Clinical Activities

A. PRE - CONSULTATION
•establish rapport
•VS taking (T,P,R, BP, Wt. & Ht.)
• Demographic Profile – Name, Age, Status, DOB, GP,TPAL
•LMP , EDC & AOG ( Naegele’s Rule, McDonald’s Bartholomew, Haase’s
and Johnson’s Rule
•Benedict’s Test (Urine) – put solution first on testube (3-4 gtts) ; blue color is
normal; color green(+) turned to red (+5)
•HAAT – urine is used first.
• Hgb – Sahli’s Test – if low = low hgb; and is prone to IDA(Iron Deficiency
Anemia)
B. CONSULTATION
• Antepartal Assessment
• Measure FHT
• Leopold’s Maneuver (Fundic Grip, Umbilical Grip, Pelvic Grip & Pawlick’s
Grip)
Clinical Activities
C. POST CONSULTATION
- Give Tetanus Toxoid
TT 1 Give on the second trimester

TT2 4 weeks after Gives 3 years protection

TT3 6 months later Gives 5 years protection

TT4 1 year later Gives 10 years protection

TT 5 1 year later Lifetime protection

-Blood Chemistry, CBC, Hepatitis Profile, Blood Typing, Urinalysis,

CBG
- Give Iron Supplementation = FeS04 (start on the 5th month antepartum
to 2 months post partum, which is equal to 210 days)
-Note when TBC on HBMR
 DANGER SIGNS
 HG
 Hypertension
- Pregnancy Induced Hypertension
- Pre –eclampsia
- Eclampsia, Toxemia
 Pre deliver
– Premature Rupture of Membranes(NORMAL), Spontaneous Rupture of
Membrane, Artificial Rupture of Membranes
 BLEEDING
- 1st Trimester – Possible cause is Abortion or Hyaditiform Mole
- 2nd Trimester – Ectopic Pregnancy and Incompetent Cervix
- 3rd Trimester – Placenta Previa and Abruptio Placenta
 Complete Abortion - induced termination of a pregnancy with destruction
of the embryo or fetus.
 Incomplete Abortion - induced abortion in which the contents of the uterus
are not completely expelled.
 Missed Abortion - retention in the uterus of an abortus that has been dead
for at least eight weeks.
 Threatened Abortion - signal the impending loss of the products of
conception.
 Inevitable - a condition in which vaginal bleeding has been profuse and the
cervix has become dilated, and abortion will invariably occur.
 Habitual abortion - spontaneous abortion occurring in three or more
successive pregnancies, at about the same level of development.
 Spontaneous abortion - that occurring naturally.
 Criminal abortion – abortion done illegally.
 Therapeutic abortion – that for the sake of the mother’s health.
 Hydatidiform Mole is a relatively rare condition in which tissue around a
fertilized egg that normally would have developed into the placenta instead
develops as an abnormal cluster of cells. (MANAGEMENT : D/C)
 Ectopic Pregnancy is a fertilized egg has implanted outside the uterus,
usually in the fallopian tubes. ( AREAS: Interstitial, Ampullary,
Abdominal, Cervical and Ovarial)
 Incompetent Cervix - uterine cervix that becomes dilated before term and
without labor often resulting in miscarriage or premature birth. (MGT. :
Suture cervical opening, it is called SHIRODKAR or cerclage)
 Placenta previa - pregnancy in which the placenta is implanted in the lower
part of the uterus; painless vaginal bleeding.
AREAS : Marginal, Low Lying, Total Previa, Incomplete
 Abruptio placenta – vaginal bleeding accompanied by sever abdominal
pain.
MENSTRUATION
 Menstrual Phase = 0-5 FERTILIZATION:
days EGG CELL = Life Span is 24 hours
SPERM CELL = 24 to 48 hours (2-3 days)
- low estrogen and
progesterone
 Proliferative = 6- 13 days
- production of FSH;
Estrogen is dominant
 Secretory = 14 -22
- maintained estrogen
level; Progesterone is
dominant.
 Ishemic = 23 – 28 days
 Decreased production of
Progesterone and Estrogen
Normal ejaculation pf se,em averages 2.5 ml of fluid
containing an average of 400 million sperm per
ejaculation.
Sperm reach uterine cavity within 80-90 seconds and
the outer end of the fallopian tube within 3-5 minutes
after deposition.
Sperm dissolves the corona radiata with a proteoltyic
enzyme “hyaluronidase”.
Fertilization occurs in the outer third of the fallopian
tube.
After 24 hours, the first mitotic division happens,
which is called the “cleavage”.
IMPLANTATION
Cleavage occur at a rate of one about every 22 hours

Becomes cluster of cells called morula.

Becomes blastomere produced by cleavage of a zygote

Blastocyst – remains for 7-10 days

PROCESS : FERTILIZATION- union of ovum and spermatozoon.

APPOSITION - mode of growth that is characteristic of many tissues in the body by
which nutritive matter from the blood is transformed on the surface of an organ into
solid unorganized substance.
NIDATION - The implantation of the early embryo in the uterine mucosa.
IMPLANTATION – contact between growing structure and uterine endometrium.

TROPHOBLAST
Outer layer = synctiotrophoblast or synctial layer.
Inner Layer = cytotrophoblast or Langhans layer.
DECIDUA - term for the uterine lining
(endometrium) during a pregnancy, which forms the
maternal part of the placenta.
1. Decidua basalis, the part of endometrium that lies
directly under the embryo ( near the fetus)
2. Decidua capsularis, the portion of endometrium that
stretches or encapsulates the surface of the
trophoblast. (encloses fetus)
3. Decidua vera, remaining portion of uterine lining.
(near placenta).
Calendar Method
5 days prior to menstruation, it is safe to have sex as
well as 5 days after menstruation. A woman will
ovulate around Day 14 from the first day of
menstruation.
LAB TEST : HCG
Trace amounts of hCG appear in serum as early as 24
hours to 48 hours after implantation. They reach a
measurable level of about 50 mIU/mL 7 to 9 days after
conception.
LEVEL PEAKS at about 100 mIU/mL between 60 and
80th day of gestation.
 Corpus Luteum
The corpus luteum, which means yellow body in Latin, is
what is left of the follicle after a woman ovulates.
After a woman ovulates, the corpus luteum only lasts for
about 12-14 days unless it begins receiving HCG from a
developing embryo. If the egg is not fertilized, the corpus
luteum dies and progesterone production stops. When
progesterone levels drop, the uterus lining stops
thickening and is consequently shed during menstruation.
If the egg is fertilized, the corpus luteum will begin
receiving HCG from the embryo. HCG tells the corpus
luteum to keep producing progesterone. The corpus
luteum lasts for about ten weeks after ovulation. After ten
weeks the placenta takes over progesterone production
through the end of pregnancy
Placenta
Size = 15 to 20 cm in diameter and 2 to 3 cm I depth.
Weight = 400 to 600 g or 1 lb.
Number of Cotyledons = 12 - 30