1/29/25

MATERNAL MALE REPRODUCTIVE

SYSTEM
NURSING
CHRISTIAN JOHN B. TIMOGAN, RN, USRN ANDROLOGY – Study of the male
Lecturer reproductive organ

1 2

EXTERNAL ORGANS INTERNAL ORGANS

SCROTUM TESTES
Ø Pouch hanging below the penis Ø First formed: Pelvic / abdominal cavity
Ø Contains the testes
Ø Temperature Regulator Descends (28 – 38 weeks AOG)
Ø (Cold = Contract ; Hot = Relax)
Ø Undescended: CRYPTORCHIDISM
PENIS
Ø Functions: Passage way of urine and sperm Ø Functions:
Ø Glans Penis – Most sensitive part • Exocrine (With Duct / Opening)
- Covered by Prefuse – Sperm production
(Foreskin) – Site of circumcision • Endocrine (No Ducts / Directly to the bloodstream)
– Hormone production (Testosterone)

3 4

INTERNAL ORGANS INTERNAL ORGANS

TESTES EPIDIDYMIS
Ø 3 Important structures: Ø Site of Sperm maturation
Ø 14 days for the sperm to mature
• SEminiferous Tubules – Spermatozoa production
LEydig Cells – Testosterone production
•
VAS DEFERENS
• SErtoli Cells – Sperm Nourishment
Ø Passageway of sperm
Ø Site of vasectomy & varicocele
Ø Normal Assessment:
• Ovoid Shape / Egg shape EJACULATORY DUCT
• Firm & Smooth Ø Force semen into the urethra during ejaculation
• Left testes is slightly lower than the right

5 6

1
 1/29/25

INTERNAL ORGANS
SEMINAL VESICLES
Ø Semen Composition: FEMALE REPRODUCTIVE
- Fructose (Sugar that provides energy to sperm)
- Vitamin C (Maintains pH environment for sperm) SYSTEM
- Prostaglandin (Aids in the opening of cervix)

PROSTATE GLAND GYNECOLOGY – Study of the female

Ø Contributes 60% of sperm alkalinity reproductive organ
Ø Secretes a thin alkaline fluid
Ø Sensitive part of male reproductive organ

7 8

EXTERNAL ORGANS EXTERNAL ORGANS

MONS PUBIS / MONS VENERIS LABIA MINORA
Ø Thin lips
Ø Mountain / Hill of Venus
Ø Made up of thin connective tissue
Ø Made up of subcutaneous tissue that increases during puberty Ø Pink-colored
Ø Hairless
Ø Function: To protect the symphysis pubis from the impact of sexual
Ø Anterior: Clitoris
intercourse Ø Posterior: Perineum / Fourchette

9 10

EXTERNAL ORGANS EXTERNAL ORGANS

LABIA MAJORA
Ø Large lips URETHRAL OPENING
Ø Made up of subcutaneous tissues from mons pubis Ø 3 – 4 Inches
Ø Function: Protects distal vagina & urethra Ø Portal of entry for UTI

CLITORIS VAGINAL OPENING

Ø Sexual orgasm center due to its abundant nerve endings Ø Hymen covering
Ø Covered by clitoral hood - Can be torn by: Coitus, Active Sports, Tampons
Ø Key to catheterization - Can be reconstructed (Hymenorrhapy)

11 12

2
 1/29/25

EXTERNAL ORGANS INTERNAL ORGANS

SKENE’S GLAND OVARIES
Ø Lubricates vulva during coitus Ø Functions: - Exocrine : Ovum Production
- Endocrine: Estrogen & Progesterone
BARTHOLIN’S GLAND Ø Shape: Almond
Ø Secretes fluid to make vagina Ø Color: Grayish – White
alkaline for sperm survival Ø 3 layers of ovaries
• Cover protective layer – Outermost layer / Protects
FOURCHETTE / PERINEUM ovary
Ø Site of episiotomy • Cortex – Site of ovum maturation
- Immature Ovum (Primordial Follicle)
- Mature Ovum (Graafian Follicle)
• Central medulla – Innermost layer / blood supply

13 14

INTERNAL ORGANS INTERNAL ORGANS

FALLOPIAN TUBE UTERUS
Ø Interstitial - Shortest Ø Shape: Pear-Shaped
- Most dangerous site Ø 3 main parts:
for ectopic pregnancy • Corpus
• Isthmus
Ø Isthmus – Site of BTL • Cervix
Ø 3 layers:
Ø Ampulla – Site of fertilization • Perimetrium
- Common site for • Myometrium
ectopic pregnancy • Endometrium

Ø Infundibulum – Holds the ovary

15 16

UTERUS MAIN PARTS UTERUS MAIN PARTS

CORPUS ISTHMUS
Ø Uppermost part of the uterus Ø Common site for CS (Bikini Cut)

Contains the growing fetus

Ø
CERVIX
Ø 2 structures: Ø Lower uterine segment
• Cornua – Where the fallopian tubes are attached Ø Prone to cancer growth: Human Papilloma Virus
Ø HPV Prevention: GARDASIL Vaccine
• Fundus – Pushes the fetus into the vagina during delivery - Target: Young women
- Site of placental implantation - Given in 3 doses:
1. Anytime
2. After 2 months from 1st shot
3. After 6 months from 1st shot

17 18

3
 1/29/25

LAYERS OF UTERUS LAYERS OF UTERUS

PERIMETRIUM ENDOMETRIUM
Ø Outer Layer of the uterus
Ø Inner highly vascular layer
Ø Protects & strengthens uterus
Ø 2 sub - layers: (Basal and Glandular)
MYOMETRIUM Ø Non – Pregnant : Basal layer retained ; Glandular layer will
Ø Largest, middle, muscular layer
Ø Controls the power of labor and delivery slough off (Menses)
Ø Functions:
• Constricts cornua to prevent menstrual reflux
• Holds the internal orifice to prevent preterm labor
• Expels fetus thru equal uterine contraction
• Constricts the uterine blood vessels to prevent hemorrhage
• Key to myoma

19 20

LAYERS OF UTERUS
ENDOMETRIUM
Ø Pregnant: It will become DECIDUA
3 types:
MENSTRUAL CYCLE
Ø
• Decidua Basalis – Site for implantation
• Decidua Capsularis – Encapsulates the
fetus
• Decidua Vera – Remaining portion
(Becomes LOCHIA)

