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MATERNAL AND CHILD NURSING

MATERNAL AND CHILD NURSING

ANATOMY OF FEMALE REPRODUCTIVE SYSTEM
I. FEMALE REPRODUCTIVE SYSTEM
A. The External Genitalia
1. Mons Pubis or Veneris- a pad of fat which lies over the symphysis pubis
covered by skin and at puberty
2. Labia Majora- two fold of skin with fat underneath containing Bartholins glands
that secrete a yellow mucus which acts as a lubricant during sexual intercourse
3. Labia Minora- two thin folds of delicate tissues forming an upper fold encircling
the clitoris (called the Prepuce) and unite posteriorly (called the Fourchette)
4. Glans Clitoris- a small, erectile structure at the anterior junction of the labia
minora which is comparable to the penis in its extremely sensitive.
5. Vestibule- a narrow space seen when the labia minora are separated.
6. Urethral Meatus- an external opening of the urethra that is slightly behind and
to the sides are the openings of the Skenes glands
7. Vaginal Orifice or Introitus- an external opening of the vagina covered by a
thin membrane (called Hymen) in virgins.
8. Perineum- an area from the lower border of the vaginal orifice to the anus that
contains the muscles which support the pelvic organs
B. The Internal Genitalia
1. Vagina- a 3-4 inch long dilatable canal located between the bladder and the
rectum that contains rugae which permit considerable stretching without
tearing; it is also a passageway for menstrual discharges, copulation and fetus.
2. Uterus- a hollow pear-shaped fibromuscular organ which measures 3 inches
long, 2 inches wide, 1 inch thick and weighing 50-60 grams in a non-pregnant
woman
It is composed of three muscle layers:
a. Peritoneum
b. Myometrium
c. Endometrium
3. Fallopian Tubes- 4 inches long from each side of the fundus with its widest part
called Ampulla spreads into fingerlike projections called Fimbriae; it is
responsible for transport of mature ovum from ovary to uterus; fertilization takes
place in its outer third or outer half
4. Ovaries- an almond-shaped, dull white sex glands near the fimbriae kept in
place by ligaments; it produces, matures and expels ova and manufacture
estrogen and progesterone.
II. THE PELVIS
1. False Pelvis
2. True Pelvis
a. Transverse diameter
= 13.5 cm
b. Antero-posterior diameter
= 11 cm
c. Right and left oblique diameter = 12.75 cm
Types
1. Gynecoid- normal female pelvis where inlet is well rounded forward and
back; it is most ideal for childbirth.
2. Anthropoid- transverse diameter is narrow, AP diameter is larger than
normal.
3. Platypelloid- inlet is oval, AP diameter is shallow.
4. Android- male pelvis where inlet has a narrow, shallow posterior portion
and pointed anterior portion
PHYSIOLOGY OF FEMALE REPRODUCTIVE SYSTEM

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MATERNAL AND CHILD NURSING

Menstruation: the periodic sloughing off of the endometrium which occurs every
28 days and usually last 3-5 days
General Considerations
1. 300, 000- 400, 000 immature oocytes per ovary are present at birth formed
during the first 5 months of intrauterine life; 300-400 mature only after
degeneration and atrophy called Atresia during the entire reproductive cycle of
a woman
2. Menarche- first menstruation in girls
Menopause- permanent cessation of menstruation and no more functioning
oocytes in the ovaries; age of onset and termination vary widely depending on
heredity, racial background, nutrition and climate.
3. Menstrual cycle- from first day of menstrual period to the first day of the next
menstrual period with an accepted average length is 28 days.
4. Associated terms:
a. Amenorrhea- temporary cessation of menstrual flow
b. Oligomenorrhea- markedly diminished menstrual flow nearing amenorrhea
c. Menorrhagia- excessive bleeding during regular menstruation
d. Metrorrhagia- bleeding at completely irregular intervals
5. Three Major Phases of Menstruation:
a. Uterine Cycle- Proliferative Phase, Secretory Phase, Menstrual Phase
b. Ovarian Cycle- Follicular Phase , Luteal Phase
, Menstrual Phase
Functions of Estrogen Hormone of Womanhood"
1. Responsible for the development of secondary sex chromosomes
2. Responsible for changes in cervical mucus
3. Responsible for control of proliferative phase
4. Responsible for maturation of the immature oocytes which are contained in the
graafian follicle, in turn, contains the mature ovum.
Functions of Progesterone Hormone of Pregnancy
1. It increases Basal Body Temperature (BBT)
2. It prepares the uterus for pregnancy because it makes the uterus nutritionally
abundant with blood in order for the fertilized zygote to survive should
conception take place
3. It maintains pregnancy because it relaxes the uterine muscles
4. It decreases peristaltic activity of the intestines
A.
1.
2.
3.
4.
5.
6.

