MSU-IIT COLLEGE OF NURSING

TIBANGA, ILIGAN CITY

MATERNAL AND CHILD NURSING(part I) HANDOUTS
PREPARED BY: THIENNETTE M. REVILLE, RN, MAN

INTRAUTERINE DEVELOPMENT

• ___________– body organ that produces sex cells

o Male Gonads: ________
o Female Gonads: _________
• ________ – primitive gonadal tissues are formed
o Mesonephric (Wolffian)
o Paramesonephric (Mullerian)
• 7- 8th week – formation of _______________
o Mesonephric duct becomes the __________reproductive organs
• th
10 week - No Testosterone
o Paramesonephric becomes the__________ reproductive organs

• ________ week – External genitals become visible

• If testosterone is halted – chromosomal male with female-appearing genitalia
• If increased testosterone – chromosomal female with male-appearing genitalia

PUBERTAL DEVELOPMENT
• __________– developmental stage where secondary characteristics begin to develop
• ________ years (GIRLS) • ________ years (BOYS)
• __________ – “gonadostat”
• Girls – 95 lbs / critical mass of fat

SECONDARY SEX CHARACTERISTICS in males:

• Weight • Voice • Spermatogenesis
• Testes growth • Penis
• Hair • Height
SECONDARY SEX CHARACTERISTICS in females:
• Height • Pubic hair • Vaginal secretion
• Pelvis • Menarche*
• Breast • Axilla hair
MALE REPRODUCTIVE SYSTEM
The External Reproductive Organs:
 _______– organ for copulation
-an outlet for both the urinary and reproductive system
o _________- bulging, sensitive ridge of tissue at the distal end; prepuce
 _____________– muscular pouch that houses the testes
o Rugated, skin-covered muscular pouch suspended from the perineum (to the left)
o Contains the TESTES, EPIDIDYMIS, SPERMATIC CORD
o Function: supports the testes and helps regulate temperature (1o F below body temperature)
 ___________– male gonads
o Composed of 250 lobules made up of Leydig’s cells (produces testosterone) and seminiferous
tubules (produces spermatozoa)

CRYPTORCHIDISM-_________________________________________________________
Difference Between Ova and Sperm
Ova: Sperm:
 begin in utero begin @ ____________
 Cyclic pattern continuous
 stops @ __________ for life
Spermatozoa Production
1. Hypothalamus release GnRH 4. LH à testosterone
2. APG release FSH & LH 5. ABP binding with testosterone =
3. FSH à release of ABP ________________

NORMAL SPERM MORPHOLOGY:

1. PEARLY WHITE HEAD 2. SHORT HEAD 3. LONG TAIL

SPERM MORPHOLOGY:____________________________
NORMAL SPERM COUNT
Count: > 20 million sperm per milliliter of ejaculate
____________ Test – test for sperm count, motility and activity
Note: Take sample to lab within_________hours, tucked under the arm
• SPERM MOTILITY: at least 50 percentof sperm should have normal motion patterns
Causes of Decreased Motility:
• increased scrotal temperature (frequent hot tub or sauna use)
• tight clothing, or varicocele
• heavy alcohol, marijuana, or cocaine use
• trauma to the scrotum, mumps during childhood, developmental factors, and
cigarette smoking

The Internal Reproductive Organs

1. EPIDIDYMIS 4. EJACULATORY 6. BULBOURETHRAL
2. VAS DEFERENS DUCTS GLANDS
3. SEMINAL VESICLES 5. PROSTATE GLANDS 7. URETHRA
Epididymis
• ___ feet long
• Conduit of spermatozoa from the testes to the vas derens
• ________ days to travel the entire length
• 64 days for spermatozoa to mature
Vas Deferens
• Also called _______________
• Carries sperm through the inguinal canal into the abdominal cavity where it ends
at the seminal vesicles
• Blood vessels + vas deferens = spermatic cord
• Vasectomy – method of contraception
Seminal Vesicles (30%)
• Releases basic sugar, protein and prostaglandins
• Alkaline fluid
Prostate Gland (60%)
• Lies just below the bladder • ANNUAL DIGITAL RECTAL EXAM –
• Secretes a thin, alkaline fluid 40 years and above
Bulbourethral Gland (5%)
• Also called _________ glands • Secretes an alkaline fluid
URETHRA : ____________ cm

FEMALE REPRODUCTIVE SYSTEM

• The External Reproductive Organs (Vulva)
A. Mons Pubis or Veneris E. Vestibule
B. Labia Majora F. Urethral Meatus
C. Labia Minora G. Vaginal Orifice/Introitus
D. Glans Clitoris H. Perinuem
The External Reproductive Organs (Vulva)
A. Mons Pubis or ______________
-Pad of fat which lies over the symphisis pubis covered by skin and at puberty by
short hairs
B. Labia Majora
o Two folds of skin with fat underneath; contains _____________ glands which secretes lubricant
during sexual intercourse.
o The External Reproductive Organs (Vulva)
C. _______________ -Forms the prepuce anteriorly and the fourchette posteriorly
D. _____________-Erectile tissue; counterpart of the male penis
E. _________________-Narrow space seen when the labia majora are separated
F. Urethral Meatus : ________ glands
• The External Reproductive Organs (Vulva)
G. Vaginal Orifice/__________ -external opening of the vagina covered by a thin
membrane called the hymen.
H. ____________ -Area from the lower border of the vaginal orifice to the anus;
Mammary Glands
• accessory organs of the female reproductive system that are specialized to
produce and secrete milk after pregnancy.
• located within the breasts on the ________________.
• A _________ is located at the tip of each breast surrounded by an area of pigmented
skin called the ____________.
• composed of irregularly shaped lobes containing glands and a lactiferous duct
leading to the nipple.
• Dense connective tissue and fat separate the lobes.

