Responsible Parenthood and – 21 – 25 y/o – parent advice

Pregnancy  Equity – responsibility with emotional

support to each other
As a Concept:
– Kind of love
 Stable union entered into by a man and a
woman – Discuss problem with your partner
 For procreation , education of children, – Discuss with partner the daily
and mutual support activities
As a programme:  Communication – to be open with one
another
 Framework for Family Planning

Developmental Tasks of Adolescent (13 – 18

y/o) Six Stages of Parenthood

 Accepting one’s physique and using the I – Image Making

body effectively
 Occurs during pregnancy
 Achieving emotional independence from
 Time when prospective parents begin to
parents and other adults
gather or select through, to form, and
 Achieving more mature relationship with reform images of what to come of birth
both sexes and parenthood

 Acquiring a set of values and ethical  Prepare for a change in themselves and in
system as a guide for behavior their other important adult relationship

 Developing an ideology II. Nurturing Stage

 Designing and achieving socially  Reconciling image to reality

responsible behavior
 Parent attach to the baby
Developmental Tasks of Young Adult (19 –
III. Authority Stage
40 y/o)
 Discipline of their children
 Selecting a mate
IV. Interpretive Stage
 Learning to live with partner
 Anticipating teenage life
 Starting a family
V. Interdependent Stage
 Bearing a child
 Accepting teenage identity
 Managing a home
VI. Departure Stage
 Taking a civic response
 Parents should prepare for the departure
 Getting started in an occupation
of the child getting married
 Finding a congenial social growth
Family Task
Predictors of Marital Satisfaction
 Physical maintenance
 Timing – involves the age of couple
– Being certain that family has ample
– 18 – 21 y/o – parent consent resources

 Allocation of resources
– Prioritizing family need, especially
the need of children
 Socialization of Family Members
– Involves preparation of the children
to live in the community and
interact outside the family
 Maintenance of Order
– Opening an effective means of
communication between family
members, establishing values and
rules
 Division of Labor
– Giving roles to the family members
 Reproduction, Recruitment and
Release of the Family Member
– Accepting new family member by
pregnancy or adoption
 Placement of members into a larger
society
 Maintenance of motivation and
morale
Parenting Pattern
 Ideal Role
 Perceived Role
 Performed Role
MALE REPRODUCTIVE ORGANS
Function:
 Production of spermatozoa
 Provide a means so sperm can travel &
fertilize the ovum
External Organs
 Scrotum – contains and supports the
testes; consists of subcutaneous tissue &
smooth muscles (dartos layer) which
contracts / relaxes during changes in
temperature
 Penis – male organ of copulation;
consists of cavernous bodies & a urethra
thru which the seminal fluid is brought to
the female generative tract during
ejaculation.
Internal Organ
 Testes
 3 Types of Cells
 Spermatogenic cells
 Interstitial cells or Leydig Cells
 Sertoli Cells
 Canal System
 Accessory structures
 Epididymis - a tightly coiled tube on the
outside of the testes that leads into vas
deferens stores and nourishes immature
sperm cells and promote their maturation.
 Vas deferens - is a muscular tube that
forms part of the spermatic cord
 Seminal vesicle - is a sac-like structure
attached to the vas deferens. It secretes
thick viscous alkaline –fluid high in protein
(fructose), Vitamin C, and prostaglandins
that contributes to sperm nutrition &
activation.
 Prostate gland – a gland surrounding the
urethra; secrets a milky fluid slightly
acidic, contains proteolytic and clotting
enzymes.
 Bulbourethral glands or Cowper’s
gland - two glands are two- small
structures beneath the prostate gland.
They secrete a fluid that serves as a
lubricant for the penis in preparation for
sexual intercourse
FEMALE REPRODUCTIVE SYSTEM
External
 Mons Pubis
 Labia Majora
 Labia Minora
 Clitoris
 Vestibule
  Urinary Meatus Attachments
 Vaginal opening
 Skenes Glands a. Broad ligaments are reflections of
 Bartholins Glands peritoneum and extend from the uterus
 Hymen and pelvic organs to the lateral pelvic
 Perineal body walls
*Myrtiform Caruncles
*Fourchette b. Round ligaments are reflections of the
same peritoneum that arises from cornu of
Functions of Vagina the uterus and inserted in the upper
border of the labia minora. They are
1. Serves as secretory duct of the uterus capable of contraction at time of labor and
serves to hold the uterus in anteflexion
2. Female organ of copulation
position
3. Part of the Birthcanal
c. Cardinal ligaments of Mckenrodt
Vasicovaginal septum (Transverse Cervical Ligament) are a
condensation of subserous fascia
Retrovaginal septum extending from the uterus to the lateral
pelvic wall. If overstretched or damaged
*Retrouterine can result to prolapse of the uterus.
pouch d. Uterosacral ligaments are condensation
of subserous fascia that extend from
Cul de sac of Douglas
sacrum around the rectum of to the
Culdocentesis cervix. Helps the uterus from sagging
downwards and maintaining anteflexion
Internal Organs: position.

Uterus Positions

Parts a. Anteverted – the uterus is tipped

FORWARD in more than 50% of women
* Fundus
b. Retroverted – the uterus is tipped
* Corpus
BACKWARD in approximately 25% of
* Isthmus women

* Cervix c. Midposition – the uterus is in the

midposition in the remainder of women
Endocervix
FUNCTIONS of the UTERUS
Lower surface of cervix contains stratified
squamous epithelium a. Facilitates sperm transport from the cervix
to the oviduct
Layers
b. Provides a rich vascular environment for
Endometrium nourishment of the developing embryo

Myometrium c. Provides a safe location for the growing

fetus throughout pregnancy
Perimetrium
d. Expels the mature fetus by means of
• Upper contractile Zone myometrial contractions to outside the
body
• Lower Passive Zone
Fallopian Tubes Four Body Structures involved in
Menstruation
Parts
1. Hypothalamus 2. Pituitary Gland
* Interstitial
3. Uterus 4. Ovaries
* Isthmus
Purpose of Menstrual Cycle
* Ampulla
1. To bring an ovum to maturity
* Infundibulum
2. To renew a uterine tissue bed that will be
responsible to its growth if ovum is fertilized.