NORMAL ADAPTATIONS IN PREGNANCY

Systemic Changes
Cardiovascular Change
Respiratory Changes
Gastro-intestinal Changes
Urinary Changes
Musculoskeletal Changes
Weight Gains:

B. Local Changes
1. Uterus- houses the growing fetus
a. Hegars sign
b. Goodels sign
2. Breast
a. Colostrum- a thin, watery, high protein fluid is formed by the 4 th month
3. Vagina
a. Chadwicks sign
b. Leukorrhea
c. Viginal pH
4. Skin
a. Melasma or chloasma
b. Linea nigra
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MATERNAL AND CHILD NURSING

c. Striae gravidarum
ANTEPARTUM/PRENATAL CARE
FETAL WELL BEING
1. Fetal Movements- <10 FM in 12 hours, lack of movement for 8 hours and
sudden increase in violent movements especially if followed by reduced
movement
Nursing Care:
a. Left lateral position
b. Oxygen preparation
c. Refer to MD
2. Biochemical Assessment
a. Level of HCG
b. AFP
3. Amniocentesis- done at 15-18 weeks of pregnancy with a guide of ultrasound
Nursing Care:
a. Puncture site for possible leakage of amniotic fluid
through the site and vagina
b. Preterm labor
c. Infection
d. Fetal compromise
4. Electric Fetal Monitoring- non stress test and in a semi-sitting position
a. Reactive - stimulate baby by making sound or drink juice;
- HB: 15 beats/min for 15 secs
b. Non reactive- no change in HB, with change but not 15 beats/15 secs or
with change but 15 beats but not 15 secs
5. Contraction Stress Test: Oxytocin Challenge Test
baby withstand the stress of labor
mother will do the nipple stimulation
do fundal massage
oxytocin drip or pitocin drip which is best given by infusion pump
10-15 min period 2 or 3 uterine contraction that last for about 30-45 secs
3 types of FHT: a. Early- reactive; normal; (+) head compression
b. Late- non reactive
c. Variable
3 Phases of uterine contraction:
a. Start- increment
b. Peak- acme
c. End- decrement
If HB decelerates after- late but if decelerates before- early
Maximum duration for a uterus to contract- 90 sec, more than 90
seconds considered abnormal
MATERNAL WELL-BEING
Nursing Consideration:
1) Frequency of visits:
2) Danger Signs: vaginal bleeding, abdominal pain, fever & chills, edema of face &
finger, severe HA & dizziness, severe N & V, passage of watery vaginal discharge
and absence of fetal movement
Prenatal Visit:
History Taking
1. Personal data- name, age (<15 and >35), civil status (unwed/married),
occupation, education and religion
2. Medical history
3. Family history
4. Obstetric data:
a. Gravida- # of pregnancies a woman has had
b. Parity
- # of viable deliveries regardless of # and outcome
TPAL score (_,_,_,_) # of FT, Premature, Abortion, Living
c. Computation of AOG/EDC
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MATERNAL AND CHILD NURSING

