MATERNAL AND CHILD HEALTH NURSING

Maternal and Child Health Nursing involves care of the woman and family
throughout pregnancy and child birth and the health promotion and illness care
for the children and families.
Primary Goal of MCN
1 The promotion and maintenance of optimal family health to ensure
cycles of optimal childbearing and child rearing
I. ANATOMY & PHYSIOLOGY
1. Ovaries
o lmond shaped
o Produce! mature and discharge ova
o "nitiate and regulate menstrual cycle
o # cm long! $ cm in diameter! %.& cm thic'
o Produce estrogen and progesterone
Estrogen: promotes breast devt & pubic hair distribution prevents osteoporosis keeps keeps
cholesterol levels reduced & so limits efects of atherosclerosis Fallopian tubes. .
1 ppro(imately %) cm in length
2 Conveys ova from ovaries to the uterus
3 *ite of fertili+ation
4 Parts, interstitial
isthmus - cut.sealed in /T0
ampulla - site of fertili+ation
infundibulum - most distal segment1 covered with 2mbria
$. 3terus
1 1 Hollow muscular pear shaped organ
uterine wall layers, endometrium1 myometrium1 perimetrium
2 2 Organ of menstruation
3 3 4eceives the ova
4 4 Provide place for implantation 5 nourishment during fetal growth
5 5 Protects growing fetus
6 6 6(pels fetus at maturity
7 7 Has 7 divisions, corpus - fundus ! isthmus 8most commonly cut during C* delivery9 and
cervi(

7. 3terine :all
1 6ndometrial layer, formed by $ layers of cells which are as follows,
2 basal layer; closest to the uterine wall
3 glandular layer - inner layer in<uenced by estrogen and progesterone1 thic'ens and shed o=
as menstrual <ow
4 Myometrium - composed of 7 interwoven layers of smooth muscle1 2bers are arranged in
longitudinal1 transverse and obli>ue directions giving it e(treme strength
4. ?agina
5 cts as organ of copulation
6 Conveys sperm to the cervi(
7 6(pands to serve as birth canal
8 :all contains many folds or rugae ma'ing it very elastic
Fornices uterine end of the vagina; serve as a place for pooling of semen following coitus
ulbocavernosus circular muscle act as a voluntar! sphincter at the e"ternal opening to the
vagina #target of $egels e"ercise%
II. PUBERTAL DEVELOPMENT
1. Puberty ,
1 the stage of life at which secondary se( changes begins
2 the development and maturation of reproductive organs
which occurs in female %);%7 years old 5 male at %$;%# yrs old
3 the hypothalamus serve as a gonadostat or regulation
mechanism set to @turn onA gonad functioning at this age
2. Repr!u"t#$e De$e%p&e't
Readiness for child bearing
1 begins during intrauterine life
2 full functioning initiated at puberty
&the hypothalamus releases the GnRF which triggers the '() to form and release F*+
and ,+. 8B*H 5 0H initiates production of androgen and estrogen ;;;C 2( )e*u+%
",+r+"ter#)t#")
Role of Androgen
1 ndrogenic hormones - are produced by the testes! ovaries and adrenal corte( which is
responsible for,
muscular development
physical growth
inc. sebaceous gland secretions
1 testosterone -primary androgenic hormone
Related terms
a. drenarche - the development of pubic and a(illary hair 8due to androgen stimulation9
b. Thelarche - beginning of breast development
c. Menarche - 2rst menstruation period in girls 8early D y.o. or late %E y.o.9
d. Tanner *taging
2 "t is a rating system for pubertal development
3 "t is the biologic mar'er of maturity
4 "t is based on the orderly progressive development of,
5 breasts and pubic hair in females
6 genitalia and pubic hair in males
-. B!y Stru"ture) I'$%$e!
1 Hypothalamus
2 nterior Pituitary Gland
3 Ovary
4 3terus
.. Me')tru+% Cy"%e
1 Bemale reproductive cycle wherein periodic uterine bleeding occurs in response to cyclic
hormonal changes
2 llows for conception and implantation of a new life
3 "ts purpose it to bring an ovum to maturity1 renew a uterine bed that will be responsive to the
growth of a fertili+ed ovum
/. Me')tru+% P,+)e)
0#r)t, #;& days after the menstrual <ow1 the endometrium is very thin! but begins to proliferate rapidly1
thic'ness increase by F folds under the in<uence of increase in estrogen level
also 'nown as, proliferative1 estrogenic1 follicular and postmentrual phase
Se"'!+ry, after ovulation the corpus luteum produces progesterone which causes the endometrium
become twisted in appearance and dilated1 capillaries increase in amount 8becomes rich! velvety and
spongy in appearance also 'nown as, secretory1 progestational1 luteal and premenstrual
T,#r!1 if no fertili+ation occurs1 corpus luteum regresses after F - %) days causing decrease in
progesterone and estrogen level leading to endometrial degeneration1 capillaries rupture1 endometrium
sloughs o= 1 also 'nown as, ishemic
0#'+% p,+)e, end of the menstrual cycle1 the 2rst day mar' the beginning of a new cycle1 discharges
contains blood from ruptured capillaries! mucin from glands! fragments of endometrial tissue and
atrophied ovum.
P,y)#%2y 3 Me')tru+t#'
1. bout day %# an upsurge of 0H occurs and the graa2an follicle ruptures and the ovum is released
2. fter release of ovum and <uid 2lled follicle cells remain as an empty pit1 B*H decrease in
mount1 0H increase continues to act on follicle cells in ovary to produce lutein which is high in
progesterone 8 yellow <uid9 thus the name corpus luteum or yellow body
3. Corpus luteum persists for %G - $) wee's with pregnancy but with no fertili+ation ovum atropies in
# - & days! corpus luteum remains for F ;%) days regresses and replaced by white 2brous tissue!
corpus albicans
C,+r+"ter#)t#") 3 Nr&+% Me')tru+t#' Per#!
1. Menarche - average onset %$ ;%7 years
2. "nterval between cycles - average $F days
3. Cycles $7 - 7& days
4. Huration - average $ - E days1 range % - D days
5. mount - average 7) - F) ml 1 heavy bleeding saturates pad in I%hour
6. Color - dar' red1 with blood1 mucus1 and endometrial cells
A))"#+te! Ter&)
%. menorrhea ; temporary cessation of menstrual <ow
$. Oligomenorrhea ; mar'edly diminished menstrual <ow
7. Menorrhagia ; e(cessive bleeding during regular menstruation
#. Metrorrhagia ; bleeding at completely irregular intervals
&. Polymenorrhea ; fre>uent menstruation occurring at intervals of less than 7 wee's

