NCM 107 (LECTURE) – MIDTERM REVIEWER

THE ANTEPARTAL PERIOD LMP: March 28, 2020

 The period of pregnancy of the period 12
before labor is the Antepartal 3 -28 -2020
Period, also called Prenatal Period. -3 +7
The woman in this period is called the ______________________
Gravida. 12 -35
 Length of pregnancy: 31
A. Days 267 to 280 days ______________________
B. Calendar months – 9 months
C. Weeks – 40 weeks-42 weeks 1 4 2021
D. Trimesters – 3 EDC: Jan. 4, 2021
E. Lunar month – 10
 It is best to express gestational age or Note:
length of pregnancy in weeks. Add 12 (months in 3 months)
 At expected date of confinement Add 1 month in 12
(EDC), the fetus is 40 weeks old.
 Estimated date of Confinement LMP: Jan. 15, 2020
NAEGELE’S RULE 1 15 2020
 Estimated date of Confinement : -3 +7 -2020
Ask for the LMP (Last ______________________
Menstrual Period)
 Formula: 10 22 2020 EDC: Oct. 22, 2020
Add 7 days to the first day of
LMP LMP: Jan. 29, 2020
Subtract 3 months
Add 1 year 1 29 2020
-3 +7 2020
EXAMPLE: ______________
 Given: LMP – October 13, 2020
10 36 2020
10 13 2020 -31
-3 +7 2020 ______________
_____________________
EDC: 7 20 2021 11 5 2020 – EDC
(July 20, 2021)

P a g e 1 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

COMPUTATION TO DETERMINE AGE TRIMESTERS OF PREGNANCY:

OF GESTATION OF AOG:  1st TRIMESTER: period of rapid
organogenesis; teratogens like
ASK FOR LMP: DEC 16 alcohol, drugs, virus, and radiation
CLINIC VISIT: FEB 14 are highly damaging.
 2nd TRIMESTER: most comfortable
31 for the mother with continued growth
Dec. 16 of the fetus.
_________________  3rd TRIMESTER: with rapid
15 deposition of fats, iron, and calcium,
Jan. 31 the period of most rapid fetal growth.
Feb 14
_________________ FACTORS INFLUENCING A WOMAN’S
60 divide by 7 RESPONSE TO PREGNANCY
 Memories of her own childhood
AOG: 8 weeks and 5 days  Cultural background
 Existing support system
 Socioeconomic conditions
LMP: SEPT. 10  Perception of maternal role
CLINIC VISIT: JAN 19  Impact of mass media
 Coping mechanism
30
Sept. 10 MATERNAL ADAPTATION TO
_________________ PREGNANCY/PSYCHOLOGICAL
20 ASPECT:
Oct. 31  1st TRIMESTER: ACCEPTING THE
Nov. 30 PREGNANCY. Initial feeling of
Dec. 31 ambivalence about pregnancy,
Jan 19 normal denial to confirmation of
_________________ being pregnant. Pregnant woman
131 divide by 7 places focus on self, physical
changes associated with pregnancy
AOG: 18 weeks and 7 days and emotional reactions to
pregnancy.
 2nd TRIMESTER: ACCEPTING THE
FETUS. Relatively tranquil period.
Acceptance of reality of pregnancy
increased awareness and interest in
fetus. Introversion and feeling of
wellbeing. With fantasy and day
dreaming.

P a g e 2 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

 3rd TRIMESTER: PREPARING FOR II. PARA – number of pregnancies

THE COMING OF THE NEWBORN that lasted more than 20 weeks,
AND END OF PREGNANCY. regardless of the outcome.
Anticipation of labor and delivery and  Nullipara – a woman who has not
assuming mothering role. Viewing given birth to a newborn beyond
infant as reality vs. fantasy, fear and 20 weeks gestation.
fantasies and dreams about labor are  Primipara – a woman has given
common. (Nesting Behavior- when broth to one newborn more than
the mother tries to fix about the 20 weeks gestation.
things and room of her new-born.)  Multipara – a woman who
has/had 2 or more births at more
COUVADE SYNDROME than 20 weeks gestation (twins or
 Many husbands experience physical triplets count as 1 Para)
symptoms such as nausea and
vomiting. Backaches, sleepless 4 – POINT SYSTEM: PAST
nights. PREGNANCIES AND PERINATAL
 This results from anxiety and OUTCMES: FPAL
stress and even empathy for the  F – number of 37 to 40 weeks (full
wife or partner. Worries about his term births)
new role as a father.  P – number of below 37 weeks
(Premature births)
PHYSIOLOGICAL CHANGES AND  A – number of abortions
ADAPTATIONS IN PREGNANCY  L – number of current living children

TERMINOLOGIES OF PREGNANCIES: Example: History given by the mother :

I. Gravida – number of times G5 P4
pregnant, regardless of F=3
durating, including the present P=1
pregnancy. A=0
 Nulligravida – a woman L=4
who is not pregnant now,
and never has been Upon delivery: G5 P5
pregnant.
 Primigravida – pregnant F=4
for the first time P=1
 Multigravida – pregnant A=0
for the second or L=5
subsequent.

