Handout Ob 1

NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*MIDWIFERY*MEDTECH
LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM

NCLEX*DHA*HAAD* PROMETRIC* UK-CBT
RETARDATION)
o NITRIC OXIDE (VASODILATOR)
MATERNAL AND CHILD - MODIFY PLACENTAL BLOOD FLOW
- INCREASES VASCULAR TONE
NURSING - INCREASES EMBRYONIC
DEVELOPMENT AND IMPLANTATION
- 12 WEEKS BELOW AOG: PELVIC
REFRESHER ORGAN/SYMPHYSIS
ORGANS: - @ 12 WEEKS AOG:
A. OVARIES - PRODUCE ESTROGEN AND INTRAABDOMINAL ORGAN
PROGESTERONE o DEXTROROTATION: UTERUS TO
FUNCTION: MAX  6-7 WEEKS AOG THE RIGHT BECAUSE OF PRESENCE
- SURGICAL REMOVAL BEFORE 7 OF SIGMOID COLON
WEEKS AOG = SPONTANEOUS - BLOOD FLOW: 450-650 ML/MIN
ABORTION (LATE PREGNANCY)
*** PCOS- MENSTRUAL IRREGULARITY - FAST METABOLISM: FIRST
AND HIRSUTISM; CONFIRM: TRIMESTER (ORGANOGENESIS)
ULTRASOUND; UNTREATED: DM (10 D. CERVIX
YEARS) - NO NERVE ENDINGS
B. FALLOPIAN TUBES - IUD- COPPER: SPERMICIDE;
- SITE OF FERTILIZATION PLACED DURING MENSTRUATION OR
- PERISTALTIC MOVEMENT  RIGHT AFTER
TRAVEL TO UTERUS AT 1 WEEK  o IUD: IT PROVIDES LOCAL
IMPLANTATION STERILE INFLAMMATION PREVENTING
- MINIPILL: SLOW DOWN IMPLANTATION
PERISTALTIC MOVEMENT OF E. VAGINA
FALLOPIAN TUBE = ECTOPIC - RAPE: KEEP EVIDENCE IN PAPER
PREGNANCY BAG (CLOTHES, UNDERWEAR ETC),
C. UTERUS SOAKED CLOTHES – AIR DRY AS IS
- PEAR SHAPED o HYMEN: SUPER THIN TISSUE
- CONTROL OF UTEROPLACENTAL o FORCED ENTRY: LACERATION IN
BLOOD FLOW MEDIOLATERAL POSITION (7 & 5
o CATECHOLAMINES O’CLOCK)
(VASOCONSTRICTOR) – DECREASES
PLACENTAL PERFUSION
o ANGIOTENSIN II- INCREASES
SEGMENTS OF FALLOPIAN TUBE:
UTEROPLACENTAL BLOOD FLOW =
1. INTRAMURAL INTERSTITIAL
LOW BP  RELEASE RENIN  BY VASA
- EMBODIED W/IN THE MUSCULAR WALL
RECTA (JUXTOGLOMERULAR CELLS) –
OF UTERUS
KIDNEY  ACTS ON
- 2% OF ECTOPIC PREGNANCY
ANGIOTENSINOGEN (LIVER)
2. ISTHMUS
ANGIOTENSIN I (WEAK)
- NARROW PORTION
CONVERTED BY ACE (LUNGS)
- 12% OF ECTOPIC PREGNANCY
ANGIOTENSIN II (POTENT
3. AMPULLA
VASOCONSTRICTOR)  INCREASE BP
- WIDEST AND MOST TORTUOUS AREA
 ACE INHIBITOR NOT GIVEN TO
- 80% OF ECTOPIC PREGNANCY; COLD
PREGNANT: TERATOGENIC EFFECT
COMPRESS
(RENAL DYSPLASIA, HYPOTENSION,
4. INFUNDIBULUM
INTRAUTERINE GROWTH
TOP RANK REVIEW ACADEMY

- o L- LSH
FIMBRIATED EXTREMITY  INC ESTROGEN, INC
- TUNNEL SHAPED OPENING PROGESTERONE
- 5% OF ECTOPIC PREGNANCY o F- FSH
 INC ESTROGEN
MENTRUAL CYCLE o MSH (MELANIN)
 OVARIAN CHANGES  DARK PIGMENT
o PREOVULATORY PHASE  GLUTA DESTROYS
 SECRETION OF FSH TYROSINE
 ESTROGEN IS PRODUCED BY ***PKU – ABSENCE OF PHENILALANINE
FOLLICLE HYDROXYLASE  KETONES ACCUMULATE
 ESTROGEN STIMULATES LH NORMAL: PHENYLALANINE  USES
PRODUCTION PHENILALANINE HYDROXYLASE TO CONVERT
 FOLLICLE RUPTURES AND TOTYROSINE
RELEASES IT INTO THE MANIFESTATION: DECREASED PIGMENT
PERITONEUM
 PITUITARY GLAND - MASTER GLAND OXYTOCIN – LOOK FOR WATER INTOXICATION
o G-GROWTH HORMONE
 EPIPHYSEAL PLATE (F: 13-15; MENARCHE- REQUIRES 10% FAT
M: 15-19)
 OPEN- GIGANTISM CYCLE OF MENSTRUATION:
 CLOSED- ACROMEGALY
(HORIZONTAL) ***ESTROGEN STIMULATES PROLIFERATIVE
 DOC: ACTREOTIDE *** PROGESTERONE CAUSES THICKENING
o T- THYROID STIMULATING DYSMENORRHEA – CAUSED BY SPIRAL
HORMONE ARTERIES (TWIST THAT GIVE PAIN)
 INCREASE =
HYPERTHYROIDISM (INC T3
AND T4 = INC BASAL
METABOLIC RATE  HEAT
INTOLERANT
 DECREASE =
HYPOTHYROIDISM (DEC T3
AND T4 = DEC BASAL
METABOLIC RATE  COLD
INTOLERANT
o P- PROLACTIN
 MILK PRODUCTION
o A- ADRENOCORTOCOTROPIC
HORMONE (ACTH)
 SUPREADRENAL GLAND:
GMA (GLUCOCORTICOID
(SUGAR),
MINERALOCORTICOID
(ALDOSTERONE 
REGULATES SODIUM 
WATER RETENTION INC BP
), ANDROGEN (SEX))

