OB NORMALS HANDOUT



OB NORMALS HANDOUT

ANATOMY AND PHYSIOLOGY

FEMALE EXTERNAL GENITALIA

1. MONS PUBIS-a fat pad above symphisis pubis

2. LABIA MAJORA- two thick folds of adipose tissue originating from the mons and terminating in the perineum

3. LABIA MINORA- two thin folds of connective tissue that joins anteriorly to form the prepuce and posteriorly to form the fourchette

4. CLITORIS- a highly sensitive and erctile tissue situated under the prepuce of the labia minora

5. FOSSA NAVICULARIS- refers to the space between the fourchette and the vaginal introitus

6. VESTIBULE- triangular space located between the labia minora

7. BARTHOLIN’S GLANDS- located at each inner side of the vagina

8. SKENE’S GLANDS- pair of glands situated at each inner side of the urethral meatus

9. VAGINAL ORIFICE- external opening of the vagina

10. HYMEN- thin circular membrane made of elastic tissue situated at the vaginal opening.

11. URETHRAL MEATUS- external opening of the female urethra

BLOOD SUPPLY- pudendal artery and inferior rectus artery

NERVE SUPPLY-ilioinguinal and genitofemoral nerve for the anterior portion and the posterior portion is derived from S3(pudendal nerve)

THE FEMALE INTERNAL ORGANS

1.VAGINA- a hollow, membranous and muscular canal about 8 to 12 cm long.

FUNCTIONS

-organ of copulation

-discharges menstrual flow

-birth canal

RUGAE- transverse folds of skin in the vaginal wall.

VAGINAL pH- before puberty is 6.8 o 7.2, after puberty vainal pH goes down to 4-5

BLOOD SUPPLY- from the vaginal artery

-Upper portion- cervicovaginal branch of uterine artery

-Middle portion- inferior vesical arteries

-Lower portion- rectal and pudendal arteries

NERVE SUPPLY- provided by the uterovaginal plexus or Lee Franken hauser plexus and S1 to S3 nerves

2.UTERUS- hallow muscular organ canal resembling an inverted pear which is situated in the true pelvis

FUNCTIONS OF THE UTERUS

-organ of reproduction

-organ of menstruation

-uterine contraction

PARTS OF THE UTERUS

FUNDUS- the upper most portion located between the insertion of the fallopian tubes

CORNUA- the portion at which the fallopian tubes are inserted

ISTHMUS-the upper third of the cervix which is very thin and which forms the lower uterine segment delivery

CORPUS- makes up two-third of the said organ.

CERVIX- neck of the uterus is about 2.5 cm long and has a diameter of 2.5 cm, too.

PARTS OF THE CERVIX

a. Internal Os- opens to corpus

b. Cervical Canal-continuation of the triangular uterine cavity located between the internal and external os

c. External Os- opens to vagina

LAYERS OF THE UTERUS

1. Perimetrium- the outermost serosal layer attached to the broad ligaments

2. Myometrium- the middle muscular layer responsible for uterine contractions during labor.

3. Endometrium- the innermost ciliated mucosal layer containing numerous uterine glands.

TWO LAYERS OF THE ENDOMETRIUM

a. Glandular Layer- composed of columnar epithelium

b. Basal Layer- layer adjacent to the myometrium

UTERINE LIGAMENTS

• Cardinal/Transverse-Cervical/Mackenrodt Ligaments-main support of the uterus

• Broad Ligaments/Peritoneal Ligament- supports the sides of the uterus and assists in holding the uterus in anteversion

• Round Ligaments-connects uterus to the labia majora. Gives stability to the uterus

• Uterosacral Ligament-connects uterus to sacrum

• Anterior Ligament-provides support to the uterus in connection with the bladder.

• Posterior Lligament- forms the Cul-de-Sac of Douglas

BLOOD SUPPLY OF THE UTERUS

a. Uterine Artery

b. Ovarian Artery

3. FALLOPIAN TUBES(OVIDUCTS)-pair of tube-like structures originating from the cornua of the uterus with the distal ends located near the ovaries.

