1. MATERNITY NURSING L E C T U R E ( Arellano University) ARLENE D. LATORRE R.N. MAN

6. FEMALE REPRODUCTIVE SYSTEM : EXTERNAL STRUCTURES ( VULVA/ PUDENDUM) A. MONS PUBIS OR MONS VENERIS = PAD OF FAT OVER THE SYMPHYSIS PUBIS. HAIRLESS & SMOOTH IN CHILDHOOD, IT IS COVERED BY DARK & CURLY HAIR CALLED ESCUTCHEON AFTER PUBERTY. HAIR PATTERN IS TRIANGULAR WITH BASE UP. B. LABIA MAJORA = LENGTHWISE, TWO THICK FOLDS OF FATTY SKIN EXTENDING FROM THE MONS TO THE PERINEUM THAT PROTECTS THE LABIA MINORA, URINARY MEATUS AND VAGINAL MUCOSA.

9. C. LABIA MINORA = THINNER, LENGTHWISE FOLDS OF HAIRLESS SKIN, ENCIRCLING THE CLITORIS ANTERIORLY ( PREPUCE ) AND UNITE POSTERIORLY ( FOURCHETTE ) .BELOW THE PREPUCE IS CALLED FRENULUM. HIGHLY SENSITIVE TO MANIPULATION AND TRAUMA, THE REASON WHY IT IS OFTEN TORN DURING DELIVERY. D. VESTIBULE = TRIANGULAR SPACE LOCATED BETWEEN THE LABIA MINORA CONTAINING VAGINAL INTROITUS, URETHRAL MEATUS BARTHOLIN’S & SKENE’S GLANDS

10. E. GLANS CLITORIS = SMALL ERECTILE STRUCTURE; CONTAINS NERVE ENDINGS, SENSITIVE TO TEMPERATURE AND TOUCH . IT IS THE SEAT OF SEXUAL AROUSAL AND EXCITEMENT IN FEMALES . IT IS THE MOST SENSITIVE PART OF A WOMAN’S BODY . IT IS ALSO THE STRUCTURE THAT GUIDES THE NURSE TO THE URINARY MEATUS.

11. F . URETHRAL MEATUS = THE EXTERNAL OPENING OF THE URETHRA. SLIGHTLY BEHIND AND TO THE SIDE ARE THE OPENINGS OF THE SKENE’S GLANDS ( PARAURETHRAL GLANDS ); THE SECRETIONS OF WHICH HELP TO LUBRICATE THE EXTERNAL GENITALIA. THE SHORTNESS OF THE FEMALE URETHRA MAKES WOMEN MORE SUSCEPTIBLE TO UTI THAN MEN. G . HYMEN . = A TOUGH BUT ELASTIC SEMICIRCLE OF TISSUE THAT COVERS THE OPENING TO THE VAGINA. THE REMNANT OF HYMEN IS CALLED CARUNCULAE MYRTIFORMIS.

14. H. VAGINAL ORIFICE / INTROITUS = EXTERNAL OPENING OF THE VAGINA, COVERED BY A THIN MEMBRANE ( HYMEN) IN VIRGINS.LOCATED LATERAL TO THE VAGINAL OPENING ON BOTH SIDES ARE THE BARTHOLIN’S GLANDS ( VULVOVAGINAL GLANDS ). IT LUBRICATES THE EXTERNAL VULVA DURING COITUS AND THE ALKALINE PH OF THEIR SECRETION HELPS TO IMPROVE SPERM SURVIVAL IN THE VAGINA. THE GRAFENBERG OR G-SPOT IS A VERY SENSITIVE AREA LOCATED AT THE INNER ANTERIOR ASPECT OF THE VAGINA.

18. ** DODERLIEN’S BACILLUS MAINTAINS THE NORMAL FLORA OF THE VAGINA, WHICH MAKES THE pH OF VAGINA ACIDIC, DETRIMENTAL TO THE GROWTH OF PATHOLOGIC BACTERIA.

22. B. UTERUS = HOLLOW, MUSCULAR PEAR SHAPED ORGAN LOCATED IN THE PELVIS, WEIGHING 50-60 g IN A NON-PREGNAT WOMAN. HELD IN PLACE BY BROAD LIGAMENTS. ABUNDANT BLOOD SUPPLY COMES FROM UTERINE AND OVARIAN ARTERIES.

27. DIVISIONS OF THE UTERUS 1. CERVIX = LOWER PORTION CALLED THE NECK a. EXTERNAL CERVICAL OS = DISTAL OPENING TO THE VAGINA b. CERVICAL CANAL = THE CAVITY c. INTERNAL CERVICAL OS = OPENING TO THE UTERUS 2. FUNDUS = UPPERMOST CONVEX PORTION AND CAN BE PALPATED TO DETERMINE UTERINE GROWTH DURING PREGNANCY , TO ASSESS UTERINE CONTRACTIONS DURING LABOR,& INVOLUTION DURING THE POSTPARTUM PERIOD

30. 2. MYOMETRIUM = MIDDLE LAYER , EXPELS FETUS DURING BIRTH PROCESS THEN CONTRACTS AROUND BLOOD VESSELS TO PREVENT HEMORRHAGE (OXYTOCIN SITE) 3. ENDOMETRIUM = INNERMOST LAYER; THIS LAYER UNDERGO CHANGES IN RESPONSE TO THE HORMONES AT VARIOUS PHASES OF THE MENSTRUAL CYCLE & DURING PREGNANCY; IT CONSISTS OF TWO LAYERS:

32. UTERINE LIGAMENTS : 1.BROAD LIGAMENT – SUPPORTS THE SIDES OF THE UTERUS & ASSISTS IN HOLDING THE UTERUS IN ITS NORMAL ANTEVERSION AND ANTEFLEXION POSITION.

37. 2. CARDINAL LIGAMENT – LOWER PORTION OF THE BROAD LIGAMENT. IT IS THE MAIN SUPPORT OF THE UTERUS.DAMAGE TO THIS LIGAMENT WILL RESULT TO UTERINE PROLAPSE .

39. 3. UTEROSACRAL LIGAMENT – CONNECTS UTERUS TO THE SACRUM 4. ANTERIOR LIGAMENT – PROVIDES SUPPORT TO THE UTERUS IN CONNECTION WITH THE BLADDER. OVERSTRETCHING OF THIS LIGAMENT WILL LEAD TO HERNIATION OF THE BLADDER TO THE VAGINA ( CYSTOCELE). 5. POSTERIOR LIGAMENT – FORMS THE CUL-DE-SAC OF DOUGLAS. DAMAGE TO THIS LIGAMENT WILL LEAD TO HERNIATION OF THE RECTUM TO THE VAGINA. ( RECTOCELE )

40. C. FALLOPIAN TUBES / OVIDUCTS / UTERINE TUBES = TWO SLENDER MUSCULAR TUBES WHICH ARISES FROM EACH OF THE UPPER CORNER OF THE UTERINE BODY AND EXTEND OUTWARD. PROVIDES A PLACE FOR FERTILIZATION ( CONCEPTION, FECUNDATION, IMPREGNATION) OF OVA BY THE SPERM.

43. PARTS: 1. INTERSTITIAL =( 1cm) LIES WITHIN THE UTERINE WALL. IT HAS THE SMALLEST LUMEN. 2. ISTHMU S =( 2cm) PORTION CUT OR SEALED DURING TUBAL LIGATION .( BTL) 3. AMPULLA =( 5cm) LONGEST PORTION, EXACT SITE OF FERTILIZATION ( DISTAL 3 RD , OUTER 3 RD ) 4. INFUNDIBULUM =MOST DISTAL PORTION; RIM OF THE FUNNEL IS COVERED BY FIMBRAE THAT HELPS GUIDE THE OVA INTO THE FALLOPIAN TUBE.