FERTILIZATION AND IMPLANTATION

o LUTEAL PHASE  FERTILIZATION
 BEGINS WITH OVULATION o X – SLOW SWIMMER, LONG LIFE
 CORPUS LUTEUM IS FORMED SPAN, FAVOR ACIDIC
 CORPUS LUTEUM SECRETES ENVIRONMENT
ESTROGEN AND PROGESTERONE o Y- FAST SWIMMER, SHORT LIFE
 CL DEGENERATES IF THE OVUM IS NOT SPAN, FAVOR ALKALINE
FERTILIZED AND SECRETION OF ENVIRONMENT
ESTROGEN AND PROGESTERONE XX- FEMALE
DECLINES XY- MALE
o UTERINE CHANGES *DOUCHE- AFFECTS BABY
 MENTRUAL PHASE BABY GIRL- DOUCHE WITH VINEGAR
 CONSIST OF 4-6 DAYS OF BLEEDING (DILUTE; 1 TBSP TO 1 LITER OF WATER THEN
 FSH RISES ENABLING THE BEGINNING WASH)
OF A NEW CYCLE BABY BOY- DOUCHE WITH BAKIND SODA
o PROLIFERATIVE PHASE/FOLLICULAR (DILUTE THEN WASH WITH WATER)
 LASTS FOR 9 DAYS *FOREPLAY- THE LONGER THE
 ESTROGEN STIMULATES FOREPLAY, MOST LIKELY BABY GIRL
PROLIFERATION OF ENDOMETRIUM WET = ACIDIC
 AS ESTROGEN INCREASES, IT *POSITION – DEEP PENETRATION
SUPPRESSES FSH PRODUCTION AND CLOSER THE DISTANCE = BABY GIRL;
LH IS PRODUCED NOT Y BECAUSE SHORT LIFE SPAN
 LH STIMULATES OVULATION AND *TWINS – GOOD OXYGENATION
DEVELOPMENT OF A CORPUS LUTEUM 1. WARM BATH – 30 MINS
 ESTROGEN IS HIGH AND PROGESTERONE 2. LEFT SIDE – FEMALE; RIGHT SIDE – MALE; L
IS LOW SIDE TO NOT COMPRESS VENA CAVA
o SECRETORY 3. SSD- SHALLOW SHALLOW DEEP
 LASTS FOR 12 DAYS PENETRATION
 FOLLOWS OVULATION
 INITIATED BY INCREASE IN LH  IMPLANTATION
 CORPUS LUTEUM IS PRODUCED
 CORPUS LUTEUM SECRETED  EMBRYONIC STAGE
PROGESTERONE AND ESTROGEN o WEEK 1- FREE FLOATING BLASTOCYST
 PROGESTERONE PREPARES THE o WEEK 2-3 – BEGINNING OF CIRCULATION;
ENDOMETRIUM FOR PREGNANCY
HEART IN TUBULAR SHAPE
o WEEK 4- DOUBLE HEART CHAMBERS
FOLLICLE PROFILE VISIBLE; LIMB BUDS
AT BIRTH – 2 MILLION OOCYTES
o WEEK 8- EVERY ORGAN SYSTEM IS
PUBERTY- 400,000 FOLLICLES
PRESENT; EYELIDS BEGAN TO FUSE
DEPLETION RATE (PUBERTY TO 35 Y.O)-
 INCREASE METABOLISM- FIST TRIMESTER
1,000 FOLLICLES PER MONTH
DUE TO ORGANOGENESIS
TOTAL FOLLICLES DUREING
o WEEK 12- FACE WELL FORMED; KIDNEY
REPRODUCTIVE STAGE – 400 FOLLICLES
BEGIN TO FORM URINE; SPONTANEOUS
ATRESIA (APOPTOSIS)- 99.99%
MOVEMENT OCCUR; HEAR TONES
*AGE 21-29- PRODUCE PRIME GENES
DETECTED ON ELECTRONIC DEVICES
FROM 8-12 WEEKS; SEX RECOGNIZABLE
(TURTLE SIGN – MALE)

 EARS 2. I- INVOLUTION – RETURN T PRE-

SAME TIME PREGANANT STATE
 LAYER: 3. R- RISING OF FUNDUS
o ECTODERM – CNS AND PNS; 4. L- LENGTHENING OF CORD
SENSOR ORGANSOF SEEING AND
HEARING; INTEGUMENT KAYER PLACENTA
o ENDODERM – LINING OF GIR AND - DEVELOPS IN THE THIRD MONTH
RESPIRATORY TRACT - DEPENDENT ON MATERNAL
o MESODERM- MUSCLE, CARTILAGES, CIRCULATION
CVS, UROGENTIAL SYSTEM, RBC - BACTERIA CANNOT PASS THROUGH
 EMBRYONIC PERIOD PELVIC TYPE

o CNS- FIRST TO DEVELOP AND  ANTERIOR – DICTATES THE TENDENCY
CONTINUES POST NATAL OF PELVIS
o HEART – COMPLETED BY 8 WEEKS  POSTERIOR – DICTATES THE
o UPPER LIMB- COMPLETED BY 8
WEEKS
o LOWER LIMB- COMPLETED BY 8
WEEKS
o EXTERNAK GENITALIA-
COMPLETED BY 9 WEEKS
*60% INTELLIGENCE – FROM MOM
FETAL ENVIRONMENT
 AMNION
-
ENCLOSES THE AMNIOTIC CAVITY
 CHORION
- OUTER MEMBRANE
- FORMS THE FETAL PART OF THE
PLACENTA
 AMNIOTIC FLUID
- 500-1000 ML
- POLYHYDRAMNIOS =
ESOPHAGEAL ATRESIA TYPE/CHARACTER OF THE PELVIS
- OLIGOHYDRAMNIOS = RENAL o GYNECOID – ROUND SHAPED
AGENESIS; CAN CAUSE BREECH
- 32 WEEKS AOG – TURN TO FETAL CIRCULATION
CEPHALIC - UMBILICAL CORD (AVA)
- NORMAL:
- FETAL HEART RATE – INTRAUTERINE:
o 12 WEEKS = 60 ML
120-160 BPM; AT BIRTH: 110-150
o 34-36 = 1L - FETAL CIRCULATION BYPASS
o TERM= 840 ML o DUCTUS ARTERIOSUS
o 42 WEEKS = 540 ML o DUCTOS VENOSUS
*DIRTY – DUNCAN, MATERNAL o FORAMEN OVALE
SHINY- SCHULTZ, FETAL
 SIGNS OF PLACENTAL SEPARATION: EXTRAUTERINE CIRCULATION
1. G- GUSH OF BLOOD

 PRIMARY – CHANCRE SORES

SUPERIOR AND INFERIOR VENA CAVA  (PAINLESS ULCER - DAMAEG
RIGHT ATRIUM  TRICUSPID VALVE  NERVE ENDINGS)
RIGHT VENTRICLE  PULMONIC VALVE   SECONDARY – WART-LIKE 
PULMONAR ARTERY LUNGS  CONDYLOMA LATUM
PULMONARY VEIN  LEFT ATRIUM   TERTIARY – SAC-LIKE (HAS
MITRAL VALVE  LEFT VENTRICLE  SPIROCETES INSIDE) 
AORTIC VALVE  AORTA  SYSTEMIC GUMMAS
CIRCULATION o GENITAL HERPES
MITRAL VALVE – AFFECTED IN RHEUMATIC  BLISTER
HEART DISEASE  HSV1 – ABOVE WAIST
 HSV2- BELOW WAIST
INTRAUTERINE CIRCULATION *VARICELLA ZOSER (CHICKEN POX)  HEALS
INFERIOR VENA CAVA (BYPASS LIVER)  RA THEN VIRUS STAYS AT DORSAL HORN
 FORAMEN OVALE  TV  RV PULMONIC (TRANSMITTING SENSATIONS)  PUYAT AND
VALVE  PULMONARY ARTERY  DUCTUS IMMUNOCOMPROMISED  HERPES ZOSTER
ARTERIOSUS  AORTA SYSTEMIC (SHINGLES): ZEBRA LIKE SKIN RED STRIPES,
CIRCULATION UNILATERAL
o GONORRHEA
OBSTETRICAL ASSESSMENT  DISCHARGE
 GESTATION  HIV
o NAEGELE’S RULE (-3+7+1)  SUBSTANCE ABUSE
 FIRST DAY OF LMP o CAUSE ABORTION
 GRAVIDITY AND PARITY
o GRAVIDITY PHYSIOLOGICAL CHANGES IN PREGNANCY
 GRAVIDA  UTERINE CHANGES
 GRAVIDITY  CERVICAL CHANGES
 NULLIGRAVIDA  VAGINAL CHANGES
 PRIMIGRAVIDA  OVARIAN CHANGES
 MULTIGRAVIDA  BREAST CHANGES
o PARITY – NUM OF DELIVERY  SYSTEMIC CHANGES – FROM 4.5-5.5 CC
 PARITY TO 7 L = PSEUDOANEMIA (DILUTION OF
 NULLIPARA – NEVER BEEN PREG OR BEEN BLOOD)
PREG BUT DID NOT REACH AGE OF  INTERGUMENTARY SYSTEM CHANGES –
VIABILITY CHOLASMA/MELASMA, LINEA NIGRA
 PRIMIPARA  RESPIRATORY/CARDIOVASCULAR
 MULTIPARA SYSTEM- INC HEART RATE, NASAL
o G- NUM OF PREG CONGESTION (NOT TO TAKE
o T- PREG THAT REACH 37-41 WEEKS ANTIBIOTIC/NASAL DECONGESTANT)
o P-20-36 WEEKS  GI – CONSTIPATION
o A- BELOW 20 WEEKS  URINARY SYSTEM – UTI
o L- LIVING CHILDREN AT PRESENT  ENDOCRINE SYSTEM – INC GMA
o GDM – MOM HAS ANTI-INSULIN
EFFECT  INC GLUCOSE IN
MATERNAL RISK FACTORS:
BLOOD  INC INSULIN IN BABY =
 GERMAN MEASLES (RUBELLA)
MACROSOMIC BABY,
 STD
HYPOGLYCEMIC (JITTERY),
o SYPHILIS