21 22

MENSTRUAL PHASE
SECRETORY / LUTEAL MENSTRUAL CYCLE
(Day 1 – 5)
PHASE
(Day 15 – 21) PROLIFERATIVE FOLLICULAR PHASE (6-14)
Decrease Estrogen and Progesterone
Day 5 Day 14 Day 21

Day 1 Day 28 Detected by the Hypothalamus

GnRH

ANTERIOR PITUITARY GLAND

PROLIFERATIVE / FOLICULAR ISCHEMIC PHASE
(Day 22 – 28)
FSH, LH
PHASE
(Day 6 – 14)
OVARIES

23 24

4
 1/29/25

MENSTRUAL CYCLE MENSTRUAL CYCLE

PROLIFERATIVE FOLLICULAR PHASE (6-14) SECRETORY / LUTEAL PHASE (15-21)
MATURE / GRAAFIAN CORPUS
TERTIARY FOLLICLE LUTEUM
SECONDARY
PRIMARY
FOLLICLE
FOLLICLE OVUM
PRIMORDIAL FOLLICLE
FOLLICLE

Day 6 Day 14
Day 15 Day 21
Day 13, Super Increase
While the follicle grows, it releases ESTROGEN ESTROGEN concentration,
APG will release LH to halt CORPUS LUTEUM
the Graafian Follicle - Broken eggshell
ESTROGEN will go into the uterus - 14 days lifespan
Day 14 = OVULATION - Releases PROGESTERONE (will go to uterus for Blood Supply)
Thickens endometrial lining

25 26

MENSTRUAL CYCLE MENSTRUAL CYCLE

ISCHEMIC PHASE (22-28) MENSTRUAL PHASE (1-5)

Day 22 Day 28 Day 1 Day 5

If dili maburos J; Corpus Luteum will start to die: Endometrium will slough off

Decrease Progesterone Decrease Estrogen

Decrease Blood Supply

Ischemia

27 28

MENSTRUAL CYCLE MENSTRUAL CYCLE

PROLIFERATIVE FOLLICULAR PHASE (6-14) SIGNS OF OVULATION
1. Abrupt rise in basal body temperature
Decrease Estrogen and Progesterone
- Due to thermogenic action of progesterone
- 0.3 – 0.5 C
Detected by the Hypothalamus

GnRH 2. Presence of Mittelschmerz

- Unilateral abdominal discomfort
ANTERIOR PITUITARY GLAND - Due to irritation from ruptured Graafian follicle
FSH, LH
3. Fertile Cervical Mucous
- Clear & Transparent discharges
OVARIES
- Slippery & Elastic
- Due to the increase presence of estrogen

29 30

5
 1/29/25

MENSTRUAL CYCLE MENSTRUAL CYCLE TERMS

Ø MENARCHE – First menses
MENARCHE DURATION
Ø AMENORRHEA – No menses
Ø First menstruation Ø Normal: 3 – 8 days
Ø Normal: 9 – 17 y/o Ø Average: 5 days Ø DYSMENORRHEA – Painful menses
Ø Average: 12 y/o
Ø METRORRHAGIA – Bleeding between menses

INTERVAL AMOUNT Ø MENOPAUSE – Stop menses

Ø Normal: 23 – 35 days Ø Normal: 30 – 80 cc Ø HYPOMENORRHAGIA - < 3 days
Ø Average: 28 days Ø Average: 50 cc
Ø POLYMENORRHAGIA - > 8 days
Ø OLIGOMENORRHEA - < 30 cc
Ø MENORRHAGIA - > 80 cc

31 32

METHODS OF CONTRACEPTION
NATURAL METHOD
METHODS OF
1. Calendar Standard Days Method
- Uses timing
- Women must be on regular cycle (23 – 35 days)

CONTRACEPTION - Have a diary of 6 months cycle

- Subtract 18 in shortest cycle
- Subtract 11 in longest cycle
(RA 10354 – Responsible Parenthood and
Reproductive Health Act of 2012) 2. Withdrawal Method
- Coitus Interruptus
- Least effective method
- No ejaculation inside the vagina

33 34

METHODS OF CONTRACEPTION METHODS OF CONTRACEPTION

NATURAL METHOD NATURAL METHOD
4. Billing’s Method / Cervical Mucus Method
3. Lactation Amenorrhea method - Uses cervical mucus:
- Prolactin – Inhibits ovulation Clear and Thin
- 98% EFFECTIVE if all conditions are met: Length of mucus up to 12 cm
1. Exclusive breastfeeding (for 6 months) Elastic / Stretchable
2. Frequent breastfeeding (atleast every 3-4 hours) Abundant but NOT thick
3. First 6 months post partum Resembles like uncooked egg white
4. No return of menstruation - Elastic: UNSAFE SEX (Fertile Days)
- Tacky: SAFE SEX

35 36

6
 1/29/25

METHODS OF CONTRACEPTION METHODS OF CONTRACEPTION

HORMONAL METHOD HORMONAL METHOD
1. Pills
1. Pills
- Content: Progestin + Estrogen
- 21-day pill: - Contraindication: (It increases blood viscosity)
> 7 days pill - free break (Expect withdrawal bleed) • Chain smoker
> Start new pack on 8th day • Extreme obesity
- 28-day pill: • Hypertension
> 21 true pills
• Diabetes Mellitus
> 7 placebo pills
> Start new pack after finishing the 28 pills • Thrombophlebitis

37 38

METHODS OF CONTRACEPTION METHODS OF CONTRACEPTION

HORMONAL METHOD HORMONAL METHOD
1. Pills 1. Pills / Implant
- When to stop using pills: - If discontinued: Residual hormones on the 1st 3 months
Abdominal pain - Sex on 1st 3 months = NO PREGNANCY
Chest pain
Headache 2. Patch
Eye problem - Place in non hairy and less fats
Severe leg cramps - Worn continuously for 3 weeks (1 week patch free)
- If pills is forgotten for 1 dose:
1. Take as soon as you remember
2. Take 2 doses the following day (1 day forgotten)
3. Change to another method (2 days forgotten)

