Intrapartal

uterine stretch theory

( any hallow organ stretched, will always contract & expel its content) - contraction action

oxytocin theory

posterior pituitary gland releases oxytocin. Hypothalamus produces oxytocin

prostaglandin theory

stimulation of arachidonic acid - prostaglandin- contraction

progesterone theory

before labor, decrease progesterone will

stimulate contractions & labor

theory of aging placenta

life span of placenta 42 wks. At 36 weeks

degenerates (leading to contraction - onset labor).

Stress

decrease in responsibility taking is the reaction to the stress of pregnancy not the pregnancy itself affects decision making abilities

Couvade - syndrome

men experiencing nausea/vomiting, backache due to stress, anxiety and empathy for partner

Emotional labile

mood changes/swings occur frequently due to hormonal changes

Change in Sexual Desire

may increase or decrease needs correct

interpretation... not as a loss of interest in sexual partner

Uterus

wt. increase to about 1000 grams at full term due to increase in fibrous and elastic tissues

Becomes ovoid in shape

• Softening of lower uterine segment:

❖ Hegar's sign seen at 6th week

Operculum

mucus plug to seal out bacteria

Goodell's sign

cervix becomes vascular and edematous giving it consistency of the earlobe

Vagina

increased vascularity occurs

Chadwick's sign

purplish discoloration of the vagina

Leukorrhea

increased amount of vaginal discharges due to increased activity of

estrogen and of the epithelial cells.

• Must not be itchy, foul smelling, excessive, nor green/yellow in color.

• Management: good hygiene

• Under the influence of estrogen, vaginal epithelium & underlying tissues hypertrophic & enriched with glycogen

• pH of vaginal secretions during pregnancy fall

Ovaries

• Inactive since ovulation does not take place during pregnancy.

• Placenta produces Progesterone and Estrogen during pregnancy

Abdominal Wall

• 1 Striae Gravidarum - due to rupture and atrophy of connective tissue layers on

the growing abdomen

• 2 Linea Nigra - pregnancy Line, is the dark line

that develops across your belly during pregnancy.

• 3 Umbilicus is pushed out

• 4 Melasma or Chloasma - increased pigmentation due increased production of melanocytes by the pitutitary

• 5 Unduly activated sweat glands

Striae Gravidarum

due to rupture and atrophy of connective tissue layers on

the growing abdomen

Linea Nigra

pregnancy Line, is the dark line

that develops across your belly during pregnancy.

Melasma or Chloasma

increased pigmentation due increased production of melanocytes by the pitutitary

SIGNS OF PREGNANCY

1 Prenatal care is important for prevention of infant and maternal morbidity and mortality

• 2 Care is a cooperative action based on client's understanding of treatment modalities

• 3 Duration of normal pregnancy 266 - 280 days of 38 - 42 weeks or 9 calendar months or 10 lunar

months.

4 Infant born < 38 weeks pre-term & 42 post term)

• 5 Diagnosis: Urine examination - tests presence of HCG (present from 40th -100th day, peak 60

days) conduct test 6 weeks after LMP

Prenatal Visit

• History Taking:

• Personal Data: name, age, address, etc Baseline Data: v/s especially BP, weight Obstetrical Data:

•gravida - # pregnancy, para- viable pregnancy, Physical Exams

Pelvic Exams

B. Basic knowledge in Intrapartum.

• History Taking:

• personal data

• obstetrical data

• gravida (number of pregnancies)

• para (the number of completed pregnancies beyond 20 weeks gestation (whether viable or nonviable)

• TPAL

• past pregnancies

• present pregnancy: cc

• LMP

• medical data: hx of diseases/illnesses

GTPAL

Gravida/ Term Preterm Abortion Living

G

No. Or pregnancies, including the current one

T

No. Of pregnancies terminating after 36 weeks gestation

P

No. Of pregnancies terminating 20 to 36 weeks gestation

A

No. Of pregnancies terminating before 20 weeks gestation

L

No. Of living children

Danger Signals of Pregnancy

• 1. Vaginal bleeding (any amount)

• 2. Swelling of face or fingers

• 3. Severe, continuous headache

• 4. Dimness or blurring of vision

• 5. Flashes of light or dots before eyes

• 6. Pain in the abdomen

• 7. Persistent vomiting

• 8. Chills and fever

• 9. Sudden escape of fluids from the vagina

• 10. Absence of FHT after they have been initially heard on 4th or 5th month

Assessment

• a. Physical examination - review of systems

• b. Pelvic examination (ask client to void)

• c. IE - determine Hegar's, Goodell's, Chadwick's

• d. Ballotement - on 5th month

• e. Pap Smear

• f. Pelvic measurements (done after 6th month or 2 wks before EDC)

• g. Leopold's Maneuver: to determine fetal presentation, position, attitude, est. size and fetal parts

• h. Vital signs

• i. Blood studies: CBC Hgb, Hct , blood typing, serological tests

• j. Urinalysis: test for albumin, sugar & pyuria

Important Estimates: Age of Gestation

Naegele's Rule: -3 calendar months and +7 Ex. LMP= May 15, 2006 or 5-15-06

•LMP: 515

• Formula: - 3 + 7

• EDC: 2 22 or February 22, 2007

McDonald's Rule:

• Ht fundus/4 (AOG wks)

• 1. Measure in cms the length from the symphysis to the level of fundus

• 2. Lunar months: Fundal Height (cms) x 2/7

• 3. Weeks of pregnancy: Fundal height (cms) x 8/7

Ex. Fundal Height = 14 cms

• Lunar Month: 14cms x 2 = 28 / 7 = 4 months

• Weeks Pregnant: 14 cms x 8 = 112 / 7 = 16 weeks AOG

Through LMP: