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MATERNAL & CHILD
HEALTH NURSING
ANTEPARTUM
Venice Joy Toledo - Malonzo, RN
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Maternal and Child Health Nursing
involves care of the woman and
family throughout pregnancy and
child birth and the health promotionand illness care for the children and
families.
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Primary Goal of MCN
The promotion and maintenance of
optimal family health to ensure
cycles of optimal childbearing andchild rearing
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ANATOMY AND
PHYSIOLOGY OFFEMAL REPRODUCTIVE
ORGANS
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EXTERNAL
Mons Pubis - pad of adipose tissue whichlies over the symphysis pubis covered byskin and at puberty, by short hairs;protecting the surrounding delicate tissue.
Labia Majora -two folds of skin with fatunderneath; contain Bartholins gland.
Labia Minora -two thin folds of delicatetissues; form an upper fold encircling clitoriscalled the prepuce; and unite posteriorlycalled the fourchette.
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Clitoris - small, erectile structure at
the anterior junction of the labia minora
Vestibule narrow space seen when
the labia minora are separated.
Urethral meatus external opening of
the urethra; slightly behind and to side
are the opening of skenes gland
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Vaginal orifice external opening of
the vagina, covered by a thin
membrane called hymen.
Perineum area from the lower
border of the vaginal orifice to the anus
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INTERNAL
UTERUS A hollow pear shaped
muscular organ Serves various function
1. To receive ovum from
fallopian tube2. To provide a place for the
ovum implant
3. To offer nourishment &
protection to the growingfetus
4. To expel the fetus from themothers body when mature
It has 3 layers endometrium,
myometrium,perimetrium
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VAGINA
a 3-4 inches long dilatable canal
located between the bladder and therectum.
it contains rugae which permit
considerable stretching without tearing
passageway for menstrual discharges,
copulation and fetus.
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OVARIES
almond shaped,dull white sexglands near thefimbrae, kept in
place byligaments.
Produce matureand expel ovaand manufactureestrogen andprogesterone.
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FALLOPIAN TUBES
4 inches long from each side of
the fundus, widest part (called the
ampula) spreads into fingerlikeprojections (called fimbrae).
Responsible for transport of
mature ovum to the uterus.
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Related Structure
Pelvis - support and protect the reproductive
organ
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Types/ Variation of Pelvis
Gynecoid normal female pelvis. Inlet iswell rounded forward and back. Most idealfor child birth.
Anthropoid transverse diameter isnarrow, AP diameter is larger than normal.
Platypelloid inlet is oval, AP diameter is
shallowAndroid male pelvis. Inlet has a
narrow, shallow posterior portion andpointed anterior portion.
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Division of the Pelvis
False pelvis
Part above the pelvic brim
Serves to support the weight of the enlarged pregnant
uterus
Directs the presenting fetal part into the true pelvis
Inlet: upper border of pelvis Pelvic cavity: Curved canal with a longer posterior than
anterior wall
Outlet: Pelvic outlet is at the lower border of the true
pelvis
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FIGURE 312 Female pelvis.A, The false pelvis is a shallow cavity above the inlet; the true pelvis is a
deeper portion of the cavity below the inlet.
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Pelvic Measurements
Pelvic inlet
Diagonal conjugate
Measure at least 11.5 cm
Obstetric conjugate - 10 cm or
more
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FIGURE 105 Manual measurement of inlet and outlet.A, Estimation of the diagonal conjugate, which
extends from the lower border of the symphysis pubis to the sacral promontory.B, Estimationof the
anteroposterior diameter of the outlet, which extends from the lower border of the symphysis pubis to the tip of
the sacrum. Cand D, Methods that may be used to check the manual estimation of anteroposterior
measurements.
A
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FIGURE 105 (continued) Manual measurement of inlet and outlet.A, Estimation of the
diagonal conjugate, whichextends from the lower border of the symphysis pubis to the
sacral promontory.B, Estimation of the anteroposterior diameter of the outlet, which
extends from the lower border of the symphysis pubis to the tip of the sacrum. Cand D,
Methods that may be used to check the manual estimation of anteroposterior
measurements.
B
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FIGURE 105 (continued) Manual measurement of inlet and outlet.A, Estimation of the
diagonal conjugate, whichextends from the lower border of the symphysis pubis to the sacral
promontory.B, Estimationof the anteroposterior diameter of the outlet, which extends from the
lower border of the symphysis pubis to the tip of the sacrum. Cand D, Methods that may be used
to check the manual estimation of anteroposterior measurements.
C
D
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Pelvic Measurements
Pelvic outlet
Anteroposterior diameter
Should be 9.5 to 11.3 cm
Transverse diameter should
be 8 to 10 cm
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FIGURE 106 Use of a closed fist to measure the outlet. Most examiners know the distance between their
first and last proximal knuckles. If they do not, they can use a measuring device.
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Breast
Consist of glandular,fibrous, and adiposetissue.
