|ATEFNAL NUFSNC

(D8)
|CN
TradItIonally refers to care of women
durIng pregnancy 8Irth and postpartum
as well as the care of Infants ChIldren
and adolescents. SpecIfIcally tasked
complexItIes In health care has nurses to be
maternal and women's health care
practItIoners, nurse and mIdwIves etc.

D8STETFCS - ScIence that deals

wIth chIldbIrth
It deals wIth duratIon
Pregnancy J842 weeks
Labor E 0elIvery 20 hours
PuerperIum 68 weeks

t deals wIth 2 clIents

1. mother
2. fetus

|enstrual 0Isorders

nfertIlIty

ContraceptIon/ FamIly PlannIng

|enopause
The best managed care prIncIples value a
comprehensIve approach that focus on:
*PreventIon
ex: mammograms, S8E, cervIcacancer,
screenIng, cervIcal vaccInes, prenatal care,
smokIng cessatIon programs, healthy lIfestyle,
food choIces etc.
*Early nterventIon
*ContInuIty of Care

7agIna - connects external to

Internal reproductIve organ
t Is a tube wIth rugae, dIstensIble
CopulatIon and passage way
J4 Inches long
AcIdIc, due to Its normal flora
Ph - 45 average
nternal FeproductIve Drgans
p.47 FIg. J 1
Dvary Cortex, medulla ovulatIon
(4cm long) endocrIne

Uterus Fundus menstruatIon

(JX2X1) Corpus gestatIon
CervIx
FallofIan nfundIberlum
Tubes Ampulla FertIlIzatIon
4 Inches ntramus Passageway
nterstItIal
UTEFUS

Pear shaped

J Layers
1. endometrum
2. myometrum
J. perImetrIum

5060gms weIght

Antenor rectum

PosterIor to the bladder

LIgaments

8road, CardInal, uterosacral

DvarIan cycle FollIcular maturatIon

of follIcles
ntral ovulatIon

EndometrIal Cycle

ProlIferatIve

Secretory

menstrual

|onthly sheddIng of the uterIne lInIng

Ave onset =12years - menarche

Ave duratIon =5052 years menopause

Ave amount =50ml (J080ml)

Ave cycle =28 days

|enstrual blood consIsts of endometrIal

cells, blood, mucus unfertIlIzed ovum

|enorrhagIa

0ysmenorrhea

Amenorrhea

menopause
Drgans Hormones FunctIons
8raIn
Hypothalamus CnFH
stImulates the APC to
secrete gonodo trophIc
Hormones
8raIn
APC FSH FesponsIble for
maturatIon of FollIcles
Dvary Estrogen FesponsIble for
*development of ducts of
the breasts
*spInnbarkeIt secretIons
Drgans Hormones FunctIons
Uterus Estrogen FesponsIble for
*prolIferatIon of the
endometrIal glands
*endometrIum Increases
In thIckness
Contracts uterus
8raIn
APC LH FesponsIble for the
rupture of the follIcle
Dvary Progesteron FesponsIble for
development of the AcInI
cells of the breast
thIck mucus secretIon
*relaxes the uterus
Drgans Hormones FunctIons
Uterus Progestero
ne
FesponsIble for secretory
phase
*EndometrIum becomes
more thIckened, more
vascular and glandular
*Preparedness for
ImplantatIon

Produced by the endometrIum

TechnIcally not a hormone because they are

produced by tIssues rather than specIal
glands

Play a role In rupturIng the grafIan follIcle

Large amount of prostaglandIns are found In

the menstrual blood

Found to have a contractIng effect on the

uterus

DvulatIon occurs 14 days In a 28 day cycle

To get the approxImate ovulatIon day,

subtact 14 from the cycle

Ex. Cycle Is dJ2 days - 14 = 18

th
day
WDhAN hAN
Dne ovum |IllIons of sperms
22 chromosomes Around 200J00| to
effect fertIlIzatIon, but
only one to fertIlIzed the
ovum
And X sex chromosome 22 chromosomes and Y
sex chromosome
24 hours vIabIlIty 72 hours vIabIlIty

FertIlIzatIon takes place In the ampulla

of the fallopIan tube

UnIon of sperm and ovum forms a zygote

(46 chromosomes)

Zygote contInues to form a |DFUL

(16cells)
|orula - 8lastocysnner cell mass
Embryo ammIon
Duter cell |ass
trophoblast
ChorIonIc 7IllI