45. D. OVARIES = ALMOND SHAPED ORGANS LOCATED ON EITHER SIDE OF THE UTERUS. BEFORE PUBERTY, THE OVARIES ARE SMOOTH, FLAT & OVOID ORGANS. AFTER OVULATIONS, THEY ASSUME A NODULAR & PITTED APPEARANCE. FUNCTIONS: = RESPONSIBLE FOR THE PRODUCTION, MATURATION AND DISCHARGE OF OVA AND SECRETION OF ESTROGEN AND PROGESTERONE = ORGAN OF OVULATION

49. FOLLICLES, CORPUS LUTEUM & CORPUS ALBICANS. - two months intrauterine = 600,000 oogonia - 5 months intrauterine = 6,800,000 - at birth = 2 million oocytes - prepuberty / childhood = 300,000 to 400,000 - 36 years old = 30,000 to 40,000 - menopause = absent 3. MEDULLA - LAYER WHICH CONTAINS THE BLOOD VESSELS, LYMPHATICS, NERVES & MUSCLE FIBERS.

52. 3.ACINAR CELLS – MILK SECRETING CELLS THAT IS STIMULATED BY PROLACTIN 4.LACTIFEROUS DUCTS = MILK RESERVOIR – WHICH OPEN TO THE NIPPLE. 5. AREOLA = DARK PIGMENTED PART AROUND THE NIPPLE 6 . MONTGOMERY TUBERCLE = SECRETES FATTY SUBSTANCE TO LUBRICATE NIPPLES 7 . NIPPLE = ELEVATED PART OF THE BREASTS CONTAINING 15-20 OPENINGS FROM THE LACTIFEROUS DUCTS 8 . COOPER’S LIGAMENT = PROVIDES SUPPORT TO THE MAMMARY GLAND

53. PHYSIOLOGY OF MILK PRODUCTION ** THE PRODUCTION OF BREAST MILK IS NOT ACHIEVED DURING PREGNACY BECAUSE OF THE PREDOMINANCE OF ESTROGEN & PROGESTERONE. ** IMMEDIATELY AFTER THE DELIVERY OF THE PLACENTA, THERE IS MARKED DECREASE OF BOTH ESTROGEN & PROGESTERONE W/C SERVES AS A STIMULUS FOR THE APG TO PRODUCE PROLACTIN . ** PROLACTIN ACTS ON THE ACINI CELLS TO STIMULATE PRODUCTION OF MILK & ARE THEN STORED IN THE LACTIFEROUS DUCTS.

54. ** AS THE INFANT SUCKS, THE PPG IS STIMULATED TO RELEASE THE HORMONE OXYTOCIN CAUSING THE COLLECTING SINUSES OF THE MAMMARY GLANDS TO CONTRACT, FORCING MILK FORWARD THROUGH THE NIPPLES CALLED “ LET DOWN REFLEX ” OR “ MILK EJECTION REFLEX ” .

59. = EACH LOBULE CONTAINS INTERSTITIAL CELLS ( LEYDIG’S CELLS ) AND SEMINIFEROUS TUBULES = SEMINIFEROUS TUBULES PRODUCE SPERMATOZOA = LEYDIG’S CELLS PRODUCE THE HORMONE TESTOSTERONE

62. b. FSH = FOLLICLE STIMULATING HORMONE = CAUSES RAPID SPERM PRODUCTION BY THE TUBULE c. ICSH – INTERSTITIAL CELL STIMULATING HORMONE = STIMULATES LEYDIG’S CELLS TO INCREASE TESTOSTERONE PRODUCTION

63. Male

65. MALE REPRODUCTIVE SYSTEM: 4. Ejaculatory duct : the canal formed by the union of the vas deferens and the excretory duct of the seminal vesicle, which enters the urethra at the prostate gland. 5. Prostate Gland : located just below the urinary bladder. Secretes alkaline and most of the seminal fluid. 6. Bulbourethral glands or Cowper’s Gland : adds alkaline fluid to the semen. Counterpart of the Bartholin’s glands in females. 7. Urethra : the passageway for both urine and semen, extending from the bladder to the urethral meatus . (8 inches in long)

66. SEMINAL FLUID / SEMEN : = A GRAYISH WHITISH SUBSTANCE CONTAINING SPERMATOZOA AND FRUCTOSE RICH SUBSTANCES. = AT THE TIME OF EJACULATION, APPROXIMATELY 3-5 ML OF SEMEN IS SECRETED WITH ABOUT 100 MILLION SPERMATOZOA PER ML, OR ABOUT 250-500 MILLION SPERMATOZOA AT EACH EJACULATION. IF THE SPERM COUNT DROPS TO LESS THAN 20 MILLION PER ML OF SEMEN, THE RATE IS CONSIDERED INFERTILE .

72. SEQUENTIAL ORDER OF PUBERTAL CHANGES IN GIRLS : 1. GROWTH SPURT 2. INCREASE IN THE TRANSVERSE DIAMETER OF THE PELVIS 3. BREAST DEVELOPMENT (THELARCHE) 4. GROWTH OF PUBIC HAIR 5. ONSET OF MENSTRUATION (MENARCHE) 6. GROWTH OF AXILLARY HAIR(ADRENARCHE) 7. VAGINAL SECRETIONS

75. MENSTRUAL CYCLE / FEMALE REPRODUCTIVE CYCLE = EPISODIC UTERINE BLEEDING IN RESPONSE TO HORMONAL CHANGES = PERIODIC SERIES OF CHANGES THAT RECUR IN THE UTERUS AND ASSOCIATED ORGANS BEGINNING AT PUBERTY AND ENDING AT MENOPAUSE = TAKEN FROM THE FIRST DAY OF MENSTRUATION TO THE FIRST DAY OF THE NEXT MENSTRUATION

76. Basis for menstrual cycle is 6-12 month graphing. Menarche – first menstrual period that occurs typically at age 12 but may occur as early as 9 or as late as 17. Thelarche – is the development of the breast buds that occur at puberty. Adrenarche – is the development of pubic & axillary hair due to androgen stimulation.

81. PHASES OF THE MENSTRUAL CYCLE 1. PROLIFERATIVE/ FOLLICULAR/ ESTROGENIC/PREOVULATORY/POST MENSTRUAL 2. SECRETORY/ LUTEAL/ PROGESTATIONAL POST OVULATORY 3. PREMENSTRUAL OR ISCHEMIC PHASE 4. MENSTRUAL PHASE

86. 12345678910111213141516171819202122232425262728 Uterine phase Ovarian phase Menstrual phase Proliferative phase Secretory phase Follicular phase Luteal phase Ovulatory Phase Ischemic

89. OVARIAN cycle Consists of three phases 1. Pre-ovulatory : follicular phase 2. Ovulatory phase 3. Post-ovulatory : Luteal phase

98. 6. MOOD CHANGES DUE TO HORMONAL CHANGES 7. BREAST CHANGES AND ENLARGEMENT AND NIPPLES BECOME ERECT 8. INCREASED LIBIDO

100. 6. INCREASES CONTRACTIONS OF THE FALLOPIAN TUBES 7. INCREASES QUANTITY AND PH OF CERVICAL MUCUS CAUSING IT TO BECOME THIN & WATERY & CAN BE STRETCHED TO A DISTANCE OF 10-13CM ( SPINNBARKHEIT TEST OF ELASTICITY ) 8. STIMULATES UTERINE CONTRACTIONS

104. Menstrual disorders 1. Dysmenorrhea – painful menstruation 2. POLYMENORRHEA = TOO FREQUENT MENSTRUATION OCCURING AT INTERVALS OF LESS THAN THREE WEEKS 3. MENORRHAGIA = EXCESSIVE MENSTRUAL BLEEDING 4. METRORRHAGIA = BLEEDING BETWEEN PERIODS; INTERCYCLIC BLEEDING 5. HYPOMENORRHEA = ABNORMALLY SHORT MENSTRUATION 6. HYPERMENORRHEA = ABNORMALLY LONG MENSTRUATION 7. AMENORRHEA – absence of menses 8 . OLIGOMENORRHEA – decreased menstrual flow

106. 2. PLATEAU PHASE = NIPPLES BECOME FURTHER ENGORGED. IN MEN, VASOCONGESTION LEADS TO FULL DISTENTION OF THE PENIS, FLUSHING OCCURS “SEX FLUSH”, BREATHING BECOMES DEEPER, CR,RR & BP INCREASE MARKEDLY 3. ORGASMIC PHASE = SHORTEST STAGE IN THE SEXUAL RESPONSE CYCLE, STRONG MUSCULAR CONTRACTIONSBOTH VOLUNTARY & INVOLUNTARY IN MANY PARTS OF THE BODY, RR,CR DOUBLES AND BP INCREASING AS MUCH AS 1/3 ABOVE NORMAL.

107. 4. RESOLUTION PHASE = GENERALLY TAKES APPROXIMATELY 30 MINUTES FOR BOTH MEN & WOMEN , GENERAL MUSCLE RELAXATION OCCURS, EXTERNAL & INTERNAL ORGANS TO UNAROUSED STATE. ** REFRACTORY PHASE IN MEN

109. ** OVUM CAN STAY VIABLE & IS CAPABLE OF BEING FERTILIZED FOR 12-24 HOURS AFTER OVULATION BUT CAN LIVE UP TO 3-4 DAYS. ** MATUR

112. ** HAS 3 PARTS : HEAD THAT CONTAIN CHROMATIN MATERIALS; NECK OR MID PIECE THAT PROVIDE ENERGY & TAIL THAT IS RESPONSIBLE FOR ITS MOTILITY. **SPERMATOZOA DEPOSITED IN THE VAGINA REACHES THE WAITING EGG IN THE FALLOPIAN TUBE IN ABOUT 5 MINUTES ** THE FUNCTIONAL LIFE OF SPERMATOZOA IS 48-72 HRS (OR 3 TO 4 DAYS AFTER EJACULATION) BUT CAN STAY ALIVE IN THE VAGINA FOR 5 -7 DAYS. SPERM CELL : .

115. ** When the sperm cell reaches the uterus, it removes its protective covering, a process called “ CAPACITATION” , the outer covering at the head of the sperm cell disappears & tiny holes appear on it. ** when it meets the ovum in the fallopian tube it secretes the enzymes HYALURONIDASE through the holes in its head which dissolves the outermost covering of the egg cell, the corona radiata (a process called “ ACROSOME REACTION ”.) ** when radiata is dissolved, the sperm will again secrete another enzyme called ACROSIN to dissolve a portion of the zona pellucida & will enter the ovum.

116. ** once the sperm cell has entered the ovum & their nucleus has fused together, fertilization is completed . ** the plasma membrane of the ovum will undergo structural changes to prevent POLYSPERMY ( or other sperms cells entering the ovum) ** the hereditary traits & characteristics of a person are found in the cell’s nucleus in the form of chromosomes. Each strand of chromosome is made up of thousands of genes that are composed of protein substances called deoxyribose nucleic acid (DNA) & ribonucleic acid (RNA)

117. ** REPRODUCTIVE CELLS, DURING GAMETOGENESIS DIVIDE BY MEIOSIS ( HAPLOID NUMBER OF DAUGHTER CELLS ) THEREFORE THEY CONTAIN ONLY 23 CHROMOSOMES). = 22 pairs of autosomes = 1 pair of sex chromosomes

118. ** ( BODY CELLS OR SOMATIC CELLS HAVE 46 CHROMOSOMES BEC THEY DIVIDE VIA MITOSIS) ** SPERMS HAVE 23 CHROMOSOMES = 22 AUTOSOMES & 1 X SEX CHROMOSOME OR 1 Y SEX CHROMOSOME. ** THE UNION OF AN X CARRYING SPERM (GYNOSPERM) & A MATURE OVUM RESULTS IN A BABY GIRL (XX) ** THE UNION OF A Y CARRYING SPERM(ANDROSPERM) & A MATURE OVUM RESULTS IN A BABY BOY (XY) ** ONLY FATHERS CAN DETERMINE THE SEX OF THEIR CHILDREN ** SEX OF A CHILD IS DETERMINED AT THE TIME OF FERTILIZATION.

121. ZYGOTE : - IS THE FIRST CELL FORMED FROM THE FERTILIZATION OF SPERM & OVUM. - IT CONTAINS 46 CHROMOSOMES: 44 AUTOSOMES & EITHER XX CHROMOSOMES IF THE OFFSPRING IS A FEMALE, OR XY CHROMOSOME, IF THE OFFSPRING IS A MALE. - IT JOURNEYS FROM THE FALLOPIAN TUBE TO THE UTERUS FOR 3-5 DAYS - 16 HOURS AFTER FERTILIZATION, IT UNDERGOES ITS FIRST CELL DIVISION ,” BLASTOMERE”

124. - WHEN THERE ARE ALREADY 16 OR MORE BLASTOMERES, THE ZYGOTE IS TERMED “ MORULA ”( MORUS – MULBERRY) - WHEN IT REACHES THE UTERUS IT IS TRANSFORMED INTO A “ BLASTOCYST ” – A BALL LIKE STRUCTURE COMPOSED OF AN INNER CELL MASS , CALLED EMBRYONIC DISC OR BLASTOCELE & AN OUTER LAYER OF RAPIDLY DEVELOPING CELLS CALLED TROPHOBLASTS OR TROPHODERM. FLUID FILLS THE SPACES FOUND WITHIN THE CELLS. -

127. TROPHOBLASTS OR THE OUTER CELLS: AT ABOUT 3 WEEKS, THE TROPHOBLAST CELLS DIFFERENTIATE INTO TWO DISTINCT LAYERS: 1.CYTOTROPHOBLAST OR LANGHAN’S LAYER : - INNER LAYER THAT PROTECTS THE FETUS AGAINST SYPHILIS UNTIL THE 2 ND TRIMESTER. 2. SYNCYTIOTROPHOBLAST OR SYNCYTIAL LAYER : - OUTER LAYER THAT PRODUCES THE HORMONES 1. HUMAN CHORIONIC GONADOTROPIN (HCG), 2.HUMAN PLACENTAL LACTOGEN (HPL). 3.ESTROGEN & 4.PROGESTERONE.