P a g e 3 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

5 POINT SYSTEM: THE TOTAL  Linea Nigra – line of

NUMBER OF PREGNANCIES. GTPAL M dark/brown/ pinkish
G = Gravida – the number of pregnancy pigmentation on the
including the present one. abdomen.
T = Term Birth – the total number of  Melasma – dark
infants born at term 37 or 42 weeks pigmentation found in the
gestation. face.
P = Preterm – the total number of  Stria Gravidarum – red
infents born before 37 weeks. streaks on the abdomen
A = Abortions – total number of  Chloasma Gravidarum –
abortions mask of pregnancy.
L = Living – total number of abortions U – Uterine Enlargement
M = Multiple Birth – total multiple L – Leukorrhea – vaginal
pregnancies. secretions – increased in estrogen
W – Weight changes: 25 to 25
Example: G 6 P 5 lbs entire pregnancy.
PROBABLE SIGNS OF PREGNANCY:
G=6  Are objective so can be documented
T=3 by the examiner. Through more
P = 1 (twins) reliable than presumptive signs, they
A=1 still are not positive or true diagnostic
L=5 findings.
M=1 1. Serum Laboratory Tests –
PRESUMPTIVE SIGNS OF increased HCG (Human Chorionic
PREGNANCY: Gonadotropin)
 Considered the least indicative of 2. Hegar’s sign – softening uterus
pregnancy; taken single entities, they 3. Chadwick’s sign – bluish /
could indicate other conditions. More purplish discoloration of the
of subjective, cannot be used to vaginal walls.
diagnose pregnancy. 4. Goodell’s sign – softening of the
M – morning sickness: nausea cervix
and vomiting 5. Ballottement – tossing of
A – Amenorrhea rebounding of the fetus
C – changes in breast intrauterine.
F – fatigue 6. Evidence of ultrasound of
L – Lasstitude – state of Gestational sac
physical and mental; weariness. 7. Braxton Hicks Contraction –
Lack of energy. painless uterine contraction
U – urinary frequency 8. Fetal outline felt by the
Q – Quickening – fetal examiner.
movement felt at 18th to 20th
week.
S – skin changes:

P a g e 4 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

POSITIVE SIGNS OF PREGNANCY:  Aid in the development of breast

 Absolute indicator of pregnancy duct and secretory system to
1. Evidence on ultrasound of fetal prepare for lactation.
outline. 6th to 8th week fetal
identification positive, PROGESTERONE: Produced in the
earliest positive method of Corpus Lutuem for the first 5th to 8th
diagnosing pregnancy. week, then by the placenta.
2. Fetal heart beat audible: Main functions are:
8th – 12th week heard by  Acting as regulatory mechanism to
Doppler handle increased needs of woman
18th week to 20th week and fetus.
heard through fetoscope.  Causing slight increase in basal
Normal heart rate: 120 – metabolic rate – temperature.
160 bpm.  Causing smooth muscle of uterus to
3. Fetal movement felt by the relax.
examiner about 20th week.  Sustaining pregnancy.
 Causing endocervical glands to
CHANGES/EFFECTS OF PREGNANCY secrete thick mucus, impede sperm
ON BODILY SYSTEM migration.
I. ENDOCRINE SYSTEM  Causes body temperature to increase
PLACENTA: slightly during the 16th week
 Chorion of placenta secretes HCG gestation.
which functions to maintain the
Corpus Lutuem. Aid in diagnosing ANGIOTENSIN: A system in the kidney
pregnancy by detection of maternal increase responses, under the influence
serum and urine. of progesterone. This leads in
 Serum: as early as 8th to 10th day aldosterone production leading to
after a missed menstruation. increased sodium water retention
 Urine: As early as 10th to 14th day that increases blood volume and serves
after a missed menstruation. as a ready nutrients to the fetus.
 Elevation of HCG: Results as
nausea and vomiting. ADRENAL GLAND: Adrenal gland
 Excessive Vomiting: Termed as activity increases in pregnancy as
hyperemesis gravidarum. increased levels of Corticosteriods
and Aldosterone are produced to
ESTROGEN: Produced by the Corpus surpress an inflammatory reaction or to
Lutuem during 5th to 8th week, then by help reduce the possibility of woman’s
placenta. Main functions are: body rejecting the foreign protein of the
 Growth of uterine muscles and fetus as in the case of foreign tissue
ability of uterine muscles to transplant.
contract.
 To release Oxytocin – helps in PROSTAGLANDINGS AND RELAXIN:
uterine contraction increases in level. Prostaglandins are
found in the female reproductive tracts
P a g e 5 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

and deciduas during pregnancy which  Leukorrhea – secretion of vaginal

they affect smooth muscle cells
contractility. Helps maintain normal  Ballotement – rebounding of fetal
blood pressure and prevents head.
preeclampsia.  Ovaries – ovum reproduction ceases
 Placenta – major endocrine organ in
PARATHYROID HORMONE: pregnancy
Production increases during pregnancy  Breasts – increased in size and
as needed for calcium metabolism, firmness. Enlargement of aerola and
being important for fetal growth. nipples. Colostrum = first milk
Important for calcium requirement. produced by the mother. As early 4 to
5 months.
PANCREAS: Islet of Langerhan – III. CARDIOVASCULAR
increased insulin secretions in response SYSTEM
to increased metabolism in pregnancy.  Increased in blood volume by 30 to
50% peaking in the 3rd trimester.
ANTERIOR PITUITARY GLAND: No  Cardiac rate increase by 10 to 15 bpm
ovulation increased follicle stimulating in the 2nd to 3rd trimester.
hormone. Breasts is prepared for  Deliver blood to the uterus to fulfil
lactation with increased prolactin. requirements of placental circulation.
 Varicose veins starts of develops
POSTERIOR PITUITARY GLAND:  Reason: The growing fetus empedes
Oxytocin is produced by the diaphragm and pushed the lungs
Hypothalamus. upward… putting pressure to the
heart.
Fetal head pressure on the  Palpitation in the early pregnancy due
cervix stimulate PPG to secrete to increased pressure from growing
Oxytocin – stimulates uterine fetus.
myometrium – uterine  Blood pressure changes: remains but
contractions – labor onset may drop slightly in the 2nd trimester.
(Aided by the drop of  Inferior vena cava compression. (left
progesterone in late pregnancy). lateral position is the position when
mother is sleeping.
II. REPRODUCTIVE SYSTEM Supine Hypotension or Vena Cava
 Amenorrhea – ovulation is prevented Syndrome – a sudden drop of blood
due to increase of progesterone and pressure causing the mother to feel
estrogen levels. dizzy.
 Goodell’s sign – softening of the
cervix
 Hegar’s sign – softening of the
uterine walls
 Chadwick’s sign – purplish/
darkening of vaginal walls

P a g e 6 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

IV. RESPIRATORY SYSTEM VIII. MUSCOLO-SKELETAL SYSTEM

 Increases in respiration  Backache – a pregnancy progresses.
 Nasal Stuffiness – due to increases  Lordosis – from shift in the center of
estrogen gravity during pregnancy results in
 Difficulty of Breathing – the growing backache and fatigue. The pride of
fetus displaces the diaphragm and the pregnancy walk.
lungs upward thus resulting to  Muscle cramps – from calcium and
increased respiration. phosphorous imbalance and pressure
 Dizziness and light headedness – of the gravid uterus on the nerves
supine hypotension syndrome or vena supplying the lower extremities.
cava syndrome.
V. URINARY SYSTEM HEALTH PROMOTION BEFORE AND
 Increased/urinary frequency. DURING PREGNANCY
Increased in the 1st trimester and 3rd  Establish a baseline of present health
trimester because of uterine pressure. – Prenatal check-up.
 The growing fetus displaces the  Determine the gestation age of the
bladder downward – urinary fetus.
frequency.  Monitor maternal and fetal wellbeing.
VI. GASTROINTESTINAL SYSTEM  Identify the risk of complications.
 Increased in appetite and thirst –  Minimize the risk of possible
25lbs to 35lbs for the entire duration complicatongs by anticipating and
of pregnancy. preventing problems before they
 Heartburn of Pyrosis and Constipation occur.
– the growing fetus pushed the  Procide education about, pregnancy,
intestines side wards and backwards prenatal visits, lactation and newborn
thus metabolism of food intake care.
becomes slower. PRENATAL MANAGEMENT:
 To prevent nausea and  FIRST VISIT: As soon as the mother
vomiting/morning sickness – eat dry has missed a menstrual period when
toast, avoid spicy and greasy food, pregnancy is suspected.
avoid soda and coffee. Eat small  SCHEDULE OF VISITS:
amount frequent feedings. Once a month up to first 32 to
 Flatulence, constipation and 36 weeks
Haemorrhoids. Twice a month every 2 weeks
VII. MMUNE SYSTEM from 32 to 36 weeks
 Decreased immune system – body has Four times a month every week
to adapt to the changes that is caused from 36 to 40 weeks.
by pregnancy. Note: There are women whose
 Immunoglobulin (IgG) are advised to do prenatal
Reproduction is decreased – the check-up closed duration if,
woman is prone to infection. problems may arise during
pregnancy. For close
monitoring.

P a g e 7 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

CONDUCTING OF INITIAL VISIT: DANGER SIGNS OF PREGNANCY:

1. Baseline Data Collection.
2. Obstetrical History – Menarche, LMP,  V – VAGINAL BLEEDING
and Contraceptive method used,  P – PREGNANCY INDUCED
Sexual History. HYPERTENSION
3. Medical and Surgical History – Past Rapid weight gain
illnesses and surgical procedures, Swelling of fingers and face –
current drugs used. particularly on the early
4. Family History – illness of the family trimester
5. Current Problems – activities of daily Flashes of light
living, discomforts and danger signs. Blurring of vision
INITIAL AND SUBSEQUENT VISITS: Severe headache
 Vital signs Decreased urine output
 Weight is checked every visit. A total  P – PERSISTEN VOMITING
of weight gain 25-35lbs with average  A – ABDOMINAL/CHEST PAIN
of 25lbs upper limit to 35lbs.  S – SUDDEN ESCAPE OF FLUEID –
 25-35lbs for the entire duration of premature labor delivery and birth
pregnancy.  I – INCREASED FHT, DECREASED
 1st Trimester: 1lb per month which is FETAL MOVEMENT
3 to 4lbs total.
 2nd Trimester: 1lb per week or LEOPOLD’S MANEUVER
about 10 to 12lbs.  A procedure performed in pregnancy
 3rd Trimester: 1lb per week or about beyond 24th week – 28th up gestation
8 to 11lbs. as fetal outline is viable. This is to
determine the following:
WHAT IS INCLUDED IN THE 25 TO 25 1. Fetal Presentation – fetal part
LBS that comes out (Head) –
 FETUS – 7.5lbs average weight Cephalic Position.
 PLACENTA AND MEMBRANES – 2. Fetal Position – left or right
1.5lbs 3. Fetal Heart Rate – 120 to 160
 AMNIOTIC FLUID – 2lbs beats per minute
 BREAST – 1.5 to 3 lbs 4. Presenting part is engaged
 UTERUS – 2.5lbs or not
 INCREASED BLOOD VOLUME – 2.4lbs
 BODY FATS – 7lbs
DIAGNOSTIC STAGE
 URINE TESTING FOR ALBUMIN
AND SUGAR – diabetic
 PROTEINURIA – ideally more than
1+
 ALBUMIN – negative
 INCREASED IN RESULT: indicates
Gestational Diabetes Mellitus or
Pregnancy Induced Hypertension
P a g e 8 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

NURSING RESPONSIBILITIES PRIOR THIRD MANEUVER: PAWLICK’S GRIP

THE PROCEDURE – DROPPED INTO THE
 Introduce self and explain the PELVIS/ENGAGED HAS BEEN
procedure ACHIEVED.
 Identify the patient  Answers: Where the Presentation
 Gather all equipment at part is. This is to confirm the 1st
bedside/stethoscope Maneuver. Presenting part has
 Woman must empty her bladder. A engaged – head
full bladder this might be mistaken a  Grasp the lower portion of the
fetal head. That give us false positive abdomen just aboce the symphysis
result. pubis.
 Maintain patient on Dorsal  This determines the part of the fetus
Recumbent position. at the inlet and its mobility.
 Maintain privacy  If the presenting part moves upward,
 Wash hands the examiners hand can be pressed
FIRST MANEUVER: FUNDAL GRIP together.
 Answer the question: What is in the  If the presenting part is engaged –
fundus (The Top)? HEAD OR the nurse cannot palpate the
BUTTOCKS. presenting part.
 Finding: Presentation. This
Maneuverer identifies that part of the FOURTH MANEUVER: PELVIC GRIP –
fetus that lies over the inlet into the ENGAGED HEAD HAS DESCENT
pelvis. The most common  Facing the foot part of the patient,
presentations are: Cephalic (head place the fingers on both sides of the
first) and breech (shoulder, abdomen.
buttock, footling first).  Determines fetal attitude and degree
 The nurse faces the patient. of fetal extension into the pelvis.
 Head: hard, globular, mobile
 Buttock: soft less defined ADDITIONAL DANGER SIGNS OF
SECOND MANEUVER: UMBILICAL PREGNANCY
GRIP  Fever – may indicate infection.
 Answer the question: Where is the  Rush of water from the vagina
back?  Epigastric pain – premature uterine
 Finding: Position. Identifies the fetal contraction
back.  Swelling – edema on the early 1st
Remaining facing the patient, trimester
place hands on the sides of the  Absence of fetal movement – fetal
abdomen. demise/fetal death in utero
Back: firm and smooth with resistant  Continuous headache – pregnancy
Extremities, elbow, knees, and induced hypertension (PIH)
fingers: irregular, nodules and knobby.  Persistent vomiting – lead to
dehydrate and fluid and electrolyte
loss.

P a g e 9 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

 Vaginal bleeding – abortions/ o Multigravida – occurs

spontaneous either a day before labor or
 Dimness or blurring of vision – on the day of the labor.
indication of Pregnancy Induced
hypertension ENGAGEMENT: is not exactly the same
 Seizures – severe hypertension as lightening. It is said to be engaged
when the largest diameter of the fetal
INTRAPARTAL PERIOD head passes through the pelvic inlet.
Description:
 A series of physiologic and MC DONALD’S RULE
mechanical processes by which all Measure of the size of the uterus used to
the products of conception: assess fetal growth and development
 Fetus/Placenta/Fetal Membranes during pregnancy
– are expelled from the birth canal.

THEORIES OF WHY LABOR BEGINS:

 The uterine muscle stretches from the
increasing size of the fetus which
results in release of prostaglandins.
 The fetus presses the cervix which
stimulates the release of oxytocin –
produced by estrogen.
 Oxytocin together with
prostaglandin initiate uterine
contraction. Responsible for labor and
delivery.
 Changes in the ration increased
estrogen to decreased
progesterone initiate uterine
contraction.
 Placental Age
 Placenta must come out 15-20
minutes
PRELIMINARY SIGNS OF LABOR

I. LIGHTENING:
 Descent/dipping/dropping of
the presenting part in the true
pelvis.
 Presentation – fetal head
 Onset
o Primigravida – occurs
earliest, 2 weeks before
labor
P a g e 10 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

FETAL GROWTH AND DEVELOPMENT ADDITIONAL SIGNS OF

Estimated Fetal Growth: PRELIMINARY LABOR
 McDonald’s rule – method of VI. RUPTURE OF BAG OF WATER
determining, during mid-pregnancy,
that the fetus is growing in utero by VII. BRAXTON HICK’S
measuring fundal (uterine) height. CONTRACTION – painless labor
 Distance from fundus to symphysis  This may be considered as false
in centimeters is equal to the week labor contraction – irregular / do
of gestation between weeks 20 to not dilate / relieved by walking.
31.
 Measure from the notch of the VIII. INCREASED BACKACHED due to
symphysis pubis to over the top of progressive fetal descent
the fundus with woman lies supine.
 This becomes inaccurate in 3rd TRUE LABOR VS. FALSE LABOR
trimester because the fetus is
growing in weight than height.
CRITERIA TRUE FALSE
 Milestone:
LABOR LABOR
 12 weeks – over symphysis
Contraction Regular Irregular
pubis
(Duration, and and non-
 20 weeks at umbilicus
frequency, progressive progressive
 36 weeks - xiphoid process
interval)
Discomfort Lumbo Confined in
II. INCREASED IN ENERGY /
/ pain Sacral the
BURST OF ENERGY because of
(intensity) Pain – abdomen
hormone epinephrine that result
from the
to NESTING PERIOD.
back
radiating to
III. SLIGHT LOSS OF MATERNAL
the front,
WEIGHT – drop of 2 to 3 lbs, 1 to
groin.
2 days before labor – Normal
Increasing
weight loss
intensity.
Activity/ Intense No effect of
IV. RIPENING OF THE CERVIX/ walking contraction contraction
EFFACEMENT – becomes soft as Cervical Dilated: No cervical
butter Dilatation Most dilatation.
important – Cervix is
cervical still closed.
V. SHOW – blood tinged mucus dilatation
discharge from the cervix shortly progresses:
before or after labor 0-10 cm