0ecIdua 8asalIs
PLACENTA

mplantatIon occurs 7 to 10 days after conceptIon

Drgan of metabolIc and nutrIent exchange

between the embryonIc and maternal
cIrculatIon - begIns J
rd
week of embryonIc
development

WeIght - 400 to 600gms

0Iameter - 15 to 20 cm (8In)

Average: 1 Inch thIck

|aternal Fetal
Cotyledons |embranes

ChorIon

amnIon
1. FespIratory
2. NutrItIve
J. Excretory
4. 8arrIer - 8acterIa, 7Irus
5. EndocrIne
HCC, HPL, Estrogen E Progesterone

FunctIons:

Acts as a cushIon to protect agaInst mechanIcal Injury

|aIntaIns a constant temperature

Acts as a nudge durIng labor

Ph Is alkalIne and contaIns L,S, bIlIrubIn, vernIx,

Lanugo, epIthelIal cells, albumIn
After 20 weeks, ranges between 700
800ml

Fetus contrIbutes to volume of amnIotIc

fluId by excretIng urIne

Fetus swallows up to 600ml every 24

hours and about 400ml flows out of fetal
lungs each day

UmbIlIcal veIn LIver

nferIor 7ena Cava
thru 0uctus 7enosus

FIght AtrIum Foramen Dvale left ventrIcle

Aorta

From the superIor vena cava rIght atrIum

rIght ventrIcle pulmonary artery
ductus EnterrosIns Aorta
by passIng the lungs

4 weeks - Heart begIns to beat

8 weeks - all body organs are formed

812 weeks - FH8 heard by doppler

16 weeks - Sex can be seen

20 weeks - FH8 - heard by stethoscope

quIckenIng
baby has patterns of sleep,
suckIng, kIckIng
vernIx and lanugo are present

24 weeks - Fetal respIratory movements

begIn

28 weeks - Eyes begIn to open and close

Head haIr, eyebrows and
eyelashes are present surfactant
Is formed

J2 weeks - Subcutaneous fat

FIngernaIls and toenaIls
0escend of testes begIns

J8 weeks - Term baby

Uterus

nonpregnant - 60gms pregnant 1000gms

capacIty 10ml
5000cc

Hypertrophy (Largely)

HyperpalasIa (LImIted)

StImulated by E and P

8raxton HIcks - startIng 4

th
month
* stImulates movement of blood thru the
spaces of the placenta

CervIx
*Coodells
*ChadwIcks
hIgher glandular cell glands leadIng to
leukorrhea
D7AFES

Cease to functIon

Corpus luteum covers 1/J of ovary

and Is maIntaIned by HCC whIch
wIll persIst and produce hormones
untIl placenta takes over

7ACNA

Hypertrophy

HyperplasIa

7ascularIzatIon
Fesults In:

ThIckenIng of mucosa

Loosened connectIve tIssue

HIgher vagInal secretIons (thIck, whIte,

acIdIc Ph J.5 to 6.00)

ChadwIck's SX
8FEASTS

HIgher In sIze

NIpples erectIle

PIgmented areola

|ontgomary tubercles

Colostrummay be present (yellowIsh, A8

rIch)
FESPFATDFY SYSTE|

SlIght hypervIlatIon

SlIght Increase In FF

0Iaphragm Is elevated due to

enlargIng uterus

8reathIng may become thoracIc

than abdomInal

Nasal stuffIness and congestIon

EpIstaxIs may occur

CAF0D7ASCULAF SYSTE|

Heart Is pushed upward and to the

left

SystolIc murmur cab be heard In most

pregnant women

8lood 7olume progressIvely hIgher to

about 4050 above nonpregnant
level.

CardIac output hIgher and peaks 20

24 weeks

CAF0D7ASCULAF SYSTE|

8P may decrease especIally 2

nd

trImester and returns to Its
prepregnant level at term.

UterIne pressure on the vanal cava

when the woman Is supIne results
In supIne hypotensIve syndrome.