128. 1.HCG: HUMAN CHORIONIC GONADOTROPIN - FIRST HORMONE TO APPEAR IN PREGNANCY WHICH SERVES AS THE BASIS FOR PREGNANCY TESTING - SECRETED BY TROPHOBLASTS DURING EARLY PREGNANCY - PREVENTS INVOLUTION OF THE CORPUS LUTEUM, STIMULATES IT TO CONTINUE PRODUCING PROGESTERONE AND ESTROGEN FOR 11-12 WEEKS - 8 – 10 DAYS AFTER FERTILZATION, HCG IS PRESENT IN THE MATERNAL BLOOD - FEW DAYS AFTER MISSED MENSES (+) IN THE URINE

132. ORIGIN AND DEVELOPMENT OF ORGAN SYSTEMS

133. - At the time of implantation, the blastocyst already has differentiated at which two separate cavities appear in the inner structure.1. a large one, the Amniotic cavity which is lined with ECTODERM cells 2. a smaller cavity, the yolk sac, lined with ENDODERM cells ( provides fetal RBC until the embryo’s hematopoietic system matures on the 12 th week after which it atrophies) - Between the amniotic cavity and the yolk sac, a third layer of cells, the MESODERM forms . The embryo will begin to develop at the point where the three cell layers ( ECTODERM, MESODERM, ENDODERM) meet called embryonic shield.

134. - THE BLASTOCELE OR EMBRYONIC DISC GIVES RISE TO THE THREE PRIMARY GERM LAYERS: ECTODERM, MESODERM, ENDODERM.

135. PRIMARY GERM LAYERS TISSUE LAYER BODY PORTIONS FORMED ECTODERM NERVOUS SYSTEM, SKIN, HAIR ( OUTER LAYER) NAILS, SENSE ORGANS, MUCUS MEMBRANES OF NOSE & MOUTH MESODERM CONNECTIVE TISSUE, BONES, ( MIDDLE LAYER) CARTILAGE, MUSCLES, TENDONS, KIDNEYS, URETERS, REPRODUCTIVE SYSTEM, HEART, CIRCULATORY SYSTEM, BLOOD CELLS

136. ENDODERM / ENTODERM LINING OF THE GI TRACT, ( INNER LAYER) RESPIRATORY TRACT, TONSILS, PARATHYROID, THYROID, THYMUS GLANDS, BLADDER, URETHRA

138. 2. AMNIOTIC MEMBRANE –( INNER FETAL MEMBRANE) = IT IS A SMOOTH, THIN, TOUGH & TRANSLUCENT MEMBRANE DIRECTLY ENCLOSING THE FETUS & THE AMNIOTIC FLUID. IT IS CONTINUOUS WITH THE UMBILICAL CORD & COVER THE FETAL SURFACE OF THE PLACENTA & UMBILICAL CORD. = AMNION & CHORION DOES NOT CONTAIN NERVE ENDINGS

141. IMPLANTATION/NIDATION - THE BLASTOCYST REMAINS FREE FLOATING IN THE UTERINE CAVITY FOR 3-5 DAYS & IMPLANTS IN THE ENDOMETRIUM 6-7 ( 8-10 ) DAYS AFTER FERTILIZATION. - AS IT ATTACHES ITSELF TO THE WALL OF THE UTERUS ( APPOSITION ), ITS TROPHOBLAST CELLS RELEASE ENZYMES ALLOWING IT TO BURROW DEEP & THEN ATTACHES INTO THE ENDOMETRIUM ( ADHESION ) RESULTING IN RUPTURE OF VESSELS & BLEEDING AT THE IMPLANTATION SITE. “ IMPLANTATION BLEEDING ”. AFTERWHICH IT SETTLES DOWN INTO ITS SOFT FOLDS ( INVASION) IMPLANTA

145. AMNIOTIC FLUID : - 500 ML TO 1200 ML AT TERM; AVERAGE 1000 ML; replaced approximately every 3 hours - 99% WATER & 1% SOLID PARTICLES CONTAINING ALBUMIN, UREA, URIC ACID, CREATININE, LECITHIN, SPHINGOMYELIN, BILIRUBIN & VERNIX CASEOSA. - SHOULD BE CLEAR, COLORLESS TO STRAW COLORED WITH TINY SPECKS OF VERNIX CASEOSA. - AMNIOTIC FLUID VOLUME INCREASES DURING PREGNANCY & PEAKS APPROXIMATELY 2 WEEKS BEFORE EDC

149. UMBILICAL CORD / FUNIS -STRUCTURE THAT CONNECTS THE FETUS TO THE PLACENTA - MAIN FUNCTION IS TO CARRY O2 & NUTRIENTS FROM THE PLACENTA TO THE FETUS & RETURN THE UNOXYGENATED BLOOD & FETAL WASTE PRODUCTS TO THE PLACENTA. - 50 -55 CMS LONG. APPEARS DULL WHITE,MOIST & COVERED BY AMNION. - COMPOSED OF 2 ARTERIES & 1 VEIN ( AVA ) - IF ONLY TWO BLOOD VESSELS, SUSPECT RENAL AND CARDIAC ANOMALIES.

150. - 2 arteries carry deoxygenated blood from the fetus to the placenta - 1 vein carries oxygenated blood to the fetus, along with nutrients, hormones etc

151. ** UMBILICAL CORD ORIGINATES FROM THE YOLK SAC & UMBILICAL VESICLES. ** WHARTON’S JELLY – GELATINOUS SUBSTANCE THAT COVERS THE UMBILICAL CORD TO PREVENT TRAUMA TO THE CORD.

159. Umbilical knot

160. THE PLACENTA IS FORMED FROM THE CHORIONIC VILLI AND DECIDUA BASALIS . ** ITS GROWTH PARALLELS THAT OF THE FETUS, GROWING FROM A FEW IDENTIFIABLE CELLS AT THE BEGINNING OF PREGNANCY TO AN ORGAN 15 TO 20 CM IN DIAMETER. IT COVERS ABOUT HALF OF THE SURFACE OF THE INTERNAL UTERUS * IT REACHES MATURITY AT 8 WEEKS AND BECOMES FUNCTIONAL AT 12 WEEKS GESTATION ( 3 MONTHS) AND CONTINUE TO FUNCTION EFFECTIVELY UNTIL THE 40 TO 41ST WEEK.. IT BEGINS TO DEGENERATE AFTER THE 42ND WEEK MAKING IT DANGEROUS FOR THE FETUS TO REMAIN IN UTERO BEYOND 42 WEEKS GESTATION. * DEVELOPMENT IS STIMULATED BY PROGESTERONE SECRETED BY THE CORPUS LUTEUM PLACENTA

164. FUNCTIONS OF THE PLACENTA 1. RESPIRATORY SYSTEM = EXCHANGE OF GASES TAKES PLACE IN THE PLACENTA, NOT IN THE FETAL LUNG 2. RENAL SYSTEM = WASTE PRODUCTS ARE BEING EXCRETED THROUGH THE PLACENTA NOTE: IT IS THE MOTHER’S LIVER WHICH DETOXIFIES THE FETAL WASTE PRODUCTS 3. GASTROINTESTINAL SYSTEM = NUTRIENTS PASS TO THE FETUS VIA THE PLACENTA BY DIFFUSION THROUGH THE PLACENTAL TISSUES.