TRUE SIGNS OF LABOR

P a g e 11 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

 Uterine Contraction – true labor 3 PHASES OF UTERINE

which is progressing and is CONTRACTIONS – INTENSITY (PAIN
intensifying in terms of pain.
 Show 1. INCREMENT (CRESCENDO) –
 Rupture of mebranes building up of contraction. The first
phase and the longest phase.
TWO MOST IMPORTANT 2. ACME (APEX) – the height/the peak
CONFIRMATION OF TRUE LABOR of the uterine contraction.
ARE: 3. DECREMENT (DECRESCENDO) –
I. Effacement – thinning of the the phase of decreasing contraction.
cervix / buttersoft.
II. Cervical Dilatation – expressed in  Duration – the beginning of the
centimeters during internal increment to the completion of the
examination. Opening or widening decrement of the same contraction.
of the cervix.  Frequency – the period of the time
 10 cm is fully dilated cervix- from the beginning of one contraction
the end of the 1st stage of labor to the beginning of the next
(True Labor and ends with Full contraction.
Dilatation of Cervix)  Interval – the resting period. From
the decrement of the first to
FIVE ESSENTIAL FACTORS IN LABOR increment of the second contraction.
OR CALLED THE 5P’S  Intensity – refers to the strength of
the uterine contraction that causes
I. POWER pain felt by the mother.
 The uterine contractions and the
ability of the mother to push or
bear down during contraction.
 Voluntary: the correct pushing
and bearing own of the mother.
 Involuntary: it happened
anytime. Uterine contractions due
to the release of Estrogen –
Oxytocine – Prostaglandin.
 Effacement and Cervical Dilatation
will progress.
 Dystocia – prolonged painful labor
cause fetal distress.

P a g e 12 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

II. PASSENGER
 The Fetus. The size, presentation,
position of the fetus, fetal attitude and
fetal lie to achieve a normal
spontaneous vaginal delivery.
 The fetal skull has 7 bones: 2 Frontal,
2 Parietal, 2 Temporal and 1 Occipital
 Fontanels:
 Anterior Fontanel (Bregma) –
formed by 2 frontal bones and 2
parietal bones. Diamond shaped. FETAL ATTITUDE
Closes at 12-18 months of age  Relationship of the fetal parts of
 Posterior Fontanel (Lambda) – the trunk or to one another.
formed by union of 2 Parietal and 1. Vertex - good attitude, full
1 Occipital bones. Triangular flexion/complete flexion
shaped, closed at 6 – 8 weeks or 2 - chin touches sternum/spinal
to 3 months of age. cord bend
- arms flexed, folded on chest
2. Brow – partial extension, brow
presentation
3. Sinciput/military/mentum –
moderate flexion. Fetus does not
flex. Chin presentation
4. Face – poor flexion, complete
extension (Face presentation)

FETAL LIFE
 Relationship of the long axis of the
fetal to the long axis of the mother’s
spine.
 Longitudinal Lie – long axis of
the fetus is parallel to the long
axis of the maternal spine.
(Head or Breech)
 Transverse Lie – long axis of
the fetus perpendicular to the
mother’s spine (Shoulder
presentation)

P a g e 13 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

FETAL PRESENTATION: FETAL POSITION

The lowest part in the pelvic inlet, the  Refers to the relationship of the
part that is felt during internal denomination or landmark of the
examination. presenting part to the 4 imaginary
quadrants of the mother's pelvis.
1. Cephalic: Head Presents  LOA (LEFT OCCIPUT
 Vertex: Head acutely flexed. Head is ANTERIOR) - Fetus is born
flexed with chin on chest. fastest
 Sinciput/Mentum: Head moderately  ROA (RIGHT OCCIPUT
flexed ANTERIOR) - Fetus js born
 Brow: head moderately extended fastest
 Face: head acutely extended  LOP (LEFT OCCIPUT
POSTERIOR).
2. Breech  ROP (RIGHT OCCIPUT
 Complete: feet and legs are flexed on POSTERIOR)
thighs, buttocks, and feet presenting.
 Incomplete: Frank, thighs flexed ASSESSMENT OF FETAL POSITION
against the abdomen, legs extending CAN BE MADE BY:
up to the shoulders 1. Leopold's Maneuver
 Footling: single or double 2. Vaginal Examination - Internal
Examination
3. Shoulders: 3. Auscultation of the FHT - Fetal
 Usually referred to as Transverse lie. Heart Tone
Fetal long axis lies Perpendicular to
maternal spine and fetus appears to FETAL STATION:
lie crosswise in the uterus. Shoulders  Floating (High): not engaged
or buttocks.  Station 0: Presenting part at the
level if the Ischial Spines engaged.
 Minus station: presenting part is
above the ischial spines. (Station -1 -
2 -3 -4)
 Plus Station: Presenting part is
below the Ischial spones- outlet.
Descent has been achieved. (Station
+1 +2 +3 +4)

P a g e 14 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

III. PASSAGEWAY  Fear and anxiety affects labor

 Shape and measurement of the progress
maternal pelvis and the birth canal
The mother upon realizing that she is
 True Conjugate: 11-11.5cm pregnant must prepare for labor and
 Diagonal Conjugate: 12.5cm delivery that includes pain brought about
 Pelvimetry - procedure to measure uterine contractions.
the pelvis of the mother.
V. PLACENTAL AGE
TYPES OF PELVIS: Aging... Its role is done. Once fetus is
 Android - male - Never a NVSD expelled, placenta has to be delivered.
 Gynecoid - female - ideal pelvis
 Anthropoid - ape like Sides of the placenta:
 Platypelloid - flat Schultze - shiny and fetal side
and Duncan - Dirty rough
maternal side

30 cotyledons inside. Retention of

these cotyledons - result to severe
bleeding.

