Maternal

and
Child Nursing
NCM 101

1. Obstetrics- care for women during childbirth.

- derived from the Greek word obstare, which
means to keep watch.
2. Pediatrics -is the branch of medicine dealing with
the health and medical care of infants, children,
and adolescents from birth up to the age of
- The word paediatrics means
healer of children; they are derived from two
Greek words: (pais = child) and (iatros = doctor or
healer)
3. DNA carries the genetic code
4. Chromosomes - Threadlike strands compose of
hereditary materials known as DNA

5. Normal amount of ejaculated sperm

3-5 cc or 1 tsp or 10-15 million/cc
6. Sperm is viable within - 48-72 hours or 2-3 days
7. Age of Reproduction - Below 18 and above 35
years old is considered high risk
8. Childbearing age 2035 y/o

Organs responsible for

Menstruation

Hypothalamus- releases GnRH or LHRH

which initiates the menstrual cycle.
Anterior pituitary gland-produces FSH and
LH
Ovaries- follicles reaches its maximum size,
it is being propelled toward the surface
Uterus- changes occur monthly as a result
of stimulation from the hormones by the
ovaries

Estrogen and progesterone levels

decrease
Hypothalamus secretes GnRH
Stimulates the pituitary gland to secrete
FSH and LH
FSH develops graafian follicle
LH completes follicle development and
stimulates ovulation

Matured follicle and corpus luteum

stimulates proliferation of the
endometrium
No fertilization
The corpus luteum degenerates
Estrogen and progesterone decrease

4 Phases of menstrual cycle

1.Proliferative- also known as estrogenic,
follicular or postmenstrual phase
- 1st 4-5 days of a cycle
- Proliferation increases the thickness of the
endometrium.
2. Secretory-progestational, luteal, premenstrual
- the formation of progesterone in the corpus
luteum causes the endometrium to become
twisted in appearance and dilated

3. Ischemic
- If there is no fertilization, the corpus
luteum in the ovary begins to regress
after 8- 10 days
- Decreases the production of estrogen
and progesterone
- Endometrium begins to degenerate
- Capillaries rupture and endometrium
sloughs of
4. Menses

Fetal Growth and

Development

Fetal Growth and Development

Spermatogenesis- maturation of the
spermatocyte.
Oogenesis- maturation of oocyte to ovum
Gametogenesis- maturation of gametes (sperm
and ovum) using meiosis to create haploid cells
with 23 single chromosomes.
Fertilization- a union of 1 ovum and 1 sperm to
create a zygote.

Implantation- the blastocyst reaches

the uterus in 3 to 4 days where it
burrows into the endometrium.
Conception- fertilization of the ovum
creates a zygote(1st cell of a human
being)

3 periods or stages of fetal

growth:
1. Pre-embryonic or ovum
-

The period from conception until day 14.

The zygote develops into the blastocyst that
implants into the endometrium.

2. Embryonic
- The period from day 15 until 8 weeks gestation.
- Embryo is the term now used to refer to the
fertilized ovum.
- This is the critical stage for organ and external
feature development. The embryo is especially
vulnerable to teratogen exposure.

3. Fetal
- The period from 9 weeks gestation until
pregnancy ends.
- Characterized by refinement of structure and
function developed during the previous stages
- Fetus is the term now used to describe the
embryo.
- The fetus is less vulnerable to teratogens,
except for those that can interfere with the
development of the brain and nervous system
(CNS)

morula
zygote

embryo

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Pre-embryonic stage
1. Zygote
- fertized ovum develops because the combined structure of the ovum
and the sperm
- it takes 3-4 days for the zygote to reach the body of the uterus
2. Morula
- is the mull berry like ball
- it contains 16-50 cells
- floats free in the uterine cavity for 3-4 days


3. Blastocyst
- is the enlarging cells forming a
cavity that later becomes embryo
- it is this structure that attached to
the uterine endometrium
- Trophoblast cells covers the outer
ring of blastocyst that ill later on
form the placenta and membranes

4. Implantation/ Nidation
- it occurs 8-10 days after fertilization
- Refers to the contact between the growing
structure and the uterine endometrium
- 3 process of implanation:
a. Apposition blastocyst brushes
against the
rich endometrium
b. adhesion blastocyst attaches to the surface of
the endometrium
c. Invasion settles down into the
soft fold
- signs of implantation:
1. slight pain
2. vaginal spotting
placenta previa: implantation on the lower uterine
segment