O$u%+t#'
1 Occurs appro(imately the %#th day before the onset of ne(t cycle 8$ wee's before9
2 "f cycle is $) days - %# days before the ne(t cycle is the Gth day! so ovulation is day G
3 "f cycle is ## days - %# days! ovulation is day 7).
4 *light drop in /T 8).& - %.) JB9 Kust before day of ovulation due to low progesterone level then
rises %JB on the day following ovulation 8spinnbar'heit1 mittelschmer+9
5 "f fertili+ation occurs! ovum proceeds down the fallopian tube and implants on the endometrium
Me'p+u)e
o Mechanism; a transitional phase 8period of % - $ years9 called climacteric! heralds the onset of
menopause.
o Monthly menstrual period is less fre>uent! irregular and with diminished amount.
o Period may be ovulatory or unovulatory ; advised to use Bamily planning method until menses
have
been absent for G continuous months
o Menopause is has occurred if there had been no period for one year.
-lassical signs: ?asomotor changes due to hormonal imbalance
a. hot <ushes
b. e(cessive sweating especially at night
c. emotional changes
d. insomnia
e. headache
f. palpitations
g. nervousness
h. apprehension
i. depression
K. tendency to gain weight more rapidly
'. tendency to lose height because of osteoporosis 8dowager hump9
l. arthralgias and muscle pains
m. loss of s'in elasticity and subcutaneous fat in labial folds
'rti.cial menopause / surgicall! induced menopause
a. oophorectomy or irradiation of ovaries
b. panhysterectomy
III. PROMOTE RESPONSIBLE PARENTHOOD 4 0AMILY PLANNING
A. Art#5"#+% Met,!)1
%. physiologic method, oral contraceptives 1 natural methods
$. mechanical methods
7. chemical methods
#. surgical methods
Or+% "'tr+"ept#$e
ction, inhibits release of B*H no ovulation
Types, Combined 1 *e>uential1 Mini pill
*ide 6=ects, due to estrogen and progesterone
C nausea and vomiting C Headache and weight gain
C breast tenderness C di++iness
C brea'through bleeding.spotting
C chloasma
Contraindications,
a. /reastfeeding
b. Certain diseases,
o thromboembolism
o Hiabetes Mellitus
o 0iver disease
o migraine1 epilepsy1 varicosities
o C1 renal disease1recent hepatitis
c. :omen who smo'e more than $ pac's of cigarette per day
d. *trong family H( of heart attac'
Nte1 I3 t+6#'2 p#%% #) &#))e! ' )",e!u%e7 t+6e 'e +) )' +) re&e&bere! +'! t+6e 'e*t
p#%% ' )",e!u%e8 #3 't !'e 9#t,!r+9+% b%ee!#'2 ""ur).
B. N+tur+% Met,!)1
a. Rhythm/Calendar/Ogino Knause Formula
o Couple abstains on days that the woman is fertile
o Menstrual cycles are observed and charted for %$ months
*tandard Bormula, 2rst day of the beginning of one cycle to the 2rst day of the ne(t cycle
shortest cycle L minus %F
longest cycle L minus %%
6(ample, shortest cycle L $F
longest cycle L 7&
*hortest cycle, $F days - %F L %)
0ongest cycle, 7& days - %% L $#
Bertile pd, %)th to $#th day of cycle L No se(ual intercourse
b. Billings Method / Cerical Mucus
o woman is fertile when cervical mucus is thin and watery1 may be e(tended
o *e(ual "ntercourse may be resumed after 7 - # days
c. !ymptothermal Method / BB"
1 4e>uires daily observation and recording of body temperature before rising in the
morning or doing any activity to detect time of ovulation
2 Ovulation is indicated by a slight drop of temperature and then rises
3 4esume *e(ual intercourse after 7 - # days
4 4ecommended observation of //T is G menstrual cycle to establish pattern of
<uctuations
C. Me",+'#"+% Met,!)
%. I'tr+uter#'e De$#"e : prevents implantation by non;speci2c cell in<ammatory reaction
inserted during menstruation 8cervi( is dilated9
*6, increased menstrual <ow
spotting or uterine cramps
increased ris' of infection
Note, when pregnancy occurs! no need to remove "3H! will not harm fetus
2. D#+p,r+2&
o a disc that 2ts over the cervi(
o forms a barrier against the entrance of sperms
o initially inserted by the doctor
o maybe washed with soap and water is reusable
o when used! must be 'ept in place because sperms remains viable for G hrs. in the
vagina but must be removed within $# hours 8to decrease ris' of to(ic shoc'
syndrome9
-. C'!&
1 a rubber sheath where sperms are deposited
2 it lessens the chance of contracting *THs
3 most common complaint of users interrupts se(ual act when to apply
D. C,e&#"+% Met,!)
These are spermicidals 8'ills sperms9 li'e Kellies! creams! foaming tablets! suppositories
E. Sur2#"+% Met,!
a. Tubal 0igation,
Ballopian tubes are ligated to prevent passage of sperms
Menstruation and ovulation continue
b. ?asectomy,
?as deferens is tied and cut bloc'ing the passage of sperms
*perm production continues
*perms in the cut vas deferens remains viable for about G months hence couple
needs to observe a form of contraception this time to prevent pregnancy
IV. BEGINNING O0 PREGNANCY
. 0ert#%#;+t#'
1. 3nion of the ovum and spermato+oon
2. Other terms, conception! impregnation or fecundation
3. Normal amount of semen.eKaculationL 7;& cc L % tsp.
4. Number of sperms, %$);%&) million.cc.eKaculation
5. Mature ovum may be fertili+ed for %$ -$# hrs after ovulation
6. *perms are capable of fertili+ing even for 7 - # days after eKaculation 8life span of sperms
E$ hrs9
/. I&p%+'t+t#'
General Considerations,
o Once implantation has ta'en place! the uterine endometrium is now termed decidua
o Occasionally! a small amount of vaginal bleeding occurs with implantation due to brea'age
of capillaries
o "mmediately after fertili+ation! the fertili+ed ovum or +ygote stays in the fallopian tube for 7
days! during which time rapid cell division 8mitosis9 is ta'ing place. The developing cells
now called blastomere and when about to have %G blastomere called morula.
o Morula travels to uterus for another 7 - # days
o :hen there is already a cavity in the morula called blastocyt
o 2nger li'e proKections called trophoblast form around the blastocyst! which implant on the
uterus
o "mplantation is also called nidation! ta'es place about a wee' after fertli+ation
C. St+2e) 3 ,u&+' pre'+t+% !e$e%p&e't
%. Cytotrophoblast - inner layer
$. *yncytiotrophoblast - the outer layer containing 2nger
li'e proKections called chorionic villi which di=erentiates
into,
o 0angerhanMs layer - protective against Treponema Pallidum! present only
during the second trimester
o *yncytial 0ayer - gives rise to the fetal membranes! amnion and chorion
D. 0et+% Me&br+'e)
1. mnion - gives rise to umbilical cord.funis - with $ arteries and % vein supported by
2. :hartonMs Kelly
3. mniotic <uid, clear albuminous <uid! begins to form at %% - %&th wee' of gestation! chie<y
derived from maternal serum and fetal urine! urine is added by the #th lunar month! near term is
clear! colorless! containing little white spec's of verni( caseosa! produced at rate of &)) ml.day.
Nnown as /O: or /ag of :ater
E. A&'#t#" 0%u#!
Purposes of mniotic Bluid
Protection - shield against pressure and temperature changes
Can be used to diagnose congenital abnormalities intrauterine- amniocentesis
id in the descent of fetus during active labor
"mplication,
Polyhydramios L more than C%&)) ml due to inability of the fetus to swallow the <uid as in
trachoesophageal 2stula.
Oligohydramnios L less than I&)) ml due to the inability of the 'idneys to add urine as in
congenital renal anomaly
0. 0et+% Me&br+'e)
Chorion ; together with the deciduas basalis gives rise to the placenta! start to form at Fth
wee' of gestation1 develops %& - $) cotyledons
Purpose of Placenta, respiratory1 e(change of nutrients and o(ygen
4enal system
Gastrointestinal system
Circulatory system
6ndocrine system, produces hormones 8before Fth wee';corpus luteum produces these
hormones9 hCG 'eeps corpus luteum to continue producing estrogen and progesterone
HP0 or human chorionic somatomammotropin which promotes growth of mammary
glands for
lactation
Protective barrier, inhibits passage of some bacteria and large molecules
V. 0ETAL GRO<TH AND DEVELOPMENT
0#r)t %u'+r &'t,
Germ layers di=erentiate by the $nd wee'
%. endoderm - gives rise to lining of G"T! 4espiratory Tract! tonsils! thyroid 8for basal metabolism9!
parathyroid 8for calcium metabolism9! thymus gland 8for development of immunity9!
bladder and urethra
$. Mesoderm - forms into the supporting structures of the body 8connective tissues! cartilage!
muscles and tendons91 heart! circulatory system! blood cells! reproductive system! 'idneys and
ureters.
7. 6ctoderm - responsible for the formation of the nervous system! s'in! hair and nails and the
mucous membrane of the anus and mouth
1 &'t,, $nd wee' - fetal membranes %Gth day - heart forms 1 #th wee' - heart beats
2'! &'t,1 ll vital organs and se( organs formed1 placental fully developed1
meconium formed 8&th -Fth w'9
-r! &'th, Nidneys function ; %$th w'; urine formed 1 /uds of mil' teeth form 1 begin bone ossi2cation 1
allows amniotic <uid 1 establishment of feto;placental e(change
.t, &'t,, 0anugo appears1 buds of permanent teeth form1 heart beat heard by fetoscope
/t, &'t,, ?erni( appears1 lanugo over entire body1 >uic'ening1 BH4 audible with stethoscope
=t, &'t,, ttains proportions of full term but has wrin'led s'in
>t, &'t,, $F wee's - lower limit of prematurity1 alveoli begins to form
?t, &'t,, 7$ wee's - fetus viable1 lanugo disappears! subcutaneous fat deposition begins
@t, &'t,, 0anugo continue to disappear1 verni( complete1 amniotic volume decrease
Focus of Fetal #eelopment
Birst Trimester - period of organogenesis
*econd Trimester - period of continued fetal growth and development1 rapid increase in length
Third Trimester - period of most rapid growth and development because of the deposition of
subcutaneous fat
Assessing Fetal $ell%being
Betal Movement,
Ouic'ening at %F - $) wee's ! pea's at $D ;7F wee's
Consistently felt until term
a. Cardi= Method, @Count to tenA ; records time interval it ta'es for %)
; fetal movements to be felt usually occurs in G)
minutes
b. Contraction *tress Test, Betal Heart 4ate 8BH49 analy+ed in conKunction with contractions
Nipple stimulation done to induce gentle contractions
PPP7 contractions with #) sec duration or more must be
present
in %) minutes window
Normal 4esult no fetal decelerations with contractions
c. Non;stress Test, Measures response of BH4 to fetal movement 8%);$)mins.9
with fetal movement BH4 increase by %& beats and
remain for %& seconds then decrease to average rate 8no
increase means poor o(ygen perfusion to fetus9
d. mniocentesis ; done to determine fetal maturity, "dentify 0.* ratio
%G w's - detect genetic disorder
7) w's - assess
1. Prior to the procedure! bladder should be emptied1 ultrasonography is used to avoid
trauma from the needle to the placenta! fetus
2. Complications include premature labor! infection! 4h isoimmuni+ation
3. Monitor fetus electronically after procedure! monitor for uterine contractions
4. Teach client to report decreased fetal movement! contractions! or abdominal discomfort
after procedure.
e. 3ltrasound - transducer on abdomen transmits sound waves that show
fetal image on screen
a. Hone as early as 2ve wee's to con2rm pregnancy! gestational age
b. Multiple purposes - to determine position! number! measurement of fetus8es9 and other
structures 8placenta9
c. Client must drin' <uid prior to test to have full bladder to assist in clarity of image
d. No 'nown harmful e=ects for fetus or mother
e. Noninvasive procedure
VI. NORMAL ADAPTATIONS IN PREGNANCY
0. -ardiovascular/ -irculator! changes:
a. (h!siologic anemia of pregnanc!
;7);&)Q gradual increase in total cardiac volume 8pea' Gth month9 causing drop in Hemoglobin
and Hematocrit values 8inc only in plasma volume9
Conse>uences of increased cardiac volume,
%. easy fatigability 5 shortness of breath due increase cardiac wor'load
$. slight hypertrophy of the heart
7. systolic murmurs due to lowered blood viscosity
#. nosebleeds may occur due to congestion of nasopharyn(
b. (alpitations
caused by the *N* stimulation during early part of pregnancy1 increased pressure of the uterus
against the diaphragm during the second half of pregnancy
c Edema of the lower e"tremities & varicosities
due to poor circulation caused by the pressure of the gravid uterus on the blood vessels of the
lower e(tremities
d. 1aginal and rectal varicosities
; due to pressure on blood vessels of the genitalia
Management, side lying hips elevated on pillow modi2ed 'nee chest position
e. (redisposition to blood clot formation
;due to increased level of circulating 2brinogen as a protection from bleeding implication, no
massage
$. Gastrointestinal Changes
a. 2orning sickness
2 nausea and vomiting in the %st trimester due to HCG or due to increased acidity or emotional
factors
3 Management, dry toast 7) mins before get up in M
b. +!peremesis gravidarum
4 e(cessive nausea 5 vomiting which persists beyond 7 months causing dehydration! starvation
and acidosis
5 Management, hydration in $# hrs1 complete bed room
c. -onstipation and Flatulence
G" displacement slows peristalsis 5 gastric emptying time1 inc progesterone
d. +emorrhoids
1 due pressure of enlarged uterus
2 Management, cold compress with witch ha+el and 6psom salts
e. +eartburn
1 due to increased progesterone and decreased gastric motility causing regurgitation through
gastric sphincter
2 Management, pats o= butter before meals
avoid fried! fatty foods
sips of mil' at intervals
small! fre>uent meals ta'en slowly
donMt bend on waist
ta'e antacids 8mil' of magnesia9

