I.

GROWTH AND DEVELOPMENT Probable Signs (Seen by examiner) Check-ups include:

• Chadwick’s sign – Bluish cervix • BP, weight
1st Trimester
• Goodell’s sign – Soft cervix • Fundal height
• Week 4 – Heart starts beating
• Hegar’s sign – Soft lower uterus • Fetal heart rate
The baby’s heart begins forming and
• Positive pregnancy test – hCG detected • Urine test
pumping.
• Ballottement – Fetus floats when tapped Fundal Height Landmarks
• Week 8 – Organs form; fetus stage
Positive Signs (Confirm pregnancy) • 12 weeks – Pubic bone
Basic body parts and organs are
• Fetal heartbeat – Heartbeat heard Baby just above pelvic level.
already present.
• Ultrasound – Baby seen • 20–22 weeks – Umbilicus
• Week 12 – Sex can be seen; heartbeat
• Fetal movement palpable – Examiner Belly button level.
heard
feels movement • 36 weeks – Below sternum
Baby looks more human; heartbeat
Highest level before dropping.
audible on Doppler
2nd Trimester Body Changes in Pregnancy III. LABOR AND DELIVERY
• Week 16 – Quickening Cardiovascular
Mother feels the baby’s first • ↑ Blood volume – More blood to support
movements. baby True Labor
• Week 20 – Lanugo & vernix • Physiologic anemia – Blood becomes • Regular, stronger contractions
Baby has fine hair and a protective diluted • Cervix opens
creamy coating. Respiratory • Pain goes to lower back
• Week 24 – Viability • Diaphragm rises – Shortness of breath • Does NOT go away with rest
Baby can survive with medical help if common False Labor
born early GI System • Irregular contractions
3rd Trimester • Heartburn – Acid comes up due to • No cervical change
• Week 28 – Lungs develop relaxed muscles • Pain in front
Baby practices breathing movements. • Constipation – Slower bowel movement • Goes away with rest
• Week 32 – Fat increases Urinary
Baby looks fuller and gains weight. • Frequency – Frequent urination
• Week 36–40 – Full term Musculoskeletal Stages of Labor
Baby is ready for birth. Stage 1 – Opening of cervix
• Lordosis – Back curves more due to
belly • Latent: 0–3 cm (mild)
• Active: 4–7 cm (strong)
II. PREGNANCY (ANTE-PARTUM)
Prenatal Visits • Transition: 8–10 cm (very strong)
Presumptive Signs (Mother feels) • Every 4 weeks at 0-28 weeks: Check Stage 2 – Birth of baby
• Amenorrhea – Missed period growth • Mother pushes
• Nausea – Morning sickness • Every 2 weeks at 28–36 weeks: Closer • Baby comes out
• Breast tenderness – Breasts become monitoring Stage 3 – Delivery of placenta
sore • Weekly at 36–40 weeks: Preparing for • Placenta is expelled
• Quickening – Baby’s movement felt labor • Should come out within 5–30 mins
• Fatigue – Easily tired
Stage 4 – Recovery NO vaginal exam 3. Postpartum Depression
• First 1–2 hours after birth Usually requires C-section Mother feels prolonged sadness and emptiness.
• Watch for bleeding Needs: emotional support + treatment
6. Placental Abruption
Cardinal Movements Placenta detaches early.
Danger Signs of Pregnancy
1. Engagement – Baby enters pelvic Symptoms: painful bleeding, hard abdomen
Emergency! Requires immediate delivery • Strong headache
opening
• Blurred vision
2. Descent – Baby moves downward
3. Flexion – Baby tucks chin • Face/hand swelling
Labor Complications • Bleeding
4. Internal rotation – Turns to face
1. Uterine Atony • Severe abdominal pain
mother’s back
Uterus doesn’t contract → heavy bleeding • No fetal movement
5. Extension – Head comes out
Treatment: fundal massage, oxytocin Normal Fetal Heart Rate
6. External rotation – Shoulders align to
body 110–160 bpm
2. Meconium-Stained Fluid
7. Expulsion – Baby is fully born Best Fetal Position
Baby poops inside uterus → risk of inhaling
LOA – easiest for birth
Action: suction only if baby is weak
IV. COMMON COMPLICATIONS
1. Ectopic Pregnancy DIAGNOSTIC TESTS DURING PREGNANCY
3. Shoulder Dystocia
Baby implants outside uterus.