39 40

METHODS OF CONTRACEPTION METHODS OF CONTRACEPTION

BARRIER METHOD SURGICAL METHOD
Condom
1.
1. Vasectomy – Need atleast 20 – 30 ejaculation to clear
2. IUD
3. Cervical Cap out sperm (within 1 month)
2. Tubal ligation

41 42

7
 1/29/25

STAGES OF FETAL DEVELOPMENT

PRE – EMBRYONIC STAGE
Ø From Fertilization to Implantation

PREGNANCY EMBRYONIC STAGE

Ø From Implantation to 8 weeks

FETAL STAGE
Ø 9 weeks until birth

43 44

STAGES OF FETAL DEVELOPMENT STAGES OF FETAL DEVELOPMENT

PRE – EMBRYONIC STAGE PRE – EMBRYONIC STAGE
Ø Union of (Ovum + Sperm) = ZYGOTE (FERTILIZATION)
IMPLANTATION
1st Cell Division (BLASTOMERE)

16 – 50 Cells (MORULA)

BLASTOCYSTS Ø 3 Process:
Ø Structure that implants at endometrium
• Apposition – Blastocyst are still floating
Ø 2 layers:
• Attachment – Blastocyst are attached to the endometrium
• Embryoblast - Embryo • Invasion – Blastocyst are settling in
• Trophoblast – Placenta and
Maternal Hormones

45 46

STAGES OF FETAL DEVELOPMENT STAGES OF FETAL DEVELOPMENT

EMBRYONIC STAGE EMBRYONIC STAGE
Ø Structures: PLACENTA
• EMBROYOBLAST – Becomes Embryo - Functions:
• THROPOBLAST – Fetal Structures 1. Lung of fetus – O2 and CO2 exchange
2. GIT – Glucose transport
MATERNAL HORMONES 3. Circulatory – Feto-placental circulation
• HCG - Maternal and Fetal blood WILL NEVER MIX
• Estrogen
• Progesterone
• Human Placental Lactogen - Diabetogenic
• Relaxin – Will soften the joints (Lordosis)

47 48

8
 1/29/25

STAGES OF FETAL DEVELOPMENT STAGES OF FETAL DEVELOPMENT

EMBRYONIC STAGE EMBRYONIC STAGE
AMNIOTIC MEMRANE AMNIOTIC FLUID
Ø Early: Clear / Transparent
- 2 layers:
Ø Late: Slight yellow, amber with fleeks of vernix caseosa
> Chorion – Amniotic sac Ø pH: 7.0 – 7.5 (Alkaline)

Ø Volume: 800 – 1,200 mL

> Amnion – Amniotic fluid
Ø Abnormal Color:
- No nerve supply so no pain while the fetus is moving • Cloudy / Gray – Infection
• Pink / Red – Possible bleeding
• Yellow – Hyperbilirubinemia
• Greenish – Meconium staining
• Dark Brown – Fetal death

49 50

STAGES OF FETAL DEVELOPMENT STAGES OF FETAL DEVELOPMENT

Ø Common Amniotic fluid problems:
Ø Amniotic Fluid Diagnostic Test
OLIGOHYDRAMNIOS POLYHYDRAMNIOS • FERN TEST
Ø Less than 300 mL Ø More than 2,000 mL - Using a sterile cotton swab to collect sample
Ø Baby: (p) Renal Agenesia Ø Baby: (p) Esophageal Atresia - Put in microscope slide
Ø Mother: (p) Placental problems Ø Mother: (p) DM (+) Fern – Positive amniotic fluid
Ø Mngt: Amnioinfusion Ø Mngt: Amniocentesis (-) Fern - Negative amniotic fluid

51 52

STAGES OF FETAL DEVELOPMENT STAGES OF FETAL DEVELOPMENT

Ø Amniotic Fluid Diagnostic Test Ø Amniotic Fluid Diagnostic Test
• CHORIONIC VILLUS SAMPLING
• NITRAZINE TEST
- To detect Genetic Disorders
Blue Color – Positive amniotic fluid - Earliest test possible on fetal cells
- Perform: Between 8 – 12 weeks
Red Color – Urine
- Procedure: Catheter is passed thru a thin cervix and sample
is taken from the placental tissue

53 54

9
 1/29/25

STAGES OF FETAL DEVELOPMENT STAGES OF FETAL DEVELOPMENT

Ø Amniotic Fluid Diagnostic Test EMBRYONIC STAGE
• AMNIOCENTESIS UMBILICAL CORD
- Done: 14 – 16 weeks Ø Length: 50 – 55 cm
- Empty the bladder prior to the procedure to prevent puncture Ø If short:
- Not required but encouraged - Possible Abruptio Placenta
- Helps diagnosed chromosomal abnormalities - Uterine Inversion
> Inc. AFP – (+) Neural Tube Defects Ø If long:
> Dec. AFP – (+) Down Syndrome - Cord coil
> Normal AFP: 2.5 MOM (Multiple of Means) - Cord prolapse
Ø Thickness: 2cm
Lung Maturity via SHAKE TEST Ø (+) Warton’s Jelly
> (+) Bubbles – Mature Lungs Ø Vessel: A - Deoxygenated
> (-) Bubbles – Immature Lungs V - Oxygenated
A - Deoxygenated

55 56

STAGES OF FETAL DEVELOPMENT RULES OF PREGNANCY

FETAL STAGE NAEGEL’S RULE
Ø Full term: 37 – 42 weeks Ø Used for estimating an expected due date based on the last menstrual
period.
Ø Rules of Pregnancy: Ø Jan – March : +9, +7, +0
• Naegel’s Rule Ø April – Dec: -3, +7, +1
Ø Note: LEAP YEAR: 2008, 2012, 2016, 2020, 2024 (Divisible by 4)
• Bartholomew’s Rule Ø Example:
• Mc Donald’s Rule 1. LMP – May 25, 2020
2. LMP – Oct. 6, 2021
• Haase’s Rule 3. LMP – Jan. 21, 2023