MECHANISM OF LABOR. CARDINAL

MOVEMENT

IV. PSYCHE
 The mind-set of the woman
 The state of readiness
 Psychological responses of the
mother

P a g e 15 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

CARDINAL MOVEMENTS:

 Engagement - this is when the

largest diameter of the fetal head
descends into the maternal pelvis.
 Descent - the fetus descends into the
pelvis
 Flexion - the fetal skull has a smaller
diameter which assists passage
through the pelvis
 Internal Rotation - the pelvic floor
has a gutter shape with a forward and
downward slope, encouraging the
fetal head to rotate from left or right
occipito-transverse position a total of
90-degrees.
 Extension - the occiput slips beneath
the suprapubic arch allowing the head
to extend. The fetal head is now born
and will be facing the maternal back
with its occiput anterior.
 Restitution or External Restitution
– head and shoulders are delivered
 Expulsion - the entire body is
delivered.

EXPULSION

P a g e 16 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

MOLDING STAGES OF LABOR

Changes in the shape of the fetal skull
produced by the force of the uterine Stage 1 of Labor
contractions pressing the vertex of the  Cervical dilatation stage. From onset
head against the not yet dilated cervix. of true labor until the full dilatation of
the cervix

FIRST PHASES

A. LATENT PHASE - from 0-3cm

cervical dilation. (4.5 hours in multipara
and 6 hours in Nullipara) in terms of
duration. Mother is still sociable and
excited.

Contraction:
TERATOGENS  Frequency - every 20 minutes
Is any factor chemical or physical that decreasing to every 5 minutes.
adversely affects the fertilized ovum,  Intensity- mild to moderate
embryo or fetus  Duration - 20 to 40 seconds
 Membranes - may be intact or
TORCH ruptured
T = Toxoplasmosis - from uncooked  Normal color of Amniotic Fluid is
meat "Protozoa Toxoplasma Gondii" / Cat clear as water
feces.  Nitrazine Test - if ruptured paper
O = others/Viral Diseases - Lyme turns - blue green or blue gray or
disease - Deer Tick deep gray
R = Rubella - Permanent blindness,  If not ruptured - yellow or olive
facial defects, cleft lip and cleft palate yellow or olive green.
C = Cytomegalovirus - Herpes Family
H = Herpes simplex (Genital Herpes) NURSING INTERVENTIONS
 Record time of onset of contraction
DRUGS: That are not prescribed by  Record cervical dilatation changes
the doctor  Ask for time which food was taken
Must undergo thorough assessment prior  FHR monitoring every 15 minutes
giving medications.  Check maternal vital signs
 Antidepressants  Monitor progress of labor: duration,
 anticonvulsants frequency, intensity and interval.
 alcohol  Reinforce/teach breathing techniques
 analgesics as needed
 narcotics  Support laboring woman/provide
 tranquillizers emotional support.
Note: All medications that the mother
takes must be prescribed by the doctor.

P a g e 17 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

 Monitor signs of ruptured  High risk of injury related to

membranes - note for the color unguarded mothers during labor and
amount and consistency delivery.
 Altered tissue perfusion related to
NURSING DIAGNOSIS dehydration
 Anxiety related to unexpected
outcome of labor and delivery C. TRANSITION PHASE
 Ineffective breathing patterns related  7 TO 10 CM FULLY DILATED.
to anxiety, labor pains
 Pain related to uterine contractions CONTRACTION
 Knowledge deficit - not all mothers  FREQUENCY: EVERY 2-3 MINUTES;
are aware of labor and delivery  INTENSITY: FIRM/VERY STRONG
process.  DURATION: 60-90 SECONDS
 MEMBRANES RUPTURE, BLOODY
B. ACTIVE PHASE SHOW INCREASED, CERVICAL
 4-7 cm (2 hours for multipara and 3-6 DILATATION COMPLETED.
hours for nullipara)  MATERNAL MOOD: IRRITABLE,
AGGRESSIVE AND LOSS OF
Contraction CONTROL.
 Frequency – 3-5minutes apart  TIRED AND UNABLE TO COPE WITH
 Intensity - moderate to firm uterus THE DEMANDS OF LABOR AND
 Duration - 40-60 seconds DELIVERY.
 Cervical changes - effacement of
cervix completed NURSING DIAGNOSIS
 Membranes may be ruptured  Ineffective breathing patterns related
to anxiety/feeling of loss of control
NURSING INTERVENTIONS  Powerlessness - she is not in control
 Progressed of Descent: Fetuses  Individual coping-pain - uterine
descends in pelvis and internal contractions that becomes very
rotation begins intense.
 Monitor Fetal and Maternal Well being
 Provide emotional support NURSING INTERVENTIONS:
 Strict NPO ince in active labor  Continue monitoring progress of labor
 Keep client aware of progress of labor  Maternal and fetal vital signs and well
being
NURSING DIAGNOSIS  Observe for signs of delivery
 Ineffective coping related to  Monitor for signs of dehydration
knowledge deficit about labor and
delivery process.
 Pain related to labor and delivery. As
it progresses.
 Anxiety related to unexpected
outcome of labor and delivery

