Prenatal Care

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Goodell sign

Soft cervix

Cervical softening occurs

with pregnancy

Hegar Sign

is the palpation of softening of the lower uterine segment that occurs early in pregnancy, indicating a positive early sign of pregnancy.

Quickening

is the first noticeable movement of the fetus, typically felt between 16 and 25 weeks of gestation. It signifies fetal activity and is often an exciting moment for expectant mothers.

Amenorrhea + nausea

are common symptoms during early pregnancy, often indicating hormonal changes and the body's adaptation to pregnancy.

Supine + dizziness after ~20 weeks

Turn lateral, preferably left. Relieves vena cava compression and improves venous return.

Montgomery’s tubercles

Hypertrophied sebaceous glands on the areola that secrete a lubricating, protective fluid; considered a presumptive sign of pregnancy. it prevent the nipples from cracking

Colostrum

The thick, yellowish precursor to breast milk rich in antibodies and nutrients, produced starting around the 16th week of pregnancy.

Chadwick’s sign

Bluish-purple discoloration of the cervix- probable sign

Braxton Hick contration

Irregular, painless uterine contractions that occur intermittently throughout pregnancy without causing cervical dilation (false labor)

Operculum

its a mucus plug that act to seal out bacteria during pregnancy therefore helps prevent infection in the fetus and membranes

Melasma/ Chloasma

it is the Mask of Pregnancy

Residual volume in preggy mon

It decreases up to 20% by the pressure of diaphragm ( the amount of air remaining in the lungs after expiration)

Tidal volume in preggy mom

it increases up tp 40% ( the volume of air inspired)

Vital Capacity in preggy mom

IT DOES NOT DECREASE NOR INCREASE ( the max volume exhaled after a minimum inspiration)

Blood volume of preggy mom

it increases up to 30% to 50% - to provide adequate exchange of nutrient in the placenta and compensate to blood loss

Blood loss in preggy mom

vaginal birth - 300 to 400 ml

cs birth - 800 to 1000 ml

Heart rate of preggy mom

it increases 10 beats per min

Diastasis Recti

medical condition characterised by separating the two large, parallel abdomen muscles during pregnancy.

Presumptive

Subjective (Mother), weak evidence

a. Breast tenderness

b. Amenorrhea

c. Urinary changes

d. Nausea and vomiting

e. Skin changes

i. Chloasma/Melasma:

Mask of pregnancy

ii. Linea nigra:

Hyperpigmentation

iii. Striae gravidarum:

Stretch marks

f. Quickening: Fetal movement

felt by the mother

Probable

Objective (Nurse)

● Stronger evidence

a. Pregnancy test (+)

b. Reproductive changes

i. Hegar’s

ii. Chadwick’s

iii. Goodell’s

c. Braxton Hicks contraction:

painless irregular contraction

d. Ballottement: Passive

movement of an engaged

Positive

Absolute (100% pregnant)

a. Fetal heart tone (120-16o

bpm)

b. Fetal movement felt by

examiner

c. Ultrasound

Homan’s sign

Dorsiflexion of the foot (+)

Homan’s

■ Possible DVT

■ Do not massage

■ Elevate the legs

FHT monitoring

FHT monitoring: 120-160 bpm normal

Auscultation:

3 months: Doppler

4 months: Fetoscope

5 months: Stethoscope

UTZ - TRANSVAGINAL

EARLY PREGNANCY → EMPTY BLADDER

UTZ- ABDOMINAL ULTRASOUND

LATE PREGNANCY → DRINK WATER (3-4 GLASSES)

PAP SMEARK

• Class l- normal

• Class Il-inflammation: No IE

• Class III-mild to moderate dysplasia: No sex

• Class IV-probably malignant: Difficult to

recover

Class V-possibly malignant: Slimmest chance

to survive

4 P’S OF LABOR

Passageway

Passenger

Power

Psych

Anterior Fontanelle

‘ Diamond shape’

closes at 12-18 months

Posterior Fontanelle

“triangular shape”

closes at 3 months

POWER ( 4p’s of labor")

