Maternal & Child Nursing MAY 2024 PNLE

NORMAL OB PROF. ARCHIE ALVIZ

Refresher Phase 11-24-23

● E.g. Paracetamol
OUTLINE
■ 3 Germ Layers:
OVERVIEW OF MCN & PREGNANCY ● Ectoderm: brain development

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SIGNS & SYMPTOMS OF PREGNANCY ● Mesoderm: heart
ADAPTATIONS IN PREGNANCY ● Endoderm: GI
PSYCHOLOGICAL TASK IN PREGNANCY ■ Ambivalence: 2 opposing feelings

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MEMBRANE ● nagdadalawang isip yung mother
ANTEPARTUM CARE ● normal in 1st Trimester only
DISCOMFORTS OF PREGNANCY ○ postpartum blues/depression: if
HEALTH TEACHINGS present in 2nd / 3rd Trimester
COMPONENTS OF LABOR (4 Ps) ○ 2nd T: Easiest part
TYPES OF LABOR ■ Mother has already adapted to the pregnancy state

or
STAGES OF LABOR & DELIVERY ■ Comfortable
THEORIES OF LABOR ONSET ■ Period of increased libido
EFFECTS OF LIGHTENING ● ⭐ Best time to have sex with husband
CONSEQUENCES OF SPONTANEOUS RUPTURE OF MEMBRANES ○ 3rd T: Unattractiveness (low self-esteem)
POSTPARTUM CARE ■ Uterus most biggest
■ Melanin secretion is increasing (dark nape, singit,
bc
MCN: Maternal Child Nursing
● 2 patients: Mother & Child
● Priority: Both pts (act as one)
■
etc.)
👩🏻‍⚕️
Assess support mechanisms
● Iparamdam na maganda pa rin sila

Pregnancy
● Periods:
○ 1st T: Organogenesis
ay
■ most critical part of pregnancy
■ organs are developed
■ Avoid: teratogenic drugs, OT w/o prescription
■ Category A (drug):
● safe in pregnancy
● don’t cross the placental barrier

♡ AYBCORTEZ 1
SIGNS & SYMPTOMS OF PREGNANCY
2. Pregnant: ear
lobe
Presumptive Probable Positive 3. During Labor:
butter
- subjective - objective - confirm
- BAUN QC - “Overt Symptoms”
HCG (Human
- HCG HCG UTZ (Ultrasound)
Chorionic
B - Breast changes - proBaBle - 2 Types

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Gonadotropin)
- inc. in size; 1. Transvaginal
- (+) pregnancy test
prepares for
pregnancy
H - Hegar’s
- thinning of the – 👩🏻‍⚕️
– early pregnancy
Empty bladder
- can be: H mole,
Choriocarcinoma,

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A - Amenorrhea uterus (for proper — to insert the UTZ
Tumors in Uterus
- d/t changes in contractions; to expel properly; dec
hormones fetus) discomfort)
B - Braxton Hicks
U - Urinary — inc the effect of 2. Abdominal
Contraction
Changes
N - Nausea &
vomiting
contraction

C - Chadwick’s
– 👩🏻‍⚕️
– late pregnancy
Drink water
— for better
- painless
- irregular
- True Labor: Painful

or
- purplish / blush visualization
& regular
Q - Quickening vagina — 2-3 glasses of
- movement felt by — d/t lack of water
B - Ballotment
mother circulation (gravid
- bouncing of fetus
- 5 months uterus → blood to FHT
- Triggered by:
C - Chloasma / vagina is not - 120-160 bpm
1. Inserting 2 fingers
Melasma reached) - <120: brady
2. Presenting part is
- discoloration (face & - temporary only:
👩🏻‍⚕️
- >160: tachy
neck)
bc once uterus become
normal, fetus
delivers→ pink again
- Assess (sx of
fetal distress)

Movement felt by
reached (
3. Bounce in the 2
fingers
If fetus is ballotable =
not engaged fetus
G - Goodell’s Examiner
If non-ballotable =
- softening of the
engaged fetus
cervix
— helps in the normal
ay
● Braxton Hicks: painless / irregular

⭐
expulsion of fetus
3 Types of
Softening of Cervix
●
●
Ballottement: bouncing
Montgomery’s tubercle: lubricates the breast during
1. Non-pregnant: breastfeeding
nose (soft as)