Grow & Develop
from stimulation ofsecretion from thehypothalamus,anterior pituitary andovaries.
Provide nourishmentto the infant andtransfer maternalantibodies duringbreast feeding
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MenstrualCycle
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Female Reproductive Cycle
Purpose:
To bring an ovum to maturity and renew the
uterine tissue bed that will be responsive to
its growth once its fertilized Menarche
First menstruation
May occur early as age of 7 or late as age 17
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The menstrual cycle
Varies from woman to woman
average length of cycle is 28 days fromthe beginning of one menstrual flow to
the beginning of next.
aveverage length of the menses is 2 to
7 days
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Initiated by the release of LUTEINIZING
HORMONE RELEASING HORMONE, also
known as gonadotropin releasing hormone
from the hypothalamus Under the influence of LHRH, the anterior
lobe of pituitary produces two hormone:
a. Follicle stimulating hormone
b. Luteinizing hormone
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Characteristics of Normal Menstruation
Period
1. Menarche average onset 12 -13 years
2. Interval between cycles average 28 days
3. Cycles 23 35 days
4. Duration average 2 7 days; range 1 9
days
5. Amount average 30 80 ml ; heavy
bleeding saturates pad in
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Phases of menstrual cycle
Menstrual phase (days 1-5)
Estrogen and progesterone level
decrease
FSH levels rise, and steady levels of LH
influence the ovary to secrete estrogen
Menstrual flow begins
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Proliferative (follicular) phase (6-13 days)
Estrogen production increases, leading
to proliferation of endometrium andmyometrium in preparation for possibleimplantation of ovum
Follicle secrete estradiol
FSH stimulates graafian follicleFSH production decreases before
ovulation (around day 14)
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Secretory (Luteal) (days 14-25)
The corpus luteum forms under the
influence of LH
Estrogen and progesterone production
increases
The endometrium id prepared for
implantation of fertilized ovum
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Ischemic (days 26-28)
The corpus luteum degenerates if
conception doesnt occur
Estrogen and progesterone levels
decline if conception doesnt occur
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A i t d T
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Associated Terms
1. Amenorrhea - temporary cessation of
menstrual flow
2. Oligomenorrhea - markedly diminished
menstrual flow3. Menorrhagia - excessive bleeding during
regular menstruation
4. Metrorrhagia - bleeding at completelyirregular intervals
5. Polymenorrhea - frequent menstruation
occurring at intervals of less than 3 weeks
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BEGINNING OF
PREGNANCY
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Process of Conception
Fertilization
1. Union of the ovum and spermatozoon
2. Other terms: conception, impregnation or fecundation
3. Normal amount of semen/ejaculation= 3-5 cc = 1 tsp.
4. Number of sperms: 120-150 million/cc/ejaculation
5. Mature ovum may be fertilized for 12 24 hrs afterovulation
6. Sperms are capable of fertilizing even for 3 4 days
after ejaculation (lifespan of sperms 72 hrs)
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FIGURE Sperm penetration of an ovum.A, The sequential steps of oocyte penetration by a spermare depicted
moving from top to bottom.B, Scanning electron micrograph of a human sperm surrounding a human ovum (750).
The smaller spherical cells are granulosa cells of the corona radiata. Scanning electron micrograph used with
permission from Nisson, L. (1990). A child is born. New York: Dell publishing.
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FIGURE 72(continued) Sperm penetration of an ovum.A, The sequential steps of oocyte penetration by a
sperm are depicted moving from top to bottom.B, Scanning electron micrograph of a human spermsurrounding a
human ovum (750). The smaller spherical cells are granulosa cells of the corona radiata. Scanning electron
micrograph used with permission from Nisson, L. (1990). A child is born. New York: Dell publishing.(Photo
Lennart Nilsson/Albert Bnniers Folag AB)
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Implantation
Once implantation has taken place, the uterineendometrium is now termed deciduas
Occasionally, a small amount of vaginal bleedingoccurs with implantation due to breakage ofcapillaries
Immediately after fertilization, the fertilized ovum orzygote stays in the fallopian tube for 3 days, duringwhich time rapid cell division (mitosis) is takingplace. The developing cells now called blastomereand when about to have 16 blastomere calledmorula.
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Morula travels to uterus for another 3 4
days
When there is already a cavity in the morula
called blastocyt finger like projections calledtrophoblast form around the blastocyst, which
implant on the uterus
Implantation is also called nidation, takes
place about a week after fertlization
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FIGURE During ovulation the ovum leaves the ovary and enters the fallopian tube. Fertilizationgenerally occurs
in the outer third of the fallopian tube. Subsequent changes in the fertilizedovum from conception to implantation
are depicted.