7. 4espiratory Changes
a. *hortness of reath
due to inc. o(ygen consumption and production of carbon dio(ide during the %st Trimester1
and increased uterine si+e pushing the diaphragm crowding chest cavity
management, side lying position to promote lateral chest e(pansion
#. 3rinary Changes
a. 3rinar! fre4uenc!
felt during the %st trimester due to the increase blood supply to the 'idneys and then on
the 7rd trimester due to pressure on the bladder.
b. 5ecreased renal threshold for sugar
due to increased production of glucocorticoids which cause lactose and de(trose to spill
into the urine1 and inc. progesterone
&. Musculos'eletal changes
a. (ride of (regnanc!
1 due to need to change center of gravity result to lordotic position
b. 6addling gait
1 due to increased production of hormone rela(in! pelvic bones becomes more movable
2 increasing incidence of falls
c. ,eg cramps
1 due to pressure of gravid uterus! fatigue! muscle tenseness! low calcium and phosphorus
inta'e
G. 6ndocrine Changes
a. ddition of the placenta as an endocrine organ producing HCG! HP0! estrogen and
progesterone
b. Moderate enlargement of the thyroid due to increased basal metabolic rate
c. "ncreased si+e of the parathyroid to meet need of fetus for calcium
d. "ncreased si+e and activity of adrenal corte( increasing circulating cortisol! aldosterone!
and HH which a=ect CHO and fat metabolism causing hyperglycemia.
e. Gradual increase in insulin production but there is decreased sensitivity to insulin during
pregnancy
E. :eight Change
a. Birst Trimester %.& to 7 lbs normal weight gain
b. $nd and 7rd trimester %) - %% lbs per trimester is recommended
c. Total allowable weight gain during throughout pregnance is $) - $& lbs or %) - %$ 'gs.
d. Pattern of weight gain is more important than the amount of weight gained.
F. 6motional responses
a. %st trimester, some degree of reKection! disbelief! even depression because of its future
implication ;C give health teachings on body changes and allow for e(pression of
feelings
b. $nd trimester, fetus is perceived as a separate entity and fantasi+es appearance
c. 7rd trimester, best time to tal' about layette! and infant feeding method. To allay fear of
death let woman listen to the BHT.
VII. COMMON EMOTIONAL RESPONSES DURING PREGNANCY
*tress -decrease in responsibility ta'ing is the reaction to the stress of pregnancy not the pregnancy
itself a=ects decision ma'ing abilities
Couvade - syndrome - men e(periencing nausea.vomiting! bac'ache due to stress! an(iety and
empathy for partner
6motional labile - mood changes.swings occur fre>uently due to hormonal changes
Change in *e(ual Hesire - may increase or decrease needs correct interpretationR not as a loss of
interest in se(ual partner
VIII. LOCAL CHANGES DURING PREGNANCY
%. 3terus - wt increase to about %))) grams at full term due to increase in 2brous and elastic tissues
a. /ecomes ovoid in shape
b. *oftening of lower uterine segment, HegarMs sign seen at Gth wee'
c. Operculum - mucus plug to seal out bacteria
d. GoodellMs sign - cervi( becomes vascular and edematous giving it consistency of the
earlobe
$. ?agina - increased vascularity occurs
a. Chadwic'Ms sign - purplish discoloration of the vagina
b. 0eu'orrhea - increased amount of vaginal discharges due to increased activity of
estrogen and of the epithelial cells.
a. Must not be itchy! foul smelling! e(cessive! nor green.yellow in color.
b. Management, good hygiene
c. 3nder the in<uence of estrogen! vaginal epithelium 5 underlying tissues hypertrophic
5 enriched with glycogen
d. pH of vaginal secretions during pregnancy fall
Microorganisms that thrive in an al'aline environment,
a. Tr#",&'+) 4 causes tr#",&'+) $+2#'+%#)A$+2'#t#) r tr#",&'#+)#)
s.s, frothy! cream;colored! irritatingly itchy! foul smelling discharges! vulvar
edema
Management , Blagyl %) days p.o. or trichomonicidal cmpd suppositories
8e.g. Tricofuron! ?agisec! Hevegan9
Management,
%. treat male partner also with Blagyl
$. avoid alcohol to prevent *6
7. dar' brown urine e(pected
#. cidic vaginal douche 8% tbsp vinegar,% >t water or %& ml, %))) ml9
&. avoid intercourse to prevent reinfection
a. C+'!#!+ A%b#"+') : condition is called M'#%#+)#) r C+'!#!#+)#)
6 it thrives in an environment rich in CHO and those on steroid or antibiotic
therapy
7 seen as oral thrush in the N/ when transmitted during delivery
8 s.s, white! patchy! cheese;li'e particles that adhere to vaginal walls! foul
smelling discharges causing irritating itchiness
Management ,
1. Mycostatin.Nystatin p.o. or vaginal suppositories %))!))) 3 /"H ( %& days
2. Gentian violet swab to vagina
3. cidic vaginal douche
4. void intercourse
7. Ovaries
"nactive since ovulation does not ta'e place during pregnancy. Placenta produces Progesterone
and 6strogen during pregnancy
#. bdominal :all
1 *triae Gravidarum - due to rupture and atrophy of connective tissue layers on the growing
abdomen
2 0inea Nigra
3 3mbilicus is pushed out
4 Melasma or Chloasma - increased pigmentation due increased production of melanocytes by the
pitutitary
5 3nduly activated sweat glands
IB. SIGNS O0 PREGNANCY
". Pre2'+'"y
1 Prenatal care is important for prevention of infant and maternal morbidity and mortality
2 Care is a cooperative action based on clientMs understanding of treatment modalities
3 Huration of normal pregnancy $GG - $F) days of 7F - #$ wee's or D calendar months or %) lunar
months.
4 "nfant born I 7F wee's pre;term 5 #$ post term9
5 Hiagnosis, 3rine e(amination - tests presence of HCG 8present from #)th -%))th day! pea' G)
days9 conduct test G wee's after 0MP
$. Pre'+t+% V#)#t
History Ta'ing,
personal data obstetrical data
gravida para
TP0 past pregnancies
present pregnancy, cc 0MP
medical data, h( of diseases.illnesses
7. #anger !ignals of &regnancy
1. ?aginal bleeding 8any amount9
2. *welling of face or 2ngers
3. *evere! continuous headache
4. Himness or blurring of vision
5. Blashes of light or dots before eyes
6. Pain in the abdomen
7. Persistent vomiting
8. Chills and fever
9. *udden escape of <uids from the vagina
10. bsence of BHT after they have been initially heard on #th or &th month
#. A))e))&e't
a. Physical e(amination - review of systems
b. Pelvic e(amination 8as' client to void9
c. "6 - determine HegarMs! GoodellMs! Chadwic'Ms
d. /allotement - on &th month
e. Pap *mear
f. Pelvic measurements 8done after Gth month or $ w's before 6HC9
g. 0eopoldMs Manuever, to determine fetal presentation! position! attitude! est. si+e and
fetal parts
h. ?ital signs
i. /lood studies, C/C Hgb! Hct ! blood typing! serological tests
K. 3rinalysis, test for albumin! sugar 5 pyuria
&. I&prt+'t E)t#&+te)1
a. ge of Gestation,
N+2e%eC) Ru%e1 ;7 calendar months and SE days
6(. 0MPL May %&! $))G or &;%&;)G
0MP, & %&
Bormula, ; 7 S E
6HC, $ $$ or Bebruary $$! $))E
M"D'+%!C) Ru%e, Ht fundus.# 8OG w's9
%. Measure in cms the length from the symphysis to the level of fundus
$. 0unar months, Bundal Height 8cms9 ( $.E
7. :ee's of pregnancy, Bundal height 8cms9 ( F.E
6(. Bundal Height L %# cms
0unar Month, %#cms ( $ L $F . E L # months
:ee's Pregnant, %# cms ( F L %%$ . E L %G wee's OG
B+rt,%&e9C) Ru%e1 based on position of fundus in abdominal cavity
7
rd
month L above symphysis
&
th
month L umbilical level
D
th
month L below (iphoid process9
b. Betal 0ength,
1 HaaseMs 4ule, %st half of pregnancy - s>uare number of months
6(ample , $ months L $($ L # cm
$nd half of pregnancy - number of months multiplied by &
6(ample, E months ( & L 7& cm
c. Betal :eight,
1 TohnsonMs 4ule, Bundic Ht - n ( ' 8 'L%&&1 n L %% not engaged.%$ engaged9
6(ample for a not engaged fetus
Bundic Height given L 7& cms
n L %% 8standard for not engaged fetus9
'L %&& gms. 8D standard9
*olution, 7& cms - %% L $# ( %&& L7!E$) g
5. He+%t, Te+",#'2)
a. *mo'ing - lead to 0/: babies
b. Hrin'ing - can cause respiratory depression in the N/ and fetal withdrawal syndrome if
e(cessive1 alcohol has empty calories
c. Hrugs - may be teratogenic hence contraindicated unless prescribed by Hoctor
d. *e(ual activity - allowed in moderation but not during last G w's; high incidence of post
partum infection noted.
counseling is important on changes in desire and positions
contraindication, bleeding! ruptured /O:! incompetent cervi(!
deeply engaged presenting part
e. Prepared childbirth.Childbirth education
1 /ased on G+te C'tr% T,ery, pain is controlled in the spinal cord and there
is a gate that can be closed to ease pain felt.
2 "nformation and breathing techni>ues help minimi+e discomfort of labor
e(perience
3 Hiscomfort can be lessened if abdomen is rela(ed and allows uterus to rise freely
against it during contractions
2a7or 'pproaches to prepared childbirth
1 Teaching about anatomy! pregnancy! labor and delivery! rela(ation techni>ues!
breathing e(ercises! hygiene! diet and comfort measures
Grant;Hic' 4ead Method, Bear leads to tension and tension leads to pain
0ama+e Method, Psychoprophylactic method 1 based on *;4 conditioning1
concentration on breathing is practiced
f. "mmuni+ation, Tetanus To(ois 8TT9 L D./ &% IM for all pregnant women shall be
given in $ doses; # w's interval with $
nd
dose at least 7 w's
before delivery
L booster doses given during succeeding
pregnancies
regardless of interval.
L 7 booster doses is e>ual to lifetime immunity
g. Clinic ?isits for Pre:'+t+% ",e"6:up
2 Birst E lunar months - e$ery &'t,
3 On F
th
and D
th
lunar month - e$ery 9ee6
4 On %)
th
lunar month - e$ery 9ee6 u't#% %+br
B. LABOR AND DELIVERY
0. 8+E9:;E* 9F ,'9: 9<*E8
3terine stretch theory
O(ytocin theory
Progesterone Heprivation theory
Prostaglandin theory
=. F93: (* 9F ,'9:
a. Power ; the uterine contraction
b. Passenger - the fetus
c. Passageway - the maternal pelvis
d. Psyche - the mental and emotional aspect of the woman
a. &O$'R % 3terine Contractions,
a.%. Bre>uency - the beginning of one contraction to the beginning of the ne(t contraction
a.$. "nterval - pattern which increases in fre>uency and duration
a.7. Huration - the beginning of one contraction to the end of the same contraction
a.#. "ntensity - strength of contraction! measured through a monitor or through touch of a 2ngertip
on the fundus 8mild! moderate or strong9
b. &A!!'(G'R % Betus
b.%. Betal *'ull,
a. largest part of the fetus ; most fre>uent presenting part1 least compressible
/ones, sphenoid! ethmoid! temporal! frontal! occipital! parietal
*uture lines, sagittal. coronal! lamboidal
b.$. Bontanels ; membrane covered spaces at the Kunction of the main suture lines
anterior fontanel, larger! diamond shaped1 closes at %$ - %F months
posterior fontanel, smaller! triangular shaped! closes at $ - 7 months

