Responsible Parenthood And Pregnancy Auto Saved)

Responsible Parenthood and Pregnancy

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 Equity – responsibility with emotional support to each other

As a Concept: 

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Stable union entered into by a man and a woman For procreation , education of children, and mutual support

As a programme: 

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Accepting one’s physique and using the body effectively

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Achieving emotional independence from parents and other adults

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Achieving more mature relationship with both sexes

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Acquiring a set of values and ethical system as a guide for behavior

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Developing an ideology

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Designing and achieving socially responsible behavior

Developmental Tasks of Young Adult (19 – 40 y/o) 

Selecting a mate

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Learning to live with partner

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Starting a family

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Bearing a child

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Managing a home

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Taking a civic response

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Getting started in an occupation

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Finding a congenial social growth

Predictors of Marital Satisfaction

 Timing – involves the age of couple –

18 – 21 y/o – parent consent

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Kind of love

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Discuss problem with your partner

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Discuss with partner the daily activities

 Communication – to be open with one another

Framework for Family Planning

Developmental Tasks of Adolescent (13 – 18 y/o)

21 – 25 y/o – parent advice

Six

Stages of Parenthood

I – Image Making 

Occurs during pregnancy

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Time when prospective parents begin to gather or select through, to form, and reform images of what to come of birth and parenthood

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Prepare for a change in themselves and in their other important adult relationship

II. Nurturing Stage 

Reconciling image to reality

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Parent attach to the baby

III. Authority Stage 

Discipline of their children

IV. Interpretive Stage 

Anticipating teenage life

V. Interdependent Stage 

Accepting teenage identity

VI. Departure Stage 

Parents should prepare for the departure of the child getting married

Family Task 

Physical maintenance –

Being certain that family has ample resources

smooth muscles (dartos layer) which contracts / relaxes during changes in temperature 

Allocation of resources –

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Internal Organ  

Opening an effective means of communication between family members, establishing values and rules

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outside of the testes that leads into vas deferens stores and nourishes immature sperm cells and promote their maturation.

Giving roles to the family members

Reproduction, Recruitment and Release of the Family Member Accepting new family member by pregnancy or adoption

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Placement of members into a larger society

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Maintenance of motivation and morale

 Vas deferens - is a muscular tube that forms part of the spermatic cord

 Seminal vesicle - is a sac-like structure attached to the vas deferens. It secretes thick viscous alkaline –fluid high in protein (fructose), Vitamin C, and prostaglandins that contributes to sperm nutrition & activation.

 Prostate gland – a gland surrounding the urethra; secrets a milky fluid slightly acidic, contains proteolytic and clotting enzymes.

Parenting Pattern 

Ideal Role

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Perceived Role

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Performed Role

Testes 3 Types of Cells  Spermatogenic cells  Interstitial cells or Leydig Cells  Sertoli Cells Canal System Accessory structures

 Epididymis - a tightly coiled tube on the

Division of Labor –

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Involves preparation of the children to live in the community and interact outside the family

Penis – male organ of copulation; consists of cavernous bodies & a urethra thru which the seminal fluid is brought to the female generative tract during ejaculation.

Maintenance of Order –

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Prioritizing family need, especially the need of children

Socialization of Family Members –

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 Bulbourethral glands or Cowper’s gland - two glands are two- small structures beneath the prostate gland. They secrete a fluid that serves as a lubricant for the penis in preparation for sexual intercourse

MALE REPRODUCTIVE ORGANS Function: 

Production of spermatozoa

FEMALE REPRODUCTIVE SYSTEM

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Provide a means so sperm can travel & fertilize the ovum

External

External Organs

 Scrotum – contains and supports the testes; consists of subcutaneous tissue &

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Mons Pubis Labia Majora Labia Minora Clitoris Vestibule

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Urinary Meatus Vaginal opening Skenes Glands Bartholins Glands Hymen Perineal body *Myrtiform Caruncles *Fourchette

Functions of Vagina 1. Serves as secretory duct of the uterus 2. Female organ of copulation 3. Part of the Birthcanal Vasicovaginal septum Retrovaginal septum *Retrouterine pouch Cul de sac of Douglas Culdocentesis

Internal Organs: Uterus

Attachments a. Broad ligaments are reflections of peritoneum and extend from the uterus and pelvic organs to the lateral pelvic walls

b. Round ligaments are reflections of the same peritoneum that arises from cornu of the uterus and inserted in the upper border of the labia minora. They are capable of contraction at time of labor and serves to hold the uterus in anteflexion position

c. Cardinal ligaments of Mckenrodt (Transverse Cervical Ligament) are a condensation of subserous fascia extending from the uterus to the lateral pelvic wall. If overstretched or damaged can result to prolapse of the uterus.

d. Uterosacral ligaments are condensation of subserous fascia that extend from sacrum around the rectum of to the cervix. Helps the uterus from sagging downwards and maintaining anteflexion position. Positions

a. Anteverted – the uterus is tipped

Parts * Fundus * Corpus * Isthmus * Cervix Endocervix Lower surface of cervix contains stratified squamous epithelium Layers Endometrium Myometrium Perimetrium •

Upper contractile Zone

•

Lower Passive Zone

FORWARD in more than 50% of women

b. Retroverted – the uterus is tipped BACKWARD in approximately 25% of women

c. Midposition – the uterus is in the midposition in the remainder of women FUNCTIONS of the UTERUS a. Facilitates sperm transport from the cervix to the oviduct b. Provides a rich vascular environment for nourishment of the developing embryo c. Provides a safe location for the growing fetus throughout pregnancy d. Expels the mature fetus by means of myometrial contractions to outside the body

Fallopian Tubes Parts * Interstitial * Isthmus * Ampulla * Infundibulum

Four Body Structures involved in Menstruation 1. Hypothalamus

2. Pituitary Gland

3. Uterus

4. Ovaries

Purpose of Menstrual Cycle 1. To bring an ovum to maturity 2. To renew a uterine tissue bed that will be responsible to its growth if ovum is fertilized.

