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Unit 11- Mother and Child Health with such natural law are morally correct.

Those
A. PROCREATIVE HEALTH DEFINITION AND that go against such natural laws are morally
THEORIES RELATED TO PROCREATION wrong.
Procreative Health – is the moral For the theists there is still the belief that
obligation of the parents to humans have reasoning ability and with it the laws
have the healthiest children of nature are discernible. For atheists who accept
thru all natural and artificial this approach to act in keeping with the laws of
means available. nature is the morally correct thing to do.
DISTINCTION BETWEEN PROCREATION AND
REPRODUCTION Parent Development Theory: Understanding
Reproduction - defined as the action Parents, Parenting Perceptions and Parenting
of making a copy of something, or the Behaviors
production offspring by sexual intimacy. In - for the importance of parenting, with the
contrast, procreation roots sexuality and long-term implications for children, families,
childbearing deeply within with two and society, there is precious little
relations: psychological theory specifically on parents
That of the man and woman, and that and parent development. And, while there
between the couple and GOD (2006). are many parent education programs
THEORIES RELATED TO PROCREATION available and certainly substantial research
1. Theories of conception have to do with on parents (e.g., Baurmind, 1975, 1991),
far more than the physical process of none are based on an overall theoretical
human coming into being. In all times model regarding who parents are and how
and places, people have had ideas they develop in relation to the parenting role.
about the process, and these ideas are This article provides as theoretical
interrelated with ideas about gender, framework, the Parent Development Theory
kinship, property, and religion. (PDT) to assist professionals in organizing
2. Natural Law Theory: with this theory their thinking, practice, and research
actions in conformity and support of regarding parenting. Originally called the
natural laws are morally correct. A Parent Role Development Theory (PRDT).
simple summary would be: What is Theory for Child Oriented Professionals
Consistent with the Natural Law Is Theoretical Perspectives on Siblings
Right and What is not in keeping with Relationships
the Natural Law is Wrong. Theories of Motivation
Note: This is NOT what is natural is morally Evolutionary Theory of Motivation - according to
correct and what is unnatural is morally wrong. evolutionary psychology, individuals are
The focus is on the natural Laws and not simply motivated to engage in behaviors that maximize
natural acts. Natural Law Theory support doing their genetic fitness.
unnatural deeds such as surgery for the sake of Process of Human Reproduction
realizing a restoration of health and the Reproductive development begins at the moment
prolongation of human life which are each of conception and continues through life.
consistent with the natural drives of organisms: Intrauterine development gonad-is a body organ
survival that produces the cells necessary for reproduction
(the ovary in females, the testis in
Two Types of Natural Law Theory: males) oocytes- cells that will develop
into eggs throughout the woman’s
Natural Law Theory - can be held and mature years)
applied to human conduct by both theists and
atheists. The atheist uses reason to discover the
laws governing natural events and applies them to
thinking about human action. Actions in accord

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Pubertal development influences the development of the uterus;
- is the stage of life at which secondary sex fallopian tubes, and vagina; typical female fat
changes begin. These changes in girls are distribution; hair patterns; and breast
stimulated when the hypothalamus development. It also closes the epiphysis of
synthesizes and releases long bones in girls the same way
gonadotropinreleasing hormone (GnRH), testosterone closes the growth plate in boys.
which then triggers the anterior pituitary The beginning of breast development is
to release follicle-stimulating hormones termed thelarche, which usually starts 1 to 2
(FSH) and luteinizing hormone (LH). FSH years before menstruation.
and LH are termed gonadotropin (gonad = Secondary Sex Characteristics
“ovary”; tropin = “growth”) hormones not Adolescent sexual development has been
only because they begin the production of categorized into stages (Tanner 1990). There is
androgen and estrogen, which in turn wide variation in the time required for adolescents
initiate secondary sex characteristics, but to move through these developmental stages;
also because they continue to cause the however, the sequential order is fairly constant. In
production of eggs and influence girls, pubertal changes typically occur as:
menstrual cycles throughout women’s •Growth spurt
lives. Hypothalamus- serves as gonadostat •Increase in the transverse diameter of the pelvis
or regulation mechanism to “turn •Breast development
on”gonad functioning •Growth of pubic hair
•Onset of menstruation
The Role of Androgens •Growth of axillary hair
- Androgenic hormones are the hormones •Vaginal secretions
responsible for muscular development, The average age at which the menarche (the first
physical growth, and the increase in menstrual period) occurs is 12, 4 years of age
sebaceous gland secretions that cause typical (Ledger, 2012). It may occur as early as age 9 years
acne in both boys and girls during as late as age 17 years, however, and still be within
adolescence. In males, androgenic hormones a normal age range. Irregular menstrual periods
are produced by the adrenal cortex and the are the rule rather than the exception for the first
testes, and, in females, by the adrenal cortex year or two, menstrual periods do not become
and the ovaries. regular until ovulation occurs consistently and this
- The level of the primary androgenic does not to happen until 1 to 2 years after
hormone, testosterone, is low in males until menarche. In boys, production of spermatozoa
puberty (between ages 12 and 14 years) does not begin in intrauterine life as does the
when it rises to influence pubertal changes in production of ova in girls nor are spermatozoa
the testes, scrotum, penis, prostate, and produced in a cyclic pattern as are ova; rather,
seminal vesicles; the appearance of male they are produced in a continuous process. The
pubic, axillary and facial hair; laryngeal production of ova stops at menopause. In
enlargement with its accompanying voice contrast, sperm production continues from
change; maturation of spermatozoa; and puberty throughout the male’s life.
closure of growth plates in long bones
Secondary sex characteristics of boys usually occur
(termed adrenarche). In girls, testosterone
in the order of:
influences enlargement of the labia majora
*Increase in weight
and clitoris and formation of axillary and
*Growth of testes
pubic hair.
*Growth of face, axillary, and pubic hair
*Voice changes
The Role of Estrogen
*Penile growth
- when triggered at puberty by FSH, ovarian
*Increase in height
follicles in females begin to excrete a high
*Spermatogenesis (production of sperm)
level of the hormone estrogen. This increase