165. 4. CIRCULATORY SYSTEM = FETO PLACENTAL CIRCULATION IS ESTABLISHED BY SELECTIVE OSMOSIS 5. PROTECTIVE BARRIER = INHIBITS PASSAGE OF CERTAIN BACTERIA & LARGE MOLECULES ** PROVIDES MATERNAL IMMUNOGLOBULIN G ( IG G) THAT GIVES FETUS PASSIVE IMMUNITY TO CERTAIN DISEASES FOR THE FIRST FEW MONTHS AFTER BIRTH. 6. ENDOCRINE SYSTEM = PRODUCES HORMONES HCG, HPL ( HUMAN PLACENTAL LACTOGEN “ CHORIONIC SOMATOMAMMOTROPIN”, ESTROGEN , PROGESTERONE, RELAXIN

172. The Growing Fetus

174. NORMAL FETAL DEVELOPMENT ( measurement done at end of the lunar month) 4 WEEKS FORM OF EMBRYONIC DISC, NOT CLEARLY DEFINED FEATURES, SPINAL CORD IS FORMED; RUDIMEN TARY HEART APPEARS AS A PROMINENT BULGE ON THE ANTERIOR SURFACE, ARMS & LEGS BUD LIKE STRUCTURES, RUDIMENTARY EYES, EARS, & NOSE ARE DISCERNABLE L = 0.75 to 1 cm W= 400 mg

175. 8 WEEKS ORGANOGENESIS IS COMPLETE, HEART BEATS RHYTHMICALLY, , FACIAL FEATURES ARE DISCERNABLE,EXTREMITIES HAVE DEVELOPED,, EXTERNAL GENITALIA PRESENT BUT SEX IS NOT DISTINGUISHABLE PRIMITIVE TAIL IS REGRESSING, ABDOMEN APPEARS LARGE AS FETAL INTESTINES GROWS RAPIDLY,EYES MOVE FROM FACE TO FRONT SONOGRAM SHOWS GESTATIONAL SAC ( DIAGNOSTIC OF PREGNANCY) L= 2.5 cm ( 1 inch) W=20g

176. 12 WEEKS NAIL BEDS FORMING ON FINGERS & TOES, BONE OSSIFICATION BEGINS, TOOTH BUDS PRESENT, SEX DISTINGUISHABLE BY OUTWARD APPEARANCE, KIDNEYS SECRETE, HEARTBEAT AUDIBLE BY A DOPPLER 16 WEEKS FETAL HEART SOUNDS AUDIBLE VIA FETOSCOPE , LANUGO IS WELL FORMED, LIVER & PANCREAS FUNCTIONING, FETUS SWALLOWS AMNIOTIC FLUID SHOWING AN INTACT BUT UNCOORDINATED SWALLOWING REFLEX, SEX CAN BE DETERMINED BY ULTRASOUND; QUICKENING FELT BY A MULTIGRAVIDA L=7 TO 8 CM w- 45G L-10 TO 17CM W-55 TO 120 G

177. 20 WEEKS QUICKENING FELT BY A PRIMAGRAVIDA, ANTIBODY PRODUCTION IS POSSIBLE, HAIR FORMS INCLUDING EYEBROWS & HAIR ON HEAD, MECONIUM PRESENT IN UPPER INTESTINE, BROWN FAT ( AIDS IN TEMPERATURE REGULATION AT BIRTH) BEGINS TO BE FORMED BEHIND THE KIDNEYS, STERNUM, & POSTERIOR NECK, FETAL HEART AUDIBLE VIA STETHOSCOPE, VERNIX CASEOSA BEGINS TO FORM, DEFINITE SLEEPING PATTERNS ARE DISTINGUISHABLE ( WILL GUIDE SLEEP/WAKE PATTERNS THROUGHOUT LIFE L= 25 CMS W= 223g

179. 24 WEEKS PASSIVE ANTIBODY TRANSFER FROM MOTHER TO FETUS BEGINS .INFANTS BORN BEFORE ANTIBODY . TRANSFER HAS TAKEN PLACE HAVE NO NATURAL IMMUNITY & NEED MORE THAN THE USUAL PROTECTION AGAINST INFECTIOUS DISEASE IN THE NEWBORN UNTIL THE INFANT’S OWN STORE OF IG’S CAN BUILD UP; MECONIUM IS PRESENT IN THE RECTUM; ACTIVE PRODUCTION OF LUNG SURFACTANT BEGINS; EYEBROWS & EYELASHES WELL DEFINED; EYELIDS NOW OPEN; PUPILS REACTIVE TO LIGHT; HEARS IN RESPONSE TO SUDDEN SOUND. L = 28 TO 36 CMS W= 550g

180. 28 WEEKS LUNG ALVEOLI BEGINS TO MATURE; SURFACTANT PRESENT IN AMNIOTIC FLUID; TESTES BEGIN TO DESCEND;BLOOD VESSELS OF THE RETINA ARE THIN & EXTREMELY SUSCEPTIBLE TO DAMAGE ( an imp. consideration when caring for preterm infants who need oxygen) 32 SUBCUTANEOUS FAT BEGINS TO BE DEPOSITED ( THE FORMER “ STRINGY” OLD MAN APPEARANCE IS LOST); FETUS IS AWARE OF SOUNDS OUTSIDE THE MOTHERS BODY; ACTIVE MORO REFLEX PRESENT, BIRTH POSITION( VERTEX OR BREECH) MAY BE ASSUMED; IRON STORES THAT PROVIDE IRON FOR THE TIME THAT THE NEONATE WILL INGEST ONLY MILK AFTER BIRTH ARE BEGINNING TO BE DEVELOPED; FINGERNAILS GROW TO REACH END OF FINGERTIPS. weeks

181. 36 WEEKS ADDITIONAL AMOUNTS OF SUBCATANEOUS FATS ARE DEPOSITED ; SOLE OF THE FOOT HAS ONLY ONE OR TWO CRISSCROSS CREASES; LANUGO BEGINS TO DIMINISH; MOST BABIES TURN INTO A VERTEX OR HEAD-DOWN PRESENTATION DURING THIS MONTH 40 WEEKS FETUS KICKS ACTIVELY CAUSING DISCOMFORT TO THE MOTHER; VERNIX CASEOSA IS FULLY FORMED; ** IN PRIMIPARAS, THE FETUS OFTEN SINKS INTO THE BIRTH CANAL DURING THE LAST TWO WEEKS ( UP TO 4 WEEKS), GIVING THE MOTHER A FEELING THAT HER LOAD IS BEING LIGHTENED. THIS IS TERMED LIGHTENING . IT IS A FETAL ANNOUNCEMENT THAT THE THIRD TRIMESTER OF PREGNANCY HAS ENDED AND BIRTH IS AT HAND.** L-48 to 52 cm W-3,000g -7 to 7.5 lbs

182. ** THE DURATION OF A NORMAL PREGNANCY IS 266 – 280 DAYS OR 38-42 WEEKS ( AVERAGE IS 40 WEEKS) ; OR 9 CALENDAR MONTHS OR 10 LUNAR MONTHS. ** BOTH OVULATION & GESTATIONAL AGE ARE ALSO SOMETIMES MEASURED IN LUNAR MONTHS ( 4 WEEK PERIODS) OR IN TRIMESTERS ( 3 MONTH PERIOD) RATHER THAN IN WEEKS. IN LUNAR MONTHS, A PREGNANCY IS 10 MONTHS ( 40 WEEKS OR 280 DAYS) LONG; A FETUS GROWS IN UTERO 9.5 LUNAR MONTHS OR THREE FULL TRIMESTERS ( 38 WEEKS OR 266 DAYS)

183. Psychological Tasks of Pregnancy

184. PATERNAL REACTIONS TO PREGNANCY : A. FIRST TRIMESTER = AMBIVALENCE & ANXIETY ABOUT ROLE CHANGE; CONCERN FOR IDENTIFICATION WITH MOTHER’S DISCOMFORTS ( COUVADE SYNDROME ) B. SECOND TRIMESTER = INCREASED CONFIDENCE & INTEREST IN MOTHER’S CARE; DIFFICULTY RELATING TO FETUS; “ JEALOUSY ”

187. CHLOASMA LINEA NIGRA STRIAE GRAVIDARUM STRIAE ALBICANTES

190. SYSTEMIC CHANGES: CIRCULATORY / CARDIOVASCULAR : ** BEGINNING THE END OF THE FIRST TRIMESTER, THERE IS A GRADUAL INCREASE OF ABOUT 30%-50% IN TOTAL CARDIAC VOLUME. THIS CAUSES A DROP IN HgB & HcT VALUES SINCE THE INCREASE IS ONLY IN PLASMA .” PHYSIOLOGIC ANEMIA OF PREGNANCY” Mx : iron supplement

191. CONSENQUENCES OF INCREASED CARDIAC VOLUME: ** EASY FATIGABILITY & SOB DUE TO INCREASED WORKLOAD OF THE HEART MX: REST ** SLIGHT HYPERTHOPHY OF THE HEART CAUSING IT TO BE DISPLACED TO THE LEFT ** SYSTOLIC MURMURS DUE TO LOWERED BLOOD VISCOSITY ** NOSEBLEEDS MAY OCCUR DUE TO MARKED CONGESTION OF THE NASOPHARYNX

192. ** PALPITATIONS DUE TO INCREASED PRESSURE ON THE DIAGPHRAGM ** EDEMA OF LOWER EXTERMITIES OCCURS DUE TO POOR CIRCULATION RESULTING FROM PRESSURE OF THE GRAVID UTERUS ON THE BLOOD VESSELS MX; > RAISE LEGS ABOVE HIP LEVEL > AVOID PROLONGED STANDING & SITTING NOTE: EDEMA OF THE LE IS NOT A SIGN OF TOXEMIA.

193. ** VARICOSITIES COULD OCCUR DUE TO PRESSURE OF THE GRAVID UTERUS ON THE BLOOD VESSELS OF THE LE MX: > DO NOT CROSS LEGS WHEN SITTING > WEAR SUPPORT HOSE TO PROMOTE VENOUS FLOW THUS PREVENTING STASIS IN THE LOWER EXTREMITIES > AVOID USE OF KNEE HIGH SOCKS

194. ** VARICOSITIES OF THE VULVA & RECTUM MX: > SIDE LYING POSITION WITH HIPS ELEVATED ON PILLOWS > MODIFIED KNEE CHEST POSITION ** THERE IS INCREASED CIRCULATING FIBRINOGEN ( CLOTTING FACTOR) THAT IS WHY PREGNANT WOMEN ARE NORMALLY SAFEGUARDED AGAINST UNDUE BLEEDING. HOWEVER THIS ALSO PREDISPOSES THEM TO CLOT FORMATION ( THROMBI)

195. IMPLICATION : PREGNANT WOMEN SHOULD NOT BE MASSAGED SINCE BLOOD CLOTS CAN BE RELEASED & CAUSE THROMBOEMBOLISM. ** DURING DELIVERY, THE ALLOWABLE BLOOD LOSS IS 250-450 ML (MAXIMUM 500 ML) FOR A SINGLE FETUS, 1000 ML FOR VAGINAL DELIVERY OF TWINS OR CESARIAN SECTION.

196. ** SUPINE HYPOTENSION SYNDROME OR VENA CAVA SYNDROME = THE WEIGHT OF THE GRAVID UTERUS PRESSES ON THE VENA CAVA OBSTRUCTING BLOOD FLOW. THE WOMAN EXPERIENCES LIGHTHEADEDNESS , FAINTNESS & HEART PALPITATIONS . MX: LEFT SIDE LYING OR LEFT LATERAL SO AS NOT TO COMPRESS THE VENA CAVA. NO SUPINE POSITION AFTER 20 WEEKS AOG

197. RESPIRATORY SYSTEM : ** SLIGHT DYSPNEA MAY OCCUR UNTIL LIGHTENING CAUSED BY INCREASED O2 CONSUMPTION & PRODUCTION OF CO2 GASTROINTESTINAL SYSTEM : ** MORNING SICKNESS MX: EAT DRY CRACKERS 30 MINUTES BEFORE ARISING IN THE MORNING. AVOID SPICY, FATTY FOODS

198. HYPEREMESIS GRAVIDARUM ( PERNICIOUS VOMITING ) = EXCESSIVE NAUSEA & VOMITING WHICH PERSISTS BEYOND 3 MONTHS THAT COULD RESULT TO DEHYDRATION, STARVATION, MALNUTRITION AND F & E IMBALANCE MX: 3000 ML f Ringer’s Lactate with added Vit B IN 24 HOURS IS THE PRIORITY OF TREATMENT > REST > ANTI- EMETICS (EX. PLASIL, REGLAN ) - Cause is unknown but women with the disorder may have increased thyroid function d/t the thyroid stimulating properties of HCG

200. HEARTBURN = REFLUX OF STOMACH CONTENT INTO THE ESOPHAGUS DUE TO INCREASED PROGESTERONE WHICH DECREASES GASTRIC MOTILITY MX: > PATS OF BUTTER BEFORE MEALS > AVOID FRIED, FATTY FOODS > BEND AT THE KNEES NOT AT THE WAIST > TAKE ANTACIDS EX. MILK OF MAGNESIA BUT NEVER SODIUM NHCO3 ( ALKA SELTZER OR BAKING SODA) BECAUSE IT PROMOTES FLUID RETENTION. > DON’T LIE DOWN AFTER EATING

201. PICA = **ABNORMAL CRAVING FOR NON NUTRITIOUS SUBSTANCES. THE MOST COMMON IS CRAVING FOR ICE CUBES. THERE COULD ALSO BE CRAVING FOR PAPER, ETC., **OFTEN ACCOMPANIES IRON DEFICIENCY ANEMIA **ENCOURAGE TO TAKE IRON SUPPLEMENTS

202. MUSCULOSKELETAL SYSTEM GRADUAL SOFTENING OF PELVIC LIGAMENTS AND JOINTS TO FACILITATE PASSAGE OF THE BABY. ( RELAXIN) LORDOSIS = FORWARD CURVATURE OF THE LUMBER SPINE . “THE PRIDE OF PREGNANCY ” LEG CRAMPS – ALSO KNOWN AS “CHARLEY HORSE” MAY OCCUR FROM AN IMBALANCE OF CALCIUM / PHOSPHORUS RATIO IN THE BODY AND FROM PRESSURE OF THE UTERUS ON LOWER EXTREMITIES; FATIGUE; CHILLS BACK PAINS – RELIEVED BY WEARING LOW HEELED SHOES

203. MANAGEMENT: **FREQUENT REST PERIODS WITH FEET ELEVATED **WEAR WARM, COMFORTABLE CLOTHING **INCREASE CALCIUM INTAKE (CALCIUM TABLETS AND DIET) **DO NOT MASSAGE= BLOOD CLOTS CAN CAUSE EMBOLISM

211. MLNG CELESTE, RN, MD

216. PATERNAL REACTIONS TO PREGNANCY : A. FIRST TRIMESTER = AMBIVALENCE & ANXIETY ABOUT ROLE CHANGE; CONCERN FOR IDENTIFICATION WITH MOTHER’S DISCOMFORTS ( COUVADE SYNDROME ) B. SECOND TRIMESTER = INCREASED CONFIDENCE & INTEREST IN MOTHER’S CARE; DIFFICULTY RELATING TO FETUS; “ JEALOUSY ”

218. COMPONENTS OF PRE NATAL VISIT 1. PRE - CONSULTATION PHASE: History Taking PERSONAL DATA: AGE, SEX, CIVIL STATUS, WEIGHT, HEIGHT 1. AGE : UNDER 17 OR ABOVE 35 (GREATER RISK IF OVER 40) ** PREGNANT ADOLESCENTS HAVE A HIGHER INCIDENCE OF PREMATURITY, PIH , CEPHALOPELVIC DISPROPORTION, POOR NUTRITION & INADEQUATE ANTEPARTAL CARE . ** WOMEN OVER 35 YEARS OLD ARE AT RISK FOR CHROMOSOMAL DISORDERS IN INFANTS, PIH & CESARIAN DELIVERY.