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Placentation
In placentation, the chronic villi invade
the decidua
This becomes the fetal portion of the
future placenta
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Stages of Fetal Development
Preembryonic period
Begins with fertilization and lasts about 3
weeks
As the zygote passes through the fallopiantube, it undergoes a series of mitotic division,
or cleavage
Once formed, the zygote develops intomorula and then blastocyst, eventually
attached to the endometrium.
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Embryonic Period
Begins with the 4th week of gestation andends with the 7th week
The zygote now called an embryo, begins to
take on a human shape Germ layers develop, giving rise to organ
system
The embryo is highly vulnerable to injury from
maternal drug use, certain maternal
infections, other factors
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Fetal Period
Begins with 8th week of gestation and
continues until birth
During this period, the embryo now calledfetus, matures, enlarges, and grows heavier.
The head of the fetus is disproportionately
larger than its body.
The fetus also lacks subcutaneous fat
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Embryonic & Fetal Structures
Decidua
Refers to endometrial lining during pregnancy
Provides a nesting place for the developing
ovum
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Fetal membranes
The chorion is the fetal membrane closest tothe uterine wall:
- It gives rise to placenta
- It forms the outer wall of blastocyst
- Vascular projections, called chronic villi,arise from its periphery
Amnion is the thin, though inner fetalmembrane that lines amniotic sac, gives riseto umbilical cord supported by Whartons
jelly
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Embryonic germ layers
Three layers develop during the embryonic
period
Ectoderm outermost layer
Mesoderm middle layer Endoderm inner most layer; differentiation
of endoderm results in formation of epithelium
lining respiratory and digestive tracts
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FIGURE Endoderm differentiates to form the epithelial lining of the digestive and respiratory tractsand associated
glands.
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Amniotic sac
Gradually increases in size and surrounds theembryo
Contains fluid, called amniotic fluid
Purpose1. Protection shield against pressure and
temperature changes
2. Can be used to diagnose congenital
abnormalities intrauterine amniocentesis
3. Aid in the descent of fetus during active labor
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Umbilical cord
Serves as the lifeline from the embryo to theplacenta
Measures from 30.5 90 cm in length & 2 cm in
diameter at full term
Contains AVA (2 artery 1 vein)
artery carries blood from fetus to placenta
vein returns blood to the fetus from the
placenta Contains whartons jelly, jellatenous substance
that helps prevent kinking of the cord in utero
Blood flows through the cord at about 400ml/min
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Placenta
A flat disk shaped structure formed from thechorion, chronic villi, and adjacent decidua
basalis
Contains 15-20 subdivison called cotyledons It supplies fetus with carbohydrates, water,
fats, protein, minerals & inorganic salts
It transfer passive immunity via maternal
antibodies
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Maternal portion
Consists of deciduas basalis and its circulation
Surface appears red and flesh-like
Fetal portion Consists of the chorionic villi and their
circulation
The fetal surface of the placenta is covered by
the amnion
Appears shiny and gray
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FIGURE Maternal side of placenta (Dirty Duncan).
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FIGURE 7 Fetal side of placenta (Shiny Shultz).
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FETAL GROWTH &
DEVELOPMENT
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Fetus Growth & Development
4 weeks: 46 mm, brain formed from
anterior neural tube, limb buds seen,
heart beats, GI system begins
6 weeks: 12 mm, primitive skeletal
shape, chambers in heart, respiratory
system begins, ear formation begins
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12 weeks: 8 cm, ossification of skeleton
begins, liver produces red cells, palate
complete in mouth, skin pink, thyroid
hormone present, insulin present in pancreas
16 weeks: 13.5 cm, teeth begin to form,
meconium begins to collect in intestines,
kidneys assume shape, hair present on scalp
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FIGURE The fetus at 20 weeks weighs 435 to 465 g and measures about 19 cm. Subcutaneousdeposits of
brown fat make the skin a little less transparent. Woolly hair covers the head,and nails have developed on
the fingers and toes. Use with permission from Nilsson, L. (1990). A child is born. New York: Dell Publishing.
(Photo Lennart Nilsson/Albert Bnniers Folag AB)
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20 weeks: 19 cm, myelination of spinal cordbegins, suck and swallow begins, lanugocovers body, vernix begins to protect thebody
24 weeks: 23 cm, respiration and surfactantproduction begins, brain appears mature
28 weeks: 27 cm, nervous system beginsregulation of some functions, adipose tissueaccumulates; nails, eyebrows, and eyelidsare present; eyes are open
36 weeks: 35 cm, earlobes soft with littlecartilage, few sole creases
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40 weeks : 40 cm, adequate surfactant,
vernix in skin folds and lanugo on shoulders,
earlobes firm, sex apparent
Weight about 3,000 to 3,600 g (6 lb., 10 oz. to7 lb., 15 oz.)
