Providing the highest quality of

care for our patients

Maternity
‫ﻻ اﺑﻴﺢ وﻻ اﺣﻠﻞ ﻣﻦ ﻳﺴﺘﻐﻞ ﻣﻠﻔﻲ ﻣﺎدﻳﺎ‬
Fetal Development Preembryonic Period "Germinal"
(0-2 weeks)
Stages First 2 weeks after conception
Start at fertilization and ends with implantation.
Rapid cell division and beginning of cell
differentiation.

Embryonic Period (3-8 weeks)

Beginning day 15 through week 8 after conception
-Basic form of all body structures develop.
-Most internal and external organs and systems
-Brain & Spinal cord

Fetal Period (9-birth)

Starts at 9 weeks until birth
Gestational period ‫ﺣﺴﺎب اﻟﻮﻗﺖ اﻟﻤﺘﻮﻗﻊ ﻟﻠﻮﻻده‬ JF MARAM JASON D
‫ﺑﺈﺳﺘﺨﺪام اﻟـ‬
Time from fertilization of
Naegele’s Rule
the ovum until the January
estimated date of delivery February
‫ ﻓﻲ اول ﺛﻼث‬LMP ‫اذا ﻛﺎﻧﺖ اﺧﺮ دوره‬
‫ﺷﻬﻮر‬ March
About 280 days/ 40 weeks (January, February, March) Providing theApril
highest quality of
EDD= care for our patients
May
Naegele’s Rule 1- (+7 Days) June
Naegele’s Rule is used to July
2- (+9 months)
calculate a woman’s August
estimate delivery date September
‫اذا ﻛﺎﻧﺖ اﺧﺮ دوره ﺑﻌﺪ اول ﺛﻼث ﺷﻬﻮر‬
(EDD). October
EDD=
**Requires a regular 28-day menstrual
November
cycle 1- (+7 Days) December
2- (- 3 months)
February=28 days
3- (+1 Year) **Saap June=30days
September
April
June
November
‫ ﻳﻮﻡ‬31 ‫ﺑﺎﻗﻲ ﺍﻟﺸﻬﻮﺭ‬
Obstetric History
Practice Example:
"GTPAL" Pregnant client is making her first Antepartum visit. She has
a two year old son born at 40 weeks. a 5 year old daughter
G = Gravida born at 38 weeks and 7 year old twin daughters born at 35
‫ﻋﺪد ﻣﺮات اﻟﺤﻤﻞ‬
*Nulligravida ‫وﻻ ﻣﺮه ﺣﻤﻠﺖ‬ weeks. She had a spontaneous abortion 3 years ago at 10
*Primigravida ‫اول ﺣﻤﻞ‬ weeks. Using the GTPAL format the nurse should identify
*Multigravida ‫ﺣﺎﻣﻞ اﻛﺜﺮ ﻣﻦ ﻣﺮه‬
that the client is:
T = Full term birth
‫ اﺳﺒﻮع واﻛﺜﺮ‬37 ‫ﻋﺪد اﻟﻮﻻدات ﻣﻦ‬ A. G4 T3 P2 A1 L4
P = Preterm birth B. G5 T2 P2 A1 L4
‫ﻋﺪد اﻟﻮﻻدات اﻟﻤﺒﻜﺮة‬
‫ اﺳﺒﻮع‬37 ‫ اﺳﺒﻮع واﻗﻞ ﻣﻦ‬20 ‫ﻣﻦ‬
C. G5 T2 P1 A1 L4
A = Abortion D. G4 T3 P1 A1 L4
‫ اﺳﺒﻮع‬20 ‫ﻋﺪد ﻣﺮات اﻻﺟﻬﺎض اﻗﻞ ﻣﻦ‬

L = Living children
‫ﻋﺪد اﻻﻃﻔﺎل اﻻﺣﻴﺎء‬

*Parity
*Nullipara
‫وﻻ ﻣﺮه وﻟﺪت‬
*Primipara
‫ اﺳﺒﻮع واﻛﺜﺮ‬20 ‫وﻟﺪت ﻣﺮه وﺣﺪه ﺑﺲ " ﻣﻦ‬
*Multipara
"‫ اﺳﺒﻮع واﻛﺜﺮ‬20 ‫وﻟﺪت اﻛﺜﺮ ﻣﻦ ﻣﺮه "ﻣﻦ‬
Fundal Height Fundal Height during Fundal Height after
Pregnancy Pregnancy
What is the purpose of
measuring fundal About 1 hour after birth the
fundal height is at the belly
height?
button.
It helps assess if the
baby is growing The fundus will decrease by 1
properly and helps cm per day and you won’t be
determine the able to palpate it by day 10-
gestational age of the 14.
baby.