219. OBSTETRICAL DATA : MENSTRUAL HISTORY : INCLUDES MENARCHE, LENGTH & REGULARITY OF MENSES, INTERVAL BETWEEN PERIODS, AMOUNT OF FLOW, DYSMENORRHEA TERMINOLOGIES : GRAVIDA = THE NUMBER OF PREGNANCIES REGARDLESS OF DURATION OR OUTCOME PARA = PAST PREGNANCIES RESULTING IN VIABLE FETUS ( 20 WEEKS) WHETHER BORN DEAD OR ALIVE. ( TWINS, TRIPLETS ETC. CONSIDERED AS ONE).

220. T = NUMBER OF FULL TERM BIRTHS P = NUMBER OF PREMATURE BIRTHS A = NUMBER OF ABORTIONS L = NUMBER OF LIVING CHILDREN M = MULTIPLE PREGNANCIES PRIMIGRAVIDA = A WOMAN WHO IS PREGNANT FOR THE FIRST TIME PRIMIPARA = A WOMAN WHO HAS DELIVERED A VIABLE LIVE OR DEAD CHILD MULTIGRAVIDA = A WOMAN WHO HAS HAD 2 OR MORE PREGNANCIES NULLIGRAVIDA = A WOMAN WHO HAS NEVER BEEN & IS NOT CURRENTLY PREGNANT

221. NULLIPARA – A WOMAN WHO HAS NEVER DELIVERED A FETUS THAT REACHED THE AGE OF VIABILITY. SUCH WOMAN MAY OR MAY NOT HAVE BEEN PREGNANT BEFORE. MULTIPARA – A WOMAN WHO HAS COMPLETED TWO OR MORE PREGNANCIES TO THE AGE OF VIABILITY.

222. EX: Utilize the GTPAL system to classify a woman who is currently 8 months pregnant. This is her fourth pregnancy. She delivered 1 baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation. a.3 2 1 2 1 b.4 2 2 1 1 c.3 2 1 1 1 d.4 1 1 1 1

227. MATERNAL MORTALITY RATE – NUMBER OF DEATHS THAT OCCURRED DUE TO COMPLICATIONS OF PREGNANCY, LABOR & PUERPERIUM PER 10,000 LIVE BIRTHS. THE THREE MAJOR CAUSES OF MATERNAL MORTALITY ARE: 1. HEMORRHAGE 2. INFECTION 3. PREGNANCY INDUCED HYPERTENSION INFANT MORTALITY RATE – NUMBER OF INFANT DEATHS DURING THE FIRST 12 MONTHS OF LIFE PER 1000 LIVE BIRTHS FERTILITY RATE – NUMBER OF LIVE BIRTHS PER 1000 FEMALE POPULATION AGED 15 TO 44 YEARS

248. LOCATING FETAL HEART SOUNDS BY FETAL POSITION FHT – heard best at the FETAL BACK

265. Amniotic Fluid Volume Assessment

268. BASELINE VITAL SIGNS = TEMPERATURE, PULSE AND RESPIRATORY RATES ARE IMPORTANT ESPECIALLY DURING THE INITIAL PHASE OF THE PRENATAL VISIT . BUT CERTAINLY MORE IMPORTANT ARE THE WEIGHT & BLOOD PRESSURE AS BASELINE DATA TO DETERMINE ANY SIGNIFICANT INCREASE. BP – SLIGHT DECREASE IN THE SYSTOLIC & DIASTOLIC BP ON THE 1 ST TRIMESTER, LOWEST IN THE 2 ND TRI; & RETURNS TO PREPREGNANCY LEVELS ON THE 3 RD TRI - HIGHEST READING AT SITTING POSITION, LOWEST AT LLP

269. WEIGHT *DURING THE FIRST TRIMESTER, WEIGHT GAIN OF 1.5-3LBS.( 1lb per month or 0.4 kg) *ON THE 2 ND AND 3 RD TRIMESTERS, WEIGHT GAIN OF 10-12 POUNDS PER TRIMESTER IS RECOMMENDED.( 1 lb per week)( a trimester pattern of 3-12-12) *TOTAL ALLOWABLE WEIGHT GAIN DURING THE ENTIRE PERIOD OF PREGNANCY IS 25-35 LBS . ( 11.2 -15.9 KGS.). MORE THAN 35 LBS OF WEIGHT GAIN IS A DANGER SIGN = POSSIBLE PREECLAMPSIA.

271. DISTRIBUTION OF WEIGHT GAIN DURING PREGNANCY: FETUS 7 LBS PLACENTA 1 LB AMNIOTIC FLUID 11/2 LBS INCREASED WT. OF UTERUS 2 LBS INCREASED BLOOD VOLUME 1 LB INCREASED WT. OF THE BREASTS 11/2-3 LBS WT. OF ADDITIONAL FLUID 2 LBS FAT & FLUID ACCUMULATION 4-6 LBS. TOTAL 25 LBS

274. BATHING : DUE TO INCREASED PERSPIRATION , THE PREGNANT WOMAN IS ENCOURAGED TO HAVE A DAILY BATH TO KEEP HER FRESH & CLEAN. 2. TUB BATH IS DISCOURAGED BECAUSE ALTERATION IN THE WOMAN’S BALANCE MAKES GETTING IN & OUT OF THE BATH TUB DIFFICULT, SHE MIGHT SLIP & FALL & HURT HERSELF. 3. SWIMMING IS OK BUT NO DIVING.

276. BREAST CARE : 1. WELL FITTING & LARGER SIZED BRASSIERE ( WIDE STRAPS & DEEP CUPS TO PREVENT LOSS OF BREAST TONE.) 2. WASH BREAST WITH WATER ONLY. NO SOAPS OR ALCOHOL SHOULD BE USED AS THESE CAUSES DRYING & CRACKING. DRY NIPPLES THOROUGHLY

278. ** TERATOGENICITY OF CIGARETTES = ( associated w/ infertility in women) CAUSES VASOCONSTRICTION LEADING TO DECREASED BLOOD FLOW TO THE PLACENTA & UTERUS WHICH IN TURN DIMINISHES O2 SUPPLY TO THE FETUS. FETAL HYPOXIA LEADS TO LOW BIRTH WEIGHT BABIES AND THEREFORE IS CONTRAINDICATED DURING PREGNANCY. ** SLEEP = NEEDS INCREASE TO PROMOTE OPTIMAL FETAL GROWTH

279. ** EMPLOYMENT = AS LONG AS THE JOB DOES NOT ENTAIL HANDLING TOXIC SUBSTANCES OR LIFTING HEAVY OBJECTS , OR EXCESSIVE EMOTIONAL STRAIN, THERE IS NO CONTRAINDICATION TO WORKING. ADVISE PREGNANT WOMEN TO WALK ABOUT EVERY FEW HOURS OF HER WORKDAY DURING LONG PERIODS OF STANDING OR SITTING TO PROMOTE CIRCULATION THEREBY MINIMIZING VARICOSE VEINS.

