Professional Documents
Culture Documents
HEALTH NURSING
ANTEPARTUM
1
Maternal and Child Health Nursing
involves care of the woman and
family throughout pregnancy and
child birth and the health promotion
and illness care for the children and
families.
2
Primary Goal of MCN
The promotion and maintenance of
optimal family health to ensure
cycles of optimal childbearing and
child rearing
3
ANATOMY AND
PHYSIOLOGY OF
FEMAL REPRODUCTIVE
ORGANS
4
EXTERNAL
Mons Pubis - pad of adipose tissue which
lies over the symphysis pubis covered by
skin and at puberty, by short hairs;
protecting the surrounding delicate tissue.
7
8
INTERNAL
UTERUS
A hollow pear shaped
muscular organ
Serves various function
1. To receive ovum from
fallopian tube
2. To provide a place for the
ovum implant
3. To offer nourishment &
protection to the growing
fetus
4. To expel the fetus from the
mother’s body when mature
It has 3 layers endometrium,
myometrium,perimetrium 9
VAGINA
almond shaped,
dull white sex
glands near the
fimbrae, kept in
place by
ligaments.
Produce mature
and expel ova
and manufacture
estrogen and
progesterone.
11
FALLOPIAN TUBES
4 inches long from each side of
the fundus, widest part (called the
ampula) spreads into fingerlike
projections (called fimbrae).
Responsible for transport of
mature ovum to the uterus.
12
13
Related Structure
Pelvis - support and protect the reproductive
organ
14
Types/ Variation of Pelvis
Gynecoid – normal female pelvis. Inlet is
well rounded forward and back. Most ideal
for child birth.
Anthropoid – transverse diameter is
narrow, AP diameter is larger than normal.
Platypelloid – inlet is oval, AP diameter is
shallow
Android – “male pelvis”. Inlet has a
narrow, shallow posterior portion and
pointed anterior portion. 15
Division of the Pelvis
False pelvis
Part above the pelvic brim
Serves to support the weight of the enlarged pregnant
uterus
Directs the presenting fetal part into the true pelvis
Inlet: upper border of pelvis
Pelvic cavity: Curved canal with a longer posterior than
anterior wall
Outlet: Pelvic outlet is at the lower border of the true
pelvis
16
FIGURE 3–12 Female pelvis. A, The false pelvis is a shallow cavity above the inlet; the true pelvis is a
deeper portion of the cavity below the inlet.
17
Pelvic Measurements
Pelvic inlet
Diagonalconjugate
Measure at least 11.5 cm
Obstetric conjugate - 10 cm or
more
18
A
FIGURE 10–5 Manual measurement of inlet and outlet. A, Estimation of the diagonal conjugate, which
extends from the lower border of the symphysis pubis to the sacral promontory. B, Estimation of the
anteroposterior diameter of the outlet, which extends from the lower border of the symphysis pubis to the tip of
the sacrum. C and D, Methods that may be used to check the manual estimation of anteroposterior
measurements.
19
B
FIGURE 10–5 (continued) Manual measurement of inlet and outlet. A, Estimation of the
diagonal conjugate, which extends from the lower border of the symphysis pubis to the
sacral promontory. B, Estimation of the anteroposterior diameter of the outlet, which
extends from the lower border of the symphysis pubis to the tip of the sacrum. C and D,
Methods that may be used to check the manual estimation of anteroposterior
measurements. 20
C
FIGURE 10–5 (continued) Manual measurement of inlet and outlet. A, Estimation of the
diagonal conjugate, which extends from the lower border of the symphysis pubis to the sacral
promontory. B, Estimation of the anteroposterior diameter of the outlet, which extends from the
lower border of the symphysis pubis to the tip of the sacrum. C and D, Methods that may be used
to check the manual estimation of anteroposterior measurements.
21
Pelvic Measurements
Pelvic outlet
Anteroposterior diameter
Should be 9.5 to 11.3 cm
Transverse diameter should
be 8 to 10 cm
22
FIGURE 10–6 Use of a closed fist to measure the outlet. Most examiners know the distance between their
first and last proximal knuckles. If they do not, they can use a measuring device.
23
Breast
Consist of glandular,
fibrous, and adipose
tissue.
Grow & Develop
from stimulation of
secretion from the
hypothalamus,
anterior pituitary and
ovaries.
Provide nourishment
to the infant and
transfer maternal
antibodies during
breast feeding
24
Menstrual
Cycle
25
Female Reproductive Cycle
Purpose:
To bring an ovum to maturity and renew the
uterine tissue bed that will be responsive to
its growth once it’s fertilized
Menarche
First menstruation
May occur early as age of 7 or late as age 17
26
The menstrual cycle
Varies from woman to woman
28
Characteristics of Normal Menstruation
Period
1. Menarche – average onset 12 -13 years
2. Interval between cycles – average 28 days
3. Cycles 23 – 35 days
4. Duration – average 2 – 7 days; range 1 – 9
days
5. Amount – average 30 – 80 ml ; heavy
bleeding saturates pad in <1hour
6. Color – dark red; with blood; mucus; and
endometrial cells
29
Phases of menstrual cycle
Menstrual phase (days 1-5)
30
Proliferative (follicular) phase (6-13 days)
33
34
Associated Terms
1. Amenorrhea - temporary cessation of
menstrual flow
2. Oligomenorrhea - markedly diminished
menstrual flow
3. Menorrhagia - excessive bleeding during
regular menstruation
4. Metrorrhagia - bleeding at completely
irregular intervals
5. Polymenorrhea - frequent menstruation
occurring at intervals of less than 3 weeks
35
BEGINNING OF
PREGNANCY
36
Process of Conception
Fertilization
41
FIGURE During ovulation the ovum leaves the ovary and enters the fallopian tube. Fertilization generally occurs
in the outer third of the fallopian tube. Subsequent changes in the fertilized ovum from conception to implantation
42
are depicted.
Placentation
43
Stages of Fetal Development
Preembryonic period
Begins with fertilization and lasts about 3
weeks
As the zygote passes through the fallopian
tube, it undergoes a series of mitotic division,
or cleavage
Once formed, the zygote develops into
morula and then blastocyst, eventually
attached to the endometrium.
44
Embryonic Period
Begins with the 4th week of gestation and
ends with the 7th week
The zygote now called an embryo, begins to
take on a human shape
Germ layers develop, giving rise to organ
system
The embryo is highly vulnerable to injury from
maternal drug use, certain maternal
infections, other factors
45
Fetal Period
Begins with 8th week of gestation and
continues until birth
During this period, the embryo now called
fetus, matures, enlarges, and grows heavier.
The head of the fetus is disproportionately
larger than its body.
The fetus also lacks subcutaneous fat
46
Embryonic & Fetal Structures
Decidua
Refers to endometrial lining during pregnancy
Provides a nesting place for the developing
ovum
47
Fetal membranes
The chorion is the fetal membrane closest to
the uterine wall:
- It gives rise to placenta
- It forms the outer wall of blastocyst
- Vascular projections, called chronic villi,
arise from its periphery
49
FIGURE Endoderm differentiates to form the epithelial lining of the digestive and respiratory tracts and associated
glands.
50
Amniotic sac
Gradually increases in size and surrounds the
embryo
Contains fluid, called amniotic fluid
Purpose
1. Protection – shield against pressure and
temperature changes
2. Can be used to diagnose congenital
abnormalities intrauterine– amniocentesis
3. Aid in the descent of fetus during active labor
51
Umbilical cord
Serves as the lifeline from the embryo to the
placenta
Measures from 30.5 – 90 cm in length & 2 cm in
diameter at full term
Contains AVA (2 artery 1 vein)
artery – carries blood from fetus to placenta
vein – returns blood to the fetus from the
placenta
Contains wharton’s jelly, jellatenous substance
that helps prevent kinking of the cord in utero
Blood flows through the cord at about 400ml/min 52
Placenta
A flat disk shaped structure formed from the
chorion, chronic villi, and adjacent decidua
basalis
Contains 15-20 subdivison called cotyledons
It supplies fetus with carbohydrates, water,
fats, protein, minerals & inorganic salts
It transfer passive immunity via maternal
antibodies
53
Maternal portion
Consists of deciduas basalis and its circulation
Surface appears red and flesh-like
Fetal portion
Consists of the chorionic villi and their
circulation
The fetal surface of the placenta is covered by
the amnion
Appears shiny and gray
54
FIGURE Maternal side of placenta (Dirty Duncan).
