Female Reproductive System NCM 107 Lecture Notes PDF

LICEO DE CAGAYAN UNIVERSITY Paseo del Rio Campus, Macasandig, Cagayan de Oro City COLLEGE OF NURSING First Semester, Academic Year 2024-2025 NCM 107...

LICEO DE CAGAYAN UNIVERSITY Paseo del Rio Campus, Macasandig, Cagayan de Oro City COLLEGE OF NURSING First Semester, Academic Year 2024-2025 NCM 107 LECTURE TRANSCRIBED BY: BARBIE MAY GABIANA Female Reproductive System Ovaries UTERUS Duct System Located between the urinary bladder Uterine tubes (fallopian tubes) and rectum Uterus Hollow organ Vagina Functions of the uterus External genitalia Receives a fertilized egg Retains the fertilized egg OVARIES Nourishes the fertilized egg Composed of ovarian follicles (sac-like Parts of the Uterus structures) Fundus Structure of an ovarian follicle Corpus ○ Oocyte Isthmus ○ Follicular cells Cervix OVULATION Support for the Uterus - An ovary contains thousands of Broad ligament - attached to the pelvis immature egg cells. Round ligament - anchored interiorly - During each menstrual cycle, Uterosacral ligaments - anchored follicle-stimulating hormone (FSH) posteriorly causes one egg to begin Walls of the Uterus development; this takes place inside Endometrium a primary follicle. ○ Inner layer - The follicle enlarges as its cells ○ Allows for implantation of a proliferate, and begins to fill with fluid, fertilized egg becoming a secondary follicle that ○ Sloughs off if no pregnancy moves to the ovary's surface. occurs (menses) - It also increases its production of the Myometrium - middle layer of hormone Estrogen. smooth muscle - A surge of luteinizing hormone (LH) Serous layer - outer visceral causes the follicle to rupture and peritoneum release the ripe egg-this is ovulation. - The lining of the empty follicle thickens CERVIX into a corpus luteum-a temporary source Parts: of hormones. The ovary contains undeveloped eggs, eggs in Internal Cervical os follicles at various stages of maturation, and Cervical Canal empty follicles forming corpora lutea. The bulk External Cervical Os of the glandular tissue surrounding these follicles is known as the stroma. THE VAGINA: A TUNNEL WITH THREE CORE FUNCTIONS Support for Ovaries - The vagina extends down from the Suspensory ligaments - secure ovary cervix, the lower part of the uterus, to to lateral walls of the pelvis the vestibule, which is part of the Ovarian ligament - attach to uterus vulva and the external genitalia. Broad ligament - a fold of the peritoneum, encloses suspensory - It sits behind the bladder and in front ligament of the rectum. - An inner mucous membrane lines UTERINE (FALLOPIAN) TUBES the smooth muscle walls of the Receive the ovulated oocyte vagina. Provide a site for fertilization - This lining, like the inner layer of the Attaches to the uterus uterine tubes, is continuous with the Does not physically attach to the ovary mucous lining of the uterus. Supported by the broad ligament The vagina has three core functions: Uterine Tube Function It carries menstrual flow outside the Fimbriae - finger-like projections at the body distal end that receive the oocyte It receives the male penis during Cilia inside the uterine tube slowly move sexual intercourse the oocyte towards the uterus (takes 3-4 It serves as a birth canal during days) labor. Fertilization occurs inside the uterine tube EXTERNAL GENITALIA (VULVA) Mons pubis - Fatty area overlying the pubic symphysis  - Covered with pubic hair after puberty The head contains the nucleus with densely Labia — skin folds coiled chromatin fibers (chromosomes), with ○ Labia majora a front section - the Acrosome that contains ○ Labia minora enzymes for penetrating the female egg. Vestibule The midpiece has a central filamentous - Enclosed by labia majora core with-many Mitochondria spiraled - Contains opening of the urethra and around it, to give it energy to move the tail the greater vestibular glands which propels it forward. (produce mucus) Clitoris EPIDIDYMIS - Contains erectile tissue Comma-shaped, tightly coiled tube - Corresponds to the male penis Found on the superior part of the testis and along the posterior