P a g e 18 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

CERVICAL CHANGES IN THE FIRST THIRD STAGE

STAGE OF LABOR Placental Stage - from the delivery of
the fetus to the delivery of the placenta
1. EFFACEMENT – Shortening and Occur - 15-30 minutes after delivery
thinning of the cervix Crede's Maneuver - gently apply
Primipara - effacement usually well pressure on the contracted uterine
advanced before dilatation begins fundus by the nurse and the doctor
Multipara: effacement and dilatation Ritgen's Maneuver - putting pressure
progress together on the perineum to allow and assist fetal
head to be delivered.
2. DILATATION OF THE CERVIX - full
dilatation is considered 10cm BRANDT’S MANEUVER

SECOND STAGE OF LABOR

Expulsion stage - from full dilatation of

the cervix to the expulsion or delivery of
the fetus.

It is considered the shortest stage of

labor.

Episiotomy is performed. The shortest CREDE’S MANEUVER

this stage and allow passage of fetus.
Crowning takes place

CROWNING - presenting part at which

is the fetal head is visible at the vaginal
opening.

SIGNS OF IMMIMENT DELIVERY:

 Progress of Descent - to complete the
mechanism of labor
 Bulging of the perineum
 Birth of the fetus - for safe delivery
 Note the time/date of delivery
 Continue monitoring maternal and
fetal well being

P a g e 19 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

RITGEN’S MANEUVER NURSING INTERVENTIONS

 Palpate the uterus if “boggy" -
uterus is not contracting massage the
uterus until firm.
 Nipple stimulation - produces
oxytocin that enhances uterine
contractions. Involution of the uterus
- process that the uterus goes back to
its non-pregnant state.
 Uterine Atony - failure of the uterus
to contract resulting to severe
bleeding and death of the mother.
 Vital signs monitoring
 Encourage to urinate - when
bladder is full, it pushes the uterus
sidewards preventing it to contract.
 Check completeness of placental
cotyledons

EXPECTED OUTCOME
SIGNS OF PLACENTAL SEPERATION  Placenta will be delivered without
1. Calkin's sign - earliest sign of complication
placental seperation.  Maternal blood loss will be prevented
2. Change in shape of uterus from  Uterus will contract to prevent uterine
discord to globular - shape of the atony - medical crisis wherein mother
uterus from flat to round will experience blood loss due to
3. Sudden gush of blood failure of the uterus to contract.
4. Lengthening of the umbilical cord  Palpate fundus immediately after
5. Placenta is visible at the vaginal delivery of the placenta massage
opening. gently if not firm
 Palpate fundus every 15 minutes for
TYPES OF PLACENTAL DELIVERY the first 1-2hours.
 Schultze- placentas seperates from  Inspect perineum
the center of the edge fetal side.  Offers fluids as indicated. Only for
Shiny NVSD
 Duncan - placenta separates from
edge to the center
 30 Cotyledons

P a g e 20 | 21
 NCM 107 (LECTURE) – MIDTERM REVIEWER

FOURTH STAGE AVERAGE LENGTH

 Recovery/Puerperium/Postnatal/Postp
artum
 Monitor vital signs PRIMIPARA MULTIPARA
 Check for Lochial discharges Stage 1: 12 -23 Stage 1: 8 hours
 Inspect perineum - signs of infection hours
 Encourage mother to urinate - to Stage 2: 1 hour Stage 2: 20
prevent boggy uterus that is ude to minutes
displace uterus Stage 3: 5-30 Stage 3: 4-5
 May resume diet as tolerated only for minutes minutes
NVSD women Stage 4: 1-2 Stage 4: 1-2
 Monitor signs of infection - hours hours
episiotomy. CS incision site
 Encourage bonding - breastfeeding
and rooming in. Allows uterus to
contract.

DURATION OF LABOR: SUCCESSFUL

LABOR AND DELIVERY

A. DEPENDS ON
 Regular progressive uterine
contraction
 Progressive effacement and
dilatation of cervix
 Progressive descend on
prensenting part

P a g e 21 | 21