Lining Length = 28 days cycle

– Ciliated Shortest = 20 days Longest = 45 days

– Muscular
– Peritoneal Average menstrual flow = 4 – 6 days

Functions of fallopian tube Shortest = 1 day Longest = 9 days

a. Facilitates sperm migration from the Phases of Menstrual cycle

uterus to the ampulla for fertilization of
the ovum 1. Menstrual Phase- day 1 to 5

b. Transport the fertilized ovum toward the - Corpus luteum degenerates

uterus
- There is cessation of progesterone and
Main Function of the Ovary estrogen produced by the corpus luteum and
blood level drops
1. Ovulation
- drop in blood levels of estrogen and
Endocrine Function progesterone stimulate the production of FSH and
new cycle begins
a. Estrogen
2. Proliferative Phase –day 6 to 14
b. Progesterone
- Follicle stimulating hormone (FSH)
c. Relaxin released by the anterior pituitary stimulates the
development of the graafian follicle
Common terms in Menstruation
- As graafian follicle develops, it produces
Menstruation - is the periodic discharge of
increasing amounts of follicular fluid containing a
blood, mucus and epithelial cells from the uterus
hormone called estrogen
Menarche - first menstrual period that occurs
- Estrogen stimulates thickening of the
typically at age 12 but may also occur as early as
endometrium.
9 and as late as 17.
- As estrogen increases in the blood
Puberty - age in which the regenerative organ
stream, it suppresses secretion of FSH and favors
becomes functionally active
secretion of the luteinizing hormone (LH)
Menopause - is the cessation of menstrual
3. Secretory Phase- day 15-21
cycles that occurs between 40 and 55 years of
age - Follows ovulation which is the release of
mature ovum from the graafian follicle
Menstruation
 - Cavity of the graafian follicle is replaced
by the corpus luteum (secretes progesterone and
some estrogen
- Progesterone acts upon the
endometrium to bring about secretory changes
that prepare it for pregnancy. It also maintains
the endometrium during the early phase of
pregnancy, should a fertilized ovum be implanted
4. Pre-menstrual – day 22 to 28
- If fertilization does not occur the corpus
luteum in the ovary begin to regress
- Production of estrogen and progesterone
decreases
- Endometrium of uterus begins to
degenerate and sloughs off
- If fertilization occurs, the corpus luteum
will stimulate the production of progesterone
Abnormalities in Menstruation
 Amenorrhea - absence of menstrual flow
 Dysmenorrhea - painful menstruation
 Oligomenorrhea - less frequent
menstruation
 Polymenorrhea - too frequent
menstruation
 Menorrhagia - excessive menstrual
bleeding
 Metrorrhagia - bleeding between periods
 Hypomenorrhea - abnormally short
menstruation
 Hypermenorrhea – abnormally long
menstruation
Reproductive Hormones
1. Follicle Stimulating Hormone-
- secreted by the anterior pituitary gland
during the first half of menstrual cycle
- stimulates development of graafian
follicle
- thins the endometrium
2. Lutienizing Hormone
- secretes by pituitary gland
- stimulates ovulation and development of
corpus luteum
- thickens the endometrium
3. Estrogen – true ovarian hormone;
HORMONE OF WOMEN
 secreted primarily by the ovaries by the
adrenal cortex and by placenta in
pregnancy
 stimulates thickening of the
endometrium ; causes suppression of
FSH secretion
 assists in maturation of ovarian follicles
 responsible for the development of
secondary sex characteristics
 stimulates uterine contractions
 mildly accelerates sodium and water
reabsorption by kidney tubules; increase
water content of uterus
 accelerate protein metabolism
 increases sexual desire
 increases vaginal secretions – spinnbarkeit
(ability to thread and spinn 10-12 cms)
 increase vaginal pH – alkaline to keep the
sperm alive
1. Progesterone – HORMONE OF
MOTHERS
– Secreted by corpus luteum and
placenta during pregnancy
– inhibits secretion of LH - has
thermogenic effect ( increases
temperature
– relaxes smooth muscles; decrease
GIT motility
– thickens cervical mucus –
operculum
– maintain thickness of
endometrium
– increases vascularization of the
uterus
– allows pregnancy to be maintained
– stimulates alveoli of the breast
during the 2nd half of pregnancy
1. Prostaglandin
– fatty acids categorized as hormone
– produced by many organs of the body
– affects menstrual cycle
 – influences the onset and maintenance
of labor
Family Planning
Reproductive Life Planning
 Includes all the decisions an individual or
couple make about:
– if and when to have children
– how many children are desired
– How they are spaced
 Includes couples who are having difficulty
conceiving children to explore infertility
programs, helping couples space their
children, helping couples to avoid
conception
A. Natural Family Planning / Fertility
Awareness Method
 Rely on periods of temporary abstinence
and requires an understanding of the
changes that occur in a woman’s
ovulatory cycle
 The couple determines fertile days and
abstain from sex
Calendar (Rhythm)
 Requires a couple to abstain from coitus
on the days of a menstrual cycle when the
woman is most apt to conceive
 3- 4 days before and after ovulation
 18 – shortest = first fertile day
 11 – longest = last fertile day
 25 - 29
Basal Body Temperature
 A woman’s basal body temperature falls
about one degree on ovulation because of
progesterone
Symptothermal /Cervical Mucus Method
 Use the changes in cervical mucus that
occur naturally with ovulation
 Before ovulation each month
– cervical mucus is thick and does
not stretch when pulled between
thumb and finger (Spinnbarkeit)
 Just before ovulation (peak day)
– Mucus becomes thin, watery,
transparent, feels slippery,
stretches at least one inch before
the strand breaks
A. Artificial Family Planning
1. Oral Contraceptive Pills (OCP)
– Synthetic estrogen combined with
a small amount of synthetic
progesterone
– Estrogen acts to suppress FSH and
LH (gonadotrophic hormone of the
pituitary)
– Progesterone decreases
permeability of cervical mucus,
limiting sperm mobility and access
to ova
– Interferes with endometrial
proliferation to such a degree that
implantation becomes unlikely
 Monophasic
– Fixed doses of estrogen and
progesterone
 Biphasic
– Constant amount of estrogen with
increased progesterone
 Triphasic
– Varying levels of estrogen and
progesterone
Side effects:
– nausea
– Monilial vaginal infection
– Weight gain
– headache
 – Breast tenderness  Small plastic object inserted into the
uterus through the vagina where it
– Break through bleaching remains in place

– Mild hypertension and depression  Before the client has had coitus, following
the menstrual flow
Contraindications:
Side effects :
– Hx of CVA
– Infection, PID (fever, lower
– Woman who smoke
abdominal pain, heavier flow)
– > 40 y/o
 Example:
– obese
– Progestasert
– High serum level
 T-shaped, of permeable
– High blood pressure plastic with drug reservoir
of progesterone in the stem
 Mini-pills
– Copper T380
– Oral contraceptive containing only
progesterone  T-shaped plastic device
wound with copper
– Post-coital contraceptive
 Physical placement of a barrier between
– High level of estrogen the cervix and sperm so that sperm
cannot enter the uterus and fallopian
2. Subcutaneous Implants tubes
 Norplant – subdermal hormonal implant  Changes the vaginal pH to strong acid
level
 Levonorgestrel – synthetic progesterone
– Vaginally inserted spermicidal
 Inserted after abortion: 6 weeks after
products (24 hrs)
delivery
– Diaphragm – circular rubber disk (6
 Disadvantages: cost, weight gain,
hrs)
headache, irregular period
– Cervical cap – timber (48 hrs)
3. Injectable Contraceptive
– Condom – latex rubber
 Medroxyprogesterone Acetate (DMPA,
Depo-Provera)

 Single dose every 3 months A. Permanent Methods of

Side effects Reproductive Life Planning
 Vasectomy
– Vaginal spotting
– Small incision is made on each
– headache side of the scrotum, vas
deferens is cut, tied,
– Weight gain cauterized, plugged

4. Intrauterine Devices  Tubal ligation

– Cautery, clamping, crushing

the fallopian tube
  Laparotomy Terms: conception, impregnation,
fecundation
 Culdoscopy
Egg life - 24 hrs.
 Colpotomy
Sperm life -72 hrs.-5ml with 400 million
Genetic Counseling per ejaculation

 Mendelian Inheritance Zona pellucida - ring of

mucopolysaccharide and Corona radiata
– Dominant Pattern
– circle of cells
– Recessive Pattern
The ovum and surrounding cells are
 Chromosomal Abnormalities propelled FIMBRIAE –part of the fallopian
tube – the fine hairlike structures
– Nondisjunction
Capacitation –is the final process that
– Deletion sperm must undergo to be ready for
fertilization
– Translocation
Fertilization has three functions:
THE CHILD BEARING CYCLE
• transmission of genes from both
PREGNANCY parents to offspring

 is a normal physiology process. It is • restoration of the diploid number of

not a disease condition. It is not an chromosomes reduced during
illness but a wellness state, meiosis