1) Naegeles Rule
LMP known
subtract 3 months and add 7 days
if the LMP is on the first 3 months of the year: add 9 months & 7
days
Example:
LMP- Feb 14= 2 14
2 14
+9 +07
-3 +07
EDC=
11 21
-1 21
2) Bartholomews Method
LMP unknown
3 landmarks of the abdomen:
Xiphoid
Umbilicus
= 20-22 weeks
Symphysis pubis= >12-16 weeks
3) McDonalds Rule
Fundic height in cm x 2/7
= age in months
Fundic height in cm x 8/7
= age in weeks
4) Haases Rule
determines the length of the fetus in centimeters
AOG first months
= square the age in months
AOG 6-10 months
= multiply age by 5
5) Johnsons Rule
estimates the weight of the fetus in grams
Formula: FH in cms- n (12- if engaged or 11- if not engaged) x
k (155)
HEALTH TEACHINGS
A. Nutrition- most important aspect
1. Proteins- 75 gms/day for brain development
B. Smoking- causes vasoconstriction leading to low birth weight babies (Small
Gestational Age)
C. Alcoholism- supplies empty calories causing transient respiratory depression in
NB and fetal withdrawal syndrome
D. Clothing- loose and light with flat shoes
E. Employment-make sure to have periods of rest
F. Bathing- discourage in bath tubs to prevent fall and public pools for possible
infection
G. Exercises- to strengthen the muscles used in labor and delivery
1. Squatting (Flat on floor) and tailor sitting (Indian sit)-help stretch &
strengthen perineal muscles
2. Pelvic rock (hands on floor and knee bended)-maintains good posture &
relieves abdominal pressure & low backaches
3. Modified knee-chest position- relieves pelvic pressure and cramps in the
thighs or buttocks and relieves discomfort from hemorrhoids
4. Shoulder-circling- strengthens muscles of the chest
5. Walking
6. Kegel- relieves congestion and discomfort in pelvic region and tones up
pelvic floor muscles
H. Traveling- seatbelt not to compress the abdomen
I. Sexual Activity- permitted but not during the last 6 weeks of pregnancy because
there is increase incidence of postpartum infection
Contraindication:
1. Bleeding or Spotting
2. Incompetent cervical os
3. Ruptured BOW
4. Deeply engaged presenting part
INTRAPARTUM CARE
A. FOUR PS OF LABOR
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MATERNAL AND CHILD NURSING

1. Power
Uterine contractions
Voluntary bearing down
Abdominal muscle contractions
Contractions of levator ani muscle
2. Passageway
3. Passenger
Attitude
Engagement
Position
Presentation and presenting part
station
4. Person
B. THEORIES OF LABOR ONSET
1. Uterine Stretch Theory
2. Oxytocin Stimulation Theory
3. Progesterone Deprivation Theory
4. Prostaglandin Theory
5. Theory of Aging Placenta
C. PRODROMAL SIGNS OF LABOR
1. Lightening
2. Loss of weight
3. Increased level of activity (nesting)
4. Braxton-Hicks contractions
5. Ripening of the cervix
6. Rupture of the membranes
7. Bloody Show
D. SIGNS OF LABOR
1. Uterine contractions
2. Effacement
3. Dilatation
4. Uterine changes
E. FALSE LABOR PAINS
1. Remain irregular
2. Confined to abdomen
3. No increase in duration, frequency and intensity
4. Often disappear if the woman ambulates
5. Absent cervical changes
F. TRUE LABOR PAINS
1. May be slightly irregular to regular and predictably
2. First felt in lower back and sweep around to abdomen
3. Increasing frequency, duration and intensity
4. Continuous
5. (+) Effacement and dilatation
G. EFFECTS OF LIGHTENING
1. Shooting pains down the legs
2. Increased lordosis
3. Increased amount of vaginal discharge
4. Resurgence of a sign of pregnancy
H. CONSEQUENCES OF SPONTANEOUS RUPTURE OF MEMBRANES
1. Labor is inevitable
2. If (-) labor need for induction
3. (+) umbilical cord compression
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MATERNAL AND CHILD NURSING