lateral Mammary Glands side Present in both sexes, but only Functions to mature and store sperm function in females cells (at least 20 days) ○ Modified sweat glands Expels sperm with the contraction of Function is to produce milk muscles in the epididymis walls to Stimulated by sex hormones (mostly the vas deferens estrogens) to increase in size Anatomy of Mammary Glands SEMINAL VESICLES Areola - central pigmented area Located at the base of the bladder Nipple - protruding central area of Produces a thick, yellowish secretion areola (60% of semen) Lobes - internal structures that ○ Alkaline fluid radiate around nipple ○ Fructose Alveolar glands - clusters of milk ○ Prostaglandins producing glands within lobules ○ Clotting Factors Lactiferous ducts - connect alveolar Other substances that nourish and glands to nipple activate sperm Reproductive System PROSTATE GLAND Gonads - primary sex organs Encircles the upper part of the ○ Testes in males urethra ○ Ovaries in females Secretes a milky fluid Gonads produce gametes (sex cells) ○ Helps to activate sperm and secrete hormones ○ Enters the urethra through ○ Sperm - male gametes several small ducts ○ Ova (eggs) - female gametes Semen Male Reproductive System Mixture of sperm and accessory Testes gland secretions Duct system Advantages of accessory gland ○ Epididymis secretions ○ Ductus deferens ○ Fructose provides energy for ○ Urethra sperm cells Accessory organs ○ Alkalinity of semen helps ○ Seminal vesicle neutralize the acidic ○ Prostate gland environment of vagina ○ Bulbourethral gland ○ Semen inhibits bacterial External genitalia multiplication ○ Penis ○ Elements of semen enhance ○ Scrotum sperm motility TESTES EXTERNAL GENITALIA Each lobule contains one to four Scrotum seminiferous tubules ○ Divided sac of skin outside ○ Tightly coiled structures the abdomen ○ Function as sperm-forming ○ Maintains testes at 3°C lower factories than normal body ○ Empty sperm into the rete temperature to protect sperm testis viability Sperm travels through the rete testis Penis to the epididymis ○ Delivers sperm into the Interstitial cells produce androgens female reproductive tract such as testosterone ○ Regions of the penis Sperm develop in the testes and consist of a Shaft head, a midpiece, and a tail.  Glans penis Endometrial Stage (enlarged tip) 1. Proliferative Phase Prepuce After menstruation, the endometrium (lining (foreskin) of the uterus) regenerates and thickens, Folded cuff of driven by rising estrogen levels. skin around 2. Secretory Phase proximal end Following ovulation, progesterone from the Often removed corpus luteum causes the endometrium to by mature and prepare for a potential embryo circumcision implantation. Internally there are three areas of spongy 3. Ischemic Phase erectile tissue around the urethra If no fertilization occurs, hormone levels drop, causing the blood supply to the Fertilization and Conception endometrium to decrease, leading to tissue breakdown. Conditions for Fertilization 4. Menses Live, motile and normal sperm. The shedding of the uterine lining occurs as Fallopian tube patent. menstrual bleeding, marking the start of a Female hormones are present. new cycle. General Consideration 1. Normal amount of semen per ejaculation – 2.5cc 2. Number of sperm per ejaculation – 50-200 million/ml 3. Mature ovum is capable of being fertilized for 24 hours 4. Sperm are capable of fertilizing for 48-72 hours 5. Sperm once deposited in the vagina will generally reach the cervix within 80 seconds after deposition and to the fallopian tube about 5 minutes after deposition. Accomplishing Fertilization For fertilization to occur, coitus must occur: – 48 hours before ovulation – 24 hours after ovulation Fertilization – when a sperm fuses with an egg to form a zygote Fertilization: Four Major Steps 1. Sperm contacts the egg 2. Sperm or its nucleus enters the egg 3. Egg becomes activated and developmental changes begin 4. Sperm and egg nuclei fuse Human Sperm Cell Ovarian Cycle 1. Follicular Phase The first phase of the ovarian cycle, where follicles in the ovary mature under the influence of FSH (follicle-stimulating hormone). Estrogen levels rise as the dominant follicle prepares for ovulation. 