How do you measure

fundal height?
*To measure Use a
measuring tape and Above the symphysis pubis
start at the symphysis at 12 weeks
pubis and extend it up to
the top of the uterus at the belly button
"The Fundus" (umbilicus) at 20 weeks

At 16 weeks, the fundus can

be found approximately
halfway between the
symphysis pubis and the
umbilicus.

At 36 weeks, the fundus is

at the xiphoid process.
How much weight is Antepartum visit
recommended to gain?
• Conception to 28 weeks
"Every 4 weeks"

• 29 to 36 weeks
"Every 2 weeks"

• 37 weeks to birth
"Weekly"

*Vaccines

*Folic Acid
Placental variations

Succenturiate placenta

Circumvallate placenta

Battledore placenta

Velamentous placenta
Complications of
Pregnancy
Bleeding in early Abortion Incomplete
Partially expelled products
pregnancy A pregnancy that ends Some products of conception have been
before 20 weeks’ expelled, but some remain.
Cervix open
The three most common gestation, spontaneously
causes of hemorrhage or electively.
during the first half of Missed
pregnancy are: Types of Abortion: Persistent dark brown discharge
Abortion Non-viable fetus
**Pregnancy tests for hCG show a
Ectopic pregnancy Complete decline
All products of conception are
Gestational expelled from the uterus
trophoblastic disease
Therapeutic
"Hydatidiform mole"
Threatened Management:
Light bleeding
OS closed
Viable Fetus

Inevitable
Heavy bleeding
OS open
Rupture of membranes
Nonviable fetus
"Cervix closed until products start to expel
then external OS open"
Bleeding in late Placenta previa Abruption Placenta
pregnancy ‫ﻫﺒﻮط اﻟﻤﺸﻴﻤﻪ‬ "Separate"
‫إﻧﻔﺼﺎل اﻟﻤﺸﻴﻤﻪ‬
After 20 weeks of
pregnancy, the two major Signs & Symptoms Signs & Symptoms
causes of hemorrhage are
the disorders of the Placenta Previa Abruptio placenta
placenta called placenta
previa and abruptio
placentae.
-Painless bright red -Acute Abdominal pain
vaginal bleeding -Dark red vaginal bleeding

-Uterine Pain or
-Relaxed, soft, and
Tenderness or both, and
nontender uterus.
uterine rigidity.
Placenta previa Types of placenta previa
‫ﻫﺒﻮط اﻟﻤﺸﻴﻤﻪ‬
is an improperly implanted placenta in the
lower uterine segment near or over the
internal cervical OS.

Signs & Symptoms

Placenta PRevia
-Painless bright red vaginal bleeding
-Relaxed, soft, nontender Uterus

Vaginal exams are contraindicated

Hypertension in Preeclampsia 3. Monitor for signs of
magnesium toxicity
pregnancy Hypertension after 20 weeks
keep antidote (calcium gluconate)
available for immediate use, if
necessary.
of gestation.
-Gestational HTN 4. Administer
(pregnancy-induced antihypertensives as
Signs & Symptoms prescribed.
hypertension [PIH])
HTN >140/90
-Preeclampsia 5. Prepare for the induction
Proteinuria
of labor.
-Eclampsia Edema
(eyes, face, extremities, pulmonary
-Chronic HTN edema, increase weight gain, cerebral
edema)
Weight gain Eclampsia
Occurrence of seizures in a
preeclamptic woman.

Interventions for
Severe Preeclampsia
1. Maintain bed rest.

2. Administer magnesium
sulfate as prescribed to
prevent seizures.
 Gestational GDM effect on fetus & neonate
Diabetes The major fetal complications are:

Macrosomia & Hypoglycemia

Diabetes that develops during
pregnancy, usually during the
2nd or 3rd trimester. other complications

Pregnant should be screened for Hypocalcemia

gestational diabetes between 24 Hyperbilirubinemia
and 28 weeks of gestation
Respiratory distress syndrome
Congenital anomalies

Signs & Symptoms

Complications to the mother
Similar to hyperglycemia…
remember the 3Ps Future diabetes
Preeclampsia & Eclampsia
Polyphagia ‫ﺟﻮع ﺷﺪﻳﺪ‬
Polydipsia ‫ﻋﻄﺶ ﺷﺪﻳﺪ‬
Polyuria ‫ﺗﺒﻮل ﻛﺜﻴﺮ‬
 Providing the highest quality of
care for our patients