Varies in different ethnic groups
Skin has a smooth, polished look
Hair on head is coarse and about 1 inch long
Body and extremities are plump
Focus of Fetal Development
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Focus of Fetal Development
First Trimester period of organogenesis
Second Trimester period of continued fetal
growth and development; rapid increaseinlength
Third Trimester period of most rapid growth
and development because of the deposition
of subcutaneous fat
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64FIGURE 7 The actual size of a human conceptus from fertilization to the early fetal stage. The embryonic stage
begins in the third week after fertilization; the fetal stage begins in the ninth week.
Fetal Development: What Parents
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Fetal Development: What Parents
Want to Know
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Fetal Blood Circulation
The fetus is connected by the umbilical cord to the
placenta, the organ that develops and implants in the
mother's uterus during pregnancy.
Through the blood vessels in the umbilical cord, the
fetus receives all the necessary nutrition, oxygen, and life
support from the mother through the placenta.
Waste products and carbon dioxide from the fetus aresent back through the umbilical cord and placenta to the
mother's circulation to be eliminated.
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Placenta
Umbilical vein (composed of two arteries and
one vein AVA)
Liver
Ductus Venosus (First Shunt)
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Inferior Vena Cava
Right Atrium
Foramen Ovale (Second Shunt)
Left Atrium
Left Ventricle
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Aorta
To upper half of the fetal body only
Upper Extreme
Brain
Heart
Pulmonary
Upper part of the GUT
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Then this blood is recollected
with less oxygen and then it goes to
the
Superior Vena Cava
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Right Atrium
Right Ventricle
Pulmonary Artery (but lungs are collapsed;
Surfactant inadequate and amniotic fluid ispresent)
Ductus Arteriosus
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Descending Aorta
Supply the lower half of the fetal body
Blood is recollected
Hypogastric Artery
Umbilical Artery
Placenta
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SHUNTS
When the baby is delivered, the shunts are
normally removedDuctus Venosus
Foramen ovale
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Two (2) types of Closure
Functional ClosureAnatomic Closure
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FORAMEN OVALE
Closed functionally immediately after birth or
IMMEDIATELY AFTER CORD IS CLAMPEDAnatomically, it can persist up to one (1) year
after delivery
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Therefore, in auscultation in twenty-eight (28) dayold baby There is a MURMUR
This is Normal
This is NOT A PATHOLOGIC MURMUR
It is a SYSTEMIC / INNOCENT MURMUR
A PHYSIOLOGIC MURMUR IN NEONATES
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DUCTUS ARTERIOSUS
Functional Closure
Ten to ninety-six hours (10 96 hrs) after birth
or approximately four (4) days
Anatomically
Two to three months (2 3 mos.)
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Normal Adaptation to Pregnancy
SystemicChanges
1 Cardiovascular/ Circulatory changes
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1. Cardiovascular/ Circulatory changes
a. Physiologic anemia of pregnancy
30-50% gradual increase in total cardiac
volume (peak 6th month) causing drop in
Hemoglobin and Hematocrit values (inc onlyin plasma volume)
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Consequences of increased cardiac volume:
1. easy fatigability & shortness of breath due
increase cardiac workload
2. slight hypertrophy of the heart3. systolic murmurs due to lowered blood
viscosity
4. nosebleeds may occur due to congestion ofnasopharynx
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b. Palpitations
caused by the SNS stimulation during early
part of pregnancy; increased pressure of the