MANIFESTATIONS:
HYPOCALCEMIA (INSULIN o OVERGROWTH OF UTERUS
RELEASE USES CALCIUM) o HIGH POSITIVE HCG
o NO FETUS PRESET IN
FIRST TRIMESTER BLEEDING: SOSNOGRAM
 ABORTION (BELOW 20 WEEKS AOG) o VAGINAL BLEEDING WITH CYST
o SPONTANEOUS – OPEN CERVIX FORMATION
o THREATENED – CERVIX IS CLOSED MANAGEMENT:
o INEVITABLE – OPEN CERVIX o MOLE XTRACTION
o INCOMPLETE/COMPLETE – o HCG ANALYSIS
EXPULSION o NO PREGNANCY FOR 1 YEAR-
o MISSED – DEATH IN UTERUS MONITOR HCG
CAUSES: o METHOTREXATE
 TERATOGENIC FACTOR:  PREMATURE CERVICAL DILATION OR
ISOTRETINOIN (ACUTANE) INCOMPLETE CERVIX
 COCAINE MANIFESTATIONS:
MANIFESTATIONS: o PAINLESS CERVICAL DILATION
 VAGINAL SPOTTING o PINK-STAIN VAGINAL DISCHARGE
 SLIGHT CRAMPING o INCREASED PELVIC PRESSURE
 NO APPARENT LOSS IN o RUPTURE MEMBRANE
PREGNANCY
o DISCHARGE OF AMNIOTIC FLUID
 INCOMPLETE/COMPLETE EXPULSIN
MANAGEMENT:
OF UTERINE CONTENTS
o MODIFIED TRENDELENBURG
MANAGEMENT:
o CERVICAL CERCLAGE
 PROGESTERONE
 DILATION AND CURETTAGE o MCDONALD PROCEDURE –
 BED REST TYING OF CERVIX AT 37 WEEKS
 PROSTAGLANDIN SUPPOSITORY OR (VAGINAL DELIVERY)
MISOPROSTOL (CYTOTEC)/ISELPIN o SHIRODKAR PROCEDURE –
– MISSED ABORTION TYING OF CERVIX
 OXYTOCIN PERMANENTLY (CS)
THIRD TRIMESTER BLEEDING
 ECTOPIC PREGNANCY  PLACENTA PREVIA
MANIFESTATIONS: TYPES:
o NAUSEA AND VOMITTING o LOW-LYING PLACENTA – LOWER
o VAGINAL BLEEDING PORTION OF UTERUS
o SHARP STABBING PAIN IN LOWER o MARGINAL IMPLANTATION –
ABDOMINAL QUADRANT APPROACHES CERVICAL OS
o CULLEN’S SIGN o PARTIAL PLACENTA PREVIA –
MANAGEMENT: COVER A PORTION OF CERVICAL
o METHOTREXATE – ATTACK FAST OS
GROWING CELLS o COMPLETE PLACENTA PREVIA-
o LEUCOVORIN - ANTIDOTE COVER THE CERVICAL OS
o MIFEPRISTONE TOTALLY
MANIFESTATIONS:
o LAPAROSCOPY
o ABRUPT, PAINLESS, BRIGHT RED
SECONG TRIMESTER BLEEDING
VAGINAL BLEEDING
 GESTATIONAL TROPHOBLASTIC
o PREMATURE LABOR
DISEASE (HYDATIDIFORM MOLE)

o SHORT TERM MANAGEMENT:

o NO FETAL HEAD ENGAGEMENT CRYOPRECIPITATE (CLOTTING
FACTORS)  STOP FURTHER
MANAGEMENT: COAGULATION TEMPORARILY
o BEDREST AND SIDELYING POSITION o BEST MANAGEMENT: TREAT
FOR 48 HRS -EMERGENCY THE CAUSE
o ASSESS DURATION OF MANAGEMENT:
PREGNANCY, TIME BLEEDING HAS o FLUID REPLACEMENT
BEGAN, ESTIMATION OF BLOOD o OXYGEN
LOSS, COLOR OF BLOOD IF SHE o SIDE LYING
INSERTED TAMPON o IF DIC = CRYOPRECIPITATE
o USE OF APT OR KLEIHAUR-BETKE
TEST – DETERMINE IF FETAL OR DECELARATION OF FETAL HEART RATE:
MATERNAL BLOOD EFLUVC
o NEVER DO RECTAL EXAM TO 1. EARLY – FETAL HEAD COMPRESSION 
CLIENT WITH PAINLESS VAGINAL LEFT SIDE LYING
BLEEDING - STRAINING 2. LATE- UTEROPLACENTAL
o ASSESS BP INSUFFICIENCY  O2
o BETAMETHASONE – 24 HRS APART 3. VARIABLE- CORD COMPRESSION 
2 DOSES LEFT SIDE LYING
 PREMATURE SEPARATION OF
PLACENTA (ABRUPTIO PLACENTAE)
TYPES:
o PARTIAL SEPARATION
o CONCEALED
o APPARENT
o COMPLETE SEPARATION
CAUSES:
o HIGH PARITY
o ADVANCE MATERNAL AGAE
o SHORT UMBILICAL CORD
o DIRECT TRAUMA
o COCAINE AND CIGARETTE USE –
VASOCONSTRICTION
MANIFESTATION
o SHARP STABBING PAIN HIGH IN
THE UTERINE FUNDUS
o TENSE RIGID OR BOARDLIKE
ABDOMEN
o COUVELAIRE UTERUS
(UTEROPLACENTAL APOPLEXY) –
AREA WHERE UTERUS DETACHED
WILL POOL BLOOD  RUPTURE
o DISSEMINATED INTRAVASCULAR
COAGULATION – KALAT KALAT
CLOT; CAUSE: MASSIVE BLEEDING
 FORM CLOT