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Factors that may lead to genetic abnormalities: Examples of multifactorial inheritance include:
- They may be due to several problems, or a heart disease; high blood pressure, Alzheimer’s
combined effect of genes and the disease, arthritis, diabetes, cancer, and obesity.
environment. It is difficult to predict Multifactorial inheritance also is associated with
inheritance of abnormalities caused by heritable traits such as fingerprint patterns,
multiple factors. Examples include heart height, eye color, and skin color.
defects, cleft lip or cleft palate, and neural b. Chromosome abnormalities
tube defects (defects in the spine or brain). - Chromosomes, distinct structures made up of
DNA and protein, are located in the nucleus of
Genetic Disorders: each cell. Because chromosomes are the carriers
- Many human diseases have a genetic of the genetic material, abnormalities in
component. Some of these conditions are chromosome number or structure can result in
under investigation by researchers at or disease. Abnormalities in chromosomes typically
associated with the National Human Genome occur due to a problem with cell division.
Research Institute (NHGRI).
A genetic disorder is a disease caused in whole or
in part by a change in the DNA sequence away For example, Down syndrome (sometimes
from the normal sequence. referred to as Down’s syndrome) or trisomy 21 is
- Most genetic diseases are the direct result of a common genetic disorder that occurs when a
a mutation in one gene. However, one of the person has three copies of chromosome 21. There
most difficult problems ahead is to further are many other chromosome abnormalities
elucidate how genes contribute to diseases including:
that have a complex pattern of inheritance, a. Turner syndrome (45, XO)
such as in the cases of diabetes, asthma, b. Klinefelter syndrome (47, XXY)
cancer, and mental illness. c. Cri du chat syndrome - or the “cry of the cat
- A genetic disease is any disease caused by an "syndrome (46. XX or XY, 5p-) Diseases may also
abnormality in the genetic make-up of an occur because of chromosomal translocation in
individual. The genetic abnormality can range which portions of two chromosomes are
from miniscule to major-from a discrete exchanged.
mutation in a single base in the DNA of a c. Mitochondrial Genetic Inheritance
single gene to a gross chromosome - This type of genetic disorder is caused by
abnormality involving the addition or mutations in the nonnuclear DNA of mitochondria.
subtraction of an entire chromosome or set Mitochondria are small round or rod-like
of chromosomes. Some people inherit organelles that are involved in cellular respiration
genetic disorders from the parents, while and are found in the cytoplasm of plant and animal
acquired changes or mutations in a cells. Each mitochondrion may contain 5 to 10
preexisting gene or group of genes cause circular pieces of DNA. Since egg cells, but not
other genetic diseases. Mutations can occur sperm cells, keep their mitochondria during
either randomly or due to some fertilization, mitochondrial DNA is always
environmental exposure.- inherited from the female parent.
Examples of mitochondrial disease include:
a. Multifactorial inheritance is also called complex a. Leber’s hereditary optic atrophy (LHON), an eye
or polygenic inheritance. disease;
- are disorders caused by a combination of b. Myoclonic epilepsy with ragged red fibers
environmental factors and mutations in (MERRF); and
multiple genes. For example, different genes c. Mitochondrial encephalopathy, lactic acidosis,
that influence breast cancer susceptibility and stroke-like episodes (MELAS) , a rare form of
have been found on chromosomes 6, 11, 13, dementia
14, 15, 17 and 22. Some common chronic
diseases are multifactorial disorders.

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B. Antepartum/ Pregnancy Uterine Layers:
a. Endometrium – inner mucous
MALE REPRODUCTIVE SYSTEM membrane layer of the uterus that sheds during
menstruation
The Female Reproductive System b. Myometrium – three interwoven layers
Female External Structures- are termed the vulva- of smooth muscle that give the uterus its strength
from the Latin word for “covering”. c. Perimetrium – outer layer that covers
FEMALE INTERNAL GENITALIA the body of the uterus and part of the cervix
Cervix - lowest portion of the uterus Types of Uterine Deviations
Fallopian tubes - long channels that 1. Bicornuate uterus-oddly shape
transport the ovum from the ovary to the uterus “horns” at the junction of the fallopian tubes.
Fundus - portion of the uterus between the (heart shape)
points of attachment of the fallopian tubes 2. Septum- Dividing Uterus
Ovary - almond-shaped glandular 3. Double Uterus
structure on either side of the uterus that
produces, matures, and discharges ova Deviations in Uterine Position That Are Commonly
Uterus - hollow, pear-shaped muscular Seen:
organ in the lower pelvis that provides a 1. Anteversion-the entire uterus tips far forward.
place for fertilized ovum to implant and 2. Retroversion-the entire uterus tips far back
houses growing fetus. 3. Anteflexion-body of uterus bends sharply
Vagina - vascularized muscular forward at the junction with the cervix
membranous tube that extends from the 4. Retroflexion-body of uterus bends sharply
external genitals to the uterus and is the backward just above the cervix.
organ of intercourse
Types of Pelvis
Fallopian tubes divided into 4 parts • Gynecoid - round shaped
1. Interstitial portion- most proximal – Transversely rounded and slightly ovoid
division,lies within the uterine wall. • Android – wedge-shaped / heartshaped
2. Isthmus- portion of the tube that is cut – Angulated, resembles male pelvis;
or sealed in a tubal ligation. • Anthropoid - inlet oval-shaped
3. Ampulla- third and the longest portion – Oval, wider anteroposterior diameter
of the tube.Fertilization of an ovum usually • Platypelloid -oval shaped transversely
occurs. – Flat anteroposterior diameter; wide
4. Infundibular portion- most distal transversely
segment of the tube. Covered by fimbria
(small hairs) that help to guide the ovum FEMALE REPRODUCTIVE CYCLE
into the fallopian tube. Purpose is to mature ovum and renew the uterine
tissue bed
Three Parts of the Uterus: Menarche usually occurs between ages 9 and 17
1. Body or corpus – uppermost portion; Average length of menstrual cycle is 28 days
bulk of uterus; expands to accommodate Average length of menses is 2 to 9 days
fetus. The portion of the uterus between Initiated by the release of LHRH, also known as
the points of attachment of the fallopian GnRH, from the hypothalamus
tubes is termed the fundus. Under the influence of LHRH, the anterior lobe of
2. Isthmus – Short segment between the pituitary produces two hormones (FSH and LH)
corpus and cervix. It is the portion where that act on the ovaries to further influence the
the incision is made when a fetus is born by menstrual cycle
caesarean birth.
3. Cervix – Lowest part; 1/3 of total size
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The MENSTRUAL CYCLE B. Luteal Phase
– Periodic uterine bleeding in response to Days 15 to 22
cyclical hormonal changes Corpus luteum develops from a ruptured
– Begins at puberty, ends at menopause – follicle
Structures involved: Corpus luteum produces large quantities
• Hypothalamus of progesterone
• Pituitary gland *If conception occurs, ovum proceeds down the
• Ovaries fallopian tube and plants on the endometrium of
• Uterus the uterus.
1. Uterine Phase *If conception does not occur the unfertilized
A. Menstrual Phase ovum atrophies after4-5 days.
Days 1 to 5 *The corpus luteum remains only 8-10 days and
Endometrial lining is shed gradually regresses and turns into corpus albican
LH, Estrogen, & Progesterone at their or white body.
lowest level •The first day of menstrual flow is used to mark
FSH increases --Graafian follicle begins the beginning days of a new menstrual cycle.
maturing •Menstrual cycle begins with the first day of
B. Proliferative Phase bleeding which is counted as day 1, the cycle ends
Days 5 to 14 just before the next menstrual period.
Uterine lining grows due to increased •For example if your period starts on Oct 6th, that
Estrogen; thickens by 8 to 10-folds is day 1,if your next period starts on the nov 3, the
Glands and vascularization are developed 2nd of nov was the 28th day of your last cycle and
3 to 4 days before ovulation the 3rd day of Nov is the first day of the next
C. Ovulation menstrual cycle.
Days 12 to 16
Estrogen is high & Progesterone is low Menstrual Cycle
LH stimulates the release of mature, non- Purpose:
fertilized ovum 1. To bring ovum to maturity
Spinnbarkeit – stretchable cervical mucus 2. Renew a uterine tissue bed that will be
D. Secretory or Luteal Phase responsible for ova’s growth should it be fertilized.
Days 15 to 26 * Interval: Ave: 28 days, 23-35 days not unusual
Uterus prepared for implantation *Duration: Ave:4-6 days, may be 1-9 days
Estrogen level drops, Progesterone level is *Amt. Of menstrual flow: ave: 30-80 ml
high (produced by corpus luteum) *Color- Dark red, made up of blood, mucus and
Increased uterine vascularity; Tissue endometrial cells
glycogen levels increase Determination of Ovulation
E. Ischemic Phase Mittelschmerz
Days 27 to 28 Spinnbarkeit
Estrogen & Progesterone levels declines Basal Body Temperature
Arterial vessels constrict Ferning
Endometrium prepares to shed Glycogen content of vagina and the
Blood vessels rupture Menstruation cervical cells
begins To compute for the exact date of ovulation,
count back 14 days from the first day of
2. Ovarian Response menstruation.
A. Follicular Phase Spinnbarkeit
Days 1 to 14 First half of the cycle- cervical mucus is
Follicle matures due to FSH thick and scant
Ovulation occurs due to LH surge

