1
Heartburn
Increased
progesterone
which dec.
gastric
motility
causing
esophageal
reflux.
Constipation
Due to
displacemen
t of the
stomach and
intestines;
iron
supplements
Hemorrhoids
Pressure of
growing
fetus,
Increase
venous
pressure
Urinary
Frequency
Increase
blood supply
to the
kidney/
Pressure of
enlarged
uterus in the
3rd Tri
From
exaggerated
lumbosacral
curving
during
pregnancy.
Reason
Increased
HCG
Health
Teachings
Dry crackers
30 min. before
arising
Small,
frequent, low
fat meals
Liquids bet.
meals
Avoid antiemetics.
Backache
Pats of butter
before meals
Avoid fried ,
fatty foods
Sips of milk at
frequent
intervals.
Small,
frequent meals
taken slowly.
Bends at the
knees, not at
the waist
Take antacids
Increased
fluids and
roughage in the
diet.
Regular
elimination
time.
Increase
exercise
Avoid enemas,
harsh laxatives
and mineral oil.
Warm sitz
bathing
High fiber diet
and increase
fluid.
Sit on soft
pillow
Sleep on the
side at night.
Limit fluid
intake during
evening
Bladder
training
Back exercise
(pelvic rock)
Wear lowheeled shoes.
Avoid heavy
lifting
Leg Cramps
Increase
pressure of
gravid fetus,
low calcium
Ankle Edema
From
venous
stasis
Varicose
Veins
From faulty
valves or
weakened
vessel walls
Shortness of
breath
From
pressure on
diaphragm
Elevated
Estrogen
levels
Nasal
stuffiness and
epistaxis
Fatigue
Due to
hormonal
changes
Breast
Tenderness
Increase
estrogen and
progesterone
level
Due to
hyperplasia
of mucosa
and increase
mucus
production
Increased
Vaginal
discharges
2
Frequent rest
with feet
elevated
Regular
exercise like
walking
Increase milk
intake
Elevate legs at
least twice a
day.
Sleep on left
side
Elevate feet
when sitting.
Use support
hose
Apply elastic
bandage
Avoid use of
constricting
garters
Sleep with feet
elevated or on
regularly.
Direct pressure
to the nasal
area
Avoid blowing
of nose.
Get regular
exercise
Sleep as much
as needed.
Avoid
stimulants.
Wear well
fitted bra
Warm
compress
Consult
physician if
infection is
suspected
Wash carefully
and keep it dry.
Use
Nageles Rule
Date of
Quickening
Formula
First day of
LMP 3
months + 7
days
Primi:
Q + 4 months
+ 20 days
Multi:
Q + 5 months
+ 4 days
Use
McDonalds
rule
Formula
Height in cm
FH x 2/7 =
duration in
months
FH x 8/7 =
Duration in
weeks
Use
Standard
Formula
Johnsons
Ruler
Formula
Rump-to-crown
length in utero cm.
x 100 = weight in
gm
FH (cm)
- 11 (if unengaged )
- 12 ( if engaged ) x
155
PRENATAL VISIT
Maternal Health Program of the DOH
is tasked to reduced the maternal mortality
ratio by three-quarters by 2015:
MMR of 112/100,000 live births in 2010
MMR of 80/100,000 live births in 2015
Strategic Thrusts for 2005-2010
Launch and implement the Basic Emergency
Obstetric Care or BEMOC. The BEMOC
strategy entails the establishment of facilities
that provide emergency care for every 125,000
population.
Improve the quality of prenatal and postnatal
care
Reduce womens exposure to health risks
through the institutionalization of responsible
parenthood and provision of appropriate health
care package to all women of reproductive ages.
LGUs, NGOs and other stakeholders must
advocate for health through resource generation
and allocation of health services for the mother
and the unborn.
Prenatal Clinic Visits
Schedule of first visit is as soon as the woman
missed her menstrual period and pregnancy is
suspected
First 32 weeks : once a month
32-36 weeks : twice a month
36-40 weeks : every week
Length of Pregnancy
267-280 days
38-42 weeks (ave.40 weeks)
9 calendar months
10 lunar months
3 trimester
First Trimester: Period of Organogenesis
Second Trimester: Most comfortable for mother
with continued fetal growth.
Third Trimester: Period of rapid fetal growth
bec. of rapid deposition of fats
iron and calcium.
TPAL
T = Full Term Babies
P = Premature
A = Babies Abortion
L = Living Children
Physical Examination
Review of System
Pelvic Examination
( Cardinal Rule: EMPTY BLADDER )
Internal Exam (I.E) to determine:
Hegars Sign softening of the uterus
Goodells Sign softening of the cervix
Chadwicks Sign bluish discoloration of
vagina.