2. Ovulation Phase Mid-cycle phase where the mature egg is released from the dominant follicle, triggered by a surge in LH (luteinizing hormone). 3. Luteal Phase The final phase, where the ruptured follicle transforms into the corpus luteum, A human sperm cell consists of three main producing progesterone to prepare the parts: uterus for possible pregnancy. If fertilization doesn’t occur, the corpus luteum degrades, 1. Head: Contains the nucleus, which leading to menstruation. holds the genetic material (DNA) necessary for fertilization. It also has  an acrosome that releases enzymes divisions to help penetrate the egg. – It creates a multicellular embryo from 2. Midpiece: Packed with mitochondria the zygote that provide energy for the sperm to – first cleavage occurs after 24 hours move. Takes 3 -4 days 3. Tail (Flagellum): Propels the sperm Cleavage produces a blastocyst forward to reach and fertilize the egg. - A blastocystisis a fluid-filled cavity - The innier cells of the blastocyst Sperm Capacitation form the baby - Removal of adherent seminal plasma - The outer cells form the embryo protein , plasma membrane lipids and proteins Embryonic Stage - It destabilize the sperm’s membrane in Zygote- fertilized ovum preparation for acrosomal reaction Morula- mulberry-like ball with 15-50 cells, - Acrosome a lysosome that is packed with travels by ciliary action and peristaltic zona digestive enzymes contraction of the falllopian tube to the - Tends to make sperm become hyper uterus ( 3-4 days more ) activated and display hyper activated Blastocyst – enlarging cells that forms a motility cavity in the morula, later becomes an embryo Trophoblast- fingerlike projections covering around the blastocyst Implantation 6th – 9th day after fertilization, blastocyst attaches to uterine wall. Stages of Implantation 1. Apposition 2. Adhesion 3. Invasion 3 processes of Implantation 1. Apposition – blastocysts begin to brush the endothelial lining 2. Adhesion – blastocysts begin to attached the endothelial lining 3. Invasion – blastocysts begin to settle down “Proteolytic enzyme” – for dissolving endothelial lining allowing implantation. Implantation Fertilization takes place in the ampulla Zygote formation 12-14 days after fertilization. The zygote(fertilized ovum) takes 3-4 days to enter the uterus. It takes 6-9 days days to complete the process of nidation or implantation. The implanted blastocyst is covered over by endometrial cells Implantation is completed by the fourteenth day after ovulation Viability of the corpus luteum is maintained by human chorionic gonadotropin (hCG) secreted by the trophoblasts hCG prompts the corpus luteum to continue to secrete progesterone and estrogen Between the second and third Cleavage produces a ball of cells from month, the placenta: the zygote - Assumes the role of progesterone Cleavage is the first major phase of and estrogen production embryonic development - Is providing nutrients and removing – It is the rapid succession of cell wastes  Weighs approximately 400-600gms Decidua – thickened endometrium and 15 to 20cm in diameter and 2-3 (Greek word – falling off); cm in depth at term implantation has taken place Functions as a transport mechanism between the mother and the fetus, it Layers of Decidua:: serves as: Basalis (base) part of endometrium - fetal lungs located directly beneath or under the - kidneys implanted ovum/fetus where - GIT placenta is developed. - endocrine gland Capsularies – encapsulate or co the Progesterone: fetus - Suppresses uterine contractions. Vera – remaining portion of - Stimulates uterine growth. endometrium. - Suppresses LH and FSH. - Stimulates development of alveolar Placentation tissue of the mammary gland. The placenta is fully formed and The placenta allows for a variety of functional by the end of the third substances to pass from mother to fetus month - Protective antibodies Embryonic placental barriers include: - German measles virus - The chorionic villi - HIV - The endothelium of embryonic - Drugs (prescription