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PROMOTING MATERNAL & CHILD HEALTH: FAMILY-CENTERED CARE

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PROMOTING MATERNAL & CHILD HEALTH: FAMILY-CENTERED CARE

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Family Centered Care's ultimate goal is to promote and maintain optimal family health to ensure cycles of optimal child bearing and child-rearing/parenting.

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What are we expected to do as maternal and child health nurses?
1.) Provide pre-conceptual health care
- Focusing not only on the baby's health but the mother and father's as well.
2.) Care of women during trimesters of pregnancy and the puerperium
- Antenatal/ Prenatal
- Trimester
- Labor and birth
- During recovery
3.) Care of Infants
4.) Care of children from birth to adolescence
- The principles of growth and development
5.) Care in settings as varied as the birthing room, the pediatric intensive care unit, and the home.

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Health Promotion - Promotes certain practices to further improve one's health
Health Maintenance - Prevents the risk from occurring (e.g. teaching parents about childproofing)
Health Restoration - Restoring health or reconstruction of the body from what it used to before
Health Rehabilitation - a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment

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Country: PH; Infant mortality rate (deaths/1,000 live births): 20; Year: 2020

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The vital statistic of infant mortality rate in a country is the best health indicator of the country's health care service.

Basically the higher ⬆️ the infant mortality rate, the lower or poorer ⬇️ the health care service is.

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PROMOTING MATERNAL & CHILD HEALTH: FAMILY-CENTERED CARE (PARKING QUESTION)

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PROMOTING MATERNAL & CHILD HEALTH: FAMILY-CENTERED CARE (PARKING QUESTION)

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It's been a custom that a woman should be using contraception (other than male condoms) to prevent unwanted pregnancy but in fact, it is more suitable for men to use contraception because a male body is constantly creating sperm that can get a woman pregnant, unlike pregnancy it occurs for 9 months. To summarize, it is more likely for men to cause a pregnancy to women than it is for a woman to get pregnant.

Question:
Why is there a limited male contraceptive offered in the world? Is there a possibility to create various contraception for males?

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LESSON 1: PRINCIPLES OF GROWTH & DEVELOPMENT

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LESSON 1: PRINCIPLES OF GROWTH & DEVELOPMENT

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Peak developing time of body systems

Neurologic System - first 2 years
Lymphatic System - infancy and childhood
Reproductive System - puberty
Musculoskeletal System - childhood

*note:
growth - quantitative change
maturation - qualitative change

*behavior - most comprehensive indicator of developmental status

*Principle of Asynchronism - not all body parts grow at the same time and same rate

* Deductive reasoning - general → specific
Inductive reasoning - specific in general
Transductive reasoning - specific → specific

*Id - pleasure principle
Ego - reality
Superego - moral

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Photo by Ismail Salad Hajji dirir on Unsplash

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Download this free HD photo of learning, reading, school and mogadishu in Mogadishu, Somalia by Ismail Salad Hajji dirir (@hajjidirir)

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LESSON 1: PRINCIPLES OF GROWTH & DEVELOPMENT (PARKING QUESTION)

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LESSON 1: PRINCIPLES OF GROWTH & DEVELOPMENT (PARKING QUESTION)

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Among the four theories of development, psychosexual development, psychosocial development, moral development, and cognitive development, which of these theories is the most accurate? which theory do you believe best characterizes a child's growth and the stages it goes through?

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Physical growth of a toddler
- "Baby fat" begins to disappear
- Noticeable lordosis (forward curvature of the spine)
*Appetite of a toddler: decreases; adequate intake of vitamins are needed

Body Systems
- Respirations slows slightly but continue to be mainly abdominal

Parental Difficulties in Evaluation Illness
- note that parents should defer the normal and abnormal signs of their toddler; how? = be literate

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Developmental Milestones

15th month (1 year, 3 months)
- speaks 4-6 words
- avoid baby talks (child needs to practice)
- resistant to cuddles (attain independence)
*object permanence

18th month (1 year, 6 months)
- parallel play is beginning (a form of play in which children play adjacent to each other, but do not try to influence one another's behavior)
- for parents; show the right way to hold/use the object/toy correctly

24 months (2 years old)
- 2-word sentences (noun-pronoun and verb)
- parallel play becomes evident
*note: toddlers: aggressive personality = probably have the most difficulty adapting to playgroups
*note: you have to duplicate the toys that the other child is playing with to your child (e.g: stacking blocks (appearance is not important))

30th month (2 years, 6 months)
- imitates the parents' actions often
- play outdoors (to prevent the breakage of fragile things)
*note: play behavior - the toys toddlers enjoy most are those they can play with by themselves and that requires action.

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Additional Notes:
- Safety is the main concern of the parents
- Discipline the kid but don't force them
- Independent feeling - choosing their own food, finishing food on the plate, brushing, putting socks, putting shoes
- Refusing - not refusing love but the feeling of being assisted
- Temper tantrums - ignore (but not in the public place) -- don't give in (e.g cry = toy)

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LESSON 3: FAMILY WITH A TODDLER (PARKING QUESTION)

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LESSON 3: FAMILY WITH A TODDLER (PARKING QUESTION)

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As mentioned in the 18th months (1 year and 6 months), children at this period tend to do things in the wrong way. Question, is this also the time where kids wear the slippers in the wrong feet?

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Body contour/ Body changes
Ectomorphic - slim (t=thin)
Endomorphic - large (d=dambuhala :)) )

Handedness begins to be obvious (left-handedness, right-handedness)

Genu valgus - knock-knees may be evident

Increased coordination, stronger muscles

More frequent in voiding

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3-years-old
Fine motor skills (FMS-small movements): undress self
Gross motor skills (GMS-bigger movements): run, standing in one foot
Language: (don't baby talk) vocabulary of 900 words, questions 300-400 "how" and "why"
Play: able to take turns, pretend play/associative play (there's social interaction), very imaginative

4-years-old
FMS: simple buttons, can cut stuff using scissors, outlines stuff
GMS: makulit, jumps, skips
Language: vocab: 1500 words
Play: creative play, fantasy play
c - encourage the parents to make eating time enjoyable
x - no arguments/talking about problems in the dining table
*the child can sense if something is wrong

*bathroom language
- mentions "poo" and "pee"

5-years-old
FMS: can lace shoes
GMS: throws overhand
Language: vocab: 2100 words
Play: loves games with numbers and letters
* preschoolers does not need a lot of toys

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additional notes:

imitation - imitates the roles of the people are them
fantasy - let children know there are still recognizable (even though they're in their imaginative role)
Oedipus and Electra Complexes - opposite attraction to different gender in parents'
e.g: girl preschooler to her mother - "I hate you!
mother to her daughter - "Well, I don't like to be shouted at, but I still love you"
Gender Roles - preschoolers need to be exposed to adult opposite gender, so that they can become familiar with opposite gender roles.
Socialization - sensitive and critical time for socialization
- "best friends" - develops besties
- elementary rule: even no. of children = play;
odd number of children = won't play
*when talking about sex, always be honest!
*phallic stage - talks about genitalia
-Egocentrism increase
*Moral and Spiritual development
- conscience has developed

Cognitive Development
1. Preoperational
2. Intuitional thought (intuitive thought phase)

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LESSON 4: FAMILY WITH A PRE-SCHOOLER (PARKING QUESTION)

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LESSON 4: FAMILY WITH A PRE-SCHOOLER (PARKING QUESTION)

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Is it normal for them to play their own genitals?

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LESSON 5: FAMILY WITH A SCHOOL-AGED CHILD

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LESSON 5: FAMILY WITH A SCHOOL-AGED CHILD

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Physical Growth
Malocclusion - a deviation from the normal with teeth malalignment
Frontal sinuses develop at about 6 years - sinus headache
Maturation of the respiratory system leads to increased oxygen–carbon dioxide exchange - increases exertion ability and stamina
Scoliosis - may become apparent for the first time in late childhood, about over 8 years of age the child should be screened.

Sexual Maturation
Girls - 12 - 18 yrs old
Boys - 14 - 20 yrs old

gonadal hormone (sex steroid) -  increase and cause the sexual organs to mature

Puberty
boys:
Voice - deepens
*androgen - hormones responsible for the male features and reproduction
9 - 11 yrs old
prepubertal weight gain occurs
11 - 12 yrs old
Face - pimples (sebaceous gland)
Private - bigger penis and testicles
Sweat - armpits
12 - 13 yrs old
Height - taller
Hair - grows in their face, arms, legs, chest, armpits, and between your legs

*gynecomastia -  hypertrophy of breast tissue,  can occur in prepuberty (most often in stocky or obese boys)
* nocturnal emissions -  seminal fluid is produced,  ejaculation during sleep

girls:
9 - 11 yrs old
Breasts - grows
11 - 12 yrs old
Face - pimples
Sweat - armpits
Height - taller
Hair - grows in their armpits, legs, and between your legs
12 - 13 years old
Menstruation - period begins

* Prepubertal girls are usually taller
* Breast self-examination
* Supernumerary - (additional) nipples may darken or increase in size at puberty
*  menarche - first menstruation, starts around age 12 but can occur as early as age 9 and still be considered normal

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LESSON 5: FAMILY WITH A SCHOOL-AGED CHILD (PARKING QUESTION)

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LESSON 5: FAMILY WITH A SCHOOL-AGED CHILD (PARKING QUESTION)

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Does depression occurs in this age?

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Adolescence
- period between 13 and 18 or 20 years old
-transition between childhood & young adulthood

It can be divided into:
- early period (13-14 yrs)
- middle period (15-16 yrs)
- late period (17-20 yrs)

* Adolescents invariably feel a sense of pressure throughout this period because they are mature in some respects but still young in others.
for example:
- Adolescence sexual interests are awakening, yet personal for parental pressures discourage sexual exploration.
-Adolescence may not feel mature enough to live away from home, yet parents and teachers are urging the adolescent to apply for an out-of-town college

*This duality causes a major dilemma for an adolescence, leading to many of the growth & developmental concerns of the age

* Adolescents grow both rapidly & mature dramatically during this period

* most developed countries (eg: USA)
- adolescence covers long time span

* Developed countries
- adolescence tends to be shorter because children must take full-time jobs early in life to help support their families.

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Physical growth
- the major milestones of development in the adolescent "period are the onset of puberty at 9-12 yrs. of age
-cessation (complete stopping) of body growth 16-20 yrs.

* between these milestones; occurs the ff.

- physiologic growth
- development of adult coordination

1.) Gain in physical growth is mostly in weight
- stocky, slightly obese appearance of prepubescence
2.) comes thin, gangly appearance of late adolescence

GIRLS :
-1-2 inc (2.4 to 5cm) ↑ taller than boys (coming to adolescence)
- Stop growing within 3yrs. from menarche
- Start menstruation: 10 years old; reach adult height: 13 yrs. old

BOYS:
height: 4-12 in (10 to 30 cm)
weight: 15-65 lbs (7 to 30 kg)

GIRLS:
height: 2-8 in (5 to 20 cm)
weight: 15-55 lbs (70 to 25kg)

* growth stops w/ closure of the epiphyseal lines of long bones
females: 16 or 17 yrs old
males: 18 to 20 yrs. old

* androgen (influence the growth & development of the male reproductive system)
- stimulates sebaceous glands to extreme activity = results in acne

* Apocrine sweat glands (present in the axillae & genital area
- forms shortly after puberty
- produces strong odor = emotional stimulation

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TEETH

2nd molars: 13 yrs of age
3rd molars ( wisdom teeth): 18-21 yrs old
Jaw: reaches adult site only toward the end of adolescence.

PUBERTY
- the time at which an individual first becomes capable of sexual reproduction.

puberty begins when: (11 - 14 yrs old)
girls: begins to menstruate
boys: begins to produce spermatozoa

* puberty creates many questions for early teenagers about what is normal & what is not

SECONDARY SEX CHANGES
- body hair configuration
- breast growth
* the secondary sex character that began in the late school-age period, continue to develop during adolescence.

PLAY or RECREATION
13 yr old: from school-age activities of active games to more adult forms of recreation (eg: listening to music, chatting on computer, following sports  teams wins & losses)

* team/school loyalty is intense & following a coach's instructions becomes mandatory = 6 yr. old loyalty shown to their 1st grade teacher

* talking w/ peers as a social interaction serves as a major way to learn about the world.

* estrogen (women) & testosterone (men) - sex hormones

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Emotional development

Developmental task: Identity vs Role Confusion

according to Erikson, the developmental task in early & mid-adolescence is to form a sense of identity or decide who they are & what kind of person they will be.

* In late adolescence the task is to:

-form a sense of intimacy or form close relationships with persons of the opposite as well as the same-sex. It is the concentration on these two tasks that leads to typical adolescent behavior.

The 4 main ideas in which adolescents must make gains to achieve a sense of identity are:
1.)  Accepting their changed body image
2.) Establishing a value system for what kind of person they want to be
3.) Making a career decision
4.) Becoming emancipated* from their parents
*not constrained or restricted by custom, tradition etc.

Body Image
- They may need to help to realize the characteristics that make someone creative, compassionate, and fun to be with are the qualities on which lasting relationships are built.

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NCM107-TERM 1-MODULE 2: CARE OF A PREGNANT WOMAN AND HER FAMILY

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NCM107-TERM 1-MODULE 2: CARE OF A PREGNANT WOMAN AND HER FAMILY

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Changes during pregnancy
Uneven hormones - supports the growing fetus

1.) Blood volume - increases 30% - 40% necessary for the growing fetus
2.) antibodies - defense mechanism against antigens
- decreases so as not to reject the fetus (bc it comes from the father)
3.) ligaments (pelvic area)
- becomes softer and pliable = mother easier to push out the baby
*blood clot = increase = childbirth no blood loss
4.) Lactation = breastfeeding
16th week (colostrum)

37 weeks (not yet full term)
- considered as early term

39-40 weeks
- full term

Major changes:
Physiologic - body changes
2 types:
1.) Systemic - all the systems (except repro. system)
2.) Local - change in reproductive system (vagina, cervix, uterus, breast)
*can attributed to the body changes

Psychologic - feelings, emotion
*ambivalence - uncertainty
e.g. "pregnant or not?"
(normal feeling for pregnant woman)

Trimesters
1st tri: 1-3 months
2nd tri: 4-6 months
3rd tri: 7-9 months

Presumptive
- "I think i'm pregnant but I am not sure"
*highly subjective
e.g. - breast tenderness (only a woman feels, sees this)
- enlarged uterus

Probable
- "most likely i'm pregnant"
*has objective cues/signs - indications of medical reasons condition
e.g. pregnancy test (detects hormone HCG hormone)
**increased HCG = HMole (medical condition)
= Ectopic pregnancy (implantation outside the uterus)

