HANDOUTS IN MCH DIVISIONS:

Romeo S. Dela Fuente, RM, RN, MAN Interstitial – found within the uterine musculature
Isthmus – narrow sttraight portion
I – DEFINITION OF TERMS Ampulla – ends with the funnel shape of
1. OBSTETRICS infundibulum, widest part
– is the branch of medicine that deals with the medical Infundibulum
management pregnancy, parturition & puerperium. Fimbriae
- the word obstetrics is derived from latin word “obstetrix”
meaning midwife or the person who “stands by” a woman A.3 UTERUS
during childbirth. − an inverted pear-shaped muscular organ
- the art of science of maternal-fetal & newborn care. − lies b/n the anterior bladder & posterior rectum
- OB is not only focused on the care of the mother but also and sigmoid
to her baby. LENGTH – 7.5 cm/ 3 inches
2. MIDWIFE Width – 5cm/ 2 inches
- A trained or experienced woman who attends other Thickness – 3 cm/ 1 inch
women in labor and delivery. Weight – 50-60 grams
3. MIDWIFERY Parts of the Uterus:
- it is the practice of obstetrics. a. Fundus – the dome of the uterus above the points of the
- it is the practice and art of assisting women in childbirth entranceof the fallopian tubes
- it is the practice of delivering babies or assisting womenin b. Body (Curpus) – largest portion
childbirth by somebodywho is not a physician but who is c. Cervix – the neck of the uterus, which opens into the
trained in obstetrical procedures. vagina at the external os; the internal os is the cervial
4. PREGNANCY opaning into the os; the lowest portion
-STATE OF A WOMAN WHO HAS WITHIN HER
BODY THE GROWINGPRODUCT OF CONCEPTION Uterine Supporting Structures:
(FETUS, MEMBRANES, PLACENTA) a. Ligaments- the broad and round ligament aid in holding
5. LABOR the uterus in normal position
- A series ofphysiologic and mechanical processes by b. the pelvic floor and surrounding organs provide the
which all the products of cenception ae expelled from the mainsupport
birth canal c. the uterus is movable and may be found in varying
- involuntary process by which the fetus and placenta are positions
propelled from the uterus.
6. DELIVERY A. 4. VAGINA
- process by which a woman gives birth to her offspring to − distensable tube connecting perineum and the
the external environment. cervix
7. PUERPERIUM − a musculumembranous canal approximately 8cm.
- REFERS TO THE SIX WEEK PERIOD AFTER Long located between the rectum and the urethra
DELIVERY OF THE PRODUCTS OF CONCEPTION − ends in a blind pouch around the cervix
− lubrication is via bartholin's blands (their
II – REVIEW OF FEMALE REPRODUCTIVE SYSTEM
openings are located posterior on either side of
1. Structure and Function of the Female Organs.
vaginal orifice), cells of the vagina itself, and
A. Internal Organs:
cervical secretions
A.1 OVARIES – female gonads, homologous to the
testes in the male − vaginla secreions are usually acid during
- two endocrine glands about the reproductive years
sixze of unsheld almonds − when the vaginal ph is below 4.0 or above 5.0
- lie near the fimbriae of the ther eis a greater frequency of vaginal infections
fallopian tubes − the bagina serves as part of the bith canala and
- attached to the side of the represents the female organ of copulation
uterus by the ovarian ligament and passageway of menstruation
to the pelvic wall by the
suspensory ligament B. EXTERNAL GENITALIA (VULVA)
- contain at birth all the eggs B.1. MONS PUBIS (MONS VENERIS)
(ova) about 450,000 − cushion for pelvic bones
- one ovarian follicle, which − rounded fat pad anterior to the syphysis pubis
contains the ovum reaches − covered with hair after puberty/ one to 2 years
maturity every 28-32 days and before the onset of mentruation dark, curly pubic
releases the ripe ovum (ovulation) hai grow
- manufactures estrogen and B.2. LABIA MAJORA
progesterone − prominent hair covered folds of tissue extending
* LIGAMENT – holds the ovaries from the mons pubis to the perineum
in normal position − often called the external lips
- supporting − protects labia minora, urinary meatus and vaginal
structures introitus
- keep the B.3. LABIA MINORA
ovaries in − two smaller fold of hairless skin lying medial to
place the labia majora
− often called the inner lips
A.2. FALLOPIAN TUBES (UTERINE TUBES,
− the upper folds join just in front of the clitoris to
OVIDUCTS)
form the prepuce of the clitoris
− approximately 10cm long; lie close to the ovary
− extend downward from the clitoris to the
on each side.
fourchette
− Extend from the upper uterus abd open into the B.4. CLITORIS
pelvic cavity
− a pea-shaped projection of erectile tissue
− long figerlike projections at the end of the tube
− located behind the junction of the labia minora
(fimbria) sweep the ovum into the tube where it
and is highly sensitive to tactile stimulation
move along into the uterus
− it is important in the sexual excitation of the
− fertilization of the ovum generally takes place in
female
the distal 1/3 of the tube
− represents the homologue of the penis in the male

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 B.5. HYMEN 2. Maturation of Oocytes – each oocyte lies in the ovary
− a thin fold of vascularized mucous membrane surrounded by a protective sac, or thin layer of cells called
− considered as the criterion for virginity a follicle.
B.6. VESTIBULE 3. Ushered in by menarche and end with menopause
− flattened smooth surface inside the labia 4. Normal period – days when there is menstrual flow lasts for
B.7. URETHRAL MEATUS 3-5 days.
− EXTERNAL OPENING OF THE URINARY
BLADDER
B.8. FOURCHETTE MENSTRUAL CYCLE – begins with the first day of
− thin fold of tissue formed by the posterior mentruation and ends with the onset of menses the
joining of the two labia below the vaginal orifice following month. May be anywhere from 25-35 days but
B.9. VAGINAL ORIFICE & HYMEN the accepted average length is 28 days.
C. Body Structures Involved
− Elastic partial fold of tissue surrounding opening
1. Hypothalamus – initiates the menstrual cycle
to the vagina
2. Anterior pituitary gland (adenohypophysis) – produces
− criterion for virginity hormones that act on the ovaries to further influence the
B.10. PERINEUM menstrual cycle
− muscular skin covered area between vaginal PITUITARY GLAND (HYPOPHYSIS)
opening and anausthis isa the area cut to enlarge - Small but mighty structures
vaginal opening - “master gland” because of its ability to control other
endocrine glands
LUBRICANTS: - measures 1.2 – 1.5 cm and weighs 0.5 grams
A. SKENES GLAND (PARAURTEHRAL GLAND) 3. Ovaries
− located just lateral to the urinary meatus on both 4. Uterus
sides D. Hormone which Regulate Cycle Activities
− theri ducts open into the urethra 1. Follicle Stimulating Hormone
− theri secretions helps lublicate tye external 2. Luteinizing Hormone
genitalia during coitus
B. BARTHOLIN'S GLAND (VULVOVAGINAL E. Hormones Produced by the Ovaries
GLAND) 1. Estrogen
− located just lateral to the V opening on both sides 2. Progesterone
− their ducts open into the vaginal introitus F. Effects of Estrogen in the Body
− secretions lubricate external genitalia during 1. Inhibits the production of FSH
coitus 2. Causes Hypertrophy of myometrium
3. stimulates growth of the ductile structures of the breasts
BREAST 4. increases quantity and ph of cervical mucus, causing it to
− the two mammary glands are accessory become thin and watery ans can be stretched to a distance
reproductive organ because of their role in of 10-13 cm. (spinnbarkheit test of ovulation)
lactation SPINNBARKHEIT – the stingy, elastic character of
− each breast consist of 15-20 lobes cervical mucus during the ovulatory
1. ACINI (ALVEOLI) – these are lobules that secretes milk period.
2. lactiferous duct – carries the milk secretd by the sinuses − resembles the uncooked
near the nipple eggwhite
3. areola- pigmented area surrounding the nipple G. Effects of Progesterone in the Body
4. nipples – located at the center of the areola; consist or 1. Inhibits production of LH
erectile tissue 2. Increases endometrial tortousity
5. tubercle of montgomery – sebaceous gland that secretes oil TORTOUS – having many curves, full of turns and twists
to lubricate the nipple protecting themwhile the baby 3. increases endometrial secretions
suckles 4. inhibit uterine motility
5. decrease muscle tone of GIT and Urinary tract
III. PHYSIOLOGY OF MENSTRUATION 6. Facilitates transport of the fertilized ovum through the
A. Associated Terms fallopian tubes
1. MENSTRUATION – is the sloughing off of the 7. increases body temperature after ovulation. Just before
endometrium, which occurs at regular monthly intervals if ovulation, basal body temperature (BBT) decreases slightly
conceprion fails to take place. The discharge consist s of because of low progesterone level in the blood and then
blood, mucus, and cells it usually last for 4-5 days. increases slightly a day after ovulationbecause of the
2. MENARCHE – is the establishment of the menstrual presence of progesterone.
function; the time of the first mentrual period of flow. Can
take place in girls as young as 9 or as late as 17. H. Sequential Steps in the Menstrual Cycle
3. AMENORRHEA – absence of menstrual flow 1. On the third day of menstrual cycle , serum estrogen level
4. OLIGOMENORRHEA – markely diminished menstrual is at its lowest. This low estrogen level serves as the
flow, nearing amenorrhea; scanty menstraul flow stimulus for the hypothalamus to produce follicle
5. MENORRHAGIA (HYPERMENORRHEA)- excessive stimulating Hormone releasing factor (FSHRF)
bleeeding during regular mentruation deu to tumors, 2. FSHRF id responsible for stimulating the anterior pituitary
inflammatory conditions of the uterus gland to produce the first of two hormones which regulate
6. METRORRHAGIA – irregular acyclic bleeding between the cyclic activities the follicle stimulating hormone (FSH)
periods; symptoms of disease process; benign tumors; 3. FSH is turn, will stimulayte the growth of an immature
cancer; oral contraceptives; PID; endometriosis/uterine oocyte inside the primordial follicle by stimulating
prolapsed/fibroids, polyps production of estrogen by the ovary. Once estrogen is
7. DYSMENORRHEA – painful menstruation produced, the primordial follicleis now termed as Graafian
8. MENOPAUSE – the cessation of mentrauation caused by follicle( the structure the contains high amount of estrogen)
physiologic factors ovulation no longer occurs. It occurs PRIMORDIAL – relating to a structure in its first or
between ages 40-50 earliest stage of development.
4. Estrogen in the Graafian follicle will cause the cells in the
B. General Considerations endometrium to proliferate thereby increasing the thickness
1. 300,000-400,000 immature oocytes per ovary are present at to an out eight fold.
birth ( were formed during the first 5 monthsof intrauterine * this particular in the uterine cycle therefore is called
life). May degenerate and atrophy ( process called atresia). PROLIFERATIVE PHASE
About 300-400 mature during the entire reproductive cycle *in view of the change from primordial to graafian follicle,
of women. it is also called the FOLLICULAR PHASE

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 * because of the preominance of estrogen, it is also called
ESTROGENIC PHASE
* since it comes right after the menstrual period it is also THE GROWING FETUS
called POST MENSTRUAL PHASE.
5. On the 13th day of menstrual cycle, there is a very low level IV. STAGES OF FETAL DEVELOPMENT
of progesterone in the blood. This is now the stimulus for A. FERTILIZATION
the hypothalamus to produce LUTEINIZING HORMONE - The union of the sperm and mature ovum in the
REALEASING FACTOR (LHRF) outer third or outer half of the fallopian tube (in the
ampullary portion)
6. LHRF is responsible for stimulating the APG to produce Other Terms: Conception, Impregnation, Fecundation
the 2nd hormone which regulate the cyclic activity, the
LUTEINIZING HORMONE. A.1. General Considerations
7. LH in turn, is responsible for stimulating the ovary to a. the normal amount of semen per ejaculation is
produce the second hormone produced by the ovaries, 3-5 ml or 1 tsp. Average 2.5 ml. Each milliliter of
PROGESTERONE semen contains from about 120-150 million
8. The increased amount of both estrrogen and progesterone sperm, average is 400 million per ejaculation.
pushes the mature ovum to the surface of the ovary until b. sperma are capable of fertilizing for 3 days
the following day (the 14th day of menstrual cycle) the after ejacualtion
graafial follicle ruptures and releases the amture ovum, a c. the normal life span of aperm is 48-72 hrs
process called ovulation. d. mature ovum is capable of being fertilized for
9. Once ovulation has taken place, the graafian follicle 12-24 hrs after ovulation. 48 hrs at the most,
because it now contains increasing amount of progesterone after that time it atrophies and become non
giving it its yellow appearance, is termed curpos luteum. functional
10. Progesterone causesteh glands of the uterine endometrium e. sperma arae depposited in the vagina will
to become corkscrew or twisted in appearance because of genrally reach the cervix within 90 seconds after
the increasing amounts of capillaries. ejaculation
* progeterone therefore, is said to be the hormone designed f. reproductive cells during gametogenesis divide
to promote pregnancy bacause it makes the uterus by meiosis; therefore they contain only 23
nutritionally abundant with blood in order for the zygote to chromosomes. Sperms have 22 autosomes and 1
survive X sex chromosome or 1 Y chromosomes. Ova
* This phase in the uterine cycle is called SECRETORY contains 22 autosomes and 1 x sex chromosome.
PHASE because it secreytes the most important hormone in The union of an X carrying sperm and a mature
pregnancy ovum results in a baby girl (XX). The union of Y
* In view of the change in graafian foollicle to corpus carrying sperm and a mature ovum results in a
luteum, it is also called the LUTEAL PHASE baby boy (XY)
* Because it occurs just after ovulation, it is also called the * GAMETOGENESIS – is the development
POST OVULATORY PHASE. It is also called the PRE of a mature male and female gametes
MENSTRUAL PHASE. • Gametes- sex cells (ova & sperm)
g. Only one ovum reaches maturity each month.
ADDITIONAL INFORMATION h. The mature ovum is surrounded by two plasma
1. When the ovary releases mature ovum on the day of membranes such as:
ovulation, sometimes a certain degree of pain either the 1. Zona Pellucida – is the clear
right or left lower quadrant. This sensation is normal and is gelatinous noncellular layer closest to
termed MITTELSCHMERS. the cell membrane.
2. The first 14 days of the menstrual cycle is a very variable 2. Corona Radiata – is a ring of
period. The last 14 days of mentrual cycle is a fixed period. elongated cells that radiate from the
Exactly 2 weeks after ovulation, menstruation will occur ovumlike the gaseous corona around
(unless pregnancy has taken place) because th corpus the sun.
luteum has a life span of only 2 weeks. These are two layes the sperm must
IMPLICATION: When given options regarding the exact penetrate to achieve fertilization.
date of ovulation choose two weeks before menstruation. i. The mature sperm consists of head and a tail,
the head forming most the bulk of the sperm. The
OVULATION anterior 2/3 of the nucleus in the head of the
− dischage of a mature ovum by the graafian follicle of the sperm is covered by the acrosome, which
ovary contains the enzymes that are beleived to
− mature ovum is released. facilitate sperm penetraton through the corona
radiata and zona pellucida of the ovum
− Cardinal function of the ovaary
j. freshly ejaculated spaermatozoa cannot
− usually occurs in the middle of the menstrual cycle fertilize ova; before a mature sperm can fertilize
− estimating the day of ovulation: the ovum, it must undergo CAPACITATION –
− in regular 28 day cycle ovulation takes place on the process occuring in the female genitaltract
the 14th day. whereby spermatozoa acquire the ability to
Ex. 28 fertilize ova, charaacterized by the loss of the
- 14 acrosome cap by the sperm and increase in therir
14th day respiratory metabolism and content of DNA. It
takes about 4-6 hrs before they are capable of
− 32 day cycle ovulation takes place on the 18th day. fertilizing the ovum.
− 26 day cycle ovulation takes place on the 12th day k. Fertilization usually occurs at the ampula of
− subtract 14 days from the cycle fallopian tube.
l. All the sperm that reach the ovum cluster
SIGNS OF OVULATION: around its protective layers of corona cells. As
a. Mittekschmerz – ovulatory pain occuring at the time of they surround the ovum they deposit minute
ovulation in the lower quadrant of the abdomen. This amount of HYALORODINASE – a proteolytic
sensation is normal enzyme which breakdown/ dissolve the layer of
b. tenderness of the breast ovum
c. slight rise in BBT which is preceded by a slight drop m. Out of the fertilized ovum will form not only
(0.3-0.6 0C). This rise in temperature is due to progesterone the future child but also the accessory structures
d. Spinnbarkheit – a cervical mucus that is elastic, watery, needed to support the fetus during intrauterine life:
thin, clear and slippery can be stretched from 10-13 cm. 1. the placenta
Most reliable sign of ovulation. 2. the fetal membranes