and capillaries nonprescription) The placenta also secretes other - Alcohol hormones – human placental - Chemicals in tobacco smoke lactogen, human chorionic thyrotropin, and relaxin Formation of the Placenta and Amniotic Chorion – where placenta is Sac developed – outermost membrane Decidua basalis: Placenta – (Secundines) Greek – - Maternal tissue in contact with the pancake, combination of chorionic chorion frondosum. villi + deciduas basalis. Decidua basalis and chorion fondosum together become placenta. Functions of Placenta: Maternal and fetal blood do not mix. Respiratory System – beginning of lung function after birth of baby Gastrulation GIT – transport center, glucose - Gastrulation occurs and organs transport is facilitated diffusion more develop from the ectoderm, rapid from higher to lower. If mom endoderm, and mesoderm. hypoglycemic, fetus hypoglycemic - Meanwhile, the four embryonic Excretory System- artery - carries membranes develop: waste products. Liver detoxifies Amnion waste products of the fetus. Chorion Circulating system – achieved by Yolk sac osmosis Allantois Endocrine System – produces hormones Gastrulation produces a three- layered embryo Placental Hormones Gastrulation is the process of Human Chorionic Gonadrophin – transforming the two-layered maintains corpus luteum alive; basis embryonic disc to a three-layered of pregnancy test embryo containing three germ layers: Human placental Lactogen or ectoderm, mesoderm, and sommamommamotropin Hormone endoderm – for mammary gland development. It is the second major phase of Has a diabetogenic effect – serves embryonic development as insulin antagonist - It adds more cells to the embryo Relaxin Hormone- causes softening - It sorts all cells into three distinct cell joints & bones layers ○ estrogen - The embryo is transformed from the ○ progestin blastula into the gastrula. The three layers produced in gastrulation Ectoderm, the outer layer Endoderm, an embryonic digestive tract Mesoderm, which partly fills the Placenta space between the ectoderm and Arises out of trophoblast tissues endoderm Fetal membranes Blood flow through the umbilical cord Chorion- fetal membrane closest to at an estimated 400ml/minute. the uterine wall; and encloses the Development Stage embryonic body and all other Zygote – 12-14 days after membranes fertilization - time the ovum is Amnion- is the thin but tough fetal fertilized until implanted in the uterus. membrane that lines the amniotic Embryo – 3-8 weeks after sac fertilization - most vulnerable Allantois-A membranous sac that teratogens. develops from the posterior part of Fetus – 9 weeks from fertilization to the alimentary canal in the embryo, It term - up to 38 – 42 of gestation. is important in the formation of the umbilical cord and placenta. Yolk sac – hypoblast cells that form Antepartum Care a sac on the ventral surface of the Pregnancy- the condition of having a embryo developing embryo or fetus in the body. - Forms part of the digestive tube Calculated as: - Produces earliest blood cells and - 280 days vessels - 40 weeks - Is the source of primordial germ - 10 lunar months cells Divided into 3 time periods- TRIMESTERS 1st trimester 0-12 weeks Amnion 2nd trimester 13-27 weeks Envelop the embryo and umbilical 3rd trimester 28-40 weeks cord. Amniotic fluid initially is isotonic, but Terms: as fetus develops; concentration Viability- earliest age of fetal changes by urine and sloughed cells survivability of the fetus, placenta, and amniotic Age of viability-20-24 weeks or sac. weighing more than 500gms Amniotic Fluid Gestation – the period of fetal dev. Amniotic Fluid , also known as from time of fertilization of the ovum (BOW) bag of water, clear, odor to birth. mousy/musty, with crystallized forming pattern, slightly alkaline. PRENATAL Management Maternal serum provides amniotic SCHEDULE OF VISITS fluid in early gestation with Every 4 weeks, up to 32 weeks increasing amounts derived from Every 2 weeks from 32-36 weeks fetal urine in late gestation (more frequently if problems exist) At term, the uterus contains 800 to Every week from 36-40 weeks 1200ml of