Embryonic Stage (15th day 2 months or 8 weeks)

1. Decidua
- latin word means falling of
- otherwise known as the thickened endometrium
because of its thickness and vascularity
- deciduas + chorionic villi will develop placenta
- 3 separate areas:
1.decidua basalis part of the endometrium lying
directly under the embryo where the placenta
develops
2. decidua capsularies the portion of the endometrium
that
encapsulates the surface of the
trophoblast
3. decidua vera the remaining
uterine lining

portion of the

2. Chorionic Villi
- finger-like projection that is surrounded
by a double layer of a trophoblast cells

Chrionic Villi Sampling diagnostic procedure for the removal of tissue

sample from the fetal portion of the developing placenta
- Purpose: genetic screening
- Most common complication: missing digit/ fetal limb defect

3.
Cytotrophoblas
t
- inner layer or
langhans layer
- to protect the
growing embryo
and fetus against
syphilis
- present only
until 24 weeks (6
months)

4. Synsitiotrophoblast
- The outer of the 2 covering layer
- aka. Syncytial layer
-Function: responsible for the production
of various placental hormones. Such as
Hcg, somatomammotropin (HPL), estrogen
and progesterone

Amnion innermost membrane layer

- it covers the fetal surface of the
placenta and that surface is typically shiny
in appearance
- it produces amniotic fluid

a.1. Umbilical cord aka. funis

- is formed from the amnion and chorion and provides circulatory
pathway connecting the embryo to the chorionic villi
function: to transport oxygen and nutrients to the fetus from the
placenta and to return waste products from the fetus to
placenta
- it contains the AVA- 2 arteries (carries blood from the fetus to
placenta) and 1 vein ( carries blood from placenta to fetus )

- normal color: whitish gray

- normal length: 50-55 cm long or 20-21 inches
- contains the Whartons jelly which protects the
umbilical cord from pressure on the vein and
artery
short cord: may lead to abruption placenta,
uterine inversion
long cod: may lead to cord coil/ cord prolapse

a.2. Amniotic fluid aka. BOW- bag of water

- never stagnant within the membrane because
the fetus swallows the fluid, it is absorbed
across the fetal intestine into the fetal blood
stream
- slightly alkalinic ph of 7.2
- normal color: clear with specks

- odor: musty or mousy odor

- normal amount: 500-1000 ml

Hydramnios excessive amniotic fluid more

than 1500 cc

- Because the fetus is unable to swallow (in case of

esophageal atresia)
oligohydramnios reduction in the amount of
amniotic fluid less than 300 ml
- common in kidney malformation

Functions of amniotic fluid:

1. Cushions the fetus against sudden
blow or trauma
2. Maintains the temperature
3. Facilitate musculoskeletal
development
4. Prevent cord compression
5. Aids in delivery process

Amniocentesis diagnostic test for

amniotic fluid
- Purpose; to obtain a sample of
amniotic fluid by inserting a needle
through the abdomen into the
amniotic sac, fluid is tested for:

a. genetic screening fluid is tested for

MSAFP (maternal serum alpha-feto
protein)
- if the result is below the normal
value: down syndrome
- above normal: neural tube defects or
spina bifida
- normal value: 38-45 g/dl
b. determination of fetal lung maturity

Nursing responsibility:
1. Informed consent
2. Pre-op NPO
3. Empty bladder
4. Place woman in supine position
5. Place a towel in the right buttock to
displace the urinary bladder
Dangerous complication: spontaneous
abortion
Most common complication: infection

Amnioscopy direct exam through an

intact fetal membrane
- direct visualization through an intact
fetal membrane in ultrasound

Ferns test test for ruptured bag of water

- to determine the number of patterns of
ferning seen in the microscope (sleed like
structure)
- (+) ferning means ruptured bag of water

Nitrazine Paper Test to diferentiate

amniotic fluid from urine
- if nitrazine paper turns blue: amniotic
fluid (BOW ruptured)
- if nitrazine paper turns yellow: urine
(intact BOW)

b. Chorion outer most membrane

- it ofers support to the sac that
contains the amniotic fluid
b.1.Placenta aka. Secudines or
pancake
- Normal weight: 500 gm
- Normal size: 3 inches in diameter, 1
inches wide