INTENSIVE EARLOBE
c. DURING LABOR- SOFT AS
BUTTER
PREGNANCY 4. HCG: + PREG TEST
5. B- BRAXTON HICKS: PAINLESS,
1ST: ORGANOGENESIS - CRITICAL IRREGULAR CONTRACTION
- CATEGORY A DRUGS (SAFE IN 6. B- BALLOTEMENT: BOUNCING OF
PREGNANCY): PARACETAMOL ETC FETUS, TEST FOR ENGAGEMENT
- DEVELOPMENT OF GERM LAYERS:
ECTODERM (BRAIN), MESODERM POSITIVE (CONFIRM)
(HEART), ENDODERM (GI) 1. UTZ
- AMBIVALENCE (OPPOSING FEELINGS) a. TRANSVAGINAL- EARLY; MUST
VOID (FULL
2ND: MOST COMFORTABLE/EASIEST PART BLADDER=DISCOMFORT)
b. ABDOMINAL- LATE; MUST
- INCREASED LIBIDO DRINK (ABDOMINAL
DISTENTION=PUSH UTERUS)
3RD: FEELINGS OF UNATTRACTIVENESS 2. FHT: NORMAL: 120-160 BPM (LESS:
(DECREASED SELF ESTEEM) BRADY; MORE TACHY) - CONTINUE
MONITORING, CAN BE A SIGN OF
S/S FETAL DISTRESS
3. MFE (MOVEMENT FELT BY EXAMINER)
PRESUMPTIVE (SUBJECTIVE)
1. B- BREAST CHANGES: SLIGHT S/Sx:
ENLARGEMENT
2. A-AMENORRHEA 1. LIGHTENING: ENGAGEMENT; PAGBABA
3. U-URINARY CHANGES: DUE TO NG FETAL HEAD TO MATERNAL PELVIS
COMPRESSION OF BLADDER 2. BRAXTON HICKS (PAINLESS,
4. N-NAUSEA & VOMITING: CLASSIC IRREGULAR)
SIGN (METABOLIC ALKALOSIS) 3. BALLOTTEMENT
5. Q-QUICKENING: MOVEMENT FELT BY 4. MONTGOMERY’S TUBERCLE: SEEN IN
MOTHER; AT 5 MONTH BREAST, DOT BESIDE AREOLA;
6. C-CHLOASMA/MELASMA: MASK OF LUBRICATES BREAST DURING FEEDING
PREGNANCY, HANGGANG NECK 5. MELASMA/CHLOASMA
ONLY 6. LINEA NIGRA:BLACKISH = ONLY
LIGHTENS AFTER PREGNANCY (LINEA
ALBA- WHITISH)
PROBABLE (OBJECTIVE)
1. H-HEGAR SIGN: THINNING OF
UTERUS, FOR EFECTIVE ADAPTATIONS IN PREGNANCY:
CONTRACTION
2. C-CHADWICK SIGN: BLUISH VAGINA, A. CARDIOVASCULAR CHANGES:
PRESSURE BELOW; RETURN TO a. INCREASE IN TOTAL CARDIAC OUTPUT
NORMAL, PINKISH b. PALPITATIONS: SHOULD BE
3. G-GOODLE SIGN: SOFTENING OF TEMPORARY
CERVIX, FOR FETUS TO PASS c. EDEMA: LOWER EXTREMITIES/BIPEDAL
a. NON-PRENANT- LIKE NOSE :NORMAL; UPPER
b. PREGNANT - SOFT AS EXTREMITIES/ANASARCA

a. INCREASE URINARY FREQUENCY

(GENERALIZED)/ FACIAL/PERIORBITAL: – NAIIPIT BLADDER
ABNORMAL → PIH b. DECREASE URINARY
d. VARICOSE VEINS: OVERWORKED VEINS THRESHOLD
i. HOMAN’S SIGN: DORSIFLEXION OF E. MUSCULOSKELETAL CHANGES
FOOT → PAIN IN CALF MUSCLE → a. LORDOSIS – PRIDE OF
POSITIVE HOMAN SIGN PREGNANCY
1. NO MASSAGE i. LOW HEEL SHOES WITH
2. ELEVATE GRIP
3. RISK FOR DVT: VIRCHOW’S TRIAD b. LEG CRAMPS – PRESSURE IN
a. VENOUS STASIS- WEAR LOW EXTREMITIES
ANTIEMBOLIC STOCKINGS F. TEMPERATURE
b. VENAL WALL DAMAGE a. INCREASE IN TEMPERATURE –
c. BLOOD COAGULATION) INCREASE BASAL METABOLIC
B. GASTROINTESTINAL CHANGES RATE, TO PRODUCE GLUCOSE
a. MORNING SICKNESS → G. ENDOCRINE CHANGES
HYPOGLYCEMIA (KINUKUHA a. THYROID GLAND – MODERATE
GLUCOSE WHEN ASLEEP) ENLARGEMENT
i. OFFER SIMPLE CARBS (CHO) - - RELEASE CALCITONIN (CA
CRACKERS, DRY TOAST; BEFORE ENTER THE BONE)
GETTING OUT OF BED - RELEASED BY MOTHER FOR
b. HYPEREMESIS GRAVIDARUM: BABY; HELPS CALCIUM TO
EXCESSIVE VOMITING DURING ENTER BABY’S PLACENTA=
PREGNANCY; CAUSED BY HCG BRITTLE BONES,
i. SMALL FREQUENT FEEDING- OSTEOPOROSIS, TOOTH DECAY
MORE FOOD,MORE PRESSURE =
PROJECTILE b. PARATHYROID GLAND –
c. CONSTIPATION AND FLATULENCE - INCREASED SIZE
GRAVID UTERUS INC PERISTALSIS - PARATHORMONE (EXITS CA IN
i. INCREASE FIBER: STIMULATES BONE)
PERISTALSIS - RELEASED BY MOTHER FOR
ii. INCREASE ORAL FLUID INTAKE: MOTHER
SOFTEN STOOL AND ENHANCE
DIGESTIONS H. ADRENAL GLANDS
d. HEMORRHOIDS a. INCREASE SIZE AND ACTIVITY =
i. INTERNAL - ASYMPTOMATIC SYMPATHETIC
ii. EXTERNAL - PAINFUL, LOCATED I. SKIN
IN ANAL SPINCTER a. MELASMA/CHLOASMA – MASK OF
1. Sitz bath +WITCH HAZEL PREGNANCY
(ASTRINGENT) b. LINEA NIGRA  LINEA ALBA
C. RESPIRATORY CHANGES c. STRIAE GRAVIDARUM – USE
a. SOB – LIMITED DIAPHRAGMATIC COCOA BUTTER (ENHNACES
EXPANSION COLLAGEN  DECREASE
i. LEFT SIDE LYING SCARRING)
POSITION –OPEN VENA J. UTERUS
CAVA = INCREASE a. HEGAR’S – THINNING OF THE
CARDIAC OUTPUT  INC UTERUS
OXYGENATION K. CERVIX
D. URINARY CHANGES a. GOODELL’S – SOFTENING

