OBSTETRIC NURSING NORMAL

Female Reproductive System pituitary gland-- Release 2 hormones (FSH-Follicle

stimulating hormone-- increase production of follicular
-Ovaries/Ovary 1st day of next menses: Aug 4-- From the first day up to
fluid in the graafian folicler-- rupture of GF= Ovulation--
the last day
-Responsible for producing progesterone and increase estrogen level-(*Estrogen - Hormone of
estrogen in non pregnant women Ovulation)- thicken the endometrium-- to prepare for When will be the day of ovulation-- (32-14= 18-- 18th
pregnancy and prevent abortion)--(LH- Lukinizing day of the cycle day of ovulation) July 20
-Releases the ovum during ovulation Hormone-- formation of corpus lukum-- inc level of
progesterone that will maintain the thickness of the Fertility Period- 3 to 4 days before and after ovulation
-Graafian folicler-location ng ovum and and follicular
endometrium to prevent possible
fluid-- rupture= ovulation-- pag naubos = menopause
abortion)(*Progesterone-- Hormone of pregnancy)-- No
-Fallopian Tube fertilization-- ovum will atrophy-- C.L- will remain for 10 30 day cycle- Regular
days, pag may fertilization=pregnancy -- CL-- Will remain
- Ampulla/Third distal portion- site of fertilization for 16 weeks-- then placenta will be formed-- to maintain LMP- July 12-15

-Uterus pregnancy 1st day of the next menses-- Aug 11

-Endometrium- Inner lining of the uterus, Site of -LH- Rippening of the Graafian Follicle Date of Ovulation- 30-14= 16-- July 27
implantation
Fertility period-- 23-21 July
PHASES OF THE MESTRUAL CYCLE Safest Day - During menses-- before and after fertility
1st Phase: Follicular Phase; Estrogenic Phase;
Female Reproductive cycle: period
Proliferative Phase-- End during Ovulation-- determine
Onset of Menarche: Average 11-13 y/o , Normal- the length of mens *14 days before magkamens ulit
9-17y/o 2nd Phase: Luteal; Progestational;Secretory Phase=
Interval of Menses: Regular q28 days, can vary from Pregnancy stop the cycle OVULATION -14 days before the next
one women to another women 3rd Phase: Ischemic phase: Dec Progesterone and menstruation bleeding
Duration of Bleeding: 2-9 days Estrogen(No pregnancy) Most Fertile time: 3-4 days before and after ovulation
Amount: 30-80mL- 1/3 of a cup- all throughout the 4th Phase: Menstrual Bleeding- shreading of the
duration endometrium due to dec level of pro and estrogen due to Signs and Symptoms of Ovulation:
Odor: Smell like Marigold no pregnancy-- 1st day ng mens - Increased body temperature-- due to inc level of
pregesterone-- Day of ovulation-- dec of temp 24
deg-- after 24 hrs to 3 full days inc to .07-.08 deg cel
CALENDAR METHOD OF CONTRACEPTION: - Mittelschmerz- Unilateral(alternate) lower abdominal
PHYSIOLOGY OF MENSES 32 Days Cycle discomfort(Peritoneal Irritation-- due to rupture of
graafian follicler)
Decrease level of Estrogen--Stimulate LMP- July 3- July 7 - (+) Spinbarkeit-- Elasticity of cervical mucus
hypothalamus(Master gland)-- Send signal in the anterior
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- (+) Ferning/Ferm Test- Palm leaf patter under the Umbilical Cord- 21 inches/55 cm ⚫ 20 weeks- Quickening for primigravidad women
microscope 2 arteries ⚫ -Age of viability
- Cervical Mucus- Fertile: Clear, thin, slippery, watery 1 vein ⚫ 24 weeks- Transfer of antibodies
“egg white”-- what causing the characteristics of ⚫ -Only antibody that could pass through the placenta
cervical mucus is the estrogen Amniotic Fluid IgG
- -Protection for temp and pressure changes ⚫ 28 weeks- Eyes open
-To aid in mascular development ⚫ 32 weeks- Reflexes developed
- Enusre adequate oxygenation- Prevent cord ⚫ -Moro Reflex(In response to movement)
STAGES OF FETAL DEVELOPMENT compression ⚫ -Startle Reflex(In response to sound)
OVUM-Ferilization after 24hrs - One of the main component- Fetal Urine ⚫ 36 weeks- L/S ration 2:1(indicate fetal lung
