MATERNAL AND CHILD

NURSING
Prepared by: Mariel Eleonor B. Moldin, RN
 GROUP 2

• TOPICS
I. REVIEW CONCEPTS ON PHYSIOLOGY OF MENSTRATON
II. PSYCHOLOGICAL, PSYCHOSOCAL, AND PHYSIOLOGICAL
CHANGES IN PREGNANCY
III. LABOR AND DELIVERY
 OBJECTIVES
• Discuss and understand the process of menstruation in the two different parts of the
reproductive organ.
• Review and discuss psychological, psychosocial, and physiologic changes that occur
with pregnancy, the underlying principles of theses changes, and the relationship of the
changes to the pregnancy diagnosis.
• Discuss how can health professionals’ best assist pregnant women in adapting t
pychological, psychosocial and physiologic changes during pregnancy
• Review and discuss the standard practices in relation to labor and delivery.
• Integrate knowledge in reproductive health and sexuality with nursing process, and
with researches or studies to achieve quality maternal and child health nursing care.
ANATOMY AND PHYSIOLOGY
OF
FEMALE REPRODUCTIVE
SYSTEM
FEMALE REPRODUCTIVE SYSTEM
FEMALE REPRODUCTIVE SYSTEM
MENSTRUATION
 FACTS/MYTHS ABOUT MENSTRUATON

• 1. You can get your PERIOD in your NOSE

• 2. Periods are more painful in the cold
• 3. You sound uglier during your moon time
• 4. Periods can make you stupidererer (more stupid)
• 5. You don’t bleed as much as you think you do
• 6. Those clots? They’re made by CONTRACTIONS
• 7. Your body mimics pregnancy symptoms in the run-up to your period
 FACTS ABOUT MENSTRUATON
• 8. In the middle ages, people thought that red-haired people were
conceived during a period
• 9. Menstrual blood used to cure everything from headaches to warts
• 10. Women used to menstruate during the new moon
• 11. Some scientists also think that artificial lights influence women’s
periods
• 12. There is a disney movie about your period
• 13. Retail fever hits you two weeks before your period, says science
• 14. Under 18? Got irregular periods? Don’t worry, it’s normal
 WHAT IS MENSTRUATION?

• A discharging of blood, secretions, and tissues debris from

the uterus that recurs in nonpregnant breeding-age primate
females at approximately monthly intervals and that is
considered to represent a readjustment of the uterus to the
nonpregnant state following proliferative changes
accompanying the preceding ovulation. (aka Period)
 NORMALCY OF MENSTRUATION

• Menarche : 9-17 years old (12.4 years old)

• Menstrual cycle: 26-36 days (28 days)
• Duration: 1-8 days (2-7 days)
• Menstrual flow: 30-80ml
• Odor: Marigold
 ABNORMALITIES IN MENSTRUATION

•Amenorrhea
•Dysmenorrhea
•Menorraghia
•Metrorraghia
•Oligomenorrhea
 PREMENSTRUAL SYNDROME (PMS)

• Is a term commonly used to describe a wide variety of physical and

psychological symptoms associated with the menstrual cycle.
• Pms appears to be caused by rising and falling levels of the hormones
estrogen and progesterone, which may influence brain chemicals,
including serotonin, a substance that has a strong affect on mood.
• Physical symptoms associated with PMS include:
• -Bloating
• -Swollen, painful breasts
• -Fatigue
• -Constipation Emotional symptoms associated with PMS include:

• -Headaches -anger
• -Clumsiness
-anxiety or confusion

-mood swings and tension

-crying and depression

-inability to concentrate
MENSTRUAL CYCLE

• A menstrual cycle (a female reproductive cycle) is episodic uterine

bleeding in response to cyclic hormonal changes.
• The purpose of a menstrual cycle is to bring an ovum to maturity and
renew a uterine tissue bed that will be responsible for the ova’s
growth to be fertilized. It is the process that allows for conception and
implantation of a new life.
 PHYSIOLOGY OF MENSTRUATION