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At the time of ovulation, when the Cell division commences even as the
estrogen level is high- cervical mucus become thin fertilized ovum is propelled proximally
and copious down the uterine tube. It is called the
During the second half of the cycle, the morula when it is at the 16-50 cell stage.
cervical mucus again becomes thick and The outermost cells of the morula then
sperm survival is poor. secrete fluid which forms a sac within
Fern Test- mucus can be examined at mid cycle to which an inner mass of cells is located. The
detect ferning latter then becomes a two layered group of
Cervical mucous forms “fernlike “ patterns cells called the embryonic disc which will
when it smeared and dried on a glass slide. later on form the embryo and amnion. The
The pattern are due to crystallization of outermost cells, also known as
sodium chloride on mucus fibers. trophoblast, will become the placenta and
If increased progesterone fern pattern is the chorion.
no longer discernible. The fertilized ovum has 46
Basal Body Temperature chromosome
The basal temp. drops before the day of Spermatozoon and ovum each
ovulation and rises on the day after ovulation carried 23 chromosomes
The temperature remains at this level until (22 autosomes and 1 sex
approximately day 24 of the menstrual cycle when chromosomes)
the level of the progesterone drops. If TWO X chromosomes (XX)
Process of Conception female
(Chapter 9) If X and Y (XY) male
Fertilization Growth and development of the
Proper timing is essential for fertilization to fetus begins with fertilization
occur. The ovum will only be receptive to After fertilization, fetal
fertilization for 24 hours whereas the development occurs in 3 stages
sperm remains viable only for 24-72 hours. 1st (preembryonic stage) - 1st 14 days after
During ovulation, the fimbriae of the conception
fallopian tubes pick up the released ovum 2nd (embryonic stage) - 3rd wk after
and the ovum moves down the tubes by conception until the embryo reaches 3 cm
ciliary action. It usually takes about 3 days (1.2 in.) in length (8 wks); referred to as
for this whole process to be completed. fetus
Of the 200-400 million sperm released into 3rd (fetal stage) - 8 to 10 wks after
the vagina during intercourse, only about conception until the end of pregnancy
one hundred reach the distal end of the
uterine tube to reach the ovum and FETAL DEVELOPMENT
fertilize it. The sperm that do reach the Zygote
ovum shall surround the latter and secrete –Cell that results from fertilization of the ovum by
hyaluronidase which will break down the the sperm cell
cells surrounding the ovum. This process Blastomere
will allow the sperm to penetrate the ovum –results from mitotic division of the zygote
and fertilize it. Morula
Upon penetration of the sperm, the zona –solid ball of cells formed by 16 or more
pellucida will undergo several changes blastomeres
which shall prevent fertilization of the Blastocyst
ovum by another sperm. Fertilization –morula that has reached the uterus (7 days after
culminates with the combining of the 23 fertilization)
unpaired chromosomes for each of the
gametes and initiate further cell division.
FETAL DEVELOPMENT

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Embryo blood travels to the non-functioning lungs.
–organism that contains the 3 germ layers (7 days While the remaining blood is shunted
to 8th week); All organ systems present through the ductus arteriosus into the aorta
Fetus to supply the rest of the body.
-organ systems develop and grow, from the 8th wk - One umbilical vein carries oxygen and
until term nourishment from the placenta to the fetus
11 wks 16 wks 20 wks 24 wks - Two umbilical arteries carry deoxygenated
blood from the fetus to the placenta.
- Blood flow through the cord is about 400
ml/min.

Milestone of Fetal Development


Week 1 – Ovum becomes fertilized. Divides and
implant into the uterus
The Primary Germ Cells
Week 2 – Ectoderm, mesoderm, endoderm are
Germ Layer Structure Formation formed
• Ectoderm Skin Week 3 – The first body segment appears which
Nervous system will eventually form the spine, brain and spinal
Nasal passages cord
Eyes Week 4 – Heart, blood circulation, and digestive
Pharynx tract take shape
Mammary Week 5 – Heart starts to pump blood
Lens of the gland Week 6 – Eyes begin to take shape
Salivary gland Week 7 – Face is complete with nose, eyes, lips
Mesoderm Muscles and tongue
Circulatory system Week 8 – Heart beating at about 40 to 80/min
Bones Week 9 – Genitals are well defined. Embryo
Reproductive system becomes a fetus
Connective system Week 10 – Fetus assumes a more human shape.
Kidneys, ureters First movements begin.
Week 11 – Pancreas produces insulin. The kidneys
Formation Structure urine
• Endoderm Week 12 – Swallowing reflexes mastered as the
Alimentary tract fetus sucks its tongue
Respiratory tract Week 14 – Musculoskeletal system matured
Bladder Week 15 – Kicks restlessly against the amniotic sac
Pancreas Week 18 – Fine hairs covers the body and keeps
Liver the oil on the skin
Week 19 – Eyebrows, eyelashes & hair developed
Fetal circulation Week 20 – Has a regular schedule of sleeping,
- The umbilical vein carries oxygen rich blood turning, sucking and kicking
from the placenta to the liver and the ductus Week 22 – Skeleton develops
venosus. From there it is carried to the Week 23 – Eyelids begin to open and close
inferior vena cava to the atrium of the heart. Week 26 – Baby can breathe, swallow, & regulates
Some of the blood is shunted through the its body temperature
foramen ovale to the left side of the heart Week 27 – Surfactant forms in the lungs
where it is routed to the brain and upper Week 29 – Fat deposits builds up beneath the skin
extremities. The rest of the blood travels Week 30 – Digestive tract & lungs nearly fully
down to the right ventricle and through the matured.
pulmonary artery. A small portion of the

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Week 30 to 34 – 280 to 320 mm in length and Determination of Age of Gestation
weighs 700 to 2,500 g. Vigorous fetal movement Assessment of Fundic Height
occurs – McDonald’s Rule
Week 35 to 37 – 330 to 360 mm in length; weight Fundic height (cm) x 2/7 = AOG in lunar
2,700 to 3,400 g. months
Week 38 to full term – 360 mm in length and Fundic Height (cm) x 8/7 = AOG in wks –
weighs 3,400 to 3,600 g. Skin is smooth, chest is Bartholomew’s Rule
prominent, bones of skull are ossified. Testes are Estimates AOG by the position of the
in scrotum uterus in the abdominal cavity
Determination of Age of Gestation »12 wks – symphysis pubis
Last Menstrual Period (LMP) »16 wks – halfway between umbilicus & symphysis
–Calculating time from the first day of the last pubis
menstrual period up to the present »20 wks – level of umbilicus
–Can be used to compute the EDD (expected date »24 wks – 2 FB above umbilicus
of delivery) using the »30 wks – half way bet umbilicus & xiphoid
Naegele’s Rule process
Add 7 days to the first day of LMP, count »36 wks – level of xiphoid process
back 3 months, and add 1 year if applicable. »40 wks – just below xiphoid process
Quickening 36 weeks 40 weeks
– noted at 20 weeks in Primi & 16 wks in 5th lunar months
multigravidas 3rd lunar months
Using Nagele's, what would be the
estimated date of delivery for a woman
whose first day of her last menses was Measuring Fundal Height
March 17, 2016?
1. Explain the procedure to the client
Months 2. Have the woman void
Measured as nine months on the calendar 3. Help the woman into a supine position and
-- starting one week after your LMP. drape her, expose her abdomen
Trimesters 4. Measure the FH using a tape measure from the
Three periods of three months each. symphysis pubis over the abdomen to the top of
Months 1 - 3 are the first trimester the fundus
Months 4 - 6 are the second trimester Typically, between the 20th and 32nd weeks of
Months 7 - 9 are the third trimester gestation, the FH in centimeters corresponds to
Lunar Months the week of gestation
Prenatal development is often measured in lunar Determination of Age of Gestation
months.
Each lunar month consists of 28 days,
Johnson’s Rule
organized into four weeks of seven days each.
That means a pregnancy is 10 lunar months Estimates the weight of fetus in grams relative to
long. height of the fundus
Weeks Fetal weight = fundic ht (cm) – N x K
40 weeks from the start of your LMP. K – 155 (constant)
Gestation is 38 weeks from conception to birth. N – 12 if engaged, 11 if not yet engaged
Days
280 days from your LMP. No matter what Hasse’s Rule
method is used to determine EDD. To determine the length of fetus in cm.
1st half of pregnancy (1 to 5 lunar months)–
square the no. of mos