57 58

RULES OF PREGNANCY RULES OF PREGNANCY

BARTHOLOMEW’S RULE MC DONALD’S RULE
Ø Used to determine Age of Gestation (AOG) Ø Used for estimating Age of Gestation (AOG) via fundic height
via fundic location Ø Formula:
Ø Landmarks: Fundic height (cm) = AOG (Weeks)
• 12 weeks – Symphysis pubis

• 16 weeks – Halfway between symphysis HAASE’S RULE

Ø Used for estimating fetal height
pubis and umbilicus Ø Formula:
• 20 weeks – Level of umbilicus [1-5 months] x itself = fetal height (cm)
[6-9 months] x 5 = fetal height (cm)
• 26 weeks – Halfway between xyphoid

process and umbilicus

• 36 weeks – Xyphoid process

59 60

10
 1/29/25

SIGNS OF PREGNANCY SIGNS OF PREGNANCY

PRESUMPTIVE PROBABLE
1ST Brest changes (+) Pregnancy Test POSITIVE SIGNS
trimester Amenorrhea Hegar – softening of uterus Ø (+) UTZ (Sex of the Fetus can be determine on 16 weeks)
Urinary frequency Chadwick – Bluish vagina Ø (+) Fetal Heart Tone
Nausea & Vomiting Goodels – softening of cervix • Transvaginal sonography – 6 weeks
(Morning Sickness) • Doppler – 10 - 12 weeks
2nd Quickening – fetal Braxton Hix Contraction – • Stethoscope – 16 weeks
trimester movement felt by the painless irregular contraction • Fetoscope – 20 weeks
mother (16-20 weeks) Ballotment – painless Ø (+) Fetal Skeleton
Chloasma – Inc. movement Ø (+) Fetal movement FELT BY THE EXAMINER
pigmentation due to inc.
melanocyte

61 62

FREQUENCY PRE NATAL VISIT PSYCHOLOGICAL TASK

0 – 7 MONTHS = Once a month 1ST TRIMESTER

Ø Task: Accept pregnancy
Ø Mood: Ambivalence / Surprise

8 MONTHS = Twice a month Ø Health Teaching: Nutrition & Body changes related to pregnancy

2nd TRIMESTER
9 MONTHS = Once a week Ø
Ø
Task: Accept pregnancy via quickening
Mood: Day dreaming / Fantasy
Ø Health Teaching: Fetal growth & development

63 64

PSYCHOLOGICAL TASK MATERNAL NUTRITION

Ø Weight gain:
3rd TRIMESTER • Single pregnancy: 20 – 35 lbs
Ø Task: Accept parenthood
Ø Mood: Impatient / Unpretty / Awkward • Multiple: 40 – 45 lbs
Ø Health Teaching: Responsible parenthood / Delivery preparations

Ø Caloric need:
• Non pregnant – 2,200 kcal/day
• Pregnant – 2,500 kcal/day
• Lactating – 2,700 kcal/day

65 66

11
 1/29/25

MATERNAL NUTRITION GTPAL Scoring

Ø Vitamin A Supplementation: Ø Gravida = Number of pregnancy
• Normal Pregnant Ø Para = Number of viable pregnancy (20 weeks up)
- Dose: 10,000 IU (Twice a week) Ø Term = Number of fetus who have reached 37 – 42 weeks AOG
- Note: Start from 4th month of pregnancy Ø Preterm = 20 – 36 weeks AOG
Ø Abortion = Below 20 weeks AOG
• Pregnant with Xerophthalmia Ø Living = Living child
- Dose: 10,000 IU (Once a day)
- Note: Give OD x 12 weeks NOTE: Multiple pregnancy is counted is as 1 Gravida, as well as 1 for term,
preterm, or abortions, BUT ARE RECORDED AS THE ACTUAL NUMBER
• Post Partum: OF LIVING
- Dose: 200,000 IU (One dose only)
- Note: Given within 1 month after delivery

67 68

PRACTICE #1 PRACTICE #2
Ø Ann is pregnant now and has had 1 miscarriage at 12 weeks, son born at Ø Lisa is pregnant and had triplets born at 35 weeks and 3 miscarriages
36 weeks, daughter born at 39 weeks, and a son born at 25 weeks that between 10-12 weeks.
died shortly after delivery. G–5
T–0
G–5 P–1
T–1 A–3
P–2 L–3
A–1
L–2

69 70

PRACTICE #3 PRACTICE #4
Ø Beth is pregnant and has two sons: one born at 40 weeks and the other at Ø Jessica is pregnant and gave birth to twins two years ago at 30 weeks
39 weeks. She also has one daughter born at 34 weeks. gestation. One is living, but the other died of respiratory complications
shortly after birth.
G–4
T–2 G–2
P–1 T–0
A–0 P–1
L–3 A–0
L–1

71 72

12
 1/29/25

PRACTICE #5 MATERNAL DIAGNOSTICS

Ø A 30 year old female is 25 weeks pregnant with twins. She has 5 living
NON STRESS TEST
children. Four of the 5 children were born at 39 weeks gestation and one Ø To assess Fetal Heart Rate in response to Fetal Movement
child was born at 27 weeks gestation. Two years ago she had a
miscarriage at 10 weeks gestation. Ø Purpose: To determine utero-placental insufficiency
Ø Position: Semi-fowler’s ; Side lying
G–7
T–4 Ø REACTIVE:
P–1 • > 2 FHR acceleration of 15 bpm (NORMAL)
A–1
L–5 Ø NON REACTIVE:
• No FHR acceleration with Fetal Movement
• (+) FHR acceleration with less than 15 bpm

73 74

MATERNAL DIAGNOSTICS MATERNAL DIAGNOSTICS

CONTRACTION STRESS TEST
CONTRACTION STRESS TEST Ø Interpretation:
Ø Indication: Non Reactive NST ( - ) CST - Fetus is okay
- No abnormal deceleration
Ø Detects abnormal deceleration - Fetus is on EARLY DECELERATION
Ø Assessing FHR q contraction > Due to head compression
> No treatment Required
Ø 2 Types of Contraction Stress Test

• Nipple – Stimulated Contraction Stress Test

• Oxytocin Challenge Test

75 76

MATERNAL DIAGNOSTICS MATERNAL DIAGNOSTICS

CONTRACTION STRESS TEST CONTRACTION STRESS TEST
Ø Interpretation: Ø Interpretation:
( + ) CST - Fetus is in distress ( + ) CST - Fetus is in distress
- Fetus is on VARIABLE DECELERATION - Fetus is on LATE DECELERATION
> Due to cord compression > Due to utero-placental insufficiency
> Give O2 to the mother > Give O2 to the mother
> Position to knee-chest > Increase fluids
> Position to left side lying to inc. blood supply
to the uterus

77 78

13
 1/29/25

MATERNAL DIAGNOSTICS MATERNAL DIAGNOSTICS

LEOPOLD’S MANEUVER • PAWLICK’S GRIP
Ø Position: Dorsal Recumbent - Position facing the head of the patient
Ø Warm hands prior to the procedure - Grasp the lower abdomen just above symphysis
Ø Use palm, not the fingers pubis
Ø Empty bladder prior to the procedure - To determine degree of movement
Ø Procedure:
• FUNDAL GRIP • PELVIC GRIP
- Palpate side of the fundus - Position facing the foot of the patient
- To determine fetal part at fundus - Palpate side of the uterus that is above inguinal
ligament
• UMBILICAL GRIP - To determine fetal attitude
- Palpate side of the uterus
- To determine fetal back placement

79 80

FETAL PRESENTATION FETAL PRESENTATION

CEPHALIC PRESENTATION • BROW PRESENTATION
Ø Most common type of presentation - Presenting Part: Brow
Ø Types: - Baby: Moderately extended head
• VERTIX / OCCIPUT PRESENTATION
- Presenting Part: Lambda / Posterior Fontanel • FACE PRESENTATION
- Baby: Chin touches the chest - Presenting Part: Face
- Baby: Sharply extended head
• SINCIPUT PRESENTATION
- Presenting Part: Bregma / Anterior Fontanel
- Baby: Moderately flexed head

81 82

FETAL PRESENTATION FETAL PRESENTATION

BREECH PRESENTATION • FOOTLING BREECH
Ø Types: - Presenting Part: Feet (Single / Both)
• FRANK BREECH - Caution: Possible Cord Prolapse
- Presenting Part: Buttocks
- Baby: > Thighs on abdomen
> Foot on shoulder

• COMPLETE BREECH
- Presenting Part: Buttocks and small foot parts
- Baby: > Thighs on abdomen
> Knee is flexed upon thighs

83 84

14
 1/29/25

FETAL PRESENTATION DISCOMFORTS DURING PREGNANCY

SHOULDER PRESENTATION NAUSEA & VOMITING (MORNING SICKNESS)
Ø Presenting Part: Shoulder / Acromion process Ø Due to HCG
Ø Fetal lie: Transverse lie Ø Best Action: Give crackers or dry toast prior to getting up in bed
Ø Caution: For Cesarean Section delivery
HEART BURNS (PYROSIS)
Ø Due to gastric reflux secondary to increase pressure from enlarging
fetus
Ø Best Action: Small frequent feeding , upright position post meal

CONSTIPATION
Ø Due to compression of intestine by the enlarging uterus
Ø Best Action: Increase fiber intake

85 86

DISCOMFORTS DURING PREGNANCY DISCOMFORTS DURING PREGNANCY

URINARY FREQUENCY
Ø Due to compression of bladder by the enlarging uterus RISK FOR THROMBUS FORMATION
Ø Best Action: Kegel’s Exercise Ø Due to venous stasis in the lower extremities
Ø Best Action: Encouraged ambulation & compression stockings
LEG EDEMA & VARICOSITIES Ø If (+) Thrombus – Bed rest to prevent clot to become mobile
Ø Due to compression of femoral veins by the enlarging uterus =
Decrease venous return LEG CRAMPS
Ø Best Action: Leg elevation for 20 minutes and compression stockings Ø The baby is consuming the calcium of the mother for bone
development
ORTHOSTATIC HYPOTENSION Ø Best Action: Dorsiflexion of the foot
Ø Due to compression of vena cava by the enlarging uterus
Ø Best Action: Position to left side-lying

87 88

DISCOMFORTS DURING PREGNANCY TETANUS TOXOID IMMUNIZATION

Ø To prevent Tetanus Neonaturum
SEXUAL SCHEDULE Ø Frequency of injections:
Ø Appropriate sexual position: Spooning, Sitting, Girl on Top
Ø No sex 6 weeks prior to Expected Date of Confinement (EDC) TT1 - Anytime during pregnancy - No Protection
Ø Sex can stimulate uterine contraction = premature delivery TT2 - 4 weeks after TT1 - 3 years protection
Ø Sex may resume 3 – 4 weeks post partum TT3 - 6 months after TT2 - 5 years protection
Ø No blowing of air in case of cunnilingus; it could lead to air embolism TT4 - 1 year after TT3 - 10 years protection
TT5 - 1 year after TT4 - Lifetime protection

89 90

15
 1/29/25

STAGES OF LABOR
STAGE 1: CERVICAL PERIOD
STAGES OF Ø 2 Process:
•
•
Effacement – Thinning of the cervix (0-100%)
Dilatation – Opening of the cervix (0-10 cm)

LABOR NOTE: Primigravida – E before D

Multigravida – D before E

Ø Nursing Management:
Ø Stage 1: Cervical Period - From 1cm to 10 cm of cervical dilation 1. Encourage to void q2 hours
Ø Stage 2: Fetal Period - From 10cm dilation to delivery of fetus 2. When to place at delivery room: - Primi: 10 cm
Ø Stage 3: Placental Period - From delivery of fetus to delivery of placenta - Multi: 7-8 cm
Ø Stage 4: Recovery Period - From delivery of placenta to 6 weeks p.partum 3. No. of hours in labor - Primi: 20 hours
- Multi: 14 hours

91 92

STAGES OF LABOR STAGES OF LABOR

STAGE 1: CERVICAL PERIOD STAGE 1: CERVICAL PERIOD
Ø 3 Phases of Labor
Ø Characteristics of true contraction
• Latent Phase
• Regular and progressive
• Active Phase
• Increasing duration and intensity
• Transition Phase
• Decrease intervals
• Starts from lumbosacral area radiating to the front
Ø Contraction Terms:
• Intensified by activity
• Frequency – From the beginning one contraction to the beginning
of the next contraction
• Intensity – Strength of contraction
• Duration – Beginning up to end of one contraction
• Interval – From the end of one contraction to the beginning of
another contraction

