OBSTETRIC NURSING Parts of the Testes:

Lecturer: Ma’am Princess

●​ Interstitial Cells (Leydig’s Cells) – produce
testosterone​
Topics:
●​ Male and Female Reproductive System
●​ Seminiferous Tubules – location of
●​ Sexual Response Cycle
●​ Menstrual Cycle spermatozoa (developing sperm)​
●​ Menstrual Disorders
●​ The Life Process ●​ Sertoli Cells – provide nourishment to sperm
●​ Amnion & Umbilical Cord cells
●​ Fetal Development
●​ Pregnancy
●​ GTPALM
●​ Physiologic Changes during Pregnancy
FEMALE GONAD – OVARIES
●​ Probable and Presumptive Signs of
Pregnancy
●​ Diagnostic Tests related to Pregnancy Functions of Ovaries (OOH):
●​ Fetal Monitoring
●​ Psychological Adaptation during Pregnancy ●​ Oogenesis – production and maturation of egg
cells​

MALE AND FEMALE REPRODUCTIVE SYSTEM ●​ Ovulation – rupture of mature follicles to

release egg​
Analogous Male & Female Organs
●​ Hormone production – secretes estrogen and
-​ Analogous means not similar in structure but progesterone
somewhat same in function.
Layers of the Ovary:

●​ Tunica Albuginea – outer protective layer​

GONADS
●​ Ovarian Cortex – main functional layer;
●​ Organs that produce gametes (sex cells).​ contains ova, follicles, site of ovulation, and
Corpus Luteum​
●​ Gametes are egg cells (ova) in females and
sperm cells in males. ●​ Medulla – contains blood vessels, nerves, and
lymphatics

MALE GONAD – TESTES

ERECTILE TISSUES
●​ Site of spermatogenesis (sperm production).​
Male – Penis
●​ A male gonad located externally, outside the
pelvic cavity, for better temperature ●​ Composed of 3 erectile tissues:​
regulation.​ • 2 Corpora Cavernosa​
• 1 Corpus Spongiosum​
●​ Maintains temperature 1°F lower than body
temp.​ ●​ Erectile tissue becomes engorged with blood
during arousal.​
●​ Cremasteric muscle – contracts to pull the
testes closer to the body when cold. ●​ Endothelial lining releases nitric oxide,
leading to vasodilation, increased blood supply,
and penile erection.​

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 ●​ Ischiocavernosus muscle contracts to trap GLANDS – LUBRICATION
blood, maintaining the erection.​
Male Glands:​
●​ The parasympathetic nervous system • Prostate Gland
controls the excitement phase.​
●​ Secretes alkaline fluid to neutralize acidic
environments in the urethra and vagina​
Female – Clitoris
●​ Vagina is acidic due to Döderlein’s bacilli
●​ Located under the prepuce (clitoral hood)​ converting sugar to lactic acid, which helps
prevent infections​
●​ Enlarges during sexual arousal​
●​ Prostate contributes 60% of semen volume
●​ Contains numerous nerves, very sensitive​
• Bulbourethral (Cowper’s) Gland
●​ Serves as a landmark for female
catheterization ●​ Secretes alkaline fluid for lubrication and
neutralization

• Seminal Vesicles
PROTECTIVE COVERINGS
●​ Secretes thick, viscous fluid that includes:​
Male – Scrotum • Alkaline fluid​
• Protein and sugar (energy for sperm)​
●​ Contains the testes​ • Prostaglandins (enhance uterine
contractions)
●​ Rugae – transverse folds that help regulate
temperature​ Female Glands:​
• Skene’s Gland (Paraurethral Gland)
●​ Dartos Muscle – assists in
relaxation/contraction with rugae​ ●​ Located near the urethral meatus​

●​ Secretes lubricating fluid during arousal

Female – Labia Majora
• Bartholin’s Gland (Vestibular Gland)
●​ Covers external genitalia (labia minora,
vestibule, urethral meatus)​ ●​ Located near the vaginal opening​

●​ Contains hair follicles, nerves, and has rich ●​ Secretes mucus to lubricate the vaginal introitus
blood supply​

Vulva (Pudendum) TRANSPORTATION TUBES

●​ Very vascular, sensitive to touch​ Male Tubes:​

• Vas Deferens (Ductus Deferens)
●​ Supplied by:​
• Pudendal artery – oxygenated blood​ ●​ Conduit for sperm​
• Pudendal vein – drains deoxygenated blood​
●​ Site of vasectomy (surgical sterilization)​
●​ Innervation:​
• Anterior portion – Ilioinguinal and ●​ Vasectomy Info:
Genitofemoral nerves​ -​ Ambulatory procedure (no need for
• Posterior portion – Pudendal nerve​ hospitalization)
-​ Sex can resume after 1 week

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 -​ Does not provide immediate sterility blood in penis​
-​ Sterility achieved after 10–20 ejaculations • Controlled by the parasympathetic nervous
-​ Must have 2 consecutive zero sperm counts system​
(taken 6–10 weeks after)
-​ Semen should be placed in a special
container, stored near the body, and submitted 2. Plateau Phase
within 2 hours
●​ Occurs just before orgasm​
• Ejaculatory Duct

⭐ Conduit of semen
●​ Continued stimulation (e.g., foreplay)​
●​
●​ Vital signs remain elevated​
• Epididymis

●​ Reservoir or storage site of sperm 3. Orgasm Phase

Female Tubes – Fallopian Tubes (Oviducts):​ ●​ Intense pleasure and release​

Parts:
●​ Pelvic contractions occur​
●​ Interstitial – nearest to the uterus, most
muscular portion​ ●​ Male: 3–7 rhythmic contractions​

●​ Isthmus – narrowest part; site of tubal ●​ Female: 8–15 contractions​

ligation for permanent sterilization, usually
done 3–4 days postpartum​
4. Resolution Phase
●​ Ampulla – site of fertilization and most
common site of ectopic pregnancy​ ●​ Body returns to normal state​

●​ Infundibulum – nearest to the ovaries; ●​ Refractory period:​

contains fimbriae, which are finger-like • Males typically require recovery time before
structures that catch the egg after ovulation next orgasm​
• Females may continue to orgasm with
SEXUAL RESPONSE CYCLE sufficient stimulation

Mnemonic: “EPOR” = Excitement → Plateau → Orgasm MENSTRUATION

→ Resolution
MENSTRUAL CYCLE
1. Excitement Phase
A regular, episodic, and cyclic episode of uterine
●​ Triggered by physical (e.g., kissing, touch) or bleeding in response to hormonal changes, primarily
psychological stimulation (e.g., fantasies, involving estrogen and progesterone. Bleeding occurs
visuals)​ due to the shedding of the endometrial lining
(innermost layer) of the uterus.
●​ Physiological changes:​
• Increased vital signs​ Uterine Layers:
• Vaginal introitus widens​
• Nipples become erect​ ●​ Perimetrium: Outermost layer​
• Clitoris enlarges​
• Scrotum thickens​ ●​ Myometrium: Middle muscular layer
• Testes elevate​ (responsible for uterine contractions)​
• Penis becomes erect via nitric oxide →
vasodilation → engorgement​
• Ischiocavernosus muscle contracts to trap

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 ●​ Endometrium: Innermost lining that thickens 2. Anterior Pituitary Gland (APG / Adenohypophysis)
and sheds during menstruation​
●​ Responds to GnRH by releasing:​

Purpose of Menstrual Cycle: ○​ FSH (Follicle-Stimulating Hormone)​

●​ Ovum maturation​ ○​ LH (Luteinizing Hormone)​

●​ Renewal of the uterine lining in preparation for

possible implantation (pregnancy)​ 3. Ovaries

●​ Respond to FSH and LH​

○​ Estrogen: Secreted by the Graafian

NORMAL CHARACTERISTICS follicle​

Onset: ○​ Progesterone: Secreted by the Corpus

Luteum (ruptured Graafian follicle)​
●​ Menarche: First menstruation; usually occurs
2–3 years after onset of thelarche (breast
development)​ 4. Uterus