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2nd half of pregnancy (6 to 10 lunar months) Health History
multiply the no. of months by 5 • Data: Age, Marital Status, Family Setting, source
Mc Donald's rule of income, cultural values and practices relative to
FH = 34 cm 34cm multiply by 8 divided by 7 bearing and child rearing, education, employment
Ans. = 38 to 39 weeks background
34cm multiply by 2 divided by 7 Ans.= 9 to 10 Initial Prenatal History:
lunar months A.Family History of Health Problems
B.Patient’s medical history
Johnson's rule (grams) C.Gynecologic History
Fh= 21 cm, not engaged D.Obstetrical History
FH (cm) – n multiply by K (155) 21 – 11 =10 multiply A.Relevant data of previous pregnancies
by 155 = ?? Ans. = 1550 grams B.History of present pregnancy:
Hasse's rule LMP, EDC
7 months= 7 multiply by 5 = 35 cm length *Estimating Fetal Growth by:
Information to obtain from prenatal clients-- •Naegele’s Rule
Obstetrical history •McDonald’s Rule
Gravida, Parity (20 weeks AOG) 1. Measurement of fundal height
T-infant born @ 37 wks or after, weight is Bartholomew’s Rule- position of uterus in the
5 -8 lbs (2,500 – 4000 grams) abdomen
P-infant born before 37 wks , ended after 20 wks •12 wks, above symphysis pubis
A-(spontaneous/induced)-delivered before the •20 wks, umbilicus
end of 20wks (5 month) •36 wks xyphoid process
L-living children •Baseline height / weight and vital sign
M-multiple pregnancies-- para 1 –Medical and measurement
Surgical History, -sudden increased of BP and weight gain –
–Family History,Current problems gestational hypertension
Gravida- indicates the number of times the -sudden increased in pulse or respiration-
mother has been pregnant, regardless of whether undetected bleeding
these pregnancies were carried to term. A current Weight Gain during Pregnancy
pregnancy, if any, is included in this count •Roughly 20 to 30 lbs / 30 to 35 lbs
Para- indicates the number of viable (>20 wks) •First Trimester
births. Pregnancies consisting of multiples, such as •2 to 4 lbs; 1 lb per month
twins or triplets, count as ONE birth •Second
Trimester
Prenatal Assessment during
Antepartum/Antepartal •11 to 14 lbs; 0.9 lb per week
Purposes of prenatal care: Period •Third Trimester
1. Establish a baseline of present health. •8 to 11 lbs; 0.5 to 1 lb per week
2. Determine the gestational age of the fetus. •Note: Pattern of weight gain is more important
3. Monitor fetal development and maternal well than amount of weight gain.
being Physical Examination
4. Identify women at risk for complications 1. General Appearance and Mental Status
5. Minimize the risk of possible complications by •-hygiene, sad facial expression,the way they
anticipating and preventing problems before they speak,check for sign of partner abuse ( marks from
occur. battering and ecchymotic spots)
6. Provide time for education about pregnancy, 2. Head and Scalp
lactation and newborn care.
9
-examine women’s head for symmetry,normal -Veins become prominent
contour,and tenderness . • Colostrum as early the16th week of pregnancy
-presence of hair (distribution,thickness,dryness/ Physical Examination
oiliness 10.Heart
•dryness or sparseness of hair suggests poor -ranges from 70 to 80 beats / min in pregnant
nutrition 3. Eyes woman - no accessory sounds or murmurs should
-edema of the eyelids combined with a swollen be present.
optic disk suggests gestational hypertension -teach woman to rest or sleep on their side ( left
-Report spots before their eyes or diplopia side)-to keep their uterus from compressing their
suggests gestational hypertension vena cava(a cause of supine hypotension
4. Nose syndrome as well as heart palpitations).
-increased level of estrogen cause nasal 11.Lungs
congestion or the appearance of swollen nasal -diaghragmatic excursion (diaphragm movement )
membrane is lessened because the diaphragm cannot
Physical Examination descend fully as usual because of the distended
5.Ears uterus.
- nasal stuffiness may lead to blocked eustachian 12.Back
tubes -lumbar curve is accentuated and standing so that
( fullness in the ears or dampening of sound ) they can maintain body posture in the face of
6.Sinuses increasing abdominal size( Lordosis –the pride of
- should feel nontender headache suggests a pregnancy )
danger sign until ruled otherwise. 13.Rectum
7.Mouth, teeth and throat -hemorrhoidal tissue commonly occurs from
-gingival (gum) hypertropy result from increased uterine pressure on pelvic veins.
estrogen 14.Extremities and skin
-cracked corners of the mouth suggests Vit.A -palmar erythema or itching early in pregnancy
deficiency due to high estrogen level
-pinpoint lesion with erythematous base on the -subclinical jaundice (jaundice that is not yet
lips –suggests herpes infection. apparent by a color change) from reabsorbed
- encourage good dental hygiene or yearly dental bilirubin because of slowed intestinal peristalsis
exam -assess for varicosities (filling time of toenails
8.Neck should be under 5 seconds) and edema caused by
-slight thyroid hypertropy may occur due to impaired venous return from the lower
increased metabolic rate extremities
-encourage a serving of seafoods at least once •Edema more than ankle swelling may be a danger
weekly to supply enough iodine for the increased sign of pregnancy.
thyroxine production -Use iodized salt - waddling gait late in pregnancy may cause pain if
Physical Examination the cartilage at the joint becomes so unstable that
9.Lymph nodes it moves from walking.
-no palpable lymph nodes should be present -
10.Breast Measurement of fundal height and fetal heart
-Areolae darken sound
-Secondary areola develop Bartholomew’s Rule- position of uterus in the
-Montgomery tubercles in the areola become abdomen
prominent 12 wks, above symphysis pubis
-Overall breast size increase 20 wks, umbilicus
-Breast consistency firms 36 wks xyphoid process
10
•-lightening- uterus returns 4cm below the Prenatal Care
xiphoid at 40 weeks PRENATAL CARE VISITS
Fetal heart sound First visit
-120 to 160 beats / min heard at - As soon as the woman missed her menstrual
*10 to 12 weeks using a doppler technique period and pregnancy is suspected
*18 to 20 weeks using a regular stethoscope Follow up visits
- Once a month – first 28 weeks; Twice a month
Internal Pelvic Measurement – 28 to 36 weeks; Every week – 37 to 40
-Give actual diameters of the inlet and outlet in weeks
which the fetus must pass Leopold’s Maneuver
-Lithotomy position (on her back with her thighs - A systematic method of observation and
flexed and her feet resting in the examining table palpation to determine fetal presentation
stirrups) – used for pelvic exam and position.
Internal Pelvic Measurement page 263 First Maneuver (Fundal Grip) - To determine
1. Fingers are introduced vaginally and pressed presenting part at the fundus
inward and upward until the middle finger Second Maneuver - To determine fetal back
touches the sacral prominence. With the other Third Maneuver - To determine position and
hand, the part of the examining hand where it mobility of the presenting part
touch the symphysis pubis is marked. After Fourth Maneuver ( Pelvic Grip) - To determine
withdrawing the hand , the distance between the fetal descent and attitude
tip of the middle finger and the mark point on the
glove is measured. Psychological Task of
3. Ischial tuberosity diameter- the narrowest Pregnancy
diameter
-most apt to cause a misfit First Trimester: Acceptance of the pregnancy
-a pelvimeter / ruler - is used to measure the Second trimester: Acceptance of the baby
medial or lowermost aspect of the ischial Third trimester: Preparation for parenthood
tuberosity at the level of the anus. 11 cm is - If more than 12.5 cm, the pelvis is rated as
considered adequate adequate for child birth. (the diameter of fetal
Pelvis: Internal Measurements head that must pass that point averages 9cm in
•Diagonal conjugate diameter)
–Distance between anterior surface of sacral True conjugate or conjugate vera
prominence & posterior surface of inferior margin - The usual depth of the symphysis pubis (1.5 -
of symphysis pubis 2cm) is subtracted to the diagonal conjugate
–Should be 10.5 cm-11cm to be adequate measurement.
•True conjugate/ Conjugate vera Ave is 10.5-11 cm.
–Distance between anterior surface of sacral Psychosocial changes that occur with Pregnancy
prominence & posterior surface of inferior margin - Accepting the Pregnancy
of the SP - Woman and partner both spend time recovering
–[ 1.5 – 2 cm(usual depth of sp) is subtracted from from shock of learning they are pregnant and
DC ] = 10.5-11.0 cm concentrate of what it feels like to be pregnant.
•Transverse Diameter Common reaction is ambivalence
–Distance bet. Ischial tuberosities or the - Accepting the Baby
transverse diameter of the outlet - Woman and partner move through emotions
–Adequate measurement: 11 cm ( fetal head such as narcissism and introversion as they
9cm) concentrate on what it feel like to be a parent.