b.7. Betal 0ie - relationship of the cephalocaudal a(is of the fetus to the cephalocaudal a(is of the
mother.
Measurements,
b.#. Betal ttitude - fetal position
Pelvis is divided into G areas, nterior! Posterior! Transverse 0eft! Transverse
4ight! Posterior 0eft! Posterior 4ight
Betal landmar's, Occiput 8O91 mentum 8M9! sacrum 8*9! and scapula 8*c9
b.&. Presentation -the part of the passenger that enters the pelvis is the presenting part
a. Cephalic - ?erte( 8occiput9 1 /row 8sinciput91 Bace 8mentum9
b. /reech - Complete 8sacrum9 1 Bran'1 Bootling
c. *houlder
b.G. Movement of Passenger upon birth or descent,
d. Hescent
e. Ble(ion
f. "nternal 4otation
g. 6(tension
h. 6(ternal rotation. restitution
c. &A!!AG'$A) - maternal pelvis
c.%. Hivisions
a. Balse Pelvis ;supports the growing uterus during pregnancy
;directs the fetus into the true pelvis near the end of gestation
b. True Pelvis, the bony canal through which the fetus will pass during delivery formed by the
pubis in front! the iliac and ischia on the sides and the sacrum and coccy( behind
c.$. *igni2cant Pelvic Measurements
a. 6(ternal - *uggestive only of pelvic si+e
C 6(ternal ConKugate. /audelaoc>ueMs Hiameter
; the distance between the anterior aspect of the symphysis pubis and the depression
below lumbar & 8verage, %F - $) cm9
b. "nternal - the actual diameters of the pelvic inlet and outlet
C Hiagonal ConKugate
; the distance between the sacral promontory and inferior.lower margin of the
symphysis pubis
; widest P diameter at outlet estimated on vaginal.pelvic e(am 8verage, %$.& cm9
CObstetrical ConKugate
; the distance from the inner border of the symphysis pubis to the sacral prominence
; most important pelvic measurement
; shortest P diameter of the inlet through which the head must pass
; %.& to $ cm or less than the diagonal conKugate
CTrue ConKugate.ConKugate ?era
; the distance between the anterior surface of the sacral promontory and superior margin
of the symphysis pubis
; diameter of the pelvic inlet 8%).& ;%% cm9
C/i;"schial. Tuberiischial Hiameter
; the distance between the ischial tuberosities
; narrowest diameter of the outlet
; transverse diameter of the outlet 8verage, %% cm9
D. &!)C*'; the emotions of the mother
Bactors that may increase a womanMs chance of depression,
1 History of depression or substance abuse
2 Bamily history of mental illness
3 0ittle support from family and friends
4 n(iety about the fetus
5 Problems with previous pregnancy or birth
6 Marital or 2nancial problems
7 Uoung age 8of mother
*igns and *ymptoms of Post;partum depression,
1 Beeling restless or irritable
2 Beeling sad! hopeless! and overwhelmed
3 Crying a lot
4 Having no energy or motivation
5 6ating too little or too much
6 *leeping too little or too much
7 Trouble focusing! remembering! or ma'ing decisions
8 Beeling worthless and guilty
9 0oss of interest or pleasure in activities
10 :ithdrawal from friends and family
11 Having headaches! chest pains! heart palpitations 8the heart beating fast and
feeling li'e it is s'ipping beats9! or hyperventilation 8fast and shallow breathing9
>.(:E,;2;<':?/(:95:92', *;)<* 9F ,'9:
a. 0ightening
b. "ncreased activity level; @nesting behaviorA
c. 0oss of weight 8 $;7 lbs9
d. /ra(ton Hic'Ms Contractions
e. Cervical Changes - e=acement
; GoodellMs sign - ripening of the cervi(
f. "ncrease in bac' discomfort
g. /loody *how ; pin'ish vaginal discharge
h. 4upture of Membranes- labor e(pect in $# hours
i. *udden burst of energy
K. Hiarrhea
'. 4egular Contractions ; phases, increment!acme!decrement
; characteristics, intensity! fre>uency! interval! duration
Balse 0abor Pains True 0abor Pains
o% 4emain irregular
o$ Con2ned to abdomen
o7 No increase in duration! fre>uency! intensity
o# Hisappears on ambulation
o& No cervical changes
oG /ecomes regular and predictable
oE 4adiates in girdle li'e fashion
oF "ncrease in duration! fre>uency! intensity
oD Continue regardless of activity
o%) 6=acement and dilatation occurs
o%% *igns of True labor
6=acement
Hilatation

1 3terine Changes- upper and lower segments1 physiologic retraction ring
2 /andlMs pathologic retraction ring; a danger sign of impending rupture of the uterus if
obstruction is not relieved
1. Nursing "nterventions of :oman in 0abor,
a. ssessment - history and physical assessment
a.%. Personal data
a.$. Obstetrical data
1 determine 6HC
2 obstetrical score
3 amount. character of show
4 status of the /O:
5 general physical e(amination
6 0eopoldMs Maneuver, presentation
7 "nternal e(amination, e=acement 1 dilatation1 station
b. Monitoring and 6valuating Progress of 0abor
b.%. /lood pressure
b.$. Betal Heart Tone
b.7. Observe for signs of fetal distress
12 bradycardia
13 fetal thrashing
14 meconium stained amniotic <uid in non;breech presentation
b.#. Monitor and inform patient of progress of labor
b.&. Monitor progress - fetal
a9 during labor chec' BH4
b9 manage fetal distress
&. nalgesia.anesthesia during childbirth
&.%. nalgesia - relieves pain and its perception
&.$. nesthesia - produces local or general loss of sensation 1
; usually regional anesthesia 8e.g. spinal9
o 4elieve uterine and perineal pain
o 3sually safe for the fetus 8potential for maternal hypotension9
o Types of nesthesia,
a. Paracervical bloc'
b. Peridural bloc', 6pidural.caudal
c. "ntradural, spinal.saddle bloc'
d. Pudendal bloc'
e. 0ocal anethesia
o 4egional nesthesia is mostly preferred because it does not enter maternal
circulation nor a=ect fetus
o Vylocaine is used 8NPO with "? infusion9
C allows to be awa'e and participate in process1
C can increase incidence of maternal hypotension and fetal
bradycardia
&.7. nalgesics,
&.7.% Narcotics 8Hemerol9
o produces sedation.rela(ation
o depresses N/Ms respiration
o given in active labor
o *pecial Considerations,
Hemerol is most commonly used
Has sedative and antispasmodic e=ect
Hose is usually $& -%)) mg depends on body weight
Not given early in labor due to possible e=ect on contractions
Not given too late 8% hr before delivery9 can cause respiratory
depression in the newborn
Given if cervical dilatation is G - F cms.
&.7.$. Narcotic ntagonist, Narcan1 Nalline
G. Nursing Care before administration of anesthesia.analgesia
%.%. ssess pain status
%.$. 6(plain the action of drugs
%.7. Chec' vital signs of mother and fetus
%.#. Observe safety measures
6valuate allergies
Provide siderails - have call bell ready
NPO 8anesthesia9
Chec' time last medication was given
%.&. Nursing Care after administration of anesthesia.analgesia
%.G. Monitor, vital signs - /P and BH4 8be alert for bradycardia9
%.E. 4ecord properly
%.F. Provide comfort measures
%.D. 4emember that the use of 0r"ep) is needed in delivery of patient under anesthesia due
to loss of coordination in bearing down during $nd stage
%.%). *ide e=ects,
a. postspinal headaches - place <at on bed for %$ hrs and increase <uid inta'e
b. common side e=ect is hypotension 8(ylocaine -vasodilator9,
<ursing ;ntervention,
turn to side
elevate legs
administer vasopressor and o(ygen as ordered
Betal bradycardia
Hecreased maternal respirations
8Observe for bulging of the perineum9
BI. STAGES O0 LABOR
1. St+2e) 3 L+br
St+2e C,+r+"ter#)t#")
0#r)t St+2e
; the stage of true labor until the
complete cervical dilatation