I. STAGES OF LABOR
1. Dilatation
2. Complete dilatation to delivery
3. Placental stage: delivery of baby placenta
4. Homeostasis: 1-2 hours post delivery
J. MECHANISMS OF LABOR
1. Descent
2. Flexion
3. Internal Rotation
4. Extension
5. External rotation
6. Expulsion
K. DANGER SIGNS DURING LABOR AND DELIVERY
1. Vaginal bleeding
2. Premature labor
3. Abnormal fetal presentation
4. Ruptured membranes
5. Crowning
L. TWO PHASES IN THE THIRD STAGE OF LABOR
1. Placental separation
2. Placental expulsion
M. SIGNS OF PLACENTAL SEPARATION
1. Firm and round uterus
2. Sudden gush of blood
3. Lengthening of the umbilical cord
N. FOURTH STAGE OF LABOR
- Recovery and bonding
POSTPARTUM CARE
HEALTH TEACHINGS
1. Hygiene
- Do not use soap or alcohol in cleaning the breasts
2. Breast engorgement felt during the 3rd pp day
- With increase in temp (milk fever)
- Use firm-fitting brassiere
- Cold compress if not breastfeeding
- Warm compress if breastfeeding
3. Sore nipples
- Expose to air for 10-15 minutes
- If air is not effective, expose to 20 watt bulb placed 12-18 inches away
Postpartum Sexual activity
Should not resume until:
VAGINAL BLEEDING has stopped
Episiotomy has healed
NEWBORN CARE
The Normal Newborn
Head 34 35 Cm
Chest 33 34 Cm
Abdomen 32 33 Cm
Length 50 Cm
Weight 2,500 G - 4,250 G
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MATERNAL AND CHILD NURSING

APGAR SCORING
0
A
Absen
ACTIVITY
t
P PULSE
G
GRIMACE
A
APPEARA
NCE
RRESPIRAT
ION

Cord

Absen
t
No
respo
nse
Blue
all
over
absen
t

1
Arms and
legs
flexed
Below
100 bpm
Grimace

Acrocyan
osis

2
Active
moveme
nts
Above
100 bpm
Sneeze,
coughs,
pulls
away
Pink all
over

Slow,
irregular

Good,
crying

Molding
Ocular hypertelorism wide-spaced eye
Anterior fontanel
Posterior fontanel
Dolls eye
Nystagmus
Blue or gray iris
Breast engorgement
Pseudomenstruation (female)
Descended testes
Epispadias
Hypospadias
Care
Bathing
Cord dressing
Credes prophylaxis
Vitamin K administration

Neonatal complications
BIRTH ASPHYXIA
CAUSES:
- Cord prolapse
- Cord coil
MANIFESTATIONS:
- Poor response to resuscitation
- Hypoxia
- Minimal or absent respiration
PRETERM NEWBORN
CAUSES:
- History of preterm delivery
- PROM
MANIFESTATIONS:
- Grunting
- Nasal flaring
- Cyanosis
- Poor skin turgor
- Oliguria
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MATERNAL AND CHILD NURSING