FUCTION

-transport ovum from ovary to the uterus

-the site of fertilization

-provides nourishment to the ovum during its journey

PARTS OF THE FALLOPIAN TUBE

1. Interstitial/ Intramural-thick walled, located inside the uterus, about 1 cm long

2. Isthmus-narrowest portion of the uterus and about 1 cm long

3. Ampulla- middle portion and the widest part.

4. Infundibulum- most distal portion. It has fingerlike projections called fimbria.

BLOOD SUPPLY- ovarian artery and drainage is via the ovarian and uterine arteries

4.OVARIES- almond-shape glandular organs located on either side of the uterus. Each ovary weighs between 6 to 19 g, 1.5 to 3 cm wide and 2 to 5 cm long.

FUNCTION

-oogenesis

-ovulation

-hormone production

LAYERS OF THE OVARY

• Tunica Albuginea-the outermost protective layer.

• Cortex- functional layer which is the site of ovum formation and maturation.

-two months intrauterine- 600,000 oogonia

-5 months intrauterine-6,800,000

-at birth-2 million oocytes

-prepuberty/childhood-300,000-400,000

-36 years old-30,000 to 40,000

-Menopause-absent

3. Medulla- layer which contains blood vessels, lymphatics, nerves and muscle fibers

ANALOGOUS STRUCTURES IN THE MALE AND FEMALE REPRODUCTIVE SYSTEM

MALE

-spermatozoa

-glans penis

-scrotum

-penis

-testes

-vas deferens

-prostate glands

-cowper’s glands

FEMALE

-ovum

-glands clitoris

-labia majora

-vagina

-ovaries

-fallopian tubes

-skene’s glands

-bartholin’s glands

THE MAMMARY GLANDS

EXTERNAL STRUCTURES

1.Nipple or Mammary Papillae-located at the center of the anterior surface of each breast.

2.Areola-pigmented skin that sorrounds the nipple

3. Montgomery Tubercles-glands in the areola that secrete an oily substance that keeps the areola and nipple lubricated.

INTERNAL STRUCTURES

1. Lobes- 15 to 20 lobes are found in each breast

2. Lobules-composed of acini cells

3.Acini cells-milk secreting cells that is stimulated by prolactin

4. Lactiferous Ducts- stimulates development of the ductile structures of the breast

5. Lactiferous Sinus-dilated portions of the ducts located behind the nipple that serve as reservoir of milk.

Hormones that influence the Mammary Glands

1. Estrogen- stimulates development of the ductile structures of the breast

2. Progesterone-stimulates the development of the acinar structures of the breast

3. Human Placental Lactogen-promotes breast development during pregnancy

4. Oxytocin- let-down reflex

5.Prolactin- stimulates milk production

THE MALE REPRODUCTIVE SYSTEM

EXTERNAL ORGANS

1. Penis- composed of three longitudinal erectile tissue: two corposa cavernosa and one corposa spongiosum

FUNCTIONS

-organ of copulation and of urination

PARTS

Shaft or body

Glans Penis-most sensitive part

Prepuce/Foreskin-fold of retractable skin coverig the glans

Urethral Meatus- a slitlike openig located at the tip of the penis

2.Scrotum-sac-like structure containing the testes and hangs behind the penis

INTERNAL ORGANS

1.Testes- two oval shape glandular organs lying within the abdominal cavity in early fetal life and descend to the scrotum after 28 weeks gestation.

FUNCTIONS

-hormone production-testosterone

-spermaogenesis-production and maturation of sperm cell begins at puberty and continue until old age

PARTS

Seminiferous tubules- long coiled tube where spermatogenesis take place, the testes produce about 176 sperm cells a day

Leydig/Interstitial cells-produce testosterone, found around seminiferous tubules

Sertoli Cells- suppporting cells which plays a role in sperm transport.

2.Epididyms- long coiled tube approximtely 20 feet long at which the sperm travels for 12 to 20 days after it leaves the testis.