a. 0atent Phase
b. ctive Phase
c. Transitional
Phase
6(tent,
Primigravida - 7.7.;%D.E hrs
Multigravida - ).% ; %#.7 hrs
);# cms. cervical dilatation
"nterval, %&;$) mins interval
Huration, %);7) seconds
&;E cms. cervical dilatation
"nterval, 7;& mins
Huration, 7);G) seconds

F;%) cms cervical dilatation
"nterval, $;7 mins.
Huration, &);D) seconds
Se"'! St+2e
; begins with complete dilatation of the
cervi( until the birth of the newborn
Huration,
Primigravida - 7) mins. ; $ hrs.
Multi;gravida; $) mins - % hr.
Contractions; $;7 mins for &);D) secs
Mother is e(hausted and has urge to push
T,#r! St+2e
; from delivery of the newborn to the
delivery of the placenta
*till with mild contractions until the placenta
is e(pelled.
3sually! placenta is e(pelled within 7)
minutes.
0urt, St+2e
; the 2rst hour after complete delivery
until the woman becomes physically
stable
3terine cramping
4ubra with small clots
$. Principles of Postpartum Care
a. Promote healing and the process of involution
b. Provide emotional support
c. Prevent postpartum complications
d. 6stablish successful lactation
e. Promote responsible parenthood 8BP9
7. Nursing Care of the :oman in Birst 5 *econd *tage 0abor
a. Monitor discomfort.e(haustion.pain control - support client in choice of pain control
b. 4ela(ation techni>ues taught during pregnancy where breathing is taught as a rela(ed
response to contraction
c. 0ow bac' pain - massage of sacral area
d. 3se di=erent breathing techni>ues during the di=erent phases of labor
e. 6ncourage rest between contractions
f. Neep couple informed of progress
g. dminister analgesic , side e=ects;may prolong labor1 local. bloc'. general
#. Nursing Care of :oman in the 7
rd
*tage of 0abor
a. Principle Of :atchful :aiting
b. 3se /randt ndrews Maneuver
c. Note Time Of Helivery 8$) Minutes fter Helivery Of The /aby9
d. Chec' /p1 "nKects O(ytocin 8Methergin ).$ Mg.Ml Or *yntocinon %) 3.Ml "m9
e. "nspect Cotyledons Bor Completeness
f. Chec' 3terus Bor Contraction
g. Chec' Perineum Bor 0acerations ;Give perineal care1 apply perineal pads
h. Change gown
i. Place <at on bed
j. Neep warm - provide e(tra warm blan'et
k. Give initial nourishment - warm mil'! tea
l. llow to rest. sleep
&. Nursing Care of :oman in Bourth *tage
a. 0actation, promote lactation by encouraging early breastfeeding to stimulate mil'
production
PPP Those mothers who cannot breastfeed,
suppressing agents are given - estrogen; androgen preparations given 2rst hours
post partum to prevent mil' production. These drugs tend to increase uterine
bleeding and retard involution. 8e.g. diethylstilbestrol! Parlodel or deladumone9
b. 4ooming;in;concept
provides opportunity for developing positive family relationship
promotes maternal infant bonding
releases maternal careta'ing responses
c. ssess vital signs! fundus and <ow every %& minutes.
d. Hydration and elimination
e. May ambulate
Puerperium ; the G wee's period following delivery
"nvolution; time period for the return of the reproductive organs to return to its pre;
pregnant state
F. Categories of 0acerations
F.%. Birst degree - involves vaginal mucous membrane and perineal s'in
F.$. *econd degree - involves the perineal muscles! vaginal mucous membrane and
perineal s'in
F.7. Third degree - involves all in the $nd degree lacerations and the e(ternal sphincter of
the rectum
F.#. Bourth degree - involves all in 7rd degree lacerations and the mucus membrane of the
rectum
BII. PROMOTING HEALING AND INVOLUTION DURING POST:PARTUM
%. ?ascular Changes
; 4eabsorption of the 7);&)Q increase in cardiac volume within & - %) minutes after the third
stage of labor.
; :/C increases to $)!))) - 7)!))).mmW
; ctivation of the clotting factor
; ll blood values are bac' to prenatal levels by 7rd or #th wee'
$. 0ocation of the Bundus
; 3terine involution is measured by determining the level of the fundus in relation to the
umbilicus
; Nursing care,
ssess condition and level of the fundus
Position in prone or 'nee chest
1 Occurrence of afterpains - it is an indication of uterine contractions and are normal. 3sually
lasts up to 7 days after birth
Nursing Care,
6(plain to client cause of pain
Ho not apply heat
dminister analgesics as prescribed
7. Genital Changes. Hischarges
; Presence of 0ochia, uterine discharges consisting of blood! decidua! :/C and some bacteria
; Characteristics,
pattern should not reverse -
%;7 days - rubra ; ; ; bright red with no or minimal clots
#;D days - serosa; ; ; thinner! serous sanguinous blood
%); 7 to G w's pp - alba ; ; ; whitish discharge
same amount as menstrual <ow! decreased if with breastfeeding ! increased with activity
with <eshy odor1 never foul smelling
#. Perineal Pain
Nursing Care,
Place in *imMs position - lessens strain on the suture line
6(pose to dry heat or warm *it+ bath
pplication of topical analgesics or oral analgesics as ordered
Provide. encourage perineal care
&. *e(ual ctivity
1 se(ual stimulation may be decreased due to emotional factors and hormonal changes
2 it may be resumed if bleeding has stopped and episiorrhaphy has healed by the 7rd or
#th wee'
G. Menstruation
1 /reastfeeding in<uences return of the menstrual <ow.
2 /reastfeeding - menses return in 7 - # months1
o some do not menstruate throughout lactation period
o ovulation is also possible with lactational amenorrhea
3 Non;/reastfeeding Mothers - menstrual <ow return within F wee's
E. 3rinary Changes
o mar'ed diuresis occurs within %$ hours postpartum to eliminate e(cess tissue <uids
during pregnancy
o fre>uent urination in small amounts may be e(perienced by some
o others have diXculty of urination
Nursing Care,
6(plain cause of urinary changes
ssist to promote voiding utili+ing appropriate measures 8encouraging voiding! let
client listen to sound of <owing water! etc.9
F. Gastrointestinal Changes
; Change is more on the delay of bowel evacuation1 constipation
; Cause, decreased muscle tone
lac' of food inta'e
dehydration
fear of pain
;Nursing Care, encourage early ambulation
increase <uids
increase 2bers in the diet
D. ?ital *igns
o Temperature, may increase because of dehydration on the 2rst $# hours pp.
o C4 &) - E) beats.min 8bradycardia9 is common for G ; F days pp.
o 44 - no change is e(pected
o :eight L %) - %$ lbs is e(pected to be immediately lost. This corresponds to the weight of
the fetus! placenta! amniotic <uid and blood. Hiaphoresis will contribute to further weight
loss
%). Provision of 6motional *upport
Post;partum Psychological Phases
%. Ta'ing - in , Birst % - $ days1 mother focuses on herself and her e(perience
$. Ta'ing - hold, mother starts to assume her role
7. 0etting go
Postpartum /lues - overwhelming sadness that cannot be accounted for. Could be due to
hormonal changes! fatigue or feelings of inade>uacy.
Nursing Care, 6ncourage verbali+ation1 crying is therapeutic! e(plain that it is normal
%%. 6stablish *uccessful 0actation
Physiology of 0actation,
6strogen 5 progesterone levels stimulates PG to produce Prolactin acts on acinar cells to
produce foremil' stored in collecting tubules ;C infant suc'ing stimulates PPG to
produce o(ytocin causes contraction of smooth muscles of collecting tubules mil'
eKected forward 8mil' eKection re<e( or let down re<e( hindmil' is produced
"mplications of lactation,
1 /reast mil' will be produced postpartum
2 0actation do not occur during pregnancy due to levels of estrogen and progesterone
3 0actation suppressing agents are to be given immediately after placental delivery to be e=ective
4 Oral contraceptives decrease mil' supply and are contraindicated in lactating mothers
5 fterpains are felt more by breastfeeding mothers due to o(ytocin production1 have less lochia
and rapid involution
%$. dvantages of /reastfeeding
Mother, faster involution
less incidence of C
economical; time! e=ort! cost
"nfant, bonding with the mother
protection against common illness
less incidence of G" diseases
always available
%7. Health Teachings
a. Hygiene
:ash breasts daily
No soap1 No lcohol for cleaning
Handwashing
"nsert clean O* s>uares. absorbent cloth in brassiere for breast discharges
b. Beeding Techni>ues
c. Nutrition, 7))) calories daily1 DG grams protein
d. Contraindications,
Hrugs - oral contraceptives! atropine! anticoagulants! antimetabolites! cathartics!
tetracyclines.
Certain disease conditions - T/ because of close contact during feeding
8T/ germs are not transmitted thru breast mil'9
BIII. ASSOCIATED PROBLEMS
%. 6ngorgement
breast becomes full! tense and hot with throbbing pain
e(pected to occur on the 7rd post partum day accompanied by fever 8mil' fever9last for $#
)