Functions of PLACENTA:
1. Respiratory system responsible for
exchange of oxygen and carbon dioxide via
simple difusion e.g. O2, CO2, Na and Cl
2. Gastrointestinal system for transport of
nutrients via facilitated difusion e.g. glucose
3. Excretory system excretion of waste product
- waste products are carried by 2 arteries
- however, the liver of the mother detoxify the
fetal waste product

4. Circulatory system significant for fetoplacental circulation that is needed in the

delivery of O2 and other nutrients i.e.
glucose, amino acids, fatty acids,
minerals, vitamins and water
- although there is no direct exchange
between the fetus and the mother it is
only facilitated by means of selective
osmosis through chorionic villi
5. Endocrine system also important in
producing hormones during pregnancy

6. It serves as protection barrier against some

microorganism i.e. HIV, Heap B, CMV,
Rubella.
a. Human Chorionic Gonadotropin
- maintain the corpus luteum during the 1st
trimester or within 3 months of pregnancy
- because the corpus luteum continue to
produce estrogen and progesterone
b. Estrogen
- contributes to the mothers mammary gland
development in preparation for lactation
- stimulates uterine growth to accommodate
the developing fetus

c. Progesterone
- necessary to maintain endometrial
lining of the uterus during pregnancy
- reduces the contractility of the uterus
which revert re-term labor
d. Human placental lactogen
- aka. Chorionic somatommamotropin
- responsible for the development of
mammary gland

Anatomic and Physiologic

Adaptations Associated with
Pregnancy

BSE distinguishes expected

change from pathology;
assess for the following:
Masses: fixed, firm, unilateral
Skin changes: dimpling,
erythema, rashes,
ulcerations, edema
Nipple retractions

- Painful breasts
NOTE: Pathologic changes usually
are unilateral, not bilateral

 Vaginal bleeding to any degree must be

evaluated to determine the cause
RTI: lesions, pruritus, erythema
- Vaginal discharge changes: color,
amount, consistency, odor
Preterm labor: pelvic pressure; sensation
of something falling out
- Low backache; menstrual-like or
intestinal cramps with or without
diarrhea

- Uterine contraction every 10 minutes

or less (6 or more per hour)
- Change in vaginal discharge
- Diagnosis confirmed by cervical
changes: efacement (80%) or
cervical dilatation (more than 1cm),
or both

 Signs and symptoms indicative of cardiac

decompensation and pulmonary edema
especially in high risk women with cardiac,
hypertensive, or renal health problems:
- Anxiety; fatigue
- Rapid, weak, irregular pulse
- Moderate to severe dyspnea with tightness
in the chest
- Orthopnea
- Crackles; productive cough with frothy
sputum

 Signs of PIH
Hypertension: 140/ 90 mm Hg or higher
after 20 weeks gestation, 2
measurements 4-6 hours apart
Pathologic edema
Signs of pathologic anemia
Signs of thrombophlebitis
- Positive Homans sign- sharp pain in calf
in dorsiflexion of foot

 Weight gain pattern that does not

follow expected norms
Hyperemesis gravidarum- severe
vomiting leads to weight loss
Pica- ingestion of nonnutritive
substances or food stuf low in
nutritional value

 Abdominal cramping and pain could

indicate ruptured ectopic pregnancy,
appendicitis, separation of the
placenta, miscarriage
- Assess: location, frequency, onset,
character of pain and accompanying
signs and symptoms
- Diarrhea could indicate presence of
intestinal tract infection

 Risk for UTI is increased

Signs of pyelonephritis or UTI
- Flank pain; positive cost vertebral angle CVA
tenderness
- Fever
- Frequency, urgency accompanied by dysuria
- Change in characteristics of urine (cloudy,
hematuria, odor)
- Presence of microorganisms in urine

 Signs of carpal tunnel syndrome

Signs of PIH

melasma

PSYCHOLIGAL ADAPTATIONS
Developmental tasks in preparation for the
maternal role:
1st trimester: acceptance of pregnancy; states I
am pregnant.
2nd trimester: acceptance of the fetus as distinct
from herself; states I am going to have a baby.
3rd trimester: acceptance of impending birth and the
reality of parenthood; states I am going to be a
parent.