♡ AYBCORTEZ 2
 ● Melasma / Chloasma: mask of pregnancy
● Linea Nigra
○ location: midline of abdomen
👩🏻‍⚕️ Assess for Homan’s sign

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○
■Dorsiflexion of foot
Pain in the calf → (+) Homans sx
❌
■
Massage (dislodge blood clot)
✔️
●

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○ color: ● Elevate
■ blackish (“During”) ○ DVT (Deep Vein Thrombosis)
■ whitish (“After”) → Linea Alba ■ “Virchow’s Triad”
■ 3Vs
ADAPTATIONS IN PREGNANCY ● V - Venous Stasis
○ main cx
1. Cardiovascular / Circulatory Changes
✳️

or
● Inc total cardiac volume → inc cardiac output ○ Mngt: Anti-embolic stockings
● Palpitations (heart is adjusting) ● V - Venal Wall Damage
○ must be temporary ● V - V(B)lood Coagulation
○ permanent: heart condition
● Edema 2. Gastrointestinal Changes
○ Lower Extremities: normal
bc ● Morning Sickness
■ d/t dec venous return (gravid uterus) ○ d/t hypoglycemia in the morning
■ e.g. edematous feet ■ Why? At night: mother is asleep; fetus is getting
glucose
○ Upper Body: Anasarca (generalized), Facial, Periorbital
■ abnormal ○ ✔️
Simple Carbohydrates (Easily converted to glucose)
■ sx of PIH (fluid retention) ■ dry crackers/toast
● Varicosities of the Lower Extremities ■ When: BEFORE getting out of the bed
○ d/t Tortuous/Overworked Veins ● Hyperemesis Gravidarum
ay
○ “Hyperemesis” = vomiting
○ “Gravidarum” = pregnancy
○ d/t high HCG levels
✔️
SFF (Small Frequent Feeding)
❌
○
○ Large Meals

♡ AYBCORTEZ 3
 ● Constipation & Flatulence
○ d/t gravid uterus (slows down peristalsis)
○ ✳️ Mngt: (to stimulate peristalsis)
■ Inc OFI
■ High Fiber Diet
■ Exercise/Ambulation
● Hemorrhoids Backache

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○
○ d/t inc pressure in the perianal area (bulging of veins) Leg Cramps
✳️
○
○ 2 TYPES OF HEMORRHOIDS Low Heel Shoes (with grip)
✳️
■
■ Internal:
⭐ ■ Proper Posturing

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● Painless (asymptomatic) 6. Temperature Changes
■ External:
● ⭐ Painful
● Inc Temp → Inc BMR → faster conversion of glucose
7. Endocrine Changes
○ Ex = pain
○ ✳️ Warm Sitz Bath (to enhance circulation, dec
● Thyroid gland-enlargement
○ r. calcitonin: calcium (blood) → bone
inflammatory process)
✳️

or
○ Witch Hazel (Vesicant/astringent): dehydrates
hemorrhoids → dec size
■ Astringent: parang eskinol/master for acne
● Heartburn
○ ✔️ SFF (Small Frequent Feeding) ● Parathyroid gland enlargement
■ to not trigger gag reflex ○ r. PTH/Parathormone: calcium (bone) → blood

●
bc
3. Respiratory Changes
SOB (Shortness of Breath)
○ d/t limited lung & diaphragmatic expansion
○ ✔️ Left-Side Lying position: best mngt
○ If DOB = needs other mngt ● Why do BOTH increase? Mother self sacrifice.
4. Urinary Changes ○ Parathormone: from mother
● Inc Urinary Frequency ○ Calcitonin: for fetus
ay
○ d/t pressure of the gravid uterus ○ During Pregnancy:
● Dec Urinary Threshold ■ At risk for osteoporosis
5. Musculoskeletal Changes ■ Calcium Depletion
● Lordosis: “pride of pregnancy” ○ ✔️Milk for Pregnancy (Anmum)
● Adrenal Gland: inc size & activity (metabolism)