Positive
100% sure pregnant
3 F'S
F - fetal outline (seeing an ultrasound)
F - fetal heart rate
F - fetal movement felt by the examiner

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Physiology:
enlargement of uterus

*AOG - Age of Gestation
- how many weeks/months far along the pregnancy is

Bartholomew's rules of 4's
- estimates the AOG based on the location of the fundus, i.e. top most part of the uterus
- locate the highest point
*why rule of 4? bc of the interval

36 weeks - xiphoid process
38 weeks - lightening (preparation for childbirth)
20 weeks - umbilicus
16 weeks - below the umbilicus; above the symphysis pubis
12 weeks - symphysis pubis

*lightening process

McDonald's rule
- est. the AOG by measuring the height of the fundus in cm
- get tape measure 0 cm - pubic bone
- cross the abdomen across umbilicus
*20 cm = 20 weeks

how to position a pregnant client: abdomen
- supine position
- knees slightly flexed
- w/ a small pillow behind the right pelvis

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- slight increase in HR (more blood in circulation)
- palpitations may be present
- innocent murmur - presence of extra heart sounds (bc mild hypotrophy)
uterus growing = push all oxygen = more heart diff to the side
DISCLAIMER: they may be present but if associated with other s/sx such as DOB, chest pain, high BP, then it has be checked by a physician

slight decrease in BP = PROGESTERONE relaxes your blood vessels = wider = pressure within is lower

varicosities and edema in the lower extremities ONLY
e.g. edema in the lower extremities and face = DANGER SIDE = high blood pressure = gravity
!!note!! not in the upper extremities or in the face

*during pregnancy there is an increase urinary frequency = uterus = pressing the bladder
*prone to urinary tract infection or UTI bc of the compression of the bladder, increased side of the ureters = relax = progesterone and relaxin = urine output will be pushed back up = risk UTI

assess for signs of urinary infection
- lower back pain
- pain in urination (dysuria)
- urinalysis (test) pus cells, presence of bacteria, WBC, cast cells
*UTI = manage well for pregnant woman

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Respiratory System
- there is slight increase in respiratory rate
- shortness of breath but no difficulty in breathing

normal: breath in - diaphragm expands
pregnant: lungs can expand to the sides
*put pillow when supine

*nasal stuffiness
estrogen - dilates capillaries in the nose
to do:
- do not prescribe any OTC medicines (bc it's not 100% safe)
- take vitamin C or vitamin rich foods
ask: cough? secretion charges?

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pica (pie-cah)
- craving for non-food items
- maybe anemia = loss blood in the brain

melanocyte (melanin)
- hyperpigmentation; darkening of the skin
- linea nigra = line from the symphysis pubis to the umbilicus melasma/chloasma mask of pregnancy

increased thyroid gland = thyroid hormone = increased cellular basal rate
*increased bc of metabolic needs

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Assessing
health history and physical examination
normal weight gain: 30-35 lbs

sudden increased BP and weight gain = HTN

pattern of weight gain:
1 lbs - per month - first 3 months
1 lbs - per week - 2nd to 3rd trimester

e.g. preggy pre-natal check up 112 lbs 6th month of pregnancy + 15 lbs = 127 lbs
1 lbs - 1st month
1 lbs - 2nd
1 lbs - 3rd
4 lbs - 4th
4 lbs - 5th
4 lbs - 6th
total: 15 lbs

Eyes
- no blurring of vision
- if blurring of vision is present = HTN

backpain - softening of ligaments

purple color of vagina - normal
blisters - abnormal

Pre-natal care
- pre-natal visits WHO - 8 visits
8 visits:
1st and 2nd tri - once a month
3rd tri - twice a month
9th month - weekly
post-term - twice a week

- educate
- emphasize the importance
- ensure privacy and comfort
- engage and involve

Naegele's rule
- standard method used to predict the length of pregnancy

ask to ur client "when is the first day of your last menstrual period"

-3 (month) +7 (day) +1 (year)

EDD - Estimated Due Date

e.g. September (9) 13, 2021
- 3 +7 +1
= June 20, 2020

Homework:
January 25, 2021
-3 +7 +1
= November 1, 2021

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NCM107-TERM 1-MODULE 2: CARE OF A PREGNANT WOMAN AND HER FAMILY (PARKING QUESTION)

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NCM107-TERM 1-MODULE 2: CARE OF A PREGNANT WOMAN AND HER FAMILY (PARKING QUESTION)

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What influences "paglilihi" and is it real?

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Women's bodies go through many physical changes during pregnancy, the majority which are out of their control.

Stretch marks are a natural result of a woman's skin stretching as she develops further in her pregnancy.

While the end result of giving birth is undoubtedly worth it, understanding how they can be prevented and treated will be welcomed.

Statistically, women getting stretch marks during pregnancy is relatively high with around 70% to 90% of women suffering from them in some way, according to the NHS.

We chatted to dermatologists and doctors specialising in skin health to find out more.
Why causes women to get stretch marks during pregnancy?
"Stretch marks develop when the collagen in the skin is stretched beyond its elastic limit," Dr Justine Hextall, consultant dermatologist, at The Harley Medical Group told HuffPost UK Parents.