6
Classification of Findings
Types of Pelvis
Clinical Stages of Cervical Cancer
Stage 1 - Cancer confined to the cervix
Stage 2 - CA extends beyond the cervix into
the vagina
Stage 3 - metastasis to the pelvic wall
Stage 4 - metastasis beyond pelvic wall into
the bladder and rectum.
A.
1 : Nulligravida cervix
2 : Cervix after childbirth
3 : Stellate cervix seen after mild
cervical tearing.
B
1 : Herpes II
2 : Chancre of syphilis
3 : Erosion or infection
7
to determine fetal back
still facing the head part of the mother, palpate
side to locate the fetal back.
a feel smooth hard resistant surface is the back
part. ( best place to hear the FHT )
a number of angular nodulation are knees and
elbows.
3rd Maneuver
Procedure:
1st Maneuver
4th Maneuver
2nd Maneuver
Benedicts Test
Test for glycosuria, a sign of possible
gestational diabetes.
Urine should be collected before breakfast
results:
Blue - no sugar
Green - +1 sugar
Yellow - +2 sugar
Orange - +3 sugar
Red - +4 sugar
8
Nutritional Assessment
- Food preferences and eating habits
- Cultural and religious influences
- Education and occupational level
PRENATAL
HEALTH TEACHINGS
Carbohydrates X 4
Proteins X 4
Fats X 9
10
Food Sources
Protein
Vit. A
Vit. D
Vit. E
Vit. C
Folic Acid
Vit. B
Calcium and
Phosphorus
Iron
Iodine
Micronutrient Supplementation
Vitamin A Supplementation
Target
Prep.
Pregnant 10,000
IU
Women
Post
Partum
Women
Dose
1
cap
2x a
week
200,000 1
IU
cap
Duration
Start from
the 4th
month of
pregnancy
until
delivery
One dose
only
within 4
weeks
after
delivery
Remarks
Vit. A
should
not be
given to
woman
who
already
taking
vit. that
also
contain
Vit. A
Vit.A
(200K
IU)
should
not be to
pregnant
women.
10,000
Pregnat
IU
women
with
night
blindness
1
cap /
day
For 4
weeks
upon
diagnosis
Vit. A
should
not be
given to
woman
who
already
taking
vit. that
also
contain
Vit. A
Iron Supplementation
Target
Prep.
Dose /
Duration
1 tab/day for
Pregnant Coated
Tab.
6 months or
Women
contains 180 days
60 mg
during
elemental pregnancy
iron with period
400 mg
OR
folic acid 2 tab/day if
prenatal
consultation
are done
during the
2nd/3rd
trimester
1 tab / day for
Lactating Coated
Tab.
3 months or
Women
contains 90 days
60 mg
elemental
iron with
400 mg
folic acid
Remarks
A dose of
800 mcg
folic acid
is still
safe to
pregnant
woman
Iodine Supplementation
Target
Women
15-45
yrs.old
Prep.
Iodized oil
capsule with
200 mg.
iodine
Dose / Duration
1 capsule for 1
year
11
Vaccine
Minimum
Interval
TeTox 1
As early as
possible
during
pregnancy
4 weeks
after
TeTox 1
TeTox 2
Minimum
required
TeTox for
pregnant
mother
Percent
Protected
80%
TeTox 3
6 months
after
TeTox 2
95 %
TeTox 4
1 year
after
TeTox 3
99 %
99 %
Duration of
Protection
infant will
be
protected
by neonatal
tetanus
3 years
protection
for the
mother
infant will
be
protected
by neonatal
tetanus
5 years
protection
for the
mother
infant will
be
protected
by neonatal
tetanus
10 years
protection
for the
mother
all infant
born to that
mother will
be
protected
lifetime
protection
for the
mother
12
Sexual Activity
Traveling
Sexual desires continue
pregnancy, but levels change:
throughout
Employment
As long as the job does not entail handling
toxic substance or lifting heavy objects or
excessive physical and emotional strain, there is
no contraindication to work.
Advise pregnant women to walk about every
few hours of her work day during long periods
of standing or sitting to promote circulation.
Exercises
Chief Aim : To strengthen the muscles used in
labor and delivery
Should be done in moderation
Should be individualized: according to age,
physical condition, customary amount of
exercise and stage of pregnancy
Recommended Exercises
Squatting
Tailor
Sitting
Pelvic Rock
Modified
knee-chest
position
Shouldercircling
Walking
Kegel