93 94

INTERNAL EXAMINATION
Ø Purpose: INTERNAL EXAMINATION
1. To determine degree of cervical effacement and dilation Ø Assessment:
2. To determine fetal presenting part • 1 finger = 1 – 2 cm dilated
3. To determine fetal station • 2 fingers = 3 – 4 cm dilated
• 3 fingers = 5 – 6 cm dilated
Ø Steps: • 4 fingers = 7 – 10 cm dilated
1. Orient the patient and wash hands
2. Don sterile gloves
3. Apply lubricant to index and middle finger
4. Thumb & Index finger of the other hand: Separate the labia majora
5. “Get ready for insertion stance”
6. Insert index and middle finger of the gloved hand
7. Rotate hand until palm faces upward

95 96

16
 1/29/25

STAGES OF LABOR STAGES OF LABOR

STAGE 1: CERVICAL PERIOD STAGE 1: CERVICAL PERIOD
LATENT ACTIVE TRANSITION Ø 4 P’s that affects labor period
Frequency 5 – 10 minutes 3 – 5 minutes 2 – 3 minutes PASSENGER
- The presenting part of the fetus
Duration 20 – 40 sec 40 – 60 sec 60 – 90 sec
Intensity Mild Moderate Strong PASSAGEWAY
Dilatation 0 – 3 cm 4 – 7 cm 8 – 10 cm - 4 types of pelvis:
Mood Excited Irritable Loses Control • GYNECOID – Round, wide, most suitable for
pregnancy
Activity Ambulation Comfort Prepare for • ANDROID – Heart-shaped; common in men
Void q 2 hours Analgesic delivery • ANTHROPOID – Oval Shape
FHT Monitoring q 1 hour q 30 mins q 15 mins • PLATYPELOID – Flat / Narrow pelvic

97 98

STAGES OF LABOR STAGES OF LABOR

STAGE 1: CERVICAL PERIOD STAGE 1: CERVICAL PERIOD
Ø 4 P’s that affects labor period Ø 4 P’s that affects labor period
PASSAGEWAY POWER
- Fetal Stations - Force of contraction

-3 3 cm above the ischial spine PSYCHE

-2 2 cm above the ischial spine - Psychological well-being of the mother and its support
-1 1 cm above the ischial spine
system
0 At the level of the ischial spine

+1 1 cm below the ischial spine

+2 2 cm below the ischial spine

99 100

STAGES OF LABOR STAGES OF LABOR

STAGE 1: CERVICAL PERIOD STAGE 2: FETAL PERIOD
Ø Pain management during labor
Ø Cardinal Movement: ED FIRE ERE
BRADLEY METHOD
1. Engagement
- Having a coach: partner
2. Descend
- Slow deep breathing for relaxation
DICK-READ METHOD
3. Flexion
- Reduce fear perception by education
4. Internal Rotation
- Exercises to improve muscle tone and relaxation
5. Extension
KITZINGER METHOD
- Having a supportive environment
6. External Rotation
- Making informed decision
7. Expulsion – Check for cord coil
LAMAZE METHOD
- Effleurage – stroking at the abdomen - Do Ritgen’s maneuver – Supporting the perineum
- Guided imagery

101 102

17
 1/29/25

STAGES OF LABOR STAGES OF LABOR

STAGE 3: PLACENTAL PERIOD
STAGE 3: PLACENTAL PERIOD Ø Signs of placental separation:
Ø Methods to separate the placenta: • Lengthening of the cord – BEST SIGN ! ! !
• CREDE’S MANEUVER – One hand is placed on the uterine • Sudden gush of blood
fundus and the uterus is squeezed between the thumb and • Globular abdomen (Calkin’s Sign) – FIRST SIGN ! ! !
other finger
Ø Abnormal placenta:
• BRANDT ANDREW MANEUVER – One hand puts gentle • Meconium – stained
traction on the cord while the other presses the anterior - Greenish placenta and cord
surface of the uterus backward

103 104

STAGES OF LABOR STAGES OF LABOR

STAGE 3: PLACENTAL PERIOD STAGE 3: PLACENTAL PERIOD
Ø Signs of placental separation: Ø Abnormal placenta:
• Lengthening of the cord – BEST SIGN ! ! ! • Battledore Placenta
• Sudden gush of blood - Umbilical cord attached at placental margin
• Globular abdomen (Calkin’s Sign) – FIRST SIGN ! ! ! • Placenta Circumvallata
- Insertion of membranes at center via the margin
Ø Abnormal placenta:
• Meconium – stained
- Greenish placenta and cord
• Placenta Succenturiata
- Has an accessory lobe
- With blood vessels
- May retain at uterus

105 106

STAGES OF LABOR STAGES OF LABOR

STAGE 3: PLACENTAL PERIOD STAGE 4: RECOVERY PERIOD
Ø Post op vital signs: q 15 mins for 2 hours
Ø 2 Types of Episiotomy
Ø Check the fundus:
MEDIAN MEDIOLATERAL • NORMAL – Firm and contracted
More painful - 1 fingerbreadth from umbilicus per day
Ø Less painful Ø
• ABNORMAL – Soft & Buggy – Massage the uterus
Ø Less bleeding Ø More bleeding
- Deviated – Facilitate urination
Ø Easy to heal Ø Slow to heal
Ø Check the lochia
• Rubra : Red : Day 1 – 3
• Serosa : Pinkish : Day 4 - 7
• Alba : White : Day 8 - 14

107 108

18
 1/29/25

STAGES OF LABOR STAGES OF LABOR

STAGE 4: RECOVERY PERIOD STAGE 4: RECOVERY PERIOD
Ø RIVA RUBIN’S THEORY Ø CREDE’S PROPHYLAXIS
• Taking – In (Day 1 – 3) - To prevent ophthalmia neonatorum
- Mother: Passive - Drug: Tetracycline / Erythromycin
- Focus: Self - Direction: Inner to outer canthus
- Apply at lower lid of the eye
• Taking Hold (Day 4 - 7)
- Mother: Active Ø Vitamin K Prophylaxis
- Focus: Baby - Drug: Phytomenadione
- Dose: 1 mg (0.1 mL)
• Letting Go (Day 8 – 14) - Route: IM at Vastus Lateralis
- Mother: Interdependent
- Focus: Family