Q1: Linda, A 30 year old post hysterectomy client has visited the health center. She inquired
about BSE and asked the nurse when BSE should be performed. You answered that the BSE is
best performed:__________________________
Q2: What is the best position in palpating the breast?______________________
Q3: When is the best time in performing breast self examination?____________________

The Internal Reproductive Organs:

VAGINA
• Organ for copulation
• passageway for menstrual discharge and the fetus
• 3 – 4 inch long dilatable canal located between the bladder and the rectum
• contains RUGAE (permits considerable stretching without tearing)
UTERUS
• Function: Menstruation and build-up of the endometrium
• Pregnancy; Dimensions: 1x2x3 and 50 – 60 grams
 • Held in place by BROAD ligaments (from sides of uterus to pelvic walls, also hold
the fallopian tubes and ovaries in place) and ROUND ligaments (from side of the
uterus to mons pubis

• Three layers:
– endometrium myometrium
– – perimetrium
(innermost) (middle (outer layer)
muscular layer)
• Corpus (body) – upper portion with a triangular part called the ___________
• __________- area between the corpus and cervix which forms part of the lower
uterine segment
• ___________is the lower part of the uterus – creates an outlet for the fetus to be
expelled
FALLOPIAN TUBES
• Site of __________________
• Function: transport the ova from the ovaries to the uterus; pair of muscular tubes
Divided into 4 parts:
• Interstitial – closest to the • _________ – most distal,
uterus fimbrae
• Isthmus – site of sterilization • OVARIES
• Ampulla – site of fertilization

_____________-containing organs on either side of the uterus

 Function: ovulation, production of estrogen and progesterone
___________– releases the mature ovum
THE PELVIS
• The pelvis is a basin-shaped structure that supports the spinal column and
protects the abdominal organs. It contains the following:
1. hip bones 2. Sacrum 3. coccyx
1. 2 Os Coxae/Innominate bones; 3 hip bones:
 Ilium - the broad, flaring portion of the hip bone (the crest of the pelvis).
- iliac crest
 Ischium – ischial tuberosities; ischial spines
-midpoint of the pelvis
 Pubis – the lower, posterior part of the hip bone; symphisis pubis

2. ________ - 5 fused bones, sacral promontory (prominent upper margin);

sacroiliac joint
3. __________– sacrococcygeal joint (allows movement for delivery)
• -Also called the ____________
• -formed by the fusion of four originally separated coccygeal bones

B. Divisions – set apart by the _______________

1. ___________– superior half formed by the ilia; directs fetus to true pelvis
2. ___________– inferior half formed; made up of three parts
• Inlet – T > AP
• Cavity - space between I and O, curved
• Outlet – AP > T
• Measurements
1. __________– suggestive only of pelvic size
2. ___________– give the actual diameters of the inlet and outlet
 • Diagonal conjugate – 12.5 cm
• True conjugate/conjugate vera – 10.5 – 11 cm
• Bi-ischial diameter/tuberischial – 11 cm
• Types/Variations
1. Gynecoid – “normal pelvis”
2. Android – “male” pelvis
3. Anthropoid – AP > Transverse
4. Platypelloid – inlet is oval, AP diameter is shallow

MENSTRUAL CYCLE
• periodic uterine bleeding in response to cyclic hormonal changes.
• A process that allows for conception and implantation of new life.
• Also called_____________________
• It is usually determined by counting as day 1 the 1st day of a menstrual period
until the last day before the next menstrual period.
• Purpose:
• To bring an ovum to maturity
• To renew a uterine tissue bed that will be responsive to fetal growth
• To prepare the uterus for pregnancy
• ___________ (first menstruation in girls) and ends with ___________ (permanent cessation of
menstruation; no more functioning oocytes in the ovaries). Age of onset and termination depends
on heredity, racial background, nutrition and climate.

Discomforts of Menstruation
• Breast tenderness and feeling of fullness
• Tendency towards fatigue
• Temperament and mood changes - because of hormonal influence and decreased
levels of estrogen and progesterone
• Discomfort in pelvic area, lower back and legs
• Retained fluids and weight gain
Abnormalities of Menstruation
• _____________- absence of • _____________ - too frequent
menstrual flow menstruation
• _____________ - painful • _____________ -excessive menstrual
menstruation bleeding
• _____________ - scanty menstruation • _____________ - bleeding between
periods of less than 2 weeks
 • _____________ - abnormally short • _____________ - abnormally long
menstruation menstruation

Four body structure involved in the physiology of the menstrual cycle:

• Hypothalamus
– _____________ (adrenal cortex)
– Produces LHRH or GnRH
• Pituitary gland: Produces _____& ________
• Uterus
• Ovaries

OVARIES
 FSH and LH will stimulate the one ovum to mature.
 Follicular fluid (estrogen and progesterone) – Graafian follicle (blister)
 Prostaglandins is released and ovum is released –Ovulation (14 days before the
next menstrual cycle)
 FSH decreases but LH stimulates ovary to produce lutein (high in progesterone) to
fill the corpus luteum
• BBT drops 0.5 – 1.0 F before ovulation, increases 1.0 F after (progesterone is
thermogenic)
Reproductive Hormones:
• _________________________
– Stimulates release of FSH and LH initiating puberty and sustaining menstrual
cycle.
• _________________________
– secreted by anterior pituitary gland during the 1st half of menstrual cycle
– stimulate growth and maturation of graafian follicle before ovulation
– thins the endometrium
• __________ secreted by the anterior pituitary gland; stimulates secretion of milk
• _________________________-secreted by the anterior pituitary gland
– stimulates final maturation of graafian follicle
– surge of LH about 14 days before next menstrual period causes ovulation
– stimulates transformation of graafian follicle into corpus luteum
– thickens the endometrium
• ROLE OF ______________
– secreted primarily by the ovaries, corpus luteum, adrenal cortex and placenta
in pregnancy
– Hormone of Women
– stimulates thickening of the ______________
– Causes hypertrophy of the ______________
– stimulates uterine contractions
– increases water content of uterus
– high estrogen concentration inhibits secretion of ___ and ______________n but
stimulates secretion of _______.
– low estrogen concentration after pregnancy stimulates secretion of
______________
– Increases quantity and pH of cervical mucus, causing it to become thin and
watery (_________test)
 • Progesterone
– secreted by the ovary, corpus luteum and placenta during pregnancy
– inhibits secretion of LH
– has thermogenic effect (increases body temperature)
– relaxes smooth muscles thereby decreases contractions of uterus
– causes cervical secretion of thick mucus
– maintain thickness of endometrium by increasing endometrial secretions
– allows pregnancy to be maintained : Hormone of ______________
– prepares breasts for ______________
– Inhibits production of _______
– Decreases muscle tone of GI and GU tract
– Facilitates transport of ovum through fallopian tubes
– Increases temperature after ovulation
– Increases_____________ levels
• Oxytocin
– secreted by the ___________ pituitary gland
– stimulates uterine contractions during birth and compress uterine blood vessels
and control bleeding
– stimulates ______________or ______________reflex during breastfeeding
• Prostaglandins
– fatty acids’ categorized as hormones
– produced by many organs of the body, including the endometrium
– affects menstrual cycle
– influences the onset and maintenance of labor
PHYSIOLOGY OF MENSTRUATION
First Phase of the Menstrual Cycle: ______________ PHASE
• First 4 – 5 days post mens endometrium is very thin
• Myometrial thickness up to eightfold
• Increase continues (Day 5 to Day 14)
• Also called the ______________, ______________and ______________phase
Second Phase of the Menstrual Cycle: ______________
• Endometrium has a _____________or twisted appearance
• Filled with glycogen and mucin
• Increase continues (Day 15 to Day 24)
• Also called the progestational, luteal and pre –menstrual phase
Third Phase of the Menstrual Cycle: ______________
• Day 24 - 25
• Corpus luteum becomes ______________– 8 to 10 days
• Decrease in production of estrogen and progesterone
Menses: Final Phase
• Blood from ruptured capillaries
• Mucin from glands
• Endometrial fragments
• Microscopic, unfertilized ovum
Blood lost during menstruation: ______________