Lining – – –

Ciliated Muscular Peritoneal

Functions of fallopian tube a. Facilitates sperm migration from the uterus to the ampulla for fertilization of the ovum b. Transport the fertilized ovum toward the uterus

Main Function of the Ovary 1. Ovulation Endocrine Function a. Estrogen b. Progesterone c. Relaxin

Common terms in Menstruation

Length = 28 days cycle Shortest = 20 days

Longest = 45 days

Average menstrual flow = 4 – 6 days Shortest = 1 day

Longest = 9 days

Phases of Menstrual cycle 1. Menstrual Phase- day 1 to 5 - Corpus luteum degenerates - There is cessation of progesterone and estrogen produced by the corpus luteum and blood level drops - drop in blood levels of estrogen and progesterone stimulate the production of FSH and new cycle begins

2. Proliferative Phase –day 6 to 14 - Follicle stimulating hormone (FSH) released by the anterior pituitary stimulates the development of the graafian follicle

Menstruation - is the periodic discharge of blood, mucus and epithelial cells from the uterus

- As graafian follicle develops, it produces increasing amounts of follicular fluid containing a hormone called estrogen

Menarche - first menstrual period that occurs typically at age 12 but may also occur as early as 9 and as late as 17.

- Estrogen stimulates thickening of the endometrium.

Puberty - age in which the regenerative organ becomes functionally active

- As estrogen increases in the blood stream, it suppresses secretion of FSH and favors secretion of the luteinizing hormone (LH)

Menopause - is the cessation of menstrual cycles that occurs between 40 and 55 years of age

Menstruation

3. Secretory Phase- day 15-21 - Follows ovulation which is the release of mature ovum from the graafian follicle

- Cavity of the graafian follicle is replaced by the corpus luteum (secretes progesterone and some estrogen

- thickens the endometrium

3. Estrogen – true ovarian hormone;

- Progesterone acts upon the endometrium to bring about secretory changes that prepare it for pregnancy. It also maintains the endometrium during the early phase of pregnancy, should a fertilized ovum be implanted

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HORMONE OF WOMEN  secreted primarily by the ovaries by the adrenal cortex and by placenta in pregnancy

4. Pre-menstrual – day 22 to 28 - If fertilization does not occur the corpus luteum in the ovary begin to regress

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responsible for the development of secondary sex characteristics

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stimulates uterine contractions

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mildly accelerates sodium and water reabsorption by kidney tubules; increase water content of uterus

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accelerate protein metabolism

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increases sexual desire

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increases vaginal secretions – spinnbarkeit (ability to thread and spinn 10-12 cms)

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increase vaginal pH – alkaline to keep the sperm alive

- If fertilization occurs, the corpus luteum will stimulate the production of progesterone Abnormalities in Menstruation

 Amenorrhea - absence of menstrual flow  Dysmenorrhea - painful menstruation  Oligomenorrhea - less frequent menstruation

 Polymenorrhea - too frequent menstruation

 Menorrhagia - excessive menstrual bleeding  Metrorrhagia - bleeding between periods  Hypomenorrhea - abnormally short menstruation  Hypermenorrhea – abnormally long menstruation Reproductive Hormones 1. Follicle Stimulating Hormone- secreted by the anterior pituitary gland during the first half of menstrual cycle - stimulates development of graafian follicle - thins the endometrium 2. Lutienizing Hormone - secretes by pituitary gland - stimulates ovulation and development of corpus luteum

assists in maturation of ovarian follicles

 - Production of estrogen and progesterone decreases - Endometrium of uterus begins to degenerate and sloughs off

stimulates thickening of the endometrium ; causes suppression of FSH secretion

1. Progesterone – HORMONE OF MOTHERS – Secreted by corpus luteum and placenta during pregnancy – inhibits secretion of LH - has thermogenic effect ( increases temperature – relaxes smooth muscles; decrease GIT motility – thickens cervical mucus – operculum – maintain thickness of endometrium – increases vascularization of the uterus – allows pregnancy to be maintained – stimulates alveoli of the breast during the 2nd half of pregnancy 1. Prostaglandin – fatty acids categorized as hormone – produced by many organs of the body – affects menstrual cycle

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influences the onset and maintenance of labor

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Family Planning  Reproductive Life Planning 

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if and when to have children

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how many children are desired

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How they are spaced

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1. Oral Contraceptive Pills (OCP)

Includes couples who are having difficulty conceiving children to explore infertility programs, helping couples space their children, helping couples to avoid conception

Rely on periods of temporary abstinence and requires an understanding of the changes that occur in a woman’s ovulatory cycle The couple determines fertile days and abstain from sex 

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Synthetic estrogen combined with a small amount of synthetic progesterone

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Estrogen acts to suppress FSH and LH (gonadotrophic hormone of the pituitary)

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Progesterone decreases permeability of cervical mucus, limiting sperm mobility and access to ova

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Interferes with endometrial proliferation to such a degree that implantation becomes unlikely

Monophasic –

Calendar (Rhythm) 

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Requires a couple to abstain from coitus on the days of a menstrual cycle when the woman is most apt to conceive 3- 4 days before and after ovulation 18 – shortest = first fertile day 11 – longest = last fertile day 25 - 29

Basal Body Temperature 

A woman’s basal body temperature falls about one degree on ovulation because of progesterone