uterus against the diaphragm during thesecond half of pregnancy
c Edema of the lower extremities & varicosities
due to poor circulation caused by the
pressure of the gravid uterus on the blood
vessels of the lower extremities
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http://rds.yahoo.com/_ylt=A0S02030eW5KRRAA7cWJzbkF;_ylu=X3oDMTBpdnJhMHUzBHBvcwMxBHNlYwNzcgR2dGlkAw--/SIG=1is65th9a/EXP=1248840564/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dvaricose%252Bveins%252Band%252Bpregnancy%2526fr%253Dyfp-t-152%2526fr2%253Dsg-gac%26w=400%26h=496%26imgurl=static.howstuffworks.com%252Fgif%252Fhow-to-cope-with-varicose-veins-3.jpg%26rurl=http%253A%252F%252Fhealth.howstuffworks.com%252Fhome-remedies-for-varicose-veins1.htm%26size=18k%26name=how%2Bto%2Bcope%2Bwith...%26p=varicose%2Bveins%2Band%2Bpregnancy%26oid=e0df180bc0f27f78%26fr2=sg-gac%26no=1%26tt=137%26sigr=125ejqncc%26sigi=1227vs32b%26sigb=133jaulrrhttp://rds.yahoo.com/_ylt=A0S02030eW5KRRAA7sWJzbkF;_ylu=X3oDMTBpZTByOGFiBHBvcwMyBHNlYwNzcgR2dGlkAw--/SIG=1jh8ae1jd/EXP=1248840564/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dvaricose%252Bveins%252Band%252Bpregnancy%2526fr%253Dyfp-t-152%2526fr2%253Dsg-gac%26w=400%26h=320%26imgurl=www.theholisticcare.com%252Fcure%252520diseases%252FImages%252Fvaricose%252520veins.jpg%26rurl=http%253A%252F%252Fwww.theholisticcare.com%252Fcure%252520diseases%252FVaricose%252520Veins.htm%26size=24k%26name=varicose%2Bveins%2Bj...%26p=varicose%2Bveins%2Band%2Bpregnancy%26oid=202ee9014e304344%26fr2=sg-gac%26no=2%26tt=137%26sigr=1236riv6a%26sigi=123in757h%26sigb=133jaulrrhttp://rds.yahoo.com/_ylt=A0S020uIeW5KxFoBfImJzbkF;_ylu=X3oDMTBpdnJhMHUzBHBvcwMxBHNlYwNzcgR2dGlkAw--/SIG=1hgaagoop/EXP=1248840456/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DPREGNANCY%252B%252BEDEMA%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=500%26h=333%26imgurl=static.flickr.com%252F3107%252F2438453829_7624844ddb.jpg%26rurl=http%253A%252F%252Fwww.flickr.com%252Fphotos%252Funderwaterclownconspiracy%252F2438453829%252F%26size=124k%26name=Edema%26p=PREGNANCY%2B%2BEDEMA%26oid=c26796d98a6f99c0%26fr2=%26fusr=%252AApril%252A%26no=1%26tt=95%26sigr=122tvurdg%26sigi=11gljad8k%26sigb=12lek3hvjhttp://rds.yahoo.com/_ylt=A0S020uIeW5KxFoBgomJzbkF;_ylu=X3oDMTBpZm5udGl1BHBvcwM1BHNlYwNzcgR2dGlkAw--/SIG=1hij7fv0q/EXP=1248840456/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DPREGNANCY%252B%252BEDEMA%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=375%26h=500%26imgurl=static.flickr.com%252F3231%252F2855804589_671779db4d.jpg%26rurl=http%253A%252F%252Fwww.flickr.com%252Fphotos%252Fchristopherandtia%252F2855804589%252F%26size=103k%26name=Soooo%2Bswollen%26p=PREGNANCY%2B%2BEDEMA%26oid=ddc98d1b50bf5258%26fr2=%26fusr=christophera...%26no=5%26tt=95%26sigr=11q49jk82%26sigi=11g6mp1p9%26sigb=12lek3hvj -
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d. Vaginal and rectal varicosities
due to pressure on blood vessels of the
genitalia
e. Predisposition to blood clot formation due to increased level of circulating fibrinogen
as a protection from bleeding implication: no
massage
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2. Gastrointestinal Changes
a. Morning sickness nausea and vomiting in the 1st
trimester due to HCG or due to
increased acidity or emotional factors
b. Hyperemesis gravidarum excessive nausea & vomiting which
persists beyond 3 months causing
dehydration, starvation and acidosis
http://rds.yahoo.com/_ylt=A0S020mVem5KRPYARq6JzbkF;_ylu=X3oDMTBpdnJhMHUzBHBvcwMxBHNlYwNzcgR2dGlkAw--/SIG=1ggvn5rpr/EXP=1248840725/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DMORNING%252BSICKNESS%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=200%26h=200%26imgurl=www.i-am-pregnant.com%252Fimages200%252F32051299.jpg%26rurl=http%253A%252F%252Fwww.i-am-pregnant.com%252Fencyclopedia%252FM%252FMorning-Sickness%26size=12k%26name=32051299%2Bjpg%26p=MORNING%2BSICKNESS%26oid=88025f41ef402550%26fr2=%26no=1%26tt=14740%26sigr=11sgpb4uq%26sigi=11cvdheih%26sigb=12lpsb87ohttp://rds.yahoo.com/_ylt=A0S020mVem5KRPYASa6JzbkF;_ylu=X3oDMTBpc2ozM2gzBHBvcwM0BHNlYwNzcgR2dGlkAw--/SIG=1gkbbv21n/EXP=1248840725/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DMORNING%252BSICKNESS%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=250%26h=148%26imgurl=www.pregnancywizard.com%252Fmorning-sickness.jpg%26rurl=http%253A%252F%252Fwww.pregnancywizard.com%252Fsigns-symptoms%252Fmorning-sickness.php%26size=7k%26name=morning%2Bsickness...%26p=MORNING%2BSICKNESS%26oid=fefc6bc89dc74cd8%26fr2=%26no=4%26tt=14740%26sigr=122lp3mq5%26sigi=11cjub7kp%26sigb=12lpsb87o -