3. Vas deferens- contractile power of this part of the duct system propels the spermatozoa to the urethra during ejaculation.

4. Ejaculatory Duct- it connects the seminal vesicles to the urethra.

ACCESORY ORGANS

• Seminal Vesicle- a two-pouch like organs consisting of many saclike structures located behind the bladder and in front of the rectum

• Prostate Gland- a walnut-shape(conical) body lying below the bladder

• Cowper’s/Boulburethral Gland- two small glands located below the prostate that secrete alkaline fluid before ejaculation.

• Seminal Fluid or Semen-mixture of secretions from the seminal vesicles, prostate gland,Cowper’s gland, ejaculatory duct and sperm cells.

THE MENSTRUAL CYCLE

• Hypothalamus-ultimate initiator. Secretes gonadotropin releasing hormones.

• Anterior Pituitary Gland-releases the gonadotropin hormones(FSH,LH).

• Ovaries- site ovulation,source of estrogen and progesterone.

• Uterus-it is where menstrual discharged is formed.

HORMONES INVOLVED IN THE MENSTRUAL CYCLE

1.FSHRF-produced by the hypothalamus,stimulates APG to release FSH

2.FSH-stimulates production of several Graafian Follicles

3.Estrogen- “hormone of women”.Produced by the Graafian Follicles.

THREE TYPES OF ESTROGEN

-estradiol

-estrone

-estriol

EFFECTS OF ESTROGEN

-inhibit FSH

-stimulates deposition of fat in subcutaneous tissues that gives a female shape and development of secondary characteristics.

-stimulates growth of vagina and uterus, thickening of the endometrium

-causes mucus to be thin, highly stretchable

-stimulates the growth of the ductile structures of the breasts

-menarche and menstruation

-premenstrual water retention

4. LHRF-produced by the hypothalamus, stimulates APG to release LH.

5.Progesterone- hormone for mothers.Produced by the corpus luteum.

EFFECTS OF PROGESTERONE

-Thermogenic effect

-relaxes uterine muscles

-promotes growth of acini cells of the breasts

-causes fluid retention

-cause of PMS

-prepares endometrium for implantation

-causes tingling sensation and feelling of fullness in the breast during menstruation

PHASES OF THE MESTRUAL CYCLE

1.MENSTRUAL PHASE

-day 1-5 of a 28 day cycle

-begins on the first day of menses,lasts 2-7 days

-because of progesterone withdrawal

-desquamation of the layer of the ndometrium

-2/3 of the endometrium is shed off

-uterus lining is in its thinnest

-total blood loss-30-80 ml,iron loss-12 to 29mg

-saturating a pad or tampons more than an hour is a heavy flow

2.PROLIFERATIVE PHASE

-from day 6-13 of a 28 day cycle. Lasts 8-10 days

-low estrogen stimulates FSHRF which in turn stimulater APG to secrete FSH

-Primordial follicle to Graafian follicle

-estrogen is on its highest causing endometrium to be highly vascular,thickness increasing up to 8th folds

-genital tract is prepared for sperm migration,cervical secretion becomes abundant

-called follicular, postmenstrual and estrogenic phase

3. SECRETORY PHASE

-13th to 25th day

-rise in estrogen inhibits the APG to secrete FSH.suppression of FSH,high estrogen,low progesterone triggers hypothalamus to release LHRF which stimulates APG to secrete LH that promotes ovulation

-after ovulation, Graafian follicle is now the Corpus Luteum.

-Corpus lutuem produces large amounts of progesterone

- progesterone increases vascularity of the endometrium and stimulates endometrial glansds to produce mucin and glycogen

-endometrium becomes very soft, spongy and edematous

-corpus luteum has a lifespan of 7-8 days. If fertilization occurs, it regresses and becomes non-functional 10-12 days after ovulation resulting in withdrawal of progesterone and estrogen.