Symptothermal /Cervical Mucus Method 

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Use the changes in cervical mucus that occur naturally with ovulation Before ovulation each month

Mucus becomes thin, watery, transparent, feels slippery, stretches at least one inch before the strand breaks

A. Artificial Family Planning

A. Natural Family Planning / Fertility Awareness Method 

Just before ovulation (peak day) –

Includes all the decisions an individual or couple make about:

cervical mucus is thick and does not stretch when pulled between thumb and finger (Spinnbarkeit)

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Biphasic –

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Fixed doses of estrogen and progesterone

Constant amount of estrogen with increased progesterone

Triphasic –

Varying levels of estrogen and progesterone

Side effects: –

nausea

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Monilial vaginal infection

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Weight gain

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headache

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Breast tenderness

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Break through bleaching

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Mild hypertension and depression

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Small plastic object inserted into the uterus through the vagina where it remains in place

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Before the client has had coitus, following the menstrual flow

Contraindications:

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Hx of CVA

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Woman who smoke

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> 40 y/o

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obese

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High serum level

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High blood pressure

Side effects : –

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Example: –

Oral contraceptive containing only progesterone

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Post-coital contraceptive

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High level of estrogen

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Norplant – subdermal hormonal implant

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Levonorgestrel – synthetic progesterone

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Inserted after abortion: 6 weeks after delivery

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Disadvantages: cost, weight gain, headache, irregular period

Medroxyprogesterone Acetate (DMPA, Depo-Provera)

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Single dose every 3 months

Side effects –

Vaginal spotting

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headache

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Weight gain

4. Intrauterine Devices

T-shaped plastic device wound with copper

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Physical placement of a barrier between the cervix and sperm so that sperm cannot enter the uterus and fallopian tubes

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Changes the vaginal pH to strong acid level

3. Injectable Contraceptive 

T-shaped, of permeable plastic with drug reservoir of progesterone in the stem

Copper T380 

2. Subcutaneous Implants 

Progestasert 

Mini-pills –

Infection, PID (fever, lower abdominal pain, heavier flow)

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Vaginally inserted spermicidal products (24 hrs)

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Diaphragm – circular rubber disk (6 hrs)

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Cervical cap – timber (48 hrs)

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Condom – latex rubber

A. Permanent Methods of Reproductive Life Planning Vasectomy

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Small incision is made on each side of the scrotum, vas deferens is cut, tied, cauterized, plugged Tubal ligation

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Cautery, clamping, crushing the fallopian tube

 Laparotomy

 Culdoscopy  Colpotomy Genetic Counseling 

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Mendelian Inheritance –

Dominant Pattern

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Recessive Pattern

Chromosomal Abnormalities –

Nondisjunction

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Deletion

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Translocation

THE CHILD BEARING CYCLE

Terms: conception, impregnation, fecundation Egg life - 24 hrs. Sperm life -72 hrs.-5ml with 400 million per ejaculation Zona pellucida - ring of mucopolysaccharide and Corona radiata – circle of cells The ovum and surrounding cells are propelled FIMBRIAE –part of the fallopian tube – the fine hairlike structures Capacitation –is the final process that sperm must undergo to be ready for fertilization Fertilization has three functions: •

transmission of genes from both parents to offspring

 is a normal physiology process. It is not a disease condition. It is not an illness but a wellness state,

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restoration of the diploid number of chromosomes reduced during meiosis

 thus the main responsibility of nurses

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initiation of development in offspring

PREGNANCY

is to help mothers maintain that state of wellness throughout the periods of pregnancy and parenthood. Conception The penetration of one ovum (female gamete) by one sperm (male gamete) resulting in a fertilized ovum (zygote). Each gamete has haploid number (23). Zygote has a diploid number (46) with one of each pair from each parent. Sex of child is determined at moment of conception by male gamete.

 If X-bearing male gamete unites with

Embryonic and Fetal Structures 

Morulla – 16 – 50 cells

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Blastocyst – fluid space mass in the uterus

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Trophoblast – cells in the outer ring will become placenta and membranes

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Embryoblast – inner cells will form the embryo

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Decidua – endometrium; has 3 separate areas: 

Decidua basalis – part under the embryo, communicates with maternal blood vessels

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Decidua capsularis – encapsulates the surface of the trophoblast

ovum, result is a female child (X + X).

 If Y- bearing male gamete unites with ovum, result is a male child (X + Y). Fertilization Is the union of the ovum and a spermatozoa

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Decidua Vera – remaining portion

 Chorionic villi – trophoblastic layer of the blastocyst forming miniature villi at 11 – 12th day; with the following areas 

layers : Syncytiotrophoblast (hCG, HPL, E and P), Cytotrophoblast (protects from viral infection, disappears at 20 – 24th week) Amniotic Membranes – the chorionic villi on the medial surface of the trohoblast forms the amniotic membrane and chorionic membrane

 Umbilical cord – has 2 arteries and 1 vein; 53 cms in length; 2 cms thick; with Wharton’s jelly 

Ectoderm forms tissues associated with outer layers: skin, hair, sweat glands, epithelium. The brain and nervous system also develop from the ectoderm.

Central Core – contains fetal capillaries

 Outer covering has 2

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 Ectoderm

Placenta – from the trophoblastic tissue, 15 – 20 cms in diameter; 23cms in depth; 400 – 600 grams

 Mesoderm The mesoderm forms structures associated with movement and support: body muscles, cartilage, bone, blood, and all other connective tissues. Reproductive system organs and kidneys form from mesoderm.

 Endoderm The endoderm forms tissues and organs associated with the digestive and respiratory systems. Many endocrine structures, such as the thyroid and parathyroid glands, are formed by the endoderm. The liver, pancreas, and gall bladder arise from endoderm.