L. VAGINA TERM
a. CHADWICKS – BLUISH/PURPLISH
DISCOLORATION MEMBRANES
b. LEUKORRHEA (VAGINAL a. CHORION: OUTER
SECRETIONS) – PROTECTS b. AMNION: INNER
VAGINA FROM PATHOGENS LIKE - AMNIOTIC FLUID: 500-1000 ML
UTI (CAUSE PRETERM LABOR)  <500: OLIGOHYDRAMNIOS
*WBC: UNANG LUMALABAS - PROB: KIDNEY
(Never Let Monkeys Eat Bananas)  >1000: POLYHYDRAMNIOS
NEUTROPHILS - PROB: ESOPHAGUS
LYMPHOCYTES - TEF-
MONOCYTES TRACHEOESOPHAGEAL
EOSINOPHILS FISTULA
BASOPHILS - ESOPHAGEAL ATRESIA
*CHRONIC LYMPHOCYTES (FAILURE TO DEVELOP)
*ACUTE  FUNCTIONS:
NEUTROPHILS/SEGMENTERS - PROTECTION
*GRANULOCYTES – BEN - TEMP REGULATION
10 (K) - SUPPORTS GROWTH
c. VAGINAL pH – SLIGHTLY ACIDIC - FETAL MOVEMENT
(5.5-6.5) UMBILICAL CORD
M. WEIGHT CHANGES - NORMAL: AVA
a. 1ST – 1.5-3 LBS - VAV = CONGENITAL HEART
b. 2ND – 10-11 LBS DEFECTS
c. 3RD – 10-11 LBS - WHARTON’S JELLY PROTECTS
TOTAL WEIGHT GAIN: 20-30 LBS
ANTEPARTUM CARE
N. PSYCHOLOGICAL TASK - CARE GIVEN BETWEEN
a. 1ST – ACCEPT PREGNANCY CONCEPTION TP ONSET OF
(AMBIVALENCE IS PRESENT) LABOR
b. 2ND - ACCEPT THE BABY INCLUSIONS:
(FANTASIZE) A. FETAL WELL BEING
c. 3RD – PREPARING FOR a. AUSCULTATION
PARENTHOOD i. 3 MONS – DOPPLER
(RESPONSIBILITIES) ii. 4 MONS – FETOSCOPE
iii. 5 MONS – STETHOSCOPE
STAGES OF FETAL DEVELOPMENT: - NORMAL FHT 120-160 BPM
1. FERTILIZATION (AMPULLA) 
IMPLANTATION (UTERUS/UPPER UTERINE - FUNDIC SOUFFLE – SOUND
SEGMENT) FROM UMBILICAL CORD;
CONCEPTUS PERIOD - ELECTRONIC FETAL HEART
OVUM OVULATION
MONITORING
FERTILIZATION
NON-STRESS STRESS TEST
ZYGOTE FERTILIZATION 
TEST
IMPLANTATION
- ACCELERATION - ABNORMAL
EMBRYO IMPLANTATION  8
(NORMAL) - TRIGGER CONTRACTION
WEEKS
RULE 15X15 – 15 (NIPPLE
FETUS 8 WEEKS  FULL BEATS INCREASE STIMULATION/OXYTOCIN)

- CEPHALIC, BREECH,
FOOTLING,
IN 15 SEC - INVASIVE (CONSENT) TRANSVERSE, FACIAL
DURATION - DECELERATION (EARLY 2ND UMBILICAL FETAL BACK – PMI
LATE VARIABLE) GRIP (POINT OF MAXIMUM
*REACTIVE – 1. EARLY – HEAD IMPULSE)
NORMAL; GOOD COMPRESSION DETERMINE FHT
*NON-REACTIVE – 2. LATE – 3RD PAWLICKS ENGAGEMENT/STATIONS
BAD; PROCEED UTEROPLACENTAL GRIP - 3: FLOATING
TO STRESS TEST INSUFFICIENCY -2:FLOATING
3. VARIABLE – CORD -1
COMPRESSION 0: ENGAGED
+1
RESULTS: +2: CROWNING
1. POSITIVE: BAD  +3: CROWNING
PHYSICIAN 4TH PELVIC GRIP ATTITUDE/ORIENTATION
2. NEGATIVE: GOOD - FLEX
b. AMNIOCENTESIS b. CLEAN CATCH URINE/MID STREAM

- EVALUATE FETAL MATURITY AND URINE
CERTAIN DEFECTS - METHOD OF COLLECTING URINE
- AFP SAMPLE (ALPHA SAMPLE
FETOPROTEIN) - PURPOSE: UTI
 INCREASED – NEURAL 1. FIRST STREAM – DISCARD
TUBE DEFECTS (CONTAMINATED)
 DECREASED – DOWN 2. MIDDLE STREAM – USE
SYNDROME c. PAPANICOLAU SMEAR/PAP SMEAR
- DETECT CERVICAL CANCER
B. MATERNAL WELL BEING 1. CLASS I: NORMAL
DIAGNOSTIC PROCEDURE: 2. CLASS II: INFLAMMATION
a. ULTRASOUND 3. CLASS III: MILD TO MODERATE
- TO DIAGNOSE DYSPLASIA
PREGNANCY 4. CLASS IV: PROBABLY MALIGNANT
- CONFIRMS SEX 5. CLASS V: POSSIBLY MALIGNANT
- CONFIRM GROWTH AND
ABNORMALITIES CERVICAL CA MANAGEMENT:
- FETAL MATURITY 1. CHEMOTHERAPY
2. UPERA (OPERA)
ii. CONSIDERATIONS 3. RADIATION
- TRANSVAGINAL: EARLY, 4. EMOTIONAL SUPPORT
VOID/EMPTY BLADDER
- ABDOMINAL: LATE, DRINK
3-4 GLASSES OF WATER
(ABDOMINAL DISTENTION)
DISCOMFORTS OF PREGNANCY
LEOPOLD’S MANEUVER – URINATE/EMPTY 1. NAUSEA AND VOMITING: DRY
BLADDER TOAST/CRACKERS/SFF
1ST FUNDAL GRIP PRESENTATION

2. BREAST *6 weeks before delivery – no sex

TENDERNESS: SUPPORTIVE BRA; TIGHT 6 weeks after delivery – ok sex
= LACK CIRCULATION, LOOSE = SAGGY 6 weeks – normal due to involution (RETURN
BREAST OF ORGANS TO NON-PREGNANT STATE
3. PTYALISM (EXCESSIVE SALIVATION): 5. EMPLOYMENT: NO TO HAZARDOUS WASTE
MOUTHWASH, GUM, HARD CANDY (TERATOGENIC EFFECT)
(DECREASES CHANCE OF DENTAL 6. TRAVELING: EVERY 2-3 HRS, REST FOR 10-15
CARRIES/CAVITY) MINS
4. ANKLE EDEMA: VARICOSITIES – - ON AIRCRAFT: NEEDS PRESCRIPTION
ELEAVATE AND NO PROLONGED
STANDING COMPONENTS OF LABOR:
5. BACKACHE: LOW HEEL SHOES, WITH PASSENGER: FETUS
GRIP PASSAGEWAY: PELVIS, CERVIS, VAGINA
6. CONSTIPATION: INCREASE FIBER AND *IF DI KASYA FETUS = CPD
OFI (CEPHALOPELVIC DISPROPORTION) / FPD
7. HEARTBURN: SFF (FETOPELVIC DISPROPORTION)
8. HEMORRHOIDS: SITZ BATH (WARM) + POWER:
WITCH HAZEL - PRIMARY: UTERINE CONTRACTION;
9. SOB: LEFT LATERAL RECUMBENT/LEFT STRONGER
SIDE LYING - SECONDARY: BEARING DOWN; BEAR
RISK FACTORS: DOWN WHEN THERE’S CONTRACTION
1. 5TH OR MORE PREGNANCY: NUMINIPIS PSYCHE: OVERALL STATUS OF MOTHER
UTERUS (PHYSICAL, PSYCHOLOGICAL, EMOTIONAL)
2. PREVIOUS CS: UTERUS HAS SCARRING
= WEAKENS UTERUS TYPES OF LABOR:
3. POST-PARTUM HEMORRHAGE: NSD: FALSE LABOR
500ML; CS: 800-1000ML 1. REMAIN IRREGULAR
4. 3 CONSECUTIVE ABORTION: PROBABLY 2. CONFINED IN ABDOMEN
HAS UTERINE PROBLEMS 3. NO INCREASE IN FREQUENCY, DURATION
5. HEART DISEASE (GRAVIDOCARDIAC AND INTERVAL
CLIENTS) 4. RELIEVED DURING AMBULATION
5. ABSENT CERVICAL CHANGES
POST-PARTUM HEMORRHAGE
HEALTH TEACHINGS TRUE LABOR
1. NUTRITION: WELL BALANCED DIET 1. REGULAR, PREDICTABLE
- PREGNANT: ADD 300 CALORIES 2. RADIATING PAIN TO LOWER BACK TO THE
- BREASTFEEDING: +500 CALORIES ABDOMEN
2. SMOKING: CAUSE LOW BIRTH WEGHT BABY 3. INCREASE FREQUENCY, DURATION,
(HIGH IN CO, HEMOGLOBIN INAAGAW NYA O2) SHORTENED INTERVAL
3. DRINKING: FETAL WITHDRAWAL SYNDROME 4. NOT RELIEVED BY AMBULATION
(FETUS IS LETHARGIC, DEC LOC, MUKHANG 5. WITH CERVICAL EFFACEMENT AND
LASING) DILATATION
4. SEXUAL ACTIVITY: 6. RUPTURE OF MEMBRANES (ROM)/BLOODY
1ST TRI: DECREASED SHOW
2ND TRI: INCREASED, DUE TO INC LIBIDO
3RD TRI: DECREASED, DUE TO ENLARGING STAGES OF LABOR AND DELIVERY:
UTERUS  MAY CAUSE RUPTURE OF 1. STAGE OF DILATATION AND EFFACEMENT
BAG OF WATER PHASES:

L-  DESCENT: FETAL HEAD  MATERNAL

LATENT:0-3 CM PELVIS (ENGAGEMENT)
- MOTHER IS ABLE TO  FLEXION: PREPARATION OF THE
COMMUNICATE FETAL HEAD TO PASS THE CERVIX
- HEALTH TEACHINGS  INTERAL ROTATION: ACTUAL
A- ACTIVE: 4-7 CM PASSAGE OF FETAL HEAD TO
- INCREASING FREQUENCY, CERVIX
DURATION AND INTERVAL  EXTENSION: EXPULSION OF FETAL
- FOCUS: PAIN = MOTHER LOSES HEAD
SELF CONTROL  EXTERNAL ROTATION: EXPULSION
T- TRANSITION: 8-10 CM OF FETAL SHOULDERS; IF WALA =
- FULL DILATATION AND SHOULDER DYSTOCIA
EFFACEMENT  EXPULSION: EXPULSION OF THE
- TRANSFER FROM LABOR ROOM TO WHOLE FETUS
DR *EPISIOTOMY – (-OTOMY = CUTTING)
*FREQUENCY – START OF 1 CONTRACTION MEDIAN: STRAIGHT; FASTER HEALING, INC
TO THE START OF ANOTHER RISK FOR ANAL LACERATION
CONTRACTION MEDIOLATERAL: ACROSS THE MUSCLE;
DURATION – START OF 1 CONTRACTION TO SLOWER HEALING, DEC RICK FOR NAL
THE END OF SAME CONTRACTION LACERATION
INTERVAL – END OF 1 CONTRACTION TO THE
START OF ANOTHER
ANALGESIA: LOSS OF PAIN
STATIONS:
ANESTHESIA: LOSS OF SENSATION
-3
REGIONAL- INJECTED AT THE SITE (EX.
-2
LIDOCAINE IN VAGINA)
-1
EPIDURAL – INJECTED AT EPIDURAL
0
SPACE
+1
SPINAL – CAN CAUSE SPINAL
+2
HEADACHE (FOB 6-8 HRS)
+3
PRESENTATION:
NPA NAA APA AAA (NA PA PA AB AG AB AG)
 CEPHALIC – HEAD
NATURAL PASSIVE BREASTMILK
 BREECH – BUTTOCKS
ANTIBODY
 FOOTLING – FOOT NATURAL ACTIVE DISEASE CONDITION
 TRANSVERSE/ACROMNION – SHOULDERS ANTIGEN
 FACIAL -FACE
ARTICIFIAL PASSIVE SERUM (ATS, VERORAB)
POSITION: ANTIBODY - TOXOID OR NON-
BEST: LOA (LEFT OCCIPITOANTERIOR) ATTENUATED
AND ROA
ARTIFICIAL ACTIVE LIVE ATTENUATED
BACKACHE: LOP (LEFT
ANTIGEN EPI
OCCIPITOPOSTERIOR) AND ROP
2. FETAL EXPULSION
3. PLACENTAL STAGE/PLACENTAL EXPULSION
MECHANISMS OF LABOR: (D FIrE ErE)
2 TYPES OF PLACENTA:
1. SCHULTZE: SHINY

2. D IgE PARASITIC AND FUNGAL INFECTION /

UNCAN: DIRTY, MEATY IgD ALLERGIC REACTION
ii. CHECK COTYLEDONS: 20-30
4. RECOVERY AND BONDING/POST PARTUM EPISIOTOMY AND PERINEAL CARE:
- FIRST 1-4 HRS AFTER DELIVERY 1. ICE PACK: VASOCONSTRICTION –
- MOST CRITICAL (RAPID BLEEDING; FIRST 24 HRS
DETERIORATION) 2. SITZ BATH: VASODILATION – HEALING,
CONSIDERATIONS: ENHANCE CIRCULATION; AFTER 24 HRS
1. ASSESS THE FUNDUS: FIRM AND 3. PERINEAL LAMP: HEALING – 12-18
GLOBULAR INCHES AWAY
2. ASSESS THE LOCIA: 4. WITCH HAZEL
a. RUBRA: REDDISH, FRESH BLOOD; 1- 5. USE COTTON UNDERWEAR:
3 DAYS ABSORBENT
b. SEROSA: PINKISH TO BROWNISH; 6. INCREASE FIBER AND OFI: PREVENT
4TH-9TH DAY) CONSTIPATION; STRAINING AFFECTS
c. ALBA:WHITISH; 10TH DAY TO 6TH THE EPISIORHAPPY
WEEK
3. BLADDER: SHOULD BE EMPTY POST PARTUM SEXUAL ACTIVITY
4. PERINEUM: MONITOR FOR S/SX OF 1. VAGINAL BLEEDING HAS STOPPED
INFECTION 2. EPISIOTOMY HAS HEALED (6 WEEKS)
a. PUS *if may bleeding pa but uterus is firm and
b. FOUL ODOR globular = perineal lacerations
c. FEVER
5. BLOOD PRESSURE: S/SX OF SHOCK
ANTEPARTUM COMPLICATIONS
LACTATION AND ROOMING CONCEPT
o ABORTION
- EO 51 (MILK CODE)
- RA 7600 (BREASTFEEDING LAW) - EXPULSION OF FETUS BEFORE
- CLEAN WITH WATER ONLY (WARM) AGE OF VIABILITY (20 WEEKS)
- IF MAY NATIRANG MILK AFTER TYPES:
FEEDING, DON’T WIPE; IT 1. THREATENED: CLOSED CERVIX, W/O
PREVENTS DRYNESS AND CERVICAL DILATION
SORENESS (MOISTURIZING - GIVE TOCOLYTICS– HALT LABOR
EFFECT) (DECREASE CONTRACTION)
- 10-15 MINS EACH BREAST; IN NEXT (MTIN)
FEEDING, KUNG SAN TUMIGIL DUN  MGSO2
MAGUUMPISA  TERBUTALINE – MOST
COMMON
PROPER LATCHING  INDOMETHACIN
- LOWER LIP MORE OUTWARD  NIFEDIPINE
2. IMMINENT: OPEN CERVIX, W/ CERVICAL
COLOSTRUM: IgA; YELLOWISH (IF WALA, DILATATION (INEVITABLE)
ORANGE) 3. COMPLETE: ALL PRODUCTS OF
IgG CROSS PLACENTAL BARRIER; HAS CONCEPTUS ARE EXPELLED
MEMORY 4. INCOMPLETE: EACH PART; BLEEDING,
DIC, DFS (DEAD FETUS SYNDROME)
IgA MILK, COLOSTRUM
5. INDUCED: NEVER ALLOWED IN PH
Ig INFECTIOUS PROCESS
(ILLEGEL AND IMMORAL)
M
6. THERAPEUTIC: LEGAL, PLANNED,