Q1: A client’s basal body temperature graph shows a nearly straight line. Which of the
following describes the etiology of what the graph means? ______________
Q2: After ovulation has occurred, the ovum is believed to remain viable for:
______________
Q3: A high concentration of estrogen in the blood: ______________
Q4: One of your clients asks “When does ovulation take place?”. Your answer will most
likely be: ____________________________
Q5: Melissa asks how many days is her menstrual cycle if she had her previous
menstrual flow last March 26 – 30 and her last menstrual period was last April 24. The
nurse’s response will likely be: ______________
Q6: Which phase of the menstrual cycle promotes the uterine lining to grow and thicken
to an eight to ten-fold rate? ____________________________
Q7: Which of the following is the function of your estrogen hormone?
____________________________
Q8: Which of the following is the function of your estrogen hormone?
____________________________
Q9: Progesterone is secreted in relatively large quantities by the:
____________________________
Q10: The chief function of progesterone is the: __________________________________________
Q11: Which phase of the menstrual cycle promotes the uterine lining to grow and
thicken to an eight to ten-fold rate? ______________
Q12: When assessing the client, the nurse should be aware that the characteristics of
the normal pelvis include:
a. ________________________________________________________
Q13: Nurse Ronald is aware that the amiotic fluid in the third trimester weighs
approximately: _____________
Q14: Myrna a pregnant client reports that her last menstrual cycle is July 11, her
expected date of birth is______________
Q15: Maureen is admitted with a diagnosis of ectopic pregnancy. Which of the following
would you anticipate?
____________________________
Q16: Gina a postpartum client is diagnosed with endometritis. Which position would you
expect to place her based on this diagnosis? __________________________________________
Q17: Nurse Hazel knows that Myrna understands her condition well when she remarks
that urinary frequency is caused by: ____________________________
Q18: How many ml of blood is loss during the first 24 hours post delivery of Myrna?
______________
Q19: Which of the following hormones stimulates the secretion of milk? ______________
Q20: Nurse Carla is aware that Myla’s second stage of labor is beginning when the
following assessment is noted: __________________________________________
Q21: The leaking fluid is tested with nitrazine paper. Nurse Kelly confirms that the
client’s membrane have ruptures when the paper turns into a: __________________
Q22: After amniotomy, the priority nursing action is: ____________________________
Q23: Which is the most frequent reason for postpartum hemorrhage?
____________________________
Q24: On 2nd postpartum day, which height would you expect to find the fundus in a
woman who has had a caesarian birth? ____________________________
Q25: Which of the following criteria allows Nurse Kris to perform home deliveries?
____________________________
Q26: Nurse Candy is aware that the family planning method that may give 98%
protection to another pregnancy to women______________

HUMAN SEXUALITY
• SEXUALITY AND SEXUAL IDENTITY
______________– includes attitudes, feelings and actions towards sexual identity
______________– chromosomal sexual development
______________– inner sense of being male or female
• DEVELOPMENT OF GENDER IDENTITY
______________ – female and male babies are treated differently by the parents.
Dainty rattles, ruffles, rocking-______________
Larger rattles, sports-related -______________
By end of first year, boys appear to demonstrate more ______________than girls.
• DEVELOPMENT OF GENDER IDENTITY
______________ – can distinguish between male and female roles by age 2; absorb cultural
expectations of that role
______________– reinforced through behavior and expectations towards the child, social
contacts with adults, clothing
Oedipus complex-__________________________________________
Elektra complex -__________________________________________