Labor and Delivery

WHO WE ARE
 Fetal Station Example: The nurse is reviewing the
record of a client in the
The measurement of the If the baby’s presenting part is labor room and notes that
progress of descent in the health care provider has
centimeters above or below at 5 cm above the ischial documented that the fetal
the midplane from the spines…the fetal station would presenting part is at the –1
presenting part to the ischial be (–5). station. This documented
spine
finding indicates that the
Station 0: At ischial If at 2 cm above the ischial
fetal presenting part is
spines…the fetal station would
spine be (-2) located at which area?
Refer to figure
Minus station: Above If at the ischial spines…the fetal
ischial spine station would be (0).
"Engaged"

Plus station: Below If at 1 cm below the ischial

ischial spine spines…the fetal station would
be (+1)

When fetal station is 4 cm

(+4) or 5 cm (+5) baby’s
birth is very near so be 1. 1
prepared for delivery.
2. 2
3. 3
4. 4
 Fetal Positions
Fetal vertex (occiput)
presentations in relation to the
front, back, or side of the maternal
pelvis

During vaginal
examination the
nurse palpated
the posterior
fontanel to be at
the right side and
upper quadrant
of the maternal
pelvis ?

A. ROP
B. LOP.
C. ROA
D. LOA
Stages of labor Factors affecting
Stage1: "Cervix dilation" 0-10 cm Labor (5 P’s)

"Late" Powers: Uterine

Phase1 "Latent" 0-3 cm contractions
Phase2 "Active" 4-7 cm
Passageway: The birth
Phase3 "Transition" 8-10 cm
canal.
Stage2: "Fetal expulsion" Passenger: The fetus
From full dilation to delivery of the
and placenta.
baby.
Psych: A women's
Stage3: "Placenta expulsion" emotions.
From delivery of the baby to the
delivery of the placenta. Position:

Stage4: The first 1-4 hour after

delivery.
*Problems during the 4th Stage of labor see
page NO....
Postpartum care
 Episiotomy Lochia ‫دم‬
assessment ‫اﻟﻨﻔﺎس‬

REEDA "Russia"
Redness
Rubra "Birth-3 days"
Edema Dark red
Ecchymosis Serosa"4-10 days"
Pinkish brown
Discharge
Approximation Alba "11-6weeks"
"The edges of the wound should
Whitish-yellow
be close, as though stuck or
glued together"
 Psychological changes
The puerperal phases " PP phases"
1-Taking-in phase (Birth-2days)
‫اول ﻳﻮﻣﻴﻦ اﻻم ﺗﺮﻛﺰ ﻋﲆ ﻧﻔﺴﻬﺎ وﻣﺎﺗﻬﺘﻢ ﺑﻄﻔﻠﻬﺎ‬

"passive, dependent behavior"

Mom is self-focused, reliving the delivery pain. Requires support from staff and relatives.

2-Taking-hold phase (3-10days)

‫ﺛﺎﻟﺚ ﻳﻮم ﺗﺒﺪأ اﻻم ﺗﻬﺘﻢ ﺑﻨﻔﺴﻬﺎ وﺑﻄﻔﻠﻬﺎ‬

Mom is infant-focused.
the mother is ready to take responsibility for her care as well as the infants care.

**Postpartum blue ‫ﻣﻤﻜﻦ ﺗﻈﻬﺮ اﻋﺮاض ال‬

3-Letting-go (11-several weeks)

Adjust to life as a family with new child. Letting go of pregnancy period & birth experience into new family life
 Breast-feeding Benefits
Types of breast
milk: For the mother:
Colostrum "1-3 days" • protection against breast cancer
• assistance in uterine involution due to the
Transitional "4-10 days" release of oxytocin
• less preparation time and less cost than
Mature "11-2 years" using infant formula.

For the Neonate:

-Immunity
........?

Sexual activity and

contraception
-Oral contraceptives containing estrogen
are not recommended for breast-feeding
mothers; progestin-only birth control pills
are less likely to interfere with the milk
supply.

When you can resume sexual activity

and contraceptive measures?
Most couples can resume having sex
within 3 to 4 weeks after delivery or
possibly as soon as lochia ceases.
Postpartum Complication
*Postpartum hemorrhage
*Puerperal Infection
*Breast engorgement
*Mastitis