Baby’s shoulder gets stuck.
Signs: sharp pain, bleeding Ultrasound (Transvaginal or
Sign: turtle sign
Danger: may rupture Transabdominal)
Interventions: McRoberts position, suprapubic
Treatment: methotrexate or surgery How it is done:
pressure
• Gel placed on abdomen or probe
2. Hyperemesis Gravidarum inserted vaginally (early pregnancy).
4. Cord Prolapse
Excessive vomiting leading to dehydration. • Uses sound waves to show fetus,
Cord slips out before baby.
Treatment: IV fluids, antiemetics placenta, and amniotic fluid.
Danger: cuts off oxygen
Patient Instructions:
Action: lift head off cord → emergency CS
3. Gestational Diabetes • Full bladder for abdominal ultrasound
High blood sugar during pregnancy. (pushes uterus up).
Postpartum Complications
Effects: large baby, newborn hypoglycemia • Empty bladder for transvaginal
1. Postpartum Hemorrhage (PPH)
Treatment: diet, insulin ultrasound.
Severe bleeding after birth.
Causes: atony, retained placenta, trauma • Stay still during the exam.
4. Preeclampsia Normal Findings:
Treatment: massage, medications
High BP + protein in urine. • Fetal heartbeat present
Signs: headache, vision changes, swelling • Normal fetal position and growth
2. Postpartum Infection
Treatment: magnesium sulfate, delivery • Proper placental location
Fever and foul-smelling discharge after delivery.
Treatment: antibiotics Abnormal Findings:
5. Placenta Previa
• No cardiac activity (possible fetal death)
Placenta covers cervix.
• Placenta previa
Symptoms: painless bright red bleeding
 • Growth restriction 4. Muscle tone • Bacteria: UTI
• Congenital anomalies 5. Amniotic fluid volume
Patient Instructions: Amniocentesis
Doppler Fetal Heart Rate Monitoring • No special prep; lasts 20–30 minutes. How it is done:
How it is done: Normal Findings: • Needle inserted into abdomen under
• A handheld Doppler device placed on • Score 8–10 = healthy fetus. ultrasound guidance
mother's abdomen. Abnormal Findings: • Takes small amount of amniotic fluid
Patient Instruction: • Score 4 or less = fetal compromise → • Done at 15–20 weeks
• Relax and lie still; gel is applied. delivery considered. Patient Instructions:
Normal Findings: • Empty bladder before procedure
110–160 bpm Glucose Tolerance Tests (GCT/OGTT) • Rest afterwards
Abnormal Findings: How it is done: • Report abdominal pain, fluid leakage, or
Below 110 (bradycardia) • Drink glucose solution. bleeding
Above 160 (tachycardia) • Blood drawn at 1 hour (screening) or Normal Findings:
multiple hours (diagnostic). • Normal genetic profile
→ May indicate fetal distress
Patient Instructions: • Normal lung maturity later in pregnancy
Non-Stress Test (NST) • 1-hour GCT: No fasting needed. Abnormal Findings:
How it is done: • OGTT (3-hour): Fasting for 8–12 • Genetic disorders (Down syndrome,
hours. etc.)
• Belts placed on mother’s abdomen to
Normal Findings (1-hour GCT): • Infection
record fetal heart rate and movements.
< 140 mg/dL • Fetal anemia
Patient Instructions:
Abnormal Findings:
• Eat lightly before the test (baby moves
≥ 140 mg/dL → needs 3-hour OGTT Group B Strep (GBS) Screening
more).
If 2 or more abnormal results → Gestational How it is done:
• Press a button when the baby moves.
Diabetes • Vaginal and rectal swab at 35–37
Normal Result (Reactive):
• At least 2 accelerations of 15 bpm for weeks
Urinalysis (Dipstick & Microscopic) Patient Instructions:
15 seconds in 20 minutes
How it is done: • No preparation; quick, painless swab
→ Indicates good oxygenation
• Clean-catch midstream urine sample. Normal Findings:
Abnormal Result (Non-reactive):
Patient Instructions: • Negative result
• No accelerations → possible fetal
• Wipe front to back Abnormal Findings:
hypoxia → needs BPP or CST
• Collect midstream urine • Positive → mother needs IV antibiotics
Normal Findings: during labor to protect the baby.