-if fertilization occurs:the fertlized ovum will implant in 7-8 days after fertilization

4.ISCHEMIC PHASE-progesterone withdrawal results in formation and release of prostaglandins

-arteriolar spasms cuts off blood supply that causes necrosis and rupture of blood vessels that would cause endometrial sloughing

-onset of dysmennorhea may signal the beginning of another menstrual cycle

OVULATION

-midpoint of the cycle,the very high level of estrogen and very low level of progesterone tiggers the release of LH which is the hormone that promotes ovulation

-occurs 14 days before menstruation

SIGNS OF OVULATION

• Mittelschmerz-lower abdominal pain felt at the side of the ovary that released the ovum.

• Spinnbarkheit-signals that a woman is nearing ovulation or is ovulating.Cervical mucus is thin, watery or transparent, abundant and highly strechable

• Increased basal body temperature-due to progesterone

Peak blood level of LH.

Example: First day of menstruation is January 30

January 30-14=16

ovulation occured on January 16

MENSTRUAL PROBLEMS

• Dysmenorrhea- painful menstruation

a. Primary dysmenorrhea- no known cause

-discomfort begis 1-2 days before onset of menses then subsides by the second day

-nausea, vomiting,diarrhea,syncope, leg pain

Intervention: sedatives,narcotic analgesics, oral contraceptive is contraception is desired

b. Secondary dysmenorrhea- has underlying disease condition

causes: PID

-Endometriosis

-Adenomyosis

-Uterine prolapse

-Uterine myomas and polyps

Intervention:treat the cause

2. Amenorrhea-absence of menses. May be due to pregnancy, lactation, abnormality of the endocrine system, rapid weight loss, anorexia nervosa or strenous exercise.

3. Oligomenorrhea- decreased menstrual flow

4. Menorrhagia-heavy and prolonged menses. May be due to endocrine imbalance, infection and uterine tumors.

5. Metrorrhagia- bleeding in between menses

6. Polymenorrhea- bleeding at frequent intervals. Frequently due to a disease process.

MENOPAUSE

Climacterium-change of life, refers to that time in a woman’s lefe when she undergoes a transition from the reproductive stage to the non-reproductive stage

Menopause-rung of the ladder, is culmination of climacterium,it specifically refers to the last menstrual period.

SIGNS AND SYMPTOMS OF MENOPAUSE

a. hot flushes

b. loss of breast mass and firmness, and atrophy of reproductive organs

c. dyspareunia

d. musculoskeletal symptoms.

MANAGEMENT:

1. Estrogen replacement therapy(ERT) to relieve hot flushes, mood instability and for prevention and treatment of osteoporosis.

2. Provide information regarding contraception.

3. Calcium (1g/day at HS) and vitamin D supplementation.

4. Increase fluid intake

5. Teach how to manage hot flushes

6.Role of the nurse-midwife

-encourage woman to engage in regular exercise

-instruct on proper use of water-soluble vaginal lubricant for painful intercourse

-provide emotional support and sympathetic understanding

-refer for counselling as the need arise

-instruct to avoid smoking and alcohol

-regular physical examination

THE FETUS

OVUM

-female sex cell

-has two layers of protective covering, the outer layer is the corona radiata and the inner layer is the zona pellucida

-life span is 48 hours

SPERM CELL

-has three parts;the head that contain the chromatin materials, a neck or mid-piece that provides energy for movement, and the tail for motility

-life span is 72 hours

-must be in genital tract 4-6 hours before they are able to fertilize an ovum

THE SPERM

TWO TYPES OF SPERM CELL

a. Gynosperm-x carrying, has a large oval head, lesser in number, thrive better in acidic env’t.

b. Androsperm- y carrying, small head,thrive better in alkaline env’t.

INSEMINATION

-deposition of sperm cell in the female internal organs

-only few can reach the uterus

-reaches the uterus in 90 seconds and the fallopian tube in 5 minutes.

FERTILIZATION

-it undergoes capacitation.