• DEVELOPMENT OF GENDER IDENTITY

______________– spend time imitating adult roles as a way of learning gender roles. They
start to form strong impressions of what a female or a male role should be.
Note: School nowadays are more lax with gender______________.
______________ – establish sense of identity
• Initially strong ties to own gender • Safer sex practices (partner,
group condom, do not share toys)
• Gender role model • Gay / Lesbian adolescents
• Sexual history
______________– homosexuality or bisexuality is expressed at this time; possible
marriages
Gender identity can affect parenting roles.
______________– sexuality has a degree of stability
• Menopause • Medications can affect sexual
• Men – changes in the repro functioning
system; reassurance about virility • Surgery such as oophorectomy
OLDER ADULT – decrease sexual functioning
Use a ______________to address the problem of painful intercourse.
• SEXUAL RESPONSE CYCLE: Masters and Johnson, 1966
• Classifies the human sexual response into four discrete stages:
i. Excitement ii. Plateau iii. Orgasm
 iv. Resolutio
n
EXCITEMENT
• ______________stimulation • Nipples become erect
• Arterial _________and venous • Men – scrotal _______; elevation of
________ testes
• ______________ – widens in diameter • Increase vital signs
and increases in length; produces
lubrication
PLATEAU
• Stage reached just before orgasm
• Women – clitoris is drawn _______; lower part of the vagina extremely congested;
nipple engorgement
• Men – full distention of penis
• HR – ______________beats per minute
• RR – _______beats per minute
____________
• Body discharges accumulated sexual tension
• Vigorous muscle contraction in the genital area
 Women: ________ contractions / 1  Men:_________ ejaculatory
every 0.8 sec contractions
Intense pleasure and highly personal experience
RESOLUTION
• Genital organs return to the unaroused state
• ________ minutes for both men and women
• _________period – only found in the males; further orgasm is impossible; not found
in females (YEHEY!)
FERTILITY AWARENESS METHODS
• Methods that rely on detecting when the woman will be capable of reproduction
• Through a set formula, woman’s body temperature, cervical mucus consistency
CALENDAR (RHYTHM) METHOD
• Requires couple to abstain from coitus on the days when the woman is most likely
to conceive. (3 -4 days before and after ovulation)
• Major drawbacks: timing is highly variable
• Contraindications: patient with irregular cycles, adolescents, women approaching
menopause, women who have just given birth.
• Calculation of Fertile Window
• Keep track of menstrual cycle length for at least 6 months.
• Subtract 18 days from the shortest cycle and 11 days from her longest cycle.
• Example: Shortest = 24 days; Longest = 28
24 28
- 18 - 11
6 17
BILLING’S METHOD
• Monitoring changes in the cervical • SYMPTOTHERMAL METHOD
mucus • Combines the cervical mucus and
• With ovulation, mucus stretches 1 BBT method
inch before breaking. • Abstain from coitus 3 days after
• Avoid coitus when mucus is ovulation
copious and 3 days after.
Q1: The nurse explains that the efficiency of the BBT depends on the fluctuation of the
basal body temperature. A factor that will alter its effectiveness is:
____________________________
LACTATION AMENORRHEA
• As long as the woman is ______________, there is natural suppression of the
ovulation (_________).
• CAUTION: Effective only if the mother is nursing at least 10 feedings over a 24-
hour period.
COITUS INTERRUPTUS
• One of the oldest known method of contraceptive
• Also called ______________
• Unfortunately, pre-ejaculatory fluid may contain sperm
• Not recommended for sexually inexperienced and adolescent boys; does not
protect against STDs; requires self-control
ORAL CONTRACEPTIVES
• Also called pills or OCP
• Composed of varying amounts of estrogen (suppresses LH and FSH) and
progesterone (prevents implantation)
• 99.5% effective
• THE PILL
 Start taking pill 1 on a Sunday for convenience
 (the first Sunday following the beginning of a menstrual flow)
 Use a second form of contraceptive for the 1st 7 days.
 For 21-pill packages, do not take pills for one week after completing a
dispenser.
• I forgot to take my pill!!!
WHAT TO DO:
• If you forgot to take the pill yesterday, take two tablets today as soon as you
remember. Resume pill taking tomorrow.
• If you forgot to take your pills for two days in a row, STOP the cycle and use
another form of contraception.
• CONTRAINDICATIONS
ABSOLUTE
• Breast – feeding • History of thromboembolic disease
• History of CAD • Undiagnosed vaginal bleeding
POSSIBLE
• Age 40+ • Certain drug therapy (INH,
• Breast malignancy barbiturates, tetra)
• High BP • Use by Adolescents of Pills
• Mental depression • Well-established menstrual cycle
• Pregnancy for 2 years
• Seizure disorders • Decreased compliance
• Smoking • Possible growth arrest
• High cost is prohibitive for teens
• Benefits: improve facial acne, decrease dysmenorrhea
• Discontinuing Use
• Woman may not become pregnant for 1 – 2 months and possibly 6 - 8 months
• If ovulation does not occur, it can be stimulated by clomiphene citrate (Clomid)
Mini-Pills: NO estrogen only progesterone
• Advantageous for patients who have contraindications to the estrogen component
of the OCPs
 • Can be taken during breast-feeding and even during menstrual flow
Q: The physician ordered an estrogen – progestin oral contraceptive for a client. The
nurse would know that the teaching was effective when the client verbalizes that she
should observe for side effects such as: __________________________________________
Q: The physician ordered an estrogen – progestin oral contraceptive for a client. The
nurse would know that the teaching was effective when the client verbalizes that she
should observe for side effects such as: ____________________________
SUBCUTANEOUS IMPLANTS
• Norplant consists of 6 silastic • Disadvantages and S/E
implants filled by synthetic • Expensive
progesterone • Weight gain
• Five years protection • Irregular menstruation
• Implants are inserted during • Scarring at insertion site
menses and no later than day 7 of • Need for removal
the menstrual cycle
ADVANTAGES
• Decrease estrogen complications
• Used safely with adolescents and breastfeeding mothers
• Rapid return to fertility (3 months)
CONTRAINDICATIONS
• Pregnancy
• Desire to be pregnant within 1 - 2 years
• Undiagnosed uterine bleeding
• Infection of the insertion site
INTRAMUSCULAR INJECTIONS
• Medroxyprogesterone acetate (DMPA or Depo-povera)
• Given every 12 weeks
• Nearly 100% effectivity
• Possible S/E: spotting, breakthrough bleeding, headaches, weight fluctuations,
glucose intolerance
ADVANTAGES
• No estrogen side effects • Can be used during breast
• No visible sign of BC feeding
DISADVANTAGES
• Must return to health care provider every 3 months
• Fertility is delayed for up to 6 – 12 months
INTRAUTERINE DEVICES
• Small plastic object inserted into the uterus through the vagina
• MOA: inflammatory process, impedes sperm movement, prevents fertilization
• Inserted before the client has coitus after a menstrual flow
• Side Effects and Contraindications:
1. Spotting and uterine cramping the first 2 or 3 weeks; as long as present, use
another form of contraception
2. Heavier than usual menstrual flow for 2 – 3 months
3. Dysmenorrhea
4. Higher risk of ectopic (tubal) pregnancy and PID
5. Not recommended for people who have never been pregnant*, have multiple
sexual partners or with history of PID.*
6. Not for patients with distorted uterus, with menorrhagia, with valvular heart
disease.
Q: The nurse teaches that the most common side effect associated with the use of the
IUD is: ______________
 SPERMICIDES
• Causes death of the spermatozoa before it can enter the cervix
• Available in gels, creams, films, foams and suppositories
• Benefits: Purchased anywhere, may help protect against STDs
• Disadvantage: 80% failure rate
• APPLICATION
• Gels or Creams: inserted before coitus with an applicator; 1 hour before and leave
for 6 hours after
• Film: Folded and inserted vaginally
• Vaginal suppositories: insert 15 min prior
DIAPHRAGM
• Circular rubber disk that is placed over the cervix prior to intercourse
• Diaphragm + ______________
• Failure rate may be as low as 5% if used with jelly, it fitted well and cared for
properly.*
• SPECIAL CONSIDERATIONS:HAVE IT REFITTED IF:
• You have just given birth
• You have lost or gained 15 lbs
• You have had cervical surgery and miscarriage
• CONTRAINDICATIONS
 History of UTI
 Anatomical deviations of the cervix and uterus
 Cystocele and rectocele
 Acute cervicitis
• GUIDELINES FOR DIAPHRAGM INSERTION
 Before coitus, coat the rim of the diaphragm with a contraceptive jelly.
 Squat, elevate one leg or lie in a supine position.
 Insert into vagina sliding along the posterior wall.
 Check if it is secure by palpating the cervical os.
 Keep the diaphragm in place for at least 6 hours after coitus. Diaphragm may be
left in place for not more than 24 hours.*
 Remove by loosening the device by pressing the anterior rim and withdrawing.
 Wash with mild soap and water and store in container.
CERVICAL CAP
• Soft rubber shaped like a thimble that fits snugly over the cervix; more easily
dislodged.
• CONTRAINDICATIONS
• Abnormally short or long cervix • Allergy to latex or spermicide
• Previous abnormal Pap Smear • History of cervical cancer
• History of toxic shock syndrome
MALE CONDOMS
• Latex rubber or synthetic sheath that is placed over an erect penis
• Typical failure rate: 12%
• Prevents the spread of STDs
• Major part of the fight against HIV - AIDS
• No contraindications except latex allergies
• Must be applied before any penile-vulvar contact.*
• Must be loose at the tip to collect the ejaculate.
• Penis is withdrawn before it becomes flaccid.
FEMALE CONDOMS
 • Latex sheaths made of polyurethane and lubricated with nonoxyl-9; has inner and
outer rings; should NOT be used together with male C.