●​ Average onset: 12.4 years​ ●​ Responds to hormonal changes​

●​ Range: 9–17 years​ ●​ Endometrium thickens (estrogen) and becomes

vascularized (progesterone); sheds if no
fertilization occurs​
Interval (cycle length):

●​ Average: 28 days​ HORMONES INVOLVED

●​ Range: 25–35 days​ Mnemonic: G → FELP​

GnRH → FSH → Estrogen → LH → Progesterone

Flow Duration:
Hormo Timing Role Source
●​ Average: 4–6 days​ ne

GnRH Initiates the Stimulates APG Hypothala

●​ Range: 2–9 days​
cycle to release FSH & mus
LH
Amount of Blood Loss: 30–80 mL​
FSH Early in Follicular Anterior
Color: Dark red​
cycle maturation → Pituitary
Odor: Marigold-like (not foul-smelling under normal
(Follicular) Graafian follicle
conditions)
Estrog Before Thickens Graafian
ORGANS INVOLVED IN THE MENSTRUAL CYCLE en ovulation endometrium, follicle
increases (Ovary)
1. Hypothalamus myometrial
contractility
●​ Initiates the menstrual cycle​
LH Mid-cycle Triggers Anterior
●​ Secretes GnRH (Gonadotropin-Releasing (Day 14) ovulation, forms Pituitary
Hormone)​ corpus luteum

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 OVULATION (Day 14)
Proge After Vascularizes Corpus
steron ovulation endometrium, Luteum
●​ Triggered by LH surge​
e (Luteal) relaxes
myometrium
●​ Graafian follicle ruptures → releases egg into
ampulla of fallopian tube (site of fertilization)​

FOLLICULAR PHASE (Days 1–14) ●​ Remaining follicle in ovary becomes Corpus

Luteum (CL)
●​ Low estrogen & progesterone → triggers
hypothalamus → secretes GnRH → stimulates Explanation:
APG to secrete FSH​
Mid-Cycle – Ovulation Phase
●​ FSH stimulates follicular growth → forms
Graafian follicle in ovarian cortex → secretes Sa midpoint ng menstrual cycle, around Day 14,
estrogen​ nagkakaroon ng tinatawag na LH surge — si LH o
Luteinizing Hormone ay sine-secrete ng anterior
●​ Estrogen thickens endometrium & increases pituitary, at siya ang nagti-trigger ng ovulation.
myometrial contractility​
Kapag nag-ovulate ang babae, ibig sabihin puputok o
●​ High estrogen → triggers LH surge → leads to magra-rupture si Graafian follicle, and then lalabas
ovulation ang egg cell. Yung egg ay pupunta sa fallopian tube,
specifically sa ampulla, kasi doon ang site of
Note: During pregnancy, high estrogen from placenta fertilization.
suppresses FSH, preventing follicular maturation → no
ovulation → amenorrhea Pero hindi lahat ng follicle ay lumalabas — yung
natirang part ng ruptured follicle stays sa ovary, at
tinatawag na itong Corpus Luteum (CL). Basically, ang
Corpus Luteum ay yung dating Graafian follicle na
Explanation: nag-rupture after ovulation.

Sa first part ng menstrual cycle, which is called the

follicular phase, mababa pa ang levels ng estrogen at
progesterone. Kaya ang goal ng body is to increase LUTEAL PHASE (Days 15–28)
estrogen levels first.
●​ CL secretes progesterone (and some estrogen)​
Lahat nagsisimula sa hypothalamus, which is part of
the brain na in charge sa hormonal control. It releases ●​ Progesterone prepares endometrium for
GnRH (gonadotropin-releasing hormone), na implantation by increasing vascularity and
nagti-trigger naman sa anterior pituitary gland para relaxing myometrium​
mag-release ng FSH (Follicle-Stimulating Hormone).
●​ High progesterone → suppresses LH → no
Si FSH ay nai-secrete early in the cycle, and it’s further ovulation (anovulation during
responsible for stimulating the growth and pregnancy)
development of ovarian follicles. Maraming follicles
ang magsisimulang mag-develop, pero only one Explanation:
becomes dominant — ito yung tinatawag na Graafian
follicle, or the mature follicle. Post-Ovulation – Progesterone Phase

As the Graafian follicle matures, it starts to produce After ng ovulation, si Corpus Luteum na ang nagiging
estrogen. Si estrogen ang hormone na responsible sa active sa hormone production, specifically ng
pagpapakapal ng endometrial lining (lining ng uterus), progesterone. Kaya after ovulation, tumataas ang
para ma-prepare yung uterus for possible implantation. It progesterone levels — dahil si CL ang nag-se-secrete
also helps improve the contractility of the uterine nito.
muscles (myometrium).

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Ang main role ng progesterone ay tulungan i-maintain FEEDBACK MECHANISMS
ang endometrial lining. It causes vascularization,
meaning pinapataas niya ang blood supply sa uterus 1. Hypothalamic-Pituitary Feedback:
para ma-nourish ang possible product of
conception.​ ●​ ↓ Estrogen/Progesterone → Hypothalamus →
Bukod sa endometrium, may effect din si progesterone GnRH → APG → FSH or LH ↑
sa myometrium (uterine muscles) — pinapa-relax
niya ang muscles para maiwasan ang contractions, 2. Ovarian Feedback:
which helps prevent early miscarriage.
●​ Pre-ovulatory phase (Days 1–13):​
Sino ang nagre-regulate ng progesterone? Si LH pa rin.
So if progesterone is low, kailangan mo si LH para ○​ Low E & P → FSH ↑ → Follicular
buhayin si Corpus Luteum. Pero during pregnancy, maturation → ↑ Estrogen​
mataas na talaga ang progesterone dahil tuloy-tuloy na
ang production, kaya suppressed na si LH. Kapag ●​ Post-ovulatory phase (Days 15–26):​
suppressed si LH, wala nang ovulation, kaya tinatawag
itong anovulation — which explains kung bakit hindi ○​ High Estrogen → triggers LH →
nag-oovulate ang buntis. Ovulation → CL forms → ↑
Progesterone (waits 8–10 days for
If no fertilization: implantation)​

●​ CL degenerates → becomes Corpus Albicans​

ENDOMETRIAL FEEDBACK MECHANISM
●​ ↓ Estrogen & Progesterone → endometrial
shedding → menstruation restarts​ Mnemonic: “Mens po si Inday” (Menstrual –
Proliferative – Secretory – Ischemic)​
These are the 4 phases of the endometrial cycle, based
Kapag Walang Fertilization – Luteal to Menstruation on hormone changes and follicle development:
Phase
1. MENSTRUAL PHASE (Days 1–4)
So kung walang fertilization na nangyari sa ampulla,
hindi na kailangan ng Corpus Luteum. Kaya after ●​ Shedding phase – the endometrial lining
ilang araw, magde-degenerate na si CL — at pag breaks down and exits the body as
nawala na siya, ang tawag sa kanya ay Corpus menstruation.​
Albicans (parang scar tissue na lang siya sa ovary,
inactive na). ●​ Happens when there's a drop in estrogen and
progesterone.​
Dahil wala na si CL, bababa na rin ang levels ng
estrogen at progesterone — kasi si CL ang gumagawa ●​ Follicles are still immature at this stage.​
ng hormones na ‘yan after ovulation. Kapag bumaba na
ang hormones, hindi na masusustentuhan ang kapal
ng endometrium, kaya magshe-shed na siya — ito na 2. PROLIFERATIVE PHASE (Days 5–14)
ang menstruation.
●​ Controlled by FSH, which stimulates follicular
So magsisimula ulit ang cycle, babalik sa hypothalamus, maturation.​
maglalabas ulit ng GnRH, then FSH, then bagong
follicle... and the cycle goes on. ●​ The follicle grows and eventually becomes a
Graafian follicle.​

