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Intrapartal
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321 Terms
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uterine stretch theory
( any hallow organ stretched, will always contract & expel its content) - contraction action
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oxytocin theory
posterior pituitary gland releases oxytocin. Hypothalamus produces oxytocin
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prostaglandin theory
stimulation of arachidonic acid - prostaglandin- contraction
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progesterone theory
before labor, decrease progesterone will
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stimulate contractions & labor
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theory of aging placenta
life span of placenta 42 wks. At 36 weeks
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degenerates (leading to contraction - onset labor).
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Stress
decrease in responsibility taking is the reaction to the stress of pregnancy not the pregnancy itself affects decision making abilities
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Couvade - syndrome
men experiencing nausea/vomiting, backache due to stress, anxiety and empathy for partner
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Emotional labile
mood changes/swings occur frequently due to hormonal changes
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Change in Sexual Desire
may increase or decrease needs correct
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interpretation... not as a loss of interest in sexual partner
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Uterus
wt. increase to about 1000 grams at full term due to increase in fibrous and elastic tissues
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Becomes ovoid in shape
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• Softening of lower uterine segment:
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❖ Hegar's sign seen at 6th week
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Operculum
mucus plug to seal out bacteria
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Goodell's sign
cervix becomes vascular and edematous giving it consistency of the earlobe
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Vagina
increased vascularity occurs
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Chadwick's sign
purplish discoloration of the vagina
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Leukorrhea
increased amount of vaginal discharges due to increased activity of
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estrogen and of the epithelial cells.
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• Must not be itchy, foul smelling, excessive, nor green/yellow in color.
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• Management: good hygiene
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• Under the influence of estrogen, vaginal epithelium & underlying tissues hypertrophic & enriched with glycogen
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• pH of vaginal secretions during pregnancy fall
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Ovaries
• Inactive since ovulation does not take place during pregnancy.
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• Placenta produces Progesterone and Estrogen during pregnancy
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Abdominal Wall
• 1 Striae Gravidarum - due to rupture and atrophy of connective tissue layers on
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the growing abdomen
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• 2 Linea Nigra - pregnancy Line, is the dark line
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that develops across your belly during pregnancy.
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• 3 Umbilicus is pushed out
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• 4 Melasma or Chloasma - increased pigmentation due increased production of melanocytes by the pitutitary
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• 5 Unduly activated sweat glands
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Striae Gravidarum
due to rupture and atrophy of connective tissue layers on
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the growing abdomen
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Linea Nigra
pregnancy Line, is the dark line
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that develops across your belly during pregnancy.
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Melasma or Chloasma
increased pigmentation due increased production of melanocytes by the pitutitary
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SIGNS OF PREGNANCY
1 Prenatal care is important for prevention of infant and maternal morbidity and mortality
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• 2 Care is a cooperative action based on client's understanding of treatment modalities
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• 3 Duration of normal pregnancy 266 - 280 days of 38 - 42 weeks or 9 calendar months or 10 lunar
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months.
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4 Infant born < 38 weeks pre-term & 42 post term)
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• 5 Diagnosis: Urine examination - tests presence of HCG (present from 40th -100th day, peak 60
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days) conduct test 6 weeks after LMP
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Prenatal Visit
• History Taking:
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• Personal Data: name, age, address, etc Baseline Data: v/s especially BP, weight Obstetrical Data:
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•gravida - # pregnancy, para- viable pregnancy, Physical Exams
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Pelvic Exams
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B. Basic knowledge in Intrapartum.
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• History Taking:
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• personal data
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• obstetrical data
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• gravida (number of pregnancies)
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• para (the number of completed pregnancies beyond 20 weeks gestation (whether viable or nonviable)
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• TPAL
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• past pregnancies
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• present pregnancy: cc
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• LMP
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• medical data: hx of diseases/illnesses
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GTPAL
Gravida/ Term Preterm Abortion Living
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G
No. Or pregnancies, including the current one
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T
No. Of pregnancies terminating after 36 weeks gestation
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P
No. Of pregnancies terminating 20 to 36 weeks gestation
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A
No. Of pregnancies terminating before 20 weeks gestation
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L
No. Of living children
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Danger Signals of Pregnancy
• 1. Vaginal bleeding (any amount)
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• 2. Swelling of face or fingers
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• 3. Severe, continuous headache
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• 4. Dimness or blurring of vision
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• 5. Flashes of light or dots before eyes
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• 6. Pain in the abdomen
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• 7. Persistent vomiting
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• 8. Chills and fever
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• 9. Sudden escape of fluids from the vagina
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• 10. Absence of FHT after they have been initially heard on 4th or 5th month
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Assessment
• a. Physical examination - review of systems
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• b. Pelvic examination (ask client to void)
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• c. IE - determine Hegar's, Goodell's, Chadwick's
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• d. Ballotement - on 5th month
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• e. Pap Smear
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• f. Pelvic measurements (done after 6th month or 2 wks before EDC)
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• g. Leopold's Maneuver: to determine fetal presentation, position, attitude, est. size and fetal parts
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• h. Vital signs
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• i. Blood studies: CBC Hgb, Hct , blood typing, serological tests
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• j. Urinalysis: test for albumin, sugar & pyuria
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Important Estimates: Age of Gestation
Naegele's Rule: -3 calendar months and +7 Ex. LMP= May 15, 2006 or 5-15-06
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•LMP: 515
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• Formula: - 3 + 7
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• EDC: 2 22 or February 22, 2007
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McDonald's Rule:
• Ht fundus/4 (AOG wks)
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• 1. Measure in cms the length from the symphysis to the level of fundus
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• 2. Lunar months: Fundal Height (cms) x 2/7
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• 3. Weeks of pregnancy: Fundal height (cms) x 8/7
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Ex. Fundal Height = 14 cms
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• Lunar Month: 14cms x 2 = 28 / 7 = 4 months
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• Weeks Pregnant: 14 cms x 8 = 112 / 7 = 16 weeks AOG
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Through LMP:
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