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c. Constipation and Flatulence
GI displacement slows peristalsis &
gastric emptying time; inc
progesterone
http://rds.yahoo.com/_ylt=A0S0204re25Kt_AAF3aJzbkF;_ylu=X3oDMTBqMjRpazg1BHBvcwMxMARzZWMDc3IEdnRpZAM-/SIG=1h3entmkf/EXP=1248840875/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dtoilet%252Bbowl%252Bcartoons%2526fr%253Dyfp-t-152%26w=200%26h=156%26imgurl=static.flickr.com%252F2%252F1995419_9318f8a098.jpg%26rurl=http%253A%252F%252Fwww.flickr.com%252Fphotos%252Fjesus_loves%252F1995419%252F%26size=8k%26name=Spongebob%2Bon%2Btoi...%26p=toilet%2Bbowl%2Bcartoons%26oid=9abea7aa2d7dfbea%26fr2=%26fusr=Cannie%2BKor%26no=10%26tt=2118694%26sigr=11h6i7l3c%26sigi=11avlks9s%26sigb=12ghck6dj -
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d. Hemorrhoids
due pressure of enlarged uterus
http://rds.yahoo.com/_ylt=A0S020yme25KmK8A4hWJzbkF;_ylu=X3oDMTBpc2ozM2gzBHBvcwM0BHNlYwNzcgR2dGlkAw--/SIG=1hqna1329/EXP=1248840998/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dthrombosed%252Bexternal%252Bhemorrhoids%2526fr%253Dyfp-t-152%26w=203%26h=132%26imgurl=www.bosa.co.kr%252Flink%252F3684-20p3.jpg%26rurl=http%253A%252F%252Fwww.bosa.co.kr%252Fspecial%252Fview.asp%253Fboard_pk%253D14696%2526page%253D6%2526what_board%253D24%26size=10k%26name=3684%2B20p3%2Bjpg%26p=thrombosed%2Bexternal%2Bhemorrhoids%26oid=7f11f9d88c8c1b5e%26fr2=%26no=4%26tt=33%26sigr=12aseo4je%26sigi=111mbtq2k%26sigb=12rpgs33fhttp://rds.yahoo.com/_ylt=A0S020lne25KWwYBSa6JzbkF;_ylu=X3oDMTBqNzBoY2J0BHBvcwMxNARzZWMDc3IEdnRpZAM-/SIG=1mjukri04/EXP=1248840935/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DHEMORRHOIDS%2526js%253D1%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=294%26h=308%26imgurl=www.luckyworld.net%252Fbbs%252Fdata%252Fplay_04%252FHemorrhoids1USdepartmentofhealtha.jpg%26rurl=http%253A%252F%252Fwww.luckyworld.net%252Fbbs%252Fboard.php%253Fid%253Dplay_04%2526page%253D6%2526s_name1%253D%2526div%253D1%2526s_name%253Doff%2526s_title%253Don%2526s_cont%253Doff%2526orderby%253Dheadnum%2526order2%253Dasc%2526no%253D725%26size=12k%26name=Hemorrhoids1USde...%26p=HEMORRHOIDS%26oid=c3f00d400ec9c992%26fr2=%26no=14%26tt=13376%26sigr=14bs8afdu%26sigi=1290hfgh8%26sigb=12ltjr5tc -
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e. Heartburn
due to increased progesterone and
decreased gastric motility causing
regurgitation through gastric sphincter
3 i Ch
http://rds.yahoo.com/_ylt=A0S0203Fe25KLRAAO2.JzbkF;_ylu=X3oDMTBpdDZuNzZrBHBvcwM5BHNlYwNzcgR2dGlkAw--/SIG=1iojkb556/EXP=1248841029/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DHEARTBURN%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=200%26h=150%26imgurl=blogs.abcnews.com%252Fgma%252Fimages%252F2008%252F06%252F02%252Fnm_heartburn_080602_mn.jpg%26rurl=http%253A%252F%252Ffeeds.feedburner.com%252F%257Er%252FAbcNews_GMAMentionedOnAir%252F%257E3%252F303038122%252Flearn-how-to-co.html%26size=8k%26name=nm%2Bheartburn%2B080...%26p=HEARTBURN%26oid=c67e6c46567e24a6%26fr2=%26no=9%26tt=32266%26sigr=12q2a3v2l%26sigi=122nqm8h7%26sigb=12eu2t6tj -
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3. Respiratory Changes
a. Shortness of Breath
due to inc. oxygen consumption and
production of carbon dioxide during the 1st
Trimester; and increased uterine size pushingthe diaphragm crowding chest cavity
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4. Urinary Changes
a. Urinary frequency
felt during the 1st trimester due to the
increase blood supply to the kidneys and then
on the 3rd trimester due to pressure on thebladder.
b. Decreased renal threshold for sugar
due to increased production of
glucocorticoids which cause lactose and
dextrose to spill into the urine; and inc.
progesterone
5 M l k l t l h
http://rds.yahoo.com/_ylt=A0S020stfG5KFGEBTVKJzbkF;_ylu=X3oDMTBpc2ozM2gzBHBvcwM0BHNlYwNzcgR2dGlkAw--/SIG=1i1niljdt/EXP=1248841133/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DSTANDING%252BPREGNANT%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=150%26h=150%26imgurl=www.freeprintablecoloringpages.net%252Fthumbs%252FAt_The_Doctor%252FStanding_Pregnant_Woman.png%26rurl=http%253A%252F%252Fwww.freeprintablecoloringpages.net%252Fcategory%252FAt_The_Doctor%26size=3k%26name=Standing%2BPregnan...%26p=STANDING%2BPREGNANT%26oid=5e4471b03ca5aaa8%26fr2=%26no=4%26tt=423%26sigr=120k6vmvd%26sigi=12jmeb8cl%26sigb=12mpg7b48 -
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5. Musculoskeletal changes
a. Pride of Pregnancy
due to need to change center of gravity result
to lordotic position
b. Waddling gait due to increased production of hormone
relaxin, pelvic bones becomes more movable
increasing incidence of falls
c. Leg cramps
due to pressure of gravid uterus, fatigue,
muscle tenseness, low calcium and
phosphorus intake
http://rds.yahoo.com/_ylt=A0S020stfG5KFGEBTVKJzbkF;_ylu=X3oDMTBpc2ozM2gzBHBvcwM0BHNlYwNzcgR2dGlkAw--/SIG=1i1niljdt/EXP=1248841133/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DSTANDING%252BPREGNANT%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=150%26h=150%26imgurl=www.freeprintablecoloringpages.net%252Fthumbs%252FAt_The_Doctor%252FStanding_Pregnant_Woman.png%26rurl=http%253A%252F%252Fwww.freeprintablecoloringpages.net%252Fcategory%252FAt_The_Doctor%26size=3k%26name=Standing%2BPregnan...%26p=STANDING%2BPREGNANT%26oid=5e4471b03ca5aaa8%26fr2=%26no=4%26tt=423%26sigr=120k6vmvd%26sigi=12jmeb8cl%26sigb=12mpg7b48 -
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d. Increased size and activity of adrenal cortexincreasing circulating cortisol, aldosterone,
and ADH which affect CHO and fat
metabolism causing hyperglycemia.
e. Gradual increase in insulin production but
there is decreased sensitivity to insulin during
pregnancy
6 E d i Ch
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6. Endocrine Changes
a. Addition of the placenta as an endocrineorgan producing HCG, HPL, estrogen and
progesterone
b. Moderate enlargement of the thyroid due toincreased basal metabolic rate
c. Increased size of the parathyroid to meet
need of fetus for calcium
http://rds.yahoo.com/_ylt=A0S0205mfG5KM_gAIc.JzbkF;_ylu=X3oDMTBpcWpidGtpBHBvcwM4BHNlYwNzcgR2dGlkAw--/SIG=1gatak5os/EXP=1248841190/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DWEIGHING%252BSCALE%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=220%26h=220%26imgurl=www.umm.edu%252Fweightloss%252Fimages%252Fweight-scale.jpg%26rurl=http%253A%252F%252Fwww.umm.edu%252Fweightloss%252Fonline_resources.htm%26size=14k%26name=weight%2Bscale%2Bjpg%26p=WEIGHING%2BSCALE%26oid=9a7217201e986d2a%26fr2=%26no=8%26tt=41868%26sigr=11iep1n3q%26sigi=11edds63f%26sigb=12j3g824u -
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7. Weight Change
a. First Trimester 1.5 to 3 lbs normal weight
gain
b. 2nd and 3rd trimester 10 11 lbs pertrimester is recommended
c. Total allowable weight gain during throughout
pregnance is 20 25 lbs or 10 12 kgs.
d. Pattern of weight gain is more important thanthe amount of weight gained.
8 E i l
http://rds.yahoo.com/_ylt=A0S0205mfG5KM_gAIc.JzbkF;_ylu=X3oDMTBpcWpidGtpBHBvcwM4BHNlYwNzcgR2dGlkAw--/SIG=1gatak5os/EXP=1248841190/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DWEIGHING%252BSCALE%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=220%26h=220%26imgurl=www.umm.edu%252Fweightloss%252Fimages%252Fweight-scale.jpg%26rurl=http%253A%252F%252Fwww.umm.edu%252Fweightloss%252Fonline_resources.htm%26size=14k%26name=weight%2Bscale%2Bjpg%26p=WEIGHING%2BSCALE%26oid=9a7217201e986d2a%26fr2=%26no=8%26tt=41868%26sigr=11iep1n3q%26sigi=11edds63f%26sigb=12j3g824uhttp://rds.yahoo.com/_ylt=A0S0206SfG5KrPMALH.JzbkF;_ylu=X3oDMTBqamdoM3Q5BHBvcwMxMgRzZWMDc3IEdnRpZAM-/SIG=1ij3h6afe/EXP=1248841234/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DPOST%252BPARTUM%252BBLUES%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=266%26h=357%26imgurl=www.planet.vertbaudet.com%252Fphotos%252Fbomastersite%252Fimages%252F129%252F357x480.aspx%26rurl=http%253A%252F%252Fwww.planet.vertbaudet.com%252Fbaby-blues-depression-post-partum-comment-le-surmonter.htm%26size=16k%26name=357x480%2Baspx%26p=POST%2BPARTUM%2BBLUES%26oid=d3e0c25532193d34%26fr2=%26no=12%26tt=158%26sigr=12romgc2v%26sigi=125r4ut9q%26sigb=12mrhp8pi -
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8. Emotional responses
a. 1st trimester: some degree of rejection,disbelief, even depression because of its
future implication -> give health teachings on
body changes and allow for expression of
feelings
b. 2nd trimester: fetus is perceived as a
separate entity and fantasizes appearance
c. 3rd trimester: best time to talk about layette,and infant feeding method. To allay fear of
death let woman listen to the FHT.