●​ As the follicle matures, estrogen increases,

while progesterone remains low.​

●​ Estrogen causes the thickening of the

endometrial lining to prepare for possible

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 implantation.​ ●​ Placenta Increta: Invades up to myometrium​

●​ Toward the end of this phase, LH is secreted, ●​ Placenta Percreta: Penetrates through
leading to ovulation around Day 14. myometrium​

3. SECRETORY PHASE (Days 15–25) ●​ Retained Placenta: >30 mins post-delivery and
placenta not expelled​
●​ After ovulation, the ruptured Graafian follicle
becomes the Corpus Luteum, which produces ●​ Retained Placental Fragments: Placenta
progesterone.​ expelled, but fragments remain

●​ Progesterone promotes vascularization of the

endometrium — meaning dumadami ang blood
vessels to support implantation.​ CYCLE LENGTH RULE

●​ The endometrium becomes thick, soft, and rich ●​ Luteal phase = constant 14 days​
in nutrients (often described as “corkscrew”
appearance due to the coiled arteries). ●​ Follicular phase = variable​

4. ISCHEMIC PHASE (Days 26–28) ○​ Ex: 35-day cycle → 35 – 14 = Ovulation

on Day 21
●​ If no fertilization, the Corpus Luteum
degenerates into Corpus Albicans.​ Follicular Phase: FSH → Estrogen​
Luteal Phase: LH → Progesterone
●​ This leads to a drop in progesterone and
estrogen, which causes the uterus to contract.​ OTHER CYCLIC CHANGES

●​ Blood flow to the endometrium decreases → 1. Basal Body Temperature (BBT)

leading to necrosis (cell death) → and the
lining starts to break down.​ ●​ Measure daily before rising (oral, vaginal, or
rectal only)​
●​ This breakdown leads to menstruation — and
the cycle starts again. ●​ Before ovulation: ~37°C​

●​ During ovulation: Slight drop (~0.5°C)​

PREGNANCY & HORMONAL EFFECTS ●​ After ovulation: ↑ Temp due to thermogenic

effect of progesterone​
●​ High Estrogen (from placenta) → suppresses
FSH → no follicular maturation​ ●​ No drop before period = Possible pregnancy​

●​ High Progesterone → suppresses LH → no

ovulation​ 2. Cervical Mucus Method (Billings Method)

●​ Before ovulation: Thick, viscous (not

●​ Amenorrhea occurs due to sustained
sperm-friendly)​
suppression of FSH/LH during pregnancy

●​ During ovulation: Thin, stretchable, slippery

(Spinbarkeit) – due to high estrogen​
PLACENTAL IMPLANTATION ABNORMALITIES
●​ After ovulation: Thickens again​
●​ Placenta Accreta: Implanted deeply in
endometrium​
3. Symptothermal Method: Combines BBT + cervical
mucus for fertility awareness

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4. Abstinence: Most effective natural method to prevent 4. Endometriosis​
pregnancy → Presence of endometrial tissue outside the uterus
(ectopic location)​
MENSTRUAL DISORDERS → Forms endometrioma or "chocolate cyst" – old
blood not expelled, gets trapped, inflamed, and forms
cyst​
1. Amenorrhea – Absence of menstruation​
→ Tissues are estrogen and progesterone sensitive →
→ Two types:
cyclic bleeding and inflammation​
→ Healing leads to scar tissue, fibroids, adhesions
• Primary Amenorrhea – No menstruation since birth​
- Common cause: Hypothalamic-Pituitary-Ovarian
Etiology:​
(HPO) axis problem​
• Unknown (Idiopathic)​
- Body fat <14% → not enough estrogen to trigger
• Theory: Retrograde menstruation – blood flows back
menses
through fallopian tubes into pelvic cavity​
→ implants on ovary, bladder, rectum, etc.
• Secondary Amenorrhea – Cessation of menstruation
for 3 to 6 months (previously had regular menses)​
Signs & Symptoms:​
- Most common causes:​
• Dysmenorrhea – Cyclic, acute pelvic pain, worse
• Pregnancy (always rule out first)​
during menstruation/exercise​
• Malnutrition/starvation​
• Dyspareunia – Chronic pain during intercourse​
• Hypothyroidism​
• Dyschezia – Painful defecation​
• Type 1 Diabetes Mellitus
• Infertility – No conception after:​
<35 y/o: 1 year of unprotected sex​
>35 y/o: 6 months of unprotected sex
2. Dysmenorrhea – Painful menstruation​
→ Two types:
MANAGEMENT OF ENDOMETRIOSIS
• Primary Dysmenorrhea​
- Cause: ↑ Prostaglandin → causes uterine
Pharmacologic:
contractions → pain​
- Onset: Late teens to early 20s​ • NSAIDs – For pain relief
- Not associated with structural pathology
• GnRH Analogues: Leuprolide (Lupron)​
• Secondary Dysmenorrhea​ - Induces "medical menopause" by ↓ estrogen &
- Cause: Pathologic (e.g., endometriosis, PID, progesterone​
endometrial polyps)​ - Prevents thickening & vascularization of
- Onset: After 25 years old​ endometrium​
- Associated with pelvic abnormalities or diseases - Side Effects: Vaginal dryness, hot flashes,
headaches​
- Duration: Given for <6 months (longer use causes
bone demineralization)
3. Other Menstrual Irregularities
• Danazol – Androgenic synthetic steroid​
• Oligomenorrhea – Infrequent menstruation​
- Derived from testosterone → ↓ estrogen &
- Less than 6 to 8 periods per year
progesterone​
- Induces amenorrhea​
• Hypomenorrhea – Light menstruation​
- Side Effects: Masculinization​
- Flow <30 mL, duration <2 days
• Hirsutism​
• Hypermenorrhea / Menorrhagia – Heavy • Deepened voice​
menstruation​ • ↓ Breast size
- Flow >80–100 mL, duration >9 days

• Metrorrhagia – Bleeding in between menstrual cycles

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Diagnostics & Procedures: Fertilization occurs in the ampulla of the fallopian
tube. Before fertilization, the sperm must undergo
• Hysterosalpingogram (HSG)​ capacitation, a process where the protective covering of
- X-ray with contrast dye inserted into uterus → the sperm is removed to enable it to penetrate the egg.
fallopian tubes​ Once the sperm successfully fuses with the egg, a
- Assesses tubal patency and fertility​ zygote is formed.
- May help open blocked tubes

• Laparoscopy ⭐️​
The resulting zygote contains 46 chromosomes
(diploid)—23 pairs of chromosomes—coming from
- Gold standard for diagnosis and removal of both parents. This fusion of genetic material marks the
endometrial implants​ beginning of a new life.
- Involves CO₂ gas to inflate pelvic cavity
ZYGOTE DEVELOPMENT AND EARLY PREGNANCY
PROCESSES

ART – Artificial Reproductive Techniques Zygote – Formed after fertilization with 46

chromosomes (diploid).​
• IVF (In vitro fertilization)​ Within 24 hours, the zygote undergoes mitotic cellular
- Fertilization occurs in lab​ division (cleavage).
- Embryo implanted into uterus
●​ 1st Cleavage: Occurs around 22 hours after
• GIFT (Gamete Intrafallopian Transfer)​ fertilization.​
- Sperm and egg inserted into fallopian tube →
fertilization occurs inside body ●​ Morula: A solid ball of cells (blastomeres),
appears by 3 to 4 days post-fertilization. It
• ZIFT (Zygote Intrafallopian Transfer)​ begins its journey from the fallopian tube to the
- Fertilized zygote placed in fallopian tube uterus.​

• Surgical Management (For severe or refractory ●​ Blastocyst: Formed after the morula stage.​
cases)​
- Hysterectomy with Bilateral Salpingectomy & ○​ Embryoblast → develops into the
Oophorectomy​ embryo​
- Definitive and sterilizing treatment
○​ Trophoblast → develops into the
THE LIFE PROCESS placenta; this layer secretes hCG​

THE LIFE PROCESS

The egg cell, which is viable for 24 hours after

ovulation, contains 23 chromosomes Human Chorionic Gonadotropin (hCG)
(haploid)—composed of 22 autosomes and 1 X
●​ Secreted by the trophoblast to maintain the
chromosome. On the other hand, a sperm cell remains
corpus luteum until the placenta is fully formed
viable for 48 to 72 hours after ejaculation, and it also
at around 2 months (8 weeks) gestation.​
contains 23 chromosomes (haploid)—22 autosomes
and either an X or Y chromosome.
●​ The corpus luteum provides nourishment and
The total critical time for fertilization is around 72 hormones for the first 2 months of pregnancy.​
hours, which includes:
●​ After 2 months, the placenta takes over
●​ 48 hours before ovulation, when sperm may hormone production.​
already be present in the reproductive tract​
●​ hCG levels normally decrease within 1–2
●​ 24 hours after ovulation, when the egg is still weeks postpartum.​
viable​

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 ○​ If hCG remains elevated → suspect Chorionic villi has two layers:
retained placental fragments​
1.​ Cytotrophoblast (Langhan’s layer):​

○​ Offers protection against Treponema

pallidum (causative agent of syphilis)​
Implantation
○​ Present only during the first 18–20
●​ Defined as the burrowing of the blastocyst weeks AOG, offering early pregnancy
into the endometrial lining of the uterus.​ protection​

●​ Ideal implantation site: upper fundal portion of 2.​ Syncytiotrophoblast:​

the uterus (rich in blood supply).​
○​ Lacks protection against Treponema
●​ Outcome of implantation: embryo formation​ pallidum​

●​ By 8 weeks AOG (age of gestation) → ○​ Produces hCG​

organogenesis is completed.​
○​ After 20 weeks, only syncytiotrophoblast
●​ Implantation process is also called nidation, remains, so protection against syphilis
which occurs around 8–10 days after decreases​
fertilization.​
○​ Syphilis (under TORCH infections) must
be treated with Penicillin​

DECIDUA – Endometrial lining modified by progesterone TORCH Infections:

during pregnancy.
●​ T – Toxoplasmosis​
●​ Decidua capsularis – covers the embryo​
●​ O – Other (including syphilis)​
●​ Decidua basalis – lies beneath the embryo;
where the placenta will form​ ●​ R – Rubella​

●​ Decidua parietalis (vera) – the remaining ●​ C – Cytomegalovirus​

portion of the endometrium not directly involved
in implantation​ ●​ H – Herpes Simplex Virus​

EMBRYO AND MEMBRANES PLACENTA – Fully functional by the 2nd trimester; acts
as the lifeline of the fetus.​
Embryonic membranes: Produces several hormones critical for pregnancy:

●​ Chorion – outer membrane; attached to the 1.​ hCG – Maintains corpus luteum; early
decidua, forms chorionic villi which will pregnancy hormone​
contribute to placenta formation​
2.​ hPL (Human Placental Lactogen) / hCS
●​ Amnion – inner membrane surrounding the (Human Chorionic Somatomammotropin):​
embryo​
○​ Promotes mammary gland
development and breast enlargement
in preparation for lactation​

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 ○​ Has anti-insulin effect → causes ○​ Provides lubrication during labor
insulin resistance​ when membranes rupture​

○​ Beta cells increase insulin production ○​ Acts as a cushion that absorbs shock​
as a compensatory mechanism​
○​ Serves as a medium for fetal waste
○​ This hormonal shift may cause exchange​
Gestational Diabetes Mellitus (GDM)
starting in the 2nd trimester, due to ○​ Used in amniocentesis (for genetic and
placental hormones​ maturity testing)​

3.​ Progesterone:​ ●​ Characteristics of Amniotic Fluid​

○​ Promotes development of acinar cells ○​ Alkaline (pH 7.0–7.25)​

in the breast (milk-producing cells)​
○​ Normal color: clear and colorless​
○​ Enhances vascularization of the uterus
for better nutrient and blood supply​ ○​ Abnormal colors and meanings:​
• Greenish – Meconium staining due to
○​ Maintains pregnancy by relaxing the fetal hypoxia or distress​
uterus to prevent contractions​ • Yellow/Golden – Rh incompatibility;
hemolysis of fetal RBCs increases
4.​ Estrogen:​ bilirubin​
• Grayish/Cloudy – Infection (e.g.,
○​ Encourages uterine growth and breast chorioamnionitis)​
duct development​ • Brownish/Tea-colored – Fetal
demise or death; breakdown of blood or
○​ Promotes endometrial thickening​ tissue products

○​ Stimulates contractions in late

pregnancy​
POST-TERM PREGNANCY (>42 weeks)
○​ Estriol – the type of estrogen secreted
by the placenta responsible for uterine ●​ Complications​
contractility
○​ May lead to fetal hypoxia due to
placental aging (↓ oxygen/nutrient
AMNION AND UMBILICAL CORD transfer)​

AMNION & AMNIOTIC FLUID ○​ Signs of fetal distress:​

• Heart rate abnormalities lasting >90
●​ Functions of Amniotic Fluid​ seconds​
• Uterine contractions (UCs) occurring
○​ Protects the fetus from:​ too frequently (<2-minute intervals)​
• Mechanical trauma (e.g., fetal • Vaginal bleeding​
bumping or pressure)​ • Maternal vasoconstriction or
• Sudden changes in maternal body hypotension​
temperature​
• Umbilical cord compression (which ○​ Meconium-stained fluid is common,
can cut off oxygen supply)​ caused by relaxation of fetal anal
sphincter due to hypoxia
○​ Allows fetal movement for proper
musculoskeletal development​

OB | ish & gil 11

AMNIOTIC FLUID VOLUME ○​ Placental insufficiency (↓ blood supply
→ ↓ fetal urine output)​
●​ Normal Volume: 700 to 1000 mL
○​ ROM (Rupture of membranes) → fluid
leaks out prematurely​

POLYHYDRAMNIOS (>2000 mL) ●​ Complications​

●​ Causes​ ○​ Fetal contractures (limited movement

→ abnormal joint development)​
○​ Fetal inability to swallow amniotic fluid​
• Example: Tracheoesophageal fistula​ ○​ Cord compression → causes variable
decelerations in fetal heart rate​
○​ Multiple gestation (e.g., twins or more
produce more fluid)​ ○​ Pulmonary hypoplasia (lungs fail to
fully develop due to lack of breathing
○​ Maternal diabetes mellitus:​ practice inside womb)​
• High maternal glucose → crosses
placenta → fetal hyperglycemia​ ●​ Management​
• Fetal pancreas produces excess
insulin → macrosomia​ ○​ Amnioinfusion (instillation of warm
• Excess glucose used → fetal polyuria normal saline or LR into amniotic sac via
→ ↑ amniotic fluid​ IUPC to restore volume and cushion
cord)
●​ Complications​
UMBILICAL CORD
○​ Shortness of breath (SOB) in mother
due to diaphragm displacement​ ●​ Development​

○​ Preterm labor from overstretched ○​ Starts forming during the 5th week of
uterus​ gestation​

○​ Cord prolapse if membranes rupture ●​ Vessels (AVA)​

early due to high pressure​
○​ 1 umbilical vein: carries oxygenated
●​ Management​ blood from placenta to fetus​

○​ Amniocentesis to remove excess fluid​ ○​ 2 umbilical arteries: carry

deoxygenated blood from fetus to
○​ Indomethacin (NSAID that decreases placenta​
fetal urine production)​
• Used with caution after 32 weeks ○​ If only 2 vessels (single umbilical artery),
AOG due to risk of premature ductus report immediately​
arteriosus closure • May indicate cardiovascular, renal,
or genitourinary anomalies​