 thus the main responsibility of nurses • initiation of development in

is to help mothers maintain that offspring
state of wellness throughout the
periods of pregnancy and Embryonic and Fetal Structures
parenthood.
 Morulla – 16 – 50 cells
Conception
 Blastocyst – fluid space mass in the
The penetration of one uterus
ovum (female gamete) by one sperm
(male gamete) resulting in a fertilized  Trophoblast – cells in the outer ring
ovum (zygote). Each gamete has haploid will become placenta and membranes
number (23). Zygote has a diploid
 Embryoblast – inner cells will form
number (46) with one of each pair from
the embryo
each parent.
 Decidua – endometrium; has 3
Sex of child is determined at
separate areas:
moment of conception by male gamete.
 Decidua basalis – part
 If X-bearing male gamete unites with under the embryo,
ovum, result is a female child (X + X).
communicates with
 If Y- bearing male gamete unites with maternal blood vessels
ovum, result is a male child (X + Y).
 Decidua capsularis –
Fertilization encapsulates the surface
of the trophoblast
Is the union of the ovum and a
spermatozoa
  Decidua Vera –
remaining portion
 Chorionic villi – trophoblastic layer of
the blastocyst forming miniature villi
at 11 – 12th day; with the following
areas
 Central Core – contains
fetal capillaries
 Outer covering has 2
layers :
Syncytiotrophoblast
(hCG, HPL, E and P),
Cytotrophoblast
(protects from viral
infection, disappears at
20 – 24th week)
 Amniotic Membranes – the chorionic
villi on the medial surface of the
trohoblast forms the amniotic
membrane and chorionic membrane
 Umbilical cord – has 2 arteries and 1
vein; 53 cms in length; 2 cms thick;
with Wharton’s jelly
 Placenta – from the trophoblastic
tissue, 15 – 20 cms in diameter; 2-
3cms in depth; 400 – 600 grams
Primary Germ Layers:
 At implantation, blastocyst
differentiates into:
1. amniotic cavity – larger, ectoderm
2. yolk sac – lined with entoderm,
nourishment for embryo
3. mesoderm-between ecto/ento
First lunar month:
Gastrulation
Gastrulation involves a series of
cell migrations to positions where they
will form the three primary cell layers.
Ectoderm forms the outer layer.
Endoderm forms the inner layer.
Mesoderm forms the middle layer.
 Ectoderm
Ectoderm forms tissues associated with outer
layers: skin, hair, sweat glands, epithelium.
The brain and nervous system also develop
from the ectoderm.
 Mesoderm
The mesoderm forms structures associated
with movement and support: body muscles,
cartilage, bone, blood, and all other
connective tissues. Reproductive system
organs and kidneys form from mesoderm.
 Endoderm
The endoderm forms tissues and organs
associated with the digestive and respiratory
systems. Many endocrine structures, such as
the thyroid and parathyroid glands, are
formed by the endoderm. The liver, pancreas,
and gall bladder arise from endoderm.
Cardiovascular System
 Simple blood cells → network of blood
vessels → single heart tube
 As early as the 16th day of life
 Heart beats as early as the 24th week
 Septum develops on the 6th and 7th week
 Heart valves develop on the 7th week
Respiratory System
 Alveoli and capillaries begin to form
between the 24th to 28th weeks
 Spontaneous respiratory movements
begin as early as 3 months
 Surfactant
– Phospholipid substance
– Excreted by the alveolar cells at
about 24th week
– Decreases alveolar surface tension
on expiration
 – Prevents alveolar collapse,
improves the infant’s ability to
maintain respiration in the outside
environment
Nervous System
rd
 Neural plate is apparent on the 3 week of
gestation
 Brain waves can be detected by EEG on
the 8th week
 All parts of the brain form in utero
although not completely mature at birth
 Eye and inner ear develop as projections
of the origin neural tube
 By 24 weeks, the ear is capable of
responding to sound, the eyes exhibit a
pupillary reaction
Endocrine System
 Fetal adrenal glands supply a precursor for
estrogen synthesis by the placenta
 Fetal pancreas produces the insulin
needed by the fetus
 Thyroid and parathyroid glands play vital
roles in metabolic function and calcium
balance
Digestive System
 Digestive tract is separated from the
respiratory tract at about 4th week of
gestation
 Meconium forms in the intestines as early
as the 16th week
 Sucking and swallowing reflexes are not
mature until about 32 weeks
 Ability to secrete enzymes mature at 36
weeks
 Amylase is not mature until 3 months after
birth
 Liver is active throughout gestation
Musculoskeletal System
 Fetus can be seen to move on ultrasound
as early as the 11th week
 Quickening – felt by mother at about 20
weeks
 First 2 weeks – cartilage prototypes
provide support and position
 Ossification begins at 12th week
Reproductive System
 Child’s sex is determined at the moment
of conception by a spermatozoon carrying
an X or Y chromosome
 Can be determined as early as 8 weeks by
chromosomal analysis
 Gonads form at 6th week
– If testes form, testosterone is
secreted influencing the sexually
neutral duct to form other male
organs
– In the absence of testosterone,
female organs will develop
 Testes descend from the pelvic cavity at
the 34th – 38th week
Urinary System
 Rudimentary kidneys are present at the
end of 4th week
 Urine is formed by the 12th week
 Urine is excreted into the amniotic fluid by
the 16th week
 At term, fetal urine is being excreted at a
rate of 500 ml/ day
Integumentary System
 Skin appears thin and translucent until
subcutaneous fat begins to be deposited
at about 36 weeks
 Lanugo – soft downy hair
 Vernix caseosa – cream-cheese like
substance important for lubrication and
keeps skin from macerating
Immune System
 Level of passive IgG immunoglobulins
peaks at birth and then decreases over
the next 9 months
 Fetus is capable of active antibody
production late in pregnancy
First Trimester
End of 4 Gestation Weeks
 Length is 0.75 to 1 cm
 Weight is 400 mg
 Spinal cord is formed and fused at the
midpoint
 Lateral wings that will form the body are
folded forward to fuse at the midline
 Head folds forward, becoming prominent
 Back is bent so the head almost touches
the tip of the tail
 Rudimentary heart appears as a
prominent bulge on the anterior surface
 Arms and legs are budlike structures
 Discernible rudimentary eyes, ears, and
nose
 Germ Layer formation
 Heart, digestive system, backbone and
spinal cord begin to form
 Placenta (sometimes called "afterbirth")
begins to develop
 The single fertilized egg is now 10,000
times larger than size at conception
End of 8 Gestation Weeks
 Length is 2.5 cm
 Weight is 20 grams
 Organogenesis is complete
 The heart with a septum and valves is
beating rhythmically
 Facial features are definitely discernible
 Extremities have developed
 External genitalia are present, but sex is
not distinguishable
 Primitive tail is regressing
 Abdomen appears large as the fetal
intestine is growing rapidly
 Sonogram shows a gestational sac,
diagnostic of pregnancy
 Eyes, nose, lips, tongue, ears and teeth
are forming
 Penis begins to appear in boys
 Baby is moving, although the mother
cannot yet feel movement
End of 12 Gestation Weeks
 Length is 7 – 9 cms
 Weight is 45 g
 Nail beds are forming on fingers and toes
 Spontaneous movements are possible
 Some reflexes (Babinski) are present
 Bone ossification centers are forming
 Tooth buds are present
 Sex is distinguishable by outward
appearance
 Kidney secretion has begun although urine
may not yet be evident in amniotic fluid
 Heart beat is audible by doppler
 Placenta is fully developed
Second Trimester
End of 16 Gestation Weeks
 Length is 10 – 17 cms
 Weight is 55 to 120 grams
 Fetal heart sounds are audible with an
ordinary stethoscope
 Lanugo is well-formed
 Liver and Pancreas are functioning
 Fetus actively swallows amniotic fluid,
demonstrating an intact but
uncoordinated swallowing reflex
End of 20 Gestation Weeks
 Length is 25 cms
 Weight is 223 grams
 Spontaneous fetal movement can be
sensed by the mother
 Antibody production is possible
 Hair forms extending to include eyebrows
and head
 Meconium is present in the upper
intestine
 Brown fat begins to be formed
 Fetal heart beat is audible
 Vernix caseosa begins to form
 Definite sleeping and activity patterns are
distinguishable
End of 24 Gestation Weeks
 Length is 28 – 36 cm
 Weight is 550 g
 Passive antibody transfer from mother to
fetus probably begins as early as 20 wks
and certainly by the 24th week
 Meconium is present as far as the
rectum
 Active production of the lung surfactant
begins
 Well defined eyebrow and eyelashes
 Eyelids are now open
 Pupils are capable of reacting to light
Third Trimester
End of 28 Gestation Weeks
 Length is 35 – 38 cms
 Weight is 1200 grams
 Lung alveoli begin to mature
 Surfactant can be demonstrated in the
amniotic fluid
 Testis begin to descend into the
scrotal sac from lower abdominal
cavity in males
 Blood vessels in the retina are extremely
susceptible to damage from high oxygen
concentration
End of 32 Gestation Weeks
 Length is 38 – 43 cms
 Weight is 1600 grams
 Subcutaneous fat begins to deposit
 Fetus is aware of sounds outside the
mother’s body
 Active moro reflex is present
 Delivery position (breech/ vertex) may be
assumed
 Iron stores that provide iron are beginnig
to develop
 Fingernails grow to reach the end of
fingertips
End of 36 Gestation Weeks
 Length is 42 – 49 cms
 Weight is 1900 – 2700 gms
 Body stores of glycogen, iron,
carbohydrate, and calcium are augmented
 Additional amounts of subcutaneous fat
are deposited
 Sole of the foot has only one or two
criscross creases
 Amount of lanugo present begins to
diminish
 Most babies turn into a head-down or
vertex presentation during this month
 End of 40 Gestation Weeks  6 consecutive digits