maturity)
ZYGOTE-- Blastocyst-- Impantation after 1 week of Normal Amount: 800-1200mL ⚫ Leathin/Sphingomyelin(Lung surfactant- para
fertilization-- Endometrium will be called decidua Oligohydramnios: Less than 800 makainflate and deflate yung lungs)
-Decidua Basalis-, base In contact with the blood - Caused by fetal renal problem/ Renal ⚫ 37th- at term
vessels Agenesis (Hindi maganda yung development ng ⚫ 40 weeks - Fetal hemoglobin is converted to Adult
-Decidua Capsularis- encapsulates kidneys ni baby) hemoglobin
-Decidua Vera- Remaining portion
Polyhydramnios: More than 1200/ Fetal GI FETAL HEART CIRCULATION:
EMBRYO- Between 5th and 8th week of pregnancy -- 8th Esophageal Atresia(Difficulty swallowing) Ductus Venosus- Direct the blood from umbilical vein to
week organogenesis(Formation of fetal organs) Gestational DM-- Maternal Hyperglycemia-- Maternal the inferior vena cava thereby bypassing the liver
Polyuria-- BEcause glucose attracts water-- goes to
FETUS - 8th-37th week amniotic fluid--Fetal Hyperglycemia-- Fetal Polyuria-- Ductus Arteriosus- Temporary opening of pulmonary
Polyhydramnios artery to aorta/ must closed at birth
EMBYONIC FETAL STRUCTURES
Artery- Oxygenated blood Foramen Ovale- Temporary opening of right atrium to
-No direct exchange of blood from mother and
the left atrium/ must closed at birth
the baby only the nutrients, oxygen and waste
FETAL GROWTH AND DEVELOPMENT
product
⚫ 4 weeks- Head, Heart, Lungs, Spinal cord have GRAVITY AND PARITY
already been developed Gravity: Number of pregnancies regardless of outcome
Placenta
⚫ 8 weeks- Organogenesis is complete and duration
-Serves as the Fetal lungs(O2), GIT(Nutrients),
⚫ -Earliest time to monitor the fetal heart rate using Parity: Number of deliveries that reach the age of viability
Kidneys(Waste Product)
fetal doppler (20 wks) dead or alive
-Production of progesterone and estrogen
⚫ 12 weeks- Kidneys begins to function(Urine)
-Produce Human Chorionic Gonadotrophin (HCG--
⚫ -FHR- Fetoscope Principle in identifying parity:
causes N/V during pregnancy-- Peak of HCG production
⚫ 16 weeks- Quickening(1st movement of the baby) 1. Abortion- Do not count (termination before the 20th
and N/V-- 3rd month of pregnancy )
for Multigravida woman weeks of gestation)
⚫ -Sex is determined through ultrasound
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2.Stillbirth- (Death of the fetus but reach the 20th Feb 14, 2021(9+7= November 21, 2021) 7. Linea Nigra(Dark line extending from the xyphoid
weeks) process down to the symphisis pubis)
3.Twins- Counted as 1 Formula: Month Day Year 8. Melasma/Cholasma (Dark spots that can be found on
Jan-March= +9 + 7 the face)
April- Dec= -3 +7 +1 Striae Gravidarum (Pinkish streaks at the lower abd)

Examples: PROBABLE
1. Patient A is pregnant for the first time and BARTHOLOMEW’S METHOD - If the mother -Highly documented
carries a twin - G1 P0 cannot remember her LMP- this method will be Signs And Symptoms
2. Patient B delivered to an alive monozygotic used 1. ChadWicks Sign (Purplish discoloration of the
twin- G1 P1 12wks- Symphisis Pubis vagina)
3. Patient C is now pregnant. Her pregnancy three palpable fundus 2. Goodell’s Sign (Softening of cervix)
years ago ended in abortion- G2 P0 20 wks-Umbilicus palpable 3. Hegar’s Sign (softening of the lower uterine
4. Patient D has delivered an alive baby girl. Her fundus segment/uterus)
pregnancy three yeas ago ended in abortion- 36wks- Xyphoid process 4. Braxton Hick’s Contraction (Painless contractions
G2P1 palpable fundus relieved by walking)
5. Patient E pregnancy three years ago ended in 20th to 36th weeks- 5. Ballotement (Rebounding of the Fetus)
abortion. She aborts for the second time- G2 P0 Fundic Height in cm would (+) Pregnancy Test
usually be equal in the AOG in
GP- Gravity Parity wks POSITIVE