●​ Wharton's Jelly​
OLIGOHYDRAMNIOS (<300 mL)
○​ A gelatinous substance that protects the
●​ Causes​
cord’s blood vessels from compression
and kinking​
○​ Renal agenesis (baby has no kidneys
→ no urine → ↓ fluid)​

OB | ish & gil 12

UMBILICAL CORD INSERTION TYPES ○​ Lining of pulmonary system (lungs)​

●​ Central​ ○​ Lining of urinary bladder​

○​ Ideal type; cord is inserted at the center ●​ Mesoderm (Middle Layer)​

of the placenta where blood supply is
richest​ ○​ Connective tissues, muscles​

●​ Lateral/Eccentric​ ○​ Dermis of the skin​

○​ Slightly off-center but still within ○​ Bones, heart, blood vessels​

placental tissue​
○​ Kidneys and gonads​
●​ Marginal (Battledore)​
●​ Ectoderm (Outer Layer)​
○​ Inserted at the edge of the placenta; risk
for reduced circulation​ ○​ Epidermis (outermost skin)​

●​ Velamentous​ ○​ Hair follicles, nails​

○​ Inserted into fetal membranes 5–10 cm ○​ Sweat, sebaceous, and mammary

away from placenta​ glands​

○​ Risk: exposed vessels not protected by ○​ Central nervous system (CNS)​

Wharton's jelly​
• May lead to vasa previa ○​ Peripheral nervous system (PNS)

VASA PREVIA FETAL DEVELOPMENT

●​ Definition​ CARDIOVASCULAR SYSTEM

○​ Fetal vessels run through membranes ●​ Timeline of Development​

across the cervical os​
○​ 24th day or around 3 weeks AOG –
●​ Complication​ Heart begins to beat​

○​ Vessels may rupture during labor, ○​ 6th week – Septum (chamber)

causing rapid fetal blood loss​ formation begins (division into left and
right)​
●​ Management​
○​ 7th week – Heart valves begin to
○​ Requires Cesarean section (CS) develop​
before rupture occurs to save fetus​
○​ 8th–12th week (average = 10th week) –
Fetal heart tones (FHT) can be heard
via Doppler​

EMBRYONIC GERM LAYERS – ORGANOGENESIS ○​ 19th–22nd week – Heart tones audible

with fetoscope​
●​ Endoderm (Inner Layer)​

○​ Lining of Gastrointestinal tract (GIT)​

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RESPIRATORY SYSTEM ○​ Dysmature fetal lung​

●​ Timeline of Development​

○​ 4th week – Development of diaphragm

begins​ NERVOUS SYSTEM

○​ 7th week – Diaphragm completely ●​ Timeline of Development​

developed​
○​ 8th week – Detectable brain waves via
○​ 24th week – Surfactant begins to be EEG​
produced​
• Surfactant prevents fetal lung collapse ○​ 24th week –​
after birth​ • Fetus can respond to sound (ear
• Composed of lecithin and functioning begins)​
sphingomyelin​ • Pupillary reaction starts, indicating
early visual function
●​ Lecithin-Sphingomyelin (L:S) Ratio​

○​ Lecithin starts to appear at 8th week​

DIGESTIVE SYSTEM
○​ 35th week – Lecithin production
●​ Timeline of Development​
increases sharply​

○​ 6th week – Abdominal contents are

○​ A 2:1 L:S ratio usually indicates fetal
temporarily located outside the
lung maturity​
abdominal cavity (physiologic
• But in diabetic mothers, a ratio of 2:1
herniation)​
can be a false positive​
• For diabetics, maturity is confirmed at
○​ 10th week – Abdominal organs return
3:1 or at least 2.5:1​
inside the abdominal cavity​
• Failure of this process may cause
●​ Clinical Case Example​
abdominal wall defects:​
○​ A pregnant woman at 34 weeks AOG,
■​ Omphalocele – Organs remain
with signs of preterm labor, has an L:S
outside but covered by a sac​
ratio of 2:1​

■​ Gastroschisis – Organs remain

○​ She is hypertensive and diabetic, FHT
outside without protective sac​
= 130 bpm​

○​ 16th week – Meconium (first fetal stool)

○​ Interpretation: L:S ratio of 2:1 is not a
begins to form in the intestine​
reliable sign of fetal lung maturity in
diabetic mothers​
→ Correct answer: Immature fetal
lung​
GENITOURINARY SYSTEM
●​ Choices:​

○​ Immature fetal lung – ✅ Correct answer​ ●​ Timeline of Development​

○​ 12th week – Kidneys start producing

○​ Mature fetal lungs​ urine​

○​ Postmature fetal lung​

OB | ish & gil 14

 ○​ 16th week – Fetus begins to excrete ●​ 3rd Trimester (27–40 weeks)​
urine into the amniotic fluid​
○​ Period of most rapid fetal growth​

○​ Fetus gains weight, organs mature

(especially lungs and brain)​
REPRODUCTIVE SYSTEM
○​ Discomforts increase (e.g., back pain,
●​ 5th week – Formation of primitive reproductive edema, SOB)​
ducts:​

○​ Mesonephric (Wolffian) duct → Male

(testes)​
PRENATAL CHECK-UP SCHEDULE
○​ Paramesonephric (Müllerian) duct →
Female (ovaries)​ ●​ Purpose:​

●​ 7th week – If testosterone is present, male ○​ To monitor maternal and fetal

reproductive system develops automatically​ well-being​

●​ 10th week – In the absence of testosterone, ○​ To prepare the couple for the birth of
female structures (uterus, fallopian tubes) the baby​
continue to develop from the Müllerian duct​
○​ Priority: Safety of both mother and
●​ 14th week – External genitalia are more defined​ fetus​

●​ 16th week – Gender can usually be identified ●​ Visit Schedule:​

via ultrasound (UTZ)
○​ From 1st month to 7th month → Every
PREGNANCY 4 weeks​

○​ From 7th to 8th month → Every 2

TRIMESTERS OF PREGNANCY
weeks​
●​ 1st Trimester (0–13 weeks)​
○​ From 8th to 9th month → Every week
until delivery​
○​ Main event: Organogenesis (formation
of all major organs and systems)​

○​ Fetus is most vulnerable to teratogens

(e.g., drugs, infections)​ LMP & EDD CALCULATION

●​ 2nd Trimester (14–26 weeks)​ ●​ LMP (Last Menstrual Period)​

○​ Considered the most comfortable ○​ Refers to the first day of the last
period for most pregnant women​ menstrual period​

○​ Common signs: quickening (first fetal ○​ Used as a baseline for estimating due
movement felt), visible baby bump, date​
decreased nausea​
●​ EDD (Estimated Date of Delivery)​
○​ Risks of miscarriage lower; prenatal
screenings often done during this stage​ ○​ Calculated using Naegele’s Rule​

OB | ish & gil 15

 ○​ Formula:​ ■​ Preterm deliveries (20 to 36
• Add 7 days to the first day of LMP​ weeks AOG)​
• Add 9 months if LMP is from
January to March​ ■​ Multiple births (e.g.,
• Subtract 3 months + Add 7 days + twins/triplets) → Counted as 1
Add 1 year if LMP is from April to delivery only​
December​

GTPALM SYSTEM​
Example:​ Used for detailed obstetric history
LMP: May 10, 2025
●​ G - Gravida​
●​ Subtract 3 months → February 10​
○​ Total number of pregnancies (including
●​ Add 7 days → February 17​ current)​