55
FIGURE 7 Fetal side of placenta (Shiny Shultz).
56
FETAL GROWTH &
DEVELOPMENT
57
Fetus Growth & Development
4 weeks: 4–6 mm, brain formed from
anterior neural tube, limb buds seen,
heart beats, GI system begins
58
12 weeks: 8 cm, ossification of skeleton
begins, liver produces red cells, palate
complete in mouth, skin pink, thyroid
hormone present, insulin present in pancreas
59
FIGURE The fetus at 20 weeks weighs 435 to 465 g and measures about 19 cm. Subcutaneous deposits of
brown fat make the skin a little less transparent. “Woolly” hair covers the head, and nails have developed on
the fingers and toes. Use with permission from Nilsson, L. (1990). A child is born. New York: Dell Publishing.
(Photo Lennart Nilsson/Albert Bönniers Folag AB)
60
20 weeks: 19 cm, myelination of spinal cord
begins, suck and swallow begins, lanugo
covers body, vernix begins to protect the
body
24 weeks: 23 cm, respiration and surfactant
production begins, brain appears mature
28 weeks: 27 cm, nervous system begins
regulation of some functions, adipose tissue
accumulates; nails, eyebrows, and eyelids
are present; eyes are open
36 weeks: 35 cm, earlobes soft with little
cartilage, few sole creases 61
40 weeks : 40 cm, adequate surfactant,
vernix in skin folds and lanugo on shoulders,
earlobes firm, sex apparent
Weight about 3,000 to 3,600 g (6 lb., 10 oz. to
7 lb., 15 oz.)
Varies in different ethnic groups
Skin has a smooth, polished look
Hair on head is coarse and about 1 inch long
Body and extremities are plump
62
Focus of Fetal Development
63
FIGURE 7 The actual size of a human conceptus from fertilization to the early fetal stage. The embryonic stage
64
begins in the third week after fertilization; the fetal stage begins in the ninth week.
Fetal Development: What Parents
Want to Know
65
66
Fetal Blood Circulation
69
▼▼▼
Inferior Vena Cava
▼▼▼
Right Atrium
▼▼▼
Foramen Ovale (Second Shunt)
▼▼▼
Left Atrium
▼▼▼
Left Ventricle
70
▼▼▼
Aorta
▼▼▼
▼▼▼
To upper half of the fetal body only
Upper Extreme
Brain
Heart
Pulmonary
Upper part of the GUT
71
▼▼▼
▼▼▼ Then this blood is recollected ▼▼▼
with less oxygen and then it ▼▼▼ goes to
the
▼▼▼
Superior Vena Cava
72
▼▼▼
Right Atrium
▼▼▼
Right Ventricle
▼▼▼
Pulmonary Artery (but lungs are collapsed;
Surfactant inadequate and amniotic fluid is
present)
▼▼▼
Ductus Arteriosus
73
▼▼▼
Descending Aorta
▼▼▼
Supply the lower half of the fetal body
▼▼▼
▼▼▼ Blood is recollected
▼▼▼
Hypogastric Artery
▼▼▼
Umbilical Artery
▼▼▼
Placenta
74
SHUNTS
When the baby is delivered, the shunts are
normally removed
DuctusVenosus
Foramen ovale
75
Two (2) types of Closure
Functional Closure
Anatomic Closure
76
FORAMEN OVALE
Closed functionally immediately after birth or
IMMEDIATELY AFTER CORD IS CLAMPED
Anatomically, it can persist up to one (1) year
after delivery
77
Therefore, in auscultation in twenty-eight (28) day
old baby
There is a MURMUR
This is Normal
This is NOT A PATHOLOGIC MURMUR
It is a SYSTEMIC / INNOCENT MURMUR
A PHYSIOLOGIC MURMUR IN NEONATES
78
DUCTUS ARTERIOSUS
Functional Closure
Ten to ninety-six hours (10 – 96 hrs) after birth
or approximately four (4) days
Anatomically
Two to three months (2 – 3 mos.)