-when it meets the ovum, it secretes the enzymes hyalurunidase and acrosin

FERTILIZATION PROCESS

ZYGOTE

-fertilized ovum

-journeys from the fallopian tube and to the uterus in 3-4 days

-24 hrs after fertilization, it undergoes the first cell division(blastomere)

-after 22 hrs. it becomes a morula that travels into the uterus and becomes a blastocyst.

BLASTOCYST

-called embryonic disc/blastocoele

-on its outer layer is the trophoblast/trophoderm.

-trophoblast gives rise to the placenta, fetal membranes, umbilicus cord and amniotic fluid

-important functions of the trophoblasts are to absorb nutrients from the endometrium and secrete HCG

-the embryonic disc gives rise to the three primary germ layers:

a. Ectoderm-gives rise to the skin, hair, nails, sense organs, nervous system, mucous membrane of the mouth and the anus

b. Mesoderm- gives rise to the kidney, musculoskeletal system, reproductive system nand the cardiovascular system

c. Entoderm-gives rise to he bladder, lining of the GIT, tonsils, thyroid gland and respiratory system.

IMPLANTATION

-blastocyst remains free floating in the uterine cavity for 3-4 days

-blastocyst implants in the endometrium approximately 6-7 days after fertilization

-site of implantation is the fuNdal portion

TROPHOBLAST

-differenttiates in two distinc layers after 3 wks.

a. Cytotrophobast/langhan’s layer-first layer that develops. Protects the fetus against treponema pallidum/syphilis until 2nd trimester of pregnancy.

b. Syncytiotrophoblast-outer layer. It produces hormones

THE FETUS

CHORIONIC VILLI

a. Chorionic frondosum-responsible for absorbing nutrients and oxygen from maternal blood stream and disposing fetal waste products including carbon dioxide

b. Chorion leave- forms the chorionic membrane

DECIDUA

a. Decidua parietalis- under decidua basalis

b. Decidua basalis- layer where implantation takes place

c. Decidua capsularis- encloses the blastocyst after implantation

THE MEMBRANES

a. Chorionic membrane- thick,opaque and friable

b. Amniotic membrane-smooth, thin, tough, translucent membrane dirrectly enclosing the fetus and the amniotic fluid

AMNIOTIC FLUID

- volume: 500 to 1200ml, average is 1000 ml

-composition: 99% water and 1% solid particles, contains albumin, urea, uric acid, creatinine, lecithin, sphingomyelin, ilirubin and vernix caseosa

-early pregnancy it is chiefly composed of maternal

serum

-at 10th wk. of pregnancy, the fetus urinates and contributes to the volume of the amniotic fluid

-appearance;clear and colorless to straw colored

-green tinged

-golden

-gray

-red

- pH- 7.0-7.25

-specific gravity-1.005 to 1.025

FUNCTION OF THE AMNIOTIC FLUID

-protects the fetus

-allows freedom of movement

-secretion and excretion system of the fetus

-maintain constant temperature

-source of oral fluid

-aids in diagnosis of maternal and fetal complications

-aids in fetal descent during labor

-prevents pressure on the cord

UMBILCAL CORD/FUNIS

-main function is to carry oxygen and nutrients from the placenta

-contains 2 arteries and 1 vein

-length: 50-55 cm long, 2 cm in diameter

-Wharton’s Jelly found inside the cord

PLACENTA

- reaches maturity at 12weeks gestation

-weight: 500 grams, diameter of 15-20 cm and about 3 cm thick

-occupies about ¼ of the uterine cavity

-MATERNAL SIDE: faces the mother, 15-20 cotyledons

-FETAL SIDE: faces the fetus, the amnion covers it

FUNCTIONS OF THE PLACENTA

-respiratory system

-renal system

- gastrointestinal system

- circulatory system

-endocrine system

ABNORMALITIES OF THE PLACENTA

• Placenta Bipartita-placenta not divided in two lobes

• Placenta Duplex-placenta is separated completely into two parts

• Placenta Succenturiata- has an accesory lobe with blood vessels connected to it.