OVARY, CERVIX, PERITONEAL CAVITY

MEDICAL; EX: ECTOPIC PREG
7. MISSED ABORTION: EARLY FETAL MANIFESTATIONS:
UTERINE DEATH WITHPUT EXPULSION - PATHOG: SEVERE SHARP
(<20 WEEKS) STABBING KNIFELIKE
o IUFD: >20 WEEKS ABDOMINAL PAIN
8. RECURRENT: HABITUAL, 3  PROVOKING/
CONSECUTIVE FETAL ABORTIONS PRECIPITATING
 QUALITY
MANAGEMENT:  RADIATION
1. CBR: 12-24 HRS; MORE MOVEMENT,  SEVERITY: PAIN SCALE
MORE BLEEDING  TIME
2. COITUS IS RESTRICTED FOR 2 WEEKS; - SPOTTING
FRICTION=BLEEDING (VAGINAL REST) - (+) CULLEN’S SIGN
3. SAVE ALL PADS, CLOTS AND TISSUES: (DISCOLORATION IN
MEASURE BLEEDING (WEIGHING PADS- PERIUMBILICAL AREA) – MEANS
TIMBANG BEFORE USE AND AFTER USE) RUPTURE  SHOCK (HYPO
4. D AND C TACHY TACHY)
∙ CUSHING’S TRIAD
o HYDATIDIFORM MOLE INTERVENTIONS:

- AKA GESTATIONAL TROPHOBLASTIC - COMBAT SHOCK: POSITIONING
DISEASE  ELEVATE FOOT OF BED
BLAST: IMMATURE CELLS (MODIFIED
CYTES: MATURE TRENDELENBERG): TO
CLAST: DYING INCREASE VENOUS
- EMBRYO DIES RETURN
- NO FETUS, NO AMNIOTIC SAC, NO - LAPAROTOMY
BLOOD VESSELS - DOC: METHOTREXATE: KILLS
RAPIDLY DIVIDING CELLS 
MANIFESTATIONS: MISCARRIAGE (THERAPEUTIC
- HIGH LEVELS OF HCG ABORTION)
- RAPID INCREASE IN FUNDIC
HEIGHT – DUE TO IMMATURE
CELLS  FAST PRODUCTION o INCOMPETENT CERVICAL OS/
- NO FHT INCOMPETENT CERVIX
- HALLMARK: PASSAGE OF CLEAR - PAINLESS CERVICAL DILATATION
FLUID FILLED GRAPE SIZED OS WITHOUT CONTRACTIONS
VESICLES - 20TH WEEK OF AOG
INTERVENTIONS: MANIFESTATIONS:
- NO PREGNANCY W/IN 1 YEAR 1. CERVICAL DILATION
- D&C 2. PROLAPSE OF THE MEMBRANES
- DOC: METHOTREXATE (KILLS MANAGEMENT:
RAPIDLY DIVING CELLS) 1. CERVICAL CERCLAGE: SUTURING
OF CERVIX
o ECTOPIC PREGNANCY a. MCDONALD’S: TEMPORARY
- IMLANTATION OUTSIDE UTERUS  NSD
- COMMON SITES: FALLOPIAN TUBE, b. SHIRODKAR: PERMANENT 

CS
2. VAGINAL REST (NO SEX, NO MANAGEMENT:
ORGASMS):
3. PREPARE FOR CHILD BIRTH IF WITH 1. NO IE
RUPTURE OF MEMBRANES (TRUE 2. NO SEX
LABOR) 3. STRICT BED REST
4. FHR MONITORING – MONITOR
FETAL DISTRESS
o HYPEREMESIS GRAVIDARUM 5. DOUBLE SET WHEN DELIVERING –
PREPARE DR AND OR
- EXCESSIVE VOMITTING DURING PREG
- SEVERE NAUSEA AND VOMITING
- INCREASED HCG o ABRUPTIO PLACENTA
- AT RISK FOR ELECTROLYTE - PREMATURE SEPARATION OF THE
IMBALANCES PLACENTA AFTER 20TH WEEK OF AOG
- DARK RED, PAINFULL BLEEDING
MANIFESTATIONS
- UNREMITTING NAUSEA AND TYPES:
VOMITING (EASILY TRIGGERED) 1. UNCONCEALED/OVERT – OBVIOUS
 INITIAL VOMITUS: BLEEDING; DETACHED AT THE SIDE
UNDIGESTED FOODS 2. CONCEALED/COVERT – HIDDEN
 LATE VOMITUS: BILE BLEEDING; DETACHED IN THE
- WEIGHT LOSS MIDDLE = PERITONITIS;
- TACHYCARDIA: COMPENSATORY COUVELAIRE UTERUS
MECH DUE TO FLUID LOSS
MANAGEMENT:
MANAGEMENT: 1. NO IE
- ∙ NPO – ACUTE VOMITING 2. NO SEX
- ∙ IVF 3. STRICT BEDREST
- ∙ I AND O 4. FHT MONITORING
- SFF: IF NO VOMITING 5. DOUBLE SET
- VITAMIN B6 <100MG:
DECREASED NAUSEA AND
VOMITING DURING EARLY o TOXEMIA/PIH
PREGNANCY -
GESTATIONAL HYPERTENSION
-
CHRONIC HYPERTENSION
o PLACENTA PREVIA -
PIH
- PAINLESS BRIGHT RED BLEEDING - TRIAD: HYPERTENSION, EDEMA,
PROTEINURIA
TYPES:
A. MILD PRE-ECLAMPSIA
1. TOTAL – TOTALLY COVERS OS - BP: 140/90 ABOVE Q 6 HOURS
2. PARTIAL – PARTIALLY COVERS - EDEMA: FACE, NECK AND ANKLES
3. MARGINAL – PLACENTAL BORDER - PROTEINURIA: 300 MG/DL IN 24 HR
REACHES THE BORDER OF CERVICAL OS URINE SPECIMEN (PAG BUMABABA LVL
4. LOW LYING – LOW LYING SA KATAWAN = FLUID RETENTION)
MANAGEMENT:
1. BED REST:LOWER BP