1st Trimester
1st trimester: acceptance of pregnancy;
states I am pregnant.
Seeks confirmation of the pregnancy
Reacts to the confirmation
Adjusts to the physical changes and
sensations
Exhibits egocentricity
Exhibits emotional liability
Has diminished sex drives

nd

Trimester

2nd trimester: acceptance of the fetus as

distinct from herself; states I am going
to have a baby.
Fetus becomes a reality
Woman focuses on the fetus and
motherhood
Discomforts in the 1st trimester diminish
Sexual drive increases
Body contours change

3
Trimester
trimester: acceptance of impending birth and
rd

3rd
the reality of parenthood; states I am going to
be a parent.
Couples begin nest- building
Discomforts increase
- Fetal activity interferes with rest
- Decreased sex drive
- Enlarging uterus changes a womans center of
gravity
Impending birth motivates woman to participate in
childbirth classes

Warning signs of ineffective

adaptation:
1.

2.

Intense denial of pregnancy results

Avoidance of confirmation
Attempts to conceal pregnancy
Lack of preparation
Unrealistic expectations about birth
and parenting
3. Low tolerance for pregnancys physical
changes
4. Refusal to alter lifestyle to ensure a
healthy outcome

Paternal Psychosocial Adaptation

1. Accepts reality that partner is pregnant;
man states I am going to be a father.
Views pregnancy as confirmation of
virility(the capacity to function as a male
in copulation)
Experience about his ability to support
partner
Experiences concerns about the impact
on finances, lifestyle and sexuality

Paternal Psychosocial Adaptation

Is influenced by couvade, the

culturally pattern of expected
paternal behaviors during pregnancy
and birthing
Reviews relationship with his own
father
Fantasizes about the baby and
himself as a father

Paternal Psychosocial Adaptation

2. Copes in a positive manner with

partners changing body and emotions
Views physical and emotional changes
of pregnancy as natural and beautiful
Alters sexual relationship in tune with
partners changing sex drive, body
contours and needs

Paternal Psychosocial Adaptation

- Sex positions during pregnancy:
Man on top (Missionary position)
Woman on top
Rear entry (Doggie style)
Standing
Seated etc.
- Coitus contraindications during pregnancy:
X Unexplained vaginal bleeding
X Preterm labor
X STD
X Problems with the cervix
X Problems with the placenta

Paternal Psychosocial Adaptation

Openly communicates concern while

working with partner to find mutually
satisfying ways to express love and afection
3. Participates in the process of pregnancy
and birth

Ineffective Paternal Psychosocial

Adaptation
1. Unwilling or unable to meet the
physical and emotional needs of his
partner or to participate in preparation
activities
2. Refuses to discuss the fetus or NB
3. Expresses anger about the changes
4. Expresses displeasure
5. Experiences difficulty about the sexual
relationship

Antepartum
Antepartal period- begin with conception
and ends with the onset of labor
40 weeks or 280 days- pregnancy duration
Term- 37 weeks after and 42 weeks before
Preterm- before 38 weeks gestation but
after viability is reached at about 20-24
weeks gestation
Trimesters- segments of prenatal period,
about 13 weeks or 3 months

 Gravida- total number of pregnancies

Nulligravida- never pregnant
Primigravida- 1st pregnancy
Multigravida- 2 or more pregnancies
Para- number of pregnancies reaching
viability; fetus is born alive or still born
Nullipara- no pregnancy completed to
viability
Primipara- completion of 1 pregnancy to
viability
Multipara- completion of 2 or more
pregnancies to viability

 5 digit- system to describe

pregnancies and outcomes:
G- gravida
T- number of term births
P- number of preterm births
A- number of abortions
L- number of living children
M- number of multiple pregnancies

Signs of
pregnancy

Presumptive:
Are subjective findings felt by the woman.
Suggestive but not diagnostic of
pregnancy
Breast changes
Nausea and vomiting
Amenorrhea
Frequent urination
Fatigue
Uterine enlargement
Quickening
Linea nigra
Melasma
Striae gravidarum

Probable

Are objective findings noted by the

examiner that are more suggestive but
yet diagnostic of pregnancy
Serum laboratory tests
Chadwicks signs
Goodells signs
Hegars sign
Evidence on ultrasound of gestational
sac
Ballottement
Braxton Hicks contractions
Fetal outline felt by examiner

Positive
Are objective findings that are
diagnostic of pregnancy
Evidence on ultrasound of fetal
outline
Fetal heart audible
Fetal movement felt by examiner

Week 1

Week 1
The ovum becomes
fertilized, divides
and burrows into
the uterus.
Ovaries increase
production of
pregnancy
maintaining
hormone,
progesterone.