GTPALM Scoring Abnormal Findings: 30th wks pregnant- Fundic Ht- - Confirms the presence of a Fetus
G-ravity 25cm= Small for Gestational Age (Smoking can affect the
T-erm -Number of infants born, Pregnancies baby-- Smoking-- nicotine-- vasoconstriction-- dec fh) SIgns and Symptoms
that reach 37th week and above 1. Fetal heart rate confirmed by the doppler
P-re term- Number of infants born, 2. Fetal Movement confirmed by the examiner/nurse
Pregnancies that reach 36th week and before 3. Fetal outline confirmed by the Ultrasound
A-bortion- Less than 20 wks SIGNS AND SYMPTOMS OF PREGNANCY
L-iving- PRESUMPTIVE PHYSIOLOGIC CHANGES
M-ultiple pregnancy- Twins will be counted - Highly subjective signs, only felt by the mother COMMON DISCOMFORTS DURING PREGNANCY -
as 1 -Signs can be caused by other conditions NORMAL
Signs and Symptoms -No need to notify the physician, only provide comfort
OBSTETRICAL FORMULA AND COMPUTATIONS: 1. Amenorrhea
NAEGELE’S RULE 2. N/V ⚫ Caused by Inc in level of HCG-- due to relaxing
To estimate EDC (Expected Day of Confinement) 3. Urinary Frequency effect-- relaxation of the GIT-- relaxation of the
Pre-requisite: LMP - First day of the Last Menstrual Period 4. Breast Changes pelvic joint
5. Uterine Enlargment ⚫ Nausea and Vomiting - Instruct to eat dry crackers
Example: Nov. 20, 2021 - (-3+7+1= August 27, 2022) 6. Quickening or carbohydrates, Instruct to eat Small Frequent
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Feeding, Instruct to drink fluids in between meals, ⚫ Proteins: Increase intake-- needed for fetal and
Avoid spicy, fatty, fried foods ⚫ Leg Cramps- Due to dec Calcium-- Because the fetus plancental development
needs the Ca for bone development results to Inc ⚫ Carbohydrate (1st trimester)- Inc intake- Glucose is
⚫ Heartburn (Pyrosis)- Elevate the head of the bed Phosphorus of the mother= Cramps needed for fetal and placental development
3hrs after meals, Milk inbetween meals ⚫ -Instruct the women to DorsiFlex the legs, Drink 4 ⚫ Carbohydrate (2nd and 3rd trimester)- Dec Intake-
glasses (1200mg/day) of milk per day Prevent hyperglycemia
⚫ Constipation- Inc Oral fluid intake, inc Fiber intake,
Use of stool softeners as prescribed by the physican ⚫ Urinary Frequency - Common on the first Normal Weight(Best index of health during Preg)
(Safe: Docusate Na, Metamucil, Milk of magnesia, trimester(Low level of uterus-- compression of the Gain in Pregnancy;
Bisacodyl (Dulcolax)) bladder) and on the 3rd trimester of 1st trimester-1lb/months-=3lbs
pregnancy(Engagement of the fetus-- compression 2nd Trimester-1lb/week=12lbs
⚫ Backache- Pelvic Rocking/Pelvic Tilt of the bladder), Uncommon on the 2nd trimester-- 3rd trimester- 1lb/week=12lbs
Exercise(“otso-otso”), use flat shoes, flat firm Uterus elevate and becomes a part of the abdominal Total: 27lbs
mattress cavity Total weight Gain: 25-35lbs

⚫ Lordosis(Nakaliyad)- SUPINE HYPOTENSIVE SYNDROME/Vena Cava Normal BMI for Non Pregnant: 18.5-24.9
⚫ Waddling Gait(Duck walk) Syndrome Normal Pregnancy BMI:19.5- 25.9
-Due to the compression of the inferior vena cava--Dec
⚫ Due to Inc Level of Estrogen-- Inc Secretion-- Inc blood going to the heart-- dec O2 that will reach the PSYCHOLOGICAL CHANGES IN PREGNANCY
Vascularity/Growth of small BV brain-- dizziness while lying supine--
⚫ Breast Tenderness- Instruct the women to use Management- Position the mother in a left side lying 1st Trimester- Task: Accept the Pregnancy
supportive bra, Avoid the use of soap position-- To prevent compression of the vena cava -Shock and Anxiety
which is in the right side of the body -Ambivalence- Two opposing feelings felt by the
⚫ Leg Varicosities& Pedal Edema - Due to pressure -- women
Elevate the legs(To promote the venous return), -Couvade Syndrome- When the husband is
Avoid prolonged sitting and standing (To avoid PVD), ROUND LIGAMENT PAIN experiencing the s/sx of pregnancy