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 3. the aniotic fluid − lined by distinctive layers of cells of the endoderm
4. the umbilic
FUNCTIONS OF THE YOLK SAC:
FERTILIZATION DEPENDS ON 3 FACTORS 1. Supplies the nourishment while the uteroplacental
1. maturation of both sperm and ovum circulation is being established.
2. ability of the sperm to reach the ovum 2. Provides a source of red blood cells until the embryo's
3. ability of the sperm to penetrate the Zona hematopoietic function begins.
Pellucida and cell membrane and achieve fertilization
3. Cells of the yolk sac become incorporated into fetal
B. IMPLANTATION (NIDATION) organs. It atrophies after the hematopoietic function is
− the embedding of the zygote in the complete and remains only as thin white streak
uterus immediately after fertilization, the discernable in the cord at birth.
fertilized ovum od the zygote stays in the
fallopian tube for 3 days, during which time
rapid cell division is taking place. It takes 3-
4 days for the zygote to reach the body of the AMNION AND AMNIOTIC ACTIVITY
uterus. The developing cells are now called − originates from the ectoderm in the early stages of embryonic
Blastomere and when there are already 16 development. As the decidua is differentiating, a fluif filled
blastomeres, it is now termed as MORULA. space develops around the embryo. The space is lined with
In this morula form, it will enter the uterus smooth, glistening membrane, the AMNION.
wher it will stay for another 3-4 days. It
floats free in the uterine cavity. Where ther AMNION – The membrane that forms the amniotic sac; contains the
is already cavity formed in the morula, it is fetus anad amniotic fluid.
now called BLASTOCYST, leaving as fluid
space surrounding an inner cell mass. AMNIOTIC FLUID – a clear albuminous fluid in which the baby
Fingerlike projections are called floats;
TROPHOBLASTS, which form around − begins to form at 11-15 weeks of gestation
blastocyst and there trophoblast are the ones − ph is 7.0 – 7.5
which will implant high on posterior surface slightly alkaline
of uterus. Nidation takes place about a week − produces at a rate
after fertilization (8-10 days). Once of 500 ml in 24 hrs and the fetus swallows it at
implanted the zygote is an embryo anequally rapid rate
− CLEAVAGE – a series of mitotic cell − by the 4th month
division after sperm penetration. urine is added to the amount of amniotic fluid.
− Derived chiefly
B. THE DECIDUA from maternal serum and fetal urine
− when conception has occuredthe curpos − near term is clear,
luteum in the ovary continues to function slightly yeloowish with a non-foul characteristic
rather than to atrophy under the influence of odor with specks pf vernix caseosa and other
HCG by the trophoblast cells. Thus the solid particles
endometrium in the uterus instead of − alson kown as the
sloughing off as in a normal menstrual cycle, BAG OF WATER (BOW) it serves as a
continues to grow in thickness and protection in several ways.
vascularity FUNCTIONS OF THE AMNIOTIC
The Decicua Has 3 separate areas: FLUID:
1. decidua basalis- part of 1. Helps to maintain an even temperature for
endometrium lying directly under the the embryo/ fetus.
embryo 2. Shields the fetus against certain infections.
2. decidua capsularis – it 3. Shield agains blow or pressure on the
stretches and encapsulates the surface mothers abdomen
of the trophoblast 4. serves as fetal drinnk
3. decidua vera – remaining 5. aids muscular development because it
portion of the uterine lining. allows fetus to move
6. protects umbilical cord from pressure,
TROPHOBLAST DIFFERENTIATION: protecting fetal oxygenation
The trophoblastic cells multiply and 7. aids in the descent of the fetus during active
differentiates in to 2 layers. labor
1. Cytotrophoblast or langhan's layer- the inner layer of well 8. separates the fetus from the fetal membrane
differentiated cells. Present as early as 12 days gestation 9. serves as specimen foe varied diagnostic
and appears to be functional early in pregnancy disappears examination to determine fetal health.
between the 20th-24th week. This layer of cells protects the
growing embryo and fetus from certain infectious organism POLYHDRAMNIOS – more than 1,500
such as the SPIROCHETE and SYPHILIS. This is why ml of amniotic fluid. Stems from inability of the fetus to
syphilis is considered to have potential for fetal damage swallow rapidly as in tracheoesophageal fistula.
late in pregnancy whne ytotrophoblast cells are not
functioning. Unfortunately, the layer apperas to offer little OLIGIHYDRAMNIOS – less than 500 ml.
protection against viral invasion. Results when kidneys are not functioning normally as in congenital
2. SYNCYYTOTROPHOBLAST/SYNCYTIUM/SYNCYTI renal anomaly.
AL LAYER – the outer layer.
F. THE CHORION
E. EMBRYONIC LAYER OF CELLS − the outer wall of the amniotic sac that gives rise to the placenta
− implantation of the blastocyst in the decidua of the uterus is and the outer membrane surrounding the amnion. It supports the
completed by the 2nd week of development. Simultaneously, the sac containing the amniotic fluid.
embryonic layer of cells become the EMBRYONI DISC which − The chorion develops from the hairlike projections along the
forms the basic layers: the ectoderm and endoderm. trophoblast (outer layer of cells) referred to as CHORIONIC
1. ectoderm – gives rise to the amnion VILLI. The villi closest to the uterine wall (chorion frondosum)
2. endoderm – gives rise to the yolk sac will form the fetal portion of the placenta. The villi farthest from
the uterine wall degenerate into a smooth membrane known as
YOLK SAC the CHORION (chorion leave). The inner portion of the chorion
− Arises from the endoderm of the embryonic disc adheres to the amnion and surrounds the developing fetus and
4
 amniotic fluid. The outer portion of the chorion lies against the and fat levels so that adequate aamounts of these are always
decidua vera. available to the fetus
c. estrogen (estriol) produced as 2nd
product of cells in the palcenta – it contributes to the
G. THE UMBILICAL CORD (FUNIS) devlopment of the mammary gland in preparation for
− the lifeline that links the fetus and placenta lactation; stimulates the uterus to grow to accomodate the
− aboout 53 cm average 55 cm in length at term developing fetus.
− about 2 cm in thickness d. progesterone – maintains the
− contain 1 vein -carry ocygenated blood to the fetus; 2 artery – endometrial lining of the uterus during pregnancy; hormone
carrying deoxygenated blood from the fetus back to the placenta designed for pregnancy because it reduces contractility of
− the early embryo is connected to the yolk sac by a connecting or the uterine muscles during pregnancy which prevents
body stalk containing 2 arteries and 1 vein. During the rapid premature labor; it is present early in pregnancy as a result
development of the embryo the amniotic cavity enlarges and the of the continuation of the corpus luteum.
amnion begins to envelop the connecting or body stalk and yolk
sac, crowding them together after the 3 rd month when the • Placenta is the major source of progesterone
amnionhas in contact with the chorion, the yolk sac sinks and is about after the 8th week
gradually eliminated. The connecting body elongates to become 6. Protective barrier – inhibits the passage of some bacteria and
the umbilical cord. some substances.
− The umbilical cord is attached to the fetal side of the palcenta.
I. ORIGIN AND DEVELOPMENT OF ORGAN SYSTEM
− The rate of blood flow through the umbilical cord at term is 350
1. Stages of Human Prenatal Development
ml/minute
a. ovum from ovulation to
− the umbilical cord transports oxygen and nutrients to the fetus fertilization
from placenta and reeturned waste from the fetus to the placenta. b. zygote from fertilization to
− Because the umbilical cord has no nerve supply, it can be cut at implantation
birth without discomfort to the child and the mother. c. embryo from impalntation to 8
weeks
WHARTON'S JELLY – tissue rich in d. fetus from 8 weeks to
mucopolysaccharides birth
− it gives the cord body 2. Primary germ layers – at the time of implantation, the
which is the bulk of the blastocyst has already differentiated to a point at which two
cord. separate cavities appear in the inner structure;
− Prevents from the v ein a. Amniotic cavity – larger cavity;
and arteries − it is lined of the cells of the primary germ
layer, the ECTODERM.
H. THE PLACENTA − Filled with amniotic fluid
− a specialized vascular dic-shaped organ for maternal and fetal b. Yolk Sac – the smaller cavity
gas and nutrients exchange. It is formed by the unionof − it is lined by another distinctive layer of
chorionic villi and decidua basalis. It starts to form on the 8th cells, ENTODERM.
week of gestation c. Between the amniotic cavity and the yolk sac forms
− develops into 15-20 subdivisiona called COTYLEDONS and the third layer of primary cells the MESODERM. The
each cotyledon is a functioning unit embryo will begin to develop at the point where these
− 4/5 of the palcenta is approximately 6-10 inches in diameter; 1 three cell layers meet called the embryonic shield.
inch thick; dark red; average weight is 1 pound (400-600 gm);
1/6 the weight of the newborn Each Germ Layer of primary tissue develops
− it covers about half of the surface area of internal uterus. into distinctive specific body systems.

Parts of the Placenta: 3. Origin of body systems by tissue layer (Organs, tissues,
1. Matenal Aide – divided into irregulr lobes or cotyledons. arising from the 3 primary germ layer):
Adherent to the decidua basalis. It is rough and the Tissue Layer Body portions formed
maternalblood gives it bluish-red color. a. Ectoderm responsible for the formation
2. Fetal Aide – smooth, shiny white or slightly grayish in of the:
color with branches of the umbilical vein and arteries and (outer layer) -nervous system
the insertion of the umbilical cord. It is covered with - skin, hair, nails
amnion which extends beyond the placental edge. - sense organs
- mucus membranes
Functions of the Placenta: of the anus and the mouth
1. Respiratory system – exchange of gases takes place in the - pituitary glands
placenta, not in the fetal lungs b. Mesoderm Froms into:
2. Renal/Excretory system – waste products are being (middle) - structures of the body
excreted through the placenta with the amniotic fluid as the ( connective tissues, bones,
medium of excretion. cartilages,muscles, tendons)
3. Gastrointestinal system – nutrients pass to the fetus via the - the upper porion of
placenta by diffusion through the pplacental tissues. the urinary system (kidney, ureter)
4. Circulatory system – feto-placental circulation is - the reproductive
extablished by selective osmosis. system
5. Unique kind of Endocrine system or gland - the heart,
a. Human Chorionic Gonadotropin circulatory system & blood cells
– secreted early by the trophoblast cells. It preserves the c. Entoderm Develops into:
corpus luteum to keep on producing estrogen and (inner) - lining of the GIT –
progesterone that is why menstruation does not take place from pharynx to rectum
during pregnancy. It is also the basis of positive pregnancy - respiratory tract
test. Peak of HCG is about 8-10 weeks then later in - tonsils
pregnancy it decreases. - parathyroid,
b. Human placental lactogen (HFL) thyroid, thymus glands
or human chorionic somatotropin – it promotes growth of - lower urinary
the mammary glands necessary for lactation; a hormone system ( bladder & urethra)
with both growth promoting and lactogenic (milk - liver , pancreas
producing) properties; produces by the palcenta as early as
6th week of pregnancy; regulates maternal glucose, protein 4. Milestones of fetal Growth and Development

5
a. Four Weeks/ 1st Lunar month − surfactant production in the lungs begin
− Length – 0.7 cm to 1 cm − nails appear
− weight – 400 mg − with iron stores in the liver
− germ layer differntiate by the 2nd week
− fetal membranes (amnion and h. 30 weeks/ 8th lunar month
chorion)appear by the 2nd week − length – 30-43 cm
− nervous sytem develops very rapidly by the − weight – 1600 g
3rd week . Dizziness is said to be the earliest − good chances of survival if delivered at this
sign of pregnancy because as the fatla brain point
raapidly develops, glucose stores of the − subcutaneous fats begins to be deposited
mother are depleted, thus causing − more reflexes present
hypoglycemia inthe latter. − lanugo begins to disappear
− Fetal heart begins to form and begins to beat − skin smooth and pink
− digestive system & respiratory tracts exists − with iron and calcium storage
as a single tube. They start to separate on the
3rd week of life. i. 36 weeks/ 9th lunar month
− length – 42-49 cm
b. 8 weeks/2nd lunar month
− weight – 1900-2700 g (5-6 pounds)
− length – 2.5 cm ( 1 inch)
− lungs mature with adequate surfactant
− weight – 20 gm
− nails are firm
− all vital organs are formed at teh end of the
− lanugo and vernix disappears
8th week
− with definite sleep-awake pattern
− placenta develops fully
− survival same as term
− external genitalia appears
− MECONIUM – first stools are formed in the j. 40 weeks/ 10th lunar month
intestines
− lenght- 40-52 cm
− rapid brain devlopment
− weight – 3400 g (7-7.5 lbs)
− the sex of the fetus is determined at the time
− full term with good muscle tone and reflexes
of conception.
− little lanugo
c. 12 weeks/3rd lunar month − if male, testes in scrotum
− length – 7-9 cm
5. Focus on Fetal Development
− weight – 45 g
a. 1st Trimester – Organogenesis
− kidneys develope, urine is formed
− the most dangerous stage
− with sucking and swallowing reflexes (not b. 2nd trimester – period of continued fetal growth and
yet fully mature) development
− sex is distinguishable c. 3rd trimester – period of most rapid growth and
− buds of permanent teeth form development because of depodition
− beginning bone ossification of SQ fats
− fetal heart tone detected by ultrasound and
doppler 6. Fetal Circulation
As early as the 3rd week of IU life, fetal blood has
d. 16 weeks/4th lunar month begun to accept nutrients by the chorionic villi from the maternal
− length – 10-17 cm circulation.
− weight – 55 – 120 g Oxygenated blood from the placenta enters the
− more human appearance fetus by way of the umbilical vein. It then passes through the ductus
− lanugo appears (fine downy hair covering venosus then empties into the IVC. From the IVC blood enters the
the body and limbs of the fetus RA. At this point about 2/3 of this oxygenated blood is deflected
− buds of permanent teeth formed directly into the LA passing through the foramen ovale. From the left
− quickening in multigravida atrium, this portion of oxygenated blood enters the LV, them pumped
out to the aorta and is channeled primarily to the head and upper
− external genitalia obvioous
extremities. The reamining original oxygenated blood in the RA
− scalp hair develop enters the RV via the bicuspid valve. Blood from the RV leaves the
Rv through the PA in the normal manner. A small portion of this
e. 20 weeks/5th lunar month blood services to the lung tissue;the larger portion is shunted away
− length – 25 cm from the lungs through Ductus arteriosus directly into the aorta. This
− weight - 223 g basically independent stream of blood from the RV that move down
− vernix caseosa appears (white cheesy the descending branch of the aorta supplies the lower areas of the
substance that covers the body of the fetus) body. The remainder returns to the placenta via the umbilical arteries.
− stronger quickening felt by the primigravida
− bone hardening Two Shunts of Fetal Circulation that are necessary to
− FHT louder, audible byy stethoscope supply the most important organs of the fetus:
1. DUCTUS VENOSUS – supplies the liver
f. 25 weeks/ 6th lunar month 2. FORAMEN OVALE – allows oxygenated blood to move
− length – 20-36 cm directly to the left side of the heart and the aorta, the vessel
− weight – 550 g from whicg the arteries arise that aupply the BRAIN,
− body well proportion HEART, KIDNEYS.
− skin red and wrinkled
7. Fetal structure that are not found in the adult
− hearing established, fetus can respond to
circulation:
stimuli
a. Umbilical vein
− when born, may breath but usually does not
b. Right and left umbilical arteries
survive c. Ductus venosus
d. Foramen Ovale
g. 28 weeks/ 7th lunar month e. Ductus arteriosus
− length – 35-38 cm f. Hypogastris arteries
− weight – 1200 g
− viable, immature if born 8. Fetal Hemoglobin

6
 Fetal hemoglobin differs from adult in several a pregnancy of 6 weeks duration, that is counting
ways: from the first day of LMP.

Fetal Hemoglobin Adult b. Based on LMP and date of check up/

hemoglobin consultation
− more concentrated Ex. LMP = August 12, 1998
− 17.1 g/100ml 11g/100ml Date of Check up = NOV. 5, 1998
− hematocrit is 53 % 45%
− the change from fetal to August = 31 days
adult hgb levels begins before -12 days
birth 19 days
September = 30 days
9. Fetal Blood October = 31 days
Hematopoiesis (blood production) November = 5 days
− 1st in the yolk sac 85 days diveded by 7
days = 12 weeks & 1 day AOG
− next is the liver (major site of RBC
production)
c. McDonald's Rule – a method of determining if the
− finally the bone marrow fetus is growing in the uterus by measuring
the fundic height.
ASSESSMENT OF FETAL GROWTH AND DEVELOPMENT
− measurement is amde from the notch of
1. Average Length of Pregnancy
the symphysis pubis to over the top of
a. from ovulation
the uterine fundus as the woman lies
38 weeks
supine.
266 days
Formula:
9 ½ lunar months
1. AOG in lunar months = fundic height in cm x
2/7
− baby born before 38th week of gestation – Ex. Fundic ht = 16cm x 2 -32/7 = 4
PRETERM/PREMATURE mos. AOG
− BABY born after 42nd week of gestation – 2. AOG in weeks = fundic ht in cm x 8/7
POATTERM/POSTMATURE Ex. Fundic ht = 16 cm x 8 = 128/7 = 18
weeks AOG
2. Determination of estimated Birth Date
a. NAEGELES RULE – is the most commonly used B. Estimating Fetal length
method of determining the EDD procedure. a. Haase's rule – determine the length of fetus in
1. determine the LMP centimeters
2. consider the 1st day of LMP Rules:
3. consider the month in numerical term 1. During the 1st half of pregnancy ( 1st to 5th
Example: January = 1 month) square the month to get the
February = 2 length in centimeters.
April = 4 Ex. 1 x1 =1 cm 4 x 4 = 16
May = 5 cm
4. for the 1st three months of the year, add 12 to 2 x 2 = 4 cm 5 x 5 = 25
the numerical value cm
Example: JANUARY: 1+12 = 13 3 x 3 = 9 cm
February : 2+12 = 14 2. During the 2nd half of pregnancy (6th-10th mo)
March : 3+12 = 15 multiply months by 5.
Ex. 6 x 5 = 30 cm 9 x 5 = 45
5. now use the Naegeles formula: subtract 3 cm
months and add 7 days to the first day of LMP. 7 x 5 = 35 cm 10 x 5 =
50
b. Date of quickening – quickening is the first 8 x 5 = 40 cm
sensation/ perception of fetal
movement by the mother and is felt a slight fluttering 4. Assessing fetal well being
movements in the abdomen. A. Fetal Movement- begins at 18 weeks of pregnancy
In general, quickening occurs between and reached a peak at 29-38 weeks.
18-20 weeks, and this maybe METHOD:
related to parity. One popular approach is to ask teh
mother to lie in a left recumbent position
Formula: after a meal and record hoe many fetal movements she feels over the
A. PRIMIGRAVIDA -date of quickening + 4 next hour.
months + 20 days = EDD − If fetal movement is fewer than 5/hr –
ex. Date of quickening – March 5 instruct woman to consult her health care
3–5 provider.
+ 4 20
− if fetus normally a minimum of 2x every 10
7 25 (july 25) = EDD
minutes or an average of 10-12/hr.
B. MULTIGRAVIDA – Date of quickening + 5 − Fetal movements vary, a false positive rate
months + 4 days = EDD (not detecting movements although the fetus
ex. Date of Quickening = january 10 is healthy id extremely high.
1 – 10
+5 4 B. Fetal Heart Rate (FHR) – Fetal Heart Beat (FHB)
6 14 ( June 14) = EDD − Normal value = 120-160 beats/min
− 3rd lunar month/12 weeks – FHB/FHT is
3. Assesment of Fetal Growth and Development detected by UTZ and doppler
A. Estimating Gestational Age − 5th lunar month/20 weeks – FHB/FHT is
a. Early Prenatal Care louder, audible by stethoscope
This is the simplest method of
establishing gestational age. If a woma C. Amniotic Fluid Volume Assessmet
seeks prenatal care within 2 weeks after her missed menses and − measure by placing an UTZ scanner against
has a positive urine PT, this is ondicative of the side of abdomen.
7
 − For gestations less tahn 20 weeks – uterus is F. Fetoscopy – inspection of the fetus before birth by passing a
hypotheticallydivided along the linea Nigra special fiberoptic instrument known as fetoscope,
into two vertical halves. The vertical through the abdomen of a pregnant woman in to her uterus
diameter of the largest pocket of amniotic − usually performed in the 18th - 20th week of
fluid present is measured in cm on each side. gestation
1. Amniotic Fluid Index (AFI) − for viasualization of certain abnormalities
- the sum of the 2 measurement and blood sampling by inserting a hallow
- for gestations of 20 weeks or more – needle under direct vision into a placental
the uterus is divided onto 4 quadrants. blood vessel. The blood can then b
Vertical dividing line – linea examined for abnormalities.
Nigra − The Prenatal diagnosis of blood disorders.
horizontal dividing line – ex. sickle cell disease
level of the umbilicus
− the vertical diameter of the largest NORMAL ADAPTATIONS IN PREGNANCY
pocket of fluid in each quadrant
then four values are added to I. PHYSIOLOGIC CHANGES IN PREGNANCY
produce the amniotic fluid index A. Systemic changes
− Average AFI 15 cm – between 28- 1. Circulatory/ cardiovascular system
40 weeks gestation. a. Beginning the end of teh 1st trimester of
− AFI greater than 20-24 cm – pregnancy there is a gradual increase o about
polyhydramnios 30-40% in total cardiac volume reaching its peak at the 6th month.
− AFI less tahn 5-6 cm – This causes a drop in Hgb and Hct values
Oligohydramnios since the increase in only in the plasma
volume causing PHYSILOGIC ANEMIA IN PREGNANCY.
D. Amniocentesis
− the aspiration of amniotic fluid from CONSEQUENCES OF INCREASED
the uterus for examination TOTAL CARDIAC VOLUME:
− can be done as early as the 12th to 13th 1. Easy fatigability and SOB because of
week of gestation increased work load of the heart.
− required only 1 ml of fluid 2. slightly hypetrphy of the heart
causing it to be displaced to the left,
− also used late in pregnancy to test for
resulting in tortion of the great vessel
fetal maturity
3. systolic murmura are common due to
Procedure:
lowered blood viscosity
1. ask woman to void
4. nosebleeds may occur because of
2. lie in supine position (pregnant woman)
marked congestion of the nasopharynx
3. BP and FHR are taken as baseline data
as pregnancy progresses.
4. wash womans abdomen with antiseptic
solution
b. Palpitations due to :
5. Skin is infiltrated with local anesthesia. Needle
1. sympathetic nervous system
used is guage 20-22, 3-4 inches inserted
stimulation during 1st half of pregnancy
into the abdomen and into the amniotic cavity carefully avoiding the
2. increased pressure of uterus against
fetus and the palcenta.
the diaphragn during the 2nd half of
6. fluid is withdran then the needle is removed
pregnancy
c. Because of poor circulation resulting form the
RESULT:
pressure of the gravid uterus on the blood
Normal color: color of water
vessels of the lower extremities, EDEMA occurs.
late in pregnancy: slightly yellow tinged
Management: Raise leg above the hip
strong yellow color: indicates blood
level
incompatibility
> edema of lower extremities is not a
green color: indicates meconium staining and
sign of toxemia
fetal distress
Varicosities also on lower extremities
E. Lecithin/Sphingomyelin Ratio
can occur:
− protein components of the lung enzyme surfactant Management: Wear support hose or
− SURFACTANT – phospholipid substance that elastic stockings to promote venous
decreases alveolar surface tension on exppiration. flow thus preventing stasis in the ,ower extremities
Prevents alveoli from collapsing on expiration and − apply elastic bandage
greatly adds to the infants ability to maiintain
− avoid constrictive garters
respirations in the outside environment.
d. Varicosities on vulva and rectum
− L/S ratio may be determined by shake and bubble Management: side lying position with
test hips elevated on pillows, modified
knee chest position
Procedure: e. There is an increased level of circualting
1. amniotic fluid is placed on a test tube and diluted fibrinogen, that is why pregnant are
with saline. normally safeguarded against undue bleeding also predisposes
2. Ethanol alcohol is added and the mixture is them to formation of blood clots (thrombi).
shaken Pregnant women should not be massaged since blood
clot can be released and casue thromboembolism.
Result:
1. if stable bubbles appear, the L/S ratio is 2. GI Changes
greater than 2:1 which means that fetal a. Morning sickness – nausea and vomiting
pulmonary systtem is sufficiently mature for during the 1st trimester is due to
birth increased HCG, increased acidity or even emotional factors.
2. If the bubbles are unstable, L/S ratio is less Management: eat crackers 30 mins
than 2:1 not enough lecithin is present to before arising in teh morning. Dry,
ensure lung function if the fetus should be CHO, low fat, low spices in the diet.
deliered at this time
b. Hyperemesis Gravidarum – excessive nausea
& vomiting which persist beyond 3 mons
8
and will result in DHN, starvation and acidosis. on the lower extremities
Management: − fatigue
− D 10 NSS 3000 ml in 24 hrs, − chills
priority management − muscle tenseness
− CBR (complete bed rest) − low calcium, high phosphorous intake
Management:
c. Constiaption and Flatulence – due to the − frequent rest periods with feet
dis[lacement of teh stomach and elevated
intestines thus alowing peristalsis and gastric emptying time, − wear warm comfortable
due increased progesterone. clothing
− increase calcium intake
Management:
− press knee of the affected leg
− INCREASE ROUGHAGE ANF and dorsiflex the foot
FLUIDS IN THE DIET 6. Temperature – slight increase in body temp due to
− ESTABLISH REGULAR increased progeaterone but the body
ELIMINATION TIME adapts after 4th month
− AVOID ENEMAS 7. Endocrine changes
− AVOID HARSH LAXATIVES a. Addition to the placenta as an endocrine organ,
LIKE DULCOLAX, COLACE producing large amounts of estrogen,
ARE BETTER progesterone, HCG, HPL
− MINERAL OIL SHOULD NOT b. Moderate enlargement of the thyroid gland due
BE TAKEN BECAUSE IT to hyperplasia of the glandular tissues and
INTERFERES WITH increased vascularity
ABSORPTION OF FAT c. Increased size of the parathyroids probably to
SOLUBLE VITAMINS. satisfy teh increased need of the fetus for
calcium
d. Hemorrhoids - due to uterine pressure d. Gradual increase in insulin production
Management 8. Weight - 1st trimester – weight gain of 1.5 to 3 lbs.
- cold compress with hazel and epsom - 2nd trimester – wt gain – 10-11
salt lbs/trimester, 1 lb per week
e. Heartburn (pyrosis) – substernal pain usually - total allowable wt gain = 20-25 lbs.
a/w regurgiattion of stomach contents (10-12 kg)
causing irritation.
Management: Distribution of weight gain during
− pats of butter before meals pregnancy
− sips of milk at frequent intervals Fetus 7.0 lbs
− small frequent feedings 3.1 kg
− no fatty fried foods placenta 1.0 lb
− bend on the knees not on the waist 0.6 kg
− take antacids but never Amniotic fluid 1.5 lbs
bicarbonate 0.9 kg
Inc weigth of the uterus 2.0 lbs
3. Respiratory changes 1.1 kg
a. Shortness of breath due to increased o2 inc. Blood volume 1.0 lb
consumption and production of CO2 1.5 kg
during the 1st trimester and the increase in the uterine size inc. Weight of breast 1.5-3 lbs
causes the diaphragm to be displaced or 0.6-1.3kg
pushed thus crowding the chest. wt of absominal fluid 2.0 lbs
4. Urinary Changes 3.6 kg
a. Urinary frequency fat and fluid accumulation 4-6 lbs
Causes: 20-25 lbs
1st teimester – due to 11.4 – 12.1 kg
increased blood supply in the kidneys
B. Local Changes
− due to the
1. Uterus
rising out of
the uterus − wt increases to about 1000 g at full
from the term due to the incresed amount of
pelvic cavity fibrous and elastic tissues.
Last trimester – due to the − Change in shape from pear like to
pressure of teh uterus on the bladder ovoid
b. Decreased renal threshold for sugar due to − change in consistency of the lower
increased production of gluco uterine segment causing extreme
corticoids which causes lactose and dextrose to spill in the softening known as HEGARS sign-
urine. seen about 6th week
Implication: − cervix become moer vascualr and
− difficulty in diagnosing diabetes in edematous resembling the consistemcy
pregnancy basd on urine samples of an earlobe known as GOODELLS
alone because all pregnant women SIGN
have sugar in their urine − operculum – mucus plug which fills the
cerbical canalwhich seal out bacteria
5. Musculoskeletal changes during preganancy.
a. Lordotic position (pride of pregnancy)
b. Wobbly gait – due to increased production of 2. Vagina
hormone relaxin, [elvic bones − incresed vascularity causes changes in
become more supple and movable, increasing the incidence of the color from light pink to purple/blue
accidental falls. Use only low heeled known as CHADWICKS SIGN
shoes. − due to increased estrogen , activity of
c. Leg Cramps due to: teh epithelial cells increases thus
− increased pressure of the gravid uteruss increasing the amount of vaginal

9
 discharge called LEUKORRHEA. − skin surrounding areola become dark
− As long as the discharges are not − colustrom is formed at 4th month
excessive green/yellowish in color, foul 6. Ovary – no activity whatsoever since ovulation
smelling or irritatingly itchy it is does not tale place during pregnancy
normal. and estrogen and progesteron are being produced by the placenta.
− Normal vaginal discharges – whitish,
thick, non itchy. II. DIAGNOSIS OF PREGNANCY
− Ph of vagina changes from normally A. PRESUMPTIVE SIGNS – presumed but not proven, least
acidic (because of the presence of the indicaative of pregnancy
DODERLEINS BACILLI) to alkaline 1. Amenorrhea
because of increased estrogen. 2. Fatigue- may also due to illness, over exertion, depression
3. nausea and vomiting – normally disappears by the end of
Two Microorganism which love to the 12th week
thrive in an alkaline env't: 4. Frequent micturation- due expanding uterus puts pressure
a. Trichomonas – a protozoa or on the bladder
flagellate 5. Breast changes- feeling of fullness, increased in diameter,
prominence of vein, colustrom secretions
TRICHOMONIASIS/TRICHOMONAS VAGINALIS – a 6. Skin changes – striae gravidarum, linea nigra, melasma
condition caused by the
protozoa.
7. Quickening- 1st fetal movement felt by the mother
8. enlargement of the abdomen/uterine enlargement
Symptoms: B. Probable signs – likely but not surely the definite signs of
a. Frothy, cream colored irritatingly pregnancy
itchy foul smelling discharges 1. Chadwicks sign
b. Vulvar edema and hyperemia due to 2. Hegars sign
irritation from the discharges. 3. Goodells sign
4. Braxton Hicks' contraction – painless uterine contraction
Treatment: 5. ballotement – sinking and reboounding of the fetus in its
a. Flagyl for 10 days per orem surrounding amniotic fluid
b. Vaginal suppositories 6. Fetal outline – ooutline of the fetus by abdominal palpation.
c. Vaginal douche 7. Positive HCG in the urine
d. Prevent intercourse
C. Positive signs – there are only 4 positive signs of pregnancy
b. Monilia- a fungus called candida 1. Fetal heart sounds – normal value ranging from 120-160
albicans beats per min
2. fetal movements felt by the examiner – can be felt by the
MONILIASIS OR CANDIDIASIS - a 20th to 24th week of gestation
condition caused by the candida 3. fetal heart movement recorded by sonogram – as early as 7
albicans week of geatation
Symptoms: 4. x-ray outline of fetal skeleton – an x-ray showing the
a. White patchy cheese like outline as early as 14th weeks of gestation. X-ray amy be
paarticles that adhere to vaginal walls teratogenic that is why its rarely being used.
b. Irritatingly itchy and foul
smelling discharges
PRENATAL CARE
Treatment: A. OBJECTIVE: To reach all pregnant women, give sufficient care,
a. Mycostatin/Nystatin po to ensure a healthy pregnancy and the birth of a full term healthy
b. Vaginal suppositories 2x a baby.
day for 15 days
c. Gential violet swab to B. PRINCIPLES: Ideally, prenatal care begins in the mother's
vagina childhood.
d. Acidic vaginal douche 1. it includes a good calcium and vitamin D intake during
e. Avoid intercourse infancy and childhood which helps widen a woman's pelvis
and prevent contractions from malformations such as
* Moniliasis is seen a oral thrush in the rickets.
newborn when transmitted during 2. Good overall diet so that a woman enter a pregnancy in the
delivery thru the birth canal of the infeectd mother best state of health ppossible.
3. Adequate immunization
3. Abdominal wall 4. prompt and effective tretment of STD's that will help
a. Striae gravidarum – increase uterin prevent PID thus protecting fertility
size results in rupture and atrphy of 5. Reproductive Planning Information.
a connective tissue layers seen as pink and rddish streaks. Later,
after birth, becomes silvery streaks. C. Prenatal Care
b. Umbilicus pushed out a. First visit- as soon as woman misses menstrual
4. Skin period
− Linea Nigra – brown line running from b. Schedule of visits
umbilicis to symphysis pubis once a month up to 32
− Chloasma or melasma – extra weeks (8th lunar month)
pigmentation on the cheeks every two weeks 32-36 weeks
5. Breast every week 37 wks up
− all increased due to increased esreogen to delivery
− due to hyperplasia af mammary alveoli
and fat deposits More frequent visits in High Risk conditions:
− nipples more erect every 2 weeks up to 30
− feeling of fullness and tingling sensatin weeks
in the breast. every week up to 36
− Montgomery glands become bigger and weeks
more protuberent twice a week 37 weeks
− areola become darker onwards