11
Role playing and increased dreaming are more -before pregnancy uterine blood flow is 15 to 20
common. ml/min, by the end of pregnancy as much as 500
- Preparing for the baby and the end of pregnancy to 750 ml/ min which 75 % goes to the placenta.
- Woman and partner prepare for clothing and - uterus feels more ante-flexed, larger and softer
sleeping arrangements for the baby but also grow to the touch
impatient with pregnancy as they ready -Hegar’s sign- softening of the lower uterine
themselves for birth. segment
-lightening - the uterus returns to the height it was
Emotional Responses to Pregnancy at 36 weeks, it seems to lighten the woman’s load.
Ambivalence - normal response; discomforts of Ballottement-16th to 20th weeks of pregnancy
pregnancy caused mixed feelings. She may make -if the lower uterine segment is tapped sharply by
comments such as: “I thought I wanted a baby, but the lower hand, the fetus can be felt to bounce or
now I'm not so sure.” rise in the amniotic fluid up against the top
Grief - commonly occurs as a result of changes in examining hand.
the woman's role Braxton Hicks Contractions -“practice”
Narcissism - woman focuses on self and changing contractions
body -felt by a woman as waves of hardness or
-Signifies an effort by the woman to protect her tightening across her abdomen
body and the fetus
Introversion or Extroversion - woman focuses on Ovaries
self or become more out going -Ovulation stops with pregnancy because of the
Stress reaction - pregnancy interferes with ability active feedback mechanism of estrogen &
to perform daily tasks such as caring for other progesterone produced by the corpus luteum
family members; support systems can alleviate early in pregnancy and by the placenta later in
some stress and aid adaptation to pregnancy pregnancy. this feedback causes the pituitary
Emotional lability-mood changes; influenced by gland to halt production of FSH & LH ,thereby
hormones; avoiding fatigue and reducing stress ovulation will not occur.
can help -Amenorrhea (absence of menstruation) occurs
Couvade Syndrome - partner may experience with pregnancy because the suppression of FSH by
discomforts such as nausea, vomiting, fatigue, rising estrogen levels
similar to or possibly more intense than those that Cervical changes
the pregnant woman experiences -The cervix of the uterus becomes more vascular
and edematous, it darkens from a pale pink to a
Maternal Physiology Changes During Pregnancy violet hue
Uterus -endocervix undergo both hypertrophy and
-length increases from approximately 6.5 to 32cm hyperplasia
-depth increases from 2.5 to 22 cm -operculum- mucous plug in the cervix
-width expands from 4 to 24 cm Goodell’s sign – softening of the cervix
-weight increases from 50 to 1000g nonpregnant cervix- nose
-early in pregnancy uterine wall thickens about 1 pregnant cervix- earlobe
cm to 2 cm towards the end of pregnancy only just before labor- soft as butter ,said to be ripe for
about 0.5 cm thick birth
-the volume of the uterus increases from about
2ml to more than 1000ml Vaginal changes
-the uterus can hold a 7 lb(3175) fetus plus 1000ml -Chadwick’s sign–increase in circulation changes
amniotic fluid for a total of 4000g at term the color of the vaginal walls from the normal light
pink to deep violet
12
-Vaginal secretions during pregnancy fall from a -increased activity of sweat glands- increase in
pH of greater than 7 ( alkaline pH) respiration
-pH 4 or 5 (an acid pH) owing to increased Palmar erythema-(redness and itching) occurs on
production of lactic acid from glycogen in the hands due to increased estrogen level.
vaginal epithelium by lactobacillus acidophilus. -scalp hair growth is increased due to increased
-vaginal epithelium and underlying tissue become metabolism
hypertrophic and enriched with glycogen which
results in a white vaginal discharge throughout Respiratory system (RR 18 to 20 breaths/min)
pregnancy -marked congestion or stuffiness of the
nasopharynx due to increased estrogen
Changes in the breast -crowding of the chest cavity causes shortness of
-feeling of fullness, tingling or tenderness in her breath late in pregnancy, until lightening relieves
breast because of high estrogen level the pressure
-areola of the nipple darkens and its diameter -tidal volume (volume of air inspired) is increased
increases from about 3.5cm to 5 or 7.5 cm. up to 40% as a woman draws in extra volume to
-darkening of the skin surrounding the areola in increased the effectiveness of air exchange.
some women, forming a secondary areola. -total oxygen consumption increases by as much
-Montgomery’s tubercules enlarge and become as 20%
protuberant. -increased mild hyperventilation to blow off
-by 16th week, colostrum can be expelled from the excess CO2 shifted to her by the fetus to prevent
breasts the mother’s ph level becoming acidic
-to exhale more than the usual CO2 the woman
Systemic changes may develop respiratory alkalosis, to compensate
Integumentary system kidney excrete plasma bicarbonate in urine.This
-Striae gravidarum often develop- pink or reddish, result in polyuria .
slightly depressed streaks in the skin of abdomen,
breast, and thighs. (Become glistening silvery lines Temperature
after pregnancy.) -body temp increases slightly because of
-Diastasis-rectus muscles separate to progesterone as the placenta takes over the
accommodate the growing fetus.(after pregnancy function of the corpus luteum at about 16 weeks,
it appear as a bluish groove at the site of the temp usually decreases to normal.
separation) Cardiovascular system
-umbilicus appear as if it has turned inside out, *Blood volume
protruding as a round bump at the center of the -Increased total circulatory blood volume by at
abdominal wall. least 30% or 50%
Linea nigra – a narrow brown line may form -Blood loss NSVD – 300 to 400 ml
running from the umbilicus to the symphysis pubis -Blood loss CS – 800 to 1000 ml
and separating the abdomen into right and left
hemisphere Pseudoanemia - a condition where the plasma
Melasma / Chloasma volume increases faster than RBC production,
“the mask of pregnancy”- darkened areas may thereby hemoglobin and erythrocytes
appear on the face (cheek and across concentration declines on the first trimester
the nose)
-vascular spider or telangiectases (small, fiery red -increased need of iron about 800 mg
branching spots) on the thigh,result from Decreased gastric acidity during pregnancy
increased level of estrogen impaired iron absorption
-increased need of folic acid
13
Megalohemoglobinemia (large nonfunctioning due to increased plasma cholesterol level and
RBC) cholesterol incorporated in bile
Neural tube disorders in fetus -hypertrophy of the gums and bleeding of gingival
-encourage woman to eat (spinach, asparagus, tissue
legumes) Hyperptyalism -increased saliva formation due to
increased estrogen level
Heart
-heart rate increases by 10 beats/ min Skeletal syatem
-diaphragm is pushed upward by the growing The increasing mobility of sacroiliac,
uterus late in pregnancy, the heart is shifted to a sacrococygeal, and pelvic joints during pregnancy
more transverse position in the chest cavity. is the result of hormonal (progesterone) changes.
-palpitation of the heart in the early months of - This mobility contributes to alteration of
pregnancy are probably caused by sympathetic maternal posture and to back pain.
nervous system stimulation, in later months result - Lordosis- the pride of pregnancy
from increased thoracic pressure caused by the
pressure of the uterus against the diaphragm. Endocrine system
-placenta produces estrogen, progesterone, HCG,
Peripheral blood flow human placental lactogen, relaxin, prostaglandin
-blood flow to the lower extremities is impaired by
the pressure of the expanding uterus on veins and Pituitary gland-a major change in the PT is the halt
arteries leads to edema and varicosities of the in production of FSH and LH because of high
vulva, rectum and legs estrogen and progesterone levels produced by
Supine hypotension syndrome placenta.
-when a pregnant woman lies supine ,the weight -increased production of growth hormone and
of the growing uterus presses the vena cava melanocyte-stimulating hormone, late in
against the vertebrae, obstructing blood flow from pregnancy oxytocin and prolactin.
the lower extremities.
-woman experiences hypotension, as Thyroid and Parathyroid
lightheadedness, faintness, and palpitations. -may -levels of protein- bound iodine,
cause fetal hypoxia butanolextractable iodine, and thyroxine are all
- can be corrected by having a woman turn on her elevated
side (left side) -emotional lability, tachycardia, palpitation, and
increased perspiration may lead to a mistaken
Gastrointestinal system diagnosis of hyperthyroidism.
-nausea and vomiting /morning sickness-due to -parathyroid gland necessary for metabolism of
increased HCG and progesterone calcium also increased
-as the uterus increases in size, it pushes the
stomach and intestines toward the back and sides Adrenal gland
of the abdomen, this pressure slow intestinal -increased level aid in suppressing an
peristalsis and the emptying time of the stomach inflammatory reaction or help reduce the
leading to heartburn, constipation and flatulence possibility of a woman’s body rejecting the foreign
-relaxin / progesterone may contribute to protein of the fetus.
decreased gastric motility -help regulate glucose metabolism
-decreased emptying of bile from the gallbladder -Aid in promoting sodium reabsorption and
can lead to reabsorption of bilirubin into the maintaining osmolality in the amount of fluid
maternal bloodstream which lead to generalized retained
itching -increased tendency to stone formation
14
 Laboratory test results indicating
Pancreas pregnancy (positive HCG pregnancy test)
-secretes an increased level of insulin, it appears  Uterine souffle (soft blowing sound heard
to be not effective when auscultating the abdomen, caused
-to ensure against hypoglycemia ,diet high in by blood pulsating through the placenta
calories and should never go longer than  Palpable fetal outline during examination
12 hrs between meals  Ultra-sonographic evidence of a
-Immune system gestational sac (visible as early as 4 to 6
-Decreased immunoglobulin to prevent a weeks gestation)
woman’s body from rejecting the fetus.
Immunoglobulin G(IgG) is decreased which make SIGNS & SYMPTOMS OF PREGNANCY
a woman prone to infection. Diagnostic (Positive) Changes
Signs are completely objective and caused only by
SIGNS & SYMPTOMS OF PREGNANCY pregnancy
Subjective (Presumptive) Changes – symptoms Fetal heartbeat audible at 10 to 12 weeks
are experienced by a woman gestation by Doppler ultrasound and at 16 to 20
 Amenorrhea (80% of patients) or slight, weeks gestation with a fetoscope
painless spotting of unknown cause in Ultrasonography results as early as 6 weeks
early gestation (20% of patients) gestation
 Nausea and vomiting Fetal movements felt by the examiner after 16
 Urinary frequency and urgency weeks gestation
 Breast enlargement and tenderness, Visualization of the fetus and fetal outline by
fatigue sonogram
 Intensified skin pigmentation [melasma,
linea nigra, striae gravidarum] COMMON DISCOMFORTS DURING THE FIRST
 Quickening (mother's perception of fetal TRIMESTER
movement) 1. Nausea and vomiting (morning sickness)
 Thinning and softening of fingernails Cause: Hormonal changes, fatigue, emotional
Probable - signs are perceived by the examiner factors, changes in carbohydrate metabolism
 Uterine enlargement Patient teaching – avoid greasy, highly seasoned
 Goodell's sign (softening of the cervix) foods; eat small, frequent meals; eat dry toast or
crackers before getting out of bed
 Chadwick's sign (bluish mucous 2. Nasal stuffiness, discharge or obstruction
membranes of the vagina, cervix and vulva Cause: Edema of the nasal mucosa from elevated
 Hegar's sign (softening of the lower uterine estrogen levels
segment Patient teaching – use a cool moist humidifier; use
normal saline nose drops or nasal spray; apply cool
 SIGNS & SYMPTOMS OF PREGNANCY compresses to nasal area
 Probable (continued) 3. Breast enlargement and tenderness
Cause: Increased estrogen and progesterone
 Braxton Hicks contractions (painless
levels
uterine contractions that recur throughout
Patient teaching: wear a well-fitting bra with wide
pregnancy)
shoulder straps; maintain good posture; wash
 Ballottment (passive fetal movement and
breast and nipple area with water only
response to tapping of the lower portion of
4. Urinary frequency and urgency
the uterus or cervix)