Week 2
The embryonic
disk is formed.
These 3
primitive germ
layers will
generate every
organ and tissue
in your babys
body.
1st missed
period.

Week 3

Week 3
The 1st body segments appear which will
form the primitive spine, brain, and spinal
cord.
Yolk sac, this cavity lining will soon be the
yolk sac that produces your babys RBC and
delivers nutrients until the placenta is ready
to take over.
Cells become the embryo
Amniotic fluid is beginning to collect, which
will soon develop the embryo and become
the amniotic sac.
Placental cells will soon form the placenta.
Its producing hCG.

Week 4

End of Week 4
Length: 0.75-1cm.
Weight: 400 mg.
The spinal cord is formed and fused
in the midpoint.
Lateral wings that form the body are
folded forward to fuse in the midline.
The head folds forward and becomes
prominent, representing about 1/3 of
the entire structure.

End of Week 4
The back is bent so that the head
almost touches the tip of the tail.
The rudimentary heart appears as a
prominent bulge on the anterior
surface.
Arms and legs are budlike structures.
Rudimentary eyes, ears, and nose
are discernable.

Week 5
The heart starts to pump blood. Limb buds
appear. Major divisions of the brain can now
be discerned.

Week 6
Eyes begin to take shape, external
ears develop from skin folds.

Week 7

Week 8
The embryo is now a little than an
inch long, its tiny heart beating about
40-80bpm.

End of Week 8

Length: 2.5cm or 1 in.

Weight: 20 g
Organogenesis is complete.
The heart with septum and valves, is
beating rhythmically and detectable
by UTZ
Facial features are definitely
discernable.
Arms and legs have developed.

End of Week 8
External genitalia are forming, but
sex is not yet distinguishable by
simple observation.
The primitive tail is regressing.
The abdomen bulges forward
because the fetal intestine is growing
so rapidly.
U/S shows gestational sac.

Week 9

Week 10

Week 11
Organs begin to function. The
pancreas is producing insulin; the
kidneys produce urine.

Week 12

End of Week 12

Length: 7-8cm
Weight: 45 g
Spontaneous movements are
possible, although they are
usually too faint to be felt by the
mother.
Some reflexes, such as Babinski
reflex, are present.
Bone ossification centers begin to
form.

End of Week 12
Tooth buds are present.
Sex is distinguishable by outward
appearance.
Urine secretion begins but may
not be evident in AF.
The heart beat is audible by
Doppler technology.

Week 13
Fingers has fingerprints.
Head is proportional.

Week 14

The musculoskeletal system has

matured. The nervous system begins
to exercise some control over the
body; blood vessels rapidly develop.
Lanugo develops.

Week 15
With hands ready to grasp, the fetus
is now weighing about 7 oz, kicks
restlessly against the amniotic sac.
Eyelids sense light.

Week 16
All organs and structures have been
formed and a period of simple growth
begins.
Toes are growing toenails.
Circulatory system is working.

End of Week 16
Length: 10-17cm
Weight: 55-120 g
Fetal sounds are audible by an
ordinary stethoscope.
Lanugo is well formed.
Liver and pancreas are functioning.

End of Week 16
Fetus actively swallows AF,
demonstrating an intact but
uncoordinated swallowing reflex;
urine is present in the AF.
Sex can be determined by U/S.

Week 17
Sense of hearing develops.
Can move all joints.

Week 18
Arms and legs flex.
Ears are in position.

Week 19
Eyebrows, eyelashes and head hair
develop.

Week 20

The fetus is now following a regular

schedule of sleeping, turning,
sucking and kicking and has settled
on a favorite position in the uterus.

End of Week 20
Length: 25 cm
Weight: 223 g
Spontaneous fetal movements can be felt
by mother.
Antibody production is possible.
The hair forms in the head, extending to
include eyebrows.
Meconium is present is the upper
intestine.

End of Week 20
Brown fat, a special fat that will aid in
temperature regulation at birth, begins to be
formed behind the kidneys, sternum and
posterior neck.
Vernix caseosa begins to form and cover the
skin.
Passive antibody transfer from mother to fetus
begins.
Definite sleeping and activity patterns are
distinguishable.
Heartbeat is detectable by stethoscope

Week 21
Eyelids and eyebrows are fully
developed.