10
D. Components of prenatal visit 1. UTERINE STRETCH THEORY- as the uterus gets
1. Collection of Baselin data stretched, the contractility of the muscles increased
2. History taking 2. Oxytocin Theory – the realease of ocytocin initiates uterine
a. demograpic data contraction
b. personal and famil history – with whom does she 3. Progesterone deprivation theory – when the level of
lives; congenital d.o.; multiple pregnancy; DM, heart progesterone decreases, contractions are initiated
disease, HPN, Metal retardation 4. Prostaglandin theory – prostaglandins stimulates the uterus
c. OB history to contractility
-mentrual history 5. Theory of teh aging Placenta -bec. the placenta, as it
- sexual history reaches term, degenerates in terms of its functional
- date of previous pregnanciesv and deliveries capacity, it causes insufficient nutrition for the fetus,
-length of labor because of the decreased blood supply, the uterus contracts.
- multiple births
-abortion • GROWTH AND DEVELOPMENT
- matenal and neonatal compliqs • Growth- refers to an increase in physical size or structure
-palce of delivery that is measurable.
-risk involved- spotting, swelling of hands and • Development- refers to an increase in skills and capacity to
feet function occurring in orderly fashion.
-medications taken • Maturation-refers to increase in competence or ability to
-falls function at a higher level.
-surgery • PRINCIPLES OF GROWTH AND DEVELOPMENT
- present pregnancy • Growth and development occur in a cephalocaudal
- LMP, EDD, gravidity, Parity, GTPAL, Signs direction that is starting at the head and moving to the
and symptoms of pregancy trunk, the legs and the feet.
• Growth and development occur in a proximal to distal body
TERMINOLOGIES: parts.
1. GRAVIDA – A woman who is pregnant w/o regard to • PRINCIPLES GROWTH AND DEVELOPMENT
pregancy outcome. • Growth and Development from general to specific, from
2. Nulligravida – a woman who is not now and never has been simple to complex.
pregnant • Growth and development are continuous, orderly,
3. primigravid -pregnant for the first time sequences and process influenced maturational,
4. multigravida – has been pregnant for several times. environmental and genetic factors.
5. para/parity – past pregnancies that have reached viability • Children have different growth rates.
6. nullipara – woman who has never completed a pregnancy • Growth is sometimes rapid and sometimes slows down.
to period of viability • PRINCIPLES OF GROWTH AND DEVELOPMENT
7. primipara- a woman who has completed one pregnancy to • Growth and development are interrelated.
period of vaibility • There is an optimum for initiation of experiences or
8. multipara – woman has completed two or more pregnancies learning.
9. viability- the earliest age at which fetuses sould survive if • Different body structures grow and developed at different
they were born at that time. times.
• Neonatal reflexes must be lost before development can
proceed.
• FACTOR AFFECTING GROWTH AND
TPAL DEVELOPMENT
T- the number of full term infants born • GENETICS
P – the number of preterm infants born • SEX
A – the number of abortions • RACE
L – the number of liing children • INTELLIGENCE
• HEREDITY
d. Day history • ENVIRONMENT
1. nutritional history – wt gain, eating patterns, type • ASSESSMENT TOOLS FOR GROWTH AND
snd smt of food eaten, fluid intake DEVELOPMENT
2. Rest and sleep pattern – length, quality, regualrity • CHRONOLOGICAL AGE
of rest and sleep, insomnia 3 to 4 mos. Hands and eyes
3. activity and employment – hobbies, exercise, coordination develop this period.
type and hrs of employment 6 mos. – Hold bottle
4. Sexual activity DENVER DEVELOPMENTAL SCREENING
5. elimination history TESTS
6. hygiene history – sensitivity to soaps skin care - It does not measures intelligence.
preparation • ASSESSMENT TOOLS FOR GROWTH AND
DEVELOPMENT
PRENATAL EXAMINATION • BRAZELTON NEONATAL BEHAVIOR ASSESSMENT
A. VITAL SIGNS SCALE
Temperature – slightly elevated due to high level of 1. New born behavior during the first month of
progesteron age.
pulse rate - may increased by 10-15 beats/min 2. document individual differences among babies
respiratory rate – does not change in rate only on 3. determine how environment shapes the
depth behavior of babies
* sudden increase in RR and PR may suggest • ASSESSMENT TOOLS FOR GROWTH AND
bleeding DEVELOPMENT
Blood pressure – there is not much change in BP • 4. Emotional and cognitive development.
except for a slight drop in the 2nd trimester ( • SAMPLE QUESTION
sudden increase in weight and BP – danger sign of hypertension) • 1. The following are characteristics of growth:
1. quantitative changes
THE LABOR PROCESS 2. individual becomes taller and heavier
3. occurs with multiplication of cells and
LABOR – a series of physiologic and mechanical processes by which enlargement of the component cells
all the products of conception is expelled from the birth canal. 4. there is increase in skills/ abilities
A. 1,2 and 3 C. 2,3 and
THEORIES OF LABOR ONSET 4

11
 B. 1,2 and 4 D. 1,3 and - child follows standards of society for the good
4 of all people.
• SAMPLE QUESTION Stage 6 Age: older than 12
• 2. Development are measured by: - principled conscience
[Link] the weight and height -universal ethical principle orientation
2. eruption of teeth - child follows internalized standards of conduct
3. observe the child’s ability to perform a specific • Let’s Evaluate Guys!
tasks • Situation: Melai, a 6 year old prep pupil is seen at the
4. getting the head and circumference school clinic in University of Northen Philippines for
A. A only growth and development. Which of the following
C. 3 only characterized of the rate of growth and development during
B. 1,2,3 D. 1,2,3,4 this period?
• SAMPLE QUESTION a. decline in growth rate c. growth spurt
• 3. Midwife Maria conducting a lecture regarding Denver b. rapid growth d. slow and uniform
developmental screening test. Caridad as one of rate
participants would like to know what this test all about • Which of the following information indicate that Melai is
Which of the following statement provide further normal for her age?
teaching. a. has the ability to try new things.
a.” this test will help to determine personal, social, b. develop sense whether she can trust the world.
fine motor-adaptive, language and gross motor skills.” c. learn basic skills within his culture
b. “this test will determine some abnormalities pattern d. determine own sense of self.
of growth and development .” • Growth refers to an increase in size while development
c.” this test will be able to determine her intelligence in applying refers to:
her social and motor skills.” a. maturity c. inc. in exploration
d.” this test can detect delays during infancy and preschool years.” b. increase in adaption d. inc. in capacity to
• SAMPLE QUESTION function
4. Which of the following body system to a 6 years old is reaching • In assessing her growth and development the midwife is
its peak of development during this period guided by principles of growth and development. Which
a. Lymphatic system one is not included?
b. Neurological system a. growth rate differs at different ages.
c. reproductive system b. rate and pattern of growth is the same throughout
d. musculoskeletal system the life.
• SAMPLE QUESTION c. different parts of the body grow at different times
5. Denotes the increase in skills or ability to function and it can be d. all individuals follow a cephalocaudal and
measured by observing a child’s ability to perform a specific task is proximodistal growth pattern.
called_______ • Immediate Care of the Newborn
a. maturation c. growth AIRWAY
b. development d. none of these BREATHING
• Theories of Personality Development TEMPERATURE
• Psychosexual Model- Sigmund Freud • CARE OF THE NEWBORN
• Psychosocial Model- Erick Erickson • 1. airway 8. vitamin k
• Moral Development- Lawrence Kohlberg • [Link] 9. identf.
• Interpersonal Model- Sullivan • [Link] care
• Cognitive Development- Jean Piaget • 4. eye care
• PRINCIPLES OF GROWTH AND DEVELOPMENT • 5. initial feeding
• 6. bathing
• Theories of Personality Development • 7. vitamin k administration
• Psychosexual Development- Freud • POINTERS TO REMEMBER!!!
• Psychosexual Development- Freud • 1. The best way to assess Heart rate is by auscultation with
• Psychosexual Development- Freud a stethoscope for one full minute.
• Psychosocial - Erikson • 2. RR is assessed by counting respiration movements.
• Psychosocial - Erikson • 3. Muscle tone is assessed by observing the resistance of
• Cognitive Theory-Piaget the newborn
• Moral Development- Kohlberg • 4. Reflex irritability can be evaluated by suction catheter or
• LEVEL 1: PRE-CONVENTIONAL slapping newborn’s sole
Stage 1 Age 2-3 • POINTERS TO REMEMBER!!
- punishment or obedience • 5. Color – most important newborn’s respiratory status and
- a child does the right things because a oxygenation
parent tell him or her to avoid punishment • Immediate care of the Newborn
Stage 2 Age 4-7 • APGAR SCORING
- child carries out of actions to satisfy – The most important assessment is the heart rate
own needs rather than society’s . The child does something for him in Followed by respiratory rate, muscle tone, reflex irritability and color
return. in decreasing order.
• Moral Development- Kohlberg After birth it is taken at one minute and five minutes after birth.
• Level II: Conventional If depressed? How many minute? Five minutes until condition is
Stage 3 Age 7-10 stable
- Good boy/girl •
- a child follows rules because of a APGAR SCORING
need to be a good person in own eyes and in the eyes of others. • Five minute- is more reliable in predicting mortality and
Stage 4 Age 10-12 neurologic deficits
- law and order • Factors that affect the APGAR score
- maintenance of social order, fixed 1. degree of physiologic maturity
rule, and authority. 2. fetal cardiorespiratory and neurologic
- child follows rules and authority conditions.
figures as well parents to keep the system working. 3. maternal perinatal therapy such as use of
• Moral Development- Kohlberg analgesia during labor.
• Level III: Postconventional • APGAR SCORING
Stage 5 Age: older than 12 • APGAR SCORING
- social contract, utilitarian law making, • Score Interpretation
perspective.  Normal 7-10/ Good adjustment-