●​ Add 1 year → EDD = February 17, 2026 ●​ T - Term deliveries​

GTPALM ○​ Number of full-term births (≥37 weeks

AOG)​

GRAVIDITY & PARITY

●​ P - Preterm deliveries​
●​ Gravidity (G)​
○​ Number of births between >20 weeks to
<37 weeks AOG​
○​ Refers to the number of pregnancies
regardless of outcome​
●​ A - Abortions​
○​ Includes:​
○​ Number of pregnancies terminated
before 20 weeks AOG​
■​ Current pregnancy​
○​ Includes spontaneous and induced
■​ Abortions or miscarriages​
abortions​
■​ Multiple pregnancies (twins,
●​ L - Living children​
triplets, etc.) → Counted as 1
pregnancy only​
○​ Number of currently living children​
●​ Parity (P)​
○​ Counted individually, unlike G and P​
○​ Refers to the number of pregnancies
●​ M - Multiple pregnancies​
carried beyond 20 weeks of gestation
(viability), regardless of outcome​
○​ Indicates if any pregnancy involved
twins, triplets, etc.​
○​ Does not include:​
○​ Note: In Gravida and Parity, they are
■​ Current pregnancy​
counted as 1, but in Living, each baby
is counted individually
■​ Abortions or miscarriages <20
weeks AOG​

○​ Includes:​

OB | ish & gil 16

 ●​ Goodell’s Sign​
PHYSIOLOGIC CHANGES DURING PREGNANCY

○​ Softening of cervix due to increased

REPRODUCTIVE CHANGES vascularity​

●​ Uterine enlargement: Measured via fundic ●​ Hegar’s Sign​

height​
○​ Softening of isthmus or lower uterine
○​ Patient should be in supine position for segment​
at least 3 minutes​
●​ Chadwick’s Sign​
○​ Ask patient to void before assessment​
○​ Bluish/purplish discoloration of vulva
○​ Use non-stretchable tape measure and cervix​
from symphysis pubis to uterine
fundus​ ○​ Due to increased vascularity​

○​ Best between 18 to 30 weeks AOG​ ●​ Leukorrhea​

○​ Fundic Height (cm) ≈ AOG (weeks)​ ○​ Increase in vaginal discharge forming

a mucus plug (operculum)​
○​ 20 cm ≈ 18–22 weeks AOG​
○​ Serves as lubrication​
○​ Palpable at 12 weeks at symphysis
pubis​ ○​ If mixed with blood → results in pinkish
discharge or bloody show​
○​ At 20 weeks: level of the umbilicus​
●​ Amenorrhea​
○​ At 24 weeks: about 2 fingerbreadths
above umbilicus​ ○​ Due to increased estrogen → FSH
suppression → anovulation​
○​ At 30 weeks: midway between
umbilicus and xiphoid process​ ○​ Increased progesterone → LH
production​
○​ At 36 weeks: at level of xiphoid process​

○​ At 38–40 weeks: drops below xiphoid

process due to lightening or
engagement​ BREAST CHANGES

●​ Ballottement​ ●​ Fullness, tingling, tenderness​

○​ Rebound or bouncing of fetus upon ●​ Darkening of areola​

palpation​
●​ Montgomery tubercles: enlarged and
○​ Seen between 6th to 20th week AOG​ protruding​

●​ Braxton Hicks Contraction​ ●​ Breast care: Clean with water only, avoid soap
on nipples​
○​ False labor or practice contraction​

○​ Begins at 16th week AOG​

OB | ish & gil 17

INTEGUMENTARY CHANGES ○​ Encourage calcium-rich foods​

●​ Linea nigra: Dark line on abdomen due to ○​ Dorsiflex foot during cramping​
melanocyte-stimulating hormone (MSH)​
●​ Ossification begins around 12th week AOG​
●​ Melasma/Chloasma: “Mask of pregnancy,”
darkening of face​

●​ Striae gravidarum: Stretch marks from skin

stretching and rupture of dermal layer​ GENITOURINARY CHANGES

●​ Palmar erythema: Due to vasodilation and ●​ Increased urine output (UO) and glomerular
increased blood flow​ filtration rate (GFR)​

●​ Pruritus gravidarum: Caused by hormone ●​ Increased creatinine clearance, but

levels​ decreased serum creatinine, BUN, uric acid​

○​ Management:​ ●​ Frequent urination:​

■​ Calamine/cocoa-based lotion​ ○​ Common in 1st and 3rd trimester​

■​ Cool bath with baking soda​ ○​ If it occurs in 2nd trimester, assess for
UTI​
■​ Loose clothing​
■​ UTI may be triggered by
glycosuria due to HPL/HCS​

●​ UTI prevention:​
MUSCULOSKELETAL CHANGES
○​ Fluid intake: >2000 mL/day, but limit
●​ Lordosis: Inward curve of lumbar spine due to fluid intake at night​
abdominal weight​
○​ Drink cranberry juice​
●​ Lower back pain:​
○​ Wipe front to back​
○​ Encourage proper posture​
○​ Avoid bubble baths​
○​ No bending from the waist, instead
squat​ ○​ Avoid wearing tight/stagnant clothing​

○​ Wear low-heeled shoes​ ○​ Use cotton underwear​

○​ Take rest and perform pelvic tilt

exercise​

○​ Taylor sitting: relieves back pain​ CARDIOVASCULAR CHANGES

●​ Leg cramps:​ ●​ ↑ Cardiac Output, ↑ Pulse Rate, ↑ Blood

Volume​
○​ Common in 2nd trimester​ These changes support the increased metabolic
and oxygen demands of the mother and fetus.​
○​ Caused by low calcium​
●​ ↑ Plasma Volume → Leads to hemodilution,
which lowers the concentration of red blood

OB | ish & gil 18

 cells.​ TRUE ANEMIA IN PREGNANCY

●​ ↑ RBC Production → Results in physiologic Based on standard clinical thresholds:

anemia or pseudoanemia, which is expected
during pregnancy due to dilutional effect.​
Trimester Hemoglobin Hematocrit
●​ Normal Blood Loss During Delivery:​ (Hgb) (Hct)

○​ NSD (Normal Spontaneous Delivery):

500 mL​
1st & 3rd <11 g/dL <33%
○​ CS (Cesarean Section): 1000 mL​ Trimester

●​ Normal Laboratory Values in Pregnancy:​

2nd Trimester <10.5 g/dL <32%
○​ Hemoglobin (Hgb): 12–16 g/dL​

○​ Hematocrit (Hct): 37%–47%​

Values below the thresholds above indicate true
anemia requiring further intervention.

WBC CHANGES IN PREGNANCY

SITUATION: A Pregnant Woman in 2nd Trimester
●​ ↑ WBC count, especially neutrophils and
Labs: Hgb = 14 g/dL, Hct = 39%​ granulocytes → A normal immune adaptation
Question: What is the priority nursing intervention? to protect mother and fetus.​

●​ Encourage supplement​ ●​ Lymphocytes (especially NK cells) play a role

✅​
in adaptive immunity.​
●​ Encourage iron-rich food
○​ If lymphocyte levels rise excessively,
●​ Document the finding​ it may trigger an immune response that
could attack the fetus, treating it as a
●​ Report the finding​ foreign body

✅ Answer: Encourage iron-rich food – Even if values PLATELETS & CLOTTING FACTORS

are within normal range, increased nutritional demand ●​ ↑ Platelet Count and ↑ Clotting Factors (e.g.,
during pregnancy justifies reinforcing iron intake through fibrinogen)​
diet to prevent future anemia.
○​ These changes help prevent massive
bleeding during labor and delivery.​

○​ This is a protective physiologic

response.​

●​ Risk in Prolonged Bed Rest:​

○​ If the pregnant woman is immobile for a

long period, she becomes at risk for
hypercoagulability, which can lead to
DVT (Deep Vein Thrombosis).​

OB | ish & gil 19

DVT Prevention Measures: RESPIRATORY CHANGES

●​ Encourage early ambulation​ ●​ Increased respiratory rate and basal

metabolic rate​
●​ Promote leg exercises​
○​ Normal RR: 18–20 cpm​
●​ Use supportive stockings or compression
devices ●​ Diaphragm displacement due to gravid uterus​