Week 22
Eyes are developed but the irises still
lack pigment.
Lips are distinct.

Week 23
Eyelids begin
to open and
close.
Loud noises
can be heard
in utero.

Week 24

Week 24
Taste buds are developing.
Lungs are developing
Respiration is possible but many
fetuses die if born at this time
Fetus is active, movements become
observable by mother and examiner

End of Week 24

Length: 28- 36 cm
Weight: 550 g
Meconium is present.
Active production of lung surfactant
begins.
Eyebrow and eyelashes become well
defined.
Eyelids fused at 12th week are now open.

End of Week 24
Pupils are capable reacting to light.
When fetus reach 24th week, or 601
g, they have achieved a practical
low-end age of viability if they are
cared for after birth in a modern
intensive care facility.
Hearing can be demonstrated by
response of sudden sound.

Week 25
Hair has
color
and
texture
although
both
change
after
birth.

Week 26
To a certain
extent, the baby
can now breathe,
swallow, and
regulate its body
temperature, but
still depends
greatly on
maternal
supprort.

Week 27
A substance
called
surfactant
forms in the
lungs,
preparing
them to
function
independently
at birth.

Week 28
Movements become regular.

End of Week 28
Length: 35- 38 cm
Weight: 1200 g
Lung alveoli begin to mature, and
surfactant can be demonstrated in
AF.
Testes begin to descend into the
scrotal sac from the lower abdominal
cavity.

End of Week 28
The blood vessels of the retina are
formed but thin and extremely
susceptible to damage from high
oxygen concentrations.

Week 29
Fat deposits
are building up
beneath the
skin to insulate
the baby
against the
abrupt change
in temperature
at birth.

Week 30

The digestive tract

and lungs are now
nearly fully
matured and the
skin becomes less
wrinkled.
Eyes distinguish
light and dark,
20/400 can see
objects near the
face.

Week 31
Legs and arms are filling.

Week 32
Fingers and
nails have
grown.
Some have
full hair,
others have
peach fuzz.

End of Week 32
Length: 38- 43 cm
Weight: 1600 g
Subcutaneous fat begins to be
deposited.
Fetus responds by movement to
sounds outside the mothers body.
Active Moro reflex is present.

End of Week 32
Iron stores, which provide iron from
the time during which the neonate
will ingest only milk after birth, are
beginning to be developed.
Fingernails grow to reach the end of
the fingertips.

Week 33
Skull is quite
pliable and
not
completely
joined. This
will help him
ease out of
the birth
canal.

Week 34
Lungs are well
developed.
99% can
survive
without long
term
problems.

Week 35
Maternal antibodies
against measles,
mumps, rubella,
whooping cough, and
scarlet fever are
transferred to the baby,
providing protection for
about 6 months until
infants own immune
system can take over.

Week 36
Braxton Hicks
contractions
become frequent.
Body is shedding
of body hair and
vernix caseosa.
Swallow all of
these and turn it
into meconium.

End of Week 36
Length: 42- 48 cm
Weight: 1800- 2700 g (5-6lb)
Body stores of glycogen, iron
carbohydrate and calcium are
deposited.
Sole of the foot has one or two
crisscross creases, compared to the
term.

End of Week 36
Amount of lanugo begins to diminish.
Most babies turn into vertex
presentation during this month.

Week 37
Has full head of hair.

Week 38
Baby has firm grasp now.

Week 39
Outer layer of skin sloughs of as new
skins form underneath.
Still putting up fat.

Week 40
Hair and nails continue to get longer.

End of Week 40
Length: 48- 52 cm
Weight: 3000 g (7-7.5lb)
Fetus kicks actively, hard enough to
cause mother considerable
discomfort.
Fetal hemoglobin begins its
conversion to adult hemoglobin.

End of Week 40
Vernix caseosa is fully formed.
Fingernails extend over fingertips.
Creases on the soles of the feet
cover at least two thirds of the
surface.

Week 41
Less AF.
Skin starts to peel.

Relief of the Common Discomforts

of Pregnancy:
Nausea and vomiting
***Avoid odours or factors that trigger
nausea.
***Eat dry toast or crackers before rising.
***Have small but frequent dry meals with
fluid between meals.
***Avoid greasy or highly seasoned foods.
***Drink carbonated beverages or herbal
teas.