79
Normal Adaptation to Pregnancy
Systemic
Changes
80
1. Cardiovascular/ Circulatory changes
81
Consequences of increased cardiac volume:
1. easy fatigability & shortness of breath due
increase cardiac workload
2. slight hypertrophy of the heart
3. systolic murmurs due to lowered blood
viscosity
4. nosebleeds may occur due to congestion of
nasopharynx
82
b. Palpitations
caused by the SNS stimulation during early
part of pregnancy; increased pressure of the
uterus against the diaphragm during the
second half of pregnancy
c Edema of the lower extremities & varicosities
due to poor circulation caused by the
pressure of the gravid uterus on the blood
vessels of the lower extremities
83
84
d. Vaginal and rectal varicosities
due to pressure on blood vessels of the
genitalia
e. Predisposition to blood clot formation
due to increased level of circulating fibrinogen
as a protection from bleeding implication: no
massage
85
2. Gastrointestinal Changes
a. Morning sickness
nausea and vomiting in the 1st
trimester due to HCG or due to
increased acidity or emotional factors
b. Hyperemesis gravidarum
excessive nausea & vomiting which
persists beyond 3 months causing
dehydration, starvation and acidosis
86
c. Constipation and Flatulence
GI displacement slows peristalsis &
gastric emptying time; inc
progesterone
87
d. Hemorrhoids
due pressure of enlarged uterus
88
e. Heartburn
due to increased progesterone and
decreased gastric motility causing
regurgitation through gastric sphincter
89
3. Respiratory Changes
a. Shortness of Breath
due to inc. oxygen consumption and
production of carbon dioxide during the 1st
Trimester; and increased uterine size pushing
the diaphragm crowding chest cavity
90
4. Urinary Changes
a. Urinary frequency
felt during the 1st trimester due to the
increase blood supply to the kidneys and then
on the 3rd trimester due to pressure on the
bladder.
b. Decreased renal threshold for sugar
due to increased production of
glucocorticoids which cause lactose and
dextrose to spill into the urine; and inc.
progesterone
91
5. Musculoskeletal changes
a. Pride of Pregnancy
due to need to change center of gravity result
to lordotic position
b. Waddling gait
due to increased production of hormone
relaxin, pelvic bones becomes more movable
increasing incidence of falls
c. Leg cramps
due to pressure of gravid uterus, fatigue,
muscle tenseness, low calcium and 92
phosphorus intake
d. Increased size and activity of adrenal cortex
increasing circulating cortisol, aldosterone,
and ADH which affect CHO and fat
metabolism causing hyperglycemia.
e. Gradual increase in insulin production but
there is decreased sensitivity to insulin during
pregnancy
93
6. Endocrine Changes
a. Addition of the placenta as an endocrine
organ producing HCG, HPL, estrogen and
progesterone
b. Moderate enlargement of the thyroid due to
increased basal metabolic rate
c. Increased size of the parathyroid to meet
need of fetus for calcium
94
7. Weight Change
95
8. Emotional responses
a. 1st trimester: some degree of rejection,
disbelief, even depression because of its
future implication -> give health teachings on
body changes and allow for expression of
feelings
b. 2nd trimester: fetus is perceived as a
separate entity and fantasizes appearance
c. 3rd trimester: best time to talk about layette,
and infant feeding method. To allay fear of
death let woman listen to the FHT.
96
COMMON EMOTIONAL
RESPONSES DURING PREGNANCY
Stress –decrease in responsibility
taking is the reaction to the stress of
pregnancy not the pregnancy itself
affects decision making abilities
99
Common Obstetric Terminology
(cont’d)
Nullipara: Woman who has had no births at
more than 20 weeks’ gestation
Primipara: Woman who has had one birth at
more than 20 weeks’ gestation
Multipara: Woman who has had two or more
births at more than 20 weeks’ gestation
Stillbirth: Infant born dead after 20 weeks’
gestation
Multigravida: Woman in second or any
subsequent pregnancy
100