POST TERM NEWBORN

EFFECTS:
Placental sufficiency LGA newborn
Placental insufficiency subcutaneous fats will be utilized >>> Fetal Dysmaturity
Syndrome
SMALL-FOR-GESTATIONAL-AGE
CAUSES:
- PIH
- Cardiac disease
- DM
- Poor nutrition
- Maternal smoking
MANIFESTATIONS:
- Soft tissue wasting
- Loose, dry, scaling skin
- Decreased glycogen store
- Polycythemia increased RBC due to hypoxia
LARGE-FOR-GESTATIONAL-AGE
- More than 4,000 g or more than 90% of the normal
MANIFESTATIONS
>>> birth injuries
- Fractured clavicle
- Facial nerve injury
MATERNAL COMPLICATIONS
ANTEPARTUM COMPLICATIONS
ABORTION
Threatened
Imminent
Therapeutic
Missed
MANAGEMENT:
CBR 12-24 hrs
D and C
HYDATIDIFORM MOLE
Aka Gestational Trophoblastic Disease
No fetus, no amniotic sac, no blood vessels
Manifestations:
High levels of HCG
rapid increase in fundic height
Interventions:
D&C
Use of methotrexate
ECTOPIC PREGNANCY
Common sites: fallopian tube, ovary, cervix, peritoneal cavity
Manifestations:
severe sharp stabbing knifelike abdominal pain
spotting
(+) Cullens Sign means RUPTURE
Cushings Triad
Interventions:
Combat SHOCK
Elevate foot of bed
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MATERNAL AND CHILD NURSING

INCOMPETENT CERVICAL OS
painless cervical dilatation os without contractions
20th week of AOG
MANIFESTATIONS:
1. Cervical dilation
2. Prolapse of the membranes
MANAGEMENT:
1. Cervical Cerclage
2. Vaginal rest
3. Prepare for child birth if with rupture of membranes
HYPEREMESIS GRAVIDARUM
MANIFESTATIONS
- Unremitting nausea and vomiting
- Weight loss
- Tachycardia
MANAGEMENT
- NPO acute vomiting
- IVF
- I and O
ABRUPTIO PLACENTA
- Premature separation of the placenta after 20th week of AOG
MANIFESTATIONS:
1. painful, dark red vaginal bleeding
TOXEMIA/PIH
GESTATIONAL HYPERTENSION
CHRONIC HYPERTENSION
PIH
- triad: hypertension, edema, albuminuria
A. Mild Pre-Eclampsia
B. Severe Pre-Eclampsia
C. Eclampsia
Gestational Diabetes Mellitus
Factors: GLUCOSE AND INSULIN
DIAGNOSTIC: ORAL GLUCOSE TOLERANCE TEST
NPO after midnight
2 ml of 50% glucose/3 kg of prepregnant body weight is given IV
Interpretation of results:
If < 100 mg
If 100 120 mg
If > 120 mg
HEMOLYTIC DISEASE OF THE NEWBORN
- Rh incompalibility
DIAGNOSTICS:
1. Amniocentesis measures bilirubin in amniotic fluid
2. Direct Coombs test measures Rh antigen in the baby
3. Indirect Coombs test measures Rh antibody in the maternal circulation
MANAGEMENT:
Rhogam administration:
1. At 28 weeks AOG
2. Within 72 hours after birth
INTRAPARTUM COMPLICATIONS
PREMATURE RUPTURE OF MEMBRANES
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10

MATERNAL AND CHILD NURSING

MANIFESTATIONS:
- Amniotic fluid gushing into the vagina
- Fetal tachycardia
MANAGEMENT;
1. minimize IE
2. Assess for signs of infection
CAESARIAN BIRTH
TYPES:
1. Classic or vertical
2. Transverse or Pfannenstial
Factors leading to CS
1. CPD
2. Herpes
3. Previous cs
4. Hypertension or heart disease
5. Placenta previa
6. Abruption placenta
7. Transverse lie
8. Fetal distress
9. macrosomia
POSTPARTUM COMPLICATIONS
SUBINVOLUTION
- Delayed return of uterus to its prepregnant state.
CAUSES:
- Retained placental fragments
MANIFESTATIONS:
- Prolonged lochial discharge
- Excessive bleeding
MANAGEMENT:
- Massage uterus
- Facilitate voiding
- Prepare for D and C
THROMBOPHLEBITIS and THROMBOSIS
- Clot formations inside the vessel wall
- EMBOLUS may travel to:
a. Brain
b. Heart
c. Lungs
Manifestations:
- Virchows triad
- Homans sign
Management:
1. Elevate
2. Do not massage
3. No ambulation

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