Urinary frequency
***Increase daytime fluid intake.
***Void when the urge is felt.
***Decrease fluid in the evening to
decrease nocturia.

Fatigue
***Plan time for daily nap or rest
period.
***Go to bed earlier.
***Seek family assistance with tasks so
that more time is available to rest.

Breast tenderness
***Wear well-fitting, supportive bra.

Increased vaginal discharge

***Bathe daily but avoid douching,
nylon panties, and pantyhose.
***Wear cotton underpants.

Nasal stuffiness and

epistaxis
***Cool-air vaporizer may help.
***Avoid nasal sprays and
decongestants.

Ptyalism
***Use mouthwash, chew gum or suck
hard candy.

Pyrosis (heartburn)
***Eat small frequent meals.
***Avoid overeating or lying after
eating.
***Use low-sodium antacids.

Ankle edema
***Dorsiflex foot frequently.
***Elevate legs when sitting or resting.
***Avoid tight garters or constricting
bands.

Varicose veins
***Wear supportive hose and elevate
foot frequently.
*** Avoid crossing legs at knees,
prolonged standing and garters.

Constipation
***Increase fluid in diet at least 8-oz.
glasses daily.
***Increase fiber in diet.
***Increase daily exercise to promote
peristalsis.

Hemorrhoids
***Avoid constipation and straining to
defecate.
***Reinsert into rectum if necessary.
***Treat with topical anaesthetics.
***Warm soaks, sitz bath or ice packs.

Backache
***Use good body mechanics.
***Do pelvic tilts exercise in regular.
***Avoid uncomfortable heights, highheeled shoes, lifting heavy loads and
fatigue.

Leg cramps
***Practice dorsiflexing foot to stretch
afected muscle.
***Apply heat to afected muscle.

Faintness
***Avoid prolonged standing in warm
area.
***Rise slowly from resting position.

Dyspnea
***Use proper posture when sitting and
standing.
***Sleep propped up with pillows if
problems occur at night.

Difficulty in sleeping
***Drink a warm beverage before bed.
***Use pillows to provide support for
back, between legs, or under upper
arm when side-lying position.

Flatulence
***Chew food thoroughly and avoid
gas-forming food.
***Exercise regularly and maintain
normal bowel habits.

Determination of EBD
Nageles rule
A method used for estimating a
womans due date that was
developed by German obstetrician
Franz Nagele. The date is determined
by taking the first day of the last
menstrual period (LMP), adding seven
days, subtracting three months and
adding one year.

 Naegeles Rule

For LMP between April to December:

- 3 (months) +7 (days) +1 (Year)

For LMP betwen January to March:

+ 9 (months) +7 (days)

Examples:
1. LMP : January 15, 2005

01 15 2005
+ 9 +7
__________________
10
22 2005 (October 22, 2005)

2. LMP : December 16 2004

12 16 2004
-03 +7
+1
__________________
09
23 2005
(September 23, 2005)

Determining the Age of Gestation

(AOG)
Number of days since LMP to the
present day divided by 7

Example:
A pregnant woman comes to the clinic for
an initial prenatal check up. Her LMP
was December 16, 2004. Present day is
February 14, 2005.
December - 15 (31 days 16 days)
January
- 31
February - 14
______________________
60 days / 7 = 8 weeks and
4 days (AOG)

 Mc Donalds Rule
Formula: AOG (months)= Fundic height (in
cm) 4

E.g. FH of 24 cm
= 24 4
= 6 months (24 weeks)
***For 20 weeks AOG and above:
FUNDIC HEIGHT (CM) = AOG (WEEKS)
**For below 20 weeks AOG:
= FH (CM) x 8 / 7
= AOG in weeks

Bartholomews Rule estimates AOG

by the relative position of the uterus
in the abdominal cavity

Prenatal Exercises
1. Tailor sitting
-stretches and strengthen perineal
muscles; increase circulation in the
perineum; make pelvic joints more
pliable

2. Pelvic rock
-maintains good posture; relieves
abdominal pressure and low
backache; strengthens abdominal
muscles following delivery

3. Squatting
-stretches the pelvic floor muscle;
should be done15 minutes daily

 4. Pelvic Floor Contraction (Kegels)

-promotes perineal healing; relieves
congestion and discomfort in pelvic
region; tones up pelvic floor muscles
`