109 110

HIGH RISK
PREGNANCY

111 112

Rh INCOMPATIBILITY Rh INCOMPATIBILITY
Ø Goal of the antibody: Attack the fetus’ RBC = HEMOLYSIS
1st PREGNANCY 2nd PREGNANCY
Ø Father: Rh (+) Ø Father: Rh (+)
Ø Mother: Rh (-) Ø Mother: Rh (-) (but with Rh antibody) Ø Fetal complication:
Ø Fetus: Possible Rh (+) Ø Fetus: Possible Rh (+) 1. Anemia
2. Jaundice
- After delivery, - The mother has Rh (+) antibodies 3. Splenomegaly
maternal and fetal
blood will mix - It will flow to the placenta and attack
4. Heart Failure
the baby
- Mother will develop
antibody against Rh
(+)

113 114

19
 1/29/25

Rh INCOMPATIBILITY
Ø Management: Rhogam Shot
- Given IM
- 1st dose: 28 weeks during pregnancy
- 2nd dose: Within 72 hours post partum if the baby is Rh (+)
- Action: Stops the immune system from creating Rh antibodies

NOTE: Mother will be given Rhogam every successive pregnancy

because the father is Rh (+)

115 116

ABORTION ABORTION
Ø Termination of pregnancy before 20 weeks AOG Ø Causes:
Ø 2 types: FETAL CAUSE MATERNAL CAUSE
• INDUCED – Via artificial means Ø Abnormal zygote Ø Infection
Ø Hypothyroidism
• SPONTANEOUS – Natural / Miscarriage
Ø Diabetes Mellitus
Ø Legal bases: RA 10354 Ø Progesterone deficiency
Ø Tobacco
“Responsible Parenthood and Reproductive Health Act of 2012”
Ø Alcohol
Ø Timing: Ø Excessive caffeine intake
EARLY ABORTION LATE ABORTION Ø Trauma
Ø < 12 weeks AOG Ø > 12 weeks AOG
Ø Age: >35 y/o
Ø Mngt: D & C Ø Mngt: Deliver the baby
D&C

117 118

ABORTION ABORTION
Ø Categories of spontaneous abortion: Ø Categories of spontaneous abortion
CATEGORIES CERVIX BOW FHT SHOW CONTRACTION CATEGORIES CERVIX BOW FHT SHOW CONTRACTION
INTERVENTION INTERVENTION
(B leeding) (B leeding)

THREATEND closed (+) (+) (+) (+) - Bed rest MISSED closed (-) (-) Spotting (-) -D&C
- Avoid coitus x 2
weeks

119 120

20
 1/29/25

ABORTION
Ø Categories of spontaneous abortion:
CATEGORIES CERVIX BOW FHT SHOW CONTRACTION INTERVENTION
INEVITABLE open (-) (-) (++) (++) - Allow delivery
- D & C post
delivery
INCOMPLETE open (-) (-) (+++) (-) - D&C
(Some products - Monitor for
remain)
Hemorrhage

121 122

HYPEREMESIS GRAVIDARUM HYPEREMESIS GRAVIDARUM

Ø Excessive vomiting beyond 1 st trimester due to increase HCG level Ø Goal: To minimize episodes of vomiting
NORMALLY: HCG decreases after 1 st trimester
Ø Pathophysiology:
Increase HCG on the 2nd trimester Ø Management:
1. Use nasogastric tube feeding
Excessive Vomiting 2. Offer dry crackers
3. Increase fluids intake
DEHYDRATION HYPOGLYCEMIA HYPOKALEMIA

Fetal Distress Altered cell metabolism Heart Problem

(+) Ketones

123 124

HYDATIDIFORM MOLE
Ø AKA: Gestational Trophoblastic Disease

Ø Abnormal proliferation of trophoblast WITH OR WITHOUT fetal

development

Ø 2 types:
• Complete – Most common; No fetal parts
• Incomplete – With fetal residue

Ø Risk factors:
• Maternal Age: <20 y/o ; >40 y/o
• Paternal Age: >40 y/o
• History of previous H.Mole
• Diet: Dec in carotene intake & animal fat

125 126

21
 1/29/25

HYDATIDIFORM MOLE HYDATIDIFORM MOLE

Pathophysiology:
Ø
Ø Management:
Blastocyst degeneration
1. DOC: Methotrexate – Folic Acid inhibitor
(+) HCG Formation of trophoblastic tissues 2. Avoid pregnancy for 1 year
(Grape-Like Clusters) 3. Contraceptive teaching
N/V (+) Pregnancy 4. D&C until HCG becomes (-)
Test 5. Antihypertensive medications except ACE inhibitors

RAPID ABDOMINAL HYPERTENSION VAGINAL BLEEDING

ENLARGEMENT (1st Trimester)

127 128

ECTOPIC PREGNANCY
Ø Implantation outside the uterus
Ø Common Site: Ampulla
Ø Risk Factors:
• Pelvic Inflammatory Disease (PID)
• Previous surgeries
• Presence of IUD
• History of previous ectopic pregnancy

129 130

ECTOPIC PREGNANCY ECTOPIC PREGNANCY

Ø Manifestations: Ø Lab test:
• (+) HCG
• Abdominal pain • CBC = Dec. Hgb ; Inc. HCT
• Bleeding • Ultrasound
• Culdocentesis
• Amenorrhea - Gauge 18 needle inserted thru the
• Abdominal tenderness space between uterus & rectum
(Cul-de-sac)
• HypoTachyTachy - Aspirate blood
• Pelvic Mass - (+) presence of non clotting blood
indicates continuous bleeding on
• Shoulder Tip Pain – Indicates rupture ! ! ! the area

131 132

22
 1/29/25

ECTOPIC PREGNANCY
Ø Management:
1. Methotrexate – To prevent fetal growth
2. Monitor for bleeding
3. Emotional support
4. Surgery:
• Salpingotomy - If ectopic is <2cm
- Opening of fallopian tube
- LEFT UNSUTURED

• Salpingectomy - Removal of fallopian tube

133 134

PLACENTA PREVIA PLACENTA PREVIA

Ø Low lying implantation of placenta
Ø Management:
Ø Risk factors: 1. If mother (stable) ; (-) bleeding ; (+) FHT = OBSERVE
• Age >35 y/o
• Multiparity 2. (-) bleeding ; fetus is already term = Elective CS
• Prior CS 3. Mother (unstable) ; (+) bleeding ; (+) FHT = Emergency CS
• Cigarette smoking

Ø Diagnostics:
• Trans-abdominal Sonography
• Trans-vaginal Sonography – Done with caution ! ! !