 Length is 48 – 52 cms, crown-rump length – G–P–F–P–A–L

is 35 – 37 cms
– Gravidity – parity – full term –
 Weight is 3000 grams preterm – abortion - living

 Fetus kicks actively Measurements of length of pregnancy:

 Fetal hemoglobin begins its conversion to Days: 267-280

adult hemoglobin
Weeks: 40, plus or minus 2
 Vernix caseosa is fully formed
Months (lunar):10
 Fingernails extend over the fingertips
Months (calendar):9
 Creases on the soles of the feet cover at
least 2/3 of the surface Trimesters:3

Gravidity and Parity Determination Estimated Due Date/Estimated Date of

Confinement(Nagele’s rule); This
Definition of terms: calculation is an estimation only.

 Gravida – number of times a woman has Most women deliver: due date + or – 2
been pregnant week.

 Nulligravida – a woman of childbearing a. Add 7 days to the first day of the

age who has never been pregnant LMP
b. b. Subtract 3 months.
 Primigravida – a woman who has been c. Add 1 year
pregnant once
Example: LMP: Dec. 5, 2007 EDC:
 Multigravida – a woman who has been September 12, 2008
pregnant for 5 times or more
Sonogram dating used to confirm dates.
 Parity – number of times a woman has
given birth

 Primipara – a woman who has given birth Computation of AOG

once
 Example:
 Multipara – a woman who has given birth
for 5 times or more  Date today: December 1, 2008

Obstetrical Scoring  LMP: August 2, 2007

 4 consecutive digits  Computation:

– F-P-A-L  August = 29 days

– Full term – preterm – abortion –  September = 30 days

living
 October = 31 days
 2 consecutive digits
 November = 30 days
– G, P
 December = 1 day
– Gravidity - Parity
 Answer: 121 days = 17
weeks 2/7 days
Estimating Fetal Growth:
 McDonald’s Rule
– Method of determining the growth
of fetus in utero by measuring
fundal height
a. That is why there is
amenorrhea during pregnancy.
b. It is also the basis for
pregnancy tests.
 Human Placental Lactogen

– 20th to 31st weeks – fundic height is -promotes the growth of the mammary
equivalent to the gestational weeks glands necessary for lactation.

Assessing Fetal well-being  Estrogen and Progesterone

 Fetal movement – quickening; at least  3 subtypes of Estrogen:

10 times/day; Sandovsky Method
1. Estrone(E1)- post
 Fetal heart rate – 120 – 160 bpm; menopausal women
Doppler 10 -12 weeks; Stethoscope (20
weeks) 2. Estradiol(E2)- non-
pregnant
 Non-stress testing – reactive (with 2
accelerations of FHR by 15 beats or more 3. Estriol(E3)- pregnancy
lasting for 15 secs occur after movement)
Umbilical Cord
 Contraction stress testing – with IV
oxytocin administration or nipple A circulatory pathway connecting the embryo
stimulation; normal if no FHR to the chorionic villi: Length 55 cm or 21
decelerations are present with contraction inches

 Ultrasound – used to diagnose Function:

pregnancy as early as 6 weeks
a. Transport oxygen and nutrients to the
Placenta: fetus from the placenta and to return
waste products from the fetus to the
Pancake – weighs 1 lb. or 1/6 of baby’s placenta
weight
Parts- maternal and fetal side

1 vein carries oxygenated blood

Function:
2 arteries carry deoxygenated blood
a. Fetal lungs
Wharton’s jelly- gelatinous
b. Kidneys mucopolysacharides

c. Gastrointestinal AMNIOTIC FLUID

d. Endocrine  It is also known as the bag of water,

it serves the ff purpose:
e. Barrier
 protects the fetus against
ENDOCRINE blows or pressure on the
mothers abdomen
 Human Chorionic Gonadotropin (HCG)
 protects the fetus against
- orders the corpus luteum to keep on
the sudden changes in to
producing estrogen and progesterone,
since liquid changes to
more slowly than air.
  protects the fetus from blood entering form the IVC to pass across in
infection to the left atrium.

 provides free movement for Ductus arteriosus (artery to an artery) –

the fetus channel between fetal aorta and main
pulmonary artery. It closes during normal
 Acts as fluid wedge respiration. Allows the blood to bypass the
fetal lungs.
Terms:
Hypogastric arteries – They return the
Polyhydramnios - excessive amount of
blood to the placenta.
amniotic fluid greater than 1000 ml. to 1500
ml. Signs of Pregnancy

