUTATION FOR THE EXPECTED WEIGHT DURING Urinary frequency PREGNANCY ✓ because of a compressed bladder ▪ it is the only condition that appears during the first NORMAL VALUES trimester, disappears during the second trimester, ✓ Average weight gain (1st trimester/12 weeks) and reappears during the late third trimester. ▪ 3 lbs. (for the whole 12 weeks) Specifically, after lightening dahil bababa na ulit si ✓ Average weight gain (2nd & 3rd trimester) baby in preparation to labor and delivery ▪ 1 lbs. (per week) o Which specimen is more advisable if I want to detect GDM? EXAMPLE SCENARIO ▪ it would be blood, not urine. Dahil normal sa urine na positive sa glucose. Because of progesterone. Pre pregnancy weight: 115 lbs. ✓ Progesterone decreases renal threshold to glucose. She is now in her 32 weeks AOG ▪ That is why whether diabetic ka or hindi meron ka paring glucose sa urine basta buntis ka. So GDM will not be detected in this phase. University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing ✓ What is the expected weight at present? Positive o Ultrasound (average 8 weeks) (earliest 5 weeks) In 32 weeks minus twelve o 4F’s present ▪ kasi 12 weeks/first trimester constant 3 lbs. and ▪ fetal heart tone weight gain ▪ fetal palpable part So, 20 weeks remaining ▪ fetal movement 20 x 1 ▪ fetal outline ▪ because 1 lbs. per week ang madadagdag) = 20 + 3 PSYCHOSOCIAL ADAPTATION ▪ plus 3 is galing sa first trimester nya which is constant na 3 lbs. First trimester = 23 lbs. o Accepting pregnancy ▪ help the mother accept the pregnancy. ▪ expected weight gain at 32 weeks pregnancy ▪ How? = 23 + 115 - provide ultrasound ▪ 115 lbs. is the pre pregnancy weight o ambivalence and opposing feelings are expected = 138 lbs. o Statement should be ▪ “I am pregnant” So, 138 lbs. is the expected overall weight at 32 weeks pregnancy ▪ mother accepted the pregnancy SIGNS OF PREGNANCY oHow does the mother perceive the baby? Presumptive, Probable, Positive ▪ “Lumalaki ang tyan ko” ▪ common in first trimester Presumptive ▪ They perceive the baby as UFO or the baby is just ✓ All the subjective signs verbalized by the patient part of her body ✓ Pregnancy is not yet confirmed Management ✓ Sino ang observe nito? ▪ provide comfort for the mother at first trimester because ▪ si patient mother is focused on her body changes o In presumptive, are you sure that you are pregnant? ▪ hindi and this is more subjective because it is the px that usually observes the manifestations. So Second trimester hindi ka confirm na buntis ka dito o Accepting the baby o Kapag alam mong subjective in nature o Perception of the mother ▪ presumptive nay un ▪ the baby is a separate growing individual ▪ “Lumalaki ang baby ko” First Trimester: BUFAME (mnemonics) o The time where the mother will address the fetus as her baby B- breast changes o Statement should be: U- urinary frequency ▪ “I am going to be a mother” F- fatigability ▪ the mother accepted that fact that she is pregnant A- amenorrhea o Discuss growth and development M- morning sickness ▪ Maniniwala ba sya sayo? E- enlarged abdomen - Yes, because may tangible signs and symptoms of growing baby inside her. 2nd & 3rd trimester: CLISQ (mnemonics) o all skin changes C- chloasma (parang freckles) Third Trimester L- Linea Nigra o Accepting the parenthood I- increase pigmentation (nangingitim na singit) o preparing for labor and delivery and responsible S- strail (stretchmarks) parenthood Q- quickening o Prepare the mother ▪ teach the mother how to push Probable ▪ include family planning as well as birth plan o CGHEP (mnemonics) ▪ Holistic care that involves physiological, C- Chadwick’s sign (bluish discoloration of vagina) psychosocial G- Goodell sign (butter softening of the cervix) H- Hegar sign (softening of uterus) o Statement should be: E-elevated BBT ▪ “I am going to be a mother” P- positive pregnancy test ▪ mother accepts parenthood o BEB (mnemonics) When should you introduce the concept of breastfeeding? B- Braxton hicks’ contraction (painless irregular contraction) ▪ at first trimester/ first prenatal (as early as E- enlarge uterus (assessed by the nurse) possible) B- ballottement (rebounding of presenting part) o Patient verbalize “I might be pregnant” University of Santo Tomas – College of Nursing / JSV  Obstetric Nursing ANTEPARTUM CARE ▪ total of 3 viable delivery: year 2013, year 2016 and year Pre-natal Care 2020 o Ideal prenatal visit: ▪ first 7 months: every month TPAL (under ng Parity) ▪ 8-9 months: every 2 weeks Meaning inaalam kung Term, Pre term, Abortion, Living ang ▪ 4th lunar month: every week delivery o EINC/CHN T1 P2 A1 L3 ▪ at least 4 prenatal visits ▪ divided into 3 trimesters o T1 - 1st trimester: 1 visit ▪ term is 38-42 weeks - 2nd trimester: 1 visit ▪ year 2013 at 39 weeks - 3rd trimester: 2 visits o P2 ▪ Still the whole pregnancy is monitored ▪ basta pinanganak mo at 20-37 weeks regardless kung patay o Home Deliveries are discouraged o buhay ▪ more infections present at home ▪ year 2016 twin delivery at 28 weeks o Should at least deliver in facility-based delivery ▪ and year 2020 IUFD ▪ BEMNC- Basic emergency maternal and newborn o A1 child care ▪ year 2010 abortion ▪ CEMNC- Comprehensive emergency maternal and o L3 newborn care ▪ head count ng nabubuhay ▪ preferable midwife should assist ▪ year 2013 39 weeks counted as 1 ▪ and 2016 twin pregnancy counted as 2 HISTORY TAKING COMPUTATION of EDC Basic but common in board exam Estimated Date of Confinement (EDC) o Due date Gravida o number of pregnancies regardless of outcome and number o Kapag ang LMP is January to march = +9 +7 ▪ basta nabuntis ka, patay or buhay, isa or dalawa. ▪ (Add 7 days, add 9 months) Normal or hindi= isang gravida o Pag April to December = -3 +7 +1 ▪ (Minus 3 months, add 7 days, add 1 year) Parity Example: o number of viable deliveries (20 weeks and above) o LMP: November 14, 2022 ▪ basta nilabas mo, buhay or patay, regardless of outcome or number November = -3 +7 +1 COMPUTATION of GP(TPAL) ▪ So, November minus 3 months is October, September, Example: AUGUST ▪ Add 7 days from LMP = 14 + 7 is 21 Px 32 weeks at present ▪ Add 1 year from 2022 is 2023 2010 she had abortion (elective) EDC: August 21, 2023 2013 39 weeks delivery o Expect to deliver 2 weeks before or 2 weeks after August 21, 2016 twin pregnancy (delivered at 28 weeks gestation) 2023 ▪ Pag nakuha na ang EDC automatic 40 weeks (so 2020 Intrauterine Fetal Death 38-42 weeks) Compute for Gravida and Parity COMPUTATION of AOG o G5 LMP: November (30 days)