fluid. Data Collection Vital signs Functions of Amniotic Fluid Temperature- slight rise because of Prevents heat loss and preserves increased progesterone and increase constant fetal body temperature activity of thyroid glands Cushions the fetus/ shields against RR- may tend to be rapid and deep, pressure or blow to the mother’s maximum increase of 24/min at rest abdomen BP- tends to be hypotensive with supine Facilitates fetal growth and hypotension development because it allows the Roll- over test fetus freedom to move. The embryo floats in the fluid-filled Weight amniotic cavity, while the chorion and Total weight gain: 20-25 lbs with average of embryonic mesoderm form the 24 lbs. not to exceed 35 lbs embryo's part of the placenta. 1st Trimester: 1 lb/min, a total of 3-4lbs The placenta's chorionic villi absorb 2nd Trimester: 0.9 to 1 lb. week or a total of food and oxygen from the mother's about 10-12 lbs. blood. 3rd Trimester: 0.5 lb. – 1 lb. /week or about 8-11 lbs. Umbilical Cord Where does all the weight go? Serves as lifeline from the embryo to Breast: 1.5-3 lbs. the placenta Fetus: 7 lbs Measures from 20in to 22 in ( Uterus: 2.5 lbs 50-55cm) in length and 2cmin Placenta: 1.5 lbs diameter at term Amniotic Fluid: 2 lbs Contains two arteries and one vein Body Fluids: 8 lbs. Contains Wharton's jelly that helps Blood volume: 3.5 lbs prevent kinking of the cord  (use this calculation formula for patients CLASSIFICATIONS OF PREGNANCY whose LMP falls PARA between January-March rather than the - number of pregnancies that lasted more other formula) than 20 weeks, regardless of outcome. NULLIPARA- a woman who has not given birth to a baby beyond 20 weeks gestation. PRIMIPARA- woman who has given birth to one baby more than 20 weeks gestation. MULTIPARA- a woman who has had two or more births at more than Date of Quickening 20 weeks gestation. Primigravida: EDC =Date of Q + 4 months Note: Twins or triplets counted as 1 para. and 20 days GRAVIDA- indicates the total number of Multigravida: EDC = Date of Q + 5 months times a woman has been pregnant, and 4 days regardless of whether these pregnancies were carried to term. B. Age of Gestation (AOG) – Fundal NULLIGRAVIDA- gravida 0 is a Height woman who has never been Bartholomew's Rule of Fours pregnant. At about 12 to 14 weeks of PRIMIGRAVIDA- gravida 1 is a pregnancy, the uterus becomes woman who is pregnant for the first palpable as a firm globular time or has been pregnant one time. sphere over the symphysis MULTIGRAVIDA-is a woman who pubis. has been pregnant more than one It reaches the umbilicus at 20 to 22 time. weeks. TPAL xiphoid process at 36 weeks - Para subdivided to reflect births that went then often returns to about 4 to Term, Premature births, Abortions, and cm below the xiphoid because Living children. of “lightening” at 40 weeks. PRETERM- newborn born before 37 weeks of gestation. McDonalds’s Rule (used in 2nd and 3rd TERM- newborn born after 37 weeks trimester) to 40 weeks of gestation. POST-TERM- newborn born after 40 weeks of gestation. Estimates in Pregnancy A. Expected Date of Confinement (EDC) or Expected Date of Delivery (EDD) Naegele’s Rule Formula LMP Date DETERMINATION OF PREGNANCY 1.Subtract 3 months from the LMP Diagnosis of pregnancy is based on 2.Add 7 Days to the LMP pregnancy-related physical and hormonal 3.Add 1 Year changes and is classified as presumptive, (use this calculation formula for patients probable, or positive. whose LMP falls between April-December) (see ppt for the table) Physiologic Adaptation, Discomforts and Hormones in Pregnancy Reproductive System 1. Uterus a. Size – increase due to hypertrophy of muscles and connective tissues Length increases from approximately 6.5 to 32 cm. Depth increases from 2.5 to 22 cm. Width expands from 4 to 24 cm. Weight increases from 50 to 1000 g LMP Date b. Shape: from globular to oval 1.Add 7 Days to LMP c. Braxton Hicks contraction 2.Then add 9 months d. Ballottement e. amenorrhea 2. Ovaries 7. Adrenal Cortex – Increased aldosterone Menstrual Cycle stops promotes sodium retention. Amenorrhea 8. Relaxin and Prostaglandin- Ovum production