• Ring-shaped placenta- associated with fetal growth retardation,postpartum and antepartum bleeding

• Fenestrated Placenta- the central portion of the maternal side of the placenta is missing.

• Placenta Circumvallata-cental depresion sorrounded by a thickened white-grayish ring .

• Circummarginate placenta-when the white-grayish ring is located at the margin of the placenta

• Placenta accreta- deeply implanted placenta

• Large placenta- encountered in syphilis and erythroblastosis fetalis

MATERNAL ADAPTATIONS TO PREGNANCY

UTERUS

Prepregnancy Term Pregnancy

Weight 50 gm 1100 gm

Thickness 2 cm 0.5 cm

Length 6.5 cm 32 cm

Depth 2.5 cm 20 cm

Width 4 cm 24 cm

Capacity 10 m 5000 ml

-Blood flow: increases from 20ml before pregnancy to 700-900 ml at the end of pregnancy

-Shape: pear shape to spherical to ovoid

-Position: after 12 weeks gestation , the uterus loses its anteflexed position

LOCATION OF THE FUNDUS

-12 wks-at the level of the symphisis pubis

-16 wks-halfway between symphisis pubis and umbilicus

-20 wks-at the level of the umbilicus

-24 wks-two fingers above umbilicus

-30 wks- midway between umbilicus and xyphoid process

-36 wks-at the level of xyphoid process

-40 wks-two fingers below umbilicus, drops at 34 wks.level because of lightening.

CERVIX

-color: pinkish or purplish

-leukorrhea: protects the fetus against bacteria and infection.

-consitency: softening of the cervix known as the Goodel’s sign is observable by 6 to 8 weeks gestation

ISTHMUS

-it softens and elongates up to 25 mm.

-Hegar’s sign:softeing of the lower uterine segment begins as early as 5 wks. gestation.

VAGINA

-Chadwick sign-vaginal mucosa change in color from pinkish to purplish or dark-bluish

-pH:3.5 to 6 acidic

OVARIES

-no graafian follicles develop and no ovulation occurs during pregnancy

-corpus luteum is the chief source of hormone during pregnancy (on the first 12 weeks).

BREAST

-increase in size due to alveolar tissue growth, fat deposition and increased vascularity

-feeling of fullness and tingling sensation, darkening of the areola, nipples stand out

-colustrum can be expressed from it as early as the fourth month.

CARDIOVASCULAR SYSTEM

-increase in plasma

-increased RBC and hemoglobin

-increase in clotting factors

HEART

-displaced to the left

-slight cardiac enlargement

-splitting third sound

-systolic and diastolic murmurs

-pulse rate increases about 10 to 15 bpm

-supine hypotensive syndrome

GASTROINTESTINAL SYSTEM

-nausea and vomiting

-decreased GIT motility

-Pyrosis

-slowed bile movement from gall bladder

-ptyalism

-epulis

INTEGUMENTARY SYSTEM

-melasma

-linea nigra

-darker areola

-palmar erthema

-vascular spider nevi

-activation of the sweat glads

-striae gravidarum

ENDOCRINE SYSTEM

-slight enlargement of the thyroid gland

-elevated glucocorticoid levels

-enlargement of the parathyroid

-posterior pituitary gland secrete increasing amounts of oxtyocin and prolactin as pregnancy nears term

SKELETAL SYSTEM

-softening of joint and ligaments

-leg cramps

PSYCHOLOGIC/EMOTIONAL ADAPTATIONS OF PREGNANCY

1. Acceptance of Pregnancy (first trimester)

-”I am pregnant”

2. Acceptance of the Fetus as a separate individual

-”I am going to have a baby”

-she begin to fantasize about the child’s sex and appearance

-she gives the fetus identity

3. Acceptance of motherhood (third trimester)

-’I am going to be a mother”

-she plans about her baby

SIGNS AND SYMPTOMS OF PREGNANCY

PRESUMPTIVE SIGNS (QUELNACS)