Duration= beginning to end

• early labor _20-30 sec; late = 60-70 secs

Interval= end of one contraction to beginning of one

• early labor : 40-45 mins ; 2-3 mins

Frequency = beginning to beginning

• 2-3 contraction

Intensity = strength of contraction

1st stage of Labor (dilation)

NORMAL = 1CM/HOUR

L- atency = 0-3 cm- health teaching

A- ctive = 4-7 cm- Mother loses self control, Increase frequency, duration, shortened, interval, Focus: PAIN

T- ransition = 8-10cm - Fully dilated,effaced. Transfer LR ➡DR

2nd stage ( expulsion stage) ‘EDFIEREE’

ENGAGEMENT

DESCENT

FLEXION

INTERAL ROTATION

EXTENSION

RESTITUTION

EXTERNAL ROTATION

EXPULSION

CARDINAL SIGN ( edfieree)

• Engagement – The widest part of the fetal head enters the pelvic inlet.

• Descent – The baby moves downward through the birth canal.

• Flexion – The baby's chin moves toward the chest, allowing the smallest head diameter to pass.

• Internal Rotation – The baby's head rotates to align with the mother's pelvic outlet.

• Extension – The baby's head extends as it passes under the pubic bone and emerges.

• Restitution (External Rotation) – The baby's head rotates to realign with the shoulders.

• Expulsion – The shoulders and the rest of the baby's body are delivered.

lochia

rubra 0-3 days Reddish

Serosa 4-9th day Pinkish to brownish

Alba 7-10 days Up to 6 weeks Whitish

True Labor

Regular and predictable

● Lower back abdomen

● Increase frequency, duration

● Shortened interval

● Pain is not relieved by ambulation

● With cervical changes

○ Dilatation and effacement

○ Show: mucus plug expulsion

False Labor

Irregular contraction

● Pain is confined in the abdomen

● No increase in frequency, duration and interval

● Pain is relieved by ambulation

● Absent cervical changes

Danger sign of Pregnancy

Chills and fever

Cerebral disorders (dizziness )

Abdominal pain

Boardlike Abdomen

Blood pressure elevation

Blurred Vision

Bleeding

Swelling

Scotoma ( blind spot on the retina )

Sudden gush of fluid

oxytocin

labor stimulates PPG to produce oxytocin that causes uterine

contraction.

Prostaglandin

labor causes release of arachidonic acid which in turn increases the production of prostaglandin -> uterine contraction

PROGESTERONE DEPRIVATION

decrease causes uterine contraction

Fetal Station

Relationship of the presenting part to ischial

spine

 -1: 1 cm above ischial spine

 -3: needs therapeutic rest

 0: level of ischial spine, ENGAGEMENT

 +3, 4, 5: crowning (2nd stage of labor)

Ankle Edema DISCOMFORT OF PREGNANCY

Elevate feet when sitting or resting

Practice frequent dorsiflexion of feet

Avoid standing for a long period of time.

BACK ACHE (DISCOMFORT)

Practice good body mechanics

Practice pelvic tilt exercise

Avoid long standing, high heels, heavy lifting, over fatigue and excessive bending or reaching

CONSTIPATION (DISCOMFORT)

Increase fiber in the diet

Drink additional fluids

Have a regular time for bowel movement

Exercise

Use stool softeners as needed

FAINTHNESS

Arise and move slowly

Avoid prolonged standing

Remain in a cool environment; avoid crowded places

Lie on left side when lying down.

HEARTBURN (PYROSIS)

Eat small, frequent meals

 Avoid spicy, greasy foods

 Refrain from lying down immediately after eating

 Use low – sodium antacids

HEMORRHOIDS

Avoid constipation and straining with BM

Take hot sitz bath, apply topical anesthetics, ointments, ice packs

PTYALISM - SALIVATION

Use mouthwash as needed

Chew gum or suck on hard candy.

LEUKORHEA

VAGINAL DISCHARGE

Wear cotton underwear; bath daily; avoid tight panty hose