280. ** TRAVELLING = NO TRAVEL RESTRICTIONS BUT POSTPONE A TRIP DURING THE LAST TRIMESTER. ON LONG RIDES , 15-20 MINUTE REST PERIODS EVERY 2-3 HOURS TO WALK ABOUT OR EMPTY THE BLADDER IS ADVISABLE. ** EXERCISE = SHOULD BE DONE IN MODERATION; SHOULD BE INDIVIDUALIZED: ACCORDING TO AGE, PHYSICAL CONDITION, CUSTOMARY AMOUNT OF EXERCISE ( SWIMMING OR TENNIS) NOT CONTRAINDICATED UNLESS DONE FORE THE FIRST TIME ; & STAGE OF PREGNANCY

281. ** TERATOGENICITY OF ALCOHOL = ALCOHOL HAS NOW BEEN FIRMLY ISOLATED AS A TERATOGEN. FETUSES CANNOT REMOVE THE BREAKDOWN PRODUCTS OF ALCOHOL FROM THEIR BODY. THE LARGE BUILD UP OF THESE LEADS TO VIT B DEFICIENCY & ACCOMPANYING NEUROLOGIC DAMAGE. (pregnant women should be screened for alcohol use because an infant born with fetal alcohol syndrome is not only small for gestational age but can be cognitively challenged. ( short palpebral fissures, thin upper lip, upturned nose)

282. . ** DRUGS = DANGEROUS TO FETUS ESPECIALLY DURING THE FIRST TRIMESTER WHEN THE PLACENTAL BARRIER IS STILL INCOMPLETE AND THE DIFFERENT BODY ORGANS ARE DEVELOPING. ARE TERATOGENIC (CAN CAUSE CONGENITAL DEFECTS)(AND THEREFORE, CONTRAINDICATED UNLESS PRESCRIBED BY THE DOCTOR)

283. Drugs Teratogenic Effects Androgen, Estrogen - Musculinization of female infants Progesterone Thalidomide - Phocomelia, cardiac & lung defect Anticonvulsant - cleft lip & palate; CHD Lithium - CHD Tetracycline - yellow staining of teeth, inhibit bone growth Vitamin K - Hyperbilirubinemia Salicylates ( aspirin) - neonatal bleeding,decreased IUG Streptomycin - Nerve defects Vitamin A - CNS defects Barbiturates - Bleeding disorders

285. ** SEXUAL INTERCOURSE IS ALLOWED UNTIL THE LAST 6 WEEKS OF PREGNANCY ( BECAUSE IT HAS BEEN FOUND OUT THAT THERE IS INCREASED INCIDENCE OF POSTPARTUM INFECTION IN WOMEN WHO ENGAGE IN SEX DURING THE LAST 6 WEEKS) AS LONG AS THERE ARE NO CONTRAINDICATIONS LIKE THE FOLLOWING: 1. BLEEDING 2. INCOMPETENT CERVICAL OS 3. DEEPLY ENGAGED PRESENTING PART 4. RUPTURED BOW

286. ** SEXUAL INTERCOURSE SHOULD BE DONE WITH THE WOMAN IN A COMFORTABLE POSITION: 1. SIDE LYING 2. WOMAN SUPERIOR – WOMAN ON TOP

289. TT IMMUNIZATION : > TT1 GIVEN ANYTIME DURING PREGNANCY > TT2 ONE MONTH AFTER TT1 ( 3 YEARS PROTECTION) > TT3 SIX MONTHS AFTER TT2 ( 5 YEARS PROTECTION) > TT4 ONE YEAR AFTER TT3 ( 10 YRS) > TT5 ONE YEAR AFTER TT4 OR NEXT PREGNANCY ( LIFETIME PROTECTION)

292. NUTRITION = MOST IMPORTANT ASPECT OF POST CONSULTATION FOOD SOURCES : ** PROTEIN RICH FOODS = MEAT, FISH, EGGS, MILK, POULTRY, CHEESE, BEANS, MONGO ** VIT. A = EGGS, CARROTS, SQUASH, CHEESE, BEANS, VEGETABLES ** VIT. D = FISH, LIVER, EGGS, MILK ( EXCESS VIT.D DURING PREGNANCY CAN LEAD TO FETAL CARDIAC PROBLEMS) ** VITAMIN E = GREEN LEAFY VEGETABLES, FISH

293. **VITAMIN C= TOMATOES, GUAVA, PAPAYA **VITAMIN B= PROTEIN RICH FOODS **CALCIUM/PHOSPHORUS=MILK, CHEESE ** I RON = ESPECIALLY IMPORTANT DURING THE LAST TRIMESTER WHEN THE PREGNANT WOMAN IS GOING TO TRANSFER HER IRON STORES FROM HERSELF TO HER FETUS SO THAT THE BABY HAS ENOUGH IRON STORES DURING THE 1ST 3 MONTHS OF LIFE WHEN ALL HE TAKES IS MILK(WHICH IS DEFICIENT IN IRON). IRON HAS A VERY LOW ABSORPTION RATE: ONLY 10% OF THE IRON INTAKE CAN BE ABSORBED BY THE BODY. THUS, FOR OPTIMUM ABSORPTION, GIVE VITAMIN C.

294. IRON SHOULD BE GIVEN AFTER MEALS BECAUSE IT IS IRRITATING TO THE GASTRIC MUCOSA. SOURCES: LIVER AND OTHER INTERNAL ORGANS, CAMOTE TOPS, KANGKONG, EGG YOLK, AMPALAYA, MALUNGGAY, SALUYOT. **MALNUTRITION DURING PREGNANCY CAN RESULT IN PREMATURITY , PREECLAMPSIA , ABORTION , LOW BIRTH WEIGHT BABIES , CONGENITAL DEFECTS OR EVEN STILL BIRTHS .

295. ** FOLIC ACID – TO PREVENT NEURAL TUBE DEFECTS ( SPINA BIFIDA, MENINGOCOELE ) SOURCES: ** GREEN LEAFY VEGETABLES ** FRUITS ( oranges) ** liver, legumes, nuts ** RDA FOR SALT IN A PREGNANT WOMAN IS 3g/DAY BECAUSE OF INC IN BLOOD VOLUME TO MAINTAIN F & E BALANCE.

298. ** THE PROVISION OF PRENATAL CARE IS THE PRIMARY FACTOR IN THE IMPROVEMENT OF MATERNAL MORBIDITY & MORTALITY STATISTICS. “”

300. EDC LAST MENSTRUAL PERIOD ( LMP ) – counted from first day of the last menses

302. 2. MC DONALD’S RULE = ( ESTIMATION OF AOG IN MONTHS & WEEKS BY FUNDIC HEIGHT MEASUREMENT)= FORMULA : FUNDIC HEIGHT IN CMS X 2/7 OR 8/7 EXAMPLE: FUNDIC HEIGHT IS 21 CMS 21 CMS X 2 =42 42/ 7 = 6 ( AOG IN MONTHS) 6 MONTHS X 4 = 24 ( AOG IN WEEKS)

304. Measuring Fundic Height