Quickening

Urinary frequency

Easy fatigabilty

Leukorrhea

Nausea and Vomiting

Amenorrhea

Chadwick’s Sign

Skin changes

PROBABLE SIGNS (PUGO HUB)

Positive pregnancy test

Uterine growth

Goodel’s sign

Outline of the fetus

Hegar’s sign

Uterine souffle

Ballotement

POSITIVE SIGNS (FUX F2)

FHT Funic Souffle

UTZ Fetal movement felt by the examiner

X-ray

PRENATAL CARE

COMPONENTS OF PRENATAL CARE

• History taking

• Physical examination

• TT Immunization

• Iron Supplementation

• Health Education

• Laboratory examination

• Oral-dental examination

• Referral when necessary

OBSTETRIC HISTORY

1. History of past pregnancies

T-number of full term infants born after 37 wks

P-number of preterm infants born before 37 wks

A-number of spontaneous or induced abortions

L-number of living children

G-number of pregnancies irrespective of gestational age

P-number of pregnancies that has reached viability

SIGNS OF PREVIOUS PREGNANCIES

a. pendulous and lax abdominal wall

b. abdominal striae

c. Labia gapes wider

d. Hymen is transformed into myrtiform carunculae

e. Cervix admits tip of cervix

f. Sites of healed laceration of the cervix

SIGNS OF FIRST PREGNANCY

a. Uterus is tense and firm

b. Frenulum is intact

c. Labia majora in close opposition

d. Vagina is narrow with numerous rugae

e. Cervix is soft but do not admit tip of finger until very end of pregnancy

2. Expected Date of delivery

Naegele’s Rule

ex. April 3 2010

-3 +7 +1

EDC=January 10,2011

3. Determination of Age of Gestation

Menstrual age/Gestation Age-measures from LMP

4.Assesment of fundic height-done to estimate AOG, EDC and fetal growth rate

Mc Donald’s Rule-use to calculate AOG

Fundic height (cm) X 2/7=AOG I lunar months

Fundic height (cm) X 8/7= AOG in wkS

Bartolomew’s Rule-use to calculate AOG

12 wks-level of symphysis pubis

16 wks- halfway between umbilicus and symphisis pubis

20 wks- level of umbilicus

24 wks- 2 fingers above umbilicus

30 wks- halfway between umbilicus and xyphoid process

34 wks- halfway between umbilicus and xyphoid process

36 wks- level of xiphoid process

40 wks- at 34 wks. Level due to lightening

Johnson’s Rule-use to calculate fetal wEight in grams

Fundic height(cm)-N X K= fetal weight

K=155(constant)

N= 12 if engagedd

N=11 if not yet engaged

Haase’s Rule to determine the length of the fetus

a. during the first half of pregnancy, square the number of months

b. during the second half of pregnancy, multiply the number of months by 5.

Greater fundic height indicates:

- multiple pregnancy

-miscalculated due date

-polyhydramnios

-Hydatidiform mole

Lesser Fundic height indicates

-fetal growth retardation

-fetal death

-error in estimating AOG

-oligohydramnios

LEOPLODS MANUEVER

First manuever (fundal grip)

-to determine fetal part lying in the fundus

-round,smooth- HEAD

-soft, angular- BUTTOCKS

Second Manuever (Umbilical grip)

-to identify location of the fetal back

-fetal back feels smooth and hard

Third Manuever (Pawlik’s Grip)

-to determine engagement of the presenting part

-movable-not yet engaged

Fourth Manuever (Pelvic Grip)

-to determine degree of flexion

-if descended deeply, only a small portion of the fetal head can be palpated

LABORATORY TESTS

1.Urinalysis

2.Blood Tests

-hgb and hct

-Rh determination

-VDRL

-HbSAG

-Rubella antibody titer

OTHER TESTS

1.UTZ- to detect developmental abnormalities, size of the baby, to confirm baby’s position at birth, to locate the placenta, to detect the number of babies, to assess how well the baby is doing

2. Amniocentesis-to detect chromosomal abnormalities, infections, to determine if the baby’s lungs are developed enough

3. Chorionic Villi Sampling-to detect chromosome abnormalities such as Down Syndrome, ad genetic disorders such as cystic fibrosis

4. Maternal Serum Alphafetoprotein-to determine the amount of alphafetoprotein present in the mothers’ blood. A high amount is indicative of spina bifida and anencephaly of the fetus.A low amount may indicate Trisomy 21 and varying degrees of mental retardation.