TUBAL LIGATION
• Must be viewed as an irreversible procedure
• May be done ______________
• Patient is discharged a few hours after. She may notice abdominal bloating and
sharp diaphragmatic pain after the procedure.*
• NO unprotected coitus before the procedure.
• May resume sexual activities 2 -3 days after.
…BUT THE BEST FORM OF CONTRACEPTIVE WITH 0% FAILURE RATE : ______________
Q: After instructing a 20-year old nulligravid client about the side effects of oral
contraceptives, the nurse determines that further instruction is needed when the client
states which of the following as a side effect? ______________
Q: A 20-year old nulligravida tells the nurse that she and her husband have been
considering condoms for family planning. Which of the following instructions would the
nurse include about the use of condoms as a family planning method? ______________
Q:In counselling a client about the use of diaphragm, which of the following would be an
important assessment data to collect? ______________
Q:Client is having Norplant inserted. Which of the following side effects should the client
be informed of? _____________________
Q: A client with history of toxic shock syndrome comes to the reproductive clinic seeking
contraception. Based on this information, which method should the nurse avoid
recommending? _____________________
Q:Following delivery a cardiac client with type 2 diabetes asks the nurse, “Which prevent
pregnancy in the near future? The nurse’s best response would be?
__________________________________________
INFERTILITY EIO
• Defined as pregnancy has not occurred within one year of unprotected coitus
every 3 times a week.
• 4x/week – 50% take 6 months, 85% within 1 yr
• Inadequate sperm count
 less than 20 million sperm/ml or 50 million per ejaculation
 At least 50% have normal motility
• Obstruction or impaired sperm motility
 mumps orchitis, vasectomy
• Ejaculation problems – ______________
Female Infertility Factors AVUCT
• ANOVULATION – tumors, Turner’s syndrome
• Tubal transport problems – Pelvic Inflammatory Disease –______________and
______________ (most common causes)
• Uterine problems – ____ENDOMETRIOTIS__________ (implantation of uterine
endometrium outside the uterus)
• Cervical problems – cervical os ______________
• Vaginal Problems – anti-sperm antibody, pH
FERTILITY TESTING
• ______________– abstinence for 2 – 4 days; ejaculate into a clean, dry specimen jar,
examined within 1 hour. Amount: 2.5 – 5 ml; 50 – 200 million sperm
• ____________________________and ______________– male or female
• Ovulation Determination (strip LH test, cervical mucus – fern, spinnbarkenheit)
 • ______________Test – report within 2-8 hours after coitus
FERTILITY TESTING
• Ultrasonography (hypersalphinography – use radiopaque dye to check patency of
FT). Tell patient to expect a cramping sensation.*
DRUGS: ______________ – estrogen agonist, stimulates the ovaries
• Infertility Management • Artificial insemination
• Increasing sperm count and • In Vitro Fertilization and embro
motility transfer
• Reducing the presence of infection • Surrogate embro transfer
• Hormone therapy • Surrogate mothers, adoption, child-
free living
CHROMOSOMAL ABNORMALITIES
• ______________Syndrome – Patau syndrome- severe cognitively challenged,
microcephaly, microphthalmos
• ______________Syndrome – severely cognitively challenged, rocker-bottom feet
• ______________Syndrome – missing portion of chromosome 5
• Turner Syndrome – genotype:X
• Klinefelter Syndrome – ______
• ______________Syndrome – hyperactivity and autism, reduced intellectual
functioning
Q: Cheryl is scheduled to have a hysterosalphingogram. Which of the following
instructions would you give her regarding this procedure?
__________________________________________
Q: A client is diagnosed with endometriosis. This condition interferes with fertility
because: ______________
Ovum movement facilitated by:
 Peristaltic movement of the  Increased ovum bulk
fallopian tube  Action of the fimbriae
Mechanism of Fertilization
Normal ejaculation: Average = ______________ Sperm count =
______________million/ml
Time Span: ____80 sec.____– reaches the cervix
_____5 min.____– reaches the outer end of the fallopian tube
_capacitation___ – changes in the plasma membrane of the sperm which reveals sperm-
binding sites.
NAME TIME PERIOD
Zygote From fertilization to implantation (2 weeks)
Embryo From implantation (2 weeks) to 8 weeks (2
months)
Fetus From 8 weeks (2 months) until term
Conceptus Developing embryo or fetus throughout
pregnancy
______________– union of the ovum and the spermatozoon; also called conception,
impregnation and fecundation
LIFE SPAN:
Spermatozoon – ______________hours Ovum – ______________hours
Zygote – result of fertilization
XX –______________ XY – ______________