ceases Prostaglandin corpus luteum persist in early pregnancy -affects smooth muscles contractibility Placenta- major endocrine organ during - helps maintain normal blood pregnancy pressure 3. Cervix Relaxin shorter, thicker and more elastic - soften the cervix and the collagen of the Goodell’s sign- increased vascularity joints causing the cervix to be soft mucus plug Circulatory System 4. Vaginal Changes Cardiac rate increases by 10 to 15 hypertrophy and hyperplasia - thickened bpm in the 2nd and 3rd trimester vaginal mucosa Palpitation in early and late Leukorrhea pregnancy Chadwick’s Sign –increased Transient murmurs and slight vascularity causing bluish discoloration cardiomegaly 5. Perineum BP remains constant but my drop hypertrophy, edema, and slightly in the second trimester relaxation, there is an increase in size - supine hypotension increased vascularization – deeper color Circulating blood volume increases 6. Breast from the end of the 1st increase size and firmness trimester(30%) up to the period just breast tenderness before labor (50%) enlargement of areola, alveoli duct and Physiologic Anemia (Psuedo alveoli system Anemia) areola of the nipple darkens, Cardiac output increases by 20% - and its diameter increases 30% in the 1st and 2nd trimester from about 3.5 cm (1.5 in) to 5 or 7.5 cm Vascularity increases – leg (2 or 3 in) varicosities, dilation of pelvic veins enlargement of Montgomery’s gland Fibrinogen level increases by 50% - Colostrum – 4 to 5 months Non pregnant state: 200-400mg/dL - clotting – risk for thrombophlebitis Endocrine System - positive Homan”s sign in DVT 1. Placenta – chorion of placenta secretes HCG Respiratory System - pregnancy test : 1. Nose – increased vascularity serum - 8- 10 days (implantation) (estrogen effect) urine – 10-14 days (missed 2. Respiratory Rate – lung volume changes menstruation) due to mechanical hormonal - mature placenta at 10-12 weeks changes - placental hormones: estrogen, 3. Diaphragm – rises by as much as 1 inch progesterone, HCG and HPL (the major at 36 weeks AOG diabetogenic 4. Lungs – slight increase in vital capacity hormone or insulin antagonists in increase in oxygen consumption by 15% at pregnancy) 6 to 40 weeks 2. APG – no ovulation Hyperventilation - prepares breast for lactation - need to blow off carbon dioxide with increased prolactin - direct effect of progesterone on respiratory 3. PPG – oxytocin is produced by the center hypothalamus, stored and secreted by the PPG Signs: - Fetal head pressure on the - dizziness/lightheadedness cervix stimulates PPG to secrete oxytocin - pallor 4. Thyroid glands – changes in thyroid - tingling sensation on fingertips and lips activity resulting to elevate BMR due to: - elevated serum estrogen Digestive System Discomforts 5. Parathyroid Gland Nausea and Vomiting (Morning - enhanced calcium and phosphorus Sickness) metabolism to meet fetal needs for ○ 70%of all pregnancies increased calcium ○ Lasting from 6-8 weeks until - the leading cause of cramps in pregnancy 13-16 weeks to due calcium-phosphorus imbalance ○ Changes in smell and taste 6. Pancreas- increased insulin secretion in contribute response to increasing metabolism in ○ More severe in women with pregnancy higher hCG levels* (multiple  gestation and hydatidiform floor. mole) Remain upright 3 to 4 Mouth – increased estrogen level hours after eating. - increased vascularity – soft and swollen Take as ordered gums. Stomach Flatulence Eat small frequent meals. - displaced backward – faint Avoid gas-forming food. bowel sounds - displaced upward and compresses Frequency Increase fluids to replace resulting in difficult digestion of urination losses except at - cardiac sphincter relaxed – causes bedtime to prevent esophageal reflux (heartburn) nocturia. - slow motility and digestion Practice regular voiding. Practice frequent flushing Urinary System : ‘front to back.’ Renal plasma volume increased by 25% to Report any burning 50% in the 1st and 2nd trimester, normal by sensation, dysuria, the end of the 3rd trimester cloudy urine, or GFR – increased by 50% tea-colored urine. Increased renal tubular reabsorption rate Bladder Capacity : 1,500ml in the second Fatigue Have adequate rest and trimester sleep (8 hrs. Frequency- Caused by the vascular average night sleep). engorgement and altered bladder function Avoid prolonged standing. due to increased hormonal level Practice good body First trimester due to increased pressure mechanics (posture). on the bladder from the uterus until it rises Report increasing fatigue out of the pelvis in second trimester with regular Third trimester due to fetal engagement of activities –a danger sign presenting part of heart disease. Increased circulation volume Increased glomerular filtration rate Constipation Increase fluid intake (6 to 8 glasses of Musculoskeletal System water per day). Increased estrogen, progesterone, and Increase roughage in the relaxin; relaxed ligaments and joints diet (daily fruits Lower Backache and vegetables). Altered center of gravity (increased abd wt Regular exercise (best and breast wt) walking) is Stretched abdominal muscles recommended. Compensatory lumbar lordosis causing Observe daily/regular predisposition to lower back pain bowel movement. Latter half of pregnancy joints and Drink warm water in the ligaments in the body become more relaxed morning. Women with poor abdominal muscle tone are more susceptible Hemorrhoid Avoid constipation and s other forms of Common Pregnancy Discomforts and straining. How to Deal with Them Promote comfort: sitz bath, warm Discomforts Relief Measures compresses. Reinsert hemorrhoids, Morning Eat dry crackers upon physician’s Sickness (carbohydrates) or toast recommendation. in the morning 30 minutes before getting Faintness/ Avoid sudden changes in up. supine position. Drink adequate fluids hypotensive Avoid supine position in between meals. syndrome/ 2nd to 3rd Eat small frequent meals; vena caval trimesters. avoid syndrome Arise from a bed from a overeating. lateral position Avoid fatty, highly and gradually. seasoned foods. Avoid staying in one position for a long Heartburn Bend at the knees and time. NOT at the waist when Assume frequent left picking things from the lateral positions in bed.  - mother with complete 3 doses DPT Leg cramps Include adequate calcium young age considered as TT1 & 2 in the diet; Begin TT3 calcium-phosphorus TT1 – any time during pregnancy imbalance is the TT2 – 4 weeks after TT1 – 3 yrs recognized most protection important cause of leg TT3 – 6 months after TT2 – 5 yrs cramps. protection Avoid prolonged standing TT4 – 1 year after TT3 – 10 yrs and sitting. protection Dorsiflex the foot while TT5 – year after TT4 – lifetime extending the leg; this protection hyperextends the Note: if the mother received 3 involved muscle doses of DPT during childhood, causing relief. she will be given TT3. Varicose No round garters around veins the abdomen DANGER SIGNS OF PREGNANCY and legs; avoid knee-high FRESH A/C PADS stockings. F – Fever Wear a supportive panty R – Rush of water from the vagina hose. E - Epigastric pain Frequent elevation of legs S - Swelling of the face, hands and feet and hips is H – Hard Fall advised. A – Absence of fetal movement Backache Maintain good posture. C – Continuous Headache Wear flat shoes. Avoid prolonged standing. P - Persistent Vomiting Pelvic rock exercise and A - Any vaginal bleeding tailor sitting are D - Dimness/blurring of vision advised. S - Seizures Use a supportive mattress. Health Teachings Wear maternity girdle in Dental Hygiene selected situations as Exercise recommended. Hygiene Breast Care Pedal edema Assume left-lateral Clothing position/elevation of Sexual Activity legs frequently to promote Employment venous return. Travel Avoid prolonged standing. S-A-D Habits No round/constricting garters. Report swelling of hands and face. ———-——End of Transcription———— Shortness of Maintain good posture. breath Avoid fatigue. Elevate head by several pillows in sleep, avoid supine position. Avoid constricting bra and other tight clothes. Report increasing dyspnea with minimal activity or dyspnea prior to 36 weeks (with normal pressure on the diaphragm. Tetanus Immunizations – prevents tetanus neonatum