12
 NO INTERVENTION REQUIRED Treatment can be delayed for up to 1 hour- to
 Intermediate 4-6 /moderately promote /allow initial parent-child bonding.
depressed infant • CARE OF THE EYES
OXYGEN Erythromycin or Tetracyline Opthalmic Oinment.
 Low 0-3/ severely depressed infant 1. open a newborn’s eye is to shade them over
from the over head light and open one eye at a time by pressure on
NEED RESUSCITATION the lower and upper lids.
2. squeeze a line of ointment along the lower
• Lets have exercise!!! conjunctival sac, from the inner and outer canthus.
• Which is not true in APGAR score? 3. close the eyes to allow the ointment to spread
a. at 60 seconds and 5 minutes. The newborn must across the conjunctiva.
observed and rated based on the 5 factors. • CARE OF THE EYES
b. a score of 4 to 6 means the condition is “guarded Measures:
and may need supplementary oxygen. 1. Hand washing- the most single most effective
c. there is a low correlation between low 5 minutes way of preventing infection among NB.
APGAR scores and mortality and morbidity, particularly neurologic 2. Hand washing by health care team:
abnormality -before and after caring a baby
• Lets have exercise!!! - in between newborn handling or after care of
• Which is not normal observation in the newborn one each baby
minute after birth? - before and after preparing milk formula
a. usually cries spontaneously at about 30’s after - after changing soild diaper.
birth. • CARE OF THE EYES
b. a baby whose mother is sedated during labor will 3. Each baby have their own crib.
have a APGAR score. [Link]/ infected person should not be allowed to
c. color of the NB corresponds to how well they are enter in the nursery.
breathing.. 5. single-dose tube should be used to prevent
d. NB resist any effort to extend extremities as they contamination.
have if flexed most of the time. 6. explain the side effects are just temporarily
• Lets have exercise!!! subsides in a few days and usually no interventions.
• An infant is born with an APGAR score of 3 at one minute. • VITAL SIGNS
The midwife is aware that this score necessitates: TEMPERATURE
a. oxygen and mask RESPIRATORY RATE
b. immediate resuscitation HEART RATE
c. additional warning measures BLOOD PRESSURE
d. stimulation of the soles of the feet • VITAL SIGNS
• Lets have exercise!!! • Temperature
• Midwife Matutina was rotated in the nursery at Vigan 1. Heat regulation- is the second most important task
Polyclinic. She observed that the newborn baby having a must achieve after birth
heart rate of 78 bmp, she look pale, with grimace, active in  The temperature falls out immediately
motion and her respiratory rate is slow and irregular what is to below normal because of heat loss
the APGAR SCORE? and immature temperature
A. 5  37.2 Celcius or 99 Fahrenheit- normal
C.4 temperature at birth
B. 6 • VITAL SIGNS
D.8 • Hypothermia- occurs when the body temperature drops
• SILVERMAN AND ANDERSON SCORING SYSTEM below 36.5 degree celcius.
• SILVERMAN AND ANDERSON SCORING SYSTEM  Most sensitive during stabilization period in the first 6 -12
• SCORE INTERPRETATION: hours after birth.
 Score 0 indicates no respiratory Newborns loss heat easily why?
distress. 1. having immature regulating system.
 4-6 –moderately depressed. 2. little amount of subcutaneous fat.
 7-10- severely depressed. 3. little ability to conserve energy
• Establish respiration and main clean airway 4. they depend on the temperature of env.
• Measures to establish and maintain normal respiration. 5. larger body surface
1. wipe secretions from mouth and nose after delivery • TEMPERATURE
of the head using sterile gauze • How can they conserve energy?
[Link] secretions from mouth to nose. 1. constricting blood vessels
3.a crying infant is a breathing infant 2. moving blood away from the skin
4. place infant in a position would promote drainage 3. burning fat
and secretions. How can they produce Heat?
• Establish respiration and main clean airway 1. increasing muscular activity
• 5. position on right side after feeding [Link] brown fat
• 6. make sure diapers, clothing, and blankets are loose. 3. increasing metabolic rate
• 7. Keep the nares or nose patent shivering is not matured
• CARE OF THE EYES
Crede’s Prophylaxis- topical treatment
Treatment/ prevention of the newborn from • TEMPERATURE REGULATION
gonorrheal conjunctivitis or ophthalmic neonatorum causing blindess • Factors of hypothermia
Causative agent: Neisseria gonorrhoeae and – Preterm are born poikilothermic.
chlamydia – Inadequate subcutaneous tissues.
0.5 to 1 % erythromycin- most common – Newborn are born wet.
tetracycline ointments and drops – Newborn are not yet capable of shivering.
1 % silver nitrate • TEMPERATURE
• CARE OF THE EYE Methods
Complications - Newborn taken rectally? To assess patency of the
1. redness anus.
2. swelling - Below 6 years old- axillary – 5 minutes
3. drainage - Rectal- 3 minutes/ 5 minutes length of the bulb – ½
4. discoloration of the skin around the neonate’s inches and not over inch
eye. - Consideration: radiant warmer and crying

13
 may falsely increase temperature [Link] – prolonged gasping inspiration followed
• TEMPERATURE by very short, usually insufficient expiration.
• Hypothermia 4. Grunting- a whistling sound heard on inspiration
occurs when the body temperature drops below caused by air being pushed through narrowed bronchioles.
36.5 degree celcius. • RESPIRATORY RATE
Effects 5. Rhonchi- a coarse snoring sound cause by air
1. acidosis through mucus in a major air passage.
2. hypoxemia 6. Stridor- a high crowing sound heard on inspiration
3. hypoglycemia caused by narrowing of air passages.
4. fluids and electrolytes imbalace 7. Hyperventilation- excessive amount of air deep
• TEMPERATURE respirations.
Considerations 8. Hypoventilation- decreased rate and depth
1. remove the wet cloth respiration
2. place the baby under heat source • RESPIRATORY RATE
3. encourage breastfeeding Considerations
4. oxygen administration 1. take respiratory rate while the newborn baby is
5. inform doctor immediately sleeping.
6. kangaroo care- placing newborn against the 2. allow child sits in parent’s lap or lying quietly
mother’s skin and covering the newborn also helps to transfer heat in a crib.
from the mother to newborn 3. respiration should be counted for 1 full minute.
• TEMPERATURE • PULSE RATE
• Hyperthermia- temperature of 37.5 degree celcius. • Normal values: 120-130 BPM
Causes: Characteristics
1. infection 1. respiratory depth, rate and rhythm are likely to be
2. too much clothing irregular.
3. hot environment 2. short periods of apnea not accompanied with
• TEMPERATURE cyanosis
S/S of Hyperthermia 3. newborn heartbeat is often irregular and murmur
1. irritable • PULSE RATE
2. abdomen and extremities are warm Considerations
3. red flushed skin 1. taking the apical pulse by listening at the heart
4. 40-41 Celsius degree – coma, convulsion apex through a stethoscope that must be younger than 1 year old.
Interventions: Where?
1. do not use cold/ice water for sponge. Above and outside the left nipple ( just lateral to the
2. undress partially and fully midclavicular line at the third or fourth intercoastal space).
3. measure newborn temperature • PULSE RATE
• PROCESS OF HEAT LOSS What if there’s no stethoscope??
• PROCESS OF HEAT LOSS femoral pulses
1. Evaporation- body to air. why not radial or temporal pulses?
2. conduction-body to solid object. Because it’s difficult to palpate with any degree of accuracy
3. convection- body to cooler surrounding object. • PULSE RATE
4. radiation- body to a cold subject not in contact 1. Rhythm is characterized as sinus arrhythmia, rate
with the body increasing with inspiration and decreased with expiration.
• PROVDING WARMTH AND MAINTAIN NORMAL 2. Heart beat is often irregular and heart murmurs
BODY TEMPERATURE maybe heard until 6 months of age.
• 1. dry newborns head and body immediately 3. Heart rate slows down during infancy period
• 2. wrap with dry and warm blanket before giving to mother • BLOOD PRESSURE
to hold. • Normal Values: 80/46 mm Hg
• 3. Place newborn preheated environment such as radiant 10th day- 100/50 mm Hg
warmer or next to mother for about 2 hours after birth. Considerations:
• 4. keep newborn away from air-conditioning vents 1. Blood pressure is not routinely measured in
• PROVDING WARMTH AND MAINTAIN NORMAL newborns.
BODY TEMPERATURE 2. For accurate reading: cuff width used must be no
• 5. maintain ambient temperature of delivery room and more than 2/3 the length of the upper arm and thigh
nursery. 3. increased of blood pressure when the baby is
• 6. delay initial bath for at least 2 hours crying
• 7. cover newborn by placing them first under radiant
warmer. • BLOOD PRESSURE
• RESPIRATORY RATE 1. This is not routinely done because of the in
• Normal Values: 30 to 60 BPM accurate results unless a cardiac anomaly is suspected.
Characteristics 2. NO BP taking older than 3 years old.
1. periodic respirations
2. loud and clear upon auscultation • PREVENTING HEMORRHAGE
3. respiration is irregular and shallow Hemorrhagic Disease of the Newborn
4. increases with sensory and tactile stimulations Sterile of intestine
5. newborns are nose breathers Intestinal bacteria
6. diaphragmatic and abdominal in nature Cannot manufacture Vitamin K
• RESPIRATORY RATE • PREVENTING HEMORRHAGE
S/S of Respiratory Distress Signs and Symptoms
1. nasal flaring 1. Nose bleeding
2. see-saw inspiration 2. Bruising
3. chest retraction 3. Bleeding umbilical are
4. respiratory grunting 4. Dark vomit
5. more than 60? TACHYPNEA 5. hematuria
less than 30? BRADYPNEA 6. black tarry stools
• RESPIRATORY RATE 7. Excessive bleeding
Adventitious Chest Sounds 8. Pallor, irritabilty,and jaundice
1. wheezing – a whistling sound heard by inspiration. • VITAMIN K
2. rales- a crackling sound caused by air passing Other name: Aquamephyton/Menadiaone
through mucus in a major air. /phytonadiene