○​ Occurs in late 2nd and 3rd trimester​

BLOOD PRESSURE CHANGES IN PREGNANCY ○​ Causes SOB, especially before

lightening​
●​ ↓ Blood Pressure is expected due to the
vasodilating effect of progesterone, ○​ Management:​
especially in early pregnancy.​
■​ Avoid overexertion​
●​ If ↑ Blood Pressure in 1st Trimester:​
■​ Rest​
○​ May indicate Chronic Hypertension or
Hydatidiform Mole (H-mole)​ ■​ Sleep with head elevated​

●​ If ↑ Blood Pressure after 20 weeks AOG (age ●​ Nasal stuffiness:​

of gestation):​
○​ Due to increased estrogen​
○​ Suspect PIH (Pregnancy-Induced
Hypertension) or Preeclampsia​ ○​ Management:​

■​ Use humidifier​
BP Criteria for Hypertension in Pregnancy:
■​ Avoid antihistamines​
●​ Systolic ≥140 mmHg and/or Diastolic ≥90 mmHg​
■​ Use normal saline nasal
●​ Diagnosis must be confirmed with 2 separate spray/drops
readings taken 4–6 hours apart​

GASTROINTESTINAL CHANGES

SUPINE HYPOTENSIVE SYNDROME ●​ Nausea and Vomiting (Morning sickness)​

●​ Caused by compression of the inferior vena ○​ Caused by increased HCG​

cava by the gravid uterus when the mother lies
flat on her back.​ ○​ Common in 1st trimester​

●​ Leads to reduced venous return, which lowers ○​ Management:​

cardiac output and causes maternal
hypotension.​ ■​ Eat dry crackers upon waking​

●​ Blood flow is impeded: ↓ venous return → ↓ ■​ Avoid brushing teeth

right heart filling → ↓ pulmonary circulation → ↓ immediately after waking​
left ventricular output → ↓ systemic circulation
and fetal oxygenation. ■​ Small, frequent meals​
●​
○​

OB | ish & gil 20

 ■​ Avoid fried, spicy, and raw foods​ ■​ Increase fiber, fluids, fruits​

■​ Drink liquids between meals, ■​ Regular exercise​

not during​
●​ Hemorrhoids​
■​ Suck on hard candy​
○​ Caused by varicose veins of rectum
■​ Antiemetics: Phenergan, due to pressure and constipation​
Zofran​
○​ Management:​
●​ PICA​
■​ Warm sitz bath​
○​ Craving for non-edible or non-nutritive
substances​ ■​ Sit on soft pillows​

○​ Common in women with iron deficiency ■​ Prevent constipation​

anemia (IDA)​
■​ Topical rectal creams (e.g.,
○​ Examples: soil, hair, ice cubes, hydrocortisone)
cornstarch​
PRESUMPTIVE, PROBABLE & POSITIVE SIGNS
●​ Ptyalism​ OF PREGNANCY

○​ Excessive salivation due to increased

PRESUMPTIVE SIGNS (Subjective; reported by the
estrogen​
woman—may be caused by other conditions)

Mnemonic: PRESUME

●​ P – Period is absent (amenorrhea)​

●​ Heartburn (Pyrosis)​
●​ R – Really tired (fatigue)​
○​ Due to increased progesterone and
gravid uterus​
●​ E – Enlarged breasts​

○​ Common in 2nd trimester​

●​ S – Sore or tender breasts​

○​ Management:​
●​ U – Urinary frequency (due to pressure on the
bladder)​
■​ Similar to nausea advice​
●​ M – Movement felt by the mother (quickening;
■​ Sip water​
occurs between 16th to 20th week)​

■​ Avoid: carbonated drinks,

●​ E – Emesis and nausea (morning sickness)​
chocolate, peppermint, citrus
fruits​
These signs make the woman presume
●​ Constipation​ she is pregnant but are not diagnostic, as
they can also occur with stress, infection,
○​ Due to progesterone and uterine or hormonal imbalance.
pressure​

○​ Management:​

OB | ish & gil 21

PROBABLE SIGNS (Objective; observed by the ●​ Seen – Visualization of the fetus by ultrasound
examiner, usually a nurse or healthcare provider) (can confirm as early as 4–6 weeks gestation)​

Mnemonic: PROBABLE
These are definitive signs of pregnancy. If
●​ P – Positive pregnancy test (OT—urine or blood; present, pregnancy is confirmed with no
detects hCG)​ other possible cause.

○​ Note: False positives can occur in

DIAGNOSTIC TESTS
hydatidiform mole (H-mole) or with use
of some psychotropic drugs​
Rubella Titer (German Measles Immunity Test)
●​ R – Rebound effect during internal exam
●​ Detects immunity to rubella.​
(Ballottement: fetus floats then returns when
tapped)​
●​ Positive titer = Immune​
●​ O – Outline of the fetus can be palpated through
●​ Negative titer = No immunity (<1:8)​
abdominal examination​

●​ Vaccine:​
●​ B – Braxton Hicks contractions (irregular,
painless uterine contractions felt mid-to-late
○​ Given during postpartum (NOT during
pregnancy)​
pregnancy)​
●​ A – A softening of the cervix (Goodell’s sign)​
○​ Ask about egg allergy​
●​ B – Bluish discoloration of cervix and vaginal
○​ Administered subcutaneously​
mucosa (Chadwick’s sign) due to increased
vascularity​
○​ Do NOT give with RhoGAM – give
RhoGAM first, then rubella vaccine after
●​ L – Lower uterine segment softening (Hegar’s
72 hours​
sign) felt during bimanual examination​

○​ Advise to avoid pregnancy for 1–3

●​ E – Enlarged uterus detectable through pelvic
months​
exam​

○​ Avoid contact with pregnant women

These signs are stronger evidence than and immunocompromised individuals
presumptive signs, but still not after vaccine
confirmatory as they can be caused by
other gynecologic conditions.
PAP Smear

●​ Done on 1st prenatal visit​

POSITIVE SIGNS (Confirmatory—only caused by
pregnancy)
●​ Screens for cervical neoplasm​
Mnemonic: "Heard, Felt, Seen = Confirmed"
●​ Lithotomy position with an empty bladder​
●​ Heard – Fetal Heart Tones (FHT) heard via
Doppler (10–12 weeks) or fetoscope (18–20 ●​ Encourage verbalization of feelings to reduce
weeks)​ anxiety​

●​ Felt – Fetal movement palpated by a trained ○​ ↓ Anxiety = ↓ pelvic tension → ↓ pain​

examiner​
●​ Done by a physician

OB | ish & gil 22

Tuberculosis Screening (Mantoux Test) ●​ No harm; sensitization begins​

●​ Uses Purified Protein Derivative (PPD)​

2nd Pregnancy:
●​ Identifies presence of Mycobacterium
tuberculosis ●​ Mother: Rh (–), Baby: Rh (–)​

●​ No harm​

Chorionic Villus Sampling (CVS)

3rd Pregnancy:
●​ Done at 10 to 13 weeks AOG​
●​ Mother: Rh (–), Baby: Rh (+)​
●​ For genetic analysis​
●​ Mother's antibodies attack baby's RBC →
●​ Usually done transabdominally​ Hemolysis

●​ Contraindicated: Transcervical route

Hemolysis Pathophysiology

Rh Factor & Rh Incompatibility ●​ Destruction of Rh-positive fetal RBCs​

●​ Occurs when Rh-negative mother carries an ●​ Bone marrow, spleen, liver attempt to
Rh-positive fetus​ compensate​

●​ Blood mixing (from placental break) can trigger ○​ Leads to extramedullary

immune response​ hematopoiesis​

●​ Rh antibodies develop → Sensitization / ○​ Produces immature RBCs:

Isoimmunization​ Erythroblasts → Erythroblastosis
fetalis​
●​ Invasive procedures like CVS, amniocentesis,
and percutaneous umbilical blood sampling ●​ Results in unconjugated bilirubin buildup →
(PUBS) may increase risk​ Pathologic Jaundice​