CAF0D7ASCULAF SYSTE|

Total F8C volume hIgher by 18J0

Plasma volume Increase Is 50 but

HCT lower slIghtly, whIch causes
physIologIc anemIa of pregnancy

HIgher W8C productIon

FIbrInogen hIgher by as much as 50

CASTFDNTESTNAL SYSTE|

N and 7 (HCC effect)

PtayalIsm

Heart burn

CastrIc emptyIng tIme Is delayed leadIng

to bloatIng and constIpatIon

hemorrhoIds

UFNAFY TFACT

HIgher urInary frequency due to growIng

uterus

Clomerular FIltratIon Fate(CFF) hIgher by

as much as 50

ClycosurIa Is common

AmIno AcIds and water soluble vItamIns

are excreted In greater amounts

SKN AN0 HAF

HIgher PIgmentatIon - areola, nIpples,

vulva, perIanal area, lInea alba

Chloasma

StrIae or stretch mark

Sweat and sebaceous glands are

hyperactIve

|USCULDSKELETAL SYSTE|

SacroIlIac, sacrococcygeal and

pubIc joInts of the pelvIs relax -
(waddlIng gaIt)

Postural changes (lordosIs)

CENTFAL NEF7DUS SYSTE|

Sleep problems

|ood swIngs

0epressIon

PCA
|ost metabolIc functIons
accelerate durIng pregnancy In
support to the addItIonal demands
of the growIng fetus, the mother's
tIssue replacement needs and In
preparatIon to labor and lactatIon.
Normal =25J0 lbs.
=111J kg.

WeIght CaIn 0IstrIbutIon

5kg.(11lbs) Fetus, placenta AF
.9kg(2lbs) uterus
1.8kg(4lbs) 8lood volume
1.4kg(Jlbs) 8reasts
2.J4.5kg |aternal stores
(510lbs.)
8raxton HIcks Nausea E 7omItIn
FA8 8allotement
ChadwIck's Pregnancy Test
SkIn Changes Amenorrhea
8reast enlargement UTZ vIsualIzatIon
Hegar's nsx 8reast tenderness
AccordIng to Feva FunIn (1984) there are tasks that a
woman must accomplIsh to Incorporate the
maternal role successfully Into her beIng.
1. EnsurIng a safe passage throughout pregnancy and
bIrth
*PartIcIpatIon In posItIve self care actIvItIes related
to dIet, exercIse and overall well beIng
2. SeekIng acceptance of Infant by
others
J. SeekIng acceptance of self In
maternal role to Infant (bIndIng In)
*mother acknowledges fetus as a
separate beIng w/In her - wIt her
experIence of quIckenIng
4. LearnIng to gIve of oneself
* what must be gIven up to assume
new role
AmbIvalence
conflIctIng feelIngs, consIdered normal

ntroversIon
focusIng on oneselfcommon durIng early
pregnancy
woman becomes passIve to her famIly and
frIends
Acceptance
generally, wnd trImester feelIng

|ood scrImp
feels, great joy, cry, dIsbelIef etc.

PromotIon of the health and well beIng of a

woman and her partner before pregnancy.
CDAL:
dentIfy any areas such as health problems,
lIfestyle habIts or other concerns that mIght
unfavorably affect pregnancy.
CDAL:
Healthy mother for a healthy baby
Frequency.
17 months = monthly
8 months = 2x moth
9 months = weekly
TEF|S:
CravIda # of pregnancy regardless of outcome
Para # of pregnancy that has reached vIabIlIty
|ultIgravIda a woman who has never been pregnant
D8 ScorIng CP (TPAL)

Example:
JuanIta Is pregnant and vIsIts you at the PNC.
She had one ectopIc pregnancy at 8 weeks.
She has one baby born at J9 weeks and one
born at J2 weeks whIch Is a set of twIns.
What Is her D8 Score:
Answer: C4P2 T P A L
1 1 1 J

0ATA -
Age, C, P, ADC
D8 HX
|edIcal Hx

P.E.
7Ital sIgns
WeIght and HeIght
Head to toes Assessment
*Head, 8reast, Abdomen, CenItals,
ExtremItIes, E
*FH and Leopold's |aneuver

Laboratory Test

UrIne

8lood

Pap smear negatIve, organIsms, presence of

squamous cells or glandular cell
may favor neoplastIc cells.
WeIght - 25 lbs

8P

UrIne testIng for preoteIn, glucose and albumIn

FH measurement

F |ovement

FHF
A procedure that Is performed to
determIne presentatIon, posItIon and lIe.
FIrst |aneuver = To determIne presentatIon
2
nd
|aneuver = To determIne posItIon
J
rd
|aneuver = To confIrm presentatIon and
Engagement
4
th
|aneuver = To determIne attItude

HygIene of Pregnancy

|Inor 0Iscomforts

0anger SIgns

Teratogens

ExercIses

NutrItIon
NutrIent NP Present LactatIon
CalorIes 2,200 2,500 2,700
ProteIn 60 gms 80 gms 80 gms
Folate 400 mcg 600 mcg 500 mcg
ron 18mg 27mg 9mg
CalcIum 1000g 1000g 1000g