Fallopian Tube

• 4 significant segments– Infundibulum – most distal part, trumpet shape,

has fimbrae– Ampulla – outer 3rd or 2nd half, site of fertilization,

common site for ectopic preg.– Isthmus – site for sterilization, site for BTL– Interstitial – most dangerous site for ectopic

pregnancy

13th day of menstruation, estrogen level is PEAK while progesterone is , these stimulates the hypothalamus to release GnRH/ LHRF

GnRH/ LHRF - release LHFunctions of LH

Stimulates the release of progesteroneHormone for ovulation

14th day estrogen level is while progesterone level is S/S

Rupture of the graafian follicle - OVULATIONMittelschsmerz – slight abdominal pain lower right quadrant

15th day, after ovulation day, graafian follicle starts to degenerate, estrogen level , progesterone , causing degeneration of the graafian follicle becoming yellowinsh known as CORPUS LUTEUM – secretes large amount of progesterone

Menstrual Cycle

• Hypothalamus – initiates menstrual cycle – GnRH• Pituitary – initiates follicular phase – FSH, LH• Ovaries – initiates uterine phase – Est, Prog• FSH- ovulation• LH – implantation• Est – thickening of endometrial lining 8th fold• Progest – increase blood supply to uterus

ExerciseWalking – best form of exerciseSquatting – strengthen perineum & ↑circulation to the

perineum (raise the buttocks before head to prevent postural hypotension)

Tailor sitting – same purpose with squatting Kegel exercise – strengthen pubococcygeal muscle Abdominal exercise – muscle of the abdomen ( done as if

blowing a candle) Shoulder circling exercise – strengthen muscle of the chest Pelvic rocking exercise or pelvic tilt – relieve low back pain &

maintain good posture (arching back for 3 sec)

Preeminent Signs of Labor

lightening settling of the presenting part into the pelvis brim (shooting pain

radiating to the legs, urinary frequency)primi- early 2 weeks prior to EDD

Braxton Hicks Contractions – painless irregular contractionsIncrease Activity of the Mother – Nesting

Instinct (mgt: save energy) epinephrine production (hormone that ↑ the activity of the mother)

Ripening of the cervix –butter softnessDecrease in weight – 1.5-3 lbs.Bloody show

pinkish vaginal discharge (blood + leucorrhea + operculum = pink in color)Rupture of membranes

check FHTIE check for cord prolapseafter several hrs – check temp.

DM

• Maternal Effects : – 1st trim - hypoglycemia– 2nd & 3rd trim – Hyperglycemia

• Mgt : give insulin. OHA are teratogenic. • 1st trimester - ↓ insulin, 2nd trimester - ↑ insulin, post

partum – drop suddenly• Frequent infections à eg. Moniliasis• Polyhydramnios• Dystocia

• Fetal Effects : – hypoglycemia during the 1st trimester and

Hyperglycemia during the 2nd & 3rd trimester thru facilitated diffusion

– Macrosomia/LGA .4000gms– Preterm birth - promote still birth

• Morning Sickness– Due to HCG levels– Crackers 30 min before arising– AM – Carb diet 30 mins– PM – small frequent meal

Pill

• contains estrogen that inhibits FSH and progesterone that inhibit LH

• 21 day feel on the 5th day of mense start taking• 28 day – 1st day of mense• if forgotten, take 2 tablets the following day• adverse effect : breakthrough bleeding• if mother wants to get pregnant

– wait 3 monts– another 3 months if unsuucessful before consulting gyne

• contraindications– chain smoking– Hypertension– DM– Extreme obesity– Thrombophlebitis

• Side effects (ressembles Hypertension)/ Immediate Discontinuation– Abdominal paon– Chest pain– Headache– Eye problem– Severe leg cramp

• Cervical effacement – (thinning of the cervix, measured thru %)

• dilatation - (widening of the cervix, measurement thru cm)

*best/major sign of true labor

• Duration of Labor – Primipara – 14 hrs but not more than 20 hrs– Multipara – 8 hrs but not more than 14 hrs

Preeminent Signs of Labor

lightening settling of the presenting part into the pelvis brim (shooting pain radiating to the

legs, urinary frequency)primi- early 2 weeks prior to EDD

Braxton Hicks Contractions – painless irregular contractions

Increase Activity of the Mother – NestingInstinct (mgt: save energy) epinephrine production (hormone that ↑ the activity of the mother)

Ripening of the cervix –butter softnessDecrease in weight – 1.5-3 lbs.Bloody show

pinkish vaginal discharge (blood + leucorrhea + operculum = pink in color)Rupture of membranes

check FHTIE check for cord prolapseafter several hrs – check temp.

Preeminent Signs of Labor

lightening settling of the presenting part into the pelvis brim (shooting pain radiating to the

legs, urinary frequency)

primi- early 2 weeks prior to EDDBraxton Hicks Contractions – painless irregular contractionsIncrease Activity of the Mother – Nesting

Instinct (mgt: save energy) epinephrine production (hormone that ↑ the activity of the mother)

Ripening of the cervix –butter softnessDecrease in weight – 1.5-3 lbs.Bloody show

pinkish vaginal discharge (blood + leucorrhea + operculum = pink in color)Rupture of membranes

check FHTIE check for cord prolapseafter several hrs – check temp.

Difference Between True and False Contraction

False True No in intensity Pain confined in the

abdomen Pain is relieved by

walking No cervical changes

There is an in intensity Pain begins @ the

lower back to abdomen Pain is intensified by

walking Cervical effacement (thinning of the cervix, measured thru %) & dilatation (widening of the cervix, measurement thru cm) *best/major sign of true labor

Premature Rupture of Membranes (PROM)contraction drop in intensity even though very painful• contraction drop in frequency• uterus tense &/or contracting between contractions• abdominal palpitations• Nursing Care:

–administer analgesics (morphine)–attempt manual rotation for ROP or LOP–bear down with contractions–adequate hydration–sedation as ordered–cesarean delivery may be required, especially if fetal

distress is noted

Placenta Previa

it occurs when the placenta is improperly implanted in the lower uterine segment, sometime covering the cervical os.

• Assessment– Outstanding sign : frank, bright red, painless bleeding– enlargement (usually has not occurred)– fetal distress– abnormal presentation

• Nursing care :– Initial mgt : NPO à candidate for CS– Bedrest– prepare to induce labor if cervix is ripe– administer IV – No IE, No Sex, No enema – complication : Sudden

fetal blood loss– prepare Mother for double set –up –DR is

converted to OR

First stageDilatations

Frequency Duration

Latent Phase

0-3 cm 5-10 mins 20-40 mins

Encourage walking : shortens 1st stage of laborEncourage to void q 2-3 hrs : full bladder inhibits uterine contractionbreathing (chest breathing technique)

Active 4-8 cm 3-5 mins 30-60 secs

M – edications – have meds readyA – ssessment include: v/s, cervical dilatation & effacement, fetal monitor, etcD – ry lips – oral care (ointment), dry linensBreathing – abdominal breathing

Transition 8-10 cm 2-3 mins 45-90 secs

I – inform of progress (to relieve emotional support)R – restless support her breathing techniqueE – encourage & praise

Transverse Lie (Perpendicular)/Horizontal liePosition – relationship of the fetal presenting part to

specific quadrant of the mother’s pelvis.ROA/LOA

left occipito anteriormost common & favorable position

ROT/LOT – left occipito transverseROP/LOP – left occipito posterior

L/R- side of maternal pelvisMiddle – presenting part

ROP/ROT – most common malpositionROP/LOP – most painful mgt: pelvis squatting

12. POSTPARTUM CARE

Common complication: uterine atony

Nursing priority: massage the uterus

Common cause of uterine atony: twin birth

• BULGING OF PERENIUM surest sign of delivery initiation

• PANT & BLOW Breathing, fetal pushing should be done on an open glottis

Uterine Inertia

• Sluggishness of contraction• Types

– Primary/ Hypertonic• Intense contraction resulting to ineffective pushing• Management : Sedation

– Secondary/ Hypotonic• Slow, irregular contraction resulting to ineffective

pushing• Management : Oxytocin Augmentation