"This causes fissuring which appears as stretch marks in our skin."

During the latter stages of pregnancy specifically when the baby is rapidly growing, a woman's skin cells rupture due to being pulled apart so much.

When the cells rupture they will also leave scarring - the stretch mark.

Better Births midwife Rachel Scanlon from The Royal College of Midwives said it also may be a result of your genes.

"Some women have a genetic disposition to stretch marks, so if your mum had them you might be more likely to have them."

Dr Hextall agreed, adding: "There are some women who may just have more elastic skin and can sail through growth spurts and pregnancies with perfect skin, others are not so lucky.

"It is that old-age, look at your mother!"
How can I prevent getting stretch marks?
Before noticing stretch marks have developed, there are a number of things women can do to prevent them.

No single thing will always work, so understanding how you can look after your skin as early as possible will be an advantage.

Dr. Erich Schulte, founder of QMS Medicosmetics said an effective method to prevent stretch marks is a combination of regular exercise and healthy nutrition.

Maintaining a healthy weight will minimise any rapid weight gain that could contribute towards excessive stretching of the skin.

He told HuffPost UK Parents: "Boost your routine with supplements ideally containing Vitamins E and C (like Intravital Plus) and make sure you choose skincare products that will strengthen the collagen and elastin fibres in your skin tissue before you're further along in your pregnancy."

Dr. Kishan Raichuram, skin health expert at IGDP, said another way to prevent stretch marks is through keeping your skin as healthy and hydrated as possible.

"While it's impossible to entirely prevent them, pregnant women can improve skin condition to hopefully reduce the chances by keep the area well moisturised and nourished," he said.

Dr. Schulte agreed, adding that preparing your skin as soon as you know you are pregnant will help strengthen it.

He explained: "This will make your less prone to damage and injury to the tissue. It will also help restore the skin post-pregnancy.

"Exfoliation is a key benefit as that continues to stimulate the cell turnover and works well in conjunction with body-firming creams.

"Also don't stop the skin care routine once you have given birth as the skin still needs the support."
What should women do if they notice them during pregnancy?
Firstly, don't panic - finding stretch marks on your stomach does not mean they will stay there forever.

The wider, red, dipped scarring will improve significantly and over time, they are likely to become less pigmented and more silvery in colour.

"If stretch marks do develop try to prevent too much sun exposure to the area as they can pigment and take longer to fade," explained Dr Hextall.

"Massaging the skin with bio-oil or silica gel may well reduce the redness and improve the appearance.

"I like Bio-oil as it is very accessible for patients and enables them to be pro-active in treating their stretch marks. I suggest massaging oil into the skin.

"Soon the redness of new stretch marks fades and they appear silvery and as such are much less noticeable.

"Topical silica gels are also good at reducing redness in all scars."

For pregnant women, Bio oil is recommended to be massaged in a circular motion into the stretch marks, twice daily.

It should be applied from the start of the second trimester to areas that are prone to stretch marks such as the abdomen, breasts, lower back, hips, buttocks and thighs.

Midwife Scanlon agreed that moisturising and massaging your stretch marks will be beneficial, as well as keeping hydrated.

"Drinking lots of water will keep your skin more elastic," she said.

Are there any treatments to get rid of stretch marks post-pregnancy?
There are more invasive techniques women can try with a higher chance of removing stretch marks.

Dr Hextall said The Harley Medical Group's Dermaroller involves 'micro-needling' to stimulate the skin and regenerate naturally and safely.

Also referred to as 'Collagen Induction Therapy', this treatment introduces fine needles to the skin to create microscopic channels.

The skin is encouraged to produce new collagen which will generate new skin cells. The skin then becomes thicker and plumper reducing any marks.

She explained: "Another treatment includes bipolar radio frequency which also helps to stimulate new collagen.

"This also has the effect of plumping and tightening the skin which lessens the appearance of stretch marks."

This treatment delivers targeted heat to the dermis [the lower or inner layer of the two main layers of cells that make up the skin]. The energy is delivered beneath the surface of the stretch mark, stimulating the body's natural healing response and maximising collagen production.

Dr. Raichura agreed micro-needling is helpful in lessening the appearance of stretch marks.

He said: "It can be very effective but of course the result varies with individual cases and relies totally on the 'natural' healing processes of the body.

"Other treatments include formulations of Vitamin A which are improve surface texture and pigmentation, and can be combined with skin peels to enhance the result further.

"Laser resurfacing, dermabrasion and even surgery (in extreme cases) are also options for treating stretch marks."

Dr Hextall said her main advice would be for women not to worry if they notice them.

"Relax, you are not alone!" she said. "Around 80% of women develop stretch marks in pregnancy, the appearance will improve naturally over time, it's amazing how our bodies and specifically our skin will bounce back.

"Try to enjoy your pregnancy and look forward to your new baby, that's the most important thing."