USe compression stockings/Anti Embolic Stockigs -Stabbing or jabbing pain in the lower abd which is
aggravated by movement-- movement causing 2nd Trimester: Task: Accept the baby
Hemorrhoids-Prevent constipation, Cold compress stretching of the round ligament -Quickening Happen
(Pain), warm compress (Promote comfort) -Apply warm compress to relax the round ligament -Narcissism(Self centered)
-Instruct the women to sit to relax -Introversion
⚫ LEUKORRHEA- Whitish non foul vaginal discharge
“normal”, Instruct the women to use cotton Placenta-Transport of nutrition at 3 months 3rd Trimeste- Task: Prepare for thr baby
underware to absorb the discharge, proper perineal -Nest building
care NUTRITION IN PREGNANCY
“Pregnant women is not allowed to Douche can cause ⚫ Fats: Decrease intake -- Difficult to digest OBSTETRICAL PROCEDURES
infection” LEOPOLD’S MANEUVER
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Client instruction: Empty the bladder- Promote Comfort Level I- Done by RadTech- For normal Pregnancy, No. Of
Client Position: Dorsal Recumbent Position fetus, plancental location Contraction STRESS test
Nursing Considerations: Level II-Done by a Radiologist (MD)- For ABnormal -FHR in response in Uterine Contraction
-Provide Privacy Pregnancy, Chromosomal abnormality, fetal defect -Normal Result- Negative result- No decelaration-
-Provide warmth Types of ultrasound: No dec to Dec of FHR
-Use Palms Transabdominal- Supine Position- Full bladder- To -Positive Result- Dec of FHR, w/ decelaration
elevate the uterus for better visualization and stabilize
RN: Right Handed- Right Side of the women- To perform the uterus FINDINGS AND INTERPRETATIONS
the palpation easier Transvaginal- Lithotomy Position- Empty the bladder- to (FHT monitoring)
promote comfort
Position of the nurse: EARLY DECELERATIONS
FETAL MOVEMENT COUNT - A decrease in FHR on the start of contraction- due to
First Maneuver: Fundal Grip (On the SANDOVSKY METHOD: Fetal Head Compression-- Cranial Nerve 10/Vagal
Fundus of the Mother) ✓ Done early in the morning, mother is well rested stimulation--Slow/Dec of FHR-- Normal
Hard and Round- Fetal Head-- Presentation -- ✓ After Meals-- High glucose-- Fetus has an energy -Continue Monitoring
Breech ✓ POSITION: Left side lying position
Soft and Glandular- Fetal buttocks-- ✓ Same time each day LATE DECELERATIONS
Presentation- Cephalic ✓ 2 attempts -Decrease in FHR on the end of a contraction-- Due to
Utero Placental Insufficiency-- dec O2 to the baby
Second Maneuver - Umbilical Grip NORMAL fetal movement count: 10movements/hr -Stop Giving Oxytocin’
Hard and Smooth - Fetal BAck-- FH is located, -Reposition the mother-Left side lying Position- Prevent
nearest to the fetal heart CARDIFF METHOD: Count to 10 in 12hrs compression of the Vena cava--Inc O2 to the heart-
Irregular and Bony - Fetal Extremities Plancenta
FETAL HEART TONE MONITORING -Give Oxygen
Third Maneuver- Pawliks Grip- To PRINCIPLES/Equipment used: - Notify the Physician
determine engagement and non engagement - Doppler (8th week)- Obese use doppler ultrasound
Movable- Not Engage NORMAL Fetal Heart Rate: 120-160bpm (Less than VARIABLE DECELERATION
Not movable-Engage 120 and more than 160- Notify the Physicain- Sign of -Dec of FHR anytime or during the contraction- Due to
Fetal Distress) cord compression
Fourth Maneuver/Pelvic Grip - To -Reposition in knee chest position- to prevent cord
determine the fetal attitude NON - STRESS Test compression
Degree of Flexion- degree of flexion of the -Monitoring the FHR in response to fetal movement,
fetal neck -REACTIVE RESULT-Normal Result- Inc of FHR of
Fetal attitude: Good- Acutely Flexed 15bpm for 15sec (for 2 consecutive Readings)- Fetal HR
is reacting to Fetal Movement
ULTRASONOGRAPHY -NON REACTIVE RESULT-No inc in Fetal heart less
Categories: than 15bpm upon movement