14
What kind of Vitamin: Fat-soluble vitamin newborn are separated.
Purpose: neonatal bleeding and hemorrhage Foot Print- are considered the permanent proof and
Where? IM (vastus lateralis/ lateral anterior aspect of the midthigh fool proof method of newborn identification.
muscle) Name tag- wrist brand/ ankle band
Dose: .5 mg ( preterm) to 1 mg ( full term) usually
single dose • GESTATIONAL AGE
Overdose: hyperbilirubinemia and kernicterus Gestational Age- refers to the actual time, from
• VITAMIN K conception to birth, that the fetus remains in the uterus. Denoted by
Considerations weeks
1. never give in the buttock area/ gluteal area. This is usually measured from the last day of the
2. if bleeding persist may give more Vit K mother’s last normal menstrual period.
3. given usually below 12 mos. of age. Gestational age can be measured with early
4. assume back lying position. ultrasound
5. This is given immediately after birth. 20 weeks- only measure fetal size not gestational age
• NEWBORN SCREENING
• CORD CARE OF NEWBORN • R. A 9288 mandated in April 2004
1. Assess umbilical cord pulsation Newborn Screening
2. Note the number of Umbilical Vessels - is a simple procedure using the heel prick
A-Arteries method.
V-Vein - Newborn screening is ideally done on the 48-72
A- Arteries 2nd hour of life or at least 24 hours from birth.
2 arteries and 1 Vein - some disorder are not detected if the test done
3. Inform doctor the presence of single umbilical earlier than 24 hours.
artery: possible for congenital malformations. • NEW BORN SCREENING
Disorders
1. Congenital Hypothyrodism
• CORD CARE OF THE NEWBORN - results from lack or absence of thyroid hormone
4. Cord is clamped and cut around 30 seconds after which is essential to growth and brain development.
birth in the delivery room. Causes
clamped twice about 8 inches from the abdomen 1. underdeveloped fetal thyroid glands
and cut in between. 2. hereditary condition
5. 48 hours- removed when the cord has dried. 3. maternal iodine deficiency
Remember: cord stump usually dries and falls off within 7-10 days of • CONGENITAL HYPOTHYRODISM
life leaving granulating areas and heals next 4 days. Manifestation during infancy
• UMBILICAL CORD 1. poor suck and poor feeding
1. This is a good portal entry of infection and 2. swelling of the eye
possible site of blood loss. 3. large fontanels
2. cord should be cut with sterilize blade, newly 4. poor weight gain and growth
boiled stainless blade. 5. delayed milestones
3. umbilical stump should be inspect at least 2 to 4 6 hoarse cry
hours of ligation. Child- mental retardation, short stature, speech delays
4. First hour of life • CONGENITAL HYPOTHYRODISM
-appears gelatinous substance with visible blood Treatment
vessels as red and blue stakes 1. L-thyroxine- to promote normal development.
• UMBILICAL CORD 2. can be crushed and mixed with food or formula.-
2ND Day- blackens the color. It falls of 6-14 days L-thyroxine
leaving granulating area 3. avoid soy-based formulas and iron supplements
Totally heal- one month old. 4. excessive medications causes tachycardia, diarrhea,
Large at the base could be hematoma or omphalocele inability to sleep and shakiness of the child.
if present cut the cord about inches from the enlargement. • CONGENITAL ADRENAL HYPERPLESIA
Abnormalities: Congenital Adrenal Hyperplesia
1. bleeding 2. - caused by deficiency of adrenal gland hormones.
infection This disorders develops when a particular enzyme called 21 –
• CORD CARE OF THE NEWBORN hydroxylase is missing or not working.
Considerations aldosterone and sodium - is responsible for blood
1. no tub bathing until cord falls off. pressure regulation.
2. avoid creams, lotions or oils near the cord. Androgens- these are male sex hormones are
3. dabbing with 70 percent of alcohol or betadine responsible for the developmental characteristic.
solution once or twice a day. • CONGENITAL ADRENAL HYPERPLESIA
4. leave cord exposed to air. S/S of Infants
5. if cord is bleeding you can apply firm pressure 1. poor feeding
[Link]
• CORD CARE OF THE NEWBORN [Link]
6. S/S of infection 4. dehydration
-the cord remains wet and does not fall off 5. weight loss
within 7 to 10 days. 6. low blood pressure
- foul smelling odor 7. low salt
- presence of discharge • CONGENITAL ADRENAL HYPERPLASIA
- redness around the cord • CONGENITAL HYPERPLASIA
- fever Treatment
• CORD CARE OF THE NEWBORN 1. Hydrocortisone- lessens the amount of androgens,
 Umbilical arteries- 2 blood vessels in the prevent early puberty, and allow typical growth and development.
umbilical cord that carry deoxygenated from the Overmedication:
fetus to the placenta. Cushing syndrome- stretch marks on the skin, round
 umbilical vein- 1 vein carries oxygenated blood face, weight gain, high blood pressure and bone loss
from the placenta to the fetus. • GALACTOSEMIA
• NEWBORN IDENTIFICATION Galactosemia
Purpose: - a condition in which the body is unable to
-to prevent switching of babies in the hospital. process galactose, the sugar present in milk.
- made in the delivery room before mother and Infant with Galactosemia

15
 1. diarrhea 2. milk and all diary product
2. vomiting 3. regular formula
3. failure to weight gain 4. fish
4. poor feeding and suck 5. nuts and peanut butter
5. lethargy and irritabilty 6. regular floor
6. Jaundice • SICKLE CELL DISEASE
• GALACTOSEMIA Sickle cell disease
Serious complications - is inherited autosomal-recessive genetic disorder
1. hypoglycemia that affects the red blood cells, which become acutely sickle-shaped.
[Link] They clumped together and block blood flow in blood vessels
3. serious infections resulting in pain, vital organs, damage and even death.
4. cataracts • SICKLE CELL DISEASE
Consideration Generally infant with sickle cell disease do not show
1. special lactose free formula and exclusion of manifestation until after 4 months age.
lactose and galactose food such as milk ( including breastmilk) Common s/s
• GALACTOSEMIA 1. anemia- fatigue, pale skin, and nail beds,
Food must avoided jaundice and dyspnea
1. tomato sauces 2. pain- blockage of blood flow that are clumped
2. milk and daily products together.
3. processed food
• SICKLE CELL DISEASE
• GLUCOSE-6 -PHOSPHATE Complications
Glucose-6-Phosphate 1. hand and foot syndrome- the first sign of sickle cell
- is necessary for maintenance of red blood cells. anemia in infant.
- lack of enzyme results in premature destruction 2. infection-pneumonia
of the red blood cells. 3. splenic crisis- the spleen removes red blood cells
Causes from circulation and helps fight infection.
- hemolytic anemia 4. acute chest syndrome- this is a life threatening that
- jaundice caused by infection trapped in the lungs.
-drugs- antypyretic, antimalarial drugs • SICKLE CELL DISEASE
- hereditary 5. stroke- block blood vessels in the brain causing
• CYSTIC FIBROSIS stroke in children that can lead learning disabilities
Cystic Fibrosis 6. eye problems- poor blood supply
- inherited caused by absence or deficiency of a 7. priapism- prolonged and painful erection
cell protein manufactured by the body that cystic fibrosis membrane 8 leg ulcers- poor blood supply
conductance regulator. • GESTATIONAL AGE
- the 2 primary organ affected: lungs and the Classification Criteria
pancreas. by size:
- confirmation test: sweat chloride test Low Birth Weight - Weights 5.1/2 lbs
(2,500
• CYSTIC FIBROSIS grams)
S/S or less at
1. salty sweat birth.
2. failure to thrive Very low birth weight - 1,000 to 1,500 grms.
3. constant coughing Extremely very low birth 500 to 1000 grams
4. thick phlegm and mucus weight.
5. pneumonia • GESTATIONAL AGE
6. greasy, smell stools that are bulky and pale
colored. • GESTATIONAL AGE
• CYSTIC FIBROSIS • GESTATIONAL AGE
Treatment • GESTATIONAL AGE
1. airway clearance • MEASUREMENTS OF NEWBORN
2. high caloric diet Head Circumference 33 cm to 35 cm
3. increased fluid intake 13 to 14 inches
4. keeping the child, away for lung irritants [Link] circumference-occipito frontal
such as smoke, good hand washing circumference .
techniques, and regular exercise 2. the head circumference is greater than chest
• PHENYLKETONURIA circumference by 2 cm
Phenylketonuria 3. measure head circumference at the level of
- a rare condition in which the baby cannot eyebrows to the most prominent portion of the
properly use one of the building blocks of protein called infant’s head with the use of tape measure.
phenylalanine. • HEAD CIRCUMFERNCE
- babies with PKU seem perfectly normal at birth. Changes:
The effects usually seen around 6 months 1. at birth maybe equal or greater than chest
- blood sample for PKU should be drawn 48 circumference
hours after birth for accurate results 2. after 2 to 3 days- is greater than cc by to 2 to 3
• PHENYLKETONURIA cm
Manifestation 3. six mos. Head circumference is equal to chest
1. mental retardation circumference
2. cerebral damage 4. after one year hc is less than cc.
Guthrie screening test Abnormalities:
- test on the capillary blood sample 1. less than 32 cm
- reliable indicator of the disorder 2. hc more than cm or more than 37 cm
- test after eating protein feedings
• PHENYLKETONURIA • CHEST CIRCUMFERENCE
1. Babies are placed on a special low phenylalanine Normal Circumference: 31 to 33 cm
diet through out childhood. 12-13 inches
2. give small phenylalanine milk formula 1. it is measured at the level of the nipple line using a
3. food must be avoided tape measure.
1. eggs 2. less than 30 cm indicates prematurity.

16
 • ABDOMINAL CIRCUMFERNCE because it is about ¼ of the body length.
Normal Circumference: 31 to 33 cm 2 Types of Fontanels
12 to 13 inches [Link] Fontanel (Bregma)
1. same as chest circumference. - located at the junction of two parietal bone and
2. measure above the level of the umbilicus. two fused bone.
3. usually not routinely done unless suspected - diamond in shape
obstruction in the gastrointestinal tract - about 3 cm long and 2 to 3 cm wide
- closes at 12- 18 months.
• MEASUREMENTS OF THE HEAD
• WEIGHT Posterior Fontanel (Lambda)- located at the junction
Normal Weight: 6 to 8.5 lbs./ 2700 to 4000 g. of parietal and occipital bones.
Average wt. loss: 3500 g. - closed at 2 mos
Physiologic weight loss (10 %) during 3 to 4 days. - measures about .5 to 1 cm in length
1. passage of meconium. - triangular in shape
2. excretion of fluids. - it is smaller than anterior fontalle
3. minimal food intake
4. NPO
• WEIGHT
Breastfed infants- 10 days
Formula fed infants- 7 days
Weight Changes
5-6 mos. 2 x birth weight
1 year- 3 x birth weight
2 years- 4 x birth weight
3 years- 5 x birth weight
5 years- 6 x birth weight
7 years- 7 x birth weight
10 years- 10 x birth weight
• WEIGHT
Assessment:
1. weight should compare with height and head
circumference to see any disproportion that indicates risk condition.
2. infant should be weight not wearing a diaper.
3. same weighing scale should be used.
4. weight is affected by race, nutrition, intrauterine
growth and genetic factors.
• WEIGHT
Abnormal Findings:
1. 1000 grams- extremely low birth weight.
2. 1500 grams- very low birth weight.
3. 2500 grams- Small gestational age
4. more than 4000 grams- Large gestational age
5. weight loss ? 10 % of birth weight
• LENGTH
Normal Length: 44 to 55 centimeter
18 to 22 inches
Average: 50 centimeter
Considerations:
1. measure newborn length from top of the head to
heel using tape measure.
2. crown of the head to heel – the most accurate way
to measure length.
• LENGHT
3. crown to rump measurement- dwarfism

• LENGTH
Length Changes
Birth to 3 months- 9 cm
3 to 6 months- 8 cm
6 to 9 months- 5 cm
9 to 12 months- 3 cm
1 year – 30 inches of ½ length
2 years- ½ mature height in boys
3 years- 3 feet tall

• ASSESSMENT OF THE NORMAL NEWBORN

Considerations
1. before assessment hand washing should be
performed.
2. assess the newborn’s attitude and position of
flexion first
3. assessment head to toe finishing neurological
condition.
4. provide in a warm and well-lit environment
5. undress only the part of the body to be examined
• MEASUREMENTS OF THE HEAD
1. The head is disproportionately larger than the body

17