SEE ALSO: Mum-Of-Four Shares Tummy Photo To Challenge What It Means To Have A 'Perfect' Body Mum-Of-Two Posts Stretch Mark Photo Online To Inspire Body Confidence, Instagram (Temporarily) Removes It Me, My Body and a Bikini

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Stretch Marks During Pregnancy: How To Prevent And Treat Them

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Women's bodies go through many physical changes during pregnancy, the majority which are out of their control. Stretch marks are a natural result of a woman's skin stretching as she develops further in her pregnancy. While the end result of giving birth is undoubtedly worth it, understanding how they can be prevented and treated will be welcomed.

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PRESUMPTIVE
1- --> Tests of blood serum reveal presence of HCG
2 - Breast changes, Nausea,vomiting, Amenorrhea
-->Feeling of tenderness, fullness, or tingling, enlargement and darkening of the areola
-->Felt on arising
-->Absence of menstruation
3 - Frequent urination
-->Sense of having to void frequently
12 - Fatigue
- Uterine enlargement
-->General feeling of tiredness
-->Uterus (rises) can be palpated over the symphysis pubis

18 - Quickening
-->Fetal movement feltby woman (16-20 weeks)

24 - Melasma
- Striae Gravidarum
-->Dark line pigmentation on the abdomen
-->Dark pigment on the face
-->Red streaks on the abdomen

PROBABLE
1 - Serum Laboratory Test/Pregnancy Test
-->Test of bloodserum reveal the presence of HCG
6 - CHADWICK’S sign
- GOODEL’S sign
- HEGAR’S sign -->SOFTENING of the CERVIX
- Sonographic evidence of GESTATIONAL SAC
-->Color of the VAGINA changes from PINK → VIOLETS

-->SOFTENING of the LUS
-->Characteristic ring is evident

16 - Ballottement
-->The fetus can be felt to rise against the abdominal wall

20 - BRAXTON-HICKS contraction
-->Periodic uterine tightening occurs
-->"practice contractions"

- FETAL OUTLINE felt by EXAMINER
-->Periodic uterine tightening occurs
-->Fetal outline can be palpated through abdomen

POSITIVE
8 - Evidence on Ultrasound of fetal outline
-->Fetal outline can be seen and measured by ultrasound

10-12 FETAL HEART audible n. FHT: 120 - 160 bpm
-->Doppler UTZ

18-20 - fetal heart audible by ordinary stet

20 - FETAL MOVEMENT by examiner
-->Fetal movement can be palpated

--------------------------------------
>REPRODUCTIVE SYSTEM <
- Uterine blood flow increases

uterine - predictable rate of growth. It rises
above the symphysis pubis at 12 weeks at the
umbilicus at 20 weeks.

Estrogen
- promotes growth of muscle fibers
- inc. vaginal discharge

Progesterone - prevents uterine contraction and
at the same time maintains the uterine wall (endometrium) --> decidua

a. Amenorrhea
• Occurs because of suppression of FSH
b. Cervical changes
• Becomes more vascular and edematous
• Coating of mucus fills the cervical canal called the Operculum
or mucus plug
• Cervix softens (Goodell’s sign)
c. Ovarian changes
• Ovulation stops (halt FSH and LH production)
• Corpus luteum continues to increase in size
d. Vaginal changes
• Presence of white vaginal discharge (Leukorrhea)
• Increase vascularity→ deep violet color (Chadwick’s sign)
• Vaginal secretion changes during pregnancy from a PH of
greater than 7 (alkaline) to a 4 or 5(acidic)

Consistency of the cervix
Nonpregnant- tip of the nose
Pregnant-earlobe
Term-soft as a butter (this is termed as ripening)

Colostrum is the earliest breastmilk produced by the 12th-18th week of pregnancy.
- clear yellowish fluid is continuously produced for the first few weeks after birth.

The Montgomery tubercle is present to lubricate the nipples
-----------------------------------------------------------------------------------
>> Systemic Changes <<

>Integumentary System<
a. Striae gravidarum → striae albicans
b. Umbilicus becomes stretched and protrudes
c. Appearance of skin pigmentations
(linea nigra from the umbilicus to the symphysis pubis ;
darkened areas on the face known as melasma or mask of pregnancy)

reason for hyperpigmentation is the inc. production of MSH melanocyte stimulating hormones

> Respiratory System <
VARIABLE --- CHANGE
Respiratory rate --- Increased, 1 or 2/minute
Tidal Volume inh --- Increased by 30-40%
Plasma pH --- Increased to 7.40-7.45
Plasma pO2 --- Increased to 104-108 mmHg

Residual Volume left --- Decreased by 20%
Plasma pCO2 --- Decreased to about 27-32 mmHg

Vital Capacity inh.ex --- No change

**IMPORTANT: Remember that there is an increased need for Oxygen and an increased amount of CO2 that needs to be eliminated!**

normal: 35 - 45 mmHg
preg: 27 - 32 mmHg (dec. bc sa baby inc.)

diffuse (movement from higher to lower concentration)
---------------------------------------------------------------------------------------
> Cardiovascular System <
A. Blood Volume
• INCREASED by 30% - 50% during the end of 3rd trimester
up to 28th - 32nd week
ntbk: inc. end of 3rd tri and start of 2nd tri
note: However if anemia persists beyond this time, this may be attributed to iron deficiency and is considered PATHOLOGIC or TRUE ANEMIA.