Cardiovascular System 

Simple blood cells → network of blood vessels → single heart tube

Primary Germ Layers:

 As early as the 16th day of life

 At implantation, blastocyst differentiates into:

 Heart beats as early as the 24th week

1. amniotic cavity – larger, ectoderm 2. yolk sac – lined with entoderm, nourishment for embryo 3. mesoderm-between ecto/ento First lunar month:

 Septum develops on the 6th and 7th week  Heart valves develop on the 7th week Respiratory System  Alveoli and capillaries begin to form between the 24th to 28th weeks 

Spontaneous respiratory movements begin as early as 3 months

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Surfactant

Gastrulation Gastrulation involves a series of cell migrations to positions where they will form the three primary cell layers. Ectoderm forms the outer layer. Endoderm forms the inner layer. Mesoderm forms the middle layer.

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Phospholipid substance

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Excreted by the alveolar cells at about 24th week

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Decreases alveolar surface tension on expiration

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Prevents alveolar collapse, improves the infant’s ability to maintain respiration in the outside environment

Nervous System

 Fetus can be seen to move on ultrasound as early as the 11th week 

Quickening – felt by mother at about 20 weeks

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First 2 weeks – cartilage prototypes provide support and position

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 Neural plate is apparent on the 3 week of gestation

 Brain waves can be detected by EEG on

 Ossification begins at 12th week

the 8th week

Reproductive System

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All parts of the brain form in utero although not completely mature at birth

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Child’s sex is determined at the moment of conception by a spermatozoon carrying an X or Y chromosome

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Eye and inner ear develop as projections of the origin neural tube

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Can be determined as early as 8 weeks by chromosomal analysis

By 24 weeks, the ear is capable of responding to sound, the eyes exhibit a pupillary reaction

 Gonads form at 6th week

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If testes form, testosterone is secreted influencing the sexually neutral duct to form other male organs

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In the absence of testosterone, female organs will develop

Endocrine System 

Fetal adrenal glands supply a precursor for estrogen synthesis by the placenta

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Fetal pancreas produces the insulin needed by the fetus

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Thyroid and parathyroid glands play vital roles in metabolic function and calcium balance

Digestive System  Digestive tract is separated from the respiratory tract at about 4th week of gestation

 Testes descend from the pelvic cavity at the 34th – 38th week

Urinary System  Rudimentary kidneys are present at the end of 4th week

 Urine is formed by the 12th week  Urine is excreted into the amniotic fluid by the 16th week

 Meconium forms in the intestines as early as the 16th week 

Sucking and swallowing reflexes are not mature until about 32 weeks

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Ability to secrete enzymes mature at 36 weeks

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Amylase is not mature until 3 months after birth

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Liver is active throughout gestation

Musculoskeletal System

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At term, fetal urine is being excreted at a rate of 500 ml/ day

Integumentary System 

Skin appears thin and translucent until subcutaneous fat begins to be deposited at about 36 weeks

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Lanugo – soft downy hair

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Vernix caseosa – cream-cheese like substance important for lubrication and keeps skin from macerating

Immune System 

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Level of passive IgG immunoglobulins peaks at birth and then decreases over the next 9 months Fetus is capable of active antibody production late in pregnancy

First Trimester

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Extremities have developed

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External genitalia are present, but sex is not distinguishable

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Primitive tail is regressing

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Abdomen appears large as the fetal intestine is growing rapidly

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Sonogram shows a gestational sac, diagnostic of pregnancy

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Eyes, nose, lips, tongue, ears and teeth are forming

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Penis begins to appear in boys

End of 4 Gestation Weeks 

Length is 0.75 to 1 cm

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Weight is 400 mg

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Spinal cord is formed and fused at the midpoint

 Baby is moving, although the mother cannot yet feel movement

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Lateral wings that will form the body are folded forward to fuse at the midline

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Head folds forward, becoming prominent

End of 12 Gestation Weeks

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Back is bent so the head almost touches the tip of the tail

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Length is 7 – 9 cms

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Weight is 45 g

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Nail beds are forming on fingers and toes

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Rudimentary heart appears as a prominent bulge on the anterior surface

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Arms and legs are budlike structures

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Spontaneous movements are possible

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Discernible rudimentary eyes, ears, and nose

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Some reflexes (Babinski) are present

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Bone ossification centers are forming

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Germ Layer formation

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Tooth buds are present

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Heart, digestive system, backbone and spinal cord begin to form

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Sex is distinguishable by outward appearance

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Placenta (sometimes called "afterbirth") begins to develop

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Kidney secretion has begun although urine may not yet be evident in amniotic fluid

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The single fertilized egg is now 10,000 times larger than size at conception

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Heart beat is audible by doppler

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Placenta is fully developed

End of 8 Gestation Weeks 

Length is 2.5 cm

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Weight is 20 grams

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Organogenesis is complete

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The heart with a septum and valves is beating rhythmically

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Facial features are definitely discernible

Second Trimester End of 16 Gestation Weeks

 Length is 10 – 17 cms  Weight is 55 to 120 grams  Fetal heart sounds are audible with an ordinary stethoscope

 Lanugo is well-formed

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Length is 35 – 38 cms

 Liver and Pancreas are functioning

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Weight is 1200 grams

 Fetus actively swallows amniotic fluid,

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Lung alveoli begin to mature

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Surfactant can be demonstrated in the amniotic fluid

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Testis begin to descend into the scrotal sac from lower abdominal cavity in males

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Blood vessels in the retina are extremely susceptible to damage from high oxygen concentration

demonstrating an intact but uncoordinated swallowing reflex End of 20 Gestation Weeks 