COMMON EMOTIONAL
http://rds.yahoo.com/_ylt=A0S02070fG5KMfYAv4CJzbkF;_ylu=X3oDMTBpc2VvdmQ2BHBvcwM3BHNlYwNzcgR2dGlkAw--/SIG=1ivnlq4f3/EXP=1248841332/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DSAD%252BPREGNANT%252BWOMAN%2526js%253D1%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=228%26h=148%26imgurl=i.dailymail.co.uk%252Fi%252Fpix%252F2006%252F09%252Fpregwomsad_228x148.jpg%26rurl=http%253A%252F%252Fwww.dailymail.co.uk%252Fpages%252Flive%252Ffemail%252Farticle.html%253Fin_article_id%253D406974%26size=10k%26name=pregwomsad%2B228x1...%26p=SAD%2BPREGNANT%2BWOMAN%26oid=4ae9bfe6038847fc%26fr2=%26no=7%26tt=33%26sigr=12etpj7au%26sigi=11mm1mo3l%26sigb=12snbuhqdhttp://rds.yahoo.com/_ylt=A0S020q8fG5KlYAA4FOJzbkF;_ylu=X3oDMTBqdGFzdWxiBHBvcwMxNQRzZWMDc3IEdnRpZAM-/SIG=1j8mqlosf/EXP=1248841276/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DPOSTPARTUM%252BBLUES%2526js%253D1%2526ni%253D21%2526ei%253DUTF-8%2526y%253DSearch%2526fr%253Dyfp-t-152%26w=300%26h=350%26imgurl=media.canadianfamily.ca%252Fimages%252Fcf_postpartum_main_.jpg%26rurl=http%253A%252F%252Fwww.canadianfamily.ca%252Farticles%252Farticle%252Fantepartum-depression-baby-blues%26size=16k%26name=cf%2Bpostpartum%2Bma...%26p=POSTPARTUM%2BBLUES%26oid=b4a581519a35a368%26fr2=%26no=15%26tt=261%26ni=21%26sigr=12epgignj%26sigi=11md0vibt%26sigb=139qj8ee5http://rds.yahoo.com/_ylt=A0S0206SfG5KrPMALH.JzbkF;_ylu=X3oDMTBqamdoM3Q5BHBvcwMxMgRzZWMDc3IEdnRpZAM-/SIG=1ij3h6afe/EXP=1248841234/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DPOST%252BPARTUM%252BBLUES%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=266%26h=357%26imgurl=www.planet.vertbaudet.com%252Fphotos%252Fbomastersite%252Fimages%252F129%252F357x480.aspx%26rurl=http%253A%252F%252Fwww.planet.vertbaudet.com%252Fbaby-blues-depression-post-partum-comment-le-surmonter.htm%26size=16k%26name=357x480%2Baspx%26p=POST%2BPARTUM%2BBLUES%26oid=d3e0c25532193d34%26fr2=%26no=12%26tt=158%26sigr=12romgc2v%26sigi=125r4ut9q%26sigb=12mrhp8pi -
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RESPONSES DURING PREGNANCY
Stress decrease in responsibilitytaking is the reaction to the stress of
pregnancy not the pregnancy itself
affects decision making abilities
Couvade syndrome men
experiencing nausea/vomiting,backache due to stress, anxiety and
empathy for partner
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Emotional labile moodchanges/swings occur frequently due to
hormonal changes
Change in Sexual Desire may
increase or decrease needs correct
interpretation not as a loss of interestin sexual partner
Appropriate Relief Measures
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Appropriate Relief Measures
Urinary frequency Increase fluid intake during day
Decrease fluid intake in the evening
Fatigue: Plan rest periods and ask for helpfrom family or support persons
Breast tenderness: Wear well supporting bra
Common Obstetric Terminology
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(contd)
Nullipara: Woman who has had no births atmore than 20 weeks gestation
Primipara: Woman who has had one birth atmore than 20 weeks gestation
Multipara: Woman who has had two or morebirths at more than 20 weeks gestation
Stillbirth: Infant born dead after 20 weeksgestation
Multigravida: Woman in second or anysubsequent pregnancy