OBSTETRICS
FEU - NRMF | NOV PNLE 2025
Sir John
IN - HOUSE REVIEW
■ ↑ Estrogen - mild
SIGNS OF PREGNANCY uterine contraction
, braxton hicks
I. Presumptive ■ Oxytocin - true
labor (hormone)
■ ↑ progesterone -
Morning Sickness relaxation
● ↑HCG hormones (placenta) ● 1st month - 9
● 1st trimester(1,2,3 months) - month of
Normal pregnancy:
● 2nd trimester (4,5,6 months) - relaxation
Abnormal
● Possible medical condition:
Breast Enlargement
● H-mole (no fetus)
○ cause: ↑ estrogen
● Placenta makes it enlarged
(abnormal proliferation) Fatigue
● Hyperemesis Gravidarum - - ↓RBC / anemia
● Dry crackers/ sky flakes - rich in ○ Iron deficiency
Na bicarbonate (alkaline) ○ Fetus deposits iron - liver
● Inc HCG - inc acid ○ Consumes iron of mother
Amenorrhea ○ Breastmilk is nutritious
but : no iron
● temporary loss
○ How many iron deposits
○ Return of menses
in the liver will last - 6
○ Breastfeeding - 6 months
months
■ Exclusive - 6
○ Note: after 6 months ng
months
baby need na ng
■ Lactational
supplemental food, dapat
amenorrhea
rich in iron because by
method - natural
that time consumed na
contraceptive for 6
ng baby ang iron na
months
dineposit nya sa liver
○ Non - 2-3 months after
○ Food - rich in iron
delivery
○ Cause:
■ ↑estrogen Urinary Frequency
↑progesterone ○ Compression of bladder -
■ More elevated dec bladder capacity
during pregnancy: ○ Dysuria (pain) - UTI
progesterone (presence of sugar)
➢ effects on uterus ○ 1st - present
FRANCHE, RN (NOV 2025) | 1
OBSTETRICS
FEU - NRMF | NOV PNLE 2025
Sir John
IN - HOUSE REVIEW
○ 2nd - not present (going
II. Probable
up)
Common : discoloration & softening
■ Present - h mole
● Abnormal Chadwick’s Sign
and rapid ● bluish discoloration/ purplish
enlargement
Goodell’s Sign
of placenta,
● softening of the cervix
continuous
○ Mode of assessment:
compression
palpation
in the
○ Procedure: internal
bladder
examination
○ 3rd present
○ Contraindication:
placenta previa and
abruptio placenta
Quickening
Hegar’s sign
softening of the uterus
○ Subjective (felt by the
○ Lower segment of the
mother)
uterus - softening
○ + fetal movement -
■ Rationale: Labor
confirmatory (felt by the
process
examiner)
○ Upper segment -
○ 2nd trimester - onset
thickened
■ Starts to move the
■ ↑ blood supply
upper body
○ Saan mas higher ang
■ Primi - 5th/ 20
pressure kapag nag
weeks (viability)
contract?
■ Multigravida - 4th/
■ Upper - ipupush
16 weeks
nya ang baby
■ Board exam:
during labor
If choices are both
■ Pag lower ang
give, choose 5th
manipis - isusuka
month ; 20 weeks
mo ang baby sa
of the pregnancy
sobrang taas lmao
○ 3rd trimester - moves the
● Chloasma
lower body (legs)
● Linea Nigra -
■ Breech - normal sa
5th month kasi iikot
Notes:
pa
● Determine the gender - sperm
FRANCHE, RN (NOV 2025) | 2
OBSTETRICS
FEU - NRMF | NOV PNLE 2025
Sir John
IN - HOUSE REVIEW
● 1 cycle - 1 egg cell ● Most fatal site of ectopic
● Ejaculation -150 - 200 million pregnancy - Interstitial
● Sex chromosome of sperm cell: ○ Ruptured - internal
X or Y bleeding
● Sex chromosome of egg cell: X
○ Normal chromosome: 46
chromosomes Other term for Implantation
● NIdation Process
Implantation of Zygote
● Occurs: uterus
● ORGAN: Uterus
Board Exam:
○ If outside uterus - called
ECTOPIC PREGNANCY
NIDATION / IMPLANTATION - UTERUS
■ which occurs in the
1. Which part of uterus does
ampulla of the
zygote site of nidation
fallopian tube
○ Answer: Upper segment
● Part of the uterus: Upper
○ If lower segment -
Segment
abnormal, placenta
○ If lower segment -
previa
abnormal, placenta
2. Which site for implantation
previa
a. Answer: Endometrium
● Site: Endometrium
only
○ If Myometrium, magiging
b. If Myometrium, magiging
kapit na kapit ang
kapit na kapit ang
placenta
placenta
■ Placenta Accreta -
i. Placenta Accreta -
placenta attaches
placenta attaches
too deeply ; ayaw
too deeply ; ayaw
maalis kasi
maalis kasi
umabot ang root of
umabot ang root of
placenta sa
placenta sa
Myometrium
Myometrium
Fertilization
Braxton Hicks
● Organ: Fallopian tube
● Ampulla - normal site of
fertilization False Labor True Labor
● Isthmus - site of bilateral tubal Estrogen Oxytocin
ligation Painless Painful
● Common site of ectopic Lower abdomen Lower back
pregnancy : Ampulla Ambulation: dec (lumbar sacral)
pain Ambulation: inc
FRANCHE, RN (NOV 2025) | 3
OBSTETRICS
FEU - NRMF | NOV PNLE 2025
Sir John
IN - HOUSE REVIEW
pain
Board Exam Question: Full bladder
- Common UTZ: Transabdominal
Which one is allowed to ambulate
during labor?