♡ AYBCORTEZ 4
8. Skin MEMBRANES
● Chloasma / Melasma ● Chorion: outer layer
● Linea Nigra: during pregnancy; blackish → Linea Alba: after ● Amnion: inner layer
pregnancy; white ○ w/ amniotic fluid (500-1000mL)
● Striae Gravidarum: “stretch marks” ○ <500mL: oligohydramnios
○ ✔️
Cocoa Butter (lessen scarring, enhances collagen ■ inom ng inom, ‘di makaihi

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matrix) ■ kidney px
9. Uterus ■ renal px
● Hegar’s Sign: thinning of the uterus ○ >1000mL: polyhydramnios
10. Cervix ■ ihi ng ihi, ‘di makainom

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■ esophageal atresia
● Goodell’s Sign: softening of cervix
■ TEF: Tracheoesophageal Fistula
11. Vagina
● Amniotic Fluid: pH 7.0-7.5
● Chadwick’s Sign: purplish/bluish discoloration
○ Nitrazine test
Leukorrhea: vaginal secretions
⚠️
●
● FUNCTIONS OF AMNIOTIC FLUID
○ UTI: predisposes to Preterm Labor
1. Protection

or
● Vaginal pH: slightly acidic (pH 5.5-6.5)
2. Temperature Regulation
○ prevents infection
3. Support Growth
○ secreted by döderlein bacilli
4. Fetal Movement
12. Weight Changes
● UMBILICAL CORD
● 1st T: 1.5-3 lbs ○ AVA: 2 arteries, 1 vein (normal)
● 2nd T: 10-11 lbs ○ VAV: 2 veins, 1 artery (Congenital Heart Defect)
●
●
bc
3rd T: 10-11 lbs
Total Weight Gain: 25-35 lbs

PSYCHOLOGICAL TASK IN PREGNANCY

○ Wharton’s Jelly: protective covering of the umbilical
cord

ANTEPARTUM CARE
● 1st T: Accepting the pregnancy ● Care given between CONCEPTION to ONSET OF LABOR
○ Ambivalence must be resolved ● Inclusions:
● 2nd T: Accepting the baby ○ Fetal well being
ay
○ Fantasize about the baby’s appearance ○ Maternal well being
● 3rd T: Preparing for parenthood 1. Fetal well being
○ Responsibilities as a parent
● Auscultation
○ 3 mos: Doppler

♡ AYBCORTEZ 5
 ○ 4 mos: Fetoscope determine fetal maturity
■
○ 5 mos: Stethoscope 2 TYPES OF UTZ
■
● Normal FHT: 120-160 bpm A. Transvaginal: early pregnancy → empty
■
● Electronic Fetal Heart Monitoring bladder
■ B. Abdominal: late pregnancy → drink 2-3
NST ST
glasses of water (better visualization)
(Non Stress Test) (Stress Test)
⭐
👩🏻‍⚕️
Leopold’s Maneuver
👩🏻‍⚕️
●

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- won’t trigger stressor; wait for - invasive → consent ○ Empty Bladder (must void/urinate)
the normal contraction - Nipple Stimulation / Oxytocin ○ 1st: Fundal Grip
- Looking for: Acceleration - AKA: Oxytocin Challenge Test ■ Presentation

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(normal) - Looking for: Deceleration
● Cephalic (head)
— 15 beats ⬆️
- Rule of 15 x 15

— 15 seconds duration
- Early D: Head Compression
- Late D: Uteroplacental
Compression
● Breech (buttoks)
● Transverse/Acromion (shoulder)
- Variable D: Cord Compression ● Footling (feet)

-⭐ Result:
● Facial (face)
○ 2nd: Umbilical Grip

or
— Positive: bad result ■ Fetal back
— “P” must go to Physician
● Location of PMI (Point of Maximum
— Negative: good result
-⭐ Result:
— Reactive: good result
— “N” go back to NST Impulse)
● FHT are most audible
— Non-Reactive: bad result (go ○ 3rd: Pawlik’s Grip
to Stress Test) ■ Station (3)

■
■
bc
Amniocentesis: amniotic fluid sample
○ AFP (Alpha Fetoprotein)
⬆️
: Neural Tube Defects
⬇️
: Down’s Syndrome (Trisomy 21)
-3