15
Cause: Pressure of the enlarging uterus on the patterns; avoid use of mineral oil which can
bladder; around the 12th week the uterus rises deplete her level of fat soluble vitamins
into the abdominal cavity causing symptoms to
disappear; symptoms recur in the 3rd trimester as
the uterus again presses on the bladder 3. Hemorrhoids
Patient teaching: decrease fluid intake in the Cause: Pressure on the pelvic veins by the
evening to minimize nocturia; limit intake of enlarging uterus, which interferes with venous
caffeinated beverages; promptly response to the circulation; increased pressure secondary to
urge to void to prevent bladder distention and constipation
urine stasis; perform Kegel's exercises; teach signs Patient teaching: Avoid constipation; avoid
and symptoms of UTI and instruct to report prolonged standing and wearing constrictive
promptly clothing; lie on left side with feet slightly elevated;
5. Increased leukorrhea use topical ointment or anesthetic if allowed; use
Cause: Hyperplasia of vaginal mucosa; increased of witch hazel compresses, sits bath or apply warm
mucus production by the endocervical glands soaps
Patient teaching: daily bath and avoid using soap 4. Backache
on the vulvar area; reinforce the need to wipe Cause: Postural adjustment of pregnancy
from front to back; wear loose, absorbent cotton secondary to curvature of the lumbosacral
underwear and to avoid tight pants and vertebrae that increases with uterine enlargement
pantyhose; avoid douching; notify health care Patient teaching: Use proper body mechanics;
provider if the discharge changes in color or odor maintain good posture; wear low-to-mid heeled
6. Increased fatigue shoes; walk with pelvis tilted forward; use a board
Cause: The increased effort of the body to under the current mattress to add firmness;
manufacture the placenta; the need to adjust to perform pelvic rocking or tilting exercises; apply
the many physical and emotional demands of local heat to the back, if necessary
pregnancy 5. Leg Cramps
Patient teaching – have frequent rest periods; Cause: Pressure from the enlarging uterus; poor
obtain rest during the day; eat a balance diet and circulation; fatigue; balance in the calcium-
take iron supplement; suggest use of warm milk or phosphorus ratio
warm shower before going to bed at night to aid Patient teaching: Rest with legs slightly elevated;
in relaxation; engage in moderate regular exercise wear warm clothing; assist woman with measures
to alter calcium and phosphorus intake; teach her
THE 2ND AND 3RD TRIMESTER what to do during a leg cramp (pull the toes up
1. Heartburn toward the legs while pressing down on the knee)
Cause: decreased GI motility; increased 6. Shortness of breath
production of progesterone; gastric displacement Cause: Pressure of the uterus on the diaphragm
Patient teaching: Eat small, frequent meals; avoid Patient teaching: maintain proper posture; use
fatty and fried foods and caffeine products; semifowler's position when sleeping; encourage a
remain upright for one hour after meals balance of activity and rest
2. Constipation 7. Ankle edema
Cause: Oral iron supplement; displacement of the Cause: Poor venous return from the lower
intestines by the fetus; bowel sluggishness caused extremities aggravated by prolonged sitting or
by increased progesterone standing and by warm weather; fluid retention
Patient teaching: engage in moderate daily Patient teaching: Lie on the left side in bed to
exercise; drink plenty of fluids; increase daily enhance glomerular filtration rate of the kidneys;
intake of fiber; maintain regular elimination avoid wearing tight, constrictive clothing; elevate
legs during rest periods; dorsiflex the feet when
16
standing or sitting for prolonged period; get up Preterm signs of labor such as, rhythmic
and move about every 1 to 2 hours when sitting contractions
for long periods