IMPLANTATION
Once fertilization occurs, zygote migrates towards the body of the uterus
______________– first cleavage occurs at a rate of one every 22 hours
Takes 3 – 4 days to reach the uterus
______________ – 16 – 50 cells; bumpy appearance
Takes another 3 – 4 days floating in the uterine cavity
______________– has a collection of fluid inside a cavity; attaches to the uterine
edometrium
______________ – finger-like projections around the blastocyst which will later form the
placenta and the membranes.
Implantation occurs approximately ______________days after fertilization.
Stages of Implantation:
• Apposition • Adhesion • Invasion

• What is the role of hormones during pregnancy?

• ____________________________
This hormone is only produced during pregnancy - first by the ovaries and later by
the placenta.
 contribute to causing nausea and vomiting often associated with pregnancy.
• ____________________________
-produced by the placenta, ensures proper fetal development and plays a role in
stimulating milk glands in the breasts in anticipation of breastfeeding.
• ______________
-responsible for the development of the female sexual characteristics.
-Normally formed in the ovaries, IT also produced by the placenta to help maintain
a healthy pregnancy.
• ______________
- produced by the ______________and by the placenta during pregnancy
 -stimulates the thickening of the uterine lining in anticipation of implantation
of a fertilized egg.
EMBRYONIC AND FETAL STRUCTURES
The endometrium is not sloughed off and is now called the decidua.
The DECIDUA
• _____________ – directly under the embryo where the trophoblasts are located
• _____________– portion that stretches and encapsulates the trophoblast
• _____________– remaining portion of the uterine lining.
CHORIONIC VILLI
• Probing “fingers”; reach out from the cell to the endometrium as early as 11th or
12th day
• _____________ – outer layer; also called syntial layer; produces hCG, human
placental lactogen, estrogen and progesterone.
• _____________ – Langerhan’s layer; offers protection against syphilis but disappers
between the 20th and 24th week.
PLACENTA
• Serves as the fetal lungs, kidneys and GI tract and as a separate endocrine organ
durin pregnancy
• _____________cm in diameter and _____________cm in depth.
Placental Circulation
• NO direct contact between the fetal and maternal blood
• Plasma osmosis is so effective that as much as possible no drugs.
• 30 cotyledons in mature placenta
• Most efficient when mother lies on the left side.
 Maternal blood jets from coiled or spiral arteries in streams or spurts into intervillus
spaces
↓
Blood is propelled from compartment to compartment by currents initiated
↓
Blood circulates around the villi
↓
Nutrients osmose from maternal bood to villi
↓
Maternal blood loses momentum gradually
↓
Maternal blood settles at the floor of cotyledons
↓
Blood enters the orifices of maternal veins in cotyledons
↓
Blood returned to maternal circulation

UMBILICAL CORD
NEED TO REMEMBER:
• Function: transports nutrients from fetus to placenta
• A–V–A
Incomplete – have renal and cardiac abnormalities
• Protected by Wharton’s jelly
• The Membranes and the Amniotic Fluid

Chorionic membrane-____________________________________________________
_____________membrane – Functions: protects against mechanical trauma, changes in
temperature, aids muscular development and protects the umbilical cord, produces
amniotic fluid (500 ml/day) and initiates formation of prostaglandins.*
At term: _____________ml (8 cm pocket):
Oligohydramnios -__________________________
Polyhydramnios -__________________________
Amniotic fluid is slightly alkaline, pH = _________

PRIMARY GERM LAYERS

GERM LAYER BODY PORTIONS FORMED

Ectoderm CNS; skin, hair, nails; sense organs, mucous membranes

Mesoderm Connective tissues, bones, heart, circulatory system, renal
system
Endoderm Lining of the GI tract; lining of the pericardial, pleura and
 peritoneal cavities; respiratory tract and tonsils

NEED TO REMEMBER: All organs are complete, at least in rudimentary form at

8 weeks gestation. During this period of organogenesis, the growing structure is most
vulnerable to teratogens.

Cardiovascular System
• One of the first system to be functional
• Formed by the 16th day, starts beating on the 24th day.
• Heard with the Doppler as early as 10 - 12 weeks.

3rd week – fetal blood begins to exchange nutrients with maternal circulation
Blood goes to lungs in the infant but it is not for oxygen exchange.*
Shunts: brain, liver, heart and kidneys
Umbilical vein carries oxygenated blood to the ductus venosus (to supply the fetal liver)
then to the right atrium where blood passes through the foramen ovale and is shunted to
the left atrium.

• Fetal Circulation:
Placenta with highly oxygenated blood
↓
Umbilical vein
↓
Ductus venosus
↓
IVC
↓
R side of the heart (R atrium)
↓
Bulk of blood directly to L atrium though an opening the FORAMEN OVALE
↓
L ventricle
↓
Aorta
↓
Various body systems
Deoxygenated blood to SVC
↓
R atrium
↓
Tricuspid valve
↓
R ventricle
↓
Pulmonary artery
↓
Shunted away from lungs through DUCTUS ARTERIOSUS
↓
Aorta
↓
 Descending aorta
↓
Umbilical arteries
↓
Placental villi (new O2 exchange)

Blood level in the fetus is only 80% saturated.