2. LEFT SIDE LYING: MAXIMIZE

CARDIAC OUTPUT o GESTATIONAL DIABETES MELLITUS
3. MODERATE PROTEIN AND - FACTORS: GLUCOSE AND INSULIN
SODIUM - PROBLEM: HYPERGLYCEMIA
4. MgSo4: MAGNESIUM = *24-28 WEEKS, MOTHERS SHOULD BE
DEPRESSANT (PREVENT SCREENED FOR GDM – HIGH HPL
SEIZURE) (HUMAN PLACENTAL LACTOGEN) 
B. SEVERE PRE-ECLAMPSIA ANTI-INSULIN PROPERTIES
- BP: 160/110 ABOVE Q 6 EVEN IN BED - DIAGNOSTIC: ORAL GLUCOSE
REST TOLERANCE TEST
- EDEMA: PITTING EDEMA ON SACRUM, INTERPRETATION OF RESULTS:
FACE, UPPER EXTREMITIES, BLURRING  ∙ IF < 100 MG = NORMAL
OF VISION (RUPTURE OF CAPILLARIES)  ∙ IF 100 – 120 MG = POSSIBLE
- PROTEINURIA: 500 MG IN 24 HRS URINE GDM
SPECIMEN  ∙ IF > 120 MG = OVERT GDM
. NPO AFTER MIDNIGHT
MANAGEMENT: ∙ 2 ML OF 50% GLUCOSE/3 KG OF
1. COMPLETE BED REST PREPREGNANT BODY WEIGHT IS GIVEN
2. LEFT LATERAL RECUMBENT IV
3. HIGH PROTEIN DIET
4. LOW SODIUM INFANTS OF DIABETIC MOTHER:
5. MgSo4 + HYDRALAZINE (ANTI- - LONGER AND WEIGH MORE
HYPERTENSIVE) - MACROSOMIC
- CUSHINGOID APPEARANCE
C. ECLAMPSIA (PUFFY, LETHARGIC)
- HYPERTENSION, EDEMA, MANAGEMENT:
PROTEINURIA 1. ADJUST INSULIN DOSAGE
- WITH SEIZURE (GRAND MAL
SEIZURE)
 AURA: EPIGASTRIC PAIN o HEMOLYTIC DISEASE OF THE
OR ABDOMINAL CRAMPS NEWBORN
- RH INCOMPALIBILITY
MANAGEMENT: - ERYTHROBLASTISIS FETALIS (FETAL
1. DOC: MgSo4 + HYDRALAZINE COND. OF DESTRUCTION OF
2. ANTI-CONVULSANTS IMMATURE RBS)
(DIAZEPHAM, PENOBARBITAL, - COMMON: (-) MOTHER
PHENYTOIN) DIAGNOSTICS:
a. MAGNESIUM TOXICITY: a. DURING PREGNANCY:
i. BP - <90/60 MMHG = i. AMNIOCENTESIS – MEASURES
DON’T GIVE INC. BILIRUBIN IN AMNIOTIC
ii. URINE OUTPUT - <30 FLUID
ML/HR = DON’T GIVE ii. *28 WEEKS AOG - RHOGAM
iii. RR - <12 CPM = DON’T b. AFTER DELIVERY:
iv. PATELLAR REFLEX - i. DIRECT COOMB’S TEST –
<+2 (HYPOREFLEXIA) = MEASURES RH ANTIGEN IN THE
DON’T BABY
*GIVE CALCIUM GLUCONATE ii. INDIRECT COOMB’S TEST –

3. TRENDELENBURG AND KNEE CHEST

MEASURES RH ANTIBODY IN (GENUPECTORAL)
THE MATERNAL CIRCULATION 4. O2- 10-12 L/P
iii. GIVE RHOGAM W/IN 48-72 HRS 5. FIRM MANUAL UPWARD PRESSURE –
ITULAK PRESENTING PART PARA
S/SX: MARELEASE CORD; LAST RESORT
A. BABY: 6. WRAP THE CORD WITH GAUZE SOAKED
o PATHOLOGIC JAUNDICE – W/IN THE WITH NSS – PREVENT DRYNESS OF
FIRST 24 HRS CORD
*PHYSIOLOGIC – NORMAL 24 HRS
AFTER DELIVERY (IMMATURE LIVER o SHOULDER DYSTOCIA
 PHOTOTHERAPY, EARLY - ANTERIOR SHOULDER OF BABY IS
BREASTFEEDING) UNABLE TO PASS THE MATERNAL
o HEMOLYTIC ANEMIA PELVIS
B. MOTHER: - LACK OF EXTERNAL ROTATION
o EXCESSIVE BILIRUBIN IN THE ETIOLOGY:
AMNIOTIC FLUID 1. MACROSOMIA
PATHOPHYSIO: 2. MATERNAL OBESITY
RBC (HEMOGLOBIN)  DESTRUCT HEME (IRON) 3. POST DATE PREGNANCY (POST
 INCREASES BILIRUBIN TERM)
S/SX:
1. TURTLE SIGN: FETAL HEAD
INTRAPARTUM COMPLICATIONS RETRACTS AGAINST THE MOTHER
CERVIX
o PREMATURE RUPTURE OF MEMBRANES MANAGEMENT:
1. NO FUNDAL PUSH
MANIFESTATIONS:
- AMNIOTIC FLUID GUSHING INTO THE CAESARIAN BIRTH
VAGINA: NITRAZINE TEST *(pH 7.0- TYPES:
7.5) 1. CLASSIC OR VERTICAL
- MATERNAL FEVER 2. TRANSVERSE OR PFANNENSTIAL
- FETAL TACHYCARDIA
FACTORS LEADING TO CS
MANAGEMENT;
1. CPD
1. MINIMIZE IE: RISK FOR INFECTION
2. HERPES
2. ASSESS FOR SIGNS OF INFECTION
3. PREVIOUS CS
3. BED REST – IF NOT ENGAGED
4. HYPERTENSION OR HEART DISEASE
(PREVENT CORD PROLAPSE)
5. PLACENTA PREVIA
4. AMBULATE – IF ENGAGED
6. ABRUPTION PLACENTA
7. TRANSVERSE LIE
o CORD PROLAPSE
8. FETAL DISTRESS
- EMERGENCY
9. MACROSOMIA
- COMPRESSION OF CORD BETWEEN
THE FETAL PRESENTING PART AND
MATERNAL PELVIS
POSTPARTUM
- COMPROMISE CIRCULATION COMPLICATIONS
MANAGEMENT:
1. FHR Q 5-10 MINS SUBINVOLUTION
2. EMERGENCY CS ∙ DELAYED RETURN OF UTERUS TO ITS

PREPREGNANT STATE.
CAUSES:
∙ RETAINED PLACENTAL FRAGMENTS
MANIFESTATIONS:
∙ PROLONGED LOCHIAL DISCHARGE
∙ EXCESSIVE BLEEDING
MANAGEMENT:
∙ MASSAGE UTERUS
∙ FACILITATE VOIDING
∙ PREPARE FOR D AND C
THROMBOPHLEBITIS AND THROMBOSIS

∙ CLOT FORMATIONS INSIDE THE
VESSEL WALL
∙ EMBOLUS MAY TRAVEL TO:
A. BRAIN
B. HEART
C. LUNGS
MANIFESTATIONS:
∙ VIRCHOW’S TRIAD
∙ HOMAN’S SIGN
MANAGEMENT:
1. ELEVATE
2. DO NOT MASSAGE
3. NO AMBULATION

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NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*MIDWIFERY*MEDTECH

LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM

TOP RANK REVIEW ACADEMY

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FERTILIZATION AND IMPLANTATION

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 EARS 2. I- INVOLUTION – RETURN T PRE-

 EMBRYONIC PERIOD PELVIC TYPE

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 PRIMARY – CHANCRE SORES

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o SHORT TERM MANAGEMENT:

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a. INCREASE URINARY FREQUENCY

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b. AMNIOCENTESIS b. CLEAN CATCH URINE/MID STREAM

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2. BREAST *6 weeks before delivery – no sex

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L-  DESCENT: FETAL HEAD  MATERNAL

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2. D IgE PARASITIC AND FUNGAL INFECTION /

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OVARY, CERVIX, PERITONEAL CAVITY

o HYDATIDIFORM MOLE INTERVENTIONS:

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2. LEFT SIDE LYING: MAXIMIZE

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3. TRENDELENBURG AND KNEE CHEST

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THROMBOPHLEBITIS AND THROMBOSIS

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