due to increased lymphatic and venous circulation
Nursing care,
o encourage breastfeeding
o advise use of 2rm;supportive brassiere
o 8if not going to breastfeed - apply cold compress1 no massage1 no breast pump1 apply
breast binder9
$. *ore Nipples
Nursing care,
encourage to continue /B
e(pose nipples to air for %) - %& minutes after feeding
8alternative9 e(posure to $) watt bulb placed %$ - %F inches away promotes vasodilation
and therefore promote healing
do not use plastic liners
use nipple shield
7. Mastitis ; in<ammation of the breast
*igns 5 *ymptoms, pain! swelling! redness! lumps in the breasts! mil' becomes scanty
Nursing Care,
"ce compress
*upportive brassiere ! empty breast with pump
Hiscontinue /B in a=ected breast
pply warm dressing to increase drainage
dminister antibiotics as prescribed
PPP Postpartum Chec';up, Gth wee' postpartum to assess involution
BIII. HIGH RISE PREGNANCY CONDITIONS
1. "nfections
2. /leeding . Hemorrhage. P"H
3. Hiabetes Mellitus
4. Heart Hisease
5. Multiple Pregnancy
6. /lood "ncompability
7. Hystocia
8. "nduced 0abor
9. "nstrumental Heliveries
1. IN0ECTIONS
%.%. *!philis
Cause, Treponema pallidum ; a spirochete transmitted thru se(ual intercourse
Treatment, $.# - #.F million units of Penicillin 8or 7) - #) gms 6rythrocin9 ( %) days
readily cross placenta thus prevent congenital syphilis
3ntreated, Cause mid;trimester abortion
Cause CN* lesions
Can cause death
%.$. 89:-+ test series
T O(oplasmosis 8proto+oa9 avoid eating uncoo'ed meat and handling cat litter
bo(
O thers, *yphilis! ?aricella. *hingles
Hepatitis /1 Hepatitis 1 "H*
4( - Yoster "mmune Globulin !Penicillin
R 3bella 6=ect, if contracted early! slows down cell division
during organogenesis causing congenital
defects N/ can carry and transmit the virus for about
%$ - $# months after birth
C Utomegalovirus 8CM?9 8HN virus9
H erpes type $
Group of maternal systemic infections that can cross the placenta or by ascending infection
8after rupture of membranes9 to the fetus.
"nfection early in pregnancy may produce fetal deformities! whereas late infections may result in
active systemic disease and.or CN* involvement causing severe neurological impairment or
death of newborn
*ources. Cause,
%. 6ndogenous.primary sources ; normal bacterial <ora
$. 6(ogenous sources ; hospital personnel! e(cessive obstetric manipulations
brea's in aseptic techni>ues! coitus late in pregnancy
premature rupture of membranes

General symptoms, malaise! anore(ia! fever! chills and headache
Management,
Complete /edrest
Proper Nutrition
"ncreased Bluid "nta'e
nalgesics
ntipyretics and antibiotics as ordered
%.7. ;nfection of the perineum
*igns 5 *ymptoms, pain! heat! feeling of pressure!
in<ammation of suture line with % -$ stitches sloughed o=
temperature elevation
Management, drain area 5 resuturing 1 sit+ bath 5 warm compress
%.#. Endometritis
; n infection.in<ammation of the lining of the uterus
*igns 5 *ymptoms, bdominal tenderness 3terus not contracted and painful to touch
Har' brown Boul smelling lochia
Management, O(ytocin administration
BowlerMs position to drain out lochia
Prevent pooling of discharges
%.&. 8hrombophlebitis
;infection of the lining of a blood vessel with formation of clots! usual an e(tension of
endometritis
*igns 5 *ymptoms,
o% Pain
o$ *ti=ness and redness in the a=ected part of the leg
o7 0eg begins to swell below the lesion because venous circulation has
been bloc'ed
o# *'in is stretched to a point of shiny whiteness! called mil' leg of
Phlegmasia alba dolens
o& Positive HomanMs sign, calf pain on dorsi;<e(ing the foot
*peci2c Management,
1 bed rest with a=ected leg elevated
2 anticoagulants 8e.g. Hicumarol or Heparin9 to prevent formation or e(tension
of a thrombus
*ide e=ect of nticoagulant, hematuria! increased lochia
Considerations,
1 discontinue breastfeeding
2 monitor prothrombin time
3 have Protamine *ulfate at bedside to counter act severe bleeding
4 analgesics are given but not *P"4"N because it prevents prothrombin formation
which may lead to hemorrhage
2. HEMMORRHAGEA BLEEDING
He2nition, blood loss more than &)) cc. 8 normal blood loss $&); 7&) cc9
PPP 0eading cause of maternal mortality associated with childbearing
$.%. 6arly Post;partum hemorrhage - 2rst $# hrs after delivery

$.$. 0ate Postpartum Hemorrhage
6arly Post;partum hemorrhage 0ate Postpartum Hemorrhage
Cause
3terine tony - uterus is not well
contracted! rela(ed or boggy
8most fre>uent cause9

0acerations
Hypo2brinogenemia
Clotting defect
4etained Placental Bragments
Management
/leeding in Pregnancy
blood transfusion H 5 C 8Hilatation and Curettage
Predisposing factor,
Overdistension of the uterus 8multiparity! large babies! polyhydramnios!
multiple pregnancies9
Cesarean *ection
Placental accidents 8previa or abruptio9
Prolonged and diXcult labor
Management, Massage -2rst nursing action
"ce compress
O(ytocin administration
6mpty bladder
/imanual compression to e(plore retained placental fragments
Hysterectomy 8last alternative9
$.7. +ematoma
; Hue to inKury to blood vessels in the perineum during delivery
"ncidence, Commnon in precipitate delivery and those with perineal varicosities
Treatment,
1 "ce Compress in 2rst $# hours
2 Oral nalgesics as prescribed
3 *ite is incised and bleeding vessel ligated
$.#. (regnanc! ;nduced +!pertension #(;+%
; vascular disease of un'nown cause
; Occurs anytime after the $#th w' of gestation up to $ w's PP
; Hevelops during pregnancy and resolves during postpartum period
Predisposing Bactors,
a. large fetus
b. Older than 7&! younger than %E
c. primigravida
d. multiple pregnancy or H mole
e. poor nutrition
f. H( of HM! renal and vascular disease
g. Morbid obesity or weight less than %)) lb
h. Bamily history
Hiagnosis,
:oll over test , ssess the probability of developing to(emia when done between the
$Fth and 7$nd wee' of pregnancy.
Procedure of 4oll;over test,
1 Patient in lateral recumbent position for %& minutes until /P *table
2 4olls over to supine position
3 /P ta'en at % minute and & minutes after roll over
4 "nterpretation, "f diastolic pressure increases $) mmHg or more! patient is
prone to To(emia
"ypes of &regnancy +nduced *ypertension ,&+*-,
a. Transient hypertension ; without proteinuria or edema
b. Pre;eclampsia! mild
o /P of %#).D) mmHg or increase of 7).%&mmHg
o $S to 7S proteinuria
o begins past $)th wee'
o slight generali+ed edema may be present! weight gain of %; & lbs.w'
c. Pre;eclampsia! severe
o /P of %&);%G).%));%%) mmHg
o #S proteinuria 8& gm.0 or more in $# hrs
o Headache and epigastric pain8aura to convulsions9
o Oliguria of #)) ml or less in $# hrs. 8normal 3O.day %&)) ml9
o Cerebral or visual disturbances
d. 6clampsia ; Obstetrical 6mergency
o HPN
o Proteinuria
o Convulsions
o Coma
"mmediate "ntervention for 6clampsia,
a. Maintain "? line with large;bore needle
b. Monitor <uid balance
c. Minimi+e stimuli
d. Have airway and o(ygen available
e. Give medications as ordered 8e.g Magnesium sulfate! presoline!
?alium9
f. Prepare for possible delivery of fetus
g. Monitor fetal status
h. Type and cross match for blood
i. Postpartum; monitor vital signs and watch for sei+ure