• May cause Pseudoanemia = during late 1st tri and early 2nd tri
• True anemia = early 1st tri and late 2nd to 3rd tri
(Hgb <11.5g/ 100mL)/ Hct <30%)

• Compensated by INCREASED production of RBC→ near
normal levels by 2nd trimester

B. Iron needs (INCREASED)
• Requirement of the fetus to grow (350-400 mg)
• Increase in circulatory RBC (400 mg)
• Iron supplement to prevent True anemia
(Hgb<11.5g/100ml)/ Hct<30%)

• Folic Acid need also INCREASES→ prevents Megalohemoglobinemia (non-func.RBC)
• May also cause Neural tube defects
• Advise to eat food high in folic acid

-------------------------------------------------------------------------------
> Heart <
• Cardiac Output INCREASES by 25%-50%
• HR INCREASES by10 beats/minute
• Happens mostly in the 2nd trimester
• Has implications to a woman with cardiac disease
• Altered heart position→ appear larger on CXR & presence of heart murmur (innocent)
• May experience palpitation

* The increased blood volume will result to an
increased venous return which will in turn
lead to increased cardiac output

d. Blood Pressure
• Does not normally rise
• Decreases slightly during the second trimester→ Rises again to 1st trimester levels

e. Peripheral Blood Flow
• Decreased blood flow to extremities→ EDEMA and VARICOSITIES of the vulva, rectum and legs

*Presence of edema may be caused by impaired blood flow going to the lower extremity. The weight of the gravid uterus
impedes the venous return from the lower extremity.

f. Supine Hypotension Syndrome
• Supine position→ vena cava compression→ obstruction
of BF from the LE→ DECREASED blood return to the
heart→DECREASED CO→HYPOTENSION
• Can cause fetal hypoxia
• Experienced as light headedness, faintness and palpitations
• Assume the left side-lying position

g. Blood Constitution
• Fibrinogen INCREASES to 50% as well as other clotting
factors (VII, VIII, IX and X) and Platelet count
• Total WBC INCREASES
• Total Protein DECREASES → Osmotic = Hydrostatic Pressure→ ankle andfoot edema
• Blood lipids INCREASE by 1/3; cholesterol serum
INCREASES by 90%-100%
---------------------------------------------------------------------------------
> Gastrointestinal <
• Decrease intestinal peristalsis and stomach emptying time→
heartburn, constipation and flatulence
• Can be due to Relaxin, Progesterone and uterine enlargement
• Pressure of the uterus→ compresses veins from LE→
hemorrhoids
• Increased in levels of Hcg and progesterone; Increased in
levels of estrogen and decreased glucose→ “morning
sickness”(subsides after 3 months)
• Upward displacement of stomach & relaxed cardioesophageal sphincter→ heartburn
• Slow GI tract→ delayed emptying of bile from
gallbladder→ absorption in blood stream→ generalized
itching
• Increased estrogen→ hyperptyalism with decreased pH→
toothdecay
---------------------------------------------------------------------------------
> Urinary System <

a. Fluid Retention
• Total body water INCREASES to 7.5L for effective placental exchange
• Regulated by INCREASED progesterone level→
activation of RAA system
• To aid increase in blood volume and as a ready source
of nutrients to the fetus; can also replenish mother’s
blood volume
• b. Ureter and Bladder changes
• Urinary Frequency
• INCREASED Progesterone→ INCREASE in
diameter of ureters; bladder capacity to 1500L
• More prone to infection which may cause PRETERM
LABOR

*Aside from this, a woman is more prone to infection during
pregnancy because of the obstruction of the urine flow due to
bladder and ureter compression.
---------------------------------------------------------------------------------
> Endocrine System <
a. Presence of placenta as hormone-producing
structure (Estrogen, Progesterone, HPL, HCG and
relaxin), Also increases concentration of Prostaglandins in the Female reproductive tract

b. Pituitary gland
INCREASED Progesterone and Estrogen→ halt in
production of FSH and LH
INCREASED production of growth hormone and
melanoctye stimulating hormone
Produces Oxcytocin late in pregnancy, as well as
prolactin production

HPL or Human placental lactogen has a function similar to
that of the growth hormone. It also contributes to the
development of the mammary gland. However, it has an
effect of making insulin less effective.

c. Thyroid and parathyroid glands
• Enlarged thyroid gland→ INCREASE BMR by 20%→INCREASED Iodine and thyroxine inblood serum
• Maybe accompanied by emotional lability, tachycardia, palpitations, and increased perspiration
• Parathyroid gland also INCREASES in size → to supply for Calcium requirement
d. Adrenal glands
• INCREASED activity; INCREASES corticosteriods and aldosterone production→aids in suppressing inflammatory reaction
• Help regulate glucose metabolism
• INCREASED Aldosterone→ Sodium reabsorption→maintain osmolarity
e. Pancreas
• INCREASES Insulin level but is LESS effective
• Fat stores andglucose a reutilized → maintains a fairly steady glucose level
• FBS80-85 mg/100 mL
• High calorie diet and no meal interval > 12hours

*In general, there is an increased demand on the thyroid gland
during pregnancy because of the increased metabolic
requirements to support a growing fetus.