Biophysical Profile (BPP)
• No protein
(NST + ultrasound)
How it is done: • No glucose Alpha-Fetoprotein (AFP) / Quad Screening
Assesses 5 parameters: • No bacteria How it is done:
1. NST Abnormal Findings: • Maternal blood test at 15–20 weeks.
2. Breathing movements • Protein: Preeclampsia Patient Instructions:
3. Body movements • Glucose: Possible diabetes • No fasting needed
 • Used for screening, NOT diagnosis 4. Vitamin B6 (Pyridoxine) o Oligohydramnios
Normal Findings: • Purpose: Relieves nausea and vomiting o Skull abnormalities
• AFP levels appropriate for gestational in early pregnancy. 3. Tetracyclines (e.g., Doxycycline)
age 5. Doxylamine + Vitamin B6 • Bad Effects:
Abnormal Findings: • Purpose: Safe first-line treatment for o Teeth discoloration
• High AFP: Neural tube defects morning sickness. o Inhibits bone growth of fetus
• Low AFP: Possible Down syndrome 6. Acetaminophen (Paracetamol) 4. Isotretinoin (Accutane)
• Purpose: Pain reliever and fever • Bad Effects:
Cervical Length Ultrasound reducer. o Severe birth defects
How it is done: • Safe when taken in recommended o Heart, brain, and facial
• Transvaginal ultrasound to measure the doses. abnormalities
cervix 7. Antacids (Calcium carbonate) • Strictly contraindicated; requires
Patient Instructions: • Purpose: Relief from heartburn/GERD. pregnancy test + two contraceptives.
• Empty bladder 8. Insulin 5. Warfarin
• Relax, procedure takes 5 minutes • Purpose: Safest treatment for • Bad Effects:
Normal Findings: gestational diabetes. o “Warfarin embryopathy” – nasal
• Cervical length > 3 cm • Why: Does not cross placenta. hypoplasia, stippled bones
Abnormal Findings: 9. Heparin (Unfractionated or LMWH) o Fetal bleeding
• Cervical length < 2.5 cm → risk for • Purpose: Safe anticoagulant for • Switch to heparin instead.
preterm labor pregnant women with clotting disorders. 6. Anticonvulsants (Certain types)
• Why safe: Does not cross placenta. • Valproic acid: neural tube defects
Medications SAFE During Pregnancy • Phenytoin: fetal hydantoin syndrome
1. Prenatal Vitamins Medications UNSAFE During Pregnancy • Carbamazepine: spina bifida
• Purpose: Provide folic acid, iron, 1. NSAIDs (Ibuprofen, Aspirin [high dose], • Safer option: Lamotrigine (still
calcium. Naproxen) monitored closely)
• Why important: Prevents neural tube • Bad Effects: 7. Fluoroquinolones (e.g., Ciprofloxacin)
defects, anemia, and supports fetal o Early pregnancy: miscarriage • Bad Effects:
growth. risk o Cartilage and tendon damage to
2. Folic Acid o Late pregnancy: premature fetus
• Purpose: Prevents neural tube defects closure of ductus arteriosus, 8. Aminoglycosides (e.g., Gentamicin)
(anencephaly, spina bifida). oligohydramnios • Bad Effects:
• Dose: 400–800 mcg daily, or 4 mg • Safe exception: Low-dose aspirin (81 o Congenital hearing loss
daily if previous NTD baby. mg) may be prescribed for (ototoxicity)
3. Iron Supplements preeclampsia prevention. 9. Methotrexate
• Purpose: Prevents/treats iron- 2. ACE Inhibitors / ARBs (e.g., Captopril, • Bad Effects:
deficiency anemia during pregnancy. Losartan) o Miscarriage
• Tip: Take with vitamin C, avoid with • Bad Effects: o Neural tube defects
milk. o Fetal renal failure o Cranial abnormalities
o Potter sequence
 • Never use unless medically necessary • May feel insecure or worry (“Am I doing patch closure if large defect
for ectopic pregnancy (controlled dose this correctly?”).
by doctor). • Responds well to teaching and ASD (Atrial Septal Defect)
10. Thalidomide encouragement. Hole between atria → often asymptomatic,
• Bad Effects: Why: murmur
o Limb defects (“phocomelia”) Her confidence is building, and she is Nursing Care:
o Ear/organ abnormalities transitioning into active motherhood. Monitor growth, activity tolerance; small defects
may close spontaneously
Phases of Maternal Adjustment 3. Letting-Go Phase Surgery:
Time: After 2 weeks onward (can last months) patch closure if symptomatic
1. Taking-In Phase What the mother does:
Time: Birth to 24–48 hours postpartum • Fully assumes her maternal role with PDA (Patent Ductus Arteriosus)
What the mother does: confidence. Ductus arteriosus remains open → “machinery”
• Focuses on herself, not the baby yet. • Lets go of her old lifestyle or murmur
• Very dependent on others for care expectations. Nursing Care:
(rest, food, comfort). • Adapts to new family routines and Monitor oxygenation, growth, HF signs
• Talks a lot about her birth experience responsibilities. Medications:
→ “re-living the labor.” • Adjusts relationship with partner (role indomethacin or ibuprofen (to close PDA in
• Wants to sleep, eat, and recover. changes). preterm infants)
• May seem passive, quiet, or tired. • Accepts that things won’t return to “how Surgery:
ligation if needed
• Allows others (nurses, partner) to they used to be.”
handle the baby. • Integrates baby into the family and life.
Tetralogy of Fallot
Why: • May experience emotional shifts (joy,
Cyanotic → “tet spells,” squatting
She is physically exhausted and processing the sadness, role conflict).
4 defects → cyanotic
birth. Why:
Nursing Care:
She is reorganizing her identity and lifestyle
Monitor oxygenation, allow rest periods
2. Taking-Hold Phase around motherhood.
Medications:
Time: Around 2–3 days postpartum to 2
prostaglandin E1 pre-op to maintain ductus
weeks PEDIATRIC
arteriosus if needed
What the mother does: COMMON CONGENITAL HEART DISEASES
Surgery:
• Starts focusing on the baby, not just (CHD)
corrective surgery (open heart, usually in
herself.
infancy)
• Becomes more independent and ready VSD (Ventricular Septal Defect)
to learn. Hole between ventricles → murmur, HF signs
Coarctation of Aorta
• Actively learns newborn care Nursing Care:
Narrowing of aorta → BP difference upper vs
(breastfeeding, bathing, diapering). Monitor growth, nutrition, HF symptoms,
lower limb
• Asks many questions; wants to do oxygenation
Nursing Care:
things “right.” Medications:
Monitor BP, pulses, renal function
diuretics, digoxin
Medications:
Surgery:
antihypertensives
Surgery: ADHD
resection or balloon angioplasty Inattention, hyperactivity, impulsivity
Nursing Care:
Maintain structured environment, behavioral
DEVELOPMENTAL DISORDERS therapy, family education
Medications:
stimulants (methylphenidate, amphetamines),
Cerebral Palsy (CP)
non-stimulants (atomoxetine)
Non-progressive motor impairment, spasticity,
delayed milestones
Nursing Care:
Promote mobility & positioning, prevent
contractures, physical therapy, occupational
therapy, speech therapy
Medications:
muscle relaxants (baclofen, diazepam),
antiepileptics if seizures present

Autism Spectrum Disorder (ASD)

Social/communication deficits, repetitive
behaviors
Nursing Care:
Promote structured routine, early intervention
therapy, speech therapy, behavioral therapy
Medications:
sometimes risperidone or aripiprazole for
irritability or aggression

Down Syndrome
Trisomy 21 → hypotonia, intellectual disability,
cardiac defects
Nursing Care:
Monitor for cardiac issues, promote early
stimulation, occupational & speech therapy
Medications:
supportive care, treat comorbidities (thyroid,
infections)
Surgery:
correct congenital heart defects if present