• Four body
structures are
involved in the
physiology of the
menstrual cycle:
 Four body structures are involved in the physiology of
the menstrual cycle:
• HYPOTHALAMUS
-The release of GnRH (also called luteinizing hormone– releasing hormone, or LHRH) by the
hypothalamus initiates the menstrual cycle.
-When the level of estrogen (produced by the ovaries) rises, release of the hormone is
repressed, and menstrual cycles do not occur.
- During childhood, the hypothalamus is apparently so sensitive to the small amount of
estrogen produced by the adrenal glands that release of the hormone is suppressed.
-Beginning with puberty, the hypothalamus becomes less sensitive to estrogen feedback; this
results in the initiation every month in females of the hormone GnRH
 Four body structures are involved in the physiology of
the menstrual cycle:
• PITUITARY GLAND
- Under the influence of GnRH, the anterior lobe of the pituitary gland (the
adenohypophysis) produces two hormones that act on the ovaries to further influence
the menstrual cycle:
(a) FSH, a hormone that is active early in the cycle and is responsible for maturation
of the ovum
(b) LH, a hormone that becomes most active at the midpoint of the cycle and is
responsible for ovulation, or release of the mature egg cell from the ovary, and
growth of the uterine lining during the second half of the menstrual cycle.
 Four body structures are involved in the physiology of
the menstrual cycle:
• OVARIES
- FSH and LH are called Gonadotropic hormones because they cause growth
(trophy) in the gonads (ovaries).
- Every month during the fertile period of a woman’s life (from menarche to
menopause), one of the ovary’s Primordial follicles is activated by FSH to begin to
grow and mature (Graafian follicle).
- After an upsurge of LH from the pituitary, prostaglandins are released and the
graafian follicle ruptures. The ovum is set free from the surface of the ovary, a
process termed ovulation.
• OVARIES
- After the ovum and the follicular fluid have been discharged from the ovary,
the cells of the follicle remain in the form of a hollow, empty pit.
-LH influences the follicle cells to produce lutein, a bright-yellow fluid.
-formation of Corpus Luteum (Yellow body)
-Basal Body Temperature of a woman will increase by 1ºF
-If conception occurs, ovum proceeds down to fallopian tube and implantation
of the fertilized ovum in the endometrium occurs
-But, if conception does not occur, unfertilized ovum atrophies after 4 or 5
days
 Four body structures are involved in the physiology of
the menstrual cycle:
• UTERUS
First Phase of Menstrual Cycle (Proliferative) Day5-14
- Immediately after a menstrual flow (which occurs during the first 4 or 5 days
of a cycle), the endometrium, or lining of the uterus, is very thin, approximately
one cell layer in depth.
- As the ovary begins to produce estrogen (in the follicular fluid, under the
direction of the pituitary FSH), the endometrium begins to proliferate.
- This growth is very rapid and increases the thickness of the endometrium
approximately eightfold.
- aka estrogenic, follicular, or postmenstrual phase.
• UTERUS
Second Phase of Menstrual Cycle (Secretory) Day 15-28
-After ovulation, the formation of progesterone in the corpus luteum
(under the direction of LH) causes the glands of the uterine endometrium
to become corkscrew or twisted in appearance and dilated with
quantities of glycogen (an elementary sugar) and mucin (a protein).
-The capillaries of the endometrium increase in amount until the lining
takes on the appearance of rich, spongy velvet.
- aka progestational, luteal, or premenstrual phase.
• UTERUS
Third Phase of Menstrual Cycle (Ischemic) Day 24 or 25
- If fertilization does not occur, the corpus luteum in the ovary begins to
regress after 8 to 10 days.
- As it regresses, the production of progesterone and estrogen decreases.
- With the withdrawal of progesterone stimulation, the endometrium of
the uterus begins to degenerate
- The capillaries rupture, with minute hemorrhages, and the endometrium
sloughs off.
• UTERUS
Fourth Phase of Menstrual Cycle (Menses) Day 1-4
-Menstrual flow is composed of:
• Blood from the ruptured capillaries
• Mucin from the glands
• Fragments of endometrial tissue
• The microscopic, atrophied, and unfertilized ovum

-a menstrual flow contains only approximately 30 to 80 mL of blood

OVARIAN EVENTS AND UTERINE CHANGES DURING
THE MENSTRUAL CYCLE.
• CERVIX
-The mucus of the uterine cervix, as well as the uterine body,
changes each month during the menstrual cycle.

-Women can analyze cervical mucus changes to help plan

coitus to coincide with ovulation if they want to increase their
chance of becoming pregnant or plan to avoid coitus at the
time of ovulation to prevent pregnancy
 CERVICAL MUCUS TEST

• FERN TEST
- When high levels of
estrogen are present in the
body, as they are just
before ovulation, the
cervical mucus forms
fernlike patterns caused by
the crystallization of
sodium chloride on mucus
fibers when it is placed on
a glass slide and allowed
to dry.
CERVICAL MUCUS TEST

• SPINNBARKEIT TEST
- At the height of
estrogen secretion,
cervical mucus not only
becomes thin and watery
but also can be stretched
into long strands.
 MENOPAUSE

• Is the cessation of menstrual cycles

• The age range at which menopause occurs is wide, between
approximately 40 and 55 years of age with a mean age of 51.3.
• “change of life”
• Can cause psychological stress and physiologic stress (When ovaries
begin to atrophy, reducing estrogen production, “hot flashes,” vaginal
dryness, or osteoporosis (lack of bone mineral density [BMD]) occurs.)
 EXERCISES:
• Yassi is a 25 year-old woman, a mother of 5 children with 1 year age gap. She
verbalized that she doesn’t want to use any family planning contraceptives. She just
want the natural way. As a Maternal and Child Health Nurse, how would you teach
her plan to avoid coitus at the time of ovulation to prevent pregnancy? Her LMP
was July 21, 2017 with a menstrual cycle of 30 days.
a) When will be her next menstruation?
b) When will be her ovulation day?
c) When will be the unsafe period (high chance of pregnancy)?
d) When will be the safe period (low chance of pregnancy)?
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28 29 30 31 1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24
 ACTIVITY III
• SITUATION:
Maria is a 27 year-old woman, married for 2 years and want to
conceive a child. As a maternal and child health nurse, how would you
teach her to help plan coitus to coincide with ovulation if they want to
increase her chance of becoming pregnant. Her LMP was June 22,
2017 and her menstrual cycle is 31 days.
a) When will be her next menstruation?
b) When will be her ovulation day?
c) When will be the unsafe period (high chance of pregnancy)?
d) When will be the safe period (low chance of pregnancy)?