Normal fetal heart rate = 120 – 160 beats per minute

Fetal Hemoglobin
• Different composition: two alpha and two gamma chains.
• Has greater oxygen affinity.
• Changes to adult composition at about 6 months of age.
• Respiratory System
IMPORTANT DEVELOPMENTAL MILESTONES
• Alveoli and capillaries begin to form – 24th and 28th weeks
• Spontaneous respiratory movements – as early as 3 months
• Surfactant produced at 24th week of pregnancy. Lecithin:Sphingomyelin = 2:1;
stress increases surfactant production.*
• Nervous System
• A neural plate is apparent by 3rd week of gestation.
• All parts of the brain are not completely mature at birth. Growth continues
rapidly during the 1st year.
• By 24 weeks, ear is capable of responding to sound.
• Endocrine System
• The fetal pancreas produces the insulin needed by the fetus (insulin does not
cross the placenta from the mother to the fetus).
• Digestive System
• Meconium forms as early as early as 16th week*; black or dark green in color;
passed within 24 hours after birth.
• GI tract is sterile before birth.* (Vitamin K)
• MUSCULOSKELETAL SYSTEM
• Quickening – 20 weeks; important milestone for the mother.*
• Ossification begins about 12th week.
• Reproductive System
• Sex is determined at the moment of conception. Who determines sex?*
 • With testosterone: male genitalia forms. What happens when mother with a
female fetus takes an androgen supplement?*
• 34th – 38th day testes descend into the scrotum. Observe closely in preterm
babies.
• Urinary System
• Urine is formed by the 12th week and is excreted into the amniotic fluid by
the 16th week of gestation.
• Fetal urine: 500 ml/day
• Implication of oligohydramnios and polyhydramnios

• Integumentary System
• _____________– cream, cheesy-like substance important for lubrication; begins
to forms at 20 weeks, fully formed at 40 weeks.
• _____________ – fine, downy hair covering the fetus; well-formed at 16 weeks
• Immune System
• ________– the only antibody that can cross the placenta, giving the fetus
temporary immunity.
• Peaks at birth then decreases over the next 8 months.
• Measles – started at around _____________
Duration of Pregnancy
Pregnancy in Lunar Months = 10 months = 40 weeks = 280 days
long
Fetus = 9.5 lunar months = 38 weeks = 266 days
• End of 4 Gestation Weeks
 Spinal cord is formed  Rudimentary eyes, ears and
 Rudimentary heart appears nose are discernible
 Arms and legs are buds
• End of 8 Gestation Weeks
 Organogenesis is complete  Extremities are developed
 Heart is beating rhythmically  External genitalia are
present
• End of 12 Gestation Weeks
 Spontaneous movements are  Kidney secretion has begun
possible but too faint  Heartbeat is audible by
 Sex is distinguishable Doppler
• End of 16 Gestation Weeks
 FHT audible with an ordinary  Fetus actively swallows
stet amniotic fluid
 Lanugo is well formed  Urine is present in AF
 Sex can be determined by
UTZ
• End of 20 Gestation Weeks
 Quickening  Meconium is present in the
 Vernix caseosa begins to form upper intestine
 Brown fat begins to
form
• End of 24 Gestation Weeks
 Lung surfactant production  Passive antibody transfer
begins begins even as early as 20
weeks.*
  Hearing demonstrated  Low-end viability
 Eyelids are open and
eyebrows are well-defined.
• End of 28 Gestation Weeks
 Surfactant can be  Sensitive blood vessels of the
demonstrated in the amniotic retina.*
fluid  Eyes are open.
 Testes descend
• End of 32 Gestation Weeks
 Subcutaneous fat deposited  Fetus aware of sounds
 Fingernails reach the end of outside the mother’s body
fingertips  Iron stores are being
developed
• End of 36 Gestation Weeks
 Amount of lanugo decreases  Sole of foot has only one or
 Vertex or head down position two criss-cross patterns
is assumed  Additional subcutaneous fats
• End of 40 Gestation Weeks
 Fetus kicks considerably hard  Vernix caseosa fully formed
to cause discomfort  Creases on the foot cover at
 HbF converted to HgA least two-thirds of the
surface.
• Determination of Estimated Birth Date
NAGELE’S RULE – count back 3 calendar months from the first day of the LMP and add
seven days.
Example: LMP: May 15 – 20
05 15
- 3 +7