Positive Fetal Heart Tone
a. Floating
● Leopold’s maneuver= to
b. Engaged - correct answer
determine the landmark for fetal
i. Ischial spine if ambulate
heart tone - which is fetal back
and pumutok ang
○ Cephalic - below
panubigan, no cord
maternal abdomen
prolapse
○ Breech - above
Rationale: Kapag ang fetus above the
● Doppler Ultrasound (12 weeks/ 3
passageway (floating) and then you
months)
allow ambulation, there is gravity and
● Fetoscope (16 wks/ 4 months
it causes rupture. Mauunang lalabas
● Stethoscope (20 wks/ 5
placenta which is called cord prolapse
months)
○ Bell - low pitched sound
(normal heart sound)
lab-dub
Mechanism of Labor
○ Diaphragm - high pitched
1. Engagement - before walk
sound (abnormal heart
2. Descent
sound) murmur
○ Lung sounds (stridor,
Ballotement wheezing) - high pitched
- Bouncing movement ○ Normal : 120-160 bpm
- Floating ○ Sleep fetus: 100 bpm
III. Positive
Positive Fetal Movement (examiner)
● 10-12 fm/hr
Ultrasound ○ normal
Positive UTZ ● > 12 fm/hr - hyperactive fetus
I. Transabdominal Ultrasound ○ Abnormal
● Full bladder - pushes uterus for ○ Sign of fetal distress,
clear visualization restlessness bec of low O2
● Amount of water - 1000 mL or 1 L ○ Early sign - hyper
II. Transvaginal Ultrasound ● < 10 fm/hr - hypoactive fetus
● Invasive ○ Abnormal
● Consent - doctor ! Sign of fetal distress
○ Witness - nurse! ○ Late sign - hypo
● Empty bladder
FRANCHE, RN (NOV 2025) | 4
OBSTETRICS
FEU - NRMF | NOV PNLE 2025
Sir John
IN - HOUSE REVIEW
Volume
Transient Organs during Pregnancy
● UTZ - measure the volume of the
1. AMNIOTIC FLUID
amniotic fluid
Other Name:
● Normal value: 800-1,200 ml
● Fetal Urine
○ If > 1,200
Function:
■ Polyphydramnios -
● Protection - cushion
Gestational
● Thermoregulation - heat to
Diabetes mellitus
prevent hypothermia
● Gi problem
● Musculoskeletal development
● Cleft - lip
● Nutrition
palate
○ meconium → sterile
○ If >800 ml
○ Location: intestine - sterile
■ Oligohydramnios
Color: Clear straw color - normal
● Renal
amniotic fluid (pale yellow/ amber)
problem
● Black color: fetal death (IUFD)
○ Necrosis - sepsis
● How to differentiate urine and
● Green color: Meconium stained
amniotic fluid? Check for the
fetus (nakatae na ang fetus)
acidity and alkalinity!
○ Post-term problem >42
○ Using nitrazine paper test
weeks
■ Blue - alkaline
■ prob : meconium
result
■ Risk for aspiration -
■ Yellow - acid
suction and
(urine)
prophylactic
antibiotic (-mycin)
2. UMBILICAL CORD - passageway
● Dark yellow - inc bilirubin bcs of
of oxygen and nutrients
destroyed rbc (hemolysis)
Other Name: Funis
○ Common Hemolytic
Blood vessels:
disorder : Rh
● 3 blood vessels
incompatibility
○ 2 Arteries - small
● Red (bleeding)
diameter diameter
○ Abruptio placenta - dark
○ 1 Vein - large diameter
○ Placenta previa - bright
■ Carrier of
● wait for the rupture of bag of
oxygenated blood
water
● Via inspection , no need for any
equipments to determine the
color
FRANCHE, RN (NOV 2025) | 5