NON-STRESS TEST

Done to assess FHT vs. fetal activity

Heart beat of the fetus should accelerate by 15 beats for 15 seconds, twice in a 20 minute period(reactive).

-if the result is Non-reactive, the doctor orders for CST/OCT.

CONTRACTION STRESS TEST/OXYTOCIN CHALLENGE TEST

-it evaluates the reaction of the fetal heart rate induced by oxytocin induction or nipple stimulation

-POSITIVE- there is persisent late deceleration

-NEGATIVE-there is no pesistent late deceleration

-SUSPICIOUS- inconstant late decelearation pattern.

HEALTH TEACHINGS

1. Schedule of Clinic Visit

-diagnosis of preg.to 28 wks-every month

-28 wks to 36 wks. every two weeks

-36 wks. until delivery- evry week

2. Exercise

-pelvic rocking

-squatting and tailor sitting

-Rib Cage Lifting

-calf stretching

-shoulder circling

-abdominal muscle contractions

-modified knee chest

ADVANTAGES OF EXERCISE DURING PREGNANCY

-strengthen muscles

- promote circulation

-relieves tension and anxiety

-improves posture and appetite

-improves metabolic efficiency

3. Dental Care

-dental carries should be treated

-alkaline mouthwash can be used to counteract the acidic saliva during pregnancy

4. Clothing

-light-weight, non-constrictive

-absorbent and reasonably priced

-flat heeled shoes

5. BathinG

-daily bath

-no tub bath

-swimming is ok, but no to diving

-no bathing if there is vaginal bleeding and if BOW is ruptured.

6. Breast Care

-well fitting and larger size brassiere

-wash breast with water only

7.Immunizations

-no to Rubella vaccine,Mumps vaccine, Oral Poliomyelitis Vaccine

-Hep B and Typhoid fever vaccine can be given only if risk factors are present.

-TT immunizations

8. Employment

-no lifting of heavy objects

-no sitting and standing for a long time

-no excessive physical and emotional strain

-no to exposure of toxic substances

9. Travel

-Avoid long trips on the third trimester

-best time to travel-second trimester

-when travelling:

-15-20 minute rest period every 2 hours on a long ride

-use shoulder and lap belts

-the place should be pressurized

10. Sexual Relations

-first trimester- decreased sexual desire

-second trimester-increased sexual desire

-third trimester-decreased sexual desire

CONTRAINDICATION OF SEXUAL INTERCOURSE

-deeply presenting part

-rupture of bag of water

-vaginal bleeding or spotting

-incompetent cervix

11. Alcohol

-no to alcohol during pregnancy

12. Caffeine

-not more than 4 cups a day

Effects of Caffeine

-diuretic

-feeling satisfaction without being nutritious

-causes mood swings and sleep disturbances

-interfere with iron absorption

-baby may develop diabetes later in life

13. Drugs

-they should not take any drug nor prescribed by a physician.

DANGER SIGNS OF PREGNANCY

-vaginal bleeding of any amount

-persistent vomiting

-chills and fever

-sudden escape of fluid from the vagina

-swelling of face and fingers

-visual disturbances

-painful urination or dysuria

-abdominal pain

-severe or continous headache

MINOR DISCOMFORTS OF PREGNANCY

• Nausea and vomiting

• Frequent urination

• Fatigue

• Breast tenderness and nipple irritation

• Leukorrhea

• Nasal stuffiness

• Heartburn or pyrosis

• Varicose veins

• Backache

• Leg cramps

• Headache

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