8. Varicose Veins
May affect the lower extremities, vulva, and Self – care Needs
pelvis. Bathing
1. Cause: -sweating tends to increased during pregnancy
a.Heredity -daily bath tubs or showers are now
b.Pressure of gravid uterus on the great veins of recommended
the pelvis. -woman should not soak for long periods in
c.Prolonged standing extremely hot water or hot tubs may lead to
d.Constrictive clothing2. Treatment: hyperthermia in the fetus
a.Avoid restrictive clothing -as pregnancy advances, she should change to
b.Elevate legs and hips on pillows above the level showering or sponge bathing for her own safety
of the heart. -if membranes ruptured, cervix begin to dilate or
c.Wear elastic stockings or bandages. vaginal bleeding present, tub baths are
d.Take frequent rest periods. contraindicated because of danger of
contamination of uterine content
SEXUAL DESIRE BY TRIMESTER
First Trimester -may decrease due to discomfort Breast care
and fatigue Proper breast support promotes comfort,retains
Second Trimester – may increase when breast shape,and prevent back strain
discomforts wane. The woman may have greater Washing the breast with clear water and no soap
sexual daily
satisfaction than before pregnancy because of Gauze or breast pads may be needed if the
vascular congestion of the pelvis woman's secretion of colostrum is significant
Third Trimester – may decrease due to increasing
fatigue and abdominal size. Changes in position Dental Care
and use of water soluble lubricant may be – dental check up early in pregnancy and routine
necessary examinations and cleaning are encourage
Sexual behavior is usually unrestricted in -Nausea, vomiting, heartburn may lead to poor
complication-free pregnancies oral hygiene and dental caries
- The fetus receives calcium and phosphorus from
PATIENT COUNSELING the pregnant patient's diet not from her teeth, the
Danger signs to report immediately: belief that a patient looses a tooth for every
Severe vomiting pregnancy is a fallacy
Frequent, severe headaches -Nutritional snacks (fresh fruits and vegetables)
Epigastric pain are recommended to avoid excessive contact of
Fluid discharge from vagina sugar with the teeth
Fetal movement changes or cessation after
quickening Perineal hygiene
Swelling of the fingers or face -the woman may desire to have a vaginal douche
Vision disturbances due to an increased vaginal discharges during
Signs of vaginal or UTI pregnancy
Unusual or severe abdominal pain -Douching is contraindicated during pregnancy
Seizure or muscular irritability
17
-the force of the irrigating fluid could cause to pregnant ,interference with adequate rest and
enter the cervix and lead to infection nutrition, the pregnnat woman should not
-douching alters the ph of the vagina, leading to continue working.
an increased risk of bacterial growth Travel
Clothing – Comfort is the key • When riding in a car, wear seat belts low, under
-recommend loose-fitting,comfortable garments the abdomen
- Non restrictive and low-to-mid heeled shoes to • On a long trip, get out of the car every hour ,but
prevent backache and poor balance at least every 2 hrs to walk around
- Avoid tight-fitting such as garters,girdles with • Travel by air in airplanes with well-pressurized
panty legs, and knee –high stockings cabins. Some airlines have restrictions for woman
Sexual activity more than 7 months pregnant
• sexual relation during pregnancy are
contraindicated: Perineal and Abdominal Exercises
• woman with a history of spontaneous 1. Tailor sitting- stretches abdominal muscles -It
miscarriage also improves your posture, keeps your pelvic
• woman whose membranes have ruptured or joints flexible and increases blood flow to your
have vaginal spotting to avoid infection lower body.
• advise caution about male –oral female genital 2. Squatting- stretches perineal muscle and can be
contact, because accidental air embolism has been a useful position during the 2nd stage of labor
reported 3. Pelvic floor contractions or kegel exercises- a
• Side by side position or woman in a superior perineal muscle strengthening exercise, helpful in
position may be more comfortable the post partum period to reduce pain and
Exercise promote perineal healing.
• extreme exercises has been associated with 4. Abdominal muscle contractions- help
lower birth weight strengthen abdominal muscle during pregnancy
• moderate exercise is healthy therefore may help prevent constipation as well as
• walking is the best exercise during pregnancy restore abdominal tone after pregnancy
• jogging can cause pelvic pain 5. Pelvic rocking- helps relieve backache during
• high –impact aerobics contraindicated pregnancy and early labor by making lumbar spine
• swimming is not contraindicated as long as the more flexible.
membranes are intact
• diving or long distance swimming should be Nutrition during pregnancy
avoided – Calories-requirement exceeds pre-pregnancy
• Hot tubs/ saunas after workouts longer than 15 needs by 300calories/day(from 2,200 kcal/day to
mins is contraindicated 2,500 kcal/day)
Sleep – Protein-from 46g/day to 71 g/day
• Pregnant woman need rest period during the – Fats-20% to 35% of woman's daily calorie intake
afternoon as well as a full night sleep *Linoleic acid( found in veg oils ,such as corn,
• Modified sim’s position- with the top leg forward olive),
• Avoid resting on her back to prevent supine Vitamins-Intake of all vit. should be increased
hypotension syndrome Fat –soluble vitamins
Employment – Vit A- 750 ug /day
Check the work site for potential environmental – Vit D-5 ug /day
hazards(pesticides, anesthetic gas, heavy metals – Vit E- 15 mg/day Water – soluble vitamins
as lead and mercury – Vit C -80mg/day
-If it involves lifting heavy object ,excessive – Folic acid -600ug/day
physical strains, long periods of standing or sitting – Niacin -18 mg/day
18
– Thiamine B1- 1.4 mg/day Danger Signs of Pregnancy
– Vit B12 -2.8ug/day -Signs Indicating Complications of Pregnancy
– Vit B6 – 1.9 mg/day 1. Vaginal Bleeding – spotting
2. Persistent Vomiting - vomiting continues after
Nutrition during pregnancy Minerals 12th weeks (hyperemesis gravidarum)
-Calcium 1300mg/day 3. Chills and Fever - benign gastroenteritis -
-Fluoride 3 mg/day intrauterine infection
-Iodine 220 ug/day 4. Sudden Escape of Fluid from the Vagina -
-Iron 220 ug/day threatened abortion ,umbilical cord prolapse,
-Magnesium 400 mg/day 5. Abdominal or Chest Pain - ectopic
-Phosphorous 400 mg/day pregnancy,separation of the placenta, - preterm
-Zinc 12 mg/day labor, appendicitis, ulcer - chest pain (pulmonary
Fluid needs embolus that can fallow thrombophlebitis)
-6 to 8 glasses daily 6. Pregnancy Induced Hypertension several
Fiber needs symptoms
-encourage women to eat plenty of fruits and • severe and even fatal elevation of blood
vegetables pressure that occurs during pregnancy.
1. Rapid wt. Gain( over 2 lb per week in the 2nd
Foods to avoid or limit in pregnancy trimester, 1 lb per week in the third trimester)