*Corticosteroid - preventing the woman’s body to
initiate an inflammatory response against the fetus

----------------------------------------------------------------------------------
7. Immune System
• DECREASED Immunologic Competency
• IgG production DECREASED→ more prone to infection
• Maybe counteracted by INCREASED WBC

8.SkeletalSystem
• INCREASE Calcium and Phosophorus needs
• INCREASED progesterone and presence of relaxin→
INCREASE in pliabilityof pelvic joints and ligaments

# data[].attributes.body
onset of labor
• unclear in humans
• attributed to progesterone withdrawal in animals
• multiple theories
- uterine muscle stretching releasing prostaglandins
- cervical pressure causing release of oxytocin
- oxytocin and progesterone balance
- placental aging
- fetal cortisol and prostaglandin
----------------------------------------------------------------------
theories of labor onset
1. decrease in progesterone
2. release of oxytocin
3. production of prostaglandins
(heavyness of the lower back)
----------------------------------------------------------------------
Preliminary signs of labor
-> subtle signs
-> imminent labor
-> educate to detect

1. Lightening (10-14d. before labor)
-> down of fetal -> true pelvis
-> w= can breathe better
-> changes woman’s abdominal contour
-> gives woman relief from diaphragmatic pressure &
SOB
-> it will cause shooting leg pains, increased vaginal discharge & urinary frequency

2. Braxton-Hicks Contractions (20 probable)
-> Do not achieve cervical dilatation
-> begin & remain ireg.
-> felt in abdomen 1st, stay: abdomen groin
-> Often disappear with ambulation & sleep
-> Do not increase in duration, frequency, or intensity

3. Nesting Instinct (38 to 39)
-> "increase in level of activity"
-> morning full = enery
- inc. epinephrine release bc prepare the body 4 labor

4. Ripening of the cervix (6w. probable)
-> an internal sign seen only on pelvic examination
-> Goodell’s sign:
-> pregnancy -- earlobe
-> at term -- “butter-soft”
-> internal announcement that labor is close at hand

5. Weight loss
6. Bloody show
7. Rupture of membranes
--------------------------------------------------------------------------
TRUE LABOR
1. uterine contractions
-> start: ireg. but --> regular & predictable
-> lower back 1st then abdomen wave
-> cont. no matter lvl act.
-> duration: start contraction -> end of same contra.
- how long/ gano katagal
-> frequency: from end of 1 contra. -> start of next 1
- interval, how often
-> intensity: strength/ power of contra.

2. show
-> mucus plug that filled the cervical canal is expelled
-> “bloody show” exposed capillaries seep blood and mixed with mucus resulting to pink-tinged color

3. Rupture of the membranes
-> sudden gush or as scanty, slow seeping of clear fluid from the vagina
-> no - "dry labor"
-> early rupture is advantageous if it causes the fetal head to settle snugly into the pelvis, resulting to short labor

True:
freq: regular
inten: inc.
pain relief: intense = walking
location: begins -> lower back then radiates -> abdo.
uterine change: physiologic retraction
cervical change:
-> effacement
= soft & thin-ing of cervical canal recorded in %
-> dilation
= external cervical widening os to 10 cm
note:
*Primipara: 1st effacement then dilation
*Multipara: Both processes occur at the same time
note:
- bf. labor = 0% eff
- early eff = 30%
- complete eff = 100%
- complete dilation

Duration of Labor:
1. Primipara: 14 hours-20 hours
2. Multipara: 8-14 hours

In true labor, contractions are accompanied by cervical dilatation and effacement
-------------------------------------------------
A successful labor depends on 4 factors
note: increment - acme (peak) - decrement

components of labor
1. Passage (or pelvis)
-> gynecoid
-> pelvic measurements are met
-> adequate size and contour

2. Passenger (or fetus)
-> good attitude = g. flexoin = fully flexed position

3. Powers (or uterine factors)
-> should be adequate

4. Psyche
-> should be preserved , so that afterward labor can be viewed as a positive experience
------------
Bony:
If an infant can’t be born vaginally…
• emphasize to parents that it is the pelvis that is too small, not that the fetal head is too big.

Pelvic Shape: Gynecoid

True pelvis
-> The bony passageway through which the
fetus must pass during delivery

Obstetric/True Conjugate
-> The most important measurement of the inlet because it has the smallest diameter (N-11cm)
----------------------
Two pelvic measurements important to determine the adequacy of the pelvic size:
-> pelvic inlet
= diagonal conjugate
(the AP diameter of the inlet)
- up and down
- 11 cm
- sacral promontory to the pubic arch
- shorter

-> pelvic outlet
= transverse diameter of the outlet
- side by side
- 10 cm
- bi-ischial diameter