Length is 25 cms

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Weight is 223 grams

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Spontaneous fetal movement can be sensed by the mother

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Antibody production is possible

End of 32 Gestation Weeks

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Hair forms extending to include eyebrows and head

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Length is 38 – 43 cms

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Weight is 1600 grams

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Subcutaneous fat begins to deposit

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Fetus is aware of sounds outside the mother’s body

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Active moro reflex is present

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Delivery position (breech/ vertex) may be assumed

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Iron stores that provide iron are beginnig to develop

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Fingernails grow to reach the end of fingertips

 Meconium is present in the upper intestine

 Brown fat begins to be formed  Fetal heart beat is audible  Vernix caseosa begins to form 

Definite sleeping and activity patterns are distinguishable

End of 24 Gestation Weeks 

Length is 28 – 36 cm

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Weight is 550 g

 Passive antibody transfer from mother to fetus probably begins as early as 20 wks and certainly by the 24th week

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Length is 42 – 49 cms

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Weight is 1900 – 2700 gms

rectum

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Active production of the lung surfactant begins

Body stores of glycogen, iron, carbohydrate, and calcium are augmented

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Additional amounts of subcutaneous fat are deposited

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Sole of the foot has only one or two criscross creases

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Amount of lanugo present begins to diminish

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Most babies turn into a head-down or vertex presentation during this month

 Meconium is present as far as the 

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End of 36 Gestation Weeks

Well defined eyebrow and eyelashes

 Eyelids are now open  Pupils are capable of reacting to light Third Trimester End of 28 Gestation Weeks

End of 40 Gestation Weeks 

Length is 48 – 52 cms, crown-rump length is 35 – 37 cms

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Weight is 3000 grams

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Fetus kicks actively

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Fetal hemoglobin begins its conversion to adult hemoglobin

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Vernix caseosa is fully formed

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Fingernails extend over the fingertips

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Creases on the soles of the feet cover at least 2/3 of the surface

Gravidity and Parity Determination Definition of terms:

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6 consecutive digits

 Nulligravida – a woman of childbearing age who has never been pregnant

 Primigravida – a woman who has been pregnant once

 Multigravida – a woman who has been pregnant for 5 times or more

 Parity – number of times a woman has

G–P–F–P–A–L

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Gravidity – parity – full term – preterm – abortion - living

Measurements of length of pregnancy: Days: 267-280 Weeks: 40, plus or minus 2 Months (lunar):10 Months (calendar):9 Trimesters:3 Estimated Due Date/Estimated Date of Confinement(Nagele’s rule); This calculation is an estimation only. Most women deliver: due date + or – 2

 Gravida – number of times a woman has been pregnant

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week.

a. Add 7 days to the first day of the LMP b. b. Subtract 3 months. c. Add 1 year Example: LMP: Dec. 5, 2007 September 12, 2008

EDC:

Sonogram dating used to confirm dates.

given birth

 Primipara – a woman who has given birth once

 Example:

 Multipara – a woman who has given birth for 5 times or more Obstetrical Scoring 

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Computation of AOG

4 consecutive digits

 Date today: December 1, 2008  LMP: August 2, 2007  Computation:

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F-P-A-L

 August = 29 days

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Full term – preterm – abortion – living

 September = 30 days

2 consecutive digits –

G, P

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Gravidity - Parity

 October = 31 days  November = 30 days  December = 1 day  Answer: 121 days = 17 weeks 2/7 days

Estimating Fetal Growth: 

McDonald’s Rule –

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Method of determining the growth of fetus in utero by measuring fundal height 20th to 31st weeks – fundic height is equivalent to the gestational weeks

a. That is why there is amenorrhea during pregnancy. b. It is also the basis for pregnancy tests.  Human Placental Lactogen -promotes the growth of the mammary glands necessary for lactation.

Assessing Fetal well-being

 Estrogen and Progesterone

 Fetal movement – quickening; at least

 3 subtypes of Estrogen:

10 times/day; Sandovsky Method

1. Estrone(E1)- post

 Fetal heart rate – 120 – 160 bpm;

menopausal women

Doppler 10 -12 weeks; Stethoscope (20 weeks)

2. Estradiol(E2)- nonpregnant

 Non-stress testing – reactive (with 2 accelerations of FHR by 15 beats or more lasting for 15 secs occur after movement)

 Contraction stress testing – with IV oxytocin administration or nipple stimulation; normal if no FHR decelerations are present with contraction

 Ultrasound – used to diagnose pregnancy as early as 6 weeks Placenta: Pancake – weighs 1 lb. or 1/6 of baby’s weight

3. Estriol(E3)- pregnancy Umbilical Cord A circulatory pathway connecting the embryo to the chorionic villi: Length 55 cm or 21 inches Function: a. Transport oxygen and nutrients to the fetus from the placenta and to return waste products from the fetus to the placenta Parts- maternal and fetal side 1 vein carries oxygenated blood

Function: a. Fetal lungs

2 arteries carry deoxygenated blood

b. Kidneys

Wharton’s jelly- gelatinous mucopolysacharides

c. Gastrointestinal

AMNIOTIC FLUID

d. Endocrine

 It is also known as the bag of water,

e. Barrier ENDOCRINE  Human Chorionic Gonadotropin (HCG) - orders the corpus luteum to keep on producing estrogen and progesterone,

it serves the ff purpose:  protects the fetus against blows or pressure on the mothers abdomen  protects the fetus against the sudden changes in to since liquid changes to more slowly than air.

 protects the fetus from infection

blood entering form the IVC to pass across in to the left atrium.

 provides free movement for the fetus

Ductus arteriosus (artery to an artery) – channel between fetal aorta and main pulmonary artery. It closes during normal respiration. Allows the blood to bypass the fetal lungs.