●​ Complications:​ ○​ Visible within 24 hrs post-delivery​

○​ Abruptio placenta​ ○​ May cross BBB → Kernicterus

(irreversible brain damage)
○​ Abortion​

○​ Ectopic pregnancy
Fetal Complications of Hemolysis

●​ Fetal Anemia → Heart compensates​

Rh Incompatibility Scenarios
●​ Ineffective contractions → Blood stasis​
1st Pregnancy:
●​ Heart Failure → Edema (Anasarca)​
●​ Mother: Rh (–)​
●​ Hydrops Fetalis​
●​ Baby: Rh (+)​
●​ Hepatosplenomegaly​

OB | ish & gil 23

 ●​ Organ failure​
Test Source ↑ Suggests ↓
Suggests
●​ Sinusoidal pattern on FHR (no variability)​
AFP Fetal Neural tube Down
○​ Sign of severe anemia and fetal (Alpha-fetop liver defects, abdominal syndrome
demise rotein) wall defects,
multiple gestation

hCG Placenta Down syndrome, —

Management of Rh Incompatibility multiple gestation

●​ RhoGAM (anti-D immunoglobulin)​ Estriol Placenta — Down

syndrome
○​ Given IM at 28 weeks AOG​

○​ Repeat dose within 72 hours after Inhibin A Placenta Down syndrome —

delivery of Rh (+) baby​

Interpretation Mnemonic:
○​ Also given after abortion, miscarriage, or
invasive procedures​
●​ ↓ AFP + ↓ Estriol = Possible Down syndrome​

●​ Do NOT give RhoGAM if the mother is already

●​ ↑ hCG + ↑ Inhibin A = Possible Down syndrome​
sensitized (has antibodies)​

●​ How to check for sensitization:​

○​ Indirect Coombs Test – mother’s blood​ Non-Stress Test (NST)

○​ Direct Coombs Test – newborn’s blood ●​ Non-invasive, safe; no contraindications​

(tests for hemolysis)​
●​ Checks fetal well-being (FHR in response to
●​ RhoGAM = temporary antibodies to trick the movement)​
immune system​
●​ Duration: 20–40 minutes​
●​ If mother is sensitized:​
●​ Position: Any comfortable (avoid supine)​
○​ Intrauterine exchange transfusion
(give Rh-negative blood to fetus)​ ●​ Parameters:​

○​ FHR: At least 2 accelerations​

○​ Acceleration: ↑ 15 bpm for 15 sec =

Quad Screen Reactive NST​

●​ Done at 15–22 weeks AOG​

○​ If criteria not met = Non-reactive NST

●​ Specimen: Maternal blood​

●​ Not routine but helpful in risk assessment​ Contraction Stress Test (CST)

●​ Tests 4 Parameters:​ ●​ Assesses if fetus can tolerate labor stress

●​ Parameters: FHR + Uterine Contractions​

OB | ish & gil 24

 ●​ Method:​
Safe method Less safe, requires
ruptured membranes
○​ Nipple stimulation (1 side, then both if
(–BOW) & cervical
needed)
dilation of at least 2–3
○​ Oxytocin infusion
cm
○​ Duration: 10 minutes
○​ Goal: 3 contractions in 10 mins​ Position: Side-lying More accurate

●​ Results:​

○​ Negative = Normal (no late decels)​ FETAL MONITORING PARAMETERS

○​ Positive = Late decelerations >50% → ●​ Tachycardia: FHR > 160 bpm​

Uteroplacental insufficiency​
●​ Bradycardia: FHR < 110 bpm​
○​ Suspicious/Equivocal = Late decels
<50%​ ●​ Acceleration: Increase of at least 15 bpm
above baseline, lasting at least 15 seconds​
○​ Unsatisfactory = Fewer than 3
contractions​ ●​ Decelerations:​

○​ Hyperstimulation = Contractions >90 ○​ Early Deceleration:​

sec duration or <2 min frequency
■​ Mirror image of contraction​
Contraindications to CST:
■​ Cause: Fetal head compression​
●​ Preterm labor
●​ Incompetent cervix ■​ Nursing action: Document the
●​ Previous cesarean section finding, continue monitoring​
●​ Placenta previa
●​ Vasa previa ○​ Late Deceleration:​
●​ Transverse lie
●​ Cannot deliver vaginally ■​ Begins after contraction starts
(delay of 45–60 seconds),
FETAL MONITORING returns to baseline after UC
ends​
FETAL MONITORING DURING LABOR​
■​ Cause: Uteroplacental
(Electronic Fetal Monitoring)
insufficiency​

EXTERNAL INTERNAL ■​ Nursing management:​

• Stop oxytocin infusion​
Non-invasive Invasive • Reposition to left side-lying​
• Elevate legs if hypotensive​
Done by locating fetal back Transcervical insertion • Administer O₂ at 8–10 LPM
(via Leopold’s Maneuver) via facemask​
• Report to physician
immediately​
Uses ultrasound transducer Uses spiral electrode
for FHT & tocodynamometer for FHT & intrauterine ○​ Variable Deceleration:​
(tocotransducer) for uterine pressure catheter
contractions (UC) (IUPC) for UC ■​ Abrupt drop in FHR with
variable shape (V, W, U)​

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 ■​ Cause: Umbilical cord
PSYCHOLOGICAL ADAPTATION
compression​

■​ "Dedmatology" pattern — not in 1st Trimester

sync with contraction​
●​ Ambivalence​
■​ Management:​
○​ Mixed emotions about pregnancy
• Reposition (side-lying or
(excited but unsure)​
knee-chest position)​
• Trendelenburg position to
○​ Common reaction, especially for
relieve pressure​
first-time mothers​
• Administer O₂ at 8–10 LPM
via facemask​
○​ Must be resolved by the end of the first
• May require amnioinfusion or
trimester for healthy emotional bonding​
emergency cesarean section

VEAL CHOP Mnemonic: ●​ Focus: Acceptance of the pregnancy​

●​ Variable deceleration → Cord compression​ ○​ Realization: “I am pregnant”​

●​ Early deceleration → Head compression​

●​ Acceleration → Okay (normal)​

2nd Trimester
●​ Late deceleration → Placental insufficiency
●​ Quickening​

○​ First perception of fetal movement

DYSTOCIA (Abnormal/Prolonged Labor) (usually around 16–20 weeks)​

○​ Helps mother begin to see the fetus as a

HYPERTONIC HYPOTONIC separate individual​

Latent phase Active phase ●​ Anticipatory Role-Playing​

Painful contractions Limited pain ○​ Starts imagining herself as a parent​

Strong, frequent, Weak and infrequent ●​ Fantasizing​

uncoordinated contractions contractions
○​ Dreams or mental images about the
High risk for dehydration Risk of prolonged baby (e.g., appearance, personality)​
labor
●​ Focus: Acceptance of the baby​
After delivery: Risk of uterine
atony ○​ Realization: “I am going to have a baby”

Management: Do NOT give Management: Give

oxytocin oxytocin
3rd Trimester
Give sedation Do NOT give
sedation ●​ Nesting Behavior​

○​ Strong desire to prepare the home and

environment for the baby’s arrival​

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 ●​ Preparation Activities:​

○​ Choosing a name for the baby​

○​ Attending childbirth classes​

○​ Preparing infant items and hospital bag​

○​ Deciding on sleeping arrangements​

■​ Avoid co-sleeping with infants to

reduce the risk of SIDS (Sudden
Infant Death Syndrome)​

○​ Preparing older siblings:​

■​ To avoid sibling rivalry, start

shifting physical closeness of
the older child to the father
(about 2–3 months before
delivery), e.g., “Kay daddy ka
muna matulog o yakap.”​

●​ Focus: Acceptance of the maternal role​

○​ Realization: “I am going to be a mother”

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