1.alcoholic beverages-teratogenic effect 2. Swelling of the face or fingers
2.food additives 3. flashes of light or dots before the eyes
3.excess seafood 4. dimness or blurring of vision
-2 to 3 meals of seafood or shellfish / week 5. severe continous headache
-For their omega -3 and iodine content 6. decreased urine output
-6 ounces(1 meal) per week of fish
- sharks, swordfish,king mackerel or tilefish are 7. Increase or Decrease in Fetal movement -
high in mercury contamination unusual increase or decrease in movement
4. Foods with caffeine suggests that a fetus is responding to a need of
-a central nervous system stimulant capable of oxygen
increasing heart rate,urine production in the Laboratory assessment
kidney,and secretion of acid in the stomach urine pregnancy test -determine pregnancy
-2 to 3 cups of coffee has not been associated with through the detection of the hormone Human
low birth weight infant Chorionic Gonadotropin (hCG) in a woman’s urine.
- drinking over 3 cups is associated with early - Human Chorionic Gonadotropin (hCG) is a
miscarriage hormone which is produced early in pregnancy by
-chocolate, cocoa bean,softdrinks and tea contain the placenta in great volume (hormone released
caffeine by developing embryos).
Artificial sweeteners -used to improve the taste -test is done 10 to 14 days after the missed
and to limit the caloric content of foods -pregnant menstrual period.
woman need carbohydrates from sugar rather Main Causes for False Positive Pregnancy Test
than artificial substances -sweetener aspartame- • Soap or detergents -don’t use soap or any
safe for pregnancy -saccharine not recommended detergents before making your pregnancy test.
during pregnancy because it is eliminated slowly • Some medications may cause a false positive on
from the fetal bloodstream a pregnancy test. These include anti-Convulsants,
medications to treat Parkinson’s disease, certain
tranquilizers,oral contraceptives and certain
diuretics
19
• Do not drink fluids from 8pm to concentrate the 8.HIV screening
urine • Screening cannot be mandatory in prenatal
• Collect first- voided urine in the morning setting
serum pregnancy test • Done by enzyme-linked immunosorbent assay
• In pregnant woman trace amount of HCG appear (ELISA) if positive , the finding is confirmed by
in the serum as early as 24 to 48 hrs after Western blot.
implantation 9. to rule out gestational diabetes
• About 50 milli IU / ml after 7 to 9 days after • history of unexplained fetal death ,fetal loss
conception ,family history of diabetes, LGA babies ,obese, has
• Levels peak at about 100 m IU / ml between the glycosuria
60th and 80th day of gestation,after that point, • 50 g oral 1 hour glucose loading or tolerance test
the concentration of HCG declines again so that , towards the end of the first trimester to rule out
at term ,it is barely detectable in serum or urine gestational diabetes
Blood studies • Done routinely at 24th to 28th week to evaluate
1.Complete blood count insulin-antagonistic effects of placental hormones
• Hemoglobin , hematocrit and red cells index- to • Plasma glucose level should not exceed 140
determine anemia mg/dl at 1 hour
• White blood cell- to determine infection 10. Urinalysis
• Platelet count- to estimate clotting ability • to test for proteinuria , glycosuria, and pyuria (
2. Genetic screen pus in urine )
• For common ethnically inherited disease Tuberculosis screening
3.Serologic test for syphilis ( VDRL or rapid plasma • purified protein derivative (PPD) tuberculin test
reagin) • if positive reaction- a chest radiograph is
4.Blood typing (including Rh factor ) indicated further diagnosis
5. Maternal serum for alfa-fetoprotein(MSAFP)
• done at 16 to 18 weeks of pregnancy Monitoring Fetal Status
• elevated for neural tube or abdominal defect is Ultrasonography- non-invasive use of sound
present in the fetus waves to determine fetal presence, size, position
• decreased for chromosomal anomaly and presentation and to detect abnormalities.
• 2.5 MOM ( multiple of the mean) normal value Provides information about the fetus during each
6. Indirect Coombs test trimester:
• Determination if Rh antibodies are present in an First trimester: Assessment of gestational
Rh negative woman age,evaluation for congenital anomalies;
• Test is repeated at 28 weeks of pregnancy Diagnostic evaluation of vaginal bleeding;
• if the titers are not elevated, an Rh negative Confirmation of suspected multiple
woman will receive RhoGAM at 28 weeks and after gestation,evaluation of fetal growth, adjunct to
any procedure that might cause placental bleeding prenatal testing such as amniocentesis or
• It may be administered within 72 hours after CVS(chorionic villus sampling)
birth of a positive Rh baby whose cord blood Second trimester: Assessment of placental
showed no antibodies ,a negative reaction, or location, diagnosis of multiple gestation
after an ectopic pregnancy. Evaluation for congenital anomalies Guidance of
7.Antibody titers for rubella and hepatitis B procedure such as amniocentesis and fetoscopy
• determine whether a woman is protected Third trimester: Determination of fetal position,
against rubella and whether a newborn well have estimation of fetal size A full bladder may
the chance of developing hepatitis B improve ultrasonic resolution before 20 weeks'
gestation Client may be instructed to drink a
quart or more of fluids 1 to 2 hours before the
20
procedure (abdominal UTZ), for transvaginal UTZ
usually performed during first trimester, a full
bladder is unnecessary

Preparation of labor
1.Lightening or descent -Settling of the fetal head
into the inlet of the true pelvis
-in primiparas approximately 2 weeks(10 to 14
days) before labor -in multiparas on the day of
labor or after labor has begun.
-experience frequency in urination(frm pressure
on bladder),sciatic pain (pain across a buttocks
radiating down her legs) from the lowered fetal
position,increased amts of vaginal discharge.
2.Show -as the cervix softens and ripens, the
mucus plug that filled the cervical canal during
pregnancy is expelled.
-the release of the cervical plug (operculum) -it
consist of a mucus, often blood
–streaked vaginal discharge -indicates the
beginning of cervical dilatation
Rupture of membranes -a sudden gush of clear
fluid (amniotic fluid ) from the vagina indicates
rupture of the membranes
-after rupture of membranes there is danger of
cord prolapse and infection
-early rupture of the membrane can be
advantageous as it can cause the fetal head to
settle snugly into the pelvis,aiding cervical dilation
and shortening labor.
Excess energy -extremely energetic is a sign of
labor -part of body‘s physiologic preparation of
labor
Uterine contractions -labor begins with
contractions
-true labor contractions usually start in the back
and sweep forward across the abdomen
-gradually increase in frequency and intensity

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