-2

-1
floating below the level of ischial
spine

● Fetoscopy: direct visualization

2. Maternal well being 0 engaged at the ischial spine
● Pregnancy Diagnostic Procedures
ay
+1
○ UTZ
■ diagnose pregnancy +2 crowning below the ischial spine
■ confirms sex
■ confirms growth and abnormalities +3

♡ AYBCORTEZ 6
 ○ 4th: Pelvic Grip
■ Attitude/Fetal Lie DISCOMFORTS OF PREGNANCY
■ Flexion/Extension ● Normally occurring but needs mngt
● Clean Catch Urine-Collecting Urine Sample 1. Nausea & Vomiting
○ Detect: UTI (predispose preterm labor)
■ First Stream: discard (contaminated)
● ✔️ SFF (dry crackers/toast) early morning

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2. Breast tenderness
■ Middle Stream: use (accurate)
○ OT: Mid-Stream Urine
● ✔️ Supportive Brassiere (firm fitting)
● Pain: masakit kahit ‘di hawakan
● Pap Smear/Papanicolaou Smear ● Tenderness: masakit pag inawakan lang

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○ Detect: Cervical cancer 3. Ptyalism: excessive salivation
○ 5 CLASSES OF CERVICAL CANCER
○ Class I: normal
● ✔️ Hard Candy, Gum
4. Ankle edema & Varicosities:
■ okay ka lang ✔️ Elevate
❌
●
○ Class II: inflammation ● Prolonged standing
■ pupunta sa hospital 5. Backache
✔️

or
■ check-up ● Low heeled shoes (with grip, good posture)
■ bawal ang IE 6. Constipation:
○ Class III: mild to moderate dysplasia
■ bawal ang “F” word (sex)
● ✔️ Inc OFI & Fiber (enhances peristalsis)
7. Heartburn:
○ Class IV: probably malignant
■ mahirap itayo daliri = difficulty recovery
● ✔️ SFF
8. Hemorrhoids:
bc
○ Class V: possibly malignant
■ pinky finger = slimmest chance of living
● ✔️ Warm Sitz Bath + Witch Hazel

⚠️Cancer HAS a CURE

9. SOB:
✔️
🎶🎶🎶
○ ● Left side lying position
○ also prevent supine hypotension syndrome / Vena Cava
Oh cancer syndrome
Cancer has a cure
Chemotherapy HEALTH TEACHINGS
ay
Upera ● Nutrition: Well balanced diet
Radiation ○ Add calories:
Emotional support
■ Pregnant: +300 calories
If you lack this… you will surely die
🎶🎶🎶 ●
■ Breast feeding: +500 calories
Avoid smoking (low birth weight baby, cleft palate)

♡ AYBCORTEZ 7
 ● Avoid drinking (fetal withdrawal syndrome: lethargic/irritable) ○ 👩🏻‍⚕️
Bear down only if there’s uterine contraction; will
● Sexual Activity waste energy if none.
○ 1st T: dec ● Abdominal muscle contractions
○ 2nd T: inc (libido) ● Contractions of levator ani muscle
○ 3rd T: dec (uncomfortable d/t gravid uterus) 4. Psyche
○ Rule of 666
■ 6 wks BEFORE delivery: ❌ sex
● overall status of the mother

✔️

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● Physical, Psychological, Emotional
■ 6 wks AFTER delivery: sex ● ready dapat sila
● 6 wks (normal INVOLUTION): going back to
the non-pregnant state TYPES OF LABOR

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● Employment: NO hazardous waste (farm, salon, etc.)
● Traveling: every 2-3 hrs, rest for 15-20 mins False Labor True Labor

COMPONENTS OF LABOR - irregular (contraction) - regular & predictable

● FOUR (4) Ps OF LABOR

1. Passenger
- confined in the abdomen (pain)
- no inc in frequency, duration,
interval
- lower back➡️
(contraction)
abdomen (pain)
— shooting pains down the legs

or
● “FETUS” - relived by ambulation (pain) - inc frequency, duration,
● Attitude - (-) cervical changes shortened interval
— inc lordosis
● Engagement
— inc vaginal discharge
● Position - not relieved by ambulation
● Presentation and presenting part (pain)
● Station bc - (+) cervical changes
2. Passageway — bloody show
— rupture of membrane (ROM)
● Three (3)
○ Pelvis (main)
○ Cervix STAGES OF LABOR & DELIVERY
○ Vagina 1. Dilatation & Effacement
● CPD: Cephalopelvic disproportion/fetopelvic disproportion 2. Fetal expulsion
○ “di kasya yung passenger sa passageway”
✳️
3. Placental expulsion
ay
○ Mngt: CS 4. Recovery & Bonding (Homeostasis)
3. Power STAGE 1: DILATATION & EFFACEMENT
● Primary: Uterine contractions (stronger) ● PHASES: LAT
● Secondary: Bearing down ○ Latent: 0-3 cm; mother is able to communicate

♡ AYBCORTEZ 8
 ■ health teachings ● Cotyledon: 20-30
○ Active: 4-7 cm; mother begins to lose self control ● TYPES OF PLACENTA
■ Focus: pain ○ Schultze: S (hiny)
○ Transition: 8-10 cm; transfer mother from LR to DR ○ Dunchan: D (dirty/meaty) - inc risk for retained placenta
■ full dilatation & effacement fragments
STAGE 2: EXPULSION STAGE / FETAL EXPULSION ● TWO PHASES IN THE THIRD STAGE OF LABOR
1. Placental separation

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D FIRE ERE
➡️
●
● D - Descent: fetal head maternal pelvis 2. Placental expulsion
● F - Flexion: preparation of the fetal head to pass the cervix
I - Internal STAGE 4: RECOVERY & BONDING (POST PARTUM)
➡️
●

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R -Rotation: actual passage of the fetal head maternal cervix ● First 1-4 hrs after delivery
● E - Extension: expulsion of the fetal head most critical stage
👩🏻‍⚕️
●
● E - External Considerations:
✔️ ✔️
●
R - Rotation: expulsion of the fetal shoulder ○ Assess fundus ( firm & globular; well-contracted)
● E - Expulsion: expulsion of the fetus ○ Assess for lochia
● DANGER SIGNS DURING LABOR AND DELIVERY ■ Rubra: Reddish (1-3 days)

or
1. Vaginal bleeding ■ Serosa: Pinkish → Brownish (4-9th day)
2. Premature labor ■ Alba: Whitish (10th day-6 wks)
3. Abnormal fetal presentation ● 6 wks: normal involution
4. Ruptured membranes ✔️
○ Assess the bladder ( empty bladder)
5. Crowning ○ Perineum: Assess s/sx of infection
STAGE 3: PLACENTAL EXPULSION
bc ○ Blood Pressure (Shock)
● 3 SIGNS OF PLACENTAL SEPARATION ■ Normal Blood loss:
1. Lengthening of the cord ● NSD: 500mL
2. Sudden gush of blood ● CS: 800-1000mL
3. Culkin’s sign (uterus become form & globular)
⚠️ Soft & Boggy: Uterus is not well contracted THEORIES OF LABOR ONSET
✔️
○
( massage/oxytocin) 1. Uterine Stretch Theory
⚠️ Uterus is dislodged to the right: full bladder 2. Oxytocin Stimulation Theory
✔️
○
ay
( urinate/catheter) 3. Progesterone Deprivation Theory
⚠️ Oxytocin given = there is still bleeding: retained 4. Prostaglandin Theory
✔️
○
placental fragments ( D & C / reclean uterus) 5. Theory of Aging Placenta
○ ⚠️ Uterus is well contracted = still bleeding: perineal
laceration

♡ AYBCORTEZ 9
 CONSEQUENCES OF SPONTANEOUS RUPTURE OF MEMBRANES
1. Labor is inevitable
2. If (-) labor → need for induction
3. (+) umbilical cord compression

POSTPARTUM CARE

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1. Hygiene
● Do not use soap or alcohol in cleaning the breasts
2. Breast engorgement – felt during the 3rd pp day
● With increase in temp (milk fever)

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● Use firm-fitting brassiere
● Cold compress: ❌ breastfeeding
● Warm compress: ✔️ breastfeeding
3. Sore nipples
● Expose to air for 10-15 minutes
● If air is not effective, expose to 20 watt bulb placed 12-18 inches

or
away
4. Postpartum Sexual activity
● Should not resume until:
○ Vaginal bleeding has stopped
○ Episiotomy has healed
bc
ay

♡ AYBCORTEZ 10