Management for 6clampsia,
a. Higitalis 8with Heart Bailure9
"ncrease the force of contraction of the heart decrease heart rate
Nursing Considerations, Chec' C4 prior to administration 8 do not give if
C4 IG).min9
b. Potassium supplements - prevent arrhythmias
c. /arbiturates - sedation by CN* depression
d. nalgesics1 antihypertensives! antibiotics! anticonvulsants! sedatives
e. Magnesium *ulfate - drug of choice
ction, CN* depressant 1 ?asodilator
ntidote, Calcium Gluconate; given %)Q "? to maintain Cardiac and
vascular tone
6arliest sign of Mg*O# to(icity disappearance of 'nee Ker'.patellar
re<e(
Method of delivery - preferably ?aginal but if not possible C*
Prognosis, the danger of convulsions is present until #F hrs
postpartum
f. Cathartic - cause shift of <uid from the e(tra cellular spaces into the intestines
from where the <uid can be e(creted
Hosage,
%) gms initially -either by slow "? push over & - %) minutes or
deep "M!
& gms.buttoc'! then an "? drip of % gm per hour 8% gm.%)) ml H%):9!
Chec' 2rst the =. before administration,
1 Heep tendon re<e(es are present
2 4espiratory rate L %$ . min
3 3O L at least %)) ml . G hrs.
Nursing "ntervention,
a. dvised bedrest! left lateral
b. b. 6ncourage a well;balanced diet
c. :eigh daily! 'eep daily log
d. d. 6ducation on self - assessment
e. Hiversion
f. Bamily support
e. (ost&deliver! (;+
o with Hisseminated "ntravascular Coagulation - anticoagulant therapy
o Monitor blood pressure for #F hours
Hiagnosis, :oll over test , ssess the probability of developing to(emia when done between the
$Fth and 7$nd wee' of pregnancy.
Procedure on 4oll;over test,
5 Patient in lateral recumbent position for %& minutes until /P *table
6 4olls over to supine position
7 /P ta'en at % minute and & minutes after roll over
8 "nterpretation, "f diastolic pressure increases $) mmHg or more! patient is
prone to To(emia
Management,
a. Higitalis 8with Heart Bailure9
"ncrease the force of contraction of the heart decrease heart rate
Nursing Considerations, Chec' C4 prior to administration 8 do not give if C4
IG).min9
b. Potassium supplements - prevent arrhythmias
c. /arbiturates - sedation by CN* depression
d. nalgesics1 antihypertensives! antibiotics! anticonvulsants! sedatives
e. Magnesium *ulfate - drug of choice
ction, CN* depressant 1 ?asodilator
ntidote, Calcium Gluconate; given %)Q "? to maintain Cardiac and vascular
tone
6arliest sign of Mg*O# to(icity disappearance of 'nee Ker'.patellar re<e(
Method of delivery - preferably ?aginal but if not possible C*
Prognosis, the danger of convulsions is present until #F hrs postpartum
f. Cathartic - cause shift of <uid from the e(tracellular spaces into the intestines from
where the <uid can be e(creted
Hosage, %) gms initially -either by slow "? push over & - %) minutes or deep "M!
& gms.buttoc'! then an "? drip of % gm per hour 8% gm.%)) ml H%):9!
May administer if ,
4 Heep tendon re<e(es are present
5 4espiratory rate L %$ . min
6 3O L at least %)) ml . G hrs.
-. DIABETES MELLITUS
a. Chronic hereditary disease characteri+ed by mar'ed hyperglycemia
b. Hue to lac' or absence of insulin abnormalities in CHO! fat and protein metabolism
c. 6=ects of pregnancy - may develop abnormalities in glucose tolerance decreased renal
threshold for sugar due to increased estrogen! inc. production of adenocorticoids! nterior
Pituitary hormones! and thyro(in which a=ect CHO concentration in blood 8hyperglycemia9
d. 4ate of insulin secretion is increased but sensitivity of the pregnant body to insulin is
decreased
Pregnancy 4is's,
1 To(emia
2 "nfection
3 Hemorrhage
4 Polyhydramnios
5 *pontaneous abortion - because of vascular complications which a=ect placental circulation
6 cidosis - because of nausea and vomiting
7 Hystocia - due to large baby
Hiagnosis , Glucose Tolerance Test 8GTT9
Procedure for GTT,
NPO after midnight
$ ml of &)Q glucose . 7 'g of pre;pregnant body weight given "? 8oral glucose not advisable
due to decreased gastric motility and delayed absorption of sugar
during pregnancy9
"nterpretation of 4esults,
a. "f less than %)) mgQ L normal
b. "f %)) - %$) mgQ possible GHM
c. "f more than %$) mgQ ; overt gestational diabetes
Management,
a. Hiet ; highly individuali+ed; ade>uate glucose inta'e 8%!F)) -$$)) calories9 to prevent
intrauterine growth retardation
b. "nsulin re>uirements - individuali+ed1 increased during $nd and 7rd trimester because
of more pronounced e=ect of hormones
c. Method of Helivery - Cesarian *ection
d. Postpartum Period - more diXcult to control /lood Glucose because of hormonal changes
6=ect on "nfant,
a. Typically longer and weighs more due to, e(cessive supply of glucose from the mother
b. "ncreased production of growth hormone from maternal pituitary gland
c. "ncreased secretion of insulin from the fetal pancreas
d. "ncreased action of adrenocortical hormone that favor the passage of glucose from mother to
fetus congenital anomalies are often seen
e. Cushingoid appearance 8pu=y! but limp and lethargic9
f. /orn premature more often - 4H* common
g. Greater weight loss because of loss of e(tra <uid
h. Prone to hypoglycemia 8/G I7) mgQ9
*igns and symptoms of Hiabetic /abies. Hypoglemic "nfant,
a. *hrill! high pitched cry
b. 0istlessness.Kitteriness.tremors
c. 0ethargy.poor suc'
d. pnea.cyanosis
e. Hypotonia1 hypothermia

PPPConse>uence of hypoglycemia, untreated hypos brain damage and even death
PPPManagement, feed with glucose water earlier than usual! or administer "? of glucose
.. HEART DISEASE
Classi2cation,
Class " ; no physical limitation
Class "" ; slight limitation of physical activity
; Ordinary activity causes fatigue! palpitation! dyspnea! or angina
Class """ ; moderate to mar'ed limitation of physical activity1 less than ordinary activity causes
fatigue
Class "? ;unable to carry on any activity without e(periencing discomfort
Prognosis, Classes " 5 "" - normal pregnancy 5 delivery
Classes """ 5 "? - poor candidates
*igns 5 *ymptoms,
Heart murmur due to increased total cardiac volume
-ardiac output decreased nutritional and o"!gen re4uirements not met
;ncomplete empt!ing of the left side of the heart (ulmonar! edema and +(<
#moist cough in )ravidocardiacs danger sign%
Congestion of liver and other organs due to inade>uate venous return increased venous pressure
<uid escapes through the walls of engorged capillaries and cause edema and ascites CHB is a
high probability due to increased CO during pregnancy dyspnea! e(haustion!
edema! pulse irregularities! chest pain on e(ertion and cyanosis of nailbeds are obvious
Management, 8depends on cardiac functional capacity9
a. /ed rest - especially after 7)th wee' of gestation
b. Hiet - gain enough 8consider e=ect on cardiac wor'load9
c. Medications, Higitalis! "ron preparations
d. void lithotomy position to avoid increase in venous return! place in semi;sitting
position
e. Not allowed to bear down1 /irth is via low forceps or Cesarean section
f. nesthetic choice - caudal anesthesia
g. 6rgotrate and other o(yto(ics! scopolamine! diethylstilbestrol and oral contraceptives -
h. contraindicated can cause <uid retention and promote thromboembolism
i. Most critical period, immediate postpartum period when 7) - &)Q increased blood volume
j. is reabsorbed bac' in & - %) minutes and the wea' heart needs to adKust
/. MULTIPLE PREGNANCY
4is's, "ncreased /lood 0oss
*mall for Gestational ge "nfants
Premature /irth
Hystocia
Management,
a. Monitor BHT! ?*! weight
b. Cesarean *ection
c. Health Teaching on importance of regular pre;natal chec';up visits
d. 6ducate regarding proper nutrition and e(ercise
=. BLOOD INCOMPATIBILITY
; n antigen;antibody reaction which causes e(cessive destruction of fetal red blood cells
Mt,er 0etu)
4h; negative 4h Positive 8Bather is homo+ygous or
hetero+ygous 4h positive9
/loodType O 6ither Type or / 8Brom father9
>. DYSTOCIA ; broad term for abnormal or diXcult labor and delivery
3terine "nertia - sluggishness of contractions
Cause, "nappropriate use of analgesics
Pelvic bone contraction
Poor fetal position
Overdistention - due to multiparity! multiple pregnancy! polyhydrmanios or e(cessively
large baby
Management, *timulation of labor by o(ytocin administration or amniotomy
@.0. (recipitate 5eliver!
; labor and delivery that is completed in I 7 hours due to multiparity or following
o(ytocin administration or amniotomy
6=ects, 6(tensive lacerations
bruptio placenta
Hemorrhage due to sudden
4elease of pressure shoc'
@.=. (rolonged ,abor & 3sually occurs in primi gravida
; 0abor lasting more than %F hrs and in multigravidas! more than %$ hours
6=ects, Maternal e(haustion
3terine atony
Caput succedaneum
@.>. 3terine ;nversion ; fundus is forced through the cervi( so that the uterus is turned inside
out
; "nsertion of placenta at the fundus! so that as fetus is rapidly
delivered! fundus is pulled down
; *trong fundal push! attempts to deliver the placenta before signs of separation
;Management, Hysterectomy
F. INDUCED LABOR
; *tages of labor and birth occurs due to chemical or mechanical means which is usually performed to
save the mothe or fetusr from complications which may cause death
"ndications,
Maternal - to(emia
Placental accidents
Premature 4upture Of Membrane
Betal, HM - terminated at about 7E w's OG if indicated
/lood incompatibility
6(cessive si+e
Postmaturity
Prere>uisites to "nduce 0abor ,
No Cephalo; Pelvic Hislocation
Betus is already viable C7$ wee's OG
*ingle fetus in longitudinal lie and is engaged
4ipe cervi( - fully or partially e=aced1 Cervical Hilatation at least %L$ cm
Procedure for "nduced labor,
%. O(ytocin dministration1 %) "3 of Pitocin in %))) ml of H&: at a slow rate of F gtts.min given
initially no fetal distress in 7) minutes rate %G ;$) gts.min
$. mniotomy - done with Cervical Hilatation L # cm 1 Chec' BH4 and >uality of amniotic <uid
Nursing Considerations,
Monitor uterine contractions potential for rupture
Monitor <ow rate regularly
Turn o= "? with any abnormality in BH4 or contractions
:atch out for complications, HPN! ntidiuresis
Prostaglandin administration, 4oute, oral or "? 8never "M causes irritation91 e=ect is
slower than o(ytocin
@. INSTRUMENTAL DELIVERIES
a. Forceps 5eliver!
; 3se of metal instruments to e(tract the fetus from the birth canal! when at S7 . S# and sagittal
suture line is in an P position in relation to the outlet 8e.g. *impson! 6lliot! Piper for breech
presentation9
Purposes,
shorten second stage of labor because of fetal distress1 maternal e(haustion1
maternal disease - cardiac! pulmonary complication
ine=ective pushing due to anesthesia
prevent e(cessive pounding of fetal head against perineum 8low forceps for prematures9
poor uterine contraction or rigid perineum
Prere>uisites,
Pelvis ade>uate! no disproportion
Betal head is deeply engaged
Cervi( is completely dilated and e=aced
Membranes have ruptured
?ertical presentation has been established
The rectum and bladder are empty
nesthesia is given for suXcient perineal
4ela(ation and to prevent pain
Types, 0ow or Mid Borceps Helivery
Complications,
Borceps mar's - noticeable only for $# - #F hrs
/ladder or rectal inKury
Bacial paralysis
Ptosis
*ei+ures
6pilepsy
Cerebral Palsy
a. -esarean *ection - birth through a surgical incision on the abdomen
"ndications,
o Cephalo;pelvic disproportion 8CPH9
o *evere To(emia
o Placental ccidents
o Betal Histress
o Previous classic C* - done prior to onset of labor pains1 scheduled birth
Types,