 Acts as fluid wedge Terms: Polyhydramnios - excessive amount of amniotic fluid greater than 1000 ml. to 1500 ml. Oligohydramnios- amount less than 300500 ml. Abnormal colors: 1. green-tinged in a non-breech presentation –fetal distress 2. Golden- color – hemolytic disease FOCUS OF DEVELOPMENT

Hypogastric arteries – They return the blood to the placenta. Signs of Pregnancy 1. Presumptive signs  Amenorrhea  Nausea and vomiting  Increased breast sensitivity and breast changes

 Integumentary changes – increased pigmentation in localized area

1.First trimester- Organogenesis

 Constipation

2.Second Trimester – period of continued fetal growth and development

 Frequent urination due to increased renal blood and plasma flow ; increased GFR

3.third trimester – period of most rapid growth and development because of rapid deposition of subcutaneous fats. Fetal Circulation The oxygen is delivered from the placenta. The placenta is also:  

The source of nutrition The site of waste excretion

Temporary Structures involved in fetal circulation: Placenta Umbilical cord Ductus venosus – (vein to a vein) connects the umbilical vein to the inferior vena cava. Allows the oxygenated blood from the placenta to bypass the liver. Foramen ovale – temporary opening between atria that allows the majority of

 Quickening  Abdominal enlargement 2. Probable sign  Uterine enlargement

 Hegar’s sign- softening of the lower uterine segment

 Goodel’s sign – softening of the cervix due to increased blood supply

 Chadwick’s – purplish discoloration of the vaginal mucosa –

bluish discoloration of vagina and cervix

 Ballotment- when fetus rebounds against examiners finger’s during palpation

 Braxton’s Hicks contraction irregular painless contractions of the uterus, false labor

 Positive pregnancy test



 Fetal outline can be felt by examiner

Types of pelvis

3. POSITIVE SIGN 

Fetal heart tone can be heard



X-ray or ultrasound of fetus



Palpable fetal movements

Components of pre-natal check up:  

Initial Interview Health History –

Demographic data

–

Chief concern

–

Family profile

–

Past medical history

–

Family history

–

Social profile

–

Gynecologic history

–

Obstetric history

–

Day history



Gynecoid



Android



Anthropoid



Platypelloid

Internal Measurement 

Diagonal conjugate



True conjugate/ conjugate vera



Ischial tuberosity

Laboratory assessment 

Blood studies



Urinalysis



Ultrasonography

Self-care Needs: 

Bathing



Breast care



Dental care



Perineal hygiene



Dressing



Sexual activity



Exercise



Sleep



Work



travel

Review examination 

Baseline height and weight



Vital signs measurement



Assessment of system



Measurement of fundic height and fetal heart tones

Pelvic examination 

External genitalia



Internal genitalia



Papaniculao smear



Vaginal examination



Examination of pelvic organs

Rectovaginal examination

Common discomforts of early pregnancy: 

nausea/ vomiting



Heartburn/ pyrosis



Breast tenderness



Frequency of urination



Constipation



Leg cramps



Varicosities



Hemorrhoids



Pedal edema



Hypotension



Leukorrhea



pruritus

Discomforts of middle to late pregnancy: 

Backache



Dyspnea



Ankle edema



Braxton Hick’s contractions



Headaches

Urine Tests: Benedicts Test To determine sugar or glucose Result : (-) – no change in color +1 – bluish +2 – greenish yellow +3 – yellow orange +4 – brick red COMMON PRESCRIPTIONS: Iron supplementation shall be given from the 5th mos. of pregnancy up to 2 months post-partum. (100-200 mg. orally per day daily per orem for 210 days) –

–

Low –dose Vit.A supplementation ( 10,000 IU in 2 weeks In endemic areas , 1 iodized capsule to all pregnant women

–

In areas with Malaria , 2 tablets of Chloroquine ( 150 mg/ 2 tablets every week for the duration of pregnancy

PHYSIOLOGICAL CHANGES DURING PREGNANCY: Reproductive System 1. Uterus- enlarges; painless contractions occur 2. Ovaries- ovulation stops due to high levels of placental estrogen and progesterone 3. Vagina- becomes softer; mucosa thickens ,vascularity increases, vaginal discharge increases and becomes more acidic 4 Breast – increase in size and and become full and tender, areola darkens ; colostrum is excreted 5. Cervix- soften’s ( Goodel’s sign) becomes congested with blood (Chadwicks sign) proliferating glands form mucus plug. Musculoskeletal System 1. Relaxation of joints 2. Widening of symphysis pubis 3. Waddling gait 4. Lordosis 5. Increased back strain Cardiovascular System 1. Heart muscle enlarges 2. Heart rotates upward and to the left 3. Stroke volume increases 4. Cardiac output increases primarily as a result of expanded vascular volume 5. Pulse rate increases by about 10-15 beats per minute 6. Peripheral vascular resistance falls under the influence of progesterone and prostaglandins 7. 7. Femoral venous pressure increases

8. 8. Blood pressure remains essentially the same , despite increase blood volume

4. Lower specific gravity as a result of increase urinary output

9. 9. Blood volume increases to 1200-1500 ml. above pre-pregnancy values

Endocrine System

10. 10. Total red cell mass increases , however , the increase in plasma volume is even more pronounced 11. 11. White blood cell count increases to to an average of 10,000 /mm3 12. 12. Clotting factors increase, offering protection against but increasing Respiratory System 1. Oxygen consumption increases by about 20 percent

1. Thyroid activity is increased 2. HCG reaches a peak in the third month 3. Secretion of oxytocin which stimulates uterine contractions coupled with the drop of progesterone brings about labor 4. Uterine contractions increase in frequency and intensity culminating in fetal expulsion Skeletal System

2. Dyspnea is common

Gradual softening of pelvic ligaments

3. Nosebleeds and nasal stuffiness are common

and joints to facilitate passage of the fetus

4. Rib cage widen

1. Lordosis ( forward curvature of the spine in order to change the center of gravity) Pride of Pregnancy

5. Respiratory depth increases Gastrointestinal System 1. Gums appear red and swollen and bleed easier, caused by elevated levels of estrogen 2. Reduced tone of esophageal sphincter allows reflux of acidic stomach contents , producing heart burn 3. Decreased motility in large intestine allows more water to be absorbed ; may cause constipation and hemorrhoids

2. Leg cramps may occur from an imbalance of calcium phosphorus ratio in the body and from pressure of the uterus Nutrition 

Recommended weight gain during pregnancy



Components of healthy nutrition for pregnant woman

4. Increased thirst and appetite

–

Caloric needs

Urinary System

–

Protein needs

1. Increased urinary frequency on the first and third trimester because of pressure on the bladder

–

Fat needs. Vitamins and minerals

–

Fluid needs

2. Glomerular filtration rate increased 50%

3. Glycosuria – because of increase secretion of sugar by lowered renal threshold



Mineral needs –

Calcium and phosphorus

–

Iodine

–

Iron



–

Fluoride

–

Sodium

–

Zinc



(a) Proteinuria (the presence of an excess of serum proteins in the urine).

Foods to avoid in pregnancy –

Alcohol

–

Caffeine

–

Artificial sweeteners

–

Weight loss diets

it is normal in pregnancy as long as it is not accompanied by the following:

(b) Edema of nondependent parts. (c) Sudden increase in weight. (d) Hypertension. 

Nursing intervention consists of advising the patient to: (a) Maintain good posture.



Assessment of nutritional health



Nutritional risk factor during pregnancy



Common problems affecting nutritional health



Promoting nutritional health in women with special needs

(b) Avoid prolonged standing or sitting. (c) Wear support stockings. (d) Avoid constrictive clothing (garters, knee-high hose). (e) Drink at least eight glasses of fluid for "natural" diuretic effect.

DISCOMFORTS OF PREGNANCY

(f) Get adequate rest and exercise; include rest periods to elevate legs.



ANKLE EDEMA



BACKACHE



BREAST TENDERNESS



CONSTIPATION



DYSPNEA

(b) Apply support stockings before getting up.



FATIGUE

(c) Diuretics are contraindicated.



HEMORRHOIDS



LEG CRAMPS



URINARY FREQUENCY

Backache:



VAGINAL DISCHARGE

 caused by relaxation of the sacroiliac



VARICOSITIES



(a) Elevate the feet as often as possible.



occurs during the second and third trimesters.



caused by reduced blood circulation in the lower extremities

If condition worsens to a generalized edema, the patient should notify her physician.

joint which is due to increased hormones (steroid sex hormone and relaxing) resulting in slight joint and muscle relaxation and increased mobility

ANKLE EDEMA: 

Treatment of ankle edema.



exaggerated lumbar and cervico thoracic curves caused by changes in the center of gravity from the enlarging abdomen and breasts.



practice good posture and good body mechanics (use the pelvic tilt and bend at the knees).



wear appropriate, well-fitting shoes.

(c) Avoid drinking more than one (1) quart of milk - will create too much phosphorus in the system.



sleep on a firm mattress or backboard.

(d) Take the prescribed vitamins B and D per doctor's instructions.

Backaches may indicate a kidney or bladder infection.

(b) Eat a diet with adequate calcium or prescribed calcium.



(a) The patient should lie on her back and extend the affected limb. A second individual should apply pressure on the patient's knee with one hand and sharply flex the foot with the other hand. The affected muscle may also be needed with the heel or palm of the hand.

Constipation: 

Interventions to prevent and ease constipation. 

Never ignore the feeling to have a bowel movement.



Monitor what you are eating.



Eat foods that are high in fiber such as fruits, vegetables, cereals and whole grain breads.



Eat small and frequent meals throughout the day.





Dyspnea: 

(a) Sleep on additional pillows. (b) Maintain good posture. (c) Avoid overeating.

Exercise: Yoga, walking, swimming or simple stretches

(e) Limit activity

(d) Stop or decrease smoking.

Hemorrhoids: 

caused by: (a) Compression of nerves supplying the lower extremities due to the enlarging uterus. (b) Reduced level of diffusible serum calcium or elevation of serum phosphorus in the bloodstream. (c) Fatigue, chilling, or tense body posture.



Nursing interventions consist of advising the patient to:

Drink six to eight glasses of water every day. Sometimes, apple or prune juice can help.

Muscle Cramps: 

Treatment during muscle cramps.

Nursing interventions : (a) Avoid fatigue and cold legs.

As pressure builds from the growing uterus, venous return of blood from the rectal area back to the heart is impeded. The vessels near the rectum stretch, and as they stretch, so will the surrounding skin or mucosa

Urinary Frequency 

caused by:  the vascular engorgement and altered bladder function.  an increase in hormones  reduction of bladder capacity due to the enlarging uterus and fetal presenting part.



Nursing interventions consist of advising the patient:



If in the vulva, may be relieved by placing a pillow under the buttocks to elevate the hips, assuming the Sim's position for a few minutes several times a day, avoid standing as much as possible, or laying down instead of sitting when practical.



To relieve pain and swelling, take hot sitz baths or local application of astringent compresses (witch hazel pads).