EDC: _____________
Q: At 36 weeks of pregnancy, a woman is to have lecithin/sphingomyelin (L/S) ratio
performed. She should be instructed that the purpose of this test is to determine:
_______________________________________
Q: A woman at 7 months of pregnancy talks to the fetus and claims that this calms the
fetus when kicking in her ribs. She asks if this is just her imagination. Your best reply
would be: _______________________________________
Q: The nurse assesses a client at 20 weeks gestation and expects the woman to report:
__________________________
Q: A client about 8 weeks pregnant, asks the nurse when she will be able to hear the FH
beat. The nurse would respond by telling the mother that it can be heard through the
Doppler as early as: _____________
ESTIMATING FETAL GROWTH
_____________RULE – method of determining that the fetus is growing in utero by
measuring the fundal height.
Fundal Height (in cm) = Week of gestation (20th to 31st week)
Assessment Of Fetal Growth and Development
• ESTIMATING FETAL AGE
_____________– estimate AOG by the relative position of the uterus in the abdominal
cavity.
MILESTONES:
12th week – _____________ 20th week – _____________
36th week – _____________
• ESTIMATING FETAL LENGTH
_____________– determines the length of the fetus in centimeters
First half of pregnancy, square the number of the month. (E.g. First Lunar Month = 1x1 =
1 cm)
Second half of pregnancy, multiply the number by 5 (E.g. Sixth Lunar Month = 6x5 =
30cm)
• ESTIMATING FETAL WEIGHT
_____________ RULE – estimates the weight of the fetus in grams
Formula:
Fundic height in cm – n x k = Weight in grams
k = 155 (constant)
n = 12 (if fetus is engaged),11 (if fetus is not yet engaged)
• FETAL MOVEMENT
_____________can be felt by the mother approximately 18 to 20 weeks and peaks at 28 –
38 weeks.
A healthy fetus moves at least _________ times a day.
• _____________ METHOD
Ask mother to lie in a _____________position after meal and record the number of
fetal movement in one hour. Normal: 2x/10 minutes or 10 -12x/hour REPORT IF
FEWER THAN _______!!!
• _____________METHOD
(Count-to-Ten Method)
Mother records the time it takes to make fetal movements. Usually occurs within
60 minutes. FM may vary.*
• FETAL HEART RATE
Fetal Heart Tones – _____________beats per minute
Doppler - 10th – 11th wk Fetoscope - 20 wks
Position: Near woman’s midline – OA; lateral to midline - OT; in flank – OP; below
umbilicus in cephalic, at or above umbilicus in breech
Rhythm Strip Testing
• Assessment of the fetal heart rate in terms of short-term and long-term variability
• Woman is placed in a semi-Fowler’s position and FHR is recorded for 20 mins.
• Inform the woman of the purpose of the test and that she is required to remain in
a fairly fixed position for 20 minutes.
_____________Test-Measures response of fetal heart rate to fetal movement
Reactive: (term normal) 2 accelerations w/in 20 min lasting 15sec, FHR should increase
by 15bpm and long term variability of 10 or more bpm is present.
Reactive: (preterm) 2 accelerations w/in 60 - 90min, each lasting 10 sec with FHR
elevated by 10bpm
_____________ _____________ (VST)-Application of 80 db sound at a frequency of 80Hz.
Reactive: 2 accelerations meeting 15x15 criteria
Non-reactive: (-)accelerations
Repeat if none within 5 minutes and 10 minutes.*
Contraction Stress Test (CST)
also known as the __________________________
Warm packs 10 min before, Nipple stimulation 4 cycles of 2 min on, min off
• Baseline FHR is obtained.
• Mother rolls nipple until contractions begins.
• 3 contractions with a duration of 40 seconds must be present in a 10-minute
window
 • Test is negative: (normal) - > 3 uterine contractions in 10 minutes w/o late
decelerations
• Test is positive: (abnormal) persistent late decelerations with >50% of uterine
contractions even if frequency is <3 contractions in 10 minutes
• Test is suspicious (equivocal) if there is late deceleration with 1 of the 3
contractions or contractions q 2 minutes for 10 minutes (hyperstimulation)
ULTRASOUND
Patient Teaching
• Procedure is painless and does not involves radiation.
• Patient must drink full glass of water every 15 minutes beginning 1 ½ hours before
the procedure and then not to void.
• To prevent supine hypotension syndrome*
• Caution the mother that the gel is cool.
• Maternal Serum Alpha-Fetoprotein
• Substance produced by the fetal liver and present in the amniotic fluid and
maternal serum.
• Assessed during the 15 - 20 wk
• Maternal Serum Alpha-Fetoprotein
During pregnancy, increased levels of AFP may indicate:
• Spina bifida, anencephaly, • Duodenal atresia
omphalocele. • Turner's syndrome
• Tetralogy of Fallot • Intrauterine death
Decreased maternal serum levels in Down’s Syndrome.
• AMNIOCENTESIS
• Aspiration of amniotic fluid from the pregnant uterus for examination
• Can be done as early as 12th to 13th week but delayed until 14th to 16th week.*
• Only 1 ml of amniotic fluid is needed.
PREPARATION:
• Position patient in supine position.*
• Attach fetal monitors and monitor contractions. Get baseline data.
• Inform client that she will feel a sensation of pressure as the needle is inserted.
• Do not suggest that she take a deep breath.*
• Monitor client 30 minutes post – op.
• Give RhoGam to the mother if Rh (-).
• Information from the AF
• Color
• Lecithin:Sphingomyelin Ratio
• Bilirubin Determination
• Alpha-Fetoprotein
• Inborn Errors of Metabolism
• Percutaneous Umbilical Blood Sampling
• Also called cordocentesis or funicentesis
• Blood D/O, RH iso, Blood gases, Karyotyping
• Considerations
• Kleihauer-Betke test – to determine if sample is fetal blood.
• RhoGam given to Rh (-) mothers
• Biophysical Profile Description (BPP)
Combines four to six parameters:
• Fetal breathing movements • Amniotic Fluid Volume
• Fetal movement • Placental Grading
• Fetal tone • Fetal heart re-activity
Pregnancy and Pre-Natal Care
• Signs and Symptoms of Pregnancy
A. Presumptive (subjective) signs of pregnancy: signs and symptoms that the
woman reports, which may or may not be associated with pregnancy
B. Probable (objective) signs of pregnancy: noted by the examiner, which may or
may not be associated with pregnancy
C. Positive (diagnostic) signs of pregnancy: noted by the examiner and can only
be caused by pregnancy
Presumptive Probable Positive
Amenorrhea Chadwick’s sign Fetal heartbeat
Nausea and Goodell’s sign Fetal movement
vomiting Fatigue Hegar’s sign palpable by the
Urinary frequency Abdominal Enlargement examiner
Breast changes Abdominal striae Visualization of the fetal
Quickening Ballottement outline by ultrasound
Pigmentation (+) pregnancy test
changes (chloasma, Palpation of fetal outline
melasma, striae Braxton Hicks’ sign
gravidarum)
• PSYCHOLOGICAL TASKS OF PREGNANCY
• First Trimester: Accepting the Pregnancy
-______________________________
• Second Trimester: Accepting the Baby
_____________ – second turning point of pregnancy; woman begins to have
anticipatory role-playing
Baby-related activities makes it real.
It is normal for mothers to refer to the baby as “it” or “fetus”.
Observe how the mother follows pre-natal instructions.
• Third Trimester: Preparing for Parenthood
Emotional Responses to Pregnancy
• Ambivalence • Stress
• Grief • Couvade Syndome
• Narcissism • Emotional Lability
• Introversion vs. Extroversion • Changes in Sexual Desire
• Body image and boundary