Oligohydramnios- amount less than 300- 1. Presumptive signs

500 ml.
 Amenorrhea
Abnormal colors:
 Nausea and vomiting
1. green-tinged in a non-breech presentation
–fetal distress  Increased breast sensitivity and breast
changes
2. Golden- color – hemolytic disease
 Integumentary changes – increased
FOCUS OF DEVELOPMENT pigmentation in localized area

1.First trimester- Organogenesis  Constipation

2.Second Trimester – period of continued  Frequent urination due to increased

fetal growth and development renal blood and plasma flow ; increased
GFR
3.third trimester – period of most rapid
growth and development because of rapid  Quickening
deposition of subcutaneous fats.
 Abdominal enlargement
Fetal Circulation
2. Probable sign
The oxygen is delivered from the
placenta.  Uterine enlargement

The placenta is also:  Hegar’s sign- softening of the lower

uterine segment
 The source of nutrition
 The site of waste excretion  Goodel’s sign – softening of the cervix
due to increased blood supply
Temporary Structures involved in
fetal circulation:  Chadwick’s – purplish discoloration of
the vaginal mucosa
Placenta
– bluish discoloration of
Umbilical cord vagina and cervix

Ductus venosus – (vein to a vein) connects  Ballotment- when fetus rebounds

the umbilical vein to the inferior vena cava. against examiners finger’s during
Allows the oxygenated blood from the palpation
placenta to bypass the liver.
 Braxton’s Hicks contraction -
Foramen ovale – temporary opening irregular painless contractions of the
between atria that allows the majority of uterus, false labor
  Positive pregnancy test  Rectovaginal examination

 Fetal outline can be felt by Types of pelvis

examiner
 Gynecoid

 Android
3. POSITIVE SIGN
 Anthropoid
 Fetal heart tone can be heard
 Platypelloid
 X-ray or ultrasound of fetus
Internal Measurement
 Palpable fetal movements
 Diagonal conjugate
Components of pre-natal check up:
 True conjugate/ conjugate vera
 Initial Interview
 Ischial tuberosity
 Health History
Laboratory assessment
– Demographic data
 Blood studies
– Chief concern
 Urinalysis
– Family profile
 Ultrasonography
– Past medical history
Self-care Needs:
– Family history
 Bathing
– Social profile
 Breast care
– Gynecologic history
 Dental care
– Obstetric history
 Perineal hygiene
– Day history
 Dressing
Review examination
 Sexual activity
 Baseline height and weight
 Exercise
 Vital signs measurement
 Sleep
 Assessment of system
 Work
 Measurement of fundic height and fetal
heart tones  travel

Pelvic examination Common discomforts of early

pregnancy:
 External genitalia
 nausea/ vomiting
 Internal genitalia
 Heartburn/ pyrosis
 Papaniculao smear
 Breast tenderness
 Vaginal examination
 Frequency of urination
 Examination of pelvic organs
 Constipation – In areas with Malaria , 2 tablets of
Chloroquine ( 150 mg/ 2 tablets every
 Leg cramps week for the duration of pregnancy

 Varicosities PHYSIOLOGICAL CHANGES DURING

PREGNANCY:
 Hemorrhoids
Reproductive System
 Pedal edema
1. Uterus- enlarges; painless contractions
 Hypotension
occur
 Leukorrhea
2. Ovaries- ovulation stops due to high levels
 pruritus of placental estrogen and progesterone

Discomforts of middle to late pregnancy: 3. Vagina- becomes softer; mucosa thickens

,vascularity increases, vaginal discharge
 Backache increases and becomes more acidic

 Dyspnea 4 Breast – increase in size and and become

full and tender, areola darkens ; colostrum is
 Ankle edema excreted
 Braxton Hick’s contractions 5. Cervix- soften’s ( Goodel’s sign) becomes
congested with blood (Chadwicks sign)
 Headaches
proliferating glands form mucus plug.
Urine Tests:
Musculoskeletal System
Benedicts Test
1. Relaxation of joints
To determine sugar or glucose
2. Widening of symphysis pubis
Result :
3. Waddling gait
(-) – no change in color
4. Lordosis
+1 – bluish
5. Increased back strain
+2 – greenish yellow
Cardiovascular System
+3 – yellow orange
1. Heart muscle enlarges
+4 – brick red
2. Heart rotates upward and to the left
COMMON PRESCRIPTIONS:
3. Stroke volume increases
Iron supplementation shall be given from
4. Cardiac output increases primarily as a
the 5th mos. of pregnancy up to 2 months
result of expanded vascular volume
post-partum. (100-200 mg. orally per day
daily per orem for 210 days) 5. Pulse rate increases by about 10-15 beats
per minute
– Low –dose Vit.A supplementation ( 10,000
IU in 2 weeks 6. Peripheral vascular resistance falls under
the influence of progesterone and
– In endemic areas , 1 iodized capsule to all
prostaglandins
pregnant women
7. 7. Femoral venous pressure increases
8. 8. Blood pressure remains essentially the
same , despite increase blood volume
9. 9. Blood volume increases to 1200-1500
ml. above pre-pregnancy values
10. 10. Total red cell mass increases ,
however , the increase in plasma volume
is even more pronounced
11. 11. White blood cell count increases to to
an average of 10,000 /mm3
12. 12. Clotting factors increase, offering
protection against but increasing
Respiratory System
1. Oxygen consumption increases by about
20 percent
2. Dyspnea is common
3. Nosebleeds and nasal stuffiness are
common
4. Rib cage widen
5. Respiratory depth increases
Gastrointestinal System
1. Gums appear red and swollen and bleed
easier, caused by elevated levels of estrogen
2. Reduced tone of esophageal sphincter
allows reflux of acidic stomach contents ,
producing heart burn
3. Decreased motility in large intestine allows
more water to be absorbed ; may cause
constipation and hemorrhoids
4. Increased thirst and appetite
Urinary System
1. Increased urinary frequency on the first
and third trimester because of pressure on
the bladder
2. Glomerular filtration rate increased 50%
3. Glycosuria – because of increase
secretion of sugar by lowered renal
threshold
4. Lower specific gravity as a result of
increase urinary output
Endocrine System
1. Thyroid activity is increased
2. HCG reaches a peak in the third
month
3. Secretion of oxytocin which
stimulates uterine contractions
coupled with the drop of
progesterone brings about labor
4. Uterine contractions increase in
frequency and intensity culminating
in fetal expulsion
Skeletal System
Gradual softening of pelvic ligaments
and joints to facilitate passage of the
fetus
1. Lordosis ( forward curvature of the
spine in order to change the center of
gravity) Pride of Pregnancy
2. Leg cramps may occur from an
imbalance of calcium phosphorus
ratio in the body and from pressure
of the uterus
Nutrition
 Recommended weight gain during
pregnancy
 Components of healthy nutrition for
pregnant woman
– Caloric needs
– Protein needs
– Fat needs. Vitamins and
minerals
– Fluid needs
 Mineral needs
– Calcium and phosphorus
– Iodine
– Iron
 – Fluoride  it is normal in pregnancy as long as it is
not accompanied by the following:
– Sodium
(a) Proteinuria (the presence of an
– Zinc excess of serum proteins in the
urine).
 Foods to avoid in pregnancy
(b) Edema of nondependent parts.
– Alcohol
(c) Sudden increase in weight.
– Caffeine
(d) Hypertension.
– Artificial sweeteners
 Nursing intervention consists of
– Weight loss diets
advising the patient to:

(a) Maintain good posture.

 Assessment of nutritional health
(b) Avoid prolonged standing or
 Nutritional risk factor during sitting.
pregnancy
(c) Wear support stockings.
 Common problems affecting
(d) Avoid constrictive clothing
nutritional health
(garters, knee-high hose).
 Promoting nutritional health in
(e) Drink at least eight glasses of
women with special needs
fluid for "natural" diuretic effect.
DISCOMFORTS OF PREGNANCY
(f) Get adequate rest and exercise;
 ANKLE EDEMA include rest periods to elevate legs.

 BACKACHE  Treatment of ankle edema.

 BREAST TENDERNESS (a) Elevate the feet as often as

possible.
 CONSTIPATION
(b) Apply support stockings before
 DYSPNEA getting up.

 FATIGUE (c) Diuretics are contraindicated.

 HEMORRHOIDS  If condition worsens to a generalized

edema, the patient should notify her
 LEG CRAMPS physician.

 URINARY FREQUENCY Backache:

 VAGINAL DISCHARGE  caused by relaxation of the sacroiliac
joint which is due to increased hormones
 VARICOSITIES
(steroid sex hormone and relaxing)
ANKLE EDEMA: resulting in slight joint and muscle
relaxation and increased mobility
 occurs during the second and third
trimesters.  exaggerated lumbar and cervico thoracic
curves caused by changes in the center of
 caused by reduced blood circulation in the gravity from the enlarging abdomen and
lower extremities breasts.
  practice good posture and good
body mechanics (use the pelvic tilt
and bend at the knees).
 wear appropriate, well-fitting
shoes.
 sleep on a firm mattress or
backboard.
Backaches may indicate a kidney or
bladder infection.
Constipation:
 Interventions to prevent and ease
constipation.
 Never ignore the feeling to have a
bowel movement.
 Monitor what you are eating.
 Eat foods that are high in fiber such
as fruits, vegetables, cereals and
whole grain breads.
 Eat small and frequent meals
throughout the day.
 Drink six to eight glasses of water
every day. Sometimes, apple or
prune juice can help.
 Exercise: Yoga, walking, swimming
or simple stretches
Muscle Cramps:
 caused by:
(a) Compression of nerves
supplying the lower extremities
due to the enlarging uterus.
(b) Reduced level of diffusible
serum calcium or elevation of
serum phosphorus in the
bloodstream.
(c) Fatigue, chilling, or tense body
posture.
 Nursing interventions :
(a) Avoid fatigue and cold legs.
(b) Eat a diet with adequate
calcium or prescribed calcium.
(c) Avoid drinking more than one
(1) quart of milk - will create too
much phosphorus in the system.
(d) Take the prescribed vitamins B
and D per doctor's instructions.
 Treatment during muscle cramps.
(a) The patient should lie on her
back and extend the affected limb.
A second individual should apply
pressure on the patient's knee with
one hand and sharply flex the foot
with the other hand. The affected
muscle may also be needed with
the heel or palm of the hand.
Dyspnea:
 Nursing interventions consist of
advising the patient to:
(a) Sleep on additional pillows.
(b) Maintain good posture.
(c) Avoid overeating.
(d) Stop or decrease smoking.
(e) Limit activity
Hemorrhoids:
 As pressure builds from the growing
uterus, venous return of blood from the
rectal area back to the heart is impeded.
The vessels near the rectum stretch, and
as they stretch, so will the surrounding
skin or mucosa
Urinary Frequency
 caused by:
 the vascular engorgement and
altered bladder function.
 an increase in hormones
 reduction of bladder capacity due
to the enlarging uterus and fetal
presenting part.
 Nursing interventions consist of
advising the patient:
(a) That this is normal.
(b) To limit fluid intake before
bedtime to ensure rest.
(c) To wear perineal pads.
(d) Notify the physician if pain or
burning is noted.
Varicose Veins
 caused by the relaxation of smooth
muscle walls of veins, which is due to
increased hormones (progesterone). It is
also aggravated by gravity and bearing
down for bowel movements. This may also
be a hereditary disposition.
 involves the veins of the lower
extremities, the external genitalia (vulva
or labia), the pelvis, and the perineal area
(hemorrhoids).
 Nursing intervention consists of
advising the patient to:
(a) Avoid obesity.
(b) Avoid lengthy standing or
sitting.
(c) Avoid constrictive clothing.
(d) Avoid constipation and bearing
down.
(e) Elevate legs when sitting. Get
adequate rest.
(f) Perform moderate exercise.
(g) Rest with legs and hips
elevated.
Treatment for Varicose Veins
 Wear support stockings before
rising (getting up) if varicose veins
are severe.
 Lie on the bed with legs extended
at a right angel to the body if
ordered by the physician (see
figure 8-3 A).
 If in the vulva, may be relieved by
placing a pillow under the buttocks
to elevate the hips, assuming the
Sim's position for a few minutes
several times a day, avoid standing
as much as possible, or laying
down instead of sitting when
practical.
 To relieve pain and swelling, take
hot sitz baths or local application of
astringent compresses (witch hazel
pads).
Vaginal Discharges: Leukorrhea
 a white or yellowish mucous discharge
from the cervical canal or the vagina.
 caused by the hormonal stimulation of the
cervix, which becomes hypertrophic and
hyperactive producing an abundant
amount of mucous.
 Leukorrhea may lead to pruritis (severe
itching), burning on urination, foul odor
from the discharge, or edema of the vulva.
 Treatment/nursing intervention
consists of:
 reassuring the patient that this is
normal.
 use perineal pads and to change
them frequently
 cleanse the vulva at least once a
day with soap and water and to dry
thoroughly
 Advising the patient to maintain
good hygiene.
Supine Hypotension
 Caused by pressure of the gravid uterus
on the ascending vena cava when the
woman is supine which decreases the
return of the blood.
 Symptoms include nausea, cold and
clammy, feels faint, and hypotensive
(decreased blood pressure).
 Nursing interventions consist of advising
the patient to:
 (a) Get up slowly.  Effleurage