(a) That this is normal. (b) To limit fluid intake before bedtime to ensure rest. (c) To wear perineal pads. (d) Notify the physician if pain or burning is noted. Varicose Veins

 caused by the relaxation of smooth muscle walls of veins, which is due to increased hormones (progesterone). It is also aggravated by gravity and bearing down for bowel movements. This may also be a hereditary disposition. 



involves the veins of the lower extremities, the external genitalia (vulva or labia), the pelvis, and the perineal area (hemorrhoids). Nursing intervention consists of advising the patient to:

Vaginal Discharges: Leukorrhea 

a white or yellowish mucous discharge from the cervical canal or the vagina.



caused by the hormonal stimulation of the cervix, which becomes hypertrophic and hyperactive producing an abundant amount of mucous.



Leukorrhea may lead to pruritis (severe itching), burning on urination, foul odor from the discharge, or edema of the vulva.



Treatment/nursing intervention consists of:

(a) Avoid obesity. (b) Avoid lengthy standing or sitting.



reassuring the patient that this is normal.

(c) Avoid constrictive clothing.



use perineal pads and to change them frequently

(d) Avoid constipation and bearing down.



cleanse the vulva at least once a day with soap and water and to dry thoroughly



Advising the patient to maintain good hygiene.

(e) Elevate legs when sitting. Get adequate rest. (f) Perform moderate exercise. (g) Rest with legs and hips elevated.

Supine Hypotension 

Caused by pressure of the gravid uterus on the ascending vena cava when the woman is supine which decreases the return of the blood.



Symptoms include nausea, cold and clammy, feels faint, and hypotensive (decreased blood pressure).



Nursing interventions consist of advising the patient to:

Treatment for Varicose Veins 



Wear support stockings before rising (getting up) if varicose veins are severe. Lie on the bed with legs extended at a right angel to the body if ordered by the physician (see figure 8-3 A).

(a) Get up slowly.



Effleurage

(b) Use the side-lying position, preferably on the left side.



Focusing



Second-stage breathing

DANGER SIGNALS OF PREGNANCY  Vaginal bleeding

Alternative Methods of Birth 

 Persistent vomiting  Chills and Fever  Sudden escape of fluid from the vagina  Abdominal or chest pain  Danger signs of pregnancy induced hypertension a. swelling of the face and fingers b. flashes of lights or dots before the eyes c. dimness or blurring of vision d. severe or continuous headache



Preparation 

Tailor sitting



Squatting



Kegel exercises



Abdominal muscle contractions

 

Pelvic rocking

Pain management methods 

Bradley



Psychosexual



Dick-Read

 Lamaze 

Conscious relaxation



Cleansing breath



Conscious controlled breathing

Birthing room is darkened



Soft music



Infant placed immediately into a warm-water bath

Hydrotherapy and water birth

Validation – observed during the first trimester 

Ambivalence, shock or denial may be experienced at the time of knowing occurrence of pregnancy.



Introvert manifestation is usual with weight gain and other outward signs of pregnancy.

Perineal and abdominal exercises 



DEVELOPMENTAL TASKS OF PREGNANCY

Preparation for Childbirth 

Leboyer method

Fetal Embodiment; Second trimester. 

Fetus is viewed as part of self



Role adjustments- time of emotional maturity

 Gains inner strength with the condition Fetal distinction -5th lunar month 

Fetus is viewed as separate to self



Quickening encourages this feeling



Woman daydreaming on her role as mother and future of the baby



Role Transition – Third trimester



Woman becomes irritable and wanted to end the pregnancy



With concrete plans about herself and the baby

Breast 





Lobes- consist of 15-20 lobes which are subdivided into lobules or acinar cells ( responsible for milk production)

Oxytocin causes uterus to contract and uterine cramping maybe experienced



Wash breast without using soaps



With flat nipples, nipple- rolling is done

Excretory ducts / lactiferous ducts ( milk reservoir) which open to the nipple



Avoid medications and gas –forming foods



Erectile tissue with muscle fibers which serves as a sphincter like action in controlling the flow of milk.



Calories should be increased to 3,000 per day or additional 500 calories per day and 1,000ml of fluids



Areola- the dark pigmented part around the nipple



Baby’s stool will be watery, frequent and light yellow in color



Montgomery tubercles-responsible in secreting fatty substances used to lubricate the nipple



Start with the breast used on last feeding



Stimulate rooting to start and finish each session by burping the baby



Nipple- an elevated part on top of the breast containing 15-20 openings from the lactiferous ducts

Function :

Schedule of Breastfeeding 

As soon as both mother and baby is stable



Regular and sustained sucking at the breast is 8-10 times per day



Gradually increase time of breastfeeding foe each breast with subsequent feedings



Baby will develop their own schedule of feeding

Lactation Milk secretion/ejection Benefits of Breastfeeding To infants 



Provides a nutritional complete food for the young infant Strengthens the infant’s immune system , preventing many infections



Safely rehydrates and provides essential nutrients to a sick child, especially those suffering from diarrheal diseases



Reduces the infant’s exposure to infection

To mother 

Reduces a woman’s risk of excessive blood loss after birth



Provides a natural method of delaying pregnancies



Reduces the risk of ovarian and breast cancers and osteoporosis

General Principles in Breastfeeding

Breastfeeding problems and immediate intervention 1. Engorgement 

More frequent feedings and ice packs

2. Retracted Nipples



Nipple –rolling



wear breast-shield

3. Cracked nipple



Lubricate nipple with Vit A and D



Rotate feeding position



expose nipple to air 10-20 mins after feeding

4. No milk or Inadequate supply



increase frequency of feeding and make interval longer