%. ,ow *egment - the method of choice.
"ncision is made in the lower uterine segment! which is the thinnest and most passive
Part during active labor.
dvantages,
Minimal blood loss
"ncision is easier to repair
0ower incidence of post partum infection
No possibility of uterine rupture
$. ,ower vertical incision - recommended in,
/ladder or lower uterine segment
dhesions from Previous operations
nterior Placenta Previa
Transverse lie
Preoperative Care
a. The patient is both a surgical and an O/ patient
b. Chec' vital signs! uterine contractions! and BH4
c. Physical e(amination1 routine laboratory tests1 blood typing and cross matching
d. bdomen is shaved from the level of the (iphoid process below the nipple line!
e(tending out to the <an's on both sides up to the upper thirds of the thighs
e. 4etention catheter is inserted to constant drainage to 'eep the bladder away from
the operative site
f. Preoperative medication is usually only atropine sulfate.
No narcotics are given causes respiratory depression in the N/
Postoperative Care
a. Heep breathing! coughing e(ercises! turning from side to side
b. mbulate after %$ hours
c. Monitor vital signs
d. :atch for signs of hemorrhage - inspect lochia1 feel fundus 8if boggy! massage
with proper abdominal splinting and give analgesics as ordered9
e. /reastfeeding should be started $# hrs after delivery
f. Most common complication, Pelvic thrombosis
1D. OTHER RISE 0ACTORS1
%).%. 'ge:
; Maternal and infant mortality rates tend to be high in age below %& and older
than #) years
dolescent pregnancy dvanced age
Most common problems,
To(emia
precipitating factor in,
Placental accidents
"ron;de2ciency anemia To(emia
3terine atony or inertia
?aricosities1 hemorrhoids
0ow birth weight babies
Chromosomal bnormalities li'e HownMs Chromosomal bnormalities li'e HownMs
*yndrome . Trisomy $% *yndrome . Trisomy $% 8associated with
menopause9
%).$. (arit! - 2rst pregnancy is the period of high ris'
Multiparity G& and above and age is over #)
%).7. irth ;nterval - 7 months from previous delivery or more than & years
%).#. :eight
Pre;pregnant weight I E) lbs or C %F) lbs
:eight gain I %) lbs 0/: babies
:eight gain C 7) lbs L sign of to(emia1 HM1 H;mole1 polyhydramnios1 multiple
pregnancy
%).&. Height
*hort stature I # feet! %) inches L contracted pelvis or CPH
BIV. MATERNAL COMPLICATIONS
%. *pontaneous bortion
Termination of pregnancy spontaneously at any time before the fetus has attained viability
ssessment,
%. Persistent uterine bleeding and crampli'e pain
$. 0aboratory 2nding - negatively or wea'ly positive urine pregnancy test
7. Obtain history! including last menstrual period
$. 6ctopic Pregnancy
; ny gestation outside the uterine cavity
Causes of 6ctopic Pregnancy,
a. Pregnancy "nduce Hypertension
b. Previous tubal surgery
c. Congenital anomalies of the fallopian tubes
*igns 5 *ymptoms,
1 *evere! sharp! 'nife;li'e stabbing pain
2 4igid abdomen
3 Positive CullenMs sign 8bluish umbilicus9
4 6(cruciating pain on "6
5 *igns of shoc'
Management, 4uptured 6ctopic Pregnancy is an emergency re>uiring immediate intervention
*alpingostomy - if Ballopian tube can still be replaced and preserved!pregnancy is terminated
*aphingectomy - removal of BT and /T
Nursing "nterventions,
1 Help woman to combat shoc'
2 6levate foot of the bed
3 Maintain body heat
4 Prepare for surgery
5 Monitor for shoc' preoperatively and postoperatively
6 Provide emotional support and e(pression of grief
7 dminister 4hogam to 4h negative women
8 Hischarge teaching
7. Hydatidiform Mole 8H;Mole9
;Hegenerative anomaly of chorionic villi
*igns & *!mptoms:
%. 6levated hCG levelsmar'ed nausea 5 vomiting
$. 3terine si+e greater than e(pected for dates
7. No BH4
#. Minimal dar' red.brown vaginal bleeding with passage of grapeli'e clusters
&. No fetus by ultrasound
G. "ncreased nausea and vomiting and associated with P"H
2anagement:
%. Curettage to completely remove all molar tissue that can become malignant
$. Pregnancy is discouraged for % year
7. hCG levels are monitored for % year 8if continue to be elevated! may re>uire
hysterectomy and chemotherapy9
#. Contraception discussed1 "3H not used
#. "ncompetent Cervical Os
One that dilates prematurely
Chief cause of habitual abortion 8 7 or more9
Causes,
1 Congenital Hevelopmental Bactors
2 6ndocrine factors
3 Trauma to the cervi(
*igns 5 *ypmtoms,
1 Presence of show and uterine contractions
2 4upture of membranes! Painless cervical dilatation
&. "ncompetent Cervi(
G. Placenta Previa - the placenta is the presenting part
%. Birst and second trimester spotting
$. Third trimester bleeding that is sudden! profuse! painless
7. 3ltrasonography - classi2ed by degree of obstruction
Management,
1 Hospitali+ation! initially
2 /edrest side;lying or Trendelenberg position for at least E$ hrs.
3 3ltrasound to locate placenta
4 No vaginal! rectal e(am unless delivery would not be a problem 8if necessary must be
done in O4 under sterile conditions9
5 mniocentesis for lung maturity1 monitor for changes in bleeding and fetal status
6 Haily Hgb and Hct
7 Two units of crossmatched blood available
8 Monitor amount of blood loss
9 *end home if bleeding ceases and pregnancy is maintained
10 0imit activity
11 No douching! enemas! coitus
12 Monitor fetal movement
13 N*T at least every % - $ wee's
14 Monitor complications
15 Helivery by cesarean if evidence of fetal maturity! e(cessive bleeding! active labor!
other complications
E. bruptio Placenta
*igns 5 *ymptoms,
%. Painful vaginal bleeding
$. bdomen 8uterus9 is tender! painful! tense 8couvelaire uterus9
7. Possible fetal distress
#. Contractions
8Occurrence increased with maternal HPN and cocaine abuse1 sudden release of amniotic <uid1
short cord1 advanced age1 multiparity1 direct trauma1 hypo2broginemia9
Management,
a. Monitor maternal and fetal progress
b. /lood loss seen may not match symptom
c. Could have rapid fetal distress
d. Prepare for immediate delivery
e. Monitor for post partal complications
Predisposing Bactors,
b. Hisseminated intravascular coagulation
c. Pulmonary emboli
d. "nfection
e. 4enal failure
f. Transfusion hepatitis
Nursing "ntervention,
/edrest
?ital signs! BHT
Monitor inta'e and output
*ei+ure precautions
Medications 8Magnesium sulfate! presoline! ?alium9
F. 3terine 4upture ;occurs when the uterus undergoes more straining than it is capable of sustaining

Cause, *car from previous C*
3nwise use of o(ytocins
Overdistention
Baulty presentation
Prolonged labor
*igns 5 *ypmtoms,
*udden severe pain
Hemorrhage and clinical signs of shoc'
Change in abdominal contour 8two swelling on the abdomen due to retracted uterus and
the e(trauterine fetus9
Management, Hysterectomy
D. mniotic Bluid 6mbolism - 8Obstetric 6mergency9
- occurs when amniotic <uid is forced into an open maternal uterine <ood sinus through some
defect in the membranes or after partial premature separation of the placenta. *olid particles in
the amniotic <uid enter maternal circulation and reach the lungs as emboli
*igns and symptoms, Hramatic
*udden inability to breathe! sits up! grasps chest and sharp chest pain
Turns pale then bluish gray color
Heath may occur in a few minutes
Management,
6mergency measures to maintain life, "?! o(ygen! CP4
Provide intensive care in the "C3
Neep family informed
Provide emotional support
BVI. PREMATURE LABOR AND DELIVERY
; 3terine contractions occur before 7Fth wee' of gestation
Cause,
a. Pre;eclampsia
b. Placenta Previa
c. ge, dolescent or #) yrs old above primigravids
Management,
o "f no bleeding1 no CH! Good BHT! medication is given
6thyl alcohol 86thanol9 "? - bloc's release of O(ytocin
?asodilan "? - vasodilator
4itodrine - muscle rela(ant per orem
/ricanyl - bronchodilator
o "f premature delivery is evident pain meds are 'ept to a minimum to prevent respiratory
depression

o *teroids 8glucocrticoids9 for maturation of fetal lung surfactant production
o nesthesia preferred - caudal! spinal or in2ltration - do not a=ect the infant

o 4espiration forceps may be applied gently
o Cord is cut immediately - prevents transfer of e(tra amounts of blood because prematures
have diXculty e(creting large amounts of bilirubin that will come the e(tra blood.