135 136

OTHER PLACENTAL ABNORMALITIES

PLACENTOMEGALY
Ø Placenta is >40 mm thick
Ø Common cause: Gestational Diabetes

PLACENTA ACCRETA
Ø Placenta attached at myometrium

PLACENTA INCRETA
Ø Placenta invades at myometrium

137 138

23
 1/29/25

OTHER PLACENTAL ABNORMALITIES OTHER PLACENTAL ABNORMALITIES

PLACENTA PERCRETA
Ø Placenta penetrates the myometrium Ø Management:
Ø Reaches the bladder / bowel 1. Assess for FHT:

ABRUPTIO PLACENTA
Ø Premature separation of placenta ALIVE DEAD
Ø Risk factors:
• Trauma Reassuring Unstable fetus Stable mother Unstable mother
• Hypertension Fetal Status or mother
• Smoking Vaginal
Vaginal STAT CS STAT CS
• Cocaine use Delivery
Delivery

139 140

OTHER PLACENTAL ABNORMALITIES

PLACENTA PREVIA ABRUPTIO PLACENTA
BLEEDING Ø Painless Ø Painful
Ø Bright red blood Ø Dark red blood
UTERUS Ø Soft & Relax Ø Tender & Rigid
PLACENTA Ø Placenta in lower segment Ø Placenta in upper segment

141 142

GESTATIONAL DIABETES MELLITUS GESTATIONAL DIABETES MELLITUS

Ø Cause: Decrease insulin production during 2 nd trimester ; Inc. HPL level The baby will receive too much glucose
Ø Symptoms: 3P’s + Hypertension
Ø Pathophysiology: Some glucose will be The baby’s pancreas will
Increase Human Placental Lactogen
stored as fats make too much insulin

HPL impairs the action of insulin

MACROSOMIA After delivery, because there
Insulin resistance occur
are lots of insulin without
No glucose will be transported to cell constant supply

HYPERGLYCEMIA HYPOGLYCEMIA

143 144

24
 1/29/25

GESTATIONAL DIABETES MELLITUS

Ø Management:
1. Diabetic diet
2. Insulin therapy:
- Increase demand during 2 nd & 3rd trimester
- Decrease insulin needs after delivery kay wala nay HPL
3. No oral hypoglycemic agents – Teratogenic
4. Moderate exercise
5. Antihypertensive medications – except ACE inhibitors

145 146

MATERNAL HYPERTENSION Classification of HPN in Pregnancy

Ø BP of >140/90 mmHg in more than 1 occasion
GESTATIONAL HYPERTENSION
Ø Risk factors: Ø BP OF >140/90 mmHg
• Maternal – Nulliparous / Multiple Gestation
Ø After 20 weeks of AOG
• Comorbidities: Diabetes Mellitus Ø No proteinuria
• Smoking
• Obesity
• Age: >35 years old PRE - ECLAMPSIA
Ø BP OF >140/90 mmHg
Ø Management: Ø After 20 weeks of AOG
1. Antihypertensive medications except ACE Inhibitors Ø (+) proteinuria
2. Low salt diet
3. Adequate rest periods

147 148

Classification of HPN in Pregnancy

CHRONIC HYPERTENSION
Ø BP OF >140/90 mmHg
Ø Before 20 weeks of AOG
Ø No proteinuria

SUPER IMPOSED PRE – ECLAMPSIA ON CHRONIC HPN

Ø BP OF >140/90 mmHg
Ø Before 20 weeks of AOG
Ø (+) proteinuria

149 150

25
 1/29/25

ECLAMPTIC DISORDERS ECLAMPTIC DISORDERS

PRE - ECLAMPSIA ECLAMPSIA PRE - ECLAMPSIA ECLAMPSIA
Ø (-) Seizure
Ø Goal: Prevent onset of seizure
Dec. blood to RAAS
Ø Pathophysiology:
reach the fetus Activation
Presence of protein in the urine
(Proteinuria)
Fetal Death HYPERTENSION
Dec. Albumin in the blood

Dec. Oncotic pressure

EDEMA

151 152

ECLAMPTIC DISORDERS ECLAMPTIC DISORDERS

PRE - ECLAMPSIA ECLAMPSIA Ø Nursing Management:
1. Limit Na intake (2-4G/day)
Ø (-) Seizure Ø (+) Seizure
Goal: Prevent onset of seizure 2. Limit fluids intake (1.5 liters per day)
Ø Ø Goal: To treat the cause 3. DASH Diet (Fruit and vegetable, low fat and dairy products)
Ø Pathophysiology: Ø Priority: Safety
Presence of protein in the urine 4. Limit stimuli
Ø DOC: Magnesium Sulfate
(Proteinuria) 5. Antihypertensive medications:
- 4-7 mEq/L – Therapeutic • Hydralazine – Fast acting vasodilator
- >8 mEq/L – Toxic 6. Watch out for: AURA
Dec. Albumin in the blood - Signs of Toxicity:
• Dec.DTR Ø Complication: HELLP Syndrome
Dec. Oncotic pressure • Dec. RR Hemolysis / Elevated Liver enzyme / Low Platelet
• Dec. BP
EDEMA - Patient will complain: RUQ pain on the 3rd trimester
- Antidote: Calcium Gluconate

153 154

THANKS! DO YOU HAVE ANY QUESTIONS?

christiantimogan@gmail.com
https://www.facebook.com/christianjohn.timogan
https://www.instagram.com/xtiandump20/

CREDITS: This presentation template was created by Slidesgo, and includes icons by
Flaticon, and infographics & images by Freepik

Please keep this slide for attribution

155

26