(b) Use the side-lying position,  Focusing

preferably on the left side.
 Second-stage breathing
DANGER SIGNALS OF PREGNANCY
Alternative Methods of Birth
 Vaginal bleeding
 Leboyer method
 Persistent vomiting
 Birthing room is darkened
 Chills and Fever
 Soft music
 Sudden escape of fluid from the vagina
 Infant placed immediately into a
 Abdominal or chest pain warm-water bath

 Danger signs of pregnancy induced  Hydrotherapy and water birth

hypertension
a. swelling of the face and fingers
b. flashes of lights or dots before the
eyes
c. dimness or blurring of vision
d. severe or continuous headache
Preparation for Childbirth
DEVELOPMENTAL TASKS OF PREGNANCY
Validation – observed during the first
trimester
 Ambivalence, shock or denial may be
experienced at the time of knowing
occurrence of pregnancy.

 Preparation  Introvert manifestation is usual with

weight gain and other outward signs of
 Perineal and abdominal pregnancy.
exercises

 Tailor sitting
Fetal Embodiment; Second trimester.
 Squatting
 Fetus is viewed as part of self
 Kegel exercises
 Role adjustments- time of emotional
 Abdominal muscle maturity
contractions
 Gains inner strength with the condition
 Pelvic rocking
Fetal distinction -5th lunar month
 Pain management methods
 Fetus is viewed as separate to self
 Bradley
 Quickening encourages this feeling
 Psychosexual
 Woman daydreaming on her role as
 Dick-Read mother and future of the baby

 Lamaze  Role Transition – Third trimester

 Conscious relaxation  Woman becomes irritable and wanted to

end the pregnancy
 Cleansing breath
 With concrete plans about herself and the
 Conscious controlled baby
breathing
 Breast
 Lobes- consist of 15-20 lobes which are
subdivided into lobules or acinar cells
( responsible for milk production)
 Excretory ducts / lactiferous ducts ( milk
reservoir) which open to the nipple
 Erectile tissue with muscle fibers which
serves as a sphincter like action in
controlling the flow of milk.
 Areola- the dark pigmented part around
the nipple
 Montgomery tubercles-responsible in
secreting fatty substances used to
lubricate the nipple
 Nipple- an elevated part on top of the
breast containing 15-20 openings from the
lactiferous ducts
Function :
Lactation Milk secretion/ejection
Benefits of Breastfeeding
To infants
 Provides a nutritional complete food
for the young infant
 Strengthens the infant’s immune
system , preventing many infections
 Safely rehydrates and provides
essential nutrients to a sick child,
especially those suffering from
diarrheal diseases
 Reduces the infant’s exposure to
infection
To mother
 Reduces a woman’s risk of excessive
blood loss after birth
 Provides a natural method of delaying
pregnancies
 Reduces the risk of ovarian and breast
cancers and osteoporosis
General Principles in Breastfeeding
 Oxytocin causes uterus to contract and
uterine cramping maybe experienced
 Wash breast without using soaps
 With flat nipples, nipple- rolling is done
 Avoid medications and gas –forming foods
 Calories should be increased to 3,000 per
day or additional 500 calories per day and
1,000ml of fluids
 Baby’s stool will be watery, frequent and
light yellow in color
 Start with the breast used on last feeding
 Stimulate rooting to start and finish each
session by burping the baby
Schedule of Breastfeeding
 As soon as both mother and baby is stable
 Regular and sustained sucking at the
breast is 8-10 times per day
 Gradually increase time of breastfeeding
foe each breast with subsequent feedings
 Baby will develop their own schedule of
feeding
Breastfeeding problems and immediate
intervention
1. Engorgement
 More frequent feedings and ice
packs
2. Retracted Nipples
 Nipple –rolling
 wear breast-shield
3. Cracked nipple
 Lubricate nipple with Vit A and D
 Rotate feeding position
 expose nipple to air 10-20 mins after
feeding
4. No milk or Inadequate supply
 increase frequency of feeding and make
interval longer